Maltepe Medical Journal - 2010; 2(2)

The Research of the Effectiveness and Reliability of the Usage of Midazolam and Hydroxyzine as an Sedative and Anxiolytic on the Patients Who Have Multi-Slice Computed Tomography Coronary Angiography

2010-03-01

Objective: Multi-slice computed tomography is a highly accurate non-invasive diagnostic test for coronary artery analysis. In present day, beta-blocker drugs are routine medications before the procedure. In our work, we aimed to study the effectiveness and reliability of use of midazolam and hydroxyzine (which have sedative and anxiolitic effects) along with esmolol (which is a short term beta blocker) in reaching targeted heart rates. The study was done with ASA I and II patients who will have multislice computerized tomography coronary angiography at the radiology department at the Kartal Kosuyolu Medical Training and Research Hospital. Method: 63 patients who are selected for multislice computed tomography coronary angiography (CTCA) and whose heart rates are over 70 pulse/minute are informed for the study and approvals are gained. Patients are randomly divided into three groups, assessed with Beck Anxiety Scale and arterial blood pressures and heart rates are noted down. An intravenous line is opened before the procedure. In group M, midazolame 0.05 mg/kg is given intravenously 10 minutes before the procedure. In group H, hydroxyzine 1 mg/kg is given perioral. In control group, no sedative anxiolytic drug is added. Every patient undergone to the multislice CTCA procedure are reevaluated. Patients who have heart rates between 70 to 80 pulse/min are given 1 mg/kg esmolol and patients with heart rates between 80 to 90 pulse/min are given 2 mg/kg esmolol intravenously. 2 minutes after the medication, patients who could not reach the target heart rates are received esmolol with an additional dose of 1 mg/kg intravenously. Patients with heart rates over 90 pulse/min are not included to the study. Intraoperative sedation is evaluated by using Ramsey Sedation Scale. In every group, arterial blood pressures, heart rates, peripheral oxygen saturations, total esmolol doses, complications (hypoxia, bradycardia, hypotension) are noted down before, at the time of and after the procedure. After the procedure, each patient is evaluated by anesthesiologist with Modified Aldrete Scale and discharged when the score becomes 10 points. Results: There is no statistically difference between three group(p>0,05).We have observed a higher number of patients with targeted heart rate in the group of patients who had hydroxyzine than the group who were given midazolam; moreover the need for esmolol was lower in the group who had hydroxyzine (p<0,05). There were no complications in our patients. Conclusion: We have observed that the midazolam and hydroxyzine that we applied to the patients before the Multislice Computerized Tomography Coronary Angiography reduced the amount of esmolol needed for reaching the target heart rate; on the other hand, we have also observed that hydroxyzine is more effective in reducing the hart rate than midazolam.

Smoking Habits of The Students at Maltepe University Medical Faculty

2010-03-01

Aim: The aim of this study was to investigate the smoking habits of the students of Maltepe University Faculty of Medicine and to examine the factors affecting smoking. Methods: The study was conducted in all classes of the faculty of medicine by using a questionnaire about demographic characters and “Fagerstr�m Test for Nicotine Dependence”. Results: Two-hundred and forty-three students were enrolled to the study and 45.7% of them (n:111) were male. Mean age of the students was 22�2 years (range;18-28 years). Prevalance of current smokers was 18.9% (n:46) (males:80.4%, females:19.6%). The mean age of starting smoking was 18�3 years (range;13-23 years). Of the smokers 15 had (32.6%) started to smoke at the university years. According to the “Fagerstr�m Test for Nicotine Dependence” scores; 26% of smokers had high and very high levels of nicotine dependence. It was found that 43.5% of smokers had begun smoking because they enjoyed smoking and 69.6 % had tried to quit smoking and 43.5 % intended to quit. Health protection requirements were found to be the most important reason (50%) for quiting smoking. Conclusion: In 32.6% of smokers starting age of smoking fell at the university years. To be a medical student did not prevent cigarette smoking.

Prevalence of Potential Eating Disorders Among the Students of Maltepe University, Faculty of Medicine

2010-03-01

Objective: The aim of this study is to determine the prevalence of potential eating disorders among the students of Maltepe University Medical Faculty. Method: Though it was planned to include all the students at Maltepe University Faculty of Medicine (224) in this cross-sectional study, for several reasons 136 (60.71%) students were reached. A questionnaire covering sociodemographic characteristics, dietary habits and EAT-40 (Eating Attitudes Test) has been applied to the students. The data were analyzed by Statistical Package for the Social Sciences (SPSS) for Windows 16.0 software. Results were expressed as percentage and chi-square test was performed. Results: 58.5% of the study group were female and 41.5% were male. 55.9% of the female students were found to have eating disorder. Eating disorder was diagnosed significantly higher in female students (p<0.05), the students coming from families which have a monthly income more than 1000 TL (p<0.05) and the students who intend to lose weight (p<0.001), Conclusion: Eating disorders are important health problems for university youth; for this reason, it is neccessary to screen the university students and provide them early diagnose and if needed, treatment facility.

The Effect of Limited Food Intake with Vitamin C Application on the Some Tissues Vitamin C Levels

Dr. Birsen Kaplan, Dr. Bilge G�n�l — 2010-03-01

Objective: The present work investigated the effect of limited food intake on some tissues vitamin C levels and the role of vitamin C application to this effect. Methods: The animals receiving vitamin C treatment were given vitamin C by a single dose (500 mg kg-1body weight) intraperitoneally before periods of limited food intake lasting 24, 48 and 120 hours. Application to animals without vitamin C in 24 hours, 48 hours and 120 hours were limited diet. Results: The results indicated that limited food intake decreased blood vitamin C level. An application-induced increase was observed in the blood vitamin C levels of the animals which received vitamin C application prior to limited food intake periods. Brain vitamin C level increased especially during 120 hour and 48 hour limited food intake, and in 24 hour and 48 hour limited food intake after vitamin C treatment. Liver vitamin C level significantly increased in 24 hour and 48 hour limited food intake after vitamin C treatment. Conclusion: We conclude that limited food intake period is important for brain vitamin C levels, and limited food intake period with vitamin C is important for liver vitamin C levels.

Erythroid Differentiation Inducer, Hemin Inhibits Cyclic AMP Production in K562 Cells

Dr. Bahire K��kkaya — 2010-03-01

Objective: This study investigated the intracellular cyclic AMP concentrations in hemin-induced and uninduced K562 cell line. Method: K562 cell line were grown in RPMI medium supplemented with 10% fetal calf serum (FCS), 100 IU/ml penicillin, 100 �g/ml streptomycin, 25 �g/ml amphotericin B and 2 mM L-glutamin at 37 ºC in humidified air containing 5% CO₂ . A Trypan blue stain viability test was performed for produced K562 cells, and those used to obtain cell pellets from 1 day to 6 day, under the the following conditions: without hemin treatment as a control group and with hemin treatment as an experimental group. All data were statistically analyzed using one-way ANOVA, followed by Student`s t-test. Results: Treatment of K562 cells with hemin leads to inhibition of cell proliferation. Cyclic AMP levels of K562 cells that were treated with hemin are decreased in a time dependent manner, although the hemin-induced cells are proliferated. Intracellular cyclic AMP levels of hemininduced K562 cells decreased, while the control cells had stable cyclic AMP concentrations. Conclusion: On the basis of these results, it is recommended that further data collection is needed to analyze the mechanism by which intracellular cyclic AMP levels are regulated in K562 cells treated with hemin or other erythroid inducers.

Lymphoma Presented with Only Pleural Effusion

Dr. Asl� G�l Akg�l, Dr. T�lay Tecimer, Dr. Mustafa Y�ksel — 2010-03-01

Extranodal lymphomas comprise only 3% - 5% of all lymphomas. Organ envelopment by lymphoma has been described in a variety of anatomical locations including the kidneys, mediastinum, pericardium, oesophagus, rectosigmoid and psoas. We report a case of lymphoma of the pleura with pleural effusion and thickening apparent on chest computed tomography.

Surgery for Tracheal Pathologies

Dr. Asl� G�l Akg�l, Dr. Hasan F.Bat�rel, Dr. Mustafa Y�ksel — 2010-03-01

Upper airway stenosis is usually associated with a complex of pathological conditions at the high tracheal and the subglottic levels. Inflammatory stenosis of the trachea remains the most common indication for tracheal resection and reconstruction. Primary tumors of the trachea are best treated by resection when primary reconstruction may be safely accomplished. Nine cases with ages between 24–50 were treated with surgery for benign and malign tracheal stenosis. Tracheal resection and end-to-end anastomosis were successfully performed to 5 cases with a diagnosis of postintubation stenosis via cervical approach and 4 cases with tracheal tumors via thoracotomy. Accurate preoperative assessment and preparation associated with a perfect surgical technique is mandatory to obtain good results for tracheal surgery.

Adult's Still Disease with High Fever and Rash

Dr. Melahat Cengiz, Dr. Mahmure Uraz, Dr. Esen Kasapo�lu — 2010-03-01

Adult's Still disease is a systemic inflamatory illness with unknown etiology and pathogenesis. Clinically it is marked by high fever and typical skin rash. As there is no spesific clinic or labaratory findings it can only be diagnosed after other diseases are ruled out. It is characterized by very high ferritin levels. In our case, a 65 years old female patient is evaluated by detailed history, physical exam and labaratory tests. As the other diseases are ruled out indifferantial diagnosis the case is evalutaded as Adult's Still disease.

Corynebacterium pseudodiphtheriticum is Isolated from Patient with Brain Cancer: A Case Report

2010-03-01

C. pseudodiphtheriticum is a member of human skin and upper respiratuar tract flora. It rarely causes pneumoniae. C. diphtheriticum is isolated in the tracheal aspirate of the patient who is treated for brain cancer. As a result, this case emphasizes that members of flora bacteria could be considered to be infection agent in both immunocompetent and immunocompromised patients and correctly identifying of this bacteria in Clinical Microbiology Laboratory is important.

Case Report: Wellen's Syndrome

2010-03-01

Wellens' syndrome describes a characteristic pattern of ECG T-wave changes in association with critical narrowing of the left anterior descending coronary artery. Failure to diagnose this condition, with subsequent inappropriate management, may have fatal consequences. We report the case of a 55 year old male patient without any known cardiac disease with an ECG that demonstrates the classic Wellen's T-waves that was unrecognized. One week later he came to emergency department complaining severe chest pain. His ECG findings appropriate with anterior myocardial infarction which was treated with primary percutaneous intervention. This case highlights the importance of recognizing this kind of changes because patients with Wellens' syndrome are at high risk for the development of extensive myocardial infarction of the anterior wall and death.

Bilateral Parotid Gland Hyperplasia due to Long-Term Lithium Treatment

2010-03-01

It is known that short- or long-term use of lithium, which is used for the treatment of manic-depressive disorders can cause both constitutional and systemic (cardiovascular, neurological, dermatological, endocrine and metabolic, gastrointestinal, genitourinary) side effects. Here we discuss a case of bilateral parotid hyperplasia which occurred as a result of treatment, in a 55-year-old man who has presented with dysphagia and who had been using lithium for a long time. We believe that close monitoring of such patients who are on long-term lithium treatment is very important.

Primary Mediastinal Ectopic Goitres

2010-03-01

True primary mediastinal ectopic goiters are quite rare, occurring in less than 1% of all goiters. Ectopic thyroid tissue in embryonic development is the result of abnormal migration of the thyroid gland as it travels from the floor of the primitive foregut to its pretracheal position. We report a case of 54 year old male. He suffered from chest pain, cough and dyspnea on exertion. His medical history had hypertansion and aortic aneurism and no additional disoders. On physical examination thyroid was not palpable. Serum thyroid tests and thyroid nuclear scans were normal. There was a mass lesion on computerized thorax thomography in azygos-caval junction, 45x42mm in size, smooth circumference. There was no endobroncial lesion on fiber optic bronchoscopy. Standart servical mediastinoscopy was performed in order to diagnosis. Pathology reported as a benign thyroid tissue. Because of compression on vena cava superior we resected completly this tumor via right lateral thoracotomy. Postperative period was uneventful. Postoperative pathology was reported also benign thyroid tissue. We present an uncommon true primary ectopic mediastinal goiter resected with complete excison in order to relief of symptoms and to prevent potential venous obstruction and malignant transformation.

Diagnosis and Management of Renal Colic in Emergency Department

Dr. Orhun Sinano�lu, Dr. Sinan Ekici, Dr. Mahmure Uraz, Dr. Rahmi �ubuk — 2010-03-01

Renal colic (RC) is a frequent disease in emergency room. The most common cause of RC is ureteral stone. Primary care physician play the initial role in the management of urolithiasis. This article reviews the current recommendations in terms of renal colic emergency management: biological assessment, imaging, pain relief and specific treatment. The majority of renal colic patients only needs strong analgesic treatment and an urologic outpatient follow-up. Care must be taken considering diagnostic tools in case of complicated RC as it requires urgent treatment in urology department.

Liver Diseases Caused by Drugs and Chemical Agents

Dr. A. Melih �zel, Dr. Oya Uygur Bayrami�li — 2010-03-01

Because liver is the most important organ in the human body where drugs and toxic materials are metabolized and eliminated, liver injury caused by drugs and other chemical agents is eventually seen as a possible complication of almost all prescribed medications. These toxic materials which pass through intestinal mucosa and hepatocyte membrane, after being ingested in the body, are transformed into compounds that are excreted either by urine or bile. During this transformation liver is exposed to several chemical agents and metabolites that are potentially toxic. In this manuscript, pathophysiological mechanisms of liver injury caused by drugs and toxic agents which liver was exposed to, is being presented as well as the epidemiological features and individual and environmental factors that play a role in these diseases. Characteristic clinical features and some treatment implications are also discussed.