Autoimmune myasthenia gravis after coronary artery bypass surgery

We report a rare case of spontaneous dissection of an anomalous systemic artery supplying a normal basal segment of the right lung during pregnancy, leading to recurrent hemoptysis. This article aims to discuss the clinical presentation, diagnostic curiosity, management using a minimally invasive technique (video-assisted thoracoscopic lobectomy), and finally the histopathologic findings.     

A comparison of fentanyl-propofol with a ketamine-propofol combination for sedation during endometrial biopsy

STUDY OBJECTIVE: The purpose of this study was to compare the clinical activities of ketamine and fentanyl when used in combination with propofol for outpatients undergoing endometrial biopsy. The investigated parameters were respiration, sedation, recovery rate, side effects, time to discharge, and patient satisfaction. DESIGN: Prospective, randomized, double-blind study. SETTING: University hospital. PATIENTS: Forty American Society of Anesthesiologists physical status I and II patients (age range 38-61 years) scheduled for elective endometrial biopsy. INTERVENTIONS: Patients received intravenous bolus doses of either fentanyl 1 microg/kg and propofol 1 mg/kg in (group 1 n = 20) or ketamine 0.5 mg/kg and propofol 1 mg/kg in (group 2 n = 20). MEASUREMENTS: Heart rate, systolic and diastolic blood pressure, respiratory rate, and peripheral O(2) saturation were monitored in all patients. Depth of sedation was assessed by the Ramsay sedation score. The Aldrete score was used for postoperative recovery evaluation. The time to Aldrete score >/=8, side effects, and time to discharge were recorded. MAIN RESULTS: Respiratory depression was observed in 5 patients from group 1 and 1 patient from group 2, but the difference was not significant (P > .05). Nausea, vertigo, and visual disturbances were more frequent in group 2 (P < .05). The time to Aldrete score >/=8 was similar in the 2 groups (6.2 +/- 3.5 minutes in group 1 and 7.0 +/- 3.1 minutes in group 2); the time to discharge was significantly longer in group 2 (71.2 +/- 9.7 minutes in group 1 and 115.2 +/- 25.6 minutes in group 2). Frequency of patient satisfaction was 95% in group 1 and 60% in group 2. CONCLUSIONS: Hemodynamic change and degrees of sedation showed that fentanyl-propofol and ketamine-fentanyl combinations can be used safely in patients undergoing endometrial biopsy. However, with regard to side effects and patient satisfaction, the fentanyl-propofol was superior.     

Correlation of middle meatus and ethmoid sinus microbiology in patients with chronic sinusitis

Empirical antibiotics constitute the cornerstone of medical therapy for chronic sinusitis due to difficulties of obtaining cultures from the paranasal sinuses. Indirect isolation of the pathogenic microorganisms outside the paranasal sinuses with a non-invasive method may enable administration of specific antibiotics. In this prospective study, we obtained cultures from the middle meatus and ethmoid sinuses of 193 sides from 127 patients who had undergone FESS for chronic sinusitis with a method that minimizes the risk of nasal contamination. The same bacterial species were isolated from both the ethmoid sinus and middle meatus in 59.3% of the cultures. There was no bacterial growth in either site in 32.3% of the cultures. The overall correlation rate of middle meatus and ethmoid sinus cultures was estimated to be 91.6%. In conclusion, middle meatal cultures can be used for the isolation of pathogenic microorganisms indirectly, while administration of specific antibiotics can be possible according to the results of these cultures.     

Vaginal delivery of dicephalic parapagus conjoined twins: case report and literature review

After an unsuccessful midwife-assisted delivery in which a head was born but delivery could not be advanced, episiotomy performed at Sanliurfa Maternity Hospital allowed vaginal delivery of female conjoined twins. Visual and x-ray examination showed two heads, two vertebral columns, two feet, two arms, and fusion at the level of the pelvis. The baby was born dead, but the mother made an uneventful recovery. Parapagus (anterolaterally joined) dicephalus (two-headed) twins account for only 11-13% of all conjoined twins, and they rarely survive. Complex malformations of hearts, lungs and abdominal organs, duplication of the tracheae, upper gastrointestinal tract and spinal column, and either double or single versions of other organs have been reported in parapagus dicephalus cases. The incidence, anatomical, embryological, diagnostic, prognostic, obstetrical, perinatal, and ethical aspects of conjoined twins are reviewed, with a focus on parapagus dicephalus conjoined twins.     

Diagnosis of abdominal tuberculosis： Experience from 11 cases and review of the literature

AIM: To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis.METHODS: The records of 11 patients (4 males, 7 females,mean age 39 years, range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed.RESULTS: Ascites was present in all cases. Other common findings were weight loss (81%), weakness (81%), abdominal mass (72%), abdominal pain (72%), abdominal distension (63%), anorexia (45%) and night sweat (36%). The average hemoglobin was 8.2 g/dL and the average ESR was 50 mm/h (range 30-125). Elevated levels of cancer antigen CA-125 were determined in four patients. Abdominal ultrasound showed abnormalities in all cases: ascites in all, tuboovarian mass in five, omental thickening in 3, and enlarged lymph nodes (mesenteric, para-aortic) in 2. CT scans showed ascites in all, pelvic mass in 5, retroperitoneal lymphadenopathy in 4, mesenteric stranding in 4, omental stranding in 3,bowel wall thickening in 2 and mesenteric lymphadenopathy in 2. Only one patient had a chest radiograph suggestive of a new TB lesion. Two had a positive family history of pulmonary TB. None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two. Laparotomy was performed in 6 cases, laparoscopy in 4 and ultrasoundguided fine needle aspiration in 2. In those patients subjected to operation, the findings were multiple diffuse involvement of the visceral and parietal peritoneum, white‘miliary nodules‘ or plaques, enlarged lymph nodes, ascites,‘violin string‘ fibrinous strands, and omental thickening.Biopsy specimens showed granulomas, while ascitic fluid showed numerous lymphocytes. Both were negative for acid-fast bacilli by staining. PCR of ascitic fluid was positive for Mycobacterium tuberculosis ( M. tuberculosis) in all cases.CONCLUSION: Abdominal TB should be considered in all cases with ascites. Our experience suggests that PCR of ascitic fluid obtained by ultrasound-guided fine needle aspiration is a reliable method for its diagnosis and should at least be attempted before surgical intervention.     

Work-related asthma-like symptoms among florists

OBJECTIVES: In this study, we evaluated the prevalence of work-related asthma-like symptoms and possible risk factors among florists in Turkey. METHODS: We collected questionnaire data from 128 florists, and investigated occupational history and respiratory, ocular, dermal, and nasal symptoms. We evaluated pulmonary function tests with spirometry and atopy by using the skin-prick test. Possible risk factors were analyzed by age-adjusted, smoking-adjusted, and gender-adjusted logistic regression models comparing symptomatic and asymptomatic individuals. RESULTS: The prevalence of work-related asthma-like symptoms was 14.1% (18 patients). We observed excess risk with a high work intensity (odds ratio [OR], 7.3; 95% confidence interval [CI], 1.1 to 51.8) and long work duration (OR, 5.1; 95% CI, 1.2 to 21.6). Florists with work-related asthma-like symptoms were 5.9 times more likely (95% CI, 1.4 to 24.3) to have a positive skin test response to a flower mix allergen. We also observed an excess risk for work-related asthma-like symptoms among those with allergic rhinitis (OR, 13.2; 95% CI, 3.1 to 56.4) and conjunctivitis (OR, 8.4; 95% CI, 2.4 to 29.2). CONCLUSION: The most prominent risk factors in florists were work intensity, work duration, and specific atopy.