Growth pattern in children with beta-thalassemia major and its relation with serum ferritin, IGF1 and IGFBP3
Mona Ramadan Nasr, Nermin Ali Ebrahim, Omnia Salahedin
J Clin Exp Invest 2012;3(2):157-163.
https://doi.org/10.5799/ahinjs.01.2012.02.0135
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Objectives: Growth impairment in children with Beta-thalassemia major (BTM) has several possible etiologies including excess iron overload and endocrinologic abnormalities. We aimed to assess growth in children with BTM and its relation with serum ferritin, thyroid hormones, IGF1 and IGFBP3.
Materials and methods: Thirty-three children with BTM and 30 healthy children (control group) matched in age, sex and height were subjected to full clinical history and examination, including anthropometric measurements. Fasting blood samples from both groups were taken for complete blood counts, fasting blood sugar, liver function tests, serum ferritin, thyroid profiles, IGF1 and IGFBP3. Bone ages for both groups were determined radiologically.
Results: A total of 57.6% of BTM group had retarded linear growth and 45.5% of them were with delayed puberty. There was statistical significant decrease in upper/lower segment (U/L) ratio in the BTM group compared to the control group (p=0.035). No apparent hypothyroidism was found in the thalassemia group, but significant decreases were found in both IGF1 and IGFBP3 levels of the thalassemia group compared with the control group (p=0.022 and p=0.037, respectively). There was a significant correlation between T4 and U/L ratio (p<0.05); IGF1 was significantly correlated with height, duration of transfusions and duration of chelation (p<0.05). No significant correlation was found between serum ferritin and other variables of the patients.
Conclusions: Growth retardation in children with BTM is evident despite regular transfusions and chelation therapy, especially in children with older age and the cause is mainly in growth hormone-IGF1 and IGFBP3 axis.
Keywords: Beta-thalassemia major, children, growth, thyroid profile, IGF1, IGFBP3, ferritin
Effects of intravenous anesthetic agents on vascular endothelium
Alp Gurbet, Fatma Nur Kaya, Alper Bayraktar, İlkin Çavuşoğlu, Serap Şirvancı, Berin Özcan
J Clin Exp Invest 2012;3(2):164-167.
https://doi.org/10.5799/ahinjs.01.2012.02.0136
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Objectives: The objective of this study was to compare the effects of Propofol 1%, Propofol 2%, Ketamine, Pentothal, Etomidate and Etomidate-lipuro on venous endothelium.
Materials and methods: The study was done from August 2007 to May 2008 after approval of Faculty’s Ethic Committee. Forty rabbits were obtained. Propofol 1% (n=6), Propofol 2% (n=6), Ketamin (n=6), Penthotal (n=6), Etomidate (n=6), Etomidate lipuro (n=6) and normal saline (Control Group, n=4) was given 1 cc via external jugular vein. After 5 minutes from the injenction 6 species 2 mm in length segments were taken from the injencted veins. Species were fixed in 4˚C gluteraldehyde than postfixed in 4°C osmium tetroxide. Visualisation was performed with scanning electron microscope.
Results: In Propofol 1 %, Propofol 2% and Penthotal groups normal endothelial structures were observed. In Etomidate group damage of the endothelial cells were observed significantly compared with control. In Etomidate lipuro group minimal deformation was observed compared to control.
Conclusion: Etomidat causes significant endothelial deformation, moreover lipuro minimalises these effects. In order to need to use etomidate for general anesthesia, for less pain during injection depending on vascular injury lipuro form would be more appropriate. However, further study is required.
Keywords: Propofol, ketamine, etomidate, pentothal, etomidate lipuro, vascular damage
The Success of Cardiotocography in predicting Perinatal Outcome
Alpaslan Kaban, Hüseyin Cengiz, Işık Kaban, Alim Özcan, Sema Karakaş
J Clin Exp Invest 2012;3(2):168-171.
https://doi.org/10.5799/ahinjs.01.2012.02.0137
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Objectives: The determination of the fetal condition during labor is important to minimize fetal death due to asphyxia and the neurological sequelae of fetal hypoxia. This study evaluated the success of fetal cardiotocography in predicting perinatal consequences.
Materials and methods: This study enrolled 101 full-term pregnant women admitted for delivery to Vakif Gureba Training and Research Hospital between October 2009 and February 2010. Women were included if they were aged 18-45 years and within 36-41 weeks of gestation. During a 20-min period of fetal monitoring, a change in FHR (fetal heart rate) lasting for 15 s or two elevated runs of 15 beats was evaluated as a reactive NST (non-stress test). The umbilical artery pH was used as the “gold standard” for assessing fetal asphyxia.
Results: The mean age of the women included in the study was 27.82 ± 5.29 years, the average parity was1.09 ± 0.96. The pH was normal in 85 neonates, while 13 had fetal asphyxia. No significant difference in umbilical cord blood pH, pO2, or pCO2 was observed between these two groups (p = 0.497, p = 0.722, and p = 0.053, respectively. No significant difference in maternal age, parity, or birth weight was found between the group with fetal distress based on CTG (cardiotocography) and the normal group.
Conclusion: Cardiotocography is an important test during labor for labor management, it is insufficient for predicting the perinatal outcome. Therefore, labor should be evaluated on an individualized basis.
Keywords: Apgar score, blood gas analysis, caesarean section, cardiotocography
The effectiveness of treatment with enoxaparin in lichen planus
Derya Uçmak, Gökçen Balcı, Mehmet Harman
J Clin Exp Invest 2012;3(2):172-173.
https://doi.org/10.5799/ahinjs.01.2012.02.0138
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Objectives: As it is known, the low doses of Heparin’s analogues have the antiproliferative and immunomodulator activities. This research aims to evaluate the activity of enoxaparin by using the low doses.
Materials and methods: 21 patients with lichen planus diagnosis have been cured within 12 weeks. 3 mg of enoxaparin has been used for subcutaneus injection to all of patients weekly. The efficient and reliable data has been saved.
Results: The perfect recovery has been observed 15 (71%) of 21 patients, the distinct recovery has been observed 4 (19%) of 21 patients. The treatment has not given response on 2 (9%) of 21 patients. The best score has been received on acute generalized type of Lichen Planus.
Conclusions: As the result; it has been reported that enoxaparin treatment can be an effective choice in Lichen Planus medication.
Keywords: Lichen planus, enoxaparin, treatment
Relationship between Oxidative Stress Markers and Cardiac Syndrome X
Durmuş Yıldıray Şahin, Zafer Elbasan, Mustafa Gür, Caner Türkoğlu, Betül Özaltun, Zehra Sümbül, Murat Çaylı
J Clin Exp Invest 2012;3(2):174-180.
https://doi.org/10.5799/ahinjs.01.2012.02.0139
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Objectives: To investigate the alterations of oxidative and antioxidative status in patients with cardiac syndrome X (CSX).
Materials and methods: Thirty-three patients with CSX (CSX group), 27 patients without CSX (NSX) and 20 healthy volunteers as control group were included into the study. Oxidative status of serum was evaluated by measuring total oxidant status (TOS), lipid hydroperoxide levels (LOOH) and oxidative stress index (OSI) of serum, and antioxidative status of serum was evaluated by measuring total antioxidant capacity (TAC). Also, hsCRP and other biochemical markers were measured in all subjects.
Results: The oxidants (TOS, LOOH and OSI) and CRP levels were higher, and TAC was lower in the patients with CSX than NSX group and control group. Also, the oxidants (TOS, LOOH and OSI) and hsCRP levels, a marker of chronic inflammation, were higher, and TAC was lower in the patients with NSX than control group. In addition, in patients with CSX, a significant positive correlation (ß =0.606, p<0.001) was found between the OSI level and ST depression.
Conclusion: Oxidants increased and antioxidants decreased, namely oxidative/antioxidative balance shifted to oxidative stress in patients with CSX. Thus, oxidative stress may have a role in the etiopathogenesis of the disease.
Keywords: Oxidative stress, oxidant, antioxidant, cardiac syndrome X
Inappropriate requests of viral hepatitis serologic tests
Harun Ağca
J Clin Exp Invest 2012;3(2):181-184.
https://doi.org/10.5799/ahinjs.01.2012.02.0140
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Objectives: Inappropriate end excessive requests of laboratory tests are labor intensive and a vast burden of cost. Diagnostic algorithms are advised to prevent inappropriate and excessive usage of tests. In this study it was aimed to determine inappropriate test ordering rates and cost.
Materials and methods: To assess the number of inappropriate test orders, laboratory records of samples sent for hepatitis A and B viral serologic tests were evaluated retrospectively with respect to diagnostic algorithms. Orders including serological marker groups without adequate clinical information whether or not the order was inappropriate was excluded from the study.
Results: According to the diagnostic algorithms 1.452 anti-HAV IgM tests, 1.452 anti-HAV total tests, 208 anti-HBs tests, 208 anti-HBc total tests, 1.210 anti-HBc IgM tests, 1.358 HBeAg tests and 1.216 anti-HBe tests are inappropriate requests. Total cost of these tests is calculated as 56.153 TL.
Conclusion: This study shows that a significant amount of hepatitis serologic tests are inappropriate requests. Diagnostic algorithms for hepatitis should be used more commonly to decrease the amount of inappropriate requests result in significant workload and cost.
Keywords: Hepatitis, serologic test, algorithms
First trimester serum PAPP-A levels and the prediction of small-for-gestational age infants
Nilgün Güdücü, Gökçenur Gönenç, Herman İşçi, Alin Başgül Yiğiter, İlkkan Dünder
J Clin Exp Invest 2012;3(2):185-188.
https://doi.org/10.5799/ahinjs.01.2012.02.0141
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Objectives: The aim of this study was to detect the predictive value of PAPP-A in small-for-gestational age (SGA) infants.
Materials and methods: We retrospectively searched the patient charts of our hospital for first trimester Down syndrome screening test results. PAPP-A levels less than 5th percentile were considered as predictive of SGA infants.
Results: Low PAPP-A levels were associated with SGA infants, sensitivity was 3,5%, specificity 90%, positive predictive value 1,6% and negative predictive value 95%.
Conclusions: The low positive predictive value of PAPP-A prevents it from being used as a screening test for the detection of SGA infants.
Keywords: Small for gestational age, PAPP-A, pregnancy
Diagnostic value of mycobacteriophage based fast plaque technique for early detection of pulmonary tuberculosis
Servet Kayhan
J Clin Exp Invest 2012;3(2):189-193.
https://doi.org/10.5799/ahinjs.01.2012.02.0142
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Objectives: The aim of this study was to evaluate diagnostic performance of FASTPlaqueTBTM (FPTB) test and to compare with mycobacterial Löwenstein-Jensen (LJ) culture and smear test.
Materials and methods: Respiratory samples were obtained from 60 patients with suspected tuberculosis and 20 control patients who had any diagnosis other than tuberculosis. One sample of case with suspected tuberculosis was excluded from the study due to contamination. All specimens were examined by smear, LJ culture and fast plaque test for Mycobacterium tuberculosis.
Results: A total of 54 specimens of 59 patients with clinically and radiologic tuberculosis grew on LJ media and all the isolates were M. tuberculosis complex. M. tuberculosis was isolated by LJ culture from 42 smear-positive and 12 smear-negative specimens. Smear and LJ culture negative five cases were diagnosed as tuberculosis with clinical and radiologic findings. Fast plaque method determined M. tuberculosis in 36 (61%) specimens of 59 cases with tuberculosis. The sensitivity, specificity, positive predictive value, negative predictive value and efficiency of prediction were calculated as 61%, 100%, 100%, 46% and 0,70 respectively in all cases. We found the performance of fast plaque test with a high (73,8%) sensitivity in smear-positive cases and low sensitivity (29,4%) in smear-negatives.
Conclusion: Fast plaque assay is not a preferable diagnostic test to LJ culture or smear in M. Tuberculosis and It may be used for a rapid detection of pulmonary tuberculosis.
Keywords: Mycobacteriophage, Mycobacterium tuberculosis, diagnostic test, pulmonary tuberculosis
Neonatal asphyxia: A study of 210 cases
Hülya Üzel, Selvi Kelekçi, Celal Devecioğlu, Ali Güneş, İlyas Yolbaş, Velat Şen
J Clin Exp Invest 2012;3(2):194-198.
https://doi.org/10.5799/ahinjs.01.2012.02.0143
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Objectives: Perinatal asphyxia remains an important cause of neonatal morbidity and mortality. The aim of this study was to investigate antenatal, natal, and postnatal risk factors of neonatal asphyxia, relationship with known risk factors and stage of Sarnat and Sarnat scores, the effect of risk factors on hospital discharge and survival for neonates with perinatal asphyxia.
Materials and methods: In this study, we retrospectively analyzed the hospital records of 210 patients diagnosed as perinatal asphyxia. The patients' demographic characteristics, antepartum, intrapartum, and postpartum risk factors and Sarnat and Sarnat clinical staging criteria of newborns were analyzed.
Results: The risk factors for asphyxia were detected antepartum period in 67.7% of newborns, intrapartum in 91% and potpartum in of 29.5% of neonates. When cases were examined according to the studied years, perinatal asphyxia ratio was the most frequent in 2007 as 28.1%. With a decline over the years, frequency dropped to %21 in 2010. The number of patients with stage 3 and mortality rate were significantly decreased over the years (p <0.05).
Conclusions: Less preventable intrapartum causes of birth asphyxia are seen more frequently. Early detection of risk factors together with appropriate prenatal, natal and postnatal care provision, reduced emergency caesarean sections and will decrease considerably decrease frequency of perinatal asphyxia. We think that following up neonates who needed intensive care in neonatal units sufficiently equipped will decrease complications due to asphyxia.
Keywords: Asphyxia, newborn, risk factors, prognosis
Cardiovascular findings of children with Marfan syndrome
Osman Yılmaz, Meki Bilici, Özben Ceylan, Selmin Karademir, Utku Arman Örün, Senem Özgür, Mahmut Keskin, Filiz Şenocak
J Clin Exp Invest 2012;3(2):199-201.
https://doi.org/10.5799/ahinjs.01.2012.02.0144
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Objectives: The aim of our study is to investigate the frequency of structural heart diseases in patients with Marfan syndrome (MS) and to reveal the importance of clinical follow-up in MS.
Materials and methods: Study population consisted of 17 patients admitted to the Pediatric Cardiology department between January 2005 and March 2010 with the diagnosis of MS according to the Ghent criteria. Patients were evaluated for the eye, genetic and the cardiovascular system abnormalities. Physical examination findings, echocardiographic, and radiological examinations of the patients were evaluated retrospectively.
Results: Of the 17 cases, 9 were girls and 8 were males, ages ranged from 1 month to 17 years (mean 9.7 years). There was a second degree of kinship between mothers and fathers in 5 patients. Respiratory distress, syncope, chest pain and palpitation were the most seen in the presentation complaint of the patients. Skeletal findings observed in 13 patients, 4 patients had subluxation of the lens. Two patients had positive family history. When cardiovascular findings were examined, there were aortic root dilatation with mitral valve prolapse and/or tricuspid valve prolapse in 8 patients, mitral valve prolapse in 3 patients only aortic root dilatation in 3 patients and mitral valve prolapse and tricuspid valve prolapse in 3 patients. Mean follow-up period was 2.6 years, aneurysm and rupture of the aorta wasn’t observed during this period.
Conclusion: In patients with Marfan syndrome, regular follow-up and cardiological evaluation should be done because significant structural heart diseases can be seen in these patients.
Keywords: Marfan syndrome, aortic root dilatation, mitral valve prolapse
Comparison of preemptive intravenous paracetamol and caudal block in terms of analgesic and hemodynamic parameters in children
Serbülent Gökhan Beyaz
J Clin Exp Invest 2012;3(2):202-208.
https://doi.org/10.5799/ahinjs.01.2012.02.0145
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Objectives: Paracetamol has a widespread use for fever and symptomatic relief of pain in children. The aim of this study was to compare analgesic effects of preemptive intravenous (i.v.) paracetamol, and caudal block with levobupivacaine.
Materials and methods: A total of 60 children with ASA I-II physical status, aged 5-15 years and undergoing inguinal hernia repair, were randomly allocated to three groups so that each group contained 20 patients. Group P children received i.v. 15mg/kg paracetamol. Group C received only caudal block with levobupivacaine, and Group PC received both i.v. paracetamol, and caudal block with levobupivacaine. Pain level assessed by modified Eastern Ontario Children’s Hospital pain scale (mCHEOPs), sedation status by Ramsey sedation scale at postoperative 5, 15, 30 min and 1,3, and 6th hours.
Results: No significant differences were found in age, gender distribution, body weight, ASA status, type and duration of surgery between three groups (p>0.05). Although significant difference were found in mCHEOPs scores within groups by repeated measures, no difference of pain scores was observed between three groups (p>0.05). There were no significant differences in the hemodynamic parameters (heart rate, blood pressure) both within groups and between groups (p>0.05).
Conclusions: Preemptive intravenous paracetamol had similar analgesic effects compared with caudal block with levobupivacaine with regard to postoperative pain scores in children undergoing inguinal hernia repair. No hemodynamic or other adverse effects were observed with intravenous paracetamol.
Keywords: Intravenous paracetamol, caudal block, preemptive analgesia, children, inguinal hernia repair
Retrospective Analysis of the patients with gynecological cancer: 11-Year Experience
Abdulkadir Turgut, Ali Özler, Muhammet Erdal Sak, Mehmet Sıddık Evsen, Hatice Ender Soydinç, Serdar Başaranoğlu
J Clin Exp Invest 2012;3(2):209-213.
https://doi.org/10.5799/ahinjs.01.2012.02.0146
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Objectives: We planned this study with the aim of obtaining knowledge about epidemiological characteristics of gynecological malignancies followed up in our hospital.
Materials and methods: In our study we analyzed 231 patients that were operated with the appraisal diagnosis of gynecological cancer in Gynecology and Obstetrics Department of Dicle University Medical Faculty between the dates of 2001, January and 2011, November.
Results: The mostly diagnosed gynecological malignancy was ovarian cancers among the gynecological cancers seen in the first group compassing the period between the year 2001 and the first half-term of the year 2006. In the second group compassing the period from the second half-term of the year 2006 to the end of the year 2011, ovarian cancers were again the most frequently seen gynecological cancers. On the other hand it was found that there was an increase in the percentage of endometrial cancers. While cases with advanced staged constituting the major part of the patients with ovarian cancer, it was seen that the majority of the patients with endometrium cancer were consisting of stage 1 cases. In the 4 of 6 cases having endometrium cancer and applying with the complaint of pain, the disease was noticed in the advanced stage. Being the most frequently seen gynecological cancer all over the world and especially in the societies with lower socio-economic status, the cervix cancer was taking place in the 3rd order after endometrium cancer in terms of frequency in our region.
Conclusion: Consequently, in the recent years the gynecological cancer showing the most frequent increase was endometrium cancer in our region. The increase in the frequency of obesity, relating with the reasons like the improper nutrition behavior, the increase in the socio-economic status, may be associated with the increase in the frequency of endometrium cancer. The healthcare personals and the public body must be instructed to diagnose the gynecological cancer cases especially the ones having ovarian cancer in the early stage.
Keywords: Ovarian cancer, uterine cancer, cervical cancer, cancer epidemiology
The relationship between the frequency of cervical metastases and tumor related factors in laryngeal cancer and outcome of surgical treatment in these cases
Engin Şengül, Tekin Bağlam, Cengiz Çevik, Cemile Arıkan Şengül, Ferit Kara, Zeynel Abidin Karataş, Muzaffer Kanlıkama
J Clin Exp Invest 2012;3(2):214-222.
https://doi.org/10.5799/ahinjs.01.2012.02.0147
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Objectives: We aimed to assess the associations between localization, size, stage and histopathological differentiation of primary tumor in larynx and neck metastases and the impact of disease stage on survival.
Materials and methods: We analyzed the medical records of 333 laryngeal cancer patients who underwent total or partial laryngectomy as primary treatment, combined with neck dissection and/or postoperative radiotheraphy if required, between 2000 and 2010 years at our clinic. Age and gender of patients, tumor localization, size, stage and histopathological differentiation of tumor; presence of preoperative positive lymph nodes, performed operations, operation findings and histopathological results were analysed retrospectively.
Results: Tumor localizations were glottic in 172 (51.6%) cases, supraglottic in 108 (32.4%), and transglottic 53 (15.9%) of the the cases. In glottic cancers; cervical metastases were observed in 18.6% of the patients, whereas occult metastases in 11%. In supraglottic cancers; cervical metastasis rate was 45.3% and occult metastases rate was 24%. In transglottic cancers, cervical metastases rate was 49% and occult metastases was 22.6%. Postoperative recurrence was 41 (12.3%). Postoperative radiotherapy was recommended to 111 of 333 patients. The overall survival rate was 75.4% at 50th month and the cumulative survival rate was 68.9%.
Conclusion: In conclusion, although there is controversy regarding the optimal treatment in the N0 larynx cancers, in case of a high risk for occult metastases, elective unilateral or bilateral neck dissection should be performed according to the anatomic localization of the tumor. In addition, survival rate decreased significantly with the increasing tumor stage.
Keywords: Larynx cancer, localization, stage, cervical lymph node metastases, survival
Comparing the results of VATS pleurectomy and talc pleurodesis with small sized catheter in randomised patients with malign pleural effusion
Fatih Meteroğlu, Bülent Tunçözgür
J Clin Exp Invest 2012;3(2):223-228.
https://doi.org/10.5799/ahinjs.01.2012.02.0148
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Objectives: Pleural effusion occurs as a result of detoriation in equilibrium between absorption and secretion. We aimed to investigate the clinical responses of talk pleurodesis and pleurectomy with video assisted thoracoscopic surgery (VATS) in patients with malignant pleural effusion.
Materials and methods: Forty-five patients with malignant pleural effusion between June 2007 and June 2008 were included in this study. Thoracentesis was performed in order to study the biochemical, microbiologic, cytological analysis. Glucose, total protein, albumin, lactic dehydrogenases and cytological examination were studied in effusion and blood sample simultaneously. Cases were classified into two groups; in group I (n=25), small calibrated catheter and talk pleurodesis were performed. In group II (n=20), VATS pleurectomy was performed.
Results: There were 32 females and 13 males with mean age 51.58 (27-75) years. Diagnosis was made with cytologic examination of pleural fluid that was aspirated with thoracentesis. Transudate- exudate discrimination was done according to Light’s criteria. Success rates of the groups were as complete response; 84% (n=21) in group I, 85% (n=17) in group II. Unsuccessful response was 16% (n=4) in group I and 15% (n=3) in group II. There was no statistically significant difference between hospital stay and tube duration of groups when compared to each other.
Conclusion: The treatment of malignant pleural effusion is palliative due to poor prognosis. The purpose is to eliminate dyspnea in patients with short survival time. There was no significant difference between the VATS pleurectomy and talc pleurodesis that has been known as effective sclerosant agent.
Keywords: Talc, thoracoscopy, pleurodesis, outcome
Relationship among Gensini score and levels of glucose and adiponectin in patients with stable angina pectoris
Ferhat Özyurtlu, Özgül Yıldız, Erkan Ayhan, Turgay Işık, Halit Acet, Zihni Bilik, Uğur Kemal Tezcan
J Clin Exp Invest 2012;3(2):229-234.
https://doi.org/10.5799/ahinjs.01.2012.02.0149
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Objectives: Adiponectin is an adipocyte-secreted protein that modulates insulin sensitivity and whose low circulating concentration is associated with insulin resistance. We evaluated the association between serum adiponectin and blood glucose levels with coronary artery disease severity on the angiogram in patients with stable angina pectoris.
Materials and methods: The study included 160 patients (82 males) with stable angina pectoris. The patients were divided into three groups according to the blood glucose levels on admission; thus, 24 had normal glucose group, 53 had impaired glucose tolerance group, and 53 had diabetes mellitus (DM) group. The severity of coronary lesions was assessed using the Gensini score. Serum adiponectin levels were measured in the all group.
Results: The hypertension, hyperlipidemia, obesity, and insulin resistance were significantly higher in the DM group. Patients with DM significantly lower serum levels of adiponectin (13.55±7.16, p=0.002). The mean Gensini score was 40.84± 37.25 in the DM group (p=0.006).
Conclusion: Serum adiponectin levels may be a clue for severity coronary artery disease in patients with stable angina pectoris.
Keywords: Adiponectin, diabetes mellitus, coronary angiography, insulin resistance, stable angina pectoris
Comparison of plasma homocysteine levels in patients with type 2 diabetes mellitus with normal subjects
İsmail Erşan, Banu Turgut Öztürk, Ümit Kamış, Ahmet Özkağnıcı, Kemal Gündüz
J Clin Exp Invest 2012;3(2):235-239.
https://doi.org/10.5799/ahinjs.01.2012.02.0150
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Objectives: To compare the plasma homocysteine levels between control group and diabetic patients with no diabetic retinopathy, with preproliferative diabetic retinopathy, with proliferative diabetic retinopathy.
Materials and methods: Plasma homocysteine levels of 23 diabetic patients were measured and were compared with 25 age-matched controls with no systemic problem and no ocular disease. Plasma homocysteine levels were measured using high-performance liquid chromatography.
Results: Diabetic patients were divided into three groups according to their ophthalmological findings. There were 8 patients with no diabetic retinopathy, 8 patients with preproliferative diabetic retinopathy, 7 patients with proliferative diabetic retinopathy. Plasma homocysteine levels were higher in diabetic patients (13.30±4.03 µmol/L) compared to the control group (11.71±3.41 µmol/L) but no statistically significant difference was found between the two groups (p>0.05). Plasma homocysteine levels were measured 12.50±3.73 µmol/L in no diabetic retinopathy group, 12.90±2.59 µmol/L in preproliferative diabetic retinopathy group, 14.64±5.69 µmol/L in proliferative diabetic retinopathy group. In diabetic group, plasma homocysteine levels increased with the increase of the severity of retinopathy but not reached statistically significance (p>0.05).
Conclusion: Although no statistically significance was found, retinopathy progresses with the increase of plasma homocysteine levels. This can be used for the follow-up of the diabetic patients but further evaluation in large groups is needed.
Keywords: Homocysteine, diabetes mellitus, diabetic retinopathy
Isolation frequency of Mycobacterium tuberculosis in tertiary reference hospital and their susceptibility patterns against four major anti-tuberculosis drugs
Meral Saygun, Sedef Göçmen, Aytül Çakmak, Aydanur Ekici, Altan Aksoy, Tevfik Pınar, Teoman Apan, Latife İşeri Abut
J Clin Exp Invest 2012;3(2):240-244.
https://doi.org/10.5799/ahinjs.01.2012.02.0151
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Objectives: As soon as possible to detection of tuberculosis bacilli and to determination of their anti-tuberculosis drug susceptibilities are very important for an optimal anti-tuberculosis therapy. Therefore, two different culture methods in suspected patient samples were performed. The results of anti-tuberculosis drug susceptibility testing of culture positive samples were examined.
Materials and methods: Following the homogenization and decontamination processes, patient’s samples were stained with Ziehl-Neelsen dye and each preparation were inoculated separately onto Lowenstein-Jensen (LJ) and into Mycobacterium Growth Indicator Tube (MGIT) media. After incubation period, drug susceptibilities of bacillus in culture positive samples against four major anti-tuberculosis drugs were investigated.
Results: The samples obtained from 163 different patients between 2007 and 2010 years were evaluated. In all samples, it was determined that positivity of Acid Resistant Bacillus (ARB), MGIT and LJ media were 7 (4.0%), 6 (3.5%) and 7 (4.0%), respectively. MGIT method was demonstrated significantly earlier growth than LJ method the tuberculosis bacillus. All isolates were found to be sensitive to four major anti-tuberculosis drugs.
Conclusion: In our study, MGIT method was found to be superior to LJ media because of its quick result and drug resistance was not determined in all isolates.
Keywords: Tuberculosis, culture techniques, drug resistance
Visual and hearing disabilities and epilepsy frequency in children with cerebral palsy
Bahadır Konuşkan, Hüseyin Per, Hakan Gümüş, Sefer Kumandaş
J Clin Exp Invest 2012;3(2):245-249.
https://doi.org/10.5799/ahinjs.01.2012.02.0152
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Objectives: The aim of this study was to evaluate visual and hearing disabilities and epilepsy frequency in children with cerebral palsy.
Materials and methods: The medical records of patients who were followed up with the diagnosis of cerebral palsy in Child Neurology Department were examined retrospectively.
Results: In this study, Totally 460 patients of which 63.3% male and 36.7% female were included. Male/female ratio was 1.7 and 60% of the patients were mature and 40% of them were premature. The distribution of the cases according to clinical description was as follows: 39.7% spastic quadriplegia, 28.7% spastic diplegia, 18.2% spastic hemiplegia, 7% choreoathetoid cerebral palsy, 3.5% mixed type cerebral palsy, 1.1% hypotonic cerebral palsy, 0.9% monoparesis, 0.4% dystonic cerebral palsy and 0.4% ataxic cerebral palsy. Disorderss coexisting with cerebral palsy were epilepsy in 54.3%, strabismus in 38.5%, and hearing loss in 22% of patients.
Conclusion: Although cerebral palsy is known as a disease with motor disability, brain pathology frequently causes hearing and visual disturbances and epilepsy. Early diagnosis and treatment of these accompanying disabilities will affect positively quality of life of these patients.
Keywords: Cerebral palsy, visual disability, hearing disability, epilepsy
The respiratory functions and radiologic findings of the marble factory workers
Cengizhan sezgi, Özlem Abakay, Hakan Önder, Hadice selimoğlu Şen, Abdurrahman Abakay, Halide Kaya, Mustafa Ayhan, Abdullah Çetin Tanrıkulu
J Clin Exp Invest 2012;3(2):250-254.
https://doi.org/10.5799/ahinjs.01.2012.02.0153
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ABSTRACT
Objectives: The aim of this study is to investigate the probable effect of exposure to marble dust on respiratory symptoms, respiratory function tests and chest radiographies.
Materials and methods: Totally 110 marble workers were enrolled as study group. Marble workers were divided into 4 groups according to work places: block cutting line (Group A, n=25), polishing unit (Group B, n=33), tile cutting unit (Group C, n=31), and office workers (n=21). Control group (Group E, n=30) consisted of similar demographical characteristics without dust exposure. Dust concentrations of all groups working environments were measured. The patients administered the questionnaire, and examination findings and respiratory function test results were recorded. Chest graphies were obtained.
Results: All of factory workers were male and mean age was 33,4±6,3 years. There was no difference between groups in mean age and cigarette consumption. Dust concentrations were similar in the first three groups, but it was lower in the office. In first three groups, cough and sputum frequencies were more than office group. Regarding the respiratory function test results, no significant difference was detected between the FEV1, FVC and FEV1/FVC values. But lower values in first three groups than control group according to FEV1, FEV1/FVC and FEF25-75 were detected. Although statistically not different, more abnormal chest radiographic findings were found in first three groups. Workers, who had a history of marble dust exposure more than ten years, had more chest radiographic abnormalities.
Conclusion: Marble dust exposure was related to respiratory symptoms and chest radiographic findings in relation to the intensity and duration of exposure in marble factory workers.
Keywords: Marble workers, respiratory functions, chest x-ray
Clinical evaluation of World Health Organization criteria proposed for the diagnosis of tuberculosis in children
Erhan Bayram, Demet Can, Suna Asilsoy, Meral Torun Bayram, Hüdaver Alper, Şükrü Cangar, Özgür Olukman
J Clin Exp Invest 2012;3(2):255-259.
https://doi.org/10.5799/ahinjs.01.2012.02.0154
Research Article
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ABSTRACT
Objectives: Because of the difficulty in confirming childhood tuberculosis, the World Health Organization developed a scale based on clinical parameters. In our study the utility of this scale was evaluated.
Materials and methods: Patients whom were admitted to the Dr. Behçet Uz Children Hospital due to the complaints of chronic cough, weight loss and/or close household contact with adult tuberculosis were included. Patients were evaluated in according to the history, physical examination and/or chest radiography, PPD and the results of the cultures obtained from fasting gastric juice/sputum and implanted on Bactec and Lowenstein-Jensen culture medium.
Results: Totally, 108 patients were included in this study. According to World Health Organization criteria, 24 cases (22.2%) were classified as suspicious, 80 cases (74.1%) as probable and 4 of them (3.7%) as definite tuberculosis. Lymphodenopathy and atelectasis in chest radiography and in addition lymphodenopathy, bronchiectasis and calcification in thorax computed tomography were more frequently seen in the PPD positive group compared with the PPD negative group (p=0.012, p=0.02). Anti-tuberculosis treatment were not given for twenty four patients who were included in suspicious group and tuberculosis were not seen in any of these patients during their six month follow up period. During the six months follow-up of the probable and definite tuberculosis groups, clinical findings improved in all of the patients who were treated.
Conclusion: World Health Organization diagnosis criteria were considered to be useful for the diagnosis of tuberculosis in children.
Keywords: Tuberculosis, diagnosis, children, World Health Organization, criteria
The endoscopic and clinical characteristics of patients with erosive reflux disease diagnosed in gastroscopy unit of a regional hospital
Nurettin Tunç, Mehmet Mahfuz Şıkgenç, Mustafa Yakut
J Clin Exp Invest 2012;3(2):260-262.
https://doi.org/10.5799/ahinjs.01.2012.02.0155
Research Article
[Abstract]
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ABSTRACT
Objectives: Gastroesophageal reflux disease (GERD) is a common gastrointestinal disorder, presenting with a broad spectrum of symptoms and can be associated with a variety of complication. It has been defined into three groups of patients: nonerosive reflux disease, erosive esophagitis, and Barrett's esophagus. The aim of the study was to evaluate patients with erosive reflux disease in our endoscopic unit.
Materials and methods: All patients underwent gastroscopy were evaluated retrospectively. H.pylori statuses were evaluated in erosive reflux disease (ERD) patients. All patients were evaluated by videoendoscopy. Evaluation was made by the same operator at single center. Biopsy specimen was taken for H.pylori. Diagnosis of esophagitis was done based on Los Angeles classification criteria.
Results: All patients that underwent gastroscopy in our Endoscopy Unit are evaluated. Endoscopically ERD was detected in 104 (13.5%) of 773 patients. The mean age of the ERD patients evaluated in the study was 43.74±18.79 years. Sixty five (62.3%) patients were female, and 39 (38.7%) were male. In 104 patients with ERD, the sliding hiatal hernia and Barrett’s esophagus was seen in 18 and 10 patients, respectively. H.pylori was positive in 50.9% of 104 ERD patients.
Conclusion: GERD is a common gastrointestinal disorder and should always be considered during gastroscopy.
Keywords: Erosive gastritis, endoscopy unit, diagnosis, regional hospital
Management of forgotten ureteral double J stents: Report of two cases and review of the literature
Ahmet Ali Sancaktutar, Mete Kilciler, Lütfü Tahmaz, Murat Dayanç
J Clin Exp Invest 2012;3(2):263-266.
https://doi.org/10.5799/ahinjs.01.2012.02.0156
Case Report
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ABSTRACT
Double J (DJ) ureteral stents are frequently used as a natural consequence of common use of endoscopic procedures. Even though use of these stents is practical and safe, undesired problems such as urinary tract infection, kidney dysfunction may develop in case of their long stay in the body. DJ stents staying for a long time in the body due to forgotten by urologist and frequently by the patients or due to carelessness of the patients which may cause serious medical and legal problems.
Herein, we reported two cases with DJ stent placed 4 and 2 years ago after open kidney stone operation and encrusted as they were forgotten. These 2 cases were treated by application of ESWL, endoscopic laser cystolithotripsy, suprapubic percutaneous cystolithotripsy, ureteroscopic lithotripsy and percutaneous nephrolithotomy methods consecutively. In conclusion, cases with DJ stents should be informed and warned strictly to avoid rare but serious problems due to delay or forget of these stents. We think that with an algorithm including the consecutive treatment alternatives management of encrusted DJ stents might be more successful.
Keywords: Forgotten ureteral stent, endoscopic treatment
Avulsion fracture of the anterior inferior iliac spine in an uncommon way: A rare case
Burak Kaymaz, Mehmet Eroğlu
J Clin Exp Invest 2012;3(2):267-269.
https://doi.org/10.5799/ahinjs.01.2012.02.0157
Case Report
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ABSTRACT
Apophyseal anterior inferior iliac spine fractures are rare injuries. They most commonly occur in athletes in adolescence period. Because the ossification of pelvis is not completed, apophyses are the weakest part of musculotendinous unit during this period, thus avulsion fractures are more frequent than muscle ruptures. The fracture occurs as a result of the pull of the straight head of the rectus femoris muscle. Patients feel a severe pain localized in groin, and cannot bear weight. With conservative treatment including bed rest, analgesia, using crutches and toe-touch weight bearing, progressing to full weight bearing as tolerated, satisfactory results could be obtained. We present a 14-year old boy with anterior inferior iliac spine fracture occurred in an uncommon manner.
Keywords: Bone fractures, adolescent, ilium
A Neglected case admitted with paraplegia: An intradural extramedullary epidermoid cyst
Nihal Özaras, Mustafa Akif sarıyıldız, Saliha Eroğlu Demir, Feyza Karagöz Güzey, Feyza Karagöz Güzey, Abdurahman Aycan, Meltem Esenyel
J Clin Exp Invest 2012;3(2):270-272.
https://doi.org/10.5799/ahinjs.01.2012.02.0158
Case Report
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ABSTRACT
Spinal epidermoid tumors are rare tumors, constituting about 1.5-2% of the spinal tumors. Cervical and thoracic spinal cord epidermoid tumors are exceedingly rare. We reported a case of a 28-year-old patient with an intradural extramedullary epidermoid cyst at the thoracic region presented with urinary incontinence and paraparesis to our outpatient clinic. First symptoms of patient started 16 years ago and diagnosed as peroneal muscular atrophy and he couldn’t be investigated sufficiently. Because of the delayed diagnosis and treatment, paraparesis and urinary incontinence were persistent in spite of successful surgery and proper physical therapy. Spinal epidermoid tumors have a good prognosis, as they are histologically benign. When diagnosed early, complete surgical resection offers the patient good neurologic outcome. It is important to investigate extensively patients with neurological deficits and to make diagnosis as soon as possible.
Keywords: Epidermal cyst, spinal cord compression, spinal cord neoplasms, paraplegia, early diagnosis
Multifocal tumorlets and a carcinoid tumor associated with bronchiectasis
Ahmet Erbey, Neşe Karadağ, Hakkı Ulutaş, Akın Kuzucu, Ömer Soysal
J Clin Exp Invest 2012;3(2):273-276.
https://doi.org/10.5799/ahinjs.01.2012.02.0159
Case Report
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ABSTRACT
Pulmonary tumorlet is multifocal neuroendocrine cell proliferation believed to be precursor lesion to pulmonary carcinoids. A 52-year-woman underwent a left lower lobectomy and lingulectomy for bronchiectasis. Histopathologically, multiple tumorlets and a carcinoid tumor were detected in the surgical specimen.
Keywords: Bronchiectasia, tumorlets, carcinoid tumor
Anesthetic management of a patient with dermatomyositis
Zeynep Nur Akçaboy, Erkan Yavuz Akçaboy, Sinem Yalçın Bayrakçı, Özlem Soyal, Nermin Göğüş
J Clin Exp Invest 2012;3(2):277-279.
https://doi.org/10.5799/ahinjs.01.2012.02.0160
Case Report
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ABSTRACT
Dermatomyositis is a rare disease of unknown etiology characterized by proximal muscle weakness as a result of inflammation and degeneration of muscles. Concerning the anesthetic management of a patient with dermatomyositis, there is little and conflict information on the appropriate use of muscle relaxants. In this case we present an anesthetic management in a patient diagnosed as dermatomyositis.
Keywords: Dermatomyosit, anesthetic management, succinylcholine
Dental fracture and finger amputation in a child after cell phone battery explosion: A case report
Engin Ağaçkıran, Caferi Tayyar Selçuk, İsmet Rezani Toptancı
J Clin Exp Invest 2012;3(2):280-283.
https://doi.org/10.5799/ahinjs.01.2012.02.0161
Case Report
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ABSTRACT
Pediatric dentists often encounter with traumatic injuries. Explosive material injuries are seen very rare than other types. Tissue damage in the explosion is because of blast injury, penetrating injury and thermal burn injury. In our study we described pediatric case exposed to blast effect. After multiple finger injury treatment performed, left central maxillary incisor fracture was treated with composite resin restoration. At sixth month control visit, adequate soft tissue support was provided and no color discoloration, fracture or abscess formation was seen. As a result of this case report, the blast injury that rarely seen in pediatric patients in dentistry can be repair properly with appropriate restoration techniques.
Keywords: Blast injury, dental fracture, trauma
Recurrent Guillain-Barré syndrome associated with idiopathic thrombocytopenic purpura
Süber Dikici, Gülşen Kocaman, Hatice Gümüş, Ayhan Öztürk
J Clin Exp Invest 2012;3(2):284-286.
https://doi.org/10.5799/ahinjs.01.2012.02.0162
Case Report
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ABSTRACT
Guillain-Barré syndrome (GBS) usually present with acute inflammatory polyradiculoneuropathy having clinical features of rapid and progressive weakness at the limbs, symmetric decrease or loss of tendon reflexes. The exact mechanism of clinical picture is not well known but immune factors are blamed. Patients having GBS have an recurrence rate ranging between 1% and 10%. Idiopathic thrombocytopenic purpura (ITP) is an acquired systemic disease presented with mild to severe thrombocytopenia. The patient who followed with ITP diagnosis for 12 years underwent 2 times GBS attacks within 2-year interval. We would like to present this case due to rare association of ITP diagnosis & GBS attacks.
Keywords: Guillain-Barré syndrome, Idiopathic thrombocytopenic purpura, recurrent
Descending necrotizing mediastinitis and mediastinal abscesses following odontogenic infection: A case report
Sema Koç, İbrahim Aladağ, Levent Gürbüzler, Adnan Ekinci
J Clin Exp Invest 2012;3(2):287-289.
https://doi.org/10.5799/ahinjs.01.2012.02.0163
Case Report
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ABSTRACT
Descending necrotising mediastinitis (DNM) is a type of mediastinitis caused by head and neck infections, which spreads to the mediastinum via the cervical fascial planes. This infection is a rarely reported but highly lethal infection. Computed tomography was used to diagnosis the disease and assess the efficacy of treatment. Delay in diagnosis and insufficient drainage of the mediastinum and deep neck infection are the main causes of mortality in DNM. We report on a case that was treated successfully, even if with a long, protracted course.
Keywords: Odontogenic infection, descending necrotising mediastinitis, mediastinal abscesses
A balanced reciprocal translocation case in family with a history of recurrent abortions: 46,XY,t(4;13)(q31.3;q33)
Etem Akbaş, Hicran Şenli, Selahittin Çayan, Zuhal Mert Altıntaş, Badel Arslan Mamur, Filiz Çayan, Gözde Türköz, Nazan Eras Erdoğan
J Clin Exp Invest 2012;3(2):290-292.
https://doi.org/10.5799/ahinjs.01.2012.02.0164
Case Report
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ABSTRACT
Objective: A couple with recurrent spontaneous abortions has been referred to cytogenetic laboratory of Medical Biology and Genetics Department for chromosomal analysis.
Material and methods: For chromosome analysis, peripheral blood culture was performed. The samples were stained by Giemsa Technique (GTG).
Results: Twenty metaphase chromosomes were karyotyped, and 46,XY,t(4;13)(q31.3-q33) karyotype was identified in the case. As a result of the analysis, his wife was found to have normal karyotype. He had balanced translocation between chromosome 4 and 13 breakpoints in bands: der(4) monosomy 4qteràq31.3, trisomy 13qà33qter, and der(13) trisomy 4qteràq31.3, monosomy13qà33qter.
Conclusions: Although no phenotypically abnormalities were found in the male, the habituel abortions were frequently observed in his wife. We concluded that this carrier family might be due to the unbalanced distribution (46,XY/46,XX, monosomy 4qteràq31.3, trisomy 13qà33qter or 46,XY/46,XX,der(13) trisomy 4qteràq31.3, monosomy 13qà33qter) of translocation during gamete formation and prenatal diagnosis recommended for their further pregnancies.
Keywords: Balanced translocation (4;13), habituel abortus, monosomy, trisomy, 4qteràq31.3, 13qà33qter
A snake bite case developing thrombocytopenia
Taner Çiftçi, Alaaddin Akay, Asım Adıgön, Fahri Güneş
J Clin Exp Invest 2012;3(2):293-295.
https://doi.org/10.5799/ahinjs.01.2012.02.01165
Case Report
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ABSTRACT
We present a case of a twenty four year old man who was bitten by a snake on his right leg. It was a severe envenomation with ensuing marked edema and severe pain with complicated coagulation defects. After medical treatmant with antivenom the patient discharged without any complication.
Keywords: Snakebite, disseminated intravascular coagulation, thrombocytopenia
Idiopathic atrophoderma of Pasini and Pierini: A case report and review of the literature
Enver Turan, Siraç Aktar, Yavuz Yeşilova, Tuğba Kökgil, Gül Türkçü
J Clin Exp Invest 2012;3(2):296-299.
https://doi.org/10.5799/ahinjs.01.2012.02.0166
Case Report
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ABSTRACT
Idiopathic atrophoderma of Pasini and Pierini (IAPP) is a type of rarely seen dermal atrophy which little sunken from the skin, characterized with sharp edged plaque lesion. Lesions frequently placed symmetrically and not cause to subjective complaint. It is not certain whether IAPP is a different entity or it is a primary atrophic variant of morphea. Seventeen year-old male patient applied to our clinic with complainant of many slightly sunken from skin brown color spots that settle the front of body and at the middle line of back. The patient was diagnosed of IAPP according to clinical and histopathological findings. In this case of presentation, the clinical and histopathological features of the IAPP has been described and other atrophic dermatosis and their distinctive features have been excluded in the discussion.
Keywords: Morphea, atrophoderma of Pasini and Pierini
'Foetus' in Heart: A case of myxoma
Murat Yüksel, Ahmet Çalışkan, Hekim Karapınar, Zekeriya Kaya, Hasan Kaya
J Clin Exp Invest 2012;3(2):300-302.
https://doi.org/10.5799/ahinjs.01.2012.02.0167
Case Report
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ABSTRACT
The most common primary cardiac tumor in adulthood is myxoma which is a benign mass pathologically. Patients with myxoma may be asymptomatic which are recognized incidentally and also they may be clinically presented with different signs and symptoms one of which is peripheral emboli. In this paper, a case of myxoma which is detected as a source of emboli in a young woman in sinus rhythm admitted with acute arterial occlusion, which is excised surgically is presented. Echocardiographic view of myxoma was remarkable which looks like ‘a fetus in uterus.
Keywords: Myxoma, peripheral emboli, echocardiography
A Genetical approach to deep venous thrombosis
Celal Yavuz
J Clin Exp Invest 2012;3(2):303-306.
https://doi.org/10.5799/ahinjs.01.2012.02.0168
Review
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ABSTRACT
Deep venous thrombosis (DVT) is a common disorder that frequently occurs after surgical procedures and trauma and in the presence of cancer or immobilization conditions. However, it can also develop without any of these predisposing factors. This condition directs the researcher's enquiry to investigating the basis of organismal thrombotic predisposition. The common prothrombotic genetic mutations include factor V Leiden, factor II G20210 A, plasminogen activator inhibitor-1, prothrombin A20210, and factor XIII - VIII. Nevertheless, current studies suggest that the thrombotic events are not connected with single gene deletion or homeostatic regulation is also affected by other genetic risk factors. Complex interactions of genetic mutations can be affects different levels of thrombotic system or reinforce each other's effects on homeostatic mechanisms. The analysis of literature, together with the action mechanisms of the classic genetical factors and new suggestions, may contribute significantly to our understanding of the genetic predisposition to venous thrombosis.
Keywords: Venous thrombosis, genetic predisposition, homeostatic mechanisms