Davud Yapici

Total versus subtotal thyroidectomy for the management of benign multinodular goiter in an endemic region

Background:  Because controversy still continuous to surround use of total thyroidectomy for the management of benign multinodular goiter, the present study aims to prospectively compare the safety and efficacy of total thyroidectomy with subtotal thyroidectomy.

The comparison of the efficacy of scoring systems in organophosphate poisoning

The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II scoring systems for organophosphate poisoning (OPP) in an intensive care unit (ICU). The following data were collected on all consecutive patients who were admitted to the ICU between June 1999 and December 2004. Demographic data, GCS, APACHE II and SAPS II scoring systems were recorded. Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was computed with 95% confidence intervals (CI). The sensitivity and specificity for each scoring system were evaluated by calculating the Area Under the Receiver Operating Characteristic Curves. The actual mortality in OPP was 21.9%. Predicted mortality by all systems was not significantly different from actual mortality [SMR and 95% CI for GCS: 1.00 (0.65-1.35), APACHE II: 0.87 (0.54-1.03), SAPS II: 1.40 (0.98-1.82)]. The area under the ROC curve for APACHE II is largest, but there is no statistically significant difference when compared with SAPS II and GCS (GCS 0.9009 / 0.059, APACHE II 0.9299 / 0.045 and SAPS II 0.8919 / 0.057). In our ICU group of patients, in predicting the mortality rates in OPP, the three scoring systems, which are GCS, APACHE II and SAPS II, had similar impacts; however, GCS system has superiority over the other systems in being easy to perform, and not requiring complex physiologic parameters and laboratory methods.

Effects of levosimendan on myocardial ischaemia-reperfusion injury

Background and objective: Levosimendan has a cardioprotective action by inducing coronary vasodilatation and preconditioning by opening KATP channels. The aim of this study was to determine whether levosimendan enhances myocardial damage during hypothermic ischaemia and reperfusion in isolated rat hearts. Methods: Twenty‐one male Wistar rats were divided into three groups. After surgical preparation, coronary circulation was started by retrograde aortic perfusion using Krebs‐Henseleit buffer solution and lasted 15 min. After perfusion Group 1 (control; n = 7) received no further treatment. In Group 2 (non‐treated; n = 7), hearts were arrested with cold cardioplegic solution after perfusion and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. In Group 3 (levosimendan treated; n = 7), levosimendan was added to the buffer solution during perfusion and the hearts were arrested with cold cardioplegic solution and subjected to 60 min of hypothermic global ischaemia followed by 30 min reperfusion. At the end of the reperfusion period, the hearts were prepared for biochemical assays and for histological analysis. Results: Tissue malondialdehyde levels were significantly lower in the levosimendan‐treated group than in the non‐treated group (P = 0.019). The tissue Na+‐K+ ATPase activity was significantly decreased in the non‐treated group than in the levosimendan‐treated group (P = 0.027). Tissue myeloperoxidase (MPO) enzyme activity was significantly higher in the non‐treated group than in the levosimendan‐treated group (P = 0.004). Electron microscopic examination of the hearts showed cardiomyocytic degeneration at the myofibril, mitochondria and sarcoplasmic reticulum in both non‐treated and levosimendan‐treated groups. The severity of these findings was more extensive in the non‐treated group. Conclusions: Treatment with levosimendan provided better cardioprotection with cold cardioplegic arrest followed by global hypothermic ischaemia in isolated rat hearts.

Manufacturing defect in an endotracheal tube connector: risk of foreign body aspiration

To the editor: Routine inspection and testing of endotracheal tubes (ETTs) prior to use may fail to identify certain manufacturing defects [1]. We would like to discuss the potential morbid complication of foreign body aspiration associated with a manufacturing defect in the tip of an ETT connector. A 28-year-old woman was scheduled for laparoscopic ovarian cystectomy. Induction of anesthesia was performed with 2 mg·kg propofol, 0.1 mg fentanil, and 0.1 mg·kg vecuronium bromide i.v. Tracheal intubation was achieved with a size 7.5-mm ETT (Well Lead Medical Instruments, Jinhu Industrial Estate Hualong, Panyu Guangzhou, P. R. China). Chest auscultation revealed clear, bilaterally equal breath sounds. The lungs were ventilated at 6 l·min and 17-mmHg peak airway pressure. While we were fi xing the ETT with tape, a moving particle was noticed in the lumen of the ETT. The ETT was immediately disconnected from the ventilator, and a tiny particle was noted in the distal part of the tube connector (Fig. 1). The connector was changed immediately and ventilation was maintained with no problem during the operation. Inspection of the connector revealed that the presence of the particle was caused by a manufacturing defect. Neither atelectasis nor a foreign body was seen on chest radiograph taken at the end of the operation. The postoperative course was uneventful. Problems associated with an ETT defect, if not corrected immediately, would lead to failure in ventilating the lungs, hypoxemia, and serious complications [2,3]. It is recommended that the use of transparent tubes and a pre-use check might allow visualization of the lumen and hence prevent problems [3]. However, some problems may still occur even with high-quality, pre-packed single-use transparent plastic ETTs [3]. In our patient, the foreign body moved with ventilation, and then it could be seen only in the lumen of the tube. If it had not been noticed, a possible problem would have been the inward migration of the particle, possibly leading to serious complications. There has been no previous report of this type of structural defect in an ETT. We suggest that an internal visual check of the lumen should be performed routinely, because the opaque nature of the connector makes visual Fig. 1. A Tiny particle in the distal part of an endotracheal tube connector. B The foreign body moved with ventilation, and then it could be seen in the lumen of the tube