1996;27(4):179-254.
CONTENTS


ABSTRACTS

Inhalation corticosteroids in chronic obstructive pulmonary disease

Sipahioglu B, Erk M, Yilmaz G

Cerrahpasa J Med 1996;27: 183-186.

BACKGROUND AND DESIGN: To evaluate the efficiency of inhaled corticosteroids in COPD, 12 patients were treated with budesonide 800 mcg/day where as 8 patients were observed as control group. Pulmonary function test were performed at the beginning and at the second, fourth and sixth weeks. RESULTS: PEFR increased from 166 L/min in the group treated with budesonide (p<0.05). Spirometric parameters did not change. In the control group no significant change was observed. CONCLUSION: Inhaled corticosteroids may be beneficial in the treatment of COPD. Some controversies exist in this field and further invastigation should be undertaken. (Return)


Insulin and cortisol levels in hypoglycemia of small for gestational age newborns

Ozcan S, Celebi A, Gur E, Arvas A, Ilter O

Cerrahpasa J Med 1996;27: 187-191.

BACKGROUND AND DESIGN: To investigate the role of insulin and cortisol in the hypoglycemia of the small for gestational age (SGA) newborns, blood glucose, serum insulin and cortisol levels were prospectively measured in 33 SGA infants within the first 4, 24, and 48 hours after birth. RESULTS: Eleven of the 33 SGA newborns were found to be hypoglycemic and 9 of them were hyperinsulinemic within the first 4 hours. The mean insulin level of the hypoglycemic group was higher than that of the normoglycemic SGA infants (t=3.9, p<0.001). There was an negative correlation between insulin and blood glucose concentrations. Hypoglycemia persisted in 3 of the 11 hypoglycemic infants at 48 hours after birth and all had raised insulin concentrations during hypoglycemic state. The mean cortisol levels in hypo- and normoglycemic groups were not significantly different. CONCLUSION: These results suggest that hyperinsulinemia has an important role in the hypoglycemia of SGA newborns, and these infants may have diminished adrenocorticol response to hypoglycemia. (Return)


The significance of markedly elevated erythrocyte sedimentation rate in adults

Kocabas C, Tunca M

Cerrahpasa J Med 1996;27: 192-198.

BACKROUND AND DESIGN: Erythrocyte sedimentation rate (ESR) of 100 mm/hr and over is usually related to serious diseases such as malignancy, infection and rheumatic disease. In a retrospective study, 33677 ESR measurements obtained between 24.1.1993 and 24.7.1994 in the Internal Medicine Department of Dokuz Eylul University, Medical Faculty, were screened for values over 100 mm/hr. RESULTS: There were 650 patients who had ESR levels of 100 mm/hr and over (1.9%). A definite diagnosis was available in 361 patients. One hundred fourty six patients had malignancies (40.4%), 172 had infectious diseases (26.5%), 34 had rhemautic diseases (5.2%), 40 had chronic renal failure (6.2%) and 40 had various other disorders. Among infections the most common cause was the lower respiratory tract infections and the most frequent malignancy was lung cancer. Contrary to other reports, plasma cell disorders, colorectal and breast carcinomas were rare among 361 patients with markedly elevated ESR levels. CONCLUSION: Infectious diseases and malignancies are the main diagnosis in patients with significantly raised ESR levels. (Return)


The significance of handgrip Doppler echocardiography in the assesment of mitral stenosis

Mutlu H, Kucukoglu S, Gurmen T, Baltay A, Gultekin N, Uner S

Cerrahpasa J Med 1996;27: 199-203.

BACKGROUND AND DESIGN: This study was designed to evaulate the significance of handgrip Doppler echocardiography in the assesment of patients with mitral stenosis. Heart rate, systolic and diastolic blood pressure, mean mitral gradient and pulmonary artery systolic pressure were determined before end after handgrip test in 22 patients with mitral stenosis. RESULTS: When pre and post gripest results were commpared, a significant increase in all parameters tested was observed. The mean heart rate increased from 77.8±11.9/min to 99.3±12.7/min (p<0.001), the mean systolic pressure from 105.2±10.7 mmHg to 131.3±10.7 mmHg (p<0.002), the mean diastolic blood pressure from 70.9±6.83 mmHg to 79.4±6.0 mmHg (p<0.005), the mean mitral gradient from 9±3.3 mmHg to 15.6±4.3 mmHg (p<0.001), and the mean pulmonary artery systolic pressure from 51.2±7.7 mmHg to 63.2±8.1 mmHg (p<0.001) after the application of the test. Dyspnea devoleped in 8, fatigue and palpitation in 14 patients. The increase observed in pulmonary artery systolic pressure was significantly greater in patients who devoleped dyspnea compared to the rest of the group (20.1± 4.9 mmHg vs 11.2±3.4 mmHg; p<0.001). There was no significant difference with regard to increase in mean mitral gradient and mitral valve area at rest in patients who did and did not experience dyspnea after the test. CONCLUSION: We conclude that the handgrip Doppler echocardiography is a valuable supplementary method for the clinical evaluation of patients with mitral stenosis. (Return)


Brucellosis: Evaluation of 38 cases

Mert A, Dumankar A, Tabak F, Tunc R, Hondur N, Aktuglu Y

Cerrahpasa J Med 1996;27: 204-211.

BACKGROUND AND DESIGN: Thirty-eight cases with acute brucellosis that had been treated in Cerrahpasa Medical Faculty, Department of Internal Medicine, Division of Infectious Diseases between January 1994 and 1996 were evaluated prospectively with regard to clinical, laboratory paramaters and responce to treatment. RESULTS: Twenty-six percent of the patients were from rural areas and 21% had a history of drinking unpasteurized milk. Fifty-three percent were admitted to the hospital during spring and summer. There were 22 female and 16 male patients with a mean age of 35 years (range 15-65 yrs). Major complaints were fever, malaise, arhtralgia, anorexia, myalgia, low back pain, weight loss and headache in decreasing order. Fever was present in all, hepato- and splenomegaly in half, and lymphadenopthy in one-third of the patients. Joints were involved in 58% of the patients (n: 22). 11 had monoarthritis (29%), 7 had spondylitis (18%), and 4 sacroileitis (11%). Erythrocyte sedimentation rate was found to be over 100 mm/hr in 5 (13%) patients. Wright, Rose-Bengal and ELISA tests were positive in 38, 20 and 15 cases respectively. 20 patients were treated with tetracycline plus streptomycine (group I), and 18 received doxycycline plus rifampicine (group II). Fever responded in all patient within 7 days. The relapse rate at 18 month after the onset of the disease was 10% (n:2) in group I, and 5% (n:1) in group II. Wright test was repeated in 30 (79%) of the patients within two years after onset of the disease and all had titers of less than 1/160. CONCLUSION: Brucellosis is a frequently diagnosed infectious disease in Turkey, and has a wide spectrum of clinical symptoms and signs. It must be considered in every patient presenting with fever lasting more than a week. (Return)


The frequency of hypermobility in Turkish children

Kasapcopur O, Ingol H, Sungurtekin N, Ozdogan H

Cerrahpasa J Med 1996;27: 212-215.

BACKGROUND AND DESIGN: To determine the frequency of hypermobility in healthy Turkish children, we examined 243 children (124 girls and 119 boys) and assesed the articular mobility was not shown remarkable difference with age and sex. RESULTS: Thirty eight percent (13/34) of the children with hypermobility compared to 7% (15/209) without, complained of joint pains. There was a significant relation between hypermobility and joint complaints (c2 = 24.7). All of these children had normal physical examination and erytrocyte sedimentation rates. CONCLUSION: In otherwise healthy children with joint complaints hypermobility should be considered. (Return)


Spontaneous non-clostridial anaerobic cellulitis in a diabetic patient

Osar Ersanli Z, Damci T, Karayigit TC, Cercel A, Ozturk R, Mert A, Gorpe U, Ilkova H, Ozyazar M, Bagriacik N

Cerrahpasa J Med 1996;27: 216-220.

BACKGROUND: Nonclostridial anareobic cellulitis is a severe necrotizing soft tissue infection that may be fatal when not treated appropriately. Skin lesions, particularly foot ulcers, common in diabetics may lead to such infections. Review of the literature revealed some case reports of spontaneous necrotizing fasciitis in diabetics, but we were not able to find any case of spontaneous nonclostridial anaerobic cellulitis in a diabetic patient. OBSERVATION: In this report, a case with spontaneous nonclostridial anaerobic cellulitis secondary to diabetes and review of the literature on necrotizing soft tissue infections have been given. (Return)


A case of Madura foot caused by Nocardia brasiliensis

Yucel A, Sezgic N, Aygun G, Bahar H, Kotogyan A

Cerrahpasa J Med 1996;27: 221-224.

BACKGROUND: Actinomycetoma is a rare condition related with difficulties in identification, antimicrobial susceptibilty testing, and treatment. Residual and metastatic lesions are frequent even in cases who received appropriate treatment. OBSERVATION: Here we report a woman of 47 who had N. brasiliensis infection continuing for the last 22 years. The infection which had been controlled with the tretment of sulfamethoxazole-trimetoprime for several times, exacerbated after the cessation of the antibiotic therapy. (Return)


Varicella vaccine

Palanduz A, Yalcin I

Cerrahpasa J Med 1996;27: 225-229.

BACKGROUND: Varicella in a self-limited disease and rarely complicated in otherwise healtly children. On the other hand the course may be severe in aldults and immunocompromised patients. Live attenuated varicella vacine was licensed in USA on March 17, 1995 for use in individuals 12 months of age and older who did not develop varicella. It has beens shown to be immunogenic and adverse effects were acceptable. There is some concern that if extensive immunization with varicella vaccine is achieved, the infection might be seen more frequently in adulthood, which has a more severe course. The duration of immunity the booster effect of wild type varicella is a question of consideration. More data is needed before recommending routine varicella vaccination.(Return)