Mesut Erbaş

Normal values correlates' of carotid intima- media thickness and affecting parameters in healthy adults

OBJECTIVE Early changes in atherosclerosis can be diagnosed by the carotid artery intima-media thickness (CIMT) measurement. Normal range of CIMT in healthy subjects has not been studied yet in our country. Therefore, the aim of this study was to measure the CIMT in healthy individuals and investigate affecting parameters of CIMT. METHODS Overall, 2298 subjects, aged 18 to 92 years were undergone CIMT measurement in this observational cohort study. 151 healthy adult subjects, aged 20 to 79 year without atherosclerotic risk factors, normal body mass index and normal metabolic parameters were selected to establish normative CIMT values. Correlations between CIMT and atherosclerotic risk factors were evaluated in the Turkish population. The independent variables associated with CIMT were evaluated with multiple linear regression analysis. RESULTS CIMT value was 0.458 ± 0.116 mm in males and 0.47 ± 0.104 mm in females. Mean values of CIMT (in mm) for healthy reference sample aged 20-29, 30-39, 40-49, 50-59, 60-69 and 70-79 years were 0.402; 0.466; 0.492; 0.586; 0.692 and 0.733, respectively. CIMT increased significantly (p<0.001) by 0.066 mm, in every decade. Correlates of CIMT were age, visceral fat level, fasting serum glucose, total and low-density lipoprotein cholesterol. Multiple linear regression analysis revealed that age was the single independent predictor of CIMT thickness in healthy individuals (β=0.007, 95% CI: 0.006-0.008, p<0.001). CONCLUSION CIMT was 0.458 ± 0.116 mm in men and 0.47 ± 0.104 mm in Turkish healthy adults. Age was the only predictor of CIMT. CIMT measurement can be used in the assessment of early atherosclerosis burden in adults.

Comparison of the effects of N-acetyl cysteine and erdosteine in rats with renal injury caused by paracetamol intoxication

Aim: The aim of the present study was to investigate the therapeutic and preventive effects of N-acetyl cysteine and erdosteine on renal injury associated with paracetamol (acetaminophen) intoxication. Materials and methods: Female albino Wistar rats were divided into six groups: control; paracetamol (1 g/kg, oral); paracetamol (1 g/kg, oral) + erdosteine (150 mg/kg/day, oral); paracetamol (1 g/kg, oral) + N-acetyl cysteine (140 mg/kg bolus, followed by 70 mg/kg, oral); N-acetyl cysteine control (140 mg/kg bolus, followed by 70 mg/kg, oral); and erdosteine control (150 mg/kg/day, oral). Potential renal injury was assessed using biochemical analyses, radionuclide imaging, and histopathological parameters. Results: In the paracetamol group, blood urea nitrogen and creatinine levels were significantly increased compared with controls. Histopathological examination showed tubular vacuolization, tubular necrosis, and remarkable interstitial inflammation. The excretion function was observed to be insufficient on radionuclide imaging. However, in the groups treated with erdosteine or N-acetyl cysteine after paracetamol, biochemical analyses, radionuclide imaging, and histopathological parameters showed significantly less evidence of renal toxicity than that observed in the group receiving paracetamol alone. Less renal toxicity was detected in rats receiving N-acetyl cysteine than in those receiving erdosteine. Conclusion: Renal injury may develop after paracetamol overdose. Erdosteine and N-acetyl cysteine are both effective in the prevention of renal injury when given in the early phase of paracetamol nephrotoxicity. N-acetyl cysteine is more protective than erdosteine.

Primary Hydatid Cyst of the Chest Wall

A 69-year-old female was examined in the emergency room for abdominal pain that had recurred during the preceding 4 years. During the physical evaluation no pathology was determined, except for sensitivity to deep palpations in the upper right quadrant of the abdomen. On the chest roentgenogram, a nonhomogeneous dense area with calcific foci was observed adjacent to the right costophrenic sinus (Fig. 1). The thorax tomography revealed a mass lesion of 5 9 6 cm with calcification, which was located in the chest wall of the lower outer region of the right hemithorax (Fig. 2). Abdominal ultrasonography showed a mass that was pressuring the right lobe of the liver from the outside. The acid-fast bacillus test was negative and other laboratory tests were within normal limits. The results of the transthoracic fine-needle aspiration biopsy indicated the presence of necrotic tissue material containing calcifications. The patient was admitted for surgery with the prediagnosis of chest wall tumor. The mass was completely removed by excisional biopsy (Fig. 3). A 7 9 7 cm defect caused by the en bloc chest wall resection was reconstructed using the M. serratus anterior muscle flap. During the histopathological examination, germinative and cuticular membranes showed dystrophic calcification and chronic inflammation, and a hydatid cyst was diagnosed (Fig. 4a, b). The patient was discharged without any complications. Albendazol 15 mg/kg/day was prescribed for 3 months. Upon completion of the 1 year of follow-up, the patient was still asymptomatic and no recurrence was observed, either clinically or radiologically. A hydatid cyst is a parasitic disease caused by Echinococcus granulosus. It is endemic in countries where sheep and cattle farming is prevalent, such as the Middle East, New Zealand, South Africa, and South America. Although hydatid cyst is frequently seen in the liver and lungs, it can lead to disease in any part of the body [1]. Hydatid cysts can be located in the chest wall through to the sternum, ribs, and regional soft tissues. Yilmaz Avci et al. [2] reported that hydatid cysts in the chest wall might form due to either the rupturing of lung hydatid cysts into the pleural space or inoculation. Currently, the primary treatment for hydatid cyst disease is surgery in which all of the parasitic material is removed. Even though the roentgenographic findings are frequently diagnostic for hydatid cyst, in cases where a definite preoperative diagnosis of lesions cannot be reached, a final diagnosis can be made histopathologically through surgical intervention. Thus, the surgical treatment of these patients S. Karapolat Department of Thoracic Surgery, Duzce University School of Medicine, Duzce, Turkey

EFFECTS OF PROPHYLACTIC OZONE THERAPY ON GENERAL ANESTHESIA AND SURGICAL STRESS RESPONSE: NEUTROPHIL/LYMPHOCYTE RATIO AND ISCHEMIA MODIFIED ALBUMIN

Abstract Background:General anesthesia and surgical stress cause an acute endocrine, metabolic, and immunological inflammatory response in organisms and an increase in neutrophil lymphocyte ratio (NLR) and ischemia modified albumin (IMA) levels. Ozone, other than inhalation administration, reduces the release of antioxidants and some proinflammatory cytokines and has been shown to have an anti-inflammatory effect. Our aim is to research how the NLR and IMA response is affected in rabbits undergoing surgical intervention with general anesthesia given prophylactic with ozone therapy. Methods: Twelve New Zealand rabbits were divided into two groups: GroupO was given 70 µg/ml 10 ml ozone by the rectal route in 6 sessions on alternate days, and GroupC was given air by the rectal route.The rabbits underwent surgical intervention under general anesthesia.Blood samples were taken at basal, preoperative, 30th minute of operation, and 24 hour postoperative times and were examined for hemogram and IMA. Results:In th...

Turkish Anaesthesiologist’s Experiences of Anaesthetic Management of Patients with Obstructive Sleep Apnea (OSA)

OBJECTIVE Obstructive sleep apnea (OSA) is an important health problem that is increasing with the increase in the incidence of obesity. For patients with OSA, it is reported that preoperative OSA diagnosis is made in only 10%-20% of the patients. Therefore, it gains importance that these patients are diagnosed in the preoperative period. The aim of this study is to analyze with a survey the experiences of anaesthesia experts working in Turkey about the diagnosis of patients with OSA, anaesthetic methods and postoperative care. METHODS The study was completed with an online survey form distributed via email. Survey participants were sent an email, and those experts who wished to participate clicked on the link, answered the questions and returned the survey via email. RESULTS A total of 134 anaesthesia experts participated in this study. While 97% of the participating anaesthetists considered diagnosis of patients with OSA to be important, only 53% trusted themselves to recognize this patient group. Of the total number of participants. 43% did not know the STOP-BANG test used in the preoperative period to diagnose patients with OSA. The percentage who thought that patients with OSA would increase the incidence of difficult intubation was 84%. In the intraoperative period, the percentage who chose inhalation anaesthetics was 35%, whereas the rate of those who chose total intravenous anesthesia (TIVA) was 48%. CONCLUSION This study indicates that the medical knowledge of Turkish anaesthetists on the topic of OSA requires updating. In addition, we believe a practical guide to standardize the diagnosis and preoperative/perioperative management of patients with OSA should be prepared for Turkish anaesthetists.

Primer Hiperparatiroidi Nedeniyle Opere Edilen Vakalarda Eşlik Eden Tiroid Patolojilerinin Değerlendirilmesi

Purpose: In this study we aimed to evaluate thyroid pathologies in patients with primaryhyperparathyroidism who underwent surgery for parathyroidectomy.Methods: Patients who underwent parathyroidectomy for primary hyperparathyroidism betweenthe years of 2006-2012 were included in this retrospective study. Before and after surgery,hormonal and biochemical examinations of the patients and results of preoperative imagingstudies were recorded.Results: Of the patients included in the study, 86 were female and 12 were male. Preoperativemean serum calcium level was 12.25 ± 1.48 mg/dL (normal range 8.5-10.1 mg/dL), meanparathyroid hormone (PTH) level was 425.09 ± 440.47 pg/mL (normal range 11-65 pg/mL).The thyroid ultrasound records of 93 patients were available. Of these patients, 26 (28%) hadnormal ultrasound, 18 (19.4%) had solitary nodule, 43 (46.2%) had multinodular goiter and 4(4.3%) had thyroiditis (without nodule) and 2 (% 2.2) had solitary nodule with thyroiditis.Adenoma was detected by ultrasonography in 45.2 % of patients, and by scintigraphy in 72.7of patients. Parathyroidectomy and thyroidectomy were performed at the same time in 54 of 98patients (65.1%). Of these patients Seven (7.1%) had papillary thyroid cancer, 30 (30.6%) hadbenign multinodular goiter, 8 patients (8.2%) had benign solitary nodule, 2 patients (2%) hadlymphocytic thyroiditis, and 7 (7.1%) had normal thyroid tissue.Conclusion: Thyroid diseases are frequently encountered with primary hyperparathyroidism.Therefore, before performing parathyroidectomy with minimally invasive procedure, patientsmust be evaluated for thyroid disorders

Traumatic pulmonary pseudocyst: 2 case report

Traumatic pulmonary pseudocysts (TPP) are cavitary lesions that are rarely seen after blunt thoracic traumas. Two male patients who were diagnosed with cystic lesions in the left lung after trauma were followed in our clinic with the diagnosis of TPP. Due to increase in cyst dimensions and wall tension, which were seen on the follow-up thorax tomography, surgical intervention was decided for both cases. The first case underwent cystotomy and capitonnage via thoracotomy, and was discharged without any complication. However, the second case was lost due to cardiac arrest during the operative preparations. Thorax tomography is an important method in the diagnosis and radiological follow-up of TPP. The surgery option should always be remembered for patients who show progression during the follow-up.