Diagnostic value of oxidative stress markers in patients presenting with primary dysmenorrhea to the emergency department.

Background and Aim: Primary dysmenorrhea (PD) is a common presentation for emergency departments. This study investigates the diagnostic value of oxidative stress and ischemia markers in patients with PD. Materials and Methods: The participants were classified into the PD group (patients with PD) and the control group (healthy volunteers). Thiol/Disulfide Homeostasis (TDH) parameters (Ds, Disulfide; NT, Native Thiol; TT, Total Thiol) and serum ischemia modified albumin (IMA) levels of the groups were measured. The Numeric Rating Scale (NRS) was used for pain assessment. Bivariate correlation analysis was performed to test the relationship between NRS and oxidative stress parameters. A P < 0.05 was considered significant. Results: A total of 135 patients (PD group, n = 83; Control group, n = 52) were included in the study. PD group had statistically higher oxidant biomarkers (Ds level, Ds/NT ratio and Ds/TT ratio) and lower antioxidant biomarkers (NT/TT ratio) compared to the control group (p = 0.001; 0.003; 0.002, and 0.002, respectively). Serum IMA level in the PD group was higher than in the control group (P = 0.000). There was a positive correlation between IMA and NRS score (r = 0.342, P < 0.01), but no correlation was found between the other oxidative stress parameters and NRS. Conclusions: PD is characterized by increased oxidative stress and ischemia in the endometrium, which can be detected by TDH parameters and serum IMA. NRS score in PD patients is positively correlated with serum IMA level, which suggests IMA level can be valuable to determine the severity of endometrial ischemia and pain in patients with PD.

Preliminary Results of Instantaneous Centre of Rotation Change after Thoracic Instrumentation in Adolescent Idiopathic Scoliosis Patients.

Introduction: The instantaneous centre of rotation (ICR) is the centre of motion with zero velocity where a rigid body moves in a particular plane. ICR, as a dynamic measurement, gives more accurate results in terms of quality and quantity of the vertebral motions compared to range of motion (ROM). We aimed to determine the effect of thoracic instrumentation on cervical movement of adolescent idiopathic scoliosis (AIS) patients who had undergone thoracic level instrumentation by measuring pre-operative and post-operative ICR change in a pilot study. Materials and methods: A total of 25 AIS patients were included in this study. C4-C5 and C6-C7 segmental ICR were determined by pre-operative and post-operative cervical flexion-extension radiographs. In addition, cervical sagittal parameters and global sagittal parameters were investigated. Results: There was no statistically significant change in ICR location post-operatively in both x and y coordinates at C4-C5 segment (p: 0.326 and p: 0.946, respectively) and C6-C7 segment (p: 0.209, p: 0.086, respectively). There was a positive correlation between LCL and C4-C5 ICR y coordinate (r: 0.481), but not with C6-C7 ICR y coordinate (r: -0.2, p: 0.398). T5-T12 kyphosis decreased (p: 0.002) and T1 pelvic angle (0.003), SVA (0.02) and sacral slope (0.049) increased significantly post-operatively. T1S was correlated with LCL (r: 0.595, p: 0.002), T5-T12 kyphosis (r: 0.423, p: 0.035), SVA (r: 0.658, p<0.001) and C2-C7 SVA (r: 0.416, p: 0.039). Conclusion: The ICR for cervical region was not changed post-operatively in AIS patients with thoracic instrumentation. There was no relationship found between the development of post-operative cervical kyphosis or lordosis and ICR, which represents the quality and quantity of intervertebral motion. The T1 vertebra plays a key role for cervical, thoracic, and global parameters interaction.

The effect of gender differences in protracted hiccups.

BACKGROUND: Although little importance is attached to hiccups, they may be associated with several diseases. The purpose of this study was to investigate the effects of gender differences on types of hiccups and the relation with diseases involved in the etiology. MATERIALS AND METHODS: Patients presenting to the Kirikkale University Medical Faculty Hospital with hiccups were investigated retrospectively. Patients' age, sex, duration of hiccups, additional diseases, advanced imaging results, laboratory tests, and clinical follow-up were recorded. Patients were divided into two groups; Group transient hiccup (TH) consisted of subjects with a duration of hiccups less than 48 h, and Group protracted hiccup (PH) of patients with a duration exceeding 48 h. The Chi-square test was used for comparisons, and P < 0.05 were regarded as significant. RESULTS: Eighty-four patients were enrolled, 44.1% (n = 37) in Group TH, and 55.9% (n = 47) in Group PH. Male patients comprised 67.5% (n =25) of Group TH and 89.4% (n = 42) of Group PH (P = 0.027). The conditions most associated with hiccups were gastrointestinal system (GIS) diseases. Correlation was determined between GIS diseases and male gender (P = 0.034), no relation between other system diseases and gender. Correlation was determined between GIS diseases and protracted hiccups (P = 0.037), but no relation between other system diseases and type of hiccups. CONCLUSION: Protracted hiccups are more common in males. This gender variation applies particularly to hiccups of GIS origin.

Serum ischaemia-modified albumin increases in critical lower limb ischaemia.

BACKGROUND: Ischaemia is a common phenomenon in the pathogenesis of a wide range of medical and surgical conditions, including myocardial infarction, mesenteric vascular occlusion and compartment syndrome. Ischaemia modified albumin has been suggested as an aid to clinical decision making in various clinical settings. This study examines the usefulness of IMA in the diagnosis of limb ischaemia (LI). METHODS: This case-controlled study was performed in the emergency department of Karadeniz Technical University Hospital, Turkey. 22 patients presenting to the emergency departments and definitively diagnosed with LI were enrolled in the study. A control group of 22 healthy volunteers served as a reference for biochemical parameters. RESULTS: The mean serum IMA level for LI patients was 0.295 (SD 0.062) ABSU. The mean serum IMA level for control patients was 0.174 (SD 0.061) ABSU. There was a statistically significant difference between the mean LI patient and mean control patient IMA levels (p<0.0005). A ROC curve analysis reveals the relationship between sensitivity and specificity for IMA in limb ischaemia. CONCLUSION: There is a significant increase in serum IMA in limb ischaemia. Furthermore, using a cutoff of 0.22 ABSU, ROC curve analysis shows that IMA is 81.8% sensitive and 81.8% specific 81.8% in patients with clinically severe lower limb ischaemia. Future studies would be needed to determine if IMA would be clinically useful in the diagnosis of subtle limb ischaemia.

An external support technique for the malacic trachea--treatment of tracheomalacia.

A 76-year-old woman was found to have a large, substernal, intrathoracic goiter. During excision, the trachea was found to be malacic. The trachea was sutured to a 16-mm ringed Gore-Tex (Gore & Associates, Arizona, USA) graft with Vicryl (Ethicon, Johnson & Johnson, USA) sutures. The graft was placed on the external surface of the trachea and surrounded the trachea almost 300 degrees. The patient was discharged on postoperative day seven without complications. She was seen at follow-up six months later and found to be free of complications.

An unusual localization of thymoma.

A 41-year-old man with myasthenia gravis was referred to our clinic to undergo a thymectomy by video-assisted thoracic surgery. After physical examination of the thorax and evaluation by computed tomography, a mass lesion was noticed in the neck and thymectomy was performed by partial sternotomy combined with a cervical incision. The cervical thymoma was discontinuous with the thymus. Thymoma in the neck has rarely been reported. In this case report we emphasize the possible presence of thymoma in the neck and the importance of neck evaluation in patients with myasthenia gravis.

Comparison of early postoperative results of thymectomy: partial sternotomy vs. videothoracoscopy.

BACKGROUND: The aim of this study was to compare the early postoperative results of thymectomy operations after partial sternotomy and videothoracoscopy for myasthenia gravis. METHODS: A total of 51 thymectomy operations were reviewed. The surgical procedure was simple thymectomy with partial sternotomy in the first 19 patients (Group I) and videothoracoscopic thymectomy (Group II) in the remaining patients. Both groups were compared in terms of preoperative data (age, gender, classification, duration of disease, medications), operative data (operation time, the mean amount of drainage, the duration of chest tube drainage), and postoperative data (duration of hospital stay, complications and pain). RESULTS: Groups were statistically uniform in terms of preoperative and operative data. Statistically significant differences were noted for the duration of chest tube drainage (48.8 vs. 29.8 hours, p < 0.001), the amount of drainage (264.4 vs. 178.6 ml, p = 0.001), the length of hospital stay (5.6 vs. 2.3 days, p = 0.000), and the visual analogue scale score (4.8 vs. 3.1, p < 0.001). CONCLUSIONS: Thymectomy with videothoracoscopic surgery demonstrated a more comfortable and faster recovery period without deterioration in myasthenic status.