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.

Percutaneous management of benign biliary disorders in children.

PURPOSE: The goal of this study was to analyze the outcomes of percutaneous transhepatic management of benign biliary disorders in pediatric patients. MATERIALS AND METHODS: This study included 11 pediatric patients who underwent percutaneous transhepatic biliary interventional procedures between September 2007 and December 2016. There were 3 males and 8 females with a mean age of 9.6±5.4 (SD)years (range: 2-17years). Technical details, complications and outcome of the procedures were evaluated. RESULTS: The underlying pathologies were bile duct stones (n=2), bile leakage (n=4), choledochal cyst (n=3) and benign biliary stricture (n=2). The therapeutic interventional procedures were as follows; percutaneous stone removal in patients with bile duct stones, external biliary drainage in patients with choledochal cyst, bile diversion by internal-external percutaneous biliary drainage (IE-PBD) in patients with bile leakage, plastic stent placement, IE-PBD with balloon dilatation in patients with benign biliary stricture. The procedures were successful in all patients technically and clinically. One patient experienced intermittent fever. CONCLUSION: Percutaneous transhepatic biliary interventional procedure is an effective and safe approach for the treatment of pediatric patients with bile duct stones, bile leakage, symptomatic choledochal cyst and benign biliary stricture when endoscopic procedure is unavailable or fails.

Fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes in 102 patients.

PURPOSE: The purpose of this study was to evaluate the technical and clinical results of fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes. MATERIALS AND METHODS: This retrospective study included 102 patients (61 men, 41 women) with a mean age of 59years±16.3 (SD) (range, 18-94years) who had fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes. All procedures were performed after inflating the stomach with air via an orally inserted 5-Fr catheter by retrograde catheterization of the esophagogastric junction. Demographic data, results of the procedures and complications were evaluated. RESULTS: A technical success was observed in 101/102 patients, yielding a technical success rate of 99%. Complications due to the procedure were observed in 17/102 patients yielding a procedure-related complication rate of 16.7%. Procedure-related complications included peristomal superficial cellulitis (6/102; 5.9%), peristomal abscess (4/102; 3.9%), subcutaneous hematoma (3/102; 2.9%), peristomal leakage (2/102; 2%), inadvertent removal of the tube (1/102; 1%) and death due to procedure-related peritonitis (1/102; 1%). CONCLUSION: Fluoroscopy-guided placement of pull-type mushroom-retained gastrostomy tubes is a feasible and effective method for enteral nutrition.

Percutaneous management of residual bile duct stones through T-tube tract after cholecystectomy: A retrospective analysis of 89 patients.

PURPOSE: The purpose of this study was to analyze the outcome of percutaneous management of residual common bile duct (CBD) stones in patients with surgically inserted T-tube in CBD after cholecystectomy. MATERIAL AND METHODS: Between April 2001 and August 2015, 89 patients (52 women, 37 men) with a mean age of 55.7 years±18 (SD) (range, 22-88 years) underwent percutaneous sphincteroplasty and stone expulsion into the duodenum with a Fogarty balloon catheter through the T-tube tract for residual CBD stones. All patients had previously undergone open cholecystectomy with CBD exploration and T-tube insertion 7 to 60 days (mean, 14.4 days) before the procedure. Results of the procedure and complications were evaluated by a review of clinical notes, imaging and laboratory findings. RESULTS: The procedure was successful in 87/89 patients (97.7%). Complete CBD clearance was achieved in a first session in 86 patients (96.6%). One patient (1.1%) needed a second session. The procedure was unsuccessful in 2 patients (2.2%) due to inappropriate position of T-tube and stone impaction into the cystic duct remnant. Two complications (2.2%) including intra-abdominal bile collection and distal CBD stricture were observed after the procedure. CONCLUSION: Percutaneous CBD expulsion into the duodenum through the T-tube tract is a non-traumatic, effective and safe method for the treatment of residual CBD stones in patients who had cholecystectomy and T-tube insertion.

Comparison of HbA1c analysers: Agilent 1100 HPLC using kits produced by Gordion Diagnostic (Turkey) with Premier Hb9210 using kits produced by Trinity Biotech (USA) in different patient groups.

BACKGROUND: The aim of this study was to compare the performance of Agilent 1100 HPLC analyser using HbA1c kits manufactured by Gordion Diagnostic (Turkey) with that of Premier Hb9210 using the original kits for the measurement of HbA1c in different patient groups. METHODS: Subjects were divided into four groups: Group 1 included 140 diabetic and non-diabetic subjects with normal urea and haemoglobin levels; Group 2 included 84 diabetic and non-diabetic subjects with high urea levels; Group 3 included 44 diabetic and non-diabetic subjects with iron deficiency anaemia; and Group 4 included 52 diabetic and non-diabetic subjects with high haemoglobin levels. EP Evaluator Release 8 program was used to evaluate the resultant data. RESULTS: According to the comparison results of the two methods in all groups, there was an excellent correlation between the two methods (R>0.98). Moderate-low correlation was found between increased urea concentration and the difference of the two methods (R= -0.374, p = 0.0005). The difference between the methods was found to be increased with increased urea concentrations. This difference, although statistically significant, was within the permitted limits. The observed correlation between the difference of the two methods and the low and high haemoglobin concentrations was statistically non-significant (R = 0.149, p = 0.3343; R = 0.263, p = 0.0594). CONCLUSIONS: We found that Agilent 1100 HbA1c analyser and Gordions' HbA1c kit comply with the clinical requirements and are suitable for HbA1c analysis at high levels of urea and Hb and low levels of Hb in diabetic and non-diabetic patients.

Assesment of correlation between bispectral index and four common sedation scales used in mechanically ventilated patients in ICU.

PURPOSE: The aim of this study was to compare the correlation between bispectral index (BIS) monitor and four commonly used subjective clinical scales (Ramsay Sedation Scale (RSS), Richmond Agitation Sedation Scale (RASS), Sedation Agitation Scale, Adaptation to Intensive Care Environment scale) in mechanically ventilated patients in intensive care unit (ICU). In addition, comparison of responsiveness of the clinical scales in respect to BIS changes is another goal of this study. MATERIALS AND METHODS: Mechanically ventilated thirty patients who required sedation for any reason were enrolled to study. Patients who needed neuromuscular blockade, patients with known hearing and visual problems, neurological diseases, anoxic encephalopathy, mental retardation and who developed hemodynamic instability (mean arterial pressure below 60 mmHg) and hypoxemia (sPO2 below 90%) during follow-up were excluded. Starting before the initiation of sedation, first BIS scores then clinical sedation scales were evaluated. This procedure is repeated every 2 hours for 24 hours. RESULTS: All of the four clinical scales were significantly correlated with BIS. BIS and clinical scale values, except Adaptation to Intensive Care Environment scale, showed significant changes compared to baseline after the initiation of sedation. Ramsay and Richmond scales showed the highest correlation with BIS (respectively, r = 0.758, r = 0.750). Adaptation to Intensive Care Environment revealed the lowest correlation (r = 0.565). CONCLUSIONS: All of the scales were significantly correlated with BIS. RSS and RASS showed higher correlation than other scales. As a conclusion: RSS and RASS can be used for monitoring the depth of sedation in mechanically ventilated patients in ICU.

Psychometric properties of the Turkish version of the perception of aggression scale.

The aim of this study was to investigate the psychometric properties of the Turkish version of the Perception of Aggression Scale. Cross-sectional data were collected by the completion of questionnaires by 350 nursing students from two nursing schools in Istanbul, Turkey. The psychometric properties of the Turkish version of the scale were analysed by using factor analysis (principal component analysis), assessment of internal consistency and reliability, and Spearman's rank correlation coefficients. The two-factor structure was confirmed by principal component analysis: the first factor treated aggression as functional and the second as dysfunctional. The correlation between the means of the items and dimensions was moderate (r for factor 1: 0.47-0.73; r for factor 2: 0.29-0.70). The coefficient of internal consistency of the scale was 0.85 for factor 1 and 0.81 for factor 2. Thus, Turkish version of Perception of Aggression Scale is a valid and reliable tool. It is essential to understand perceptions of aggressive behaviour in order to establish effective management strategies to tackle untoward events in clinical settings.

Incidental finding of a proatlantal intersegmental artery. A case report.

We describe the case of a 70-year-old woman who had a left proatlantal intersegmental artery disclosed during carotid artery angiography with the findings of carotid-basilar anastomosis which originated from the petrous segment of the ICA and was filling the horizontal segment of the vertebral artery. Awareness of this vascular variation can prevent morbidity and mortality associated with carotid ligation or carotid endarterectomy, especially when an incomplete circle of Willis is present.

Endovascular Treatment of Isolated PICA Insufficiency. A Case Report.

The vertebral artery terminating in the posterior inferior cerebellar artery is rare but it may cause cerebellar infarction when total occlusion of the vertebral artery occurs. Therefore treatment of vertebral artery stenosis in these patients is crucial. Surgical treatment of osteal vertebral artery stenosis is possible but is associated with approximately 4% mortality and up to 20% risk of procedural complications including perioperative VA occlusion, Horner syndrome, lymphatic injury and injury to the phrenic, vagus, laryngeal and thoracic nerves. Therefore percutaneous angioplasty with or without stent placement is emerging as an alternative treatment method with a high success rate and good initial angiographic outcome. Percutaneous angioplasty of the VA origin is associated with an approximately 15% restenosis rate. Stent placement is believed to decrease the incidence of elastic recoil and restenosis. Herein we present a rare symptomatic case with an anomalous, small-caliber right VA terminating in the PICA which was successfully treated with a drug-eluting stent.

Embolization of postbiopsy and postnephrostomy complications in transplanted kidney: a case report.

Complications such as arteriovenous, arteriocalyceal fistula, pseudoaneurysm, or perinephric hematoma occur in allografted and native kidneys after interventional procedures. When these complications are not detected and treated immediately, they might be associated with a poor allograft prognosis. Reoperation may produce parenchymal injuries, therefore, endovascular embolization may be a preferred treatment modality. Herein we report an arteriocalyceal fistula and an arteriovenous fistula in a transplant kidney that were detected after biopsy and nephrostomy, respectively, they were treated with endovascular coil embolization. Percutaneous treatment is a safe and effective method for arteriocalyceal fistula and arteriovenous fistula following interventional procedures in renal allografts.

Anterior meningocele misdiagnosed as an ovarian cyst.

OBJECTIVE: An undiagnosed anterior meningocele may mimic an ovarian cyst. Careful evaluation and consultation must be the mainstay of surgery for adnexal masses. RESULTS: A patient initially diagnosed as having an adnexal mass was discovered to have an anterior meningocele at surgery. In vitro fertilization plans were delayed to prevent complications during procedures.

Association between GSTP1 gene polymorphism and serum alpha-GST concentrations undergoing sevoflurane anaesthesia.

BACKGROUND AND OBJECTIVES: The measurement of alpha-glutathione-S-transferase enzyme is one of the most sensitive indicators of hepatocellular function. Variation in the glutathione-S-transferase P1 gene clusters has been intensively investigated and polymorphism has been described. The aim of the study was to assess whether an association exists between glutathione-S-transferase P1 gene polymorphism and serum alpha-glutathione-S-transferase concentrations for the first postoperative day in patients who underwent anaesthesia with sevoflurane. METHODS: In all, 54 unrelated patients were enrolled in this study. Anaesthesia was induced with thiopental and fentanyl. Vecuronium was used for neuromuscular relaxation before endotracheal intubation. Anaesthesia was maintained with sevoflurane in a gas mixture containing 50% nitrous oxide in oxygen. Peripheral venous blood samples to determine serum alpha-glutathione-S-transferase concentrations were collected before induction (T1), at the end of anaesthesia (T2) and at 24-h postoperatively (T3). Enzyme-linked immunosorbent assay (ELISA) immunoassay was used to measure alpha-glutathione-S-transferase levels. Genomic DNA was isolated from serum samples using a genomic DNA purification kit. In order to detect the variants of glutathione-S-transferase P1, polymerase chain reaction-restriction fragment length polymorphism analysis was employed. RESULTS: Early postoperative serum alpha-glutathione-S-transferase levels for all patients were significantly increased when compared with preanaesthetic and 24-h postoperatively (P 0.05). CONCLUSIONS: Although alpha-glutathione-S-transferase levels were elevated in all patients after sevoflurane anaesthesia, levels remained high at 24 h in patients with glutathione-S-transferase P1 Ile105Val genotypes compared to controls.

Epidemiology and etiology of catheter-related nosocomial infections in a Turkish hospital.

In this study a total of 219 patients who developed nosocomial infections and were treated in Sisli Etfal Training and Research Hospital between January 2001 and March 2003 were evaluated retrospectively. In all, 337 bacterial strains were isolated in these patients. The aim of our study was to assess the causative agents of catheter-related nosocomial infections, the distribution rate of causative agents due to hospital units, infection sites and catheter types, and determine the risk factors which facilitate such nosocomial infections. The most frequently isolated causative agents in catheter infections were Pseudomonas spp. (17%), Klebsiella spp. (16%), E. coli (13%), Acinetobacter spp. (12%), Coagulase Negative Staphylococci (CNS) (11%) and Methicillin-Resistant S. aureus (MRSA) (9%). In 136 (59%) patients infections were due to urinary catheterization and in 52 patients (23%) due to tracheal aspiration catheters. Of the 229 catheters applied, the polymicrobial infection rate was found to be 24% (55 patients). Multiple drug resistant strains were more frequently isolated in Intensive Care Units (ICU). It was emphasized that as ICUs are important risk factors for the development of catheter infections, the resistance patterns of the isolated microorganisms from the unit should be taken into consideration for the selection of appropriate antibiotics. We also conclude that it is important to avoid unnecessary catheterization and that preventive measures should be properly applied.

Masses of the tongue and floor of the mouth: findings on magnetic resonance imaging.

The purpose of this study was to determine the value of MR imaging for the demonstration of masses in the tongue and floor of the mouth. Nine patients were prospectively examined with MR imaging after physical examination. Imaging protocol included T2 and contrast-enhanced and non-contrast-enhanced T1-weighted turbo spin-echo sequences, and the findings were compared with surgical and histopathological results. Histopathological examination revealed four squamous cell carcinomas, one adenoid cystic carcinoma, two tongue abscesses, and one chronic inflammatory change. The other case was diagnosed as hemangioma depending on clinical and imaging findings alone. In cases with squamous cell carcinoma, staging was done on the basis of MR imaging findings, and was found to be T4 in two cases, T3 in one case, and T2 in another. The primary role of MR imaging of the tongue and oropharynx is not to make a tissue diagnosis. Multiple deep biopsies are mandatory for the differentiation of other inflammatory and neoplastic lesions. Magnetic resonance imaging produces coronal and sagittal image planes to assess the volume and spread of the lesion and helps the surgeon determine the direction in which the biopsy should be performed.

Comparison of caudal bupivacaine, bupivacaine-morphine and bupivacaine-midazolam mixtures for post-operative analgesia in children.

Sixty children undergoing inguinal or urogenital surgery were allocated randomly to three groups to receive a caudal injection of either 0.125% bupivacaine 0.75 mL kg-1 with 0.5% midazolam 50 micrograms kg-1 (n = 20) or with 1% morphine chlorhydrate 0.05 mg kg-1 (n = 20), or bupivacaine alone (n = 20) after surgery under general anaesthesia. There were no significant changes in heart rate, blood pressure, respiratory rate or oxygen haemoglobin saturation values in all groups, and there were no significant differences in the incidence of vomiting and pruritus between the groups (P > 0.05). Sedation scores were higher in the bupivacaine-midazolam and the bupivacaine-morphine groups than in the bupivacaine group at 8-12 h post-operatively (P < 0.01). The durations of analgesia were 21.15 +/- 1.2 h in the bupivacaine-midazolam group, 14.50 +/- 1.6 h in the bupivacaine-morphine group and 8.15 +/- 1.3 h in the bupivacaine group. Differences between the bupivacaine-midazolam group and the bupivacaine group (P < 0.001), the bupivacaine-midazolam group and the bupivacaine-morphine group (P < 0.01), and the bupivacaine-morphine group and the bupivacaine group (P < 0.01) were significant. It is suggested that caudal administration of a bupivacaine-midazolam mixture produces a longer duration of post-operative analgesia than a bupivacaine-morphine mixture and bupivacaine alone with sedation for 8-12 h post-operatively.

Elevated Lp(a) is the most frequent familial lipoprotein disorder leading to premature myocardial infarction in a country with low cholesterol levels.

Disorders of the lipoprotein metabolism are an important cause of premature coronary artery disease and myocardial infarction. Of the genetic lipoprotein disorders, elevation of apoprotein (apo) B containing lipoproteins is the most frequent one in the western population. We aimed to define the prevalence of genetic lipoprotein disorders and other risk factors in a population from a country with a low average cholesterol levels. We examined 48 consecutive patients with premature myocardial infarction below age 55, their 78 siblings and age and body mass index matched controls for familial lipoprotein disorders. The patients with premature myocardial infarction had higher triglyceride, low-density lipoprotein, apo B, lipoprotein (Lp) (a) and lower apo A1 levels then controls (p < 0.05). Of the nonlipid risk factors, 67% smoked, 8% had diabetes mellitus, 17% had hypertension and 58% a family history of premature coronary artery disease. Fifty percent of these patients with premature myocardial infarction had a familial lipoprotein disorder. Familial excess of Lp(a) was the most frequent lipoprotein abnormality present in 16% of the patients followed by familial combined hyperlipidemia. We conclude that, Lp(a) increase was the most frequent familial lipoprotein abnormality in this population. The frequency of familial lipoprotein disorders in this population emphasises the need to screen siblings of patients with premature myocardial infarction.