Is Placing Prophylactic Dural Tenting Sutures a Dogma?

Objective In this study, we investigated if and when dural tenting sutures are necessary during craniotomy. Methods Results from 437 patients aged 18 to 91 years (average, 43.5 years) who underwent supratentorial craniotomy between 2014 and 2019 were evaluated. The patients were categorized into 1 of 3 groups, patients who had at least 3 prophylactic dural tenting sutures placed before opening of the dura (group 1), at least 3 dural tenting sutures placed after surgery was completed, during closure (group 2), or no dural tenting sutures (group 3 [control]). All such sutures in groups 1 and 2 were placed in the circumference of the craniotomy and dural junction. No central dural tenting sutures were placed in any of the patients. Results Among the 437 patients, 344 underwent surgery for the first time and 93 were undergoing a second surgery. Cranial computed tomography imaging was performed for each patient 1 hour, 3 days, and 1 month after surgery. In group 1, 3 patients had a cerebral cortex contusion and 2 patients had acute subdural hematoma after the sutures were placed. In groups 2 and 3, none of the patients had a cerebral cortex contusion or acute subdural hematoma. Fewer complications were observed when dural tenting sutures were placed during postsurgical closure. Conclusion Placing dural tenting sutures is an important technique for ensuring hemostasis. However, when not needed, they seem to cause inadvertent complications. As our results suggest, knowing when and where to use them is equally important

Alkol dışı yağlı karaciğer hastalığında metabolik sendromla ilişkili parametreler ve steatoz-steatohepatit ayrımındaki değerleri

Bu tezin, veri tabanı üzerinden yayınlanma izni bulunmamaktadır. Yayınlanma izni olmayan tezlerin basılı kopyalarına Üniversite kütüphaneniz aracılığıyla (TÜBESS üzerinden) erişebilirsiniz.ABSTRACT The term 'non-alcoholic fatty liver disease' (NAFLD) is used to describe a wide spectrum of fatty liver changes ranging from steatosis on one side to non-alcoholic steatohepatitis (NASH) on the other. Liver steatosis is a benign, non-progressive condition, in contrast to NASH which is a frequent liver disease that develops in close association with insulin resistance (IR) and may progress to cirrhosis. These two entities are clinically and radiologically indistinquishable and, at present, there is no sensitive non invasive test to differentiate them. Clinical characteristics associated with NAFLD include obesity, hyperlipidemia, diabetes mellitus, and hypertension, all of which have been associated with underlying insulin resistance. IR commonly is associated with NASH. To establish whether IR causes NASH, this study was undertaken to determine metabolic syndrome parameters among fatty liver patients and association between severity of IR and liver histology. The homeostasis model of insulin resistance (HOMA-IR ) was used as a measure of IR. Biopsy proven twenty-eight NASH patients and twenty-six simple liver steatosis patients had been evaluated for diabetes mellitus, body mass index, hypertension, lipid profile, HOMA-IR, carotid artery intima media thickness (CAIMT) and plasma C- reactive protein, fibrinogen, uric acid, and homocystein levels. There was no statistical significant difference among two population in terms of serum inflammation parameters, BMI, DM, age, gender, hypertension, CAIMT and lipid picture.Among the parameters only HOMA-IR (6.6±5.9'a 3.6±2.5; p=0.02) and plasma homocystein (13.0±3.6'ya 19.8±9.7 umol/L; p=0.002)levels were significant. For these parameters ROC analysis was performed.In order to differentiate steatohepatitis from steatosis the level of HOMA-IR (>4.5 ) has 84 % sensitivity and 59% specifity. Homocystein level that exceeds 14 umol/L has 71.4% specifity and 64% sensitivity. Liver biopsy still the only test that can differentiate steatohepatitis from benign steatosis. Insulin resistance is more severe and prevelant among the patients with steatohepatitis than steatosis. In these population medication that ameliorates insulin resistance, such as thiazoledinediones and life style modification, such as weight loss will prevent liver and cardiovascular complicationes. Keywords: Non-alcoholic fatty liver disease, metabolic syndrome, HOMA-IR, carotid artery intima- media thickness, homocysteine.ÖZET Alkol Dışı Yağlı Karaciğer Hastalığı (ADYKH) terimi karaciğerin basit steatozundan steatohepatitine kadar giden geniş yelpazedeki yağlanmasının genel tanımlamasıdır. Basit steatoz iyi seyirli, ilerlemeyen bir durum iken steatohepatit yaygın, insülin rezistansı ile yakın ilişkili ve ilerde siroza kadar gidebilen ciddi bir tablodur. Bu iki klinik durumu şu an için ayırabilen invaziv olmayan herhangi bir metod yoktur. Bilinen radyolojik ya da klinik parametreler bu noktada yetersiz kalmaktadır. ADYKH, altında insülin rezistansının yattığı obezite, hiperlipidemi, diyabet ve hipertansiyon ile yakın ilişkilidir. Yağlı karaciğer hastalığı populasyonunda, bahsedilen metabolik sendrom parametrelerini incelemek ve insülin rezistansı ile karaciğer histolojisi arasındaki ilişkiyi ortaya koymak amacı ile biopsi ispatlı 28 NASH, 26 steatoz lu bireyde bu çalışma tasarlandı. Hastalarda yaş, cinsiyet, diyabet varlığı, karotis arter intima media kalınlığı (CAMT), insülin rezistansı için HOMA-IR, lipid tablosu, beden kitle indeksi (BMI), plazma inflamasyon göstergelerinden C-reaktif protein, fibrinojen ve ürik asid, plazma homosistein seviyesi parametreleri incelendi. Steatohepatitli ve steatozlu hastalar arasında anlamlı istatistiksel fark sadece HOMA-IR (6.6±5.9'a 3.6±2.5; p=0.02) ve plazma homosistein (13.0±3.6'ya 19.8±9.7 umol/L; p=0.002) düzeyleri arasında saptandı. Çeşitli sınır değerleri içinde 4.5 umol/L nin steatohepatiti ayırtetmedeki duyarlılığı %84, özgüllüğü %59 bulundu. Homosistein düzeyleri için sınır değer >14 olarak alındığında steatoz ve steatohepatiti ayırtettirmedeki özgüllüğü %71.4, duyarlılığı %64 olarak saptanmıştır. Alkol dışı steatoz ve steatohepatit arasında metabolik sendromun çeşitli parametreleri arasından sadece plazma homosistein ve HOMA-IR testleri bakımından fark saptanmıştır. Bu testlerin iki durumu birbirinden ayırmadaki Özgüllüğü ve duyarlılığı yeterli değildir. İki hastalığı ayırtetmek için karaciğer biyopsisi dışmda bir yöntem geçerli değildir. Steatohepatitli hastalarda atheroskleroz için de artan riske neden olan insülin direnci daha fazla bulunmuştur. Bu hastalan hem karaciğer komplikasyonlarından, hem de diğer komplikasyonlardan korumak için insülin direncini azaltan, kilo verme ve medikal tedaviler yönünden ciddi olarak ele almak gerekmektedir

A comparative histological study on early thyroid gland development in Acipenser stellatus and A. gueldenstaedtii larvae in hatchery

The thyroid is an endocrine gland, with an important role in fish growth, development and adaptation of larvae. The aim of this study was to describe the development of the thyroid gland and to determine the initial functional activity of thyroid gland and hormones in Acipenser gueldenstaedtii and A. stellatus larvae using immunohistochemistry. For this aim, fertilized eggs of two species were reared in a hatchery and larval samples were collected daily for 20 days post hatching (dph). For immunostaining, rabbit polyclonal primary antibodies for thyroglobulin and mouse monoclonal antibodies for thyroid transcription factor-1 (TTF-1) were used. In histological analyses, it was observed that the first development of the thyroid gland in stellate sturgeon larvae occurs on the 3-4 dph and on the 4-5 dph in Russian sturgeon larvae in the ventral pharyngeal region of the fish. In the immunostaining analyses of 12-day-old stellate larvae and 19-day-old Russian sturgeon larvae, the thyroid follicles showed dispersion in great numbers around the aorta, and also it was observed that they were stained positively with antithyroglobulin staining, but the same sections gave negative results with TTF-1 staining. Also melanomacrophage centres, which are generally found in the haemopoietic tissues in some cases, were first observed around the thyroid follicles of sturgeon larvae. The results of this study revealed a similarity in the early thyroid gland development between two sturgeon species but using immunostaining methods, it was described that A. stellatus shows a faster functional development and earlier hormone production than A. gueldenstaedtii

Late effects of cutaneous 3-methylcholanthrene exposure on DNA damage-related pleiotropic growth factors and oxidative stress markers in mice

WOS: 000530579900002PubMed: 32356428BACKGROUND: Skin is the body's first defence against direct exposure to variety of chemicals. Polycyclic aromatic hydrocarbons such as 3-methylcholanthrene (3-MC) are common in polluted urban air and have a potential of producing harmful effects. Moreover, their late effects can occur months or years after exposure. OBJECTIVES: We aimed to investigate the long-term effects of 3-MC induced dermal toxicity on the expression of markers of apoptosis, pleiotropic cytokines, and oxidative stress and to determine the protective effect of cisplatin. METHODS: Groups were designed as control (group 1), 3-MC applied (group 2) and 3-MC+cisplatin applied mice (group 3). Cutaneous expressions of TGF beta, PDGFA, PDGFC, bFGF, PDGFR alpha, USP28, and Ki67 were evaluated with qPCR. Total oxidant (TOS), total antioxidant (TAS) and oxidative stress index (OSI) values were determined in liver and kidney tissues. RESULTS: The expression levels of TGF beta, PDGFR alpha, USP-28, Ki67, and PDGFA were decreased significantly in MC applied groups. Renal TAS levels were significantly lower in group-3. Liver and kidney OSI values were increased in both groups 2 and 3. CONCLUSION: The results indicated that low dose 3-MC caused oxidative stress and downregulated apoptotic and cytokine markers in the long term and cisplatin had no ameliorative effects on this degeneration processes (Tab. 3, Fig. 3, Ref. 32).Scientific Research Projects Coordination Unit of Kirikkale UniversityKirikkale University [2019/030]This study was supported by The Scientific Research Projects Coordination Unit of Kirikkale University (Project code: 2019/030)

Künt göğüs travması sonrası gelişen nefes darlığı ve karaciğer enzim yüksekliği

Son zamanlarda giderek artan taşıt kullanımı, Acil Servislere gelen araç içi trafik kazalarında artışı da beraberinde getirmiştir. Sıklıkla karşılaşılan delici olmayan göğüs yaralanmalarında akılda tutulması gereken bir diğer organ da kalptir. Özellikle bu hastalarda korda tendinea, papiller kas veya doğrudan kalp kası yırtılmaları ani ve hayatı tehdit edici acil durumlar yaratabilir. Ani gelişen ve/veya izlemde aniden kötüleşen kalp yetmezliği kliniklerinde, yeni saptanan karaciğer enzim testlerindeki yüksekliklerde ve kardiyak dinleme bulguları anormalliklerinde, öyküde delici olmayan göğüs yaralanması varsa, korda tendinea yırtılmaları ve kapak yetmezlik durumları akla gelmelidirRecently, an increased vehicle use, resulted in icreased in-vehicle traffic accidents at emergency departments. Heart is the another organ that should be kept in mind in frequently encountered blunt chest traumas. Chorda tendinea and papillary muscle ruptures even including myocardium may be life threatening emergent condition. Chorda ruptures and cardiac valve regurgitations should be kept in mind in patients with worsening heart failure symptoms, cardiac auscultatory abnormalities and elevated liver enzymes, who injured at in-vehicle acciden

Factors affecting the survival in renal transplantations

Ege Üniversitesi Tıp Fakültesi, İç Hastalıkları Anabilim Dalı, Nefroloji Bilim DalıBöbrek nakli, son dönem böbrek yetmezliği tedavisinde hem sağkalım avantajı hem de yaşam kalitesinde yaptığı artışlar nedeniyle tercih edilen böbrek yerine koyma tedavisidir. Nakil sonrası yaşam süresini etkileyen alıcıya ait, donöre ait ve uygulanan tedaviye ait birçok faktör bulunmaktadır. Bu faktörlerden bazıları donörün yaşı, adayın yaşı, eşlik eden hastalıkların varlığı ve derecesi, adayın ırkı, cinsiyeti ve nakil sonrası bağışıklık yitimi seviyesidir. Bu yazıda nakil sonrası sağkalımı etkileyen faktörler, yapılan çalışmaların sonuçları dahilinde incelenmiştirRenal transplantation is the preferred renal replacement therapy due to both the advantage of survival and the increased quality of life in the treatment of end-stage renal failure. There are many factors related to the recipient, donor, and applied therapy that affect the posttransplant life expectancy. Some of these factors are donor age, recipient age, the presence and level of comorbid diseases, the race, sex, and the level of posttransplant immunosuppression. In this review, we examined the factors affecting the survival after transplantation within the results of the studies don