Minimal invasive surgical approach with standard laparoscopic ınstruments for type I liver hydatid cyst patients

Hayvancılığın yaygın olduğu coğrafyalarda sık görülen ve Echinococcus granulosus’un etken olduğu hidatik kistinde antiparaziter ilaçlar kullanılsa da, en etkili tedavi minimal perkütan girişimlerden açık cerrahiye kadar uzanan invazif yaklaşımlardır. Çalışmamızda tip 1 karaciğer kist hidatik hastalarında standart laparoskopik el aletleriyle uygulanan minimal invazif cerrahinin etkinliğini araştırdık. Kliniğimizde 2013-2014 arasında on tane tip I (CE 1 – pür kistik) karaciğer kist hidatik hastasına uyguladığımız laparoskopik cerrahi girişimin verileri, literatür bilgileri ışığında değerlendirildi. Hastaların 5’i kadın 5’i erkekti. Hastaların ortalama yaşı 44 idi. Ortalama kist çapı 82.6 mm idi. Kistlerin en sık yerleşim yeri segment 2-3 idi. On hastanın sadece birinde indirekt hemaglitunasyon testi pozitif bulundu. Tüm hastalarda tanı histopatolojik olarak doğrulandı. Hastaların tamamına standart laparoskopik el aletleri kullanılarak laparoskopik unroofing+total kistektomi+drenaj uygulandı. Ortalama ameliyat süresi 95 dakika, hastaların ortanca yatış süresi 4 (2-18) gün, ortalama takip süreleri 13 aydı. Poliklinikten takip edilen hastalarda nüks saptanmadı. Günümüzde deneyimli merkezlerde seçilmiş hastalarda laparoskopik cerrahi girişimler karaciğer kist hidatik hastalığının tedavisinde etkin ve güvenli bir alternatif olarak tedavi algoritmasında yerini almaktadır ve düşük komplikasyon oranlarıyla uygulanabilmektedir. Özellikle pür kistik ekinokokkozların cerrahisinde özelleşmiş laparoskopik aletlere gerek olmadığını düşünmekteyizDespite antiparasite-drug-regimen, most effective treatment modality in hydatid disease – that is common in the husbandry regions and caused by Echinococcus granulosus – is still invasive in a spectrum of percutaneous techniques to major surgery. We evaluated the efficacy of minimal invasive surgery with standart laparoscopy instruments for type I hydatid cyst patients. Data of patients between 2013-2014 undergone laparoscopic surgery for liver type I (pure cystic) hydatid cyst were evaluated and discussed with literature data. There were 5 male, 5 female patients. Mean age was 44. Mean diameter of cysts was 82.6 mm. Most common locations for cysts in liver were segments 2 and 3. Only one patient had positive indirect hemagglutination test result. All diagnosis confirmed by histopathology. All patients had undergone laparoscopic procedure of unroofing+total cystectomy+drainage performed with standart instruments. Mean operative duration was 95 minutes. Median hospital stay value was 4 (2-18) days. Mean follow-up period was 13 months; no recurrence during follow-up. Laparoscopy take place as an effective and safe alternative in treatment algorythm of hydatid disease and can be performed with low rate of complications. We suggest that special laparoscopic instruments aren’t necessary for pure cystic echinococcosis’ surgery

Protez kalp kapak trombozu olan hastalarda trombolitik tedavininhemen sonrasında endotel fonksiyonlarında gözlenen iyileşme

Objective: Prosthetic valve thrombosis (PVT) is a serious complication among patients with prosthetic heart valves. Thrombolytic therapy (TT) is now widely used as first-line treatment for PVT. Endothelial dysfunction has previously been reported in patients with PVT. The aim of this study was to investigate the changes in endothelial function soon after TT in PVT patients.Methods: The study group included 85 patients with PVT [female: 53 (62.3%); age: 48.7 +/- 13.9 years] who were evaluated prospectively before and shortly after TT. All of the patients were evaluated using transthoracic and transesophageal echocardiography. TT was administered in all cases with a low-dose, ultra-slow infusion regimen. Endothelial function was evaluated using a noninvasive measurement of flow-mediated dilatation (FMD) of the brachial artery during reactive hyperemia.Results: The study population included 38 (44.7%) obstructive and 47 (55.3%) non-obstructive PVT patients. The obstructive PVT patients had lower baseline FMD values than the non-obstructive PVT group (5.31 +/- 0.76% vs. 5.87 +/- 0.84%; p=0.003). TT was successful in 79 patients (92.9%). FMD was significantly increased in the successfully thrombolyzed patients after TT (5.65 +/- 0.86% vs. 7.13 +/- 1.26%; p<0.001). There was no significant difference in the FMD values after TT in patients who were unresponsive to TT (5.07 +/- 0.61% vs. 5.38 +/- 0.95%; p=0.371). There was a significant increase in FMD values after TT in patients with obstructive PVT (5.31 +/- 0.76% vs. 8.22 +/- 1.15%; p<0.001). However, this difference was not statistically significant for patients with non-obstructive PVT (5.87 +/- 0.84% vs. 6.11 +/- 0.95%; p=0.276).Conclusion: This study demonstrated that successful TT may contribute to improvement of impaired endothelial function in patients with obstructive PVT.Amaç: Protez kapak trombozu (PKT) gelişimi protez kalpkapaklı hastalarda ciddi bir komplikasyondur. Son zamanlarda trombolitik tedavi (TT) PKT tedavisinde ilk tercih olarakyaygın olarak kullanılmaktadır. Daha önceki çalışmalarda PKThastalarında endotel disfonksiyonunun varlığı bildirilmiştir.Bu çalışmada, PKT hastalarında TT sonrasında endotelfonksiyonlarında olan değişiklikleri araştırmayı amaçladık.Yöntemler: Bu çalışmaya TT öncesi ve sonrası prospektifolarak takip edilen 85 PKT hastası [kadın: 53 (%62,3), ortalama yaş: 48,7±13,9 yıl] dahil edildi. Tüm hastalar transtorasik ve transözofajiyal ekokardiyografi ile değerlendirildi. Tümhastalarda düşük doz ultra yavaş infüzyon rejimine göre TTuygulandı. Endotel fonksiyonları reaktif hipereminin nedenolduğu akım aracılı genişleme (Flow Mediated Dilation, FMD)ölçülmesi ile değerlendirildi.Bulgular: Çalışmaya 38 (%44,7) tıkayıcı ve 47 (%55,3)tıkayıcı olmayan PKT hastası alındı. Tıkayıcı PKT hastalarıtıkayıcı olmayan PKT hastalarına göre daha düşük bazal FMDdeğerlerine sahiplerdi (%5,31±0,76 ve %5,87±0,84; p=0,003).TT 79 (%92,9) PKT hastasında başarılı idi. Ortama FMDdeğerleri başarılı TT grubunda TT sonrasında anlamlı olarakyükseldi (%5,65±0,86 ve %7,13±1,26; p<0,001). BaşarısızTT grubunda TT sonrası FMD değerlerinde anlamlı değişiklikizlenmedi (%5,07±0,61 ve %5,38±0,95; p=0,371). TıkayıcıPKT olan hastalarda TT sonrasında FMD değerleri anlamlıolarak yükseldi (%5,31±0,76 ve %8,22±1,15; p<0,001).Fakat, tıkayıcı olmayan PKT hastalarında TT sonrası FMDdeğerlerinde anlamlı değişiklik izlenmedi (%5,87±0,84 ve%6,11±0,95; p=0,276).Sonuç: Bu çalışmada, tıkayıcı PKT hastalarında başarılıTT’nin bozulan endotel fonksiyonlarının düzelmesine katkısunabildiği gösterilmiştir

Inter-arm blood pressure difference is associated with contrast-induced nephropathy in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention

Objective Contrast-induced nephropathy (CIN) is a serious complication in patients with ST segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (p-PCI). An interarm systolic blood pressure difference (IASBD) ≥10 mmHg has been identified as an independent risk factor for cardiovascular disease and mortality. The aim of this study was to evaluate the predictive value of the IASBD for the risk of CIN in patients with STEMI who underwent p-PCI. Method We prospectively investigated 2120 consecutive patients who were hospitalized with a diagnosis of STEMI and underwent p-PCI. A relative increase in serum creatinine levels of ≥ 25% or an absolute increase of ≥ 0.5 mg/dL from baseline within 72 h of contrast exposure was defined as CIN. The IASBD was calculated on admission to the emergency department. The risk of CIN was evaluated. Results The incidence of CIN was 6.6% (n = 139). The patients were divided into 2 groups based on the development of CIN. Age (p = .001), baseline creatinine levels (p < .001), DM (p < .001), HT (p < .001) and anemia (p = .001) were higher in patients with CIN. An IASBD ≥10 mmHg was noted in 13 (9.3%) patients in the CIN group and 83 (4.1%) (p = .001) in the non-CIN group (Table 1). According to the multivariate analysis, the IASBD was found to be a predictor of CIN development (OR: 2.36, 95% CI: 1.42–3.90, p: 0.001). Conclusion The IASBD on admission can be a potential predictor of CIN development in patients with STEMI who underwent p-PCI

Comparison of the INR Values Measured by CoaguChek XS Coagulometer and Conventional Laboratory Methods in Patients on VKA Therapy

Background: Warfarin, which is a widely used oral anticoagulant, has a narrow therapeutic window and requires regular international normalized ratio (INR) monitoring to maintain optimal anticoagulation. Recently, several portable coagulometers have been developed to measure INR levels

The usefulness of morphology‐voltage‐P wave duration ECG score for predicting early left atrial dysfunction in hypertensive patients

Objective Left atrial (LA) function is an important predictor of adverse cardiovascular outcomes in patients with hypertension (HT). Therefore, recognition of subtle LA dysfunction in the early stages of HT is essential for controlling modifiable variables. Several electrocardiographic and echocardiographic parameters have been studied to show early LA dysfunction. The goal of this study was to investigate the relationship between newly defined morphology‐voltage‐P wave duration electrocardiography (MVP ECG) score and early LA dysfunction in hypertensive patients. Materials and methods Eighty-nine hypertensive patients were included in this study. Based on speckle tracking echocardiography results, the patients were divided into two groups: 67 patients with normal LA function were included in Group 1, and 22 patients with abnormal LA function in Group 2. Results Age, diabetes mellitus history, duration of HT history, left ventricular mass index, E/Em, and MVP ECG score values were statistically significant between the two groups. Based on the results of the multivariate logistic regression test, duration of HT history, E/Em, and MVP ECG score were determined as independent predictive parameters for early LA dysfunction in hypertensive patients. Conclusion In conclusion, MVP ECG score assessment could be a novel approach to detect early LA dysfunction in hypertensive patients