Superior mezenterik arter sendromunda cerrahi yaklaşım: Dört olgu sunumu

Background and Aims: Superior mesenteric artery syndrome is an uncommon but well-recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum against the aorta by the superior mesenteric artery, resulting in chronic, intermittent, or acute complete or partial duodenal obstruction. the treatment of this arteriomesenteric compression includes conservative measures and surgical intervention. the purpose of the present study was to evaluate our surgical management and outcomes of the patients with superior mesenteric artery syndrome. Materials and Methods: Between January 2000 and January 2006, the patients with superior mesenteric artery syndrome were retrospectively analyzed from the case records. Results: All four patients had a history of chronic abdominal pain, nausea, postprandial discomfort, vomiting, and weight loss. Diagnostic methods included barium esophagogastroduodenography, upper gastrointestinal endoscopy, and computed tomography. Medical management was administrated in all cases before surgery. of those, three underwent duodenojejunostomy and one underwent gastroenterostomy. Postoperative period was uneventful and mean day of hospital discharge was postoperative day 6. Conclusions: Because the main problem is the narrowing of the aortomesenteric angle in patients with superior mesenteric artery syndrome, conservative initial treatment usually results in surgical intervention. Diagnosis of the pathology is the first step of the treatment, and superior mesenteric artery syndrome should be considered in the differential diagnosis in patients with chronic upper abdominal pain. Duodenojejunostomy is the most frequently used procedure with a high success rate.Giriş ve Amaç: Duodenumun 2. veya 3. kısmının süperior mezenterik arter basısı nedeniyle kronik aralıklı, ya da akut total ya da parsiyel obstrüksiyonu sonucu olarak ortaya çıkan iyi tanımlanmış bir klinik tablo olmasına rağmen sık karşılaşılmayan bir durumdur. Bu arteriomezenterik kompresyonun tedavisinde medikal ve cerrahi tedavi modaliteleri yer almaktadır. Biz bu çalışmamızda süperior mezenterik arter sendromlu hastaların cerrahi tedavi yaklaşımlarını ve sonuçlarımızı değerlendirmeyi amaçladık. Gereç ve Yöntem: Ocak 2000 ve Ocak 2006 yılları arasında kliniğimizde süperior mezenterik arter tanılı hastalar retrospektif olarak tarandı. Bulgular: Süperior mezenterik arter sendromlu dört hastanın tümünde karın ağrısı, bulantı, yemeklerden sonra kusma, kilo kaybı şikayetleri mevcuttu. Tanıda özefagus pasaj grafisi, endoskopi, bilgisayarlı tomografi kullanı ldı. Tüm hastalar cerrahi tedavi öncesi medikal tedavi almıştı. Cerrahi tedavi olarak 3 hastaya duodenojejunostomi ve bir hastaya gastroenterostomi uygulandı. Postoperatif dönemde sorun gözlenmeyen hastalar ortalama postoperatif 6. gün taburcu edildi. Tartışma: Süperior mezenterik arter sendromu olgularında esas problem aortomezenterik çıkış açısındaki daralma olması nedeniyle tek başı- na konservatif tedavi genellikle yetersiz kalmaktadır. Tanı koyabilme bu tür hastalarda önemlidir ve karın ağrısı olgularında mutlaka düşünülmelidir. Bu olgularda duodenojejunostomi yüksek başarı oranına sahip cerrahi tedavi şeklini oluşturmaktadır

Weed Species and Their Impacts: Fruit Nursery Area Sample in Duzce

WOS: 000496182800010Weeds cause significant product and economic losses by causing direct (competitive elements such as plant nutrient, water, light, covering area) and / or indirect (host to diseases and pests) problems in crops areas. It can also cause environmental and socioeconomic impacts in different ways. In order to understand these impacts, this study was carried out between 2018-2019 in a fruit nursery field which is in the centre of Duzce province and produces certified seedlings. According to the results, 68 weed species (herbaceous / shrub) from 29 families were determined. The identified taxon were represented by Poaceae with 11 taxa and Asteraceae with 10 taxa, followed by Brassicaceae (6 taxa) and Fabaceae (5), respectively. While the majority of species are annual (34 species) and perennial (22), one taxa has biennial and 11 species have common life time. In terms of life form, 67 taxon are herbaceous and only one taxa (Rubus sp.) have shrub structure. The environmental and socioeconomic impacts caused by the identified species were evaluated as positive and negative impacts and the highest impact type was determined in 44 taxa which are included in the scope of environmental and socioeconomic impact. The results can be used to develop the necessary measures and control programs to reduce the negative impacts of weeds in nursery areas. In addition, it can provide awareness to preserve positive impacts and biodiversity

Stress evolution of Ge nanocrystals in dielectric matrices

Germanium nanocrystals (Ge NCs) embedded in single and multilayer silicon oxide and silicon nitride matrices have been synthesized using plasma enhanced chemical vapor deposition followed by conventional furnace annealing or rapid thermal processing in N-2 ambient. Compositions of the films were determined by Rutherford backscattering spectrometry and x-ray photoelectron spectroscopy. The formation of NCs under suitable process conditions was observed with high resolution transmission electron microscope micrographs and Raman spectroscopy. Stress measurements were done using Raman shifts of the Ge optical phonon line at 300.7 cm(-1). The effect of the embedding matrix and annealing methods on Ge NC formation were investigated. In addition to Ge NCs in single layer samples, the stress on Ge NCs in multilayer samples was also analyzed. Multilayers of Ge NCs in a silicon nitride matrix separated by dielectric buffer layers to control the size and density of NCs were fabricated. Multilayers consisted of SiNy:Ge ultrathin films sandwiched between either SiO2 or Si3N4 by the proper choice of buffer material. We demonstrated that it is possible to tune the stress state of Ge NCs from compressive to tensile, a desirable property for optoelectronic applications. We also observed that there is a correlation between the stress and the crystallization threshold in which the compressive stress enhances the crystallization, while the tensile stress suppresses the process

Stress evolution of Ge nanocrystals in dielectric matrices

Germanium nanocrystals (Ge NCs) embedded in single and multilayer silicon oxide and silicon nitride matrices have been synthesized using plasma enhanced chemical vapor deposition followed by conventional furnace annealing or rapid thermal processing in N-2 ambient. Compositions of the films were determined by Rutherford backscattering spectrometry and x-ray photoelectron spectroscopy. The formation of NCs under suitable process conditions was observed with high resolution transmission electron microscope micrographs and Raman spectroscopy. Stress measurements were done using Raman shifts of the Ge optical phonon line at 300.7 cm(-1). The effect of the embedding matrix and annealing methods on Ge NC formation were investigated. In addition to Ge NCs in single layer samples, the stress on Ge NCs in multilayer samples was also analyzed. Multilayers of Ge NCs in a silicon nitride matrix separated by dielectric buffer layers to control the size and density of NCs were fabricated. Multilayers consisted of SiNy:Ge ultrathin films sandwiched between either SiO2 or Si3N4 by the proper choice of buffer material. We demonstrated that it is possible to tune the stress state of Ge NCs from compressive to tensile, a desirable property for optoelectronic applications. We also observed that there is a correlation between the stress and the crystallization threshold in which the compressive stress enhances the crystallization, while the tensile stress suppresses the process

Peri-operative blood transfusion in elective major surgery: incidence, indications and outcome – an observational multicentre study

Background - Patients’ demographic and epidemiological characteristics,local variations in clinicians’ knowledge and experience and types of surgerycan influence peri-operative transfusion practices. Sharing data on transfusionpractices and recipients may improve patients’ care and implementation ofPatient Blood Management (PBM).Materials and methods - This was a multicentre, prospective, observational,cross-sectional study that included 61 centres. Clinical and transfusion dataof patients undergoing major elective surgery were collected; transfusionpredictors and patients’ outcomes were analysed.Results - Of 6,121 patients, 1,579 (25.8%) received a peri-operative transfusion.A total of 5,812 blood components were transfused: red blood cells (RBC),fresh-frozen plasma and platelets in 1,425 (23.3%), 762 (12.4%) and 88(1.4%) cases, respectively). Pre-operative anaemia was identified in 2,019(33%) patients. Half of the RBC units were used by patients in the age group45-69 years. Specific procedures with the highest RBC use were coronaryartery bypass grafting (16.9% of all units) and hip arthroplasty (14.9%).Low haemoglobin concentration was the most common indication forintra-operative RBC transfusion (57%) and plasma and platelet transfusionswere mostly initiated for acute bleeding (61.3% and 61.1%, respectively).The RBC transfusion rate in study centres varied from 2% to 72%. RBCtransfusion was inappropriate in 99% (n=150/151) of pre-operative, 23%(n=211/926) of intra-operative and 43% (n=308/716) of post-operative RBCtransfusion episodes. Pre-operative haemoglobin, increased blood loss, opensurgery and duration of surgery were the main independent predictors ofintra-operative RBC transfusion. Low pre-operative haemoglobinconcentration was independently associated with post-operative pulmonarycomplications.Conclusions - These findings identified areas for improvement inperi-operative transfusion practice and PBM implementation in Turkey.Keywords: Blood components, patient blood management, peri-operative, transfusion</p

Assessment of the results of a three-year program for National Standardization and Quality Improvement of Medical Laboratories on Drug of Abuse Testing by the Ministry of Health in Turkey

The aim of this study is to assess the results of inspections in the last three years of drug abuse testing in medical laboratories according to the latest regulations in Turkey. The on-site inspections of medical laboratories for drugs abuse testing performed in Alcohol and Drug Addiction Treatment Centers during 2014-2016 are described, and laboratory processes and performance evaluated. The performance of 35 laboratories in 2014, 62 laboratories in 2015, and 94 laboratories in 2016 were scored as the sum of the scores for all answers on the inspection form. An inspected laboratory was considered to have an unconformity if the total score was less than 2/3 of maximum score. The total scores of inspections and the number of laboratories with between years were compared using one-way analysis of variance and slope Chi-square for trend test, respectively. Total scores increased statistically significantly from 35.9 +/- 16.2 in 2014, to 43.5 +/- 16.3 in 2015 and 49.1 +/- 1.3 in 2016 (p < 0.001). The laboratories with unconformities decreased statistically significantly from 57% in 2014 to 37% in 2015 and 22% in 2016 (p < 0.001). The published legislation and the inspections contributed to national standardization and improved quality of service in medical laboratories for drug abuse testing

Consensus statement: Long-term results of ABI in children with complex inner ear malformations and decision making between CI and ABI

7th IEEE Asia-Pacific Conference on Applied Electromagnetics, APACE 2016 -- 11 December 2016 through 13 December 2016 -- 127632‘Second Consensus Meeting on Management of Complex Inner Ear Malformations: Long Term Results of ABI in Children and Decision Making Between CI and ABI’ took place on 5–6 April 2013 in Kyrenia, Northern Cyprus with the participation of 20 centers from 11 countries. These centers presented their auditory brainstem implantation (ABI) experience in children and infants and also provided the selection criteria and cochlear implant (CI) results in patients with an abnormal cochlea and nerve. In addition, Cochlear and Med El companies provided presentations regarding solutions to problems during revision surgery and future projections of device technology. According to the results from different centers, it was evident that an ABI is capable of providing hearing sensation in prelingually deafened children with complex inner ear malformations and diseases. It is possible to obtain a pure tone average with an ABI between 30 and 60 dB HL in most of these patients. It has been observed that the majority of children obtain Categories of Auditory Performance (CAP) scores around 5, but occasionally certain ABI users obtained scores of up to CAP 8-II, NEAP-Nottingham Early Assessment Package. The Ear Foundation 2009). CAP scores tend to increase with earlier implantation, i.e. under 2 years of age. However, after 3 years of use, it usually reaches a plateau. Children with additional disorders cannot reach CAP scores of children without disorders. However, they obtain an improvement of cognitive functions but duration of ABI use and increasing chronological age also play a role in this improvement