1996;27(2):55-114.
CONTENTS


ABSTRACTS

An evaluation of the cases of neural tube defects

Tasdelen E, Arvas A, Perk Y, Ataoglu N, Ilter O

Cerrahpasa J Med 1996;27: 59-62.

BACKGROUND AND DESIGN: The cases with neural tube defects seen in Cerrahpasa Medical Faculty, Pediatric Clinic were evaluated with respect to maternal age, consanginous marriages, associated anomalies, type and incidence of neural tube defects. RESULTS: All liveborn and stillborn deliveries from January 1989 to December 1991 were reviewed. Sixty-two cases with neural tube defects in cases of 11852 deliveries (0.52%) were analyzed in detail. There were 18 newborns with anencephaly (0.15%) and 44 newborns with spina bifida (0.37%). The incidence of neural tube defect in liveborns was noted in the infants of nulliparous mothers and female infants. CONCLUSION: The pregnant women who are in the risk group for neural tube defects should undergo preconceptional counseling including prenatal screening tests such as ultrasound and alpha- fetoprotein. (Return)


Radiotherapy alone vs combined chemotherapy and radiotherapy in nonresectable non-small cell lung cancer: A phase III randomized clinical trial

Koca S, Oner-Dincbas F, Serdengecti S, Yaman M, Ongen G, Demirci S, Molinas-Mandel N, Turkan S, Atkovar G, Okkan S, Sozer K, Celikoglu S

Cerrahpasa J Med 1996;27: 63-69.

BACKGROUND AND DESIGN: Treatment of regionally advanced non-small cell lung cancer (NSCLC) is unsatisfactory. Combined irradiation with chemotherapy may improve local control rates and systemic disease. This study was designed to test the efficacy of radiotherapy alone versus combined chemotherapy (cisplatinum, 5-FU, etoposide). Thirty-four patients with NSCLC were randomly allocated to A) conventional radiotherapy, B) hiperfractionated radiotherapy, C) conventional radiotherapy plus chemotherapy, D) hiperfractioneted radiotherapy plus chemotherapy groups. RESULTS: Local control rates (60-71%) and overall survival rates were not different in between groups. Toxic side effects were common in groups c and d in which there were 2 drop-outs and 3 patients with grade III-IV toxicity. All patients died within 2 years. CONCLUSION: No beneficial effect was obtained by chemo and radiotherapy combination protocol in NSCLC, and it was associated with high and severe toxic side effects. (Return)


Dorsal vein ligation operation in the treatment of impotance

Akkus E, Alici B, Ozkara H, Hattat H

Cerrahpasa J Med 1996;27: 70-73.

BACKGROUND AND DESIGN: The efficacy of dorsal vein ligation operation in the treatment of impotance with short and long term results is evaluated and discussed. RESULTS: Thirty of the 48 cases (62.5%) had sufficient erection to perform sexual intercourse in short term follow up however long term follow up of the 30 cases revealed 29% success rate with 14 cases who had sufficient rigid erections. Seven of the 30 cases who had recurrence in long term follow up had benefited from intracavernous injection therapy. All 14 cases who have responded the dorsal vein ligation operation were between 23-45 years of age. CONCLUSION: The success of the dorsal vein ligation operation in the treatment of impotence seems to decrease in long term when compared with the short term results. Even though the success rate is 29% in long term, additional intracavernous injection therapy may increase the response rate and quality of erection. (Return)


Evaluation of the prognosis of silent and symtomatic myocardial ischemia in elderly patients

Karpuz H, Doat M, Adamec J, Keser N, Sztajzel J, Righetti A

Cerrahpasa J Med 1996;27: 74-77.

BACKGROUND AND DESIGN: It has been proposed that the incidence of silent myocardial ischemia is increased in elderly patients. To assess the prognostic importance of silent myocardial ischemia, a retrospective study was designed. One hundred sixty five patients with stable or suspected coronary artery disease who had undergone a cycloergometric exercise test and developed signs of ischemia in their ECG were included in to the study. RESULTS: Of these 165 patients, 110 had silent and 55 symptomatic ischemia. ECG and hemodynamic parameters at rest were similar between two groups. During exercise test, the silent ischemia group had higher maximal mean values of load, heart rate, systolic pressure and double product. A total of 20 patients (12%) had developed major cardiac events (cardiac death and myocardial infarction) during a mean follow-up of 26±14 months. Nine of these patients belonged to the silent ischemia group (8%) and 11 to the symptomatic group (20%). CONCLUSION: Contrary to previous studies reporting no significant difference between these two groups, our results indicate a better prognosis for 2 years in elderly patients with silent ischemia. (Return)


Effect of levadopa therapy on VEPs in Parkinson patients

Apaydin H, Oral Y, Ergin N, Ozekmekci, Hattat N

Cerrahpasa J Med 1996;27: 78-84.

BACKGROUND AND DESIGN: In idiopathic Parkinson's disease (PD), dopamine deficiency involves also the multisnaptic visual patways resulting in a delay of visual evoked potentials (VEPs) P100 latency. In this study, VEPs were recorded in 34 patients (63 eyes) with PD and in 8 healthy controls (12 eyes) using a reversing checkerboard pattern stimulus with different spatial frequencies and the effect of levodopa (LD) therapy, disease duration and severity on VEPs were divided into two subgroups according to their daily doses of LD (=<400 mg> and =<300 mg>). RESULTS: The P100 latency of PD patients was found to be longer (124.03±19.7 msec) than that of controls (113.9±15.7 msec) (p<0.05) only when visual angle of 9.6 degrees/ sec and pattern of small size were used. Patients without LD treatment (n=7) showed slightly more delayed VEPs than those on LD (n=27) (p>0.05), but this delay was significant when compared with the control group (p<0.02). Our data showed that PD patients on LD treatment were older than tended to have a mean stage of PD of Hoehn-Yahr scale and a longer disease duration than patients without treatment (p<0.05, p<0.05 and p<0.001 respectively). PD patients on LD with 0>400 mg daily dose showed more prolonged VEP latencies than those of lower LD doses (p<0.02). We observed similar results of delayed VEPs with =>300 mg vs <300 mg daily doses of LD (p<0.01). VEPs latencies were not statistically different with regard to duration of LD therapy (shorter than 1.5 year vs longer), age of disease onset (before vs after 55 years), stage and staging of PD according to Hoehn-Yahr scale. CONCLUSION: VEPs latencies were significantly delayed in patients with PD than controls. The beneficial effect of LD treatment on VEPs in PD has been reported previously, but according to our results this effect was significant only with lower doses of LD. Higher doses of LD resulted in a marked delay in VEPs contradicting with the clinical improvement. (Return)


Splenectomy for treatment of immune (idiopathic) thrombocytopenic purpura

Uras C, Erturk MS, Yardimci H, Baslar Z, Soysal T, Ferhanoglu B

Cerrahpasa J Med 1996;27: 85-89.

BACKGROUND AND DESIGN: Immune trombocytopenic purpura (ITP) is a condition causing hemorrhagic diathesis and characterized by marked reduction in the number of circulating platelets, shortened platelet life span and abundant megakaryocytes in the bone marrow. Pathogenesis of ITP is related to IgG autoantibodies against platelets. It may be idiopathic or due to other disorders e.g. SLE, lymphoproliferative diseases, some bacterial or viral infections or drugs. Treatment of ITP depends on the age of the patients, severity of the disease, duration of trombocytopenia and type of clinical course. Splenectomy is indicated for patients who do not respond to steroids or relaps after initial remission. RESULTS: Of the 40 female and 23 male patients with ages ranging from 14 to 60 years, the majority were in 2nd and 3rd decades. Decision to proceed to splenectomy was given due to steroid unresponsiveness in 65%, relapse or steroid dependency in 25% and unacceptable toxicty of steroids in 10%. Accesory spleens were found in 17.4%. In 3 patients post-operative infections developed, one of whom died at one mounth in septic shock. Treatment-related mortality was 1.6% and failure (platelet <50x109/L) rate was 4.7%; partial response (PLT 50-100x109/L) was obtained in 12.6% and 80% of the cases remained in remission (PLT>100x109/L) with follow up ranging 1 and 6 years. CONCLUSION: In ITP, splenectomy is an effective treatment modality in patients who are unresponsive to or relapse after treatment with glucocorticoids or in whom they are contraindicated or treatment leads to major complications. (Return)


Prior history of head trauma in Parkinson's disease

Apaydin H, Ozekmekci S, Ergin N, Ertan S, Yeni N

Cerrahpasa J Med 1996;27: 90-93.

BACKGROUND AND DESIGN: A history of severe head trauma have been reported to be more frequent in patientīs with Parkinson s disease (PD) compared to controls. To test the importance of this observation 110 patients with PD and 150 age matched controls were questioned for the history of severe head trauma. The patients with PD were evaluated in two subgroups with respect to the positive (Group I) or negative (Group II) history of head trauma. These two groups were compared according to age of disease progression and relationship between trauma and the localization of the first symptom. RESULTS: Positive trauma history was recorded in 30.9% of patients with PD and in 13.3% of controls (p<0.001). The mean age of onset, rate of disease progression and relationship between trauma and first symptom localizations did not show any significant difference between two subgroups. CONCLUSION: Our data suggested that: a) there is a more frequent history of head trauma in PD compared to the controls; b) presence or the localization of trauma does not influence either the presence or the progression of PD. (Return)


The effect of prick duration on pathergy positivity in Behcet's syndrome

Mat MC, Gokler G, Yurdakul S, Tuzun Y, Hamuryudan V, Kosem V, Ozyazgan Y, Yazici H

Cerrahpasa J Med 1996;27: 94-97.

BACKGROUND AND DESIGN: Pathergy phenomenon (nonspecific skin hyperreactivity) is highly specific for diagnosis of Behcet's syndrome (BS). Application of the test with a blunt needle increases the positivity of the pathergy reaction. To test the effect of prick duration on pathergy positivity 97 patients with BS and 31 healthy controls were included into the study. A 20G1 1/2 (No:1) needle was used. After insertion, the needle was kept in place for 30, 60, 90 seconds or was drawn back immediately as in the classical method. The assessments were done by two blind observers after 48 hours. RESULTS: The number of patients with a positive test increased as the duration of the prick was increased (38% for the first and 39% for the second observer). This increase was significant only when the results obtained at 90 seconds were compared with classical method (p<0.006). No change was observed in the control group. Interobserver agreement was 88% for the classical method (k=0.69) and 85% for the assessment done at 90 seconds (k=0,41). CONCLUSION: Keeping the needle in the insertion site for 90 seconds increased the posivity of the pathergy test in patients with BS significantly.(Return)


A rare course of the splenic vein

Tanyeli E, Sargon MF, Surucu S, Karahan ST, Arifoglu Y

Cerrahpasa J Med 1996;27: 98-99.

BACKGROUND: The splenic vein, which drains the short gastric, left gastroepiploic, pancreatic and gastroepiploic veins is especially used for portographic investigations. This vein is also an important shunt way for the surgical treatment of portal hypertension. OBSERVATION: Here we describe a rare course of the splenic vein, running anteriorly to the splenic artery. Review of the literature revealed a frequency of 2%. (Return)


Mycosis fungoides: Clinical features, histopatology, treatment and a case report

Karpuz V, Erdogan G, Kapanci Y

Cerrahpasa J Med 1996;27: 100-103.

BACKGROUND: Mycosis fungoides is a distinct clinicopathologic type of T cell malignant lymphomas. Its clinical course has three stages; premycotic, mycotic and tumorous. Advanced disease with systemic features is resistant to chemotherapy. OBSERVATION: The clinical course of a 54 years old female patient with painful erythematous lesions around the mouth and over the scapula diagnosed as mycosis fungoides is presented. (Return)


Treatment of superficial bladder tumours

Erozenci A

Cerrahpasa J Med 1996;27: 104-110.

BACKGROUND: Superficial bladder tumours are transitional cell carcinomas that have invaded the mucosa or lamina propria (Ta/T1). Primary treatment of these tumours is transurethral resection or cauterisation, followed by intravesical chemotherapy (epirubicin, adriamycin, mitomycin-C) or immunotherapy (BCG, interferon) in order to prevent tumour recurrences or progression. With the treatment of these tumours with effective intravesical therapy, the recurrence rates have dropped to 15% and the progression rates to 20% in long term follow up. (Return)