For the early diagnosis of breast cancer the selection of the proper radiological imaging modality is very crucial. Color Doppler ultrasonography(CDUS) is a non- invasive and easily applicable modality which can detect tumor neovascularization. We aimed to explore the contribution of CDUS to the other modalities for the diagnosis of breast lesions. MATERIAL AND METHOD 71 patients having solid breast masses were evaluated by ultrasonography (US), CDUS, and mammography. Also, spectral datas were examined and maximum peak systolic velocities, minimum end diastolic velocities, resistivity index(RI) values were measured and the presence of venous flows were noted. For the control values same measurements were obtained from locations other than the mass area. Histopathological diagnosis was achieved by fine needle, incisional or excisional biopsies. 49 masses were found to be malignant, 22 masses were benign. FINDINGS Eight of the benign lesions had venous flow pattern, others had arterial vascularity. 2 of the lesions with arterial flow pattern had central, 12 had peripheral vascularization. All had RI values less than 0.70. 2 of the 49 malignant masses had venous vascularization. 22 of the 47 masses with arterial flow had central vascularity. 8 of the malignant masses had RI values below 0.70, 39 malignant lesions had RI values greater than 0.70. Venous vascularization was found to be statistically significant, as a critera for benignity (p<0.05). Also, a statistically significant correlation was found between histopathological diagnosis and central-peripheral vascularity patterns (p<0.05). In addition, higher RI values were found to be a significant criteria for malignancy (p<0.05). CONCLUSION When the modalities US, CDUS, and mammography are used together, the sensitivity for the diagnosis of breast masses was 98%, the specificity was 86%. Positive predictive value was 94% and correction rate was 94%. It was concluded that CDUS is a complementary modality for the differentiation of malignant and benign breast masses.

Purpose: This prospective, randomized, double-blind, controlled study was designed to investigate the effects of tramadol on the bispectral index (BIS) during anesthesia with sevoflurane and N2O. Methods: 60 ASA class 1 and 2 patients, scheduled for elective lumbar microdiscectomy operation under general anesthesia, were included in this study. None of the patients were premedicated; anesthesia was induced with thiopental 5 mg.kg-1 and rocuronium 0,6 mg.kg-1, and maintained with 40% N2O-O2 mixture and sevoflurane. At induction of anesthesia, subjects were randomly allocated into 2 groups to receive either saline (control group), or tramadol 2 mg kg-1 (T group) intravenously. Hemodynamic data and BIS values were then recorded until the completion of the operation, during which time the concentrations of sevoflurane were not modified. Results: The BIS values were significantly different between groups throughout the operation. No significant changes in the hemodynamics were noted, except mean arterial blood pressure in the T group which was significantly high in the first 5 minutes of entubation. Conclusıons: There were no patients that has BİS values more than 60 or who presented explicit recall of events under anesthesia. Tramadol didn’t seem to cause a problem with respect to depth of anesthesia and can be safely administered perioperatively.

Purpose:Ultrasound is usually the first line of imaging in hepatobiliary disease for its widespread availability and due to advantages such as lack of radiation exposure and IV contrast administration. In this study we attempted to assess the success rate of US examination when the cystic duct is examined in a different position in addition to routine supine position. Materials and Method:79 patients referred to our department between January 2009 and May 2009 (23 male, 56 female, with a mean age of 47) were included in this study. After routine assessment of upper abdominal US examination, evaluation was maintained on left lateral position. In this position, neck of the gallbladder and the continuity of the cystic duct was focused and evaluated through the lateral and/or posterolateral intercostal windows. Approximately 5 minutes additional time was needed just for sonographic evaluation of the cystic duct. Especially during sonography in left lateral position, repeated examinations were performed in deep expiration and following deep inspiration for the possibility of improved cystic duct visualization. Results:In 7 cases, non-complicated biliary stones and sludge were noted. Except seven cases out of 79 cases (5 cases with duodenal gas superposition and 2 cases had excessive folding anatomy of duct), the cystic duct was adequately visualized implementing the posterior view in the remaining 72 patients. Conclusıon:The cystic duct must be examined in our new position during hepatobiliary ultrasonograpy. Especially in terms of increasing the likelihood diagnosing the pathologies such as micro- calculi, crystals and ductal wall-thickening, all the findings should be added to the conventional report accordingly.

The treatment of SIADH, consists of fluid restriction, salt or salt plus a loop diuretic administration, which may be poorly complied by the patients. In this case we report successfull management of a patient with rezistant(resistant) hyponatremia due to cranial meningioma with oral vasopressin receptor antagonist (Tolvaptan) therapy.

Undifferentiated embryonal sarcoma (UES) of the liver is a very rare and highly malignant entity. UES has no specific clinical or laboratory features. At computed tomography images , the tumour typically appears as a large, predominantly cystic mass with well defined borders. This cystic appearance of UES can be cause a misdiagnosis with hydatid cyst very easily due to rarity of UES and more common seen hydatic cyst especially in endemic areas. We present a eight year old male case with cystic mass in liver, which was misdiagnosed and treated as hydatic cyst. Percutaneous sample was obtained .Cytological examination did not confirm the hydatid cyst. Because of progressive respiratory deterioration, urgent abdominal operation was performed. Gross haemorrhagic cystic lesion was discovered and evacuated. Pathological examination revealed UES. Because of pure cystic appearance of UEA in liver can be suggestive of benign similar pathologies , and cause delaying or misdiagnosis in such hydatic areas. Undifferentiated embryonal sarcoma (UES) of the liver is a very rare entity that was first described by Stocker and Ishak in 1978 (1,2). This rare neoplasm accounts for approximately 9% to 13% of all hepatic tumours in children (2). UES has no specific clinical or laboratory features, and fewer than 60 cases of paediatric UES have been reported in the literature (1). This cystic appearance of UES can cause the misdiagnosis of hydatid cyst very easily due to the rarity of UES, especially in endemic areas for hydatid cyst (3,4).