The comparison of the efficacy of scoring systems in organophosphate poisoning

The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II scoring systems for organophosphate poisoning (OPP) in an intensive care unit (ICU). The following data were collected on all consecutive patients who were admitted to the ICU between June 1999 and December 2004. Demographic data, GCS, APACHE II and SAPS II scoring systems were recorded. Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was computed with 95% confidence intervals (CI). The sensitivity and specificity for each scoring system were evaluated by calculating the Area Under the Receiver Operating Characteristic Curves. The actual mortality in OPP was 21.9%. Predicted mortality by all systems was not significantly different from actual mortality [SMR and 95% CI for GCS: 1.00 (0.65 1.35), APACHE II: 0.87 (0.54-1.03), SAPS II: 1.40 (0.98-1.82)]. The area under the ROC curve for APACHE II is largest, but there is no statistically significant difference when compared with SAPS II and GCS (GCS 0.900 +/- 0.059, APACHE II 0.929 +/- 0.045 and SAPS II 0.891 +/- 0.057). In our ICU group of patients, in predicting the mortality rates in OPP, the three scoring systems, which are GCS, APACHE II and SAPS II, had similar impacts; however, GCS system has superiority over the other systems in being easy to perform, and not requiring complex physiologic parameters and laboratory methods.     

Effects of lead on Na(+)-K(+) ATPase and Ca(+2) ATPase activities and lipid peroxidation in blood of workers

Lead is considered one of the major environmental toxicants that causes hematological, neurological, and gastrointestinal dysfunction. In this study, the authors examined the relationship between lead and lipid peroxidation, lead and Na(+)-K(+) ATPase activity, and lead and Ca(+2) ATPase activity in blood of workers. The working group consisted of 30 male workers occupationally exposed to lead at least for 10 years. The control group consisted of 20 healthy male individuals not involved with job-related lead exposures. Blood lead content of the control group and the working group were 10.0 +/- 1.8 microg/dl and 317.3 +/- 47.6 microg/dl, respectively. Malondialdehyde (MDA) value of the working group (0.57 +/- 0.30 nmol MDA/ml) was significantly greater than MDA value of the control goup (0.17 +/- 0.02 nmol MDA/ml). In the working group, both Na(+)-K(+) ATPase activity (105.0 +/- 47.0 nmol Pi. mg protein(-1) x h(-1)) and Ca(+2) ATPase activity (58.0 +/- 40.0 nmol Pi. mg protein(-1) x h(-1)) were lower compared with the corresponding values of Na(+)-K(+) ATPase activity (247.0 +/- 41.0 nmol Pi. mg protein(-1) x h(-1)) and Ca(+2) ATPase activity (230.0 +/- 41.0 nmol Pi. mg protein(-1) x h(-1)) of normal controls. The results show that lead exposure causes inhibition of Na(+)-K(+) ATPase and Ca(+2) ATPase activities and also results in increased lipid peroxidation.     

Evaluation of individuals’ satisfaction with health care services in Turkey

Objectives

To demonstrate whether features related to the institution and service provider affect individuals’ level of satisfaction regarding the public health care services they receive.

Cold exposure and left ventricular diastolic performance in coronary artery disease

It is known that cold exposure is accompanied by coronary artery vasoconstriction and ischemia in patients with coronary artery disease (CAD). The aim of the present study was to evaluate the response of left ventricular (LV) diastolic and systolic functions, estimated by means of Doppler echocardiography, to cold pressor test (CPT) in patients with CAD. Twenty-five male patients (mean age 50.8 +/- 8.1 years) with documented CAD underwent CPT with Doppler echocardiographic assessment of LV diastolic and systolic functions. According to the development of ischemic response to CPT, all patients were divided into 2 groups: group 1, 10 patients with ischemia and group 2, 15 patients without ischemia during CPT. Cold exposure caused significant increase in blood pressure with no changes in heart rate in all CAD patients. Patients with signs of ischemia during cold exposure had lower transmitral flow velocity during early filling (p < 0.001), prolonged isovolumic relaxation time (p < 0.04), shortened deceleration time of early transmitral flow velocity (p < 0.001), and higher values of Doppler-derived index of myocardial performance (p < 0.0001) than those without ischemic response to CPT. Cold exposure in CAD patients through stimulating of vasoconstriction and ischemia was associated with derangements in LV myocardial performance, manifested by delayed relaxation, impaired stiffness, and reduced contractility.     

Prevalence of atrial fibrillation in obstructive sleep apnea

Objective

Recent data suggest that obstructive sleep apnea (OSA) is significantly associated with atrial fibrillation (AF). In the present study, we aimed to investigate the prevalence of AF in a large cohort of OSA patients and to compare the characteristics of patients with vs. without AF.

Methods

We retrospectively analyzed electrocardiographic data from 587 patients who had been admitted to our sleep laboratory for suspected sleep apnea. In all patients, anthropometric parameters, medical history with special reference to cardiovascular and metabolic co-morbidities and polysomnographic data were evaluated. Patients without sleep apnea and those with other types of sleep-disordered breathing were excluded from further analysis.

Results

A total of 427 patients (i.e., 72.7%) were found to suffer from OSA. Of these patients, 38 (i.e., 8.9%) were identified as having AF; the other 389 patients were in sinus rhythm. OSA patients with AF were significantly older than those without AF, whereas BMI and gender distribution were similar. Compared to patients in sinus rhythm, the AF group had a higher percentage of patients with hypertension, coronary artery disease, and diabetes mellitus. The severity of OSA did not significantly differ between patients with vs. without AF.

Conclusions

The prevalence of AF in OSA is considerably higher than in the general population. Our data suggest that the risk of AF is particularly increased in elderly OSA patients suffering from concomitant cardiovascular and metabolic disease.     

Laparoscopic management of gallbladder duplication

Gallbladder duplication is a rare condition. Because laparoscopic cholecystectomy is the primary treatment modality for the diseased single gallbladders, it should be the choice of treatment for double gallbladders. However, preoperative imaging methods may be unsatisfactory for the correct diagnosis. As a result, incomplete resections may be performed. Intraoperative cholangiography should be performed in suspected cases to prevent inadvertent injury to the biliary system. In this report, we present a symptomatic patient with double gallbladders with separate cystic ducts in whom the gallbladders were successfully resected as a single specimen by laparoscopic means. The pitfalls of diagnostic modalities and surgical strategy are discussed in the context of the available literature.     

Anatomical assessment of bile ducts of Luschka in human fetuses

Bile ducts of Luschka (also called subvesical or supravesicular ducts) can cause bile leakage during laparoscopic cholecystectomy, especially if surgery is carried out in ignorance of such variations. The aim of this study was to clarify the clinical anatomy of these ducts in human fetuses and frequency of the ducts locating near gallbladder fossa. Thirty-two fetal cadaver livers were dissected and the gallbladders were separated from the livers and ducts were investigated under a surgical microscope. All observed ducts were examined microscopically and connective tissue cords were excluded. Bile ducts of Luschka locating near cystic fossa were found in 7 of 32 fetuses (21.9%). Three of the seven ducts ran towards to liver segment 5 (S5); three ducts were found in the gallbladder fossa; and one duct ran towards to liver segment 4 (S4). Also it was found that three of the seven ducts drained into the subsegmental duct of S5, two ducts drained into the right hepatic duct, one duct drained into the right anterior branch bile duct, and one duct drained into the subsegmental duct of S4. Subvesical ducts running along the gallbladder fossa between the gallbladder and the liver parenchyma were found in a relatively high incidence in fetuses than adults. Awareness and knowledge about incidence of such ducts alerts the surgeon during laparoscopic cholecystectomy. Therefore morbidity due to bile leaks can be reduced.