Introduction: Vitamin D deficiency is a common problem throughout the world. Also vitamin D deficiency has been reported in up to 82% of patients in intensive care unit (ICU). In addition, corticosteroid insufficiency is a common problem in ICU patients. In this study, we investigated the effects of initial cortisol and vitamin D levels on mortality, hospital infection development and intubation status in geriatric ICU patients. Methods: This study was conducted in a tertiary ICU. In a one-year period, 117 consecutive ICU patients older than 65 years of age were evaluated retrospectively. Looking at the first with Vitamin D and cortisol levels of the patients were collected in the first 24 hours of hospitalization. At follow up period, relationship between these data’s and mortality, hospital infection, and intubation conditions were evaluated. Results: Initial Vitamin D, the morning cortisol, and albumin levels were found to be significantly lower (respectively; p <0.001, p <0.001 and p <0.001), and lactate levels were found to be significantly higher (p <0.001) in patients who died in ICU than alive patients. Development rate of hospital-acquired infection was found to be significantly higher (p = 0.025) in patients with low vitamin D levels than alive patients. Vitamin D and cortisol levels were found to be lower and lactate levels were found to be higher (respectively: p <0.001, p = 0.004, p = 0.035) in intubated patients than alive patients. Conclusion: In geriatric patients, relationship between initial vitamin D and cortisol levels and mortality, hospital infection and intubation conditions were evaluated in our study for the first time. The low level of vitamin D is seen as an important risk factor for the mortality, development of hospital-acquired infections and intubation. Also it is determined that the low cortisol creates a negative situation in terms of mortality and intubation.
Introduction: The aim of the study is to investigate the impact of fixed or mobile-bearing tibial inserts on patellofemoral arthrosis and evaluate which one to be preferred for patients with patellofemoral arthrosis. Methods: Operated in our clinic between January 2009 and February 2013, 33 with patellofemoral arthritis together with anteromedial compartment arthritis were included in the study. Patellofemoral joints of patients were evaluated according to the scoring system defined by Fulkerson-Shea. Results: Unicondylar knee arthroplasty with fixed-bearing tibial inserts and 22 (66,6%) (male: 3, female: 19) and unicondylar knee arthroplasty with mobile-bearing tibial inserts 11 (33,9 %) (male: 2, female: 9) were implanted.Average knee flexion was found to be 116,5 (100-135) degrees in 22 patients with mobile-bearing tibial inserts, and 114,5 (95-135) in 11 patients with fixed-bearing tibial inserts. Conclusion: Patellofemoral arthrosis is an important factor for unicondylar knee arthroplasty prognosis and one of the determinants of patient satisfaction. Significantly less patellofemoral complaints were seen with UKA with fixed-bearing tibial insert compared to mobile-bearing tibial insert.
Received: 20.07.2015 Accepted: 05.10.2015 1Erzurum Regional Training and Research Hospital of Radiology, Erzurum, Turkey. 2Ataturk University, Faculty of Medicine, Department of General Surgery, Erzurum, Turkey. 3Ataturk University, Faculty of Medicine, Department of Pathology, Erzurum, Turkey. Afak Durur-Karakaya1, Mufide Nuran Akcay2, Elif Demirci3 Sonoelastography Findings of Breast Juvenile Papillomatosis: A Case Report
1 Department of Anesthesiology and Reanimation, Abant Izzet Baysal University, Turkey 2 Department of Infectious Diseases and Clinical Microbiology, Abant Izzet Baysal University, Turkey 3 Union of Public Hospitals, Abant Izzet Baysal State Hospital, Clinic of Infectious Diseases, Turkey 4 Department of Emergency Medicine, Abant Izzet Baysal University, Turkey 5 Infection Control Unit, Abant Izzet Baysal University Training and Research Hospital, Turkey
Methods: Seventy-five knee MRI exams of 69 adult consecutive patients were included in the study. Fat-saturated T2-weighted (FST2), fat-saturated proton density (FSPD), water-only T2-weighted DIXON (T2mD), T2-weighted 3 dimensional steady state (3DT2FFE), merged multi-echo steady state (3DmFFE), and water selective T1-weighted fatsuppressed (WATSc) images were acquired. Quantitative comparison of grade 1 and grade 5 lesions were made using contrast-to-noise (CNR) ratios. Grade 2-4 lesions were scored qualitatively and scorings of the lesions were compared statistically. Analysis of variance and Tukey’s tests were used to compare CNR data. Two sample z-test was used to compare the ratio of MR exams positive for grade 1 lesions noted on T2-mapping and other conventional sequences. Paired samples t-test was used to compare two different pulse sequences. Results: In detecting grade 1 lesions, FSPD, FST2 and T2mD images were superior in comparison to other sequences. FSPD and FST2 images were statistically superior in detecting grade 2-4 lesions. Although all grade 5 lesions were noted in every single sequence, FST2 images have the highest mean CNR followed by 3DT2FFE images. Conclusion: FST2 sequence is equal or superior in detecting every grade of patellar chondromalacia in 3.0T MR imaging of the knee in comparison to FSPD, T2mD, WATSc, 3DT2FFE, and 3DmFFE images.
A nine-year-old female was referred for the evaluation of murmur. She had a history of frequent lower respiratory tract infections. There were no complaints of esophagus compression such as resistant vomiting or dysphagia. There was no finding of compression in esophagus. Transthoracic echocardiography revealed a right aortic arch, a small restrictive inlet ventricular septal defect and crossed pulmonary arteries. Transthoracic echocardiography failed to visualize the branches of aortic arch. She underwent computerized tomography (CT) and it determined a right aortic arch. The left common carotid artery was the first main artery to arise from the arch, is followed by the right common carotid artery, right subclavian and left subclavian arteries. The aberrant left subclavian artery was originated from a Kommerell’s diverticulum at the distal part of aortic arch which compressed the esophagus (Figure 1). CT also showed the crossed pulmonary arteries (Figure 1). Right aortic arch and aberrant left subclavian artery that originates from Kommerell’s diverticulum is a rare condition that is diagnosed in approximately %0.1 of the population (1). However, this condition is mostly asymptomatic in general, some patients may present with the compression symptoms to the esophagus and trachea. Children who present with airway symptoms such as a combination of stridor, apnea, cyanosis, or recurrent infection. (2,3). Crossed pulmonary arteries (CPAs) is an abnormality in which the ostium of the left pulmonary artery originates superior to the right pulmonary artery and to its right. It is generally accompanied by other congenital heart defects, extra cardiac anomalies, and certain genetic problems. To date, only a few cases have been reported, and most of these cases have been associated with complex cardiac abnormalities and genetic syndromes (4). This is the first case of right aortic arch associated with aberrant left subclavian artery and crossed pulmonary arteries from Turkey.
Department of Otolaryngology, Dicle University, Faculty of Medicine, Diyarbakir, Turkey. Engin Şengül, Beyhan Yılmaz, Musa Özbay, İsmail Topçu Thyroid Masses: An Analysis of 135 Cases
Carotid sinus hypersensitivity is a common cause of fainting and falls in older adults and can be diagnosed by carotid sinus massage. We have presented a 67-year-old diabetic male patient who was admitted to our clinic because of hyperglycemia. In thyroid examination, clouding of consciousness occurred with unilateral palpation. Documented 4,8 seconds and undocumented 7 seconds of asystole were detected during the carotid sinus massage. An implantable cardioverter defibrillator was implanted in our patient. Carotid sinus hypersensitivity should be kept in mind in the examination of diabetic patients.
Results: In the 138 patients, whose mean age was 75.6 ± 7.2 years at the time of first seizure, we found the most common seizure type was generalized seizure and the most common etiologic factor was cerebrovascular diseases. Levetirasetam was the most used antiepileptic drug, and for the overall group, the rate of adverse effect of the antiepileptic drugs were 20.3%. At the last visit, 89.9% of the patients were seizure free with a mean time of 17.8±22.7 months.
Screening Cytomegalovirus Infections in First Trimester of Gestation among High Prevalence Population
The electrocardiogram showed 1 mm ST segment elevation in leads DII, DIII, aVF derivations and also complete AV block. His general condition and hemodynamic parameters were suddenly deteriorated. His blood pressure and heart rate dropped to 60/40 mmHg and 40/min respectively. Isotonic solution infusion started 1000 cc/hour and Atropin 1 mg initiated intravenously. After that his cardiac rhythm changed to the ventricular fibrillation. Following cardiac defibrillation, immediately coronary angiography performed.
Methodology: In our study, a number of 450 patients who had undergone radical prostatectomy surgery at 2 centers within the last 5 years was evaluated. Age, total PSA, number of positive cores for prostate cancer, Gleason score, transfusion amount and prostate volume were all evaluated in the study. Evaluated all these parameters, 170 consecutive patients of whom data were available were included in the study
There is no industry that does not benefit from the advantages of information technology (IT). Health care industry is no different from them. IT solutions are used to (1) minimize the human resource required for labor-intensive or time consuming tasks by automating them, (2) benefit from the intelligent software solutions that not just store the data in electronic format but also ease the decision making process, (3) accelerate the business processes by providing services simultaneously, and (4) provide maintainable and consistent services. Despite all of these advantages, health care industry spends only 2% of its revenues on technology, which is very limited when it is compared to other industries that spend around 10% (1). According to the report published by University of Illinois at Chicago’s Online Health Informatics Program, 50,000 health care informatics professionals will be needed in the next 5-7 years which means 21% projected increase in health care informatics jobs between 2010 and 2020 (2). The advantages of IT solutions for health care industry can be listed as:
Results: Patients were divided four group according to source of sperm and sperm parameters. Testicular spermatozoa obtained from men with azoospermia (group 1, n=43), severe oligoasthenoteratozoospermia (sOAT), (group 2, n=93), oligoasthenoteratozoospermia (OAT) (group 3, n=209) and normal semen analysis (group 4, n=539). The most reduced fertilization rate was observed with testicular spermatozoa and the fertilization rate increased as semen quality increased from Group 2 to 4. Our results indicated that semen quality can affect the fertilization process. We observed that the cleavage and high-quality embryo rates were highest in group I (88.4% and 93%, respectively) compared to other groups. Clinical outcomes of ICSI did not show statistically significant differences in the rates of clinical pregnancy, miscarriage and live birth rate. Conclusion: Neither sperm parameters nor the source of spermatozoa affects live birth rate in normoresponder women when motile/morphologically normal spermatozoa is present.
Introduction: One of the important spinal anesthesia complications is the occurrence of postdural puncture headache (PDPH). The incidence of PDPH is related to the age, the size and tip shape of the spinal needle used and the type of surgery. Incidence may vary depending on the type and size of needle. This study was conducted to compare the frequency of PDPH using different kind of spinal needles.
Correspondence: Mahmut S. Abit, Bingol State Hospital; 12000 Bingol/Turkey Conflict of Interest: None E-mail: sinanabit@gmail.com
Relapsing polychondritis is a rare immune-mediated systemic inflammatory disease. It is associated with inflammation in cartilaginous tissue and primarily affects cartilaginous structures of the ears, nose and tracheobronchial tree but also the joints, the inner ear, the eyes, and the cardiovascular system (1). With this report we share the multisystem imaging findings of a case with relapsing polychondritis.
Results: MPI revealed reversible perfusion defects in 24 of 141 patients and no perfusion defects in 117 patients. The STAI-2 and HADS-A and HADS-D scores were significantly higher in patients with myocardial ischemia than in those without (STAI-2: 50.8 ± 7.5 vs. 46.3 ± 7.1, respectively; p = 0.008; HADS-A: 9.5 ± 3.9 vs. 7.8 ± 3.4, respectively; p = 0.033; HADS-D: 8.7 ± 3.0 vs. 7.3 ± 3.0, respectively; p = 0.05). Unadjusted correlation analysis showed that there was statistically significant correlation between reversible perfusion defects and anxiety scores (r=0.186, p= 0.029). Conclusion: The patients with symptoms of depression and high-trait anxiety may be at higher risk of myocardial ischemia than patients without such symptoms. Thus, the emotional status of patients should be taken into consideration during clinic al evaluation for CAD.
