ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 19 (2)
Volume: 19  Issue: 2 - 2014
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1.Brain scintigraphy in brain death: The experience of nuclear medicine department in dokuz eylul university, school of medicine
Erdem Sürücü, Melahat Aslan, Yusuf Demir, Hatice Durak
Pages 66 - 70
We investigated the propriety between the findings of brain death scintigraphy and the patient outcomes after the scan. We figured out the benefits of scintigraphic findings to the diagnosis. This study was performed in our department between 2006-2011 and patients were evaluated retrospectively. Pre-diagnosis of brain death and final diagnosis were compared. 24 patients were referred to our nuclear medicine department between 2006-2011. All patients underwent brain scintigraphy following IV injection of 20 mCi of Tc 99m DTPA or 10 mCi Tc 99m HMPAO with one-second dynamic images in 128x128 matrix for a period of 60 seconds. Anterior, posterior, right and left lateral static images were obtained with 5-minute in 256x256 matrix after dynamic images. Patients were referred by the departments of internal medicine intensive care and anaesthesiology intensive care. No blood flow into the middle, anterior and posterior cerebral arteries and no activity in the venous sinuses were accepted as showing the brain death. 22 of 24 patients were reported that findings in brain scan were consistent with brain death as in the prediagnosis. Brain death was not reported in two patients with Tc-99m HMPAO scan and brain death was suspicious in one patient with Tc-99m DTPA scan. Two patients with Tc-99m HMPAO scan were died two weeks after the brain scan and the patient with Tc-99m DTPA was died one day after the brain scan. Brain scintigraphy is a non-invasive procedure supporting the clinical diagnosis and it can be also easily performed and can exclude the negative and suspicious patients.

2.The examination of the relationship between health promotion life-style profile and self-care agency of women who underwent mastectomy surgery
Sukriye Ilkay Guner, Senay Kaymakci
Pages 71 - 78
Mastectomy is a difficult process that starts with the diagnosis of the illness and requires a long and tiring treatment process which can cause the emergence of physical, psychological, and social difficulties. The patient can face problems regarding the materialization of self-care activities and healthy lifestyle behavior. This study has been performed in order to determine the relation between the healthy lifestyle behavior of women who have undergone mastectomy and their self-care agency. 150 patients who completed three months after mastectomy and who received the first or more than one dose of their radiotherapy, chemotherapy or hormone treatments constituted the sample of this study. In the data collection process which was performed by face-to-face interviews, a questionnaire form which aimed to determine the socio-demographic characteristics of the patients, and the scale of Health Promotion Life-style Profile (HPLP) and the scale of exercise self-care agency (ESCA) were used. After mastectomy, the average total score in the health promotion life style profile scale is 162.60±13.81 and the total average score in the Scale of Self-care Agency (SCA) is 118.2±12.52.The average scores in the sub-groups of the scale of HPLP are calculated as follows: self-realization: 47.01±4.62; health responsibility 32.63±4.61, interpersonal support: 25.93±2.53, stress management: 23.18±3.62, nutrition: 22.05±2.19, and exercise 11.83±3.63. It can be claimed that the development of positive health behaviors in the patients who underwent mastectomy increases self-care power. This is why the interventions were made by the nurses with the aim of improving positive health behaviors and they can be considered influential in coping with the disease.

3.The value of F-18 FDG PET/CT for detecting primary foci in the metastatic cancer of unknown primary origin
Erdem Sürücü, Melike Şentay Aşcıoğlu, Tarık Şengöz, Yusuf Demir, Hatice Durak
Pages 79 - 83
Cancers of unknown primary origin (CUP) have poor prognosis and the median survival for patients with CUP is approximately 1 year. This survival can be extended by the identification of the primary origin and treating with specific therapy. F-18 FDG PET/CT scans of 75 patients (39 female, 36 male, mean age 60 ±12) with CUP referred to our clinic between January 2009 and January 2011 were evaluated retrospectively. Whole body images were obtained 60 minutes after the injection of approximately 370 MBq (10 mCi) F-18 FDG by PET/CT (Gemini-TOF-Philips). Emission scans were obtained for 1.5 min per bed position and transmission scans were obtained with low dose CT using 50 mA and 120 kvp. The tumor was identified histopathologically in 58 of 75 patients. 4 of 58 patients were treated as CUP. 17 of 75 patients could not be followed, so final diagnosis could not be made. In 54 patients, the primary was identified as 17 lung, 8 colorectal, 7 breast, 3 stomach, 3 pancreas, 2 endometrial, 2 nasopharynx, 2 gallbladder cancers, 2 lymphoma, 2 peritoneum, 1 maxillary sinus, 1 salivary gland carcinoma, 1 brain tumor, 1 leiomyosarcoma, 1 ovary cancer and 1 multiple myeloma. If reports are considered, F-18 FDG PET/CT helped to detect primary origin in 65% of these 58 patients, 38 of 54 primary sites were true positive (70%). There were 6 false positive sites (10.3%), 16 false negative (27.5%) results in F-18 FDG PET/CT. After the retrospective evaluation of the false negative patients, we have realized that primary sites were ignored in 5 of 14 patients, so actually F-18 FDG PET/CT helped in 74% of the patients showing 43 of 54 primary sites (80%). In first evaluation, F-18 FDG PET/CT missed 2 breast cancers, 1 lymphoma, 1 colon cancer and 1 intra maxillary sinus cancer. F-18 FDG PET/CT is an important imaging tool for detecting primary origin in the patients with CUP. F-18 FDG PET/CT helped in 74% of the patients showing the primary sites. In the patients with CUP, lung, breast, colon and the physiologic uptake areas should be scrutinized carefully for any tumor location.

4.The effect of bronchoscopy on oxidative and antioxidative status
Erkan Ceylan, Özcan Erel
Pages 84 - 89
Hypoxemia often occurs during bronchoscopy. Pulmonologists managed it with supplement oxygen and sometimes stopping the procedure. We suggest that the main source of the reactive oxygen species is hypoxia during bronchoscopy. We investigated the alterations in oxidative and antioxidative status during bronchoscopy using oxidative stress parameters including oxidative stress index (OSI) and total oxidant status (TOS). Twenty two patients included to the study for whom bronchoscopy was performed. Twelve patients were diagnosed with lung cancer. Ten patients with normal bronchoscopy comprised the control group. Blood samples were taken just before and 1 hour after bronchoscopy. For antioxidative status, total antioxidant capacity (TAC) and total free sulfhydryl groups were determined. Indicators of oxidative stress (TOS, lipid hydroperoxides, and OSI) were statistically higher (p<0.05, p<0.05, p<0.05), whereas indicators of antioxidative status (TAC and free sulfhydryl) were statistically lower in the after bronchoscopy blood samples than before bronchoscopy blood samples in all patients (p<0.05, p<0.05). Before bronchoscopy, indicators of oxidative stress were higher (p <0.001, p<0.05, and p<0.001 respectively), and indicators of antioxidative status (p<0.05, p<0.001 respectively) were lower in the lung cancer group than control group. After bronchoscopy of lung cancer group, indicators of oxidative stress (TOS, lipid hydroperoxides, and OSI) showed significant increases (p<0.05, p<0.05, and p<0.01 respectively), whereas indicators of antioxidative status (TAC and total free sulfhydryl groups) (p<0.05, p<0.01 respectively) were significantly decreased than control group. We demonstrate that bronchoscopy is associated with increased oxidative stress and decreased antioxidative response through possibly caused hypoxemia.

5.Prevalence and etiological causes of sinus headache in 113 consecutive patients with chronic rhinosinusitis
Mustafa Kaymakçı, Özer Erdem Gür, Güneş Pay
Pages 90 - 93
The aim of this article is to examine the prevalence and etiological causes of sinus headache in patients with chronic rhinosinusitis. Patients who complained of sinus headache were identified and their presenting symptoms were analyzed in the light of the final diagnosis, after surgical treatment and follow-up. The mean follow-up time for patients with sinus headache was 3.2 months (range, 4-16 weeks). Patients’ responses to treatment were classified under three categories; complete improvement, partial improvement and no response to treatment. Headache resolved completely in nine (34.6%) out of 26 patients diagnosed with chronic sinusitis and complaining of headache, while partial resolution was seen in five (19.2%) and no change in pain in 12 (46.1%). Five patients with partial improvement and 12 patients with no improvement were re-evaluated through consultation with the neurology clinic. Eleven patients were diagnosed with migraine and five with tension type headache. No additional disease to sinusitis was determined in one patient. Sinonasal surgery may be beneficial in patients with primary headaches. We believe that new diagnostic criteria for migraine without aura and tension type headache accompanied by sinonasal pathologies are now needed.

6.Awareness of hyperacusis management among hearing health care professionals - a nationwide telephonic survey
Suman Kumar, Indranil Chatterjee, Punam Kumari, Sujoy Kumar Makar
Pages 94 - 101
Hyperacusis has recently attracted professional attention. Previously, this topic was not well researched or documented. In many instances, due to a lack of understanding regarding the diagnosis, the pathophysiology and treatment options, patients' complaints were ignored. Hyperacusis is defined as an abnormally strong reaction to sound occurring within the auditory pathways. In the present study, an attempt has been made to make a telephonic survey regarding awareness of hyperacusis by asking a set of 19 questions from otorhinolaryngologists and audiologists in almost all parts of India. It is found that 56.6% of the participants report that hyperacusis is not diagnosed in their clinics, 73.4 % do not know the etiology, 33.3% manage hyperacusis and tinnitus simultaneously while others are not sure which should be managed. Decreased sound tolerance, including hyperacusis, misophonia, and phonophobia, is a challenging topic to study and treat. The etiology is not clear, neural mechanisms are speculative and treatments are not yet proven. The general recognition of decreased sound tolerance, as a problem requiring attention and proper treatment, should be considered a priority in the community of hearing professionals.

7.Validation of Malay Caregiver Strain Index
Zahiruddin Othman, Wong SiongTeck
Pages 102 - 104
This study aimed to validate the Caregiver Strain Index (CSI), a self-administered questionnaire for rating burden and strain related to care provision, for use in local clinical practice. The CSI was translated into Malay language using forward and back translation method. The final Malay version was administered to 50 caregivers of post-stroke patients attending the medical clinic, Hospital Umum Sarawak in December 2011. The Malay Caregiver Strain Index (CSI-M) has a good face and content validity as well as internal consistency (Cronbach’s alpha 0.79). In conclusion, the CSI-M is a reliable tool for assessment of burden experienced by caregivers in Malaysia.

8.Assessment of PTCH1a promoter methylation in BCC carcinogenesis
D. Beyza Sayın Kocakap
Pages 105 - 106
Basal Cell Carcinoma (BCC) is the most common cancer in humans. It is known that PTCH1 mutations in Sonic Hedgehog pathway play significant role in BCC pathogenesis. However PTCH1 (Patched) inactivation through promoter methylation is still under investigation. In this study, promoter methylation of the PTCH1 gene was analysed by Combined Bisulphite Restriction Analysis in 10 formalin-fixed paraffin-embedded (FFPE) BCC tissues. There was no methylation in any of the samples. Results suggest that PTCH1 promoter methylation is not effective in BCC carcinogenesis and FFPE tissues are not suitable for methylation analysis since 44 specimens were included in the study and only 10 of them gave result.

9.Mean platelet volume as an indicator of disease in patients with acute pulmonary embolisms
Aysel Sunnetcioglu, Sevdegul Karadas
Pages 107 - 111
Mean platelet volume (MPV) is a simple and easy method of assessing platelet function in routine clinical practice. The data concerning MPV in pulmonary embolism are controversial. Therefore, the aim of this study was to evaluate MPV levels and platelet numbers in patients with acute pulmonary embolisms. This retrospective study was conducted in the emergency department of the Medical Faculty Hospital of Yuzuncu Yil University between January 2010 and April 2012. The study enrolled 67 patients with acute PE (36 females and 31 males) and 53 healthy controls (31 females and 22 males). The platelet number and MPV values in patients with acute pulmonary embolism were reviewed. There were no statistically significant differences between the acute PE patients and the controls with respect to the MPV values and platelet numbers (both, p>0.05). The MPV values were inversely correlated with the platelet number in the patients with acute PE (r:0.388; p<0.001). These results suggest that MPV is not a reliable indicator for diagnosing acute pulmonary embolism. Further studies are necessary to confirm these findings.

10.Thyroglossal Duct Cysts – A ten years retrospective review
Eyzawiah hassan, Goh Bee See, Dayang Anita Aziz
Pages 112 - 118
Thyroglossal duct cyst (TDC) is the most common congenital midline anterior neck mass which may present at any age particularly in the pediatric age group. To review the pre-operative evaluation and the subsequent management in patients diagnosed with TDC. Medical records of all the patients diagnosed with TDCs from January 2001 till December 2010 were retrospectively reviewed. The patients’ clinical presentations, types of radiological investigation performed, the surgery and the outcome were documented. There were 23 records of patients identified, but only 12 records were included due to incomplete data. They were 7 female and 5 male. The age ranged from 2 to 58 years. Mean age of presentation was 11.8 years. Eighty three percent of patients were in the pediatric age group. Ten cases (83%) presented as a painless neck swelling and a case with discharging cyst (8.3%) and infected cyst (8.3%). The site of the cyst was infrahyoid in seven cases (59%), suprahyoid in three cases (25%), one over the hyoid bone (8%) and another one case situated at the base of tongue (8%).Neck ultrasound was the most common radiological investigation performed prior to surgery. All patients underwent Sistrunk operation. The histopathological examination of the excised specimens was confirmed as thyroglossal duct cyst; in one patient papillary carcinoma was identified. There were no post-operative complications or recurrence. TDCs may manifest at any age but most commonly in pediatric age group. Diagnosis is usually be made clinically. Ultrasound of the thyroid gland and the neck structures is an adequate tool of investigation; however other adjunct investigations may be required. Sistrunk operation is the surgery of choice at our centre with no recurrence documented.

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