2001; 32 (1): 1-68.
CONTENTS

    STUDIES
  • The effects on dose parameters of shielding blocks at the irregular nasopharynx that irradiated [Abstract] [Full Text - Turkish]


  • Can neuronal intestinal dysplasia be diagnosed in our domestic environment? [Abstract] [Full Text - Turkish]


  • The effects of intratracheal dexamethasone on lipid peroxidation in acute lung injury [Abstract] [Full Text - Turkish]


  • Evaluation of the diagnostic test's performance and their comparisons [Abstract] [Full Text - Turkish]


  • Correction of prominent ears using anterior scoring technique [Abstract] [Full Text - Turkish]


  • The relationship between the dose of heparin and free plasma hemoglobin in open heart surgery [Abstract] [Full Text - Turkish]


  • The NK activation and the interaction of the parameters IL-2, IFN-gamma and CD19 in the alcoholic pregnant rats and their offspring [Abstract] [Full Text - Turkish]


  • CASE REPORTS
  • A case with probable idiopathic intracranial pachymeningitis: Two years follow up [Abstract] [Full Text - Turkish]


  • Retrocaval (circumcaval) ureter: A case report [Abstract] [Full Text - Turkish]


  • REVIEW
  • Asthma in pregnancy [Abstract] [Full Text - Turkish]


  • ABSTRACTS

    The effects on dose parameters of shielding blocks at the irregular nasopharynx that irradiated

    Bas M, Alkaya F, Kemikler G, Gursoy O

    Cerrahpasa J Med 2001; 32 (1):7-15.

    BACKGROUND: Shielding blocks for protection of vital organs within a radiation field give rise to changes in dose distribution of open field due to decreasing of scattered radiation from the shielded areas. Several methods have been used to calculate depth dose values for irregular fields. However, validity of such methods should be verified before routine use in clinic. DESIGN: In this study, measured percentage depth doses for selected irregular fields have been compared with percentage depth dose for fields obtained using equivalent squares (negative field) and [4x(A/P)] techniques. Dose rates for blocked and unblocked fields have been measured. Also, dose profiles for open fields at 0.5 cm and blocked fields for three depths-0.5, 5 and 10 cm depth - have been obtained and the effect of blocking on dose profile for open field has been investigated. RESULTS: When measured percentage DD for the selected fields were compared with percentage DD for equivalent squares technique, the percentage difference was found 0.20 %-2.34 % in the nasopharyngeal fields since the block edge was close to central axis. When measured percentage DDs were compared with percentage DD for [4x (A/P)] technique, the percentage difference was found 0. 20 %-2.34 % for the nasopharygeal fields. But both techniques were convenient for percentage DD except points at block edge. When out-put values for selected blocked fields were compared with those of open fields, if blocked fields were less than 25 %, out-put of open fields could be used for irregular fields. Since blocks were close to center of the fields in cranial fields out-puts were found to have 2%-3% difference from outputs of open fields. CONCLUSION: The dose under the block for selected field was about 10 % of dose at d max.(Return)


    Can neuronal intestinal dysplasia be diagnosed in our domestic environment?

    Topuzlu Tekand G, Yesildag E, Erdogan E, Mobin AA, Unal T, Dervisoglu S, Sarimurat N, Yeker D

    Cerrahpasa J Med 2001; 32 (1):16-19.

    BACKGROUND AND DESIGN: Classic aganglionosis is detected in only 50% of patients presenting with clinical symptoms of Hirschsprung's disease; neuronal intestinal dysplasia (NID) is the real pathology in 20-40% of this group. Herein, the outcome of cases presenting with complaints related to bowel dysmotility and diagnosed to have NID, is evaluated. RESULTS: 8 NID cases, admitted to our unit had gastrointestinal decompression, barium enema and anorectal manometry, performed routinely. The full thickness rectal biopsies, peroperative colonic biopsy and anal myectomy samples were histopathologically evaluated with hematoxylin eosin stain (HE). Those cases histopathologically labeled as NID were either given oral Cisapride or surgically treated and followed up. In our domestic environment deprived of immunohistochemical facilities, diagnosis of NID is dependent on the combined experience of the pathologist, using the HE stain, and the clinical presentation of the cases. CONCLUSION: Anorectal manometry and barium enema, provide nonspecific information for NID and pathology reveals the most important diagnostic criteria.(Return)


    The effects of intratracheal dexamethasone on lipid peroxidation in acute lung injury

    Meyanci G, Aricioglu F, Oz H, Aydemir A

    Cerrahpasa J Med 2001; 32 (1):20-24.

    BACKGROUND AND DESIGN: The aim of our study was to show the effect of intratracheal (IT) dexamethasone on lipid peroxidation in hydrochloric acid (HCl) aspiration induced acute lung injury of rabbits. We measured the levels of malonyldialdehyde (MDA) which is end product of lipid peroxidation in plasma and bronchoalveolar lavage (BAL). Fourteen New Zeland rabbits were randomly assigned to 2 groups as the control group (CG, n=6) and dexamethasone group (DG, n=8). An endotracheal tube was placed trough a tracheostomy in all animals following ketamine hydrochloride (50 mg/kg, intramusculary) induced anesthesia. Maintenance of anesthesia was achived by the use of ketamine hydrochloride 10 mg/kg/h and atracurium besylate 1mg/kg/h. The animals were ventilated with pressure control mode for 5 hours and the parametres of ventilation were FiO2: 1.0, RR: 80/min, VT: 10 mL/kg, PEEP: 5 cmH2O. IT HCl (2mL/kg) was given following the initial sampling of MDA from plasma and BAL. Five minutes after the application of HCl theDG received IT dexamethasone (2.5mg/kg). Plasma and BAL resampling for the measurement of MDA was done at the second and fifth hour of HCl aspiration. RESULTS: The levels of MDA in the fifth hour samples of plasma and BAL were significantly different between two groups (p<0.01). (Mean plasma MDA levels of DG and CG were 1.14±0.6 nmol/mL and 2.5±1.36 nmol/mL, respectively; mean BAL MDA levels of DG and CG were 1.03±0.3 nmol/mL and 3.18±1.2 nmol/mL, respectively). CONCLUSION: Intratracheal dexamethasone given after 5 minutes of HCl aspiration had a beneficial effect on the lipid peroxidation in acute lung injury of rabbits.(Return)


    Evaluation of the diagnostic test's performance and their comparisons

    Dirican A

    Cerrahpasa J Med 2001; 32 (1):25-30.

    BACKGROUND AND DESIGN: Diagnostic tests are widely used in many areas of our modern technological society, but they are of particular importance in medicine, where early and accurate diagnosis can decrease the morbidity and mortality of disease. As new diagnostic tests are introduced, their impact on patients health must be determined. It is often important to compare various diagnostic tests with each other for specific clinical conditions in order to determine which one is the best to use.A perfect diagnostic test would be one with no false positive or false negative results and would be represented by a line that started at the origin and went up the y-axis to a sensitivity of 1, and then across to false positive rate of 0. The methods of ROC curve, Kappa coefficient, Youden index, and Mc-Nemar test are used to present and/or compare the performances of one or more diagnostic tests. ROC curves plot sensitivity against 1-specificity for the different cut-off points. Most popular information is the area under the curve, which has been called the best index of detectability. RESULTS AND CONCLUSION: In this study, we expressed mathematical basics and calculations of ROC curve analysis and the other methods within hypothetical examples.(Return)


    Correction of prominent ears using anterior scoring technique

    Aydin Y, Guzel MZ, Yildirim AM

    Cerrahpasa J Med 2001; 32 (1):31-36.

    BACKGROUND: Prominent ears are frequent in the white population with an incidence of 5 percent. Many surgical techniques can roughly be classified as the cartilage-incision techniques versus the suture-placement techniques have been described to correct prominent ears. The purpose of this article is to demonstrate the details of anterior scoring technique for the correction of prominent ears and compared with other published ones. DESIGN: A total of 63 prominent ears underwent repair. The age of patients at surgery ranged from 9 to 23 years (mean age, 11.8 years). Of 33 patients, 20 were female and 13 were male. The procedure was bilateral in 30 cases, unilateral 3 cases. All patients were treated with anterior scoring technique alone. All patients were placed into a head bandage for 5 to 7 days and then usually for 3 weeks in a headband. RESULTS: Average follow-up was performed at 4,2 years. There was no encountered any complication. The patient satisfaction survey found that all patients were either very satisfied or extremely satisfied with the overall appearance of the ears. Symmetry was noted to be good to excellent by all the patients-parents and surgeon. CONCLUSION: Anterior scoring technique is safe, efficacious for correction of prominent ears with excellent long-term results.(Return)


    The relationship between the dose of heparin and free plasma hemoglobin in open heart surgery

    Uslu A, Yigit R

    Cerrahpasa J Med 2001; 32 (1):37-42.

    BACKGROUD AND DESIGN: New equipments and methods which will be crucial in decreasing hemolyze rate have been experienced for the last years. For this reason, the equipments that are used in cardiopulmonary bypass (CPB) must show similarities to biological tissues. That's because, those equipments must be coated with immobilize heparin and thus it must be worked for gaining them similar attributes with vessel endothel. The aim is to decrease the mortality rate of operation incidence by decreasing contraindications result from CPB. 1) In the operations that make up the control group, full dose of systemic heparinization (4,0 mg/kg) with uncoated CPB system (UCS) was used. 2) In the experiment group, low dose systemic heparinization (1,5 mg/kg) with heparin coated CPB system (HCS) was used. RESULTS: By taking the levels of free plasma hemoglobin (FpHb) in to consideration, the differences occurred in different stages within each group and the differences in same stages between opponent groups were observed. CONCLUSION: In both HCS, UCS, and 30 mins after the operation, FpHb level started to gradually increase from the preoperative period level. In HCS, FpHb level stayed constants from the beginning of the third period, and it decreased to period level after the fifth stage. In UCS, the level increased excessively until the forth period and then the level decreased gradually.

    Conclusion.- FpHb levels of the UCS group were found to be statistically significantly higher than the HCS group in every stages of the than stage 1. (p<0.05).

    (Return)


    The NK activation and the interaction of the parameters IL-2, IFN-gamma and CD19 in the alcoholic pregnant rats and their offspring

    Akyol S, Tunali H, Kiran B, Ilter O

    Cerrahpasa J Med 2001; 32 (1):43-50.

    BACKGROUND: Our study aims to show how the NK cells interact with the parameters of IL-2, IFN-g and CD 19 in the alcoholic pregnant rats and their offspring. Several experimental animal models have been described for the study that was carried out on a total number of 80 Wistar albino female rats. DESIGN: In our study, rats were divided into 8 groups; 1) Control group (K) (n=10) 2) Group that received ethanol through gavage (G) (n=10) 3) Control pregnant group (KG) (n=10) 4) Pregnant group that received ethanol through gavage (GG) (n=10) 5) Control offspring (10 days old) (KY10) (n=10) 6) Control offspring (30 days old) (KY30) (n=10) 7) 10-day-old offspring of pregnant rats that received ethanol through gavage (GY10) (n=10) 8) 30 day old offspring of pregnant rats that received ethanol through gavage (GY30) (n=10). RESULTS: Data from this study show that there has been a considerable decrease in the NK values the successive groups [(K: % 54.90±10.86 and G: % 38.40±3.43), (KG: % 40.00±2.1 and GG: % 37.1±2.10)] and the groups of 10 to 30 day old offspring of rats [(KY10: %30.2±2.1 and GY10: %13.0±0.7), (KY30: %32.28±2.6 and GY30: %20.75± 1.2)] respectively. A significant decrease is observed in the IL-2 values between the consecutive groups [(K: 86.5±1.3 pg/ml and G: 71.0±2.4 pg/ml), (KG: 65.9±1.1 pg/ml and GG: 60.9±2.1 pg/ml)] and the groups of 10 to 30 day old offspring of rats [(KY10: 75.4±3.2 pg/ml and GY10: 63.0±3.2 pg/ml), (KY30: 76.0±3.4 pg/ml and GY30: 70.0±2.6 pg/ml)] respectively. The IFN-g values indicated a considerable decrease among the successive groups [(K: 1250±29.6 pg/ml and G: 860±27.3 pg/ml) (KG: 720±13.6 pg/ml and GG: 570±9.1 pg/ ml)] and the groups of 10 to 30 day old offspring of rats [(KY10: 850±25.0 pg/ml and GY10: 520±17 pg/ml) (KY30: 900±10 pg/ml and GY30: 640±16.10 pg/ml) ] respectively. No significant changes were observed in the CD-19 values between the groups [(K: % 25.73±3.07 and G: % 23.83±1.6) while there was a significant decrease between the groups (KG: %23.98±1.7 and GG: % 18,46± 1.7)] The CD-19 values displayed a considerable increase among the consecutive groups of [(KY10: %11.15±1.7 and GY10: % 32.5±2.0) (KY30: %21.35±1.2 and GY30: % 30.8±1.8)] respectively. CONCLUSION: It has been observed that in the female pregnant rats that received alcohol through gavage, the NK activity falls considerably according to the control group and in parallel to that there is a decrease in the levels of the parameters CD 19, IL-2 and IFN-g. Compared to the 30-day old-offspring, a more suppressive effect was observed in the NK, IL-2 and IFN-g levels of the 10 day old offspring of the rats that received alcohol during the period of pregnancy. Also in the CD-19 level, a significant increase is observed both in 10 and 30 day old offspring. These results point out the fact that the teratogenic factors like alcohol are primarily responsible for the profound and harmful effects on the special immune tolerance systems that have developed through the period of pregnancy of the mother.(Return)


    A case with probable idiopathic intracranial pachymeningitis: Two years follow up

    Ertan S, Apaydin H, Kocer N, Ozekmekci S

    Cerrahpasa J Med 2001; 32 (1):51-56.

    BACKGROUND: Idiopathic hypertrophic cranial pachymeningitis is a rare inflammatory disease of the dura mater of unknown origin with frequent recurrences, progressive cranial nerve palsies and headache despite initial response to steroid therapy and may cause sequels. OBSERVATION: We report a two-year follow-up of a patient having recurrent multiple cranial nerve palsies whose radiological and clinical features were consisted with pachymeningitis. Her initial symptomatic response to steroids disappeared during the course of the disease. In accordance with the patient who had the diagnosis of idiopathic hypertrophic pachymeningitis (IHP) due to absence of any etiological causes, we discussed the diseases to be considered in the differential diagnosis of IHP. (Return)


    Retrocaval (circumcaval) ureter: A case report

    Atakan IH, Kaya E, Alagol B, Kaplan M, Inci O

    Cerrahpasa J Med 2001; 32 (1):57-59.

    BACKGROUND: Retrocaval ureter is a rare entity that causes dysfunction of the effected kidney and is at times hard to diagnose. OBSERVATION: A rare right retrocaval (circumcaval) ureter case leading to hydronephrosis has been presented and the types, diagnosis and the treatment of this entity has been discussed.(Return)


    Asthma in pregnancy

    Tetikkurt C

    Cerrahpasa J Med 2001; 32 (1):60-67.

    BACKGROUND: Asthma is one of the most common potentially serious diseases complicating pregnancy. Epidemiological studies have shown that approximately %1-4 of pregnancies are complicated by asthma. These percentages are likely to be underestimated because in many cases the condition will be undiagnosed or not recorded. Under treatment of pregnant asthmatics owing to the adverse pharmacological effects of the drugs on the fetus is another problem. Poor control and exacerbations of asthma may result in maternal hypoxia with resultant decreases in fetal oxygen saturation causing fetal hypoxia. As a result, optimal management of asthma during pregnancy requires consideration of the altered pulmonary physiology during pregnancy, the differential diagnosis of gestational asthma, the effect of pregnancy on asthma and the potential effects of asthma on the outcome of pregnancy. The goals of treatment are to maintain normal pulmonary function, prevent exacerbations and avoid adverse effects of medications.(Return)


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