Epistaxis, active bleeding from the nose, is a common ear nose and throat emergency, and can be severe or even fatal. We report a severe life threatening recurrent massive nasal bleeding caused by intranasal heroin use that has not hitherto been reported in the English literature. A 24-year-old male who took heroin several times nasally presented with massive nasal bleeding. A blood transfusion and an operation to halt nasal bleeding were required. The patient did not experience a bleeding attack 2 months following cessation of nasal heroin use.
Blood Transfusion ; Ear ; Emergencies ; Epistaxis ; Hemorrhage ; Heroin ; Humans ; Male ; Nose ; Pharynx ; Young Adult

Antrochoanal polyps (ACPs) are benign polypoid lesions arising from the maxillary antrum and they extend into the choana. They occur more commonly in children and young adults, and they are almost always unilateral. The etiopathogenesis of ACPs is not clear. Nasal obstruction and nasal drainage are the most common presenting symptoms. The differential diagnosis should include the causes of unilateral nasal obstruction. Nasal endoscopy and computed tomography scans are the main diagnostic techniques, and the treatment of ACPs is always surgical. Functional endoscopic sinus surgery (FESS) and powered instrumentation during FESS for complete removal of ACPs are extremely safe and effective procedures. Physicians should focus on detecting the exact origin and extent of the polyp to prevent recurrence.
Child ; Diagnosis, Differential ; Drainage ; Endoscopy ; Humans ; Maxillary Sinus ; Nasal Obstruction ; Polyps ; Recurrence ; Young Adult

No abstract available.
Aged ; Aged, 80 and over ; Blood Platelets/*cytology ; Chronic Disease ; Female ; Fractures, Bone/diagnosis ; Hemoglobins/analysis ; Hip Fractures/*diagnosis ; Humans ; Male ; *Mean Platelet Volume ; Risk Factors

BACKGROUND AND OBJECTIVES: Balloon sizing remains the main technique for determining occluder device size for atrial septal defects (ASDs). New evidence has proposed that accurate estimation of device size could be possible without using the balloon technique. Operators have predicted the amount of possible enlargement depending on their experiences. Thus, selection criteria have mostly relied on personal observations and experiences. The objective of this study was to determine the relationship between age, sex, defect size, and deployed device size based on the balloon technique. SUBJECTS AND METHODS: Sixty-six patients who underwent percutaneous ASD closure with a Cardi-O-Fix occluder between 2011 and 2012 were retrospectively evaluated. Patients whose maximum defect size and device size were available were included. Enlargement amount (EA) (device size−defect size) and enlargement ratio (ER) (EA/defect size) were calculated. The relationship between these 2 calculations and age, sex, and defect size were analyzed. RESULTS: EA and ER were 5.2±3.6 mm (min: 0, max: 15, median: 5) and 39.3%±31.5% (min: 0, max: 125, median: 32), respectively. EA and ER did not differ between genders (p=0.800; p=0.430). EA and ER were not correlated with maximum defect size (p=0.310; p=0.050). EA and ER showed no correlation with age (p=0.970; p=0.640). However when patients were dichomotized based on age 40, ER was significantly lower in older group (p=0.030). Unexpectedly, no difference was observed between the 2 groups in terms of EA (p=0.110). Size of deployed device had a strong correlation with defect size measured with two-dimensional (2D) transesophageal echocardiography (TEE; device size=1.1177×TEE defect size+3.5297; R=0.84; p<0.010). CONCLUSION: EA and ER did not show a significant correlation with sex and defect size in our study. Patients older than 40 had a significantly lower ER compared to younger patients. Device size was strongly correlated with defect size measured with TEE.
Aged* ; Echocardiography ; Echocardiography, Transesophageal ; Heart Defects, Congenital ; Heart Septal Defects, Atrial* ; Humans ; Patient Selection ; Retrospective Studies

No abstract available.
Endometriosis ; Female ; Hernia, Inguinal ; Humans ; Male

AIMTo examine the effects of melatonin treatment on lipid peroxidation (LPO) and the activities of antioxidant enzymes in the testicular tissue of streptozotocin (STZ)-induced diabetic rats.

METHODSTwenty-six male rats were randomly divided into three groups as follows: group I, control, non-diabetic rats (n = 9); group II, STZ-induced, untreated diabetic rats (n = 8); group III, STZ-induced, melatonin-treated (dose of 10 mg/kg . day) diabetic rats (n = 9). Following 8-week melatonin treatment, all rats were anaesthetized and then were killed to remove testes from the scrotum.

RESULTSAs compared to group I, in rat testicular tissues of group II , increased levels of malondialdehyde (MDA) (P < 0.01) and superoxide dismutase (SOD) (P < 0.01) as well as decreased levels of catalase (CAT) (P < 0.01) and glutathione peroxidase (GSH-Px) (P > 0.05) were found. In contrast, as compared to group II, in rat testicular tissues of group III, levels of MDA decreased (but this decrease was not significant, P > 0.05) and SOD (P < 0.01) as well as CAT (P < 0.05) increased. GSH-Px was not influenced by any of the treatment. Melatonin did not significantly affect the elevated glucose concentration of diabetic group. At the end of the study, there was no significant difference between the melatonin-treated group and the untreated group by means of body and testicular weight.

CONCLUSIONDiabetes mellitus increases oxidative stress and melatonin inhibits lipid peroxidation and might regulate the activities of antioxidant enzymes of diabetic rat testes.

Animals ; Catalase ; metabolism ; Diabetes Mellitus, Experimental ; metabolism ; Glutathione Peroxidase ; metabolism ; Lipid Peroxidation ; Male ; Malondialdehyde ; metabolism ; Melatonin ; pharmacology ; Rats ; Rats, Sprague-Dawley ; Reference Values ; Superoxide Dismutase ; metabolism ; Testis ; drug effects ; metabolism

INTRODUCTIONThis study aimed to determine the incidence and risk factors of infections among patients admitted to intensive care units (ICUs) in tertiary care hospitals in Turkey.

METHODSAdult patients who were admitted to the ICUs of five tertiary care hospitals for over 48 hours between June and December 2007 were monitored daily. Potential risk factors such as age, gender, comorbidities, diagnosis at admission, severity of disease (Acute Physiology and Chronic Health Evaluation II scores), exposure to antibiotics, history of invasive procedures and significant medical interventions were evaluated. A multivariate analysis of these risk factors was carried out using Cox regression.

RESULTSA total of 313 patients with a median ICU stay of 12 days were selected for the study. 236 infectious episodes (33.8/1,000 ICU-days) were diagnosed among 134 patients (42.8/100 patients) in this group. Multivariate analysis revealed that exposure to a cephalosporin antibiotic (hazard ratio [95% confidence interval] 1.55 [1.10-2.19]) was an independent risk factor, whereas having a tracheostomy cannula (0.53 [0.36-0.81]) or nasogastric tube (0.48 [0.33-0.70]) was protective. Patients admitted to the ICUs from surgical wards were significantly more exposed to cephalosporins.

CONCLUSIONICU-associated infections, which are quite high in Turkey, are largely due to inadequate infrastructure and facilities and understaffing. Abuse of antibiotics, particularly in patients who have undergone surgery, and prolonged ICU stays are significant risk factors for such infections.

Adult ; Cross Infection ; epidemiology ; Female ; Humans ; Incidence ; Intensive Care Units ; statistics & numerical data ; Length of Stay ; Male ; Multivariate Analysis ; Prospective Studies ; Risk Factors ; Tertiary Care Centers ; Turkey ; epidemiology

BACKGROUNDIn the early stages of atrial remodeling, aortic stiffness might be an indication of an atrial myopathy, in particular, atrial fibrosis. This study aimed to investigate the association between left atrial (LA) mechanical function, assessed by two-dimensional speckle tracking echocardiography, and aortic stiffness in middle-aged patients with the first episode of nonvalvular atrial fibrillation (AF).

METHODSThis prospective study included 34 consecutive patients with the first episode of AF, who were admitted to Kartal Koşuyolu Research and Training Hospital between May 2013 and October 2015, and 31 age- and gender-matched healthy controls. During the 1 st month (mostly in the first 2 weeks) following their first admission, 34 patients underwent the first pulse wave measurements. Then, 21 patients were recalled for their second pulse wave measurement at 11.8 ± 6.0 months following their initial admission. Echocardiographic and pulse wave findings were compared between these 34 patients and 31 healthy controls. We also compared the pulse wave and echocardiographic findings between the first and second measurements in 21 patients.

RESULTSPulse wave analysis showed no significant differences between the AF patients and healthy controls with respect to PWV (10.2 ± 2.5 m/s vs. 9.7 ± 2.1 m/s; P = 0.370), augmentation pressure (9.6 ± 7.4 mmHg vs. 9.1 ± 5.7 mmHg; P = 0.740), and aortic pulse pressure (AoPP; 40.4 ± 14.0 mmHg vs. 42.1 ± 7.6 mmHg, P = 0.550). The first LA positive peak of strain was inversely related to the augmentation pressure (r = -0.30; P = 0.02) and aortic systolic pressure (r = -0.26, P = 0.04). Comparison between the two consecutive pulse wave measurements in 21 patients showed similar results, except for AoPP. In 21 patients, the AoPP at the second measurement (45.1 ± 14.1 mmHg) showed a significant increase compared with AoPP at the first measurement (39.0 ± 10.6 mmHg, P = 0.028), which was also higher than that of healthy controls (42.1 ± 7.6 mmHg, P = 0.000).

CONCLUSIONThe association between aortic stiffness with reduced atrial strain and the key role of AoPP in the development of AF should be considered when treating nonvalvular AF patients with normal LA sizes.

Adult ; Atrial Fibrillation ; physiopathology ; Atrial Function, Left ; physiology ; Atrial Remodeling ; physiology ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Prospective Studies ; Vascular Stiffness ; physiology