ISSN 1301 - 0883 / E-ISSN 1309 - 3886


Eastern J Med: 18 (3)
Volume: 18  Issue: 3 - 2013
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1.Molecular targeted therapy in epithelial ovarian cancer
Şenol Şentürk, Işık Üstüner, E. Seda Güvendağ Güven
Pages 101 - 107
Ovarian cancer is the most common cause of mortality of tumors from gynecologic origin and is often diagnosed after patients have already progressed to advanced disease stage. The current standard of care for treatment of epithelial ovarian cancer includes cytoreductive surgery followed by adjuvant chemotherapy. However, the development of resistance, disease recurrence and poor prognosis is still the most important problems. In spite of enhancements in tumor debulking surgery and combination regimens, the majority of patients with ovarian cancer not only experience adverse effects, but also eventually relapses. Therefore, additional therapeutic possibilities need to be explored to minimize adverse events and prolong progression-free survival and overall response rates in patients with ovarian cancer. Recent advances in the understanding of molecular mechanisms and genetics of epithelial ovarian cancer have led to the identification of new targets. In this review we focus on the molecular mechanisms and the clinical efficacy of molecular targeted therapy on epithelial ovarian cancer.

2.Evaluation of patients who underwent radical nephrectomy due to renal tumor
Mustafa Gunes, İlhan Gecit, Necip Princci, Kerem Taken, Kadir Ceylan, M. Reşit Öncü
Pages 108 - 112
The aim of the present study was to evaluate the results of the cases that underwent radical nephrectomy due to renal cell carcinoma (RCC) and to discuss the results together with the literature. Eighty-three patients (51 males), who underwent radical or partial nephrectomy because of renal tumor between 2005 and 2011 were retrospectively evaluated 70 patients underwent open radical nephrectomy and 13 patients underwent open partial nephrectomy. With regard of tumor localization, 50 were localized in the left and 33 were localized in the right kidney. Tumor sizes varied between 2 cm to 16 cm. According to the subtypes of RCC, five-year survival rate was 72% for clear cell, 80% for papillary carcinoma, 66.6% for chromophobe, and 71.4% for other malignant lesions. Five-year disease specific survival rates of the patients with T1, T2, T3, and T4 renal carcinoma were 91.3%, 87.5%, 50%, and 0%, respectively. Radical nephrectomy is the standard method for the treatment of RCC. Survival rate in the patients with renal tumor is directly associated with the tumor stage.

3.The role of MR Myelogram in the diagnosis of traumatic pseudomeningocele
Hanifi Bayaroğulları, Nesrin Atci, Murat Altaş, Mustafa Aras, Raif Özden
Pages 113 - 117
Traumatic pseudomeningocele is a valuable indicator of nerve root injury. Secondary to trauma, the traction forces firstly tear meninges and later if the traction forces are great enough, nerve root avulsions occur. In this article, we aimed to show pseudomeningoceles localized at the level of brachial and lumbar plexus secondary to nerve root injury. We retrospectively reviewed the patients who admitted to our hospital between 2009 and 2011 due to various accidents. After clinical and radiological examinations, spinal root injuries were detected in six patients at different levels. Brachial plexopathy was detected in four patients and lumbosacral plexopathy was detected in two patients. Pseudomeningocele is a valuable indicator of nerve root injury. It occurs after dural torn like pouch. MR and MR myelography is the best imaging modality to indicate its’ pouch and cerebrospinal fluid (CSF) within it. MR and MR myelography are best effective imaging modalities to indicate the pseudomeningoceles due to nerve root injury.

4.Evaluation of the patients with lymph node tuberculosis
M. Fatih Garca, Mehmet Aslan, Guner Demir, Suayip Bilgen, Muhsin Uysal
Pages 118 - 122
Lymph node tuberculosis (LNT) is chronic granulomatous inflammation of the lymph nodes. The aim of the present study is to review the epidemiologic, clinical and laboratory features of patients with LNT retrospectively. The records of 138 patients admitted to tuberculos dispensary between 2005 and 2010 with the diagnosis of tuberculosis were reviewed retrospectively and LNT cases were investigated. Twenty one cases were identified with LNT. 13 patients were female (61.9%), 8 (38.1%) were male and mean age was 41 ± 21 years. The female to male ratio of LNT cases was 1.625 (13/8). The most common complaint was palpable mass on neck. Just cervical lymph nodes were the most frequently involved; in 15 (71.5%) patients. Only 2 cases have contact history with tuberculosis cases (9.5%) and two cases had a history of pulmonary tuberculosis (9.5%). After confirmation of diagnosis all patients were treated with combined anti-tuberculous therapy for at least six months. LNT is seen more frequently in females than males. It should be considered in the differential diagnosis of the neck masses.

5.Epidemiology of the hepatitis C infection in Van’s region
Bilge Gültepe, Ahmet Cumhur Dülger, Enver Aytemiz
Pages 123 - 126
Hepatitis C virus (HCV) is an enveloped positive-strand RNA virus of the genus hepacivirus in the family of Flaviviridae. HCV causes chronic infection in more than 80% of cases. It is responsible for more than 50% of liver transplantation among adults in the developed countries. Approximately 200 million people are infected with HCV entire of the world. Africa and many parts of Asia are the major endemic areas for HCV infection. Although HCV is one of the most common cause of chronic liver disease in middle-east, its epidemiology remains unclear around the Lake Van region. Therefore, we assessed the prevalence of HCV infection in individuals who live in rural areas of eastern part of Turkey. We retrospectively analyzed 1062 (405 male, 657 female) patients who admitted to Gastroenterology clinic of Yuzuncu Yil University Faculty of Medicine between January -October in 2011. Patients with prior HCV infection and with acute HCV infection were excluded. Presence of HCV infection was assessed by the routine ELISA method. Anti-HCV antibodies were screened by ELISA method using ADVIA Centaur ® XP Immunoassay System (Siemens, Ireland). Samples with positive HCV RNA real-time PCR was used as the correction method. Isolation reaction processes were analyzed by QIAGEN (Düsseldorf, Germany) brand in the QIAsymphony SP/AS instrument. Real Time PCR analysis was studied by Rotor Gene Q instrument and Artus HCV Virus-1 QS-RGQ kits (QIAGEN, Düsseldorf, Germany). All data was recorded on SPSS and was analyzed by simple statistical methods. The mean age was 46.1±17.9 years in males and was 42.5±17 years in females. 3 men and 6 women had anti-HCV antibody. Total Anti-HCV seropositivity was 0.8%. Interestingly, HCV infection is not a serious health problem in eastern part of Turkey. It may be due to low prevalence of intravenous drug users and homosexuals as well as to strict traditional rules. Further analyses may be required to establish this phenomenon particularly in eastern part of Turkey which is located on the main cross-road of the world narcotic trade.

6.Free-floating thrombus at left atrium in an advanced mitral stenosis case
Ali Kemal Gur, Vural Polat
Pages 127 - 129
Even though rheumatismal valve diseases are recently reduced, they are still frequently seen in developing countries. Left atrial thromboses commonly may occur within the left atrial appendix in the presence of an atrial fibrillation and are adhered to the left atrium wall. The case we are presenting in this article demonstrated symptoms such as syncope and shortness of breath and controls carried out indicated an advance degree of mitral narrowing, determined by echocardiography and accompanied with a presence of a "free-floating" thrombus at the left atrial. Once pre-operative studies were performed, patient was operated. The "free floating" thrombus at the left atrial was removed, a mitral valve replacement was performed and the patient was discharged from our clinic without any complications, at post-operative 7th day.

7.Prolonged asystole during head-up tilt testing in a patient with Behcet’s disease
Vural Polat, Ali Kemal Gur, Orhan Dogdu
Pages 130 - 132
Behcet’s disease (BD) is a systemic inflammatory disorder and cardiac involvement is rare. Head-up tilt test is used for evaluating patients with neurocardiogenic syncope (NCS) and syncope of unknown etiology. A 31-year-old woman was examined for three syncopal episodes during the past two months, all of which preceded by nausea and sweating. Examinations including electrocardiography and echocardiography showed normal findings. A head-up tilt table testing was performed at an angle of 60 degrees. At about 8 minutes, syncope associated with bradycardia and asystole was observed. She became hypotensive, and there was a ventricular asystolic pause lasting 20 seconds, associated with loss of consciousness. She was placed in the supine position and cardiac massage was started. After 20 seconds, she slowly returned to sinus rhythm and regained consciousness. The patient was treated with dual-chamber (DDD-R) pacemaker implantation. During six months of follow-up, no major events occurred.

8.Bronchogenic cyst mimicking hydatid cyst or enfected bulla in child patient
Mahmut Tokur, Yakup Yesilkaya, Fuat Ozkan, Naime Tokur
Pages 133 - 135
Bronchogenic cysts are congenital anomalies of the bronchial tree and they are generally asymptomatic, and often incidentally diagnosed. If the bronchogenic cyst is infected or high protein level include, differantial diagnosis should be included lung abscess, hydatid cyst, fungal disease, tuberculosis, infected bullae, vascular malformations, and tumoral conditions. Complete surgical excision as the most reliable therapeutic option due to the risk of development of complications and recurrence, even in incidentally diagnosed cases.

9.Undetected piece of wood causing osteomyelitis of the metacarpal bone: A case report
Mehmet Fethi Ceylan, Savas Guner, Levent Ediz, Tulin Turkozu, Daghan Isik
Pages 136 - 138
The patients with soft tissue injuries by foreign bodies are encountered frequently by the emergency physicians. In the emergency services, the advanced radiological imaging techniques should be requested in the patients who have a history of foreign body injury, if it was not detected by plain radiographs. Though the plain radiography is very useful for detection of metal foreign bodies, ultrasonography, magnetic resonance imaging and the computed tomography are superior for the detection of wood, glass and plastic foreign bodies. The foreign bodies that were not removed with the surgery can cause allergic, inflammatory or infectious process. Old foreign body injuries should be investigated in the patients with non-healing infection, or osteomyelitis history. The surgical exploration should not be avoided for diagnostic aim. In this case, we are presenting a pediatric patient developed metacarpal bone osteomyelitis due to foreign body which was diagnosed lately.

10.A rare cause of median nerve compression: A fibroma originating from the tendon sheath in the carpal tunnel
Mustafa Baltacıoğlu, Serdar Yücel
Pages 139 - 141
Carpal tunnel syndrome is a widespread clinical condition, the cause of which is compression of the median nerve in the tunnel. For a large proportion of patients, the surgical release of the median nerve in the carpal tunnel is sufficient treatment. In some cases, the cause of this condition may be due to a mass along the median nerve path. These could be lipomas, ganglia, rarely tendon sheath origin fibromas. In such conditions, the symptoms are not alleviated by a simple release of the transverse carpal ligament; an excision of the mass may be required. Fibromas originating from the tendon sheath are rare benign tumors. When this causes compression of the median nerve, the presentation is similar to carpal tunnel syndrome. In our study, a patient developing median nerve compression due to a fibroma stemming from the tendon sheath has been presented and mass-presenting cases in literature have been reviewed.

11.Delayed status epilepticus due to bupropion and lamotrigine overdose
Nitin K. Sethi, Philippe Douyon, Ulrike Kaunzner, Prahlad K. Sethi, Josh Torgovnick, Frances Cukierwar, Justin Marcus
Pages 142 - 144
Bupropion is a well known atypical antidepressant marketed in the United States under the trade name Wellbutrin. In its sustained release form, it is also used for smoking cessation. It lowers seizure threshold and its potential to cause seizures has been widely publicized. Lamotrigine is a broad spectrum anticonvulsant with an extremely favorable side-effect profile and has thus rapidly become the preferred drug for a broad range of seizure types such as absence seizures, primary generalized epilepsy syndromes such as idiopathic generalized tonic-clonic seizures, juvenile myoclonic epilepsy as well as partial (focal) epilepsy. It is also used by psychiatrists as a mood stabilizer. We report a patient who presented with delayed status epilepticus following a failed suicidal attempt after overdosing on bupropion XL and lamotrigine.

12.Surgical management of a persistent lichen sclerosus case and reconstruction of vulva with free rotation and V-Y advancement flaps
Cihangir Mutlu Ercan, Mufit Cemal Yenen, Murat Dede, Mustafa Deveci, Mustafa Ulubay, Ibrahim Alanbay, Hakan Coksuer
Pages 145 - 149
Lichen sclerosus (LS) is a lymphocyte-mediated, chronic, inflammatory dermatitis which most commonly involves the anogenital area. Treatment options include topical corticosteroids, tacrolimus, carbon dioxide laser ablation and, as a last resort vulvectomy. The objective of this study is to report a refractory anogenital LS case and describe the use of a V-Y advancement flap for reconstruction of the perineal defect after vulvectomy. A case of persistent LS, treated succesfully with surgery is presented and the literature is reviewed. The patient tolerated the surgical procedure well and a satisfactory cosmetic result was obtained. A multidisciplinary team is ideal in the management of patients with persistent LS. Surgical management of LS should be reserved as a last resort for patients who are refractory to other medical treatment options and, in the case of a surgical attempt, techniques for reconstruction of the vulva should be well known.

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