Performing only one cardiovascular reflex test has a high positive predictive value for diagnosing autonomic neuropathy in patients with chronic renal failure on hemodialysis

BACKGROUND: Autonomic neuropathy is an important cause of morbidity and mortality in patients with chronic renal failure (CRF) on hemodialysis. Generally, cardiovascular reflex tests are used to determine autonomic neuropathy. Our purpose in this study was to determine the frequency of autonomic neuropathy in patients with CRF on hemodialysis by using cardiovascular reflex tests and compare the sensitivity of each test. METHODS: The authors performed five tests: heart rate response to the Valsalva maneuver, heart rate variation during deep breathing, heart rate response to standing up, blood pressure response to standing up, and blood pressure response to hand grip exercise in order to determine autonomic neuropathy. Each test subject was evaluated as normal, borderline, and abnormal and scored as 0, 1, and 2, respectively. Subjects with a total score > or = 5 were considered to have autonomic neuropathy. Forty subjects with CRF on hemodialysis were included in this study. None of the subjects had diabetes mellitus or any other etiology that could cause autonomic neuropathy. RESULTS: Thirty-five of 40 subjects (87.5%) had abnormal autonomic tests. In 35 subjects, the relationship between autonomic neuropathy and biochemical parameters, effects of treatment with vitamin D and erythropoietin, and urea reduction rate were studied. No relationship was found between autonomic neuropathy and age, time on hemodialysis, urea reduction rate, albumin, ferritin, calcium, inorganic phosphorus, intact parathyroid hormone, hemoglobin levels, and treatment with vitamin D and erythropoietin. The abnormal test results were as follows: 20 subjects (50%) in the heart rate response to the Valsalva Maneuver, 31 (77.5%) in the heart rate variation during deep breathing, 28 (70%) in the heart rate response to standing up, 6 (15%) in the blood pressure response to standing up, and 31 subjects (77.5%) in the blood pressure response to hand grip exercise tests. Among these five tests, the two most abnormal tests were the heart rate variation during deep breathing and the blood pressure response to hand grip exercise. CONCLUSION: Patients with CRF on hemodialysis frequently have autonomic neuropathy. For the diagnosis and follow-up of patients, five cardiovascular autonomic reflex tests are generally used. In this study, it was determined that performing only one test instead of all five tests has a high sensitivity and is more practicable in terms of determining autonomic neuropathy.     

Outcomes of Kidney Transplantations From the Same Deceased Donor to Two Different Recipients: A Single-Center Experience

Background

Kidney transplantation is the best treatment method for end-stage renal disease. Technically, left kidney transplantation is easier than right kidney, and the complication rates in the right are higher than the left kidney. We performed 28 kidney transplantations from 14 deceased donors between November 2010 and May 2016. Our aim was to share our outcomes and experiences about these 28 patients.

Immediate Continence Rates in RALRP: A Comparison of Three Techniques

Methods:We retrospectively analyzed the patients who underwent RALRP for localized prostate cancer by a single surgeon in our clinic from January 1, 2009–February 1, 2016. Continence was defined as no leakage or use of a safety pad for minimal leakage. The main outcome measure was continence at postoperative week 1 and months 1, 6, and 12.Results:Between 2009 and 2016, 239 patients underwent RALRP for localized prostate disease. Seventy-four patients underwent a standard approach (group 1), 88 had posterior reconstruction (group 2), and 77 had posterior reconstruction with total anatomic restoration (group 3). After 1 week, 24.3% of the patients in group 1 (18/74), 31.8% in group 2 (28/88), and 45.8% in group 3 (33/72) were continent (P = .02). One month after the surgery, continence rates for groups 1, 2, and 3 were 56.7, 67, and 75%, respectively (0.065). After 6 and 12 months, continence rates for groups 1, 2, and 3 were 72.9 and 87.8%, 81.8 and 89.7%, and 84.7 and 91.6%, respectively (P = .178 and .7484).Conclusion:Anatomic restoration improves continence rates in the early period after RALRP. Even though other parameters were higher in the total restoration group, immediate continence (at 1 week) was significantly better.     

Comparison of two different techniques for brachial plexus block: infraclavicular versus axillary technique

BACKGROUND: Brachial plexus block via the axillary approach is problematic in patients with limited arm mobility. In such cases, the infraclavicular approach may be a valuable alternative. The purpose of our study was to compare axillary and infraclavicular techniques for brachial plexus block in patients undergoing arm or forearm surgery. METHODS: After institutional approval and informed consent were obtained, 30 patients (ASA physical status I or II) scheduled for forearm and hand surgery under brachial plexus anesthesia were included in the study. Patients were randomly allocated into two groups. Brachial plexus block was performed via the axillary approach in the Group A patients and via the infraclavicular approach in the Group I patients using a peripheral nerve stimulator. All blocks were performed with a total dose of 40 ml 0.375% bupivacaine. RESULTS: In each nerve territory (radial, ulnar, median, and musculocutaneous), the mean values of the degree and the duration of the sensory block and motor block were not significantly different between the two groups (P > 0.05). Inadvertent vessel puncture was significantly more frequent in the axillary approach (P < 0.05). CONCLUSION: Brachial plexus block performed via the infraclavicular approach is as safe and effective as the axillary approach. Infraclavicular approach may be preferred to the axillary approach when the upper arm mobility is impaired or not desired.     

Comparison of lumbar epidural tramadol and lumbar epidural morphine for pain relief after thoracotomy: a repeated-dose study

OBJECTIVE: The purpose of this study was to compare lumbar epidural morphine and lumbar epidural tramadol with respect to onset and duration of analgesia, analgesic efficacy, and drug-related side effects after muscle-sparing thoracotomy. DESIGN: Prospective, randomized, double-blind, clinical study. SETTING: Single university hospital. PARTICIPANTS: Forty patients who underwent elective muscle-sparing thoracotomy. INTERVENTIONS: Before anesthesia induction, an epidural catheter was placed in the L2-3 or L3-4 interspace using the loss-of-resistance technique. On arrival at the intensive care unit, patients were randomized to receive doses of either 100 mg of tramadol (group T) or 4 mg of morphine (group M) via the lumbar epidural catheter. Each dose was diluted in 10 mL of normal saline. On awakening from anesthesia, if the patient's pain score on a 0- to 100-mm visual analog scale was above 40 mm, the initial epidural drug dose was administered. The initial injection in each case was taken as time 0. Subsequent pain scores above 40 mm were considered indications for epidural dosing; each patient was allowed 2 doses in the first 12 hours postoperatively and 2 more in the second 12 hours. MEASUREMENTS AND MAIN RESULTS: The groups' analgesia onset times were similar, but duration of analgesia was significantly shorter in group T than in group M (p < 0.01). There were no differences between the groups with respect to pain scores at rest or during coughing at any of the time points investigated. Sedation scores were lower in group T than in group M at 1, 2, 3, 4, and 8 hours (p value range, 0.0001-0.05). Compared with group T, group M showed significantly greater drops in arterial oxygen tension from baseline at 3, 4, 8, and 12 hours (p value range, 0.0001-0.05). The group means for arterial carbon dioxide tension and respiratory rate were similar at all time points investigated. CONCLUSION: The study revealed that the quality of analgesia achieved with repeated doses of lumbar epidural tramadol after muscle-sparing thoracotomy is comparable to that achieved with repeated doses of lumbar epidural morphine. Compared with morphine, lumbar epidural tramadol results in less sedation and a less-pronounced decrease in oxygenation.     

The use of a vessel sealing system in thyroid surgery

Thyroidectomy is one of the most common operations performed for thyroid diseases throughout the world and has an extremely low morbidity rate. Although the technique of thyroidectomy has changed little for several years, different techniques have been developed for haemostasis in addition to the conventional methods. The vessel sealing system (Ligasure) is a new technology that can be applied in several surgical situations. However, there is no data in the literature regarding its use in thyroid surgery. Fifteen consecutive euthyroid patients (ten women, five men) with a range of 37-71 years of age who met the inclusion criteria were studied. The surgical procedures were performed by a single surgeon using standard techniques, but all vascular structures encountered were sealed by Ligasure and no suture material was used. The pre-operative, intraoperative and postoperative parameters were recorded and analyzed. Fluid collection was evaluated by ultrasonography and clinical examination on the 3rd postoperative day, The results were compared with the conventional knot tying method in a group of 25 patients. A Ligasure device was successfully used in 15 consecutive procedures, including ten total thyroidectomies, three hemithyroidectomies, one subtotal thyroidectomy and one near-total thyroidectomy. There was no operative mortality or technique-related morbidity in patients. The operating time was 75 +/- 11 minutes. The mean volume of the resected thyroid specimens was 68.3 +/- 18.9 cm3. The mean fluid collection at postoperative day three was 7.5 +/- 1.6 cm3. In conclusion, we have found that a Ligasure device can be safely used for haemostasis in thyroid surgery. It has the potential to decrease the operating time, fluid collection and blood loss.     

Cyclospora cayetanensis associated with diarrhea in a patient with idiopathic compensated hepatic cirrhosis

A 52 year-old male patient with idiopathic hepatic cirrhosis complaining of diarrhea and weakness was accepted to the gastroenterology clinic. In order to find out the causative etiologic agent of diarrhea, stool samples were examined by different methods and stained using modified Kinyoun's acid-fast stain. Following examination, approximately 9 microns diameter, acid-fast variable wrinkled spheres were seen and diagnosed as Cyclospora cayetanensis. Confirmation of the diagnosis was established by fluorescent microscope (380 to 420 nm excitation filter), which showed bright green to intense blue autofluorescent oocysts. It has been shown that, Cyclospora cayetanensis is a coccidian parasite mainly found in immunocompromised patients and that it may be the agent of prolonged diarrhea. Only three cyclosporiosis cases have been previously reported in our country; all three cases were AIDS patients. We report here a further case of Cyclospora cayetanensis infection in a patient with hepatic cirrhosis and we consider that this is the first case, which was reported in hepatic cirrhosis.     

The potential use of unmanned aircraft systems (drones) in mountain search and rescue operations

Objective

This study explores the potential use of drones in searching for and locating victims and of motorized transportation of search and rescue providers in a mountain environment using a simulation model.

Clinical characteristics of pulmonary artery involvement in patients with Behçet’s syndrome: single-centre experience of 61 patients

Clinical Rheumatology - To report the clinical characteristics of pulmonary artery involvement (PAI) in patients with Behçet’s syndrome (BS) and to define the predictors of relapses. We...