Translation,cultural adaptation,cross-validation of the Turkish diabetes quality-of-life (DQOL) measure

Objective The aim of this study was to test the validity and reliability of the Turkish version of the diabetes quality of life (DQOL) questionnaire for use with patients with diabetes. Methods Turkish version of the generic quality of life (QoL) scale 15D and DQOL, socio-demographics and clinical parameter characteristics were administered to 150 patients with type 2 diabetes. Study participants were randomly sampled from the Endocrinology and Diabetes Outpatient Department of Dr. Lutfi Kirdar Kartal Education and Research Hospital in Istanbul, Turkey. Results The Cronbach alpha coefficient of the overall DQOL scale was 0.89; the Cronbach alpha coefficient ranged from 0.80 to 0.94 for subscales. Distress, discomfort and its symptoms, depression, mobility, usual activities, and vitality on the 15 D scale had statistically significant correlations with social/vocational worry and diabetes-related worry on the DQOL scale indicating good convergent validity. Factor analysis identified four subscales: satisfaction”, impact”, “diabetes-related worry”, and “social/vocational worry”. Conclusion Statistical analyses showed that the Turkish version of the DQOL is a valid and reliable instrument to measure disease related QoL in patients with diabetes. It is a simple and quick screening tool with about 15 ± 5.8 min administration time for measuring QoL in this population.     

Renal replacement therapies in the aftermath of the catastrophic Marmara earthquake

BACKGROUND: Renal replacement therapy is of vital importance in the treatment of crush syndrome victims, who are frequently encountered after catastrophic earthquakes. The Marmara earthquake, which struck Northwestern Turkey in August 1999, was characterized by 477 victims who needed dialysis. METHOD: Within the first week of the disaster, questionnaires containing 63 clinical and laboratory variables were sent to 35 reference hospitals that treated the victims. Information considering the features of dialyses obtained through these questionnaires was submitted to analysis. RESULTS: Overall, 639 casualties with renal complications were registered, 477 of whom (mean age 32.3 +/- 13.7 years, 269 male) needed dialysis. Among these, 452 were treated by a single dialysis modality (437 intermittent hemodialysis, 11 continuous renal replacement therapy and 4 peritoneal dialysis), while 25 victims needed more than one type of dialysis. In total, 5137 hemodialysis sessions were performed (mean 11.1 +/- 8.0 sessions per patient) and mean duration of hemodialysis support was 13.4 +/- 9.0 days; this duration was shorter in the non-survivors (7.0 +/- 8.7 vs. 10.0 +/- 9.8 days, P = 0.005). Thirty-four victims who underwent continuous renal replacement therapy had higher mortality rates (41.2 vs. 13.7%, P < 0.0001). Only eight victims were treated by peritoneal dialysis, four of whom also required hemodialysis or continuous renal replacement therapy. The mortality rate in the dialyzed victims was 17.2%, a significantly higher figure compared to the mortality rate of the non-dialyzed patients with renal problems (9.3%; P = 0.015). CONCLUSION: Substantial amounts of dialysis support may be necessary for treating the victims of mass disasters complicated with crush syndrome. Dialyzed patients are characterized by higher rates of morbidity and mortality.     

Posterior sling (infracoccygeal sacropexy): an alternative procedure for vaginal vault prolapse

This study of 30 patients evaluated the effectiveness and safety of the posterior sling (infracoccygeal sacropexy) in the surgical treatment of vaginal vault prolapse. The patients were reevaluated 3 months, 6 months and yearly postoperatively. Coexisting preoperative symptoms of pelvic pain, urgency, nocturia and 'obstructed' micturition feeling were followed-up. There was remarkable improvement in vault prolapse and in coexisting symptoms.     

Interdialytic weight gain and pulmonary membrane diffusing capacity in patients on hemodialysis

Background: Measurement of pulmonary diffusion capacity for carbon monoxide (DLCO) may be useful for assessing disease affecting the alveolar-capillary bed or the pulmonary vasculature. It was reported that hemodialysis (HD) therapy causes DLCO reduction via decrease of pulmonary capillary blood volume components. The aim of the study was to evaluate the effect of interdialytic weight gain on pulmonary function and especially DLCO. We further determined whether intravascular volume status, assessed by inferior vena cava diameter (IVCD) contributes to DLCO in patients on HD. Methods: Routine pulmonary function testing including forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC, forced mid-expiratory flow rate (FEF_25–75), DLCO IVCD index and other echocardiographic parameters were evaluated in 20 patients (mean age 48.6 ± 18.3 years, mean dialysis duration 17.4 ± 19.2 months) on chronic HD, 1 hour after HD and after an interdialytic period (1 hour before HD therapy). Single-breath DLCO measurements were corrected for hemoglobin concentration (cDLCO). Results: Routine pulmonary function tests (spirometry) showed no significant changes in FEV1, FVC and FEF_25–75 whereas a statistically significant fall in FEV/FVC was found. At the end of the interdialytic period a statistically significant increase in weight, IVCD index, left ventriculer diastolic diameter (LVDD), and diastolic blood pressure (DBP) were observed (P < 0.05). Using the single-breath DLCO, we found unchanged cDLCO at the end of the interdialytic period. There was no correlation of cDLCO with increases in weight, DBP, IVCD index, LVDD (P > 0.05). Conclusion: The accumulation of body water between dialyses has no significant influence on DLCO.     

The effect of granulocyte macrophage-colony stimulating factor on bacterial translocation after administration of 5-fluorouracil in rats

BACKGROUND: After surgical resection for colorectal carcinoma there is a high recurrence rate and, therefore, adjuvant chemotherapy may be useful in some patients. 5-Fluorouracil (5-FU) is the most commonly used chemotherapeutic agent in the management of patients with colorectal cancer. However, gastrointestinal injury induced by chemotherapeutic agents may result in bacterial translocation from the gut into the systemic circulation. Granulocyte macrophage-colony stimulating factor (GM-CSF) may be used to prevent this side effect by means of macrophage activity stimulation. MATERIALS AND METHODS: A total of 45 rats were divided into three groups. Control group received intraperitoneal saline solution, 5-FU and GM-CSF groups received 50 mg/kg/day 5-FU intravenous infusion and GM-CSF group also received 200 ng/day GM-CSF subcutaneously for 6 days. Intestinal tissue was also sampled for pathological examination at day 7. Plasma levels of tumor necrosis factor-alpha and interleukin-6 were determined, bacterial translocation was quantified by lymph node, liver and spleen culture, and plasma endotoxin content was measured. RESULTS: White blood cell counts of the 5-FU rats were significantly lower than in the control and GM-CSF groups (P < 0.01). The plasma endotoxin, tumor necrosis factor-alpha and interleukin-6 levels in the 5-FU and GM-CSF groups were significantly increased at day 7 compared with the control groups (P < 0.01), but these levels were significantly lower in the GM-CSF group compared to the 5-FU group (P < 0.01). 5-FU intervention caused significant increase in the frequencies of bacterial translocation at liver, spleen, mesenteric lymph node, and portal blood. Compared with 5-FU group, GM-CSF decreased the bacterial translocation (P < 0.01). CONCLUSIONS: This study observed that the administration of 5-FU resulted in bacterial translocation. Activation of inflammatory response with GM-CSF is highly effective in prevention of bacterial translocation in 5-FU interventions.     

Translation, cultural adaptation, initial reliability, and validation of Turkish 15D's version: a generic health-related quality of life (HRQoL) instrument

This article describes the adaptation of the Finnish 15D standardized measure of health-related quality of life (HRQoL) instrument for use in Turkey and assesses its psychometric properties. The HRQoL is measured in a sample of 75 patients with Type 2 diabetes using both 15D and Nottingham Health Profile (NHP) instruments. The internal consistency within the domains of 15D was high, with Cronbach's alpha values 0.89 for 15D scale and 0.89 for NHP. Significant correlations were observed between the scores of similar domains of 15D and the NHP in general health perception supporting the construct validity of the new 15D Turkish version. Overall, the results indicated that the adaptation of the 15D for use in Turkey was successful. The Turkish version was found to be a reliable and valid instrument. It is suitable and applicable to both clinical and population-based studies for the measurement of HRQoL in Turkey.     

Anatomical dimensions of anterior bundle of ulnar collateral ligament and its role in elbow stability

OBJECTIVE: To study the anatomical dimensions of the anterior bundle of ulnar collateral ligament and its role in elbow instability. METHODS: We studied 20 elbows of 10 cadavers. Anterior bundle of ulnar collateral ligament was dissected in all elbows and its anatomical length and width were measured. After measuring it, we assessed the role of the anterior bundle of ulnar collateral ligament in the medial elbow joint stability, with the capsule, the radial head and anterior bundle of ulnar collateral ligament being cut. RESULTS: The mean right length of the anterior bundle of ulnar collateral ligament was 21.10 +/- 6.29 mm and the mean left length was 21.70 +/- 5.31 mm. The mean right width of the anterior bundle of ulnar collateral ligament was 12.70 +/- 2.79 mm and the mean left width was 13.90 +/- 2.37 mm. Anterior bundle of ulnar collateral ligament was found to be the main stabilizer of the valgus stress. The anterior capsule and the radial head also make contributions to this stability. However, when anterior bundle of ulnar collateral ligament is cut, the radial head and the anterior capsule fails to maintain the stability against valgus stress. CONCLUSIONS: The anatomical dimensions of the anterior bundle of ulnar collateral ligament are important for a surgeon when graft is used in reconstructing this ligament. Our study is an initiator of this topic and we believe that with larger series, more reliable anatomical measurements can be obtained. We also showed that the anterior bundle of ulnar collateral ligament is the main medial stabilizer of the elbow joint.     

Endometrioid carcinoma of the endometrium with choriocarcinomatous differentiation: a case report and review of the literature

OBJECTIVE: An endometrioid adenocarcinoma (EAC) with true trophoblastic differentiation is a rare event with a highly aggressive clinical course. CASE: We report an endometrioid adenocarcinoma of the endometrium in which there was a morphologically conventional-appearing EAC component admixed with multinucleated giant cells and large pleomorphic tumor cells that resembled a choriocarcinoma without an elevated serum level of human chorionic gonadotropin (hCG) in a 42-year-old unmarried woman with a history of abnormal uterine bleeding. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection were performed. Histopathologic study of the specimen showed endometrioid adenocarcinoma extended to the deep myometrium with a focus of hemorrhagic and necrotic tumor composed of multinucleated giant cells, large pleomorphic tumor cells, suggesting choriocarcinomatous differentiation (CD). Immunohistochemical studies demonstrated intense reactivity of tumor cells for human chorionic gonadotropin (hCG) confirming the diagnosis. A complete clinical workup ruled out metastatic spread to the brain, lungs, skeleton, or abdomen. The patient was alive with no evidence of disease 6 months later. CONCLUSION: Although endometrioid adenocarcinoma with choriocarcinomatous differentiation is known to behave in a more aggressive course, this disease may have a good prognosis with a clinically indolent course when it is small, and without elevated serum hCG levels.