Unexpected cerebrospinal fluid rhinorrhea after a spinal anesthesia

A 47-year-old woman presented with a left-sided watery nasal discharge persisting for 3 weeks after an orthopedic operation using spinal anesthesia. The testing of the nasal fluid for β-2 transferrin confirmed that the leakage was cerebrospinal fluid (CSF). The computed tomographic cisternography revealed a left-sided bone defect in the cribriform plate. Endonasal approach was performed for closing the defect. At 3-month follow-up, CSF rhinorrhea had not recurred. In this report, we present an unexpected CSF rhinorrhea after a spinal anesthesia and discuss the reason of spontaneous leak after spinal anesthesia, as well as discuss current diagnosis and management of CSF rhinorrhea with the composite graft.     

Vesico-cutaneous fistula: unusual complication after transobturator mid-urethral sling

The transobturator tape (TOT) procedure was described in 2001 as the safest sling technique for the treatment of stress urinary incontinence (SUI). Although routine intraoperative cystoscopy to detect bladder and urethra injuries after the TOT procedure is not usually advocated, when such perforations do occur, there is potential for further patient morbidity. We present a case report of a vesico-cutaneous fistula detected after placement of a TOT sling in a 44-year old woman, 3 months postoperatively. Cystoscopic evaluation after mid-urethral sling procedures, especially in high-risk situations such as patients with cystocele, previous pelvic floor surgery or during the learning curve of the procedure, may avoid such complications associated with unrecognized lower urinary tract injuries.     

Self esteem and assertiveness of final year Turkish university students

This study developed a quantitative methodology to ascertain the level of self esteem and assertiveness of last year students in baccalaureate degree programs at Cumhuriyet University Nursing School, School for Health Sciences' Midwifery School, Education Faculty's Mathematics Teacher, Classroom Teacher, and Social Sciences Teacher programs and to determine if there is a correlation between self esteem and assertiveness. The research population was a total of 372 students who were in their final year of university in these programs. Sampling was not done in the research, the entire population was studied. However there was a total of 82 students who were not included in the research because of illness, absenteeism, registration on hold, who could not be found on campus or who did not want to participate in the research and who did not correctly complete the survey form. The research was conducted with total of 290 students. Total response rate was 77.9%. The data were collected using a "Personal Information Form," Stanley Coopersmith Self Esteem Inventory (SEI) and Rathus Assertiveness Schedule (RAS). Frequency distribution, t test, correlation and variance analysis were used in the analysis of the data. The results of the study were that the nursing students had the highest scores from SEI (80.64+/-15.83). Similarly the nursing students had the highest scores on the RAS (36.29+/-25.33).     

A scale-development study: Exploration of intensive-care nurses’ attitudes towards futile treatments

The study was conducted to determine the validity and reliability of the tool used to assess nurses’ attitudes towards futility, and to explore intensive-care nurses’ attitudes towards futility. Principal components analysis revealed that 18item scale was made up of four subdimensions that assess Identifying(beliefs), Decision-Making, Ethical Principles and Law, and Dilemma and Responsibilities related to futile treatments. The internal consistency of the scale was in the acceptable range, with a total Cronbach’s alpha value of 0.72. Overall the results of study suggest that scale can be used as a valid and reliable assessment tool to assess nurses’ attitudes towards futility.     

Unilateral renal agenesis and urethral atresia associated with ergotamine intake during pregnancy

Ergotamine, an ergot alkaloid, used for the treatment and prevention of migraine attacks, is considered as a teratogenic drug and, therefore, should be avoided in pregnancy. Here, we report a newborn infant with unilateral renal agenesis, urethral atresia, and pulmonary hypoplasia associated with the use of ergotamine for the treatment of migraine attacks at early pregnancy. Genitourinary anomalies in association with ergotamine usage were rarely reported and this was the third case of renal agenesia in association with ergotamine usage in literature. We suggest that ergotamine teratogenicity may be dose dependent and should be avoided in pregnancy for the possibility of genitourinary anomalies.     

The effectiveness of thrombolytic therapy in patients with massive and submassive pulmonary thromboembolism

Thrombolytic therapy is the most effective therapy for massive pulmonary embolism (PTE). In this study we evaluated the symptoms, clinical and radiologic features and response to thrombolytic therapy in patients who had massive or submassive PTE. Thrombolytic therapy was administered for a mean period of 3 (1-5) hours to 19 patients with a mean age of 63.7 years who had the diagnosis of PTE based on symptoms which lasted for an average of 72 (2-240) hours and findings of echocardiography, spiral computed tomography (CT) angiography and perfusion scan. The patients to whom heparin infusion and oral anticoagulant treatment were given after thrombolytic therapy were evaluated. Bleeding as a complication was noted in six patients after thrombolytic therapy. Two patients died due to this complication. Control spiral CT angiography was performed to 12 of 15 (80%) patients who were initially diagnosed PTE by spiral CT angiography. While marked regression was noted in 5 (41.7%) patients in the early phase (second week), in 7 (58.3%) patients in the late phase (sixth month) PTE findings were completely disappeared. The median value of pulmonary artery pressure was 65 (45-70) mmHg before and 39.5 (30-45) mmHg after the treatment. Of the genetic factors studied before thrombolytic therapy, antithrombin III deficiency was found as the most common one. This study demonstrates that spiral thorax CT angiography is a very accurate diagnostic tool for the definitive diagnosis and transthoracic echocardiography is very useful for the rapid diagnosis and to decide for thrombolytic therapy, in especially patients who are not hypotensive and have submassive to massive PTE, and support the idea that thrombolytic therapy is life saving after reaching the certain diagnosis.     

Mycobacterial infection of intraparenchymal bronchogenic cysts

Bronchogenic cysts (BCs) may rarely cause some interesting and unusual complications. Although infection is a common complication of BCs, there are only two patients with BC infected with mycobacterium in English literature. Two intraparenchymal BCs infected with mycobacterium are presented here as unusual complications. Cystectomy was performed for the cysts. They were given antituberculosis treatment. No complication or recurrences were detected in follow up period.     

Forty month follow-up of persistent and difficultly controlled acromegalic patients treated with depot long acting somatostatin analog octreotide

The objective of the present study was to investigate the effects of octreotide long acting release (S-LAR) preparation on GH and IGF-1 serum concentrations and pituitary tumor size in patients with persistent and difficultly controlled acromegaly even after adjuvant irradiation and/or dopamine agonists. Thirty-three patients with active acromegaly (26 female and 7 male, mean age; 43.94 +/- 14.01 SD years) were included in this study. Patients were evaluated at baseline and at 6, 12, 30 and 40 months for GH, IGF-1, and GH response to OGTT and biliary ultrasonography. Sella MRI was performed at initial and at 40 months. All patients received 20 mg S-LAR. Afterwards, the dosage was titrated to improve individual GH response and reduction of IGF-1 into normal ranges. Basal serum IGF-1 levels decreased from median: 530 microg/l [IQR: 420-600] to 340 microg/l [IQR: 230-460] at 6 months (p = 0.01), to 400 microg/l [IQR: 222.4-600] at 12 months (p = 0.48), to 396 microg/l [IQR: 318-468] at 30 months (p = 0.49), to 482 microg/l [308-580] at 40 months (p = 0.47). Nadir GH levels in OGTT fell from 2.70 ng/ml [IQR: 1.35-6.90] to 1.60 ng/ml [IQR: 0.36-4.10] at 6 months (p = 0.03), to 0.31 ng/ml [IQR: 0.18-0.65] at 12 months (p<0.0001), to 1.50 ng/ml [IQR: 0.83-4.00] at 30 months (p = 0.398) and to 0.89 ng/ml [IQR: 0.58-1.35] at 40 months (p<0.0001). Initially, pituitary adenoma volume was median: 1.18 ml [IQR: 0.08-3.50] and it shrank to 0.21 ml [IQR: 0-2.1] at 40 months (p = 0.08). Gallstones were detected in 12 patients and six of them underwent cholecystectomy. S-LAR is an effective treatment regimen in reducing GH and IGF-1 concentrations and as well as in shrinking tumor volume in persistent and difficultly controlled acromegalic patients.