Amaç: Hematolojik hastalýklar, travma sonrasý splenektomi geçiren hastalarda en sýk görülen endikasyondur. Bu çalýþmada, hematolojik malignite nedeniyle splenektomi yapýlan hastalarýn tedavi sonuçlarýnýn deðerlendirilmesi amaçlanmaktadýr. Hastalar ve Yöntem: 1998-2009 yýllarý arasýnda hematolojik malignite tanýsýyla splenektomi yapýlan hastalar retrospektif olarak deðerlendirildi. Hastalarýn yaþý, cinsiyeti, cerrahi öncesi ve sonrasý uygulanan medikal tedavileri, uygulanan cerrahi tedavi ve geliþen komplikasyonlar ve hastalarýn ameliyat sonrasý dönemdeki trombosit yanýtlarý incelendi. Bulgular: Çalýþmaya ortalama yaþý 50,7 (17-79) olan 17 erkek ve 13 kadýn hasta alýndý. Hastalarýn 10’unda (% 33,3) Hodgkin lenfoma, 12’sinde (% 40) Non Hodgkin lenfoma, beþinde (% 16,6) Kronik Lenfositik Lösemi, iki (% 6,6) tanesinde MALT lenfoma ve bir (% 3,3) hastada ise Hairy Cell Lösemi tanýsý mevcuttu. Yirmi hasta splenomegali ve komplikasyonlarý nedeni ile opere edilirken, beþ hasta mide obstrüksiyon bulgularý nedeni ile, üç hasta taný amaçlý, bir hasta apse ve bir hasta kanama nedeni ile ameliyat edildi. Postoperatif komplikasyon olarak hastalardan 6’sýnda pnömoni görülürken iki hastada kanama, bir hastada apse ve bir hastada sepsis gözlendi. Ýki hasta postoperatif erken dönemde kaybedildi. Trombosit yanýtlarý takip edilen hastalarýn 19’u (% 63,3) tam yanýt, 8’i (% 26,7) parsiyel ve 3 (%10) tanesi ise yanýtsýz olarak deðerlendirildi. Sonuç: Splenektomi, hematolojik maligniteli hastalarda hipersplenizme baðlý sitopenilerin ve komplikasyonlarýn geliþtiði durumlarda ve taný amaçlý güvenle uygulanabilen bir cerrahi giriþimdir

Purpose: Hematological disorders are the most common indications for performing splenectomy after trauma in adults. The aim of this study is to investigate the treatment outcomes of splenectomy in hematological malignancy patients who were operated between the years 1998 and 2009. Patients and Methods: We analyzed the patients’ clinical characteristics, type of surgical treatment, preoperative and postoperative medical treatments, complications and thrombocyte responses, retrospectively. Results: Seventeen male and 13 female patients, with a mean age of 50.7 (17-79), underwent splenectomy due to following indications: Hodgkin lymphoma (n=10), Non Hodgkin lymphoma (n=12), Chronic Lymphocytic lymphoma (n=5), MALT lymphoma (n=2) and Hairy Cell Leukemia (n=1). The indications for surgery was splenomegaly and its complications (n=20), gastric obstruction (n= 5), diagnosis splenic mass (n=3), major bleeding (n=1) and abscess (n=1). Complications related to surgery occurred in 10 patients: pneumonia (n=6), bleeding (n=2), abscess (n=1) and sepsis (n=1). Early 30-day mortality was observed in two cases. During the follow-up period, platelet value revealed response in 19 (63.3 %), partial response in 8 (26.7 %) and unresponsive in 3 (10 %) patients due to splenectomy. Conclusion: In conclusion; for hematological diseases, thrombocytopenia, massive splenomegaly and its complications, splenectomy is a safe method with acceptable complications rate and improves the patients’ survival outcomes.

Amaç: Geliþen radyolojik görüntüleme yöntemleri ve abdominal bölgeye yapýlan inceleme sayýsýnýn artmasý ile pankreas kistik neoplazileri daha çok tanýnmaya baþlamýþtýr. Hem müsinöz kist adenomlar hem de intraduktal papiller müsinöz neoplaziler deðiþik oranlarda malignite potansiyeli taþýyan lezyonlardýr. Benign, premalign ve malign lezyonlarýn tanýnmasý tedaviye yön verir. Bu yazýda, 21 hastanýn klinik verileri eþliðinde pankreas kistik neoplazilerinde taný, tedavi ve takip uygulamalarý ile bunlarýn sonuçlarý tartýþýlmýþtýr. Hastalar ve Yöntem: Kliniðimizde 2000-2008 yýllarý arasýnda histolojik ve/veya radyolojik olarak ‘pankreas kistik neoplazi’ tanýsý alan 21 hasta retrospektif olarak incelendi. Hastalarýn yaþ, cinsiyet, tümör özellikleri, klinik ve radyolojik bulgularý, doku tanýsý için uygulanan giriþimler, ek malignite varlýðý, takip ve tedavi þekilleri kaydedildi. Malign transformasyon ya da nüks geliþen hastalarda bunun zamaný, tümör tipi ve yerleþimi saptandý. Bulgular: Onu erkek, 11’i bayan olan hastalarýn, ortalama yaþý 55.6 (30-77) olarak saptandý. Primer lezyon 12 hastada pankreas baþýnda, 5 hastada gövdede ve 4 hastada kuyrukta yerleþmiþti. Ortalama kist boyutu 29,5 mm (10-60 mm) olarak saptandý. Altý hastada taný baþka sebeplerle yapýlan tetkikler sýrasýnda insidental olarak konulmuþtu. Onyedi hastaya takip kararý verilirken, 4 hastaya tanýdan sonra rezeksiyon uygulanmýþtý. Takip kararý alýnan 17 hastanýn ikisinde, ortalama 15,8 aylýk süre içinde malignite geliþtiði saptandý. Sonuç: Pankreasýn kistik neoplazilerinin tedavisi konusunda literatürde görüþ birliði yoktur. Bu hastalarýn tedavileri planlanýrken, klinik ve radyolojik malignite kriterleri hasta bazýnda deðerlendirilmeli ve cerrahi riskler de göz önünde tutularak karar verilmelidir. Radyolojik olarak þüphede kalýnan ve yüksek cerrahi risk taþýyan hastalarda mevcut taný yöntemlerinin kombine kullanýmý ile taný netleþtirilmeye çalýþýlmalýdýr. Cerrahi giriþime karar verilen hastalarda total pankreatektomi en uygun seçim gibi görünmektedir.

Purpose: Cystic neoplasms of pancreas (CNP) are frequently diagnosed with improved radiological imaging. Mucinous cystadenomas and intraductal mucinous papillary neoplasms have malignancy potential. Our aim was to share our experience about the diagnosis, treatment and outcomes during follow-up of patients with CNP. Patients and Methods: Twenty-one patients with histological and/or radiological diagnosis of CNP between 2000-2008 were evaluated according to patient and tumor characteristics, diagnostic procedures, radiological and clinical findings, retrospectively. Malignant transformation and/or recurrence were also evaluated in accordance with tumor type and localization. Results: Male/female ratio was 0.9 (10/11). Mean age was 55.6 (range, 30-77). Head of pancreas was the most common site. Mean cyst size was 29,5 mm (range, 10-60 mm). Six patients were diagnosed incidentally during abdominal evaluations for other reasons. Median follow up was 15.8 months. Four patients had been operated and the others were followed-up. Two patients in follow-up group had malign transformation within 21 and 25 months. Conclusion: CNPs are most frequent in fifth decade and have no gender predominance. It is common in pancreatic head. Malign transformation is rare. Treatment should be indivudialized by taking into account clinical / radiological malignancy criteria and surgical risks. Total pancreatectomy might be an option in selected patients.

Amaç: Operasyon uygulanan küçük hücreli dýþý akciðer kanserli (KHDAK) olgularda klinik ve patolojik evrelerin karþýlaþtýrýlarak klinik evreleme yöntemlerinin KHDAK evrelemesindeki etkinliðinin araþtýrýlmasý amaçlandý. Hastalar ve Yöntem: Ocak 2005 - Ocak 2009 tarihleri arasýnda opere edilen 365’i erkek 37’si kadýn toplam 402 KHDAK tanýlý olgu deðerlendirildi. Neoadjuvan tedavi uygulanan, mediastinoskopide N2 veya N3 saptanan, lenf nodu örneklemesi veya sistematik lenf nodu diseksiyonu yapýlmayanlar ile uzak metastazý olan olgular çalýþma dýþý býrakýldý. Non-invaziv evreleme toraks bilgisayarlý tomografi (BT) ve 103 olguya pozitron emisyon tomografisi (PET-BT) ile yapýldý. Mediastinoskopi 80 hastaya uygulandý. Operasyonda alýnan tüm materyaller histopatolojik olarak incelenerek patolojik evreleme yapýldý. Bulgular: Yaþ ortalamasý 61.36±9.71 idi. Erkeklerde en sýk (%54.2) skuamöz hücreli karsinom, kadýnlarda ise adenokarsinoma (%73) saptandý. BT’nin T faktöründe doðruluk oraný %70 olarak bulundu. En iyi uyum %79.2 ile T2’nin deðerlendirilmesinde, en düþük uyum %31.8 ile T4’de bulundu. N faktöründe doðruluk oraný BT’nin %74, PET-BT’nin ise %89 idi. T,N faktörleri birlikte deðerlendirildiðinde; klinik ve patolojik uyum en iyi evre Ib olgularýnda %61.3 iken tüm olgularýn klinik ve patolojik uyumu %54.4 bulundu. Sonuç: Noninvaziv ve invaziv yöntemler kullanýlsa bile olgularýn ancak yarýsý doðru evrelendirilmektedir. KHDAK olgular için en iyi evreleme operasyon bulgularý ve mediastinal lenf bezi diseksiyonu ile olabilmektedir.

Purpose: The aim of this study is to compare the clinical and the pathological staging results and to evaluate the value of clinical staging methods. Patients and Methods: Between January 2005 and January 2009, a total of 402 patients (365 male, 37 female) were operated with non-small cell lung cancer (NSCLC), were evaluated. The patients who received neoadjuvant therapy, having N2 or N3 disease proven by mediastinoscopy or having distant metastatic disease, patients without lymph node dissection or sampling were excluded from the study. All patients underwent CT, and 103 patients underwent PET-CT. Mediastinoscopy was performed 80 patients. All the specimens were examined histopathologically and staging was done according to these results. Results: The mean age was 61.36 ± 9.71. The most common type was squamous cell carcinoma in males (%54.2) and adenocarcinoma in females ( %73). The accuracy of thorax CT was %70 in the staging of T factor. The highest complaince between clinically and pathological results was seen in the T2 factor (% 79.2) and the lowest was in T4 factor (% 31.8). The accuracy of thorax CT was 74%, accuracy of PET-CT was 89% in N factor. When T and N factors are evaluated together, the highest complaince between clinically and pathological results was in stage Ib (61.3%) where it was 54.4% in all the study population. Conclusion: By the usage of non-invasive and invasive methods, only 50% of the non-small cell lung cancer patients are staged correctly. For NSCLC the best staging is achieved by operative findings and mediastinal lymph node dissection.

Amaç: Yaygýn olarak kullanýlan sitotoksik bir ilaç olan metotreksatýn kullanýmý sýklýkla ciddi karaciðer hasarý nedeniyle kýsýtlanmaktadýr. Propolis antioksidan aktiviteleri bilinen polifenolik bileþiklerden zengin doðal bir arý ürünüdür. Bu çalýþmada, sýçanlarda metotreksata (MTK) baðlý karaciðer hasarý üzerine propolisin koruyucu rolünü araþtýrdýk. Yöntem: Wistar albino 48 erkek sýçan, eþit olarak dört gruba ayrýlmýþtýr. MTK grubu 10 gün boyunca 100 mg/kg/gün plasebo distile su oral yolla ve tek doz 20 mg/kg MTK’ý 7. günde intraperitoneal almýþtýr. Propolis-MTK grubu 10 gün boyunca 100 mg/kg/gün propolis ve ayný doz MTK almýþtýr. Propolis grubu 10 gün boyunca 100 mg/kg/gün propolis ve MTK yerine 7. günde eþit hacim fizyolojik tuzlu su intraperitoneal almýþlardýr. Kontrol grubu 10 gün boyunca distile su ve 7. günde eþit hacim fizyolojik tuzlu su intraperitoneal almýþtýr. Karaciðer homojenat örneklerinde malondialdehit (MDA) konsantrasyonu, süperoksit dismutaz (SOD), glutatyon peroksidaz (GSH-Px) ve katalaz (KAT) aktivite düzeyleri ölçülmüþtür. Bulgular: MTK karaciðer MDA düzeylerini artýrmýþ ve SOD, GSH-Px ve KAT düzeylerini belirgin olarak azaltmýþtýr (p<0.001). Propolis eklenmesi, MTK alan sýçanlarýn karaciðerinde MDA düzeyini azaltmýþ ve GSH-Px seviyelerini anlamlý olarak artýrmýþtýr. SOD ve KAT seviyelerinde izlenen rakamsal iyileþme istatistiksel olarak anlamlý seviyelere ulaþmadý. (p>0.05). Sonuç: MTK’ýn neden olduðu oksidatif stres propolis verilmesiyle azalmýþ ve bu etkinin büyük olasýlýkla propolisin yapýsýndaki antioksidan bileþenlerden kaynaklandýðý düþünülmüþtür.

The efficacy of methotrexate (MTX), a widely used cytotoxic chemotherapeutic agent, is often limited by severe liver injury. Propolis is a natural bee product rich in polyphenolic compounds known for antioxidant activity. We investigated the protective role of propolis on MTX-induced liver injury in rats. Methods: Forty-eight Wistar Albino male rats were assigned equally into four groups: MTX group received placebo (distilled water) orally (for ten days) and a single dose of 20mg/kg MTX was administered intraperitoneally (on the seventh day). Propolis-MTX group received 100 mg/kg/day propolis extract orally (for ten days), and same dose MTX. Propolis group received 100 mg/kg/day propolis extract (for ten days), and equally volume physiological saline was administered intraperitoneally instead of MTX (on the seventh day). Control group received distilled water (for ten days), and also physiological saline was administered intraperitoneally (on the seventh day). Malondialdehyde (MDA) concentration, and superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) activity levels were determined in the homogenate of liver. Results: MTX increased liver MDA concentration and decreased the SOD, GSH-Px and CAT activity levels (p<0.001). The addition of propolis significantly decreased MDA concentrations and increased the GSH-Px levels in liver of the rats receiving MTX (p<0.001). There was numeric improvement SOD and CAT activity levels but it did not reach to the statistically significance (p>0.05). Conclusions: The MTX-induced oxidative stress was decreased by propolis, probably by its antioxidant components.

Spinal tümörlerin en sýk sebebi metastazdýr. Sýklýkla akciðer, meme ve prostattan kaynaklanan tümörler spinal metastaza neden olmaktadýr. Ýzole spinöz proses tutulumu ile seyreden metastazlar oldukça nadirdir. Endikasyonlu erken cerrahi giriþim ve maksimum tümör rezeksiyonu hayat kalitesinin saðlanmasýnda en önemli noktadýr. Yazýmýzda 60 yaþýnda akciðer kanserli erkek hastanýn torakal bölgesinde ele gelen ve sadece spinöz prosesi tutan metastazý tartýþýldý.

The most common cause of spinal tumors is metastasis. Mostly, tumors originating from the lungs, breasts and the prostate lead to tumoral spinal metastasis. Metastases that exhibit isolated spinous process involvement are quite rare. Indicated early surgical intervention and maximum tumor resection are the most effective ways of improving quality of life. In this case report, we present the case of metastasis palpable in the thoracic region of a 60-year-old male patient which only involves the spinous process.

Osteoid osteoma is a benign tumor that usually involves the cortex of the long bones, the vertebrae and, occasionally, the cranial bones. Osteoid osteoma is a lesion mostly occurring in young males, characterized by a nidus, a radiolucent nodule with a diameter less than 2 cm, and a sclerotic region surrounding this nodule. Clinically, it is also characterized by a pain that wakes the sufferer at night, which is relieved upon the administration of aspirin. In this case report, we present a case of osteoma in the frontal region of a 56-year-old female patient

Santral venöz kateter (SVK) günümüzde önemli bir yere ve yaygýn kullaným alanýna sahiptir. SVK, kanser hastalarýnda uygulama kolaylýðý nedeniyle destek tedavisinde ve kemoterapi uygulanmasýnda güvenilir bir venöz yol olarak kullanýlmaktadýr. Santral vene baðlý trombüs sýk olarak görülmekle birlikte, trombüse baðlý vena kava süperior sendromuyla (VKSS) daha az karþýlaþýlmaktadýr. Bu yazýda, sol subklaviyan vene port kateteri yerleþtirilmesinden sonra tromboza baðlý semptomatik VKSS’na yol açan 49 yaþýnda kolon kanserli bir kadýn hasta sunuldu. Sonuç olarak, SVK uygulanan hastalarda sýk görülen trombozlar nadir olarak yaþamý tehdit eden VKSS þeklinde karþýmýza çýkabileceðinden hastalarýn kateter bakýmýný düzenli yaptýrmasý gerektirmektedir.

Central venous catheterization plays an important role in cancer patients. Central venous catheterization and port placement are essential practices for high dose chemotherapy applications or palliative therapy. Thrombosis is one of the most frequent complications of port catheter but vena cava superior syndrome secondary to related thrombosis has been reported as a very rare complication. We present a 49 years female patient with colon cancer who developed thrombosis causing vena cava superior syndrome after a left subclavian vein port catheter. In conclusion, we suggest that cancer patients with central venous catheter should be regularly followed up, because a life-treating complication such as vena cava superior syndrome may be seen.

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