New Treatment modality for Burn Injury Related ARDS : High-Flow Nasal Oxygen Therapy in Major Burns

Pulmonary insufficiency is the primary cause of death in cases of major burns accompanied by inhalation damage. It is important to consider the impact on the face and neck in flame burns. Early implementation of bronchial hygiene measures and oxygenation treatment in inhalation injury can reduce mortality. This case series presents the effects of high-flow nasal oxygen application on patient outcomes in major burns and inhalation injury. This report discusses three different patients. One patient, a 29-year-old male with 35% TBSA burns, received high-flow nasal oxygen (HFNO) treatment for inhalation injury on the sixth day after the trauma. After 72 hours of HFNO application, the patient's pulmonary symptoms improved. The second patient had 60% TBSA burns and developed respiratory distress symptoms on the fifth day after the trauma. After 7 days of HFNO application, all symptoms and findings of acute respiratory distress syndrome (ARDS) were resolved. HFNO has used for the treatment of ARDS releated to major burn ( 60% of burned TBSA) 28 years-old patient and improvement was achived. The use of HFNO in pulmonary insufficiency among burn patients has not been reported previously. This series of patient cases demonstrates the successful application of HFNO in treating inhalation injury and burn-related ARDS. However, further clinical studies are necessary to increase its clinical utilization.

Anesthetic management of toxic epidermal necrolysis: a report of two cases

Toxic epidermal necrolysis (TEN), is an acute, life-threatening emergent disease involving the skin and mucous membranes with serious systemic complications. It is characterized by widespread epidermal sloughing. Drugs are the most common triggers of TEN, but infection, vaccination, radiation therapy and malignant neoplasms can all induce it in susceptible patients. We report two cases in whom a hair dye and a COVID-19 vaccine (BioNTech®, Pfizer) were believed to be the causative agents. These patients have to undergo repeated debridements of the necrotic tissue. In this manuscript the anesthetic management of TEN patients is discussed. Detailed preoperative evaluation, aggressive fluid and electrolyte replacement, avoidance of hypothermia during debridement, minimizing anesthetic agents and limiting traumatic procedures are key points in the management. Abbreviations: BUN: blood urea nitrogen; BSA: Body surface area; Cr: Creatinine; OR: Operating room; SJS: Stevens-Johnson Syndrome; TEN: Toxic epidermal necrolysis Key words: Anesthesia; COVID-19; Toxic epidermal necrolysis; Vaccine Citation: Bilge B, Erkilic E, İlhan G, Akin M, Kanbak O. Anesthetic management of toxic epidermal necrolysis: a report of two cases. Anaesth. pain intensive care 2022;27(1):135−138; DOI: 10.35975/apic.v27i1.2113 Received: November 22, 2022; Reviewed: November 29, 2022; Accepted: December 02, 2022

Nitric Oxide Detection Using a Corona Phase Molecular Recognition Site on Chiral Single-Walled Carbon Nanotubes

Semiconducting single-walled carbon nanotubes (s-SWCNT) are structures that fluoresce in the near-infrared region. By coating SWCNT surfaces with polymeric materials such as single-chain DNA, changes in fluorescence emission occur in the presence of reagents. In this way, polymer-coated SWCNT structures allow them to be used as optical sensors for single molecule detection. Especially today, the inadequacy of the methods used in the detection of cellular molecules makes the early diagnosis of diseases such as cancer difficult at the single-molecule level. In this study, the detection of nitric oxide (NO) signals, which are a marker of cancer, was carried out at the single-molecule level. In this context, a sensor structure was formed by coating the 7,6-chiral s-SWCNT surface with ssDNA with different oligonucleotide lengths (AT). The sensor structure was characterized by using UV-vis spectroscopy and Raman spectroscopy microscopy. After formation of the sensor structure, a selectivity library was created using various molecules. As a result of the coating of the SWCNT (7,6) surface with DNA corona phase formation, Raman peaks at 195 and 276 cm-1 were observed to shift to the right. Additionally, the selectivity library results showed that the (AT)30 sequence can be used in NO detection. As a result of the studies using SWCNT (7.6)- (AT)30, the limit of detection (LOD) and limit of determination (LOQ) values of the sensor against NO were found to be 1.24 and 4.13 μM, respectively.

Oxygen transmission rates of skin substitutes and graft survival

AIM

Oxygen is required for cell migration into the scaffold and for the survival of the overlying graft in the use of a single-layer scaffold. In the absence of diffusion from the avascular wound base, such as in areas above the bone/tendon, oxygen delivery from the lateral edges of the scaffold is important. This study compared the oxygen permeability of skin scaffolds, currently commercially available in Turkey (Nevelia®, MatriDerm®, and Pelnac®), in the lateral plane.

MATERIALS AND METHODS

To measure oxygen permeability, an interconnected closed system was created. Oxygen permeability was evaluated based on the color change that occurred as a result of the reaction of iron with oxygen. After the dermal matrices placed in the closed system were exposed to oxygen, the color change on the surface of the dermal matrices was measured, and electron microscopic images were recorded to compare deformation before and after the procedure.

RESULTS

Two scaffolds did not show deformation after the procedure while Pelnac® had minimal deformation. The oxygen rates on the nitrogen side of the test apparatus were found to be 29%, 34%, and 27% for Nevelia®, MatriDerm®, and Pelnac®, respectively; and the oxygen transmission lengths (length of color change) of these scaffolds in the lateral plane were 1, 2, and 0.5 cm, respectively.

CONCLUSION

Although none of the scaffolds showed significant deformation, and all continued to exhibit their scaffold properties after the procedure, MatriDerm® was determined to be the most suitable scaffold for use in avascular areas, with a 2-cm oxygen transmission length in terms of lateral oxygenation.

A Rare Bacteremia in a Burn Patient: A Case Report of Achromobacter Xylosoxidans and Denitrificans

Achromobacter is a rare bacteria that causes bacteremia in immune-compromised patients. In this case, a 26-year-old male patient with major burns with a positive blood culture for Achromobacter is presented. A rare bacterium, Achromobacter xylosoxidans, and denitrificans, was detected in the blood culture of a patient who was hospitalized due to major burn trauma and had delayed wound healing and had no graft take. After treatment with culture-specific antibiotics, the patients' acute phase reactants decreased, and he was discharged with 100% graft-take. Sepsis is the most common cause of death in major burns. Endogenous and exogenous bacteria cause sepsis. Bacteremia and sepsis are the most important factors affecting wound healing in burn patients. This case shows that rare opportunistic bacteria such as Achromobacter spp. should be considered in major burn patients with delayed wound healing and recurrent graft lysis.

Bimetallic Biogenic Pt-Ag Nanoparticle and Their Application for Electrochemical Dopamine Sensor

In this study, Silver-Platinum (Pt-Ag) bimetallic nanoparticles were synthesized by the biogenic reduction method using plant extracts. This reduction method offers a highly innovative model for obtaining nanostructures using fewer chemicals. According to this method, a structure with an ideal size of 2.31 nm was obtained according to the Transmission Electron Microscopy (TEM) result. The Pt-Ag bimetallic nanoparticles were characterized using Fourier Transform Infrared Spectroscopy (FTIR), X-ray Diffractometry (XRD), and Ultraviolet-Visible (UV-VIS) spectroscopy. For the electrochemical activity of the obtained nanoparticles in the dopamine sensor, electrochemical measurements were made with the Cyclic Voltammetry (CV) and Differential Pulse Voltammetry (DPV) methods. According to the results of the CV measurements taken, the limit of detection (LOD) was 0.03 µM and the limit of quantification (LOQ) was 0.11 µM. To investigate the antibacterial properties of the obtained Pt-Ag NPs, their antibacterial effects on Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus) bacteria were investigated. In this study, it was observed that Pt-Ag NPs, which were successfully synthesized by biogenic synthesis using plant extract, exhibited high electrocatalytic performance and good antibacterial properties in the determination of dopamine (DA).

Synthesis and characterization of activated carbon supported bimetallic Pd based nanoparticles and their sensor and antibacterial investigation

Activated carbon (AC) supported palladium cobalt bimetallic nanoparticles (PdCo@AC NPs) were obtained by green synthesis method using Cinnamomum verum (C. Verum) extract. The obtained NPs were characterized by Fourier Transform Infrared Spectroscopy (FTIR), X-Ray Crystallography (XRD), Transmission Electron Microscope (TEM) and Ultraviolet Visible (UV-VIS) spectroscopy, and the functional groups and morphology of the nanoparticle were elucidated. The resulting particle size was found to be 2.467 nm. NPs were evaluated using Cyclic Voltammetry (CV), Scan Rate (SR), and Differential Pulse Voltammetry (DPV) techniques for potential dopamine sensors application. According to the obtained DPV results, Limit of Detection (LOD) and Limit of Quantitation (LOQ) values are found to be 5.68 pM and 17.21 pM, respectively. It was also observed that AC supported PdCo nanoparticles obtained from C. verum extract sensed dopamine quite well. Besides, to examine the antibacterial properties of NPs, antibacterial analyzes were performed with Escherichia coli (E. Coli) and Staphylococcus aureus (S. Aureus). It was observed that it showed good antibacterial properties against gram positive (S. aureus) and gram negative (E. coli) bacteria. The study gave important results in terms of the synthesis of bimetallic NPs using the green synthesis method and their usability in different areas. With this study, it was observed that a good antibacterial dopamine sensor were obtained with the successful biogenic synthesis of AC supported PdCo bimetallic NPs.

Medical faculty students risk perception, attitudes, and behaviors regarding protection from COVID-19 infection

OBJECTIVE

This study aims to determine the risk perception, attitude, and behavior characteristics of Pamukkale University Faculty of Medicine students towards protection from COVID-19.

SUBJECTS AND METHODS

A total of 698 (48.2%) students of Pamukkale University Faculty of Medicine participated in this analytical cross-sectional study. Dependent variables were attitudes and behaviors related to protection from COVID-19, and independent variables were socio-demographic characteristics, sources of information about COVID-19, and health status. Data was collected through a survey using Google Forms. SPSS 17.0 (Inc., Chicago, IL, USA) software package was used for statistical analysis. Descriptive statistics were expressed as numbers and percentages for nominal data and mean and standard deviation for numerical data. Numerical data were compared with Mann Whitney U and Kruskal Wallis tests. Spearman correlation and backward linear regression analyses were used. A p-value of <0.05 was considered significant.

RESULTS

The mean age of 698 students participating in the study was 21.8±2.2, and 60% of them were female. The mean attitude score was 54.99±5.17 and the mean behavior score was 50.64±6.06. The information sources of the students about COVID-19 were TV news (69.3%). Linear regression analysis revealed that attitude scores of the female gender were higher than male gender (β=0.757±0.364 p=0.038, 95% CI: 0.440-1.471) and scores for using websites/social media accounts of professional organizations and professional associations as information sources were higher than not using (β=0.981 ± 0.388 p=0.011 95% CI: 0.230-1.732).

CONCLUSIONS

Medical students' attitude and behavior score towards protection against COVID-19 infection is slightly above the average level. Medical education should prepare students to manage epidemics.

Effects of hyperbaric oxygen therapy on clinical and economic outcomes in patients with deep second-degree burns

INTRODUCTION

Deep second-degree burn injuries are the most challenging situations for the burn surgeon in the treatment of adult cases. While waiting for spontaneous closure increases the risk of hypertrophic scar and keloid, early excision and grafting pose the risk of donor site wound and permanent color differences. Unlike many studies in the literature, the current study was planned in a way to minimize factors other than burn wounds to investigate the effect of adding hyperbaric oxygen (HBO2) therapy to conventional treatment in deep second-degree burn wounds.

MATERIAL AND METHODS

This prospective observational study included patients with burn injuries who underwent conventional treatment alone and those who underwent conventional plus HBO2 treatment performed by a single experienced surgeon and who met the study criteria.

RESULTS

Thirty-eight patients completed the study. Mean burned total body surface area (TBSA) was. 9.22 ± 3 43% (range 5% to 20%). There was no difference between the two groups in terms of age, burned TBSA, and burn etiology. The need for surgery and grafting was lower in patients who received HBO2 in addition to conventional treatment (p=0.003 and p=0.03, respectively). The patients in the HBO2 group had a shorter hospital stay, and their wounds epithelialized in a shorter time (p=0.169 and p≺0.001, respectively). They also had a higher satisfaction level and lower treatment cost (p=0.03 and p=0.36, respectively).

DISCUSSION

The results of this prospective study, in which co-factors were eliminated, showed that adding HBO2 to the conventional treatment of deep second-degree burns had a significant positive effect on patient outcomes, as well as reducing treatment costs.

Synthesis and application of AuNi@AC nano adsorbents for the removal of Maxilon Blue 5G azo dye from aquatic mediums

In this research, gold-nicel supported on activated carbon (AC) nanoadsorbent (AuNi@AC) synthesized by following a series of physicochemical procedures was prepared for the removal of Maxilon Blue 5G (MB) which is a cationic textile dye. Experimental studies based on parameters specifically pH, contact time, nano catalytic adsorbent particle, initial MB dye concentration and temperature effect were conducted in aqueous solutions in a batch system. AuNi@AC nanoadsorbents (NAs) reached the equilibrium in 30 min under optimum conditions in adsorption of the dye. The pseudo-first, second-order, and intra-particle diffusion models were tested to evaluate a the experimental results. Adsorption kinetics were found to be represented by the pseudo-second-order model, and the maximum adsorption capacity (q_max.) was calculated to be 542.90 mg/g (or 2.041 mmol/g). The synthesized magnetic AuNi@AC nanoadsorbent showed a high-efficiency reusability effect of about 64% after five reuse runs. Also, thermodynamic function parameters such as activation energy (Ea), Gibbs free energy (ΔG *), and entropy (ΔS *) were investigated in the sorption study. After all evaluation of data, it was concluded that the novel AuNi@AC nanoadsorbent could be considered as an effective support material for the removal of various organic pollutants in aquation solution especially for the removal of MB.

Applying a Silver-containing Dressing to the Incision Site and Its Effect on the Development of Surgical Site Infection After Ostomy Closure: A Prospective Randomized Clinical Pilot Study

BACKGROUND: Surgical site infections (SSIs) can occur after colorectal surgery. Ionic silver has been used to prevent the development of SSIs. New-generation dressings, defined as total occlusive ionic silver–containing dressings, have been shown to reduce bacterial colonization in SSIs. PURPOSE: To evalute the effect of a silver hydrofiber dressing on the development of SSIs at the abdominal incision after ostomy closure. METHODS: There was a total of 37 eligible patients who underwent temporary ostomy closure. Five patients required an associated intervention during ostomy closure and were excluded. One patient was lost to follow-up. Hence, 32 patients were included in the study. Silver-containing occlusive dressings and conventional dressings were used in patients who underwent ostomy closure. In the control group (n = 16), the wound area was covered with a standard sterile gauze dressing for 24 to 48 hours, and then wound cleansing was performed with 10% povidone iodine, followed by daily dressing replacement with sterile gauze for 5 days. The patients in the study group (n = 16) were treated with a silver-containing hydrofiber dressing, which was not changed for 5 days following application in the operating room. RESULTS: At the end of the 30-day follow-up period, no SSIs were observed in the study group. When the dressing methods applied to the patient groups with and without SSIs were compared, SSIs developed at a higher rate in the control group (n = 4; 26.7%) compared with the study group (n = 0); this result was statistically significant (P = .043). CONCLUSIONS: In this study, the use of a wound care product containing ionic silver reduced the rate of SSIs related to ostomy closure. Multicenter, randomized, clinical studies involving a larger number of patients are needed. In addition, occlusive wound dressings with and without silver should be investigated in further studies.

Synthesis of a functionalized carbon supported platinum–iridium nanoparticle catalyst by the rapid chemical reduction method for the anodic reaction of direct methanol fuel cells

Direct methanol fuel cells (DMFCs) stand out among the most common technologies in energy storage and are environmentally friendly energy converters that convert chemical energy into electrical energy.

Is it Necessary to Perform a Histopathological Examination of Pilonidal Sinus Excision Material?

BACKGROUND

Although pilonidal sinus disease is common, development of associated malignancy is very rare. After surgical treatment, most surgeons send the excision material for a histopathological examination. The aim of this study was to examine whether it is necessary to routinely send the pilonidal sinus surgical excision material for this examination.

METHOD

The data of 3146 patients were retrospectively screened, and 2486 patients with available histopathological reports of the excision material were included in the study.

RESULTS

Of the 2486 patients included in the study, 2165 were men and 321 were women, and 94.7% of the patients were under the age of 50 years while 5.3% were 50 years or above. The rate of patients who underwent surgery due to recurrence was 1.2%. No malignancy was detected in any patient after the histopathological examination.

DISCUSSION

In this study, none of the pathology results was reported as malignant. This confirms that it is necessary to ask the question whether we should routinely send the surgical excision material for a histopathological examination.

P1706Neurological outcome in patients with out-of-hospital cardiac arrest undergoing a standardised protocol including therapeutic hypothermia and routine coronary angiography

Purpose

To establish cut-offs for neuromarkers such as neuron-specific enolase (NSE) and S-100 predicting good neurological outcome for patients treated with therapeutic hypothermia with out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) as current cut-offs had been derived from normothermic cohorts.

Methods

Consecutive data of all patients with OHCA admitted to our institution between 01/2011 and 12/2016 were collected in a database. Patient received standard intensive care according to the Hannover Cardiac Resuscitation Algorithm (HaCRA) including mandatory hypothermia. Neurological markers such as neuron-specific enolase (NSE) and S-100 have been used to assess neurological damage following OHCA.

Results

Mean age of overall patient population (n=302) was 63±14 [54–74] years with a male predominance (77%). Cardiac arrest was witnessed in 81% and bystander cardiopulmonal resuscitation (CPR) was performed in 67%. Initial rhythm was ventricular fibrillation in 69%. ROSC had been achieved after 24±17 minutes. Hypothermia was applied in all patients. In 95% percutaneous coronary angiography and in 57% of them coronary intervention was performed. After ROSC, STEMI was present in 44%. Mechanical support was required in 19%. 30 day mortality was 44% in the total cohort. Mean NSE was 27±69 μg/l, mean NSE with good neurological outcome was 20±8.7 μg/l, highest NSE with good neurological outcome was 46 μg/l. Mean S-100 was 0.114±2.037μg/l, mean S-100 with good neurological outcome was 0.068±0.067 μg/l, highest S-100 with good neurological outcome was 0.360 μg/l.

Conclusion

Even when using a strict protocol for OHCA patients and routinely applying therapeutic hypothermia, the cut-offs for NSE and S-100 regarding good neurological outcome are similar to those reported before without therapeutic hypothermia, but they must not be used solitary to withdraw life support as even very high markers can be associated with goof neurological outcome in individual patients.

Response to parenteral iron therapy distinguish unexplained refractory iron deficiency anemia from iron-refractory iron deficiency anemia

INTRODUCTION

We evaluated that response to parenteral iron therapy could be helpful in distinguishing the types of iron deficiency anemia.

PATIENTS AND METHODS

This study analyzed responses to IV iron sucrose therapy of 15 children with unexplained refractory iron deficiency anemia (URIDA). We compared the results at diagnosis, 6 weeks and 6 months after the therapy. Results were compared with responses of 11 patients' results with iron-refractory iron deficiency anemia (IRIDA) from our previous study.

RESULT

Six weeks after the start of treatment, ferritin, MCV, MCH and Hb values were in normal range in 10 patients. The increase in Hb, MCH, MCV, and ferritin values ranged 2.6-3.5 g/dL, 1.7-4.2 pg, 2-9 fL, and 13-25 ng/mL, respectively. In five patients, Hb, MCH, and MCV mean (range) values [11.2 g/dL (11-12.2), 24.5 pg (24-25.6), and 67 fL (65-70)] were nearly normal but ferritin mean (range) values [9.8 ng/mL (8-11)] were below normal. Six weeks after the start of treatment, Hb, MCH, MCV and ferritin values of patients with IRIDA were increased. The increase in Hb, MCH, MCV, and ferritin values ranged 0.8-2.7 g/dL, 1.7-4.2 pg, 2-9 fL, and 13-25 ng/mL, respectively. IRIDA is only partially responsive to parenteral iron supplementation. In conclusion, this study demonstrated that the response to intravenous iron therapy for the URIDA cases improved blood parameters more effectively than hereditary IRIDA. Response to parenteral iron therapy would be helpful to distinguish unexplained refractory IDA from hereditary IRIDA for clinicians who do not have access to hepcidin or TMPRS6 mutation analysis.

Factors influencing cost, length of hospital stay and mortality in colorectal cancer

PURPOSE

Colorectal cancers (CRCs) are the most common cancers in the world after lung and prostate cancer in men and breast and lung cancer in women, and usually occur in the recto-sigmoid region. There are many factors that affect their morbidity and mortality. Some markers have been evaluated to predict disease prognosis. However, a gold standard prognostic biomarker has not yet been found for CRC. In the present study, we aimed to evaluate the factors associated with the duration and cost of hospital stay and mortality.

METHODS

Patients who were admitted to the emergency service and general surgery clinic with abdominal pain, rectal bleeding, weight loss, diminished stool discharge, and ileus were included in this study. Recorded were patient age, gender, comorbid factors, family history, surgical treatment procedure, elective or urgent surgical intervention, bowel cleansing before surgery, pathological stage, neutrophil/lymphocyte ratio (NLR), red cell distribution width (RDW), mean platelet volume (MPV) and CEA, CA 19.9 and hemoglobin levels.

RESULTS

The mean patient age was 61.2±12.4 years. The male/female ratio was 0.596(81/136). Emergency surgery was an independent factor increasing the cost and length of hospital stay (p=0.007 and p=0.018). Additionally, patients >65 years of age had increased length of hospital stay and mortality (p=0.008 and p=0.024, respectively). Anemic patients had 50% higher mortality risk compared with patients with normal hemoglobin levels (p=0.030).

CONCLUSION

Based on our results, anemic patients in the geriatric population who underwent emergency CRC surgery may have higher costs, longer hospital stay and greater mortality rates than other CRC patients.

Shear bond strength of a self-adhering flowable composite when used for lingual retainer bonding

OBJECTIVE

The goal of this work was to assess the shear bond strength (SBS) and fracture mode of a self-adhering flowable composite when used after thermocycling for lingual retainer bonding.

MATERIALS AND METHODS

A total of 80 human mandibular incisor teeth were categorized into four equal groups: group 1: Vertise™ Flow (VF) without acid etching; group 2: VF with acid etching; group 3: VF with a self-etching bonding agent accompanied by an additional acid etching; group 4: Transbond LR control. Either VF or Transbond LR was applied to the lingual surface of the teeth by packing the material into cylindrical plastic matrices to simulate the lingual retainer bonding area. After all teeth were thermocycled (5000 cycles, 5 and 55 °C), fracture modes were examined under × 20 magnification. The SBS data were assessed via analysis of variance (ANOVA) and Tukey's tests. Fracture modes were analyzed by the χ(2) test at a significance level of 0.05.

RESULTS

Statistically significant differences in SBS values between groups (p < 0.001) were observed. Group 4 exhibited the highest (14.63 ± 1.36 MPa) and group 1 the lowest SBS (2.67 ± 1.35 MPa) values. Statistically significant differences were noted in fracture modes between groups 1, 3, and 4 (p < 0.001). In all the self-adhering flowable composite groups, the adhesive type (tooth-composite interface) fracture occurred more frequently than cohesive and mixed-type fractures.

CONCLUSION

When applied to bond lingual retainers to unetched enamel or with self-etching bonding agent accompanied by an additional acid etching, Vertise™ Flow resulted in a significant decrease in bond strength.

Feasibility of using thrombin generation assay (TGA) for monitoring of haemostasis during supplementation therapy in haemophilic patients without inhibitors

Monitoring factor replacement treatment and observing concordance with clinical haemostasis is crucial in vital haemorrhages and major surgeries in haemophilic patients. We aimed to investigate the value of the thrombin generation assay (TGA) and thromboelastography (TEG) for monitoring haemostasis in haemophilic patients during factor replacement treatment. The study group consisted of 29 patients (21 haemophilia A, 8 haemophilia B). All the patients FVIII-inhibitor were negative. A total of 35 bleeding episodes and/or surgical interventions were evaluated. aPTT, FVIII/FIX activity, TEG and TGA tests were conducted before and after factor therapy during the bleeding episode or surgical prophylaxis of haemophilic patients. Correlations among these tests were evaluated and compared with clinical responses. No correlation was found among aPTT, factor activities and clinical outcome. There were also no correlation found between TEG parameters and clinical outcome. The only significant correlation found between TGA parameters and clinical outcome was the correlation between peak thrombin. In conclusion, we found superiority of TGA-peak thrombin over other traditional tests for monitoring haemostasis in haemophilic patients in this study.

Surgery in patients with haemophilia and high responding inhibitors: Izmir experience

  This report evaluates the haemostatic efficacy of recombinant factor VIIa (rFVIIa) and activated prothrombin complex concentrate (APCC) in patients with haemophilia and high responding inhibitors who underwent major and minor surgery. Data pertaining to surgeries from 2001 to 2009 at a single centre were retrospectively analysed. During this period, 53 surgical procedures were performed in 30 haemophiliacs with high responding inhibitors. Mean age was 16.2±9.4 years. Eleven major surgeries in 4 patients, 41 radioisotope synovectomies (RS) and one circumcision classified as minor surgery in 28 patients were performed. Among the major surgery procedures, four were treated with rFVIIa, five with APCC and two with sequential use of APCC and rFVIIa. We used rFVIIa at the dosage of 80-120 μg kg(-1) every 2 h and APCC 100 IU kg(-1) every 12 h for the major surgery. When performing RS, we used rFVIIa in 18 patients with 26 target joints and APCC in 9 patients with 15 target joints. Three consecutive doses of rFVIIa (90 μg kg(-1) ) were used at 2-h intervals followed by additional three doses at 6-h intervals. The initial dose of APCC was 75 IU kg(-1) followed by a second and third dose of 50 IU kg(-1) at 12-h intervals. APCC and rFVIIa demonstrated excellent efficacy in our major and minor surgical interventions [100% (22/22) and 94% (31/33), respectively]. We had only two bleeding complications with rFVIIa. There were no thromboembolic complications. APCC and rFVIIa provide an effective and safe first line haemostatic therapy for inhibitor-positive haemophiliacs, allowing both major and minor surgery to be successfully performed.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey)

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

Rhomboid excision and Limberg flap for managing pilonidal sinus: long-term results in 411 patients

OBJECTIVE

To investigate the results of rhomboid excision and the Limberg flap procedure to treat pilonidal sinus disease.

METHOD

The records of 411 patients with pilonidal sinus disease, who underwent rhomboid excision and Limberg flap procedure, were analysed. All sinus tracks were resected en bloc, and a Limberg flap was prepared from left or right gluteal region. A suction drain was routinely used.

RESULTS

The mean follow-up period was 109.2 +/- 4.5 months (range: 12-183 months). Recurrence occurred in 12 (2.91%) patients who were all male. In 42 (10.21%) patients, anaesthesia or hypoaesthesia of the upper portion of the flap occurred; this was temporary in 25 patients. Twelve (2.91%) patients developed a seroma and 15 (3.64%) a wound infection. The average hospital stay was 3.2 days (range: 1-10 days), and the average time of return to work was 12.4 days (range: 7-18 days). The average time to walk without pain was 13.4 days (range: 10-28 days) and the average time to sitting on the toilet without pain was 16.1 days (range: 12-28 days).

CONCLUSION

The Limberg flap procedure is effective and has a low complication rate, short time for returning to normal activity and short hospitalization.

Comparison of free jejunal graft with gastric pull-up reconstruction after resection of hypopharyngeal and cervical esophageal carcinoma

The purpose of this study is to evaluate the operative outcomes of a gastric pull-up and free jejunal graft reconstruction after resection of hypopharyngeal and cervical esophageal carcinoma. Records of all patients who underwent esophageal resection for carcinoma of the hypopharynx and cervical esophagus were reviewed. Reconstruction after esophagectomy was performed using the gastric pull-up (n = 38) or free jejunal graft (n = 14) techniques. The hypopharynx was the most common primary tumor site for the free jejunal graft group, whereas the gastric pull-up group had lesions more frequently in the cervical esophagus (P < 0.05). Both operative time and blood loss in the gastric pull-up group were significantly longer and excessive than those of the free jejunal graft group (P < 0.05). The graft survival rate was 95% (32/34) in the gastric pull-up group and 93% (13/14) for the free jejunal transfer group. The overall leakage rate was 1.9% (1/52). Three patients died (6%) in the postoperative period. There was no significant difference with regard to operative morbidity and mortality between the gastric pull-up group and free jejunal graft group. In conclusion, both free jejunal graft and gastric pull-up are safe and effective methods for the immediate restoration of alimentary continuity.

Correlation of risk and postoperative assessment methods in wound surveillance

BACKGROUND

Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine practicality of SSI risk assessment methods (Study on the Efficacy of Nosocomial Infection Control [SENIC] and National Nosocomial Infections Surveillance [NNIS]) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure.

MATERIALS AND METHODS

Patients were followed with a prospective data chart from January 1, 2003, to December 31, 2005. Correlation of SENIC and NNIS together with ASEPSIS were performed.

RESULTS

During the study period, 222 SSI occurred. SSIs were determined within the 21-d period after operations. Correlation between SENIC with ASEPSIS (r(s) = 0.47, P < 0.001) was found better than that for NNIS with ASEPSIS (r(s) = 0.41, P < 0.001). Type of operation (emergency versus elective), body mass index, operation class, and American Society of Anesthesiologists scores were found independently predictive factors for SSI.

CONCLUSIONS

This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS.

Effect of levosimendan on right ventricular systolic and diastolic functions in patients with ischaemic heart failure

OBJECTIVES

Levosimendan is a novel positive inotropic calcium sensitiser agent used in acute left heart failure. In this study, the effect of levosimendan on the right ventricular systolic and diastolic functions was evaluated by tissue Doppler comparing them with dobutamine in patients with ischaemic heart failure.

METHODS

Patients having an acute decompensated heart failure with ischaemic cardiomyopathy and left ventricular ejection fraction <40% were included in the study. Before and 24-h after treatment, peak systolic (Sa), peak early (Ea), peak late (Aa) diastolic annular velocities and Ea/Aa ratio from tricuspid lateral annulus by tissue Doppler and systolic pulmonary artery pressure (SPAP) were measured.

RESULTS

Sa, Ea and the Ea/Aa ratio were significantly increased in the levosimendan group whereas SPAP was significantly reduced. In the dobutamine group, no significant differences were observed in the Sa, Ea, Aa and Ea/Aa ratio in spite of a significant reduction in SPAP. Decrease in SPAP was greater in the levosimendan group (p=0.002).

CONCLUSION

Levosimendan improves right ventricular systolic and diastolic functions.