Objectives: This study aimed to investigate the early results of the patients presented with acute coronary syndrome (ACS) who underwent coronary artery bypass grafting (CABG) after percutaneous coronary intervention (PCI) to the culprit lesion. Methods: Patients who underwent CABG between January 2011 and January 2014 were enrolled and divided into two groups. Group 1 (102 patients) was consist of the patients who were hospitalized with ACS and underwent CABG after a previous PCI. Group 2 (107 patients) was consisting of the patients who underwent elective CABG operation after elective coronary angiography. Results: There was no statistically significant difference between the groups in terms of demographic features and preoperative risk factors. Preoperative use of angiotensin-converting enzyme inhibitor and levosimendan were significantly higher in group 1 compared to group 2. (95 (93.1%) vs. 89 (83.1%), p = 0.027). The operative variables were similar between two groups whereas the postoperative blood drainage amounts were significantly higher in group 1 than group 2 (546.3 ± 172 cc vs. 424.2 ± 185 cc, respectively, p < 0.001). The blood product usage was significantly higher in group 1 than in group 2 (3.3 ± 1.8 units vs.1.7 ± 0.9 units, respectively, p < 0.001). Conclusions: Early CABG operation after ACS is a safely applicable process with acceptable mortality and complication rates.
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Objectives: One of the most common reasons for admission to the emergency department is chest pain. The clinical presentation of chest pain is quite wide. The study aimed to compare the diagnoses of patients under and/or over the age of 65 admitted to the emergency department with non-traumatic chest pain.Methods: A thousand patients admitted to the emergency department with non-traumatic chest pain between 15.10.2014 and 15.07. 2015 were included in the study. Patients were divided into two groups according to age group as < 65 years old and ≥ 65 years old. Age, gender, the type of admission, comorbidities, accompanying symptoms, diagnosis, outcome and hospitalization were recorded.Results: Five hundred eighteen males and 482 females were included in the study. Eight hundred nineteen patients were between the ages of 18 to 64. The most common accompanying symptom was dyspnea in both age groups. Hypertension was the most common concomitant disease in the 18-64 year age group while coronary artery disease was the most common diseasein the 65 and over age group. Conclusions: Non-cardiac chest pain is more common in the young population admitted to the emergency department while life-threatening chest pain is more common in the population over the age of 65.
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Mehmet KAPLAN, İbrahim Halil KURT, Alaa QUİSİ, Gökhan ALICI, Şerafettin DEMİR, Fethi YAVUZ, Yurdaer DÖNMEZ
Mehmet KAPLAN, İbrahim Halil KURT, Alaa QUİSİ, Gökhan ALICI, Şerafettin DEMİR, Fethi YAVUZ,
... Devamını oku
Objectives: We evaluated the efficacy and safety of single high-dose versus double high-dose intracoronary bolus tirofiban in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methods: A total of 80 patients, who were admitted to our clinic and underwent primary PCI, were included in this observational cohort study. The patients were divided into the single high-dose group (n = 40) and the double high-dose group (n = 40) according to the intracoronary bolus tirofiban regime. The primary endpoint was assumed as the incidence of major adverse cardiac event (s) (MACE) defined as all-cause mortality and repeat coronary revascularization (target vessel revascularization [TVR]) at 30 days. MACE and bleeding events were evaluated at 7 and 30 days. Results: The primary endpoint was not significantly different between the single and the double high-dose groups (40.0% vs. 17.5%, p = 0.994). However, a significantly lower 30-day TVR rate was observed in the double high-dose group (27.5% vs. 7.5%, p = 0.019). No significant difference was observed in terms of 30-day all-cause mortality between the two groups (12.5% vs. 10.0%, p = 0.712). Major bleeding events were not observed in any group. Multivariate logistic regression analysis demonstrated that CRUSADE score (Hazard ratio [HR]: 5.721; 95% CI: 2.036 to 16.073, p = 0.001) and platelet count (HR: 1.009; 95% CI: 1.000 to 1.018, p = 0.048) were the independent predictors of bleeding at 7 days. Conclusions: Double high-dose intracoronary bolus tirofiban in STEMI patients undergoing primary PCI was associated with significantly lower 30-day TVR rates without an increase in bleeding events. However, it did not significantly affect MACE and all-cause mortality rates.
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Objectives: Socially
disconnected widows usually live a lonely and depressing life with anxiety and
low self-worth. Many have contemplated suicide and others have become a victim
of suicide already. Evolving an intervention to provide succor to them to take
control of their lives may help a great deal. This paper presents the results
of a nonrandomized study assessing the potency of cognitive reframing (CR) in
reducing social disconnectedness (SD) among the widows.Methods: The
pre- and post-data was collected from a non-randomized sample of 41 widows in
the treatment group and 45 in the waitlist control group. The mean age of the participants was 41.383 ± 6.730 [95% CI = 39.940–42.940] (min. = 25 - max. = 56) years. The
cognitive reframing administered spanned for eight weeks.Results: Analysis
of the data collected suggests that cognitive reframing is significantly
effective in reducing socially disconnected behavior among the widows in the
study. The social disconnected behavior among the widows reduced by 40.95%
compared to 8.29% observed in the waitlist control group.Conclusions: The CR technique may be helpful in
reducing social disconnectedness in widows. However, further study may be
required in a randomized sample to enhance generalization.
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Objectives: Colorectal cancer could be prevented with some basic lifestyle modifications.In this study we query the awareness of the participants about colorectal cancer who visit the general surgery outpatients clinic.
Methods: A questionnaire consisting of 13 questions was applied to the participants as well as demographic data. Differences in awareness of screening and risk factors were sub-grouped according to age, BMI, education, employment status, monthly income, marital status, status of first-degree relative colorectal cancer, smoking-alcohol use status and exercise status.
Results: The most known screening method was colonoscopy with 73.6%, while the least known screening method was sigmoidoscopy with 13.4%. Also, the best known risk factor was smoking with 67.4%, while the least known risk factor was type 2 diabetes with 29.8%. In our study, those over 45 years of age, having higher education, working, having more monthly income, having a family history of colorectal cancer and exercising regularly had more awareness about colorectal cancer screening and risk factors.
Conclusions: Our study had high levels of awareness compared to developing countries, however, awareness levels are not high enough and it is possible to increase these rates by educating the patients on cancer awareness.
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Objectives: Although proximal ureteral stones are common, some difficulties are encountered in semi-rigid ureterorenoscopy (URS) treatment, especially as a result of stone migration to the kidney. In this paper, we present a different use of a basket catheter for the treatment of proximal ureteral stones. Methods: Between September 2016 and January 2019, 101 patients over 18 years of age detected to have a maximum 15-mm proximal ureteral stone were retrospectively evaluated, and 93 patients fulfilling the criteria were included in the study. Semi-rigid URS and a modified basket catheter were used together in 44 patients while no auxiliary equipment was utilized for the remaining 49 patients. In the study group, a 3F zero-tip basket catheter was disintegrated and positioned in a way to capture and retrieve the stone from the semi-rigid ureterorenoscope. Results: No difference was found between the two groups in terms of age, body mass index, gender, and stone characteristics. The duration of operation was shorter in the basket catheter group (p < 0.001). The rates of stone migration, requirement to switch to flexible ureterorenoscopy (FURS), and double J-stent (JJ-stent) placement were significantly higher in the control group (p < 0.005). There were no significant differences between the two groups concerning operation success and complications (p = 0.068 and p = 0.772, respectively). Conclusions: The modified basket catheter technique with semi-rigid URS was successful in preventing the migration of proximal ureteral stones. This method can be considered as an alternative in cases where FURS is not available.
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Objectives: Decreased drug metabolism, coagulation disorders, wound infections, and cardiac arrhythmias are the most important and well-known results of intraoperative hypothermia. Perioperative amino acid infusion is known to prevent intraoperative hypothermia during general anesthesia in adults. In this study, we aimed to demonstrate the effect of perioperative amino acid infusion on the prevention of hypothermia during general anesthesia in newborn surgery. Methods: Twenty surgical newborns, aged 1-30 days, were enrolled in this prospective randomized controlled study. Newborns were assigned randomly into two groups: the amino acid/dextrose (AAD) group and the dextrose (D) group. The core temperatures of the newborns were measured from the distal esophagus in the first minute of the induction once and every fifteen minutes thereafter. The core body temperature changes in each group during the operation and the differences between the two groups were analyzed. Results: The surgical operations in each group were similar. The mean operating room temperatures of AAD and D groups were 25.4 ± 0.2°C and 25.3 ± 0.3°C, respectively. There were no significant differences in the general characteristics of the two groups. The mean core temperatures began to decrease after the induction of anesthesia in both groups and continued to decrease during the course of the surgery. There was no significant difference between the two groups. Conclusions: Hypothermia develops in all neonates when surgical time exceeds one hour, even in warmer ambient temperatures. Although it seems effective in adults, amino acid-induced thermoregulation does not seem effective in newborns during general anesthesia.
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Nur TÜRKMEN, Yeşim Sücüllü KARADAĞ, Zeynep Neşe ÖZTEKİN
Nur TÜRKMEN, Yeşim Sücüllü KARADAĞ, Zeynep Neşe ÖZTEKİN
Objectives: This study is aimed to investigate the frequency of olfactory dysfunction in Parkinson’s Disease (PD) and its relationship with motor/non-motor symptoms and treatment in comparison to isolated olfactory dysfunction patients and healthy controls.Methods: This study includes 40 PD patients, 37 anosmia patients and 42 healthy controls. PD patients are evaluated with PD evaluation form including; sociodemographic features, disease history, Unified Parkinson’s Disease Rating Scale (UPDRS) score, and Hoehn and Yahr (H-Y) score. All patients were evaluated with cranial CT and MRI. Olfactory function was evaluated with Sniffin' Sticks Test (SST). A p value < 0.05 was considered to be statistically significant. Results::The mean age and median disease duration of PD patients were 62.2 ± 11.9 and 4.5 years, respectively. Fifteen of them had comorbid diseases. Median UPDRS score was 19.5 (4-60) and 67.5% of subjects were H-Y Stage-1. Most frequent non-motor symptom was constipation (67.5%). Olfactory dysfunction was found in 75% of PD patients by SST. No difference was observed between PD patients with or without olfactory dysfunction regarding non-motor symptoms and dementia (p > 0.05). Patients with isolated olfactory dysfunction were significntly younger than both patients with PD and the healthy controls (p <0.001). Non-motor symptoms were not significantly different between isolated olfactory dysfunction group and healthy subjects (p > 0.05). Conclusions: Most of the patients with PD had olfactory dysfunction, which was found not to be correlated with disease duration and stage based on the results of an objective test, namely Sniffin-Sticks odor test.This result might support the role of non-dopaminergic pathways in the etiopathogenesis of olfactory dysfunctions in PD. In clinical practice, data from further studies is required to comment on an ideal screening or diagnostic test in the olfactory system evaluation of early stage PD patients that would be repeatable and objective.
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Objectives: Adrenal masses are more frequently detected in autopsy series in recent years and are more frequently detected in clinical practice due to the development of radiological examinations. After the detection of an adrenal mass, the first two important questions come to mind. Does the mass hormonally active (functionally) or not active (non-functional), and this mass is a benign formation or is it malignant? The answer to these two questions is the obligatory questions that clinicians must answer in order to make an operation decision. The decision of operation in non-functioning adrenal masses is directly proportional to the mass's neoplastic potential. If a preoperative histopathological diagnosis is not available; this potential is predicted by the size of the mass in radiological imaging. It is shown that the malignancy rate in adrenal masses is higher in lesions 6 cm and above. In this study, we aimed to determine whether the rate of malignancy is really high in histopathological examination as a result of adrenalectomy operations performed in our clinic between the years of 2010-2012.Methods: Fourteen women and 4 men with 6 cm or higher adrenal masses patients which performed adrenalectomy by Eskişehir Osmangazi University Faculty of Medicine Department of General Surgery between 2010-2012 were included in this study. The results of the final histopathological analysis were classified retrospectively. Results: The rate of malignancy in adrenal masses of 6 cm or more supported by the literature was found to be high in our clinical series. Conclusions: As a result of our clinical retrospective study, we think that the extent of the formation in the related gland is highly effective and significant in making an operation decision before adrenalectomy.
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Objectives: Chemotherapy induces an immunosuppressive state in patients with solid organ tumors. Cytomegalovirus (CMV) reactivation as a result of immunosuppression causes a severe clinical manifestation. However, in this group, CMV infections developing due to reactivation were not adequately discussed in the literature. The aims of this study were to determine the incidence of CMV reactivation after chemotherapy, to evaluate the contribution of chemotherapy to reactivation, to determine the incidence of asymptomatic and symptomatic infections and to investigate the results of the treatment.Methods: A total of 93 patients with solid tumors were included in the study. Weekly blood samples were collected from the patients for three weeks before and after chemotherapy. Quantitative analysis of DNA was detected using CMV PCR kit (GeneProof CMV PCR kit, Bruno, Czech Republic). Diagnosis and treatment of patients were retrospectively reviewed.Results: Of the patients, 65.6% were female and 34.4% were male. The mean age was 55 ± 12 years. The most common cancer types among the patients were breast cancer in 45.2%, lung cancer in 15.1%, and colon cancer in 12.9%. The mean leukocyte count of the patients was 7,647/mm3. CMV DNA was not detected in any patient. According to this result, none of the patients had CMV reactivation after chemotherapy. Conclusions: In this study including patients with solid organ tumors with mild to moderate level of immunosuppression CMV DNA was not detected in any patient. Based on this finding no standard prophylaxis was required for CMV in this group of patients.
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