Erciyes Medical Journal - 2008; 30(2) - Current Issue

Can Laboratory and Clinical Signs Predict Persistence in Gestational Trophoblastic Disease?

Nermin K��, �etin �elik, Ayd�n K�� — 2008-06-01

Purpose: Laboratory and clinical signs of gestational trophoblastic disease (GTD) and their importance in the prediction of persistence of this disease were evaluated. Material and Methods: Ninety-two patients with GTD were evaluated prospectively. Patients were divided into four groups as complete mole, partial mole, invasive mole and choriocarcinoma. All patients were evaluated for persistence by clinical, ultrasound and laboratory findings. Methotrexate+folinic acid were administered to the patients with persistent disease. Combined chemotherapy protocols were applied to patients with no mor minimum response. Hysterectomy was performed on older patients who had no desire for a child. Results: Molar pregnancy and gestational choriocarcinoma rates were 4.8/1000 and 2/10,000 respectively. Mean age and mean beta-hCG levels were higher in the invasive mole group. Theca-lutein cysts and excessive uterine enlargement were detected in a higher proportion of patients with complete or invasive mole. These findings were seen more frequently in cases with persistence. Conclusion: Persistent GTD can be predicted by clinical and biochemical markers. Risk of the development of persistence is lower in patients under the age of 35, in the absence of theca-lutein cysts and hCG level below 100,000 IU. In addition, negative predictive value of hCG level shows low risk of persistence to the same extent as negative predictive value of combination of parameters. With early detection and effective treatment, prognosis is excellent.

Effects of metformin therapy on malondialdehyde level and paraoxonase 1 activitiy in patients with polycystic ovary syndrome

Derya Ko�er, Sabahattin Muhtaro�lu, Fahri Bayram — 2008-06-01

Purpose: The aim of this study was to assess the effects of metformin on oxidative stress that may increase the risk of cardiovascular disease in patients with polycystic ovary syndrome. Materials and methods: Fifteen patients with polycystic ovary syndrome and 17 healthy subjects were included in this study. Patients were treated with 2x850 mg/day metformin for six months. Serum androgen and malondialdehyde levels and paraoxonase 1 activity levels were measured in serum obtained from study groups. Results: Significantly decreased paraoxonase 1 activities, but increased free testosterone, dihydroepyandrostenedione sulfate and Malondialdehyde levels were found in patients with polycystic ovary syndrome compared to those of controls. Paraoxonase 1 activities increased and Malondialdehyde levels decreased significantly after metformin therapy (p<0.05). Conclusions: Increased reactive oxygen species levels in patients with polycystic ovary syndrome might result in decreasing antioxidant paraoxonase 1 activity and increasing Malondialdehyde levels. Metformin therapy may inhibit the risk of cardiovascular diseases by decreasing lipid peroxidation and increasing paraoxonase 1 activity.

The Effect of IV Paracetamol on the Hemodynamic Indices, Liver Functions and the Postoperative Analgesia in the Patients Underwent Major Orthopaedic Surgery

2008-06-01

Purpose: We aimed the investigate of the effect of iv paracetamol on hemodynamic indices, liver functions in the patients underwent major orthopaedic surgery. Material and Methods: This study was performed on 120 patients with ASA I-II risk group underwent major ortopaedic surgery. The patients are randomly divided into there groups: Group I (only iv meperidine), Group II (Parasetamol in doses 1g is intravenously given by infusion during the 30 mins ago end of the operation, and this dose is repeated in every 6 hours.) and Group III: Parasetamol iv 1gr is given by infusion during the 30 mins ago from the anesthesia induction, and this dose is repeated in every 6 hours. Patient Control Anaestesia (PCA) method; meperidin was administered via PCA as loading dose 0.5mg/kg, set bolus dose 0.1mg/kg and standing locked term 10 mins. Blood for ALT and AST taken on preoperative and postoperative 24th hour is examined. Results: In control group, compared with parasetamol and preemptive groups, SAP in postop 60th, DAP in postop 30. and 60th mins, HR in postop 15th mins were recorded higher. The preop and postop examined ALT and AST were similar. Conclusion: We concluded that iv paracetamol administration to the patients underwent to major ortopaedic surgery did not cause negative hemodynamic results and liver functions.

The Value of Low-Dose Multidetector CT and Virtual Bronchoscopy Findings in Pediatric Patients With Suspected Foreign Body Aspiration

Serap Do�an, Abdulhakim Co�kun, Ali Y�k�lmaz, Leyla Hasd�raz, Fulya Tahan — 2008-06-01

Purpose: To investigate the potential use of low-dose multidetector CT (MDCT) and virtual bronchoscopy for the evaluation of children with suspected foreign body aspiration. Patients and Method: Low-dose MDCT (mA: 50-100) was performed in 15 patients (3 girls, 12 boys) with a mean age of 34.4 months (6 months-10 years) with suspicion of foreign body aspiration. MDCT findings were prospectively evaluated by two radiologists. The findings were compared with the results of rigid bronchoscopy. Results: In ten patients, foreign bodies were revealed in tracheobronchial system. The foreign body was in the right bronchial system in five patients, left bronchial system in four patients and in the distal trachea in one patient. In all patients CT images were evaluated optimal for diagnosis. In eight patients, no discordance was found between two modalities. One patient spontaneously extracted foreign body and rigid bronchoscopy was not performed. In another patient, foreign body was not revealed with MDCT and virtual bronchoscopy. In this patient, there were infiltrates at the location of the foreign body. The sensitivity and specificity of MDCT were %90 and %100, respectively. Conclusion: Low-dose multidetector CT and virtual bronchoscopy are alternative radiological methods for the diagnosis of foreign body aspiration.

Evaluation of the Knowledge of Participants Before an Anapylaxis Treatment Education Program
(Anaflaksi Tedavisi E�itim Program� �ncesi Kat�l�mc�lar�n Bilgilerinin Ara�t�r�lmas�)

2008-06-01

Bilateral Anterior Shoulder Dislocation Due to Traffic Accident: Case Reports

2008-06-01

The most common dislocation seen by emergency physicians is anterior dislocation of the shoulder joint. Bilateral dislocation of this joint is rarely seen. From the history of the patient it was discovered that during the trauma elbow joints were tense (hyperextension), arms were abducted from the shoulder and the patient had fallen on his hands. This position explained how anterior dislocation had happened. With this case presentation we aimed to draw attention to a frequently seen clinical entity in emergency departments and its rarely seen form.

Preoperative Diagnosis of Solid Pseudopapillary Tumor of the Pancreas: a Case Report

Aptullah Haholu, G�ner S�nmez, Nuri Yi�it — 2008-06-01

Solid pseudopapillary tumor (SPT) of pancreas is rather rare. Despite having low malignant potential, it is curable with complete resection. Histologic, cytologic and radiologic features of SPT diagnosed in a 42-year old female patient were presented in this study. The abdominal computerized tomography revealed sharply demarcated mass on the head of the pancreas. Prominent cellularity and papillary like structures were seen in core biopsy. It should be kept in mind when seeing a pancreatic mass including solid areas or areas showing cystic changes. Surgical resection should be done, since tumor has low malignant potential. After complete resection, prognosis is excellent.

Bullous Emphysema in Congenital Syphilis Infection:Case Report

Yasemin Altuner Torun, Dilek Uluba�, Sebahat T�lpar, Aylin Okur, Mustafa �zt�rk — 2008-06-01

We report a case of congenital lobar emphysema diagnosed postnatally in an infant of one- day old.Congenital lobar emphysema is characterized by overinflation of pulmonary lobe and is caused by localised bronchial obstruction. The disease may result in severe respiratory distress in early infancy. Histology and serology confirmed infection with syphilis. Syphilis pneumonitis leading to inflammation and obstruction in the bronchial tree may have resulted in the development of congenital Bullous emphysema.

Evaluation of Burnout Levels of Health Managers in Kayseri City

Ahmet �zt�rk , Yasemin Tolga, Vesile �enol, Osman G�nay — 2008-06-01

Purpose: The present study was performed to determine the burnout levels and the factors related with this situation of health care managers in Kayseri City. Material and Methods: Between April and May 2005, 119 care managers who were employed in health facilities of health ministry and Erciyes University were recruited in this study. Data collection was performed with Maslach burn out scale and an interview form with information on their working environment. One-way analysis of variance (ANOVA), Kruskal Wallis H tests and the significance test of the difference between two means in independent groups were used in data analysis. Results: We found that managers with commensurate authority and responsibility those who like both their jobs and job environment experienced more lower burnout and were more sensitive to their professions and jobs. It was determined that managers who were medical doctors were experiencing more burn out than other managers who were not medical doctors. Conclusion: Burnout levels of those health care managers, who are single, medical doctors with post graduate education, who are not satisfied with their jobs, and those who do not have authorization commensurate with their professions, are higher. Age, sex and weekly working hours did not affect their burnout levels.

Predicting Death Anxiety by Psychological Dispositions of Individuals from Different Religions

Mustafa Y�ksel Erdo�du — 2008-06-01

Purpose: The purpose of this study is the prediction of death anxiety with symptom distress of individuals from different religions. Material and Methods: The study includes 240 people as a sample who are Syrian, Yezidi and Muslim, were choosen randomly from Mardin, Batman, Diyarbak�r and �anl�urfa. In this study SCL-90 “symptom distress check list” and “Thorson Power Death Anxiety” scales are applied. Results: From symptom distress respectively, for Syrian people, anxiety and interpersonal sensitivity; for Muslim people, interpersonal sensitivity, sometization, obsession, pschooid, paronoid, anger and additional variables; for Yezidi people have sometization, obsession, pschoid, paronoid, phobia, additional variables are seen as an important reasonable prediction of death anxiety. Conclusion: Fear of death and anxiety exist everywhere and every time and effects our life deeply. Most of energy of human beings are spent to deny the reality “death”. According to some of psychological theorist, death anxiety is the first symptom of nevroz, for some of other ones, it is the first source of pathology. According to the study results, there are relations between death anxiety and symptom distress.

Fertility Sparing Options in Ovarian Cancers

B�lent �z�elik — 2008-06-01

Although the vast majority of ovarian cancers are of advanced stage and detected in postmenopausal period, a spot of them (15%) can be seen in girls or younger women. The diagnosis of a gynecologic malignancy such as ovarian cancer can be devastating to these patients who desire future fertility. Some of these women can be candidates for fertility sparing management. Subcategories of ovarian cancers, which appropriate for this option include stage IA epithelial ovarian cancer, low malignant potential ovarian cancer, malignant germ cell tumor and sex-cord stromal tumors. Though the care of these patients is challenging and complex, we have got better alternatives than the former period. In this review, overviewing of the fertility sparing alternatives in patients with ovarian cancer was aimed in the light of literature.

“Acrania”: Two Case Reports With Prenatal Ultrasound Results

Mustafa Ko�, G�khan Akba� — 2008-06-01

Acrania is a rare congenital anomaly and characterized by partial or complete absence of the calvarium with abnormal brain tissue development. The pathogenesis of acrania is unknown and differential diagnosis should be searched to rule out other similer conditions to anencephaly and acalvaria. Diagnosis of cranial bone defects can be established by ultrasonography in the first trimester of pregnancy. We report two cases, diagnosed prenatally by ultrasonography, one with isolated acrania and the other one associated with meningocele.

Two Multiple Sclerosis Cases Confused with Cerebral Tumor

Vaner K�ksal, Mehmet Ali Ekici, Ahmet Menk�, Turgay Bulut, �brahim Suat �ktem — 2008-06-01

Multiple sclerosis (MS) is an inflammatory disease of central nervous system. As a result of the damage done to the myelin, lesions termed as plaques are formed in the white matter. The sizes of those plaques vary from milimetric values to 4-5cm. Large lesions of that size may behave like an abscess or tumor in the brain. Differentiating single lesions from gliomas, and distinguishing multiple lesions from tumor or abscess, are not easy processes. In the present study, we made an effort to denote that large and multiple MS lesions should be included in the differential diagnosis of intracranial space-occupying lesions, as well.

Erciyes Medical Journal - 2008; 30(2) - Current Issue

Can Laboratory and Clinical Signs Predict Persistence in Gestational Trophoblastic Disease?

Effects of metformin therapy on malondialdehyde level and paraoxonase 1 activitiy in patients with polycystic ovary syndrome

The Effect of IV Paracetamol on the Hemodynamic Indices, Liver Functions and the Postoperative Analgesia in the Patients Underwent Major Orthopaedic Surgery

The Value of Low-Dose Multidetector CT and Virtual Bronchoscopy Findings in Pediatric Patients With Suspected Foreign Body Aspiration

Evaluation of the Knowledge of Participants Before an Anapylaxis Treatment Education Program(Anaflaksi Tedavisi E�itim Program� �ncesi Kat�l�mc�lar�n Bilgilerinin Ara�t�r�lmas�)

Bilateral Anterior Shoulder Dislocation Due to Traffic Accident: Case Reports

Preoperative Diagnosis of Solid Pseudopapillary Tumor of the Pancreas: a Case Report

Bullous Emphysema in Congenital Syphilis Infection:Case Report

Evaluation of Burnout Levels of Health Managers in Kayseri City

Predicting Death Anxiety by Psychological Dispositions of Individuals from Different Religions

Fertility Sparing Options in Ovarian Cancers

“Acrania”: Two Case Reports With Prenatal Ultrasound Results

Two Multiple Sclerosis Cases Confused with Cerebral Tumor

Evaluation of the Knowledge of Participants Before an Anapylaxis Treatment Education Program
(Anaflaksi Tedavisi E�itim Program� �ncesi Kat�l�mc�lar�n Bilgilerinin Ara�t�r�lmas�)