ISSN 1301 - 0883 | E-ISSN: 1309-3886
Eastern Journal Of Medicine - Eastern J Med: 20 (4)
Volume: 20  Issue: 4 - 2015
EDITÖRE MEKTUP
1.A late diagnosis of vein of Galen aneurysm in newborn
Nihat Demir, İbrahim Ece, Abdussamet Batur, Erdal Peker, Oğuz Tuncer
Pages 175 - 176
Abstract | Full Text PDF

DERLEME
2.Hospital infections related with hospital microbial environment
Hüseyin Güdücüoğlu
Pages 177 - 181
This review discusses the important role of contaminated environmental surfaces in contributing to transmission of healthcare-associated pathogens, including the ability of pathogens on dry environmental surfaces, touched by patients and healthcare workers, and so transmission to patients. Contamination of hospital equipment, medicines and water supplies with hospital pathogens is common source of outbreaks of infection. This study reviews several important pathogens including Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin- resistant enterococci (VRE), Acinetobacter baumannii, Pseudomonas aeruginosa, and norovirus that have the ability to survive in the dry-surface environment, which may then become a source for transmission. The role of contaminated environmental surfaces in transmission of healthcare-associated pathogens is also supported by the fact that cleaning and/or disinfection of the environment can reduce the incidence of healthcare-associated colonization or infection.

ORIJINAL MAKALE
3.Ultrasound-guided percutaneous treatment of abscess foci in different localizations of the body: Results of three year-experience
Mehmet Deniz Bulut, Alpaslan Yavuz, Abdussamet Batur, Mehmet Beyazal, Serhat Avcu
Pages 182 - 186
In this study, we evaluated abscess foci which are found in different localizations of the body, diagnosed with US, CT and MRI and performed US-guided percutaneus drainage. We evaluated the effectiveness of treatment, etiologic factors, organs and localizations of abscess in the cases who underwent drainage. A total of 63 patients diagnosed with abscess in different tissues and organs, had US-guided percutaneous drainage performed (34 male, 29 female aged between 1-75 years), and 68 abscess foci were analysed. Abscess size varied between 2.5-21 cm and the mean diameter was detected as 8 cm. Diagnosis of abscess was made with US in 45 cases, CT in 23 cases and MRI in 6 cases. While 48 out of 68 abscess foci were simple, 20 were multilocular and contained septations. Air was observed in 19 of all abscess foci. Clinical findings of abscess completely resolved in 60 out of 63 patients who underwent abscess drainage (95.2%). In 3 abscess, the abscess cavity did not shrink as desired due to multiloculation, dense content, adhesions and fistulization. A drainage catheter had also been inserted, so a decision of surgical therapy was made. Secondary drainage was applied due to recurrence in 2 patients. Thirty two abscess foci (47%) developed postoperatively. Complications were not observed in any of the cases. The duration of catheter was calculated as 5-23 days (mean 10.5 days). US-guided percutaneous drainage should be the primarily preferred method in treatment of abscess and collections as it is easily applicable, does not require general anesthesia, is well tolerated, and has high success and low complication rates.

4.Results of open reduction and Salter innominate osteotomy for developmental dysplasia of the hip
Seyyid Şerif Ünsal, Mehmet Fethi Ceylan, Savaş Güner, Mehmet Ata Gökalp, Uğur Türktaş, Ali Doğan, Abdurrahim Gözen
Pages 187 - 191
We aimed to evaluate the clinical and radiological results of open reduction (OR) and Salter innominate osteotomy (SIO) for patients with developmental dysplasia of the hip (DDH). In this study, the results of 45 instances of OR and SIO treatment on 36 DDH patients between 2004 and 2012 were evaluated retrospectively. 28 (77.77%) of the patients were female and 8 (22:33%) of them were male. The mean age was 28.8 (18-55) and the mean follow-up period was 41.8 months (6-101). A recovery percentage was calculated by measuring the acetabular index on plain radiographs recorded before surgery, immediately after surgery, and final checkup. During patients’ final checkup, the clinical evaluation was performed according to a modified version of McKay’s criteria and the evaluation of the range of the joint motion was carried out according to the Trevor-Johns-Fixen scoring system. The acetabular index values recorded from patients’ hips had an average of 39.9 (35-47) degrees before the operation, but had a mean of 30.5 (20-35) degrees after the operation and an average of 18.5 (10-30) degrees during the final checkup. Clinically, excellent results were obtained in 22 hips (49%), good results were obtained in 17 hips (38%), and satisfactory results were obtained in 4 hips. Two of the patients could not be evaluated since they could not be mobilized due to cerebral palsy. Re-dislocation emerged in 3 hips (6.6%), deep infection emerged in 1 hip (2.2%), and a supracondylar femur fracture emerged for 1 patient (2.2%). OR and Salter’s innominate osteotomy is a highly effective surgical technique in the treatment of DDH cases that have lasted more than 18 months.

5.Family factor, treatment options and evaluation of results in pes equinovarus disease
Abdurrahim Gozen, Mehmet Ata Gokalp, Seyyid Şerif Unsal, Savas Guner
Pages 192 - 198
In this study, we analyzed the patients who had applied to Yüzüncü Yıl University Medical Faculty due to pes equinovarus between 2011 and 2013 and treated with the Ponseti method. Thus we evaluated 56 feet of 38 patients in the early-treatment period and the factors affecting the treatment. All of the patients were systematically examined before and after the treatment. For the feet that had anomaly we used the scale that was used by Dimeglo et.al. Averagely 7.5 plaster casts were applied to the feet of the patients (range: 3-16). In patients with PEV, after the recovery of hindfoot varus and forefoot adduction in 48 feet in which equine deformity, achillotomy operation was applied under local anesthesia with mini open technique. After plastering, Steenbeek orthosis was applied to the feet. Average follow-up time was 14 months (range 5-28 months). In patients with PEV, the most commonly recurred component was metatarsus adductus. While this rate was 36% in idiopathic PEVs, in complex PEVs it was 83%. The plantigrade walking ratio in patients with idiopathic PEV was 92%. In patients with idiopathic PEV, the compliance with orthosis was 81% whereas in patients with complex PEV it was 33%. In addition to this, except one patient, in all patients with complex PEV recurrence was observed and additional treatments were made for these patients. The final Dimeglio score of the patients with idiopathic PEV was very good in 16 feet, good in 6 feet. On the other hand, in patients with complex PEV, this score was very good in 4 feet, good in 3 feet, and bad in 1 foot. The most important recurrence reason for PEV was non-compliance with orthosis. The reasons for non-compliance with foot abduction orthosis are as follows: long processing time the negative psychological effects of orthosis on families and considering orthosis as unnecessary since the correction in the feet was seen by the family. The education level of the family is an important risk factor for the development of recurrence. In this sense, it was determined that the recurrence risk was 10 times higher in the families whose education level was high school and below in comparison to the families with university degree. We achieved success at a rate of 92% in manipulation and plastering treatment of PEV which was materialized by Ponseti method. The most important factor affecting the treatment was the continuity of the treatment and the compliance with orthosis.

6.17ß estradiol / norethisterone acetate and estradiol valerate / norgestrel therapies in patients with dysfunctional uterine bleeding: The effects on estrogen and progesterone receptor levels and clinical response
Mevlüde Ayik, Metin Ingec, Necla Konar Ustyol, Cemal Gundogdu
Pages 199 - 203
To compare estrogen receptor (ER) and progesterone receptor (PR) levels before and after estradiol valerate/norgestrel or 17ß estradiol/norethisterone acetate therapy in dysfunctional uterine bleeding (DUB) and to examine the clinical response to these therapies. The study was performed with 60 patients diagnosed with DUB. Patients were divided into two groups. One was given 17ß estradiol / norethisterone acetate (group A) and the other estradiol valerate / norgestrel (group B). Pre- and post-treatment clinical parameters and ER and PR levels were measured. Changes in ER levels following treatment were significant in both groups, while the change in PR levels was significant in the group B (p<0.05). Compared to the pre-treatment levels, an increase in hemoglobin-hematocrit values, decreased endometrial thickness and prolongation of menstrual cycle were observed in both groups (p<0.05). Furthermore, pre- and post-treatment bleeding was significantly shorter in group A (p<0.05). Clinical responses obtained with hormonal preparates in the treatment of DUB are associated with decreases in ER and PR levels. A correlation can be established between determination of receptor level at the begining of treatment and clinical response.

7.Longitudinal reference intervals for ductus venosus Doppler indices
Lale Usta, Necla Konar Ustyol, Ragıp Atakan Al
Pages 204 - 209
To perform a longitudinal investigation to establish reference intervals for repeated measurements for ductus venosus indices in women in weeks 15-40 of pregnancy. Ductus venosus Doppler investigation was performed by inviting the pregnant women included in the study for ultrasonography once every four weeks. Several indices were designated in order to define ductus venosus wave form, using peak velocity atrial contraction (a), systolic peak velocity (S) and diastolic peak velocity (D) values. The association between ductus venosus S, A, and D flow rates (Vs, Vd Va) and the S/A, PVIV and PLI indices calculated using these parameters and week of pregnancy was then investigated. Va and PLI exhibited a significant correlation with gestational weeks and increased with gestational age (p? 0.05). S/A and PVIV indices decreased significantly with week of pregnancy (p? 0.05) Ductus venosus measurements being performed near the central part of the vein elicited lower absolute flow rates. This resulted in different reference intervals to those of other studies for these designated parameters.

8.The effects of lymphatic massage on serum lipid levels and venous flow in patients with lymphedema
Meral Ekim, Hasan Ekim, Yunus Keser Yılmaz, Zeynep Tuğba Özdemir
Pages 210 - 214
Interstitial fluid proteins play an important role in cholesterol homeostasis. Accumulation of protein rich fluid in interstitial tissue leads to lymphedema. Current study aimed to evaluate the effects of manuel lymphatic drainage (MLD) on the serum cholesterol and trigliserid levels and venous flow changes. Our study included thirty patients with lower limb lymphedema. MLD treatment was performed after measurements of pretreatment serum cholesterol and triglyceride levels of the patients. Four to ten days after MLD treatment serum cholesterol and triglyceride levels were measured again. The caliber of femoral vein and mean flow velocity changes were also examined by venous Doppler ultrasonography. The statistical comparisons were done by using paired sample t-test. P<0.05 values were accepted as significant. There were six male and twenty-four female patients ranging in age from 34 to 70 years Pre-treatment, mean serum cholesterol levels was 182±39 mg/dl and triglyceride levels was 123±47 mg/dl. Post-treatment mean serum cholesterol and triglyceride levels were 196±42 mg/dl, and 127±52 mg/dl respectively. Post-treatment serum cholesterol and triglyceride levels were found to be significantly high. The caliber and mean flow velocity of femoral vein were also significantly increased after MLD. MLD effectively decreases the interstitial lymphatic fluid volume, alleviates the symptoms and improves the quality of life. MLD also significantly increases mean serum cholesterol and triglyceride levels and increases venous flow.

9.The use of methylene blue as mouthwash in periodontology
Burak Ak, Esma Özeroğlu, Mehmet Taspinar
Pages 215 - 221
The aim of this study is to investigate the cytotoxicity effects of methylene blue on the human gingival fibroblasts cell-lines in vitro. 3T3 human gingival fibroblast cell-lines were used to evaluate the cytotoxicity of mouthwashes containing methylene blue and chlorhexidine gluconate. The cultured fibroblasts were divided into two groups which subjected into chlorhexidine gluconate or methylene blue in vitro. The cells viability was determined at 30 seconds, 1 minute and 3 minutes of exposure to mouthwashes using by XTT colorimetric assay. Spectrophotometric absorbance was measured at 550 nm using ELISA analyzer. The IC50 values were calculated for each time points for methylene blue and chlorhexidine gluconate mouthwashes. The effect of the methylene blue and chlorhexidine gluconate on the human gingival fibroblast viability was expressed as a percentage of the control groups. Comparison between two groups in different time and concentration values showed that, chlorhexidine gluconate were found to be more cytotoxic on gingival fibroblast than methylene blue. Cell viability exposured to methylene blue in 1% concentration during 3 minutes was 99% and in 100% concentration the cell viability was 88%. The chlorhexidine gluconate at the same conditions was 92% and 18% respectively. Our study demonstrates that 100% chlorhexidine gluconate (0.2% chlorhexidine gluconate concentration in commercially available products) has much more cytotoxic effect than methylene blue to human gingival fibroblast at clinical use time and different concentrations in vitro.

ORIGINAL ARTICLE
10.A prospective evaluation of patients with tuberculosis peritonitis
Eşref Araç, Hakan Temiz, Hakan Yıldız, İdris Oruç, Serdar Polat
Pages 222 - 227
INTRODUCTION: Peritoneal tuberculosis is one of the common form of abdominal tuberculosis and leading cause of ascites in developing countries. We aimed to evaluate the distribution, demographic characteristics, physical examination findings, laboratory and imaging results of patients with tuberculous peritonitis in our clinic.
METHODS: A total of 21 patients diagnosed with tuberculous peritonitis admitted to Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Clinic of Internal Medicine, Istanbul, Turkey, were prospectively included in the study. The distribution, demographic characteristics, physical examination findings, laboratory and imaging results of patient with tuberculous peritonitis were analysed
RESULTS: 19 of the cases (81.5%) were female, mean age was 27.6 years (range 15-57). Two cases (9.4%) had underlying disease or facilitators. One of the cases (4.7%) had active pulmonary tuberculosis. Accompanying abnormal laboratory findings; increased erythrocyte sedimentation rate in all patients (%100), anemia, increased ascitic fluid adenosine deaminase levels and increased serum CA-125 levels. Chest radiograph were normal in 13 (62%) of the patients. Mycobacterium tuberculosis was not isolated from any of the samples taken for culture of 21 cases. During the period of hospitalization, mortality was found in one person
DISCUSSION AND CONCLUSION: Peritoneal tuberculosis is common in developing countries such as our country and should be considered in patient with fever, weight loss, abdominal pain, ascites in differential diagnosis. Early diagnosis and treatment will be able to prevent development of complications and mortality

OLGU SUNUMU
11.A rare cause of myocardial infarction: Blunt chest trauma
Şeref Kul, Aytac Akyol, Müntecep Aşker, Musa Sahin, Okkes Taha Kucukdagli, Huseyin Uyarel
Pages 228 - 230
Blunt chest trauma is a rare cause of myocardial infarction. If the diagnosis is delayed, serious complications may occur. To prevent them, electrocardiography should be performed to all patients with chest pain after blunt chest trauma. In the event of myocardial infarction, coronary angiography should be performed as soon as possible and appropriate management interpreted according to clinical situation.

12.Neurophysiotheraphy and its effects on school performance
Erna Zgur
Pages 231 - 234
This article shows the school achievement results in reading and writing of a female pupil in primary school with adapted programme and lower educational standards. Cerebral palsy and impaired mental development, manifests various mobility and academic deficits. Case study shows how individual therapies (neurophysiotherapy, based on the concept of Neurodevelopmental Treatment (NDT), and hipotherapy) influence reading and writing performance in a child with special needs. The effects of a direct therapeutic treatment are reflected in results achieved at individual tasks. The aim of the study was to establish the correlation between a therapy type and its effects on the task performance. To demonstrate the effects of a therapy type on the task performance, the statistical method of chi - square test was used. The results of four observations showed that NDT has a significant effect on completion time in a text writing task. The most significant effect on the reading performance was demonstrated by the NDT before class.

13.A rare cause of metabolic acidosis; Hypoplastic left heart syndrome
Nihat Demir, İbrahim Ece, Kaan Demirören, Nesrin Ceylan, Erdal Peker, Oğuz Tuncer
Pages 235 - 237
Metabolic acidosis is a common problem especially in newborns. Metabolic acidosis develops due to acid deposition rather than HCO3 loss in body fluids. It separates into two groups as anion gap normal and anion gap increased depending on anion gap level. Metabolic diseases, neonatal sepsis, congenital adrenal hyperplasia and congenital heart diseases should be thought with the observation of metabolic acidosis in a previously healthy infants. NaHCO3 infusion, renal replacement treatment and tamps like karbicarb, dichlora acetate, tromethamine are used for treatment of congenital heart diseases or lactic acidosis secondary to hypoxia. In this article we want to emphasize there are not only congenital metabolic illnesses under this non-response acidosis table but also there are congenital heart diseases which are in substantial rate.

14.Massive gastrointestinal bleeding due to vitamin K deficiency in a newborn
Nihat Demir, Erdal Peker, Kaan Demirören, Sultan Kaba, Oguz Tuncer
Pages 238 - 240
Early hemorrhagic disease of the newborn is a disease resulting from vitamin K deficiency, developing within the first 24 hours after birth. The disease may develop in babies born to mothers treated with anticonvulsants and antituberculous drugs, and sometimes as an idiopathic state despite prophylaxis with vitamin K. In this article, a case of early hemorrhagic disease in a newborn, presenting with a course of abundant gastrointestinal bleeding, has been discussed, who was born to mother with no risk factors and no history of drug use during pregnancy, with the disease onset in the first 24 hrs after birth despite administration of 1 mg vitamin K. With this article, we intended to point out that idiopathic early hemorrhagic disease may develop in newborns.

15.A rare case that can be diagnosed with prenatal ultrasound: Fryns syndrome
Fatma Beyazal Çeliker, Nesrin Ceylan, Arzu Turan, Mehmet Beyazal
Pages 241 - 244
Fryns syndrome is a syndrome that is accompanied by multiple congenital anomalies, with extremely high mortality, showing autosomal recessive inheritance and often leaves severe mental retardation on those who survive. Abnormal facial appearance, distant faded nipples, small rib cage, distal extremity and nail hypoplasia, pulmonary hypoplasia and diaphragmatic hernia are among major criteria for the diagnosis. Later, cardiovascular, genitourinary, central nervous system and skeletal system anomalies have been identified. Here, we presented Fryns syndrome case which has been diagnosed by prenatal ultrasound, and of which the diagnosis has been confirmed by physical examination and ultrasound at the postnatal period.

16.Abnormal origin of the left coronary artery from the pulmonary artery (ALCAPA): A rare case report
İbrahim Halil Altıparmak, Aydemir Koçarslan, Muslihittin Emre Erkuş, Uğur Aktı, Remzi Yılmaz
Pages 245 - 247
Abnormal origin of the Left Coronary Artery from the Pulmonary Artery (ALCAPA) syndrome is a rare congenital coronary anomaly (1/300000 live births). Generally most of the patients with the anomaly die in childhood because of several reasons. It is seen that only a few patients survive up to adulthood in the literature. We report a 39 years old man with the anomaly which reached adulthood and successfully treated surgically.

17.Psychosis with vitamin B12 deficiency and increased extrapyramidal side effects: A case report
Emine Füsun Akyüz Çim, Özgür Deniz Değer
Pages 248 - 250
Vitamin B12 is a methyl donor important for the continuity of neuronal metabolism. Deficiency in vitamin B12 has been associated with a variety of neuropsychiatric pathologies that include extrapyramidal symptoms such as mood disorders, depressive disorder, delirium, and paranoid psychosis. Extrapyramidal symptoms are also associated with factors such as gender, age, and the presence of a mood disorder. Novel generation antipsychotics are less likely to cause extrapyramidal symptoms than typical antipsychotics due to their selective anti-dopaminergic action and antagonistic effects on serotonin receptors. The present case report describes a patient with psychosis in which a vitamin B12 deficiency not only complicated the treatment of extrapyramidal symptoms, but also tended to increase them.

18.Galactorrhea case unrelated to the hyperprolactinemia caused by paliperidone use: A case report
Emine Füsun Akyüz Çim, Numan Çim, Özgür Deniz Değer
Pages 251 - 253
Paliperidone is an atypical antipsychotic derived from the combination of 9-hydroxy risperidone which is an active metabolite of risperidone with OROS (osmotic controlled-release oral delivery system) technology. Galactorrhea may develop as a result of hyperprolactinemia caused by paliperidone use. In our case, paliperidone was added to the treatment of a 35-year old female patient having a hypomanic episode. 2.5 months after the start of paliperidone treatment, the patient experienced galactorrhea and menstruation delays. Unexpectedly, normal hyperprolactinemia does not accompany galactorrhea and other symptoms.

19.Cough-induced rib fracture: A case report
Aysel Sünnetçioğlu, Abdussamet Batur
Pages 254 - 255
Coughing is a crucial defense mechanism that prevents the entry of foreign material into the tracheobronchial tree. It is generally self-limited and uncomplicated, but complications may develop especially when the cough is violent and paroxysmal. Rib fractures are one of these complications. In this case report, we describe a cough-induced rib fracture

20.A giant solitary fibrous tumor of the pleura: A case report
Aysel Sünnetçioğlu, Abdussamet Batur, Selami Ekin, İrfan Bayram
Pages 256 - 258
Solitary Fibrous Tumor of the Pleura (SFPT) are rare neoplasms and can have giant diameters. Immunohistochemical analysis has confirmed that SFPTs originate from the mesenchyme underlying the mesothelial layer of the pleura. SFPTs are usually asymptomatic. However, larger tumors occupying larger spaces in the thoracic cavity present more commonly with symptoms like dyspnea or chest pain. In this case report, we present a giant SFPT in a 71-year-old woman who presented with chest pain on the left side and progressive dyspnea over the previous 4 years.

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