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von Recklinghausen disease is a type I neurofibromatosis originating from the nervous system. In this syndrome, there is abnormal deposition of neural tissue in the nervous system, endocrine system, visceral structures, and skin. We report the anesthetic management of a 31-year-old female patient with multiple thorax deformities who was diagnosed as von Recklinghausen disease. The patient was admitted to the Plastic and Reconstructive Surgery Department because of a huge subcutaneous neurofibroma on her right upper extremity. General anesthesia was considered a high risk for this patient on the basis of her laboratory results and physical findings. We planned brachial plexus block with axillary approach under sedation. The subcutaneous neurofibroma was not in contact with the nerve sheath; thus, regional anesthesia was our preference for this particular patient. The anesthetic management of this patient was satisfactory and uneventful, and there were no complications.

Introduction: The aim of the present study was to asses the effects of sevoflurane and desflurane as inhalational anaesthetics on heart rate variability, dysrhythmias, QT interval and QT dispersion in patients who will undergo laporoscopic cholecystectomy under general anaesthesia. Material and Methods: 34 patients who will undergo elective laparoscopic cholecystectomy are enrolled in the study. The patients were monitored with Holter device 15 minutes before the anaesthesia induction till 30 minutes in recovery room. Anaesthesia was induced using 4-7 mg kg-1 thiopental sodium, l ?g kg -1 fentanyl and 1 mg kg-1 vecuronium for muscle relaxation. Cases were randomized into 2 groups; Group 1 Sevoflurane, Croup 2 Desflurane. End tidal CO2, O2, N2O were monitorized and ventilation were maintained to Keep EtCO2 between 30-40 mmHg. Minimum, maximum, mean heart rates and heart rate variability parameters included low frequency (LF), high frequency (HF) values which are heart rate variability Parameters, LF/HF ratio, Global Sympathetic Index (GSI), R-R intervals were measured in preoperative, intraoperative periods and 2 nd, 10th and 30th minutes after extubation. Atrial and ventricular dysrhythmias (AES, VES) were determined. QT interval was corrected using Bazett's formula (QTc=QT?RR). QT dispersion was calculated by finding shortest and longest QT interval. Results: Assessing data from Holter Monitor maximum heart rates values were significantly higher in Desflurane group (p=0.049). LF/HF ratio, GSI values were higher in Desflurane group in perioperative period except in induction-extubation events. Maximum R-R intervals in Sovoflurane group in perioperative period were significantly higher. In desflurane group QT intervals were significantly longer and QT dispersion was significantly more frequent. Positive correlation between sympathetic tonus increase and YES was recognized in both groups. Conclusion: In this study sympathetic activation was frequently seen in desflurane group, Severe dysrhythmias did not occur in both groups. Although both desflurane and sevoflurane increased the rate of QT, the increased of QTc and QTd in desflurane anesthesia were significantly higher than sevoflurane anesthesia.

Background and Goal of Study: After the removal of exhaled CO2, rebrcathing of 50% or more of exhaled gases is possible during low flow anaesthesia. The purpose of this study is to compare the thoracic electrical bioimpedancc (TEB) method for hcmodynamic monitoring under low flow and high flow desfluranc anaesthesia. Material and Methods: After Institutional Ethics Committee approval, 40 ASA I-II patients scheduled for elective surgery were included into the study. For all patients, anaesthesia was induced with 1.5 ?g kg-1 fentanyl and 5-7 mg kg-1 thiopcnthal. The trachea was intubated after 0,1 mg kg-1 vecuronium, Patients were randomly divided into two groups to receive low flow (1 L min-1 50% N2O+O2) in group I or high flow (4 L min-1 50% N2O+O2) in group II with 4-6%. Ejection fractions (EF), end-diastolic indexes (EDI), cardiac indexes (CI), stroke indexes (SI) were monitored and recorded with noninvasivc TEB for basal, induction, intubations and 15 min. intervals. The level of anaesthesia was adjusted by the concentration of dnsflurane to achieve a target BIS in the range of 40-60. Postoperative Aldrete Recovery Score (ARS) was recorded. Student-t test and repeated measures of variance were used to statistical analysis. p

Objective: The aim of this study was to assess the effectiveness of preloading with crystalloid and colloid fluids on hypotension following spinal anaesthesia. Method: One hundred ASA Class I-II patients were randomly assigned to the study and divided into five groups. Group I: Lactated Ringer (LR) 1000 mL 30 minutes before spinal anaesthesia, Group II: HES %6 500 mL solution before the procedure, Group III: 500 mL RL before and HES %6 250 mL within 15 minutes after the procedure. Group IV and Group V received RL 500 mL + 500 RL mL, and HES %6 250 mL + HES %6 250 mL respectively, using the same timing protocol. Systolic, diastolic and mean arterial pressures and heart rates were measured at 1 minute intervals in the first 20 minutes and then every 5 minutes. Results: With the exception of the differences in diastolic blood pressures at the 2nd, 3rd, and 5th minutes, there was no difference in arterial blood pressures and heart rates between Group III and IV or Group IV and V. Conclusion: While significant correlation was found between spinal block level and the incidence of spinal hypotension, no difference was observed regarding the type, dosage, and timing of loading solutions before spinal anaesthesia.

Combined sciatic-femoral nerve block was performed in a 48-year-old woman for the removal of a right lateral malleolar lesion. The patient became unconscious at the 12th minute of the block. As vital signs were stable and no additional complication was seen, the operation was carried out and completed. The patient began to respond to painful stimulus, and was conscious and fully oriented. 95 and 135 minutes after the block respectively. Although the patient's symptoms were not consistent with classical central nervous system toxicity, relatively high dose of lidocaine used, and coexistence of anemia, occurrence of muscular twitching which could be related to seizure activity, and the treatment of this twitching with a small dose of midazolam were thought to indicate toxicity.

Introduction: A 42 year- old man with adult policystic renal disease admitted to Urology out-patient with men hemospermia without any other symptoms. Result: After detailed evaluation including transrectal ultrasonography (TRUS) and specific and nonspecific cultures, multiple seminal vesicle cysts were detected. After treatment with anti-inflammatory and antiboitics, hemospermi was resolved and did not recurrence in 6 months follow up.

Adult polikistik böbrek hastalığı ile takip edilen 42 yaşında erkek hasta hemospermi yakınması ile başvurdu. Transrektal Ultrasonografi (TRUS) ve spesifik, non-spesifik kültürleri içeren detaylı değerlendirme sonrası hastada vezikülo seminalis kistleri dışında herhangi bir hemospermi nedeni saptanmadı. Anti-inflamatuar ve antibiyotik tedavisi sonrası hastanın yakınmaları düzeldi ve 6 aylık takipte hemospermi tekrarlamadı. Introduction: A 42 year- old man with adult policystic renal disease admitted to Urology out-patient with men hemospermia without any other symptoms Result: After detailed evaluation including transrectal ultrasonography (TRUS) and specific and non-specific cultures, multiple seminal vesicle cysts were detected. After treatment with anti-inflammatory and antiboitics, hemospermi was resolved and did not recurrence in 6 months follow up.

Sevoflurane, one of new inhalation agents, is metabolized to organic and inorganic fluoride metabolites. Nephrotoxicity is due to free fluoride. In this study; we investigated the renal effects of repeated and different concentrations of sevoflurane anesthesia, experimentally. Sensitive urinary indicators n-asetil-d- glukozaminidaz (NAG), alkalen phosfatase (ALP), and gamma glutamil transferase (GGT) were assessed. This study was performed in 14, male New Zelland rabbits. Rabbits were divided into two groups (n=7). Group I (n=7) received sevoflurane 1% and Group II (n=7) 3% sevoflurane with O2+N2O (4 Lmin-1) 3 hours a dayfor 3 days Urine samples were collected via a special apparatus for 24 hours preoperative and after anesthesia. Urine samples were taken five days after the last administration of anesthesia and NAG, ALP and GGT levels in urine were determined. Blood samples taken from ear veins were obtained to determine BUN and Creatine. In Group II, urinary NAG levels increased significantly on the third day and a significant increase in GGT was observed on second and third days. There was no significant change in BUN, Cre and urinary ALP. NAG and GGT levels returned to normal on the 9th day. We concluded that, the effects of repeated sevoflurane administration on renal system are temporary.

Bu çalışmada ESWL'nin hastalarda yarattığı anksiyetenin ağrı yoğunluğu üzerinde olumsuz etkisinin ortaya konması amaçlanmıştır. ASA fiziksel durum I-II 20-64 yaşları arasında (Ortalama: 39.1) 71 hasta çalışmaya alındı. Hastalar randomize iki gruba ayrıldı. Grup I'deki hastalara işlem ile ilgili ayrıntılı bilgi verilirken Grup Il'deki hastalara bilgi verilmedi. ESWL, 3.kuşak litotriptörlerden elektrohidrolik Litho3pter (PCK ) ile gerçekleştirildi. Analjezik amaçlı Fentanyl 1mugr/kg. işlemden 2 dakika önce intravenöz olarak uygulandı. Hastaların ağrı yoğunluğu işlemin birinci dakikası ve her 10 dakikada bir 0-100 mm Visuel Analog Scala (VAS) ile değerlendirildi. Durumluk ve sürekli anksiyete State/Trait Anxiety Inventory-Trait Anxiety (STAI-TA) ve State/Trait Anxiety Inventory-State Anxiety (STAI-SA) ile ölçüldü. Sürekli anksiyete skoru ile ağrı yoğunluğu arasında ilişki tespit edilmedi. Bununla birlikte STAI-TA skoru yüksek olan hastalarda ağn yoğunluğunun daha fazla olduğu gözlendi ve bu hastalarda ek analjezik ihtiyacı daha fazla oldu. işlem ile ilgili ayrıntılı bilgi verilen grupta durumluk anksiyete ve ağrı yoğunluğu skorları daha düşük bulundu. 20-29 yaş grubundaki genç kadınlarda ağn yoğunluğu daha fazla olup durumluk anksiyete düzeyleri daha yüksek olarak tespit edildi. ESWL, anksiyete yaratan bir işlemdir. Anksiyetesi daha yoğun olan hastalarda ağrı yoğunluğunun daha fazla olduğu ve bunun da hasta memnuniyetini olumsuz etkilediği düşünülmüştür. ESWL öncesi hastaya aynntılı bilgi verilmesi, genç kadınlarda daha çok ağrı ve anksiyete olabileceğinin bilinmesi ürolog için önemli avantaj yaratabilir. Introduction: To clarify the negative effect of anxiety on pain intensity in patients, who underwent Extracorporeal Shock Wave Lithotripsy (ESWL). Patients and Method: ASA physical status I and II 71 patient with the age ranging 10 to 64 were included the study. Patients divided into two groups randomly. Detailed information about ESWL session was given to the patients in Group I and patients in Group II did not receive any descriptive information. All procedures were performed by a third generation electrohydraulic Stone LithoSpter (PCK ). Intravenous fentanyl 1mugr/kg. was administered 2 minutes before the procedure for analgesic purposes. Pains intensity was evaluated by 0-100 mm Visuel Analog Scala (VAS) at the first minute and every 10 minutes of the treatment. Conditional and continual anxiety were assessed by State/Trait Anxiety Inventory-Trait Anxiety (STAI-TA), and State/Trait Anxiety Inventory-State Anxiety (STAI-SA). Results: There was no correlation between STAI-SA and pain intensity. However, patients with higher STAI-TA scores needed higher doses of supplement analgesics because of higher pain intensity. Patients, who had received information, had lower scores of STAI-TA and pain intensity. Young female patients between 20-29 years old had the highest anxiety with high pain intensity. Conclusion: ESWL is an anxiety promoting procedure. The more intense pain and anxiety negatively effected the overall patient satisfaction. Detailed information of patients about the procedure and the knowledge of pain intensity has been higher in young female patients may be advantageous for patients and care givers.

Ketamine is known as a N-Methyl-D-Aspartate (NMDA) antagonist. Purine analogues attenuate pain transmission and also act as glutamate antagonists. The aim of the present study was to determine the antiallodynic effect of adenosine A1 receptor agonist, cyclohexyladenosine (CHA) and ketamine on thermal nociception in chronic constriction injury model in the rat. The present study was constituted on 32 male Sprague Dawley rats weighing 180-220 g. The right common sciatic nerve was exposed and ligated loosely with 4/0 chromic catgut under barbiturate anaesthesia. Drugs were administered after 7th postoperative day and given through four days. Treatment protocol was two injections/day performed by a 20 min interval through intraperitoneal route. Adenosine analogues were administered as the first drug. Doses were 1 mg/kg and 10 mg/kg for CHA and ketamine respectively. Doses were reduced to half when both of drugs were combined. Nociceptive tests were performed by Hot Plate Test (HPT) at 46°C through 120 min period every 30 minutes. Initiation time of jumping and licking movements at the operated side of the rats on the HPT was determined. Motor activity were increased on animals that received ketamine. Adenosine receptor analogue CHA clearly produced antinociception. Ketamine abolished CHA induced analgesia. The results were disappointing, antagonism was observed by two class of drugs known as glutamate antagonist and can be explained by excitatory phenomenon induced by ketamine. Future studies directed at other routes may show promise.