Venous Thromboembolism Risk and Thromboprophylaxis Among Hospitalized Patients

Objectives: To evaluate venous thromboembolism (VTE) risk and use of thromboprophylaxis in the acute care hospital setting. Methods: A total of 1701 patients hospitalized for acute or exacerbated chronic medical illnesses or elective major surgery at 11 different hospitals across Turkey were included in the study. Patients at risk and VTE prophylaxis application were retrospectively identified based on medical charts. Results: According to the American College of Chest Physicians (ACCP) criteria, overall 35.6% (606 of 1701) of the patients were identified to be at VTE risk. Venous thromboembolism-risk was observed in 64.9% of surgical and 23.8% of medical patients, the latter being lower than global Epidemiologic International Day for the Evaluation of Patients at Risk for Venous Thromboembolism in the Acute Hospital Care Setting (ENDORSE) study results; while prophylaxis was prescribed in 39.0% and 38.5% of them, respectively. Contraindication to anticoagulant prophylaxis was observed in 8.7% of medical and 8.8% of surgical patients. Conclusions: VTE remains a risk factor among patients hospitalized across Turkey, since identification as well as prophylaxis of patients at VTE risk seems to be neglected.

Diagnosis and treatment of spontaneous pneumomediastinum

BACKGROUND

Due to its rarity there is no clear policy on the management of spontaneous pneumomediastinum (SPM).

METHODS

We treated 23 SPM patients between January 1 996 and November 2 006. There were 20 males and 3 females and their mean age was 27. Clinical records of the patients were collected and analyzed.

RESULTS

The most frequent symptoms were neck swelling (n = 20) and rhinolalia (n = 15). Onset of the symptoms was acute. A preceding factor was found in 19 (83 %) patients; these included vigorous cough, forced physical activity, vigorous sneezing and enormous efforts during spontaneous vaginal delivery. Chest X-ray was sufficient to show mediastinal free air in 18 patients. Computerized chest tomography showed pneumomediastinum in all patients. Twenty patients were treated expectantly. Subcutaneous air drainage was needed to drain massive subcutaneous emphysema in three patients.

CONCLUSIONS

Acute onset of typical symptoms, the existence of a preceding factor and the exclusion of other possible causes of pneumomediastinum with the help of CT are sufficient to make a diagnosis of SPM. A surgical intervention is generally not needed for the treatment of this entity.

Surgical treatment of superior sulcus tumors: results and prognostic factors

BACKGROUND

This study aims to investigate the treatment modalities and factors influencing survival in surgically treated superior sulcus tumors.

PATIENTS AND METHOD

Sixty-five cases of surgically treated non-small cell carcinoma of the lung occurring as superior sulcus tumors between 1994 and 2007 were retrospectively reviewed. Twenty-five patients underwent induction radiotherapy (RT), 10 had induction chemoradiotherapy (CT/RT). In thirty patients surgery was performed directly. The mortality rate was 6.2 %. Pathological stage was T3 in 55, T4 in 10, N0 in 52, and N1 in 5 and N2 in 8 patients.

RESULTS

Overall 5- and 10-year survival rates were 31 % and 28 %, respectively. Complete resection rate was 90 % for patients who received induction CT/RT and 80 % for patients who either received induction RT alone or patients in whom surgery was performed directly. In patients who received neoadjuvant therapy with complete tumor resection, the median survival time was 33 months (28 months for patients who received induction RT alone and 36 months for patients who received induction CT/RT), and the 5-year survival rate was 41 %. Median survival time and 5-year survival rate of patients treated by direct surgery with complete resection was 24 months and 37 %, respectively ( P = 0.87). Five-year survival and 10-year survival rates were significantly higher after complete resection than after incomplete resection (38 % and 34 % vs. 0 %, P = 0.0001). In multivariate analysis, only N2 disease ( P = 0.04) and incomplete resection ( P = 0.03) were found to be poor prognostic factors.

CONCLUSION

The presence of N2 disease and incomplete resection are the two most important factors affecting survival. Induction CT/RT may increase the ability to achieve complete surgical resection.

Vascular endothelial growth factor gene polymorphisms in Turkish patients with sarcoidosis

Polymorphism at +813 locus of vascular endothelial growth factor (VEGF) gene is considered to decrease predisposition to sarcoidosis. Our study aimed to investigate the roles of this polymorphism in the development and extent of sarcoidosis. We examined polymorphisms of the VEGF gene in 90 cases with histopathological diagnosis of sarcoidosis and in 110 healthy subjects. VEGF +813 gene polymorphisms were determined using a polymerase chain reaction-based method after DNA isolation. A significant increase in the frequency of the T allele was found in healthy subjects (odds ratio 0.55; 95% confidence interval 0.32-0.97, P<0.05). Our results suggest that increase in rarer T allele at + 813 locus of VEGF gene may diminish susceptibility to sarcoidosis in Turkish population.

Characteristics and prognosis of resected T3 non-small cell lung cancer

AIM

The aim this study is to determine the characteristics, survival, and factors affecting the survival of resected T3 non-small cell lung cancer.

METHODS

The records of 97 cases were retrospectively reviewed with T3 non-small cell lung cancer patients that were operated between 1996-2001. Complete resection was achieved in 71 (73.2%) patient. The distribution of N status was 47.4%, 28.9%, and 23.7% for N0, N1 and N2 respectively. The evaluated prognostic factors in univariate and multivariate analyses were, histologic type, type of resection, N status, subgroups of pT3, resection margins and effect of adjuvant therapy.

RESULTS

Overall 5-year survival rate was 24.3%. Median survival and 5-year survival of the patients whose tumors resected completely was 33 months and 31.5%, whereas 18 months and 7.3% for the patients resected incompletely (P=0.03). Median survival being not significantly different among the three subgroups: 25, 23, and 32 months (P=0.7) in the bronchial pT3, mediastinal pT3, and peripheral pT3 subgroups, respectively. Histology (P=0.57), type of surgical resection (lobectomy versus pneumonectomy) (P=0.25), and use of adjuvant therapy (P=0.054) did not influence the survival significantly. However N status influenced the survival significantly (P=0.01). According to the multivariate analyses, two factors were selected as prognostic indicators: N2 status (P=0.03) and incomplete resection (P=0.03).

CONCLUSION

Three pT3 subgroups did not show survival differences. Complete resection and N2 status are the two most influencing factors in survival of the patients. Adjuvant therapy effected the survival and the quality of life reversely.

Results of Multimodal Treatment of Two Patients with Thoracic Primitive Neuroectodermal Tumor. Is Surgery Really Helpful for Survival?

Primitive neuroectodermal tumors (PNET) belong to the group of small round cell tumors and are rarely seen. They are rapidly progressive tumors, despite usually being treated by a multimodal therapy which includes surgery and chemoradiotherapy. We present two patients with PNET of the thorax treated in our clinic. The first patient had a huge tumor in the right hemithorax, which shifted the mediastinum to the contralateral hemithorax. Diagnosis was established by transthoracic fine-needle aspiration biopsy and the tumor was treated by surgical resection. Surgery resulted in a microscopically incomplete resection. Chemoradiotherapy was given postoperatively. The patient had local recurrence after seven months and died of cranial metastasis. The second patient had a small tumor on the right costovertebral angle which protruded towards the skin and was diagnosed by incisional biopsy. The tumor responded very well to preoperative chemotherapy and complete resection was achieved surgically. Postoperative chemoradiotherapy was also given. This patient had bone metastasis, local recurrence and pleural pulmonary metastasis after 6, 18 and 28 months, respectively, and died 30 months after the operation.We discuss the limited effect of surgery on the treatment of thoracic PNET on the basis of the results of these patients in whom we performed surgery.

Delayed diagnosis of a complete bronchial rupture after blunt thoracic trauma

Bronchial ruptures due to blunt chest traumas are rarely encountered injuries. They can be missed in the emergency room depending on the clinical findings. We present a case report of a previously healthy 32-year-old woman who received multiple rib and clavicula fractures on the right side in a traffic accident. The plain radiograms taken on the first and fifth day showed no other pathological findings than the above-mentioned fractures. Her control chest radiography, which was taken 7 weeks later, showed a totally opaque left hemithorax but no findings of pneumothorax were present. Fiberoptic bronchoscopy and virtual bronchoscopy showed a left main bronchial rupture. The patient was treated with an end-to-end anastomosis via left posterolateral thoracotomy.

A giant adrenal pseudocyst: case report and review of the literature

A 45-year-old woman whose MR images revealed a lobulated, complicated cyst with septations on the superior pole of left kidney underwent retroperitoneoscopic cyst marsupialization. In pathologic examination beneath the atrophic adrenal gland, hyalinized, calcification foci cyst wall without any surrounding epithelium was seen microscopically. It was reported to be "adrenal pseudocyst".

Primary tracheal schwannoma: a case report

We present a rare case of primary tracheal schwannoma in a 49-year-old man who had experienced obstructive airway symptoms for 4 years. Computed Tomography (CT) showed an intratracheal polipoid mass lesion originating from the left lateral wall. Fibre-optic bronchoscopy revealed the diagnosis of an intratracheal poylpoid mass obstructing 70% of the lumen. After diagnosing a benign lesion by punch biopsies with bronchoscopy, thoracotomy was performed and the tumour was totally excised. Histopathological examination revealed a benign neurogenic tumour of schwann cell origin.

Paratesticular pleomorphic rhabdomyosarcoma in an adult

Rhabdomyosarcoma (RMS) is the commonest variety of soft tissue sarcoma in children and young adults. It represents 6.5% of all malignant tumours in paediatrics with an annual incidence of 4 to 7 cases/million children. The primary paratesticular site is considered to have a good prognosis in comparison with other rhabdomyosarcomas, despite the frequency of retroperitoneal lymph node invasion. This superficial site allows rapid diagnosis and consequently often complete resection of the tumor. The multi-disciplinary treatment of paratesticular RMS has improved control of the disease with a 2-year survival of 80%. We herein report a case with paratesticular pleomorphic RMS, a rare and prognostically unfavorable variant of RMS, who is disease free for 60 months after management with multidisciplinary approach.

Availability of mental health services for older adults: a cross-cultural comparison of the United States and Turkey

Researchers conducted a cross-cultural study using qualitative methods (based on a phenomenological approach) to explore the availability of mental health services (MHS) for older adults in the United States and Turkey. Using purposive sampling, semi-structured in-depth interviews were conducted with administrators (n=24) from a wide-range of sites (nursing homes, hospice, senior centers) in a rural area of North Central Florida, United States and Ankara, Turkey. Interview questions focused on types of staff employed; integration of MHS with other services provided; community promotion of services; coordination, cooperation and communication with other service providers; and administrators' perceptions of barriers in the provision of MHS for older adults. Interestingly, employing on-site mental health staff was a much more popular practice in Turkey compared to the United States with three times as many Turkish sites having on-site mental health professionals. As anticipated, administrators in both countries cited inadequate funding as the most common barrier to MHS provision. Potential solutions to MHS barriers in both countries are discussed.

A Pedicle-Lengthening Technique for Free Latissimus Dorsi Muscle Flaps: The “Y-V-I” Principle

This article describes a pedicle-lengthening procedure (the Y-V-I principle) that reverts a Y-shaped vascular structure into an I-shaped vascular structure, and its application to the latissimus dorsi muscle. If the Y-shaped vascular structure is divided proximal to the branching point and ligated, it becomes a V-shaped vascular structure. To obtain a linear I-shaped vascular structure, the V is opened, and the length of the vascular pedicle will become equal to the combined length of both limbs of the V. This report indicates that the latissimus dorsi flap may be transferred based on the circumflex scapular artery or the serratus branch.

Silica microspheres for biomolecular detection applications

Microsphere-based biosensors have been attracting the attention of the photonics community due to their high sensitivity, selectivity and implementation. Microspheres, with their high quality-factor (Q-factor) morphology dependent resonances, are very sensitive to refractive index and size changes. The perturbation of the microsphere morphology dependent resonances can be used for the detection of biomolecules. Adsorption of different biomolecules on the surface of microspheres causes a change of effective size and refractive index leading to the shift of resonance wavelengths. A biosensor, based on this phenomenon, can detect a single molecule sensitively depending on the configuration that needs to be designed and optimised. Silica with a refractive index of 1.5, which is very close to that of bimolecular agents, is a suitable photonic material to use for biosensing applications. The transverse electric and transverse magnetic elastic scattering spectra at 90 degrees and 0 degrees are calculated at 1.55 microm with the associated shifts after adding a layer on it. 90 degrees scattering is used to monitor the scattered signal, whereas 0 degrees scattering is used to monitor the transmission signal.

Hepatitis B virus genotype D prevails in patients with persistently elevated or normal ALT levels in Turkey

BACKGROUND

The clinical relevance of hepatitis B virus (HBV) genotypes are poorly understood and it is unclear if the prevalence of HBV genotypes differs with the various clinical features of HBV carriers. The aim of our study was to examine the prevalence of the HBV genotype in a group of patients with chronic hepatitis B, compared to a group with chronic inactive hepatitos B surface antigen (HbsAg) carriers.

PATIENTS AND METHODS

HBV genotypes were determined in 32 patients with chronic hepatitis B and in 12 chronic inactive HBsAg carriers. 35 males and nine females with a mean age of 33.95 +/- 13.04 were studied. Serum samples were examined for the presence of HBV DNA by polymerase chain reaction (PCR). Samples negative in first round PCR were further amplified with nested PCR. The PCR product was sequenced with the Cy5/5.5 dye primer kit on a Long Read Tower automated DNA sequencer.

RESULTS

HBV DNA was detectable in 29 (66%) and 44 (100%) patients by the PCR with universal primers and nested-PCR, respectively. All patients were found to be infected with HBV genotype D. Genotype D was the only detected type found in different clinical forms of chronic HBV infection, in all hepatitis B e antigen (HbeAg)-positive and negative patients, in all patients who had elevated or normal alanine transaminase (ALT) levels and in all ages.

CONCLUSION

In the present study we could not find any association between genotype D and distinct clinical phenotypes. Genotype D is the predominant type among hepatitis B carriers residing in our region and is not associated with more severe liver diseases. This genotype did not influence clinical manifestations in carriers with chronic hepatitis B virus infection. However, additional large-scale longitudinal studies are needed to find the relationship of HBV genotypes to liver disease severity and clinical outcomes.

An HIV-negative Penil Kaposi?s sarcoma

Kaposi's sarcoma is a tumour of reticuloendothelial system. Non-epidemic Kaposi's sarcoma limited to the penile involvement should be aggressively treated because it is rarely associated with diffuse organ involvement localized surgical excision or small-field external beam or electron beam radiation has been effective. In this case, we presented a man 53 years old, who presents with a papular indolent lesion on the glans penis, which is reported as a Kaposi sarcoma after excision of the lesion.

Investigation of factors influencing burnout levels in the professional and private lives of nurses

This is a descriptive, cross-sectional and partly analytic study aiming to determine the factors causing burnout in professional and private lives of nurses working in the university and state hospitals in a city. About 333 nurses were reached by sampling method. Data collection was made by a question form consisting of two parts. The first part was developed by the investigators. In this part, data on demographic, professional and private life conditions of individuals were collected. In the second part, "Maslach Burnout Inventory" was used to determine the burnout levels of individuals. The most important findings of the present study are as follows: higher education level, work experience and higher status decrease burnout while working at night shifts increases it. In addition, nurses who have problems in relations with the other team members and are not satisfied with their work conditions have higher levels of burnout. Having difficulty in childcare and in doing house chores, health problems of the nurse herself or her children, economic hardships and difficulties encountered in transportation are other factors increasing burnout.