ISSN: 2149-2247 | E-ISSN: 2149-2549
ERCİYES MEDICAL JOURNAL - Erciyes Med J: 36 (2)
Volume: 36  Issue: 2 - 2014
ORIGINAL ARTICLE
1.Correlation of Nm23 and P27 Expression in Nodal Diffuse Large B Cell Lymphomas with Clinicopathologic Parameters and the Effect on Prognosis
Yelda Dere, Aylin Orgen Çallı, İnci Alacacıoğlu, Betül Bolat Küçükzeybek, Sadi Bener, Bahriye Payzın
doi: 10.5152/etd.2014.7752  Pages 53 - 57
Objective: Diffuse large B cell lymphoma (DLBCL) is the most common type of adult lymphoma. No certain histopathological parameter was found, except proliferation index, for predicting prognosis. In hematological malignancies, the prognostic effect of Nm23 expression, which shows metastatic potential in solid tumors, has been researched by a few studies. Loss of p27, a negative regulator of the cell cycle, indicates aggressiveness; however, some studies showed that high expression is relevant to poor prognosis. Here, we aimed to investigate whether they can be used as prognostic markers in DLBCLs.
Materials and Methods: Forty-two cases were included in the study. Demographic data were collected from hospital records. Manual immunohistochemical staining procedure was performed on one paraffin block of every case. Intensity and percentage of staining were grouped as positive and negative.
Results: From 25 males and 17 female patients with a mean age of 62.9, 28 cases (66.7%) were Nm23-positive, and 13 (30.9%) were p27-positive. International Prognostic Index (IPI) score was relevant to prognosis. No significant relationship was found between prognosis and the expression of these two markers.
Conclusion: Advanced age, high IPI score, and high serum lactate dehydrogenase (LDH) level were considered poor prognostic factors in DLBCLs. Larger series are needed for using Nm23 and p27 in predicting prognosis because of different results in the literature.

2.Assessment of Hand Functions in Patients with Chronic Hepatitis B
Pelin Oktayoğlu, Recep Tekin, Mehmet Çağlayan, Mehtap Bozkurt, Serda Em, Mehmet Yıldız, Feyzullah Uçmak, Kemal Nas
doi: 10.5152/etd.2014.8416  Pages 58 - 61
Objective: Motor dysfunction is an important clinical finding in patients with liver cirrhosis (LC), but there is no study assessing fine motor coordination in patients with chronic hepatitis B (CHB). We aimed to investigate hand functions and fingertip dexterity in patients with CHB.
Materials and Methods: A total of 17 female and 15 male patients diagnosed with CHB without histopathological findings of cirrhosis were enrolled to the study; 21 female and 9 male healthy volunteers were included as a control group. Hand grip strength was assessed by Jamar hand dynamometer. Three kinds of pinch strength of fingers were assessed by Jamar pinchmeter. Functional status was evaluated by using the Stanford Health Assessment Questionnaire (HAQ). Duruoz Hand Index (DHI) was used to assess the hand functions. Fingertip dexterity was evaluated by Purdue pegboard test.
Results: Bilateral hand grip strength and pinch strength were not statistically different from controls (p>0.05). There was also no significant difference between the categories of the Purdue pegboard test between the groups. HAQ scores of patients were higher than controls (p<0.05).
Conclusion: Hand functions are not influenced in patients with CHB. Disruptions in the functional status of patients with CHB may be due to fatigue and depression, which are usually seen in chronic liver diseases.

3.Retrospective Assessment of Children with Henoch-Schonlein Purpura in and around Kocaeli Province and Comparison with Literature
Aslan Yılmaz, Mehmet Baha Aytaç, Zelal Ekinci
doi: 10.5152/etd.2013.63  Pages 62 - 67
Objective: The aim of this retrospective study was to evaluate demographic, etiologic and epidemiologic characteristics, and clinical and laboratory findings of Henoch-Schonlein purpura (HSP) and to determine risk factors increasing the kidney involvement in our region.
Materials and Methods: Records of 151 patients who were followed-up with the diagnosis of HSP between May 2002 and December 2010 in the Department of Child Nephrology in Kocaeli University Medical Faculty and fulfilled the inclusion criteria were retrospectively evaluated. Demographic characteristics of the patients, season of presentation, complaints on admission, triggering factors, pathological examination, laboratory data, and the duration of follow-up periods were assessed.
Results: Of 151 patients, 90 (60%) were male and 61 (40%) were female. The mean age was 7.4±3.4 years (range, 1.8-16.5 years). While 33 (22%) patients did not have purpuric rash on admission, they were then observed to have purpuric rash during the follow-ups. Increasing age was found to be a risk factor for kidney involvement (p=0.011). Testicular involvement was identified as a negative risk factor for kidney involvement (p=0.020). Factors such as gender, GIS and musculoskeletal system involvement, recurrence, and steroid treatment were not found to be associated with kidney involvement.
Conclusion: Etiologic, epidemiologic, and clinical findings of HSP patients in our region were found to be similar to those reported in the national and international studies. In parallel to the literature, the present study showed an increased risk of kidney involvement with increasing age.

4.Assessment of Effects of Education Provided to the Family Physicians on Home Visits in Primary Care Setting in Burdur Province in 2011 on Physicians’ Knowledge, Skills and Attitudes
Mehmet Öner, Ethem Kavukcu, Melahat Akdeniz, Yeşim Şenol
doi: 10.5152/etd.2014.6452  Pages 68 - 74
Objective: Home visit is an essential part of primary health care services. In Turkey, as is all over the world, need for home visits will increase with aging population. The number of studies carried out by physicians on home visits in Turkey is quite limited. In the present study, we aimed to make a favorable change in family physicians’ knowledge and attitudes about home visits via an education on home visits.
Materials and Methods: The present study was conducted as a dissertation project. The universe of this study, which is a cross-sectional study, comprised all family physicians, who were working at Family Health Centers (FHCCs) affiliated to Burdur Provincial Directorate of Health and volunteer to participate in the study. A total of 72 family physicians, 37 being in the intervention group and 35 being in the control group, participated in the study. At the beginning of the study, a survey on home visits was performed in both groups; whilst the intervention group received education on home visits, the control group did not. The survey was repeated after three months and the intervention group underwent a core exam. Data obtained were transferred to the Statistical Package for the Social Sciences (SPSS) 18.0 statistics program and were analyzed. Intervention and control groups were compared. Additionally, pre- and post-education results of the intervention group were also compared.
Results: Of 72 physicians received the first survey, 39 (54.2%) reported that family physicians should perform home visits and 18 (25%) physicians reported that they should not, whereas 15 (20%) were undecided. Thirty-one (43.1%) of 72 physicians were in the opinion that they performed adequate number of home visits. There were 26 (36.1%) family physicians thinking that the number of home visits they performed was not adequate, whereas 15 (20.8%) family physicians were undecided. Although the number of physicians, who considered the number of home visits they performed adequate, increased after education, it was not statistically significant. Whilst 44.4% (n=32) of the family physicians were eager about home visits, 45.8% (n=33) were not. The rate of eagerness increased after the education.
Conclusion: Knowledge and skills of the family physicians were enhanced with the education on home visits as was expected. While the rate of eagerness about home visits was increased, expected increase in the rate of home visits was not achieved.

5.The Relationship between Medical Education and Eating Habits Along with Mental Condition in Medical Students
Yasin Yılmaz, Ece Vural, Dilara Ece Toprak, Elif Gürdeniz, Elif Dede, M. Çiğdem Oba, Hande Saygılı, Murat Emül
doi: 10.5152/etd.2014.6472  Pages 75 - 81
Objective: To screen the effect of medical education on eating and physical activity habits, along with mental health, in medical students.
Materials and Methods: Preclinical (n=659) and clinical (n=336) term medical students were asked to fill in an eating habits questionnaire, a physical activity inquiry, along with a general health state inquiry, and the Beck depression inventory.
Results: Seventy percent of medical students did not care about gaining weight, did not exercise to reduce excess weight, did not even care about the caloric or nutritional content of foods, and lived a sedentary life. The clinical term students (years 4 to 6) preferred all-bran bread, while the preclinical term students (years 1 to 3) had a habit of salt overuse. More clinical students than preclinical ones restricted eating when they realized weight gain. Depressive students usually ate a snack at night, skipped meals, and consumed high-calorie food. Positive eating habits and general healthy behaviors in non-depressive students were more frequent, while the opposite was typical for those who were in depression.
Conclusion: This study suggests that medical education influences eating and physical activity habits necessarily, but nevertheless, medical students show unfavorable eating and physical activity habits, besides frequent depressive symptoms.

CASE REPORT
6.The Effectiveness of Bilirubin Column on Severe Hyperbilirubinemia in a Patient with Cardiac Cirrhosis
Ramazan Coşkun, Samime Uslup, Kürşat Gündoğan, Çiğdem Pala, İsmail Hakkı Akbudak, Murat Sungur, Muhammet Güven
doi: 10.5152/etd.2014.7563  Pages 82 - 84
The aim of extracorporeal detoxification through plasma exchange therapy is to eliminate protein-bound components and to prevent their potential toxic effects. It is thought that hyperbilirubinemia has a direct cytotoxic effect on T lymphocytes and that it thus increases infection and sepsis. The use of bilirubin absorption column reduces bilirubin levels in patients with hepatic insufficiency. For the first time in Turkey, we presented a patient with cardiac cirrhosis and high bilirubin levels who was successfully treated with bilirubin absorption column method.

7.Posterolateral Branch of Circumflex Artery: An Extremely Rare Location for Myocardial Bridging
Bahadır Şarlı, Şaban Keleşoğlu, Ahmet Baktır
doi: 10.5152/etd.2014.7636  Pages 85 - 87
Myocardial bridging is a rare congenital coronary artery abnormality in which the epicardial coronary artery is covered by myocardial muscle tissue at a distance during its course. Myocardial infarction, ventricular arrhythmias, and sudden cardiac death have been associated with myocardial bridging. While myocardial bridges are usually located on the left anterior descending artery, left circumflex artery involvement is reported in a few cases. Here, we present a patient admitted to the coronary care unit with unstable angina pectoris having multivessel coronary artery disease and myocardial bridging on the posterolateral branch of the left circumflex artery, for the first time.

8.Sunitinib-Induced Microangiopathic Hemolytic Anemia: A Case Report
Serdal Korkmaz, Saadettin Kılıçkap, Hatice Terzi, Mehmet Sencan
doi: 10.5152/etd.2014.7934  Pages 88 - 90
Thrombotic thrombocytopenic purpura (TTP) is a particular form of thrombotic microangiopathy typically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, neurological abnormalities, and renal dysfunction. TTP requires a rapid diagnosis and an adapted management in emergency. Daily sessions of therapeutic plasma exchange (TPE) remain the basis of management of TTP. Also, TTP is a rare disease that is fatal if it is not treated. We describe a case of a 60-year-old woman who complained of hematuria and right lumbar pain and was diagnosed clear cell renal carcinoma. The patient progressed with interferon-alpha (IFN-α) therapy, and she was treated with sunitinib. At 8 weeks after the therapy, the patient presented with pallor, weakness, and widespread ecchymosis. After evaluation of clinical and laboratory findings, the patient was diagnosed as TTP. The drug was discontinued, and her symptoms improved.

9.Spontaneous Fornix Rupture Due to Obstructive Ureteral Stone
Cevdet Serkan Gökkaya, Mehmet Murat Baykam, Sedat Yahşi, Süleyman Bulut, Binhan Kağan Aktaş, Ali Memiş
doi: 10.5152/etd.2013.48  Pages 91 - 93
Spontaneous rupture of the renal fornix and urinary extravasation are very rarely encountered in urological practice. In the present paper, a 57-year-old male patient who suddenly developed spontaneous rupture of the fornix and urinary extravasation due to obstructive ureteral stone is presented. The patient developed a sudden onset of renal colic pain without any trauma. His complete blood count and kidney function tests were within the normal limits. Microscopic hematuria was detected on complete urinalysis. There was no urinary opacity on plain X-ray. On urinary ultrasonography, the left renal pelvis and ureter were dilated and there was a hyperechoic appearance consistent with a stone approximately 4 mm in diameter at the distal end of the left ureter. Grade 1 dilatations of the left renal pelvis and ureter and extravasation of contrast material at the peripelvic area were observed on intravenous pyelography. Spiral computed tomography also showed extravasation of contrast material in the left pararenal area. In the present case, double J stent catheterization was performed in order to control symptoms and eliminate extravasation. His postoperative pain decreased and alpha-blocker treatment was initiated at the follow-up. Extravasation regressed and hydronephrosis disappeared on follow-up ultrasounds. Two weeks later, the patient stated that he had passed the stone. The catheter was withdrawn and the patient was discharged on the same day.

10.Anesthesia Management of a Patient with Lumbar Spinal Stenosis and Tracheal Stenting
Dilek Günay Canpolat, Umahan Çelik, Ahmet Aydın, Cihangir Biçer, Halit Madenoğlu
doi: 10.5152/etd.2013.57  Pages 94 - 96
Tracheal stenosis may occur after congenital problems and long-term endotracheal tube compression. Spinal stenosis is one of the 3 most common reasons in patients undergoing surgery due to low back and leg pain. Both general and regional anesthesia are used for lumbar surgery. A 56-year-old woman was admitted to our hospital with low back pain and leg paresthesia. A permanent tracheal stent was placed 11 years ago due to tracheal stenosis developed after tracheostomy performed for anaphylaxis and respiratory depression. Herein, a case of regional anesthesia technique applied during spinal stenosis surgery is presented.

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