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A thirty-eight-year-old male patient who suffered from 10th and 11th thoracal vertebrae fractures, paraplegia and acute traumatic aortic transection because of accidental fall was referred to our hospital. Open surgical repair carried a very high risk due to severe coexisting injuries. Transection was treated with 30x100 mm Valiant thoracic endograft, which was deployed just distal to the ostium of the left carotid artery. The patient was transferred to the neurosurgery clinic for treatment of paraplegia after an uneventful recovery. Endovascular repair of acute transection confers substantial advantages in mortality and morbidity compared to surgical repair. However, the long-term durability of thoracic endografts remains unknown. If the long-term results are as satisfactory as the promising mid-term results, this technique may become the gold standard approach for the treatment of acute transection.

Objective: Despite increasing incidence, data regarding clinical and demographic characteristics of patients with acute heart failure (AHF) admitted to cardiac intensive care unit (ICU) are inconclusive. The aim of this study was to assess the presentation characteristics and factors determining the length of hospital stay in this particular patient population., Methods: We conducted a single-center, prospective study involving 150 patients hospitalized to cardiac ICU with the primary diagnosis of AHF. Chi-square and Student t tests were used for the analysis of categorical and continuous variables, respectively. Linear regression analysis (LRA) was used to determine the factors affecting the length of hospital stay., Results: Forty-nine percent of the patients had new-onset AHF and 25% had preserved left ventricular ejection fraction (LVEF). In 25.3% of all patients and 46.6% of the patients with new-onset HF the precipitating factor was acute coronary syndrome. Atrial fibrillation and valvular heart disease as precipitating factors were more common in patients with preserved EF, when compared to low EF group. LRA showed that presence of anemia [β=1.62; 95% CI 0.08-3.15; p=0.039)] and severe mitral regurgitation (β=2.55; 95% CI 0.06-5.05; p=0.045) and systolic blood pressure (β=-0.03; 95% CI -0.06 - -0.002; p=0.039) and blood urea nitrogen (β=0.034; 95% CI 0.006 - 0.06; p=0.016) were the independent predictors of length of stay., Conclusion: Underlying cardiovascular risk factors, comorbidities and precipitating pathologies were diverse and highlighted the inhomogeneous characteristics of AHF syndromes. However, in-hospital mortality was high and initial clinical presentation characteristics were significantly associated with in-hospital outcome.

The most common site for gastrointestinal involvement in tuberculosis is the ileocecal region. Tuberculosis of stomach is quite uncommon. It is usually associated with pulmonary tuberculosis or with immunodeficiency. In this case non specific gastrointestinal complaints yielded a diagnosis of primary gastric tuberculosis, which is very rare. Absence of pulmonary focus and endoscopic findings of pangastritis are different features of this case which makes it presentable.

Foreign body ingestion is usually encountered in mentally retarded patients and is a common situation in patients with psychiatric illnesses, but it rarely necessitates surgical intervention. The outcome is usually defecation of the ingested materials. The treatment modality is affected by the number, size and shape of the ingested material(s). One day before presenting to our emergency room, a 21-year-old man ingested nearly 60 stones, the largest of which was 45 mm in diameter. We hospitalized the patient for conservative follow-up in our clinic. The patient was operated because of acute mechanical obstruction of the small intestine after three days of conservative follow-up. Thirty-five stones in the cecum and sigmoid colon were removed by transverse colotomy and 15 stones in the stomach were removed by gastrotomy. Because of this case, treatment modality alternatives in foreign body ingestion and the literature data are reviewed.

Objectives: We compared the electrophysiologic and histopathologic results of early primary nerve repair and grafting of transections made at different levels., Methods: Twenty-two male Sprague-Dawley rats were divided into three groups. In one group (distal group, n=8), the right sciatic nerve was transected near the proximal segment of, and in another (proximal group, n=7) at 15 mm proximal to, its branching. In the graft group (n=7), the nerve was resected from 5 mm to 15 mm proximal to its branching and the defect was repaired with the removed segment. All the nerves were repaired using the epiperineural technique. Electrophysiologic studies were performed before and after surgery. In the third month, bilateral biopsies were taken from the L4-5 dorsal root ganglion and from distal nerve segments for histopathologic examination and neuron and axon counts., Results: At two months, the distal group exhibited significantly shorter latency (p=0.001) and higher amplitude (p=0.05) values. However, at three months, all the groups had similar values of latency, amplitude, and conduction velocity. At three months, the number of the dorsal root ganglion neurons was significantly greater in the distal group compared to the graft group (p<0.001), but this did not differ from the proximal group (p>0.05). Axon counts per square millimeter were similar (p>0.05), but axon diameter was greater in the distal group (p<0.05). In correlation analyses, increases in the number of L4-5 dorsal root ganglion neurons were significantly associated with increases in the percent changes in distal latency (p<0.05) and conduction velocity (p=0.018)., Conclusion: Our findings suggest that distal injuries and primary repair of the sciatic nerve result in a faster and better recovery.

Objective: Atheromatous plaques in the ascending aorta are major risk factors for strokes caused by macroembolization after coronary artery surgery. Detection of plaque formations and changes in the surgical strategy are very important. This study was planned to compare value direct palpation and multislice computerized tomography to establish aortic plaques and to establish clinical predictors of aortic calcification., Methods: Fifty-four patients who underwent coronary bypass surgery were included in this prospective and diagnostic study. Proximal portion of each patient's aorta was evaluated with multislice computerized tomography and was compared with direct palpation. The efficacy of intraoperative palpation to predict calcifications was studied with ROC analysis and the predictors of aortic plaque formation were analyzed using logistic regression analysis., Results: Atheromatous plaques were detected with palpation in four patients (7.4%), and with multislice tomography in six patients (11.1%). The aortic instrumentation was changed in two patients (3.7%) and strategy was changed in one patient 1.8%). According to the ROC analysis, when multislice computerized tomography was taken as the reference, intraoperative direct palpation was 67% sensitive and 100% specific to predict aortic plaques. Logistic regression analysis of the risk factors showed that the older age was the only significant risk factor (OR-1.3, 95% CI -1.114-1.568, p=0.001) for plaque formation in the aorta. Neither stroke nor other neurological disorders have been observed during the study., Conclusions: It can be stated that multislice computerized tomography is more effective to show aortic plaques, but it is not sufficient. Multislice tomography may give additional information about the ascending aorta and the opportunity to visualize the aortic arch. It can be preferred in patients with aortic aneurysm or dissection.

Comparison of tramadol, tramadol-metamizol and tramadol-lornoxicam administered by intravenous PCA in management of postoperative pain. The aim of the present study was to compare of the postoperative analgesic effects of tramadol, combinations of tramadol-metamizol and tramadol-lornoxicam administered by intravenous Patient Control Analgesia (PCA) in lower abdominal surgery. Sixty adult, female patients who undergoing lower abdominal surgery, were included in this study. Patients were randomized to three groups. The solutions were prepared containing 500 mg tramadol in 50 ml saline (10 mg/ml tramadol) for Group I, 250 mg tramadol+3000 mg metamizol in 50 ml saline (5 mg/ml tramadol+60 mg/ml metamizol) for Group II and 250 mg tramadol+20 mg lornoxicam in 50 ml saline (5mg/ml tramadol + 0.4 mg/ml lornoxicam) for Group III. Loading dose 10 ml was administrated within 30 min 30 to 40 min before the end of the surgery. PCA was started at the first complaint of pain. Pain was evaluated by VAS in every 15 minute intervals at the first hour and later at 2nd, 4th, 8th, 12th, 18th and 24th hours postoperatively. Vital parameters, side-effects, sedation scores and total analgesic consumptions were also recorded concurrently. Total tramadol and anti-emetic consumption, the incidence of postoperative nausea and vomiting (PONV) were significantly higher in group I than the other groups (p<0.05). In conclusion; Tramadol-metamizol and tramadol-lornoxicam combinations administered by intravenous PCA provide efficient postoperative analgesia with less side effects.

Magnesium sulphate infusion decreases analgesic requirements after general anesthesia. Aim of this study was to assess the effects of postoperative magnesium infusion for 24 hours on duration of the block, sedation and postoperative analgesic consumption after brachial plexus block. After obtaining approval from local ethic committee, 70 ASA class I and II patients were included to the randomised double blind study. Brachial plexus block was performed using axillary approach with lignocaine 1.25% adrenaline 1/200 000 40 ml. Groups received 5 mg/kg bolus and 500 mg/h magnesium sulphate infusion or saline controls at the same volume during 24 hour. Analgesia and sedation were assessed while determining time to first pain and rescue analgesic, time to regain motor capability, visual analogue scale and sedation scores for every 4 hour during postoperative 24 h. period. While time to first pain and rescue analgesic was increased, total analgesic consumption was reduced significantly on magnesium infusion group (Meperidine: C: 36.3 +/- 42.6 mg, Mg: 11.7 +/- 12.2 mg, p: 0.001). Visual analogue scales were also observed to be lower in all periods. Time to motor block resolution, and sedation scores were similar. Magnesium sulphate infusion is thought as a safe and suitable adjunct for reducing analgesic consumption and possible complications without interfering daily activity in patients undergoing brachial plexus block.

In this study, stool samples of 9378 patients from different clinics, who presented at the laboratory of the department of parasitology of the Dokuz Eylul University, Faculty of Medicine with several gastrointestinal complaints from January 2004 to May 2006, were examined. All stool samples were examined with the saline-Lugol method and, in suspicious cases, by trichrome staining, cultivation in Robinson's medium and/or antigen detection in stool with the Entamoeba CELISA Path kit. Forty-one cases (0.44%), in which Entamoeba histolytica/Entamoeba dispar cysts and/or trophozoites were detected by at least one method, were found to be positive. Out of these 41 cases, four methods were used in 24 cases, three methods in 14 cases, whereas only saline-Lugol and trichrome staining methods were used in 3 cases. Even though all 41 positive cases had been examined with the saline-Lugol method, only 25 cases were found to be positive with this method for E. histolytica/E. dispar cysts and/or trophozoites. The remaining 16 cases were diagnosed by the other three methods. Today it is necessary to distinguish E. histolytica from E. dispar because the patient does not need to be treated if E. dispar is identified whereas if E. histolytica is identified the patient needs urgent treatment. That's why it is necessary to get reliable results using diagnostic methods together and, when needed, by ELISA specific for E. histolytica.

A retrospective evaluation of the data from 7,712 patients with gastrointestinal complaints who presented at the parasitology laboratory of the Dokuz Eylul University Medical Faculty Hospital between January 2003 and December 2004 was carried out. Fecal samples of all patients were examined using native-Lugol and the trichrome staining method after sedimentation by the fecal concentration tube. One or more parasites were detected in 495 (6.41%) of the patients. The distribution of the intestinal parasites was as follows: Blastocystis hominis 218 (44.04%), nonpathogenic amoebas 108 (21.82%), Giardia intestinalis 82 (16.57%), Enterobius vermicularis 50 (10.10%), Entamoeba histolytica 17 (3.43%) and other rare parasites 20 (4.04%). The results of this study were similar to those of other cities in the western part of Turkey and emphasize the fact that intestinal parasitic infections are still an important public health problem.

Cystic echinococcosis (CE) is a zoonosis, caused by the metacestode form of Echinococcus granulosus. The diagnosis of CE is difficult using the clinical features of the disease and it depends on the combination of serological methods aimed at determining the specific antibody response and on imaging techniques that support the serology. In this study, 465 patients who presented with a suspicion of CE to the serology laboratory of the Parasitology Department of Dokuz Eylul University between January 2003 and June 2004 were evaluated. The specific anti-E. granulosus antibodies in the serum samples of patients were examined by an in-house enzymelinked immunosorbent assay (ELISA) test and a commercial indirect hemagglutination (IHA) test. Seventy eight (17%) of the patients were positive with ELISA and 65 (14%) of them were positive with IHA with varying titrations. Fifty six (12%) of the sera were positive with both methods. Fifty-six of the eighty patients who underwent CE surgery at different times before this study were found to be seropositive, while the remaining 24 were found to be seronegative. We concluded that it is very important to combine at least two methods in the serological diagnosis of CE.

Objective: To assess the factorial structure, reliability and validity of the Turkish version of the Temperament and Character Inventory (TCI), a 240-item, self-report, paper-and-pencil test, and true-false format inventory based on Cloninger's psychobiological model of personality. It measures the four higher-order temperament dimensions and three character dimensions., Method: Using samples consisting of 470 healthy volunteers and 544 psychiatric patients, psychometric features were explored., Results: The internal consistency of the scales was good (Cronbach alpha coefficients between 0.68 and 0.84), but weak for Reward dependence (0.55) and Persistence (0.56). The factor structures of the temperament and character dimensions, explored separately, were in agreement with the hypothesized constructs, except for the scales NS1 (Novelty Seeking 1 = exploratory excitability) and SD4 (Self-directedness 4 -- self-acceptance). The present study also confirmed that the TCI scales were weakly related among themselves. On the whole, psychiatric patients had higher harm avoidance and lower self-directedness, persistence, cooperativeness, and self-transcendence scores than the normal subjects. Gender differences were also found for different dimensions., Conclusion: The findings of this study suggest that the TCI can be applied in the investigation of psychiatric and normal populations.

Suprascapular nerve blockade can be performed in chronic shoulder pain secondary to rotator cuff lesions, shoulder joint osteoarthritis, and adhesive capsulitis. Local anesthetics and steroids are commonly combined for the blockade. In this report, we present pulsed mode radiofrequency lesioning of suprascapular nerve for persistent shoulder pain in 8 patients. 8 patients with no response to six weeks physical or medical treatment were hospitalized in our Algology Clinic for suprascapular nerve pulsed mode radiofrequency lesioning. All blocks were performed in sitting position with a 22-Gauge, 100 mm "SMK" needle with 5 mm active tip and "Radionics" radiofrequency generator. Sensory stimulation at 50 Hz, 0.2 millisecond pulse width was performed and paresthesias in the shoulder joint occurred at 0.3 V. Motor stimulation at 2 Hz, 0.2 millisecond pulse width showed the contractions of the infraspinatus and supraspinatus muscles occurred at 0.4-0.5 V. Pulsed mode radiofrequency lesioning was then carried out two times for 120 seconds at 2 Hz frequency and pulse width of 20 milliseconds at 42 degrees C. Patients were evaluated for pain scores and shoulder joint movements at 1, 2, 4, 8, and 12 weeks after the procedure. Pulsed mode radiofrequency lesioning of suprascapular nerve block provided pain control for at least twelve weeks and improved shoulder joint movements.

Impar ganglion block provides pain relief in patients who suffer from sympathetically mediated pain arising from disorders of viscera and somatic structures within the pelvis and perineum. We performed impar ganglion blockade through sacrococcygeal junction instead of anococcygeal ligament in 9 patients who had localized perineal pain of visceral origin. All the blocks which were performed through sacrococcygeal junction without bending the needle under fluoroscopic guidance were easy to perform without any complication. Pain intensity by Visual Analogue Scale, daily opioid requirements, and complications related to opioids were evaluated before the procedure, and for 2 months after the procedure. The intensity of pain, daily opioid requirement and the complication related to the opioids were significantly decreased in 8 patients. We suggest that impar ganglion block through sacrococcygeal junction appears to be safe and effective procedure in the management of perineal pain related to malignancy.

Epidemiological, psychophysical and prevalence studies reveal that women have greater and more variable pain than men. Gender differences in pain are brought by genetic, physiological, anatomical, neural, hormonal, lifestyle and cultural factors. While women are more vulnerable to pain than men, they have more ways to deal with it. The clinical applicability of findings from the studies on gender differences in pain may lead to improve not only diagnosis but also treatment with various drugs and techniques.