Brachiobasilic versus brachiocephalic arteriovenous fistula: A prospective randomized study

BackgroundThe most recent Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend that the order of preference for arteriovenous fistula (AVF) placement is the radial-cephalic primary AVF, followed by the secondary brachiocephalic (BC) and, if either of these is not viable, then brachiobasilic (BB) AVF should be fashioned. However, there is limited prospective data comparing technical and clinical outcomes of these two approaches. The purpose of our study was to compare outcome, patency, and complication rates in these two autogenous upper arm AV accesses.MethodsBetween December 2003 and and January 2007, patients (61 male, 39 female) who have lost more distal AVFs were enrolled in the study. After preoperative duplex mapping, patients with patent both basilic and cephalic veins greater than 3 mm of diameter were randomized into BCAVF and BBAVF groups, each group consisting of 50 patients. All procedures were performed under local anesthesia as one-stage procedures. Follow-up data were prospectively collected. Kaplan-Meier analysis was used to calculate primary and secondary patency rates. Univariate and multivariate Cox-regression analysis was used to find risks for the occurrence of thrombosis.ResultsBaseline demographics, clinical characteristics, and preoperative history dialysis access were comparable between groups with the exception of the fact that mean caliber of the basilic veins were larger (4.51 ± 0.93 mm vs 3.90 ± 0.1 mm; P = .002). The mean duration of operation was significantly shorter in the BC group compared with the BB group (P < .001). There was no significant difference in the thirty day mortality, wound complications, 24 hour thrombosis, postoperative hemorrhage, maturation, and time to maturation between the groups. Mean follow-up was 43.2 ± 1.8 months. Primary patency at 1 and 3 years of follow-up was 87% and 81% for the BC group and 86% and 73% for the BB group (P = .7) Secondary patency at one and three year follow-up was 87% and 70% for the BC group and 88% and 71% for the BB group, respectively (P = .8). Twenty-eight patients (28%) in the BC (18 patients) and BB (10 patients) group died with a patent fistula during the follow-up period (P = .18). Multivariate analysis revealed that use of dominant arm increased the risk of fistula failure.ConclusionWe conclude that brachiobasilic and brachiocephalic AVF are equally effective alternatives; however, a longer and demanding operation with BB AVF construction should be considered

RELATIVE EFFICIENCY ANALYSIS OF BLACK SEA CONTAINER TERMINALS

Dünyada yük taşımacılığı en fazla denizyolu ile yapılmaktadır. Denizyolu taşımacılığı içerisinde konteyner taşımacılığının oranı sürekli artış göstermektedir. Diğer denizyolu taşımacılık sistemlerinde olduğu gibi konteyner taşımacılığında da limanlar arasında yoğun bir rekabet vardır. Bu nedenle limanların bu yoğun rekabet ortamında faaliyet gösterebilmeleri için, yapılan işin doğası gereği sadece ulusal değil uluslararası standartlarda iş yapabilmeleri ve uluslararası geçerliliği olan performans göstergelerine sahip olmaları gereklidir. Bu çalışmada; Karadeniz çevresinde konteyner taşımacılığına hizmet veren ve TRACECA programı çerçevesinde Karadeniz'de faaliyet gösteren 5 ülke (Türkiye, Gürcistan, Ukrayna, BulgaristanveRomanya) ve program dışında bulunan Rusya'ya ait toplam 9 konteyner terminali (Novorossisk, Odesa, Varna, Burgaz, Batum, Poti, Ilyichevsk, Köstenceve Trabzon) 2011 yıl göreceli etkinlikleri parametrik olmayan Veri Zarflama Analizi (VZA) uygulaması ile belirlenmiştir. VZA sonuçlarına göre, incelenen terminaller içerisinde Poti ve Novorossisk konteyner terminali göreceli etkin durumdadır. Diğer yandan, en düşük göreceli etkinliğe sahip olan terminal ise Burgaz konteyner terminalidir Most of the world's freight transportation is made by maritime transportation. The proportion of container transportation within maritime transportation shows a constant increase. As it is the case for other maritime transportation systems, also in container transportation there is an intense competition among ports. For that matter, it is essential for the ports to have the internationally acceptable minimum performance indicators and to be capable of performing not only at national, but also at international standards by the nature of the work done, in order to continue operation under such intense competition conditions. In this study, the year performance, 2011 of nine container terminals (Novorossiysk, Odessa, Varna, Burgas, Batumi, Poti, Ilyichevsk, Constanta and Trabzon) belonging to a total of six countries with coastlines to the Black Sea, which is the largest inland sea, as five countries from the TRACECA (Transport Corridor Europe-Caucasus-Asia) program (Turkey, Georgia, Ukraine, Bulgaria and Romania) and Russia out of the program, have been determined through the application of data envelopment analysis (DEA), as a non-parametric method. According to the results of the study, it has been determined that the Poti and Novorossiysk container terminals have been the efficient terminals. On the other hand, Burgas container terminal has been found out to be the terminal with the lowest performance

A case report of death of an adolascent with pectus carinatum (pigeon breast) deformity due to lighter gas (butane

The usage of lighter gas (butane) and similar volatile substances is an important, common and possibly fatal public health problem among young people. A significant proportion of sudden deaths due to volatile substance usage has been reported to be caused by its cardiotoxic effect. Pectus Carinatum; is the deformity of the front chest wall that protrudes forward. While it is mildly prominent at birth, it usually increases with ages (11-15 years). It was aimed to share a case of a 17-year-old male with pigeon breast deformity with literature that his autopsy and toxicological examination showed cause of death as lighter gas inhalation. [Med-Science 2018; 7(2.000): 428-30

Inflammatory mediators in the diagnosis and treatment of acute pancreatitis: pentraxin-3, procalcitonin and myeloperoxidase

Introduction: Acute pancreatitis (AP) is the third most common gastrointestinal disease at hospital admission. The etiology and pathogenesis of this disease are not completely clear. Our study was intended to determine the systemic levels of pentraxin-3 (PTX-3), myeloperoxidase (MPO), procalcitonin (PCT), and C-reactive protein (CRP) as prognostic parameters in early stages of AP. We also determined the effects of treatment on PTX-3, MPO, PCT and CRP levels in AP

Inflammatory mediators in the diagnosis and treatment of acute pancreatitis: pentraxin-3, procalcitonin and myeloperoxidase

Introduction: Acute pancreatitis (AP) is the third most common gastrointestinal disease at hospital admission. The etiology and pathogenesis of this disease are not completely clear. Our study was intended to determine the systemic levels of pentraxin-3 (PTX-3), myeloperoxidase (MPO), procalcitonin (PCT), and C-reactive protein (CRP) as prognostic parameters in early stages of AP. We also determined the effects of treatment on PTX-3, MPO, PCT and CRP levels in AP

Shear wave elastography findings in Immunoglobulin A Nephropathy patients: is it more specific and sensitive for interstitial fibrosis or interstitial fibrosis/tubular atrophy?

Background:Prediction of prognosis in Immunoglobulin A Nephropathy (IgAN) and taking appropriate precautions may reduce annual incidence of chronic kidney disease. This may be possible by close follow-up for the development and progression of interstitial fibrosis (IF) or interstitial fibrosis/tubular atrophy (IFTA) in IgAN patients. Aim:To investigate whether Young's elastic modulus (YM) which measured shear wave elastography (SWE) might be used for follow-up of IF or IFTA in IgAN patients. Methods:Prospective study was approved by Human Research Ethics Committee. Group 1 consisted of patients with IgAN. Group 2 consisted of healthy control participants. Young's elastic modulus which is a value of stiffness along with longitudinal stiffness was used to evaluate tissue elasticity. Specificity, sensitivity, positive predictive value (PPV) of YM for the presence of IF and IFTA were evaluated. Results:Group 1 consisted of 30 participants, and group 2 consisted of 32 participants. Sensitivity and specificity of SWE to diagnose presence of IF for YM > 15 kPa were 89% and 90%, respectively. PPV among the ones whom IF was diagnosed by YM >15 kPa was 91%. Sensitivity and specificity of SWE to diagnose presence of IFTA for YM > 15 were 65% and 51%, respectively. PPV among the ones whom IFTA was diagnosed by YM >15 kPa was 78.1%. Conclusions:YM which measured SWE is highly specific and sensitive in the diagnosis of IF, but not for IFTA in IgAN patients. Therefore, progression for IF in IgAN may be followed by SWE

Evaluation of the Serum Visfatin and Adiponectin Levels Related with the Activity of Juvenile Idiopathic Arthritis

Objective: This study aimed to investigate the possible relationship of serum adiponectin and visfatin levels that are derived from the adipose tissue in patients with juvenile idiopathic arthritis (JIA), in accordance with the routinely used biochemical parameters, to evaluate the management of therapy and assessment of disease activity