2001; 32 (2): 69-128.
CONTENTS


ABSTRACTS

The relationship of the uterin artery doppler at the 20th week's of gestation and maternal serum alpha-fetoprotein levels

Uludag S, Madazli R, Ocak V, Dirican A

Cerrahpasa J Med 2001; 32: 73-79.

BACKGROUND: In this study, we obtained uterine artery Doppler at 20th week of gestation for prediction of preeclampsia, intrauterine growth retardation (IUGR) and preterm labor. We determined the relationship of early diastolic notch and abnormal uterine artery Doppler with maternal serum a-fetoprotein (MSAFP) levels for prediction of adverse pregnancy outcome. DESIGN: In a group of high risk, except fetal anomaly, multiple pregnancy and type 1 DM, 80 pregnant women were followed as a study group prospectively. MSAFP levels at the 15-17th weeks of gestation and bilateral uterine artery Doppler at the 20th week's of gestation were obtained. RESULTS: Uterine artery early diastolic notch were determined at 20th weeks of gestation in 17 (21,75 %) cases. Early diastolic notch in Doppler was persistent at the 24th weeks in the nine of cases, and in the eight of cases, it was disappeared. In uterine artery Doppler, diastolic notch was found to be a significant predictive factor for preeclampsia, IUGR and preterm labor (p <0.001, OR: 69.74; p <0.02, OR: 10.11; p<0.05, OR: 3,75 respectively). MSAFP levels of 17 cases that displayed early diastolic notch in uterine artery Doppler were significantly higher than the notch negative cases (p<0.05). The levels of MSAFP, in 9 cases which demonstrated the persistence of diastolic notch, were significantly higher then in 8 cases that the notch was disappeared, at 24th week of gestation (p<0.05). MSAFP levels were found to be significantly elevated in the pregnant with preeclampsia; IUGR and preterm labor then the cases that have not any of these complications. CONCLUSION: Our findings suggested that the abnormal uterine artery Doppler was together with elevated MSAFP levels at 20 th week of gestation. Bilateral diastolic notch in uterine artery Doppler and elevated levels of MSAFP at the 20th week's of gestation will be more sensitive for prediction of adverse obstetric outcomes. (Return)


Vocal rehabilitation following total laryngectomy

Erisir F, Inci E

Cerrahpasa J Med 2001; 32: 80-85.

BACKGROUND AND DESIGN: Permanent loss of voice severely disrupts routine interaction and can result in economic, social and psychological change. The development of effective alaryngeal speech is a major step in rehabilitation of a laryngectomy patient. Current methods of vocal rehabilitation after laryngectomy includes development of esophegeal speech, use of artificial larynges and more recently, surgical restoration of voice. With the introduction of the tracheoesophageal puncture technique and valved prosthesis, a third alternative for alaryngeal speech rehabilitation became available. Restoration of voice after total laryngectomy may occur with diversion of exhaled pulmonary air into the esophagus or hypopharynx. The aim of this study was to compare the speech quality and complications between Provox and Blom-Singer voice prostheses in 35 patients who were operated at Cerrahpasa School of Medicine Otolaryngology department. RESULTS: Overall, Provox and Blom-Singer prosthesis give very similar voice quality, life time, and patient satisfaction. Cleaning management is somewhat better than Provox, but there is a trend toward better voice quality for Blom-Singer prosthesis. Secondarily placed prostheses scores are better than primary placements, and the patients with total laryngectomy have better voices than patients with extended laryngectomy combined with partial laryngectomy. CONCLUSION: We discussed the advantages and disadvantages of Provox and Blom Singer silicon voice prosthesis which are inserted by tracheooesophageal puncture technique. Given the equal and good results in terms of voice quality, other factors such as cost, maintenance and patient reference should be taken into consideration when deciding which type of tracheooesophageal voice prosthesis to use. (Return)


Headache in the elderly

Karaali F, Savrun M, Saip S

Cerrahpasa J Med 2001; 32: 86-90.

BACKGROUND: In this case group, we try to describe the features of headache in headache out-patients population aged 50 years or more. DESIGN: The database of patients admitted to Cerrahpaşa Headache Clinic between 1994-1996 was used according to the International Headache Society (IHS), 1988 criteria. RESULTS: The study included 238 cases (age range:50-83). Mean age at onset of headache was 45.1 (range: 8-83).One hundred-three of these cases had an onset age 50 (mean: 57.7) with 70.8% female. In the whole group 43% had migraine, 35% had tension-type headache (TTH) and 7% had chronic daily headache, while %5.5 had secondary type of headache such as temporal arteritis, brain tumor, and %6.8 had unclassified head pain. CONCLUSION: New onset of primary headache frequency decreases in this population. Comorbidity of depression and primary headaches and, secondary headaches increase relatively in the elderly population. (Return)


The role of having physician in family on selecting medical education

Vehid S, Koksal S, Erginoz E, Yetisyigit T

Cerrahpasa J Med 2001; 32: 91-96.

BACKGROUND AND DESIGN: The aim of this study was to show the role of having a physician in family on entering to the medical school. The study has been performed by a questionnaire, which were answered by the students who entered to medical school in the year 1998-1999. All of the entering class students were enrolled to the study. Gender, having physician in the family or among close relatives, parental and personal attitudes on entering to medical school were asked. In the data analyzing of the study chi-square test and rates were used. RESULTS: 59.6 % of the students were male and 40.4 % were female. 39.7 % of the total have a physician in family or among close relatives. Having a physician relative is higher among the female students than male students. Parental effects on selecting medical school are higher on the male students than female students. Selecting medical education with self-decision is high on both sexes, but this situation is higher among female students than male students. CONCLUSION: Although there is a significant statistical difference in the number of male and female students, our findings suggest as in literature that number of female students coming closer to male students in medical education. We have doubt that how this change will effect the physician distribution in Turkey in future. There are non-significant differences between the students having physician relatives on both sexes. But finding the number of students high in the group of not having any physician in family or among close relatives suggest that, having a physician in family or among close relatives has no influence on selecting medical education. (Return)


Lichtenstein's technique in inguinal herniorraphy

Yavuz N, Unal E, Dervisoglu A, Tortum OB

Cerrahpasa J Med 2001; 32: 97-99.

BACKGROUND AND DESIGN: Lichtenstein's tension free technique presents many important advantages in the repair of inguinal hernia. It is easy to perform, recovery is quick and the results, thus far, are superb. Between December 1994 and July 1998, in Gorbon Unit of General Surgery Clinic in Cerrahpasa School of Medicine, Istanbul University 47 Lichtenstein's inguinal herniorraphy operation was performed on 38 patients and the early results were evaluated retrospectively. RESULTS: In the postoperative period, none of our cases experienced pain requiring narcotic analgesics. Oral intake was allowed few hours following the operation and patients were mobilized on the first postoperative day. In one case, subcutaneous infection developed and it was treated successfully with drainage and antibiotics. The average postoperative hospital stay period was 3.2 days (2-5). All of the patients were pleased of postoperative comfort. During a mean follow-up of 48-months (15-60) , no other complication like mesh rejection, testicular atrophy or recurrence was seen. CONCLUSION: Lichtenstein's tension free technique is a simple and effective method as it provides many advantages from the point of view of pain, mobilization and operation time. (Return)


Experience with short bowel syndrome during childhood

Celayir S, İlce Z, Topuzlu Tekand G, Sarimurat N, Erdogan E, Yeker D

Cerrahpasa J Med 2001; 32: 100-104.

BACKGROUND AND DESIGN: Short bowel syndrome (SBS) is a disease of neonatal period which appears mostly after massive bowel resection or congenital short bowel. SBS is generally seen after massive bowel resection because of malrotation, vovulus, gastrochisis, intestinal atresia, and necrotising enterocolitis. The clinical outcome is affected by the remained bowel length, presence of ileocecal valve, motility of intestine, bowel adaptation and tolerance of nutrition. The nutrition regimen complicates as septicemia and liver failure. RESULTS: 20 patients were followed-up during the 20 year period in our institution. The mortality rate was 60%. In these patients the remained bowel length was under 30 cm and ileocecal valve was not present or removed during the surgery. CONCLUSION: In the early years of Pediatric Surgery the most common reason of death was bacteriel overgrowth and septicemia. In the last years TPN related septicemia and liver failure are the main problem. However the main reason of mortality is septicemia in our clinic. (Return)


Long term results in 32 temporomandibular joint ankylosis treated with condilectomy and silicon interposition

Aydin Y, Guzel MZ, Cinar C

Cerrahpasa J Med 2001; 32: 105-111.

BACKGROUND: Temporomandibular joint ankylosis, usually secondary to trauma, leads to both functional and aesthetic problems. The surgical treatment of such cases is usually challenging problem to the reconstructive surgeon. The main goals of treatment are to restore Temporomandibular joint function so that patients would be able to open their mouths in order to maintain essential functions such as nutrition, oral hygiene, chewing, and speech and to prevent patients from recurrence. Condilectomy, condilectomy with coronoidectomy, and silicone interpositon are commonly used to treat this pathology. DESIGN: 11 bilateral and 10 unilateral temporomandibular joint ankylosis were treated with condilectomy and silicone interposition between 1988 and 1998. The surgical goal was to achieve at least 3.5-cm.of interincisal opening. For this purpose, all patients underwent condilectomy. When condilectomy was inefficient, coronoidectomy with/without soft tissue stripping was performed. Resultant defect was filled with custom-made silicone bloc. RESULTS: Patients were followed 12 years (mean 7 years). No complication was seen during the follow-up period. The overall results were satisfactory in all patients. Only one patient who had undergone three unsuccessful surgical interventions before our treatment necessitated second surgical correction with the same technique due to the recurrence. CONCLUSION: Condilectomy, if necessary, coronoidectomy combined with silicone interposition is highly effective surgical technique to treat TMJ ankylosis especially in adult patients presenting recurrent disease and having this pathology for a long time. We also suggest that at least 3.5 cm interincisal opening be obtained in operation to ensure the satisfactory result. (Return)


Lipoma of the larynx: A case report

Bildirici K, Kecik C, Peker B, Ilgici D

Cerrahpasa J Med 2001; 32: 112-114.

BACKGROUND: Laryngeal lipomas are very rare benign laryngeal tumors. They are mostly isolated occurrences and not associated with systemic lipomatosis. To date, there are fewer than 100 cases in the English literature. OBSERVATION: We presented a 51 year-old women patient with extrinsic lipoma that localized in the lingual surface of the epiglottis. (Return)


Hiccups; as a sign of lateral medullary syndrome: reports of four cases

Pelin Z, Bozluolcay M, Erkol G, Bugay G, Denktas H

Cerrahpasa J Med 2001; 32: 115-119.

BACKGROUND: Hiccup is a reflex originated activity that is characterized by an intermittent contraction of diaphragm followed by glottic closure. Among the various systemic causes including gastrointestinal system and cardiovascular system disorders, this activity is also seen as a symptom of lateral medullary syndrome. If hiccup becomes a sustained activity, beginning to treatment is unevitable. In this report, chronic hiccup as a sign of lateral medullary syndrome was evaluated in 4 cases and the alternatives of treatment against hiccup was debated. OBSERVATION:Four cases with an acute onset neurological symptoms together with hiccups were diagnosed as lateral medullary syndrome based on their neurological examinations and cranial imagings. Hiccup is evaluated as a symptom of lateral medullary syndrome and treated with different medications. Chlorpromazine, valproic acid and baclofen constituted treatment alternatives against hiccup in different dosages and combinations. The full recovery from hiccups was observed in all patients. (Return)


Liver diseases in the elderly

Ozdemir S

Cerrahpasa J Med 2001; 32: 120-127.

BACKGROUND: Although there is no liver disease being unique to advanced age, there are important differences in the clinical presentation, course and prognosis of liver diseases in older patients compared with younger patients. In this article, the alterations in the liver and the clinical features of liver diseases seen in the elderly were reviewed. (Return)