Is general anesthesia a risk for myocardium? Effect of anesthesia on myocardial function as assessed by cardiac troponin-i in two different groups (isofluran+N2O inhalation and propofol+fentanyl iv anesthesia)

Background and objectives

Peroperative myocardial infarction (MI) is the most common cause of morbidity and mortality. What is the role of general anesthesia in this process? Is general anesthesia a risk for myocardial infarction? The present study was designed to determine whether the measurement of serum levels of cardiac troponin I (cTnI), a highly sensitive and specific marker for cardiac injury, would help establish the diagnosis of myocardial infarction in two different types of anesthesia.

Method

Elective abdominal hysterectomy was planned with the permission of the ethic committee in 40 patients who were 20–45 years range, in ASA-I group, and have a Goldman Cardiac Risk Index-0. The patients were divided into two groups. Isoflurane + N₂O was administrated to first group, and Propofol + Fentanyl to second group. cTnI levels were determined before anesthesia, after induction before surgery and 9 hours after the second period respectively.

Results

There was no significant difference between the groups by the means of demographic properties, hemodynamic parameters and cTnI levels, and the cTnI levels were determined under the basal levels in all samples.

Conclusion

General anesthesia is not a risk for myocardial infarction to state eliminating risk factors and protection hemodynamia cardiac.     

Assessing posterior ocular structures in β-thalassemia minor

Purpose

The aim of this study was to investigate the effect of β-thalassemia minor on choroidal, macular, and peripapillary retinal nerve fiber layer thickness.

Methods

To form the sample, we recruited 40 patients with β-thalassemia minor and 44 healthy participants. We used spectral-domain optical coherence tomography to take all measurements of ocular thickness, as well as measured intraocular pressure, axial length, and central corneal thickness. We later analyzed correlations of hemoglobin levels with ocular parameters.

Results

A statistically significant difference emerged between patients with β-thalassemia minor and the healthy controls in terms of mean values of subfoveal, nasal, and temporal choroidal thickness (p = 0.001, p = 0.016, and p = 0.010, respectively). Except for central macular thickness, differences in paracentral macular thicknesses between the groups were also significant (superior: p < 0.001, inferior: p = 0.007, temporal: p = 0.001, and nasal: p = 0.005). Also, no statistically significant differences were noted for retinal nerve fiber layer thickness between two groups.

Conclusion

Mean values of subfoveal, nasal, temporal choroidal, and macular thickness for the four quadrants were significantly lower in patients with β-thalassemia minor than in healthy controls.

     

The impact of case mix on timely access to appointments in a primary care group practice

At the heart of the practice of primary care is the concept of a physician panel. A panel refers to the set of patients for whose long term, holistic care the physician is responsible. A physician’s appointment burden is determined by the size and composition of the panel. Size refers to the number of patients in the panel while composition refers to the case-mix, or the type of patients (older versus younger, healthy versus chronic patients), in the panel. In this paper, we quantify the impact of the size and case-mix on the ability of a multi-provider practice to provide adequate access to its empanelled patients. We use overflow frequency, or the probability that the demand exceeds the capacity, as a measure of access. We formulate problem of minimizing the maximum overflow for a multi-physician practice as a non-linear integer programming problem and establish structural insights that enable us to create simple yet near optimal heuristic strategies to change panels. This optimization framework helps a practice: (1) quantify the imbalances across physicians due to the variation in case mix and panel size, and the resulting effect on access; and (2) determine how panels can be altered in the least disruptive way to improve access. We illustrate our methodology using four test practices created using patient level data from the primary care practice at Mayo Clinic, Rochester, Minnesota. An important advantage of our approach is that it can be implemented in an Excel Spreadsheet and used for aggregate level planning and panel management decisions.     

Acromesomelic dysplasia associated with mild lumbar spine stenosis

A rare case of acromesomelic dysplasia is reported. The radiological findings were consistent with shortness of all tubular bones, especially those of the forearms. There was also evidence of mild lumbar spine stenosis. Received: 16 June 1997; Revision received: 13 January 1998; Accepted: 24 March 1998     

Cerebrospinal fluid rhinorrhea: depiction with MR cisternography in dogs

Canine cerebrospinal fluid rhinorrhea, which occurs frequently in purebred beagles, was demonstrated in two dogs on magnetic resonance images after cisternal introduction of gadolinium-DTPA dimeglumine.     

Low Density Granulocytes and Dysregulated Neutrophils Driving Autoinflammatory Manifestations in NEMO Deficiency

Journal of Clinical Immunology - NF-κB essential modulator (NEMO, IKK-γ) deficiency is a rare combined immunodeficiency caused by mutations in the IKBKG gene. Conventionally, patients are...     

Risk factors in community-acquired urinary tract infections caused by ESBL-producing bacteria in children

In this study, risk factors were investigated in children with community-acquired urinary tract infections (UTI) caused by extended-spectrum beta-lactamases (ESBL)-producing E. coli or Klebsiella spp. One hundred and fifty-five patients were diagnosed with ESBL-positive UTI (case group) in the outpatient clinics of Hacettepe University Children’s Hospital between 1 January 2004 and 31 December 2006. A control group, 155 out of 4,105 children, was matched by age and sex among children with ESBL-negative UTI. A total of 310 patients’ files were evaluated retrospectively. As regards the symptoms of UTI, no statistical differences were seen between the two groups. Although the most frequently isolated microorganism was E. coli in both groups, Klebsiella spp. was found to be more frequent in those diagnosed with ESBL(+) UTI (p?<?0.001). Having an underlying disease and hospitalization, infections, and use of antibiotics within the last 3 months were found to be potential risk factors (p?<?0.001). With conditional logistic regression analysis, having an underlying disease and hospitalization within the last 3 months were identified as independent risk factors for ESBL(+) UTI. In conclusion, the recognition of risk factors for UTI, caused by ESBL(+) bacteria in children, may aid in the identification of high-risk cases and may enable proper management of these patients.     

Can impairments of thyroid function test affect prognosis in patients with respiratory failure?

Thyroid function test (TFT) impairments can be detected in extrathyroidal dysfunction, primarily in chronic obstructive pulmonary disease (COPD) with acute respiratory failure (RF). The aims of this study were to: (i) evaluate TFT impairments in patients with RF, (ii) compare TFT results to a control group without RF and (iii) assess the effects of thyroid dysfunction on clinical outcome and prognosis of RF. The TFT parameters were assessed in 65 patients (65.0 +/- 10.0 years, 49 males) with RF and compared to 18 patients (64.4 +/- 9.8 years, 13 males) with lung disease and no RF (p> 0.05). Arterial blood gas analysis, free T3 (FT3), free T4 (FT4) and TSH levels were all measured. The impairments of TFT were demonstrated in 34 (52.3%) patients with RF and 8 (44.4%) patients without RF (p> 0.05). The most common finding was a decrease in at least one of the TFT parameters in both groups (43.1% vs. 44.4%, respectively). In RF group, there was no significant association between TFT results and gender, age, diagnosis and co-morbid disease. However, need for invasive mechanical ventilation was higher both in patients with low FT3 and low FT4 when compared to those with normal TFT results (p= 0.001 and p= 0.003, respectively). In-hospital mortality rate was also higher both in the patients with low FT3 and low FT4 than the others (p= 0.006 and p= 0.01, respectively). We conclude that TFT impairments are not observed more frequently in patients with RF when compared to the patients without RF. However, low FT3 and FT4 levels increase the rates of invasive mechanical ventilation and mortality.