Factors Affecting Mortality and Morbidity After Traumatic Diaphragmatic Injury

Purpose We review our 11-year experience of treating diaphragmatic injury (DI), to identify the factors determining mortality and morbidity. Methods We analyzed the effects of demographic characteristics, type of injury (blunt or penetrating), number of injured organs, injury severity score (ISS), revised trauma score (RTS), Glasgow coma score, and intensive care unit and hospital stay, on complications and mortality, in 51 patients treated for DI between January 1995 and December 2005. Results Twenty-six (51%) patients suffered blunt injury and 25 (49%) suffered penetrating injury. The left diaphragm was injured in 40 (78%) patients, the right in 10 (19%), and both sides in 1 (2%). Only three (5.8%) patients had no concomitant injury. The diagnosis was made by the findings of laparotomy on 34 patients (65%), preoperative chest X-ray on 13 (25%), computed tomography on 2 (3.9%), and laparoscopy on 2 (3.9%). Complications developed in 23 (44%) patients and overall mortality was 19.6% (10/51). An ISS > 13 was found to be an independent prognostic factor for morbidity, whereas an RTS ≤ 11, age ≥ 48 years, and a major postoperative complication were independent prognostic factors for mortality. Conclusion Establishing a preoperative diagnosis of DI is still problematic. Aggressive treatment and close monitoring of patients with an ISS > 13, an RTS ≤ 11, an age ≥ 48 years, or a postoperative complication may decrease morbidity and mortality.     

Erratum to: The genotoxic effect of radiofrequency waves on mouse brain

Journal of Neuro-Oncology -     

The effect of chronic cadmium toxicity on blood pressure and plasma viscosity

Cadmium (Cd) is a heavy metal which affects many systems in humans and animals as a consequence of environmental and industrial pollution. The aim of this study was to investigate the effect of chronic Cd toxicity on blood pressure and plasma viscosity. Experimental group rats were given doses that contained 15 ppm CdCl(2) in drinking water for 8 weeks. The systolic blood pressure and heart rate were measured from rats' tails and recorded by plethysmography every two weeks. Blood samples were drawn, Cd levels were determined by atomic absorption spectrophotometer and plasma viscosity values by viscometer. Blood Cd levels were found to be significantly higher in the experimental group compared to the control group (p < 0.001). The whole blood analysis was made by an analyzer. Polymorphonuclear leukocytes and monocytes increased (p < 0.01) and lymphocyte number (p < 0.05) decreased in the experimental group. Viscosity values were 2.21 ± 0.54 and 1.62 ± 0.31 centipoises in the experimental and control groups, respectively (p < 0.001). In the experimental group, changes in systolic blood pressure between weeks were significant (p < 0.001) and were found to be correlated with plasma viscosity (p < 0.001). In the experimental group, changes in heart rate between weeks were significant (p < 0.001). According to our findings, Cd toxicity may lead to an increase in blood pressure by increasing plasma viscosity.     

A multi-center survey of childhood asthma in Turkey – I: The cost and its determinants

Successful management of childhood asthma requires a thorough idea of the economic impact of asthma and its determinants, as policy makers and physicians inevitably influence the outcome. The aim of this study was to define the cost of childhood asthma in Turkey and its determinants. In April 2006, a multi-center, national study was performed where data regarding cost and control levels were collected. Asthmatic children (6–18 yr) with at least a 1-yr follow-up seen during a 1-month period with scheduled or unscheduled visits were included. The survey included a questionnaire-guided interview and retrospective evaluation of files. Cost and its determinants during the last year were analyzed. A total of 618 children from 12 asthma centers were surveyed. The total annual cost of childhood asthma was US$1597.4 ± 236.2 and there was a significant variation in costs between study centers (p < 0.05). Frequent physician visits [odds ratio (95% confidence intervals)] [2.3 (1.6–3.4)], hospitalization [1.9 (1.1–3.3)], asthma severity [1.6 (1.1–2.8)], and school absenteeism due to asthma [1.5 (1.1–2.1)] were major predictors of total annual costs (p < 0.05 for each). The comparable cost of asthma among Turkish children with that reported in developed countries suggests that interventions to decrease the economic burden of pediatric asthma should focus on the cost-effectiveness of anti-allergic household measures and on improving the control levels of asthma.     

Prevalence and characteristics of Hymenoptera venom allergy in urban school children aged 6 to 18 years living in Trabzon

Background/aim Hymenoptera venom allergy is one of the leading causes of systemic allergic reactions in both adults and children. The present study was conducted to evaluate the prevalence and characteristics of Hymenoptera venom allergy in urban school children aged 6 to 18 years living in Trabzon.Materials and methods In this cross-sectional, two-level survey study, children were recruited using random sampling of public primary and secondary schools. Firstly, parents were asked about their child’s age and sex and whether their child had ever been stung by any kind of bee. When they responded “yes” to the last question, they attended a face-to-face interview at the outpatient clinic for the second part of the survey, which included information about history of insect stings and the presence of atopic diseases.Results Of 17,000 children, 7904 (46.5%; 3718 males, 47.0%) returned the first-level questionnaire. A total of 4312 (54.5%) were stung at least once in their lifetime. Males had a significantly higher risk of being stung (59.4%, odds ratio: 1.44, 95% confidence interval: 1.32–1.58, p < 0.0001). The second-level questionnaire was completed for 545 (12.6%) of the children. Of 950 stings reported in 545 children, 5.2% were large local reactions (LLRs), 1.9% were generalized cutaneous reactions (GCRs), and 1.3% were systemic reactions (SRs). The stinging insect was Apis mellifera and Vespula in 66.2% and 33.8% of stings, respectively (p < 0.001).Conclusion Hymenoptera stings are common in urban school children living in Trabzon. The most common type of allergic reaction is LLR and the most reported stinging insect is Apis mellifera .     

Cyclic sciatica caused by infiltrative endometriosis: MRI findings

Endometriosis, an important gynecological disorder of reproductive women, affects most commonly the ovaries and less frequently the gastrointestinal tract, chest, urinary tract, and soft tissues. Endometriosis classically appears on MRI as a mass with a large cystic component and variable signal intensities on T1- and T2-weighted images due to the presence of variable degradation of hemorrhagic products. Endometriosis in an atypical location, an infiltrative appearance and without cystic-hemorrhagic components has rarely been described. We report on a 33-year-old woman with cyclic sciatica due to histologically documented infiltrative endometriosis involving the area of the left sciatic notch.     

Mapping of internal mammary vessels by multidetector computed tomography for parasternal transthoracic intervention guidance

OBJECTIVE: To measure the distances between the internal mammary arteries (IMAs) and the sternum for determining a route for parasternal transthoracic interventions. METHODS: Coronal reconstructed multidetector computed tomography images of 202 patients were evaluated to measure the distances between the IMAs and sternum at 3 levels (manubrium, midsternal corpus, and distal sternal corpus). The arrangements (2 veins-single artery or single vein-single artery) were documented. RESULTS: The most frequently encountered arrangement (42.1%) was a single vein and single artery on both sides. Mean distances on the right and left sides were 10.2 and 10.1 cm at the manubrium, 14.5 and 14.3 cm at the midsternal corpus, and 17.9 and 17.5 cm at distal sternal corpus, respectively. CONCLUSION: To be aware of the courses of the IMAs at different sternal levels is important during attempts at transthoracic intervention via a parasternal approach.