Selçuk Tıp Dergisi Arşiv

In this study we evaluated for surgical intervention in patients surgically treated for adrenal masses and adrenal malignancy with the relationship between the mass. In this study,adrenal mass the data were retrospectively analyzed 55 patients who underwent between April 2000-January 2012 in Necmettin Erbakan University Konya Meram Medical Faculty, General Surgery Department. Patients gender, age, mass localization, surgical interventions, mass size, mass weight and pathological diagnosis were evaluated. All of 26 patients (47.2%) were male and 29 (52.8%) were female.In 24 cases (43.6%) on the right, 28 (50.9%) on the left and 3 (% 5.5) patients had bilateral adrenal mass was detected. 25 patients (45.4%) were operated laparoscopic and 26 patients (47.2%) underwent surgery with open transperitoneal venture. Pathological examination of the mass weight of the specimens extracted from 20 cases per measured 67.35gr (1.76-500), respectively.In this cases mean mass size was 5.6 cm. The evaluation of adrenal masses as size to weight of the mass may be helpful in the diagnosis. Recently theese masses can be treated successfully diagnostic methods with the development of laparoscopic surgery.

Despite major advances in the field of obstetrics and progress of other obstetric complications, current treatment modalities are not able to decrease the incidence of preterm labor (PL) and preterm premature rupture of membranes (PPROM). Recent studies support the role of infection in the etiology of PL. As an acute phase reactant ferritin levels increase in acute inflammation and inflammatory process. The aim of this study is to compare serum levels of ferritin in patients with PL and PPROM at 25-37th weeks of gestation and healthy controls. This study includes 51 healthy women and 51 patients with PL and/or PPROM. Venous blood samples were taken for measurement of complete blood count and ferritin values. Serum ferritin, hemoglobin, white blood cell and platelet values of three groups were compared. In both PL group and PPROM group serum ferritin levels were higher than control group (14.71±14.70, 12.29±10.89 and 6.05±4.33 recspectively) and the difference was statistically significant (p<0.005) but serum ferritin levels showed no statistically significant difference between the PL and PPROM groups. In conclusion, ferritine as an acute phase reactant increases in PL and PPROM patients. Serum ferritin levels can be used as a marker in diagnosis and follow up of these patients.

Ocular findings in children with neurofibromatosis type 1 (NF 1) and tuberous sclerosis (TS) are presented. The study was conducted prospectively and comprised 31children who were referred from pediatric neurology clinic to the ophthalmology clinic. Sixteen of 22 patients with NF1 (72.7%) were male and 6 (27.3%) were female and the mean age was 9.9 ± 4.2 (3-16 years). Two of 9 patients with TS (22.2%) were male and 7 (77.8%) were female, the mean age was 5.5 ± 3.6 (1.5-12 years). Twenty of children with NF1 had cooperation to the snellen chart, the mean visual acuity of the right and left eye were 0.93 ± 0.14 (0.4-1.0) and 0.94 ± 0.14 (0.4-1.0), whereas the mean visual acuity of 7 patients with TS was 0.84 ± 0.22 (0.4-1.0) at the right and 0.85 ± 0.19 (0.5-1.0) at the left eyes. Percentages of myopia, hyperopia and astigmatism in children with NF 1 were 40.9%, 4.5% and 18.1%, respectively. Percentages of myopia, hyperopia, astigmatism in children with TS were 11.1%, 22.2% and 11.1%, respectively. In a NF 1 patient with keratoconus, his visual acuity was 0.4. Also another patient with TS had diminished visual acuity of 0.4 at the right eye and 0.5 at the left eye because of hyperopic astigmatism. Iris Lisch nodules were detected in 14 (63.6%) of children with NF 1. Five cases (22.7%) had bilateral optic glioma, the mean age was 7.6 (3-15 years). All tumors were located at intraorbital and the patients were asymptomatic. Except optic glioma, it was found out that one patient (4.5%) had bilateral myelinated nerve fibers and the other one (4.5%) had bilateral optic atrophy due to previous neurosurgery. Sectorial iris hypopigmentation was determined in one (11.1%) of nine children with TS. Detailed ophthalmic examination has a great importance in patients with TS and NF 1 because of ocular findings which are commonly seen. Patients should be evaluated by ophthalmologists in terms of refractive error and optic glioma.

The aim of this study is exploring the effects of childbirth education, physiotherapy and psychotherapy-based interventions on fears and worries about childbirth and labour. Expectant mothers in the last trimester of gestation those did not have a delivery before were taken to the study. At first the participants were examined by a psychiatrist than sociodemographic data form Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ), Beck Depression and Beck Anxiety Inventories (BDI, BAI) were applied. Then 3 sessions each taking 60 minutes on possible physical and mental problems before birth were done, an exercise plan and recommendations for facilitating delivery were given to participants, information about possible physical and psychological problems after childbirth were given and their questions on these issue were answered. In results mean age of the group was found as 27.2±3.6. The mean gestational age was 35.7±2.3. Socio-demographic characteristics (age, education level, income level, etc.) was not found significantly correlated with the W-DEQ scores. W-DEQ 1 scores were positively correlated with BAI scores. In Wilcoxon test analyses W-DEQ 1 and W-DEQ 2 scores including all the subscales were significantly different p<0.001. As a conclusion on expectant mothers having their third trimester of pregnancy, education before childbirth was found helpful in reducing fears and negative thoughts related to childbirth.

Multiple Sclerosis (MS) is an autoimmune-neurodegenerative disease of the central nervous system. It is characterized by a chronic inflammatory process. The nature of MS, continuing with demyelination and remyelination, axonal and neuronal damage, has not been enlightened precisely. The oxidative stress plays role in the pathophysiology of MS. Along with this; the role of agents such as nitric oxide (NO), homocystein (HCY), asymmetric dimethylarginine (ADMA) has been researched. In this study, we aimed to compare patients of relapsing remitting MS with healthy controls by measuring NO, HCY, ADMA levels. 43 MS patients of whom are 28 females and 15 males along with 18 healthy female, 11 healthy male volunteers with the same age group have been included to the study. Their serum HCY levels have been measured with chromsystem kit ( fluorescence detector) and their serum ADMA levels have been measured with HPLC technic by using the method described by Chen and his friends. The NO measurement has been realized by using kit (level no: 1 756 281). The SPSS 16.0 package program has been used for the statistical analysis of acquired data. While the averages of serum ADMA level have been found lower than their controls among MS patients, the HCY and NO averages have been obtained higher than their controls. However, these differences were not statistically significant (p>0.05). A meaningful correlation cannot be obtained between the period of disease and disability score (EDSS) along with the ADMA, NO, HCY averages, either. It has been thought that the research of these parameters among patients with various form and phases of MS, especially in the acute attack periods, might be indicative in terms of treatment strategies in future.

The main aim of the study was to evaluate differences in conventional and tissue doppler echocardiographic parameters in patient with acute pulmonary embolism (PE). Our descriptive and cross-sectional study population included 29 healthy voluntary controls and 54 patients with diagnosis of acute PE who were admitted to Selcuk University, Meram School of Medicine Hospital between January 2010 to July 2010. Two-dimensional and doppler echocardiaographic parameters, tissue doppler parameters were recorded and these parameters were compared between patient and control groups. There was not statistically significant difference between two groups with regard to demographic features and comorbidities. Right ventricular (RV) ejection fraction (EF) was detected to be significantly lower (46.2 vs. 60.5; P<0.001), whereas systolic pulmonary artery pressure was found to be significantly higher (45 mmHg vs. 24.7 mmHg; P<0.001) and inferior vena cava (IVC) collaps index was also found to be significantly lower (0.36 vs. 0.62; P<0.001) in patient group. RV myocardial performance index (MPI) values were evaluated by pulsed wave tissue doppler technique and significantly increased in acute PE group compared to control group (0.53 vs. 0.43; P<0.001). Furthermore, RV E/Em was found significantly higher (6.5 versus 5,0; P=0.04) and RV isovolumetric relaxation time (IVRT) was significantly prolonged in acute PE group compared to control group (67 msec vs.57 msec; P<0.001). Especially RV EF, IVC collaps index, Sm, MPI, E/Em can be used as different echocardiograhic parameters for the diagnosis of acute PE.

German measles (rubella) is a viral disease characterized by rash, fever and lymphadenopathy in children and adults. This disease is passed with mild symptoms in childhood, if the virus passes to the fetus during pregnancy, it leads to congenital rubella syndrome and can lead to many anomalies. The purpose of this study was to determine the seroprevalence of rubella IgG antibodies in women of marriage-age. In this study, Rubella IgG antibodies were investigated in the serum of marriage-age women who had attended to step one health care provider for premarital tests, prospectively. Tests were performed by Electrochemiluminescence immunoassay (Cobas, Roche, Almanya) according to the manufacturer’s recommendations. 963 women who were between18-25 years old in marriage age were included in this study. Rubella IgG antibodies were positive in 929 (96.5%) and were negative in 34(3.5%) of them.The seroprevalence of rubella have been found to be high in Konya. Immunity continues during lifetime in individuals who suffered from infection but women in marriage age who had not been infected and unvaccinated are at risk. Vaccination of women attended for premarital tests may reduce morbidity and mortality associated with congenital rubella syndrome.

Diagnosis of acute abdomen in pregnancy is still a difficult situation. Due to physiological and anatomical changes of a pregnant woman during pregnancy, the diagnosis and treatment can be difficult to decide. In addition, some of the procedures used for the diagnosis are avoided because of risk to the fetus. Delay in the diagnosis may cause maternal morbidity, mortality, risk of fetal loss and can cause premature birth. Surgical intervention may be required or surgical intervention may be harmful in some cases. The incidence of acute abdomen in pregnancy has been reported as 1 in 500-635. Among the causes of nonobstetric acute abdomen in pregnancy are: acute appendicitis, intestinal obstruction, acute cholecystitis, cholelithiasis, inflammatory bowel disease, peptic ulcer, acute pancreatitis, hepatic rupture, intestinal obstruction, acute fatty liver of pregnancy and severe preeclampsia. The life of the mother and fetus are important in the diagnosis and treatment. Early diagnosis and treatment are very important for the fetus and the mother.

Epistaxis, whether spontaneous or otherwise is experienced by up to 60% of people in their lifetime, 6% requiring medical attention. The condition has a bimodal distribution, with incidence peaks at ages younger than 10 years and older than 50 years. Epistaxis appears to occur more often in males than in females. With the evolution of endoscopic technology new treatment strategies combined with the use of stepwise epistaxis management plans can limit patient complications and provide effective treatment possibilities.

Amyand hernia is described presence of appendices vermiformis in inguinal hernia sac. The incidence of Amyand hernia is approximately 1% of all hernias. There are many treatment procedures of Amyand’s hernia. Since Amyand hernia is extremely rare and there are many controversial surgical managements, we wanted to share our case. We have encountered a Amyand hernia case during right inguinal hernia repair surgery. Treatment method and outcome were evaluated. Twentyone-year-old male patient was suffering from right groin pain and swelling for almost one year. He was operated with the diagnosis of right inguinal hernia, electively. Intraoperative exploration revealed Amyand hernia, appendectomy and hernia repair were performed using polypropylene patch with same incision. The patient’s postoperative course remained without complication and after 3 days he was discharged. Amyand hernia which especially difficult to diagnose preoperatively, particularly in terms of therapeutic approach, the debate continues, is extremely rare entity. There is no current consensus about appendectomy and using patch. We think that; regardless of the appendix is inflamed or noninflamed, appendectomy should be done. If the appendix is inflamed or perforated, prosthetic materials shouldn’t be used and while repairing hernia, anatomic repair or biological materials resistant to infection should be used.

Pneumomediastinum can develop spontaneously or in the setting of trauma. Spontaneous pneumomediastinum (SPM) is a rare condition and treatment of these patients is generally limited to observation. We discovered SPM in 15-year- old male patient, who had been wrestling, admitted to our emergency service with chest pain and shortness of breath. In this case report we discussed that in a patient without trauma, medical intervention for developing pneumomediastinum, the increased vagal maneuver may lead to SPM.

Most pancreatic injuries are minor and can be treated by external drainage. CT represents the best noninvasive diagnostic method for the detection of pancreatic injury, with sensitivity and accuracy of at least 80%. Morbidity and mortality rates for isolated pancreatic trauma are directly related to the presence of damage at the pancreatic duct. This article is based on 4 patients who have applied to our Department of General Surgery in Ümraniye Training and Research Hospital between April 2009 and December 2011. Three of the patients were men, and one of them was woman. The average age of the patients was 22 (17-28). Two of them have undergone surgery and drainage. Two patients have been treated with conservative treatment. Pancreatic fistula was seen in two patients. External drainage and conservative treatment are effective treatments for the low grade pancreatic injuries.

Cyclic vomiting syndrome (CVS) is characterized by recurrent episodes of nausea and vomiting. Age at onset of symptoms ranges between 4–6 years and there is a female predominance. CVS attacks are generally associated with psychosocial or physical triggers. In last years a shared pathophysiology between migraine and CVS has suggested. Children with CVS and their mothers have elevated rates of anxiety disorders. In this report, we presented a 5-year-old girl who referred to our out-patient clinic because of recurrent vomiting episodes. Because of her anxiety symptoms and vomiting attacks, escitalopram, a selective serotonin reuptake inhibitor, was initiated and she had significant improvement during treatment.

Tracheal stenosis related to prolonged intubation is a important clinical problem, currently. Its incidence has decreased with recognition of its etiology and modifications in the endotracheal and tracheostomy tubes. A tracheal stenosis related to prolonged intubation was detected by three dimension computed tomography and bronchoscopy in a 46-year-old man. Although the bronchoscopic dilatation, stenosis recurred. Therefore the tracheal sleeve resection was performed. We aimed to emphasize the diagnosis and treatment in the tracheal stenosis related to prolonged intubation.