Canan Balci

The Influence of Nutritional Status on Complications after Major Intraabdominal Surgery

Objective: Currently most nutritional assessment techniques are based on their ability to predict clinical outcomes. However, the validity of any of these techniques to truly measure “nutritional risk” has not been proved. We have therefore prospectively assessed the prognostic value of two nutritional assessment techniques and nonnutritional factors in determining outcome after major abdominal surgery. Methods: At admission and discharge, 100 patients undergoing major abdominal surgery were assessed on the following items: Subjective Global Assessment, Nutritional Risk Index, anthropometric measurements, serum total protein, serum albumin, lymphocyte count, total serum cholesterol. Patients were monitored for postoperative complications until death or discharge. Results: At admission, 44% of the patients were malnourished according to the Subjective Global Assessment, while 61% of the patients were malnourished according to the Nutritional Risk Index. At discharge, these numbers were 67% and 82%, respectively. Higher death rates were found in the malnourished groups. The risk of complication was increased in malnourished patients with both assessment techniques. The odds ratios for the association between malnutrition and complications varied between 1.926 and 9.854 with both assessments. The presence of cancer in the patient was predictive for complication. Conclusions: Malnutrition is a marker of bad outcomes. Both Subjective Global Assessment and Nutritional Risk Index nutrition tests are predictive for malnutrition and postoperative complications in patients undergoing major abdominal surgery.

Usefulness of procalcitonin for diagnosis of sepsis in the intensive care unit

IntroductionThe diagnosis of sepsis in critically ill patients is challenging because traditional markers of infection are often misleading. The present study was conducted to determine the procalcitonin level at early diagnosis (and differentiation) in patients with systemic inflammatory response syndrome (SIRS) and sepsis, in comparison with C-reactive protein, IL-2, IL-6, IL-8 and tumour necrosis factor-α.MethodThirty-three intensive care unit patients were diagnosed with SIRS, sepsis or septic shock, in accordance with the American College of Chest Physicians/Society of Critical Care Medicine consensus criteria. Blood samples were taken at the first and second day of hospitalization, and on the day of discharge or on the day of death. For multiple group comparisons one-way analysis of variance was applied, with post hoc comparison. Sensitivity, specificity and predictive values of PCT and each cytokine studied were calculated.ResultsPCT, IL-2 and IL-8 levels increased in parallel with the severity of the clinical condition of the patient. PCT exhibited a greatest sensitivity (85%) and specificity (91%) in differentiating patients with SIRS from those with sepsis. With respect to positive and negative predictive values, PCT markedly exceeded other variables.DiscussionIn the present study PCT was found to be a more accurate diagnostic parameter for differentiating SIRS and sepsis, and therefore daily determinations of PCT may be helpful in the follow up of critically ill patients.

Evaluation of Several Clinical Scoring Tools in Organophosphate Poisoned Patients

Objective. The aim of this study was to evaluate the Acute Physiology and Chronic Health Evaluation (APACHE) II, III and Simplified Acute Physiology Score II (SAPS II) as predictors of severity of organophosphate poisoning (OPP). Methods. This is a retrospective study of 48 patients with OPP who were admitted to the intensive care unit (ICU) for at least 24 h between 1997 and 2004. Demographic, laboratory, survival data and on day one APACHE II, III, SAPS II and Glasgow Coma Scale (GCS) were recorded, and correlations between these scores and severity of poisoning were performed. Results. Forty-eight patients were evaluated. Mechanical ventilation was required by 58% of patients. The mean APACHE II, III and SAPS II values were 11.5 ± 7.21, 42.1 ± 24.49 and 25.1 ± 15.76, respectively. Total dose and duration of atropine and of pralidoxime therapy, length of ICU stay and mortality all correlated with these clinical scoring tools. Conclusions. The APACHE II, III and SAPS II clinical scoring tools seem to predict the severity of organophosphate poisoning, and may have prognostic value.

Circulating complement (C3 and C4) for differentiation of SIRS from sepsis

The systemic inflammatory response of the body to invading microorganisms, called sepsis, leads to profound activation of the complement (C3 and C4) system. The present study was conducted to compare the use of serum C3 and C4 levels with C-reactive protein (CRP) and thrombocyte and leukocyte counts in differentiating patients with systemic inflammatory response syndrome (SIRS) from those with sepsis. Over a 6-mo period, all patients with SIRS or sepsis who stayed in the intensive care unit for > 24 h were enrolled in the study. At admission, each patient’s clinical status was recorded, and blood was taken for laboratory analysis (complete blood count, CRP, C3, and C4). A total of 58 patients with SIRS and 41 patients with sepsis were admitted to the study. The mean±SD thrombocyte count was found to be significantly lower in septic patients (179,975±95,615) than in those with SIRS (243,165±123,706) (P=.005); no difference in plasma concentrations of CRP and levels of C3 and C4 was noted between groups. The thrombocyte count was determined to be the most reliable parameter for differentiating between SIRS and sepsis (highest area under the curve=0.656).

Determining entropy values equivalent to the bispectral index values during sevoflurane anaesthesia.

Introduction We aimed to identify the entropy levels that would be equivalent to the bispectral index (BIS) levels in sevoflurane anaesthesia in patients who are to undergo elective lumbar disc surgery. Material and methods Thirty cases in ASA groups I-II who underwent lumbar disc surgery under general anaesthesia were included in our study after obtaining the consent of the patients and Ethics Committee of our medical school between January 1, 2005 and October 30, 2006. BIS and entropy electrodes were applied at the same time in 30 cases in the study group. The depth of the anaesthesia was regulated so that 10 min after beginning the general anaesthesia the BIS values were between 40 and 60. At the same time equivalent entropy values corresponding to BIS values were obtained. Results At the end of the study, entropy values corresponding to general anaesthesia BIS values were identified. General anaesthesia BIS and RE/SE values at 10 min were lower than the values of the control, which was statistically significant (p < 0.05). Equivalent entropy values were obtained lower than the BIS values during general anaesthesia and these values were found to be statistically significant (p < 0.05). The blood pressure (BP) values obtained were very low at equivalent BIS values and when these BP values were compared with the initial BP values they were found to be statistically significant (p < 0.05). Conclusions Based on this observation, we think that general anaesthetic agents that might cause severe hypotension could be more safely administered under entropy monitoring.

Köpeklerde Bupivakain ve Levobupivakainin Kardiovasküler Sistem Üzerine Etkileri

Objective: In this study, following the administration of bupivacaine, levobupivacaine compared the cardiotoxic dosages and cardiotoxic effects of each agent.

Kronik Obstrüktif Akciğer Hastalarında Mekanik Ventilasyon Sonrası Görülen Hipofosfatemi

Kronik solunum yetmezligi tablosuna, akut solunum yetmezliginin eklenmesi ve mekanik ventilasyona duyulan gereksinim, beslenme bozuklugunu ve elektrolit bozukluklarini da beraberinde getirmektedir. Kronik Obstruktif Akciger Hastaligi (KOAH) nedeniyle takip edilen ve daha sonra akut solunum yetmezligi gelisen yaslari 58-75 arasinda degisen 25 erkek hastanin dosyasi retrospektif olarak incelendi. Mekanik olarak solutulan ve enteral beslenme uygulanan KOAH’li hastalarda mekanik ventilasyon oncesi, ventilasyonun birinci gunu ve 5 gunluk enteral beslenme sonrasi fosfor (P) duzeyleri karsilastirildi. Olgularin tumunun KOAH’i ve uzun yillar sigara icme anamnezi mevcuttu. P1: Mekanik ventilasyon oncesi, P2: Mekanik ventilasyonun birinci gunu ve P3: 5 gunluk enteral beslenme sonrasi fosfor (P) duzeyleri karsilastirildi. P1=3,55±0,90 iken, mekanik ventilasyondan yirmi dort saat sonra P2=2,05±0,96 degerine dustu ve bes gunluk tibbi tedavi ve yaklasik 2000 Kcal’lik beslenmeye sekonder olarak P3=4,46±0,84 degerine yukseldi. Mekanik ventilasyon oncesi normal olan P duzeylerinde mekanik ventilasyondan sonra dusme gozlemlenirken, enteral beslenme sonrasi artis saptanmistir. Buna paralel olarak hastalarin protein ve albumin degerlerinde de mekanik ventilasyon sonrasi dusme gozlemlenirken, enteral beslenme sonrasi bu miktarlarda da artis oldugu gorulmustur