Impact of pre-test information on patient compliance with the spirometry protocol: a randomized controlled clinical trial.

OBJECTIVE: This study evaluated the effect of brochure-based and video-assisted information provided before spirometry on patient compliance. PATIENTS AND METHODS: This was a randomized controlled clinical trial. Before the test, subjects in intervention groups were shown a leaflet outlining the steps of the spirometry protocol and a video prepared for the same purposes. The control group was given standard routine information by the technician before spirometry. RESULTS: The study included 450 patients. We found a significant correlation between compliance status and age, female sex, being a non-smoker, having no known lung disease, investigating respiratory disease as an indication for spirometry, having first-time spirometry, and receiving pre-test information via leaflets. Variables of age, sex, smoking, indication for spirometry, diagnosis, and previous spirometry, which were found in multivariate analysis to be associated with 'compliance with the test protocol' were further processed using regression analysis which identified 'previous spirometry' as the most decisive variable affecting 'compliance with the test protocol'. CONCLUSIONS: Providing information via brochure-based and video-supported information did not contribute to compliance with the testing protocol, leading us to the conclusion that such informative tools do not provide an additional contribution. Previous spirometry experience was the most decisive parameter influencing adherence to the test protocol.

Compliance level to Tuberculosis prophylaxis in patients undergoing therapy with tumor necrosis factor-alpha inhibitors: a cross-sectional study.

OBJECTIVE: Tumor necrosis factor-alpha (TNF-α) inhibitors are used to treat autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, and inflammatory bowel disease. However, patients using TNF-α inhibitors are at a high risk of developing tuberculosis. Therefore, this study aimed to evaluate the compliance level of patients who were prescribed TNF-α-based tuberculosis prophylactic treatment. PATIENTS AND METHODS: The study included 135 patients who were followed up at a tuberculosis dispensary between December 2020 and June 2021 and agreed to participate in the study. The study was conducted after obtaining necessary permissions from the institution, ethics committee, and patients. Data were collected using a questionnaire and evaluated using the Medication Adherence Report Scale (MARS). The MARS scale scores range from 5 to 25, with high scores indicating a high level of "medication compliance level". RESULTS: Of the included patients, 42.2% were females, 46.7% were primary school graduates, and their mean age was 43.75±11.86 years. Additionally, 35.6% of patients had ankylosing spondylitis, among whom 54.1% had a disease duration of 1-5 years and 57.8% had been using TNF-α inhibitors for a year. Of the patients taking isoniazid (INH) for tuberculosis prophylaxis, 47.4% missed their prescribed INH doses, with "forgetfulness" being the reason in 28.9% of these patients. The patients had a mean MARS score of 15.71±6.18. CONCLUSIONS: Patients using TNF-α inhibitors were found to have "moderate" compliance levels for INH-based prophylactic therapy. It is recommended that the compliance levels of patients and factors influencing their compliance should be regularly monitored.

[Postoperative implant-associated osteomyelitis of the shoulder: Hardware-retaining revision concept using temporary drainage]. / Postoperative implantatassoziierte Osteitis am Schultergürtel: Materialerhaltendes Revisionskonzept mit Einlage einer Dauerdrainage.

BACKGROUND: Posttraumatic and postoperative osteomyelitis (PPO) is a subgroup of bone infections with increasing importance. However, to date no standardized reoperation concept exists particularly for patients with PPO of the shoulder region. Therefore the purpose of this study was to evaluate a revision concept including débridement, irrigation, and insertion of temporary drainage with hardware retention until healing. PATIENTS AND METHODS: A total of 31 patients with PPO were included with a proximal humerus fracture (n = 14), clavicle fracture (n = 10), or AC-joint separation (n = 7). In all, 27 of these patients could be followed for > 1 year. RESULTS: Hardware retention until fracture or ligament healing could be achieved in > 83%. Six patients required follow-up débridement due to recurrent infections, but then were unremarkable. Clinical outcome showed excellent Constant scores (91.6 ± 2.8). CONCLUSION: A cost-efficient, simple, and successful revision concept for patients with PPO of the shoulder region is described.

[High bone consolidation rates after humeral head-preserving revision surgery in non-unions of the proximal humerus]. / Hohe knöcherne Ausheilungsraten nach kopferhaltender Revision von proximalen Humeruspseudarthrosen.

BACKGROUND: Fractures of the subcapital and proximal humerus shaft region are common fractures of the human skeleton. Their treatment should provide an early functional after-care of the shoulder joint, that is prone to arthrofibrosis. Although the upper extremity is not weight-bearing the occurrence of proximal humerus non-unions leads to severe impairment with inability to work and restrictions of activity of daily life. The aim of this study was to investigate whether an operative revision of proximal humerus non-unions with reosteosynthesis and application of distant autologous bone grafts can lead to sufficient bone healing. The second aim was to find out whether patients achieved an acceptable functional outcome, as alternatively patients could be treated by reconstruction with a shoulder prosthesis. PATIENTS AND METHODS: 27 patients (female = 15, male = 12) with reosteosynthesis of the proximal humerus and proximal humeral shaft due to non-union after initially operative fracture treatment were included between 2008 and 2014. Average age of patients was 56 years (23-87), 48% had no comorbidities, while 52% of the patients had at least 1 comorbidity such as diabetes, hypertension or nicotine abusus. The mean number of prior surgical intervention was 1.2 (1-3). The mean time between initial surgery and re-osteosynthesis was 12.3 months. Patients with signs of infection pseudarthrosis were excluded. The initial type of osteosynthesis was with plates (n = 16; thereof PHILOS Plate n = 14), and intramedullary nails (T2, Targon Nail, PHN, Seidel Nail; n = 11). Revision surgery was done with plate osteosynthesis (n = 26; thereof PHILOS Plate n = 4; LC Plate n = 10; angle plate n = 12). In 23 patients (89%) a distant bone transplantation was done from the iliac crest, and 1 patient received allogenous bone. Three patients (11%) received bone morphogenetic protein 7 (BMP 7) in combination with distant bone graft. Intraoperative swabs from the pseudarthrosis area showed no bacterial pathogen after 14 days of incubation. DASH score and Constant score were used to evaluate the functional outcome after revision surgery. Bone healing was determined by standard X-rays and evaluated by a modified radiological score. RESULTS: 89% of the patients could be followed for an average of 28 months and the radiological follow-up was at 9 months. The radiological score showed very good (50%), or good results, and a sufficient bone healing was shown in 25 of 27 patients (93%). The pseudarthrosis revision surgery failed in two cases (n = 1 persisting non-union; n = 1 humeral head necrosis after re-operation with angle plate). DASH scores provided a mean of 40 ± 28.8 with a range from 0-97 points, and the results from the Constant score provided 45 ± 25.4. The analysis with variation of age showed a trend for better results in female patients < 60 years of age. As complications after bone graft 3 patients had persistent local dysesthesia (11%), in one case fracture of the iliac bone occurred that healed with conservative treatment. CONCLUSION: The pseudarthrosis revision surgery with humeral head preserving re-osteosynthesis with bone transplantation is an effective treatment for non-unions of the proximal humerus and the proximal humeral shaft and the current results showed high bone consolidation rates. As the functional results remained limited after revision an individual treatment decision should be made concerning the most appropriate therapy. While a shoulder prosthesis may be considered in the aged patient, a revision strategy with reosteosynthesis should be considered particularly in younger patients.

Dynamics in children and adolescents who experience varicella zoster virus infections after haematopoietic stem cell transplantation: a case-control study.

We evaluated the incidence of varicella-zoster virus (VZV) infections, including herpes zoster (HZ), and investigated the associated risk factors for HZ and compared lymphocyte subsets of these patients at 1, 3 and 6 months following haematopoietic stem cell transplantation (HSCT) in a case-control study in children and adolescents. The incidence of HZ infection at the first year after HSCT was 17/125 (13·6%). The cumulative incidence of HZ infection was 22/125 (17·6%). Sixteen (73%) cases with HZ and 11 (32%) cases in the control group had a diagnosis of malignant disorder. No significant difference was noted between the HZ group and the control group in absolute lymphocyte number and subsets (except WBC) at the pre-transplant evaluation. Pre-transplant WBC count was statistically lower in the HZ group (P<0·05). The CD4/CD8 ratios were lower in the HZ group during the first 6 months after HSCT, and the decrease was statistically significant at 6 months compared to the control group. In conclusion, patients undergoing HSCT for a malignant disorder had a significantly higher risk of VZV infection than those with non-malignant disorders and pretransplant donor characteristics were not helpful in predicting risk of post-transplant VZV infection.

Piperacillin/tazobactam plus amikacin versus carbapenem monotherapy as empirical treatment of febrile neutropenia in childhood hematological malignancies.

A prospective, randomized clinical trial was conducted to compare the efficacy of piperacillin/tazobactam and amikacin combination with carbapenem monotherapy for the empirical treatment of febrile neutropenic episodes of children with acute lymphoblastic leukemia or acute myeloblastic leukemia. Patients aged 2-16 years with hematological malignancies who had febrile neutropenia were randomly assigned to receive piperacillin/tazobactam (80 mg/kg piperacillin/10 mg/kg tazobactam, q6h) combined with amikacin (PTA) (7.5 mg/kg, q12h) or meropenem or imipenem (20 mg/kg, q8h) (C). Response to antimicrobial therapy, evaluated for etiological agents, was measured. Duration of fever, neutropenia, and hospitalization, mortality, and the need for additional antibiotics or antifungal drugs were compared for the treatment success between the two groups. Out of 87 febrile neutropenic episodes that were evaluable for comparison, 46 patients received PTA and 41 patients were treated with carbapenems (imipenem or meropenem). Overall, the microbiologically documented infection rate was 21.9%, with Staphylococcus epidermidis as the most common cause of bacteremia. The rate of treatment modification was 56.5% in the PTA group and 53.6% in the carbapenem group with no statistical difference (p > .05). There was no infection-related mortality during the study period. There was no difference between the two regimens for durations of fever, neutropenia, and hospitalization (p > .05 for all categories). PTA was as effective as carbapenem monotherapy as an initial empirical regimen in febrile neutropenic episodes of pediatric hematological malignancies.

Nonimmune hydrops fetalis in two cases of consanguineous parents and associated with hereditary spherocytosis and hemophagocytic hystiocytosis.

Nonimmune hydrops fetalis may occur as a result of different etiological conditions and in about one-third of cases no cause could be identified. Here, we report two cases of nonimmune hydrops fetalis associated with hereditary spherocytosis and hemophagocytic hystiocytosis. We think that babies with hydrops fetalis born of consanguineous parents should be examined for hereditary diseases, and that these rare causes should be taken into account in problematic cases.

Effect of submaximal and incremental upper extremity exercise on platelet function and the role of blood shear stress.

INTRODUCTION: Platelets are involved in the pathogenesis of atherosclerosis. Although physical exercise is recommended to prevent atherosclerosis, the effect of exercise on platelet function and the underlying mechanisms of these effects are not completely understood. Accordingly, we aimed to examine the effect of different intensities acute arm exercises on platelet function. In addition, we evaluated the effect of lipid peroxidation and fluid shear rate on platelet response. MATERIALS AND METHODS: Twenty four healthy sedentary male volunteers aged 18-24 years performed submaximal and incremental exercises by upper extremity ergometer. The shear rate in the right artery was measured by Power Doppler Ultrasound (US) at rest and immediately after exercise. Pre and postexercise maximum intensities of ADP and collagen-induced platelet aggregation were measured using the impedance technique. Bioluminescent detection of thrombin-induced platelet ATP release and measurement of thromboxane B(2) (TxB(2)) levels (as a marker of thromboxane A(2) (TxA(2)) formation) by enzyme-linked immunoassay were performed before and after exercise. RESULTS AND CONCLUSION: Shear rate increased after both submaximal and incremental exercise. Collagen-induced platelet aggregation increased after submaximal exercise, while ADP-induced aggregation and thromboxane B(2) levels did not alter with this protocol. Incremental exercise caused increased collagen and ADP-induced platelet aggregation and thromboxane B(2) levels. Neither of the protocols altered platelet ATP release. It was shown that acute upper extremity exercise increased platelet aggregation, without an increase in platelet release. Collagen-induced signalling pathways were more sensitive than those induced by ADP. The increase in thromboxane B(2) after incremental exercise implied increase in thromboxane A(2) formation and lipid peroxidation. Despite a significant correlation between platelet aggregation and thromboxane B(2) levels at rest, we found no clear-cut relationship between thromboxane A(2) formation, blood shear rate and platelet response to exercise.

Effect of hormone replacement therapy on ocular hemodynamics in postmenopausal women.

PURPOSE: To evaluate the effect of hormone replacement therapy on ocular hemodynamics in postmenopausal women. METHODS: Ocular Doppler ultrasonography was performed in 20 postmenopausal women on hormone replacement therapy (HRT) and in 20 women without treatment, as the control group. Central retinal artery (CRA), posterior ciliary artery (PCA) and ophthalmic artery (OA) flow velocities and vascular resistances were measured prospectively by a radiologist blinded to the therapy. There were no associated systemic or ocular diseases or any medication history. RESULTS: The mean age of the patients on HRT was 50.05 +/- 4.5 yrs (range 44-62). The mean age of the control group was 52.8 +/- 4.09 yrs (range 46-65). The mean duration of HRT was 1.6 +/- 1.4 yrs (range 3 months - 5 years). There were no differences between the groups in terms of flow velocities, vascular resistivities or pulsatility indices of OA, CRA and PCA (p>0.05). CONCLUSIONS: HRT is essential in postmenopausal women for relief of vasomotor symptoms, cardioprotection and prevention of osteoporosis. Even though vaso-occlusive complications of hormone preparations have been reported, we did not observe any changes in ocular hemodynamics detectable with Doppler ultrasonography.

Deep venous thrombosis of the extremity diagnosed by color Doppler ultrasonography after isolated limb perfusion.

AIM: Isolated limb perfusion (ILP) is used to treat locally advanced sarcoma and melanoma of the extremities. ILP is associated with a 1.7% to 10% incidence of deep venous thrombosis (DVT). The aim of the study was to examine the effect of ILP on the peripheral venous system and to evaluate the diagnostic accuracy of color Doppler ultrasonography (US). METHODS: A total of 26 patients with locally advanced sarcoma or melanoma of the extremities received a total of 38 ILP. The patients were evaluated preoperatively and postoperatively by color Doppler US as a noninvasive venous measurement. We used a color Doppler US system (SSA-270A, Toshiba) with a 7.5-MHz linear transducer for gray-scale imaging and a 5-MHz vascular transducer for color Doppler imaging. RESULTS: Seventeen patients underwent single ILP while the others were treated with multiple ILPs. Color Doppler US showed a reflux flow in three (7.9%) patients and DVT occurred subsequently in these patients. CONCLUSIONS: Color Doppler US is a noninvasive and clinically useful diagnostic technique in the diagnosis of extremity DVT. We recommend anticoagulant therapy in patients with reflux on ultrasonographic examination.

Effect of transurethral electrovaporization of the prostate on serum prostate specific antigen concentration.

OBJECTIVE: To assess the effect of transurethral electrovaporization of the prostate (TUVP) on serum prostate specific antigen (PSA) concentration. PATIENTS AND METHODS: Twenty-five men (mean age 61.7 years) with symptoms of prostatism underwent TUVP. Serum PSA levels were determined before any prostatic manipulation, and again at 1 and 24 h after TUVP. In the first 6 weeks after TUVP, serum PSA was measured every week. Prostatic size was measured by transrectal ultrasonography before and again at 6 weeks after TUVP. RESULTS: The mean serum PSA concentration was significantly higher at 1 and 24 h after TUVP (P<0.001) than before. The PSA level returned to less than the value before TUVP at 2, 3 and 4 weeks afterwards in eight (32%), 13 (52%) and 20 (80%) patients, respectively; five (20%) patients reached the baseline value 6 weeks after TUVP. The mean reduction in prostatic volume 6 weeks after TUVP was 42% and the reduction in tissue volume was significantly correlated with the decrease in serum PSA concentration at 6 weeks (P<0.05). CONCLUSION: TUVP increases serum PSA levels, the transient elevation persisting for up to 6 weeks but then declining to a stable, low PSA concentration. Therefore, it is important to wait at least 6 weeks to obtain an accurate and meaningful serum PSA level after TUVP.

Multimodality demonstration of primary splenic angiosarcoma.

Angiosarcomas are rare, accounting for only 1-2% of all soft tissue sarcomas. Primary abdominal angiosarcomas usually arise in the liver or spleen. We report the first color Doppler findings of a rare, low-grade splenic angiosarcoma in a 52-year-old woman.

A prospective randomized study of transurethral resection of the prostate and transurethral vaporization of the prostate as a therapeutic alternative in the management of men with BPH.

OBJECTIVE: The common goals of new surgical treatment for benign prostatic hyperplasia (BPH) are to improve subjective and objective symptoms, to decrease the risk of postoperative complications and short hospitalization. Transurethral electrovaporization of the prostate (TUVP) is a new, minimally invasive and a promising alternative to standard transurethral resection of the prostate (TURP) in the treatment of BPH. The aim of this study is to compare the efficacy and safety of these two treatment alternatives. METHODS: A prospective randomized trial of 60 patients with symptomatic BPH was performed. Preoperative and postoperative International Prostate Symptom Score (IPSS), maximum flow rates (Qmax) and complications were recorded in each patient. The volume of the prostate was measured preoperatively and postoperatively using transrectal ultrasound. RESULTS: Of the 30 patients who underwent TURP, mean hospital stay was 4.5 days. The Foley catheter was removed on postoperative day 4 following surgery. IPSS decreased from 21.6 to 5.2, Qmax increased from 9.2 to 19.2 ml/s at 3 months. Mean prostatic volume at 3 months decreased from 51.7 to 26.2 g, a 49.3% reduction. Of 30 patients undergoing TUVP, mean hospital stay was 2.5 days and the catheter was removed within 2 days following surgery. Postoperative urinary retention did not occur in any patient. IPSS decreased from 19.4 to 4.1 and Qmax increased from 7.9 to 17.7 ml/s at 3 months. Mean prostatic volume decreased from 48.9 to 27.8 g, a 43.1% reduction at 3 months. In the TUVP group, none of the patients required blood transfusions or developed clinical transurethral resection syndrome. There were no major complications. Sphincteric incontinence, urethral strictures or bladder neck contractures were not recorded. At 3 months postoperatively, 13 patients in the TURP group and 7 patients in the TUVP group had retrograde ejaculation. CONCLUSION: Our initial experience of TUVP suggests advantages over conventional TURP through reduced blood loss and shorter hospital stay. It appears to be an effective treatment for BPH; however, long-term results should be evaluated.

Pseudotumour due to surgical sponge: gossypiboma.

The plain-film, ultrasonography and computed tomography findings of retained surgical sponges (gossypibomas) are described in three patients. When a mass with hyperechoic wavy structures and posterior acoustic shadowing is seen on ultrasonography, the history of previous surgery must be questioned. Gossypiboma should be included in the differential diagnosis of such cases with a previous surgery. Plain film and computed tomography examinations should be obtained for correct pre-operative diagnosis.

Abscess formation due to dropped gallstone after laparoscopic cholecystectomy.

Laparoscopic cholecystectomy is a popular treatment modality of symptomatic gallstones with decreased major complications and shortened hospital stay. Complications following laparoscopic cholecystectomy, most of them involving strictures of biliary tract have been well described in recent reports. However, there are only a few reported cases about dropped gallstones after the procedure, all of which were opaque and easily demonstrated with multiple imaging modalities. An unusual complication of laparoscopic cholecystectomy; abscess formation due to a dropped non-opaque gallstone is described in which diagnosis was suggested with the combination of ultrasound and computed tomography findings and confirmed by surgery.

Intrarenal varices in portal hypertension: demonstration by color Doppler imaging.

The gray-scale ultrasonographic appearances of dilated intrarenal vascular structures may mimic peripelvic cysts or hydronephrosis. We report a patient with portal hypertension in whom color Doppler ultrasound was found to be a very practical imaging technique in demonstrating varices of the renal segmental veins.

Testicular microlithiasis associated with seminoma: Gray-scale and color Doppler ultrasound findings.

Testicular microlithiasis associated with seminoma was found in a 32-year-old infertile man. Gray-scale and color Doppler ultrasound findings are discussed and a brief review of the literature is presented.

Image-directed color Doppler ultrasonography of kidney in systemic lupus nephritis.

We evaluated intrarenal arterial waveforms with image-directed color Doppler ultrasonography in 21 patients with systemic lupus erythematosus (SLE). The systolic-diastolic ratio, resistive index, and pulsatility index were compared with serum creatinine levels, creatinine clearance, and quantitation of urinary protein excretion, as well as with histopathologic scores of specimens obtained from 9 patients who underwent renal biopsy. Doppler parameters were in the normal ranges in all patients, without showing significant correlation with any of the histopathologic scores or laboratory parameters except creatinine levels. We conclude that image-directed color Doppler ultrasonography is of no practical value in the evaluation of lupus nephritis during the early stages of the disease.