1998;29(4):161-240.
CONTENTS


ABSTRACTS

Primary repair of the unilateral cleft lip nasal deformity

Aygit AC, Guzel MZ, Cinar C, Yildirim AM

Cerrahpasa J Med 1998;29: 165-168.

BACKGROUND: Despite the recent advances in plastic surgery, treatment of the cleft lip nasal deformity is sitill a great problem. We suggest a simplified procedure for reconstruction of the position and shape of the cleft side alar cartilage that cause deformity. DESIGN: During the cleft lip repair by the Millard technique, the lower lateral cartilage dissected and fully mobilised from overlying tissue. It is repositioned anteriorly, superiorly and medially and stabilised in its new position by using through- and - through crosswise suture tied over tulle grasses. These stent sutures go through skin and nasal lining but over the septal cartilage. RESULTS: We treated the displaced, malaligned and deformed cartilage of the nose on 10 patients with unilateral incomplete and complete cleft lip, using this simplified procedure. The results assessed functionally and aesthetically good. CONCLUSION: This simplified procedure eliminates the severe cleft nasal deformity seen in many secondary cases. (Return)


The effects of adenosine on glomerular filtration and perfusion pressure in the isolated perfused rat kidney

Akbas N, Kucukhuseyin C

Cerrahpasa J Med 1998;29: 169-174.

BACKGROUND: Renal effecis of adenosine seem to be rather complex and likely to be mediated by difering mechanisms, some of which needs still further elucidation. So, it was of interest to see the effects of adenosine applied into the renal artery by infusion rather the,an by bolus injection under constant perfusion rate and to eplore its interaction with theophylline and quinidine. DESIGN: Adenosine (10 m/ml) was applied into the renal artery at a connstant rate for 15 min, during which perfusion pressure and rate of urine production as number of drops/10 min was continuously recorded. The interaction of adenosine with theophylline (1mM), a P1-Purinoceptor antagonist and quinidine (2mg/ml), a P2-purinoceptor antagonist, was studied by appliying adenosine in the presence of these agents. RESULTS: Intrarenal perfusion of adenosine saused a biphasic vascular responce, e.g. an initial pressory phase followed by a depressory one, during which urineproduction tended to reduce nonsignicantly . The pressory effect of adenosine was fully antagonized by theophylline with no remarkable effect on depressory one. Quinidine was, however, almost ineffective on these parameters or caused some potentiation. Reduction of urine production by adenosine was readily responsive to blockade by these purinoceptor antagonists. Perfusion pressure and urinne production were increased in a perfusion rate-dependent manner. Under different perfusionn rate, the biphasic vascullar effect of adenosine appeared to be rather identical and urine production was not effected markedly. (Return)


Therapeutic abortion in Cerrahpasa Medical Faculty between 1982-1996

Aksu MF, Oral E, Yedigoz V, Atasu T, Kazancigil A

Cerrahpasa J Med 1998;29: 175-179.

BACKGROUND AND DESIGN: Therapeutic abortion and its problems has always been of considerable interest to both the medical and legal societies. Women who have major medical disorders, have fetuses with major malformations and chromosomal abnormalities are eligible for pregnancy termination. Therapeutic abortion was approved in 1967 in Republic of Turkey. Inn our study, one hundred twenty nine medical abortions performed in our clinic between 1982-1996 years were reviewed. Their clinica reatures, indications, and techniques are discussed. The data compared with the 30 years cumulative data of our cilinic. RESULTS: During this period (1982-1996) there were 129 therapeutic abortions carried out in our institute. The ratio of therapeutic abortions to deliveries was 1:514. There were 55 (%42.6) primigravidas in the series. Fetal indications were more frequent (85 cases, 65.9%) than maternal ones (44 cases 34.1%). In 112 of 129 (87%) abortion occurred before 25 weeks. Neural tube detects and multiple congenital anomalies were the main causes of fetal indications (36.4%), whereas heart disease was the most common cause of maternal indications (13.2). Medical mothods were used more frequent than surgical methods were used more frequent than surgical methods for the termination of pregnancy (65.3% ve 34.7%). CONCLUSION: Because of the enhanced care of the pregnant women; nowadays fetal indications for therapeutic abortions outnumber maternal ones and medical methods are preferred most of the time for these procedures. (Return)


Hepatitis A risk factors in nurses and office workers

Basaran G, Buyukbese MA, Ozturk R

Cerrahpasa J Med 1998;29: 180-183.

BACKGROUND AND DESIGN: The availability of active immunization against hepatitis A infection inspired many investigators to evaluate the necessity for vaccination of health care workers; and contradicting recommendations are being made on this issue. Numerous studies exist showing that seroprevalence of hepatitisA is similar between health care workers and general population. However some risk factors are reported to exist amonng health careworkers. In order to determine the presence of risk factors of hepatitis A that necessitate vaccination we assessed the immune status and some variables in 115 health care workers in Cerrahpa■a Medical School. RESULTS: Of the 115 workers 32 (28%) were men and 83 (%72) were women. Sixty-nine (%60) were nurses and 46 (%40) were office workers. Sixty of them (%52) were working in medical departments while 55(%48) were working in surgical departments. The mean duration of employement was 11.2 years. The mean ageof the workers was 33.3 years. Anti-HAV was positive in 104 workers (%90.4). Seroprsitivity ratios were statistically similar between seropositive annd seronegative workers in terms of age, sex, occupation, duration and department of employement. CONCLUSION: As a result we have not found any risk factors for hepatitis A in nurses and the office workers in our hospital which indicate necessity for vaccination. (Return)


Early diagnosis of subclinical neurosarcoidosis

Yanardag H, Bilir M, Sipahi S, Kiziltan M, Cagatay T, Demirci S, Karayel T

Cerrahpasa J Med 1998;29: 184-188.

BACKGROUND AND DESIGN: Although lungs, lymph nodes, liver, and eye are the most involved sites in sarcoidosis, which is a chronic granulomatous disease of unknown etiology , 5-10% of patients have symptoms related to central nervous system (CNS) involvement. Nevertheless, subclinic CNS invovement is more common 15% of sarcoidosis patients in necropsy. Peripheral nerve and muscla involvement in subclinic and/our undiagnosed neurosarcoidosis can be detected by electromyographic (EMG) studies in early aatsge of the disease. In this study, 44 sarcoidosis patients withhout symptoms of neurosarcoidosis were examined for peripheral nerve and/or muscle involvement by EMG. Five of patients were male and 39 were fermale (mean age=38▒13) RESULTS: In 18 patients (40.9%) motorconduction velocities were found to be slowed. In five of these, the slowing was localised in both lower extremities and symetric, whereas in 13 patient it was asymmetric andrestricted to one nerve. In ten out of 13 patients, it was localised in lover extremities. In two out of 3 patients with upper extremity involvement, lower extremities were also involved. The conduction abnormalities could be considered as mild to moderate regarding the mean age of patient population and they did nnot exceed the limit of demyelinating neuropathies. The highest figure for peripheral neuropathy in sarcoidosis reported from previous studies is 22.2%. In 14 patiens, slowings in sensorial distal conduction velocities and/or reduction in amplitudes of median nerve were detected and considered as compatible with carpal tunnel syndrome. Because htere is no previous report on the relationship between carpal tunnel syndrome and sarcoidosis, this finding was interpreted as irrelevant regarding the mean age annd gender distribution of our patient group. In 8 patients myographic involvement was detected by concentric needle EMG, therefore in 31 patients electro myographic abnormality was found. CONCLUSION: Our results suggest that peripheral nerve involvements are frequent in sarcoidosis patients without neurological sings and symptoms and therefore electromyographic studies should be made in these patient population in early stages. (Return)


Measles outbreak in the vaccinated Kazak students' dermitory

Basaran G, Saglam GM, Seneldir S, Aygun P, Ozturk R

Cerrahpasa J Med1998;29: 189-193.

BACKGROUND AND DESIGN: Measles outbreaks are being reported from vaccinated populations. This study was carried out in vaccynated Kazak students' dormitory in Istanbul. RESULTS: All of the 87 students in the school were male and the mean age was 18.2 (12-25). We diagnosed measles in 13 (15%) students. The mean age of the patients was 17.5 (12-22). The mean ages of the patients and the healthy ones were statistically similar. Eleven patients (85%) were positive for measles IgM. All healthy students except for two were positive for measles IgG. CONCLUSION: These findings indicate that the measles outbreak in this mostly vaccinated population has occurred among nonimmune students and it is not due to decreased immunity after vaccination. (Return)


Retrospective analysis of the tuberculosis case found by passive surveillance

Yanardag H, Bilir M, Sipahi S, Midilli K, Demirci S, Karayel T

Cerrahpasa J Med 1998;29: 194-197.

BACKGROUND AND DESIGN: Three major methods are used for finding of tuberculosis (TB) cases in a population: finding of symptomatic cases (passive surveillance), active surveillance and screening of high risk populations. In passive surveillance, symptomatic patients attending by themselves to any health care anstitution or physician, are evaluated with regard to TB. The advantage of this method of the active screening based on microfilm, tuberculin test and sputum examination relies on higher rates of finding both of pulmonary- and extrapulmonary TB cases. Patients referred to our outpatient clinic were analysed retrospectively. RESULTS: The rate of case finfing in previous active surveillance programs performed between 1960-1983 in Turkey was =.76% whereas the corresponding figure in our study was 5.81% (7.64 fold). The yield of active surveillance programs is very low, compared to the required ennormous labour, staff and other resources. On the other hand, passive surveillance is more costeffective, permits identificantion of extrapulmonary TB cases and is pysicologically more comfortable due to voluntary attendance. CONCLUSION: Regarding all of these we recommend to incorporate the passive surveillance into nnational TB prevention programs. (Return)


Tuberous sclerosis complex

Benli S, Can U, Seckin D, Caner H, Altinors N, Coskun M

Cerrahpasa J Med 1998;29: 198-202.

BACKGROUND AND OBSERVATION: Tuberous selerosis complex is a hamartamatosis which mainly effects central nervous system, skin, kidney, liver and heart. The predominant neurologic manifestations are seizure and mental retardation. A 39 year old female patient with late onsetseizure and typical skinn findings and her sons are presented and this clinical entity 13 reviewed with are emphasis on the importance of sysmetic family screening. (Return)


Bronchiolitis obliterans organizing pneumonia: A case report

Sipahi S, Bilir M, Karayel T, Demirci S, Oz B

Cerrahpasa J Med1998;29: 203-206.

BACKGROUND: Bronchiolitis is an inflammatory process that primarily affects the small conducting airways of the lung. BOOP is a nonspecific pattern with different causes or associationns, includig a varlaty of infections, fume exposures, drugs, and collagen diseases. No etiology is found in a number of cases which are then termed idiapathic. The diagnostic distinction is important, because patients with idiopathic BOOP have a favorable prognosis and response to steroid therapy. (Return)


Role of capnography in critical care

Karcioglu O

Cerrahpasa J Med 1998;29: 207-213.

BACKGROUND: In this article we reviewed the role of endtidal CO2 monitoring the critical care setting as a raliable predictor of trancheal intubation and outcome of patients in emergency setting. End-tidal CO2 concentration level is reported to serve as a discriminating factor between survivors and nonsurvivors in case of cardiopulmonary collapse. Patients with certain levels of end-tidal CO2 concertration had significantly lower rates of survival and retum of spontaneous circulation. Published data also suggest that initial ETC2 concentration level can be an important predictor of successful endotracheal intubation in lifesaving procedures. More prevalent utilization of capnograph will be a useful adjunct in both detecting endotracheal intubation and also guiding bedside monitoring of cardiopulmonary resuscitation. (Return)