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Adem Dirican,1 Sevket Ozkaya,2 Ali Ekber Atas,3 Esra Kayahan Ulu,4 Ilknur Kitapci,5 Ferah Ece21Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey; 2Department of Pulmonary Medicine, Faculty of Medicine, Bahçesehir University, Istanbul, Turkey; 3Department of Cardiology, Medical Park Samsun Hospital, Samsun, Turkey; 4Department of Radiology, Medical Park Samsun Hospital, Samsun, Turkey; 5Department of Intensive Care Unit, Medical Park Samsun Hospital, Samsun, TurkeyAbstract: Patients with pulmonary thromboembolism (PE) often decompensate suddenly, and once hemodynamic compromise has developed, mortality is extremely high. Currently, thrombolytic therapy for PE is still controversial. We retrospectively evaluated 34 patients with PE between January 2010 and December 2013 in the Department of Pulmonary Medicine, Medical Park Samsun Hospital, Samsun, Turkey. The demographic and disease characteristics of patients who received thrombolytic treatment were retrospectively analyzed. The female to male ratio was 19/15 and the mean age was 63.1±13.2 years. PE diagnosis was made using echocardiography (64.7%) or contrast-enhanced thorax computed tomography with echocardiography (32.4%). Twenty-two (64.7%) patients went into the cardiopulmonary arrest due to massive PE and 17 (50%) patients recovered without sequelae. Eleven (32.4%) patients were diagnosed with massive PE during cardiopulmonary arrest with clinical and echocardiographic findings. Alteplase (recombinant tissue plasminogen activator [rt-PA]) was administered during cardiopulmonary resuscitation (CPR) and four (36.3%) patients responded and survived without sequelae. The complications of rt-PA treatment were hemorrhage in five (14.7%) patients and allergic reactions in two (5.9%) patients. There was no mortality due to rt-PA treatment complications. In conclusion, mortality due to massive PE is much more than estimated and alteplase can be used safely in patients with massive PE. This thrombolytic treatment was not associated with any fatal hemorrhage complication. If there is any sign of acute PE, echocardiography should be used during cardiopulmonary arrest/instability. Alteplase should be given to patients with suspected massive PE.Keywords: massive pulmonary embolism, thrombolytic treatment, rt-PA, cardiopulmonary arrest, resuscitation, mortality, hemorrhage

Background: Ultrasonography (USG), which is used as the first step in the diagnosis of acute appendicitis (AA), sometimes cannot visualize the appendix. The aim of this study was to retrospectively analyze the clinical, imaging, and pathology results of these cases and to provide information to clinicians about the next step to be taken., Methods: The study was performed retrospectively between January 1, 2021 and December 31, 2021. Patients with a prediagnosis of AA who underwent USG as the first-line imaging modality and in whom the appendix could not be visualized were included. Imaging, clinical, and pathology results of the patients were analyzed, and the study was completed by comparing patients with and without computed tomography (CT) scans as well as patients with and without AA diagnosis., Results: The study included 176 patients aged 18-89 years, 63 (35.8%) of whom were male and 113 (64.2%) female. The mean age was 37.5 ± 17.8 years. CT was not performed in 97 patients (55.1%), while it was performed in 79 patients (44.9%). Of the patients, 121 (68.7%) were discharged and 55 (31.2%) were hospitalized. Of the patients who were hospitalized, 36 (20.5%) received medical treatment and 19 (10.7%) received surgical treatment. Fifteen patients (8.5%) were pathologically diagnosed with AA. Two patients (1.1%) who were discharged without CT were subsequently diagnosed with AA. The white blood cell (WBC) count of patients operated on for AA was 13.4 ± 3.9 × 10 3 /mL, while the WBC count of the other patients was 10.3 ± 4.2 × 10 3 /mL (p = 0.009). The proportion of patients with an Alvarado score of ≥ 6 was 80% in patients diagnosed with AA, while this rate was 4.3% in other patients (p < 0.001)., Conclusions: In cases of a nonvisualized appendix on USG, the absence of leukocytosis and an Alvarado score below 6 may suggest a reduced likelihood of AA. Consequently, further investigations, such as CT and magnetic resonance imaging, could be avoided., (© 2024 Wiley Periodicals LLC.)

Background: This study aimed to elucidate the diagnostic significance of changes in periappendiceal fat density observed on computed tomography (CT) in patients with acute appendicitis (AA)., Methods: Patients who underwent surgery with a diagnosis of AA based on CT findings from January 1, 2020 to December 31, 2020 were included in the study. Patients were divided into three grades. In Grade 1, the periappendiceal tissue appears hypoechoic, indicative of normal tissue. In Grade 2, the periappendiceal tissue is slightly hyperechoic but confined to the periappendiceal area. In Grade 3, dense hyperechoic areas are present not only in the periappendiceal tissue but also extend into surrounding organs and deeper tissues. The groups were compared in terms of clinical, laboratory, and pathological outcomes., Results: A total of 195 patients-131 males and 64 females-were included in the study. A correlation was identified between grade and several factors: appendix diameter, appendix wall thickness, incidence of lymphadenopathy, and duration of symptoms onset (p<0.001). Conditions such as appendicolitis, free air, and intra-abdominal abscesses were more frequently observed in Grade 3 patients compared to Grade 1 and Grade 2 patients (p=0.002, p<0.001). Both operative time and length of hospital stay were highest in Grade 3 patients (p<0.001). The rate of patients found to have a normal appendix upon pathological examination was significantly higher in Grade 1 than in Grade 2 (p=0.03)., Conclusion: In cases where the diagnosis is uncertain, the hyperechogenicity in periappendiceal tissue observed on CT strengthens the diagnosis of AA. Additionally, cases of AA become increasingly complex as echogenicity in periappendiceal tissue increases.

Objective: Heart failure (HF) is a growing public health problem with high morbidity and mortality. Recently, angiotensin receptor neprilysin inhibitor (ARNi) has emerged as a promising treatment for HF with reduced ejection fraction (HFrEF). Here, we shared our experience with the use of ARNi in HFrEF from multiple centers in Turkey., Methods: The ARNi-TR is a multicenter, noninterventional, retrospective, observational study. Overall, 779 patients with HF from 22 centers in Turkey who were prescribed sacubitril/valsartan were examined. Initial clinical status, biochemical and echocardiographic parameters, and New York Heart Association functional class (NYHA-FC) values were compared with follow-up values after 1 year of ARNi use. In addition, the effect of ARNi on number of annual hospitalizations was investigated, and the patients were divided into 2 groups, depending on whether ARNi was initiated at hospitalization or under outpatient clinic control., Results: N-terminal pro-brain natriuretic peptide (NT-proBNP), left-ventricle ejection fraction (LV-EF), and NYHA-FC values improved significantly in both groups (all parameters, p<0.001) within 1-year follow-up. In both groups, a decrease in hemoglobin A1c (HbA1c) values was observed in ARNi use (p<0.001), and a decrease in daily diuretic doses and hospitalizations owing to HF were observed after ARNi use (all comparisons, p<0.001). Hypotension (16.9%) was the most common side effect in patients using ARN., Conclusion: The ARNi-TR study offers comprehensive real-life data for patients using ARNi in Turkey. The use of ARNi has shown significant improvements in FC, NT-proBNP, HbA1c levels, and LV-EF. Likewise, reductions in the number of annual hospitalizations and daily furosemide doses for HF were seen in this study.

Inadequate expansion of coronary stents is associated with stent thrombosis in early stage and with stent restenosis in later stages. Postdilatation (postD) performed using non-compliant balloons improves stent expansion. However, use of this ballooning strategy in primary percutaneous coronary intervention (PPCI) has not been evaluated adequately. Patients who presented with ST segment elevation myocardial infarction (STEMI) and underwent PPCI were included in the present study. Patients were randomized into two groups as those for whom postD was performed (n=62) and those for whom postD was not performed (n=62). Coronary blood flow was evaluated using the thrombolysis in myocardial infarction (TIMI) flow and TIMI frame count (TFC). Total of 124 patients with STEMI were included in the study. There was no difference with respect to baseline TIMI flow, culprit coronary artery and MI localization. However, slow-reflow rate (14.5% vs 35.5%, p=0.007) and final corrected TFC (28.9±16.9 vs 37.0±23.1, p=0.028) were significantly higher in the postD group. Multivariate regression analysis showed postD as an independent variable for slow reflow (OR 11.566, 95% CI 1.633 to 81.908, p=0.014). In our study, routine postD during PPCI was found to be associated with an increased risk of slow reflow in patients without angiographic stent expansion problems., Competing Interests: Competing interests: None declared., (© American Federation for Medical Research (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)