Transcatheter aortic valve replacement (TAVR) initially emerged as an alternative option to surgical aortic
valve replacement (SAVR) for patients with severe aortic stenosis who were considered either inoperable or
high-risk for surgery. However, since its advent the role of TAVR has been continuously evolving on the basis
of clinical trials which showed that TAVR is non-inferior to SAVR in patients with moderate as well as lowrisk for surgery. Because of recent technological advances, multidetector computer tomography (MDCT) is
inherently suitable for the pre-procedural assessment of patients being considered for TAVR within a very
short imaging time, MDCT can measure the diameter of the aortic annulus, provide detailed information
regarding the status of the entire thoracoabdominal aorta, and assess the caliber of the peripheral vasculature used for transcatheter heart valve delivery. This information helps interventionists make optimal preprocedural decisions and avoid complications. To familiarize non-imaging specialists with the role of MDCT
in TAVR, we provide a concise overview of our approach to using this modality for the pre-procedural
assessment of TAVR candidates.
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ntraoperative floppy iris syndrome (IFIS) is described by three characteristics: floppy iris that billows in
reaction to intraocular fluid currents during phacoemulsification surgery, flaccid iris stroma that tends to
prolapse through well-constructed surgical incisions, and progressive pupillary miosis despite preoperative
pharmacologic dilatation. A 63-year-old man presented with decreased vision in both his eyes. Ophthalmic
examination revealed bilateral nuclear cataract. He was prescribed silodosin for the management of benign
prostatic hyperplasia a month ago. Consecutive cataract surgery was planned at a 2-week time interval. All
features of IFIS were encountered in both eyes of the patient during phacoemulsification surgery. IFIS was
successfully managed by the aid of an iris retractor, and a 20/20 final visual acuity was achieved postoperatively in both eyes of the patient. To the best of our knowledge, this is the first study about bilateral IFIS
associated with silodosin intake. Ophthalmologists and urologists prescribing silodosin should be aware of
this possible association.
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Objective: In this study, the aim is to observe changes induced by dehydroepiandrosterone (DHEA) and
resveratrol (RES) in diminished ovarian follicles that was induced by 4-vinylcyclohexenediepoxide (VCD).
Materials and Methods: Twenty four Wistar albino female rats were divided into 3 groups: control, DHEA
and RES. Unilateral oophorectomy was performed in control group to remove the right ovary of 4 rats and
the left ovary of 4 rats. After administration of 160 mg/kg VCD, remaining ovaries were removed. Following the same VCD treatment, in DHEA and RES groups, 60 mg/kg DHEA and 20 mg/kg RES were given
for 45 days respectively and residual ovaries were removed. Hematoxylin-eosin and TUNEL staining were
performed. Follicle stimulating hormone (FSH), estradiol (E2) and anti-mullerian hormone (AMH) values
were measured.
Results: In control group, VCD-induced apoptosis in follicles increased the TUNEL-positive cell counts
(p<0.001) with decreased number of follicles. On the other hand, DHEA significantly increased all three
follicle types in the ovaries and decreased apoptosis (p<0.001). The decreased follicle number in all three
follicle types after VCD treatment were found to be significantly increased after RES treatment (p<0.001).
Apoptosis in the follicles was significantly decreased by RES administration (p<0.001). FSH values were found
to be increased with VCD and to reach control values with DHEA and RES. E2 values significantly decreased
with VCD, but significantly increased with RES and DHEA.
Conclusion: Both DHEA and RES may improve VCD-induced diminished ovarian reserve. DHEA and RES
increased the number of primary, primordial and growing follicles, with no significant difference between
them.
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Objective: Primary acquired nasolacrimal duct obstruction (PANDO) is an idiopathic narrowing of the nasolacrimal duct caused by chronic inflammation and consecutive stenosis of the nasal tissue. In the current
investigation, we aimed to study the etiopathogenic role of sinonasal anatomical abnormalities and paranasal
inflammatory pathologies in PANDO.
Materials and Methods: Computed tomography (CT) findings of 459 patients who were diagnosed with
unilateral PANDO between April 2009 and March 2017 were compared with that of a control group, which
comprised 200 subjects without nasolacrimal duct obstruction who had been referred to the ear nose throat
(ENT) clinic with the complaint of vertigo and headache. A radiologist (R. S.) masked to the clinical situation
of participants retrospectively examined their CT findings.
Results: The prevalence of deviated nasal septum was found to be strongly associated with PANDO incidence (55.3% on PANDO side of patients vs. 28.3% among controls; p˂0.001). Significant increases, albeit
of smaller magnitude, were also observed in the relative frequency of Agger nasi cells and maxillary sinusitis
on the PANDO side of the subjects (14.6% and 27.0%, respectively) compared to controls (9.5% and 20.6%,
respectively) (p=0.023 and p=0.038, respectively). Unilateral PANDO was also found to be robustly associated with an ipsilateral deviated nasal septum (p˂0.001). The odds of septal deviation occurrence were 3.037
times (95% Confidence Interval (CI): 2.303-3.990; p˂0.001) more on the PANDO than the non-PANDO
side of the studied cases.
Conclusion: Ipsilaterally deviated nasal septum appears to have a role in the development of unilateral primary acquired obstructive disease of the lacrimal drainage system. The incidence of PANDO might also be
affected by Agger nasi cells and maxillary sinusitis. Multicenter studies are essential to further elucidate the
interaction between type, severity, extent, and dimensions of different pathologies with nasolacrimal duct
obstruction.
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Elif BAYRAKTAR,
Pınar TOSUN TAŞAR , Doğan Nasır BİNİCİ, Ömer KARAŞAHİN, Özge TİMUR, Sevnaz ŞAHİN
Elif BAYRAKTAR,
Pınar TOSUN TAŞAR ,
Doğan Nasır BİNİCİ, Ömer KARAŞAHİN, Özge TİMUR, Sevnaz ŞAHİN
Objective: Sarcopenia, a geriatric syndrome, is an indicator of poor prognosis in elderly inpatients. In this
study, we aimed to determine the effect of sarcopenia on mortality in elderly patients.
Materials and Methods: Mobile/immobile geriatric inpatients, treated in the internal medicine ward between
February and November 2018, were included in the study between Days 2 and 7 of hospitalization. The patients’ fat-free mass (FFM) was measured by bioimpedance. The FFM index (FFMI) (kg/m2
) was determined
by dividing fat-free mass by body surface area (FFM/BSA). Sarcopenia was defined as a FFMI value at least
two standard deviations below the gender-specific mean of normal young adults.
Results: The study included 200 geriatric inpatients; 96 (48.0%) were men, and the mean age was 74.49±6.32
years. Sarcopenia was detected in 28 (14%) of the patients. Diabetes mellitus was associated with a significantly lower sarcopenia prevalence (p=0.006). The risk of sarcopenia was 9.046 times higher in malnourished patients. The sarcopenia group had more deaths (p=0.012).
Conclusion: Sarcopenia in geriatric inpatients increased the length of hospital stay and mortality. Our findings may guide future studies examining the relationship between sarcopenia and mortality among elderly
inpatients in other hospitals.
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Onur SELVİ, Serkan TULGAR, Özgür ŞENTÜRK, Talat Ercan SERİFSOY,
David Terence THOMAS , Uğur DEVECİ, Zeliha ÖZER
Objective: The serratus intercostal plane block (SIPB) is a recently defined interfascial plane block. The
oblique subcostal transversus abdominis plane block (OSTAP) is another type of interfascial plane block, and
it is also used as a part of multimodal analgesia in patients undergoing laparoscopic cholecystectomy (LC).
In this retrospective study, we evaluated the effects of the bilateral OSTAP and a combination of the right
SIPB and bilateral rectus sheath block (RSB) on the postoperative pain and analgesia requirement in patients
undergoing LC.
Materials and Methods: Data of the patients who underwent LC between May 2018 and November 2018
were evaluated retrospectively. Postoperative pain was evaluated using the numeric rating scale (NRS), and
24-hour tramadol consumption and rescue analgesia requirements were compared.
Results: Bilateral OSTAP was applied to 47 patients, and SIPB+RSB was applied to 25 patients. Postoperative pain scores were similar between the two groups. In the first 24 hours, tramadol requirement in the
SIPB+RSB group was significantly lower than in the OSTAP block group (p<0.001). There was no statistically
significant difference between the NRS averages at different time frames between the two block groups.
Conclusion: We found that when SIPB is used as a part of multimodal analgesia in a combination with RSB
in LS, it improves the quality of analgesia and decreases the analgesic requirement compared to patients
undergoing a bilateral OSTAP block. Randomized controlled trials are necessary to compare the effects of
SIPB alone and in a combination with other blocks in LC.
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Mastura AHMAD, Ab Fatah AB RAHMAN, Sapiah SAPUAN
Mastura AHMAD, Ab Fatah AB RAHMAN, Sapiah SAPUAN
Objective: This study aims to generate a reference range for valproic acid (VPA) in this cohort and determine the factors associated with good seizure control in patients taking this drug.
Materials and Methods: We conducted a prospective, cohort, observational study among patients with
epilepsy who received VPA treatment at Hospital Kuala Lumpur. The patients were considered to have good
control if they had a 50% or higher seizure reduction in the one-year study period compared with the previous year. The VPA reference range was generated from those patients who had good control and whose
drug concentration values were available. Multiple logistic regression analysis with a backward likelihood ratio
method was applied to assess the predicting factors for good seizure control.
Results: A total of 242 patients were recruited and followed up for one year. The VPA reference range was
determined to be 40-85 mg/L. After multivariate analysis, significant predictive variables for good control
were monotherapy [adjusted OR 4.74, 95% CI: 2.258, 9.947, p<0.001], non-smoking [adjusted OR 3.23, 95%
CI: 1.099, 9.473, p=0.033], normal brain imaging results [adjusted OR 5.83, 95% CI: 2.507, 13.552, p<0.001],
and the absence of stress [adjusted OR 19.98, 95% CI: 9.255, 42.764, p<0.001].
Conclusion: Monotherapy, non-smoking, normal brain imaging results, and the absence of stress are predictive of good seizure control in patients on VPA. However, a serum concentration of VPA in the reference
range failed to predict good seizure control.
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Adem KARAMAN
Adem KARAMAN
Acute respiratory distress syndrome is characterized by dyspnea at presentation, tachypnea on physical
examination, findings of bilateral infiltration in chest radiography, refractory hypoxia, and high mortality.
Although the main treatment approach is to address the underlying disease, there are also pharmacological
and nonpharmacological options for supportive treatment. There is currently no pharmacological agent with
proven efficacy in this syndrome, and many drugs are being studied for this purpose. One of these is the
endothelin receptor antagonist bosentan.
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Özgür ÖZMEN, Mehmet AKSOY, İlker İNCE, Ayşenur DOSTBİL, Nazım DOĞAN, Hüsnü KÜRŞAD
Özgür ÖZMEN, Mehmet AKSOY, İlker İNCE, Ayşenur DOSTBİL, Nazım DOĞAN, Hüsnü KÜRŞAD
Objective: This retrospective study aimed to compare the clinical characteristics and trauma scores of Intensive Care Unit (ICU) trauma patients 65 years and older with the patients under 65 years old.
Materials and Methods: Trauma patients (n=161) who stayed at least 24 hours in ICU were included. Patients younger than 65 years were included into Group 1 (n=109) and patients aged ≥65 years (n=52) were
included into Group 2. Patient characteristics and trauma index scores (GCS; APACHE II score, ISS; TRISS
and RTS) at ICU admission were calculated.
Results: The patients in Group 2 had more comorbid disease compared with Group 1 (61.5%, 6.4%)
(p=0.001). The Trauma-related Injury Severity Score score were higher in Group 1 (49.76±33.75) compared with Group 2 (35.38±34.93) (p=0.006). The APACHE II score were higher in Group 2 (20.08±7.60)
compared with Group 1 (17.00±6.90) (p=0.007). The need for invasive mechanical ventilation and tracheostomy were more frequent in Group 2 trauma patients compared with those of patients in Group 1
(92.3%, 73.4%; p=0.003; 26.9%, 8.3%; p=0.002; respectively). The need for transfusion of packed red blood
cell suspension (PRBC) was more frequent in Group 2 compared with Group 1 (92.3%, 55.0%; respectively)
(p=0.001). The mortality rate was found to be higher in Group 2 compared with Group 1 (48.1%, 19.3%;
respectively) (p=0.001).
Conclusion: The elderly trauma patients have more comorbid disease, higher scores for APACHE II and
lower scores for TRISS, more mechanical ventilation and tracheostomy requirements and higher mortality
rate compared with young trauma patients.
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Objective: In this study, we developed a novel technique to harvest the sural nerve using the mini incisions
and the carpal tunnel dilators.
Materials and Methods: The technique was applied to the 29 sides on 27 patients (24 men and 3 women).
The mean age was 27.1 years (range 9-51). The diagnoses were soft tissue traumas in 23 cases, fracture in 2
cases, and previous complicated operation in 2 cases. The harmful effects of harvest procedure on the sural
nerve graft were assessed double-blind histopathologically and compared with control group.
Results: All the nerve grafts were successfully harvested with no macroscopic damage to the sural nerve
graft. There was no statistically significant difference between the histopathologic scores of the distal and
proximal nerve segments (p>0.05). The average follow-up time was 17 months (range 8-46). In the postoperative period, no complication such as massive bleeding/hematoma, wound infection, skin necrosis, painful
neuroma formation, or prolonged calf tenderness was observed. In all cases, there were inconspicuous scars.
Conclusion: The method seems safe and has no damage on the nerve graft histopathologically. We believe
that this technique may be used in future.
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