The Eurasian Journal of Medicine - 2010; 42(2) - Current Issue

The Contribution of Chemoreceptor-Network Injury to the Development of Respiratory Arrest Following Subarachnoid Hemorrhage

2010-08-01

Objective: Respiratory arrest following brainstem herniation has been attributed to injuries resulting from compression of the respiratory centers. While it is widely perceived that the chemoreceptor network, consisting of the glossopharyngeal nerve and carotid body (GPN-CB), is essential for the modulation of respiration, its contribution to the development of respiratory arrest has not been investigated. Therefore, the aim of this study was to investigate whether injury to the GPN-CB occurs in animals with respiratory arrest caused by experimentally-induced subarachnoid hemorrhage. Materials and Methods: Eighteen hybrid rabbits were used in this study. Four rabbits (n=4) were used to determine the normal structure of the GPN-CB. The remaining rabbits (n=14) received an autologous blood injection into the cisterna magna to produce a subarachnoid hemorrhage, after which they were observed for 20 days. The number of axons and the neuron density in the glossopharyngeal nerve and carotid body, respectively, were counted by stereological methods. The Mann-Whitney U test was used to analyze the results. Results: Six of 14 rabbits died within the first week, likely due to brain swelling and crushing injuries that were observed in the brain stem and related structures. In control rabbits, the average neuronal density of the carotid body was 4250 � 1250/ mm³ , while the axonal density in the glossopharyngeal nerve was 18000 � 5100 mm² . Conversely, in the dead rabbits, the degenerated neuron density of the carotid body was 2100 � 500/ mm³ , while the degenerated axon density in the glossopharyngeal nerve was 8500 � 2550 mm² . In addition, histopathological lesions were more severe in the dead rabbits in terms of their glossopharyngeal nerve and carotid body. Conclusion: There is an important relationship between neurodegeneration in the GPN-CB and mortality rates following experimentally-induced hemorrhage. This relationship suggests that injury to the GPN-CB network disrupts the breathing reflex and results in respiratory arrest following a subarachnoid hemorrhage (SAH).

Determination of Linear X-Ray Attenuation Coefficients of Pathological Brain Tissues and Use of Filters in Tissue Contrast Enhancement in Computed Tomography

M. Erdem Sagsoz, Fazl� Erdogan, Salih Z. Erzeneoglu, �hsan Yuce — 2010-08-01

Objective: X-ray attenuation coefficients are used in common radiological, pathological and spectroscopic examinations and in the determination of the radiation dose distribution in biological tissues. In radiology, these coefficients enable diagnosis by differentiating the abnormal tissues from the normal ones using their morphological structure and contrast differences. In this study, our aim is to precisely determine the linear x-ray attenuation coefficients of pathological brain tissues and to use x-ray beam filters to enhance the tissue contrast in computed tomography. Materials and Methods: To directly measure the relative linear attenuation coefficients, an energy dispersive x-ray spectroscopy system (EDXRS-Canberra, Si(Li) with DSA-1000 spectrum analyzer 1998; CT, USA) was used with collimators and a medical-purpose x-ray tube (Siemens, Siremobil, 1985; Erlangen, Germany) in a linear geometry. Results: Using a Mo filter with Computed Tomography CT and photon energies from 15 to 25 keV, EDXRS acquisitions were found to significantly distinguish grades of brain tumors (p<0.05). For the data acquired from CT systems with the decreasing filtered photon mean energy, the x-ray attenuation coefficients (i.e., the Hounsfield units) show that the ratio of EDXRS to CT for water's attenuation coefficient are increased. With our suggested x-ray filters, the tissue contrast has been found to be increased in ex vivo brain tumor slices compared with slices scanned in conventional CT scanners. Conclusion: X-ray attenuations measured with the EDXRS are found to be statistically more reliable because of the length of acquisition times in this study.

Diffusion-Weighted Magnetic Resonance Imaging in Evaluation of Gastric Cancer

2010-08-01

Objective: To investigate the role of diffusion-weighted magnetic resonance imaging (DW-MRI) in the diagnosis of gastric tumors and discuss the diagnostic importance and potential use of apparent diffusion coefficient (ADC) measurements. Materials and Methods: Beginning in March 2009, DW-MRI was added to the routine abdominal and pelvic MR examination for all patients imaged at our institution. A total of 21 patients (12 men and 9 women; mean age 55�6.3SD, range: 39-74 years) with known gastric malignancy were referred to our MR unit. All MRI examinations were performed using a 1.5-T MRI scanner (Magnetom Avanto, Siemens Healthcare). The evaluation of the DW-MRI examinations was made by radiologists' consensus. Changes in the signal intensity of the lesions were determined by their appearance in images at b=50, 400, and 800 s/mm² and in ADC maps. Results were compared with histopathological findings. Results: All of the gastric tumors in this study showed high signal intensity in DW-MRI and low signal intensity in ADC maps. Mean ADC values for gastric tumor and normal gastric wall were 0.892�0.23 SD mm² /s and 1.453�0.35 SD mm² /s respectively. The mean ADC values of gastric tumors were significantly lower than that of the normal gastric wall. Conclusion: DW-MRI and ADC values together can successfully differentiate gastric tumors from normal gastric wall.

Dexmedetomidine in the Supratentorial Craniotomy

Osman Ilhan, Senem Koruk, Gokcen Serin, Ibrahim Erkutlu, Unsal Oner — 2010-08-01

Objective: In this double-blind prospective clinical study, we investigated the effects of fentanyl and dexmedetomidine as adjuvant agents in supratentorial craniotomies on the following: hemodynamic changes during perioperative and recovery periods, brain edema perioperatively, recovery times and side effects, such as hypertension, shivering, nausea and vomiting. Materials and Methods: Thirty consenting ASA physical status I-II patients undergoing intracranial tumor surgery were randomly divided in two groups. In group D (n=15), dexmedetomidine was infused as a 1 �g/kg bolus dose 10 minutes before induction of anesthesia and maintained with 0.4-0.5 �g/kg/min during the operation. In group F (n=15), animals were given fentanyl 0.02 �g/kg/min as an infusion for anesthesia maintenance. At induction, fentanyl was given as a 2 �g/kg dose in group D and as a 4 �g/kg dose in group F. Hemodynamic changes, recovery times and postoperative side effects were recorded before induction, during the perioperative period and 24 hours postoperatively. Results: In group D; MAP and HR values after intubation, after skull clamp insertion and after extubation were lower than in group F (p<0.05). In group D, cerebral relaxation scores were also significantly lower. Recovery times were found to be shorter in group D as compared to group F; the same trend was observed for the supplemental opioid requirement. During the postoperative period, there was no shivering, nausea or vomiting in group D, but in group F, 3 patients complained of shivering, and 2 patients experienced nausea and vomiting. Conclusion: In our study, we found that dexmedetomidine controlled the hemodynamic changes better than fentanyl perioperatively, after extubation and during the early postoperative period. Our results suggest that that dexmedetomidine is safer and more effective in controlling hemodynamic changes during surgical stimulation than the standard agents used in neuroanesthesia.

A Stereological Assessment Method for Estimating the Surface Area of Cycloids

Bunyami Unal, Adem Kara, Selina Aksak, Deniz Unal — 2010-08-01

Objective: In this study, we sought to determine differences in estimations of surface area made by classical vertical uniform random (VUR) section series and vertical section series obtained perpendicular to a fixed horizontal plane. Materials and Methods: One volunteer subject (male, 25 years of age) with no neurological deficit was chosen at random from a bank of controls in the magnetic resonance (MR) image data library of the Department of Radiology. First, a soccer ball with known geometrical features (radius: 9.75 cm) was imaged using a T1-weighted MR scanner at 5-mm thickness (total 40 sections) to test the validity and reliability of surface area and volume measurements obtained via stereological methods. Second, T1-weighted MR section profiles were obtained from a volunteer individual. Surface area and volume estimation procedures were carried out using the Stereo Investigator 6, MicroBrightField, Inc., USA. Conclusions: We determined that there are no differences in either surface area or volume estimations made using VUR sections and direct vertical sections. We have performed an exhaustive series analysis with a variety of objects.

Smoking Prevalance and the Degree of Nicotine Dependence Among Healthcare Workers at the Ataturk University Medical Facility

Leyla Saglam, Ravza Bayraktar, Esra Ekbic Kadioglu, Hamit Acemoglu — 2010-08-01

Objective: In this study, we aimed to investigate smoking prevalence and the degree of nicotine dependence in our hospital healthcare workers. Materials and Methods: This study was conducted between January 2008 and June 2008 in our hospital (Medical Facility of Atat�rk University). A total of 691 (370 females, 321 males) subjects were included in this study. A questionnaire, including demographic findings, tobacco consumption information and the Fagerstr�m nicotine dependence test, was distributed to healthcare workers and collected. Results: The questionnaire was answered by 691 health workers, 46.5% of whom were male, and 53.5% of whom were female. Overall, the rate of smoking was 36.9%; 48% of males and 27.6% of females were current smokers. When classified according to clinic, the greatest rate of smoking was in the psychiatry clinic (60.0%), and the lowest rate of smoking was in the ear, nose and throat (ENT) Clinic (0.0%). Thirty-four percent of nurses, 18.7% of doctors, 45.5% of officers, and 50.4% of ancillary staff were smokers. According to education level, 50% of the cases (smokers) graduated from primary school, 45% of the cases graduated from high school and 26.9% of the cases graduated from university. The major reason for the initiation of smoking was attention-seeking behavior. The age at smoking initiation was 7 to 20 years in 83.9% of cases and 21 to 35 years in the remaining 16.1%. Thirty-five percent of smokers had very low levels of dependence, while 11.9% had very high levels dependence. Ninety-two percent of cases indicated they would prefer to work at a smoke-free hospital. Ninety-five percent of cases would support making this facility a smoke-free hospital. Conclusion: The smoking rate was 36.9% amongst our hospital health workers. Smoking prevalence was higher in males (48%) than females (27.6%). The greatest smoking rate was amongst ancillary staff. Ninety-five percent of healthcare workers were supportive of a law requiring hospitals to be smoke-free.

Subcutaneous Infusion Ports Via the Internal Jugular Vein: Single Center Experience

Bulent Karaman, Cagatay Andic, Nisa Cem Oren, Bilal Battal, Bahri Ustunsoz — 2010-08-01

Objective: Our purpose is to report and review the results and early complications of subcutaneous infusion port placement by our interventional radiology department. Materials and Methods: Three-hundred twenty-five subcutaneous infusion ports were placed in 320 patients between January 2005 and May 2010. Ports were placed under both general and local anesthesia. Five patients were catheterized twice. The internal jugular veins were used for access. Both ultrasonographic and fluoroscopic guidance were used in our interventions. Retrospectively, we evaluated the ports' duration time. Results: Our technical success rate was 100% and only five complications occurred during port placement. The common carotid arteries were punctured in three patients but bleeding stopped ten minutes following withdrawal of the needle and artery compression. An air embolism occurred in two patients and both were successfully treated with good positioning and suctioning. Early catheter removal was required in five patients. One patient had a right internal jugular vein thrombosis, three patients had catheter occlusions and two patients had catheter fractures. The mean duration of catheter usage was 354 days (range: 2 to 1,478 days). Conclusion: Image guided placement of infusion ports has a greater success rate and lower early complication rate when compared with the unguided series. The right internal jugular vein is the first choice for infusion port access.

Comparison of Power Doppler Ultrasound with Gray Scale Transrectal Ultrasound in Predicting Cancer Positive Prostate Biopsy Cores

2010-08-01

Objective: The aim of this study is to compare the eff ect of transrectal power Doppler ultrasound (PDUS) and gray scale transrectal ultrasound (TRUS) for the diagnosis of prostate cancer. Materials and Methods: Seventy-six patients evaluated with transrectal PDUS and TRUS underwent eight systematic TRUS guided core-needle biopsies, with additional cores from abnormal areas. Histologic diagnoses were classifi ed as benign prostatic hyperplasia, chronic prostatitis, intraepithelial neoplasia and adenocarcinoma. TRUS and PDUS fi ndings of the cases were recorded. Results: PDUS sensitivity, specifi city, positive predictive value (PPV) and negative predictive values were 81%, 81%, 54% and 94%, respectively. PDUS had a greater sensitivity and specifi city than TRUS (43% and 60%, respectively) and identifi ed cancer cases more accurately (Table 2). Conclusion: Hypervascular foci in PDUS signify suitable zones for biopsy. When combined with systematic TRUS guided biopsy, PDUS increases the cancer detection rate with additional biopsies from suspicious hypervascular foci. Transrectal PDUS guided biopsy should be combined with gray scale TRUS guided biopsy to increase accuracy in the diagnosis of prostate cancer.

Nutritional Rickets in Turkey

Behzat Ozkan — 2010-08-01

Nutritional rickets (NR) remains the most common form of developmental bone disease, in spite of the efforts of clinicians and health care providers to reduce the incidence of the disease in Turkey. Today, it is well known that the etiology of NR exists along a spectrum ranging from isolated vitamin D deficiency to isolated calcium deficiency. In Turkey, almost all NR results from vitamin D deficiency that may have temporary but profound effects on short- and long-term skeletal development. Recent evidence suggests that vitamin D deficiency during infancy may predispose a patient to diseases such as diabetes mellitus, cancer, multiple sclerosis, etc. The factors responsible for the high prevalence of vitamin D deficiency in developing countries and its resurgence in developed countries include the following: limited sunshine exposure as individuals spend more time indoors watching television and working on computers or intentional sunshine avoidance for skin cancer prevention. Traditional clothing (covered dress) further limits the exposure to sunshine and thus decreases the endogenous synthesis of vitamin D. In Turkey, maternal vitamin D deficiency and breast feeding without supplementation are the most prominent reasons. The diagnosis of NR is established with a thorough history and physical examination and confirmed by laboratory evaluation. In conclusion, recent literature has drawn attention to the supplemental doses of vitamin D required to achieve a serum 25-hydroxyvitamin D level of at least 20 ng/ml (50 nmol/l), the serum concentration that is needed to optimize absorption of dietary calcium, suppress excess secretion of parathyroid hormone, and reduce fracture risk as well as prevent long-term negative effects.

Infant Botulism

Eren Cagan, Erdal Peker, Murat Dogan, Huseyin Caksen — 2010-08-01

Infant botulism is a rare condition caused by intestinal colonization with Clostridium botulinum. The enteric toxin causes intestinal immobility and progressive descending paralysis due to the effect on acetylcholine release at the neuromuscular junction and other cholinergic nerve terminals, particularly in the gut. Herein, we report an infant with infantile botulism because of rare clinically entity, with early diagnosis and appropriate treatment recover no squeal.

A Rare Presentation of an Entrapment in a Liver Transplant Candidate Depicted by MDCT Angiography

2010-08-01

Hypertrophic caudate lobe veins can mimic a normal venous configuration. In cases of multiple vascular collaterals, Doppler evaluations must be conducted, and the flow direction of these veins as well as the IVC should be evaluated. If the flow in the IVC is reversed, Budd-Chiari syndrome should be suspected; moreover, at the supra diaphragmatic level, which may be considered a blind spot, particularly for radiologists, a web should be searched for in the area where the IVC opens into the right atrium. In this study, we present the unique findings of multidetector computed tomography (MDCT) angiography for a liver transplant candidate with Budd-Chiari syndrome caused by a web in the proximal IVC.

Self-Bloodletting: An Unusual Form of Self-Mutilation in Adolescence

Onur Burak Dursun, Fatma Varol Tas, Taner Guvenir — 2010-08-01

In this paper, we introduce an adolescent suffering from a rare form of self-mutilation, “self-bloodletting”, and discuss dynamics of this maladaptive behavior. Deliberate bloodletting is a rare, but not unheard of, form of self-mutilation associated with eating and personality disorders. Although there are already several case reports in the adult psychiatry literature regarding the clinical features of Lasthenie de Ferjol Syndrome or factitious anemia, this is the first reported adolescent case of self-bloodletting.

A Case of Anomalous Left Coronary Artery Arising From the Pulmonary Artery in Adulthood: Multidetector Computed Tomography Coronary Angiography Findings

2010-08-01

Anomalous left coronary artery arising from the pulmonary artery (ALCAPA) is a rare but very serious congenital coronary artery anomaly. Multidetector computed tomography (MDCT) coronary angiography has recently become the gold standard for depicting anatomical variations and anomalies of the coronary arteries because the origin and course of anomalous arteries can be demonstrated very accurately by this technique. In this report, we present a case of 22-year-old female who was admitted to our emergency department with cardiac arrest. In the course of diagnosis, MDCT coronary angiography revealed a left coronary artery arising from the pulmonary artery as well as marked dilatation of the coronary arteries.

Krukenberg Tumor: CT and PET-CT Findings

Nuri Tasali, Rahmi Cubuk, Ahmet Midi — 2010-08-01

Scheuermann's Disease of the Thoracolumbar Spine in a Boy

2010-08-01