Determination of the optimal position of the lower extremity for femoral nerve block with ultrasonographic measurements: a prospective volunteer-based study.

OBJECTIVE: The aim of the study was to determine the optimal position for femoral nerve block (FNB) under ultrasound guidance. PATIENTS AND METHODS: We included fifty volunteers between 18-65 years of age in this study. The distances from the skin to the landmarks, which were taken as a reference for the ultrasound-guided FNB (apex point of the femoral artery = F12, lateral point = F9, and lower point = F6), were measured and compared in 3 different positions given to the lower extremity (neutral position: P1, 45° abduction: P2, and flexed knee: P3). The ease of application and the quality of the ultrasound images were evaluated at each measurement by assigning a subjective observer score and comparing them in three positions. RESULTS: All three measurement points were found to be closest to the skin at position P3. However, the distances from F9 (p = 0.023) and F6 (p = 0.006) to the skin were significant. A significant difference was found between P1 and P3 in terms of the distance from F9 (p = 0.027) and F6 to the skin (p = 0.007). P3 was determined to be the position with the highest score for clarity of the ultrasonography images and ease of detection of the measurement points (p < 0.001). As the scores of ease of access to the femoral nerve (FN) and image clarity increased, the distance from the measurement point to the skin surface decreased, which was statistically significant. CONCLUSIONS: The ideal position for ultrasound-guided FNB is the P3 position. As an alternative for patients with limited mobility, the P2 position can be used.

DNA damage and changes in oxidized biomolecules in COVID-19 patients treated in intensive care units: a single center experience.

OBJECTIVE: COVID-19 is a deadly disease. Investigations are being conducted on the underlying mechanisms to predict prognosis and reduce mortality rates. In this study, the extent of DNA damage and serum levels of oxidized biomolecules were investigated. We hypothesize that malondialdehyde (MDA) and protein carbonyl (PC) serum levels and DNA damage levels may be biomarkers that can be used in prognostic decision making and prediction of mortality in COVID-19 patients. PATIENTS AND METHODS: Patients included in the study were divided into two groups according to their survival. These groups were compared in terms of serum MDA, PC levels, DNA damage degrees and mortality on the 1st, 3rd, and 5th days of ICU admission. RESULTS: In patients who died, MDA levels increased over time (p=0.023), PC levels peaked on the third day of admission to the intensive care units (ICU), and then decreased, while DNA damage increased gradually (p=0.013). In surviving patients, MDA levels decreased over time (p=0.018); PC levels were at their peak on the first day of admission to the ICU and then decreased (p=0.018); DNA damage decreased initially, and then increased minimally compared to Day 1. CONCLUSIONS: For COVID-19 ICU patients, serum levels of MDA and PC and degrees of DNA damage can strengthen prognostic decision-making and contribute to reducing mortality.

Comparison of cytotoxic, reactive oxygen species (ROS) and apoptotic effects of propofol, thiopental and dexmedetomidine on liver cells at accumulative doses (AML12).

OBJECTIVE: Propofol, thiopental and dexmedetomidine are hypnotic, sedative, antiepileptic and analgesic agents used in general anesthesia and intensive care. There are many known and yet unknown side effects. Our aim in this study was to examine and compare the cytotoxic, reactive oxygen species (ROS) and apoptotic effects of propofol, thiopental and dexmedetomidine drugs, which are widely used in anesthesia, on liver cells (AML12) in vitro. MATERIALS AND METHODS: The half-maximum inhibitory concentration (IC50) doses of the three drugs on AML12 cells were determined using the 3-[4,5-dimethylthiazol-2yl]-2,5-diphenyltetrazolium bromide (MTT) method. Then at two different doses of each of the three drugs, apoptotic effects were determined by the Annexin-V method, morphological examinations were determined by acridine orange ethidium bromide method and intracellular reactive oxygen species (ROS) levels were determined by flow cytometry. RESULTS: The IC50 thiopental, propofol and dexmedetomidine doses were found to be 255.008, 254.904 and 34.501 µgr/mL, respectively (p<0.001). The highest cytotoxic effect on liver cells was found in the lowest dose of dexmedetomidine (34.501 µgr/mL) compared to the control group. This was followed by thiopental and propofol, respectively. CONCLUSIONS: In this study, propofol, thiopental and dexmedetomidine drugs on AML12 cells were found to have toxic effects by increasing intracellular ROS at two different concentrations higher than clinical doses. It was determined that cytotoxic doses caused an increase in ROS and induced apoptosis in cells. We believe that the toxic effects of these drugs can be prevented by examining the values obtained from this study and the results of future studies.

Factors increasing mortality in Echinococcosis patients treated percutaneously or surgically. A review of 1,143 patients: a retrospective single center study.

OBJECTIVE: While cystic echinococcosis (CE) is a serious problem in underdeveloped countries, it also becomes a serious public health problem in developed countries due to recent migration and population movements. This study aimed to investigate the relationship between pregnancy, multi-organ involvement, treatment methods, and emergency surgery (unfollowed patients), with mortality in patients with CE who underwent surgical or percutaneous treatment. PATIENTS AND METHODS: In this study, demographic characteristics, pregnancy status, organ involvement, development of relapse and anaphylaxis, need for intensive care and mortality rates of patients with CE treated with percutaneous or surgical methods at Harran University Hospital between January 1997 to January 2022 were investigated. RESULTS: Of the 1,143 patients who underwent surgery or percutaneous treatment for CE, 18 were pregnant. Mortality was found to be significantly higher in pregnant patients with CE (p<0.001). Mortality was significantly higher in those who developed anaphylaxis (p<0.001). In percutaneous treatment, recurrence (p<0.001) and anaphylaxis (p=0.026) were found to be significantly higher. Mortality was found to be three times higher in patients without follow-up who were operated on urgently (p=0.108). CONCLUSIONS: CE is a disease that can occur at any age and can be fatal. Although multi-organ involvement and percutaneous treatment may be associated with recurrence, they do not directly increase mortality. The mortality is high, especially in pregnant women with pulmonary CE. Cardiac involvement, brain involvement and anaphylaxis increase mortality. Mortality is higher in patients without follow-up who are operated on urgently.

Psychopathology and psychiatric co-morbidities in patients seeking rhinoplasty for cosmetic reasons.

AIM: The purpose of the study was to examine psychopathological traits and psychiatric co-morbidities in seekers of cosmetic rhinoplasty. SUBJECTS AND METHODS: Fifty persons seeking cosmetic rhinoplasty and 50 control subjects were admitted to the study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Symptom Checklist-90 [Revised] (SCL-90-R) were administered to people who requested cosmetic rhinoplasty and control subjects. All participants were also screened by the Structured Clinical Interview for DSM-IV-(SCIDI/CV, SCID-II). RESULTS: Thirteen cosmetic rhinoplasty seekers [CRS] (26%) and three control subjects (6%) had at least one psychiatric diagnosis. There was a significant difference between the two groups (p = 0.006). Beck depression inventory (p = 0.002) and BAI (p = 0.046) levels above the cut-off point were significantly higher in the CRS group than in the normal control. Somatoform disorders were statistically higher in the CRS than control group (p = 0.007). Nine CRS (18%) and two control subjects (4%) had at least one personality disorder. There were differences between the two groups (p = 0.025). The average of SCL-90-R was significantly higher in the CRS than in the control subjects (p < 0.001). The most prevalent somatoform disorders of the CRS were six with body dysmorphic disorder [BDD] (12%). The most prevalent personality disorders of the CRS were three with avoidant (6%) and three with narcissistic (6%) personality. CONCLUSION: Assessment of detailed psychopathological aspects and psychiatric co-morbidities could help to define the clinical profile of people requesting cosmetic rhinoplasty in cosmetic surgery settings. Research into these factors may be important as it is essential to detect crucial problems such as personality disorders and BDD before surgery.

Psychopathology and psychiatric co-morbidities in patients seeking rhinoplasty for cosmetic reasons / Psicopatología y comorbilidad psiquiátrica en pacientes que buscan rinoplastia por razones cosméticas

AIM: The purpose of the study was to examine psychopathological traits and psychiatric co-morbidities in seekers of cosmetic rhinoplasty. SUBJECTS AND METHOD: Fifty persons seeking cosmetic rhinoplasty and 50 control subjects were admitted to the study. Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) and Symptom Checklist - 90 [Revised] (SCL-90-R) were administered to people who requested cosmetic rhinoplasty and control subjects. All participants were also screened by the Structured Clinical Interview for DSM-IV-(SCIDI/ CV, SCID-II). RESULTS: Thirteen cosmetic rhinoplasty seekers [CRS] (26%) and three control subjects (6%) had at least one psychiatric diagnosis. There was a significant difference between the two groups (p = 0.006). Beck depression inventory (p = 0.002) and BAI (p = 0.046) levels above the cut-off point were significantly higher in the CRS group than in the normal control. Somatoform disorders were statistically higher in the CRS than control group (p = 0.007). Nine CRS (18%) and two control subjects (4%) had at least one personality disorder. There were differences between the two groups (p = 0.025). The average of SCL-90-R was significantly higher in the CRS than in the control subjects (p < 0.001). The most prevalent somatoform disorders of the CRS were six with body dysmorphic disorder [BDD] (12%). The most prevalent personality disorders of the CRS were three with avoidant (6%) and three with narcissistic (6%) personality. CONCLUSION: Assessment of detailed psychopathological aspects and psychiatric co-morbidities could help to define the clinical profile of people requesting cosmetic rhinoplasty in cosmetic surgery settings. Research into these factors may be important as it is essential to detect crucial problems such as personality disorders and BDD before surgery.

OBJETIVO: El propósito del estudio fue examinar los rasgos psicopatológicos y las comorbilidades psiquiátricas en los solicitantes de rinoplastia cosmética. SUJETOS Y MÉTODO: Cincuenta personas que buscaban rinoplastia cosmética, y 50 sujetos de control fueron registrados en el estudio. El Inventario de Depresión de Beck (BDI), el Inventario de Ansiedad de Beck (BAI), y el Listado de Síntomas 90 (Revisado) (SCL 90), fueron aplicados a las personas que solicitaron rinoplastia cosmética y a los sujetos del control. Todos los participantes fueron también sometidos a tamizaje mediante la Entrevista Clínica Estructurada para DSM - IV-(SCID-/ CV, SCIDII). RESULTADOS: Trece solicitantes de rinoplastia cosmética solicitantes (SRC) (26%) y tres sujetos de control (6%) tuvieron al menos un diagnóstico psiquiátrico. Hubo una diferencia significativa entre los dos grupos (p = 0.006). Los niveles de BDI (p = 0,002) y BAI (p = 0.046) por encima del valor límite, fueron significativamente más altos en el grupo de SRC que en el grupo control normal. Los trastornos somatoformes fueron estadísticamente más altos en el grupo SRC que en el grupo control (p = 0.007). Nueve SRC (18%) y dos sujetos de control (4%) tenían al menos un trastorno de personalidad. Hubo diferencias entre los dos grupos (p = 0. 025). El promedio de SCL-90-R fue significativamente más alto en el grupo de SRC que en los sujetos del grupo control (p < 0.001). Los trastornos somatoformes más prevalentes de SRC fueron seis con trastorno dismórfico corporal (TDC) (12%). Los trastornos de personalidad más prevalentes de SRC fueron: tres con trastorno de la personalidad por evitación (6%) y tres con personalidad narcisista (6%). CONCLUSIÓN: La evaluación de los aspectos psicopatológicos detallados y las comorbilidades psiquiátricas podrían ayudar a definir el perfil clínico de las personas que solicitan rinoplastia cosmética en los escenarios de cirugía cosmética. La investigación en estos factores puede ser importante, ya que es esencial para detectar problemas cruciales tales como los trastornos de personalidad y TDC antes de la cirugía.

Effectiveness of temozolomide treatment used at the same time with radiotherapy and adjuvant temozolomide; concomitant therapy of glioblastoma multiforme: multivariate analysis and other prognostic factors.

AIM: Prognostic factors which affect treatment results of glioblastoma multiforme (GBM; WHO Grade IV) patients has been investigated in many researches. For these patients determination of prognostic factors helps generating multimodal therapy protocols. For this purpose, in the Baskent University Medical School, Neurosurgery Clinic, Adana Medical Research Center, specific characteristics of GBM patients who have surgery retrospectively investigated and factors which affect prognosis has been determined. METHODS: Between January 2005 and January 2009, 59 patients (25 female, 34 male) who have GBM have been evaluated retrospectively. Mean follow-up period was 27.4 (+/-17.3) months. Headache (66.1%) was the most seen symptom. Time of diagnosis was 1-2 months for most of the patients (54.2%). Fifty-nine patients had 67 operations totally. Preoperative Karnofski Performance Scale (KPS) was >or=70 for 43 operations, or=70, for 26 operations KPSor=70 (P=0.0000) , postoperative KPS 2 was >or=70 (P=0.0000), type of tumor resection (P=0.00002), multiple operations (P=0.001), adjuvant RT (P=0.0000) and ConcT with adjuvant TMZ (P=0.0000) were all positive prognostic factors which extend the survival. After multivariate analysis, post operative KPS was >or=70 (P=0.003; OR:0.89; % 95 CI:0.83-0.96), type of resection (P=0.055; OR:0.37; % 95 CI:0.13-0.12) and multiple operations (P=0.042; OR:2.65; % 95 CI:1.03-6.82) were independent prognostic factors. CONCLUSION: When independent prognostic factors were examined ,median survival found out 7.8 months longer fort he patients whose postoperative KPS were >or=70, 5.7 months longer for the patients who had radical resection, 6.6 months longer for the patients who had multiple operations. Although patients who had ConcT with adjuvant TMZ had 1.7 months longer survival compared to patients who had only adjuvant RT, it was not determined as an independent prognostic factor.

Radiotherapy in the adjuvant setting of cervical carcinoma: treatment, results, and prognostic factors.

To evaluate the efficacy of postoperative radiotherapy and to investigate prognostic factors for early-stage cervical cancer patients. From December 1993 to December 2001, 141 patients with stage I-II cervical cancer without para-aortic lymph node (LN) metastases and treated by surgery and postoperative radiotherapy (RT) were included in this study. Indications for postoperative external RT were based on pathologic findings, including LN metastasis, positive surgical margins, parametrial involvement, pT2 tumor, and presence of any two minor risk factors like lymphvascular space involvement, deep stromal invasion, and tumor diameter between 2-4 cm. Sixty-six (47%) patients received RT alone, whereas 59 (42%) were treated with RT and concomitant chemotherapy (CT), and 16 received neoadjuvant CT. Patients with positive vaginal margins also received 27.5 Gy high-dose rate vaginal cuff brachytherapy in five fractions. Median follow-up time was 55 months. The actuarial 5-year overall (OS), disease-free (DFS), locoregional recurrence-free (LRFS), and distant metastases-free (DMFS) survival rates are 70%, 68%, 77%, and 88%, respectively. Univariate and multivariate analyses revealed that level and number of metastatic LNs and concomitant CT were unique significant prognostic factors for OS, DFS, and LRFS. Endometrial involvement, on the other hand, was proven to be significant for DFS and DMFS. Patients with less than three LN metastases or having only obturator LN involvement showed similar prognosis with their counterparts having no LN metastases. On the other hand, patients with either common iliac LN or more than three LN metastases had significantly worse outcome. Our results indicate that level and number of metastatic LNs are the most important prognostic factors determining the survival rates, and patients with upper lymphatic involvement or more than three metastatic LNs seem to need more effective treatment approaches.