A case with late clinical presentation of Takayasu’s arteritis

Takayasu's arteritis also known as pulseless disease is a kind of granulomatous vasculitis that characterized large size vessels involvement with massive intimal fibrosis. It is usually occurs in female gender in middle ages. Unusual Takayasu's arteritis case with different clinical presentation was reported in current paper. A 42 years old male patient was admitted to cardiovascular surgery clinic with sudden onset cyanosis in first finger of right hand. There was not any finding or complaint in his past medical history. The right brachial, radial and ulnar pulses were not palpable in physical examination and blood pressure could not measured from this extremity. Bilateral upper limb arterial doppler ultrasound revealed minimal flow in right and disrupted biphasic flow pattern in left. Peripheral angiography revealed total occlusion after the osteal segment of right subclavian artery, pre-occlusive stenosis in proximal segment of left subclavian artery and total occlusion in abdominal aorta just prior the iliac bifurcation. There was no serological or biochemical positivity in blood parameters and no additional visualization finding. Antiaggregant, anticoagulant and intravenous peripheral vasodilator therapy was utilized to patient for finger cyanosis. Patient was discharged with full recovery of finger coloration and referred to rheumatology clinic for further investigation. Microembolism may be messenger of wide-spread vascular disorders for example vasculitis. Thus, detailed systemic examinations should be applied in patients who admitted with micro-circulatory system symptoms

Endarterectomy and saphenous vein ‘Y’ patchplasty technique for severe carotid artery bifurcation lesion

Arteriosclerosis, is mostly affect coronary and carotid arteriesespecially the ostium and bifurcation due to the natureof the flow. Arterial bifurcation lesions cause dilemmafor the treating physician during both surgical and invasiveprocedures because they require a higher clinical experienceand longer processing time. In carotid artery surgery,it is accepted that patchplasty prevents perioperativeand postoperative restenosis, and as a result of this, itreduces the incidence of ipsilateral stroke. In the presenttime synthetic patch materials (PTFE, Dacron) and autologouspatch materials (saphenous and jugular veins) areused. We report a case of carotid endarterectomy and ‘Y’shaped saphenous patchplasty to the carotid bifurcation.According to our research in the literature, we didn’t findany case with ‘Y’ shaped saphenous vein patch. Therewas only one Y shaped carotid patchplasty case by usingPTFE material. Our original technic is advantageous interms of easy preparation and application as well as itssuccessful outcome.Key words: Carotid artery diseases, saphenous vein,patchplast

PPI kullanımının clostridium difficile serum antijen değerlerine olan etkisi

Aim: To evaluate the effects of proton-pump inhibitor (PPI) use on distrubtion of intestinal flora by measuring serum Clostridium Difficile antigen levels before and at the end of a three- months treatment in patients with Laryngopharyngeal reflux (LFR) treatment. Material and Method: The study covers 32 patients with LFR, out of which 24 were female (75%) and 8 were male (25%). The mean age of the patients was 34.13 +/- 11.59. All patients included in the study were administered Lansoprazole 30 mg tablets perorally before meals and twice a day for treatment. Reflux Symptom Index (RSI), Reflux Finding Score (RFS), white blood cell count, CRP and serum Clostridium Difficile toxin A, B measurement results were comparatively evaluated through the blood serum samples drawn from the patients before and at the end of the three- months treatment. Results: While the mean values of pre-treatment RSI and RFI were 20.81 +/- 4.05 and 13.31 +/- 3.30 respectively, the mean values were measured to be 3.41 +/- 2.37 and 1.50 +/- 1.88 respectively following the three- months treatment (p< 0.05). The pre-treatment mean value of serum Clostridium Difficile Ag was 140.56 +/- 11.74, while it was seen that the same value became 114.94 +/- 10.70 after the three- months treatment (p< 0.05). There was, however, no statistically significant change in the other parameters. Discussion: According to the results obtained, it was seen that the treatment with PPI was not cause to increase Clostridium difficile toxin A, B serum antigen levels. So these drugs could be used in long time therapies confidently.Amaç: Larengofarengeal Reflü (LFR) hastalığının tedavisi amacıyla Proton pompa inhibitörü (PPİ) kullanan hastalarda tedavi öncesi ve üç aylık tedavinin sonunda serum Clostridium Difficile antijen miktarı ölçülerek PPİ kullanımının serum Clostridium Difficile serum antijen miktarı üzerindeki etkisinin değerlendirilmesi. Gereç ve Yöntem: Çalışmaya LFR hatalığı tespit edilen 32 hasta ( 24 ( % 80)’ü kadın, 8 (% 20)’i erkek) dahil edildi. Hastaların yaş ortalaması 34.13 ± 11.59 idi. Çalışmaya dahil edilen tüm hastalara tedavi için günde iki kez yemeklerden önce alınacak şekilde lansoprazol 30 mg tablet peroral olarak başlandı. Tedavi öncesinde ve üç aylık tedavinin sonunda hastaların LFR şiddeti Reflü Semptom İndeksi ( RSI) ve RBS ( Reflü Bulgu Skoru) kullanılarak değerlendirildi. Ayrıca hastalardan tedavi öncesi ve üç aylık tedavinin sonunda alınan kan serum örneklerinde beyaz küre, CRP, sedimantasyon ve serum Clostridium Difficile toxin A, B ölçümleri yapılarak karşılaştırmalı olarak değerlendirildi. Bulgular: Tedavi öncesi RSI ve RBS ortalamaları sırasıyla 20.81±4.05 ve 13.31±3.30 iken, üç aylık tedavi sonrasında bu ortalamalar sırasıyla 3.41±2.37 ve 1.50±1.88 olarak tespit edildi ( p< 0,05). Tedavi öncesi serum Clostridium Difficilie Ag değerlerinin ortalaması 140.56±11.74 iken üç aylık tedavi sonrasında bu ortalamanın 114.56±10.70 olduğu görüldü ( p 0,05). Tartışma: Elde ettiğimiz sonuçlara göre, proton pompa inhibitörü kullanan hastaların Clostridium difficilie toxin A, B serum antijen düzeylerinde istatistiksel olarak anlamlı bir düşüş olduğunu görüldü

Clinical evaluation of an antero-medial approach for plate fixation of the proximal humeral shaft

Objective Surgical approach of fractures of the proximal humeral shaft should protect the muscular insertions and the vascularisation of fragments, improving bone union and functional recovery. The aim of this study is to review cases operated with an original anteromedial approach, in cases of specific fractures of the proximal humeral shaft. Materials and methods Prior to clinical application, a cadaveric study was accomplished. Based on the results, six clinical cases had surgery using an approach medial to the biceps and brachialis. The osteosynthesis was performed with locked plates and 4.5 screws. The approach was indicated in fractures presenting with a large lateral wedge including the deltoid muscle insertion. Stable osteosynthesis achieved with this approach allowed early postoperative mobilization of the arm in all cases. Results The case-series consisted of three women and three men with a mean age of 52.1 years (range 38–68). The minimal follow-up was 1 year. Bone union was observed at an average time of 11.2 weeks. There were no intra- or postoperative complications. Discussion Open reduction and internal fixation with compression plating is a standardized and successful procedure in the treatment of humeral fractures. Internal fixation with lateral plating is difficult in the proximal third of the humeral shaft, where the positioning of the implant may hurt the long biceps tendon and the deltoid insertion. This approach was successful and safe in the presented cases. Conclusion The antero-medial approach with metaphyseal locking plate protects the muscular insertions and the vascularisation of the wedge fragment, leading to good results in all the cases in this series

Arthroscopic release of the subscapularis for shoulder contracture of obstetric palsy

Objective Retrospective study of one surgeon’s experience with arthroscopic release in obstetrical brachial plexus palsy. Methods Over a four-year period, 6 patients who presented with a shoulder contracture secondary to obstetric palsy before the age of 8 years were treated arthroscopically. Small arthroscopy instruments, small shaver blades, including a 2.7-mm, 30° angled scope, and 90° radiofrequency probe, were used for this surgery. Patient selection for this approach was based on the lack of bone deformity and targeted soft tissue release. Postoperative brace immobilization for 6 weeks was used in all patients. Functional status of the patients was evaluated pre- and postoperatively with the assessment of external rotation. Results The case series consisted of 2 girls and 4 boys with a mean age of 5.1 years (range, 3–8 years). No patient was lost to follow-up, and all patients completed a minimum 1 year of clinical and radiographic follow-up. Increases in external rotation were observed in all patients. There was no intra- or postoperative complications. Conclusion Arthroscopic treatment of the shoulder contracture in obstetric palsy was found to be a safe and eVective procedure in patients who are likely to undergo future tendon transfer or bone surgery

Open heart surgery in dialysis-dependent patients with end stage renal failure

Objective: Patients with chronic renal insufficiency remaina risky subgroup in open heart surgery becauseof various reasons. The incidence of cardiovascular diseasein hemodialysis dependent renal failure is found tobe higher when compared with the normal population.Chronic dialysis is still a very important independent riskfactor for mortality and morbidity despite of many studies.In this study, we retrospectively evaluated the outcome ofpatients with chronic renal failure who had undergone toopen cardiac surgery.Methods: The medical charts of 36 patients on maintenancedialysis who underwent cardiovascular surgerywere retrospectively analyzed. Peroperative findings ofthese patients were analyzed from patients’ hospital records.Results: Twenty-seven men (75%) and nine women(25%) totally 36 patients were included to study. Themean age was 58.3±8.5 (range, 44-76) years. 12 patientsunderwent coronary artery bypass surgery, 10 hadconcomitant coronary artery bypass surgery and valvereplacements, five had valve replacements, three hadconcomitant coronary artery bypass surgery and left ventriculectomy,four had valve replacement with other valverepair, two had aortic surgery due to ascending aortic aneurysms.The mean cross clamp time was 78.1±31.3 minand the mean perfusion time was 158.8±92.2 min. Themean intensive care unit stay was 60±41 hours, and themean hospital stay was 12±5 days. Hospital mortality ratewas %38.8.Conclusions: Cardiac and renal functions are closely associatedwith each other. Cardiac surgery operations canbe applied to patients with end-stage renal failure underacceptable risks. Appropriate preoperative preparationwith good postoperative patient follow-up is necessary tohave acceptable levels of morbidity and mortality rates. JClin Exp Invest 2013; 4 (3): 335-338Key words: Cardiac surgery, chronic renal failure, mortalit

Anesthetic management in endovascular treatment of aortic pathologies

Objective: In this study we aimed to compare the anesthesia methods we used in the endovascular treatment of thoracic and abdominal aorta pathologies and to discuss accompanied by literature. Methods: Our study was carried out be retrospectively assessing a total of 20 patients on whom we had administered endovascular treatment for aortic aneurism and aortic dissection. The demographic features of the patients, their American Anesthesia Association (ASA) scores, laboratory findings, accompanying diseases, whether they smoke, their ejection fraction and the place and type of aortic pathology was recorded. Also the surgical procedure, anesthesia method, the amounts of crystalloids, colloids and blood products used during the surgery, the anesthesia and surgery durations, complications and interventions, duration of stays in intensive care and the hospital in general and the mortality rates were recorded. All cases were provided with standard anesthesia monitoring. Results: A total of 20 (M=15, F=5) cases were included in our study. 16 of our cases were in ASA 3 risk group and 4 were in ASA 4 risk group. While patients who had been administered with thoracic endovascular aortic repair (TEVAR) were all given general anesthesia, seven patients who had been administered with abdominal endovascular aortic repair (EVAR) were given regional and 6 were given general anesthesia and one case was only given sedoanalgesia. While 8 of the patients administered with EVAR had hypertension all of the patients administered with TEVAR had hypertension. No significant differences were found in blood and blood product transfusions, preoperative and postoperative hemoglobin, hematocrit, urea and creatinine values between two groups. Conclusion: In EVAR and TEVAR applications general anesthesia, regional anesthesia, sedoanalgesia accompanied by local anesthesia can be successfully administered depending on the patient’s status and the location of the procedure

Malatya Yöresinde Organik Kayısı Yetiştiriciliği

Bu çalışma, Malatya yöresinde organik tarım tekniğinde yer alan bitki besleme uygulamalarını konvansiyonel uygulamasıyla karşılaştırarak, kayısı yetiştiriciliği için en uygun organik tarım programını oluşturmak amacıyla planlanmıştır. Çalışma 2002-2006 yıllarında Malatya ili Akçadağ ilçesi Karapınar Köyü’nde, 5 yıldır sertifikalı olarak organik tarım yetiştiriciliği yapılan, 15 yaşında, 10x10 m aralık ve mesafede dikilmiş Hacıhaliloğlu kayısı çeşidinden kurulu kayısı bahçesinde yürütülmüştür. Bu bahçenin yakınında, konvansiyonel tarım sisteminin uygulandığı, 15 yaşında ve 10x10 m aralık ve mesafe ile dikilmiş Hacıhaliloğlu kayısı çeşidinden kurulmuş bir üretici bahçesi de kontrol bahçesi olarak kullanılmıştır. Deneme tesadüf blokları deneme desenine göre 3 tekerrürlü ve her tekerrürde 3 ağaç olacak şekilde kurulmuştur. Çalışmada, organik tarım sistemine uygun 5 farklı bitki besleme uygulaması A (Toprağa Ticari Organik Gübre + Toprağa Çiftlik Gübresi + Yeşil Gübre Uygulaması), B (Toprağa Ticari Organik Gübre + Toprağa Humik Asit Uygulaması), C (Toprağa Ticari Organik Gübre + Toprağa Çiftlik Gübresi Uygulaması), D (Toprağa Organik Gübre + Yeşil Gübre Uygulaması) ve E (Toprağa Ticari Organik Gübre + Yaprağa Ticari Organik Gübre Uygulaması) yapılmıştır. Uygulamaların meyve verim ve kalitesi üzerine etkileri ile ekonomik analizleri yapılmıştır. Uygulamaların ortalama ağaç başına ve gövde kesit alanına verim değerleri üzerine etkisi %1 düzeyinde önemli bulunmuştur. En yüksek ağaç başına ve gövde kesit alanına verim değerleri sırası ile 111.30 kg/ağaç ve 0.18 kg/cm2 ile kontrol uygulamasından, organik uygulamalardan ise en yüksek verim 83.09 kg/ağaç ve 0.16 kg/cm2 ile A uygulamasından elde edilmiştir. En düşük verim ise 55.25 kg/ağaç ve 0.10 kg/cm2 ile D uygulamasından elde edilmiştir. Çalışmanın sonucunda, Malatya koşullarında verim, kalite ve net karlılık kriterleri göz önüne alınarak, organik kayısı yetiştiriciliği için A kombinasyonunun (Toprağa Ticari Organik Gübre Uygulaması + Toprağa Çiftlik Gübresi Uygulama + Yeşil Gübre Uygulaması), tavsiye edilebilir ve uygulanabilir en uygun organik kombinasyon olduğu saptanmıştır

Hearing Thresholds and Serum Apelin Levels in Patients with Vertebrobasilar Insufficiency

Objective: Vertebrobasilar insufficiency (VBI) is a clinical entity that results from the decrease in flow volumes due to hemodynamic changes in the vertebral artery and its branches. Herein, we aimed to investigate the hearing thresholds and serum apelin levels in VBI patients who were admitted to our clinics with vertigo.Methods: Patients who were admitted to our clinics with vertigo were included in our study. They underwent bilateral carotid and vertebral artery color Doppler ultrasound investigation to determine VBI. Then, they were grouped into two groups: having VBI or not. Pure tone audiometry tests between 2500-8000 Hertz (Hz) were applied, and plasma levels of apelin, routine biochemistry parameters, and levels of C-reactive protein were studied in these patients.Results: Thirty-eight (47% women, mean age 57.6±9.3) patients with VBI and 24 controls (50% women, mean age 57.0±10.1) were included. In patients with VBI, hearing thresholds were higher in the left ear except at the 500 Hz frequency. Serum apelin levels were not statistically different between the 2 groups.Conclusion: In this study, several abnormalities in hearing tests were determined in VBI patients. The hypothesis was that basilar artery dysfunction caused by asymmetry of vertebral artery flow volumes in VBI might increase apelin levels, which have functions in angiogenesis, hemostasis, and cardiovascular hemodynamics. However, we could not find a significant difference in apelin levels between the 2 groups. This result was thought to be due to the absence of severe hemodynamic abnormalities and atherosclerosis in the study groups