Effects of crossed leg on blood pressure

It is known that many factors influence an individual's blood pressure measurement. However, guidelines for accurately measuring blood pressure inconsistently specify that the patient should keep feet flat on the floor. The purpose of this study was to examine the effects of a crossed leg position on blood pressure in a Turkish sample. A prospective study of 238 subjects with an unmedicated high-normal blood pressure, stage 1 or stage 2 hypertension was conducted. After obtaining informed consent, subjects positioned their feet flat on the floor while their blood pressure was being measured. After 3 min, the blood pressure was measured again with the subject's leg crossed at the knee. Mean values of blood pressure were compared by t-test between two measurements. Statistical significance for all analysis was taken at the 5% level. The results indicated that both systolic and diastolic blood pressure increased significantly with the crossed leg position. Crossing the leg at the knee results in a significant increase in blood pressure. When blood pressure is measured, subjects should be instructed to have feet flat on the floor to eliminate a potential source of error.     

SPLENIC ANGIOMATOID NODULAR TRANSFORMATION IN A CHILD WITH INCREASED ERYTHROCYTE SEDIMENTATION RATE

An 11-year-old girl was referred to the authors’ hospital with a complaint of growth retardation. Physical examination revealed splenomegaly. Laboratory examination revealed increased sedimentation rate. Her imaging studies showed a splenic mass. Splenectomy was performed and histopathological examination revealed sclerosing angiomatoid nodular transformation (SANT) of the spleen. The disease rarely affects children but it could cause growth retardation and increased sedimentation rate, mimicking the chronic inflammatory diseases.     

Results of classical and augmented bimedial rectus recession in infantile esotropia

PURPOSE. To compare the success rates of augmented bimedial rectus recession and the standard recession. MATERIALS AND METHODS. Ninety patients were included in the study. The patients were evaluated in two groups according to the amount of recession. Group 1, the standard surgery group, received 5 mm or less of recession; Group 2, the augmented surgery group, received 6 mm of recession or more. The mean postoperative follow-up was 29 months (6-60 months) in Group 1, and 20 months (6-58 months) in Group 2. RESULTS. The mean age at the time of surgery was 4.61 years in Group 1 and 4.58 years in Group 2. The 56 patients in Group 1 underwent bilateral rectus recession varying from a minimum of 3 mm to a maximum of 5 mm; the 34 patients in Group 2 had recessions varying from a minimum of 6 mm to a maximum of 8 mm. The mean preoperative angle size was 39.64 ± 8.93 SD (range 20-50 PD) in the standard surgery group, and 59.70 ± 10.04 SD (range 51-85 PD) in the augmented surgery group. The average postoperative de viation was 13.37 ± 11.87 SD (range 0-45) in Group 1 and 9.02 ± 10.02 (range 0-45) in Group 2. A good surgical result was achieved with one operation in 29 of 56 patients (51.8%) in Group 1 and 24 of 34 patients (70.58%) in Group 2. DISCUSSION. The optimal surgical technique for the correction of large-angle esotropia is still controversial; it appears that the augmented bilateral medial rectus recession is an effective and reasonable alternative to three- or four-muscle procedures as the initial surgical treatment.     

Efficacy and tolerability of antibiotic combinations in neurobrucellosis: results of the Istanbul study

No data on whether brucellar meningitis or meningoencephalitis can be treated with oral antibiotics or whether an intravenous extended-spectrum cephalosporin, namely, ceftriaxone, which does not accumulate in phagocytes, should be added to the regimen exist in the literature. The aim of a study conducted in Istanbul, Turkey, was to compare the efficacy and tolerability of ceftriaxone-based antibiotic treatment regimens with those of an oral treatment protocol in patients with these conditions. This retrospective study enrolled 215 adult patients in 28 health care institutions from four different countries. The first protocol (P1) comprised ceftriaxone, rifampin, and doxycycline. The second protocol (P2) consisted of trimethoprim-sulfamethoxazole, rifampin, and doxycycline. In the third protocol (P3), the patients started with P1 and transferred to P2 when ceftriaxone was stopped. The treatment period was shorter with the regimens which included ceftriaxone (4.40 ± 2.47 months in P1, 6.52 ± 4.15 months in P2, and 5.18 ± 2.27 months in P3) (P = 0.002). In seven patients, therapy was modified due to antibiotic side effects. When these cases were excluded, therapeutic failure did not differ significantly between ceftriaxone-based regimens (n = 5/166, 3.0%) and the oral therapy (n = 4/42, 9.5%) (P = 0.084). The efficacy of the ceftriaxone-based regimens was found to be better (n = 6/166 [3.6%] versus n = 6/42 [14.3%]; P = 0.017) when a composite negative outcome (CNO; relapse plus therapeutic failure) was considered. Accordingly, CNO was greatest in P2 (14.3%, n = 6/42) compared to P1 (2.6%, n = 3/117) and P3 (6.1%, n = 3/49) (P = 0.020). Seemingly, ceftriaxone-based regimens are more successful and require shorter therapy than the oral treatment protocol.