Validation of the EuroSCORE risk models in Turkish adult cardiac surgical population

Objective: The aim of this study was to validate additive and logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) models on Turkish adult cardiac surgical population. Methods: TurkoSCORE project involves a reliable web-based database to build up Turkish risk stratification models. Current patient population consisted of 9443 adult patients who underwent cardiac surgery between 2005 and 2010. However, the additive and logistic EuroSCORE models were applied to only 8018 patients whose EuroSCORE determinants were complete. Observed and predicted mortalities were compared for low-, medium-, and high-risk groups. Results: The mean patient age was 59.5 years (±12.1 years) at the time of surgery, and 28.6% were female. There were significant differences (all p< 0.001) in the prevalence of recent myocardial infarction (23.5% vs 9.7%), moderate left ventricular function (29.9% vs 25.6%), unstable angina (9.8% vs 8.0%), chronic pulmonary disease (13.4% vs 3.9%), active endocarditis (3.2% vs 1.1%), critical preoperative state (9.0% vs 4.1%), surgery on thoracic aorta (3.7% vs 2.4%), extracardiac arteriopathy (8.6% vs 11.3%), previous cardiac surgery (4.1% vs 7.3%), and other than isolated coronary artery bypass graft (CABG; 23.0% vs 36.4%) between Turkish and European cardiac surgical populations, respectively. For the entire cohort, actual hospital mortality was 1.96% (n = 157; 95% confidence interval (CI), 1.70-2.32). However, additive predicted mortality was 2.98% (p< 0.001 vs observed; 95%CI, 2.90-3.00), and logistic predicted mortality was 3.17% (p< 0.001 vs observed; 95%CI, 3.03-3.21). The predictive performance of EuroSCORE models for the entire cohort was fair with 0.757 (95%CI, 0.717-0.797) AUC value (area under the receiver operating characteristic, AUC) for additive EuroSCORE, and 0.760 (95%CI, 0.721-0.800) AUC value for logistic EuroSCORE. Observed hospital mortality for isolated CABG was 1.23% (n = 75; 95%CI, 0.95-1.51) while additive and logistic predicted mortalities were 2.87% (95%CI, 2.82-2.93) and 2.89% (95%CI, 2.80-2.98), respectively. AUC values for the isolated CABG subset were 0.768 (95%CI, 0.707-0.830) and 0.766 (95%CI, 0.705-0.828) for additive and logistic EuroSCORE models. Conclusion: The original EuroSCORE risk models overestimated mortality at all risk subgroups in Turkish population. Remodeling strategies for EuroSCORE or creation of a new model is warranted for future studies in Turkey. © 2011 European Association for Cardio-Thoracic Surgery

Good’s syndrome: An uncommon cause of therapy-resistant diarrhoea

Diarrhoea is a common symptom for which the aetiology will be straightforward in many cases. However, when a common aetiology is not found, the wide variety of other options can feel like finding a needle in a haystack. In this case report, we describe a patient who was referred to our centre with therapy-resistant, secretory diarrhoea, which was the presenting symptom of Good’s syndrome, a rare form of adult-onset immunodeficiency associated with thymoma. The conclusions from this case report give direction for ‘finding the needle’ and contribute to a focused approach to patients who present with therapy-resistant diarrhoea

Influence of isolation system characteristic strength on the earthquake behavior of base-isolated liquid storage tanks

346-352Earthquake performance of liquid storage tanks may be substantially improved by base-isolation. However, the possibility of facing large isolator displacements in case of large magnitude near-fault earthquakes threatens the safety of these structures, which may be realized if the period of the velocity pulses that typically exist in the near-fault earthquake records are close to their isolation periods. Increasing isolation system characteristic strength may help reducing the aforementioned large isolator displacements but this in turn may have a negative impact on the superstructure response. Therefore, this study aims to investigate the influence of the characteristic strength of the isolation system on the behavior of base-isolated liquid storage tanks under representative historical near-fault and far-fault earthquakes by making use of a set of benchmark tank models with different levels of isolation system characteristic strength ratios. Numerical modeling and non-linear time history analyses are carried out via the academic software 3DBASIS-ME,which offers the possibility of conducting such modeling and analysis following a highly preferred mechanical analog that is able to take the deformability of the tank wall and sloshing of the fluid into account by considering the fundamental sloshing and fundamental fluid-tank modes of vibration as single degree of freedom systems sharing a common isolation base-mat. The seismic responses including isolation system displacement, sloshing fluid displacement, isolation system shear force, fluid-tank shear force, and sloshing fluid shear force are reported in a comparative manner. Results show that while higher characteristic strength effectively reduces large base displacements observed under near-fault earthquakes, it may cause significant amplifications in the superstructure responses particularly under far-fault earthquakes

Behavior of base-isolated liquid storage tanks under synthetic near-fault earthquake pulses

Protection of liquid storage tanks from earthquake hazards is vital as damaging of these structures may result in significant economic losses. Base isolation has emerged as a successful alternative to classical earthquake resistant design of liquid storage tanks. However, near-fault earthquake records may include velocity pulses with long periods and large amplitudes that may cause large seismic responses since the isolation periods of base-isolated liquid storage tanks encompass a similar range with pulse periods of near-fault earthquakes. In order to assess the influence of near-fault earthquakes on the seismic response parameters, here, the behavior of a benchmark base-isolated liquid storage tank is evaluated under synthetically generated pulses which represent near-fault earthquakes of different magnitudes recorded at different fault-distances. Seismic response parameters including base and sloshing fluid displacements, isolation system shear, fluid-tank shear force, and fluid shear force are reported in a comparative manner

Isolated giant intrathoracic meningocele associated with vertebral corpus deformity

Published reports of intrathoracic meningocele with vertebral corpus defects in the absence of neurofibromatosis are very rare. We report a 9-year-old male with intrathoracic meningocele. We believe that vertebral corpus defects may play a certain role in the etiology of intrathoracic meningocele. © 2004 Elsevier B.V. All rights reserved