The present study compared the effects of anesthesia induction with sevoflurane and propofol on hemodynamics, P-wave dispersion (Pwd), QT interval and corrected QT (QTc) interval. A total of 72 adult patients were included in this prospective study. All patients had control electrocardiograms (ECGs) before anesthesia induction. Anesthesia was induced with sevoflurane inhalation or intravenous propofol. Electrocardiography for all patients was performed during the 1(st) and 3(rd) minutes of induction, 3 minutes after administration of muscle relaxant, and at 5 minutes and 10 minutes after intubation. Pwd and QT intervals were measured on all ECGs. QTc intervals were determined using the Bazett formula. There was no significant difference in Pwd and QT and QTc intervals on control ECGs. In the sevoflurane group, except for control ECGs, Pwd and QTc interval on all ECGs were significantly longer than those in the propofol group (p < 0.05). We conclude that propofol should be used for anesthesia induction in patients with a predisposition to preoperative arrhythmias, and in those whose Pwd and QTc durations are prolonged on preoperative ECGs.

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The aim of this study is to evaluate antibiotic susceptibilities, emm gene types, toxin gene profiles and clonal relatedness of group A streptococci (GAS) isolates obtained from patients and carriers. A total of 79 clinical isolates from patients and 60 isolates from carriers were included in the study. Emm typing, toxin gene detection for speA, speB, speC, speG and smeZ genes and pulsed-field gel electrophoresis (PFGE) was performed. Twenty-one distinct emm types were detected; the most common types were emm12, emm89, emm1, emm77, emm4 and emm3. The detection rates of both emm types and the toxin genes didn't differ significantly between patients and carriers. The presence of speA and smeZ was significantly higher in emm1 and speG was significantly lower in emm4 when compared to the other emm types. The rate of clustering obtained with PFGE wasn't significantly different in patients and carriers. As a result, twelve of the 21 emm types detected in this study were covered by the 26-valent vaccine, constituting 77.7% of the emm typeable isolates; however the emm4 type which is one of the most common types in the present study is not among this coverage.

A Bullous Pilomatricoma Developed after Hepatitis A VaccinationThe Editor, Sir, Pilomatricomas originate from hair matrix cells and usually appear as firm, solitary and asymptomatic nodules beneath the skin. These tumours occur mostly in children. They are generally located on the face and neck (1). Bullous pilomatricoma is an uncommon lesion and only few cases of this variant have been reported in the literature (1, 2). We report a 7-year old girl with a pilomatricoma showing bullous appearance. The patient suffered from a dome shaped, bullous mass on the left arm. The 1.5 × 1.5 cm lesion presented one month previously and progressively enlarged. In the history of the patient, there was a hepatitis A vaccination to the same area with the bullous lesion, about four months earlier. Two days after the vaccination, severe inflammation occured in the same region. The patient did not have any family history of such or mechanical trauma. On dermatologic examination, a dome shaped, red-brown coloured, semi-translucent bullae was noted (Fig. 1A).The bullae collapsed inward with palpation and a firm, small, painless mass was felt at the bottom of the lesion. When the lesion was pressed with the tip of a pen, it had a wrinkledatrophic appearance (Fig. 1B). The other physical and systemic examination findings were normal and there was no lymphadenopathy. Routine haematological and biochemical examinations of the patient were within the normal limits. With dermatoscopy, red-coloured tortuous small vessels on an irregular white opacity, which settled on a livid-red background, were observed (Fig. 1C).Needle aspiration material of the bullae was haemorrhagic and its microbiological culture was sterile. With these findings, the diagnosis of the lesion was made as a "bullous pilomatricoma". The mass was totally removed with surgical excision. On histopathological examination, the tumour nests were composed of eosinophilic shadow cells, basophilic cells and surrounded by a fibrous capsule in the deep dermis. Calcium salt depositions were observed in the tumour mass. In the superficial dermis, marked lymphoedema and increased numbers of dilated lymphatics filled with eosinophilic lymph fluid were observed (Fig. 2). Bullous pilomatricoma is a very rare form of pilomatricoma (3). Their incidence is between 3% and 6% (1). Although pilomatricomas can be associated with other genetic disorders such as myotonic dystrophy and Gardner's syndrome, the bullous variant is not associated with these syndromes (2). The bullous lesions are located mostly in the shoulder and upper extremity and predominantly in females. They are usually asymptomatic lesions (1, 2). Clinical characteristics reported include semi-transparent, erythematous, bluish or skin-coloured, heavily folded or striae-like, flaccid blisters overlying a solitary, firm-to-hard nodule (2, 4). Mechanical irritations such as continuous mechanical stimulation, scratching and pinching trauma and continuous pressure play an important role in the development of bullous pilomatricomas ...

Introduction In the current literature, several studies show that PAS (pulmonary artery stiffness) is associated with RV (right ventricular) dysfunction, PAH (pulmonary arterial hypertension), and disease severity in subjects with structural cardiac disease, HIV (human immunodeficiency virus), and chronic lung disease. Hence, our main aim was to use PAS to show the early changes in the pulmonary vascular region in subjects with cirrhosis. Material and Methods In this prospective cross‐sectional study, 39 subjects who were being followed up with cirrhosis and 41 age‐ and sex‐matched healthy subjects were included in this study. For each case, the PAS value was obtained by dividing mean peak velocity of the pulmonary flow by the PfAT (pulmonary flow acceleration time). Results The measured PAS was 23.62 ± 5.87 (Hz/msn) in cirrhotic participants and 19.09 ± 4.16 (Hz/msn) in healthy cases (P < .001). We found a positive statistical significance between PAS and RVSP (right ventricle systolic pressure)/sPAP (systolic pulmonary arterial pressure) (r = .395; P = .013). PAS was an independent predictor that was associated with cirrhosis disease according to multivariate LR (logistic regression) analysis (OR: 1.209; 95% CI: 1.059–1.381; P = .005). Conclusion Based on the study results, we consider that PAS may help in the early detection of findings in the pulmonary vascular area, even if the RV function findings or sPAP is within the normal range.