ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 9 (1)
Volume: 9  Issue: 1 - 2004
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1.The Effect of Indole-3-Acetic Acid on Some Metabolic Enzymes in Kidney of the Second Cross Maternal Mice and Their Offsprings
H. Ramazan Yılmaz, Eşref Yüksel
Pages 1 - 3
Indole-3-acetic acid (IAA) generates reactive oxygen species (ROS) and excited oxygen intermediates. IAA causes renal dysfunction, hypoglycemia, and myotonia. The first aim of the study is to investigate the possible indirect effect of the plant growth hormone IAA on some renal enzyme activities such as hexokinase (HK), glucose-6-phosphate dehydrogenase (G6PD), 6-phosphogluconate dehydrogenase (6PGD), lactate dehydrogenase (LDH), and malate dehydrogenase (MDH) of second cross offsprings of the second cross maternal mice (Mus musculus) that are given IAA. The second aim was to investigate the possible direct effect of IAA on the same renal enzymes in second cross maternal mice. Method: Female mice was divided into two groups: IAA administered group and ethanol control group. Two chemicals used were applied intraperitoneally. IAA was administrated to maternal mice as a 1/40 dilution of 300 mg/kg body weights in 3-day intervals. Ethanol was administrated in the controls. Spectrophotometric methods were used to determine the activities of enzymes in the kidney of the second cross-maternal mice and their offsprings. Results: In the second cross-maternal mice, the activities of LDH, MDH, and G6PD were higher in IAA administrated animals than in controls. 6PGD and HK showed decreases in IAA study group compared to control group. In the offsprings of the second cross maternal mice, the activities of G6PD, HK, and MDH enzymes were decreased, and 6PGD and LDH enzymes were increased in IAA group compared to control group. Even so differences were not statistically significant. Conclusion: The results obtained suggested that metabolic enzymes studied were not affected from IAA toxicity. This may be due to low dose of IAA.

2.Determination of Lethal Doses of Volatile and Fixed Oils of Several Plants
Hanefi Özbek, Mustafa Öztürk, Abdurrahman Öztürk, Ebubekir Ceylan, Zabit Yener
Pages 4 - 6
To determine lethal doses of fixed and/or volatile oils extracted from leafs or fruits of Pimpinella anisum, Foeniculum vulgare, Sesamum indicum, Eugenia caryophyllata, Nigella sativa, Urtica pilulifera, Apium graveolens, Cuminum cyminum, Coriandrum sativum and Thymus fallax. Method: Swiss albino mice were injected intraperitoneally with different concentrations of the extract and results were evaluated with the method of probit analysis. Results: Maximum volume of oil administered to mice was kept below 0.5 ml. The oils of Sesamum indicum and Urtica pilulifera was completely non-lethal even at doses reaching 12.8 ml/kg and considered non-toxic. Conclusion: Lethal doses were determined for all other plants and LD1, LD10, LD50, LD90 and LD99 values were given.

3.The Diagnostic Value of Polymerase Chain Reaction (PCR) in Bronchioalveolar Lavage
Süleyman Güven, Esra Yılmaz, Hatice Kutbay, Salim Sarıyıldız, Levend Dalar, Arman Poluman
Pages 7 - 12
In this study we investigated the diagnostic value of polymerase chain reaction (PCR) which is fast and highly specific in terms of isolating the Mycobacterium tuberculosis (M. tuberculosis) from the bronchoalveolar lavage obtained by bronchoscopy when tuberculosis is suspected in the patients with negative sputum smears or when the sputum can not be collected. Method: Our cases consist of patients who can not expectorate or have three respective negative sputum samples taken at the morning after starvation. Fiberoptic broncoscopy was applied to all patientsunder local anestesia-at the hospital. Lavages were taken from bronchi, which were appropriate to the lesion. Lavage samples were sent to the laboratory without delay. Results were evaluated 2 days later. Totally 47 cases from 3rd Thoracic Diseases Clinic of Yedikule Thoracic Diseases and Thoracic Surgery Education and Research Hospital were included in this study. Thirty-five of the cases had a higher possibility for tuberculosis, and the remaining 12 cases had no evidence for tuberculosis (control group). In these cases M. tuberculosis complex DNA specific IS6110 field has been investigated by PCR and the results were compared with the microbiological culture, lavage AFB. Results: Twenty-one of 35 patients in the study group had positive lavage PCR results. Fourteen patients had negative lavage PCR results. Four of 21 lavage PCRpositive patients were found to be ARB positive by lavage. Nine of 21 lavage PCR positive patients were found to be ARB positive by culture. We had no false positive results. All control cases were negative in terms of AFB smear, culture, and lavage PCR. Lavage PCR sensitivity and specificity calculations were compared with ARB culture and lavage results. Considering the culture positivity as gold standard, the sensitivity and specificity of PCR were 60% and 100% respectively. Conclusion: PCR can be used as a supportive diagnostic test providing rapid and accurate results, if tuberculosis is suspected clinically and radiologicaly in patients with three consecutive AFB smear-negative sputum specimens or when the sputum can not be collected.

4.How To Weaponize Anthrax?
Ufuk Dizer, Levent Kenar, Mesut Ortatatlı, Turan Karayılanoğlu
Pages 13 - 16
Anthrax, a zoonotic disease caused by Bacillus anthracis, occurs in domesticated and wild animalsprimarily herbivores. Humans usually become infected by contact with infected animals or their products. Anthrax is so easy to obtain that it could be weaponized for biological warfare if a laboratory area of 5 m2 is owned with 10.000$.

5.Arrhythmia Due to Reperfusion After Thrombolytic Therapy in Patients with Acute Myocardial Infarction
Talat Tavlı, Alaettin Avşar, Bayram Kortuk, Abdullah Doğan, Sedat Demir, Refik Ali Sarı, Hasan Gök
Pages 17 - 21
The aim of this study was to determine the relation between the incidence and frequency of ventricular arrhytmias and the time course of STsegment changes in patients with successful thrombolysis. Method: This study included 46 patients (31 males 53±12 years) with acute myocardial infarction (MI) who were treated with streptokinase (SK Group) and 41 MI patients (27 males 55±12 years) who did not receive any thrombolytic agent (Control Group). Electrocardiograms were obtained 90 minutes 6, 12, 18, 24, 48 and 72 hours after thrombolytic therapy and reduction in ST elevation at 90 minutes was calculated. All patients had wall motion abnormalities. Results: Overall arrhythmias were observed in 67% (n: 31) of patients in SK group compared to 63% (n:26) in control group (p=0.05). In subgroup analysis of SK group ventricular tachycardia (VT) was more frequent (37%) in patients with more than 50% reduction in ST elevation at 90 minutes compared with in other subgroups of patients (p<0.01). Postinfarction angina and systolic dysfunction were more frequent in the control group compared to the SK group (p<0.05). Conclusion: Our results suggest that reperfusion with fibrinolytics or the faster reflow may induce ventricular arrhythmias. However, it can also prevent the impairment in systolic function of the left ventricle.

6.Dietary Assesment of Children with Cerebral Palsy: Case Control Study in Isparta
Mustafa Öztürk, Süleyman Kutluhan, Serpil Demirci, Galip Akhan, A. Nesimi Kısıoğlu, Seniha Akgün, Halime Hacıahmetoğlu
Pages 22 - 25
To evaluate nutrient intakes and dietary assessment of the children with cerebral palsy (CP) in our region, and to investigate the effects of various factors specific to this condition. Method: Forty-three children (24 males 19 females; mean age 8.1±4.2 years) with CP admitting to an outpatient center were included in the study. In addition, a control group of 27 children were recruited from the siblings of the children with CP. All caretakers were interviewed and a three-day dietary record of the children with CP and controls were obtained. Results: Overall, 32.6% of the children were quadriplegic, 44.2% diplegic and 14.0% hemiplegic. The mean percent of the Recommended Dietary Allowances for energy intake was lower in the children with CP than that in the controls (p<0.05), while no differences were detected between the groups according to protein, calcium, iron and vitamin C intakes. We also observed that there were differences in the amount of daily nutrients in the CP group according to some characteristic like gender and age. Conclusion: These results showed that daily nutrient intakes of the children with CP in Isparta province are insufficient.

7.Hypertrophied Anal Papillae and Fibrous Anal Polyps: Should They be Removed During Anal Fissure Surgery?
Pravin j. Gupta
Pages 26 - 29
Objective: The present study is aimed to establish that hypertrophied anal papillae and fibrous anal polyps can cause symptoms and could cause concern to the patients and that these should be removed while dealing with patients of chronic fissure in ano. Method: Two groups of patients were studied. Onehundred patients were studied in Group A where the associated fibrous polyp or papillae were removed by radio frequency surgical device after performing a lateral subcutaneous sphincterotomy for relieving the sphincter spasm. Another group of one-hundred patients who also had papillae or fibrous polyps, were treated by lateral sphincterotomy alone. They were followed up to one year to assess their complaints. Results: 89% patients from Group A expressed their satisfaction with the treatment in comparison to only 64% from Group B who underwent sphincterotomy alone with the papillae or anal polyps left untreated. Group A patients showed a marked reduction with regard to pain and irritation during defecation (p=0.0011), pricking or foreign body sensation in the anus (p=0.0006) and pruritus or wetness around the anal verge (p=0.0008). Conclusion: Hypertrophied anal papillae and fibrous anal polyps should be removed during treatment of chronic anal fissure. This would add to effectiveness and completeness of the procedure.

8.Radio Frequency Removal of Hypertrophied Anal Papillae and Fibrous Anal Polyps
Pravin J. Gupta
Pages 30 - 33
The presence of hypertrophied anal papillae and fibrous anal polyps is mostly ignored while dealing with chronic anal fissures. However, anal papilla tends to produce a discharge resulting in a sodden perianal skin with itching and discomfort. Similarly, polyps can prolapse, bleed or traumatize. This study is aimed to assay the impact and utility of attending to these two conditions concurrently while dealing with cases of fissure in ano. Method: A prospective study was carried out in 100 patients of chronic anal fissure with concomitant hypertrophied anal papillae or fibrous anal polyp. Radio frequency surgical technique was employed to destroy the papillae and polyps after a lateral sphincterotomy. Associated complaints like pruritus, pricking sensation, wetness, crawling in the anus etc. were subjected to comparison before and after removal of the papillae or polyps by an independent observer. Results: At a follow up of one month, anoscopy conducted on the patients showed total eradication of the treated papillae. The associated symptoms were reduced significantly and there was a marked decline in the primary complaints of pain and bleeding. At 24- month follow-up, 2% patients had recurrence of fissure, but none was found to have the papilla or polyp. Conclusion: Hypertrophied anal papillae and fibrous anal polyps encountered during surgical treatment of chronic fissure in ano should be removed to improve patient compliance. Radiofrequency procedure can tackle these associated pathologies effectively.

9.Randomized Clinical Trial of Longo´s Technique Versus Ferguson’s Haemorrhoidectomy; Follow-up Three Years
Yousef Thwayeb, F. Hermoso Gonzalez
Pages 34 - 38
The introduction of a Longo´s technique for the treatment of haemorrhoids has the potential for less postoperative pain, a short operating time and an early return to full activity. The outcome of Longo´s technique was compared with that of current standard surgery in a randomized controlled study, and followed up three years. Method: Forty patients were randomized to either Ferguson technique (n = 20) or Longo’s techniques (n = 20). Each patient received standardized postoperative analgesic and laxative regimens, and completed a linear analogue pain score every 6 h during the first day after operation, after the first motion and daily until the end of the second week. Operating time, frequency of postoperative analgesic intake, hospital stay, time to return to normal activity and postoperative complications were also recorded. Results: The mean ages of patients in the Longo and Ferguson groups were [47(25-65) and 45(23-71)] years respectively. The Longo´s group had a shorter operating time, less frequent postoperative analgesia intake, and earlier return to normal activity. Length of hospital stay was not significantly different between the groups being discharged within 24 hours. In third degree haemorrhoid disease functional outcome was better in the Longo´s group. Conclusion: Use of a Longo’s technique in the treatment of third degree haemorrhoid disease was safe and effective, but not effective in fourth degree.

10.Management of The Lower Extremity Arterial Injuries
Hasan Ekim, Veysel Kutay, Recep Demirbağ, Abdülsamet Hazar, Melike Karadağ
Pages 39 - 43
The incidence of vascular injuries has increased considerably during the past 40 years. However, although they represent less than 1% of all injuries, they deserve special attention because of their severe complications. Method: From May 1999 to March 2003, 30 patients with lower limp vascular injury were surgically treated in our clinic. Diagnosis was made by physical examination alone, or in combination with angiography. Primer vascular repair was carried out where possible; if not possible the interposition graft was used. When an interposition graft was necessary either polytetrafluoroethylene (PTFE) or saphenous vein was used for vascular reconstruction. Results: The study group consisted of 24 males and 6 females, ranging in age from 14 years to 39 years with a mean age of 26.2±8.1 years. Penetrating trauma was the cause of a high proportion of cases. There were 31 arterial injuries. Only one patient had bilateral arterial injuries (right and left tibial arteries). Arterial injuries were most common in the femoral artery area, followed by the tibial and popliteal arteries. Surgical procedures performed were primary repair in 12 arterial injuries, saphenous vein interposition graft in 15, and PTFE interposition graft in 4. There were 18 patients with associated venous injury, of which 11 cases had primary repair, and 7 had vein graft interposition. There were concomitant femur fracture in 3 patients, and fibula fracture in 1. Conclusion: Patients who suffer lower extremity arterial injury should be transferred to vascular surgery centers as soon as possible. Anticoagulant treatment should be started as soon as possible to prevent the propagation of the thrombosis. Early fasciotomy is warranted if there is any suspicion of occurrence of compartment syndrome.

11.Severe Hyperphosphatemia After Phosphate Containing Bowel Cleansing Regimen
Ferah Sönmez, Güzel Dişçigil, Çınar Adıyaman, Münevver Türkmen
Pages 44 - 45
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