Effect of transcutaneal electric nerve stimulation (TENS) on H-reflex and spasticity

Karantay F, Kiziltan M, Hanci M

Cerrahpasa J Med 1997;28: 185-192.

BACKGROUND: The objective of this study was to evaluate the clinical efficacy of TENS on spasticity and its direct effect on H-reflex (HR) in spastic cases. DESIGN: Patient population consisted of 26 patients with hemiplegia and 10 normal controls. Hmax and HR recruitment curves were elicited in 16 of the 26 hemiplegic subjects (Group A) and normals (N) before, during and after TENS application. The same procedure was applied with the same apparatus to the remaining 10 subjects (Group B) with hemiplegia but without electrical stimulation, for control purposes. Following stimulation for 20 minutes once a day for 10 days, HR and recruitment curves were obtained from both group A and B. RESULTS: Inhibition of the maximum H-reflex amplitude has been observed in 9 of 10 normal controls (90%) after TENS application. After the initial TENS, inhibition of H-reflex amplitude was noted in 14 cases (87.5%) from Group A compared to 4 cases (40%) from Group B. Assessment at the10th day of treatment revealed an increase in the ROM of the hip flexion and knee extension and considerable reduction in the spasticity score. No significant change of H-reflex was detected. CONCLUSION: Application of TENS for ten days provided some relief in the severity of spasticity in hemiplegic cases. (Return)

Corporal perforation as a late complication of penile prosthesis

Culha M, Mutlu N, Baykal M, Merder E, Guvendi A, Canbazoglu N

Cerrahpasa J Med 1997;28: 193-195.

BACKGROUND AND DESIGN: The true incidence of corporal perforation of penile prosthesis is unknown, but it is believed to be relatively rare. Here we report 2 cases with penile perforation out of 29 who underwent penile prosthesis. RESULTS: Between 1991-1993, 21 semirigid and 8 inflatable penile prosthesis were implanted in 29 patients with organic erectile dysfunction. Infection and other early post-operative complications were not noticed. However, we experienced corporal perforation in two of our patients in 7th and 9th months after operation. These two patients had semirigid penile prostheses. In the first patient the rupture was intraurethral and in the second one below coronal sulcus. CONCLUSION: Multiple urethral catheterization and urethritis, in the patient with urethral perforation, and erosion of fibrotic plaque during operation, in the other patient with Peyronie disease are possible causes of corporal perforation. As a result, corporal perforation should be recognized as a late complication in patients who have corporal and urethral problems. (Return)

Meta-analysis of carcinoembryonic antigen (CEA) in the differential diagnosis of pleural fluids

Senocak M, Cagatay P, Cagatay T, Narin G

Cerrahpasa J Med 1997;28: 196-200.

BACKGROUND AND DESIGN: Meta-analysis as a definition is the integration of the results of several different studies performed for a particular subject and statistical analysis of research findings. This method is a systematic, statistical evaluation of multiple investigations with their analytic and common findings. RESULTS: In this study we used meta-analysis method in order to verify the effect of CEA (a tumor marker) in differential diagnoses of malignant and benign pleural fluids. As a result of synthesising different studies on this subject we used Weighted averages, Quantative integration, Stouffer, Woolf, Mantel-Haenszel methods. CONCLUSION: In nine different researches CEA levels has been found elevated in the malign group. When meta-analysis has been applied this theory has been enforced. Therefore meta-analysis also showed that CEA levels are higher in the malign group in contrast to the benign group. (Return)

Non-scalp and non-breast tissue expansion

Aydin Y, Guzel Z, Altintas M, Aygit C, Okur I

Cerrahpasa J Med 1997;28: 201-207.

BACKGROUND AND DESIGN: Although there are numerous published data on tissue expansion in the last 15 years, only few of them are non-scalp, non-breast expansions. In this study, the results of 34 tissue expansions of sites other than the breast and scalp in 23 patients were presented. RESULTS: We have encountered a postoperative major complication rate of 6 percent. Complications relative to specific anatomic areas were as follows: upper extremity, 1 out of 3 (33%); neck and face,1 out of 13 (8 %); trunk and lower extremity, none out of 18. CONCLUSION: Details of the technique used and results are discussed. (Return)

Injuries due to assaultive violence

Melikyan EY, Can G, Baltas Z, Kaypmaz A

Cerrahpasa J Med 1997;28: 208-213.

BACKGROUND AND DESIGN: Violence is a widespread public health problem. It is the second most common cause of death among individuals aged between 15-24 in the United States. Although high on the agenda in the daily press and media, violence is inadequately assessed in scientific journals in this country. We aimed to do a retrospective study on injuries related to assaultive violence considering only the new referrals during 1996 in one of the two busiest medical faculty hospitals of Istanbul. RESULTS: There were 12750 new emergency admissions during 1996 of which 778 (6.1%) were reported to be caused by assaultive violence. 662 (85.1%) patients were male and 116 (14.9%) female. The mean age of the male patients was 28.1 and the females was 29.8 years. The most common form of violence was beating accounting for 284 male and 82 female referrals (47%) followed by stabbing. 269 male and 22 female patients (37.4%) were admitted for stab wounds. Gunshot wounds comprised 14% of all injuries. A total of 100 male and 9 female patients were the victim of firearm violence. 5 patients (0.6%) were injured otherwise. CONCLUSION: Obtaining a valid database is a prerequisite for solving the public health problems associated with assaultive violence. We as physicians are confronted with this problem in our every day life and so we must be aware of the backgrounds which contribute to this widespread problem and provide the necessary counseling beside dealing with the treatment of the injuries. The backgrounds are social problems, inequality in education and payment etc. We must teach our children that violence, as a way of problem-solving is an inappropriate one. (Return)

Role of H. influenza in acute exacerbations of COPD due to infection

Mutlu B, Bahar H, Musellim B, Fistikci H, Mamal Torun M, Vural S, Erk M

Cerrahpasa J Med 1997;28: 214-217.

BACKGROUND AND DESIGN: Data on the prevalance of H. influenzae infections in Turkey are insufficient and usually, the treatment is empiric during acute exacerbations in patients with chronic obstructive pulmonary disease (COPD). We investigated the effect of H.influenzae in this group of patients. Microbiological examination of sputum was made in 20 patients (18 males, 2 females) with COPD who were admitted to our clinic with an acute infection. RESULTS: Only one pathogenic agent was determined in 32% of patients and more than one in 37%. H. influenzae was detected in 40% of the cases, while Enterobacter spp. was found in 20%, B. catarrhalis in 15%, S. pneumoniae in 10%, E. coli in 10%, H. parainfluenzae in 5% and P. aeruginosa in 0.5%.CONCLUSION: We conclude that H. influenzae is one of the most important pathogens causing acute infection in COPD patients. (Return)

Central nervous system anomalies which associated with meningomyelocele

Erdincler P, Oguz E, Kaynar MY, Canbaz B, Akar Z, Kuday C

Cerrahpasa J Med 1997;28: 218-222.

BACKGROUND AND DESIGN: Myelomeningocele results from failure of the embryonic neural folds to flex and fuse into a tube. Many central nervous system and spinal colon abnormalities are associated with myelomeningocele. The aim of this study was to evaluate the associated central nervous system and spinal colon abnormalities in 17 children with myelomeningocele. RESULTS: Associated central nervous system abnormalities were found in 88% of the patients. These included Chiari II malformation, hydrocephalus, hidromyelia, spinal lipoma, diplomyelia and agenesis of corpus callosum. Hydrocephalus was always associated with Chiari II malformation. In addition, 8 patients presented with alterations in the normal configuration of their spinal colon. CONCLUSION: Associated abnormalities were the main causes of late deterioration in myelomeningocele patients. Most, possibly all, of this deterioration is preventable or correctable. Optimal care of these patients requires a comprehensive, coordinated plan of treatment by a multidisciplinary team.(Return)

Rare variants of squamous cell carcinoma (SCC) of cervix; Papillary SCC and lymphoepithelioma-like carcinoma

Culhaci N, Ozkal S, Yorukoglu K

Cerrahpasa J Med 1997;28: 223-226.

BACKGROUND: Papillary squamous cell carcinoma (PSCC) and lymphoepithelioma-like carcinoma (LCC) are rare variants of squamous cell carcinoma of the uterine cervix. It is important to distinguish PSCC from other cervical papillary lesions. Also, demonstration of invasion is almost always impossible in superficial biopsies. It is behaviour may be different from classical SCCs because of its late metastases and recurrences. LCC occurs mostly in younger ages and its better prognosis makes the diagnosis important. OBSERVATION: Here we present a PCSS and a LCC case and their differential diagnoses. (Return)

Hemorrhagic radiation cystitis and hyperbaric oxygen therapy

Alici B, Akkus E, Ozkara H, Yaycioglu O, Ataus S, Dundar K, Hattat H

Cerrahpasa J Med 1997;28: 227-229.

BACKGROUND: The effectiveness of hyperbaric oxygen therapy (HBOT) is emphasized in the treatment of hemorrhagic radiation cystitis. OBSERVATION: A case of hemorrhagic radiation cystitis, which has been unresponsive to other forms of treatment, but responsive to HBOT is presented. (Return)