Bu uygulama Lady Montagu ile \u0130ngiltere\u2019ye ta\u015f\u0131nm\u0131\u015f ve y\u0131llarca uygulanm\u0131\u015f. 1796 y\u0131l\u0131nda Edward Jenner, ba\u015fka bir yol denemeye karar vermi\u015f. \u201cCowpox (\u00e7i\u00e7ek hastal\u0131\u011f\u0131n\u0131n ineklerdeki versiyonu) \u201d ile enfekte olmu\u015f bir sa\u011fman\u0131n elindeki irini al\u0131p 8 ya\u015f\u0131ndaki James Phipps\u2019in \u00e7izilmi\u015f koluna s\u00fcrm\u00fc\u015f. \u00c7ocu\u011fun ise 6 haftal\u0131k g\u00f6zleminin sonunda \u00e7i\u00e7ek hastal\u0131\u011f\u0131na yakalanmad\u0131\u011f\u0131n\u0131 g\u00f6rm\u00fc\u015f.<\/p>\n\n\n\n
Buraya dek anlatt\u0131\u011f\u0131m uygulamalar birinci ku\u015fak a\u015f\u0131lar olarak an\u0131l\u0131yor. \u0130kinci ku\u015fak a\u015f\u0131lar ise Louis Pasteur\u2019\u00fcn tavuk koleras\u0131 ve \u015farbon i\u00e7in a\u015f\u0131lar\u0131yla ba\u015fl\u0131yor. Tavuk koleras\u0131 i\u00e7in geli\u015ftirdi\u011fi a\u015f\u0131 ba\u015far\u0131s\u0131z olsa da \u015farbon a\u015f\u0131s\u0131 i\u015fe yar\u0131yor. Nas\u0131l m\u0131? Kamuya a\u00e7\u0131k bir alanda a\u015f\u0131lanm\u0131\u015f ve a\u015f\u0131lanmam\u0131\u015f koyunlar\u0131 bir araya koyan Pasteur, iki gruba da \u015farbonu enjekte ediyor ve t\u0131p b\u00fcy\u00fck bir ad\u0131m at\u0131yor: A\u015f\u0131lanan hayvanlar\u0131n hepsi ya\u015farken a\u015f\u0131lanmayan hayvanlar\u0131n t\u00fcm\u00fc \u00f6l\u00fcyor. Unutmadan \u015funu da ekleyelim: Pasteur ve Roux 1885 y\u0131l\u0131nda kuduz a\u015f\u0131s\u0131n\u0131 buluyor. Mant\u0131k yine ayn\u0131: Enfekte tav\u015fanlar\u0131n sinir dokusu \u00e7\u0131kar\u0131l\u0131yor ve dokuya tutunmu\u015f vir\u00fcs\u00fcn zay\u0131flamas\u0131 i\u00e7in 5-10 g\u00fcn kurumaya b\u0131rak\u0131l\u0131yor. Sonra da zay\u0131flam\u0131\u015f vir\u00fcs, v\u00fccuda veriliyor.<\/p>\n\n\n\n
\u00d6b\u00fcr hastal\u0131klar\u0131n a\u015f\u0131s\u0131 m\u0131? Gerisi \u00e7orap s\u00f6k\u00fc\u011f\u00fc gibi geliyor: 1896\u2019da tif\u00fcs ve kolera, 1897\u2019de veba (Y. pestis kaynakl\u0131), 1923\u2019te difteri, 1926\u2019da tetanoz, 1927\u2019de t\u00fcberk\u00fcloz, 1935\u2019te sar\u0131 humma, 1936\u2019da grip, 1955\u2019te polio, 1963\u2019te k\u0131zam\u0131k, 1967\u2019de kabakulak ve 1969\u2019da k\u0131zam\u0131k\u00e7\u0131k a\u015f\u0131s\u0131.<\/p>\n\n\n\n
Size k\u0131saca tarihini anlatt\u0131m. Anlatt\u0131klar\u0131m\u0131n i\u00e7erisinde daha \u00e7a\u011fda\u015f teknolojiyle \u00fcretilmi\u015f mRNA a\u015f\u0131lar\u0131 (tan\u0131d\u0131k geldi mi?) gibi a\u015f\u0131lar yoktu \u00e7\u00fcnk\u00fc de\u011finmek istedi\u011fim ba\u015fka bir konu var. 21. y\u00fczy\u0131l\u0131n bireyleri olan bizler i\u00e7in \u00e7i\u00e7ek, veba, polio, k\u0131zam\u0131k gibi s\u00f6zc\u00fckler anlaml\u0131 de\u011fil. Niye? Biz bu hastal\u0131klar\u0131 g\u00f6rmedik de ondan. Bu hastal\u0131klar\u0131 g\u00f6rmedi\u011fimizden a\u015f\u0131lar \u00e7ok da etkili de\u011filmi\u015f gibi geliyor. \u00c7\u00fcnk\u00fc hi\u00e7birimizin v\u00fccudunda a\u011fr\u0131l\u0131 kabarc\u0131klar ve d\u00f6k\u00fcnt\u00fcler olmad\u0131, bir anda hi\u00e7birimizin baca\u011f\u0131 fel\u00e7 olmad\u0131, hi\u00e7birimiz 40o<\/sup> ate\u015fle k\u0131vranmad\u0131k. A\u015f\u0131lar olmasayd\u0131 biz de b\u00f6yle olacakt\u0131k.<\/p>\n\n\n\n 12. y\u00fczy\u0131lda Eski\u015fehir\u2019de, Anadolu Sel\u00e7uklu Devleti\u2019nde ya\u015fayan birisiniz diyelim. \u201cBu \u00e7i\u00e7ek hastal\u0131\u011f\u0131 nereden \u00e7\u0131k\u0131yor?\u201d diye \u015fehre giren \u00e7\u0131kan herkese soracak olsayd\u0131n\u0131z bu musibetin i\u015fledikleri g\u00fcnahlardan, Tanr\u0131 \u00f6yle istedi\u011finden dolay\u0131 oldu\u011funu s\u00f6ylerlerdi \u00e7\u00fcnk\u00fc bu hastal\u0131klar\u0131n ba\u015fka bir a\u00e7\u0131klamas\u0131 yoktu. D\u00fcn sapasa\u011flam olan adam, 2 g\u00fcn sonra ate\u015fler i\u00e7inde k\u0131vran\u0131yordu. Neden? Bilinmiyordu. Bilgisizlik de gittik\u00e7e yukar\u0131da sayd\u0131\u011f\u0131m\u0131z inan\u00e7lara kay\u0131nca ger\u00e7ek neden aray\u0131\u015f\u0131 b\u0131\u00e7ak gibi kesildi.<\/p>\n\n\n\n Yaln\u0131z Eski\u015fehir de\u011fil, t\u00fcm d\u00fcnya b\u00f6yleydi. Okumu\u015f etmi\u015f, hekim olmu\u015flar ise \u201cmiyazma teorisini\u201d, yani \u201ck\u00f6t\u00fc havan\u0131n solunmas\u0131yla\u201d bula\u015f\u0131c\u0131 hastal\u0131klar\u0131n ortaya \u00e7\u0131kt\u0131\u011f\u0131n\u0131 savunuyordu. Bozulmu\u015f suyun, \u00e7\u00fcr\u00fcm\u00fc\u015f yiyeceklerin, pis havan\u0131n, kirli ortamlar\u0131n hastal\u0131klara neden oldu\u011funu biliyoruz. Demek ki hepsinin ortak bir y\u00f6n\u00fc, hepsinden ortama yay\u0131lan bir \u201ck\u00f6t\u00fc hava\u201d olmal\u0131yd\u0131 ki hastal\u0131k bireyler aras\u0131nda yay\u0131ls\u0131n. \u0130\u015fte bu, 1800\u2019l\u00fc y\u0131llara de\u011fin bask\u0131n olan teoriydi. Sonra yerini mikrop teorisine b\u0131raksa da etkisini g\u00fcn\u00fcm\u00fcze dek s\u00fcrd\u00fcr\u00fcyor: \u201cG\u00fczel\u201d kokan \u015feylerin temiz oldu\u011funu d\u00fc\u015f\u00fcn\u00fcyoruz.<\/p>\n\n\n\n Ancak miyazma teorisi tek g\u00f6r\u00fc\u015f de\u011fildi. Galen, mikrop teorisinin ilkel formunu savunuyordu: Ona g\u00f6re salg\u0131nlar havadaki \u201csalg\u0131n tohumlar\u0131yla\u201d ta\u015f\u0131n\u0131yor ve hastalara ge\u00e7iyordu. Bu g\u00f6r\u00fc\u015f uzun bir s\u00fcre ya\u015fam\u0131n\u0131 s\u00fcrd\u00fcrd\u00fc.<\/p>\n\n\n\n 1670\u2019lerde Antonie van Leeuwenhoek, su damlalar\u0131n\u0131 mikroskop alt\u0131nda incelerken oradan oraya devinen \u201chayvanc\u0131klar\u201d g\u00f6rd\u00fc. Ancak tek g\u00f6ren o de\u011fildi. 1646\u2019da Athanasius Kircher, s\u00fct ve sirkeyi mikroskop alt\u0131nda incelerken \u201csay\u0131lamayacak denli \u00e7ok kurt\u00e7uk\u201d g\u00f6rd\u00fc\u011f\u00fcn\u00fc s\u00f6yl\u00fcyor, 1656 Roma h\u0131yarc\u0131kl\u0131 veba salg\u0131n\u0131nda \u00f6len hastalar\u0131n kan\u0131nda \u201chayvanc\u0131klara\u201d rastlad\u0131\u011f\u0131n\u0131 yaz\u0131yordu.<\/p>\n\n\n\n Mikroplarla hastal\u0131klar\u0131 birbiriyle ili\u015fkilendirip bunu a\u00e7\u0131klayan ise Louis Pasteur oldu. Bu deney i\u00e7in Pasteur \u00f6nce bir cam \u015fi\u015feyi besleyici agarla doldurup a\u011fz\u0131na havadaki partik\u00fcllerin ge\u00e7mesini engelleyecek bi\u00e7imde filtreli ve k\u0131vr\u0131ml\u0131 bir boru takt\u0131. \u015ei\u015feyi \u0131s\u0131t\u0131p bir s\u00fcre bekletti, \u00f6rne\u011fi inceledi\u011finde agarda bakteri yay\u0131l\u0131m\u0131 g\u00f6rmedi. \u0130kinci deneyinde \u00f6nce \u015fi\u015feyi \u0131s\u0131t\u0131p sonra cam \u015fi\u015fenin ucundaki boruyu \u00e7\u0131kard\u0131. Bakteriler agar\u0131n her yerini i\u015fgal etmi\u015flerdi. \u00dc\u00e7\u00fcnc\u00fc deneyde ise yine agarl\u0131 \u015fi\u015feyi \u0131s\u0131tt\u0131 ve boruyu \u015fi\u015fenin ucuna takt\u0131 ancak bu kez farkl\u0131 bir \u015fey denedi, \u015fi\u015feyi yan tuttu. B\u00f6ylece hava \u015fi\u015fenin i\u00e7ine hi\u00e7 giremeyecekti ancak filtre devre d\u0131\u015f\u0131 kalacakt\u0131. Beklenen oldu. Bakteriler yine \u00fcremi\u015fti. Demek ki patojen hava de\u011fildi, havan\u0131n i\u00e7indeki partik\u00fcller yani mikroplard\u0131. Bu deney asl\u0131nda spontan olu\u015fumu yanl\u0131\u015flamak i\u00e7in yap\u0131lm\u0131\u015ft\u0131 ancak mikrop ve bula\u015f\u0131c\u0131 hastal\u0131klar\u0131 birbirine kopmaz ba\u011flarla ba\u011flad\u0131.<\/p>\n\n\n\n Son olarak Robert Koch\u2019un post\u00fclatlar\u0131na geliyoruz:<\/p>\n\n\n\n Ancak, Koch ilk post\u00fclat\u0131 terk etti \u00e7\u00fcnk\u00fc kolera ve tif\u00fcs\u00fcn asemptomatik ta\u015f\u0131y\u0131c\u0131lar\u0131 vard\u0131. Sonradan bu hastal\u0131klara Polio, Herpes simplex, HIV, Hepatit C ve COVID-19 eklendi.<\/p>\n\n\n\n \u0130kinci post\u00fclat\u0131n da pabucu dama at\u0131ld\u0131: Baz\u0131 mikroorganizmalar k\u00fclt\u00fcrde \u00e7o\u011falt\u0131lam\u0131yordu. Vir\u00fcsler ke\u015ffedildi\u011finde ise anla\u015f\u0131ld\u0131 ki vir\u00fcsler konaks\u0131z \u00e7o\u011falamazd\u0131.<\/p>\n\n\n\n \u00dc\u00e7\u00fcnc\u00fc post\u00fclatta Koch zorunluluk yerine bir \u00f6ng\u00f6r\u00fcde bulundu: T\u00fcberk\u00fcloz ve kolerayla kar\u015f\u0131la\u015fan organizmalardan baz\u0131lar\u0131 enfekte olmuyordu \u00e7\u00fcnk\u00fc organizmalar birbiriyle ayn\u0131 de\u011fildi. Baz\u0131lar\u0131 \u00f6b\u00fcrlerine g\u00f6re daha g\u00fc\u00e7l\u00fcyd\u00fc, baz\u0131lar\u0131 da a\u015f\u0131l\u0131yd\u0131. B\u00f6ylece \u00fc\u00e7\u00fcnc\u00fc post\u00fclat da g\u00f6zden d\u00fc\u015fm\u00fc\u015f oldu.<\/p>\n\n\n\n D\u00f6rd\u00fcnc\u00fc post\u00fclat da t\u0131bb\u0131n tozlu sayfalar\u0131na g\u00f6m\u00fcld\u00fc: Baz\u0131 hastal\u0131klar\u0131n birden \u00e7ok nedeni var. \u00d6rne\u011fin tonsilit hem bakteriyel hem de viral enfeksiyondan kaynaklanabilir.<\/p>\n\n\n\n Yine uzun bir ge\u00e7mi\u015ften sonra \u015funu s\u00f6ylemeliyiz ki t\u0131pta en zor sorular, asl\u0131nda en genel sorular. \u201cHastal\u0131klar nas\u0131l bula\u015f\u0131r?\u201d sorusunu yan\u0131tlamak y\u00fczy\u0131llar\u0131m\u0131z\u0131 alsa da hastal\u0131klarla ilgili yan\u0131tlanmay\u0131 bekleyen tonla soru var. \u00d6rne\u011fin psikolojik \u201chastal\u0131klar\u201d bula\u015f\u0131c\u0131 m\u0131d\u0131r? E\u011fer bula\u015f\u0131c\u0131ysa bir a\u015f\u0131 geli\u015ftirilebilir mi? \u0130nan\u0131yorum ki bu sorular, beynin a\u015fa\u011f\u0131s\u0131nda kalan t\u00fcm organlar\u0131n ve sistemlerin sorunlar\u0131 \u00e7\u00f6z\u00fcld\u00fckten sonra t\u0131bb\u0131n g\u00fcndemi olacakt\u0131r.<\/p>\n\n\n\n Evet, el y\u0131kamak t\u0131p i\u00e7in bir d\u00f6n\u00fcm noktas\u0131d\u0131r \u00e7\u00fcnk\u00fc g\u00fcn i\u00e7erisinde hemen her i\u015fimizi ellerimizle yapar\u0131z. Dokundu\u011fumuz t\u00fcm y\u00fczeylerden elimize mikrop ge\u00e7er, bu mikroplar da bizden \u00f6b\u00fcrlerine ge\u00e7er. Elimizi fark\u0131nda olmadan y\u00fcz\u00fcm\u00fcze s\u00fcreriz, mikrop deriyle bula\u015fm\u0131yorsa bile do\u011frudan v\u00fccut i\u00e7erisine girer ve tebrikler! Art\u0131k bir ta\u015f\u0131y\u0131c\u0131s\u0131n\u0131z.<\/p>\n\n\n\n El y\u0131kaman\u0131n yararlar\u0131yla ilgili \u015fu kayna\u011f\u0131 \u00f6neriyorum: Show Me the Science – Why Wash Your Hands? | Handwashing | CDC<\/a>. Bug\u00fcn size anlatmak istedi\u011fim bu denli \u00f6nemli ve kolay bir eylem, nas\u0131l oldu da literat\u00fcre y\u00fczy\u0131llar sonra girdi?<\/p>\n\n\n\n Konumuz Dr. Med. Ignaz Philipp Semmelweis. Viyana Genel Hastanesi\u2019nin Kad\u0131n Hastal\u0131klar\u0131 ve Do\u011fum Klini\u011fine atand\u0131 ancak bu klinik, s\u0131radan bir klinik de\u011fil. O y\u0131llarda t\u00fcm Avrupa\u2019da maternite, yani anal\u0131k klinikleri vard\u0131. Bu kurumlar\u0131n amac\u0131 analar\u0131n \u00e7ocuklar\u0131n\u0131 \u00f6ld\u00fcrmelerini engellemekti. Tahmin edebilece\u011finiz \u00fczere sosyoekonomik d\u00fczeyi d\u00fc\u015f\u00fck olan kad\u0131nlara hitap eden bu klinikler, \u00fccretsizdi ancak bir ko\u015fulla: Kad\u0131nlar doktorlar\u0131n ve ebelerin e\u011fitimi i\u00e7in denek olmak zorundayd\u0131. \u0130\u015fte bunlardan ikisi de Viyana Hastanesi\u2019ndeydi. Ancak bu anal\u0131k klinikleri aras\u0131nda \u00e7ok b\u00fcy\u00fck bir fark vard\u0131: Birinci klinikte ana \u00f6l\u00fcmleri puerperal ate\u015ften dolay\u0131 %10 iken ikinci klinikte ana \u00f6l\u00fcmleri %4 dolay\u0131ndayd\u0131. Semmelweis bile kendi yaz\u0131lar\u0131nda kad\u0131nlar\u0131n birinci klini\u011fe gitmemek i\u00e7in yalvard\u0131\u011f\u0131ndan bahseder. Hatta bu birinci klini\u011fin ad\u0131 \u00f6ylesine k\u00f6t\u00fcye \u00e7\u0131km\u0131\u015ft\u0131 ki baz\u0131 kad\u0131nlar s\u0131rf birinci klini\u011fe gitmemek i\u00e7in \u201chastaneye giderken\u201d do\u011furup klini\u011fe yatmadan \u00e7ocuk bak\u0131m\u0131 yard\u0131mlar\u0131ndan yararlan\u0131yordu. Semmelweis\u2019\u0131n kafas\u0131 kar\u0131\u015fm\u0131\u015ft\u0131: Klinikte, i\u015fin uzman\u0131 doktor ve ebelerin g\u00f6zetiminde olmadan sokakta her t\u00fcrl\u00fc hastal\u0131\u011f\u0131n aras\u0131nda do\u011fum yapan kad\u0131nlar nas\u0131l puerperal ate\u015f ge\u00e7irmiyordu? Bu kad\u0131nlar\u0131 puerperal ate\u015ften ne koruyordu?<\/p>\n\n\n\n Puerperal ate\u015ften dolay\u0131 klinikler aras\u0131ndaki mortalite oran\u0131 Semmelweis\u2019\u0131 \u00e7ok rahats\u0131z ediyordu. \u0130ki klinik de hemen hemen ayn\u0131 teknikleri kullan\u0131yordu. \u00dcst\u00fcne ikinci klini\u011fe hep daha \u00e7ok hasta geliyordu, buna kar\u015f\u0131n ikinci klinikte \u00f6l\u00fcmler \u00e7ok daha azd\u0131. \u0130ki klini\u011fin iklimi birebir ayn\u0131yd\u0131. Semmelweis her fakt\u00f6r\u00fc elemeye ba\u015flad\u0131, hatta \u00e7al\u0131\u015fanlar\u0131n dinsel pratiklerini bile inceledi. Hi\u00e7biri bu fark\u0131 a\u00e7\u0131klam\u0131yordu. Bir fakt\u00f6r d\u0131\u015f\u0131nda: \u0130ki klini\u011fin \u00e7al\u0131\u015fanlar\u0131 birbirinden farkl\u0131yd\u0131. Birinci klinikte t\u0131p \u00f6\u011frencileri e\u011fitim al\u0131rken, ikinci klinik 1841\u2019de yaln\u0131zca ebelerin e\u011fitilmesi i\u00e7in se\u00e7ilmi\u015fti.<\/p>\n\n\n\n 1847 y\u0131l\u0131nda Semmelweis\u2019\u0131n yak\u0131n arkada\u015f\u0131 Jakob Kolle\u00e7ka, kadavra \u00fcst\u00fcnde ders anlat\u0131rken eli yanl\u0131\u015fl\u0131kla \u00f6\u011frencilerden birinin ne\u015fterine de\u011fdi. Ve Kolle\u00e7ka \u00f6ld\u00fc. Otopsisi, puerperal ate\u015ften \u00f6len kad\u0131nlar\u0131n patolojisine benzerdi. Semmelweis o anda kadavra kontaminasyonu ile puerperal ate\u015f aras\u0131nda bir ba\u011f var m\u0131 diye d\u00fc\u015f\u00fcnmeye ba\u015flad\u0131.<\/p>\n\n\n\n Kolle\u00e7ka ve t\u0131p \u00f6\u011frencileri, otopsi odas\u0131ndan \u00e7\u0131k\u0131p birinci klini\u011fe gittiklerinde ellerinde \u201ckadavr\u00f6z partik\u00fcller\u201d ta\u015f\u0131yordu. Bu da neden ikinci klinikteki \u00f6l\u00fcm oran\u0131n\u0131n d\u00fc\u015f\u00fck oldu\u011funu a\u00e7\u0131kl\u0131yordu \u00e7\u00fcnk\u00fc ikinci klinikteki \u00f6\u011frenci ebeler, otopsi s\u00fcrecine kat\u0131lm\u0131yor ve kadavralara dokunmuyordu. B\u00f6ylece \u201ckadavr\u00f6z partik\u00fclleri\u201d de hastalara ge\u00e7irmiyordu.<\/p>\n\n\n\n Yukar\u0131da anlatt\u0131\u011f\u0131m mikrop teorisi hen\u00fcz Viyana\u2019da kabul edilmemi\u015fti. Bu y\u00fczden Semmelweis, puerperal ate\u015fe bilinmeyen bir t\u00fcr \u201ckadavr\u00f6z materyalin\u201d neden oldu\u011funu d\u00fc\u015f\u00fcnmeye ba\u015flad\u0131 ancak Semmelweis beklemeden yeni bir uygulamay\u0131 devreye ald\u0131: Bundan sonra herkes otopsiden hasta bakmaya giderken elini kalsiyum hipoklorit [Ca(OCl)2<\/sub>] \u00e7\u00f6zeltisi ile y\u0131kayacakt\u0131 \u00e7\u00fcnk\u00fc Semmelweis, en \u00e7ok bu klorlu \u00e7\u00f6zeltinin kadavrayla \u00e7al\u0131\u015ft\u0131ktan sonra ortaya \u00e7\u0131kan k\u00f6t\u00fc kokuyu ald\u0131\u011f\u0131n\u0131 g\u00f6rm\u00fc\u015ft\u00fc, bu y\u00fczden de elde ta\u015f\u0131nan \u201ckadavrik ajan\u201d kalsiyum hipoklorit ile yok ediliyor olmal\u0131yd\u0131.<\/p>\n\n\n\n Sonu\u00e7 inan\u0131lmazd\u0131. Birinci klinikteki \u00f6l\u00fcmler %90 d\u00fc\u015fm\u00fc\u015f ve ikinci klini\u011fe yakla\u015fm\u0131\u015ft\u0131. \u0130nanm\u0131yor musunuz? A\u015fa\u011f\u0131daki grafikte de g\u00f6rebilece\u011finiz \u00fczere Nisan 1847\u2019de \u00f6l\u00fcm oran\u0131 %18,3\u2019t\u00fc. El y\u0131kama ise ayn\u0131 y\u0131l\u0131n may\u0131s ay\u0131n\u0131n ortas\u0131nda ba\u015flad\u0131. Haziran\u2019da mortalite %2,2\u2019ye, Temmuz\u2019da ise %1,2\u2019ye d\u00fc\u015fm\u00fc\u015ft\u00fc. A\u011fustos\u2019ta ise mortalite %1,9\u2019du.<\/p>\n\n\n\n Semmelweis\u2019\u0131n konuyla ilgili hipotezi \u015fuydu: Hijyen o zamanlarda g\u00f6z ard\u0131 edilen, reddedilen ve dalga ge\u00e7ilen bir konu oldu\u011fundan t\u00fcm bunlar ya\u015fan\u0131yordu ancak 1848 y\u0131l\u0131nda Avrupa\u2019da ya\u015fanan olaylara kar\u0131\u015ft\u0131\u011f\u0131ndan hastaneden uzakla\u015ft\u0131r\u0131ld\u0131 ve Budape\u015fte\u2019ye ta\u015f\u0131nmaya zorland\u0131. Yine de Semmelweis bo\u015f durmad\u0131. Avrupa\u2019n\u0131n \u00f6nde gelen KHD uzmanlar\u0131na onlarca \u00f6fkeli mektup yazd\u0131 ve t\u00fcm\u00fcn\u00fc katillikle su\u00e7lad\u0131. T\u00fcm \u00e7a\u011fda\u015flar\u0131, hatta e\u015fi bile Semmelweis\u2019\u0131n akl\u0131n\u0131 yitirdi\u011fini d\u00fc\u015f\u00fcnd\u00fc ve 1865\u2019te ak\u0131l hastanesine kapat\u0131ld\u0131. Bundan 14 g\u00fcn sonra b\u00fcy\u00fck olas\u0131l\u0131kla gardiyanlar\u0131n sert\u00e7e d\u00f6vmesinden dolay\u0131 septik \u015foktan \u00f6ld\u00fc. \u0130\u015fin \u00fcz\u00fcc\u00fc yan\u0131, \u00f6l\u00fcm\u00fcnden yaln\u0131zca birka\u00e7 y\u0131l sonra Louis Pasteur, Semmelweis\u2019\u0131n bulgular\u0131na bir a\u00e7\u0131klama getirebilmek amac\u0131yla mikrop teorisini geli\u015ftirdi.<\/p>\n\n\n\n Buradan \u00e7\u0131karmam\u0131z gereken \u015fu: Bilim narsizmi kabul etmez. \u201cBen yanl\u0131\u015f yapamam, ben en iyisiyim, asla yan\u0131lmam.\u201d gibi benmerkezcil d\u00fc\u015f\u00fcnceler yaln\u0131zca ki\u015fiyi geriye g\u00f6t\u00fcr\u00fcr. Bilim ise yolundan asla sapmaz.<\/p>\n\n\n\n An + aisthesis = anaithesia, oradan da anestezi. Duygu yoksunlu\u011fu demek. Ancak her \u015feyden \u00f6nce baz\u0131 kavramlar\u0131 birbirinden ay\u0131ral\u0131m:<\/p>\n\n\n\n Anestezi ise t\u0131bbi ama\u00e7lar i\u00e7in kontroll\u00fc ve ge\u00e7ici olarak duyular\u0131n ve bilincin yitirilmesidir ve \u00fc\u00e7e ayr\u0131l\u0131r:<\/p>\n\n\n\n Anestezi neden gereklidir? \u00c7\u00fcnk\u00fc baz\u0131 operasyonlar dayan\u0131lamayacak kadar \u00e7ok ac\u0131 vericidir. Bu kez 12. y\u00fczy\u0131l Eski\u015fehirine de\u011fil, 1921 Eski\u015fehirine gidelim. Ordumuz i\u015fgalci Yunan ordusuna kar\u015f\u0131 amans\u0131z bir sava\u015f verirken b\u00fct\u00fcn bir \u00fclke sava\u015fa kat\u0131l\u0131yor ve biz de cephe gerisindeki sahra hastanelerinde 7\/24 hi\u00e7 durmadan, ara vermeden \u00e7al\u0131\u015fan doktorlardan biriyiz. Her saniye yeni bir yaral\u0131 asker geliyor, \u00fcst\u00fcm\u00fczden durmadan top mermileri ya\u011f\u0131yor, u\u00e7aklar\u0131n g\u00fcmb\u00fcrt\u00fcs\u00fc camlar\u0131 sars\u0131yor. Sava\u015f\u0131n tam ortas\u0131ndayken, t\u00fcm hastane a\u011fz\u0131na dek dolmu\u015fken \u00f6n\u00fcm\u00fcze 15 yerinden makineli t\u00fcfek kur\u015funuyla bi\u00e7ilmi\u015f, gencecik bir te\u011fmen geldi. Biliyoruz ki yabanc\u0131 bir nesne v\u00fccut i\u00e7inde kald\u0131k\u00e7a enfeksiyon riski tavan yapar. Ayr\u0131ca kur\u015fundan kana zararl\u0131 metaller ge\u00e7er. \u00dcst\u00fcne kan ak\u0131\u015f\u0131 kesilen organlar bir s\u00fcre sonra kangren olacak. Bunlar\u0131 \u00e7\u0131karmak gerek. Gazi te\u011fmen hemen operasyona al\u0131n\u0131yor ama o da ne? Bir tane bile anestetik kalmam\u0131\u015f. Evet, gazi te\u011fmenimiz o kur\u015funlar\u0131 \u00e7\u0131kar\u0131l\u0131rken o ac\u0131ya dayanmak zorunda. \u0130nanmazlar diye kur\u015funlar da sinir u\u00e7lar\u0131n\u0131n en yo\u011fun oldu\u011fu yerlere denk gelmi\u015f. Elden ne gelir, hemen bir bezi katlay\u0131p a\u011fz\u0131na koyduk ki ac\u0131ya katlans\u0131n. Te\u011fmenimiz, 15 kez ba\u015ftan derisinin y\u00fcz\u00fcl\u00fcp yak\u0131l\u0131yormu\u015f gibi hissedecek \u00e7\u00fcnk\u00fc. San\u0131r\u0131m anestezinin de\u011ferini ba\u015fka hi\u00e7bir olay b\u00f6ylesine anlatamam\u0131\u015ft\u0131r.<\/p>\n\n\n\n Anestezinin tarihi ise \u015f\u00f6yle:<\/p>\n\n\n\n \u0130lk anesteti\u011fin tarih \u00f6ncesi d\u00f6nemde kullan\u0131lan bitkiler oldu\u011fu d\u00fc\u015f\u00fcn\u00fcl\u00fcyor. Alkol ise bilinen ilk sedatif, Mezopotamya\u2019da binlerce y\u0131l \u00f6nce kullan\u0131lm\u0131\u015f. S\u00fcmerler ha\u015fha\u015f bitkisini, antik M\u0131s\u0131rl\u0131lar adamotunu kullanm\u0131\u015f. Antik \u00c7inli ve Hintliler ise kenevir ve kurtbo\u011fan bitkilerini d\u00fcnyayla tan\u0131\u015ft\u0131rm\u0131\u015f. Orta \u00c7a\u011f\u2019a geldi\u011fimizde Zerd\u00fc\u015ftlerin sezaryen do\u011fum i\u00e7in \u00f6zel bir \u015farap kulland\u0131\u011f\u0131n\u0131, \u0130bni Sina\u2019n\u0131n \u201caromatik ve narkotik emdirilmi\u015f uyutucu bir s\u00fcnger\u201d kulland\u0131\u011f\u0131n\u0131, \u0130ngilizlerin safra, ha\u015fha\u015f, marul, sirke ve birka\u00e7 tane daha ye\u015filli\u011fi kar\u0131\u015ft\u0131rarak bir kar\u0131\u015f\u0131m elde etti\u011fini biliyoruz. Ayr\u0131ca o d\u00f6nemde dietil eter de kullan\u0131l\u0131yor. Dietil eteri 1540 y\u0131l\u0131nda ilk kez sentezleyen Valerius Cordus, bu materyalin t\u0131bbi \u00f6zelliklerini saymakla birlikte etanol ve s\u00fclfirik asidi dam\u0131tmas\u0131yla sentezledi\u011fini yaz\u0131yor.<\/p>\n\n\n\n 18. y\u00fczy\u0131lda Humphry Davy, kahkaha gaz\u0131 ad\u0131n\u0131 verdi\u011fi nitr\u00f6z oksidin anestetik etkilerini ke\u015ffediyor. Bir cerrah olmad\u0131\u011f\u0131ndan bunu bir operasyonda kullanmam\u0131\u015f ancak operasyon s\u0131ras\u0131nda a\u011fr\u0131lar\u0131 dindirmek i\u00e7in kullan\u0131labilece\u011fini s\u00f6yl\u00fcyor.<\/p>\n\n\n\n Bu s\u0131rada Japonya\u2019da anestetik kar\u0131\u015f\u0131mlar geli\u015ftiriliyor ve 1804 y\u0131l\u0131nda kay\u0131tlara ge\u00e7mi\u015f ilk genel anestezi etkisindeki operasyon ger\u00e7ekle\u015ftiriliyor: Hanaoka Seishu, 60 ya\u015f\u0131ndaki bir kad\u0131na k\u0131smi mastektomi yap\u0131yor.<\/p>\n\n\n\n Bat\u0131da ise morfin sentezleniyor, karbondioksidin anestetik \u00f6zelli\u011fi ke\u015ffediliyor ve 1842 y\u0131l\u0131nda ilk kez solunan anestetikle operasyon yap\u0131l\u0131yor. Bunu izleyen y\u0131llarda \u00f6zellikle nitr\u00f6z oksit ve dietil eterle operasyonlar ger\u00e7ekle\u015ftiriliyor ve anestezinin \u00f6nemi g\u00fcn ge\u00e7tik daha iyi anla\u015f\u0131l\u0131yor. Bu y\u0131llarda anestezi ile ilgili en \u00f6nemli olay, 1845 y\u0131l\u0131nda Boston Massachusetts Hastanesi\u2019nde ilk kez halk\u0131n \u00f6n\u00fcnde inhalasyonal anesteti\u011fin kullan\u0131lmas\u0131. Ne var ki kullan\u0131lan nitr\u00f6z oksit yanl\u0131\u015f kullan\u0131ld\u0131\u011f\u0131ndan hasta a\u011fr\u0131dan a\u011flamaya ba\u015flay\u0131nca operasyon durduruluyor. Sonras\u0131nda kloroform kullan\u0131l\u0131yor ancak hepatik ve kardiyak toksisitesinden dolay\u0131 kullan\u0131mdan kald\u0131r\u0131l\u0131yor. Kald\u0131r\u0131lana de\u011fin tonla operasyon yap\u0131ld\u0131\u011f\u0131n\u0131 da unutmayal\u0131m.<\/p>\n\n\n\n 20. y\u00fczy\u0131lda ise barbit\u00fcratlar piyasaya s\u00fcr\u00fcl\u00fcyor. GABAA<\/sub> agonisti olan bu ila\u00e7lar, n\u00f6rotransmitter iletimini inhibe ederek \u00e7al\u0131\u015f\u0131yor. G\u00fcn\u00fcm\u00fczde hala daha kullan\u0131lsa da b\u00fcy\u00fck oranda yerini benzodiyazepin ve nonbenzodiyazepinlere b\u0131rakm\u0131\u015f durumda. Bu arada da anestezi makineleri geli\u015ftiriliyor. Anestezi makineleri anestezi durumunu korumak i\u00e7in inhalasyonal anestezikleri s\u00fcrekli kar\u0131\u015ft\u0131r\u0131p yeni gaz kar\u0131\u015f\u0131m\u0131 olarak hastaya veriyor. B\u00f6ylece \u00e7ok daha dengeli genel anestezi ile operasyonlar kolayla\u015f\u0131yor. 1956\u2019da ise halotan piyasaya s\u00fcr\u00fcl\u00fcyor. \u00d6zelli\u011fi ise yan\u0131c\u0131 olmamas\u0131. Gibi gibi yeni, daha az zararl\u0131 anestetikleri piyasaya s\u00fcr\u00fcl\u00fcyor. Size burada g\u00fcn\u00fcm\u00fcz anestetiklerinden de bahsetmek isterdim ama genel anestetiklerin etki mekanizmas\u0131 daha \u00e7\u00f6z\u00fclemedi. S\u00f6z\u00fc de uzatmaya gerek yok, s\u00f6yleyece\u011fimi yukar\u0131da s\u00f6yledim zaten.<\/p>\n\n\n\n <\/p>\n\n\n\n Ve son kilometre ta\u015f\u0131m\u0131za geldik. Yine d\u00fc\u015f\u00fcnelim: Neden bu tekniklere gerek duyuyoruz? \u00c7\u00fcnk\u00fc v\u00fccudun i\u00e7ini g\u00f6remiyoruz ve i\u00e7eride say\u0131lamayacak denli \u00e7ok olay oluyor. Eminim ki r\u00f6ntgen bulunmadan \u00f6nce t\u00fcm doktorlar \u201cKe\u015fke \u015f\u00f6yle bir ara\u00e7 olsa da bize v\u00fccut i\u00e7ini g\u00f6sterse.\u201d diye d\u00f6v\u00fcnm\u00fc\u015ft\u00fcr.<\/p>\n\n\n\n Bu kez yine sizi ate\u015ften y\u0131llara g\u00f6t\u00fcr\u00fcyorum. Sakarya Sava\u015f\u0131\u2019ndan hemen \u00f6nce, Ba\u015fkomutan Gazi Mustafa Kemal Atat\u00fcrk Polatl\u0131\/Ankara\u2019da mevzileri gezerken bir anda yanl\u0131\u015f yerle\u015ftirilmi\u015f bir batarya g\u00f6r\u00fcr. Bataryan\u0131n komutan\u0131 y\u00fczba\u015f\u0131y\u0131 azarlad\u0131ktan sonra sinirlenip h\u0131zl\u0131ca at\u0131na biner ancak aya\u011f\u0131 \u00fczengiden kayar, Ba\u015fkomutan Atat\u00fcrk g\u00f6\u011fs\u00fcn\u00fc ta\u015fa \u00e7arpar. \u0130lk ba\u015fta Atat\u00fcrk rahats\u0131zl\u0131\u011f\u0131n\u0131 belli etmemeye \u00e7al\u0131\u015fsa da art\u0131k dayanamay\u0131nca telefon edilir ve Dr. Adnan Ad\u0131var ile Dr. Refik Saydam hemen Atat\u00fcrk\u2019\u00fcn yan\u0131na gelir. \u0130lk muayenede kaburga kemiklerinden birinin zedelendi\u011fini anlarlar ama yukar\u0131da da s\u00f6yledi\u011fim gibi, g\u00f6\u011fs\u00fcn i\u00e7i d\u0131\u015far\u0131dan g\u00f6r\u00fclemedi\u011finden dolay\u0131 ileri tan\u0131 i\u00e7in r\u00f6ntgen ayg\u0131t\u0131 gerekiyordu. Koca \u00fclkede bir tek r\u00f6ntgen ayg\u0131t\u0131 vard\u0131, o da Cebeci Hastanesi\u2019ndeydi. Atat\u00fcrk hemen hastaneye kald\u0131r\u0131ld\u0131 ve r\u00f6ntgen olup biteni an\u0131nda g\u00f6sterdi: Atat\u00fcrk g\u00f6\u011fs\u00fcn\u00fc ta\u015fa vurdu\u011funda kaburgalar\u0131ndan biri k\u0131r\u0131l\u0131p akci\u011ferine batm\u0131\u015f, iki kaburgas\u0131 da zedelenmi\u015fti. \u0130\u015fte bilim g\u00fcc\u00fcn\u00fc g\u00f6stermi\u015fti. Sonra ne mi oldu? Ba\u015fkomutan\u2019a 20 g\u00fcn boyunca konu\u015fmadan dinlenmesi gerekti\u011fi s\u00f6ylendi ama nas\u0131l olacakt\u0131? Olmazd\u0131, olmad\u0131 da. Atat\u00fcrk o haliye sava\u015f\u0131 y\u00f6netti ve bu \u00fclkeyi sonsuza dek bizim yapan ilk sava\u015f\u0131 kazand\u0131.<\/p>\n\n\n\n \u015eimdi de biraz t\u0131bbi g\u00f6r\u00fcnt\u00fcleme tekniklerinin ge\u00e7mi\u015fine bakal\u0131m.<\/p>\n\n\n\n 8 Kas\u0131m 1895\u2019te fizik profes\u00f6r\u00fc Wilhelm Conrad R\u00f6ntgen X-\u0131\u015f\u0131nlar\u0131n\u0131 ke\u015ffetti ve bu \u0131\u015f\u0131nlar\u0131n dokulardan ge\u00e7ebildi\u011fini ancak metal, kemik gibi yap\u0131lardan ge\u00e7emedi\u011fini belirtti ve ilk radyograf\u0131 kendisi \u00e7ekti. Bu bulu\u015fundan dolay\u0131 da Nobel Fizik \u00d6d\u00fcl\u00fc\u2019n\u00fc kazand\u0131.<\/p>\n\n\n\n <\/p>\n\n\n\n X-\u0131\u015f\u0131nlar\u0131 11 Ocak 1896\u2019da, \u0130ngiltere\u2019de eline i\u011fne batan bir hastan\u0131n g\u00f6r\u00fcnt\u00fclenmesinde kullan\u0131ld\u0131. Bu g\u00f6r\u00fcnt\u00fclemeyi ger\u00e7ekle\u015ftiren John Hall-Edwards, 14 \u015eubat 1896\u2019da bir operasyonda ilk kez X-\u0131\u015f\u0131nlar\u0131n\u0131 kullanan doktor \u00fcnvan\u0131n\u0131 kazand\u0131. X-\u0131\u015f\u0131nlar\u0131 mastektomilerde ve meme kanserine erkenden tan\u0131 koymada da kullan\u0131ld\u0131. 1. D\u00fcnya Sava\u015f\u0131\u2019nda da kullan\u0131lmas\u0131yla art\u0131k X-\u0131\u015f\u0131nlar\u0131 t\u0131bbi g\u00f6r\u00fcnt\u00fclemenin ayr\u0131lmaz bir par\u00e7as\u0131 olmu\u015ftur.<\/p>\n\n\n\n Ancak bilim yerinde saymad\u0131. 2. D\u00fcnya Sava\u015f\u0131\u2019n\u0131n getirdi\u011fi n\u00fckleer g\u00fc\u00e7le yer g\u00f6k n\u00fckleer olmu\u015ftu. T\u0131p da bundan pay\u0131n\u0131 ald\u0131. Emisyon ve transmisyon tomografisi kavramlar\u0131 1950\u2019lerin sonlar\u0131nda literat\u00fcre ge\u00e7erken bundan y\u00fcr\u00fcyen bilim insanlar\u0131 1961\u2019de ilk tek-d\u00fczlemli PET (pozitron emisyon tomografi) taray\u0131c\u0131 geli\u015ftirildi. 1975\u2019te de tomografik g\u00f6r\u00fcnt\u00fcleme teknikleri Washington \u00dcniversitesi T\u0131p Fak\u00fcltesi\u2019nde daha da \u00f6teye ta\u015f\u0131nd\u0131. \u0130lk deneme ise 1976 y\u0131l\u0131nda iki sa\u011fl\u0131kl\u0131 g\u00f6n\u00fcll\u00fc \u00fczerinde yap\u0131ld\u0131.<\/p>\n\n\n\n Sistemin \u00e7al\u0131\u015fma mant\u0131\u011f\u0131 basit. Hastaya radyoaktif bir madde veriliyor. \u00d6rne\u011fin 18-floro-2-deoksi glikoz. Bu \u201c\u0131\u015f\u0131kl\u0131 glikoz\u201d, normal glikoz gibi hemen kana kar\u0131\u015f\u0131yor. H\u0131zl\u0131 b\u00fcy\u00fcyen malign t\u00fcm\u00f6rlerde hekzokinaz d\u00fczeyinin artt\u0131\u011f\u0131n\u0131 biliyoruz. \u0130\u015fte bu t\u00fcm\u00f6rler, yeni gelen \u0131\u015f\u0131kl\u0131 glikoza \u00fc\u015f\u00fc\u015f\u00fcyorlar ve hedef 12\u2019den vuruluyor: G\u00f6r\u00fcnt\u00fc olu\u015fturuldu\u011funda t\u00fcm\u00f6rlerin radyoaktif glikozu ald\u0131\u011f\u0131n\u0131 g\u00f6r\u00fcyoruz. B\u00f6ylece metastaz\u0131 da g\u00f6r\u00fcnt\u00fclemek m\u00fcmk\u00fcn oluyor.<\/p>\n\n\n\n G\u00f6rsel 2:<\/p>\n\n\n\n a) PET taramas\u0131nda pankreas b\u00f6lgesinde hipermetabolik t\u00fcm\u00f6re benzeyen ancak otoimm\u00fcn pankreatitin (AP) neden oldu\u011fu glikoz toplanmas\u0131 g\u00f6r\u00fcl\u00fcyor.<\/p>\n\n\n\n b) PET bu kez kar\u0131ndan \u00e7ekilmi\u015f. Pankreastan yay\u0131lan \u0131\u015f\u0131nlar\u0131 yine g\u00f6r\u00fcyoruz.<\/p>\n\n\n\n c) Ayn\u0131 b\u00f6lgenin iyile\u015ftirilmemi\u015f CT\u2019si.<\/p>\n\n\n\n d) Bu g\u00f6r\u00fcnt\u00fcde ise CT ve PET birle\u015ftirilmi\u015f. CT bize pankreasta bir kitle oldu\u011funu g\u00f6steriyor, PET o b\u00f6lgeden \u00e7ok fazla radyoaktif \u0131\u015f\u0131n yay\u0131ld\u0131\u011f\u0131n\u0131 g\u00f6steriyor.<\/p>\n\n\n\n PET yaln\u0131zca kanser taramalar\u0131nda kullan\u0131lm\u0131yor. Alzheimer tan\u0131s\u0131nda da kullan\u0131l\u0131yor. Biliyoruz ki Alzheimer tan\u0131s\u0131 konmu\u015f bireylerin beyinlerinde glikoz ve oksijen metabolizma \u00e7ok b\u00fcy\u00fck oranda geriliyor \u00e7\u00fcnk\u00fc n\u00f6ronlar \u00f6l\u00fcyor.<\/p>\n\n\n\n Yeri gelmi\u015fken CT\u2019ye de\u011finmemek olmaz. CT, yani bilgisayarl\u0131 tomografinin temelleri 1917\u2019de Radon d\u00f6n\u00fc\u015f\u00fcmleri teorisine dayan\u0131yor. 1963\u2019te ise ilk patent ABD\u2019de al\u0131n\u0131yor. \u0130lk ticari CT taray\u0131c\u0131 ise 1972\u2019de Godfrey Hounsfield taraf\u0131ndan ger\u00e7ekle\u015ftiriliyor. \u00c7al\u0131\u015fma mekanizmas\u0131 ise \u015f\u00f6yle: Hasta makineye yat\u0131yor. Hasta \u00e7epe\u00e7evre X-\u0131\u015f\u0131nlar\u0131yla \u201cbombalan\u0131yor\u201d, bir yandan da hastan\u0131n dokular\u0131ndan ge\u00e7ebilen X-\u0131\u015f\u0131nlar\u0131 dedekt\u00f6rlerce yakalan\u0131yor. Bilgisayar burada devreye giriyor: Radon d\u00f6n\u00fc\u015f\u00fcmlerini kullanarak gelen \u0131\u015f\u0131nlar\u0131 enine kesitlere d\u00f6n\u00fc\u015ft\u00fcr\u00fcyor. Son olarak da radyoloji uzman\u0131 ekran\u0131nda final g\u00f6r\u00fcnt\u00fcy\u00fc g\u00f6r\u00fcyor ve raporu yaz\u0131yor.<\/p>\n\n\n\n Ve s\u0131ra MR\u2019a geldi. Asl\u0131nda bu teknolojinin tam ad\u0131 n\u00fckleer manyetik rezonans, yani NMR, ancak \u00e7\u0131kt\u0131\u011f\u0131 y\u0131llarda ABD\u2019de halk n\u00fckleer denince bile \u00fcrkt\u00fc\u011f\u00fc i\u00e7in n\u00fckleer s\u00f6zc\u00fc\u011f\u00fc at\u0131lm\u0131\u015f, MR kalm\u0131\u015f.<\/p>\n\n\n\n Ge\u00e7mi\u015fi de \u015f\u00f6yle:<\/p>\n\n\n\n 1971 y\u0131l\u0131nda Stony Brook \u00dcniversitesi\u2019nde \u00e7al\u0131\u015fan Paul Lauterbur \u00fc\u00e7 boyutta manyetik alan uygulay\u0131p bunlar\u0131n geri yans\u0131mas\u0131n\u0131 alarak ilk NMR\u2019\u0131 \u00e7ekiyor. 1970\u2019lerin sonlar\u0131nda do\u011fru fizik\u00e7i Peter Mansfield ve yukar\u0131da ad\u0131 ge\u00e7en Paul Lauterbur bu teknolojiyi geli\u015ftiriyor. Yar\u0131 iletkenlerin geli\u015fmesi ise MR\u2019\u0131 kullan\u0131labilir hale getiriyor \u00e7\u00fcnk\u00fc MR\u2019\u0131 i\u015fleyip bir g\u00f6r\u00fcnt\u00fcye d\u00f6n\u00fc\u015ft\u00fcrmek \u00e7ok zor. Bunu yaln\u0131zca bilgisayarlar yapabiliyor.<\/p>\n\n\n\n \u00c7al\u0131\u015fma mant\u0131\u011f\u0131 bu kez biraz daha karma\u015f\u0131k: V\u00fccudumuzun her bir yerinde hidrojen atomu var. MRI taray\u0131c\u0131 g\u00f6r\u00fcnt\u00fclenecek alana \u00e7ok g\u00fc\u00e7l\u00fc bir manyetik alan uyguluyor ve protonlar manyetik alana paralel ya da antiparalel s\u0131ralanmaya zorlan\u0131yor. Sonras\u0131ndaysa bir radyo frekans\u0131 at\u0131m\u0131 ile paralel s\u0131ralananlar antiparalel duruma ge\u00e7iyor. Bu d\u00f6n\u00fc\u015f\u00fcm s\u0131ras\u0131nda hidrojen atomlar\u0131 bir manyetik ak\u0131 olu\u015fturuyor. Hidrojen atomlar\u0131n\u0131n b\u00f6lgedeki yo\u011funlu\u011funa g\u00f6re olu\u015fan manyetik ak\u0131 de\u011fi\u015fiyor. \u00c7ok olan yerler ak, az olan yerler kara g\u00f6r\u00fcn\u00fcyor. Bunu an\u0131nda belirleyen dedekt\u00f6rler g\u00f6r\u00fcnt\u00fcy\u00fc i\u015fleyip enine kesitlere d\u00f6n\u00fc\u015ft\u00fcr\u00fcyor. Sonra da kesitler \u00fcst \u00fcste dizilip as\u0131l g\u00f6r\u00fcnt\u00fc olu\u015fturuluyor.<\/p>\n\n\n\n Kullan\u0131m alan\u0131 \u00e7ok \u00e7e\u015fitli. N\u00f6rolojik kaynakl\u0131 kanserlerde CT\u2019den daha etkili \u00e7\u00fcnk\u00fc ak ve boz madde aras\u0131ndaki kontrast daha iyi incelenebiliyor. B\u00f6ylece SSS\u2019yi ilgilendiren demyelinating hastal\u0131klar, demans, serebrovask\u00fcler hastal\u0131klar, Alzheimer ve epilepsi gibi durumlara \u00e7ok daha iyi tan\u0131 konabiliyor. Kardiyovask\u00fcler durumlar\u0131n incelenmesinde de bir numara. Kalbin ve kalp damarlar\u0131n\u0131n yap\u0131s\u0131n\u0131 bir b\u00fct\u00fcn olarak, milisaniyelik aral\u0131klarla \u00e7\u0131kard\u0131\u011f\u0131ndan \u00e7ok terch ediliyor. Musk\u00fcloskeletal sistemdeki uygulamalar\u0131n\u0131 da unutmayal\u0131m. Omurgan\u0131n g\u00f6r\u00fcnt\u00fclenmesinde, eklem rahats\u0131zl\u0131klar\u0131nda ve yumu\u015fak doku t\u00fcm\u00f6rlerinin incelenmesinde kullan\u0131l\u0131yor \u00e7\u00fcnk\u00fc ayg\u0131t\u0131n \u00e7\u00f6z\u00fcn\u00fcrl\u00fc\u011f\u00fc \u00e7ok fazla, bu y\u00fczden de \u00f6zellikle yumu\u015fak dokular\u0131 incelemede \u00e7ok etkili. Hepatobiliyer MR karaci\u011fer, pankreas ve safra yollar\u0131n\u0131n g\u00f6r\u00fcnt\u00fclenmesinde kullan\u0131l\u0131yor ancak bu dokular incelenirken kana kontrast ajanlar\u0131 veriliyor ki MRI\u2019\u0131n \u00e7\u00f6z\u00fcn\u00fcrl\u00fc\u011f\u00fc arts\u0131n. Anjiyografide de \u00f6nemli bir yere sahip. Stenoz (anormal daralma) ya da anevrizman\u0131n (damar duvar\u0131n\u0131n \u015fi\u015fmesi) de\u011ferlendirilmesinde kullan\u0131l\u0131yor. Stenoz k\u00f6t\u00fcd\u00fcr \u00e7\u00fcnk\u00fc besledi\u011fi b\u00f6lgeye giden kan ak\u0131\u015f\u0131 azal\u0131r. Anevrizma da k\u00f6t\u00fcd\u00fcr \u00e7\u00fcnk\u00fc kan damar\u0131n\u0131n duvar\u0131 zay\u0131flad\u0131\u011f\u0131ndan y\u0131rt\u0131lma riski artar. Bu damar\u0131n beyin damarlar\u0131ndan biri oldu\u011funu d\u00fc\u015f\u00fcnsenize! Hi\u00e7 iyi olmazd\u0131.<\/p>\n\n\n\n MRI herhangi bir \u0131\u015f\u0131n kullanmad\u0131\u011f\u0131ndan \u00e7ocuklar ve gebelerde kullan\u0131labiliyor ancak koklear implant ya da kalp pili ta\u015f\u0131yan hastalarda, v\u00fccudunda \u015farapnel bulunan gazilerimizde MRI kullan\u0131lam\u0131yor.<\/p>\n\n\n\n 1: Smallpox (who.int)<\/a><\/p>\n\n\n\n 2: Variolation – Wikipedia<\/a><\/p>\n\n\n\n 3: (PDF) The introduction of variolation \u2018A La Turca\u2019 to the West by Lady Mary Montagu and Turkey’s contribution to this (researchgate.net)<\/a><\/p>\n\n\n\n 4: Anthrax vaccines – Wikipedia<\/a><\/p>\n\n\n\n 5: Rabies – Wikipedia<\/a><\/p>\n\n\n\n 6: History of vaccination | PNAS<\/a><\/p>\n\n\n\n 7: Miasma theory – Wikipedia<\/a><\/p>\n\n\n\n 8: Germ theory of disease – Wikipedia<\/a><\/p>\n\n\n\n 9: Koch’s postulates – Wikipedia<\/a><\/p>\n\n\n\n 10: Tonsillitis – Symptoms and causes – Mayo Clinic<\/a><\/p>\n\n\n\n 11: Ignaz Semmelweis – Wikipedia<\/a><\/p>\n\n\n\n 12: Puerperal ate\u015f: Lo\u011fusal\u0131k hummas\u0131, albast\u0131 adlar\u0131yla da bilinir. Kad\u0131n \u00fcreme organlar\u0131n\u0131n do\u011fum ya da abortus sonucu enfeksiyonuyla ortaya \u00e7\u0131kar. Buradan v\u00fccuda giren patojenler, kana ve lenf sistemine girer. Do\u011fum ya da d\u00fc\u015f\u00fck sonras\u0131 10 g\u00fcnl\u00fck y\u00fcksek ate\u015f (38o<\/sup>) ile karakterizedir. Kaynak: puerperal fever | infection | Britannica<\/a><\/p>\n\n\n\n 13: Septik \u015fok: V\u00fccuda yay\u0131lm\u0131\u015f bir enfeksiyonun tehlikeli d\u00fczeydeki hipotansiyona neden oldu\u011fu durum. Kaynak: Septic shock: MedlinePlus Medical Encyclopedia<\/a><\/p>\n\n\n\n 14: General anaesthetic – Wikipedia<\/a><\/p>\n\n\n\n 15: Anaesthetic machine – Wikipedia<\/a><\/p>\n\n\n\n 16: Molecular mechanisms of general anesthesia – PMC (nih.gov)<\/a><\/p>\n\n\n\n 17: Sakarya Muharebeleri\u2019nde Duatepe’den harekat\u0131 idare ederken. (10.09.1921) | \u0130\u015fte Atat\u00fcrk | Atat\u00fcrk Hakk\u0131nda Bilmek \u0130stedi\u011finiz Her\u015fey (isteataturk.com)<\/a><\/p>\n\n\n\n 18: (PDF) Localized autoimmune pancreatitis mimicking pancreatic cancer: Case report and literature review (researchgate.net)<\/a><\/p>\n\n\n\n 19: CT scan – Wikipedia<\/a><\/p>\n\n\n\n 20: File:PET scan-normal brain-alzheimers disease brain.PNG – Wikipedia<\/a> <\/p>\n\n\n\n2. Mikrop teorisi<\/h1>\n\n\n\n
![\"\"](\"https:\/\/blog.ulubat.org\/wp-content\/uploads\/2022\/09\/Louis_Pasteur_Experiment-1-1008x1024.png\")
3. El y\u0131kama..?<\/h1>\n\n\n\n
![\"\"](\"https:\/\/blog.ulubat.org\/wp-content\/uploads\/2022\/09\/750px-Yearly_mortality_rates_1841-1846_two_clinics-1024x1024.png\")
![\"\"](\"https:\/\/blog.ulubat.org\/wp-content\/uploads\/2022\/09\/750px-Monthly_mortality_rates_1841-1849-1024x1024.png\")
4. Anestezi<\/h1>\n\n\n\n
5. T\u0131bbi g\u00f6r\u00fcnt\u00fcleme teknikleri<\/h1>\n\n\n\n
![\"\"](\"https:\/\/blog.ulubat.org\/wp-content\/uploads\/2022\/09\/download-1024x1024.jpeg\")
![\"\"](\"https:\/\/blog.ulubat.org\/wp-content\/uploads\/2022\/09\/image-1024x1024.png\")
<\/figure>\n\n\n\n![\"\"](\"https:\/\/blog.ulubat.org\/wp-content\/uploads\/2022\/09\/image-1-1024x1024.png\")
![File:PET scan-normal brain-alzheimers disease brain.PNG – Wikipedia<\/a> <\/p>\n\n\n\n21: Magnetic resonance imaging – Wikipedia<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"Huhhh.. Bu ay\u0131n yaz\u0131s\u0131n\u0131 yeti\u015ftirmeye \u00e7al\u0131\u015f\u0131yordum ancak ge\u00e7 kald\u0131m. Ge\u00e7en ayki yaz\u0131mda t\u0131pta \u00fcstesinden gelmemiz gereken sorunlar\u0131 s\u0131ralam\u0131\u015ft\u0131m. Bu kez<\/p>\n","protected":false},"author":1194,"featured_media":12592,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[1],"tags":[],"acf":[],"views":314,"_links":{"self":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/12590"}],"collection":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/users\/1194"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/comments?post=12590"}],"version-history":[{"count":5,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/12590\/revisions"}],"predecessor-version":[{"id":12603,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/posts\/12590\/revisions\/12603"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media\/12592"}],"wp:attachment":[{"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/media?parent=12590"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/categories?post=12590"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.ulubat.org\/index.php\/wp-json\/wp\/v2\/tags?post=12590"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}](\"https:\/\/en.wikipedia.org\/wiki\/File:PET_scan-normal_brain-alzheimers_disease_brain.PNG\"){kind=link}