Comparison of serum dynamic thiol/disulphide homeostasis and nitric oxide levels of total intravenous vs inhaled anaesthesia in endoscopic transsphenoidal pituitary surgery.

BACKGROUND: Transsphenoidal pituitary surgery (TPS) is traditionally performed under general anaesthesia. This study aimed to compare the effects of total intravenous anaesthesia (TIVA) or sevoflurane, an inhalation anaesthetic, on thiol-disulphide homeostasis in patients undergoing endoscopic endonasal TPS. METHODS: In this study, 84 patients scheduled for TPS were randomly categorised into two groups: propofol (n = 42, the TIVA group) or sevoflurane (n = 42, the SEVO group). Blood samples were taken before induction of general anaesthesia and at the 30 minutes of postoperation. Serum native thiol and total thiol levels were detected, and the number of dynamic disulphide bonds and related ratios were calculated from these values. Serum nitric oxide (NO) levels were measured using a chemiluminescence method. RESULTS: Although native thiol levels in TIVA postoperation group were markedly increased (P < .05), total thiol levels in SEVO postoperation group were significantly decreased (P < .01). Disulphide levels were declined in both groups (P < .05 for TIVA and P = .001 for SEVO groups). Disulphide/native thiol (P < .05 for both groups) and disulphide/total thiol ratios (P < .05 for TIVA and P < .01 for SEVO groups) were depressed in postoperation groups. We found a marked elevation in native thiol/total thiol ratio in both groups (P < .05 for TIVA and P < .01 for SEVO groups). There was significant augmentation in serum NO levels in the SEVO postoperation group (P < .05). CONCLUSION: These results are the first to show that both TIVA and sevoflurane showed similar antioxidant effect with reduced disulphide levels, but sevoflurane may offer more robust oxidative stress protection and augmented NO production than TIVA during TPS. However, the clinical effect is needed to further investigate.

A novel id-iri score: development and internal validation of the multivariable community acquired sepsis clinical risk prediction model.

We aimed to develop a scoring system for predicting in-hospital mortality of community-acquired (CA) sepsis patients. This was a prospective, observational multicenter study performed to analyze CA sepsis among adult patients through ID-IRI (Infectious Diseases International Research Initiative) at 32 centers in 10 countries between December 1, 2015, and May 15, 2016. After baseline evaluation, we used univariate analysis at the second and logistic regression analysis at the third phase. In this prospective observational study, data of 373 cases with CA sepsis or septic shock were submitted from 32 referral centers in 10 countries. The median age was 68 (51-77) years, and 174 (46,6%) of the patients were females. The median hospitalization time of the patients was 15 (10-21) days. Overall mortality rate due to CA sepsis was 17.7% (n = 66). The possible predictors which have strong correlation and the variables that cause collinearity are acute oliguria, altered consciousness, persistent hypotension, fever, serum creatinine, age, and serum total protein. CAS (%) is a new scoring system and works in accordance with the parameters in third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). The system has yielded successful results in terms of predicting mortality in CA sepsis patients.

Effect of a novel extracorporeal cytokine apheresis method on endocan, copeptin And interleukin-6 levels in sepsis: An observational prospective study.

PURPOSE: There is still an evident need for useful biomarkers and effective therapeutic approaches regarding the challenging management of sepsis. The aim of the study is to evaluate the effect of each Cytosorb hemoadsorption therapy course on blood levels of inflammatory biomarkers of sepsis including endocan, copeptin, interleukin-6, procalcitonin, C-reactive protein. METHODS: There were a total of 178 samples belonging to 34 patients that were diagnosed with sepsis and undergone Cytosorb therapy during the study period. Patient demographics were recorded. Arterial blood samples were obtained both before and and after each Cytosorb course. Levels of copeptin, interleukin-6, procalcitonin, C-reactive protein, erythrocyte sedimentation rate, white blood cell count, and creatinine were assessed both before and after each Cytosorb treatment. RESULTS: Levels of endocan, copeptin, interleukin-6, procalcitonin, C-reactive protein, and erythrocyte sedimentation rate were all significantly decreased after the Cytosorb course when compared with levels before therapy (p = 0.039, 0.001, 0.010, 0.001, 0.002 and 0.001, respectively). There was no significant difference between white blood cell count and creatinine levels before and after Cytosorb courses (p = 0.204 and 0.277). CONCLUSION: Cytosorb courses achieved significant decreases in endocan, copeptin, interleukin-6, procalcitonin and C-reactive protein levels. Decreasing plasma levels of inflammatory cytokines may help alleviate the cytokine storm and may have a role in improve outcomes. Further prospective randomized controlled studies with larger sample size are needed concerning the long-term effects of this decrease in cytokine levels on outcome and mortality.

Letter To The Editor.

We read the letter of F. Rudman et al [Rudman 2017] about our article entitled "Utility of Omentoplasty in Mediastinitis Treatment following Sternotomy" [Colak 2016]. We thank them for their evaluations.

Asymmetric Synthesis of Amino-Bis-Pyrazolone Derivatives via an Organocatalytic Mannich Reaction.

A new series of N-Boc ketimines derived from pyrazolin-5-ones have been used as electrophiles in asymmetric Mannich reactions with pyrazolones. The amino-bis-pyrazolone products are obtained in excellent yields and stereoselectivities by employing a very low loading of 1 mol % of a bifunctional squaramide organocatalyst. Depending on the substitution at position 4 of the pyrazolones, the new protocol allows for the generation of one or two tetrasubstituted stereocenters, including a one-pot version combing the Mannich reaction with a base-mediated halogenation.

Squaramide-Catalyzed Asymmetric aza-Friedel-Crafts/N,O-Acetalization Domino Reactions Between 2-Naphthols and Pyrazolinone Ketimines.

N-Boc ketimines derived from pyrazolin-5-ones were explored to develop an unprecedented domino aza-Friedel-Crafts/N,O-acetalization reaction with 2-naphthols. The novel method requires a catalyst loading of only 0.5 mol % of a bifunctional squaramide catalyst, is scalable to gram amounts, and provides a new series of furanonaphthopyrazolidinone derivatives bearing two vicinal tetra-substituted stereogenic centers in excellent yields (95-98 %) and stereoselectivity (>99:1 d.r. and 97-98 % ee). A different reactivity was observed in the case of 1-naphthols and other electron-rich phenols, which led to the aza-Friedel-Crafts adducts in 70-98 % yield and 47-98 % ee.

Utility of Omentoplasty in Mediastinitis Treatment following Sternotomy.

BACKGROUND: Mediastinal infection is one of the most serious complications that occurs following open-heart surgery by sternotomy. In the present study, omentoplasty was initially and aggressively used to treat the infection and prevent the recurrence caused by bones in cases of mediastinitis following open-heart surgery at our clinic. METHODS: Among the 3656 patients who underwent surgery at our department of cardiovascular surgery between January 1996 and December 2012, omentoplasty as a treatment for mediastinitis was applied to 19 (0.51%) patients (of which 13 were males) following sternotomy. The cases were revised on the 15th day following the first surgery and/or when there was a suspicion of mediastinal infection. The necrotic skin, subcutaneous tissue, and bone tissue were resected, and all the affected sternal tissues were removed until healthy hemorrhagic areas were reached. RESULTS: The average age of the patients was between 49 and 81 years (mean: 65.7 ± 10.5 years). The mean age of the men was 66.08 ± 12.7 years (age range: 49-81 years) and that of the women was 63.2 ± 6.8 years (age range: 55-71 years). The male to female ratio was 2:1, and in both the male and female groups, the approximate age ranged from 55 and 70 years. In the intraoperative cultures received from wound cases, the most common agent of infection was methicillin-resistant coagulase-negative staphylococci. Purulent leaks from eight patients stopped in approximately 4 days. Purulent leaks from the other 11 patients continued until the 6th day, and thus, medical dressing also continued, after which the leaks stopped on the 15th day. The approximate postoperative hospital stay was 32 days (range: 13-63 days). CONCLUSION: Omentoplasty in heart surgery can be considered an effective method when used to control infection and treat secondary poststernotomy mediastinitis.

Diversity of Water Frogs Pelophylax spp. in Turkey: Do Mating Vocalizations Mirror Nominal Taxon Delimitation?

Informed conservation management requires exact knowledge on the species diversity of the taxon group in focus within a geographic area, specifically on the occurrence of endemics. In Turkey, there are three water frog taxa of the genus Pelophylax; one is the widespread P. bedriagae, the other two are geographically restricted to either Thrace (P. ridibundus) or to the Anatolian Lake district (P. caralitanus). The species status of the Beysehir frog P. caralitanus has been questioned since its proposal in 2001. We recorded and analyzed advertisement and release vocalizations at representative populations of Pelophylax taxa to assess the degree of inter-taxon differentiation and the potential for premating isolation. We found that P. bedriagae and P. caralitanus have much more similar vocalizations than both have compared to P. ridibundus. A functional bioacoustic premating barrier between bedriagae and caralitanus in syntopy does not exist according to our study. The low degree of bioacoustic differentiation mirrors earlier genetic, karyological, and morphological findings. We conclude that the Beysehir frogs do not deserve species status and that P. caralitanus should be considered a junior synonym of P. bedriagae. Therefore, the number of endemic anuran species in Turkey decreases to one.

Skeletal description of Pelophylax caralitanus (Anura: Ranidae): Comparison with other ranids.

A description of the skeletal development of ranids is scarce despite being well known in the family Ranidae. Herein, the description of several species of two genera representing the family Ranidae from Turkey is studied wherein the larval and adult cranial skeletons of Pelophylax caralitanus are described and compared with that of the water frog (Pelophylax bedriagae) and mountain frog (Rana macrocnemis). The data are based on cleared and double-stained specimens of 20 Gosner developmental Stages (26-46). The first element to ossify in P. caralitanus is the parasphenoid (Stage 30), followed by the exoccipitals (Stage 34) and prootics (Stage 35). The metamorphic climax commences at Stage 42 during which several modifications to the chondrocranium will unfold. In addition, ranids demonstrate remarkable differences between the water (Pelophylax sp.) and mountain (Rana sp.) frog species: (a) the ventromedial bridge between the corpora of the suprarostral cartilage in the larval upper jaw, (b) the number of processes of the central corpus in the hyobranchial skeleton, and (c) the differences in the ossification time and sequence between Pelophylax sp. and Rana sp. A detailed description of the larval osteological features of P. caralitanus conforms to the current phylogenetic position and provides a model for comparison with other ranids.

Pituitary apoplexy: An emergent and potential life-threatening complication of pituitary adenomas.

BACKGROUND: Pituitary apoplexy is an emergent and potential life-threatening complication of pituitary adenomas if not managed properly. The aim of our study is to present our series of pituitary adenomas and to focus on the clinical, radiological, and surgical characteristics of this rare complication. METHODS: In this study, a total of 143 patients with pituitary adenoma underwent surgical treatment between 2016 and 2018. All patients were operated using endoscopic endonasal transsphenoidal (EET) technique. The data of pituitary apoplexy cases were recorded. Resection rates, hormonal results, and visual outcomes of patients with pituitary apoplexy were evaluated. RESULTS: Of the 143 patients, 8 (5.59%) were presented with the symptoms and radiological findings of pituitary apoplexy. The mean age was 26.75 years, and 4 (50%) of them were male and 4 were female. Pre-operative mean Knosp grading score was 2.1 All of eight patients underwent emergent surgical intervention and total resection was achieved in 75% of patients with apoplexy. Hormone levels were significantly decreased after surgery (p<0.05), except prolactin (p>0.05). Cerebrospinal fluid leakage occurred in one pa-tient. None of the patient with pituitary apoplexy died in our series. CONCLUSION: Pituitary apoplexy is an important complication of pituitary adenomas. Early diagnosis and surgical intervention provide excellent ophthalmological and hormonal outcomes. Emergent EET approach is crucial for patients with ophthalmological findings and macroadenomas.

Standard reference values of the upper body posture in healthy male adults aged between 31 and 40 years in Germany-an observational study.

BACKGROUND: In order to classify and analyze the parameters of upper body posture, a baseline in the form of standard values is demanded. To this date, standard values have only been published for healthy men aged 18-35 and 41-50 years. Data for male adults aged between 31 and 40 years are lacking. METHODS: The postural parameters of 101 symptom-free male volunteers aged 31-40 (35.58 ± 2.88) years were studied. The mean height of the men was 179.89 ± 7.38 cm, with a mean body weight of 86.36 ± 11.58 kg and an average BMI of 26.70 ± 3.35 kg/m2. By means of video rasterstereography, a 3-dimensional scan of the upper back surface was measured in a habitual standing position. The means or medians, confidence interval, tolerance range, and group comparisons and correlations of BMI and physical activity were calculated for all parameters. RESULTS: The habitual standing position was found to be almost symmetrical and the axis aligned in the spine, pelvis, and shoulder region, while the spine position was marginally inclined ventrally. The kyphosis angle of the thoracic spine was greater than the lordosis angle of the lumbar spine. All deviations fell under the measurement error margin of 1 mm/1°. The greater the BMI, the greater was the pelvic and scapular distance. The lower the BMI, the further caudally positioned was the right shoulder. The pelvic and scapular distances were also lower with the increasing athleticism of the participants. CONCLUSION: The upper body posture of men between the ages of 31 and 40 years was found to be almost symmetrical and axis-conforming, with the kyphosis angle, pelvic distance, and shoulder distance enlarging with increasing BMI. Consequently, postural parameters presented in this survey allow for comparisons with other studies, as well as the evaluation of clinical diagnostics and applications.

Retrospective Analysis of 120 Cases of Iatrogenic and Traumatic Peripheral Arterial Pseudoaneurysms.

OBJECTIVE: The pseudoaneurysm formation is the most common complication of arterial catheterization. This study aimed to report our clinical experience with the treatment of iatrogenic and post-traumatic pseudoaneurysms of the peripheral arteries. MATERIALS AND METHODS: One hundred twenty patients, who were treated with the diagnosis of arterial pseudoaneurysm of the lower or upper extremity artery between January 2010 and October 2017, took part in this study. Patients with pseudoaneurysms originated from the anastomotic line of the previous vascular operations were excluded from the study. The diagnosis of pseudoaneurysms was made using ultrasonography and confirmed by magnetic resonance imaging (MRI) or computed tomography (CT) scan when deemed necessary. RESULTS: The most frequent symptom was a pulsatile mass. The mean diameter of pseudoaneurysms was 4.7±1.8 cm (2.3-8 cm). Among 120, 108 patients underwent surgery, and 10 patients required a blood transfusion during the operation. Wound infection was reported in 20 (15.5%) patients as an early postoperative complication. Arterial thrombosis developed in 6 (4.5%) patients, venous thrombosis in 2 (1.7%) patients, and lymphorrhea in 15 (12.5%) patients. A male patient died on the postoperative 25th day, while two patients died on postoperative 10th and 12th days (2.5%). CONCLUSION: Although lesser invasive treatment modalities have been described with some advantages or disadvantages, open surgical repair is the standard method of treatment for iatrogenic and traumatic peripheral arterial pseudoaneurysms.

The Effectiveness of Endovenous Radiofrequency Ablation Application in Varicose Vein Diseases of the Lower Extremity.

We aimed to determine the outcome, complications, and quality of life effects of radiofrequency ablation (RFA) in the treatment of superficial venous insufficiency. A total of 134 extremities from 100 patients were evaluated in this retrospective study performed at the Cardiovascular Surgery Department of Atatürk University Faculty of Medicine. Treatment success was determined by occlusion. The clinical, etiologic, anatomic, and pathophysiologic (CEAP) and venous clinical severity score (VCSS) scores of patients were assessed pre- and postoperatively to evaluate clinical outcome and quality of life. The pain was assessed with the Wong-Baker score. Complications and their frequency were assessed and recorded. Treatment success, as measured by occlusion rate, was 99% percent. Prior to treatment, the CEAP clinical score was C2 (81.0%), while after treatment, it was C0 (54.0%) (p<0.001). The pretreatment median VCSS score was 5 (min-max: 1-9) while the post-treatment median was 1 (min-max: 1-3) (p<0.001). The mean pain score was 1.34; only one patient reported a score of 6 while the minimum score was 1. A total of 15 complications occurred; only one was a major complication (deep vein thrombosis or DVT) while the remaining 14 were minor complications. While longstanding surgical treatments still provide significant success, the RFA technique not only surpasses them in success rate but also in terms of pain, complications, and better patient satisfaction. The results of our study indicate that RFA is an effective and safe option for the treatment of superficial venous insufficiency.

Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study.

OBJECTIVE: To compare spinal anesthesia (SA) with general anesthesia (GA) in gynecologic laparoscopic surgery regarding anesthetic parameters and patient satisfaction together with an assessment of total oxidant, antioxidant levels, and Oxidative Stress index (OSI). MATERIALS AND METHODS: Sixty patients who were planned to undergo gynecologic laparoscopy were randomized into group G (GA) and group S (SA). Demographics, adverse events and anesthetic parameters were recorded before induction, after induction, and at the 5th, 10th, 15th, 30th, 60th, 90th, and 120th minutes. Patients and surgeons completed questionnaires. Total antioxidant capacity (TAC), total oxidant level (TOL), and OSI were measured. RESULTS: There was no difference between the groups in terms of hemodynamic parameters except heart rate at 30th minute and mean arteral pressure at 10th, 15th, 30th, and 60th minute (p<0.05). The postoperative arterial blood pH value was lower in group S (p=0.021). Intraoperative hypotension was lower in group S (p=0.038). There was more intraoperative hypotension in group S when compared with group G (p=0.038). Postoperative analgesic consumption was higher and onset of postoperative pain was shorter in group G (p=0.001 for both). There was no difference between the groups in terms of patient and surgeon satisfaction. There was no difference in terms of TAC, TOL, and OSI between the groups (p=0.862, p=0.940, and p=0.728, respectively). CONCLUSION: SA may become a reliable alternative to GA in gynecologic laparoscopy when hemodynamic and respiratory parameters, patient and surgeon satisfaction, as well as total oxidant, antioxidant levels, and OSI are considered.

The impact of coronary artery bypass grafting surgical technique on stroke in young and elderly patients.

BACKGROUND: Today, the elderly represent a large and rapidly growing segment of society and are being referred in increasing numbers for coronary artery bypass grafting (CABG) surgery. Stroke is a major complication of CABG surgery. The risk of stroke after CABG can be managed successfully, especially in high-risk patients, by choosing an adequate and appropriate surgical technique. METHODS: We evaluated 890 consecutive patients who underwent isolated CABG surgery by the same team between June 2006 and July 2008. The patients were divided by age into 2 groups. Group I consisted of 480 patients <65 years of age, and group II comprised 410 patients >65 years of age. Each group was then divided into 4 subgroups according to the surgical technique used: double-clamp technique (DCT), single-clamp technique (SCT), off-pump, and on-pump cross-clamp off. Preoperative risk factors for stroke and all clinical data were collected for the patients. RESULTS: In group I, 192 (40%) of the patients were female, and 288 (60%) were male. In group II, 170 (41.5%) were female, and 240 (58.5%) were male. Five patients in each group experienced stroke, with an incidence of 1.04% in group I (4 men and 1 woman) and 1.21% in group II (3 men and 2 women). The stroke rates of the 2 age groups were not significantly different (P= .802). Three of the 480 patients in group I died, with only 1 (33.3%) of the deaths related to stroke. In group II, however, 2 (50%) of the 4 deaths were related to stroke. The incidences of stroke-associated mortality in the 2 age groups were not significantly different (P=1.0). CONCLUSION: Although off-pump and on-pump cross-clamp off techniques were performed for some of the patients, DCT and SCT were used for the majority of the patients. We detected no statistically significant difference between these 2 groups of patients in the impact of applying DCT and SCT on the stroke rate. We conclude that this result was due to the different surgical techniques performed on a minority of the patients (82 patients).

Treatment of Pericardial Effusion Through Subxiphoid Tube Pericardiostomy and Computerized Tomography- or Echocardiography - Guided Percutaneous Catheter Drainage Methods.

OBJECTIVE: In this retrospective study, we aimed to observe the efficacy of pericardial effusion (PE) treatments by a survey conducted at the Department of Cardiovascular Surgery, Faculty of Medicine, Atatürk University. METHODS: In order to get comparable results, the patients with PE were divided into three groups - group A, 480 patients who underwent subxiphoid pericardiostomy; group B, 28 patients who underwent computerized tomography (CT)-guided percutaneous catheter drainage; and group C, 45 patients who underwent echocardiography (ECHO)-guided percutaneous catheter drainage. RESULTS: In the three groups of patients, the most important symptom and physical sign were dyspnea and tachycardia, respectively. The most common causes of PE were uremic pericarditis in patients who underwent tube pericardiostomy, postoperative PE in patients who underwent CT-guided percutaneous catheter drainage, and cancer-related PE in patients who underwent ECHO-guided percutaneous catheter drainage. In all the patients, relief of symptoms was achieved after surgical intervention. There was no treatment-related mortality in any group of patients. In patients with tuberculous pericarditis, the rates of recurrent PE and/or constrictive pericarditis progress were 2,9% and 2,2% after tube pericardiostomy and ECHO-guided percutaneous catheter drainage, respectively. CONCLUSION: Currently, there are many methods to treat PE. The correct treatment method for each patient should be selected according to a very careful analysis of the patient's clinical condition as well as the prospective benefit of surgical intervention.

Predictive Value of Mean Platelet Volume in Saphenous Vein Graft Disease.

OBJECTIVE: To determine whether mean platelet volume (MPV), platelet distribution width (PDW), and platelet count could be used as determinants of mortality following coronary artery bypass graft (CABG) surgery and patency of saphenous vein grafts (SVG). METHODS: The records of 128 patients who underwent emergency or elective coronary angiography after CABG surgery, and who died at an early stage were retrospectively reviewed. Patients were divided into three groups as early death, no SVG disease (SVGD), and SVGD group. MPV, PDW, and platelet count were evaluated at different times. RESULTS: MPV was significantly higher in the stenotic group than in the nonstenotic group (9.7±1.8 fl and 8.2±0.9 fl, P<0.05). The postoperative MPV ratio was found to be higher in the stenotic group when compared to the preoperative period (9.6±1.8 fl and 7.8±0.9 fl, P<0.05). MPV values were also found to be higher in patients who died during the early stage than in surviving patients (9.4±1.9 fl and 8.0±1.0 fl, P<0.05). There was no statistically significant difference regarding platelet count and PDW ratios between the early deaths group and surviving patients. An MPV value higher than 10.6 predicted SVGD with 85% sensitivity and 45% specificity; and an MPV higher than 7.9 predicted early death with 80% sensitivity and 68% specificity were observed. CONCLUSION: MPV may be a useful indicator for the prediction of SVGD and mortality following CABG surgery.

Spontaneous Early Resolution of an Iatrogenic Type A Aortic Dissection Following Coronary Angiography.

A 74-year-old man was admitted with the diagnosis of non-ST-elevation myocardial infarction. During right coronary angiography, a coronary artery dissection extending into the proximal ascending aorta was noticed without hemodynamic compromise. Immediate computed tomography angiography showed no evidence of dissection in the ascending aorta. The patient remained hemodynamically stable with medical therapy alone. This case report highlights the importance of medical therapy in patients with uncomplicated iatrogenic aortic dissection.