Selçuk Tıp Dergisi Arşiv

The amount of data, increasing together with the technology, has brought the concept of “data warehouse” in every field of life. Data Mining is a set of approaches analyzing these data warehouses formed by very large data sets and allows to gather useful information. One of the fields where the amount of data is large and getting larger everyday is the health sector. Many personal and medical data belonging to thousands of patients are recorded and stored. However, small part of these data can be analyzed and the remaining part may not be helpful to obtain useful information. The data in warehouses must be analyzed to improve the methods for hospital management systems, treatment and health care systems to reduce the costs. Since analyzing large data sets using classical statistical methods is difficult, various data mining methods have been developed and these methods have become more feasible with the help of certain softwares. Association rule is an important datamining task to find hidden patterns between the variables and used recently in the field of healthcare. In this study, we have calculated the support and confidence of the associations in data set. APRIORI algorithm have been applied onto the retrospectively obtained breast cancer data belonging to Oncology Hospital of Meram Faculty of Medicine.

In this study, we aimed to compare procalcitonin (PCT) and C-reactive protein (CRP) levels in patients with gram-negative bacteremia, as Brucella spp., Escherichia coli, Klebsiella spp., and Acinetobacter spp. Simultaneous studies on culture, PCT and CRP were done on the blood samples obtained from the patients. Samples were investigated in Konya Research and Education Hospital, Konya, Turkey. Samples were collected and incubated in BACTEC 9120 blood culture system. Phoenix-100 automated identification panels were used. For Brucella spp. identification, Brucella polyvalent serum was used in addition to conventional methods. CRP values >5 mg/L and PCT values >0.5 ng/ml were considered pathological. (Cut of value of PCT is 0.02-50 ng/ml.) PCT values were evaluated in three groups as: Group 1 (<0.5 ng/ml), Group 2 (0.5-2.0 ng/ml) and Group 3 (>2.0 ng/ml). Brucella spp. were detected in 100 patients, while E. coli in 50 patients, Klebsiella spp. in 50 patients, and Acinetobacter spp. in 40 patients, and these 240 patients were included in the study. For Brucella spp., PCT was in Group 1 (<0.5 ng/ml) in all 100 patients, and CRP was >5 mg/L in 92. For E. coli, PCT was in Group 3 (>2.0 ng/ml) in 34 patients and CRP was >5 mg/L in 46. For Klebsiella spp., PCT was in Group 3 (>2 ng/ml) in 47 patients and CRP was >5 mg/L in 39. For Acinetobacter spp., PCT was in Group 2 (0.5-2.0 ng/ml) in 24 patients and CRP was >5 mg/L in all 40. In some of the gram-negative bacterial infections, PCT and CRP levels were increased, but in patients in whom Brucella spp. were grown in blood culture, CRP level increased while PCT level did not.

Evaluation of ocular side effects of systemic isotretinoin in patients with acne vulgaris The aim of the study was to evaluate effectiveness and ocular side effects of systemic isotretinoin treatment. 1 mg/kg/day systemic isotretinoin was given to the 38 patient with moderate-severe-very severe acne vulgaris. Patients were evaluated by using Global Acne Grading System. At baseline, second and forth months subjective complaints of patients were recorded and ophthalmological examinations were performed in ophthalmology clinic. Biomicroscopical examination, fundus examination, Schirmer 1 test, Schirmer test with anesthesia, tear-film break-up time tests were performed at baseline second and forth months. GADS values were 30,65±4,74 at the beginning and 1,26±3,78 at the end of the therapy. This decrease was statistically significant. Subjective complaints were observed in 24 patients (63.15%) at the end of second month of treatment. At the end of forth month 11 of 14 patients who did not have any complaints at second month had some complaints. A significant decrease was seen in Schirmer 1 test, Schirmer test with anesthesia, tear-film break-up time tests. In cases considering isotretinoin treatment, we think that the ophthalmologic examination performed at least once may be helpful.

Endoscopic retrograde cholangiopancreatography (ERCP) has an important role in the diagnosis and treatment of hepatobiliary and pancreatic diseases. This study was discussed the three years’ experience of general surgery of endoscopy unit. The records of 242 ERCPs of 200 patients, performed between February 2010 and March 2013, were retrospectively evaluated. The age range 19-84 years (mean; 47.3 years) and 116 patients (58%) were female. The most common indication was the presence of obstructive jaundice and/or a high serum bilirubin level (159 patients, 79.5%). The average ERCP duration was 16.5 min (5-55 min.). A repeat ERCP was needed in 38 patients (19%) and cannulation was successful 185 patients (92.5%). Endoscopic sphincterotomy was performed in 177 patients (88.5%), biliary balloon application in 156 (78.3%), and stone extraction in 144 (72%). Complication occurred in 8 patients (4%) and the most common complication was acute pancreatitis (4 patients, 2%). There was no mortality in any patient in this series. Although the relationship between the risk of mortality and morbidity of ERCP, a reliable method of diagnosis and treatment of hepatobiliary and pancreatic diseases.

To evaluate the etiologic and anatomic aspects of the patients who admitted a university clinic with vision loss from Diyarbakir and surrounding cities. Between May 2011-April 2013, the records of patients who admitted Dicle University Hospital Chairman of the Board Health with low vision and without any systemic disease were reviewed retrospectively. Demographic characteristics of patients, uncorrected and the corrected best visual acuity were recorded. Patients with best corrected visual acuity less than 0.5 were divided into 4 groups according to the classification of World Health Organization’s vision loss. Group 1 (best corrected visual acuity <0.05) were evaluated. Those patients were divided into 2 groups as bilateral and unilateral according to visual loss. The etiologies of vision loss in patients were classified into 5 groups as anterior segment pathology, retinal disease, optic disc disease, simulation, globe/refraction related disorders.167 patients were enrolled.88(52.6%) patients had bilateral and 79(47.4%)had unilateral visual loss. The most common cause of bilateral blindness was retinal diseases. The most common retinal disease was retinitis pigmentosa. The most common cause of unilateral blindness was anterior segment pathologies in which cataract/congenital cataracts were consist of the most common subgroup. The second most common cause was perforating of trauma and refraction disorder. In this study the most frequent etiologic factor was found to be retinal diseases especially hereditary retinal dystrophies in patients. We thought that might be due to particularly from the marriage between closely related individuals. Public awareness about marriage between closely related individuals and prevention of trauma is likely to reduce exposure to these results.

The aim of the present study is to identify the diagnoses of patients who referred to a child and adolescent psychiatry outpatient clinic. Medical records of 2109 patients referred to the Children and Adolescent Psychiatry outpatient clinic at Ordu States Hospital, between January 2012 and April 2013 were studied retrospectively. It was found that the patients were mostly male (59.6 %) and within 7 to 18 years of age (78.6%). It was also determined that 74.8% of patients had at least one diagnosis. The diagnosis rate of 44.8% in patients between the ages of 0-6, 84.6% of patients aged 7-11 were determined as 80.3% in patients aged 12-18. Of the cases, 9.7% were diagnosed with multiple conditions. They were mainly in the attention deficit hyperactivity disorder (ADHD) group. The most common diagnosis was attention deficit hyperactivity disorder followed by depression, anxiety disorders, enuresis and mental retardation, respectively. When the distribution of the diagnoses to sex were assessed, the most common diagnoses in boys are ADHD, enuresis, depression, generalized anxiety disorder and mental retardation respectively, they were ADHD, depression, generalized anxiety disorder, enuresis and mental retardation in girls. In our study, although the externalizing disorders are the most frequent diagnoses, there are differences between genders. The rate of comorbid diagnosis was found to be considerable. In the presence of comorbid diagnoses, the disorder is experienced more heavily and psychosocial functionality gets deteriorated. To know the most common diagnoses, diagnosis differences within genders and possible diagnoses for certain age groups will be useful for improving child and adolescent psychiatry services.

The aim of this prospective study is to evaluate the results of our total laparoscopic hysterectomy (TLH) cases. Forty one patients underwent TLH due to benign or malign disorders were reviewed prospectively between January 2013 and April 2014. Rigid instruments 10 mm telescope, and advanced bipolar energy modalities were used during the procedure. A primary 10-mm trocar was inserted directly through a 1-cm sub umbilical incision. The laparoscope was inserted through this trocar after insufflation of the abdominal cavity with 3–4 L of CO2. The second and third incisions were performed in the avascular right and left lower quadrant of the abdomen and two ancillary 5-mm trocars were inserted through these incisions. Uterine manipulation was performed by using RUMI® II. During the removal of the specimen, if necessary, intracorporeal myomectomy and morcellation were performed before the uterus and ovaries were delivered intact through the vagina. A 0-Vicryl suture was used for close the vaginal cuff. The sutures were passed through the left and right uterosacral and cardinal ligaments in all patients. All procedures were performed by the same surgeon. The mean age of the cases, body mass indexes (BMI), duration of operations, the amounts of blood loss, rates of complications and post operative hospital stay were assessed. The indications of for hysterectomies were, 16 myoma uteri, 6 medical treatment-resistant abnornal uerine bleeding, 5 benign ovarian cyst, 4 adenomyozis, 3 myoma uteri+ovarian cyst, 2 endometrial polyp, 2 endometrioma, 2 endometrial hyperplasia and 1 early stage cervical cancer. The mean age of patients were 47.5 (30-68 years), mean BMI of patients were 30.2 (24-44), mean specimen weight was 215.9 (90-650 gr), mean operation duration was 107.9 (60-210 min), mean blood loss was 81.1 (30-300 ml), mean preoperative hemoglobin (Hb) was 12.5±0.9 gr/ dl, mean postoperative Hb was 11.5±0.8, and the mean hospital stay was 2.5 (2-4 days). There were no intraoperative complications. Late postoperative complication was vaginal vault infection in 2 cases. Total laparoscopic hysterectomy is safe and feasible method for gynecological diseases. Careful selection of patients is critical for obtaining the best results.

Agenesis of the gallbladder is a rare congenital anomaly occurring in 1 to 4 people of a population of 10000. It may present with biliary type symptoms such as upper abdominal pain requiring further investigation. Ultrasound is the first choice of imaging for biliary symptoms but is frequently misleading in the context of Gallbladder Agenesis. We report a case of congenital Gallbladder Agenesis and a biliary tract abnormality diagnosed by laparoscopy. As a result most patients are diagnosed following conversion of laparoscopic to open cholecystectomy and subsequent failure to identify the gallbladder. Failure to suspect Gallbladder Agenesis at laparoscopy can result in unnecessary open surgery and a high risk of bile duct damage with corresponding postoperative morbidity and mortality.

Croup syndrome is a term that defines barking cough , hoarseness, inspiratory stridor, and presenting with changeable severity of respiratory distress according to the l (severity) of obstruction, Foreign body aspirations, retropharyngeal abscess, bacterial tracheits and epiglottitis are also reasons for croup like acute airway obstructions. We a 4 years old child with biphasic stridorwho admitted to the Pediatric Emergencydepartment In consequence of unresponsive medical treatment pati endoscophic examination has performed and a Szygium aromaticum at the level of vocal cordswas found The foreign body had removed with general anesthesia by endoscophy.

Swyer-James Syndrome is a rare pulmonary disease, characterized by one-sided hyperlucency, smaller hilum shadow and lack of vascular structures in affected side. Although usually asymptomatic, can also be symptoms such as recurrent lung infection, exertional dyspnea and hemoptysis. 23-year-old male patient presented with exercise-induced dyspnea. On physical examination, decreased breath sounds on the left hemithoraxes. Chest x-ray showed right middle and lower lobe more prominent hyperlucency, mediastinal shift to the left and small hilar shadow. Ventilation-perfusion scintigraphy were determined consistent defect areas. Swyer-James Syndrome diagnosed by chest X-ray is possible, but it is unthinkable because of the rarity. Swyer-James syndrome diagnosed patient is presented with literature data.

Endometriosis is the presence of normal endometrial tissue outside the uterus. Scar endometriosis is a rare pathology resulting after obstetric and gynecologic surgery procedures on abdominal wall which is not pre-diagnosed in differential diagnosis by general surgeons. Six cases referred to General Surgery outpatient clinic with mass on abdominal wall that have been totally excised and diagnosed as endometriosis in pathology laboratory between 2008-2012 , have been reviewed retrospectively with clinic, radiologic and pathologic findings. The presenting symptoms of six pateints were different; four of them referred with cyclic pain and swelling and two with nonspesific symptoms to general surgery outpatient clinic. All of the masses have been totally excised and diagnosed as endometriosis in pathology laboratory. Scar endometriosis should be considered in differential diagnosis of incisional abdominal wall masses in females referring to General Surgery.

Very long-chain fatty acid dehydrogenase (VLCAD) deficiency is an autosomal recessive disorder of mitochondrial fatty acid oxidation. Elevated plasma level of acyl-carnitine by Tandem mass spectrometry prompts the diagnosis of VLCAD. We herein report a neonate with a diagnosis of VLCAD whose mother’s pregnancy was complicated with HELLP syndrome. Physical examination revealed poor peripheral perfusion and hypotonia on the 15 days of life. Metabolic acidosis, dilated cardiomyopathy developed during follow-up.

Bullous lung disease, one of the serious pulmonary diseases which is mostly observed together with paraseptal emphysema spreads on the outer part of lobulus adjacent to septums between pulmonary lobulus. It is widely common among smokers’ upper lobs. This patients present with spontaneous pneumothorax. And foreign bodies in bronchial system is a situation mostly emerging at childhod which has critical importance in terms of its consequences and complications. If not pulled out, foreign bodies remaining inside bronchi for extended periods can cause complications such as bronchial stenosis, abscess and bronchiectasis. In our case, the patient was a chronic smoker who applied us having spontaneous pneumothorax. Bilateral giant bullae spreaded on lower lobes was spotted. Organized foreign body in the neighbourhood of throughly grown up bullae formation segment on distal part of right lower lobe was observed during the surgery. Agents of bronchial obstruction can cause proteolytic – antiproteolitik imbalance in check-valve mechanism and inflammatory process. This circumstance can harm the lungs or increase the existing harm. Localization of bullae in the lower lobes rather than their standard location and presence of a foreign body is a rare occasion of association for bullous diseases.

Our case was pre-diagnosed with appendicitis but during the surgery it was seen that the patient had cecal diverticulum perforation. Further, as the dissection continued appendicitis with retrocecal subserous localization was identified. The goal of our study is to underline the possibility that appendicitis in a rare localization can be overlooked in patients diagnosed with simultaneous cecal diverticulum complications. Although cecal diverticulum is a rare lesion, there are some difficulties regarding its diagnosis and treatment since its symptoms are similar to acute appendicitis when there is a complication. It can hardly be differentiated from acute appendicitis through physical examination and radiological imagining methods are mostly insufficient. Therefore, patients are generally diagnosed intraoperatively. Acute appendicitis is one of the most frequent causes of acute abdomen. Appendectomy, too, is the most frequently performed surgery among intraabdominal emergency surgical procedures. A good anamnesis and a careful and sufficient physical examination are very significant in the diagnosis of acute appendicitis. Alongside these, various laboratory and imaging techniques can be utilized. Although the appendix can be seen in different localizations, the retrocecal site is one of the rare localizations among all. In patients presenting to the emergency departments with complaints of right lower quadrant pain, many diseases, led by appendicitis, based on the patient’s age and sex should be taken into consideration. The possibility that these diseases may co-exist should always be remembered and, therefore, intra-operational exploration should be performed thoroughly.