1997;28(1):1-64.
CONTENTS


ABSTRACTS

Clinical features and their prognostic importance in non-Hodgkin lymphomas.

Osar Ersanli Z

Cerrahpasa J Med 1997;28: 5-11.

BACKGROUND AND DESIGN: The factors which are prognostically important in non-Hodgkin lymphomas (NHL) are controversial. They have not been extensively evaluated in Turkey. The present study which was performed in the Hematology Division of the Department of Internal Medicine in Cerrahpasa Medical Faculty between 1986 and 1990 included in 50 cases with histopathologically diagnosed NHL that were followed up for 2-5 years. The histopathological and clinical features, complete remission and survival rates of the patients along with factors affecting these were analyzed. RESULTS AND CONCLUSION: Amongst factors which previously were proved to have prognostic significance, clinical stage, Karnofsky score and bone marrow involvement were found to affect the rate of complete remission achievement, whereas histologic type and LDH levels were found to be predictive of survival.(Return)


The ultrastructural changes in renal allograft depending on cold ischaemic time in preservation by simple cold storage

Memmedoglu A, Onder AU, Seckin I, Sariyar M

Cerrahpasa J Med 1997;28: 12-16.

BACKGROUND AND DESIGN: We performed this experimental study to investigate the ischemic damages related to the preservation time during cadaveric renal transplantation using simple cold storage (SCS). Priority was given to investigate the changes of the endothelium due to cold ischemic time and the aggregation of the erythrocytes in the capillaries and arterioles; factors that underlie the "no-reflow" phenomenon. RESULTS: Although aggregation of the erythrocytes in the glomerular peritubular capillaries was a frequent finding, there was no agglutination among the erythrocytes and no adhesion of the erythrocytes to the endothelium following perfusion and a 12 hr preservation. When the preservation time was 24 hr or more, agglutination of the erythrocytes and adhesion of the erythrocytes to the capillary endothelium were seen. There was degeneration of the endothelial cells at the adhesion regions and the endothelial completeness was impaired when the cold ischemic time was 48 hr or more. CONCLUSION: We have concluded that ultrastructural changes due to long cold ischemic time such as agglutination of the erythrocytes, adhesion of the blood elements to the endothelium and impairment of the endothelial completeness can cause microcirculation damage and dysfunction of the allograft if reperfusion is performed during renal preservation using simple cold storage.(Return)


Free gracilis muscle transfer, full masseter transposition and McLaughlin procedure for the treatment of facial paralysis

Senyuva C, Aydin Y, Yucel A, Guzel MZ, Yildirim I

Cerrahpasa J Med 1997;28: 17-23.

BACKGROUND: Various techniques have been described for the restoration of smile and to achieve symmetrical oral comissures in patients with facial paralysis. Techniques such as skin excisions combined with suspension with facia strips and temporalis muscle transposition have major disadvantages. DESIGN: Twelve patients with unilateral facial paralysis are presented: free gracilis muscle transfer was done in 4 patients. McLaughlin's procedure was performed in 4 patients and full masseter transposition was done in 4 patients. All patients were evaluated on the same day by a detalied questionnaire filled both by the patient and surgeon. RESULTS: The overall results were satisfactory in all patients. Oral comissure symmetry was achieved in all patients with satisfactory muscle excursion. Bulky apeearance in the cheek was observed in patients with free gracilis muscle transfer and depression over the angle of the mandible was seen in patients with full masseter transposition. Unilateral tongue atrophy, speech and swallowing disorders were present in two patients in whom the hypoglossus nerve was used for the innervation of gracilis muscle. CONCLUSION: Our results obtained 2 years after the operation suggests that sophisticated techniques such as free muscle transfers may not be superior to the conventional techniques such as full masseter transposition or McLaughlin procedure in the treatment of facial paralyses.(Return)


Intraoral carcinoma infiltrating the floor of the mouth: Report of 20 cases

Senyuva C, Aydin Y, Yucel A, Guzel MZ, Turkaslan T, Mindikoglu AN

Cerrahpasa J Med 1997;28: 24-32.

BACKGROUND: Resection of tumors infiltrating the floor of the mouth or adjacent areas cause complex reconstructive problems because of the anatomic and functional properties of the region. Reconstruction of the floor of the mouth should allow free movements of the tongue and should maintain the continuity of the mandible in order to preserve normal speech, swallowing and digestion. DESIGN: Twenty patients with malignant tumors infiltrating the floor of the mouth were treated between 1990 to 1995. The mandible was also invaded in 13 cases. In 6 cases unilateral and in 3 cases bilateral neck dissection was performed during tumor resection. Reconstructions were done in the same stage in all cases except the one reconstructed with bilateral nasolabial flaps (Lattissimus dorsi, Pectoralis major, Trapezius) in 4 cases, local flaps (frontal flap, bilateral nasolabial flaps, tongue flap) in 3 cases, free flaps (radial forearm, scapular, DCIA flap) in 7 cases and a sequentially linked free flap (vascularized fibula and radial forearm fasciocutaneous flaps) in one case was used for the reconstruction. RESULTS: Early postoperative complications were mandibular fracture in one case, temporary salivary fistula in 2 cases and limited wound dehiscence in one case. One case died because of aspiration pneumonia 12 days after the operation. Local tumor recurrence was observed in 2 cases and one of them died due to intracranial tumor infiltration. CONCLUSION: Free tissue transfers with microvascular surgical technique started a new era in the reconstruction of the floor of the mouth. Pedicled flaps can be used when bulkiness is needed, but free flaps should be used when a thin lining or complex reconstruction is necessary.(Return)


Treatment of Peyronie's disease with verapamil

Alici B, Akkus E, Ozkara H, Yaycioglu O, Hattat H

Cerrahpasa J Med 1997;28: 33-36.

BACKGROUND AND DESIGN: Multiple oral or topical agents have been used in the treatment of Peyronie's disease. Responses have not been satisfactory. Verapamil is a calcium channel blocker which can alter the metabolism of fibroblasts. It has been used to decrease fibroblastic activity in the tunica albuginea of the penis. In this nonrandomized study, a group of 27 previously untreated men with Peyronie's disease received biweekly injections of verapamil intralesionally for 6 months. RESULTS: Subjective improvement in curvature (25%) and pain (85%) was significant. Objectively, decreased plaque volume of 50% or more was noted in 43.5% of the patients. Ease of injection into plaque was noted in 80% of the patients during the treatment. Erectile status was better in 35% of the patients. CONCLUSION: Although this nonrandomized study shows that intralesional verapamil injection is promising in Peyronie's disease, prospective double-blind clinical studies will determine its ultimate usefulness.(Return)


Evaluation of 252 patients with gastric carcinoma

Demir G, Ozguroglu M, Molinas-Mandel N, Demirelli F, Buyukunal E, Serdengecti S, Berkarda B

Cerrahpasa J Med 1997;28: 37-42.

BACKGROUND AND DESIGN: This is a retrospective evaluation of 252 patients with gastric carcinoma (151 males and 101 females) followed up in the Department of Oncology, Cerrahpasa Faculty of Medicine. Effects of five different chemotherapy protocols on survival are compared on an adjuvant and metastatic basis. RESULTS: 8.3% of the patients were in stage II, while 31.7% were in stage III, and 60% were stage IV. Histologically 57% of the tumors were low differentiated adenocarcinoma. 36.5% of the patients were found to have inoperable disease at the time of their admission. There was a positive correlation between the initial CEA and CA 19-9 levels and the stage of the disease. In the metastatic group, the mean follow-up period was 219 days (median: 183), while in the adjuvant group it was 441.85 days (median: 359). The CDDP+FU+FA protocol given in an adjuvant basis, was shown to induce a survival period of 42 months. This was statistically significant when compared to other protocols (p<0.009). On the other hand, there was no significant difference between treatment protocols in the metastatic group. CONCLUSION: Gastric cancer in Turkish people bears differences such as early age of onset and advanced disease at presentation. It is concluded that, CDDP+FU+FA protocol is beneficial on an adjuvant basis in patients with gastric carcinoma. However, there is still the need for developing new and more effective treatment protocols in this disease. (Return)


Cesarean section rates and indications of Cerrahpasa Medical Faculty Department of Obstetrics and Gynecology during 1986 and 1995

Aksu MF, Madazli R, Oz U, Cepni I, Ocak V

Cerrahpasa J Med 1997;28: 43-47.

BACKGROUND: Cesarean section (C/S) rates, indications and increases in C/S rates in our clinic are evaluated. The effects of cesarean delivery on the mother and the newborn is discussed. DESIGN: Annual cesarean section and vaginal deliveries in our clinic between 1986 and 1995 are obtained from delivery ward documents. Annual cesarean rates and percentage increase of the cesarean deliveries are calculated. Additionally, the indications and their trend between 1990 to 1995 are evaluated. RESULTS: Cesarean section rate of our clinic between 1986 and 1995 was 20.9%. This rate increased from 14.2% in 1986 to 33% in 1995. The annual increase in C/S rate was 1.4 and 2.6 between the time periods 1986 to 1990 and 1991 to 1995, respectively. Cesarean section for previous cesarean was found to be the most common indication (6.77 for 100 deliveries). "Elective" indication rised rapidly during the study period. CONCLUSION: Cesarean section rates in developed countries have been declined and approached stability. However, they show a rapid rise in our clinic. Elective indication is an important contributor to this increase. Current cesarean rates can be substantially reduced to a reasonable level without sacrificing fetal and newborn safety by a wide auto-control system of the indications. (Return)


Mitoxantrone, etoposide and intermediate dose Ara-C combination chemotherapy protocol in resistant or recurrent ANLL

Demir M, Baslar Z, Soysal T, Ferhanoglu B, Aydin Y, Ulku B, Aktuglu G, Akman N

Cerrahpasa J Med 1997;28: 48-52.

BACKGROUND AND DESIGN: Intensive sequential chemotherapy with mitoxantrone 12 mg/m2/d on days 1 through 3; etoposide 200 mg/m2/d as a continuous infusion on days 8 through 10, cytarabine (Ara-C) 500 mg/m2/d as a continuous infusion 1 through 3 and 8 through 10 was administered of 13 patients aged less than 60 years (median 37, range 19-58) with previously treated acute non-lymphoblastic leukemia (ANLL). RESULTS: Five patients had refractory ANLL (no response to prior therapy), one patient had early first relapse, four patients had late first relapse, three patients had second relapse. Forty six percent (6 patients) of the patients achieved complete remission, fifteen percent did not respond to therapy and five died from therapy-related toxicity. Median duration of aplasia was 28 days. Non-hematological WHO grade 3 of more toxicity included 6 patients with infections (sepsis 50%, pneumonia 33.3%, meningitis 16.7%), vomiting (30.7%), mucositis (53.8%), diarrhea (30.8%), skin rash (7.7%), clinical bleeding (30.8%), cardiac toxicity (7.7%), neurotoxicity (23.1%). Median disease-free survival was 215 days, one patient is alive (825 days). All other patients died (two patients died from induction therapy, three patients are early death due to bone marrow aplasia). CONCLUSION: These results, when combined with other studies concerning this chemotherapy protocol and keeping in mind the rate of increased toxicity, may indicate that it can be a good choice as a second line treatment protocol.(Return)


An extragenital (umblical) endometriosis: Case report

Cepni I, Gezer A, Bese TT, Aksu MF

Cerrahpasa J Med 1997;28: 53-56.

BACKGROUND AND OBSERVATION: Extragenital endometriosis is a benign disease. The literature is limited to the standardization of the therapeutic regimens. The probability of extragenital endometriosis must be excluded on the evaluation of any tumoral lesion around the umblicus and abdominal scars. Thus, in connection with a case report in our clinic -an umblical endometriosis-, we aimed to summarize the current approach to this phenomenon.(Return)


A case of syphilitic hepatitis

Dumankar A, Mert A, Koskeroglu C, Tabak F, Ozbay G, Aktuglu Y

Cerrahpasa J Med 1997;28: 57-59.

BACKGROUND: Syphilis is a chronic, multisystem infectious disease caused by spirochete Treponema pallidum. It is often transmitted by sexual contact and lasts in graded stages. Skin lesions are predominant in primary and secondary stages. Hepatitis and fever are rare in secondary syphilis. Diagnosis is made by treponemal and non-treponemal tests. Penicillin is the first choice in patients who are not allergic to this drug. OBSERVATION: A 26 years old, single, male patient with syphilis having fever and abnormal liver function tests is presented. The diagnosis of syphilis was made by RPR and TPHA tests. After initiation of penicillin therapy, the fever disappeared and the liver function tests became normal. CONCLUSION: Syphilis should be considered in the differential diagnosis of unexplained liver enzyme abnormalities and fever. (Return)


C-reactive protein response in systemic lupus erythematosus

Basaran M, Hizli N

Cerrahpasa J Med 1997;28: 60-62.

BACKGROUND: The value of increased C-reactive protein in differentiating between infection and flares of disease activity in systemic lupus erythematosus is reviewed. High levels of C-reactive protein can be seen in patients with systemic lupus erythematosus either during flares with serositis or during infections. Slight increases in the levels of C-reactive protein are not helpful for the differential diagnosis of infection and disease activity. (Return)