Femoral arter embolisinin ilk semptom olduğu sol atrial miksoma: Olgu sunumu

Cardiac myxomas are the most common primary tumor of the heart and they cause systemic embolization if they are located in the left atrium. We report a young case of cardiac myxoma presenting as acute ischemia of limb due to embolic phenomena. In histological study, besides the thrombus, there were stellate and fusiform cells with hiperchromatic nuclei in a myxoid matrix. It was thought that it could be systemic embolization of a cardiac myxoma.Transthoracic two dimensinal cardiac echocardiography showed the primary cardiac tumor. The cardiac myxoma diagnosis was also confirmed in surgical specimen. Calretinin antibody was used in the differential diagnosis of cardiac myxoma and a myxoid thrombus. Left atrial myxoma should be suspected as a cause of systemic embolization in young patients without arrhythmia and atherosclerosis. Calretinin antibody is a useful marker in differential diagnosis of cardiac myxoma and myxoid thrombus.Kardiak miksomalar en sık görülen primer kalp tümörleridir ve sol atrial yerleşimli olduklarında sıklıkla sistemik emboliye neden olurlar. Sol bacakta emboliye bağlı akut iskemik değişikliklerle başvuran kardiak miksomalı genç bir olgu sunuldu. Embolinin histolojik incelemesinde, trombüs alanları yanısıra, miksoid zeminde iğsi, yer yer yıldızsı, hiperkromatik hücrelerin görülmesi nedeniyle kardiak miksomanın sistemik embolizasyonu olabileceği düşünüldü. Transtorasik iki boyutlu ekokardiyografide primer kardiak tümör tespit edildi. Cerrahi eksizyon materyalinde miksoma tanısı kanıtlandı. Ayrıca, immunhistokimyasal olarak, kardiak miksoma ile miksoid trombüs ayırıcı tanısının yapılmasında kalretinin antikoru kullanıldı. Embolizasyona zemin hazırlayacak aritmi ve aterosklerozu bulunmayan genç hastalarda periferik embolilerin nedeni olarak sol atrial miksomalardan şüphelenilmelidir. Ayrıca kardiak miksoma ve miksoid trombüs ayırıcı tanısında immunhistokimyasal olarak kalretinin antikoru önemli bir role sahiptir

The Effect of Cord Blood Bile Acid Levels on the Meconium Passage in Utero in Normal Pregnancies

OBJECTIVE: To investigate the effect of bile acids on meconium passage in utero in normal pregnancies. STUDY DESIGN: This prospective case control study was performed at Zekai Tahir Burak Women’s Health and Teaching Hospital between September 1, 2010 and January 1, 2011. Inclusion criteria were: singleton viable pregnancy, gestational age ≥37 weeks. Exclusion criteria were: presence of any maternal disease, obstetric cholestasis, hepatic infections and multiple pregnancies. Sixty one pregnant women were recruited for the study: 31 women with meconium stained amnion liquid and 30 women with normal amnion liquid. Demographic data and clinical data were collected. Each patient’s cord blood gases, cord blood bile acids levels, maternal serum liver function tests and bilirubin levels were investigated. RESULTS: There were no significant differences in maternal age, gestational age, parity and body mass index. We found no differences in the serum bilirubin levels and liver function tests. And there were also no differences in the cord blood gas values between the two groups. The mode of delivery was significantly different between the two groups. We didn’t find a statistically significant difference in cord blood bile acid levels between the two groups. CONCLUSION: Cord blood bile acid levels appeared to have no significant effect of meconium passage in normal pregnancies

Ahmet Yücel Çiftçi : bir kaçağın hikayesi

Ankara : İhsan Doğramacı Bilkent Üniversitesi İktisadi, İdari ve Sosyal Bilimler Fakültesi, Tarih Bölümü, 2014.This work is a student project of the The Department of History, Faculty of Economics, Administrative and Social Sciences, İhsan Doğramacı Bilkent University.by Ünsal, Mehmet Süha

Use of embolectomy with local anesthesia for anticoagulation failure in radial artery thrombosis

Objective: Although prevention of radial artery thrombosis and cardiac complications after interventions using radial access is well investigated, there is yet no clinical study that completely evaluated access-related complications. However, there is still no consensus on what exact treatment should be used in these patients. In clinical practice, analgesic, anticoagulant, and antiplatelet treatments usually improve symptoms in patients with pain; however, in some patients, complaints may persist and may not respond to these treatments. In these patients, low-risk embolectomy with a small skin incision may be beneficial. Methods: A total of 102 patients with radial artery thrombosis after cardiac catheterization were included in the study between 2016 March and 2018 December. After the patients’ initial evaluation, anticoagulation with enoxaparin or tinzaparin and antiplatelet therapy with acetylsalicylic acid and oral/local analgesic/anti-inflammatory and local anesthetic therapy were administered for 1 month. Patients whose symptoms resolved after medical treatment were followed up as outpatients. Embolectomy was performed in consenting patients who did not respond to the medical treatment. Results: Of 102 patients included in the study, 33 underwent embolectomy, whereas 69 received only medical treatment. None of the patients experienced any complications, morbidity, or mortality in the peroperative period and during the medical treatment. The pretreatment symptom scores of patients who actively use their hands in daily life and profession were significantly higher than the scores of patients who are relatively less active (P =.013). Pretreatment symptom scores were negatively correlated with age (r = −0.584); symptom scores increased significantly with the decrease of patient age. No benefit from medical treatment and need for surgery was significantly greater in patients who are younger and use their hands actively in daily life and profession (P =.028). The decrease in symptom scores after treatment was significantly greater in the surgical group than in the medical group (P =.003). Conclusion: Radial access should be exercised with care in patients who may develop significant thrombosis-related complaints and it is necessary to decide whether radial access is essential. If patients have ongoing symptoms despite medical treatment, embolectomy can be considered as a treatment option

Factors Influencing the Surgical Success in Patients with Infantile Esotropia

Purpose: To determine the factors that influence the surgical success in patients with infantile esotropia and to evaluate the relationship between amount of bilateral medial rectus recession and convergence. Material and Method: We retrospectively investigated the records of 188 patients with infantile esotropia who were operated on. The surgical success rate, the factors that influence the surgical success, and the relationship between amount of bilateral medial rectus recession and convergence deficiency were evaluated. Successful outcome was defined as deviation amount lower than 10 prism diopters postoperatively. Results: The mean age of the 188 patients included in the study at presentation was 54.9±56.8 (5-276) months, and the mean surgical age was 60.7±54.8 (7-276) months. Success was provided in 70.7% of patients after the first surgery and in 86.7% of patients after repeated surgeries. It was seen that gender, surgical age, refractive error, surgical procedure and the presence of fusion before surgery did not affect surgical success. Residual esotropia was found more frequently in patients with large-angle preoperative deviation, whilst both residual esotropia and consecutive exotropia were found more frequently in patients with amblyopia. It was observed that augmented bilateral medial rectus recession did not cause an increase in postoperative convergence deficiency. Discussion: Since the presence of amblyopia affects the surgical success negatively, it must be identified and treated preoperative. Residual esotropia is more frequently seen in patients with large-angle deviation preoperative, and more than one surgery may be required to provide orthophoria. In these cases, augmented bilateral medial rectus recession is a safe and effective method that rescues the patient from repeated surgeries and may be preferred to three-or four-muscle surgeries. (Turk J Ophthalmol 2013; 43: 413-8