Anatolian Clinic Journal of Medical Science / Anadolu Kliniği Tıp Bilimleri Dergisi

169-172

Authors: Orhan Alimoglu, Tunc Eren, Kerem Tolan, Ali Kilic, Tamador Shamaileh, Gurhan Bas

Aim: Currently, the primary method for assessing the prognostic differences among patients is the tumor-node-metastasis (TNM) staging system developed by the American Joint Committee on Cancer (AJCC). Our aim was to evaluate the incidence of the presence of pericolonic tumor deposits in patients operated on for colorectal cancer, and to demonstrate its relation with tumor stages. Materials and Methods: The pathological findings of a total number of 190 patients who underwent surgical resections for colorectal cancer were evaluated retrospectively. Staging was carried out according to the 7th edition of the AJCC staging manual. Results: Among all 190 colorectal cancer patients, a total of 30 (15.8%) patients were detected to harbor pericolonic tumor deposits. In the final pathology reports, 66.6% of the patients were reported as T3, and 46.6% were reported as N1c. Thus, 56.6% of the patients were reported as Stage IIIB. Discussion and Conclusion: In the absence of other evidence of lymph node involvement, the presence of pericolonic tumor deposits results in the reclassification of the disease from Stage II to Stage III. The fact that Stage III disease necessitates adjuvant treatment puts forth an emphasis on the importance of upstaging due to the presence of tumor deposits.

179-186

Authors: Vahdet Gormez, A. Cahid Orengul, Omer Faruk Ozer, Selcuk Uzuner, Sehabettin Selek

Aim: Research investigating association between attention deficit/hyperactivity disorder (ADHD) and oxidative stress have reported conflicting and inconsistent findings. We aimed to investigate a novel oxidative stress marker, thiol/disulphide homeostasis, in patients with ADHD and compare the results with the healthy control group. Materials and Methods: A total of 47 medication naïve children and adolescents (35 boys and 12 girls) aged 6–17 years with a diagnosis of ADHD were investigated for oxidative stress parameters and results were compared with that of 41 subjects (28 boys and 13 girls) matched for age and gender. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (KSADS-PL) was conducted to support ADHD diagnosis and to exclude comorbid psychiatric disorders. Thiols, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI) levels were measured in serum samples in addition to myeloperoxidase (MPO) and dynamic thiol/disulphide homeostasis. Results: TOS, OSI and MPO levels were significantly lower in ADHD group (p=0.001, p=0.022, p=0.007, respectively). Predominantly inattentive type ADHD had significantly higher levels of TAS (p=0.014) and TOS (p=0.01) than those with combined ADHD subtype. Oxidative stress index (OSI) levels decreased with increasing age in both ADHD and control groups as well in the whole sample when control and patient groups were tested together (r=-0.376, p=0.009; r=-0.479, p= 0.002; and r=-0.367, p<0.001, respectively). TAS scores significantly increased with age in ADHD group (r= 0.523, p<0.001). Thiol/disulphide homeostasis showed no difference. Discussion and Conclusion: The current study reveals no association between pediatric-age ADHD and thiol/disulphide homeostasis. The nature of relationship between oxidative stress and ADHD needs to be clarified with methodologically robust studies.

197-206

Authors: Seyit Ankarali, Ersin Beyazcicek, Handan Ankarali, Serif Demir

Aim: Approximately fifty million people in the world suffer from epilepsy, and a large part of these patients are resistant to antiepileptic drugs discovered so far. In addition, side effect profiles of these drugs are very wide. Rapamycin that is an inhibitor of mammalian target of rapamycin (mTOR) has antineoplastic, aging-retarding, and anti-inflammatory effects. The studies regarding the effects of mTOR on nervous system have shown that it has neuro-protective effects. Moreover, it has been reported that use of rapamycin reduces epileptic seizures in tuberous sclerosis patients. In this study we aimed to investigate acute effects of the mTOR inhibitor rapamycin on penicillin-induced experimental epilepsy in rats. Materials and Methods: In this study, a model of forty adult male Wistar rats with penicillininduced experimental epilepsy was used. The forty rats were divided into five groups, which were saline group, solvent (dimethylsulfoxide) group, and 0.1 mg/kg, 0.4 mg/kg and 0.8 mg/kg rapamycin groups. All substances were administered intraperitoneally. After the administration of 1.25 g/kg urethane for anesthesia, the left part of each rat’s skull was opened and electrodes were placed on the brain. Electrocorticography recording was initiated. Penicillin was intracortically administered two hours after the administration of rapamycin. After the administration of penicillin, electrocorticographic data were recorded for another two hours. Results: In rapamycin-treated rat groups, administration of 0.4 mg/kg and 0.8 mg/kg rapamycin significantly reduced epileptic spike-wave frequency and amplitude of epileptiform activity. However, when compared in terms of latency no significant difference was found between the groups. Discussion and Conclusion: Acute administration of rapamycin reduced spike-wave frequency and spike-wave amplitude of penicillin-induced epileptiform activity in the rats, and these findings indicate that rapamycin has an antiepileptogenic potential.

215-217

Authors: Dilşad Yıldız Miniksar

Netherton syndrome is a rare and autosomal recessive form of ichthyosis characterized by ichthyosis linearis circumflexa, trichorrhexis invaginata and atopic manifestations. Mental retardation may be also observed in some patients. We present here a rare case of Netherton syndrome with mental retardation.

223-234

Authors: Hakan Ertin, M. Kemal Temel

Due to the human experimentation conducted in the Nazi Germany in the past, the subsequent Tuskegee syphilis and Guatemala STD studies, and the ongoing clinical pharmaceutical trials, potential harms to and exploitation of human subjects have long been discussed as a serious problem. Especially during the trials held in Nuremberg regarding the human experimentation that had been conducted by Nazi scientists the important lack of an internationally binding regulatory code was recognized, and the Nuremberg Code was created and adopted by countries to fill this gap. Given the ongoing in vivo pharmaceutical trials, in vitro procedures, stem cell research, etc., more various and complicated scientific research than ever before is conducted today on humans and human cells and tissues. The main tension in the field of human experimentation is between potential harms to the human subjects and potential benefits for science and humanity. A variety of scientific and ethical codes and rules have been developed and declared both in ethical declarations and in legal regulations in order to proceed to achieve these benefits without harming the subjects. In parallel with changes in these trials and research, these texts have also been either modified or supplemented by new texts. The Helsinki Declaration, for instance, has been revised for seven times up to the present. This systematic review aims to provide a source that gathers these nationally and internationally binding ethicolegal texts concerning human experimentation.

97-104

Authors: Süreyya Ekem, Nida Fatma Taşcılar, Esra Acıman Demirel, Banu Özen Barut, Handan Ankaralı, H. Tuğrul Atasoy

Aim: Typical antipsychotics and clozapine could cause EEG abnormalities and risk of epileptic seizures. Little is known about the effects of newer antipsychotics on EEG. The present study therefore examined the risk of EEG abnormalities associated with the use of atypical antipsychotics [clozapine, quetiapine, risperidone, olanzapine and new atypical antipsychotics (amisulpride, aripiprazole, paliperidone)] and of the typical antipsychotics (chlorpromazine, haloperidol, zuclopenthixol, pimozide). Materials and Methods: EEG patterns were prospectively investigated in 102 patients with schizophrenia or schizoaffective disorders. While 82 out of the 102 patients were under atypical [clozapine (n=16), risperidone (n=20), quetiapine (n=10), olanzapine (n=14), and new atypical antipsychotics (n=10)] and typical [haloperidol (n=5), chlorpromazine (n=2), zuclopenthixol (n=3), pimozide (n=2)] antipsychotic treatment, 20 of them were not under any treatment. These three groups were compared with a sex- and aged- matched control group of healthy volunteers (n=29). Results: No statistically significant difference regarding demographic characteristics was found between the groups. Both the patients who were not on any medication and the healthy volunteers had normal EEG’s. Epileptic activity was observed in 31.3% of the patients under clozapine treatment (p<0.05) and in 10% of the patients under quetiapine treatment (p>0.05). EEG abnormalities other than epileptic activity were observed in 58.3% of the patients under typical antipsychotics (p<0.01) and 35% of the patients under risperidone treatment (p<0.01). EEG was normal in 78–80% of the patients using quetiapine and new atypical antipsychotics, compared to 33.3% of the patients under typical antipsychotic treatment (p=0.012). Discussion and Conclusion: Herein, we found that clozapine was the most epileptogenic antipsychotic and that typical antipsychotics were making the worse EEG changes. Nevertheless, in the psychotic patients under clozapine treatment EEG is a must. Psychotic patients with consequential epilepsy could be given new atypical antipsychotics because it has the least unwanted effects on EEG. Moreover, it should also be emphasized that there is a need for further scientific research to clarify all aspects characterizing the complex link between seizure threshold and psychotropic drugs.

119-128

Authors: Nurten Elkin

Aim: In this study, we aimed to determine the preferred mode of delivery and the related factors in women aged 18–49 years who applied to a family health center. Materials and Methods: This is a descriptive study based on a questionnaire applied to the 307 women aged 18–49 years who applied to a family health center in the central Istanbul and had a history of pregnancy. The data were analyzed by the SPSS (Statistical Package for the Social Sciences) 16.0 software. Results: During the survey, 24.4% of the women were pregnant and 91.8% had a previous delivery, of whom 46.8% had a Cesarean section. 49.2% of those who had had a delivery reported that their doctors had decided on the mode of delivery. 54.4% of those who had a normal delivery the last time they gave birth reported that they preferred normal delivery because they thought it to be the natural way of giving birth. For 73.1% of those who had a delivery by Caesarean section, the operation was medically indicated. 81.4% of the women who were pregnant at the time of the survey reported that they were planning about the mode of delivery; and 68% of these reported that they were thinking of having a normal delivery. A statistically significant correlation was found between the preferred mode of delivery and the characteristics of the women including the level of education, the type of the settlement where they live, employment status, monthly income status and presence of problems experienced in previous pregnancies (p<0.05). 73.4% of the women who previously gave birth received information on the modes of delivery, and 61.8% of these received such information from their doctors. Discussion and Conclusion: Women’s lack of knowledge about the modes of delivery in pregnancy is one of the preventable factors that increase the frequency of delivery by Caesarean section. Therefore it is quite important that women be informed on the modes of delivery by primary care family doctors and family health workers.

135-138

Authors: Pınar Dervisoglu, Mehmet Karacan, Mustafa Kosecik

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a disorder which is attracting increased awareness in clinical practice. Despite being an uncommon disease, it is a frequent cause of unexpected death in young persons. Although the term ARVC used for this cardiomyopathy suggests that it involves the muscle of the right ventricle, in recent years there were cases reported in which the left ventricle was severely affected. The current study reports an ARVC-diagnosed fifteen-year-old male patient who had no clinical features previously and died from sudden congestive heart failure; he had two siblings with a history of sudden unexpected death. We would like to bring to mind once again the important role of early diagnosis for ARVC to avoid undesirable consequences of the disease.

143-148

Authors: Ahmet Salduz, Necmettin Turgut, Serkan Bayram, Murat Altan, Mehmet Chodza, Mehmet Ekinci, Turgut Akgül

Although pathogens causing osteomyelitis vary, relatively uncommon microorganisms can cause osteomyelitis in immunosuppressed patients. In this study we aimed to present the diagnosis and treatment of a patient with a rare case of osteomyelitis due to infection with a species of Fusobacterium. A 48-year-old female patient complaining of swelling and pain in her left thigh for the last three months was referred to our clinic with a prediagnosis of bone malignancy based on the MRI findings. The patient had a history of immunosuppressive drug use for scleroderma. The patient suffered a pathological femoral fracture two days after her first visit to us. Abscess drainage and debridement were performed to treat her osteomyelitis, and an osteosynthesis including antibiotic cement-coated intramedullary nail insertion was performed for the fracture. Fusobacterium necrophorum grew in the culture of the preoperative specimens. The patient for whom vacuum-assisted closure was used during her hospitalization was discharged after the acute phase reactants returned to normal and the IV antibiotic treatment was completed. It should be noted that bacteria from the genus Fusobacterium can cause osteomyelitis in immunosuppressed patients, and that while making the differential diagnosis of the lytic lesions of bones osteomyelitis is one of the possibilities.

153-161

Authors: Orhan Alimoglu, Julide Sagiroglu, Moaath Alsmadi, Tamador Shamaileh, Mutaz Albrezat, Mohammad Nayfeh, Neyaf Almajali, Sara Alsauod, Ali Abualhayja’a, Tunc Eren

General surgical diseases have been long treated via conventional (open) or laparoscopic operations. With the advances in technology, there is a paradigm shift from conventional laparoscopy. As a result, single incision laparoscopic surgery (SILS), natural orifice transluminal endoscopic surgery (NOTES), and robotic surgery have evolved as new treatment options for minimal invasive surgery. It has been shown in many series that a wide variety of procedures of general surgery can be managed safely and effectively by robot assisted laparoscopic surgery (RALS). In this review, current advances and practice in robotics in the most commonly applied gastrointestinal surgical procedures will be emphasized.

4-41

Authors: İbrahim Yıldırım , Hakan Ertin , İbrahim Başağaoğlu

We would like to present one of the most noteworthy medical periodicals, “Anadolu Kliniği”, published in Turkey. Started to be published in 1933 in Konya, Anadolu Kliniği (Anatolian Clinic) was edited by Dr. Ahmet İhsan, Dr. Asil Mukbil Atakam and Dr. Şerif Korkut. On its early periods the board of publishing was composed of Turkish physicians, then starting from 1935 foreign physicians were integrated to the editorial group. The periodical was ceased two times, in 1942 and in 1949. It can be assumed that the first break in 1942 was due to World War II’s distressing atmosphere and the second break in 1949 was probably due to economic reasons. The periodical was published till 1954. In this work, there can be found all the names of articles published in Anadolu Kliniği within 20 years with a bibliographic analysis.

48-53

Authors: Orhan Alimoglu, Seyit Ankarali, Tunc Eren, Metin Leblebici, Busra Burcu, Tamador Shamaileh, Oya Cigerli, Sedat Tuzuner, M. Sait Ozsoy, Kerem Kinik

Aim: Our aim was to evaluate, and report the experiences of the volunteer surgical team of Doctors Worldwide (DWW) Turkey during their medical activites in Uganda. Materials and Methods: A surgical camp was organized by DWW Turkey between 3-8 February 2015 in the Butambala and Kampala districts of Uganda. The surgical camp, in addition to other surgeries, was intended to conduct herniorrhaphies for all forms of abdominal wall hernias. Outcomes obtained as results of all surgical practices, including the demographic data of the patients, the types of anaesthesiological, and surgical procedures performed were recorded, and analyzed. Results: Surgical interventions were carried out under either general, spinal, or local anesthesia in a total of 115 patients with the diagnosis of inguinal hernia in 80 (69.57%), umbilical hernia in 15 (13.04%), and epigastric hernia in 9 (7.82%) cases. Additionally, operations were performed for hydrocele in 11 (9.57%) cases. Postoperative minor complications were met in 10 (8.70%) patients, and no postoperative mortality took place at the end of all operations. Discussion and Conclusion: DWW Turkey Surgical Team conclude that, as an efficacious modality of treatment, surgery should be considered as one of the most important priorities when conducting humanitarian health aid programs.

60-63

Authors: Hacer Uyanıkoğlu, Adnan İncebıyık, Emel Yiğit Karakaş

Aim: We aimed to investigate whether the 50-gram oral glucose tolerance test is essential for the screening of gestational diabetes. Materials and methods: Clinical records related to 143 pregnant women who had applied to the Obstetrics and Gynecology Department of the OSM Hospital for antenatal care were included in this retrospective study. All of the pregnant women between 24 and 28 weeks of gestation had been screened for gestational diabetes. The patients were separated into two groups. The 50- gram oral glucose tolerance test had been performed in the first group (n=76), and the 75-gram oral glucose tolerance test in the second group (n=67). The women who had tested positive in the first group had undergone the 100-gram oral glucose tolerance test. All of the tests were performed in accordance with the recommendation of the American Diabetes Association. Results: In the first group who had undergone the 50-g OGTT, the mean age was 27.4 ± 5.5 (18–42) and 23 patients had tested positive. Of these, 13 patients (17%) had also tested positive with the 100-g OGTT. In the second group who had undergone the 75-g OGTT, the mean age was 26.9 ± 5.9 (17–43) and 14 patients (21%) had tested positive. Although the second group had tested positive for GDM more frequently, no statistically significant difference was found between the two groups (p>0.05). Discussion and Conclusion: The 50-g and 75-g OGTTs revealed a diagnosis of GDM at a similar frequency. Therefore, it may be concluded that the 50-g OGTT that consists of two stages and hence leads to a higher intake of glucose may not be essential.

72-75

Authors: Sule Aydin Turkoglu, Elif Sultan Bolac, Serpil Yildiz, Nebil Yildiz

A case report with progressive weakness, bilateral facial paralysis and acute motor axonal polyneuropathy demonstrating electrodiagnostic evaluation will be presented. The condition was preceded by diarrhea, flu-like infection, abdominal pain and gastric tenderness; eventually, autonomic manifestation with episodes of visual hallucinations and disordered speech was added. Relation with Campylobacter jejuni infection, Lyme disease and porphyria are debated in differential diagnosis. Western-blot tests confirmed Lyme disease, and porphyrin specific test results were found positive.

80-83

Authors: Yusuf Muhammed Durna, Mahmut Noberi, Özgür Yiğit, Kemal Behzatoğlu

Primary tuberculosis infection mostly involve the lungs, bones, meninx and lymph nodes. The diagnosis can be made by fine-needle aspiration biopsy. The “caseification necrosis and granulomatous inflammation” revealed by the histopathological examination of the specimen following the parotidectomy indicates primary parotid gland tuberculosis in the cases in which the diagnosis cannot be made by fine-needle aspiration biopsy. In this article, we discuss a case with primary tuberculosis infection in the right parotid gland in the light of the relevant literature.

88-96

Authors: Harun Cansız, Murat Yener

Laryngotracheal reconstruction still remains as one of the most challenging procedures in otolaryngology practice. A variety of reconstruction materials and methods are used to repair laryngotracheal defects. No single surgical procedure exists that is appropriate for all situations, and the surgeon has to make a choice among these methods. This article describes the technical data on, the indications of, and our experience with the use of composite nasal septal cartilage graft for the reconstruction of laryngotracheal defects.