Air Embolism Developed As A Result Of Opening The Central Catheter Tip By The Patient's Relative.

Central catheterization can be placed in critically ill patients in the intensive care unit (ICU) for some purposes such as dialysis, nutrition, and hemodynamic monitoring. Air embolism is a very rare complication of central catheterization. A 46-year-old male patient with no known comorbidities underwent laparoscopic total colectomy and protective loop ileostomy for colon cancer. He was taken to the general surgery ICU for close hemodynamic follow-up in the postoperative period. Since he was cachectic and could not reach the target of oral nutrition within 1 week, a central catheter was inserted in the right internal jugular vein with ultrasonographic imaging, and total parenteral nutrition (TPN) was started. The patient, who had no additional problems in the follow-up, was transferred to the general surgery ward. Three and half hours after the transfer, the patient became unconscious and had extensor posture. Therefore, emergency cranial computed tomography (CT) was performed and he was taken back to the ICU. There was no finding in favour of bleeding in cranial CT. The patient was intubated to protect the airway, as he had a generalized tonic-clonic seizure during his follow-up. Air bubbles were seen in the main pulmonary artery and right ventricle in the multidetector thorax CT. Cranial CT angiography was taken at the 24th hour, and diffusion cranial MRI was performed for diagnosis of central air embolism. No air was detected to be aspirated in the cerebral arteries in cranial CT angiography. On the 6th day, the patient regained consciousness, extubated, and physical therapy was started. On the 12th day of hospitalization, the patient was discharged with 2/5 loss of motor power in the left upper extremity. When the patient's wife's anamnesis was detailed, it was learned that in order to mobilize the patient, she separated the TPN from the catheter and left the catheter tip open.

The investigation of the gait parameter alterations in response to levodopa therapy and tap test in patients with idiopathic normal pressure hydrocephalus.

OBJECTIVE: To investigate the impact of dopamine oral therapy, the effect of cerebrospinal fluid (CSF) tap test on gait parameters in our idiopathic normal pressure hydrocephalus (iNPH) subjects. METHODS: Patients with a possible diagnosis of iNPH who had been admitted to our outpatient polyclinic between March 2022 and May 2022 were enrolled. In addition to the clinical evaluations, basal gait analysis was performed using a "Gait Analyzer" program which was uploaded to a mobile phone. Thereafter, the gait analyses were re-evaluated after levodopa therapy, 4 h and 2 weeks after the CSF tap test at distinct times, separately. RESULTS: Ultimately, the data of 8 patients with iNPH were enrolled in this study (mean age = 67.37 ± 7.74, F/M = 3/5). Friedman's analysis of variance analyses did not show a difference in any parameters of gait between the distinct evaluation times. On the other hand, the pairwise analysis results showed that the step time and cadence had improved after levodopa therapy, whereas no significant improvement was detected in any of the parameters after the CSF tap test. CONCLUSION: In our pilot study, we found that the gait parameters improved after levodopa therapy. However, the gait parameters did not change after the CSF tap test which may suggest that our measurement method might overlook detecting the gait disturbance specific to the iNPH. Future research to develop new evaluation methods and questionnaires detecting the gait disturbance specific to the iNPH pathophysiology may provide substantial clinical applications.