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Introduction: The aim of the study is to detect possible gender-related differences in the semiology of psychogenic non-epileptic seizures (PNES). Methods: One hundred fifty-five patients (male: female=63:92) aged 13 to 67 years, who were diagnosed with PNES by video-monitoring electroencephalogram (EEG) between 2010 and 2017, were included in this retrospective study. Patients were grouped according to their gender. The primary semiological characteristics of PNES for each case were defined, standardized, and categorized by an epileptologist during video-monitoring EEG. The chi-square test and the Fisher exact test were used statistically. Results: An age histogram showed peaks at ages 20 to 23 and at ages 40 to 43, which were more prominent in the female gender. Whereas major motor activity (p=0.032), lateralizing motor activity (p=0.017), and opisthotonic posture and pelvic thrust motion (p=0.017) were significantly related to the male gender, weeping (p<0.001) was significantly related to the female gender. Conclusion: Our study showed that there are some semiological differences between the genders in PNES. In male patients, lateralized motor findings are more prominent and not accompanied by ictal crying in seizures, which may lead to further confusion with epileptic seizures. It is important to know the semiological characteristics for early and accurate diagnosis. [ABSTRACT FROM AUTHOR]

Background Medication-overuse headache is a common clinical entity, but neuroimaging studies investigating volumetric and microstructural alterations of the brain in medication-overuse headache are rare. Therefore, in the current longitidunal study we evaluated gray matter volume and white matter integrity in patients with medication-overuse headache before and after drug withdrawal. Methods A prospective study evaluated 27 patients with medication-overuse headache and 27 age-, sex-, and education-matched healthy adults. High-resolution T1-weighted magnetic resonance imaging and diffusion tensor imaging were obtained from the control group and medication-overuse headache patients before and six months after drug withdrawal. Tract-based spatial statistics of multiple diffusivity indices and voxel-based morphometry were employed to investigate white and gray matter abnormalities. Results No correlation was found between age, gender, education and smoking status in both groups. The most commonly overused medications were simple analgesics (96.3%) and combined analgesics (3.7%). The mean duration of the history of medication overuse and headaches was 56.7 ± 63.5 months. White matter diffusional and gray matter morphological alterations including volume, fractional anisotropy, radial diffusivity, and axial diffusivity analyses showed no significant relationship in the patients before and six months after withdrawal of analgesics. Also no difference was observed between the patients versus controls. Conclusion Our data demonstrated no structural alterations within the brain in medication-overuse headache. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the analgesic efficacy of intravenous PCA using tramadol in patients, undergoing supratentorial tumor resection with craniotomy. Material and Method: One hundred and fifty patients with ASA I-II between 18 and 70 years of age scheduled for an elective supratentorial craniotomy for tumor resection, were assigned to receive standardized general anesthesia. Postoperative pain was assessed at standard time intervals using a visual analogue scale (VAS) score. When the VAS score was >3, 1 to 1.5 mg/kg of tramadol was administered intravenously and PCA using tramadol was started. For 48 h postoperatively, the VAS, Glasgow coma, sedation, comfort, and nausea and vomiting scores were assessed. Results: During the first 48 hours, 46% of the patients needed analgesic therapy and PCA with tramadol was adequate for these patients. Most patients needed analgesic drugs at 2 hours and their mean analgesic usage was higher at that point than at other periods in the first 2 h (p<0.05). Conclusion: PCA with tramadol can be used effectively for postoperative pain management after craniotomy. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the incidence of side effects and their relation with anesthetic techniques in patient undergoing ambulatory surgery. 654 patients, ASA I-II, aged between 20 and 70 years scheduled for ambulatory surgery were enrolled into the study protocol. Patients were requested to record the existence of headache, sore throat, postoperative pain, nausea, vomiting, muscle weakness, lack of appetite, drowsiness, sleep disturbances, dizziness, dysuria, and lumbar pain during first week postoperatively. Postoperative pain was significantly higher after peripheral neural blockage. Muscle weakness, sore throat, lack of appetite, dysuria, sleep disturbances, headache, and dizziness were significantly higher after inhalational anesthesia (P<0.05). It was concluded that total intravenous anesthesia or neural blockade should be preferred for ambulatory surgery and an effective postoperative analgesic therapy should be planned before discharge. [ABSTRACT FROM AUTHOR]

During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. In this prospective, randomized study, dexmedetomidine has been used to attenuate the hemodynamic response to endotracheal intubation with low dose fentanyl and etomidate in patients undergoing myocardial revascularization receiving beta blocker treatment. Thirty patients undergoing myocardial revascularization received in a double blind manner, either a saline placebo or a dexmedetomidine infusion (1 µg/kg) before the anesthesia induction. Heart rate (HR) and blood pressure (BP) were monitored at baseline, after placebo or dexmedetomidine infusion, after induction of general anesthesia, one, three and five minutes after endotracheal intubation. In the dexmedetomidine (DEX) group systolic (SAP), diastolic (DAP) and mean arterial pressures (MAP) were lower at all times in comparison to baseline values; in the placebo (PLA) group SAP, DAP and MAP decreased after the induction of general anesthesia and five minutes after the intubation compared to baseline values. This decrease was not significantly different between the groups. After the induction of general anesthesia, the drop in HR was higher in DEX group compared to PLA group. One minute after endotracheal intubation, HR significantly increased in PLA group while, it decreased in the DEX group. The incidence of tachycardia, hypotension and bradycardia was not different between the groups. The incidence of hypertension requiring treatment was significantly greater in the PLA group. It is concluded that dexmedetomidine can safely be used to attenuate the hemodynamic response to endotracheal intubation in patients undergoing myocardial revascularization receiving beta blockers.

Chronic subdural hematomas (cSDH) are often managed with a burr-hole craniostomy and drainage, but surgery is associated with elevated mortality, morbidity, and recurrence. Despite reports of steroid use for such patients, its efficacy and feasibility are still debated. We present our patient series treated with low-dose hydrocortisone. We retrospectively reviewed data from patients treated with hydrocortisone between 2017 and 2023. Demographics, clinical and radiological data were collected. Of 27 patients identified, nine required a burr-hole craniotomy for an average volume of 120.23 cm 3 , average midline shift of 9 mm, and neurological deficits. Eighteen met the criteria for inclusion. The mean age was 78.5 years; 13 were male. None had severe symptoms requiring urgent intervention. Except for one with a Karnofsky Performance Scale score of 70, all could maintain normal activity before treatment. The mean baseline volume was 52.6 cm 3 . Midline shift, present in six, averaged 6.8 mm. Patients underwent treatment for an average of 5.15 months. Nine had complete resolution within 3 months, while nine required longer treatment, including one who needed 9 months for a re-bleed after a fall. Paired t-tests indicated significant reductions in hematoma volumes at the second week (p = 0.01), first month (p < 0.0001), and third month (p < 0.0001) of treatment. No complications occurred and the post-treatment Karnofsky scores ranged from 90 to 100. Treatment for cSDH should be tailored to the patient. Low-dose hydrocortisone is safe and effective in asymptomatic patients, those with mild to moderate symptoms, and those who are either unsuitable for or decline surgical intervention., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The objective was to demonstrate the surgical steps and outcomes of the sublabial transmaxillary microsurgical approach with endoscopic assistance to treat lesions in the inferior aspect of the orbit, as well as to describe the use of patient-specific 3D models to facilitate surgical preparation and improve experience with the technique., Methods: The authors' study evaluated data from patients who underwent an endoscope-assisted sublabial transmaxillary approach for inferior orbital lesions. For 2 patients, 3D models were created for preoperative planning and assessment of the approach. Surgical steps comprised osteotomy to access the maxillary sinus, bony resection of the orbital floor, opening of the periorbital fascia, and dissecting and removing the lesion, followed by closure. The neuroendoscope was used to inspect the surgical cavity between each step., Results: The study included 5 patients with varying visual field defects and proptosis who underwent the sublabial transmaxillary microsurgical approach with endoscopic assistance. Complete resection was achieved in all, and all patients reported improvement in visual field defects and proptosis after the procedure. No complications were observed except for transient unilateral maxillary edema noted around the incision site in 3 patients during the early postoperative period, which resolved within a few days. Histopathological examination confirmed the diagnosis of cavernous malformation in all patients., Conclusions: The sublabial transmaxillary approach is a direct and safe method to resect cavernous malformations at the inferior aspect of the orbit. It reduces the risk of complications associated with lateral, transcranial, and transnasal approaches that may cross critical structures. The microsurgical approach provides the benefit of two-handed dissection for lesions embedded in orbital fat, which can be challenging because of adhesions to surrounding tissues. The use of 3D models can facilitate surgical planning and enhance familiarity with the approach.

The Turkish Journal of Anaesthesiology and Reanimation, established in 1972, is 50 years old now. The number of citations of the journal and the interest of national and international researchers are high. This success has been achieved by the editorial boards who have contributed to the journal since its establishment and the writers who have contributed to its development, and this success will continue to increase., Competing Interests: Declaration of Interests: The authors have no conflict of interest to declare., (©Copyright 2024 by the Turkish Anesthesiology and Reanimation Association / Turkish Journal of Anaesthesiology & Reanimation is published by Galenos Publishing House.)

As a scientific field, anaesthesiology and reanimation, with their significant place in the medical structure, have been practised since the beginning of surgical procedures. Today anaesthesiology and reanimation speciality cover more complex techniques and areas than alleviating patients' pain during surgery. In the first hundred years since the proclamation of the Turkish Republic, the path covered in our scientific field is to pave the way for the next hundred years.

Objective: The authors report on a large, consecutive, single-surgeon series of patients undergoing microsurgical removal of midbrain gliomas. Emphasis is put on surgical indications, technique, and results as well as long-term oncological follow-up., Methods: A retrospective analysis was performed of prospectively collected data from a consecutive series of patients undergoing microneurosurgery for midbrain gliomas from March 2006 through June 2022 at the authors' institution. According to the growth pattern and location of the lesion in the midbrain (tegmentum, central mesencephalic structures, and tectum), one of the following approaches was chosen: transsylvian (TS), extreme anterior interhemispheric transcallosal (eAIT), posterior interhemispheric transtentorial subsplenial (PITS), paramedian supracerebellar transtentorial (PST), perimedian supracerebellar (PeS), perimedian contralateral supracerebellar (PeCS), and transuvulotonsillar fissure (TUTF). Clinical and radiological data were gathered according to a standard protocol and reported according to common descriptive statistics. The main outcomes were rate of gross-total resection; extent of resection; occurrence of any complications; variation in Karnofsky Performance Status score at discharge, 3 months, and last follow-up; progression-free survival (PFS); and overall survival (OS)., Results: Fifty-four patients (28 of them pediatric) met the inclusion criteria (6 with high-grade and 48 with low-grade gliomas [LGGs]). Twenty-two tumors were in the tegmentum, 7 in the central mesencephalic structures, and 25 in the tectum. In no instance did the glioma originate in the cerebral peduncle. TS was performed in 2 patients, eAIT in 6, PITS in 23, PST in 16, PeS in 4, PeCS in 1, and TUTF in 2 patients. Gross-total resection was achieved in 39 patients (72%). The average extent of resection was 98.0% (median 100%, range 82%-100%). There were no deaths due to surgery. Nine patients experienced transient and 2 patients experienced permanent new neurological deficits. At a mean follow-up of 72 months (median 62, range 3-193 months), 49 of the 54 patients were still alive. All patients with LGGs (48/54) were alive with no decrease in their KPS score, whereas 42 showed improvement compared with their preoperative status., Conclusions: Microneurosurgical removal of midbrain gliomas is feasible with good surgical results and long-term clinical outcomes, particularly in patients with LGGs. As such, microneurosurgery should be considered as the first therapeutic option. Adequate microsurgical technique and anesthesiological management, along with an accurate preoperative understanding of the tumor's exact topographic origin and growth pattern, is crucial for a good surgical outcome.

Objective: The objective of this study was to describe the distribution pattern of cerebellar hemispheric tentorial bridging (CHTB) veins on the tentorial surface in a case series of perimedian or paramedian supracerebellar approaches and to describe a novel technique to preserve these veins., Methods: A series of 141 patients with various pathological processes in different locations was operated on via perimedian or paramedian supracerebellar approaches by the senior author from July 2006 through October 2022 and was retrospectively evaluated. During surgery, the number and locations of all CHTB veins were recorded to establish a distribution map on the tentorial surface, divided into nine zones. Patients were classified into four groups according to the surgical technique used to manage CHTB veins: 1) group 1 consisted of CHTB veins preserved without intervention during surgery or no CHTB veins found in the surgical route; 2) group 2 included CHTB veins coagulated during surgery; 3) group 3 included CHTB veins preserved with arachnoid and/or tentorial dissection from the cerebellar or tentorial surface, respectively; and 4) group 4 comprised CHTB veins preserved using a novel tentorial cut technique., Results: Overall, 141 patients were included in the study. Of these 141 patients, 38 were in group 1 (27%), 32 in group 2 (22.7%), 47 in group 3 (33.3%), and 24 in group 4 (17%). The total number of CHTB veins encountered was 207 during surgeries on one side. According to the distribution zones of the tentorium, zone 5 had the highest density of CHTB veins, while zone 7 had the lowest. Of the patients in group 4, 6 underwent the perimedian supracerebellar approach and 18 had the paramedian supracerebellar approach. There were 39 CHTB veins on the surface of the 24 cerebellar hemispheres in group 4. The tentorial cut technique was performed for 27 of 39 CHTB veins. Twelve veins were not addressed because they did not present any obstacles during approaches. During surgery, no complications were observed due to the tentorial cut technique., Conclusions: Because there is no way to determine whether a CHTB vein can be sacrificed without complications, it is important to protect these veins in supracerebellar approaches. This new tentorial cut technique in perimedian or paramedian supracerebellar approaches makes it possible to preserve CHTB veins encountered during supracerebellar surgeries.

Background: Istanbul, home to numerous historical treasures, houses one of the oldest fully constructed hospitals., Methods: This 50-bed hospital was built in the early 12 th century during the Byzantine period by Empress Irene of Hungary and her husband Emperor John II Komnenos inside one of the largest monasteries of its time. The monastery housed one of the first hospitals and schools of medicine and included a nursing home, ophthalmologic health center, library, and cemetery. After the Empress died, her husband continued to enlarge the complex to its current state. Soon after the fall of Constantinople in 1453, the complex was renamed after Zeyrek Mehmet, who was ordered by Fatih Sultan Mehmet (Mehmet II or Mehmed the Conqueror) to convert the monastery into a mosque, constructing a Fatih Medrese for a short period of time. The hospital, however, remained untouched, and its rooms were used for Koran lessons. The building was fully restored from 2009 to 2017 and is still used as a mosque today. We would like to introduce the Pantokrator Monastery, maybe the only remaining hospital of the Byzantine era., Conclusion: Although it was built in the 12 th century, the monastery is still a modern facility meeting current standards., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The surgical approach to the atrium of the lateral ventricle remains a challenge because of its deep location and close relationship to important neurovascular structures. We present an alternative and safer approach to lesions of the atrium using a natural pathway through the parieto-occipital fissure. We demonstrate this approach through cadaveric anatomical microdissection and a case series. Five formalin-fixed brain specimens (10 hemispheres) were dissected with the Klingler technique. Transillumination was used to show the trajectory of the approach in cadaveric specimens. Clinical data from five patients who underwent this approach were reviewed. This data included intraoperative ultrasound images, operative images, pre- and postoperative magnetic resonance imaging, MR tractography, and visual field examination. The parieto-occipital fissure is a constant, uninterrupted fissure that can be easily identified in cadavers. Our anatomical dissection study revealed that the atrium of the lateral ventricle can be approached through the parieto-occipital fissure with minor damage to the short association fibers between the precuneus and cuneus, and a few fibers of the forceps major. In our series, five patients underwent total resection of their atrial lesions via the posterior interhemispheric transparieto-occipital fissure. No morbidity or mortality was observed, and the disruption of white matter was minimal, as indicated on postoperative tractography. The postoperative visual fields were normal. The posterior interhemispheric transparieto-occipital fissure approach is an alternative to remove lesions in the atrium of the lateral ventricle, causing the least damage to white matter tracts and preserving visual cortex and optic radiation., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Over the past 30 years, the treatment of deep and eloquent arteriovenous malformations (AVMs) has moved away from microneurosurgical resection and towards medical management and the so-called minimally invasive techniques, such as endovascular embolization and radiosurgery. The Spetzler-Martin grading system (and subsequent modifications) has done much to aid in risk stratification for surgical intervention; however, the system does not predict the risk of hemorrhage nor risk from other interventions. In more recent years, the ARUBA trial has suggested that unruptured AVMs should be medically managed. In our experience, although these eloquent regions of the brain should be discussed with patients in assessing the risks and benefits of intervention, we believe each AVM should be assessed based on the characteristics of the patient and the angio-architecture of the AVM, in particular venous hypertension, which may guide us to treat even high-grade AVMs when we believe we can (and need to) to benefit the patient. Advances in imaging and intraoperative adjuncts have helped us in decision making, preoperative planning, and ensuring good outcomes for our patients. Here, we present several cases to illustrate our primary points that treating low-grade AVMs can be more difficult than treating high-grade ones, mismanagement of deep and eloquent AVMs at the behest of dogma can harm patients, and the treatment of any AVM should be tailored to the individual patient and that patient's lesion., (© 2022. The Author(s), under exclusive license to Springer Nature Switzerland AG.)

This study aimed to explore the antimicrobial effects of activated lactoferrin (ALF) and rosemary extract (RE) on Escherichia coli O157:H7, Salmonella Enteritidis and Listeria monocytogenes , and to investigate their application potential in the meat storage. Minimum inhibitory concentrations (MICs) of ALF, RE and ALF-RE combinations were determined via microtiter plate assay. MICs of ALF were 1% for E. coli O157:H7; 0.5% for S. Enteritidis and 0.1% for L. monocytogenes. While 15% RE inhibited L. monocytogenes ; 30% RE partially inhibited E. coli O157:H7 and S. Enteritidis growth. Synergistic effect of ALF and RE on the inhibition of E. coli O157:H7 increased the activity of ALF two to three folds. Food application of antimicrobials was performed by dipping of meat samples. Both ALF and RE were found effective in the prevention of L. monocytogenes growth about two logs. According to the data, choice of natural antimicrobials may be promising in food preservation., Competing Interests: Conflict of interestThe authors declare that they have no conflicts of interest., (© Association of Food Scientists & Technologists (India) 2020.)

Objective: The object of this study was to present the surgical results of a large, single-surgeon consecutive series of patients who had undergone transcisternal (TCi) or transcallosal-transventricular (TCTV) endoscope-assisted microsurgery for thalamic lesions., Methods: This is a retrospective study of a consecutive series of patients harboring thalamic lesions and undergoing surgery at one institution between February 2007 and August 2019. All surgical and patient-related data were prospectively collected. Depending on the relationship between the lesion and the surgically accessible thalamic surfaces (lateral ventricle, velar, cisternal, and third ventricle), one of the following surgical TCi or TCTV approaches was chosen: anterior interhemispheric transcallosal (AIT), posterior interhemispheric transtentorial subsplenial (PITS), perimedian supracerebellar transtentorial (PeST), or perimedian contralateral supracerebellar suprapineal (PeCSS). Since January 2018, intraoperative MRI has also been part of the protocol. The main study outcome was extent of resection. Complete neurological examination took place preoperatively, at discharge, and 3 months postoperatively. Descriptive statistics were calculated for the whole cohort., Results: In the study period, 92 patients underwent surgery for a thalamic lesion: 81 gliomas, 6 cavernous malformations, 2 germinomas, 1 metastasis, 1 arteriovenous malformation, and 1 ependymal cyst. In none of the cases was a transcortical approach adopted. Thirty-five patients underwent an AIT approach, 35 a PITS, 19 a PeST, and 3 a PeCSS. The mean follow-up was 38 months (median 20 months, range 1-137 months). No patient was lost to follow-up. The mean extent of resection was 95% (median 100%, range 21%-100%), and there was no surgical mortality. Most patients (59.8%) experienced improvement in their Karnofsky Performance Status. New permanent neurological deficits occurred in 8 patients (8.7%). Early postoperative (< 3 months after surgery) problems in CSF circulation requiring diversion occurred in 7 patients (7.6%; 6/7 cases in patients with high-grade glioma)., Conclusions: Endoscope-assisted microsurgery allows for the removal of thalamic lesions with acceptable morbidity. Surgeons must strive to access any given thalamic lesion through one of the four accessible thalamic surfaces, as they can be reached through either a TCTV or TCi approach with no or minimal damage to normal brain parenchyma. Patients harboring a high-grade glioma are likely to develop a postoperative disturbance of CSF circulation. For this reason, the AIT approach should be favored, as it facilitates a microsurgical third ventriculocisternostomy and allows intraoperative MRI to be done.

Competing Interests: Conflict of Interest: The authors have no conflicts of interest to declare.

Purpose: Despite developments in the treatment of pain, the availability of new drugs or increased knowledge of pain management, postoperative pain control after different surgeries remains inadequate. We aimed to compare the postoperative analgesic efficacy of tramadol versus tramadol with paracetamol after lumbar discectomy., Design, Setting, Participants: Sixty patients undergoing lumbar discectomy were randomly assigned into two groups., Methods: Patients in Group T (n = 30) received tramadol (1 mg/kg), and patients in Group TP (n = 30) received tramadol (1 mg/kg) with paracetamol (1 g) 30 minutes before the end of surgery and paracetamol was continued during the postoperative period at 6 hours intervals for the first 24 hours. Patient-controlled analgesia with tramadol was used during the postoperative period., Main Outcome Measures: Duration, postoperative pain scores, Ramsay sedation scores, analgesic consumption, and side effects were recorded in all patients during the postoperative period. Continuous random variables were tested for normal distribution using the Kolmogorov-Smirnov test, than Student's t-test was used for means comparisons between groups. For discrete random variables chi-square tests and McNemar test was used., Results: Demographic data, mean duration of anaesthesia and surgery were similar in both groups. Postoperative pain scores were significantly higher in Group T than Group TP at 5; 15; 20; and 30 minutes (P = .021, P = .004, P = .002, P = .018). Late postoperative pain scores were similar. Total tramadol consumption in Group T (106.12 ± 4.84 mg) was higher than Group TP (81.20 ± 2.53) during the 24 hours postoperative period. However, continuing the paracetamol at 6 hours interval did not change late postoperative pain scores., Conclusion: The administration of tramadol with paracetamol was more effective than tramadol alone for early acute postoperative pain therapy following lumbar discectomy. Therefore, while adding paracetamol in early pain management is recommended, continuing paracetamol for the late postoperative period is not advised., (© 2019 John Wiley & Sons Ltd.)

Clinical correlates of obsessive-compulsive symptoms (OCS) were evaluated in 100 adult consecutive outpatients with epilepsy, using the Obsessive-Compulsive Inventory (OCI-R), Beck Depression Inventory (BDI), Dissociative Experiences Scale (DES-II), and the Schizotypal Personality Questionnaire (SPQ). Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) was applied to determine the types and severity of OCS to the 45 patients with epilepsy who were over 21 points on the OCI-R scale and 30 patients who were with diagnosed obsessive-compulsive disorder (OCD) among the patients in the psychiatry outpatient clinic, as a control group. As a result, it was found that patients with epilepsy with OCS tend to have more symmetry/exactness obsessions and compulsions, whereas patients with OCD had significantly more contamination/cleaning and aggressiveness obsessions and compulsions. In addition, OCS was found to be significantly higher in temporal lobe epilepsy (TLE) and extratemporal epilepsy than generalized epilepsy. However, OCS were correlated with depression, dissociation, and schizotypy in patients with epilepsy, while only depression was predictive when regression analysis was performed for OCS. This study is the first study to compare patients with OCD with patients with epilepsy in terms of the nature of OCS and first identified the differences in OCS dimensions between patients with epilepsy with OCS and patients with OCD., (Copyright © 2019 Elsevier Inc. All rights reserved.)

In this study, hydroxyapatite (HA)-containing alginate-gelatin films were prepared by solution casting method by blending alginate (A) and gelatin (G) solutions, followed by crosslinking with calcium chloride. HA (1, 2, 5, 10, 20% w/w) was added to film solutions prepared at different ratios (A:G = 40:60, 50:50, and 60:40) and the swelling and degradation behavior, mechanical, antimicrobial and thermal properties, and morphologies of the obtained films were examined. The release of tetracycline hydrochloride (TH), selected as a model drug, from the prepared films was studied. It was observed that the swelling ratio and weight loss of the films decreased as the amounts of alginate and HA increased. Scanning electron microscopy analysis indicated that as the amount of HA in the films increased, the film surface becomes rougher. The mechanical properties of the films were affected by the amount of HA and the A:G ratio. Incorporation of HA increased the thermal stability of films. The amount of TH released from the films within 15 min decreased as the amounts of alginate and hydroxyapatite increased. It was found that films containing TH showed slightly higher antimicrobial activity against Staphylococcus aureus than Escherichia coli., (Copyright © 2018. Published by Elsevier B.V.)

OBJECTIVE The semisitting position of a patient confers numerous advantages in various neurosurgical procedures, but venous air embolism is one of the associated complications of this position. To date, no prospective studies of the relationship between the degree of head elevation and the rate and severity of venous air embolism for patients undergoing a procedure in this position have been performed. In this study, the authors compared changes in the severity of venous air embolism according to the degree of head elevation (30° or 45°) in patients undergoing an elective cranial neurosurgical procedure in the semisitting position. METHODS One hundred patients undergoing an elective infratentorial craniotomy in the semisitting position were included, and each patient was assigned to 1 of 2 groups. In Group 1, each patient's head was elevated 30° during surgery, and in Group 2, each patient's head elevation was 45°. Patients were assigned to their group according to the location of their lesion. During surgery, the standard anesthetic protocol was used with total intravenous anesthesia, and transesophageal echocardiography was used to detect air in the blood circulation. Any air embolism seen on the echocardiography screen was classified as Grade 0 to 4. If multiple events occurred, the worst graded attack was used for statistical analysis. During hemodynamic changes caused by emboli, fluid and vasopressor requirements were recorded. Surgical and anesthetic complications were recorded also. All results were compared statistically, and a p value of < 0.05 was considered statistically significant. RESULTS There was a statistically significant difference between groups for the total rates of venous air emboli detected on transesophageal echocardiography (22.0% [n = 11] in Group 1 and 62.5% [n = 30] in Group 2; p < 0.0001). The rate and severity of air embolism were significantly lower in Group 1 than in Group 2 (p < 0.001). The rates of clinically important venous air embolism (Grade 2, 3, or 4, venous air embolism with decreased end-tidal carbon dioxide levels and/or hemodynamic changes) were 8.0% (n = 4) in Group 1 and 50.0% (n = 24) in Group 2 (p < 0.0001). There was no association between the rate and severity of venous air embolism with patient demographics (p > 0.05). An association was found, however, between the rate of venous air embolism and the type of surgical pathology (p < 0.001); venous embolism occurred more frequently in patients with a meningioma. There were no major surgical or anesthetic complications related to patient position during the postoperative period. CONCLUSIONS For patients in the semisitting position, an increase in the degree of head elevation is related directly to a higher rate of venous air embolism. With a 30° head elevation and our standardized technique of positioning, the semisitting position can be used safely in neurosurgical practice.

Introduction: Postoperative Nausea and Vomiting is one of the most common problems after implementation of general anesthesia. The incidence can reach 80% in high-risk patients, depending on the type of surgery. In our study, we aimed to compare dexamethasone-dimenhydrinate and dexamethasone-ondansetron combinations in prevention of nausea and vomiting in postoperative patients., Method: Sixty 18-65-year-olds ASAI-II females who underwent rhinoplasty were included in the study. Patients were randomly included in two groups: Dexamethasone-dimenhydrinate group (group DD) and dexamethasone-ondansetron group (group DO). All patients received dexamethasone 8 mg iv after endotracheal intubation. Anesthesia continuation was established with sevoflurane, air-oxygen mixture and remifentanil infusion. At the 30th minute of the operation, group DO received ondansetron 4 mg iv and group DD received dimenhydrinate 1 mg/kg iv. For postoperative analgesia tramadol (1.5 mg/kg) iv, tenoksikam (20 mg) and afterward for postoperative patient-controlled tramadol was used. In the postoperative recovery room, nausea and vomiting were evaluated at the 30th, 60th, 120th minutes and at the end of 24 h. Total amount of tramadol was recorded. All results were statistically evaluated., Observations: Demographics and Apfel risk scores of both groups were similar. Surgical operation duration (p = 0.038) and total preoperative remifentanil consumption were higher in group DD (p = 0.006). In group DO, nausea at 30 and 60 min (p = 0.001, p = 0.007), retching at 30 and 60 min (p = 0.002, p = 0.006) were higher than group DD. The additional antiemetic need in group DO was significantly higher at 30 min (p = 0.001). Postoperative analgesic consumption was similar in both groups., Result: Our study revealed that dexamethasone-dimenhydrinate combination was more effective than dexamethasone-ondansetron in prevention of nausea and vomiting after rhinoplasty operations., Level of Evidence Iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Objective We planned a cross-sectional analysis to determine the frequency and severity of metabolic acidosis in patients taking topiramate while awaiting craniotomy. Methods Eighty patients (18 - 65 years) taking topiramate to control seizures while awaiting elective craniotomy were enrolled. Any signs of metabolic acidosis or topiramate-related side effects were investigated. Blood chemistry levels and arterial blood gases, including lactate, were obtained. The severity of metabolic acidosis was defined according to base excess levels as mild or moderate. Results Blood gas analysis showed that 71% ( n = 57) of patients had metabolic acidosis. The frequency of moderate metabolic acidosis was 56% ( n = 45), while that of mild metabolic acidosis was 15% ( n = 12). A high respiratory rate was reported in only 10% of moderately acidotic patients. Conclusions In patients receiving topiramate, baseline blood gas analysis should be performed preoperatively to determine the presence and severity of metabolic acidosis.

Multifunctional composite coatings on bi-oriented polypropylene (BOPP) films were obtained using borax and microfibrillated cellulose (MFC) added to the main pullulan coating polymer. Spectroscopy analyses suggested that a first type of interaction occurred via hydrogen bonding between the C6OH group of pullulan and the hydroxyl groups of boric acid, while monodiol and didiol complexation represented a second mechanism. The deposition of the coatings yielded an increase in the elastic modulus of the entire plastic substrate (from ∼2GPa of the neat BOPP to ∼3.1GPa of the P/B+/MFC-coated BOPP). The addition of MFC yielded a decrease of both static and kinetic coefficients of friction of approximately 22% and 25%, respectively, as compared to the neat BOPP. All composite coatings dramatically increased the oxygen barrier performance of BOPP, especially under dry conditions. The deposition of the high hydrophilic coatings allowed to obtain highly wettable surfaces (water contact angle of ∼18°)., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: A challenging step of the paramedian supracerebellar-transtentorial approach is to expose the anterior portion of the mediobasal-temporal region (MTR), a step that seems most affected by the steepness of the tentorium. The objective of this study was to define magnetic resonance imaging measurements that can predict the level of challenge in exposing the anterior portion of the MTR., Methods: Cranial magnetic resonance imaging studies of 100 healthy individuals were examined. The tentorial and occipital angles were measured, and the amount of brain tissue that remained hidden on the microscopic view in front of the petrous apex was indirectly estimated. These measurements were statistically compared with the cephalic index of each person., Results: The mean values for the tentorial and occipital angles were 42° (range 25°-53°) and 98° (range 69°-122°), respectively. The results proved that the higher the tentorial angle, the higher the occipital angle and the greater the amount of hidden brain tissue. Of 100 persons, 3 (3%) were found to be dolichocephalic, 23 (23%) were mesocephalic, and 74 (74%) were brachycephalic. Statistical analysis proved that individuals with a dolichocephalic cranial shape have lower tentorial and occipital angles., Conclusions: The results provide strong evidence proving that the lesser the tentorial and occipital angles, the easier the exposure of the anterior portion of the MTR during the paramedian supracerebellar-transtentorial approach. The tendency of the cranial shape toward dolichocephaly seems to have the same practical value in choosing the approach. It is easier to expose the anterior portion of the MTR in these individuals., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: One significant drawback during a cranial reoperation is the presence of meningocerebral adhesions. The appearance of connective tissue bridges between the inner surface of the dura and the pia-arachnoid is mostly related to dural closure and the condition in which the surgical field was left in the previous surgery. This study was done to determine the benefit of placing a thin-layer gelatin sponge of polypeptides subdurally to prevent meningocerebral adhesions., Methods: From September 2005 through May 2012, 902 craniotomies were performed for various lesions by the senior author (U.T.). Beginning in February 2009, we began placing a gelatin sponge under the dural flap to isolate the dural healing process from the cortical surface. To compare the degree of meningocerebral adhesions statistically, reoperation cases between February 2009 and May 2012 were divided into 2 groups as group G (gelatin) and group C (Control) in which the dural closure was made with and without subdural application of the gelatin sponge, respectively., Results: In all patients of group G (n = 15), a neomembrane was found when the dura was opened. This layer was easily dissected and showed no or minimal attachment to the underlying cerebral cortex. However, in group C (n = 14), meningocerebral adhesions in various degrees were detected. Adhesion scores were significantly greater in group C than in group G (P < 0.001)., Conclusion: This study proves that, during the dural closure, placing a thin layer of gelatin sponge in the subdural space is a safe and effective method for preventing meningocerebral adhesions., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: Dexmedetomidine has been reported to produce analgesia after intrathecal administration. In the present study the α2-adrenoceptor agonist dexmedetomidine was evaluated for its potential spinal neurotoxic effects., Material and Methods: Three days after intrathecal cannulation, rats were administered either dexmedetomidine (3 μg/30 μL, i.t.) or saline (30 μL, i.t.). Antinociceptive, sedative and motor effects of intrathecal administrations of dexmedetomidine or saline were evaluated during 90 min. The tail-flick and hot plate tests were used to assess the thermal nociceptive threshold. Seven days after drug administration, animals were sacrified and spinal cords were evaluated for histopathological changes by light microscopy., Results: Dexmedetomidine administered intrathecally produced antinociception. Antinociception was accompanied by immediate sedation and loss of placing-stepping reflexes that lasted over 40 min in all dexmedetomidine administered rats. In all rats, microscopic examination revealed mild gliosis and minimal infiltration of inflamatory r cells in posterior white matter. Mild (total score 4-6) histopathologic lesions were seen in four animals in dexmedetomidine adminisered rats, but there was no statistically significant difference when compared with the saline administered rats., Conclusion: We observed that intrathecal injections of dexmedetomidine at the dose of 3 μg/30 μL produce antinociception but did not cause any histopathological sign of injury in the spinal cord.

Background: Ketamine is an analgesic suitable for the induction of anesthesia during Caesarean delivery. This double blind, randomized trial examined the effect of intravenous ketamine used before the induction of general anesthesia on morphine consumption, immediate and long term postoperative pain after Cesarean delivery., Methods: One hundred and forty term pregnant women undergoing elective Cesarean delivery were randomized into four groups (N.=35 each), placebo (0.9% normal saline), ketamine 0.25, 0.5, or 1 mg kg(-1) intravenously. In all patients 2-2.5 mg kg(-1) propofol was used for the induction of anesthesia, 0.6 mg kg(-1) rocuronium to facilitate the tracheal intubation and 50% oxygen in N2O and sevoflurane (end-tidal concentration of 1.2-1.3 %) for the maintenance of anesthesia. Postoperative analgesia was provided with intravenous morphine chloride patient-controlled analgesia (PCA) and rescue analgesia with intramuscular diclofenac sodium in the postoperative period. Apgar scores of the neonates and hemodynamic variables of the mothers were recorded during anaesthesia. Groups were compared regarding the cumulative morphine consumption and pain scores assessed with a numerical rating (0-10) scale at 2, 6, 12, 18, 24, and 48 h postoperatively. Postoperative side effects were recorded. Patients were evaluated for persistent postoperative pain at 2 weeks, 1 and 6 months, and 1 year., Results: The cumulative morphine consumption at 48 hours after the surgery was the primary outcome of the study. There was no significant difference in terms of acute pain at 2 (P=0.3), 6 (P=0.7), 12 (P=0.4), 18 (P=0.4), 24 (P=0.8), and 48 (P=0.5) hours postoperatively. Cumulative morphine consumption obtained at 2 (P=0.9), 6 (P=0.5), 12 (P=0.4), 18 (P=0.4), 24 (P=0.1), and 48 (P=0.2) hours was also similar among the groups. Prolonged postoperative pain evaluated 2 weeks (P=0.3), 1 month (P=0.7), 6 months (P=0.1) and 1 year (P=0.3) after the operation was also similar among the groups. There was no significant difference in side effects among the groups during the postoperative 48 hours. Apgar scores at 1 min (P=0.5) and 5 mins (P=0.5) were similar among the groups. Maternal intraoperative hemodynamic parameters were similar among the groups., Conclusion: There was no difference regarding early and late postoperative pain and morphine consumption with ketamine at doses of 0.25, 0.5, and 1 mg kg(-1) in women undergoing Caesarean delivery under general anaesthesia, compared with the control group.

Object: The exploration of lesions in the mediobasal temporal region (MTR) has challenged generations of neurosurgeons to achieve an appropriate approach. To address this challenge, the extensive use of the paramedian supracerebellar-transtentorial (PST) approach to expose the entire length of the MTR, as well as the fusiform gyrus, was investigated., Methods: The authors studied the microsurgical aspects of the PST approach in 20 cadaver brains and 5 cadaver heads under the operating microscope. They evaluated the features, advantages, difficulties, and limitations of the PST approach and refined the surgical technique. They then used the PST approach in 15 patients with large intrinsic MTR tumors (6 patients), tumor in the posterior fusiform gyrus with mediobasal temporal epilepsy (MTE) (1 patient), cavernous malformations in the posterior MTR including the fusiform gyrus (2 patients), or intractable MTE with hippocampal sclerosis (6 patients) from December 2007 to May 2010. Patients ranged in age from 11 to 63 years (mean 35.2 years), and in 9 patients (60%) the lesion was located on the left side., Results: In all patients with neuroepithelial tumors or cavernous malformations, the lesions were completely and safely resected. In all patients with intractable MTE with hippocampal sclerosis, the anterior two-thirds of the parahippocampal gyrus and hippocampus, as well as the amygdala, were removed selectively through the PST approach. There was no surgical morbidity or mortality in this series. Three patients (20%) with high-grade neuroepithelial tumors underwent postoperative radiotherapy and chemotherapy but needed a second surgery for recurrence during the follow-up period. In all patients with MTE, antiepileptic medication could be decreased to a single drug at lower doses, and no seizure activity has occurred until this point., Conclusions: The PST approach provides the surgeon precise anatomical orientation when exposing the entire length of the MTR, as well as the fusiform gyrus, for removing any lesion. This is a novel technique especially for removing tumors involving the entire MTR in a single session without damaging neighboring neural or vascular structures. This approach can also be a viable alternative for selective removal of the parahippocampal gyrus, hippocampus, and amygdala in patients with MTE due to hippocampal sclerosis.

Background: Gabapentin is an anticonvulsant drug that has analgesic properties for acute postoperative pain. However, the analgesic effect of gabapentin as an antiepileptic prophylactic drug on patients undergoing craniotomy is unclear. In this study, we evaluated the postoperative effectiveness of gabapentin on acute postoperative pain when it is used for antiepileptic prophylaxis in patients undergoing craniotomy for supratentorial tumor resection., Methods: Eighty patients undergoing craniotomy for supratentorial tumor resection were randomly assigned into two groups. Patients in Group G (n = 40) received oral gabapentin (3 x 400 mg), and patients in Group P (n = 40) received oral phenytoin (3 x 100 mg) for 7 days before the operation and postoperatively. An identical anesthesia protocol was performed for both the groups. Anesthesia was maintained with propofol and remifentanil infusion. Patient-controlled analgesia with morphine was used, and pain levels were measured. The antiepileptic-related side effects, anesthetic consumption, duration of anesthesia and surgery, tracheal extubation time, postoperative pain scores, morphine consumption, and sedation scores were recorded., Results: Thirty-seven patients in Group G and 38 patients in Group P completed the study. During the preoperative period in Group G, one patient had severe fatigue, one had severe dizziness, and one patient's surgical procedure was changed. The median plasma levels of gabapentin were 34 micromol/mL (range, 23-51 micromol/mL) in 34 patients. In Group P, one patient withdrew from the study preoperatively and one developed transient neurological symptoms postoperatively. The demographic data and mean duration of anesthesia and surgery were similar in both the groups. The total propofol and remifentanil consumption in Group G (1847 +/- 548 mg/3034 +/- 1334 microg) was significantly less than that of Group P (2293 +/- 580 mg/4287 +/- 1282 microg) (P = 0.01). However, tracheal extubation could be done earlier in Group P (4.5 +/- 2 min) than in Group G (16.6 +/- 22 min) (P < 0.001). Pain scores were significantly higher in Group P at 15 min, 30 min, and 1 h (P < 0.001). The total morphine consumption was also significantly higher in Group P (33 +/- 17 mg vs 24 +/- 19 mg) (P = 0.01). The postoperative sedation scores were significantly higher in Group G at 15 min, 30 min, 1 h, and 2 h (P < 0.001)., Conclusions: The administration of gabapentin to patients undergoing craniotomy for supratentorial tumor resection was effective for acute postoperative pain. It also decreased analgesic consumption after surgery. However, it may lead to side effects such as delayed tracheal extubation and increased sedation postoperatively.

Background: In this study, we investigated the effects of propofol infusion on hepatic and pancreatic enzymes and acid-base status compared with baseline values in children undergoing craniotomy who were receiving phenytoin for antiepileptic prophylaxis., Methods: In this prospective clinical study, we measured the serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), pancreatic amylase, lipase, and triglyceride levels of 30 children ranging from 4 to 12 yr. All children received propofol anesthesia and were taking phenytoin for antiepileptic prophylaxis. Patients already receiving phenytoin were continued on their medication. Peroral 5 mg x kg(-1) x d(-1) phenytoin was started in patients who were not receiving phenytoin. Serum AST, ALT, GGT, ALP, bilirubin, pancreatic amylase, lipase, and triglyceride levels were studied on admission to the hospital, 1 day before surgery, and on postoperative Days 1, 3, 5, and 7. Arterial blood gas samplings were taken after tracheal intubation, during the operation (2nd and 4th h), just after extubation, and 1, 2, 6, and 12 h after extubation., Results: Serum AST, ALT, GGT, ALP, pancreatic amylase, lipase, and triglyceride levels were increased significantly in the postoperative period compared with baseline with a peak value on postoperative Day 1 and returned to normal values within a week. Base excess levels after extubation were significantly decreased compared with baseline. They were in the normal range, however, and returned to baseline values by 6 h after surgery. There were no clinical signs of hepatitis or pancreatitis. Bilirubin levels were normal. None of the children developed complications related to the liver or pancreas during the 4-6 mo after surgery., Conclusions: Despite the slightly increased pancreatic and hepatic enzyme levels during the postoperative period, anesthesia maintenance with propofol in children undergoing craniotomy had no significant clinical effect on the acid-base status or pancreas or liver enzymes.

The use of unilateral spinal block with a specific hyperbaric mixture of bupivacaine and fentanyl in two centenarian women is presented. This technique was very effective in restricting sympathetic block, and it provided satisfactory analgesia and hemodynamic stability.

We reviewed many of the essential Greek myths to identify the methods used at that time to relieve the pain of both illness and surgery, and we discovered many pioneering methods. Both gods and demigods implemented these methods to ease pain, to conduct surgery, and, on occasion, to kill mythological beings. The myths describe the three most common components of anesthesia: hypnosis, amnesia, and (an)algesia. Drugs and music-aided hypnosis were two of the most common methods use to treat emotional and surgical pain. This article identifies highlights in the development of concepts to treat pain in Greek mythology. The examples found in the Greek myths remind us of the historical significance of pain treatment.

For the study 1000 families were interviewed during 1996 in the city of Denizli, which is situated in Western Anatolia and has a population of 79211 families. The overall rate of consanguinity was 11.7%, with a mean inbreeding coefficient of 0.00873. The principal type of consanguineous marriage recorded was between first cousins, which accounted for 49.6% of all unions. For both sexes, a significant negative association was observed between consanguinity and mean age at marriage and level of education.