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Kocaeli Medical Journal - Kocaeli Med J: 5 (2)
Volume: 5  Issue: 2 - August 2016
ORIGINAL ARTICLE
1. Analysis and prognostic significance of hematological parameters in patients with tinnitus
Nagihan Bilal, Selman Sarıca, İsrafil Orhan, Anıl Aktaş Samur
Pages 1 - 7
INTRODUCTION: In our study neutrophil lymphocyte ratio (NLR) and also lymphocyte platelet ratio (LPR), mean platelet volume (MPV), MPV/PLT examined in patients those suffer from tinnitus.
METHODS: Prospective study. 65 patients those suffer from tinnitus and admitted to Kahramanmaras Sutcu Imam University ENT Department between August 2015- November 2015 is the first group and the second group is control group. Blood count parameters; haemoglobin, erytrocyte, leucocyte, neutrophil, lymphocyte, platelet count and, PLR, NLR examined. Patients were asked to fill out the tinnitus handicap index. Patients divided into five groups according to the tinnitus handicap index.
RESULTS: The mean age of the patient with tinnitus was 47.95±11.82. %55.6(35) was female, %44.4(28) was male. There was no significant difference between group1 and control group according to NLR. Likewise there was no significant difference between two groups according to PLR and MPV/PLT ratio. (p values 0.213, 0.216, 0.262)
DISCUSSION AND CONCLUSION: Tinnitus is a common symptom with multifactorial etiology. In previous researchs conducted in patients with tinnitus NLR found significant, but in our study the NLR was not statistically significant between two groups. Keeping the high number of patients is essential for the significant rise in the ratio.

2. Comparison of balloon and amplatz dilatation in percutaneous nephrolithotomy according to Modified Clavien classification
Emre Can Polat, Levent Özcan, Bülent Katı, Alper Ötünçtemur
Pages 8 - 14
INTRODUCTION: Comparing balloon and amplatz dilatation complication rates according to Modified Clavien classification in percutaneous nephrolithotomy (PCNL).
METHODS: Records of 206 standard PCNLs performed between Nov 2008 and Dec 2015, were evaluated retrospectively. All patients were evaluated with a detailed medical history form preoperatively. General examination was held and interrogated in terms of systemic disease. Patients’s preoperative blood count, serology, blood biochemistry and urine cultures were evaluated. 119 patients underwent balloon, 97 patients underwent amplatz dilation. Complications were compared according to the Modified Clavien classification.
RESULTS: No complication was seen in 44 of 66 patients who underwent balon dilatation and 31 of 46 patients who underwent amplatz dilatation for simple kidney stones. Also no complication was seen in 34 of 53 patients who underwent balon dilatation and 24 of 41 patients who underwent amplatz dilatation for complex kindey stones. When all subgroups were included there was not any significant statistical difference seen between the two groups in terms of complication rates ( p > 0.05). Only in complex stone formers, degree of 3b complications were seen less in balloon dilatation group (p = 0.03 ).
DISCUSSION AND CONCLUSION: No superiority was observed in terms of complications between amplatz and balloon dilation methods when all subgroups were included according to Modified Clavien classification except degree 3b in the complex stone formers.

3. Effect of 0.25% Levobupivacaine infiltration time on postoperative pain after laparoscopic cholescystectomy
Onur Dülgeroğlu, Birzat Emre Gölboyu, Murat Aksun, Senem Girgin, Ali Ahıskalıoğlu, Pınar Karaca Baysal, Mürsel Ekinci
Pages 15 - 20
INTRODUCTION: We compared the effects of preincisional versus endoperative levobupivacaine infiltration around trochar ports on pain control, analgesic requirements and patient satisfaction after laparoscopic cholecystetomy.
METHODS: Eigthy ASA I-III Laparoscopic cholescytectomy patients aged 19-65 were randomly assigned into two groups; levobupivacaine infiltration surrounding trochar ports was performed preincisionally in Group 1 and after closure of incision in Group 2. VAS scores were asked at 0., 1., 4., 8., 12 and 24. hours for postoperative pain evaluation. Intravenous 0.5 mg/kg tramadol was administered to the patients with VAS score ≥ 4. First analgesic requirement time and 24 hours total analgesic consumption were recorded for each patient. Additional analgesic requirements were noted at 0-4., 4-12. ve 12-24. hours.
RESULTS: Regarding first analgesic requirement time and total analgesic consumption, there was statistically significant difference between groups (p=0.024, p=0.044). First analgesic requirement was later and total opioid consumption was lower in Group 1. Patient satisfaction was also increased in Group 1(p=0,041).
DISCUSSION AND CONCLUSION: Preincisional infiltraton of 10 ml 0,25 levobupivacaine around trochar ports is an effective and safe method to obtain better results in sense of pain control, analgesic consumption and patient satisfaction after laparoscopic cholesistectomy surgery.

4. Nutritional condition scanning in gastrointestinal cancer patients
Eyüp Murat Yılmaz, Erdem Barış Cartı, Erkan Karacan, Ethem Bilgiç, Şükrü Boylu
Pages 21 - 25
INTRODUCTION: Malnutrition is a clinical process that begins with a deficiency in immune system of human metabolism and dispreads through systematic inflammation.. We have planned a nutritional condition scanning with a simple scanning questionnaire for the patients who are diagnosed with gastrointestinal cancer.
METHODS: 52 voluntary patients were included in the research. Patients are the patients who had just received the diagnosis of gastrointestinal system cancer. Patients who had received neoadjuvant treatment, who had had a tumor operation and who has another type of cancer were excluded from the study. MNA-SF forms were applied to the patients, and their body mass indexes (BMI), were recorded.
RESULTS: When phases of the patients were taken into consideration, rates of illnesses with the risk of malnutrition at the time of diagnosis were 50% for first phase, 77,8% for second phase, 72% for third phase and 100% for fourth phase, and there is not any statistical significance. When we take a look at the comparison between BMI and malnutrition rates, patients who are under the risk of malnutrition; it is designated as 100% for weak patients, 75% for normal patients, 76,2% for over-weight patients and 50% for obese patients, and there is not any statistical significance (p: 0,222).
DISCUSSION AND CONCLUSION: Gastrointestinal system cancers are the cancers that are observed very frequently among the society. As soon as diagnosis was received by the patient, their nutritional conditions shall be evaluated with nutritional scanning and most appropriate nutritional support shall be provided for those patients.

5. When Cholecystectomy Should Be Done in Acute Mild Biliary Pancreatitis?
Adem Yüksel, Murat Coşkun, Mehmet Özyıldız, Hamdi Taner Turgut, Murat Burç Yazıcıoğlu, Osman Civil, Gizem Fırtına, Selim Yiğit Yıldız
Pages 26 - 31
INTRODUCTION: After an attack of acute biliary pancreatitis (ABP) in order to avoid repetitive biliopancreatic events, the definitive treatment is cholecystectomy. In particular, different approaches to the timing of cholecystectomy in ABP which was constituted 80% of mild forms of pancreatitis. In this study, we aimed to compare the outcomes of patients after mild biliary pancreatitis attacks who underwent early (in the first admission) and late (after 4 - 12 weeks) laparoscopic cholecystectomy.
METHODS: In this study, patients who underwent laparoscopic cholecystectomy in our clinic between January 2010 and December 2014 with the diagnosis of ABP were retrospectively evaluated. Patients divided into two group; in group 1 (n = 23) early (in the first admission) cholecystectomy and in group 2 (n = 54) late (after 4 - 12 weeks) cholecystectomy was performed. Groups were respectively compared in terms of demographic data, operation time, complications, mortality and recurrence of biliopancreatic events.
RESULTS: In this study, patients who underwent laparoscopic cholecystectomy in our clinic between January 2010 and December 2014 with the diagnosis of ABP were retrospectively evaluated. Patients divided into two group; in group 1 (n = 23) early (in the first admission) cholecystectomy and in group 2 (n = 54) late (after 4 - 12 weeks) cholecystectomy was performed. Groups were respectively compared in terms of demographic data, operation time, complications, mortality and recurrence of biliopancreatic events.
DISCUSSION AND CONCLUSION: In mild ABP attack early period laparoscopic cholecystectomy is a safe and effective treatment choice for preventing recurrent biliopancreatic events. However, early cholecystectomy in the treatment of ABP is applied to a limited number of patients in clinical practice. New studies are need for the reasons of this approach and suggestions to fix this problem.

6. Deksmedetomidine-propofol versus remifemtanyl-propofol usage in endoscopic retrograde cholangio pancreatography procedures at monitored anesthesia care
Yahya Ömür, Mehmet Yılmaz, Asu Özger Özgültekin, Ayşe Zeynep Turan, Mehmet Hamdi Aytekin
Pages 32 - 37
INTRODUCTION: In recent years endoscopic procedures are being under sedation. In this study we aimed to compare deksmedetomidine –propofol vs. remifentanyl-propofol sedation at monitored anesthesia care on patients who underwent endoscopic retrograde cholangio pancreatography procedure.
METHODS: In the deksmedetomidine –propofol group deksmedetomidine loading dose of 1 mg/kg was administered in ten minutes. Following the loading dose, deksmedetomidine infusion rate of 0,5 mg/kg/hr was continued. In the remifentanyl-propofol group, remifentanyl loading dose of 0,2 μg/kg was administered in five minutes and infusion of 0,1 mcg/kg/dk was continued. In both groups patients were given 3 mg/kg/hr of propofol infusion
RESULTS: We found a significantly lower heart rate, systolic arterial pressure, diastolic arterial pressure in group deksmedetomidine –propofol. But controversly, apne and recovery times were found significantly higher in group deksmedetomidine –propofol than group remifentanyl-propofol.
DISCUSSION AND CONCLUSION: At monitored anesthesia care, both deksmedetomidine –propofol and remifentanyl-propofol sedation protocols are applicable. But in any case all equipments must always be ready to be able to give general anesthesia for the patient in order to control safety.

7. First Six Months Analysis of a Stroke Center
Uygar Utku, Soner Şahin
Pages 38 - 41
INTRODUCTION: The aim of this study is to analyze the data we obtain retrospective interventional neurology in the first six months.
METHODS: We admitted patients between February 2015 and July 2016. Symptoms, demographic data, neuro-imaging features, angiography findings and clinical characteristics were recorded.
RESULTS: Angiography was performed to the 74 patients. Carotid stenting was performed to five patients (a patient had both extra-cranial and intra-cranial stenting in the same session). Two patients had aneurysm coiling and four patients had flow-diverter stenting for their aneurysms. We gave IV thrombolysis to 10 patients and two patients underwent mechanical thrombectomy plus IV thrombolysis.
DISCUSSION AND CONCLUSION: In this study it observed that the first six months of the stroke center is now in active service.

CASE REPORT
8. A delayed rehabilitation case: Rhizomelic chondrodysplasia punctata type 3
Yasemin Yumuşakhuylu, Afitap İçağasıoğlu, Erkan Mesci, Ali İhsan Sungur
Pages 42 - 45
Rhizomelic chondrodysplasia punctata (RCDP) is a disorder resulting from mutations in peroxisomal genes essential for lipid biosynthesis. Affected patients have characteristic features like proximally shortened limbs, epiphyseal punctuate calcification, bilateral cataracts, growth and developmental delays. The majority of patients have RCDP type 1, around 5% have RCDP type 2 or 3. In this paper we report a case of 9 years old male child diagnosed as RCDP type 3 whose rehabilitation was ignored. We would like to emphasize the importance of rehabilitation which even a slight intervention of rehabilitation can contribute a lot to his functionality.

9. Extra-anatomic Bypass with Tumescent Anesthesia: A Case Report
Seyhan Yılmaz, Özgür Barış, Adnan Yalçınkaya, Behice Kaniye Yılmaz
Pages 46 - 50
Peripheral arterial circulatory disorders is an important cause of morbidity and mortality today. Extra-anatomic bypass operations in patients which have high risk for limb salvage are alternative methods that may be preferred. In this case, we aimed to present a 54 year-old male patient who underwent extraanatomic bypass graft surgery for chronic aortoiliac occlusive arterial disease under local and tumescent anesthesia because of to accompany with advanced stage chronic obstructive pulmonary disease and resting dyspnea, previous thoracic aortic surgery and migrated lumbar disc hernia operations.

10. Case Report: Relapsing Polychondritis
Hacer Baran
Pages 51 - 54
Relapsing polychondritis is a rare chronic autoimmune systemic disease that presents with destruction and inflammation of cartilaginous and connective tissues. Clinical features of the disease include chondritis of the auricular, nasal, and tracheal cartilages; audiovestibular dysfunction; ocular inflammation; vasculitis; myocarditis and nonerosive arthritis. In this paper a 54-year-old woman who presented to our otolaryngology clinic with complaints of pain, eritema, edema on both auricules are reported.

11. Another Treatment Choice of Cerebral Venous Sinus Thrombosis: Endovascular Intervention
Atilla Özcan Özdemir, Uygar Utku, Demet Funda Baş
Pages 55 - 57
Cerebral venous sinus thrombosis (CVST) is a less common stroke type compared with arterial system. 35-year-old female patient was diagnosed CVST. She did not benefit from standard anticoagulation therapy. When clinical signs of patients worsened she underwent endovascular intervention. We aimed to show patients who show rapid clinical deterioration despite adequate anticoagulation, endovascular intervention can be life-saving.

REVIEW ARTICLE
12. Subarachnoid Hemorrhage: Diagnosis, Treatment and Management
Gökhan Evcili, Uygar Utku
Pages 58 - 62
Subarachnoid hemorrhage is a pathologic condition that exists when the blood spread through the subarachnoid space and it is an important cause of morbidity and mortality in middle-age group. Primary goal in the treatment of patients with subarachnoid hemorrhage is to occlude the aneurysm sac entirely and safely without leaving a residue. However, it is not adequate the occlusion of aneurysm sac but also the complications that occurs due subarachnoid hemorrhage should be treated carefully. Morbidity and mortality rates will decrease greatly, if close miniaturization and early intervention is done for the patients of aneurysms to prevent postoperative complications.

LETTER TO THE EDITOR
13. 
Sürekli ayaktan periton diyalizi yapılan bir hastada Arcanobacterium Haemolyticum’a bağlı peritonit
Erkan Şengül, Emel Bozyel, Ayşen Elmas, Vesile Yazıcı
Pages 63 - 64
Abstract |Full Text PDF