Comparison of colistin-carbapenem, colistin-sulbactam, and colistin plus other antibacterial agents for the treatment of extremely drug-resistant Acinetobacter baumannii bloodstream infections.

The purpose of this investigation was to compare the efficacy of colistin-based therapies in extremely drug-resistant Acinetobacter spp. bloodstream infections (XDR-ABSI). A retrospective study was conducted in 27 tertiary-care centers from January 2009 to August 2012. The primary end-point was 14-day survival, and the secondary end-points were clinical and microbiological outcomes. Thirty-six and 214 patients [102 (47.7%): colistin-carbapenem (CC), 69 (32.2%): colistin-sulbactam (CS), and 43 (20.1%: tigecycline): colistin with other agent (CO)] received colistin monotherapy and colistin-based combinations, respectively. Rates of complete response/cure and 14-day survival were relatively higher, and microbiological eradication was significantly higher in the combination group. Also, the in-hospital mortality rate was significantly lower in the combination group. No significant difference was found in the clinical (p = 0.97) and microbiological (p = 0.92) outcomes and 14-day survival rates (p = 0.79) between the three combination groups. Neither the timing of initial effective treatment nor the presence of any concomitant infection was significant between the three groups (p > 0.05) and also for 14-day survival (p > 0.05). Higher Pitt bacteremia score (PBS), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Charlson comorbidity index (CCI), and prolonged hospital and intensive care unit (ICU) stay before XDR-ABSI were significant risk factors for 14-day mortality (p = 0.02, p = 0.0001, p = 0.0001, p = 0.02, and p = 0.01, respectively). In the multivariable analysis, PBS, age, and duration of ICU stay were independent risk factors for 14-day mortality (p < 0.0001, p < 0.0001, and p = 0.001, respectively). Colistin-based combination therapy resulted in significantly higher microbiological eradication rates, relatively higher cure and 14-day survival rates, and lower in-hospital mortality compared to colistin monotherapy. CC, CS, and CO combinations for XDR-ABSI did not reveal significant differences with respect to 14-day survival and clinical or microbiological outcome before and after propensity score matching (PSM). PBS, age, and length of ICU stay were independent risk factors for 14-day mortality.

Liver involvement in patients with brucellosis: results of the Marmara study.

Brucellosis is a zoonotic disease that primarily affects the reticuloendothelial system. But, the extent of liver damage in due course of the disease is unclear. This study included 325 brucellosis patients with significant hepatobiliary involvement identified with microbiological analyses from 30 centers between 2000 and 2013. The patients with ≥5 times of the upper limit of normal for aminotransferases, total bilirubin level ≥2 mg/dl or local liver lesions were enrolled. Clinical hepatitis was detected in 284 patients (87.3 %) and cholestasis was detected in 215 (66.1 %) patients. Fatigue (91 %), fever (86 %), sweating (83 %), arthralgia (79 %), and lack of appetite (79 %) were the major symptoms. Laboratory tests showed anemia in 169 (52 %), thrombocytopenia in 117 (36 %), leukopenia in 81 (25 %), pancytopenia in 42 (13 %), and leukocytosis in 20 (6 %) patients. The most commonly used antibiotic combinations were doxycycline plus an aminoglycoside (n = 73), doxycycline plus rifampicin (n = 71), doxycycline plus rifampicin and an aminoglycoside (n = 27). The duration of ALT normalization differed significantly in three treatment groups (p < 0.001). The use of doxycycline and an aminoglycoside in clinical hepatitis showed better results compared to doxycycline and rifampicin or rifampicin, aminoglycoside, doxycycline regimens (p < 0.05). However, the length of hospital stay did not differ significantly between these three combinations (p > 0.05). During the follow-up, treatment failure occurred in four patients (1 %) and relapse was seen in three patients (0.9 %). Mortality was not observed. Hepatobiliary involvement in brucellosis has a benign course with suitable antibiotics and the use of doxycycline and an aminoglycoside regimen seems a better strategy in select patients.

Emergence of West Nile virus infections in humans in Turkey, 2010 to 2011.

In 2010, 47 human cases of West Nile virus (WNV)infection, including 12 laboratory-confirmed and 35 probable cases, were identified in Turkey. These were the first cases detected during routine surveillance.The patients were from 15 provinces, mainly located in the western part of the country. Incidence was 0.19/100,000 with a maximum of 1.39 in Sakarya province.Forty of the total 47 cases showed neuroinvasive manifestation. Median age was 58 years with a range of four to 86. Ten of the patients died. Enhanced surveillance in humans and animals and mosquito control measures were implemented. The WNV infections were included in the national notifiable diseases list as of April 2011. In 2011, three probable and two confirmed cases of WNV infection were diagnosed in provinces where infections had been detected in the previous year, supporting a lower activity than 2010. However,detection of WNV infections in humans in 2010 and 2011 consecutively, may indicate that WNV has become endemic in the western part of Turkey. Field epidemiological studies were undertaken to understand more about the nature of infection in Turkey.

Evaluation of follow-up colonoscopy in acute colonic diverticulitis for detection of advanced adenoma and colon cancer: a retrospective cohort study.

BACKGROUND: Due to variable rates of colon carcinoma or advanced adenoma mimicking an acute diverticulitis episode, the necessity of colonoscopy to detect colon cancer or advanced adenoma remains to be explored. This study investigated the incidence and predictive factors of colon cancer or advanced adenoma following acute diverticulitis. METHODS: We evaluated retrospectively all consecutive patients with an episode of computed tomography-proven acute diverticulitis between June 2016 and August 2019. A follow-up colonoscopy was performed. Demographic and clinical parameters were recorded. Patients with clinically substantial colonic neoplasia (colon cancer or advanced adenoma) were classified as Group A, while Group B included patients without clinically significant colonic neoplasia. The incidence of clinically significant colonic neoplasia in acute diverticulitis patients was regarded as the primary outcome. RESULTS: The mean age of 233 patients with acute diverticulitis was 58.6 ± 12.7 years. Complicated diverticulitis was detected in 39 patients (16.7 %). Sixteen patients (6.9 %) were assigned to Group A and 217 patients (93.1 %) to Group B. The age of the patients in group A was significantly higher than in Group B (p =0.001). Age above 50 and 65 years was also significantly associated with clinically significant colonic neoplasia (p =0.015 and p =0.012, respectively). The other variables did not influence the development of clinically significant colonic neoplasia (p >0.05). CONCLUSIONS: Colonoscopy examination following an episode of acute diverticulitis may not be recommended for all patients due to the rare occurrence of colon cancer or clinically significant colonic neoplasia in those younger than 50 years. HIPPOKRATIA 2021, 25 (2):69-74.

Effects of legal antibiotic restrictions on consumption of broad-spectrum beta-lactam antibiotics, glycopeptides and amphotericin B.

In 2002, antimicrobial drugs were the most frequently prescribed drugs in Turkey. On February 15, 2003, the Turkish Government implemented a new Budget Application Instruction (BAI) to promote rational antibiotic usage in order to decrease the costs. This BAI restricted the reimbursement of certain antibiotics without prescription or approval by the infectious diseases specialists (IDS). The purpose of this study is to evaluate the effect of BAI on antibiotic consumption for the 3 years before and 2 years after its implementation, according to IMS Health Office findings. Based on the data of the IMS Health Turkey Office, the amount of some broad-spectrum antibiotics (piperacillin/tazobactam, imipenem, meropenem, cefoperazone/sulbactam, ceftazidime, cefepime, teicoplanin, vancomycin, and amphotericin B) that were prescribed by IDS between 2000 and 2002 and between 2003 and 2004 are determined. The Anatomical Therapeutic Chemical classification and the defined daily dose (DDD)/1,000 methodology are used to calculate antibiotic consumption. Total antibiotic consumption before BAI, in 2000, 2001 and 2002 was 0.091, 0.107 and 0.119 DDD/1,000 inhabitant-days, respectively, and after BAI, in 2003 and 2004, 0.137 and 0.135 DDD/1,000 inhabitant-days, respectively. Average utilization of antibiotics before the implementation of BAI was 0.105 DDD and increased to 0.136 DDD after BAI. Antibiotic consumption has increased 1.3-fold after the implementation of BAI. However, the effect of restricted antibiotic utilization was revealed especially in the second year after BAI. The consumption of antimicrobials decreased to 0.135 in 2004 while it was 0.137 in 2003.

The efficacy of a computer alert programme for increasing HBV screening rates before starting immunosuppressive therapy.

BACKGROUND AND AIM: Hepatitis B Virus (HBV) screening before starting immunosuppressive treatment is of vital importance in order to prevent HBV reactivation and its associated clinical consequences. Despite all recommendations by international organizations, screening rates are far below desired. The aim of this study was to assess the efficacy of a computer alert programme 'HBVision' for increasing HBV screening rates. MATERIAL AND METHODS: 'HBVision' identifies patients at risk of HBV reactivation by specific ICD-10 codes and immunosuppressive medication reports and sends sequential alert messages to screen for HBsAg, anti-HBc IgG and consult a specialist if one of them is positive. The demographic variables, treatment protocols, HBV screening and consultation rates of oncology and hematology patients who started immunosuppressive treatments within one year before (control group) and after "HBVision" (study group) were retrospectively compared. RESULTS: HBsAg and anti-HBc IgG screening rates (68.6% and 13.1%, respectively) were significantly higher in the study group (n=602) compared to control group (n=815) (55% and 4.3%, respectively) (p<0.001, for both). Subgroup analysis revealed significant improvements in the screening rates of HBsAg (65.8%) and anti-HBc IgG (5.1%) in oncology patients (p<0.001), anti-HBc IgG (89.1%) in hematology patients (p<0.001). CONCLUSION: The computer alert programme significantly increased HBV screening rates before starting immunosuppressive treatments, however the results were still below ideal. Additional efforts, such as modifying the computer programme according to feedbacks, are probably needed.

Prevalence and antibiotic susceptibility of genital Mycoplasma hominis and Ureaplasma urealyticum in a university hospital in Turkey.

This study aimed to assess the colonization prevalence and antibiotic susceptibility of genital Ureaplasma urealyticum and Mycoplasma hominis in a teaching hospital, in Turkey. A total of 382 sexually active women with abnormal vaginal discharge were included in the study. Samples that were obtained with cotton swabs were microbiologically analyzed for U. urealyticum and M. hominis, together with antimicrobial susceptibility to doxycycline, ciprofloxacin, ofloxacin, erythromycin, josamycin, pristinamycin, and tetracycline. Ureaplasma urealyticum was detected in 185 (48.4%) cultures, and M. hominis in 17 (4.4%). Eight (2.1%) cultures were positive for both. Resistance of M. hominis to doxycycline, ciprofloxacin, ofloxacin, erytromycin, josamycin, pristinamycin and tetrascycline was 5.9%, 17.6%, 41.2%, 88.2%, 5.9%, 5.9% and 11.8%, respectively. Resistance to doxycycline, ciprofloxacin, ofloxacin, erytromycin, josamycin, pristinamycin and tetrascycline in U. urealyticum isolates was 1.6%, 40.5%, 58.4%, 54.0%, 1.6%, 8.1% and 13.5%, respectively. Both U. urealyticum (94.1%) and M. hominis (96.2) were most sensitive to josamycin, and most resistant to erytromycin (U. urealyticum 54.0%, M. hominis 88.2) and ofloxacin (U. urealyticum 58.4%, M. hominis 41.2%). As a result, the rate of U. urealyticum and M. hominis was found to be 48.4% and 4.4%, respectively. We conclude that doxycycline may be used in empirical treatment of genital tract infections in sexually active women.

Abdominal actinomycosis: a report of two cases.

Actinomyces spp. cause a chronic suppurative, granulomatous disease which is characterized clinically by extensive abscess formation, recurrent draining of sinuses and fistulae and histologically by the presence of the so-called "sulphur granules". Colonic actinomycosis is a relatively rare infection and its diagnosis is difficult. We report the case of a female patient who was operated on for ovarian cyst and the case of another female patient operated on for a mass in the transverse colon. In both cases the pathology of the excised tissues revealed actinomycosis. Actinomycosis must be considered in the differential diagnosis of patients who present with abdominal pain, fever, leucocytosis and intestinal wall thickness and/or abdominal mass.

Nasal carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in nursing home residents in Bolu, Turkey.

BACKGROUND: This study aimed (a) to provide information on methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) Staphylococcus aureus colonization ratio in residents of nursing homes; (b) to determine the effect of hand-washing education given to nursing home residents and employees on nasal carriage of Staphylococcus aureus (NCSA) and (c) to obtain probable risk factors for MRSA colonization of residents in two nursing homes. METHODS: Seventy-nine volunteers (24 females and 55 males) from Bolu nursing homes were included in the study. Nasal samples were taken with sterile swabs from the anterior nares. Staphylococcus aureus strains were identified using classical methods and genotyping of methicillin resistant strains was done using Arbitrary Primed PCR (AP-PCR). Antibiotic susceptibilities were determined by disk diffusion methods according to NCCLS standards. After first nasal samples were taken, all employees and residents of nursing homes were educated about the methods of hand hygiene over two days. RESULTS: With hand-washing education, the decrease of NCSA rate (initially 43%; after education, 21%) was significant (p < 0.05) while decrease of MRSA carriage (initially 5%, after education 1%) was not (p > 0.05). MRSA carriage was significantly correlated with presence of skin lesions, prior hospitalization within the last six months, and antibiotics usage within the last six months. AP PCR results suggested that residents' carriage of MRSA was the result of the same source. CONCLUSION: MSSA and MRSA colonization rates were found to be 38% and 5% in nursing homes, respectively. These ratios can decrease with simple precautions like hand-washing after a short education period

Managing atypical and typical herpetic central nervous system infections: results of a multinational study.

There have been many studies pertaining to the management of herpetic meningoencephalitis (HME), but the majority of them have focussed on virologically unconfirmed cases or included only small sample sizes. We have conducted a multicentre study aimed at providing management strategies for HME. Overall, 501 adult patients with PCR-proven HME were included retrospectively from 35 referral centres in 10 countries; 496 patients were found to be eligible for the analysis. Cerebrospinal fluid (CSF) analysis using a PCR assay yielded herpes simplex virus (HSV)-1 DNA in 351 patients (70.8%), HSV-2 DNA in 83 patients (16.7%) and undefined HSV DNA type in 62 patients (12.5%). A total of 379 patients (76.4%) had at least one of the specified characteristics of encephalitis, and we placed these patients into the encephalitis presentation group. The remaining 117 patients (23.6%) had none of these findings, and these patients were placed in the nonencephalitis presentation group. Abnormalities suggestive of encephalitis were detected in magnetic resonance imaging (MRI) in 83.9% of the patients and in electroencephalography (EEG) in 91.0% of patients in the encephalitis presentation group. In the nonencephalitis presentation group, MRI and EEG data were suggestive of encephalitis in 33.3 and 61.9% of patients, respectively. However, the concomitant use of MRI and EEG indicated encephalitis in 96.3 and 87.5% of the cases with and without encephalitic clinical presentation, respectively. Considering the subtle nature of HME, CSF HSV PCR, EEG and MRI data should be collected for all patients with a central nervous system infection.

In vitro activity of sodium-benzoate against isolates of methicillin-resistant Staphylococcus aureus.

BACKGROUND: Worldwide, methicillin-resistant Staphylococcus aureus (MRSA) rates have increased dramatically during the last decades. Sodium benzoate (SB) is a chemical substance that is used for preparing food and drinks and in the treatment of some metabolic (urea cycle disorders and hepatic coma) diseases. No studies were found which focussed on the effects of SB in MRSA infections. The aim was to determine in vitro activity of sodium benzoate against MRSA clinical isolates. METHODS: In this study, MIC for SB in 36 MRSA and 29 methicillin-sensitive Staphylococcus aureus (MSSA) isolates were determined by a broth microdilution method recommended by the National Committee for Clinical Laboratory Standards. RESULTS: The MIC at which all of the MRSA and MSSA strains were inhibited was at 32 microg/ml and higher concentrations. CONCLUSION: Sodium benzoate showed good in vitro activity against clinically relevant MRSA and MSSA isolates. It is suggested in this study that this cheap substance, which has been used for systemic and local treatment of infection in humans, may be used alternatively for the treatment of MRSA infections. However, it is clear that more comprehensive and in vivo studies are needed to further elucidate the activity of SB against MRSA infections.

Investigation of the frequency of COVID-19 in patients treated with intravesical BCG

SUMMARY INTRODUCTION In this retrospective study, we aimed to investigate the frequency of COVID-19 in patients with and without BCG application due to bladder tumors. METHODS The presence of COVID-19 was investigated in 167 patients with BCG and 167 without bladder cancer. All patients were compatible with COVID-19 infection. Patients with RT-PCR positive for SARS-CoV-2 and/or Chest CT positive for viral pneumonia between March and May 2020 were included in the study. RESULTS A total of 334 patients were included in the study. The mean age of the 167 patients in the study group was 71.1±14.2 1 (min. 38.0- max. 98.0 years), 141 (84.4%) were male. The mean age of the 167 patients in the control group was 70.5±13.8 years (min. 41.0- max. 96.0 years), and 149 were male (p> 0.05). COVID-19 was detected in 5 patients in the BCG group and in 4 patients in the control group (P> 0.05). CONCLUSION Intravesical BCG administration does not decrease the frequency of COVID-19 infection.

RESUMO INTRODUÇÃO Neste estudo retrospectivo, objetivou-se investigar a frequência de COVID-19 em pacientes com e sem aplicação de BCG por tumor de bexiga. MÉTODOS A presença de COVID-19 foi investigada em 167 pacientes com BCG e 167 sem câncer de bexiga. Todos os pacientes compatíveis para infecção por COVID-19. Resumidamente, os pacientes foram incluídos no estudo com RT-PCR positivo para Sars-CoV-2 e/ou TC de tórax positivo para pneumonia viral entre março e maio de 2020. RESULTADOS Um total de 334 pacientes foi incluído no estudo. A idade média dos 167 pacientes no grupo de estudo foi de 71,1±14,2 1 (min. 38,0 - máx. 98,0 anos), 141 (84,4%) eram do sexo masculino; 167 pacientes do grupo controle tinham idade média de 70,5±13,8 (min. 41,0 - máx. 96,0 anos) e 149 eram do sexo masculino (p>0,05). A COVID-19 foi detectada em cinco pacientes no grupo BCG e em um no grupo controle (p>0,05). CONCLUSÃO A administração intravesical de BCG não diminui a frequência da infecção por COVID-19.

Arterial stiffness and cardiac functions in patients with chronic venous disease.

AIM: Although the venous system is in direct continuity with the heart and the arterial system, it is not known whether chronic venous disease (CVD) has any impact on either of these. The aims of this study were to investigate the global functions of the left and right heart, and also arterial stiffness parameters in patients with CVD. METHODS: Forty-eight patients with primary stage C4-C6 CVD were enrolled into the study. The control group consisted of 39 age/sex and Body Mass Index matched healthy volunteers. All of the patients underwent detailed echocardiographic examination with further focus on Doppler and tissue Doppler (TD) parameters of the left and right ventricle. Arterial stiffness was evaluated via applanation tonometry in each patient. RESULTS: The left atrial area (LAA) and interventricular septum thickness were slightly increased in patients with CVD. Regarding Doppler and tissue Doppler measurements of the LV, all of the parameters were similar among the groups, while RV tissue Doppler systolic velocity and TAPSE were higher in patients with CVD. Among the arterial stiffness parameters, central aortic pressure, augmentation index, and pulse wave velocity were slightly higher in patients with CVD. CONCLUSION: The results of this study indicated that CVD may be associated with a subclinical disease state in the arterial system and also in the heart. Further studies are needed to confirm this association and to describe the possible mechanisms.

Knowledge and attitudes towards COVID-19 among emergency medical service workers

SUMMARY OBJECTIVE: Good knowledge of the coronavirus disease 2019 (COVID-19) among healthcare workers is essential for keeping health systems active and controlling the outbreak. We aimed to investigate the knowledge and attitudes of Emergency Medical Service (EMS) employees who fight COVID-19 at the forefront. METHODS: A total of 400 EMS workers (doctors, nurses, emergency medical technicians, paramedics, and ambulance drivers) were included in this study. Knowledge, attitude, and preventive behaviors for COVID-19 were evaluated using an online questionnaire. RESULTS: A total of 275 EMS workers participated in the study with a response rate of 68.8%. The respondents reported that their highest common sources of knowledge about COVID-19 were social media and television (n=240, 88%). Overall, > 96% of the participants had adequate knowledge about the transmission routes of COVID-19. Among the respondents, 36% of them were unaware of the correct hand washing or scrubbing technique. In addition, 78% of the participants had poor knowledge about floor and surface disinfection. The majority of the participants exhibited inaccurate attitudes toward the use of personal preventive equipment. More than half of EMS workers (52%) agreed that a surgical mask is not enough during the procedures that do not generate aerosol. Moreover, a significant proportion of the participants (66%) perceived that a N95 mask is required. CONCLUSIONS: As a consequence, although emergency workers have sufficient basic knowledge about COVID-19, there is a need for postgraduate training in many subjects.

RESUMO OBJETIVO: Um bom conhecimento sobre a doença por coronavírus 2019 (COVID-19) entre profissionais de saúde é essencial para manter os sistemas de saúde ativos e controlar o surto. Nosso objetivo foi investigar o conhecimento e as atitudes dos funcionários do serviço médico de emergência (EMS) que lutam com o COVID-19 na vanguarda. MÉTODOS: Um total de 400 trabalhadores do SME (médicos, enfermeiros, técnico de emergência médica, paramédicos e motoristas de ambulância) foram incluídos neste estudo. Conhecimento, atitude e comportamentos preventivos para COVID-19 foram avaliados usando um questionário on-line. RESULTADOS: Um total de 275 trabalhadores do SME participou do estudo com uma taxa de resposta de 68,8%. Os entrevistados relataram que as maiores fontes comuns de conhecimento sobre COVID-19 foram as mídias sociais e a televisão (n = 240, 88%). No geral,> 96% dos participantes tinham conhecimento adequado sobre as rotas de transmissão do COVID-19. Entre os entrevistados, 36% deles desconheciam a técnica correta de lavar ou esfregar as mãos. Além disso, 78% dos participantes tinham pouco conhecimento sobre desinfecção de pisos e superfícies. A maioria dos participantes exibiu atitudes imprecisas em relação ao uso de equipamentos preventivos pessoais. Mais da metade dos trabalhadores do SME (52%) concordou que a máscara cirúrgica não é suficiente durante os procedimentos que não geram aerossol. Além disso, uma proporção significativa dos participantes (66%) percebeu que a máscara N95 é necessária. CONCLUSÕES: Como conseqüência, embora os trabalhadores de emergência tenham conhecimento básico suficiente sobre o COVID-19, há necessidade de treinamento de pós-graduação em muitas disciplinas.

Predictors for limb loss among patient with diabetic foot infections: an observational retrospective multicentric study in Turkey.

We aimed to investigate the predictors for limb loss among patients with diabetes who have complicated skin/soft-tissue infections. In this observational study, consecutive patients with diabetic foot infection (DFI) from 17 centres in Turkey, between May 2011 and May 2013 were included. The Turkish DFI Working Group performed the study. Predictors of limb loss were investigated by multivariate analysis. In total, 455 patients with DFI were included. Median age was 61 years, 68% were male, 65% of the patients were hospitalized, 52% of the patients had used antibiotics within the last month, and 121 (27%) had osteomyelitis. Of the 208 microorganisms isolated, 92 (44.2%) were Gram-positive cocci and 114 (54.8%) were Gram-negative rods (GNR). The most common GNR was Pseudomonas; the second was Escherichia coli, with extended spectrum ß-lactamase positivity of 33%. Methicillin-resistant Staphylococcus species were found in 14% (29/208). Amputations were performed in 126/455 (28%) patients, 44/126 (34%) of these were major amputations. In multivariate analysis, significant predictors for limb loss were, male gender (OR 1.75, 95% CI 1.04-2.96, p 0.034), duration of diabetes >20 years (OR 1.9, 95% CI 1.18-3.11, p 0.008), infected ulcer versus cellulitis (OR 1.9, 95% CI 1.11-3.18, p 0.019), history of peripheral vascular disease (OR 2, 95% CI 1.26-3.27, p 0.004), retinopathy (OR 2.25, 95% CI 1.19-4.25, p 0.012), erythrocyte sedimentation rate >70 mm/hr (OR 1.6, 95% CI 1.01-2.68, p 0.05), and infection with GNR (OR 1.8, 95% CI 1.08-3.02, p 0.02). Multivariate analysis revealed that, besides the known risk factors such as male gender, duration of diabetes >20 years, infected ulcers, history of peripheral vascular disease and retinopathy, detection of GNR was a significant predictor of limb loss.

The effect of coronary artery bypass surgery on brain perfusion.

UNLABELLED: Coronary artery bypass grafting (CABG) is one of the major treatment methods of coronary artery disease. CABG is an open-heart surgery that uses cardiopulmonary bypass (CPB). After CPB, it is well known that neurological and neuropsychological complications may occur. The purpose of this study was to evaluate brain perfusion patterns before and after CPB and to locate brain perfusion changes in patients with neurological and neuropsycological complications after CPB. METHODS: Twenty-five patients who underwent open-heart surgery (22 CABG, 3 valve replacement) and 5 patients (4 cholecystectomy, 1 periferic vascular surgery) as a control group were included in the study. The 99mTc-HMPAO injected dose was 925 MBq. Brain perfusion SPECT images were obtained 30-60 min postinjection using a dedicated triple-head brain SPECT camera. Imaging was performed 1 wk before and 4-6 wk after surgery. Technetium-99m-HMPAO brain SPECT slices were evaluated visually and semiquantitatively. RESULTS: None of the patients had severe neurologic complications. Neuropsychological deficits occurred in eight patients after CABG. Cognitive deterioration and depressive mood occurred in five patients. Disorientation, agitation and confusion periods were present in another two patients. Frontal hypoperfusion was found in these patients by visual and semiquantitative evaluations (p = 0.0277) and left parietal hypoperfusion was also present semiquantitatively (p = 0.0277). Visual hallucinations occurred in one patient. Computed tomography of these patients was normal. No perfusion abnormalities were observed in the patient with visual hallucinations and in patients without symptoms after open-heart surgery nor in the control group. Brain SPECT was repeated in two symptomatic patients 5 mo after CABG. Frontal hypoperfusion became normal, and these patients' symptoms disappeared. CONCLUSION: The results of this study indicate that regional cortical hypoperfusion may occur in patients with neuropsychological complications after CABG. Technetium-99m-HMPAO brain SPECT is a useful method to locate and determine brain perfusion changes after CABG.

Retrograde cerebral perfusion with hypothermic circulatory arrest in a child.

This report describes a 4-year-old boy who presented with infective endocarditis involving the ascending aorta and the arch vessels, with supravalvular aortic stenosis as the underlying pathology. Operation was indicated because of the embolic potential of the vegetations inside the aorta. Retrograde cerebral perfusion was utilized in conjunction with hypothermic circulatory arrest, to flush particulate materials from the arch vessels during operation.

Upper extremity deep vein thrombosis: clinical and treatment characteristics.

We aimed to evaluate patients with upper extremity deep vein thrombosis (UEDVT) in terms of the risk factors, symptoms, clinical course, diagnostic approaches and treatment outcome. Thirty-six patients with a diagnosis of UEDVT, comprising 19 males (52.7%) and 17 females (47.3%), were included in the study; the mean (+/- SD) age was 54 +/- 12.3 years. The most common risk factor was central venous catheter use. The treatment protocol consisted of low molecular weight heparin for up to 7 days, followed by oral anticoagulants for up to 6 months. All patients were followed up for 1 year. More than 90% of the patients responded well to treatment. Nine patients (25%) died due to underlying diseases; no patients died secondary to UEDVT. None of the patients developed pulmonary embolus or recurrent deep venous thrombosis, and post-thrombotic syndrome was not observed. The mortality rate was related to the underlying diseases.