Aggressive surgical treatment of invasive basal cell carcinomas

Guzel MZ, Aydin Y, Bayramicli M, Okur I, Mindikoglu AN, Kaner G

Cerrahpasa J Med 1996;27: 8-16.

BACKGROUND AND DESIGN: Twenty-six patients with invasive basal cell carcinoma were surgically treated in Department of Plastic and Reconstructive Surgery of Cerrahpasa Medical Faculty, between 1985-1993. The mean duration between the onset of the lesion to the first examination in our center was 8.3 years (range 2-15 years). All 26 patients were treated with aggressive surgical intervention because of deep tissue invasion. RESULTS: None of the patients died during the operation except one who had undergone extensive resection of the skull, dura mater and superior saggital sinus. Mean post-operative follow up was 4.2 years with a range of 2.5 and 6 years. Nine patients were lost to follow up after a mean of 14 months, and the remaining 15 patients were in full remission at their last visit in December 1995. CONCLUSION: Aggressive resection of basal cell carcinomas should be considered if they are recurrent, large, located at the embrionic fusion planes, and histologically morphea-like or basosquamous. Secondary revisions for cosmetic purposes should be performed only after proper follow-up periods. (Return)

Surgical reconstruction of the developmental abnormalities of the female reproductive tract: Cerrahpasa Medical Faculty Depatment of Obstetrics and Gynecology

Aksu MF, Madazli R, Yedigoz V, Demir F, Cepni I, Benian A

Cerrahpasa J Med 1996;27: 17-23.

BACKGROUND AND DESIGN: Patients with developmental abnormalities of the female reproductive tract who had a surgical reconstruction were evaluated. 73 cases with developmental abnormalities of the female reproductive tract who had an operation during 1974-1994 are included in three main groups as external genitelia, internal genitelia and gonadal abnormalities. Ages of the patients, presenting symptoms, type of abnormalities and the performed operations are investigated. RESULTS: Internal genitalia abnormality was found in 75.3%, external genitalia abnormalitiy in 13.7%, gonadal abnormality in 8.3% and male pseudohermafroditism in 2.7% of the patients. Primary amenorea was the presenting symptom in 45.3% of the cases. Laparotomy was performed in 30, laparoscopy in 5 and vaginal approach in 38 patients. CONCLUSION: The majority of the cases operated for the developmental abnormalities of the female reproductive tract had an internal genitalia abnormality and the most common symptom was primary amenorrhea. (Return)

The role of radiotherapy in treatment of solitary plasmacytoma of bone or soft tissues

Koca S, Dincbas F, Turkan S, Abacioglu U, Igdem S, Atkovar G, Okkan S

Cerrahpasa J Med 1996;27: 24-27.

BACKGROUND AND DESIGN: Solitary plasma cell tumors are classified as either solitary plasmacytomas of bone (SPB) or extramedullary plasmacytomas (EMP) of soft tissues. They are very rare and radiosensitive tumors. Radiotherapy plays a major role in the treatment of plasmacytomas. Here we report an evaluation of the 21 patients with solitary plasmacytomas seen between 1981 and 1993 in Radiation Oncology Department of Cerrahpasa Medical Faculty. RESULTS: The diagnosis was SPB in 14 and EMP in 7 patients. Local control rates were 100% in SPB and 86% in EMP groups. Progression to multiple myeloma was observed in 6 cases. CONCLUSION: Radiotherapy is the treatment of choice in solitary plasma cell tumors. Permanent local control was achieved in the majority of patients. However there is a need for the alternative approach to avoid systemic progression. (Return)

Infants of diabetic mothers: Problems and the risk of morbidity

Atici A, Satar M, Narli N, Evruke C, Turkmen M, Ozgunen FT, Ozbarlas N

Cerrahpasa J Med 1996;27: 28-32.

BACKGROUND AND DESIGN: Approximately 1-5% of all pregnancies are complicated with diabetes mellitus. Each year about 15.000 to 35.000 diabetic mothers give birth to a child in Turkey. The aim of this study is to assess the complications, morbidity and mortality rates in infants of 45 diabetic mothers (IDMs) seen in the Newborn Unit in Cukurova University Medical Faculty between 1993-1995. RESULTS: Fourteen infants (31.1%) were born prematurely and 31 (68.9%) were at term. Cesarean section was performed to 34 (75.6%) diabetic mothers. Three infants (6.6%) were small for gestational age (SGA) while 23 (51.1%) large (LGA), and 19 (42.3%) appropriate for gestational age (AGA). White classification was used to classify mothers and 18 (40%) were included in gestational diabetes group, 7 (15.5%) in A, 18 (40%) in B and two (4.5%) in group C. Hypoglycemia was the most frequent (68.8%) complication in IDMs and followed by cardiac abnormalities (10/19, 52.6%), hyperbilirubinemia (37.7%), polycythemia (31.1%), birth asphyxia (28.5%), respiratory distress (22.2%), hypocalcemia (13.3%), and congenital abnormalities (11.1%). The duration to establish normoglycemia was 12.7 hours in infants of gestational diabetic mothers, 32 hours in group A and 36.5 hours in group B diabetic mothers (p<0.05). The overall mortality rate was 13.3% (six patients) and septicemia was the leading reason for death. CONCLUSION: In conclusion, hypoglycemia was found to be the most frequent complication in IDMs and the duration of hypoglycemia was correlated by the severity of maternal diabetes. (Return)

Surgical repair of myelomeningocele

Erdincler P, Kaynar MY, Akar Z, Ciplak N, Sarioglu AC, Kuday C

Cerrahpasa J Med 1996;27: 33-37.

BACKGROUND AND DESIGN: Meningomyelocele is the most commen congenital deformity of medulla spinalis. Between 1983-1933, 159 patients with myelomeningocele were treated in Cerrahpasa Medical Faculty, Department of Neurosurgery. RESULTS: One fourth of patients were operated during the neonatal period and the rest within the first 6 months of life. Eighty-one percent of the defects were in lumbar and lumbosacral regions. Preoperative neurological examination revealed paraplegia or weakness of the lower extremities in 66 patients. In 40 cases V-P shunt were placed before or during the repairment of the myelomeningocele. In 12 cases, V-P shunt were inserted after the surgical repair. 8 cases died within the first week of the operation because of sepsis or fluid-electrolyte imbalance. Only 67 patients werefollowed-up for 30 months. 38 of these patients are disabled and dependent. CONCLUSION: We have not observed any significant improvement of the motor functions after surgery. The presence of hydrocephalus is an important factor in the development of inteelect and motor disfunctions. A multidisciplinary approach is recommended for better results. (Return)

Methanol intoxication: Report of 2 cases

Araz M, Vatansever S, Yildiz A, Karan MA, Halici E, Erk O, Guler K

Cerrahpasa J Med 1996;27:38-40.

BACKGROUND: Methanol intoxication is seldomly diagnosed in emergency medicine. Prompt recognition and early treatment improves prognosis. The most effective method of treatment is the removal of methanol and its toxic metabolites by hemodialysis. OBSERVATION: Here we report two cases who consumed vodka containing methanol, 36 hours before admission. Despite general supportive care and early hemodialysis, one of the patients died. It should be remembered that methanol causes metabolic acidosis with high anion and osmolar gap and is frequently used to produce illegal alcoholic beverages. (Return)

Antioxidant defense systems

Seven A, Candan G

Cerrahpasa J Med 1996;27: 41-50.

BACKGROUND: Oxidative damage inflicted by reactive oxygen species is also referred to as "oxidative stress" and reflects a shift in the prooxidant-antioxidant balance in favor of the former. Antioxidant defenses that protect the body from free-radical damage include enzymatic (superoxide dismutaze, catalase, glutathione peroxidase, glutathione reductase, glucose-6-phosphate dehydrogenase) and nonenzymatic (vitamins A, E, C, glutathione, uric acid, bilirubin) scavenger systems. In this review, the structures, effects and defense mechanisms of these antioxidants are discussed. (Return)