Effect of cigarette smoking on the washout time of sevoflurane anesthesia

<p>Abstract</p> <p>Background</p> <p>Cigarette smoking affects the pharmacodynamic and pharmacokinetic behavior of many drugs and causes deterioration of pulmonary mechanics. We have evaluated the effect of cigarette smoking on washout time after one minimum alveolar concentration-h (1 MAC-h) of sevoflurane anesthesia.</p> <p>Methods</p> <p>We investigated the washout time of sevoflurane in 30 non-smoking and 30 healthy cigarette smoking (≥20 cigarettes/day for>1 year) ASA I-II physical status patients, aged 18-63 years, who were candidates for otorhinolaryngologic elective surgery under 1MAC-h standardized sevoflurane anesthesia. At the end of the surgery, the sevoflurane vaporizer was turned off and the time taken for the sevoflurane concentration to decrease to MAC-awake (0.3) and 0.1 MAC levels were recorded. In addition, the ratio of the fractions of inspired concentration (Fi) and expired concentration of sevoflurane (Fexp) at 1 MAC and Fexp of sevoflurane at 0.1MAC were recorded. The patients were mechanically ventilated during the washout time.</p> <p>Results</p> <p>We found no difference between the 2 study groups with regard to washout time of sevoflurane. The times of 1MAC down to MAC-awake (106 ± 48 sec in non-smokers vs 97 ± 37 sec in smokers, <it>p </it>> 0.05) and down to 0.1MAC (491 ± 187 sec in non-smokers vs 409 ± 130 sec in smokers, <it>p </it>> 0.05) were similar. Similarly, there were no significant differences in the ratios of Fi/Fexp at 1MAC (1.18 in non-smokers vs. 1.19 in smokers, <it>p </it>> 0.05) and Fexp of sevoflurane at 0.1MAC (0.26 in non-smokers vs. 0.25 in smokers, <it>p </it>> 0.05).</p> <p>Conclusions</p> <p>Washout time of 1MAC-h sevoflurane anesthesia is not appear to be effected by cigarette smoking in patients without significant pulmonary disease.</p

Case of Primary Carcinosarcoma as an Extremely Rare Cancer of Gallbladder

Introduction: Gallbladder carcinosarcomas (GBCS) are a rare type of gallbladder malignancies. These tumors are characterized by interlaced epithelial and mesenchymal components.Presentation of Case: The experience with diagnosis and follow-up of these cancers is limited because of the number of patients diagnosed with this tumor is so small and the tumor has a poor prognosis. Therefore, we present the following case report to share our experience with a 13-month survival of a 55-year-old woman presenting with right flank pain and jaundice who underwent laparoscopic cholecystectomy with an initial diagnosis of chronic cholecystitis and later diagnosed with GBCS.Conclusion: GBCS have  poor survival rate even with successful surgical therapy due to unclear etiopathogenesis, extremely very low incidence, and lack of consensus regarding its follow-up and treatment

Comparison between 18F-FDG PET/CT and diffusion-weighted imaging in detection of invasive ductal breast carcinoma

Objective(s): Breast carcinoma is the most common type of cancer in females. This study aims to compare fluorine-18-fluorodeoxyglucose (18F-FDG) uptake pattern and apparent diffusion coefficient (ADC) value for the detection of the primary tumour and axillary metastases of invasive ductal breast carcinoma.Methods: This study included 40 breast carcinoma lesions taken from 39 patients. After staging by positron emission tomography-computed tomography (PET/CT) and diffusion-weighted magnetic resonance imaging (MRI), breast surgery with axillary lymph node dissection or sentinel lymph node biopsy was performed.Results: Primary lesion detection rate for PET/CT and diffusion-weighted MRI was high with 39 of 40 lesions (97.5%). The sensitivity and specificity for the detection of metastatic lymph nodes in axilla were 40.9%, 88.9%, with 18F-FDG PET/CT scans and 40.9%, 83.3%, for dw-MRI, respectively. No significant correlation was detected between ADC and SUVmax or SUVmax ratios. Estrogen receptor (p=0.007) and progesterone receptor (p=0.036) positive patients had lower ADC values. Tumour SUVmax was lower in T1 than T2 tumour size (p=0.027) and progesterone receptor-positive patients (p=0.029). Tumour/background SUVmax was lower in progesterone receptor-positive patients (p=0.004). Tumour/liver SUVmax was higher in grade III patients (p=0.035) and progesterone receptor negative status (p=0.043).Conclusions: This study confirmed the high detection rate of breast carcinoma in both modalities. They have same sensitivity for the detection of axillary lymph node metastases, whereas the PET/CT scan had higher specificity. Furthermore, ADC, SUVmax and SUVmax ratios showed some statistical significance among the patient groups according to different pathological parameters

Infection prevention and control practice for Crimean-Congo hemorrhagic fever - A multicenter cross-sectional survey in Eurasia

<div><p>Background</p><p>Crimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers.</p><p>Aim</p><p>Evaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia.</p><p>Methods</p><p>A cross-sectional CCHF IP&C survey was designed and distributed to CCHF centers in 10 endemic Eurasian countries in 2016.</p><p>Results</p><p>Twenty-three responses were received from centers in Turkey, Pakistan, Russia, Georgia, Kosovo, Bulgaria, Oman, Iran, India and Kazakhstan. All units had dedicated isolation rooms for CCHF, with cohorting of confirmed cases in 15/23 centers and cohorting of suspect and confirmed cases in 9/23 centers. There was adequate personal protective equipment (PPE) in 22/23 facilities, with 21/23 facilities reporting routine use of PPE for CCHF patients. Adequate staffing levels to provide care reported in 14/23 locations. All centers reported having a high risk CCHFV nosocomial exposure in last five years, with 5 centers reporting more than 5 exposures. Education was provided annually in most centers (13/23), with additional training requested in PPE use (11/23), PPE donning/doffing (12/23), environmental disinfection (12/23) and waste management (14/23).</p><p>Conclusions</p><p>Staff and patient safety must be improved and healthcare associated CCHF exposure and transmission eliminated. Improvements are recommended in isolation capacity in healthcare facilities, use of PPE and maintenance of adequate staffing levels. We recommend further audit of IP&C practice at individual units in endemic areas, as part of national quality assurance programs.</p></div

DİKKAT EKSİKLİĞİ HİPERAKTİVİTE BOZUKLUĞU TANISINA VARILAN OLGULARIN DSM-IV ÖLÇÜTLERİNE GÖRE BELİRTİ SIKLIĞI VE DAĞILIMI VE DİĞER YIKICI DAVRANIŞ BOZUKLARI İLE BİRLİKTELİĞİ

Araştırma DSM-IV ölçütlerine göre DEHB tanısı alan 60 çocuk ve anneleri üzerinde yürütülmüştür