ISSN 1301 - 0883 / E-ISSN 1309 - 3886
 
 








  Eastern J Med: 13 (1)
Volume: 13  Issue: 1 - 2008
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ORIJINAL MAKALE
1.An analysis of corrosive substance ingestion of children in eastern Turkey
Mehmet Melek, Yeşim Edirne, Ufuk Çobanoğlu, Abdullah Ceylan, Muhammet Can
Pages 1 - 6
In this study, we aimed at describing corrosive substance ingestion and related problems in Eastern Turkey. This type of injury is still a serious problem to be given a careful attention in our country like the other developing countries. The charts of children managed in our hospital with corrosive substance ingestion in the period of 1996- 2008 were evaluated retrospectively. Gender, age, ingested substance and the volume, symptoms, morbidity of caustic injury were considered in the analysis of the charts. We had 40 male and 35 female cases. 82% of children were under 5 years old. Mean age was determined as approximately 3.5 years. Bleach was the most common corrosive substance received and it was followed by hydrochloric acid. The volume of the ingested substance varied between 1-100 ml. The volume could not be estimated in 36 children. It was determined that 54% of ingested corrosive substance was in its original package. Twenty-five cases ingested the substance from food or drink containers that was stored somewhere in the kitchen. Five children had developed esophageal strictures. They were included in esophageal dilatation program. In our country the morbidity of caustic esophageal burn is still a problem that should be involved. Attention to the storage conditions and secured bottle cap seems to be the easiest and simplest way to prevent corrosive substance ingestion.

2.Efficacy and safety of lamotrigine in refractory epilepsy of children
Razieh Fallah, Zia Islami
Pages 7 - 12
It is known that current antiepileptic drugs can not control seizures in 20-30% of patients. The aim of this study was to evaluate the efficacy and safety of lamotrigine as add-on therapy in intractable epileptic children in Yazd- Iran. In a drug study, 42 children with mean age of 5/35 ± 4 years, 23 boys and 19 girls with refractory seizures and seeking treatment, recruited to be subjects of this study. Mixed and myoclonic were the most common seizure types ( 38% and 31% respectively). At the end of three months of lamotrigine treatment concomitantly with previous AED, 31% became seizure free, 35.7% had more than 50% reduction in seizure frequency and 12% had increasing seizures. All of seizures in absence and juvenile myoclonic epilepsies stopped with lamotrigine. Good drug response (stopping of seizures or > 50% of reduction in seizure frequency) was seen in 100% of idiopathic, 67% of cryptogenic and 54% of symptomatic epilepsies. 75% of Lennox-Gastaut syndrome and progressive myoclonic epilepsy and 33% of West syndrome had good response. Drug rash was seen in 6.7% of children and serious hematologic abnormality, hepatotoxicity and nephrotoxicity side effects were not seen. Lamotrigine can be considered as an effective and safe drug in controlling of intractable epilepsy of children especially in absence and juvenile myoclonic epilepsy.

3.The effects of non-steroid anti-inflammatory drugs on healing of colonic anastomosis in rats
Ersoy Esen, Ilker Sucullu, Huseyin Sinan, Zafer Küçükodacı, Ali Ilker Filiz, Ergun Yucel, Mehmet Levhi Akın
Pages 13 - 18
NSAIDs have dual roles of providing analgesia and promoting healing. This study investigated the effects of 3 different NSAIDs on healing of colonic anastomosis in rats. The aim is to provide an evidence-based rationale for choice of postoperative analgesic agent in surgical patients who undergo this procedure. Forty-eight Sprague-Dawley conventional rats were separated into 4 groups of 12 rats, with one group as control, and the other groups receiving tenoxicam, metamizole, or diclofenac, respectively. Each group was subdivided into 2 subgroups according to sacrifice on postoperative day 3 or 7. Anastomotic healing was assessed by 3 parameters: (1) physical evaluation (bursting pressure), (2) histological evaluation (fibrotic index), and (3) biochemical evaluation (tissue hydroxyproline levels). Diclofenac had a negative effect on bursting pressures. Tenoxicam significantly increased the fibrotic index at day 7. Metamizole increased tissue hydroxyproline levels at day 3, but there was no significant difference between control and NSAID groups at day 7. Each drug showed benefits and drawbacks. Because tenoxicam promoted fibrosis, and metamizole increased collagen synthesis, with both agents showing few disadvantages, these 2 agents are recommended above diclofenac for promoting healing.

4.Evaluation of the relationship between urogenital abnormalities and neuromuscular disorders
Gulden Diniz, Mustafa Barutcuoglu, Aycan Unalp, Safiye Aktas, Nedret Uran, Hursit Apa, Ragip Ortac, Saniye Gulle, Aysel Aydoğan
Pages 19 - 24
Because of its striated muscle origin; the cremaster muscle may possibly be affected by neuromuscular diseases and may cause the increased incidence of undescended testes and other urogenital malformations. Therefore we aim at determining the frequency of inguinopenoscrotal abnormalities in children with muscle disease.This study was conducted at the Izmir Dr.Behcet Uz Children’s Hospital from May 2004 through April 2009. Twenty eight normal muscle and 105 boys holding diagnoses of neuromuscular disorders which were confirmed by muscle biopsy were included in this study. Detailed clinical information, physical and laboratory examination findings were obtained from patient files. All findings were evaluated statistically. The mean age of all boys was 6.42 (± 3.89), years. Dystrophies were diagnosed in 79 (75.2%) patients. Other disorders were 5 primary, 7 inflammatory and 7 metabolic/mitochondrial myopathies and 7 neuropathies. Twenty seven (25.7%) patients had similarly affected family members. Consanguinity rate was 24.7%. Alterations in serum enzymes, EMG pathologies and fiber type disproportions were determined in 88 (83.8), 82 (78%) and 28 (26.6%) of the patients respectively. Urogenital malformations were detected in 11 (8.27%) boys. Although both in Spearman’s Correlation Analysis and in Fisher exact Chi-Square test, there were no statistical significances between the types of neuromuscular disease and urogenital malformations (p=0.344 and p=0.457), the odds ratio for urogenital pathologies was found 2.83. This result supported that urogenital abnormalities were more common in children with neuromuscular disorders than control cases.Congenital muscle disease may create a disturbance during development of inguinal region possibly with influence of cremaster muscle or other inguinal tissues. Therefore children with muscle diseases must be more carefully physically examined for the presence of urogenital pathologies and paradoxically children with urogenital pathologies must be neurologically examined for the presence of any neuromuscular disorders.

5.Traumatic diaphragma rupture: an experience of 13 cases
Ali Ilker Filiz, Yavuz Kurt, Ilker Sucullu, Ergun Yucel, M.Levhi Akın
Pages 25 - 29
Diaphragmatic injury is a rare condition, but late diagnosis may be associated with increased mortality and morbidity. The aim of this study was to present our experience with the management of this injury. Between 2004 to 2007, 13 patients with traumatic diaphragmatic rupture or diaphragmatic hernia were treated. We described the findings in patients, who had operated urgent or had complaints due to intestinal obstruction months to years after an injury. All patients were male and mean age was 23.1 years. Diaphragmatic rupture was left-sided in all patients. Six of these patients had blunt and the remaining 7 had penetrating trauma. Diagnosis of diaphragmatic rupture was established in less than 24 hours in 4 patients. In the remaining 9 patients, who developed intra- throracic herniation of abdominal organs, diagnostic delay ranged from 12 to 48 months. The most frequent herniated organ was transverse colon. Non-absorbable sutures were used for closure of the defect. Complication rate was 30% and no death was observed. After blunt or penetrating trauma in upper abdomen and distal chest, a high index of suspicion is important to diagnose diaphragmatic rupture. Late presentations are associated with increased morbidity.

OLGU SUNUMU
6.Radiological findings in the primary hyperparathyroid case with multiple brown tumors: a case report
Mehmet Hamdi Sahan, Savas Guner, Sukriye Ilkay Guner
Pages 30 - 34
Primary hyperparathyroidism is a disease characterized with the excess secretion of parathormone. During the course of this disease, bone loss occurs, particularly depending on resorption in the skeletal system. One of the complications of primary hyperparathyroidism is fibrotic, cystic bone pathology which is called brown tumor. We have planned to present a 15-year-old Turkish female patient with primary hyperparathyroidism and multiple brown tumors depending on parathyroid adenoma and to discuss the radiological changes in the presentation article.

7.Pericentric inversion in chromosome 2(p11q13) in two cases
Figen Celep, Ahmet Karagüzel
Pages 35 - 37
Pericentric inversion of chromosome 2 was detected in two cases with cytogenetic analyses. Chromosome analyses were performed on routinely cultured peripheral blood lymphocytes. Slides were processed for trypsin-Giemsa banding. This study, and data from the literature, suggests that the pericentric inversion of chromosome 2 is generally considered a benign familial variant without significant reproductive consequences. Generally, inherited phenotypic or developmental abnormality and, even in a rare de novo form, has been found to be benign. According to the literature, the implications for management in these cases are discussed.

8.Acute stent occlusion due to secondary thrombosis in a patient with romatoid arthritis
Mustafa Tuncer, Hasan Ali Gümrükcüoğlu, Yılmaz Gunes, Hakki Şimsek, Musa Şahin, Ünal Güntekin, İmdat Dilek
Pages 38 - 42
It has been known that rheumatoid arthritis is a risk factor for cardiovascular events. However, secondary thrombocytosis is not accepted as a risk factor for acute myocardial infarctus. We presented a case of acute myocardial infarction associated with secondary thrombocytosis. Primary percutaneous transluminal coronary angioplasty and stenting were performed due to acute myocardial infarction. Then, patient started to receive clopidogrel, aspirin, glycoprotein IIb/IIIa receptor blocker (trofiban) and standard heparin. But, repeated coronary angiography was required due to stent thrombosis, because persistent chest pain and ST elevation at anterior leads were observed approximately 4-6 hours after primary percutaneous transluminal coronary angioplasty. Repeated angiograph revealed acute stent restenosis and then the revascularization was achieved by balloon angioplasty.

EDITÖRE MEKTUP
9.An absence seizure: methylphenidate, clonidine and photic stimulation
Racha Nazir, Karim Sedky, Steven Lippmann
Pages 43 - 44
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