Mesenteric venous thrombosis due to protein c deficiency: report of four cases

AMAÇ: Akut mezenter iskemilerinin %5-15'ini mezenter ven trombozları oluşturur. Genellikle mezenter ven trombozu, hiperkoagulasyon bozuklukları ile iliskilidir ve bir hiperkogulasyon bozukluğu olan Protein C eksikliği, mezenter ven trombozu oluşumu için önemli bir risk faktörüdür. Bu çalışmada, protein C eksikliğine bağlı mezenter ven trombozu gelişen 4 olguyu inceledik. OLGULAR: Olgularımızın ikisi bayan, ikisi ise erkek olup, ortak hastaneye başvuru şikayetleri karın ağrısı idi. Fizik muayenede 3 olguda akut batın bulguları bulunduğundan laparotomi yapıldı. Nekroze barsak segmentlerine rezeksiyon yapıldıktan sonra hastalara jejunojejunal anastomoz (olgu 1), uç jejunostomi (olgu 2) ve çifte namlulu enterostomi (olgu 3) yapıldı. Intestinal nekroz bulgusu saptanmayan diğer olguda (olgu 4) mezenter ven trombozu tanısı, batın tomografisi ile konuldu. Bu olguya 5.000 Ü bolus ve 1.000 Ü/ saat olacak şekilde heparin infüzyonu 10 gün süre ile yapıldı. Olguların hiperkoagulabilite testleri yapıldığında protein C düzeyi sırası ile %42.20, %38.50 , %35.40 ve %29.25 seklinde düşük oldukları saptandı. Bütün hastalara düşük molekül ağırlıklı heparin verildikten sonra warfarin tedavisine geçildi. SONUÇ: Mezenter ven trombozu tanısı konulan hastalarda etiyolojik sebep mutlaka araştırılmalıdır. Protein C eksikliği mezenter ven trombozu gelişmesi için önemli bir risk faktörüdür. Intestinal nekroz gelisen hastalarda laparotomi yapılmalı ancak intestinal nekroz bulgusu olmayan hastalarda ise nonoperatif tedavi uygulanabilir.OBJECTIVE: Mesenteric venous thrombosis is seen in 5-15% of acute mesenteric ischemia patients. Mesenteric venous thrombosis is generally related to hypercoagulation disorders and proteinCdeficiency, which is a hypercoagulation disorder and one of the important risk factors for mesenteric venous thrombosis development. In this study, we investigated 4 cases of mesenteric venous thrombosis related to protein C deficiency. CASES: Cases included 2 male and 2 female patients and the main symptom was abdominal pain. The patients with physical examination findings of acute abdomen undergone emergency laparotomy. During operation, following resection of necrotic part of bowel; in Case 1, jejunojejunal anastomosis; in Case 2 end jejunostomy and in Case 3 double jejunocolic ostomy were performed. In one patient, mesenteric venous thrombosis was diagnosed by abdominal tomography without any finding of acute abdomen. This patient had 5000 U bolus and 10000 U/h heparin infusions for 10 days. Hypercoagubility tests' results for Protein C levels were as 42.20%, 38.50% , 35.40% and 29.25%, for Cases 1-4, respectively. All patients had low molecular heparin initially then continued with warfarin therapy. CONCLUSION: Etiology of mesenteric venous thrombosis must be investigated in patients diagnosed with mesenteric venous thrombosis. Protein C deficiency is one of the important risk factors of mesenteric venous thrombosis development. Laparotomy is necessary in patients with intestinal necrosis whereas patients without intestinal necrosis might be followed with nonoperative treatment

Photonic band gaps of the honeycomb photonic crystal fiber structure

In this study, full wave solutions are presented for a photonic crystal fiber structure with cylindrical air holes of circular cross-section in a honeycomb type periodic arrangement on silica substrate, and a low index core region obtained by introducing an extra air hole. Numerical results are presented for the variations of the band structure and modal fields which are obtained via plane wave end localized basis function expansion techniques, respectively

An investigation of the photonic crystal fiber structure with different air hole diameter.

In this study, full wave solutions are presented for a specific photonic crystal fiber (PCF) structure via the Localized Basis Function (LBF) method. The PCF structure consists of an unbounded periodic cladding and a high index core region. In the LBF method, a guided mode localized in the core region and the transverse refractive index of the PCF structure are decomposed by using Hennite-Gaussian basis functions and periodic functions. Numerical results are presented to demonstrate the variation of the modal fields in the PCF

Design of a blended learning environment: Considerations and implementation issues

This study identified critical issues in the design of a blended learning environment by examining basic design considerations and implementation issues. Following a design-based research approach with the phenomenological tradition of qualitative research, the study investigated instructor experiences relating to the design, development, and implementation processes of a blended course. The results reveal that the design considerations centred on the pedagogical approach, course organization, materials preparation, interactions, and the instructor's and students' roles. The affordances of the implementation included the arousal of the students' interest and participation, flexibility, time conservation, the ability to track student progress, and the improvement of interaction, collaboration, and communication opportunities. The challenges were increased workload, course and time management, overlaps, and the creation of harmony between the face-to-face and online environments. The overall results show that the critical issues involved context, the pedagogical framework, instructor competency, and technical issues in the blended course design

Preoperative Seroprevalence of HBsAg, Anti-HCV, Anti-HIV in general surgery patients

Objectives: Exposure to blood borne pathogens is the most serious occupational health risk faced by health-care workers. The aim of this study was to evaluate the preoperative seroprevalences of HBsAg, anti-HCV and anti-HIV.Materials and methods: In this study we evaluated the seroprevalence of HBsAg, anti-HCV and anti-HIV in 486 preoperative patients who admitted to Dicle University Medical Faculty General Surgery Clinic for elective sur-gical procedures between January 2007 and July 2007; retrospectively. The results were compared with those of 14354 blood donations during the same period as con-trol group.Results: The seroprevalence of HBsAg and anti-HCV were; %6.6 and %1.6 subsequently in preoperative pa-tients. HBsAg and anti-HCV seropositivity rates were lower in the control group. Thus, the positively rates of HBsAg and anti-HCV for preoperative patients should be assessed higher than the data obtained from the blood bank. Anti-HIV seropositivity was not detected in both patient and control group. Conclusion: All healthcare workers must be trained about occupational diseases and vaccinated against he-patitis B. Establishment of universal precautions is nec-essary and these precautions must be strictly followed particularly in the operating room. In addition all patients should be considered as potential carriers

Primer Hydatid Cyst In Paravertebral Muscle

Hydatid cysts may occur in any area of the body, but usually localize to the liver and the lungs. Primary localization in muscle isn’t common, accounting for 2-3 % of all sites. We presented a patient with hydatid cyst, diagnosed by ultrasonography and computed tomography, and the cyst was located in the paravertebral muscle of the patient. Surgical and medical treatment combination.The intact intramuscular cyst was completely excised. Postoperatively, the patient began receiving albendazol 400 mg twice daily, for 6 months. At two years postoperatively, a clinical and radiological examination yielded no evidence of recurrence