Carbon Dioxide Guided Endovascular Aortic Aneurysm Repair in Impaired Renal Function: Propensity Score Matched Study.

OBJECTIVE: Carbon dioxide (CO2) is the preferred contrast agent in patients with impaired renal function and or contrast allergy and, particularly, in patients who require large volumes of contrast for complex endovascular procedures. In this study, the aim was to clarify the possible protective effects of CO2 guided endovascular aneurysm repair (EVAR) for patients with impaired renal function by propensity score matching. METHODS: A retrospective analysis of the database was performed for 324 patients having EVAR between January 2019 and January 2022. A total of 34 patients treated with CO2 guided EVAR were evaluated. This cohort was matched for age, sex, pre-operative serum creatinine levels and glomerular filtration rate (GFR) levels and specific comorbidities to obtain homogeneous groups that included only patients with impaired renal function (eGFR < 60 mL/min/1.73m2). The primary endpoint was to compare the decrease in eGFR from baseline and development of contrast induced nephropathy (CIN) using propensity score matching. Secondary endpoints were the need for renal replacement therapy, other peri-procedural morbidity and mortality. RESULTS: Thirty-one patients (9.6%) of the total population developed CIN. There was no difference in the rate of CIN development between the standard EVAR group and the CO2 guided EVAR group in the unmatched population (10% vs. 3%, p = .15). After matching, the decrease in eGFR values after the procedure was more pronounced for the standard EVAR group (from 44 to 40 mL/min/1.73m2, interaction p = .034). Meanwhile, CIN development was more frequent for the standard EVAR group (24% vs. 3%, p = .027). In matched patients, early death did not differ between the groups (5.9% vs. 0, p = .15) CONCLUSION: Patients with impaired renal function are at higher risk of CIN after an endovascular procedure. CO2 guided EVAR is a safe, effective, and feasible treatment option, especially for patients with impaired renal function. CO2 guided EVAR may be a protective measure for contrast induced nephropathy.

Sleep disturbances in patients with lung cancer in Turkey.

INTRODUCTION: Sleep quality is known to be associated with the distressing symptoms of cancer. The purpose of this study was to analyze the impact of cancer symptoms on insomnia and the prevalence of sleep-related problems reported by the patients with lung cancer in Turkey. MATERIALS AND METHODS: Assesment of Palliative Care in Lung Cancer in Turkey (ASPECT) study, a prospective multicenter study conducted in Turkey with the participation of 26 centers and included all patients with lung cancer, was re-evaluated in terms of sleep problems, insomnia and possible association with the cancer symptoms. Demographic characteristics of patients and information about disease were recorded for each patient by physicians via face-to-face interviews, and using hospital records. Patients who have difficulty initiating or maintaining sleep (DIMS) is associated with daytime sleepiness/fatigue were diagnosed as having insomnia. Daytime sleepiness, fatigue and lung cancer symptoms were recorded and graded using the Edmonton Symptom Assessment Scale. RESULT: Among 1245 cases, 48.4% reported DIMS, 60.8% reported daytime sleepiness and 82.1% reported fatigue. The prevalence of insomnia was 44.7%. Female gender, patients with stage 3-4 disease, patients with metastases, with comorbidities, and with weight loss > 5 kg had higher rates of insomnia. Also, patients with insomnia had significantly higher rates of pain, nausea, dyspnea, and anxiety. Multivariate logistic regression analysis showed that patients with moderate to severe pain and dyspnea and severe anxiety had 2-3 times higher rates of insomnia. CONCLUSIONS: In conclusion, our results showed a clear association between sleep disturbances and cancer symptoms. Because of that, adequate symptom control is essential to maintain sleep quality in patients with lung cancer.

Dopamine Administration is a Risk Factor for Delirium in Patients Undergoing Coronary Artery Bypass Surgery.

BACKGROUND: Delirium is an important morbidity following heart surgery. We sought to determine whether dopamine infusion is associated with increased risk of delirium in patients undergoing coronary artery bypass grafting. METHODS: A total of 137 patients (mean age; 61.02±7.83, 105 males) were included in the study. Patients undergoing isolated coronary artery bypass grafting were considered eligible and those with preoperative neurological deficit or significant neurocognitive disorders, dementia or psychiatric disorders were excluded. Primary outcome measure was occurrence of delirium within 72 hours after operation. The diagnosis of delirium was made using confusion assessment method for the intensive care unit questionnaire. Both administration of dopamine as a dichotomised variable and the total amount of dopamine per kg body-weight were included in two different logistic regression models. RESULTS: Delirium occurred in 18 (13.1%) patients. Age adjusted Mantel-Haenszel relative risk for delirium with receiving dopamine was 4.62. Relative risk was 2.37 (0.18 to 31.28, 95% CI, p=0.51) in total doses over 10mg whereas it was 3.55 (1.16 to 10.89 95% CI, p=0.02) in total doses over 30 mg per kg body-weight. Older age (p=0.03), dopamine administration (OR: 9.227 95% CI, 2.688-32.022, p<0.001) and the amount of dopamine administered (OR: 1.072, 95% CI, 1.032-1.115, p<0.001) were independent predictors for delirium 72 hours after surgery. CONCLUSION: Along with older age, dopamine infusion--even in low doses but more probably in higher doses--emerged as an independent risk factor for delirium in patients undergoing CABG. Further study is needed to confirm the validity of results presented.

Comparison of the Effectiveness of Single Anastomosis Sleeve Ileal Bypass and Roux-en-Y Gastric Bypass in Obese Patients with Type 2 Diabetes.

INTRODUCTION: The rapid increase in obesity and related problems has heightened the importance of obesity and metabolic surgery, resulting in a continuing search for the ideal surgical method. This study aimed to compare the effectiveness of Roux-en-Y gastric bypass (RYGB), which is the gold standard method, and the relatively newer method of single anastomosis sleeve ileal (SASI) bypass. METHODS: The medical records of patients who underwent RYGB and SASI bypass were reviewed and compared regarding excess weight loss (EWL) and HgA1c, fasting glucose, serum iron, ferritin, hemoglobin (Hgb), and vitamin B12 levels. RESULTS: The body mass index was significantly lower (p = 0.003), and the %EWL was significantly higher (p = 0.023) at 6 months postoperative in patients who underwent SASI bypass. Both groups had similar results at the other follow-up visits. The mean HgA1c levels at the 6- and 12-month follow-up visits were significantly lower in SASI patients (p = 0.037 and p = 0.012, respectively). At the 24-month follow-up, no difference was detected in HgA1c levels between the groups (p = 0.476). In patients who underwent RYGB, ferritin (p < 0.001), plasma iron (p = 0.001), and Hgb levels (p = 0.001) were significantly lower at 12, 24, and 12 months postoperatively, respectively. CONCLUSION: SASI bypass is effective and comparable to RYGB in terms of EWL and metabolic control and has the advantage of not producing excluded segments and reducing nutritional deficiencies.

Comparative analysis of laparoscopic nissen fundoplication and rossetti modification in gastroesophageal reflux disease: A focus on life quality enhancement.

OBJECTIVE: This study aims to investigate the focus of surgical treatment of gastroesophageal reflux disease (GERD) on enhancing life quality beyond symptom relief. The comparison involves laparoscopic Nissen fundoplication and Rossetti modification techniques. METHODS: Patients intolerant to or experiencing relapse after medical therapy underwent either standard Nissen procedure (Group 1, n = 61) or Rossetti modification (Group 2, n = 42). A disease-specific quality of life questionnaire for GERD was utilized for evaluating life quality preoperatively and 2 years postoperatively. Symptom scores and patient satisfaction were also assessed. RESULTS: Preoperatively, groups were similar in symptom duration, hiatal hernia presence, and DeMeester scores (p = 0.127, p = 0.427, and 0.584, respectively). Both groups exhibited a statistically significant increase in life quality postoperatively (p < 0.001), with no significant intergroup difference. Symptoms decreased after both surgeries, except for dysphagia and bloating. Bloating significantly increased in both groups after surgery (p = 0.018 and p = 0.017, respectively), and dysphagia increased significantly only in Group 2 (p = 0.007). The surgery refusal rate was significantly higher in Group 2 for similar preoperative symptoms (p = 0.040). CONCLUSION: Despite increased life quality scores, the combination of increased dysphagia and bloating in patients undergoing Rossetti modification resulted in a decreased satisfaction rate.

Predicting Amputation Rates in Acute Limb Ischemia: Is the Neutrophil-Lymphocyte Ratio a Reliable Indicator?

Objective This study aimed to investigate the causes of amputation and the associated biochemical parameters in patients with acute limb ischemia (ALI). Methods Patients who presented to our clinic with ALI between January 2012 and January 2022 were deemed eligible for participation. Patients who developed ALI owing to atherosclerosis or atrial fibrillation were included in the study. In contrast, patients who developed ALI owing to trauma, iatrogenic causes, or popliteal artery aneurysms were excluded. Patients' demographic data, biochemical parameters, and hemogram values at the time of admission were retrospectively analyzed. Results A total of 374 patients were included in the study. Of them, 57.82% (n = 218) were male and 42.18% (n= 156) were female. Amputation was required in 7.95% (n = 30) of the patients after presenting with ALI and receiving necessary surgical or medical intervention. Multivariate analysis revealed the symptom-to-door time to be the primary factor determining the need for amputation in patients. With each passing hour following the manifestation of symptoms, the risk of amputation increased by 1.3 times [odds ratio (OR): 1.289%, 95% confidence interval (CI): 1.079-1.540 p = 0.05]. The neutrophil-to-lymphocyte ratio (NLR) and other hematological parameters had no effect on amputation in both univariate and multivariate analyses (OR: 1.49%; 95% CI: 0.977-2.287 p = 0.512). Conclusions Based on our findings, the main factor affecting the need for amputation in ALI patients was the symptom-to-door time. Biochemical and hematological parameters had no effect on amputation in ALI.

Comparison of Tenon duplication with dura mater covering technique for Ahmed glaucoma valve implantation.

PURPOSE: To compare the efficacy and complications of Tenon duplication with dura mater covering technique for Ahmed glaucoma valve (AGV) implantation. METHODS: This retrospective study included 44 refractory glaucoma patients (44 eyes) who underwent AGV implantation from 2017 to 2020 in the Ophthalmology Clinic of Eskisehir Osmangazi University Hospital and attended regular postoperative follow-ups. The patients were divided based on whether they underwent Tenon duplication technique (group 1: n = 20) or dura mater covering technique (group 2: n = 24) during surgery. The patients' age, gender, systemic diseases, glaucoma type, pre-op intraocular pressure (IOP), and ocular surgeries were recorded. The groups were compared for IOP level control, early and late complications, postoperative antiglaucomatous medication requirements, glaucoma surgery requirements, presence of postoperative hypertensive phase (HP), and surgical success which was defined as an IOP ≥5 and ≤21 mmHg, with or without antiglaucoma medication. RESULTS: By the end of the mean follow-up (22.6 ± 10.6 months), the success rates were 95% (group 1) and 96% (group 2). The groups showed no differences in postoperative complications, postoperative antiglaucomatous drugs' onset time, additional glaucoma surgery, need for needling, presence of HP at 6 months postoperatively, and relationship between the glaucoma type and success rates ( P values: 0.86, 0.9, 0.48, 0.12, 0.36, and 0.8, respectively). The IO P values at the last follow-up were 15.2 ± 4.1 in group 1 and 14.7 ± 4.8 in group 2. The IOP reduction rates showed no significant differences. CONCLUSION: Since success and complications are similar in both Tenon duplication and dura mater covering technique, unique grafting materials may not be needed in AGV implantation surgery, except in special cases.

Is familial Mediterranean fever (FMF) common in patients with negative appendectomy?

OBJECTIVES: Familial Mediterranean fever (FMF) is an autosomal-recessive disease characterized by recurrent attacks of fever with serositis. Differential diagnosis of a FMF abdominal attack with acute abdomen is difficult. Acute appendicitis is the most common cause of acute abdominal pain that requires surgical treatment. The aim of this study was to investigate frequency of FMF in patients with negative appendectomy. METHODS: We assessed 278 patients (female/male 127/151) who were operated with preoperative diagnosis of acute appendicitis. In 250 of the patients, definitive diagnosis of acute appendicitis was established by histo-pathological examination. Patients with negative appendectomy were assessed for FMF by rheumatologist. RESULTS: Negative appendectomy was detected in 28 patients (M/F 5/23, mean age 25.3 ± 8.4 years). Negative appendectomy ratio was 10.1 %. Among 28 patients two had FMF (7.7 %). CONCLUSIONS: FMF were established in 7.7 % of patients with negative appendectomy. Our study suggests patients having negative appendectomy should be evaluated for FMF. Further large sample studies are needed to define the real prevalence of FMF among negative appendectomy patients.

Factors Affecting Recanalization in Femoropopliteal Deep Vein Thrombosis.

Effects of warfarin and new-generation direct oral anticoagulants (DOACs) on thrombus resolution after the treatment of deep vein thrombosis (DVT) are still unknown. The study aimed to investigate the effects of warfarin and DOACs on thrombus resolution after DVT treatment. Methods: The study included 666 patients who were diagnosed with femoropopliteal DVT between January 2016 and January 2022 and had complete medical records without missing data. Patients with and without recanalization were added to groups 1 (n = 396) and 2 (n = 270), respectively. Ultrasonography/venous Doppler examinations of the patients during follow-up were performed by 3 radiologists. Recanalization was defined as the presence of complete flow in the femoral and popliteal veins and the absence of residual venous thrombus. Results: Among the included patients, recanalization was observed in 59.5% patients. The mean follow-up period was 23.6 ± 17.8 (range 1-72; median 17) months. There was no difference between the 2 groups in terms of the types of drugs used in the treatment (P = .208). Cox regression models were used to investigate the factors affecting recanalization. Analysis of the variables having significant differences between both groups revealed the low rate of recanalization in patients with coronary artery disease (odds ratio [OR], 2.3%; 95% confidence intervals [CI]: 1.6-3.4; P < .001) and diabetes mellitus (OR, 1.5; 95% CI: 1.1-1.9; P = .009). Conclusion: Thrombus resolution after femoropopliteal DVT is not affected by the drugs used in the treatment.

Mid-term results of surgical interventions of high-grade vena cava tumor thrombus.

Background: This study aims to investigate whether the coexistence of advanced renal cell carcinoma and inferior vena cava tumor thrombus could be treated with a multidisciplinary approach and teamwork and to evaluate early and mid-term results. Methods: Between January 2017 and December 2020, a total of 33 patients (28 males, 5 females; mean age: 55.8±13.2 years; range, 27 to 76 years) who underwent radical nephrectomy and thrombectomy of the inferior vena cava were retrospectively analyzed. Demographic characteristics of the patients, types of operations, postoperative data, mortality and morbidity rates were recorded. Results: Of the patients, 12% (n=4) had Stage 2 tumor thrombus, 60.6% (n=20) had Stage 3 tumor thrombus, and 27% (n=9) had Stage 4 tumor thrombus. A total of 55% (n=19) of the patients had right-sided renal cell carcinoma, while 45% (n=14) of them had a left-sided mass. Totally, 66% (n=22) of the patients underwent primary inferior vena cava repair. The thrombectomy procedure and a Dacron® patch was applied with patch plasty in 24% (n=8) of the patients, and Dacron® graft interposition was applied to the inferior vena cava in 9% (n=3) of the patients. The mean follow-up was 20.3±13.0 (range, 2 to 70) months. Deep vein thrombosis was detected in the follow-up of seven (21%) patients, and no pulmonary thromboembolism was observed during the postoperative follow-up period. The mean length of stay in the intensive care unit was 1.39±0.6 (range, 1 to 3) days. The 30-day mortality rate was 3%, due to the loss of one patient from massive pulmonary embolism intraoperatively. Conclusion: Vascular surgical procedures performed regardless of the stage of the tumor thrombus provide satisfactory mid-term results in patients with advanced renal cell cancer.

Surgical treatment of massive pulmonary thromboembolism due to renal cell carcinoma.

While renal cell carcinomas frequently invade the renal vein and inferior vena cava, the right atrial extension or formation of bilateral pulmonary massive embolism is quite unusual. A 65-year-old male patient underwent bilateral pulmonary tumor endarterectomy and total thrombectomy of the inferior vena cava combined with left nephrectomy under total circulatory arrest with antegrade cerebral perfusion. Both mediastinal and abdominal approaches facilitated the complete removal of the caval thrombus under the guidance of transesophageal echocardiography. The patient is still under follow-up for six months without metastasis. In conclusion, pulmonary thromboembolism due to renal cell carcinoma is rare, surgical treatment is possible.

Evaluation of hemodialysis patients and hemodialysis health workers with COVID-19 IgM and IgG antibody test; a multicenter study from Eskisehir, Turkiye.

OBJECTIVE: Hemodialysis (HD) patients are a population at high risk for exposure to the severe respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Undiagnosed mild or asymptomatic SARS-CoV-2 infection in HD patients can make these patients a potential source of infection. In our study, we aimed to evaluate the entire spectrum of SARS-CoV-2 infection with the IgM and IgG rapid antibody kit in HD patients and healthcare providers working in HD unit. METHODS: 633 HD patients and 134 health workers from all dialysis centers (three private and three public) in Eskisehir were included in the study. Blood samples obtained from participants were allowed to clot for 30 min at room temperature at 15°C using a serum separator tube. Then it was centrifuged at 1000 g at 2-8°C for 15 min. The supernatant was collected and the samples were stored at -20°C until use. Serum samples stored at the end of the study were studied with the A.B.T.™ Biotechnology COVID-19 Rapid IgG-IgM Diagnostic Test. Routine examination was measured by standard methods. All participants were evaluated by serological analysis of IgG and IgM antibodies against the SARS-CoV-2 recombinant antigen. RESULTS: Two symptomatic HD patients (0.27%) were diagnosed with SARS-CoV-2 infection by real-time reverse-transcription-polymerase-chain - reaction test and chest tomography. In 15 (2.36%) of 633 asymptomatic patients, antibody was positive against the SARS-CoV recombinant antigen (IgG in 13, both IgG and IgM in 2), while no antibodies were detected in 134 health workers. CONCLUSION: We have shown that most HD patients with SARS-CoV-2 experience the disease asymptomatically, and that antibody testing plays an important role in identifying patients with asymptomatic infection.

Superiority of Baseline Biomechanical Properties over Corneal Tomography in Predicting Keratoconus Progression

Objectives: To determine corneal biomechanical and tomographic factors associated with keratoconus (KC) progression. Materials and Methods: This study included 111 eyes of 111 KC patients who were followed-up for at least 1 year. Progression was defined as the presence of progressive change between the first two consecutive baseline visits in any single parameter (A, B, or C) ≥95% confidence interval or two parameters ≥80% confidence interval for the KC population evaluated by the Belin ABCD progression display. The eye with better initial tomographic findings was chosen as the study eye. Analyzed Pentacam parameters were maximum keratometry (Kmax), minimum pachymetry (Kmin), central corneal thickness, thinnest corneal thickness, 90° vertical anterior and posterior coma data in Zernike analysis, and Belin Ambrosio Enhanced Ectasia Display Final D value. Corneal hysteresis (CH) and corneal resistance factor (CRF) were analyzed together with the waveform parameters obtained with Ocular Response Analyzer (ORA). Factors related to KC progression were evaluated using t-tests and logistic regression tests. Statistical significance was accepted as p<0.05. Results: There were 44 (mean age: 27.1±8.5 years, female: 25) and 67 (mean age: 31.1±9.1 years, female: 36) patients in the progressive and non-progressive groups, respectively. Although Pentacam parameters along with CH and CRF were similar between the two groups, ORA waveform parameter derived from the second applanation signal p2area was statistically significantly lower in the progressive group (p=0.02). Each 100-unit decrease in p2area increased the likelihood of keratoconus progression by approximately 30% in the logistic regression analysis (ß=0.707, p=0.001, model r2=0.27). Conclusion: Parameters derived from the second applanation signal of ORA may be superior to conventional ORA parameters and corneal tomography in predicting KC progression.

A new seton tightening method for anal fistula treatment: sailor's knot.

AIM: There are certain problems experienced while retightening the seton material during the patient follow-ups, such as pain and anaesthesia requirements in perianal fistula. The aim of the present study was to compare a sailor's knot with other seton tightening methods for the surgical treatment of perianal fistulas. MATERIAL AND METHODS: The records of 105 patients who underwent surgeries for perianal fistulas using the seton method between 2016 and 2019 were analysed retrospectively. The demographic characteristics, complaints, fistula localizations, surgery types, hospital stay lengths, postoperative complications and imaging modalities of the patients included in the study were recorded. The patients were divided into two groups according to the surgical treatment method. Those patients who underwent seton procedures with a sailor's knot were included in Group 1. Group 2 included those patients who underwent other seton procedures, including silk and penrose drain procedures. Groups were compared with regard to success rates and postoperative recurrence. RESULTS: There was no statistically significant difference between the groups in terms of the age, gender, fistula type and follow-up duration. Success rate in all patient was 88.6%, 91.2% in group 1 and 87.1% in group 2 (p=0.36). The number of patients with a kind of incontinence was 7 (7.1%), 3 (5.8%) in Group 1 and 4 (7.4%) in Group 2 (p = 0.297). CONCLUSION: There were no statistically significant differences with regard to complications and recurrences between the sailor's knot and the other seton tightening methods used for the treatment of anal fistulas. The sailor's knot is recommended with regard to its easy application and seton retightening with satisfactory outcomes. KEY WORDS: Perianal fistula, Sailor's knot, Seton.

Nitric oxide, lipid peroxidation and total thiol levels in acute appendicitis.

BACKGROUND: The mechanisms involved in the pathology of acute appendicitis (AA) and the factors affecting the progression have still been investigated. Oxidative stress is one of the factors of interest. Nitric oxide (NO) and its role in AA has not been studied previously. METHODS: Thirty-four patients who underwent operation with a perioperative diagnosis of AA and 16 age and sex-matched controls were included in the study. Serum thiobarbituric acid reactive substances (TBARS), thiol groups (SH), NO metabolites (NO(x)), and conventional inflammation markers were determined. RESULTS: NO(x), TBARS, C-reactive protein (CRP) levels, white blood cell (WBC) count, and erythrocyte sedimentation rate (ESR) were significantly higher, and total SH was significantly lower in AA than in control group. NO(x), TBARS, and SH levels were comparable in acute phlegmonous appendicitis and advanced appendicitis. There was a significant positive correlation between NO(x) and TBARS, CRP, ESR, WBC and a significant negative correlation between NO(x) and SH. CONCLUSIONS: Serum NO(x) levels and oxidative stress elevate in AA independent from the extent of the lesion. Increased NO may play a role in the increased oxidative stress in AA.

A case of intratracheal schwannoma presenting at the emergency department with a diagnosis of asthmatic attack.

Primary tumors of the tracheobronchial tree are rare, and benign tumors are even rarer. Patients with tracheobronchial tumors are at times wrongly diagnosed with asthma. A 77-year-old woman presented to our Emergency Department with increasing dyspnea and stridor. She had been treated for bronchial asthma for the last 7 years. Due to the presence of the stridor, a cervical soft tissue computed tomography scan was performed. It revealed a tracheal polyp at the level of the thyroidal isthmus. Polyp excision with rigid bronchoscopy was performed by a thoracic surgeon. This case demonstrates that intratracheal masses should be considered in patients with dyspnea and stridor or in patients with asthma refractory to usual treatment.

The Effect of Increased Neutrophil Lymphocyte Ratio on Mortality in Patients Operated on Due to Hip Fracture.

Introduction In this study, we aimed to examine the effect of neutrophil-lymphocyte ratio (NLR) on mortality and morbidity in elderly patients over the age of 65 who presented to our clinic and were operated on due to hip fracture. Methods The study included patients over the age of 65 who were operated on in our hospital between January 2014 and December 2018 due to hip fracture. Those with multiple fractures and those who were operated on due to cancer-related fracture were excluded. Patients' age, gender, American Society of Anesthesiologists (ASA) score, preoperative waiting time, type of anesthesia, operation duration, amount of erythrocyte suspension used, and duration of intensive care unit (ICU) stay were recorded. The effect of increased preoperative and postoperative 5th day neutrophil-lymphocyte ratios (NLR 1 and NLR 5, respectively) on mortality and morbidity was investigated. Results We examined 132 patients operated on due to hip fracture. NLR 5 was higher among patients who were admitted to the ICU (p = 0.007) and among those who died (p = 0.007). Additionally, the rate of increase of NLR 5 was higher among patients who were admitted to the ICU (p = 0.044) and among those died (p = 0.009). Conclusion The rate of increase of NLR in the postoperative period can be used as a criterion for predicting mortality in patients who are operated on due to hip fracture.

A Combined Biomechanical and Tomographic Model for Identifying Cases of Subclinical Keratoconus.

PURPOSE: To develop a combined biomechanical and tomographic model for identifying eyes with subclinical keratoconus (SKC) that are categorized as normal or borderline in the Pentacam Belin/Ambrósio Enhanced Ectasia Display. METHODS: This case-control study comprised 62 eyes with SKC and randomly selected eyes of 186 age-matched healthy controls. SKC was defined as the presence of the following: 1) normal topography, topometric indices, and slit lamp; 2) normal or borderline Belin/Ambrósio Enhanced Ectasia Display D index, back and front elevation difference; and 3) keratoconus in the fellow eye. Stepwise logistic regression analysis was performed to identify the best variable combination for detecting SKC cases from Ocular Response Analyzer and Pentacam parameters. Receiver operating characteristic curve analysis was used to determine the predictive accuracy [area under the curve (AUC)] of the model. Based on the predictors in the final logistic regression model, a linear equation was derived using the discriminant function analysis. RESULTS: The final model (AUC: 0.948, sensitivity: 87.1%, and specificity: 91.4%) chose corneal hysteresis (CH) and D index from a total of 63 candidate variables. The final model had a higher AUC compared with D (0.933, P = 0.053) and CH (0.80, P < 0.001) alone. According to the discriminant function analysis, a higher CH was required with increasing D index to classify an eye as normal. CONCLUSIONS: The proposed combined model provided varying cutoffs for CH and D as a function of the other. The probability plot as a function of CH and D index may be used for identifying eyes with SKC.

[Rare reflex in regional anesthesia which have a high-risk in case of forgotten: Bezold-Jarisch reflex]. / Rejyonel anestezide nadir görülen unutulmasi durumunda yüksek risk tasiyan bir refleks: Bezold-Jarisch refleksi.

Bezold-Jarisch reflex is a reflex that may occur during regional anesthesia, upper-extremity blocks and sometimes in general anesthesia, resulting in hypotension, bradycardia, apnea or cardiac arrest elicited by chemical or mechanical receptor stimulations. This reflex mostly occurs in the sitting position during upper-extremity nerve blocks can be forgotten in other complications. The complications that occurred after this reflex can be overcome by taking necessary precautions and providing sufficient cardiac monitorization. In our cases to be presented, we want to remind you of Bezold-Jarisch reflex, which may cause severe complications when forgotten.

Comparison of General Anesthesia (Sevoflurane) and Spinal Anesthesia (Levobupivacaine) Methods on QT Dispersion in Inguinal Hernia Operations.

Introduction Arrhythmias are one of the most frequently seen issues during surgical operations. In this study, we investigated and compared the effects on the QT dispersion of patients when using a method of volatile inhalation mask anesthesia with sevoflurane (VIMA: Group I) and when spinal anesthesia was performed with levobupivacaine (Group II). Methods The study included 40 patients who had American Society of Anesthesiology scores of I-II (ASA I-II), were aged from 18 to 65 years, and were scheduled for inguinal hernia operations. Approval of the university ethics committee was obtained before the study began. All patients had measurements taken for non-invasive blood pressure, including systolic arterial pressure (SAP), diastolic arterial pressure (DAP), and mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SO2) values. The QT intervals were measured using the 12-derivation electrocardiogram (ECG) device (Cardiofax V). Our study was performed with randomization using the closed envelope method. Results When the percentage differences of the HR values from the initial period in both groups were compared, we observed significant differences between the groups, with increases in the VIMA group at the second period as well as increases in the VIMA group at the fourth, fifth, sixth, seventh, and ninth periods but decreases in the spinal anesthesia group for these periods. There were statistically significant differences between the two groups at the third and fifth periods when the percentage differences of the QTc values from the initial period were compared. We observed increases in the spinal anesthesia group. Conclusion In our study, we suggest that the tendency toward arrhythmia may be reduced by choosing general anesthesia with sevoflurane rather than levobupivacaine in patients with cardiac complaints who are undergoing regional anesthesia and/or taking medication that affects QT intervals.