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Volume : 47 Issue : 2 Year : 2022

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ZEYNEP KAMIL MEDICAL JOURNAL - Zeynep Kamil Med J: 47 (2)
Volume: 47  Issue: 2 - 2016
1.Effect of Uterine Massage in the Perception of Women’s Postpartum Pain Intensity
Zümrüt Bilgin, Nuran Kömürcü
doi: 10.16948/zktb.86700  Pages 39 - 44
GİRİŞ ve AMAÇ: Araştırma, uterus masajlarının kadınların postpartum ağrı şiddetini algılamasındaki etkisini belirlemektir.
YÖNTEM ve GEREÇLER: Bir eğitim ve araştırma hastanesi’nde Ağustos 2015-Kasım 2015 tarihleri arasında toplam (50 transabdominal dairesel fundus masajı grubu=TDFMG, 50 transabdominal bimanuel fundus masajı grubu=TBFMG ve 50 kontrol grubu=KG) 150 kadın randomize
kontrollü olarak standardize edildi. Kadınlar; 18-37 yaş arasında, 37.-41. gebelik haftasında, sistemik hastalığı, uterusu aşırı geren bir riski ve gebelik komplikasyonu olmayan, doğum ve doğum sonu herhangi bir komplikasyon gelişmeyen spontan vajinal doğum yapanlar şeklinde standardize edildi. Girişimli (forseps veya vakum) doğum yapan, kollum lesarasyonu, postpartum analjezik alan
olgular çalışma dışı bırakıldı. Araştırmada kadınlara eylemin latent fazında uygulama ile ilgili bilgilendirme yapılıp
onay alındıktan sonra her üç gruba “Gebe Tanıtım Bilgi Formu”, “Doğum Sonu Görüşme ve İzlem Formu”
ve kadınların ağrı algılamasını belirlemek için “Vizüel Analog Skala [Visual Analog Scale (VAS)]” (postapartum
1., 2., 6.saatte) uygulandı.
Her üç gruba postpartum dönemde standart hemşirelik bakımı verildi ve deney gruplarına farklı olarak postpartum birinci saatin sonunda 5 kez (15 dakikada bir ve 60 saniye süren) uterus masajı uygulandı.
BULGULAR: Kadınların %78’inin uterus masajının kendilerini rahatlattığını ve postpartum ikinci saatteki ağrı şiddetini algılama (VAS) puan ortalaması açısından gruplar arasında anlamlı fark olduğu belirlenmiştir (p<0,05). Plasentanın çıkarılma şekli ile kadınların postpartum
6.saatteki VAS puanı ortalaması arasındaki farkın anlamlı olduğu belirlenmiştir (p<0,05). Beden kitle indeksi (BKİ) ile kadınların postpartum 2.-6.saatteki VAS puanı ortalaması arasındaki farkın anlamlı olduğu saptanmıştır
(p<0,05). Uterus masajı uygulanan kadınların daha az postpartum ağrı deneyimledikleri en az ağrı algılayan grubun ise TBFMG’u olduğu belirlenmiştir.
TARTIŞMA ve SONUÇ: Araştırmamızda, uterus masajı uygulanan kadınların postpartum dönemde daha az ağrı deneyimlediği
saptanmıştır.
INTRODUCTION: The research aims to find out effect of uterine massage in the perception of women’s postpartum pain intensity.
METHODS: Total of 150 women (50 trans abdominal circular fundus massage TDFMG, 50 trans abdominal bimanuel fundus massage TBFMG and 50 control group CG) were checked and randomly standardized in a research and training hospital. A standardized group
of women chosen from age between 18-37, who is in maternity week without a systematic disease and a pregnancy complication that excessive tensioning the uterus, in addition, spontan vaginal birth who does not have any birth and after-birth complication. Incidents with Interference birth (forceps or vacuum) or collum laceration, and who had analgesic postpartum are out of scope for the research. In the latent phase of research women were informed and asked for their approval then, the forms were filled out for all three groups as follows; “Pregnant Information Form”, “Postpartum Interview and Follow-
up Form”. In addition, to determine women’s pain perception, Visual Analog Scale (VAS) was applied within
postpartum 1st, 2nd and 6th hours.All three groups were provided by standard postpartum nursing care, and given massage 5 times at the end of the 1st hour (in every 15 minutes for 60 seconds duration) that differs from each other for every group.
RESULTS: 78% of women stated that a uterus massage relieved them and there was a significant difference in
2nd hour’s VAS points between the groups(p<0.05). In addition, there was a substantial correlation between the
method of taking out placenta and 6th hour postpartum pain (VAS) the average sensing (p<0.05). The difference
between body mass index (BMI) and 2-6th hours postpartum pain the average sensing (VAS) was substantive. The women who were provided by a uterus massage, experienced less postpartum pain and the group TBFMG had the least postpartum pain.
DISCUSSION AND CONCLUSION: The research shows that, the women provided by a uterus massage had experienced less pain in postpartum period.

CASE REPORT
2.A Vulvar Angiomyofibroblastoma in A Child: The Youngest Case And Literature Review
Uğur Keskin, Fahri Burçin Fıratlıgil, Mustafa Ulubay, Ulaş Fidan, Müfit Cemal Yenen, Ali Ergün
doi: 10.16948/zktb.76647  Pages 45 - 47
Angiomyofibroblastoma (AMFB) is a rare seen mesenchymal tumor that is categorized as a genital stromal tumor. It is commonly seen in the middle-aged women usually affecting the vulva and rarely the vagina. A variant called AMFB-like tumors are also rarely seen in male patients. AMFB with its clinical presentation and location can be wrongly diagnosed as an aggressive angiomyxomas, bartholin cyst or lower genital tract
lipomas. The treatment of this rare tumor is generally a simple surgical excision. In the following case, an AMFB that was seen in childhood for the first time according to the literature with it’s clinical and histopathological characteristics, was explained.

3.Necrotizing Fasciitis at Pfannenstiel Incision Region, Case Report
Fedi Ercan, Osman Balcı, Bayram Can
doi: 10.16948/zktb.50161  Pages 48 - 51
Necrotizing fasciitis is severe soft tissue that contain with skin-subcutaneous tissue and fascial necrosis, too. Necrotizing fasciitis usuallay
occurs post operation and after blunt trauma, even in minör intramusculer injection areas. To correct diagnosis and to make surgical debridement with reconstructive intervention should be very important. İn spite of early diagnosis and treatment is high mortality and morbidity. Such as immun system weakening conditions diabetes mellitus, liver and kidney failure, various malignancy, chronic alcohol use, peripheral vasculer diseases, conditions provoke Necrotizing fasciitis mortality of Necrotizing fasciitis ratio is %20-%50.

ORIGINAL RESEARCH
4.Evaluating the Effects of Insulin Resistance And Hypertension in Obese Children On Cardiac Functions Using Echocardiography
Ayhan Erdem, Taner Yavuz, Ilknur Arslanoğlu, Kenan Kocabay
doi: 10.16948/zktb.45127  Pages 52 - 56
INTRODUCTION: The purpose of this research was aimed to evaluate the cardiac functions of obese children by echocardiography and in addition to find out the affects of insulin resistance and/ or hypertension on cardiac functions.
METHODS: The Obese group included 52 children in this study (32 boys and 20 girls) with ages ranged between 4-19 years old (mean 11.6±3.7 years) and BMI ≥ 95 percentiles. Children with appropriate for age (4-19 years, mean 11.0±4.1 years), sex (25 boys and 19 girls), and with normal BMI were selected as control group. Serum fasting glucose, thyroid functions, lipid profile, insulin and cortisole levels were measured in the obese group. The patients were also divided into 4 subgroups according to existing of hypertension and/or insulin
resistance, and they were also compared between each other. Echocardiographic measurements of both groups were made by
using M-mode, 2-D and PW Doppler techniques and MPI values of the left and the right ventricles were calculated. The student’s
t test was used to compare the main groups, and Analysis of variance (ANOVA) was used for comparisons of the different
groups. Sidak test as a posthoc test was used for comparisons of the subgroups. Probability values of p <0.05 in all tests were
considered significant.
RESULTS: The mean BMI value of obese children was 29.37±5.08 kg/m2 whereas mean BMI of controls was 26.66±7.84 kg/m2 (p<0.05). The mean SBP (115.9±13.2 mmHg) and also the mean DBP (70.6±10.1 mmHg) values of the obese group were significantly higher from the control group values (respectively 110.8±8.8 and 65.7±7.8 mmHg). LVDd, IVSd, LVM, LVM/height2.7, SV, IVRT, EF and FS values of the obese group were significantly higher than the values of control group. It was revealed that these parameters were higher in the subgroup with IR alone and the subgroup with HT&IR, when compared to the control group. There was no significant difference between the values of E, A, and E/A of the control and the obese groups On the other hand, both IVRT and MPI values of right and left ventricle were significantly higher in children with obesity than controls. No differences of MPI values of the left ventricle were
noted between obese subgroups. Finally, it was found out that the significant difference between obese and control groups for
the MPI values of right ventricle was originated from obese subgroups with IR alone and with HT&IR.
DISCUSSION AND CONCLUSION: HT and/or IR accompanying to obesity could worsen the present cardiac dysfunction. We suggest that the measurement of MPI and IVRT values in children with obesity, as it used in many other diseases, can reveal the cardiac dysfunction at the early stages, and should be considered as a useful and valuable parameters.

5.Assessment of Procalcitonin as Diagnostic Marker in Children with Neutropenic Fever
Nilüfer Eldes Hacıfazlıoğlu, Aynur Oğuz, Ceyda Karadeniz, Caglar Elvan Çıtak
doi: 10.16948/zktb.71019  Pages 57 - 62
INTRODUCTION: The aim of this study is to predict the usefulness of procalcitonin (PCT) for diagnosis of systemic and bacterial infections in children with neutropenic fever.
METHODS: In this study 46 neutropenic fever attacks of the 32 cancer patients were evaluated. Newly diagnosed 35 cancer patients were selected as controls. Serum levels of PCT and CRP (C- reactive protein) were determined on the first and third days of fever and at the end of the antimicrobial therapy in study group. Neutropenic fever episodes were classified as fever of unknown origin (FUO), microbiologically and clinically documented infection (MDI, CDI). MDI were further subdivided into two groups as systemic and localized infection.
RESULTS: Serum levels of PCT were highest on the first day of neutropenic fever in MDI group. The levels of PCT were higher in systemic infections than localized ones. There was no difference for the serum levels of CRP in FUO, CDI and MDI or systemic and localized infections. The PCT levels rapidly decreased to the normal range by resolution of fever with successful antimicrobial therapy.
DISCUSSION AND CONCLUSION: We conclude that serial measurement of serum PCT levels is more sensitive and specific than that of CRP for diagnosis and sequential assessment of febrile neutropenic episodes.

CASE REPORT
6.A Rare Cause of Drug-Resistant Epilepsy and Nonconvulsive Status Epilepticus: Ring Chromosome 20
Olcay Ünver, Serap Uysal
doi: 10.16948/zktb.42866  Pages 63 - 65
Ring chromosome 20 presents as a drug-resistant epilepsy syndrome with complex partial seizures and nonconvulsive status epilepticus. Other characteristics are mild to moderate learning disability, and various dysmorphic features. Its diagnosis necessitates a high index of suspicion since the incidence is rare and there is no a specific phenotypic expression.

7.A Neonate with A Giant Cavernous Hemangioma in the Axilla
Gökmen Kurt, Dolunay Alver, Ceyhan Şahin, Ayşenur Cerrah Celayir
doi: 10.16948/zktb.01165  Pages 66 - 68
Hemangiomas are benign proliferative lesions of the blood vessels. The hemangiomas may be present in different locations such as skin, abdomen or intracranial. They may accompany syndromes as Kasabach-Meritt and Klippel-Trenaunay-Weber. The aim of this study is to emphasize the importance of early surgical intervention during the early postnatal period in order to prevent the late complications of giant hemangiomas.

ORIGINAL RESEARCH
8.Comparison of Outcomes of KOH/IUI and IVF Treatment in Advanced Age Infertile Women
Selçuk Selçuk, Evrim Bostancı, Mehmet Küçükbaş, Bülent Emre Bilgiç, Hüseyin Tayfun Kutlu, Belgin Devranoğlu, Semra Kayataş Eser
doi: 10.16948/zktb.33976  Pages 68 - 70
INTRODUCTION: The aim of the study was to compare the outcomes of patients > 38 years of age who underwent COH/IUI and those who underwent IVF treatment.
METHODS: 113 patients who meet the inclusion criteria were enrolled into the study. Of the 113 patients; 42 patients who underwent KOH/IUI and 71
patients who underwent IVF treatment. The biochemical, clinical and ongoing pregnancy rates were compared between two groups.
RESULTS: There were significant differences in terms of biochemical and clinical pregnancy rates between two groups and those were higher in IVF treatment (p1=0.033, p2=0.031). Ongoing pregnancy rate was higher in IVF treatment group but there was no significant difference between two groups (p=0.084).
DISCUSSION AND CONCLUSION: IVF treatment may be first line treatment option in advanced age women because of the higher success rates of IVF treatment than COH/IUI treatment.

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