ISSN 1301 - 0883 / E-ISSN 1339 - 3886


Eastern J Med: 15 (1)
Volume: 15  Issue: 1 - 2010
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1.Nonobstetric surgical intervention in pregnancy
İsmet Alkiş, Mertihan Kurdoğlu, Zehra Kurdoğlu
Pages 1 - 6
Nonobstetric surgery during pregnancy is relatively common. This review mainly focuses on common surgical diseases in pregnancy including appendicitis, biliary disease, bowel obstruction, trauma and relevant issues such as timing of surgery, the prevention of preterm labor and fetal monitorisation.

2.Fluorouracil and folinic acid bolus schedule (nordic regimen) combined with irinotecan as a first-line chemotherapy in metastatic colorectal cancer
Yüksel Küçükzeybek, Bülent Karabulut, Halit Yetiş, Rüçhan Uslu, Ulus A. Sanli, Adem Uslu, Cengiz Demir, Erdem Göker
Pages 7 - 14
The recent incorporation of irinotecan (CPT-11) for the management of advanced colorectal cancer has generated further improvement in survival. The goal of this retrospective analysis was to evaluate the efficacy and toxicity of irinotecan plus bolus FU/FA (Nordic regimen) as first-line therapy in patients with advanced colorectal cancer. A total of 43 patients with metastatic colorectal cancer treated with irinotecan plus bolus FU/FA (Nordic regimen) as first-line chemotherapy were reviewed. Patients with metastatic adenocarcinoma of the colon or rectum and who had measurable disease and WHO performance status of 2 or less were treated with irinotecan 210 mg/m2 as a 30-90 min intravenous infusion on day 1, followed by 5-FU 500 mg/m2 and FA 60 mg/m2 bolus on days 1 and 2, every 2 weeks, until disease progression or unacceptable toxicity. Patients were evaluated for response rates, survival and toxicity. Median patient age was 56 (29-76) years. Response rates were 72% as a carcino embryogenic antigen (CEA) level and 45% as a clinic evaluation. Disease control rates were 76% as a CEA level and 80% as a clinic evaluation. Median duration of response was 5,8 (2-9) months as a clinic evaluation and median duration of response was 6,6 (2-11) months as a CEA level. Median progression free interval was 9 (2-13) months and median overall survival was 16 (3-18) months. Grade 3-4 neutropenia occurred in 30% of the patients. Non-haematological toxicities were mild. There was no treatment-related death. Irinotecan - Nordic regimen is considered as a reasonable option for first-line treatment of patients with metastatic colorectal cancer

3.Assessment of patients with thrombotic thrombocytopenic purpura
Cengiz Demir, Abdullah Altıntaş, Semir Paşa, M. Ali Kaplan, Yüksel Küçükzeybek, Orhan Ayyıldız
Pages 15 - 20
Thrombotic thrombocytopenic purpura (TTP) is a severe microvascular occlusive thrombotic microangiopathy characterized by systemic platelet aggregation, organ ischemia, profound thrombocytopenia, and fragmentation of erythrocytes. Unexplained occurrence of thrombocytopenia and anemia should prompt immediate consideration of the diagnosis and evaluation of peripheral blood smear for evidence microangiopathic hemolytic anemia. Excellent remission and survival rates were achieved by therapeutic plasma exchange. We reviewed characteristics and response rates to plasmapheresis of our TTP patients. A total of 25 cases were diagnosed. The parameters of hemoglobin and platelet were analyzed at presentation, as well as the number of plasmapheresis sessions and adjunctive treatment given. We found a response rate of 80 percent to plasma exchange. Response was better in 23 patients who presented with idiopathic TTP. Response was poor in patients with TTP secondary to underlying metastatic carcinoma. Two patients relapsed and one of the relapsed patients died. Plasmapheresis is mandatory and effective for primary TTP. Plasmapheresis may not be effective in all instances, especially if TTP is secondary to underlying disseminated cancer.

4.Management of esophageal foreign bodies: A report on 26 patients and literature review
Hasan Ekim
Pages 21 - 25
The purpose of this study is to present our experience of the removal of esophageal foreign bodies in children and adults using rigid esophagoscope under general anesthesia. A total of 26 patients with a history of ingested foreign body in the esophagus were admitted and treated in our hospital between July 2005 and August 2007, of whom 20 children and 6 adults. There were 14 male and 12 female patients between 6 months and 70 years of age. All patients except one had a clear history and symptoms of foreign body ingestion. The main symptoms were difficulty in swallowing, acute onset of pain, dysphagia, choking and excessive salivation. A lateral neck plain radiograph and a posteroanterior view that included the oropharynx, neck, chest, and abdomen were made routinely before esophagoscopic examination. Foreign bodies were most commonly identified in the cervical esophagus, usually immediately below the cricopharyngeus (16 children). Remaining foreign bodies were as follows: 6 (4 children, 2 adults) foreign bodies were lodged in the midesophagus and 4 (all adults) in the distal esophagus. All foreign bodies were removed under general anesthesia. A rigid esophagoscope was used to remove them. Coins were the most common foreign body removed from the esophagus, occurring in 14 patients, all children. Other foreign bodies were bones mixed with pieces of meat, button battery, staples, safety pins, chicken bones, and fish bone. There were no deaths, no perforations, no cases of mediastinitis, and actually no complications secondary to insertion of the esophagoscope and removal of the foreign body. Rigid esophagoscopy remains as safe method of esophageal foreign body removal. The timely diagnosis and endoscopic removal should be performed to prevent serious life-threatening complications.

5.The impact of high gain conventional hearing aid on OAEs in a case of auditory neuropathy/ dys-synchrony
Piyali Kundu, Nachiketa Rout
Pages 26 - 30
Aim of the study is to focus on the impact of high gain hearing aid on outer hair cells’ functioning as reflected by otoacoustic emission (OAE) changes. A child diagnosed as bilateral moderate -moderately severe sensori neural hearing loss with primary auditory neuropathy / dys-synchrony (AN/ AD) was referred to AYJNIHH (ERC) after being fitted with high gain hearing aid. She had used the hearing aid for less than a year. Audiological evaluation at AYJNIHH (ERC) was indicative of moderate to moderately severe hearing loss with absence of distortion product otoacoustic emissions (DPOAE). She was recommended to discontinue the use of the hearing aid for a couple of weeks. Auditory brainstem response (ABR) and OAE was administered after 14 days. No identifiable peak V was obtained in both the ears however the case had emissions on DPOAE. She was fitted a mild class hearing aid and included for speech language therapy. Conservative trials with amplification devices, diligent monitoring of amplification output levels and OAEs along with possibilities of a cochlear implant was to be explored during therapy. The primary reason behind deterioration in DPOAE may be temporary physiological changes resulting in temporary threshold shift. Therefore, high quality, low gain, wide dynamic range compression hearing aids may be the probable cause of return back of OAEs following two weeks without amplification. Amplification may contribute to loss of OAEs and the risk from use of amplification must be weighed against the benefits of amplification provided to the client.

6.EDTA-Dependent platelet clumping in a patient with hypothyroidism
Felipe Montes Pena, Sabrina Bernardez Pereira, Renato de Freitas Ribeiro Niemeyer, Bruno de Freitas Ribeiro Niemeyer
Pages 31 - 33
The pseudothrombocytopenia by ethylenediaminetetraacetic acid is caused by natural antiplatelet antibodies and is responsible for thrombocytopenia when platelet count is performed by automatic devices. Although it is difficult to assess the rate of this phenomenon, it is believed that the incidence is higher in hospitalized patients, especially in those with liver and autoimmune diseases and cancer. In this article we describe a female patient with complaints of clinical hypothyroidism and repeated values of thrombocytopenia, which was diagnosed as pseudothrombocytopenia due to ethylenediaminetetraacetic acid after proper analysis.

7.Herpes simplex encephalitis
Hasan Karsen, Cengiz Demir, Mustafa Kasım Karahocagil, Mahmut Sünnetcioğlu, Hayrettin Akdeniz
Pages 34 - 39
We presented four cases diagnosed with Herpes simplex virus encephalitis of those treated in our clinic in 2006 one of whom died, one recovered without any sequels. Two cases were left with advanced motor mental sequel. In this paper, clinical and laboratory findings along with diagnosis and treatment of Herpes simplex virus encephalitis were discussed.

8.Congenital primary hypothyroidism associated with the rare form of nonimmune hydrops fetalis
Sevil Arı Yuca, Yaşar Cesur, Ercan Kırımi, Şehabettin Sarı, Avni Kaya, Murat Doğan
Pages 40 - 42
We present a male newborn born with diffuse edema and ascites. A diagnosis of congenital primary hypothyroidism was made based on thyroid hormone levels of total T4 1.74 µg/dL, free T4 0.30 ng/dL and TSH >75 µIU/mL and thyroid hormone replacement therapy was initiated. At day 15 of therapy, the thyroid function tests of the patient reached normal limits, and his edema and ascites regressed. In this report we present a newborn case of hypothyroidism that was accompanied by nonhydrops fetalis. We want to emphasize that congenital hypothyroidism may present with severe symptoms such as hydrops.

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