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Clinicopathologic and Prognostic Differences between Three Different Age Groups (Child/Adolescent, Young Adults, and Adults) of Colorectal Cancer Patients: A Multicentre Study
No full textKaplan, Muhammet Ali/0000-0003-0882-0524; SAKIN, Abdullah/0000-0003-2538-8569WOS: 000489996700003PubMed: 31437835Background: Colorectal cancer (CRC) is a rare disease amongst children and adolescents. Previous studies have reported a number of differences between children/adolescents, young adults, and adult patients with CRC. However, none of these studies compared these age groups according to their clinicopathologic and prognostic characteristics. in the current study, we compare these three age groups. Methods:A total of 173 (1.1% of 15,654 patients) young CRC patients (25 years) were also included. Patients were divided into three age groups: child/adolescent (10-19 years), young adult (20-25 years), and adult (>25 years). Results: Statistical differences amongst the three groups in terms of gender (p = 0.446), family history (p = 0.578), symptoms of presentation (p = 0.306), and interval between initiation of symptoms and diagnosis (p = 0.710) could not be demonstrated. Whilst abdominal pain (p < 0.001) and vomiting (p = 0.002) were less common in young adults than in other groups, rectal bleeding and changes in bowel habits were relatively less common in adolescents than in other groups. Rectal localisation (p = 0.035), mucinous adenocarcinoma (p < 0.001), and a poorly differentiated histologic subtype (p < 0.001) were less common in the adult group than in other groups. the percentage of patients with metastasis and sites of metastasis (e.g., peritoneum and lung) differed between groups. the median overall survival was 32.6 months in the adolescent group, 57.8 months in the young adult group and was not reached in the adult group (p = 0.022). the median event-free survival of the adolescent, young adult, and adult groups was 29.0, 29.9, and 61.6 months, respectively (p = 0.003). Conclusions: CRC patients of different age groups present different clinicopathologic and prognostic characteristics. Clinicians should be aware of and manage the disease according to these differences
Evaluation of Nurses' Knowledge about Risk Monitoring and Risk Prevention for Pressure Ulcers
No full textWOS: 000473218600011Objective: the aim of the study was to evaluate the levels of nurse's knowledge on prevention of pressure ulcers and its associated factors. Methods: This is a cross-sectional, descriptive study. the research sample consisted of 250 nurses who worked at a training research hospital from 1 September to 1 December 2016. the research data were collected using the "Nurse Information Form" and "Pressure Ulcer Prevention Knowledge Survey" prepared in light of the literature. Results: the sample was mostly undergraduate (70.0%) and the mean age was 26.11 +/- 5.33 years. Nurses (98.8%) indicated that "advanced age" has a significant influence among risk factors that cause pressure ulcers. the item on the "Pressure Ulcer Prevention Knowledge Survey", that was answered incorrectly most often (92.8%) was "when conscious patients with learning ability sit on chairs, they should be informed that they should shift their weight every 15 minutes," in the sub-dimension of "Nursing Interventions for Preventing Pressure Ulcers". There was a statistically significant difference between the knowledge level scores of nurses with respect to nurses' age, education level, working unit and pressure ulcer education (p<0.05). Conclusion: Nurses' knowledge level scores for prevention of pressure ulcers were above the average value. It is important to organize continuous education programs to increase nurses' knowledge about the risk factors for pressure ulcers and their prevention
Performance of first and second generation supraglottic airway devices in patients with simulated difficult airway: a randomised controlled trial
No full textWOS: 000505051800006PubMed: 31893603Background: Guidelines for management of unanticipated difficult intubation recommend the use of supraglottic airway devices (SADs) in cases of failed intubation. However, there is a lack of comparative studies for different type of devices. in this randomised controlled trial, the performance of 1st and 2nd generation supraglottic airway devices was compared in patients with a simulated difficult airway. Material and methods: We enrolled 90 patients, scheduled for elective surgery and suitable for supraglottic airway device insertion. Laryngeal mask airway (LMA)-classic (LMAC), LMA-proseal (LMAP) and LMA-flexible (LMAF) were evaluated. the modified Mallampati test was used for the preoperative airway assessment. Maximal mouth opening, body mass index, thyromental and sternomental distances, and neck circumference were measured, and patients with predicted difficulty were excluded. Insertion time, ease of insertion, oropharyngeal leak pressure, and Brimacombe and Berry Bronchoscopy Scores were evaluated. Peak airway pressure was measured at 1, 15 and 60 min following the insertion of SADs. Complications were recorded. Results: Oropharyngeal leak pressures were 35.2 +/- 8.1, 31.7 +/- 7.7 and 31.3 +/- 6.0 mm Hg for LMAP, LMAC and LMAF respectively (P = 0.079). First min peak airway pressure values were 14.0 +/- 4.2, 15.0 +/- 3.9, 14.9 +/- 4.4 mm Hg respectively (P = 0.403). There was a significant positive correlation between oropharyngeal leak pressure and first min peak airway pressure (r = 0.264, P = 0.013). Mean number of attempts was 1.1 +/- 0.3 times (P = 0.840). Insertion time was 20.0 +/- 10.4, 17.0 +/- 5.7 and 16.4 +/- 10.2 s respectively (P = 0.440). Ease of insertion score was 2.0 +/- 0.9, 2.1 +/- 0.9 and 2.1 +/- 1.3 respectively (P = 0.837). There was no significant difference for optimization manoeuvre requirement or fibreoptic scope grades (P = 0.265, P = 0.651, respectively). Conclusions: First and second generation of supraglottic airway devices provided similar clinical performance for patients with difficult airway and trauma due to limited cervical motion
Value of Intravoxel Incoherent Motion for Hepatocellular Carcinoma Grading
No full textDAYANGAC, MURAT/0000-0002-1240-7233WOS: 000482696500036PubMed: 31399170Background. To evaluate the diagnostic accuracy of intravoxel incoherent motion (IVIM) parameters in estimation of hepatocellular carcinoma (HCC) grading. Materials and methods. Twenty-nine patients with histopathologically diagnosed as 42 HCC at explant were included in this retrospective study. All patients were examined by 1.5T magnetic resonance imaging with the use of 4-channel phased array body coil. in addition to routine pre- and postcontrast sequences, IVIM (16 different b factors varying from 0 to 1300 s/mm(2)) and conventional diffusion-weighted imaging (3 different b factors of 50, 400, 800 s/mm2) were obtained with single-shot echo planar spin echo sequence. Apparent diffusion coefficient (ADC) and IVIM parameters including mean D (true diffusion coefficient), D* (pseudo-diffusion coefficient associated with blood flow), and f (perfusion fraction) values were calculated. Histopathologically, HCC was classified as low (grade 1, 2) and high (grade 3, 4) grade in accordance with the Edmondson-Steiner score. Quantitatively, ADC, D, D*, and f values were compared between the low- and high-grade groups by Student t test. the relationship between the parameters and histologic grade was analyzed using the Spearman's correlation test. To evaluate the diagnostic performance of the parameters, receiver operating characteristic analysis was performed. Results. High-grade HCCs had significantly lower ADC and D values than low grade groups (P = .005 and P = .026, retrospectively); ADC and D values were inversely correlated with tumor grade (r = -0.519, P = .011, r = -0.510, P = .026, respectively). High-grade HCCs had significantly higher f values when compared with the low-grade group (P = .005). the f values were positively correlated with tumor grade (r = 0.548, P = .007). the best discriminative parameter was f value. Cut-off value of 32% of f values showed sensitivity of 75.6% and a specificity of 73.5%. Conclusion. ADC values and IVIM parameters such as f values appear to reflect the grade of HCCs
Single center experience with biodegradable stents in treatment of refractory biliary strictures after living donor liver transplantation
No full text25th Annual International Congress of the International-Liver-Transplantation-Society (ILTS) -- MAY 15-18, 2019 -- Toronto, CANADAWOS: 000494805000853[No abstract available]Int Liver Transplantat So
Obezite tedavisinde intragastrik balon yöntemi güvenli ve etkili mi?
No full textAim: Bariatric surgery is a costly and invasive method with permanent effects and medications for treatment of obesity is less costly but may cause systemic side effects. Intragastric balloon (IGB) therapy is a minimal invasive and temporary option between medical therapy and bariatric surgery. The aim of this study is to evaluate the safety and efficiency of intragastric balloon application and present our results. Methods: 39 patients who underwent IGB therapy between 2015 and 2017 were included in the study. IGB was advanced into the stomach, and then the balloon was filled with saline and methylene blue solution. The patients were assessed by a nutritionist during the follow-up period and after balloon removal they were evaluated for results. Results: Of 39 patients, 33 were female and the median body mass index (BMI) was 33.2 kg/m2 before the procedure. Three patients (7.6%) could not tolerate the balloon; therefore balloon extraction was performed on the day 1, 5 and 25. Median duration of therapy was 8 months (1 day-17 months). While excessive weight loss (EWL) ratio was 22.8% in patients whose balloon was removed in 6 months, EWL ratio was 41.6% in patients whose balloon remained more than 6 months. The median BMI after balloon removal was 28.3 kg/m2. The only complication was spontaneous IGB deflation and excretion transanally. Conclusion: Intragastric balloon therapy may be recommended as a safe and effective option for the patients who have had failed attempts of diet and exercise and will not undergo bariatric surgery.Amaç: Obezite tedavi yöntemlerinden bariatrik cerrahi, invazif ve maliyetli bir yaklaşım olup kalıcı yan etkilere sahipken, göreceli daha az maliyetli medikal tedavinin sistemik yan etkileri söz konusu olabilir. İntragastrik balon (IGB) uygulaması ise medikal tedavi ve bariatrik cerrahi arasında minimal invazif ve geçici bir yöntemdir. Bu çalışmanın amacı, IGB uygulamasının etkinliğini ve güvenliğini değerlendirmektir. Yöntemler: Çalışmaya 2015 – 2017 yılları arasında IGB tedavisi uygulanan 39 hasta dahil edildi. İşlem öncesi ve sonrası vücut kitle indeksi (VKİ), fazla kilonun kayıp oranı, balonun hastalar tafından tolere edilebilmesi ve gelişen komplikasyonlar değerlendirildi. Bulgular: İşlem öncesi ortanca vücut kitle indeksi (VKİ) değeri 33.2 kg/m2 olan 39 hastanın 33’ü (%84,6) kadındı. İşlemi tolere edemeyen 3 hastanın (%7,6) balonu 1., 5. ve 25. günlerde çıkarıldı. Tedavinin ortanca süresi 8 aydı (1 gün-17 ay). Balonları ilk 6 ayda çıkarılan hastalarda fazla kilonun kayıp oranı %22,8 iken, 6 aydan uzun kalanlarda bu oran %41,6 idi. Balon çıkarılması sonrası VKİ ortanca değeri 28.3 kg/m2 olarak bulundu. Sadece bir hastada (%2,5) spontan IGB rüptürü ve balonun defekasyonla atılması görüldü. Sonuç: IGB uygulaması başarısız diyet ve egzersiz denemeleri olan ve bariatrik cerrahi yapılmayacak hastalara güvenli ve etkili bir yöntem olarak önerilebilir
Nonadherence in hemodialysis patients and related factors: A multicenter study
No full textPubMed ID: 30720548Background: Nonadherence to dietary and fluid restrictions, hemodialysis (HD), and medication treatment has been shown to increase the risks of hospitalization and mortality significantly. Sociodemographic and biochemical parameters as well as psychosocial conditions such as depression and anxiety are known to affect nonadherence in HD patients. However, evidence related to the relative importance and actual impact of these factors varies among studies. Purpose: The aim of this study was to identify the factors that affect nonadherence to dietary and fluid restrictions, HD, and medication treatment. Methods: This descriptive study was conducted on 274 patients who were being treated at four HD centers in Turkey. The parameters used to determine nonadherence to dialysis treatment were as follows: skipping multiple dialysis sessions during the most recent 1-month period, shortening a dialysis session by more than 10 minutes during the most recent 1-month period, and Kt/V 7.5 mg/dl, predialysis serum potassium level > 6.0 mEq/L, and interdialytic weight gain > 5.7% of body weight. The Morisky Green Levine Medication Adherence Scale was performed to determine nonadherence to medication treatment. A patient was classified as nonadherent if he or she did not adhere to one or more of these indices. The Hospital Anxiety and Depression Scale was used to identify patient risk in terms of anxiety and depression. Logistic regression was used to determine the predictors of nonadherence. Results: The nonadherence rate was 39.1% for dietary and fluid restrictions, 33.6% for HD, and 20.1% for medication. The risk of nonadherence to dietary and fluid restriction was found to be 4.337 times higher in high school graduates (95% CI [1.502, 12.754], p = .007). The risk of nonadherence to HD treatment was 2.074 times higher in men (95% CI [1.213, 3.546], p = .008) and 2.591 times higher in patients with a central venous catheter (95% CI [1.171, 5.733], p = .019). Longer duration in HD resulted in 0.992 times decrease in risk of nonadherence to treatment (95% CI [0.986, 0.998], p = .005). Conclusions/Implications for Practice: Educational status, being male, having a central venous catheter, and having a short HD duration were found to be risk factors for nonadherence. Nurses must consider the patient's adherence to the dietary and fluid restrictions, HD, and medication treatment at each visit. Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved
The relationship of spleen stiffness value measured by shear wave elastography with age, gender, and spleen size in healthy volunteers
No full textWOS: 000463655400004PubMed ID: 30689067PurposeThe aim of this study is to evaluate spleen stiffness values with shear wave elastography (SWE) quantitatively in healthy adults and investigate the relationship of spleen stiffness with age, gender, and spleen size.MethodsThis study included 65 healthy individuals. Spleen stiffness measurement was obtained with 2 dimensional (2-D) SWE method from the middle portion of spleen and calculated in kilopascals by taking the average of three valid measurements. Longitudinal and transverse spleen sizes were measured. The relationship of spleen stiffness with age, gender, and spleen size was investigated. The association between spleen size and age and gender was also evaluated.ResultsThe mean spleen stiffness value was 13.822.91kPa, and the spleen stiffness was not affected by age, gender, or spleen size. Longitudinal spleen size was significantly lower in females than that in males. Moreover, there was a significant negative correlation between longitudinal spleen size and age (r=0.247, p=0.048).Conclusion p id=Par4 Spleen stiffness can be quantitatively measured by 2-D SWE, and the spleen stiffness is not affected by age, gender, and spleen size. The values obtained in this study can be used as normal base values in examination of different spleen pathologies
The Feasibility of Conventional Forward-viewing Endoscope for Endoscopic Retrograde Cholangiopancreatography in Patients With Altered Gastrointestinal Anatomy
No full textWOS: 000471032200018PubMed ID: 30720694Background: Endoscopic retrograde cholangiopancreatography (ERCP) has been commonly used for biliopancreatic diseases of patients with normal gastrointestinal (GI) anatomy with a success rate of >90%. However, this procedure may also be necessary in patients with altered GI anatomy such as Billroth II or Roux-en-Y reconstructions. Performing ERCP in these patients may pose extreme technical challenges, and increase the risk of complications. The aim of this study was to analyze the feasibility of ERCP using forward-viewing endoscopy in patients with altered GI anatomy. Materials and Methods: Twenty-three patients with previous gastric resections and GI anastomosis, who underwent ERCP between 2012 and 2017, were included in this retrospective study. The major indication for ERCP was choledocholithiasis in 19 patients, and the others were acute cholangitis, sphincter Oddi dysfunction, and biliary pancreatitis. The sedation was induced using a combination of midazolam and propofol, and all procedures were performed using a forward-viewing endoscope. Results: Among the 23 patients, 14 were male individuals and 9 were female individuals, with an average age of 62 (range: 58 to 73) years. The median procedure time was 24 (range: 19 to 43) minutes. The success rate of bile duct cannulation was 91.3% (21/23 patients) and that of stone extirpation was 89.4% (17/19 patients with choledocholithiasis). Plastic stents were placed in the 2 patients in whom stone extirpation was not successfully performed. ERCP was repeated in these patients 8 weeks after the initial approach, and stone extraction procedures were successfully completed. The only procedure-related complication was edematous pancreatitis, which was observed in 1 patient (4.7%). The mean length of hospitalization was 2 (range: 1 to 5) days. Conclusions: Forward-viewing endoscopes can be effectively used in patients with altered GI anatomy by facilitating the access to the papilla and bile duct cannulation without increasing the incidence of complications
Liver Graft Volume Estimation by Manual Volumetry and Software-Aided Interactive Volumetry: Which is Better?
No full textPurpose: Estimation of graft volume is critical in living donor liver transplantation (LDLT). In this study, we aimed to evaluate the accuracy of software-aided automated computer tomography (CT) volumetry in the preoperative assessment of graft size for LDLT and to compare this method with manual volumetry. Materials and Methods: Forty-one donors (27 men; 14 women) with a mean age in years ± standard deviation (28.4 ± 6.6) underwent contrast-enhanced CT prior to graft removal for LDLT. A liver transplant surgeon determined the weights of liver grafts using automated 3-dimensional volumetry software, and an abdominal radiologist specializing in liver imaging independently and blindly used the commercial interactive volumetry-assisted software on a viewing workstation to determine the liver volume on CT images. Both results were then compared to the weights of actual grafts obtained during surgery. Intraclass correlation coefficients were used to assess the consistency of numerical measurements and Pearson correlation coefficients were calculated to detect a linear relationship between numerical variables. To compare correlation coefficients, z scores were used. Results: Regarding the right and left lobe graft volume estimation by the surgeon, there was a positive correlation between the results and actual graft weight (r = 0.834; P =.001; and r = 0.587; P =.001, respectively). Likewise, graft volume estimation by the radiologist for the right and left lobe was also positively correlated with the actual graft weight (r = 0.819; P =.001 and r = 0.626, P =.001, respectively). There was no significant difference between correlation coefficients (P =.836). Conclusion: Volumetric measurement of donor graft using 3-dimensional software provides comparable results to manual CT calculation of liver volume. © 2019 The Author