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Abstract

Objective: In this present study, the association of hyperlactatemia frequency with probable risk factors, postoperative morbidity and mortality were investigated in patients undergoing paediatric open heart surgery. Materials and Methods: The present study included 45 consecutive paediatric patients who had undergone open heart surgery with hypothermic cardiopulmonary bypass in the cardiovascular surgery clinic between January 2008 and July 2008. Four blood samples for lactate analysis were collected from each of the patients preoperatively, intraoperatively and at 1 and 12 hours post- operatively. The patients were divided into two groups according to blood lactate levels as the high lactate group (mean lactate level≥ 3 mmol/L) and the normal lactate group (mean lactate level <3 mmol/L). Hyperlactatemia frequency, associated risk factors, and the relationship with morbidity and mortality were statistically analysed. Results: Of 45 cases, 33 (73.3%) were included in the normal lactate (NL) group, and 12 (26.7%) were included in the high lactate (HL) group. A borderline association was found between lactate levels and mortality in the HL group (p=0.052). Body surface area, age, low cardiac output syndrome, intraoperative and postoperative inotropic support requirement, duration of mechanical ventilation were determined as risk factors associated with mortality (p<0.05), and low cardiac output syndrome, urine output and metabolic acidosis were determined as risk factors associated with hyperlactatemia (p<0.05). Conclusion: In patients followed up in the intensive care unit, lactate concentration is a good indicator for disease severity. Blood lactate levels seems to be a parameter that can be used in routine follow-up.

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... Normal lactate levels are approximately 1.5 mmol/L in healthy individuals and less than 2.0 mmol/L in critically ill patients. 1 On arrival at the CICU, the patient's lactate level was 7.1 mmol/L. Is this hyperlactatemia related to tissue hypoxia, or is it an expected finding after cardiac bypass in the operating room? ...
Article
Elevated serum lactate level, or hyperlactatemia, is often associated with alterations in tissue perfusion, increased risk for complications in the postoperative period, and patient mortality. Measuring lactate levels is a relatively simple and noninvasive method of obtaining useful data about an impending clinical deterioration in a seemingly hemodynamically stable patient. This article evaluates the current practice of measuring lactate levels in pediatric patients after cardiac surgery and the association between these levels and patient outcomes. The article addresses periods of increased risk for decreased perfusion, the critical postoperative period, use of lactate measurements in conjunction with a risk scoring system for pre-and postoperative congenital heart disease patients, and the implications of elevated lactate levels in nursing practice.
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Background : Coronary heart disease is the number one cause of death in the world each year. Coronary artery bypass surgery (CABG) is a type of treatment that improves blood flow to the heart by surgical operation. Hyperlactataemia in CABG procedure is associated with low tissue perfusion, which could worsen postoperative outcomes. High lactate level therefore can be placed as a marker to predict postoperative outcomes. Aim : To asses correlation between lactate levels and length of stay (LOS) in the Intensive Care Unit (ICU) in post CABG patients. Methods : This was an observational correlation study with Prospective Cohort design. Subject of the study were 55 people selected by consecutive sampling from post CABG patients at RSUP Dr. Kariadi Semarang. Statistical hypotheses testings were using the MannWhitney test and Spearman correlation test. Results : There was a significant correlation between lactate levels and LOS in the ICU (p=0.002). Spearman correlation value (r=0.400) indicates that there was a positive correlation between the variables. There was no significant difference in LOS between levels of lactate<4 mmol / L and ≥4 mmol / L (p = 0.612). Average blood lactate levels of post CABG patients was 4.1 mmol / L. Conclusions : There was a relations between lactate levels and ICU in post CABG patients. There was no significant difference in length of stay between post CABG patients lactate levels <4 mmol / L and ≥4 mmol / L. Key Words : Coronary Artery Bypass Grafting, CABG, Coronary Artery Disease, Hyperlactatemia, Cardiopulmonary bypass, Intensive Care Unit, Length of stay, LOS
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Bronchogenic cysts are rare, and predominantly occur in the mediastinum. We present a case of a 4 year old girl presenting a shoulder bronchogenic cyst. On clinical examination it appears as a lymphangioma. Bronchogenic cyst, in its subcutaneous localization is extremely rare. We reported herein a new case of subcutaneous bronchogenic cyst and discuss the literature.
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Objective: In that report, we present an unusual localization of a bronchogenic cyst which was the low anterior cervical region. Methods: A 4 years old girl admitted to our clinic with a mass located in the low anterior cervical region. In physical examination, there was a 3 cm × 3 cm, painless, semi-mobile mass in cervical region. Results: Surgical intervention revealed a 3 cm × 3 cm, multilocular infectious fluid filled cyst that was appeared as an abscess. Histopathological diagnosis was bronchogenic cyst. Conclusions: Although the incidence of a bronchogenic cyst is rare, it must be considered in the differential diagnosis of the cervical masses.
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Due to emergence of bacterial resistant strains, the effectiveness of current antibiotic treatment without culture/sensitivity testing is questionable. Our study aims to assess the present sensitivity profiles of Klebsiella isolates from urine samples and provide options for empiric prescription in critically ill patients. Klebsiella pneumoniae isolates collected over a period of 28 months till January 2011 from 1,617 urine samples of subjects presenting with Urinary Tract Infections were identified at a local diagnostic lab using standard protocol and subjected to Kirby-Bauer disk diffusion sensitivity testing. MICs were also estimated by E-nephelometry. Among 20 drugs used, low sensitivity was found to amoxicillin (0.1%), doxycycline (11.5%), nitrofurantoin (15.5%), amoxiclav (18.2%), gentamicin (35.4%), pipemidic acid, cephradine (40.3%) and cotrimoxazole (43.1%). The isolates were more sensitive to cefuroxime (55.9%), cefixime (57.7%), ciprofloxacin (62.5%), ofloxacin (63%), ceftriaxone (66.2%), ceftazidime (66.4%), cefotaxime (66.6%), fosfomycin (77.5%) and amikacin (89.4). Most effective were cefroperazone.sulbactam (95.8%), piperacillin.tazobactam (95.7%) and imipenem (97.7%). Self-medication, lack of awareness, and the misuse of antibiotics by doctors has exacerbated the menace of microbial resistance. The study warrants the prudent choice of drugs in adherence with prevailing sensitivity profiles.
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Gastrointestinal stromal tumours (GIST), though rare, present to the gastric surgeon not infrequently making a heightened awareness of this condition a pre-requisite of prompt recognition and timely treatment.. We describe the presentation, diagnosis and the limitations of treatment and follow up of a patient with GIST in a developing country. Surgery still remains as the only readily available modality of treatment in developing countries.
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SüleymanDemirel Üniversitesi TIP FAKÜLTESİ DERGİSİ: 2006 Aralık; 13(4) 2000-2004 yılları arasında izole edilen üropatojen Escherichia coli suşlarında artan antibiyotik direnci Onur Kaya, Füsun Zeynep Akçam, Cemile Uyar, Canan Demir, Güler Yaylı Özet Üriner sistem infeksiyonları antimikrobiyallere artan direnç oranı ile birlikte en sık görülen infeksiyonlar arasındadır. Bu çalışmanın amacı Ocak 2000 ile Ocak 2004 arasında üriner sistem infeksiyonlu hastalardan izole edilen Escherichia coli izolatlarının direnç değişimlerini saptamaktır. Çalışma retrospektif olarak planlanmıştır. Izole edilen 457 üropatojen Escherichia coli suşunun ampisilin, amoksisilin-klavulonat, sefuroksim, seftizoksim, seftriakson, seftazidim, sefotaksim, aztreonam, gentamisin, amikasin, tobramisin, netilmisin, trimetoprim-sülfametoksazol, norfloksasin, siprofloksasin, sefoperazon-sulbaktam ve imipeneme karşı duyarlılıkları değerlendirildi. Ampisilinin % 66.4 ile en yüksek, imipenemin ise % 1 ile en düşük dirençli olduğu gösterildi. Yıllara göre karşılaştırıldığında amoksisilin-klavulonat, sefuroksim, seftizoksim, seftriakson, seftazidim, sefotaksim, aztreonam, gentamisin, tobramisin, norfloksasin, siprofloksasin ve sefoperazon- sulbaktamda direnç artışları istatistiksel olarak anlamlı bulunmuştur (p
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Electroconvulsive therapy (ECT) is an exceptionally effective treatment for a number of psychiatric conditions; however, a common adverse effect is temporary cognitive impairment, especially memory loss. The dissociative disorders also involve disturbances of memory, as well as consciousness and personal identity, but are rarely iatrogenic. We report a case in which dissociative symptoms developed after ECT. A 51-year-old woman with hypothyroidism, migraine headaches, bipolar disorder, and anorexia by history was admitted for worsening depression with suicidal ideation. After a course of 7 right-sided ECT treatments, she experienced remarkable personality change, claiming that it was 1976 and behaving as though she was 30 years younger. Neuropsychological tests were normal, and her memory and former personality spontaneously returned 2 weeks later. This case illustrates that such events may be seen in patients with certain psychiatric profiles, and further studies are needed to determine the risk factors for the occurrence of dissociative episodes after ECT.
Article
Aims: Failure to cross a calcified tight stenosis or chronic total occlusion (CTO) with a balloon after having passed a guidewire is a rare but serious intricacy with a high likelihood of failure. We report our experience of a three years period (December 2004-November 2007) using a novel metal penetration catheter (Tornus) to bail-out 44 failures to cross a lesion with a balloon catheter. Methods and results: The Tornus (Asahi Intecc, Aichi, Japan), an over-the-wire metal exchange catheter that might be "screwed" counter-clockwise into a lesion, was used in 44/2881 PCI-patients with calcified and tortuous coronary anatomy in whom a 1.5 mm lubricious balloon catheter could not be pushed into the lesion despite optimal support of a 6 Fr guiding catheter and additional anchoring with a stiff-shafted guidewire (anchor wire) when applicable. In 39/421 patients the target was a chronic total occlusion and in 5/2460 patients it was a stenotic lesion or recent occlusion. In these 44 consecutive balloon-failures the Tornus completely passed 35 lesions (79.5%) - all but one were successfully followed with a balloon and stent. In one patient, the balloon did not follow despite successful passage of the Tornus. In 5/9 patients in whom the Tornus passed incompletely, the channel was opened sufficiently to allow for successful passage with a balloon. In three failures to dilate after Tornus, the procedure was successfully finished with the use of a Rotablator. Three of the 44 finally failed. Over all, the Tornus procedure relevantly contributed to success in 91% of the cases with failure of balloon crossing. We experienced no complications or fractures. Conclusion: The Tornus is an easy to use over-the-wire device to increase a coronary channel and enhance balloon entry of complex tight lesions and chronic total occlusions.
Article
One of the last frontiers facing interventionalists is the treatment of chronic total occlusions. Chronic total occlusions (CTO) are present in about one-third of all diagnostic coronary angiograms. Recanalizations of these CTOs have demonstrated a trend towards lower mortality. Unfortunately, use of standard angioplasty equipment has only resulted in a 50-60% success rate.5,6,7 Several recently developed guidewires have increased success rates to 79-90%. Further success in CTO revascularization has been improved by use of novel techniques such as crossing the lesion in a retrograde fashion from collateral vessels. Niche devices such as the Frontrunner CTO catheter (Lumend Inc., Johnson and Johnson, Picataway, NJ) have also facilitated in successful treatment of CTOs. Unfortunately, none of these developments address the issue of deliverability of angioplasty balloons and stents. A newly developed device, the Tornus catheter (Asahi Intech; Abbot Vascular, Redwood City, CA), plays a niche role in the recanalization of this lesion subset. The following contains two case reports which highlight successful revascularization of CTOs with utilization of this new catheter.
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Untreated major depressive disorder (MDD) is a major risk factor for suicide, but some data suggest antidepressants may be associated with increased suicidal ideation (SI) in some depressed patients. The purpose of this study was to determine whether, and in whom, treatment of MDD is associated with increased or emergent SI. Patients were treated with Citalopram, 10-60 mg/day for 12-14 weeks. A score >0 on Item 12 of the Quick Inventory of Depressive Symptomatology - Self-Report indicated the presence of SI. Worsening was defined by a >or=1 point increase. Emergent SI was defined by an increase from 0 at baseline to >or=1 during treatment. Of the 1909 participants with baseline SI, 57% experienced improvement in SI by their first post-baseline visit and 5% worsened. By the final visit, 74% experienced improvement and 4% worsened. Of 1721 participants without baseline SI, 7% experienced emergence by the first postbaseline visit. Of these, 63% had no SI at their final visit. Major risk factors for treatment-emergent SI at the first treatment visit were drug abuse, severe depression and melancholic features. Main limitations are lack of a comparison group to help pinpoint whether citalopram treatment added risk or protection, a placebo group to determine whether changes in SI were related to illness factors, medication effects or other factors, and more detailed and validated measures of SI. SI and behaviors, core features of MDD, wax and wane in intensity before, during, and perhaps after treatment. It is clinically important to understand risk factors, maintain careful surveillance and treat as vigorously as necessary to attain remission.
Article
• A presternal subcutaneous cyst was removed from a 21-month-old male infant. This is a rare congenital lesion that typically appears as a pinpoint opening over the sternum that periodically drains small amounts of mucinous material. Histologically, these lesions have the features of their intrathoracic and mediastinal counterparts. Surgical excision is advocated because of the potential for infection. (Arch Otolaryngol 103:52-54, 1977)
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Treatment of 100 consecutive knee joints affected with osteoarthritis with shortwave diathermy and ultrasound showed that the latter was somewhat the more effective of the two methods.
Article
Ultrasound increases soft tissue extensibility and may be an effective adjunct in the treatment of knee contractures secondary to connective tissue shortening. A randomized clinical trial was conducted to determine the effectiveness of ultrasound in relieving stiffness and pain in patients (age mean = 67.5 years, SD = 13.0) who had osteoarthritis (OA) and a chronic knee contracture. Subjects received 12 treatments of exercise preceded by either ultrasound (n = 34) or sham ultrasound (n = 35) and a blinded evaluation at baseline, after treatment, and 2 months after treatment. MANCOVA controlling for baseline scores showed that there were no significant differences in knee active range of motion (ROM) (goniometry) or pain (visual analogue scale) between experimental and control groups. Possible explanations for the no difference finding involve dosage issues, muscle shortening, transiency of effects, and the effects of exercise. Paired t-tests revealed that both groups significantly improved (p less than 0.05) in active ROM, pain, and gait velocity, and maintained improvement for at least 2 months. Although ultrasound may not contribute to the management of patients with chronic knee stiffness and OA, benefits of the exercise program and increased activity secondary to program participation probably influenced the overall improvement.
Article
It has been reported that exceptional association exists between primary colon cancer and hypernephroma. In this paper we are reporting a case of a male patient carrying an hypernephroma synchronous with a proximal colonic adenocarcinoma in addition to a second adenocarcinoma, growing on a tubular adenoma, nearly of first. These findings get seen as partially coincidental with some features of the cancer family syndrome (Lynch syndrome II), and we have considered that genetics conditions, like those of Lynch syndrome II, could to explain some multiple neoplasms in patients carrying then.
Article
The purpose of this study was to investigate the effect of ultrasound and shortwave diathermy, with and without therapeutic exercise on osteoarthritic (OA) knees. From February 1987 to January 1989, we collected 94 OA knees from 61 female patients and divided them into 4 groups. Group 1 received ultrasound therapy, group 2 had shortwave diathermy, group 3 received ultrasound and an exercise program, and group 4 received shortwave diathermy and exercise therapy. All 61 patients (94 knees) were assessed by functional incapacity scoring and isokinetic testing before and after treatment. At the termination of treatment, all patients had significant improvement in both functional capacity and peak torque. This study failed to prove any significant difference in treatment effect between ultrasound and shortwave diathermy for chronic OA knees. However, the exercise program in addition to the diathermy did promote the treatment effect in both function and muscle torque.
Article
Cardiac rhabdomyoma, a rare benign tumor often detected in infancy, is frequently associated with tuberous sclerosis. This association is commonly stated to occur in 50% of all cases of cardiac rhabdomyoma. Recently at our institution, the prenatal detection of a cardiac rhabdomyoma in a fetus at no known risk for tuberous sclerosis emphasized the need to determine the frequency of association in order to provide accurate diagnosis and counseling in such situations. After a review of reported cases and review of patients from our institution diagnosed to have cardiac rhabdomyoma, we estimate that 51-86% of cardiac rhabdomyomas are associated with tuberous sclerosis. We present the results of our literature and case review.
Article
A case of a surgically treated primary quartet cancer is reported, along with a review of the Japanese literature. A 68-year-old woman, curatively operated for a right breast cancer 6 years previously, was then diagnosed as having a left renal cell carcinoma, a thyroid cancer, and a sigmoid colon cancer as a result of a subsequent screening examination within one year. These synchronous, triple cancers were resected in a curative operation for each. Histopathologically, each neoplasm was proven to be a primary cancer lesion, and two different types (papillary and trabecular) were found in the thyroid gland.
Article
Multiple personality disorder (MPD) has been diagnosed with increasing frequency in the 1980s: according to one estimate 6,000 cases have now been diagnosed in North America (Coons 1986). The diagnosis of MPD can be difficult because patients usually present in a polysymptomatic fashion, and the specific features of their dissociative disorder may be difficult to elicit (Kluft 1985a, 1987). One of the most common presenting features consists of suicidal ideation and suicide attempts. Putnam et al. (1986), for instance, noted suicidality as a presenting symptom in nearly 70% of 100 cases of MPD reported to them by 92 clinicians throughout North America. We have collected a series of 236 cases of MPD reported to us by 203 clinicians throughout North America. Our results show that 72% of the patients attempted suicide. The purpose of this report is to compare 48 cases of MPD from this series with no previous suicide attempts to 167 cases that have attempted suicide to determine features that differentiate the patients who attempt suicide from those who do not.
Article
Within the context of a double blind randomized controlled parallel trial of 2 nonsteroidal antiinflammatory drugs, we validated WOMAC, a new multidimensional, self-administered health status instrument for patients with osteoarthritis of the hip or knee. The pain, stiffness and physical function subscales fulfil conventional criteria for face, content and construct validity, reliability, responsiveness and relative efficiency. WOMAC is a disease-specific purpose built high performance instrument for evaluative research in osteoarthritis clinical trials.
Article
The clinical syndrome of multiple personality disorder (MPD) is an unusual dissociative condition that has been poorly characterized. In an attempt to better delineate the clinical phenomenology of MPD, 100 recent cases were collected on a 386-item questionnaire completed by clinicians involved in the treatment of MPD patients. This study documents the existence of a clinical syndrome characterized by a core of depressive and dissociative symptoms and a childhood history of significant trauma, primarily child abuse.
Article
A study of 30 patients with bronchogenic cysts in the skin and subcutaneous tissue is reported. In most instances the cysts were discovered at or soon after birth. They presented as a swelling or draining sinus, usually at or in the vicinity of the suprasternal notch and manubrium sterni. There was a marked preponderance of male patients. The lesion has rarely been correctly diagnosed either clinically or pathologically. Its distinctive histologic features are similar to those of the bronchogenic cysts in intrathoracic locations, including the presence of ciliated pseudostratified columnar epithelium, usually of smooth muscle and seromucous glands, and of cartilage in a few. It is likely that these cutaneous bronchogenic cysts arise during embryologic development as a result either of distant migration of sequestrated cells from the respiratory tree or of displacement of a preformed cyst from its origin in the thorax.
Article
The time course of lactacidemia was studied prospectively in 17 patients during fluid resuscitation for an episode of noncardiogenic shock, in 5 patients after grand mal seizures, and in 5 patients after successful CPR for cardiac arrest. The 9 patients in whom shock was reversed with fluid administration demonstrated a regular decrease in lactate concentrations, which exceeded 5% of the initial value during the first 60 min of treatment. In the other patients who expired despite similar therapy, lactacidemia was not significantly affected. During circulatory shock, repeated lactate determinations represent a more reliable prognostic index than an initial value taken alone. Changes in lactate concentration can provide an early and objective evaluation of the patient's response to therapy.
Article
The thirty-eighth case of bronchogenic cyst in the skin is reported in a 5-year-old boy. This is the first case report of cutaneous bronchogenic cyst presenting as a distinct, pedunculated growth with a sinus tract at the base. Embryogenesis, differential diagnosis, and treatment are discussed.
Article
Cardiac tumors are a rare, but potentially curably form of heart disease. A high index of clinical suspicion is necessary for diagnosis as these tumors have protean manifestations that mimic a variety of other cardiac and noncardiac diseases. Presently, M-mode and two-dimensional echocardiography are utilized as safe, reliable, and noninvasive imaging modalities. Seventy-five per cent of these tumors are benign, with myxoma accounting for 50% and rhabodomyoma comprising 20% of lesions. Various histologic types of sarcoma are the predominant malignant cardiac neoplasms. With strict attention to avoiding perioperative tumor embolization, surgical resection of these lesions can be accomplished with minimal morbidity and mortality. Sixteen consecutive primary tumors of the heart have been surgically treated at Duke University Medical Center since 1966 with no perioperative deaths and no late recurrences.