Glutaraldehidin kazara epidural uygulanmasının ağır komplikasyonu

Epidural anestezi altında sol femoropopliteal bypass uygulanan hastaya ameliyat sonrası altıncı saatte epidural kateter yoluyla kazara 3 ml %3 glutaraldehid solüsyonu uygulandı. Glutaraldehid uygulamasını takiben hastada hipotansiyon, taşikardi, bulantı ve kusma gibi sistemik semptomlara ek olarak parapleji gelişti. Bir yıllık medikal tedavi ve rehabilitasyon programı sonunda nörolojik semptomlarda iyileşme olmadı.In a patient operated for left femoropopliteal bypass under epidural anesthesia, 3 ml of 3% glutaraldehyde solution was administered through the epidural catheter at the postoperative sixth hour accidentally. Following glutaraldehyde administration, the patient developed paraplegia in addition to systemic symptoms such as hypotension, tachycardia, nausea and vomiting. At the end of the first year, neurologic symptoms didn't improve despite medical treatment and rehabilitation program

A complication of venous cut-down: Migration of catheter that remained in the vein

Amiyotrofik lateral skleroz tanısıyla takip edilen, parenteral besleme ve tıbbi tedavi amacıyla sol kolda sefalik vene cut-down yaklaşımıyla santral kateterizasyon uygulanan 32 yaşındaki bir erkek hastada, gerekli tedavilerin tamamlanmasından sonra kateterin çekilmesi aşamasında kateter koparak büyük bir kısmı hastanın venöz yapıları içinde kaldı. Posterior-anterior akciğer grafisinde yeri bulunan kateter, subklaviyan venden yapılan venotomi ile çıkarıldı.A 32-year-old male patient who was followed-up with a diagnosis of amyotrophic lateral sclerosis was inserted a catheter into the left arm via cephalic vein cut-down in order to maintain parenteral nutrition and medical treatment. After the treatment, while the catheter was being removed, it was broken and a large part of it remained in the vessel. The catheter was located on a posteroanterior chest radiograph and removed by venotomy of the subclavian vein

Leser-Trélat sign: Does it really exist?

Leser-Trelat sign is a rare cutaneous disorder that appears by sudden emergence of seborrheic keratoses and increase in their numbers and size just in weeks or months. Its cooccurence with many kinds of malignancies, especially with adenocarcinoma and lymphoma, has been reported in literature. In this case report, a patient having Leser Trélat sign, without any detected malignancy in spite of a detailed examination and 18 months of follow-up, is presented. The current literature is being discussed whether Leser-Trélat is a paraneoplastic syndrome or not

The relationship between preoperative plasma total antioxidant capacity and ischemia-reperfusion injury in patients undergoing coronary artery bypass surgery

Amaç: Miyokardiyumda iskemi-reperfüzyon sırasında oluşan hasarın oksidatif stresten kaynaklandığı ileri sürülmektedir. Bu çalışmada bazal total antioksidan kapasite (TAOK) düzeyinin iskemi-reperfüzyon hasarına olan etkisi incelendi. Hastalar ve Yöntemler: Koroner bypass ameliyatı uygulanan 21 hastanın koroner sinüslerinden koroner bypass başlamadan önce (bazal durum), iskemi sonunda, çapraz klemp kaldırıldıktan beş dakika sonra (erken reperfüzyon) ve yan klemp kaldırıldıktan 15 dakika sonra (geç reperfüzyon) kan örnekleri alındı. Total antioksidan kapasite, lipid peroksit (LPO) ve laktat dehidrogenaz (LDH) düzeyleri ölçüldü. Hastalar bazal TAOK düzeyine göre iki gruba ayrıldı: TAOK değeri %60'dan düşük bulunan 10 olgu grup I'i (8 erkek, 2 kadın; ort. yaş 57), %60 veya üzeri olan 11 olgu grup II'yi (10 erkek, 1 kadın; ort. yaş 53) oluşturdu. Bulgular: Ameliyat süresince her iki grupta da LDH ve LPO düzeyleri ameliyat döneminde artarken, TAOK düzeylerinin baskılandığı görüldü. Grup I’de LDH ve LPO salınımı grup II’den fazla idi. Ameliyat öncesi ve ameliyat süresince TAOK düzeyleri grup I'de grup II'den anlamlı derecede düşük bulundu (ameliyat öncesi, iskemi ve erken reperfüzyon dönemleri için p<0.001, geç reperfüzyon dönemi için p<0.05). Bazal TAOK ile LPO arasında tüm evrelerde, LDH ile geç reperfüzyon döneminde negatif ilişki görüldü. Sonuç: Ameliyat öncesindeki düşük TAOK değerlerinin iskemi-reperfüzyon hasarı ve miyokard hasarının şiddetiyle ilişkili olduğu sonucuna varıldı.Objectives: Oxidative stress has been implicated in the occurrence of myocardial injury during ischemia-reperfusion. The aim of this study was to investigate the effect of basal total antioxidant capacity (TAOC) on ischemiareperfusion injury. Patients and Methods: Blood samples were taken from the coronary sinus of 21 patients prior to coronary bypass (basal), at the end of ischemia, five minutes after the removal of the cross clamp (early reperfusion), and 15 minutes after the removal of the lateral clamp (late reperfusion). The levels of TAOC, lipid peroxide (LPO), and lactate dehydrogenase (LDH) were determined. The patients were divided into two groups as follows: group I included 10 patients (8 males, 2 females, mean age 57 years) with TAOC &lt;%60 and group II included 11 patients (10 males, 1 female, mean age 53 years) with TAOC .%60. Results: The levels of LDH and LPO increased, while those of TAOC were suppressed in both groups throughout surgery. The levels of LDH and LPO were higher in group I than those of group II. The TOAC levels in group I were invariably and significantly lower than those of group II (for basal, ischemia, early reperfusion periods, p&lt;0.001; late reperfusion, p&lt;0.05). Inverse relationships were found between the basal TOAC and LPO at all the periods, and with LDH in the late reperfusion period. Conclusion: Our data suggest that basal TAOC values may be associated with ischemia-reperfusion injury and the degree of ensuing myocardial damage

Successful treatment of generalised discoid lupus erythematosus with imiquimod cream 5%: A case report and review of the literature

Discoid lupus erythematosus (DLE) is the most common form of chronic cutaneous lupus erythematosus and tends to heal with scarring, hair loss and pigmentary changes if treatment is not initiated in the early phase of the disease. Classic DLE lesions are initially red-purple macules, papules or small plaques that rapidly acquire a hyperkeratotic appearance. Only a minority of the patients with DLE progress to develop systemic lupus erythematosus (SLE). A small percentage of patients with SLE have concomitant DLE. However, generalised DLE is more frequently associated with systemic involvement than classic DLE. The diagnosis of DLE is usually based on clinical features, although in some cases histopathologic examination may be required to confirm the diagnosis. Standard therapy for cutaneous lupus includes broad-spectrum sunscreens, topical and intralesional glucocorticoids and antimalarial agents. A 63-year-old man presented with erythematous scaly patches that he had had on his face for approximately eight months. Although it was mainly his face that was affected, lesions were also noted on his scalp, neck, chest, shoulder, upper arms and trunk. Histopathologic examination verified the diagnosis of DLE. No systemic involvement was detected through laboratory examinations or consultations with the other departments. Imiquimod cream 5% was applied three times a week, every other week. After 24 applications over a period of two months an almost complete improvement was achieved. Topical imiquimod may, then, be an alternative treatment for generalised DLE

Syndrome of Inappropriate Secretion of Antidiuretic Hormone Cholestasis and Pericardial Effusion Due to Brucellosis Infection: A Case Report

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is an extremely rare complication of infectious diseases. A rare case of brucellosis complicated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH) cholestasis and pericardial involvement is reported. A 27-year-old woman was admitted for fever, abdominal pain, and scleral icterus. Her medical history revealed no recent use of diuretic agents. In addition to cholestasis and elevated liver enzymes, euvolemic hyponatremia, hypouricemia, low plasma osmolality, and high urinary osmolality were also detected. Surrenal and thyroid tests were also within normal range. Echocardiography revealed minimal pericardial effusion with normal cardiac functions. The final diagnosis was SIADH due to Brucellosis. Hyponatremia, cholestasis, and pericardial disease were resolved with effective antibrucellar treatment with streptomycine and doxycycline. After completing treatment of brucellosis, there was not any more evidence of cholestasis and pericardial fluid

The Role of Chlamydia pneumoniae in the Atherosclerotic Process of Patients under 50 Years of Age Who Underwent Coronary Artery Bypass Graft Surgery

ABSTRACT Background: To evaluate the presence of C. pneumoniae DNA in the tissues and C. pneumoniae DNA antibodies in the blood samples of patients who underwent CABG surgery. Material and Methods: Fifty-one patients &lt;50 years of age were included in the study, and analyzed in two groups according to the intimal thickness of aorta. C. pneumoniae DNA was evaluated in the tissues collected from the atrium, left internal thoracic artery and ascending aorta of patients. Results: Although, C. pneumoniae DNA was negative in the atrial and left internal thoracic artery tissues of all patients, it was positive in the tissues obtained from the ascending aortas of twelve patients. C. pneumoniae DNA positivity was significantly higher in patients with increased aortic intimal thickness compared to those without increased aortic thickness. Conclusion: The question whether C. pneumoniae is triggering atherosclerosis or is involved as a superinfection could not be clarified

Off-pump coronary artery bypass grafting: Edirne experience

Amaç: Çalışan kalpte koroner baypas (off-pump) tekniğiyle ameliyat edilen olguların orta dönem sonuçları değerlendirildi. Çalışma Planı: Bu retrospektif çalışmaya 1999-2003 yılları arasında off-pump baypas yapılan 60 olgu (45 erkek, 15 kadın; ort. yaş 62±9.1; dağılım 42-78) alındı. Ameliyatlar aynı cerrah tarafından gerçekleştirildi. Hasta verileri ameliyat ve yoğun bakım kayıtları taranarak elde edildi. Dosyalardaki adres veya telefon numaralarından hastalara ulaşılarak son durumları öğrenildi. Ortalama takip süresi 23.3±14.9 ay (dağılım 1.1-59.4 ay) idi. Bulgular: Hiçbir hastada ameliyat anında miyokard infarktüsü görülmedi. Ameliyat sonrası erken dönemde hiçbir hasta kaybedilmedi, geç dönem mortalite dört hastada (%6.7) görüldü. Beş yıllık sağkalım Kaplan-Meier yaşam analizine göre %66 bulundu. Sonuç: Bulgularımız, çalışan kalpte koroner baypas ameliyatının güvenli ve rahat uygulanabilir bir teknik olduğu yönündedir.Objectives: The aim of this study was to evaluate the mid-term results of off-pump coronary artery bypass surgery. Study Design: The study included 60 patients (45 males 15 females; mean age 62&plusmn;9.1 years; range 42 to 78 years) who underwent off-pump coronary artery bypass operation in our clinic between 1999 and 2003. All operations were performed by the same surgeon. Data were collected by review of operation and intensive care unit records. Final status of the patients were inquired by telephone calls. The mean follow-up period was 23.3&plusmn;14.9 months (range 1.1 to 59.4 months). Results: Perioperative myocardial infarction was not detected in any patient. No postoperative mortality occurred in the early period. Late mortality was found in four patients (6.7%). Five-year survival was 66% using the Kaplan-Meier survival analysis. Conclusion: Our results show that off-pump coronary artery bypass can be performed with safety and comfort

Tubular gastric adenocarcinoma: machine learning-based CT texture analysis for predicting lymphovascular and perineural invasion

PURPOSELymphovascular invasion (LVI) and perineural invasion (PNI) are associated with poor prognosis in gastric cancers. In this work, we aimed to investigate the potential role of computed tomography (CT) texture analysis in predicting LVI and PNI in patients with tubular gastric adenocarcinoma (GAC) using a machine learning (ML) approach.METHODSSixty-eight patients who underwent total gastrectomy with curative (R0) resection and D2-lymphadenectomy were included in this retrospective study. Texture features were extracted from the portal venous phase CT images. Dimension reduction was first done with a reproducibility analysis by two radiologists. Then, a feature selection algorithm was used to further reduce the high-dimensionality of the radiomic data. Training and test splits were created with 100 random samplings. ML-based classifications were done using adaptive boosting, k-nearest neighbors, Naive Bayes, neural network, random forest, stochastic gradient descent, support vector machine, and decision tree. Predictive performance of the ML algorithms was mainly evaluated using the mean area under the curve (AUC) metric.RESULTSAmong 271 texture features, 150 features had excellent reproducibility, which were included in the further feature selection process. Dimension reduction steps yielded five texture features for LVI and five for PNI. Considering all eight ML algorithms, mean AUC and accuracy ranges for predicting LVI were 0.777–0.894 and 76%–81.5%, respectively. For predicting PNI, mean AUC and accuracy ranges were 0.482–0.754 and 54%–68.2%, respectively. The best performances for predicting LVI and PNI were achieved with the random forest and Naive Bayes algorithms, respectively.CONCLUSIONML-based CT texture analysis has a potential for predicting LVI and PNI of the tubular GACs. Overall, the method was more successful in predicting LVI than PNI

Electrophysiological evaluation of phrenic nerve injury during cardiac surgery – a prospective, controlled, clinical study

BACKGROUND: According to some reports, left hemidiaphragmatic paralysis due to phrenic nerve injury may occur following cardiac surgery. The purpose of this study was to document the effects on phrenic nerve injury of whole body hypothermia, use of ice-slush around the heart and mammary artery harvesting. METHODS: Electrophysiology of phrenic nerves was studied bilaterally in 78 subjects before and three weeks after cardiac or peripheral vascular surgery. In 49 patients, coronary artery bypass grafting (CABG) and heart valve replacement with moderate hypothermic (mean 28°C) cardiopulmonary bypass (CPB) were performed. In the other 29, CABG with beating heart was performed, or, in several cases, peripheral vascular surgery with normothermia. RESULTS: In all patients, measurements of bilateral phrenic nerve function were within normal limits before surgery. Three weeks after surgery, left phrenic nerve function was absent in five patients in the CPB and hypothermia group (3 in CABG and 2 in valve replacement). No phrenic nerve dysfunction was observed after surgery in the CABG with beating heart (no CPB) or the peripheral vascular groups. Except in the five patients with left phrenic nerve paralysis, mean phrenic nerve conduction latency time (ms) and amplitude (mV) did not differ statistically before and after surgery in either group (p > 0.05). CONCLUSIONS: Our results indicate that CPB with hypothermia and local ice-slush application around the heart play a role in phrenic nerve injury following cardiac surgery. Furthermore, phrenic nerve injury during cardiac surgery occurred in 10.2 % of our patients (CABG with CPB plus valve surgery)