Change in causes of death statistics between year 2008-2009 in the practice and research hospital of adnan menderes university: an ıntervention study

Bu çalısmanın amacı, “Ölüm Nedeni Istatistikleri” konusundaki ilgi proje kapsamındaAdnan Menderes Üniversitesi Uygulama ve Arastırma Hastanesinde ölüm nedenlerinin iyilestirilmesi için yapılan egitim ve denetim müdahalesinin 2008 ve 2009 yılları ölüm nedeni istatistiklerinde meydana getirdigi degisimi degerlendirmektir. Çalısma, ölüm belgesinin doldurulmasına yönelik egitim ve denetim olarak tanımlanan müdahalenin, müdahale öncesi dönem olan 2008 yılı ile müdahale sonrası dönem olan 2009 yılları ölüm nedeni istatistiklerinde meydana getirdigi degisimin karsılastırılmasına dayanmaktadır. Adnan Menderes Üniversitesi Uygulama ve Arastırma Hastanesinde 2008 yılında ölüm nedeni olarak toplam 54 farklı ölüm nedeni saptanmıstır. Eriskinlerde 72 (%36,4) ve çocuklarda 19 (%65,5) olmak üzere tüm ölümlerin 91'i (%40,1) “Kardiyak Arrest /Kardiyopulmoner arrest” olarak bildirilmistir. 2009 yılında “KardiyakArrest/ Kardiyopulmoner arrest” olarak bildirim yapılmamıstır (p<0,01). Ölüm nedenleri 2008 yılında 52 kodla tanımlanır iken, 2009 yılında 83 kodla tanımlanmıstır. Her iki yıl arasında ölüm sayısında %4,0'lık bir artıs meydana gelirken, ölüm nedenleri çesitliligi%59,6 oranında artmıstır. Ölüm belgesinin doldurulması ile ölüm nedeninin tanımlanmasında hekimlere yönelik egitim müdahalesinin etkili oldugu veAdnan Menderes Üniversitesi Uygulama veArastırma Hastanesinde ölüm nedeni istatistiklerinin iyilestigi saptanmıstır.The aim of this study was to evaluate the influence of an intervention of education and control to improve the death causes registries in The Practice and Research Hospital of Adnan Menderes University in the years 2008 and 2009, under the project of “Death Causes Statistics”. This study interests on the differences in-between the pre-intervention (the year 2008) and the post-intervention (the year 2009) periods, of an intervention of education and control on the registration of death causes documents. In year 2008, 54 different death causes were registered in The Practice and Research Hospital of Adnan Menderes University Cardiac Arrest/Cardiopulmonary Arrest was the cause in 91 (40,1% of all) deaths as a sum of 72 (%36,4) in adults and 19 (%65,5) in children. In the year 2009, there was no registry of Cardiac Arrest/Cardiopulmonary Arrest (p<0,01). While the death causes were registered under 52 different codes in 2008, in the year 2009, there were 83 codes.Although the increment rate in the number of deaths was only 4,0% in this study period of one-year; the increment rate in the causes of the deaths was 59,6%. The educational intervention of detecting the death causes and to register the death documents on medical doctors of The Practice and Research Hospital Adnan Menderes University was found to be efficient to improve the Death Causes Statistics

Reversible ıschemia-like electrocardiographical changes after adjuvant radiotherapy to the left chest wall ın a diabetic breast cancer patient

Meme kanseri sebebiyle mastektomi yapıldıktan sonra sol göğüs duvarına adjuvan radyoterapi alan bir diyabetik olguda iskemi ile uyumlu geçici elektrokardiyografi bulguları gözlenmiştir. Radyoterapi alanında cildi eritemli, hiperemik ve hassas olan olgunun göğüs ağrısı olmamıştır. Bununla birlikte diyabetik bir bayanda atipik bir tablo ihtimali dikkate alınarak, koroner anjiyografi ile kardiyak iskemi ekarte edilmiştir. Göğüs duvarı yanıkları sonrasında iskemi ile uyumlu elektrokardiyografik değişiklikler gelişebilmektedir. Bu olguda da sebebin radyoterapinin göğüs duvarındaki yakıcı etkisi olduğu düşünülmüştür. Literatürde sol göğüs duvarına uygulanan radyoterapinin geç kardiyak etkileri araştırılmış olmakla birlikte erken ve geçici etkiler yeterince irdelenmemiştir. Radyoterapi sonrası erken dönemde gelişen elektrokardiyografik değişikliklerin tanımlanması amacıyla kliniğimizde prospektif bir çalışma başlatılmıştır.Ischemia-like electrocardiographical changes were observed in a diabetic case who had received adjuvant radiotherapy to the left chest wall after mastectomy. The skin on the radiotherapy field was erythemateus, hyperemic and tender on palpation, and the patient did not have chest pain. The possibility of an atypical presentation of cardiac disease in a diabetic woman was investigated and cardiac ischemia was excluded by coronary angiography. Ischemia-like electrocardiographical changes have been observed after burns of the chest wall. In this case also, the etiology was thought to be related with the burn effect of the radiotherapy on the chest wall. Although the late cardiac effects of the radiotherapy on the left chest wall were reported in the literature, the early and reversible effects were not sufficiently studied. We started a prospective study in our clinic to evaluate the early electrocardiographical changes after radiotherapy

Normocalcemic brown tumor mimicking metastatic bone disease: report of a case

Kemik sintigrafisi oldukça yaygın kullanılan bir tarama yöntemidir. Brown tümör ilerlemis hiperparatiroidinin oldukça nadir görülen bir bulgusudur. Primer hipertroidi, hiperkalsemi ve hipofosfatemi ile seyreden bir hastalıktır ve sintigrafik görüntülemede metastatik kemik hastalıgını taklit edebilir. Biz bu yazımızda yaygın kemik agrısı yakınması ile basvuran ve çekilen tüm vücut kemik sintigrafisinde kostalarda ve sol femur proksimalinde metastatik olarak degerlendirilen aktivite artısları saptanan 65 yasında bir kadın hastayı sunuyoruz. Ancak, yapılan tetkiklerinde serum kalsiyum ve fosforu normal sınırlardaydı. Paratiroid sintigrafisinde sag alt bölgede paratiroid adenomu ile uyumlu artmıs tutulum saptandı ve paratiroidektomi yapıldı.Bone scintigraphy is a commonly used screening tool in medicine. Brown tumor can be a rare skeletal manifestation of advanced hyperparathyroidism. Primer hyperparathyroidism presents with hypercalcaemia and hypophosphatemia and it can mimic metastatic bone disease. We described a 65-year-old woman who has referred for generalized pain exacerbating on movement and increased uptake in the ribs, proximal of the left femur neck suggestive of metastatic lesions by whole body bone scintigraphy. However, serum calcium and phosphorus levels were normal. Parathyroid scintigraphy revealed extensive uptake in the right lower neck regions consistent with parathyroid adenoma. Parathyroidectomy was performed

Organization of the new hospital of adnan menderes university: the decisions and advices of the academics

AMAÇ: Bu çalışmanın amacı 2009 yılı içinde kullanıma açılacak olan Uygulama ve Araştırma Hastanesinin yeni binasının yapılandırılması konusunda Adnan Menderes Üniversitesi Tıp Fakültesi ögretim üyelerinin tercih ve önerilerinin belirlenmesidir. GEREÇ ve YÖNTEM: Bu çalışma kesitsel ve tanımlayıcı bir araştırmadır. Bir anket formu aracılığıyla ilk bölümde öğretim üyelerinin temel demografik özellikleri ile eğitim ve çalışma yaşamları incelenmiş ikinci kısımda da yeni hastane binasının yapılanması hakkındaki görüşleri alınmıştır. Elde edilen veriler Windows için SPSS 10.0 programı kullanılarak analiz edilmiştir. BULGULAR: Öğretim üyelerinin (n=78; 49 erkek, 29 kadın) ortalama yası 43.0 ±6.2 yıldır. Hekimlerin (n=77) ortalama çalışma süresi 19.44±5.25 yıl olup 16'sının (%20.3) yöneticilik deneyimi bulunmaktadır. Katılımcılar hemşire ve eczacılar gibi yardımcı meslek gruplarının görüşünün alınmasını büyük oranda (~%70-87 arası) gerekli görmüş, çalışmaların çoğunlukla (%75.6) için çoklu altkurullar tarafından yürütülmesini savunmuştur. Yine katılımcıların %65.8'i bu çalışmalara kişisel destek vermeye olumlu bakarken, %67'i kliniğinin temsil edilmesi gerektiğini belirtmistir. Hastane organizasyonunda uzmanlık dalları arasındaki paylaşımlar konusunda özellikle Hasta-Is Potansiyeli, Hastaneye Getiri/Karlılık ve Eğitimdeki Rol ile Bilimsel Aktivite önemli kriterler olarak belirtilmiştir. Katılımcıların %76.9'u yabancı/dıs merkezlerin yapılanmasının da dikkate alınması gerektiğini savunmuştur. SONUÇ: Yeni binasına tasınmayı hedefleyen hastanemiz, kapasitesini en az iki kat artırmaya hazırlanmaktadır. Katılımcılar yeni binamızın hem bir üniversite hastanesi gibi eğitim, öğretim ve araştırma hem de bir hastane olarak kaliteli ve verimli hizmet sunacak şekilde yapılanması gerektiğine işaret etmişlerdir.Öğretim üyelerimizin birikim ve tecrübeleri ışığında sağladıkları görüşlerinin hastanemizin yapılanma sürecinin daha sağlıklı olmasına katkı sağlayacağı inancındayız.OBJECTIVE: The aim of this study was to report the decisions and advices of the academicians of Adnan Menderes University Medical Faculty on the organization of new Practice and Research Hospital building. MATERIALS and METHODS: The study was a cross-sectional, descriptive research. In the first part, the demographic properties and education and practice carriers of the academics was noted while in the second part their decisions on organization of the new hospital building was questioned. The data was analyzed by SPSS 10.0 forWindows program. RESULTS: The mean ages of the 78 (49 male, 29 female) academics was 43.0 ±6.2 years. The mean carrier periods of medical doctors (n=77) was 19.44±5.25 years and 16 of them (20.3%) had experience on hospital management. Majority of the participants (about ~70-87%) approved the idea of taking into consideration the decisions of the other team mates such as nurses and pharmacists and also (75.6%) suggested the formation of multiple organization subgroups. While 65.8% of the participants were positive about contributing to the organization studies individually, 67.1% stated that their clinical department should be represented. On the distribution of hospital resources among the clinical departments; the criteria such as, Patient-work potential, Hospital incomes/profits, and Predominance in education as well as Scientific activities were emphasized as important. Other hospitals' organization models were advised to be looked into by 76.9% of the participants. CONCLUSION: Our hospital's aim is at least, to duplicate its capacity in its new building. The participants of this study indicated that the new building should serve not only as a university hospital for education and research but also as hospital for public healthcare with high quality and performance.We believe, the suggestions of the academics in the light of their training and experience will contribute to a better organizational process for our hospital

NF-KappaB expression correlates with apoptosis and angiogenesis in clear cell renal cell carcinoma tissues

<p>Abstract</p> <p>Background</p> <p>Clear cell renal cell carcinoma (ccRCC) is the most frequently encountered tumor in the adult kidney. Many factors are known to take part in the development and progression of this tumor. Nuclear factor kappa B (NF-κB) is a family of the genes that includes five members acting in events such as inflammation and apoptosis. In this study, the role of NF-κB (p50 subunit) in ccRCC and its relation to angiogenesis and apoptosis were investigated.</p> <p>Methods</p> <p>Formalin-fixed and paraffin embedded tissue blocks from 40 patients with ccRCC were studied. Expressions of NF-κB (p50), VEGF, EGFR, bc1-2 and p53 were detected immunohistochemically. The relationship of NF-κB with these markers and clinicopathological findings were evaluated.</p> <p>Results</p> <p>The expression of NF-κB was detected in 35 (85%), VEGF in 37 (92.5%), EGFR in 38 (95%), bc1-2 in 33 (82.5%) and p53 in 13 (32.5%) of 40 ccRCC patients. Statistical analyses revealed a significant relation between NF-κB expression and VEGF (p = 0.001), EGFR (p = 0.004), bc1-2 (p = 0.010) and p53 (p = 0.037). There was no significant correlation between NF-κB and such parameters as tumor grade, stage, age and sex.</p> <p>Conclusion</p> <p>The results of this study indicated that in ccRCC cases NF-κB was associated with markers of angiogenesis and apoptosis such as VEGF, EGFR, bc1-2 and p53. In addition, the results did not only suggest a close relationship between NF-κB and VEGF, EGFR, bc1-2 and p53 in ccRCC, but also indicate that NF-κB was a potential therapeutic target in the treatment of ccRCC resistant to chemotherapy.</p

Arterial Stiffness in Breast Cancer Patients Treated with Anthracycline and Trastuzumab-Based Regimens

Aims. Cardiovascular diseases are the primary cause of premature morbidity and mortality in early breast cancer patients after treatment with cardiotoxic chemotherapeutic agents. Arterial stiffness is an independent risk factor for future cardiovascular diseases and can be used as a predictive marker of subclinical cardiac damage. The aim of this study is to analyze the arterial stiffness in breast cancer patients who are in the follow-up period after receiving anthracycline-based chemotherapy regimens with trastuzumab. Methods and Material. We enrolled 45 HER2-positive breast cancer patients who are on follow-up at least for six months after completion of adjuvant chemotherapy with trastuzumab, and cardiovascular risk matched 30 control volunteers. The measurements were done with pulse wave analyzing machine. Results. Mean pulse wave velocity was higher in breast cancer patients compared to controls. The pulse wave velocity was significantly higher in patients receiving aromatase inhibitors compared to patients under tamoxifen. It was also significantly higher in postmenopausal breast cancer patients than postmenopausal controls. Conclusions. Arterial stiffness measurements may predict the breast cancer survivors with higher risk for cardiovascular events earlier in the follow-up period, and necessary preventive approaches and/or treatments can be applied

Anti-Yo Antibody-mediated Paraneoplastic Cerebellar Degeneration in a Female Patient with Pleural Malignant Mesothelioma

Paraneoplastic cerebellar degeneration is a rare non-metastatic complication of malignancies. It presents with acute or subacute onset of ataxia, dysarthria and intention tremor. Paraneoplastic cerebellar degeneration is most commonly associated with malignancies of the ovary, breast and lung. The anti-Yo (anti-Purkinje cells) antibodies that specifically damage the Purkinje cells of the cerebellum are found in the serum and cerebrospinal fluid. Anti-Yo-related paraneoplastic cerebellar degeneration is most commonly found in women with gynecological and breast cancers, but it is reported in other malignancies. Patients with paraneoplastic syndromes most often present with neurologic symptoms before an underlying cancer is detected. We report a case of anti-Yo-related paraneoplastic cerebellar degeneration associated with pleural malignant mesothelioma in a 51-year-old female patient. She presented to our department with a 2-week history after the last chemotherapy of progressive diziness related to head movement, nausea, vomiting, ataxia and unsteady gait. A western blot assay was negative for anti-Hu, anti-Ri, anti-Ma2, anti-CV2 and anti-amphiphysin paraneoplastic antibody markers but positive for anti-Yo. In conclusion, we report a case of paraneoplastic cerebellar degeneration in a patient with pleural malignant mesothelioma because of the rarity of this neurologic presentation after the diagnosis of malignant mesothelioma and of the association with anti-Yo antibodies

Is there any effect of lower extremity deep vein thrombosis which proven by Doppler ultrasonography on cancer recurrence in patients with stage III colon cancer? A study of the Turkish Descriptive Oncological Researches Group

WOS: 000342079600032PubMed ID: 25208817This study aimed to determine the predictive value of lower extremity deep vein thrombosis (LE-DVT) on first cancer recurrence in patients with stage III colon cancer. A total of 113 eligible patients with stage III colon cancer were divided into two groups according to whether they had LE-DVT. LE-DVT was detected in 29 (26 %) patients. Presence of recurrence with distant metastasis had a significant positive correlation with baseline platelet count, baseline mean platelet volume, and the presence of lower extremity deep vein thrombosis. It was concluded that the relation between disease progression and the presence of LE-DVT in stage III colon cancer is independent of other study variables (P = 0.031; OR = 4.27; 95 % CI 1.89-6.71). We hypothesized that the presence of LE-DVT in patients with stage III colon cancer may predict to early cancer recurrence with distant metastasis

Is there any effect of lower extremity deep vein thrombosis which proven by Doppler ultrasonography on cancer recurrence in patients with stage III colon cancer? A study of the Turkish Descriptive Oncological Researches Group

İstanbul Bilim Üniversitesi, Tıp Fakültesi.This study aimed to determine the predictive value of lower extremity deep vein thrombosis (LE-DVT) on first cancer recurrence in patients with stage III colon cancer. A total of 113 eligible patients with stage III colon cancer were divided into two groups according to whether they had LE-DVT. LE-DVT was detected in 29 (26 %) patients. Presence of recurrence with distant metastasis had a significant positive correlation with baseline platelet count, baseline mean platelet volume, and the presence of lower extremity deep vein thrombosis. It was concluded that the relation between disease progression and the presence of LE-DVT in stage III colon cancer is independent of other study variables (P = 0.031; OR = 4.27; 95 % CI 1.89–6.71). We hypothesized that the presence of LE-DVT in patients with stage III colon cancer may predict to early cancer recurrence with distant metastasis