Right Coronary Artery Originating from the Left: Do Not Miss the Diagnosis!

Objective. Left circumflex (LCx) artery originating from the right coronary arterial (RCA) system has been reported as the most common form of anomalous origination of a coronary artery from the opposite sinus (ACAOS). However, some studies claim that RCA originating from the left coronary sinus (LCS) is the most frequent form. The aim of this study was to determine the most common type of ACAOS in a single center. Materials and Methods. The database of the catheterization laboratory was retrospectively searched. All patients who were performed coronary angiography between 1999 and 2006 were included to registry. All examinations were carefully analyzed to determine the most frequent type of ACAOS. Results. We detected ACAOS in 35 cases (16 RCA originating from the LCS, 13 LCx from the RCS or the RCA, and 6 others) out of 5165 coronary angiograms. The most common form was RCA originating from LCS. Moreover, we revealed that 5 cases with RCA originating from the LCS were previously misdiagnosed and not reported as a coronary anomaly. Conclusions. RCA originating from the LCS was the most common form of ACAOS in our registry. The high change of misdiagnosis or underreporting of this anomaly could have biased the true prevalence

Infectious Agents And Antibiotic Susceptibility Isolated from CSF Samples of The Patients With Prediagnosis of Nosocomial and Community-Acquired Meningitidis

AbstractIn our study we aimed to contribute survelliance data espesially to increase awareness on treatment plannig for nosocomial meningitis.Meterials and MethodsFor this we collected data about 15519 cerebro-spinal fluid (CSF) patients with nosocomial and community based meningitis suspicion during six years. After culturing bacterias identification and susceptibility test made automatised system and susceptibility state evaluated according to CLSI standards.ResultsFrom a total of 10632 samples, 53% of them was male and 47% was female. Only 7% growth was from this samples. 23% and 76% of samples were from children and adolescent, respectively. CSF samples from community mostly gave growth to coagulase-negative staphilococci (CNS) (58%) and S. aureus (20%), while nosocomially isolated agents were as CNS (60%) and Acinetobacter spp. (11.4%). Despite CNS, Enterobacter spp.-mostly Klebsiella and Enterococcus growth from CSF samples were mostly isolated agents in children, in adolescents this order was as CNS and Acinetobacter spp. Predominance among gram positive agents isolated from CSF samples were CNS and S. aureus with resistance patern to penisillin and methicillin as 96% and 97%, and %83 and 36%. Resistance rates of S. pneumonia isolates to penicillin and ceftriaxone were as 18% and 5%, respectively; however ampicillin, penicillin, vancomycin resistance in enterococci were %52, %63 and %6, respectively. Mostly isolated agents from all samples as gram negative were Acinetobacter species with susceptibility rates of 40% to amikacin and 58% to meropenem in general.ConclusionWe observed that distribution of menigitis causing microorganisms could be affected by presence of underlying factors

Antithrombotic effect of epigallocatechin gallate on the patency of arterial microvascular anastomoses

Background Microvascular anastomosis patency is adversely affected by local and systemic factors. Impaired intimal recovery and endothelial mechanisms promoting thrombus formation at the anastomotic site are common etiological factors of reduced anastomosis patency. Epigallocatechin gallate (EGCG) is a catechin derivative belonging to the flavonoid subgroup and is present in green tea (Camellia sinensis). This study investigated the effects of EGCG on the structure of vessel tips used in microvascular anastomoses and evaluated its effects on thrombus formation at an anastomotic site. Methods Thirty-six adult male Wistar albino rats were used in the study. The right femoral artery was cut and reanastomosed. The rats were divided into two groups (18 per group) and were systemically administered either EGCG or saline. Each group were then subdivided into three groups, each with six rats. Axial histological sections were taken from segments 1 cm proximal and 1 cm distal to the microvascular anastomosis site on days 5, 10, and 14. Results Thrombus formation was significantly different between the EGCG and control groups on day 5 (P=0.015) but not on days 10 or 14. The mean luminal diameter was significantly greater in the EGCG group on days 5 (P=0.002), 10 (P=0.026), and 14 (P=0.002). Intimal thickening was significantly higher on days 5 (P=0.041) and 10 (P=0.02). Conclusions EGCG showed vasodilatory effects and led to reduced early thrombus formation after microvascular repair. Similar studies on venous anastomoses and random or axial pedunculated skin flaps would also contribute valuable findings relevant to this topic

Suturing of the Arachnoid Membrane for Reconstruction of the Cisterna Magna: Technical Considerations

Background Postoperative cerebrospinal fluid (CSF) fistula following cranial or spinal surgery is associated with increased morbidity and mortality. To prevent CSF fistulas, various techniques have been described. Here, we describe the arachnoid membrane continuous-running suture technique in cisterna magna reconstruction for preventing postoperative CSF leakage. Methods After craniotomy and dural opening, the incision of the arachnoid of the cisterna magna was performed using a diamond blade. To prevent the arachnoid from drying out and shrinking during surgery, it was periodically irrigated with warm saline solution. Posterior fossa surgery was performed. When closing the membranes, the arachnoid membrane was closed with the running-suture technique. After the first surgical knot was made in the cranial end of the arachnoid opening, continuous suturing with a 2-mm distance between the stitches was performed without stretching them. After every 3 stitches, the free end of the thread was pulled gently along the suturing axis, and the edges of the arachnoid were closed. After the arachnoid edges were approximated, the surgical knot was tied. Watertight closure was checked by performing the Valsalva maneuver at the end of the surgery. Results No CSF leakages were observed after surgery. Conclusions Arachnoid membrane suturing seems to be safe and effective in preventing postoperative CSF leakage and CSF-related complications. Using continuous running suturing alone, without any sealant, might be effective in cases with untraumatized arachnoid membrane

Military jet pilots have higher p-wave dispersions compared to the transport aircraft aircrew

Objectives: For the purpose of flight safety military aircrew must be healthy. P-wave dispersion (PWD) is the p-wave length difference in an electrocardiographic (ECG) examination and represents the risk of developing atrial fibrillation. In the study we aimed at investigating PWD in healthy military aircrew who reported for periodical examinations. Material and Methods: Seventy-five asymptomatic military aircrew were enrolled in the study. All the subjects underwent physical, radiologic and biochemical examinations, and a 12-lead electrocardiography. P-wave dispersions were calculated. Results: The mean age of the study participants was 36.15±8.97 years and the mean p-wave duration was 100.8±12 ms in the whole group. Forty-seven subjects were non-pilot aircrew, and 28 were pilots. Thirteen study subjects were serving in jets, 49 in helicopters, and 13 were transport aircraft pilots. Thirty-six of the helicopter and 11 of the transport aircraft aircrew were non-pilot aircrew. P-wave dispersion was the lowest in the transport aircraft aircrew, and the highest in jet pilots. P-wave dispersions were similar in the pilots and non-pilot aircrew. Twenty-three study subjects were overweight, 19 had thyroiditis, 26 had hepatosteatosis, 4 had hyperbilirubinemia, 2 had hypertension, and 5 had hyperlipidemia. The PWD was significantly associated with thyroid-stimulating hormone (TSH) levels. Serum uric acid levels were associated with p-wave durations. Serum TSH levels were the most important predictor of PWD. Conclusions: When TSH levels were associated with PWD, uric acid levels were associated with p-wave duration in the military aircrew. The jet pilots had higher PWDs. These findings reveal that military jet pilots may have a higher risk of developing atrial fibrillation, and PWD should be recorded during periodical examinations

A swot analysis to raise awareness about cyber security and proper use of social media: Istanbul sample

Internet is a cyber-ambient where the number of users is increasing consistently as a result of wide opportunities those are provided and where access can be ensured with information technologies. Today, via internet and social media where the number of users reaches billions, the samples of committed cybercrimes and cyber-attacks are increasing throughout the world. For this reason, it is inevitable to raise awareness in the society about cyber security and social media use. Raising awareness also can be done by providing education for all sections of the society. It is aimed to bring the expert person who has knowledge and experiences to provide support about creating substructure of education about both cyber security and using social media, by considering potential of institution and organization, and these sharers hosted by Istanbul Provincial Directorate of National Education and it is aimed to make cooperations. In line with this aim, Cyber Security and Proper Use of Social Media Workshop was realized in Istanbul on 17-18 February 2018. In discussions made within the scope of the workshop, the participants made SWOT analyses on behalf of using social media properly and to raise awareness for cyber security. In that study, information will be given about these analyses performed for Istanbul province. Keywords: Cyber security; social media; awareness; swot analysi

Hypothyroidism, new nodule formation and increase in nodule size in patients who have undergone hemithyroidectomy

Introduction: The current medical literature has conflicting results about factors related to hypothyroidism and nodular recurrences during follow-up of hemithyroidectomized patients. We aimed to evaluate factors that may have a role in new nodule formation, hypothyroidism, increase in thyroid lobe and increase in nodule volumes in these patients with and without Hashimoto’s thyroiditis (HT), and with and without levothyroxine (LT4) use. Material and methods: We enrolled 140 patients from five different hospitals in Ankara and evaluated their thyroid tests, autoantibody titre results and ultrasonographic findings longitudinally between two visits with a minimum 6-month interval. Results: In patients with HT there was no significant difference between the two visits but in patients without HT, thyroid stimulating hormone (TSH) levels and nodule volume were higher, and free T4 levels were lower in the second visit. Similarly, in patients with LT4 treatment there was no difference in TSH, free T4 levels, or lobe or nodule size between the two visits, but the patients without LT4 had free T4 levels lower in the second visit. Regression analysis revealed a relationship between first visit TSH levels and hypothyroidism during follow-up. Conclusions: Patients who have undergone hemithyroidectomy without LT4 treatment and without HT diagnosis should be followed up more carefully for thyroid tests, new nodule formation and increase in nodule size. The TSH levels at the beginning of the follow-up may be helpful to estimate hypothyroidism in hemithyroidectomized patients