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Göztepe Tıp Dergisi 21(3):81-82, 2007
Romatoid faktörü pozitif olgularda parvovirus B19 IgM seropozitifliği
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Muhammet Güzel KURTOĞLU, Hamza OZKURT, Yasemin BAYRAM, Oğuz TUNCER, Mustafa BERKTAŞ
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Çalışmada, PVB19 virusuna karşı IgM antikorlarının araştırılmasında, Romatoid Faktör (RF) varlığının sonucu etkileyip etkilemediğinin ortaya konulması amacıyla, çeşitli düzeylerde RF tespit edilen, ancak infeksiyon semptomları göstermeyen 100 hasta serumu alınarak, PVB19’a karşı ELISA yöntemiyle antikor araştırıldı.
RF’ü pozitif 0-71 yaşları arasındaki 100 hasta serumunda % 22 oranında Parvovirus B 19 IgM antikor pozitifliği saptandı ve bu çalışma ile Parvovirus B 19 IgM antikorlarının araştırılmasında RF’e bağlı pozitifliklerin önlenmesinin önemi vurgulandı.
Anahtar kelimeler: Parvovirus B19, romatoid faktör, RF
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Parvovirus B19 IgM seropositivity in cases with reumotoid factor
At the present study, for the purpose of finding out whether to effect the result of existence of Rheumatoid Factor (RF), determining in different level of RF obtained but 100 sera without semptoms was examined in different level by ELISA.
Parvovirus B19 IgM antibody positivity was established at the rate of 22 % on the sera of 100 patients between 0-71 years with RF positive patient. With this study, at the investigation of Parvovirus B 19 IgM antibody, the positivity should prevent dependent to RF.
Key words: Parvovirus B19, rheumotoid factor, RF
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Göztepe Tıp Dergisi 21(3):83-86, 2007
Cerrahi hastalarında renal risk değerlendirilmesi
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Ali SÜNER, Nesrin TÜRK, Muhammet Kasım ARIK
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Major cerrahi operasyon geçiren hastalar postoperatif akut böbrek yetersizliği gelişme riski taşımaktadır. Postoperatif böbrek yetersizliği gelişimi için risk faktörleri iki grupta sınıflandırılabilir. Hasta ile ilgili risk ve preoperatif renal fonksiyon ile ilişkilidir.
Araştırmamızda, tüm hastaların glomerüler filtrasyon değerinin (GFR) azalmadığı hatta bir miktar arttığını gördük, bunun nedeni operasyon yapılacak hastalarımıza anestezistin ve cerrahın düzenlediği sıvı replasmanı olduğu görülmüştür.
Anahtar kelimeler: Cerrahi, renal risk
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The surgery patient’s renal risk stratification
Patients undergoing major surgical operations are under risk of developing acute renal failure postoperatively. Factor of risk is classfied in two groups for postoperative failure developing.
In our investigation we saw that an illness’s GFR didn’t became less also it a little increased because of this reason; ill people who will have operation have mai supply which is organized by anesthesia and surgean.
Key words: Surgery, renal risk
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Göztepe Tıp Dergisi 21(3):87-91, 2007
Genel anestezi ile epidural-genel anestezi kombinasyonunun stres yanıt üzerine etkileri
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Hayriye BABA, Melek ÇELİK, Aydemir YALMAN, E. Nursen KOLTKA, Zeynep AYDOĞAN
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Major batın ve üroloji operasyonu planlanan olgularda, tek başına genel anestezi ile genel anestezi ve epidural anestezi kombinasyonunun hemodinami ve kortizol, prolaktin ve kan şekeri düzeyleri saptanarak stres yanıt üzerine etkilerinin karşılaştırılması amaçlandı.
ASA I grubu, 22-70 yaş arası 48 olgu genel anestezi grubu (Grup GA) ve genel anestezi + epidural anestezi kombinasyonu grubu (Grup GA+EA) olacak şekilde rasgele iki gruba ayrıldı. Grup GA+EA olgularına % 0.5 bupivakain ile epidural anestezi uygulandı. Olguların indüksiyon öncesi OAB, KAH ve SpO2 değerleri kaydedildi. Kortizol, kan şekeri ve prolaktin seviyeleri için ilk kan örnekleri alındı. Anestezi indüksiyonu tiyopental ve vekuronyum bromid ile, anestezi idamesi O2 + N2O + sevofluran ile sağlandı. Cilt insizyonundan hemen sonra ve 30 dk. sonra kortizol, kan şekeri ve prolaktin seviyeleri için diğer kan örnekleri alındı. İnsizyondan hemen sonra, 30. dk., 60. dk., operasyonun sonunda, postoperatif 10. dk. ve 30. dk.’larda OAB, KAH ve SpO2 değerleri kaydedildi.
Gruplar arasında kortizol ve prolaktin düzeyleri açısından istatistiksel olarak anlamlı farklılık bulunmadı. Grup GA+EA’da insizyondan hemen sonra ve 30. dk kortizol düzeyleri başlangıç düzeyine göre yüksekti. Tüm olgularda insizyondan hemen sonra ve 30 dk. sonra prolaktin düzeyleri başlangıç düzeylerine göre yüksekti. İndüksiyondan hemen önce ve insizyondan hemen sonraki kan şekeri düzeyleri gruplar arasında ve grup benzerdi. İnsizyondan 30 dk. sonraki kan şekeri düzeyleri Grup GA'da, Grup GA+EA'dan istatistiksel olarak anlamlı derecede yüksekti ve her iki grupta da başlangıç kan şekeri düzeylerine göre anlamlı derecede yüksekti. İndüksiyon öncesi, insizyondan 30 dk. ve 60 dk. sonra, operasyon sonu, postoperatif 10. ve 30. dk.’lardaki OAB düzeyleri Grup GA'da, Grup GA+EA'dan yüksekti.
Kombine genel anestezi+epidural anestezinin hemodinamik stabiliteye minimal etkileri olduğu ve stres yanıtı baskılamakta yetersiz kaldığı kanısına varıldı.
Anahtar kelimeler: Stres yanıt, genel anestezi, epidural anestezi, kombine epidural-genel anestezi
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To compare the effects of general anesthesia alone and general anesthesia-epidural anesthesia combination on stress response
Aim: To compare the effects of general anesthesia alone and general anesthesia-epidural anesthesia combination on hemodynamic responses and stress response including cortisol, prolactine, and blood glucose levels in patients undergoing major abdominal and urological surgery.
Material and method: 48 ASA I patients aged 22-70 years old were divided randomly into general anesthesia (Group GA) and general anesthesia + epidural anesthesia combination (Group GA+EA) groups. Patients in Group GA+EA received epidural anesthesia with 0.5% bupivacaine. The MAP, HR and SpO2 values of the patients were recorded preoperatively. First blood samples to measure basal cortisol, prolactine, and blood glucose levels were also taken preoperatively. Thiopental and vecuronium bromide were used for anesthesia induction and sevoflurane in O2 + N2O was used for anesthesia maintenance. Blood samples to measure cortisol, prolactine, and blood glucose levels were taken immediately after skin incision and 30 minutes after skin incision. The MAP, HR and SpO2 values were recorded immediately after skin incision, 30 and 60 minutes after skin incision, at the end of the operation, 10 and 30 minutes after the operation.
Findings: There was no statistically significant difference between the groups in terms of cortisol and prolactine values. In Group GA+EA cortisol values immediately after skin incision and 30 minutes after skin incision were higher than the basal values. In all patients prolactine values immediately after skin incision and 30 minutes after skin incision were higher than the basal values. Blood glucose levels before induction and immediately after skin incison were similar both intergrouply and intragrouply. In Group GA blood glucose levels 30 minutes after skin incision were statistically significantly higher than Group GA+EA and in both groups these values were statistically significantly higher than the basal values. MAP values in Group GA were higher than the MAP values of Group GA+EA before induction, 30 and 60 minutes after skin incision, at the end of the operation, 10 and 30 minutes after the operation.
It was concluded that general anesthesia-epidural anesthesia combination had minimal effects on hemodynamic stability and was insufficient to suppress stress response.
Key words: Stress response, general anesthesia, epidural anesthesia, combined general-epidural anesthesia
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Göztepe Tıp Dergisi 21(3):92-94, 2007
Perforan göz yaralanmalarının epidemiyolojik değerlendirmesi
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Ayşe SÖNMEZ, Cem MESCİ, Sevil ARI YAYLALI, Hasan HOROZ, Hasan H. ERBİL
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Amaç: Perforan yaralanmalarında risk faktörlerini ve travma nedenlerini araştırmak.
Materyal ve metod: Bu retrospektif çalışmaya perforan göz yaralanması bulunan 105 olgunun 105 gözü dahil edildi. Olguların yaş, cinsiyet, eğitim ve mesleklere göre dağılımı ile kaza yeri ve travma nedenleri analiz edildi.
Bulgular: Olguların 28’si kadın (% 26.7), 77’si erkekti (% 73.3). Yaşları 2-88 arasında olup, ortalama yaş 29.09±20.42 idi. Olguların 37’si çocuk (% 35.2), 68’i yetişkin (% 64.8) idi. Meslek grupları incelendiğinde, 26 olgu ile en fazla kaza işçi sınıfında görüldü (% 24.48). Yaş gruplarına göre kaza yerleri dağılımları arasında istatistiksel olarak anlamlı farklılık vardı (p<0.01).
Sonuç: Perforan göz yaralanmalarında epidemiyolojik faktörlerin bilinmesi koruyucu önlemlerin etkin olarak alınmasına olanak sağlayacaktır.
Anahtar kelimeler: Perforan göz yaralanması, epidemiyoloji
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The epidemiological evaluation of perforating eye injuries
Aim: To investigate the causes of trauma and the risk factors of penetrating eye injuries.
Material and methods: This retrospective study involved 105 eyes of 105 patients with penetrating eye injury. The distribution of age, sex, education and occupation of the cases and the place of accident and the causes of trauma were analyzed.
Results: 28 (% 26.7) of the cases were female and 77 (% 73.3) were male. It was proved that, 37 (% 35.2) of the cases were child and 68 (% 64.8) were adult. When the occupation groups were examined, the most accident was found in the worker groups with 26 cases. There was a significant statistical difference between the age groups and the distribution of accident places (p<0.01).
Conclusion: To know the epidemiyological factors of penetrating eye injuries will give an opportunity to take protective precautions effectively.
Key words: Perforating eye injury, epidemiology
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Göztepe Tıp Dergisi 21(3):95-99, 2007
İnfertil hastalarda uterin faktörün değerlendirilmesinde transvaginal salin infüzyon sonografi
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İrem ŞENYUVA, Cüneyt EFTAL TANER, Ayşe Gül KEBAPÇILAR
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Uterin kavite anormalliklerinin saptanmasında kullanılan histerosalpingografi (HSG), transvaginal salin infüzyon sonografi (TV-SİS) ve histeroskopi (H/S) yöntemleri karşılaştırılarak TV-SİS’nin tanı koymadaki değeri araştırıldı.
HSG’de tubal faktör bulunmayan ama kavitede yer kaplayan oluşum bulunan 112 birincil infertil olguya TV-SİS ve H/S yapıldı. Saptanan patolojiler karşılaştırıldı. Olguların TV-SİS sırasında duydukları ağrı verbal skala ile değerlendirildi.
Uterin kavite TV-SİS ile değerlendirildiğinde endometrial patolojileri saptamada duyarlılığı % 87.8, özgüllüğü % 100 olarak saptandı. TV-SİS sonrasında olguların ağrı ortalaması verbal skala ile 1,06 olarak saptandı.
Uterin kaviteyi değerlendirmede TV-SİS kolay uygulanabilen ve güvenilir bir yöntemdir.
Anahtar kelimeler: Hidrosonografi, infertilite, uterin faktör
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Transvaginal saline infusion sonography in infertile women with uterin factor
Diagnostic accuracy of transvaginal saline infüzyon sonography (TV-SIS) were evaluated by performing and comparing, HSG (Hysterosalphingography) and H/S (Hysteroscopy) in women with uterin cavity abnormalities.
TV-SIS and H/S were performed in 112 primer infertil women without any tubal factor but with a uterin mass in hysterosalphingographies. Detected pathologies were compared and verbal pain scores were noted during TV-SİS.
The sensitivity and spesifity of TV-SIS in detecting uterin cavity abnormalities were found as 87.8 % and 100 % respectively. Mean score of Verbal Scale Rate (VSR) was 1.06 during TV-SIS.
We concluded that; for detecting uterin cavity abnormalities, TV-SIS can be easly performed and a reliable process.
Key words: Hydrosonography, infertility, uterin factor
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Göztepe Tıp Dergisi 21(3):100-103, 2007
Klebsiella suşlarında ESBL varlığı ve antibiyotik duyarlılığının araştırılması
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Kadriye KART YAŞAR, Gönül ŞENGÖZ, Filiz YILDIRIM, Özcan NAZLICAN
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Klebsiella cinsi bakteriler, hastane ortamlarında endemik ve epidemik infeksiyonlardan sorumlu patojenlerdir.
Bu çalışmada, hastanemiz Mikrobiyoloji laboratuvarına gönderilen çeşitli materyalden izole edilen 201 Klebsiella cinsi bakterinin antibiyotik duyarlılığı ve “Extended Spectrum Beta-Lactamases” (ESBL) varlığı araştırıldı. Çalışılan materyaller içinde sırasıyla en sık idrar, kan ve balgam örneklerinden Klebsiella cinsi bakteri üretildi (% 43.3, % 21.4, % 14.4). Bakteri tanımlaması konvansiyonel biyokimyasal yöntemler ve API ID 32E (BioMerieux, Fransa) ile, duyarlılık testleri ise disk difüzyon ve API ATB (BioMerieux, Fransa) ile yapıldı. Suşların % 78'i K. pneumoniae olarak tanımlandı. ESBL varlığı 201 suşta çift disk sinerji (ÇDS) yöntemi ile araştırıldı ve suşların 126'sının (% 62.7) ESBL ürettiği gösterildi. Karşılaştırmalı olarak çalışılan ve bu 201 suş içinden rastgele seçilen 80 suşta ise; ÇDS ile % 65 (52/80), API ATB BLSE (BioMerieux, Fransa) ile ise % 92.5 (74/80) oranında ESBL varlığı saptandı. ATB BLSE ile ÇDS yönteminden daha yüksek pozitiflik oranları saptanmasının, ÇDS yöntemi uygulamasının yeterince standart olmamasına bağlı olabileceği düşünüldü.
Klebsiella cinsi bakterilerin özellikle hastane kaynaklı suşlarında ESBL oranı oldukça yüksektir. Bu durum sefalosporinlerle tedavi başarısızlığına yol açmaktadır. Bu yüzden fırsatçı Klebsiella suşlarının antibiyotik duyarlılığı ve ESBL üretimi mikrobiyoloji laboratuvarlarında mutlaka araştırılmalıdır.
Anahtar kelimeler: Klebsiella, ESBL, fırsatçı infeksiyon
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Evaluation of antibiotic susceptibilities and presence of ESBL in klebsiella strains
AKlebsiella spp. is the responsible pathogens for endemic and epidemic infections in hospitals.
In this study, we examined the existence of extended spectrum beta lactamases (ESBL) and the antibiotic suspectibilities of 201 Klebsiella strains isolated from materials sent to the microbiology laboratory of our hospital. From the materials, the most Klebsiella isolated ones were urine, blood and then sputum (43.3 %, 21.4 %, 14.4 %). The identifications of bacteria were done with conventional methods and API ID 32E (Bio-Merieux, France), the antibiotics susceptibilities were studied with double disk synergy method and API ATB (Bio-Merieux, France). 78 % of strains were identified as Klebsiella pneumoniae. The search of ESBL existence were made with double disk synergy method in 201 strains and there were 126 strains producing ESBL (62.7 %). ESBL producing were determined in 80 strains which were selected randomly also with API ATB BLSE (Bio-Merieux, France). While 65 % of strains were pozitive for ESBL with double disc synergy method, 74 strains searched with API ATB BLSE were positive for ESBL existence (92.5 %). The positive results were higher with ATB BLSE method than double disc synergy method. This condition may result from inadequate standards for double disc synergy method.
The presence of ESBL produced by Klebsiella strains is very high, especially in nosocomial strains. This is why there is treatment failure with cephalosporins. Therefore the antibiotic susceptibilites and ESBL existence must be evaluated in nosocomial klebsiella strains in microbiology laboratories certainly.
Key words: Klebsiella, ESBL, nosocomial infection
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Göztepe Tıp Dergisi 21(3):104-106, 2007
Yutulan dikiş iğnesinin duodenumu penetrasyonu sonrası transvers mezokolona migrasyonu
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Hamis Mehmet ŞENER, Adem KARATAŞ, Barbaros Şahin KARAGÜN, Yavuz MERCİMEK, Adıgüzel GÖRMÜŞ
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Penetration of the duodenum by an ingested needle with migration to transverse mesocolon
Foreign body ingestion is a common problem frequently encountered in both children and adults, but perforation of gut by sharp metallic objects is rare and rarer still is their migration. This case is about a penetration of the duodenum by an ingested needle with migration to transvers colon mezoderm.
A 21 years old man was referred to us with a four day history of ingestion a sewing needle accidentally. An abdominal roentgenogram showed the needle on the upper abdominal area. We hospitalized the patient and decided to follow him conservatively with abdominal roentgenogram because he had no symptom of perforation. He had complaint of abdominal pain after eating meal, an abdominal plain roentgenogram showed a needle in the upper abdominal area. On general physical examination he had no clinical findings except tenderness at palpation on the upper abdomianl area. After following five day we decided to explore the patient because the needle has not mooved at the roentgenogram. At the abdominal exploration there was no sign of peritonitis and perforation. We found the needle in the transvers colon mezoderm and extirpate the needle uneventfully. We thougth that the needle migrated by penatrating the third part of he duodenum. The patient was extarnated the postoperative fifth day without any complication.
Management of ingested foreign bodies differs according their localizations, shapes and structures. About % 80 of ingested foreign bodies have uncomplicated spontaneous passage but a rate % 1 of sharp foreign bodies penatrates the bowel. Metallic foreign bodies can be vizualized on plain X-rays. Ultrasonografy can be helpful. Endoscopy should be used for diagnozis and also for removing the foreıgn bodies which lodges in the cricopharyngeal sphincter or esophagus in 24 hours.
If there is no perforation or obsbtruction the patients can be followed conservatively but the followed patient which had ingested a sharp foreign body should be explored if the foreign body did not pass through the gastrointestinal tractus with an enough waiting time or if it does not moove at roentgenograms.
Key words: Foreign body, penetration of the duodenum
Anahtar kelimeler: Yabancı cisim, duodenum penetrasyonu
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Göztepe Tıp Dergisi 21(3):107-108, 2007
Kronik hepatit B’de konvansiyonel interferon tedavisi
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Feruze YILMAZ ENÇ, Canan YEŞİLOĞLU
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HBsAg seroconversion with convensional interferon treatment for chronic hepatit B
Each year HBsAg clearance appears spontenously between the range of 1-2 percent of hepatit B and, also antiHBs appears in 1/3 rate of these cases. HBsAg serokonversion is seen in 4 percent of patients treated with convensional interferon and this rate is also similar for the treatment with peginterferon. We present a case who cleared HBsAg and achieved anti HBs positivity after treatment with convensional interferon.
Key words: Chronic hepatit B, convensional interferon treatment, HbsAg seroconversion
Anahtar kelimeler: Kronik hepatit B, interferon tedavisi, anti HBs pozitifleşmesi
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Göztepe Tıp Dergisi 21(3):109-110, 2007
Bağışıklığı baskılanmış hastada gelişen Trichosporon asahii infeksiyonu
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Kadriye KART YAŞAR, Gönül ŞENGÖZ, Seher BAŞTÜRK, Kadir İDİN, Özcan NAZLICAN
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Trichosporon asahii infection in a immunosupressed patient
Trichosporon fungi are rare infectious agents in normal healthy people while they cause various clinical diseases ranging from a simple superficial infection to serious deep infections. A 5 year old case who was being treated with acute lenfoblastic leukemia (ALL) diagnosis was started wide spectrum empirical antibiotic therapy because of fever. Soon after he had status epilepticus, he was internalized to the intensive care unit. A mass lesion was detected in his liver and he still had fever and Trichosporon asahii was isolated from his urine sample. The patient died although he was treated with fluconazole which was shown to be susceptible.
Key words: Immunsupression, Trichosporon asahii
Anahtar kelimeler: İmmunsupresyon, Trichosporon asahii
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Göztepe Tıp Dergisi 21(3):111-113, 2007
Çocukluk çağında hepatit A infeksiyonuna bağlı gelişen plevral efüzyon ve peritoneal asit birikimi
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Barbaros Şahin KARAGÜN, S. Tolga YAVUZ, Şehri PUNAR, Adıgüzel GÖRMÜŞ
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An unusual complication of hepatitis A virus infection; pleural effusion
Pleural effusion due to hepatitis A virus infection is a rare complication during childhood and occur during early period of the disease. Here an 8-year-old girl with pleural effusion during hepatitis A infection is reported.
An 8-year-old girl admitted to hospital with complaints of fever, jaundice, nausea and lack of appetite. Physical examination revealed abdominal tenderness, hepatomegaly and scleral icterus. A clinical diagnosis of viral hepatitis was made. Laboratory data revealed normal complete blood count and serum bilirubin of 8.5 mg/dl (direct 3.5 mg/dl). Alanine aminotransferase was 555 IU/L and aspartate aminotransferase was 331 IU/L. Serum proteins and prothrombin time was normal. Positive anti hepatitis A virus (HAV) IgM antibody titres confirmed the diagnosis of hepatitis A. Other viral hepatitis markers were negative. Abdominal sonography revealed mild hepatomegaly with increased echogenicity. Mild ascites with right sided pleural effusion was also noticed.
With this case we want to emphasize that pleural effusion and ascites can be seen during hepatitis A virus infection and this complication usually resolves spontaneously.
Key words: Hepatitis A, pleural effusion, ascites
Anahtar kelimeler: Hepatit A, plevral efüzyon, asit
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Göztepe Tıp Dergisi 21(3):114-115, 2007
Doksisiklin-streptomisin tedavisi sonrası nükseden Brucella abortus'a bağlı brusella hepatiti
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Davut ÖZDEMİR, Abdulkadir KÜÇÜKBAYRAK, Hakan ARABACI, Tevfik YAVUZ, İdris ŞAHİN, Mustafa YILDIRIM, İrfan ŞENCAN
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Relapsing brucella hepatitis due to Brucella abortus following doxycycline-streptomycin treatment
We report a case of Brucella abortus-induced brucellosis that displayed high hepatic transaminases similar to that in acute hepatitis, fourth month relapsed following doxycycline-streptomycin treatment, and developed doxycycline-related hepatotoxicity in second treatment. Brucella hepatitis may occur with various Brucella spp. and may relapse even following effective treatment.
Anahtar kelimeler: Brucella abortus, hepatit, nüks
Key words: Brucella abortus, hepatitis, relapsing
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Göztepe Tıp Dergisi 21(3):116-117, 2007
Adefovir dipivoksil kullanımı ve missed abortus
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Turhan ARAN, Esra Çakırca ARAN, Mustafa KARA
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Using adefovir dipivoxil and missed abortion
Missed abortion is usually asymptomatic and diagnosed when fetal cardiac activity can't be seen in ultrasonographic examination. Chromosomal abnormalities and morphologic defects are mostly seen in etiology. In this article, 39 years old patient using adefovir dipivoxil, because of chronic active hepatitis B was disscussed.
Key words: Adefovir dipivoxil, hepatitis B, missed abortion
Anahtar kelimeler: Adefovir dipivoksil, hepatit B enfeksiyonu, missed abortus
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Göztepe Tıp Dergisi 21(3):118-120, 2007
Larsen sendromlu hastada entübasyon güçlüğü
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Hayal TEZEL, Mustafa SÜREN, Sibel FADILLIOĞLU, Suzan ADALI, Tayfun ALDEMİR
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Airway problems in Larsen syndrome
Larsen syndrome is a rare congenital connective tissue disorder which is caracterised with a typical facial appearance, and it is neurological and musculosceletal abnormality, Because of this special features, the patients are scheduled to have orthopedic and E-N-T region operations along their lifes. The patients have short stature, small chin, cervical instability that cause to diffucult intubation possibility during the operation. Airway problems caused by lack of rigidity of the upper airway may occur during intubation and extubation phases (1).
A 4 month old baby with a know diagnosis of Larsen syndrome and motor retardation was scheduled for bilateral patellar lucsation repair. The baby was evaluated as a case for a difficult intubation before the operation. The intubation was performed with a guidewire at a second attempt. After the difficult intubation there were no problems observed during perioperative and postoperative 24h periods about anesthesia.
Larsen syndrome is a rare disorder that needs a perfect preoperative preparation. Therefore it needs to review all alternative intubation techniques of elective difficult airway management.
Key words: Larsen syndrome, difficult intubation, preoperative preparation.
Anahtar kelimeler: Larsen sendromu, entübasyon güçlüğü, preoperatif hazırlık
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