GÝRÝÞ ve AMAÇ: Ailesel adenomatöz polipoziste (AAP) cerrahi tedavi, abdominal kolektomi-ileorektal anastomoz (IRA), restoratif proktokolektomi-ileal J poþ anal anastomoz (IPAA) ve total proktokolektomi- kalýcý ileostomiyi içerir. Bu çalýþma ile hangi tip cerrahi yöntemin en iyi seçenek olduðu irdelendi.
YÖNTEM ve GEREÇLER: Ailesel adenomatöz polipozis tanýsýyla 2004-2014 yýllarý arasýnda ayný merkezde cerrahi giriþim uygulanmýþ 20 hasta çalýþmaya alýndý. Hastalar uygulanan ameliyat türüne göre 3 gruba ayrýldý. Demografik özellikler, ameliyat bulgularý, patoloji sonuçlarý ve klinik seyirlerine iliþkin veriler geriye dönük olarak hastane kayýtlarýndan elde edildi.
BULGULAR: Yirmi hastada AAP tanýsý kolonoskopi ve patoloji raporuna dayanýlarak konuldu. Bunlarýn 15’inde kanser geliþmiþken 5 hastada kolonoskopik taramada kanser henüz geliþmeden taný konuldu. Kanser geliþen ve geliþmeyen hastalarýn ortanca yaþý sýrasýyla 37 ve 20 yaþ. Dört hastaya IPAA, 4 hastaya IRA ve geri kalan 12 hastaya total proktokolektomi kalýcý ileostomi uygulandý. Hastalarýn hepsinde 100 ve üzerinde kolonda polip vardý. Hastalar ortanca 38 aya takip edildi. Bu takip esnasýnda 8 hastada (%40.0) tekrarlayan veya metastatik hastalýk geliþti. Bunlar; 4 hastada uzak metastaz, 3 hastada rektum kanseri (hepsine daha önce IRA yapýlmýþ) ve bir hastada ise desmoid tümör þeklindeydi. Ayrýca IRA yapýlmýþ 1 hastada rektumda adenom geliþti. Ileal poþ adenomu ya da ileostomide adenom geliþimi izlenmedi. Dört hasta hastalýða baðlý kaybedildi. Bunlardan 3’ü metastatik hastalýk geliþimine baðlýyken kalan 1 hastada dev desmoid tümörün neden olduðu böbrek yetmezliði ölüm sebebiydi.
TARTIÞMA ve SONUÇ: Ameliyat öncesi kanser tanýsý konulmuþ klasik AAP hastalarýnda cerrahi yöntem olarak abdominal kolektomi-IRA seçimi iyi bir seçenek olmayabilir. Ancak çalýþmanýn az sayýda hastayý kapsadýðý da göz önünde bulundurulmalýdýr.

INTRODUCTION: Familial adenomatous polyposis (FAP) is treated by abdominal colectomy with ileorectal anastomosis (IRA), restorative proctocolectomy with ileal J-pouch anal anastomosis (IPAA), and total proctocolectomy with ileostomy. This study investigated question is what type of surgery is better.
METHODS: Twenty FAP patients, who underwent surgery in a single hospital between 2004 and 2014, were included. Patients were classified in 3 groups according to the operation procedures. Demographic, surgical, pathological, and outcome data were analyzed from hospital records retrospectively.
RESULTS: Overall 20 patients were included, 15 index patients, and 5 relatives diagnosed by screening. Median age of patients with or without colorectal cancer was 37 and 20 years respectively. Four patients were treated by IPAA, 4 by IRA, and 12 by proctocolectomy. All patients presented with 100 or more colonic polyps. The median follow-up time was 38 months. During the follow-up period, 8 (40.0%) patients developed recurrent or metastatic disease. There were; distant metastasis in 4 patients, rectal cancer in three (who underwent IRA), desmoid tumor in one. Adenoma developed in one rectal remnant, ileal pouch adenoma or adenoma in ileostomy was not seen in any patient. Four patients died 3 of them because of metastatic disease and the other one died because of a huge desmoid that caused renal failure.
DISCUSSION AND CONCLUSION: Abdominal colectomy with IRA was not a good option for classic FAP patients who presented with colorectal cancer preoperatively, but it should be noticed that this study consists of small number of patients.

GÝRÝÞ ve AMAÇ: Meme kanseri, kadýnlarda ölüme yol açan kanserler içinde ikinci sýradadýr. Kanser, meme dokusunda genellikle duktus veya lobüllerden geliþir. Bu çalýþmadaki amacýmýz, meme karsinomunda vaskuler endotelyal büyüme faktörü (VEGF) ve nitrik oksit (NO) seviyeleri ile tümör grade’i, lenf nodu durumu ve tümör büyüklüðü iþe iliþkisini araþtýrmaktýr.
YÖNTEM ve GEREÇLER: Bu çalýþmada meme kanserli 50 hastada ve 38 saðlýklý kontrolde serum VEGF ve NO seviyelerini ölçtük.
BULGULAR: Meme kanserli hastalarda serum VEGF ve NO seviyeleri kontrollere göre anlamlý derecede daha yüksekti (p<0.001). Tümör çapý açýsýndan, meme kanserli hastalarda serum NO seviyelerinde anlamlý bir fark bulunamadý. Aksiller lenf nodu tutulum durumu açýsýndan, meme kanserli hastalarda serum VEGF ve NO seviyelerinde anlamlý bir fark bulunamadý. Meme kanserli hastalarda, serum NO düzeyleri ile serum VEGF düzeyleri arasýnda (r: 0.380, p=0.006) pozitif bir korelasyon vardý.
TARTIÞMA ve SONUÇ: Serum VEGF ve NO seviyeleri meme kanserli hastalarda prognozu öngören faydalý bir belirteç olabilirler. Bu hipoteze açýklýk getirmek için uzun süre takipli daha geniþ çalýþmalara ihtiyaç vardýr.

INTRODUCTION: Breast cancer is the second leading cause of cancer deaths in western among woman worlwide.Cancer that forms in tissues of the breast usually the ducts or lobules. The aim of the present study was to investigate the association between serum NO and VEGF levels and lymph node status and tumor size of breast carcinoma.
METHODS: In this study we measured serum VEGF and NO levels in 50 patients with breast cancer and 38 healty controls.
RESULTS: Serum VEGF and NO levels are higher patients with breast cancer than controls (p<0.001). Ýn terms of tumoral size, there is no significant difference serum NO levels in the patients with breast cancer. There are positive correlation between serum NO levels and serum VEGF levels (r: 0.380, p=0,006) in the patients with breast cancer.
DISCUSSION AND CONCLUSION: Serum VEGF and NO levels may be a useful marker to predict prognosis of patients with breast cancer.To clarify this hypothesis, larger studies with long-term follow -up are needed.

GÝRÝÞ ve AMAÇ: Endometrium kanseri (EK)’nde halen standart cerrahi her ne kadar tam evreleme þeklinde olsa da, erken evrede lenf nodu diseksiyonu (LND)’nun yeri tartýþmalýdýr. O nedenle yüksek riskli hastalarýn tespiti önem taþýmaktadýr. Bu çalýþmada lenf nodu metastazý (LNM) için yüksek riskli hastalarýn operasyon sýrasýnda frozen kesit (FK) ile kurumumuzda hangi doðrulukta tespit edilebileceðini görmek amaçlanmýþtýr.
YÖNTEM ve GEREÇLER: EK’li 37 hastada intraoperatif FK ile, histopatolojik tiplendirme, greyd, tümör çapý (TÇ), miyometrial invazyon derinliði (MÝD) ve lenfovasküler emboli (LVE) parametrelerine bakýldý. Bu parametreler parafin takip (PT)‘lerindeki nihai sonuçlarý ile karþýlaþtýrýldý.
BULGULAR: FK incelemede histopatolojik tip I taný alan bir hasta (%2,7), PT’te tip II olarak deðerlendirildi. MÝD deðerlendirmesinde FK incelemede bir hasta derin invazyon açýsýndan yanlýþ negatif (%2,7) taný aldý. TÇ ölçümü FK ve PT tüm hastalarda uyumlu idi. LVE bakýldýðýnda, FK incelemede 4 hastada (%10,8) LVE tespit edilemedi. Tümörler diferansiasyon açýsýndan derecelendiðinde nükleer yüksek greyd 5 hastada (%13,5), yapýsal yüksek greyd ise 3 hastada (%8,1) FK ile yanlýþ negatif taný aldý. Histopatolojik tip tayini, MÝD, LVE, nükleer ve yapýsal greyd için testlerin doðruluðu sýrasý ile %94, %97, %89, %86 ve %91 olarak hesaplandý. Tüm parametreler birlikte deðerlendirildiðinde EK hastalarda LNM için yüksek riskli olaný yakalama açýsýndan FK incelemenin duyarlýlýk, özgüllük ve doðruluðu sýrasý ile %96, %100 ve %97 olarak hesaplandý. FK inceleme yüksek riskli EK’ni yakalama açýsýndan (1/37) bir hastada (%2,7) baþarýlý olamadý.
TARTIÞMA ve SONUÇ: EK’li hastada FK incelemenin histopatolojik tip tayini, TÇ ve MÝD deðerlendirmesi açýsýndan baþarýlý fakat LVE, nükleer ve yapýsal greyd tayini için doðruluk oranýn düþük olduðu izlendi.

INTRODUCTION: Although the current standard surgical procedure is still staging comprehensively in endometrial cancer (EC), the therapeutic effect of lymph node dissection (LND) is debatable for early stages. Therefore, it is important to identify high risk patients. In this study, it is intended to see the accuracy rate of frozen section (FS) in our institution by determining high-risk patients for lymph node metastasis (LNM) in EC.
METHODS: Intraoperative FS were studied in 37 EC patients, histopathological typing, grade, tumor size (TS), myometrial invasion depth (MID) and lymphovascular emboli (LVE) parameters were measured. These parameters were monitored and compared with the final paraffin results (PR).
RESULTS: In FS examination, the histopathological diagnosis of a patient with type I was a type II in PR (2.7%). In MID assessment one patient was (2.7%) misdiagnosed. In TS measurement, FS and PR were consistent in all patients. Referring to LVE, 4 patients (10.8%) were false negative by FS examination. FS received a false negative diagnosis in 5 patients (13.5%) for nuclear high grade and in 3 patients (8.1%) for structural high grade. The accuracy of the test sequence were calculated for histopathological type determination, MID, LVE, nuclear and structural grade as 94%, 97%, 89%, 86% and 91%, respectively. When all parameters were evaluated together, in terms of capturing the high-risk EC patients for LNM by FS examination, the sensitivity, specificity, and accuracy were calculated as 96% 100% and 97%, respectively. FS examination was failed for diagnosing one high-risk (1/37) EC patient (2.7%).
DISCUSSION AND CONCLUSION: FS examination was successful for histopathological type determination, TS and evaluation of MID but low accuracy rate was observed for LVE, for the determination of nuclear and structural grades.

GÝRÝÞ ve AMAÇ: Bu retrospektif çalýþmada amacýmýz lokalize gastrointestinal stromal tümörlü (GÝST) hastalarýn klinik ve histopatolojik özellikleri ile saðkalým oranlarýný deðerlendirmektir.
YÖNTEM ve GEREÇLER: Nisan 2004 - Ekim 2014 tarihleri arasýnda Ankara Numune Eðitim ve Araþtýrma Hastanesi Týbbi Onkoloji Kliniði'ne baþvuran GÝST tanýlý 94 hasta arasýndan opere olmuþ ve taný sýrasýnda metastazý olmayan 65 hastanýn dosya bilgileri kaydedildi.
BULGULAR: Çalýþmaya alýnan 65 hastanýn ortanca yaþý 53 (22-78) olup; çoðunluðu erkekti (erkek/kadýn: 41/24). Tümörlerin yerleþim yeri sýklýk sýrasýna göre mide (%58.5), mide dýþý gastrointestinal (%29.2), ve ekstragastrointestinal (%12.3) olarak belirlendi. AFIP'e göre hastalarýn %24.6'sý düþük, %21.5'i orta ve %53.9’u yüksek risk grubunda yer alýrken; sadece %33.8'i adjuvan imatinib tedavisi aldý. Tüm grupta ortanca genel saðkalýma ulaþýlamazken; 3 yýllýk hastalýksýz saðkalým (DFS) %81, 2 yýllýk DFS ise %84 olarak belirlendi. Cinsiyet, tümörün lokalizasyonu, tümör çapý, mitoz sayýsý, CD34, AFIP risk grubu ve adjuvan tedavi alýp almama durumuna göre hem 2 hem de 3 yýllýk DFS'de istatistiksel anlamlýlýða ulaþan fark saptanmadý.
TARTIÞMA ve SONUÇ: Taný sýrasýnda lokalize olup cerrahi tedavi yapýlan GÝST olgularýnda ortanca saðkalýma ulaþýlamazken; DFS oranlarý yüksek bulunmuþtur.

INTRODUCTION: In this retrospective study, we aimed to evaluate the clinical and histopathological features and survival rates of patients with localized gastrointestinal stromal tumors (GIST).
METHODS: Between April 2004 and October 2014, 94 patients diagnosed with GIST who were referred to the Department of Medical Oncology, Ankara Numune Education and Research Hospital were retrospectively reviewed. A total of 65 nonmetastatic operable GIST patients were included in the study.
RESULTS: The median age was 53 years (22-78) and most patients were male (male/female: 41/24). The most common localization of tumors were stomach (58.5%), non-gastric gastrointestinal (29.2%), and ekstragastrointestinal (12.3%). According to the AFIP prognostic criteria, 24.6% of patients was located in low risk group, 21.5% in intermediate risk group, and 53.9% in high risk group. Only 33.8% of patients received adjuvant imatinib treatment. While the median overall survival (OS) was not reached, 3 year and 2 year disease free survival (DFS) was 81% and 84% respectively. There was no statistically significant difference neither in 2 year DFS nor in 3 year DFS according to gender, tumor site, tumor size, mitotic count, CD34, AFIP risk group and adjuvant treatment.
DISCUSSION AND CONCLUSION: The median OS was not reached in localized GIST patients who underwent surgery, whereas a high DFS rate was found.

GÝRÝÞ ve AMAÇ: Pankreas kanserleri hastalarýnýn taný anýnda sadece %15-20’si cerrahi olarak çýkarýlabilir aþamada olup %52’sinde yaygýn hastalýk %26’sýnda bölgesel yayýlým mevcuttur (1). Pankreas kanserinin bir yýllýk genel sað kalým oraný %26, beþ yýllýk ise % 6’dýr (2). Bu çalýþmanýn amacý Türkiye’de merkezi bir bölgede bulunan ve referans merkez olarak kabul edilen Ankara Onkoloji Eðitim Araþtýrma Hastanesi’ne baþvuran pankreas adenokanserli hastalarýn klinikopatolojik özelliklerinin incelenmesidir.
YÖNTEM ve GEREÇLER: Çalýþma için Ankara Onkoloji Eðitim ve Araþtýrma Hastanesi’nde 2007-2011 tarihleri arasýnda izlenmiþ 121 erkek ve 72 kadýndan oluþan toplam 193 pankreas adenokanseri hastasý retrospektif olarak tarandý.
BULGULAR: Hastalarýn 26’sýna (%13,5) küratif rezeksiyon uygulanmýþtý, 54 hasta (%28) lokal ileri çýkarýlamaz, 113 hasta ise (%58,5) metastatik evredeydi. Tüm grup için (n=193) ortanca sað kalým süresi 6 ay olarak bulundu. Yaþýn, ortanca yaþ olan 61 den büyük olmasý, ECOG performans durumunun 3 ve üzerinde deðer olmasý, baþlangýçta kilo kaybý olmasý, baþlangýçta karýn aðrýsý olmasý, tümör gradýnýn yüksek olmasý, tümörün lokal ileri veya metastatik olmasý, baþlangýç metastaz bölgesinin periton veya karaciðer dýþý olmasý, baþlangýçta çoklu metastaza sahip olunmasý sað kalýma anlamlý olumsuz yönde etkilemekteydi. Küratif opere edilen hastalar dýþlanarak çýkarýlamaz ve metastatik hastalar için bakýlan CA19-9 deðerinin ortanca deðer olan 616’nýn üzerinde olmasý kötü sað kalým ile iliþkili idi (p=0,021). Metastatik aþamada kemoterapi almýþ olmak en iyi destek tedavisine bariz olarak üstündü. Ortanca sað kalým kemoterapi almayan kol için 1 ay (0,2-1,7) iken almýþ olan kolda 7 (4,7-9,3) ay idi (p<0,0001). Lokal ileri çýkarýlamaz grupta ise bu fark gösterilemedi.
TARTIÞMA ve SONUÇ: Hastalarýn klinik ve demografik incelenmesi neticesinde daha önceden yapýlmýþ çalýþmalarla genellikle benzer sonuçlara ulaþýlmýþtýr. Hastalardaki ortanca yaþýn dünya ortancasýna göre düþük olmasý, Türkiye’de sigaraya baþlama yaþýnýn daha erken olmasý ile iliþkili olabileceðini akla getirmektedir. Tedavi kararý verirken yaþ durumundan çok performans durumuna ve evresine göre karar vermek akýllýca olacaktýr.

INTRODUCTION: In patients with pancreatic cancer twenty-six percent are locally advanced, 52% are metastatic and only 20-15% are surgically removable at the time of diagnosis (1). One-year overall survival rate of pancreatic cancer is 26% while 5 year overall survival rate is only 6% (2) The aim of this study is to analyze the clinicopathological features of the pancreatic adenocarcinoma patients who admitted to the Ankara Oncology Training and Research hospital.
METHODS: Total 193 pancreatic adenocarcinoma patients, including 72 women and 121 men, who were followed in Ankara Oncology Training and Research Hospital between dates 2007-2011, were evaluated retrospectively.
RESULTS: Twenty-six of the patients (13,5%) had undergone curative resection, 54 patients (28%) with locally advanced disease were unresectable, while 113 patients (58,5%) had metastatic disease. For the entire group (n=193), median survival time was 6 months. Older age (more than median “61”), low performance status (ECOG≥3), weight loss or abdominal pain on admission, high grade tumor, locally advanced or metastatic disease, metastasis other than peritonea or liver, multiple metastases at the time of diagnosis were the parameters which significantly affect survival negatively. After excluding the curatively operated patients, high levels of Ca 19-9 (higher than median value: 616) were associated with poor survival in patients with locally advanced or metastatic disease (p=0,021). Chemotherapy was significantly superior to best supportive care in the metastatic disease. Median overall survival in patients treated with chemotherapy versus best supportive care was 7 months (4,7 to 9,3) and 1 month (0,2 to 1,7) respectively (p<0,0001). There was no significant difference in overall survival with chemotherapy versus best supportive care in locally advanced unresectable group.
DISCUSSION AND CONCLUSION: As a result of demographic and clinical examination of patients, we generally reached similar conclusions with previous studies. Low median age of the disease may be associated with an earlier age of onset of smoking in Turkey. It would be wise to consider performance status and stage of the disease rather than the age of the patient while making treatment decisions.

GÝRÝÞ ve AMAÇ: Santral Venöz port kateter (SVPK) kanser hastalarýnýn kemoterapi ve palyatif bakýmýnda önemli yer almaktadýr. SVPK cerrahi klinikler tarafýndan yerleþtirilmekte ve onkoloji ile cerrahi klinikleri arasýnda iþlem için geçen süre genelde tedavide gecikmeye neden olmaktadýr. Biz çalýþmamýzda literatürde ilk kez bir týbbi onkoloji kliniði tarafýndan yerleþtirilen SVPK’lere baðlý komplikasyonlarýnýn incelenmesini amaçladýk.
YÖNTEM ve GEREÇLER: Dokuz Eylül Üniversitesi Týbbi Onkoloji Bilim Dalý’nda týbbi onkoloji hekimleri tarafýndan SVPK takýlan 2179 kanser hastasý çalýþmaya alýndý. Hastalarýn týbbi kayýtlarý retrospektif olarak incelendi.
BULGULAR: 2179 hastaya perkütan yöntemle SVPK takýlma iþlemi uygulandý. 2055 (%94,3) hastada juguler vene, 90 (%4,1) hastaya femoral ve 34 (%1,6) hastaya subklavyen vene SVPK takýldý. Hastalarýmýzýn 2167 (%99,4) hastada akut komplikasyon görülmezken 12 hastada akut komplikasyon gerçekleþti. 9 (%0.04) hastada pnomotoraks, 2 (%0,009) hastada hematom ve 1 (%0,0046) hastada giriþime baðlý akut atriyal fibrilasyon ataðý komplikasyonlarý saptandý. Kronik komplikasyonlara bakýldýðýnda 19 (%0,87) lokal port enfeksiyonu, 19 (%0,87) hastada port týkanmasý, 15 (%0,68) hastada derin ven trombozu, 11 (%0,50) hastada port çýkmasý veya kopmasý, 10 (%0,45) hastada kateterle iliþkili kan damarý enfeksiyonu, 2 (%0,09) hastada cilt nekrozu, 1 (%0,045) hastada port sýkýþmasý (pinch-off sendromu) ve 1 (%0,045) hastada rezervuar giriþ yarasý olduðu saptandý.
TARTIÞMA ve SONUÇ: Literatürdeki medikal onkologlarýn yerleþtirdiði en fazla hasta sayýsýna sahip olan çalýþmamýza ait veriler incelendiðinde komplikasyon oranýnýn literatürdeki cerrahi kliniklere ait sonuçlardan kötü olmadýðýný hatta sonuçlarýn pek çok çalýþmadan daha iyi olduðunu saptadýk. Çalýþmamýz SVPK yerleþtirilmesi yönünde medikal onkologlarý cesaretlendirici sonuçlara ulaþmýþtýr.

INTRODUCTION: The central venous catheter port (CVCP) is a key component of the chemotherapy and palliative care for patients with cancer. The CVCP is placed by surgical clinics, and the period of time it takes to complete the procedure between oncology and surgery clinics usually causes delays in the treatment. The present study aims to investigate the results associated with CVCPs placed by a medical oncology clinic for the first time in the literature.
METHODS: We included 2,179 patients with cancer who underwent a CVCP placement performed by medical oncology physicians within Dokuz Eylül University Medical Oncology Department. The patients’ medical records were examined retrospectively.
RESULTS: 2,179 patients underwent a percutaneous CVCP placement procedure. 2,055 (94.3%) patients had CVCP in their jugular vein, 9 (4.1%) in the femoral vein, and 34 (1.6%) in the subclavian vein. 12 (0.6%) patients exhibited acute complications while 2,167 patients (99.4%) had none. We detected pneumothorax in 9 patients (0.04%), hematoma in 2 patients (0.009%), and 1 patient (0.0046%) presented with complications of acute atrial fibrillation associated with the procedure. Chronic complications included 19 (0.87%) local port infections, 19 (0.87%) blocked ports, 15 (0.68%) deep vein thrombosis, 11 (0.50%) displaced ports, 10 (0.45%) catheter-associated blood vessel infections, 2 (0.09%) skin necrosis, 1 (0.045%) compressed port (pinch-off syndrome), and 1 (0.045%) wound in the reservoir access.
DISCUSSION AND CONCLUSION: For the first time in the relevant literature, we found that the complication rates for the CVCPs placed by medical oncologists in a medical oncology clinic were no worse than those reported for the surgery clinics. Our findings encourage medical oncologists to place CVCPs themselves.

Günümüzde insidansý gittikçe artan malign melanom biyolojisinin anlaþýlmasýnda ve tedavisinde son zamanlarda meydana gelen geliþmelere raðmen, melanom tedavisinde cerrahi yaklaþým önemini korumaktadýr. Melanomun cerrahi tedavisinin planlanmasýnda tümörün histopatolojik özellikleri, anatomik lokalizasyonu, hastanýn tercihleri gibi pek çok faktör göz önünde bulundurulmalý ve tedavi her hasta için kiþiselleþtirilmelidir. Onkolojik tedavi prensiplerini korurken tedavi sonucunu iyileþtirmek melanom tedavisindeki asýl amaçtýr. Bu makalede malign melanoma cerrahi yaklaþým tartýþýlmýþtýr. Tanýsal biyopsi, primer ve rekürren tümör eksizyonu, nodal evreleme, ve metastazektomi konularýnýn yanýnda literatürde fikir birliðine varýlamamýþ alanlar üzerinde durulmuþtur.

In spite of new developments in the knowledge of the biology of melanoma and its treatment modalities, surgery remains the key treatment modality for malignant melanoma of which the incidence is rising all over the world. Numerous factors such as the histopathologic features of the tumor, its anatomic localization and patient preferences must be considered in the planning of the surgery, and the treatment should be personalized for each patient. Improving the outcome while preserving oncologic treatment principles is the main goal in melanoma treatment. In this article, the authors discuss the surgical approach to malignan melanoma. Topics such as diagnostic biopsy, excision of the primary and recurrent tumors, nodal staging and metastasectomy as well as areas of controversy have been highlighted.

GÝRÝÞ ve AMAÇ: Akut abdominal aðrý toplumda çok sýk görülmektedir ve acil polikliniðe baþvuran hastalarýn %5-%10’unu oluþturmaktadýr. Fakat hipofizer yetmezlik gibi cerrahi dýþý baþka patolojiler olaya dahil olabilir ya da hastalýkla birlikte geliþen stresli durum hipofizer yetersizliði ortaya çýkarabilir.
YÖNTEM ve GEREÇLER: Bu çalýþmada tek bir merkezde karýn aðrýsý yakýnmalarý olan ve hipofizer yetersizlik saptanan hastalar deðerlendirildi.
BULGULAR: Hipofizer yetmezlik tespit edilen tüm hastalarda tedavi sonrasý karýn aðrýsý geriledi.
TARTIÞMA ve SONUÇ: Sonuç olarak özellikle geriatrik popülasyonda karýn aðrýsý nedenlerinin multifaktöryel olabileceði unutulmamalýdýr.

INTRODUCTION: Acute abdominal pain is a common symptom and constitutes 5% -10% of patients admitted to the emergency department. But non-surgical events such as pituitary insufficiency also may be clinically evident together or pituitary insufficiency may occur during the stressful situations.
METHODS: In this study, we evaluated five patients that abdominal pain with pituitary insufficiency in a single center.
RESULTS: After treatment, abdominal pain regressed all patients finding pituitary insufficiency
DISCUSSION AND CONCLUSION: Eventually, especially in geriatric populatýon abdominal pain causes for it should be noted that it might be multifactoriel.

Senkron bilateral seminom, tüm testis tümörlerinin %1-2.8’sinde görülür. 33 yaþýndaki hastaya senkron bilateral klasik tip seminom tanýsý konuldu. Evre T1N2S0 tanýsýyla bilateral pelvik ve paraaortik lenf nodlarýna 24.5 Gy, kalan testis dokusuna 20 Gy ve sol paraaortik lenf nodu bölgesine ek doz 10.8 Gy radyoterapi verildi. Hasta 26 aydýr remisyonda izlenmektedir. Bu makalede, senkron bilateral klasik tip seminomlu vakada radyasyon tedavisinin yeri, etkinliði ve önemi tartýþýldý.

Synchronous bilateral seminoma is encountered in 1.0-2.8% of all testicular tumors. A 33-year old patient was diagnosed as bilateral synchronous seminoma of classical type. The stage of the disease was T1N2S0. Radiotherapy was delivered with a dose of 24.5 Gy to bilateral pelvic and paraaortic lymph nodes whereas 20Gy to residual testicular tissue on the left; in addition, radiotherapy was delivered with a dose of 10.8Gy to paraaortic lymph node region. The patient has been in remission for 26-months. Here, we presented a case with synchronous bilateral seminoma of classical type and discussed effectiveness and value of radiation therapy.

Malign periferal sinir kýlýf tümörleri (MPSKT) sýk rastlanýlan tümörlerden deðillerdir. Perinöral hücre farklýlaþmasý olanlar hariç çok agresif tümörlerdir ve prognozu kötüdür. Patolojik tanýsý MPSKT olan olgunumuza cerrahi eksizyon yapýldý

Malignant peripheral nerve sheath tumors (MPSKT) are not of common tumors. Except the perineural cell differentiation are very aggressive tumors and a poor prognosis. Surgical excision was performed with our case MPSKT pathological diagnosis.

Skrotal leiomyosarkoma nadiren görülür ve paratestiküler veya intratestiküler olabilmektedir. Ýki yýl önce paratestiküler leiomyosarkoma nedeniyle opere edilmiþ olan 18 yaþýnda erkek hasta rezeke edilemeyen intraabdominal metastazlarla bölümümüze baþvurdu. Kombinasyon kemoterapi rejimen (doksorubisin ve mesna korumasýyla birlikte ifosfamid) baþlandý ve 6 uygulama sonrasýnda çok iyi parsiyel regresyon saðlandý. Bizim olgumuz, paratestiküler leiomyosarkomalý hastalarýn uzun dönem takiplerinin gerekli olduðunu ve metastatik durumda sistemik kemoterapinin çok etkili olabileceðini vurgulamaktadýr.

Scrotal leiomyosarcoma is seen rarely and may be paratesticular or intratesticular. An 18-year-old male, operated for paratesticular leiomyosarcoma 2 years before, was referred to our department with unresectable intraabdominal metastases. Combination chemotherapy regimen (ifosfamide with mesna protection and doxorubicin) was started and very good partial regression was achieved after 6 cycles.
Our case highlighted that long-term follow-up of the patients with the paratesticular leiomyosarcoma is required and systemic chemotherapy might be very effective in metastatic setting.

Gangliogliom, genellikle çocuklarda gözlenmekte olup, sinir sisteminin nadir tümörüdür. Hem nöronal hem de glial hücrelerden oluþan mikst tipte kitledir. Eriþkin yaþta oldukça nadirdir. Sýklýkla supratentorial olarak yerleþim gösteren bu tümör, çok daha az sýklýkta serebellar olarak yerleþim gösterir. Genellikle kistik olan bu lezyon, oldukça az sýklýkta kalsifiye olarak izlenir. Baþaðrýsý ve yürüme güçlüðü nedeniyle baþvuran kýrkaltý yaþýndaki bayan olguda kalsifiye serebellar gangliogliom tespit edildi. Amacýmýz, eriþkin yaþta görülen kalsifiye serebellar gangliogliom olgusunu sunarak, bu çok ender olarak rastlanan tümör lokalizasyonunu literatüre kazandýrmaktýr.

Ganglioglioma, is commonly seen in children, is the rare tumor of the nervous system. This tumor is composed of a mixed type of neuronal as well as glial cells. It is very rare in adults. This tumor is often supratentorial showing the layout, much less often show as cerebellar location. This lesion, which is generally quite less frequently, showed as cystic and calcified tumors. Calcified cerebellar ganglioglioma was detected in forty-six-year-old female patient with headache and gait disturbance. Our goal is to present that calcified cerebellar ganglioglioma seen in adult patients, is to make the tumor localization rarely encountered.

Aktinomikoz nadir görülen kronik enfeksiyöz bir hastalýktýr. En sýk görülen formu servikofasiyal enfeksiyondur. Karaciðer tutulumu tüm aktinomikoz enfeksiyonlarýnýn %5’ini oluþturur. Abdominal aktinomikoz enfeksiyonu bulunan olgularýn yaklaþýk %15’inde karaciðer lezyonlarý eþlik etmekte ve karaciðer tutulumunun, batýn içindeki baþka bir enfeksiyon odaðýna, sekonder olarak meydana geldiðine inanýlmaktadýr. Ancak bazý olgularda enfeksiyonun kaynaklandýðý primer odak saptanamaz ve bu olgular primer ya da izole hepatik aktinomikoz olarak sýnýflandýrýlýr. Genellikle tek bir apse odaðý þeklinde, hassas, sert, fikse görünümdedir. Bazen tümör ile karýþtýrýlabilir. Mikroskopik tanýsý, gram(+) basil þeklindeki mikroorganizmalarýn görülmesi veya kültürde üretilmesi ile konulur.

Actinomycosis is a rare chronic infectious disease. The most common form is cervicofacial infection. Hepatic involvement constitutes 5% of all actinomycosis infections. Approximately 15% of patients with abdominal actinomycosis is accompanied by liver lesions. Liver involvement is believed to occur as a secondary to another infected focus in the abdomen. However, in some cases, the infection’s primer focus can not be detected and are classified as primary or isolated hepatic actinomycosis.
Generally they are in the form of a single, sensitive, firm, and fixed abscess. Sometimes it may be mistaken as tumor. Tissue specimens for microscopic examination are necessary for diagnosis.

Biz, akciðer metastazý olan sinovyal sarkomlu, yüksek doz ifosfamid tedavisi sonrasý lökositoklastik vaskülit geliþen bir olguyu tanýmladýk. Kýrk iki yaþýnda erkek hasta, sol kol ön-iç kýsýmda geliþen kitle nedeniyle baþvurdu. Operasyon sonrasý yüksek gradlý sinovyal sarkom tanýsýyla adjuvan tedavilerini aldý. Tedavi bitiminden 10 ay sonra, çok sayýda akciðer metastatik nodülleri nedeniyle yüksek doz ifosfamide tedavisi baþlandý. Kemoterapiyi takiben 1 hafta sonra hastada karýn aðrýsý, kanlý idrar ve her iki alt ekstremitede eritematöz lezyonlar ve palpable purpura geliþti. Hastanýn otoantikorlarý negatif (antikardiyolipin IgG/M, antifosfolipid IgG/M, anti dsDNA, ANA, pANCA ve cANCA), RF normal, C3 ve C4 normal sýnýrlarda saptandý. Deriden yapýlan tam kat deri biopsisi lökositoklastik vaskülit ile uyumlu geldi. 1mg/kg prednizolon tedavisi sonrasýnda hastanýn döküntüleri, kanlý idrar ve karýn aðrýsý tamamýyla geriledi. Ýlaca baðlý olumsuz ilaç etkisi ihtimalini öngören Naranjo skalasýna göre vaskülit ile ifosfamid arasýnda olasý bir iliþki olabileceðini saptadýk. Güncel bilgiler ýþýðýnda literatürde ifosfamid sonrasý lökositoklastik vaskülit geliþen olguya rastlamadýk. Biz, burada, yüksek doz ifosfamid alan hastalarda nadir ve olaðan dýþý bir durum olan lökositoklastik vaskülit geliþebileceðini vurgulamak istedik.

We described a case that synovial sarcoma with lung metastasis, presenting with leukocytoclastic vasculitis after treatment with high dose ifosfamide. Forty-two years old male patient was admitted to the hospital due to anteromedial mass on his left arm. He was operated with the diagnosis of high grade synovial sarcoma and he received adjuvant treatment. 10 months later after the end of the therapy, numerous metastatic lung nodules developed and started high dose ifosfamide treatment. Stomachache, hematuria, erythematous lesions, palpable purpura on his bilateral lower extremities developed after 1weeks later of the starting chemotherapy. His autoantibodies were negative (anticardiolipin IG G/M, antiphospholipid Ig G/ M, antids DNA, ANA, pANCA, cANCA) and RF, C3, C4 were normal. Full-thickness skin biopsy resulted as leukocytoclastic vasculitis. After treatment 1 mg/kg prednisolone, patient's rash, hematuria, abdominal pain disappeared completely. We found that a possible relationship between ifosfamide and vasculitis according to Naranjo scale which envisioning the possibility of drug induced adverse drug effects. In the light of current knowledge, we found no cases developing leukocytoclastic vasculitis after ifosfamide treatment in the literature. Here, we wanted to emphasize that in patients treated with high dose ifosfamide might develop leukocytoclastic vasculitis, which is rare and unusual case.