Brachiobasilic versus brachiocephalic arteriovenous fistula: A prospective randomized study

BackgroundThe most recent Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines recommend that the order of preference for arteriovenous fistula (AVF) placement is the radial-cephalic primary AVF, followed by the secondary brachiocephalic (BC) and, if either of these is not viable, then brachiobasilic (BB) AVF should be fashioned. However, there is limited prospective data comparing technical and clinical outcomes of these two approaches. The purpose of our study was to compare outcome, patency, and complication rates in these two autogenous upper arm AV accesses.MethodsBetween December 2003 and and January 2007, patients (61 male, 39 female) who have lost more distal AVFs were enrolled in the study. After preoperative duplex mapping, patients with patent both basilic and cephalic veins greater than 3 mm of diameter were randomized into BCAVF and BBAVF groups, each group consisting of 50 patients. All procedures were performed under local anesthesia as one-stage procedures. Follow-up data were prospectively collected. Kaplan-Meier analysis was used to calculate primary and secondary patency rates. Univariate and multivariate Cox-regression analysis was used to find risks for the occurrence of thrombosis.ResultsBaseline demographics, clinical characteristics, and preoperative history dialysis access were comparable between groups with the exception of the fact that mean caliber of the basilic veins were larger (4.51 ± 0.93 mm vs 3.90 ± 0.1 mm; P = .002). The mean duration of operation was significantly shorter in the BC group compared with the BB group (P < .001). There was no significant difference in the thirty day mortality, wound complications, 24 hour thrombosis, postoperative hemorrhage, maturation, and time to maturation between the groups. Mean follow-up was 43.2 ± 1.8 months. Primary patency at 1 and 3 years of follow-up was 87% and 81% for the BC group and 86% and 73% for the BB group (P = .7) Secondary patency at one and three year follow-up was 87% and 70% for the BC group and 88% and 71% for the BB group, respectively (P = .8). Twenty-eight patients (28%) in the BC (18 patients) and BB (10 patients) group died with a patent fistula during the follow-up period (P = .18). Multivariate analysis revealed that use of dominant arm increased the risk of fistula failure.ConclusionWe conclude that brachiobasilic and brachiocephalic AVF are equally effective alternatives; however, a longer and demanding operation with BB AVF construction should be considered

Elevated high sensitivity C-reactive protein and uric acid levels in coronary artery ectasia

PubMedID: 25285332Aim: The aim of this study is to examine uric asid (UA) and high sensitive C-Reactive protein (Hs-CRP) levels in patients with coronary artery ectasia (CAE). Materials and Methods: Ninety-eight patients with isolated CAE (mean age 57.5±10.3), (group-I), 110 patients with CAD but without CAE (mean age 56.3±10.7), (group-II), and 105 patients with normal coronary angiographies (mean age 58.1±10.8), (group-III) were included in the study. Blood samples of all individual were taken after coronary angiography from an antecubital vein, the patients uric acid and Hs-CRP levels were assessed. The severity of ectasia was evaluated and categorized according to Markis. Results: A significant difference was not seen in serum uric acid and Hs-CRP levels between CAE and CAD groups. However, relative to the control group, uric acid and Hs-CRP levels in CAE and CAD groups were higher to a significant degree (p=0.001, p<0.001, respectively), (p<0.001, p<0.001, respectively). The statistical significant was detected between subgroups type I and type IV, Hs-CRP and UA were statistically high in subgroup type I. (p=0.012, p=0.033, respectively) In multiple regression analysis, CAE and CAD were independently associated with UA (ß=0.76; p<0.001, ß=0.68; p<0.001, respectively) and Hs-CRP (ß=0.66; p<0.01, ß=0.62; p<0.01, respectively) along with diabetes mellitus (ß=0.61; p=0.039, ß=0.94; p=0.028, respectively). Conclusion: In conclusion, the blood uric acid and Hs-CRP values in our study have been observed to be higher in the individuals with coronary arteri ectasia in comparison to normal individuals, and the increase in these values were found to be parallel to the extent of the ectasia

Irritable bowel syndrome in childhood: Review

Irritable bowel syndrome (IBS), is also known spastic colon, is one of the functional bowel diseases. Etiology of IBS is unknown and is associated with symptoms such as diarrhea and constipation. It usually affects both adults and adolescents. Functional bowel differences, disordered defecation habits and chronic abdominal pain, which is the most common of the symptoms, is due to bowel disorder. The frequency of the pain varies from patient to patient and is usually observed on the around umblicus but the pain observed another places on the abdomen. Etiopathogenesis hasn't become definite yet. The second important symptom is disturbed defecation and the changes in defecation pattern. Constipation and diarrhea often follow each other. Patients need to defecate after each meal. Dyspeptic symptoms; especially postprandial abdominal tenderness, abdominal discomfort, bloating, gas, indigestion, loss of appetite, nausea are also common in IBS. Diagnostic criteria which named Rome III criteria based on recurrent abdominal pain or discomfort following; improvement with defecation or change in frequency of stool or stool appearance. We report here; irritable bowel syndrome, diagnosis and treatment of it in children. © 2015 by Türkiye Klinikleri

Bioassay guided isolation of naphthoquinones from Onosma aksoyii, investigation of their cytotoxic properties

67th International Congress and Annual Meeting of the Society-for-Medicinal-Plant-and-Natural-Product-Research (GA) -- SEP 01-05, 2019 -- Innsbruck, AUSTRIAWOS: 000503772900343[No abstract available]Soc Med Plant & Nat Prod Res, French Soc PharmacognosyTUBITAKTurkiye Bilimsel ve Teknolojik Arastirma Kurumu (TUBITAK) [116Z463]This study was supported by TUBITAK (Project Number: 116Z463)

Prevalence of gastroesophageal reflux disease in Turkish children aged 3-6 years old; development of gastroesophageal reflux disease questionnaire to use for Turkish children (Sm-2 Reflux Questionnaire) [Yaş Araligi Üç-Alti Yil Olan Türk Çocuklarinda Gastroözofageal Reflü Hastaligi Sikligi; Türk Çocuklarinda Kullanilmak Üzere Gastroözofageal Reflü Hastaligi Anket Formu Hazirlanmasi (Sm-2 Reflü Anket Formu)]

Objective: We aimed to develop a questionnaire form for the diagnosis of gastroe-sophageal reflux disease in Turkish children aged 3-6 years old, and to analyze the frequency of gastroesophageal reflux disease in children aged 3-6 years old. Material and Methods: The study included the 3 groups of patients. Group 1 included 45 patients with gastroesophageal reflux disease, group 2 included 100 healthy children and group 3 included 283 children aged 3-6 years old in Menderes district. Previous questionnaire forms translated to Turkish and then modified with novel questions. The novel questionnaire form performed to children in group 1 and group 2. Each item was given a score according to odds ratio of symptoms between two groups. Reflux score was calculated according to sensitivity and specificity. Then, frequency of gastroesophageal reflux disease was analyzed in children aged 3-6 years old in Menderes district (group 3). Results: Reflux scores in children in group 1 and 2 (mean±SD) were 16±8.24 and 2±3.52, respectively. Sensitivity and specificity of reflux score ?6 was 92% and 88.9%, respectively and reflux score ?6 was diagnostic for gastroesophageal reflux disease. The frequency of gastroesophageal reflux disease in children aged 3-6 years old in Menderes district (group 3) was 18.7%. The duration of breastfeeding was short, and the frequency of doctor diagnosed gastroesophageal reflux disease was high in children with gastroesophageal reflux disease. Conclusion: Our questionnaire form may be used reliably in diagnosis and follow-up of the gastroesophageal reflux disease in children aged 3-6 years old. © 2018 by Türkiye Klinikleri