Selçuk Tıp Dergisi Arşiv

Aim: The purpose of this study was to investigate the value of contrast material-filled virtual cystoscopy in the detection of bladder tumors. Material and method: Thirty-six consecutive patients (28 male and 8 female; range age, 51-82 years; mean age ± SD, 65 ± 7 years) who had painless hematuria and suspected to have bladder neoplasm prospectively evaluated with virtual cystoscopy. After the intravenous injection of contrast medium, the contrast material-filled bladder was examined with single detector helical computed tomography (CT) scan with 2-mm slice thickness. Source CT data were transferred to a workstation for interactive navigation using surface rendering. All patients also underwent conventional cystoscopy. The results of virtual cystoscopy were compared with the findings of conventional cystoscopy. Results: Seventy-one of 78 bladder tumors detected with conventional cystoscopy in 28 patients were also shown on virtual images. Five patients had a normal appearance on both conventional cystoscopy and virtual cystoscopy. On virtual cystoscopy, seven of the 12 lesions 5 mm or smaller in diameter could be identified. We found the following statistical values for the identification of bladder lesions on virtual cystoscopy: sensitivity, 94%; specificity, 90%; positive predictive value, 87%; negative predictive value, 93%; and accuracy 93%. Conclusion: CT virtual cystoscopy is a noninvasive technique which is used successfully for detection of bladder tumors larger than 5 mm.

Aim: The aim of this experimental study is to determine the relationship of the element levels in different tissues and the postmortem process and the reliability of this relationship in the determination of postmortem interval. Material and method: For this purpose, 52 three-month-old male Sprague-Dawley rats were sacrified by cervical dislocation and four of them were seperated for dissection. On the other hand, remaining 48 rats were divided into two groups for the purpose of investigating surrounding temperature the corps existed to the tissue element levels. One of the groups was kept at 4 ºC and the other at 18±2 ºC. Just after sacrifice, seperated four rats were dissected. Then the dissection was made at 6., 12., 24., 48., 72. and 96. hours four rats each among the groups kept in both temperatures. Brain, myocardium, liver, kidney and skeletal muscle samples were taken from each rat. Element levels were determined by ICP-AES in the samples which were prepared for analysing with microwave digestion method. The values acquired for Ca, Cu, Fe, K, Mg, Na, P, S and Zn were statistically evaluated by Kruskal-Wallis and Mann-Whitney tests. Results: When the findings of both temperatures were evaluated together in all tissues, it was determined that Fe, K, Na, Ca and Cu showed significant changes in more than one tissue at 4 ºC and 18±2 ºC. Conclusion: It was concluded that, the availability of tissue element levels as a reliable method in the determination of postmortem interval needs to be revealed by experimental studies that will be done on wider series and the analyses on the autopsy material.

Aim: Diarrhea is one of the most common causes of mortality and morbidity in childhood, especially in developing countries. Dehydration related to diarrhea can be mortal if it could not be prevented. Mothers play important role in preventing children from diarrhea and replacing fluid and elect rolytes before the dehydration. Material and Method: Information levels of the mothers about diarrhea and oral rehydration solution were extracted from an questionnaire form. The results of the questionnaire were investigated according to socioeconomic, educational levels of the mothers. Results: In the study, 250 mothers’ answers (ages varied 17 to 50-years-old, median; 32-years-old) were evaluated. Seventy-seven (30.8%) of the mothers were from upper-socioeconomic-class 98(39.2%) were from middle-socioeconomic-class, and 75 (30%)were from lower-socioeconomic-class. Approximately, half of the mothers were graduated from primary school. 190 (76%) of mothers pointed out that diarrhea is a mortal disease and the most common protection practice is to be aware of hygiene, whereas 26.8% of the participants remarked that they did not have any idea for protection from diarrhea. The most common method that the mothers choose when their children had diarrhea was juicy drinks (55.6%), and application to medical center (24.4%). 93.6% of the mothers remarked that they should increased intake of juicy drinks and 88.4% remarked that they did not stop breast feedings when their children had diarrhea. Oral rehydration solution was known by 76.4% of the participants, and this knowledge had been achieved from a medical center (42%) and broadcast media (18.8%). Seven of the mothers (2.8%) had a history of child death related to diarrhea. Conclusion: Since diarrhea still remains one of the most common causes of mortality in childhood in the twenty-first century, the mothers must be instructed, and much time must be allowed in primary medical center and media for education about diarrhea. Unlabored achievement to oral rehidration solution must be provided for the parents.

Aim: Patients who diagnosed acute viral hepatitis between 1990-2004 were avaluated for etiological, epidemiological, clinical and laboratory characteristics, retrospectively. Material and method: Patients who had acute symptoms and physical examination findings suggesting acute viral hepatitis were evaluated by ELISA and PCR methods. Results: Mean age of the patient group was 26.76±14.51 years (7-77). 297 of the patient groups were male, 270 of them were female. Acute viral hepatitis A, B, C, D, E were diagnosed in 270 (48.2%), 233 (41.5%), 18 (3.2%), 3 (0.5%), 1 (0.2%) patients respectively. Hepatitis A + B coinfection were diagnosed in 4 (0.7%) patients whereas; in 29 patients (5.2%) diagnosis remained obscured. Acute viral hepatitis A was tend to occur in students during autumn and winter. Route of infection could not be identified in 377 (67.2%) patients. Weakness (73.8%), jaundice (67%), nausea (66.1%) and dark urine (56.9%) are the most frequent complaints whereas; jaundice (85%), hepatomegaly (44%) and splenomegaly (8.2%) were the most common signs noted during physical examination. Mean AST, ALT, total bilurubin values were 1433.38 (106-7963), 1951.96 (218-15596), 9.13 (1.3-35) respectively. Conclusion: Value of anti-hepatitis A and B virus vaccination is underlined because of lackness of any transmission-associated risk factors in majority of acute viral hepatitis patients.

Aim: Propofol is a frequently used anesthetic in outpatient anesthesia and pain is often experienced when propofol is injected. Opioids are effective in preventing the propofol pain injection. In this study it’s aimed to evaluate effectivity of sufentanil, a selective μ receptor agonist 5-10 times more effective analgesic than fentanyl, in propofol injection pain. Material and method: Sixty patients scheduled for elective surgery under general anesthesia were randomly allocated to one of two groups to receive either saline 2 ml or 5μg sufentanil before propofol was injected. Each patient was given one of these agents intavenous via 20 G cannula on the dorsum of the hand in 10-20 second. Then 5 ml propofol at room temperature was injected. Pain was assesed verbally and scored none (0), mild (1), moderate (2), severe (3). Results: There was no statistically difference in demographic datas between two groups. In saline group, the incidence of pain (% 80) was higher than in the flidsufentanil group (%46,7) the result was statistically significant (p< 0,05). Conclusion: Pretreatment with 5μg sufentanil was effective in reducing the propofol injection pain. So, we thought that sufentanil can be useful for preventing propofol injection pain.

Objective: To present a case of pulmonary hyalinizing granuloma (PHG). Case Report: The patient was a 48-year-old female who had abnormal chest X ray showing bilateral mass shadows incidentally. She was asymptomatic. Subpleural two nodules removed by open lung biopsy revealed a homogenous cut surface. Histological diagnosis was PHG consisting hyalinized collagen fibers and bundles infiltrated with chronic inflamatory cells. Conclusion: The case was presented to attract attention to take this rarely benign disease in to account in the differantial diagnose of multiple pulmonary nodules.

Aim: Multiple sclerosis (MS) is an immune- mediated disease of the central nervous system. We will emphasize in this article; very different mechanisms, and complex interactions have important role in immunopathology of multiple sclerosis. Main Findings: The pathogenesis of MS is best viewed as a complex interaction between genetically predetermined susceptibility markers and environmental stimuli. MS is charecterized by inflammation, demyelination, apoptosis in oligodendrocytes, remyelination, and axon loss. Immune reaction against different components of the central nervous system (particularly myelin structures) are thought to play an important role in the initiation of the destructive process. The inflammation in MS appears to be caused by an overactive pro-inflammatory TH1 profile in T cells. Demyelination can result as a consequence of direct damage to myelin by inflammatory cells or indirectly because of the enviroment produced by inflammation. Axon loss occurs in MS lesions starting early in the disease. Conclusion: MS occurs with different immünopathological mechanisms.

Aim: Multiple sclerosis (MS), is characterized by demyelination of different parts of brain and spinal cord and episodic neurologic symptoms. In this case report we aimed to present a patient, and highlighting anesthetic management for these patients. Case Report: A 42 year old man who had neurogenic bladder with primer progressive multiple sclerosis undergoing bladder stone operation is discussed. Conclusion: Stress such as surgery or general anesthesia may be associated with an exacerbation of the disease. We thought that to carry out desflurane and remifentanil combination used safely in anesthetic management for MS.