diş apselerinde gümüş anot uygulaması

T.C.
d8.8529$h1ø9(56,7(6,
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TEZ YÖNETICISI
Doç. Dr. Fügen YARKIN
DOKTORA TEZI
Murat AYDIN
ADANA / 1997
1
7(ù(..h59('(67(.
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Ismail GÜNAY1'a, Dr. Fügen YARKIN2 ve Dr. Joseph A. SPADARO3'ya, elektron
PLNURVNRSXQGD IRWR÷UDIODUÕQ oHNLPLQL JHUoHNOHúWLUHQ +LVWRORML $QDELOLP 'DOÕ¶QD EX
IRWR÷UDIODUÕ \RUXPOD\DQ 'U <D\RL 1,SYIYAMA4, Dr. Greg W. ERDOS5, Dr. Brigitte
MONTES6 ve Dr. Antonio CASSONE7
\HDQWLEL\RWLNGX\DUOÕOÕNGLVNOHULQGHQELUNÕVPÕQÕ
WHPLQHGHQ(F]DFÕEDúÕLODoILUPDVÕQDWHúHNNUHGHULP
%X oDOÕúPD dXNXURYD hQLYHUVLWHVL $UDúWÕUPD IRQX WDUDIÕQGDQ 6%(-96.1 nolu
SURMHRODUDNGHVWHNOHQPLúWLU
1
2
3
,*QD\3URI'Udh7ÕS)DN%L\RIL]LN$QDELOLP'DOÕ$GDQD
)<DUNÕQ'Ro'Udh7ÕS)DN0LNUREL\RORML$QDELOLP'DOÕ$GDQD
, J.A. Spadaro, Ph. D., Assoc Prof. S.U.N.Y. Health Science Center, Syracusa, USA
, Y. Nishiyama, Ph. D., Assoc Prof., Institute of Medical Micology, Teikyo Univ., Japan
5
, G.W. Erdos, Ph. D., Scientific Director, Electron Microscopy Core Lab. Florida, USA
6
, B. Montes, Laboratoire de Virologie, Cedex, France
7
, A. Cassone, Prof., Director of Lab. of Bacteriology and Medical Mycology, Institute Superiore di Sanita, Italy
4
2
IÇINDEKILER
Konu:
Sayfa:
I- TABLO LISTESI
II- ù(.,//,67(6,
III- ÖZ
IV- ABSTRACT
I
II
III
IV
1-*,5,ù9($0$d
'LúLQDQDWRPR-fizyolojisi
'LúHQIHNVL\RQXQJHOLúPHVL
'LúHQIHNVL\RQXQDKDOHQX\JXODQDQWHGDYL
2- GENEL BILGILER
*Pú
(OHNWULNDNÕPÕ
*PúDQRW
gQoDOÕúPD-1
gQoDOÕúPD-2
gQoDOÕúPD-3
gQoDOÕúPD-4
(QIHNWHN|NNDQDOÕIORUDVÕYHHNRORMLVL
gQoDOÕúPD-5
2.10 Ön çalÕúPD-6
3- GEREÇ VE YÖNTEM
3.1 Hasta seçimi
'LúOHU
+D]ÕUOÕN
0DWHU\DODOÕQPDVÕ
.DQDODHOHNWURW\HUOHúWLUPH
3LOOLDSDUH\LQKD]ÕUODQPDVÕ
3LOOLDSDUH\LQD÷Õ]DX\JXODQPDVÕ
6DIODúWÕUPDYH,GHQWLILNDV\RQ
$QWLEL\RWLNGX\DUOÕOÕNWHVWOHUL
3.10 Optik okuma
.|NNDQDOÕGH]HQIHNVL\RQXQXQNRQWUROHGLOPHVL
.XOODQÕODQEHVL\HUOHUL
4- BULGULAR
4.1 Elektriksel parametreler
4.2 Pilli aparey
4.3 Klinik sonuçlar
4.4 Mikrobiyoloji
$QWLEL\RWLNGX\DUOÕOÕNWHVWOHUL
5-7$57,ù0$
6- KAYNAKLAR
7-g=*(d0,ù
3
1
2
2
3
3
5
7
9
10
10
13
18
19
21
21
21
22
22
23
25
25
27
28
29
30
32
32
32
33
36
38
52
57
I- TABLO LISTESI
Tablo.I
Tablo.II
Tablo.III
Tablo.IV
Tablo.V
Tablo.VI
Tablo.VII
Tablo.VIII
Sayfa
*PúQDJDULoHULVLQGHNLHPLV\RQSURILOL
8
JPúQ0,&GH÷HUOHUL
12
JPúL\RQNRQVDQWUDV\RQODUÕ
19
KuOODQÕODQDQWLEL\RWLNOHULQLVLPOHULYHNRQVDQWUDV\RQODUÕ
28
%D]ÕEDNWHULYHPD\DODULoLQPHWDOLNYHDQRGLN
*PúDQRWX\JXODQPÕúGLúOHULQGHQWLQGRNXVXQGDNL
*PúDQRWX\JXODPDVÕQÕQD\VRQUDNLVRQXoODUÕ
(QIHNWHN|NNDQDOODUÕQGDQL]ROHHGLOHQPHFEXULDQDHURSYH
33
mikroaerofilik bakteriler
34
anaerop bakteriler
35
etki süreleri
38
(QIHNWHN|NNDQDOODUÕQdan izole edilen fakültatif
.|NNDQDOÕGROJXPDGGHOHULQLQSHQHWUDV\RQGHULQOL÷LYH
-I-
4
II-ù(.ø//ø67(6ø
ùHNLO
ùHNLO
ùHNLO
Sayfa
'LúLQDQDWRPR-fizyolojisi
1
*PúHOHNWURWXQSRODUL]DV\RQH÷ULVL
6
XOWUDVWUNWUHOGH÷LúLPOHU
9
*PúDQRWX\JXODQPÕúP. aeruginosa hücrelerindeki
A. Kontrol grubu, x40.000
B. Vakuolizasyon, x40.000
C. Pili defekti, x80.000
ùHNLO
D. Kusurlu bölünme, x100.000
*PúDQRWX\JXODQPÕúC. albicans hücrelerindeki
XOWUDVWUNWUHOGH÷LúLPOHU
11
A. Kontrol grubu, x80.000
B. Otofajik vakuoller, x100.000
C. Vakuolizasyon, x80.000
ùHNLO
ùHNLO
ùHNLO
ùHNLO
',QWUDVLWRSOD]PLNLQNO]\RQODUYHGÕúGXYDU[
.|NNDQDOÕQGa kommensalizm
.|NNDQDOÕHQIHNVL\RQXQXQVDIKDODUÕ
'HQH\VHOJPúDQRWX\JXODPDVÕ
*PúDQRWX\JXODQPÕúGLúOHULQODWHUDONHVLWOHUL
16
17
18
20
A. Kontrol grubu, x20
%$QDNDQDOÕQOPHQL[
&'HQWLQNDQDOFÕNODUÕ[
ùHNLO
ùHNLO
ùHNLO
ùHNLO
ùHNLO
''HQWLQNDQDOFÕNODUÕ[
%LUSLOOLDSDUH\LQKD]ÕUODQPDVÕ
'LúHJPúDQRW\HUOHúWLULOPHVLQLQúHPDWLNJ|UQWV
*PúDQRWX\JXODQPÕúGLúOHULQUDG\RORMLNJ|UQWV
.|NNDQDOÕGH]HQIHNVL\RQXQXn kontrol edilmesi
(OGHHGLOHQDQDHURSEDNWHULOHULQDQWLEL\RWLNGX\DUOÕOÕNODUÕ
A. Gram-pozitif bakteriler
B. Gram-negatif bakteriler
-II5
23
24
24
29
36
III- ÖZ
6DIJPúPHWDOLQLQDQWLEDNWHUL\HOHWNLVLYDUGÕUIDNDWHOHNWULNDNÕPÕLOHNRPELQH
edLOGL÷L ]DPDQ EX HWNL \DNODúÕN \] GHID DUWDU 'RNX X\XPOXOX÷X YH GúNWRNVLVLWHVL
J|VWHULOPLú RODQ JPú DQRW DQWLPLNURELN RODUDN RUWRSHGLVWOHU WDUDIÕQGDQ GHULQ NHPLN
OH]\RQODUÕQGD NXOODQÕOPÕú YH EDúDUÕOÕ VRQXoODU HOGH HGLOPLúWLU %X OLWHUDWU oDOÕúPDODUÕ
ED] DOÕQDUDN GLúOHULQ HQIHNWH N|N NDQDOODUÕQÕ JPú DQRW LOH GH]HQIHNWH HWPHN YH EX
VÕUDGD HQIHNWH N|N NDQDOODUÕ LoHULVLQGHQ HOGH HGLOHQ PLNURRUJDQL]PDODUÕQ DQWLEL\RWLN
GX\DUOÕOÕNODUÕQÕGH÷HUOHQGLUHUHNDNXWGLúDSVHOHULQGHLONWHUFLKHGLOHELOHFHNDQWLELyotikleri
tespit etmek hedeflendi.
<DúODUÕLOHDUDVÕQGDGH÷LúHQDGHWKDVWDQÕQDGHWNURQLNHQIHNVL\RQOX
GLúLQLQ N|N NDQDOODUÕQD ELUHU JPú HOHNWURW X\JXODQGÕ ,oHULVLQGH NoN ELU JPúO
VDDWSLOLEXOXQDQSURWH]D÷Õ]D\HUOHúWLULOGLSR]LWLINXWXEXGLúLoHULVLQGHNLHOHNWURWDWHPDV
HWWLULOGLJQER\XQFDKDVWDQÕQEXSURWH]LNXOODQPDVÕVD÷ODQGÕ
*PúDQRWX\JXODPDVÕQGDQ|QFHVRQUDYHELUHUKDIWDDUDLOHLNLGHIDROPDN
]HUH GLúLQ N|N NDQDOÕQGDQ DOÕQDQ PDWHU\DOLQ NOWU \DSÕOGÕ 8\JXODPD\Õ Wakiben 58
GLúLQWDQHVLQLQN|NNDQDOÕQGDQEDNWHULUHWLOHPHGLEXQODUGDQWDQHVLQGH
UDG\RORMLNG]HOPHJ|UOGKDVWDQÕQLVHN|NNDQDOÕQGDEDNWHULUHPHVLGHYDPHWWL
%XQODUGDQQGHDNXWHQIHNVL\RQJHOLúWL÷LLoLQGLúOHUoHNLOGL
Ellisekiz GLúWHQ WRSODP RODUDN EDNWHUL VXúX L]ROH HGLOGL YH LQFHOHQGL
%XQODUGDQ WDQHVL PHFEXUL DQDHURS GL÷HU WDQHVL LVH IDNOWDWLI
DQDHURS LGL (Q VÕN UDVWODQDQ PLNURUJDQL]PDODU PHFEXUL DQDHURELN VWUHSWRNRNODU YH
PrevotellaODUGÕ $QWLEL\RWLN GX\DUOÕOÕN WHVWOHULQH J|UH UH\HQ PLNURRUJDQL]PDODUÕQ
DPR[LFLOOLQ FODYXODQLF DFLG YH PDNUROLG JUXEX DQWLEL\RWLNOHUH GDKD GX\DUOÕ ROGXNODUÕ
tespit edildi.
Anahtar sözcük:*PúDQRWHQGRGRQWLDPR[LFLOOLQFODYXODQLFDFLG
-III-
6
IV- ABSTRACT
SILVER ANODE TREATMENT ON DENTAL ABSCESSES
Pure silver metal has antibacterial effect enhances approximately 100 times
when silver is combined with positive pole of a low electric current. Silver anode was
used by ortopaedists in deep bone infections as an antimicrobic agent which was
postulated it's low toxicity and tissue compatibility. In this study, to disinfect root canals
of teeth by a silver anode and to predict the most effective antibiotic(s) in dental
abscesses was aimed.
Fifty eight teeth of 46 patients (age range 16-60) was treated a silver electrode.
A removable applience that was included a silver watch battery was applied into mouth
throughout 4 succesive days.
Microbiological detection was made before, after and 2 times of one week
intervals of silver anode procedure. Disinfection was provided in 44 of 58 (75.8%)
teeth. A satisfactory radioopacity was demonstrated in 17 teeth. Disinfection was not
obtained in 14 teeth, 4 of them were extracted because of acute infection.
Totally 90 strains were isolated. 73 strains (81%) was strickly anaerobic, other
17 (18.9%) was facultative anaerobic. Most prevalan strains were anaerobic
streptococci and Prevotella sp.. Amoxicillin + clavulanic acid and macrolid group was
found to be more effective on all isolates.
Keywords: Silver anode, endodontics, amoxicillin + clavulanic acid
-IV7
*ø5øù9($0$d
'LúLQanatomo-fizyolojisi:
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YHULOHQGDPDUYHVLQLUGHQ]HQJLQELUED÷
GRNXVXEXOXQXU%XGRNX\DNDQDNÕPÕGLú
kökünün apeksinde bulunan foramen
apikale yoluyla gelir. Pulpa dokusu kök
boyunca genellikle oval kesitli bir ana
kanal (N|NNDQDOÕ) içerisinde bulunur. Bu
NDQDO NXURQGD JHQLúOH\HUHN pulpa
RGDVÕQÕ PH\GDQD JHWLULU Pulpa, dentin
GRNXVX LOH oHYULOPLúWLU 'HQWLQ WEOHU
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KDULFL HWNHQOHUH J|UH GH÷LúLU Pulpaya ùHNLO .N N|N NDQDOÕ &6- &HPHQWR-Enamel Junction; S,
ÕúÕQVDO NRQXPGD \HUOHúPLú PP2 de sement; D, dentin; P, pulpa; O, odontoblast; Ou,
X]DQWÕ ,G LQWHUWXEXOHU GHQWLQ $) DSLNDO
LOHDUDVÕQGDGH÷LúHQVD\ÕGD RGRQWREODVWLN
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NDQDOFÕNODUÕLoHULVLQGHodontoblastDGÕYHULOHQKFUHOHULQX]DQWÕODUÕ\HUDOÕU2GRQWRblastlar
SXOSDQÕQ SXOSD-GHQWLQ VÕQÕUÕQD \DNÕQ E|OJHVLQGH SXOSR-dentinal membran) bulunurlar ve
HPEUL\RORMLNJHOLúLPOHULVÕUDVÕQGDSXOSDGDQIDUNOÕODúDQKFUHOHUGLU%XKFUHOHULQX]DQWÕODUÕ
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bulunur. Dentin, kuronda mine, kök yüzeyinde ise sement WDEDNDVÕ LOH |UWOU 6HPHQW
periodontal ligamanODU DUDFÕOÕ÷Õ LOH DOYHRO NHPL÷LQH ED÷ODQÕU %|\OHFH GLúOHU DOYHRO
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GRNXVXQD XODúÕU YH GLú N|N DSVHVLne (apikal enfeksiyon) sebep olurlar. Apikal
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alevlenmeler (subakut apikal apseler) yapabilirler.
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2. GENEL BøLGøLER
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GH÷LOGLU 6LVWHPLN DUMLUL LVH LQKDODV\RQ YH\D \XWPDNOD PH\GDQD JHOHELOLU YH DQFDN
endüstriyel sahada görülebilir.
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ELU HWNLVL YDUGÕU %XQD oligodinamik etki DGÕ YHULOLU /RNDO DQWLVHSWLN RODUDN \DQÕN
\DUDODUÕQGD YH J|] HQIHNVL\RQODUÕQGD NXOODQÕOPDVÕQÕQ VHEHEL EXGXU 6RQ \LUPL \ÕOD
9
NDGDU GLúOHULQ N|N NDQDOODUÕ LoHULVLQGH JPú NRQODU NXOODQÕOPDNWD LNHQ GDKD VRQUD
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(OHNWULNDNÕPÕ
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WDUDIÕQGDQ\DSÕOPÕúWÕU%HFNHUKDVDUOÕGRNXQXQL\LOHúPHVLVÕUDVÕQGD\DUD\]H\LQGH
ROXúDQ —$FP2 \R÷XQOXNOX ELU HOHNWULN DNÕPÕQÕQ YDUOÕ÷ÕQÕ J|VWHUPLú YH EXQX cilt
EDWDU\DVÕ VNLQ EDWWHU\ RODUDN WDQÕPODPÕúWÕU37 +DVDUOÕ GRNXQXQ L\LOHúPHVL
WDPDPODQÕQFDGDEXDNÕPÕQND\EROGX÷XQXJ|VWHUPLúWLU&LOWEDWDU\DVÕQÕQ\DUDL\LOHúPH
ROJXVXQXQ ELU LWLFL JF ROGX÷X GúQOPúWU .HUWHQNHOHQLQ NHVLOHQ NX\UX÷XQXQ
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\DSÕODQ oDOÕúPDODUGD NURQLNOHúHQ YH\D L\LOHúPHVLJHFLNHQ\DUD\]H\LQHGÕúND\QDNOÕ
ELU
HOHNWULN
DNÕPÕ
X\JXODQGÕ÷ÕQGD
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L\LOHúPHQLQ
KÕ]ODQGÕ÷Õ
J|VWHULOPLúWLU35,36,37,61,64 %LU JQON úDUM PLNWDUÕ FRXORPE
X FRXORPE DPSHU [
VDQL\HJHoPHGL÷LQGHFDQOÕGRNX\DX\JXODQDQHOHNWULNDNÕPÕQÕQHWNLOHULúXQODUGÕU37:
Negatif kutup:
1HJDWLI\NOROGXNODUÕLoLQSURWHLQOHULWLOLUE|\OHFHRQNRWLNEDVÕoGúHU|GHPD]DOÕU
1HNURWLNGRNXGDOL]LVROXúXU
*) Granülasyon dokusu desteklenir,
.DQGRODúÕPÕKÕ]ODQÕU
)LEUREODVWSUROLIHUDV\RQXKÕ]ODQÕU21,
*) Kollajen sentezi artar21,
*) Epitel hücreleri ve nötrofiller dokuya davet edilir36,
1|UDOGRNXGDWDPLUROD\ÕKÕ]ODQÕU91.
*) Osteoblastik aktivite desteklenir24,26,30,77,94
Pozitif kutup:
(SLWHO\DOE\PHYHRUJDQL]DV\RQKÕ]ODQÕU
*) VazokonstrüksiyonROXúXU
*) Proteinlerin denaturasyonu artar,
*) Lipid peroksidasyonu engellenir,
*) Mast hücreleri itilir61,
+LVWDPLQVDOÕQPDVÕVÕQÕUODQÕU
*) Makrofajlar davet edilir,
*) Virusit51, bakterisit13,30,35,63,64,78,77,76,84,85,86, fungusit16, ve antitümöraldir 17,74 ,
*) cAMP ve Prostoglandin E sentez ettirilir, osteolitiktir29,
%XHVDVODUGR÷UXOWXVXQGDHOHNWULNDNÕPÕX\JXODPDODUÕJHQHWLNERWDQLNRUWRSHGL
YH PLNUREL\RORMLGH JHQLú NXOODQÕP DODQODUÕ EXOPXúWXU %R]XN \L\HFHN PDGGHOHULQLQ
tesbiti, neoplastik ROXúXPODUÕQ HOLPLQDV\RQX FLOW OVHUOHULQLQ WHGDYLVL ]HULQH \D\ÕQODU
YDUGÕU37 1RUWRQ YH 'DYLGRYLW]FK KÕ]ODQGÕUÕOPÕú RUWRGRQWL\L VD÷ODPÕúWÕU29,57. Steiner
GHQWDO LPSODQW ILNVDV\RQX ]HULQH oDOÕúPÕúWÕU80. Periodontal kemik defektleri üzerine
HOHNWULN DNÕPÕ X\JXODQDUDN L\LOHúPH KÕ]ODQGÕUÕOPÕúWÕU45 $\UÕFD SHN oRN NURQLN FLOW
OVHUOHUL YH RVWHRP\HOLW YDNDODUÕ EX \RO LOH WHGDYL HGLOPLúWLU14,83,88. Bütün bu etkilerin
ROXúDELOPHVL LoLQ X\JXODQDQ HOHNWULN DNÕPÕ SDUDPHWUHOHUL ]HULQH GH SHN oRN oDOÕúPD
\DSÕOPÕú YH HVDV RODUDN &RXORPEJQ GR]XQXQ DúÕOPDPDVÕ ]HULQGH ILNLU ELUOL÷LQH
YDUÕOPÕúWÕU91.
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HQ D] DNÕP \R÷XQOX÷XQGD YH HQ X]XQ VUH\H \D\ÕOPDVÕ WDYVL\H HGLOPLúWLU17. Belirli bir
PLNWDU HOHNWULN \NQ oRN NÕVD ELU ]DPDQGD X\JXODPDN VXUHWL\OH GDKD D] EDúDUÕOÕ
VRQXoODU HOGH HGLOPLúNHQ D\QL HOHNWULN \NQ ]D\ÕI DNÕP úLGGHWLQGH YH X]XQ VUH
10
X\JXODPDN VXUHWL\OH GDKD EDúDUÕOÕ VRQXoODU DOÕQPÕúWÕU %XQD J|UH FDQOÕ GRNX\D
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,ON GHID \ÕOÕQGD )XNDGD YH <DVKXGD WDUDIÕQGDQ LQVDQ NHPL÷LQLQ
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DNÕPÕ ROXúXU SLH]RHOHNWULN YH EX DNÕP NHPL÷LQ \HQLGHQ úHNLOOHQPHVLQGHQ YH KDVDU
J|UG÷QGH GH WDPLULQGHQ VRUXPOXGXU22,28. .HPLNWHNL HOHNWULN UHWLPL ND\QD÷ÕQÕ
NROODMHQ PDWULVWHQ DOÕU65 YH PHNDQL]PDVÕ +RRNH NDQXQX LOH DoÕNODQÕU .HPLNWHNL
SLH]RHOHNWULNUHWLPLWHUVLQHELOLU\DQLEDVÕQoLOHROXúDQPLNWDUGDHOHNWULNDNÕPÕNHPL÷H
GÕúDUÕGDQ X\JXODQGÕ÷ÕQGD NHPLNWH úHNLO GH÷LúLPOHUL ROXU .HPL÷LQ EX |]HOOL÷LQGHQ
ID\GDODQÕODUDN NÕUÕN NHPLN \]H\OHULQH GÕú ND\QDNOÕ HOHNWULN DNÕPÕ X\JXODQPÕú YH
QHJDWLI NXWXS DOWÕQGD NHPLN \DSÕPÕ KÕ]ODQGÕUÕOPÕúWÕU24,71,75,83,94. Ortopedistlerin bu
NRQXGDNL EDúDUÕOÕ oDOÕúPDODUÕ D÷Õ] LoHULVLQGHNL GLúOHUH HOHNWULN DNÕPÕ X\JXODPDVÕQD
cesaret verecek niteliktedir14,83,88.
$÷Õ] VHUW GRNXODUÕQGD GD EHQ]HU ELU SLH]RHOHNWULN UHWLPL YDUGÕU %LU 1HZWRQOXN
PHNDQLN \NH NDUúÕOÕN VHPHQW GRNXVX S& GHQWLQ GRNXVX S& YH DOYHRO
NHPL÷L S& HOHNWULN \N üretir52 (pC = pico-coulomb). Mekanik kuvvetler ancak
GLúOHU YH GLúOHULQ SHULRGRQVL\XPODUÕ YDVÕWDVÕ LOH DOYHRO NHPL÷LQH LOHWLOLU %X VHEHSOH
DQFDNGLúOHULQEXOXQGX÷XoHQHNHPLNOHULQGHSLH]RHOHNWULNUHWLOHELOLU
$÷Õ]GRNXODUÕQDHOHNWULNDNÕPÕX\JXODPDVÕWDPDPHQGÕúND\QDNOÕELUPGDKDOH
ROPD\ÕS DVOÕQGD D÷Õ] VHUW GRNXODUÕQGD ]DWHQ PHYFXW RODQ HOHNWULN \NOHULQLQ
UHRU\DQWDV\RQX úHNOLQGHGLU %X GúQFH D÷Õ] LoHULVLQGH \HU DODQ GLúOHUH JPú DQRW
X\JXODPDVÕQÕQEL\RORMLN]DUDUVÕ]OÕ÷ÕQDWHPHOROXúWXUXU
2.3 GüPúDQRW
*Pú DQRW GH\LPL ELU HOHNWULN ND\QD÷ÕQÕQ SR]LWLI NXWXSXQD ED÷ODQPÕú VDI ELU
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DQWLIXQJDO HWNL J|VWHUGL÷L ELOLQPHNWHGLU $QWLPLNURELN HWNLQLQ ND\QD÷Õ PHWDOLQ
yü]H\LQGHQRUWDPDGLI]\RQ\ROXLOH\D\ÕODQJPúL\RQODUÕGÕU72,73.
2UWDPD \D\ÕODQ JPúQ ROLJRGLQDPLN |]HOOL÷L YDUGÕU YH HOHNWULN DNÕPÕ X\JXODQPDVD
ELOH VDI JPú WHOLQ oHYUHVLQGH ]D\ÕI ELU DQWLPLNURELN HWNL ]DWHQ YDUGÕU )DNDW JPú
telin pozitif yönde SRODUODQPDVÕ HOHNWURW \]H\LQGHQ GDKD ID]OD PLNWDUGD JPú L\RQ
emisyonuna sebep olur ve antimikrobik etki artar. %X ROD\ ELU L\RQWRIRUH] GH÷LOGLU
dQN HOHNWULN DNÕPÕ EHOLUOL ELU VHYL\HQLQ ]HULQH oÕNDUÕOVD ELOH HPLV\RQD X÷UD\DQ
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DNÕPÕQÕQ E\NO÷ LOH GR÷UX RUDQWÕOÕ RODUDN DUWDU60 *Pú L\RQODUÕQÕQ DQRWWDQ
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EXOPDNWDGÕUhVWHOLN$J-AgCl elektrotlar fevkalade stabildir ve "referans elektrot" olarak
NDEXOJ|UHQHOHNWURWVLVWHPLQGHQELULVLQLROXúWXUXUODUGL÷HULNLVL6+( -Standart Hidrojen
Elektrot- ve Calomel elektrot sistemidir).
11
*Pú DQRW LOH HOGH HGLOHQ DQWLPLNURELN HWNLQLQ HQ úDúÕUWÕFÕ |]HOOLNOHULQGHQ ELU
WDQHVL HOHNWULN DNÕPÕ NHVLOVH ELOH X\JXODQGÕ÷Õ RUWDPGDNL DQWLPLNURELN HWNLQLQ GHYDP
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doku kültürlerinde 10 hafta boyunca
UHPH ROPDPDNWDGÕU %X GHQH\
ER\XQFD NOWU VÕYÕVÕ KDIWDGD GHID
GH÷LúWLULOPLúWLU51 %X GD JPú DQRW LOH
elde edilen antimikrobik etkinin uzun
VUHOLROGX÷XQXJ|VWHUPHNWHGLU
øoHULVLQH EDNWHULHNLOPLúELUDJDU
EHVL\HULQHJPúHOHNWURWODU\HUOHúWLULOLS
]D\ÕI ELU HOHNWULN DNÕPÕ LOH -2 saat
ER\XQFD
SRODUODQGÕ÷ÕQGD
JPú
anodun çevresinde 8- PP oDSÕQGD
bir
inhibisyon
zonu
meydana
gelmektedir10,11 (OHNWULN DNÕPÕ NHVLOVH
bile bu zon en az 2 ay steril olarak
NDOPDNWDGÕU *Pú WHO -45 dakika
78
ùHNLO*PúHOHNWURWXQSRODUL]DV\RQH÷ULVL .
süreyle anodize edilip daha sonra
EDNWHUL HNLPL \DSÕOVD ELOH DQRW
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LQKLELV\RQGD PLQ|U URO R\QDGÕ÷ÕQÕ J|VWHUPHNWHGLU $QWLPLNURELN HWNLQLQ DVÕO ND\QD÷Õ
RUWDPD GLI]H RODQ JPú L\RQODUÕ YH EX JPúQ ROXúWXUGX÷X HOHNWURNLP\DVDO
ELOHúLNOHUGLU %X JPú ELOHúLNOHULQLQ E\N NÕVPÕ SURWHLQDW YH GDKD D] ELU NÕVPÕ LVH
NORULW NRPSOHNVOHULGLU dRN GDKD D] ELU NÕVPÕ LVH QRQ-stabil ve atipik komplekslerdir.
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GH÷LúWLUPHGL÷LQLJ|VWHUPLúWLU53%XGHQH\LQVRQXoODUÕQDJ|UHPJ'1$\D—PRO
JPú ED÷ODQÕUNHQ PJ 51$\D —PRO JPú ED÷ODQPÕú EDNWHUL KFUHVLQLQ
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fumarate, succinate, D- ve L-ODFWDWH RNVLWOHQLUNHQ VHUEHVW VXOSK\GU\O JUXSODUÕ YH
1$'+
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gQoDOÕúPD-1:
dXNXURYD hQLYHUVLWHVL 7ÕS )DNOWHVL 0LNUREL\RORML $QDELOLP GDOÕQGD \DSÕODQ ELU
|Q oDOÕúPDGD JPú L\RQODUÕQÕQ DJDU RUWDPÕQGDNL HPLV\RQ oDSODUÕ YH P. aeruginosa
]HULQH HQJHOOH\LFL HWNLVL LQFHOHQPLúWLU %X DPDoOD VR÷XPDNWD RODQ PO (QGRDJDU
içerisine 2.8x103 CFU konsantrasyonda P. Aeruginosa inoküle edilerek 4 tane standart
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msec) kare dalga akÕP 64: X\JXODQPÕú YH EX LúOHPH VDDW ER\XQFD GHYDP
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12
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(mm)
14
0
22
11
7
0
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Inhibisyon zonu
(mm)
12
DC anot
0
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15
SQW anot
6
SQW katot
Sham elektrot 6
0
Kontrol
MIC
(µg Ag x ml-1)
2.16
1.40
1.50
2.32
-
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10
.
-A-
-B-
13
-D-
P. aeruginosa hücrelerindeki
. A, kontrol grubu hücreleri
(x40.000); B, vakuolizasyon (x40.000); C, pili defekti
(x80.000); D, kusurlu bölünme (x100.000)
ùHNLO*PúDQRWX\JXODQPÕú
XOWUDVWUNWUHO
10
GH÷LúLPOHU
-C-
gQoDOÕúPD-2:
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YH DVVHPEOHU NWSKDQHVL LOH \D]ÕOPÕú ROXS EDNWHUL LGHQWLILNDV\RQXQGD HVDV DOÕQDQ
VWDQGDUW IL]\RORMLN YH EL\RNLP\DVDO WHVWOHULQ WDQHVLQL NXOODQDELOPHNWHGLU dR÷X RUDO
patojen olan 440 adet bakterinin biyokimyasal testlerini gösteren tablolar bilgisayara
JLULOGL ùSKHOL EDNWHULQLQ WHVW VRQXoODUÕ EX SURJUDPD JLULOGL÷LQGH KÕ]OÕ YH GR÷UX
identifikasyon yapabilmektedir8%XoDOÕúPDXOXVODUDUDVÕDUúLYOHUGH*DUERYH6LP7HO
sergilenmektedir7.
gQoDOÕúPD-3:
dXNXURYDhQLYHUVLWHVL7ÕS)DNOWHVL0LNUREL\RORML$QDELOLPGDOÕQGD\DSÕODQELUEDúND
|Q oDOÕúPDGD JPú DQRW X\JXODPDVÕQGD HOHNWULN DNÕPÕQÕQ EDNWHUL PHWDEROL]PDVÕQD RODQ
HWNLVLLQFHOHQPLúWLU%XoDOÕúPDGDWHVDGILRODUDNVHoLOPLúG|UWEDNWHUL|UQH÷L(Citrobacter freundii,
Enterobacter aerogenes, Pseudomonas aeruginosa ve Proteus vulgaris) LNL JQ ER\XQFD JPúDQRWD
PDUX]NDOPÕúWÕU,QKLELV\RQ]RQODUÕGÕúÕQGDQWRSODQDQEDNWHUL|UQHNOHULQLQVWDQGDUWIL]\RORMLNYH
biyokimyaVDO WHVWOHUH YHUGLNOHUL FHYDSODU LQFHOHQPLúWLU %DNWHUL |UQHNOHULQLQ EDúODQJÕoWD
J|UOHQ EL\RNLP\DVDO |]HOOLNOHULQLQ E\N |OoGH IDUNOÕODúWÕ÷Õ J|UOPúWU %X GH÷LúLPOHUL
L]OH\HELOPHN LoLQ |Q oDOÕúPD- GHNL ELOJLVD\DU SURJUDPÕ NXOODQÕOPÕúWÕU *Pú DQRWD maruz
kalan bakteri örneklerinin fenotiplerinin 10 ile 32 OTU (Operational Taxonomic Unit) DUDVÕQGD
IDUNOÕOÕNJ|VWHUGL÷LWHVSLWHGLOPLúWLU%XEDNWHULOHULQTXLQRORQJUXEXDQWLEL\RWLNOHUHE\N|OoGH
GX\DUOÕOÕNND]DQGÕ÷ÕGDJ|UOPúWU11*PúDQRWDPDUX]NDOGÕNWDQVRQUDD\QLEDNWHULQLQ
D\QL EL\RNLP\DVDO WHVWOHUH IDUNOÕ UHDNVL\RQODU YHUPHVL VHOOHU GHIHNWLQ NDOÕFÕ ROGX÷XQX
J|VWHUPHNWHGLU /ÕWHUDWUGH GH EHQ]HU IHQRWLS GH÷LúLPOHUL UDSRU HGLOPLúWLU20,34,70,79. Bu ön
oDOÕúPDQÕQVRQXoODUÕQDEDNDUDNGLúLQN|NNDQDOÕLoHULVLQHJPúDQRWX\JXODPDVÕQÕWDNLEHQ
N|N NDQDO VLVWHPLQGHNL EDNWHULOHULQ NDOÕFÕ RODUDN HWNLOHQHFH÷L VRQXFXQD YDUGÕN %X VHEHSOH
JPú DQRW X\JXODQPÕú EDNWHUL |UQHNOHULQH LGHQWLILNDV\RQ YH DQWLEL\RWLN GX\DUOÕOÕN WHVWOHUL
yapmamaya karar verdik.
gQoDOÕúPD-4:
<DSWÕ÷ÕPÕ] ELU EDúND |Q oDOÕúPD12 LVH JPú DQRWXQ DQWLIXQJDO HWNLVL ]HULQHGLU
$÷Õ]GD VÕNOÕNOD UDVWODQDQ C. albicans hücreleri 510 nm'de optik dansitesi 20 olacak
NRQVDQWUDV\RQGDKD]ÕUODQÕSVR÷XPDNWDRODQ6DERXUDXGDJDULoHULVLQHLQRNOHHGLOPLúYH
14
JQ ER\XQFD JPú DQRWD PDUX] EÕUDNÕOPÕúWÕU ,QKLELV\RQ ]RQX ]HULQGHQ DOÕQDQ PD\D
KFUHOHUL HOHNWURQ PLNURVNRSXQGD LQFHOHQPLú YH EDNWHULOHUGHNLQH EHQ]HU úHNLOGH
YDNXROOHQGLNOHULJ|UOPúWU2VPRWLNGHQJHQLQER]XOPDVÕQDED÷OÕRODUDNPD\D hücrelerinde
OL]LV J|UOPúWU +FUH KDVDUÕQÕQ XOWUDVWUNWUHO LQFHOHPHVL LOH ELU NDo DQWLIXQJDO NLP\DVDO
PDGGHQLQHWNLVLQLQD\QÕDQGDROXúWX÷XQXJ|UPHNPPNQROPXúWXU.DQGLGDKFUHOHULQGH
tespit edilen hasar hücre içerisinde kitin sentezinde koordinas\RQXQ ER]XOGX÷XQX
GúQGUPHNWHGLU33,54,56%XúHNLOGHNLKFUHKDVDUÕ6DSHUFRQD]ROHYH,WXULQ$JLELDQWLIXQJDO
LODoODUÕQHWNLVLQHEHQ]HPHNWHGLUùHNLO%XoDOÕúPDGDNXOODQÕODQDJDUEHVL\HULQLƒ&GH
D\EHNOHWPHPL]HUD÷PHQLQKLELV\RQ]RQXoDSÕQGDELUGDUDOPDROPDGÕ÷ÕQÕJ|UGNAntifungal
HWNLQLQGHLUUHYHUVLEÕOROGX÷XVRQXFXQDYDUGÕN
-B-
-A-
-C-
15
-D-
C. albicans KFUHOHULQGHNL XOWUDVWUNWUHO GH÷LúLPOHU $ .RQWURO JUXEXQGDQ DOÕQDQ
33
C. albicans KFUHOHUL [ % *Pú DQRW X\JXODPDVÕQÕ WDNLEHQ J|UOHQ RWRIDMLN YDNXROOHU
(x100.000); C,
33,56
VLWRSOD]PLN VÕ]ÕQWÕ YH vakuolizasyon (x80.000);
GÕú GXYDUÕQ DOWÕQGD LQWUDVLWRSOD]PLN LQNO]\RQODU RUWD\D oÕNWÕ
56
DQFDN GÕú GXYDUGD EHOLUJLQ ELU KDVDU J|UOPHGL
(x120.000). %X IRWR÷UDIODU PD\D KFUHOHULQLQ HOHNWURQ
ùHNLO *Pú DQRW X\JXODQPÕú
PLNURVNRSLVL ]HULQH oDOÕúDQ ELOLUNLúLOHUH LQWHUQHW DUDFÕOÕ÷Õ J|QGHULOPLú YH RQODUÕQ GúQFHOHUL
DOÕQPÕúWÕUYHQROXND\QDNODUEXúHNLOGHHOGHHGLOPLúWLU
/LWHUDWU ELOJLOHUL DQRGLN JPúQ DQWLEDNWHUL\HO HWNLVLQLQ QRQSRODU JPúWHQ
GDKD ID]OD ROGX÷XQX LIDGH HWPHNWHGLU %X HWNL \DNODúÕN GHID GDKD ID]ODGÕU
$÷Õ]GDQ L]ROH HGLOHQ ELU S. aureus VXúX ]HULQH JPúQ PLQLPXP LQKLELV\RQ
NRQVDQWUDV\RQX 0,& —JPO RODUDN EXOXQPXúWXU +DOEXNL JPú H÷HU ELUDQRWWDQ
JHOL\RU LVH D\QL EDNWHUL VXúX VDGHFH —JPO NRQVDQWUDV\RQXQGD LQKLEH
olabilmektedir.
Tablo.II
16,17
%D]ÕEDNWHULYHPD\DODULoLQPHWDOLNYHDQRGLNJPúQ0,&GH÷HUOHUL
S. aureus
E. coli
P. stuartii
P. mirabilis
P. aeruginosa
S. odorifera
D grup Strept.
E. cloacae
Ag MIC (µg/ml)
25
3.13
12.50
1.56
1.56
3.13
50
400
C. albicans
C. albicans I
T. glabrata
C. tropicalis
C. parapsilosis
100
>100
400
>100
>100
Anodik Ag MIC (µg/ml)
0.25
1.03
0.13
0.08
0.31
0.08
0.63
3
0.5
3.5
1.6
1
4.7
/LWHUDWUGHJPúDQRWXQDQWLPLNURELNHWNLVLQLQEDNWHULVD\ÕVÕQDED÷OÕROPDGÕ÷Õ
bildirilmektedir72,73 )DNDW oDOÕúPDODUÕPÕ]GD EDNWHUL NRQVDQWUDV\RQX LOH JPú DQRWXQ
oHYUHVLQGH ROXúDQ LQKLELV\RQ ]RQX DUDVÕQGD ELU WHUV LOLúNL J|]OHQPLúWLU %DNWHUL
VD\ÕVÕQGDNLDUWÕúLQKLELV\RQ]RQXQXGDUDOWPÕúWÕU%LUDQWLPLNURELNPDGGHQLQoHYUHVLQGH
ROXúDQ LQKLELV\RQ ]RQX oDSÕ LOH DQWLPLNURELN HWNL DUDVÕQGD PXWODN ELU LOLúNL YDUGÕU %X
LOLúNL GLNNDWH DOÕQGÕ÷ÕQGD EDNWHUL VD\ÕVÕQÕQ ID]OD ROPDVÕ EDNWHULOHULQ JPú DQRWWDQ
HWNLOHQPHOHULQLD]DOWÕ\RUROPDOÕGÕU
GüPú DQRWXQ DQWLEDNWHUL\HO HWNLVL JHQLú VSHNWUXPOXGXU /LWHUDWUGH IDUNOÕ
EDNWHULOHU]HULQGH\HWHUOLVD\ÕGDoDOÕúPDYDUGÕUYHEXQODUGDJPúDQRWDGLUHQoOLELU
EDNWHUL VXúX LIDGH HGLOPHPHNWHGLU *HQLú DQWLPLNURELN VSHNWUXPX DQHURSODUÕ GD
LoHULVLQHDOÕUEXVHEHSOHDQWLPLNURELNHWNLRUWDPGDNLRNVLMHQYDUOÕ÷ÕQDED÷ÕPOÕGH÷LOGLU
%DNWHULQLQ KDQJL PHWDEROLN \ROODUGDQ HQHUML WHPLQ HWWL÷LQH GH ED÷OÕ GH÷LOGLU13.
0LNURRUJDQL]PDODU ]HULQH E|\OHVLQH JHQLú VSHNWUXPGD HQJHOOH\LFL HWNLVLQH UD÷PHQ
JPúDQRWXQPHPHOLKFUHOHUL]HULQHNDOÕFÕYH]DUDUOÕELUHWNLVLJ|]OHQPHPLúWLU17.
$úÕUÕ GR]GD X\JXODQPDVÕ KDOLQGH PHPHOL KFUHVLQLQ PHPEUDQ SHUPHDELOLWHVLQGH
]D\ÕIoD ELU DUWÕú WHVELW HGLOPLú DQFDN EXQXQ JHUL G|QúPO ROGX÷X J|VWHULOPLúWLU17.
'RNXNOWUQGH\DSÕODQoDOÕúPDODUGDLVHHOHNWULNDNÕPÕQÕQJHoLú\|QQHSDUDOHORODUDN
16
KFUHOHULQURWDV\RQDX÷UDGÕNODUÕJ|VWHULOPLúWLU$QFDNFDQOÕGRNXGDEXOXQDQLQWHUVHOOHU
\DSÕODUKFUHVHOURWDV\RQDHQJHORODFD÷ÕQGDQE|\OHELUHWNLLQYLYRRODUDNJ|UOPH]En
D]ÕQGDQE|\OHELUHWNLkemik dokusu için beklenmez.
*Pú NDWRW LVH JPú DQRWXQ WHUVLQH RVWHRMHQLNWLU71,77 %X |]HOOL÷L
J|VWHULOGLNWHQ VRQUD RUWRSHGLVWOHU NURQLN RVWHRP\HOLW YDNDODUÕQGD JPú DQRW GÕúÕQGD
JPú NDWRW GD NXOODQPÕúODUGÕU 8\JXODQDQ WHGDYL\H \HWHUOL FHYDS YHUPH\Hn ve
L\LOHúPHVLQGHQ E\N |OoGH XPXW NHVLOPLú RVWHRPL\HOLW YDNDODUÕ ]HULQGH \DSÕODQ
oDOÕúPDODUGDNRQWUROJUXEXQDNÕ\DVODEDúDUÕHOGHHGLOPLúWLU%XX\JXODPDODUGDHQIHNWH
NHPLNORFDVÕQDLQYD]HHGLOHQVDIJPúHOHNWURWDGÕúDUÕGDQ]D\ÕIELUHOHNWULNDNÕPÕQÕQ
pozitif kutbu uygulanmakta ve 2- JQ VRQUD HQIHNWH NHPLN E|OJHVLQLQ \ÕNDPD
VX\XQGDQ \DSÕODQ NOWUOHUGH UHPHQLQ D]DOGÕ÷Õ YH\D KLo ROPDGÕ÷Õ J|VWHULOPHNWHGLU
Daha sonra kutuplar ters çevrilerek, kemik içi lezyona temas eden elektrot katodize
edilmektedLU %X X\JXODPDQÕQ YH QF KDIWDVÕQGD UHRVVLILNDV\RQ NHPLN
dokusunda radyolojik olarak gösterilebilmektedir14,83,88. Halen, Syracuse Health
&HQWHU
GD UXWLQ RODUDN JPú HOHNWURW X\JXODPDODUÕ \DSÕOPDNWDGÕU %X WLS YDNDODUGD
SUHQVLS RODUDN JPú DQRW X\JXODPDVÕQÕ KHPHQ WDNLEHQ JPú NDWRW
X\JXODQPDNWDGÕU )DNDW oDOÕúPDPÕ]GD VDGHFH PLNUREL\RORMLN KHGHIOHU VHoWL÷LPL]GHQ
HQIHNWHGLúOHUHJPúNDWRWX\JXODPDGÕN/LWHUDWUoDOÕúPDODUÕJHUHNWL÷LQGHN|NNDQDOÕ
LoHULVLQH JPú NDWRW X\JXODQDUDN SHULRGRQWDO Ye periapikal dokuda) yeni kemik
\DSÕPÕQÕQVD÷ODQDELOHFH÷LQLGHGúQGUPHNWHGLU
3UHQVLS RODUDN RUWRSHGLVWOHULQ EX EDúDUÕOÕ oDOÕúPDODUÕ JHUoHNWH ELU NHPLN LoL
HQIHNVL\RQ RODQ GLú N|N DSVHOHULQLQ JPú DQRW LOH WHGDYLVLQH ED] ROXúWXUPDNWDGÕU
Zaten bu çaOÕúPDQÕQEDúODWÕOPDVÕRUWRSHGLVWOHULQEDúDUÕOÕX\JXODPDODUÕVHEHEL\OHGLU
(QIHNWHN|NNDQDOÕIORUDVÕYHHNRORMLVL
$÷Õ]IORUDVÕGHQID]ODPLNURRUJDQL]PDWUQEDUÕQGÕUGÕ÷ÕKDOGHHQIHNWHN|N
NDQDOÕIORUDVÕQGD\DNODúÕNJHQXVWHVSLWHGLOHELOPLúWLr81. Bu da göstermektedir ki kök
NDQDOÕQÕQJD\HWVHoLFLELUHNRORMLVLYDUGÕUYHEXUDGDDQDHURSODUKDNLPGLU6XQGTXYLVW
H
J|UHHQIHNWHN|NNDQDOÕQGDEXOXQDELOHFHNEDNWHULOHUYHEXOXQPDVÕNOÕNODUÕú|\OHGLU81:
Fusobacterium nucleatum (%48), Porphyromonas (Bacteroides) genusunun
asakkarolitik üyeleri (%35), Prevotella (Bacteroides) intermedia (%34),
Peptostreptococcus micros (%34), Eubacterium alactolyticum (%34), Lactobacilli
(%32), Peptostreptococcus anaerobius (31), Eubacterium lentum 'L÷HU
Fusobacterium türleri (%29), Wolinella recta (%25), Streptococcus anginosus (%17),
GL÷HU Peptostreptococcus türleri (%15), Streptococcus mitis (%15), Actinomyces
israelii (%11), Eubacterium timidum (%11), Capnocytophage ochracea (%11),
Eubacterium brachy (%9), Prevotella buccae (%9), Porphyromonas endodontalis
(%9), Porphyromonas gingivalis (%9), Selenomonas sputigena (%9), Veillonella
parvula (%9), Propionobacterium propionicus (%8), Prevotella oris (%8), Eubacterium
nodatum (%6), Prevotella denticola (%6), Prevotella loescheii (%6).
Kök kanalÕQGD UDVWODQDELOHFHN GL÷HU PLNURRUJDQL]PDODU LVH úXQODUGÕU
Streptococcus mutans, S. sanguis, S. morbillorum, Enterococcus faecalis GL÷HU
Streptokoklar, Peptostreptococcus niger, P. prevotii, Actinomyces meyerii, A.
naeslundii, A. odontolyticus, A. viscosus, Lactobacillus catenaforme, L. minitus ED]Õ
Propinobacterium türleri, sakkarolitik olan Prevotella (Bacteroides) grubu, Bacteroides
gracilis, B. ureolyticus, Porphyromonas gingivalis, Wolinella curva, Eikenella
corrodens, Enterobacter agglomerans ve Bifidobacteriumlar.
17
Stafilokok, Neisseria ve mantarlar ya çok nadir olarak bulunurlar veya
bulunmazlar. Mecburi aeroplar ise genellikle bulunmazlar82.
(QIHNWHELUN|NNDQDOÕQÕQHNRORMLNGHWHUPLQDQWODUÕúXQODUGÕU
'úPú YH\D GúPHNWH RODQ RNVLMHQ EDVÕQFÕ Enfeksiyon kurondaki bir çürükten
ND\QD÷ÕQÕ DOÕ\RU LVH NXURQ SXOSDVÕQGDNL RNVLMHQ EDVÕQFÕ N|N NDQDOÕQGDQ ELUD] GDKD
ID]ODGÕU(QIHNVL\RQNDSDOÕELUNXURQGDSXOSDQHNUR]XSHULRGRQWDODIHWYH\DUHWURJUDG
SXOSLWLVWHQ ND\QD÷ÕQÕ DOÕ\RU LVH JHQLúOH\HQ SHULRGRQWDO DUDOÕN VHEHEL\OH N|N NDQDOÕQÕQ
RNVLMHQEDVÕQFÕSXOSDRGDVÕQDRUDQODELUPLNWDUDUWPÕúRODELOLU+HULNLGXUXPGDGDHQ
D]RNVLMHQGHQWLQNDQDOFÕNODUÕLoHULVLQGHEXOXQXU
$] YH\D KLo ROPD\DQ NDQ GRODúÕPÕ +LSHUHPL YH VHU|] SXOSLWLVLQ HUNHQ ID]ÕQGa
NDSLOOHU GLODWDV\RQD DNWLI KLSHUHPL YH YHQ|] VWD]D SDVLI KLSHUHPL ED÷OÕ RODUDN NDQ
DNÕPÕ ELU PLNWDU DUWDU $QFDN HQIHNVL\RQXQ LOHUOH\HQ G|QHPOHULQGH GDPDU KDUDEL\HWL
VHEHEL\OH NDQ DNÕPÕ JLGHUHN D]DOÕU YH EWQ\OH GXUXU %R]XODQ NDQ DNÕPÕ RUWDPÕQ
redNVL\RQSRWDQVL\HOLQLQ(KYROWDMÕQÕQGúPHVLLOHVRQXoODQÕU
1HNURWLN ED÷ GRNXVX SXOSD ,VNHPLN SXOSD JLGHUHN QHNUR]H ROXU %X VÕUDGD N|N
NDQDOÕQÕQLoHULVLQGHQHNURWLNED÷GRNXVXNDOÕQWÕODUÕEXOXQXUYH(KYROWDMÕJLGHUHNGúHU
'HQWLQ NDQDOFÕNODUÕ LoHULVLQGH EXOXQDQ SURWHLQGHQ ]HQJLQ PDWHU\DO Dentin
NDQDOFÕNODUÕ LoHULVLQGH EXOXQDQ RGRQWREODVWLN KFUH X]DQWÕODUÕ OL]LVH X÷UDU 'HQWLQ OHQIL
SURWHROLWLNJUXSEDNWHULOHULoLQELUEHVLQND\QD÷ÕROXúWXUXUEDNWHULOHUWDUDIÕQGDQSXWULIL\H
degrade ve deamine edilir. Proteolitik anaerop bakteriler için cezbedici rol oynar.
3HULDSHNVWHQ NDQDO LoHULVLQH VHUXP VÕ]ÕQWÕVÕ Nekroze olan pulpadan periapikal
GRNXODUD VÕ]DQ ED÷ GRNXVXQXQ \ÕNÕP UQOHUL YH EDNWHUL\HO WRNVLQOHU SHULDSHNVWH
iritasyona ve kapiler dilDWDV\RQD VHEHS ROXU $UWDQ GDPDU SHUPHDELOLWHVL N|N NDQDOÕ
LoHULVLQHVHUXPVÕ]PDVÕQDVHEHSROXUVHUXPGLDSHGHVL*HoG|QHPGHEDNWHULOHULQHQ
|QHPOLEHVOHQPHND\QDNODUÕQGDQELULVLNDQDODVÕ]DQVHUXPSURWHLQOHULDOEPLQOHULGLU
6. Dentinin yüzeyine bakteriyel adezyon: Bakterilerin kalsifiye dentinin yüzeyine
DGH]\RQ NDELOL\HWOHUL N|N NDQDOÕ HNRORMLVL LoLQ DQFDN ELU PLQ|U IDNW|U RODUDN
GH÷HUOHQGLULOPHNWHGLU39,40,41,47.
7. Immun savunma: 6D÷OÕNOÕ SXOSD GRNXVXQGD 7 OHQIRVLWOHUL ,J* YH ,J(
QLQ
EXOXQDELOGL÷LJ|VWHULOPLúWLUIDNDW,J0,J$YH%OHQIRVLWOHULSXOSDGDQDGLUHQEXOXQXUODU5.
3XOSLWLVLQ HUNHQ G|QHPOHULQGH ELU PLNWDU DNXW NRQDN FHYDEÕ EXOXQVD ELOH LOHUOH\HQ
G|QHPOHUGHGDPDU\HWHUVL]OLNOHULVHEHEL\OHLPPXQFHYDSVÕQÕUOÕGÕU%XVHEHSOHNRQDN
FHYDEÕ VDGece apikal lezyonlar için enfeksiyon ancak prognozunu belirleyebilir fakat
N|NNDQDOÕIORUDVÕQÕQHNRORMLVL]HULQHSHND]HWNLVLYDUGÕU
%DNWHULOHUDUDVÕQGDNLHWNLOHúLPOHU
a. Bakteriosinler:%DNWHULRVLQOHUN|NNDQDOÕIORUDVՁ]HULQHROGXNoDEHOLUOH\LFidir.
P. endodontalis ve P. gingivalisin bakteriosinleri P. intermedia\ÕNXYYHWOHLQKLEHHGHU
%XVHEHSOHJHQHOOLNOHD\QÕIORUDGDELUOLNWHEXOXQPD]ODU
E .RPPHQVDO LOLúNLOHUProteinler, proteolitik grup bakteriler (Peptostreptococci, P.
intermedia, EubacteriumWDUDIÕQGDQSHSWLWOHUHG|QúWUOGNWHQVRQUDNDUERNVLOLNDVLW
amonyak ve H26 ROXúWXUXOXU <NVHN NRQVDQWUDV\RQGDNL DPRQ\DN EDNWHULOHU ]HULQH
WRNVLNHWNLJ|VWHUGL÷LKDOGHActinomycesOHULQD]RWND\QD÷ÕQÕROXúWXUXUP. gingivalis, P.
endodontalis ve P. intermediaKHPLQ
HED÷ÕPOÕPLNURRUJDQL]PDODUGÕUYHEXLKWL\DoODUÕQÕ
Wolinella rectaNDUúÕODU%HQ]HULOLúNLOHUùHNLO¶GHYHULOPLúWLU
18
%X
HWNLOHúLPOHULQ
sonucu
olarak,
enfekte kök kaQDOÕ
IORUDVÕQGDQ
L]ROH
edilen
mikro
RUJDQL]PDODU
HúLW
konsantrasyonlarda
NDUÕúWÕUÕODUDN
ELU
EDúND GLúLQ N|N
NDQDOÕQD
LQRNOH
edilseler bile yeni
ROXúDQ
GHQH\VHO
enfeksiyonda tekrar
RULMLQDO
RUDQODUÕQD
dönmektedirler81.
P. intermedia P. anaerobius, E.
lentum
P.
anaerobius,
P.
ùHNLO.|NNDQDOÕQGDNRPPHQVDOL]P
intermedia - P. micros
DUDVÕQGD EHOLUJLQ ELU
NRPPHQVDOLOLúNLQLQEXOXQGX÷XJ|VWHULOPLúWLU81.
F0HWDEROLNHWNLOHúLPOHU.|NNDQDOÕIORUDVÕQGDEXOXQDQEDNWHULOHUEDNWHULRVLQOHU
ROPDGDQ GD HWNLOHúLUOHU %D]Õ Streptokoklardan bir katDEROLN UQ RODUDN DoÕ÷D oÕNDQ
NDWDOD]RUWDPÕQ(KYROWDMÕQÕ\NVHOWHUHNED]ÕQDULQDQDHURSODUÕQUHPHOHULQLHQJHOOH\LFL
HWNL J|VWHULU %XQXQ HQ EHOLUJLQ |UQH÷L VWUHSWRNRNODUGDQ DoÕ÷D oÕNDQ NDWDOD]ÕQ B.
gracilis üzerine inhibe edici etkisidir. Bu bakteri genellikle P. gingivalisin hemin
ND\QDNODUÕQGDQ ELULVLQL ROXúWXUXU YH RNVLMHQH IHYNDODGH GX\DUOÕGÕU %X EDNWHULQLQ
VWUHSWRNRNODU WDUDIÕQGDQ VD\ÕVÕQÕQ D]DOWÕOPDVÕ GROD\OÕ RODUDN P. gingivalisLQGHVD\ÕVÕQÕ
D]DOWÕU
$\UÕFDNXYYHWOLDVLGRMHQRODQLeptotrichia ve LaktobasilJHQXVXS+
\Õ
HNDGDU
GúUHELOLU%XGXUXPED]ÕQDULQPLNURRUJDQL]PDODUÕQUHPHOHULQLHQJHOOHU
%LU EDúND LOLúNL N|N NDQDOÕ HQIHNVL\RQXQXQ oDSÕ LOH EDNWHUL oHúLWOLOL÷L DUDVÕQGD
YDUGÕU82 U dDSÕ NoN RODQ N|N NDQDOÕ HQIHNVL\RQODUÕQGD GDKD D] oHúLWOLOLNWH
PLNURRUJDQL]PD EXOXQXUNHQ JHQLú oDSOÕ HQIHNVL\RQODU GDKD ID]OD PLNURRUJDQL]PD
EDUÕQGÕUÕU
(QIHNWH ELU GLúLQ N|N NDQDOÕ IORUDVÕQGDQ L]ROH HGLOHELOHFHN DHURS EDNWHULOHUOH
\XNDUÕGDEHOLUWLOPH\HQGL÷HUEDNWHULOHULQIORUDQÕQJHoLFL\esi veya kontaminant olarak
\RUXPODQPDVÕ WDYVL\H HGLOPHNWHGLU81,87 %|\OH EDNWHULOHU HQIHNWH N|N NDQDOÕ IORUDVÕQGD
bulunsalar bile enfeksiyonun patogenezinde genellikle rol almazlar. Enfeksiyonun ilk
G|QHPLQGH E|\OH EDNWHULOHU EXOXQDELOLU %LU N|N NDQDOÕ Hnfeksiyonunda üç faz
D\ÕUGHGLOLU82
19
1. Faz: (UNHQ G|QHPGH RUWDPGDNL QHNURWLN GRNX DUWÕNODUÕQGDQ ND\QD÷ÕQÕ DODQ
karbonhidratlar fermente edilir, pirüvaW ODNWLN YH IRUPLN DVLWOHU DoÕ÷D oÕNDU %X ID]GD
floraya S. faecalis, S. mutans, S. mitis, S. salivarius gibi fakültatif anaerop bakteriler
KDNLPGLU $\UÕFD PLNURDHURILOLNOHU LaktobasilOHU GH EXOXQXU %X EDNWHULOHULQ oR÷X
sakkarolitiktir ve kuvvetli asiWROXúWXUXUODU2UWDPGDNLNDUERQ-KLGUDWODUÕQWNHQPHVLLOH
VUDWOHND\EROXUODUYH\DVD\ÕODUÕD]DOÕU
2. Faz: Bu fazda proteinler
SDUoDODQÕU NÕVPHQ DPLQR DVLWOHU
VHUXP ND\QDNOÕ JOLNRSURWHLQOHU YH
NDOPÕúVD NDUERQKLGUDWODU IHUPHQWH
edilir. Bu fazda P. intermedia,
Veillonella parvum ve Eubacterium
türleri floraya hakimdir.
3. Faz: Son fazda ilerleyen
SURWHLQ SDUoDODQPDVÕ YH DPLQR DVLW
IHUPHQWDV\RQX\HUDOÕUP. micros, F.
nucleatum ve Eubacteria floraya
hakimdir. Bu bakteriler asakkarolitik
olup amino asit fermentasyonu ile
HQHUMLVD÷ODUODU
%WQ EX EDNWHULOHU GLúLQ N|N
NDQDOÕ VLVWHPLQGH \D\JÕQ RODUDN
ùHNLO.|NNDQDOÕHQIHNVL\RQXQXQVDIKDODUÕ
EXOXQXUODU YH GHQWLQ NDQDOFÕNODUÕ
içerisinde
hemen
daima
oR÷DOPDODUÕQD \HWHFHN NDGDU EHVOHQPH ND\QD÷Õ EXODELOLUOHU dDOÕúPDPÕ]GD DQRGLN
JPúQ GHQWLQ NDQDOFÕNODUÕQD GLI]\RQX LOH HOLPLQH HWPH\H oDOÕúWÕ÷ÕPÕ] EDNWHUL
WRSOXOX÷XQXQ E\N ELU E|OPQ oQF ID]GD \HU DODQ DQDHURS YH SURWHROLWLN JUXS
EDNWHULOHUROXúWXUPDNWDGÕU
%X oDOÕúPDGD JPú L\RQODUÕQÕQ D÷Õ]-LoL X\JXODPDVÕQÕ \DSPDGDQ |QFH GHQWLQ
NDQDOFÕNODUÕQD GLI]H RODELOHFHN JPú L\RQ NRQVDQWUDV\RQXQX WHVSLW HWPH\L
DPDoODGÕN%XVHEHSOHú|\OHELU|QoDOÕúPD\DSWÕN
gQoDOÕúPD-5:
$÷Õ]
LoHULVLQGH
\DSÕOPDVÕ
SODQODQDQ LúOHPOHU oHNLOPLú GLúOHU
]HULQGH YH ODERUDWXYDU úDUWODUÕQGD
\DSÕOGÕ 'DKD |QFH NDQDO WHGDYLVL YH\D
DPDOJDP GROJX \DSÕOPDPÕú WDQH
oHNLOPLú DOW NoN D]Õ GLúLQLQ
laboratuvarda kök kanal preparasyonu
\DSÕOGÕ 'LúOHU LNL JUXED D\UÕOGÕ +HU LNL
JUXEXQ GLúOHULQLQ N|N NDQDOODUÕ LoHULVLQH
D÷Õ]GD NXOODQÕODFDN WHOLQ D\QÕVÕ RODQ PPoDSÕQGDELUJPúWHONRQXOGX'LúOHU
NROH KL]DVÕQD NDGDU ODNWDWOÕ Uinger
VROXV\RQX
LoHULVLQH
EDWÕUÕOGÕ
Bu ùHNLO'HQH\VHOJPúDQRWX\JXODPDVÕ9*$JPú
solusyona Cr-Ni bir elektrot konuldu. Bu DQRW . NDWRW .. N|N NDQDOÕ *63 JPúO VDDW SLOL
G]HQH÷LQ HPSHGDQVÕ “ NRKP RS, ringer solusyonu; R1, direnç
20
RODUDN |OoOG %LULQFL JUXED DLW GLúOHU LoLQ &U-Ni elektrottan negatif kutup, kök
NDQDOÕQGDNLJPúWHOGHQLVHSR]LWLINXWXSJHOHFHNúHNLOGHJQVUHLOH—$GR÷UX
DNÕPX\JXODQGÕ,NLQFLJUXEDGDHOHNWURWED÷ODQPDVÕQDUD÷PHQHOHNWULNDNÕPÕYHULOPHGL
%X GHQH\ VÕUDVÕQGD D÷Õ]GD X\JXODQPDVÕ SODQODQDQ VDDW SLOL NXOODQÕOGÕ YH D÷Õ]D
X\JXODQPDVÕGúQOHQX\JXODPDVUHVLNDGDUEHNOHWLOGL%XVUH sonunda elektrotlar
V|NOS GLúOHULQ NXURQODUÕ X]DNODúWÕUÕOGÕNWDQ VRQUD N|NOHU úHNLO ¶GHNL JLEL SDUoD\D
NHVLOGLNXUXWXOGXWDUWÕOGÕGHPLQHUDOL]HHGLOGLYHDWRPLNDEVRUEVL\RQVSHNWURIRWRPHWUHVL
LOHSDUoDODUÕQKHUELULVLQGHNLJPúL\RQNRQVDQWUDV\RQODUÕWHVSLWHGLOGL
%X VRQXoODUD J|UH N|N NDQDOÕQD X\JXODQDQ JPú DQRWWDQ HPLV\RQDX÷UD\DQ
JPúL\RQODUÕQÕQHPLV\RQoDSÕ!PPRODUDNEXOXQGX*PúQE\NNÕVPÕQÕQ
6 YH 6 SDUoDODUÕQGD WRSODQGÕ÷Õ J|UOG YH —JPO YH SHULRGRQWDO
dokularD VÕ]DQ JPú L\RQX NRQVDQWUDV\RQX —JPO LGL (OHNWULN DNÕPÕ
X\JXODQPD\DQ JUXSWD LVH EX GH÷HUOHULQ DQWLPLNURELN VÕQÕUODUÕ —JPO DúPDGÕ÷Õ
tespit edildi (Tablo.III).
%X oDOÕúPDPÕ]GD D÷Õ] LoHULVLQGH \DSPD\Õ SODQODGÕ÷ÕPÕ] LúOHPOHULQ D\QÕVÕQÕ
uyguladÕN %|\OHFH EXUDGD HOGH HWWL÷LPL] GH÷HUOHUL D÷Õ]GDNL oDOÕúPDPÕ] LoLQ GH
kullanmak mümkün oldu.
9
Tablo.III*PúDQRWX\JXODQPÕúGLúOHULQGHQWLQGRNXVXQGDNLJPúL\RQNRQVDQWUDV\RQODUÕ .
Anot grubu (n=15)
S3
S4
0.040
0.028
1.161
1.378
0.065
0.117
0.412 ±0.19
Kök kesiti
$÷ÕUOÕNJ
Ag (µg/ml)
Ag (µg/g)
Ringer Sol.
S1
0.036
1.149
0.067
S2
0.094
28.319
0.601
S5
0.062
30.048
1.252
S6
0.018
1.343
0.135
Kontrol grubu (n=11)
Kök kesiti
S1
S2
S3
S4
S5
S6
$÷ÕUOÕNJ
0.034
0.179
0.037
0.018
0.058
0.021
Ag (µg/ml)
0.141
0.355
0.132
0.088
0.262
0.093
Ag (µg/g)
0.009
0.006
0.007
0.007
0.009
0.009
Ringer Sol.
0.001 ±0.0001
%X oDOÕúPDGD NXOODQÕODQ GLú N|NOHULQGHQ LNL WDQHVLQLQ ODWHUDO NHVLWL ÕúÕN
PLNURVNRSXQGD LQFHOHQGL YH GHQWLQ NDQDOFÕNODUÕ LoHULVLQH SHQHWUH RODQ JPú
görüntülendi 9 (ùHNLO
gQoDOÕúPD-6:
$÷Õ] GRNXODUÕQÕQ HOHNWULNVHO GLUHQFLQL KHVDSOD\DELOPHN LoLQ WD]H NHVLOPLú NR\XQ
NDIDODUÕ ]HULQGH |OoPOHU \DSWÕN .R\XQXQ D]Õ GLúLQLQ N|N NDQDOÕ LoHULVLQH EX
oDOÕúPDGD NXOODQÕODFDN RODQ ELU JPú WHO \HUOHúWLULOGL .R\XQXQ D÷Õ] PXNR]DVÕQD ELU
JPú SODND WHPDV HWWLULOGL 6ÕUD LOH +] +] YH .+] OLN NDUH GDOJD VLQ\DOL
X\JXODQDUDN \DSÕODQ |OoPOHUGH GRNX GLUHQFL “ NRKP RODUDN EXOXQGX Q %LU
RKPPHWUH\L GR÷UXGDQ ED÷OD\DUDN \DSÕODQ |OoPOHUGH GH \DNÕQ GH÷HUOHU EXOXQGX LNL
terminal metodu1 %X VHEHSOH D÷Õ] LoHULVLQGH \DSÕODFDN oDOÕúPDGD GRNX GLUHQFL kohm olarak kabul edildi.
21
-A-
-B-
-C-
-D-
9
ùHNLO $÷Õ] LoHULVLQGHX\JXODQDQLúOHPOHULQD\QÕVÕODERUDWXYDUúDUWODUÕQGDoHNLOPLúGLúOHUHX\JXODQPÕúWÕU
.
$ .RQWURO JUXEXQGDQ ELU GLú N|NQQ ODWHUDO NHVLWL [ % *Pú DQRW X\JXODQGÕNWDQ VRQUD VHUEHVW NDODQ
JPúQ NDQDOÕQ OPHQLQL NDSODPÕú [ & 'HQWLQ NDQDOFÕNODUÕ LoHULVLQH SHQHWUH ROPXú [ YH ' VHPHQWLQ
DOWÕQDNDGDULOHUOHPLúWLU[3UHSDUDWODU+(LOHER\DQPÕúWÕU
22
'NGHQWLQNDQDOFÕNODUÕ$JJPú.NN|NNDQDOÕ
3- GEREÇ VE YÖNTEM
3.1 Hasta seçimi:
%XoDOÕúPD\DNURQLNDSLNDOHQIHNVL\RQXRODQKDVWDQÕQDGHWHQIHNWHGLúL
GDKLO HGLOGL .DUGL\DN YH Q|UDO SUREOHPL RODQ KDVWDODU oDOÕúPD JUXEXQD DOÕQPDGÕ
+DVWDODUÕQHQD]ELUHQoRNLNLDGHWDSLNDOHQIHNVL\RQOXGLúLQHJPúDQRWX\JXODQGÕ
+DVWDODUGDQWDQHVLHUNHNWDQHVLNDGÕQLGL+DVWDODUÕQ\DúODUÕLOHDUDVÕQGD
ROXS \Dú RUWDODPDVÕ PHGLDQ LGL dDOÕúPD\D GDKLO RODQ KDVWDODU EX GLúOHULQL
oHNWLUPH\LLVWL\RUODUGÕ%WQKDVWDODUDNHQGLOHULQHX\JXODQDFDNWHGDYLSURWRNROXve ne
\DSÕODFD÷Õ DoÕNoD DQODWÕOGÕ LúELUOL÷L VD÷ODQGÕ %X oDOÕúPD LoLQ dXNXURYD hQLYHUVLWHVL 7ÕS
)DNOWHVL'HRQWRORML$QDELOLP'DOÕ¶QGDQHWLNUDSRUXDOÕQPÕúWÕU).
'LúOHU
'LúOHULQ WDPDPÕQGD HQ D] \ÕOOÕN HQ oRN \ÕOOÕN PHGLDQ N|N NDQDO
enfHNVL\RQX EXOXQX\RUGX (OOLVHNL] GLúLQ WDQHVLQGH ILVWO YDUGÕ 'LúOHUGHQ WDQHVLQHGDKD|QFHGHQDQD]GHIDN|NNDQDOÕWHGDYLVLX\JXODQPÕúWÕ'LúOHUGHQL
N|NOVLN|NOGL÷HUWDQHVLWHNN|NOLGL8\JXODPD\DSÕODQGLúOHULQWDPDPÕQGD
zamanODDOHYOHQHQNURQLNDSLNDOHQIHNVL\RQODUYDUGÕWDQÕNOLQLNPXD\HQHYHSHULDSLNDO
UDG\RJUDIL\DUGÕPÕLOHNRQXOGX
+D]ÕUOÕN
dDOÕúPD\DEDúODPDGDQ|QFHKHUKDVWDLoLQLUUHYHUVLEOKLGURNROORLG|OoPDGGHVL
(Precise, SS White, England) ile ilgili çenenin |OoV DOÕQDUDN DOoÕGDQ ELU PRGHOHOGH
HGLOGL+DVWDODUÕQD÷Õ]ODUÕQÕQIRWR÷UDIODUÕoHNLOGLEXUDGDYHULOPHPLúWLU
Muhtelif çaptaki paper-SRLQWOHU $UWLGHQW PP [ FP HEDGÕQGD NHVLOHQ
DPEDODM ND÷ÕWODUÕQD VDUÕODUDN ND÷ÕGÕQ GÕú \]QH NDOHPOH NDo QXPDra paper-point
EXOXQGX÷X \D]ÕOGÕ %X VXUHWOH DPEDODMÕQÕ DoPDGDQ SDSHU-SRLQWLQ oDSÕQÕ ELOPHN
PPNQROGX+DVWD\DUDQGHYXYHULOHQJQGHQELUJQ|QFHYHD\QLJQQVDEDKÕQGD
olmak üzere iki defa kuru-hava sterilizatöründe sterilize edildi.
.XOODQÕODFDN NDQDO DOHWOHUL IUH]OHU YH SDPXN UXORODU GD DPEDODM ND÷ÕWODUÕQD
VDUÕODUDNNXUX-hava sterilizatöründe önceden sterilize edildi.
+DVWDQÕQ D÷Õ]ÕQGDQ PDWHU\DO DOPDGDQ |QFH VÕYÕ EHVL\HUL ND\QDWÕOGÕ YH
VR÷XPD\D EÕUDNÕOGÕ %XQXQ VHEHEL EHVL\HUL LoHULVLQGH o|]QPú EXOXQDQ KDYDQÕQ
RNVLMHQLQLQX]DNODúWÕUÕOPDVÕGÕU
0DWHU\DODOÕQPDVÕ
$SLNDO HQIHNVL\RQX RODQ GLúWHQ PDWHU\DO DOÕQÕUNHQ KDVWDQÕQ HQ D] JQ
öncesinden bu yana sistemik veya lokal herhangi bir antibiyotik veya antiseptik
NXOODQPÕ\RU ROPDVÕQD GLNNDW HGLOGL $QWLEL\RWLN NXOODQGÕ÷Õ WHVSLW HGLOHQ KDVWDODU \D
oDOÕúPD JUXEXQD GDKLO HGLOPHGL YH\D NXOODQGÕNODUÕ DQWLEL\RWL÷LQ ELWPHVLQGHQ JQ
sonraya randevu verildi. Materyal, "paper-SRLQW WHNQL÷L5 LOH DOÕQGÕ $÷Õ] GDNLND
boyunca %10 poviodin-iyot içeren bir DQWLVHSWLN VROV\RQ %HWDGLQH LOH \ÕNDQGÕ $\QÕ
VROV\RQD EDWÕUÕOPÕú ELU SDPXN PHo LOJLOL GLúLQ NXURQX ]HULQGH \DNODúÕN GDNLND
EHNOHWLOGLD÷Õ]VXLOH\ÕNDQGÕ,OJLOLGLúLWNUNWHQL]ROHHGHFHNúHNLOGHSDPXNUXORODU
\HUOHúWLULOGLYHD÷Õ]DELUVDO\DHPLFLWDNÕOGÕOÕNHWLODONROHPGLULOPLúELUSDPXNPHo
GLúLQ NXURQX ]HULQGH GDNLND EHNOHWLOGL JLULú NDYLWHVLQLQ NDSDOÕ ROGX÷X GXUXPODUGD
X\JXQ E\NONWH VWHULO ELU HOPDV IUH] LOH NDQDO D÷Õ]ODUÕQD NDGDU NDYLWH DoÕOGÕ *LULú
NDYLWHVLDoÕNROGX÷XQGDSXOSDRGDVÕYHN|NNDQDOODUÕQÕQD÷Õ]ODUÕJHQLúOHWLOGL8\JXQ
E\NONWHVWHULOELUN|NNDQDOH÷HVLLOHN|NNDQDOÕQDJLULOGL.|NNDQDOODUÕJHQLúOHWLOGL
%X LúOHP VÕUDVÕQGD NOLQLN DSHNVL VPHDU WDEDNDVÕ YH\D QHNURWLN GRNX DUWÕNODUÕ LOH
WÕNDPDPD\D |]HQ J|VWHULOGL .|N NDQDO SUHSDUDV\RQX VÕUDVÕQGD DSLNDO E|OPGH VRQ
23
RODUDN.WLSLQXPDUDOÕH÷HNXOODQÕOGÕ8\JXQoDSWDVWHULOELUSDSHU-point bir pens ile
WXWXODUDN N|N NDQDOÕ LoHULVLQH LWLOGL YH \DNODúÕN VDQL\H EHNOHQGL %X VDIKDGDEROS
geliyorsa ilk paper-SRLQW DWÕOGÕ YH N|N NDQDOÕQD LNLQFL ELU SDSHU-SRLQW X\JXODQGÕ Kanal
VD\ÕVÕ ELUGHQ ID]OD\VD HQ NROD\ JLULOHQ NDQDOGDQ PDWHU\DO DOÕQGÕ 'L÷HU NDQDOODUD GD
JLULOHELOL\RUVD ELU EDúND SDSHU SRLQW X\JXODQGÕ %LU DONRO EHNL \DQÕQGD 3<* 3HSWRQHYeast extract-*OXFRVHEX\\RQLoHULVLQHNRQXOGXYHEHVL\HULHQNÕVDVUHGHLQNEDW|UH
\HUOHúWLULOGL%XoDOÕúPDGDNXOODQÕODQEHVL\HUOHULYHIRUPOOHULE|OPGHYHULOPLúWLU
$\QÕ VHDQVWD N|N NDQDOÕ SUHSDUDV\RQX WDPDPODQGÕ $SLNDO VWRS KD]ÕUODQPDGÕ
Kök kanaOÕLoHULVLQHDVLWIHQLNRNVLMHQOLVXVRG\XPKLSRNORULWYH\DEHQ]HUELUDQWLVHSWLN
PDGGHX\JXODQPDGÕ.DQDOVWHULOWX]OXVXLOH\ÕNDQGÕNXUXODQGÕ
.DQDODHOHNWURW\HUOHúWLUPH
7LFDUL RODUDN WHPLQ HGLOHQ PP oDSÕQGD VDI JPú WHOGHQ FP
X]XQOX÷XQGDNHVLOGLDOHYGHQJHoLULOHUHNVWHULOL]HHGLOGLYHN|NNDQDOÕLoHULVLQHLWLOGLJLULú
NDYLWHVL GÕúÕQD WDúDQ PLNWDUÕ NDYLWHQLQ GÕúÕQGDQ ELU PDNDV \DUGÕPÕ LOH NHVLOGL YH WHOLQ
NXURQ GÕúÕQD WDúDQ NÕVPÕ NDYLWH LoHULVLQH ENOG $UWDQ WHOLQ X]XQOX÷X |OoOHUek kök
NDQDOÕLoHULVLQGHNLJPúWHOLQX]XQOX÷XEXOXQGXYHQRWHGLOGL%LUGHQID]ODNDQDOÕRODQ
GLúOHU LoLQ KHU ELU NDQDOD D\UÕ ELU JPú WHO HOHNWURW \HUOHúWLULOGL (OHNWURWODUÕQ NXURQ
GÕúÕQGD NDODQ SDUoDODUÕ NDYLWH LoHULVLQH GR÷UX ENOUOHUNHQ SR]LWLf polarlanma
VÕUDVÕQGD HOHNWULN DNÕPÕQÕQ EWQ NDQDOODUD XODúPDVÕQÕ WHPLQ HWPHN LoLQ ELUELUOHULQH
WHPDV HWPHOHUL VD÷ODQGÕ %X VDIKDGD HOHNWURWXQ NRQXPXQX J|UHELOPHN DPDFÕ LOH
JHUHNWL÷LQGHUDG\RJUDILWHNUDUODQGÕùHNLO*HUHNGX\XOGX÷XQGDHOHNWURWXQNRQumu
\HQLGHQD\DUODQGÕ(OHNWURWXQXFXQXQDSHNVWHQGÕúDUÕoÕNPDVÕGXUXPXQGDH÷HUKDVWD
D÷UÕGX\PX\RULVHHOHNWURWJHULoHNLOPHGL%XQXQVHEHELX\JXODQDQHOHNWULNDNÕPÕQÕQYH
JPúQNHPLNGRNXVXLoLQ]DUDUOÕELUHWNLVLQLQROPDPDVÕGÕU
*LULú NDYLWHVL LoHULVLQH VWHULO ELU SDPXN PHo EÕUDNÕOGÕ YH ]HUL NDOÕQ ELU JHoLFL
GROJX&ROWRVRO&ROWqQH$*6ZLW]HUODQGWDEDNDVÕLOHVÕNÕFDNDSDWÕOGÕ
.|N NDQDOÕ LoHULVLQH KLoELU DQWLVHSWLN NXOODQÕOPDGÕ÷Õ JLEL KDVWD\D KLoELU
DQWLPLNURELNNXOODQPDPDVÕWDYVL\HHGLOGL,NLJQVRQUDVÕQDUDQGHYXYHULOGL
3LOOLDSDUH\LQKD]ÕUODQPDVÕ
+DVWDD÷Õ]ÕQGDQHOGHHGLOHQDOoÕ
PRGHO ]HULQGH úX LúOHPOHU \DSÕOGÕ
Katot
olarak
kullanmak
üzere
piyasadan temin edilen 4 mm
NDOÕQOÕ÷ÕQGD VDI ELU JPú SODND [
FP ER\XWODUÕQGD NHVLOGL h]HULQGH
LúOHP \DSÕODQ GLúLQ DSHNVLQH HQ \DNÕQ
SDODWLQDO OLQJXDO \]H\H \HUOHúWLULOGL
hVW oHQH LoLQ JHQHOOLNOH VHUW GDPD÷ÕQ
oWH ELU |Q NÕVPÕ DOW oHQH LoLQ D]ÕODU
grubunun lLQJXDO \] NXOODQÕOGÕ
*Pú SODND oHNLo GDUEHOHUL LOH DOoÕ
\]H\LQH VÕNÕFD DGDSWH HGLOGLùHNLO
ùHNLO%LUSLOOLDSDUH\LQKD]ÕUODQPDVÕ
$÷Õ]ÕQ \XPXúDN GRNXODUÕQÕ UDKDWVÕ]
HGHELOHFHN NHQDUODUÕ YDUVD PDNDVOD NHVLOGL %X VDIKDGD JPú SODNDQÕQ ER\XWODUÕ
|OoOHUHNDODQÕKHVDSODQGÕYHQRWHGLOGLh]HULQGHLúOHP\DSÕODFDNRODQGLúLQLoHULVLQH
D÷Õ]GDNLQH EHQ]H\HQ ELU NDYLWH DoÕOGÕ PP oDSÕQGD L]RODV\RQOX ELU NDEOR EX
NDYLWHQLQ LoHULVLQH LWLOGL NRKP OXN YH ZDWWOÕN ELU GLUHQo EX WHOH OHKLPOHQGL %X
24
GLUHQoER÷XPODUÕRODQVLOLQGLUúHNOLQGHROXSX]XQOX÷XFPHQNDOÕQ\HULQLQoDSÕ
mm dir.
'LUHQFLQ GL÷HU XFX JPúO VDDW
pilinin pozitif kutup'una lehimlendi. Bu
DPDoODNXOODQÕODQJPúOVDDW pilinin
(Sony, Silver Watch Battery, 1.55V
317-SR516SW, Sony energytec Inc
-DS oDSÕ PP NDOÕQOÕ÷Õ PP GLU
3LOLQ QHJDWLI NXWXS
X DOoÕ PRGHO
üzerine daha önce adapte edilen
JPúSODND\]H\LQHOHKLPOHQGL
%LUD÷Õ]GDLNLGLúHJPúDQRW
X\JXODPDVÕ\DSÕODFDNVDLNLD\UÕ
GLUHQoIDNDWELUWHNSLONXOODQÕOGÕ
ùHNLO
'LúH
JPú
DQRW
\HUOHúWLULOPHVLQLQ
úHPDWLN
görüntüsü.
ùHNLO*PúDQRWX\JXODQPÕúGLúOHULQUDG\RORMLNJ|UQWOHUL
$÷Õ]GDNLPHYFXWGLúOHULQNRQXPODUÕQDJ|UHGH÷LúHQWLSYHVD\ÕGDWXWXFXNURúHOHU
KD]ÕUODQGÕ 6ÕNOÕNOD LNL E\N D]Õ\D PP oDSÕQGD RUWRGRQWLN WHOGHQ ELUHU $GDPV
NURúH KD]ÕUODQGÕ YH\D H÷HU GLúVL] VDKD YDUVD PP WHOGHQ \DUÕP NRO NURúH WHUFLK
HGLOGL %X VDIKDGD H÷HU D÷Õ]GD PHWDOLN ELU NXURQ YH\D N|SU YDUVD HOHNWULN \NQ
WDúÕ\DQ SDUoDODUÕQ EXQODUD WHPDV Htmemesine özen gösterildi. (Böyle istenmeyen bir
GXUXPGDKHVDSODQDQGRNXHPSHGDQVÕYHDNÕPÕQWUDVHVLER]XODFDNWÕU%XG]HQHNELU
VR÷XN úHIIDI DNULOLN 8QLWHN 21 - 1RQURYLD &DOLIRUQLD NXOODQÕODUDN
PWHKDUULN ELU DSDUH\ úHNOLQGH ELWLULOGL %LOLQHQ úHNLOGH WHVIL\H YH FLODVÕ \DSÕOGÕ $÷Õ]D
X\JXODQDFD÷Õ]DPDQDNDGDUEX]GRODEÕQGDPXKDID]DHGLOGL
25
3LOOLDSDUH\LQD÷Õ]DX\JXODQPDVÕ
'DKD |QFHGHQ NDYLWH YH NDQDO SUHSDUDV\RQX \DSÕODUDN LoHULVLQH DQRW J|UHYL
J|UPHN]HUHJPúWHOX\JXODQPÕúGLúLQJLULúNDYLWHVLVWHULOúDUWODUDOWÕQGDDoÕOGÕ.|N
NDQDOÕ YH DQRW DUDVÕQGDNL HOHNWULN WHPDVÕQÕ DUWÕUPDN LoLQ JPú WHO oÕNDUÕOPDGDQ
NDQDOD VWHULO WX]OX VX VÕNÕOGÕ IDNDW NXUXWXOPDGÕ 3ODN D÷Õ]D X\JXODQGÕ 3URWH] PXNR]D
X\XPVX]OX÷XYDUVDEXVDIKDGDJLGHULOGLJHUHNL\RUVDNURúHOHULQVÕNÕOÕ÷ÕD\DUODQGÕ3LOLQ
SR]LWLI NXWXS
XQX WDúÕ\DQ WHO YH NDYLWH LoHULVLQGHNL JPú WHO DUDVÕQD ELU DPSHUPHWUH
WHPDV HWWLULOHUHN DNWHO úDUM PLNWDUÕ |OoOG YH QRW HGLOGL %X PLNWDUÕQ —$ L
DúPDPDVÕQD GLNNDW HGLOGL 0WHKDUULN DSDUH\GHQ JHOHQ YH SR]LWLI NXWXS
X WDúÕ\DQ WHO
JLULúNDYLWHVLLoHULVLQHLWLOGL(OHNWURWYHEXWHODUDVÕQGDNLHOHNWULNWHPDVÕQÕQWDPROPDGÕ÷Õ
GúQOG\VHHOHNWULNWHPDVÕQÕQGHVWHNOHQPHVLDPDFÕLOHN|NNDQDOÕD÷Õ]ÕQDNoNELU
DPDOJDP GROJX SDUoDVÕ LWLOGL %XQXQ PPNQ ROPDGÕ÷Õ YDNDODUGD ; FP
ER\XWODUÕQGD ELU NDOD\ ND÷ÕW GÕú \] GÕúDUÕ JHOHFHN úHNLOGH NDWODQDUDN NDYLWH LoLQH
VÕNÕúWÕUÕOGÕ3LOOLDSDUH\GHQJHOHQWHOEXNDOD\OÕND÷ÕGDWHPDVHWWLULOGL.DYLWHJHoLFLGROJX
PDGGHVLLOHVÕNÕFDNDSDWÕOGÕ
+DVWD DQWLPLNURELN KLoELU NLP\DVDO PDGGH NXOODQPDPDVÕ VXOX GL\HW DOPDVÕ
DSDUH\L D÷Õ]ÕQGDQ oÕNDUWPDN LoLQ X÷UDúPDPDVÕ NRQXVXQGD H÷LWLOHUHN JQ VRQUD
gelmesi istendi.
6DIODúWÕUPDYHLGHQWLILNDV\RQ
Iki gün 37 °C de inkübe edilen materyalden CD&DQDHURSNDQOÕDJDUDHNLOHUHN
DQDHURS NDYDQR] LoHULVLQGH LQNEH HGLOGL $\QÕ PDWHU\DOGHQ NDQOÕ DJDUD GD HNLOHUHN
DHURS RODUDN LQNEH HGLOGL ,NLQFL JQ UHPH ROXS ROPDGÕ÷ÕQD EDNÕOGÕ *HUHN
GX\XOGX÷XQGD LQNEDV\RQ LQFL JQH NDGDU VUGUOG )ORUD\D KDNLm olan bakteri
SDWRMHQ PLNURRUJDQL]PD RODUDN \RUXPODQGÕ &'& DQDHURS NDQOÕ DJDUGD UH\LS NDQOÕ
DJDUGDUHPH\HQEDNWHULOHUPHFEXULDQDHURSWUOHURODUDN\RUXPODQGÕ)ORUD\DKDNLP
RODQNRORQLOHUGHQL\LGLIHUDQVL\HROPXúELUWDQHVLÕVÕWÕOPÕúELU|]H\DUGÕPÕLle agar yüzeyi
LOH ELUOLNWH \HULQGHQ NRSDUÕOGÕ YH ÕVÕWÕOPÕú-VR÷XWXOPXú 3<* EX\\RQD DNWDUÕOGÕ Böylece
IORUD\D KDNLP RODQ EDNWHULQLQ VDI NOWU HOGH HGLOGL %X DúDPDGD IORUD\D KDNLPRODQ
LNLQFL ELU PLNURRUJDQL]PD YDUVD D\UÕFD VDIODúWÕUÕOGÕ $\QÕ SODN ]HULndeki kolonilere
NDWDOD] YH RNVLGD] WHVWOHUL X\JXODQGÕ VRQXoODUÕ QRW HGLOGL %X WLS NRORQLOHUGH YDUVD
KHPROL] SLJPHQWDV\RQ YH IORUHVDQV ND\GHGLOGL <LQH D\QÕ WLS NRORQLGHQ DOÕQDQ ELU
EDúND PDWHU\DOLQ GR÷UXGDQ PLNURVNRSLVL \DSÕOGÕ KDUHNHWH EDNÕOGÕ *UDP boyama
.RRSOHU
VPRGLILNDV\RQXLOH\DSÕOGÕ32 (Preparat metanol ile tespit edildi, 5 dakika kristal
YL\ROH YH OXJRO X\JXODQGÕNWDQ VRQUD OXN VRG\XP ELNDUERQDW LOH \ÕNDQGÕ NRQWUDVW
ER\D RODUDN VDIUDQLQ VXOX IXNVLQ GDNLND X\JXODQGÕ ,GHQWLILNDV\RQ Eakterinin
EL\RNLP\DVDOSURILOLQHEDNÕODUDNELOJLVD\DU\DUGÕPÕLOHJHUoHNOHúWLULOGL
%XDPDoODELUGL]L3<EX\\RQLoHULVLQHJONRQVDQWUDV\RQGDPXKWHOLIúHNHUOHU
LODYH HGLOGL %X WSOHULQ LKWLYD HWWL÷L úHNHUOHU úXQODUGÕU JOLNR] VXNUR] ODNWR] PDQQR]
mannitol, trehaloz, maltoz, arabinoz, rafinoz, sellibioz, mellibioz, ramnoz, ksiloz,
GXOVLWRO DGDQLWRO YH VDOLVLQ %XQODUGDQ EDúND LNL DGHW 3< EX\\RQ WS LVH UHD] YH
HVNXOLQWHVWLLoLQD\UÕOGÕ%LUDGHW3<EX\\RQWSQHLVHKHUKDQJLELUúHNHUNRQXOPDGÕ
IDNDW HNLP \DSÕOGÕ%XWSNRQWURODPDFÕLOHNXOODQÕOGÕ7SOHULQLoHULVLQGHNLúHNHUOHULQ
LVLPOHUL WSOHULQ ]HULQH QRW HGLOGL .RFK ND]DQÕQGD VWHULOL]H HGLOGL YH VR÷XWXOGX %X
WSOHUHVDIODúWÕUÕODQEDNWHULQLQEX\\RQNOWUQGHQPOLODYHHGLOHUHN°C de 2 gün
LQNEHHGLOGL,QNEDV\RQVUHVLVRQXQGDJHQHOOLNOHEX\\RQXQDOWNÕVÕPODUÕQGDUHPH
ROGX(÷HUUHPHROPDPÕúVDLQNEDV\RQDGHYDPHGLOGLActinomyces grubu bakteriler
için daha uzun bir inkübasyon süresi gerekli oldu. Bakteri üremesi göz ile rahatça
J|UOPH\H EDúODQGÕ÷ÕQGD WSOHUH ELUHU S+ ND÷ÕGÕ EDWÕUÕODUDN DVLW ROXúXPX DUDQGÕ S+
GH÷HUL YH DOWÕQGD LVH R úHNHUH DLW IHUPHQWDV\RQ WHVWLQLQ VRQXFX SR]LWLI RODUDN
26
\RUXPODQGÕ 3K ND÷ÕWODUÕ LOH NDUDU YHULOHPH\HQ GXUXPODUGD ELU S+ PHWUH NXOODQÕOGÕ 2
EDNWHUL\H DLW úHNHU IHUPHQWDV\RQ VRQXoODUÕ QRW HGLOGL (NLP \DSÕODQ YH KHUKDQJL ELU
úHNHU LKWLYD HWPH\HQ SR]LWLI NRQWURO WSQGH GH S+ XQ DOWÕQD GúPúVH WHVWOHU
WHNUDUODQGÕ %X GXUXP VDGHFH LNL Bacteroides ve bir Lactobacillus VXúXQGD PH\GDQD
geldi.
ùHNHU IHUPHQWDV\RQ WHVWOHULQGH NXOODQÕODQ 3< EX\\RQ WSOHULQGHQ ELU WDQHVLQLQ
LoHULVLQH OLWUH\H J RODFDN úHNLOGH XUHD LODYH HGLOGL 'L÷HUWSOHUOHELUOLNWHLQRNOHYH
LQNEH HGLOGL ,QNEDV\RQX WDNLEHQ EX\\RQXQ S+ VÕ XQ ]HULQH oÕNPÕúVD UHD]
testiQLQVRQXFXSR]LWLIRODUDN\RUXPODQGÕùHNHUIHUPHQWDV\RQWHVWOHULQGHNXOODQÕODQ3<
EX\\RQWSOHULQGHQELUGL÷HULQLQLoHULVLQHOLWUH\HJDHVFXOLQYHJIHUULFFLWUDWHLODYH
HGLOHUHNGL÷HUWSOHUOHELUOLNWHLQRNOHYHLQNEHHGLOGL,QNEDV\RQXWDNLEHQNDUDQOÕNELU
RGDGD XOWUD YL\ROH ÕúÕ÷D \DNODúWÕUÕODUDN IORUHVDQV YHULS YHUPHGL÷LQH EDNÕOGÕ (÷HU
floresans veriyor ise eskulin hidroliz testinin sonucu negatif kabul edildi. Floresans
vermiyorsa eskulin hidrolizi pozitif kabul edildi. Bu test anaeroplar için gayet spesifik
ROGX÷XQGDQKHUEDNWHULLoLQPXWODND\DSÕOGÕ32. Inkübasyonu takiben bu tüpün içerisinde
J|UOHELOHQ VL\DK UHQN ROXúXPX KLGURMHQ VOILWLQ RUWDPGDNL GHPLU LOH )H6 ELOHúL÷L
ROXúWXUPDVÕQGDQGÕU32 %X VHEHSOH VL\DK UHQN ROXúPXúVD R EDNWHUL LoLQ +2S
ROXúXPXSR]LWLIRODUDNND\ÕWHGLOGL%XEHVL\HULQGHDVLWROXúXPXHVNXOLQLQKLGUROL]LQL
GH÷LOHVNXOLQLQIHUPHQWHROGX÷XQXJ|VWHUGL÷LQGHQGH÷HUOHQGLULOPHGL
ùHNHU LKWLYD HWPH\HQ YH EDNWHUL HNLPL \DSÕOPÕú 3< EX\\RQ WS LoHULVLQH
.RYDF
VD\ÕUDFÕQGDQp-dimethylaminobenzaldehyde (10g), isoamyl alcohol 150 ml,
%10 HCl POLNLGDPODLODYHHGLOGL.ÕUPÕ]ÕUHQNGH÷LúLPLROPXúVDREDNWHULLQGRO
pozitif kabul edildi, sonuçlar not edildi.
%WQ WHVW VRQXoODUÕ |Q oDOÕúPD- GH DQODWÕODQ ELOJLVD\DU SURJUDPÕQD7,8
JLULOGL ROPDVÕ PXKWHPHO EDNWHULOHULQ OLVWHVL HOGH HGLOGL H÷HU YDUVD GL÷HU
EDNWHULOHUGHQD\ÕUGHELOHFHNLODYHWHVWOHU\DSÕODUDNLGHQWLILNDV\RQJHUoHNOHúWLULOGL
%X \|QWHPOH WHVWOHUL WDPDPODQDQ EDNWHUL |UQHNOHULQLQ 7+,2 EX\\RQD SDVDMÕ
\DSÕODUDN IRWR÷UDIÕ oHNLOLQFH\H NDGDU VDNODQGÕ $QDHURS EDNWHULOHULQ KFUH
PRUIRORMLOHULQLQ ER]XOPDGDQ VDNODQDELOHFH÷L HQ X\JXQ EHVL\HUL EXGXU32. Yeterli
PLNWDU|UQHNELULNWL÷LQGHIRWR÷UDIODUÕoHNLOGL)RWR÷UDIODUEXUDGDYHULOPHPLúWLU
$QWLEL\RWLN'X\DUOÕOÕNWHVWOHUL
AnWLEL\RWLNGX\DUOÕOÕNWHVWOHUL%X\\RQ'LVN<|QWHPL:LONLQV7KLHOLOH
\DSÕOGÕ19 +HU EDNWHUL LoLQ \DSÕODQ DQWLEL\RWLN GX\DUOÕOÕN WHVWL R EDNWHULQLQ úHNHU
IHUPHQWDV\RQWHVWOHULLOHD\QÕ]DPDQGDYHELUOLNWHX\JXODQGÕ
3<*EX\\RQHUPORODFDNúHNLlde 13 tane steril spektrofotometre tüplerine
GD÷ÕWÕOGÕ %X\\RQ LoHULVLQGHNL o|]QPú RNVLMHQLQ X]DNODúPDVÕ DPDFÕ LOHEXWSOHU
20 dakika süre ile kaynamakta olan su içerisinde bekletildi. Bu tüplerden 11
WDQHVLQH VWDQGDUW DQWLEL\RWLN GLVNOHUL DWÕODUDN RGD ÕVÕVÕQGD WSOHULQ VR÷XPDVÕ
EHNOHQGL EX VUH LoHULVLQGH WSOHULQ VDOODQPDPDVÕQD |]HQ J|VWHULOGL Tüplerden 2
WDQHVLQH DQWLEL\RWLN GLVNL DWÕOPDGÕ %X LNL WSWHQ ELU WDQHVLQH HNLP \DSÕOGÕ SR]LWLI
NRQWURO IDNDW GL÷HULQH HNLP \DSÕOPDGÕ QHJDWLI NRQWURO %X WHVWOHU VÕUDVÕQGD
NXOODQÕODQ DQWLEL\RWLNOHU EXQODUÕQ NÕVDOWÕOPÕú LVLPOHUL YH VRQ EX\\RQ
NRQVDQWUDV\RQODUÕú|\OHGLU
27
Tablo.IV.XOODQÕODQDQWLEL\RWLNOHULQLVLPOHULYHNRQVDQWUDV\RQODUÕ
Antibiyotikler
Trimethoprim+sulfamethox. (SXT)
Piperacillin (PIP)
Sulbactam+cefoperazone (SCF)
Erythromycin (E)
Tetracycline (Te)
Azithromycin (AZM)
Amoxicillin+clav.acid (AmC)
Ciprofloxacin (CIP)
Clindamycin (CC)
Netilmicin (NET)
Cefuroxime (CXM)
Bir diskteki
kons. (µg/ml)
23.75
100
5
15
15
15
30
5
10
15
30
Kaç tane disk
kulODQÕOGÕ÷Õ
1
1
1
1
2
1
1
1
2
2
1
Son buyyon
kons. (µg/ml)
8
33
25
5
10
5
3.3
1.6
6.6
10
10
ùHNHU IHUPHQWDV\RQ WHVWOHUL LoLQ VDIODúWÕUÕODQ EDNWHUL VROXV\RQXQGDQ HU
PLOLOLWUH DOÕQDUDN WDQH 3<* EX\\RQD HNLP \DSÕOGÕ 1HJDWLI NRQtrol tüpüne ekim
\DSÕOPDGÕ ùHNHU IHUPHQWDV\RQ WSOHUL LOH ELUOLNWH ƒ& GHJQLQNEHHGLOGLOHU%X
VUH VRQXQGD SR]LWLI NRQWURO WSQGH UHPH \HWHUVL] ROPXú LVH LQNEDV\RQD LQFL
JQHNDGDUGHYDPHGLOGL*HQHOOLNOHEXWSOHUGHúHNHUIHUPHQWDV\RQWSOerinden daha
JHo UHPH ROPXúWXU 3R]LWLI NRQWURO WSQGH \HWHUOL UHPH J|UOG÷QGH ELU
VSHNWURIRWRPHWUH 6SHFWURQLF ' %DXVFK/RPEV 86$ LOH WSOHULQ ÕúÕN
geçirgenlikleri (transmittance) ölçüldü.
3.10 Optik okuma:
%X LúOHPGHQ |QFH EWQ WSOHU YRUWHNV LOH NDUÕúWÕUÕOGÕ YH ELU |]H LOH WSOHULQ
LoHULVLQGHNL DQWLEL\RWLN GLVNOHUL oÕNDUÕOGÕ WSOHULQ GÕú \]H\OHUL DONRO HPGLULOPLú ELU
SDPXN LOH VLOLQGL GDKD VRQUD NXUX ELU SDPXN LOH VLOLQGL %|\OHFH YDUVD WSOHULQ GÕú
\]H\OHULQGHÕúÕNJHoLUJHQOL÷LQLGH÷LúWLUHELOHFHNNDOÕQWÕODUX]DNODúWÕUÕOGÕ
1HJDWLINRQWUROWSVSHNWURIRWRPHWUHFLKD]ÕQD\HUOHúWLULOGLYHFLKD]HQ\NVHN
ÕúÕN JHoLUJHQOL÷LQLQ ROGX÷X GDOJD ER\XQD D\DUODQGÕ 'DKD VRQUD EX PLNWDU NDEXO
HGLOHFHN úHNLOGH VW VÕQÕU NDOLEUDV\RQX \DSÕOGÕ Pozitif kontrol tüpü vortex ile
NDUÕúWÕUÕODUDN FLKD]D \HUOHúWLULOGL %X WSQ ÕúÕN JHoLUJHQOL÷L VÕIÕU \DQL DOW VÕQÕU RODFDN
úHNLOGHNDOLEUHHGLOGL'DKDVRQUDDQWLEL\RWLNLoHUHQKHUHNLOLEX\\RQWHNWHNYRUWHNVLOH
NDUÕúWÕUÕOGÕ FLKD]D \HUOHúWLULOHUHN ÕúÕN JHoLUJHQOLN GH÷HUOHUL RNXQGX YH QRW HGLOGL )DUNOÕ
PRUIRORML\HVDKLSKHUEDNWHULWLSLLoLQIDUNOÕGDOJDER\XQGDELUÕúÕNNXOODQÕOGÕ+DQJLGDOJD
ER\XQGD ÕúÕN NXOODQDUDN RNXPD \DSÕODFD÷ÕQD QHJDWLI NRQWURO WSQGHNL HQ ID]OD ÕúÕN
JHoLUJHQOL÷LQHEDNÕODUDNNDrar verildi.
)DNOWDWLI DQDHURS PLNURRUJDQL]PDODU LoLQ DQWLEL\RWLN GX\DUOÕOÕN WHVWOHUL VWDQGDUW
Bauer Kirby GLVN GLI]\RQ \|QWHPL LOH \DSÕOGÕ19. Her antibiyotik diskinden 1 tane
NXOODQÕOGÕ÷ÕQGDQ IDNOWDWLI DQDHURS EDNWHULOHUH X\JXODQDQ DQWLEL\RWLN NRQVQWUDV\RQODUÕ
PHFEXULDQDHURS|UQHNOHUHX\JXODQDQGDQIDUNOÕROPXúWXU%XVHEHSOHLNLJUXSEDNWHUL
|UQHNOHULQLQDQWLEL\RWLNGX\DUOÕOÕNODUÕD\UÕD\UÕGH÷HUOHQGLULOPLúWLU
.|NNDQDOÕGH]HQIHNVL\RQXQXQNRQWUROHGLOPHVL
Dördüncü günde steriliteye dikkat edilerek geçici dolgu maddesi söküldü, plak
D÷Õ]GDQ oÕNDUÕOGÕ YH \XNDUÕGD DQODWÕODQ ELoLPGH \HQLGHQ PDWHU\DO DOÕQDUDN NOWU
\DSÕOGÕ NRQWURO NOWU ùHNLO (÷HU UHPH ROPDPÕúVD JPú WHO NDQDOGD
EÕUDNÕODUDN (QGRPqWKDVRQH 6HSWRGRQW 6DLQW-Maur, France) ve kon güta ile kök
28
NDQDOÕ GROJXVX \DSÕOGÕ 'LúH DPDOJDP GROJX YH\D JHUHNL\RU LVH GL÷HU UHVWRUDV\RQODU
\DSÕOGÕ+DVWDLNLúHUD\OÕNSHU\RGLNNRQWUROODUÕQDoD÷ÕUÕOGÕ
%LULQFL NRQWURO NOWUQGH UHPH ROPXúVD QRW HGLOGL IDNDW UH\HQ EDNWHUL
VDIODúWÕUÕODUDN LGHQWLILNDV\RQX \DSÕOPDGÕ %XQXQ VHEHEL |Q oDOÕúPD- WH JPú DQRWD
maruz kalan bakterilerde fenotipik dHYL\DV\RQODUÕQROGX÷XQXJ|UG÷P]LoLQGLU11. Bu
VDIKDGD EDNWHUL |UQH÷LQH \DSÕODFDN
WHVWOHULQ VRQXoODUÕ PXKWHPHOHQ \DQOÕú
LGHQWLILNDV\RQD VHEHS RODFDNWÕU %X
DúDPDGD D\QÕ VHEHSOH UH\HQ EDNWHULQLQ
DQWLEL\RWLNGX\DUOÕOÕ÷ÕQDGDEDNÕOPDGÕ
Birinci kontrol kültüründe üreme
ROGX÷XQGD GLúH KHUKDQJL ELU X\JXODPD
\DSÕOPDGDQ JPú WHO WHNUDU NDQDO
LoHULVLQGH EÕUDNÕOGÕ JLULú NDYLWHVL JHoLFL
GROJX LOH VÕNÕFD NDSDWÕOGÕ +DVWD KDIWD
VRQUD\D oD÷ÕUÕOGÕ %X VUH VRQXQGD
\HQLGHQ PDWHU\DO DOÕQGÕ NRQWURO
kültürü). AlÕQDQ PDWHU\DOGH KDOD UHPH ùHNLO *Pú DQRW X\JXODPDVÕQÕ WDNLEHQ N|N NDQDOÕ
ROX\RUVD KLoELU X\JXODPD \DSÕOPDGDQ dezenfeksiyonunun kontrol edilmesi
NDYLWH WHNUDU NDSDWÕOGÕ YH KDIWD VRQUD
\HQLGHQ NOWU LúOHPL WHNUDUODQGÕ NRQWURO NOWU %|\OHFH GLúLQ JPú DQRW
X\JXODPDVÕQGDQ|QFHWDQHYHX\JXODPD\ÕWDNLEHQWDQHNRQWURONOWUHOGHHGLOPLú
ROGX ùHNLO%XoNRQWURONOWUQGHQKHUKDQJLELUWDQHVLQGHUHPHROPDPÕúLVH
N|N NDQDOÕ GH]HQIHNVL\RQX JHUoHNOHúPLú NDEXO HGLOGL EDúND NOWU \DSÕOPDGÕ .|N
NDQDOÕ\XNDUÕGDDQODWÕODQELoLPGHGROGXUXODUDNGLúUHVWRUHHGLOGL
Üçüncü kRQWUROGDGDUHPHROX\RULVHRYDNDEDúDUÕVÕ]NDEXOHGLOGL%DúDUÕVÕ]
YDNDODUGD GLúLQ oHNLPL \HQL ELU DNXW DOHYOHQPH\H NDGDU HUWHOHQGL %|\OH GLúOHUGH N|N
NDQDOÕ(QGRPqWKDVRQHLOHGROGXUXOGXNWDQVRQUDD\QÕJPúWHOWHNUDUNDQDOLoHULVLQH
sokularak orada bÕUDNÕOGÕ NRQ JWD X\JXODQGÕ YH GLú UHVWRUH HGLOGL (QIHNVL\RQGD
DOHYOHQPHROGX\VDGLúoHNLOGL
.XOODQÕODQEHVL\HUOHUL
1. CDC (Centre of Disease Control) Anaerop agar32:
TSA (BBL)
40 g
Agar
5g
Yeast extract
5g
Hemin
5 mg
400 mg
L-cystine
Vit K1
1 ml
Distile su
1000 ml
0DGGHOHU NDUÕúWÕUÕODUDN ND\QDWÕOGÕ $\UÕ ELU WS LoHULVLQH OÕN 1D2+ GHQ -3 ml
konuldu, hemin ve L-F\VWLQH LODYH HGLOGL ,VÕWÕODUDN WDPDPHQ o|]QPHVL VD÷ODQGÕ YH
EHVL\HULQHLODYHHGLOGLS+ DD\DUODQGÕ, otoklavda sterilize edildikten sonra, 45°C
\H VR÷XWXOGX DVHSWLN RODUDN GHILEULQH NDQ LODYH HGLOLS NDUÕúWÕUÕOGÕ 9LW .1 in alkol
LoHULVLQGHNL OLN VWRN VROXV\RQX LODYH HGLOGL YH SHWUL NXWXODUÕQD G|NOG $QDHURSODU
LoLQJHQHODPDoOÕEHVL\HULRODUDNNXOODQÕOGÕ
29
2. Peptone-Yeast extract Glucose (PYG) buyyon32:
Trypticase
5g
Peptone
5g
Glucose
1g
Yeast extract
10 g
Cysteine HCL
4 mg
Hemin
5 mg
Vit K1 (stok sol.)
1 ml
Distile su
1000 ml
%X EHVL\HUL PLNURRUJDQL]PDODUÕQ LON L]RODV\RQODUÕQGD YH DQWLEL\RWLN GX\DUOÕOÕN
testlerinde tüp dilüsyon (buyyon-GLVN\|QWHPLLoLQNXOODQÕOGÕ
3. Peptone-Yeast extract (PY) buyyon19,32:
3<* EX\\RQXQ WHUNLELQGHQ JOXFRVH oÕNDUÕOÕUVD EX EHVL\HUL 3HSWRQH-Yeast
H[WUDFWEX\\RQ3<%URWKDGÕQÕDOÕU%XEHVL\HULQHJOXNR]\HULQHEDúNDúHNHUOHULODYH
HGLOLSDQDHURSEDNWHULOHULQúHNHUIHUPHQWDV\RQODUÕQÕQLQFHOHQPHVLQGHNXOODQÕOGÕ
4. THIO (Thioglycolate broth) buyyon19,32:
Peptone
20 g
0.25 g
L-cystine
Glucose
6g
NaCl
2.5 g
Na-thioglycolate
0.5 g
Sodium sulfite
0.1 g
Agar
0.7 g
Distile su
1000 ml
L-F\VWLQH
LQ KD]ÕUODQÕúÕ &'& DQDHURS NDQOÕ DJDUGDNL JLELGLU S+
\H D\DUODQÕS KHU
WSH HQ D] PO RODFDN úHNLOGH NRQXOGX ,]RODV\RQ VDIODúWÕUPD YH LGHQWLILNDV\RQ
LúOHPOHULWDPDPODQDQDQDHURSEDNWHULOHULQIRWR÷UDIODUÕQÕQoHNLOLQFH\HNDGDUVDNODQPDVÕ
DPDFÕ\OD EHNXS EDFNXS NOWUOHUL LoLQ NXOODQÕOPÕúWÕU (÷HU VDNODQDFDN RODQ EDNWHUL
hemine ihtiyaç duyuyor ise bu besiyeri içerisine 5 mg/l hemin ilave edildi. Bu bakteri
uzun sürHEHNOH\HFHNVHKDIWDELUGHIDSDVDMÕ\DSÕOGÕ
30
4. BULGULAR
4.1 Elektriksel parametreler:
%X úDUWODU DOWÕQGD |OoOHQ NDWRW \]H\L RUWDODPD “ FP2 ROPXúWXU +HU
ELUDQRWXQX]XQOX÷XPPGHQPP\HNDGDUGH÷LúPLúWLUPHG\DQPP$QRW
yüzeyi 0.2985 - 0.9664 cm2 DUDVÕQGD GH÷LúPLúWLU PHGLDQ FP2 $NWHO úDUM
PLNWDUÕ WR —$ PHGLDQ —$ ROXS WRWDO úDUM \R÷XQOX÷X - 1.67
FRXORPEJQ DUDVÕQGD GH÷LúPLúWLU PHGLDQ RUWDODPD %X PLNWDU FDQOÕ
dokuya zarar verebilHFHN RODQ FRXORPEJQ VÕQÕUÕQÕQ DOWÕQGDGÕU $NÕP
\R÷XQOX÷XQXQ NDWRW WDUDIÕQGD —$PP2 DQRW WDUDIÕQGD LVH —$PP2 ROGX÷X
KHVDSODQGÕ
4.2 Pilli aparey:
%WQKDVWDODUDSDUH\LUDKDWoDWROHUHHWWLOHUWDQHVLSURWH]NHQDUÕYXUX÷XQGDQ
\DNÕQGÕ DQFDN DSDUH\LQ oÕNDUÕOPDVÕ LOH úLND\HWOHUL ND\EROGX +HU DSDUH\ D÷Õ]GDQ
oÕNDUÕOGÕ÷ÕQGDELUDYRPHWUH\DUGÕPÕLOHSLOLQGXUXPXNRQWUROHGLOGL+HSVLQLQKDODHOHNWULN
DNÕPÕ UHWHELOGL÷L J|UOG .|N NDQDOÕ LoHULVLQH \HUOHúWLULOHQ JPú HOHNWURWODUGDQ tanesiQLQ \]H\LQGH NRUR]\RQ J|UOG GL÷HUOHULQGH X\JXODPDQÕQ G|UGQF JQQQ
VRQXQGDPHWDOLNJPúLONX\JXODQGÕ÷ÕJQNUHQJLQLNRUXGXYDNDGDGLúNXURQXQGD
UHQNER]XOPDVÕJ|]OHQGL%XGLúOHUHNXURQNDSODQPDVÕWHNOLIHGLOGLKDVWDEXQDX\GX
4.3 Klinik sonuçlar:
7RSODP GLúH JPú DQRW X\JXODQGÕ YH WDQHVLQGH EDúDUÕ VD÷ODQDPDGÕ
YH\D EDúDUÕVÕ] NDEXO HGLOGL %XQODUGDQ GLúWH SLOOL DSDUH\LQ D÷Õ]D X\JXODQPDVÕQÕ
WDNLEHQ DNXW DOHYOHQPH J|UOG÷QGHQ KDVWD\D DQWLEL\RWLN X\JXODQGÕNWDQ VRQUD EX
GLúOHUoHNLOGL'L÷HUGLúLQN|NNDQDOÕQGDUHPHGHYDPHGL\RUGXIDNDWoHNLOPHGL%X
KDVWDODU LNLQFL NRQWUROOHULQGH QF D\ EX GLúOHUL LOH LOJLOL ELU úLND\HWWH EXOXQPDGÕODU
ancak, radyolojik bir düzelme de görülmedi.
.|N NDQDOÕQGD GH]HQIHNVL\RQ VD÷ODQDQ GLúLn 14 tanesi radyolojik olarak
izlenemedi. WDQHVLQGH LVH UDG\RORMLN G]HOPH J|UOG 'L÷HU WDQHVLQGH
GH]HQIHNVL\RQVD÷ODQDELOPHVLQHUD÷PHQUDG\RORMLNG]HOPHJ|UOPHGL%WQKDVWDODU
LNLúHU D\OÕN NRQWUROODUD oD÷ÕUÕOGÕ DQFDN ED]Õ KDVWDODUÕ L]OH\HELOmek mümkün oldu.
7RSODPKDVWDNRQWUROUDQGHYXVXQDJHOPHGL÷LLoLQQFD\GDQVRQUDNOLQLNRODUDN
L]OHQHPHGL 'L÷HUOHUL G]HQVL] WDULKOHUGH JHOGLOHU %X EDNÕPGDQ EX oDOÕúPDQÕQ NOLQLN
VRQXoODUÕJHUH÷LJLELGH÷HUOHQGLULOHPHGL
Tablo.V*PúDQRWX\JXODPDVÕQÕQD\VRQUDNLVRQXoODUÕ
Uygulama
sonunda
Dezenfekte
edilebilen
'LúVD\ÕVÕ
(n=58)
%
44
75.8 +HSVLUHVWRUHHGLOGLD÷Õ]GD
Dezenfekte 14
edilemeyen
Akibeti
Klinik
24.1 VXENOLQLNHQIHNVL\RQD÷Õ]GD
4 Akut apse, çekildi
Radyolojik
L\LOHúPHYDU
L\LOHúPH\RN
14 izlenemedi
L\LOHúPH\RN
4 izlenmedi
'H]HQIHNWH HGLOHELOHQ N|N NDQDOÕQÕQ LQGH JPú DQRW X\JXODPDVÕQÕ
KHPHQWDNLEHQDOÕQDQNRQWUROPDWHU\DOLQGHUHPHROPDGÕùHNil.12). Buna göre en
HWNLOL N|N NDQDOÕ GH]HQIHNVL\RQX RUDQÕ LOH X\JXODPD\Õ KHPHQ WDNLEHGHQ LON
NRQWUROGD J|UOG %X VD\Õ X\JXODPD J|UHQ WRSODP GLúLQ LVH VLQL
ROXúWXUPDNWDGÕU ,NLQFL NRQWUROGD GLúLQ N|N NDQDOÕQGD UHPH ROPDGÕ %X VD\Õ
31
uygXODPD\DSÕODQWRSODPGLúVD\ÕVÕQÕQVÕGÕUhoQFNRQWURONOWUQGHGLúLQ
N|N NDQDOÕQGD UHPH ROPDGÕ÷Õ J|UOG %X PLNWDU X\JXODPD J|UHQ GLúOHULQ LQL
J|VWHUPHNWHGLU %LULQFL NRQWURO NOWUQGH UHPH ROPDVÕQD UD÷PHQ LNLQFL YH oQF
kontrol külWUOHULQGH UHPHQLQ ROPD\ÕúÕ N|N NDQDO VLVWHPLQGHNL JPú L\RQ
GLI]\RQXQD ED÷OÕGÕU .RQWURO NOWUOHULQGH UH\HQ DQFDN LON L]RODV\RQ SODNODUÕQGD
rastlanmayan Stafilokok YH PD\D NRORQLOHUL IORUDQÕQ JHoLFL \HVLYHYH\DNRQWDPLQDQW
NDEXO HGLOHUHN GH÷HUOHQGLUPH\H DOÕQPDGÕODU %|\OH PLNURRUJDQL]PDODU N|N NDQDOÕ
SDWRMHQLROPDGÕ÷ÕQGDQEXSODNODUGDUHPHROPDGÕ÷ÕQRWHGLOGL
4.4 Mikrobiyoloji:
8\JXODPD \DSÕODQ GLúOHUGHQ VDGHFH WDQHVLQLQ N|N NDQDOÕ DoÕOGÕ÷ÕQGD ERO
PLNWDUGD S JHOGL %X GLúOHULQ N|N NDQDOÕ IORUDODUÕQGDQ SUDWLNWH DQODPÕ RODELOHFHN
herhangi bir ortak mikroorganizma izole edilemedi (ikisinden P. anaerobius, bir
tanesinden, P. intermedia GL÷HULQGHQ M. multiacidus HOGH HGLOGL *Pú DQRW
X\JXODPDVÕLOHIORUDGDLONND\ERODQPLNURRUJDQL]PDODUPrevotella grubu iken, en uzun
süre direnen ve daha geç dönemde kaybolan mikroorganizma ise Lactobacillus ve
EikenellaGÕU (OOLVHNL] GLúWHQ WRSODP RODUDN EDNWHUL VXúX L]ROH HGLOPLú YH
LQFHOHQPLúWLU %XQODUGDQ  PHFEXUL DQDHURS GL÷HU WDQHVL ise
IDNOWDWLI DQDHURS EDNWHULOHUGLU $QDHURS EDNWHULOHULQ L]ROH HGLOPH VÕNOÕ÷Õ YH HQ GX\DUOÕ
ROGXNODUÕDQWLEL\RWLNOHU7DEOR9,GDYHULOPLúWLU
Tablo.VI(QIHNWHN|NNDQDOODUÕQGDQL]ROHHGLOHQPHFEXULDQDHURSYHPLNURDHURILOLNEDNWHULOHU.
Bakteri
Anaerobic streptococci
Peptostreptococcus micros
P. asaccharolyticus
P. productus
P. tetradius
Streptococcus intermedius
S. parvulus
Prevotella sp.
P. denticola
P. buccae
P. intermedia
P. melaninogenica
P. bivia
Lactobacillus sp.
L. casei
L. yamashiensis
L. plantarum
Actinomyces sp.
A. israelii
A. viscosus
A. bovis
,]ROH HGLOHQ VXú genus
'X\DUOÕ
ROGX÷X
VD\ÕVÕ
seviyesinde % antibiyotik(ler)
LQVLGDQVÕ
24.4
AmC, E
9
5
3
1
3
1
21.1
AZM, AmC
5.5
E, AmC
4.4
AmC, CC
6
5
4
3
1
3
1
1
2
1
1
32
Eubacterium sp.
E. nodatum
E. alactolyticum
Mistuokella multiacidus
Porphyromonas asaccharolytica
Capnocytophaga sp.
C. ochracea
C. gingivalis
Selenomonas sputigena
Bifidobacterium dentium
Fusobacterium sp.
F. nucleatum
F. symbiosum
Dichelobacter nodosus
Propionibacterium propionicum
Bacteroides gracilis
Identifiye edilemeyen
2
1
3
3
2
1
2
2
1
1
2
1
1
1
3.3
AmC, E
3.3
3.3
3.3
AZM
AZM, SCF
E, AZM
2.2
2.2
2.2
AZM, AmC
CXM, E
CC, CXM
2.2
1.1
1.1
1.1
AZM
CC
AZM
AZM
Anaerop bakterilerden bir tanesi identifiye edilememiúWLU%XEDNWHULKDUHNHWVL]
*UDP QHJDWLI NoN NRN ]LQFLUOHUL úHNOLQGH ROXS ODFWRVH WUHKDORVH FHOORELRVH D[\ORVHPDOWRVHIHUPHQWDV\RQXDHVFXOLQKLGUROL]LYHK\GURJHQVXOSKLGH\DSÕPÕQHJDWLI
D-mannitol, sucrose ve arabinose fermentasyonu pozitif buOXQPXúWXU%XEL\RNLP\DVDO
profil Bacteroides gracilis veya Dichelobacter nodosusDNÕVPHQX\PDNWDGÕU
Mecburi anaerop bakterilerin içerisinde Gram pozitif (%59.4) veya Gram negatif
EDNWHULOHUGHQ ELULVLQLQ EHOLUJLQ úHNLOGH GDKD VÕN L]ROH HGLOGL÷LQL V|\OHPHN mümkün
GH÷LOGLU 0HFEXUL DQDHURSODU LoHULVLQGH WDQHVL oRPDN úHNOLQGH ROXS
EXQODUGDQ VÕ *UDP QHJDWLI  *UDP-pozitiftir. Mecburi anaerop bakteri
SRSXODV\RQXQ LoHULVLQGH HQ VÕN L]ROH HGLOHQ *UDP SR]LWLI EDNWHULOHU DQDHURS
VWUHSWRNRNODUGÕU(QVÕNL]ROHHGLOHQ*UDP-negatif bakteriler ise Prevotella grubudur. Bu
grup bakteriler anaerop Gram-negatif bakterilerin %52.7 sini, toplam 73 anaerop
EDNWHULQLQLVHVÕQÕROXúWXUPDNWDGÕU%XQDUD÷PHQPHFEXULDQDHURSVWUHSWRNRNODU
(18 Peptostreptococcus sp., 4 Streptococcus sp.) anaerop floraya daha hakim olarak
EXOXQPXúODUGÕUPrevotellaJUXEXEDNWHULOHULNLQFLVÕUDGD\HUDOPDNWDGÕU
Elde edilen toplam 17 tane fakültatif anaerop bakteriden 12 si Streptococcus, 3
ü Enterobacter ve 2 tanesi de Eikenella olarak identifiye edildi. Bu bakterilerin izole
HGLOPHVÕNOÕ÷ÕYHGX\DUOÕROGXNODUÕDQWLEL\RWLNOHU7DEOR9,,GHYHULOPLúWLU
33
Tablo.VII(QIHNWHN|NNDQDOODUÕQGDQL]ROHHGLOHQIDNOWDWLIDQDHURSEDNWHULOHU
Bakteri
Izole edilen
VXúVD\ÕVÕ
Sreptococci
Streptococcus faecalis
S. mutans
S. sanguis
S. haemolyticus
S. gallinarum
Enterobacteria
Enterobacter clocea
E. intermedium
Eikenella corrodens
Genus seviyesinde 'X\DUOÕROGX÷X
LQVLGDQVÕ
antibiyotik(ler)
70.58
AmC, Cef
5
3
2
1
1
2
1
2
17.64
CIP, SCF
11.76
AmC, E
)DNOWDWLIDQDHURSEDNWHULOHULoHULVLQGHHQVÕNL]ROHHGLOHQJUXSVWUHSWRNRNODUGÕU
Fakültatif anaerop populasyonun %70.5 ini ve toplam izole edilen bakterilerin 13.3 ünü
IDNOWDWLI DQDHURS VWUHSWRNRNODU ROXúWXrdu. Fakültatif anaerop bakterilerin içerisinde
VWUHSWRNRNODUGDQ EDúND *UDP-pozitif bakteri türü üretilemedi, Gram-negatif bakteriler
LVHLVWDWLVWLNL\|QGHQ\HWHUOLELUELOJLYHUHFHNVD\ÕGDGH÷LOGLU
$QWLEL\RWLNGX\DUOÕOÕNWHVWOHUL
Izole edilen mikroRUJDQL]PDODUGDQ KHU ELULVLQLQ GX\DUOÕ ROGXNODUÕ DQWLEL\RWLNOHU
7DEOR9, YH 7DEOR9,,
GH |]HWOHQPLúWLU %X PLNURRUJDQL]PDODUGDQ HQ VÕN UDVWODQDQ
Peptostreptococci üzerine en etkili antibiyotikler amoxicillin + clavulanic acid ile
erythromycin'dir. Anaerop bDNWHULOHU LoHULVLQGH LNLQFL VÕUDGD \HU DODQ Prevotella grubu
bakterilere en etkili antibiyotikler ise azithromycin ve amoxicillin + clavulanic acid'tir.
%X oDOÕúPDGD NXOODQÕODQ DQWLEL\RWLNOHU WHN WHN HOH DOÕQGÕNODUÕQGD DPR[LFLOOLQ clavulanic acid'in GraP SR]LWLI DQDHURS EDNWHULOHUH HQ HWNLOL DQWLEL\RWLN ROGX÷X
J|UOPHNWHGLU %X DQWLEL\RWL÷LQ WP PHFEXUL DQDHURS L]RODWODU LoLQ RSWLN WUDQVPLWDQV
RUWDODPDVÕPHGLDQGH÷HUL“YHPRGLVHRODUDNEXOXQPXúWXU
-B-
-A-
ùHNLO Elde edilenDQDHURSEDNWHULOHULQDQWLEL\RWLNGX\DUOÕOÕNODUÕ$*UDP-pozitif; B, Gram-QHJDWLIL]RODWODUÕ
göstermektedir. $QWLEL\RWLNOHULQLVLPOHULQLQNÕVDOWPDODUÕ7DEOR,9¶GHYHULOPLúWLU
34
Gram-pozitif anaerop bakteriler üzerine etkili olan ikinci antibiyotik ise
erythromycin'dir. Bu antibiyotiklerin Gram negatif anaerop bakteriler üzerine olan
HWNLOHULLVHùHNLO%GHYHULOPLúWLU
+HP HQ VÕN UDVWODQDQ *UDP QHJDWLI DQDHURS EDNWHULOHU KHP GH GL÷HU *UDP
negatif anaerop bakteriler üzerine en etkili antibiyotik ise azithromycin idi. Gram negatif
anaerop bakteriler üzerine etkili olan ikinci antibiyotik ise amoxicillin + clavulanic acid
idi.
Anaerop popülasyonun tümü üzerine en etkili antibiyotik ise amoxicillin +
clavulanic acid olarak bulundu. Hem fakültatif anaeroS PLNURRUJDQL]PDODUÕQ WP
]HULQHYHKHPGHHQVÕNL]ROHHGLOHQStreptococci]HULQHHQHWNLOLDQWLEL\RWL÷LQ\LQH
DPR[LFLOOLQFODYXODQLFDFLGROGX÷XWHVSLWHGLOGL)DNOWDWLIDQDHURSEDNWHULOHULQVD\ÕODUÕ
D] ROGX÷XQGDQ DQWLEL\RWLN GX\DUOÕOÕN WHVWOHUL KDNNÕQGD GH÷HUOL ELU LVWDWLVWLNL \RUXP
\DSÕODPDGÕ
(OGHHWWL÷LPL]VRQXoODUDJ|UHHQIHNWHN|NNDQDOÕQGDQL]ROHHWWL÷LPL]EDNWHULOHUH
NDUúÕHQD]HWNLOLDQWLEL\RWLNFLSURIOR[DFLQGLU
35
7$57,ù0$
.URQLN ELU DSLNDO HQIHNVL\RQGD GLNNDWOL \DSÕOPÕú ELU N|N NDQDOÕ WHGDYLVL
oR÷XQOXNODHQIHNVL\RQXQRUDWDGDQNDOGÕUÕOPDVÕQÕVD÷OD\DELOLU5*HQHORODUDNN|NNDQDOÕ
WHGDYLVLGL÷HU\|QWHPOHUHJ|UHDWUDYPDWLNYHHWNLOLELU\|QWHPGLU.|NNDQDOÕWHGDYLVLQLQ
EDúDUÕVÕ]OÕN VHEHSOHULQLQ HQ VÕN J|UOHQL \HWHUVL] GHEULWPDQ YH EXQD ED÷OÕ RODUDN N|N
NDQDOÕ LoHULVLQGH WHPL]OHQHPHPLú E|OJHOHULQ NDOPDVÕGÕU (÷UL YH\D GDU NDQDOODUGD EX
GXUXP ED]HQ NDoÕQÕOPD] RODELOLU $\UÕFD HQ LGHDO úHNLOGH \DSÕOPÕú ELU N|N NDQDOÕ
WHGDYLVLQGH ELOH GHQWLQ NDQDOFÕNODUÕQÕQ WDP RODUDN GH]HQIHNVL\RQX YH VÕ]GÕUPD]
ELoLPGH WÕNDQPDVÕ ]RUGXU89,90 %X VHEHSOH GHQWLQ NDQDOFÕNODUÕQÕQ GH]HQIHNVL\RQX YH
WÕNDQPDVÕ LoLQ ELU DOWHUQDWLI \|QWHP JHUHNOLOL÷L YDUGÕU *Pú DQRW X\JXODPDVÕ KHP
GHQWLQNDQDOFÕNODUÕQÕQWÕNDQPDVÕQÕYHKHPGHPHNDQLNRODUDNXODúÕODPD\DQE|OJHOHULQ
GH]HQIHNVL\RQXQX VD÷ODPÕúWÕU 'HQWLQ NDQDOFÕNODUÕQÕQ GH]HQIHNVL\RQX N|N NDQDOÕ
WHGDYLVLQLQPDM|UKHGHIOHULQGHQELULVLGLU.|NNDQDOÕWHGDYLVLVÕUDVÕQGDNDQDOÕQLoHULVLQH
X\JXODQDQDQWLVHSWLNOHULQX]XQHWNLOLYHQIX]HGHELOLUROPDODUÕLVWHQLU%XVXUHWOH\eterli
DOHW PDQSODV\RQXQXQ PPNQ ROPDGÕ÷Õ H÷UL YH GDU RODQ N|N NDQDOODUÕQGD NÕVPHQ
GH]HQIHNVL\RQVD÷ODQDELOPHNWHGLU)DNDWN|NNDQDOÕWHGDYLVLQGHUXWLQRODUDNNXOODQÕODQ
N|N NDQDOÕ GROJX PDGGHOHUL KHP VHUXP LOH NÕVD VUHGH LQDNWLYH ROXUODU KHP GH
penetUDV\RQGHULQOLNOHULVÕQÕUOÕGÕU
58
Tablo.VIII.|NNDQDOÕGROJXPDGGHOHULQLQSHQHWUDV\RQGHULQOL÷LYHHWNLVUHOHUL
Dolgu maddesi
AH26
Diaket A
Endomèthasone
CRCS
Kloroperka
N2 Normal
Procosol
Sealapex
*PúDQRW
Etki süresi
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Bu dolgu maddelerinden antibakteriyel etkisini en uzun süre devam ettiren
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Fakat bu madde bir kaç gün sonra antibakteriyel etkisini kaybetmektedir. Halbuki
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"en az" 1.38 mm dir. %XWHVSLWLPL]LGHVWHNOH\HQOLWHUDWUELOJLOHULGHYDUGÕU6SDGDUR
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J|UH DQRGLN JPú VSRQJL\R] NHPL÷H PP SHQHWUH RODELOPHNWHGLU14. Dentinin
36
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göstermektedir.
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VSRQWDQHPLV\RQ%XPLNWDUÕDJDURUWDPÕQGDFP2 yüzey için ve 51 saat içerisinde
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edemeyecektik.
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SURWHLQOHULQ HOHNWULN DNÕPÕQD NDUúÕ ROXúWXUGXNODUÕ GLUHQo UHDNWDQV LKPDO HGLOPLúWLU
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dentLQL LOH VÕNÕ ELU HOHNWULNVHO WHPDV LoHULVLQGHGLU %X VHEHSOH GRNX GLUHQFL NHPLN
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37
(÷HU EX X\JXODPD ELU L\RQWRIRUH] ROVD\GÕ HOHNWULN DNÕPÕ DQRW WDUDIÕQGDQ
X\JXODQPÕú YH NDWRW WDUDIÕQGDQ FH]EHGLOPLú RODFDNWÕ %X GXUXPGD X\JXODQDQ HOHNWULN
DNÕPÕQÕQ EHNOHQHQ WUDVHVL úX \|QGH RODFDNWÕ N|N NDQDOÕ LoHULVLQGHNL DQRWXQ \]H\L kök dentini - sement - periodonsiyum - DOYHRO NHPL÷L - VXEPXN|] ED÷ GRNXVX - D÷Õ]
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bir faktördür14,78 (÷HU HOHNWULN DNÕPÕ NDWRGD GR÷UX \|QOHQVH\GL DQD NDQDO LoHULVLQGH
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WHVSLW HWWLN gQ oDOÕúPDPÕ]GD JHUHN NDWRWD EDNDQ JHUHN NDWRWWDQ X]DN RODQ GHQWLQ
GRNXVXQGD |OoOHQ JPú L\RQ NRQVDQWUDV\RQODUÕ DUDVÕQGD DQODPOÕ ELU IDUN GD
EXOXQDPDPÕúWÕU 7DEOR,,, %|\OHFH GHQWLQ NDQDOFÕNODUÕQÕQGH]HQIHNVL\RQXQXQVDGHFH
NDWRWD GR÷UX GH÷LO KHU\|QHGR÷UXUDG\DOROGX÷XQXV|\OHPHNPPNQGUùHNLO
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KHQ] QHNUR]H ROPDPÕú ELU SXOSD GRNXVXQX DQWLVHSWLN JPú L\RQODUÕ LOH GH]HQIHNWH
HGHQELUFLKD]GLúKHNLPOL÷LQGHNXOODQÕOPDNWDGÕU6\EURQ&RUSEastman Dental Center,
1< .UXVH N|N NDQDOÕ LoHULVLQH JPú NDSODQPÕú ELU WHO VRNXOPDVÕQÕ |QHUPLú IDNDW
elHNWULN DNÕPÕ LOH DNWLYH HWPHPLúWLU31 0HLPDQ DoÕNODPDGÕ÷Õ DODúÕPGDNL ELU WHOL N|N
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D÷Õ] LoHULVLQH HOHNWULN DNÕPÕ X\JXODPÕúWÕU31 /LWHUDWUGH (OOLV YH DUNDGDúODUÕQÕQ NHQGL
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eOHNWULN úDUMODUÕ EXOXQXU %|\OH KDVWDODUGD RUJDQL]PD\D X\JXODQDFDN HNVWHUQDO úDUM
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klinik uygulamDGDGDE|\OHKDVWDVÕQÕUODPDVÕYDUGÕU37.
Mikrobiyoloji
+HP LON GHID PDWHU\DO DOÕUNHQ YH KHP GH o NRQWURO NOWUQGH 3<* EX\\RQ
NXOODQÕOPDVÕQÕQ VHEHEL HQIHNWH N|N NDQDOÕ IORUDVÕQGD ID]OD VD\ÕGD EXOXQGX÷XQX
ELOGL÷LPL] DQDHURS EDNWHULOHULQ UHWLOHELOPHVLQL NROD\ODúWÕUPDN LoLQGLU %X DúDPDGD
DQDHURS UHPH\L VD÷OD\DFDN KHUKDQJL ELU DJDU EHVL\HUL NXOODQÕOVD\GÕ KDVWDQÕQ
EDúÕQGDQ DQDHURS RUWDPD XODúÕQFD\D NDGDU JHoHQ VUH LoHULVLQGH ED]Õ RNVLMHQH
GX\DUOÕ EDNWHULOHU |OHELOHFHNWL %X oDOÕúPDGD HQIHNWH N|N NDQDOODUÕndan izole edilen
mecburi anaeroplar içerisinde Veillonella türleri ve Acidaminococcus gibi Gram-negatif
NRNODUEXOXQPDPDNWDGÕUYH\DUHWLOHPHPLúWLU%XEDNWHULOHUN|NNDQDOÕHQIHNVL\RQXQGD
38
ELOKDVVD oQF ID]GD RUDQÕQGD EXOXQXUODU82. Bu grup bakteriler oksijene
IHYNDODGH GX\DUOÕ ROGXNODUÕQGDQ PXKWHPHOHQ PDWHU\DO DOPD VÕUDVÕQGD NÕVD ELU VUH
KDYDLOHWHPDVHGHUHN|OPúRODELOHFH÷LJLELIORUDGDKLoEXOXQPX\RUGDRODELOLUOHU$]RW
JD]Õ NXOODQDUDN PDWHU\DO DOÕQPDVÕ YH JORYH-ER[ LoHULVLQGH oDOÕúÕOPDVÕ GXUXmunda bu
EDNWHULOHULQ UHWLOPHVL EHONL GH PPNQ RODELOHFHNWL (QIHNWH N|N NDQDOÕQGD RUDQÕQGD EXOXQDELOHFH÷LQL OLWHUDWUGHQ |÷UHQGL÷LPL] Camphylobacter ve Wolinella
JUXEXEDNWHULOHUHGHPXKWHPHOHQD\QÕVHEHSLOHUDVWODPDGÕN
%XoDOÕúPDGDL]ROHHGLOHQEDNWHULOHULQoR÷XHQIHNWHN|NNDQDOÕSDWRMHQOHULROXS
OLWHUDWUGH \HU DODQ EDNWHULOHUGLU IDNDW UDVWODQPD VÕNOÕNODUÕ OLWHUDWUGHQ IDUNOÕ
EXOXQPXúWXU =DWHQ EX EDNWHULOHULQ LQVLGDQVÕ KHU OLWHUDWUGH IDUNOÕ RUDQODUGD LIDGH
HGLOPHNWHGLU gUQH÷LQ 6XQGTYLVW HQ VÕN L]ROH HGLOHQ N|N NDQDOÕ SDWRMHQLQLQ RUDQÕQGD FusobacteriumODU ROGX÷XQX LIDGH HWPHNWHGLU81. Wasfy ise enfekte kök
NDQDOODUÕQGD HQ VÕNEubacteriumWUOHULQLQEXOXQGX÷XQXELOGLUPHNWHGLU87. Brook
ise BacteroidesOHULQ HQ VÕN NDUúÕODúÕODQ EDNWHULOHU ROGX÷XQX \D]PDNWDGÕU25.
Moenning’in istatistiksel sonucu da BacteroidesOHULQ HQIHNWH N|N NDQDOÕQGD RUDQÕQGDYHHQID]ODVD\ÕGDEXOXQGX÷XGXU46*PULVHHQIHNWHN|NNDQDOÕQGDQHQVÕN
L]ROH HGLOHQ EDNWHULOHULQ RUDQÕQGD Peptostreptococcus FLQVL ROGX÷XQX
\D]PDNWDGÕU42%L]LPoDOÕúPDPÕ]GDGDPeptostreptococcusYHGL÷HUPHFEXULDQDHURS
VWUHSWRNRNODU IORUD\D KDNLP VD\ÕGD EXOXQPXúWXU %X JUXS EDNWHULOHU EWQ L]RODWODUÕQ
Q PHFEXUL DQDHURSODUÕQ LVH Q ROXúWXUPDNWD LGL %URRN kendi
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dDOÕúPDPÕ]GD DUGÕúÕN GLúOHULQ HQIHNWH N|N NDQDOÕ IORUDODUÕ ELUELUOHULQLQ D\QÕVÕ
veya çok benzeri olarak tespit ettik. Elde edilen bu sonuçlar interdental kemik
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GLúOHULQ D\QÕ HNRORMLN GHWHUPLQDQWODUÕ SD\ODúWÕNODUÕQÕ GD J|VWHUHELOLU (÷HU LQWHUGHQWDO
kemik septumu gerçekten bakterilerin invazyonunu engelleyebiliyor ise bu durumda
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8\JXODPD \DSÕODQ GLúOHUH PDWHU\DO DOPD VÕUDVÕQGD KD]ÕUOÕN RODUDN N|N NDQDO
SUHSDUDV\RQX\DSÕOPÕúWÕU(QIHNWHN|NNDQDOÕIORUDVÕQÕQRUWDGDQNDONPDVÕQÕQELUEDúND
VHEHEL GH EX RODELOLU )DNDW N|N NDQDOÕQÕQ GH]HQIHNVL\RQX ]HULQH KDQJL RUDQGD
NDWNÕGD EXOXQGX÷XQX V|\OHPHN ]RUGXU .|N NDQDOÕQÕQ GH]HQIHNVL\RQX VÕUDVÕQGD
HQIHNWH N|N NDQDOÕQÕQ IORUDVÕQÕQ PHFEXUL DQHURS \HOHULQLQ ELU NÕVPÕQÕQ NÕVD VUHGH
RUWDGDQNDONPDVÕQDNDWNÕGDEXOXQDQELUEDúNDIDNW|UGHLúOHPOHUVÕUDVÕQGDDQDNDQDO
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NOWUOHUGH NRQWUROGD UHPH ROPDVÕQD YH GLúH KHUKDQJL ELU PGDKDOH
\DSÕOPDPDVÕQD UD÷PHQ YH\D NRQWURO NOWUOHULQGH UHPH D]DOPÕú YH\D
ND\EROPXúWXU %XQXQ VHEHEL GHQWLQ GRNXVXQXQ LoHULVLQGH ELULNHQ DQWLEDNWHUL\HO
JPúWU %L]Lm bu tespitimiz literatür ile gayet uyumludur. Spadaro steril tuzlu su
LoHULVLQH EDWÕUGÕ÷Õ JPú HOHNWURWODUÕ VDDW ER\XQFD —$PP2 LOH SRODUODPÕú YH EX
WX]OXVX\XVÕYÕKFUHNOWUQHLODYHHWPLú530,-*LEFRDUDOÕNODUODS. aureus inoküle
ederek üreme ROXSROPDGÕ÷ÕQÕNRQWUROHWPLúYHKDIWDER\XQFDEXRUWDPGDEDNWHUL
UHPHGL÷LQLWHVELWHWPLúWLU78. Bu deneyin sona erdirilmesine sebep ilerleyen pasajlarda
EDNWHULQLQ UHPH\H EDúODPDVÕ GH÷LO GHYDP HGLOPHVLQGH DUWÕN ID\GD ROPD\ÕúÕGÕU
39
Spadaro'nun bu deneyGHNXOODQGÕ÷ÕS. aureusGÕúRUWDPúDUWODUÕQDJD\HWGD\DQÕNOÕELU
EDNWHULGLUYHX\JXQVX]NRúXOODUDX]XQVUHGLUHQHELOLU2,3. Bu sebeple bu bakteri ile elde
HGLOHQVRQXoODUGDKDQDULQRODQGL÷HUEDNWHULOHULoLQED÷OD\ÕFÕGÕU<D]DUÕQEXGHQH\GHQ
oÕNDUGÕ÷Õ VRQXo DQWLEDNWHUL\HO HWNLQLQ DVOÕQGD KDIWDGDQ GDKD GD X]XQ VUG÷GU
%LUEDúNDOLWHUDWULVHELUGHIDDQRGL]HHGLOHQYHHOHNWULNDNÕPÕX\JXODPDVÕGXUGXUXODQ
JPúPHWDOLQLQHWUDIÕQGDKDIWDER\XQFDEDNWHUL\HOUHPHROPDGÕ÷ÕQÕ\D]PDNWDGÕU72.
gQ oDOÕúPD-4 WH ELU GHIDDQRGL]HHGLOHQJPúHOHNWURWXQoHYUHVLQGHLNLD\ER\XQFD
C. albicans
ÕQ UHPHGL÷LQL WHVSLW HWWLN %X WU GHQH\OHU WDWPLQNDU VD\ÕGDGÕU YH RUWDN
VRQXo JPú DQRWXQ HWNLVLQLQ NDOÕFÕ ROGX÷XGXU %X VHEHSOH N|N NDQDOÕQGD
J|UG÷P]©JHoGH]HQIHNVL\RQªOLWHUDWUGHNLGL÷HUVRQXoODUÕGHVWHNOHPHNWHGLUYHEX
GXUXPGHQWLQNDQDOFÕNODUÕLoHULVLQHGLI]HRODQJPúQDQWLEDNWHUL\HOHWNLVLQLQGHYDP
HGL\RU ROPDVÕQD ED÷OÕGÕU *Pú DQRWXQ EX |]HOOL÷L VHEHEL\OH N|N NDQDOÕ
GH]HQIHNVL\RQX VD÷ODQDPD\DQ GLúOHULQ PLNUREL\RORMLN WDNLELQLQ ELWWL÷L NRQWURO
NOWUQGHQ VRQUD GD N|N NDQDOÕ GH]HQIHNWH RODELOHFHNWLU %X VHEHSOH \DSÕODQ VRQ
NOWUGHUHPHROPXúVDELOHNOLQLN\DNÕQPDROPDGÕNoDGLúOHUoHNLOPHGL
Ilk seçilecek antibiyotikler:
$QWLEL\RWLN GX\DUOÕOÕN WHVWLQGH VSHNWURIRWRPHWULN RNXPDODU \DSÕOÕUNHQ RNXQDQ
WUDQVPLWDQV GH÷HUL ,t FLKD]ÕQ DNWHO ÕúÕN úLGGHWLQH ,0), ortam sabitine (b), buyyon
NRQVDQWUDV\RQXQD F EX\\RQXQ KDFPLQH [ ÕúÕ÷ÕQ GDOJD ER\XQD V EDNWHUL
KFUHVLQLQ oDSÕQD U ED÷OÕGÕU YH It = I0 + e-b.c.x.r.s formülü ile gösterilir. Her bakteri
KFUHVL YH KD]ÕUODQDQ KHU EX\\RQ LoLQ EX SDUDPHWUHOHU GH÷LúHFH÷LQGHQ
VWDQGDUGL]DV\RQXQ WHPLQL DPDFÕ LOH FLKD]ÕQ NDOLEUDV\RQX KHU GHIDVÕQGD IDUNOÕ GDOJD
ER\XQGD ÕúÕN LOH \DSÕOGÕ %X GXUXP DQWLEL\RWLN GX\DUOÕOÕN WHVWOHULQLQ VWDQGDUGL]DV\RQX
VD÷ODPÕúWÕU
'X\DUOÕOÕNWHVWOHULQGHNXOODQÕODQDQWLEL\RWLNOHUVHoLOLUNHQKHUDQWLEL\RWLNJUXEXQXQ
WHPVLO HGLOL\RU ROPDVÕQD JD\UHW J|VWHULOGL $\UÕFD ELU JUXED DLW DQWLEL\RWLN GLVNLQL
VHoHUNHQ RUDO NXOODQÕPÕ PPNQ RODQ DQWibiyotikler tercih edildi. Bunun sebebi
oDOÕúPDQÕQ VRQXoODUÕQÕQ NOLQL÷H \DQVÕWÕOPDVÕQÕ NROD\ODúWÕUPDNWÕU gUQH÷LQ VHIDORVSRULQ
JUXEX DQWLEL\RWLNOHUL WHPVLOHQ RUDO NXOODQÕPD PVDLW RODQ FHIXUR[LPH D[FHWLO VHoLOGL
Fakat, oral formunu seçebilmek için denenmeVL JHUHNHQ DQWLEL\RWLN JUXSODUÕQGDQ
IHGDNDUOÕN \DSÕOPDGÕ gUQH÷LQ SHQLVLOLQ JUXEXQGDQ DQWLEL\RWLN VHoHUNHQ RUDO IRUPX
bulunan aminopenisilin veya karboksipenisilin yerine BacteridecaeaeIDPLO\DVՁ]HULQH
GDKD HWNLOL ROGX÷X ELOLQHQ4 piperacillin tercih edilGL $\UÕFD RUDO IRUPX EXOXQPDPDVÕQD
UD÷PHQ ELU DPLQRJOLNR]LW QHWLOPLFLQ EX oDOÕúPD\D GDKLO HGLOGL 1HWLOPLVLQ JHQHOOLNOH
DHURS YH JUDP QHJDWLI PLNURRUJDQL]PDODU ]HULQH HWNLOL ROXS SDUHQWHUDO X\JXODQÕU
D\UÕFD N|N NDQDOÕ SDWRMHQOHUL ]HULQH HWNLVL] ROGX÷u bilinir49 %XQD UD÷PHQ GX\DUOÕOÕN
WHVWLQHELUDPLQRJOLNR]LWGDKLOHGHUHNDQDURSODUDHWNLVLQLQROPDGÕ÷ÕQÕQGR÷UXODQPDVÕQÕ
GúQGN 1HWLOPLFLQ GL÷HU DPLQRJOLNR]LWOHUGHQ GDKD D] RWRWRNVLNWLU EX VHEHSOH
VHoLOPLúWLU
Antibiyotiklerin buyyon konsantras\RQODUÕD\DUODQÕUNHQNXOODQÕODQDQWLEL\RWLNOHULQ
NHPLN LoHULVLQH GLI]H ROXS RODPDGÕNODUÕ J|] |QQH DOÕQGÕ gUQH÷LQ FOLQGDP\FLQ
LQ
WNUNYHNHPLNLoL\R÷XQOX÷XVHUXPGDNLQGHQID]ODGÕU4, bu sebeple kan kültürleri için
standardize edilen 2 µg/ml19 yerine üo NDWÕ NRQVDQWUDV\RQGD NXOODQÕOPÕúWÕU
7ULPHWKRSULP VXOIDPHWKR[D]ROH
XQ NHPLN LoHULVLQH GLIX]H ROPD |]HOOL÷L D]GÕU4 bu
sebeple kan kültürleri için önerilen 23.75 µg/ml19 yerine 8 µg/ml konsantrasyonda
NXOODQÕOPÕúWÕU 7HWUDF\FOLQH NHPL÷H GDKD NROD\ GLI]H ROGX÷XQGDQ4 4 µg/ml yerine 10
—JPONRQVDQWUDV\RQGDNXOODQÕOPÕúWÕU
%X oDOÕúPDGD HOGH HGLOHQ DQWLEL\RWLN GX\DUOÕOÕN VRQXoODUÕQD J|UH N|N NDQDOÕ
SDWRMHQOHUL ]HULQH HQ HWNLOL DQWLEL\RWL÷LQ DPR[LFLOOLQ FODYXODQLF DFLG HQ D] HWNLOL
40
DQWLEL\RWL÷LQ LVH FLSURIOR[DFLQ ROGX÷X EXOXQPXúWXU Ciprofloxacin quinolon grubu bir
DQWLEL\RWLNWLU$VOÕQGDTXLQRORQODUNHPL÷HUDKDWoDGLIX]HRODELOPHOHULQHUD÷PHQVDO\D\D
JHoHPH]OHU$\UÕFDTXLQRORQODUÕQE\NELUNÕVPÕDQDHURSRUWDPGDEDNWHULKFUHVLQLQ
içerisine de giremez, bu sebeple, pekçok mecburi anaerop bakteri quinolonlara dirençli
kabul edilir15. Buradaki sonuçlar bu bilgileri desteklemektedir.
Benzer bir etki edememe aminoglikozit grubu (netilmicin) için de beklenmesine
UD÷PHQ QHWLOPLFLQ
LQ HWNLVL WHWUDF\FOLQH
GHQ GDKL \NVHN EXOXQPXúWXU %XQD UD÷PHQ
hem netilmicin, hem de tetracycline akut apsede ilk tercih edilen antibiyotik
ROPDPDOÕGÕU %LU WHWUDF\FOLQH WUHYL RODQ GR[\F\FOLQH¶LQ D÷Õ] LoL HQIHNVL\RQODUGD
NXOODQÕOPDVÕ |QHULOPHNWHGLU92. Burada tetracycline için elde HGLOHQ GH÷HUOHU
GR[\F\FOLQH
H \DQVÕWÕODPD] dQN GR[\F\FOLQH PROHNOQGH WHWUDF\FOLQH
PROHNOQGHQ IDUNOÕ RODUDN 2+ YH &+3 JUXSODUÕ EXOXQPDNWDGÕU YH EX LNL DQWLEL\RWL÷LQ
HWNLPHNDQL]PDODUÕIDUNOÕGÕU
Bu sonuçlara göre bir akut apikal enfeksiyonda mutlaka antibiyotik kullanmak
JHUHNL\RULVHDPR[LFLOOLQFODYXODQLFDFLG¶LQLONVHoLOHFHNDQWLEL\RWLNROGX÷XV|\OHQHELOLU
$PR[LFLOOLQ FODYXODQLF DFLG
LQ \DSÕVÕQGD ELU DPLQRSHQLVLOLQ YH ‰-laktamaz inhibitörü
RODQ FODYXODQLF DFLG EXOXQXU %X DQWLEL\RWL÷LQ HWNL PHNDQL]PDVÕ EDNWHUL KFUHVLQLQ
penisilinaz görevi yapan enzimlerinin (ß-ODNWDPD]FODYXODQLFDFLGLOHHWNLVL]OHúWLULOPHVL
YH DPR[LFLOOLQ WDUDIÕQGDQ EDNWHULQLQ KFUH GXYDUÕ VHQWH]LQLQ ER]XOPDVÕ HVDVÕQD
GD\DQÕU(QIHNWHN|NNDQDOÕIORUDVÕQÕQRUWDGDQNDOGÕUÕOPDVÕQGD‰-laktamaz inhibisyonu
PXKWHPHOHQDQDKWDUUROR\QDPDNWDGÕU(QIHNWHN|NNDQDOODUÕQGDNRORQL]HRODQSHNoRN
bakteri ß-laktamaz üretir42 (NVLN YH \DQOÕú DQWLEL\RWLN NXOODQÕPÕQD ED÷OÕ RODUDN VRQ
\ÕOODUGD *UDP QHJDWLI EDNWHULOHULQ SHULSOD]PLN ERúOXNODUÕQGD GHQ ID]OD ‰-laktamaz
HQ]LPLWDQÕPODQPÕúWÕU66%XHQ]LPOHULQED]ÕODUÕHNVWUDVHOOHURUWDPDVDOJÕODQÕUODUYHELU
HN]RHQ]LP RODUDN VÕQÕIODQGÕUÕOÕUODU 'ROD\ÕVÕ\OD IORUD LoHULVLQGHNL ELU PLNURRUJDQL]PDQÕQ
ß-ODNWDPD] DNWLYLWHVLQLQ EXOXQPDVÕ IORUDGDNL GL÷HU PLNURRUJDQL]PDODUÕ GD SHQLVLOLQLQ
etkisinden korur66 %X |]HOOLN L]ROH HGLOHQ ELU SDWRMHQLQ SHQLVLOLQH GX\DUOÕ ROPDVÕQD
UD÷PHQ R HQIHNVL\RQXQ SHQLVLOLQ LOH QHGHQ WHGDYL HGLOHPHGL÷LQL DoÕNODU ‰-laktamaz
UHWLPL SOD]PLGOHU DUDFÕOÕ÷ÕLOHIORUDGDNLGL÷HUEDNWHULOHUHGHDNWDUÕODELOLU2,3. Bu sebeple
herhangi bir patojen bakteri, enfeksiyonun ilerleyen dönemlerinde ß-laktamaz aktivitesi
ND]DQDELOLU.|NNDQDOÕSDWRMHQOHULLoHULVLQGHPrevotella genusunun üyeleri ß-laktamaz
üretiminde fevkalade aktiftirler. Könönen 226 tane P. melaninogenica VXúXQX
LQFHOHPLúYHVXúXQ‰-ODNWDPD]DNWLYLWHVLQLQEXOXQGX÷XQXJ|VWHUPLúWLU48. Bu miktar
incelenen PrevotellaVXúODUÕQ
QHWHNDEXOHWPHNWHGLU%URRNEXRUDQÕPrevotella
JHQXVX LoLQ RODUDN EXOPXúWXU25. Gümrü ise tüm flora için %39.4 olarak
EXOPXúWXU42 %X oDOÕúPDGD LVH L]ROH HGLOHQ PrevotellaODUÕQ ‰-laktamaz aktivitelerinin
tesbiti hedeflenmedi, ancak, izole edilen 19 PrevotellaQÕQ
XSLSHUDFLOOLQ
HGLUHQoOLYH
DPR[LFLOOLQFODYXODQLFDFLG
HGX\DUOÕEXOXQGX (%52.6).
Liebana penicillin türevlerinin Streptococcus'lar üzerine 2 µg/ml
NRQVDQWUDV\RQGDHWNLOLROGX÷XQX\D]PDNWDGÕU50, fakat biz amoxicillin + clavulanic acid'i
piperacillin'den daha etkili bulduk
Pajukanta 82 tane P. gingivalisVXúXQXLQFHOHPLúYHKepsinin 1 µg/ml den daha
D] NRQVDQWUDV\RQGD D]LWKURP\FLQ LOH LQKLEH ROGX÷XQX J|VWHUPLú YH D]LWKURP\FLQ
L
HQIHNWH N|N NDQDOÕ IORUDVÕQÕQ *UDP-QHJDWLI \HOHUL ]HULQH HWNLOL EXOPXúWXU59. Bizim
VRQXoODUÕPÕ]GD GD *UDP-negatif mecburi anaerop bakteriler azithromycin'e daha
GX\DUOÕ EXOXQPXúWXU ùHNLO% $QFDN EX oDOÕúPDGD D]LWKURP\FLQ HQIHNWH N|N
NDQDOODUÕQGD IORUD\D KDNLP RODQ *UDP-SR]LWLI SDWRMHQOHULQ WDPDPÕQD HWNLOL ROPDPÕú
sadece Gram-QHJDWLI EDNWHULOHU ]HULQH GDKD HWNLOL ROPXúWXU %X GXUXP N|N NDQDOÕ
enIHNVL\RQODUÕQGD D]LWKURP\FLQ¶LQ LON WHUFLK ROPDVÕQD HQJHO WHúNLO HGHU $\UÕFD EX
41
oDOÕúPDGDNL WRWDO L]RODWODU ED] RODUDN DOÕQGÕ÷ÕQGD FOLQGDP\FLQ YH HU\WKURP\FLQ
LQ
D]LWKURP\FLQ
GHQGDKDHWNLOLROGX÷XWHVELWHGLOPLúWLUùHNLO&OLQGDP\FLQ
LQDQDHURS
etkLVLGDKDID]ODIDNDW\DUÕODQPD|PUGL÷HUOHULQGHQGDKDNÕVDHWNLVSHNWUXPXGDKD
GDU YH JDVWURLQWHVWLQDO LULWDV\RQX GDKD ID]ODGÕU %X VHEHSOH HOGH HGLOHQ VRQXoODUD
UD÷PHQFOLQGDP\FLQLONWHUFLKRODUDNGH÷HUOHQGLULOPHPLúWLU
Bu durumda tek bir antibiyotik GH÷LO DQWLEL\RWLN NRPELQDV\RQX NXOODQPDN GD
GúQOHELOLU 6DWR FLSURIOR[DFLQ PHWURQLGD]ROH YH FHIDFORU NRPELQDV\RQX LOH
HQGRGRQWLN OH]\RQODUÕQ WHGDYLVLQL |QHUPLúWLU67. Fakat böyle bir tedavi pek çok
istenmeyen etkiyi de davet edebilir66gUQH÷LQGLVNRUGDQVDED÷OÕRODUDNPLNR]ODURUWD\D
oÕNDELOHFH÷L JLEL IORUD EDNWHULOHULQLQ EX DQWLEL\RWLNOHUH GLUHQo ND]DQPDVÕ GD
PPNQGU %X oDOÕúPDGDQ HOGH HGLOHQ VRQXoODU ELU DQWLEL\RWLN NRPELQDV\RQXQD
JHUHN ROPDGÕ÷Õ úHNOLQGHGLU $PR[LFLOOLQ FODYXODQLF DFLG YH\D Pacrolid grubu
DQWLEL\RWLNOHULQ HQIHNWH N|N NDQDOÕ IORUDVÕ ]HULQH WHN EDúODUÕQD \HWHUOL VHYL\HGH HWNLOL
ROGX÷XQXWHVSLWHWWLN
*PúDQRWXQDYDQWDMODUÕ
*Pú DQRW X\JXODPDVÕ LOH VWDQGDUW N|N NDQDOÕ WHGDYLVLQGH HOGH HGLOPHVL ]RU
RODQED]ÕDYDQWDMODUHOGHetmek mümkündür:
1.'HQWLQNDQDOFÕNODUÕQÕQX]DNE|OJHOHULQLQGH]HQIHNVL\RQX
2. 'HQWLQ NDQDOFÕNODUÕQÕQ DQD NDQDOD EDNDQ JLULúOHULQLQ VÕ]GÕUPD] úHNLOGH
WÕNDQGÕ÷Õ|QoDOÕúPD-WHIRWR÷UDIÕoHNLOHUHNWHVSLWHGLOPLúWLUùHNLO
3..DOÕFÕYH\DoRNX]XQVUeli) dezenfeksiyon
4..|NNDQDOÕSDWRMHQOHULQLQDOH\KLQHRODQELUHNRORMLNGH÷LúLP
*Pú DQRW X\JXODPDVÕQÕ WDNLEHQ GHQWLQ NDQDOFÕNODUÕ LoHULVLQGH NDODQ JPú
L\RQODUÕN|NNDQDOÕQÕQHNRORMLVLQLPXKWHPHOHQúXúHNLOGHGH÷LúWLUHFHNWLU
a) *PúQ NXYYHWOL SURWHLQ ED÷ODPD |]HOOL÷L VHEHEL\OH GHQWLQ NDQDOFÕNODUÕ
LoHULVLQGHNL RGRQWREODVWLN KFUH X]DQWÕODUÕQD DLW SURWHLQOHU NDOÕQWÕODUÕ NROD\FD
ED÷OD\DELOLU%XGXUXPE\N|OoGHSURWHROLWLNWDELDWOÕEDNWHULOHULQDOH\KLQHRODFDNWÕU
%X JUXS EDNWHULOHU EX oDOÕúPDGD HOGH HGLOHQ EDNWHULOHULQ oR÷XQOX÷XQX LQL
ROXúWXUPDNWDGÕU %DúND oDOÕúPDODUGD GD EX EDNWHULOHU IORUD\D KDNLP EXOXQPXúWXU
81,82,87
'HQWLQGRNXVXLoHULVLQGHNLSURWHLQNDOÕQWÕODUJPúWDUDIÕQGDQLUUHYHUVLEÕORODUDN
ED÷ODGÕ÷ÕQGDQ N|N NDQDOÕ LoHULVLQH WHGDYLGHQ VRQUD VÕ]DELOHFHN N|N NDQDOÕ
SDWRMHQOHULQLQ NRORQL]DV\RQXQX HQJHOOHPLú ROXU 6WDQGDUW N|N NDQDOÕ WHGDYLVLQGH EX
DPDoLOHHVNLGHQDVLWIHQLNNXOODQÕOPDNWDLNHQVRQ]DPDQODUGDJOXWDUDOGHK\GHYH
IRUPDOLQH ELOHúLNOHUL WHNOLI HGLOPHNWHGLU )DNDW DVLW IHQLN DGÕ LOH ELOLQHQ &RPSKRUHG
Mono-Chloro-3KHQRO JPú NDGDU NXYYHWOL ELU SURWHLQ ED÷OD\ÕFÕ GH÷LOGLU VWHOLN EX
PDGGHOHU SURWHLQOHUL UHYHUVLEÕO RODUDN ED÷ODPDNWDGÕU5 +DOEXNL JPú SURWHLQDW
NRPSOHNVOHULKDOLQHG|QúWNWHQVRQUDWHNUDUYHNRlayca çözünmez51.
b).DQDOWHGDYLVLQLWDNLEHQN|NNDQDOÕQÕQNDSDWÕOPDVÕLOHWHNUDUKDYDVÕ]ELURUWDP
ROXúXU YH N|N NDQDOÕQÕQ HNRORMLVL E\N |OoGH HVNL KDOLQH G|QHU .|N NDQDOÕ
LoHULVLQGHNL UHGNVL\RQ SRWDQVL\HOL VUDWOH GúHU +DOEXNL JPú DQDHURSODUÕn
DOH\KLQH RODUDN RUWDPÕQ (K YROWDMÕQÕ \NVHOWLU *Pú DQRW X\JXODQPÕú GLúOHULQ N|N
NDQDOODUÕ LoHULVLQGHNL EDNL\HJPúVHEHELLOHNDQDOÕQLoGXYDUÕELUUHIHUDQVHOHNWURWD
J|UHVUHNOLSR]LWLI\NORODUDNNDODFDNWÕU
Anaerop bakterilerin üreyebilmeleri için elektron vermeye istekli kimyasal
ELOHúLNOHULQ RUWDPGD EXOXQPDODUÕ JHUHNLU %XQODU L-cytine, Na-thioglycolatte, ascorbic
acid ve cytein HCl JLEL UHGNWD]ODUGÕU *HQHOOLNOH EX PDGGHOHU DQDHURS EHVL\HUOHULQH
RUWDPÕQ UHGNVL\RQ SRWDQVL\HOLQL GúUPHN DPDFÕ\OD LODYH HGLOLUOHU3,32,44. Bu suretle
redüksiyon potansiyeli (Eh) THIO buyyon için -P9
D&'&DQDHURSNDQOÕDJDULoLQ
42
(kan ilavesinden önce) -140 mV'a , PYG buyyon için -P9
DGúUOHELOPHNWHGLU32.
Anaerop bakteriler ancak bu ortamda kolayca üreyebilirler. Halbuki bir referans
HOHNWURWD VÕIÕU YROW NDEXO HGLOHQ VLVWHPH J|UH JPú PHWDOLQLQ \N 9ROWWXU78
ùHNLO%XGXUXPGDJPúPHWDOLDQDHURSODULoLQWHNEDúÕQDELOHIHYNDODGHWRNVLNWLU
'LúH JPú DQRW X\JXODPDVÕQÕ WDNÕEHQ ROXúDQ EX \HQL HNRORML ELOLQHQ N|N NDQDOÕ
SDWRMHQOHULQLQ \HQLGHQ NRORQL]DV\RQXQD PVDLW ROPD\DFDNWÕU %X LVH N|N NDQDOÕ
GH]HQIHNVL\RQXQXQNDOÕFÕROPDVÕQÕQEDúNDELUVHEHELQLROXúWXUXU
%X GXUXPGD \HQL ROXúDFDN N|N NDQDOÕ HNRORMLVL ELU EDúND NRPSR]LV\RQGD \HQL
bir bDNWHULSRSXODV\RQXQXGDYHWHGHELOHFHNWLU$QFDNKHPGHQWLQNDQDOFÕNODUÕKHPGH
DQD NDQDO LoHULVLQGHNL PLNURRUJDQL]PDODU PHYFXW JPúQ DQWLEDNWHUL\HO HWNLVLQH
VUHNOL RODUDN PDUX] NDODFDNODUÕQGDQ \HQL ELU IORUD ROXúVD GDKL VD\ÕFD EDVNÕ DOWÕQGD
RODFDNWÕU
c) %HQ]HU HNRORMLN GH÷LúLPOHU SHULDSLNDO GRNXODU LoLQ GH V|\OHQHELOLU $QFDN EX
E|OJHGHNRQDNVDYXQPDVÕYDUGÕUYHPLNURRUJDQL]PDODUVD\ÕFD]DWHQGDKDD]GÕUYH\D
D]DOPDH÷LOLPLQGHGLUOHU6.
*PúDQRWXQGH]DYDQWDMODUÕ
%LU GLúLQ N|N NDQDOODUÕQD JPú DQRW X\JXODPDVÕQÕQ ED]Õ GH]DYDQWDMODUÕ GD
YDUGÕUEXQODUú|\OH|]HWOHQHELOLU
1. 3HULDSLNDO LOWLKDSODUÕQ KHSVL PLNURELN ROPD\DELOLU5. Aseptik bir iltihabi olayda
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