Funda Yalcin

Impact of COPD exacerbation on cerebral blood flow

We aimed to investigate the impact of chronic obstructive pulmonary disease (COPD) exacerbation on cerebral blood flow (CBF). In 21 COPD patients - in both exacerbation and stable phases -Doppler ultrasonographies of internal carotid artery (ICA) and vertebral artery (VA) were performed. There were significant differences in total, anterior and posterior CBF, ICA and VA flow volumes in exacerbated COPD compared to stable COPD. Total CBF was correlated with cross-sectional areas of left and right ICA, whereas independent predictor of total CBF was cross-sectional area of right ICA. Increased CBF might indicate cerebral autoregulation-mediated vasodilatation to overcome COPD exacerbation induced hypoxia.

Oxigênio Suplementar em Cesariana Eletiva sob Raquianestesia: Manejar um Punhal com Cuidado

BACKGROUND AND OBJECTIVES We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1st and 5th minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Supplemental oxygen in elective cesarean section under spinal anesthesia: Handle the sword with care.

BACKGROUND AND OBJECTIVES We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1(st) and 5(th) minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Acute Respiratory and Renal Failure due to Hypermagnesemia, Induced by Counter Laxatives in an Elderly Man.

Sir, Increased serum magnesium levels are generally iatrogenic and rare clinical situations with significant cardiovascular, neurological and neuromuscular effects. Patients with bowel disorders, renal insufficiency, and patients with old age are especially at high risk for hypermagnesemia. The treatment of hypermagnesemia includes discontinuing the magnesium intake, gastrointestinal decontamination, intravenous calcium gluconate and hemodialysis [1]. Herein, we report a life threating hypermagnesemia situation induced by a magnesium containing product, used for the treatment of chronic constipation. A 70-year-old man presented with constipation, chest tightness and dyspnea. He had a history of chronic obstructive pulmonary disease, chronic kidney failure and diabetes mellitus. Contrast enema was planned on the first hospital day. The patient became lethargic in the second day of hospitalization. Abdominal pain with diminished bowel sounds was observed. The neurological examination showed symmetric decrease in muscle tone and in deep tendon reflexes. Mechanical ventilation was initiated according to arterial blood gas results. Biochemical results were as follows; magnesium, 9.07 (1.5–2.6) mEq/L; calcium, 7.78 (8.4–10.2) mEq/L, sodium, 140 (135–145) mEq/L; potassium, 5.5 (3.5–5.1) mEq/L; creatine, 3.85 (0.2–1.2) mg/dL; blood urine nitrogen, 202.5 (70–105) mg/dL. Calcium gluconate was infused for antagonizing most of the clinical effects of toxicity. A nasogastric and rectal tube were inserted for gastrointestinal decontamination. Emergency continuous veno-venous haemodialysis (CVVHD) for hypermagnesemia was performed and continued during 48 hours. Finally, after a 48 hour CVVHD treatment, the Mg level decreased to 2.0 mEq/L) and the patient was extubated. The follow up period was uneventful. Magnesium is an important intracellular cation that functions as a co-factor in several enzyme pathways. The magnesium plasma value is generally between 1.4 and 2.1 mEq/L and closely regulated through interaction of the gastrointestinal absorption, bone store and kidney excretion [2]. Hypermagnesemia can occur with various processes such as renal failure, Addison disease, milk alkali syndrome, hypothyroidism and with lithium therapy. Decreased elimination, magnesium overdose and increased absorption are the main causes of hypermagnesemia. Our patient had both decreased elimination as a consequence of kidney failure and magnesium overdose due to laxative usage [3]. Clinical manifestations of hypermagnesemia vary according to the serum Mg concentration. Symptomatic hypermagnesemia typically presents with neurological, neuromuscular and cardiac manifestations including hyporeflexia, sedation, muscle weakness and respiratory depression but many physicians are relatively unfamiliar with these conditions [4]. Especially elder patients are at high risk of magnesium toxicity as the kidney function declines with age [5]. Relationship between hypermagnesemia and laxative usage should induce physicians to pay more attention to hypermagnesemia especially in this subgroup of patients and urgent CVVHD is highly effective in preventing significant morbidity and mortality.

Paratracheal air cysts: prevalence and relevance to pulmonary emphysema and bronchiectasis using thoracic multidetector CT

PURPOSE We aimed to determine the prevalence of paratracheal air cysts (PTACs) and the relationship of PTACs with emphysema and bronchiectasis through retrospective analysis of multidetector computed tomography (MDCT) findings. METHODS MDCT findings of 1027 consecutive patients who underwent routine thorax examination between January 2012 and January 2013 were evaluated retrospectively for the presence of PTACs. Localization of the PTACs, as well as their size, shape, and relationship with the trachea were examined. Presence of emphysema and bronchiectasis was recorded, and bronchiectasis severity index was calculated when present. We randomly selected 80 patients who had no visible PTACs as the control group. The findings of patients with and without PTACs were compared. RESULTS PTACs were determined in 82 of 1027 patients (8%), in 8.8% of females and 7.3% of males. The presence of PTACs was determined to be independent of gender (P = 0.361). Eighty-one PTACs (98.8%) were located in the right side of the trachea and 56.1% had a tracheal connection. The presence of PTACs significantly correlated with the presence and severity of bronchiectasis (P = 0.001 and P = 0.005 respectively). There was no significant relationship between the presence of PTACs and the presence of emphysema on CT images (P = 0.125). CONCLUSION The prevalence of PTACs was determined as 8% in this study. There was significant association between PTACs and bronchiectasis.

Efficacy of CT in diagnosis of transudates and exudates in patients with pleural effusion.

PURPOSE We aimed to evaluate the efficacy of multidetector computed tomography (CT) imaging in diagnosis of pleural exudates and transudates using attenuation values. MATERIALS AND METHODS This retrospective study included 106 patients who were diagnosed with pleural effusion between January 2010 and June 2012. After the patients underwent chest CT, thoracentesis was performed in the first week. The attenuation values of the pleural effusions were measured in all patients. RESULTS According to Lights criteria, 30 of 106 patients with pleural effusions had transudates, and the remaining patients had exudates. The Hounsfield unit (HU) value of the exudates (median, 12.5; range, 4-33) was significantly higher than that of the transudates (median, 5; range, 2-15) (P = 0.001). Additionally, when evaluated by disease subgroups, congestive heart failure and empyema were predictable in terms of median HU values of the pleural effusions with high and moderate sensitivity and specificity values (84.6% and 81.2%, respectively; 76.9% and 66.7%, respectively). Compared with other patients, the empyema patients had significantly more loculation and pleural thickening. CONCLUSION CT attenuation values may be useful in differentiating exudates from transudates. Although there is an overlap in most effusions, exudate can be considered when the CT attenuation values are >15 HU. Because of overlapping HU values, close correlation with clinical findings is essential. Additional signs, such as fluid loculation and pleural thickness, should be considered and may provide further information for the differentiation.

Impaired global and segmental myocardial deformation assessed by two-dimensional speckle tracking echocardiography in patients with vitamin B12 deficiency

BACKGROUND Contrary effects of vitamin B12 deficiency have been shown on the cardiovascular system. Aim of our study was to analyze left ventricular (LV) myocardial deformation, by using the two dimensional (2D) speckle tracking echocardiography (STE) in patients with vitamin B12 deficiency and normal LV ejection fraction. METHODS Twenty-five patients with vitamin B12 deficiency (B12 levels < 200 pg/mL; mean age: 29.6 ± 8.2 years, 15 female), and 27 healthy controls (B12 levels > 200 pg/mL; mean age: 30.1 ± 6.9 years, 13 female) were included in the study. 2D echocardiography images were transferred to a workstation for further offline analysis. Longitudinal peak systolic (LPSS) and global strain (LGS) was obtained from 4 chamber and apical long axis (APLAX) views. RESULTS Standard echocardiographic parameters and tissue Doppler imaging (TDI) velocities were compared between the groups. All LPSS values in the patient group except for apical 4C septal wall longitudinal strain were significantly decreased than those in the control group. There was a positive correlation between B12 levels and strain values except apical 4C septal wall strain values. CONCLUSIONS We found that in patients with vitamin B12 deficiency, global and segmental myocardial deformation was impaired and this impairment was correlated with the levels of vitamin B12.