Effect of intra-abdominal pressure rise on hematological parameters in laparoscopic urologic surgery

Objective: To determine the potential utility of hematological parameters in the diagnosis of intra-abdominal hypertension [IAH]

Study Design: Cross-sectional descriptive study

Place and Duration of Study: Health Sciences University, Samsun Training and Research Hospital, Samsun, Turkey, from January 2016 to July 2017

Methodology: Forty-two patients who underwent transperitoneal laparoscopic urologic surgery were included. Blood samples were obtained during periods of pre-insufflation, insufflation, and desufflation to determine the effects of increased intraabdominal pressure [IAP] on hematological parameters, respectively

Results: Leukocyte and neutrophil median values changed with time [p<0.001]. The median pre-insufflation, insufflation, and desufflation values for leukocytes were 6.3 fL [4.2-7.8 fL], 7.2 fL [4.4-9.9 fL], and 8.1 fL [4.9-13.5 fL], respectively.In the pre-insufflation period, the median value for neutrophils was 3.7 x 10[3] MuL [2.0-6.2 x 10[3] MuL], increasing 5.1 x 10[3] MuL [2.1-9.7 x 10[3] MuL] during insufflation and 6.1 * 10[3] MuL [3.1-10.0 x 10[3] MuL] during desufflation. The median values obtained in pre-insufflation period were significantly lower than those recorded in the other periods. There was no difference between the median values obtained during insufflation and those obtained during desufflation. The mean platelet volume [MPV] values during pre-insufflation, insufflation, and desufflation were 8.2 fL [6.3-9.6 fL], 8.8 [6.2-10.3 fL], and 8.1 [6.6-10.6 fL], respectively. There was a statistically significant increase in MPV values during high IAP [p<0.001]

Conclusion: The rise in MPV during IAP rise indicated that this parameter may be used to detect IAH

Atrial conduction times and left atrial mechanical functions and their relation with diastolic function in prediabetic patients

BACKGROUND/AIMS: The aim of this study was to investigate atrial conduction times and left atrial mechanical functions, the noninvasive predictors of atrial fibrillation, in prediabetic patients with impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). METHODS: Study included 59 patients (23 males, 36 females; mean age 52.5 ± 10.6 years) diagnosed with IFG or IGT by the American Diabetes Association criteria, and 43 healthy adults (22 males, 21 females; mean age 48.5 ± 12.1 years). Conventional and tissue Doppler echocardiography were performed. The electromechanical delay parameters were measured from the onset of the P wave on the surface electrocardiogram to the onset of the atrial systolic wave on tissue Doppler imaging from septum, lateral, and right ventricular annuli. The left atrial volumes were calculated by the disk method. Left atrial mechanical functions were calculated. RESULTS: The mitral E/A and E′/A′ ratios measured from the lateral and septal annuli were significantly lower in the prediabetics compared to the controls. The interatrial and left atrial electromechanical delay were significantly longer in prediabetic group compared to the controls. Left atrial active emptying volume (LAAEV) and fraction (LAAEF) were significantly higher in the prediabetics than the controls. LAAEV and LAAEF were significantly correlated with E/A, lateral and septal E′/A′. CONCLUSIONS: In the prediabetic patients, the atrial conduction times and P wave dispersion on surface electrocardiographic were longer before the development of overt diabetes. In addition, the left atrial mechanical functions were impaired secondary to a deterioration in the diastolic functions in the prediabetic patients.

Pathological investigation of childhood foreskin: are lichen sclerosus and phimosis common?

Objective: To evaluate histopathological results of foreskin removed during circumcision in the pediatric age group and the relationship between these and the degree of phimosis

Study Design: Cross-sectional study

Place and Duration of Study: Department of Urology, Samsun Training and Research Hospital, Samsun, Turkey, from June to December 2014

Methodology: Male children undergoing planned circumcision were examined for the presence and degree of phimosis which was recorded before the operation. After circumcision, the preputial skin was dermatopathologically investigated. Pathological investigation carefully evaluated findings such as acute inflammation, chronic inflammation, increased pigmentation and atrophy in addition to findings of Lichen Sclerosus [LS] in all specimens. The pathological findings obtained were classified by degree of phimosis and evaluated

Results: The average age of the 140 children was 6.58 +/- 2.35 years. While 61 [43.6%] children did not have phimosis, 79 [56.4%] patients had different degrees of phimosis. Classic LS was not identified in any patient. In a total of 14 [10%] children, early period findings of LS were discovered. The frequency of LS with phimosis was 12.6%, without phimosis was 6.5% [p=0.39]. The incidence of histopathologically normal skin in non-phimosis and phimosis groups was 37.7% and 22.7%, respectively. In total, 41 [29.3%] of the 140 cases had totally normal foreskin

Conclusion: Important dermatoses such as LS may be observed in foreskin with or without phimosis. The presence of phimosis may be an aggravating factor in the incidence of these dermatoses

Intravesical Sodium Chondroitin Sulphate to Treat Overactive Bladder: Preliminary Result / 대한배뇨장애요실금학회지

PURPOSE: This study aimed to verify the efficacy and safety of intravesical treatment with sodium chondroitin sulfate (CS) in patients with overactive bladder (OAB) who are refractory to previous antimuscarinic treatment. METHODS: This study was performed between June 2012 and January 2015 and included 31 consecutive women (mean age, 42.10+/-7.34 years) with OAB who had been previously treated with two types of antimuscarinic drugs. The results of gynecologic and cystoscopic examinations were normal, and OAB comorbidity was absent. Treatment with intravesical instillations containing 40 mL CS (0.2%; 2 mg/mL) was administered for 6 weeks; after weekly treatments, monthly treatments were administered. The OAB-validated 8 (OAB-V8) symptom scores, nocturia, frequency, urgency, urge incontinence, and urinary volumes measured by uroflowmetry were evaluated for all the patients. The values obtained before the treatment were statistically compared with those obtained six months after the treatment. RESULTS: The duration of the symptoms was 18.36+/-6.19 months. A statistically significant improvement of the patients' conditions was observed in terms of the OAB-V8 symptom scores, nocturia, frequency, urgency, urge incontinence, and urinary volumes measured by uroflowmetry after the treatment. CONCLUSIONS: Despite the limitations of this study, the outcomes confirmed that CS therapy is safe and effective for the treatment of OAB.

Presence of Fragmented QRS Complexes in Patients with Obstructive Sleep Apnea Syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Obstructive sleep apnea syndrome (OSAS) is a disease with increasing prevalence, which is mainly characterized by increased cardiopulmonary mortality and morbidity. It is well-known that OSAS patients have increased prevalence of cardiovascular diseases including coronary heart disease, heart failure, and arrhythmias. The aim of this study was to evaluate the presence of prolonged and fragmented QRS complexes, which have previously been associated with cardiovascular mortality, in OSAS patients.</p><p><b>METHODS</b>Our study included 51 patients (mean age 41.6 ± 10.1 years) who were recently diagnosed with OSAS (apnea-hypopnea index [AHI] ≥5 events/h) and never received therapy. The control group consisted of 34 volunteers (mean age 43.1 ± 11.6 years) in whom OSAS was excluded (AHI <5 events/h). The longest QRS complexes was measured in the 12-lead electrocardiogram (ECG) and the presence of fragmentation in QRS complexes was investigated.</p><p><b>RESULTS</b>Fragmented QRS frequency was significantly higher in patients with OSAS (n = 31 [61%] vs. n = 12 [35%], P = 0.021). QRS and QTc durations were also significantly longer in OSAS patients than controls (99.8 ± 13.9 ms vs. 84.7 ± 14.3 ms, P < 0.001; 411.4 ± 26.9 ms vs. 390.1 ± 32.2 ms, P = 0.001, respectively). Analysis of the patient and controls groups combined revealed a weak-moderate correlation between AHI and QRS duration (r = 0.292, P = 0.070). OSAS group had no correlation between AHI and QRS duration (r = -0.231, P = 0.203).</p><p><b>CONCLUSIONS</b>In our study fragmented QRS frequency and QRS duration were found to increase in OSAS patients. Both parameters are related with increased cardiovascular mortality. Considering the prognostic importance of ECG parameters, it may be reasonable to recommend more detailed evaluation of OSAS patients with fragmented or prolonged QRS complexes with respect to presence of cardiovascular diseases.</p>

Sero-prevalence of hepatitis- a virus among children aged 1- 18 years in Easter Anatolia, Turkey

To determine the seroprevalence of hepatitis A virus among children aged 1-18 years in Elazig before national hepatitis A virus immunization program in Turkey. Prospective study. Elazig Education and Research Hospital and Elazig Harput State Hospital in Eastern Anatolia, Turkey. 1258 patients admitted to pediatric polyclinic with suspicion of hepatitis A virus infection between January 2011 and December 2012 were included in the study. ELISA blood test. Serological markers of hepatitis A, anti-HAV IgM and anti-HAV IgG, were tested using the ELISA method. Two hundred and forty-eight patients who were Anti-HAV IgM positive were excluded from study. The mean age of the remaining 1010 pediatric patients was 10.7 +/- 5.1 years [range: 1-18 years]. Out of these, 558 [55.2%] were male and 452 [44.8%] female. Overall, 575 [56.9%] cases were seronegative against hepatitis A virus. Anti-HAV IgG was detected in435 patients [43.1%]. Out of these, 236 [54.3%] were male and 199 [45.7%] female. The mean age of seropositive cases was 11.7 +/- 5.2 years. Hepatitis A is an important public health problem in our region. This study has revealed an advanced age of exposure to hepatitis A virus infection. We argue that the application of routine hepatitis A vaccine to children in our region will reduce the potential severe complications of the infection

Imipenem-Resistant Pseudomonas aeruginosa : Risk Factors for Nosocomial Infections

The aim of this study was to determine the risk factors for nosocomial infections of imipenem-resistant Pseudomonas aeruginosa (IRPA). A prospective case-control study was performed at a tertiary care hospital in Ankara from January to December 2004. The patients with nosocomial P. aeruginosa infection were included in the study. The features of the patients with IRPA infections were compared to those with imipenem-sensitive P. aeruginosa (ISPA) infections. Only the first isolation of P. aeruginosa was considered. Nosocomial infections were defined according to Center for Disease Control (CDC) criteria. IRPA was isolated from 75 (44.1%) patients, and ISPA was isolated from 95 (55.9%) patients during the study period. IRPA were most frequently isolated from endotracheal aspirate (19%) cultures (p= 0.048), whereas ISPA were most frequently isolated from urine (28%) cultures (p= 0.023). In multivariate analysis, a longer duration of hospital stay until P. aeruginosa isolation (odds ratio [OR], 1.027; 95% confidence interval [CI], 1.002-1.054, p=0.034), arterial catheter administration (OR, 2.508; 95% CI, 1.062-5.920, p=0.036), vancomycin (OR, 2.882; 95% CI, 1.130-7.349, p=0.027), piperacillin-tazobactam (OR, 6.425; 95% CI, 2.187-18.875, p=0.001), and imipenem (OR, 3.580; 95% CI, 1.252- 10.245, p=0.017) treatment within the 14 days before isolation of IRPA were independently associated with imipenem resistance. It was concluded that treatment with imipenem, vancomycin and piperacillin-tazobactam were major risk factors for IRPA infections in hospitalized patients. The nosocomial occurrence of IRPA was also strongly related to the duration of hospital stay, arterial catheter administration.