Abstract Background Serial multiparametric cardiovascular magnetic resonance (CMR) in patients undergoing coronary artery bypass grafting (CABG) may provide mechanistic insight into dynamic and persistent abnormalities of the myocardium in patients with stable coronary artery disease (CAD). Objectives To assess for dynamic CMR markers of myocardial hypoperfusion and cardiac remodelling in patients undergoing CABG. Methods Patients with CAD awaiting elective CABG were recruited into an observational cohort study. Baseline evaluation included bloods, Seattle Angina Questionnaire-7, and adenosine stress perfusion CMR. Automated fully quantitative stress and rest myocardial blood flow was calculated, alongside assessment of the visual ischaemic burden. Native and post-contrast septal T1 indices were also measured. Repeat evaluation at 6-12 months post CABG was performed. Results Of 43 patients who underwent serial evaluation with CMR (mean age 62.1±9.3, median LVEF 68% [IQR: 62-73%]), there was improvement in the median visual ischaemic burden (18% [IQR: 11-21] vs 42% [IQR: 27-51], P<0.001), mean global stress myocardial blood flow (1.5±0.5 ml/min/g vs 1.3±0.5 ml/min/g, P=0.002) and median global myocardial perfusion reserve (2.4 [IQR: 1.7-2.8] vs 1.7 [IQR: 1.4-2.2], P=0.002) following CABG. Greater improvement in the SAQ-7 summary score was associated with a larger visual ischaemic burden at baseline (ρ=0.44, P=0.004) and a greater decrease in the visual ischaemic burden following CABG (ρ=-0.38, P=0.02). Quantitative MBF metrics did not associate with baseline or change in SAQ-7 summary score. Mean LV extracellular matrix volume decreased following CABG (16.6±3.6ml/m2 vs 18.2±4.6ml/m2, P=0.009). Conclusion Multiparametric CMR identifies dynamic changes in markers of myocardial perfusion and interstitial fibrosis in patients following CABG. Visual assessment of inducible myocardial hypoperfusion may identify patients who will derive the most symptomatic benefit from CABG. The results, however, suggest an important degree of residual inducible ischaemia and an unclear clinical role for CMR-derived MBF calculations.Serial CMR perfusion dataAssociation of SAQ with perfusion

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ Trust and King’s College, the Centre of Excellence in Medical Engineering funded by the Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC; WT088641/Z/09/Z). M.J.B. is supported by a Medical Research Council New Investigator Grant (MR/N011007/1) and British Heart Foundation (Project grant PG/18/74/34077). This work was supported by EPSRC 2018/19 DTP - EP/R513064/1 grant. This work was supported by a National Heart and Lung Institute Foundation grant awarded to Professor Sanjay Prasad and Dr Richard Jones. This work was supported by a National Heart and Lung Institute Foundation grant awarded to SKP, DJH, REJ, UT and BPH. Additionally, the study was supported by an Intermediate Clinical Research Fellowship awarded to BPH (FS/ICRF/21/26019). Background The presence of ring-like patterns of mid-wall fibrosis identified on late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) is associated with an increased risk of major arrhythmic events (MAE) in non-ischemic cardiomyopathy (NICM). Analysis of tissue bordering core fibrosis and healthy myocardium (Gray Zone [GZ]) has been suggested as an important pro-arrhythmic substrate in this population. Purpose To investigate refined anatomical definitions of the fibrotic ring pattern, including the importance of GZ inclusion in the association with MAE in NICM. Methods LGE CMR data from 292 NICM patients were analysed to delineate both core and GZ fibrosis. Fibrosis quantification masks for each 2D image slice were used, along with AHA 17-segment maps, to identify fibrotic ring patterns: defined by fibrosis extending by 3 or more continuous AHA-segments for any individually-contiguous fibrotic component within each slice (Fig 1A). Ring patterns were assessed separately for core fibrosis and core + GZ, as well as individually in basal, mid-basal and mid-apical regions. In separate analysis, LGE contours were aligned, interpolated, and used to generate 3D computational volumetric models (Fig 1B). Individually-connected scar components were extracted and the 3D circumferential angular variation (3DCAV) of each separate fibrotic structure quantified as a continuous variable (Fig 1C). Association of the presence of ring patterns and 3DCAV with a composite MAE were investigated. Results Of 292 patients, 67(23%) had core fibrotic ring patterns (54 basal, 28 mid-cavity level, 6 apical). Over a median(IQR) of 6(4) years, 16(24%) patients experienced MAE. On univariate Cox analysis, ring pattern core fibrosis was a strong predictor of MAE (Hazard ratio [HR] 2.2, 95% confidence interval [CI] 1.13-4.31, p=0.021). Apical-basal region analysis showed that basal ring pattern was associated with MAE (HR 2.25, 95%CI, 1.13-4.51, p=0.022). Multivariate Cox analysis including raised NYHA Class and severely reduced LVEF, overall ring (HR 2.14, 95%CI, 1.05-4.33, p=0.035) and basal ring pattern (HR 2.9, 95%CI 1.39-6.02, P=0.004) continued to show independent association with the MAE. Analysis of the full 3D geometry of the individual scar components also showed that our novel 3DCAV metric was associated with the MAE on both univariate (HR 1.31, 95%CI 1.08-1.59, P=0.007) and multivariate (HR 1.3, 95%CI, 1.06-1.60, P=0.013). Analysis of core ring patterns outperformed analysis of core+GZ patterns in all cases. Conclusions Our study confirms that ring-like patterns of fibrosis in NICM are strongly associated with MAE in NICM, with patterns predominantly at the basal regions conferring enhanced risk relative to mid-basal and mid-apical regions. Inclusion of GZ quantification in ring-pattern analysis did not enhance risk prediction. Our novel 3D analysis of circumferential fibrosis patterns may provide a more robust quantitative metric for stratification.

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the National Institute for Health Research Biomedical Research Centre at Guy’s and St. Thomas’ Trust and King’s College, the Centre of Excellence in Medical Engineering funded by the Wellcome Trust and Engineering and Physical Sciences Research Council (EPSRC; WT088641/Z/09/Z). M.J.B. is supported by a Medical Research Council New Investigator Grant (MR/N011007/1) and British Heart Foundation (Project grant PG/18/74/34077). This work was supported by EPSRC 2018/19 DTP - EP/R513064/1 grant. This work was supported by a National Heart and Lung Institute Foundation grant awarded to Professor Sanjay Prasad and Dr Richard Jones. Background Arrhythmic risk stratification of patients with stable coronary artery disease (CAD) for defibrillator implantation remains imprecise. Current clinical guidelines center on a basic assessment of adverse cardiac remodelling, an approach with well documented limitations. More advanced analysis of intricate and regional LV remodelling in these patients may shed new insight for enhanced risk prediction of life-threatening arrhythmia in stable CAD. Objective We explored a novel computational 3D LV shape analysis strategy to accurately represent, and quantify, arrhythmogenic LV remodelling patterns in late gadolinium enhancement cardiovascular magnetic resonance images (LGE-CMR) in patients with stable CAD. We assess the utility of our patient-specific 3D LV arrhythmic shape (LVAS) score predicting major arrhythmic event; comparing to the current clinical benchmark of severely reduced LVEF and NYHA functional class. Methods Patients with stable CAD were prospectively recruited into a CMR registry and followed up for a composite endpoint of major arrhythmic events (MAE) consisting of sudden cardiac death (SCD), aborted SCD or haemodynamically unstable VT. Time-to-event data was also recorded. 2D LGE-CMR images were contoured and used as input to an advanced computational shape-analysis approach (Figure 1A). Reconstructed 3D LV shape models were analysed using Principle Component Analysis and Cox-Lasso to characterise the average arrhythmogenic LV shape, which was then used to quantitatively define a patient-specific LV arrhythmic shape (LVAS) score. Results Of 397 patients (mean [SD] LVEF% 45.4 ± 16.0) followed for a median (IQR) of 6 (3) years, 55 (14%) experienced a major arrhythmic event (MAE). The mean (SD) LVEF for patients who experienced MAE was lower than for those that did not (37.1% ± 13.2 vs 46.7% ± 16.0), yet there was no difference in NYHA class. LVAS mean (95% confidence interval [CI]) score was different between event and event-free patients: 2.98 (0.48-6.44) vs 19.83 (10.66-29), P<0.001. On univariate Cox regression analysis both LVAS score (hazard ratio [HR] 2.1, 95% CI 1.6-2.7, P<0.001) and LVEF<35% (HR 2.9, 95% CI 1.6-5.0, P<0.01) were associated with the primary endpoint. NYHA Class >I was not associated with the primary endpoint (HR 1.5, 95% CI 0.8-2.7, P=0.221). In multivariate Cox regression analysis, LVAS remained independently associated with the primary endpoint after adjusting for LVEF<35% and NYHA>Class I: LVAS score HR 2.1, 95% CI 1.5-3.0, P<0.001; LVEF<35% HR 1.0, 95% CI 0.5-2.2, P=0.923; NYHA>Class I HR 1.3, 95% CI 0.7-2.5, P=0.443 (Figure 1 B, C). The addition of the LVAS score increased the C-statistic from 0.6 to 0.75 between models. Conclusion A Left Ventricle Arrhythmic Shape score improved arrhythmic risk stratification compared to guideline-based clinical parameters, highlighting a potentially novel approach to identifying candidates for implantable cardioverter defibrillators in stable CAD.

Objective: It was aimed to examine the changes in homocysteine, folic acid, and vitamin B12, which metabolize homocysteine from the body, and trace elements (zinc, copper, selenium, nickel) that affect the structure of tissues and epithelium in female patients with gallstone disease. Moreover, it was aimed to investigate the contribution of these selected parameters to the etiology of the disease and their usability in treatment according to the findings obtained.Materials and Methods: Eighty patients, including 40 female patients (Group I) and 40 completely healthy female individuals (Group II) were included in this study. Serum homocysteine, vitamin B12, folate, zinc, copper, selenium, and nickel levels were evaluated. Electrochemiluminescence immunoassay was used in the analysis of vitamin B12, folic acid, and homocysteine levels, and the ICP-MS method was used in the analysis of trace element levels.Results: Homocysteine levels in Group I were statistically significantly higher than in Group II. In terms of vitamin B12, zinc, and selenium, Group I levels were found to be statistically significantly lower than group II. There was no statistically significant difference between Group I levels and Group II in terms of copper, nickel, and folate.Conclusion: It was suggested that homocysteine, vitamin B12, zinc, and selenium levels should be determined in patients with gallstone disease and that vitamin B12, which is especially important in the excretion of homocysteine from the body, and zinc and selenium, which prevent the free radical formation and protect from its effects, should be added to the diets of these patients.

Abstract Background Prospective studies harnessing late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) afford the potential to non-invasively characterise the phenotypic substrate for sudden cardiac death (SCD) and simultaneously interrogate its mechanistic drivers. Purpose To assess the utility of infarct characterisation by CMR, including scar microstructure analysis, to predict SCD in prospectively investigated patients with coronary heart disease (CHD). Methods Patients with stable CHD were prospectively recruited into a registry between August 2009 and January 2016. The primary outcome for this study was SCD or aborted SCD. Patients with a secondary prevention implantable cardioverter defibrillator (ICD) indication were excluded. All patients had CMR with LGE imaging. Infarct quantification (core scar and peri-infarct zone [PIZ]) was performed by an independent level 3 CMR reader. Outcome events were adjudicated by a panel of cardiologists blinded to the CMR data. To investigate fibrosis microstructure, bespoke computational image processing algorithms were applied to the LGE images in order to extract specific morphological and texture related features. Results Of 437 patients (mean age 64, mean left ventricular ejection fraction [LVEF] 47%, 91% with LGE) followed for a median of 6.3 years, 49 patients (11.2%) experienced the primary outcome. Patients with higher PIZ mass had an increased risk of the primary outcome (10-year risk 0.7%, 24.0% and 37.8% for patients with PIZ mass <5.66g, 5.66–12.28g and ≥12.29g respectively, P<0.001; figure 1a). On univariable analysis, an increase in PIZ mass and core infarct mass was associated with an increased risk of the primary outcome (per gram: HR 1.12, 95% CI 1.09–1.15, P<0.001 and HR 1.05, 95% CI 1.04–1.06, P<0.001 respectively). PIZ mass and core infarct mass remained independently associated with the primary outcome after adjustment for baseline predictors (per gram: HR 1.10, 95% CI 1.06–1.14, P<0.001 and HR 1.04, 95% CI 1.02–1.06, P<0.001 respectively) and together provided incremental value compared to conventional variables in predicting the endpoint (Harrell's C-statistic 0.76 to 0.82, figure 1b-c). Bespoke analysis of imaging data identified several shape-based scar metrics that associated with the primary outcome (figure 2). These included core infarct transmurality, radiality and interface length (the latter defining the core scar-PIZ boundary length), and the number of PIZ islets. Conclusions In this large prospective study of patients with stable CHD, both PIZ mass and core infarct mass independently predicted long-term SCD risk after adjusting for conventional predictors including LVEF. Reassuringly, minimal or absent LGE portended a comparatively low risk of SCD. Analysis of the scar microstructure identified several shape-based features that associated with SCD. These results highlight a potential avenue towards a more personalised approach to ICD implantation decisions. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Lung and Heart Institute, Imperial College London

Objective: End-stage liver disease (ESLD) is a devastating condition, which leads to liver transplantation (LT).There are various proposed predisposing factors for ESLD.A significant proportion of ESLDs is of undetectable (cryptogenic) origin.Accumulation of heavy metals is a proposed but not thoroughly researched predisposing factor for ESLD.In this study, we measured the concentration of accumulated heavy metals in the explanted liver tissue of ESLD patients.Apart from various accompanying etiologies, such as rare hereditary diseases, infections, and tumors were also evaluated.Method: This prospective study aimed to evaluate the concentrations of heavy metals in the explanted liver of consecutive patients with ESLD and different etiologies who underwent elective and/or emergency LT.Bioaccumulation of nine heavy metals (Hg, As, Zn, Cr, Pb, Cu, Ni, Mg, and Fe) was evaluated by atomic absorption spectrophotometer in the explanted liver tissue of ESLD patients.Also, histopathologies of explanted livers and etiologies of patients were evaluated using data from histopathological techniques, medical records, or genetic counseling processes. Results:The male/female ratio was 33:15.The results of our study showed no statistical significance in terms of total heavy metal levels in the explanted livers (p > 0.05), including patients with cryptogenic etiology.However, four patients with Wilson's disease had copper levels of 250 uq/g dried liver tissue.Histopathological examinations of explanted livers revealed that four (8%) patients had Wilson's disease, one (2%) patient had tyrosinemia, 15 (31%) patients had unknown/undetectable (cryptogenic) etiology, 24 patients had viral infections (20 had hepatitis B virus infection, one had hepatitis C virus infection, three had multiple viral infections at once), one patient had a metastatic tumor, one patient had an unidentified autoimmune disease, and one patient had polycystic liver disease. Conclusion:Accumulated total heavy metal levels in explanted livers of ESLD patients do not appear to be a differential diagnosis tool, except the copper levels for Wilson's disease.More research is needed to further elucidate the different roles of heavy metal concentrations in both normal and disease states of heavy metals in the liver.

AIM OF THE STUDY:The purpose of the study was to determine the aeroallergen sensitisation patterns of children aged 5 years and younger with asthma (AS) and/or allergic rhinitis (AR) in Istanbul, Turkey. METHODS:This cross-sectional observational study was conducted between January and December 2018 in the outpatient clinic of a hospital department of pediatric allergy. Patients, who had regular outpatient controls, full clinical and laboratory records, positive skin prick test results, and were willing to participate in the study, were included. RESULTS:In total, 148 children aged 5 years or younger who had positive skin prick test results were included in the study. The male/female ratio and the mean age at onset of symptoms were 87/61 and 2.13±1.33 (0.4-4.5) years, respectively. Of the 148 patients, 63 (42.6%) had AS, 11 (7.4%) AR, and 74 (50.0%) had both AS and AR. The age of the patients, age at symptom onset, male/female ratio, number of allergen sensitivities, total IgE levels, total eosinophil levels, and skin prick test results for aeroallergens did not differ between the patients with AS, AR, and AS+AR. House dust mite (HDM) was the most common aeroallergen in patients, while the cockroach was the least common aeroallergen. The severity of asthma and control levels were not found to be associated with aeroallergen sensitisation in children. CONCLUSION:One out of every four atopic children aged 5 years or younger is sensitised to aeroallergens. The most common sensitisation is to house dust mites. Weed aeroallergen may be related to severity of asthma in children aged 5 years or younger in Istanbul. We speculate that HDM and weed allergens could be used in the diagnostic or treatment strategies for the management of asthmatic children aged 5 years or younger.

Background. Appendicitis is the most frequent acute abdominal disease and there are actual effective diagnostic tools for its detection. Objectives. The objective of this study was to determine whether a thermal imaging camera is a useful tool for diagnosing acute appendicitis on the basis of abdominal skin surface temperature changes which reflect intra-abdominal inflammation. Material and methods. The prospective data consisting of surgical and pathological findings of 51 patients who had undergone appendectomy between January 2013 and December 2014 with the diagnosis of acute appendicitis was collected, as well as thermal imaging camera recordings. A handheld infrared (IR) thermal imaging camera (ITIC) was used to take measurements. Results. Of the 51 patients studied, 30 were male and 21 were female. Of these, 12 had their highest temperature measurement in the epigastric and 17 in the umbilical areas. These 2 groups constituted 56.9% of the patients. Regarding the lowest temperature measurement, 10 patients had the lowest temperature in the right inguinal and 15 in the hypogastric area. These 2 numbers constituted 49% of the patients. Conclusions. This is the first report concerning the use of a thermal camera as a diagnostic tool for the evaluation of acute abdominal illness. Considering the results of our study, ITIC is not feasible as a new diagnostic tool for acute appendicitis. It may be suitable for determining superficial inflammation; however, it is not suitable for determining deep inflammation.

INTRODUCTION:Cholecystectomy performed for benign diseases of the gallbladder is important for the diagnosis of gallbladder cancer. This is done by pathological examination of the removed specimens for patients with no detected or suspected complications before surgery. Although some centers undertake selective approaches for histopathological examination of gallbladder specimens, many centers perform this examination routinely. In our study, we investigated results of pathological examinations carried out on cholecystectomy specimens, in respect to unexpected cases of gallbladder cancer. METHODS:We reviewed cholecystectomy cases performed for benign diseases of gallbladder from January 2012 to February 2016 by investigating pathological specimens from the gallbladder. We evaluated demographical properties and their association with the pathological diagnosis and frequency of unexpected gallbladder cancer cases. We reported additional treatment and survival information of the malignancy cases after surgery. RESULTS:We reviewed 1294 cases of cholecystectomy, and the mean patient age was 47.5 ± 14.3 years. The most frequent diagnosis was chronic cholecystitis (92.3%), and it was more prevalent among younger patients and female sex (P < 0.0001). Five patients (0.4%) were determined to have gallbladder cancer, and the mean age of these cases was 65.6 ± 18.2 years. Two cases were Stage 2, two cases were Stage 3B, and one case was Stage 3A. There was no T1 or Tis tumor. CONCLUSION:Routine histopathological examination of gallbladder is significant with respect to the determination of additional interventions at the postoperative period required for cancer cases coincidentally diagnosed.

This study is aimed to investigate and compare the regenerative effects of Silymarin (SLM); and Sun Dried Organic Apricot (SDOA) on liver regeneration after 70% Partial Hepatectomy (PH) in rats. Rats mean weighing was 238.1 ± 17.8 g, and they were randomly divided into the five groups. During the 17 d of the study period, the following feed and drug administration order was maintained: group 1 (sham) (n=6) and group 2 (n=8) were fed with standard rat chow, group 3 (n=8) was fed with standard rat chow and given additionally daily 100 mg/kg dose of silymarin extract by gavage, group 4 (n=8) was fed with 10% supplemented SDOA to chow and, in addition, they were given daily 100 mg/kg dose silymarin extract by gavage, and group 5 (n=8) was fed with 10% supplemented SDOA to chow. Water was given ad-libitum to all groups. After a week, group 1 had a laparoscopic procedure; the others underwent a 70% PH. On 18th d of the study, all rats were humanely sacrificed. Taken liver tissue samples of all groups were used to histopathological and tissue biochemical examination. Approximately 10 ml blood samples were taken and the obtained serum samples were used for measurement of serum Aspartate Transaminase (AST) AST, Alanine Transaminase (ALT) and Alkaline Phosphatase (ALP) levels. The results of the present study revealed a remarkable protective effect of silymarin rather than SDOA based on the histopathological and Proliferating Cell Nuclear Antigen, (PCNA). PCNA findings and liver tissue/serum biochemical parameters. Therefore, before 7 and after 10 d of PH, silymarin administration have shown beneficial effect than SDOA consumption on liver regeneration of rats.

Objective: Many countries set up clinical emergency response systems such as medical emergency team, rapid response team. But there are still some problems regarding the benefit, design, and advisability of implementing a clinical emergency response system. The present study evaluated the outcomes of in-hospital cardiopulmonary resuscitation after introduction of the first comprehensive the code blue and medical emergency team (MET) system on cardiopulmonary resuscitation (CPR) attempts in-hospital.Design: Retrospective studySetting: Harput State Hospital, Department of Emergency Medicine, Elazig, TurkeySubjects: All code blue calls applied in this hospital from January 2010 to June 2011 were evaluatedIntervention: NoneMain outcome measures: Rates of return of spontaneous circulation (ROSC) and survival to hospital discharge after CPRResults: A total of 264 code blue calls were performed during study period. There were 186 (70.5%) calls required immediately CPR attempt, 50 (18.9%) calls required only medical treatments, 18 (6.8%) drill calls for code blue team and 10 (3.7%) missed calls. ROSC and survival to hospital discharge were 41.4% and 6.4% respectively. Time of arrival at the scene was less than two minutes in 74.7% of code blue calls. ROSC occurred in 88.2% of VT/VF cases. A duration of CPR of less than 15 min was related to better CPR outcomes and ROSC (p <0.001).Conclusion: Response to CPR attempts is affected by early activation of the code blue system and early response of the MET. Therefore, introduction of MET and code blue systems is required for all hospitals in the world.

BACKGROUND Etiology of acute appendicitis (AA) rarely involves parasitic infections of gastrointestinal (GI) tract. Preoperative diagnosis of parasitic infections in appendix remains difficult, although parasites can sometimes be observed inside the lumen during histopathological examination. The aim of the present study was to prospectively screen prevalence and species of intestinal parasites and adherence of fecal occult blood (FOB) in patients admitted to emergency department (ED) with clinical symptoms of AA who underwent appendectomy. METHODS Demographic and stool analysis data of a total of 136 patients (≥13 years old) who underwent appendectomy between July 2009 and December 2014 were prospectively assessed, and histopathological data of all patients were retrospectively assessed. RESULTS In histopathological examination after appendectomy, of 136 patients, 75.5% (n=103) had AA, 11.1% (n=15) had perforated appendicitis (PA), and 13.2% (n=18) had a negative appendicitis (normal appendix, NA). Pre-operative stool analysis revealed that 25% (n=34) had intestinal parasites and 14.7% (n=20) of patients had positive fecal occult blood test (FOBT). Those with positive FOBT represented 9.7% (n=10) of 103 AA patients, 53.3% (n=8) of 15 PA patients, and 11.1% (n=2) of 18 NA patients; this was statistically more significant for PA than other groups (p<0.001). CONCLUSION Presence of intestinal parasites in stool might not be associated with appendicitis, but it can occasionally lead to pathological findings of appendicitis. A positive FOBT may be a predictor for PA.

The aim of this study was to evaluate WhatsApp messenger usage for communication between consulting and emergency physicians. A retrospective, observational study was conducted in the emergency department (ED) of a tertiary care university hospital between January 2014 and June 2014. A total of 614 consultations requested by using the WhatsApp application were evaluated, and 519 eligible consultations were included in the study. The WhatsApp messages that were transferred to consultant physicians consisted of 510 (98.3 %) photographic images, 517 (99.6 %) text messages, 59 (11.3 %) videos, and 10 (1.9 %) voice messages. Consultation was most frequently requested from the orthopedics clinic (n= 160, 30.8 %). The majority of requested consultations were terminated only by evaluation via WhatsApp messages. (n = 311, 59.9 %). Most of the consulting physicians were outside of the hospital or were mobile at the time of the consultation (n= 292, 56.3 %). The outside consultation request rate was significantly higher for night shifts than for day shifts (p =.004), and the majority of outside consultation request were concluded by only WhatsApp application (p <. 001). WhatsApp is useful a communication tool between physicians, especially for ED consultants who are outside the hospital, because of the ability to transfer large amounts of clinical and radiological data during a short period of time.

BACKGROUND:Etiology of acute appendicitis (AA) rarely involves parasitic infections of gastrointestinal (GI) tract. Preoperative diagnosis of parasitic infections in appendix remains difficult, although parasites can sometimes be observed inside the lumen during histopathological examination. The aim of the present study was to prospectively screen prevalence and species of intestinal parasites and adherence of fecal occult blood (FOB) in patients admitted to emergency department (ED) with clinical symptoms of AA who underwent appendectomy.METHODS:Demographic and stool analysis data of a total of 136 patients (≥13 years old) who underwent appendectomy between July 2009 and December 2014 were prospectively assessed, and histopathological data of all patients were retrospectively assessed.RESULTS:In histopathological examination after appendectomy, of 136 patients, 75.5% (n=103) had AA, 11.1% (n=15) had perforated appendicitis (PA), and 13.2% (n=18) had a negative appendicitis (normal appendix, NA). Pre-operative stool analysis revealed that 25% (n=34) had intestinal parasites and 14.7% (n=20) of patients had positive fecal occult blood test (FOBT). Those with positive FOBT represented 9.7% (n=10) of 103 AA patients, 53.3% (n=8) of 15 PA patients, and 11.1% (n=2) of 18 NA patients; this was statistically more significant for PA than other groups (p<0.001).CONCLUSION:Presence of intestinal parasites in stool might not be associated with appendicitis, but it can occasionally lead to pathological findings of appendicitis. A positive FOBT may be a predictor for PA.

OzetBezoar, sindirilemeyen yabanci maddelerin yetersiz cigneme ve ogutme, mide cikis yolu obstruksiyonu, mide bosalmasinda bozukluk gibi bircok faktor etkisi ile mide ve/veya ince barsakta birikmesi sonucu olusan bir kitledir.Normalde buyuk miktarlarda sindirilemeyen yabanci cisimler gastrointestinal sistemden temizlenebilir. Bezoar olusumunda, mide ve gastrointestinal sistem anatomi ve fizyolojisindeki degisiklikler ile alinan yabanci maddenin israrli olarak alimi sorumludur. Devamli olarak alinan yabanci maddeler lifli sebzeler ise fitobezoar, hayvansal yaglar ve killar ise trikobezoar veya antiasit gibi ilaclara bagli ise farmobezoar denilir. Mide bezoarlari siklikla mide cerrahisi sonrasi olusmakta olup mide cerrahisi oykusu bulunmayan kisilerde siklikla kendi saclarini koparmak ve yutmak icin dayanilmaz istek duydugu psikiyatrik problemlerin oldugu trikotilomani bulunur. Gastrik bezoar; enzim kullanimina dayanan medikal yontemle, endoskopik veya cerrahi mudahale ile tedavi edilebilir. Bu vaka sunumunda, cerrahi olarak tedavi ettigimiz genc bir bayan hastada mide cikisinda darligina sebep olmus bir dev gastrik trikobezoar (Rapunzel Sendromu) vakasini mevcut literaturu gozden gecirerek sunduk.

BACKGROUND:Spinal anesthesia has become appropriate for many surgical procedures. Neuraxial anesthesia can result in acute and late complications like hypotension, bradycardia, local anesthetic toxicity, postdural-puncture headache, backache and spinal nerve damage. Although the body's physiological responses to spinal anesthesia are well understood, its effects on intraocular pressure (IOP) haven't been mentioned before.OBJECTIVES:The aim of this study was to investigate the effects of spinal anesthesia on IOP.MATERIAL AND METHODS:Forty patients receiving spinal anesthesia for subumblical surgery were recruited for the study, after ethics committee approval and patients' written informed consent. IOP was measured by Icare PRO tonometer (Icare, Finland) before spinal anesthesia (BS), immediately after spinal anesthesia (AS) and finally on the first postoperative day (PO1). Both eyes of the patients were included in the study.RESULTS:Thirty-eight patients completed the study. Mean BS, AS and PO1 intraocular pressures were 16.53±3.17 (9.40-24.00), 17.08±3.16 (10.00-24.00) and 16.76±2.80 (10.20-23.00) mm Hg, respectively. Mean IOP measurements were not statistically different among the three groups (p=0.104).CONCLUSIONS:Spinal anesthesia alone has no acute or subacute effects on IOP. Studies can be made to evaluate the chronic effects. Further studies must be focused on the relationship between postdural puncture headache and intraocular pressure changes after spinal anesthesia.