Objective: This study was aimed to determine whether preprocedural ultrasonography (USG) affects the
technical performance of spinal anesthesia in elderly patients with difficulty in palpating landmarks, scoliosis,
or previous spine surgery.
Materials and Methods: This prospective study was conducted in 156 elderly patients scheduled for elective
orthopedic lower extremity surgery. The patients were randomly divided into 2 groups to receive spinal
anesthesia by the preprocedural USG examination (group U) or conventional landmark palpation technique
(group P). The primary finding of our study was the rate of successful access to the subarachnoid space on
initial needle insertion attempt. Secondary achievements included number of needle insertion attempts,
number of needle redirections, total procedure time, needle pain scores, patient satisfaction, and complications of spinal anesthesia.
Results: The rate of successful access to the subarachnoid space at the first needle insertion attempt was significantly higher in group U than in group P (74.4% vs 53.8%, p=0.008). Medians (interquartile range) of both
needle insertion attempts (group P, 2 [1-3] vs group U, 1 [1-2]; p=0.038) and needle redirections (group P,
3 [2-5] vs group U, 2 [1-4]; p=0.028), requiring to achieve dural puncture, were significantly higher among
the patients in group P than those in group U. No statistically significant difference was found between the
groups regarding total procedure time, pain scores, patient satisfaction scores, and spinal anesthesia-induced
complications (p>0.05).
Conclusion: Our study findings showed that preprocedural neuroaxial USG improves technical performance
of spinal anesthesia in elderly patients with difficult anatomy
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Objective: This study aimed to investigate the destructive effects of acidic blood on the intestinal structures,
which has been reported as the most hazardous biochemical result of vagosympathetic autonomic imbalances in intensive care unit patients with subarachnoid hemorrhage (SAH).
Materials and Methods: In total, 27 hybrid rabbits were used; 5 rabbits were used as a control group, 7 as
the SHAM group into whom 1 cc saline was injected into the cisterna magna, and the remaining 15 were
used as the study group. These animals received 1 cc of autologous arterial blood injection into the cisterna
magna to create the SAH group. Blood pH values were recorded before, during, and after the experimental
procedures. Computed tomography was performed to examine the intestinal morphology. Normal and degenerated epithelial cell densities of the intestine were estimated by stereological methods. The relationship
between pH values and intestinal tissue changes was analyzed statistically using the Mann–Whitney U test.
Results: The mean blood pH values were 7.364±0.042 in the control group, 7.326±0.059 in the SHAM
group, and 7.23±0.021 in the study group. Intestinal epithelial cell injury, desquamation of villus, and cell loss
were observed. It is observed that the number of degenerated epithelial cells, fragmented villi numbers, and
vacuoles significantly increased in the study group (p<0.05).
Conclusion: Acidotic intestinal injury secondary to blood pH changes following SAH may be considered as a
generalized and dangerous complication with their multiorgan insuficiency effect.
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Objective: It is important to measure left ventricular function (LVF) accurately in the diagnosis and follow-up
of cardiovascular diseases. Different imaging algorithms and mathematical calculations have been developed
for the evaluation of LVF in cardiac magnetic resonance imaging (MRI), and numerous studies are still being
carried on this. In our study, LVF was calculated by two different measurement methods in MRI and were
compared with transthoracic echocardiography (TTE) to assess the correlation and the consistency of these
with TTE.
Materials and Methods: In this study, 31 patients with left ventricular dysfunction due to different etiologies
were evaluated with simultaneous TTE and MRI. In the Cine MR images, LVF parameters of ejection fraction, end-diastolic volume, end-systolic volume, and myocardial mass were measured using short axis images
(short axis method) and short axis plus four chamber and two chamber images (combined method). The
results were compared with the results from TTE.
Results: We found that the combined and the short axis–based calculations of ejection fraction, end-diastolic
volume, end-systolic volume, and myocardial mass in cardiac MRI showed correlation and consistency with
those calculated via echocardiography. We also determined that the short axis–based calculations in cardiac
MRI showed better correlation with the echocardiography compared with the combined method.
Conclusion: Because our results revealed that the cardiac MRI results obtained from the short axis method
better correlate with the TTE, we recommend using short axis–based measurements in the evaluation left
ventricular dysfunction.
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Objective: A successful interlaminar epidural injection relies on correct epidural space needle placement.
Most interlaminar epidural steroid injection (ESI) procedures are performed with a blind technique known
as loss-of-resistance (LOR) without an imaging guide. This study aims to evaluate the success rate of the LOR
technique in interlaminar epidural steroid injection under fluoroscopic control.
Materials and Methods: Patients who underwent interlaminar ESI owing to a history of at least 3 months
of chronic low back and leg pain not responding to medications and physical therapies were included in an
observational trial. Participants’ age was between 27 and 88 years, and they had an American Society of Anesthesiologists physical status of I–III. The patients were placed in a prone position, and a Tuohy needle was
introduced at the level of the L5–S1 interlaminar foramen using fluoroscopic image with an anteroposterior
view. A lateral view was obtained when the LOR was felt. The procedures that achieved epidural spread by
contrast agent in the first attempt were deemed successful. Those that did not and those that had false positive LOR were regarded as unsuccessful.
Results: Interlaminar ESİ was administered to 150 patients. The procedure’s success and failure rates were
76% (114 patients) and 24% (36 patients), respectively. A total of 58.3% (21 patients) of patients who underwent an unsuccessful procedure had a false LOR, whereas 41.6% (15 patients) of the same group exhibited
other causes. Sex, age, and body mass index (BMI) showed no statistical significance in terms of procedural
success. There were statistically significant differences in the distance between the skin and the epidural space
according to the body mass index groups.
Conclusion: The LOR technique identified the epidural space in most epidural procedures. However, in
some cases, LOR was shown to be inadequate. Therefore, we suggest that the LOR technique must be supported by imaging such as fluoroscopy during epidural injections.
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Objective: The most important problem for emergency physicians in patients presenting with chest pain is
deciding whether to discharge the patient or not. Therefore, many scoring systems have been developed to
help with this decision making process. We aim to achieve a modified HEART value by combining the VAS
value with the HEART score.
Materials and Methods: Data were collected on age, sex, duration of the symptoms, pain severity using a
10-point visual analog scale (VAS), and the presence of a major adverse cardiac event (MACE). The HEART
score was calculated and modified (mHEART) by adding 1 point to the total HEART score for a VAS score
of ≥7.
Results: During the study period, 4781 patients were admitted, and 293 participants were analyzed. Of the
patients, 34(11.6%) experienced MACE within a month after the encounter. The mean VAS scores were
5.65±1.44. However, 77(26.3%) patients had VAS scores ≥7. Taking 3 as the threshold, 42(14.3%) patients
had HEART scores of 4 and above, where 47(16.0%) had mHEART scores ≥4. The mHEART scoring demonstrated better test indicators than the HEART score. According to the HEART score, 6(2.3%) of the 251
patients predicted as negative would develop MACE, but this number decreased to 1(0.4%) in 246 using the
mHEART score.
Conclusion: Although the HEART score performs reasonably well in discriminating patients who are MACE
negative, it is possible to further improve the score by adding the VAS item. After validation by other studies,
we would suggest modifying the HEART score by including the VAS item.
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Objective: Shakuyakukanzoto, one of the traditional herbal medicines commonly used in North-East Asian
countries, is known to be effective for muscle cramps. This retrospective study aimed to evaluate the effect
of shakuyakukanzoto on chemotherapy-induced metoclopramide-uncontrolled hiccups.
Materials and Methods: We retrospectively investigated the medical records of all the consecutive patients
with lung cancer who were prescribed with shakuyakukanzoto (Tsumura Co. Tokyo, Japan) for chemotherapy-induced hiccups in our hospital from September 2013 to November 2017. In the medical record from
the initiation of shakuyakukanzoto until the start of the next chemotherapy, when there was description of
“complete or partial disappearance of hiccups” after the prescription of shakuyakukanzoto, it was judged as a
complete or partial response. A statement of “unchanged,” no description of improvement, or exacerbation
was judged as no change.
Results: Of the 49 chemotherapy courses in 15 patients with lung cancer, 93.9% had a “partial or complete”
response within a few hours after the administration of shakuyakukanzoto. The effect of shakuyakukanzoto
was observed irrespective of the pathological type of lung cancer, platinum-containing or non-platinum chemotherapy, and with or without other anti-hiccup drugs. No adverse event was observed.
Conclusion: Shakuyakukanzoto may offer an effective pharmacological approach to treat chemotherapyinduced metoclopramide-uncontrolled hiccups. Well-planned prospective studies will confirm our results.
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Objective: After chemotherapy, cancer survivors suffer from acquired immunological defects and become vulnerable to vaccine-preventable diseases. There are no universally approved revaccination guidelines for non-transplanted oncology patients. This study aimed to share our experience of revaccination in childhood
cancer survivors to plan future vaccination schedules.
Materials and Methods: This retrospective study was conducted in a Pediatric Oncology Department of a university-affiliated hospital. Patients who were diagnosed with malignancy other than leukemia constituted the study population. Patients were directed for revaccination 6 months after the cessation of treatment. Revaccination was performed according to patients’ vaccination status before chemotherapy and seronegativity.
Results: Of the 64 patients in the study, 44 (68.75%) were boys. The mean age at the time of diagnosis and at start of vaccination was 8.8±5.3 years and 10.6±5.1 years, respectively. Hodgkin’s lymphoma was the most common diagnosis. The vaccination schedule of 7 patients was interrupted because of chemotherapy;
after completing the missing vaccine doses, the serology of 2 patients was negative for at least 2 antigens. The vaccination schedule of 57 patients was completed before beginning chemotherapy and 52 of them were seronegative for at least 1 antigen. No adverse reactions or life-threatening infections were observed
because of vaccinations.
Conclusion: There are different approaches when vaccinating the oncology patients after chemotherapy. Watching out for the four touchstones mentioned in our study will protect the patient and do no harm.
More studies are needed to constitute universal and standardized revaccination guidelines for these patients.
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Objective: The strength or weakness of the respiratorymuscles comparedwith other skeletal muscles owing
to their more specialized structures is considered as an indicatororcause of a disease. This study aimed to
investigate the effects of inspiratory muscle training with royal jelly (RJ) supplement on ironmetabolism in
cigarette addicts.
Materials and Methods: A total of 40 male volunteers participated in the study who were divided into 4
groups before the study as follows: smoker control group (n=10), inspiratory muscle training (IMT) group
(n=10), RJgroup (n=10), and RJ+IMT (n=10) group. Blood samples were taken from all the participants for
analysis of iron, ironbinding, and total iron binding capacity. Maximal inspiratory pressure (MIP) and maximal
expiratory pressure (MEP) measurements for the groups to perform trainingwere carried out with 40% of
their MIP values. The training sessions were carried out at thesame time every day for 4 weeks (5 days per
week).
Results: The Statistical Package for Social Sciences version 22.0 program was used for statistical analyses.
The results of the analysis found that the iron, ironbinding, and total ironbindingcapacities were in favor of
post-tests in theRJ supplement IMT, and RJ+IMT groupscompared with those in the control group (p<0.05).
Therewas a statistically significant difference between the RJ supplement, IMT, and RJ+IMT groups compared
with the controlgroup (p<0.05).
Conclusion: Therefore, it could be concluded that the IMT and RJ supplements positively affected these
parameters by altering the iron metabolism of the cigarette addicts.
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Objective: Nasal polyposis (NP) is an inflammatory chronic disease in which polyps are located in the nose or
paranasal sinuses. A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) genes have
roles in vascular biology, inflammation, tissue morphogenesis, and pathophysiological remodeling. Therefore,
some members of the ADAMTS gene family may contribute to pathogenesis of NPs. This study aimed to
detect the potential relation between NP and the expression levels of ADAMTS 5, 8, and 9 genes.
Materials and Methods: This study consisted of nasal polyp tissues from 34 patients in whom nasal polyps
had been diagnosed clinically, and healthy nasal mucosal tissues from 14 controls. RNA was isolated from the
nasal polyps and normal nasal mucosal tissue in each subject. The expression levels of ADAMTS 5, 8, and 9
genes in the patients and controls were detected by quantitative real-time reverse transcriptase polymerase
chain reaction (qRT-PCR) method.
Results: The expression levels of ADAMTS 5 and 9 genes were significantly decreased in NP tissues. In
contrast, the expression levels of ADAMTS 8 genes were also decreased in NP tissues, but they were not
significantly different from those in the normal nasal tissues.
Conclusion: An association was detected between the expression levels of ADAMTS genes and NP. ADAMTS 5 and 9 genes may have an effect on the formation of NP
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