ABSTRACT

Objectives: The aim of this study was to evaluate the etiological factors for cervical lymphadenopathy in children and the role of ultrasonography (USG) in diagnosis.
Methods: A total of 200 children of significant cervical lymphadenopathy between 3 months to18 years were pro-spectively included in a tertiary referral hospital. All subjects were evaluated by history, examination, hemogram, chest X-ray, mantoux test, fine needle aspiration cytology (FNAC), acid-fast bacillus (AFB) staining, ultrasonography (USG) of lymph node. Open lymph node biopsy, bone marrow examination, serological tests were optional.
Results: A total of 84 subjects (42%) identified as benign reactive, 80 (40%) as tuberculosis, 20 (10%) chronic lym-phadenitis, 12 (6%) non-Hodgkin and 4 (2%) Hodgkin’s lymphoma by USG. However, on USG among 84 subjects of benign reactive lymphadenopathy, 60 (71.4%) were having features of benign reactive lymph node, remaining 24 (28.6%) have normal sonogram; out of 80 subjects of tuberculosis lymphadenitis 66 (82.5%) have features of tuber-culosis and rest14 (17.5%) have nonspecific ultrasound changes; among 16 subjects of lymphoma, 10 (62.5%) have features of malignancy, rest 6 (37.5%) have nonspecific changes in USG examination. Male to Female ratio was1.68:1. Cervical lymphadenopathy was most prevalent in 6 to 10 years age group.
Conclusion: Reactive lymphadenitis due to underlying acute bacterial or viral infection was the commonest cause of significant cervical lymphadenopathy in children and ultrasonography is a good noninvasive diagnostic modality, but requires other tests for definitive diagnosis.

Keywords: Cervical lymphadenopathy, ultrasonography, children, diagnosis

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Objectives: Aim of the study was to compare the analgesic and hemodynamic effects of levobupivacaine, levobupivacaine-fentanyl, levobupivacaine-morphine for arthroscopic knee surgery under unilateral spinal anesthesia.
Methods: A total of 44 ASA I/II patients scheduled for arthroscopy were included in the study. After prehydration patients kept in a lateral position on the nondependent side. Spinal puncture was performed at L3–4/L4–5 intervertebral space. Patients divided into three subgroups: Group L (n=14) received 0.5% levobupivacaine 1 ml+1 ml distilled water; Group LF (n=15), 25 mcg fentanyl (0.5 ml)+0.5 ml distilled water; and Group LM (n=15), 0.01 mg morphine (0.5 ml)+0.5 ml distilled water. Patients remained in that position for 15 minutes. Blood pressure and heart rate were recorded before and 1^st, 3^rd, 5^th, 10^th, 15^th, 20^th and 30^th minutes after the block and every 15 minutes during the operation. Motor blockade and sensorial level, side effects, motor block regression time (MBRT), first urination time and first analgesic need (FAN) were recorded.
Results: Group LM had the longest MBRT, but difference with other groups did not reach to a significant level (p>0.05). Group LM had significantly longer FAN time compare with other groups (p<0.05). The first urination time was latest in Group LM (p<0.05). Motor blockade was least in Group L (p<0.05) and almost 50% patients had not motor block.
Conclusion: All three groups had successful anesthesia. Morphine group added group had significantly longer analgesia without significant urinary retention and motor blockade regression time. We concluded that additional low doses of morphine will be a better choice.

Keywords: Unilateral spinal, hypobaric, levobupivacaine,analgesia, hemodynamic effects

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Objectives: In present study, we investigated the seroprevalence of the antibodies against Toxoplasma gondii and Rubella virus, which may cause congenital infections in risk groups including childbearing age women in a period of two years.
Methods: The samples of sera, which were taken from risk groups including pregnant and childbearing age women admitted to our hospital during May 2008 and April 2010, were tested for antibodies against Toxoplasma gondii and Rubella virus. Anti-Toxoplasma IgM/IgG and anti-Rubella IgM/IgG antibodies were assayed with chemiluminescent method by autoimmunanalyzer (Advia Centaur, Siemens) according to the manufacturer’s instructions.
Results: Seroprevalences of IgM and IgG for Toxoplasma gondii (n=3.474) were found as 4.6% and 17.5%, respectively. Seroprevalences of IgM and IgG for Rubella virus (n=3.460) were found as 0.95% and 76.5%, respectively.
Conclusion: Widespread population screening may contribute to the prevention of congenital infections due to Toxoplasma gondii and Rubella virus. Because of the high seropositivity of Toxoplasma gondii and Rubella virus in childbearing age women, preventive measures should be implemented.

Keywords: Rubella, Toxoplasma gondii, Seroprevalence, women, childbearing age

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Objectives: The aim of this study was to evaluate the effect of intraarticular local anaesthesia on postoperative pain and patients satisfaction in arthroscopic knee surgery.
Methods: A total of 64 patients (18–45 years) who underwent arthroscopic knee surgery were included in this study. At the end of surgery %0.5 bupivacaine (20 ml, 100 mg) in group B and saline solution (20 ml) in group K were admitted to the knee joint. Ten minutes after application, knee joint was washed with saline solution in both groups. Postoperative visual analog scores (VAS) values of patients and additional analgesic requirements were recorded.
Results: Postoperative VAS values of groups were compared, on the first 8 hours there was a significant difference but on the 12^th and 24^th th hours significant difference was not found.
Conclusions: Intraarticular bupivacaine administiration was found as a reliable and effective method for pain control in arthroscopic knee surgery and can ameliorate patient satisfaction.

Keywords: Arthroscopic, intraarticular local anaesthesia, bupivacaine, postoperative analgesia

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Objective: The research was conducted to investigate the opinions of nurses and physicians pertaining to euthanasia who are working at Internal Medicine, Surgery and Intensive Care Unit departments at Baskent University Ankara hospital.
Methods: The research is a descriptive one. The sample consisted of 154 nurses and physicians who are working at Internal Medicine, Surgery and Intensive Care Unit departments at Baskent University Ankara hospital and accepted to participate and could be reached. A questionnaire with 30 items was used to collect data to obtain the socio-demographic characteristics and the opinions pertaining to euthanasia of nurses and physicians. Frequencies, mean values and chi-square tests were used in statistical analysis.
Results: The participants didn’t approve euthanasia with a high ratio however it was determined that almost half of them asserted it as patient’s rights of a patient who want his/her death to be fastened and who has no chance to be cured and who are spending the last days of their life with unbearable pain. Except the age groups and marital status there was no significant difference found statistically between the opinions of physicians and nurses regarding euthanasia (p>0.05).
Conclusion: It was stated that nurses and physicians consider not active euthanasia but passive euthanasia as acceptable.

Keywords: Euthanasia, nurses, physicians, opinion

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Objectives: In present study was aimed to investigate the seroprevalences of hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) among healthcare workers in Mardin Obstetric and Children Hospital between 2008 and 2009.
Methods: In sera samples obtained from 180 healthcare workers, hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs), HCV antibody (anti-HCV) and HIV antibody (anti-HIV) markers were tested by chemiluminescent immunoassay with Advia Centaur (Siemens) autoanalyser.
Results: We found HBsAg positive and anti-HBs negative in 2 healthcare workers (1.1%); HBsAg negative and anti-HBs positive in 123 healthcare workers (68.3%); HBsAg negative and anti-HBs negative in 55 healthcare workers (30.6%); 2 healthcare workers (1.1%) anti-HCV antibody positive in 115 (63.3%) girls and 65 (36.7%) boys on the way total 180 healthcare workers. None of these patients found HIV antibody. It was also seen that 107 (59.4%) healthcare workers had anti-HBs positivity due to vaccination and 16 (8.9%) healthcare workers without vaccination. As the HBsAg positivity rate was detected expected low, anti-HBs positivity rate was detected expected high.
Conclusion: As a result, healthcare workers are not at risk more than normal population for hepatitis B and C in our hospital. However, standard infection control programs and immunization should be applied for the protection of both patients and healthcare workers.

Keywords: HBV, HCV, HIV, seroprevalence, healthcare workers, hospital

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Objectives: The aim of this study was to evaluate the results of the patients who underwent cervical cerclage placement and the contribution of this intervention to the maintenance of pregnancy.
Methods: Data of 29 patients who underwent cervical cerclage placement due to cervical insufficiency in Ataturk University Medical Faculty Obstetrics and Gynecology Department Between January 2002 and April 2007 were retrospectively analyzed.
The patient’s age, gestational week, history of abortion, history of previous cervical cerclage, preoperative measurement of cervical length, types of cerclage and delivery weeks were recorded and analysed.
Results: The patient’s ages were between 24 and 43 years. Weeks of gestation were between 12 weeks 2 days and 26 weeks and 1 day. Nineteen patient’s cervical lengths were less than 20 mm by transvaginal ultrasonography. Eight of patients had funneling sign by transvaginal ultrasonography. Sixteen patients treated with prophylactic cervical cerclage, thirteen women treated with therapeutical cerclage. The cervical lengths of twenty one patients were over 20 mm after the procedure. Five patients reached term.
Conclusion: The patient who has risk for cervical insufficiency should be followed with serial ultrasound examination and cervical cerclage should be performed when needed. The prophylactic cerclaje process is still best choice for patients with the history of two or more painless 2nd trimester or early 3rd trimester abortion that typical for cervical incompetence.

Keywords: Preterm labor, cervical cerclage, cervical insufficiency

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Objectives: The aim of this study was to evaluate the left ventricular functions with transthoracic echocardiography after coronary bypass surgery.
Methods: Sixty-four patients who underwent coronary bypass surgery between January 2008 and March 2009 were retrospectively evaluated. The diagnosis, age and gender of the patients, presence of diabetes mellitus and/or hypertension, smoking, and left ventricle functions before and after surgery were recorded.
Results: The mean age of the patients was 58 ± 6,2 years. Forty-four of 64 patients were male, and 20 were female. The lowest ejection fraction was measured in two patients as 30% preoperatively. The mean preoperative and postoperative left ventricle ejection fractions were 48 ± 5.4% and 58 ± 2.4% respectively. This difference was found statistically significant. The mortality rate of by-pass surgery was 4.68% (3 patients).
Conclusion: The left ventricular functions were significantly recovered after coronary by-pass surgery.

Keywords: Coronary by-pass, left ventricle function, transthoracic echocardiography

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Varicella is one of the most contagious diseases of childhood. Whenever varicella is seen in adults, it can cause serious complications. Pneumonia is one of the most serious complications of varicella during adulthood and it has a high mortality rate. Cases of varicella pneumonia which need mechanical ventilation in intensive care unit, have %50 of mortality rate.
This report presents a patient who was diagnosed as varicella pneumonia in our intensive care unit. Our treatment and diagnostic approach is presented together with actual literature.

Keywords: varicella pneumonia, critical care, respiratory failure

ABSTRACT

Septum is the most important anatomical and functional structure of nose. Thus, any kind of damage to septum can cause serious structural deformity of nose. Although nasal trauma at childhood hood is seen frequently, septal heamatoma and abscess formation is very rare. Septal heamatoma and abscess cause serious nasal and systemic complications in children. We presented a 6 years-old boy with the complaining of difficulty in nasal breathing and diagnosed as septal abscess five days after a nasal trauma.

Keywords: Nasal trauma, septal heamatoma, septal abscess, complication

ABSTRACT

Lidocaine can be seen systemic intoxication, central nervous system (CNS) and cardiovascular toxicities, due to its common usage and broad safety margin.
Lidocaine overdose has been reported with convulsion, cardiac collapse and coma. In present case, a patient underwent surgical excision of wrist mass who erroneously received 1200 mg 10% lidocaine instead of 225 mg 2% dose. Interestingly, the case shows only some mild CNS side effects without any serious adverse effect.

Keywords: Lidocaine, intoxication, intravenous, regional anesthesia, side effect

ABSTRACT

Musculoskeletal tuberculosis (MT) occurs in 1–3% of patients with tuberculosis, while MT of the chest wall constitutes 1% to 5% of all cases of musculoskeletal MT. They are most frequently found at the margins of the sternum and along the rib shafts. Computed tomography is a useful tool for investigation in the diagnosis of abscess and in determining the extent of an abscess. Antituberculous chemotherapy and surgical excision should be started immediately after the appropriate microbiological and histological samples have been obtained if the clinical suspicion is high. We presented our experience with a 49-year-old woman who had musculoskeletal tuberculosis at the anterior chest wall together with a review of the literature on this subject.

Keywords: Anterior chest wall, tuberculosis, diagnosis, treatment

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Thrombophilia is defined as the general name for a group of genetic and acquired situations, arising from defects of hemostasis mechanism and generating tendency to thrombosis. Examples of the acquired risk factors that increase the tendency to thrombosis are venous catheters, sepsis, surgery, hyperlipidemia, congestive heart disease, increased lipoprotein a, old age, antiphospholipid syndrome, nephrotic syndrome, hyperviscosity, chronic myeloproliferative neoplasms, paroxysmal nocturnal hemoglobinuria, heparin induced thrombocytopenia, vasculitis, immobility, obesity, major surgery, trauma, burns, malignancy, pregnancy and oral contraceptive usage. Genetic tendency to venous thromboembolism in early ages, even without any known cause, is named as thrombophilia. Factor V Leiden, prothrombin G20210A, methylenetetrahydrofolate reductase gene mutations, factor VIII elevation, protein C, protein S and antithrombin deficiency parameters are suggested for evaluation, in patient groups suspected of inherited thrombophilia. Detection of inherited thrombophilic factors in selected patient groups is a guide in developing treatment strategies and in establishing prognosis. Due to the genetic heterogeneities, each society should determine their thrombophilic risk pool. Thus, with the determination of the risk factors, unnecessary assessments will be prevented and a cost-effective approach can be developed.

Keywords: Thrombophilia, venous thromboembolism, Factor V Leiden gene mutation; Prothrombin G20210A gene mutation

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Abdominal adhesions following abdominopelvic surgical interventions are well-known causes of increased morbidity and mortality at early and late postoperative period. It is suggested that intraabdominal adhesions are thought to be developed secondary to peritoneal or bowel serosal surface trauma, foreign body reaction and ischemia. In present study, development and clinical importance of postoperative peritoneal adhesions are discussed together with literature knowledge.

Keywords: Postoperative, peritoneal adhesions, pathogenesis, prevention

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Keywords: JAK2V617F mutation, BCR/ABL translocation, miyeloproliferative disorders, myelofibrosis

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Keywords: Herpes zoster, ophtalmic, oculomotor nerve, palsy