Dan ZHAO, Jun LI, Rui YANG, Guang Hong XU
Dan ZHAO, Jun LI, Rui YANG, Guang Hong XU
Background/aim: Hypertension is an important risk factor for cognitive impairment. This study explored whether elderly patients with stage I hypertension (HPs) and normotensive patients (NPs) showed differences in the recovery of postoperative attention network
function according to the attentional network test (ANT) performance.
Materials and methods: Of 110 patients screened, 25 HPs and 25 NPs completed this study. The Mini-Mental State Examination
(MMSE) was applied to all participants before the operation and the ANT (on days 2 and 7) after the operation. All participants
completed 1 day preoperatively and the ANT on postoperative days (PODs) 2 and 7.
Results: Compared with NPs, HPs had significantly lower alerting network effect scores and more difficulty resolving conflict on POD
7. However, no significant difference was observed between the groups on POD 2. Orienting network performance was similar between
the groups at all time points. Significant differences in alerting and executive control network performances were observed between
PODs 2 and 7 in each group.
Conclusion: HPs showed selective cognitive impairment at different time points following elective hip or knee arthroplasty. Compared
with NPs, during the first postoperative week, HPs were more likely to experience delayed recovery of alerting and executive control
network function, but not orienting network function.
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Background/aim: The Analgesia Nociception Index (ANI) is a new method of identifying nociception-analgesia balance. In this study,
we investigate the correlation between the ANI and numeric rating scale (NRS) values immediately before and after extubation. The
NRS values were recorded in the postanesthesia care unit, in a group of patients who underwent laparoscopic cholecystectomy, with the
aim of evaluating the potential use of ANI values in the prediction of postoperative pain levels.
Materials and methods: The ANI and NRS values, heartbeat rate (HR), systolic and diastolic arterial pressure (SAP/DAP), and oxygen
saturation (SpO2) values of the patients were recorded into three groups based on the initial NRS values recorded in the postanesthesia
care unit (group I: NRS ≤ 3, group II: NRS 4–6, group III: NRS ≥ 7). Patients whose ANI values were lower than 47, considered as the
pain threshold, and the groups to which these patients belonged were also recorded.
Results: Statistically significant increases were noted in HR, SAP, and DAP after extubation, while there was no significant change in
ANI values. A weak correlation was identified between the ANI and NRS values of all patient groups.
Conclusion: We failed to identify a correlation between ANI and NRS values before and after extubation. Previous studies suggested that
the ANI provides more valuable information in anesthetized patients, whereas our findings show that it is ineffective in the prediction
of potential postoperative pain.
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Koray KILIÇ, Melih AKYÜZ, Emetullah CINDIL, Nesrin ERDOĞAN, Gonca ERBAŞ, Mehmet ARAÇ
Koray KILIÇ, Melih AKYÜZ, Emetullah CINDIL, Nesrin ERDOĞAN, Gonca ERBAŞ, Mehmet ARAÇ
Background/aim: When reading a chest CT, a radiologist needs to evaluate each rib one by one due to complex curvy shape, which
makes reporting a tiresome and time-consuming task. A new curved planar reformat application that flattens ribs on a single plane may
find a place in the radiology reporting room. This study aimed to evaluate the effect of a two-image set created by using the rib-flattening
application on the performance of a radiologist in detecting sclerotic rib lesions in cancer patients.
Materials and methods: The local Institutional Review Board approved this retrospective study. Two radiologists with different
experience levels reviewed chest CT examinations of 106 patients (76 men, 30 women). We divided the patients into group A (n =
54), reviewed by a standard method, and group B (n = 52), reviewed by a standard method and the two-image set created on the ribflattening
application. Reading times, validity indices, and agreement levels with reference data were evaluated for both readers.
Results: The median reading time of the junior examiner significantly decreased with the rib-flattening method (160.5 s vs. 70.0 s; P <
0.001). Diagnostic indices of the senior reader were improved significantly at per patient level (group A, AUC: 0.867; group B, AUC:
0.982; P = 0.046). The new method showed better agreement levels (kappa: 0.69 to 0.96) than the general method (kappa: 0.53 to 0.91).
Conclusion: Based on improved agreement levels, reading times, and diagnostic validity indices we conclude that a two-image set
consisting of an axial and a coronal flattened-rib image may be used in conjunction with an ordinary exam.
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Zafer Yasin KONYA, Suna AKIN TAKMAZ, Hülya BAŞAR,
Bülent BALTACI , Gülçin BABAOĞLU
Zafer Yasin KONYA, Suna AKIN TAKMAZ, Hülya BAŞAR,
Bülent BALTACI ,
Gülçin BABAOĞLU
Background/aim: The aim of this study was to investigate the medium- to long-term effects of radiofrequency (RF) ablation of genicular
nerves for chronic refractory knee pain due to osteoarthritis (OA).
Materials and methods: Forty-eight patients who underwent RF ablation of the genicular nerves were evaluated retrospectively. The
visual analogue scale (VAS) score, Western Ontario and McMaster universities osteoarthritis index (WOMAC index), opioid and
nonsteroidal antiinflammatory drug (NSAID) use score, quality of life score, and treatment satisfaction score were examined at 1, 3, and
6 months after the procedure.
Results: The mean VAS scores were significantly lower at the 1-, 3-, and 6-month evaluations compared with the preoperative values (P
< 0.001). A significant decrease was observed in the WOMAC index compared with preoperative values (P < 0.001). It was found that
66.7% of opioid users and 56.3% of NSAID users stopped using medication. No serious complications were encountered during or after
the procedure.
Conclusion: In chronic refractory knee pain due to OA, the application of RF ablation to the genicular nerve is an effective and safe
treatment option in the medium to long term.
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Ayşegül CANSU, Dilara ATASOY, İlker EYÜBOĞLU, Murat KARKUCAK
Ayşegül CANSU, Dilara ATASOY, İlker EYÜBOĞLU, Murat KARKUCAK
Background/aim: This study aimed to evaluate the diagnostic efficacy of vertebral Hounsfield unit (HU) values on routine contrastenhanced
abdominal computed tomography (CT) scans for the assessment of osteoporosis using dual-energy X-ray absorptiometry
(DXA) T-scores as a reference standard.
Materials and methods: A total of 111 consecutive patients who underwent contrast-enhanced abdominal CT examination for any
indication and DXA within a 6-month period were retrospectively analyzed. The CT attenuation values of trabecular bone in HUs were
measured in axial and sagittal planes from lumbar vertebrae 1–4 (L1–L4). The correlation between the DXA T-scores and HU values
measured on the CT scans was evaluated by Pearson’s correlation test. Areas under the curves (AUCs) were calculated by receiver
operating characteristic analysis for diagnostic proficiency, and threshold values were determined. Paired t-test and Bland–Altman plot
test were used to evaluate the correlation between axial and sagittal HU values.
Results: There was a strong correlation between the DXA T-scores and HU values of all the lumbar vertebrae (P < 0.001). The highest
correlation was for the L3 vertebra; L3 was thus chosen for additional analyses. The mean axial and sagittal L3 attenuations were 133.7
HU and 131.9 HU, respectively. The axial measurements were not significantly different from the sagittal measurements, with a mean
difference of 1.8 HU (P > 0.05). The L3 axial CT attenuation threshold for 90% sensitivity was 170 HU and that for 90% specificity was
102 HU for distinguishing osteoporosis from osteopenia and normal bone mineral density (BMD). To distinguish the low BMD group
from the normal group, the L3 axial CT attenuation threshold for approximately 90% sensitivity was 102 HU and for 90% specificity
was 165 HU.
Conclusion: The HUs derived from routine contrast-enhanced abdominal CT scans can be used for the evaluation of osteoporosis,
without additional radiation exposure and cost.
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SAVAŞ ŞENCAN , Alp Eren ÇELENLİOĞLU, Ruslan ASADOV, Osman Hakan GÜNDÜZ
SAVAŞ ŞENCAN ,
Alp Eren ÇELENLİOĞLU, Ruslan ASADOV, Osman Hakan GÜNDÜZ
Background/aim: The aim of this study was to identify predictive factors for treatment success in transforaminal epidural steroid
injection in patients with lumbar disc herniation-induced sciatica.
Materials and methods: A total of 219 patients who were diagnosed with unilateral sciatica and underwent transforaminal epidural
steroid injections at the level of L4-5, L5-S1, or S1 neural foramina between March 2016 and May 2018 were retrospectively analyzed.
The presence of transitional vertebrae and the grade of nerve root compression were evaluated by a radiologist. Data including age, sex,
body mass index, duration of symptoms, injection levels, and pain scores were recorded. Pain scores were evaluated using the numerical
rating scale. Treatment success was defined as a ≥50% decrease in pain scores at 3 months.
Results: The study included 118 female and 101 male patients with a mean age of 43.65 ± 12.18 years. The mean duration of symptoms
was 25.64 ± 2.17 weeks. Although the duration of symptoms was longer in patients for whom treatment failed, it did not reach statistical
significance. Decreased pain scores at 1 h had a significant effect on treatment success (p = 0.012, odds ratio (OR): 1.015, 95% confidence
interval (CI), 1.003–1.026).
Conclusions: Our study results suggest that a decreased pain score at 1 h is a predictor for a favorable three-month response to
transforaminal epidural steroid injection in patients with lumbar disc herniation-induced sciatica.
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Mehmet ÇAKIR, Erhan OZYURT
Mehmet ÇAKIR, Erhan OZYURT
Background/aim: In the recent years, videolaryngoscopes (VL) have emerged as alternative devices to direct laryngoscopes (DL) in
difficult intubation situations. Therefore, we aimed to compare the Macintosh DL and McGrath VL in terms of the glottic image quality,
intubation success, intubation time, hemodynamic response after intubation, and complications in bariatric surgery patients.
Material and methods: After obtaining approval by the ethics committee and receiving informed consent, we recorded the demographic
and physical data of patients undergoing bariatric surgery. Patients were divided into 2 groups: Group M was intubated with the
Macintosh DL, and Group V was intubated with the McGrath VL. After intubation, we noted the Cormack–Lehane score, the duration
of intubation, the number of intubation interventions, and the hemodynamic data of patients.
Results: A total of 62 patients (ASA II, body mass index of >35 kg/m2) were included in the study. All patients except 1 patient were
intubated on the first attempt. Although there was a decrease in heart rate and blood pressure with induction, similar hemodynamic data
were obtained between groups during the operation. In group V, we obtained a better glottic image (P = 0.011), but intubation success
was similar between the study groups. We also measured the intubation time in group M as 45.9 ± 19.1 s and group V as 57.1 ± 15.8 s
(P = 0.015).
Discussion: Although we measured longer intubation times with the McGrath VL compared with the Macintosh DL, we obtained a
better glottic image without causing hemodynamic changes. However, these findings did not make any difference in terms of intubation
success.
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Fuat KIZILAY, Bayram ALİYEV, Adnan ŞİMŞİR, Serdar KALEMCİ, Timur KÖSE, Meltem TAŞBAKAN, Hüsnü PULLUKÇU
Fuat KIZILAY, Bayram ALİYEV, Adnan ŞİMŞİR, Serdar KALEMCİ, Timur KÖSE, Meltem TAŞBAKAN,
... Devamını oku
Background/aim: Carbapenem-resistant Klebsiella pneumoniae (CR-KP) infections encountered in urology patients differentiate from
infections caused by other factors, both in respect to prophylaxis and treatment stage, and require a special approach. We aimed to
analyse the predisposing factors and the antibiotherapies for CR-KP infection outbreak in a tertiary urology clinic.
Materials and methods: There were 75 patients in the CR-KP positive group (Group I) and 146 patients in the CR-KP negative group
(Group II). Analysis of the predisposing factors for CR-KP infection and comparison of the reinfection rate and the antibiotherapies in
the 2 groups were the endpoints.
Results: In the first group, age, comorbidity, previous antibiotic use, and nephrostomy tube rates were higher (P = 0.015, P = 0.001, P
= 0.004, and P < 0.001, respectively). In the second group, open urological surgery rate, and the proportion of patients presenting with
flank pain, lower urinary tract symptoms, and haematuria were higher (P = 0.029, P < 0.001, P < 0.001, and P = 0.007). In the first group,
the proportion of patients treated with transurethral bladder tumour resection was higher, whereas, percutaneous nephrolithotomy
was higher in the second group (P = 0.045 for both). While hospitalization and Foley catheterization duration were longer in the first
group (P < 0.001 for both), double J stent and nephrostomy duration were longer in the second group (P < 0.001 and P = 0.005). Mean
leukocyte count at admission was higher in the first group (P < 0.001).
Conclusion: Advanced age, comorbidities, previous antibiotic use, and prolonged Foley catheterization duration are predisposing factors
for this infection in the urology department. Two-week administration of combination antibiotic regimens containing carbapenem were
effective for the treatment of this infection.
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Demet YAVUZ, Rahman YAVUZ, Mehmet Derya DEMİRAĞ, Düriye Sıla KARAGÖZ ÖZEN, Zeynep Banu RAMAZANOĞLU
Demet YAVUZ, Rahman YAVUZ, Mehmet Derya DEMİRAĞ, Düriye Sıla KARAGÖZ ÖZEN, Zeynep Banu RAMAZANOĞLU
aim of this study is to determine the relationship between vitamin D deficiency and depression status and sleep disorders of patients on
dialysis.
Materials and methods: In this cross-sectional study, 121 hemodialysis patients were enrolled. All patients had been on hemodialysis
for at least six months at the time of the study. Sleep quality and depression status were measured by using specific inventories. All the
patients filled out Pittsburg Sleep Quality Index (PSQI) and Beck Depression Inventory (BDI), and gave blood samples. Vitamin D levels
were measured for 121 patients, and statistical analysis was done by using SPSS.
Results: Regression analyses demonstrated that low levels of 25(OH)D and high BDI score were independent risk factors for poor sleep
quality [ORs were 0.668 (0.566–0.789), 1.080 (1.001–1.164), and 1.080 (1.001–1.164), respectively].
Conclusion: Our results suggest that deficiency of 25(OH)D is an important independent risk factor for poor sleep quality in
hemodialysis patients.
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Hilal Uslu YUVACI, Arif Serhan CEVRİOĞLU, Yasemin GÜNDÜZ, Nermin AKDEMİR, Alper KARACAN, Ünal ERKOKRMAZ, Abdurrahim KESKİN
Hilal Uslu YUVACI, Arif Serhan CEVRİOĞLU, Yasemin GÜNDÜZ, Nermin AKDEMİR, Alper KARACAN, Ünal ERKOKRMAZ,
... Devamını oku
diagnostic tool, in predicting the presence of intraabdominal adhesions, especially near the trocar entry area, to provide safe surgical
access to the abdomen.
Materials and methods: Fifty-nine women with a previous history of open abdominal surgery (group A) and a group of 91 women
with no previous history of surgery (group B) underwent dynamic ultrasound evaluation of the abdominal fields before laparoscopic
operations. The anterior abdominal wall was divided into six quadrants: right upper, right lower, left upper, left lower, suprapubic, and
umbilical. Adhesions were evaluated by surgeons during the operation and by radiologists using USG prior to the operation. Visceral organ
movements greater than 1 cm was defined as normal visceral slide (positive test), with less than 1 cm of movement defined as abnormal
visceral slide (negative test). Sliding test measures movements of omental echogenicity or a stable echogenic focus that corresponds to
intestine peritoneal echogenicity that underlies abdominal wall during exaggerated inspiration and expiration. Adhesions observed during
surgery were evaluated on a four-point scale, with 0 indicating no adhesions present, 1 indicating the presence of a thin, filmy avascular
adhesion, 2 indicating the presence of a dense and vascular adhesion, and 3 indicating adhesions that connect surrounding organs with the
overlying peritoneal surfaces. The McNemar test was used to compare the results of USG and laparoscopy for each measure.
Results: We found that preoperative USG was successful in identifying adhesions [sensitivity, 96.39% (95% CI 89.8–99.2); specificity,
97.43%]
Conclusion: Preoperative ultrasound examination of the abdominal wall may enhance the safety of abdominal entry during laparoscopic
operations.
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