Impact of Postdilation on Intervention Success and Long-Term Major Adverse Cardiovascular Events (MACE) among Patients with Acute Coronary Syndromes

Postdilation is frequently used during coronary interventions to prevent stent malapposition. Currently there are contradictory findings regarding the benefits of postdilation for both intraprocedural and long-term outcomes. We evaluated the impact of postdilation among patients who presented with acute coronary syndromes (ACS) and underwent percutaneous coronary interventions (PCI). A total of 258 consecutive patients who presented with ACS and underwent PCI were included in the study. The patients were followed up for 25±1.7 months for the occurrence of major adverse cardiovascular events (MACE). During follow-up, 65 patients (25.2%) had MACE. Among patients without MACE, intracoronary nitrate infusion was less frequently used (P=0.005), myocardial blush grade was higher (P<0.001), and a drug-eluting stent was more frequently used (P=0.005). No significant differences were noted between groups regarding the predilation, recurrent dilation, postdilation, and other angiographic characteristics. In multivariate analysis, female sex (P=0.047), myocardial blush grade (P=0.038), previous coronary artery disease (P=0.030), and peak troponin level (P=0.002) were found to be predictors of MACE. In patients who were treated with PCI for ACS, performing postdilation did not predict final Thrombolysis in Myocardial Infarction (TIMI) flow grade, corrected TIMI frame count, myocardial blush grade, or MACE

A New Approach to Surgical Gowns

Emerging diseases such as Ebola hemorrhagic fever, hepatitis B, hepatitis C, SARS, and most recently the Covid 19 epidemic have increased the importance of hygiene in the world, bringing the need for personal protective equipment (PPE) to the forefront. An important part of PPE in healthcare is surgical gowns, which are worn by doctors and nurses in the operating room to serve a dual function of preventing the transmission of microorganisms and body fluids from surgical staff to patients and from patients to staff. This chapter presents the history and importance of surgical gowns. The factors to be considered in the selection of surgical gowns are discussed. The model characteristics and fabric properties of surgical gowns currently on the market and the environmental impact of reusable and disposable gowns are outlined. Finally, shortcomings in available gowns are discussed, a new knitted surgical gown design is introduced, and recommendations are given in the final section. The chapter provides broad coverage of surgical gowns for both experienced readers and those new to the field

Evaluation of patients with fibrotic interstitial lung disease: Preliminary results from the Turk-UIP study

OBJECTIVE: Differential diagnosis of idiopathic pulmonary fibrosis (IPF) is important among fibrotic interstitial lung diseases (ILD). This study aimed to evaluate the rate of IPF in patients with fibrotic ILD and to determine the clinical-laboratory features of patients with and without IPF that would provide the differential diagnosis of IPF. MATERIAL AND METHODS: The study included the patients with the usual interstitial pneumonia (UIP) pattern or possible UIP pattern on thorax high-resolution computed tomography, and/or UIP pattern, probable UIP or possible UIP pattern at lung biopsy according to the 2011 ATS/ERSARS/ALAT guidelines. Demographics and clinical and radiological data of the patients were recorded. All data recorded by researchers was evaluated by radiology and the clinical decision board. RESULTS: A total of 336 patients (253 men, 83 women, age 65.8 +/- 9.0 years) were evaluated. Of the patients with sufficient data for diag-nosis (n=300), the diagnosis was IPF in 121 (40.3%), unclassified idiopathic interstitial pneumonia in 50 (16.7%), combined pulmonary fibrosis and emphysema (CPFE) in 40 (13.3%), and lung involvement of connective tissue disease (CTD) in 16 (5.3%). When 29 patients with definite IPF features were added to the patients with CPFE, the total number of IPF patients reached 150 (50%). Rate of male sex (p<0.001), smoking history (p<0.001), and the presence of clubbing (p=0.001) were significantly high in patients with IPE None of the women <50 years and none of the men <50 years of age without a smoking history were diagnosed with IPE Presence of at least 1 of the symptoms suggestive of CTD, erythrocyte sedimentation rate (ESR), and antinuclear antibody (FANA) positivity rates were significantly higher in the non-IPF group (p<0.001, p=0.029, p=0.009, respectively). CONCLUSION: The rate of IPF among patients with fibrotic ILD was 50%. In the differential diagnosis of IPF, sex, smoking habits, and the presence of clubbing are important. The presence of symptoms related to CTD, ESR elevation, and EANA positivity reduce the likelihood of IPF

Malign plevral effüzyonların tedavisinde plörodez

ÖZET Aralık 1991 ile Temmuz 1995 yılları arasında, malign plevral effüzyon tanısı ile kliniğimize yatan ve sistemik tedaviye uygun olmayan ya da yarar görmeyen ve beklenen yaşam süresi bir aydan fazla olan 50 olguda; intraplevral Corynebacterium parvum ve nitrogen mustard uygulamalarının etkinlikleri karşılaştırılmıştır. Olguların 29'una 14 mg Corynebacterium parvum, 2 Vine 20 mg nitrogen mustard verilmiştir. Beşi dışında tüm olgulara toraks tüpü eşliğinde kapalı su altı drenajı uygulanmış, günde 150 ml'den az sıvı drene edilmeye başlandığında sklerozan ajanlar plevra boşluğuna enjekte edilmiştir. Beş olguda tekrarlanan torasentezlerle sıvı boşaltılmış ve aynı doz Corynebacterium parvum intraplevral uygulanmıştır. 22 olguda devam etmekte olan sistemik kemoterapi programı sürdürülmüştür. Corynebacterium parvum uygulanan 29 olgunun 27sinde (%93.1) tam (22) ya da kısmi (5); nitrogen mustard uygulanan 21 olgunun 1 Tinde (%52.3) tam (7) ya da kısmi (4) yanıt alınmıştır (p0.01). Her iki grupta da plörodez sonrası sistemik kemoterapi alan ya da almayan olguların yanıt oranları arasında istatistiksel olarak anlamlı bir fark saptanmamıştır (p>0.05). Corynebacterium parvum uygulanan olgularda en sık saptanan yan etki göğüs ağrısı olurken, diğer grupta bulantı- kusma olmuştur. Her iki ilacın da tolere edilebilir düzeyde yan etkilere sahip olduğu gözlenmiştir. 2

Malign plevral efüzyonlarda intraplevral bleomisin tedavisi

Treatment of Malignant Pleural Effusions with Intrapleural Bleomycin Between January 1997 and March 1999, intrapleural bleomycin (1U/kg) was administered to 35 patients with malignant pleural effusions. Patients who were not appropriate to receive systemic chemotherapy or did not benefit from the treatment and whose life expectancy was a month or more were eligible for this study. Seventeen patients were female and 18 were male. Mean age was 57.6±15.9. Tube thoracostomy was performed to 25 patients, and the rest 10 were treated with repeated thoracocentesis. Seven patients continued receiving systemic chemotherapy due to primary tumor response. Response was evaluated one month later. Total response rate was 75% (complete response 37.5%). No statistical difference was observed between the patients who received systemic chemotherapy after pleurodesis and the ones who did not receive any chemotherapy (85.7%, 72%, p >0.05). the most common side effects were tolerable pleuritic pain and fever.Ocak 1997-Mart 1999 tarihleri arasında Ege Üniversitesi Tıp Fakültesi Göğüs Hastalıkları Anabilim Dalı'na başvuran, histolojik olarak malign plörezi tanısı almış ve beklenen yaşam süresi 1 aydan fazla olan 35 hasta çalışmaya alınmıştır. Hastalara intraplevral olarak 1U/kg bleomisin verilerek bu uygulamanın etkinliği ve buna etki eden faktörler araştırılmıştır. Hastaların 17'si kadın 18'i erkek olup, yaş ortalaması 57.6±15.9 olarak hesaplanmıştır. Yirmi beş hastada toraks dreni, on hastada ise torasentez ile sıvı tamamen boşaltılıp bleomisin uygulanmıştır. Yedi olguda, ek olarak, devam etmekte olan kemoterapi programı sürdürülmüştür. Birinci ayda tam yanıt veren 9 kişi, kısmi yanıt veren 15 kişi olmak üzere toplam 24 kişide (%75) yanıt sağlanmıştır. Plöredez sonrası kemoterapi alanlarla, sadece plöredez uygulananlar arasında yanıt açısından istatistiksel farklılık saptanmamıştır (%85.7, %72, p >0.05). En sık saptanan yan etkinin ise tolere edilebilir düzeyde göğüs ağrısı olduğu gözlenmiştir

Effectiveness of gemcitabine as second-line chemotherapy in non-small cell lung cancer

The role of a second-line chemotherapy after an initial treatment with a platinum-based regimen remains largely undefined. In this retrospective clinical effectiveness study, gemcitabine as monotherapy was evaluated in the second-line chemotherapy in 34 non-small cell lung cancer (NSCLC) cases that had been previously received chemotherapy and did not respond to the treatment or presented with relapses. Gemcitabine was given intravenous at a dose of 1250 mg/m2 on days one, eight every three weeks. Median age was 50 years and squamous cell carcinoma was the most common malignancy (44.1%). No patient had a complete response, 7 (20.6%) patients had a partial response. The median survival was 29 weeks. The 1-year survival probability was estimated at 26.5%. Median time to disease progression was 13 weeks. Gemcitabine was well tolerated in this patient population. Among totally 119 chemotherapy cycles, we observed grade 3 and 4 toxicities only in 2.5% of cycles. As a result of the study, single agent gemcitabine is found to be tolerable and to have moderate effectiveness in the second-line chemotherapy in NSCLC. It should be placed among treatment options.Küçük hücreli dışı akciğer kanseri (KHDAK)’nde platin bazlı kemoterapiden sonra kullanılan ikinci basamak kemoterapiyle ilgili belirsizlikler devam etmektedir. Bu retrospektif çalışmada daha önce kemoterapi alan ve yanıt alınamayan veya daha sonra nükseden KHDAK’lı 34 hastada ikinci basamak kemoterapi için kullanılan tek ajan gemsitabinin etkisi değerlendirilmiştir. Gemsitabin, üç haftada bir, birinci ve sekizinci günlerde ve 1250 mg/m2 dozunda intravenöz olarak kullanılmıştır. Median yaşın 50 olduğu ve en çok skuamöz hücreli karsinom (%44.1) tipinin görüldüğü belirlenmiştir. Yanıt oranları değerlendirildiğinde tam yanıtın hiçbir hastada olmadığı, yedi hastada (%20.6) kısmi yanıtın elde edildiği ve median sağkalımın 29 hafta olduğu saptanmıştır. Bir yıllık sağkalım olasılığının %26.5, progresyona kadar geçen median sürenin ise 13 hafta olduğu belirlenmiştir. Uygulanan toplam 119 kemoterapi siklusu içerisinde grade III ve IV toksisitenin siklusların sadece %2.5’inde ortaya çıktığı ve bu hasta grubunda gemsitabinin iyi tolere edildiği görülmüştür. Çalışmanın tüm sonuçları değerlendirildiğinde KHDAK’nin ikinci basamak kemoterapisinde tek ajan olarak gemsitabinin orta derecede etkili olduğu, iyi tolere edildiği ve tedavi seçenekleri arasında düşünülebileceği sonucuna varılmıştır