Intragastric manometric measurements of patients with hiatal hernia: A prospective controlled study
Kemal Peker, Abdullah İnal, Mustafa Emiroğlu, İsmayil Yılmaz, İsmail Demiryılmaz, Arda Işık
J Clin Exp Invest 2014;5(1):1-6.
https://doi.org/10.5799/ahinjs.01.2014.01.0349
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Objective: Hiatal hernia is a disorder in which abdominal contents, especially gastroesophageal junction and proximal stomach are displaced through an incompetent esophageal hiatus into mediastinum. Aim of this study is to investigate the relationship betweeen intragastric pressure and incompetent cardioesophageal sphincter and hiatal hernia.
Methods: The sample is composed of 81 individuals; 51.9% of which are male (n: 42) and 48.1% of which are female (n: 39) with median age of 42.00. Two groups have been constituted: A control group of healthy volunteers (G1) and a patient group with hiatal hernia (G2). After gastroscopy, all patients and controls underwent gastric and esophageal manometry using a water perfused catheter
Results: Mean intragastric pressure was 1,308 mmHg for G1 and, -0,105 mmHg for G2. Mean lower esophageal pressure were 13,143 mmHg and 11,65 mmHg, and upper esophageal pressure were 35,273 mmHg and 27,211 mmHg for G1 and G2, respectively. 24 hour pH metry test revealed 26.8% physiologic gastroesophageal reflux and 73.2% pathologic gastroesophageal reflux in G2. There were statistically significant difference between two groups for mean intragastric pressure (p <0.001) and mean lower esophageal pressure (p <0.05).
Conclusion: This study shows that hiatal hernia results in significantly lower intragastric pressures.
Keywords: Hiatal Hernia, Manometry, Intragastric Pressures
Management of adnexal torsion
Neslihan Erkal, Bekir Sıtkı İsenlik, Mete Çağlar, Birsen Sahillioğlu, Selahattin Kumru
J Clin Exp Invest 2014;5(1):7-11.
https://doi.org/10.5799/ahinjs.01.2014.01.0350
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Objective: To evaluate clinical findings, operative reports, the pathological results of patients with diagnosis of adnexal torsion.
Methods: Fourteen patients with diagnosis of adnexal torsion who presented to our clinic between January 2009 and March 2013 were included in this retrospective analysis. Data including clinical findings, operative reports, the pathological results were recorded.
Results: The mean age of the patients was 28.1 ± 10.5 with a range of 16 to 52 years. All patients underwent ultrasonography, and a pelvic mass appearance was detected in all cases. The mean diameter of the mass was 8,04±2,96 cm. All of the patients had lower abdominal pain, nausea and vomiting. Six patients were operated laparoscopically, while eight patients had laparotomy. Detorsion and cystectomy was performed in 7 (50.0%) of the patients. Two of patients were pregnant in operation time that treated by cystectomy and detorsion of the ovaries successfully in the first and third trimester (one by laparoscopy). There was one patient of isolated fallopian tube torsion due to hydrosalpinks treated by laparoscopic salpingectomy. Two of the patients had paratubal cyst and tubal torsion. Detorsion and cystectomy by laparoscopy and salpingectomy by laparotomy were performed for these patients respectively. The most common histopathology was serous cystadenoma (28,6%).
Conclusion: Adnexal torsion is a rare gynecologic emergency of women and occur in reproductive ages mostly. Prompt diagnosis and conservative treatment is important for the safety of ovaries and fallopian tubes and future fertility.
Keywords: Adnexal torsion, conservative management, detorsion
Influence of sevoflurane on hemodynamic parameters in low flow anesthesia applied without nitrous oxide
Özer Debre, Aykut Sarıtaş, Yılmaz Şentürk
J Clin Exp Invest 2014;5(1):12-17.
https://doi.org/10.5799/ahinjs.01.2014.01.0351
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Objective: In this study, it was aimed to investigate the hemodynamic effects of sevoflurane in low flow anesthesia (LFA) without nitrous oxide.
Methods: A total of 40 ASA I-II patients aged between 18-70 years were included in this study. Patients were randomly allocated to two groups. Group 1 (LFA with nitrous oxide) was applied preoxygenation with 10 L/min 100% O2 for 2 min. After preoxygenation, 4-7 mg/kg pentothal, 0.1 mg/kg vecuronium bromide and 1 μg/kg fentanyl were applied respectively via intravenous route. Endotracheal intubation was applied 3 min later after induction. 4 L/min (50% O2-50% N2O) normal flow had been applied within the first 10 min of the operation following intubation, it was switched to 1 L/min (50% O2-50% N2O) low flow. Sevoflurane concentration was set as 0.8-1 MAK so as to keep mean blood pressure (MBP) within ± 20% limits. In Group 2 (LFA without nitrous oxide) all procedure was the same with Group I except that air was used instead of N2O. Heart rate (HR), MAP, SPO2 and ETCO2 values were recorded just after intubation and following 15, 30, 45 and 60. min and switched to 4 L/min of normal flow 15 min before termination of the operation.
Results: There were no significant differences between the groups from measurement after induction to 60 min measurement in terms of systolic blood pressure (SBP) and ETCO2. Values in Group I were found greater than those in Group II at 15 min measurement in terms of diastolic blood pressure (DBP), MAP and HR (p<0,05). No complications were encountered in patients.
Conclusion: We concluded that preferring LFA techniques applied without N2O, with sevoflurane is beneficial if proper conditions are provided
Keywords: Low flow anesthesia, nitrous oxide, sevoflurane, hemodynamic parameters
Approach to cases with postpartum haemorrhage: Retrospective analysis of 41 cases
Adnan İncebiyik, Aysun Camuzcuoglu, Nese Gul Hilali, Ahmet Kucuk, Hasan Husnu Yuce, Harun Aydogan, Hakan Camuzcuoglu, Mehmet Vural
J Clin Exp Invest 2014;5(1):18-23.
https://doi.org/10.5799/ahinjs.01.2014.01.0352
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Objective: To assess treatment approaches and outcomes in 41 cases with postpartum haemorrhage (PPH).
Methods: Screening the electronic database of the hospital identified 41 cases admitted to the obstetrics clinic with a diagnosis of PPH (ICD codes: O72, O72, O72.2) between January 1, 2010, and June 30, 2013. The clinical findings and the results of the surgical and medical treatments used were noted in all the patients.
Results: Forty-one cases with PPH were detected who had been managed at the clinic during a 3-year period. Normal spontaneous vaginal delivery (26 patients; 63.4%) was the most common type of delivery. Uterine atony was the most common cause of PPH in 30 patients (73.2%). Medical therapy was the most common therapeutic approach in PPH caused by uterine atony (16 patients; 53.3%), followed by total abdominal hysterectomy (TAH) plus bilateral hypogastric artery ligation (9 patients; 30.0%), uterine packing sutures plus bilateral hypogastric artery ligation (BHAL) (4 patients; 13.3%) and intrauterine balloon tamponade (IUBT) (one patient; 2.4%). Only one of 3 patients with uterine rupture underwent a hysterectomy. Three patients in whom placental adhesion anomalies were detected were treated by a combination of manual removal of the placenta, uterine curettage and IUBT.
Conclusion: The results suggest that care should be taken regarding PPH in pregnant women, even in those without any risk factors. In particular, the third phase of labour should be carefully monitored. Medical treatment and organ-sparing surgery are generally associated with positive outcomes in patients with stable haemodynamic status.
Keywords: Surgical treatment, medical treatment, postpartum haemorrhage
Assessment of neutrophil / lymphocyte ratio in patients with myocardial bridge
Abdulkadir Yıldız, Mehmet Ata Akil, Fetullah Kayan, Murat Yuksel, Mustafa Oylumlu, Mehmet Zihni Bilik, Nihat Polat, Mesut Aydin, Halit Acet, Sait Alan
J Clin Exp Invest 2014;5(1):24-28.
https://doi.org/10.5799/ahinjs.01.2014.01.0353
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Objective: Myocardial bridge (MB) is a congenital anomaly characterized by systolic narrowing of the epicardial coronary arterial segment while traveling in the myocardium. It is a benign entity but previous studies showed that the proximal portion is prone to an enhanced atherosclerosis. Neutrophil/lymphocyte ratio (NLR) is a sensitive marker of systemic inflammation used as a predictor for adverse cardiovascular outcomes in atherosclerotic heart disease. So in this study, we sought to evaluate the association between NLR and myocardial bridging.
Methods: A total of 172 patients (mean age: 50.8 ± 11.5 years, 77.3% men) with either angiographically proven MB or normal coronary arteries were included in the study. For the entire study population, hematologic parameters were measured using an automatic blood counter.
Results: The study population consisted of 71 patients with MB (mean age: 51.4 ± 11.9 years, 80.3% male) and 101 patients with normal coronary arteries (mean age: 50.5 ± 11.3 years, 75.2% male). There were no significant differences between groups regarding hemoglobin level, platelet count, glucose and creatinine. Compared to the control group, NLR was significantly higher in patients with MB (2.45 ± 1.19 vs. 1.72 ± 0.48; p< 0.001). In ROC analysis, NLR > 1.82 predicted myocardial bridge presence with 70% sensitivity and 71% specificity (ROC area under curve: 0.733, 95% CI: 0.654-0.811, p < 0.001).
Conclusion: Our study findings demonstrated that MB is associated with elevated NLR, which is used to assess inflammatory status of the body.
Keywords: Inflammation, neutrophil/lymphocyte ratio, and myocardial bridge
Risk factors for development of complication following peripherally inserted central catheters: A retrospective analysis of 850 patients
Hakan Aydın, Gülsen Korfalı, Suna Gören, Esra Mercanoğlu Efe, Bachri Ramadan Moustafa, Tolga Yazıcı
J Clin Exp Invest 2014;5(1):29-35.
https://doi.org/10.5799/ahinjs.01.2014.01.0354
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Objectives: Peripherally inserted central venous catheters (PICCs) are inserted into central veins through the upper extremity veins. In this retrospective study, we aimed to evaluate PICC procedures, related complications, their causes and factors influencing the success of the procedure during anaesthesia
Methods: ‘Central Venous Catheterization Forms’ filled out for 850 patients in whom a PICC was inserted by residents during general anaesthesia between November 2009 and March 2013 in the operating room of Uludag University Medical Faculty Hospital were retrospectively analysed.
Results: A total of 1174 procedures were evaluated. The most preferred vein for the first attempt was the right basilic vein (32.7%). Difficulty (more than two attempts) with the PICC procedure was correlated with the patient’s age (p<0.001), BMI <20 kg/m² (p<0.05), previously used vein (p<0.001) and resident’s experience (p<0.001). A total of 8.2% of patients had complications, with the most frequent complication subcutaneous haematoma at the procedure site (5.3%). Risk factors for complications were advanced age (p<0.05), female gender (p=0.024), BMI >30 kg/m² (p<0.05), resident with less than 4 years of training (p=0.001), number of PICC attempts ≥2 (p<0.001), more than one resident involved in the catheterization procedure (p<0.001) and previous failed PICC procedures (p<0.001).
Conclusion: We conclude that catheterization should be performed under the surveillance of a staff keeping in mind the risks of complications. In the case of failure following 2 attempts, the procedure should be handed over to a more experienced staff member.
Keywords: Peripheral venous catheterization, complications, risk factors, incidence
Comparing of two surgical techniques in large incisional hernias
Mustafa Şit, Ahmet Serkan Ilgun, Affan Cakir, Oguz Catal, Rıdvan Cakmaz
J Clin Exp Invest 2014;5(1):36-39.
https://doi.org/10.5799/ahinjs.01.2014.01.0355
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Objectives: Incisional hernias occur from incisions of previous abdominal operations. It is an often complication of abdominal interventions. Prevalence of incisional hernias is approximately 2.9% and 3.6% in vertical midline incisions and transverse incisions, respectively. Incisional hernias cause morbidity and loss of manpower. The only treatment option is surgery. We aimed to compare surgical methods of incisional hernias and discuss the postoperative data in this retrospective report.
Methods: We retrospectively analyzed the data of 54 patients with large incisional hernias operated between 2007 and 2011.
Results: We compared age, chronic diseases (e.g. Chronic obstructive pulmonary disease, diabetes mellitus),which may cause postoperative recurrence, gender, personal factors, such as patients undergoing incisional hernia repair mesh over solid fascia less or over than 5 cm with the placement of decolation; recurrence, the development of postoperative seroma, receiving postoperative drainage and postoperative length of hospital stay were compared. While the recurrence rate of less than 5 cm above the decolation; seroma development, no significant difference in length of hospital stay and drain times to get.
Conclusion: In conclusion, we think that recurrence rate should be reduced by dissection of 5 cm intact fascia and grafting in incisional hernias of anterior abdominal wall.
Keywords: incisional hernia, hernia repair, recurrence
Electrocardiographic patterns of exercise-induced ventricular arrhythmias in patients with and without coronary artery disease
Özgül Malçok Gürel, Özcan Özeke, Fırat Özcan, Cağatay Ertan, Zafer Büyükterzi, Tumer Erdem Güler, Aytun Çanga, Veli Kaya, Mehmet Fatih Özlü, Dursun Aras
J Clin Exp Invest 2014;5(1):40-44.
https://doi.org/10.5799/ahinjs.01.2014.01.0356
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Objectives: This study was carried out to compare the electrocardiographic characteristics of exercise-induced ventricular arrhythmias (EIVA) in patients with and without coronary artery disease (CAD).
Methods: The exercise tests of patients who were diagnosed to have EIVA and also underwent coronary angiography were analyzed retrospectively. The electrocardiographic patterns of EIVA in patients with and without CAD were compared.
Results: The most common EIVA was premature ventricular contractions (PVCs) with left bundle-branch block (LBBB) pattern and inferior axis in both groups (63% in normal coronary artery (NCA) group and 59% in CAD group). PVCs with right bundle-branch block (RBBB) pattern and superior axis (33% vs. 17%, p=0.001) and the presence of multifocal PVC were found to be more frequent in CAD group (23% vs. 7%, p<0.001). Also, the timing of the exercise induced PVCs (during exercise, recovery or both) did not differ between the groups.
Conclusion: The present study revealed that the most common EIVA was PVCs with LBBB pattern and inferior axis. Also, multifocal PVCs and the PVCs in RBBB pattern with superior axis were more common in CAD patients.
Keywords: Coronary artery disease, exercise test, ventricular arrhythmias
Surgery for ingrowing nail is an effective treatment choice in an urban region
Tonguç Utku Yılmaz
J Clin Exp Invest 2014;5(1):45-47.
https://doi.org/10.5799/ahinjs.01.2014.01.0357
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Objectives: The aim of this study is to evaluate the risk factors and treatment outcomes of patients with ingrowing nails in an urban region.
Methods: This descriptive prospective study was performed in a General Surgery outpatient clinic in an urban region for 6 months. The data about sex, risk factors, age, history of previous medication were obtained. Body mass index, the ratio of second toe to the length of hallux, the ratio of the diameter of hallux to width of hallux nail were calculated. The ingrowing nails with stage II and III were treated by Winograd method. The patients were followed for recurrences and complications for nearly 6 months.
Results: Total 61 patients were treated. Female to male ratio was 33/28. The man age was 24.8±11.8. The mean BMI was 28.5±5.3. Tight shoes, improper nail trimming were the leading etiological factors. Total 44 patients had a history of at least one time antibiotic usage history. Symptoms were found to be increased after pregnancy (66.7%). Lateral localization was significantly higher in patients with longer second toe than the hallux. There were 5 postoperative infections (8.2%) and only one (1.6%) recurrence.
Conclusion: Ingrowing nail is an important problem because of increased risk factors in urban region. Winograd method which is an easy method with low recurrence and high patient satisfaction can be preferred.
Keywords: Ingrowing nail, urban region, Winograd, hallux pathology
Can lactoferrin modulate the immunostimulant activity of levamisole in rats immunosuppressed by cyclophosphamide?
Wafaa Abdou Mohamed
J Clin Exp Invest 2014;5(1):48-53.
https://doi.org/10.5799/ahinjs.01.2014.01.0358
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Objective: The aim of this study was to study the immunomodulatory activity improvement of levamisole by using lactoferrin when applied to immunosuppressed rat model.
Methods: The study was designed as follows, 140 male albino rats (250-280 g) 14 weeks old were used in our work. Rats were randomly divided into seven groups, 20 in each. The group I was kept as a control, group II was given cyclophosphamide (CYP) at a single intraperitoneal dose of (250 mg/kg body weight), group III CYP and lactoferrin (Lac) treated group, group IV orally administrated Lac only (0.5%) in drinking water, group V treated with CYP and levamisole, group VI administrated levamisole orally at a dose of (2.5 mg/kg body weight) and group VII was given CYP, Lac and levamisole. Animals were sacrificed and two separate blood samples were collected after 21 days from the beginning of the experiment for measuring the total and differential leukocyte count, serum total proteins, albumin, alpha globulin, beta globulin and gamma globulin, Nitric oxide (NO) production and lysozyme activity.
Results: CYP group showed significant decrease in the above mentioned parameters, which were improved after administration of both lactoferrin and levamisole.
Conclusion: Our study concluded that lactoferrin improve the immunostimulant effect of levamisole in CYP- immunosuppressed rats.
Keywords: Bovine lactoferrin (Lac), Levamisole , Cyclophosphamide(CYP), Immunomodulation, Lysozyme assay
Retrospective evaluation of outcomes in lumbar disc surgery with spinal anesthesia
Vaner Köksal, Ahmet Şen, Başar Erdivanlı, Bülent Özdemir
J Clin Exp Invest 2014;5(1):54-58.
https://doi.org/10.5799/ahinjs.01.2014.01.0359
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Objective: We investigated feasibility, possible advantages and disadvantages of spinal anesthesia in lomber disc surgery.
Methods: We retrospectively analyzed a total of 100 patients operated for elective lomber spinal surgery under spinal anesthesia.
Results: Spinal anesthesia was sufficient for lumbar disc surgery in 97 of 100 patients. Three patients received general anesthesia due to insufficient spinal block. Allergic reaction was observed in one patient receiving general anesthesia, and treated with intravenous steroid and antihistaminic drugs. We observed bradycardia and hypotension necessitating ephedrine administration in eight patients, post dural puncture headache in 10 patients (two patients were discharged at 4 and 7 days later therefore), who received spinal anesthesia. Following spinal anesthesia, patients required first analgesic at 10th hour. Patients receiving general anesthesia demanded first analgesic in the post operative care unit.
Conclusion: We are of the opinion that spinal anesthesia may be safely used in lumbar disc surgeries, provided that patients are not positioned until sufficient anxiolytic and spinal block are established.
Keywords: Spinal anesthesia, spinal surgery, intraoperative complications, postoperative pain
Etiological factors of psoas abscesses
Mehmet Nuri Bodakçi, Namık Kemal Hatipoğlu, Mansur Dağgulli, Mazhar Utangaaç, Mehmet Guli Çetinçakmak, Nebahat Hatipoğlu, Haluk Söylemez
J Clin Exp Invest 2014;5(1):59-63.
https://doi.org/10.5799/ahinjs.01.2014.01.0360
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Objective: Psoas abscess (PA) is a rare infection disease, which is difficult to diagnose. In the present study, we aimed to evaluate etiological factors and treatment results of patients with PA.
Methods: Files of 20 patients who were diagnosed as PA between December 2006 and January 2013, were retrospectively analyzed. Patient’s whose data were entirely reached and diagnosed by Ultrasonography and/or Computed Tomography as an exact PA were included to the study.
Results: The mean age of the 20 patients was 48.8 (range 17-82) year, and 6 of them were female and remaining were male. Psoas abscess were on the right side in 12 patients (60%), on the left side in seven patients (35%), and bilateral in one (5%). According to data records four patients had Diabetes Mellitus (20%), two had Hypertension (10%), one had cerebrovascular disease (5%), one had tuberculosis (5%), one had hyperthyroidism (5%), one had mental retardation (5%), and one had paraplegia (5%). Six case (30%) were diagnosed as a primary psoas abscess (pPA, sPA) and remaining (n=14, %70) were diagnosed as secondary. Percutaneous drainage was performed to 13 patients (65%) and exploration was performed to three patients (15%) as a treatment modality. Remaining four patients (20%) were followed by medical treatment.
Conclusion: Psoas abscess is rare and have variable and non-specific clinical characteristic, which may lead to difficulty in diagnosis. In developed and developing countries, it has been reported that the most common causes of sPA are Pott's disease, and Crohn's disease, also it should be taken into account that open surgery and urinary tract stone disease can receive a significant portion of the etiological factors.
Keywords: Psoas abscess, etiological factors, primary psoas abscess, secondary psoas abscess
Skin prick test results in patients with atopic symptoms in Yozgat district
Emine Colgecen, Kemal Özyurt, Yavuz Selim İntepe, Zeliha Kapusuz Gencer, Mahmut Özkırış, Ghaniya Ede, Seyhan Karaçavuş
J Clin Exp Invest 2014;5(1):64-68.
https://doi.org/10.5799/ahinjs.01.2014.01.0361
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Objective: Skin prick test (SPT) is used widely and fastly to determine the allergens in atopic disease. We aimed in this study to analysis the relationship between total serum IgE (T.IgE) and allergens that found by SPT and looking over the frequency of allergens.
Methods: We evaluated clinical findings and SPT results and T.IgE levels of 190 patients who admitted to dermatology outpatient clinic, retrospectively.
Results: 53 (27.9%) patients had idiopathic generalized pruritus (IGP), 41 (21.6%) had atopic dermatitis (AD), 40 (21.1%) had chronic idiopathic urticaria (CIU), 38 (20%) had allergic rhinitis (AR), and 18 (9.5%) had allergic asthma (AA). 123 (64.7%) patients had positive reaction to at least one or more allergen on SPT. Of these patients 28 were IGP, 30 were AD, 20 were CIU, 28 were AR, and 17 were AA. The most common allergens were pine pollen (25.3%), wheat pollen (18.4%), and dog epithelium (15.8%). The mean levels of T.IgE was 382.61 ± 517.28 IU/ml (1-2500). T.IgE is higher 54.9% of patients. It was seen that DPT positivity was significantly more frequent in patients with increased T.IgE levels than those with normal total serum IgE level (p<0.05).
Conclusion: We think that pine tree and wheat pollens are the most commonly encountered allergens at Yozgat area. Moreover, our findings indicated to the requirement and benefits of DPT in patients with AD, AR and AA in addition to the those KİU and İJP, particularly in patients with increased T.IgE levels, although further studies with larger sample size are needed.
Keywords: Skin prick test, total IgE, atopy
Diagnostic evaluation of patients presenting with hirsutism
İsmail Zeki Tekiş, Recep Dokuyucu, İhsan Üstün, Cumali Gökçe, Murat Çelik, Gamze Serarslan, Edip Uçar, Kenan Dolapçıoğlu, Hasan Öztürk, Ramazan Davran, Filiz Ertekin, Hatice Rızaoglu, Hasan Kaya
J Clin Exp Invest 2014;5(1):69-75.
https://doi.org/10.5799/ahinjs.01.2014.01.0362
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Objective: Hirsutism, similar to men, is the presence of terminal hairs in androgen-to sensitive areas in women. The present report aimed to study etiology and determine the prevalence of the diseases that causes hirsutism in these patients.
Methods: In this study, total number of 40 patients who admitted because of hirsutism to Department of Endocrinology and Metabolism clinic was enrolled. Demographic, clinical and laboratory parameters of the patients were evaluated.
Results: Result of the study showed that polycystic ovary syndrome is the most common cause of hirsutism. The second most common cause was found as idiopathic hirsutism.
Conclusion: By the present study, etiologic factors of hirsutism were examined firstly in our region in which Ethnic and cultural diversity is concentrated. In rare cases like Cushing's syndrome, hyperprolactinemia, non-classic adrenal hyperplasia, androgen-secreting tumors should be considered in the differential diagnosis of hirsutism.
Keywords: Hirsutism, polycystic ovary syndrome, idiopathic
Surgical management and our clinical experiences in burns
Zeynep Özkan, Emine Tuğba Alataş
J Clin Exp Invest 2014;5(1):76-79.
https://doi.org/10.5799/ahinjs.01.2014.01.0363
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Objective: Burn is defined as a trauma that affects skin, largest organ in human body, and underlying tissue in varying degrees, and its management includes both systemic and local treatment modalities. In the present study, we aimed to review current surgical methods used in burns and patients in our burn unit who underwent surgical treatment.
Method: Medical records of 21 patients, who admitted to burn unit of Elazığ Education and Research Hospital between October, 2008 and February, 2011 and underwent surgical treatment, were retrospectively evaluated.
Results: Overall, 260 patients were admitted to burn unit and 21 (8%) of these patients underwent surgical treatment during 26-months study period. Mean age was 12.2 years in patients underwent surgical treatment. Of these patients, 13 (62%) were men. In the burn unit, escharotomy was performed in 5 patients (23%) underwent whereas escharotomy plus autografting in 3 patients (14%) and early excision plus autografting in 13 patients (63%). Wound healing was achieved in 18 patients (86%) by above-mentioned treatments, while 3 patients were referred to tertiary care facility for further management. No mortality was observed.
Conclusion: Early excision plus grafting is highly successful in profound burns and improves survival rate and quality of life when performed by experienced team.
Keywords: Burn, epidemiology, surgery
Prognostic significance of c-erbB-2 and p53 expression in colorectal carcinoma
Aynur Albayrak, Nesrin Gürsan, Cemal Güngoğdu
J Clin Exp Invest 2014;5(1):80-85.
https://doi.org/10.5799/ahinjs.01.2014.01.0364
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Objective: Colorectal cancer is the fourth commonest form of cancer occurring worldwide. In order to recognize the prognosis in colorectal carcinoma, a lot of clinic and pathologic parameters such as; tumor size, microscopic type, microscopic grade, depth of invasion, lymph node involvement, invasion of vascular and perineural, tumor stage have been used. In this study, we aimed to compare expression of c-erbB-2, p53 and classical prognostic factors, and to investigate the correlation with prognosis.
Methods: In our study, operation materials belonging to 50 colorectal cases were examined retrospectively.
Results: Overall, 100 % of colorectal carcinomas had nuclear-staining for p53 protein and 78% of carcinomas cytoplasmic and membranous staining or the c-erbB-2 showing distribution in a heterogeneous fashion. p53 overexpression correlated with (p<0.005) pathologic stage, metastasis of lymph node, invasion of angiolymphatic, differentiation and degree of tumors. c-erbB-2 overexpressions correlated with (p<0,005) histologic differentiation and peritumoral lymphocytic infiltration but not correlated with tumor size, tumor growth pattern, localisation of tumors, pathologic stage, metastasis of lymph node, invasion of angiolymphatic.
Conclusion: These results suggest that evaluation of c-erbB-2 and p53 Immunohistochemical expression in colorectal carcinomas may be of value in predicting the clinical course in these patients.
Keywords: Colorectal carcinoma, c-erbB-2, p53
West syndrome: Clinical characteristics and short-term outcome
Ünsal Yılmaz
J Clin Exp Invest 2014;5(1):86-92.
https://doi.org/10.5799/ahinjs.01.2014.01.0365
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Objective: Limited data are available on the etiology, clinical approach, treatment and outcome in West syndrome. In the present study, we aimed to document clinical characteristics, etiology and treatment response in children with West syndrome.
Methods: Hospital charts of children who were diagnosed with West syndrome between July-2011 and December- 2013 and who had a follow-up at least 12-month, were reviewed retrospectively.
Results: 38 patients (14 females, 24 males), mean aged 27.1±7.60 months were included. The mean age of seizure onset, interval to diagnosis, and follow-up period were 6.23±4.27 months, 1.36±1.58 months, and 19.3±5.86 months respectively. Perinatal asphyxia (13), tuberous sclerosis (2), cortical dysplasia (2), encephalitis (1), asphyxia due to aspiration (1), congenital cytomegalovirus infection (1), perinatal infarct (1), nonketotic hyperglycinemia (1) and Prader Willi syndrome (1) were the identified causes. The etiology could not be ascertained in the remaining 15 children. Psychomotor development was mildly retarded in 12, moderately retarded in 13, and severely in 13 patients at onset, and did not change significantly at month 12. The initial therapy was synthetic adrenocorticotropic hormone in 11, vigabatrin in 17, levetiracetam in 8 and valproate in 2 patients. At 12th month of therapy, 15 patients were seizure-free, 12 patients showed more than 50% decrease in seizure frequency, and remaining 11 patients showed no significant reduction in seizure frequency.
Conclusion: Besides the perinatal asphyxia as most frequent cause, a wide variety of disorders can present as West syndrome. Although, a 12-month-long treatment achieves seizure control in half of the patients, not beneficial effect on psychomotor development was seen.
Keywords: West syndrome, vigabatrine, adrenocorticotropic hormone
The efficiency of high dose botulinum toxin type-A in the treatment of cerebral palsy
Alper İbrahim Dai
J Clin Exp Invest 2014;5(1):93-97.
https://doi.org/10.5799/ahinjs.01.2014.01.0366
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Objective: Cerebral palsy is the most common cause of severe physical disability in childhood. Botulinum toxin type A (BTX-A), has rapidly gained acceptance as a different treatment for spasticity. However, no consensus exists among clinicians about optimal dose of BTX-A in pediatric patients. Doses of 2-6 U/ kg bodyweight with a maximum total dose of 29U/kg have been reported. This study was conducted due to uncertain dosage rage in pediatric use.
Method: In this study, 12 patients with cerebral palsy and spastic eqinus foot deformity who referred to our center, were treated with BTX-A in the dosage of 25 U/kg. After treatment of BTX-A, patients were followed up total of 6 months. Three months after treatment, Gross motor functional measurement (GMFM) and Modified Ashwort scale (MAS) were done. At the same time, questionnaires (PCQ) were filled for possible side effects.
Results: Average age of 6 girls and 6 boys were 4.5 ± 2.8 years. GMFM and MAS were done before and 3 months after treatment and were found statistically significant (p<0.05). Muscle soreness was the most common symptom at PCQ forms.
Conclusion: Using these two objective scales and PCQ form, high dose of BTX-A treatment was found statistically successful. Larger dose of BTX-A was used which was considered safe, effective and better tolerated by children. Titration of the dose of BTX-A, should be individualized for each patient due to different level of spasticity affecting patients in different ways.
Keywords: Botulinum toxin, cerebral palsy, medical treatment
Bilateral camptodactyly in the fourth and fifth fingers of hands
Ahmet Boyacı, Ahmet Tutoğlu, İrfan Koca
J Clin Exp Invest 2014;5(1):98-99.
https://doi.org/10.5799/ahinjs.01.2014.01.0367
Brief Report
[Abstract]
[PDF]
ABSTRACT
Camptodactyly is characterized by permanent flexion contracture in the proximal interphalangeal joint. Two forms have been defined; the congenital type seen in the first years of life and the adolescent type seen after 10 years of age and the etiology is unknown. In most cases, involvement is limited to the 5th finger. Although generally sporadic, various rates of autosomal dominant genetic inheritance have been reported. The case is presented here of bilateral camptodactyly in the 4th and 5th fingers of hands.
Keywords: Dynamic splint, flexion contracture, camptodactyly
Adenomyotic cyst of the uterus associated with pelvic pain: A case report
Berna Dilbaz, Özlem Şengül, Tuba Zengin, Hatice Dilek Bülbül, Leyla Mollamahmutoğlu
J Clin Exp Invest 2014;5(1):100-102.
https://doi.org/10.5799/ahinjs.01.2014.01.0368
Case Report
[Abstract]
[PDF]
ABSTRACT
Adenomyotic cysts of the uterus are extremely rare and this case report is to document an adenomyotic cyst of the uterus associated with pelvic pain. A 27-year old nulliparous patient admitted to the hospital with the complaint of dysmenorrhea, dyspareunia and pain in the right pelvic region for the last 3 months. Transvaginal ultrasonographic examination revealed a 50 × 36 mm intramural cystic lesion on the right region of the corpus uteri. Hysteroscopic examination showed that it did not deteriorate the endometrial cavity. During laparatomy dissection of the uterine wall revealed 5 cm cystic lesion that was excised circumferentially protecting the surrounding myometrial tissue. The definitive pathology report came out as adenomyotic tissue. Imaging techniques are critical in differential diagnosis of adenomyotic cysts and to choose the appropriate intervention. Medical therapy or surgical intervention like excision of the cyst or hysterectomy may be the choices of treatment.
Keywords: Adenomyotic cyst, pelvic pain, laparatomy
Anesthetic management in VACTERL syndrome
İlker Öngüç Aycan, Hüseyin Turgut, Zeynep Baysal Yıldırım, Gönül Ölmez Kavak
J Clin Exp Invest 2014;5(1):103-105.
https://doi.org/10.5799/ahinjs.01.2014.01.0369
Case Report
[Abstract]
[PDF]
ABSTRACT
VACTERL Syndrome consists of many problems regarding to anesthesia management due to multiple congenital malformations which may include vertebral, cardiac, trachea-osephageal, renal and limb anomalies. Here we present our anesthetic management -in terms of preanesthetic evaluation, premedication, induction and maintenance of anesthesia and postoperative follow up- in a newborn patient with VACTERL Syndrome undergoing tracheo-eosophagial fistula operations.
Keywords: VACTERL syndrome, anesthesia, ketamin
Myxoid degeneration of the tendon as a cause of pediatric trigger finger
Mehmet Eroglu, Mehmet Serhan Er, Recep Abdullah Erten, Hasan Metineren
J Clin Exp Invest 2014;5(1):106-107.
https://doi.org/10.5799/ahinjs.01.2014.01.0370
Case Report
[Abstract]
[PDF]
ABSTRACT
Pediatric trigger finger is rarely seen in clinical practice and when seen is the trigger thumb mostly. A myxoid degeneration of the tendon in the nodule has been detected at superficial flexor tendon of third finger on left side of a 12 year old child who underwent surgery with a diagnosis of trigger finger. The patient is free of pain and triggering after the excision of this degeneration. The aim of this report is to remind that rare pathologies as tendon tumors (or myxoid degeneration, as in our case) of the tendon may be the cause of pediatric trigger finger with most of them requiring surgery.
Keywords: Myxoid degeneration; pediatric; trigger finger
Status epilepticus induced by intrathecal bupivacaine use: A case report
Eşref Akıl, Sefer Varol, Abdulmenaf Guzel, Cuneyt Gocmez
J Clin Exp Invest 2014;5(1):108-111.
https://doi.org/10.5799/ahinjs.01.2014.01.0371
Case Report
[Abstract]
[PDF]
ABSTRACT
Local anesthetics are commonly used as analgesics and anesthetics. Local anesthetics from the amide group may lead to symptoms of the central nervous system (CNS) such as depression, seizures or altered mental state, while they may lead to arrhythmia in the cardiovascular system (CVS). The causes of the neurologic complications observed with spinal local anesthetics are the administration of high doses, rapid entry into the systemic circulation, erroneous administration through the IV route, or the diffusion of the drug towards the cephalic region. Bupivacaine is among the most commonly used local anesthetics from the amide group. However rare, neurological injury after administered bupivacaine can be distressing to patients and their families. In our patient, we have administered bupivacaine through the intrathecal route. Thus, we would like to present a case where status epilepticus in the form of generalised tonic-clonic seizures (GTC) has developed subsequent to the intrathecal administration of bupivacaine.
Keywords: Local anesthetics, status epilepticus, bupivacaine
Acute monoplegia associated with non-traumatic intradural cervical disc herniation: A case report
Ahmet Menkü, Kağan Kamaşak, Cüneyt Göçmez, Kağan Başarslan, Yurdaer Doğu
J Clin Exp Invest 2014;5(1):112-114.
https://doi.org/10.5799/ahinjs.01.2014.01.0372
Case Report
[Abstract]
[PDF]
ABSTRACT
Intradural disc herniation has been reported as a rare and particular type of intervertebral disc herniation. It occurs mostly in the lumbar spine, and rarely in the cervical or thoracic spine. Non-traumatic cervical intradural disc herniation is rare, with only 17 cases reported in English literature at the cervical region and can manifest itself by severe symptoms such as Brown-Sequard syndrome, transverse myelopathy and radiculopathy. We present a unique case of intradural cervical disc herniation only causing lower extremity monoplegia. To our knowledge, this is the first case described in the literature. The patient underwent microsurgical removal of the herniated disc via an anterior approach followed by interbody fixation using a cervical cage.
Keywords: Cervical disc herniation, intradural, monoplegia
Minimally invasive tethered cord release in children: A technical note
Kağan Seyit Başarslan, Kağan Kamaşak, Cüneyt Göçmez, Ahmet Menkü
J Clin Exp Invest 2014;5(1):115-117.
https://doi.org/10.5799/ahinjs.01.2014.01.0373
Case Report
[Abstract]
[PDF]
ABSTRACT
Tethered cord release is commonly performed in pediatric neurosurgery. Nowadays, minimally invasive procedures are created growing interest due to its highly tolerable nature for surgery. It has been main purpose a minimal damaging on access route and maximum protection of normal structures in surgery. We present a surgical treatment of tethered cord syndrome, by which is provided the cord releasing unlike the many methods being applied with tissue removal. The main advantage of performing this surgery through 2 cm hole is to avoid removing ligamentum flavum and bony structure like lamina in addition to reduce the length of the incision and the related scar tissue.
Technical note: the patient was taken on the operating table in the sitting-prone position, and L5-S1 distance was determined by fluoroscopy. The skin and subcutaneous tissues was passed via a 2 cm vertical incision settled in 0.5 cm laterally from midline. L5-S1 distance and its covering ligamentum flavum are displayed by the guidance of L5 lamina. Williams’s retractor was placed in the distance after fetching microscope. The foregoing procedures are the same with microdiscectomic surgery. By a vertical incision made on the flavum, its both layer was lifted up and hanged with simple suture on the back tissue for a comfortable exposure of the Dura. Thecal sac was opened by 0.5 cm long vertical incision on the Dura after obtaining secure CSF drainage with the help of yellow-tipped syringe needle. With finding by a nerve hook, the phylum was burned and released securely. Then the Dura was sutured primarily for the closure by means of microsurgery instruments, and flavum was laid on it again.
Keywords: Minimally invasive, tethered cord, children
The importance of surveillance in children with minor head trauma: A case report
Kağan Seyit Başarslan, Arsal Acarbaş, Cüneyt Göçmez
J Clin Exp Invest 2014;5(1):119-120.
https://doi.org/10.5799/ahinjs.01.2014.01.0374
Case Report
[Abstract]
[PDF]
ABSTRACT
Here we present an analysis of the case of delayed epidural hematoma which had a significant mass effect and required surgical evacuation. We consider that maintaining a high clinical suspicion, coupled with a low threshold for computed tomography scanning, is the key to morbidity prevention in this situation. Close observation for signs of clinical deterioration and repeat CT scan are the most important factors for early detection of the delayed epidural hematoma.
Keywords: Children, epidural hematoma, head injury
A 17-year-old female patient with sigmoid volvulus: Considering the diagnosis
Mustafa Uğur, Akın Aydoğan, Seçkin Akküçük, Ramazan Davran, Aydın Kaplan
J Clin Exp Invest 2014;5(1):121-124.
https://doi.org/10.5799/ahinjs.01.2014.01.0375
Case Report
[Abstract]
[PDF]
ABSTRACT
Sigmoid volvulus is an extremely rare disease among young adults. This may cause delay in diagnosis and treatment and so it may cause life threatening ischemia and necrosis at the colon. In this article we present the case which was confirmed to be sigmoid volvulus with tomographic examinations which was carried upon suspicion of sigmoid volvulus in a 17 years old girl who attended with increasing abdominal pain, constipation, obstipation and distention complaints. Taking a detailed history, performing a physical examination and evaluation of laboratory tests of a patient presenting with complaints like abdominal pain, constipation and distention are the most essential steps to diagnose the sigmoid volvulus. The most important method for early diagnosis in young adults is to keep the diagnosis in mind. So it would be possible to plan advanced radiologic and endoscopic examinations which would confirm the diagnosis.
Keywords: Sigmoid volvulus, detorsion, young patient
Local steroid injection accompanied by ultrasonographic imaging in the treatment of facet syndrome
Murat Karkucak, İpek Can, Erhan Capkın, Mustafa Avni Önder, Emre Baki, ibrahim Batmaz
J Clin Exp Invest 2014;5(1):125-127.
https://doi.org/10.5799/ahinjs.01.2014.01.0376
Case Report
[Abstract]
[PDF]
ABSTRACT
Ultrasonography (USG) is becoming increasingly important in visualizing the musculoskeletal system. It is used as a diagnostic guide and in local injection procedures but is less frequently applied in visualizing deep joints and injections. The purpose of this study is to describe the results of USG-guided facet joint injection in a 19-year-old male patient with low back pain for the preceding year and a preliminary diagnosis of facet syndrome, together with a review of the literature.
Keywords: Facet syndrome, Ultrasonography, Local injection
Hypoxanthine urolithiasis in an 11-month-old child: A case report of
Ahmet Midhat Elmacı, Fatih Akın
J Clin Exp Invest 2014;5(1):128-130.
https://doi.org/10.5799/ahinjs.01.2014.01.0377
Case Report
[Abstract]
[PDF]
ABSTRACT
Hereditary xanthinuria is a novel autosomal recessive disorder of purine metabolism resulting from the deficiency of xanthine dehydrogenase. An 11-month-old boy admitted with the complaints of irritability for 6 months, darkening of the urine and spontaneous passage of stone. Both serum and urine levels of uric acid were below normal. Urinary ultrasonography was normal. Stone analysis revealed that it was a hypoxanthine stone. The case is reported because hereditary xanthinuria is a rare cause of childhood urolithiasis.
Keywords: Hypoxanthinuria; urolithiasis; infancy
Pathophysiology of the spinal cord injury
Tevfik Yılmaz, Yahya Turan, Ayşenur Keleş
J Clin Exp Invest 2014;5(1):131-136.
https://doi.org/10.5799/ahinjs.01.2014.01.0378
Review
[Abstract]
[PDF]
ABSTRACT
Spinal cord injury (SCI) causes significant morbidity and mortality leading to serious social problems. Although many studies conducted on it, any universal treatment protocol has not been accepted to date. Studies about treatment of SCI focused on two mechanisms. First is usage of neuroprotective agents, and second are regeneration studies to improve axonal functions of injured spinal cord. Pathophysiological changes occurring after SCI has to be well understood in order to develop ideal treatment.
Keywords: Spinal cord injury, pathophysiology
Heparin induced thrombocytopenia
Yunus Nazli, Necmettin Çolak, Selim Colak, ömer Çakır
J Clin Exp Invest 2014;5(1):137-144.
https://doi.org/10.5799/ahinjs.01.2014.01.0379
Review
[Abstract]
[PDF]
ABSTRACT
Heparin-induced thrombocytopenia (HIT) is a rare but serious prothrombotic adverse effect of heparin treatment. It is induced by platelet-activating antibodies against complexes of platelet factor 4 and heparin. Diagnosis rests on a clinical assessment of disease probability and laboratory testing. Prompt diagnosis of HIT, discontinuation of heparin use, and subsequent treatment with alternative anticoagulant drugs are essential steps to prevent serious complications such as thrombus formation, limb amputation, and death. In this review, we describe the clinical features of HIT and to summarize the data available for its management.
Keywords: Heparin, thrombocytopenia, cardiac surgery
Mistletoe in the treatment of malignant melanoma
Esin Sakallı Çetin, Pınar Aslan Koşar, Nurten Özçelik
J Clin Exp Invest 2014;5(1):145-152.
https://doi.org/10.5799/ahinjs.01.2014.01.0380
Review
[Abstract]
[PDF]
ABSTRACT
Malignant melanoma is a malignant neoplasia drives from melanocytes. Malignant melanoma, the most causing death, is seen in the third place at skin cancer. Malignant melanoma shows intrinsic resistance to chemotherapeutic agents and variability in the course of the disease which are distinct features separating from other solid tumors. These features prevent the development and standardization of non-surgical treatment models of malignant melanoma. Although there is a large number of chemotherapeutic agents used in the treatment of metastatic malignant melanoma, it hasn’t been demonstrated the survival advantage of adjuvant treatment with chemotherapeutic agents. Because of the different clinical course of malignant melanoma, the disease is thought to be closely associated with immune system. Therefore, immunomodulatory therapy models were developed. Mistletoe stimulates the immune system by increasing the number and activity of dendritic cells, thus it has been shown to effect on tumor growth and metastasis of malignant melanoma patient. Outlined in this review are the recent developments in the understanding the role of mistletoe as a complementary therapy for malignant melanoma.
Keywords: Malignant melanoma, mistletoe, Viscum album
Clinical significance of central corneal thickness and comparison of central corneal thickness measurements methods
Özgür Çakıcı
J Clin Exp Invest 2014;5(1):153-158.
https://doi.org/10.5799/ahinjs.01.2014.01.0381
Review
[Abstract]
[PDF]
ABSTRACT
Significance of central corneal thickness has been increasing in ophthalmology practice. It is an important clinical evaluation tool especially prior to refractive surgery and in diagnosis of glaucoma and keratoconus. Refractive surgery is planned according to preoperative central corneal thickness measurements. Besides, in order to determine actual intraocular pressure, central corneal thickness is measured and corrected eye pressure is obtained. Today, devices used in measurement of central corneal thickness do the measurement according to two principles. First and relatively older method is ultrasonic method. Optic method is the second and more recent method. In daily practice, the most commonly used clinical method in measurement of central corneal thickness is ultrasound pachymeter. However, this measurement technique requires contact between cornea and probe and gives thinner measurement results compared to the methods that use optic principle. Recently, several technologic methods based on optics have been put in use; they provide advantages of non-contact technique and objective determination of central corneal thickness. Of these methods, most commonly used include Specular Microscopy, Optical coherence tomography, Laser Doppler Interferometry, Optical low coherence reflectometry pachymetry, Optic based topographic mapping (also called screening section pachymetry) and Pentacam. In this article, it was aimed to evaluate importance of central corneal thickness in clinical use and compare measurement methods.
Keywords: Central corneal thickness, glaucoma, refractive surgery, ultrasound pachymetry, optical method