Aort Koarktasyonu Tanısıyla Cerrahi Düzeltme Uygulanan Hastalarda Rekoarktasyon Gelişimi Üzerine Etki Eden Faktörler

Amaç: Çalışmamızda, aort koarktasyonu (AK) tanısıyla opere edilmiş hastalarda rekoarktasyon gelişimi üzerine etki eden faktörler araştırılmış ve elde edilen sonuçlar ışığında, rekoarktasyon oranlarının azaltılmasına katkıda bulunulması hedeflenmiştir. Gereç ve Yöntem: Bu retrospektif çalşmaya, Hacettepe Üniversitesi Tıp Fakültesi Kalp ve Damar Cerrahisi Kliniği’nde 1977-2010 arasında AK tanısıyla cerrahi düzeltme yapılan 358 hastadan, verilerine tam olarak ulaşılabilen ve düzenli olarak takiplerine gelmiş olan 217 hasta dahil edildi. Rekoarktasyon gelişen olgularda cerrahi düzeltme esnasındaki yaş, vücut ağırlığı ve kullanılan cerrahi tekniklerin sonuçları karşılaştırıldı. Veriler istatistiksel olarak değerlendirildi. Kategorik değişkenler için tanımlayıcı istatistikler sayı (n) ve yüzde (%) olarak belirtildi. Sonuçlar ortalama±standart sapma ve/veya yüzde (frekans) cinsinden sunuldu. Alfa anlamlılık değeri <0,05 olarak kabul edildi. Bulgular: Hastaların 147’si (%67,7) erkek, 70’i (%32,3) kadındı. Doksan (%41,4) hasta basit koarktasyon, 127 (%58,6) hasta ise koarktasyon ve eşlik eden kompleks intrakardiyak anomaliler tanıları ile opere edildi. Otuz altı hastada (%16,5) rekoarktasyon tespit edildi. Rekoarktasyon tespit edilen 36 hastadan 21’i (%58,3) balon anjiyoplasti, 10’u (%27,7) cerrahi, 5’i stent implantasyonu (%13,8) ile tedavi edildi. Sonuç: Çalışmamızda vücut ağırlığı <3 kg ve yaşı <1 yaş olan hasta grubunda rekoarktasyon gelişimi istatistiksel olarak anlamlı bulunmuştur. Kullanılan cerrahi teknikler arasındaysa istatistiksel bir anlam tespit edilmemiştir. AK nedeni ile opere edilecek hasta gruplarında vücut ağırlığı <3 kg ve yaşı <1 yaş olan hasta gruplarının post operatif takiplerinde rekoarktasyon gelişimi açısından daha dikkatli olunması gerekmektedir

Bilateral Serous Macular Detachment After Attempted Suicide with Pregabalin

A 24-year-old female presented with bilateral vision loss following attempted suicide with pregabalin. Her best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/50 in the left eye. The bilateral visual disturbance was associated with serous macular detachment. Fundus examination of both eyes showed foveal serous retinal detachment, which was confirmed by optical coherence tomography. Topical nepafenac 0.1% eye drops were started as single drop every 8 hours for 4 weeks. One month later, the serous macular detachment had regressed and BCVA increased to 20/20 in both eyes. To the best of our knowledge, this is the first reported case of bilateral serous macular detachment presumably caused by pregabalin intoxication

Çocuklarda ve Genç Erişkinlerde Subaksiller Sağ Torakotomi Yaklaşımıyla (Bikini İnsizyonu) Minimal İnvaziv Atriyal Septal Defekt Onarımı

Aim: The minimally invasive techniques in the treatment of congenital heart diseases have widely expanded recently both in terms of cosmetic results and patient comfort. In this report, we aimed to present our results of patients with the diagnosis of atrial septal defect and associated intracardiac pathologies who were operated through subaxillary mini thoracotomy.Materials and Methods: Seven patients who underwent subaxillary mini thoracotomy out of 53 patients with atrial septal defect that were operated with minimally invasive techniques in our clinic between 2009 and 2020 were identified. Six of the patients (85%) were girls and one was a boy (15%) and the mean age at operation was 8. 1 15.8 years.Results: Three patients had secundum atrial septal defect with a deficient septal rim; two patients had primum atrial septal defect, mitral cleft and mild mitral regurgitation and two patients had atrial septal defect, partial pulmonary venous return of the right pulmonary veins. All of the intracardiac pathologies were treated through right subaxillary mini thoracotomy. The mean cardiopulmonary bypass times and aortic cross clamp times were 71.5 19.2 and 44.4 22.1 minutes, respectively. Our patients were uneventfully discharged in 5.2 0.4 days. We did not encounter and morbidity or mortality in a mean follow up period of 4.4 3.1 years.Conclusion: The postoperative wound healing is faster and wound related complications are less frequently seen in patients undergoing cardiac surgery performed with minimally invasive techniques. The selection of subaxillary thoracotomy provides advantages both in terms of cosmetic aspects and breast development not being affected negatively

Nomogram for second trimester corpus callosum measurements: are nomograms reliable?

Objective: To define normal values of second trimester fetal corpus callosum (CC) length and width in a low-risk population and to compare the presented nomograms to those in the literature. Methods: The prenatal records of singleton fetuses who underwent second trimester anomaly screening at 18.0–22.0 weeks of pregnancy were retrospectively analyzed for CC width and length. A total of 710 fetuses, whose anomaly scans were completely normal, were included in the study. The correlations between CC and biparietal diameter (BPD), head circumference (HC) and gestational age (GA) were evaluated. Results: At 18.0–22.0 weeks of pregnancy, the mean CC length was 19.7±2.8 mm, while the mean CC thickness was 1.98±0.4 mm. In assessment of the correlations between the CC length and thickness values and the HC, BPD and GA values by Pearson’s correlation coefficient, there was a stronger correlation between the CC length measurements and the BPD, HC and GA values (r=0.233 vs r=0.505, p<0.001). Conclusion: Assessment of the presence of corpus callosum as well as its length and thickness during routine fetal anomaly evaluation may be important owing to the relationship between corpus callosum measurements and certain neurological disorders. Studies indicate that populations should create their own nomograms due to different values reported in the literature

Does maternal serum progesterone level in early pregnancy predict placental dysfunction in third trimester?

Objective Progesterone, which is necessary for maintenance of pregnancy, is secreted by corpus luteum until 10 weeks of gestation, and is produced from the placenta afterwards. Aim of this study is to investigate the relationship of serum progesterone concentrations measured in 6–8 weeks and 12 weeks of gestation with the parameters that may demonstrate placental dysfunction in the third trimester. Methods Relationship of the progesterone values measured at 6–8 weeks and 12 weeks of gestation with indicators of placental dysfunction, including hypertensive disorders of pregnancy, intrauterine growth restriction, preterm delivery and low birth weight, were evaluated. Furthermore, based on a previous study, two groups with progesterone levels below and above 11 ng/mL in early pregnancy were formed, and the difference between these groups regarding gestational outcomes were investigated. Results Progesterone concentrations at 6–8 and 12 weeks of gestation were not significantly different between the subgroups with and without gestational complications indicating placental dysfunction (p>0.05 for all parameters). As for the two groups, significant difference was not found in terms of third trimester complications due to progesterone cut-off of 11 ng/mL at 6-8 weeks of gestation. Conclusion In this study, we did not find progesterone values measured at early and late first trimester periods to be associated with placental dysfunction in the third trimester. Also, we did not validate a previously suggested threshold value to predict gestational outcome. Therefore, routine first trimester progesterone screening in guiding pregnancy follow-up may not be appropriate

Reappraisal of the relationship between 24-hour proteinuria and preeclampsia in terms of the maternal and perinatal outcomes

Objective This study evaluated the association between proteinuria levels and maternal, and perinatal outcomes of preeclampsia patients and determined the cutoff values for predicting severe complications. Methods We retrospectively evaluated the records of 412 patients with proteinuric preeclampsia. Results Median proteinuria levels were significantly higher in patients with severe maternal and adverse perinatal outcomes than in those without such outcomes, except in cases of placental abruption and late preterm delivery. Conclusion Proteinuria levels may aid in diagnosing preeclampsia and indicating early intervention. The revised guidelines do not suggest that proteinuria encountered during pregnancy is clinically insignificant