Evaluation of the correlation of neutrophil/lymphocyte ratio with prognostic classification systems in papillary thyroid carcinoma patients.

We aimed to evaluate the use of cost-effective NLR (Neutrophil Lymphocyte Ratio) in determining the prognosis and recurrence risk of thyroid papillary carcinoma patients. This retrospective, cross-sectional and single-center study was carried out in the Department of General Surgery, Istanbul Gaziosmanpasa Training and Research Hospital. Between 2018 and 2021, who were diagnosed with papillary thyroid cancer and underwent total thyroidectomy, and patients who underwent total thyroidectomy due to multinodular goiter were analyzed. For patients in the malignancy group, the NLR cutoff value was determined as 1.73, the sensitivity was calculated as 51.77% and the specificity as 86.15%. NLR in the malignant group was found to be 9.5 times higher than the NLR in the control group (Odds Ratio: 9.5). A statistically significant difference was found between NLR and papillary thyroid carcinoma prognostic classification systems (AJCC/TNM, AMES, and MACIS). NLR medians differ according to ATA recurrence risk classification (P = .020). According to the results we obtained in our study, we believe that cost-effective NLR can be a useful indicator in terms of predicting malignancy in a patient with thyroid nodule and in determining the prognosis and risk of recurrence in patients with thyroid papillary carcinoma.

Correlation between breast and axillary pathologic complete response after neoadjuvant chemotherapy in breast cancer.

AIM: The aim of this study was to evaluate the correlation of the pathological response in breast tissue and the axilla of patients with breast cancer who underwent surgery following neoadjuvant chemotherapy. METHOD: This retrospective cohort study included patients with T1-4, N1-3, M0 breast cancer who underwent surgery following neoadjuvant chemotherapy at Gaziosmanpasa Training and Research Hospital between 2013 and 2022. The response of the breast tissue to chemotherapy was evaluated with the Miller-Payne grading system, and the response of the axillary lymph nodes to chemotherapy was evaluated with the Pinder grading system. The patients were grouped histopathologically as luminal A, luminal B, Her-2 enriched, or triple negative breast cancer (TNBC). RESULTS: The study was completed with 140 patients. Pathological complete response (pCR) was seen in the breast in 40 patients and in the axilla in 34. Of the patients with pCR in the breast, pCR was also determined in the axilla in 45%. In the patients with pCR in both the breast and axilla, Her-2 enriched subtype, estrogen receptor negativity, progesterone receptor negativity, Her-2 neu positivity, and Ki-67 level >25% were determined to be effective (p<0.05). Her-2 neu positivity was evaluated as statistically significant in the development of pCR in both the breast and axilla (OR: 4.06, 95% CI:1.2-13.6, p=0.023). CONCLUSION: The development of pCR in the breast, especially in the Her-2 enriched subgroup, can be accepted as a predictive factor for the evaluation of axillary response in patients with breast cancer. The least compatibility was seen in the luminal A subgroup. KEY WORDS: Breast cancer, Miller-Payne, Neoadjuvant chemotherapy Pathological complete response, Pinder.

The effect of education given to Turkish adolescents with Familial Mediterranean fever on anxiety, depression, and quality of life.

To examine the effects of individual education given to Turkish adolescents with Familial Mediterranean fever (FMF) on anxiety, depression, and quality of life. The randomized controlled experimental study was performed on 70 adolescents aged 12-18 years who were diagnosed as having FMF between October 2021 and April 2022 in Turkey. The disease management education was offered individually to adolescents in the intervention group with a booklet entitled "FMF is under my control;" no intervention was applied to adolescents in the control group. The training booklet was prepared by the researchers in a multidisciplinary team and was finalized by taking expert opinions. In the data collection process, a personal information form, the State-Trait Anxiety Inventory for Children (STAI-CH), the children's depression inventory (CDI), and the Pediatric Quality of Life Inventory (PedsQL) were used. After applying the scales specified in the pretest, individual training was given and the posttest was performed 2 months later using the same scales. After the education, there was a statistically significant decrease in the mean CDI score of the intervention group (p < 0.05), whereas there were statistically significant increases in mean scores obtained on PedsQL and its sub-scales (p < 0.05). However, the decrease in the mean STAI-CH score of the intervention group was not statistically significant (p > 0.05). There was no statistically significant difference in the mean STAI-CH, CDI, and PedsQL scores of the control group after the education (p > 0.05).  Conclusion: The effectiveness of the individual education program for adolescents with FMF in improving quality of life and reducing levels of depression within the scope of disease management has been confirmed. It is recommended that all health professionals working with children with FMF regularly provide individual or group-planned education programs. What is Known: • The unpredictability of FMF attacks has a very negative effect on adolescents. • Individual education programs on FMF focus on children with a holistic approach. What is New: • To the best of our knowledge, this study is the first study to evaluate disease management education given to adolescents with FMF. • This is a pioneering study of the use of nurses in the education of adolescents with FMF and in fulfilling their educational roles.

A Delayed Presentation of Arginase Deficiency Presenting with Status Epilepticus.

Arginase 1(ARG1) deficiency is a rare disorder of the urea cycle. The presentation is usually late, leading to loss of intellectual milestones, spasticity and liver involvement. Hyperammonemic crises are rarely encountered. We herein present a case of a 16-year immigrant girl of Syrian origin who was evaluated for acute onset of fever, vomiting, and seizures. Laboratory analyses showed slightly elevated lactate, creatine kinase, and coagulation parameters. Ammonium levels were also moderately increased. On 5th day of admission, she went into an encephalopathic state. Blood amino acid analysis showed highly elevated arginine levels. An increased level of orotic acid was found in urine organic acid analysis. Molecular genetic analysis of ARG1 gene showed a novel homozygous mutation. Although the presentation of ARG1 deficiency is usually chronic in the majority of patients, an acute crisis of encephalopathy due to hyperammonemia may occur and delayed diagnosis may lead to irreversible neurological damage. Key Words: Urea cycle disorder, Hyperammonemia, Argininemia, Encephalopathy.

Grouping of Ankyloglossia According to Coryllos Anatomical Classification and Follow-Up Results for Breastfeeding: Single-Center, Cross-Sectional Study.

Ankyloglossia is a condition of limited tongue mobility caused by a short lingual frenulum. The diagnosis and treatment of ankyloglossia are still controversial. The main clinical problems encountered during breastfeeding are difficulty in sucking and its clinical reflections. This study aims to evaluate the infant population born with ankyloglossia and to determine the results of frenotomy. We conducted an observational, cross-sectional study among infants born in a tertiary hospital. We included all infants born between 1 January and 30 June 2022. The neonatal follow-up protocol for ankyloglossia was determined before the defined dates, and data were recorded during the screening period. The recorded data were retrospectively collected from the files. Within six months, 705 infants were born. Due to additional problems and other conditions that prevent breastfeeding, evaluable data of 207 (29.3%) infants could not be provided. Of the remaining 498 infants, 234 (33.2%) had ankyloglossia. While none of the infants without ankyloglossia had a breastfeeding problem after appropriate training, 28.6% of the ankyloglossia group had a breastfeeding problem (p < 0.001). The need for frenotomy differed significantly between Coryllos groups (p < 0.001). Breastfeeding was unsuccessful before frenotomy in 12 Coryllos type-1 patients, and all had difficulty in sucking. Frenotomy was performed within the three-month follow-up period in all patients with complaints of inability to firmly grasp the breast, nipple slipping from the mouth, and nipple biting during the first 24 h. In terms of breastfeeding problems, regardless of the anatomical typology, frenotomy can be performed safely in early life with successful results. If deficiencies or difficulties in breastfeeding are noticed in ankyloglossia patients even at the first control, frenotomy should be recommended in clinical conditions.

The effect of the Covid 19 pandemic on the number of patients treated for acute and complex acute appendicitis.

AIM: The aim of this study was to compare the increase in the number of complicated cases in patients who underwent surgery for acute appendicitis during the COVID-19 pandemic and the previous year. MATERIAL AND METHODS: A retrospective examination was made of the files of patients who presented at the Emergency Department and were diagnosed with acute appendicitis and underwent surgery within 24 hours or were followed up between 11 March and 1 June 2020 during the COVID-19 pandemic, and in the same period in the previous year. The patients in the pandemic period were named the pandemic group (PG) and the patients from the previous year, the control group (CG). The definition of complicated appendicitis included peri-appendicular abscess and perforated appendix. RESULTS: The number of patients in the PG was 38.33% lower than in the CG. The duration of symptoms was 2 days in the PG and 1 day in the CG, and the difference was statistically significant (p=0.001). The mean neutrophil count was determined to be higher in the PG than in the CG (p=0.018). The rate of perforated appendix was determined to be 10.9 higher in the PG than in the CG. CONCLUSION: The number of patients presenting at the Emergency Department reduced during the pandemic, especially during periods of lockdown, and it was seen that fewer but more complicated patients presented at our centre. KEY WORDS: Acute appendicitis, COVID-19, Perforation.

COVID-19 History Increases the Anxiety of Mothers with Children in Intensive Care during the Pandemic in Turkey.

This study aimed to examine the mental status of mothers whose children were hospitalized during the COVID-19 pandemic, especially in places where risk factors are higher such as pediatric intensive care units, and to contribute to the development of psychological health policies, especially for these high-risk groups in epidemic situations. METHOD: This descriptive cross-sectional study was conducted between January 2021 and July 2021. The population of the study was mothers whose children were hospitalized in the pediatric intensive care unit during the study period. Data collection was carried out via a face-to-face interview method by experienced nurses working in pediatric clinics using a sociodemographic data form, the Beck Anxiety Inventory, the Beck Depression Inventory, the Fear of COVID-19 Inventory, and the Coronavirus Anxiety Inventory. RESULTS: The median age of the participants was 33 (min: 21, max: 50). The Beck Anxiety score was affected by the child's diagnosis, location, and history of COVID-19 (* P = 0.011, ** P = 0.018, and *** P = 0.002, respectively). Similarly, the Beck Depression score was affected by the child's diagnosis and history of COVID-19 in a relative (* P = 0.034 and ** P = 0.037, respectively). The Coronavirus Anxiety score was affected by a history of COVID-19 in a relative and work status (* P = 0.040 and ** P = 0.005, respectively), while the Fear of COVID-19 score was not significantly affected by any variable. In a logistic regression model, previous COVID-19 experience was independently associated with anxiety; a history of COVID-19 increased the risk of developing anxiety by approximately 15 times (odds ratio: 14.915, 95% CI: 2.075-107.192). CONCLUSION: When children of mothers with a history of COVID-19 are hospitalized, special attention should be given to their mothers concerning psychological support and assistance.

The Relationship Between Lipid Profile and Non-alcoholic Fatty Liver Disease in Children and Adolescents with Obesity.

OBJECTIVE: To determine the relationship between lipid profile and non-alcoholic fatty liver disease in obese children and adolescents. STUDY DESIGN: A comparative cross-sectional study. PLACE AND DURATION OF STUDY: Department of Pediatrics, Kastamonu Training and Research Hospital, Turkey, from March 2018 to April 2021. METHODOLOGY: Clinical, laboratory and ultrasound findings of 290 children and adolescents diagnosed with obesity were analysed. Children and adolescents were divided into two groups as those who were diagnosed with NAFLD by ultrasonography (USG) and those who did not were diagnosed. Two groups were compared in terms of clinical and biochemical findings. RESULTS: The body mass index (BMI), bodyweight for height (BWH), insulin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), free T4, total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), hemoglobin A1c (HbA1c) and HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) levels were found to be significantly higher (p<0.05) in the children and adolescents with NAFLD In obese children and adolescents; there was a significant correlation between the increase in TC, LDL-C and TG levels in the blood and the development of NAFLD (p<0.05). Blood ALT level ≥37 U/L in obese boys and ≥23.5 U/L in obese girls was found to be a strong diagnostic biomarker in determining the presence of NAFLD. CONCLUSION: In obese children and adolescents, there was a significant relationship between the increase in BWH and blood lipid levels, insulin resistance and the development of NAFLD. ALT had high specificity and sensitivity to predict non-alcoholic fatty liver disease. KEY WORDS: Obesity, Children, Hepatosteatoz.

The association of various obstetric and perinatal factors with retinopathy of prematurity.

PURPOSE: To analyze the effects of various obstetric and perinatal factors on the severity of retinopathy of prematurity (ROP). METHODS: Infants born at ≤ 32 weeks of gestation, with less than 1500 g gestational weight and having at least stage 1 ROP, were reviewed. Group1A included treatment-requiring ROP (TR-ROP), and group 2A included the remaining patients not requiring treatment. Group 1B included stage 3 ROP cases, and group 2B included the remaining stage 2 or 1 ROP cases. Group 1C included cases with zone III disease, and group 2C the remaining. The control group (group C) was composed of premature infants without ROP. The multiple comparisons were made among groups 1A, 2A, and C; 1B, 2B, and C; 1C, 2C, and C. RESULTS: A total of 311 infants were included. Group 1A included 34 cases, group 1B 60, group 1C 51, and group C 98. Antenatal steroid administration, gestational diabetes mellitus (GDM), gestational weight (GW), gestational age (GA), sepsis, continuous positive airway pressure (CPAP) time, and invasive mechanical ventilation (MV) time were associated with TR-ROP, stage 3 ROP, and zone I, and II disease (p < 0.05). Pregestational diabetes mellitus (DM) was only associated with stage 3 ROP (p = 0.031). Gestational hypertension was only associated with zone I and II disease (p = 0.034). The use of low-molecular-weight heparin may be protective against stage 3 disease (p = 0.031). CONCLUSION: Antenatal steroid administration, GDM, GW, GA, sepsis, CPAP time, and invasive MV time were risk factors for TR-ROP and stage 3 ROP, while pregestational DM was only associated with stage 3 ROP.

The use of immature granulocyte and other complete blood count parameters in the diagnosis of transient tachypnea of the newborn.

BACKGROUND: Although Transient tachypnea of the newborn (TTN) is one of the most common causes of respiratory distress in the newborn period, there is no laboratory parameter used to diagnose it. Immatur granulocyte (IG) measurement is accepted as a useful indicator that can be used in early detection of many infectious conditions, especially neonatal sepsis. In this study, it was aimed to determine if IG and other complete blood count (CBC) parameters could be used as laboratory findings supporting TTN diagnosis. MATERIALS AND METHODS: This study, which was retrospectively planned, was conducted in the neonatal intensive care unit (NICU) a public hospital between January 1, 2019 and January 31, 2021. Randomly selected 50 infants, hospitalized with the diagnosis of TTN, constituted the patient group of the study. 50 infants hospitalized with the diagnosis of hyperbilirubinemia and did not have any additional problems accepted as the control group. IG and other CBC parameters of infants in the patient and control groups were compared in the study. RESULTS: There was no significant difference between the patient and control groups in terms of demographic data and types of delivery (p > 0.05). The rate of delivery by elective cesarean section (C/S) was significantly higher than the rate of normal spontaneous vaginal (NSV) delivery in the patient group (p < 0.001). The IG number and percentage, WBC (white blood cell) count, RDW (red cell distribution width), number and percentage of NRBC (nucleated red blood cell), neutrophil and lymphocyte ratio, count and percentage of basophil and PLR (platelet/lymphocyte ratio) of the patient group was significantly higher than the control group (p < 0.05). CONCLUSION: According to the findings obtained in the study, it was concluded that IG and other CBC parameters may be used to support clinical and imaging findings to diagnose transient tachypnea of the newborn.

High Neutrophil/Lymphocyte Ratios in Symptomatic Pediatric COVID-19 Patients.

OBJECTIVE: To investigate the symptoms and laboratory results of children hospitalised with the diagnosis of COVID-19, aiming to reveal the characteristics of symptomatic cases. STUDY DESIGN: A descriptive cross-sectional study. PLACE AND DURATION OF STUDY: Department of Pediatrics, Kastamonu Training and Research Hospital, Kastamonu, Turkey from March to December 2020. METHODOLOGY: Seventy-nine children, hospitalised with the diagnosis of COVID-19, were included in the study and were divided into two groups as symptomatic and asymptomatic. The demographic data, laboratory results and clinics of the patients of the two groups were compared. RESULTS: The mean age of participants was 10.43 ± 5.91 (0-17) years, and 57% (n=45) of them were girls. Five patients in the symptomatic group had comorbidities (2 allergic asthma,  cerebral palsy, type-1 diabetes mellitus and anorexia nervosa). The most common symptom was fever (36.7%, n=29). It was noteworthy that everyone with an NLR >3.13 (high-NLR) was symptomatic. Significantly more patients in the high-NLR group were symptomatic compared with the low-NLR group (p=0.005). On the other hand, symptomatic children had significantly higher levels of C-reactive protein (2.8 (IQR: 1.2-10.0) mg/L vs. 1.4 (IQR: 0.4-2.0) mg/L, p=0.011); and procalcitonin (0.05 (IQR: 0.02-0.10) ng/mL vs. 0.01 (IQR: 0.00-0.03) ng/mL, p<0.001) than those without symptoms. One of the children with cerebral palsy died from pneumonia during the study. CONCLUSION: C-reactive protein, procalcitonin and NLR levels were found to be significantly higher in symptomatic children. NLR can be suggested as a potential marker associated with disease severity in COVID-19 patients, which needs to be supported by other studies. Key Words: COVID-19, Children, Neutrophil / lymphocyte ratio, C-reactive protein, Procalcitonin.

The Effect of Intraarticular Insulin on Chondral Defect Repair.

OBJECTIVE: The aim of this study is to evaluate the effects of intraarticular insulin on the treatment of chondral defects. DESIGN: Twenty-four mature New Zealand rabbits were randomly divided into 3 groups as control (Group 1), microfracture (Group 2), and microfracture and insulin (Group 3). Four-millimeter full-thickness cartilage defects were created to the weight-bearing surface on the medial femoral condyles of each rabbit. In the first group, any additional interventions were not performed. Microfracture was performed on defects in groups 2 and 3. Additionally, 10 IU of insulin glargine was administrated into the knee joints of the third group. Three months after surgery, the knee joints were harvested and cartilage quality was assessed according to Wakitani and ICRS (International Cartilage Repair Society) scores histopathologically. Insulin injections were performed into the knees of 2 additional rabbits without creating a cartilage defect to evaluate the potential adverse effects of insulin on healthy cartilage (Group 4). RESULTS: The total ICRS and Wakitani scores of the insulin group were found to be significantly lower than the microfracture group but similar to the control group. No negative effects of insulin on healthy cartilage were detected. Intraarticular insulin after surgery has led to a statistically significant decrease in systemic blood sugar levels whereas the decrease observed after administration to intact tissues was not statistically significant. CONCLUSIONS: Insulin had a negative influence on the quality of cartilage regeneration and had no effect on healthy cartilage. Intraarticular insulin administration does not cause significant systemic effects in intact tissue.

Comparison of the Sleep Problems Among Adolescents Who Attempted Suicide and Healthy Adolescents.

The aim of this study was to compare sleep problems among adolescents who attempted suicide and healthy adolescents who never attempted suicide. Adolescents who attempted suicide (study group, n = 103) and healthy adolescents (control group, n = 59) completed a questionnaire prepared by researchers including demographic factors. In addition, the Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS) were administered to both groups. The median age was 16 years and 73% were girls, in both groups. The study group had lower rate of attending to school (88.3% vs. 100%; p = 0.001), academic achievement (45.7% vs. 83.1%; p = 0.001), higher rate of smoking (37.9% vs. 13.8%; p = 0.001), socializing problems (31.1% vs. 3.4%; p = 0.001), and appetite changes (57.3% vs. 39.7%; p = 0.032) than controls. The rate of those with PSQI scores 6 or higher was 53.4% in the attempted suicide group and 37.3% in the control group (p = 0.048). Adolescents, classified as sleepy according to the ESS, did not differ significantly between the groups (p = 0.214). Adolescents who attempted suicide had poor sleep quality. It is crucial to examine the kinds of sleep problems adolescents who have attempted suicide have experienced. Among adolescents attending outpatient clinics with poor sleep quality, PSQI can be a useful screening tool. Those with high scores should be evaluated for suicide risk.

A rare chromosomal disorder in a newborn: Trisomy 3q.

Kahvecioglu D, Tatar-Aksoy H, Yildiz E, Bakir A, Alioglu B. A rare chromosomal disorder in a newborn: Trisomy 3q. Turk J Pediatr 2019; 61: 271-274. Trisomy 3q is a rare chromosomal disorder that leads to multiple congenital abnormalities. We hereby present a patient with chromosomal karyotype 46, XY, dup (3)(q23-29), which can be classified as pure 3q duplication and has thin sclera and iris dysgenesis, anterior and posterior segment dysgenesis besides the previously identified specific facial features. To the best of our knowledge only 12 cases have been reported with pure duplication in the literature. Our case is the 13th one reported and has noval findings concerning eye involvement. The ocular manifestations of the 3q duplication syndrome provide additional evidence of the involvement of genes which are responsible for eye development in this chromosomal region.

Primary cavitary tuberculosis in an infant.

In infants, tuberculosis usually progresses as hilar lymphadenopathy and parenchyma changes in lungs; associating cavitary lesions are rare. A six-month-old infant was admitted to our hospital with fever. Physical examination revealed decreased breathe sounds in the right lung. Chest radiograph showed pneumonic infiltration in the right middle lobe. The patient was hospitalized with a diagnosis of lobar pneumonia and antibiotic treatment was started. On the sixth day, because no clinical improvement was observed in the patient, computerized thorax tomography was performed. Tomography revealed multiple lymphadenopathies in the right hilar pretracheal and subcarinal region. The patient's tuberculin and acid-resistant bacteria tests were negative; however, the quantiferon test was positive. Family screening revealed active tuberculosis in the mother. Tuberculosis in infants may present with unusual clinical and radiologic findings, and primary cavitary tuberculosis can also be seen in this age group.

Two-year experience with cell salvage in total hip arthroplasty / Dois anos de experiência com recuperação intraoperatória de sangue em artroplastia total do quadril

ABSTRACT BACKGROUND AND OBJECTIVE: The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS: We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS: In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53 ± 111.88 mL) than that in the control group (170.14 ± 116.79 mL; p < 0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37 ± 193.33 mL) than the control group (152.22 ± 208.37 mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n = 29; 43.2%) was also significantly lower than control group (n = 56; 73.6%; p < 0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION: Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible.

RESUMO JUSTIFICATIVA E OBJETIVO: Determinar a eficácia do sistema de recuperação intraoperatória de sangue em artroplastia total de quadril e se o sistema de recuperação intraoperatória de sangue pode reduzir a necessidade de transfusão de sangue alogênico em pacientes submetidos à artroplastia total de quadril. MÉTODOS: Análise retrospectiva dos prontuários de pacientes submetidos a cirurgias de artroplastia de quadril entre 2010 e 2012 em um hospital universitário. Foram inscritos no estudo 181 pacientes submetidos à artroplastia. RESULTADOS: A média da taxa de transfusão de sangue alogênico no período perioperatório foi significativamente inferior no grupo de recuperação intraoperatória de sangue (92,53 ± 111,88 mL) do que no grupo controle (170,14 ± 116,79 mL; p < 0,001). Quando as médias das taxas de transfusão no pós-operatório foram comparadas, o grupo de recuperação intraoperatória de sangue apresentou valores inferiores (125,37 ± 193,33 mL) aos do grupo controle (152,22 ± 208,37 mL), embora a diferença não tenha sido estatisticamente significativa. O número de pacientes que recebeu transfusão de sangue alogênico no grupo RC (n = 29; 43,2%) também foi significativamente inferior ao do grupo controle (n = 56; 73,6%; p < 0,05). Na análise de regressão logística, a quantidade de transfusão no período perioperatório, a razão de chance (OR) -4,257 (95% CI -0,502-0,184) e o tempo cirúrgico OR: 2,720 (IC 95% 0,001-0,004) foram fatores de risco independentes para o uso de sistema de recuperação intraoperatória de sangue. CONCLUSÃO: A recuperação intraoperatória de sangue é uma estratégia eficaz para reduzir a necessidade de transfusão de sangue alogênico no período perioperatório, que auxilia no manejo sanguíneo durante as intervenções. Portanto, recomendamos o sistema de recuperação intraoperatória de sangue para uso em artroplastia total de quadril para diminuir a necessidade de transfusão de sangue alogênico, quando possível.

Two-year experience with cell salvage in total hip arthroplasty.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS: We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS: In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53±111.88mL) than that in the control group (170.14±116.79mL; p<0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37±193.33mL) than the control group (152.22±208.37mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n=29; 43.2%) was also significantly lower than control group (n=56; 73.6%; p<0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION: Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible.

[Two-year experience with cell salvage in total hip arthroplasty]. / Dois anos de experiência com recuperação intraoperatória de sangue em artroplastia total do quadril.

BACKGROUND AND OBJECTIVE: The aim of this study was to determine the efficacy of the cell salvage system in total hip arthroplasty surgeries and whether the cell salvage system can reduce the allogeneic blood transfusion requirement in total hip arthroplasty patients. METHODS: We reviewed retrospectively the medical records of patients who underwent hip arthroplasty surgeries between 2010 and 2012 in a university hospital. A total of 181 arthroplasty patients were enrolled in our study. RESULTS: In the cell salvage group, the mean perioperative rate of allogeneic blood transfusion was significantly lower (92.53±111.88mL) than that in the control group (170.14±116.79mL; p<0.001). When the mean postoperative transfusion rates were compared, the cell salvage group had lower values (125.37±193.33mL) than the control group (152.22±208.37mL), although the difference was not statistically significant. The number of patients receiving allogeneic blood transfusion in the CS group (n=29; 43.2%) was also significantly lower than control group (n=56; 73.6%; p<0.05). In the logistic regression analysis, perioperative amount of transfusion, odds ratio (OR) -4.257 (95% CI -0.502 to 0.184) and operation time, OR: 2.720 (95% CI 0.001-0.004) were independent risk factors for the usage of cell salvage system. CONCLUSION: Cell salvage is an effective strategy for reducing the need for allogeneic blood transfusion in the perioperative setting; it provides support to patient blood management interventions. Thus, we recommend the cell salvage system for use in total hip arthroplasty surgeries to reduce the need for allogeneic blood transfusion, if possible.

Hairy Cell Leukemia Presenting with Isolated Skeletal Involvement Successfully Treated by Radiation Therapy and Cladribine: A Case Report and Review of the Literature.

We describe an unusual case of hairy cell leukemia (HCL) in a 55-year-old male presenting with isolated skeletal disease as the initial manifestation without abnormal peripheral blood counts, bone marrow involvement, or splenomegaly. To the best of our knowledge, there have been only two previous reports of a similar case. The patient presented with pain in the right femur. Anteroposterior radiographs of both femurs revealed mixed lytic-sclerotic lesions. PET scan showed multiple metastatic lesions on axial skeleton, pelvis, and both femurs. Histopathological examination of the bone biopsy revealed an infiltrate of HCL. Localized radiation therapy to both proximal femurs and subsequently 4 weeks later, a 7-day course of 0.1 mg/kg/day cladribine provided complete remission with relief of symptoms and resolution of bone lesions. We addressed the manifestations and management of HCL patients with skeletal involvement.