Correlation of the clinical, radiologic and manometric findings in patients with achalasia

Dobrucali A, Curgunlu A, Celik AF, Ilkova F, Tuncer M, Bal K, Uzunismail H, Yurdakul I, Oktay E

Cerrahpasa J Med1998;29: 65-69.

BACKGROUND AND DESIGN: Achalasia is a well known primary motor disorder of the esophagus in which the lower esophageal sphincter (LES) exerts abnormally high resting pressure and incomplete relaxation with swallowing. Dynamic investigations, mainly esophageal manometry and radiological examination are needed for the diagnosis and follow-up after treatment. We present the clinical manifestations, radiological manometric abnormalities of 26 patients with achalasia seen between 1993 and 1997. RESULTS: Dysphagia was significantly correlated with bird beak deformity and impaired emptying on esophagogram. No significant relationship was found between the LES pressure and clinical and radiological features. Nonperistaltic wave amplitude and LES relaxation were inversely and significantly correlated with impaired emptying on esophagogram. CONCLUSION: Radiological findings of achalasia may not be due to hypertensive LES but decreased lower sphincter relaxation may be responsible for dysphagia and impaired esophageal emptying. Also LES pressure is in normal range in 35% of patients with achalasia. Achalasia and hiatal hernia may coexist in 8% of the patients. (Return)

Electrocardiographic findings and prognosis in ischemic stroke

Ince B, Celik Y, Bingol H, Harmanci H, Denktas H

Cerrahpasa J Med1998;29: 70-74.

BACKGROUND AND DESIGN: The prognosis of stroke has been claimed to be worsened at the presence of electrocardiographic findings. An association with mortality and ECG finding has not been well documented in patients with stroke. This case control study covers 87 consecutive patients with ischemic stroke and 87 control patients without stroke seen in any inpatient clinic other than cardiology between October 1995-June 1996. RESULTS: There was no difference between the patient and control groups in terms of sex and age. In the case of ischemic stroke, ECG changes were identified in 62.1%, whereas the rate was 29.9% in the control group. The difference was statistically significant (Odds ratio, 3.84; 95% confidence interval, 1.95 to 7.60, p<0.0001). The mostly seen ECG finding was myocardial ischemia. Case fatality rate in all patients after 6 months of follow up was 29.9%. The fatality rates of the patients with and without ECG changes (38.9% and 15.2% respectively) were significantly different ( p<0.05). CONCLUSION: Cardiac consequences of stroke are likely to contribute to the stroke mortality. Patients with acute stroke should receive continuous cardiac monitoring until the cardiac problem and ECG findings have resolved. (Return)

The effect of chronic thinner inhalation on lipid peroxidation in rat lung and liver

Zengin Ulakoglu E, Saygi A, Gumustas MK, Zor E, Akkaya A, Kokoglu E

Cerrahpasa J Med1998;29: 75-78.

BACKGROUND AND DESIGN: We studied the effect of chronic thinner inhalation (during 5 weeks) on lipid peroxidation in the lung and liver of the rats. Additionally, we studied superoxide dismutase (SOD) activities and reduced glutathione (GSH) levels. RESULTS: Significant increases were found in lipid peroxidation (TBA-RS) levels of rats which had inhaled thinnercompared to those of the control group (p=0.000). As opposed to increases in the TBA-RS levels, significant decreases in the SOD activities and GSH levels were observed when compared to the rats in the control group (p=0.000). CONCLUSION: Increases in peroxidative damage due to the reactive oxygen species generation and decreases in the antioxidant capacity may be the cause of some progressive dysfunction in these tissues. (Return)

Respiratory response to hypercapnia during depression of respiration by adenosine

Turgut G, Oruc T

Cerrahpasa J Med1998;29: 79-83.

BACKGROUND AND DESIGN: Ventilatory response to sustained (>30 minutes) hypoxia is biphasic in humans and experimental animals. A brisk initial increase in ventilation is followed by a decline that is thought to be of central origin and has been termed "hypoxic depression". Results of several studies have suggested that concentration of adenosine within the brain increases as a result of hypoxemia and adenosine could therefore play a key role in mediation of hypoxic depression. The purpose of the present study was to produce a state of inhibition in the respiratory centers by adenosine administration (i.c.v.) and to examine the respiratory response to hypercapnia. The experiments were carried out in six peripheral chemodenervated vagatomized cats under pentothal anesthesia. For i.c.v. injections of adenosine in each animal, canula was placed in left lateral cerebral ventricle by stereotaxic method. Animals were allowed to breathe air and hypercapnic (5.8% CO2-air) gas mixtures before and after i.c.v. adenosine administration. Respiratory frequency (f), tidal volume (TV), arterial blood pressure were recorded. Respiratory minute volume (VE) and the mean arterial pressure were calculated. At the end of each experimental phase pO2, pCO2, pH were measured in arterial blood samples. RESULTS: When chemodenervated vagotomized animals were allowed to breathe the hypercapnic gas mixture before adenosine administration VT and VE increased significantly ( p<0.05, p<0.01). When adenosine was administered to the animals the VT and consequently VE decreased during air breathing ( p<0.01, p<0.05). On breathing of hypercapnic gas mixture following adenosine administration VT and VE were increased ( p<0.001, p<0.001). The respiratory response of the chemodenervated vagotomized animals to hypercapnia after adenosine administration was found to be as same as that before adenosine administration. CONCLUSION: The results of this study show that adenosine acts as a central depressant of respiration during air breathing. However respiratory centers the activity of which are depressed by adenosine in normoxia can still respond to hypercapnia. (Return)

Peptic ulcer in pediatric patients: Retrospective analysis of 41 cases

Erkan T, Kutlu T, Cullu F, Goksel S, Tumay GG

Cerrahpasa J Med1998;29: 84-88.

BACKGROUND AND DESIGN: This study is a retrospective report of cases with endoscopically confirmed peptic ulcer disease diagnosed at the Department of Pediatric Gastroenterology of Cerrahpasa Medical Faculty within the past 6 years. All patients were evaluated for the use of aspirin or other nonsteroidal anti-inflammatory drugs, the presence of family history and the presence of Helicobacter pylori infection. RESULTS: Peptic ulcer was found in 41 of 1565 patients who underwent endoscopy. The mean age of the patients was 93.7 years (2-14 years), 13 being females. Thirty-two of them were diagnosed as primary and 9 of them secondary ulcer disease. Twenty-two of the primary ulcer patients and 6 of the secondary ulcer patients were males. The majority of cases (32/41) were above 6 years of age at the time of endoscopy. Abdominal pain being prominent (59%) in primary ulcers, hematemesis and/or melena were prominent symptoms (55%) in secondary ulcers. Family history of peptic disease was obtained in 6 cases. Seven cases had a history of aspirin usage. Sixteen cases were found to be positive for Helicobacter pylori in 22 cases detected. Thirteen of these 16 patients showed duodenal ulceration. Endoscopy revealed gastric ulcers in 15 patients, duodenal ulcers in 22 patients, esophageal + gastric ulcers in one patient, gastric + duodenal ulcers in two patients. CONCLUSION: Our patients, majority aged above 6 years (78%) showed male superiority, and had a predominance of primary duodenal ulcers. (Return)

Lymphocyte subsets and activation markers in allergic and non-allergic asthma

Gemicioglu B, Yildirim N, Gurel N, Adin S, Badur S

Cerrahpasa J Med1998;29: 89-94.

BACKGROUND AND DESIGN: Peripheral blood lymphocyte subgroups and activation markers in bronchial asthma are studied mainly in cases with allergic or mixed etiology. This study investigates peripheral lymphocyte subgroups and activation markers in allergic and non allergic asthma cases and compares the results with suitable controls. RESULTS: The study population consisted of 16 patients with allergic (A) asthma (10 women, 6 men with a mean age of 32.4 9.1 SD years);14 cases with non allergic (NA) asthma (10 women and 4 men with a mean age of 33.2 ± 7.8 SD years) and 11 healthy (H) controls (5 women and 6 men with a mean age of 32.9 ± 8.9 SD years). CD3 and CD4 were found to be increased in all (A and NA) asthma patients ( p<0.01) whereas CD19 and CD40 were found to be elevated only in A group ( p<0.01). In NA group there was an increase in CD45 RO and a decrease in HLA-DR. CONCLUSION: Total T lymphocytes and helper T lymphocytes are increased in all asthma patients. Allergic asthma patients have elevated B lymphocyte markers (CD19, CD40); non allergic asthma patients have increased memory T lymphocytes. (Return)

The effect of the hyperprolactinemia on semen parameters in male infertility

Alici B, Citci A, Ozkara H, Akkus E, Hattat H

Cerrahpasa J Med1998;29: 95-98.

BACKGROUND: The effect of prolactin (PRL) on spermatogenesis and semen parameters is not known well. To determine the relation between hyperprolactinemia and spermatogenesis we evaluated 85 infertile patients with hyperprolactinemia. DESIGN: We analysed the serum PRL, follicle-stimulating hormone, luteinizing hormone, total testosterone levels and obtained at least two semen analyses in all cases. RESULTS: In patients using bromocryptine mesylate for hyperprolactinemia, serum PRL levels returned to normal levels within 4 months, but semen analyse parameters did not differ from baseline values. CONCLUSION: Hyperprolactinemia has a small effect on sperm density, motility and morphology. Bromocryptine mesylate offers no additive therapeutic effect for the hyperprolactinemia in male infertility. (Return)

A case of intracranial tuberculoma: Clinical features and MRI findings

Apaydin H, Pelin Z, Ozekmekci S, Kocer N

Cerrahpasa J Med1998;29: 99-106.

BACKGROUND AND DESIGN: Intracranial tuberculomas are rare in industrialized countries, but still prevail their significance in developing nations. This paper presents a case of intracerebral tuberculoma with special emphasis on clinical characteristics and MRI findings. OBSERVATION: An 18 year-old woman was referred for evaluation of subacutely developed paraplegia, weight loss, nocturnal fever and raised intracranial pressure symptoms. Her paraplegia was attributed to an intracranial parasaggital lesion in the absence of sensory level and sphincter dysfunction. MRI of the brain showed numerous lesions located in the cerebral hemispheres, thalamus, cerebellum and brain stem as well as in parasagittal region which were compatible with tuberculomas. The tuberculomas were isointense on T1-weighted images and hyperintense with central hypointensity on T2-weighted images. Although the patient had no pulmonary symptoms, her chest X-ray and chest CAT showed miliary pattern. Following treatment with corticosteroids and antituberculous medication with four first-line agents, the patient improved rapidly and was able to walk without help within one week. All of her symptoms resolved within one month despite the slow resolution of tuberculomas on MRI. Unexpectedly we remarked a paradoxical enlargement of one of these lesions under therapy. Intracranial tuberculomas should be considered in patients with progressively developingfocal neurological deficits or raised intracranial pressure symptoms and space occupying lesions on MRI. (Return)

Female genital mutilation (A reproductive health problem of African women): Case report

Aksu MF, Oral E

Cerrahpasa J Med1998;29: 107-110.

BACKGROUND: Female genital mutilation is based on socio-cultural and traditional patterns dating back to more than two thousand years in mainly subsaharan Africa, the Middle-East, Arab peninsula, and some Southeast Asian communities. According to the World Health Organization, approximately 120 million African women are mutilated. OBSERVATION: We present a Subsaharan African girl who had undergone infubilation during her childhood and had applied for the deinfibulation procedure. (Return)