One patient, one bone, and two different tumoral lesions

In this article, we report a 67-year-old female patient who has two different tumoral lesions located in left humerus with clinical and radiological findings. Previously, the patient was diagnosed as impingement syndrome in shoulder, but, tumoral lesions were detected on the radiograms incidentally during evaluation

Effect of intraoperative esmolol infusion on anesthetic, analgesic requirements and postoperative nausea-vomitting in a group of laparoscopic cholecystectomy patients

PURPOSE: Postoperative pain and nausea/vomitting (PNV) are common in laparoscopic cholecystectomy patients. Sympatholytic agents might decrease requirements for intravenous or inhalation anesthetics and opioids. In this study we aimed to analyze effects of esmolol on intraoperative anesthetic-postoperative analgesic requirements, postoperative pain and PNV. METHODS: Sixty patients have been included. Propofol, remifentanil and vecuronium were used for induction. Study groups were as follows; I - Esmolol infusion was added to maintenance anesthetics (propofol and remifentanil), II - Only propofol and remifentanil was used during maintenance, III - Esmolol infusion was added to maintenance anesthetics (desflurane and remifentanil), IV - Only desflurane and remifentanil was used during maintenance. They have been followed up for 24 h for PNV and analgesic requirements. Visual analog scale (VAS) scores for pain was also been evaluated. RESULTS: VAS scores were significantly lowest in group I (p = 0.001-0.028). PNV incidence was significantly lowest in group I (p = 0.026). PNV incidence was also lower in group III compared to group IV (p = 0.032). Analgesic requirements were significantly lower in group I and was lower in group III compared to group IV (p = 0.005). Heart rates were significantly lower in esmolol groups (group I and III) compared to their controls (p = 0.001) however blood pressures were similar in all groups (p = 0.594). Comparison of esmolol groups with controls revealed that there is a significant decrease in anesthetic and opioid requirements (p = 0.024-0.03). CONCLUSION: Using esmolol during anesthetic maintenance significantly decreases anesthetic-analgesic requirements, postoperative pain and PNV

Seizure due to multiple drugs intoxication: a case report

The mechanism of the antidepressant effect of bupropion is not fully understood. Besides, using it in the treatment of depression, it is found to be effective in reducing withdrawal symptoms due to smoking cessation. A 28-year-old female patient with a history of depression was admitted to emergency department an hour after ingestion of bupropion, quetiapine, and levothyroxine in high doses to commit suicide. While accepting her into the Intensive Care Unit, she was awake, alert, disoriented and agitated. After 2 h, the patient had a generalized tonic–clonic seizure. The necessary treatment was given and 9 h later with hemodynamic improvement, the patients’ mental status improved.Bupropion may cause unusual behaviors such as delusions, paranoia, hallucinations, or confusion. The risk of seizure is strongly dose-dependent. We want to emphasize the importance of early gastric lavage and administration of activated charcoal. Resumo: O mecanismo do efeito antidepressivo de bupropiona ainda não está bem esclarecido. Contudo, seu uso no tratamento de depressão revelou ser eficaz para reduzir os sintomas de abstinência relacionados à cessação do tabagismo. Uma paciente do sexo feminino, 28 anos, com história de depressão, deu entrada no setor de emergência uma hora após a ingestão de bupropiona, quetiapina e levotiroxina em doses elevadas para cometer suicídio. Ao ser internada em unidade de terapia intensiva, estava acordada, alerta, desorientada e agitada. Após duas horas, apresentou uma crise tônico-clônica generalizada. O tratamento necessário foi administrado e nove horas mais tarde, com a estabilização hemodinâmica, o estado mental da paciente melhorou.Bupropiona pode causar comportamentos incomuns, incluindo delírios, paranoia, alucinações ou confusão mental. O risco de convulsão é altamente dependente da dose. Queremos enfatizar a importância da lavagem gástrica precoce e da administração de carvão ativado. Keywords: Bupripion, Intensive care unit, Seizure, Palavras-chave: Bupropiona, Unidade de terapia intensiva, Convulsã

Depresyon hastalarında serum apelin ve nesfatin-1 düzeyleri ve tedavi ile ilişkisi

Depresyon hastalarında serum apelin ve nesfatin-1 düzeyleri ve tedavi ile ilişkisi Amaç: Bu çalışma apelin ve nesfatin-1 moleküllerinin tedavi öncesi ve sonrası depresyonla ilişkisini ve biyolojik belirteç olarak kullanılıp kullanılamayacaklarını araştırmak amacıyla planlanmıştır. Yöntem: Çalışmaya psikiyatri polikliniğine başvuran 47 tedavisiz depresyon hastası ve 47 normal sağlıklı gönüllü alınmıştır. Tüm katılımcılara DSM-IV Eksen 1 Bozuklukları İçin Yapılandırılmış Klinik Görüşme (SCID-I), Hamilton Depresyon Ölçeği (HAM-D), Klinik Global İzlem (KGİ) Ölçeği uygulandı. Tedavi öncesinde ve tedavi başlangıcından sonraki 3. ayın sonunda 12 saat açlığı takiben periferik kan örnekleri alındı. Serum apelin ve nesfatin-1 düzeyleri ölçüldü. Bulgular: Kırkyedi depresyon hastasının 35'i (%74.5) kadın, 12'si (%25.5) erkekti. Kırkyedi gönüllünün 31'i (%66) kadın, 16'sı (%34) erkekti. Yaş, medeni durum, meslek ve Vücut Kitle İndeksi (VKİ) bakımından gruplar arasında fark yoktu. Başvuru serum apelin düzeyi hasta grubunda kontrol grubuna göre anlamlı derecede yüksekti. Hasta grubu ile kontrol grubu arasında başvuru serum nesfatin-1 düzeyi açısından anlamlı fark yoktu. Üç aylık tedavi sonrası hem serum apelin hem de serum nesfatin-1 düzeylerinde anlamlı fark oluşmamıştır. Sonuç: Çalışma bulgularımıza göre, serum apelin düzeyleri başvuru anında sağlıklı kontrollere göre anlamlı olarak yüksekti ve 3 aylık depresyon tedavisi (antidepresan, antidepresan + elektrokonvulsif terapi, antidepresan + terapi) sonrasında klinik iyileşmeye rağmen apelin düzeylerinde değişiklik saptanmadı. Hasta grubunda serum nesfatin-1 düzeyleri başvuru sırasında ve 3 aylık tedavi sonunda da kontrol grubundan farklı değildi. Çalışmamızda serum apelin düzeyi ile VKİ arasında ilişki saptanmamıştır. Başvuru sırasındaki serum nesfatin-1 düzeyi ile yine başvuru sırasında ölçülen VKİ arasında korelasyon tespit edilmiştir.Serum apelin and nesfatin-1 levels in depression patients and their relationship with treatment Objective: This study was designed to investigate the molecules apelin and nesfatin-1, their relationship with depression before and after treatment, and whether they can be used as biomarkers. Method: Forty-seven depression patients referred to psychiatric outpatient clinic who were not on treatment and 47 normal healthy volunteers were enrolled in the study. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), the Hamilton Depression Rating Scale (HAM-D), and the Clinical Global Impression (CGI) Scale were administered to all participants. Peripheral blood samples were collected following a 12-hour fasting at the beginning and three months after the start of treatment. Serum apelin and nesfatin-1 levels were measured. Results: Of the 47 depression patients, 35 (74.5%) were females and 12 (25.5%) were males. Thirty-one (66%) of the 47 volunteers were females and 16 (34%) of them were males. Age, marital status, occupation and Body Mass Index (BMI) did not differ between the groups. Serum apelin level was significantly higher in the patient group than in the control group. There was no significant difference between the patient group and the control group in terms of serum nesfatin-1 levels. There was no significant difference in serum apelin and serum nesfatin-1 levels after 3 months of treatment. Conclusions: Serum apelin levels were significantly higher than healthy controls at the time of admission and there was no change in apelin levels after 3-months of treatment (antidepressant, antidepressant + electroconvulsive therapy, antidepressant + therapy) despite clinical recovery. Serum nesfatin-1 levels in the patient group were not different from the control group at the time of referral and at the end of 3 months treatment. There was no relationship between serum apelin level and BMI in our study. Serum nesfatin-1 level and BMI were correlated at the time of admission

What is the importance of canal-to-diaphysis ratio on osteoporosis-related hip fractures?

Objectives: This study aims to investigate whether the ratio of the canal-to-diaphysis in femoral subtrochanteric region is helpful in determining risk before hip fracture. Patients and methods: The study group consisted of 116 patients with osteoporotic hip fractures (26 males, 90 females; mean age 77.8 years; range, 61 to 89 years) and the control group consisted of 56 subjects (11 males, 45 females; mean age 75.3 years; range, 60 to 83 years). The canal-to-diaphysis ratio of patients in the study group was measured on plain radiographs. The results of the affected side and intact side were compared. To ensure the interobserver reliability of the measurements and to minimize technical errors, the assessments were performed twice (two weeks apart) by two different orthopedic surgeons. Results: The canal-to-diaphysis ratio was significantly increased in patients with hip fracture compared with the intact side of same patient (p<0.001) and control subjects (p<0.001). According to the results of the receiver operating characteristic analysis, canal-to-diaphysis ratio had a diagnostic value in predicting hip fracture in osteoporosis patients, and the limit value was approximately 0.53 (sensitivity: 81\%, specificity: 86\%). An index of 0.53 represents a risk of intertrochanteric hip fracture of 89\%. Conclusion: This method can be easily applied by all physicians as X-ray device is readily accessible with low cost. The risk of hip fracture should be determined, osteoporosis should be evaluated, and treatment should be started in patients with high risk to take the necessary precautions before the fracture develops

Seizure due to multiple drugs intoxication: a case report

Abstract The mechanism of the antidepressant effect of bupropion is not fully understood. Besides, using it in the treatment of depression, it is found to be effective in reducing withdrawal symptoms due to smoking cessation. A 28-year-old female patient with a history of depression was admitted to emergency department an hour after ingestion of bupropion, quetiapine, and levothyroxine in high doses to commit suicide. While accepting her into the Intensive Care Unit, she was awake, alert, disoriented and agitated. After 2 h, the patient had a generalized tonic-clonic seizure. The necessary treatment was given and 9 h later with hemodynamic improvement, the patients’ mental status improved. Bupropion may cause unusual behaviors such as delusions, paranoia, hallucinations, or confusion. The risk of seizure is strongly dose-dependent. We want to emphasize the importance of early gastric lavage and administration of activated charcoal

Is it possible that the pathogenesis of osteoarthritis could start with subchondral trabecular bone loss like osteoporosis?

Objectives: This study aims to investigate the role of subchondral trabecular bone thickness in the mechanism of knee osteoarthritis and the correlation of osteoarthritis and osteoporosis pathogenesis. Patients and methods: The study included 62 patients (9 males, 53 females, mean age 66.7 years; range, 50 to 84 years) with osteoarthritk All radiographs were evaluated according to Kellgren and Lawrence classification. The bone mineral density of the patients was measured and bone samples were collected from all patients included in the study during the surgical procedure and investigated pathologically. Results: Osteoarthritis grade and trabecular bone thickness were correlated with each other. Trabecular thickness rate was higher in patients with severe osteoarthritis, whereas trabecular thickness rate was statistically significantly lower than the mean in patients with mild osteoarthritis (p=0.045). Conclusion: Trabecular thickness rate was significantly lower in the mild grade of osteoarthritis compared to the severe grade. As the level of osteoarthritis increased, the number of patients with osteoporosis decreased

Is it easy to clinically distinguish inflammatory arthritis of bacterial origin from monoarthritis attacks of gout disease?

Acute monoarthritis is a common situation in orthopedic emergency where the patient presents with typical inflamed joint. It is hard to clinically distinguish inflammatory arthritis of bacterial origin from monoarthritis attacks of gout disease. If these two situations, which are the most common causes of acute monoarthritis, are misdiagnosed, outcomes might be catastrophic and costly. Synovial fluid analysis is the most reliable method for confirming the diagnosis although it might not always lead to definitive diagnosis. If there is clinical suspicion for crystal arthropathy, repeated examinations may provide benefits for confirming the diagnosis