1998;29(1):1-60.
CONTENTS


ABSTRACTS

The late results of resective surgical approach in gastric carcinoma extending to adjacent organs

Ersan Y, Cicek Y, Erturk S, Ertem M, Sahin DA

Cerrahpasa J Med 1998;29: 7-13.

BACKGROUND AND DESIGN: 274 patients with gastric carcinoma had undergone resection between 1989 and 1993. Of 274 patients, 87 (34%) had cancer extending to adjacent organs. In this study, the late results of resective procedures in 87 patients with gastric carcinoma extending to adjacent organs is reported. These 87 patients were classified into two groups: Group I included 38 patients with neither peritoneal dissemination, liver metastasis nor widespread nodal involvement. Group II consisted of 49 patients with positive evidence of incurability. RESULTS: Among group I patients, gastrectomy, complete removal of invaded organs and sufficient lymphadenectomy were performed in 24 patients. In these patients, 5 year survival rate was 31.7%. Remaining 14 patients were treated with gastrectomy alone or with incomplete removal of invaded organs. In these patients, 5-year survival rate was 4.1% and significantly lower than that of 24 patients. In group II there were 49 patients with incurable factors and 5-year survival rates were 3.4 and 0% in complete (16) and incomplete (33) excisions, respectively. CONCLUSION: Gastrectomy, complete removal of invaded organs and sufficient lymphadenectomy should be performed in patients with gastric carcinoma extending to adjacent organs and without positive evidences of incurability. This aggressive surgical treatment (en blac resection) provides higher 5-year survival rates than those of incomplete resection. In patients with gastric carcinoma extending to adjacent organs and having positive evidences of incurability if there is involvement of one adjacent organ, good results can be obtained with complete excision. But, if there is involvement of multiple adjacent organs, there is not expressive differences in results of either with complete excision or with incomplete excision. (Return)


Maternal mortality rates in the Department of Obstetrics-Gynecology and Intensive Care Unit of Cerrahpasa Medical Faculty

Aksu MF, Madazli R, Ozgon M, Budak E, Kose Y

Cerrahpasa J Med 1998;29: 14-17.

BACKGROUND AND DESIGN: The aim of this study is to investigate maternal mortality rate in Cerrahpasa Medical Faculty and to help develop new health strategies to control maternal mortality rates by determining the factors and diseases which increase risks. Patient records between 1991 and 1996 were retrospectively reviewed in the Department of Obstetrics- Gynecology and Intensive Care Unit. RESULTS: During the period 1991 to 1996, 19.808 births had occured in Cerrahpasa Medical Faculty's Department of Obstetrics and Gynecology. There were 16 maternal deaths and maternal mortality of our department were found to be 80 per 100.000 births. Of the 16 maternal deaths, complications of pregnancy related complications during the same period and 34 of them had died. Pregnancy-induced hypertension complications were also the most significant cause of maternal death in Intensive Care Unit Department. CONCLUSION: Maternal mortality rates of Cerrahpasa Medical Faculty are similar to national statistics, mainly because it is a referral hospital of the district. Most referred cases were patients with inadequate antenatal follow-up, which comprised the majority of the maternal deaths. Pregnancy- induced hypertension is the major causal disease. The poor outcome of this disease and others can be significantly improved with proper antenatal care and patient education. (Return)


Investigation on the occurrence of Cryptococcus neoformans in natural habitats in Istanbul

Aygun G

Cerrahpasa J Med 1998;29: 18-22.

BACKGROUND AND DESIGN:The presence of Cryptococcus neoformans in its natural habitats in Istanbul was investigated in modified Staib-Seeliger medium (Guizotia abyssinica-diphenyl-creatinin-antibiotic- dextrose-agar). A total of 100 samples (49 from open area, 42 from coops, 2 from nests and 7 from soil) were cultured and C. neoformans was isolated. RESULTS: Cryptococcus neoformans was isolatedr in 1 from coop (1%). The frequency in coops was determined to be 2.3% (1/42). CONCLUSION: Cryptococcus neoformans was isolated from its natural habitats in Istanbul. (Return)


Comparison of mercury thermometer and single use plastic thermometer

Basaran G, Bagdatli Y, Balay P

Cerrahpasa J Med 1998;29: 23-26.

BACKGROUND AND DESIGN: The list of disadvantages of the mercury-glass-thermometer (MGT) is enlarging. Tempa-DOT (PyMaH), a novel single-use plastic thermometer constitutes a considerable alternative. In order to compare MGT and Tempa-DOT (TD) we investigated the shortest time required for accurate measurement with MGT, the consequences of delayed removal of TD, the parallelism between the two gauges and their costs. The data were obtained by body temperature measurements and observations made in the Infectiouss Diseases Clinic for adults in the Hospital of Cerrahpasa School of Medicine. RESULTS: We found the shortest time required for correct oral and axillary temperature measurements with MGT to be 7 and 10 minutes, respectively. Waiting for 5 minutes yielded near by readings for both oral and axillary measurements. TD and MGT gave similar results when they were read 1 to 5 minutes, respectively after sublingual placement. TD gave only 0.08oC higher readings when TD and MGT were read 3 and 5 minutes, respectively after axillary placement. According to manufacturer's instructions TD must kept for 1 minute in mouth and 3 minutes in axilla. We found that 2 minutes delay in removal of TD causes 0.58oC and 0.3oC higher sublingual and axillary readings, respectively. The per-patient cost of MGT was estimated between 86.500 TL and 288.000 TL depending on the brand purchased. The per-patient cost would have been 167.000 TL, if TD used. CONCLUSION: Our results show that waiting for 7 and 10 minutes, respectively are ideal for oral and axillary temperature measurements with MGT but 5 minutes may suffice to fulfill practical purposes. TD and MGT give similar results if recommended durations are kept to. It may be discussed whether TD usage should be limited to places like intensive care units and outpatient clinics whether the closer attention to patients contributes to the appropriate environment for thermometer replacement on time, since a delay as short as 2 minutes in removal of TD results in significantly and erroneously high readings. TD and MGT have similar per-patient costs. (Return)


Experience with the "floating forehead" in trigonocephaly: A qualitative and quantitative analysis

Erdincler P, Tuzgen S, Oguz E, Ciplak N, Kuday C

Cerrahpasa J Med 1998;29: 27-32.

BACKGROUND AND DESIGN: The effectiveness of the "floating forehead" operation for treating trigonocephaly in infants has been assessed. Four children who had undergone this procedure at the Neurosurgery Department of Cerrahpasa Medical Faculty were reviewed by a quantitative analysis of the anterior cranial fossa development obtained from computerized tomography measurements. RESULTS: Satifsfactory cosmetic results were obtained in all patients. Comparison of pre- and post-operative anterior cranial fossa measurements showed: 1) correction of acute nasopterional angle; 2) an increase in bipterional distance and a decrease in nasoclinoid distance; 3) moderate correction of acute clinopterional angle. CONCLUSION: We concluded thet the "floating forehead" operation for treating trigonocephaly in infants was effective in all cases. (Return)


The relationship between the predischarge electrocardiographic findings and coronary artery patency in patients with acute myocardial infarction treated with thrombolytic treatment

Kabukcu M, Ates I, Demircioglu F, Sancaktar O, Deger N, Ersel F

Cerrahpasa J Med 1998;29: 33-37.

BACKGROUND AND DESIGN: We sought the ability of the predischarge electrocardiographic ST segment and T wave changes to predict the patency of infarct related coronary artery in patients with acute myocardial infarction treated with thrombolytic treatment. We inculeded 100 patients were treated with thrombolytic treatment during the first acute myocardial infarction who had undergone coronary angiography and left ventriculography before hospital discharge (6th to 12th day). On the predischarge electrocardiography, the ST segment status (either isoelectric or elevated) and T wave status (positive or negative) were detemined. Perfusion status of infarct related artery was determined angiographically within the 6th to 12th days. RESULTS: ST segment isoelectricity was related the coronary artery patency with sensitivity 84%, sepicificity 38%, positive predictive values 77% and negative predictive values 50%; while T wave negativity was related the coronary artery patency with sensitivity 86%, specificity 30%, positive predictive values 73% and negative predictive values 64%. T wave negativity was not found an independent factor after ST segment status was evaluated. CONCLUSION: Patients with isoelectric ST segment and negative T wave on the standart electrocardiography at 6th-12th days have a higher incidence of patent infarct related coronary artery. Patients with ST segment elevation and positive T wave have a high incidence of non-patent infarct related coronary artery. This findings may have a role in the risk stratification of patients with a first acute myocardial infarction treated with thrombolytic treatment before discharge from the hospital. (Return)


The association of hypertransaminasemia and antigliadin antibodies with human leukocyte antigens in the Turkish pediatric celiac patients

Erkan T, Kutlu T, Yilmaz E, Cullu F, Tumay GT

Cerrahpasa J Med 1998;29: 38-42.

BACKGROUND AND DESIGN: We aimed the investigate the relation between liver injury or gliadin antibodies and human leukocyte antigens. The 30 celiac disease patients were included in our study. The mean age of study population was 5.8 years; 20 being female. The HLA-A, -B, -DR and -DQ antigens were studied by the lymphocytotoxic reaction. RESULTS: The children below and equal 2 years with gliadin antibodies above 50 AU did not have the HLA-A32, -B16, -B5, -DQ4, -DQ6(1) and -DR14(6) antigens. Among the children above 2 years with gliadin antibodies IgA above 50 AU, the HLA-B4 antigen was more frequent and the HLA-DR7 was significantly absent. Similarly, among the children above 2 years with gliadin antibodies IgG above 50 AU, the HLA phenotypes lacking HLA-A1, -A9, -B17, -B37, -B73 and -DR9 had a highly significant negative association with celiac disease. The celiac patients who had HLA-A11, -B18, -B40 and -DQ1 did not present aspartate aminotransferase elevation. Finally, despite there was found a relation between human leukocyte antigens and aminotransferassas and gliadin antibodies level's. CONCLUSION: Prospective studies were necessary to support our results. (Return)


The approachment to behavioral phenotype of a case with Lowe syndrome

Seven M, Suyugul Z, Yuksel A, Hacihanefioglu S, Aydin A, Cenani A

Cerrahpasa J Med 1998;29: 43-46.

BACKGROUND: The Lowe syndrome or oculocerebrorenal syndrome is a rare X linked recessive hereditary diseases which involves ocular defets, nervous system anomalies and renal dysfunction. The stubbornes, temper tantrums and complex repetitive movements (stereotypy) are seen frequently in these patients. Whether this behavior simply reflects the multiple disabilities found in some developmentally impaired individuals with or without Lowe syndrome or is a specific genetically - determined behavioral phenotype of Lowe syndrome is unknown. OBSERVATION: In this paper subbornes, temper tantrums and stereotypic behaviour reported in the 12 year old male patient with Lowe syndrome were evaluated. (Return)


Transhiatal oesophagectomy for benign oesophageal diseases

Taskin M, Apaydin BB, Samuk M, Saribeyoglu K

Cerrahpasa J Med 1998;29: 47-52.

BACKGROUND: Various factors are important in the selection of surgical procedures in treatment of benign disease of the esophagus. OBSERVATION: We reported 3 cases and evaluated transhiatal esophagectomy in benign esophageal disease. Two of patients were diagnosed as esophageal stricture secondary to caustic injury and the remainder as achalasia. We used the left colon for esophageal reconstruction in the first two cases with esophageal stricture, and the stomach for the achalasia case. Our patients did not develop any complication. We believe that transhiatal esophagectomy is a reliable procedure for the treatment of benign esophageal disease when indicated and performed by an experienced team. (Return)