Diabetic ketoacidosis as the presenting manifestation of pancreatic adenocarcinoma with cystic features

AbstractThe common presenting symptoms of pancreatic cancer are abdominal pain, weight loss, and jaundice. Pancreatic adenocarcinoma presenting with diabetic ketoacidosis is a very rare emergent clinical condition. However, pancreatic ductal cystadenocarcinoma presenting with diabetic ketoacidosis was not reported. We describe a 60-year-old man with pancreatic cystadenocarcinoma presenting with diabetic ketoacidosis as the initial manifestation. It must be kept in mind that in diabetic ketoacidosis cases, the precipitating factor may be pancreatic ductal cystadenocarcinoma

Does applied ultrasound prior to laparoscopy predict the existence of intra-abdominal adhesions?

diagnostic tool, in predicting the presence of intraabdominal adhesions, especially near the trocar entry area, to provide safe surgical access to the abdomen. Materials and methods: Fifty-nine women with a previous history of open abdominal surgery (group A) and a group of 91 women with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the abdominal fields before laparoscopic operations. The anterior abdominal wall was divided into six quadrants: right upper, right lower, left upper, left lower, suprapubic, and umbilical. Adhesions were evaluated by surgeons during the operation and by radiologists using USG prior to the operation. Visceral organ movements greater than 1 cm was defined as normal visceral slide (positive test), with less than 1 cm of movement defined as abnormal visceral slide (negative test). Sliding test measures movements of omental echogenicity or a stable echogenic focus that corresponds to intestine peritoneal echogenicity that underlies abdominal wall during exaggerated inspiration and expiration. Adhesions observed during surgery were evaluated on a four-point scale, with 0 indicating no adhesions present, 1 indicating the presence of a thin, filmy avascular adhesion, 2 indicating the presence of a dense and vascular adhesion, and 3 indicating adhesions that connect surrounding organs with the overlying peritoneal surfaces. The McNemar test was used to compare the results of USG and laparoscopy for each measure. Results: We found that preoperative USG was successful in identifying adhesions [sensitivity, 96.39% (95% CI 89.8–99.2); specificity, 97.43%] Conclusion: Preoperative ultrasound examination of the abdominal wall may enhance the safety of abdominal entry during laparoscopic operations

Renal subcapsular hematoma caused by hydrophilic guide wire during patent ductus arteriosus closure

Hydrophilic guide wire-associated renal subcapsular hematoma (RSH) during patent ductus arteriosus (PDA) closure is an extremely rare clinical condition. Herein, we present the case of a 16-year-old adolescent who suffered accidental hydrophilic 0.035-inch guide wire-related RSH during PDA closure. This RSH was diagnosed by computerized tomography and selective renal angiography. It was successfully treated by conservative treatment

Association of vitamin D insufficiency/deficiency with thyroid artery Doppler ultrasonography in patients with Hashimoto thyroiditis

Conclusion: Vitamin-D insufficiency/deficiency has led to reduced parenchymal blood supply and increased micro-vascular resistance in Hashimoto thyroiditis patients

Effects of losartan on the renin-angiotensin-aldosterone system and erythrocytosis in patients with chronic obstructive pulmonary disease and systemic hypertension

WOS: 000168891200003Objective: To evaluate the effects of losartan on blood pressure, erythrocytosis and the renin-angiotensin-aldosterone system (RAS) in patients with erythrocytosis and hypertensive chronic obstructive pulmonary disease (COPD). Design: Prospective, nonrandomised, two-period study. Patients and Participants: 24 patients were recruited, of whom 20 (17 men) completed the trial. The mean age was 55 +/- 8 years (range 40 to 65 years). Erythrocytosis was defined as a persistent elevation of the haematocrit to greater than or equal to 47% in females and greater than or equal to 50% in males. Patients were less than or equal to 65 years of age and hypertensive according to the WHO criteria. Patients who had hepatic and/or renal dysfunction, acute exacerbation of primary disease, were taking systemic corticosteroids, had any other systemic disease, or showed intolerance during the washout period were excluded. Methods: An initial 2-month period on, a standard regimen with nasal oxygen (2 L/min, 18 h/day) and bronchodilators (inhaled salbutamol, oral theophylline, inhaled ipratropium bromide) was followed by a second 2-month period during which losartan was administered as an antihypertensive agent in addition to standard therapy. Routine biochemical and haematological monitoring was carried out. Systolic and diastolic blood pressures (SBP and DBP respectively) were measured. ECG and arterial blood gas analyses were also performed for all patients at the beginning of the study, and all of these clinical and laboratory investigations were performed at 15-day intervals during the study. Plasma renin activity and serum aldosterone and erythropoietin levels were measured both at the beginning and at the end of each 2-month period. Results: No statistically significant changes were found in the measured parameters at the end of the 2-month standard treatment period. Fatigue and dizziness were reported by four of the patients during the first week of losartan treatment. Both SEP and DBP decreased by 10mm Hg with losartan treatment (p = 0.0003 and 0.0002, respectively). Haematocrit decreased from 53 +/- 3% to 48 +/- 4% (p = 0.0001). The mean arterial blood gas tension of CO2 (pCO(2)) was 54 +/- 11mm Hg and decreased to 48 +/- 4mm Hg (p = 0.01). Losartan treatment decreased serum aldosterone to 259 +/- 148 ng/dl from a mean baseline value of 156 +/- 140 ng/dl (p = 0.03). There were no statistically significant changes in pO(2) serum erythropoietin or plasma renin activity. Conclusion: Losartan controls blood pressure and reduces erythrocytosis in patients with hypertensive COPD, and is well tolerated. Although the mechanism of the effect of losartan on erythrocytosis requires further investigation, we propose that the RAS, in particular angiotensin II, has effects on the haemopoietic system and that blocking these effects decreases the haematocrit

Relationship Between Carotid Stenosis and Infarct Volume in Ischemic Stroke Patients

Conclusions: Our findings indicate that the percentage of carotid artery stenosis could be useful in predicting the infarct volume of the stroke

Effect of different types of intrauterine devices on intrauterine activity

Objective-To compare the effects of various IUDs on intrauterine activity. Patients and Methods-57 women volunteers aged 18 to 25 in the outpatient clinic of the Department of Obstetrics and Gynecology at Cerrahpasa Medical Faculty of Istanbul University were included in the study. All were in good health and menstruating normally. The subjects were introduced to different types of IUDs on the fifth to eighth days of their menstrual cycle. Intrauterine activities with and without naproxen were recorded, for at least 20 minutes-each time, with a micro-tip transducer before insertion, lust after insertion, and 1 month later. Results-Intrauterine activity increased lust after insertion of both IUDs and disappeared 1 month later in copper-T wearing women, but persisted in multiload wearers. Naproxen seemed to be useful in preventing intrauterine activity caused by the IUD. Conclusions-The IUD itself causes an increase in intrauterine activity which is preventable by naproxen, suggesting the possible role of prostaglandins. Persistence of intrauterine activity depends upon the type of device. Optimal designing of IUDs is required to decrease side effects and make them more acceptable

Evaluation of renal anomalies, inferior vena cava variations, and left renal vein variations by lumbar magnetic resonance imaging in 3000 patients

Conclusion: Lumbar spinal MRI is useful in detecting renal anomalies and variations of the IVC and LRV

İntraoperatif splenik hilus kanaması ve splenomegali robotik ve laparoskopik splenektomiden açık cerrahiye geçişe etki eden risk faktörleridir

Objective: Minimal invasive surgery is one of the most popular treatment approaches which is safe and effective in experienced hands in different_x000D_ clinical practices. In the present study, we aimed to evaluate the risks factors for conversion to open splenectomy and the performance of indirect hilum_x000D_ dissection technique._x000D_ Material and Methods: A total of 56 patients who underwent laparoscopic or robotic splenectomy for isolated spleen diseases were included into the_x000D_ study. Patients were divided into two groups as robotic or laparoscopic splenectomy (Group 1; n= 48) and conversion to open surgery (Group 2; n= 8)._x000D_ Patients were retrospectively evaluated according to clinical, biochemical, hematological and microbiological parameters and morbidity._x000D_ Results: No statistically significant difference was found between the groups in terms of age, gender, body mass index (BMI), ASA score, co-morbid disease,_x000D_ operation time, hospital stay, follow-up period, accessory spleen, diagnosis, international normalized ratio (INR), red cell distribution width (RDW), platelet_x000D_ distribution width (PDW), platelet to lymphocyte ratio (PLR), neutrophil to lymphocyte ratio (NLR), reapplication, splenosis, surgical site infection, vascular_x000D_ thrombus and incisional hernia (p> 0.05). On the other hand, intraoperative splenic hilum hemorrhage and increased spleen size (p< 0.05) were higher_x000D_ in the conversion to open surgery group. In logistic regression analysis, intraoperative splenic hilum hemorrhage (B= 4.127) (OR= 61.974) (95% CI= 3.913-_x000D_ 981.454) (p= 0.003) and increased spleen volume (B= 3.114) (OR= 22.509) (95% CI= 1.818-278.714) (p= 0.015) were found as risk factors for conversion to_x000D_ open surgery._x000D_ Conclusion: Intraoperative hemorrhage from the splenic hilum and increased spleen volume (> 400 cm3_x000D_ ) are risk factors for conversion to open splenectomy in patients undergoing elective robotic or laparoscopic splenectomy. Indirect splenic hilum dissection can decrease intraoperative hemorrhage and conversion to open surgery.Giriş ve Amaç: Minimal invaziv cerrahi tüm dünyada farklı klinik pratiklerde etkili ve güvenli popüler tedavi yöntemlerinden biridir. Bu çalışmada_x000D_ amacımız, robotik veya laparoskopik splenektomi (RLS)’den açık cerrahiye geçişe etki eden risk faktörlerini ve indirekt hilum diseksiyonu tekniğinin performansını ortaya koymaktır._x000D_ Gereç ve Yöntem: Çalışmaya izole dalak hastalıkları nedeniyle RLS splenektomi yapılan 56 hasta kabul edildi. Hastalar iki gruba ayrıldı; RLS yapılan_x000D_ hastalar (grup 1) (n= 48) ve açık cerrahiye geçilen hastalar (grup 2) (n= 8). Hastalar yaş, cinsiyet, beden kütle indeksi (BKİ), yandaş hastalık, tanı, ASA_x000D_ skoru, dalak çapı, biyokimyasal, mikrobiyolojik parametreler ve morbiditeler açısından retrospektif olarak değerlendirildi._x000D_ Bulgular: Yaş, cinsiyet, BKİ, ASA skoru, yandaş hastalık, operasyon süresi, hastanede kalış süresi, takip süresi, aksesuar dalak, tanı, Uluslararası_x000D_ Normalizasyon Oranı (INR), eritrosit dağılım genişliği (RDW), trombosit dağılım genişliği (PDW), trombosit-lenfosit oranı (PLR), nötrofil-lenfosit_x000D_ oranı (NLR), tekrar başvuru, splenozis, cerrahi alan infeksiyonu, vasküler trombüs ve insizyonel herni açısından gruplar arasında istatistiksel olarak_x000D_ farklılık yoktu (p> 0,05). Diğer taraftan, açık splenektomiye geçilen grupta intraoperatif splenik hilustan kanama ve dalak çapı istatistiksel olarak_x000D_ daha fazlaydı (p< 0,05). Multivaryant analizde açığa geçişe etki eden faktörler; intraoperatif hilustan kanama (B= 4,127) (OR= 61,974) (%95 GA=_x000D_ 3,913-981,454) (p= 0,003) ve artmış dalak çapı (> 400 cm3) (B= 3,114) (OR= 22,509) (%95 GA= 1,818-278,714) (p= 0,015) olarak tespit edilmiştir._x000D_ Sonuç: İntraoperatif splenik hilustan kanama ve artmış dalak çapı (> 400 cm3_x000D_ ) elektif RLS’den açık splenektomiye geçişe etki eden risk faktörleridir._x000D_ İndirekt splenik hilum diseksiyonu intraoperatif kanama ve açık cerrahiye geçişi azaltabilir