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Medeniyet Med J: 19 (2)
Volume: 19  Issue: 2 - 2004
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CLINICAL RESEARCH
1.The assessment of cardiac functions of chronic renal failure patients undergoing hemodialysis by echocardiography in Kahramanmarafl city
Aytekin Güven, M. Akif Büyükbeşe, Ali Çetinkaya, Gülizar Sökmen, Cemal Tuncer
Pages 65 - 68
Kronik böbrek yetersizliği (KBY) bütün vücudu etkilediği gibi daha da önemli olarak kardiyovasküler sistemi etkilemektedir. Bu çalışma, düzenli hemodiyalize giren kronik böbrek yetersizlikli hastalarda kalpte meydana gelen morfolojik ve fonksiyonel değişiklikleri ekokardiyografik (EKO) olarak değerlendirmek amacı ile planlandı.
Çalışmaya, düzenli olarak diyalize giren toplam 50 KBY'li hasta, ve herhangi bir böbrek veya kardiyak şikayeti olmayan 40 sağlıklı olgu alındı. M-Mode Eko ile özellikle sol ventrikül boyutları, iki boyutlu Eko ile duvar hareket bozukluğu ve perikard değerlendirildi. Pulsed Doppler ile diyastolik mitral akım ölçüleri (DMAÖ) ve renkli Doppler Eko ile kapak yetersizlikleri değerlendirildi. Pulmoner arter basıncı ölçümü için triküspit yetersizlik akımından yararlanıldı.
İki boyutlu EKO değerlendirilmesinde KBY'li hastaların % 95'inde morfolojik değişiklikler izlendi. 45 olguda sol ventrikül hipertrofisi, 20 olguda miyokartta buzlu cam görünümü, 22 olguda kapak kalsifikasyonu, 20 olguda kapak yetersizliği, 15 olguda perikardiyal effüzyon, 11 olguda pulmoner hipertansiyon saptandı. Kontrol grubunda ise 2 olguda sol ventrikül hipertrofisi, 2 olguda kapak yetersizliği, 4 olguda mitral kapak prolapsusu saptandı. KBY grubu, kontrol grubu ile karşılaştırıldığında, KBY'li hastalarda sol ventrikül erken doluşunda azalma (p<0.05) ve atrial doluşta artma görülürken (p<0.05), E/A oranlarında azalma ve deselerasyon zamanında uzama gözlendi (p<0.05, p<0.05). ‹zovolümetrik relaksasyon zamanı da KBY'li hastalarda kontrol grubundan yüksek bulundu (p<0.05).
KBY'li hastalarda ekokardiyografik takip tedavinin yönlendirilmesinde ucuz ve non invazif bir yöntem olarak değerli bilgiler vermektedir. Bu nedenle, KBY'li hastaların düzenli aralıklarla ekokardiyografik incelemeye tabi tutulması gerektiği kansındayız.
Chronic renal failure affects significantly cardiovascular system as well as other systems of the body. In this study we aimed to investigate the morphologic and structural changes
of the heart undergoing regular hemodialysis in patients with chronic renal failure, via echocardiography.
Fifty patients with chronic renal failure who were on regular hemodialysis and 40 healthy subjects without any renal or cardiac problems were included in this study. Left ventricular
dimensional were assessed via M-mode echo, wall motion disorder and pericard via two-dimensional echo, diastolic mitral flow rate via pulsed Doppler and valve insufficiencies via colored Doppler echo. Tricuspid regurgitation flow was the guide for the measurement of pulmonary artery pressure.
In 95% of the patients with chronic renal failure had morphological changes via the assessment of two-dimension echo. There were 45 patients with left ventricular hypertrophy, 20 patients with icy glass appearance of the myocardium, 22 patients with valve calcification, 20 patients with valve regurgitation, 15 patients with pericardial effusion and 11 patients with pulmonary hypertension. In the control group, 2 subjects
had left ventricular hypertrophy, and there were 2 subjects with valve regurgitation and 4 subjects with mitral valve prolapse. There was a decrease in early left ventricular filling
(p<0.05), an increase in atrial filling (p>0.05), a decrease in the ratio of E/A, and lengthening in the deceleration time (p<0.05, p<0.05) in patients with chronic renal failure when compared to the control group. Also, isovolumetric relaxation time was higher in patients with chronic renal failure (p<0.05).
Echocardiographic follow up gives economic, non-invasive and valuable information about patients with chronic renal failure. We concluded that these patients should be assessed
by echocardiography at regular intervals.

2.Sensitivity of turkish children against cockroach
Teoman Akçay, Arzu Akçay, Osman Pinçe, Rengin Şiraneci, Kamil Teker
Pages 69 - 72
Bu çalışma, hamam böceği olarak bilinen ve bilimsel adı Blatella olan böceğe karşı Türk çocuklarındaki duyarlılık oranını saptamak amacıyla yapıldı.
Çalışmaya, SSK Bakırköy Doğumevi Kadın ve Çocuk Hastalıkları Eğitim Hastanesi Çocuk Alerji-Astım polikliniğinden takipli toplam 214 bronşial astım ya da alerjik rinit tanısı almış ve en az 6 aydır izlenen yaşları 2-14 arası çocuklar alındı. Hastalara prick testi ile blatella antijeni uygulandı. Deri testleri sonucunda % 7.4 oranında hamamböceği alerjisi bulundu.
Bu çalışma sonucunda elde ettiğimiz ülkemiz çocuklarındaki hamam böceği alerjisi sıklığı, diğer ülkelerde yapılan çalışmalardaki sonuçlara göre oldukça düşük düzeyde bulundu.
The aim of this study is to determine the sensitivity of Turkish children against insect known as cockroach and the scientific name of which is blatella.
In the study total 214 patients, who had bronchial asthma or diagnosed as allergic rhinitis under observation at least 6 months, aged between 2-14, were taken from SSK Bakırköy Maternity and Child Healthy Educational Hospital, The Policlinic of Children Alergy-Asthma. As a result of skin tests cockroach allergy was found on the rate of % 7.4.
As a result of this study, we reached the conclusion that our country has low frequency of cockroach allergy of children compare to other countries.

3.Endoscopy results of upper gastrointestinal bleeding in our patients
Gamze Gököz Doğu, Nilüfer Soner, Özgül Soysal, Oğuz Yıldırım, Zeliha Aksoy, Ayça Değirmenci, Özlem Yazıcıoğlu, Bülent Eralp
Pages 73 - 74
Gastrointestinal kanamalar (GİK), acil hekimlikte nispeten sık rastlanan, erken müdahale ve sıklıkla yatış gerektiren bir problemdir. Total mortalite yaklaşık % 10’dur. Tanısal yaklaşımlar, tedavi tekniklerinden daha hızlı gelişim göstermiştir. Üst GİK'da, öncelikli tanısal yaklaşım günümüzde, özofagogastroduedonoskopidir. Biz bu çalışmamızda, Aralık 2001-Temmuz 2002 arasındaki 6 aylık periyotta geriye dönük olarak üst GİK'li 118 hastamızın endoskopi sonuçlarını gözden geçirdik.
Gastrointestinal bleeding (GIB) is a relatively common problem encountered in emergency medicine that requires early consultation and often admission. The overall mortality of
GIB is approximately 10 %. Diagnostic modalities have improved much more than therapeutic teniques. The primary diagnostic modality for evaluation of upper gastrointestinal
hemorrhage is currently esophagogastroduodenoscopy. We examined endoscopy results of upper gastrointestinal bleeding in our 118 patients retrospectively between in December
2001-July 2002 in a 6-month period.

4.The effects of intrapartum oligohydroamnios to peripartum fetal condition
Ergün Bilgiç, Ali Rıza Sözenoğlu, Kaan Koca, Ertan Adalı, Neşe Yücel, Necdet Süer
Pages 75 - 79
Oligohidramnios, gestasyonel yaşa göre <5. persantil amniotik sıvı indeksi veya gestasyonel yaşa bakmaksızın ≤5 cm amniotik sıvı indeksi olarak tarif edilebilir. Bu prospektif çalışmanın amacı, ≤5 cm amniotik sıvı indeksinin (oligohidramnios), fetal distres nedeniyle sezaryen riskini, 5. Dakikada 7'nin altında Apgar skorunu ve neonatal asidozu doğru olarak önceden tahmin edip edemeyeceğini belirlemek amaçlandı.
26 ve daha üzeri gebelik haftasında olan ve ultrasonografide amniotik indeksi ≤5 cm bulunan 70 çalışma grubu ve 50 kontrol grubu olmak üzere 120 olguya intrapartum dönemde tokokardiografi yapıldı. Her doğumdan hemen sonra umblikal kord arter kanı pH'sı için kan örneği alındı ve 5. dakika Apgar skoru belirlendi ve aralarındaki ilişki araştırıldı.
Oligohidramnios grubunda, fetal distres nedeniyle sezaryen sıklığı % 14.2, 7'nin altında 5. dakika Apgar skoru % 11.4 ve <7.10 umblikal arter pH % 2.8 iken, amniotik sıvı indeksi > 5 cm olan kontrol grupta aynı oranlar sırasıyla % 12, % 0 ve % 2 olarak tespit edildi. Ortalama pH değerleri iki grup arasında anlamlı şekilde farklı iken (7.23'e karşı 7.27) ortalama Apgar skorları arasında anlamlı bir fark bulunamadı. Ancak, ortalama pH değerleri doğum şekline göre incelendiğinde, fetal distres nedeniyle sezaryen yapılan grup ile normal vaginal doğum yapan grup arasında anlamlı fark ortaya çıkmadı. Hiç 7'nin altında Apgar skoru kaydedilmedi.
Sonuç olarak; ≤5 cm amniotik sıvı indeksi (oligohidramnios) tek başına olumsuz fetal sonuçların iyi bir prediktörü değildir. Ancak, oligohidramnios, patolojik kardiyotokografi bulguları ile birlikte olduğunda patolojik asidemi ile karşılaşma ihtimali artmaktadır.
Oligohydroamnios is defined as, depending on gestational age being <5 percent of amniotic fluid index, or undependent on gestational age ≤5 cm amniotic fluid index. The object of this prospective study is to define, if amniotic fluid index of ≤5 cm (oligohydroamnios) can be used to estimate neonatal acidosis earlier, 5th minute Apgar score <7 and the risk of cesarean section due to fetal distress correctly.
Tococardiography is performed to 120 cases in intrapartum period who have amniotic fluid index ≤5 cm in ultrasonography and gestation week of ≤26. Right after each birth blood samples were taken for umblical cord arterial blood pH and fifth minute Apgar scores were checked. The relationships among amniotic fluid volume, tocography findings, umblical cord blood pH and 5th minute Apgar score was examined.
In oligohydroamnios group, the incidences of cesarean section due to fetal distress was 14.2 %, 5th minute Apgar score <7 was 11.4 % and less than 7.1 umblical arterial pH was 2.8 % while in the group with amniotic fluid index >5 cm the same ratios were 12 %, 0 %, 2 % respectively. The average pH values were meaningfully differentiating (7.23 to 7.27) while the average Apgar scores showed no meaningfull difference.
However, when average pH values were examined by terms of labor methods no reasonable differences were observed between groups with normal vaginal labor and
cesarean section due to fetal distress. No Apgar score below 7 was recorded.
In conclusion. amniotic fluid index ≤5 cm (oligohydroamnios) is not a good predictor of negative fetal results. However, when oligohydroamnios is together with pathologic cardiotocography findings, the probability of facing pathologic acidemia increases.

5.Interferon a-2a treatment in sala cell epithelioma
İlkin Zindancı, Sema Akkız, Emek Kocatürk, Şükran Sarıgül, Mukaddes Kavala
Pages 80 - 82
Derinin en sık rastlanan tümörü olan Bbazal hücreli epitelyoma (BHE), nadir metastaz yapmasına karşın lokal invazyon ve destrüksiyona neden olmasıyla erken dönemde tedaviyi gerektirmektedir. Çeşitli tedavi seçenekleri uygulanan tümörde interferonların da etkili olduğu bildirilmiştir. İnterferonların tedavideki etkinliğini belirleyebilmek amacıyla, SSK Göztepe Eğitim Hastanesi Dermatoloji polikliniğine başvuran ve histopatolojik olarak BHE tanısı konulan 21 hastanın toplam 25 lezyonuna intralezyonel olarak IFα-2a uygulandı ve tedavi sonrası 4. ayda klinik ve histopatolojik sonuçlar değerlendirildi. 13 lezyonda klinik ve histopatolojik olarak % 100 iyileşme saptanırken, 11 lezyonda tümörün devam ettiği görüldü. Başarı oranı % 54.2 oranında saptanarak, klasik tedavi yöntemlerine göre oldukça düşük bulundu. İnterferonların, düşük başarı oranları ve yüksek maliyetleri nedeniyle klasik tedavi uygulanamayan BHE olgularında alternatif olabileceği sonucuna varıldı.
Though metastasing occasionally, the most common cutaneous malignancy basal cell epitelioma (BCE) should be treated at an early stage since it has local invasion and
destruction. Interferons, as well as various treatment options have been reported to be effective in the treatment of these tumors. In order to establish the efficacy of Interferons in the treatment of BCE’s, 25 lesions of 21 patients who referred to Dermatology outpatient clinic of SSK Göztepe Educational Hospital and diagnosed histologically as BCE were applied IFN a-2a intralesionally. Clinical and histopathological
results were assessed after 4 months following therapy. While in 13 lesions, clinically and histopathologically 100 % cure was determined, in 11 lesions BCE was observed to persist. The success rate of 54.2 % was considered to be low compared with conventional treatment methods. We conclude that, because of the low success rates and high expense, this therapy should be spared only for patients who are not convenient
for conventional methods.

6.The role of endoscopic third ventriculostomy in patients less than one year old
Burak O. Boran, Adnan Dağçınar, M. Memet Özek
Pages 83 - 86
Günümüzde endoskopik lll. ventrikülostomi, non-kommünike hidrosefalide ilk tedavi seçeneği olarak kabul edilmektedir. Hekimlerin hastalarına şanttan bağımsız bir hayat sunabilme arzusu, bu tekniğin ideal sayılamayacak hasta gruplarında da uygulanmaya başlamasını sağlamıştır. Bu çalışmada amaç, endoskopik lll. ventrikülostomi uygulanan bir yaşından küçük 31 hastayı geriye dönük olarak gözden geçirerek, başarı ve komplikasyon oranlarını sunmaktır.
Hastaların 17’si erkek, 14’ü kızdı ve yaş ortalaması 4 aydı. Endoskopik lll. ventrikülostomi sonrası şant gerektirmeyen tüm olgular başarılı olarak kabul edildi. Ortalama takip süresi 25 aydı. Hastaların % 71’inde başarı sağlandı. Bir olguda geçici 3. sinir parezisi gözlendi.
Sonuç olarak endoskopik lll. ventrikülostomi, bir yaşından küçük hastalara da şanttan bağımsız bir hayat sürme şansını sunabilir.
Currently, endoscopic third ventriculostomy is considered as the first choice in the treatment of non-communicating hydrocephalus. But the urge of the physician, to provide a shuntfree survival for his patients, leads to performing the procedure in a diverse group of patients. The aim of this study was to review 31 cases of endoscopic third ventriculostomy, performed in patients less than one year old, retrospectively, to report the rates of success and complications. Seventeen of the patients were male and 14 was female. The average age of the patients was 4 months. All the cases, who did not required a shunt surgery following endoscopic third ventriculostomy, was considered as successfull. Average follow-up period was 25 months. The rate of success was % 71. A transient 3rd nerve paresis was observed in one of the patients. As a conclusion, endoscopic third ventriculostomy can provide a shunt-free survival, also for the patients less than one year old.

7.The effect of remifentanil-propofol and remifentanilmidazolam combinations on the postoperative recovery periodin total intravenous anaesthesia
Gül Ebru Ergün, Elif Bombacı, Gülşen Bosna, Neşe Aydın
Pages 87 - 90
İntravenöz yolla kullanılan kısa etkili anestezik ilaçlar anestezi idamesinde volatil anesteziklere alternatif olarak kullanılmaktadır. Bu çalışmada propofol (P) ve midazolamın (M), remifentanil (R) ile kombinasyonlarının postoperatif derlenme dönemi üzerindeki etkilerinin karşılaştırılması amaçlandı. Elektif abdominal cerrahi planlanan 40 hasta rasgele 2 gruba ayrıldı. Hastalara premedikasyon olarak atropin 0.5 mg im uygulandı. Tüm hastalara remifentanil 1 mcg/kg iv verilmesini takiben, grup P’deki hastalara propofol 2 mg/kg iv, grup M’deki hastalara midazolam 0.3 mg/kg iv uygulandı. Anestezi idamesi N2O/O2 (% 50) inhalasyonu ve remifentanil 0.5 mcg/kg/dk perfüzyonu ile birlikte grup P’deki hastalarda propofol 75 mcg/kg/dk, grup M’deki hastalarda midazolam 0.07 mg/kg/sa perfüzyonları ile sa¤landı. Postoperatif dönemde derlenme, ağrı ve sedasyon özellikleri kaydedildi. Ekstübasyon, göz açma, kooperasyon ve oryantasyon zamanları grup P’de grup M’e kıyasla belirgin olarak kısa bulunmasına rağmen, her iki grup arasında a¤rı ve sedasyon skorları arasında farklılık yoktu. Gereğinde şumazenil kullanılması koşuluyla, midazolamın propofole iyi bir alternatif olabileceği kanaatine varıldı.
Short-acting anaesthetic agents which are used intravenous route are alternative agents to inhalation agents for anaesthetic maintenence. The purpose of this study the compare the effect of P and M which were used with R on post-operative recovery period. 40 patients performed on elective abdomen surgery were included the study. Atropin (0.5 mg im) was administered for premedication. P (2 mg/kg iv) was administered in grup P, M (0.3 mg/kg iv) in group M after administration of R (1 μg/kg iv) each grup. Anaesthesia was maintaned with N2/O2 (% 50), R infusion (0.5 μg/kg/min) plus P (75 μg/kg/min) in group P and M (0.07 mg/kg/h) in group M. Recovery, pain and sedation scores were recorded in post operative period. While the interval to extubation, eye opening, cooperation and oriantation were significantly short in group P compared with group M, there was no significant difference between two groups on pain and sedation scores. It s
concluded that if used with flumazenil, M is a good alternative for P.

8.Predictive value of insulin like growth factor binding protein-3 expression in relation with pathologic stage and prognosis in prostatic carcinoma
İ. Orkunt Ayaz, Mustafa Özyürek, Asıf Yıldırım, Levent Türkeri
Pages 91 - 95
Organa sınırlı tümörlerin preoperatif saptanabilmesi için çeşitli prognostik göstergeler ortaya atılmıştır. Bunlar içinde en sık kabul göreni Partin ve ark. tarafından bildirilen preoperatif serum PSA düzeyi, klinik evre ve Gleason skorudur. Ancak, bu sistemde bile progresyonu öngörmede oluşan başarısızlıklar nedeniyle prognozu öngörmede yeni alternatişere ihtiyaç duyulmaktadır.
Normal prostat hücrelerinin habis transformasyonuna neden olan faktörler arasında peptid büyüme faktörleri de sayılmaktadır. Bunlar arasında en önemlilerinden biri de insülin benzeri
büyüme faktörleri (IGF)’dir. IGF ailesinde IGF-1 ve-2 olmak üzere iki hormon bulunmaktadır. IGF-1 insan prostat hücreleri için mitojendir. Aktivitesi IGF-bağlayıcı proteinlerle (IGFBP) düzenlenir. IGF’nin prostat üzerindeki etkisini etkileyen ise IGFBP-3’tür. IGFBP-3, IGF-1’in indüklediği prostat hücre proliferasyonunu inhibe eder.
Bu çalışmada IGFBP-3’ün dokuda ekspresyon düzeylerinin klinik olarak organa sınırlı prostat kanserinde patolojik evre ve prognoz ile olan ilişkisi araştırıldı. Bu amaçla, lokalize prostat kanseri tanısı konulup radikal prostatektomi operasyonu gerçekleştirilen toplam 38 hastanın cerrahi doku örnekleri alınarak IGFBP-3 ekspresyonu dokularda immünohistokimyasal olarak araştırıldı. ‹mmünohistokimyasal çalışma sonucunda, tümör dokularında IGFBP-3 ekspresyonunun azaldığı, BPH hastalarından alınan dokularda ise arttığı görüldü. IGFBP-3 boyaması tüm tümör dokularında azalmış olarak bulundu.
Sonuç olarak, IGFBP-3’ün prostat kanseri gelişiminde önemli rolünün olabileceği, ancak immümhistokimya ile doku ekspresyonu düzeylerinin saptanmasının patolojik evre ve prognozu öngörmede mevcut yöntemlere ek bir fayda sağlamadığı saptandı.
There are some prognostic factors for the pre-operative prediction of organ confined prostatic carcinoma. The mostl accepted ones include preoperative blood PSA level, clinical stage and Gleason score. But, the predictive values of these factors are not very effective. So, we need more efficient prognostic factors. One of the most important factor to be investigated is the insulin like growth factor (IGF).
There are two peptide hormones in IGF family: IGF-1 and IGF-2. IGF-1 is mitogen for human prostate cells. Its activity is regulated by IGF-binding proteins (IGFBP). IGFBP-3 is
the most effective one which regulates prostatic activity.
In this study, we investigated the expression of IGFBP-3 in prostatic cancer specimens, and its relation to pathological stage and prognosis. For this purpose, 38 patients which were diagnosed as localized prostate cancer and underwent radical prostatectomy were investigated. Tissue samples of radical prostatectomy specimens were examined by immunohistochemistry for detection of IGFBP-3 expression. As a result of immunohistocehemical study IGFBP-3 expression was decreased in the tumoral tissues whereas increased in BPH tissues. Expression also decreased in the BPH tissues closer
to the tumoral areas and increased in BPH tissues away from the tumoral area.
As a conclusion, we found that IGFBP-3 may have an important role in the development of prostate cancer. But, examining the tissue expression by immunohistochemistry do not
give any additional benefit to existing methods for prediction of pathological stage and prognosis.

9.Are out-patient clinics for chronic disease successful? Experiences of Edirne state hospital
E. Melih Şahin, Hicri Tunç, Fulya Tanrıkulu, Cahit Özer, İbrahim Şahin
Pages 96 - 99
Birinci basamakta en sık rastlanan hastalık esansiyel hipertansiyondur. Esansiyel hipertansiyona seyrek olmayarak diabetes mellitus, dislipemi ve obezite eşlik etmektedir. Morbidite ve mortalite yönünden iyi hasta uyumu ve sıkı kontrolün şart olduğu bu hastalıkların takibini kolaylaştırmak amacıyla hastane bünyelerinde özel poliklinikler açılmaktadır. Çalışmamızda, Edirne Devlet Hastanesi Kronik Hastalık polikliniğinin hastalık kontrolü ve tedavi başarısı yönünden değerlendirilmesi amaçlandı.
Edirne Devlet Hastanesi Kronik Hastalık Polikliniğine Aralık 2000 ile Aralık 2001 arasında başvuran hastalara ait veriler, yapılan takipler ve tedaviler açısından geriye dönük olarak değerlendirildi. Veriler bilgisayar ortamına işlendi ve istatistiksel analizi yapıldı.
Bu süre içinde poliklinik sayısı 1673, kayıtlı hasta sayısı 559 idi. Çalışmaya 526 hasta dahil edildi. Bu hastalarla yapılan toplam tıbbi görüşme sayısı 1057 idi. Hastaların 279’u hipertansiyon, 98’i diabetes mellitus, 312’si hiperkolesterolemi, 476’sı obesite idi. Hipertansiyonlu 147 hasta ortalama 103 gün izlenmiş ve tansiyonlarında ortalama diastolik 8 mmHg, sistolik 14 mmHg bir azalma sağlanmıştır. Kayıt altına alınan 98 diabet hastasından 43’ünün tanısı polikliniğimizde konmuştu. Dislipemili 144 hasta ortalama 117 gün izlenmiş ve total kolesterol düzeylerinde ortalama 22 mg/dl azalma sağlanmış. 201 obez hasta ortalama 108 gün izlenmiş ve vücut ağırlığında ortalama % 4’lük bir azalma sağlanmış.
Birinci basamak sağlık kuruluşlarında etkili hizmet üretilemediğinden hastanelerde büyük bir yığılma vardır. Kronik hastalık poliklinikleri kronik hastalığı olanların sürekli ve kapsamlı bakım ihtiyaçlarını karşılamada onlara yardımcıdır. Bu poliklinikler birinci basamağın yerini dolduramasalar dahi, hastaların bakım kalitelerini iyileştirebilecek kapasitededirler.
Most common disease in primary health care is essential hypertension which is usually accompanied by diabetes mellitus, hypercholesterolemia or obesity. New outpatient clinics
were organized in state hospitals to provide close control and to enhance patient concordance which are essential to decrease mortality and morbidity rates. The aim of this study is to evaluate the results of outpatient clinic for choric disease of Edirne State Hospital in the aspects of disease control and treatment success.
In this retrospective descriptive study the medical history and treatment modalities of patients applied between December 2000 and December 2001 were investigated using medical records. Data transferred to and analyzed in computer media.
Workload of clinic was 1673 visits for 559 patients. 1057 visits for 526 patients were included to the study. Regarding these patients, 279 of them have hypertension, 98 of them have diabetes mellitus, 312 of them have hypercholesterolemia and 476 of them were obese. Regarding 151 suitable HT patients mean follow up duration was 103 days and blood pressures decreased 8 mmHg diastolic and 14 mmHg systolic in average. Total cholesterol levels of 144 hypercholesterolemia patients who were followed up 117 days in average were decreased 22 mg/dl. 201 obese patients were followed up 108 days in average and they lost 4 % of their body weight in average.
Hospital outpatient clinics are very crowded due to the ineffectiveness of primary care facilities. Outpatient clinics for chronic diseases may help patients for their continuous and
comprehensive care. Although they could not function as primary care, they can improve the quality of the care of their patients.

10.The correlation between total IgE and blood eosinophil level of asthma stages
A. Çetin Tanrıkulu, Canan Eren Dağlı, Abdurrahman Abakay, Mehmet Coşkunsel
Pages 100 - 103
IgE seviyesi astımla ilgili önemli bir parametredir. IgE astım fizyopatolojisinde santral bir rol oynamaktadır. Eozinofillerin astım patogenezinde önemli rolü olduğuna inanılmaktadır. Yapılan çalışmalarda, astımlı hastalarda kontrol grubuna ve KOAH hastalarına göre IgE seviyesi ve kan eozinofil seviyesi yüksek bulunmuştur.
Bu çalışmada astımlılarla sağlıklı kişiler arasında IgE düzeyleri ile kan eozinofilisinin kinetiklerini ve bunları etkileyen faktörleri incelemek, ayrıca astım şiddeti ile IgE düzeyi ve periferik kan eozinofilisinin korelasyonlarını incelemek amaçlanmıştır. Ekim 2002-Mayıs 2003 yılları arasında polikliniğiniğimize başvuran olgular çalışmaya alındı. Yaş ortalaması hasta grubunda 30.3±9.2, kontrol grubunda 30.5±12.6 olarak saptandı. IgE ve eozinofili düzeyleri karşılaştırıldığında hasta grupta eozinofil % 4.8 ± 4.2 kontrol grubunda ise % 2.1±1.0 olarak bulundu (p<0.005). Yine bu gruplar arasında IgE karşılaştırıldığında hasta grupta IgE 378.8±377.7 IU/ml iken kontrol grubunda ise 78.5±62.5 IU/ml olarak bulundu (p<0.05). Hasta grupta 13 hafif intermittant, 21 hafif persistan ve 16 orta persistan olgu saptandı. Her üç astım grubu ile kontrol grubu karşılaştırıldığında her iki parametre için oluşan fark istatistiksel olarak anlamlıydı (p<0.05). Astım hastaları kendi aralarında kıyaslandığında hafif persistan astım ile orta persistan astım arasında IgE değerleri arasında istatistiksel bir fark saptanırken (p<0.05) diğer gruplar arasında anlamlı bir fark saptanmadı (p>0.05).
Astımın tanısı ve ayırıcı tanısında IgE seviyesi ve eozinofil seviyeleri önemli rol oynamaktadır. Fakat hastalığın şiddetinin saptanmasında değerleri tartışmalıdır. Bu parametrelerin hastalığın şiddeti ve prognozu için değerinin anlaşılması amacıyla daha ayrıntılı çalışmalara ihtiyaç vardır.
The level of IgE is an important parameter relating to asthma playing a santral role in the phsyopathology of the disease. Also eosinophils are believed to have an important role in the pathogenesis of asthma. In the studies, the level of IgE and blood eosinophil level have been found to be higher than the control group and COPD. In this study, it was aimed to investigate the kinetics of the levels of IgE and blood eosinophil between the asthmatics and healthy people and the factors effecting these and also the correlation between the severity of the asthma and levels of IgE and peripheric blood eosinophil.
Total number of 100 cases applied to our polyclinic between October 2002-May 2003 were included to the study. The mean age was found as 30.3±9.2 for the group of patients and 30.5±12.6 for the control group. Comparing the IgE and eosinophil levels, the group of patients’s ratio of eosinophil was found as % 4.8±4.2 and the control group’s was as % 2.1±1.0 (p<0.005). Also comparing the ratio of IgE levels between these 2 groups showed that although IgE level of the group of patients was as 378.8±377.7, it was found as 78.5± 62.5 for the control group (p<0.05). In the group of patients,
13 mild intermittent, 21 mild persistent and 16 moderate persistent cases were detected. Comparing the 3 asthmatic groups with the control group, the difference occured for the
2 parameters were significant statistically (p<0.05). Statistical significance was detected between the IgE levels of the mild persistent and moderate persistent asthma (p<0.05), but no significant difference was detected between the other groups (p>0.05).
IgE and eosinophil levels play an important role in the diagnosis and differential diagnosis of asthma but their role to determine the severity of the disease is controversial. More
detailed studies are needed to understand the value of these parameters in determining the severity and prognosis of the disease.

11.Frequancy of type II diabetes mellitus, hyperlipidemia and obesity at nonalcoholic steatohepatit
Ayşe Kubat Üzüm, Şebnem İzmir Güner
Pages 104 - 106
NASH (nonalkolik steatohepatit), alkol almayan kişilerin karaciğerinde alkole bağlı yağlanmaya benzer histolojik bulguların varlığı ile tanımlanan ve sıklıkla asemptomatik seyreden klinikopatolojik bir durumdur.
Bu çalışmada AST, ALT değerleri 2-2.5 kat artmış olan hastalara karaciğer biyopsisi yapıldı. 27’si kadın, 6’sı erkek toplam 33 hasta çalışmaya dahil edildi. Bu çalışmada steatohepatik
saptanan hastalarda obezite, diabetes mellitus ve hiperlipidemi sıklığını araştırdık. Ortalama yaş 48.9±2.1, ortalama VKİ (vücut kitle indeksi) 32.47±3.6 kg/m2, ortalama total kolesterol 227.14±41.8, trigliserid 164.59±84.7 olarak saptandı. Hastalarda diabetes mellitus ve bozulmuş glukoz toleransını saptamak için oral glukoz tolerans testi uyguladık. 6 hastada (% 18) diabetes mellitus, 8 hastada (% 24) bozulmuş glukoz toleransı saptadık.
NASH (nonalcoholic steatohepatitis) is a frequently occuring asymptomatic clinicopathologic situation which is defined by the presence of histologic findings in the liver of patients who don’t consume alcohol where these findings are similar to fatty degeneration caused by alcohol.
In this study, we performed liver biopsy to the patients whose AST and ALT levels are increased 2-2.5 times. 33 patients (27 women, 6 men) who had steatohepatitis are included to the study. We aimed to find the frequency of obesity, diabetes mellitus and hyperlipidemia going with the steatohepatitis were included to the study. Average age was 48.9±2.1, average BMI was 32.47±3.6 kg/m2. The main value of total cholesterol
was 227.14±41.8, trigliseride was 164.59±84.7. According to the oral glucose tolerance test we found diabetes mellitus in 6 patients (% 18), impaired glucose tolerance in 8 patients (% 24).

CASE REPORTS
12.Chronic granulomatous disease accompany with ichthyosis
Çiğdem Yılmaz, Özden Türel, Rengin Şiraneci, Sadettin Sezer, Sema Yakalı, Ahmet Köse, Emel Atasoy, Hüsem Hatipoğlu, Osman Pinçe
Pages 107 - 108
Chronic granulomatous disease, is a genetic disease characterized by a disorder of oxidative metabolizm in cells capable of phagocytosis such as neutrohils, machrophages and eosinophils. Its incidence is 1/1.000.000 and more commen in males. Most of the patients present within the first year especially first 3 months of their life with soft tissue infection, lymphadenitis and abscesses in liver and spleen.
4 year old male child attended to our hospital with complaint of swelling on the neck and fever. His past medical history included common recurrent exudative lesions at various parts of his body and he had been investigated for neck mass a few times. His physical examination yielded right cervical lymphadenomegali 5x5 cm diameter, fixed to underlying tissue and dryness and fissures on the lower extremites. He was diagnosed as chronic granulomatous disease and ichthyosis vulgaris after laboratury and clinical workup and his lymphadenitis was controlled by anthbiotic therapy.
Chronic granulomatous disease should be considered in the differential diagnosis of recurrent lymphadenitis and though very rare it may accompany diseases with neutrophil disfunction such as ichthyosis, lazy-leukocyte syndrome, Cheidak-Higashi syndrome and Job syndrome.

13.A Turkish family with xerostomia
Bahadır Ceylan, Aydın Mazlum, Aslı Çurgunlu, Cengiz Çelikyurt, Şule Ceylan
Pages 109 - 110
Xerostomia is an important symptom which disrupts the quality of life very seriously, and may be the major symptom of Sjogren’s syndrom (SS). The etiology for SS remains unknown where multifactorial influences contribute to the pathogenesis of subsequent development of the disease.
In this letter we report a Turkish family with xerostomia whose genetic susceptibility to SS followed a mendelian dominant trait. This family contain one grandfather (age: 70), 5
children (age: 20-36) and 6 grandchidren (age: 5-9). Grandfather, four of five chidren and two of six grandchidren had xerostomia. Seven member of the family reported the following: Inability to eat dry food, putting a glass of water on their bed stand to drink at night, difficulty speaking for long periods of time, higher incidense of dental caries and periodontal disease. All cases stated that his complaints of dry mouth was
started at the age of 3 after a common cold. Physical examination revealed dental caries and periodontal disease. The routine laboratory tests were within normal limits and RF,
ANA, SS-A (anti-RO), SS-B (anti-LA) was negative. In all patients we found those an unstimulated whole mouth salive flow rate of < 0.1 ml/min, Rose Bengal test was positive and Schirmer test was negative. Glandulary stricture and inflamatory cells wasn’t seen in labial biopsy. Our patient had two of Fox criteria.
It seems to be a genetic predisposition for the SS in some cases. Immunogenetic studies have demonstrated that HLA-B8, - DR-3, and –DRw52 are prevalent in primary Sjogren’s syndrome patients as compared with the normal control population.
On the other hand, family studies indicated the presence of an additional autosomal dominant gene(s), not linked to HLA, in predisposition to SS. Possesion of the necessary genetic factors doesn’t invariably lead to clinical disease. The cumulative effect of interactive genetic (MHC and non MHC) and nongenetic influences (virus infection) may dictate protective and/or susceptibility factors in disease expression. In conclusion, xerostomia may show familial occurens and other family members are asked for this symptom.

14.Multiple myeloma with together solitary plasmacytoma
Gamze Gököz Doğu, Özgül Soysal, Oğuzhan Yıldırım, Zeliha Aksoy, Ayça Değirmenci, Bülent Eralp
Pages 111 - 112
Solitary plasmacytomas are tumors of plasma cell origin that constitute less than 10 % of all plasma cell neoplasms. These tumors are categorized as extramedullary plasmacytomas
(non-osseous) or solitary plasmacytomas of bone (osseous). Extramedullary plasmacytomas frequently remain localized and usually can be treated effectivelly with radiation therapy, whereas solitary plasmacytoma of bone frequently convert to multiple myeloma. Here we report a case an unusual presentation of solitary plasmacytoma involving thoracic vertebra and presented with IgA paraproteinemia

15.Wilson’s disease in pregnancy
Ali Rıza Sözenoğlu
Pages 113 - 115
Wilson’s disease is inherited disorder of copper accumulation. It can be a cause of infertility. Since the introduction of new agents treatment successful pregnancies have been reported. I report the first case to document of neurologically impaired women with Wilson’s disease who refuse the therapy and who had a successful pregnancy.

16.Leg ulcer associated with b-Talassemia intermedia
İlkin Zindancı, Zafer Türkoğlu, Buket Eskiçırak, Süleyman Şeker, Mukaddes Kavala
Pages 116 - 117
Leg ulcers, cutaneous complications of chronic hemolytic anemias, are seen as well defined recurrent chronic skin lesions healing with scarring more commonly in young adults occuring on or over each of the malleoli. Although the ethiopathogenesis has not been well established, possible relative hypoxia from chronic anemia, changes in hemodinamics caused by orthostatic pressure and bony malleolar prominences
exposed to constant trauma are the accused factors.
In this report, we present a 37 year old man who had ß-(beta) Thalassemia intermedia with recurrent chronic leg ulcers for 15 years.
It is very important to evaluate hematological studies beside the physical examination in leg ulcers of which possibility must be followed for years in patients with chronic anemia.

17.Male ereast cancer
Sezai Demirbaş, Orhan Türken, Hüseyin Baloğlu, M. Levhi Akın, Tucay Çelenk
Pages 118 - 120
Male breast cancer accounts for the 1 percentage of all breast cancer. Pure ductal carcinoma insitu (DCIS) is observed so rare in men. The health providers could mixt up true diagnosis with any benign mass like gynaecomastia. So male breast cancer unfortunatelly is diagnosed in late stage. There is a few knowledge of presenting symptoms for doctors to define the lesion as the cancer in a male breast. The patients presented here was 73 years old and had an painless mass in his own left breast with few bloody nipple discharge. There was no sign for the mass if it could be malign lesion except bloody discharging. Despite there are several diagnostic tests and genetic counseling surveys as well, the little discharging mixing blood up from nipple could be the main point to make a true diagnosis. This case report is prominent because the nipple
discharge as a clinical sign could have a greater effect than many sophisticated diagnostic tests on the making the decision in any patient with family history and job tenderness.

18.Two pediatric patients with mucormycosis
İbrahim Bayram, Atila Tanyeli, Shafik Dossaji, İlgen Şaşmaz, Aysun Oğuz, Melek Ergin, Süreyya Soyupak
Pages 121 - 124
Mucormycosis is a rare, opportunistic infection caused by Mucoroles, class Zygomycetes. It produces fatal infections in immunocomprised patients in the childhood. We describe two case of rhinocerebral mucormycosis in neutropenic patients with relapses.
Case 1 (AD); 13 year-old-boy was diagnosed as acute lymphoblastic leukemia (ALL) and treated with BFM-95 protocol. He relapsed on his 21st month of maintenance therapy. Bone marrow aspiration showed acute myeloblastic leukemia (AML) and started AML treatment. After first induction therapy, he had suffered from febrile neutropenia. On 17th day of hospitalization, he had oral infection and biopsy specimen showed mucor infection.
Case 2 (ZA); 14 year-old-girl. Bone marrow transplantation was done because of relapsed ALL. On 12st day after transplantation, she had had neutropenic period with necrotic lesion on her soft and hard palate with the diagnosis of mucor infection.

19.Rupture of bronchus due to chest trauma
Ferhan Özşeker, İlknur Dilek, Onur Çelik, Esen Akkaya, Semih Halezaroğlu
Pages 125 - 127
Rupture of the tracheobronchial tree associated with thoracic trauma is a life threatening, rarely seen and hardly diagnosed condition. 25 years old male patient was hospitalized with complaints of dyspnea and right sided chest pain. He had history of traffic accident 3 months ago. PA chest X ray demonstrated total atelectasis of the right lung. Emergency fiberoptic bronchoscopy was performed and showed that right main bronchus was almost totally obstructed with granulation tissue. The patient was operated with the diagnosis of stenosis due to fibrosis caused by bronchial rupture. The patient underwent sleeve upper lobectomy and was discharged from hospital after 11 days. The patient is under follow up without complaints. In conclusion, bronchial rupture can complicate blunt thoracic traumas and this should always be kept in mind. Treatment modality decision must be made according to the patients clinic condition.




 

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