ISSN : 1302-7123 | E-ISSN : 1308-5123
The Medical Bulletin of Sisli Etfal Hospital - Med Bull Sisli Etfal Hosp: 29 (1)
Volume: 29  Issue: 1 - 1995
ORIGINAL RESEARCH
1. Hirsutizm Tedavisinde Diane/ Androcur ve Spironolakton/Oral Kontraseptif Kullanımının Karşılaştırılması
Melahat Kesim, Mürvet Hakyemez, Figen Taşer, Fahri İnan
Pages 9 - 12
OBJECTIVE: Clinical and biochemical effect of antriandojen agents, siproteron acetate and spironoactone, in the treatment of hirsutism were studied. STUDY DESIGN: Forthy-three hirsutic women were clinically and biochemical/y evaluated aııd randomly divided in to two groups: Twenty four patients in the first group, siproteron acetate 100 mg/day during the first ten days of the menstruel cycle and siproteron acetate 2 mg/ay and ethynl estradiol 0,035 mglday on the 5th to 25th days of the mensıruel cycle were administered. The remaining 19 patients
spinolactone 100 mglday and a triphasic oral contraceptive were administered. Both treatment groups were evaluted clinically, biochemically and adverse drug reactions were evaluted.
RESULTS: There were significant decrease in Ferriman-Gallway scores after 6 months treatment with both siproteron acetate and spironoclactoııe (p<0.001, p<0.001, respectively). Free testosteron, androstenedion and DHEA -S levels were decreased in patients who were administered siproteron acetate but FSH and LH levels were unchanged. SHGB levels were increased (p<0.01, p<0.001, p<0.001, p>0.05, p>0.05, p<0.01). in those cases who were administered spinoloactone, free testosteron levels were decreased, androstenedion, DHEA-S, FSH and LH levels were unchanged, SHGB levels were increased (p<0.01, p>0.05, p>0.05, p>0.05, p>0.05, p<0.01).There were no adverse reactions in both treatment protocols.
CONCLUSION: We concluded that both siproteron acetate and spironolactone are stili effective and reliable drugs in the treatment of hirsutism.

2. Sezeryan ile Doğan Yeni Doğanların Nörobehavioral İncelemesinde,Propofol ve Thiopental İndüksiyonunun Karşılaştırılması
M. Çiçek, A. Hancı, H. Dobrucalı, B. Ekşioğlu, N. Sivrikaya
Pages 13 - 16
Some analgesic and anesthesic use in labor may cause repetitive neurologic effects.
Scanlon 's Early Neonatal Neurobehavioral Scala (ENNS) and Amiel-Tison's Neurologic and Adaptive Capacity Scoring (NACS) are the most used tests to show these effects.
in our study, we used ENNS and NACS to evaluate the effects of propofol and thiopenthal in neonates who have mothers induced with these agents before general anesthesia.
The onset of spontanous respiration of the newborns, the period between induction of anesthesia and the delivery time, Apgar scores at 1 sı. and 5th. minutes, delivery weights and gestational age were recorded. The scale of NASC was established at the 15th min, 2nd. and 24th. hours, scores more than 35 showed ıhat the newborns was active, while less ıhan 35 was accepted as depression. ENNS scoring was applied at 2nd. and 24th. hours and percentage of the high scored newborns in each group were evaluated. Statistical evaluation was done by using ANOVA and X2 tests and p<0.05 was accepted as significant.
The Apgar scores of all the newborns were more than 8 at the 5th. min. Apgar scores were significantly low and induction of spontaneous respiration time was significantly long in the propofol group. Scores of NASC and ENNS were similar in ali of ıhe three groups.
We suggest that propofol may be an altenıative induction agent except high risk cases.

3. The evolution of Carpal Tunnel Syndrome in Hemodialysis Patients
M. Kemal Başak, Serdar Kesken, Arif Demir, Özkan Ertuğrul, Deniz Egeli, Füsun Karaarslan
Pages 17 - 20
Ulnar, median, peronal and sural nerves neuro-electrophysiological studies were applied in 39 patients who have been on chronic hemodialysis far varying periods of time. Only twelve patients had Carpal Tunnel Syndrome (CTS) (without poyneuropathy), 6 had sub clinical median neuropathy (SMN), 5 had peripheral polyneuropathy (PPN), 5 had CTS (without polyneuropathy) and il patients had normal electrophysiological findings.
Nerve conduction velocity abnormalites and especially CTS findings were common in hemodialysis patients. They need frequent nerve conduction conırol studies from the onset of dialysis, in order to identify CTS early and to avoid irreversibl nerve damages and appropriate surgical management.

4. Preoperatif Diagnostic Value of the Fine Needle Nodules Aspiration Biopsy in theThyroid
Gürkan Yetkin, Adnan Işgör, Ekrem Sezgin, Akın Kaya
Pages 21 - 23
66 Patients who were admitted to Şişli Etfal Hospital 3. General Surgery Department with a diagnosis of noduler goitre between February 1992 and July 1994, underwent fine needle aspiration biopsy (FNAB) preoperatively. 16 patients were followed without being operated, in the 50 patients who had an operation cytological findings from FNAB were compared to the histopathological findings from postoperative thyroidectomy material.
it was found FNAB had false positive results in % 4 of the patients while false negativity was %0. Therefore spesificity of FNAB was found to be % 100 whereas sensitivity was % 50 that malignant nodules, which can be recognized earlier treated more efficiently.

5. Serum Transferrine value as a Tumor marker
Emine Özçelik, Bahar Türkmen, Şebnem Ciğerci, Nezaket Eren
Pages 24 - 26
We analyzed the serum levels of transferrin (TRF) in 60 patients with cancer having metastasis and without metastatis. We observed the mean value of the serum TRF as 2,22±0,62 g/L in cancer patients and 1,81±030 g/L in metastatic patients and 2,63±0,58 gr/L in non-metastatic patients. The mean value of the serum TRF was 3,00±0,57 gr/L in control group. We found a significant difference between the control group and patients have non-metastasis and also between control group and patients have metastasis (p: 0,0001 and p: 0,0000, respectively). But there was not a significant difference between control group and nonmetastatic group (p: 0,2466). According to our results, we can suggest that in terms of the determining metastasis in patients with cancer, the serum levels of the TRF is readily appliable and useful test.

6. Mıtoxantrone, 5-Fluorouracıl And Hıgh Dose Calcİum Folİnate in The Treatment Of Metastatıc Breast Cancer
Orhan Kızılkaya, Oktay Incekara, Handan Erkal
Pages 27 - 28
Metastatic breast cancer remains incurable today. Therefore the toxicity and efficacy of systemic chemotherapy has critical importance. 5-Fluorouracil and high dose calcium foliuate (Leucovorin) produced response rates of approximetely 20 % in heavily pretreated patieııts. Mitoxantrone is effective in the treatment of metastatic breast cancer and less adverse effects. We observed that this combination.

7. Clinical Predictors for diagnosis of central nervous system (CNS) infectious diseases
Nevin Bahçeciler, Hülya Kimil Kocabora, Nuray Dinçer, Nimet Kayaalp
Pages 29 - 32
The purpose of our study was to assess the reliability of meningeal signs and other physical findings in predicting central nervous system (CNS) infectious diseases.
Using some clinical indicators we performed lumbar puncture in 224 patients who were suspected to have CNS infections, and had at least one these indicators. These signs, bulging and/or pulsating fontanel, meningeal irritation signs (MIB) fever of unknown origin (FUO) hedache-vomiting, suspicious rash and irritability.
135 of 224 lumbar punctures were positive for pleocytosis. The indidence of each clinical indicator for LP according to age groups of 135 patients were evaluated.
The signs and symptoms mostly present in patients less than 2 yrs of age were neurological signs, fontanel signs and fever of unkown origin and over 2 yrs of age were headache-vomiting meningeal irritation sign and FUO. Convulsion were present more in the under 2 yrs of age group.
We would suggest that a patient less than 2 yrs of age presenting with only FUO, convulsions or neurological signs, and a child over 2 yrs of age presenting only headache-vomiting or FUO and all children presenting with only suspicious rash or irritability although not having the classical signs of CNS infections such as MIB but only have bulging fontanel must be performed a lumber puncture.

8. The Renal Involvement in Henoch-Schoenlein Purpura
Hülya Kımıl Kocabora, Nevin Bahçeciler, Oya Çetinkaya, Alparslan Akmansoy, Asiye Nuhog&774;lu
Pages 33 - 38
Between 1990-1994 75 henoch-Schoenlein purpura cases have been examined and they were classifien according to their nefrotic involvement which is 41.3%. The mean age of the patients with renal involvement was 7.9 ± 2. 7 years, and it was most frequently encountered in girls. The most frequent renal öamifestation is, misroscopic hematuria, which occured 96.7% of the patients. We detected macroscopic hematuria in 33.7% of the patients. We concluded that, the severity of the renal involvement increases with respect to age and the number of external symptoms.

9. The diagnostic reliablity of USG in childhood intracranial pathology.
Ayhan Üçgül, Hüseyin Özkurt, Ahmet Cevri Yıldız, Muzaffer Başak, Ateş Ateşalp
Pages 39 - 42
Cranial sonography is an important diagnostic method of demonstration of intracranial pathologies in neonatal age group (0-1). In this report we intended to determine the diagnostic ability of ultrasonography in cranial pathologies in 112 cases who were suspected with intracranial pathology (from February 1994 to January 1995). We observed hydrocephalus in 22 patients, meningitis in 20 patients, cerebral edema in 17 patients, imracranial hemorrhage in 9 patients, ventriculitis in 4 patients, subdural collection in 6 patients. Some of these patients had more ıhan one pathology. 45 patients were observed as normal.

10. Cranial USG in premature babies with suspicion of intracranial pathology.

Pages 43 - 46
Ultrasonography is a common using modality in the intracranial pathology of premature infants, because of some advantages, such as portability, easy applicability, lack of ionizing radiation and no need of sedation. In this study 27 premature babies were screened with cranial sonography and accuracy of cranial sonography was evaluated.

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