The attitude of students of Cerrahpa■a School of Medicine on medical education and post graduated situation

Koksal S, Vehid S, Tunckale A, Cercel A, Erginoz E, Kaypmaz A, Sipahioglu F, Ozbal AN

Cerrahpasa J Med 1999; 30: 251-258.

BACKGROUN AND DESIGN: Health indicators are not reached desirable level in our country. A good organisation of primary health care service, which depends on the quantity and quality of general practitioners employed at primary health care units, can increase health indicators. Knowing that medical schools are the only source of education as a general practitioner, we tried to determine the purposes of enrolling in a medical school and attitudes of 1340 medical students to the post graduate situation from the second to the six class of the Cerrahpa■a Medical School. The data obtained from the students by the questionnaire forms were analysed by appropriate statistical methods. RESULTS: We determined that medical education was first preference of the 586 student, the second preference of the 127 student and the third preference of the 126 student. We determined that medical education was not first three preference on 40% of the students. A lot of students were filling regret for starting education in a medical school. Only 2.2% of the students were thinking to work as a general practitioner, 87% of them wanted to become specialised. CONCLUSION: In order to have good health indicators we need good organisation of the primary health care service. The importance of primary health care service must be emphasised in medical curriculum. General practitioners who work at primary health care service must be supported morally and physically. (Return)

Congenital diaphragmatic hernia (1978-1998)

Celayir S, Ilce Z, Kiliš N, Sarimurat N, Erdogan E, Yeker D

Cerrahpasa J Med 1999; 30: 259-264.

BACKGROUND AND DESIGN: This study was carried out to determine and discuss the current status of Congenital Diaphragmatic Hernia (CDH). For this reason 74 newborns with CDH, which were treated in our unit between 1978-1998 were reviewed retrospectively. The cases have been divided into two groups as Group I which corresponds to cases admitted before 1992 and group II which corresponds to cases admitted after 1992. Age at admission; type of defect and surgical techniques in relation with mortality and complication rate were compared between these groups. CDH was diagnosed using prenatal ultrasound, postnatal clinical evaluation and x-ray studies. In addition, all cases in Group II have been controlled with blood gas samples. RESULTS: While in group I surgery was performed on an emergency basis within first 6 hours after admission, this time extended to 16 hours for Group II cases until stabilization had been achieved. 61 of 74 patients could be operated (Group I: 50, Group II: 11). Primary closure was the surgical procedure of choice regardless of the size of the defect. In the series, associated anomaly incidence was 36.2%, complication rate was 33.8% and mortality rate was 35.1%. CONCLUSION: Although there was a statistical difference in regard to complication rate between the groups, there was no significant difference between the mortality and type of diaphragmatic defect. Additionally there was no statistical significance between the preferred surgical technique, the type of defect and the mortality. (Return)

Frequency of endocrine causes of erectile dysfunction

Alici B, Akpinar H, Kantay KK, Ozkara H, Akkus E, Hattat H

Cerrahpasa J Med 1999; 30: 265-268.

BACKGROUND: Little is known about the natural history of erectile dysfunction. Erectile dysfunction is clearly a symptom of many conditions and certain risk factors have been identified, some of which may be emanable to prevention strategies. Among these, hypogonadism in association with a number of endocrinologic conditions have been demonstrated as a risk factor. DESIGN: Over a period of 7 years, from 1991 to 1998, 2750 men who had referred to our sexual dysfunctions center for erectile dysfunction have been evaluated. Sexual hystory, physical examination, hormonal evaluation (prolactin, free testosterone), Doppler ultrasound, intracavernous pharmacotest and if indicated DICC and neurologic evaluation have been performed. Data were analyzed from the files of the patients. Patients with endocrinological causes without other etiology were included in the study group. The mean age of the patients were 39.2 (range 23-75). The therapy given and results of the therapy were analyzed. RESULTS: Sexual history revealed 69/2750 (2.5 %) of the patients had primary impotence. 1100 (40.5%) patients were diabetic. Although diabetus mellitus is the most common endocrinologic cause of impotence, endocrine causes were detected in 190 patients (7%). In diabetic patients not only one factor could be determined as a cause of impotence. Cardiovascular disease was appearent in 495 patients (17.6%). Hormonal evaluation showed hyperprolactinemia in 19 of 190 (10%) patiens, hyperprolactinemia + androgen deficiency in 97 (50.8%), androgen deficiency in 74 (39.2%) patients. After the testosterone replacement therapy, 49 (70%) of the patients reported increase in penile rigidity and seminal volume and were satisfied with the therapy while 21 (30%) of the patients needed self-injection pharmacotherapy. In patients with hyperprolactinemia, bromocriptine is used and only 16% of satisfactory results were obtained. Overall success rate was 37% with hormonal therapy. CONCLUSIONS: Impotence is a major health concern. There are many determinants related to the risk factors and not only one factor could be determined as the etiological factor for erectile dysfunction. In patients with an etiology of endocrine causes, hormonal therapy is advisable but further other therapies may also be needed in case of unsatisfaction.(Return)

Surgical diagnostic procedures in the diagnosis of superior vena cava syndrome

Sayar A, Gulec H, Olcmen A, Metin M, Akin H, Demir A, Olcmen M

Cerrahpasa J Med 1999; 30: 269-272.

BACKGROUND: Superior vena cava syndrome, which is easy to diagnose develops as a result of obstruction of the superior vena cava by extrinsic compression, direct invasion or thrombus. DESIGN: We retrospectively reviewed 10 patients in whom we detected superior vena cava syndrome and applied surgical procedures in order to clarify their etiologies. We performed 12 surgical procedures. The patients were all male with a mean age of 43,5 (16-72). The surgical procedures were; 5 mediastinoscopies, 3 thoracotomies, 2 mediastinotomies, 1 sternotomy and 1 axillary biopsy. Anterior mediastinotomy was performed in two cases in addition to mediastinoscopy. RESULTS: The etiology was; malignancy originating from lung in 5, lymphoma in 3, and undifferentiated carcinoma in 2. In the postoperative period, we encountered complications in two patients but no mortality was detected. CONCLUSION: In the superior vena cava syndrome diagnostic surgical procedures are very effective in detecting the etiology and planning an appropriate oncologic treatment in malignant lesions. (Return)

Role of endoscopy in transvaginal bladder neck suspension and sling operations

Demirkesen O, Cetinel B, Yaycioglu O, Tufek I, Ismailoglu V, Solok V

Cerrahpasa J Med 1999; 30: 273-276.

BACKGROUND AND DESIGN: We retrospectively reviewed the records of 68 female patients who underwent either Pubovaginal Sling (PVS) or Modified Raz "Anterior Vaginal Wall Sling (AVWS) operations between December 1993 and March 1999, in order to determine the role and importance of endoscopic controls during transvaginal bladder neck suspension and sling operations for stress urinary incontinence. AVWS was performed in 22 and PVS in 46 patients. Endoscopic controls were performed before the sutures were tied over the rectus fascia. Bladder wall, bladder neck and the position of the balloon of the cystostomy catheter were examined and the ureters were catheterized in order to ensure that no ureteric injury occurred. RESULTS: Bladder neck perforation was detected in 2 patients and repaired accordingly. In 2 patients ureteric entrapment by the sutures was detected and the sutures were replaced. In 1 patient the balloon of the cystostomy catheter was found outside the bladder and the catheter was reinserted. One patient, whose cystostomy catheter was not controlled during cystoscopy, developed severe suprapubic pain postoperatively, on reexamination it was found that the balloon of the cystostomy catheter was placed outside the bladder. Inadequate drainage of the bladder during the operation was responsible for the injury in one of the 2 patients who suffered bladder neck perforation. Concomitant cystocele repair was performed in both of the patients whose ureters were entrapped. CONCLUSION: Concomitant cystocele repair and inadequate bladder drainage are factors that increase the risk of intraoperative complications. Endoscopic control is mandatory in sling and transvaginal suspension operations for early recognition and appropriate repair of such complications. (Return)

A case of tuberculous hydrosalpinx mimicking an ovary tumor

Cerrah Celayir A, Yalti S, Asil Z, Inalhan M, Dayicioglu V

Cerrahpasa J Med 1999; 30: 277-280.

BACKGROUND AND OBSERVATION: Tuberculosis of female genital organs in adolescent has been rarely reported. In the most common form, involvement of the fallopian tubes and co-existence of endometritis is seen. On occasion, tuberculous salpingitis can be easily misdiagnosed as adnexial tumour or acute appendicitis. An 11 year-old girl was referred to our clinic from another hospital for the right ovarian tumour and ascites. She was evaluated with clinical and laboratory exams, PPD, ultrasound and computed tomography as well as the cytologic examination of the peritoneal fluid. Tuberculosis was diagnosed and antituberculous chemotherapy with izoniazid, rifampin and pyrazinamide was initiated. The response to chemotherapy was excellent, clinical findings disappeared in one month and all radiological findings disappeared in three months. Tuberculosis still represents a severe problem in many developing countries of the world. For this reason on should think about tuberculosis in adolescent girls with pelvic and abdominal pathology. (Return)

Thrombolytic therapy in a stroke patient with vertebral artery dissection

Degirmenci N, Yeni SN, Kocer N, Islak N, Karaagac N

Cerrahpasa J Med 1999; 30: 281-285.

BACKGROUND: The importance of dissections in young stroke patients have been emphasized currently. Carotis artery dissections are more frequent than the vertebral artery. The clinical picture of vertebro-basilar artery dissections is one of an occlusion of intracranial arteries. In this article, the clinical features and evaluation of a young stroke patient due to vertebral artery dissection and the value of intra-arterial thrombolytic therapy has been debated. OBSERCATION: Forty-two years old male patient was brought to emergency room. The patient had clinical features of a sudden onset brain stem dysfunction. An early CT scan revealed a hyperdensity over the basilar artery suggestive of a basilar artery trombosis. In order to find out the etiology and to treat this young onset stroke patient, an angiography was performed revealing a vertebral artery dissection and a basilar artery trombosis secondary to this dissection. Three hours after the insult, he was treated with intra-arterial urokinase. An early recovery was observed.(Return)

Cutaneous adverse effects of cardiovasculary drugs

Basar I, Aydemir EH

Cerrahpasa J Med 1999; 30: 286-297.

BACKGROUND: Cutaneous adverse effects of cardiovasculary medicaments take an important place among the side effects of these medicaments and may be seen 1-19 % due to the used drug. Pruritus, oedema, vasculitis, thrombositopenic purpura, macule, papule, erythema, blisters, urticaria, angioneurotic oedema are common symptoms and diseases. Photosensitivity, hyperpigmentation, erythema multiforme and alopecias may be seen infrequently. Otherwise, there are some special uncommon symptoms which have been seen related with certain medicaments. Acecanide, disopramide, procainamide, propaphenone, quinidine, acebutolol, furosemide, clonidine and reserpine may cause Lupus erythematosus-like dermatitis. Atenolol, carvedilol, practolol, may cause psoriasiform reactions. Captopril, hydrochlorothiaside, aspirine may cause pityriasis rosea like dermatitis, enalapril may cause to pemphigus and diazoxide may cause to hypertrichosis.(Return)