Although preventable, acute renal failure (ARF) of obstetrical origin continues to be a common problem in developing countries despite many measures. In this study among 402 acute renal failure cases, 37 with obstetrical origin were evaluated. Acute renal failure occurred in association with postpartum hemorrhage in 15 (40.5%), eklampsia or HELLP syndrome in 9 (24.2%), sepsis in 5 (13.5%), newly diagnosed ESRD in 5 (13,5%) of the cases. ARF developed in one chronic hypertensive patient. Acute cortical necrosis was revealed in 2 patients by kidney biopsy performed due to persistence of kidney failure. In five cases, kidney failure was unknown before the delivery, after birth with the demonstration of atrophic kidneys, chronic renal failure was diagnosed. In reversible cases ARF was healed completely at last, six months after the diagnosis. In 17 cases, hemodialysis was needed. In conclusion, mortality and morbidity is still quite high in obstetrical ARF in this region. Measures for the prevention of obstetrical ARF should be done proactively.

Aim: In this study, we evaluated retrospectively 95 cases of posterior fossa tumors operated within 50 months between January 1996 and February 2000 in Neurosurgery Clinic of Ankara Numune Education and Research Hospital. Methods: Patients were diagnosed with cranial Computed Tomography (CT). All of the patients diagnosed with posterior fossa tumors underwent surgery of tumor excision and materials were histopathologicaly evaluated. Results: Forty-two (44%) of the patients were in pediatric ages (under 18 years) and 51 (56%) were adults. The most frequent complaint was headache in 90% of patients followed by vomiting (70%) and nausea (60%). The most frequent neurological manifestation was papilla stasis (80%). Medulloblastoma was the most common histopathologic diagnosis in childhood patients and was the most common in all ages. Conclusion: Early surgery is life-saving in treatment of posterior fossa tumors. Postoperative close followup is required in order to decrerase mortality and morbidity. Moreover, radiotherapy and chemotherapy contribute to lenghtening of survival of the patients.

Aim: In this study, we aimed to compare the sedative and possible side effects of the combination of propofol and alfentanil with diazepam in fiberoptic bronchoscopy (FOB) Method: Study included 30 ASA I-II patients. In all patients, premedication was applied with atropine, topical lidocaine, and lidocaine gargle. Propofol 1 mg. kg-1 and alfentanil 10 µg. kg-1 were administered intranenously to Group I, and diazepam 10 mg im for Group II. FOB was performed just after giving drug in Group I, and half an hour later in Group II. Results: Demographic data were similar in both groups. Prebronchoscopic values of heart rate, blood pressure, SpO2 were also similar in two groups. Blood pressure was found to be significantly lower in Group I 2nd and 5th minutes after starting procedure. Heart rate was significantly lower in Group I at 5th minute. SpO2 values were found to be significantly higher at 2nd minute in Group II. Sedation score values were found to be significantly higher in Group I. The frequency of cough was significantly lower in Group I. According to patient comfort, all patients in Group I declared that they might prefer the same method, but 80% of Group II patients explained that did not prefer the same method. As a result, It is concluded that propofol and alfentanil combination may be an alternative method to conventional methods such as iv diazepam in FOB, as it minimally affects the haemodynamic paremeters, has high level of patient satisfaction, and prevents coughing to some extend.

Aim: The most common congenital abnormality of ureter is the ureteropelvic junction obstruction (UPJO). Male to female ratio is 5/2 with male predominance. Clinical picture and the degree of hydronephrosis is related to the age of the patient at the time of diagnosis. Early treatment may prevent infection, nephron loss and the development of stone. In this report we emphasized the importance of early diagnosis. Methods: Fifty two cases with UPJO followed up by our clinic between 1995 and 2004 were retrospectively evaluated. Results: The mean age of the 36 male and 16 female patients was 17+8,9 (2-42). The IVP’s of 37 cases could be available. For 14 of the cases a concurrent stone was present, and more prevalent in adult compared to children. The recovery of hydronephrosis was better for pediatric age group patients (p<0.001). For two cases balloon dilatation was done for post operative narrowing. For three cases ureterocalycoctomy was performed for high grade hydronephrosis and in 14 cases, stone was present; the stone was more frequent in adult patients. Conclusions: Close inspection may be offered in patients with UPJO but early surgical intervention is necessary in case with renal calculi, nephrone loss, and infection.

Extrophy vesicale is a very uncommon congenital anomaly. The urinary bladder must be closed at the very early period. In 2 of 5 cases operated due to extrophy-epispadias complex developed multiple giant stones. We present these cases to contribute to the literature. Case-1: The 3 days old case had iliac osteotomy, symphysispubis approximation and primary closure of the bladder. At the end of the 4 years waiting period for the development of bladder capacity a 4x3x1.5 cm sized stone was detected in the bladder neck. The stone was formed on the curl of the steel wire which is used to obtain proximity of the symphysis pubis, due to the contact and incrustment of urine leaked from the epispadic urethra. The wire and accompanying stone were withdrawn together. Case-2: The 18-years old patient that holds in the animal shelter by his family had total cystectomy and Indiana Pauch operation. Cosmetically good result was obtained by connection of tip of ileal conduit to the prostatic urethra. Due to the lack of follow up for six years duration, the patient was reoperated for multiple stones including one 8x6x4 cm and one 6x5x3 cm sized. Discussion and conclusion: The stone development should be expected in the reservoirs in which urine can not be emptied adequately. Thus, early diagnosis of stone development proves early treatment chance by any lithotripsy procedure. The risk of incrustation can be obviated by to not contact with the urine of foreign materials used in the reconstructive surgery.

The most common cause of pediatric airway obstruction is the hypertrophy of tonsils and adenoids. If the obstruction to upper airways is not relieved, the child can develop obstructive sleep apnea (OSA) and its complications. Cardiovascular impairment including cor pulmonale and right heart failure are the possible life-threating complications in OSA. In this case report we want to present a child with cor pulmonale secondary to adenotonsillar hypertrophy which was successfully treated with surgial removal.

Renal Cell Carcinoma, the most common malignant tumor of the kidney, is the third most common infraclavicular neoplasm which metastase to head and neck. While the tyroid gland is the most common site for Renal Cell Carcinoma metastasis in this region, metastasis to the lower lip is extremely rare. In this study a case of lower lip metastasis from clear cell renal cell carcinoma in a 72 year old woman will be presented, and the differential diagnosis and treatment modalities will be discussed. As a result renal cell carcinoma must always be kept in mind in the differential diagnosis of any clear cell neoplasm of the head and neck region.

Blood-brain barrier, the passage of water-soluble substances from the blood to the CNS is limited by tight junctions which are found between cerebral capillary endothelial cells, limiting penetration of the cerebral parenchyma, as well as between choroid plexus epithelial cells. A number of specialized mediated transport systems allow transmission of, among other things, glucose and certain amino acids. In this study, we examined the anatomy, physiology, and physiopathology of the blood-brain barrier in the light of current literature.