The Use of Intraoperative Extracorporeal Membrane Oxygenation in Lung Transplantation: Initial Institutional Experience

ABSTRACT Introduction: Lung transplantation is the final treatment option for end-stage lung disease, and extracorporeal membrane oxygenation (ECMO) is increasingly being used during lung transplantation. Objective: The present study aimed to review our initial experience with patients who underwent lung transplantation with or without ECMO since the implementation of the lung transplantation program at our center. Methods: Data were prospectively collected on all patients between December 2016 and December 2018. Patients undergoing ECMO as a bridge to lung transplantation were excluded. Results: A total of 48 lung transplants were performed, and ECMO was used in 29 (60.4%) cases. Twenty (83%) patients were female. The median age was 48.5 (range, 14-64) years. The most common indications were idiopathic interstitial pneumonia in 9 (31%) patients, chronic obstructive pulmonary disease in 7 (24.1%) patients, and bronchiectasis in 6 (20.7%) patients. Sequential bilateral lung transplantation was performed in all patients. The 30-day mortality was 20.6% (6/29) for patients with ECMO, however, it was 10.5 (2/19) for patients without ECMO (P=0.433). The median length of stay in the intensive care unit (ICU) was 5 (range, 2-25) days. The ECMO weaning rate was 82.8% (24/29). One-year survival was 62.1% with ECMO versus 78.9% without ECMO, and the 3-year survival was 54.1% versus 65.8%, respectively (P=0.317). Conclusions: ECMO is indicated for more severe patients who underwent lung transplantation. The use of ECMO provides adjuvant support during surgery and the mortality rate is acceptable. Survival is also as similar as non-ECMO patients. ECMO is appropriate for critically ill patients.

The clinical significance of lymphovascular space invasion in patients with low-risk endometrial cancer

SUMMARY OBJECTIVE: The aim of this study was to assess the effect of lymphovascular space invasion on recurrence and disease-free survival in patients with low-risk endometrial cancer. METHODS: The study included patients with stage 1A, grade 1-2 endometrioid endometrial cancer who underwent a total hysterectomy and bilateral salpingo-oophorectomy with pelvic lymphadenectomy. Independent prognostic predictors of endometrial cancer recurrence were assessed using the Cox regression model. Binary logistic regression analysis was used to identify the predictors of distant recurrence. Kaplan-Meier analysis was used to describe survival curves, and the log-rank test was used to compare the differences in survival curves. RESULTS: A total of 189 patients met the inclusion criteria, of whom 24 (12.7%) had lymphovascular space invasion. The median follow-up time was 60 (3-137) months. Distant recurrence was present in 11 of 22 patients who developed recurrence. Kaplan-Meier survival analysis showed that the 5-year disease-free survival rates of patients with lymphovascular space invasion(+) and lymphovascular space invasion(-) were 62.5 and 91.9%, respectively, which were significantly lower (p<0.001). In multivariate Cox regression analysis, the presence of lymphovascular space invasion (p<0.001) and age ≥60 years (p=0.017) remained as prognostic factors for reduced disease-free survival. In binary logistic regression analysis, only lymphovascular space invasion (adjusted OR=13, 95%CI=1.456-116.092, p=0.022) was a prognostic factor for distant recurrence. CONCLUSION: lymphovascular space invasion is a prognostic risk factor for recurrence and distant metastasis and also a predictor of poorer disease-free survival outcomes in low-risk endometrial cancer.

Análisis de los Resultados nacionales obtenidos por grupos estatales de investigación del el cáncer ruso. Programa de Cribado de Enfermedades de la Mucosa Oral y Borde Bermellón / Analysis of The Results Obtained by National Research Groups with The Russian State Cancer Program for The Screening of Diseases of The Oral Mucosa and The Vermillion Border

This article analyzes the results obtained by national research groups in the implementation of the Russian State Cancer Program. From 2015 to the first half of 2019, specialists studied the epidemiology and structure of oncological and precancerous diseases of the oral mucosa and the vermillion border in 486,059 persons aged 18-92 years living in Tula, the Tula region, Moscow and Noyabrsk as a result of screening and medical aid appealability. In this period, the productivity of the research group from Tula grew by the factor of 18.92. The results of the research confirm low cancer alertness of practicing dentists. An individual patient registration card has been developed to systematize data and create a diagnostic register for the screening of cancer and precancerous diseases of the oral mucosa and the vermillion border.

Types of Medication-Assisted Treatment for Opioid Use Disorder in Turkey: The Perceptions of Inpatients about Treatment Success

Objective@#The aim of this study was the following. When the different dynamics of agonist or antagonist treatments considered it is assumed that the eligible treatment to the individual may be maintained with high efficacy. Thus, we aimed to examine the difference between treatment methods, considering sociodemographics and positive perception for treatment success. @*Methods@#The number of 136 individuals which their ages range between 19-50 and have been getting agonist (buprenorphinealoxone) or antagonist (naltrexone) treatment because of opioid use disorder while resting in clinics have been evaluated to reveal the factors that may alter their perception about treatment and have been compared with sociodemographic variables and characteristics such as sociotropic and autonomic. Therefore, “Sociodemographic Data Evaluation Form,” “Predictive Factors for The Addiction Treatment Success Scale,” and “Sociotropy-Autonomy Scale” were used to assess the sociodemographic data, the perception towards factors which have been affected to the treatment and characteristics. The data of the individuals have been collected by the researcher via face-to-face interviews while patients were residential in the clinic. @*Results@#According to results of our study, it has been detected that there are some differences in the perception of treatment success between individuals who have been getting agonist or antagonist treatments such as treatment method (p<0.05), treatment frequency (p<0.01) and parents’ vital statuses (p<0.05). @*Conclusion@#At the end of the study it has been understood that medical and social benefits after the selection of eligible treatment methods which is suitable for individual’s perception and characteristics have to be considered.

Types of Medication-Assisted Treatment for Opioid Use Disorder in Turkey: The Perceptions of Inpatients about Treatment Success

Objective@#The aim of this study was the following. When the different dynamics of agonist or antagonist treatments considered it is assumed that the eligible treatment to the individual may be maintained with high efficacy. Thus, we aimed to examine the difference between treatment methods, considering sociodemographics and positive perception for treatment success. @*Methods@#The number of 136 individuals which their ages range between 19-50 and have been getting agonist (buprenorphinealoxone) or antagonist (naltrexone) treatment because of opioid use disorder while resting in clinics have been evaluated to reveal the factors that may alter their perception about treatment and have been compared with sociodemographic variables and characteristics such as sociotropic and autonomic. Therefore, “Sociodemographic Data Evaluation Form,” “Predictive Factors for The Addiction Treatment Success Scale,” and “Sociotropy-Autonomy Scale” were used to assess the sociodemographic data, the perception towards factors which have been affected to the treatment and characteristics. The data of the individuals have been collected by the researcher via face-to-face interviews while patients were residential in the clinic. @*Results@#According to results of our study, it has been detected that there are some differences in the perception of treatment success between individuals who have been getting agonist or antagonist treatments such as treatment method (p<0.05), treatment frequency (p<0.01) and parents’ vital statuses (p<0.05). @*Conclusion@#At the end of the study it has been understood that medical and social benefits after the selection of eligible treatment methods which is suitable for individual’s perception and characteristics have to be considered.

Effectiveness and Influencing Factors of Percutaneous Transluminal Angioplasty for Stenosis of Transposed Brachiobasilic Arteriovenous Fistula

PURPOSE@#To evaluate effectiveness of percutaneous transluminal angioplasty (PTA) for transposed brachiobasilic arteriovenous fistula (tBBAVF), and to analyze the factors influencing patency after PTA.@*MATERIALS AND METHODS@#In 101 patients who underwent operation for tBBAVF from January 2006 to February 2008, we identified 42 patients undergoing PTA. We conducted a retrospective analysis of sequential PTAs in these patients from 2006 to 2017.@*RESULTS@#A total of 100 PTAs were performed. The technical success rate was 93% and the clinical success was 100%. Only ruptures occurred in 12% as minor complications. Primary patency rate was 61%, 29%, 7%, and secondary patency was 91%, 82%, 59% at 6, 12, and 24 months, respectively. Primary patency rate was lower in tBBAVF with rupture (p = 0.024). Secondary patency rate was significantly lower in the diabetes (p = 0.002).@*CONCLUSION@#Repetitive PTAs in tBBAVF are acceptable due to excellent secondary patency. Primary patency of tBBAVF is low in patients with rupture. Diabetes itself has a significant effect on secondary patency.

An MRI-Based Quantification for Correlation of Imaging Biomarker and Clinical Performance in Chronic Phase of Carbon Monoxide Poisoning

PURPOSE: The purpose of this study was to determine the relation between quantitative magnetic resonance imaging biomarkers, and clinical performances in chronic phase of carbon monoxide intoxication. MATERIALS AND METHODS: Eighteen magnetic resonance scans and cognitive evaluations were performed, on patients with carbon monoxide intoxication in chronic phase. Apparent diffusion coefficient (ADC) ratios of affected versus unaffected centrum semiovale, and corpus callosum were obtained. Signal intensity (SI) ratios between affected centrum semiovale, and normal pons in T2-FLAIR (fluid-attenuated inversion recovery) images were obtained. The Mini-Mental State Exam, and clinical outcome scores were assessed. Correlation coefficients were calculated, between MRI and clinical markers. Patients were further classified into poor-outcome and good-outcome groups based on clinical performance, and imaging parameters were compared. T2-SI ratio of centrum semiovale was compared, with that of 18 sex-matched and age-matched controls. RESULTS: T2-SI ratio of centrum semiovale was significantly higher in the poor-outcome group, than that in the good-outcome group and was strongly inversely correlated, with results from the Mini-Mental State Exam. ADC ratios of centrum semiovale were significantly lower in the poor outcome group than in the good outcome group, and were moderately correlated with the Mini-Mental State Exam score. CONCLUSION: A higher T2-SI and a lower ratio of ADC values in the centrum semiovale, may indicate presence of more severe white matter injury and clinical impairment. T2-SI ratio and ADC values in the centrum semiovale, are useful quantitative imaging biomarkers for correlation with clinical performance in individuals with carbon monoxide intoxication.

Predictive Factors for Complete Response and Recurrence after Transarterial Chemoembolization in Hepatocellular Carcinoma

BACKGROUND/AIMS: To investigate the predictive factors for complete response (CR) and recurrence after CR in patients with hepatocellular carcinoma (HCC) treated with transarterial chemoembolization (TACE). METHODS: Among 691 newly diagnosed HCC patients, 287 were treated with TACE as a first therapy. We analyzed the predictive factors for CR, recurrence after CR, and overall survival (OS). RESULTS: Eighty-one patients (28.2%) achieved CR after TACE, and recurrence after CR was detected in 35 patients (43.2%). In multivariate analyses, tumor size (≤5 cm) and single nodularity were predictive factors for CR, with hazard ratios (HRs) of 0.35 (p=0.002) and 0.41 (p20 ng/mL) level and multinodularity exhibited significant relationships with recurrence after CR, with HRs of 2.220 (p=0.026) and 3.887 (p5 cm), multinodularity, elevated serum AFP (>20 ng/mL) level, Child-Turcotte-Pugh score (B and C), and portal vein thrombosis were significant factors for OS. CONCLUSIONS: In patients treated with TACE as a first therapy, tumor size (≤5 cm) and single nodularity were predictive factors for CR, and multinodularity and elevated serum AFP (>20 ng/mL) levels were predictive factors for recurrence after CR. These factors were also significant for OS.

Validation of high performance liquid chromatographic and spectrophotometric methods for the determination of the antiparkinson agent pramipexole dihydrochloride monohydrate in pharmaceutical products

abstract The antiparkinson agent pramipexole dihydrochloride monohydrate was quantified in pharmaceutical products by high performance liquid chromatography (HPLC) and derivative spectrophotometry. The first method was based on HPLC using tamsulosin HCl as an internal standard. In this method, chromatographic separation was achieved using a LiChrospher 60 RP column at 25°C, with a flow rate of 1.0 mL/min at 263 nm. The eluent comprised 0.01 mol/L ammonium acetate (pH 4.4) and acetonitrile (35:65 by volume). The linearity range was found to be 10.0-30.0 µg/mL with a mean recovery of 100.5 ± 1.10. The limit of detection (8 ng/mL) and limit of quantification (50 ng/mL) were calculated. In the second method, the first derivative spectrophotometric technique for the determination of pramipexole dihydrochloride monohydrate was performed by measuring the amplitude at 249 and 280 nm. In the first derivative technique, the absorbance and concentration plot was rectilinear over the 5.0-35.0 µg/mL range with a lower detection limit of 1.5 ng/mL and quantification limit of 4.5 ng/mL. The typical excipients included in the pharmaceutical product do not interfere with the selectivity of either method. The developed methods were validated for robustness, selectivity, specificity, linearity, precision, and accuracy as per the ICH and FDA guidelines (ICH Q2B, 1996; FDA,2000). In conclusion, the developed methods were successful in determining the quantity of the antiparkinson agent pramipexole dihydrochloride monohydrate in pharmaceutical products. The RSD values for the pharmaceutical product used in this study were found to be 0.97% for the HPLC method and 0.00% for the first derivative spectrophotometric method.

resumo O fármaco antiparkinsoniano, dicloridrato de pramipexol monoidratado, foi quantificado no produto farmacêutico por cromatografia líquida de alta eficiência (CLAE) e espectrofotometria derivada. No primeiro método baseado na CLAE, o cloridrato de tansulosina foi usado como padrão interno. Nesse método, a separação cromatográfica foi realizada usando uma coluna Lichrosper 60 RP a 25 °C e acetato de amônio 0,01 mol/L (pH:4.4): acetonitrila (35:65 em volume) como eluente com fluxo de 1,0 mL /min a 263 nm. A faixa de linearidade foi de 10.0-30.0 µg/mL com média da recuperação 100.5 ± 1.10. O limite de detecção (8 ng/mL) e o limite de quantificação (50 ng/mL) foram calculados. Por outro lado, a primeira técnica de espectrofotometria derivada para a determinação de dicloridrato de pramipexol monoidratado foi realizada através da medida da amplitude a 249 e 280 nm. Na técnia da primeira derivada, a absorvância e a plotagem da concentração foi retilínea na faixa de 5.0-35.0 µg/mL com limite inferior de detecção de 1.5 ng/mL e limite de quantificação de 4.5 ng/mL. Os excipientes típicos incluídos no produto farmacêutico não interferem com a seletividade dos métodos. Os métodos desenvolvidos foram validados quanto à robustez, seletividade, especificidade, linearidade, precisão e exatidão de acordo com as diretrizes do ICH e FDA (ICH Q2B,1996; FDA,2000). Concluindo, os métodos propostos foram aplicados com sucesso para a determinação quantitativa do agente antiparkinsoniano dicloridrato de pramipexol monoidrato em produtos farmacêuticos. Os valores de RSD para o produto farmacêutico utilizado neste estudo foi 0.97% para a CLAE e 0.00% para o método de espectrofotometria de primeira derivada.

Hybrid Operation for Arteriovenous Malformation in Left Soleus Muscle with Embolization of Feeding Artery and En Bloc Resection: A Case Report / 대한족부족관절학회지

Arteriovenous malformations (AVMs) are characterized by the presence of abnormal connections between feeding arteries and draining veins. It is generally assumed that symptomatic lesions can preferably be treated. Due to high arterial blood flow, there is a risk of bleeding with surgical excision alone, which can be massive and life threatening during the operation. According to recent advances in interventional technique, a hybrid approach using embolization of the feeding artery with subsequent immediate excision of the AVM for successful management of vascular lesions could be applied to AVMs. Herein, we describe a case of successful excision of AVM in the left soleus muscle using a hybrid approach.

Procalcitonin and C-reactive protein in differantiating to contamination from bacteremia

Procalcitonin (PCT) and C-reactive protein (CRP) are important biological markers used in the diagnosis of severe infections. The aim of this study was to evaluate the consistency of blood culture with PCT and CRP in differentiating contamination and non-bacteremia from true bacteremia. In this study blood samples were obtained from 809 febrile patients and analyzed using BACTEC 9120 system. All of positive blood cultures were performed Gram staining. The microorganisms were identified with conventional methods and automated systems. Antibiotic susceptibility tests were made by disc diffusion. PCT levels were analyzed by mini VIDAS device and PCT kit. PCT and CRP levels were analyzed with blood cultures in same times. Kruskal Wallis test, Mann-Whitney U test, Spearman's rho test and ROC curve were used for statistical analyses. The bacteremia group was found to be significantly different from non-bacteremia group and contamination group in terms of both PCT and CRP (p<0.0001). The p values of PCT and CRP in differentiating bacteremia from non-bacteremia were p<0.001 for PCT, p=0.002 for CRP and in differentiating bacteremia from contamination were p<0.001 for PCT, p<0.001 for CRP. PCT is a more useful marker than CRP in the differentiating of true bacteremia from contamination according to the results of this study.

Persistent organochlorine pesticide residues in water and sediment samples from Lake Manyas, Turkey.

The extent of organochlorine pesticides (OCPs) contamination in Manyas Lake (Bird Lake) and its tributary rivers and streams which is situated near the South-eastern coasts of the Marmara Sea in Turkey was investigated. Residues of OCPs in surface water and sediment samples were analysed by gas chromatography equipped with electron capture detector. The total OCPs concentration (SOCPs) in water and sediment samples ranged from 1.43 to 8.6 µg l-1 and from 17.05 to 39.14 ng g-1, respectively. According to the concentrations and detection frequencies, HCHs, DDTs, heptachlor and heptachlor epoxide were the most dominant compounds among the OCPs. The results showed that Manyas Lake was still contaminated by organochlorine pesticides and their residues despite bans on the production and usage over a long time.

Aberrant Ovarian Artery Arising from the Common Iliac Artery: Case Report

A 46-year-old Vietnamese woman received embolization therapy in order to control postpartum hemorrhage. Angiography revealed an aberrant ovarian artery arising from the right common iliac artery. Superselective catheterization and subsequent embolization of the aberrant ovarian artery and bilateral uterine arteries were performed. Precise knowledge of the anatomic variations of the ovarian artery is important for successful embolization.

Concurrent Occurrence of Type II and Type III Endoleak of Abdominal Aortic Aneurysm Stent Graft: A Case Report

Endoleak is an important complication following stent grafts for abdominal aortic aneurysms. Here we describe ultrasonography findings in an 86-year-old man including doppler ultrasonography and CT scan in an unusual and interesting case of the concurrent occurrence of a type II endoleak that originated from the left accessory renal artery and a type III endoleak due to shaft fracture of the stent.

comparison of intra cuff pressures in high-flow and low-flow nitrous oxide anesthesia

To investigate intra cuff pressure changes in low-flow anesthesia [LFA] and high-flow [HFA] N2O anesthesia during moderate-duration surgical procedures. We carried out this prospective, randomized, single blind study at Numune Educational and Research Hospital, Ankara, Turkey between January to December 2005. Seventy patients aged between 18-65 years, American Society of Anesthesiologists [ASA] physical status grades I-III, undergoing elective surgery were enrolled in this study. Following a standardized induction, anesthesia was maintained with isoflurane [end-tidal 0.9-1%] at 4 L/minute for the HFA group, or 1 L/minute for the LFA group fresh gas flows. Endotracheal tube cuff [intra cuff] pressures were measured continuously with a pressure manometer, and inspired oxygen and N2O levels were noted every 10 minutes throughout the study. There was no significant difference between HFA and LFA groups for initial [first] cuff pressures [mean +/- SD, HFA=20.9 +/- 4.19, LFA=20.4 +/- 4.11, cmH2O], and maximum cuff pressures [MCP] [mean +/- SD, HFA=32.3 +/- 18.74, LFA=33.5 +/- 8.89, cmH2O] [p > 0.05]. The time to reach the maximum intra cuff pressure was significantly shorter in the LFA group [77.4 +/- 20.33 minutes], than the HFA group [89.3 +/- 23.94 minutes], [p=0.038]. Between the tenth and nineteenth minutes, inspired oxygen level was significantly higher in the HFA group [p=0.001], whereas inspired N2O was significantly higher in the LFA group [p=0.001]. The intra cuff pressures should be monitored carefully during LFA, since the duration to reach the maximum intra cuff pressures was shorter than that of HFA

Hounsfield Number Measurement after a Uterine Fibroid Embolization: Significance as a Predictive Factor of Embolization Success

PURPOSE: To assess the usefulness of the Hounsfield number, measured by a non-contrast enhanced pelvic CT, after a uterine artery embolization as an index of the successful outcome of a uterine fibroid embolization (UFE). MATERIALS AND METHODS: The study subjects included 15 women (age range: 28-49 years, mean age: 36.4 years) diagnosed with symptomatic uterine myomas and seen from March 2003 to August 2005. A non-contrast enhanced pelvic CT scan was performed six hours after a uterine artery embolization. The global and maximal CT numbers were measured for each myoma. In addition, a pelvic MRI was performed to measure the volume of each myoma prior to and 6 months after the UFE. The relationship between fibroid volume reduction and the global CT number were prospectively analysed. RESULTS: The mean global CT number was 91.25 HU in Group I and 40.8 HU in Group II. Further, the mean fibroid volume reduction rate was 73% in Group I and 10% in Group II (p < 0.05). CONCLUSION: The global CT number measured by a non-contrast enhanced pelvic CT is a useful predictive factor of a successful uterine fibroid embolization.

Early Ultrasonographic Findings after a Uterine Fibroid Embolization: The Value of Differentiate from Procedure-Related Uterine Infection

PURPOSE: To evaluate the early ultrasonographic (US) findings from the uterus and myoma after a uterine fibroid embolization (UFE). MATERIALS AND METHODS: From March 2004 to January 2006, eleven patients (27-48 years, mean: 37 years) with UFE to treat symptomatic uterine myoma, were retrospectively reviewed. A serial follow up gray-scale and color Doppler US were performed from one day to two weeks following a UFE. The US findings were evaluated for the presence and distribution pattern of air, time of air loss, and presence of fluid collection in the uterine cavity and color Doppler (SD Comment: Doppler is name. Should perhaps be upper case) signal. RESULTS: Numerous high echoes with reverberation artifacts (which suggest air), were observed within the myoma (in all cases), one day after UFE. A branching linear echo pattern was observed in 4 cases (36%), whereas scattered echoes were observed in 7 cases (64%). Progressive loss of air, within 7 days of a UFE, was observed in 9 cases (82%), whereas 2 cases (12%) were observed within 14 days of a UFE. Abnormal fluid collection in the uterine cavity and a color Doppler signal within the myoma was not observed for all cases. CONCLUSION: Branching or scattered echoes (suggesting air), are normally found within the myoma after a UFE, but these echoes disappeared within 2 weeks. These early US findings can be useful in differentiating from myoma infections after a UFE.

Myasthenia gravis and sevoflurane: a case report

Myasthenia gravis is characterized by weakness and easy fatiguability of voluntary muscles. Myasthenic patients are sensitive to non-depolarizing relaxants. Sevoflurane, as an alternative, can be used to achieve good tracheal intubation. In this report, we present our experiences