Kalça ve diz eklem replasman cerrahisinde ameliyat sonrasý kullanýlan ototransfüzyon sisteminin allojeneik kan transfüzyon ihtiyacý üzerine etkinliði deðerlendirildi.
Eylül 2005-Mayýs 2006 tarihleri arasýnda kalça ve diz eklem replasman cerrahisi uygulanan 15 hastada (4 erkek, 11 kadýn; ort. yaþ 64; daðýlým 42-85) ameliyat sonrasý kullanýlan ototransfüzyon seti ile postoperatif allojeneik kan transfüzyon gereksinimi deðerlendirildi. Hiçbir hastaya preoperatif ve intraoperatif dönemde kan transfüzyonu yapýlmadý. 15 hastanýn 19 alt ekstremitesine farklý endikasyonlarla artroplasti giriþimi uygulandý. Tüm hastalarda postoperatif hemovak dren yerine ototransfüzyon seti kullanýldý ve cilt kapamasýndan 4,6 saat sonra (daðýlým 4-6 saat) ortalama 560 ml kan (daðýlým 350-800 ml) transfüze edildi. Tüm hastalarýn preoperatif, tansfüzyon öncesi ve sonrasý, postoperatif 1. gün, 3. gün, 5. gün, 1.hafta, 3. hafta ve 6. hafta hemoglobin ve hematokrit deðerleri kaydedildi.
Hiçbir hastada transfüzyona baðlý allerjik reaksiyon ve enfeksiyon gibi komplikasyonlar geliþmedi. Hastalardan sadece 1 (% 5.2) tanesine postoperatif birinci gün 1 ünite kan transfüzyonu yapýldý. Diðer hastalarda postoperatif dönemde allojeneik kan transfüzyon ihtiyacý olmadý. Transfüzyon uygulanan hasta ile birlikte toplam 2 (% 10.4) hastaya postoperatif birinci hafta hemoglobin deðer düþüklüðü nedeniyle oral demir replasman tedavisi baþlandý ve 3 hafta boyunca devam edildi.
Kalça ve diz eklem replasman cerrahisi sonrasý allojeneik kan transfüzyonu ihtiyacýný azaltmak amacýyla kullanýlan otolog kan transfüzyon yöntemi; uygulamasý ve kullanýmý kolay, etkinliði yüksek bir yöntemdir.

The effectiveness of autologous blood transfusion system about the need of allogenic blood transfusion in hip and knee joint replacement surgery was evaluated.
Between September 2005-May 2006, the need of postoperative allogenic blood transfusion with the use of postoperative autotransfusion system was evaluated in 15 patients (4 males, 11 females; mean age 64 years; range 42-85 years), that were operated with hip and knee joint replacement surgery. None of the patients were transfused before and during surgery. Arthroplasty was applied for 19 extremities of 15 patients with
differential diagnosis. Postoperative autotransfusion drain was used for all patients instead of standart suction drain. The average amount of collected blood was 560 ml (range 350-
800 ml) and was transfused 4,6 hours (range 4-6 hours) later after skin closure. The hemoglobin and hematocrit levels were measured preoperatively, postoperatively (before and after transfusion), on the first, third, fifth days and first, third, sixth
weeks postoperatively.
None of the patients developed adverse effects from the reinfused material such as allergic reactions and infection. The need for allogenic blood was established for only one patient (%5.2) in the first postoperative day as one unit. Oral iron replacement
was used for two patients (% 10.4) at the first week along three weeks. Autologous blood transfusion method, which applied for decreasing the need of allogenic blood transfusion in hip and knee joint replacement, is easy useable and effective method.

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GÝRÝÞ ve AMAÇ: Kronik hepatit delta virus (HDV) infeksiyonunda 9 milyon ünite rekombinan interferon alfa-2a (haftada 3 defa) ile 5 milyon ünite rekombinan interferon alfa-2b (günde bir
defa) tedavilerinin etkisini deðerlendirmek.

YÖNTEM ve GEREÇLER: Bu geriye dönük çalýþmaya 48 hafta boyunca haftada üç defa 9 milyon ünite (mü) interferon alfa-2a (grup A) veya günde 5 milyon ünite interferon alfa-2b (grup B) ile tedavi edilen 11 hasta dahil edilmiþtir. Tedavinin 24 ve 48. haftasýnda kantitatif HDV RNA ölçümü yapýlmýþtýr. Virolojik cevap serum HDV RNA’sýnýn negatifleþmesi olarak tanýmlanmýþtýr.

BULGULAR: Tedavinin 24. haftasýnda grup A’daki yedi olgunun dördünde (% 57) ve grup B’ deki dört olgunun birinde (% 25) HDV RNA negatifleþmiþtir. ‹ki grup arasýnda anlamlý fark
bulunamamýþtýr (p=0.348). Tedavinin 48. haftasýnda grup A’daki yedi olgunun altýsýnda (% 85) ve grup B’deki dört olgunun ikisinde (% 50) HDV RNA negatifleþmiþtir. Ýki grup arasýnda anlamlý fark bulunamamýþtýr (p=279).

TARTIÞMA ve SONUÇ: Bu çalýþmada kronik hepatit D infeksiyonu nedeniyle haftada üç defa 9 milyon ünite interferon alfa-2a veya günde 5 milyon ünite interferon alfa-2b tedavisi alan hastalar
arasýnda virolojik cevap açýsýndan fark bulunamamýþtýr.

INTRODUCTION: To evaluate the efficacy of 9 million units of recombinant interferon alpha-2a (three times a week) versus that of 5 million units of recombinant interferon alpha-2b (once a day) in the treatment of chronic hepatitis delta virus (HDV) infection.
METHODS: This retrospective study included 11 patients with chronic hepatitis D treated with interferon alpha-2a with the dose of 9 million units three times a week (Group A) or interferon alpha-2b with the dose of 5 million units once a day (Group B) for 48 week. Quantitative HDV RNA was performed at week 24 and 48. Virological response was defined as undetectable serum HDV RNA.
RESULTS: Serum HDV RNA was no longer detectable in four of the seven patients in Group A (57 %), as compared with one of four patients in Group B (25 %) at week 24. The difference between two group was not significant (p=0.279). Serum HDV RNA was undetectable in six of the seven patients in the Group A (85 %), as compared with two of the four patients in the Group B (50 %) at week 48. The difference between two group was not significant (p=0.279).
DISCUSSION AND CONCLUSION: In this study, virological response at week 24 and 48 were not different between patients with chronic
hepatitis D treated with interferon alpha-2a with the dose of 9 million units three times a week and interferon alpha-2b with the dose of 5 million units once a day.

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Subacromial sýkýþma sendromunun (SSS) tedavisinde ultrason ve mobilizasyonun etkinliklerini karþýlaþtýrmak amacýyla prospektif, randomize tek kör çalýþma planlandý.
Omuz aðrýsý ile baþvurup, klinik muayene sonrasý SSS tanýsý alan 40 hasta alýndý ve 2 gruba ayrýldý. Birinci gruba sýcak paket (hot pack), egzersiz ve mobilizasyon, ikinci gruba sýcak paket (hot pack), egzersiz ve ultrason tedavileri uygulandý. Hastalar tedavi öncesi (TÖ), tedaviden sonra (TS) ve tedavi bitiminden 2 ay sonra (TBS) aðrý için vizüel analog skala (VAS) ile aktif eklem hareket açýklýðý (goniometri ile), omuz fonksiyonlarý için University of California at Los Angeles (UCLA) ve constant skalasý ile deðerlendirildi.
Gruplarýn yaþ ortalamasý 51.82±6.81, aðrý süreleri 7±4 ay, cinsiyet ve mesleklerine göre incelendiðinde homojen daðýlýmlý olduðu görüldü (P>0.05).
Aðrýnýn VAS'a göre deðerlendirilmesinde istirahat, hareket ve gece aðrýsýnda her iki gruptada tedavi öncesine göre tedavi sonrasý ile tedaviden 2 ay sonraki iyileþme ileri anlamlý bulundu
(p<0.01). fakat gruplar arasý fark yoktu (p>0.05). Aktif eklem hareket açýklýklarý ve manuel kas gücü deðerlendirilmesi her iki grupta da ileri düzeyde iyileþme görüldü (p<0.01) ve gruplar arasý fark yoktu (p>0.05). UCLA ve constant skalasýndaki artýþlar her iki grupta da ileri düzeyde anlamlýydý (p<0.01) ve gruplar arasý fark yoktu (p>0.05). Subacromial sýkýþma sendromunun tedavisinde ultrason ve mobilizasyonun aðrý, günlük yaþam aktivitesi, eklem hareket açýklýðý ve kas gücü üzerine yararlý etkileri saptandý.

Prospective, randomized, single blinded study was planned to compare the effects of ultrasound and mobilisation in subacromial impingement syndrome 40 patients, who applied with shoulder pain and whose diagnosis were subacromial impingement syndrome after physical examination, were enrolled. First group were treated with hot pack, exercises and mobilization, and the second group with hot pack, exercises and ultrasound.
The patients were evaluated 3 times: before the treatment, after the treatment and 2 months after the treatment. Visual analog scale (VAS) was used for pain, University of
California at Los Angeles (UCLA) and constant scale for shoulder function, and range of motion (ROM) was measured with a goniometry.
Mean age of the groups was 51.82±6.81years, mean pain period was 7±4 months. It was a homogeneus group (P>0.05).
When pain evaluated according to VAS in both of the groups, improvement was highly significant after treatment and two months after treatment (p<0,01). There were no difference between the groups (p>0,05). Significant improvement of active range of motion and manuel muscle strength evaluation were detected in both groups (p<0,01), and there were no difference between the groups (p>0,05). The increase in UCLA
and constant scores were highly significant in two groups (p<0,01), and there were no difference between the groups (p>0,05). The treatment of subacromial impingement syndrome by ultrasound and mobilisation were found effective on pain,
activities of daily living, range of motion and muscle strength.

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GÝRÝÞ ve AMAÇ: Kalkaneal spur (Topuk dikeni) hastalýðýnýn lokal kortikostreoid ve lokal anestezik madde karýþým enjeksiyonu ile tedavisinin etkinliðini araþtýrmak.
YÖNTEM ve GEREÇLER: Ortopedi ve fizik-tedavi ve rehabilitasyon polikliniklerine topukta aðrý þikayeti ile müracaat eden 28 hastanýn (17 kadýn, ortalama yaþ 45, daðýlým 33-72 yýl; 11 erkek ortalama yaþ 48, daðýlým 29-69 yýl) radyolojik olarak topuk dikeni tespit edilmiþ ve aðrý þikayeti yaratan 35 topuðu çalýþmaya alýndý. Her hastaya poliklinikte, steril þartlar altýnda plantar fasia'nýn kalkaneusa yapýþma yerine uyan ve en aðrýlý olduðu tespit edilen bölgeden ayný enjektör içinde 2 cc. Depomedrol (metilprednizalon asetat) ve 5 cc. Citanest (Prilokain hidroklorür) enjekte edildi. Hastalar birinci hafta, birinci ve üçüncü aylarda kontrole çaðrýlarak deðerlendirildi.

BULGULAR: Elde edilen sonuçlara göre topuk dikeni tedavisinde lokal kortikosteroid ve anestezik madde karýþým enjeksiyonu özellikle kýsa dönemde etkili bir yöntem olmakla beraber bu etkinlik zaman içinde belirgin þekilde azalmaktadýr. Ancak tek enjeksiyon yapýlmasýna raðmen üçüncü aydaki kontrollerde elde edilen yaklaþýk % 80 oranýndaki çok iyi ve iyi sonuçlar bu tedavi yönteminin ilaç ve topuk yastýðý tedavisinden yeterli yarar görmeyen hastalarda uygulanabileceðini düþündürmektedir.
TARTIÞMA ve SONUÇ: Birinci hafta kontrolünde 28 hastanýn 22'si (%78.5) þikayetlerinin tamamen geçtiðini (çok iyi), üçü (% 10.7) aðrýnýn büyük oranda geçtiðini (iyi), üçü (% 10.7) ise þikayetlerinde bir deðiþiklik olmadýðýný (kötü) ifade ettiler. Birinci ayýn sonunda iki hasta takipten çýktý ve bu oranlar sýrasýyla %61.5 (16 hasta), % 23 (6 hasta) ve % 15.3 (4 hasta) olarak tespit edildi. Üçüncü ayýn sonunda da takipten çýkan iki hasta çýkarýldýktan sonra sonuçlar sýrasýyla % 54.1 (13 hasta), % 25 (6 hasta) ve % 20.8 (5 hasta) olarak tespit edildi.

INTRODUCTION: To investigate the efficacy of local corticostroid and local anaesthetic injection in the treatment of calcaneal spur.
METHODS: Thirty-five heels (observed to cause local pain by palpation in physical examination) of 28 patients (17 female, mean age 45, range 33 to 72 years; 11 male, mean age 48, range 29 to 69 years) which have been shown to have calcaneal spur radiologically on admission to orthopaedics and physical therapy departments because of pain on calcaneal region were included in the study. Each patient had 2 cc. Depomedrol (metilprednisalon asetate) ve 5 cc. Citanest (Prilocain hidroclorure) injection under sterile conditions on the
most painful point that was the region where plantar fascia attached calcaneus. Patients were examined on first week, first and third month.
RESULTS: In the first week twenty-two of 28 patients (78.5 %) stated complete releif of pain (excelent), three patients (10.7 %) stated incomplete releif of pain (good) and three patients (10.7 %) stated no difference in complaints (bad). Two patients were out of study in the end of the first month and the results were 61.5 % (16 patients), 23 % (6 patients), 15.3 % (4 patients) respectively. Another two patients were also out of study in the end of the third month and the results were 54.1 % (13 patients), 25 % (6 patients) and 20.8 % (5 patients) respectively.
DISCUSSION AND CONCLUSION: According to our results, local corticostroid and local anaesthetic injection in the treatment of calcaneal
spur is an effective treatment method especially in short term. However it seems that this efficiency markedly diminishes by time. The high rate (80 %) of excelent and good results in the 3rd. month in spite of only one dose of injection inclined us to conclude that this method may be used in patients who had no satisfactory outcome with medical and heel cup treatments.

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Pleomorphic carcinoma is a rare epithelial malignant tumor. Pulmonary pleomorphic carcinoma was introduced by the 1999 World Health Organization classification as a new peculiar type of lung carcinoma showing concurrent malignant epithelial and sarcomatoid spindle cell elements. Rarely seening, advange age, male sex dominance, upper lobe involvement, big sized (more than 7 cm.) at time of diagnosis, and poor prognosis are the characteristics of it. We are reporting 63-year-old man with pleomorfic carcinoma in the left lower lobe who was treated by left pneumonectomy.

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Because of its complex origin eating disorders affect many organ and systems. So that, optimal evaluation and treatment of eating disorders is possible only with a multidiscipliner team approach. In this study, roles of team members during the treatment period of an anorexia nervosa patient is outlined.

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Porphyria is a result of a spesific enzyme deficiency at hem biosenthesis steps. The precursors are ALA and PBG at porfirin synthesis and the disorders at these steps are named as porphyria.
Acute porphyrias are metabolic disorders at biochemical processes on liver. Porphyria disease is very important for anaesthetists. We wanted to emphasize which anesthesia method is safer at a patient which has diagnosed as porphyria.

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