Evaluation of the effect of pancreatic volume on mortality in patients with acute pancreatitis.

BACKGROUND: Pancreatic volume is enlarged in acute pancreatitis. OBJECTIVE: This study aimed to evaluate whether there was a difference in pancreatic volume between survivors and non-survivors with acute pancreatitis using computer-generated 3D imaging. METHOD: This single-center retrospective observational cohort study was conducted between January 2015 and December 2020. The hospital automation system was used to get the patients diagnosed with acute pancreatitis by using International Classification of Diseases (ICD) (ninth edition, code 577.0 or 10th version, code K 85.0) codes. The patients' pancreatic volumes, computed tomography severity index (CTSI), and modified computed tomography severity index (mCTSI) scores were calculated using the data obtained from the hospital automation system. The pancreatic volumes of the patients were measured using the computer-generated 3D imaging method. Pancreatic volume, CTSI, and mCTSI were then statistically compared in terms of mortality prediction by using the receiver operating characteristic (ROC) analysis. RESULTS: Of the 143 patients, 57.34% were female and 42.66% were male. The cut-off value of pancreatic volume in determining mortality was>81.5 cm3 OR:17.43 (%95 CI: 2.2-138.1) Cohen's d:1.126, at which it had 92.3% sensitivity, 60.0% specificity, 18.8% positive predictive value, and 98.7% negative predictive value. As a result of the ROC analysis of pancreatic volume in mortality prediction, the area under curve (AUC) value was determined as 0.787 [95% confidence interval (CI): 0.711-0.851]. The ROC analysis of the CTSI and mCTSI scores in mortality prediction revealed AUC values of 0.822 (95%CI: 0.750-0.881) and 0.955 (95%CI: 0.907-0.983) respectively. CONCLUSION: Although CTSI scores pancreatic enlargement and mCTSI scores pancreatic necrosis and inflammation, the pancreatic volume value is not clearly scored in both. In this study population, pancreatic volume above 81.5 cm was associated with increased mortality. Both CTSI and mCTSI scores outperformed pancreatic volume in predicting mortality.

Short-Term Outcomes of Fiberoptic Bronchoscopy-guided Resection and Anastomosis Control in Thoracic Surgery.

BACKGROUND: In thoracic surgery practice, bronchial closure and anastomosis are relatively easy in technical terms; however, it is also the procedure that is most open to the development of complications with high morbidity. This study aimed to investigate the effect of simultaneous evaluation of bronchial closure under fiberoptic bronchoscopy guidance during lung resection on the development of complications. MATERIALS AND METHODS: Patients aged over 18 years who underwent elective lung resection in our clinic between 2017 and 2021 were included in the study. Postoperative complications were recorded and statistically analyzed. RESULTS: The mean age of the patients was 61.4±10.4 years, and 267 patients were male (75.4%) and 87 (24.6%) were female. Thoracotomy was performed in 258 (72.9%) patients and lung resection with the video-assisted thoracoscopic surgery technique in 96 (27.1%) patients. During the follow-up, complications were observed during the first 30 days in 78 (22.0%) of the patients and later in 9 (2.5%). Surgical mortality occurred in 11 patients (3.1%), and the rate of readmission to the intensive care unit was 5.6% (n=20). CONCLUSION: We consider that the control of the resection line with the active use of fiberoptic bronchoscopy during surgery is important for the prevention of the development of bronchial morbidity. Complications in the early period can be reduced by ensuring that the remaining bronchus is not narrowed, there are no residual stump structures that may disrupt the bronchial line, such as cartilage, and bronchial washing is frequently undertaken.

Efficacy of Phenylalanine- and Tyrosine-Restricted Diet in Alkaptonuria Patients on Nitisinone Treatment: Case Series and Review of Literature.

INTRODUCTION: Nitisinone used in alkaptonuria (AKU) can result in keratopathy due to strongly increased tyrosine levels. METHODS: This study aimed to investigate nutritional status and changes in plasma tyrosine and phenylalanine and urinary homogentisic acid (u-HGA) levels in 8 adult AKU patients (mean age, 56.3 ± 4.7 years) who were on tyrosine/phenylalanine-restricted diet together with 2 mg/day nitisinone. RESULTS: The treatment period was 23.4 ± 6.9 months. Daily dietary protein intake was restricted to 0.8-1.0 g/kg/day. Daily tyrosine intake was restricted to 260-450 mg/day for females and 330-550 mg/day for males. Tyrosine/phenylalanine-free amino acid supplements accounted for an average of 56.1% of daily protein intake. The following assessments were performed: anthropometric and plasma tyrosine level measurements every 2 months; ophthalmological examination every 6 months, and nutritional laboratory analyses and measurements of plasma amino acids and u-HGA once in a year. It was targeted to keep the plasma tyrosine level <500 µmol/L. The plasma tyrosine level was <100 µmol/L before the treatment in all patients and around a mean of 582.5 ± 194.8 µmol/L during the treatment. The diet was rearranged if a plasma tyrosine level of >700 µmol/L was detected. The u-HGA level before and after the 1st year of treatment was 1,429.3 ± 1,073.4 mmol/mol creatinine and 33.6 ± 9.5 mmol/mol creatinine, respectively. None of the patients developed keratopathy or experienced weight loss and protein or micronutrient deficiency. CONCLUSION: AKU patients should receive tyrosine/phenylalanine-restricted diet for reducing plasma tyrosine level to the safe range. Tyrosine/phenylalanine-free amino acid supplements can be safely used to enhance dietary compliance. Keratopathy and nutrient deficiency should be frequently monitored.

Evaluation of ultrasound-guided adductor canal block with two different concentration of bupivacaine in arthroscopic knee surgery: A feasibility study.

STUDY OBJECTIVE: The application of regional anaesthesia techniques as a component of multimodal analgesia in knee arthroscopic surgeries increases the quality of postoperative analgesia. Adductor canal block (ACB) is an effective "motor sparing" analgesia technique used in knee surgeries. This study aimed to evaluate the efficacy of ACB using two different concentrations of local anaesthetic in terms of analgesic requirements and pain density in patients undergoing knee arthroscopy. DESIGN: Prospective, randomised, controlled. SETTING: Tertiary hospital. PATIENTS: A total of 60 patients (ASA I-II) were evaluated in three groups, with 20 patients in each group. INTERVENTIONS: Standardised postoperative analgesia was performed in all groups. In addition, ultrasound-guided ACB (same volume/two different concentrations of bupivacaine: 0.25% vs 0.16%) was applied to the experimental groups. MEASUREMENTS: Tramadol consumption, rescue analgesic requirement and Numeric Rating Scores (NRS). MAIN RESULTS: Tramadol requirement in the first 24 hours was significantly higher in the control group (209.5 ± 23.27 mg) (P < .001), and there was no difference between the experimental groups (63 ± 42.06 mg vs 80.5 ± 36.63 mg). Although the mean NRS scores in the first three hours were higher in the control group when compared with both block groups, it was similar in all groups in the following measurements. CONCLUSION: In arthroscopic knee surgery, ACB interventions with 0.25% and 0.16% concentrations of bupivacaine were similar in terms of postoperative analgesic efficacy, and they increased the quality of multimodal analgesics when compared with the control group.

The effect of ultrasonographic measurement of vena cava inferior diameter on the prediction of post-spinal hypotension in geriatric patients undergoing spinal anaesthesia.

AIMS: In our study, we aimed to investigate whether end-expiratory vena cava inferior (expVCI) diameter and vena cava inferior collapsibility index predicted post-spinal hypotension in geriatric patients undergoing spinal anaesthesia (SA), the correlation between them and other parameters. MATERIAL AND METHODS: Our prospective study included the American Society of Anesthesiologists (ASA) I-4, 73 patients over 65 years of age, who were scheduled for operation using SA. According to the expVCI diameter displayed with ultrasonographic (USG) before SA, patients with an expVCI diameter less than 1.8 cm previously determined as the threshold value are grouped as 1 (small-VCI) group, those greater than 1.8 cm as 2 (large-VCI) group. Demographic characteristics of the patients, comorbidities, duration and type of operation, basal (preoperative) heart rate, systolic, diastolic, mean blood pressure, peripheral oxygen saturation values before SA and after SA in supine position (0 minute) and 5th, 10th, 15th, 20th, 25th, 30th min and preoperative arterial blood gas parameters, amount of preoperative urine and bleeding, inotropic and fluid requirement, complications were recorded. RESULTS: Hypotension developed in 28 (38.4%) patients and bradycardia in 14(19.2%) of patients. The patients who developed hypotension had more ASA2 and ASA3 (P = .01), shorter height (P = .02) and smaller expVCI diameter (P = .004). It was observed that they had higher lactate (P = .03), lower pH (P = .006) values and more inotropic agents were administered (P < .001). While the rate of developing hypotension was 51.1% (n = 23) in the patients in the small-VCI group, this rate was 17.9% (n = 5) in the patients in the large-VCI group (P = .004). CONCLUSION: It was concluded that the expVCI diameter value measured by USG before SA in older adults is effective in predicting post-spinal hypotension with lactate and pH values, which are among the blood gas parameters, and expVCI can be preferred to invasive methods because of its noninvasive, easy and fast application.

The Results of 16 Years of Iodization: Assessment of Iodine Deficiency Among School-age Children in Antalya, Turkey

Objective: Iodine deficiency (ID) continues to be a problem around the world. This study investigated the prevalence of ID and goiter among school-age children in the city center of Antalya, Turkey. The aim was to investigate the effect of an iodization program, which had been running for sixteen years, on nutritional iodine status in this population. Methods: A total of 1,594 school children, aged 6-14 years, were included in this cross-sectional study. ID was evaluated based on median [interquartile range (IQR)] urine iodine/creatine (UI/Cr) (µg/g) ratio and median (IQR) UI concentrations (UIC) (µg/L). UICs were measured using the Sandell-Kolthoff method. Goiter was determined by palpation and staged according to World Health Organization classification. Results: Median (IQR) UIC was found to be 174.69 (119.17-242.83) µg/L, and UIC was found to be lower than 50 µg/L in 6.5% of the population. The median UI/Cr ratio increased from 62.3 to 163.3 µg/g and goiter rates had decreased from 34% to 0.3% over the 16 years of the program. However, 19% were still classified as ID (mild, moderate or severe) and, furthermore, 11.5% were classified as excessive iodine intake. Conclusion: Comparison of two cross-sectional studies, carried out 16-years apart, showed that Antalya is no longer an ID region. However, surveillance should be continued and the percentage of ID and iodine excess individuals in the population should be monitored to avoid emerging problems.

Remarkable Increase in the Prevalence of Overweight and Obesity Among School Age Children in Antalya, Turkey, Between 2003 and 2015

Objective: Childhood obesity (OB) is an acknowledged global problem with increasing prevalence reported around the world. We conducted this study with the aim of determining the local trend in OB and overweight (OW) prevalence in the last decade and to observe the alteration of OB and OW prevalence by age group. An additional aim was to construct new age- and gender-specific body mass index (BMI) reference percentile charts for Turkish children living in the city center of Antalya. Methods: This cross-sectional study included 1687 school aged children. International Obesity Task Force guidelines were used to determine the OB and OW prevalence. OW was defined as a BMI between 85th and 95th percentile, and OB >95th percentile. The data were compared with a previous study carried out in the same region in 2003. The least mean square method was used to construct the BMI reference percentile charts. Results: The prevalence rates for OB and OW were 9.8% and 23.2%, respectively, with a combined OW/OB rate of 33%. OB prevalence was higher in boys than girls (p<0.05). The prevalence of combined OW/OB was highest at age 9-10 years. The prevalence of OB has increased 2.9 times during twelve years in this location. Conclusion: Comparing the current findings with rates of OW and OB in the previous decade, childhood OB in Antalya has reached alarming levels. Urgent measures integrated into the national education system should be taken to prevent OB. In addition more surveillance studies should be planned to show the future trend of OB prevalence nationally.

[Venous port implantation in adult patients: retrospective evaluation]. / Eriskin hastalarda venöz port implantasyonu: Retrospektif degerlendirme.

OBJECTIVES: In the cancer therapy, the role of central venous access device has been increased because of factors; such as accessing to vein frequently, having long term therapy, using of sclerosan agents, giving much fluid. A chemoport is a thin, soft, plastic tube surgically implanted into a vein in chest or arm. Portacath doesn't have a huge size and it can generate numerous advantages. All the same, portacaths have risks such as infection, thrombosis, mechanical failure, pneumothorax, arterial injury. METHODS: A retrospective study was performed with analysis of records of 82 patients admitted to our clinics between December 2006 and November 2008 for permanent catheterisation via subclavian vein. RESULTS: The most frequent complication was occlusion of port (3.66%). Further complications were infection (2.43%), migration out of the blood vessel (1.22%), and catheter rupture (1.22%). CONCLUSION: As a result, made by people who experienced venous ports inserted, provided the opinion that a safe and comfortable method.

[Comparison of the activity and reliability of intravenous administration of midazolam and dexmedetomidine on sedation levels under epidural anesthesia]. / Epidural anestezi altinda intravenöz midazolam ve deksmedetomidin kullaniminin sedasyon düzeyleri üzerine etkinlik ve güvenirliginin karsilastirilmasi

OBJECTIVES: We aimed to assess the sedative effects of midazolam and dexmedetomidine and their effects on hemodynamics and the cardiovascular system under epidural anesthesia. METHODS: This study included 50 patients. Approval of the ethics committee and written consent from patients were obtained. The patients were separated into two groups to receive dexmedetomidine (D group) or midazolam (M group). Perifix no. 18 was placed in the epidural space from the L(3-4) interspace. After lidocaine 60 mg/3 ml was applied, isobaric bupivacaine 0.5% was given as 1 ml per segment. After block reached the T10 level, midazolam was given to the M group as a bolus of 0.015 mg kg(-1) in 10 minutes until beginning the operation, followed by continuous infusion as 0.1-0.2 mg kg(-1)h(-1) dosage. Dexmedetomidine 1 mcq kg(-1) was given to the D group as a bolus dosage in 10 minutes until beginning the operation, followed by continuous infusion as 0.4-0.7 mcq kg(-1) h(-1) dosage. Systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), heart rate (HR), SpO(2), Ramsay Sedation Score (RSS), bispectral index (BIS), and respiratory rate (RR) were recorded. Sedative infusion was stopped when skin suture was closed. Adverse effects were also recorded. RESULTS: In group D, MAP was significantly higher and HR was significantly lower than in group M (p<0.05). CONCLUSION: We concluded that both drugs provided good sedation with no respiratory depression, stable hemodynamics and alertness with good cooperation. However, we consider midazolam as the first option due to its cost benefit.