A rare diagnosis in emergency department: spontaneous spinal epidural hematoma

We report a case of a 32-year-old man who presented to the emergency department (ED) with a sudden onset of paraplegia due to spontaneous spinal epidural hematoma. Although the patient had a poor neurological condition on presentation, he was successfully operated and discharged without any neurological sequel. Spontaneous spinal epidural hematoma is a rarely seen clinical entity, especially in the ED. Magnetic resonance imaging is the best choice for early diagnosis, and urgent surgical decompression is essential to prevent serious neurological deficits.     

Harvesting of the radial artery: subfasciotomy or full skeletonization: a comparative study

BACKGROUND: Long fasciotomy of the posterior aspect of the radial artery (RA) for the purpose of sympathectomy is one of the surgical techniques for the preparation of this graft. We compared the early results of this technique with those of the RA graft harvested as a pedicle in the conventional fashion. METHODS: The study patients have been selected from the patients who underwent coronary artery bypass grafting (CABG) using the RA graft harvested either with a long posterior fasciotomy (group 1) or as a whole with a pedicle in the classical manner (group 2). Only the patients with a flow study have been included. The flow index was described as the bleeding amount of the RA in a minute per body surface area (mL/m2 min). The flow index has been performed before and after fasciotomy in group 1, and after full skeletonization in group 2. The clinical and demographic parameters and flow indices were measured and compared between the groups, and in group 1, before and after fasciotomy. RESULTS: From 218 patients with CABG using the RA between January 1998 and August 2005, a total of 57 patients were recruited into the study. Group 1 consisted of 25 patients. Thirty-two patients constituted group 2. Subfascial dissection of the RA increased the blood flow index from 48 +/- 20 mL/m2 min to 51 +/- 19 mL/m2 min (p < 0.001). The comparison of the clinical, perioperative characteristics of the patients was not different between the groups. CONCLUSIONS: The necessity of total skeletonization of the RA should not be the only option when the aim is to reduce the spasm. While subfascial dissection (sympathectomy) of the pediculed RA alone provides a satisfactory increase in the blood flow index, it also reduces the manipulation time as well as the risk of injury to the graft.     

Fosfomycin in the treatment of extended spectrum beta-lactamase-producing Escherichia coli-related lower urinary tract infections

Fosfomycin tromethamine (FT) is effective in vitro in extended spectrum beta-lactamase (ESBL)-producing Escherichia coli strains. The aim of this study was to evaluate the effect of FT in the treatment of ESBL-producing E. coli-related lower urinary tract infection. All patients were aged >18; had dysuria or problems with frequency or urgency in passing urine; had >20leukocytes/mm(3) in urine sediment and an ESBL-producing E. coli urine culture (>10(5)cfu/mm(3)); no leukocytosis or fever; and were treated with FT between September 2004 and July 2006 in our outpatient clinic and hospital. ESBL detection was performed by double disk synergy tests. All patients had received FT (3gx1 every other night, three times) and had a control urine culture taken 7 to 9 days after this therapy. Clinical success was defined as resolution of symptoms on the control visit; microbiological success was defined as a sterile control urine culture. In all, 52 patients (aged 55.0+/-18.3, range 19-85; 25 males, 27 females) were included in the study. Overall clinical and microbiological success was 94.3% (49/52) and 78.5% (41/52), respectively. Although it is not a randomized controlled study, these data show that FT may be a suitable, effective and cheap alternative in the treatment of ESBL-producing E. coli-related lower urinary tract infection.     

Electrocardiographic criteria of left ventricular hypertrophy in the presence of left bundle branch block

When left bundle branch block (LBBB) is present on the electrocardiogram, the diagnosis of left ventricular hypertrophy (LVH) may be difficult. The left ventricular mass in 70 patients with LBBB was estimated by echocardiography, and was compared to the QRS configuration on the electrocardiogram. We found that there was agreement between a monophasic R pattern in lead 1 or V6 (sensitivity 79.3%, 70.7%) and left ventricular hypertrophy. We suggest that a monophasic R pattern in L1 and V6 may provide a useful simple index of left ventricular hypertrophy in the presence of left bundle branch block.     

Relapse of minimal change disease after inactivated SARS-CoV-2 vaccination: case report

International Urology and Nephrology -     

Evaluation of mineral content of enamel prepared by erbium, chromium:yttrium–scandium–gallium–garnet laser

The aim of this study was to evaluate the mineral content of enamel etched at two different power settings with an erbium, chromium:yttrium–scandium–gallium–garnet (Er,Cr:YSGG) laser. Buccal, lingual and mesial or distal surfaces of five premolar teeth were cut, and three enamel slabs were obtained from each tooth. Fifteen enamel specimens were divided into three groups (1 W, 2 W and control) of five specimens each and subjected to Er,Cr:YSGG laser. The mean percentage weights of the five elements [calcium (Ca), potassium (K), magnesium (Mg), sodium (Na) and phosphorus (P)] in each slab were measured by inductively coupled plasma-atomic emission spectrometry (ICP-AES). One way analysis of variance (ANOVA) was used to analyze differences among the groups (1 W, 2 W and control). There were no significant differences among the groups (1 W, 2 W and control) for Ca, K, Mg, Na, or P, or for the Ca/P ratio (P > 0.05). Scanning electron microscopy (SEM) photographs indicated that the surface irregularities increased with increased power setting. Laser treatment did not affect the mean percentage weights of Ca, K, Mg, Na, and P, or the Ca/P ratio, in any group.     

Effects of glutamine on wound healing

Studies reporting the need for replacing amino acids such as glutamine (Gln), hydroxymethyl butyrate (HMB) and arginine (Arg) to accelerate wound healing are available in the literature. The primary objective of this study was to present the effects of Gln on tissue hydroxyproline (OHP) levels in wound healing. This study was conducted on 30 female Sprague Dawley rats with a mean weight of 230 ± 20 g. Secondary wounds were formed by excising 2 × 1 cm skin subcutaneous tissue on the back of the rats. The rats were divided into three equal groups. Group C (Control): the group received 1 ml/day isotonic solution by gastric gavage after secondary wound was formed. Group A (Abound): the group received 0·3 g/kg/day/ml Gln, 0·052 g/kg/day/ml HMB and 0·3 g/kg/day/ml Arg by gastric gavage after secondary wound was formed. Group R (Resource): the group received 0·3 g/kg/day/ml Gln by gastric gavage after secondary wound was formed. The OHP levels of the tissues obtained from the upper half region on the 8th day and the lower half region on the 21st day from the same rats in the groups were examined. Statistical analysis was performed using the statistics program SPSS version 17.0. No statistically significant differences were reported with regard to the OHP measurements on the 8th and 21st days (8th day: F = 0·068, P = 0·935 > 0·05; 21st day: F = 0·018, P = 0·983 > 0·05). The increase in mean OHP levels on the 8th and 21st days within each group was found to be statistically significant (F = 1146·34, P = 0·000 < 0·001). We conclude that in adults who eat healthy food, who do not have any factor that can affect wound healing negatively and who do not have large tissue loss at critical level, Gln, Arg and HMB support would not be required to accelerate secondary wound healing.