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Uzmanlaşma ve kompartımanlara ayrılma akademinin her alanında bütüncül bakıştan kopmayı beraberinde getirmektir. Bu kopuş, tıp eğitiminde ve hekimlik pratiğinde de ortaya çıkmış ve sonucunda hem hekim hem hasta için tıbbi uygulamalarda tatminsizliği ortaya çıkarmıştır. Bu tatminsizlik, tıbbi uygulamalarının sonuçlarını da etkileyebilecek bir parametre olarak dikkat çekmektedir.İnsan vücudunun ve zihninin bütüncül değerlendirilmesindeki eksikliğin tıp pratiğinde ortaya çıkardığı sorunlar hem tıbbi hem sosyal düzlemde değerlendirmeye tabi tutulmalıdır.Biz bu çalışmamızda, tıbbın bütüncül bakıştan kopmasının tarihsel sürecini ve buradaki eksiği gidermeye yönelik yeni yaklaşımları ortaya koyduk., Specialization and division into compartments brings to separation from the holistic view in all areas of the academy. This has also occured in medical education and medical practice, resulting in dissatisfaction in medical practice for both the physician and the patient. This dissatisfaction draws attention as a parameter that can affect the results of medical practices.The problems caused by the lack of a holistic evaluation of the human body and mind in the practice of medicine should be evaluated at both the medical and social level.In this study, we have revealed the historical process of the separation of medicine from the holistic view and new approaches to fill the deficiency here.

Objective: The aim of this study is to analyze cervical cerclage cases in our clinic retrospectively and to evaluate the complications asso- ciated with the procedure. Methods: The patients who undergone cervical cerclage opera- tion between April 2004 and December 2012 at Suleymaniye Training and Research Hospital were included in the study. The data of patients, complications of the procedure, week of gestation at delivery, delivery type and postnatal complications were ana- lyzed retrospectively. Results: Cervical cerclage suture was applied to 100 patients. While the rate of emergency cases was 8.0% (n=8), the rate of elective cases was 68% (n=68) and the rate of prophylactic cases was 24% (n=24). Mean week of gestation was 33.55±6.06. While 31% (n=31) of the deliveries were preterm, 69% (n=69) of them were term. Mean delivery week was 27.8±7.9 in emergency group, 33.9±5.8 in elective group and 34.2±5.1 in prophylactic group. The membranes were ruptured (PPROM) after cerclage in 10 (10%) patients. While preg- nancy was lost in nine patients at the early period after the rupture of membrane, pregnancy was lost in one patient after three weeks. One of these patients developed fever and chorioamnionitis. When the complications were analyzed, it was seen that the rate of compli- cations in emergency group was statistically and significantly higher than two other groups. (p=0.005 and p

There is a well-known association between human papilloma virus (HPV) and cervical neoplasia. The aim of this study was to investigate the types of HPV DNA and to compare the results with colposcopic findings among women with abnormal cytology.A series of 76 consecutive women attending the clinic with the usual referral indications (ASC-US or higher in Pap) were examined by the conventional diagnostic tools (PAP smear, colposcopy,punch biopsy) and subjected to HPV testing. For HPV genotyping, we used a commercially avaliable HPV DNA chip (Genomica-CLART) which is a PCR based microarray system.The HPV test detected 35types of HPV (HPV-6/-11/-16/-18/-26/-31/-33/-35/-39/-40/-42/-43/-44/-45/-51/-52/-53/-54/-56/-58/-59/-61/-62/-66/-70/-71/-72/-73/-81/-83/84/-85/-89).Overall, 44.7% of all patients were HPV positive. HPV was positive in 35%, 51.9%, 77.7% of the ASCUS, LSIL and HSIL groups respectively and HPV 16 was the most prevalent type in all groups. 6 %of patients had mutiple infections. 57.8% of biopsy proven SIL's were HPV positive. The most prevalent HPV type was HPV 16 (54.5%).Colposcopic assessment revealed pathologic findings in 94.7% of biopsy proven SIL cases.Although it has been reported that the prevalence of HPV in the general population is lower than Western countries, and the prevalence and distribution of genotypes are smilar in patients with abnormal cytology. Further population based studies are needed to determine the prevalance and type distribution of HPV with normal and abnormal cytology in Turkish women. Despite the new technological progress in HPV virion, colposcopy is still very important diagnostic tool in the management of abnormal smears.Human Papilloma Virus (HPV) ile servikal neoplaziler arasında iyi bilinen bir ilişki mevcuttur. Bu çalışmanın amacı anormal servikal sitolojili kadınlarda HPV DNA tiplerini araştırmak ve sonuçları kolposkopik bulgularla karşılaştırmaktır.Genel referans endikasyonlarıyla (ASCUS ve üstü smear sonucu) başvuran 76 kadın, sırasıyla geleneksel tanı araçlarıyla (PAP-smear, kolposkopi, punch biyopsi) değerlendirmeye alındı ve tüm hastalar HPV DNA testine tabi tutuldu. HPV DNA tiplemesi için piyasada bulunan PCR bazlı mikroaarray (Genomica-CLART) sistemi kulanıldı. HPV testi, 35 tipi belirleyebiliyordu. (HPV-6/-11/-16/-18/-26/-31/-33/-35/-39/-40/-42/-43/-44/-45/-51/-52/-53/-54/-56/-58/-59/-61/-62/-66/-70/-71/-72/-73/-81/-83/84/-85/-89).Tüm hastaların %44.7 sinde HPV pozitifliği saptandı. HPV pozitifliği yüzdeleri ASCUS; LSIL ve HSIL hastalarında sırasıyla %35, %51.9 ve %77.7 idi. HPV 16 en sık tip olarak bulundu. Hastaların %6 sında multipl infeksiyon tespit edildi. Biopsi ile ispatlanmış servikal neoplazi olgularının %57.8 inde HPV pozitifliği saptandı. En sık rastlanan tip HPV 16 (%54.5) olarak bulundu. Biyopsi ile ispatlanmış sevikal neoplazi vaklarının %94.7 sinde kolposkopi patolojik olarak değerlendirildi.Batı ülkelerine kıyasla HPV sıklığının ülkemizde daha düşük olduğu yayınlanmış veri olmakla birlikte, anormal sitolojili kadınlarda HPV sıklık ve dağılımı batı ülkeleriyle benzerlik göstermektedir. Anormal ve normal sitolojili Türk kadınlarındaki HPV sıklık ve dağılımının belirlenmesi için daha ileri ve popülasyon bazlı çalışmalara gereksinim vardır. HPV virüsünün tanımlanmasıyla ilgili teknolojik ilerlemelere rağmen kolposkopik değerlendirme anormal sitolojili kadınlarda hala çok önemli bir tanı aracıdır.

Objective: Cerebral venous thrombosis is a disease with high mortality. The incidence of the disease increases in pregnancy and puerperium. It may be associated with headache, convulsions, focal deficits, coma and death. Here, we report a case of puerperal cerebral venous thrombosis, presented by convulsions and successfully treated by heparinization despite the concomitant hemorrhagic infarct. Case: Twenty-eight-year-old patient was admitted to Obstetrics and Gynecology emergency service, Gaziantep Maternity Hospital with convulsions, following severe headache. The patient (G2P2) had a cesarean section 10 days ago with the diagnosis of 32 gestational weeks of monochorionic diamniotic twin pregnancy and fetal distress. Cerebral venous thrombosis was detected in transverse and sigmoid sinus with concomitant hemorrhagic infarct at the thalamic region. The patient was successfully treated by heparinization. Conclusion: Cerebral venous thrombosis should be bear in mind, because of pitfalls in the diagnosis, high incidence in the postpartum period and the importance of the differential diagnosis with eclampsia. The mortality is still high, despite the advances in diagnosis and treatment. We report this case, because of its rarity, presentation type and the treatment success.

Ad­dress­for­Cor­res­pon­den­ce/Ya­z›fl­ma­Ad­re­si:­Isil Uzun Cilingir Acibadem Bakirkoy Hospital, Obstetrics and Gynecology, Istanbul, Turkey E-mail: isiluzu@gmail.com Received/Gelifl­Tarihi:­03 Subat 2013­Ac­cep­ted/Ka­bul­Ta­ri­hi:­18 Mart 2013 The Medical Bulletin of Haseki Training and Research Hospital, published by Galenos Publishing. Haseki T›p Bulteni, Galenos Yay›nevi taraf›ndan bas›lm›flt›r. A Life-Threatening Uterine Inversion and Massive Post Partum Hemorrhage Caused by Uterine Atony in A Primigravida Uterine Inversion Primigravid Hastada Hayat› Tehdit Eden Uterin ‹nversiyon ve Uterin Atoniye Ba€l› Geliflen Postpartum Kanama DOI: 10.4274/Haseki.1016 Case Report / Olgu Sunumu