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Computed Tomography Findings Affecting the Decision of Sternotomy in Substernal Goiter. SISLI ETFAL HASTANESI TIP BULTENI 2023; 57:305-311. [PMID: 37900343 PMCID: PMC10600595 DOI: 10.14744/semb.2023.25307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/30/2023] [Accepted: 05/05/2023] [Indexed: 10/31/2023]
Abstract
Objectives Although thyroidectomy is completed with a cervical incision in most patients with substernal goiter (SG), sternotomies may be required occasionally. The purpose of this study is to examine computed tomography (CT) findings that may predict the need for sternotomy in SG surgery. Methods Neck-thoracic CT images of patients who underwent total thyroidectomy with the diagnosis of SG between 2013 and 2022 were retrospectively examined. The patients (n=41) were divided into two groups: sternotomies (n=6) and cervical (n=35). Preoperative pathological data, CT findings, and postoperative complications of the patients were recorded. Results The total thyroid volume of the sternotomy group (280.75±127.01 mm3) was significantly greater than that of the cervical group (155.38±74.18 mm3) (p=0.015). The retrosternal thyroid volume (mm3), thyroid craniocaudal, and anterior-posterior dimensions (mm) were significantly greater in the sternotomy group (p=0.001, p<0.001, and p=0.004, respectively). While the majority of mediastinal extension degrees in the cervical group were grade 1 (80%), grade 2 (83%) predominated in the sternotomy group (p=0.001). Conclusion The radiological findings of total thyroid volume, retrosternal thyroid tissue volume, retrosternal thyroid length, thyroid anterior-posterior dimension, and mediastinal extension degree on CT are valuable in predicting the decision to perform a sternotomy in SG surgery.
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Differentiating renal cell carcinoma and oncocytoma with volumetric MRI histogram analysis. North Clin Istanb 2023; 10:636-641. [PMID: 37829753 PMCID: PMC10565746 DOI: 10.14744/nci.2023.26122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/05/2023] [Indexed: 10/14/2023] Open
Abstract
OBJECTIVE In this study, the utility of histogram parameters derived from diffusion-weighted imaging for differentiate renal cell carcinoma (RCC) from oncocytoma was investigated. METHODS This research tracked 126 individuals who were diagnosed with RCC and oncocytoma through histopathological analysis, using magnetic resonance imaging (MRI) assessments from 2015 to 2023. We observed various attributes of these patients, including demographic details, surgical records, pre-surgery MRI results, MRI apparent diffusion coefficient (ADC) histogram analysis, and post-surgery histopathological outcomes. Calculations of ADC measurements such as mean, minimum, and maximum in conjunction with the 5th, 10th, 25th, 50th, 75th, 90th, and 95th quantile points were made. In addition, we also noted the skewness, kurtosis, and variance of these data points. RESULTS The focus group for this investigation consisted of 75 male and 51 female patients. Out of these, 82 were diagnosed with RCC and 44 with oncocytoma. All ADC parameters including ADCmin, ADCmedian, ADCmean, and ADCmax, including the 5th, 10th, 25th, 50th, 75th, 90th, and 95th quantile divisions among the oncocytoma cohort were observed to be higher than the corresponding ones in the RCC group. A statistically meaningful difference was discovered between the minimum ADC value along with the 5th ranking of ADC measurements (p<0.001), in addition to mean of ADC (p=0.050), and the 10th (p=0.002) and 25th (p=0.015) quantiles of ADC data. When considering the region below the curve (AUC) in ROC analysis, the value of ADCmin was recorded as 0.739, with a sensitivity of 75.0%, and specificity of 68.2%. CONCLUSION To distinguish oncocytoma from RCC, it may be useful to conduct a whole-tumor histogram and textural analysis of ADC values.
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Analysis of Pancreatobiliary and Intestinal Type Periampullary Carcinomas Using Volumetric Apparent Diffusion Coefficient Histograms. Acad Radiol 2023; 30 Suppl 1:S238-S245. [PMID: 37211479 DOI: 10.1016/j.acra.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/21/2023] [Accepted: 04/22/2023] [Indexed: 05/23/2023]
Abstract
RATIONALE AND OBJECTIVES Magnetic resonance imaging plays an important role in the evaluation of patients with known or suspected periampullary masses. The utilization of volumetric apparent diffusion coefficient (ADC) histogram evaluation for the entire lesion eradicates the potential for subjectivity in the region of interest placement, thus guaranteeing the accuracy of computation and repeatability. PURPOSE To investigate the value of volumetric ADC histogram analysis in the differentiation of intestinal-type (IPAC) and pancreatobiliary-type periampullary adenocarcinomas (PPAC). MATERIALS AND METHODS This retrospective study included 69 patients with histopathologically confirmed periampullary adenocarcinoma (54 PPAC and 15 IPAC). Diffusion-weighted imaging was obtained at b values of 1000 mm²/s. The histogram parameters of ADC values, comprising the mean, minimum, maximum, 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles, as well as skewness, kurtosis, and variance, were calculated independently by two radiologists. Using the interclass correlation coefficient, the interobserver agreement was evaluated. RESULTS The ADC parameters for the PPAC group were all lower than those of the IPAC group. The PPAC group had higher variance, skewness, and kurtosis than the IPAC group. However, the difference between the kurtosis (P = .003), the 5th (P = .032), 10th (P = .043), and 25th (P = .037) percentiles of ADC values was statistically significant. The area under the curve (AUC) of the kurtosis was the highest (AUC=0.752; cut-off value=-0.235; sensitivity=61.1%; specificity=80.0%). CONCLUSION Volumetric ADC histogram analysis with b values of 1000 mm²/s can discriminate subtypes noninvasively before surgery.
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Evaluation of Imaging Findings of Pancreatobiliary and Intestinal Type Periampullary Carcinomas with 3.0T MRI. Acad Radiol 2023; 30:1846-1855. [PMID: 36585328 DOI: 10.1016/j.acra.2022.12.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 12/13/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVES The aim of this study was to differentiate pancreatobiliary and intestinal type periampullary carcinomas using dynamic contrast MRI and MRCP (Magnetic Resonance Cholangiopancreatography) with diffusion-weighted imaging (DWI) MATERIALS AND METHODS: MRI and MRCP images of 70 patients with pathologically proven periampullary adenocarcinoma were included. MRCP image features, extra-ampullary features, enhancement patterns, and apparent diffusion coefficient (ADC) values derived from b-values of 1000 s/mm² were evaluated by two radiologists independently. The interclass correlation coefficient (ICC) or Cohen's kappa statistic was used to evaluate the interobserver agreement. RESULTS 51 patients were diagnosed with pancreatobiliary type carcinomas, and 19 with intestinal type. In the pancreatobiliary subtype, the distal wall of the common bile duct was usually irregular (p = 0.047). Although the progressive enhancement pattern was evident in the pancreatobiliary type, an oval filling defect in the distal common bile duct was found to be more common in the intestinal type (p<0.001). The pancreatic duct cut-off sign (p<0.001), gastroduodenal artery involvement (p <0,001), and lymphadenopathy (p<0.05) were mostly observed in pancreatobiliary carcinomas. The ADCmin, ADCmean, and ADCmax values of the pancreatobiliary type carcinomas were all lower compared to the intestinal type carcinomas (p <0.05). CONCLUSION The oval filling defect seen in MRI and MRCP examinations suggests intestinal type, whereas the progressive contrasting pattern of the masses with irregular narrowing in the distal margin of the common bile duct, the pancreatic duct cut-off sign, gastroduodenal artery involvement, lymphadenopathy, and low ADC values indicate pancreatobiliary type carcinomas.
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A Comparative Olfactory MRI, DTI and fMRI Study of COVID-19 Related Anosmia and Post Viral Olfactory Dysfunction. Acad Radiol 2022; 29:31-41. [PMID: 34810059 PMCID: PMC8549400 DOI: 10.1016/j.acra.2021.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 10/15/2021] [Accepted: 10/17/2021] [Indexed: 12/24/2022]
Abstract
Rationale and Objective To evaluate how COVID-19 anosmia imaging findings resembled and differed from postinfectious olfactory dysfunction (OD). Material and Methods A total of 31 patients presenting with persistent COVID-19 related OD and 97 patients with post-infectious OD were included. Olfactory bulb MRI, DTI and olfactory fMRI findings in both groups were retrospectively assessed. Results All COVID-19 related OD cases were anosmic, 18.6% of post-infectious OD patients were hyposmic and remaining 81.4% were anosmic. Mean interval between onset of OD and imaging was 1.5 months for COVID-19 related OD and 6 months for post-infectious OD. Olfactory bulb volumes were significantly higher in COVID-19 related OD than post-infectious OD. Deformed bulb morphology and increased olfactory bulb signal intensity was seen in 58.1% and 51.6% with COVID-19 related OD; and 63.9% – 46.4% with post-infectious OD; without significant difference. Significantly higher rate of olfactory nerve clumping and higher QA values at orbitofrontal and entorhinal regions were observed in COVID-19 related OD than post-infectious OD. Absence of orbitofrontal and entorhinal activity showed no statistically significant difference between COVID-19 related OD and post-infectious OD, however trigeminosensory activity was more robust in COVID-19 related OD cases. Conclusion Olfactory bulb damage may play a central role in persistent COVID-19 related anosmia. Though there is decreased olfactory bulb volume and decreased white matter tract integrity of olfactory regions in COVID-19 related anosmia, this is not as pronounced as in other post-infectious OD. Trigeminosensory activity was more robust in COVID-19 related OD. These findings may reflect better preserved central olfactory system in COVID-19 related OD compared to COVID-19 related OD.
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Gastrointestinal stromal tumors of the stomach: A 10-year experience of a single-center. Niger J Clin Pract 2021; 24:1785-1792. [PMID: 34889786 DOI: 10.4103/njcp.njcp_558_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Gastrointestinal tract stromal tumors (GIST) are the most common mesenchymal tumors in the gastrointestinal tract (GIS). GISTs may cause significant morbidity and mortality rates. Aim In this study, it was aimed to evaluate 10 years of gastric GIST cases followed in our hospital, and to analyze the prognostic factors. Subjects and Methods In this single-center retrospective study, a total of 64 patients who were operated between May 2010 and May 2020 due to gastric GIST tumor were reviewed. Clinical and pathological features, risk classifications, overall survival (OS) and disease-free survival (DFS) were evaluated. Results According to the risk classification, 18.8% of the patients were in the high-risk group. The overall 5-year OS and DFS rates were 85.7%. The mean OS of the patients was 47.9 SD36.2 months, and the duration of DFS was 45.5 months. Patients with a 5-year OS rate above 5 cm in diameter (P = 0.024), with a mitotic index above 5/50 high power field (HPF) (P = 0.038), and those with a high-risk group (P = 0.011) were significantly lower than the other group. In the correlation analysis, it was found that tumor diameter correlated significantly with OS (P = 0.034; r = -0.317). Tumor diameter and mitotic index were found to be inversely correlated with DFS duration (P = 0.004; r = -0.425 and P = 0.035; r = -0.316, respectively). Conclusion Our findings showed that in gastric GIST cases, as the primary tumor diameter and mitotic index increase, correlate with survival rates and the mean overall and disease-free survival times decrease.
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How the Aperture of Femoral Tunnel Affected in ACL Reconstruction Performed with AM Portal Technique? ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE CECHOSLOVACA 2021; 88:428-433. [PMID: 34998446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
PURPOSE OF THE STUDY The purpose of this study was to evaluate the position of tibial tunnel (TT) and femoral tunnels (FT) performed by using the anteromedial (AM) portal technique and its effect on the aperture of FT. MATERIAL AND METHODS A total 44 patients operated for anterior cruciate ligament (ACL) rupture by AM portal technique between January 2013 and July 2015, were included in this study. They were subjected to a magnetic resonance imaging of the knee to assess the FT, dimensions of the FT aperture and TT. The location of the ACL graft within the joint was compared with the intact ACL of healthy individuals. The patients were also evaluated using Lysholm and IKDC subjective scores for functional outcome. RESULTS The mean FT angle on both the coronal plane (42.88°±5.83°) and the sagittal plane (68.47°±9.57°) was significantly different from the intra-articular part of the hamstring autograft angles (74.93°±7.27° and 58.74°±4.88°, respectively) (p<0.0001). The mean distance of the FT aperture was 13.18 (±2.49) mm on vertical axis, 10.97 (±1.50) mm on the sagittal axis (p<0.0001). The difference between TT axis and the axis of the intra-articular part of autograft on both coronal (72.78°±4.67° and 74.93°±7.27°, respectively) and sagittal planes (60.12°±5.53° and 58.74°±4.88°, respectively) were not significant (p>0.05). DISCUSSION Ilingrowth et al. claimed that the FT were scattered in the very large distance and some of them were placed outside of anatomical range in the series included the cases performed with transtibial and transtibial independent techniques. In this series, in which we used a femoral guide to drill the FT at lateral femoral condyle at 2 or 10 o'clock position depended upon the site of operation, we obtained a consistent FT which is comparable with the intra-articular part of native ACL. Amano et al. found that the FT aperture enlargement was significant in the series when hamstring tendons were used as autograft, over a 6-month period. We also found a significant difference between the narrowest part of the FT (7.01 ± 1.05 mm) and its aperture (10.97 ± 1.50 mm in sagittal, 13.18 ± 2.49 mm in vertical direction). The enlargement was mainly in the vertical direction, due to the fact that the loads resulting from daily life are mostly on the horizontal plane. CONCLUSIONS The direction of intra-articular part of the ACL graft in the cases operated with the AM portal technique is significantly different from the FT direction in both the coronal and sagittal planes. The enlargement of the FT aperture is larger in the vertical axis compared to the sagittal axis. Although the long-term clinical consequences of asymmetrical enlargement of the FT aperture are not known yet, to avoid this potential risk, a technique to approximate the direction of FT to the intra-articular part of the ACL without changing the FT entry site, can be used. Key words: knee, anterior cruciate ligament reconstruction, femoral tunnel, tibial tunnel, anteromedial portal.
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Abstract
BACKGROUND Obesity is an excessive increase in body fat mass and triggers chronic inflammation which causes increased fat accumulation in the visceral fat tissue. The aim of this study was to analyze serum zinc (Zn), Zn-alpha 2 glycoprotein (ZAG), peroxisome proliferator-activated receptor-γ (PPAR-γ) and nuclear factor kappa-light-chain-enhancer of activated B cell (NF-κB) levels in morbidly obese patients before and after laparoscopic sleeve gastrectomy (LSG) and determine the association between alteration in body mass index (BMI), the % Excess Weight Loss (% EWL) and the biochemical parameters. METHODS Thirty healthy individuals as a control group and 30 morbidly obese patients who had undergone LSG were enrolled in this study. Routine anthropometric and laboratory biochemical parameters in venous blood samples of groups at baseline and 1 and 12 months after LSG were recorded. RESULTS Significant weight loss was achieved at 1 and 12 months after LSG. At baseline serum ZAG and PPAR-γ levels were lower, while NF-кB levels were higher in morbidly obese patients compared with the control group. Serum ZAG and PPAR-γ levels increased while NF-кB levels decreased 1 month and 12 months after LSG. Decreased %EWL was negatively correlated with changes in NF-кB, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), fasting plasma glucose and insulin at 12 months after LSG in morbidly obese patients. However, %EWL was positively correlated with changes in ZAG. CONCLUSIONS Obesity was associated with down-regulated serum ZAG and PPAR-γ levels while up-regulated serum NF-кB. Our findings suggest that LSG ameliorates upregulating PPAR-γ expression, thereby inhibiting NF-κB-mediated inflammation by weight loss.
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Abstract
Genistein is a natural compound from the class of isoflavonoids found in high concentrations in legumes and soybeans. In this experimental study; we suggest that genistein might cause favorable outcomes in the hepatic surgery because of its protective effects on hepatic ischemia‒reperfusion injury (Tab. 2, Fig. 6, Ref. 28). Keywords: genistein, isoflavonoids,legumes, soybeans, hepatic surgery, ischemia‒reperfusion injury.
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Surgical Management of a Bilateral Bifid Condyle: Diagnosis, Three-dimensional Reconstruction, and Treatment - A Report of a Case and Review of the Literature. Niger J Clin Pract 2018; 21:251-255. [PMID: 29465064 DOI: 10.4103/njcp.njcp_389_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Bifid condyle is a rare entity with a difficult diagnosis and usually identified as an incidental finding on routine radiographic examination. The etiology is not well known, possible causes may be developmental, traumatic, vascular, abnormal muscle pulling, nutritional, endocrinal, teratogenic, and infections. The orientation of the condylar heads can behelpful for the etiological diagnosis.This case report describes a 56-year-old woman who suffered from a unilateral, progressively increasing, radiating pain which intensified with the movement of the mandible and includes information about the diagnosis, management, radiographic and three-dimensional model features and review of the literature.
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Neutrophil oxidative metabolism in Down syndrome patients with congenital heart defects. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2010; 51:57-63. [PMID: 19593803 DOI: 10.1002/em.20511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Down syndrome (DS) occurs when an individual has three, rather than two, copies of the 21st chromosome. Cytosolic superoxide dismutase (SOD-1) is encoded by a gene on chromosome 21 and thus, SOD-1 activity is elevated in patients with DS. Forty percent of all cases with DS are associated with congenital heart defects (CHD). Although the contribution of SOD1 to disease phenotype is unknown, it is considered to be a "molecular marker" of the disease. It was hypothesized herein that the presence of CHD may alter the expression of SOD1 and oxidative metabolism in patients with DS. This hypothesis was tested via four experimental groups as follows: patients with DS without CHD, DS patients with CHD, CHD patients without DS and controls. Expression and activity of superoxide dismutase (SOD), glutathione peroxidase (GPx), myeloperoxidase (MPO), and catalase (CAT) were determined in neutrophils from all experimental groups. Intracellular hydrogen peroxide concentration and superoxide release were also evaluated in neutrophils. A significant increase was observed in SOD and GPx amount and activity in patients with DS with and without CHD. No significant difference was found in the amount and activity of MPO and CAT among the different experimental groups. Intracellular hydrogen peroxide concentration was similar in all groups, whereas a prominent decrease was seen in superoxide release in cases with DS. Patients with DS with and without CHD showed no significant differences in any of the measured parameters. The data suggest that CHD observed in patients with DS does not result from altered redox metabolism associated with the disease.
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Abstract
In this prospective study, the plain X-rays and MRI scans of 60 patients with intraarticular distal radius fractures were examined in random order. MRI evaluation revealed that 27 of the 60 patients (45%) had triangular fibrocartilage lesions. No correlation was found between triangular fibrocartilage injury and the Melone classification system, the presence of an ulnar styloid fracture, comminution of the articular surface of the distal radius, >20 degrees dorsal angulation of the distal radius or subluxation/dislocation of the distal radioulnar joint on the plain X-rays. When Frykman Type VI and VIII fractures were compared with all the other Frykman subtypes, a significant difference in the incidence of triangular fibrocartilage complex tears was observed. We conclude that triangular fibrocartilage injury should be considered with all distal radial fractures, especially the Frykman Types VI and VIII.
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Abstract
The purpose of this study is to show the spectrum of adjacent organ invasion and to make a brief review of hepatic alveolar hydatid disease (AHD), using CT and MR imaging. We retrospectively reviewed CT and MR images of three patients with various adjacent organ invasions surgically and histologically proven to be AHD. Local invasion to right kidney and adrenal, right hemidiaphragm and lung were detected in one patient, right adrenal in another patient and gall bladder, duodenum, gastric wall and pancreas invasion in the other. AHD may rarely extend to the gall bladder, stomach, duodenum, pancreas, right adrenal and kidney, diaphragm, pleura and lung. The extension of the disease outside the liver is usually encountered in patients with large, peripherally located masses in the advanced stage of the disease.
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Perforated haemorrhagic cholecystitis: MR imaging features. Clin Radiol 2006; 61:899-901. [PMID: 16978989 DOI: 10.1016/j.crad.2006.06.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Revised: 06/13/2006] [Accepted: 06/14/2006] [Indexed: 11/23/2022]
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Reliability of procalcitonin as a severity marker in critically ill patients with inflammatory response. Anaesth Intensive Care 2002; 30:747-54. [PMID: 12500512 DOI: 10.1177/0310057x0203000605] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Procalcitonin (PCT) is increasingly recognised as an important diagnostic parameter in clinical evaluation of the critically ill. This prospective study was designed to investigate PCT as a diagnostic marker of infection in critically ill patients with sepsis. Eighty-five adult ICU patients were studied. Four groups were defined on the basis of clinical, laboratory and bacteriologic findings as systemic inflammatory response syndrome (SIRS) (n = 10), sepsis (n = 16), severe sepsis (n = 18) and septic shock (n = 41). Data were collected including C-reactive protein (CRP), PCT levels and Sequential Organ Failure Assessment and Acute Physiology and Chronic Health Evaluation II scores on each ICU day. PCT levels were significantly higher in patients with severe sepsis and septic shock (19.25 +/- 43.08 and 37.15 +/- 61.39 ng/ml) than patients with SIRS (0.73 +/- 1.37 ng/ml) (P < 0.05 for each comparison). As compared with SIRS patients, plasma PCT levels were significantly higher in infected patients (21.9 +/- 47.8 ng/ml), regardless of the degree of sepsis (P < 0.001). PCT showed a higher sensitivity (73% versus 35%) and specificity (83% versus 42%) compared to CRP in identifying infection as a cause of the inflammatory response. Best cut-off levels were 1.31 ng/ml for PCT and 13.9 mg/dl for CRP. We suggest that PCT is a more reliable marker than CRP in defining infection as a cause of systemic inflammatory response.
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[The effect of pentaglobin therapy on prognosis in patients with severe sepsis]. ULUSAL TRAVMA DERGISI = TURKISH JOURNAL OF TRAUMA & EMERGENCY SURGERY : TJTES 2001; 7:219-23. [PMID: 11705075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
This study was designed to assess the effects of polyclonal immunoglobulin administration on septic shock incidence and prognosis in patients with severe sepsis. Patients with severe sepsis were randomly allocated into two groups. One group (n = 21) received 5 ml/kg/day IgM enriched immunoglobulin preparation (Pentaglobin) for 3 days. Other group did not receive immunoglobulins (n = 18). Simplified Organ Failure Assessment (SOFA) scores, leucocyte count, duration of mechanical ventilation, ICU stay, duration of severe sepsis did not show significant differences between the groups, as regards to septic shock incidence and mortality. However, a significant decrease in procalcitonin levels were detected only in patients who received pentaglobin (p = 0.001). Mortality rate was 5/21 (23.8%) in pentaglobin group and 5/18 (27.7%) in the control group. Although pentaglobin therapy could not achieve a statistically significant improvement in septic shock occurrence and mortality, the constant reduction in procalcitonin levels indicated the beneficial effects of immunotherapy on the severity of inflammatory response to infection in severe sepsis.
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Clinical applicability of the substitution of mixed venous oxygen saturation with central venous oxygen saturation. J Cardiothorac Vasc Anesth 2001; 15:574-9. [PMID: 11687997 DOI: 10.1053/jcan.2001.26534] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To examine the clinical applicability of substituting central venous oxygen saturation (ScvO2) for mixed venous oxygen saturation (SmvO2) in monitoring global tissue oxygenation. DESIGN Prospective clinical investigation. SETTING University hospital. PARTICIPANTS Seventy-three adult patients. INTERVENTIONS Venous oxygen saturation was recorded, and oxygen saturation difference between SmvO2 and ScvO2 (DeltaSmvcv) was calculated in 2 groups of patients (group I, sepsis patients [n = 41], and group II, general anesthesia for cardiovascular surgery patients [n = 32]) during initial placement of pulmonary artery catheters. MEASUREMENTS AND MAIN RESULTS Patients were classified as follows: class A, patients having a DeltaSmvcv >-5%; class B, patients having a DeltaSmvcv between -5% and +5%; and class C, patients having a DeltaSmvcv >+5 %. Statistically significant differences were observed in cardiac index, oxygen delivery index, and oxygen extraction ratio between class A and B in both groups. Class C of group II showed the worst correlation between SmvO2 and ScvO2 and had significantly lower arterial carbon dioxide tension values than class A and B. CONCLUSION Pulmonary artery blood sampling should not be replaced with central venous blood. Hypocapnia and increased oxygen extraction ratio seem to be the major factors that worsen the relationship between ScvO2 and SmvO2.
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Oxygenation response to prone positioning in pulmonary and extrapulmonary ARDS. Crit Care 2000. [PMCID: PMC3333050 DOI: 10.1186/cc846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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