Objectives:To determine whether the mean platelet volume (MPV) and MPV/platelet (PLT) values can be used in the study of sepsis and systemic inflammatory response syndrome (SIRS).Methods:In this retrospective case-controlled study, 69 sepsis, 69 SIRS patients, and 72 control group who were treated in the years 2012-2013 were reviewed, and both the MPV and MPV/PLT rates were evaluated in all groups at Kahramanmaras Sutcu Imam University Intensive Care Unit, Kahramanmaras, Turkey.Results:Statistically significant difference was found between sepsis, SIRS, and control groups when comparing the MPV and MPV/PLT ratio (p<0.05), and no significant difference was found between sepsis and SIRS groups in terms of MPV and MPV/PLT ratio (p>0.05). Mean platelet volume values for sepsis and control groups was 10.07/8.731 femtoliter (fL) (p=0.000), and 9.45/8.731 fL (p=0.000) for SIRS and control groups. In the group of sepsis patients, the MPV was found to be at cut-off 8.915, sensitivity 71%, and specificity 63.9%. In the group of patients with SIRS, MPV was found to be at cut-off 8.85, sensitivity 69.6%, and specificity 62.5%. For the MPV/PLT values, the specificity and sensitivity were found to be insignificant.Conclusion:This study shows that although there was no significant reduction in the PLT values between the sepsis and SIRS patients, the MPV and MPV/PLT ratio values were found to have significant differences. However, the specificity and sensitivity of the values were not reliable standard to be used as a test.
283Systemic blood pressure is regulated by three mechanisms: the sympathetic nervous system, the renin-angiotensin system, and the arginine-vasopressin system. Hypotension is a condition that can occur at any stage of management of general anaesthesia, including induction, extubation, and maintenance. Many of the medications used for anaesthesia produce a mild to moderate decrease in systemic vascular resistance (SVR) with a subsequent decrease in arterial blood pressure. Profound and sustained hypotension, however, can have a global impact, resulting in a failure to adequately perfuse systemic capillary networks. The following report describes the case of a 69-year-old man undergoing surgery for total hip replacement who had hypotension that was refractory to fluid administration and inotropic agents at the end of the surgery. In this case study, the role of methylprednisolone therapy in catecholamine-resistant hypotension is also discussed.Key Words: Blood pressure, hypotension, catecholamine, fluid therapy, adrenal insufficiency Sistemik kan basıncının düzenlenmesi üç farklı mekanizma ile sağlanmaktadır: Sempatik sinir sistemi, renin-anjiyotensin ve arginin-vazopressin sistemi. Hipotansiyon genel anestezi yönetimi-nin indüksiyon, idame ve ekstübasyon dahil olmak üzere her aşa-masında ortaya çıkabilen bir durumdur. Anestezi indüksiyonunda kullanılan ilaçlar hem sistemik damar direncinde (SDD) hem de arter kan basıncında ileri derecede düşüşlere sebep olabilmektedir. Bununla birlikte ağır ve devam eden hipotansiyon, sistemik kapiller ağlarda perfüzyon yetersizliği ile sonuçlanmaktadır. Bu olgu sunumunda; kalça protezi nedeniyle üç kez ameliyata alınan 69 yaşında erkek hastada, girişimin bitimini takiben gelişen, sıvı tedavisi ve inotropik ajanlara dirençli hipotansiyon tedavisine yaklaşım anlatılmaktadır. Tüm tedavi stratejilerine rağmen düzelmeyen hipotansiyon durumunda metilprednizolon uygulanmasının rolü tartışılmıştır.Anahtar Kelimeler: Kan basıncı, hipotansiyon, katekolamin, sıvı tedavisi, adrenal yetmezlik Özet / Abstract Giriş D üşük kan basıncı yada hipotansiyon kalbin her atımında perifere normalden daha az kan pompalamasıdır; bu da organ perfüzyonunun azalmasına neden olur. Normal kan basıncı değerleri 130/80-90/60 mmHg olarak kabul edilmektedir. Hipotansiyon; alkol, bazı antidepresanlar, anksiyolitikler, diüretikler, analjezikler gibi çeşitli ilaçlarla ilişkilendirilebilen bir durumdur. Hipotansiyona neden olan diğer etkenler; ileri derecede diyabetes mellitus, dehidratasyon, anafilaksi, aritmi, şok, kanama, kalp yetmezliği şeklinde sıralanabilir. Uyku hali, bulantı, konfüzyon, güçsüzlük, senkop gibi semptomlara sebep olur. Acil tedavi edilmezse şok ve kalp durmasına kadar ilerleyebilir (1).Hipotansiyon genel anestezi yönetiminin indüksiyon, idame ve ekstübasyon dahil olmak üzere her aşamasında ortaya çıka-bilen bir durumdur. Anestezi indüksiyonunda kullanılan ilaçlar hem sistemik damar direncinde (SDD) hem de arter kan basıncında ileri derecede düşüşlere sebep olabilmektedir. Bununla birlikte ağır v...
Drug-induced pulmonary disease is an important consideration in the differential diagnosis of patients with rheumatoid arthritis (RA) who present with respiratory symptoms. We report a patient with RA who developed acute respiratory failure two weeks after the administration of abatacept. The clinical findings were consistent with drug-induced acute respiratory failure, most likely acute eosinophilic pneumonia. Pulse steroid was administered at 1000 mg/kg/day in the emergency department. Chest X-ray and arterial blood gas values revealed significant improvement on the second day of hospitalization. However, in the second week, the patient's fever rose up to 40°C, procalcitonin level increased to 15 ng/mL (<0.5 ng/mL is normal), and the patient died because of sepsis in the fourth week. This is the second report of respiratory failure, after the abatacept administration in the literature. We have reported an acute respiratory failure that occurred after use of the biological agent abatacept. With the increasing use of novel immunomodulatory agents, it is important for clinicians and pathologists to add the possibility of a drug reaction to the traditional differentials of acute respiratory failures occurring in these settings.
DerlemeS urgical access to the paraclinoid segment of the internal carotid artery is important to know for surgical treatment of aneurysms of the paraclinoid, carotid-ophthalmic and/or anterior cavernous segments of the inter-Alındığı tarih: 13.Surgical access to the paraclinoid segment of the internal carotid artery is important for safe surgical clipping of paraclinoid carotid aneurysms such as carotid-ophthalmic aneurysms and for the surgical treatment of tumors of the anterior clinoid process (ACP), anterior part of cavernous sinus and the wall of the orbital apex. Anterior clinoidectomy is useful during the surgical access to the paraclinoid segment of the internal carotid artery (ICA). The extensive surgical field gained after anterior clinoidectomy allows lesser brain retraction and increases mobilization of the intracranial ICA and optic nerve. In this report, the authors describe the anatomy of the internal carotid artery and its various segments. Anatomy of the anterior clinoid process and its relation to the internal carotid artery are reviewed. The basic principles of anterior clinoidectomy, the risks and possible complications are also discussed. Key words: Anterior clinoid process, anterior clinoidectomy, cavernous sinus meningiomas, intracranial internal carotid artery, paraclinoid carotid aneurysms J Nervous Sys Surgery 2014; 4(1):1-8 internal Karotid Arterin Paraklinoid Segmentine Cerrahi Yaklaşım: Teknik derlemeParaklinoid karotid anevrizmaların (karotid-oftalmik anerizma gibi) güvenli kliplenebilmesi, anterior klinoid çıkıntı (AKÇ), anterior kavernöz sinüs ve orbital apeks duvarı tümörlerinin cerrahi tedavilerinin yapılabilmesi için, internal karotid arterin paraklinoid segmentine cerrahi yaklaşım çok önemlidir. Anterior klinoidektomi internal karotid arterin (İKA) paraklinoid segmentine cerrahi yaklaşımda çok faydalıdır. Anterior klinoidektomi yapıldıktan sonra kazanılan geniş cerrahi alan, daha az beyin retraksiyonu yapılmasına izin verir, intrakranial İKA'nın ve optik sinirin mobilizasyonunu arttırır. Bu yazıda, yazarlar internal karotid arterin anatomisini ve değişik segmentlerini anlatıyor. Anterior klinoid çıkıntının anatomisi ve internal karotid arter ile ilişkisi gözden geçiriliyor. Anterior klinoidektominin temel prensipleri, riskleri ve komplikasyonları tartışılıyor.Anahtar kelimeler: Anterior klinoid çıkıntı, anterior klinoidektomi, kavernöz sinüs meninjiyomları, intrakranial internal karotid arter, paraklinoid karotid anevrizma J Nervous Sys Surgery 2014; 4(1):1-8
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