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Medeniyet Med J: 18 (1)
Volume: 18  Issue: 1 - 2003
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CLINICAL RESEARCH
1.The Value of Gestational Sac Morphology and Yolk Sac Morphology and Dimensions in the First Trimestr in Predicting the Pregnancy Outcome
Handan Gürpınar, Arzu Koç, Emel Kar Altundağ, Gamze Yetim, Kumral Kepkep
Pages 4 - 9
Bebek isteyen ve gebe olduğunu öğrenen aile için bu bebeğin abortus veya embriyonik ölümle sonuçlanma olasılığını bilmek önemlidir. Aynı şekilde, hekim de ister normal yoldan, ister yardımcı üreme teknikleri ile elde edilmiş olsun saptanan gebeliğin bazı ultrsonografik özelliklerine bakarak yüksek veya normal riske sahip gebelikleri önceden tahmin etmek ve rutin kontrolleri buna göre planlamak ihtiyacındadır. Böylece aileyi ve kendini gereksiz anksiyete ya da iyimserlikten koruyabilir.

Son adet tarihine göre gebeliğinin 6-12. haftalarında olan, kasık ağrısı, kramp ve vaginal kanama gibi semptomları olmayan, gebeliğin devamını isteyen, 59 olgu bilgilendirilmiş onamları alındıktan sonra çalışmaya dahil edildi. Endovaginal transduser (5 MHz transducer TOSH‹BA 220A SSA) kullanılarak önce gebelik kesesinin intrauterin olup olmadığı embriyonik kutup ve embriyonik kalp aktivitesi araştırıldı. FKA (+) olgularda gebelik kesesinin sagital planda; anteroposterior ve longitidunal çapları, koronal planda; transvers çaplarının ortalaması, ortalama gebelik kesesi ölçümü olarak kaydedildi. Embriyonun en iyi görüntülenebildiği planda başpopo uzunluğu ölçüldü. Yine yolk kesesinin sagital ve koronal planlardaki üç ölçümünün ortalaması, ortalama yolk kesesi çapı olarak alındı, genel morfolojisi, duvar kalınlığı değerlendirilip bu özellikler kaydedildi.

Tüm olgular 12. ve 20. gebelik haftalarında kontrole çağrıldı, gebeliğin devam edip etmediği öğrenildi.

Yolk sac şekline göre gebeliğin sonlanma durumları arasında anlamlı fark vardı (p<0.001). Gebeliği olumlu sonuçlananların % 95.5 (42 olgu) normal, düzgün, yuvarlak yolk kesesi şekli mevcuttu. Olumsuz sonuçlananların ise % 78.6 (11 olgu) yolk sac şekli anormaldi.
It is important for a family who desires to have baby and who learns that already has one being carried, to learn the risk of facing miscarriage or embryonic demise. In the same point of view, also the obstetrician feels the need to predict high risk or low risk pregnancies via the ultrasonographic features of detected pregnancy and to plan the routine check-ups accordingly. Hence, the clinician can protect the family and him/her
shelf, from unnecessary anxiety or optimism.

Fifty nine patients are included into the study who are within the 6th and 12th weeks of gestation according to the last menstrual period and those who are free of vaginal bleeding, inguinal pain and cramp-like symptoms and willing to complete the pregnancy to the term after a written approval of the patients has taken. At first visit it has been verified that the location of the gestational sac is intrauterine and presence
of fetal pole, and presence of embryonic fetal heart activity are ascertained with the use of endovaginal transducer (5 MHz transducer Toshiba 220 A SSA). At the Fetal Heart
Activity (FHA) (+) cases, the average of anterior-posterior and longitudinal diameters of the gestational sac in the sagittal plane and transvers diameter of the gestational sac in the coronal plane are registered as the mean gestational sac measurements. Crown-rump length is measured in the most convinient plane. The average of three measurements of yolk sac at the sagittal and coronal planes are taken as mean yolk
sac diameter and general morphology and wall thickness of yolk sac is also evaluated and registered.

All cases are recalled for for control and the maintenance of pregnancy is confirmed at the 12th and 20th weeks of gestation.
There was significant difference between the terminations of pregnancies in terms of yolk sac morphologies (p<0.001). Yolk sac was normal, regular and, rounded shaped in the 95.4 % of cases (42 cases) at whom a successful pregnancy outcome has been reached. But yolk sac was abnormal in the 78.6 % of unsuccessful pregnancies (11 cases).

2.Predictive Value of Systolic Time Intervals for Coroner Artery Stenosis after Myocardial Infarction
Nilgün Akbulut, Ayşe Gül Karaçam, Ahmet Akın, Birsel Kavaklı
Pages 10 - 12
Akut miyokard infarktüsü sonrası, % 40’ın üstünde sol ventrikül ejeksiyon fraksiyonuna sahip, muhtemel çok damar hastalarını erken tanıyabilmek amacıyla, infarktüsün 7-10. günleri arası 30 hastada izometrik egzersiz öncesi ve sonrası sol ventrikül sistolik zaman intervalleri olan preejeksiyon periyodu/sol ventrikül ejeksiyon zamanı oranı (PEP/LVET) ölçüldü. Daha sonra tüm hastalara koroner anjiyografi uygulanarak koroner anatomi belirlendi. Tüm hastalar dikkate alındığında izometrik egzersiz öncesi ve sonrası (PEP/LVET) oranında anlamlı değişiklik saptanmazken, birden fazla proksimal koroner arterde % 50 diameterden fazla darlığı olan hastalarda izometrik egzersiz sonrası (PEP/LVET) oranının anlamlı olarak uzadığı saptandı.
In our study, (PEP/LVET) preejection period/left ventricle ejection interval times were measured in order to detect early multiple coronary vessel injuries with left ventricle ejection
fractions over % 40 after acute myocardial infarction. All patients were performed coronary angiography to asses coronary anatomy. As a result, in patients with more than % 50 multiple proximal coroner artery stenosis, PEP/LVET ratios were significantly prolonged after isometric exercise.

3.Evaluation of Ocular Perfusion in Central Retinal Venous Occlusion by Coloured Doppler Ultrasonography
Varol Şen, Bengü Bozyel, Ömer İbiş, Hasan Horoz, Cem Mesçi, Hasan Erbil
Pages 13 - 15
Santral retinal ven tıkanıklığı olan hastalarda etkilenen gözlerde akım hemodinamiğinde oluşan değişiklikleri incelemek amaçlandı. Çalışmamızda santral retinal ven tıkanıklığı olan 20 hastanın 20 gözü renkli doppler ultrasonografi cihazı kullanılarak, santral retinal arterde pik sistolik hız (PSV), end diyastolik hız (EDV), pulsatilite indeksi (PI), rezistivite indeksi (RI), oftalmik arterde PSV, EDV ve santral retinal vende maksimum hız (Vmax) değerleri çalışıldı.Elde edilen değerler kontrol grubu değerleri ve aynı hasta grubunun kontralateral göz değerleri ile paired student-t testi kullanılarak karşılaştırıldı.

Hastaların 9’u (% 45) kadın, 11’i (% 55) erkek ve yaş ortalaması 59.5±1.0 idi. Santral retinal arterde; PSV ve EDV değerleri kontralateral göz grubu ve kontrol grubuna göre anlamlı derecede düşük bulundu (p<0.05), PI ve RI değerleri yine kotralateral göz grubu ve kontrol grubuna göre anlamlı derecede yüksek bulundu (p<0.05). Oftalmik arterde; PSV ve EDV değerlerinde kontralateral göz grubu ve kontrol grubuna göre anlamlı derecede farklılık saptanmadı (p>0.05). Santral retinal venden alınan Vmax değerleri kontralateral göz grubu ve kontrol grubuna göre anlamlı derecede düşük bulundu (p<0.05). Çalışılan bütün değerler için, kontralateral göz grubu ve kontrol grubu değerleri arasında istatistiksel olarak anlamlı farklılık yoktu.

Renkli doppler ultrasonografinin santral retinal ven tıkanıklığı olan hastalarda vasküler akım hemodinamiğinde oluşacak değişiklikleri değerlendirebilecek yetide olduğu kanısına varılmıştır.
In this study, our purpose is to examine the changes in ocular vascular flow hemodynamics. 20 eyes of 20 patients who had central retinal venous occlusion were evaluated by coloured doppler ultrasonography. Peak systolic velocities (PSV), end
diastolic velocities (EDV), pulsation index (PI), resitivity index (RI) in retinal artery, PSV and EDV in ophthalmic artery, maximum velocity (Vmax) in central retinal vein, results of patients with central retinal venous occlusion were compared to the results of control group and to the contralateral eyes of the same patients. Statical analyses were made by
paired student t test.

9 patients were female, 11 male and mean age of patients was 59.5±1.0. In central retinal artery; PSV and EDV result of pa-tients were statistically lower than control group and contra-lateral eyes of the same patients (p<0.05), PI and RI of pati-ents were also stastically higher than control group and contralateral eyes of the same patients (p<0.05). In ophthalmic artery, there were no statistically significant difference
for PSV and EDV results between study and control groups and also contralateral eyes of the study group (p>0.05). Vmax of central retinal vein were stastically lower
than Vmax of control group and contralateral eyes of the study group (p<0.05). For all these results there were no statistically significant difference between contralateral eyes of the study group and control group.

By coloured doppler ultrasonography, it is possible to evaluate vascular flow and hemodynamical changes in central retinal venous occlusion.

4.Relationship Between Ascorbic Acid Levels of Plasma/Leucocyte Ascorbic Acid Levels and Iron Loading in Children with Thalassemia Major
Erdal Ataözden, Hale Aral, Arif Kut, Selma Çekirdek, Çetin Tamer
Pages 16 - 19
Transfüzyon tedavisi beraberinde önemli komplikasyonlara yol açan demir birikimi ile, plazma ve lökosit askorbik asit düzeyleri arasındaki ilişkiyi ve talasemi tedavisinde askorbik asitin yerini araştırdık. 25 takipli hasta (13 kız, 12 erkek) ve 21 sağlıklı çocuk (10 kız, 11 erkek) çalışmaya alındı. Plazma ve lökosit askorbik asit düzeyleri dinitrofenil hidrazin metodu; serum ferritin düzeyleri EL‹SA metodu ile ölçüldü. Lökosit askorbik asit düzeyleri normal olan 14 hastanın ferritin değerlerinin ortalaması 1211.94±179.92 ng/ml iken, lökosit askorbik asit düzeyi normalin altında olan 11 hastanın ferritin değerlerinin ortalaması 1338.22±229.65 ng/ml idi (p>0.05). Plazma ve lökosit askorbik asit düzeylerinin azalmasıyla birlikte serum ferritin düzeylerinde yükselme gözlendi, ancak bu istatistiksel olarak anlamlı değildi.
We investigated the relationship between iron loading, which causes important complications during transfusion therapy, and plasma and leucocyte ascorbic acid levels. 25 followed patients (13 female, 12 male) and 21 healthy children (10 female, 11 male) were studied. Plasma and leucocyte ascorbic acid levels were measured using the method of dinitrophenyl hydrazine and; serum ferritin levels were measured using the
ELISA method. While for 14 patients, whose leucocyte ascorbic acid levels were within normal range, had serum ferritin mean levels of 1211.94±179.92 ng/ml; for 11 patients, whose leucocyte ascorbic acid levels were lower than the normal range, had serum ferritin mean levels of 1338.22±229.65 ng/ml (p>0.05). Decreasing the plasma and leucocyte ascorbic acid levels, serum ferritin levels were found to increase, but it was not important statistically.

5.Conservative Treatment in Painful Shoulder
Feyza Terekli, Afitap İçağasıoğlu, Zerrin Karataş, Ali Emrem, Seçil Teoman, Serdal Türker
Pages 20 - 23
Bu çalışmada Fiziksel Tıp ve Rehabilitasyon polikliniğine ağrılı omuz yakınımı ile başvuran ve çeşitli konservatif tedavi yöntemleri ile tedavi edilen 72 hasta retrospektif olarak değerlendirildi.

Hastalara goniometrik ölçüm, manuel kas gücü değerlendirmesi, rotator manşon ve bisipital tendon değerlendirme testleri yapıldı. Omuz radyografileri ve ultrason tetkikleri görüldü. Hastaların tedavi öncesi ve tedavi sonrası ağrıları vizüel analog skala (VAS) ile, fonksiyonel durumları Constant skorlaması ile değerlendirildi. Konservatif tedavi olarak hastalara istirahat, buz uygulaması, medikal tedavi, fizik tedavi, egzersiz, subakromial injeksiyon ve mobilizasyon teknikleri uygulandı. İstatiksel değerlendirmeler SPSS V.10 paket program kullanılarak yapıldı. Tedavi öncesi ve sonrası değerler eşleştirilmiş t testi ile karşılaştırıldı.

62 kontrole gelen hastanın % 53.2’si kadın, % 46.8’i erkekti. % 93.5 hastada dominant el sağ iken sağ omuzun etkilenme oranı % 40.3 idi. % 1.6 hastanın bilateral omuz tutulumu mevcuttu. % 95 hastada rotator manşon testleri pozitifdi. Has-taların tedavi öncesi ve sonrası değerleri karşılaştırıldığında; VAS, goniometrik ölçüm ve fonksiyonel durumlarında (Constnat Skoru) istatistiksel anlamlı düzeyde iyileşme saptandı (p<0.001).

Omuz ağrısı ile gelen hastalara uygulanan konservatif tedaviler ile etkin sonuçlar alınmıştır. Tedavilerin etkinliklerinin birbirleri ile kıyaslanması için ise randomize, kontrollü çalışmalara ihtiyaç vardır.
72 patients that were submitted to the phsysical therapy and rehabilitation polyclinic with painful shoulder complaints were retrospectively studied in this study.

Goniometric measurements, manual muscle strength tests, rotator cuff and biceps tendon evaluation tests were performed on all patients. The shoulder radiograms and ultrasound
inspections were evaluated. The pain status of patients before and after treatment were evaluated with visual analog scales (VAS) and the functional states with Constant scores.
The conservative therapy consisted of rest, ice application, medical treatment physical therapy, exercise, subacromial injection and mobilization techniques. Statistical evaluations were performed with the SPSS v10 software. The pre and post treatment values were compared with the paired t test.
62 patients returned for a control examination (29 male and 33 female patients). % 93.5 of the patients were right-hand dominant and the rate of affected right shoulders were %
40.3-% 1.6 of the patients were affected bilaterally. Rotator cuff tests were positive in % 95 of the patients. When the values before and after treatment were compared, there were statistically significant improvements in VAS values, goniometric measurements and functional states (Constant scores) (p<0.001).
Significant results were obtained with the use of conservative therapy on patients with shoulder pain. Randomised and controlled studies are necesssary to compare the effectiveness of different treatment options.

6.Is Serum Sialic Acid level Related with Capillary Endothelial Permeability Dysfunction in Diabetic Patients Treated with Insulin?
İncihan Ocakoğlu, Hale Aral, Alev Orhun, Bülent Eralp, Selma Çekirdek
Pages 24 - 27
Diyabetli hastalarda serum glikoproteinleri ve buna paralel olarak sialik asit seviyelerinde değişiklik olması beklenir. Bu süreç ile diyabet süresi arasında ilişki vardır. En az 5 yıl önce diyabet tanısı almış olan 38 hasta çalışmaya alındı. Serum sialik asit düzeyleri enzimatik kolorimetrik metodla, idrarda mikroalbumin (MA) düzeyleri immünopresipitasyon metoduyla ölçüldü. Kontrol grubunda (n=18) sialik asit düzeyleri 61.8±5.7 mg/dl bulundu. MA negatif (13.1±3.8 mg/gün) olan hastaların bir grubunda (n=18) sialik asit düzeyleri 68.9±9 mg/dl bulundu. MA pozitif (127.6±98.3 mg/gün) olan diğer hasta grubunda (n=20), sialik asit düzeyleri 82.6±10.8 mg/dl bulundu. Diyabetik hastalarda metabolik kontrolü ve komplikasyonları izlemek için kan glukozu ve HbA1c dışında bir parametre olarak sialik asit düzeylerini ölçebiliriz.
It’s expected in diabetic patients that changes in the levels of the serum glycoproteins and as a consequence changes in the sialic acid levels occur. There is a relation between this process and the duration of the time being diabetic. 38 patients, who had been termed as diabetes mellitus for at least 5 years, were studied. Serum sialic acid levels measured by using enzymatic colorimetric method, urine microalbumin levels were measured by using immunoprecipitation method. Group of control (n=18) had sialic acid levels of 61.8±5.7 mg/dl. One group of patients (n=18), who were MA negative (13.1±3.8 mg/day), had sialic acid levels of 68.9±9 mg/dl. The other group of patients (n=20), who were MA positive (127.6±98.3 mg/day), had sialic acid levels of 82.6±10.8 mg/dl. To observe the metabolic control and complications in diabetic patients we can measure the levels of sialic acid as a parameter other than blood glucose and HbA1c.

7.Demonstrate the Course of Lateral Antebrachial Cutaneus Nerve
Yelda Atamaz Pınar, Z. Aslı Aktan İkiz, Senem Erdoğmuş, Hülya Üçerler
Pages 28 - 31
N. cutaneus antebrachii lateralis (NCAL)’in anatomik seyrini tanımlamak amacıyla Ege Üniversitesi Tıp Fakültesi Anatomi Anabilim Dalı’nda formalinle fikse edilmiş 50 adet kadavra örneğinde çalışıldı. NCAL’in fascia brachii’yi delip yüzeyelleştiği nokta, interepikondiler çizginin vertikal hat üzerinde ortalama 3±0.51 cm yukarısında, transvers hat üzerinde ise lateral epikondilin ortalama 4.5±0.62 cm medialinde bulundu. Sinirin yüzeyelleştiği bu seviyede, medialinde yer alan m. bi-ceps brachii’nin tendonunun 21 örnekte oldukça belirgin ol-duğu izlendi. 29 örnekte ise bu seviyede m. biceps’in daha muskuler olduğu, tendonunun daha alt seviyede belirginleştiği görüldü. 50 kadavra örneğinin 37 adedinde NCAL’in terminal dalları RS dalları üzerinde uzanıyordu (overlap). 37 örneğin 10 adedinde RS ile NCAL ön dalı arasında direkt bağlantı vardı (complet overlap). 37 örneğin 27 adedinde bu iki sinir arasında direkt bir bağlantı yoktu, fakat NCAL ön ve arka dalı RS’in üzerinde örtüşerek birinci metakarpal kemiğin proksimaline kadar uzanıyordu (parsiyal overlap). 13 örnekte ise NCAL bağımsız olarak ön kol distaline kadar seyrediyordu. NCAL ön dalının RS’in sadece tenar bölge, baş parmağın radial kenarı ve birinci interosseoz aralıkta uzanan deri dalıyla bağlantı yaptığı izlendi. Bu örneklerde NCAL’in klasik duyu alanına ek olarak başparmak duyusuna da katıldığı düşünülmektedir.
This study was performed on 50 formalin fixed cadavers at Ege University Anatomy Department to demonstrate the course of lateral antebrachial cutaneus nerve (NCAL). The
point that NCAL pierced the fascia was on the vertical line 3±0.51 cm superior to interepicondylar line and 4.5±0.62 cm medial to lateral epicondyl on transvers line. The tendono of biceps brachii muscle was well-developed than expected in 21 samples at this level. The tendon of biceps muscle was inferior to this level in 29 samples. The terminal branches of NCAL were overlapped on the branches of superficial rami of the radial nerve (RS) in 37 samples of 50. There was a complete overlap between NCAL and RS in 10 samples of 37. There were no anastomoses between these two nerves in 27 of 37 but anterior and posterior rami of NCAL were overlapped on RS going towards proximal to the first metacarp (partial overlap). NCAL was alone in 13 samples and went to the distal
forearm. Anterior ramus of NCAL was connected with RS only lying to thenar area, radial side of the thumb and first interosseos area. It was thouht that NCAL was also attending
to the thumb sensitive innervation.

8.Tubularized Incised Plate Urethroplasty in the Treatment of Proximal Hypospadias
Reşit Tokuç, Erem Kaan Başok, Ömer Faruk Memiş, Erol Peltekoğlu, Necmettin Atsü
Pages 32 - 33
Günümüzde TIPU proksimal hipospadias olgularında da tercih edilen bir yöntemdir. Bu çalışmada 26 proksimal hipospadias olgusundaki TIPU sonuçları retrospektif olarak incelenmiştir. Hasta seçiminde en önemli kriter üretral plate’in canlı ve sağlam olmasıydı. Hastaların 7’si re-do olgu idi. Tüm olgularda subkutan doku ile ikinci kat kapama uygulandı. Sadece 4 olguda komplikasyon ortaya çıktı ve bu olgulara sekonder girişim uygulandı. Bir olgu dışında tüm olgularda mükemmel kozmetik sonuç elde edildi.

TIPU proksimal hipospadias olgularında da mükemmel kozmetik sonuçlarla, güvenle uygulanabilecek bir yöntemdir.
Nowadays, tubularised incised plate urethroplasty (TIPU) is a preferred method even in the proximal hypospadias cases. We report our experience with this procedure in 26 patients retrospectively. The most important criteria in the selection of the patient for this procedure is the viable and supple appearence of the urethral plate. Seven of 26 patients were re-do cases. In all cases the urethroplasty was covered with an additional layer of subcutaneous tissue. In four cases complications were documented. In complicated cases, secondary
surgical management was performed. Cosmetic results were excellent except one patient TIPU procedure seems to be a reliable technique with excellent cosmetic results for the
treatment of proximal hypospadias as well.

9.Diagnosis of Helicobacter Pylori Infection With a New Non-Invasive Test
Gülay Bekler, Nail Özgüneş, Celal Ulaşoğlu
Pages 34 - 39
Bazı gastrointestinal hastalıklarla ilişkisi olan Helicobacter pylori, insanlarda sık görülen bir patojendir. H pylori infeksiyonunun tanısı için tartışılan yeni non-invaziv tekniklerin araştırılması kapsamında, gaitadaki H pylori antijeni tespitinde kullanılan bir EIA’yı (HpSA) değerlendirdik.

Bu prospektif çalışmada gastroskopi yapılan 46 hastadan (23 kadın, 23 erkek; yaş aralığı 18-70, ortalama 42) alınan gaita örnekleri HpSA ile, endoskopik biyopsi örnekleri hızlı üreaz testi ve histolojik olarak incelendi. Histoloji ve üreaz test pozitif olanlar Helicobacter pylori pozitif, negatif olanlar ise H pylori negatif olarak tanımlandı. Belirlenen kriterlere göre H pylori infeksiyonu bulunan 33 hastanın 30’u HpSA ile pozitif bulundu (duyarlılık % 90.9). İnfeksiyon saptanmayan 13 hastanın 11’i HpSA ile negatif bulundu (özgüllük % 84.62).
Helicobacter pylori is a common human patogen implicated in certain gastrointestinal diseases. In the search for new non-invasive techniques to diagnose H. Pylori infection, we evaluated an EIA for H. Pylori antigen in stool (HpSA).

In this prospective study, stool specimens from 46 patients (23 women, 23 men; age range 18-70 years, mean 42) undergoing gastroscopy were tested with HpSA, endoscopic biopsies were tested rapid urease test and histological. Patients were defined as positive for Helicobacter pylori if histology and urease test were positive, as negative if histology and urease test were negative. Of 33 patients with H pylori infection by the predefined criteria, 30 were positive by HpSA (sensitivity 90.9 %). Of 13 patients without infection, 11 were negative by HpSA (specifity 84.62 %).

10.Diagnostic Value of Ultrasonography and Color Doppler Ultrasonography in Discriminating Benign and Malign Adnexial Masses
Semra Kayataş Eser, Erkan Coşkun, M. Murat Naki, Fahrettin Kanadıkırık
Pages 40 - 43
Selim ve habis adneksiyal kitlelerin ayırımında ultrasonografi ve renkli doppler ultrasonografinin tanısal değerinin belirlenmesi.

1.4.200-15.3.2001 tarihleri arasında SSK Göztepe Eğitim Hastanesi Kadın Hastalıkları ve Doğum Kliniğine pelvik kitle ön tanısı ile yatan ve operasyon endikasyonu verilen 61 hastaya selim-habis ayırımı için ultrasonografi, ve renkli doppler ultrasonografi yapıldı. Bu testlerin kullanımı ile her bir testin duyarlılık, özgüllük, pozitif öngörü değeri (PPD) ve negatif öngörü değeri (NPD) oranları belirlendi.

Sasone ultrasonografik skorlama sistemine göre eşik değer 9 ve renkli doppler incelemede PI (pulsatılite in-deks) için eşik değer <1 ve RI (rezistans indeks) için eşik de-ğer <0.4 alındığında elde edilen bulgular; ultrasonografi skoru için duyarlılık % 69.23, özgüllük % 91.67, PPD % 69.23 ve NPD % 91.67; PI için duyarlılık % 92.3, özgüllük % 69.7, PPD % 48 ve NPD % 96.7 ve RI için duyarlılık % 46.2, özgüllük % 88.4, PPD % 54.5 ve NPD % 84.4 idi.

Yüksek duyarlılık, özgüllük ve PPD saptanan ultraso-nografik değerlendirme jinekolojik pratikte kullanılmalıdır. Doppler değerlerinde mutlak bir sonuç oluşturulamasa da US verileri ve klinik bulgular ile birlikte değerlendirilmesi görüşündeyiz.
To determine the dignostic value of ultrasonography and color doppler ultrasonography in discriminating benign and malign adnexinl masses.

To discriminate the benign and ma-lign masses; ultrasonography and color doppler ultrasonography were perhormed to 61 patients who were hospitalized in SSK Göztepe Maternity hospital in between 1.4.2000-15.3.2001 and who had taken the operation ind›cation. With the use of these tests we determined the sensitivity, spesificity, positive predictive value (PPV) and negative predictive value (NPV) of each tests.

With the threshold values, in Sassone ultrasonographic scoring system 9 for PI in colour Doppler examination <1 and for PI in color Doppler examination <0.4, the obtained
results were as following: In ultrasonographic scoring the sensitivity, the specifity, PPV and NPV were 69.23 %, 91.67 %, 69.23 % and 91.67 %, for PI sensitivity, the specifity, PPV and NPV were 92.3 %, 69.7%, 48 %, 96.7 % and for RI 46.2 %, 88.4 % 54.5 %, 84.4 % respectively.

Ultrasonographic evaluation with its assessed high sensitivity and PPD should be used in gynaeccoloical practice. We consider that, although an absolute value can not be elicited in Doppler values, it should be evaluated with ultrasonographic data and clinical findings.

CASE REPORTS
11.Mixed Connective Tissue Disease Previously Misdiagnosed as Various Disorders
Müferet Ergüven, Yasemin Katıöz, Betül Çakır, Erkan Çakır, Sevil Özçay
Pages 44 - 46
Mixed connective tissue disease is an autoimmune multisystemic disease which is presented rarely in the childhood period. It is characterised by overlapping clinical features similar
to those of SLE, Scleroderma and Polymyositis/Dermatomyositis and very high titers of circulating antinuclear antibody to a nuclear ribonucleoprotein (RNP) antigen. Hence it can
be sometimes misdiagnosed as JRA, SLE or Scleroderma. This case is reported both becouse of this property and rare presentation in the childhood period.

12.Electrocardiographic Changes in Patients with Non-Cardiac Disorders
Saim Yüksel, Mümtaz Takır, Bedri Durmuş, Müzeyyen Karasakal, D. Burçak Eyinç
Pages 47 - 49
Transient electrocardiographic changes in patients with acute cholecystitis, pancreatitis, pneumonia and septic shock have been reported in the past 70 years. These changes usually are in the form of T-wave inversion, ST-segment depression, and rarely ST segment elevation in the absence of coronary heart disease. A vagally mediated cardio-biliary reflex is the presumed cause of these changes. Three cases was diagnosed as acute cohlecystitis, acute pancreatitis and septic shock presented with literature as a review. The signs and symtomps of gallbladder and heart disease may overlap, making diagnosis diffucult. In patients with known coronary heart disease and acute cholecystitis, the surgeon shouldn’t be discouraged from cholecystektomi merely because of questionable electrocardiogram. Undue delay in treatment while awaiting the
result of the cardiac screen may result in both cardiac and septic complications. Dopamine and dobutamine infusion induced coronary vasoconstriction should be use carefully in patients with septic shock.

13.Laparoscopy in the Diagnosis of Non-Palpable Testes
Reşit Tokuç, Erem Kaan Başok, Necmettin Atsü, Cemil Kutsal
Pages 50 - 51
In pediatric urology, cryptorchidism is frequent condition and nearly 20 % of the undescended testes are non-polpable and are localized within in the distal end of the inguinal ring or intraabdominally. Laparoscopy has been a very useful diagnostic tool in these patients who have always been challenging to manage.

In this study, we retrospctively evaluated our initial experiences of diagnostic laparoscopy in the dignosis of non-palpable testes.

14.Robert’s Syndrome
Turhan Topoğlu, Suar Çakı, F. Fetül Ceniz, Fazilet Metin, Sevil Özçay
Pages 52 - 53
Robert’s syndrome is a rare autosomal recessive disorder characterized primarily by symmetric reduction anomalies of all lims, prenatal and postnatal growth retardation and craniofacial abnormalities. A diagnosis of Robert’s syndrome clinical and genetical features was made. This disease is presented because it is seen rarely.

15.Meckel’s diverticulum at Adults
Özlem Öztürk, Haydar Yalman, Salih Tosun, Durmuş Ali Eren, Hakan Baysal, Orhan Uzun
Pages 54 - 55
Meckel’s diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. The majority of MD cases are asymptomatic although they can, occasionally, cause complications such as bleeding, intestinal obstruction and inflammatory process. The diagnosis is difficult and it usually made at surgery. The treatment in symptomatic MD is surgical resection while there are arguments about the
treatment of asymptomatic MD. The study concerns 9 cases of MD. 7 patients were males and 2 patients were females. The ages of the patients range from 21 to 59. The most common complication was diverticulitis in 7 patients. The diverticulectomy was made in all patients. There was not operative mortality and morbidity. We believe that diverticular complications are important; on account of this low postoperative mortality and morbidity, in the absence of containdications, we recommend surgical resection in the cases of asymptomatic MD also.

16.Laurence Moon Bardet Biedl Syndrome and Anaesthesia
Gönül Tezcan Keleş, Melek Sakarya, Füsun Zeylan, Sabri Özaslan
Pages 56 - 57
Laurence Moon Bardet Biedl is a congenital syndrome which is rarely seen and accompanied by multipl anomalies including skeleton and viscera.

This case report describes the presentation of a child with Bardet-Biedl syndrome. Bardet-Biedl syndrome is an autosomal recessive condition that includes retinal dystrophy, dystrophic extremities (commonly polydactyly), obesity, hypogenitalism, and renal disease. Cognitive deficit has also been considered part of the syndrome. The most common feature of Bardet-Biedl syndrome is retinal dystrophy. The renal disease often goes undetected until specific radiological testing is done after diagnosis of Bardet-Biedl syndrome. This is significant in that early death often occurs in this condition because
of the renal disease. A twelve year old male patient with Laurence Moon Bardet Biedl syndrome was reported and literature was reviewed.

17.Orbital Cellulitis and Subdural Amphyema Due to Complication of Frontal Sinusitis
Özcan Keskin, Murat Kalemoğlu, Cihan Top
Pages 58 - 60
The most common intracranial complication of sinusitis is orbital cellulitis. Another extracranial complication of sinusitis is frontal supperiostal abscess from frontal sinusitis. Intracranial complication such as epidural abscess, subdural empyema, meningitis, cerebral abscess, and dural-vein thrombophlebitis may result from sinusitis, particulary from frontal or sphenoid infections. Here we report a patient who was with complications from frontal and ethmoid sinuzitis which was with periorbital sellulitis, subdural amphyem and frontal
sinus perforation.

18.Atypical Carcinoid Tumors of Lung
Çağla Uyanusta Küçük, Yeşim Ersoy, Sevim Düzgün, Bülent Altınsoy, Ümmühan Bayram, Onur Çelik, Adnan Yılmaz
Pages 61 - 62
Atypical bronchial carcinoids are rare tumors. They have distinct clinicopathological features than typical carcinoids. Atypical carcinoids behave more aggressively compared to typical carcinoids. Two cases of atypical bronchial carcinoid are presented.

19.Spondylothoracic Dysplasia
Erkan Çakır, Betül Cengiz, Betül Çakır, Fazilet Metin, Sevil Özçay
Pages 63 - 64
Spondylothoracic dysplasia is a syndrome that is due to a defect during the segmentation process of the axial system presenting with multiple vertebral and costal malformation.
Majority of affected individuals die in the infancy with cardiopulmonary insufficiency. The chief features of this syndrome are; short trunk with short neck and “crab-like” rib cage, spina bifida, multiple vertebral and rib defects. Our case is presented to the clinic with respiratory distress. In his x-ray of thoracic cage, multiple costavertebral defects are detected. In his spinal MRI images, cervical and lomber lordosis, dorsal kyphosis, scoliosis, generalized butter-fly and hemivertebra anomalies are identified. This case is diagnosed
with his clinical and imaging findings as spondylothoracic dysplasia and reported due to its rarity in the neonatal period.




 

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