RESUMEN
OBJECTIVE: There are no reports of tracheomediastinal fistula development after tracheostomy. CASE REPORT: A 72-year-old female patient with post acute COVID-19 was transferred to our intensive care unit. After two unsuccessful weaning attempts, a tracheostomy was performed at hospitalization on day 32. The patient's body mass index was 35 kg/m2 and she had a narrow neck anatomy. A percutaneous tracheostomy was performed using the Griggs method without any problems. Pneumothorax, pneumomediastinum, subcutaneous emphysema, and hemorrhage were not observed. Twenty-two days after the tracheostomy, the patient developed subcutaneous emphysema and experienced a sudden decrease in oxygen saturation. Bedside anterior-posterior chest X-ray did not detect pneumothorax and a tracheoesophageal fistula was found via esophageal endoscopy. A tracheomediastinal fistula was observed just below the cannula distal end via computed tomography. CONCLUSIONS: There are multiple reasons why a tracheomediastinal fistula could develop after tracheostomy. Therefore, this condition should be considered in cases of sudden subcutaneous emphysema and oxygen deterioration following tracheostomy.
Asunto(s)
COVID-19 , Fístula , Neumotórax , Enfisema Subcutáneo , Anciano , COVID-19/complicaciones , Femenino , Fístula/complicaciones , Humanos , Neumotórax/etiología , Enfisema Subcutáneo/complicaciones , Enfisema Subcutáneo/etiología , TraqueostomíaRESUMEN
Coronavirus disease 2019-induced acute respiratory distress syndrome (ARDS) is more severe in morbidly obese patients. Mechanical ventilation differs between obese and non-obese patients. We examined these differences in an obese (body mass index = 47 kg/m2) 32-year-old patient followed up in our clinic. The patient was admitted to the intensive care unit due to respiratory failure. Recruitment maneuvers were performed in pressure-controlled ventilation mode. The optimal positive end-expiratory pressure was 25 cm H2O. The inspiratory pressure was adjusted to 45 cm H2O to provide a tidal volume of 6 ml/kg and driving pressure ≤ 15. The patient was discharged with full recovery.
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COVID-19/terapia , Obesidad Mórbida , Respiración Artificial/métodos , Síndrome de Dificultad Respiratoria/terapia , Adulto , COVID-19/sangre , COVID-19/complicaciones , COVID-19/diagnóstico por imagen , Humanos , Unidades de Cuidados Intensivos , Masculino , Obesidad Mórbida/complicaciones , Respiración con Presión Positiva/métodos , Síndrome de Dificultad Respiratoria/complicaciones , Volumen de Ventilación PulmonarRESUMEN
BACKGROUND: There are a lot study confirmed the relationship of bone serum markers changes and skeletal irregularities. But there is no sufficient case control studies about the role of these markers on bisphosphonate induced osteonecrosis of jaws (BRONJ). AIMS: The aim of this study is to find out if there is any derangement of bone markers in bisphosphonate-treated patients with ONJ. METHODS: We obtained serum bone markers and other relevant endocrine assays on 20 patients with osteonecrosis of the jaw (ONJ) and 20 randomized healthy volunteers. All of the ONJ group treated with zoledronic acid and had been withdrawn from bisphosphonate for at least 6 months. Diagnostic criteria for ONJ were those formulated by the American Association of Oral and Maxillofacial Surgeons. Serum levels of several indices of bone remodeling were evaluated using commercial enzyme-linked immunosorbent assays. The biochemical assays were performed on N-Telopeptides of type I collagen (NTX), bone-specific alkaline phosphatase (ALP), calcitonin, osteocalcin, intact parathyroid hormone (PTH), T3, T4, TSH, and Vitamin D 25 hydroxy (Vit-D). RESULTS: In ONJ group, PTH level is statistically higher and TSH, Vit-D, osteocalcin and NTX levels statistically lower compared to control group. CONCLUSION: We conclude that these changes in PTH, Vit-D, TSH, osteocalcin and NTX levels maybe have a role in the pathophysiology of BRONJ. But the data need to be confirmed by future studies.
Asunto(s)
Osteonecrosis de los Maxilares Asociada a Difosfonatos/sangre , Conservadores de la Densidad Ósea/efectos adversos , Remodelación Ósea/efectos de los fármacos , Colágeno Tipo I/sangre , Difosfonatos/efectos adversos , Hormona Paratiroidea/sangre , Vitamina D/sangre , Fosfatasa Alcalina/sangre , Biomarcadores/sangre , Conservadores de la Densidad Ósea/administración & dosificación , Estudios de Casos y Controles , Difosfonatos/administración & dosificación , Ensayo de Inmunoadsorción Enzimática , Femenino , Humanos , Masculino , Persona de Mediana Edad , Osteocalcina , Péptidos , Ácido Zoledrónico/uso terapéuticoRESUMEN
CONTEXT: Investigating the adverse effects of oral hormone replacement therapy (HRT), the clinical effectiveness of alternative combinations and route of administrations. AIM: To compare the effects of intranasal and transdermal 17 beta-estradiol combined with vaginal progesterone on vasomotor symptoms and vaginal cytology. SETTINGS AND DESIGN: A 12-week, prospective, randomized comparative study was conducted between July 2005 and September 2006. MATERIALS AND METHODS: Eighty postmenopausal women aged between 42-57 years, who had scores of > or =1.7 on the menopause rating scale-I (MRS-I) items "1-6", were randomly assigned to receive intranasal (300 microg/day, n =40) or transdermal (50 microg/day, n =40) 17 beta-estradiol continuously. All patients also received a vaginal progesterone gel twice weekly. Vasomotor symptoms were evaluated at weeks 0, 4, 8 and 12. Vaginal maturation index (VMI) was evaluated at weeks 0 and 12 of the study. STATISTICAL ANALYSES: The Mann-Whitney U and the Wilcoxon tests were used. P < 0.05 was regarded as significant. RESULTS: Thirty-two women in the intranasal and 29 women in the transdermal group completed the study. The total score of the MRS, the sum-scores of Factor 1 "HOT FLUSHES" and Factor 2 "PSYCHE" significantly decreased in both groups at week 4. Factor 3 "ATROPHY" scores significantly decreased only in the transdermal group at week 12. The VMI showed no changes within and between the two groups at the end of the study. CONCLUSION: Intranasal and transdermal 17beta-estradiol combined with vaginal progesterone gel as a continuous HRT caused a similar decrease in vasomotor symptoms but did not have any significant effect on VMI after 12 weeks of treatment in this study population.
Asunto(s)
Estradiol/administración & dosificación , Terapia de Reemplazo de Estrógeno , Estrógenos/administración & dosificación , Posmenopausia/efectos de los fármacos , Vagina/efectos de los fármacos , Administración Cutánea , Administración Intranasal , Administración Intravaginal , Adulto , Femenino , Humanos , Persona de Mediana Edad , Posmenopausia/fisiología , Posmenopausia/psicología , Progesterona/administración & dosificación , Progestinas/administración & dosificación , Estudios Prospectivos , Vagina/patologíaRESUMEN
This study was aimed to investigate the effect of sedation on plasma soluble P-selectin (sP-selectin) levels and initiation phase of coagulation following coronary intervention. A total of 58 patients with unstable angina were randomised into two groups of sedated (n = 29) and nonsedated (n = 29) patients. sP-Selectin, adrenaline, noradrenaline, von Willebrand factor (vWF), fibrinogen, platelet and troponin-I levels were measured before the intervention and at 30 min and 24 h after the intervention. In the sedated group, adrenaline, noradrenaline, sP-selectin and fibrinogen levels remained stable 30 min after the intervention (p > 0.05), whereas vWF level increased (p < 0.05). In the nonsedated group, 30-min sP-selectin (p < 0.001), adrenaline (p < 0.05), noradrenaline (p = 0.012), vWF (p < 0.001) and fibrinogen (p < 0.001) levels were found to be increased. Also, 24-h sP-selectin, vWF and fibrinogen levels for both groups showed significant increases when compared with the values both 30 h before (p < 0.001) and 30 min after the intervention (p < 0.001). Sedation before interventions reduces sP-selectin levels, initial phase of coagulation and, consequently, myocardial damage.
Asunto(s)
Angina Inestable/terapia , Coagulación Sanguínea/efectos de los fármacos , Cardiomiopatías/prevención & control , Sedación Consciente , Selectina-P/sangre , Adulto , Anciano , Angina Inestable/sangre , Biomarcadores/sangre , Femenino , Humanos , Hipnóticos y Sedantes/farmacología , Masculino , Midazolam/farmacología , Persona de Mediana Edad , Selectina-P/efectos de los fármacos , StentsRESUMEN
OBJECTIVE: Common carotid artery intima-media thickness (CIMT) is a non-invasively assessed marker of subclinical atherosclerosis. Our aim in this study was to investigate CIMT in women with gestational diabetes mellitus (GDM). METHODS: Thirty women with GDM and 40 unaffected women (as a control group) were included in the study. Blood samples were drawn from each woman in the morning after they had fasted for at least 8 h, and levels of fasting glucose, insulin, homocysteine, total cholesterol, high-density lipoprotein (HDL) cholesterol, triglycerides, low-density lipoprotein (LDL) cholesterol and very low-density lipoprotein (VLDL) cholesterol were measured, along with the CIMT in the two groups. RESULTS: The mean triglyceride (P = 0.016) and VLDL cholesterol (P = 0.011) levels in the GDM group were significantly higher than those in the unaffected women. There were no significant differences between the groups with respect to plasma levels of total cholesterol, HDL cholesterol, LDL cholesterol and insulin. The mean homocysteine (P = 0.027) and fasting glucose (P = 0.019) levels in women with GDM were significantly higher than those in the control group. Patients with GDM had significantly higher CIMT than did the unaffected women (0.582 +/- 0.066 mm vs. 0.543 +/- 0.049 mm, P = 0.006). CIMT correlated positively with maternal age (r = 0.316, P = 0.008), body mass index (BMI) at the time of a 50-g oral glucose load test (r = 0.414, P = 0.001) and homocysteine levels (r = 0.332, P = 0.008), and fasting glucose (r = 0.265, P = 0.031) and 1-h glucose value (r = 0.410, P = 0.001) at the time of the oral glucose tolerance test. There was a positive correlation between the presence of GDM and CIMT (r = 0.372, P = 0.001). However, stepwise multiple regression analysis showed that GDM/no GDM (95% CI +0.012 to +0.076, P = 0.008) and BMI at the time of the 50-g test (95% CI +0.001 to +0.009, P = 0.011) were independent parameters related to CIMT. CONCLUSION: Women with GDM have increased CIMT compared with unaffected women.
Asunto(s)
Aterosclerosis/patología , Enfermedades de las Arterias Carótidas/patología , Diabetes Gestacional/patología , Túnica Íntima/patología , Adulto , Aterosclerosis/sangre , Aterosclerosis/etiología , Glucemia/metabolismo , Enfermedades de las Arterias Carótidas/sangre , Enfermedades de las Arterias Carótidas/etiología , Estudios de Casos y Controles , Colesterol/sangre , Diabetes Gestacional/sangre , Femenino , Homocisteína/sangre , Humanos , Embarazo , Estudios ProspectivosRESUMEN
Zero and first order derivative UV spectrophotometric methods were developed for the analysis of lornoxicam (LOR). The solutions of the standards and pharmaceutical samples were prepared in 0.05 N NaOH. Absorbances of LOR were measured at 376 nm for the zero order by measuring height of peak from zero and at 281 and 302 nm for the first order derivative spectrophotometric method by measuring peak to peak height. The linearity ranges were found to be 0.5-35 microg/mL for the zero order and 0.2-75 microg/mL for the first order derivative UV spectrophotometric method. The methods were validated and applied to the determination of LOR in pharmaceutical preparations (tablet and injectable, both containing 8 mg LOR). It was concluded that the methods developed were accurate, sensitive, precise, robust, rugged and useful for the quality control of LOR in pharmaceutical preparations.
Asunto(s)
Antiinflamatorios no Esteroideos/análisis , Piroxicam/análogos & derivados , Piroxicam/análisis , Calibración , Concentración de Iones de Hidrógeno , Indicadores y Reactivos , Soluciones Farmacéuticas/análisis , Estándares de Referencia , Reproducibilidad de los Resultados , Espectrofotometría Ultravioleta , Comprimidos/análisisRESUMEN
The aim of the study was to compare lipoprotein(a) [Lp(a)] levels in patients with cTroponin-I (cTn-I)-positive or -negative unstable angina and to investigate their relationship with atherothrombosis. A total of 202 consecutive patients were enrolled in the study. Lp(a), fibrinogen, plasminogen, PAI-1 and t-PA levels were measured and C-reactive protein (CRP) assays were performed on admission for all patients, and venous blood samples were drawn 12 and 24 h later for cTn-I measurements. The patients were divided into cTn-I-negative (cTn-I < 1 ng/ml) and -positive (cTn-I > or = 1 ng/ml) unstable angina groups. Lp(a) levels of the cTn-I-positive patients were higher than those of the cTn-I-negative patients (52.9 +/- 6.0 and 15.7 +/- 2.5 mg/dl, p < 0.0001). There was a positive correlation between Lp(a) and cTn-I levels (r = 0.692; p = 0.0001). Increase in coagulation activity and impairment in fibrinolytic activity were significant in the cTn-I-positive patients. Elevated Lp(a) levels may have a role in the development of myocardial damage in patients with unstable angina.
Asunto(s)
Angina Inestable/sangre , Enfermedad de la Arteria Coronaria/sangre , Trombosis Coronaria/sangre , Lipoproteína(a)/metabolismo , Infarto del Miocardio/sangre , Troponina I/sangre , Femenino , Fibrinógeno/metabolismo , Humanos , Masculino , Persona de Mediana Edad , Plasminógeno/metabolismo , Valor Predictivo de las Pruebas , Factores de RiesgoRESUMEN
This case-control study was designed to outline age- and gender-related differences of metabolic risk factors in a group of patients with coronary artery disease (CAD). Accordingly, a total of 366 consecutive patients with a recent diagnosis of CAD (139 women, 41-79 yr; 227 men, 39-78 yr) were screened between October 1999 and April 2001 at Baskent University Adana Medical Center, and 366 age- and gender-matched individuals were selected as a control group. We compared demographics, blood pressure, body mass index, waist circumference, lipid profile, fasting and post-prandial glucose-insulin levels between CAD patients and the control group. Prevalence of metabolic syndrome was 72.6% in females, and 39.0% in males with CAD. Hypertension, obesity and diabetes were more common in female patients; 64.5% of female patients had premature CAD and 83.5% of those had metabolic syndrome. In logistic (OR: 3.57 for women and OR: 1.59 for men) regression analysis, metabolic syndrome was independently associated with CAD in both genders. As a conclusion, prevalence of metabolic syndrome was significantly higher in patients with CAD than the control group, especially in female patients. The metabolic syndrome was independently associated with CAD in both genders.
Asunto(s)
Enfermedad de la Arteria Coronaria/etiología , Síndrome Metabólico/etiología , Adulto , Anciano , Biomarcadores/sangre , Glucemia/metabolismo , Índice de Masa Corporal , Estudios de Casos y Controles , HDL-Colesterol/sangre , LDL-Colesterol/sangre , Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/metabolismo , Diabetes Mellitus/epidemiología , Diabetes Mellitus/etiología , Diabetes Mellitus/metabolismo , Ayuno/sangre , Femenino , Humanos , Hipertensión/epidemiología , Hipertensión/etiología , Hipertensión/metabolismo , Modelos Logísticos , Masculino , Síndrome Metabólico/epidemiología , Síndrome Metabólico/metabolismo , Persona de Mediana Edad , Periodo Posprandial/fisiología , Prevalencia , Factores de Riesgo , Factores Sexuales , Estadística como Asunto , Triglicéridos/sangre , Turquía/epidemiologíaAsunto(s)
Anomalías de los Vasos Coronarios/diagnóstico por imagen , Disfunción Ventricular Izquierda/etiología , Dolor en el Pecho/etiología , Anomalías de los Vasos Coronarios/complicaciones , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/etiología , RadiografíaRESUMEN
The aim of this study is to investigate immunoreactivity for p53, p21 and metallothionein in diffuse malignant pleural mesothelioma (DMPM) and to determine the relationships between the age, sex, asbestos exposure time, survival of DMPM patients with environmental asbestos exposure and immunoreactivity to p53, p21 and metallothionein. Sixty-seven histopathologically-confirmed DMPMs, 38 of whom had environmental and 29 had occupational asbestos exposure, were included. The tumour tissue samples were immunostained with antibodies against p53, p21 and metallothionein. Epidemiological data and the survival times for the DMPM patients with environmental asbestos exposures were obtained from hospital records. Thirty-three per cent of the DMPMs were positive for p53, 35% for p21 and 52% for metallothionein. There was no statistical difference between the histological subtypes of DMPM in terms of immunoreactivity for p53, p21 and metallothionein. For p21 and metallothionein there was a statistically significant difference between the exposure characteristics: patients with environmental asbestos exposure had shown more immunopositivity. There were statistically significant differences between age groups and between asbestos exposure times for metallothionein, and between asbestos exposure times and p21. The patients with positive immunostaining had longer exposure times and were older than those having negative immunostaining. The differences between survival of the patients were not statistically significant in terms of the immunohistochemical results for p53, p21 and metallothionein.
Asunto(s)
Mesotelioma/química , Metalotioneína/análisis , Proteína Oncogénica p21(ras)/análisis , Neoplasias Pleurales/química , Proteína p53 Supresora de Tumor/análisis , Factores de Edad , Asbestos Anfíboles/efectos adversos , Distribución de Chi-Cuadrado , Exposición a Riesgos Ambientales/efectos adversos , Femenino , Humanos , Masculino , Mesotelioma/etiología , Persona de Mediana Edad , Exposición Profesional/efectos adversos , Adhesión en Parafina , Neoplasias Pleurales/etiología , Pronóstico , Factores Sexuales , Análisis de SupervivenciaRESUMEN
Hemangiopericytoma is an uncommon mesenchymal tumor originating from pericytes. We describe the clinical and morphologic features in a case of intrathoracic extrapulmonary giant hemangiopericytoma. The tumor was radically removed, and the microscopy report was benign hemangiopericytoma. Because of the high risk of local recurrence, long-term follow-up is important in such patients.
Asunto(s)
Hemangiopericitoma/diagnóstico por imagen , Hemangiopericitoma/cirugía , Neoplasias Torácicas/diagnóstico por imagen , Neoplasias Torácicas/cirugía , Adulto , Hemangiopericitoma/patología , Humanos , Masculino , Radiografía , Neoplasias Torácicas/patología , ToracotomíaRESUMEN
PURPOSE: To evaluate intraocular pressure (IOP) control after extracapsular cataract extraction (ECCE) with posterior chamber intraocular lens (PCIOL) implantation in patients with capsular glaucoma (CG) and coexisting cataract. METHODS: This prospective study included 20 patients (20 eyes) having CG and cataract whose IOPs were under 22 mm Hg and controlled with antiglaucoma medication. All patients had ECCE with PCIOL implantation and the follow-up period was at least 18 months. IOP was measured postoperatively at 3, 6, 9, 12 and 18 months and compared with preoperative IOP. RESULTS: Following the cataract extraction, PCIOL implantation produced a statistically significant reduction in IOP at all time points compared with the preoperative IOP during the study period (p < 0. 001). The mean preoperative IOP was 18.25 +/- 1.83 mm Hg; postoperatively at 1 month, it was 13.45 +/- 2.06 mm Hg; at 3 months 14.80 +/- 2.50 mm Hg; at 6 months 15.35 +/- 1.27 mm Hg, at 12 months 14.85 +/- 1.87 mm Hg and at 18 months 15.15 +/- 1.42 mm Hg (p < 0. 0008). The mean reduction in IOP was 16.98% from baseline at 18 months postoperatively. The mean number of antiglaucoma medication was reduced from 1.35/eye preoperatively to 0.60/eye postoperatively at 18 months (p < 0.0007). CONCLUSION: The result of our study revealed that ECCE with PCIOL implantation may be a reliable choice in controlling IOP in patients with CG.
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Extracción de Catarata/métodos , Catarata/complicaciones , Síndrome de Exfoliación/complicaciones , Implantación de Lentes Intraoculares/métodos , Anciano , Síndrome de Exfoliación/fisiopatología , Femenino , Humanos , Presión Intraocular , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: To evaluate the conjunctival structure and inflammatory cell counts and to determine the predictive value of these histological parameters for postoperative intraocular pressure (IOP) levels after trabeculectomy. METHODS: A clinical and histological study was performed on consecutive patients. Postoperative (mean 32. 8 +/- 18.4 months; range 6-60 months) conjunctival biopsies of 36 eyes of 28 primary open-angle glaucoma patients who had trabeculectomy between 1992 and 1995 were included in the study. According to postoperative pressure control, patients with < or = 16 mm Hg and those with >16 mm Hg were taken as groups 1 and 2, respectively. The control group (group 3) consisted of 15 age-matched patients without glaucoma, who had received no topical therapy. We compared the conjunctival structure and cell counts within these groups. Goblet cells, acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness, vascular density, mucopolysaccharides and collagen compositions were determined in groups 1, 2 and 3. RESULTS: The number of goblet cells was significantly higher in group 1 (6.74 +/- 7.23) than group 2 (3. 09 +/- 2.77; p = 0.017). No statistical difference was observed in the number of acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness, vascular density, mucopolysaccharide or collagen compositions between groups 1 and 2 (p > 0.05). In addition, when groups 1 and 2 were compared with the control group, there was a significant decrease in goblet cells (p < 0.001), an increase in acute inflammatory cells, chronic inflammatory cells, fibroblasts, epithelial thickness and vascular density (p < 0.001), but there was no significant difference in mucopolysaccharide and collagen compositions (p > 0.05). CONCLUSIONS: This study suggests that at the time of surgery a high number of goblet cells may be a predictor of lowered IOP (< or = 16 mm Hg) following trabeculectomy without antimetabolite.
Asunto(s)
Conjuntiva/patología , Glaucoma de Ángulo Abierto/cirugía , Células Caliciformes/patología , Presión Intraocular/fisiología , Trabeculectomía , Anciano , Biopsia , Recuento de Células , Células Epiteliales/patología , Femenino , Fibroblastos/patología , Glaucoma de Ángulo Abierto/fisiopatología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Tracheal hamartoma is a rare tumor and difficult to diagnose. A case is presented in which tracheal hamartoma was misdiagnosed and treated for four years as asthma. The tumor was curatively excised via posterolateral thoracotomy.
Asunto(s)
Hamartoma/diagnóstico , Hamartoma/cirugía , Enfermedades de la Tráquea/diagnóstico , Enfermedades de la Tráquea/cirugía , Asma/diagnóstico , Asma/terapia , Diagnóstico Diferencial , Errores Diagnósticos , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Toracotomía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
OBJECTIVE: Typical bronchial carcinoids are very low grade neuroendocrine neoplasm of the tracheobronchial tree and have very good results in surgical treatment. Surgical treatment varies from bronchotomy-excision to major resective procedures. We presented our results of bronchotomy, simple excision and long-term follow-up. METHODS: In Atatürk Centre for Chest Disease and Chest Surgery, 16 patients with bronchial carcinoid tumour underwent bronchotomy-excision over a 23-year-period. In all of the cases tumours were in polypoid type. Except these 16 cases 51 patients with bronchial carcinoids underwent operations in the same period. Presenting symptoms were haemoptysis, cough, recurrent pulmonary infection, dyspnea and chest pain. Rigid bronchoscopies were performed on all of the patients preoperatively for diagnosis of the tumour and to determine the surgical procedure and we performed control bronchoscopies on all of the patients in their follow-up period. RESULTS: Patients were checked for periods ranging from 2 to 23 years both radiologically and bronchoscopically. We did not find any recurrences and death related to surgery and morbidity rate were minimal. CONCLUSION: We think that bronchotomy and simple excision are effective and safe procedures for the treatment of bronchial carcinoid tumours with low morbidity in selected cases like polypoid type lesions and have as good a long-term survival rate as the other surgical treatment methods have.
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Neoplasias de los Bronquios/mortalidad , Neoplasias de los Bronquios/cirugía , Tumor Carcinoide/mortalidad , Tumor Carcinoide/cirugía , Adulto , Bronquios/cirugía , Broncoscopía , Femenino , Estudios de Seguimiento , Humanos , Masculino , Morbilidad , Complicaciones Posoperatorias/epidemiología , Tasa de Supervivencia , Factores de Tiempo , Turquía/epidemiologíaRESUMEN
OBJECTIVE: Thoracic actinomycosis is a disease that is difficult to diagnose because its appearance varies from similarities with bronchogenic carcinoma to pneumonitis-like tuberculosis infections. Therefore the majority of patients undergo operations for diagnosis. We had seven patients with thoracic actinomycosis which were not diagnosed before operation. METHODS: Between July 1990 and November 1997, seven patients with thoracic actinomycosis were diagnosed after thoracotomy in our centre. They all had non-specific symptoms and radiographic findings, so we failed to diagnose the disease during preoperative examinations. Therefore they all underwent thoracotomy for diagnosis. Four patients were operated because of suspicion of malignancy, two patients were operated because of pulmonary infiltration and abscess formation and one patient because of undiagnosed pulmonary infiltration. Lobectomy was performed in five of them because of destroyed lobes, and wedge resection was performed in two patients. In two patients the disease was diagnosed by fresh smears obtained from specimens in the course of operation and confirmed histopathologically and in the others histopathologically in the postoperative period. RESULTS: Three major complications, acute renal failure, empyema and persistent air leakage developed in three cases after the operations. Bronchopleural fistula was found in only one of them and the patient died because of uncontrolled infection and sepsis on the 26th postoperative day. All of the other six cases are still alive. We did not observe any other problem in their long-term follow-up. All patients regularly took 20 million units/day of intravenous crystalline penicillin G when they were in the hospital. After that, antibiotic treatment was completed up to 2 months with procaine penicillin. CONCLUSIONS: Sometimes diagnosis of the actinomycosis of the lung is very difficult although it is an infection. In that case thoracotomy is needed for the diagnosis and sometimes for the treatment. In some cases because of the irreversible parenchymal change resective surgery may be needed. Actinomyces israelii infections should be suspected of in chronic infiltrative, nodular, cavitary process and tumour-like mass lesions besides other most probable causes. After diagnosed, it is treated using penicillin chemotherapy at least for 2 months.
Asunto(s)
Actinomicosis , Enfermedades Pulmonares , Actinomicosis/diagnóstico , Actinomicosis/epidemiología , Actinomicosis/cirugía , Diagnóstico Diferencial , Femenino , Humanos , Enfermedades Pulmonares/diagnóstico , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/microbiología , Enfermedades Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Toracotomía , Tomografía Computarizada por Rayos X , Turquía/epidemiologíaRESUMEN
Cystic lymphangioma is an extremely rare mediastinal benign tumor characterized by congenitally enlarged lymphatic vessels. It is often diagnosed incidentally because it is only symptomatic when it grows to be very large. We present two cases of mediastinal cystic lymphangioma and review the literature.
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Linfangioma Quístico/diagnóstico , Neoplasias del Mediastino/diagnóstico , Adulto , Diagnóstico Diferencial , Supervivencia sin Enfermedad , Femenino , Humanos , Linfangioma Quístico/patología , Linfangioma Quístico/cirugía , Masculino , Neoplasias del Mediastino/patología , Neoplasias del Mediastino/cirugía , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
It has been confirmed that topically applied bromocriptine has a satisfactory intraocular pressure (IOP) lowering effect without serious ocular or systemic side effects. We compared the IOP lowering effects of 0.05% bromocriptine and 0.25% timolol and determined whether they have an additive effect in lowering IOP in normal volunteers. In a double-blind, randomised, prospective, single-dose study, we measured IOP in 24 ocular normotensive subjects before (baseline) and 2, 4 and 6 hours after topical instillation of the following drugs: timolol and bromocriptine alone (n: 14), timolol+bromocriptine, timolol+placebo, bromocriptine+placebo (n: 10). Both bromocriptine and timolol have a significant IOP lowering effect (p < 0.01) compared with the baseline value during the study period. There were no significant differences in IOP lowering effect between timolol and bromocriptine at 2 and 4 hours (p > 0.05), but timolol was more efficacious than bromocriptine at 6 hours (p < 0.05). An additive effect in lowering IOP was not found. Although timolol and bromocriptine have no additive effect in lowering IOP, topically applied bromocriptine may be used in the treatment of glaucoma.