Selçuk Tıp Dergisi Arşiv

The aim of this study is to report our surgical results in ventricular septal defects. Between 2001 and 2009, 92 patients with ventricular septal defect underwent surgical correction in our center were included in this study. Additional cardiac defects were pulmonary hypertension in 27 (29.3 %) patients, patent ductus arteriozus in 10 (10.8 %) patients, Down Syndrom in 7 (7.6 %) patients, and aortic regurtation 5 (5.4 %) patients. Defects were closed with Dacron patch using separately sutures. Early mortality was developed in 5 (5.4 %) patients. 65 patients were followed for 6.1 years. Residual VSD was detected in 3 patients and one of them underwent secondary operation. There was no complet atrioventriculary block. 1˚- 2˚ degree aortic and tricuspit regurtation were not operated and included in our follow up programme. We hope to perform surgery for ventricular septal defect with low mortality and morbidity as a new Middle Anatolian center.

Inthisstudy,theoutcomes of subxiphoid pericardial tube drainage technique were eveluated in patients with pericardial effusion. 39 patients with pericardial effusion admitted toour clinic between January 2007 - December 2010 were treated with subxiphoid pericardial tube drainag etechnique. 16 of patients were femaleand 23 were male and their ages were between 17 to 83 years. The procedure was carried out with local anesthesia and sedation in all patients. There was no mortality in any patients. Average drainag evolume was 1050 ml. Recurrent pericardial effusion requiring repeated surgical in tervention was observed in 2 patients. Subxiphoid pericardial tube drainage is a effective and safetechnique for treatment of pericardial effusion.

To investigate the characteristic findings and histopathologic evaluation of the patients underwent to operation due to salivary gland tumor in our clinic. In this study on seven years period and between 01.01.2000-01.01.2007 dates, 110 cases were evaluated histopathologically addmitted to our clinic retrospectively. Men %51 of the cases, %49 were women. The average age of the cases were 44 years old. Tumors were orginated from parotis glands %84, submandibuler glands %15, %1 minor glands. Tumors of parotis gland were %80 benign, %20 malignant, tumors of submandibular glands were %80 benign, %20 malignant, tumors of minor salivary glands were %50 benign, %50 were found to be malignant in nature. In this study, cases with salivary gland tumors analyzed by histopathologically and discussed with literature.

Many patients admitting to ophthalmology outpatient clinics are suffering from watering eye. Watering eye may be due to hypersecretion but it may also be due to epiphora resulting from lacrimal drainage system obstruction or in adequate drainage. In patients with epiphora many tests has been developed to reach the diagnosis. When compared with the others, each tests has preferable and unpreferable aspects. We evaluated 100 eyes of 50 patients complaining from watering eye. In these patients we studied the sensitivity and specificity of the initial diagnostic tests in determining the site of blockage in the lacrimal drainage system. All patients underwent taste test, flourescein dye disappearance test, primary and secondary Jones test, lacrimal irrigation, canalicular probing, conventional dacryocystography and nuclear dacryoscintigraphy. Among the 100 eyes, 40 of them (%40) has abnormal lacrimal drainage system and 60 of them (%60) has abnormal lacrimal drainage system. Taste test, flourescein dye disappearance test and nuclear dacryscintigraphy were found to have high sensitivity and specificity value. However, the kappa agreement of taste test was lower than the flourescein dye disappearance test and nuclear dacryoscintigraphy (kappa

The infections caused by human immun deficiency virus (HIV), Hepatitis B and C virus pose a serious occupational risk for the healthcare workers especially those in emergency service, laboratory and surgery wards. Vaccination and establishment of the strict biosafety procedures are the main principles to prevent bloodborne infections in healthcare workers. Additionally, serological screening of the preoperative patients could decrease the risk for exposure. In this study, we aimed to determine the seroprevalence of HBsAg, AntiHCV, Anti-HIV ½ in preoperative urological surgery patients. A total of 260 patients (184 (%70.8) male, 76 (% 29.2) female were included in the study. HBsAg, anti-HCV and anti-HIV ½ seropositivity of the patients admitted to Urology Clinic for elective surgical procedures between March 2008-December 2010, were evaluated retrospectively. Among all patients included in the study, a total of eight patients- six male, two female- were HBsAg positive and one male patient were positive for Anti-HCV. Anti-HIV ½ positivity was not detected. The seroprevalence of HBsAg and Anti-HCV were; 3.1% (n=8) and 0.4% (n=1), respectively in patient group. Although statistically significant relationship was not detected, HBsAg positivity rate was higher in male patients than female patient group. HBsAg and Anti-HCV seropositivity rates in our study group showed concordance with the low rates reported previously in our country. Besides educational programmes to healthcare workers about bloodborne diseases, vaccination against hepatitis B, implementation of strict biosafety precautions during surgery process considering any patients as potential carriers, preoperative serological screening of the patients should be useful to reduce the risk of occupational exposure.

The manipulation and process stages effect microinjection results. Evaluation of zygote forming by the effect of centrifugation on sperm preparation was aimed. Two groups were prepared for sperm processing. In Group1 (G1, n:28) after liquefaction, two steps of centrifugation were done. While in Group 2 (G2, n: 31) after liquefaction, medium was added as 1:1 volume and layering was performed. After oocyte retrieval, intracytoplasmic sperm microinjection (ICSI) was done, 18-20 hours later pronuclear development was recorded. Results were evaluated by independent sample’s t-Test. Collected metaphase 2 oocytes were 7,5 ± 2,1 and 7,2 ± 2,1 respectively for G1 and G2 which is statistically no meaningful. Fertilized oocytes number were 52,5 ± 15,4 and 66,6 ± 19,0 respectively for G1 and G2 which is statistically meaningful ( p value, 0,03 ). In andrology laboratory, ICSI sperm preparation centrifugation process usually takes 10-15 minutes ( for 1200-1800 rpm). Higher centrifugation rates cause higher sperm condensation and free radical problems. Decondensated sperm injection is a cause for lower fertilization and implantation rate. Direct swim up prepared sperm can be more close to in vivo sperm, with lower decondensation rates, and as an advantage needs less time for laboratory manipulation.

In this light microscopic study, the effects of age and sex on the thickness of epidermis and the number of melanocytes were determined in human skin samples by using histological methods. Skin samples from a group of various ages including 10 men and 10 women were fixed in 10 % formaldehyde solution.The formalin fixed skin samples were processed using routine histologic procedures and embedded in paraffin. In this study, the most consistent results are in the epidermis of aging individuals is flattenning of the dermo-epidermal junction and decreased number of dermal papilla. However, it was found that numbers of melanocytes in epidermis decreased with age and changed with sex. Consequently, there is a significant statistical difference between epidermis thickness and age ( p< 0,0001 ). However, a high negative correlation was determined between epidermis thickness and age ( r= -0,8047). In conclusion epidermal thickness decrease %80 with age. But there is a no significant statistical difference between epidermis thickness and sex ( p= 0,7622). Also, there is a significant ( p

The current study aimed to determine the in our country patients diagnosed peripheral arterial disease (PAD), the relationship with the atherosclerotic risk factors. A better understanding of the risk factors will make it possible to take precautions against the modifiable risk factors, and will facilitate the early diagnosis and implementation of effective therapy. The patients who had been diagnosed with PAD either clinically or by using ultrasonography underwent peripheral angiography for the arteries of the lower extremities. The patients were evaluated in terms of age, gender, and atherosclerotic risk factors. Of the 408 patients, 78.4% were males, and the mean age was 61.5±9.5 years. The patients had the following risk factors: hypertension (HT), 58.3%; diabetes mellitus (DM), 26.7%; a family history of CAD (Coronary artery disease), 15.9%; smokers, 48.2%; hypercholesterolemia, 49.7%. The extent of PAD observed during peripheral lower extremity angiography was associated with atherosclerotic risk factors. Particular attention should be focused on the co-morbidities of PAD. Non-invasive, as well as invasive tests, should be performed when indicated to decrease morbidity and mortality in patients at risk for PAD.

The purpose of this study was to present, through a retrospective case series, results of the patients who were treated arthroscopically for anterior glenohumeral instability. We evaluated 41 patients. Mean follow-up of the patients were 45 months (range 32-80). There were 4 (10%) female and 37 (90%) male with a mean age of 32 (range 24- 44). There were 27 (65%) right and 14 (35%) left shoulders. Dominant side was injured in 25 patients. All of the patients were suffered from a traumatic shoulder dislocation. Many etiological factors are responsible for these traumatic dislocations like swimming, falling on the side while playing soccer or volleyball or a direct trauma to the shoulder. MRI was performed before the surgery and it was found to be a Bankart lesion for all the patients. Also, all patients were evaluated according to Rowe and Constant scores. Postoperatively, mean Rowe score was 87 (range 15-100) and mean Constant score was 95 (range 88-100). Excellent resuls were obtained in 33 (80.5) patients. There were 8 (19.5) patients of recurrences and 2 of them had arthroscopic revision surgery and Laterjet procedure was performed for the latter 2 patients. Arthroscopic shoulder surgery is a long learning curve, requiring the training process but also has the advantages of less bleeding, easy rehabilitation and wound healing. As a result, this effective method can be performed for recurrent shoulder instability patients with less complication rates.

The purpose of this study is to assess the color doppler ultrasound findings in the hemodialysis patients with arteriovenous fistula dysfunction/afunction. In this retrospective study, we searched the dossier of forty- five patients underwent to color doppler ultrasound examination because of inadequate dialysis. This color doppler ultrasound findings were compared with the literature. Twenty-seven (60%) of this 45 hemodialysis (HD) patients were female, 18 (%40) were male and the mean age was 55.15±15.03 (16-87). Twenty-eight of 45 patients have radiocephalic, 17 patients have brachiocephalic and brachiobasilic native arteriovenous fistula. Stenosis were detected in 36 HD patients, two of them settled in supporter arteries, 5 stenosis were on the level of anastomosis, 19 stenosis localized in the first segment after anastomosis and 10 stenosis settled on distal part of the first segment. Central venous oclusion were found in 4 of patients, whereas aneurysms were found in 6 patients. Seven of 13 thrombosed arteriovenous fistula were nonfunctional and the thromboses occluded the lumen of fistula. The thromboses settled in the anevrysmatic dilatation in others cases. The doppler Ultrasound examination performed well skilled is very usefull methods for diagnosis of arteriovenous fistula dysfunction.

Autism, a neurodevelopmental disorder, is defined by core abnormalities in reciprocal social interaction and communication, and by the presence of restrictive or stereotyped interests and behaviors. Its etiology is almost unclear however a number of factors is being investigated including genetic, infectious, metabolic and environmental causes. Recent findings suggest the role of abnormal lipid metabolism in autism. The aim of this study was to investigate the incidence of cholesterol deficiency in a group of subjects with autistic dis¬order (AD). Study group included 88 children and adolescents with autistic disorder according to DSM-IV criteria. Children with any diagnosed genetic, metabolic, or neurological disorders were excluded from the study. The mean cholesterol level was 150.5 ± 28.7 (81.0 – 230.0) mg / dl. Sixteen subjects (18.2 %) had a cholesterol level lower than 100 mg/dl, which is below the 5th centile. Our findings confirmed the high prevalence of abnormally low cholesterol levels in autistic disorder and support clinical significance regarding the possible role of cholesterol deficit in the etiology. Further studies are needed to investigate the relation between cholesterol metabolism and autism.

In pregnant women, trauma is responsible for nonobstetrik maternal-fetal mortality and morbidity. Approach to trauma in pregnancy is similar to non-pregnant women. Approach to patient with considering physiological changes during pregnancy and timely prevention of possible obstetrical complications is significant keeping in mind that these complications may affect maternal mortality and morbidity.

Neonatal hemochromatosis is a rare disease clinically defined as severe neonatal liver disease in association with extrahepatic siderozis. The etiology of neonatal hemochromatosis is not understood exactly. However, according to a theory neonatal hemochromatosis is accepted to be an alloimmune disorder causing liver injury in fetus. After an effected one in the pregnancy the recurrence rate of neonatal hemochromatosis is ~80%. Hepatocellular failure which occurs in the first days of life with coagulopathy, hypoglycemia, hypoalbuminemia, hypofibrinogenemia, thrombocytopenia, anemia, and direct and indirect hyperbilirubinemia characterizes neonatal hemochromatosis. In order to diagnose neonatal hemochromatosis there are some certain criteria that sould be taken into account such as a positive family history, high serum ferritin levels, high serum alpha-fetoprotein levels and siderozis demonstrated with histology or with magnetic resonance. Since an affective medical treatment has not been found yet, liver transplantation is almost always required. The prognosis of neonatal hemochromatosis is generally poor. This review will discuss neonatal hemochromatosis that leads to liver failure in the fetus or newborn.

We aimed to present a case with breast cancer which has cervical lymph nodes with increased FDG uptake in 18F-FDG PET/ CT and has biopsy result of tuberculosis lymphadenitis. Sixty-three year-old female patient with breast cancer complaining cervical and thoracal pain was imaged with PET/CT. PET/CT showed increased FDG uptake in bilaterally cervical, left submandibular and left prevertebral lymph nodes. The clinician considered that this image was related to an infectious process and continued to chemotherapy. A solid lesion was determined in follow-up ultrasonography. A PET/CT imaging was done to confirm this lesion. Increasing in quantity and SUVmax values of cervical, submandibular and prevertebral lymph nodes was determined. There was also a right axillary lymph node and a hypodense lesion with increased FDG uptake in liver. Biopsy was recommended because of increasing quantity and FDG uptake of lymph nodes and a new lesion in liver after chemotherapy. Biopsy result was tuberculosis lympadenitis in lymph nodes and metastasis in liver. False positive results in FDG-PET studies should be kept in mind because tuberculosis is a common disease in Turkey. Biopsy should be done in atypical cases.

Mitochondrial disease usually occur as a result at mitochondrial DNA (mtDNA) or nucleer DNA (nDNA) mutations.Findigs in mitochondrial myopathy are often limited with skeletel muscle symptoms, slowly progresive muscle weaknes at extremites and oftalmoplegy due to extaoculer muscle weaknes are common. Muscle weaknes is prominent in the proximal muscles but distal muscle involvement is propable. In this article, we present a patient diagnosed as adult onset mitochondrial myopathy with slow progress in 10 years , regged red fibers in muscle biopsy and ısolated muscle ınvolvement

Intraocular foreign body (IOFB) caused by penetrating eye injuries may lead to various findings by depending on the location, size and nature. However, in rare cases IOFB may remain silent for years without any complaint. In this study, we present the case of IOFB causing recurrent anterior uveitis 13 years after trauma in the patient with cataract. A 31-year-old male patient admitted to Ophthalmology department with the complaint of decreased vision which have been two years and pain, redness, light sensitivity with attacks in left eye. 15 years ago, a history of left eye injury occurred with exploding an object type of ceramic or porcelain was present. On the anterior segment examination, minimal peripheral corneal nefelyon at 2 hours position, peripheral iris defect size of 2x1 mm, grade 2 cell reaction in anterior chamber and posterior subcapsular cataract were present in left eye. In computerized tomography scan was detected the hyperdense foreign body placed in the posterior pole at the size of 3x2mm within the left globe. The possibility of intraocular foreign body should be kept in mind in patients with idiopathic uveitis specially in children and young people.

In the last 20 years the endoscopic use of fibrin tissue adhesive has been mainly used for the conservative treatment of many postsurgical esophageal, gastrointestinal leaks. In this case report, a patient with anastomotic leakage after esophagojejunostomy treated by endoscopic use of fibrin tissue adhesive was presented. If anastomotic defect is smaller, fistula flow is not more, and distance can be reached by endoscopically, this treatment method can be applied easily.

Invagination is the condition whereby a segment of intestine becomes drawn into the lumen of the proximal bowel. İnvagination in adults is a rare situation and the causes are different from childhood group. A 33 years old female patient admitted to emergency service with abdominal pain , nousea and vomiting. In ultrasonography and abdominal computed tomography suspected from invagination so the patient was operated urgently.In operation a masswas palpated and segmental resection was applied. Post-operative 7 th day , the patient was discharged from hospital without any complication. In pathological evaluation well-differentiated adenocarcinoma was detected in all polyps. Although invagination is a rare condition in adult patients when suspected from invagination the possibility of malign tumor should be considered. According to this , wide segmental resection is advised.

Self mutilation is defined as the intentional, direct injuring of body tissue without suicidal intent. Genital self mutilation is generally associated with psychosis. Personality disorder (especially borderline personality disorder) or transsexuals make up most of the non psychotic disorders. Suicidal behavior is common among schizophrenic patients. Self mutilation is also seen with these patients and can be even resulted in death. Genital self mutilation can be given as an example. An approach to genital self mutilation cases requires cooperation of surgery and psychiatry. Important steps of the treatment are to treat early psychosis and control agitation, provide emotional and social support in surgical period, and control psychosis in the long run.

In children, fracture may occur in growth plate before the epiphysis of hand distal phalanx become closed. Because of the asymmetry of the insertions of the extensor and the flexor tendons, the clinical manifestation of this injury in young children mimics a mallet finger deformity. When admitted to the emergency service due to the hand squeezing in the door of the car, the 13-year-old male child was diagnosed with Seymour fracture as a result of investigations. Fractures were fixed by a Kirschner wire (K wire) and healed without complications. Because of this case, the diagnosis and treatment of Seymour fracture‘s interesting pattern which resembles other injuries, have been researched with the accompaniment of the literature.

Atrophic rhinitis is a rarely witnessed inflamatory and chronic infection characterized by the atrophy of nasal mucosa and conchas, nasal crusting with bad smell and the enlargement of the nasal space with paradoxical nasal congestion. Primary and secondary forms of atrophic rhinitis are well-established. While primary atrophic rhinitis occurs in a previously healthy nose, secondary form frequently occurs following extensive sinus surgery, nasal trauma and chronic granulomatos diseases. On the physical examination of the case during anterior rhinoscopy, common crut and purulent, yellowish-dark green discharge were determined in nasal cavity. Klebsiella ozaenae and Staphylococcus aureus in aerobic culture with automated bacteria identification and susceptibiltiy testing system (Phoenix 100) and Actinomyces naeslundii in anerobic culture were yielded. Klebsielle ozaenae was found to be resistant only to ampicillin and was susceptible all the other tested antibiotics, and expanded spectrum beta-lactamase (ESBL) was negative. Staphylocccus aureus was found to be resistant to cefazolin, clindamycin, erythromycin, fucidic acid, meropenem, oxacillin, penicillin G and ampicillin. Actinomyces naeslundii was found to be resistant to metronidazole; susceptible to moxifloxacin and meropenem, with E-test method and beta lactamase test was negative. Presenting atrophic rhinitis in a 10-year-old male patient with clinical, microbiological and pathological features, the subject were discussed in the light of related literature.

Familial mediterranean fever (FMF) is an autosomal recessivelytransmitted disease characterised by attacks of fever and serositis. Articular involvement is the second most common manifestation following abdominal pain. Articular involvement is commonly in the large joints of the lower extremities but may occur in other joints such as the ankle, shoulder, temporomandibular joint, or sternoclavicular joint. Here, we report a 25-year-old man of FMF with accompanying costochondritis. In conclusion, arthritis of FMF is clinically presented in various forms such as costochondritis