ABSTRACT

Objectives: Ethanol exposure during pregnancy has toxic effects on the neural stem cells of the developing brain. Differential effects of the alcohol on the neural precursor cells from different regions of the brain have not been established. This study was planned to find out the difference in the morphology of the neurosphere (NS) from the embryonic mouse cortex and cerebellum when exposed to ethanol. The dose of ethanol was comparable to blood alcohol concentration in binge drinking.
Materials and methods: The germinal tissues around the lateral ventricle and fourth ventricle of the embryo of pregnant albino mice (E14) were dissected out. Primary cultures were plated using adequate density of cells in media hormone mix (MHM) and growth factors. After 48 hours, ethanol was added to the cultures (low dose = 80 mg/dl; high dose = 400 mg/dl). NS from different groups were analyzed using phase-contrast microscopy, Trypan blue exclusion assay and immunostaining with 4'-6-Diamidino-2-phenylindol (DAPI).
Results: With low dose ethanol treatment, the mean area of cortical neurospheres was reduced by 6.9% whereas that of the cerebellar neurospheres was reduced by 51.2%. The mean count of pyknotic cells increased significantly (p<0.05) in both low and high dose ethanol treatment group compared to control in both cortical and cerebellar culture. Cerebellar culture showed 4-fold-increase in mean pyknotic cells compared to 2.5-fold-increase in cortical culture, when exposed to ethanol.
Conclusions: Cerebellar neural precursor cells from E14 mouse were more susceptible to the neurotoxic effects of ethanol compared to the cortical ones.

Keywords: Neural stem cell, alcohol ethyl, in vitro toxicity

ABSTRACT

Objectives: The aim of the this study was to investigate the relation between mitral regurgitation (MR) and left ventricular (LV) strain (S)/strain rate (SR) imaging and level of BNP.
Materials and methods: This is an observational, cross-sectional study. Thirty-one consecutive patients (15 male) with mitral regurgitation (14 patients with moderate MR, 17 patients with severe MR) and age-matched 25 healthy individuals (12 male) were included in the study. Maximal strain/strain rate measurements were recorded. Plasma BNP levels of all subjects were also studied. Scheffe test was used for post hoc analysis. Kruskal Wallis test was used to compare abnormally distributed data. Categoric variables were compared with the chi-square test.
Results: S/SR values of all wall segments of left ventricle were decreased in patient with severe MR (p<0.001).  However, plasma BNP values were significantly higher in patients with severe MR when compared with the control subjects and patients with moderate MR (p<0.001).
Conclusions: Although left ventricle functions with conventional echocardiography in patients with mitral valve regurgitation were normal, subclinic deteriorations of left ventricle were detected in patients with severe mitral valve regurgitation.

Keywords: strain/strain rate, echocardiography, mitral regurgitation, left ventricular functions

ABSTRACT

Objectives: The aim of this study was to examine the effect of smoking on the efficacy of raloxifene treatment in postmenopausal osteoporosis.
Materials and methods: In this cross-sectional study, raloxifene HCl (60 mg/day) and 600 mg ionized calcium + 400 IU vitamin D/day treatment were given to 63 cases (nonsmoker group n = 39, smoker group n = 24), who were in the postmenopausal period and detected as having osteoporosis. At the end of the first year of the treatment, the bone mineral densities (BMDs; g/cm²) were measured at four regions, namely the femur neck, femur trochanter, total hip, and lumbar vertebrae between L1-4, and T-scores were determined. The changes in BMDs were compared between the two groups.
Results: Before starting the treatment, the mean ages (55.8 ± 3.3 vs. 53.0 ± 1.3 years), menopausal ages (49.3 ± 2.9 vs. 48.1 ± 2.1 years), postmenopausal periods (5.0 ± 1.3 vs. 7.0 ± 1.4 years), body mass indexes, and estradiol levels were found to be significantly not different between the two groups (p > 0.05). At the beginning of treatment, the BMD values were not different for all measured regions in both groups (p > 0.05). At the end of the first year of the treatment, statistically significant improvements in BMD values and T-scores were detected for all measured regions in the nonsmoker group (p < 0.05). However, there were no significant differences in the BMD values from the initial values in the smoker group after treatment (p > 0.05).
Conclusions: The treatment efficacy of raloxifene in improving BMD values in postmenopausal osteoporosis is negatively influenced by smoking. J

Keywords: Raloxifene, postmenopausal osteoporosis, smoking

ABSTRACT

Objectives: Tuboovarian abscess (TOA) is a serious and potentially life-threatening condition. Treatment modalities vary as broad spectrum of antibiotherapy, minimally-invasive drainage procedures, invasive surgery or combinations of these interventions. The objective of this study was to evaluate surgically treated patients for TOA.
Materials and methods: The medical records of 57 cases who had surgically treated for TOA at Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Department of Obstetrics and Gynecology from January 2007 to September 2012 were evaluated retrospectively.
Results: The average age was 37.2 years and the mean gravidity and parity were 2.9 and 2.1, respectively. The most common presenting symptom was abdominal pain 47.4% (n=27). Twenty eight (49.1%) of the patients had laparotomy and twenty nine (50.9%) of the patients had laparoscopic surgery. 6 patients had a ruptured TOA and 17.9% of the patients had complications.
Conclusions: The choice of an open or laparoscopic surgical approach should be largely based on operator skill, experience, and ability to perform the necessary surgical maneuvers.

Keywords: Complication, laparoscopy, surgery, tuboovarian abscess

ABSTRACT

Objectives: Identifying effects of different types of refractive errors on final visual acuity and stereopsis levels in patients with bilateral amblyopia.
Materials and methods: Patients with bilateral amblyopia lower than ≥1.5 D anisometropia were included. The patients were classified according to the level of spherical equivalent (0-4 D and >4 D of hypermetropia), the level of astigmatism (below and above 2D in positive cylinder) and type of composed refractive error [<4 D of hypermetropia and < 2 D of astigmatism (group I), > 4 D of hypermetropia and < 2 D of astigmatism (group II), and < 4 D hypermetropia and > 2 D of astigmatism (group III)]. Initial and final binocular best corrected visual acuities (BCVA) were compared between groups.
Results: The initial binocular BCVA levels were significantly lower in patients with > 4 D of hypermetropia (p=0.028), without correction after treatment (p=0.235). The initial binocular BCVA was not different between astigmatism groups, but final BCVA levels were significantly lower in 4-6D of astigmatism compared with 2-4 D of astigmatism (p=0.001). During comparison of composed refractive errors, only the initial binocular BCVA was significantly lower in group I compared to group II (p=0.015). The final binocular BCVA levels were not different between groups I and III (p>0.05).
Conclusions: Although the initial BCVA is lower in patients with higher levels of hypermetropia, the response of patients to treatment with glasses is good. The response of patients with high levels of astigmatism seems to be limited.

Keywords: Amblyopia, isoametropic amblyopia, hypermetropia, refractive amblyopia, visual acuity

ABSTRACT

Objectives: Relationship between several diseases and the mutations on the gene that is encoding MTHFR enzyme has been investigated. Studies are focused on the best known mutations; MTHFR C677T and A1298C. This study is planned for determining the frequency of C677T and A1298C polymorphism of MTHFR gene for individuals who have this kind of polymorphisms.
Materials and methods: 164 individuals who were determined MTHFR polymorphism in Ankara Numune Education and Research Hospital Biochemistry Laboratory were included in the study. 44 of them were men and 120 of them were women. The mean of age of the patients were 48,4±16,8 year (18-76). MTHFR polymorphism was assayed by ROCHE Light Cycler 1.5 Real Time PCR.
Results: In 109 of 164 patients (66.5%) MTHFR C677T polymorphisms were determined. While 89 of these patients (54.3%) were heterozygote, 20 of them were (12.2%) homozygote mutant type. In 95 patients (57.9%) A1298C mutation was determined, 76 (46.3%) were heterozygote and 19 of them (11.6%) had homozygote mutant genotype. Patients number with both mutations together was 40 (24.4%). In the study group, no difference was found in frequency of MTHFR C677T and MTHFR A1298C polymorphisms (p>0.05).
Conclusions: In our study, it is seen that in individuals determined polymorphism, even MTHFR A1298C polymorphism can be found as frequent as C677T polymorphism.

Keywords: MTHFR, C677T, A1298C, Polymorphism

ABSTRACT

Objectives: In this study our aim was to compare possible effects of two different oxygen concentrations (100% vs. 50%) on hyperintense signal abnormality (HSA) in pediatric patients undergoing cranial magnetic resonance imaging (MRI) under sevoflurane anesthesia.
Materials and methods: Thirty pediatric patients undergoing cranial MRI were studied. Sevoflurane was used for induction and maintenance of anesthesia with an MR-compatible anesthesia machine. Patients, whose airway patency was maintained with laryngeal mask, were divided randomly in two groups. 100% oxygen and 50% oxygen/50% nitrous oxide was used for maintenance of anesthesia in Group I and II, respectively. FLAIR sequence images were analyzed by a radiologist who was unaware of the groups and were evaluated for HSA in 11 different brain regions in cerebrospinal fluid neighborhood. A three-point scale was used for evaluation.
Results: HSA was seen in all study patients at least in one brain region. However, no significant difference was obtained between two groups in almost all brain regions (p>0.05).
Conclusions: Use of oxygen in pediatric patients undergoing cranial MRI under sevoflurane anesthesia caused a low grade HSA. However, concentration of oxygen had no significant effect on the severity of HSA.

Keywords: Anesthesia, pediatric, brain, magnetic resonance imaging, cerebrospinal fluid, oxygen

ABSTRACT

Objectives: To evaluate mortality, morbidity, and invasive mechanical ventilation complications in mechanically ventilated neonates in a tertiary care hospital, Istanbul, Turkey.
Materials and methods: The neonates followed on invasive mechanical ventilation from January 2008 to December 2009 were included in the study. A chart is formed for each patient to record patient delivery room and clinical data prospectively.
Results: The study population consisted of 236 neonates. Eighty-five percent were born at ≤37 completed weeks of gestation (n=201). Fifty-two percent (n=123) were males. The mean gestational age was 31.9±5 weeks. The mean birthweight was 1870.8±921.8 g. Antenatal steroid rate was 13.3% (n=20) in 150 cases born at ≤34 weeks of gestation. Respiratory distress syndrome (n=100, 42,3%), perinatal depression and asphyxia (n=51, 21,6%), and sepsis (n=47, 19.9%) were the commonest indications. Mechanical ventilation related complications (nosocomial infection (n=57), pulmonary hemorrhage (n=30), pneumonia (n=10), pneumothorax (n=9), and atelectasis (n=4)) developed in 33.5% of neonates (n=79). Bronchopulmonary dysplasia was 9.3%, intracranial hemorrhage (≥grade 3) 8.47%, periventricular leukomalacia 5.93%, necrotizing enterocolitis (>stage 2) 0.42%, and retinopathy of prematurity (>stage 2) 2.96%. Mortality rate was 30.17%. Neonates born at <28 weeks of gestation and with birthweight ≤1000 gram had statistically higher mortality rate than the neonates born at ≥28 weeks of gestation and with birth weight >1000 gram (p<0.05, p<0.05, respectively).
Conclusions: Low birthweight and low gestational age are important risk factors for neonatal mortality and morbidity. Low frequency of antenatal steroid use may be a contributing factor to increase neonatal mortality and morbidity.

Keywords: Neonate, invasive mechanical ventilation, mortality, morbidity

ABSTRACT

Objectives: In this study, we aimed to evaluate anesthesia applications of the patients underwent invasive interventional neuroradiology applications.
Materials and methods: Between June 2004 and October 2004, 152 emergency or elective adult patients who were undergone general anesthesia were evaluated retrospectively. Information about the patients was taken from radiology, anesthesia notes and university’s information system. Patients were evaluated in terms of age, gender, American Society of Anesthesiologists score, indication of application, the existence of concomitant diseases, anesthesia technique, anesthetic medications and the possibility of whether patient were in intensive care unit.
Results: Of all, 55.3% of the patients (n=84) were female and 44,7% (n=68) were male. General anesthesia was applied in all cases and propofol was preferred mostly in induction and sevoflurane was preferred in maintenance. Surgically, 81,6% of the patients was elective and 18,4% was emergency patients. Diagnoses of patients were as follow: Cerebral aneurysm 63,8%, arteriovenous malformation 19,7%, thrombolytic therapy 8%, tumor embolization 5,3% and carotid stenting 3,2%. Totally 58 patients were taken into intensive care unit and 6 of these died.
Conclusions: In order to provide a safe and efficient patient care, we think that permanent anesthesia equipment is necessary together with good physical conditions of the operation room, proficiency of neuroradiologist, the close relationship between the patient and anesthetist and a good knowledge of underlying neuropathology.

Keywords: Interventional radiology, general anesthesia, cerebral aneurysm, arterio-venous malformations

ABSTRACT

Objectives: Acute necrotizing pancreatitis is a condition still with high morbidity and mortality which is associated with severe acute pancreatitis because parenchyma necrosis occurs during illness. Our aim in this study is to examine the factors affecting mortality in patients undergoing surgery because of acute necrotizing pancreatitis and present our surgical outcomes.
Materials and methods: The clinical features, Ranson and APACHE II scores of 38 patients operated in clinic (2006-2012) for acute necrotizing pancreatitis were recorded retrospectively.
Results: From the patients included in the study, 11 (28.9%) were male and 27 (71.1%) were female with an age average of 55.1±16.0 years. No relationship was found between age, C-reactive proteins, amylase and liver enzymes, pancreatitis etiology, complications seen after surgery and mortality (p>0.05). The effects of white blood cell values, width of necrosis area and the APACHE II and Ranson values upon admission on mortality were significant (p<0.05).
Conclusions: Acute necrotizing pancreatitis is a disease difficult to treat with mortality rates remaining high. In our study we determined that the patients' white blood cellcounts, Ranson values, APACHE II scores and necrosis width had negative effects on mortality. If the patient cannot be stabilized or there are indications required for the surgery, surgery must be planned as soon as the patient is suitable for operation.

Keywords: Acute necrotizing pancreatitis, surgical treatment, mortality

ABSTRACT

Objectives: In our study we investigated the effects of parenteral nutrition (PN) solutions on Coagulase negative staphylococci (CoNS) biofilm production.
Materials and methods: Thirty nine CoNS strains isolated from hemocultures and a reference strain (ATCC 12228 Staphylococcus epidermidis) were included. Bacterial dilutions were made in Tryptic Soy Broth (TSB). The experimental mediums were 1. Glucose, 2. Amino acid, 3. Lipid, 4. Glucose+ Amino acid+ lipid, 5. Glucose+ Amino acid, 6. Glucose+ Lipid, 7. Amino acid+ Lipid, and 8. Control (TSB). Biofilm formation was evaluated by “quantitative microdilution plaque test”. The values greater than cut off value are considered as positive. Biofilm positivity was divided into 3 groups (mild, moderate and intensive) and all other strains under cutoff value were accepted as negative. The numbers of biofilm positive strains derived from 1-7. mediums were compared with each other, and with the results of control.
Results: The three-component PN solution and two component PN solutions containing glucose+ lipid and amino acid+ lipid were found to increase the biofilm production activity of CoNS when compared to the control group. Slime positivity in medium 1 and 2 was lower than control significantly, in medium 4, 6, and 7 slime positivity was higher considerably. The indifferent results were obtained within the mediums 1, 2, 3 and within the mediums 4, 5, 6, and 7.
Conclusions: In our study, it was found that, glucose, amino acid and lipid solutions which were building structures of PN decreased the biofilm production when used solitary. However use of the compounds increased the biofilm production. Therefore, we can conclude that PN solutions given as mixtures in routine practice increase the risk of catheter infection.

Keywords: Catheter-related infections, biofilm, parenteral nutrition

ABSTRACT

Objectives: In this study, we aimed to investigate the changes in health-related life quality via EQ-5D survey in patients with hallux valgus deformity who were treated with Lindgren-Turan method.
Materials and methods: Totally 60 patients (30 patients in Stockholm and 30 patients in Istanbul) with hallux valgus deformity who were treated with Lindgren-Turan method were included in the study. The health-related life quality levels were preoperatively and postoperatively recorded and compared for all patients via EQ-5D survey and changes were noted. Visual analogue scale (VAS) was used to evaluate the patient’s response to the question of how much healthy they feel. Radiological parameters were not taken into account in the course of life quality comparison.
Results: Pain and discomfort were found to be the most common complaints (87%) among the patients in the preoperative period which were followed by restricted motion caused by the deformity and difficulty in daily activities (60%). VAS score were significantly much worse in Turkish patients in the preoperative period. All parameters, including especially daily personal care and hygiene, were significantly improved postoperatively. VAS score which was questioning the general health status of the patients was also increased significantly (p<0.01).
Conclusions: Lindgren-Turan method for the surgical treatment of hallux valgus provides a significant recovery in patient’s health-related life quality.

Keywords: Health, life quality, outpatient surgery, hallux valgus

ABSTRACT

Objectives: Suicide is a major public health problem and challenging issue of forensic medicine, in our country as in all over the world. This study aimed to present medico-legal evaluation of group/mass suicide cases of siblings.
Material and methods: A total of 535 cases, autopsied in Kahramanmaraş between 01.01.2007 and 01.06.2012, were retrospectively investigated. There were two cases of group suicide of four siblings for each. The autopsy and forensic investigation records of these cases were investigated.
Results: There were two cases of group/mass suicide. Each of them comprised four siblings. In first case, the group comprised of 3 male and 1 female siblings. Scene investigation did not reveal a suspicious finding. Interviewing with the relatives showed that siblings were extremely dependent on their mother who was currently died, after which victims suffered social adjustment problems. Autopsy findings revealed that all victims died of asphyxia due to hanging. In second case, four female siblings found dead in a damn lake, a short while after leaving home. All found to wear similar black colored dresses. Interviewing family members revealed that the oldest sister was forced for an unwanted marriage. The family has a low socioeconomic level and migrated from another region. Death was attributed to asphyxia due to drowning.
Conclusions: In the etiology of suicide, psychological and environmental factors should be investigated. Implementing psychosocial support mechanisms is of high importance in order to avoid such consequences, particularly for broken families and in regions suffering from unwanted forced marriages.

Keywords: Suicide, sibling, hanging, drowning, autopsy

ABSTRACT

Objectives: Increased levels of free radicals and oxidant molecules and decreased levels of antioxidant molecules have been defined in patients with multiple sclerosis (MS). Ischemia-modified albumin (IMA) levels have been advocated as a biomarker for evaluating the oxidative stress status. The aim of this study was to investigate the relationship between oxidative stress and MS.
Materials and methods: We compared serum ischemia modified albumin levels and prolidase activity of 42 patients with MS (30 female, 12 male) and 30 age-matched healthy controls (21 female, 9 male).
Results: Ischemia modified albumin levels of MS patients (73,07±26,53 ng/mL) were significantly higher than those of controls (60,18±18,01 ng/mL) (p=0.024). However, there were no significant differences in prolidase levels between patients and healthy controls (p=0.856).
Conclusions: Increased ischemia modified albumin levels, supports the role of oxidative stress in patients with multiple sclerosis.

Keywords: Multiple sclerosis, ischemia modified albumin, prolidase, oxidative stress

ABSTRACT

Objectives: We compared effects of mechanical and manual ventilation during transport to the intensive care unit(ICU) in cardiac surgeries.
Materials and methods: After ethical approval, 66 patients (ASAgrade II and III, 20-80years) were assigned randomly. Ventilation during transport to ICU was performed manual (Group EV; n=36) or mechanical ventilation (Group MV; n=30). Measurements were recorded: operation room (A), during transport (T) and in ICU (YB). Systolic, diastolic pressures (SAP, DAP), pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), heart rate (HR), cardiac output (CO), blood gases (pH, PCO₂, PO₂, BE) and peripheral oxygen saturation (SpO₂) were recorded. Stroke volume index (SVI), systemic and pulmonary vascular resistance indices (SVRI, PVRI) and mean arterial pressures(MAP) were calculated.
Results: Patients were similar. Duration of transport was shorter in Group MV (p< 0.01). The alterations in HR, MAP, DAP, CVP, PAP, PCWP, PVRI, SVRI, SVI, CO, SpO₂ were similar, the increase in SAP during T period was higher in Group MV (p<0.05). Pulmonary arterial pH in Group MV was lower (p< 0.05). Arterial and pulmonary arterial pO₂, pCO₂ decreased in Group MV, there was increase in Group EV during ICU (p< 0.001, p< 0.01, p< 0.01, p< 0.05). During T period hypotension and tachycardia in Group EV, and hypertension in Group MV were observed.
Conclusions: Mechanical ventilation had short transport time, less alterations in hemodynamic and respiration values and less complication rates. We concluded that the use of mechanical ventilation is a safer method for the intrahospital transport of critical patients.

Keywords: Cardiac surgery, patient transport, mechanical ventilator, manual ventilator, hemodynamia

ABSTRACT

Objectives: The aim of the study is to investigate the contraceptive method preference of patients applied to gynecology outpatient clinic and its relationship with their education level.
Materials and methods: Totally 61 women preferring any contraceptive method were included in this study. The ages, number of pregnancy, living children, marriage period, number of spontaneous abortion and legal evacuation, contraceptive method preference, source of getting information about contraceptive method and education status of the patients were recorded.
Results: In present study, 61 patients aged 31 years (range: 18-53) were included. The number of women who prefer the traditional contraceptive methods was 21 (%34,4) and those choose modern methods 40 (%65,6). The most preferred contraceptive method was withdrawal (27.9%). The frequency respectively as follow; 26.2% condom, 14.7% intrauterine device (IUD), 13.1% tubal ligation (T/L), 9.8% oral contraceptive (OC), 6.5% calendar method, 1.6% monthly injections. The education status was as; uneducated 13.6%, primary school 50.8%, secondary school 6.6%, high school 24.6%, and university graduates 4.9%. Of all, 48.4% of primary school graduates used withdrawal method and 75% calendar method were uneducated. Modern methods were more frequently used in educated patients. Education level of the women preferring OC was 50% primary school, 33% high school; in IUD preferred women were 44% high school, and of condom used patients were 56.3% high school graduates. In comparison, tubal ligation method preferred especially in primary school graduates and uneducated (62.5% primary school).
Conclusions: Women and their partners should be educated regardless of education levels about family planning and contraceptive methods and they should be supported about appropriate contraception methods for each couple.

Keywords: Contraception, education level, source of information, women

ABSTRACT

Primary mixed cellularity Hodgkin’s lymphoma of the parotid gland is extremely rare. We report here an 80-year old woman who presented with a painless preauricular mass of two months duration. Cytological and histomorphological findings were consistent with mixed cellularity Hodgkin’s lymphoma. Due to the age and the presence of comorbid diseases, the patient only received radiotheraphy and has been in remission for 12 months since the initial diagnosis. Primary Mixed cellularity Hodgkin’s lymphoma of the parotid gland is extremely rare and the prognosis, in addition to the biologic behavior of this disease is yet to be evaluated.

Keywords: Mixed cellularity Hodgkin’s lymphoma, parotid, radiotheraphy

ABSTRACT

A 52-year-old male patient with laryngeal carcinoma was treated with docetaxel, cisplatin, and 5-fluorouracil (DCF) chemotherapy. Because of severe nausea and vomiting 15 days after the first course of chemotherapy, metoclopramide was administered. Parkinsonism symptoms were observed on the 6th day of metoclopramide therapy. Cerebral MRI revealed bilateral basal ganglia and brain stem involvement. Metoclopramide therapy was promptly discontinued and oral biperiden was commenced. Parkinsonism findings almost completely improved on his control examination performed after one month. He was not given metoclopramide during further chemotherapy courses. Cerebral MRI taken after three months revealed that the lesions have completely relieved.
This is an extremely rare case of metoclopramide-induced parkinsonism together with brain stem and basal ganglion involvement in a patient with laryngeal carcinoma treated by chemotherapy. The clinical and radiological improvement was observed with the cessation of the causative drug and biperiden therapy.

Keywords: Parkinsonism, metoclopramide, laryngeal carcinoma

ABSTRACT

Overactive bladder syndrome is a chronic condition characterised by urgency, with or without associated urge incontinence. Solifenacin succinate is a once daily, bladder selective antimuscarinic available. The recommended dose is 5 mg once daily and can be increased to 10 mg once daily if 5 mg is well tolerated. We report here a case with dyskinesia emerged following the use of solifenacin, and disappeared in a few days with stopping the agent.

Keywords: Overactive bladder syndrome, solifenacin, dyskinesia

ABSTRACT

The anti-CD20 monoclonal antibody rituximab has been used extensively in the treatment of B-cell lymphoma. Several studies reported hepatitis B virus (HBV) reactivation after rituximab. The majority of these cases have been described in chronic carriers of HBV, whereas reactivation in occult hepatitis B virus (OHBV) carriers may occur.
The presented case with the diagnosis of Waldenström’s macroglobulinemia was HBsAg negative and anti HBcIgG positive before chemotherapy. The patient was started on CVP (cyclophosphamide, vincristine, prednisolone) chemotherapy. However, no clinical or laboratory response was obtained and the patient was considered unresponsive to three cycles of CVP therapy. Therefore R-CHOP (rituximab, cyclophosphamide, adriamycin, vincristine and prednisolone) was planned as the second therapy. Laboratory work-up after the first cycle of R-CHOP therapy revealed an aspartate aminotransferase (AST) level of 267 U/L and alanine aminotransferase (ALT) level of 318 U/L. HBsAg and anti HBcIgG were positive and HBV DNA was 56400 IU/ml. Lamivudin 100 mg/day was started. Four weeks after the initiation of lamivudin therapy, ALT and AST levels returned to normal. Currently, the patient has received the fourth cycle of R-CHOP therapy. ALT and AST levels continue to be in normal range. This condition was considered to be the reactivation of OHBV following rituximab.
The aim of this case presentation is to call attention to HBV reactivation possibility in cases taking immunosupressive medications like Rituximab.

Keywords: Waldenström’s macroglobulinemia, rituximab, occult HBV infection

ABSTRACT

Nail biting (onychophagia) is a common disorder which has not been investigated yet. There are different opinions about to classify onychophagia, but according to DSM-IV-TR it is classified as impulse control disorder not otherwise specified. The knowledge about treatment of onychophagia is limited. There are a few studies about treatment of onychophagia with psychotherapy and a study with pharmacotherapy. Some studies suggest that an atypical antipsychotic aripiprazole may have beneficial effects in the treatment of impulse control disorders. In this study we report a case of onychophagia which has successfully treated with aripiprazole add-on to escitalopram treatment that has never reported before.

Keywords: Onychophagia, aripiprazole, add-on treatment

ABSTRACT

Giant bullae may mimic tension pneumothorax radiologically so that it may expand completely to hemithorax, increase of radiolucency mediastinal shift, flattening of diaphragm and printing on trachea. Sixty one year old male patient with giant bullae misdiagnosed as tension pneumothorax and underwent to tube thoracostomy. The differential diagnosis of giant bullae and tension pneumothorax may be confusing. The therapeutic approaches of these two radiologically similar entities differ significantly. Thus proper physical assessment and radiological examination is crucial in the differential diagnosis and computed tomography examination should be performed before the adjustment of therapy.

Keywords: Tension pneumothorax, giant bullae, computed tomography, tube thoracostomy

ABSTRACT

Congenital bilateral perisylvian syndrome (CBPS), which is seen by indications of mental retardasyon, epilepsi, speech disorder and pseudobulbar palsy, is a disease which comes up with genetic and non-genetic reasons. Revealing characteristic indications (like polymicrogyria) with MR imaging and clinic indications contributes making diagnosis. In present paper, we aimed to present 18 month girl case report who diagnosed as CBPS with hydrocephali indication.

Keywords: Epilepsy, congenital bilateral perisylvian syndrome, polymicrogyria, hydrocephalus, pseudobulbar palsy

ABSTRACT

Here in we present a case of a postoperative jaundice due to Gilbert's syndrome in a patient who was suffering from coronary artery disease and undergone coronary artery bypass grafting operation. Signs and symptoms of jaundice developed on the postoperative first day and resolved spontaneously after 7 days. The diagnosis and characteristics of Gilbert's syndrome and other related abnormalities and factors relevant to anesthesia and cardiopulmonary by-pass, which affect bilirubin metabolism, are discussed.

Keywords: Coronary artery disease, coronary artery bypass grafting, Gilbert’s syndrome

ABSTRACT

Keywords: