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Mitral yetersizliðinin (MY) Doppler ekokardiografi ile derecelendirilmesinde çeþitli kantitatif metodlar önerilmiþtir. In vitro þartlarda yeni bir metod olan proksimal eþ hýzlý hemisferlerin yüzey alaný (PISA) kullanýlarak akým hýzýnýn doðrulukla ölçülebildiði gösterilmiþtir. Ayný prensibin renkli Doppler ekokardiografi ile klinikte de kullanýlarak, belirli bir kan haciminin akým hýzýnýn (cm3/sn)=PISA (cm2) x aliasing hýzý (cm/cn) formülü ile hesaplanabileceði düþünülmüþtür. MY olan çocuklarda bu metodun klinik kullanýmýný belirleyen ilk çalýþma olmasý nedeni ile bu araþtýrma yapýlmýþtýr. Yaþlarý sekiz ay ile 12 yýl arasýnda (ortalama: 3.1 yýl) olan 37 hasta çalýþmaya dahil edilmiþtir. PISA-Doppler ölçümleri ile kateterizasyon sonuçlarý arasýnda anlamlý bir iliþki saptanmýþtýr (r=0.93, p<0.0001). My jet alanýnýn sol atrium alanýna orantýsý anjiografik derecelendirme ile karþýlaþtýrýldýðýnda yine anlamlý bir iliþki bulunmuþtur (r=0.92, p<0.0001). Ancak, anjiografi ile karþýlaþtýrýldýðýnda PISA metodu ile elde edilen sonuçlarýn jet alaný orantýsýna kýyasla daha iyi bir korrelasyon gösterdiði saptanmýþtýr. Sonuç olarak, mitral kapak yetersizliðinin noninvaziv kantitatif derecelendirilmesinde PISA metodu ile elde edilen sonuçlarýn hastalarýn takibinde kullanýmýnýn güvenilir olduðu kanaatine varýlmýþtýr.

Several methods have been proposed for ultrasonic quantification of mitral regurgitation. A new method, Doppler color-flow mapping of a proximal isovelocity surface area (PISA) from a red-blue aliasing radius has been shown in vitro to be accurate for estimating volume flow rates . Volume flow rate (cm3/sec) can be calculated as PISA (cm2) x aliasing velocity (cm/sec). Thirtyseven patients aged from eight months to 12 years (mean: 3.1 years) were included in this study. There was a significant correlation between PISA-Doppler and catheterization results (r=0.93, p<0.0001). The ratio of Doppler color regurgitant jet area to left atrial area correlated well with the angiographic grading of mitral regurgitation (r=0.92, p<0.0001). In our opinion, the correlation between PISA and angiography was superior to area %and angiography. In conclusion, calculating mitral regurgitant flow rate from PISA provides excellent agreement with angiography and may be useful clinically in estimating the severity of valvular regurgitation.

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Bu çalýþma minimal mitral yetmezlik (MY) haricinde saðlýklý kalbi olan kiþilerde renkli Doppler ekokardiyografik parametrelerin deðerlendirilmesi için yapýlmýþtýr. Çalýþma vakalarý, 5 aylýk bir periyodda, hasta þikayeti ve fizik muayene sonucunda ekokardiyografi yapýlan 2500 genç erkek vakadan seçildi. Sol ventrikülografi yapýlan vakalar, anjiyografik MY varlýðýnda grup-1 (n=30), yokluðunda grup-2 (n=30) olarak sýnýflandýrýldý. Grup-1'deki hastalar "gerçek MY", grup-2'deki vakalar ise "fizyolojik" olarak adlandýrýldý. Fizyolojik ve gerçek mitral yetmezliðinin Doppler ekokardiyografik deðiþkenleri birbiri ile karþýlaþtýrýldý. Aþaðýdaki ekokardiyografik deðiþkenler grup-1 ve grup-2 arasýnda farklý saptandý. 1) parasternal uzun eksende maksimum MY süresi/ortalama sistol süresi (sýrasýyla 0.710±0.244 ve 0.430±0.268, p<0.001), 2) apikal 4 odada maksimum MY süresi/ortalama sistol süresi (sýrasýyla 0.550±0.361 ve 0.317±0.272, p=0.007) 3) parasternal uzun eksende rejürjitan akým pik hýzý (sýrasýyla 180±77 ve 120±69 cm/sn, p=0.003), 4) parasternal uzun eksende regürjitan jet alaný (sýrasýyla 0.813±0.561 ve 0.411±431, p=0.007). Parasternal uzun eksende maksimum MY süresi/ortalama sistol süresi ?0.6, rejürjitan jet alaný ?0.4 cm2 ve regürjitan akým pik velosite jet alaný ?130 cm/sn olmasýnýn gerçek MY için prediktif deðeri sýrasý ile % 76, % 67 ve % 63 saptanmýþtýr.

This study is designed to assess color Doppler echocardiographic parameters in subjects with minimal mitral regurgitation (MR) in otherwise normal heart. Study cases have been selected during a five-month period among 2500 young male with an echocardiographic indication on the basis of subjects' complaints and upon physical examination. Left ventriculography was performed and subjects were dichotomized into group-I (n=30) if there was angiographically MR, and into group-2 (n=30) if they are intact. Patients in group- 1 were described as to have "true MR" and MR flow in group-2 was named "physiological". Doppler echocardiographic variables of true and physiological MR are compared to each other. The following echocardiographic variables were significantly different between group-1 and group-2: 1) the ratio of the max. duration of MR/mean systolic interval in parasternal long axis (0.7 10±0.244 vs 0.430±0.268, respectively, p<0.0001), 2) the ratio of the maximum duration of MR/mean systolic interval in apical four chamber view (0.550±0.361 vs 0.317±0.272 respectively, p=0.007), 3) the peak velocity of the regurgitant flow in parasternal long axis (180±77 vs 120±69 cm/sec., respectively, p=0.003), 4) the regurgitant jet area in parasternal long axis (0.813±0.651 vs 0.411±0.431 cm2, respectively, p=0.007). The maximal duration of MR/mean systolic time interval ?0.6, regurgitant jet area ?0.4cm2 , and regurgitant peak velocity ?130 cm/sec. in parasternal long axis dichotomize the cases into true MR with a predictive value of 76%, 67%, and 63%, respectively.

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Ocak 1980, Ocak 1996 tarihleri arasýnda 620 mültivalvüler kalp hastasýna çeþitli tiplerde triküspid kapak giriþimi uygulandý (De Vega annüloplasti: 483, Kay annüloplasti: 8. Duran ringi implantasyonu: 15, Puig-Massana ringi: 18). Bunlarýn 96'sýna (% 15.5) 100 prostetik triküspid kapaðý (69 mekanik, 31 biyolojik) takýldý. Bu olgulara ayný zamanda 65-mitral, 21 aort kapaðý implante edildi. Kýrk üç hasta daha önce kapalý mitral komissürotomi (12), mitral kapak replasmaný (18), mitral ve aort kapak replasmaný (6), ventriküler septal defekt tamiri (2), atriyal septal defekt tamiri (2), Fallot tetralojisi tam düzeltme operasyonu (1) ve Ebstein anomalisi onarýmý (2) gibi cerrahi giriþimler geçirmiþlerdi. Ortalama yaþ 35±11 (14-56) yýldý ve olgularýn % 20'si erkekti. Tüm hastalarda önce bir annüloplastik teknik denendi. Fakat yeterli sonuç alýnmayan olgularda triküspid kapak replasmaný yapýldý. Konjenital olgular dýþýndaki hastalarda triküspid giriþimleri kardiopulmoner bypass (CPB) altýnda çalýþan kalpte gerçekleþtirildi. Preoperatif pulmoner arter basýncý (PAP): 54 ± 21, pulmoner kapiller basýnç (PCWP): 23±8, santral venöz basýnç (CVP): 16 ± 5 mmHg olarak ölçüldü. Olgularýn % 95'i atriyal fibrilasyondaydý. Erken mortalite % 26 oldu. Olgularýn % 84'ü 2 ay ile 121 ay arasýnda (ortalama 45 ± 22 ay) izlendi. Dört olgu triküspid kapak disfonksiyonu (tromboz: 2, biyolojik kapak dejenerasyonu: 1, paravalvüler kaçak: 1) nedeniyle tekrar ameliyat edildi. Ýzleme döneminde 6 olgu (% 8.5) kaybedildi. Oniki, 36 ve 48 aylýk yaþama oranlarý sýrasýyla % 66, % 52 ve % 30 olarak hesaplandý. Mediyan yaþam süresi 42 ay oldu. Hayatta kalanlarýn NYHA fonksiyonel kapasiteleri % 67 olguda klas I ve II düzeyindeydi. Sonuç olarak, tamiri baþarýlý olmayan triküspid kapaklarýn prostetik kapaklarla deðiþtirilmesi, yüksek erken mortaliteye raðmen orta vadede kabul edilebilir bir yaþam süresi saðlamaktadýr.

Between January 1980 and January 1996, 620 patients with valvular heart diseases underwent several types of tricuspid valve procedures (De Vega annuloplasty: 483, Kay annuloplasty: 8, implantation of Duran ring: 15, implantation of Puig-Massana ring: 18) associated valvular heart surgery. Of these cases 96 patients (15.5%) received 100 prosthetic tricuspid. valves (96 mechanical, 31 biologic). Sixty-five mitral, 21 aortic concomitant valve replacements were also made. Forty-three cases (45%) had previous heart surgery including closed mitral commissurotomy (12), mitral valve replacement ( 18), mitral and aortic valve replacement (6), repair of ventricular septal defect (VSD: 2), repair of atrial septal defect (ASD: 2), total correction of tetralogy of Fallot ( 1 ), and repair of Ebstein's anomaly (2). Mean age was 35 ± 1 1 years (range 14-56 years), and 20% of the patients were males. In all cases, an annuloplastic technique was first attempted for the tricuspid valve, but when this was not successful, valve replacement was performed. Nearly in all patients, except congenital cases such as repair of an ASD, VSD or Ebstein's anomaly, tricuspid procedures were accomplished under cardiopulmonary bypass with the beating heart, without aortic clamping. Preoperative hemodynamic measurements of the patients were as follows: PAP 54±21, PCWP 23±8, CVP 16±5 mmHg. Atrial fibrillation was present in 95% of the cases. Early (30 days or hospital) mortality was 26%. Eighty-four percent of cases were followed-up from two months to 121 months (mean 45±22 months). Four (4%) of the patients required reoperation for tricuspid valve dysfunction (thrombosis 2, degeneration of the bioprosthesis 1, paravalvular leakage 1). During the follow-up period there were six (8.5 %) Iate deaths. survival rates for 12, 36, and 48 months were 66%, 52%, and 30%, respectively, the median survival being 42 months. Sixty- seven percent of the survivors were in NYHA functional class I and II. We conclude that, in cases in which repairing is not possible nor successful, tricuspid valve replaccment should be performed , keeping in mind that the early mortality rate is high, however, the mid-term survival is barely in acceptable limits.

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Propafenon sodyum kanallarýný hýz baðýmlý bir þekilde bloke eden bir antriaritmik ajandýr. Bu çalýþma intravenöz propafenonun (2mg/kg) sað ventrikül aksiyon potansiyeli süresi (APD90), QRS süresi ve ventriküler efektif refrakter periyod (VERP)/APD90 oraný üzerine etkileri 10 saðlýklý birey üzerinde incelenmiþtir. Çalýþmada dört farklý "pace" hýzýnda (600, 500, 400, 300 ms) intravenöz propafenonun APD90 süresi üzerine önemli bir etkisi olmadýðý görüldü. Öte yandan, propafenon sonrasý QRS süresi % 22-24 oranýnda uzadý (p<0.05) "Pace" siklus uzunluðunu 600 ms'den 300 ms'yeye indirdiðimizde QRS süresinde % 6.4'lük bir uzama gözlendi. PRopafenon öncesi ile karþýlaþtýrýldýðýnda bu artýþ istatistiksel olarak önemli deðildi (p>0.05). VERP/APD90 oranýnda da propafenon sonrasý hafif bir artýþ oldu (0.83'e karþý 0.88, p>0.05). Fakat, bu oranda da propafenon sonrasý hýz baðýmlý deðiþiklik gözlenmedi (p>0.05). Sonuç olarak, intravenöz propafenon APD90 süresinde deðiþiklik yapmaz iken, QRS süresinde ve VERP/APD90 oranýnda hafif bir artýþa neden olmaktadýr. Ýlave olarak bu deðiþiklikler 100 atým/dakikanýn üzerindeki hýzlarda hýza baðýmlý herhangi birdeðiþiklik göstermemektedir.

Propafenone is an antiarrhythmic agent that blocks sodium channels in a frequency-dependent manner. In this study, frequency-dependent effects of intravenous propafenone on right ventricular action potential duration (APD90), QRS duration and ventricular effective refractory period (VERP)/APD90 ratio were investigated in 10 healthy subjects. Intravenous propafenone caused no significant difference in APD90 at 4 different pacing cycle lengths (600, 500, 400, 300 ms). On the other hand, a 22-24 % increase in QRS duration was seen after propafenone (p<0.05). Decreasing the pacing cycle length from 600 ms to 300 ms caused a 6.4% increase in QRS duration. Compared to baseline, this increase was not statistically significant (p>0.05). VERP/APD90 ratio increased by 4-13 % after propafenone but no frequency-dependent changes were evident in this ratio (p>0.05). In conclusion, intravenous propafenone caused no change in APD90 but led to an increase in QRS duration and VERP/APD90 ratio in 10 healthy subjects. Moreover, these changes were shown not to be frequency-dependent at the pacing cycle lengths used in this study.

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1993-1996 yýllarý arasýnda polikliniðimizde perikard hastalýðý tanýsý alan olgular etyoloji, taný ve tedavi yöntemleri yönünden geriye dönük olarak deðerlendirildi. Yirmi kýz, 27 erkek toplam 47 olgunun yaþlarý yedi gün ile 14 yaþ (ortalama 7.23±4.95 yaþ) arasýnda deðiþmekte idi. Etiyolojik faktörler deðerlendirildiðinde 12 olguda pürülan perikardit, altý olguda üremik perikardit, iki olguda tüberküloz perikarditi, dört olguda malignansiye baðlý perikardit, beþ olguda kollagen doku hastalýðý, dört olguda kalp yetersizliði, iki olguda romatizmal ateþ, iki olguda hipoti.þþroidi bir yenidoðanda Down sendromu, bir olguda post-perikardiyotomi sendromu, saptandý, altý olguda viral perikardit olduðu düþünüldü, iki olguda neden bulunamadý. Taný ve/veya tedavi amacýyla 27 olguya, 31 kez perikardiyosentez yapýldý ve bunlardan 12 olguya perikardiyosentez sonrasý cerrahi girþim (tüp drenajý, perikardiyektomi veya perikardiyoplevral pencere), dört olguya perikardiyosentez ypýlmaksýzýn cerrahi giriþim uygulandý. Ayrýca üç olguya perkütan perikardiyal kateter drenajý, bunlardan birine intraperikardiyal ilaç uygulamasý yapýldý. Pürülan perikarditli olgulardan dördü, üremik perikarditlilerden biri cerrahi sonrasý olmak üzere ikisi, akut lenfositik lösemisi olan bir olgu, kalp yetersizlikli olgulardan biri ve viral perikardit olduðu düþünülen bir yenidoðan, toplam dokuz hasta eksitus oldu. Bu olgulardan pürülan perikarditliler dýþýnda diðerlerinde eksitus nedeni primer hastalýklarý idi. Sonuç olarak, bölgemizde en sýk perikardit nedeninin, pürülan perkardit olduðu, hastalarýn merkezimize geç ulaþmalarýndan dolayý mortalitenin halen yüksek olduðu (% 33) saptandý. Genel olarak perikard hastalýklarýnda tedavi yaklaþýmýnýn etiyolojik faktörlere ve hastanýn klinik durumuna göre farklýlýk göstermesi nedeniyle izlemde tek birprotokolün uygulanamayacaðý, ayrýca uygun olgularda perkütan perikardiyal kateter drenajýnýn cerrahi drenaja alternatif bir yöntem olduðu sonucuna varýldý.

Etiology, diagnose and management of patients with pericardial disease who were diagnosed at the Çukurova University, Department of Pediatric Cardiology, between 1993- 1996 were evaluated retrospectively. There were 27 male and 20 female cases ages ranged from seven days and 14 years (mean 7.23 ± 4.95 years). Etiologies of the disease were purulent pericarditis in 12 cases, uremic pericarditis in six, collagen tissue disorders in five, malignancy in four cases, rheumatic fever and hpothyroidism in two each, Down syndrome and post-pericardiotomy syndrome in one each. In six patients, pericardial effusion considered as due to viral pericarditis. Etiologic factor was not diagnosed in two cases. Diagnostic and/or therapeutic pericardiocentesis was performed 31 times to 27 cases. Twelve of these cases were needed surgical intervention after pericardiocentesis (tube drainage, partial pericardiectomy or pericardio-plevral window). Four patients were undergone surgical intervention directly. Percutaneous pericardial catheter drainage was performed at the time of pericardiocentesis in three cases, and intrapericardial drug administration was performed by this way in one case. Nine patients were died; four of them had purulent pericarditis, two had uremic, one had malign pericardial effusion, one had heart failure and one had viral pericarditis. It is concluded that purulent pericarditis is the most common etiologic reason of pericarditis in region and mortality rate is very high (% 33) because the patients admitted to hospital late. Therapeutic approach is changing usually due to etilogy of disease and clinical status of the patient so any steady protocol could not be established in patients with pericardial diseases. Percutaneous pericardial catheter drainage is an alternative method to surgery in suitable cases.

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Týp alanýnda Türkiye'den kaynaklanan uluslararasý yayýnlarýn gidiþini deðerlendirmek amacýyla, Science Citation Index'in taradýðý dergilerdeki Türkiye adresi tüm yayýnlar gözden geçirildi. 1995 ve 1996 yýllarýný kapsayan SCI CD-ROM'larýnda bulunan ve hekimliði ilgilendiren tüm kaynaklar ayýklandý. Ortak yayýnlar için bir kredi sistemi uygulandý. Anýlan iki yýlda sýrasýyle 1019 ve 1282 toplam yayýn ile 471 ve 756 tam metinli makale mevcuttu. Bu artýþlar yaklaþýk iki yýlda ikiye katýlmamak gibi müthiþ hýzlý bir tempo ifade etmekte olup 1988'den beri devam eden hamlenin sürdüðünü göstermektedir. Týp yayýnlarýnda dünyadaki payýmýz binde 4.3'e ulaþmýþtýr. Geliþmenin saðlýklý olduðunu düþündüren gözlemler þunlardý: toplantý özeti ya da editöre mektup gibi kalemlere kýyasla, makalelerde artýþýn daha fazla olmasý, temel bilimlerde ve kilinik bilimlerinde her alanda geçerliliði, Ýzmir'de ve Anadolu'nun taþra kentlerinde yerleþik birçok fakülte ile üniversite-dýþý kuruluþlarýn paylarýnýn yükseliþi, Köklü 4 týp fakültesi gerçi ilk 4 sýrayý yine iþgal ettiyse de, toplam paylarý yüzde 40'ýn altýna indi. Kardiyovasküler týp alanýnda da bu iki yýlda toplam 70 makalenin yayýna girmesiyle sýçrama gözlenmiþ ve dünyadaki payýmýz binde 3-4'e yükselmiþtir.

With the purpose of assessing the progress of the output of medical publications originating from Turkey, these were identified from the Science Citation Index compact disks SCI CD-ROM 1995 and 1996. A weighted credit system was utilized for items published jointly with a foreign or a nonmedical Turkish institution. A total of 1019 and 1260 publications were traced in the two years, respectively, which comprised 471 and 756 articles, reviews and editorials. These increases corresponded to a very fast growth of roughly doubling within two years, a trend which had emerged since 1988 and which led to a rise to 4.3 per mille of Turkey's share of world medical publication output. Following observations bolstered the nature of the progress: a stronger rise in the number of full-texed articles, extension of similar progress to medical basic sciences, rise of share of institutions in Izmir and smaller cities in Anatolia as well as of non-university hospitals. A total of 70 articles had been published in the field of cardiovascular medicine in 1995 and '96, a prominent surge which represented a world share of 3-4 per mille.

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Bazalde duvar hareket bozukluðu olmayan hastalarda koroner arter hastalýðýnýn non-invaziv tanýsýnda, dobutamin stres ekokardiyografi ve egzersiz stres testinin deðerini karþýlaþtýrmak amacýyla, koroner arter hastalýðý þüpheli olan 90 hastaya (74 erkek, 16 kadýn) prospektif olarak egzersiz stres testi, dobutamin stres ekokardiyografi ve koroner anjiyografi yapýldý. Dobutamin stres ekokardiyografinin duyarlýlýðý ve tanýsal doðruluðu egzersiz stres testinden daha yüksek bulundu (sýrasýyla % 91'e karþýlýk % 66, p<0.05; % 88'e karþýlýk % 69, p;<0.05). Bu durum, dobutamin stres ekokardiyografinin tek damar ve iki damar hastalýðýndaki yüksek duyarlýlýk göstermesine baðlýydý (Sýrasýyla % 85'e karþýlýk % 54, p<0.05; % 90'a karþýlýk % 55, p<0.05). Üç damar hastalýðýnda her iki teknik ayný sonucu verdi (% 100 ve % 100). Her iki testin özgüllükleri arasýnda istatistiki açýdan bir fark bulunamadý (% 85'e karþýlýk % 72, p>0.05). Ekokardiyografik uyum deðerlendirildiðinde duvar hareket bozukluðu meydana gelen segmentle anjiyografik olarak lezyon tesbit edilen damar arasýnda uyum vardý. Sonuç olarak; bazalde duvar hareket bozukluðu olmayan hastalarda, dobutamin stres ekokardiyografi koroner arter hastalýðýnýn tespit edilmesinde hayli yüksek duyarlýlýk ve özgüllüðe sahip, güvenilir bir metoddur.

Exercise stress testing, dobutamine stress echocardiography and coronary angiography were performed in 90 patients (74 males, 16 females) with suspected coronary artery disease to compare the value of dobutamine stress echocardiography and exercise stress testing for non-invasive diagnosis of coronary artery disease in patients who do not have basal wall motion abnormality. The sensitivity and the diagnostic accuracy of dobutamine stress echocardiography were higher than that of exercise stress test (91 % and 66 %, p<0.05; 88 % and 69 %, p<0,05; respectively). This was due to the high sensitivity of dobutamine stress echocardiography in single and two-vessel coronary artery disease (85% and 54%, p<0,05; 90 % and 55 %, p<0.05; respectively). Both proved sensitive in all patients with vessel disease The difference between the spectificities dobutamine stress echocardiography (85 %) and exercise stress testing (72 %) was not statistically significant. There was concordance between the segment which showed wall motion abnormality and the stenotic vessel identified by angiography. In conclusion, dobutamine stress echocardiography is a reliable method with a high sensitivity and specificity in the diagnosis of coronary heart disease.

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Birçok enfeksiyonun tedavisinde etkili olan penisilin ayný zamanda ucuzluðu açýsýndan da tercih edilen bir antibiyotiktir. Ülkemiz için hala önemli bir saðlýk problemi olan romatizmal ateþin primer ve sekonder profilaksisinde en etkin ilaçtýr. Ýstenmiyen etkileri ise penisiline karþý geliþen allerjik reaksiyonlarýdýr. Bunlar erken, hýzlanmýþ ve geç tipte aþýrý duyarlýlýk reaksiyonlarý olmak üzere üç tiptir. Erken aþýrý duyarlýlýk reaksiyonlarý içinde en korkulaný anaflaksidir. Ýlaç alýmýný takiben bir iki dakikada, en geç bir saat içinde ortaya çýkan anafilaksi, çok nadir görülmekle birlikte ölüme neden olabilir. Anafilaksi korkusuyla özellikle penisilin injeksiyonlarý çoðu hekim ve hasta tarafýndan çekingenlikle kullanýlmaktadýr. Medyaya yanlýþ biçimde yansýyan olaylar çekingenliði daha da artýrmaktadýr. Bu nedenle bu derlemede penisilin anaflaksisi sýklýðý, sebebi, klinik bulgularý, ayýrýcý tanýya giren diðer durumlar ve anaflaksiden korunmak için alýnmasý gerekli önlemler hakkýnda literatür bilgileri gözden geçirilecektir.

Prenicillin, when its allergic reactions are excluded, has no side effects. It is mostly used for the treatment of many infections and is the most inexpensive antibiotic. However, penicillin allergy is a significant medical problem. Many kinds of allergic reactions can be evoked by penicillin. Immediate reactions occur within two to twenty minutes after penicillin aclministration and can be manifested by diffuse urticaria, hypotension and shock. When the reaction is severe and life-treatening, it is then termed anaphylaxis. Accelerated reactions usually begin between one to seventy-two hours after penicillin administration and are generally manifested by urticaria. Late reactions begin more than three days after penicillin therapy has begun. Late reactions include various types of skin rashes, drug fever, hemolytic anemia, serum sickness-like reactions, renal manifestations and pulmonary manifestations. Among these allergic reactions the most severe problem is anaphylaxis, with its significant morbidity and mortality. Because of fear of anaphylaxis, penicillin injections are administered with some reluctance. In this article cause of the anaphylactic reactions, incidence, clinical course and detection of the allergic patients will be reviewed.

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Internet tüm dünya üzerine yayýlmýþ bilgisayar aðlarýnýn birleþiminden oluþan geniþ bir bilgisayar aðýdýr. Internet üzerinde yüzbinlerce bilgisayar yazýlýmý ve aklýmýza gelebilecek her türlü bilginin bulunabileceði kaynaklar vardýr. Ayrýca dünyanýn hangi köþesinde olursa olsun herhangi bir bilgisayar sistemine mesaj gönderebilir veya herhangi bir sistemden mesaj alabilirsiniz. Pek çok meslek dalýnda olduðu gibi týp alanýnda da Internet'ten elde edilebilecek bilgi miktarý ve Internet'teki adreslerden yararlanan doktor sayýsý gün geçtikçe artmaktadýr. Bu yazýda kardiyoloji ile ilgili bazý sayfalarýnýn Internet'teki adresleri verilmeye çalýþýlarak içeriklerine kýsaca deðinilmeye çalýþýlmýþtýr.

Internet is a huge network composed of world-wide distributed computer networks. Numerous software and any kind of knowledge can be transmitted through Internet. One is able to send to and get messages from any kind of computer system in the world via Intemet. Internet is an important knowledge source for many people and institutions. As in other professions, medical knowledge which can be obtained through Internet is getting increased everyday. Not only the amount of knowledge obtained through Internet, but also the number of health care professionals using the Internet rises steeply. In this article we aimed to provide prominent addresses of Web sites related to cardiology and some information about these Web sites.

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Kronik progressif eksternal oftalmoplejisi, retinanýn pigmenter degenerasyonu ve tip I diabeti bulunan Kearns-Sayre sendromu tanýsý almýþ 14 yaþýndaki erkek hasta kardiyak patolojisi nedeni ile yatýrýlmýþtýr. Kliniðimizde atrio-ventriküler tam blok tesbit edilen hastaya profilaktik olarak kalýcý pacemaker uygulanmýþ ve nadir bir mitokondrial miyopati olmasý nedeni ile literatür bilgileri gözden geçirilerek sunulmuþtur.

A 14-year-old male patient diagnosed as Kearns-Sayre syndrome with chronic progressive external ophtalmoplegia, primary retinal degeneration and type I diabetes mellitus was hospitalized because of cardiac involvement. Having atrio-ventricular complete block permenant pacemaker was prophylactically, since the patient showed a rare mitochondrial myopathy, the case is presented and literatüre is reviewed.

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