Evaluation of epidemiological data of 541 patients with brucellosis in Siirt, a city in south-eastern Anatolia
Fatih Demircan, Fırat Zafer Mengeloğlu, Faruk Kılınç, Affan Denk
J Clin Exp Invest 2013;4(2):136-140.
https://doi.org/10.5799/ahinjs.01.2013.02.0253
Research Article
[Abstract]
[PDF]
ABSTRACT
Objectives: We intended to examine 541 brucellosis cases by offering our experiences regarding this preventable infectious disease that is significant for our country.
Methods: We evaluated 1210 hospitalized patients between the dates of January 2006 and December 2010 in Siirt General Hospital and 541 brucellosis cases were reviewed retrospectively. Patients with Rose Bengal plate test positive and has Wright agglutination test a titer of 1:160 or higher were included in this study.
Results: A 53.6% of brucellosis cases were male and 46.4% were female. The mean age (±SD) of patients was 41.23±2.7 years. Between the ages 31 and 50 is the range brucellosis is most commonly encountered in both men and women. Hematological evidence discovered that for 67% of patient’s sedimentation is 20-40 mm/hour, 53% leukocyte count is in normal range, 36% of patients had leukocytosis, 10% had leukopenia, and 8% had thrombocytopenia. Most common three symptoms were joint pain (90%), myalgia (75%) and fatigue (70%). The most involved systems were musculoskeletal (28%), hematological (22%), and gastrointestinal systems (20%). Most commonly encountered systemic findings were sacroiliitis (20%), anemia (14%) and liver dysfunction (12%). Brucella was observed most commonly is May (30%) in Siirt. A 47% of our cases are occupied in agriculture and stockbreeding that are risky occupations regarding brucellosis, supports the conventional data regarding brucellosis epidemiology.
Conclusion: Despite the campaigns, infection rate is still high and it affects both animal industry and human health in our country. Data about brucellosis should be validated by large multicenter studies.
Keywords: Brucellosis, infectious disease, endemic disease, Rose Bengal, agglutination tests
Evaluation of fetal ventriculomegaly
Özgür Aydın Tosun, Nazan Tarhan, Sevcan Arzu Arınkan, Öykü Tosun, Yusuf Çakmak, Abdulkadir Turgut
J Clin Exp Invest 2013;4(2):141-147.
https://doi.org/10.5799/ahinjs.01.2013.02.0254
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: To evaluate the prenatal and postnatal follow up, treatment and the outcome of the patients with ventriculomegaly.
Methods: Patients with lateral cerebral ventricle size 10mm and higher were included. 69 patients were considered but 8 patients refused to join our study. The patients were divided into two groups as they had additional anomalies (combined ventriculomegaly) or not (isolated ventriculomegaly). Each group was divided into three subgroups according to their lateral cerebral ventricle size as mild (10-12 mm), moderate (12.1-4.9 mm), severe (15 mm and more) ventriculomegaly.
Results: 10 fetuses with isolated ventriculomegaly and combined ventriculomegaly died after birth. Neurosurgical operations were performed for ten patients. We performed chromosomal analysis for 16.7% of our patients. Caesarian delivery was higher (91.7%) in combined ventriculomegaly groups and all newborns went to NNICU. In isolated ventriculomegaly group 18 patients showed normal neurological development at sixth month. None of the patients with combined ventriculomegaly group showed normal neurological development at sixth month. In severe ventriculomegaly group termination ratio was higher (64.7%) than isolated ventriculomegaly group (11%). The survival rate was 90% in mild ventriculomegaly group and 42.9% in severe ventriculomegaly group.
Conclusion: Termination is more often in isolated severe ventriculomegaly than mild and moderate ventriculomegaly group because the prognosis is worse. Because the prognosis of the patients with mild ventriculomegaly is good decision for termination will be well evaluated with the family.
Keywords: Prenatal diagnosis, growth & development, prognosis
Data evaluation of Ankara Numune Training and Education Hospital immunofixation electrophoresis
Müjgan Ercan, Esra Oğuz, Sema Uysal, Sevilay Sezer, Canan Topçuoğlu, Fatma Meriç Yılmaz
J Clin Exp Invest 2013;4(2):148-152.
https://doi.org/10.5799/ahinjs.01.2013.02.0255
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: The immunofixation electrophoresis (IFE) is a method used for the diagnosis, monitoring and treatment of monoclonal gammopathies (MG). The monoclonal gammopathies include premalignant or malignant disease such as multiple myeloma, Waldenström’s makroglobulinaemia (WM), plasmacytoma, monoclonal gammopati of undetermined significance (MGUS), plasma cell leukemia and amiloidosis (AL). We aimed to evaluate IFE reports analyzed in Ankara Numune Teaching and Research hospital from January to July 2011.
Methods: IFE was studied by Interlab G26 in our laboratory. In this study, all IFE reports examined which analyzed between January and July 2011. The results assessed for frequency and type of MG and also for diagnosis of the disease.
Results: A total of 688 patients from January to July 2011 were studied by IFE and 126 (18.3%) patients have been identified as MG. There were 72 (57.1%) men and 54 (42.9%) women in patients with MG. Distribution of isotypes were IgG kappa 41.3%, IgG lambda 35.6%, IgA kappa 11.5%, IgA lambda 5.8%, IgM kappa 3.8% and IgM lambda 1.9%. There were MM (65.9%), WM (0.07%) and MGUS (33%) in patients with MG.
Conclusion: IgG kappa was the most common type of MG and MM was the most common disease in these patients. MG detection rate was 18% in patients requested IFE test. The decreased rate has shown that at first serum protein electrophoresis must studied and then IFE test must be performed in patients who have an uncertainty of MG.
Keywords: Monoclonal gammopathies, immunofixation electrophoresis, multiple myeloma
Ultrasound evaluation of metabolic syndrome patients with hepatosteatosis
Mehmet Emin Demir
J Clin Exp Invest 2013;4(2):153-158.
https://doi.org/10.5799/ahinjs.01.2013.02.0256
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: The exact incidence of hepatosteatosis in patients with metabolic syndrome (MetS) is unknown; also there is no valid, simple and inexpensive method to evaluate and follow-up for patients with MetS. In our study, we aimed to demonstrate the frequency of hepatosteatosis, and whether demonstrate presence and degree of steatosis using liver ultrasonography may provide additional benefit for evaluating and following-up in MetS patients with non-alcoholic fatty liver disease.
Methods: One hundred and twelve patients with MetS were included to the study. Patients divided into three groups; control group (n= 36) consisted of patients without hepatosteatosis, group 1 (n=43) consisted of patients with grade 1 hepatosteatosis. Finally, group 2 (n= 33) consisted of patients with grade 2 hepatosteatosis. The relationship between the presence and degree of the hepatosteatosis and MetS parameters were analyzed.
Results: The incidence of hepatosteatosis was found 69.4% in patients with MetS. There were significantly differences in HOMA-IR, AST, ALT and GGT levels among control group and group 1 (p<0.05 for all). There were also significantly differences in waist circumference, fasting blood glucose, fasting insulin, HOMA-IR, AST, ALT, GGT, ferritin, CRP, sedimentation, uric acid and microalbuminuria levels among control group and group 2 (p<0.05 for all). Blood pressures and lipid profiles were similar among all groups (p>0.05 for all). Besides, there were significantly differences in waist circumferences, fasting insulin, HOMA-IR, GGT, uric acid, CRP levels among group 1 and 2 (p<0.05 for all).
Conclusion: Our study indicates that MetS related parameters; especially insulin resistance, were significantly different in patients with hepatosteatosis compared to patients without hepatosteatosis. Because of the different measurment of waist circumferences among groups, we recommend to use liver ultrasonography and waist circumference together to evaluate and follow-up for MetS patients with hepatosteatosis.
Keywords: Fatty Liver, metabolic syndrome X, ultrasonography
A retrospective investigation of the patient-controlled analgesia methods applied for postoperative pain management
Hale Yarkan Uysal, H. Volkan Acar, Abdulaziz Kaya, Ayşegül Ceyhan
J Clin Exp Invest 2013;4(2):159-165.
https://doi.org/10.5799/ahinjs.01.2013.02.0257
Research Article
[Abstract]
[PDF]
ABSTRACT
Objectives: Patient-controlled analgesia (PCA) in postoperative pain treatment is more effective than conventional analgesia methods. It is commonly preferred for the reasons of maintaining high patient satisfaction and positive effects on patients’ recovery period with less sedation and postoperative complications. In this study we aimed to investigate the characteristics of PCA methods that have been applied at our clinic within the last two-year period retrospectively.
Methods: The records of patients who were received PCA for postoperative analgesia at our hospital between 01 January 2010 and 31 December 2011 were investigated. Patients’ genders, PCA protocols and the operations’ characteristics were evaluated.
Results: In this study, it was seen that of the 1030 patients, IV tramadol PCA was applied to 580 (56.3%) patients, epidural PCA was applied to 431 (41.8%) patients and IV morphine PCA was applied to 19 (1.8%) patients. In 2011, it was seen that of the 971 patients, IV tramadol PCA was applied to 737 (75.9%) patients and epidural PCA was applied to 234 (24.1%) patients. When compared to 2010, it was detected that IV tramadol PCA use has significantly increased (p<0,001), whereas PCEA and IV morphine PCA uses were significantly decreased in 2011 (p<0,001 and p<0,001). In both 2010 and 2011, it was detected that PCA was applied most frequently to orthopedic surgery patients while the majority of these surgeries were lower extremity and vertebra surgeries, consequently.
Conclusions: The results of this retrospective study showed that the number of PCA uses has increased over the time. In our clinic, IV PCA was used more frequently than epidural PCA while the majority of the patients whom PCA was applied was orthopedic surgery patients.
Keywords: Postoperative pain; analgesia, patient-controlled, analgesia; epidural
Frequency of HBsAg, anti-HCV, and anti-HIV in pregnant women and/or patients with gynecologic diseases in a tertiary hospital
Tülay Özlü, Tekin Taş, Fırat Zafer Mengeloğlu, Esra Koçoğlu, Melahat Emine Dönmez
J Clin Exp Invest 2013;4(2):166-170.
https://doi.org/10.5799/ahinjs.01.2013.02.0258
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: Hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) are viruses that can be transmitted to the health care workers by infected body fluids and from mother to the baby before, during or after delivery. In the present study, we aimed to investigate the frequency of hepatitis B surface antigens (HBsAg), hepatitis C antibodies (anti-HCV), and HIV antibodies (anti-HIV) in pregnant women and/or patients with gynecologic diseases that admit to a university hospital in Bolu.
Methods: HBsAg, anti-HCV, and anti-HIV results of the pregnant women and/or patients with gynecologic diseases that admitted to the obstetrics and gynecology clinics between January 2006 and June 2012 were retrospectively investigated. All markers were tested in the microbiology laboratory of our hospital by using macro ELISA method (Axsyme and Architect i2000SR systems, Abbott Diagnostics, Chicago, IL, USA).
Results: The frequency of HBsAg, anti-HCV, and anti- HIV positivity were 1.8%, 0.5%, and 0% in pregnant women and 1.9%, 1.1%, and 0% in patients with gynecologic diseases, respectively.
Conclusion: The frequencies detected in our hospital are at low levels as seen in developed countries. Since there is no effective method of prevention especially from HCV, awareness of this serologic result before high risk procedures will enable the doctors and the health care workers to take extensive measures to prevent the transmission of the disease.
Keywords: anti-HCV, anti-HIV, HBsAg, pregnant women, gynecology
Halo Vest treatment of upper cervical vertebral fracture
Ergün Karavelioğlu, Adem Aslan, Olcay Eser, İhsan Canbek
J Clin Exp Invest 2013;4(2):171-174.
https://doi.org/10.5799/ahinjs.01.2013.02.0259
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: In this study we aimed to investigate the efficacy, long term result and associated complications of Halo Vest treatment for patients with upper cervical spine fractures.
Methods: This study included 13 patients (11 men and 2 women) who applied Halo Vest treatment for traumatic upper cervical vertebral fracture between 2006 and 2011. We reviewed the radiological and clinical findings of patients before and after the treatment.
Results: Six of 13 patients had odontoid type 3 fracture, 2 patients had odontoid type 2 fracture with C1 type 1 fracture, 2 patients had odontoid type 2 fracture with Jefferson fracture, one patient had type 2 hangman fracture and two patients had unclassified C2 corpus fractures. The mean follow-up time with Halo Vest was 14 weeks (10-21 weeks). Ten patients had bone fusion and the mean time of bone fusion was 12 weeks.
Conclusions: Halo Vest treatment for upper cervical spine fracture is a safe and effective method but the patients comfort and satisfaction are low.
Keywords: Atlas fracture, odontoid fracture, halo vest
Primary intra-abdominal hydatid cyst cases with extra-hepatic localization
Ebubekir Gündeş, Tevfik Küçükkartallar, Murat Çakır, Faruk Aksoy, Ali Bal, Adil Kartal
J Clin Exp Invest 2013;4(2):175-179.
https://doi.org/10.5799/ahinjs.01.2013.02.0260
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: Hydatid cyst is presently a prevalent health problem in our area and country. Primary involvement of other intra-abdominal organs is rarely seen. We analyzed the cases of patients who had been surgically treated because of extra-hepatic primary intra-abdominal hydatid cysts alongside with literature.
Methods: The medical records of a total of 22 patients who were treated for primary intra-abdominal hydatid cysts with no liver involvement were retrospectively studied.
Results: While 16 (72.7%) of the patients were female, 6 (27. 3%) were male, and their mean age was 44. 5 (26- 75) years. The cyst was most frequently seen in the spleen (n= 8). All the patients had elective surgical procedures. Twelve (54%) patients needed to have organ resection. Total cyst excision could be achieved in 16 (72.7%) patients. The other 6 (27.3%) cases had partial cystectomy. All the patients were administered post-op 10 mg/kg albendazole. The mean follow-up period of the patients was 40 (6-68) months and no recurrences were seen in any of the patients.
Conclusions: The fact that echinococcus granulosus can involve every organ should always be remembered. Although no hydatid cysts were seen in the liver or the lungs, all the other systems should be examined carefully according to the complaints of the patient. Hydatid cysts should be considered, especially in endemic areas, in the differential diagnosis of cystic masses with intra-abdominal localization. Total pericystectomy where possible, is the treatment of choice.
Keywords: Extra-hepatic, echinococcosis, hydatid cyst, intra-abdominal
Clinical characteristics, background illnesses and in-hospital mortality rates of patients who has a temporary pacemaker implanted
Rida Berilğen, İrfan Yeşil, Faruk Ertaş, Uğur Kocabaş, Barış Düzel, Nihan Kahya Eren, Halit Acet
J Clin Exp Invest 2013;4(2):180-183.
https://doi.org/10.5799/ahinjs.01.2013.02.0261
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: The aim of the study was to determine the clinical characteristics, comorbidities, responsible diseases and in-hospital mortality of patients who received a temporary pacemaker
Methods: Our study included 545 patients who received a temporary pacemaker due to various causes during their hospitalization between January 2008 and May 2012.
Results: Of the 545 patients whose records were scanned retrospectively in our study, 235 (43%) were female and 310 (57%) were male. Average age of patients was 70±14.2 years (20,100). Leading cause for receiving pacemaker was third degree atrioventricular block (178 patients, 32.6%).Other causes were bradycardia or asystole during procedures such as coronary angiography, catheterization etc. (101 patients, 18.5%), symptomatic sinus bradycardia (70 patients, 12.8%), pacemaker end of life (During procedure, 65 patients, 11.9%). Temporary pacemaker implantation due to drugs, hyperpotasemia and both was 6.2% (34 patients), 3.6% (20 patients) and 1.1% (6 patients) respectively. Eight patients used drugs for committing suicide. While the top responsible drugs for pacemaker implantation were digoxin, beta blockers and calcium channel blockers, only one patient was using a noncardiac drug (oxcarbamazepin). Half of the patients had coronary artery disease (276 patients, 51%). 101 patients (18.5%) received a temporary pacemaker due to block in the course of myocardial infarction. 85 patients died during their hospitalization (15.5%).
Conclusıon: Although causes for temporary pacemaker implantation has changed over time, myocardial infarction with block still remains fatal even a temporary pacemaker is inserted.
Keywords: Temporary cardiac pacemaker, mortality, acute myocardial infarction, atrioventricular conduction block
Comparison between fractional flow reserve and visual assessment by multiple observers in patients with moderate coronary artery lesions
Rida Berilğen, Nihan Kahya Eren, Faruk Ertaş, Halit Acet, Ali Hikmet Kırdök, Erdal Gürsul, Sefa Nuri Akdemir, Özgen Şafak
J Clin Exp Invest 2013;4(2):184-188.
https://doi.org/10.5799/ahinjs.01.2013.02.0262
Research Article
[Abstract]
[PDF]
ABSTRACT
Objectives: Our aim was to evaluate whether more than one observer or fractional flow reserve has the same results in assessing coronary lesion severity in intermediate lesions.
Methods: Our hospital’s database was searched for fractional flow reserve procedures and then these patient’s lesions were assessed visually by three experienced interventional cardiologist.
Results: 8 of 46 patients were (17.4%) female and 38 of 46 were (82,6%) male. Average age was 61±11 years (Male: 60±11 / Female: 70±7 years). One observer could only detect 66.7% of severe lesions and 76.2% of non-severe lesions. When two observers agreed about lesion severity, true detection of severe lesions was (max) 76.7%, and true detection of non-severe lesions was (max) 66.7%, so a decrease in true detection of non-severe lesions was observed. When one of the observers called a lesion “severe” and the lesion was assumed as “severe”, detection of a severe lesion was 83.3% (p=0.017); if all of the observers agreed that the lesion was “non-severe” then true detection of a non-severe lesion was 90.5% (p<0.05).
Conclusion: One observer can’t detect a lesion severity sufficiently, but when three observers’ information was evaluated, there was nearly 90% concordance with fractional flow reserve results.
Keywords: Fractional flow reserve, visual assessment, lesion
Association of the sleep quality with pain, radiological damage, functional status and depressive symptoms in patients with knee osteoarthritis
Mustafa Akif Sarıyıldız, İbrahim Batmaz, Mehmet Cemal Kaya, Mehtap Bozkurt, Mehmet Okçu, Mehmet Yıldız, Levent Yazmalar, Tahsin Çelepkolu
J Clin Exp Invest 2013;4(2):189-194.
https://doi.org/10.5799/ahinjs.01.2013.02.0263
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: The aim of this study is to evaluate the sleep quality and relationship between the sleep quality with disease-related variables, pain, functional status, radiological damage and the psychological status in patients with Osteoarthritis (OA).
Methods: Fifty two patients diagnosed with OA and 35 healthy control subjects were enrolled in the study. The demographic characteristics of the patients such as age, education level, and marital status were recorded. Disease related disability were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Generalized pain, generalized fatigue and knee pain were assessed with the Visual Analogue Scale (VAS). Psychological status were evaluated with the Hospital Anxiety Depression Scale. The radiological grade of knee OA was evaluated according to the Kellgren Lawrence score. For the evaluation of the sleep quality, the OA and control groups were assessed with the help of the Pittsburgh Sleep Quality Index (PSQI).
Results: The patients with OA had significantly higher scores in the subjective sleep quality, sleep latency, habitual sleep efficiency and total PSQI score compared to the healthy control group (p<0.05). According to the results of Spearman’s analysis, there was a significantly correlation between the total PSQI score with age, generalized pain, knee pain, WOMAC pain, radiological damage and depressive symptoms (p<0.05).
Conclusions: The sleep quality is disturbed in patients with OA. Lower quality of sleep is especially associated with the pain, radiological damage and depressive symptoms.
Keywords: Knee osteoarthritis, sleep quality, pain, radiological grade, depression
Tear levels of macrophage migration inhibitory factor in vernal keratoconjunctivitis
Onur Çatak, Orhan Aydemir, Bilal Üstündağ
J Clin Exp Invest 2013;4(2):195-198.
https://doi.org/10.5799/ahinjs.01.2013.02.0264
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: The pathogenesis of vernal keratoconjunctivitis (VKC) is not fully understood and cannot be explained only with type I hypersensitivity reaction. The aim of this study was to determine the Macrophage migration inhibitory factor (MIF) levels in tear fluids of patients with VKC.
Methods: Tear fluid samples were collected with microcapillary tubes for hematocrit at the lateral canthus of patients in the supine position without any anesthesia. Tear levels of MIF were measured by ELISA kit. Tear fluid samples were collected from 10 healthy subjects and 20 patients with VKC.
Results: Tear levels of MIF in patients with VKC were significantly higher than those in controls (p<0,001).
Conclusion: These results suggested that MIF may have significant effect on the pathogenetic process of VKC.
Keywords: Macrophage migration inhibitory factor, vernal keratoconjunctivitis, ELISA
Magnetic resonance imaging findings of sacroiliitis in patients with psoriasis
Mehmet Fatih İnci, Rahime İnci
J Clin Exp Invest 2013;4(2):199-203.
https://doi.org/10.5799/ahinjs.01.2013.02.0265
Research Article
[Abstract]
[PDF]
ABSTRACT
Objectives: The aim of this study was to determine the frequency and characteristic magnetic resonance (MR) imaging features of sacroiliitis in patients with psoriasis disease.
Methods: A total of 68 patients who diagnosed with psoriasis in Dermatology department of our hospital between February-2012 and February-2013 were included to our study. All patients were underwent bilateral sacroiliac MR. MR study were performed with the sequences of the coronal T1 weighted turbo spin-echo, T2 weighted and STIR images using a 1,5-T MR device for all patients. Changes in the subchondral bone were classified according to MR signal features.
Results: Of these patients, 37 (54.4 %) were male and 31 (45.6 %) were female. The mean age was 32.3±7.8 years, ranging from 16 to 60 years. Mean disease duration was 12.4±8.6 years (2-24 years). While MR imaging findings were normal in 52 (76,5%) patients, signal changes consisted with sacroiliitis were observed in 16 (23.5%) patients. One or more MR lesion consisted with sacroiliitis were observed in a total of 22 sacroiliac joint of 16 patients. The signal abnormalities detected by MR imaging were as follows, Type-1 changes in 6 (27.3%) joints, Type-2 changes in 8 (36.4%) joints, Type-3 changes in 10 (45.5%) joints, erosions in 9 (40.9%) joints, narrowing the joints space in 6 (27.3%) joints and ankylosis in 5 (22.7%) joints.
Conclusion: Sacroiliitis in psoriatic patients is an important clinical problem. MR imaging is a useful diagnostic modality in the diagnosis of psoriatic sacroiliitis which can demonstrate detailed anatomy of the sacroiliac joint and the changes of sacroiliitis without radiation exposure.
Keywords: Psoriasis, sacroiliitis, magnetic resonance imaging
Assessment of the sleep parameters in patients with obstructive sleep apnea syndrome with a history of traffic accident
Özlem Abakay, Hadice Selimoğlu Şen, Mahşuk Taylan, Cengizhan Sezgi, Mehmet Halis Tanrıverdi, Abdullah Çetin Tanrıkulu, Abdurrahman Abakay, Gökhan Kırbaş
J Clin Exp Invest 2013;4(2):204-207.
https://doi.org/10.5799/ahinjs.01.2013.02.0266
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: In this study, traffic accident with a history of obstructive sleep apnea syndrome (OSAS) in patients with polysomnographic parameters was investigated.
Methods: A total of 77 OSAS patients were included in the study. All-night polysomnographic recordings obtained from patients with enuresis parameters and the presence of traffic accidents recorded in standard form.
Results: The mean age of patients was 45.15 ± 11.53 years. 53% of the patients were male and 47% female. The mean apnea hypopnea index (AHI) in patients was 13.54 events/h. History of traffic accidents was found in 12% patients. Apnea hypopnea index, supine AHI, arousal index and oxygen desaturation index were found significantly different parameters between history of traffic accidents group and non-history of traffic accidents group (p <0.05).
Conclusion: In this study, patients with OSAS severity of the disease with a history of traffic accidents were associated the relationship between the parameters. This relationship with the severity of the disease might be due to the negative effects on attention.
Keywords: OSAS, traffic accident, AHI
Colorectal cancers: 12 year-results of a single center
Mehmet Küçüköner, Muhammed Ali Kaplan, Ali Inal, Zuhat Urakci, Necip Nas, Abdurrahman Isikdogan
J Clin Exp Invest 2013;4(2):208-212.
https://doi.org/10.5799/ahinjs.01.2013.02.0267
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: In this study, we aimed to investigate retrospectively demographic, epidemiological, clinical features, and the factors affecting survival of patients with colorectal cancer who were followed up in our clinic.
Methods: A total of 767 patients diagnosed with colorectal cancer, treated and followed up in Dicle University Medical Faculty, Department of Medical Oncology, between 2000 and 2012 were retrospectively evaluated.
Results: A total of 767 patients [335 women (43.7%) and 432 men (56.3%)] were included in the study. The median age of the patients was 54 (range, 11-94). According to the stage of the tumor in 725 patients, 57 (7.9%) patients were in stage I, 230 (31.7) were in stage II, 248 (34.2) were in stage III and 190 (26.2%) were in stage IV. The median follow-up time for all the patients was 24.8 months (range: 1.5-154.1 months). There were recurrence or progression in 275 patients (35.9%) and there were death in 184 patients (24%). Disease free survival (DFS) rates of 81%, 62% and 29%, respectively. The 1, 3 and 5 yearly overall survival (OS) rates were 88%, 74% and 49%, respectively. When we evaluated the patients according to the age group, under 60 years of age was better than over 60 years in term of DFS and OS (p=0.053 and p=0.024). A statistically significant difference was observed in the survival rates (DFS and OS) related to the stage of the disease. (p<0.001 and p<0.001). Degree of tumor differentiation was effective on DFS (p=0.027). In the multivariate cox analysis, the stage was seen as a significant independent factor in both OS and DFS (p<0.001, p<0.001).
Conclusion: The majority of the patients diagnosed with colorectal cancer consisted of locally advanced patients and metastatic stage (60.4%) in our region. Stage, histological grade and age were found as effective prognostic factor on both overall and disease-free survival. In multivariate analysis, the stage was found as independent prognostic factor on both overall and disease-free survival.
Keywords: Colon cancer, prognosis, single center
Comparison of acute phase response during attack and attack-free period in children with Familial Mediterranean Fever
Erdal Çakmak, Aydın Ece, Selvi Kelekçi, İlyas Yolbaş, Ali Güneş, Velat Şen
J Clin Exp Invest 2013;4(2):213-218.
https://doi.org/10.5799/ahinjs.01.2013.02.0268
Research Article
[Abstract]
[PDF]
ABSTRACT
Objective: The aim of this study was to compare acute phase reactant (AFR) levels at attack period and attack-free period under colchicine treatment in children with Familial Mediterranean Fever (FMF).
Methods: The diagnosis of FMF was done based on clinical criteria and patients were prospectively followed up for average of 1.2 years. Symptom-onset age, age at diagnosis, clinical symptoms and features of FMF attacks were recorded. MEFV gene mutations were detected by reverse hybridization (strip assay) method. Peripheral blood leukocyte count, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and blood fibrinogen levels were measured by standard methods, both at attack period and during attack-free period.
Results: Totally 105 (55 girls, 50 boys) children with FMF were included. The mean age was 8.9±3.2 years, mean symptom onset age was 5.9 years and mean age at diagnosis was 8.1 years. MEFV gene mutations were as follows: E148Q (29.2%), M694V (24.8%), R761H (15.3%) and V726A (13.1%). The mean AFR values were over normal values in attack period and there was at least one high AFR level in 80.0% of patients. In attack-free period, although the mean values of all AFRs were within normal limits, 31.4% of patients had at least one high AFR level.
Conclusion: Based on these data, one-third of FMF children had a high AFR level, which may be a marker of subclinical inflammation. In children with continuous inflammation during attack-free period, a new anti-inflammatory drug additional to colchicine can be considered in order to prevent complications of chronic inflammation.
Keywords: Familial Mediterranean Fever, acute phase reactants, children, attack period, attack-free period
Phantom tumor of the lung in a patient with preserved left ventricular systolic function
Faruk Ertaş, Halit Acet, Ferhat Özyurtlu, Mehmet Zihni Bilik
J Clin Exp Invest 2013;4(2):242-243.
https://doi.org/10.5799/ahinjs.01.2013.02.0276
Brief Report
[Abstract]
[PDF]
ABSTRACT
A 69-year-old male patient chronic smoker with a past history of hypertension, myocardial infarction was admitted with complaints orthopnea. Examination revealed a blood pressure of 150/100 mmHg, pulse 114/min, tachypnea, jugular venous distention. Extensive bilateral crackles over both lung fields. The findings were consistent with the diagnosis of acute pulmonary edema. Chest radiography and tomography revealed a spherical mass in the middle lobe of the right lung, obscuring the right side of the cardiac silhouette (Fig. 1). Echocardiographic evaluation showed preserved left ventricular systolic function with ejection fraction of 60%, and signs of restrictive type of diastolic dysfunction (E/A=4.8, DT 100 msec). An increase in diuretic dose resulted in improvement in the patient’s symptoms and A repeat radiograph and tomography (Fig. 2) after successful treatment of the acute pulmonary edema showed complete resolution of the opacity consistent with the diagnosis of “pseudotumor” or “vanishing tumor” or “phantom tumor” of the lung. Phantom tumor is generally believed to occur in patients with systolic dysfunction (1). Phantom tumor of the lung refers to the accumulation of fluid in the interlobar spaces as a result of congestive heart failure, giving the radiological appearance of a neoplasm. Rapid radiological improvement in response to treatment for heart failure is a classical feature of this clinical entity. Although phantom tumor is generally believed to occur in patients with systolic dysfunctio, in our case, its appearance was secondary to diastolic dysfunction. We presented phantom tumor of the lung in a patient with preserved left ventricular systolic function.
Keywords: Phantom tumor, pseudotumor
Fibrous dysplasia originating from the middle ear
Ekrem Karakaş, Nihat Kılıcaslan, Ömer Karakaş, Ferhat Bozkuş
J Clin Exp Invest 2013;4(2):219-220.
https://doi.org/10.5799/ahinjs.01.2013.02.0269
Case Report
[Abstract]
[PDF]
ABSTRACT
Fibrous Dysplasia is rarely seen in adults. The anterior craniofacial bones are more commonly involved than more lateral or posterior regions. Loss of vestibular function, tinnitus and hearing loss may be seen associated with sphenoid and temporal bone involvement. We aimed to report the case of a thirty-year-old female patient with fibrous dysplasia located in the middle ear.
Keywords: CT, fibrous dysplasia, middle ear
Osteoma located in the external ear canal
Ekrem Karakaş, Nihat Kılıcaslan, Ömer Karakaş, Ferit Doğan, Ferhat Bozkuş
J Clin Exp Invest 2013;4(2):221-222.
https://doi.org/10.5799/ahinjs.01.2013.02.0270
Case Report
[Abstract]
[PDF]
ABSTRACT
Osteomas of the temporal bone are rare, slowly growing, benign neoplasms. They can cause symptoms of conductive hearing loss and fullness in the ear. We aimed to report the case of a 43-year-old female patient with osteoma located in the external ear canal.
Keywords: CT, external auditory canal, osteoma
Acute epidural hematoma manifesting with monoplegia in a child: Case report
Hakan Ak, Sadiye Yolcu, Özlem Balbaloğlu
J Clin Exp Invest 2013;4(2):223-225.
https://doi.org/10.5799/ahinjs.01.2013.02.0271
Case Report
[Abstract]
[PDF]
ABSTRACT
A seven year-old girl presented with left sided painless monoplegia at the lower extremity after falling from two meters height. Cranial computed tomography showed right sided fronto-parietal epidural hematoma. Urgent decompressive craniotomy for the evacuation of the hematoma was performed. Patient discharged two weeks after admission with minimal loss of muscle strength. Fronto-parietal epidural hematomas may also manifest with monoplegia and early evacuation should be standard management.
Keywords: Epidural hematoma, monoplegia, computed tomography
A case of Plasmodium vivax malaria with respiratory failure
Hülya Günbatar, Bünyamin Sertoğullarından, Selami Ekin, Bülent Özbay, Aysel Sünnetçioğlu
J Clin Exp Invest 2013;4(2):226-228.
https://doi.org/10.5799/ahinjs.01.2013.02.0272
Case Report
[Abstract]
[PDF]
ABSTRACT
Acute renal failure disseminated intravascular coagulation, acute respiratory distress syndrome (ARDS), hypoglycemia, coma or epileptic seizures are manifestations of severe Plasmodium (P.) falciparum malaria. P. vivax malaria is rarely associated with severe complications. We report a case of 30-year-old male refugee coming from Pakistan, has been found in hospital garden as unconscious. After therapy of pneumonia requiring intensive care unit and intensive supportive care, the patient left invasive mechanical ventilation (IMV). Because of continued fever and chills attacks focused on malaria diagnosis, Plasmodium vivax malaria detected on thick peripheral blood smear. After intensive supportive care and specific anti-plasmodial therapy, the patient recovered and was discharged from hospital. The use of IMV vivax-malaria related ARDS was associated with a good outcome.
Keywords: ARDS, Plasmodium vivax, pneumonia, respiratory failure
Anticoagulant-induced hemopericardium with tamponade: A case report and review of the literature
Faruk Ertaş, Nihat Polat, Abdulkadir Yıldız, Mustafa Oylumlu, Mehmet Sıddık Ülgen
J Clin Exp Invest 2013;4(2):229-233.
https://doi.org/10.5799/ahinjs.01.2013.02.0273
Case Report
[Abstract]
[PDF]
ABSTRACT
Acute cardiac tamponade requires urgent diagnosis and treatment. We report a case of a 43-year-old man who was receiving warfarin treatment for 8 months following mitral valve replacement. The patient had complaint of dyspnea and fatigue for a few days. Cardiac tamponade was diagnosed, and the INR at that time was 10.4. Urgent pericardiocentesis were undertaken and 1400 ml of pericardial blood was drained. Following surgery the patient’s recovery was uneventful. An intravenous vitamin K injection and fresh frozen plasma transfusion were administered to reverse the patient’s over-anticoagulated state. The final pathology revealed chronic inflammation and there was no malignancy, and no bacteria or mycobacterium were seen. Emergency physicians should remember that over-anticoagulation with warfarin may contribute to certain complications, including hemopericardium, and that strict control of target INR should be the goal for patients who require continuous warfarin treatment.
Keywords: Hemopericardium, tamponade, oral anticoagulation, warfarin, echocardiography
Anesthetic management in an appendix tumor patient undergoing hyperthermic chemotherapy
Yonca Yanlı, Erdem Akçay, Cafer Yürük, Nurten Bakan
J Clin Exp Invest 2013;4(2):234-237.
https://doi.org/10.5799/ahinjs.01.2013.02.0274
Case Report
[Abstract]
[PDF]
ABSTRACT
Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is a complex and multidiscipliner procedure that is being used increasingly for peritoneal and appendix malignency. First of all the macroscopic tumor tissues are extracted after that peritoneal perfusion is started with giving heated 42°C chemotherapeutic solution via abdominal drains. It is important to maintain normovolemia, to regulate coagulation and renal parameters during perioperative period, to compansate hypothermia during cytoreductive surgery and hyperthermia during HIPEC and to regulate hemodynamic changes due to increased abdominal pressure during HIPEC.
In this case report, we aimed to share anaesthetic experience and to evaluate anaesthetic problems in 45 years old ASA I patient undergoing cytoreductive surgery and hypertermic intraperitoneal chemotherapy in which newly established in our hospital for appendix tumor.
Keywords: Anaesthesia, general, hyperthermic intraperitoneal chemotherapy, cytoreductive surgery
Anesthetic management in a pediatric patient with Noonan syndrome, hypopituitarism and hypothyroidism: A case report
Abdulkadir Yektaş, Ramazan Ahmet Altunbay, Ayşin Alagöl
J Clin Exp Invest 2013;4(2):238-241.
https://doi.org/10.5799/ahinjs.01.2013.02.02275
Case Report
[Abstract]
[PDF]
ABSTRACT
Noonan syndrome is a genetically transmitted autosomal dominant disorder characterized by various anatomic anomalies and pathophysiologic derangements. Associated anomalies include hyperthelorism, ptosis, micrognathia, downward sloping palpebral fissures, low-set ears, abnormal helix of ear, deeply grooved philtrum, short and/ or webbed neck, low hairline and cervical vertebral anomalies. Patients with Noonan syndrome are known to present with challenging airways. Tracheal intubation can be difficult because of airway and cervical vertebral anomalies and bag mask ventilation may be difficult because of asymmetrical face. We present a case of anesthetic management for Noonan syndrome.
Keywords: Anesthesia, general, noonan syndrome, airway management
Magnesium: Effect on ocular health as a calcium channel antagonist
Şafak Korkmaz, Feyzahan Ekici, Hasan Ali Tufan, Bahri Aydın
J Clin Exp Invest 2013;4(2):244-251.
https://doi.org/10.5799/ahinjs.01.2013.02.0277
Review
[Abstract]
[PDF]
ABSTRACT
Magnesium is the physiologic calcium channel blocker, involving in many different metabolic processes by maintaining cell membrane function, modulating smooth muscle contraction and influencing enzymatic activities. Magnesium has been shown to increase blood flow to tissues by modifying endothelial function via endothelin-1 (ET-1) and nitric Oxide (NO) pathways. Magnesium also exhibits neuroprotective role by blocking N-methyl-D-aspartate (NMDA) receptor related calcium influx and by inhibiting the release of glutamate, hence protects the cell against oxidative stress and apoptosis. Both increase in blood flow and its neuroprotective effect make magnesium a good candidate for glaucoma studies. Magnesium has been shown to decrease oxidative stress and apoptosis in retinal tissue and to have retinal ganglion cell sparing effect. A series of studies has been conducted about magnesium could decrease insulin resistance in diabetic patients, ease glycemia control and prevent diabetic retinopathy. Magnesium is found to be critically important in maintaining normal ionic homeostasis of lens. Magnesium deficiency has been shown to cause increased lenticular oxidative stress and ionic imbalance in the lens so trigger cataractogenesis.
Keywords: Magnesium, calcium channel blockage, glaucoma, neuroprotection, diabetic retinopathy, cataract
Lung diseases due to non-tuberculosis mycobacteria
Özlem Abakay, Hadice Selimoğlu Şen
J Clin Exp Invest 2013;4(2):252-257.
https://doi.org/10.5799/ahinjs.01.2013.02.0278
Review
[Abstract]
[PDF]
ABSTRACT
Nontuberculous mycobacteria are ubiquitous environmental organisms that have been recognized a cause of pulmonary infection or disease for over 50 years. Traditionally patients have had underlying risk factors for development of disease; however, to describe of apparently immunocompetent patients involved appears to be possible. The diagnosis of culture-positive all patients for mycobacteria have to evaluate according to 2007 criteria. For patients with disease, combination antibiotic therapy for 12-24 months is generally required for successful treatment. However, there is a poor correlation between in vitro antibiotic susceptibility and in vivo response to antimicrobials. Therefore, the lung diseases due to nontuberculous mycobacteria are an increasing problem for clinicians and are associated with significant obstacles that thwart successful treatment of the diseases due to nontuberculous mycobacteria. Continued progress in diagnosis, pathogenesis and treatment of disease will improve the outlook for these patients.
Keywords: Nontuberculous mycobacteria, lung diseases, diagnosis
The application of laboratory tests in pediatric rheumatology practice
Aydın Ece, Cahit Şahin
J Clin Exp Invest 2013;4(2):258-261.
https://doi.org/10.5799/ahinjs.01.2013.02.0279
Review
[Abstract]
[PDF]
ABSTRACT
Rheumatologic diseases in children are an important group of disorders that may lead to severe complications and growth retardation. There are no specific diagnostic tests for rheumatologic diseases, except for anti-nuclear antibody and anti-dsDNA for systemic lupus erythematosus and c-ANCA for Wegener’s disease. Because of, taking a detailed patient’s medical history and performing a good physical examination most probably can provide a diagnosis, and there is no specific test or “test panel” to diagnose or exclude rheumatologic disorders; it is imperative to choose laboratory tests selectively, based on a good clinical knowledge. Another important point is the existence of false positive test results in normal healthy population. In this review, the use laboratory investigations and their importance in diagnosis and follow up of disease in pediatric rheumatology practice has been discussed.
Keywords: Pediatric rheumatology, laboratory investigations, diagnosis, differential diagnosis
Leukemoid reaction in a patient with acute lymphoblastic leukemia following the second chemotherapy
Osman Yokuş, Murat Albayrak, Aynur Albayrak, Habip Gedik
J Clin Exp Invest 2013;4(2):262-263.
https://doi.org/10.5799/ahinjs.01.2013.02.0280
Letter to Editor
[Abstract]
[PDF]
ABSTRACT
The occurrence of persistent neutrophilic leukocytosis above 50,000 cells/μL for reasons other than leukemia is defined as leukemoid reaction. Chronic myelogenous leukemia (CML) and chronic neutrophilic leukemia (CNL) should be excluded, and underlying diseases or causes should be examined, in differential diagnosis. The most commonly observed causes of leukemoid reactions are severe infections, intoxications, malignancies, severe hemorrhage, or acute hemolysis [1].
Keywords: