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Background: We determined the value of the inferior vena cava (IVC) diameter for predicting acute blood loss in control and blunt trauma patients and compared this with other parameters of hemorrhagic shock., Methods: Fifty volunteers and 28 consecutive hemorrhagic shock patients were recruited prospectively to participate in the study. Vital signs, blood lactate, and serum bicarbonate were measured, and shock index and base excess were calculated. Anteroposterior (AP) and mediolateral (ML) IVC diameters during inspiration and expiration were measured in the right subcostal region. IVC diameters in hemorrhagic shock patients were compared with those of controls and were also compared with other hemorrhagic shock parameters., Results: A significant relationship was determined between mean IVC AP and ML diameters during expiration and inspiration on admission in the study group and in the control group (p=0.000, p=0.000, p=0.000, p=0.000). Serum lactate levels correlated significantly with all IVC diameters (r=55), especially the IVC ML diameter during expiration., Conclusion: IVC diameter, as measured by transabdominal ultrasound, was more accurate than the shock index and other commonly used non-invasive predictors of acute blood loss (blood pressure, heart rate per minute, serum lactate level, base deficit).

Objective: The aim of this study was to investigate blood folic acid and vitamin B12 levels in patients with ischemic and hemorrhagic stroke patients and correlate these levels with prognosis., Methods: Patients presenting within 3 hours of onset of ischemic or hemorrhagic strokes were approached for participation in the study. Diagnosis was made by clinical examination and head computed tomography scan. Venous blood samples were taken for determination of blood folic acid and vitamin B12 levels. Parameters were evaluated with respect to stroke type and according to Glasgow coma scale (< or =8 or > or =9)., Results: Eighty-seven patients with ischemic stroke (mean age: 65 +/- 10 years, 53% male) and 27 patients with hemorrhagic stroke (mean age: 60 +/- 10 years, 56% male) were included in the study. A significant direct correlation was found between Glasgow coma scale and mean plasma B12 levels in ischemic, but not hemorrhagic, stroke (r=112.75 and p=0.007, respectively). A significant direct correlation was found between Glasgow coma scale and mean plasma folic acid levels in hemorrhagic, but not ischemic, stroke (r=1.03 and p=0.017, respectively). In patients with Glasgow coma scale < or =8 (either hemorrhagic or ischemic stroke), a significant direct correlation was found between Glasgow coma scale and blood vitamin B12 levels. Vitamin B12 levels were significantly lower in patients with Glasgow coma scale < or =8 than in patients with Glasgow coma score > or =9 (p=0.04)., Conclusions: In patients with ischemic stroke, low vitamin B12 levels, and in patients with hemorrhagic stroke, low blood folic acid levels, are associated with lower Glasgow coma scale values and higher hospital mortality.

Alveolar soft part sarcoma is a rare type of sarcoma that usually affects young adult women. It occurs mostly in the lower extremities, and nearly one quarter of the cases are found in the head and neck region. The most common site of origin in the head and neck region is the tongue followed by the orbit. Herein, we present an unusual case of alveolar soft part sarcoma of the tongue in an 18-year-old woman. The clinical, diagnostic, and therapeutic features of this quite rare entity were discussed.

Background: Genetic factors that predispose individuals to Behçet's disease (BD) are considered to play important roles in the development of the disease. The aim of this study was to determine, by counting sister chromatid exchange (SCE) and micronucleus (MN) frequencies, whether DNA damage have an effect on the pathogenesis of BD. Furthermore, our aim was to show if there is an association between oxidative stress and chromosome instability in BD., Methods: We analyzed lymphocytes from patients with BD (16 in active and 14 in inactive periods) and 20 healthy controls for SCE and MN frequencies. In addition, malondialdehyde (MDA) level, superoxide dismutase (SOD) level, glutathione peroxidase (GSH-Px) activity, erythrocyte sedimentation rate (ESR) and polymorphonuclear leukocyte (PMNL) count were determined in the all subjects., Results: The SCE and MN frequencies were significantly higher in both the active and inactive period patients than in the controls (p < 0.00001, p < 0.0001, p < 0.01 and p < 0.05, respectively), and the MDA level was significantly higher in both the active and inactive period patients than in the controls (p < 0.01 and p < 0.05, respectively). In contrast, the SOD and GSH-Px levels were significantly lower in both the active and inactive period patients than in the controls (p < 0.01, p < 0.05, p < 0.01 and p < 0.05, respectively)., Conclusions: Our results suggest that increased plasma MDA level and decreased plasma GSH-Px and SOD levels reflect the increased levels of oxidative stress in BD patients, and this situation may impair genetic stability in BD patients.

Hydatid cyst disease is a rare parasitic disease caused by the larval stage of Echinococcus. This parasite in the larval stage can thrive in many parts of the body, most frequently in the liver. Head and neck involvement of the disease is rare. Herein, we present a case of primary hydatid cyst occurring in the infratemporal fossa, which is an extremely rare localization.

To compare the effect of IV magnesium with other antihypertensives in emergency department (ED) patients with hypertension. ED patients with a systolic BP > 135 mmHg or diastolic BP > 85 were approached for entry into the study. Those granting consent were randomly placed into one of three treatment groups: (1) 1.5 gm IV MgSO(4) (n = 42), (2) a parenteral or oral antihypertensive agent (n = 41), (3) both IV MgSO(4) and an antihypertensive agent (n = 44). Systolic and diastolic blood pressures were measured at entry into the study and at 15, 30, 45, and 60 min after magnesium or other antihypertensive medications were given. The main outcome measure was blood pressure at 60 min, and results were compared using one-way analysis of variance with the post hoc Tukey HSD test. Compared to systolic and diastolic blood pressures at time 0, both were lower at 15, 30, 45, and 60 min in all groups (p < 0.05). No significant difference in systolic or diastolic BP at any time point was observed when response to treatment was compared between the three groups. Intravenous MgSO(4) is as effective as antihypertensives at lowering BP in emergency department patients.

We aimed to evaluate the patients who were diagnosed as Henoch Schonlein purpura (HSP) for disease characteristics and prognosis of those with joint, gastrointestinal (GI), and renal involvement. Two hundred and fifty-four children who were followed up with the diagnosis of HSP in the Pediatric Nephrology Clinics of Meram Medical Faculty of Selcuk University and Medical Faculty of Gazi University between January 2003 and June 2006 were retrospectively evaluated. The clinical follow-up and treatment regimens of patients in whom renal biopsy was performed were evaluated in detail. The study group consisted of 254 children, 147 boys (57.8%) and 107 girls (42.2%), and the ratio of boys to girls was 1.37. The percentages of skin, joint, GI, and renal manifestations were 100%, 66%, 56%, and 30%, respectively. Eight patients had intussusception. Five of them recovered with steroid treatment only while three patients were operated on. Sixty-four patients (44%) with GI involvement had severe disease and were successfully treated with steroids. Renal biopsy was performed in 26 patients. Among those 26 patients, two of them recovered spontaneously within 3 and 4 weeks. Ten patients improved with only steroid treatment while 12 patients recovered with steroid and cyclophosphamide treatment. Two patients were resistant to steroid and cyclophosphamide treatment and were treated with cyclosporine A. We believe that steroid therapy given to the HSP patients with GI manifestations might be helpful to prevent probable complications such as GI bleeding and intussusception. In addition, combined therapy with steroid and cyclophosphamide can usually be an appropriate treatment for patients with nephrotic proteinuria.

Objective: The recovery period in ischemic cerebrovascular disease is sometimes long and complicated. It is thought that a systemic inflammatory response plays an important role in this process. Therefore, promising studies have reported that neopterin and other cytokines serve as indicators of the inflammatory response. The present study investigated the effects of cerebrovascular diseases on plasma neopterin., Materials and Methods: We studied 68 consecutive patients under 65 years of age with cerebrovascular disease; the mean age was 52.08±5.74 years (yrs) (ranging from 39 yrs to 64 yrs; 28 female and 40 male). We also studied 29 randomly selected age-matched healthy subjects (control); the mean age was 49.76±13.11 years (yrs) (ranging from 41 yrs to 62 yrs; 12 female and 17 male). Blood samples for assessing plasma levels of neopterin were usually taken within seven days after admission to the hospital and stored at -20°C until analysis. Serum neopterin levels in all the subjects were measured by Enzyme Immunoassay (EÝA) using the BRAHMS method (Neopterin; Diagnostic GmbH, 16761 Berlin, Germany). Differences between the groups' means were analyzed with the Mann-Whitney U test., Results: The mean values of neopterin levels in patients (mean neopterin levels in patients, 18.51 ± 11.56 nmol/L; vs. control, 12.26 ± 3.87 nmol/L [p=.001]) were significantly different when compared with the controls., Conclusion: It has been suggested that the mortality and morbidity associated with cerebrovascular disease could be prevented by a reduction in the inflammatory response. We suggest that plasma neopterin levels were significantly increased. So, the levels of plasma neopterin may be useful monitoring of treatment and course of diseases.

The aim is to investigate whether pediatric familial Mediterranean fever (FMF) patients have an increased risk of premature atherosclerosis and to determine the possible strength of association between atherosclerosis and Mediterranean fever (MEFV) gene mutation gene type. Demographic characteristics and MEFV mutations were defined in 49 children diagnosed with FMF (26 female, 23 male; mean age, 10.71 +/- 3.69 years). Twenty-six age-, sex-, and body-mass-index-matched healthy children constituted the control group. We evaluated the blood counts and acute-phase proteins during attack-free periods. Mean C-reactive protein (CRP), serum amyloid-A (SAA), homocysteine (Hcy), lipoprotein-a (Lp-a), and common carotid artery intima-media thickness (CCA-IMT) were 10.75 +/- 15.29 vs 4.03 +/- 1.20, 23.22 +/- 41.94 vs 3.53 +/- 1.04, 10.36 +/- 3.36 vs 8.64 +/- 3.15, 20.84 +/- 23.89 vs 8.56 +/- 7.48, and 0.038 +/- 0.007 vs 0.032 +/- 0.004, respectively, and significantly higher than the mean values of control group (p < 0.05). However, no correlation was found between CCA-IMT and CRP, SAA, Hcy, and Lp-a. Twenty-nine patients had M694V mutation, and 13 patients had other mutations. There was no correlation between CCA-IMT and MEFV mutation subgroups. In conclusion, because of the nature of the disease, FMF patients should be considered to have an increased risk of early vascular alteration and atherosclerosis. For this reason, CCA-IMT measurement can be recommended as a noninvasive and early diagnostic method.

This retrospective study assessed the effects of pre- and post-training programme for healthcare professionals about breastfeeding. The study included 3,114 mothers who had children aged 1-72 month(s). Their knowledge and behaviours relating to breastfeeding were evaluated. The mothers were randomly divided into two groups: the 'before' group included 2,000 women who were not informed about breastfeeding, and the 'after' group comprised 1,114 women who had been informed about breastfeeding. 56.2% and 66.1% of the mothers started breastfeeding within 30 minutes after delivery, respectively, in the before and the after group (chi2 = 29.31, p < 0.001). 16.7% and 36.5% gave exclusive breastfeeding for six months (chi2 = 72.85, p < 0.001), and 28.5% and 23.7% stopped breastfeeding within the first five months (chi2 = 17.20, p = 0.002). Ninety-four percent delivered in a hospital or in a primary healthcare centre. Therefore, prenatal and postnatal breastfeeding education and support courses may improve a woman's chance of starting and continuing to breastfeed her baby. In terms of the number of antenatal check-ups, since the differences between the two groups were significant (chi2 = 390.67, p = 0.000), the importance of the training programme about breastfeeding was highlighted. Follow-up interventions after training are suggested.

Cells in the umbilical cord stroma have gained attention in recent years; however, differentiation to certain lineages in humans has been demonstrated in few studies. Unlike bone marrow MSCs, human umbilical cord stroma cells (HUCSCs) are far from being well characterized. This study attempts to describe proliferation, structural, and differentiation properties of these cells to account for their exceptional nature in many aspects. Cellular dynamics, cellular structure, and the degree of transformations during expansion and differentiation into mesenchymal and neuronal lineages were examined in vitro over a 10-month period. Comparisons with human bone marrow MSCs regarding differentiation were performed. HUCSCs in culture revealed two distinct cell populations, type 1 and type 2 cells, that possessed differential vimentin and cytokeratin filaments. Corresponding cells were encountered in cord sections displaying region-specific localization. alpha-Smooth muscle actin and desmin filaments, which were evident in cord sections, diminished through passages. No difference was noted regarding type 1 and type 2 cells in differentiation to chondrogenic, adipogenic, and osteogenic lineages, whereas a preferential differentiation was noted in neuronal lineage. Relative success was achieved by production of chondrocytic spheres and osteogenic monolayers, whereas adipocytes were immature compared with bone marrow MSCs. The presence of neuronal markers suggests that they transform into a certain state of maturity under neurogenic induction. Conclusively, HUCSCs retain their original phenotype in culture without spontaneous differentiation, have a limited lifespan, and bear multipotent stem cell characteristics. Given these characteristics, they may be generally considered progenitor cells if manipulated under appropriate conditions and deserve further study to be potentially used in cell-based therapies.

Background: Pregnant endometrial stroma, an immunologically privileged site in the female reproductive system, is enriched by decidual and natural killer (NK) cells. Since the cellular microenvironment in early pregnancy from the decidual tissues of normal and miscarriage cases has gained importance, with special emphasis on cell-to-cell contacts, we aimed to document the plastic structure of the cellular milieu in normal and miscarriage decidua., Methods: Endometrial biopsies were obtained from women after legal curettage or women who had been treated by curettage after miscarriage. Samples were analysed in a light microscope (LM), a scanning electron microscope (SEM) and a transmission electron microscope (TEM)., Results: Decidual cells possess several polyploidic protrusions on cell membranes. NK cells were distributed among decidual cells. Decidual cells were found to develop gap junctions in the interfaces between each other. Their cytoplasms were also found to possess well-developed protein synthesising organelles. Decidual cells obtained from miscarriages showed a moderate degree of degeneration and, in between, a decreased number of junctional complexes. Mononuclear cell infiltration was found to be significantly low., Conclusion: We conclude that decidual cells during early pregnancy build a series of miniature cell-cell contacts to assemble a proper endometrial milieu. In contrast, in miscarriage samples, those intercellular communications seem lacking, associated with an increased number of NK cells, a phenomenon which obviously alters proper implantation and leads to the induction of embryonic disgenesis and miscarriage.

Jack bean urease (urea aminohydrolase, E.C. 3.5.1.5) was entrapped into chitosan-alginate polyelectrolyte complexes (C-A PEC) and poly(acrylamide-co-acrylic acid)/kappa-carrageenan (P(AAm-co-AA)/carrageenan) hydrogels for the potential use in immobilization of urease, not previously reported. The effects of pH, temperature, storage stability, reuse number, and thermal stability on the free and immobilized urease were examined. For the free and immobilized urease into C-A PEC and P(AAm-co-AA)/carrageenan, the optimum pH was found to be 7.5 and 8, respectively. The optimum temperature of the free and immobilized enzymes was also observed to be 55 and 60 degrees C, respectively. Michaelis-Menten constant (K(m)) values for both immobilized urease were also observed smaller than free enzyme. The storage stability values of immobilized enzyme systems were observed as 48 and 70%, respectively, after 70 days. In addition to this, it was observed that, after 20th use in 5 days, the retained activities for immobilized enzyme into C-A PEC and P(AAm-co-AA)/carrageenan matrixes were found as 55 and 89%, respectively. Thermal stability of the free urease was also increased by a result of immobilization.

The purpose of this study was to define various methods of complementary and alternative medicine (CAM) used by cancer patients and their characteristics in Turkey. The sample consisted of 100 cancer patients who were monitored in the oncology outpatient and inpatient departments of two hospitals. Almost all participating patients were receiving conventional treatment, 36% of which were also using CAM methods. Female patients and individuals with lower educational background showed a tendency to use CAM methods more often. The most frequently used CAM method appeared to be herbal therapy, and the most commonly used herb was the stinging nettle. Most patients obtained information about CAM methods from their friends, the media and from CAM vendors. Patients' responses indicate that "the desire to do everything possible to fight the disease" and "the idea that it may be helpful, at least it's not harmful" were the two most common reasons for using CAM. Of the patients, 79.3% acknowledged a varying degree of benefit from the methods they use. The most frequently indicated benefit was "feeling better both physically and emotionally". Most findings in this study are similar to the results of other research conducted on the subject in Turkey.

Background: Maternal height has been reported as an obstetric risk factor, since short maternal stature may be associated with an increased incidence of obstructed labour due to cephalopelvic disproportion., Materials and Methods: There were 373 nulliparous women who were 150 cm or less in height (total n=5,650) and 367 women who were below 19 years old in the study group and 48 of these women were 150 cm or less in height. There were 37 patients who were 150 cm or less in height and over 39 years old., Results: There was no statistically significant difference between the rates of Caesarean section in patients who were 150 cm or less in height and patients who were taller than 150 cm (P>0.05). However, the rate of Caesarean section was higher in patients who were 150 cm or less in height and below 19 years old (P<0.05) and over 39 years old (P<0.05)., Conclusion: Short maternal height (<150 cm) was not associated with a greater likelihood of Caesarean section for cephalopelvic disproportion. However, patients who were below 19 years old and over 39 years old with a height of 150 cm or smaller had a greater likelihood of undergoing Caesarean section.

The present study was designed to examine which kind of memory: reference or working, better correlates with individual variation in rats' spatial learning abilities. To answer this question two groups of rats were trained to an arbitrary criterion in a partially baited 12-arm radial maze under two different experimental conditions: with or without allothetic cues. After 10 days break, rats were examined under the same conditions for memory retention. Within- and between-group variation in the length of training to criterion, and in the frequency of reference and working memory errors were analysed. The present experiment confirmed the facilitating effect of the presence of distal visual cues on place learning in rats. Task-dependent (between-group) differences in the rate of learning were attributed to differences in the frequency of reference memory errors. Conversely, within-group variation in the rate of task acquisition reflected individual variation in the frequency of working memory errors. These results were looked upon from an evolutionary perspective. Low correlation between reference and working memory errors confirms that these two types of memory have different mechanisms. The fact that differences in the rate of learning were not paralleled by the differences in the memory retention supports the notion that memory acquisition and memory retention are two independent processes.

In critically ill patients suffering from acute respiratory failure, weaning from ventilatory assistance is a key survival factor in intensive care units (ICU). The aim of this study was to provide deeper insight into laboratory methods allowing improved monitoring of that critical period. Eighty-three ICU patients (mean age 63.9 years), classified according to the Second Acute Physiology and Chronic Health Evaluation criteria, were submitted to mechanical ventilation, antibiotherapy and nutritional support. Weaning attempts required degressive pressure support ventilation. The biological status of the patients was assessed by the serial measurement of inflammatory (C-reactive protein and alpha1-acid glycoprotein) and of nutritional (albumin and transthyretin) indicators whose aggregation yields a prognostic inflammatory and nutritional index (PINI). Statistical analyses compared ventilatory and biological data recorded on admission and at the time of extubation. Results showed that vital capacity and plasma concentrations of albumin and transthyretin rose, whereas rapid shallow breathing index, C-reactive protein and PINI values declined during the tested period. Persistent low transthyretin concentrations were predictive of lethality while increased values were associated with improved ventilatory performances. The PINI scoring formula worked as an independent predictor of the weaning trial outcome. The study underlined the value of the PINI system for the successful management of the weaning procedure.

A case of acardiac twinning where the pump twin dies in utero due to massive thrombotic occlusion of umbilical arteries at a site of umbilical cord stricture of the intact twin. In acardiac twinning the morbidity and mortality of the pump twin can be reduced by some invasive or medical approaches. The authors believe that in this interesting case the death of the pump twin could not be prevented by antenatal treatment.

In evaluating a 9-year-old girl, we encountered the following cardiac anomalies: a left atrioventricular valve (the morphologic left atrium on the left side, connected with the morphologic left ventricle); concordant atrioventricular connections; a right atrioventricular valve (a morphologic right atrium on the right side, connected with the morphologic right ventricle); concordant atrioventricular connection; a "central" atrioventricular valve (separating the morphologic right atrium from the morphologic left ventricle); and discordant atrioventricular connection with intact interatrial and interventricular septa. A right-to-left shunt passed through the central valvular structure, which was situated at the atrioventricular septum. This was the only means of mixing pulmonary and systemic blood. We suggest that this case presents a newly recognized cardiac anomaly.

Twenty-two deliveries were followed by emergency postpartum hysterectomy among 109,842 deliveries in the last 10 years, an incidence of 1 in 4992 deliveries (20/100,000). The leading causes of emergency postpartum hysterectomy were uterine rupture in 8 (36.3%), uterine atony in 7 (31.8%), and abnormally adherent placenta in 6 (27.3%) patients. Five of the uterine rupture cases followed previous cesarean births, whereas the other 3 followed dystocia. Of the 7 patients with uterine atony, 4 were after vaginal delivery and 3 were after cesarean birth. Of the 6 patients with adherent placenta, 4 had repeat cesarean deliveries and the other 2 were subjected to cesarean section for postterm pregnancies. The maternal mortality rate was found to be 4.5% (1/22). The perioperative morbidity included blood transfusion in 72.2%, febrile morbidity in 40.9%, and wound infection in 13.6% of the patients. Fetal mortality rate was 45.4%.

In this study, HSV-1 IgG, IgM and HSV-2 IgG, IgM antibodies by ELISA in the sera of the mothers who had different kinds of obstetrical problems like abortus, stillbirth, prematurity, postmaturity, intrauterine development retardation and in the newborns' cord sera who had congenital anomalies like anencephaly, cataract and dolichocephaly were investigated. In these mothers HSV-1 IgG positivity ratio was 71/73 (97.3%). There was no significant difference in the age group distribution of HSV-1 IgG. The HSV-1 IgG positivity ratios in mother sera were the same as in cord sera. It was found that HSV-1 IgG antibodies passed transplacentally. It was established that one of the subjects had premature baby and the other had stillbirth inspite of HSV-1 IgG negativity but in the risk group subjects. HSV-1 IgM was found positive in 7 mothers (9.6%) of the study group. This data was the sign of active or reactive infection. There were 3 abortus, 1 stillbirth and 3 anomalous baby in HSV-1 IgM seropositive mothers. In these mothers, 65/73 (89%) HSV-2 IgG and 6/73 (8%) HSV-2 IgM seropositivity were defined. In the cord sera these ratios were 65/73 (89%) and 2/73 (2.7%). IgM seropositivity of the material of the mothers who had abortus was explained by the effect of HSV-2 activity and the presence of HSV-2 IgM, 4 mothers were noted for the active or reactive infection sign. It was understood that HSV-2 IgG passed completely via placenta and there were no significant difference between the presence of the antibody and the age group.

In this study, Ch.trachomatis antigen was investigated by ELISA, endocervical swab material of 35 infertile and sterile women, and 4 of them were antigen positive. All of these 4 cases were secondary sterile and 3 of them showed Ch.trachomatis IgG seropositivity. Chlamydia IgG seropositivity was seen in 8 of 35 cases. In this study, 68 patients were investigated for Ch.trachomatis IgG antibodies and 17 patients were found to be seropositive. These findings indicate the importance of Ch.trachomatis infections and the effect of recurrent infections on tubal factor infertility.

In this study, Toxoplasma IgM antibodies in serum samples of 54 women who had maternal problems like abortion, preterm, fetal exitus, delivery with pediatric anomalies have been investigated with ELISA. In the cord sera of babies of these mothers, Toxo-IgM has been investigated too. Six mothers have been found to be Toxo-IgM seropositivity (11.11%). Toxo-IgM has been found negative in all of the cord samples. Three of Toxo-IgM positive mothers had fetal exitus and one of them had intrauterine growth retardation. One pregnancy has been terminated as abortion, the other as newborn with multiple anomalies. We have found out that active, latent or reactive toxoplasmosis have to be discriminated and for this purpose detection of Toxo-IgM levels is useful.