Influence of the patient positioning on respiratory mechanics during pneumoperitoneum

The aim of this study was to evaluate the effect of patient positioning during laparoscopic cholecystectomy on respiratory mechanics and arterial blood gases. Thirty patients of ASA I were included. Ventilation was controlled mechanically. Tidal volume and ventilator frequency were kept unchanged throughout the operation. Intra-abdominal pressure was kept constant at 12 mmHg. Ventrak respiratory system was used for measuring respiratory mechanics. The airway resistance (Raw), the dynamic compliance (Cdyn), and the peak inspiratory pressure (PIP) were monitored. Measurements were made in five intervals: "a" after induction of general anesthesia, "b" after insufflation, "c" in the Trendelenburg position of 40 degree, "d" in the Fowler position of 40 degree, and "e" after desufflation. Samples of arterial blood gases were collected while the respiratory mechanics were being recorded. The mean arterial pressure (MAP) and heart rate (HR) were also monitored. In our study, during intervals "c" and "d", PCO2, was increased and pH decreased. With the initiation of insufflation, Cdyn, PIP, and Rawx, were altered (P < 0.05). The patient positioning had a significant effect on respiratory mechanics. After desufflation only Cdyn changed (P < 0.05). Although HR remained in normal limits, MAP increased during pneumoperitoneum (P < 0.05). We conclude that blood gas changes and respiratory mechanics were affected by the duration of pneumoperitoneum and patient positioning. The Fowler position had the least influence on respiratory mechanics.     

Do perceived health risks outweigh the benefits of modern contraceptives? A qualitative study in a suburban population in Istanbul, Turkey.

OBJECTIVES: To evaluate the health concerns and the perceived non-contraceptive benefits of modern contraceptive methods through utilizing qualitative methods. METHODS: Six focus group discussions were carried out with a total of 53 married women in a socio-economically disadvantaged community in Istanbul, Turkey. RESULTS: Women had a vague knowledge of the mechanism of menstruation. Some women believed that the uterus was filled with blood -- termed 'dirty blood' -- which should be eliminated during menstruation in order to stay healthy. For this reason, amenorrhoea was recognized as the important disadvantage of the progestin-only injectable contraceptives. While the participants mentioned fallacious and exaggerated side effects related to modern methods they did not recognize their non-contraceptive benefits. Most women gained the information concerning side effects through their social networks. Sometimes the information acquired was based on rumours that biased women against the modern contraceptives. CONCLUSIONS: Women outweighed the risks, some of which were fallacious and exaggerated, against the benefits of modern contraceptives. It is crucial to address health concerns of women and what they 'heard' from their peers during counselling sessions. Also the non-contraceptive health benefits of modern methods should be well emphasized. Since informal sources are prevalent, the effectiveness of peer education should be studied in this community.     

Primary systemic amyloidosis with severe cardiac amyloidosis

An autopsy case of primary systemic amyloidosis with severe cardiac amyloidosis in a 75-year-old Japanese man is reported. The initial signs were dyspnea and cough, followed by general fatigue and loss of appetite. Heart failure, pleural effusion, and liver cysts were found on physiological examination. Autopsy findings were primary systemic amyloidosis with severe diffuse cardiac amyloidosis and cardiac hypertrophy (585 g). Focal necrosis by infarction was found in the liver and spleen. The cause of amyloidosis was unknown.     

A patient-specific computational model of fluid-structure interaction in abdominal aortic aneurysms

It is generally believed that knowledge of the wall stress distribution could help to find better rupture risk predictors of abdominal aortic aneurysms (AAAs). Although AAA wall stress results from combined action between blood, wall and intraluminal thrombus, previously published models for patient-specific assessment of the wall stress predominantly did not include fluid-dynamic effects. In order to facilitate the incorporation of fluid–structure interaction in the assessment of AAA wall stress, in this paper, a method for generating patient-specific hexahedral finite element meshes of the AAA lumen and wall is presented. The applicability of the meshes is illustrated by simulations of the wall stress, blood velocity distribution and wall shear stress in a characteristic AAA. The presented method yields a flexible, semi-automated approach for generating patient-specific hexahedral meshes of the AAA lumen and wall with predefined element distributions. The combined fluid/solid mesh allows for simulations of AAA blood dynamics and AAA wall mechanics and the interaction between the two. The mechanical quantities computed in these simulations need to be validated in a clinical setting, after which they could be included in clinical trials in search of risk factors for AAA rupture.     

A comparison of microwave thermosphere versus radiofrequency thermal ablation in the treatment of colorectal liver metastases

Background

Microwave thermosphere ablation (MTA) is a new generation technology. The aim of this study was to compare the efficacy of MTA and radiofrequency ablation (RFA) in achieving local tumor control in patients with colorectal liver metastasis (CRLM).

Successful catheter ablation of a right-sided accessory pathway in a child with interruption of the inferior vena cava and azygos continuation

Azygos continuation is seen in 0.6% of patients with congenital heart disease. The major significance of this anomaly lies in its association with complex cardiac defects and the technical difficulty that can accompany cardiac catheterization. We report our experience with successful catheter ablation of a right posteroseptal concealed accessory pathway in a 6-year-old boy with infrahepatic interruption of the inferior vena cava and azygos continuation.     

Two female nonsmoker Buerger's disease cases with anticardiolipin autoantibodies and a poor prognosis

We present two female nonsmoker Buerger's disease cases with anticardiolipin autoantibodies and a poor prognosis. One was a 64-year-old female who has had multiple lower and upper extremity amputations, while the other was a 32-year-old female with extremity and visceral artery involvement. Since both were positive for anticardiolipin antibodies, we speculate that Buerger's disease is an autoimmune disorder.     

Age and Sex-Dependent Changes in Serum Amylase in an Apparently Healthy Population

In order to determine whether changes in serum amylase are age- or sex-dependent, we evaluated age- and sex-stratified serum amylase values in subjects who were proven to be healthy by a precise preventive health examination. Results showed that serum amylase increased as age progressed, except in the 0- to 29-yr-old female group. Mean serum amylase was higher in females than in males. A previous study indicated that the etiology of the increase in amylase in elderly persons is due to a progressive decline in renal function with aging. The etiology of the sex difference, especially in the younger generation, requires further investigation. We should pay attention to the factor of age when we evaluate serum amylase.