Showing papers by "Istanbul University published in 1996"

Reoperation for persistent or recurrent primary hyperparathyroidism.

Abstract: Objective: To analyze the causes and outcomes of reoperation for persistent or recurrent primary hyperparathyroidism. Data Sources: Medical records of 102 patients with persistent or recurrent primary hyperparathyroidism who underwent reoperation by 1 surgeon between 1985 and 1995. Study Selection: Only patients with persistent or recurrent primary hyperparathyroidism were selected; patients with secondary hyperparathyroidism, parathyroid cancer, familial hyperparathyroidism, and previous thyroid operations were omitted. Data Extraction: Performed by a single unblinded researcher. Data Synthesis: Reasons for failed parathyroid operations included tumor in ectopic position (53%), incomplete resection of multiple abnormal glands (37%), adenoma in normal position missed during previous surgery (7%), and regrowth of previously resected tumor (3%). Of the ectopic glands, 28% were paraesophageal, 26% in the mediastinum (nonthymic), 24% intrathymic, 11% intrathyroidal, 9% in the carotid sheath, and 2% in a high cervical position. Eighty-three percent of ectopic glands were accessible via cervical incision. The success rate of reoperations was 95%. One patient (1%) became permanently hypocalcemic after reoperation; 1 patient (1%) suffered permanent unilateral vocal cord paralysis. The sensitivities of preoperative localization studies were as follows: technetium Tc 99m sestamibi scan, 77%; magnetic resonance imaging, 77%; selective venous catheterization for intact parathyroid hormone, 77%; thalium-technetium scan, 68%; ultrasonography, 57%; and computed tomography, 42%. Conclusions: Repeated parathyroidectomy can be avoided in more than 95% of patients if an experienced surgeon performs bilateral cervical exploration during the initial parathyroid operation. For patients with persistent or recurrent primary hyperparathyroidism, preoperative localization studies and a focused surgical approach can result in a 95% success rate with minimum complications. Arch Surg. 1996;131:861-869

Phthalocyanines as sensitive materials for chemical sensors

Abstract: This paper provides a review of phthalocyan- ines suitable for the development of chemical sensors. Phthalocyanines may be utilized for different types of chemical sensors, including in particular electronic conductance sensors [such as semiconductive, field-effect transistor (FET), solid-state ionic and capacitance sensors], mass-sensitive sensors utilizing a quartz crystal microbalance (QCM) and surface acoustic-wave (SAW) sensors, and optical sensors. The phthalocyanines used are discussed in terms of their physical and chemical properties, as well as their sensitivity, selectivity and reversibility towards the detection of NO2 and organic solvent vapours. The interaction mechanism between phthalocyanine films and analyte molecules is also discussed.

Gastrointestinal involvement in Behçet's syndrome: a controlled study.

Abstract: OBJECTIVE: To make a retrospective and prospective analysis of the frequency of symptomatic inflammatory bowel disease in patients with Behcet's syndrome (BS). METHODS: The medical records of the first 1000 patients with BS were reviewed retrospectively for past or present history of diarrhoea. The past and present history of diarrhoea was also elicited prospectively among 147 consecutive patients with BS and 78 diseased controls (42 with rheumatoid arthritis, 17 with systemic lupus erythematosus, seven with seronegative spondylarthropathy, and 12 with miscellaneous rheumatic diseases). Inflammatory mucosal changes were sought in rectal biopsy specimens from 75 patients with BS, 47 diseased controls (29 with nephrotic syndrome, eight with rheumatoid arthritis, six with familial Mediterranean fever, and four with ankylosing spondylitis), and 14 patients with ulcerative colitis. RESULTS: In chart review there were only seven Behcet's patients with diarrhoea; none of them had inflammatory bowel disease. In the prospective survey there were no significant differences between the BS and control groups in the past and present history of diarrhoea. There were no significant differences in the rectal mucosal histology between patients with BS and controls, while patients with ulcerative colitis showed pronounced differences. CONCLUSION: Symptomatic inflammatory bowel disease is not common in BS patients from Turkey.

The interaction of adhesive systems with human dentin.

Abstract: PURPOSE To investigate the interaction of six experimental and commercial bonding systems with dentin in vivo MATERIALS AND METHODS One-Step, Clearfil Liner Bond 2, OptiBond, Permagen with 10% phosphoric acid, Permagen with 35% phosphoric acid, and Prime & Bond were applied in standard Class I occlusal cavities in premolars scheduled for extraction for orthodontic reasons, combined either with a self-cured or with a light-cured resin composite The teeth were carefully extracted 5 minutes after resin polymerization and fixed in 25% glutaraldehyde After fixation, the specimens were dehydrated, sectioned, and processed for field-emission SEM RESULTS Although some systems produced gap-free intact interfaces in specific specimens, all of them showed detachment at the transition between the resin-dentin interdiffusion zone and the fluid resin placed over it It was apparent that the presence of air-bubbles and/or thick layers of polymerized-filled fluid resin resulted in less frequent separation areas at the resin-dentin interface, providing support for the concept of the elastic cavity wall It was also confirmed that some dentin adhesive systems do not form a thick layer over the dentin, otherwise the resin composite would not have penetrated the dentin tubules

Coagulation factor v gene mutation increases the risk of venous thrombosis in behçet's disease

Abstract: We investigated the prevalence of the coagulation factor V gene G1691A mutation in 64 patients with Behcet's disease (BD) and in 107 apparently healthy individuals. The mutation was present in the heterozygous state in 37.5% of the patients with a history of deep vein thrombosis (12/32) and in 9.4% of the patients without any thrombotic event (3/32). Eleven healthy individuals were also heterozygous for the mutation (10.3%). The prevalence of the mutation in BD patients with and without thrombosis was significantly different (P = 0.0079). We conclude that the factor V gene mutation may play a major role in the development of venous thrombosis in BD.

Nasopharyngeal carcinoma in children: Retrospective review of 50 patients

Abstract: Purpose: To report a retrospective analysis of epidemiologic, clinical, and therapeutic aspects of 50 children with newly diagnosed nasopharyngeal carcinoma who were treated in a single institution over a period of 18 years. Methods and Materials: Thirty-two male and 18 female children ranging from 5 to 16 years, accounted for 7.2% of all nasopharyngeal carcinoma cases and 52% of childhood nasopharyngeal malignancies. Histopathology was World Health Organization Type 3 carcinoma in 45, World Health Organization Type 2 in 4, and World Health Organization Type 1 in one patient. Two of the patients had missing information for staging and treatment evaluation. Disease extent was T1 ( n = 4), T2 ( n = 9), T3 ( n = 21), and T4 ( n = 14); N0 ( n = 1), N1 ( n = 6), N2 ( n = 12), and N3( n = 29). Six patients had base of skull invasion, two had cranial nerve palsies, and six had both. One patient had M1 disease on admission. Twenty-three patients were treated with irradiation only. Thirteen patients received adjuvant, and 12 had neoadjuvant chemotherapy in addition to radiotherapy. Patients received 50–72 Gy to the primary tumor and involved nodes, and 45–50 Gy to uninvolved regions. Chemotherapy consisted of combinations including cisplatin, bleomycin, epirubicin, 5-flouroucil, and cyclophosphamide. Results: Thirty-eight (79%) patients attained locoregionel control. Overall, 22 patients are alive without relapse 6–195 months from diagnosis. Thirteen patients had 21 relapses, at local and/or regional sites (43%), distant sites (48%), or both (9%). The median time for first relapse was 8 months. Overall, the 5-and 10-year survival rates were 52 and 52%, respectively, and the failure-free survival rates were both 53%. The results of three distinct treatments given in subsequent time periods were not statistically different. Three second malignancies occurred 33–156 months following nasopharyngeal carcinoma diagnosis. Conclusion: In the current series, nasopharyngeal carcinoma patients under the age of 16 accounted for 7.2% of all nasopharyngeal carcinoma cases. Whereas the impact of chemotherapy on long-term survival remains to be determined by randomized studies, the results suggest that more effective treatment regimens and long-term follow-up are necessary for children with nasopharyngeal carcinoma.

Structured interview data on 35 cases of dissociative identity disorder in Turkey.

Abstract: OBJECTIVE: The aim of this study was to describe the clinical features of dissociative identity disorder in a group of Turkish patients as assessed with a structured interview. METHOD: Thirty-five consecutive patients at the dissociative disorders program of a university psychiatric clinic who met the DSM-IV criteria for dissociative identity disorder were included in this study. The subjects were assessed with the Turkish versions of the Dissociative Disorders Interview Schedule and the Dissociative Experiences Scale. A descriptive analysis of the clinical features was carried out. RESULTS: Most (88.6%) of the patients were women. The mean age of the group was 22.8 years. Childhood physical or sexual abuse was reported by 77.1% of the patients. The mean Dissociative Experiences Scale score was 49.1. The patients reported an average of 12.5 somatic symptoms, 6.2 Schneiderian symptoms, 10.0 secondary features of the disorder, 3.8 borderline personality disorder criteria, and 4.1 extrasensory experiences. CONCLUSIONS: Dissociative identity disorder has a stable, consistent set of features throughout North America, in the Netherlands, and in Turkey. Cross-cultural research using standardized assessment measures will be invaluable in further illumination of the validity of this widely neglected psychiatric category. Language: en

Seven-year follow-up of neurologic involvement in Behçet syndrome.

Abstract: Objective: To determine the long-term prognosis of neurologic involvement in Behcet syndrome. Design: Forty-six patients with Behcet syndrome, who had been the subjects of a previous report with short-term follow-up, were reexamined 7 years later; 42 of them could be reexamined neurologically. Neuropsychological testing, magnetic resonance imaging, electromyography, and evoked potential studies were performed when available. Results: Of the 27 patients who had had headaches without any neurologic symptoms or signs previously, 2 had developed an acute neurologic attack. In addition, 7 patients in this group showed minor abnormalities on neurologic examination and/or other laboratory investigations, without history of any attacks. Among the previous neuro-Behcet group (n=15), as defined by the presence of neurologic signs or symptoms, other than headache, 7 had a stationary course, while 8 had been progressive. Three of the latter group had died. Patients with progressive course had had abnormal cerebrospinal fluid findings at the time of the previous report, whereas patients with a stationary course had not. Conclusions: Silent neurologic involvement may occur in Behcet syndrome. Patients should undergo periodic neurologic evaluation. The long-term prognosis in neuro-Behcet syndrome does not seem to be as favorable as we observed in short-term follow-up. Cerebrospinal fluid findings may predict prognosis.

Cave bears and paleolithic artifacts in Yarimburgaz Cave, Turkey: Dissecting a palimpsest

Abstract: This article addresses the taphonomic issues surrounding artifact-bear associations in Yarimburgaz Cave, northwestern Turkey. Our purpose is to evaluate the circumstances of bone assemblage formation in the Middle Pleistocene deposits of the cave, identifying the agencies responsible for the accumulations and the causes of bone damage before and following deposition. Pleistocene species representation, bone damage, body part representation, and mortality data indicate that cave bear remains in Yarimburgaz are unrelated to hominid use of the same site. None of the observations on the cave bear remains contradicts the expectations developed from modern wildlife accounts of modern bear behavior; these accumulations resulted from mortality normally associated with hibernation over many generations of den use. Nonursid carnivores also played roles in bone collection and/or modification. We conclude that at least three distinct biological processes contributed to the formation of the Middle Pleistocene faunas: hibernating bears, bone-collecting carnivores such as wolves, and hominids in descending order of importance. The Yarimburgaz faunas represent palimpsests or overlays of many short-term depositional events, the close spatial associations of which are explained by slow or uneven sedimentation rates inside the cave. Although occupations by hominids appear to have been ephemeral in nature, hominids ultimately discarded nearly 1700 stone artifacts in Yarimburgaz Cave. The hominids did not discard many ungulate bones in the same circumstances. These observations suggest that hominid foraging efforts focused on resources other than large game while at the cave. © 1996 John Wiley & Sons, Inc.

The relationship between clinical attachment loss and the duration of insulin-dependent diabetes mellitus (iddm) in children and adolescents

Abstract: The periodontal status of 77 diabetic children and adolescents, and 77 paired, systemically-healthy, sex- and age-matched control subjects, was clinical examined. Fasting blood glucose, fructosamine and glycosylated haemoglobin (HbAl) values were determined. The mean periodontal pocket depths, clinical attachment levels and the parameters to assess diabetes mellitus from the diabetic group were significantly higher than those of the controls. We found a positive correlation between the duration of diabetes and clinical attachment loss, but not with periodontal probing depth, plaque index and gingival index in the diabetic group. A positive correlation was also assessed between the present serum fructosamine and gingival index in the diabetic group, but not in controls.

Interferon alfa-2a in the treatment of Behçet's disease.

Abstract: Background: There is no definite treatment for Behcet’s disease. New drugs are being evaluated in cases unresponsive to conventional treatment modalities. Objective: In this study we investigated the efficacy of interteron alfa-2a on skin lesions in 18 Behcet’s disease patients who had predominantly mucocutaneous involvement. Methods: Eighteen patients with Behcet’s disease were treated with interferon alfa-2a at 3 million lU/day in the first week (three times a week), 6 million lU/day in the second week (three times a week), 9 million IU/day in the third week and thereafter (three times a week). Interferon alfa-2a was administered subcutaneously for a total of 12 weeks. Results: At the end of the treatment the efficacy of the drug was found to be good in 9 patients and very good in 7 patients. Interferon alfa-2a is particularly effective in skin manifestations such as genital ulceration and erythema-nodosum-like lesions. It was also found to be effective in systemic manifestations such as fever, diarrhea and eye involvement. Conclusion: Our results indicate that interferon alfa-2a is a promising drug in the treatment of Behcet’s disease.

5-Fluorouracil-loaded chitosan microspheres: Preparation and release characteristics

Abstract: Cross-linked chitosan microspheres containing 5-Fluorouracil (S-FU) were prepared. Variables believed to be important for microsphere properties were examined; these included: drug and chitosan concentrations, cross-linking process, the type of oil, stirring rate and also additives. Initial 5-FU concentration, the type and concentration of chitosan, the viscosity of oil phase and glutaraldehyde concentration affected drug release from chitosan microspheres. 5-FU release from cross-linked chitosan microspheres is characterized by an initial rapid release of drug. Addition of substances such as alginic acid, chitin, agar, sodium caprylate and stearic acid changed the release properties of 5-FU microspheres.

Isochromosome 18p results from maternal meiosis II nondisjunction.

Abstract: Microsatellite analysis with 13 microsatellites spread over 18p was performed to determine the origin of the marker chromosome in 9 patients with additional metacentric marker chromosomes. Phenotypes and banding patterns suggested that the markers were isochromosomes 18p. Maternal origin was determined in all 8 cases where both parents were available for study. Six cases showed 3 alleles (one paternal, one maternal each in single and double dose) of informative markers located close to the telomere while markers close to the centromere on 18p were reduced to homozygosity (one paternal allele in single dosage and one maternal allele presumably in triple dosage). A similar result was obtained in the patient with no parents available for examination. The other 2 patients were uninformative for maternal hetero- versus homozygosity, but at some loci the maternal band was clearly stronger than the paternal one whereas the opposite was never observed. Trisomy 18 differs from trisomy 21, XXX and XXY of maternal origin through a preponderance of meiosis II versus meiosis I nondisjunction. Thus, the results of our study and the advanced mean maternal age at delivery of patients with additional i(18p) indicate that in most if not all cases the marker chromosome originates from maternal meiosis II nondisjunction immediately followed by isochromosome formation in one of the 2 maternal chromosomes 18. Possible explanations of these results include a maternally imprinted gene on 18q with a lethal effect if the paternal homologue is lost and a mechanism through which nondisjunction in some cases could be connected with isochromosome formation.

Management of late anemia in Rhesus hemolytic disease: use of recombinant human erythropoietin (a pilot study)

Abstract: The management of (Rhesus) hemolytic disease of the fetus and newborn includes intrauterine transfusions to prevent the development of hydrops, treatment of the possible hyperbilirubinemia in the immediate postnatal period, and treatment of late anemia Low levels of serum erythropoietin due to suppression of the bone marrow by multiple intrauterine transfusions is a suggested mechanism for this anemia The aim of our study was to test whether recombinant human erythropoietin reduced the need for erythrocyte transfusions in these infants Twenty infants with Rhesus isoimmunization were blindly randomized to treatment and control groups at the 2nd wk of life The number of intrauterine and exchange transfusions and demographic data were similar in both groups The infants in the treatment group received recombinant human erythropoietin, sc 200 U/kg of body weight three times a week for a period of 6 wk, whereas the infants in the control group received a placebo for the same period In the treatment group, the mean number of erythrocyte transfusions was significantly lower than that of the control group (18 versus 42) The reticulocyte counts and Hb levels rose earlier in the treatment group The platelet and neutrophil counts were similar in both groups throughout the study This study demonstrates that recombinant human erythropoietin treatment decreases the need for erythrocyte transfusions in the late anemia of infants with Rh isoimmunization Considering the risks of blood transfusions, this decrease in the donor exposure is worthwhile

MRI in subacute sclerosing panencephalitis

Abstract: Subacute sclerosing panencephalitis (SSPE) is a progressive, slow virus infection of the brain, caused by the measles virus, attacking children and young adults. We investigated 15 patients with SSPE by MRI, with 5 normal and 10 pathological results. In the early period, lesions were in the grey matter and subcortical white matter. They were asymmetrical and had a predilection for the posterior parts of the hemispheres. Later, high-signal changes in deep white matter and severe cerebral atrophy were observed. Parenchymal lesions significantly correlated with the duration of disease. A significant relationship between MRI findings and clinical stage was observed in the 1st year of the disease.

Juvenile Behçet's disease among 1784 Turkish Behçet's patients

Abstract: Background Behcet's disease is a chronic, relapsing disease, about which information on its clinical course in juveniles is only available from small groups of patients Materials and Methods Patients suffering from Behcet's disease who had their first lesion at or before the age of 16 were evaluated in terms of: age at onset, mucocutaneous signs, and findings related to systemic involvement Ninety-five patients, evaluated as having juvenile Behcet's disease (JBD), were detected among 1784 Turkish Behcet's patients The mean age of these 95 patients (51 boys or men, 44 girls or women) who had JBD was 268 ± 71 years Results The difference between sexes in terms of age at onset, development period of second lesions, and systemic involvement was not found to be significant in JBD Patients were divided into two groups, one showing severe disease (N = 27) and the other mild disease (N = 68) There was no significant difference between the two groups with respect to age, age at onset, and sex distribution The interval between the development of the first and second lesions was shorter in the patient group with severe disease (P < 0001) and the development of second lesion was most frequently seen in the first 5 years (P < 005) Systemic involvement developed also in a shorter time in the group with the severe disease (P < 001) and was most frequently encountered during the first 5 years (P < 005) Conversely, patients with the mild disease developed systemic involvement more frequently after 6 years or later Conclusions Severe Behcet's disease in children and juveniles shows no age or sex predilection, but leads to an earlier recurrence and more severe systemic signs than the mild form

Intramedullary tuberculous abscess: a case report.

Abstract: Study design This case report shows an intramedullary thoracic spinal cord abscess secondary to Mycobacterium tuberculosis in a 7-year-old boy with chronic progressive paraparesis and hypesthesia below T10. Objectives The treatment of this patient involved drainage of pus followed by appropriate chemotherapy. Summary of background data Abscess and tuberculomas of the spinal cord are rare entities. They are indistinguishable from neoplasms. The possibility of tubercular abscess or granuloma should be kept in mind when an intraspinal mass is found, provided that the clinical history is unusual for tumor. Methods A left T7-T8 hemilaminectomy was performed. A quantity of pus was drained through a small myelotomy. A small specimen was taken, and antituberculosis treatment was given after surgery. Results Excellent clinical outcome was obtained with a combination of medical and surgical management. Conclusion The treatment of intramedullary abscess consists of surgical evacuation of the pus. Appropriate treatment offers a favorable prognosis even in cases with severe deficits.

Synthesis and Characterization of Novel Phthalocyanines with Four 16‐Membered Diazadithia Macrocycles

Abstract: Metal phthalocyanines (M = Cu, Ni, Co) 3-5 bearing four 16-membered diazadithia macrocycles at the peripheral positions were prepared. Detosylation with concentrated sulfuric acid afforded products containing both sulfonated groups on the aromatic rings of the macrocyclic substituents which are excellently soluble in water and donor sites for binding four CuII ions to give a pentanuclear complex.