2000; 31(2): 57-124.
CONTENTS


ABSTRACTS

The effect of total motile sperm count to the success of intrauterine insemination

Alici B, Ozkara H, Onal B, Akkus E, Hattat H

Cerrahpasa J Med 2000; 31 (2): 61-65.

BACKGROUND AND DESIGN: In our clinic, 162 couples underwent 421 cycles of intrauterine insemination (IUI) with male factor infertility but normal female findings. The purpose of this study was to evaluate the relationship between the total motile sperm count and the success of intrauterine insemination. RESULTS: Twenty-two of 24 pregnancies had occurred in the group that underwent 289 cycles of IUI with total motile sperm count more than 5 million/cc. On the other hand only two pregnancies were obtained in the group which underwent 132 cycles of IUI with total motile sperm count less than 5 million/cc. Statistical significance was present in success of IUI between groups with total motile sperm count less than and more than 5 million/cc (c2= 6.27, p< 0.01). CONCLUSION: Post washed total motile sperm count may be considered as a predictive criteria of the success for pregnancy in couples with male factor infertility. (Return)


The relationship of delayed onset of walking with clinical prognosis in mentally retarded autistic patients

Korkmaz B

Cerrahpasa J Med 2000; 31 (2): 66-73.

BACKGROUND: This retrospective clinical study was aimed to make a statistical comparison between the mentally retarded autistic patients with delay at onset of walking and cases with no history of neuromotor delay in relation to certain clinical and laboratory features with regards to the prognosis in relation to the clinical subtypes. DESIGN: The study included 90 patients, 70 boys (78%) and 20 girls (22%) diagnosed as having typical symptoms of autism according to DSM-IV. The non-delay group (group A) had 64 (71%) patients while the delay group (group B) included 26 patients (29 %). The variables considered were, demographic data (age, sex), medical history (pre-perinatal problems, presence of epileptic seizures and/or febrile convulsions), family history (consanguinity, family history of any neurodevelopmental problem such as a language disorder), medical examination (neurological examination, dysmorphism, hand dominance), behavioral features accompanying autism (such as abnormal reactivity to sensory stimuli, presence of unusual emotional lability with sudden bursts of laugh or cry, language profile, hyperactivity), neuroimaging findings and EEG features. RESULTS: Significant results included the predominance of hyperactivity (p<0.001) and echolalia +cliché phrases (p<0.02) in group A, consanguinity (p<0.05), epileptic seizures (p<0.001), abnormal neurological examination (p<0.01) and dysmorphism (p<0.02) in group B. CONCLUSION: These results suggested that seizures were more likely for autistic kids who started to walk late and it was less likely to attain verbal ability for them. (Return)


Effects of cuprophan and polysulfone dialysers on oxidant/antioxidant status

Seymen P, Seymen HO, Ozdemir A, Belce A, Gumustas K, Turkmen F, Ozel Barut Y

Cerrahpasa J Med 2000; 31 (2): 74-81.

BACKGROUND AND DESIGN: In chronic renal insufficiency, many toxic metabolites which are normally nontoxic but become toxic when combined improving oxidative metabolism, accumulates in the body fluids. We studied the effect of the most frequently used cuprophan and polysulfone dialysers in hemodialysis treatment on oxidant/antioxidant status. For this purpose, 26 cases (9 females, 17 males, mean age of 36) that are used cuprophan dialysers (n=15) and polysulfone dialysers (n=11) were examined. The cases with COPD, DM and the ones using vitamin E and C, were excluded. First the plasma and red blood cells of the venous blood taken before and after hemodialyses were separated and than plasma MDA and intraerythrocyter GSH levels, activities of GSH-Px and SOD were measured. RESULTS: When the groups that are used cuprophan and polisulfone dialysers are compared; It is observed that the cuprophan dialysers increased plasma MDA levels (p<0,05), decreased the intraerythrocyter GSH levels (p<0,01), activities of GSH-Px (p<0,05) and SOD (p<0,05), as polisulfone dialysers did not influence the MDA and GSH levels, activities of GSH-Px and SOD (p>0,05). CONCLUSION: Hemodialysis treatment is an oxidant stress for the organism and some of used dialysers is effective on this oxidant stress. As a conclusion, this is important in developing new membranes to control the production of free oxygen radicals.(Return)


Utilization of laboratory analyses in the workup of patients with syncope in the emergency department

Ayrik C, Karcioglu O, Ersoy G, Aslan B

Cerrahpasa J Med 2000; 31 (2): 82-88.

BACKGROUND: Syncope is one of the common presenting complaints in the emergency department population which makes up to 3% of the total cases. Many diagnostic tests have been devised to evaluate these patients. There are not any well-established protocols as to which tests should be performed in order to evaluate etiologic causes of syncope. As a result, these patients generally undergo routine laboratory screening tests. This study aims to describe demographic characteristics of the patients referred to Dokuz Eylul University ED with the chief complaint of syncope and to investigate the usefulness of the diagnostic tests used to evaluate these patients. DESIGN: We examined data charts of 798 patients with final diagnoses that could be related to syncope referred to the ED in between 24.04.1998 and 31.07.1998 retrospectively. 156 of the 798 patients were eligible. The majority of the patients were consisted of middle-aged women. The most common causes of syncope were revealed to be vasovagal and psychogenic factors. Cardiac syncope was most commonly diagnosed in elderly patients and 27.6% of the patients was idiopathic. RESULTS: We could not find any usefulness of commonly ordered diagnostic tests such as Na, K, Cl, creatinine, glucose, CK, LDH, AST, total bilirubin, direct bilirubin, amylase, urinary b-HCG, occult blood in stool and ABG regarding decision to admit and establishment of diagnosis of syncope. However, factors that predict admission of patients include EKG abnormalities, cardiovascular examination, cardiac monitoring, neurologic examination and cranial CT in patients with neurologic deficits. In addition, tests that may be beneficial in determining admission to hospital are CBC, BUN, Ca. CONCLUSION: As a conclusion, future research could reveal efficiency of various laboratory tests ordered in routine work-up of syncope patients which may help cut down substantial healthcare expenses. (Return)


Psoas abscess

Ataus S, Alan C, Onder AU, Mihmanli I, Talat Z, Yalcin V

Cerrahpasa J Med 2000; 31 (2): 89-93.

BACKGROUND: Psoas abscess (PA) is a rare condition that presents diagnostic and therapeutic challenges and PA has been more frequently observed in recent years. The variable and nonspecific presentations of PA, as well as its infrequent incidence, can result in delayed diagnosis and misdiagnosis. DESIGN: Four cases diagnosed in our clinic are presented analyzing the main clinical features, microbiologic causal agents, risk factors and treatment. RESULTS: Four patients between the ages 17 and 67 years (mean: 45) were admitted to our clinic between October 1998 and December 1999. The mean delay to consultation was 30 days. The main symptoms were fever, lumbar pain. All patients were diagnosed by CAT. The casual microorganisms were: S. aureus, E. coli and Serratia marcescens. Three cases underwent open surgical drainage and death in one despite adequate medicosurgical treatment. One patient was exclusively treated with antibiotics. CONCLUSION: PA is a serious health problem which presents with non-specific symptoms and signs. To reduce morbidity and mortality, it is important to diagnose the presence and extent of PA accurately using imaging studies. CAT is the method of choice for the diagnosis. The correct identification of the microorganisms, and the prompt use of the antibiotherapy associated to surgery, helped to a total recuperation of these patients. In some cases a multidisciplinary approach may be required. (Return)


The combination of antibacterial therapy and rhG-CSF for the treatment of nosocomial pneumonia occurred during mechanical ventilation

Meyanci G, Oz H

Cerrahpasa J Med 2000; 31 (2): 94-99.

BACKGROUND AND DESIGN: We aimed to search the impacts of granulocyte colony stimulating factor (rhG-CSF), on antibiotherapy clinical and radiologic recovery, in a group of patients without any previous lung pathology but ventilated because of acute respiratory failure, in whom rhG-CSF used as the treatment of nosocomial pneumonia (VAP). The first group (n=16) received 5 ?gr/kg/day subcutaneous rhG-CSF as a supplement to antibiotherapy while in the second group (n=13) the sole treatment was antibiotherapy. For each patient studied, the chart is reviewed at the first day of mechanical ventilation and for 8 days after VAP for the following parameters: erythrocyte, leukocyte, granulocyte and platelet counts; SGOT, SGPT, blood urea, creatine; microbiological analyses of transtracheal aspirate, hemocultures and infiltrations shown on chest x-ray, body temperature follow-up hourly. APACHE II scores of patients are also recorded. Statistical comparisons among groups are performed with Mann-Whitney U test. RESULTS: The groups did not differ significantly for erythrocyte, platelet counts and blood urea, creatine, SGOT, SGPT (p>0.05). The difference is found to be much more significant according to leukocyte and granulocyte counts in rhG-CSF group, when compared to control group (p<0.001). Comparison of the mean values of body temperature, of two groups, appeared to be statistically significant on behalf of rhG-CSF group (p<0,05). CONCLUSION: We conclude, combination of antibacterial agents and rhG-CSF may be beneficial for the treatment of VAP. (Return)


Comparison between Turkey and member of European Union (EU) countries by their health and basic demographic indicators

Vehid S

Cerrahpasa J Med 2000; 31 (2): 100-106.

BACKGROUND: In recent 40 years, world population has been changed. Rate of developed countries population was decreased to one fifth from one third of the world population. Due to this change, differences between developed and developing countries are raised. During recent forty years, relation between Turkey and EU was the one of the top subject of public agenda, and at least Turkey were invited to be candidate member of the union by the 1999 Helsinki decisions. DESIGN: In this study, comparison between Turkey and member of European Union countries tried to be done according to some of their basic demographic and health indicators. RESULTS: Apart from differences on basic demographic situations, main differences were found on death rates such as maternal mortality, new born mortality and mortality of children under five years of age, which are very high in Turkey against to the members of EU countries. CONCLUSION: These differences suggest that there is a thoughtful situation on the level and distribution of the primary health care services in Turkey against to the members of EU countries, although it is possible to think optimistic that these differences will become less by looking passed values. (Return)


Subacute sclerosing panencephalitis: Case report and literature review

Oz B

Cerrahpasa J Med 2000; 31 (2): 107-112.

BACKGROUND: Subacute sclerosing panencephalitis (SSPE) is a very rare and fatal complication of measles infection which is seen 2 to 21 years after initial infection. The incidence of SSPE is 1/ 300.000. OBSERVATION: A 25 years old case with SSPE was presented. He had clinical and radiological evidence of progressive brain involvement. The stereotactic brain biopsy revealed secondary demiyelination, lymphocytic cuffing, viral inclusion within oligodendroglia and neurons which showed immunhistochemically positive reaction with measles virus primary antibody. The differential diagnosis was made between the other viral encephalitis and the literature was reviewed. (Return)


Development of mononeuritis multiplex in a patient with bronchial asthma: Churg-Strauss syndrome

Celik Y, Kiziltan G, Yaldiran A, Oz B

Cerrahpasa J Med 2000; 31 (2): 113-117.

BACKGROUND: Churg-Strauss syndrome is a rare disorder, and is characterized by association of bronchial asthma with disseminated vasculitis, eosinophilia, and extravascular granulomas. OBSERVATION: We describe a 35 year old female patient in whom necrotising cutaneous lesions, arthralgia, and symptoms due to multiple peripheral nerve involvement developed during the treatment of bronchial asthma. The diagnosis of Churg-Strauss syndrome was confirmed histopathologically. The clinical and laboratory features of the syndrome, differential diagnosis, and treatment options are discussed. (Return)


Respiratory physiology in pregnancy

Tetikkurt C

Cerrahpasa J Med 2000; 31 (2): 118-122.

BACKGROUND: Pregnancy causes significant consequences in respiratory physiology. To support fetal life normal parameters of laboratory tests undergo a dynamic and significant change during pregnancy. Evaluation of pulmonary disease states occurring during or that has been present before pregnancy requires a through comprehension of maternal respiratory physiology. In this review, the respiratory physiologic changes with consequences on pulmonary function have been discussed. (Return)