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EFFECTS OF LOWER GASTROINTESTINAL TRACT SURGERY ON SURVIVAL IN ELDERLY AND OCTOGENARIAN PATIENTS
Get PDFIntroduction: Life expectancy has significantly increased in the last decade. The decision to perform surgery has always been challenging in elderly patients. We aimed to evaluate outcomes in patients who underwent surgery for lower gastrointestinal tract diseases and investigate factors influencing morbidity and mortality, particularly in octogenarian patients, and the effects of age on prognosis and survival in the postoperative period.
Materials and Method: This study included patients aged >= 70 years who underwent lower gastrointestinal tract surgery; patients were divided into three groups as 70-75 years, 75-79 years, and >= 80 years. Age, gender, type of surgery, ASA score, length of hospital stay, morbidity, 30-day mortality, and overall survival were evaluated.
Results: The surgery was performed to 598 patients due to lower gastrointestinal tract diseases. There was a significant increase in the ASA score with increasing age (Chi-square=35.472; p<0.001). The survival rate was significantly higher in patients with malignancies than in those with benign diseases, and in patients who underwent elective surgery than in those who underwent emergency surgery (p<0.001). When patients were examined according to age groups, the overall survival was similar across groups (p=0.217).
Conclusion: There was no significant difference between octogenarian and younger patients for complications and survival. Thus, planned surgical interventions in elderly patients will not negatively affect survival and surgical interventions and can be safely performed in these patients
Cardiac effects of hemodialysis in children with chronic kidney disease
Get PDFPurpose: The aim of the study was to evaluate cardiac functions before and after hemodialysis in children with chronical renal failure.
Materials and Methods: The study comprised 24 children undergoing hemodialysis more then six months. Conventional and tissue Doppler echocardiography was performed, NT-proBNP levels were measured before and after hemodialysis. Echocardiographic results were compared regard to hydration status which measured with body composition monitor and hypotension event during dialysis.
Results: Myocardial performance indices which gained with tissue Doppler echo were high in 22 patient. Mitral E/A ratio significantly decreased after hemodialysis. NT-proBNP levels were high but no difference was determined after dialysis. Nine patient experienced hypotension but nonsignificant difference was detected regarding echocardiographic findings and NT-proBNP levels.
Conclusion: Diastolic dysfunction is frequent in chronical renal failure. Tissue Doppler echocardiography and myocardial performance index supply a more proper evaluation of global and regional cardiac function in chronical renal failure due to less hydration affectability. NT-proBNP should be monitored for cardiac dysfunction in chronical renal failure. Body composition monitor should be used in children for setting the ultrafiltration volume
The Evaluation of Clinical Signs in Patients with Suspected Renovascular Hypertension
No full textOBJECTIVE: Renovascular hypertension (RVH) is the most common yet correctable cause of secondary hypertension if diagnosed early. There are many clinical signs that can suggest RVH. The aim of this study was to find which clinical or laboratory signs are more indicative in diagnosing RVH and in determining which patients should go through renal angiography.
MATERIAL and METHODS: The study included 184 patients who presented to our clinic due to hypertension and were under risk of RVH. All patients underwent three-dimensional time-of-flight Magnetic Resonance Angiography with phase-contrast. The patients were divided into two groups as with and without renal artery stenosis, supported by MRA.
RESULTS: Advanced age, low body mass index, high serum creatinine level, presence of proteinuria, and patients with diabetes mellitus and coronary artery disease were found to be significant risk factors for RVH. Only the presence of renal asymmetry and the history of coronary artery disease were found to be independent risk factors.
CONCLUSION: In conclusion, detailed patient history and the evaluation of renal size are very important for patients with hypertension. Coronary artery disease and a difference in renal size of more than 1.5 cm could be strong indicators of RVH
Effect of Body Mass Index on Middle Ear Resonance Frequency
Get PDFOBJECTIVE: Multifrequency tympanometry (MET) analyzes tympanograms obtained using different probe tones between 226 and 2000 Hz. An important parameter of MET is resonance frequency (RF). Studies have recently demonstrated that the RF value can vary depending on many factors. To provide new data regarding MET, middle ear RF values were investigated with regard to body mass index (BMI).
MATERIALS and METHODS:This study included 78 volunteers (i.e., 156 ears) aged 18-40 years who did not have healing loss and whose otoscopic examinations were normal. Hearing thresholds were measured using pule tone audiometry, and RF values were recorded with immitansmetric measurements. The participants were divided into the following three groups according to their BMI: 25 kg/m(2), Group 3. The RE values were also analyzed.
RESULTS: Although there was no significant difference between Groups 1 and 2 in terms of RF values, a significant difference was observed between Groups 1 and 3 and between Groups 2 and 3.
CONCLUSION: In the light of these data, BMI values should be considered when middle ear RF values are assessed
Altered pulmonary functions due to biomass smoke in a rural population of Turkish women: a descriptive study
No full textIntroduction: Wood or other organic sources of fuel are used as source of energy for heating or cooking particularly in developing countries. The aim of the current study was to evaluate the association between biomass exposure time and parameters of pulmonary function tests.
Materials and Methods: Four hundred twenty-four consecutive women who lived and exposed to biomass smoke in a small province in Eastern Turkey were involved. This study was performed with women who had come to pulmonology out-patient clinic with symptom of dyspnea.
Results: The independent variables assessed in the study patients were age, BMI, starting age of cooking, hours per day and weeks per month spent cooking, and cooking years; the dependent variables were PFT parameters. Ninety-two (21.6%) patients had an obstructive PFT pattern. Sixty-seven (73%) of these patients were classified as GOLD 2 and 25 (27%) patients were classified as GOLD 3. Seventy-five (17.6 %) of the patients had restrictive lung disease; 54 (72%) of these patients were found to have a mild and 21 (27%) had a moderate restrictive pattern. Increased number of years in cooking and to start cooking at younger ages were a risk factors for the development of obstructive and restrictive disease. There was a statistically significant and negative correlation between increased number of years and the value of FEV1 (r=-0.917; p=<0.001), FEV1/FVC (r=-0.739; p<0.001), and FVC (r=-0.906; p<0.001). The median time of cooking required was 23 years for the development of obstruction, and 25 years for restriction, respectively.
Conclusion: Cumulative biomass exposure time is associated with impairment in PFT parameters; results in both obstructive and restrictive lung disease. Biomass exposure is a public health problem and pre-cautions should be taken in order to prevent impaired pulmonary functions
Endovascular Management of Iatrogenic Vascular Injury in the Craniocervical Region
No full textAIM: To evaluate iatrogenic vascular injuries in the craniocervical region and their endovascular management.
MATERIAL AND METHODS: Twenty-one patients (9 women, 12 men) with a mean age of 53.6 years (range 16-87 years), who underwent endovascular embolization for iatrogenic vascular injury in the craniocervical region between December 2000 and October 2015, were included in this retrospective study. Types of iatrogenic injuries, etiologies that caused these injuries and details of endovascular managements were reported.
RESULTS: The etiologies of the vascular injuries were as follows: transsphenoidal surgery (n=9), skull-base surgery (n=2), cholesteatoma surgery (n=1), tracheostomy (n=2), central venous catheterization (n=2), oropharyngeal tumor operation (n=1), endovascular treatment of internal carotid artery (ICA) stenosis (n=1), suprasellar epidermoid tumor operation (n=1), sphenoid sinus tumor surgery (n=1), and speech prosthesis device placement (n=1). The types of vascular injuries diagnosed at the time of angiography were; 2 occlusions, 2 stenoses, 2 dissections, 1 carotid cavernous fistula, 8 artery rupture with extravasation, and 9 pseudoaneurysms. Endovascular management of these vascular injuries were; parent artery occlusion (PAO) (n=15), aneurysm occlusion (n=3), covered stent (n=1) and conservative management (n=2). All patients except two were successfully treated. No patient had bleeding within a 30-day period after angiography. Long-term follow-up was available in all patients without occurrence of re-bleeding. One patient died due to complications related to primary vascular injury.
CONCLUSION: Although iatrogenic vascular injuries are rare, early diagnosis and management may be lifesaving. Endovascular techniques are reliable and safe in most of the patients
Outcomes for core decompression with multiple drilling of the osteonecrosis of the femoral head in patients with solid organ transplantation
No full textObjectives: This study aims to investigate the clinical and radiological outcomes of core decompression surgery performed with multiple drilling in solid organ transplantation patients with osteonecrosis of femoral head (ONFH) and evaluate the effectiveness of this procedure in regard to duration of corticosteroid use and stage of osteonecrosis.
Patients and methods: A total of 22 solid organ transplantation (kidney, liver or heart) patients (14 males, 8 females; mean age 43.3 years; range. 23 to 67 years) who were scheduled to undergo core decompression surgery with multiple drilling for ONFH were evaluated. Patients' Harris hip scores (HHSs) and radiographic data including Association Research Circulation Osseous (ARCO) staging and Kerboul grading were retrospectively reviewed at pre- and postoperative controls.
Results: Patients were followed-up for mean 34.3 months (range, 12 to 76 months). Two patients (9.09%) were performed total hip arthroplasty. These two patients' Kerboul grade was 3. There was no statistically significant relationship between preoperation and postoperative final control in terms of ARCO staging. There was no statistically significant difference between pre- and postoperative HHSs.
Conclusion: Although multiple drilling is a safe and minimally invasive surgery, its effect is limited, particularly in solid organ transplantation patients with ONFH due to long-term corticosteroid use. Therefore, solid organ transplantation patients should be closely monitored in terms of ONFH development
Career Indecision and Career Anxiety in High School Students: An Investigation through Structural Equation Modelling
No full textPurpose: The purpose of this study is to investigate the relationship between career indecision and career anxiety (career anxiety in terms of the effect of family and choice of profession) in high school students through structural equation modeling (SEM). Research Methods: The method used in the study is the relational model. The study group consisted of 444 students studying at 11th and 12th-grades. Research data was collected using The Scale for Career Anxiety and Career Decision Inventory. Findings: According to the model established, it was concluded that career indecision had an important effect on career anxiety in terms of family effect and choice of profession. In other words, for high school students, as scores related to career indecision increased, their scores related to career anxiety they experienced in terms of family effect and choice of profession also increased. Implications for Research and Practice: In order to decrease career anxiety that high school students experience during the career decision process, it is suggested to determine reasons for career indecision, and to plan career guidance process. In addition, supporting occupational development process with family guidance and professional counseling studies, giving weight to counseling services within the scope of attention, abilities and occupational values, supporting career research, and creating opportunities would also support professional decision-making skills. By this way, difficulties in decision-making related to occupational indecision and career anxiety may be precluded. (c) 2018 Ani Publishing Ltd. All rights reserve
Clinical significance of clavicle morphometry
No full textPurpose: Clavicle is the bony link between upper extremity and the body. This study is undertaken to assess the anatomical structure of clavicle and to determine the morphometric measurements.
Materials and Methods: Sixty-six clavicle of unknown gender of an Anatolian population (34 left-32 right) are included. Maximum claviculer length, the perimeter of the midpoint, the superior inferior and anterior posterior thickness of extremitas acromialis, the distance between the lateral border of the clavicle and the midpoint of linea trapezoidea, maximum length and width of impressio costoclavicularis, maximum length and width of fascies sternalis, maximum lengt hand width of facies acromialis and concave angle are measured in addition the Robustness index (endurance index) is calculated.
Results: Maximum claviculer length was 136.19 +/- 13.41 mm; superior inferior thickness of extremitas acromialis was 10.59 +/- 2.15 mm; and anterior posterior thickness of extremitas acromialis was 21.62 +/- 3.87 mm; the distance between the lateral border of the clavicle and the midpoint of linea trapezoidea was 17.06 +/- 3.83 mm; maximum length of impressio costoclavicularis was 16.51 +/- 5.11 mm; and maximum width of impressio costoclavicularis was 8.07 +/- 2.88 mm; maximum length of fascies sternalis was 16.58 +/- 3.22 mm; and maximum width of fascies sternalis was 20.26 +/- 3.29 mm maximum length of fascies acromialis was 9.10 +/- 2.55 mm; maximum width of fascies acromialis was 14.74 +/- 3.43 mm; concave angle was 139.43 +/- 8.25 degrees; the perimeter of the midpoint of the clavicle was 3.57 +/- 0.46 mm and the Robustness index (endurance index) was calculated to be 2.63 +/- 0.32.
Conclusion: Knowledge on the clavicular measurements may be essential for orthopaedic surgeons in acute displaced midshaft clavicle fractures and to choose a standart treatment modality in many other conditions
The Rare Benign Lesion That Mimics a Malignant Tumor in Breast Parenchyma: Nodular Fasciitis of the Breast
Get PDFWe herein report the clinical and pathological findings of a rare case of nodular fasciitis in the breast parenchyma of a 48-year-old female. Because of potentially malignant findings on ultrasonography and during clinical examination, the patient underwent an excisional biopsy. Histologically, the lesion was composed of spindle to round shaped cells arranged in short bundles in a storiform pattern. Immunohistochemically, the cells were positive for vimentin and SMA and negative for desmin, S100, and CD34. Based on these morphological and immunohistochemical features, a diagnosis of nodular fasciitis was made. We emphasize that nodular fasciitis of the breast may showclinical features and imaging findings similar to those of breast cancer. The histopathologic diagnosis of nodular fasciitis can also be challenging. The purpose of this case report is to highlight the characteristics and the differential diagnosis of this rare neoplasm