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Amaç: Preanalitik hataları azaltmak amacı ile yapılan eğitimin ve Laboratuvar Bilgi Sistemi ile tüp barkotlama sisteminde yapılan teknolojik yeniliklerin etkisini ortaya koymak çalışmamızda amaçlanmıştır.Gereç ve Yöntem: İyileştirmelerin sonuçlarını değerlendirmek için 2013 ve 2014 yıllarına ait preanalitik hatalar Laboratuar Bilgi Sisteminden (LBS) geriye dönük olarak alınmıştır. Preanalitik faz için on kalite indikatörü hesaplanmıştır. İyileştirme yapılmış yıl ile geçmiş yıl karşılaştırılmıştır. Kabul edilemez, minimum, kabul edilebilir ve optimal olmak üzere dört kalite spesifikasyon ölçütü tanımlanmıştır.Bulgular: İyileştirme çalışmalarından sonra tüm preanalitik hata tiplerinde azalma görülmüştür. Kalite indikatörleri spesifikasyon ölçütü olarak değerlendirildiğinde, 2013 yılında QI-14 (taşıma sırasında hasarlanmış örnekler) ve QI-16 (yanlış saklanan örnekler) kabul edilemez, QI-8 (kayıp örnekler) ve QI-12 (yetersiz hacimli örnekler) minimum ve QI-9 (yanlış kaptaki örnekler) kabul edilebilir iken, 2014 yılında tümünün optimal düzeyde olduğu görülmüştür. QI-15 (hatalı etiketlenmiş örnekler) kabul edilebilir iken 2014 yılında kabul edilemez olarak değerlendirilmiştir. QI-10a, b (hemolizli örnekler), 11a (pıhtılı örnekler) ve 13 (yetersiz hacimli örnekler-antikoagülanlı tüplerde) her iki yılda da optimal düzeyde değerlendirilmiştir.Sonuçlar: Preanalitik faz ile ilgili eğitimlerin sürekliliğinin sağlanması ve teknolojik alt yapının güçlendirilmesi bu evrenin kontrolünü sağlayacak temel faktörlerdir Background and objective: We aimed to investigate the effect of “training about the pre-analytical phase” and “technological arrangements in laboratory information systems (LISs) and tube barcoding system”, on decreasing PEs.Materials and methods: PEs in 2013 and 2014 were obtained from the LIS retrospectively in order to evaluate the effect of improvements. Ten quality indicators (QIs) described for pre-analytical phase were calculated. We compared QIs of the “improved year” with the past year. Four quality specification criteria were defined as “ unacceptable”, “minimum”, “desirable” and “optimum” for each quality indicator.Results: There was a reduction in all types of PEs related to the improvement strategies. When QIs were considered as quality specifications (QSs), QI-14 (number of samples damaged in transport) and QI-16 (samples improperly stored) were “unacceptable”, QI-8 (samples lost-not received) and QI-12 (samples with insufficient sample volume) were “minimum” and QI-9 (samples collected ininappropriate container) was “desirable” in 2013; QI-10a, 10b (samples hemolyzed), 11a (samples clotted) and 13 (samples with inadequate sample-anticoagulant) were all “optimum” in 2 years. Conclusion: It was shown that continuous education on pre-analytical phase and improvements of the technological infrastructures are the main factors that will enable the control of this phase.

The aim of this study was to determine the frequency of haemostatic abnormalities in women with menorrhagia and to evaluate their effect on quality of life (QoL). The study population was composed of patients with menorrhagia seen in the outpatient clinic, having a score of >185 with a pictorial blood assessment chart. Structured questionnaires were used in the assessment of demographic characteristics and QoL, and patients were tested for bleeding disorders. Ninety women were recruited for the study. Bleeding disorders were detected in 40% of them: 11.1% had von Willebrand disease, 2.2% had low von Willebrand factor and 26.7% had platelet function disorders (PFD). In 22 (91.6%) cases with PFD the, defect was non-specific and impaired aggregation response to ristocetine (37.5%) was the most commonly detected problem. Bleeding disorders were not associated with any significant reduction in QoL (p >.05). Hereditary bleeding disorders may be the cause of unexplained menorrhagia even in the middle-aged women, but they had no prominent effect on QoL. © 2016 Informa UK Limited, trading as Taylor & Francis Group.

Background: In 2010, the EUPHAS 2 collaborative group created a registry with the purpose of recording data from critically ill patients suffering from severe sepsis and septic shock treated with polymyxin-B hemoperfusion (PMX-HP) for endotoxin removal. The aim of the registry was to verify the application of PMX-HP in the daily clinical practice. Methods: The EUPHAS 2 registry involved 57 centers between January 2010 and December 2014, collecting retrospective data of 357 patients (297 in Europe and 60 in Asia) suffering from severe sepsis and septic shock caused by proved or suspected infection related to Gram negative bacteria. All patients received atleast one cycle of extracorporeal endotoxin removal by PMX-HP. Results: Septic shock was diagnosed in 305 (85.4%) patients. The most common source of infection was abdominal (44.0%) followed by pulmonary (17.6%). Gram negative bacteria represented 60.6% of the pathogens responsible of infection. After 72h from the first cycle of PMX-HP, some of the SOFA score components significantly improved with respect to baseline: cardiovascular (2.16±1.77 from 3.32±1.29, p&nbsp

Hemophilia B is a recessive X-linked bleeding disorder characterized by deficiency of the coagulation factor IX (FIX). In hemophilia B patients the severity of the bleeding phenotype is related to the degree of the FIX defect. Hemophilia B treatment has improved greatly in the last 20 years with the introduction first of plasma-derived and then of recombinant FIX concentrates. Replacement therapy may be administered through on-demand or prophylaxis regimens, but the latter treatment modality has been shown to be superior in prevention of hemophilic arthropathy and in improvement of patients' quality of life. The purpose of this narrative review is to summarize the current knowledge on treatment strategies for hemophilia B, focusing on recombinant FIX products either clinically used or in development. There is only one rFIX product that is licensed to treat hemophilia B patients; from the analysis of the literature data presented in this review, the authors conclude that this rFIX product has demonstrated an excellent safety profile and excellent clinical efficacy for halting and preventing bleeds in hemophilia B patients. While prophylaxis has emerged as the best therapeutic strategy for such patients because of its ability to prevent hemophilic arthropathy and to improve patients' quality of life, the pharmacokinetically tailored dosing of rFIX is another key point when planning hemophilia B treatment, as it allows optimization of the factor concentrate usage. Further clinical studies are needed to better assess the safety and efficacy (ie, the incidence of adverse reactions and inhibitor development) of newer rFIX products.

Purpose: To describe 5 pediatric patients with traumatic orbital subperiosteal hematoma and review the relevant literature. Methods: Retrospective chart analysis of 5 children with posttraumatic subperiosteal hematoma and a systematic review of the English language literature. Results: Five new pediatric cases of orbital subperiosteal hematoma are presented with varying clinical and radiologic manifestations and treatments. Literature review (including the current 5 cases) yielded 23 cases in total. Eighteen (78%) of the patients were boys, and 5 (22%) were girls. The children ranged in age from 5 to 17 years, with the mean and median ages being 12 years. The leading cause was blunt trauma related to falls or direct impact. Two patients (9%) had an inherited coagulopathy, predisposing them to orbital hemorrhage. The hematomas developed in the superior orbit in all cases except one. In 3 patients (13%), orbital hematomas were bilateral. In 9 patients (39%), the hematomas extended in subgaleal or frontal subdural spaces. In 7 patients (30%), subperiosteal hematoma was associated with compressive optic neuropathy. Four patients (17%) had a nondisplaced orbital roof fracture. Seventeen patients were treated with surgical evacuation of hematoma (52%) or with needle aspiration (22%), and 5 patients (22%) were observed for spontaneous resolution. Three patients (13%) experienced a recurrence of hemorrhage. Conclusions: In children, traumatic subperiosteal hematomas of the orbit typically occur after blunt trauma in the superior orbit. The risk of compressive optic neuropathy may be higher in patients with bilateral hematoma and massive subgaleal hematoma. Most patients are treated with evacuation of the hematoma.

Currently the treatment mainstay of sepsis is early and appropriate antibiotic therapy, accompanied by aggressive fluid administration, the use of vasopressors when needed and the prompt initiation of measures to support each failing organ. Activated protein C and hydrocortisone, when used accordingly can affect mortality. As the pathophysiologic events that take place during sepsis are being elucidated, new molecules that target each step of those pathways are being tested. However, a lot of those molecules affect various mediators of the sepsis cascade including inflammatory cytokines, cellular receptors, nuclear transcription factors, coagulation activators and apoptosis regulators. Over the last decade, a multitude of clinical trials and animal studies have investigated strategies that aimed to restore immune homeostasis either by reducing inflammation or by stimulating the innate and adaptive immune responses. Antibiotics, statins and other molecules with multipotent immunomodulatory actions have also been studied in the treatment of sepsis. © 2011 Expert Reviews Ltd. 9 11 1013 1033

Gangrene presenting at birth is a rare clinical problem; it results from diminished perfusion of a part of the body, usually the extremities. A variety of aetiological factors may account for this situation. Arterial thrombosis, emboli, trauma, congenital heart disease, sepsis, coagulopathy, polycythaemia, congenital bands, and birth trauma are some of the causes which should be considered. In the majority of cases, an aetiological factor is not identified. The management of neonatal gangrene is usually conservative, preventing infection of the affected part and allowing the gangrenous portion to declare itself in order to optimise future reconstruction and rehabilitation. In this paper, two cases of newborn with gangrene of an upper extremity are reported.

A case of mushroom poisoning by false morel, Gyromitra esculenta (Pers.) Fr. (Ascomycetes), in Denizli, Turkey, is reported and documented. A short description of the taxon, case of poisoning, and taxonomic discussions of G. esculenta is presented. © 2009 by Begell House, Inc.

Nontraumatic primary intraventricular hemorrhage (PIVH) is characterized by direct bleeding into the neuroventricular system. A very rare condition, PIVH accounts for 3% of all spontaneous intracerebral hemorrhages. Hypertension is a major cause of PIVH. Reports about PIVH in the literature are infrequent and it appears to be a relatively benign condition. Between 1998 and 2001, 15 patients with PIVH were evaluated in the Departments of Neurosurgery of Yüzüncü Yil and Pamukkale Universities; their prognosis and results of treatment with external ventricular drainage (EVD) were recorded. The diagnosis was established easily and rapidly with computed tomography. Prognoses of the patients were made by the Glasgow Coma Score (GCS). Hypertension was the most common etiology (n=9, 60%); the prognosis for survivors (73.3%) was good (mortality, 26.6%). Elderly patients, who scored low on the GCS, and patients with coagulopathy had poor prognoses. All patients with PIVH underwent surgery with EVD within 24 hours of their hospital admission. Applying EVD had positive results and influenced the prognosis and early and late complications of PIVH accordingly. ©2005 Health Communications Inc.

S-1 is a new oral fluorinated pyrimidine derivate, in which the oral 5-fluorouracil (5-FU) prodrug, tegafur, was combined with two 5-FU-modulating substances, 5-chloro-2,4-dihydroxypyridine (gimeracil), and potassium oxonate (oteracil), at a molar ratio of 1:0.4:1. The final mechanism of action is exerted by 5-FU. The present study is the first European phase II trial of S-1 in gastric cancer. The primary study objectives were the safety, toxicity and activity of S-1 in non-pretreated patients with gastric cancer. The secondary objective was the duration of response. Patients had to have histologically- or cytologically-verified metastatic or locally advanced, unresectable gastric cancer; S-1 was administered orally twice daily at 40, then 35 mg/m2 for 28 days every 5 weeks. The starting dose of 40 mg/m2 was found to be intolerable due to significant non-haematological toxicity, and this dose was rapidly reduced to 35 mg/m2 twice daily. Of the 7 patients enrolled at the 40 mg/m2 level, only 3 were evaluable. At 35 mg/m2, a response rate of 26.1% (95% Confidence Interval (CI) 12.0-45.1%) in 23 enrolled patients, and 31.6% (C.I. 14.7-53.0%) in 19 evaluable patients according to an independent radiology review, was found. The median duration of response at 35 mg/m2 (6 patients) was 223 days (range, 108-828 days), and of stable disease was 111 days (range 68-411 days). S-1 can be administered with an acceptable safety and toxicity in European patients at a dose of 35 mg/m2 days 1 - 28 every 5 weeks and is associated with a moderate response rate similar to the results achieved with other fluoropyrimidines. © 2003 Elsevier Science Ltd. All rights reserved. 39 9 1264 1270