Selçuk Tıp Dergisi Arşiv

Aim: To determine the course and the variations of radial nerve and its muscular branches in human fetuses. Material and Method: Radial nerve dissections were made on the 200 arms and forearms of 100 fetuses (50 males and 50 females). Length, thickness and distance measurements were taken by the same person using a 0.01 mm sensitive digital compass. Results: In all arms, primarily, the medial branch of muscular branch was separating from radial nerve. This branch was originating from posterior superior part of radial nerve in 153 arms (76.5%) and anterior superior part of radial nerve in 47 arms (23.5%). On forearms it was observed that the first branches of radial nerve reached to the brachioradialis muscle and extensor carpi radialis longus muscle. It was found that the motor branch which innervates extensor carpi radialis brevis muscle exit from deep branch in 48% of the arms, from radial nerve (separating location of the deep and superficial branches) in 42% of the arms, and from superficial branch in 10% of the arms. Also it was observed, in 26% of the cases, that a muscular branch originated from radial nerve and reached to the inferolateral segment of brachial muscle. It was found that there was no relationship between radial nerve and humerus body’s upper (superiorly 0.18) and lover (inferiorly 0.17) parts. Conclusion: The course, muscular branches, innervation patterns and variations of radial nerve should be well known by the specialists especially dealing with the local surgery of this region. In the fetuses, the knowledge of the spiral course of the radial nerve on the posterior face of humerus is crucial to determine the operation approach point, and this area is less safer than adults in the fetuses, according to our results.

Aim: In this study, it was aimed to investigate the frequency of bacteria isolated from blood samples accumulated from different clinics and their sensitivity to antimicrobials during the last year. Material and Method: Blood cultures were examined using Becton Dickinson 9120(USA) automatic blood culture system, and classical methods were used to isolate the bacteria. To identify pathogenic bacteria, sceptor (Becton Dickinson-USA) device and panels were used. Brucella polyvalan antisera of Refik Saydam H›fz›s›hha Institution were used to identify different types of Brucella. Also, Sceptor (Becton Dickinson-USA) panels or Müller-Hinton Agar Disc Diffusion Method were used in the provision of the sensitivity of bacteria to antimicrobials. Result: Of 565 pathogens isolated during one-year’s time, 165 (29%), 116 (21%), 60(11%), 48(8%), 36(6%) and 107 (19%) were determined to be derived from Coagulasis Negative Staphylococcus (CNS), Staphylococcus aureus, Streptococcus spp, Escherichia coli, Brucela spp., Klebsiella spp. and other microorganisms, respectively. It was detected that antimicrobials for which pathogens are the most sensitive are vancomycin, chloramphenicol, ciprofloxacin for gram negative bacteria, such as Staphylococcus and Streptococcus; the most effective antibiotics are imipenem, amikacin, cefoxitin, ciprofloxacin and cefuroxime for gram negative bacteria, such as Escherichia coli and Klebsiella pneumoniae. However, tetracycline, streptomycin and ceftriaxone were detected to be the most effective against Brucella strains isolated from the blood samples. Conclusion: Investigated the blood cultures provided from the in-patients in our hospital, Staphylococcus and Streptococcus were determined to be isolated as the most prevalent ones; then, the second most isolated group was gram negative bacteria.

Aim: The aim of the present study was to investigate the medical practitioners' approach to forensic cases and to composing forensic reports and to determine the problems they face regarding these issues and to present suggestions for solutions to problems. Material and Method: Questionnaire forms were administered to practitioners working in emergency services and 112 Hizir Acil (swift emergency ambulance and first aid) services of hospitals affiliated with the Ministry of Health in the Province of Konya and around and who participated in "Emergency Medical Service Certificate Program Basic Module Training" before their training. Results: 85.2 % of the practitioners who participated in the study stated that the undergraduate forensic medicine training was not adequate. It was seen that the percentage of the practitioners who received training on forensic medicine and report after graduation was 20.1 %. Among the subjects, 42.4 % of the practitioners stated that the forensic report should be prescribed by "the medical practitioner who made the first diagnosis", 84.3 % of the practitioners stated that they experienced an uneasiness because of the fact that the patient was a forensic case, 66.8 % stated that a unit which dealt with only forensic cases should be set up in the units they worked, however, they did not want to take part in that group. It was determined that, of the practitioners, the number of the ones who made wrong assessments regarding the issues in the Turkish Penal Code such as "vital danger", "simple medical intervention" and "the effects of bone fractures on life functions" was high. Conclusion: Although the rate of encountering forensic cases is high in practitioners, it is understood that practitioners experience uneasiness about writing forensic reports because of their lack of training and knowledge. It is suggested that practical training should be provided concerning the issues of forensic report writing, concepts used as criteria for severity of injuries and approach to forensic cases, especially to the practitioners who work at emergency services in order to remove the uneasiness experienced and to organize forensic reports according to objective criteria.

Aim: In this study we aimed to analyze effects of phospholipid solutions (preventing adhesions by increasing slipperiness between damaged surfaces and detaching them) during peritoneal reepitelization. Material and Method: Thirty Wistar Albino type rats divided in two groups. Caecum serosa was damaged using sterile gauzes to achive light serosal haemorrhagy and 1 cm2 of periton excised from right side of abdominal wall in all rats.Group I was applied 3 ml %0.9 NaCl and Group II was applied phospholipid solution (Fresnius Kabi – Deustchland) intrabdominally before closure. Rats sacrified at postopertive 10th day. After macroscopically examining adhesions, adhesion surfaces were calculated with a calibration scale. In microscopic examination lymphocytes, plasma cells, polymorphonuclear cells, histiocytes and fibroblasts were marked and counted with Clemex Image Analysis system. Results: In phospholipid group there was a significant decrease in adhesion formation compared to control group macroscopically. The decrease in adhesion formation was statistically significant (p<0.05). There were also significant differences between two groups in microscopically observed fibroblast and PMNL ratios and this difference was also statistically significant. Conclusions: Usage of phopholipid solutions decreases postoperative adhesions. Application of phospholipid solutions is a cost-effective method for preventing consequent operations for intraabdominal adhesions.

Aim: Many options have been reported in reconstruction of the facial defects such as skin grafting, local flaps and free flaps. The extended V-Y flap, a modified V-Y advancement flap, is very useful in closing defects following excision of large facial lesions. Herein, we presented our 6 years experience for covering of the large facial defects with extended V-Y flaps. Material and Method: This procedure was applied to 27 patients with age ranging from 38 to 79 between 2001 and 2007. All operations were performed under local anaesthesia. The lesions were either squamous cell carcinomas, basal cell carcinomas, malignant melanoma, trichilemmoma, seborrheic keratosis or actinic keratosis and they were localized in the malar area, infraorbital area, lateral nasal aspect, the zygomatic area and the forehead. The size of the defects ranged from 3 x 3 cm to 6 x 5, 5 cm. Results: All of the flaps were achieved suitable closure of defects. The functional and aesthetic results were satisfactory for patients, and no tumor recurrence was observed during the 9 to 17 months follow-up period. Conclusion: Extended V-Y flap can be used reliably for the reconstruction of large facial tissue defects.

Aim: This review sought to determine the relationship between cyanosis and hematological signs and findings. Main finding: Patients with cyanotic congenital heart disease are succeptible to develope hematological side effects. Several findings, including polycytemia, thrombocytopenia, factor deficiencies, iron-deficiency anemia and disseminated intravasculary coagulation have been reported. Decreased arterial oxygen saturation in cyanotic congenital heart disease causes compensatory kurise in hemoglobin and haematocrit levels. Erythrocytosis is an adaptive response to improve oxygen transport in cyanotic congenital heart disease. However, at highly increased haematocrit levels patients may experience hyperviscosity symptoms. Iron-deficiency in cyanotic congenital heart disease patients is often overlooked due to elevated hemoglobin concentrations. The detection of a hemostatic abnormality and its correction by appropriate therapy are likely to minimize the side effects. Results: Children with cyanotic congenital heart disease are prone to both thrombosis and hemorrhage. Hematological management of cyanotic congenital heart disease has received little attention. The lack of practical therapeutic guidelines forced us to consolidate our observations on patients with cyanotic congenital heart disease.

Aim: N-hexane is a commonly used alyphatic hydrocarbon derivative due to being an expensive solvent, and known as having neurotoxic characteristics. A case being exposed to hexane based chemicals for the purpose of the stabilization of electrical pressure circuits on cell phones and developing sensory neuropathy owing to the exposure was aimed to be discussed in the light of the literature. Case Report: A 50 year old man applied to the Neurology policlinic with the complaint of numbness first starting on the feet, then radiating to the legs and hands 3 years ago. On his neurologic examination, no pathologic findings were found except for the finding in the form of glove-sock hypoesthesy. In the history of the patient without any known systemic diseases, it was found out that the patient was a cell phone technician for the last 3 years, and that he was particularly exposed to hexan-based chemicals for the purpose of the stabilization of electrical pressure circuits on cell phones in very inappropriate conditions and for a long time. On the examination of his EMG, widespread peripheric pure sensory neuropathy was determined. Other causes leading to sensory neuropathy were excluded. It was thought that sensory neuropathy may be dependent on the longterm exposure to hexan-based chemicals for the purpose of the stabilization of electrical pressure circuits on cell phones in inappropriate conditions. Conclusion: Dependent on long- term n-hexane exposure, peripheric sensory neuropathy may develop in those dealing with cell phones becoming widely used in recent years, and the maintenance of these cell phones after their mechanic defects.

Aim: We aimed to evaluate surgical procedure carried out to an 8 years old child, clinically diagnosed as Henoch-Schönlein Purpura (HSP), undergoing intussusception repair, because of allergic vasculitis, erythamatose maculopapuler rashes, rectal bleeding, abdominal pain and intussusception, under the light of literature data. Case Report: An eight years old and a male child was consultated because of his biliary vomiting, nausea and diffuse maculopapuler rushes which were localised especially in lower extremites. The symptoms of HSP were observed at histopathologic examination of skin. On examination, the symptoms of acute abdomen, which were characterised with diffuse tenderness and distansion, hipoactive intestinal sounds and abondant biliary drainage from nasogastric tube, were identified. The pneumatic and hydrostatic reductions were not performed because of the risk of perforation due to severe peritonitis and his poor general condition. The patient was operated on after preoperative resuscitation. During the explorative laparatomy, edema and the symptoms of insufficient vascularisation in all intestinum were present. Also, it was observed that approximately 20 cm’s intestinal segment which begins from 10 cm proximal of ileocaecal valve, had been necrotic and ileostomy was carried out after resecting this segment. Meanwhile, it was observed that the whole intestine was edematous and localised blood circulation was distorted in some areas. The patient was operated on to make bridectomy when evisceration and brid ileus occurred on postoperative eleventh day, and the ileostomy was closed at the same session. The patient was delivered with complete recovery 16 days after closing of ileostomy. Conclusion: Although HSP is rarely seen as the cause of acute abdomen, too serious complications of this disease must be kept in mind.