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Medeniyet Med J: 16 (1)
Volume: 16  Issue: 1 - 2001
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CLINICAL RESEARCH
1.Biochemical Analysis of Hydrocele Fluid, Measurement of Sac Pressure and Histopathological Evaluation of Tunica Vaginalis in Patients with Idiopatic Hydroceles
Fatih Tarhan, Mete Ergen, Erkan Erbay, Önder Cangüven, Uğur Kuyumcuoğlu
Pages 4 - 8
Kliniğimizde hidroselektomi operasyonu geçiren hidroselli 21 hasta ve kontrol olarak ise testis biyopsisi yapılan 6 hasta hidrosel fizyopatolojisi hakkında bilgi sahibi olmak amacıyla prospektif olarak araştırıldı. Tüm hastalara skrotal ultrasonografi, hidrosel kesesi basıncı ölçümü, hidrosel sıvı miktarı, pH ve dansite tayini, hidrosel sıvısı ve kanda biyokimyasal inceleme yapıldı. Tunika vaginalis örnekleri histopatolojik olarak incelendi. Hidrosel sıvısı hacmiyle hidrosel kesesi basıncı arasında istatiksel olarak önemli korelasyon (r=0.72, p<0.0001) saptandı. Hidrosel sıvısı volümü ve hidrosel kesesi basıncı bakımlarından in-şamasyon olan ve olmayan hidrosellilerde istatistiksel olarak önemli fark bulundu (p<0.05). Hidrosel sıvısında üre, sodyum ve fosfor dışındaki parametrelerin sonuçları serum değerlerinden istatistiksel olarak düşük bulundu. Histoloik olarak kalınlık farkı gösteren gruplar arasında üre ve sodyum değerleri istatistiksel olarak farklıydı. Hidrosel sıvısının sodyum ve pH seviyeleri kontrol grubu değerlerine gre istatistiksel olarak farklıydı. Sonuç olarak, hidrosel sıvısının biyokimyasal içeriği oluşma mekanizmalarından bağımsız gibi görünmektedir.
In order to get information about physiopathology of hydrocele, 21 patients who were operated for hydrocele and as a control group 6 patients who were undergone for testes biopsies were investigated prospectively. Scrotal ultrasound, measurement of hydrocele sac pressure, determination of hydrocele fluid volume, pH and density, biochemisry of blood and hydrocele fluid were measured. Samples of tunica vaginalis were examined histopathologically. Statistically significant correlation was found between hydrocele fluid volume and hydrocele sac pressure (r=0.72, p<0.0001). Statistically significant difference was found between hydroceles histologically showing inflammatory reaction or not, from point of hydrocele fluid volume and hydrocele sac pressure (p<0.05). Results of parameters except urea, creatinine, sodium and phosphorus levels in hydrocele fluid, were found statistically lower than serum levels. Between groups that show histologically
difference in thickness, urea and sodium levels were found statistically different. Sodium and pH levels of hydrocele fluid were found statistically different from control group
values. As a result, it is seem that biochemical contents of fluid of patients with idiopathic hydroceles are not related to formation mechanisms.

2.Recirculation in Patients Taking Dialysis
Hülya Karadayı Ergin, Aysun Sevük, Sabahat Alışır, Nermin Kara, Mehtap Tınazlı, Şeyhmus Akalpoğlu
Pages 9 - 10
Bu çalışmada SSK Nişantaşı Diyaliz Merkezi’nde hemodiyaliz tedavisi gören kronik böbrek yetersizliği hastalarında resirkülasyon fenomeni açısından bir karşılaştırma yapıldı. Fonksiyonel kapasitesine göre arteriyovenöz fistülle hemodiyaliz tedavisi yapılan hastalar ile venöz kateterizasyonla hemodiyaliz tedavisi gören hastalar resirkülasyon açısından değerlendirilerek karşılaştırıldılar.
The chronic renal failure patients attending Nişantaşı SSK Dialysis Unit for hemodialysis are searched for effects on the recirculation phenomenon. The comparison is made between
the patients taking dialysis through arteriovenous fistulas according to the functional capacity of their fistulas and through venous catheterisation.

3.Subacute Sclerozing Panencephalit
Müferet Ergüven, Okay Yasa, Mavişen İşcen, Handan Yükselgüngör, Merve Kesim Usta, Aydın Angay, Sevil Özçay
Pages 11 - 13
Subakut sklerozan panensefalit (SSPE), 1 yaşından küçük çocuklarda görülebileceği gibi, 30 yaşından büyük olgularda da görülebilir. Kızamık infeksiyonu geçirildikten sonra SSPE gelişme riski 4/100.000 iken, aşılama sonrası gelişme riski 0.14/100.000’dir. Bu çalışmada, 1998 Nisan- 2000 Ocak tarihleri arasında kliniğimizde tanı konarak tedavi edilen 6 SSPE olgusunu sunduk. Amacımız, kızamık infeksiyonunun önemini bir kez daha vurgulamak ve kızamık aşısının önemini hatırlatmaktır.
Subacute sclerozing panencephalit (SSPE) is a slow in-fection with measles virus that causes progressive inflammation and sclerosis of the brain. The disease has been diagnosed in
patients less than 1 year to more than 30 years of age. The calculated risk of SSPE following measles was 4.0/100.000 cases compared with the risk after vaccine of 0.14/100.000 doses. In this study, we are to present total 6 patients diagnosed and started treatment in our clinic between 1998 April-2000 January. Our purpose is remind to important of vaccination and express to preventing infection of measles.

4.Incidence of Anti HCV Antibody in Chronic Idiopathic Urticaria
İlkin Z. Arınkal, Arzu Yakut Büyük, Sibel Südoğan, Sema Akkız, Mukaddes Kavala
Pages 14 - 16
Kronik ürtiker, etyolojisinde çok çeşitli etkenlerin rol oynadığı bir hastalıktır. Bu çalışmada, kronik ürtikerli bir grup hastada etyolojik neden olarak hepatit C seroprevalansı araştırılmaktadır. Bu amaçla, Mart-Eylül 1988 tarihleri arasında kliniğimize başvuran 55 kronik ürtikerli hastada Anti HCV Ab varlığı araştırıldı. Toplam 4 hastada (% 7.27) Anti HCV Ab sonucu pozitif olarak saptan-dı. HCV ile asosiye olabilecek hastalığı bulunmayan 50 kişiden oluşan kontrol grubunda ise bu antikora rastlanmadı. Hasta grubundan elde ettiğimiz değer, normal popülasyonda rastlanandan yüksekti. Kontrol grubu ile karşılaştırıldığında, istatiksel olarak anlamlı bulunmadı. Kronik ürtiker etyolojisi belirlenmeye çalışılırken HCV varlığının araştırılmasının, hastada risk faktörü ya da klinik bulgu olmasa dahi yapılması gerektiği sonucuna varıldı.
Chronic urticaria is a disease in which various etiologic factors play role. In this study hepatitis C seroprevelance is evaluated as an etiologic factor in a group of patients with
chronic urticaria. The presence of anti HCV antibody was detected in 55 patients with chronic urticaria who applied to our outpatient clinic between March and September 1998.
Anti HCV antibody was found positive in 4 patients (% 7.27). There was no antibody positivity in our control group which consisted of 50 patients who had no HCV associated diseases. HCV antibody positivity in chronic urticaria group was higher than normal population prevelance, but when compared with control group the difference was not statistically different. It was concluded that the presence of HCV should be detected in chronic urticaria even though the patient had no risk factors or clinic symptoms.

5.The Correlation between Histopathological Evaluation of Endometrium and Transvaginal US Measurement of Endometrial Thickness in Peri- and Postmenopausal Bleeding
İzzet Yücesoy, Gülseren Yücesoy, Aydın Çorakçı, Birol Vural, Semih Özeren, Füsun Vural, Leyla Eren
Pages 17 - 20
Pre ve postmenopozal dönemde vajinal kanaması olan olgularda transvajinal ultrasonografi (TVUS) ile endo-metrium kalınlığı ölçümünü, endometrium hispatolojisi ile karşılaştırmak amacıyla 27 pre ve 20 postmenopozal hasta çalışma kapsamına alındı. TVUS ile endometrial kalınlık ölçümü yapıldı. Ölçüm sonucu elde edilen endometrial kalınlığın 0-5 mm, 6-10 mm, 11-15 mm ve 16-20 mm değerleri arasında olmasına göre olgular dört gruba ayrıldı. Daha sonra hastaların tümüne lokal anestezi altında probe küretaj uygulandı. Endometrium histopatolojisi ile endometrial kalınlık ölçümleri karşılaştırıldı. Elde edilen sonuçlar Mann Whitney U testi ile değerlendirildi. Endometrial kalınlık cut-off değeri olarak 10 mm alındığında endometrial patoloji (endometrial hiperplazi ve endometrial karsinoma) saptanmasında duyarlılık, özgüllük, pozitif ve negatif öngörü değerleri premenopozal grupta sırasıyla % 85.7, % 60, % 42.8, % 92.3 postmenopozal grupta ise sırasıyla % 92.3, % 71.4, % 85.7 ve % 83.3 olarak bulundu. TVUS ile ölçülen endometrial kalınlık ortalama değeri atipisiz endometrial hiperplazi, endometrial polip ve endometrial karsinom için sırasıyla 14.68±32 mm, 10.95±2.61 mm, 16.45±2.47 mm olarak bulundu. Postmenopozal dönemde TVUS ile endometrial kalınlık ölçümünün endometrial patolojiyi saptamada duyarlılık ve özgüllüğü, premenopozal döneme göre daha yüksektir. Postmenopozal dönemde, transvaginal ultrasonografi bu amaçla ilk tanı yöntemi olarak kullanılabilir.
The aim of this study was to investigate the correlation between TVUS measurement of endometrial thickness and endometrial biopsy results in peri- and postmenopausal
women with abnormal uterine bleeding. The study included 27 perimenopausal and 26 postmenopausal women. Endometrial thickness was measured with TVUS. The patients were divided into 4 groups according to the measurement findings: such as 0-5, 6-10, 11-15 and 16-20 mm. Dilatation and curettage was performed in all cases under local anaesthesia. The values of endometrial thickness are compared with endometrial
histopathology. Mann Whitney U test was used for statistical analysis. When the cut-off value of endometrial thickness in the perimenopausal period was 10 mm, the sensitivity,
specificity, positive and negative predictive values in prediction of endometrial pathology were 85.7 %, 60 %, 42.35 %, 92.35 % respectively. In the postmenopausal period, these
values corresponded 92.3 %, 71.4 %, 85.7 %, 83.3 % respectively with the same cut-off value. The mean values of endometrial thickness measured by TVUS for endometrial
hyperplasia without atypia, endometrial polyp and endometrial carcinoma were found to be 14.68±32 mm, 10.95±2.61 mm, 16.45±2.47 mm respectively. Given that the sensitivity and specificity for measuring the endometrial thickness by TVUS in the postmenopausal period are superior to those in the perimenopausal period. It seems reasonable that vaginal ultrasonographic assessment of the endometrium should be
primary method for excluding any endometrial abnormality in a woman with postmenopausal bleeding.

6.Is The Use of Noseclips Necessary in Adults Performing Spirometry
Oğuz Aktaş, Hatice Türker, Ergün Karahallı, Mesut Kosku, Çiğdem Pakiş
Pages 21 - 22
Spirometri ile akciğer fonksiyon testi yaparken burun mandalı kullanmanın gerekip gerekmediğini araştırdık. Hava yolu daralması olan 20 hasta ile sağlıklı 10 kişi burun mandalı
takarak ve takmadan spirometrik teste tabi tutuldular. FVC, FEV1 ve FEF %25-75 sonuçlarında anlamlı fark gözlemlenmedi.

Sonuçlarımız, spirometrik test sırasında burun mandalı kullanmanın gerekli olmadığı sonucunu ortaya koymuştur.
We performed a cross-over study in adults to determine whether the use of noseclip significantly affected spirometric values. 20 adults with airay obstruction and 10 healthy adults performed spirometry with and without noseclip in random order. No significant
differances were found between spirometric values FVC, FEV1, FEF %25-75.

Our results showed that usage of noseclip in spirometriy is unnecessery.

7.The Effect of VDD and VVIR Pacemaker Modes on Exercise Capacity and Serum ANP Levels
M. Serkan Çınar, Mustafa Kemal Özbek, Erdal Ayker, Naciye Ayşe Erbakan, Nail Bambul, Bülent Eralp, Hilmi Çiftçi
Pages 23 - 26
Single lead VDD ve VVIR pacemaker modlarının efor kapasitesi ve serum ANP seviyesine etkisini araştırmak amacıyla, SSK Göztepe Eğitim Hastanesinde A-V tam blok ile ikinci derece A-V blok tanısı konmuş ve sinüs fonkisyonu normal olan, VDD pacemaker takılmış, ek hastalığı bulunmayan, 25 erkek, 14 kadın, yaş ortalaması 60±9.66 yıl olan, toplam 39 hasta çalışmaya alındı. Hastaların başlangıç serum ANP seviyeleri ve efor kapasiteleri ölçüldükten sonra pacemaker modları VVIR’a çevrilerek bir ay sonra ölçümler tekrarlandı.

Plazma ANP seviyeleri ve efor süreleri student-t testi kullanılarak karşılaştırıldı. Plazma ANP seviyesi VDD ve VVIR modları için sırasıyla; ortalama 28.77±14.37 μg/ml, 73.25±30.45 μg/ml, fark istatistiksel açıdan ileri derecede anlamlıydı (t=7.359, p=0.000). Efor süresi ise VDD modunda 295.74±91.02 sn, VVIR modunda 245.10±109.64 sn idi ve fark istatistiksel açıdan anlamlı bulundu (t=-10.621, p=0.000).

VDD modunun VVIR moduna göre efor kapasitesine olumlu etkisinin yanında istirahatta serum ANP seviyesini de normal sınırda tutması VDD modunun daha fizyolojik ve kardiyak doğaya daha uygun bir şekilde çalıştığını göstermektedir.
This study was design to investigate the effect of VDD and VVIR pacemaker mode on serum ANP level and exercise capacity. To asses the relation of ANP level and exercise
capacity with VDD and VVIR pacemaker modes, 39 patients (25 men and 14 women, mean age 60±9.66 years) with no other medical disorder admitted for complete or second
degree AV block to Göztepe Social Security Hospital were studied. The patient’s pacemakers were in VDD mode at baseline and were change to VVIR mode after initial measurement of serum ANP level, and exercise capacity. After having VVIR pacemaker modes for a month, the patients were reestimated for their serum ANP levels and exercise capacities. The result were compared with student-t test.

Serum ANP levels differed significantly between VDD pacemaker mode (mean 28.77±14.37 μg/mL) and VVIR pacemaker mode (73.25±30.45 μg/mL) (t=7.359, p=0.000). Exercise time was also prolonged in the group with VDD pacemaker mode
(295.74±91.02 sec) compared with the VVIR pacemaker mode (245.10±109.64 sec) (t=-10.621, p=0.000).

These data indicate that patients with VDD pacemaker mode have better exercise capacity as well as resting serum ANP levels in normal range which show us that VDD mode works in a better physiologic manner.

8.Gynecologic Malignancies
Mete Bostancı, Kadir Gülin, Öznur Gökçen, Ertunç Mega, Nilgün Tandoğan
Pages 27 - 30
SSK Göztepe hastanesi kadın-doğum kliniği onkoloji departmanına 1.10.1995-10.5.1996 tarihleri arasında başvuran hastalar arasında 74 jinekolojik genital neoplazi olgusu yatırılarak operasyona alındı. Olgular 30 over ca. (% 40.5), 25 servikal neoplazi (% 27), 14 endometriyum ca. (% 18.9), 11 serviks ca. (% 18.9), 11 servikal intraepitelyal neoplazi (% 14.8), 3 vulva ca. (% 4), 2 gestasyonel trofoblastik neoplaziden (1 koryokarsinom, 1 invazif mol) oluşmaktaydı. Tüm olgulara gerekli preoperatif tetkikler (kan biyokimyası, tümör markerleri, ultrasonografi, tomografi, MRI, sistoskopi, rektoskopi) yapılarak evrelendirildi. Gerekli operasyonlar yapılarak takibe alındı. ‹leri evre olgulara da cerrahi tedaviyi takiben radyoterapi ve kemoterapi planlandı. Tüm olgularımızın yaş, tümör evresi, grade’i, invazyon derecesi, vasküler tutulum, metastaz ve cerrahi evreleri ayrıntılı olarak değerlendirilerek literatürle karşılaştırıldı.
At SSK Göztepe Hospital Oncology departmant we operated 74 gynecologic oncology cases betwen September 1995-May 1996. The sever included 30 over neoplasia (40 %), 25 cervical neoplasia (27 %), 14 endometrium neoplasia (14.8 %) 3, vulva carcinom (4 %) & 2 gestational trophablastik neoplasia. All cases stoped of to the preoperatif evolation who
included serum biochemstry, tumor markers, ultrasonography, computurned tomogram, MRI, systoscopy, rectoscopy.

After operation we planned radioterapy&chemoterapy for high grade cases. We analyzed all the cases for age, tumor grade, stage, tissue invasion, vascular invasion, metastases&surgical stegig.

9.Retrospective Overview of Our Cases of Poisonings
Müferet Ergüven, Merve Usta, Süleyman Talay, Hamit Özkan, Osman Saçar, Sevil Özçay
Pages 31 - 33
Hastanemiz Çocuk kliniğinde Ocak 97-Aralık 99 tarihleri arasında yatırılarak izlenen, yaşları ortalama 6.417 olan 133 zehirlenme olgusu retrospektif olarak değerlendirildi. Olguların % 50.37’si (n=67) kız, % 49.62’si (n=66) erkekti. 2-6 yaş arası olgular, tüm olguların % 54.88’i (n=73) olup, en sık zehirlenme görülen yaşlar olarak belirlendi. Tüm olgularda zehirlenme etkeni saptandı; farmakolojik etkenlerden ilk sırada asetilsalisilik asit (n=18) % 18.4, ikinci sırada amitriptilin (n=15) % 15.3 sap-tanırken non-farmakolojik etkenlerden mantar (n=30) % 85.7 ilk sırayı almaktaydı. Zehirlenmelerin % 86.46’sı (n=115) kazara, % 13.53’ü intihar amaçlı gerçekleşmişti.

İntihar olgularının % 66.6’sı kız (n=12) ve intihar nedenlerinin başında okul başarısızlığı gelmekteydi. Zehirlenme nedeniyle en sık başvurular, Haziran ve Ekim ayında oluyordu. Zirve zehirlenme saatinin en sık 11-17 arası olduğu saptandı. Olguların % 9.74’ü reanimasyonda izlendi. Olguların % 5.26’sı exitus oldu (n=5). Exitus nedenlerinin tümü mantar zehirlenmesiydi.
During the period of January 1997-December 1999, 133 cases of poisoning, avarage age is 6.417, who were hospitalized in the department of pediatrics in our hospital were evaluated retrospectively. Girls were 50.37 % of the all cases, boys were 49.63 % of the all cases. 54.88 % of the cases were seen in the age group of 2-6 ye-ars. All the causes of poisonings were found. Most of the intoxications occurred with asetyylalicylate 18.4 %, amytriptyline 15.3 % among the pharmaceutical products. Mushroom poisoning (85.7 %) was the first among the non-pharmaceutical products. Accidental causes were 86.46 % of the cases. 13.53 % of the cases were exposed to the poisoning because of suicide. 66.6 % of the suicide was failure in school. All suicide attemps were seen in the age group of 11-14 Most frequently, poisioning cases were taken to the emergency room on June and
October. Peak poisoning time was the hours between 11-17. 9.74 % of the cases were taken to the intensive care unit. 5.26 % of the cases were died. All the causes of death were mushroom intoxications.

10.Community Acquired Pneumonia
Aydanur Mihmanlı, Tülin Esen Sevim, Ahmet Rasim Küçükusta
Pages 34 - 37
Pnömoni, akciğerlerin infeksiyon kaynaklı inflamasyon ve konsolidasyonu olarak tanımlanır. Hastane dışında ortaya çıkan pnömoniler, toplum kökenli pnömoniler (TKP) olarak adlandırılır. TKP’lerde etyolojik tanı, olguların % 50’sinde yapılabilmektedir. Çalışmamızda, TKP’lerde etyolojik ajanın saptanması için yapılan laboratuvar ve mikrobiyolojik çalışmaları değerlendirmeyi amaçladık. Bu çalışmada ortalama yaşları 42.6 olan 120 hasta (79 erkek, 49 kadın) bulunuyordu. Hastaların 49’unda balgamın Gram boyası ve kültürü, 1’inde kan kültür, 1’inde plevra sıvısının Gram boyası ve kültürü 5’inde serolojik testlerin yapıldığı, 4 hastada Direct Fluoresence Antibody (DFA) tekniği kullanıldığı belirlendi. Çalışmamızın sonucuna göre, pnömoninin etkeninin saptanmasını zor olduğu kanısına varıldı.
Pneumonia is defined as inflammation and consolidation of lung tissue due to an infectious agent. Pneumonia that develops outside the hospital is consdered community acquired pneumonia (CAP). The etiological diagnosis of CAP in around 50 % of cases can be made. In our study we aimed to investigate laboratory and microbiological studies for identifying etiologic agent in CAP. One hundred and twenty patients (79 men and 49 women) with mean age of 42.6 years were included in this study. In 49 patients Gram staining and culture of sputum, in one patients hemoculture, in one patients Gram staining and culture of pleural fluid, in 5 patients serological tests and in 4 patients direct Fluoresence antibody tests were investigated.

According to our study; the etiologic diagnosis of pneomonia was difficult.

REVIEW
11.Heart Failure and Renin-Angiotensin System
Durmuş Şendağ, Nurten Özçelik
Pages 38 - 44
Heart failure is an inability of the heart to deliver blood at a rate commensurate with the requirements of the metabolizing tissues desbite normal cardiac filling pressures. Clinically
heart failure is a syndrome. ACE inhibitors reduce the symptoms and signs of this syndrome. We are to optimize treatment coverage of these patients, we must consider factors that inhibit prescription of ACE inhibitors. ACE inhibitors in patients with heart failure has been shown both in short and the long term to reduce systemic pressure and pulmonary
capillary wedge pressure, to reduce systemic vascular resistance and to increase cardiac output.

CASE REPORTS
12.A Case with Postpolio Syndrome
Funda Hepşen Ertekin, Kevser Töre Onbaşı, Okan Onbaşı
Pages 45 - 47
The postpolio syndrome is a sequela of paralytic poliomyelitis seen in approximately 25 % of polio victims. It is characterized by new neuromuscular symptoms occuring 25 to 40 years after the acute episode of poliomyelitis paralysis. The symptoms are nonspesific and there is no pathognomic test and sometimes making the diagnosis may be difficult. The diagnosis of PPS is based primarily on a thorough history supported by both clinical and laboratory examination. In this case report we described about a patient who experienced the postpolio syndrome after 40 years later the acute attack. He described fatigue, weakness, knee pain and fasciculations. Activity exacerbated his joint symptoms and this suggests that chronic musculoskeletal overuse may be the cause of PPS.

13.Hydatid Cyst Cases Suggesting Malignancy
Servet Civelek Bulum, Ö. Faruk Gergerlioğlu, A. Atasalihi, G. Çamsarı, O. Taşçı
Pages 48 - 50
Hydatid cyst continues to be a health hazard in animal-raising countries. We encountered three male patients (ages 19, 30, and 50 years) with hydatid cysts exhibiting clinical and radiologic manifestations of malignancy. The lesions were localized on the right (n=2) and left (n=1). The patients complained of Claude-Bernard Horner syndrome, abundant
hemoptysis accompanied by severe chest pain in the left hemithorax, and hemoptoic sputum and weight loss, respectively. Routine laboratory examinations and radiologic, ultrasonographic, bronchoscopic, and serologic investigations were performed in all patients. It was concluded that surgical interventions bay be required in order to make a definite diagnosis when findings from clinical, radiologic, bacteriologic, and bronchoscopic examinations are not adequate.

14.Delayed Presentation of Congenital Diaphragma Hernia
Merve Usta, Hamit Özkan, Müferet Ergüven, Suar Çakı, Nail Tosyalı, Deniz Cezayirli, Sevil Özçay
Pages 51 - 52
Congenital diaphragma hernia occurs as a result of defect in the closure of pleuroperitoneal pleat on the 9th gestation week. It is usually presented with respiratory distress after birth. Rarely presentation is delayed. Diagnosis is performed with chest roentgenogram in asymptomatic individuasis. Mild or severe symptoms, such as respiratuar distress and obstruction of gastrointestinal tract may be observed.

Inguinal herni operation was planned for a 7 year old girl and her chest roentgenogram was pathologic preope-ratively and the patient was hospitalized. In history intermittan emesis complaint was told for 1 year and also she recovered from pneumonia 1 year ago. In her physical examination her height and weight are below 3SD. There was no respiratuar distress and fever and, no pathological signs except decrease of respiratuar
sounds with auscultation on the left part of chest. Laboratory findings: WBC 6700/mm3 Hb 12 g/dL, Hct 37 %, PLT 222.000/mm3, CRP (-), ESR 30 mm/hour, PPD (-), ARB (-),
biochemical findings were normal. The imaginations like diaphragma hemi were seen on thorax CT which were planned when there was no correlation between radiological
and clinical findings. With contrast material the diagnosis was proved. The patient’s diagnosis is Bochdalek herni and with surgical therapy, she is recovered without complication.

Congenital diaphragma hernia is the most frequent intrathoracic fetal anomaly, but delayed presentation of congenital diaphragma hernia is rare. This disorder must be in diferantial diagnosis with pneumonia and pleural effusion because of it this case is reported.

15.Prostatic Stromal Sarcoma
Ebru Zemheri, H. Deniz Gür, Hale Onmuş, Eren Başak, Cemil Kutsal
Pages 53 - 55
The very rare stromal lesions of prostate are classified in two groups as “prostatic stromal sarcomas” (PSS) and “prostatic stromal proliferation of uncertain malignant potential (PSPUMP)”.

67 year-old male patient admitted with prostatism symptoms and hematuria and transvesical prostatectomy (TVP) was performed with the diagnosis of prostate carcinoma. Histopathological examination of surgical material revealed spindle-cell tumour and with this diagnosis second operation, cystoprostatectomy, was performed. Histopathological examination revealed a tumour composed of fascicle forming, moderately pleomorphic, spindle/oval shaped cells with prominent nucleoli, dense chromatin, 1-3 mitosis in every high power field and necrosis. Immunophenotypically, tumour was vimentin positive. With these findings, the case was diagnosed as prostatic
stromal sarcoma.

Stromal lesions of prostate are classified as prostatic stromal sarcoma and prostatic stromal proliferation of uncertain malignant potential according to the increased cellularity in stromal cells, nuclear atypia, mitosis, necrosis and stromal overgrowth. A rare case of prostatic stromal sarcoma is presented.

16.Wegener’s Granulomatosis
Gonca Tamer
Pages 56 - 57
Wegener’s granulomatosis is a rare disease with clinicopatologic complex such as glomerulonefritis, granuloma formation and vasculitis of the upper and lower respiratory tracts, which results diffuse alveolar hemorrhage.

17.Osteomalacia
Gülbüz Sezgin, Nursel Gürtunca
Pages 58 - 60
Wearing closed and long sleeved dresses and minimal exposure to sunlight in a young woman resulted with vitamin D insufficiency and osteomalacia. She was undiagnosed for a
long time and 6 months after diagnosis the result was very well. Because this case was interesting and rarely seen we searched osteomalacia.

18.Coronary Artery Fistula
Erkan Yılmaz, Dinç Özaksoy, Metin Manisalı, Richart White
Pages 61 - 62
Coronary artery fistula is a rare entity. Steal phenomenon due to fistula can resualt in myocardial insufficiency. Cardiac MRI is an non-invazive imaging modality which has gained
popularity in recent years. In this study, we report MRI appearance of a coronary artery fistula originating from left coronary artery and draining into superior vena cava.

19.Rickettsia Meningoencephalitis
Nüket Ceylan, Nail Özgüneş, Tahir Ceylan, Pınar Ergen
Pages 63 - 64
A 35 years-old female patient with the complaints of confusion, widespread eruptions and ichterus was admitted to our clinic. Diagnosis of rickettsia meningoencephalitis was made
clinically with eruption, Tache Noire and cerebrospinal fluid findings and it was confirmed with laboratory findings. 4 grams/day chloramphenicol was administered intravenously. Considering the multiorgan effect (known in literature) that could relaps the disease following the treatment, also doxocyclin 200 mg/day was given orally to the patient for one week.
After a long convalescence period of 4 months patient was recovered.




 

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