2000; 31 (4): 187-288.
CONTENTS


ABSTRACTS

The outcome of the pleural effusions secondary to infection in children: a 6-year review

Cerrah Celayir A, Inalhan M, Etker S, Inan S

Cerrahpasa J Med 2000; 31: 191-195.

BACKGROUND AND DESIGN: Between 1993 and 1999, 47 patients with pleural effusions were treated by medical therapy and chest tube drainage in Paediatric Department of Zeynep Kamil Hospital. These cases were reviewed. RESULTS: The initial presentations in these cases were as follows: Empyema thoracis 20, parapneumonic effusion 20, tuberculous effusion 7. Only one patient with tuberculous effusion had required decortication. The mean hospitalization duration was 14.4 ± 6.2 days. CONCLUSION: In our experience, most of the children with pleural effusions and empyemas can be treated by an effective medical treatment or by simple chest tube drainage. However, a few patients with persistent fever and respiratory distress may need further surgical interventions. (Return)


The effect of scintigraphy activity on bone mineral density

Demir M, Ozmen O, Uslu I

Cerrahpasa J Med 2000; 31: 196-201.

BACKGROUND AND DESIGN: The object of this study is to investigate the effect on bone mineral density (BMD) / bone marrow for the patients who were referred for whole body scanning by 99mTc on the same day. We studied the bone density of the patients before and after whole body scintigraphy on the same day. RESULTS: Before studying the patients, we calculated the standard counts of bone mineral density using DEXA phantom within L1-L4 vertebra. We made a point source and a flat phantom with 99mTc. When using these sources along with DEXA phantom, we calculated BMD at different activities; e.g. 92.5, 185, 370 MBq. We selected 17 patients visiting our Nuclear Medicine department, irrespective of sex and age limits. CONCLUSION: In phantom study, there was no change in BMD in the presence of radionuclide 99mTc. Normally the clinical uses of radioactive materials do not make any significant effect on BMD. From our study, we also did not find any significant change in BMD of the patients after a whole body bone scintigraphy.(Return)


Free lateral thigh flap for the reconstruction of wide skin defects

Yucel A, Aydin Y, Seradjmir M, Cetinkale O

Cerrahpasa J Med 2000; 31: 202-210.

BACKGROUND AND DESIGN: The flap alternatives for the reconstruction of wide skin defects are limited. Thigh region is a versatile area for numerous flaps with large skin islands. Lateral thigh flap was first described in 1983, but has not been popularized since then. We have used free lateral thigh flap for the reconstruction of six cases with wide skin defects caused by burn trauma. RESULTS: The mean age of the patients was 24 years (5 to 46 years). Three flaps were transferred to the neck and others to the extremities. The mean size of the flaps was 21x11 cm. Donor sites were closed primarily in three cases. All flaps were survived except for one, which was lost during initial surgery due to pedicle injury. Three flaps necessitated defatting procedures subsequently. Mean follow-up period was 28 months (5 to 44 months). CONCLUSION: Lateral thigh flaps provides large amount of good quality skin for the reconstruction of wide skin defects. It is one of the largest skin flap in human body. Flap dissection is relatively easy and pedicle length and caliber is adequate. When closed primarily, donor site deformity is acceptable. The major drawbacks of the method are the thickness of the flap that usually necessitates thinning procedures and donor site deformity when skin grafting is necessary.(Return)


The effects of vitamin C administration on erythrocyte glutathione and HbA1c levels of type 2 diabetic patients

Cengiz M, Cengiz S

Cerrahpasa J Med 2000; 31: 211-215.

BACKGROUND AND DESIGN: Diabetes mellitus (DM) has some complications. Oxidative stress plays an important role in the creation of these complications. At the other hand vitamin C plays nonenzymatic antioxidant role in the organisms. The goal of our study was to compare glycosylated haemoglobin (HbA1c) and glutathione (GSH) levels of the 20 type 2 DM patients taking vitamin C with the 20 type 2 DM patients taking placebo. The amount of HbA1c by chromatographic elution and glutathione were measured by using capillary electrophoresis technique at the first day, first month and second month. RESULTS: After usage of vitamin C for one month, the values of HbA1c were decreased significantly but GSH levels were still without a significant difference. After usage of vitamin C for two months, the values of HbA1c were decreased significantly and GSH levels were increased significantly. After one and two months usage of placebo, the values of both HbA1c and GSH were still without a significant difference. CONCLUSION: Comparison of the vitamin C taking group with the plasebo receiving group showed that these findings and results must be considered as positive effect of the vitamin C to the patients. This is because of the decreasing of the glycosylated haemoglobin and increasing of the glutathione levels. The glutathione levels are all found as in lower value when compared with non-chromatographic method. This is because of the exact molecular prediction and measurement of the species.(Return)


The consequences of the recent earthquakes in Turkey as reflected in fourteen biochemical parameters

Hacibekiroglu M, Balci H, Kasim A

Cerrahpasa J Med 2000; 31: 216-219.

BACKGROUND AND DESIGN: Our objective is to determine whether the two Marmara earthquakes in 1999 have led to post-traumatic stress (Group 1), crush syndrome (Group 2), or changes in kidney functions (Group 3) and acute phase reactants (Group 4). We studied the cortisol levels for post-traumatic stress; the SGOT, SGPT, LDH, CK and K levels for crush syndrome; urea, creatinine, Beta-2-Microglobulin, and cystatin-C levels for kidney function; and CRP, transferrin, haptoglobin, and ceruloplasmin levels for acute phase reactants. RESULTS AND CONCLUSION: The study covered blood samples from those who came for the three time (Group A; n: 76, Group B; n: 32, Group C; n: 14) at average 9-day intervals. Samples from 20 healthy volunteers were used as control group. Urea, creatinine, SGOT, SGPT, LDH, CK, K and cystatin-C levels were measured with a Hitachi-717 analyzer; Beta-2-Microglobulin and cortisol levels with a DPC immulite device; and CRP, haptoglobin, ceruloplasmin transferrin levels with a Behring Nephelometer. Further analysis revealed no significant subsequent changes in the parameters of the cases in Groups A, B, C, although a decrease was observed in all high values. (Return)


The effect of aging on plasma oxidative protein damage

Cakatay U, Telci A, Yilmaz IA, Akcay T, Sivas A

Cerrahpasa J Med 2000; 31: 220-223.

BACKGROUND AND DESIGN: An increase in oxidative stress may contribute to the development of oxidative protein damage in aging. In the present study, we investigated the relation between aging and oxidative protein damage parameters such as plasma protein carbonyl and protein thiol, as well as oxidative stress parameters such as total thiol, nonprotein thiol and lipid hydroperoxides in the plasma samples of young adult, adult and young old individuals. RESULTS: Protein carbonyl and lipid hydroperoxide levels were significantly increased in aging individuals. On the other hand, total thiol and protein thiol levels were significantly decreased in aging individuals. Protein carbonyl, protein thiol, and lipid hydroperoxide levels were significantly correlated with age. CONCLUSION: The result of this study suggests that increased plasma protein carbonyl levels and decreased plasma protein thiol levels in aging individuals may reflect the oxidative protein damage.(Return)


Determination of different features of female and male patients who underwent percutaneous transluminal coronary angioplasty (PTCA) procedure

Demiroglu IC, Aytekin V, Aytekin S, Askin HK, Tufekcioglu S, Feray H, Demiroglu C

Cerrahpasa J Med 2000; 31: 224-230.

BACKGROUND AND DESIGN: Female and male patients with coronary artery disease (CAD) have significant differences to each other. To evaluate these differences which lead us to choose the optimal strategy for diagnosis and treatment, we compared some features of female and male patients (pt)s who underwent percutaneous transluminal coronary angioplasty (PTCA) procedure in our interventional cardiology department. RESULTS: 3400 pts underwent (PTCA) procedure and stent implantation, between years 1991 and 1998. 600 (18%) of the pts were female and 2.800 (82%) were male. Mean age, procedural success rate, risk factors, the location of the lesion in the coronary tree, types of the lesions, restenosis rate and mean values of stent diameters among different pt groups were compared in female and male pts. Mean age values were higher in female pts (female: 59.5±10, male: 54.7±9, p<0.0001). Procedural success rate were nearly same (female: 93.5%, male: 94.5%, p:ns). When we compared the risk factors in a group of 158 pts; hypertension (female: 53.8%, male: 28.7%, p<0.02) and hypercholesterolemia (female: 46.1%, male: 19.6%, p<0.01) were higher in female pts. Diabetes (female: 19%, male: 12%, p:ns), family history of CAD (female: 46%, male: 29%, p: ns) and smoking (female: 23%, male: 39.6%, p: ns) were no more different in two groups. Restenosis rate were 23% in female and 30 % in male pts among 308 sequential pts (p: ns). The location of the lesions in the coronary tree (LAD, CXA, RCA) and the types of the lesions (A, B, B2, C) among 1240 sequential pts showed no significant differences between two groups. When we compared the stent diameters of 647 pts, it was lower in female pts than in males (females: 3.18±0.4 mm, males: 3.32± 0.3 mm) (p<0.0001). CONCLUSION: Procedural success rate, diabetes, family history of CAD, smoking, re-stenosis rate, the location of the lesions in the coronary tree, the types of the lesions were not significantly different in male and female pts. Mean age values, hypertension and hypercholesterolemia were significantly higher and stent diameter mean value was lower in female pts.(Return)


Effect of metastasis in colorectal cancer on serum total sialic acid levels

Uslu E, Belce A, Seymen P, Kokoglu E

Cerrahpasa J Med 2000; 31: 231-234.

BACKGROUND AND DESIGN: This study was designed to asses the effect of metastasis on serum total sialic acid level in patients with colorectal cancer. RESULTS: We measured serum total sialic acid (TSA) level by using Warren's thiobarbituric acid assay. TSA levels in healthy control, colorectal cancer without metastasis and colorectal cancer with metastasis were found as 73.2 ± 6.0 ; 73.7 ± 5.0 ; and 96.0 ± 9.0 mg NANA/dL respectively. Statistical difference between metastasis and the other two groups was significant (p < 0.001). CONCLUSION: According to our results, metastasis causes the increase of serum TSA levels. We suggest that the determination of this increase may be useful for the evaluation of a possible metastatic involvement. (Return)


Physiological and psycological effects of accumulated electrostatic load on humans

Korpinar MA

Cerrahpasa J Med 2000; 31: 235-238.

BACKGROUND AND DESIGN: In this study our aim was to investigate the physiological and psychological effects of "accumulated" electrostatic load on humans and to postulate probable solutions to overcome these effects, if any. In this study 17 healthy male subjects (ages 16-18 years) were seated in a quite environment for 15 minutes and pre-experimental measurements were carried out as outlined below. For the measurement of the reaction to light and sound, the subjects were seated comfortably and requested to answer the questions related to the light and sound stimuli which were generated by the Miernik Raekeji MRK-433 model reaction time measurement device. For the measurement of the short-term memory, the subjects were requested to repeat a sequence of minimum 3, maximum of 9 digit numbers both forward and backwards and the number of errors were recorded. The stable anxiety inventory tests the anxiety level of the subjects. Two types of answer keys exists, which display the anxiety level and the numerical results obtained through these keys respectively were used to evaluate the anxiety levels of the subjects. The data obtained through the subjects under (+), (-), and neutral conditions were compared with the data obtained pre-experimentally by using the Student's t-test.  RESULTS: While (+) electrostatic field was found to be increasing all the physiological parameters (systolic and diastolic blood pressure, reaction to sound and light, rate of hand sweating) except the heart-beat rate, the reverse of that was true for the (-) electrostatic field (p< 0.05). Likewise, while the positive field was found to be decreasing the short-term memory (numbers of errors) significantly, the negative field increased this ability and neutral field had no significant effect All types of electrostatic loadings were found to have no effect on the stable anxiety inventory.  CONCLUSION: Thus, it will not be wrong to state the fact that positively charged electrostatic fields cause stress and have harmful effects on humans, while the negatively charged fields ease out the stress and might even have a beneficial effect.(Return)


An infrequent cause of acute abdomen in childhood: Torsion of the ovary

Ertekin KF, Kuyumcuoglu U, Cerrah Celayir A, Yorganci C

Cerrahpasa J Med 2000; 31: 239-242.

BACKGROUND: Torsion of ovary is approximately 3% of surgical emergencies in women. However it is rare in childhood. Prompt diagnosis and treatment may allow for preservation of adnexal structures and fertility. In cases of acute abdominal pain in girls a gynecological cause must always be considered. Torsion of a normal ovary is difficult to diagnose. This usually leads to a delayed treatment hesitating in hemorrhagic infarction and necrosis. Sonogram appears to be an excellent method to evaluate patients with suspected torsion of the ovary.  OBSERVATION: A case of an 11-year-old girl with acute abdomen due to torsion of the left fallopian tube and ovary is presented. The diagnostic problems, differential diagnosis and treatment options are reviewed.(Return)


Monosymptomatic Kleine-Levin syndrome: A case report

Karadeniz D, Erdem E, Gurdal A, Pelin Z, Ozturk L, Kaynak H

Cerrahpasa J Med 2000; 31: 243-248.

BACKGROUND: Kleine-Levin syndrome is characterized by recurring episodes of hypersomnia, mental disturbances and abnormal behaviour including hyperphagia and hypersexuality. The episodes start suddenly generally after a mild viral infection, mild head injury or sometimes after a psychological stress. They last few days to several weeks and end abruptly. Between the episodes, there is no sleep disturbance and patients are physically and mentally normal. Patients sleep as long as 18 to 20 hours of the day during the episode. Hyperphagia and/or hypersexuality are in compulsive manner. Mental disturbances include, irritability, feeling of unreality or confusion. Recently, monosymptomatic and atypic forms of the syndrome were reported. In monosymptomatic form, hypersomnia occurs without hyperphagia and hypersexuality. Atypical Kleine-Levin Syndrome includes the forms where one of the symptom is replaced by an opposite one.  OBSERVATION: The clinical course of 19 year old boy with recurrent 3 episodes of hypersomnia and mental disturbances during a period of 3 months was presented. Episodes were occurred after mild viral infections or psychological stress. Electroencephalographic, and polysomnographic data supported the diagnosis of ‘’Monosymptomatic Kleine Levin Syndrome’’ and no episode has occurred with the prophylactic treatment of Lithium carbonate during last 6 months period.(Return)


Thoughts and reflections on the distribution of old age homes in Turkey

Vehid S

Cerrahpasa J Med 2000; 31: 249-254.

BACKGROUND: The problems of the community are like skins of an onion. In spite of the population growth rate protection, population growth rate is the one of the main problems of Turkey and still seen higher than the developed countries. On the other hand increase of the diagnostic and treatment facilities cause a rise on the number of old age people. The percentage of the ageing people in our community is estimated to increase up to 9.3 % between the years 2015 - 2025. There is an imbalance in the distribution of the old age homes in Turkey. Due to this imbalance, the number of population per bed is between 67 as in Istanbul and 1610 as in Çorum, while aged population rate is higher in Çorum than Istanbul. On the other hand there is not any old age home in 37 districts, in some of them have the aged population is higher than average. Having high urbanisation rate, which reach-ed 65% in 1997 and changing the family stile from a patriarchal to a nuclear family and the imbalance in the distribution of old age homes suggest that difficult days are ahead for ageing people.(Return)


The list of diplomas and the related thesis of graduates in the twentieth certury: Istanbul University Cerrahpasa School of Medicine Department of Obstetrics and Gynecology

Kazancigil A, Aksu F

Cerrahpasa J Med 2000; 31: 255-269.

BACKGROUND: Obstetrics and Gynecology Department of Cerrahpasa Faculty of Medicine is the first and the unique clinic which has ever been founded in Ottoman Empire by Besim Ömer Pasha (Akalin) in 1892 under the name of "Veladethane" (meaning labor- in hospital)  upon a decree of the Emperor.  In 1909,  it has been united with the disipline of Gynecology and transferred from its first building located in Demirkapi Sirkeci to Kadirga and following a change from Kadirga to Haydarpasa in 1928.  In 1930,  after the great university reform of Atatürk,  It has moved again from Haydarpasa to Haseki. In 1966, from Haseki to Cerrahpasa to its last residence.  Convering all these years,  ten residents from Sirkeci, 17 from Kadirga, 7 from Haydarpasa, 195 from Haseki and 167 from Cerrahpasa were graduated.  In this documentary you will find the list of their diplomas and thesis that have been officially accepted from 1946 to the presenting time.  Essentially,  many clinics, departments and specialty hospitals have been founded in Turkish Republic by the graduates and their successors of this faculty which has anniversarried its 108 years as an Obstetrics and Gynecology Department. (Return)