The effect of rocuronium priming dose based on actual versus corrected body weight in modified rapid sequence intubation.

Background: Rapid sequence intubation (RSI) is a technique that allows patients to be quickly intubated and have the airway secured. Aims: The purpose of this study was to investigate the effect of rocuronium priming and intubation dose calculated according to actual body weight (ABW) or corrected body weight (CBW) on the neuromuscular block and intubation quality in rapid sequence induction and intubation (RSII). Patients and Methods: This prospective randomized, double-blind study was conducted on a total of 60 patients randomized into two groups using the closed-envelope method between January 2021 and December 2021, with 30 individuals in each group. In group 1, CBW was used with the formula to calculate the neuromuscular blocking drug (NMBD) dose. The ABW of patients was used to calculate the NMBD dose in group 2. Results: The data of 50 female patients who underwent group 1 (CBW, n = 25) and group 2 (ABW, n = 25) were analyzed. Age, weight, height, body mass index (BMI), quality of laryngoscopy, post-priming side effects, mean arterial pressure (MAP), and heart rate (HR) values did not differ across the groups. When train-of-four (TOF) values, priming and intubation dose, and laryngoscopy time were compared, a statistically significant difference was found between the two groups of TOF count (TOF C) 1 (the duration of action). Conclusion: This study suggests that the application of rocuronium priming and intubation dose according to CBW in RSII, especially during the pandemic, provided similar intubation conditions as the application according to ABW, while its shorter duration of action shows that it can be preferred, especially in short-term surgical cases.

A study of prolidase in mothers, their newborn babies and in non-pregnant controls.

The prolidase activity in serum and in erythrocytes was measured in 28 healthy mothers and in the cord blood of their newborn babies in using a modified Chinard method. 45 healthy non-pregnant women aged between 15-36 years formed a control group. Biochemical parameters (CK, BUN, C-peptid, AFP, Uric acid) were also measured. The serum and erythrocyte prolidase activities in maternal blood were 45.8+/-13.4 U/L and 37.8+/-2.7 U/g Hb respectively. There was no significant difference in the enzyme activities between pregnant women and the control group (p>0.05). However serum and erythrocyte prolidase activity in cord blood (20.3+/-8.2 U/L and 31.6+/-7.3 U/g Hb) was significantly different when compared with control group (53.4+/-14.7 U/L in serum and 42.3+/-10.3 U/g Hb in erythrocyte, p<0.001). There was a significant correlation between maternal and cord blood serum enzyme activity (r: 0.76 p<0.01). This correlation was also shown in erythrocyte prolidase activities of both groups (r: 0.49, p<0.05). Cord blood prolidase activity was positively correlated with birth weight (r: 0.89, p<0.01). Prolidase activity in cord blood was low even though collagen turnover is increased in fetal growth.

Hitherto undescribed venous vacuolar myopathy without mucoid degeneration in the varicose saphenous vein of a child.

Varicose vein abnormalities involving the lesser saphenous vein of a 7-year-old boy are presented. The histopathology of the vein wall revealed a vacuolar degeneration without mucoid deposits of the muscle cells, which has not been described previously in the literature in congenital varices.

An alternative repair technique for aortic periprosthetic leakage.

In case of aortic periprosthetic leakage, there are several methods of repair. When valve replacement or refixation is not suitable an alternative repair technique, 'curtaining' with a Dacron patch to prevent leakage is presented.

Transient cerebral ischemic attack and left atrial free-floating thrombus: a case report.

A patient with rheumatic mitral stenosis was found to have a free-floating thrombus in the left atrium during echocardiography. Subsequently, the patient underwent surgical treatment. At surgery, a free thrombus was found within the left atrium. The postoperative course of the patient was satisfactory.

Atrial fibrillation after coronary artery bypass surgery: predictors and the role of MgSO4 replacement.

BACKGROUND: Supraventricular arrhythmias continue to complicate the postoperative course of patients undergoing myocardial revascularization. The aim of the study was to identify factors associated with atrial fibrillation (AF) and to determine the efficacy of postoperative magnesium sulphate (MgSO4) replacement on the incidence of AF after coronary artery bypass grafting (CABG) operation. METHODS: Fifty patients undergoing CABG were studied prospectively. Consenting patients with good left ventricular function and without any documented arrhythmias were randomly divided into two groups of 25 patients each in a double-blind fashion. The clinical characteristics of both groups were similar. In the study group, 200 mEq MgSO4 was given for the first 5 postoperative days, in the control group, placebo was given instead of MgSO4. RESULTS: Five (20%) patients in the control group and one (4%) patient in the MgSO4 group experienced AF. There was no significant relationship between the development of AF and the following variables: age; sex; diabetes mellitus; hypertension; previous myocardial infarction; smoking; extension of coronary artery disease; aortic cross-clamp time; number of grafts; cardiopulmonary bypass time; postoperative pericarditis; and anemia. CONCLUSION: The use of MgSO4 in early postoperative period is effective in reducing the incidence of AF after CABG in patients with good ventricular function.

Mitral valve surgery in the presence of pulmonary hypertension.

Mitral valve surgery was performed in 59 patients with severe pulmonary hypertension (average systolic pulmonary artery pressure 77.1 +/- 18.6 mmHg; range 50-115 mmHg) between 1983 and 1990. Thirty-eight patients had been subjected to mitral valve replacement, 16 patients both mitral and aortic valve replacement, and 5 patients had open mitral commissurotomy, with an operative (30 day) mortality of 5.0%. These 3 deaths happened during the early postoperative period. Survivors were followed up for a period ranging from 6 months to 7 years with a mean of 36 months. Four late deaths (7.1%) occurred in patients with valve replacement. Actuarial survival was 93 +/- 3% at 5 years, and 90.7 +/- 4.4% at 7 years. Right ventricular catheterization was performed on 14 patients a mean of 38 months following operation. Systolic pulmonary artery pressure had decreased from a mean of 77.1 +/- 18.6 to 39.7 +/- 14.0 mmHg (p less than 0.001) and 90% of the survivors were in New York Heart Association Class 1 or II compared to 23.7% preoperatively. The clinical and hemodynamic findings in this series suggest that severe pulmonary hypertension is not a contraindication, and pulmonary hypertension decreases significantly after mitral valve surgery.

Repair and strengthening of R/C structures - research at metu

In this paper, outcome of a comprehensive research program on the behavior of repaired and stregthened reinforced concrete members and structural systems are reported. In the first phase of this research, jacketed columns were tested under monotonic uniaxial loading, or axial load combined with monotonic or reverse cyclic bending. The main variables investigated were efects of the type of jacketing (repair or strengthening) and type of loading (monotonic or reversed cyclic). The performance of jackets made under load and jackets made after unloading was also compared. Beams repaired and strengthened by introducing a new layer of concrete or by bonding steel plates using epoxy were tested under monotonic and reversed cyclic loading. Slabs repaired by putting a new layer of concrete were also tested under monotonic loading. The effectiveness of seismic strengthening of framed structures by placing cast in places reinforced concrete infills was investigated by testing thirteen one bay, two story infilled frames under reversed cyclic loading. The variables investigated were; (a) panel-frame connection, (b) effect of axial load and (c) flexural capacity of frame columns (AU)

De Vega's tricuspid annuloplasty: analysis of 195 patients.

In the years 1984-1989, 195 De Vega tricuspid annuloplasties were performed in association with mitral or mitral-aortic valve procedures. Preoperatively, 9 patients (4.6%) were in New York Heart Association functional class II, 124 (63.6%) were in class III, and the remaining 62 (31.8%) were in class IV. Tricuspid insufficiency was recognized by routine digital palpation of the tricuspid valve during the operation in 42 (21.5%) of the patients. Hospital mortality rate was 7.6% (15 patients). Late deaths occurred in 6 (3.0%) cases during a follow-up period of 3 to 72 months (mean 42 months). 8 patients (4.1%) required reoperation. Tricuspid annuloplasty failure was observed in 4 patients (2%). These valves were replaced with biological valves in three patients and with a mechanical valve in one patient. 112 of the survivors (64.3%) were evaluated by echocardiography and/or right ventriculography. Analysis of postoperative data showed that in 84 of the 112 patients (75%) tricuspid regurgitation disappeared completely after annuloplasty, 88% of surviving patients were in functional class I or II. For the series presented actuarial survival rate at 6 years was 79.1% +/- 14.4%. In the light of this study we recommend De Vega's annuloplasty as the method of choice for moderate to severe functional tricuspid insufficiency.

Complement activation during cardiopulmonary bypass.

We researched complement activation of fifteen patients who had open heart surgery and on ten patients who had closed heart surgery. Our results showed that the complement system was partially activated by the anaesthesia and partially by tissue damage. This activation was aggravated when plasma contacted the pump-oxygenator system, continued in the intensive-care unit and became normal in the 24th hour after the operation. Complement activation occurred both via the alternative and classical pathways but the alternative pathway was activated more than the classical with increase in bypass time. Pulmonary sequestration of leucocytes which occurred due to the complement activation and the complement derived inflammatory mediators could have contributed to the pathogenesis of the post-pump syndrome.