Evaluation of the effects of intraarticular glucocorticoid injections on blood glucose levels in diabetes mellitus and nondiabetes mellitus patients with adhesive capsulitis of the shoulder.

AIMS: The aim of this study was to assess the effect of intraarticular glucocorticoid injections on blood glucose levels in diabetes mellitus (DM) and non-DM patients with adhesive capsulitis of the shoulder and investigate the risk factors for hyperglycemia. METHODS: The study included 40 DM and 38 non-DM patients. The DM status, HbA1c levels, baseline fasting blood glucose (FBG) level, and post-injection 1-, 7-, 15-, and 21-day FBG levels were evaluated retrospectively. RESULTS: The FBG levels were significantly higher 1 and 7 day after the glucocorticoid injection as compared with the baseline levels (P = 0.001 and <0.001, respectively). The increase was greatest in DM patients and then returned to baseline levels 15-day post-injection. In terms of the mean difference in post-injection and baseline FBG levels, the increase on day 1 was statistically significantly greater in the DM group as compared with that in the non-DM group (P = 0.01). Linear regression model showed that only the baseline FBG level predicted the glucose level 1-day post-treatment (ß = 0.839, P < 0.01). CONCLUSION: Intraarticular glucocorticoid injections can safely be administered as a treatment for adhesive capsulitis of the shoulder in patients with well-controlled DM. Baseline FBG levels may predict peak blood glucose levels in patients with well-controlled DM. We recommend that DM patients with adhesive capsulitis should undergo frequent monitoring of blood glucose in the 2 week following intraarticular glucocorticoid injection treatment.

Prevalence study for postoperative nausea vomiting: A training hospital example.

BACKGROUND: Simplified risk models, such as the Apfel score, have been developed to calculate the risk of postoperative nausea-vomiting (PONV) for adult patients. In the absence of any risk factors, PONV risk is assumed to be 10%. While the presence of one of the four risk factors determined as female gender, non-smoking, PONV/car sickness history, and postoperative opioid use is associated with 20% risk for PONV, the risk increases by 20% with the addition of each risk factor, and reaches to 80% if four factors are present. AIM: : Our aim in this study is to investigate the prevalence of PONV, and whether the scoring systems used for nausea-vomiting in the literature are still valid. PATIENTS AND METHODS: Five groups of patients were included in the study with an Apfel score of 0, 1, 2, 3, 4. Each case was taken to the recovery room at the end of the operation. They were observed whether had nausea-vomiting was recorded according to the Abramowitz emesis score. RESULTS: While the PONV risk for women is 24.637 times higher than men, the PONV risk of those who had gynecological surgery is 6.27 times higher than that of the other type of surgery. Those who had urological surgery are 0.345 times less than the other type of surgery. Those who had lower abdominal surgery had a risk of PONV of 4.56 times higher than the others. As the duration of the case increases, the risk of PONV increases 1.01 times (P values P < 0.001, P < 0.001, P < 0.001, P = 0.048, P < 0.001, respectively). CONCLUSION: As a result, our PONV prevalence is considerably lower than the frequency rates mentioned in the literature. PONV scoring systems need long-term studies with larger populations to be updated.

Assesment of correlation between bispectral index and four common sedation scales used in mechanically ventilated patients in ICU.

PURPOSE: The aim of this study was to compare the correlation between bispectral index (BIS) monitor and four commonly used subjective clinical scales (Ramsay Sedation Scale (RSS), Richmond Agitation Sedation Scale (RASS), Sedation Agitation Scale, Adaptation to Intensive Care Environment scale) in mechanically ventilated patients in intensive care unit (ICU). In addition, comparison of responsiveness of the clinical scales in respect to BIS changes is another goal of this study. MATERIALS AND METHODS: Mechanically ventilated thirty patients who required sedation for any reason were enrolled to study. Patients who needed neuromuscular blockade, patients with known hearing and visual problems, neurological diseases, anoxic encephalopathy, mental retardation and who developed hemodynamic instability (mean arterial pressure below 60 mmHg) and hypoxemia (sPO2 below 90%) during follow-up were excluded. Starting before the initiation of sedation, first BIS scores then clinical sedation scales were evaluated. This procedure is repeated every 2 hours for 24 hours. RESULTS: All of the four clinical scales were significantly correlated with BIS. BIS and clinical scale values, except Adaptation to Intensive Care Environment scale, showed significant changes compared to baseline after the initiation of sedation. Ramsay and Richmond scales showed the highest correlation with BIS (respectively, r = 0.758, r = 0.750). Adaptation to Intensive Care Environment revealed the lowest correlation (r = 0.565). CONCLUSIONS: All of the scales were significantly correlated with BIS. RSS and RASS showed higher correlation than other scales. As a conclusion: RSS and RASS can be used for monitoring the depth of sedation in mechanically ventilated patients in ICU.

Relationship between sleep quality and the psychological status of patients hospitalised with COVID-19.

AIM: We explored the sleep quality of patients who required mental health and clinical interventions in our hospital after being diagnosed with COVID-19. METHOD: We enrolled 189 patients hospitalised with COVID-19 in April and May of 2020, of whom 78 were female and 111 male. We evaluated sleep quality and related factors in terms of demographic characteristics, the duration of hospitalisation, and Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety-Depression Scale scores. RESULTS: All participants were divided into two groups according to PSQI score: n = 102 (54%) patients with PSQI scores ≥5 and n = 87 (46%) patients with PSQI scores <5. No significant between-group difference was evident in terms of age, gender, marital status, educational level, or chronic disease history. The duration of hospitalisation (p = 0.002) and the depression rate (p = 0.010) were higher in the group exhibiting poor sleep quality (PSQI score ≥5). CONCLUSION: The duration of hospitalisation was longer in patients experiencing poor sleep quality. Therefore, improvement in sleep quality will reduce the length of hospital and intensive care unit stays.

The effects of rehabilitation on the outcomes of surgically treated acute and chronic thumb metacarpophalangeal ulnar collateral ligament ruptures.

The aim of this study was to compare the outcome of patients who received rehabilitation to those who did not receive it after surgical treatment of acute and chronic tears of the ulnar collateral ligament (UCL) of the thumb. Forty-two patients with an acute UCL injury repaired with two soft mini-anchors to bone insertion sites, and 40 patients with a chronic UCL injury reconstructed with autografts were involved in this study. The patients were divided two subgroups depending on rehabilitation. Patient characteristics were not significantly different between the two groups and subgroups. Range of motion, grip strength and pinch strength were evaluated. There was no significant change in terms of grip and pinch strength in patients with acute UCL injury who received rehabilitation after surgical treatment. However, significantly better results were achieved in flexion, extension, ulnar and radial deviation. There was no significant change in pinch strength in patients with chronic UCL reconstructions, but significantly better results were achieved in grip strength, flexion, extension, ulnar and radial deviation. A rigid MCP splint in patients with acute and chronic UCL tears is effective in preventing early ligament insufficiency.

Assessment of the use of dredged marine materials in sanitary landfills: A case study from the Marmara sea.

Worldwide production of large volumes of dredged materials (DMs) has become a pressing environmental problem. In Turkey, the government has yet to develop management strategies that successfully prevent or minimize dumping into the Marmara Sea. One potential solution is the utilization of the DMs as a source of material for earthworks, particularly in sanitary landfills in Istanbul and Kocaeli. The most economically developed cities in Turkey, they were evaluated in terms of potential environmental impacts and regulatory compliance. Five ports/harbors representing specific portions of the study area and different industrial activities were selected as pilot regions. Physical, chemical, mineralogical, toxicological, and leaching potential measurements of DMs dredged from the seabed revealed they qualify as non-hazardous waste. Index and engineering tests performed on raw and processed DMs were assessed to determine the geotechnical requirements for soil-based materials (SBM) used in sanitary landfills. The results showed that non-hazardous DMs could be utilized as a cover, base/cap liner, and/or fill material at various sections within the landfills. This method provides environmental advantages not seen with other management strategies for DMs such as dumping at sea or upland disposal.

Retraction Note: Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

The Editor-in-Chief has retracted this article [1] because it shows significant overlap with a previously published article by Pladzyk et al. [2].

Giant condyloma acuminata of Buschke-Löwenstein: successful treatment with a combination of surgical excision, oral acitretin and topical imiquimod.

Human papillomavirus (HPV) is the most common sexually transmitted disorder in young, sexually active populations in the USA and Europe. Giant condyloma acuminatum (GCA) is a unique variant of condyloma acuminata, characterized by local aggressive behaviour despite benign histology. It carries a substantial risk of squamous cell carcinoma. Various treatments have been used, but response is often poor and recurrence rates high. We present a case of GCA successfully treated with a combination of surgical excision, oral acitretin and topical imiquimod. The diagnosis was based on histological examination, immunohistochemical analysis and in situ hybridization for HPV 6 and 11. We recommend a trial of oral retinoid and topical imiquimod in selected cases of GCA.

The use of low dose plain solutions of local anaesthetic agents for spinal anaesthesia in the prone position: bupivacaine compared with levobupivacaine.

In this study, we aimed to test the hypothesis that 1-ml plain solution of 0.5% bupivacaine or 0.5% levopubivacaine administered in a subarachnoid block can provide adequate anaesthesia and operating conditions for pilonidal cyst/sinus operations performed in the prone position. There were no significant differences between the two groups in terms of patient demographic data, duration of operation, patient-surgeon satisfaction, haemodynamic changes and side effects. There were no significant differences found in the onset time, highest block level achieved, two segment regression, time to S(2) regression of sensory block and the number of anaesthetised dermatomes, between the two groups (p = 0.077, 0.057, 0.091, 0.084 and 0.057 respectively). The incidence of complete motor blockade was 16% and 8% in Group B at the start and at the end of the operation. There was no complete motor blockade in Group L (p = 0.110 and 0.490 respectively). We conclude that both regimens are effective and safe for use in subarachnoid anaesthesia for pilonidal cyst/sinus operations performed in the prone position.

Investigation of topsoil production from marine dredged materials (DMs) in Turkey for urban landscaping works.

As known, marine dredged materials (DMs) are highly nuisance wastes if they are not correctly reused or removed. In this work, the usability of DMs to the technical terms as manufactured topsoil (MT) in the urban landscaping works is discussed. Firstly, the leaching potentials of DMs were determined according to the related legislations to identify their hazardousness features. Secondly, DMs were subject to some treatment stages such as sieving, desalination, organic amelioration via peat and sheep manure, and pH adjustment to turn into an alternative natural soil pursuant to the British Standard in the scope of soil quality improvement studies as there is not any national standard in Turkey for the production of topsoil from different materials. Then, MT mixtures were prepared with washed and unwashed DM, peat and sheep manure in different mixing ratios (v/v); 33%, 50% and 67% DM, respectively. Consequently, high quality grass seed mixtures used for the landscaping applications were monitored for six months. The results demonstrate the availability of DM as alternative MT in the urban landscaping areas. Thus, important data were obtained as to the use of DM at alternative areas such as green city, green roof, shopping centers, organized industry, etc.

Cigarette smoking and the haemodynamic response to tracheal intubation.

This study investigated the effects of smoking and gender on the haemodynamic response after tracheal intubation. Patients were assigned to one of four groups: female non-smokers, female smokers, male non-smokers and male smokers. After tracheal intubation, the highest mean (SD) increase in heart rate (30 (18) %) and rate-pressure product (40 (29) %) was seen in male smokers. The increases in heart rate and rate-pressure product in male smokers were significantly greater than those in female non-smokers, p < 0.05. The increase in rate-pressure product was significantly greater in male smokers than in male non-smokers, p = 0.022.

Oxidative DNA damage and total antioxidant status in rats during experimental gram-negative sepsis.

Sepsis and septic shock remains as leading cause of death in adult intensive care units. It is widely accepted that gram-negative bacteria and their endotoxins cause sepsis and septic shock, predominantly. Enhanced generation of reactive oxygen species may be responsible for tissue injury in septic shock and endotoxemia. The aim of this study was to assess oxidative DNA damage and the total antioxidant status (TAS) in peripheral lymphocytes of rats during different intraperitoneal gram-negative sepsis stages. Adult male Sprague-Dawley rats were divided randomly into four groups. Control group was intraperitoneally inoculated with 2 mL of pyrogene-free saline (Group I, n = 6), and the other rats received an intraperitoneal inoculum with 2 mL of saline containing 2 x 10(8) CFU of Escherichia coli. The animals were killed at time zero (Group I, n = 6), at 6th (Group II, n = 7), 12th (Group III, n = 7), and 24th (Group IV, n = 7) hour after the E. coli inoculation. Oxidative DNA damage in peripheral lymphocytes of rats was evaluated by modified comet assay (single-cell gel electrophoresis). Formamidopyrimidine DNA glycosylase (Fpg) and Endonuclease III (Endo III) were used to detect oxidized purines and pyrimidines, respectively. Total antioxidant quantification was carried out using ABTS+ (2,2'-Azino-di-[3 ethylbenzthiazoline sulphonate]) radical formation kinetics (Randox kit) in serum samples. Significant elevations of basal levels of strand breaks (SB) in Group IV were observed as compared with Group I, II, and III. There was a significant increase in Fpg sites in Group III as compared with Group I and II. However, there was no significant difference in terms of Endo III sites in any of the groups. Although the TAS was decreased with the stages of sepsis, this moderate decrease was significant in only Group IV as compared with Group I. There was no statistically significant correlation between DNA damage and TAS for any of the groups.

Can facet joint infiltrative analgesia reduce postoperative pain in degenerative lumbar disc surgery?

OBJECTIVE: Perioperative analgesia effects the postoperative course of pain. The purpose of this study was to evaluate its possible relation with the consumption of dolantine and analgesics and the facet-induced pain and postoperative pain score in degenerative disc surgery. METHODS: We employed perioperative intra- and perifacet bupivacaine infiltration technique to reduce the postoperative pain after lumbar disc surgery. The study was randomized and observer blinded enrolling 40 American Society of Anesthesiologists physical status class I-II patients scheduled for elective degenerative lumbar disc surgery. The patients were divided into two groups of 20 of which Group 1 underwent injection of bupivacaine into the subcutaneous and muscular layers around the incision site, while Group 2 underwent additional intra- and perifacetal joint infiltration. Postoperatively, the patients were provided with a programmed patient-controlled pump which was only activated on demand to infuse dolantine for the next 24 hours. In the postanesthesia care unit the delay for analgesia and the dose of dolantine used were recorded. RESULTS: There was no statistical significance between these two groups regarding postoperative visual analoque scale scores. The time before the first analgesic request was significantly longer in facet group (p= 0,006). The cumulative dolantine dose was also significantly lower in the facet group (p= 0,001). CONCLUSION: The results indicate that facet joint infiltrative analgesia may have an effect on the postoperative analgesic requirement and reduce the dolantine consumption.

Obturator nerve block transurethral surgery for bladder cancer: comparison of inguinal and intravesical approaches: prospective randomized trial.

AIM: Transurethral resection of bladder tumors close to these areas may stimulate the obturator nerve, causing violent adductor contraction and possible inadvertent bladder perforation. To avoid this reaction, local anesthetic blockade of the obturator nerve as it passes through the obturator canal is effective in stopping adductor spasm during spinal anesthesia. METHODS: Forty-one patients undergoing (transurethral resection of bladder tumor) TUR-BT with spinal anesthesia who required (obturator nerve block) ONB were included in the study. After spinal anesthesia, ONB was performed with an inguinal approach (group 1) (n = 21) or an intravesical approach (group 2) (n = 20). In this study, we used 10 ml of 2 % lidocaine to perform the ONB. RESULTS: The mean age of patients was 60.8 ± 7.5 years. The groups were not different with regards to age, tumor localization and tumor size. There were two bladder perforations in group 1 and six perforations in group 2 (p = 0.130). However, the efficacy of ONB was significantly higher in inguinal approach group compared to intravesical approach group (p = 0.032). CONCLUSION: Obturator nerve block plays an additive role on the quality of analgesia for bladder surgery. Our data suggests that identification of the obturator nerve with ultrasound is easy and the block can be assessed by observing avoidance of bladder spasm.

Renal transplantation in recipients over the age of 60: the impact of donor age.

BACKGROUND: Kidneys from older donors exhibit a series of changes characterized by glomerular, vascular, and tubular senescence. These changes may be aggravated by atherosclerosis, hypertension, or diabetes, which are highly prevalent in older individuals. METHODS: We analyzed the outcome after transplantation in 230 recipients over the age of 60, who received transplants between February 1990 and December 1996. We assessed the 1- and 5-year patient and graft survival, the quality of renal function, tacrolimus levels, the incidence of rejection, and the incidence of delayed graft function, and compared the outcomes in recipients of kidneys from donors over the age of 60 (group 1, n = 40) with those in recipients of kidneys from donors under the age of 60 (group 2, n = 190). There were no differences between the two groups in terms of recipient sex, race, age, and cold ischemia time. Immunosuppression was with tacrolimus and steroids in 61% of cases; in the remainder of the patients, a third agent, either azathioprine, cyclophosphamide (for 1 week), or mycophenolate mofetil was administered as well. The median follow-up was 31.5 months (range: 1-86). RESULTS: In recipients over the age of 60 receiving tacrolimus-based immunosuppression, overall patient survival at 1 and 5 years was 90% and 76%, and was not significantly compromised in recipients receiving a kidney from a donor over the age of 60. The overall 1-and 5-year actuarial graft survival was 84% and 64%; in recipients from donors over the age of 60, it was 73% and 52%, whereas in recipients of kidneys from donors under the age of 60, it was 87% and 66% (P<0.05). Most of the effect on graft survival was seen by 1 year. The mean serum creatinine was 2.6+/-2.7 mg/dl, without any difference between the two groups. Although the incidence of delayed graft function was higher in recipients of kidneys from donors over the age of 60, this difference did not reach statistical significance. CONCLUSIONS: Although the overall outcomes of transplantation in older recipients remain reasonable, the inferior outcomes with older donor kidneys call into question proposals to utilize older donor kidneys preferentially in older recipients.

Treatment of ureteral and renal stones by electrohydraulic lithotripsy.

Manipulation of ureteral and renal calculi can be done under direct vision using a fiberscope with increased safety and efficacy. We treated 207 ureteral and renal stones in 198 patients using electrohydraulic lithotriptor combined with transurethral fiberscope from July 1985 till January 1991. Electrohydraulic lithotripsy (EHL) successfully fragmented 187 out of 207 stones (90.3%). A total of 119 patients (57.5%) became stone-free 3 months after operation, which increased to 170 cases (82.1%) at a mean follow-up of 20 months. There were 6 ureteral perforations (4 due to fiberscope and 2 due to EHL spark damage to the ureteral mucosa), which were treated immediately by open operation (2.9%). In 7 cases (3.4%), the stone could not be fragmented due to its hardness. We believe electrohydraulic lithotropsy treatment combined with transurethral fiberscopy is a safe, effective, noninvasive and economical method for the treatment of urinary tract stones.

Transitional cell carcinoma of the bladder in patients under 30 years of age.

Transitional cell carcinoma of the bladder is rare in patients younger than 30 years. We report two cases of bladder cancer under the age of 30, regarding clinical picture, treatment and follow-up results.

Colour penile Doppler ultrasonography with intraurethral prostaglandin-E2: preliminary results.

Intraurethral instillation was used in place of intracavernosal injection of vasoactive agents for the colour Doppler investigation of patients with erectile dysfunction. A total of 19 patients were enrolled in this study. Colour penile Doppler ultrasonography was done with intracavernosal injection of papaverine-HCl 60 mg and intraurethral instillation of prostaglandin-E2 0.5 mg. Arterial diameter, peak systolic velocity and end diastolic velocity were measured before and after papaverine injection and prostaglandin-E2 instillation. Colour penile Doppler parameters increased statistically significantly after papaverine injection and prostaglandin-E2 instillation (p < 0.01). But we did not observe differences between the results after papaverine-HCl and prostaglandin-E2. We believe that prostaglandin-E2 may be used with colour Doppler ultrasonography in the evaluation of patients with erectile dysfunction.

The efficacy of sildenafil in different etiologies of erectile dysfunction.

PURPOSE: The aim of this study was to evaluate the efficacy of sildenafil and success of treatment in particular etiological causes in erectile dysfunction lasting more than 3 months. MATERIAL AND METHODS: A total of 141 patients between 27 and 78 years old without any cardiac compromise, despite controversial, which precludes sildenafil (Viagra) treatment, were included in this study. All patients had only International Index of Erectile Capacity Form (IIEF) for pre-treatment evaluation and 50 mg sildenafil was started. Patients were assessed monthly for 6 months thereafter. Erectile capacity changes were questioned by IIEF on each follow-up and 100 mg sildenafil was given in patients without a response and monthly follow-up was scheduled. All patients had SMA-12, hormonal analyses and penile colour Doppler ultrasonography during the treatment course. The difference between IIEF score of each patient was displayed by Paired-t test and p-values less than 0.05 was applied as significant. RESULTS: The average beginning IIEF score of 141 patients was 11.80 +/- 0.47 [6-22], and increased to 20.70 +/- 0.62 [6-30] after a month of 50 mg sildenafil treatment. The mean increase was 75.4% and found to be significant (p = 0.000, p < 0.05). The average IIEF scores were recorded as 22.57 +/- 0.69 after 3, and 22.12 +/- 0.24 after 6 months. There was no difference between these values and 2nd month controls (P3 month = 0.5675, P6 month = 0.6138, p > 0.05). A positive response was recorded in 102 patients (72.3%) and 39 (27.7%) patients were unresponsive. Doubled doses of sildenafil (100 mg) was effective in additional 17 patients. After overall treatment, 119 (84.4%) patients had benefit from sildenafil. Penile Doppler ultrasonography displayed arterial insufficiency in 79 (56.03%), veno-occlusive dysfunction in 14 (9.93%), mixt vascular pathology in 14 (9.93%) patients. Normal ultrasonographic findings in 32 patients (22.7%) were classified as psychogenic dysfunction. Among the organic causes, sildenafil was found to be most effective in arterial insufficiency group. CONCLUSION: Sildenafil is a successful management modality in erectile dysfunction with minimal pre-treatment evaluation. As far as etiological causes concerned, sildenafil was found to be most effective in arterial insufficiency group and psychogenic group. The efficacy of sildenafil treatment has not been changed with the treatment time, since IIEF scores were stable during follow-up controls.

The outcome of urological findings in operated tethered cord patients.

We studied the urological aspects of the tethered cord syndrome before and after untethering. Presenting urological symptoms include incontinence in 10 (38%), voiding difficulty in 8 (30%), stool soilage in 7 (27%), pollakiuria in 8 (30%) and urgency and symptomatic urinary tract infection in 9 patients (34%). All patients had presacral skin lesion. In all cases cystometric study was done preoperatively and postoperatively. In this study, we noted that the overall clinical symptomatology and urodynamic parameters improved in 67.0% and 49.0%, respectively. Although no patient became normal after surgery, we found better improvement in patients treated promptly by neurosurgical intervention.