Development and treatment approaches of bronchopleural fistula after pulmonary resection

Pulmonary resections comprise most of the operations performed in thoracic surgery departments. Diseases like pulmonary cancers, bronchiectasis, pulmonary abscess, tuberculosis and fungal infections are treated surgically by pulmonary resections. One of the important steps of the pulmonary resection is to suture the bronchi through which the air is supplied to the resected pulmonary tissue. Bronchopleural fistula developed in the bronchial stump is encompassed as one of the most important factors affecting mortality and morbidity regarding postoperative complications.     

Visceral basidiobolomycosis: An overlooked infection in immunocompetent children

Visceral basidiobolomycosis is an unusual fungal infection of viscera caused by saprophyte Basidiobolus ranarum. It is very rare in healthy children and poses a diagnostic challenge due to the non-specific clinical presentation and the absence of predisposing factors. We report a case of gastrointestinal basidiobolomycosis in a 4-year-old healthy girl who presented with a short history of abdominal pain, bleeding per rectum, fever, and weight loss. The diagnosis was based on high eosinophilic count, classical histopathology findings of fungal hyphae (the Splendore-Hoeppli phenomenon), and positive fungal culture from a tissue biopsy. Fungal infection was successfully eradicated with a combined approach of surgical resection of the infected tissue and a well-monitored course of antifungal therapy. The atypical clinical presentation, diagnostic techniques, and the role of surgery in the management of a rare and lethal fungal disease in an immunocompetent child are discussed.Key words: Basidiobolomycosis, child, fungal infection, gastrointestinal, immunocompetent     

Experiences on the efficacy and safety of nalidixic acid,oxolinic acid,cinoxacin and norfloxacin in the treatment of urinary tract infections (UTI)

Summary The purpose of this study was to determine the effectiveness and tolerability of norfloxacin, cinoxacin and oxolinic acid in the treatment of urinary tract infections (UTI) in comparison to nalidixic acid. 125 patients were given the drugs in the appropriate doses for 10–14 days and 30 patients were treated for six weeks. Clinical, bacteriological, hematological and chemical checks were made on all patients before and after treatment. It was found that norfloxacin, cinoxacin and oxolinic acid are safe and effective againstEscherichia coli, Klebsiella andProteus, the commonly encountered organisms in urinary tract infections. The cure rate for norfloxacin was 93%, for cinoxacin 83%, for oxolinic acid 80% and for nalidixic acid 70% in the short course. However, these differences were not statistically significant. Oxolinic acid, cinoxacin and norfloxacin have the advantage over nalidixic acid of being administered only twice daily.

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Erfahrung mit Nalidixinsäure, Oxolinsäure, Cinoxacin und Norfloxacin bei der Behandlung von Harnwegsinfektionen — Wirksamkeit und Sicherheit

Zusammenfassung In der vorliegenden Studie sollte die Wirksamkeit und Verträglichkeit von Norfloxacin, Cinoxacin und Oxolinsäure im Vergleich zu Nalidixinsäure bei der Behandlung von Harnwegsinfektionen geprüft werden. 125 Patienten erhielten die Medikamente in den entsprechenden Dosen 10 bis 14 Tage lang, 30 Patienten wurden über sechs Wochen behandelt. Klinische, bakteriologische, hämatologische und biochemische Untersuchungen wurden bei allen Patienten vor und nach Behandlung vorgenommen. Norfloxacin, Cinoxacin und Oxolinsäure erwiesen sich als sicher und wirksam gegen Infektionen mitEscherichia coli, Klebsiella undProteus, die üblichen Erreger der Harnwegsinfektionen. Die Heilungsrate für Norfloxacin betrug 93%, für Cinoxacin 83%, für Oxolinsäure 80% und für Nalidixinsäure 70% bei der kürzeren Therapiedauer. Die gefundenen Unterschiede waren jedoch statistisch nicht signifikant. Oxolinsäure, Cinoxacin und Norfloxacin haben gegenüber Nalidixinsäure den Vorteil, daß sie nur zweimal täglich verabreicht werden müssen.

     

The Evaluation of Left Ventricular Functions with Tissue Doppler Echocardiography in Adults with Celiac Disease

Background/Aim:

The aim of this study was to investigate the effects of celiac disease on cardiac functions using tissue Doppler echocardiography (TDE).

Patients and Methods:

The study included 30 patients with celiac disease (CD) and 30 healthy volunteers. Echocardiographic examinations were assessed by conventional echocardiography and tissue Doppler imaging. The peak systolic velocity (S^''m), early diastolic myocardial peak velocity (E^''m), late diastolic myocardial peak velocity (A^''m), E^''m/A^''m ratio, myocardial precontraction time (PCT^''m), myocardial contraction time (CT^''m), and myocardial isovolumetric relaxation time (IVRT^''m), E to E^''m ratio were measured.

Results:

In pulsed wave Doppler echocardiography, mitral late diastolic flow (A) velocity and E to E^''m ratio were significantly higher (P = 0.02 and P = 0,017), E/A ratio was significantly lower (P = 0.008) and IVRT was significantly prolonged (P = 0.014) in patients with CD. In TDE, S^''m, E^''m, and E^''m/A^''m ratio were significantly lower, IVRT^''m was longer (P = 0.009) from septal mitral annulus and S^''m, E^''m, E^''m/A^''m ratio were significantly lower, PCT^''m, PCT/ET ratio, IVRT^''m were longer, and MPI was higher from lateral mitral annulus in celiac group than controls.

Conclusion:

Our study confirms that patients with CD have impaired diastolic function. More importantly, we also demonstrated an impairment of myocardial systolic function in patients with CD by TDE. We recommend using TDE in addition to conventional echocardiography parameters for the cardiovascular risk assessment of patients with CD.     

The comparison of ProSeal and I-gel laryngeal mask airways in anesthetized adult patients under controlled ventilation

Objectives:

To compare the insertion time, ease of device insertion, ease of gastric tube insertion, airway leakage pressure, and complications between the laryngeal mask airway (LMA) ProSeal (P-LMA) and I-gel (I-gel) groups.

Methods:

Eighty patients with age range 18-65 years who underwent elective surgery were included in the study. The study took place in the operation rooms of Haydarpaşa Numune Hospital, Istanbul, Turkey from November 2013 to April 2014. Patients were equally randomized into 2 groups; the I-gel group, and the P-LMA group. In both groups, the same specialist inserted the supraglottic airway devices. The insertion time of the devices, difficulty during insertion, difficulty during gastric tube insertion, coverage of airway pressure, and complications were recorded.

Results:

The mean insertion time in the I-gel group was significantly lower than that of the P-LMA group (I-gel: 8±3; P-LMA: 13±5 s). The insertion success rate was higher in the I-gel group (100%, first attempt) than in the P-LMA group (82.5%, first attempt). The gastric tube placement success rate was higher in the I-gel group (92.5%, first attempt) than in the P-LMA group (72.5%, first attempt). The airway leakage pressures were similar.

Conclusion:

Insertion was easier, insertion time was lower, and nasogastric tube insertion success was higher with the I-gel application, and is, therefore, the preferred LMA.Laryngeal mask airways (LMA) represent a good alternative to endotracheal intubation in suitable cases. The LMAs are used to provide ventilation, or to ease the insertion of an endotracheal tube (TT) in difficult airways, but they are also becoming more frequently used to reduce TT associated complications.1 In particular, the recently developed models of LMAs, which include a gastric tube, have become more commonly preferred in anesthesia applications.2 The I-gel (I-gel) (Intersurgical Ltd, Workingham, UK) has a latex-free, non-inflatable, gel-like, thermoplastic elastomeric cuff that provides easy coverage by properly fitting the anatomy of the supraglottic region and also involves a gastric tube; therefore, it has become more frequently used in patients under general anesthesia and receiving positive pressure ventilation.3 It has been reported that the single-use, inflatable cuff-free I-gel can be inserted more easily and has a reduced morbidity rate.4,5 It is recommended in emergency cases requiring intubation, and particularly in airway management of cases experiencing cardiopulmonary arrest.6 Another supraglottic airway device that enables gastric aspiration is the LMA ProSeal (Laryngeal Mask Company Ltd, Berkshire, UK). Since it is a semi-rigid device with an inflatable cuff, it has been reported to cause mucosa and nerve damage in the supraglottic region, sore throat, and hoarseness due to the cuff pressure.7The present study aimed to compare the I-gel and the LMA ProSeal (P-LMA) with respect to the duration of insertion, ease of insertion, airway pressure leakage, gastric tube insertion success ratio, and complications.     

Hopanoid lipids compose the Frankia vesicle envelope, presumptive barrier of oxygen diffusion to nitrogenase

Biological nitrogen fixation in aerobic organisms requires a mechanism for excluding oxygen from the site of nitrogenase activity. Oxygen exclusion in Frankia spp., members of an actinomycetal genus that forms nitrogen-fixing root-nodule symbioses in a wide range of woody Angiosperms, is accomplished within specialized structures termed vesicles, where nitrogen fixation is localized. The lipidic vesicle envelope is apparently a functional analogue of the cyanobacterial heterocyst envelope, forming an external gas-diffusion barrier around the nitrogen-fixing cells. We report here that purified vesicle envelopes consist primarily of two hopanoid lipids, rather than of glycolipids, as is the case in cyanobacteria. One envelope hopanoid, bacteriohopanetetrol phenylacetate monoester, is vesicle-specific. The Frankia vesicle envelope thus represents a layer specific to the locus of nitrogen fixation that is biosynthetically uniquely derived.     

Prediction of infarct-related coronary artery of patients with acute inferior myocardial infarction by a predischarge exercise test index

The predictive accuracy of electrocardiographic markers in identifying the infarct-related artery of myocardial infarctions has been a subject of extensive investigation. The present study was designed to test whether the index L II/L III ratio adapted to exercise electrocardiograms could be utilized as a marker to distinguish right coronary and left circumflex arteries as culprit coronaries in acute inferior myocardial infarctions. For this purpose, 82 patients with a positive-symptom-limited and/or submaximal treadmill exercise test with modified Bruce protocol after an acute inferior myocardial infarction were studied. Those patients with ST segment elevation during the stress test were included in the study. ST segment index was defined as the ratio of exercise-induced ST elevation amplitude in L II/L III. Patients were classified as having an index > 1 (n=24) and < 1 (n=58), and the findings were compared with the findings on coronary angiography. The groups were comparable with respect to age, gender, peak exercise level, and double products achieved. Circumflex artery was the infarct-related one in the majority (21/24; 88%) of patients with an index > 1, whereas most (51/58; 88%) patients with an index < 1 had the culprit lesion in their right coronary artery (p<0.001). The ratio of exercise-induced ST elevations in leads L II and L III has a significantly high ability to discriminate the infarct-related coronary artery in patients with uncomplicated inferior myocardial infarction. Considering the prognostic importance of the type of coronary involvement, this index could be a part of predischarge evaluation in this patient group.     

Impact of Anti-Aggregant,Anti-Coagulant and Non-Steroidal Anti-Inflammatory Drugs on Hospital Outcomes in Patients with Peptic Ulcer Bleeding

Background/Aims:

There are a limited number of studies including the impact of antiplatelet drugs use on hospital outcomes for nonvariceal upper gastrointestinal bleeding. The aim of this study was to determine the effect of anti-aggregant, anti-coagulant and non-steroidal anti-inflammatory drugs upon hospital outcomes in patients with peptic ulcer bleeding.

Materials and Methods:

The patients under treatment with antiaggregant, anticoagulant or non-steroidal anti-inflammatory drugs were categorized as exposed group (n = 118) and the patients who were not taking any of these drugs were categorized as non-exposed group (n = 81). We analyzed the data of drug intake, comorbid disease, blood transfusion, duration of hospital stay, Blatchford/total Rockall score and diagnosis of patients.

Results:

In total, 199 patients were included. Of these 59.3% (exposed group) were taking drugs. The patients in exposed group were significantly older than those in non-exposed group (62.9 ± 17.3 years; 55.5 ± 19.3 years, P = 0.005, respectively). Mean number of red blood cell units transfused (2.21 ± 1.51; 2.05 ± 1.87, P = 0.5), duration of hospital stay (3.46 ± 2.80 days; 3.20 ± 2.30 days, P = 0.532) and gastric ulcer rate (33% vs 23.4%, P = 0.172) were higher in exposed group than in non-exposed group but the differences were not statistically significant. Total Rockall and Blatchford scores of the patients were significantly higher in exposed group than in non-exposed group (3.46 ± 1.72 vs 2.94 ± 1.87, P = 0.045; 10.29 ± 3.15 vs 9.31 ± 3.40, P = 0.038).

Conclusıon:

Our study has shown that anticoagulants, antiaggregants and nonsteroidal anti-inflammatory drugs do not effect duration of hospital stay, red blood cell transfusion requirement and rebleeding for peptic ulcer bleeding.