Showing papers in "Balkan Medical Journal in 2002"

Surgical Treatment for Acute Arterial Occlusion

Abstract: Objectives: We evaluated surgical treatment of patients with acute arterial occlusion. Patients and Methods: A total of 142 patients who underwent surgical treatment for acute arterial occlusion was retrospectively evaluated in three groups according to the etiology, that is, peripheral arterial embolism (62 patients; 19 men, 43 women; mean age 62 years), peripheral arterial thrombosis (60 patients; 32 men, 28 women; mean age 68 years), and graft thrombosis (20 men, mean age 55 years). Results: The cause of arterial occlusion was embolism in 44% and thrombosis in 56% (42% native vessel thrombosis, 14% graft thrombosis). The most frequent anatomic location of occlusion was the femoral artery (52% in embolism, 84% in thrombosis). Malignancy was detected in five and two patients with peripheral arterial embolism and thrombosis, respectively. Nine patients (6%) required amputation, of whom two had embolism, four had thrombosis, and three had graft thrombosis. The mortality rate was 4% (n=6). Conclusion: Malignancies and graft thrombosis are becoming more common among the etiologic factors of acute arterial occlusion. Turkish Baslik: Akut Arter Tikanikliklarinda Cerrahi Tedavi Anahtar Kelimeler: Amputasyon; arteriyel tikaniklik hastaligi/etiyoloji/ tedavi/cerrahi; graft tikanikligi, vaskuler/tedavi; iskemi/etiyoloji/cerrahi; pulmoner embolizm/cerrahi; trombektomi/yontem; tromboembolizm/ cerrahi; tromboz Amac: Akut arter tikanikligi tanisiyla cerrahi tedavi uygulanan olgular degerlendirildi. Hastalar ve Yontemler: Akut arter tikanikligi tanisiyla cerrahi tedavi uygulanan 142 hasta, tikaniklik olusturan nedenler goz onune alinarak retrospektif olarak uc grupta incelendi: Periferik arteriyel emboli (62 hasta; 19 erkek, 43 kadin; ort. yas 62), periferik arteriyel tromboz (60 hasta; 32 erkek, 28 kadin; ort. yas 68), greft trombozu (20 erkek; ort. yas 55). Bulgular: Tikaniklik nedeni olarak olgularin %44a#39;unde emboli, %56a#39;sinda tromboz (ana damar trombozu %42, greft trombozu %14) saptandi. Tikaniklik en sik olarak femoral arterde goruldu (emboli grubunda %52, tromboz grubunda %84). Periferik arteriyel embolili bes, periferik arteriyel trombozlu iki olguda malignite saptandi. Emboli grubunda iki, tromboz grubunda dort, greft trombozu grubunda uc olguda (%6) amputasyon uygulandi. Olum orani %4 (n=6) bulundu. Sonuc: Maligniteler ve greft trombozlari, akut arter tikanikliklarinin etiyolojik faktorleri arasinda artan oranda gorulmeye baslamistir.

Transcranial Doppler Examination and Its Clinical Usage

Abstract: Transcranial Doppler sonography provides information on the velocity of blood flow in the major intracranial arteries and its direction in relation to the ultrasound probe. It is a non-invasive, inexpensive, easy, and repeatable method and can be performed at the bedside. It provides useful information on cerebral circulations, changes in the intracranial pressure, on the diagnosis of patent foramen ovale, and in the evaluation of risk factors for stroke. Other indications include monitoring of intracranial arterial occlusions and stenosis, detection of emboli, and assessment of cerebrovascular reactivity. Turkish Baslik: Transkraniyal Doppler ve Klinik Kullanimi Anahtar Kelimeler: Kan akim hizi; karotis arter hastaliklari/tani/ fizyopatoloji; serebral arterler/fizyopatoloji; serebrovaskuler dolasim; ultrasonografi, Doppler, transkraniyal Transkraniyal Doppler, ana intrakraniyal arterlerin darlik veya tikanmalarini kan akim hizlari ve ultrason probuna gore, yonleri hakkinda bilgi vererek gostermektedir. Non-invaziv, hizli uygulanabilen, anlik degisimleri yansitabilen, hasta yataginda uygulanabilen, pahali olmayan ve oldukca kolay olan bir yontemdir. Bu yontem serebral dolasim, intrakraniyal basinc degisimleri, patent foramen ovale tanisi ve inme risk faktorlerinin degerlendirilmesi hakkinda yararli bilgiler vermektedir. Serebral arterlerin darliginin veya tikanmasinin goruntulenmesi, emboli varligi ve serebrovaskuler reaktivitenin degerlendirilmesi ise diger onemli endikasyonlaridir.

Anesthesia-Associated Difficulties in an Infant with Apert Syndrome

Abstract: A twenty-two-month-old infant who had a diagnosis of Apert syndrome during the neonatal period underwent surgery for inguinal hernia. The possibility of difficult intubation was considered and necessary measures were taken. Ventilation via a facemask was difficult due to face abnormalities. The patient was intubated successfully after induction with 3% isoflurane and intravenous 0.25 mg mivacurium. A detailed physical examination with regard to difficult intubation followed by implementation of necessary preparations may enable a successful intubation in patients with Apert syndrome. Turkish Baslik: Apert Sendromlu Bir Bebekte Anestezi Sorunlari Anahtar Kelimeler: Akrosefalosindaktili/tani/komplikasyon/cerrahi; aneztezi, inhalasyon; anestezi, intrakrakeal; entubasyon; sendrom; risk faktorleri Yenidogan doneminde Apert sendromu tanisi konmus, 22 aylik bebekte inguinal herni ameliyati planlandi. Zor entubasyon olasiligina karsi hazirlik yapildi. Olgu, yuz anormallikleri nedeniyle maske ile guclukle ventile edildi. Yuzde uc izofluran induksiyonu sonrasinda i.v 0.25 mg mivakuryum ile kas gevsemesi saglanarak entubasyon gerceklestirildi. Bu olgularda entubasyon zorlugu olasiliginin onceden iyi yapilmis bir fizik muayene ile degerlendirilmesi gerektigini, gerekli onlemler alinirsa entubasyonun basarili olabilecegini dusunuyoruz.

The Role of Ionizing Radiation in the Etiology of Cancer

Abstract: Every biological organism on earth is exposed to both ionizing and non-ionizing radiation and to their effects. The main sources of radiation are present in nature (sun, earth), but radiation can also be produced artificially. Ionizing radiation causes brakes in the chemical bonds of molecules in the cell and also in chromosomes, resulting in DNA strand brakes called mutations. These mutations may result in cell death or, in the long term, transformation into a cancer cell. However, as a cause of cancer, ionizing radiation comes after smoking and bad nutritional habits. An important reduction in cancer incidence can be achieved by elimination of smoking, improved nutritional habits, and avoidance of cancerogens and excessive exposure to sunlight. Turkish Baslik: Kanser Etyolojisinde Iyonizan Radyasyonun Yeri Anahtar Kelimeler: Neoplazm, radyasyon nedenli; radyasyon dozu; radyasyon genetigi; radyasyon, iyonize; radyoterapi/yan etki; radyoterapi; risk degerlendirmesi Dunyadaki butun canlilar iyonizan ve iyonizan olmayan radyasyonun etkisine maruz kalir. Radyasyonun dogal (gunes ve yerkurenin kendisi) ve yapay kaynaklari vardir. Iyonizan radyasyon hucre ici molekullerde ve kromozomlarda kimyasal baglarin kopmasina neden olur. Bunun sonucunda meydana gelen mutasyonlar bir hucreyi olume goturebilecegi gibi, uzun donemde kansere de neden olabilir. Ancak radyasyonun kanser nedenleri arasindaki yeri, sigara ve kotu beslenme aliskanliklarina oranla daha azdir. Bu nedenle sigara kullaniminin onlenmesi, kotu beslenme aliskanliklarinin terk edilmesi, kanserojen maddelerle temastan sakinilmasi ve gunes isinlarinin zararli etkilerinden kacinilmasi ile kanser sikliginda onemli bir azalma saglanabilir.

An Approach to Essential Hypertension in Primary Care Settings

Abstract: Hypertension, being the most widespread chronic disease, causes serious mortality and morbidity with damage to target end organs. The asymptomatic nature of the disease results in delays in the diagnosis, so that life style changes and medical treatment cannot be initiated before disease-related permanent damage has occurred. Since primary care physicians are the first to confront with the disease, they should have adequate and current knowledge to handle the problem. Diagnosis, classification, and treatment of hypertension depend on a continuous, active, and positive relationship with the patient. This article reviews current issues on the evaluation, diagnosis, and treatment of hypertension for physicians who met the patient first. Turkish Baslik: Birinci Basamakta Esansiyel Hipertansiyona Yaklasim Anahtar Kelimeler: Antihipertansif ilaclar/terapotik kullanim; kan basinci olcumu; saglik davranisi; hipertansiyon/epidemiyoloji/ siniflandirma/onleme ve kontrol/ tani; risk faktoru Hipertansiyon en yaygin kronik hastaliktir ve hedef organlardaki etkileriyle ciddi mortalite ve morbidite nedenidir. Hastaligin sikayet olusturmayan ozelligi nedeniyle tani gecikmekte ve hastalik kalici tahribatini yapmadan uygun yasam tarzi degisiklikleri veya medikal tedaviye baslanamamaktadir. Birinci basamakta calisan hekimler, hipertansiyonla ilk karsilasan hekimler olduklarindan hastaligin tani ve tedavisi konusunda guncel ve yeterli bilgiye sahip olmak zorundadirlar. Hipertansiyonun taninmasi, ayrimi ve tedavisi hasta ile surekli aktif ve yapici bir iliski kurulmasina baglidir. Bu yazida hipertansiyon ile karsilasan hekimler icin tani, degerlendirme ve tedavi icin modern yaklasim modeli onerilmektedir.

The Role of Histaminergic System in Learning and Memory Functions

Abstract: Objectives: We investigated the role of central histaminergic system on learning and memory functions in mice and rats Study Design: Learning and memory functions were investigated using elevated plus-maze test in mice and radialarm maze test in rats The mice were placed in the maze for 60 seconds on the first day to allow them to learn the maze Twenty-four hours later, they were put in the maze again to record the time spent to enter one of the closed arms The effects of pyrilamine, ranitidine, thioperamide and histidine injected one hour before the test were examined in diverse groups of mice whose memory functions were intact or impaired by scopolamine injection 15 minutes before the test In the radial-arm maze test, the rats were allowed to find food placed in four arms of the maze for seven days On the eighth day, diverse groups were assigned to receive pyrilamine, ranitidine, thioperamide, histamine, and histidine Histidine and histamine were also given following induction of tuberomammillary nucleus lesions and the modulation of histamine effects by pyrilamine, ranitidine, and thioperamide was tested Results: Pyrilamine, ranitidine, thioperamide, histidine, and histamine had no effect on memory functions Histidine increased memory retention in mice with scopolamine-induced deficits in elevated plus-maze performance; this effect was blocked by pyrilamine, but not affected by ranitidine and thioperamide In rats with tuberomammillary nucleus region lesions, prolongation of the completion period of the test and working memory failures were observed; but there were no changes on reference memory failures These deteriorations were improved by histamine and histidine The enhancing effect of histamine on memory was antagonized by pyrilamine, but remained unchanged by ranitidine and thioperamide Conclusion: These results show that central histaminergic system has an enhancing effect on memory function and this effect is mediated by histamine H1 receptors Turkish Baslik: Ogrenme ve Bellek Fonksiyonlarinda Histaminerjik Sistemin Rolu Anahtar Kelimeler: Hippokampus; histamin/fizyoloji/farmakoloji; histamin antagonistleri/farmakoloji/terapotik kullanim; histidin/farmakoloji; ogrenme/ilac etkileri; ogrenme bozukluklari/kimyasal yolla olusan/onleme ve kontrol; labirent ogrenimi/ilac etkileri; bellek/ilac etkileri; fare; pirilamin/ farmakoloji; sican, Wistar; skopolamin/farmakoloji Amac: Fare ve sicanlarin ogrenme ve bellek fonksiyonlarinda santral histaminerjik sistemin rolunun arastirilmasi amaclandi Calisma Plani: Ogrenme ve bellek fonksiyonlari farelerde yukseltilmis arti labirent testi ile, sicanlarda radiyal sekiz kollu labirent ile degerlendirildi Fareler ilk gun labirenti tanimalari icin 60 saniye duzenekte tutuldu; 24 saat sonra tekrar labirente konarak kapali kola girme sureleri olculdu Farkli gruplar halinde farelere labirente konmadan bir saat once pirilamin, ranitidin, tioperamid ve histidin uygulanarak bu ilaclarin bellek performansi uzerine etkileri incelendi Ayni ilaclar labirente konmadan 15 dakika once skopolamin verilerek bellegi bozulan farelere de uygulandi Sicanlar, radiyal sekiz kollu labirentte bir hafta sure ile dort kola konmus yemleri bulmalari icin egitildi; sekizinci gun farkli gruplar halinde pirilamin, ranitidin, tioperamid, histamin ve histidin verildi Bir baska grup sicanda ise, histaminerjik noronlarin bulundugu tuberomamiler nukleus lezyonu olusturulduktan sonra histidin ve histamin verilerek bellek fonksiyonlari degerlendirildi Ayrica, histamin ile birlikte pirilamin, ranitidin ve tioperamid verilerek bu ilaclarin histaminin etkisini degistirip degistirmedigi incelendi Bulgular: Pirilamin, ranitidin, tioperamid, histidin ve histamin bellek fonksiyonlari uzerinde herhangi bir etki olusturmadi Skopolamin verilerek labirent performanslari bozulan farelerde histidin bellegi guclendirici bir etki olusturdu; bu etki pirilamin ile bloke edilirken, ranitidin ve tioperamidden etkilenmedi Tuberomamiler nukleus lezyonu olusturulan sicanlarda testi tamamlama surelerinde uzama ve working memory hatalarinda artma saptandi, reference memory hatalarinda degisiklik saptanmadi Bu bellek bozucu etki histamin ve histidin tarafindan duzeltildi Histaminin duzeltici etkisi pirilamin tarafindan antagonize edilirken, ranitidin ve tioperamidden etkilenmedi Sonuc: Santral histaminerjik sistemin bellek uzerinde olumlu bir etkisi oldugu ve bu etkiye H1-histaminerjik reseptorlerin aracilik ettigi sonucuna varildi

Alveolar Rhabdomyosarcoma in the Perianal Region in an Adult Patient

Abstract: The perianal region is an unusual localization for alveolar rhabdomyosarcoma in adults. A forty-fouryear- old woman presented with a fixed solid tumoral lesion about 4 cm in diameter in the entrance of the anal canal. Following an incisional biopsy, abdominoperineal resection was performed, during which a deep subcutaneous solid, nodular mass was detected below the anal canal, gray and white in color, and 6x5.5 cm in size. It did not have any relationship with the intestinal mucosa, but showed invasion to the subcutaneous fat tissue. Microscopic examination revealed a cellular tumor divided by marked fibrous septations and consisting of large oval-round pleomorphic cells with scanty eosinophilic cytoplasm in pseudoalveolar structures. Immunohistochemical and ultrastructural examinations yielded a diagnosis of alveolar rhabdomyosarcoma. The patient died a year after surgery because of multiple metastases. Turkish Baslik: Eriskin Bir Olguda Perianal Yerlesimli Alveoler Rabdomiyosarkom Anahtar Kelimeler: Anus neoplazmlari/cerrahi; tani, ayirici; rabdomiyosarkom/tani/patoloji/cerrahi Eriskin yas grubunda perianal bolge yerlesimli alveoler rabdomyosarkom gorulmesi oldukca nadirdir. Kirk dort yasinda kadin hasta anal kanal girisinde yaklasik 4x4 cma#39;lik sert fikse kitle ile basvurdu. Insizyonel biyopsi sonrasinda yapilan abdominoperineal rezeksiyon ameliyatinda, anal kanal deri dokusu altinda 6x5.5 cm boyutlarinda, bagirsak mukozasi ile iliski gostermeyen, deri alti yag dokusunu invaze etmis, noduler gorunumde, kirli beyaz renkte solid tumoral olusum izlendi. Mikroskobik degerlendirmede, belirgin vaskuler fibroz septumlar ile ayrilmis, psodoalveoler yapilar icinde duran iri, yuvarlak, ileri derecede pleomorfik, belirgin genis eozinofilik sitoplazmali malign hucre gruplarindan olusan tumor goruldu. Immunhistokimyasal boyamalar ve ultrastrukturel incelemeler sonucunda alveoler rabdomiyosarkom tanisi kondu. Ameliyattan yaklasik bir yil sonra hasta, multipl metastazlar nedeniyle kaybedildi.

Diabetes Mellitus and Hypertension

Abstract: Hypertension is a major worldwide health problem. Its prevalence is 1.5-2 times higher in diabetic population than that in non-diabetic individuals. Its pathogenesis depends on diabetic nephropathy in type 1, whereas may be multifactorial in type 2 diabetes mellitus. In diabetics, angiotensin converting enzyme inhibitors are most widely preferred in the treatment of hypertension because of their numerous desirable effects. In this article, the most recent data are presented on the relationship between diabetes mellitus and hypertension, and on the epidemiology, pathogenesis, and treatments of hypertension in diabetic patients. Turkish Baslik: Diabetes Mellitus ve Hipertansiyon Anahtar Kelimeler: Antihipertansif ajanlar; diabetes mellitus/ komplikasyon/ilac tedavisi; hipertansiyon; komplikasyon/ ilac tedavisi; risk faktorleri Hipertansiyon tum dunyada onemli bir saglik sorunudur. Diyabetlilerde hipertansiyon sikligi, diyabetli olmayanlardan 1.5-2 kat yuksektir. Tip 1 diyabette gelisen hipertansiyon patogenezinden diyabetik nefropati sorumludur. Tip 2 diyabette ise hipertansiyon patogenezi multifaltoriyeldir. Diyabetlilerde hipertansiyon tedavisi icin cesitli olumlu etkileri nedeniyle ilk secenek olarak, ACE inhibitorleri onerilmektedir. Bu yazida, diyabet ve hipertansiyon iliskisi, diyabetlilerdeki hipertansiyonun epidemiyolojisi, patogenezi ve tedavi konularindaki bilgiler gozden gecirildi.

The Role of Vascular Endothelium on Responses Mediated by Histaminergic Receptors in Isolated Rat Aorta Preparations

Abstract: Objectives: We investigated histamine-induced responses in isolated rat aorta preparations and the role of vascular endothelium in these responses. Study Design: Thoracic aorta segments obtained from 30 male Wistar rats were suspended in organ baths containing Krebs solution and isometric contractions and relaxations were recorded. The contractile and the relaxant effects of histamine and compound 48/80 in resting and phenylephrine-precontracted aortic strips were recorded both in endothelium-intact and andash;denuded preparations. The antagonistic effects of H1 receptor antagonist, pheniramine, and H2 receptor antagonist, cimetidine on these responses were investigated. Results: Histamine per se produced contractile responses in all samples. While pheniramine, histamine H1-receptor antagonist, prevented histamine-induced contractile responses, cimetidine, H2-receptor antagonist, had no effect. Histamine produced relaxation in the submaximally contracted endothelial samples by phenylephrine, but no relaxation was observed in preparations without endothelium. Pheniramine prevented the relaxation of preparations with intact endothelium, whereas cimetidine had no effect. Compound 48/80, which releases histamine from mast cells, had no effect on either contraction or relaxation. Conclusion: Histamine have both a contractile and endothelium-dependent relaxation effect on isolated rat aorta, mediated by H1-receptors. Turkish Baslik: Izole Sican Aort Preparatinda Histaminerjik Reseptorler Uzerinden Gerceklesen Yanitlarda Damar Endotelinin Rolu Anahtar Kelimeler: Asetilkolin/farmakoloji; aort, torasik/ilac etkileri; simetidin/ farmakoloji; endotel, vaskuler/ilac etkileri; histamin/farmakoloji; kas kontraksiyonu/ilac etkileri; kas relaksasyonu/ilac etkileri; kas, duz, vaskuler/ilac etkileri; fenileprin/farmakoloji; sican; reseptor, histamin/ ilac etkileri; vazokonstriksiyon/ilac etkileri Amac: Histaminin izole sican aort preparatinda olusturdugu yanitlar ve damar endotelinin bu yanitlardaki rolu arastirildi. Calisma Plani: Wistar tipi erkek sicanlardan (30 adet) alinan torasik aorta segmentleri, icinde Krebs solusyonu bulunan izole organ banyosuna asilarak kasilma ve gevseme yanitlari izometrik olarak kaydedildi. Histaminin ve 48/80 maddesinin endoteli saglam ve tahrip edilmis preparatlarda kasici ve fenilefrin ile onceden kastirilmis preparatlarda gevsetici yanitlari alinarak histamin H1 reseptor antagonisti feniramin ve H2 reseptor antagonisti simetidinin bu yanitlar uzerindeki antagonistik etkileri arastirildi. Bulgular: Histamin, aort preparatlarinda kasilma yaniti olusturdu. Histamin H1-reseptor antagonisti feniramin histaminin kasici etkisini onlerken, H2-reseptor antagonisti simetidin etkisiz kaldi. Onceden fenilefrin ile submaksimal kastirilmis endotelli preparatlarda histamin gevseme yaniti olusturdu, endotelsiz preparatlari gevsetmedi. Feniramin endoteli saglam preparatlardaki gevseme yanitlarini onlerken, simetidin herhangi bir etki gostermedi. Mast hucrelerinden histamin salinimini saglayan 48/80 maddesi kasici ya da gevsetici bir etki olusturmadi. Sonuc: Histaminin izole sican aortasinda kasici ve endotel bagimli gevsetici etkisi vardir. Bu etkiler, H1- reseptorler araciligi ile gerceklesmektedir.

The Students' Feedback on Practice Hours of ‘Introduction to Clinical Practice'

Abstract: Objectives: To collect and evaluate the studentsa#39; views on practice hours of “Introduction to medical practice”, which has recently been included in the curriculum of phase I sessions. Study Design: The South East Thames (SETh) Short Interactive Course rating scale was administered to the students at the end of each practical session. The scale included 18 items, each of which was responded by one of the five choices and rated between 1 and 5. A mean score above 3 was considered to reflect a positive opinion. Results: The overall mean score for practical sessions was 4.02. The responses to Item 13 (I want to know more about this subject) received an average score greater than 4 points from all practices. Conclusion: The studentsa#39; feedback was affirmative concerning the recently added lecture to the curriculum. Use of student feedback by curriculum lecturers as an educational tool will improve the quality of teaching. Turkish Baslik: Ogrenciler Egitimi Degerlendiriyor: Tibbi Pratige Giris Dersinin Pratik Saatleri Anahtar Kelimeler: Iletisim; egitim programi; egitim, medikal, temel tip; feedback; model, egitim; program degerlendirmesi; anket; ogretim Amac: Fakultemizin birinci donem ders programina ilk kez alinan “Tibbi Pratige Giris” dersinin pratik oturumlari hakkinda ogrenci degerlendirmelerinin saptanmasi amaclandi. Calisma Plani: “Tibbi Pratige Giris” dersinin pratik saatleri sonrasinda ogrencilere “South East Thames (SETh) Kisa Interaktif Kurs degerlendirme olcegi” uygulandi. On sekiz sorudan olusan olcegin seceneklerine 1-5 arasinda puan verildi. Bulunan ortalama degerlerin 3a#39;den yuksek olmasi, yanitin olumlu bir degerlendirmeyi yansittigi seklinde yorumlandi. Bulgular: Olcegin ortalama skoru 4.02 bulundu. Olcekte yer alan “Artik bu konuda daha cok sey bilmek istiyorum.” onergesinin ortalama puani, tum derslerde 4a#39;un uzerinde idi. Sonuc: Bu yil ilk kez programa alinan dersle ilgili, ogrencilerden olumlu tepki alindi. Ogretim gorevlileri tarafindan ogrencilerden geri bildirim alinmasi uygulamasinin egitimin kalitesini artiracagini dusunuyoruz.

The Range of Motion of Abduction and Opposition of the Thumb

Abstract: Objectives: The range of motion (ROM) of the carpometacarpal joint of the thumb on abduction and opposition were studied in normal individuals. Study Design: The study included 40 volunteer medical students (20 males, 20 females; mean age 22.5 years). The range of motion of the carpometacarpal joint of the thumb was measured with the use of a digital inclinometer on abduction and opposition. The highest value obtained from three measurements was taken into account. Dominant and non-dominant thumbs were compared by the Mann-Whitney U-test. Results: The mean range of motion of the carpometacarpal joint of the thumb was found as 52.6 degrees on abduction, and 37.6 degrees on opposition. No significant differences were found between dominant and non-dominant thumbs in both sexes. Conclusion: The range of motion of the thumb in Turkish individuals was found consistent with average ranges reported in the literature. Turkish Baslik: El Basparmaginin Abduksiyon ve Oppozisyon Hareketlerinin ROM Degerleri Anahtar Kelimeler: El/anatomi ve histoloji; parmak eklemi/fizyoloji; hareket acikligi, artikuler; basparmak/fizyoloji Amac: Bu calismada, basparmak karpometakarpal eklemine ait abduksiyon ve oppozisyon hareket acikliklari denekler uzerinde arastirildi. Calisma Plani: Calismaya gonullu 40 tip ogrencisi (20 erkek, 20 kiz; ort. yas 22.5) alindi. Deneklerin iki elinde karpometakarpal ekleme ait abduksiyon ve oppozisyon hareketleri elektronik dijital inklinometre ile olculdu. Uc kez yapilan olcumlerde elde edilen en yuksek deger dikkate alindi. Deneklerin dominant ve karsi taraflari Mann-Whitney U-testiyle karsilastirildi. Bulgular: Basparmak karpometakarpal eklemine ait hareket acikliklari abduksiyonda ortalama 52.6 derece, oppozisyonda 37.6 derece bulundu. Her iki cinsiyette de dominant ve karsi taraf ellerin abduksiyon ve oppozisyon hareketlerinde anlamli farklilik gorulmedi. Sonuc: Olculen basparmak hareket acikliklari, klasik kaynaklarda bildirilen normal degerlere yakin bulundu.

Monitoring of Heparin Treatment in Patients with Acute Myocardial Infarction

Abstract: Objectives: We evaluated the effectiveness of monitoring coagulation parameters and plasma heparin levels in patients receiving heparin treatment for acute myocardial infarction (AMI). Patients and Methods: The study included 30 AMI patients (19 males, 11 females; range 39 to 76 years) who were admitted to the intensive care unit. All patients received standard heparin with a bolus dosage (5,000 IU) followed by continuous intravenous infusion (1,000 IU/h) for 72 hours. Thrombolytic therapy was not applied because of contraindications. Coagulation parameters (aPTT, TT, and AT III) were monitored on coagulometer ACL 2000 at baseline and 24 hours after the initiation of heparin therapy together with plasma heparin levels. Statistical analyses were made using one-sample Kolmogorov-Smirnov test, and paired-samples t-test. Results: Fifteen patients had below-therapeutic heparin levels during treatment, which were associated with significantly increased aPTT and decreased AT III values (palt;0.001). The remaining patients with therapeutic heparin levels exhibited the same trend with regard to aPTT and AT III. However, increase in TT values was significant only in the latter group (palt;0.001). Conclusion: The two methods, plasma heparin monitoring and standard coagulograms seem to be equally effective for control over heparin therapy, and their combined use enhances the efficacy and safety of heparin treatment. Turkish Baslik: Akut Miyokard Infarktuslu Hastalarda Heparin Tedavisinin Izlenmesi Anahtar Kelimeler: Kan koagulasyon testleri; heparin/kan/uygulama ve doz; miyokard infarktusu; kismi tromboplastin zamani; referans degeri Amac: Akut miyokard infarktusu (AMI) nedeniyle heparin tedavisi goren hastalarda koagulasyon parametreleri ve plazma heparin duzeylerinin izlenmesinin etkinligi degerlendirildi. Hastalar ve Yontemler: Calismaya AMI nedeniyle yogun bakim unitesinde yatan 30 hasta (19 erkek, 11 kadin; dagilim 39-76) alindi. Tum hastalara bolus dozdan (5000 IU) sonra 72 saat sureyle surekli intravenoz infuzyonla (1000 IU/saat) standart heparin verildi. Kontrendikasyonlar nedeniyle trombolitik tedavi uygulanmadi. Koagulasyon parametreleri (aPTT, TT ve AT III) tedavi baslangicinda ve 24 saat sonra ACL 2000 koagulometrede olculdu, plazma heparin duzeyleri belirlendi. Istatistiksel degerlendirme tek ornekli Kolmogorov-Smirnov testi ve cift ornekli ttesti ile yapildi. Bulgular: Heparinin terapotik duzeylerin altinda bulundugu 15 hastada anlamli derecede artmis aPTT ve anlamli derecede azalmis AT III degerleri olculdu (palt;0.001). Heparinin terapotik duzeylerde seyrettigi 15 hastada da aPTT ve AT III degerleri ayni ozellikleri gostermekteydi. Bununla birlikte, TT degerleri yalnizca ikinci grup hastada anlamli artis gosterdi (palt;0.001). Sonuc: Plazma heparin duzeylerinin izlenmesinin ve koagulasyon parametrelerinin belirlenmesinin heparin tedavisinin kontrolunde esit derecede etkili oldugu goruldu. Bu iki yontemin birlikte kullanimi heparin tedavisinin etkinlik ve guvenligini artirmaktadir.

Increased Serum Total and Lipid-Bound Sialic Acid Levels in Lung Cancers and its Association with Metastasis

Abstract: Objectives: The aim of this study was to investigate whether total and lipid-bound sialic acid levels can be used as a tumor marker for distinguishing patients with or without extrapulmonary metastasis. Patients and Methods: Serum total and lipid-bound sialic acid levels were examined in lung cancer patients with (n=26; age range 44 to 79 years; 13 epidermoid carcinoma, 7 adenocarcinoma, 6 small cell carcinoma) or without (n=61; age range 40 to 80 years; 27 adenocarcinoma, 34 epidermoid carcinoma) extrapulmonary metastasis. The results were compared with those of a control group of 32 healthy subjects. Serum total and lipid-bound sialic acid levels were determined by the methods of Warren and Katopodis, respectively. Results: Significantly increased total and lipid-bound sialic acid levels were found in both patient groups (palt;0.001). Patients with extrapulmonary metastasis had (i) significantly elevated lipid-bound sialic acid levels compared with patients having epidermoid carcinoma (palt;0.01) and adenocarcinoma (palt;0.05) without metastasis, and (ii) significantly elevated total sialic acid levels compared with patients with epidermoid carcinoma without metastases (palt;0.05). Conclusion: Serum lipid-bound sialic acid levels may be helpful in identifying epidermoid carcinoma or adenocarcinoma with no extrapulmonary metastases, and serum total sialic acid levels in identifying epidermoid carcinoma with no extrapulmonary metastases. Turkish Baslik: Akciger Kanserinde Serum Total ve Lipide Bagli Sialik Asit Duzeylerinde Yukselme ve Bunun Metastaz ile Iliskisi Anahtar Kelimeler: Lipid/kan; akciger neoplazmlari/tani/kan; membran proteinleri/analiz; neoplazm metastazi; sialik asit/analiz; sialoglikoprotein/kan; tumor belirtecleri, biyolojik/kan Amac: Akciger kanserli hastalarda total ve lipide bagli sialik asit duzeylerinin, metastazi olan ve olmayan olgulari birbirinden ayirmada bir belirtec olup olmayacagi arastirildi. Hastalar ve Yontemler: Ekstrapulmoner metastazi olan (n=26; yas dagilimi 44-79; 13 epidermoid karsinom, 7 adenokarsinom, 6 kucuk hucreli akciger kanseri) ve olmayan (n=61; yas dagilimi 40-80; 27 adenokarsinom, 34 epidermoid karsinom) akciger kanserli hastalarda serum total ve lipide bagli sialik asit duzeyleri incelendi. Bulunan degerler saglikli 32 kisiden olusan kontrol grubu ile karsilastirildi. Total sialik asit duzeyleri Warren yontemi ile, lipide bagli sialik asit duzeyleri Katopodis yontemi ile belirlendi. Bulgular: Her iki hasta grubunun total ve lipide bagli sialik asit duzeyleri kontrol grubuna gore anlamli derecede yuksek bulundu (palt;0.001). Ekstrapulmoner metastazi olan akciger kanserli hastalarda lipide bagli sialik asit duzeyi, metastaz bulunmayan adenokarsinomlu (palt;0.05) ve epidermoid karsinomlu (palt;0.01) hastalara gore; total sialik asit duzeyi ise, epidermoid karsinomlu (palt;0.05) hastalara gore anlamli derecede daha yuksekti. Sonuc: Serum lipide bagli sialik asit duzeylerinin, metastazi olmayan epidermoid veya adenokarsinomlu hastalari ayirmada; total sialik asit duzeylerinin ise metastazi olmayan epidermoid karsinomlu hastalari ayirmada yardimci olabilecegini soyleyebiliriz.

Intractable Hiccup: Etiology and Treatment

Abstract: Hiccup is a characteristic noise caused by a sudden closure of the glottis following repeated, involuntary, spasmodic contraction of the diaphragm and the auxiliary respiratory muscles. It is usually a physiological entity when it is transitory and of short duration; however, it may become a pathological sign when its duration exceeds a certain length of time and it is unresponsive to simple measures. This situation is defined as intractable hiccup and may be associated with serious complications unless it is properly dealt with. Persistent hiccups are usually evoked by diseases of the gastrointestinal , thoracicmediastinal and central nervous systems, toxicmetabolic conditions, and the use of certain drugs. In addition to symptomatic treatment, a systematic evaluation is required to uncover the underlying cause. This article reviews the mechanisms, causes, evaluation, and treatment of intractable hiccups. Turkish Baslik: Gecmeyen Hickirik: Nedenleri ve Tedavisi Anahtar Kelimeler: Diyafram; glottis/innervasyon; hickirik/fizyopatoloji/ etiyoloji/tedavi; solunum Hickirik, solunum kaslarinin tekrarlayici, istemsiz ve spazmodik kasilmasiyla birlikte glottisin eszamanli olarak kapanmasi ve bunun sonucunda tipik bir sesin ortaya cikmasi durumudur. Kisa sureli ve gecici oldugunda fizyolojik sayilan bu durum, belli bir sureyi asar ve basit onlemlerle ortadan kaldirilamazsa bir hastalik bulgusu durumuna gelir. Gecmeyen hickirik adi verilen bu bulgu uzun sure devam ettiginde, onemli komplikasyonlara yol acabilir. Gecmeyen hickiriga yol acan baslica nedenler gastrointestinal, toraks-mediasten ve santral sinir sistemi hastaliklari, toksik-metabolik nedenler ve bazi ilaclarin kullanimidir. Boyle bir durumla karsilasildiginda, hickirigin semptomatik tedavisi yaninda altta yatan nedeni aydinlatmaya yonelik sistematik bir inceleme de baslatilmalidir. Bu yazida gecmeyen hickirigin olusum mekanizmasi, nedenleri, inceleme plani ve tedavisi gozden gecirildi.

Delirium: A Frequent Psychiatric Syndrome Encountered in Hospitalized Patients

Abstract: Delirium is a complex and serious medical disorder associated with high morbidity and mortality among hospitalized patients. While it is potentially reversible, it requires prompt medical attention due to its adverse influence on clinical prognosis. Therefore, identification of delirium is essential in hospitalized patients, together with its manifestations, methods of detection, prevention, and treatment. This article reviews this transient cognitive disorder on the basis of diagnostic and therapeutic issues. Turkish Baslik: Hastanede Yatarak Tedavi Goren Hastalarda Sik Karsilasilan Psikiyatrik Bir Sendrom: Deliryum Anahtar Kelimeler: Akut hastalik; kognisiyon bozukluklari/tani; deliryum/tani/etyoloji/fizyopatoloji; tani, ayirici; psikomotor performans Deliryum, hastanede yatirilarak tedavi edilen hastalarda mortalite ve morbiditeyi artirici etkileri olan, karmasik ve onemli bir tibbi hastaliktir. Tedavi seyrini ve klinik tabloyu olumsuz etkilemesi ve olasilikla geri donuslu olusu nedeniyle tedavi edilmesi gerekir. Bu yuzden, hastanede yatan hastalarda deliryum taninmali ve anlasilmali; tani, onleme ve tedavi yontemleri bilinmelidir. Makalemizde, bu gecici kognitif hastaligin tani ve tedavisiyle ilgili ozellikleri ve sorunlari gozden gecirmeyi amacladik.

The Relationship between Vessel Obstruction and Serum Total and Lipid-Bound Sialic Acid Levels in Patients with Coronary Heart Disease

Abstract: Objectives: This study was designed to compare serum total and lipid-bound sialic acid levels obtained from patients with and without coronary obstruction. Patients and Methods: Serum total and lipid-bound sialic acid levels were determined in 42 patients (29 men, 13 women; mean age 58 years; range 32 to 75 years) with angiographically documented coronary obstruction and in 35 patients (22 men, 13 women; mean age 54 years; range 39 to 75 years) with no obstruction. Serum total and lipid-bound sialic acid levels were determined by the methods of Warren and Katopodis, respectively. The results were compared with the use of one-way ANOVA test. Results: Serum total and lipid-bound sialic acid levels were significantly higher in patients with coronary obstruction (81.01aplusmn;10.10 mg/dl and 33.59aplusmn;7.00 mg/dl, respectively) when compared with those of patients with no obstruction (65.18aplusmn;10.23 mg/dl and 25.28aplusmn;7.40 mg/dl, respectively) (palt;0.001). Conclusion: The measurement of serum total and lipid-bound sialic acid levels may be useful in distinguishing between patients with and without coronary obstruction. Turkish Baslik: Koroner Kalp Hastalarinda Damar Tikanikligi ile Serum Total ve Lipide Bagli Sialik Asit Duzeyleri Arasindaki Iliski Anahtar Kelimeler: Akut faz proteinleri; anjina pektoris/kan; biyolojik belirtecler; serebrovaskuler hastaliklar/kan; gogus agrisi/kan; koroner anjiyografi; koroner arterioskleroz; koroner hastalik/kan; lipid/kan; lipoprotein, HDL kolesterol; miyokard infarktusu/ kan; risk faktorleri; sialik asit/kan Amac: Damar tikanikligi olan koroner kalp hastalari ve damar tikanikligi olmayan hastalar serum total ve lipide bagli sialik asit duzeyleri yonunden karsilastirildi. Hastalar ve Yontemler: Anjiyografi ile damar tikanikligi saptanmis 42 koroner kalp hastasinda (29 erkek, 13 kadin; ort. yas 58; dagilim 32-75) ve damar tikanikligi saptanmamis 35 hastada (22 erkek, 13 kadin; ort. yas 54; dagilim 39-75) serum total sialik asit ve lipide bagli sialik asit duzeyleri olculdu. Total sialik asit duzeyleri Warren yontemi ile, lipide bagli sialik asit duzeyleri Katopodis yontemi ile belirlendi. Gruplar tek yonlu ANOVA testi ile karsilastirildi. Bulgular: Damar tikanikligi olan koroner kalp hastalari nda serum total sialik asit (81.01aplusmn;10.10 mg/dl) ve lipide bagli sialik asit (33.59aplusmn;7.00 mg/dl) duzeyleri, damar tikanikligi saptanmamis hastalara (sirasiyla 65.18aplusmn;10.23 mg/dl ve 25.28aplusmn;7.40 mg/dl) gore anlamli derecede daha yuksek bulundu (palt;0.001). Sonuc: Serum total ve lipide bagli sialik asit duzeylerinin olculmesi, damar tikanikligi olan koroner kalp hastalarini damar tikanikligi olmayan hastalardan ayirmada yardimci olabilir.

A Case of Bilateral Superficial Brachial Artery

Abstract: The superficial brachial artery, an anatomical variation of the brachial artery, is usually located anterior to the aponeurosis of the biceps muscle in the forearm. Since it may be mistaken for the cubital vein, it may pose severe problems on intravenous injections. This case report illustrates findings of the superficial brachial artery encountered in the cadaver forearms of a 65-year-old male, that ran superficially along the median nerve. Turkish Baslik: Bir Olguda Iki Tarafli Yuzeyel Brakiyal Arter Anahtar Kelimeler: Kol/kan destegi; aksilla/kan destegi; brakiyal arter/anormallik/anatomi ve histoloji; kadavra; mediyan sinir/anatomi ve histoloji Brakiyal arterin anatomik varyasyonu olan yuzeyel brakiyal arter, siklikla onkolda, biseps kasinin aponeurozu onunde bulunur. Kubital ven ile karisabilecegi icin intravenoz enjeksiyonlarda ciddi sorun yaratabilir. Bu yazida, 65 yasindaki bir erkege ait kadavranin her iki ust ekstremitesinde rastlanan ve ust kolda mediyan sinirin yuzeyelinde seyreden yuzeyel brakiyal arterle ilgili bulgular sunuldu.