1997;28(2):65-124.
CONTENTS


ABSTRACTS

Cerebral palsy: Clinical and laboratory features

Narli H, Demirbilek V, Korkmaz B

Cerrahpasa J Med 1997;28: 69-72.

BACKGROUND AND DESIGN: Cerebral palsy result from a static central nervous system injury which occurs in the developing brain due to various causes of prenatal or perinatal or postnatal etiologies. It mainly consists of motor or postural abnormality which is frequently associated with seizures, speech difficulties and mental retardation. In this study cerebral palsy is studied according to the various clinical and laboratory features in relation to the 252 patients referred to the out-patient clinics. RESULTS: Prenatal etiologies were found in 10%, perinatal etiologies were found in 48%, post-natal etiologies were found in 29.3% of the patients. The type of cerebral palsy was distributed at the same rate seen in the literature. In the extrapyramidal type post-nasal etiologies were seen at a higher rate, which could be explained with the increased incidence of kernicterus in Turkey. Neuroimaging was positive in the 75.7% of patient population, particularly in the hemiplegic group. Epileptic seizures were more frequently seen in the hemiplegic and quadriplegic type. The number of patients with EEG abnormality without seizures (63.5%) far exceeded the ones with seizures. CONCLUSION: The main abnormalities detected were focal slowing, sharp elements and disturbed background activity. (Return)


Acute infectious exacerbations in chronic obstructive lung disease and effects of azitromycine, sultamycilline, ciprofloxacin and cefaclor monohydrate

Ilvan A, Gur A, Musellim B, Tutluoglu B, Kosar F, Soysal F, Tosun GA, Vahapoglu H, Turker H, Erelel M, Akman M, Erk M, Yilmaz N, Yildirim N, Arseven O, Ozturk S, Umut S, Unutmaz S, Yilmaz Kuyucu T, Goylusun V, Yilmaz V

Cerrahpasa J Med 1997;28: 73-77.

BACKGROUND AND DESIGN: Lower respiratory tract infections cause great morbidity and mortality in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to find out the causative organism and the effects of azitromycine, ampicilline sulbactam (sultamycilline), ciprofloxacine and cefaclor monohydrate therapy in COPD. One hundred and sixteen patients with COPD in acute exacerbation were randomized into four groups for antibiotic treatment following lung function test and sputum. RESULTS: The most common strains were H. influenzae (30.8%), S. pneumoniae (12.0%) and M. catarrhalis (7.7%). CONCLUSION: H. influenza is the most common causative organism in acute infectious attacks of COPD. Azitromycine, ampicilline sulbactam (Sultamycilline), ciprofloxacine and cefaclor monohydrate are of value in the treatment of acute infectious attacks of COPD. (Return)


Early surgical treatment in penile fractures

Akkus E, Oner A, Cetinel B, Arar O, Ozkara H, Alici B

Cerrahpasa J Med 1997;28: 78-81.

BACKGROUND: To assess the short term outcome of early surgical treatment in penile fractures. DESIGN: Retrospective analysis of 18 cases with penile fracture operated between 1989 and 1994. RESULTS: Early surgical treatment was successful in all cases. No complications such as penile curvature or erectile dysfunction was observed during the mean follow up of 8 months. CONCLUSION: Early surgical treatment seems to be effective in penile fractures. (Return)


Reduction of the giant breasts by the inferior pedicle technique

Guzel MZ, Aydin Y, Aygit AC, Yildirim M, Yucel A, Orak F

Cerrahpasa J Med 1997;28: 82-88.

BACKGROUND AND DESIGN: The authors performed inferior pedicle technique in 22 patients with giant breasts in the last 6 years. In this technique, the shape of the breast is created by the inferiorly based dermal nipple-areola complex. Therefore, the breast tissue can be resected in the desired volume. In this study, the authors reviewed 22 patients who had giant breasts that required reductions of more than 1500 gr. of the excess tissue from each breast. Postoperative follow-up ranged between 6 months and 6 years (mean 2.8 years). RESULTS: There were few complications, none of which affected the outcomes. CONCLUSION: The results were judged to be good, both aestetically and functionally.(Return)


The effect of the job-site noise on blood pressure

Vehid S, Koksal S, Yuceokur A, Senocak M, Erginoz H

Cerrahpasa J Med 1997;28: 89-94.

BACKGROUND AND DESIGN: The purpose of this study is to investigate the relation between job-site noise and blood pressure. With this purpose we studied worker of the Pendik Kaynarca shipyard for the six months period between September 1994 and February 1995. Female workers, the physically or the mentally handicapped, workers who had complaints of hypertension, and workers whose working period is less than three years were excluded from the study. One hundred twenty seven workers exposed to an environmental noise level of more than 85 dB(A) were the case groups of the study, whereas those 75 who were exposed level less than 85 dB(A) comprised the control group. Data including age, smoking and drinking habits, education level, body weight and height, family history of hypertension and diabetes mellitus were obtained in both groups by a descriptive questionnaire. In each participant a complete physical examination was carried out. RESULTS: The differences among two groups were found to be statistically not significant as to their main characteristics with the exception of their average systolic blood pressure level which was higher in the case group (121.25±16.77 in the case group, 115.86 ± 14.75 in the control group, t=2.306, p<0.05). CONCLUSIONS: Our results suggest that environmental noise has an increasing effect on blood pressure. The need of specific education and the need of using protective equipments such as earplugs is stressed. (Return)


Effect of prophylactic intravenous immunoglobulin on the frequency of infections in chronic lymphocytic leukemia

Baslar Z, Soysal T, Aktuglu G, Ulku B

Cerrahpasa J Med 1997;28: 95-98.

 BACKGROUND AND DESIGN: Infections are responsible from the majority of disease-related death in patients with chronic lymphocytic leukemia (CLL). Hypogammaglobulinemia is the most important cause of increased susceptibility to infections in this disease. Intravenous immunoglobulins (IVIG) is becoming an important adjunct to the prophylaxis and therapy of infections in CLL. Five patients with Rai stage III-IV CLL, and with frequent and severe infections, whowhere treated with 3 courses of IVIG (300 mg/kg, every three weeks) prophylactically are presented. RESULTS: IgG levels increased in all patients after IVIG treatment. No infections were observed during treatment and in the follow-up period, except one episode of infection in one patient. CONCLUSION: IVIG treatment is effective in reducing the frequency of infections in CLL. It should be reserved for selected patients who develop frequent, severe and life-threatening infections because of the high costs. (Return)


Medulloblastoma in adults: Treatment results and prognostic factors

Abacioglu U, Oner Dincbas F, Uzel O, Altinel A, Turkan S, Okkan S

Cerrahpasa J Med 1997;28: 99-102.

BACKGROUND AND DESIGN: A retrospective study was designed to evaluate the results of postoperative crainiospinal irradiation and prognostic factors in adult medulloblastoma patients. Twenty-nine adult medulloblastoma patients (=> 16 years of age) presented to our department for postoperative radiotherapy were analysed. Median age was 26 (16-44), median duration of symptoms was 3 months (1-12). Male/female ratio was 19/10. Seventeen of the tumors (58.6%) were located laterally and 9 (31%) were of desmoplastic variant. Gross total resection was performed in 18 patients (62.1%) and 10 (34.5%) received adjuvant chemotherapy. As a standard treatment 19 patients were given craniospinal irradiation and posterior fossa was boosted. Median dose to the whole brain was 45 Gy (36-60 Gy), spinal axis 36 Gy (24-40 Gy) and posterior fossa 54 Gy (49-60 Gy). RESULTS: Five year local control, disease free survival and actuarial survival rates for standard treatment group were 84%, 65.9% and 53.3% respectively. Female gender was found to be a bad prognostic factor between the factors analysed. CONCLUSION: Postoperative craniospinal irradiation should be given to all patients with medulloblastoma to prolong survival.(Return)


Scimitar syndrome: The report of a surgically corrected case.

Tuzun H, Bozkurt AK, Besirli K, Kaynak K, Sunar H, Eryuksel B, Aktan K

Cerrahpasa J Med 1997;28: 103-105.

BACKGROUND AND OBSERVATION: Scimitar syndrome is a relatively uncommon congenital anomaly. A 24-year-old woman with a recent onset of palpitation was referred to our hospital for an abnormal shadow on the chest x-ray which was consistent with scimitar syndrome. Angiocardiography revealed an anomalous pulmonary vein draining to the inferior vena cava. Left to right shunt, which was greater than 100%, was corrected surgically. The flow of the anomalous pulmonary vein was directed to the left atrium by creating a pericardial tunnel through the right atrium. Postoperative course was uneventful.(Return)


Five cases with ataxia telangiectasia and clinical manifestations

Okan M, Kilic S, Ozkan T

Cerrahpasa J Med 1997;28: 106-110.

BACKGROUND: Ataxia-telangiectasia is a syndrome of autosomal recessive inheritance characterized by cerebellar ataxia, oculocutaneous telangiectasias variable immune system defects, chronic progressive sinopulmonary disease and a high incidence of cancer. OBSERVATION: Clinical and laboratory findings of five cases with ataxia telangiectasia were studied between years of 1992-1994. Ophthalmologic, central nervous system and immune system symptoms were present in all cases, however musculoskleton system and skin involvement were present in only two cases. Two cases died as results of complications of recurrent sinopulmonary infections. (Return)


A rare source of rectal bleeding: Colonic lipoma

Yardimci H, Artis T, Uras C, Balcisoy U, Akcal T

Cerrahpasa J Med 1997;28: 111-113.

BACKGROUND: Lipoma, an uncommon tumor in the gastrointestinal tract, occurs most often in the colon. The treatment of the colonic lipomas is most necessary because of the potential hazards of bleeding and bowel obstruction and because the diagnosis can be confirmed only by histologic examination. OBSERVATION: Here we report a case of colonic lipoma as a rare source of massive rectal hemorrhage and details of the surgical therapy. (Return)


Diabetic cardiomyopathy

Osar Ersanli Z, Damci T

Cerrahpasa J Med 1997;28: 114-120.

BACKGROUND: Diabetic cardiomyopathy, independent from the development of coronary heart disease, increases the cardiac risk of patients with insulin dependent and non-insulin dependent diabetes. Its pathogenesis and treatment principles are reviewed. (Return)