Selçuk Tıp Dergisi Arşiv

Aim: Coughing is a common symptom in childhood. The cough last for over 4 to 6 weeks and also which makes patients the family and the doctor feel discomfort is called chronic cough. If this cough last long and repeats, it has to be investigated. After a detailed history and physical examination, distinctive studies have to be made. The purpose of this study is to evaluate the patients, which have been made flexible bronchoscopy because of chronic cough, by their clinical, laboratory and bronchoscopic findings. Material and Method: In this study we evaluated 23 patients with chronic cough; which were examined between January 2002 and December 2006 in Pediatric Chest Unit of Hacettepe University. Patients have cough for over 4 to 6 weeks, without specific chest X Ray findings, gastroesophageal reflux and problem with their immunologic system were and because of all these reasons they have been made bronchoscopy. The patients files are analyzed retrospectively by their demographic, clinic and bronchoscopic findings. Results: The study consisted of 23 patients: (12 males/11 females). The age of the patients vary between 1 and 13,8 years (mean age: 5 years). All patient’s radiological findings were normal without one patient. This patient’s have bronchial abnormalities in sanal bronchoscopy. When it is observed with flexible bronchoscopy ten patients have abnormal findings. Two patients have foreing body aspiration in their left main bronchus, two patients have tracheomalasia, three patients have hyperemia and secretions infection and two have bronchial abnormalites.In six patients’ bronchoalveolar lavage microorganism grew. Three patients have lipid laden macrophage and two patients whose previous gastroesophageal reflux scintigraphie were negative then found in and started treatment Conclusion: Although flexible bronchoscopy is an invasive technique, it evaluates respiratory system’s functional, anatomic characteristics well and it is a valuable technique in finding the etiology of chronic cough.

Aim: The aim of the study was to compare combined spinal-epidural (CSE) and epidural (EP) analgesia methods in labor analgesia. Material and Methods: The study was performed with 50 primigravid pregnant women who planned to have vaginal delivery. The patients were randomized into two equal groups: Group I: CSE analgesia group and Group II: EP analgesia group. A solution of 0.05% bupivacaine with 1.5 µg/ml fentanyl was prepared for using patient controlled epidural analgesia for both groups. Epidural catheters were introduced following the spinal administration of 1.25 mg bupivacain plus 12.5 µg fentanyl in patients in CSE analgesia group. Epidural solution infusion have been given to the EP analgesia group after the loading dose (10 ml 0.125% bupivacaine and 50 µg fentanil). Data were collected on maternal and fetal hemodynamic varibles, pain scores, motor blockade and total amount of consumed local anesthetic, the side effects. Results: Analgesia was effective in all patients. ‹nitiation time of analgesia in CSE group was much shorter than EP group (p<0.05). Better preserved maternal hemodynamics without hypotension, lower amounts of local anesthetics and beter patient satisfaction were observes in the CSE group compared with the EP group (p<0.05). Conclusion: Both CSE and EP analgesia methods used in this study were reliable and satisfactory for labor analgesia. Because of the faster initial analgesia, better maternal hemodynamics, shorter labor time in the first and second stage of labor and lower local anesthetic amounts, CSE analgesia method with lower doses of opioid and local anesthetic can be prefered to EP analgesia method.

Aim: We aimed to compare the effects of esmolol and fentanyl on haemodynamic responses during tracheal intubation in this placebo-controlled, prospective and single blind study. Material and Method: The ASA I-II group consisted of ninety patients, whose age ranged between 18-65, were divided into three groups. 150 mg esmolol were given to the first (Group E), 1,5 µg/kg fentanyl to the second (Group F) and 4 ml isotonic to the third group (Group K) by intravenous route. Propofol 2mg/kg and roküronyum 0,6 mg/kg was given during induction then intubation was performed. The systolic, diastolic and mean blood pressure and heart rate were measured and recorded at following times: before and after the induction, before the intubation and 1., 2., 3., 5., 7., 9. and 11. minutes after the intubation. Results: When it was compared between the groups, increasing heart rate of 1., 2., 3. and 5. minutes after the intubation were lower than both Group F and Group K (p<0.05). There were no significant results belonging to the systolic, diastolic and mean blood pressure between the groups (p> 0.05). Conclusion: As a result, in preventing increased heart rate after intubation esmolol was found to be more succcessful than fentanyl, although both esmolol and fentanyl were not found to be sufficient in preventing blood pressures alone.

Aim: We used Ligasure vessel sealing system in order to lessen the bleeding while cutting the parenchyma or to have a non-bleeding resection at 15 patients with mass at the liver. We aimed to present the data of the 15 patients where we applied hepatectomy and pericystectomy by the help of Ligasure, as a preliminary study. Material and Method: The records of 15 liver patients for whom we applied hepatectomy and pericystectomy by the help of Ligasure at Selcuk University Meram Medical Faculty of General Surgery Department during 2005-2007, were examined retrospectively. 10 of the patients were liver tumors (4 of them were hemangiomas, 2 were an adenoma and 4 were hepatocellular carsinoma), 3 of them were liver cyst hydatid, one of them was gall bladder Ca and the other was hepatolithiazis. Ligasure vessel sealing system (Ligasure Valleylab®) was used for all cases. Hepatectomy and pericystectomy by the help of Ligasure were applied to the patients. During parenchyma transection, sutures were used for great vessels a one patient. Result: The mean age of the patients was 53.7(32-65) and male/female ratio was 15/17. Mean blood loss was 217(30-700)cc and blood transfusion was not needed accept one case. Mean transection time was 48.93(25-85) minutes. There were no significant increases at biochemical parameters at the postoperative period. There was no morbidity at the late postoperative period. Conclusion: Ligasure application seems to be the precursor of a non-bleeding period at liver transection at them treatment of benign and malignant diseases of the liver

Aim: In our study, we evaluated the effect of antibiotics together with alpha-blocker and anti-inflammatory drugs; and we compared the effect of these treatments with placebo in patients with inflammatory chronic pelvic pain syndrome. Material and Method: Seventy-six patients with diagnosed NIH category 3A chronic prostatitis were included in this study. Placebo group included 19 patients (group 1), antibiotic + anti-inflammatory drug group included 29 patients (Group 2), while antibiotic + alpha-blocker group composed of 28 patients (Group 3). Before and after treatments all patients were evaluated separately according to national institutes of health-chronic prostatitis symptom index (NIH- CPSI) total score and pain, voiding and life quality scores. In addition; residual urine, maximum urinary flow (Q max) and prostate specific antigen (PSA) values were evaluated. All parameters of the 3 groups were evaluated by t-test before and after treatments. The values of the 3 groups after treatment were compared together by Mann Whitney-U test. Result: Patients mean age was 33.31(19-51). When we compared the pre-treatment and post treatment values of the placebo group, the pain, voiding, total NIH-CPSI score; there was a significant improvement while there were no statistically difference in other parameters. In group 2, there were statistically significant change in all parameters except Qmax, residual urine. In group 3, all parameters showed significant improvement. In comparison of the 3 groups, we found that the third group showed a more significant change than the other two groups. The patients tolerated the treatment well and there were no serious side effects. Conclusion: In our study we found that combination of antibiotics, alpha-blockers, and antiinflamatories are effective in treatment of category 3A chronic prostatitis.

Aim: Aging is a major process that results in changes in cardiovascular structure and function in elderly people. The aim of this review to summarize the effect of aging on some aspects of cardiovascular structure and function. Result: Increased arterial stiffness alters afterload and left ventricular shape. Age related deteriorations in left ventricular structure and functions are impaired ejection reserve, increase in diastolic volume and an altered diastolic filling pattern. Reduction in the number of myocytes and deterioration of subcellular structure are also remarkable with advanced age. Significant alterations in cardiovascular function during exercise are also demonstrated in elderly people. Conclusion: Significant changes have been noted in the structure and function of the cardiovascular system in older people that are considered to be the result of aging. These changes can be regarded as either adaptive or early preclinical disease, but they occur in the absence of clinically manifest dysfunction.

Aim: In this case report, it is aimed to discuss the ‘HaNDL Syndrome’ with the relevant literature. Case Report: A 20 year-old woman was admitted to the emergency department with left-sided, severe, throbbing headache accompanied with nausea, vomitting, sonophophia and phonophophia. Approximately 30 minutes after the pain emerged, she had suffered numbness and mild paresis on the right side of the body including the right side of her face accompanied with difficulty in speech which improved in approximately 20-25 minutes. She reported that 2 weeks prior these symptoms, she had suffered severe nausea and diarrhea that had lasted for 3 days. A diagnosis of viral gastroenteritis had been made and supportive therapy had been advised by a doctor. In the clinic, spinal tap was performed which revealed lymphocytic pleocytosis and mild elevation of protein level (49 mg/dL). Brain computerized tomography and the contast MR were normal. After the exclusion of other conditions which may cause CSF pleocytosis and severe headache; a diagnosis of HaNDL Syndrome was made. Conclusion: Recognition of this bening syndrome, is important as performing a diagnostic angiography may cause severe complications.

Aim: We aimed to present the anesthetic management of a case with giant liver hemangioma. Case Report: An 66 years old man with abdominal mass was diagnosed with giant liver hemangioma. Mass excision surgery continued 5.5 hours. The patient was discharged home 5 days later without any problem from department of general surgery. Conclusion: The patients should be evaluated detailed preoperatively and proper preparations must be planned to prevent intraoperative hypotention.