Arthroscopic stabilization of anterior shoulder instability using a single anterior portal

Objective: The aim of this study was to compare the effects of the use of a single anterior portal in the arthroscopic surgery treatment of traumatic anterior shoulder instability with those in the literature. Methods: The study included 72 patients (60 males, 12 females; mean age: 23.9 years) who underwent surgery using a single arthroscopic anterior portal for the treatment of traumatic anterior shoulder instability between 2002 and 2011. Clinical outcomes were assessed using the Rowe and Oxford scales, forward flexion range and external rotation limitation. Redislocation was considered failure. Results: Mean follow-up was 49.3 months. Bankart lesion was determined in 38 patients and Bankart and SLAP lesions in 34. An average of 3.7 (range: 2 to 5) anchors were used. Redislocation was observed in 4 (5.6%) patients in the postoperative period. Postoperative Rowe and Oxford scores were 93.4 and 42.6, respectively. Conclusion: Instability surgery performed using a single arthroscopic anterior portal provided findings comparable with the literature regarding clinical outcomes, postoperative shoulder movements and low recurrence rates, emphasizing the importance of appropriate patient selection rather than the number of the portals. The use of a single portal is less invasive and reduces the surgical period

Determination of rust reactions on some selected bread wheat lines

Bread wheat is important cereal crop in Turkey. Rusts (caused by Puccinia spp.) are significant fungal diseases affecting quality and yield on the Central Anatolian Plateau. Aim of this study was to determine the reactions of 24 genotypes to local rust populations at the seedling stage (for Pst, Pgt and Pt) in Ankara and at the adult plant stage (for Pst and Pgt) in Ankara (YR;Yellow rust, SR; Stem rust) and Kastamonu (SR) during 2013-2014 growing season. In this study, rust reactions were determined at selected 24 bread wheat genotypes according to quality parameters having test weight (75.5-80.4 kg/hl), mixographe (3.5-6.0), Zeleny sedimentation (57-65 ml). These materials were developed by Field Crops Central Research Institute (FCCRI) Department of Quality Assessment and Food. For seedling test; the seedlings were inoculated with local Pgt, Pt (LR; Leaf rust) and Pst populations. Yellow, leaf and stem rust developments on each entry were scored after 14 days with 0-9 and 0-4 and scale for yellow rust and leaf-stem rust, respectively. For adult plant test; the genotypes were inoculated with local Pst (YR) and Pgt (SR) populations. Yellow and stem rusts developments on each entry were scored using the modified Cobb scale. Coefficients of infections were calculated and values below 20 were considered to be resistant. At the end of this study to determine rust reactions on 24 quality bread wheat lines; at the seedling stage, 8 (33%), 6 (25%) and 6 (25%) genotypes were determined as resistant to YR, LR and SR, respectively while at the adult stage, 10 (42%) and 0 (0%) lines were found resistant to YR and SR, respectively. These 8 and 6 materials which have been selected according to resistance for YR and LR respectively were selected for next yield trial. In addition to these materials can be used in disease and quality crossing studies

Primary gastrointestinal aspergillosis: A case report and literature review

Invasive aspergillosis is a severe infection that generally involves the lungs. Primary gastrointestinal aspergillosis is the least common form of invasive aspergillosis. A patient aged 65 years developed a febrile neutropenic episode following an autologous stem cell transplant for plasmacytoid variant diffuse large B-cell gastric non-Hodgkin’s lymphoma. He had abdominal pain on the second day of the febrile neutropenic episode and ileus occurred on the sixth day. His general condition deteriorated despite broad spectrum antibiotics and caspofungin treatment, and intestinal perforation occurred on the nineteenth day of the febrile neutropenic episode. Pathological examination of the resected jejunum and ileum revealed mould hyphae compatible with aspergillus. The patient died due to massive gastrointestinal bleeding on the fifth post-operative day. Although a rare condition, primary gastrointestinal aspergillosis should be kept in mind while treating neutropenic patients with gastrointestinal symptoms

COMBINED SPINAL EPIDURAL ANESTHESIA IN A GERIATRIC PATIENT UNDERGOING COLORECTAL SURGERY

Kolorektal cerrahi olgularını daha çok geriyatrik hasta popülasyonu oluşturmaktadır. Ülkemizde de geriyatrik hasta popülasyonu giderek artış göstermektedir. 79 yaşında, fiziksel durum sınıflaması ASA-II olan erkek hastaya sigmoid kanseri nedeniyle sigmoid rezeksiyon ve kolorektal anastomoz planlandı. İzotonik NaCl solüsyonu ile 10 ml/kg intravenöz sıvı yüklemesini takiben L3-L4 aralığından direnç kaybı tekniğiyle epidural aralığa girildi ve iğne-içinden-iğne tekniği kullanılarak 27G Quincke iğne ile subaraknoid mesafeye ulaşıldı. Berrak beyin omurilik sıvısı gelişi gözlendikten sonra 10 mg %0,5 hiperbarik bupivakain + 25 μg fentanil karışımı intratekal uygulandı. On dakika sonra duyusal blok seviyesinin T6 olduğu gözlenen olguya epidural kateterden 10 ml %2 prilokain + 9 ml %0,5 izobarik bupivakain + 50 μg fentanil karışımından 5 ml volüm verildi. Epidural ilaç uygulamasından 15 dakika sonra duyusal blok seviyesinin T4 olduğu saptandı. Yaklaşık 1,5 saat süren ve hemodinamik olarak stabil seyreden operasyonda epidural kataterden ek doz uygulanmadı. Operasyon sonunda duyusal blok seviyesinin T4 olduğu saptandı. Bu olguda, düşük doz lokal anestezik + opioid ile uygulanan kombine spinal epidural anestezi yöntemi ile stabil hemodinami, yeterli kas gevşemesi ve hasta-cerrah memnuniyeti sağlanmıştır. Colorectal surgery patients are mostly in the geriatric age group. In our country, geriatric patient population is gradually increasing. For the 79 years old male patient, evaluated in the ASA II classification of physical status, sigmoid resection and colorectal anastomosis was planned due to sigmoid cancer. Following intravenous isotonic NaCl loading at 10 ml/kg, epidural space was located and entered at L3-L4 level using the loss of resistance technique, and subarachnoid space was reached with a 27G Quincke needle using the needle-throughneedle technique. After clear cerebrospinal fluid was detected, 10 mg 0.5% hyperbaric bupivacaine and 25 μg fentanyl combination was administered intrathecally. Sensory block level was observed at T6 within 15 minutes, and the patient was given 5 ml of the mixture of 10 ml 2% prilocaine + 9 ml 0.5% isobaric bupivacaine + 50 μg fentanyl through epidural catheter. 15 minutes after the epidural injection, T4 level of sensory block was determined. In operation which lasted approximately 1.5 hours, the patient remained hemodynamically stable, and no additional epidural injection was administered. At the end of the operation, T4 level of sensory block was determined. In this case, combined spinal epidural anesthesia method was performed with low-dose local anesthetic and opioid and we achieved stable intraoperative hemodynamics, adequate muscle relaxation, and patient-surgeon satisfaction as wel

A RARE COMPLICATION OF ENTERAL NUTRITION: ESOPHAGEAL OBSTRUCTION

Sindirim sistemlerinde sorun olmayan yoğun bakım hastalarında enteral yol beslenme için ilk seçenektir. Parenteral yola göre daha nadir olmakla birlikte enteral beslenme sırasında da metabolik ve mekanik komplikasyonlarla karşılaşılabilmektedir. Özefagusun besin artıklarıyla tıkanması enteral beslenme sırasında görülebilen nadir mekanik sorunlardan biridir. Elliiki yaşında kadın hasta, abdominal distansiyon, pnömoni ve solunum yetersizliği tanılarıyla Anesteziyoloji Yoğun Bakım ünitesine alındı. Mekanik ventilasyon sağaltımı boyunca sedo-analjezi ve kas gevşetici ajanlar uygulandı. AYB ünitesine alınışının 3. gününde enteral beslenme başlandı. AYB deki 9. günde nazogastrik sonda, pasajının tıkanması üzerine yenisi ile değiştirilmek istendi. Çıkartılan sondanın yerine yeni sonda yerleştirilemedi. Endoskopik değerlendirmede özefagus 1/3 alt bölümünün gıda artıklarıyla karışık beyaz sarı memb-ranlardan oluşan bir kitle tarafından tıkandığı saptandı. Kitle mideye itilerek özefagus açıldı. Mekanik ventilasyon sırasında sedo-analjezik ve kas gevşeticilerin neden olabildiği motilite bozukluğu, eşlik eden yükselmiş karın içi basıncı varlığında gastroesofageal reflüyü artırarak, özefagusun enteral beslenme ürünleriyle tıkanmasını kolaylaştırabilir. Enteral route should be used for feeding of the critically ill patients with healthy gastrointestinal system. However metabolic and mechanical complications may occur during the enteral nutrition. Esophageal obstruction is one of the rare mechanical complications of enteral feeding. Fifty-two years old women with abdominal distention, pneumonia and respiratory failure was referred to intensive care unit. Mechanical ventilation was started with intravenous application of sedo-analgesics and muscle relaxants. In the 3th day of her referral enteral nutrition was started with enteral feeding solution. In the 6th day of feeding, the nasogastric tube was obstructed. Attempts for nasogastric tube replacement failed. Yellowish-white obstructing material in the esophageal lumen has been seen during the esophagoscopy. The material was cleared from the lumen and the passage was opened. Increased intraabdominal pressure with the use of sedo-analgesics may cause gastroesophageal reflux, concretions and consequently esophageal obstruction

Comparación de los efectos de la dexmedetomidina administrada en 2 momentos diferentes para lesión de isquemia-reperfusión renal en ratones

ResumenJustificación y objetivosinvestigar los efectos de la dexmedetomidina sobre la insuficiencia renal isquémica en ratones.Métodosen el presente estudio, 26 ratones machos adultos, albinos Wistar, con un peso de 230-300g fueron divididos aleatoriamente en 4 grupos: seudooperado (n=5), isquemia-reperfusión (grupo IR, n=7), IR/tratamiento de reperfusión con dexmedetomidina (grupo Dex-R, n=7) e IR/tratamiento preisquemia con dexmedetomidina (grupo Dex-I, n=7). En el primer grupo, se realizó una seudooperación y no se aplicaron pinzamientos renales. En el grupo IR, la isquemia renal fue inducida por oclusión de las arterias y venas renales bilaterales durante 60min seguida por reperfusión durante 24h. En los grupos Dex-R y Dex-I, se llevó a cabo el mismo procedimiento quirúrgico destinado al grupo IR, y la dexmedetomidina (100μg /kg intraperitoneal) fue administrada 5min después de la reperfusión y antes de la isquemia. Al final de la reperfusión, fueron recogidas muestras de sangre, los ratones fueron sacrificados y el riñón izquierdo procesado para histología.Resultadoslos niveles de nitrógeno ureico en la sangre (BUN) de los grupos Dex-R y Dex-I eran significativamente más bajos que los del grupo IR (p=0,015; p=0,043), aunque el flujo urinario era significativamente mayor en el grupo Dex-R (p=0,003). La puntuación histopatológica renal del grupo IR fue significativamente mayor que la de los otros grupos. No hubo diferencia significativa entre los grupos Dex-R y Dex-I.Conclusioneslos resultados demostraron que la administración de dexmedetomidina redujo histomorfológicamente la lesión de IR renal. La administración de dexmedetomidina durante el período de reperfusión fue considerada más eficaz debido al aumento de producción de orina y a la disminución de los niveles de nitrógeno ureico en la sangre

Renal Ischemia/Reperfusion Injury in Diabetic Rats: The Role of Local Ischemic Preconditioning

Background. The aim of this study was to evaluate the effects of local ischemic preconditioning using biochemical markers and histopathologically in the diabetic rat renal IR injury model. Methods. DM was induced using streptozotocin. Rats were divided into four groups: Group I, nondiabetic sham group (n=7), Group II, diabetic sham group (n=6), Group III, diabetic IR group (diabetic IR group, n=6), and Group IV, diabetic IR + local ischemic preconditioning group (diabetic IR + LIPC group, n=6). Ischemic renal injury was induced by clamping the bilateral renal artery for 45 min. 4 h following ischemia, clearance protocols were applied to assess biochemical markers and histopathologically in rat kidneys. Results. The histomorphologic total cell injury scores of the nondiabetic sham group were significantly lower than diabetic sham, diabetic IR, and diabetic IR + LIPC groups. Diabetic IR group scores were not significantly different than the diabetic sham group. But diabetic IR + LIPC group scores were significantly higher than the diabetic sham and diabetic IR groups. Conclusion. Local ischemic preconditioning does not reduce the risk of renal injury induced by ischemia/reperfusion in diabetic rat model

The Effects of Remote Ischemic Preconditioning and N-Acetylcysteine with Remote Ischemic Preconditioning in Rat Hepatic Ischemia Reperfusion Injury Model

Background. Remote ischemic preconditioning (RIP) and pharmacological preconditioning are the effective methods that can be used to prevent ischemia reperfusion (IR) injury. The aim of this study was to evaluate the effects of RIP and N-Acetylcysteine (NAC) with RIP in the rat hepatic IR injury model. Materials and Methods. 28 rats were divided into 4 groups. Group I (sham): only laparotomy was performed. Group II (IR): following 30 minutes of hepatic pedicle occlusion, 4 hours of reperfusion was performed. Group III (RIP + IR): following 3 cycles of RIP, hepatic IR was performed. Group IV (RIP + NAC + IR): following RIP and intraperitoneal administration of NAC (150 mg/kg), hepatic IR was performed. All the rats were sacrificed after blood samples were taken for the measurements of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels and liver was processed for conventional histopathology. Results. The hepatic histopathological injury scores of RIP + IR and RIP + NAC + IR groups were significantly lower than IR group (P = 0.006, P = 0.003, resp.). There were no significant differences in AST and ALT values between the IR, RIP + IR, and RIP + NAC + IR groups. Conclusions. In the present study, it was demonstrated histopathologically that RIP and RIP + NAC decreased hepatic IR injury significantly

A microsatellite marker for yellow rust resistance in wheat

Bulk segregant analysis (BSA) was used to identify molecular markers associated with yellow rust disease resistance in wheat (Triticum aestivum L.). DNAs isolated from the selected yellow rust tolerant and susceptible F-2 individuals derived from a cross between yellow rust resistant and susceptible wheat genotypes were used to established a "tolerant" and a "susceptible" DNA pool. The BSA was then performed on these DNA pools using 230 markers that were previously mapped onto the individual wheat chromosomes. One of the SSR markers (Xgwm382) located on chromosome group 2 (A, B, D genomes) was present in the resistant parent and the resistant bulk but not in the susceptible parent and the susceptible bulk, suggesting that this marker is linked to a yellow rust resistance gene. The presence of Xgwm382 was also tested in 108 additional wheat genotypes differing in yellow rust resistance. This analysis showed that 81% of the wheat genotypes known to be yellow rust resistant had the Xgwm382 marker, further suggesting that the presence of this marker correlates with yellow rust resistance in diverse wheat germplasm. Therefore, Xgwm382 could be useful for marker assisted selection of yellow rust resistances genotypes in wheat breeding programs