ISSN 1301 - 0883 / E-ISSN 1309 - 3886

  Eastern J Med: 18 (1)
Volume: 18  Issue: 1 - 2013
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1.Ultrastructural and immunohistochemical evaluation of endometrial tissues of infertile women with recurrent implantation failure
Leyla Bahar, Semra Kahraman, Bora Reşitoglu, Tülin Baykal
Pages 1 - 7
To evaluate endometrial tissues of fertile women and the women with recurrent implantation failure (RIF) analyzed by using transmission electron microscopy (TEM) and MUC1 immunohistochemistry. In this study, 23 patients with RIF and 11 fertile women participated. Endometrial tissue samples were examined by light and electron microscopes. Additionaly, MUC1 immunoreactivity was evaluated. Electron microscopic examination of the endometrial surface epithelial cells of the recurrent implantation failure revealed lots of cytoplasmic extensions containing secretory vacuoles and irregular microvilli. Furthermore, most of the endometrial cells exhibited secretory vacuoles in the supranuclear region. Immunoreactivity of MUC1 was detected weakly in the luminal epithelium of the control group whereas the staining intensity was conspicuous in RIF group. Significant differences between the groups with respect to glandular epithelium were found. Endometrial tissues of both fertile women and women with RIF were thought to be important in regulating the stage for embryo implantation. Further studies should be done to have a better understanding of factors involved in the establishment of endometrial receptivity.

2.Living in rural areas is a major risk factor for severe burn injury in Turkey
Mehmet Akin Tarim
Pages 8 - 12
The surroundings and lifestyle that are typical of rural areas are less safe than those of urban areas. This retrospective study analyzed risk factors of the patients with burn injuries who lived in rural areas. Between January 2000 and June 2011, 1145 patients were hospitalized in the Adana burn unit of Baskent University of whom 600 (52.5%) lived in rural areas and 545 (47.5%) lived in urban areas. The two groups were compared with respect to demographic characteristics, cause of burn injury, severity of burn injury, and length of hospital stay. The treatment methods used were recorded in the burn treatment registry. In this study, burns occurring in rural areas were deeper, larger, and caused more deaths than those occurring in urban areas, which may be due to the characteristics of the rural population, including the unavailability of transportation to the burn units. Rural burns were more frequent and more severe than urban burns, which demonstrate the importance of appropriate prevention directed at rural populations.

3.A study of epidemiological factors affecting low birth weight
Humera Hayat, Parwez Sajad Khan, Gazala Hayat, Rehana Hayat
Pages 13 - 15
About half of all deaths in perinatal period are directly or indirectly related to low birth. A multifactorial inter-relationship exists between the pregnant mother’s environment and growth of fetus. There are numerous factors associated with low birth weight and if these factors are detected early and addressed properly, the low birth weight and the consequences thereof can be reduced. To identify the epidemiological factors affecting low birth weight in our set up.This a cross sectional study. August 2010 to July 2011. A total of 500 recently delivered mothers with alive born babies.Chi-square test was used in statistical analyses. Maternal age, socioeconomic and educational status, interpregnancy interval and number of antenatal visits along with maternal anemia, hypertension and urinary tract infection, during pregnancy were significantly associated with low birth weight. Proper health education along with over all socioeconomic development, are the very important steps to be taken to decrease the incidence of low birth weight.

4.The effect of the revascularization strategies on the severity of ischemic moderate mitral regurgitation
Korhan Soylu, Cahit Kocakavak, Sabri Demircan, Diyar Köprülü, Serkan Yüksel, İhsan Dursun, Kenan Durna, Mustafa Yazıcı, Mahmut Şahin, Özcan Yılmaz
Pages 16 - 22
Although it is known that revascularization is useful for the treatment of patients with ischemic mitral regurgitation (MR), the effects of revascularization on MR have not been well examined. In this study, we aimed to show the effect of revascularization strategies on patients with moderate ischemic MR, quantitatively and prospectively. Forty-seven patients with moderate MR (2 to 3 +) who were offered revascularization due to the diagnosis of coronary artery disease were enrolled in the study. Patients were divided into three groups according to their treatment strategies. Patients who underwent percutaneous coronary intervention (PCI) were defined as group 1 (n=18), patients who underwent surgical revascularization (CABG) as group 2 (n=17) and patients who received only medical treatment as group 3 (n=12). Transthoracic echocardiography (TTE) was performed for all patients at the beginning of the study, and after three months. MR grading was performed using semi-quantitative (I-IV) and quantitative (EOA, RV, and RF) methods. Initial MR grading parameters of the three groups were similar. When the initial and the third month MR parameters of patients were compared, there was a significant decrease in group 1 in effective orifice area (EOA) (p=0.002), regurgitant volume (RV) (p=0.005), regurgitant fraction (RF) (p=0.002) and semi-quantitative MR (p=0.002). There was also a significant decrease in group 2 in EOA (p=0.002), RV (p=0.001), RF (p=0.001) and semi-quantitative MR (p=0.005) grades after 3 months. However, mitral regurgitation severity was not changed with medical treatment in group 3. . There was no difference between groups when residual MR grades at the third month were compared with each other (p>0.05). Our study showed that percutaneous or surgical revascularization strategies significantly improved MR parameters, on the other hand no improvement was obtained with medical treatment. In spite of the improvement in the severity of MR, there were still significant residual MR after revascularization strategies without valvular intervention. For this reason it can be suggested that revascularization strategies without valvular intervention is effective but not sufficient for the treatment of patients with ischemic MR.

5.Double superior vena cava (persistent left superior vena cava draining into the coronary sinus) - case report
Mustafa Yurtdaş, Musa Şahin
Pages 23 - 25
A 24-year-old woman with no relevant cardiac history presented for evaluation of palpitation and chest pain. Electrocardiography showed non-specific ST-T wave changes in inferior leads. Transthoracic echocardiography showed a dilated coronary sinus. The thoracic computed tomography (CT) scan with contrast showed the normal right superior vena cava and the persistent left superior vena cava (PLSVC) draining into the right atrium through the coronary sinus. Transthoracic echocardiography - including agitated saline infusion to both antecubital veins - and computed tomography are important non-invasive diagnostic tools for accurate diagnosis of this rare congenital venous malformation. This malformation is quite frequently found, especially with the advent of cardiac ultrasound or CT, magnetic resonance imaging (MRI).

6.Fat embolism: A report of three cases
Elif Tanrıverdio, Aysegul Karalezli, Aysegul Senturk, Berna Botan Yildirim, Hatice Canan Hasanoglu
Pages 26 - 31
Fat embolism syndrome (FES) is a rare complication which usually follows long bone fracture. Clinical manifestations present immediately or 24 to 72 hours after injury. Symptoms are dyspnea, tachypnea, tachycardia, fever, mental status changes and petechial rashes. We reported three cases of FES. The first case had admitted to the pulmonology department with confusion and respiratory distress within 24 hours after tibia fracture. He had petechial rashes on the axillar area and subconjunctival hemorrhages. He was diagnosed as FES and treated. The second case who had right femur fracture had stupor after 48 hours. He had axillary petechial rashes and respiratory distress. He was diagnosed as FES and treated. The third case had admitted to the pulmonology department with the complaints of axillary petechial rashes, subconjunctival hemorrhages after a pelvic fracture. Both first and second patients who had respiratory failure intubated. The third patient died despite treatment. The signs of this syndrome must be carefully examined and considered in the diagnosis of the patients which attend the emergency service with confusion and petechial rashes after long-bone fractures.

7.Asymptomatic bilateral Köhler's disease: A case report
Savaş Güner, Albert Çakar, Mehmet Fethi Ceylan, Ali Murat Kalender, Mehmet Hamdi Şahan
Pages 32 - 33
Köhler’s disease is the idiopathic osteochondrosis of the tarsal navicula. It is an uncommon disorder of the foot. Köhler’s disease is a bening disease and recoverable itself. Main symptom of the disease is pain in the midfoot. Treatment is symptomatic. Generally, surgery is not necessary. The popular choices of treatment are shoe support and cast immobilization. In this article, we presented a-six year old boy who had bilateral Köhler’s disease.

8.A type of progressive myoclonic epilepsy, Lafora disease: A case report
Ömer Bektaş, Arzu Yılmaz, Aylin Heper Okcu, Serap Teber, Erhan Aksoy, Gülhis Deda
Pages 34 - 36
Lafora disease is a rare group of progressive myoclonic epilepsies characterized with progressive neurological dysfunction, myoclonus, focal and generalized seizures. Generally, a generalized tonic clonic seizure is the first symptom of the disease. An 11-year-old male patient had been followed-up at another center for epilepsy for 8 years. The patient had a history of myoclonic seizures for nearly every day for the last 2 years and cognitive detoriation for the last 8 months. He admitted to our hospital with the desire of his family. Eccrine sweat gland biopsy was performed. The biopsy of the sweat gland was positive for PAS and contained diastase resistant polyglican content (Lafora bodies), and thus, a diagnosis of Lafora disease was established. The patient presented here constitutes a rare case of pediatric epilepsy, which caused neurodegeneration in late-childhood and onset with typical epilepsy symptoms. This report also aimed to show that biopsy obtained from proper area is important for diagnosis Our patient developed cognitive dysfunction a short period of eight months. To our knowledge, this is the shortest period in literature.

9.Recurrence of tuberculosis as a cerebral abscess in a patient with systemic lupus erythematosus
Felipe Montes Pena, Raphael Freitas Jaber de Oliveira, Andréya Moreira de Souza Soares Machado
Pages 37 - 40
Infections are a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Treatment with immunosuppressive drugs can decrease the clonal proliferation of T cells and is the main predisposing factor for tuberculosis (TB). Clinically, the extrapulmonary TB is frequent in patients with SLE due to reactivation of latent foci of primary infection or simply a reinfection. A case of young woman who presented with cerebral TB. The diagnosis was established by biopsy, which showed chronic granulomatous inflammation with areas of central necrosis, with isolated Mycobacterium tuberculosis. There is increasing evidence suggesting an increased severity of TB in SLE patients. This report demonstrates the necessity of monitoring the increased susceptibility to infections in SLE patients.

10.Advance stage small cell neuroendocrine carcinoma of cervix: A case report
Yasam Kemal Akpak, Ismet Gun
Pages 41 - 44
Neuroendocrine small cell carcinoma of the uterine cervix is an entity with very aggressive behaviour. The optimal initial therapeutic approach to this rare disease has not yet been clearly defined. These tumors are difficult to manage. It is often diagnosed at an advanced stage and its prognosis is generally poor. In this paper, a 44-year-old woman with small cell neuroendocrine tumor of the cervix presenting with widespread metastasis is reported. Literature provides limited research on the issue and the reported research involves only small series and case reports on neuroendocrine small cell cervical carcinoma. Neuroendocrine differentiation can be shown by several methods. The most important of all these methods is immunohistochemical study. Surgery, radiotherapy, and chemotherapy have been used either alone or in combination. The purpose of this case is to evaluate this rarely seen, aggressive, malignant cervical tumor with poor prognosis, and thus, make some contribution to the literature.

11.The role of diffusion weighted imaging in demonstrating communication between periuterine collection and uterine cavity following caesarean section
Vivek Singh, Vaishali Tomar, Sunil Kumar, Rakesh K. Gupta
Pages 45 - 47
A 32 year-old woman presented with pelvic collection and fever following caesarean section. Diffusion weighted MRI showed the exact nature and cause of the collection, which on ultrasound appeared like tubo-ovarian mass. She was kept on conservative management and the collection was followed with repeated sonography until its complete resolution.

12.Antenatal diagnosis of placenta increta and its successful conservative management with methotrexate
Ayse Güler, Nermin Kosus, Arzu Turan, Zeki Mil
Pages 48 - 51
Growing number of cesarean deliveries lead to the increased frequency of abnormally invasive placentation. Success in the management of placenta accreta relies on accurate early diagnosis with appropriate perioperative multidisciplinary planning to anticipate and avoid massive obstetric haemorrhage at delivery. In this report, a case of placenta previa increta that was diagnosed antenatally with ultrasound and magnetic resonance imaging and managed conservatively with methotrexate was presented with the discussion of literature.

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