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Organophosphates that are commonly used in agriculture, houses, gardens, and in veterinary medicine worldwide, may be used for suicidal purposes. But suicide attempt with self-injection of organophosphates is rare. This article presents a case of a suicide attempt of a young man with self-injection of an organophosphate insecticide (dichlorvos) to both his wrists.

Purpose: Intrathecal morphine is administered to provide profound and prolonged analgesia, and to treat acute postoperative pain. We compared the effectiveness of hyperbaric bupivacaine alone and in combination with morphine for unilateral spinal anesthesia in patients undergoing knee arthroscopy., Methods: Sixty patients were randomly allocated to two groups to receive either 1.2 ml (6 mg) of 0.5% hyperbaric bupivacaine (group B; n = 30) or 1.2 ml of 0.5% hyperbaric bupivacaine containing 0.16 mg of morphine (group BM; n = 30). Spinal block was assessed by pinprick and a modified Bromage scale and compared between the operated and nonoperated sides. Visual analog scale (VAS) values, duration of analgesia, and total analgesic requirement of patients were recorded., Results: Patients in group BM had significantly lower VAS values on movement at 30 min and at 2, 4, 6, and 12 h postoperatively (P < 0.05 and P < 0.001, P < 0.001, P < 0.001, and P < 0.05, respectively). The total analgesic requirement in the first 24 h after surgery was significantly higher in group B (P < 0.001). Patients in group BM had a significantly longer duration of analgesia in the first 24 h postoperatively (P < 0.001). Motor blockade of the operated limb in group BM was similar to that in group B (P > 0.05), and motor blockade of the nonoperated limb in group BM was also similar to that in group B (P > 0.05)., Conclusion: We conclude that unilateral spinal anesthesia with hyperbaric bupivacaine plus 0.16 mg morphine is preferable to hyperbaric bupivacaine alone with respect to analgesic requirement, duration of analgesia, and VAS values.

Background: Misoprostol has been shown to increase colonic activity and decrease colonic transit time in chronic constipation patients., Aims: The aim of this prospective, randomised, double-blind study was to examine the effectiveness of rectally administered misoprostol on inducing intestinal motility after gynaecological surgery., Methods: Eighty women who underwent hysterectomy were divided randomly into three groups. Group A received misoprostol 200 microg rectally while group B received 400 microg rectal misoprostol after surgery before leaving the operating room. Patients in group C received no drugs. Bowel sounds in four quadrants were checked every hour and possible side-effects of misoprostol like nausea, vomiting, and distension were evaluated. The time interval between surgery and flatus pass and the need of analgesics were noted. Statistical analyses were done with Mann-Whitney U-test and chi2 tests where available., Results: The time between surgery and presence of bowel sounds in four quadrants were similar in all groups (2.7 +/- 1.6, 2.9 +/- 1.2, 2.8 +/- 1.3 h, for groups A, B, and C, respectively). No difference was observed in flatus pass time. The incidence of nausea was significantly increased in group B compared to controls (P < 0.01). Additional analgesic need was significantly higher in groups A and B when compared to controls (P < 0.05 and P < 0.01, for groups A and B, respectively)., Conclusion: Rectally administered misoprostol does not improve intestinal motility in the early postoperative period and thus, it is not effective in providing early oral food intake. On the contrary, it causes distention that requires additional analgesics and vomiting that naturally limits oral diet intake.

Objective: To evaluate the effects of desflurane on middle ear pressure., Study Design: A prospective clinical study., Methods: In this study, 38 ears of 19 male children that were scheduled for circumcision were included. Baseline tympanometry reading was performed on each ear just before anesthesia. After induction anesthesia with propofol a laryngeal mask was applied and desflurane administration was started. The next tympanometry reading was taken at 5th, 10th and 15th minute after administration and at the 10th minute after the cessation of desflurane. Data were analysed using Wilcoxon test., Results: Mean MEP values before anesthesia in 38 ears of 19 boys were -10.32+/-33.14. After starting the administration of desflurane 5th minute mean value was 71.15+/-60.42, at the 10 th minute 111.56+/-59.03 and at the 15th minute it increased to 120.50+/-54.14, and these measurements were significantly higher than the starting value (p<0.001). After cessation of desflurane mean MEP value dropped to 57.56+/-79.06, but compared with the starting value this was also significantly higher (p<0.001)., Conclusion: Desflurane may increase the middle ear pressure and it may be unsuitable for certain middle ear surgeries.

Post-partum hemorrhage may be a life-threatening condition. A case of a patient receiving antithrombotic therapy for the factor V Leiden mutation, in whom post-partum hemorrhage had occurred due to placenta increta, is described. In this case, the post-partum hemorrhage did not respond to bilateral hypogastric artery ligation, while the B-Lynch surgical technique was successful in obtaining hemostasis.

Background: It has been demonstrated that tramadol is an effective analgesic. We aimed to compare postoperative analgesic effects of wound infiltration with tramadol (T) or bupivacaine (B) and intramuscular tramadol (I) after herniotomy in children., Methods: In this study, 75 children were randomly assigned to group T, group B and group I. Wound infiltration was performed to the patients in group T (2 mg.kg-1 tramadol in 0.2 ml.kg-1 saline) and group B (0.2 ml.kg-1 0.25% bupivacaine) into the surgical incision. Twenty minutes before the end of the surgery 2 mg.kg-1 tramadol was injected i.m. in group I. Faces pain scale was used for assessing pain severity. Patients with pain score>2 were treated with paracetamol. The frequency of side effects and analgesic use were recorded. Patients were discharged on the next day., Results: No side effects were recorded in any group. The pain scores of the patients at the first, fourth and eighth hours were significantly higher in group B and group I than group T (P<0.05). The pain scores of the patients at the first hour were significantly higher in group I compared with group B (P<0.05). Average time to first analgesic requirement was significantly longer in group T (6.72+/-4.09 h after herniotomy than both group I (4.49+/-3.9 h) and group B (6.04+/-3.7 h) (P<0.05)., Conclusions: Wound infiltration with tramadol may be a good choice for postoperative analgesia in children having inguinal herniotomy.

Objective: To evaluate the effects of sevoflurane and TIVA with propofol on middle ear pressure and to show the importance of anesthesia without using any inhalational agents during middle ear surgery., Study Design: A prospective, randomized controlled clinical study., Methods: In this study, 25 male children that were scheduled for circumcision were randomised into two groups. Group I (n=13) received TIVA with propofol and group II (n=12) received sevoflurane. Baseline tympanometry reading was performed on each ear just before anesthesia. The next tympanometry reading was taken 10min after applying the laryngeal mask. Data were analysed by Mann-Whitney U (between groups) and Wilcoxon tests (within groups)., Results: Mean MEP values in 26 ears of 13 boys in group I did not show any significant difference before and after the anesthesia with propofol (p>0.05). In group II mean MEP values in 24 ears of 12 boys showed a significant increase after the anesthesia with sevoflurane (p<0.001). No significant difference was found between the MEP values of the two groups before the anesthesia (p>0.05), and MEP values measured during the anesthesia were significantly higher in group II (p=0.007)., Conclusion: Sevoflurane may increase the middle ear pressure and TIVA with propofol may be used in middle ear operations more safely than sevoflurane.

Background: To investigate the effects of postoperative early enteral and glutamine enriched enteral feeding on the healing of experimental colonic anastomosis., Methods: Forty Wistar-albino rats were equally divided into 4 groups. Colonic transsection and anastomosis situated at the distal left colon was performed on all animals. Animals in groups 1 and 2 received late total enteral nutrition (TEN) and in groups 3 and 4 early TEN. Glutamine was added to TEN protocol in groups 2 and 4. The colonic segment including the anastomosis was excised at the end of the 7th day postoperatively. Bursting pressure of the anastomosis and tissue hydroxyproline levels were determined., Results: Bursting pressure levels were 111.6 and 95.8 centimeters of water (cmH(2)O) in early and late nutrition groups, respectively (p=0.022). Comparison of late TEN groups showed a significant difference in favor of group with glutamine (95.8 vs 138.5 cmH(2)O; p<0.0001). Highest bursting pressures (139 and 138.5 cmH(2)O) were measured in both early and late TEN groups with glutamine. Tissue hydroxyproline level in early TEN group (2440.3 microg) was significantly higher than late TEN group (1509.6 microg; p=0.024). Comparison of late TEN groups showed a considerable but not statistically significant difference (p=0.276) in favor of group with glutamine (1509.6 vs 1981.6 microg)., Conclusion: Postoperative early TEN significantly ameliorates the resistance of the anastomosis and collagen synthesis. Glutamine enrichment in nutritional protocol decreases and reverses the disadvantages of late TEN regarding the resistance of anastomosis. A similarly positive, albeit weaker, effect of glutamine supplementation is also seen on collagen synthesis.

Purpose: We compared the effects of different doses of intrathecal sufentanil when administered together with hyperbaric bupivacaine for elective caesarean section., Methods: This was a prospective, randomized, double-blind, controlled trial involving 100 pregnant women, American Society of Anesthesiologists (ASA) I-II, who were scheduled for elective caesarean section under spinal anesthesia. The patients were assigned to four groups according to the dose of sufentanil used: no sufentanil (group I; placebo) or 1.5, 2.5, or 5.0 microg sufentanil (groups 2-4, respectively). In every group, the local anesthetic used was hyperbaric bupivacaine 0.5% (12.5 mg), and the total volume of the solution was 3.5 ml. The duration of complete analgesia, maternal side effects, and maternal/fetal outcomes were recorded. The duration of complete analgesia was defined as the time from intrathecal injection to a vernal analogue score (VAS) of more than 0., Results: No patient experienced intraoperative pain. The duration of complete analgesia was prolonged in all groups receiving opioids. The duration of the analgesia and the 0- to 6-h intravenous analgesic requirements were similar in the sufentanil groups. Moreover, the sufentanil groups had longer durations of complete analgesia than the placebo group. Pruritus was more frequent in the 2.5- and 5-microg sufentanil groups than in the 1.5-microg sufentanil and placebo groups. There were no differences among the groups in umbilical cord blood gases on in neonatal Apgar scores., Conclusion: The addition of sufentanil 1.5 and 2.5 microg to hyperbaric bupivacaine provided adequate anesthesia for caesarean delivery and good postoperative analgesia. In addition, the incidence of pruritus was significantly lower in the 1.5-microg sufentanil group when compared with that in the 2.5- and 5-microg groups.