ISSN : 1302-7123 | E-ISSN : 1308-5123
The Medical Bulletin of Sisli Etfal Hospital - Med Bull Sisli Etfal Hosp: 41 (3)
Volume: 41  Issue: 3 - 2007
REVIEW ARTICLE
1. Medical treatment and diet in urinary stone disease
Mesrur Selçuk Silay, Mustafa Kadıhasanoğlu, Cengiz Miroğlu
Pages 7 - 12
Abstract |Full Text PDF

ORIGINAL RESEARCH
2. The demographic and clinical features of autoimmune bullous dermatoses
Koray Özkan, Ilknur Kıvanç Altunay, Adem Köşlü
Pages 13 - 18
Objective: Autoimmune bullous disorders (ABD), which occur on the genetic background and characterized with vesicles and bullae, have high morbidity and mortality rates epidemiologically. They exhibit distinctive features in terms of demographic and clinical characteristics and display diagnostic and therapeutic difficulties. Our aim to evaluate and manifest the clinical and demographic features of the inpatients with ABD, between Jan 1997 and Jan 2007;to document data and review the literature.
Methods and Materials: The medical records of the patients with ABD admitting to our dermatology department between Jan 1997 and Jan 2007 were evaluated. Demographic and clinical features including anatomic localisation of the lesions, associated disorders, complications were recorded by microsoft access database software.
Results and Conclusion: 79 patients with ABD were enrolled to the study, (mean age: 52,96 and female/male ratio was 50/29.) The most frequently seen ABD was pemphigus vulgaris (PV %49,36) and bullous pemhigoid (BP, %32,9I) and pemphigus herpetiformis and linear IgA bullous disease were the least frequent OBD with a ratio of %1,26. The patients with PV had longest duration of hospitalization with a mean duration of 34,2 days The lesions were most frequently seen on the back region of trunk (%60). Oral mucosal lesions were most frequently seen on the patients with PV.The OBD with the longest period before the diagnosis was pemphigus vegetans. Our all data were compatible with the literature.

3. Effect of smoking in pregnancy on various maternal and fetal complications
Inci Davas, Ahmet Varolan, Ali Yazgan, Özge Yılmaz, Çağan Yardım, Atıf Akyol, Başak Baksu
Pages 19 - 23
Objective: This study was performed to characterize the effect of smoking on pregnancy complications.
Study Design: 1000 pregnant women were grouped into 4 categories: (Nonsmokers, 1+-5 cigarettes per day, 6+-10 cigarettes per day and more than 10 cigarettes per day) and they were retrospectively analyzed.
Results: The mean age of the study was 28+-3.4.The odds ra¬tio for preeclampsia was 0.64 and for preterm labour was 1.2.
Conclusion: Smoking increases the incidence of preterm labour and intrauterine growth restriction but by a dose related manner it decreases the incidence of preeclampsia.

4. Comparison of efficiency of bupivacaine and ropivacaine in epidural anaesthesia in lower abdominal surgery
Şükrü Çiftçi, Ayşe Hancı, G. Ulufer Sivrikaya, Metin Bektaş, Sibel Oba
Pages 24 - 29
Objective: In our study we aimed to compare the characteristics of epidural block, peroperative haemodynamic changes and analgesia in early postoperative period in epidural anaesthesia produced by bupivacaine and ropivacaine for lower abdominal surgery.
Study design: After the approval of Medical Ethics Committe of our Hospital and written informed consent, 30 patients in ASA I-II undergoing inguinal hernia repair were included the study. Midazolam was used for premedication after IV fluid replacement. Epidural anaesthesia wps performed from L} 4 epidural space with loss of resistance method with 15 ml 0.5% bupivacaine in Group B and 15 ml 0.5% ropivacaine in Group R. Haemodynamic parameters (mean blood pressure, heart ra¬te), sensory and motor block levels, time to two segment regression of sensory block, postoperative analgesia at 2. and 6. hours (with Visuel Analogue Scale-VAS), time to first analgesic demand and adverse effects were recorded as study parameters.
Results: Haemodynamic parameters were lower peroperatively in two groups when compared with control values (p>0.05). Time to two segment reggression of sensory block was significantly longer and motor block degree was significantly higher in Group B than Group R (p<0.05). VAS values were comparable between the groups. Time to first analgesic demand was significantly shorter in Group R than Group B (p<0.05).
Conclusion: High degree of motor block and delay of regression of sensory block after epidural anaesthesia produced by bupivacaine in inguinal hernia repair was evaluated more effective on quality of anaesthesia and surgery peroperatively and analgesia postoperatively than produced by ropivacaine. On the other hand, epidural ropivacine can be an alternative to bupivacaine when less cardiotoxicity and early mobilization were aimed in such operations.

5. The reaserch of the microorganisms growing in the throat cultures of healthy children
Gönül Şengöz, Cangül, Kadriye Kart Yaşar, Bülent Durdu, Şemsinur Karabela, Özcan Nazlıcan
Pages 30 - 34
Objective: Human throat flora contains many bacteria. Crowded living environments increase colonization of pathogen microorganisms along with the normal flora bacteria that could be in the throat.
Materials-Methods: The co-existence of potential pathogen bacteria with the other ones and the existence of one class of microorganisms were also considered on the school children. Therefore, we took throat cultures from 114 healthy children aged 7 to 10 (67 male, 47 female) and evaluated them in terms of grown microorganisms.
Results: We isolated 290 bacteria from 11 different genus. Among these bacteria, isolation rates of S. pneumoniae, S. pyogenes and N. meningitidis are 7,13, 4 % respectively.
Conclusions: Finally, the bacteria which have the potential to induce a disease was found to be higher in the females than males and by the increased number of siblings, the colonization of the bacteria was also increased. This condition is very important as for the infections which may develop with such pathogens. No same class accumulation of the pathogen bacteria was observed. No specialty was found when the coexistence of the bacteria was observed.

6. The evaluation of p53 and ki67 immune reactivity in normal and neoplastic thyroid tissues
Banu Yılmaz Özgüven, Yeşim Erdem, Fevziye Kabukçuoğlu, Tuğba Taşkın, Nedim Polat
Pages 35 - 39
Objective: p53 is an important transcription factor in the centre of cell cyclus coordination mechanisms. The staining of Ki67 in the tissue helps to evaluate the proliferation activity. The immunohistochemistry staining profiles in normal thyroid, fetal thyroid, hyperplastic nodule, follicular adenoma and papillary carcinoma have been investigated using p53 and Kİ67 in this study.
Study design: Fifty three thyroid operation materials diagnosed in the Pathology Laboratory of Şişli Etfal Tranining and Research Hospital, as hyperplastic nodule, follicular adenoma and papillary carcinoma were studied. Five fetal thyroid and 5 normal thyroid tissues were also included in the study. Kİ67 and p53 immunohistochemistry stains were applied. Nuclear staining was evaluated for both of the immune indicators and the number of stained cells were calculated.
Results: Immunostaining was not observed for Kİ67 or p53 stains in fetal thyroid, normal thyroid and hyperplastic nodules. Positive staining was established for Ki67 in 3 of 20 follicular adenomas, but staining was not observed for p53. In 19 of 23 papillary carcinomas, there was staining for Kİ67. In 6 of 23 papillary carcinomas, there was staining for p53. The staining rates of p53 and Kİ67 staining for the papillary carcinoma were significantly high, when compared with follicular adenoma, hyperplastic nodule, fetal thyroid and normal thyroid tissues. (p< 0,0001 for Kİ67 and p< 0,05 for p53).
Conclusions: Although papillary carcinoma are tumors with low proliferation activity, they were found to be more proliferative and have p53 gene expression when compared with benign thyroid tumors and normal thyroid tissue

CASE REPORT
7. An adrenal hyperplasia case presenting with hyperparathyroidism and diabetes insipidus
Nur Şener, Sema Uçak, Tayyibe Saler, Emine Şatır, Yüksel Altuntaş
Pages 45 - 48
Causes of primary hyperaldosteronism are aldosteron secreting adenoma, aldosteron secreting carcinoma and bilateral adrenocortical hyperplasia. %25-%35 of adrenocortical hyperplasia patients have idiopathic hyperaldosteronism. In these cases adrenal cortex may be normal, macronodular or micronodular macroscopically, or may be hyperplasic, microscopically. In our case report. we described a patient who had resistant hypokalemia since he was 2 years old. In this patient hypokalemia caused metabolic alchalosis which resulted a decrease in ionized calcium levels causing secondary hyperparathyroidism and patient also had hypokalemia releated nephrogenic diabetes insipidus.

8. Ventriculoperitoneal shunt infections: Our experiences
Leyla Telhan, Umut Zubarioğlu, Lalız Esin Kadıoğlu, Metin Uysalol, Ayşe Palanduz
Pages 46 - 48
Study Design: Medical records of 16 patients with ventriculoperitoneal shunt infection admitted between January 1 2005- April 1 2007, were evaluated retrospectively.
Results: The mean age of the patients was 6.2 months (0.5-26 months). 10 of them (% 62) were female and 6 (% 38) were girls. Hydrocephalus has developed congenitally in 13 cases and it was acquired in 3 cases. Mean age at onset of infection was 132.5 days (7-720 gün). At admission 15 cases (% 94) had fever and discomfort, 6 cases (% 38) had feeding problems, 4 cases had (% 25) convulsion, 3 cases had (% 19) increased head circumference and one case (%6) had cerebrospinal fluid leakage to skin. Methicillin resistant coagulase negative staphylococcus was isolated from the cerebrospinal fluid in 6 patients (% 38) and in the blood cultures of 2 patients. Mean time of hospitalisation was 77.4±72.9 days. Mortality rate was % 25.
Conclusion: Ventriculoperitoneal shunt infections are associated with high mortality and morbidity. Its treatment is time consuming and diffucult. Outcome may be pleasant with early diagnosis, prompt and appropriate therapy.

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