Analysis of geriatric patients with minor spinal trauma admitted to the emergency department of a university hospital

Objective:To retrospectively analyze patients aged 65 years and over,who were admitted to a level Ⅱ trauma center in Turkey due to minor spinal trauma in a period of 4 years.Methods:The study included 64 patients aged 65 years and over,who were admitted to the Emergency Department of Baskent University Ankara Hospital between January 2011 and January 2015 and diagnosed with vertebral trauma.The information of the patients was obtained from the medical records.The clinical characteristics of patients including localizafions and types of fracture,presence of additional system injuries and treatment options were investigated.Results:The most common cause was fall,accounting for 51 (79.7%),with 7 (10.9%) due to intra-vehicle traffic accident,and 6 (9.4%) due to out-of-vehicle pedestrian injury.The most common site of trauma was the lumbar region.Of the fractures,46.9% (n=30) were in the lumbar region,37.5% (n=24) in the thoracic region and 15.6% (n=10) were in the cervical vertebra region.Fourteen (21.9%) patients had an additional injury.Given the fracture types,47 fractures (74.6%) were compression,14 fractures (22.2%) were spinous process and 2 fractures (3.2%) were burst fractures.Twenty patients (31.2%) had multilevel vertebral fractures.Conclusions:The results of our study demonstrated the importance of vertebral fractures in the geriatric age group.In this age group,falls and motor vehicle accidents are the leading causes of vertebral traumas.Taking the necessary measures to prevent the risk factors which increase with aging is the most important step in preventing the mortality and morbidity that may occur as a result of vertebral fracture.

Peripapillary and macular vascular densities in healthy,ocular hypertensive,and different stages of glaucomatous eyes

AIM:To investigate vascular changes in different stages of glaucoma and to evaluate the role of optical coherence tomography angiography(OCTA)in the early diagnosis of glaucoma.METHODS:Glaucoma patients and healthy controls(n=29 eyes)were investigated in this cross-sectional comparative study.Glaucoma patients were grouped as ocular hypertension(n=44 eyes),preperimetric glaucoma(PPG;n=32 eyes),early glaucoma(EG;n=35 eyes),moderate stage glaucoma(MG;n=36 eyes),and advanced glaucoma(AG;n=35 eyes).Peripapillary and macular vascular densities(VDs)of all participants were compared and correlations of VDs and retinal nerve fiber layer thickness(RNFLT),ganglion cell analysis(GCA),and visual field(VF)tests were evaluated.Area under the receiver operation characteristic curves(AUC)of the peripapillary and macular VD parameters were obtained.RESULTS:VD values decreased with the progression of glaucoma.Most peripapillary and macular VD parameters of PPG and EG groups were lower than healthy controls(P<0.001).There was no significant difference in RNFLT between the PPG and EG groups,but most peripapillary and macular VDs were found to be lower in EG group than in PPG group(P<0.05).In most disease group,VDs were significantly correlated with OCT parameters(P<0.001)and VF index(P<0.05).There were no significant correlations between VF and RNFLT indices in the AG group,but significant correlations were found between VF and VD values(P<0.05).AUC for discriminating between healthy and glaucomatous eyes were highest in whole image peripapillary VD(AUC:0.865,0.929,and 0.986,respectively in EG,MG,and AG groups).CONCLUSION:OCTA can be used in the early diagnosis of glaucoma and can be useful in follow-up of the advanced disease.In cases where limitations or suspicions in structural and functional tests are present,OCTA can be used as a supportive diagnostic test,both in EG and AG.

Surgical and interventional management of complications caused by acute pancreatitis

Acute pancreatitis is one of the most common gastrointestinal disorders worldwide. It requires acute hospitalization, with a reported annual incidence of 13 to 45 cases per 100000 persons. In severe cases there is persistent organ failure and a mortality rate of 15% to 30%, whereas mortality of mild pancreatitis is only 0% to 1%. Treatment principles of necrotizing pancreatitis and the role of surgery are still controversial. Despite surgery being effective for infected pancreatic necrosis, it carries the risk of long-term endocrine and exocrine deficiency and a morbidity and mortality rate of between 10% to 40%. Considering high morbidity and mortality rates of operative necrosectomy, minimally invasive strategies are being explored by gastrointestinal surgeons, radiologists, and gastroenterologists. Since 1999, several other minimally invasive surgical, endoscopic, and radiologic approaches to drain and debride pancreatic necrosis have been described. In patients who do not improve after technically adequate drainage, necrosectomy should be performed. When minimal invasive management is unsuccessful or necrosis has spread to locations not accessible by endoscopy, open abdominal surgery is recommended. Additionally, surgery is recognized as a major determinant ofoutcomes for acute pancreatitis, and there is general agreement that patients should undergo surgery in the late phase of the disease. It is important to consider multidisciplinary management, considering the clinical situation and the comorbidity of the patient, as well as the surgeons experience.

Predictability of outcome of caustic ingestion by esophagogastroduodenoscopy in children

AIM: To assess the necessity of esophagogastroduodenoscopy (EGD) to predict the outcome of caustic ingestion in children. METHODS: The study included 206 children who underwent EGD because of ingestion of caustic substances between January 2005 and August 2010. Retrospective analysis of data of the patients was performed. RESULTS: The male/female ratio was 1.6 and mean age was 38.1 ± 28.8 mo. The caustic substances were acidic in 72 (34.9%) cases, alkaline in 56 (27.2%), liquid household bleach in 62 (30.1%), and unknown in 16 (7.8%). Fifty-seven (27.7%) patients were symptom-free. Significant clinical findings were observed in 149 (72.3%) patients. Upper gastrointestinal endoscopy findings of esophageal injury were grade 0 in 86 (41.7%) patients, grade 1 in 49 (23.8%), grade 2a in 42 (20.4%), grade 2b in 28 (13.6%), and grade 3a in 1 (0.5%) patient. 35 patients with grade 2a, 2b, and 3a injuries underwent esophageal dilation at second week of ingestion. Esophageal stricture, which necessitated a regular dilation program developed in 13 of the aforementioned 35 patients. There is no statistically significant difference in the rate of development of esophageal stricture between the patients who ingested acidic (15.3%) and alkaline (8.9%) substances (P = 0.32). Severe gastric injury was detected in 38 (18.5%) patients. The rate of development of gastric injury was significantly higher in the acidic group (14%) than in the alkaline group (2.9%) (P = 0.001). Out of 149 patients with clinical findings, 49 (32.9%) patients had no esophageal injury and 117 (78.5%) patients had no gastric lesion. Esophageal and severe gastric injuries were detected in 20 (35.1%) and 8 (14%) of patients with no clinical findings respectively. Pyloric stenosis developed in 6 patients. Pyloric obstruction improved with balloon dilation in 2 patients. Mean hospitalization time were 1.2 ± 0.5 d for grade 0 and 2.3 ± 5 d for grade 1 and 6.3 ± 6.2 d for grade 2a and 15.8 ± 18.6 d for grade 2b. It was significantly longer for patients with grade 2a and 2b injuries (P = 0.000). CONCLUSION: Endoscopy is an effective technique for determining the presence of esophageal and gastric damage and to avoid unnecessary treatment in patients with no or mild injury.

Amifostine enhances the antioxidant and hepatoprotective effects of UW and HTK preservation solutions

AIM:To investigate whether amifostine contributes to the antioxidant and cytoprotective effects of histidinetryptophan-ketoglutarate(HTK)and University of Wisconsin(UW)preservation solutions.METHODS:Forty-eight Sprague Dawley male ratswere equally divided into six groups:(1)ringer Lactate(RL)group;(2)RL+amifostine(RL+A)group;(3)HTK group;(4)HTK+A group;(5)UW group;and(6)UW+A group.Rats in the RL+A,HTK+A and UW+A groups were administered amifostine intraperitoneally at a dose of 200 mg/kg prior to laparotomy.The RL group was perfused with RL into the portal vein.The RL+A group were perfused with RL into the portal vein after amifostine administration.The HTK group received an HTK perfusion while the HTK+A group received an HTK perfusion after administration of amifostine.The UW group received a perfusion of UW,while the UW+A group received a UW perfusion after amifostine administration.Liver biopsy was performed to investigate histopathological,immunochemical[transferase mediated dUTP nick end labeling(TUNEL),inducible nitric oxide syntetase(iNOS)]and ultrastructural alterations.Biochemical alterations were determined by examining levels of alanine aminotransferase,alkaline phosphatase and nitric oxide in the perfusion fluid.RESULTS:Pathological sinusoidal dilatation and centrilobular hydropic alteration were significantly lower in the groups that received amifostine prior to preservation solution perfusion.Although the best results were obtained in the UW+A group,we did not observe a statistically significant difference between the UW+A and HTK+A groups.iNOS grades were significantly lower in the amifostine groups 12 h after treatment.When the amifostine groups were compared against each other,the iNOS grades obtained from the UW+A and HTK+A groups were similar while the RL+A group had a much poorer score.TUNEL assays demonstrated a lower apoptosis ratio in the amifostine groups than in the non-amifostine groups 12 h after treatment.No statistically significant difference was observed between the UW+A and HTK+A groups for apoptosis.Cellular ultrastructure was best preserved in the UW+A and HTK+A groups.CONCLUSION:Here,we show that preoperative administration of a single dose of amifostine is sufficientto minimize the preservation damage in hepatic cells.

Mattress sutures for the modification of end-to-end dunking pancreaticojejunostomy

Despite the improvement of surgical techniques,the rate of anastomotic failure of pancreaticojejunostomy remains high(30%-50%).Here we describe the use of vertical mattress sutures in the modification of dunking pancreaticojejunal anastomosis.In 7 patients who used this technique,neither anastomotic failure nor any major postsurgical complication developed.This technique is an easy,safe,and promising for the performance of pancreaticojejunostomy.

Relation of eye dominancy with color vision discrimination performance ability in normal subjects

AIM:To evaluate the performance of dominant eye(DE) for color vision discrimination ability among the medical students with normal color vision.METHODS:Total of 50 students studying at Baskent University Faculty of Medicine,including 31 males(62%) and 19 females(38%),with visual acuity of 20/20 and without congenital color vision deficiency(CCVD) evaluated by Ishihara pseudoisochromatic plate test(IPPT) were recruited for this prospective comparative study upon their voluntary participation.DE was determined by the Gündogan Method.The color discrimination ability was examined with the FarnsworthMunsell 100 hue(FM100) test.Test was applied by two days interval to all subjects for the three times while two eyes(TE),right eye(RE) and left eye(LE) were seeing for detecting red-green(r/g),blue-yellow(b/y) local color spectral regions error scores.The error scores were evaluated for both in DE and non-dominant(NDE).P values below 0.05 were considered to be statistically significant.RESULTS:The students aged 21.18±2.52 years(mean±SD).Without sex difference the RE and the LE dominancy were found 22(44%) and 28(56%) respectively and FM 100 test total error scores of DE in both r/g-b/y regions were found without gender difference 24.12±14.70,34.68±18.95,respectively.For the NDE in both,r/gb/y regions error scores without gender difference were 32.20±19.21,36.24±17.56,respectively.The difference of total error scores between the DE and NDE was found as 58.80±29.92,68.44±31.46.The statistical differences among the DE and the NDE in r/g local region and total error scores were found significant in both genders(P【0.05,P【0.001). CONCLUSION:The color vision discrimination performance ability was found prominent for DE.This superiority was attributed to higher sensitivity of the r/g local color spectral region.We conclude that DE has priority in r/g color spectral region,probably including inhibition of NDE.

The red cell distribution width to platelet ratio predicts 30-day mortality of acute pulmonary embolism patients

Objective: To specify the clinical and sociodemographic characteristics, risk factors, factors affecting mortality including hematologic parameters, and red blood cell distribution width to platelet ratio (RPR) in patients with pulmonary thromboembolism, and to reduce the mortality. Methods: The archive records of patients diagnosed with pulmonary embolism were retrospectively examined. The histories, risk factors, physical examination findings, arterial blood gas analysis, X-rays, laboratory, and computed tomography reports of all cases were obtained via the hospital information system. Logistic regression analysis was performed to determine the independent variables affecting early mortality. Results: A total of 146 patients with a definitive diagnosis of pulmonary thromboembolism were included. Thirteen point seven percent (n=20) of the deceased patients died at early term. Ninety percent of patients with early mortality was 65 years or older. There were significantly differences in age, RPR, D-dimer, creatinine, lymphocyte, pH, and body temperature between patients with and without early mortality (P=0.017, P<0.001, P=0.019, P=0.025, P=0.042, P=0.013, P=0.017, respectively). Logistic regression analysis showed that RPR was a statistically significant and independent risk factors of mortality (P=0.026, OR: 0.254., 95% CI (0.326-5.056))In addition, there was a significant difference in pulmonary embolism severity index classification between patients with and without early mortality(P<0.034). Conclusions: RPR is an independent risk factor of mortality of pulmonary embolism patients and may help emergency physician to stratify mortality risks of pulmonary embolism patients.

Cost analysis and characteristics of the patients admitted to emergency service with poisoning

Objective: To investigate the cost analysis and hospitalization rates and modes of poisoning of patients who applied to Bakent University Ankara Hospital Adult Emergency Service. Methods: Poisoning Patients who applied to emergency service due to suicide attempt between 01.01.2011- 31.12.2014 were included in the study. Patients' age, gender, date of admission, definite diagnosis, the rate of hospitalization, and hospital costs were examined. A total of 646 patients were included in the study. 208 (32.2%) of the patients were male. The median age of the patients was 29 years. Results: The most causes of poisoning was drug intake. The median cost of the patients was 75.14 TL (IQR: 66.5). Conclusion: There was a positive correlation between age and cost (P<0.05). The majority of the patients apply to emergency dapartment with drug poisoning and female.

Portopulmonary hypertension in liver transplant candidates

Pulmonary vascular disorders including portopulmonary hypertension(PoPHT) are among the common complications of liver disease and are prognostically significant. Survival is very low without medical treatment and liver transplantation. With advances in medical therapy for elevated pulmonary artery pressure(PAP) and liver transplant surgery, survival of patients with Po PHT and advanced liver disease is significantly improved. Because of the prognostic significance of Po PHT and the limited donor pool, a comprehensive preoperative cardio-pulmonary assessment is of great importance in cirrhotic patients prior to transplant surgery. Therefore, a detailed transthoracic Doppler echocardiographic examination must be an essential component of this evaluation. Patients with mild Po PHT can safely undergo liver transplant surgery. In cases of moderate to severe Po PHT, right heart catheterization(RHC) should be performed. In patients with moderate to severe Po PHT on RHC(mean PAP 35-45 mm Hg), vasodilator therapy should be attempted. Liver transplantation should be encouraged in cases that demonstrate a positive response. Bridging therapy with specific pulmonary arterial hypertension treatment agents should be considered until the transplant surgery and should be continued during the peri- and post-operative periods as needed.

Helicobacter pylori eradication lowers serum homocysteine level in patients without gastric atrophy

AIM: To determine whether Helicobacter pylori ( H pylori)infection caused hyperhomocysteinemia by altering serum vitamin B12, serum folate and erythrocyte folate levels and whether eradication of this organism decreased serum homocysteine level.METHODS: The study involved 73 dyspeptic H pylori-positive patients, none of them had gastric mucosal atrophy based on rapid urease test and histology. Out of 73 patients, 41 (56.2%) showed a successful eradication of Hpylori4 wk after the end of treatment. In these 41 patients, fasting serum vitamin B12, folate and homocysteine levels, and erythrocyte folate levels before and 4 wk after Hpylorieradication therapy were compared.RESULTS: The group with a successful eradication of Hpylori had significantly higher serum vitamin B12 and erythrocyte folate levels in the post-treatment period compared to those in pre-treatment period (210±97 pg/mL vs237±94pg/mL, P<0.O01 and 442±212 ng/mL vs 539±304 ng/mL,P = 0.024, respectively), but showed no significant change in serum folate levels (5.6±2.6 ng/mL vs 6.0±2.4 ng/mL,P= 0.341). Also, the serum homocysteine levels in this group were significantly lower after therapy (13.1±5.2 μmol/L vs 11.9±6.2 μmol/L, P = 0.002). Regression analysis showed that serum homocysteine level was positively correlated with age (P = 0.01) and negatively with serum folate level before therapy (P = 0.003).CONCLUSION: Eradication of H pylori decreases serum homocysteine even in patients who do not exhibit gastric mucosal atrophy. It appears that the level of homocysteine in serum is related to a complex interaction among serum vitamin B12, serum folate and erythrocyte folate levels.

窄谱中波紫外线治疗尿毒性瘙痒症:一项开放的前导性研究

We report the results of a pilot study of narrowband ultraviolet B phototherapy for the treatment of 20 patients with uremic pruritus. Ten patients completed the 6-week study period. A total of 8 patients were found to be responders. Of the remaining 10 patients who left the study before 6 weeks, 6 were satisfied with the response. In the follow-up period, 7 responders could be examined, and 3 were in remission 6 months after completing treatment. However, pruritus recurred in the remaining 4 responders. Narrowband ultraviolet B phototherapy may be an effective treatment for patients with uremic pruritus. Recurrence of pruritus, however, is a frequent problem.

肺主动脉侧支卷曲性栓塞后导致的食管狭窄:一种非常罕见的病因报道

A 10-year-old boy who had previously undergone surgery for tetralogy of Fallot, pulmonary atresia, and ventricular septal defect was admitted with difficulty in swallowing and significant failure to thrive. His history included that he had 2 angiographically detected aberrant pulmonary arteries extending from the descending aorta to the right and left lungs, respectively. Both collaterals had been ligated during the corrective surgery; however, early postoperative evaluation revealed that the vessel that crossed behind the esophagus to the left lung had become recanalized. Coil embolization was performed to occlude this collateral. The patient had begun to develop swallowing difficulties 2 years after the embolization. Esophagography revealed a significant stricture in the middle of the esophagus, just anterior to the location of the coil in the vessel behind. The patient underwent a program of esophageal dilatation. This was successful, and he regained normal swallowing ability. To our knowledge, no similar case of esophageal stenosis has been reported in the English literature. We believe that inflammation surrounding the coiled aberrant artery, presumably caused by injury during the corrective surgery and resulting in hemorrhage, led to fibrosis around the vessel. This fibrosis also involved the adjacent esophageal wall, thus causing progressive stenosis.

Giant hepatic hydatid cyst: A case report

Large type 1 cysts are prone to perforation. Furthermore, insufficient drainage with subsequent abscess is a frequent problem of large cysts. We report here a case of a 19-year old man who was admitted to the hospital with pain in the right upper quadrant and epigastric region. An asymmetrical right upper quadrant enlargement was detected on physical examination. Ultrasonography and computerized tomography revealed a type 1 giant hydatid cyst in the right hepatic lobe, measuring 16 cm in diameter. During operation, partial cystectomy and drainage were done. The large dead space was obliterated by the ‘sandwich’ method. Omentum and gelatin sponges were used to fill the cavity. The postoperative period was uneventful and the patient was discharged on the 5th postoperative day.

45,XY,der(13;14)(q10;q10)in an azoospermic man with hypogonadotrophic hypogonadism

Dear Sir, I am Feride Iffet Sahin in Baskent University Faculty of Medicine, Department of Medical Genetics, Ankara, Turkey. We write to you about a case of 45,XY, der（13; 14）（q10;q10） in an azoospermic man as a result of hypogonadotrophic hypogonadism.

Lyme Borreliosis with Opthalmologic Presentation

Lyme disease is a tick-borne multisystemic disease with multiple clinical presentations including rheumatological conditions. We present a 12 year old girl complaining of fever, arthralgia and redness in her eyes which was found to be the result of panuveitis. Borrelia antibodies were positive and she received 21-day treatment regimen with Ceftriaxon with resolution of all complaints at the end of treatment. Lyme disease classically occurs in three stages starting with erythema migrans, however atypical presentations skipping this stage and presenting with opthalmologic involvement in form of uveitis can be seen.

肾实质细胞癌:病例报道和文献回顾

Renal cell carcinoma arising from epithelial cells of the renal tubule is a highly aggressive and malignant tumor in all ages. Less than 2%of cases occur in childhood, relatively in older age group. Only a few pediatric series have been presented in the English literature. Tumor is presented with characteristic findings of flank pain, gross hematuria, and palpable mass. Although one half of the patients have metastasis at the time of diagnosis, most cases are currently being incidentally detected using improved imaging techniques. The overall prognosis in children appears to be similar to that in adults. Tumor stage and complete surgical resection have been reported as the most meaningful prognostic factors for the outcome. The incidence of metastatic disease is same as in adults. The effect of chemotherapy and immunotherapy, either preoperatively or postoperatively, is unclear. Cure is the most likely consequence in localized and completely resected tumors. Here, we present an 8-year-old boy with renal cell carcinoma demonstrating only hematuria without any pathological physical examination findings. The mass was described by abdominal ultrasonography and computed tomography in the left kidney. After the left nephroureterectomy, the patient was given no therapy.

Recurrent ischemic stroke as an initial manifestation of an concealed pancreatic adenocarcinoma： Trousseau＇s syndrome

In rare instances, stroke may preceed a diagnosis of cancer and be the first clinical evidence of an underlying malignancy.Cerebral infarction mostly complicates lymphomas, carcinomas, and solid tumors. Malignancy-related thromboembolism can present as acute cerebral infarction, nonbacterial thrombotic endocarditis and migratory thrombophlebitis. It is generally attributed to a cancer-related hypercoagulable period, chronic dissemiated intravascular coagulopathy （DIC）, or tumor embolism. We reported a case of malignancy-releated thromboembolism from an undiagnosed pancreatic adenocarcinoma in a 54-year-old man, who presented with recurrent ischemic stroke due to chronic DIC. He died of the underlying malignancy despite the appropriate institution of anticoagulation therapy.This case emphasizes that cerebral infarction may be the first manifestation of an undiagnosed cancer. If there is laboratory or clinical evidence associated with DIC, patients with a cerebral infarct of an unknown etiology should be investigated for a malignant process. The optimal method of anticoagulation in cancer patients with thromboembolic disease （TED） remains unclear.

Evaluation of peripheral perfusion in term newborns before and after Yintang (EX-HN 3) massage

OBJECTIVE: To identify how acupressure on the acupoint Yintang(EX-HN 3) impacts oxygen saturation, pulse rate, and peripheral perfusion in term-born infants without underlying disease.METHODS: Infants born between weeks 37 and 42 of gestation were included in this study. The polyclinic's neonatology room was noise-controlled and made half-dark to prevent the perfusion index from being confounded. A pulse oximeter was linked to the baby's left lower extremity. Acupressure was applied on Yintang(EX-HN 3) for 30 s clockwise, held for 30 s, and then acupressure was applied for another 30 s counterclockwise. The baby's SaO_2, pulse rate, and perfusion index were recorded for each minute before and after acupressure.RESULTS: When pre- and post-acupressure pulse rate values were compared, a significant decrease in pulse rate values after acupressure application was observed. When pre- and post-acupressure oxygen saturation values were compared, a significant increase in post-acupressure oxygen saturation was observed. In addition, peripheral perfusion increased significantly after acupressure.CONCLUSION: Acupressure application has been used in traditional medicine for many years. However, it is not yet widely used in modern medicine.This study shows the impact of acupressure on neonatal skin perfusion, oxygen saturation, and pulse rate.

Acupuncture in Preterm Babies during Minor Painful Procedures

Objective: To evaluate analgesic effects of acupuncture in preterm neonates during minor painful procedures. Methods: Ten preterm neonates requiring heel prick for blood gas analysis were enrolled in the study, which had a crossover design. Oxygen saturation, systolic and diastolic blood pressure, respiratory rate, heart rate, and crying duration were recorded before and after heel prick. Babies were given expressed breast milk before each procedure. Patients were randomly assigned to receive acupuncture or not, and the groups were crossed over on the following day, so that patients who had received acupuncture received only breast milk, and the previous breast milk only group received both acupuncture and breast milk. The neonatal infant pain scale (NIPS) was used for pain evaluation. Results: Crying duration and NIPS pain scores during heel prick were lower in the neonates who had received acupuncture. Conclusion: Acupuncture is an effective method for the treatment of pain in neonates.