Erciyes Medical Journal - 2008; 30(3) - Current Issue

Assessment of the Role of Fibrinogen in Preeclampsia

G�khan A�maz, Ahmet Tayyar, Mehmet Tayyar — 2008-09-01

Purpose: Our aim was to detect the levels of fibrinogen in groups which were comprised on the basis of lung maturity and evaluate diagnostic value of fibrinogen in preeclamptic pregnants. Materials and Methods: A total of 116 pregnant women between 26th and 40th weeks of gestation admitted to our department were investigated. Fibrinogen was measured in 63 pregnant women whose pregnancy was complicated with preeclampsia and in 53 pregnant whose gestation was uncomplicated. Patients were divided into two groups according to their gestational age on the basis of lung maturation. The first group constituted preeclamptic and healthy pregnant women whose pregnancies were between 26-33rd weeks of gestation. The second group constituted preeclamptic and healthy pregnant women whose pregnancies were between 34-40th weeks of gestation. Chi-square, Mann Whitney U test and Fischer exact tests were performed for comparison of means and/or medians. Results: There was a statistically significant difference between preeclamptic and healthy pregnant (p=0.005) in first group. There was no statistically significant difference between preeclamptic and healthy pregnant (p=0.234) in second group. In collective examination there was statistically significant difference between preeclamptic and healthy pregnant (p=0.012). Conlusions: Elevated levels of fibrinogen in healthy pregnancies and decreased levels of fibrinogen in preeclamptic patients were detected.

Is There a Relation Between Testosterone or Estradiol Levels in Seminal Plasma and GSTM1 Polymorphism in Infertile Patients?

�lhan Onaran, Birsen Aydemir, Ali R�za K�z�ler, B�lent Al�c� — 2008-09-01

Purpose: Glutathione S-transferase M1 (GSTM1) enzyme has been suggested to serve as a steroid-binding protein by its ability to bind to testosterone and estradiol, two important hormones in seminiferous tubule that are essential for spermatogenesis. We investigated whether GSTM1 polymorphism was associated with blood and seminal plasma levels of testosterone and estradiol in subfertile and control subjects. Material and Methods: The levels of total estradiol and testosterone were measured by using an electrochemiluminescence immunoassay in serum and seminal plasma from 103 individuals including 62 subfertile patients. GSTM1 polymorphism was examined using polymerase chain reaction. Results: The estradiol and testosterone levels in seminal plasma were not significantly different in the control and subfertile subjects. No role for GSTM1 enzyme as a steroid-binding protein seemed likely as there was also no significant difference in seminal plasma estradiol and testosterone levels according to GSTM1 genotype. Using Spearman rank correlation analysis, significant positive correlations were found between seminal estradiol and serum estradiol in infertile males, and between seminal testosterone and serum testosterone in fertile males, independent of GSTM1 genotype. Conclusion: The results suggest that GSTM1 polymorphism is not a genetic risk factor for seminal estradiol and testosterone levels in infertile males.

Effects of Lisinopril Therapy on Endothelial Function in Beh�et's Patients

2008-09-01

Purpose: Beh�et's disease (BD) is a chronic, multisystemic, inflammatory vasculitis with an unknown cause. The aim of our study is to investigate the effects of lisinopril on endothelial function in Beh�et's patients detected endothelial dysfunction. Material and Methods: We prospectively studied 31 (12 male) consecutive Beh�et's patients diagnosed according to the International Study Group criteria in Department of Dermatology, Erciyes University School of Medicine and detected endothelial dysfunction by using brachial artery flow-mediated dilatation (FMD). After patients received 10 mg/d lisinopril during three months, endothelial functions were evaluated for a second time. Results: A significant improvement was observed in FMD after therapy period (5.0 � 1.2 vs 11.4 � 5.0 %, p<0.001). Fibrinogen (355.4 � 57.8 vs 343.3 � 53.5 %, p<0.001) and high sensitive C-reactive protein (8.1 � 5.0 vs 5.4 � 2.6 %, p=0,01) levels also significantly decreased after therapy. Conclusion: Lisinopril ameliorated endothelial dysfunction in Beh�et's patients. However, further comprehensive studies are needed to determine the long-term effects of lisinopril.

Effects of Industrial Lead Expossure on Coagulation System

2008-09-01

Purpose: Lead is environmental and/or occupational toxicant. It has been known to induce hematological disturbance during haematopoiesis. However, it has not well known whether it has effects on coagulation system or not. Therefore, we aimed to investigate how coagulation system is affected by the level of elevated blood lead. Material and Methods: Fifty-two occupational lead exposure patients applied with lead intoxication symptoms. Blood examples of patients were obtained for lead level, platelet count, in-vitro bleeding time, prothrombine time, partial thromboplastine time (aPTT), fibrinogen, thrombine time, protein C, protein S and antithrombine III. The patients are evaluated according to three groups as mild, moderate and severe. Results: Blood lead levels were mean 71,15�18,19�g/dl. Mean values results of primary and secondary hemostasis and physiological coagulation inhibitors tests were in normal ranges, except fibrinogen degree. Despite mean fibrinogen degree being under normal ranges, statistically significant difference between the groups was not detected. Mean aPTT and protein S degrees were in normal ranges, however, compared with the mild-toxicated group statistically important prolongment in aPTT and reducement in protein S degrees detected in moderate-toxicated group. Conclusion: As a result, although our results need suggestion by in vivo and in vitro studies, it is concluded that haemostatic parameters excluding fibrinogen were not effected by mild and moderate degree elevation of blood lead.

Lipid Peroxidation and Antioxidant Enzyme Activity in Acute Leukemias

Mehmet Berk�z, Serap Yal�n, Volkan G�ne� G�ler, Atilla Yal��n — 2008-09-01

Purpose: The aim of our study is the investigation of possible changes in free radical-antioxidant balance in acute leukemias. Material and Methods: In this study, we have investigated 21 acute leukemia patients and 22 healthy volunteers for the control group. Among the acute leukemia patients; 10 of them as AML (Acute Myeloid Leukemia), 8 of them as ALL (Acute Lymphocytic Leukemia), and 3 of them have been diagnosed as MDS (myelodysplastic syndrome). Catalase activity for the antioxidant property and MDA (malondialdehyde) concentration for the free radical level of all collected blood samples were analyzed. Data obtained for each group were analyzed statistically using SPSS-10 software and groups were compared employing Mann-Whitney U Test. Results: The MDA levels in acute leukemia patients have been found to be increased, but the catalase levels found to be significantly decreased compared to controls. Conclusion: Our findings indicate that acute leukemia has increased the free radical and decreased antioxidant levels and as a result free radical-antioxidant balance has been impaired.

Origin of Clinically Significant Acute Phase Reaction in Acute Coronary Syndromes: Myocardial Necrosis or Plaque Rupture?

Cenker Eken, �zlem Yi�it, Y�ld�ray �ete, Refik Emre Altekin — 2008-09-01

Purpose: This study was aimed to investigate the hypothesis that clinically significant C- reactive protein releases in acute coronary syndromes (ACS) occur secondary to myocardial necrosis in response to interleukin-6. Materials and Methods: This prospectie randomized clinical study was conducted between March 2005 and May 2005 in an emergency department of a tertiary care hospital. Patients with typical chest pain were enrolled into the study. Initial cardiac Troponin-T, interleukin-6 (IL-6) and high sensitive CRP (hsCRP) levels were measured. IL-6 and hsCRP levels were compared between patients with or without myocardial infarction. Results: A total of 132 patients were enrolled to the study. Finally 15 (11.5%) patients were diagnosed as stable angina pectoris, 60 (46.2%) were unstable angina pectoris, 18 (13.8%) were non-ST segment elevation MI and 37 (28.5%) patients were ST segment elevation MI. hsCRP levels (81.8% vs 59.1%, p=0.047) and IL-6 (54.5% vs 30.1%, respectively; p=0.03) levels were significantly higher in patients with myocardial necrosis. A moderate correlation was also found between the levels of hsCRP and IL-6 (r=0.556). Conclusion: High sensitivity CRP levels can increase both in plaque rupture and myocardial necrosis. ACS is associated with greater inflammation in the presence of myocardial necrosis than in cases of angina without necrosis.

Surgical Treatment in Liver Cyst Hydatic Cases: Analysis of 276 Patients

Can K��k, Nam�k Y�lmaz, H�z�r Aky�ld�z, Erdo�an S�z�er — 2008-09-01

Purpose: Hepatic hydatid disease is still a significant public health problem in Turkey. It is a parasitic infection, which liver is the most frequently infected organ. Surgical treatment has been controversial for a long time. Material and Methods: Patients, which has been undergone surgical therapies with the diagnosis of hepatic hydatid disease were retrospectively analyzed during 15 years period between January 1986 and December 2000 at the Department of General Surgery, Erciyes University Medical School. Results: Overall 276 patients with hepatic hydatid disease were included in the study. Of these, 152 (%55) were male and 124 (%45) were female. The most common complaints were right upper quadrant or epigastric pain and abdominal fullness. Right upper quadrant or epigastric tenderness and hepatomegaly were the most common findings obtained from the physical examination. Of the patients, 17 (%6.4) patients with USG and 3(2.4%) with CT showed miscorrelation with the surgical exploratory findings. As the surgical treatment, cystodrainage with partial cystectomy was the most commonly procedure in 196(%71) patients. Twenty patients (%7.2) had complication postoperatively and biliary fistula was the most common complication (%3.2). Conclusion: Although the improvement in conventional treatment modalities, surgical therapy is still the main treatment option for hepatic hydatid disease.

Convulsions as a Rare Complication of Scorpion Bite

Mehmet Canpolat, H�seyin Per, Hakan G�m��, Nazmi Narin, Sefer Kumanda� — 2008-09-01

A 3-month-old girl was referred to our pediatric intensive care unit with a scorpion sting and convulsions. Cranial CT, MRI, biochmical parametres and complete blood count were normal. EEG revealed epileptiform activity. Scorpion stings is an important health problem in child age regarding to morbidity and mortality. In this paper we aimed to investigate convulsions as a rare complication of scorpion stings, which are very frequent in the summer season.

Succinic Semialdehyde Dehydrogenase Deficiency: Case Reports

Mustafa G�lg�n, Sebahattin Vurucu, Murat Kocao�lu, B�lent �nay, R�dvan Ak�n — 2008-09-01

Succinate-semialdehyde dehydrogenase (SSADH) deficiency is a rare neurometabolic disorder of v-amino butiric acid catabolism with autosomal recessive inheritance. Accumulation of γ- hydroxybutyrate in urine and plasma is biochemically key finding. SSADH deficiency can be demonstrated by measuring level of SSADH enzyme in lymphocytes or leukocytes. In a child with mental retardation and speech disorder the isolated pallidal brain magnetic resonance pattern with absent white-matter changes should raise the suspicion of SSADH deficiency and prompt biochemical analysis of hydroxybutyrate.

A Case of Symptomatic Aberrant Right Subclavian Artery

�it U�ar, Pelin Zorlu, Atilla �ifci — 2008-09-01

Vascular rings are formed when there is a failure of normal regression of the embrionic arch segments resulting in a persistence of a vascular ring tissue surrounding the trachea and esophagus. Aberrant subclavian artery is congenital anomaly that usually does not produce symptoms. A patient with Aberrant right subclavian artery and wheezing, defined in early infancy, was presented.

Ductus Thoracicus Injury: A Case Reports

Ufuk �obano�lu — 2008-09-01

Chylothorax usually results from trauma or it is developed iatrogenicaly during chest surgery procedures. Treatment should be started as soon as diagnosed and surgical treatment should be planned unless drainage is not decreased by conservative treatment for 10-14 days. Primary repair, ductal ligation and anastomosis are prefered during surgical treatment. We presented a case of 27 years old male with ductus thoracicus injury as a result of gunshot. In this case, injury was determined during thoracotomy and ligation was performed. There was not any complication during postoperative following and patient was discharged from hospital as welmpfare.

Bilateral Massive Vulvar Edema Due to Severe Preeclampsia: a Case Report

�a�da� T�rky�lmaz, Cem Batukan, Mahmut Tuncay �zg�n, Tolga Atakul — 2008-09-01

Vulvar edema is uncommon during pregnancy and may be an atypical symptom of severe preeclampsia. Systemic diseases, vulvovaginitis, Behcet.s disease, nephrotic syndrome, trauma, diabetes mellitus, vulvar malignancies should be considered in the differential diagnosis. Topical steroid cream and Eau de Goulard solution with elevation and cold application may be used in the treatment. Topical antibiotics may be used to prevent infection in edematous region. A small skin incision may be valuable in challenging cases. In this case report, we are presenting a case with vulvar edema related to severe preeclampsia at 34 weeks gestation. The pregnancy was terminated due to premature rupture of membranes. The reason and the management of vulvar edema were discussed along with a literature review. Isolated serious vulvar edema may be associated with severe preeclampsia, and therefore preeclampsia should be included in the differential diagnosis of such cases.

Immun thrombocytopenic purpura as sole manifestation in a case of acute hepatitis A

Mehmet Canpolat, Yasemin Altuner Torun, Sebahat T�lpar, Mehmet Akif �zdemir — 2008-09-01

Acute hepatitis due to hepatitis A virus is usually a benign selflimiting disease during childhood. Although many viral infections such as hepatitis B virus, Parvovirus, and Epstein-Barr virus are associated with extrahepatic autoimmune phenomena, such manifestations are rare in patients with acute hepatitis A infection. Immune thrombocytopenic purpura is rarely reported as a manifestation of acute hepatitis A. We report 11-year-old boy with immune thrombocytopenic purpura as the sole manifestation of anicteric acute hepatitis A infection. Acute hepatitis A should be included in the differential diagnosis of immune thrombocytopenic purpura.

Bilateral Renal Cell Carcinoma: Case Report

Ahmet G�k�e, Levent �aml�yurt, O�uz Ekmek�io�lu — 2008-09-01

Renal cell carcinoma is the most common malignancy of the kidney and radical nephrectomy is the gold standard treatment for this disorder. Nephron sparing surgery is increasingly being used to treat patients with early stage renal cell carcinoma. This is a case report of bilateral renal cell carcinoma in a 58-year-old white woman. A right partial and left radical nephrectomy was performed. Renal functions were evaluated using serum creatinine levels and technetium- 99m-dimercaptosuccinic acid (Tc-99m-DMSA) scintigraphy after partial nephrectomy. The patient had no complication on postoperative control and did not need hemodialysis.