Ondokuz Mayis Universitesi Tip Fakultesi Research Articles

The Impact of Family and Social Support during the First Six Months after Attempt for Smoking Cessation

Objective: The aim of the present study was to investigate the effect of family and social support on smoking cessation during the first six months after the cessation attempt. Methods: The files of 312 patients who were admitted to the Smoking Cessation Outpatient Clinic of Family Medicine Department, Ondokuz Mayıs University Faculty of Medicine between January 2011 and January 2012 were reviewed and their socio-demographic data, smoking characteristics, Fagerström Nicotine Dependence Test (FNDT) score and treatment methods were recorded. Participants were called in a five-minute structured interview and their quit rate was investigated. They were also evaluated for the support they received from the family and social environment during the cessation period with a ten-point Likeert Scale (0 = Never, 10= Excellent) Findings: Of the cases, 190 (61%) were male and 122 (39%) were female. While the mean FNBT score of the group was 5.1 ± 1.7 , the package / year value was 22.3 ± 18.7. Forty four out of 209 participants (21%) who were started medication (Varenicline or Bupropion) and 23 out of 127 participants (%18%) who were started Nicotine Replacement Therapy (NRT) had been smoking for six months. There was not a statistically significant difference between genders with regard to overall social and family support scores (male = 41,3 ± 15,3, female = 44,4 ± 16,0, t = 1,495, p = 0,136). According to a multivariate binary logistic regression model, overall social and family support score (OR = 1,044), age (OR= -1,038), and presence of another smoker family member (OR =0,501) were found as independent factors on smoking cessation. Conclusion: Family and social support are important factors for both gender during making a decision for smoking cessation, during smoking cessation and after smoking cessation and detailed studies are needed.Amaç: Bu araştırmada sigara bırakma denemesine karar verme ve sonraki ilk altı aylık dönemde sigara bırakma üzerine aile ve sosyal çevreden alınan desteğin etkisinin araştırılması hedeflenmiştir. Araç ve Yöntem: Ondokuz Mayıs Üniversitesi Tıp Fakültesi Aile Hekimliği Sigara Bıraktırma Polikliniği’ne Ocak 2011-Ocak 2012 tarihleri arasında başvuran 312 kişinin dosyaları taranarak kişilerin sosyodemografik verileri, sigara kullanma özellikleri, Fagerstrom Nikotin Bağımlılık Testi (FNBT) skoru ve aldıkları tedavi yöntemleri not edilmiştir. Bu kişiler telefonla aranarak beş dakikalık yapılandırılmış bir görüşme gerçekleştirilmiş ve sigarayı bırakma oranları araştırılmıştır. Görüşmede ayrıca sigara bırakma aşamasında ve sigarayı bırakırken aileden ve sosyal çevreden aldıkları destek onlu bir Likert Skala ile değerlendirilmiştir (0=Hiç, 10=Mükemmel). Bulgular: Çalışmaya alınanların 190’ı (% 61) erkek, 122’si (%39) kadındı. Grubun ortalama FNBT skoru 5,1±1,7 iken paket/yıl değeri 22,3±18,7 idi. İlaç (Vareniklin veya Bupropion) tedavisi başlanan 209 katılımcının 44’ü (%21), Nikotin Replasman Tedavisi (NRT) başlanan 127 katılımcının 23’ü (%18) altı aydır sigara içmiyordu (x2=0,283, p=0,868). Her iki cinsiyetin aldığı toplam sosyal destek ve aile desteği puanları birbirinden istatistiksel olarak anlamlı değildi (erkekler= 41,3±15,3, kadınlar= 44,4±16,0, t=1,495, p=0,136). Multivariate binary logistic regression modeline göre toplam sosyal ve ailesel destek puanı (OR= 1,044), yaş (OR= -1,038) ve sigara bağımlısının evinde başka birinin daha sigara içmemesi (OR= -0,501) sigara bırakma üzerinde bağımsız faktörler olarak bulunmuştur. Sonuç: Sigara bırakma kararı alma, bırakma esnasında ve bırakma sonrasında aile desteği ve sosyal destek her iki cinsiyet için önemli bir faktördür ve bu konuda detaylı araştırmalara ihtiyaç vardır.

Malignant Melanoma of the Nasal Cavity: Our Clinical Experience

Correspondence to: Dr. Rifat Karli, Department of Otorhinolaryngology, School of Medicine, Ondokuz Mayis University Samsun, Ondokuz Mayis Universitesi Tip Fakultesi, KBB klinigi, Samsun, Turkey; Tel: +90 530 327 73 67; E-mail: rifatkarli@yahoo.com Abstract Primary malignant melanoma (MM) in otorhinolaryngology is a rare disease that has a poor prognosis. There has been a significant increase in the incidence of MM in the nasal cavity in recent years. We performed surgery on four Turkish patients for intranasal MM during a 6-month period, and the cases were reviewed retrospectively. One patient underwent open surgery, and the other three underwent endoscopic resection. All four patients had microscopically negative surgical margins. One patient received treatment with radiotherapy during the postoperative period. A negative surgical margin and removal of mucosal melanocyt areas are important criteria for surgical success and a better prognosis.

Herbal Product Use in Patients with Chronic Kidney Disease

OBJeCtIve: Recently, despite the developments in diagnosis and treatment of diseases, herbal product use in patients with chronic diseases has become more frequent. The aim of our study was to investigate the frequency of herbal medicine use in patients with chronic kidney disease (CKD), used products, source of information, whether they were giving information to their clinicians about this subject and cost of used products. mAterIAl and methOdS: The investigation has been performed with 100 CKD patients. A questionnaire form has been used in collecting data about the patients. reSUltS: The herbal use rate in our study was 37%. The most used herbal products were ready products and stinging nettle. There was no relation between herbal product use and age, gender, educatin level, marital status (p>0.05). 87% of the patients indicated that monthly cost of the product was lower than 50 Turkish Liras. 78.4% of the patients defined that they didn’t give information to their clinicians about the herbal product they used. COnClUSIOn: A significant part of the patients with CKD use herbal products and do not give information to the clinicians about this subject. The physicians following the patients with CKD should examine the use of herbal products. KeY wOrdS: Chronic kidney disease, Herbal product, Alternative medicine Yazisma Adresi: emre erdem Ondokuz Mayis Universitesi Tip Fakultesi, Nefroloji Bilim Dali, Samsun, Turkiye Tel : 0 505 548 90 02 E-posta : emredlk@yahoo.com Gelis Tarihi : 26.09.2011 Kabul Tarihi : 05.11.2011

The Effect of Education Given to Hemodialysis Patients on Blood Pressure and Weight Gain

ObJective: This study aimed to investigate effect of salt and fluid restriction education for patients undergoing hemodialysis and nonadherent to fluid restriction treatment on blood pressure and weight gain. mateRiaL and metHODs: The study sample consisted of 100 patients, nonadherent to fluid restriction treatment, undergoing routine 3 times a week hemodialysis treatment at a hemodialysis center. Salt and fluid restriction education was given to patients once a week during two consecutive weeks. Pre and post-hemodialysis weight and means, interdialytic weight gain and means, predialysis systolic and diastolic blood pressures and means were measured. RESultS: 67 male and 33 female patients were included. The average age was 56.2 ±13.5 years. Mean hemodialysis time was 54.7+-42.1 months. After education, there was a significant reduction in pre-dialysis weight means (p<0.001) and mean interdialytic weight gain (p:0.006). Also there was a decrease in pre-dialysis systolic blood pressure means (p:0.035) after the education. However, there was no reduction in pre-dialysis diastolic blood pressure means. coNluSioN: If patients undergoing hemodialysis are given sufficient education about salt and fluid restriction; they are eager to follow salt and fluid restriction treatment. KeY WORDs: Hemodialysis, Fluid restriction, Education Yazisma Adresi: emre eRDem Ondokuz Mayis Universitesi Tip Fakultesi, Nefroloji Bilim Dali, Samsun, Turkiye Tel : 0 362 433 11 77 E-posta : emredlk@yahoo.com Gelis Tarihi : 25.05.2011 Kabul Tarihi : 15.07.2011 doi: 10.5262/tndt.2012.1001.07 Turgut Kurt Y ve ark : Hemodiyaliz Hastalarina Verilen Egitimin Kan Basinci ve Kilo Alimina Etkisi Turk Neph Dial Transpl 2012; 21 (1): 39-44 40 turk nefroloji Diyaliz ve transplantasyon Dergisi Turkish Nephrology, Dialysis and Transplantation Journal

KALP CERRAHİSİNDE DEMİNERALİZE KEMİK MATRİKSİ’NİN MEDİAN STERNOTOMİ İYİLEŞMESİ ÜZERİNE ETKİSİ

OZET Yaslanmaya bagli sternumdaki incelme, kemik iyilesmesini zorlastirmakta ve sternumun tespitlendigi yerden kaymasina neden olabilmektedir. Calismamizda demineralize kemik matriksinin sternum iyilesmesi uzerindeki etkisini arastirdik. Bu amacla Ondokuz Mayis Universitesi Tip Fakultesi Kalp ve Damar Cerrahisi Kliniginde, Kasim 2009 – Ekim 2010 tarihleri arasinda median sternotomi yapilan, yaslari 65 ve uzerinde 24 hasta calismaya alindi. Hastalar randomize olarak Grup I (n=12) calisma grubu ve Grup II (n=12) kontrol grubu olarak ikiye ayrildi. Calisma grubundaki hastalara sternumun her iki tarafinin me-dullasina 1 cc’lik demineralize kemik matriksinin macun formu suruldu. Kontrol grubuna herhangi bir madde tatbik edilmedi. Operasyon bitiminde her iki gruptaki hastalarin ster¬numlari standart olarak celik tellerle birlestirildi. Tum hastalara preoperatif donemde ve postoperatif 8. haftada bilgisayarli tomografi cekildi. Bu tomografilerde Hounsfield uni¬tesi olarak olculen sternumdaki kemik yogunluklari birbirleriyle karsilastirildi. Calisma¬ya alinan hastalarin 11’i erkek ve 13’u kadindi. Hastalarin preoperatif ve postoperatif or¬talama sternum dansitesi degerleri karsilastirildiginda, calisma grubu icin p=0,001<0,05 ve kontrol grubu icin p=0,000<0,05 oldugu saptandi. Calisma ve kontrol grubundaki has¬talarin postoperatif 8. haftada olculen sternum yogunluklari birbiriyle karsilastirildiginda ise her iki grup arasinda istatistiksel farklilik olmadigi goruldu. Sternotomi iyilesmesinde bircok faktor rol oynamaktadir. Bu calismanin sonucunda yasli hastalarda demineralize kemik matriksi uygulamasinin sternum iyilesmesini hizlandirici bir etkisinin olmadigini, ancak bu maddenin sternumdaki tellerin zamanla kemigi kesmesine bagli kemikte mey¬dana gelebilecek ayrilma ve kirilmalari uzun donemde onleyebilecegini dusunmekteyiz. Effect of demineralized bone matrix on recovery of median sternotomy in heart surgery ABSTRACT Stenosis of secondary sternum, causes to ageing, and this ageing makes difficult the re¬covery of bones, and can cause to sliding of sternum from the area that was determined. In our research, we searched that the effect of demineralized bone matrix on recover of sternum that contains noncollagen proteins like osteocalcin, osteonectin and osteopontin that has feature of osteoconductive and osteoinductive. With this purpose, in the clinic of Ondokuz Mayis University department of cardiovascular surgery between November 2009 and October 2010, 24 patients whose ages 65 and 65+ were included into the survey. These patients were randomly divided into two groups, Group I was study group (n=12) and Group II was control group (n=12). To the first group (study group), at the end of the operation, the putty form of demineralized bone matrix (1 cc) was applied to both sides of medulla of sternum. Any substances weren’t applied to the second group (control group). At the end of the operation, sternums of the patients in a standard way was com¬bined with steel wires. All patients had axial reconstruction tomography in preoperative period and 8th week in postoperative period. In these tomographies, density of bones in sternum which was measured as Hounsfield Unit (HU), was compared with each others. 24 patients, 11 of them were male and 13 of them were female. In this measurements, the density of sternum of patients which was measured in preoperative and postoperative pe¬riod, were compared with each other; It was diagnosed that for study group p=0.001<0.05 and for control group p=0.000<0.05. While the density of sternum of patients in studygroup and control group which was measured in 8th week of postoperative period was compared, any statistical differences were not found between both groups. In the end of this research, we think that demineralized bone matrix which is applied to aged patients who have got osteoporotic fragile medulla defection, has not got any accelerate effect on healing of sternum; but in the long term, this substances can prevent breaks seen on bones because of the wires on sternum that cut bones in time. J. Exp. Clin. Med., 2011; 28:141-144

Erişkinlerde Trakeobronşiyal Yabancı Cisimler

Yabanci cisim aspirasyonu, acil girisim gerektiren ve yasami tehdit edici bir durum olusturabilir. Ulkemizde, ozellikle eriskinlerde yabanci cisim aspirasyonu oldukca siktir. Bu calismada amac, eriskinlerdeki trakeobronsiyal yabanci cisim aspirasyonlarinin etiyolojisi, klinigi, bronkoskopik tedavinin onemini belirterek tedavi sonuclarini degerlendirmektir. Ocak 1998 - Aralik 2003 arasinda Ondokuz Mayis Universitesi Tip Fakultesi Gogus Cerrahisi Anabilim Dali'nda trakeobronsiyal yabanci cisim aspirasyonu tanisiyla bronkoskopi uygulanan 53 hasta retrospektif olarak degerlendirildi. Tani hikaye, fizik muayene, radyolojik bulgular ve bronkoskopi ile konuldu. Hastalarin yas araligi 14-58 olup yas ortalamasi 24±1.6 yil idi. Hastalarin 44'u (%83) kadin, 9'u (%17) erkekti. Basvuru aninda 18 (%34) hasta semptomatikti ve en sik semptom oksuruktu (%17). En sik rastlanan radyografik anormallik radyo-opak yabanci cisim gorulmesi idi (%81). Bronkoskopi uygulanan hastalarin 50'sinde (%94) yabanci cisim tespit edildi, uc hastada yabanci cisime rastlanmadi. Uc hastaya rijid + fleksibl bronkoskopi uygulandi ve yabanci cisim cikarilmadi. Bu olgulara (%5.6) torakotomi + pnomotomi uygulandi. Yabanci cisimlerin; 24'u (%48) sag bronsiyal sistemde, 18'i (%36) sol bronsiyal sistemde ve 8'i (%16) trakeada tespit edildi. Yabanci cisimlerin buyuk cogunlugunun (%80) turban ignesi oldugu goruldu. Trakeobronsiyal yabanci cisim aspirasyonunda erken tani ve tedavi onemlidir. Trakeobronsiyal yabanci cisimler bronkoskopi ile basariyla cikarilabilir. Bolgelere ve ulkelere gore aspire edilen yabanci cisimler cesitlilik gostermektedir. Tracheobronchial Foreign Bodies in Adults Foreign body aspiration can be a life-threatening emergency requiring immediate intervention. In our country and especially in adults, the prevalence of foreign bodies aspiration is high. In this study, the aim is to evaluate results of the treatment, as well as pointing the importance of bronchoscopic treatment, and etyology and clinics of tracheobronchial foreign bodies in adults. Between January 1998 and December 2003, at Ondokuz Mayis University Medical School, Department of Thoracic Surgery, 53 patients were examined with a suspicion of tracheobronchial foreign body aspirations, retrospectively. The diagnosis was made on history, physical examination, radiological methods and bronchoscopy. The age interval of the patients was 14 to 58 and the mean age was 24±1.6 years. Nine (17%) of them were male and 44 (83%) of them were female. Eighteen (34%) patients were symptomatic on admission and the most frequent symptom was cough (17%). The most common radiographic abnormality found in 81% of the cases was a radiopaque foreign body. All 53 patients had bronchoscopic evaluation, and at 50 (94%) of them foreign bodies were identified. Only in three cases a foreign body was not found during the bronchoscopy. In 3 (5.6%) cases, in which rigid + flexible bronchoscopy were unsuccessful, thoracotomy + pneumotomy was applied. Foreign bodies were localized in the right bronchial tree in 24 (48%) cases, in the left bronchial tree in 18 (36%) cases and in the trachea in 8 (16%) cases. The majority of the foreign bodies were turban pins, in 40 (80%) cases. Early diagnosis and treatment is important in tracheobronchial foreign body aspiration. Tracheobronchial foreign bodies can be successfully removed with bronchoscopy. Aspired foreign bodies vary from region to region and country to country.

Eksternal Pelvik Radyoterapi’de Cihaz Seçimi Üzerine Etkili Faktörler ve Yan Etkilerin Karşılaştırılması‡

Radyoterapinin amaci iyonizan radyasyon kullanarak malign hucrelerin ortadan kaldirilmasidir. Gunumuzde pelvik yerlesimli tumorlerin tedavisinde diger tedavi modelleri ile kombine veya tek basina sikca uygulanmaktadir. Calismamizda Ondokuz Mayis Universitesi Tip Fakultesi Radyasyon Onkolojisi Anabilim Dalinda Ocak 2006-Aralik 2007 yillari arasinda pelvise radyoterapi uygulanmis 95 hastanin akut radyoterapi toksisitesi, calisma prensipleri ve isin ozellikleri farkli olan 2 ayri radyoterapi cihazina gore karsilastirilmis, cihaz ozellikleri disinda toksisite uzerine etkili diger faktorler de incelenmistir. Hastalarin %43,2’si erkek, %56,8’i kadin, yas ortalamasi 60,71±13,1’dir. Primer tanilar degerlendirildiginde en sik rektum tumoru (%32,6) nedeniyle radyoterapi uygulanmistir. Radyoterapi cihazi hastalarin %43,2’sinde kobalt 60, %56,8’inde enerjisi 18 MV olan lineer akseleratordur. Hastalarin on-arka yari cap ortalamasi 10,63±1,43 cm, uygulanan toplam radyoterapi dozu ortalamasi 5481,68±817,24 cGy’dir. Uygulanan radyoterapi dozu lineer akselerator kolunda daha yuksek olmakla beraber aradaki fark anlamli bulunmamistir (p=0,053). Kuratif amacli radyoterapi uygulamasi lineer akselerator kolunda (p=0,04), palyatif tedaviler ise kobalt 60 kolunda daha cok yapilmistir. Coklu alan duzenlemeleri (p=0,001) ve hasta yari capi (p=0,001) lineer akselerator kolunda anlamli olarak yuksektir. Radyoterapinin birinci haftasinda alt gastrointestinal bolgeye ait (p=0,02), ucuncu haftasinda deriye ait yan etkiler (p=0,04) kobalt 60 tedavi kolunda anlamli olarak daha yuksektir. Sonuc olarak pelvik yerlesimli tumorlerin tedavisinde lineer akselerator tedavi cihazinin kullanilmasi erken yan etkilerin azaltilmasinda daha etkilidir. Anahtar kelimeler: Pelvik radyoterapi, Kobalt 60, lineer akselerator, erken yan etkiler The Factors that Effects the Choice of Treatment Machine for External Pelvic Radiotherapy and Comparison of the Side-Effects The aim of the radiotherapy is to eliminate the malign cells by using ionizing radiotherapy. Radiotherapy is being used rather frequently for the treatment of pelvic tumors as a primary modality or with the combination of the others. This study is designed in Ondokuz Mayis University School of Medicine Radiation Oncology Department between January 2006 and December 2007. Ninety-five patients were treated with pelvic external radiotherapy in this period. There were two different treatment machines which have differences for the acute radiotherapy toxicity, working principles and beam characteristics. These differences and also, the factors that might be associated with radiotherapy toxicity are analyzed. Of the patients 43,2% were male, and 56,8% were female and the mean age was 60,71±13,1. When examined the primary diagnosis, external pelvic radiotherapy treatment was given for rectal cancer (32,6%) most frequently. The treatment machine was Cobalt 60 teletherapy machine in 43,2% patients and Linear accelerator with energy of 18 MV in 56,8% patient. The mean front to back radius of the patients was 10,63±1,43 cm, the mean overall treatment radiotherapy dose was 5481,68±817,24 cGy. Although the overall treatment dose was higher in linear accelerator treatment group the difference was not significant (p=0,053). The curative treatments were made with linear accelerator (p=0,04), where more palliative treatments were made with Cobalt 60 machine. More complex treatments (multiple fields) were used in Linear accelerator treatments (p=0,001). The front to back radius of the patients in linear accelerator treatment group was higher (p=0,001). When compared for the side-effects; the patients who were treated with Cobalt 60 has more gastrointestinal side-effects at the first treatment week (p=0,02) and skin side-effects at the third treatment week (p=0,04). As a conclusion; for the external radiotherapy of pelvic tumors linear accelerator is more suitable with less side-effect. Key words: Pelvic radiotherapy, Cobalt 60, linear accelerator, early toxicities

Ondokuz Mayıs Üniversitesi Tıp Fakültesi Araştırma Ve Uygulama Hastanesi Endokrin Polikliniği’ne Başvuran Diyabetes Mellitus’lu Hastaların Hikayeleri İle Bilgi Düzeylerinin İncelenmesi

The Study of Information Level of the Diabetic Mellitus Patients applied to the Endocrine Policlinic of Ondokuz Mayis University Research and Implementation Hospital This study was conducted to determine the various demographic features of diabetic patients and their information level and attitude towards the diabetes. Before the implementation of the study, a permission was taken from the Hospital Administration. This descriptive and intermittent study was conducted from December 2006 to March 2007, two hundred and nine patients all of whom were diabetic and applied to the Endocrine Policlinic at Ondokuz Mayis University Research and Implementation Hospital were included in the experimental group. The data were obtained through the questionnaires prepared by the researcher and personal information forms, and analysed in the percentage distribution by SPSS. According to the findings, 61.3% of the diabetic patients were female and 82.8% of them were married. It was found that 59.1 of female patients did not know the normal level of the blood sugar. 42.9 % of male patients do not know that diabetes damages the body, and besides, 60% of them did not know that their diets must be rearranged because of diabetes. In conclusion, if the diabetic patients are informed about diabetes, they may be given a chance to lead a heathier life. Bu arastirma, bir universite hastanesine basvuran diyabet hastalarinin cesitli demografik ozellikleri ve diyabet hastaligi hakkindaki bilgi ve tutumlarini saptamak amaciyla yapilmistir. Calismaya baslamadan once hastane idaresinden gerekli izin alinmistir. Tanimlayici ve ke-sitsel olan bu arastirma Aralik 2006-Subat 2007 tarihleri arasinda yapilmistir. Uc ay sure ile Ondokuz Mayis Universitesi Tip Fakultesi Arastirma ve Uygulama Hastanesi Endokrin Poliklinigi'ne basvuran, diyabet tanisi konulmus bireylerin tamami olan 209 hasta ornek-lem grubuna dahil edilmistir. Veriler, ilgili literatur arastirilarak arastirmacilar tarafindan hazirlanan anket sorulari ve kisisel bilgi formu ile toplanmistir. Veriler SPSS paket programinda yuzdelik dagilim seklinde degerlendirilmistir. Arastirma bulgularina gore; orneklem grubunun %61.3'u kadin ve %82.8'inin evli oldugu saptanmistir. Kadinlarin %59.1'i kan sekerinin normal degerini, erkeklerin %42.9'u diyabetin vucuda zarar verdigini ve erkeklerin %60'i diyabetten dolayi beslenmenin duzenlenmesi gerektigini bilmemektedir. Sonuc olarak; diyabetik bireylere hastaliklarina iliskin eksik bilgilerin saptanarak verilmesinin saglikli yasam bicimi davranislarinin kazandirilmasina imkan saglayabilir.

El Yerleşimli Tendon Kılıfı Dev Hücreli Tümör: 35 Hastanın Değerlendirilmesi

Giant-cell Tumor of Tendon Sheath of Hand; Evaluation of 35 Patient We have retrospectively evaluated tendon sheath giant cell tumors regarding their complications at the time of diagnosis, during treatment period and at postoperative period. We have performed surgery to 35 patients for their tendon sheath giant cell tumors localized in their hands [20 females, 15 males, mean age was 46.6 (17-72)]. Localization of the tumor was on the right hand side in 21 of the cases and on the left in 14 of the cases. Mean follow up time was 3.1 years (8 months-9.4 years). Most common complaints of the patients was a painless soft tissue mass. They were mostly on the volar side (%72) and on index finger (%25) and they were frequently found to be localized at the proximal phalanx (%51). The duration of the symptoms was between 3 months and 2.5 years. Bony involvement was found in 2 cases. At the postoperative period we have found digital nerve injury in 5 of the cases, superficial skin infection in 3 of the cases. We have found recurrence in 12 of the cases (%34.2) in a mean time of 2.8 years and joint stiffness was found in 8 of the cases. Tendon sheath giant cell tumors have high recurrence rates so surgery should be performed meticulously in a wide surgical field and magnifying glasses should be worn. Eldeki tendon kiliflarinda gelisen tendon kilifi dev hucreli tumorleri tani, tedavi ve ameliyat sonrasi donemde olusan komplikasyonlar acisindan retrospektif olarak degerlendirildi. On bes yillik bir donem icinde, el yerlesimli tendon kilifi dev hucreli tumor nedeniyle 35 hastaya [20 kadin, 15 erkek, ortalama yas 46,6 yil (17-72)] Ondokuzmayis Universitesi Tip Fakultesi Ortopedi ve Travmatoloji AD tarafinca cerrahi uygulandi. Lezyonlarin hepsi el yerlesimliydi. Tutulum 21 olguda sag, 14 olguda sol tarafta idi. Ortalama izlem suresi 3.1 yil (8 ay- 9,4 yil) idi.Hastalarin en sik basvuru nedeni agrisiz yumusak doku kitlesi idi. Olgularin cogunda (%71,4) tumor volar bolgeden kaynaklanmisti. Tumor siklikla isaret parmaginda (%25,7), ve proksimal falanks duzeyinde (%51,4) gelismisti. Bulgularin suresi 3 ay ile 2,5 yil arasinda degismekteydi. 2 olguda kemik tutulumu gozlendi. Ameliyat sonrasi donemde 5 olguda digital sinir hasari, 3 olguda yuzeyel enfeksiyon, 8 olguda eklem sertligi gelisti. 12 hastada (%34,3) ortalama 2,8 yil icinde (2 ay -5 yil) nuks oldu.Tendon kilifinin dev hucreli tumorlerinde yuksek nuks orani goz onune alinarak, genis cerrahi sahada titiz bir cerrahi uygulanmali ve buyutucu gozluklerden yararlanilmalidir.

Ani İşitme Kaybı Olan Hastalarda Prognoz Üzerine Etkili Faktörlerin İncelenmesi

Ev aluation of Factors Effective on Prognosis in Patients with Sudden Hearing Loss Sudden sensorioneural hearing loss is one of the important illnesses that has to be managed immediately, however consensus about its treatment is not present. At its pathophysiology, causes like viral infection, vascular factors, labirinth membrane rupture and autoimmunity are thought to be responsible. Although macromolecules like steroids, vasodilatator drugs, plasma volume expanders and urografin are used at treatment, many new treatment modalities are tried. This study was performed in 37 patients with the diagnosis of sudden hearing loss admitted to Ondokuz Mayis University Faculty of Medicine Otorhinolaryngology Department between May 2003 and April 2006. Steroid (1 mg/kg oral), urografin (10 ml i.v. at first day, then 5 ml i.v.), reomakrodeks (500 ml i.v. infusion for 8 hours) and piracetam (2x6 g i.v. for 5 days) were given to all patients. Criteria determined by 'Sudden Deafness Research Team of the Japanese Ministry of Health and Welfare' were used in the evaluation of treatment results. When the treatment results were evaluated, it was seen that prognosis was bad in patients with total hearing loss and hearing loss involving low frequencies had a better prognosis. In the presence of tinnitus as a vestibulocochlear symptom, prognosis was better. Ani sensorinoral isitme kaybi acil mudahale edilmesi gereken, ancak henuz tani ve tedavisinde fikir birligine varilamamis, onemli hastaliklardan biridir. Patofizyolojide viral enfeksiyon, vaskuler patolojiler, labirent membran rupturu, otoimmunite gibi nedenler sorumlu tutulmaktadir. Tedavide steroidler, vazadilator ilaclar, plazma volum genisleticileri, urografin gibi makromolekuller kullanilmakla birlikte gun gectikce bircok yeni tedavi modaliteleri denenmektedir. Bu calisma Mayis 2003-Nisan 2006 tarihleri arasinda Ondokuz Mayis Universitesi Tip Fakultesi Kulak Burun Bogaz klinigine basvuran ve ani isitme kaybi tanisi ile tedavi edilen 37 hastada yapildi. Tum hastalara steroid (1 mg/kg, oral), urografin (ilk gun 10cc, dort gun 5 cc iv), reomakrodeks (500 cc/8 saat iv infuzyon) ve pirasetam (2x6 gr iv bes gun) verildi. Tedavi sonuclarinin degerlendirilmesinde 'Sudden Deafness Research Team of the Japanese Ministry of Health and Welfar' tarafindan belirlenen kriterler kullanildi. Tedavi sonuclari degerlendirildiginde total isitme kayipli hastalarda prognozun kotu, alcak frekanslari tutan isitme kayipli hastalarda ve vestibulokoklear semptomlardan tinnitus varliginda prognozun daha iyi oldugu gorulmustur.

Çocukluk Çağı Nefrotik Sendromu: 230 Olgunun Değerlendirilmesi

Nephrotic Syndrome in Childhood: Retrospective evaluation of 230 cases In this study, we evaluated 230 children (0 to 17 years old) with nephrotic syndrome (NS) who admitted to the Department of Pediatrics of Ondokuz Mayis University between January 1986 to December 1998, retrospectively. The diagnostic criteria of International Study of Kidney Diseases of Children (ISKDC) were used to define the patients in this study. Patients were classified into two groups according to etiology as primary and secondary NS. Clinical and laboratory findings of all cases were examined. It is observed that 77.8% of the cases had primary and 17.4% had secondary NS, 4.8% of them could not be classified. 39.1% of the patients were female and 60.9% of them were male. Female/male ratio was 1/1.6. Steroid responsive cases consisted 77.8% of the cases with minimal change NS (MCNS). 51% of the patients with steroid responsive MCNS developed one or more relapses. Among the relapses, rare and frequent relapses were 29.4% and 10.7%, respectively. 3.9% of the patients with MCNS were steroid dependent. Amyloidosis was diagnosed in 27 patients and it was the most common cause of secondary NS. The most frequent complication was infection. In 230 patients, 57.4% went to remission, 5.6% died and 10.4% progressed to chronic renal failure. These findings were evaluated according to age, sex, etiology, response to treatment, prognosis and compared with national data and the literature. Bu calismada Ondokuz Mayis Universitesi Tip Fakultesi Cocuk Sagligi ve Hastaliklari Anabilimdali Pediatrik Nefroloji unitesinde Ocak 1986 ile Aralik 1998 yillan arasinda gecen 12 yillik sure icinde izlenen 0-17 yas grubunda nefrotik sendrom (NS) tanisi alan 230 hasta retrospektif olarak incelendi. Calismaya dahil edilen NS'lu hastalarda Uluslararasi Cocuk Bobrek Hastaliklari Calisma Grubunca (ISKDC) kabul edilen tani kriterleri kullanildi. Etiyolojik nedenlere gore primer (idiyopatik) ve sekonder NS olarak siniflandirilan olgularin klinik ve laboratuvar bulgulari incelendi. Olgularin %77.8'i primer, %17.4'u sekonder NS olarak belirlendi, %4.8 olguda ayrini yapilamadi. Olgularin %39.1'u kiz, %60.9'i erkekti ve kiz/erkek orani 1/1.6 olarak saptandi. Minimal lezyonlu NS (MLNS) dusunulerek kortikosteroid tedavisi verilen hastalarin (n: 127) %77.8'i steroide yanit verdi. Steroide yanit veren hastalarin %51'inde relaps gozlendi ve relaps olgularinin %29.4'u nadir relaps, %10.7'si sik relaps seklindeydi. Hastalarin %3.9'u ise steroide bagimli olarak saptandi. Amiloidozis 27 hastada saptandi ve sekonder NS'un en sik nedeni idi. Gelisen komplikasyonlar icinde en sik enfeksiyonlar goruldu. Toplam 230 NS'lu hastanin %57.4'u remisyona girdi, %5.6'i eksitus oldu ve %10.4'unde kronik bobrek yetmezligi (KBY) gelisti. Yas, cins, etiyolojik dagilim, tedaviye yanit ve prognoz yonunden incelenen nefrotik sendrom tanisi almis 230 olgunun bulgulari ulkemiz verileri ve literatur bulgulariyla karsilastirildi.

Yoğun Bakım Ünitesindeki Hastane İnfeksiyonlarının Değerlendirilmesi

Evaluation of Nosocomial Infections in Intensive Care Unit Nosocomial infections (Nl) constitute an important health problem with prolongation of hospital stay, increased costs of direct care, morbidity and high mortality. The aim of this study was to evaluate the general features of NI in Mikail Yuksel Intensive Care Unit (ICU) in Ondokuz Mayis University. A cross sectional research was performed between 1st September 1998 and 28U1 February 1999 in Mikail Yuksel ICU in Ondokuz Mayis University. Medians of age and total lenght of hospital stay in patients with NI were 47 years (18-67 years) and 28 days (12-84 days), respectively. Medians of total length of hospital in patients witihout NI were 6 days (2-21 days) and there was a statistically significant difference between two group (p<0.001). The patient's day was found 332 days. NI rate was found 10.7% and the principal sites of NI were the urinary tract (36.4%), bacteriemia (27.3%), pneumonia (18.2%) and local vascular cauiater (18.2%). Vascular cathaterization was performed on 100.0% and urinary cathaterization, entubatioii and mechanic ventilation were performed on 90.9% of the patients. We conclude that the high economic expense, long hospitalization periods, high mortality rates which NI represent emphasized the necessity of carefully designed and conducted studies in the control of these infections. Hastane infeksiyonlari (HI) hastanede kalis surelerinin uzamasi, yuksek hasta bakim maliyeti, morbidite ve mortalite riski nedeniyle onemli bir saglik sorunudur. Calismada Ondokuz Mayis Universitesi Tip Fakultesi Mikail Yuksel Cerrahi Yogun Bakim Unitesi (YBU)'nde gorulen HI'larinin degerlendirilmesi amaclanmistir. Kesitsel tipteki bu arastirma Ondokuz Mayis Universitesi Tip Fakultesi Mikail Yuksel Cerrahi YBU'nde, 1 Eylul 1998-28 Subat 1999 tarihleri arasinda yapilmistir. HI olan hastalarin yaslarinin ortancasi 47 yil (18-67 yil), hastanede yatis suresi ortancasi 28 gun (12-84 gun) olup, hasta gunu 332 gun olarak bulunmustur. HI olmayan es grubun hastanedeki yatis suresi ortancasi 6 gun (2-21 gun) olup, iki grup arasinda yatis suresi acisindan istatistiksel anlamli fark bulunmustur (p<0.001). HI orani %10.7 olup, bu taniyi alan hastalarin %36.4'unde uriner sistem infeksiyonu, %27.3'unde bakteriyemi. %18.2'sinde pnomoni ve %18.2'sinde lokal kateter infeksiyonu saptanmistir. Invaziv girisimlerden santral venoz kateter hastalarin %100.0'une, uriner kateter, entubasyon ve mekanik ventilasyon %90.9'una uygulanmistir. HI'larinin yol actigi ek maliyet, yatis suresi ile mortalite oranlarindaki artis gozonunde bulunduruldugunda bu infeksiyonlarin kontrolune yonelik calismalara agirlik verilmesi geregi bir kez daha ortaya cikmaktadir.

Kliniğimizdeki Torasik Bölge Cerrahisi Olguları

The Cases of the Thoracic Surgery in Our Clinics A total of 1232 pediatric thoracic surgery patients were admited to the Department of Pediatric Surgery of Ondokuz Mayis University Faculty of Medicine in tire period of January 1979 to June 1996. We performed surgical procedure to 1019 cases because of surgical thoracic pathology. The pathologies, treatment modalites and results were evaluated. The major patient groups consist of the group of Esophagus-Mediastinum (58.3%) and Lung-Pleura (32.5%). When cases are evaulated in terms of mortality following surgery, ratio of all pediatric thoracic surgery cases was found to be 4.1% .In accordance with the increasing number of patients and the developments in recent years, it was observed that the number and kind of surgery, and also the number of incoming patients and treated patients suffering thoracic pathologies were increasing over the years .As a conclusion, thoracic surgery was believed to be one of the most important area of pediatric surgery. Ondokuz Mayis Universitesi Tip Fakultesi Cocuk Cerrahisi Anabilim Dali'na Ocak 1979 ile Haziran 1996 tarihleri arasinda toplam 1232 cocukluk cagi toraks cerrahisi olgusu kabul edilmistir. Bu hastalardan, 1019 olguya cerrahi girisim uygulanmistir. Bu hastalarin pa-tolojileri, tedavi sekilleri t ve sonuclari degerlendirildi. Olgular incelendiginde en buyuk hasta gruplarinin; ozofagus-mediasten grubu (%58.3) ile akciger-plevra grubu(%32.5) hastalarin oldugu goruldu. Olgular cerrahi sonrasi mortalite acisindan degerlendirildiginde tum pediatrik torasik cerrahi olgulan icin oranin %4.1 (42 olgu) oldugu bulundu.Son yillardaki gelismelere ve artan genel hasta sayisina parelel olarak klinige basvuran ve te-davi goren toraks patolojili hasta sayisiyla birlikte, uygulanan cerrahi girisim sayisinin ve niteliginin yillar icinde giderek artigi goruldu. Sonuc olarak toraks cerrahisinin cocuk cer-rahisinin onemli bir ugrasim alani oldugu kanisina varildi.

O.M.Ü. Tıp Fakültesi Acil Servisine Başvuran İntoksikasyon Hastalarının Değerlendirilmesi

Evaluation of the Intoxication Patients were Admitted in Emergency Unit In this study, 72 intoxication patients who admitted in emergency unit of Ondokuz Mayis University Medical Faculty were evaluated. 25 of 72 patients (34.7%) were male and the rest (65.3%) were female with averaga age 30.1+1.65 years. Drugs (47.2%), organic pestici¬de (41.7%), food (4.2%) and others (6.9%) were found in major etiologic reason of intoxica¬tion. Suicide was major reason in 59 of 72 patients (81.9%) and the other reasons of into¬xication was found in 11 (15.3%) and 2 (2.8%) patients, by accidentely and unknown reason, respectively. When 6 patients (%8.3) were discharged from emergency unit, 66 pa¬tients (91.7%) were admitted intensive care unit and 11 (15.3%) of them were exituced. In this study, organic pesticide was found (%41.7) one of the major etiologic reason of in¬toxication and it was responsible from most of the death (%72.7). / Ondokuz Mayis Universitesi Tip Fakultesi Hastanesi eriskin acil servise 1996 yili Ocak-Mayis aylari arasinda intoksikasyon nedeniyle basvuran hastalar degerlendirildi. Toplam 72 hastanin 25 (%34.7)'i erkek, 47 (%65.3)'i kadindi. Hastalarin yas ortalamasi 30.1+1.65 idi. 34 hastada (%47.2) ilaclar, 30 hastada (%41.7) organik fosfor, 3 hastada (%4.2) besin intoksiyonu ve 5 hastada (%6.9) ise diger toksik maddeler intoksikasyon nedeni olarak saptadi. 59 hasta (%81.9) ihtihar amaciyla, 11 hasla (%15.3) kaza sonucu ve 2 hasta (%2.8) ise belirlenemeyen nedenlerle toksik maddeyi almisti. Hastalann izleminde, 6 hasta (%8.3) acil servisde gozlemde tutulduktan sonra taburcu edilirken, 66 hasta (%91.7) yogun balom servisine yatirildi. Yalan hastalarin 11 (%15.3)'i eksitus oldu. Arastirmamizda tarim ilacina bagli zehirlenmelerin, tum intoksikasyonlar icerisinde onemli bir yer tutugunu (%41.7) ve en fazla olumlerin (%72.7) pestisidlere bagli olustugunu belirledik.

Geriatrik Hastalarda Genel Ve Bölgesel Anestezi; 16 Yıllık Geriatrik Hasta Analizi

The characteristics of the geriatric patients who has undergone surgical operation proce¬dure in the hospital of Ondokuz Mayis University medical school between 1979 and 1994 were rewieved. The information obtained from the anesthetic records were analysed with a data base programme. The patients that were accepted as geriatric over 65 years old were analysed in four different groups. During 16 years period 7.7% of the 41047 pa¬tients were over 65 years old. An increase in the distribution of the geriatric patients with respect to years was observed. Regional anesthesia showed an increase with age, having been 22% between the ages of 65-70 and 30% over the age 80.The rate of regional anest¬hesia was found higher in urology among all departments with a 57.2% Coexisting sys¬temic diseases in the patients were recorded as 54.8%, while the complications as 22.4%. 1979-1994 yillari arasinda Ondokuzmayis Universitesi Tip Fakultesi Hastanesinde opere edilen geriatrik hastalarin ozellikleri incelendi. Anestezi kayitlarindaki bilgiler bir veri tabani programi ile analiz edildi. 65 ve uzeri yas grubu yasli kabul edilerek 4 grupta ince¬lendi. 16 yil suresince anestezi uygulanan 41.047 hastanin %7.7'si 65 ve uzeri yasta idi. Yasli hastalarin yillara gore dagiliminda giderek artis gozlendi. Bolgesel anestezi yaslara gore artis gostererek 65-70 yas arasinda %22 iken. 80 yas uzerinde %30'a ulasmistir. Bolgesel anestezi bolumler arasinda en cok %57.2 orani ile uroloji bolumunde saptandi. Yandas sistemik hastaliklar %54.8, komplikasyonlar %22.4 oraninda goruldu.

Kronik Hemodiyaliz Hastalarında Lokomotor Sistem Bulguları

Musculoskeletal System Signs In Chronic Haemodialysis Patients In order to determine the prevalence and distribution of locomotor system signs and symptoms in haemodialysis patients we conducted a survey in haemodialysis centre at Ondokuzmayis University. Thirthy patients, dialysed over a long period have been exa¬mined clinically and radiologically to evaluate their musculoskeletal problems. There were 17 women (%56.6) and 13 men (%43.3). The mean age of the patients was 34+2.5 (range 15-60). The cause of the renal failure was chronic glomerulonephritis (36.6%), renal anomaly (30%), renal tuberculosis (6.6%), nephrolithiasis (6.6%), chronic pyelo¬nephritis (3.3%), amyloidosis (3.3%) or was unknown (13.3%). The average duration of dialysis at the beginning of the study was 60.7+7.6 months (range 6-120). All of the patients were dialysed with cuprophane membranes. At the end of the study we found that 24 patients (80%) had muscle cramps and 14 patients (46.6%) had arthralgia. Ra¬diological abnormalities were found in 14 patients (46.6%). The 14 patients with arti¬cular involvement were compared with the 16 dialysis patients free of these clinical abnormalities. The affected patients were significantly older at the start of the dialysis than the unaffected patients. We found no correlation between the duration of the dia¬lysis and articular involvement Bu calisma; kronik hemodializ hastalarinda gorulen romatolojik bulgularin sikligini ve dagilimini incelemek amaciyla planlandi. Ondokuzmayis Universitesi Tip Fakultesi He-modializ unitesinde takip ve tedavi edilmekte olan 30 hasta romatolojik yakinmalari yonunden klinik ve radyolojik olarak incelendi. Hastalarin % 80'inde kas kramplari, % 46.6'sinda artralji saptandi. Ondort olguda (%46.6) radyolojik bulgu vardi. Radyolojik bulgular; %40 osteoporoz, %20 spondylartroz, %20 yumusak doku kalsifikasyonu, %26.6 juxtaartikuler erozyon, %6.6 kistik degisimler ve %6.6 periferik eklemlerde dejeneratif artroz seklinde siralaniyordu. Artraljisi olan ve olmayan gruplar arasinda; cins, dialize goturen sebep ve toplam dializ suresi arasinda fark yoktu. Ancak dialize baslangic yasi ile artralji arasinda anlamli bir korelasyon vardi (p<0.05).

D Vitamini Yetmezliği Olan Raşitizm’li Olguların Klinik Olarak Değerlendirilmesi

SUMMARY THE CLINICAL EVALUATION OP THE PATIENTS WITH RICKETS Ricket s which is a common metabolie bone disease especially in developing countries, has clear physical, radiologie and biochemical findings. We evaluated the patients who had been admitted to Ondokuz Mayis university Hospital between the years 1984-1.989. Patients had different symptoms. Hypotonia was the most frequent symptom, the others were sweating and convulsion. Most of the patients were malnourished children. The evidences of physical, radiological and biochemical findings of rickets were determined in all patients. Anemia was noticed as the striking finding in the patients with rickets and the more biochemical phase increased, the more anemia become evident. Findings and the results of treatment has been discussed. OZET Gelismekte olan ulkelerde halen yaygin olarak gorulen rasitizmin belirgin fizik inceleme,, biyokimyasal ve radyolojik bulgulari vardir. Ondokuz Mayis universitesi Tip Fakultesi Cocuk Hastaliklari Polikliniginde 1984-1989 yillari arasinda rasitizm tanisi ile izlenen 134 vaka deskriptif olarak incelendi. Degisik semptomlarla hastanemize gelen hastalarda hipotoni en sik gorulen semptomdu. Hastala¬rin fizik inceleme, radyolojik ve kan biyokimyasi bulgula¬ri degerlendirilerek sonuclar tartisildi.