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Medeniyet Med J: 19 (1)
Volume: 19  Issue: 1 - 2004
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CLINICAL RESEARCH
1.Cheilectomy for hallux Rigidus
Namık Kemal Özkan, Evren Fehmi Atay, Melih Güven, Faik Altıntaş
Pages 1 - 3
Amaç, halluks rigidus tedavisinde uyguladığımız çeilektomi ve plantar gevşetme yönteminin sonuçlarının değerlendirmesi.
Aralık 1998-Kasım 2002 tarihleri arasında halluks rigidus deformitesine yönelik cerrahi tedavi uygulanan 29 hastanın 34 ayağı çalışmaya dahil edildi. Hastaların 13’ü (% 45) kadın, 16’sı (% 55) erkek idi. Tüm hastalara sırasıyla çeilektomi ve plantar gevşetme uygulandı. Ortalama takip süresi 6 ay (4-24 ay) idi.
Hastalar Mayo Kliniği Ayak Değerlendirme Cetveli (forfoot score)’ne göre değerlendirildi. Buna göre 20 (% 58.8) ayakta çok iyi, 11 (% 32.3) ayakta iyi, üç (% 8.9) ayakta orta sonuç elde edildi. Hiçbir hastanın ayaklarında kötü sonuç elde edilmedi. Halluks rigidus tedavisi için uygulanan çeilektomi ve plantar gevşetme yönteminin basit ve kolay uygulanabilir bir yöntem olduğu, ameliyat sonrası sonuçlarının tatmin edici olduğu sonucuna varıldı.
To evaluate the results of cheilectomy and plantar release for hallux rigidus is the aim of this study.
Twenty-nine patients (thirty-four feet) were treated with cheilectomy and plantar release for hallux rigidus between December 1998-November 2002. Thirteen (% 45) of the patients were female. Avarage length of follow-up was six months (4-24 months).
Twenty (% 58.8) feet rated as excellent, eleven (% 32.3) feet rated as good and three (% 8.9) feet rated as mild using the forfoot score of Mayo clinic. None of the patients had poor results.
Cheilectomy with plantar release for the treatment of hallux rigidus is simple method and it is easy to use. The results after operation are satisfactory.

2.Endobronchial Tuberculosis
Ümmühan Bayram, Çağla Uyanusta Küçük, Fatma Küçüker, Sinem Atik, Ebru Damatoğlu, Adnan Yılmaz, Esen Akkaya
Pages 4 - 6
Endobronşiyal tüberküloz, akciğer tüberkülozunun ciddi bir komplikasyonudur. Çocuklarda daha fazla olmak üzere her yaş grubunda görülebilir. Bu çalışmanın amacı, endobronşiyal tüberküloz olgularının klinik, radyolojik ve bronkoskopik bulgularını ve tedavi sonuçlarını değerlendirmektir. Çalışmamız 6 endobronşiyal tüberküloz olgusunu kapsamaktadır. Olguların 5’i erkek, biri kadın olup yaş ortalaması 41 yıl (18-64) idi. Öksürük en sık yakınma olup, radyolojik olarak 4 olguda nodül saptandı. Bronkoskopik incelemede lezyon, 2 olguda kazeöz, 2 olguda kazeöz ve tümöral, 1 olguda tümöral ve diğer olguda fibrostenotik tip olarak değerlendirildi. Bronş lavaj kültürü 4 olguda tüberküloz basili açısından pozitif bulundu. Tedavi sonrası 3 olguda bronkoskopi tetrarlandı. Kazeöz tipe sahip 2 olguda ödematöz-hiperemik tip lezyon saptanırken, fibrostenotik tipe sahip olguda stenoz devam ediyordu.
Endobronchial tuberculosis is a serious complication of pulmonary tuberculosis. It is more often seen in children, although it may also occur in adults. The aim of this study is to evaluate clinical, radiological and bronchoscopic findings and therapeutic results of the patients with endobronchial tuberculosis. The study included 6 cases of endobronchial tuberculosis diagnosed by bronchoscopy between 2000 and 2002 in our clinic. Cough was the most frequent symptom. Radiology demonstrated pulmonary nodule in four cases. In bronchoscopic examination, lesions were classified as caseating subtype in two cases,
caseating and tumoral subtypes in two cases, tumoral subtype in one case and fibrostenotic subtype in the other case. Bronchial lavage culture was positive for M. Tuberculosis in four cases. Bronchoscopy was repeated in three cases after therapy. While two cases of caseating subtype transformed into oedematous-hyperaemic subtype, fibrostenotic subtype remained in fibrostenotic state in spite of therapy.

3.Snodgrass Procedure in the Treatment of Distal and Mid-Penile Hypospadias
Reşit Tokuç, Erem Kaan Başok, Ömer Faruk Memiş, Erol Petekoğlu, Ziya Ünlüsoy, Necmettin Atsü
Pages 7 - 9
TIPU, mükemmel kozmetik sonuçları olan ve yarık şekilli meatus yaratılan bir hipospadias onarım yöntemidir. Bu çalışmada, 80 ayı aşkın süredir uygulanan 230 olguya ait sonuçlar incelenmektedir. 32 hasta önceden 1-6 arasında onarım yapılmış re-do olgudur. İki tunika vaginalis, iki de mid-skrotal penil şap dışında tüm olgulara subkutan doku şap’iyle ikinci kat kapama uygulanmıştır. Tüm olgularda glansın ucunda yarık şekilli meatus oluşturulmuştur. 18
meatal darlık, 21 üretral fistül ve 13 ikisi bir arada olmak üzere toplam 27 hastada komplikasyon görülmüştür. Oran primer olgularda % 10, re-do olgularda ise % 22’dir.
Mükemmel kozmetik sonuçlarıyla re-do ve sünnetli olgular da dahil olmak üzere tüm olgular için uygulanabilir bir cerrahi tekniktir.
Tubularised incised plate urethroplasty (TIPU) is a procedure that produces excellent cosmetic results with vertically oriented, slit like meatus. We report our experience with this procedure in 230 patients over a period of 80 months. Thirty two of the patients were re-do hypospadias cases with one to six previous surgical procedures. The urethroplasty was covered with an additional layer of subcutaneous tissue in all but tunica vaginalis in two, midscrotal penile flap in two were used. Slit like meatus at the tip of glans were obtained in all patients. Complications occured in 27 patients, with 18 meatal stenosis, 21 urethral fistulas and 13 both fistula and stenosis.
Complication rate was 10 % for primary and 22 % for re-do cases. T.I.P.U. procedure is seem to be reliable technique with excellent cosmetic results for the treatment of distal and mid penile hypospadias, even in circumcised and re-do cases.

4.Evaluation of the Immunglobulin Levels in the 6-24 Months Infant Children with Acute Gastroenteritis
Sadettin Sezer, Hasan Önal, Zerrin Önal, Rengin Şiraneci, Erdal Adal, Hüseyin Aldemir
Pages 10 - 14
Bu çalışmada; akut gastroenteritli hastalarda humoral immün sistemin nasıl etkilendiğini göstermek amacıyla, SSK Bakırköy Doğumevi Kadın ve Çocuk Hastalıkları Eğitim Hastanesi Çocuk Polikliniğine başvuran akut gastroenteritli 6-24 ay arasındaki süt çocuklarında 3 major immünglobulin fraksiyonu bakımından gösterdiği değişiklikler incelenmektedir.
6-9-12-24 aylık olmak üzere 4 grupta toplanan olgulardan elde edilen değerler, aynı yaş gruplarına uyan normal süt çocuklarından elde edilen değerlerle de karşılaştırılarak anlamlı bir fark gösterip göstermediği saptanmaya çalışılmıştır.
İntravasküler kompartmanlarda yer alan lenfositlerin normal kontrol olguları ile sayıca anlamlı bir fark göstermediği, immünglobulin seviyesinde başlıca değişikliğin bütün yaş gruplarında IgA’da olduğu görülmüştür. Bu anlamlı fark, barsak lamina propriasında yer alan IgA taşıyan hücrelerin doğal antijenlerin uyarılarına cevabı olarak değerlendirilmiştir.
IgM seviyesinde 9. aydan sonra tespit edilen anlamlı artış ise, gastrointestinal kanalın lenfoid dokudan zengin jejuno-ileal bölgesinin bu yaşta gelişimine bağlanmıştır.
In this study we investigated the changes in 3 major immunglobulin fraction in the 6-24 months aged infant children with acute gastroenteritis in order to demonstrate the alterations in the humoral immun system resulted from acute gastroenteritis 66 children who admitted with acute gastroenteritis to SSK Bakırköy Doğumevi Kadın ve Çocuk Hastalıkları Eğitim Hastanesi Çocuk Polikliniği outpatient clinic were involved the study.
Patients divided into four groups as 6, 9, 12 and 24 months age. Immunglobulin levels derived from these patients, compered to those from normal healty subjuct of aged-matched.
There were no differences between groups, in the number of lmphosytes at the intravasculer compartment. The major change in immunglobulin levels was shown in IgA levels in all age groups. This significant difference can be considered as a reply of IgA binding cells of intestinal lamina propria to natural antigenic impulse. There has been shown that significant increase in IgM levels after the 9 th months.This results may be related to growth of the lenfoid tissue riched jejuno-ileal region at this age.

5.Comparison of Basal Metabolic Rates Predicted by two Different Methods Between Normal Weight Women Having Inflamatory Bowel Disease and Healthy Controls
Aliye Özenoğlu, G. E. Pamuk, Ö. N. Pamuk, N. Caneroğlu, H. H. Hatemi
Pages 15 - 18
Çalışmanın amacı, inflamatuvar bağırsak hastalığı (İBH) olan normal ağırlıklı kadınların direkt ölçümle ve formüle göre hesaplama yoluyla bulunan bazal metabolizma hızları
(BMH)’na ilişkin iki değerin farklı olup olmadığını ve aynı uygulamanın sağlıklı, normal ağırlıklı kadınlardaki durumunu araştırmaktır.
İÜ. CTF. İç Hastalıkları ABD’nda yürütülen bu çalışma kapsamında, İBH olan 12 ve sağlıklı 26 yetişkin kadın yer aldı. Kadınların boy, kilo ve Bioelectrical Impedance Analyzer (BIA) ile vücut kompozisyonu ölçümleri yapıldı. Beden kitle indeksi (BKİ) formülüne göre (ağırlık-kg/boy-m2) normal ağırlıkta kabul edilen bireyler (BKİ=18.5-24.9 kg/m2) çalışmaya alındı. Kadınların BIA ile ölçülen BMH’ları (BMH 1) yanında, Harris-Benedict denklemine göre de BMH (BMH 2) hesaplandı. Aynı bireylerde farklı iki yöntemle elde edilen bu değerler, bilgisayar programında istatistiksel olarak t testi ile değerlendirildi.
Hem İBH grubu ve hem de kontrol grubunun BMH 1 ve 2 değerleri arasındaki fark ileri derecede anlamlı bulundu. BKİ’ne göre aynı sınırlar içinde yer almalarına rağmen, her iki grubun BIA ile ölçülen BMH 1 değerleri arasındaki farklılık da ileri derecede anlamlı bulundu (sırasıyla İBH; 1325.75±122.92 kcal. kontrol grubu; 1451.88±83.50 kcal. p=0.005). Grupların BMH 2 değerleri arasında anlamlı farklılık bulunamadı (p=0.162). Bir hasta ve bir de sağlıklı grupta farklı iki yöntemle bulunan BMH değerleri arasında ileri derecede anlamlı farklılık saptanması, enerji gereksinmesinin hesaplanmasında standart teorik formüllerin fazla güvenilir olmayacağını düşündürmektedir. Aynı BKİ grubunda oldukları için, her iki grubun BMH 2 değerleri arasında anlamlı farklılık olmaması da beklenen bir bulgudur. Buradan elde edilen sonuçlara dayanarak, gerek hasta ve gerekse sağlıklı bireylerde enerji gereksinmesinin belirlenmesinde, günümüzde kullanımı giderek yaygınlaşan ve oldukça pratik bir şekilde uygulanabilen direkt ölçüm yöntemlerinin daha yararlı olacağına inanıyoruz.
The aim of this study was to search basal metabolic rates of normal weighed inflamatory bowel diseased (IBD) women, found by two different methods which included a measurement by Bioelectrical Impedance Analyzer (BIA) and a calculation according to given formula. The same tests were also applicated to normal weight healthy women to compare the results.
Twelve adult women with IBD, and 26 healthy adult women were included to this study which was conducted at our Internal Disease Department. Weight and height of the IBH
patients and healthy subjects were measured and body compositions were performed with BIA. Only women whose weights were in normal range according to body mass index
(BMI=weight-kg/height-m2) were taken into this study. Basal metabolic rates (BMR) of all subjects were either measured by BIA (BMR 1), or calculated according to Harris-Benedict
equation (BMR 2). These results were statistically analysed at a computer program with t test.
Differences between BMR 1 and BMR 2 in both groups were statistically significant. BMR 1, that was found by BIA of both groups also showed highly significant differences (IBD
group: 1325.75±122.92 kcal., control group: 1451.88±83.50 kcal., p=0.005). But, no significant difference was found between BMR 2 values of the groups (p=0.162).
We concluded that standard teorical formulas used to calculate individual energy needs might not be much reliable. So, we recommend the usage of methods depending on measurement which are practically applicable, to predict energy needs either healthy person or patients.

6.Acute Mesenteric Ischemia
Yıldırım Gülhan, Tolga Balkan, Özgür Ekinci, Fuat İpek, Hakan Bozkurtoğlu, Fikret Aksoy
Pages 19 - 21
Akut mezenter iskemi olgularında mortaliteyi etkileyen faktörleri vurgulamak amacıyla,1996-2001 yılları arası SSK Göztepe Eğitim Hastanesi 1 ve 4. cerrahi kliniklerince opere edilen 24 akut mezenter iskemi olgusu yaş, cins, yandaş hastalıklar, şikayet, klinik bulgular, yapılan ameliyat ve mortalite açısından retrospektif olarak incelendi.
Olguların 18’i (% 75) erkek, 6’sı (% 25) kadın olup ortalama yaş 61 idi. 22 (% 91.7) olguda karın ağrısı, 18 (% 75) olguda bulantı ve kusma, 10 (% 41.7) olguda gaz-gaita çıkaramama, 6 (% 25) olguda kanlı dışkılama şikayeti mevcuttu. Yandaş hastalık olarak 10 (% 41.6) olgu hipertansif, 6 (% 25) olgu iskemik kalp hastası, 4 (% 16.7) olgu atrial fibrilasyonlu, 4 (% 16.7) olguda konjestif kalp yetersizlikli idi. 18 olguda 11.000 mm3’ün üzerinde lökositoz mevcuttu. 18 (% 75) olguya rezeksiyon+anastomoz uygulandı. 3 olgu second look amacı ile 24. saatte reopere edildi ve rezeksiyon sınırları genişletildi. 6 (% 29) olguya sadece eksploratris laparatomi yapıldı. Mortalite % 66.6 olarak tespit edildi.
Acil şartlarda değerlendirilen hastalarda, yandaş hastalıklar da göz önünde bulundurularak, mezenter iskemi tanısı ekarte edilemiyorsa angiyografi, Doppler US veya tanısal laparoskopi yapılmalı, hastanelerimiz bu konularda deneyimli personel ve cihaza sahip olmalıdır.
The aim of the study is to mention the factors affecting mortality in cases with acute mesenteric ischemia.
24 acute mesenteric ischemia cases operated by 1st and 4th surgical clinics of SSK Göztepe Education Hospital between1996-2001 were examined retrospectively by means of age, gender, concomitant diseases, symptoms, clinical findings, operation performed and mortality.
18 (% 75) of the cases were male and 6 (% 25) were female. Mean age was 61. 22 (% 91.7) cases suffered from abdominal pain, 18 (% 75) from nausea and vomiting, 10 (% 41.7) from unability to defecate, 6 (% 25) from blood in stool. As concomitant
diseases 10 (% 41.6) cases had hypertension, 6 (% 25) ischaemic heart disease, 4 (% 16.7) atrial fibrillation, 4 (% 16.7) congestive heart failure. There was leucocytosis over 11.000 mm3 in 18 cases. Resection+anastomosis was performed to 18 (% 75) cases. 3 cases were reoperated for a second look at 24th hour and resection borders were extended. 6 (% 29) cases undergone only exploratris laparotomy. Mortality was determined as 66.6 %.
Patients evaluated in cases of emergency should undergo angiographic, doppler ultrasonographic and diagnostic laparoscopic examination by considering concomitant diseases if diagnosis of mesenteric ischemia can not be excluded. Our hospitals should have experienced personnel and equipment on this issue.

7.Analysis of Patients Admitted to Gynecology and Obstetrics Clinics of Van Country
Hüseyin Avni Şahin, H. Güler Şahin, Murat Karayel, Mansur Kamacı, Ali Kolusarı, Mustafa Haki Sucaklı
Pages 22 - 25
Bu çalışmanın amacı, ikinci ve üçüncü basamakta kadın hastalıkları ve doğum polikliniklerine başvuran hastaları inceleyip sık rastlanan hastalıkları saptayarak sık görülen hastalıklara karşı strateji belirlemek idi.
Araştırma, YYÜ Araştırma Hastanesi kadın doğum polikliniğine 2001 yılında başvuran 8121 hasta ile Van SSK hastanesi kadın doğum polikliniğine başvuran 8135 hastanın prospektif olarak değerlendirilmesi ile gerçekleştirildi. Hastalar tanılarına göre gruplandırıldığında; birinci basamakta çözülebilecek sorunların sıklığı göre Tıp Fakültesi Hastanesi ve SSK Hastanesinde şöyle sıralanmaktaydı: Normal gebelik kontrolü 2929-2850, vulvovajinit 887 -785, menapoz 648-225, servisit ve servikal erozyon 397-580, ‹YE 216-212, dismenore 137-402, RIA ve Aile Planlaması hizmetleri 55-567. Bu hastalıkları hormonal disfonksiyon, infertilite, PID ve tubovaryan abse, kronik pelvik ağrı, gebelik komplikasyonu, pelvik kitle, hirsutismus, miyoma uteri, polikistik over ve amenore gibi nedenler takip etmekteydi.
Bir yıllık tarama sonuçları ikinci ve üçüncü basamağa başvuran hastaların önemli bir kısmının (ikinci basamakta % 69.1, üçüncü basamakta ise % 64.89) birinci basamakta sorunlarını çözebilecekleri halde gereksiz yere üst basamaklara başvurduklarını göstermektedir. Birinci basamakta görev alacak hekimlerin eğitiminde sık görülen hastalıklara ağırlık verilerek bu konulara hakim olmaları sağlanmalı ve böylece gereksiz sevkler önlenmelidir.
The aim of the study was to define the prevalence and types of diseases among patients admitted to outpatient polyclinics of Gynecology and Obstetrics at secondary and tertiary care level and set strategies towards frequent diseases.
A prospective study was accomplished among 8121 patients of YYU Medical Faculty Hospital and among 8135 patients of Van SSK Hospital admitted to outpatient polyclinics of
Gynecology and Obstetrics during year 2001. The patients were grouped according to diagnoses. The patients that could be managed at primary health care level in order of their frequency at tertiary and secondary care level were normal pregnancy control 2929-2850, vulvovaginitis 887-785, menopause 648-225, cervicitis and cervical erosion 397-580, urinary tract infection 216-212, dysmenorrhea 137-402, intrauterine device and family planning services 55-567 respectively. The other following reasons were hormonal dysfunction, infertility, PID and tubo ovarian abscess, chronic pelvic pain, complication of pregnancy, pelvic mass, hirsutismus, myoma uteri, polycystic ovary and amenorrhea.
At secondary care level 69.1 % of the patients and at tertiary care level 64.89 % of patients applied to outpatient polyclinics of Gynecology and Obstetrics even though they could be handled on primary health care level. Physicians must be taught about the frequent diseases in order to feel confident when raising the subject in primary care settings in order to decrease the unnecessary referrals.

8.The Role of Androgens in Preeclampsia
Burçak Tok, A. Rıza Sözenoğlu, Ergun Bilgiç, Kadir Güzin, Neşe Yücel
Pages 26 - 29
Erkek olmanın hipertansiyon etyolojisindeki yerinden yola çıkarak, androjenlerin preeklampsi etyolojisindeki rolünü araştırdık. 30 preeklamptik ve 20 kontrol grubu hastasıyla çalışıldı. Preeklamptik hastalarda kriter olarak 6 saat ara ile ölçülen 2 tansiyon arteryel de¤erinin 140/90 mmHg ve üzeri olması ve/veya ödem olması şartı arandı. Kontrol grubu ise yine üçüncü trimestrdeki gebelerden oluşmuş dahili, obstetrik problemleri olmayan hastalardı. Her hastadan serumda SHBG, E2, serbest ve total testosteron, DHEA-s, androstenodion bakıldı. Preeklamptik grupta total testosteron ve androstenodion değeri yüksek bulundu. Ancak, bu parametrelerin preeklampsi erken tanısında bir belirteç olarak kullanılması için daha fazla çalışmalara ihtiyaç oldu¤u düşüncesindeyiz.
The role of androgens in preeclampsia was investigated based on the role of being male in the etiology og hypertension. We had 30 patients in the preeclamptic group and 20
patients in the control group. Preeclampsia was based on two criteria. 1. The concordant measured blood pressure with an interval of 6 hours had to be equal or higher than 140/90 mmHg and/or edema had to be visualized. The control group consisted of pregnant woman being in thirth trimestr without any internal or obstetric complains. SHBG, E2, DHEA-s, androstenodion, free and total testosteron was measured in the serum of each patient. In the preeclamptic group total testosteron and androstenodionlevels were significant high.
But we need more scientific investigation in order to use this parameters as markers in the early diagnosis of preeclampsia.

9.Prevalance of Gastroesophgeal Reflux Symptoms in Asthma
Tolga Yakar, Nejat Altıntaş
Pages 30 - 32
Amaç, astımlı hastalarda, semptomatik gastroözofageal reflünün (GÖR), reflünün eşlik ettiği respiratuar semptomların (RERS) prevalansını belirlemek ve reflü, beta-agonist inhaler kullanımı arasındaki ilişkinin ortaya konmasıdır.
SSK Süreyyapaşa Hastanesi Astım Polikliniğine ayaktan müracaat eden 109 hasta astım grubunu, sağlıklı gönüllülerden oluşan 135 kişi kontrol grubunu oluşturdu.
Astımlı hastalardan % 77’sinde mide yanması, % 55’inde regürjitasyon, % 24’ünde yutma zorluğu tespit edilirke, kontrol grubunda bu semptomların prevalansı daha düşüktü. Astımlı hastaların % 38’si en az bir kez antireflü tedaviye gereksinim duydu (p<0.001). Astım ilaçlarının GÖR semptomlarının artışı ile bir ilişki bulunamadı. Astımlı hastalardan % 41’i anket formunu cevaplamadan bir hafta öncesi RERS (örneğin öksürük, dispne ve hışırtılı solunum) farktemişlerdi. % 28’i ise GÖR semptomları esnasında inhaler kullanma ihtiyacı duymuşlardı. İnhaler kullanım oranı yanmanın (r=0.28, p<0.05) ve regürjitasyonun (r=0.40 p<0.05) ciddiyetiyle orantılı bulundu.
Anket sonucunda, astımlı hastalarda GÖR semptom prevalansının, RERS prevalansının ve reflü ilişkili inhaler kullanımının artmış olduğu görüldü. Bu fazla inhaler kullanımı ile GÖR’ün indirekt olarak astımı nasıl kötüleştirdiği açıklanabilir.
To determine the prevalences of symptomatic gastroesophageal reflux (GER), reflux-associated respiratory symptoms (RARS), and reflux-associated beta-agonist inhaler use in asthmatics.
Asthma group consisted of 109 patients referred to SSK Süreyyapafla Hospital’s outpatient asthma clinic. Control group consisted of 135 healty volunters
Among the asthma clinics, 77 %, 55 %, and 24 % experienced heartburn, regurgitation, and swallowing difficulties, respectively. Symptoms were less prevalent in the control groups. At least one antireflux medication was required by 37 % of asthmatics (p<0.001 vs controls). None of the asthma medications were associated with an increased likehood of symptomatic GER. In the week prior to completing the questionnaire, 41 % of the asthmatics noted RARS, including cough, dyspnea, and wheeze and 28 % used their inhalers whlie experiencing GER symptoms. Inhaler use correlated with the severity
of heartburn (r=0.28, p<0.05) and regurgitation (r=0.40, p<0.005). The questionnaire demonstrated a greater prevalence of GER symptoms, RARS, and reflux-associated inhaler use in asthmatics. Trus excessive inhaler use may explain how GER indirectly causes asthma to worsen.

10.Evaluation of Haemoptysis
Ferhan Özşeker, Ateş Baran, Aydanur Mihmanlı, Ümmühan Bayram, İlknur Dilek, Esen Akkaya
Pages 33 - 36
Gelişmiş ülkelerde hemoptizinin birinci nedeni bronşitken, gelişmekte olan ülkelerde infeksiyöz akciğer hastalıklarının (özellikle tüberküloz) birinci neden olduğu söylenebilir. Biz de çalışmamızda hemoptizi etyolojisini araştırmayı amaçladık.
Şubat 2001-fiubat 2002 tarihleri arasında SSK Süreyyapaşa Göğüs Kalp ve Damar Hastalıkları Eğitim Hastanesi III. Göğüs kliniğinde yatan 68 hemoptizili olgu (5 kadın, 63 erkek) incelendi. Yaş ortalaması 46±18, en küçük 17 en büyük 76 yaş idi. Olguların 58’inde (% 85.3) hafif, 6’sında (% 8.8) orta ve 4’ünde (% 5.9) şiddetli kanama vardı. 24 (% 35.3) akciğer tüberkülozu, 12 (% 17.65) akciğer kanseri, 8 (% 11.7) bronşiektazi, 8 (% 11.7) pnömoni, 5 (% 7.3) inaktif tüberküloza bağlı kanama tanısı kondu. Bunları; KOAH (n=2), kardiyak nedenler (n=2), akut bronşit (n=2), pulmoner emboli (n=1), kist hidatik (n=1), aspergilloma (n=1) ve akciğer apsesi izlemekteydi. Tanı aşamasında tüm olgulara akciğer grafisi çekilirken, 42 olguya bilgisayarlı akciğer tomografisi çekilmiş, 28 olguya fiberoptik bronkoskopi yapılmış, bir olguya da tanısal torakotomi uygulanmıştır.
Sonuç olarak; çalışmamızda hemoptizi nedenleri arasında akciğer tüberkülozunun ilk sırada olduğu görüldü. Etkili tüberküloz savaşının gelişmiş ülkelerde olduğu gibi ülkemizde de bu sıralamayı değiştireceği kanısındayız.
In developed countries the major cause of haemoptysis is bronchitis; however the infectious pulmonary diseases (or tuberculosis) are mostly considered as the major cause of haemoptysis in developing countries.
Between February 2001 and February 2002 we evaluated 68 patients with haemoptysis in III. Clinic in SSK Sureyyapasa Chest and Cardiovascular Diseases Center. Five of these
patients were female and 63 male, mean age was 46±18 years (range, 17 to 76 years). Fifty-eight (85.3 %) of the patients had mild, 6 (8.8 %) had moderate, and 4 (5.9 %) had severe haemoptysis. It was found that the cause of haemoptysis was pulmonary tuberculosis in 24 of the cases (35.3 %), lung cancer in 12 (17.65 %), bronchiectasy in 8 (11.7 %), pneumonia in 8 (11.7 %), and inactive pulmonary tuberculosis in 5 cases (7.3 %). The other reasons of haemoptysis were COPD (n=2), cardiac causes (n=2), acute bronchitis (n=2), pulmonary embolism (n=1), hidatyd cyst (n=1), aspergilloma (n=1), and
lung abcess (n=1). As the diagnostic procedure chest X ray (n=68), thorax computed tomography (n=42), fiber optic bronchoscopy (n=28) and diagnostic thoracotomy were performed (n=1).
As a conclusion, tuberculosis was the major cause of haemoptysis in our series. We strongly believe that effective tuberculosis community control programs can help to change the place of tuberculosis from being the leading cause of haemoptysis in developing countries.

11.Hypoglycemia at Emergency Care
Özcan Keskin, Yaşar Küçükardalı, Murat Kalemoğlu
Pages 37 - 39
Acil servise hipoglisemi ile gelen hastaların klinik semptomlarını ve prespite edici faktörleri saptamak ve demografik özellikleri karşılaştırmak amacıyla planlanan çalışma, 2000 ve 2002 yılları arasında acil servise müracaat eden hastalarda prospektif olarak gerçekleştirildi. Bu çalışmada hastalarda hipoglisemi tanısı; (1) serum glikoz düzeylerinin 50 mg/dl altında olması, (2) hastada eşlik eden hipoglisemi semptomlarının olması, (3) glikoz infüzyonu sonucu semptomların düzelmesine göre konuldu. Çalışmaya dahil edilen hastaların yaş, cins, hipoglisemi süresi, hipoglisemik ilaç kullanımı, diyabet, karaciğer hastalığı, intoksikasyon ve alkol kullanımı gibi eşlik eden hastalıkları kayıt edildi.
Çalışma süresince toplam 68 hasta acil servise müracaat etti. Hastaların 47’si erkek, 21’i kadın hastaydı. Hastaların % 92’sinde nöroglikopenik semptomlar varken, % 8 hasta hiperepinefrinemik semptomlarla acil servise müracaat etti. Acil serviste hipoglisemi hastalarının en sık nedeni (% 89) diyabetik hastalarda aşırı insülin kullanımı (% 68) ve oral antidiyabetik kullanımına (% 32) bağlı ortaya çıkan hipoglisemi idi. Saptanan diğer hipoglisemi nedenileri, sırasıyla etanol intoksikasyomu (% 4), siroz (% 2), sepsis (% 1.4), intoksikasyon (% 1.4) ve panhipopituitarizm (% 1.4) idi.
Tüm hipoglisemik hastalarda önde gelen predispozan faktör düzensiz antidiyabetikc ilaç kullanımı olarak tespit edildi. Bu nedenle, tüm hekimlerin, özelliklede acil servis pratiğinde
çalışanların, antidiyabetik ilaç reçete ederken özellikle de yaşlı hastalarda, hasta-ilaç uyumunun bu tip komplikasyonlardan korunmak için en önemli faktör olduğunu akılda tutmaları gerektiği düşüncesindeyiz.
The aim of the study is to compare demographic, clinical features and precipitating factors of patients who admitted emergency department with hypoglycemic emergencies. The study was based on patients with hypoglycemia admitted to the emergency room of between 2000 and 2002 as a prospectively. In this study hypoglycemia was diagnosed by association with (1) serum glucose level of less than 50 mg/dl, (2) hypoglycemic symptoms consistent with diagnosis and (3) resolution of symptoms following glucose administration. Ages, sex, duration of hypoglycemia, hypoglycemic drug use, comorbit
disease (diabetes mellitus, liver disease, sepsis, intoxication, alcohol abuse, etc.) were recorded for all patients who enrolled in to the study.
Totally 68 patients with hypoglycemia were attended to emergency
room between 2 years. Average ages of hypoglycemic patient were 60.5 year. Forty-seven of them were male and 21 of them were female. Nighty-two patients who were hypoglycemic patient had neuroglycopenic symptoms and 8 % who were with hyperepinephrinemic symptoms. The main cause of hypoglycemia who admitted to our emergency department was to use overdose insulin (68 %) and oral hypoglycemic agents (32 %) of diabetic treatment (89 %). The other causes of hypoglycemia were respectively ethanol intoxication (4 %), cirrhosis (2 %), sepsis (1,4 %), intoxication (1.4 %) and panhypopituitarsym (1.4 %).
Prominent predisposing factor was irregularly antidiabetic drug use of all hypoglycemic patients. So all physicians who work in emergency departments should keep in mind to prescribe antidiabetic drug, the accordance between especially elderly patient and antidiabetic drug use is most important factor of diabetic hypoglycemic complications.

CASE REPORTS
12.A Trichobezoar Case Consulted for Abdominal Pain and Anemia
Ayşe Kubat Üzüm, İskender Dik, Ersan Sander, Burhan Bedir, Güngör Üzüm, Fatih Öner Kaya
Pages 40 - 41
A 21 years old woman consulted to our clinic for abdominal pain and anemia. We found out proximal esophageal web and gastric trichobezoar by upper gastrointestinal barium radiography and endoscopy. It has been removed by surgery. Because of this case we discussed about the bezoars.

13.An Otitis Media in a Newborn
Nalan Karabıyık, Demet Karakoç, Sultan Kavuncuoğlu, Sibel Öztürk, Nuri Engerek
Pages 42 - 43
In the neonatal period, otitis media is observed in patients receiving intensive care, especially in preterm babies intubated via nasotracheal route. A 6 days old term male infant who was born by vaginal delivery was referred to our outpatient clinic due to a discharge in his left ear. The otoscopic examination of the patient during physical examination made the diagnosis of otitis media where no any other features were
present. A hemoculture was carried out where infectious markers of the patient were found negative and an IV antibiotic treatment was eventually started. P. aeruginosa isolated in the infant’s culture of the aspirated middle ear effusion. The discharge in the ear of the infant disappeared at the third day of therapy. Parenteral antibiotic therapy was completed at the the end of the tenth day and the patient who has normal otoscopic
examination was discharged from the clinic. Acute otitis media should be remembered in newborns with sepsis symptoms, especially who have risk factors for otitis media.

14.Atraumatic Rupture of the Spleen in a Hemodialysis Patient
Gülçin Kantarcı, Fikret Aksoy, Özlem Durmuş, Fuat İpekçi
Pages 44 - 45
Atraumatic rupture of the spleen is an uncommon but important clinical entity. Isolated cases of spontaneous splenic rupture have not been reported in hemodialysis patients.
An unusual case is reported of spontaneous rupture of the spleen in a 54 year old woman suffering from end stage renal failure secondary to chronic pyelonephritis.
The spontaneous splenic rupture was thought be attributed to both heparinization during hemodialysis and uremic coagulopathy of end stage renal failure.

15.Dissemine Intravasculary Coagulation and Nephritis during Varicella Infection
Özden Türel, Ebru Bilgiç, Çiğdem Yılmaz, Hüsem Hatipoğlu, Osman Pinçe, Rengin Şiraneci
Pages 46 - 47
Varicella is usually a benign disease of childhood and uneventful recovery is the rule. Complications are related to the immunological status of the patient, an underlying disorder such as chronic dermatological or respiratory disease and immunosuppresive therapy, but healty children can be affectted as well. Most common complications are secondary bacterial infections of the skin. Encephalitis, myocarditis, pancreatitis, bleeding diathesis and nephritis are rarely seen. In this report a five year old preaviously healty and immunologicaly intact patient who developed dissemine intravasculary coagulation
and nephritis during varicella infection was presented and prognosis after therapy was evaluated. The patient whose sister had varicella infection 20 days ago has attended to our hospital with hemorhagic mostly crusted skin eruptions disseminated to her whole body. She developed trombocytopenia, necrotic purpura, edema and melena during the disease and fully recovered with early treatment.

16.Bullous Pemphigoid Associated with Prostate Adenocarcinoma
Zafer Türkoğlu, Filiz Özgür Çavuş, Mukaddes Kavala
Pages 48 - 50
Bullous pemphigoid is an autoimmune subepidermal bullous dermatosis that has vesicular, nodular, vegetan, eritrodermic and nonbullous variants. Although there have been some
reports on the association of malignancies with bullous pemphigoid, the correlation between internal malignancy and BP is still unclear. We describe a 69-year old man suggesting
bullous pemphigoid with histologic and immunologic findings, associated with prostate adenocarcinoma and briefly review the literature on the disease.

17.Renal Abscess
Hüsem Hatipoğlu, Çiğdem Yılmaz, Seda Yıldırım, Rengin Şiraneci
Pages 51 - 52
Renal and perirenal abscess are rarely observed in childhood. However, they should definitely be kept in mind in differentiating diagnosis of fever, flank and abdominal pain.
A nine year old girl was brought in with complaints of fever, vomiting, abdominal pain nd inability to walk that had been continuing for two weeks. It was found out that the patient had had no health problems prior to this. In physical examination there were no characteristics except for a body temperature of 39.8 degrees and abdominal pain that was more significiant on the left side. Urinary infection was identified during the initial examinations and abdominal ultrasound was performed. A calculus in the left kidney and a mass lower zone were identified. Also MRI was performed and an abscess covering
the lower zone and infiltrating psoas muscle on the left kidney was identified. After a course of 3 week antibiotherapy, the abscess vanished, ut because of the obstructive findings caused bye large sized of calculus, a surgical operation was planned and the patient was directed to the pediatric surgery department.
This case has been presented because it is rarely seen; and the abscess is remedied only by means of antibiotherapy.

18.Budd Chiari Syndrome
Gamze Gököz Doğu, Nilüfer Soner, Özgül Soysal, Oğuzhan Yıldırım, Bülent Eralp, Nail Bambul
Pages 53 - 55
Budd-Chiari syndrome (BCS) represents obstruction of hepatic venous drainage. The site of obstruction may be anywhere from the small central lobar veins of the liver to the proximal
inferior vena cava (IVC). Protein C is the zymogen of a vitamin K-dependent involved in blood coagulation. Protein C deficieny is an autosomal dominant disorder. This condition
promote excessive fibrin formation and thus constitute a risk factor for thrombosis. We report the case of a female patient who was protein C deficiency had severe thrombotic complications.

19.Fanconi Aplastic Anemia
Kenan Özcan, Faruk İncecik, Fatih Erbey, Göksel Leblebisatan, İbrahim Bayram
Pages 56 - 57
Fanconi aplastic anemia is a well known constitutional aplastic anemia. In this disorder all of the three cell lines are appeared to be affected. It may be seen frequently in heterogenic
but mostly in familial fashion. It may be inherited genetically in several ways.
Here we have presented this review to emphasize that there may coexist with malignancies or abnormalites of other organs in the case with Fanconi syndrome. So it needs more detailed investigation.

20.Necrotized Ovarian Torsion Following Hyperstimulation Syndrome and Pregnancy
Sadık Şahin, Recep Yıldızhan, Ertan Adalı, Necdet Süer
Pages 58 - 59
Ovarian hyperstimulation syndrome is the most significant complication seen in women attending for ovulation induction. The risk of adnexeal torsion is increased with severly
enlarged ovaries. For these patients, conservative approach is recommended. When the ovaries and adnex are necrotized the only choice is salphingo-oophorectomy. In this case on exploration necrotized over is recognized and salphingo-ophorectomy has been done.

21.Tyroid Tuberculosis
İlknur Dilek, Ferhan Özşeker, Ethem Ünver, Sevinç Bilgin, Esen Akkaya
Pages 60 - 61
Tuberculosis of the thyroid gland is a rare condition and histological diagnosis ranges between 0.1 % and 1.15 %. This paper presents, a female patient with thyroid tuberculosis
admitted to our clinic cervical mass and fistula formation, August 2002. She had total thyroidectomy operation on February 2001 and the pathology was thyroid thyroid tuberculosis. She wasn’t given any antituberculosis medication and chest X-ray was normal. Fistula material was culture positive for acid-fast bacilli. She was given antituberculosis medication for 6 months and currently she has no complaint.

22.GM2 Gangliosidosis
Suar Çakı, Özlem Başoğlu Öner, Banu Bal, Müferet Ergüven
Pages 62 - 63
GM2 gangliosidosis are neurodegenerative disorders, charecterized with hexosaminidase or GM2 activator protein deficiency. All are transmitted by autosomal recessive inheritance. Hexosaminidase activity measurement is necessary for the diagnosis. A five-year old girl is referred to our clinic with hypotonia, neuromotor retardation, course facial feature and hepatosplenomegaly. Her parents are relatives and with these features storage disease is thought. Hexosaminidase deficiency is found with blood leukocyte enzym analyse and GM2 ganglisidosis diagnosis is made. Gangliosidosisses are rare diseases. Relative mariages are common in our country. With this case report we want to pay attention to the patients with neuromotor retardation and hepatosplenomegaly, gangliosis must be thought in the differential diagnosis. Because there isn’t any effective therapy, prenatal diagnosis is essential for the disease.

23.Rupture of subserous myoma uteri during term delivery
Sadık Şahin, Burçak Tok, Dilek Öztürk, Recep Yıldızhan, Necdet Süer
Page 64
A case of rupture of subseroz myoma uteri during term delivery is reported.




 

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