Between August 1994 and October 1999, 69 patients underwent combined coronary artery bypass grafting and valve replacement at our clinic. There were 28 women and 41 men. The mean age was 61.46.3 years (range; 45 to 82 years). Concomittant lesions with coronary artery disease included aortic valve disease in 26 (37.7%) (55%) patients, mitral in 35 (50.7%), combined valve disease (aort+mirtal) in 8 (11.6%). Seventy-five percent (52) of the patients was NYHA class III-IV. The patients underwent a combination of coronary bypass with either isolated aortic valve replacement in 25 (36.2%), mitral valve replacement in 33 (47.8%), or combined valve replacement in 6 (8.7%). The hospital mortality was 5.8 % (4 patients). Three patients died due to low cardiac output syndrome and sepsis in the other. Late mortality was 1.4% (1 patient) as a result of pulmonary and congestive heart failure. The postoperative periods ranged from 2 to 62 months (mean; 34 months). At the follow-up ninety-one percent of the patient was NYHA class I. Early preoperative risk factors should be evaluated during combined valvular and coronary artery surgery. We believe that providing hemodynamic support with the appropriate surgical tecnique and myocardial protection has positive effects on early and late mortality.

Recent studies have shown that antioxidant enzyme activity (AOE) of patients with varicocele is low in the seminal fluid, but there is no study concerning the role of operation on the AOE activity. In this study, we evaluated the AOE activity of patients with varicocele in the seminal fluid before and after operation. A total of 15 patients with grade-2 and grade-3 varicocele (clinically palpable varicocele) and 12 normal controls were included in the study. After separation of spermatozoa, glutathion peroxidase (GSH-Px) and superoxide dismutase (SOD) activity were assessed by enzymatic methods and results were compared using Mann-Whitney U test. GSH-Px and SOD activity of patients in the seminal fluid before and after operation were found as a 325.2728.30; 70.2015.16 and 450. 3530.20; 130. 3020.00 ,respectively (p<0.05). GSH-Px and SOD activity in the control group were found as a 440.4520.30; 135.5022.00. Preoperative values were found as lower than control group (p<0.05), however there was no significant differences between postoperative values and control group (p>0.05). As a result, we conclude that reduced AOE activity of patients with varicocele is associated with impaired sperm function in these patients and these values return to normal.

In our clinic, 139 patients who had obstructive jaundice were hospitalized and investigated in view of etiology and therapy retrospectively. 62 of patients were males (44.6%), 77 of patients were females (55.4%) and mean age was 48 (17 - 87). The obstructive jaundice had benign etiology in 99 patients (71.2%) and had malign etilogy in 40 patients (28.8%). Sphincterotomy with ERCP and stone extirpation from common bile duct, bilioenteric drainage (choledochoduodenostomy, choledochojejunostomy, hepaticojejunostomy, transduodenal sphincterotomy, cholecysto-jejunostomy), external biliary drainage, whipple operation were applied for the treatment

to the general trend in the incidence of gastric cancer, several centres have reported an increase in proximal gastric cancer. It is generally accepted that the prognosis of patients with proximal gastric cancer is worse than that of patients with more distal gastric cancer. Gastrointestinal cancers, especially gastric and esophageal cancers are important cause of mortality in Van region. The aim of this study was to estimate the incidence of proximal gastric cancer in patients with gastric cancer who underwent surgery during the period of October 1994- July 1999. A total of 113 patients with gastric cancer was analyzed as a retrospective study. Proximal gastric cancer incidence in 113 gastric cancer patients analyzed was found 38.9 %.

In this study; the serum arginase activity of 24 cancer patients was determined by Thiosemicarbazide diacetyl monoxime urea method. In addition, the serum levels of blood urea nitrogen (BUN), creatinine, total protein, albumin, alkaline phosphatase were measured. The serum arginase activity of cancer patients was found significantly higher (14.9  9.2 mol urea/ g.protein/ h) than control group value (4.9  3.8 mol urea/ g.protein/ h) (p<0.001). Although the levels of total protein, albumin were obtained lower than normal group values respectively, (p<0.01, p<0.001), the level of creatinine was found higher than normal group value (p<0.05). As a result, paralel to the increased levels at creatinine, total protein and albumin, serum arginase activity was high as well. When we analyzed the correlation between serum arginase activity and other parameters. While the control group did not show any correlation, the group of cancer exhibited a positive relation between the level of BUN and arginase activity (r=0.48, p<0.05).

Diabetic nephropathy is one of the major complications of diabetes mellitus. It effects prognosis, and early diagnosis is very important. The most important finding of early diabetic nephropathy is glomerular hyperfiltration. The aim of this study is to determine the relation between the age of diabetes and GFR and importance of GFR estimations by using scintigraphy in the determination of diabetic nephropathy risc. In our study the GFR values of 96 subjects, 21 healthy and 75 patients with NIDDM, were estimated by scintigraphy. According to diabetic age, the subjects with DM are divided into three groups as 0-5 years (group I), 6-10 years (group II) and over 10 years (group III). It was observed that there was a significant reduction in GFR values in group II and III. Glomerular hyperfiltration was observed only in the first and second groups and had positive correlation with early stage diabetic nephropathy. As a result, decline of GFR values was observed as diabetic age increased. It was concluded that scintigraphic GFR estimations can be useful in the estimation of the diabetic nephropathy risc.

Leptin is a recently recognised hormone which is related to body weight, appetite and heat production and correlated with body fat mass. Leptin is produced by adipocytes and possibly catabolised partially by kidneys. In order to determine whether leptin level was affected in hemodialysis patients and leptin’s relation with nutrition, we planned a crossectional study. Forty six hemodialysis patients (28 male, 18 female, mean age 42.5 +/- 15.9) and 25 healthy volunteers (15 male, 10 female, mean age 32.8 +/- 12.5) were included in the study. Body height, weight and skinfold thickness of the four predetermined places of the body with Holtain skinfold caliper were measured in both groups. Serum leptin was measured by radioimmunoassay using commercially available kit (Linco Research, St Louis, Mo, USA). Predialysis serum BUN, albumin and cholesterol leves were measured. Body mass index (BMI) was significantly low for hemodialysis group (21.7 +/- 4.0 kg/m2) compared to control group (24.1 +/- 4.4, p:0.027), there is no significant difference between groups for fat ratio (FR) (21.0 +/- 6.49 % vs 21.7 +/- 9.8, p0.05), fat mass index (FMI) (4.71 +/- 2.13 % vs 5.52 +/- 3.11, p0.05), leptin (2.38 +/- 2.00 ng/ml vs 3.49 +/- 2.42, p0.05) and leptin/fat mass index (L/FMI) (0.51 +/- 0.41 ng. m2/ml.kg vs 0.62 +/- 0.34, p0.05) respectively. For both groups significant positive correlations were found between leptin and BMI, FR, FMI and L/FMI. No correlation was found between leptin and serum BUN, cholesterol and albumin values in hemodialysis group. In conclusion; serum leptin levels of hemodialysis patients was not different from healthy subjects and correlated positively with BMI and FR. Leptin was not correlated with serum BUN, albumin and cholesterol levels as the measure of nutrition. Further studies were needed in order to determine the role of leptin in the uremic anorexia and malnutrition and whether leptin is an uremic toxin or not.

: The aim of this study was to evaluate postoperative complications and visual results in which children had traumatic cataracts. Material and Method: Nineteen childreen with mean age of 8.2  5.9 years (ranged 4 to 14 years) with unilateral traumatic cataract underwent extracapsular cataract extraction (ECCE). Fourteen of them were implanted posterior chamber intraocular lenses (PC-IOL). The visual rehabilitation of five patients were managed with contact lenses. PC-IOL’s were implanted as a primary procedure in 13 patients and secondarily, 1 patient were underwent implantation of a sulcus fixated scleral lense. The mean postoperatively following period was 14.2 months in patients with PC-IOL’s, 23 months in those managed with contact lenses. Results: Posterior capsulotomies were applied to 1 patient rehabilitated with contact lense and 4 patient with PC-IOL implantation. One of them was performed with secondary diccission of posterior capsule for the failure of Nd-YAG laser application. The final corrected visual acuity measured with Snellen chart was equal or more of 2/10 in 9 of 14 patients (64.2%) with PC-IOL and 10/10 in 5(35.71%) of them, whereas it was more than 2/10 (40%) in just 2 of 5 patients managed with contact lenses. Conclusion: The visual rehabilitation with PC-IOL implantation resulted the better final visual acuities than contact lens application in the correction of unilateral aphakia due to traumatic cataract extraction in the childreen.

Bone mineral density (BMD) measurements in patients with renal calcium stone disease are reported to be low in the literature. In this study, we aimed to determine BMD measurements in patients with idiopathic recurrent urolithiasis. A total of 30 male patients with normal urinary and blood biochemical parameters were included in this study. Mean age was 47.8 (24-72). Bone mineral density was assessed using Dual-energy X-Ray absorbtiometry at the lumbar spine (L2-L4). The results were compared with normal controls. Sixteen patients (53.3%) were found to have lower BMD. It should be remembered that patients with idiopathic recurrent urolithiasis are under high risk with respect to osteoporosis. Dietary calcium restriction in these patients may further aggravate the probable development of osteoporosis and this condition must be kept in mind in the management.

We aimed to clarify complications and treatment of a case of pulmonary oedema developed due to acute heroin intoxication. Heroin lung rapidly causes a reversible form of pulmonary edema. Treatment is supportive and symptomatic. A 21 years old male patient with the history of heroin injection was presented with altered mental status. The patient was unconscious, and had myosis in pupils, respiratory depression, tachypnea, phyliform pulse (130/min), cyanosis (SpO2 35%), and blood pressure of 40/? mmHg. He was immediately intubated, taken to the intensive care unit with the diagnosis of pulmonary edema and started to be ventilated mechanically. Naloxone was given with the total dose of 2 mg (0.8 mg/hr) for neurologic complications and treatment of pulmonary edema was started (oxygen enriched breathing air until the hypoxia has been abolished, and support of the circulation with reasonable liquid supply and infusion of inotropic drugs). Naloxone was given to reverse the respiratory and central nervous system depression. After 3 days of mechanical ventilatory support, the patient was extubated without any problem and taken to the service on fourth day. It is concluded that acute opiate intoxication treated in hospital has an excellent prognosis, provided by absence of cardiac arrest prior to admission.

The disease caused by Echinococcus granulosus is mostly seen in liver. Although the parasite eggs in systemic circulation theorically may settle anywhere in body, settlement on abdominal wall is extremely rare. In this article we present an echinococcus cyst found on abdominal wall.