Surgical management of chronic, unreduced anterior dislocation of the shoulder

Chronic old unreduced anterior dislocations are extremely rare. We report a case of 75-year-old lady who was seen in policlinic with the symptoms of severe pain and limited shoulder range of motion in which radiographies revealed anteroinferior missed shoulder dislocation. Open reduction with Bankart repair was done, and patient was able to return her daily activities 6 weeks after the operation. To us, if the shoulder was found to be instable after reduction, anteroinferior glenohumeral ligament tear should be looked for, and if it exists should be repaired.     

Turkish adolescents' knowledge on and attitude toward emergency contraception

ObjectiveAdolescents tend to be at risk for unwanted pregnancies, so detecting their level of knowledge on emergency contraception and providing them information is important to prevent such pregnancies. Hence, in two faculties at Gazi University, this study aimed to detect freshman students' level and need of knowledge on emergency contraception and to evaluate their attitude towards emergency contraception.Materials and MethodsThe study was performed with freshman students of the Occupational Education Faculty and the Technical Education Faculty. A questionnaire including questions about demographic properties, obstetrical history, status of contraceptive use, level of knowledge and opinions on emergency contraception was administered to the students. Data was analyzed statistically with the computer program EPI Info 6.0.ResultsA total number of 385 adolescents were included in the studys; 157 of whom were males (40.8%) and 228 of whom were females (59.2%). To the question “is there any way to prevent a possible pregnancy after an unprotected sexual intercourse?”, 166 students replied “yes” (50.5%), 39 “no” (11.9%) and 124 “I do not know” (37.7%). Of 166 students replying “yes,” 114 (68.7%) listed a possible contraceptive method. The mostly cited method was “morning after pills” (n = 62; 54.4%), followed by curettage (n = 15; 13.2%). Among all students, 158 (49.8%) informed us that they were aware of the presence of “morning after pills” whereas 159 (50.2%) claimed they were not. Eighty-six male students (70.5%) and 115 female students (72%) emphasized that they would use emergency contraception upon necessity.ConclusionHalf of the participants were familiar with various options to prevent pregnancy after an unprotected sexual intercourse episode, but they lacked specific knowledge about possible methods and ways to use them. Thus, it is essential that information about emergency contraception be included in adolescents' educational programs and that adolescents be provided with easily accessible medical services.     

Severe postnatal cytomegalovirus infection with multisystem involvement in an extremely low birth weight infant

Cytomegalovirus (CMV) infection is the most common intrauterine and perinatal viral infection. Postnatal CMV infection is acquired mainly from breast milk and may cause severe illness in preterm infants. We report an extremely low birth weight infant who presented with a sepsis-like syndrome and multiple organ involvement, notably hepatitis and pneumonitis, and treated with ganciclovir without adverse effect or relapse.     

Maternal serum autotaxin levels in early- and late-onset preeclampsia

Purpose: We aimed to compare the serum autotaxin levels in early- and late- preeclamptic and healthy pregnant patients at a university hospital.

Methods: A total of 55 singleton preeclamptic women who delivered at Cerrahpasa Medical Faculty were included in the study. The patients were subdivided into two groups: early-onset preeclampsia (n = 31) and late-onset preeclampsia (n = 24). Demographic and clinical data were compared between early-onset and late-onset preeclamptic patients. The control group was composed of 32 healthy pregnant patients.

Results: The mean autotaxin levels were 1.16 ± 0.97 and 0.7 ± 0.35 ng/ml in the early- and late-onset preeclampsia groups, respectively. Autotaxin levels were significantly higher in early-onset preeclampsia group compared with late-onset preeclampsia group. Autotaxin levels were found to be significantly higher in preeclamptic patients compared with control group. Serum autotaxin levels showed a significant positive correlation with maternal systolic, diastolic blood pressures and uric acid levels.

Conclusion: Autotaxin might be a promising marker for detecting early-onset preeclampsia. However, further studies are necessary to confirm this hypothesis.     

A 13-year-old girl with recessive dystrophic epidermolysis bullosa presenting with squamous cell carcinoma

Recessive dystrophic epidermolysis bullosa (RDEB) is an uncommon and severely disabling genetic disorder characterized by trauma-induced blisters, intractable skin ulcers, scarring, milia, and nail dystrophy. Patients with RDEB have an increased tendency for fast-growing and early metastasizing squamous cell carcinoma (SCC). We report here a 13-year-old girl with RDEB who developed a large SCC on the left knee. At 6 months of evolution it was resected and covered with an autologous skin graft. To our knowledge, this is the youngest patient with RDEB complicated by SCC to be reported, and therefore may serve to emphasize the importance of vigilance in surveying RDEB patients for SCC.     

Aspirin resistance in patients with type II diabetes mellitus

Background. Diabetic patients exhibit platelet hyperreactivity, which renders them resistant to antithrombotic treatments. We aimed to investigate the prevalence and predictors of aspirin resistance in diabetic patients.

Material and methods. A total of 93 diabetic and 37 non-diabetic participants were included into the study. Aspirin resistance was measured with a whole-blood desktop platelet function analyzer (PFA-100) with an epinephrine agonist.

Results. Altogether 41.9% patients with DM were aspirin non-responders. Aspirin resistance was observed in 43.2% of non-diabetic patients (p = 0.89). Presence of diabetes mellitus had no effect on aspirin response (RR 0.95 (95% CI 0.44–2.05), p = 0.89) in the whole study population. Hypercholesterolemia was the only predictor of aspirin resistance in multivariate analysis in diabetic patients (RR 3.09 (95% CI 1.17–8.16), p = 0.023).

Conclusion. The prevalence of aspirin resistance is comparable in diabetic and non-diabetic patients. Hypercholesterolemia is the only independent predictor of aspirin resistance in diabetic patients.     

Pregnancy outcomes in women with heart disease

Aim

To evaluate the maternal and fetal outcome of pregnancies complicated by cardiac disease in a developing country.

Methods

A retrospective analysis was carried out of 144 pregnancies in women with cardiac disease who delivered in our unit between 1997 and 2006. Perinatal and maternal outcomes were interpreted according to the type of the heart disease and status of the patient according to the New York Heart Association (NYHA) classification.

Results

The rates of rheumatic and congenital heart disease were 87.5 and 12.5%, respectively. The distribution of the patients according to the NYHA functional classification were 55.6, 36.1 and 8.3% for NYHA classes I, II and III–IV, respectively. There was no maternal mortality. Maternal morbidity was observed in 16 (11.1%) cases. Six perinatal mortalities (4.2%) occurred in this series. There were no significant difference in birth weight, gestational age at delivery and perinatal morbidity between the NYHA stage I–II and stage III–IV groups (P > 0.05), whereas maternal morbidity and cesarean delivery rates were significantly higher in the NYHA stage III–IV group (P < 0.001).

Conclusion

Rheumatic heart disease with pregnancy is still predominant in Turkey. Most of the patients were in a good functional group. Maternal morbidity strongly correlates with maternal cardiac classification.     

A 13-year-old female with Turner syndrome and achalasia

The most common gastrointestinal problems associated with Turner syndrome are intestinal telangiectasia, colon carcinomas, inflammatory bowel, and liver diseases. In this paper we present for the first time a 13-year-old female with 45,X karyotype associated with achalasia. As far as we know, achalasia associated with Turner syndrome has not been reported previously. The aim of this report was to point out the association of Turner syndrome and achalasia. It could be a coincidental or Turner syndrome-associated finding.     

Effects of melatonin on enzyme activities of glucose-6-phosphate dehydrogenase from human erythrocytes in vitro and from rat erythrocytes in vivo.

The in vivo and in vitro effects of melatonin on glucose-6-phosphate dehydrogenase (G6PD) from human erythrocytes have been investigated. For this purpose, human erythrocyte glucose-6-phosphate dehydrogenase was purified, at the beginning, 13.654 times in a yield of 28% by using ammonium sulphate precipitation and 2',5'-ADP Sepharose 4B affinity gel. A temperature of +4 degrees C was maintained during the purification process. Enzyme activity was determined by the Beutler method using a spectrophotometer at 340 nm. This method was utilized for all kinetic studies. For in vitro experiments, the enzyme activity increased below 0.08 mM melatonin concentration and reached a plateau above 0.1 mM. Ten mg kg(-1)melatonin was administered intraperitonally and indicated the stimulatory effect on the enzyme. Time-dependent in vivo studies were executed for melatonin in Sprague-Dawley type rats. It was found that G6PD activity in the erythrocytes was increased by the melatonin in 1.5 and 3.5 h. These results show that both in vitro(below 0.08 mM) and in vivo pharmacological levels of melatonin increased enzyme activity in erythrocytes. The findings also indicate that melatonin may be pharmacologically useful in patients where a deficiency of the enzyme in red blood cells (RBC) causes haemolytic anaemia.