OBJECTIVE: In this study, 60 cancer patients who applied to the Anesthesiology and Reanimation Department Pain Management Center between March 1, 2000 to March 1, 2001 were respectively studied with respect to demographics, primary tumor localization, tumor spread, distribution of pain, oral and parenteral pain medication and the various form of administration, invasive procedures, success of follow-up in terms of patient compliance, adverse effects of analgesic medications and procedures.
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OBJECTIVE: Pancreatic cancer is a major health problem, which hasn’t been solved yet and different protocols were performed in the treatment. For this reason, we aimed to evaluate data of pancreatic cancer cases. Twenty-four patients [Male/female: 18/6, mean age 57,46 (37-75) years] were evaluated retrospectively, between the years 1997-2002. Median follow-up was 12 (3-55) months. Seventeen (70.8%) of cases were operated. When we have evaluated the pathological diagnosis, 22 (91.7%) were adenocarcinoma and 2 (8.3%) were indifferentiated carcinoma. As complaints at the admission, in 70.7% of cases abdominal pain, in 58.3% of cases jaundice and in 33.3% of cases weight loss were determined. At first admission, 9 (37,5%) of patients were in stage IV. Chemotherapy for all patients and radiotherapy in 11 (45.8%) cases was performed. After the treatment, in 7 cases (29.2%) hematological toxicity, in 5 cases (20.8%) gastrointestinal toxicity and in 1 case (%4,2) convulsion were seen. Overall median survival time was 13 months (SE: 13, %95 CI: 0-39) and 1-year survival rate was 68.7%. In non-metastatic group (stage I,II,III), median survival time was 12 months (SE: 4, %95 CI: 4-20) and 1-year disease-free survival was 48%. In metastatic group (stage IV) median survival time was 11 months (SE: 4, %95 CI: 3-19) and 1-year survival rate was 33.3%. The results that were appeared in the evaluation of patients data, who were followed as pancreatic cancer in our hospital were found harmonious with literature.
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OBJECTIVE: The purpose of this study was to determine the effect of neoadjuvant chemotherapy (NAC) and to compare the efficacy of NAC with that of radiotherapy (R/T) for locally advanced cervical cancer. The trial was performed on 31 patients (18 stage II and 13 stage III) who had completed 2 years of follow-up after treatment with neoadjuvant chemotherapy (“Quick” VBP scheme; Cisplatinum 50 mg/m2 day 1, Vincristine 1 mg/m2 day 1, Bleomycin 25 mg/m2 days 1,2,3.) with 80 patients (46 stage II and 34 stage III) who had given R/T. Four groups of patients operability status, according to tumor response were identified. Complete and partial responders were operated (radical abdominal hysterectomy and pelvic paraaortic lymphadenectomy plus R/T); stable or progressive responders were treated by R/T. The response to NAC is strongly associated with the initial median tumor diameter (MTD). The critical pretreatment diameter was 4 cm. Because of regression of clinical staging, 45.2% of the patients (14/31) in the NAC were operated. The tumor response to NAC correlated with the diameter of the cervical mass and lymph node involvement. NAC group had higher incidences, disease-free survival more than R/T group. We drawn the following CONCLUSIONS: Squamous carcinoma of cervix uteri is a neoadjuvant chemosensitive tumor. Three courses of Quick VBP scheme was tolerated well by patients. NAC has obtained higher rate disease free survival.

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OBJECTIVE: In this study, we investigated whether transition zone PSA density could be an adjunct in the diagnosis of prostate cancer and avoid unnecessary prostate biopsies. Between November 2002-March 2003, 50 patients with lower urinary tract complaints and known plasma PSA levels were included in the study. Transrectal ultrasound guided sextant biopsies with two additional transition zone (TZ) biopsies were performed. Total PSA (tPSA), PSA density (PSAD), PSA density of transition zone (PSAD-TZ) and free/total PSA (f/t PSA) levels of the patients were measured and calculated. Of 50 patients, 37 had histologically benign and 13 malignant results. Sensitivity of the tPSA, PSAD and f/t PSAD were found 92.3%, 76.9% and 50%; and specificity 15.6%, 59.25% and 46.6%, respectively. Sensitivity and specificity of the PSAD-TZ were 67.5% and 69.2%, respectively. PSA-TZ, which shows high sensitivity and specificity values, could be used for diagnosis of prostate cancer and helps avoiding unnecessary biopsies.
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OBJECTIVE: Although most of the site effects of ionized radiation, used extensively by the orthopedic surgeons, are well known; it seems that attention for radiological protection are not enough. The aim of this study is to document how much the personal of the orthopedics operating room are subjected to radiation, to point out the necessities for protection and to give knowledge to the personal about protection rules. During 30 days, 1006 times fluoroscopy was used. Mean dosage was 65-100 kV and 1.5-2.2 mA/sec. During the usage of the fluoroscopy, radiation was noted by two dosimeters placed at different distances. The noted values were found in the safe interval that was pointed out by the “International Commission on Radiological Protection (ICRP)” and “Turkish Nuclear Study Center of Nuclear Energy Company”. In conclusion; attention must necessary for radiological protection because we don’t have enough knowledge about the chronic usage of the low doses of ionized radiation.
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OBJECTIVE: The aim of this study is to determine estradiol, testosterone and norepinephrine levels in male patients with acute myocardial infarction (AMI) and to evaluate the relation of those parameters with the incidences of death in hospital, post MI angina and death at home in the following 3 months period. Forty male patients with the diagnosis of AMI and 30 healthy males were included in the study. The AMI group were tested for estradiol, testosterone, creatine kinase (CK) and myocardial band of creatine kinase (CK-MB) using their blood samples obtained at the first 24th hours, 48th hours and 72nd hours. Norepinephrine levels were tested on admission and at 72nd hours. Control group was tested for the same parameters using a single blood sample. Patients were followed up for 3 months to evaluate death in hospital, post MI angina and death at home rates. In MI group estradiol levels were found 51,92±19,8 pg/ml, 40,52±17,9 pg/ml and 34,76±19,9 pg/ml respectively at 24th, 48th, 72nd hours and both three levels were higher than the control group (24,44±8,2 pg/ml) and the differences were statistically significant (p<0,05). In MI group testosterone levels were found 3,99±2,6 ng/ml, 3,30±1,6 ng/ml and 3,39±1,6 ng/ml respectively at 24th, 48th and 72nd hours, but in control group they were found 4,22±1,7 ng/ml. There was no difference between control group and MI group according to their first 24th hours serum testosterone levels, but there were significant differences between the levels for the control group and MI group at 48th and 72nd hours. When compared the testosterone levels of the MI group had no statistically significant variation among themselves. The norepinephrine levels of MI group measured 114,16±110,2 pg/ml and 40,61±61,5 pg/ml respectively at on admission and 72nd hours. The levels on admission were found significantly higher (p=0,008) than the control group (62,83±53,4 pg/ml). Between CK-MB and estradiol levels statistically significant, positive corellation (24th hours p=0,000 r=0,586; 48th hours p=0,034 r=0,337; 72nd hours p=0,011 r=0,398) was found; but between CK-MB, testosteron and norepinephrine there was no such correlation. We couldn’t detect any significant effect of estradiol, testosteron and norepinephrine levels on post MI angina, death in hospital and death in home rates during the following 3 months period. But to evaluate the prognostic value of estradiol, testosteron and norepinephrine level alterations in AMI patients we need to have more data which may be supplied by large and long-term follow-up studies.
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OBJECTIVE: In this clinical study, scars placed lower abdominal wall skin after cesarean section and abdominoplasty operations were examined and effects of skin tension on the wounds were evaluated. Seven patients with abdominoplasty scars and 15 patients with cesarean section scars were analised by different observers. They were pointed out the results of the scars and their acceptable view. After abdominoplasty operations, incisions under tension were healed wide scars and scars after cesarean section were healed well. Wound tension around the incisions made scars unacceptable, however pregnancy ongoing with tissue expansion made some relaxations on the cesarean section scars and it resulted with fine scars on the lower abdominal wall.
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OBJECTIVE: Breast cancer is the most common cause of cancer death seen in women. Main goal of this study is to show definitive numbers of palpable breast masses.
METHODS: US has been applied to 48 patients and mammography has been performed for patients above 35 years of age. Following radiological results fine needle aspiration biopsies were performed for fibroadenoma, macrocyst, lipoma and suspicious malignancy cases. Results are analyzed prospectively.
RESULTS: Pathological and radiological investigations show that 20 patients (41.5%) have fibrocystic change disease, 8 patients (16.5%) have fibroadenoma, 7 patients (14.5%) have macrocyst, 6 patients (12.5%) have normal breasts, 3 patients (6.5%) have breast cancer, 1 patient (2%) has cystosarcoma phylloides. Sensitivity of physical examination is found to be as 0,94. 46% of 48 patients with the symptom of palpable mass in their breasts have benign or malignant tumoral mass. It is essential to assess the patients who have dominant palpable mass in an algoritmic manner. Malignancy rate is found to be as 6,5%.
CONCLUSION: Current screening methods remain a major diagnostic tool for breast masses. Palpable masses need special attention. Early diagnosis and treatment are the most important prognostic factors.

OBJECTIVE: Recurrent epiphora occuring after a dacryocystorhinostomy operation is an unwanted problem. This study was presented to compare the surgical success rates of external dacryocystorhinostomy (EXT-DCR) and endonasal dacryocystorhinostomy (END-DCR) in management of unsuccessful lacrimal surgery. The results of a total of 18 cases in 17 patients (3 males, 14 females) that were operated between 1999-2003 were reviwed in this retrospective study. Patients were analysed as 10 cases in the first group who underwent EXT-DCR as revision surgery and 8 cases in second group who underwent END-DCR operation. The surgical success rates were evaluated with absence of symptoms and results of lacrimal irrigation. In the first group, the success rates of 10 cases (3 males, 7 females) were evaluated after 7-40 months follow-up period. 7 of cases were successful (70%) in this group. In the second group, the success rates of 8 cases in 7 patients (one patient underwent bilateral END-DCR and one patient underwent END-DCR as third operation after a second unsuccessful EXT-DCR [first group]) were evaluated after 3-12 months follow-up period. Five cases were successful (50%) in this group. The EXT-DCR revealed superior outcomes when compared with END-DCR in recurrent dacryostenosis.
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OBJECTIVE: In this study, clinical and radiological evaluation of 51 total hip arthroplasty in 47 patients, operated in our clinic between 1991-1999, was made. The average age was 60,2 and male/female ratio was 2/3. The mean follow-up time was 47,6 months. In clinical evaluation; 19 (37%) cases had excellent, 21 (41%) had good, 7 (14%) had satisfactory and 4 (8%) had bad results.
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OBJECTIVE: Our purpose was to evaluate obstetric and perinatal outcomes of multifetal pregnancies in Zeynep Kamil Maternity and Child Hospital. The files of 834 twin and 23 triple deliveries between 2000-2002 were evaluated retrospectively. Mean maternal age was 30.4 (17-42). Multiparity was 51%, nulliparity was 49%. The rate of multiple gestations was found 2.5% in this period. 7.9% of multiple gestations was due to the use of fertility-stimulating therapy, 92.1% of them was spontaneously. Gestational age was before 37. weeks, 72.8% of spontaneously twin pregnancies. Gestational age was before 32. weeks, 78.3% of triple pregnancies. Fetal presentations of twins at labor were noted as vertex-vertex 40.4%. Cesarean sections were 52.5% of deliveries and vaginal deliveries were 47.5%. Cesarean section were due to non-vertex presentation at first fetus, preeclampsia, preterm labor respectively. Maternal morbidity was due to preterm labor 35.8%, anemia 20.7%, preterm ruptured membranes 20.5%. Fetal morbidity was due to IUGR 4.9%, congenital malformations 3.6%, intrauterin exitus 1.2% respectively. In addition we determined two conjoined twins and 11 twin -to-twin transfusion syndrome. Multifetal pregnancies are high risk pregnancies which necessity prenatal care and intapartum menagement.
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Eccrine porocarcinoma is a rare tumor of the skin. It usually develops on the base of a preexisting tumor. De novo growth is also possible. It generally involves the lower extremities. However, chest and skull involvement is also observed. The tumor, which has a poor prognosis and different biological behaviors, has a tendency to recur, and metastasizes to skin and lymph nodes. Surgery is the main treatment of eccrine porocarcinoma. The disease is very resistant to radiotherapy and chemotherapy.

The most common malignant lymphoma of the spleen is of low grade type, showing the phenotypic features of B cells. Small lymphocytic lymphoma is the most common primary lymphoma of the spleen. Splenic involvement by malignant lymphoma may present as an asymptomatic splenomegaly or result in a picture of hypersplenism. Low grade splenic small lymphocytic lymphoma usually presents grossly as multiple nodules measuring a few milimeters in diameter scattered throughout the organ. Seventy one years old female patient who had pain in the left upper quadrant and abdominal distention is admitted to the hospital. Splenomegaly and peripheral hypodense zone in the middle posterolateral aspect of spleen is found in the abdominal computarized tomography (CT). In the thorax CT, mediastinal and hilar lymphadenopathy is not detected. Biopsy of bone marrow revealed mild increase in reticular fibers, inter and paratrabecular lymphoid nodules and mild hypersellularity. Clinically, chronic lymphoproliferative disease or splenic lymphoma is suspected. For the purpose of diagnosis and treatment, splenectomy is performed. In the histopathologic examination of the spleen small lymphocytic type malign lymphoma is diagnosed. We present this rare case with the review of recent literature.

In adults massive lower gastrointestinal bleeding is most often caused by diverticular disease and angiodysplasia. Endoscopy, scintigraphy and angiography are helpful tools in diagnosis. In hemodynamically unstable cases, bleeding site should be localized and segmental resection should be performed. We presented a case of massive lower gastrointestinal bleeding to whom laparotomy and right hemicolectomy was applied.

Thirty four years old, female patient, presented with fatique, loss of appetite, noisea increased with the meals’ odor. Physical examination showed, no spesific signs except, mild right upper quadrant tenderness. The laboratory findings were as ALT: 1386 U/L, AST: 1264 U/L, LDH: 824 U/L, GGT: 108 U/L, ALP: 293 U/L, TB: 1.88 mg/dl, DB: 0,75 mg/dl, IB: 1.13 mg/dl, Anti HAV IgM (-), HBs Ag (+), Anti HBc IgM (+), Anti HCV (-). Since the liver enzymes were normal and HBs Ag was negative two months ago; the patient was concerned as, acute hepatitis B infection. During the control examination, her liver enzymes were decreased (ALT: 610 U/L; AST: 205 U/L) and her clinical findings were seemed better. On the 23rd day, patient was admitted to the hospital with fewer, headache, myalgia and fatique, followed with a worse noisea and increased jaundice. This time, laboratory values were as, ALT: 1140 U/L, AST: 569 U/L, GGT: 173 U/L, ALP: 249 U/L, TB: 7.94 mg/dl, DB: 6.02 mg/dl, ÝB: 1.92 mg/dl, anti HAV IgM (+), HBs Ag (+), anti HBc IgM (+). The patient was concerned as, hepatitis B infection and acute hepatitis A coinfection. On her 6th admission day, her liver enzymes were decreasing (ALT: 507, AST: 116), her clinical condition was recovering and there were no complications. She was discharged and called for a control to see her serological condition.

Small patella syndrome is a very rare disease. Scott and Taor firstly described the syndrome at 1979. The patient admitted to our policlinics with the complaint of restriction of range of motion of the knees and the hips and abnormal gait. Clinical and radiological assessment of the patient's face, patella and pelvis is well adjusted with rarely seen otosomal dominant disease small patella syndrome.

Enterobius vermicularis is a pinworm. Ectopic localizations as conjunctiva, omentum, peritoneal cavity, liver and female genital tract are reported in the literature. Lesions located in female genital tract or peritoneal cavity rarely cause symptoms and detected incidentally in surgical operations with other reasons. Thirty-one years old woman with inguinal pain was admitted to the hospital. 200x120 mm mass that extend to the umbilicus was found in physical examination and laparatomy was performed. In the histopatologic examination of excised specimen, Enterobius vermicularis eggs, abscess formation and inflammatory granulation tissue were detected in the left tuba. This case is reported due to its unusual ectopic localization and presentation as a big mass in abdominal cavity of Enterobius vermicularis.

Massive blood transfusion can be defined as transfusion more than the total body blood volume. The most important feature of massive transfusion is that if it is done correctly in the proper time, it will be life saving, although it has many complications. We report the details of massive transfusion in a patient with multiple myeloma and transfusion guidelines.

Gingival metastasis originating from lung cancer is very uncommon. In almost all cases the lesion involves the bonny structures in the oral cavity rather than soft tissues. Prognosis for the patients with lung cancer metastatic to the gingiva is very poor. The longest survival time reported in literature for these patients is 4 months. In this article we present our experience with a lung cancer patient who admitted to our clinic in 2003, and developed gingival metastasis during her follow-up.

Acute epiglottitis is a serious and often fatal condition that must not be missed. It is an acute inflammation of supraglottic laryngeal space. This condition present with a history of rapid progression from mild upper respiratory infection to respiratuar distress, fever and severe throat pain within hours. In our clinic we have three patients with vallecula cysts; two of them present with acute epiglotititis, one of them present with hoarsness. The airway of the patient with acute epiglottitis was maintained by tracheotomy. All patients had direct laryngoscopy. These three patients presented with the review of literature.

Ganglioneuroma, which arises from mature neuroblasts or can develop de novo, is a benign neural tumor. The mediastinum and the retroperitoneal area are the most common site that the ganglioneuroma is encountered. Most cases are seen between 2 and 30 years of age. The case we report is a 20 years old women admitted to surgical clinic with the symptoms of abdominal pain and nausea. There was a solid mass with 8x6 cm dimensions and irregular contours on computerized tomography evaluation. It was just anterior to and compressing the left kidney but not originating from it. Pathologic diagnosis was ganlioneuroma on frozen section examination during surgery. The total excision of the mass was done by operation. We present the case by reviewing the literature because it is incidental and rare tumor and the diagnosis is possible with frozen section examination and choice of treatment is total excision.

Foreign bodies in gastrointestinal tract are usually followed up unless hemorrhage, perforation or obstruction occurs. If the localization of any foreign body doesn't change through gastrointestinal tract during follow up period endoscopic extraction or elective laparotomy may be indicated. In this report we presented a case of foreign body localized in duodenum that underwent to laparotomy.

Pilomatrixoma is a benign tumor of the hair matrix. Pilomatrix carcinoma is malignant form of pilomatrixoma. In this paper, one case whose clinical history was interesting is presented with reviewing of the literature.