RESUMEN
OBJECTIVE: The usage of vessel sealing devices has been gaining popularity in all surgical specialties. Post-renal transplant drain placement is a common practice among transplant surgeons. However, prolonged drainage accompanied by surgical wound complications and perirenal fluid collections is a frequent complication experienced by the recipients. This study aimed to compare Bipolar vascular sealing with conventional back-table dissection in terms of post-renal transplant drainage duration, amount, surgical wound complication, and back-table preparation time. PATIENTS AND METHODS: A double-blind clinical study randomizes recipients into 2 groups, using Bipolar vascular sealing (Group 1) and conventional ligation (Group 2) back-table dissection. Variables such as recipient age, gender, body mass index (BMI), cause of end-stage renal disease, amount and duration of surgical drainage, back-table time, and cold ischemia time (CIT) were collected prospectively. RESULTS: Ninety-eight consecutive living donor (M/F: 69/29) renal transplant recipients were enrolled in this prospective randomized clinical trial. There were 49 patients in each group. The mean BMI was 26.76±4.57. There was no difference among the groups regarding recipient age, BMI, total drainage, and surgical drainage duration. The surgical site infection rate was not different between the two groups. Group 1 had significantly shorter back-table time, with mean back-table time being 15.26±2.51 minutes in Group 1 and 28.83±6.27 minutes in Group 2 (p<0.001). The CIT was also significantly different between the 2 groups (p<0.001). In Group 1, the recorded CIT was 43.3±11.4, and in Group 2, 57.1±13.3 minutes. CONCLUSIONS: The use of Bipolar vascular sealing to seal lymphatic vessels at the back-table is feasible, safe, and easy to perform. It also expedites the dissection and shortens the time required for back-table graft preparation.
Asunto(s)
Trasplante de Riñón , Herida Quirúrgica , Humanos , Trasplante de Riñón/efectos adversos , Estudios Prospectivos , Hemostasis Quirúrgica , DrenajeRESUMEN
OBJECTIVE: Kidney transplantation (KT) might be difficult for underweight kids (under 15 kg). Our goal was to convey information on KT in underweight children. PATIENTS AND METHODS: The study's target population consisted of children (age 18) weighing 15 kg or fewer who received KT at our facility between January 2018 and June 2021. A retrospective analysis was performed on demographic and clinical data, including age, gender, primary disease, pretransplant dialysis status, recipient weight, recipient body mass index (BMI), surgical approach type (intraperitoneal/extraperitoneal), complications, graft status (functioning/failed), patient survival, and immunological data. RESULTS: There were 94 pediatric KTs completed. Thirty-three patients were included when the selection criteria were applied. The mean recipient weight was 11.45 [6.7-15] kg, and the average patient age was 3.36 [1-7]. Three (9.9%) patients had kidney transplants from dead adult donors, whereas thirty (90.1%) patients underwent live donor kidney transplantation (LDKT). While the intraperitoneal (IPA) technique was used in 19 cases, the extraperitoneal (KT) strategy was used on 14 patients (EPA). The donor BMI was 28.24 [19.6-42] kg/m2, and the mean donor weight was 78.13 [55-109] kg. Bridectomy was necessary because five individuals experienced ileus. IPA was performed in each of these patients during LDKT. Following IPA, a 2-year-old patient with a BMI of 16 kg/m2 had renal allograft compartment syndrome and required graft nephrectomy. CONCLUSIONS: Pediatric patients weighing 15 kg or fewer can get kidney transplants successfully. Gastrointestinal problems are relatively uncommon with EPA, even though there is no agreement on the best surgical strategy.
Asunto(s)
Trasplante de Riñón , Adolescente , Adulto , Niño , Preescolar , Contraindicaciones , Supervivencia de Injerto , Humanos , Estudios Retrospectivos , Delgadez , Resultado del TratamientoRESUMEN
Polycystic liver disease is characterized by multiple cystic lesions on the liver. It is an uncommon autosomal dominant disease. The cysts' diameters range from 20 to 30 cm to small microscopic nodules. Generally, more than half of the liver parenchyma is covered. The mass effect of the liver created by the large cysts can cause life-threatening symptoms such as weight loss, reduction of oral intake, and malnutrition. Liver transplantation is the best treatment option in symptomatic patients. We present a patient who had polycystic liver and kidney disease, and we performed liver transplantation because of his life-threatening symptoms.
Asunto(s)
Quistes/cirugía , Hepatopatías/cirugía , Trasplante de Hígado/métodos , Quistes/complicaciones , Hepatectomía/métodos , Humanos , Hepatopatías/complicaciones , Masculino , Persona de Mediana Edad , Riñón Poliquístico Autosómico Dominante/complicaciones , Riñón Poliquístico Autosómico Dominante/cirugíaRESUMEN
Enhancement of Gilbert damping in polycrystalline cobalt thin-film multilayers of various thicknesses, overlayered with copper or iridium, was studied in order to understand the role of local interface structure in spin pumping. X-ray diffraction indicates that cobalt films less than 6 nm thick have strong fcc(111) texture while thicker films are dominated by hcp(0001) structure. The intrinsic damping for cobalt thicknesses above 6 nm is weakly dependent on cobalt thickness for both overlayer materials, and below 6 nm the iridium overlayers show higher damping enhancement compared to copper overlayers, as expected due to spin pumping. The interfacial spin mixing conductance is significantly enhanced in structures where both cobalt and iridium have fcc(111) structure in comparison to those where the cobalt layer has subtly different hcp(0001) texture at the interface.
RESUMEN
Multiple comorbidities and environmental factors increase the complications of incisional wounds in patients. It was demonstrated in previous prospective and randomized studies that negative pressure wound therapy (NPWT) reduced wound infection and other complications in clean, closed surgical incisions. In this case report, the Prevena incision management system was implemented on the clean, closed surgical incision of a 52-year-old female patient, who was given a renal transplantation from cadaver postoperatively in the operating theater. It was removed from the patient on the fifth day after the operation. Following the removal of Prevena, the wound and surrounding skin of the patient were observed. Wound healing was complete, and no skin lesion or tool-related complication was found around the wound due to NPWT. The Prevena NPWT system can be conveniently and safely implemented on the operational incision in renal transplant recipients in order to prevent surgical wound complications.
Asunto(s)
Fallo Renal Crónico/cirugía , Trasplante de Riñón , Terapia de Presión Negativa para Heridas , Infección de la Herida Quirúrgica/prevención & control , Femenino , Humanos , Persona de Mediana Edad , Cicatrización de HeridasRESUMEN
BACKGROUND: We aimed to test the methylene blue (MB) as a dye and also to test its antioxidant activities in devascularization-induced liver injury. METHODS: Twenty rats weighing 240-280 g were randomly divided into two groups, each containing 10 rats. High-grade liver injury was induced by using a pair of long pliers with blades. MB was injected into portal vein of the rats with no hepatic injury (Group 1; control group) and those with injured livers (Group 2; injury group). Liver and hepatic function tests, paraoxonase, stimulated paraoxonase, arylesterase activity, total antioxidant, and oxidant status were evaluated before and 24 h after MB injection. RESULTS: MB did not stain the non-perfused area. Total antioxidant status decreased significantly in Group 2 at hour 24 compared to Group 1. In Group 2, total antioxidant status was lower at hour 24 compared to hour 0. Total oxidant status in Group 2 at hour 0 increased significantly compared to Group 1. Total oxidant status in Group 2 at hour 24 was lower compared to that at hour 0. Lipid peroxidation parameters did not alter due to devascularization. CONCLUSION: MB is useful in defining the devascularization area. Moreover, it showed to have a beneficial effect on oxidant status (Tab. 3, Fig. 3, Ref. 25).
Asunto(s)
Antioxidantes/farmacología , Modelos Animales de Enfermedad , Hígado/lesiones , Hígado/patología , Azul de Metileno/farmacología , Heridas Penetrantes/tratamiento farmacológico , Heridas Penetrantes/patología , Animales , Arildialquilfosfatasa/metabolismo , Hidrolasas de Éster Carboxílico/metabolismo , Colorantes/análisis , Colorantes/farmacología , Peroxidación de Lípido/efectos de los fármacos , Hígado/efectos de los fármacos , Hígado/metabolismo , Masculino , Distribución Aleatoria , RatasRESUMEN
AIM: Definitive abdominal closure may not be possible for several days or weeks after laparotomy in damage-control surgery, abdominal compartment syndrome and intraabdominal sepsis, until the patient has stabilized. Vacuum-assisted closure (VAC therapy(®), KCI, San Antonio, TX, USA) and abdominal re-approximation anchor system (ABRA, Canica, Almonte, Ontario, Canada) are novel techniques in delayed closure of open abdomen. Our aim is to present the use of these strategies in the management of 7 patients with open abdomen. METHODS: Between August 2010 and December 2011, 7 patients with severe peritonitis were stabilized by laparotomy and treated with either ABRA system or ABRA system in conjunction with VAC dressing. VAC dressing applied to 4 patients initially and followed by ABRA. ABRA was applied alone to remaining 3 patients. Demographic data and patient characteristics, timing of VAC dressing and ABRA system were recorded. ICU and hospital stay and development of incisional hernia were also recorded. Stage of open abdomen, width of abdominal defect, extent to damage to fascia, and pressure sores were staged. RESULTS: The mean duration with VAC dressing before ABRA application was 18 days. The mean duration of ABRA application was 53 days. The average width of the abdominal defect was 18 cm. The average length of defect was 20.8 cm. Delayed primary abdominal closure was accomplished in 6 patients without further surgery. Incisional hernia with a small abdominal defect developed in 2 patients. CONCLUSION: Abdominal re-approximation anchor system and VAC dressing can be used separately or in conjunction with each other for closure of delayed open abdomen successfully.
Asunto(s)
Pared Abdominal/cirugía , Técnicas de Cierre de Herida Abdominal , Hernia Abdominal/etiología , Terapia de Presión Negativa para Heridas/métodos , Peritonitis/cirugía , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Anciano de 80 o más Años , Cuidados Críticos , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Técnicas de Sutura , Factores de TiempoRESUMEN
AIM: In this randomized prospective clinical study, we aimed to evaluate the effect of mechanical bowel preparation (MBP) before Milligan-Morgan hemorrhoidectomy on intraoperative procedures and postoperative complication rates to determine whether MBP is adventageous or not before elective anorectal surgeries. METHODS: Forty patients who had internal grade III or IV hemorrhoidal disease and who would underwent open hemorrhoidectomy were randomized into two groups: non-MBP group (female:male, 11:9; mean age, 33.8±9.57 years) that would not receive MBP before the surgery, and MBP group (female:male, 12:8; mean age, 34.7±11.37 years) that would be given one Fleet enema on the morning of Milligan-Morgan hemorrhoidectomy. Intraoperative variables and postoperative complications were compared between two groups. RESULTS: MPB had no effect on both intraoperative and postoperative variables, such as operating time, intraoperative bleeding, visual analogue scale (VAS) score for the comfort of the surgeon during operation, the presence of stool or enema remnants in anal canal, the presence of mucosal edema of the anal canal intraoperatively, the rates of postoperative bleeding and infection, VAS score for the pain on third day postoperatively, time to first stool after the operation, VAS score for the pain during first stool after the operation, and number of analgesics during one week postoperatively (P>0.05 for all). CONCLUSION: MBP performed before surgery does not provide introperative or postoperative benefit for Milligan-Morgan hemorrhoidectomy, thus MBP is not necessary before elective anorectal surgeries.
Asunto(s)
Catárticos , Hemorreoidectomía/métodos , Cuidados Preoperatorios/métodos , Adulto , Canal Anal , Femenino , Humanos , Masculino , Complicaciones Posoperatorias/prevención & control , Estudios ProspectivosRESUMEN
OBJECTIVE: We sought to report the postoperative complications, vascular reconstruction techniques and graft outcomes among our series of renal transplantations performed using grafts with multiple renal arteries. METHODS: We reviewed retrospectively the medical records of 196 renal transplant patients of mean age 35.6 ± 13.3 years (range, 6-68) including 130 males and 66 females whose grafts from living (n = 164) or deceased (n = 32) donor with multiple arteries between 2006-2012. We noted the number of renal arteries, graft function, surgical technique, as well as vascular, urological and other complications. RESULTS: Of the 196 patients, 182 had 2 and 14 had ≥ 3 renal arteries. The surgical technique was separate anastomosis of renal arteries to the external and/or common iliac artery in the majority of patients (86.2%), while 13.8% of patients underwent anastomosis as a single renal artery after cuff reconstruction. Three patients experienced a lymphocele and only 1, a urinary leak from lower end of ureter, which was repaired surgically. Graft survival was 96.9% with losses in 6 cases due to rejection. CONCLUSIONS: Grafts bearing multiple renal arterial displayed low postoperative complication rates and good outcomes.
Asunto(s)
Arterias , Trasplante de Riñón , Riñón/irrigación sanguínea , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: We sought to report the graft and patients survival of pre-emptive and non-pre-emptive kidney transplantations performed in our center. METHODS: The 859 subjects showed a mean age of 36.1 years and included 64.6%; males, who received grafts from living (n = 665) or deceased (n = 194) donors between January 2008 and June 2011. We reviewed their medical records retrospectively, to separately pre-emptive versus non-pre-emptive recipients for year transplant outcomes. RESULTS: Among the 859 patients, 153 (17.8%) underwent pre-emptive and 706 (82.2%), non-pre-emptive kidney transplantations. The rate of living donors was higher in the pre-emptive group (97.4% vs 73%, respectively). The 1-year graft survivals were 99.3% and 95.8% in pre-emptive and non-pre-emptive transplantation groups, respectively (P > .05). There was no significant difference between groups with respect to patient survival at 1 year (P > .05). CONCLUSION: In conclusion, graft and patient survival rates between pre-emptive and non-pre-emptive kidney transplantation cases were comparable at 1 year. Pre-emptive kidney transplantation, which eliminates hemodialysis costs and complications, should be preferred as the optimal renal replacement therapy for end-stage renal disease patients.
Asunto(s)
Supervivencia de Injerto , Trasplante de Riñón , Tasa de Supervivencia , Adulto , Femenino , Humanos , Masculino , TurquíaRESUMEN
AIM: The aim of this study was to evaluate the correlation between preoperative thyroid fine-needle aspiration result and final histopathology in patients with thyroid nodules. METHODS: The medical records of 298 patients (mean age, 47.7±12.3 years; 79.5% females) who underwent fine-needle aspiration for thyroid nodules and who were operated and have final pathological diagnosis were retrospectively reviewed. For reporting fine-needle aspiration specimen pathology, the Bethesda thyroid fine-needle aspiration classification was used. Tyroglobulin (Tg) and anti-Tg and anti-thyroid peroxidase (anti-TPO) antibody levels were determined preoperatively. RESULTS: Thyroid nodules were non-diagnostic, benign or atypia (Bethesda groups 1-3) in 76.8% of patients; and follicular neoplasm, suspicious for malignancy or malignant (Bethesda groups 4-6) in 23.1% of patients. Final pathology of surgery specimen was most commonly nodular goiter (36.6%) and papillary carcinoma (35.6%). Nodular goiter was significantly more prevalent in Bethesda 1 group while papillary carcinoma was more common in Bethesda 3 group (P<0.05). Tg level is significantly higher in the nodular goiter group (90.49±126.93 ng/mL), while anti-Tg and anti-TPO levels are significantly higher in the lymphocytic thyroiditis goiter group (229.77±494.42 U/mL and 282.86±360.77 U/mL, respectively) than the other pathology groups (P<0.05 for all). CONCLUSION: Papillary carcinoma is more common in Bethesda thyroid fine-needle aspiration classification 3 group. Therefore, preoperative fine-needle aspiration for thyroid nodules is predictive of final pathology and should be applied for diagnosis and follow-up.
Asunto(s)
Biopsia con Aguja Fina , Enfermedades de la Tiroides/diagnóstico , Nódulo Tiroideo/patología , Adenocarcinoma Folicular/sangre , Adenocarcinoma Folicular/diagnóstico , Adenocarcinoma Folicular/patología , Adenocarcinoma Folicular/cirugía , Adenoma/sangre , Adenoma/diagnóstico , Adenoma/patología , Adenoma/cirugía , Adulto , Autoanticuerpos/sangre , Biopsia con Aguja Fina/estadística & datos numéricos , Carcinoma Papilar/sangre , Carcinoma Papilar/diagnóstico , Carcinoma Papilar/patología , Carcinoma Papilar/cirugía , Diagnóstico Diferencial , Diagnóstico por Imagen de Elasticidad , Reacciones Falso Negativas , Reacciones Falso Positivas , Femenino , Bocio Nodular/sangre , Bocio Nodular/diagnóstico , Bocio Nodular/patología , Bocio Nodular/cirugía , Humanos , Hiperplasia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Sensibilidad y Especificidad , Tiroglobulina/sangre , Enfermedades de la Tiroides/sangre , Enfermedades de la Tiroides/patología , Enfermedades de la Tiroides/cirugía , Neoplasias de la Tiroides/sangre , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/patología , Neoplasias de la Tiroides/cirugía , Nódulo Tiroideo/sangre , Nódulo Tiroideo/cirugía , Tiroidectomía/estadística & datos numéricos , Tiroiditis Autoinmune/diagnóstico , Tiroiditis Autoinmune/patologíaRESUMEN
OBJECTIVES: The results of the studies in which the effect of hormone replacement therapy (HRT) on cardiac function have been evaluated are rather disputable. In these studies, cardiac function was evaluated with conventional echocardiographic methods. This study was planned in order to investigate the effects of HRT on myocardial velocities and myocardial performance index (MPI) in healthy early postmenopausal women. METHOD: In a prospective, controlled study, 60 healthy postmenopausal women were assigned to two groups (32 in the HRT group and 28 in the control group). After conventional echocardiographic parameters were measured, tissue Doppler echocardiography recordings were obtained from the mitral and tricuspid annulus. Systolic myocardial velocity (Sm), early and late diastolic myocardial velocities (Em and Am) and time intervals were measured and MPI was calculated. Then the symptom-limited exercise stress test using the Bruce protocol was performed. After 3 and 6 months of HRT (oral 0.625 mg conjugated estrogen + 2.5 mg medroxyprogesterone acetate/day), the same examinations were repeated. The effects of HRT on myocardial velocities, MPI and exercise time were evaluated at the 3rd and 6th months. RESULTS: The parameters of the control group remained statistically unchanged during the study. HRT did not have any effect on segmental and mean left ventricular (LV) Sm or right ventricular (RV) Sm. However, LV Em/Am and RV Em/Am ratios significantly increased at the 6th month of HRT, and LV and RV MPI values were observed to decrease significantly as compared to basal values. Additionally, a significant increase was observed in exercise duration and metabolic equivalent values after 3 months of HRT, and this increase continued at the 6th month as well. The favorable changes in all parameters in the HRT group were significantly different from those of the control group. CONCLUSION: Data obtained in this study suggest that HRT is not only effective for treating menopausal complaints but also increases cardiovascular performance by improving especially diastolic functions in early postmenopausal women.
Asunto(s)
Velocidad del Flujo Sanguíneo/efectos de los fármacos , Terapia de Reemplazo de Estrógeno , Corazón/fisiología , Contracción Miocárdica/efectos de los fármacos , Velocidad del Flujo Sanguíneo/fisiología , Ecocardiografía Doppler , Estrógenos Conjugados (USP)/farmacología , Prueba de Esfuerzo , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Acetato de Medroxiprogesterona/farmacología , Persona de Mediana Edad , Válvula Mitral/diagnóstico por imagen , Contracción Miocárdica/fisiología , Posmenopausia , Estudios Prospectivos , Válvula Tricúspide/diagnóstico por imagen , Función Ventricular Izquierda/efectos de los fármacos , Función Ventricular Izquierda/fisiología , Función Ventricular Derecha/efectos de los fármacos , Función Ventricular Derecha/fisiologíaRESUMEN
BACKGROUND: We planned this study to evaluate the effects of left bundle branch block (LBBB) on systolic and diastolic functions of left ventricle (LV) that have not previously been investigated in detail. MATERIAL AND METHODS: Forty-five cases diagnosed as isolated LBBB according to the standard electrocardiographic criteria (group I, mean age: 60 +/- 12 years) were taken as the case group and 65 cases with normal conduction system (group II, mean age 58 +/- 14 years) were taken as the control group. Echocardiography was performed to all patients and coronary angiography was performed to 21 patients in group I and 35 patients in group II. In addition to standard systolic and diastolic function parameters, isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and ejection time (ET) were measured by echocardiography, and the myocardial performance index (MPI) [(IRT+ICT)/ET] was calculated. LV end-diastolic pressure was calculated for the patients undergoing coronary angiography. RESULTS: In group I, LV end-systolic diameter was greater (3.1 +/- 0.4 cm vs 2.8 +/- 0.4 cm, P <.001) and ejection fraction was lower (64% +/- 6% vs 68% +/- 6%, P <.001) than those of group II. Rapid filling deceleration time and rate was markedly different in group I (respectively, 133 +/- 50 ms vs 166 +/- 24 ms, P <.001; 608 +/- 291 cm/s(2) vs 383 +/- 116 cm/s(2), P <.001). In addition, it was found that LBBB caused shortening of LV diastolic period and ET markedly (respectively, 347 +/- 116 ms vs 394 +/- 106 ms, P =.03; 255 +/- 40 ms vs 294 +/- 21 ms, P <.001) and prolongation of IRT and ICT (respectively; 124 +/- 36 ms vs 91 +/- 16 ms, 96 +/- 35 ms vs 38 +/- 9 ms, P <.001). The MPI was predominantly higher in group I (0.89 +/- 0.29 vs 0.40 +/- 0.06, P <.001). Invasively determined LV end-diastolic pressure was found higher in group I (14 +/- 3 mm Hg vs 10 +/- 3 mm Hg, P <.001). CONCLUSION: A marked elevation of the LV MPI and end-diastolic pressure, parallel to changes of conventional echocardiographic parameters, in patients with isolated LBBB points out that LBBB causes marked deterioration on LV systolic and diastolic functions.
Asunto(s)
Bloqueo de Rama/fisiopatología , Miocardio/metabolismo , Función Ventricular Izquierda/fisiología , Adulto , Anciano , Bloqueo de Rama/diagnóstico por imagen , Angiografía Coronaria , Diástole/fisiología , Ecocardiografía , Femenino , Sistema de Conducción Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Sístole/fisiología , Presión VentricularRESUMEN
The aim of this study was to investigate the clinical and angiographic importance of left anterior hemiblock (LAHB) during acute inferior myocardial infarction (AIMI) by comparing patient groups with and without LAHB after AIMI. One hundred seventy-two patients (141 men and 31 women) between 28 and 84 years of age (mean 55 +/-10 years) with AIMI were included in the study. Patients were divided into 2 groups according to electrocardiogram (ECG) criteria: group I comprised 25 patients in whom ECG pattern characteristic of LAHB developed, group II comprised 147 patients without this pattern. According to the electrocardiogram, patients were placed in group I if the mean QRS axis was deviated to the left < 30 degrees in the frontal plane with the following pattern: increased S-wave voltage and decreased R-wave voltage in leads II, the appearance of a deep S-wave in lead II, and a terminal positive R-wave in lead aVR. Coronary angiography was performed within 2 weeks. A coronary stenosis was considered if the vessel diameter was narrowed by > 50%. The dominant coronary artery was classified as right or left or balanced. The left ventricular ejection fraction (LVEF) was calculated from left ventriculography. The mean age of the patients in group I was significantly higher (58 vs 54 years, p = 0.007), while the risk factors were similar in both groups. Left anterior descending (LAD) and multi-vessel coronary artery disease (CAD) were found to be significantly higher in group I compared with group 11 (80% vs 38%, p=0.0001; 84% vs 52%, p=0.001, respectively). The mean LVEF was found to be lower in group I (51% vs 56%, p=0.04). Peak creatine phosphokinase MB (CKMB) values were not different (216 vs 162 IU/L, p = 0.09). The frequency of left dominant or balanced coronary artery was determined to be higher in group I (44% vs 17%, p = 0.018). LAHB development during AIMI can be an indicator of LAD lesions, multivessel coronary artery disease, and impaired left ventricular systolic function.
Asunto(s)
Bloqueo Cardíaco/complicaciones , Infarto del Miocardio/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Angiografía Coronaria , Femenino , Bloqueo Cardíaco/diagnóstico por imagen , Bloqueo Cardíaco/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Estudios Prospectivos , Factores de RiesgoRESUMEN
BACKGROUND: The aim of this study was to evaluate the reliability of peak mitral inflow (E-wave) velocity, which was thought to be easier and more practical than qualitative and quantitative methods used to grade mitral regurgitation (MR) in patients both with normal and low left ventricular (LV) ejection fraction (EF). It is known that peak E-wave velocity increases in MR. But correlation of this increase with regurgitant fraction (RF), its usefulness in grading MR, and the effect of EF on peak E-wave velocity have not been studied in detail. METHODS: We prospectively examined 135 consecutive patients with varying grades of MR with echocardiography. MR was evaluated both qualitatively and quantitatively, and concordance of these 2 methods was determined. Peak E-wave velocity, A-wave velocity, and E-wave deceleration time were measured and the E/A ratio was calculated. LV isovolumetric relaxation and contraction times were measured. Different MR groups classified by RF were compared with each other. RESULTS: Concordance of quantitative and qualitative evaluation was low in patients with low EF (kappa 0.37 vs 0.65). Peak E-wave velocity and E/A ratio showed significant differences between MR groups. Peak E-wave velocity correlated with the RF and EF (r = 0.47, r = 0.33, respectively, P <.001). Sensitivity, specificity, and negative predictive value of peak E-wave velocity >1.2 m/s suggesting severe MR were found to be different in patients with normal and low EF (96% vs 66%, 78% vs 83%, 97% vs 78%, respectively). E-wave deceleration, LV isovolumetric relaxation, and contraction time did not show a correlation with RF. CONCLUSION: Peak E-wave velocity is a screening method that could be used in common for determining severity of MR semiquantitatively, especially in patients with normal EF.
Asunto(s)
Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/diagnóstico , Válvula Mitral/fisiopatología , Disfunción Ventricular Izquierda/complicaciones , Adulto , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Valor Predictivo de las Pruebas , Estudios Prospectivos , Reproducibilidad de los Resultados , Volumen Sistólico , UltrasonidoRESUMEN
OBJECTIVE: In previous echocardiographic studies, a correlation between ejection fraction of the left ventricle and change in the movement of the mitral annular ring was found. In the light of these studies, we planned to investigate the relationship between systolic shortening (SS) and percent of systolic shortening (PSS), calculated from the long axis frame in coronary angiography and left ventricular systolic function. METHODS AND RESULTS: One hundred and thirty-eight patients (40 men and 98 women; mean age 58 +/- 10 years) who had been referred for coronary angiography and left ventriculography were included in the study. Ejection fraction (EF) was calculated from left ventriculography obtained from 30 degrees right anterior oblique projection. Distance from the lower border of the ostium of the left coronary artery to the most apical border of the left anterior descending (LAD) artery was measured at end-systole (ES) and end-diastole (ED) using coronary angiography obtained from the same projection. SS as ED-ES and PSS as SS/ED were calculated. Correlation of SS and PSS with EF was calculated (EF = 13.7 + 4.8 x SS, r = 0.91, p < 0.001 and EF = 14.2 + 6.5 x PSS, r = 0.90, p < 0.01). SS < 7 mm (criterion A) and PSS < 6% (criterion B) suggested that left ventricle EF was less than 50%, with a sensitivity, specificity and diagnostic accuracy of 83%, 100%, 95%; 95%, 86% and 88%, respectively. CONCLUSION: SS and PSS highly significantly correlate with left ventricular EF. Therefore, left ventriculography could be omitted in selected patients undergoing coronary angiography if it is not necessary to define the anatomic structure of the left ventricle.
Asunto(s)
Angiografía Coronaria , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Función Ventricular Izquierda/fisiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Sístole/fisiologíaRESUMEN
This study deals with skin diseases described in the earliest compiled or translated Turkish medical manuscripts of the 14th and 15th centuries in Anatolia. The manuscripts studied are: Müntehab-i Sifa, Edviye-i Müfrede, Tervihü'l-Ervah, Yadigâr, Cerrahiyyetü'l-Haniyye, Kamilü's-Sinaatü't-Tibbiye Tercü-mesi, Kitab-i Müntehab-i fi't-Tibb, Haza'inü's-Sa'adat, Akrabadin Tercümesi, Mücerrebname, Müfredât-i Ibn-i Baytar Tercümesi, Tuhfe-i Mübarizi and Tuhfe-i Muradi. The skin diseases known at that time are studied under the following topics: Cüderi (Ciçek, Variola, Small-pox); Hasbe (Kizamik, Rubeola, Measles); Cüzzam (Lepra, Leprosy, Hansen's disease); Demregü (Temriye, Dermatophtosis, Tinea corporis); Behak (There are two types: the white and the black; the black is Addison's disease); Baras (Ala, Vitilio); Nemle (Isirga, Makül); Ates paresi (Nar-i farisi, frunculosis); Cemre (Kara kabarcik, Sirpençe, Karbonkül, Carbuncle); Caversiye (Kabarcik hastaligi, blisters disease); Sivilceler (Various types of pimples; Humre: Yilancik, Erizipel, Erysipelas, St. Anthony's fire; Basbert: Ciban, Fronkül, Boil, Fruncle; Dümmel: Kan çibani, Abse, Abscess); Abile (Kabarcik, Bule); Seretan (Kanser, Cancer); Hanazir (Siraca, Scrofuloderma); Akile (Yinürbas, Gangren); Kurdesen (Urtiker, Urticeria); Uyuz (Gale, Scabies); Giciyik (Kasinti, Pruritus); Sa'fe (Konak, Seboreik dermatit, Scurf; Kel (Alopesi, Favus); Evram (Sisler, Urlar, Tumours); Yara (Karha, Cerahat, Wound). The terminology and symptoms of these diseases are studied and tried to find their equivalents of today. The causes and the treatment of the skin diseases known then are presented. The second part of Tokaç's article continues to deal with the etiology, symptoms and treatment of dermatological diseases.
Asunto(s)
Manuscritos como Asunto/historia , Enfermedades de la Piel/historia , Historia del Siglo XV , Historia Medieval , TurquíaRESUMEN
This study deals with skin diseases described in the earliest compiled or translated Turkish medical manuscripts of the 14th and 15th centuries in Anatolia. The manuscripts studied are: Müntehab-i Sifa, Edviye-i Müfrede, Tervihü'l-Ervah, Yadigâr, Cerrahiyyetü'l-Haniyye, Kamilü's-Sinaatü't-Tibbiye Tercü-mesi, Kitab-i Müntehab-i fi't-Tibb, Haza'inü's-Sa'adat, Akrabadin Tercümesi, Mücerrebname, Müfredât-i Ibn-i Baytar Tercümesi, Tuhfe-i Mübarizi, Tuhfe-i Muradi. The skin diseases known at that time are studied under the following topics: Cüderi (Ciçek, Variola, Small-pox); Hasbe (Kizamik, Rubeola, Measles); Cüzzam (Lepra, Leprosy, Hansen's disease); Demregü (Temriye, Dermatophtosis, Tinea corporis); Behak (There are two types: the white and the black; the black is Addison's disease); Baras (Ala, Vitilio); Nemle (Isirga, Makül); Ates paresi (Nar-l farisi, frunculosis); Cemre (Kara kabarcik, Sirpençe, Karbonkül, Carbuncle); Caversiye (Kabarcik hastaligi, blisters disease); Sivilceler (Various types of pimples; Humre: Yilancik, Erizipel, Erysipelas, St. Anthony's fire; Basbert: Ciban, Fronkül, Boil, Fruncle; Dümmel: Kan çibani, Abse, Abscess); Abile (Kabarcik, Bule); Seretan (kanser, Cancer); Hanazir (Siraca, Scrofuloderma); Akile (Yinürbas, Gangren); Kurdesen (Urtiker, Urticeria); Uyuz (Gale, Scabies); Giciyik (Kasinti, Pruritus); Sa'fe (Konak, Seboreik dermatit, Scurf); Kel (Alopesi, Favus); Evram (Sisler, Urlar, Tumours); Yara (Karha, Cerahat, Wound). The terminology and symptoms of these diseases are studied and tried to find their equivalents of today. The causes and the treatment of the skin diseases known then are presented.
Asunto(s)
Manuscritos Médicos como Asunto/historia , Enfermedades de la Piel/historia , Historia del Siglo XV , Historia Medieval , TurquíaRESUMEN
This study deals with skin diseases described in the earliest compiled or translated Turkish medical manuscripts of the 14th and 15th centuries in Anatolia. The manuscripts studies are: Müntehab-i Sifa, Edviye-i Müfrede, Tervihü'l-Ervah, Yadigâr, Cerrahiyyetü'l-Haniyye, Kamilü's-Sinaatü't-Tibbiye Tercü-mesi, Kitab-i Müntehab-i fi't-Tibb, Haza'inü's-Sa'adat, Akrabadin Tercümesi, Mücerrebname, Müfredât-Ibn-i Baytar Tercümesi, Tuhfe-i Mübarizi, Tuhfe-i Muradi. The skin disease know at that time are studied under the following topics: Cüderi (Ciçek, Variola, Small-pox); Hasbe (Kizamik, Rubeola, Measles); Cüzzam (Lepra, Leprosy, Hansen's disease); Demregü (Temriye, Dermatophtosis, Tinea coproris); Behak (There are two types: the white and the black; the black is Addison's disease ); Baras (Ala, Vitilio); Nemle (Isirga, Makül); Ates paresi (Nar-i farisi, frunculosis); Cemre (Kara kabarcik, Sirpense, Karbonkül, Carbuncle); Caversiye (Kabarcik hastaligi, blisters disease); Sivilceler (Various types of pimples; Humre: Yilancik, Erizipel, Erysipelas, St. Anthony's fire; Basbert: Ciban, Fronkül, Boil, Fruncle; Dümmel: Kan çibani, Abse, Abscess); Abile (Kabarcik, Bule); Seretan (Kanser, Cancer); Hanaziz (Siraca, Scrofuloderma); Akile (Yinürbas, Gangren); Kurdesen (Urtiker, Urticeria); Uyuz (Gale, Scabies); Giciyik (Kasinti, Prutitus); Sa'fe (Konak, Seboreik dermatit, Scurf); Kel (Aloposi, Favus); Evram (Sisler, Urlar, Tumours); Yara (Karha, Cerahat, Wound). The terminology and symptoms of these diseases are studied and tired to find their equivalents of today. The causes and the treatment of the skin diseases known then are presented.