A rare complication of recurrent cerebrovascular infarct: Bilateral vocal cord paralysis

Bilateral vocal cord paralysis (BVCP) is usually the result of an iatrogenic injury especially secondary to thyroid and parathyroid surgery. However, BVCP that cause airway obstruction due to serebral cortical stroke very rarely has been reported. We, herein report a case of BVCP that resulted in respiratory arrest as a late and life threatening complication of recurrent cerebral infract. A 67 years old male patient admitted the emergency room with complaint of respiratory insufficiency. His complaint was progressed during last 3-4 months. He had two cerebral infractions attacks in a month approximately one year ago. On admission, physical examination revealed that, he had bilateral wheezing and stridor. He had right sided hemiplegia and had no history of heart failure or chronic obstructive lung disease. Endoscopic laryngoscopy was performed to evaluate upper airway obstruction. Laryngoscopy revealed that bilateral vocal cords were fixed and immobile at midline. Due to recurrent respiratory arrest, insufficient and fixed BVCP, open tracheostomy was perormed. After operation, he had no respiratory insufficiency or any complications. So he discharged from hospital with normal respiratory function

The evaluation of Pat-Pat related injuries in the western black sea region of Turkey

BACKGROUND: Accidents caused by motorized vehicle in the agricultural sector are frequently observed. In Turkey; accidents arising from motorized vehicles, named Pat-Pat, which are used by farmers in the Western Black Sea region is not unusual. METHODS: One hundred five patients who were brought into the Emergency Department of Duzce University, Medical Faculty Hospital between September 2009 and August 2010 due to Pat-Pat related accidents were evaluated. RESULTS: The cases consisted of 73 (69.5%) males and 32 (30.5%) females, ranging from 2 to 73 years of age. In the 10-39 age group, a total of 63 (60.0%) cases were determined. The months when the greatest rate of cases applied to the hospital consisted of July, August, September and the season is summer. The cases were exposed to trauma in roads in 54 (51.4%), and 51 (48.6%) occurred in agricultural area without roads. Eighty seven (82.9%) cases were injured due to the overturning of vehicle. The patients were brought to the hospital using a private vehicle in 54 (51.4%) of the cases and in 51 (48.6%) cases, 112 ambulance system was used. The cases were determined to apply to the hospital most frequently between 6 pm-12 am. The injuries frequently consisted of head-neck and spine traumas, thorax traumas and upper extremity traumas. In 55 (52.4%) cases, open wound-laceration was determined. Seventy five (71.4%) cases were treated in the Emergency Department, and 28 (26.7%) were hospitalized. Three (2.9%) cases were deceased. CONCLUSIONS: Serious injuries can occur in Pat-Pat related accidents, and careful systematic physical examination should be conducted. In order to prevent these accidents, education of farm operators and engineering studies on the mechanics and safety of these vehicles should be taken and legal regulations should be created

Positional and nonpositional obstructive sleep apnea sendrom patient comparison of anthropometric, demographic, polysomnographic and clinical characteristics

YÖK Tez No: 282065GİRİŞ ve AMAÇ: OUAS ?Uykuda tekrarlayan üst solunum yolu (ÜSY) tıkanmaları ile karakterize ve sıklıkla oksijen desatürasyonları ile birliktelik gösteren bir sendrom? olarak tariflemiştir. Erkeklerde %3.9 kadınlarda %1.2 olmak üzere oldukça sık görülmektedir.Bu çalışmayla Pozisyonel (P) ve Nonpozisyonel (NP) OUAS hastalarının antropometrik, demografik, polisomnografik ve klinik özelliklerini karşılaştırılarak P ve NP OUAS arasında anlamlı farklılıklar gösterilebilirse bu grup hastaların tedavi ve takiplerinde olası farklı yaklaşımların klinisyenlerin dikkatine sunulması amaçlanmıştır.YÖNTEM: Düzce Üniversitesi Tıp Fakültesi Uyku laboratuarında 4 yıl boyunca Polisomnografik tetkik ile Obstrüktif Uyku Apne Sendromu tanısı alan ardışık 108 olgunun kayıtları retrospektif olarak hastalığın pozisyonla ilişkisi açısından yeniden değerlendirildi.BULGULAR: Olguların 76'sı erkek, 32'si kadındı. OUAS majör semptomları sorgulandığında olguların %98.1inde (106/108) horlama olduğu, %89.6'sında ise (95/106) bu horlamanın habitüel olduğu tespit edildi. Gündüz aşırı uykululuk hali %79.6'sında (82/103), tanıklı apne %81'inde (85/105) tesbit edildi. OUAS hastalarının 26'sı Pozisyonel OUAS (%24,1), 82 tanesi Nonpozisyonel OUAS (%75,9) olarak tespit edildi. NP OUAS'lu olguların yaş ortalaması 50.1, kilo ortalaması 88.5, boy oratalaması 165.5, BMI ortalaması 32.5, boyun genişliği ortalaması 41.2, P OUAS'li olguların yaş ortalaması 49.6, kilo ortalaması 94.3, boy oratalaması 173.4, BMI ortalaması 31.6, boyun genişliği ortalaması 41.6 olarak tesbit edildi. P grubunun boy ortalaması (173.4cm), NP grubunun boy ortalamasından (164.9cm) istatistiksel anlamlı olarak daha yüksek bulundu. P ve NP grupları AHİ yönünden karşılaştırıldığında P grubunda AHİ'nin anlamlı olarak daha düşük olduğu tespit edildi. P ve NP grupları karşılaştırıldığında P OUAS grubun istatistiksel anlamlı olarak erkek ağırlıklı olduğu görüldü. P ve NP OUAS olgularında tek değişkenli analiz yöntemleri ile anlamlı bulunan cinsiyet, AHİ ve boy kullanılarak yapılan lojistik regresyon analizinde P OUAS oluşumuna etki eden tek bağımsız risk faktörünün boy olduğu tespit edildi.SONUÇ: Göğüs Hastalıkları kliniklerine ve uyku merkezlerine başvuran OUAS klinik semptomları belirgin olan uzun boylu hastalara polisomnografi tetkiki için uzun süreli randevu verilecekse bu sürede hastaların tedavisiz kalmaması ve hastalığının şiddetinin artmaması için pozisyon tedavisi önerilebilir.Pozisyonel ve Nonpozisyonel OUAS'lu hastalara klinisyenlerin yaklaşımlarını yönlendirecek antropometrik, demografik, polisomnografik ve klinik özellikleri araştıran ve özellikle Pozisyonel OUAS ile uzun boy ilişkisini açıklayacak daha büyük çaplı prospektif çalışmalara gereksinim vardır.ANAHTAR KELİMELER: pozisyonel obstruktif uyku apne sendromu, uyku apne, pozisyonel uyku apne, uyku apne tedavisi, boyBACKGROUND and AIM: OSAS is defined as ?a syndrome which characterized by repeated upper air way tract obstruction and associated with oxygen desaturation?. It is prevalent of 3.9% in female and 1.2% in male population.In the present study, it was aimed to compare clinical, anthropometric, demographic and polysomnographic features between patients with Positional (P) and Non-positional (NP) OSAS, and present different treatment approaches and follow-up in both group patients depending on results of our study to clinicians.METHODS: Medical records of 108 consecutive patients with OSAS diagnosed by polysomnographic tests since 4 years in Sleep Laboratory of School of Medicine, Cheat Disease Department, Duzce University, were retrospectively re-evaluated with patients? positional relationRESULTS: 76 and 32 of all subjects was male and female, respectively. There was symptom of snoring in 98.1% of patients (106/108), and it was detected that snoring in 89.6% (95/106) of patients presented with snoring was habitual. Daylight somnolence (82/103), apnea (85/105) which confirmed by someone was detected in 79.6% and 81% of subjects.26 (24.1%) and 82 (75.9%) patients with OSAS was P- and NP-OSAS. In patients NP-OUAS, mean age, weight, height, body mass index and neck circumference were 50.1, 88.5, 165.5, 32.5 and 41.2. In patient with P-OSAS, mean age, weight, height, body mass index and neck circumference were 49.6, 94.3, 173.4, 31.6 and 41.6. Mean height in patients with P- OSAS was found to be significantly higher than in NP- OSAS. When AHI was compared between patients with P- and NP- OSAS, AHI was significantly lower in patients with P-OSAS. The number of male patients in P-OSAS was significantly higher. With logistic regression analysis, it was detected that height was independent risk factor for P-OSAS among gender, AHI and height confounding factors.CONCLUSION: Position treatment could advised to tall patients presented with symptoms related to OSAS, admitted to outpatient clinic of chest diseases and sleep disorder center, and to prevent to worsen his/her symptom when appointment for polysomnography tests would be dated forward.Comprehensive prospective studies on anthropometric, demographic, polysomnographic and clinical features in patients with NP-OSAS and P-OSAS, especially relation between tall height and P-OSAS, are needed

Reversible Hepatotoxicity of Mirtazapine in a Patient with Major Depression

WOS: 000292729200014Mirtazapine is a noradrenergic and specific serotonergic antidepressant that is approved for use in the treatment of major depression. It is generally well tolerated with some mild side effects such as drowsiness, excessive sedation, increased appetite, weight gain, and dry mouth. We present a case of 23 years old female depressive patient who developed abdominal pain and elevation of liver enzymes during treatment with mirtazapine and returned to normal after stopping the mirtazapine use. (Archives of Neuropsychiatry 2011; 48: 162-3

Primary Hydatid Cyst of the Chest Wall

WOS: 000308968400015PubMed: 22249910

Management of traumatic pneumothorax

PubMed ID: 20890013[No abstract available