[Shoulder arthroplasty: the situation in 2014]

Evolution of shoulder arthroplasty has led to mainly three types of implants: hemiarthroplasty, total shoulder arthroplasty and reverse shoulder arthroplasty. There is yet no clear consensus about indications for the different existing types of prothesis. The aim of this article is therefore to bring together and clarify the indications found in the current literature. Hemiarthroplasty, historically the first widely used implant, has lost much ground to total shoulder arthroplasty, and keeps its place only for specific situations. Total shoulder arthroplasty is mainly used for centered glenohumeral osteoarthritis, whereas reverse shoulder arthroplasty is indicated for most situations in which the rotator cuff or tuberoties are deficient.

Attitude and behavior related to organ donation and affecting factors: a study of last-term students at a university

AIM

The aim of this study was to detect the behavior and attitude of our last-term students.

METHODS

The study group for this cross-sectional research consisted of 1690 last-term students. We applied a questionnaire about sociodemographic features, behaviors, and attitudes about organ donation. Data were evaluated with SPSS 11.0.

RESULTS

We accessed 1287 students among whom 1.3% stated that they would donate their organs. Among students who did not agree, 58.7% were considering donation. The main reasons for not agreeing to donation were fear of commercial use (45.7%) and the belief of inappropriateness related to religion (25.7%). In contrast, 62.3% stated that they would donate their organ when needed for their relatives. Also, 50.6% indicated that if one of their relatives died, they would donate their relative's organs; there was no significant difference based on gender. In addition, favorable thoughts about donation were significantly more prevalent for female subjects (P = .001). Organ donation behavior and thoughts were significantly higher among the group with better economic position (P = .001, .018); and for students whose mother had an education higher than high school (P = .003, .004). Higher donation ratios were observed for students who had a relative working in the medical field (P = .04) and the group who stated they were well informed about organ donation (P < .001).

CONCLUSION

When we take into account that our study group consisted of university students, organ donation rates were low. To overcome the difficulties, we have to inform the community and collaborate with religious organizations. To prevent fear that organs will be used commercially we must prove confidence in the system.

COMT Val 158 Met polymorphism is related with interpersonal problem solving in schizophrenia

OBJECTIVE

The aim of this study was to investigate associations between COMT Val(158)Met polymorphism, and interpersonal problem solving capacity and cognitive functions in schizophrenia.

METHODS

COMT Val(158)Met polymorphism was studied with ARMS-PCR method in 99 outpatients with schizophrenia. Brief Psychiatric Rating Scale was used to assess symptom severity. The Assessment of Interpersonal Problem Solving Skills (AIPSS) was used to evaluate problem solving capacity. Continuous Performance Test (CPT) and Wisconsin Card Sorting Test (WCST), were used to measure cognition.

RESULTS

Patients with Met/Met genotype had higher AIPSS subscores for detecting the problem, than those with Val/Val at baseline (p=0.02). Met allele was also found to be related with higher AIPSS-receiving skills (p=0.04). Val allele was found to be related with more commission errors in CPT (p=0.03). There was no relation between Val(158)Met polymorphism and WCST and clinical measurements.

CONCLUSION

Our findings suggest that Val allele might be related to poor performance on detecting the interpersonal problems, and attention in schizophrenia.

The value of routine clinical and radiologic studies in predicting neoplastic invasion of cricoarytenoid units

BACKGROUND AND PURPOSE

Evaluation of the laryngeal cartilages is essential for the treatment strategy of patients with laryngeal carcinoma. Our aim was to assess the accuracy of preoperative clinical examinations and CT for preoperative evaluation.

MATERIALS AND METHODS

A prospective comparative study was performed at a university department on 30 patients with advanced laryngeal carcinomas. All patients were men and underwent total laryngectomy. The preoperative mobility of vocal folds was evaluated and classified as mobile, impaired, or fixed. CT was performed by using multidetector row CT. Cricoarytenoid units (CAUs) from the laryngectomy specimens were cut into sections. Histologic findings were compared with the clinical and radiologic findings.

RESULTS

The accuracy of combined clinical and CT staging in CAUs with normal mobility, impaired mobility, and absent mobility and negative CT findings was 96.5%, 50%, and 80%, respectively. These scores were 40%, 54.5%, and 83.3% for CAUs with normal mobility, impaired mobility, and absent mobility and positive CT findings, respectively.

CONCLUSIONS

Arytenoid mobility and >1 cartilage abnormality on CT were found to be reliable indicators of neoplastic cartilage invasion in patients with laryngeal carcinoma.

The presence of erythropoietin receptor in parathyroid cells

CONTEXT

Effects of erythropoietin on parathyroid cell function has not been studied before.

OBJECTIVE

We aimed to demonstrate whether erythropoietin receptor present in parathyroid cells.

DESIGN

The specimens of normal parathyroid gland, parathyroid adenoma and hyperplasia were retrieved from our pathology archives. The sections were stained immunohistochemically. Quantitative gene expression study was performed for erythropoietin and erythropoietin receptor.

RESULTS

Erythropoietin receptors were detected by immunohistochemical staining and by its gene expression. Its density was higher in normal parathyroid, followed by parathyroid adenoma and hyperplasia.

CONCLUSION

Erythropoietin receptor is present in normal parathyroid, parathyroid adenoma, and hyperplasia.

Epidermoid cyst of the testicle: unusual magnetic resonance imaging findings

Epidermoid cyst of the testis is an uncommon benign tumor that can be treated by organ-preserving surgery when diagnosed preoperatively. Although some sonographic characteristics may be suggestive of epidermoid cysts, sonography is not completely diagnostic. Magnetic resonance imaging (MRI) findings may provide support for the diagnosis of epidermoid cysts. The MRI findings of testicular epidermoid cysts have been reported as either bull's eye or target in appearance, or with signal intensity characteristics more typical of a cystic lesion. In this paper, we present typical sonographic and unusual MRI findings of a testicular epidermoid cyst.

Apolipoprotein E polymorphism in Turkish subjects with Type 2 diabetes mellitus: allele frequency and relation to serum lipid concentrations

The role of apolipoprotein E (apoE) genotypes in modulating plasma lipid and apolipoprotein levels was studied in 112 patients with Type 2 diabetes mellitus (T2DM) and 94 healthy individuals. ApoE genotypes were identified by PCR amplification and subsequent restriction endonuclease digestion. The apoE allele and genotype frequencies were similar in both the diabetic and control subjects. The apoE allele frequencies were found to be 74.3 for e3, 10.1 for e2, 15.6 for e4 in the diabetic group, and 68.1 for e3, 13.2 for e2 and 18.7 for e4 in the control group. Sex-specific genotypic distribution of apoE polymorphism did not differ between the study groups. To elucidate the association of apoE with lipid abnormalities with respect to gender, serum lipid and apolipoprotein levels were compared among apo e2 (e2/2 and e3/2), e3 (e3/3) and e4 (e4/3 and e4/4) groups of T2DM and control subjects. Apo e2 allele was found to be associated to triglycerides for both sexes, and associated to glucose, and BMI only in females. Subjects with e2 allele had higher levels of BMI, glucose and triglyceride in comparison to e3 and e4. Our data suggest that genetic variation at the apoE locus in Turkish subjects is a genetic factor that influences lipid levels. Further studies attempting to correlate apoE polymorphism with lipid profile in a large number of individuals would be helpful in establishing the true significance of this polymorphism in the Turkish population.

Coexistent thyroid pathologies and high rate of papillary cancer in patients with primary hyperparathyroidism: controversies about minimal invasive parathyroid surgery

Thyroid carcinoma and benign thyroid diseases associated with primary hyperparathyroidism (PHPT) may cause difficulties in the diagnosis, localization and therapy of PHPT. In this study, we analysed coexistent thyroid pathologies in 51 patients who underwent neck exploration with a diagnosis of PHPT between 1999--2002. Five hundred thirteen patients who underwent thyroidectomy for nodular thyroid disease without a parathyroid pathology in histopathological examination served as controls. In patients with PHPT there were 43 cases (84.3%) of coexistent thyroid pathology. Nine patients (17.6 %) had coexistent papillary thyroid cancer. Nine patients (17.6 %) had lymphocytic thyroiditis, two (3.9%) had benign thyroid adenoma and 24 (47%) had nodular hyperplasia. In one patient (2%), there was intrathyroidal metastasis from a parathyroid cancer. One patient had coexistent lymphocytic thyroiditis and multifocal papillary cancer. One of the two cases with thyroid adenomas was Hürthle cell type. In the control group only 28 patients (5.5%) had thyroid malignancy (27 papillary cancer and one follicular cancer). In conclusion, the coexistent thyroid pathologies are highly prevalent in patients with PHPT and pre- and intra-operative thyroid examination should be performed to avoid overlooking important thyroid pathologies.

Alveolar echinococcosis of the liver: correlative color Doppler US, CT, and MRI study

PURPOSE

To determine and compare the imaging features of hepatic alveolar Echinococcosis using color Doppler US, CT, and MRI.

MATERIAL AND METHODS

Abdominal CT and MRI with and without contrast agents and color Doppler US were performed on seven patients with hepatic alveolar Echinococcosis. The lesions were evaluated for location, features of echogenicity, intensity and density, calcification, and vascular, hilar, and perihepatic involvement. The diagnosis was confirmed histopathologically in all patients.

RESULTS

Six patients had solitary lesions, and one displayed multiple lesions. The lesions were generally seen as heterogeneous and hyper- or hypoechoic when imaged with color Doppler US, hypodense with CT, and hypointense with MRI, in comparison with the liver parenchyma. Calcification, central necrosis, and small peripheral cysts were observed in six, seven, and four patients, respectively. Vascular flow or contrast enhancement was not observed in any of the cases. A look at the respective advantages of each method reveals that calcification was best rendered visible via CT, small peripheral cysts with T2-weighted MRI, central necrosis with CT and MRI, and perihepatic invasion with multiplanar MRI. Vascular involvement was revealed by all methods.

CONCLUSION

Color Doppler US, CT, and MR imaging function extremely well as complementary methods in the diagnosis of HAE. Color Doppler US should be performed in these patients owing to its ability to efficiently detect the disease. Knowledge of imaging characteristics makes it possible to radiologically ascertain an early diagnosis.

Urinary beta-2 microglobulin in renal dysfunction associated with hypothyroidism

Hypothyroidism is associated with a number of functional renal disorders primarily affecting water and salt handling. In this study, we aim to investigate functional renal disorders in overt and subclinical hypothyroidism. We utilised urinary beta-2 microglobulin (beta2M) as a sensitive marker of tubular dysfunction. Urinary beta2M excretion and tests for renal functions were repeated before and after T4 replacement therapy. Forty-four patients (28 with overt disease, 16 with subclinical disease) and 31 healthy control subjects were involved in the study. There was a significant increase in urinary beta2M in both overt and subclinical hypothyroidism (p < 0.05 in both). TSH levels were correlated with beta2M excretion. Effects of hypothyroidism on renal functions were readily reversible by 3 weeks of thyroid hormone replacement therapy. Urinary beta2M was a sensitive marker of renal tubular dysfunction associated with overt and subclinical hypothyroidism.

Helicobacter pylori eradication with beta carotene, ascorbic acid and allicin

In this study, in vivo effectiveness of ascorbic acid (AA), beta carotene (BC) and allicin in HP eradication were evaluated. 210 patients who are HP positive in biopsy were involved in this study. The patients randomised to seven treatment groups (each group consisting of 30 patients). The first group was given standard eradication treatment (lansaprasol 30 mg bid, clarithromycin 500 mg bid, amoxicillin 1 g bid for 14 days). Second group received AA 1000 mg/day in addition to the standard treatment. Third group received only AA 1000 mg/day for 14 days. Fourth group was treated with standard regiment plus 120 mg/day BC. Fifth group was given only BC 120 mg/day for 14 days. Sixth group was given standard regiment and allicin 4200 micrograms/day. Seventh group received only Allicin 1200 micrograms/day for 14 days. The eradication was achieved in 20 (66.6%) in group I, 15 (50%) in group II, 3 (10%) in group III, 15 (50%) in group IV, 0 (0%) in group V, 27 (90%) in group VI and 7 (23.3%) in group VII. Allicin seemed to be potentially effective agent for HP eradication but ascorbic acid, beta caroten was found to be ineffective.

Allergic rhinitis in Rosa domescena cultivators: a novel type of occupational allergy?

After the diagnosis of allergic rhinitis due to Rosa domescena was suspected in one subject with skin prick and nasal provocation tests, we recruited all other workers employed in rose cultivation in Yakaören village, Isparta. From May 2000 to July 2000 (exposure period 'time of rose handling'), we studied 600 individuals employed in rose cultivation. A questionnaire was administered by a physician, and skin testing was done by a nurse on 75 individuals suffering from asthma and/or rhinitis. Sera from these 75 subjects were available for immunologic testing. The diagnosis of atopy against rose was based on the presence of work-related symptoms, positive skin prick test (SPT) with rose extracts, and positive RAST. While no subject reported asthmatic symptoms, twenty of them reported either rhino-conjunctivitis, rhinitis or both on exposure to Rosa domescena. Fourteen of these subjects had increased specific IgE levels to Rosa domescena. Eleven (78.5%) also had a positive skin reaction to Rosa domescena. Out of the six negative sera with normal specific IgE levels to rose, only two (33.3%) had positive skin reactivity. No subject had significant daily peak expiratoy flow rate (PEFR) variations. We conclude that exposure to Rosa domescena may represent a risk for allergic rhinitis. The possibility of an occupational rose allergy should therefore be taken into consideration in the subjects working in rose cultivation.

Selectins in normal pregnancy, pre-eclampsia and missed abortus

Selectins, are known to be increased in the serum of patients with pre-eclampsia, indicating that these molecules are possible markers of endothelial cell injury. In this study, we investigated P, E and L selectin levels in normal pregnancy, pre-eclampsia, and missed abortus. Plasma P and L selectins levels were significantly higher in normal pregnancy and pre-eclampsia than healthy controls; but plasma concentrations of E selectins were not different between these groups. Plasma P selectin was significantly higher in pre-eclampsia than normal pregnancy. Plasma concentrations of all selectins were significantly higher in missed abortus than healthy control. L selectin levels were higher in pre-eclampsia and missed abortus than normal pregnancy. We found the levels of selectins were increased in pre-eclampsia and missed abortus. Although selectins were suspected to play a role in the pathogenesis of pre-eclampsia, in conjunction with previous studies, we thought that elevated selectin levels are a non-specific consequence of endothelial injury rather than being a cause.

Effects of acid inhibition on somatostatin-producing cells in the rat gastric fundus

Somatostatin plays a role in the regulation of gastric acid secretion. Omeprazole, a potent inhibitor of gastric acid secretion, has been reported to cause either a significant decrease or increase in the formation of gastric somatostatin-producing cells. Therefore, we determined in the present study distribution patterns of somatostatin mRNA and protein in fundus mucosa of rats after long-term inhibition of gastric acid secretion. Female Sprague-Dawley rats were given 0, 20 and 100 mg/kg/day omeprazole, respectively, as gastric instillations during 2 months. Serum gastrin levels were significantly higher in the third group than in the other groups. The omeprazole-treated groups also showed an increase in the number of somatostatin-containing cells in fundus mucosa. Moreover, the intensity of somatostatin-positivity was higher in the treated groups than in the control group. We also observed an increase in the number of cells containing somatostatin mRNA in fundus mucosa of omeprazole-treated rats. These results suggest that long-term inhibition of acid secretion does not inhibit but stimulate somatostatin production in mucosa of rat gastric fundus.

Lamotrigine in two cases of Rett syndrome

Rett syndrome (RS) is a particular neurodevelopmental disorder in which symptoms develop in early infancy and manifests particular symptoms at certain ages. Two girls aged 4.5 and 2.5-years-old were admitted with complaints of seizures, regression of language, psychomotor development, and autistic behavior. They had fulfilled the criteria of classic RS. Lamotrigine was used in the treatment of the convulsions. After lamotrigine therapy, the convulsions were successfully controlled and the stereotyped hand movements and autistic behaviors markedly decreased. We would like to stress that, aside from convulsion, abnormal signs of the syndrome such as stereotyped hand movements and autistic behaviors might also be improved with lamotrigine, but detailed and controlled studies should be performed to identify whether lamotrigine has any positive effects in RS.

Thrombopoietin and mean platelet volume in coronary artery disease

BACKGROUND

Large platelets are shown to be hemostatically more active. It has been suggested that mean platelet volume (MPV) is increased during acute myocardial infarction (AMI) and unstable angina pectoris (USAP). However, the underlying mechanism of the phenomenon remains unclear.

HYPOTHESIS

In this study, platelets, MPV, and thrombopoietin (TP) levels were investigated in patients with coronary artery disease (CAD) and healthy controls.

METHODS

Twenty patients with AMI and 20 patients with USAP were included in this study. Seventeen healthy adult subjects served as controls. Venous blood samples of the subjects were drawn within 12 h after admission. Thrombopoietin levels were measured by ELISA and platelet counts and MPV were assayed by autoanalyzer.

RESULTS

Patients with AMI and USAP had higher platelet counts than those in the control group. Although the platelet counts were slightly higher in AMI than in USAP, this did not reach statistical significance. Mean platelet volume and levels of TP were found to be elevated in patients with AMI and USAP compared with control subjects (p < 0.001). Thrombopoietin levels were higher in AMI than USAP, but this was not statistically significant. There was a positive correlation between TP levels and MPV values (p < 0.05).

CONCLUSION

Increased TP levels may increase both platelet counts and platelet size, resulting in hemostatically more active platelets, which may contribute to the development and progression of CAD.

Germ line BRCA1 and BRCA2 gene mutations in Turkish breast cancer patients

Germ line BRCA1 and/or BRCA2 mutations were screened in 50 Turkish breast and/or ovarian cancer patients composed of hereditary, familial, early onset and male cancer groups. Genomic DNA samples were tested by heteroduplex analysis and DNA sequencing. Two truncating BRCA2 mutations, one novel (6880 insG) and one previously reported (3034 delAAAC), were found in two out of six (33%) hereditary breast and/or ovarian cancer patients. A novel truncating (1200 insA) and a missense (2080A-->G) BRCA1 mutation was found in two of 27 (7%) individuals in the early onset group. A total of four (8%) disease-causing mutations in 50 breast cancer patients were identified in BRCA1 and BRCA2 genes. In addition, five BRCA1 sequence variants have been identified in 23 patients. These results indicate that BRCA1 and BRCA2 genes are involved in some, but not all, forms of hereditary predisposition to breast cancer in the Turkish population.

Role of nitric oxide in gastric injury induced by hemorrhagic shock in rats

The aim of this study was to investigate the effect of nitric oxide (NO) on the gastric injury induced by hemorrhagic shock. Hemorrhagic shock was created by withdrawing 3 ml blood/200 g body weight of the rats. Before the hemorrhage, N(G)-nitro-L-arginine methyl ester (L-NAME, 10 mg/kg i.v. bolus), D-NAME (10 mg/kg i.v. bolus), or L-arginine (100 mg/kg i.v. bolus and 10 mg/kg/min infusion) + L-NAME were administered. At the end of the 1-hour hypovolemic shock period, histological analysis, gastric ulcer index, gastric myeloperoxidase (MPO) activity, and gastric protein oxidation (PO) levels were determined. In histological analysis a destructive effect of L-NAME (NO synthase inhibitor) was demonstrated. L-NAME treatment increased gastric MPO activity, L-arginine reversed this effect and D-NAME had no effect. Tissue PO activity was found to be increased in L-NAME-treated rats; L-arginine treatment reversed this activity. It is concluded that gastric barrier function is altered after hemorrhagic shock, and L-arginine (NO precursor) can prevent mucosal injury in the stomach. This effect of NO may be on gastric blood flow and can be mediated by tissue neutrophils.

Joint hypermobility and primary fibromyalgia: a clinical enigma

OBJECTIVE

To investigate the association of joint hypermobility (JH) and primary fibromyalgia (FM).

METHODS

Eighty-eight patients admitted with widespread pain and 90 matched healthy controls were blindly evaluated according to criteria for the presence of JH and FM.

RESULTS

Fifty-six patients initially recognized as having FM met the American College of Rheumatology (ACR) diagnostic criteria for FM and 6 of 90 healthy controls had these criteria at the subsequent blinded examination. The frequency of JH was 8% in patients with FM and 6% in subjects without FM (p > 0.05). Interestingly, JH was found in 10 of 32 "FM" patients (31%) who had not exactly met the ACR criteria for FM. The occurrence of JH was more common in these patients compared to controls (p < 0.001). In total, 16% of patients evaluated with widespread pain had associated with JH.

CONCLUSION

Some patients who have clinical symptoms of FM but do not exactly meet the ACR criteria could in fact have JH, and these patients may be misdiagnosed as having FM. Widespread pain is associated with JH in women under age 50, with some of them fulfilling ACR tender point criteria for FM.

Giant cavernous hemangioma of the scalp

In this article, a quite rare giant cavernous hemangioma located in right frontoparietal region of a 16 year-old boy is presented. Cavernous hemangiomas are commonly seen in extremities, neck, face and sometimes scalp, cutaneous or subcutaneous in localization. Giant cavernous hemangioma in the right frontoparietal region have been seen in two cases so far. In this article, we discussed the differential diagnosis, characteristics and therapy methods of giant cavernous hemangioma of the scalp.

Human MLH1 deficiency predisposes to hematological malignancy and neurofibromatosis type 1

Heterozygous germ-line mutations in the DNA mismatch repair genes lead to hereditary nonpolyposis colorectal cancer. The disease susceptibility of individuals who constitutionally lack both wild-type alleles is unknown. We have identified three offspring in a hereditary nonpolyposis colorectal cancer family who developed hematological malignancy at a very early age, and at least two of them displayed signs of neurofibromatosis type 1 (NF1). DNA sequence analysis and allele-specific amplification in two siblings revealed a homozygous MLH1 mutation (C676T-->Arg226Stop). Thus, a homozygous germ-line MLH1 mutation and consequent mismatch repair deficiency results in a mutator phenotype characterized by leukemia and/or lymphoma associated with neurofibromatosis type 1.

Functional neck dissection: cure and functional results

In this study, the cure and functional results of 133 functional neck dissections performed between 1992-1997 in Erciyes University Medical Faculty were evaluated. The overall recurrence rate was three per cent. This rate was 1.4 per cent for elective functional neck dissections and five per cent for curative functional neck dissections. Electromyographic studies showed that there was severe neurogenic deficit in the trapezius muscle of seven patients (12.5 per cent), and in the sternocleidomastoid muscle of 12 patients (21.4 per cent) among 56 randomly selected patients. In all cases, the flow rate and diameter of the internal jugular vein was found to be normal by Doppler ultrasonography. The results of this study showed that functional neck dissection is a reliable technique for obtaining a high cure rate and functional results.

[Chronic coronary pseudoaneurysm after stent implantation]

Recently, as a part of new stent implantation strategy in order to decrease stent thrombosis, final dilatations with high pressure and/or higher sized balloons were applied after the initial deployment of the stent. In this paper, we presented a case of chronic coronary pseudoaneurysm which occurred after an initially successful stent implantation in the left anterior descending artery, probably due to high pressure final dilatation.

Detection of c-erbB-2 mRNAs using dig-labelled oligonucleotide probe with in situ hybridisation in human breast carcinoma: comparison with immunohistochemical results

Amplification and overexpression of the c-erbB-2 oncogene are of prognostic significance in human breast cancer. Overexpression of c-erbB-2 is the result of gene amplification. However, increased transcript levels of c-erbB-2 are also detected in the absence of gene amplification. In this study for the detection of the overexpression mRNA in situ hybridisation (ISH) and immunohistochemistry (IHC) were used. Our aim was to develop the suitable mRNA ISH protocol for formalin-fixed paraffin-embedded material and to compare the localisation of transcripts and protein products in 20 primary breast carcinomas. Sections were immunostained with monoclonal c-erbB-2 antibody. In ISH method digoxigenin-labelled oligoprobe was used for the detection of c-erbB-2 mRNAs. We determined optimal condition for the ISH procedure (e.g., probe concentration, digestion, post washing). c-erbB-2 protein overproduction was detected in 11/20 cases with IHC. The mRNA signals were observed in malignant cell cytoplasm in 6/20 cases by ISH. ISH positive signals were found in only one case without detected overexpression of the protein. There were cell to cell variations in the hybridisation signals even within individual tumours. The ISH and IHC positive signals for c-erbB-2 was observed mostly in infiltrating ductal carcinomas that belong to aggressive lesions.

Evaluation of hearing loss with auditory brainstem responses in the early and late period of bacterial meningitis in children

The hearing function of 50 children with bacterial meningitis was evaluated at the second and 10th days, and eight weeks after admission with auditory brain system responses (ABR) to investigate whether meningitis causes hearing loss. Normal values were obtained in all tests from both ears of 24 patients (48 per cent). Twelve patients (24 per cent) had temporary, and seven (14 per cent) patients had persistent mild degree hearing loss. Severe hearing loss was detected bilaterally in five (10 per cent) patients and unilaterally in two (four per cent) patients. Patients, with other complications such as subdural effusion, convulsion, brain oedema and paralysis were found to have a higher incidence of hearing loss. We observed that patients treated with dexamethasone had 7.7 per cent persistent hearing loss, 11.6 per cent mild hearing loss, 34.6 per cent transient hearing loss, but in the group who did not receive dexamethasone there was 19.2 per cent persistent hearing loss, 15.3 per cent mild hearing loss and 11.6 per cent transient hearing loss. There were other significant differences between the two groups in restoration of normal body temperature, the CSF/plasma glucose concentration ratio was elevated, CSF (cerebro-spinal fluid) protein concentration was decreased and the cell count in the CSF was decreased in the dexamethasone group, significantly more than the group who were not receiving dexamethasone. The hearing loss tended to be more frequent among younger children.

Postoperative anosmia after anterior communicating artery aneurysms surgery by the pterional approach

Damage to the olfactory nerve during the pterional approach to the anterior communicating artery aneurysms has not previously been investigated in a quantified manner. In this retrospective study, 100 patients with anterior communicating artery aneurysms, for whom the pterional approach was employed, were observed from the point of view of postoperative olfactory nerve function. In the postoperative period only three cases suffered from the impaired sense of smell ipsilateral to the side of surgery. 15 patients objectively showed olfactory nerve distinctions. The functions of olfactory nerve could be preserved at a relatively high rate of 85 per cent. This high rate resulted from the microtechnique employed as well as the relatively cautious frontal lobe retraction which was less than 1.5 cm.

The epidemiology of gastrointestinal cancer in Turkey: a review of our accumulated experience

Among all organ cancers, gastrointestinal tract cancers present an interesting pattern in distribution over the world. There are several hundred differences between some incidences of cancer. Probably due to different geographical and climatic differences between western and eastern regions of Turkey, we found varying incidences in esophageal, gastric, and colonic carcinomas. The type of diet, and an excess or lack of some essential nutrients and vitamins are probably the main causes in determining what kind of gastrointestinal tumor might occur. Besides diet, living areas, socioeconomic status, salinity of soil, drinking water and many other factors may play a role. Contrary to the findings of some authors, excessive tea and alcohol consumption has not been found to be a risk factor in our study.

Transverse cerebellar diameter and transverse cerebellar diameter/ abdominal circumference index for assessing fetal growth

In a prospective study of 330 pregnant women, measurements of the transverse cerebellar diameter (TCD), abdominal circumference (AC), biparietal diameter (BPD), head circumference (HC) and TCD/AC ratio and HC/AC ratio were obtained using conventional ultrasonography between 16th and 41st weeks of gestation. Measurement of BPD yielded a strong correlation with gestational age (r = 0.9880 and R2 = 0.9761) by cubic regression analysis. The measurement of TCD also had a very close relation with gestational age (r = 0.9767 and R2 = 0.9539). The ratio between TCD and AC was calculated and found to be 0.1436 +/- 0.0106 (SD) which remained fairly constant throughout pregnancy, while the BPD/AC ratio declined. The 5th and 95th percentiles for this ratio were 0.1279 and 0.1603. Ten of eleven fetuses with TCD/AC ratios exceeding 2 SD (0.1648) were found to have asymmetrical intrauterine growth retardation upon neonatal examination. It is demonstrated that both BPD and TCD measurements are reliable techniques that correlate well with gestational age, and the TCD/AC ratio is valuable in identifying babies with asymmetrical intrauterine growth retardation.

Scapula length measurement for assessment of fetal growth and development

To determine the value of prenatal ultrasonographic scapula measurements for fetal growth and development as an adjunct to assessing in utero development, a prospective study of ultrasonography was conducted in 343 pregnant women with uneventful pregnancies with gestational ages from 16 to 41 weeks, and several biometric measurements were obtained. The relationships of scapula length with gestational age and with biparietal diameter, femur length, abdominal circumference and scapula length were examined. With the ultrasonographic examinations of 343 healthy pregnant women, a nomogram of scapula length measurements estimating gestational age and predicting the biparietal diameter, abdominal circumference, and femur length was generated. Linear relationships were found between the scapula length and the gestational age (R2 = 0.94, p < 0.0001), the biparietal diameter (R2 = 0.94, p < 0.0001), abdominal circumference (R2 = 0.94, p < 0.0001), and the femur length (R2 = 0.95, p < 0.0001). The rate of increase of scapula length was significantly higher before 28 weeks of gestation than in later pregnancy (p < 0.0001). The correlation coefficients between gestational age and scapula length were 0.95 before 28 weeks of gestation and 0.86 in later weeks. These results suggest that scapula length measurement is a valuable parameter for the assessment of fetal growth and development.

Long-term prognosis after a first myocardial infarction in Turkey: determinants of mortality and reinfarction

Long-term prognosis of a first myocardial infarction and factors associated with late cardiac mortality and reinfarction were studied in 718 survivors. Patients have been followed up for 1-10 years (mean 57.6 +/- 39.6 months). None of the patients underwent coronary bypass surgery in the follow-up period. Cumulative mortality rates were 8.6% in the first year, 17.9% in 3 years, 26.4% in 5 years and 36.5% in 10 years. The type and site of myocardial infarction (Q-wave versus non-Q-wave and anterior versus infero-posterior) were found to have no independent prognostic importance. The cardiac mortality was best predicted by the occurrence of congestive heart failure in the coronary care unit. Other determinants of late outcome were the presence of ventricular arrhythmias, left bundle branch block, and the occurrence of stable or unstable angina pectoris or reinfarction during the follow-up period. Usage of antiplatelet or anticoagulant drugs was not found to affect mortality. Reinfarction rates were 4, 9.9, 15.5 and 28% in 1, 3, 5 and 10 years, respectively, and no relation was found between the type and location of myocardial infarction and reinfarction rate. Reinfarction was higher in patients receiving anticoagulants and in patients with postmyocardial infarction angina. Our findings suggest that the prognosis of patients with a first acute myocardial infarction in Turkey is not different from that in Western populations and factors influencing prognosis are similar to those previously reported.

Umbilical artery blood flow characteristics in normal pregnancies

585 pregnant women were investigated with both conventional sonographic examination and color Doppler examination. The cases with intrauterine growth retardation, preeclampsia, twin pregnancies, congenital malformations and diabetes were excluded. The remaining 550 cases (between ages 16 and 40) were investigated in the first trimester and gestational ages were compatible with the last menstrual date. In order to evaluate fetal development, biparietal diameter, femur length, abdominal circumference, and estimated fetal weight were calculated by conventional ultrasonographic method. The application of Doppler ultrasound to the study of fetal umbilical arterial blood flow velocity is a relatively new technique. The failure to obtain useful Doppler signals was about 18-22% with pulse-wave Doppler system. Recently, color Doppler technology solved this problem. We used an ALOKA 680-SSD ultrasonography device and color Doppler ultrasonography technique and recorded umbilical arterial Doppler signals from every case and calculated classical Doppler indices--systolic/diastolic (S/D) ratio, pulsatility index (PI), Pourcelot index or resistive index (RI). Statistical comparisons were made by SPSS program. Correlation coefficient and R2 values between gestational age and other indices were calculated. The aforementioned values were r:-0.79; R2:0.63 0.63; r:-0.71; R2:0.50, r:-0.64; R2:0.41, for S/D, PI, RI, respectively.

A case of ventricular tachycardia refractory to medical treatment related to a cystic mass in left ventricle--a case report

This is a case report of a twenty-two-year-old woman who had attacks of ventricular tachycardia that could be prevented by the use of various antiarrhythmic drugs for three months. Electrophysiologic study showed that the mechanism of the tachycardia was "reentry." In cardiac catheterization a non-contractile mass having calcification was seen on the apical portion of the left ventricle. Angiographically, the mass resembled a diverticulum. Recurrence of attacks was terminated by resection of this mass, which had a cystic appearance.

Thumbsucking and falling asleep

A review of the studies on the etiology of habitual thumbsucking reveals either contradictory or inconclusive results. In this study carried out in Turkey, 50 thumbsuckers, 50 non-thumbsuckers, 250 school children and 312 'problem' children were investigated through interviews, questionnaires and other clinical techniques with their mothers. Among variables studied, were aspects of feeding, onset and incidence of thumbsucking, strength of the sucking drive, sex distribution, educational level and occupation of mothers, parental attitudes toward physical contact with children, mother-child relationships, and particular forms of falling asleep. It was found that thumbsucking was etiologically more related to ways of falling asleep than to other factors. An attempt was made to explain the social, psychological and physiological basis of the etiological significance of the falling asleep stage in habitual thumbsucking.

Sustained-release verapamil as a first-step drug in the treatment of mild to moderate hypertension

The efficacy of sustained-release verapamil as a first-stage treatment for mild to moderate, uncomplicated essential hypertension was studied. Nineteen patients aged 36-70 years (mean +/- SD 55 +/- 10 years) entered the study. Treatment with 240 mg sustained-release verapamil, once daily for 8 weeks, caused systolic and diastolic blood pressures to decline significantly during the first 2 weeks and this lower level was maintained until week 8. Heart rate decreased gradually during the treatment period reaching significance at week 8. After 2 weeks maximum systolic and diastolic blood pressures during isometric exercise were significantly reduced compared with pre-treatment values; there was no difference in the percentage increase occurring pre- and post-treatment. These measures for heart rate did not change significantly. Except for a significant reduction in cardiac index after 8 weeks left ventricular function and left ventricular mass were unchanged. The 24-h urinary Na+ excretion increased significantly after 2 and 8 weeks' treatment. Plasma renin activity, serum lipid concentrations and routine blood chemistries were not affected. Side-effects were transient and did not require discontinuation of therapy. In conclusion, sustained-release verapamil is an efficacious and well tolerated first-stage drug in the treatment of essential hypertension.

Alternating sinus rhythm and intermittent sinoatrial block induced by propranolol

Alternating sinus rhythm and intermittent sinoatrial (S-A) block was observed in a 57-year-old woman, under treatment for angina with 80 mg propranolol daily. The electrocardiogram showed alternation of long and short P-P intervals and occasional pauses. These pauses were always preceded by the short P-P intervals and were usually followed by one or two P-P intervals of 0.92-0.95 s representing the basic sinus cycle. Following these basic sinus cycles, alternating rhythm started with the longer P-P interval. The long P-P intervals ranged between 1.04-1.12 s and the short P-P intervals between 0.80-0.84 s, respectively. The duration of the pauses were equal or almost equal to one short plus one long P-P interval or to twice the basic sinus cycle. In one recording a short period of regular sinus rhythm with intermittent 2/1 S-A block was observed. This short period of sinus rhythm was interrupted by sudden prolongation of the P-P interval starting the alternative rhythm. There were small changes in the shape of the P waves and P-R intervals. S-A conduction through two pathways, the first with 2/1 block the second having 0.12-0.14 s longer conduction time and with occasional 2/1 block was proposed for the explanation of the alternating P-P interval and other electrocardiographic features seen. Atropine 1 mg given intravenously resulted in shortening of all P-P intervals without changing the rhythm. The abnormal rhythm disappeared with the withdrawal of propranolol and when the drug was restarted a 2/1 S-A block was seen. This was accepted as evidence for propranolol being the cause of this conduction disorder.