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Makale, diferensiasiyon teriminin özünü ortaya koymakta ve dünya dilbiliminde bu terime yaklaşımı açıklamaktadır. Çalışmada, difenesiasiyon kavramının içeriğini ve özünü, dilbilimdeki gelişim alanlarını ve çevrelerini tanımlar ve bu terimin dilbilimdeki yeri ve önemini göstermeye çalışır. Aynı zamanda dilbilimde Türk lehçelerinde diferensiasiyon alanları örneklerle anlatılmış ve araştırma sorusu geniş çapta tartışılmıştır. Araştırmada, Türk lehçeleri arasında karşılaştırma yapılarak diferensiasiyon betimlenmeğe çalışılmaktadır. Yunanca kökenli olan diferensiasion kelimesi, bir birimi, bir bütünü düşüncenin parçalarına ayırma sürecidir ve entegrasyon, tam tersine, parçalar ve bir bütün olma süreci arasında bir etkileşim aracıdır. Dilbilimde bununla ilgili değişik araştırmalar yapılmış, çeşitli teorik bilgiler ve tanımlar vardır. Sonuç olarak makale diferensiasiyonu tanımlar ve bu terimin teorik temellerin incelenmesinde ve Türk dillerinin bölünmesinin nedenlerini ortaya koymada önemini vurgular. Məqalədə diferensiasiya terminin mahiyyəti açılmış, dünya dilçiliyində bu terminə yanaşma tərzi təsvir edilmişdir. Tədqiqatda diferensiasiya termin anlayışının məzmununu, mahiyyəti, onun linqivistikada işlənmə hududları və sahələri müəyyənləşdirilərək dilçilikdə bu terminin yeri və əhəmiyyəti göstərilməyə çalışılmışdır. Eyni zamanda dilçilikdə hansı sahələrdə diferensiasiya baş verdiyi, bunun hansı formalarda olduğu nümunələrlə izah edilmiş, verilmiş tədqiqat sualı geniş şəkildə müzakirə edilmişdir. Tədqiqatda türk ləhcələri arasında müqayisələr aparılaraqdiferensiasiya təsvir olunmağa çalışılır. Yunan mənşəli diferensiasiya sözü vahidin, bütövün düşüncə hissələrinə ayrılması prosesidir, inteqrasiya isə əksinə, hissələr arasında qarşılıqlı təsir vasitəsi və bütövləşmə prosesidir. Dilçilikdə bu mövzuda müxtəlif araşdırmalar aparılıb,müxtəlif nəzəri məlumat və təriflər var.Nəticədə diferensiasiyaya tərif verilərək, bu terminin nəzəri əsaslarının öyrənilməsi ilə türk dillərinin bölünmə səbəblərinin ortaya qoyulmasında böyük əhəmiyyətə malik olduğu məqalədə vurğulanmışdır

Massive hemorrhage in pediatric cranioplasty operations may necessitate blood transfusion, which may cause many complications. Radical-7 Pulse CO-Oximeter (Massimo Corporation, Irvine, CA) can provide continuous hemoglobin concentration (SpHb) measurements noninvasively. In this study, we aimed to evaluate the effects of SpHb measurement on perioperative transfusion management and postoperative patient outcomes. For this retrospective case-control study, we collected the data of pediatric patients undergoing fronto-orbital advancement surgery for plagiocephaly and trigonocephaly between 2018 and 2021. Perioperative SpHb monitoring was performed for patients in the SpHb Group. Other patients that were managed conventionally were considered as the control group (C Group). The data on patients\" demographic and clinical characteristics, intraoperative hemodynamic and laboratory variables such as blood gases, intraoperative blood losses, the amount of the transfused blood products, the length of postoperative intensive care unit (ICU) stay, and the duration of hospital stay were collected. The data of 42 patients were collected, and 29 of these patients were males (69%). In 16 of the patients, SpHb monitoring was performed. The demographic, clinical, and perioperative hemodynamic characteristics of the patients were comparable between the groups. Compared to the C Group, the SpHb Group had significantly lower perioperative packed red blood cell (PRBC) transfusion (136.3 +/- 40.1 vs. 181.5 +/- 74.8 mL, P = 0.015), less postoperative drainage (125.3 +/- 47.7 vs. 185.8 +/- 97.6 mL, P = 0.013), and shorter ICU stay (37.1 +/- 12.0 vs. 64.8 +/- 24.9 h, P < 0.001). There was a positive correlation between the amount of PRBC transfusion and the length of ICU stay (r = 0.459, P = 0.003). Patients with perioperative continuous SpHb measurement have lower intraoperative PRBC transfusion, less postoperative bleeding, and shorter ICU stay. When necessary, SpHb, together with clinical judgment and laboratory confirmation, can be used in decision-making for perioperative PRBC transfusion.

Aim: New coronavirus disease (COVID-19) has become an international emergency. As many of the intensive care unit (ICU) patients with the disease also present multiple organ failure, blood purification techniques might be a good choice in their treatment. In this study we aimed to investigate the role of cytokine removal in COVID-19 patients managed in ICUs. Methods: For this case-control study we have investigated the role of the cytokine removal by means of two resin membranes (HA330 and Mediasorb) in COVID-19 patients managed in ICUs. Particularly, we investigated the overtime variation in clinical severity scores, laboratory variables, and effects on hospital and ICU stay and mortality. Results: Seventy-two patients have been evaluated, of which half constituted Cytokine Filtration (CF) Group, and other half the Case-Control (CC) Group. Mortality was 55.6% and 50% in CF and CC groups, respectively. In the CF Group, there was decrease in C-reactive protein (CRP) and fibrinogen levels measured at the end of cytokine adsorption; lymphocyte count and ratio were increased, whereas neutrophile ratio was decreased. There were no differences between the groups regarding other laboratory variables, SOFA scores and vasopressor uses. Conclusions: We have demonstrated decrease in CRP, fibrinogen and increase in lymphocyte count in the patients having cytokine adsorption, but there was no clinical reflection of these benefits, and no decrease in mortality as well. Even though there is physio-pathologic rationale to use cytokine adsorption techniques for immunomodulation in critically ill COVID-19 patients, it is early to make strong suggestions about their benefits.

Resumo Justificativa e objetivo As escalas baseadas na autoavaliacao de pacientes, como a Escala de Classificacao Numerica e a Escala Visual Analogica, que sao usadas para avaliar a dor pos‐operatoria podem ser problematicas em pacientes geriatricos ou em estado critico com problemas de comunicacao. Portanto, um metodo capaz de avaliar a dor de maneira objetiva vem sendo pesquisado ha anos. O indice de analgesia/nocicepcao, baseado em dados eletrocardiograficos que refletem a atividade parassimpatica, tem sido proposto para tal avaliacao. Neste estudo, objetivamos investigar a eficacia do indice de analgesia/nocicepcao como uma ferramenta para a avaliacao da dor pos‐operatoria aguda. Nossa hipotese foi que o indice de analgesia/nocicepcao pode ter boa correlacao com os valores da Escala de Classificacao Numerica. Metodos Um total de 120 pacientes com estado fisico ASA I e II, submetidos a qualquer procedimento cirurgico com o uso de anestesicos halogenados (fentanil ou remifentanil), foi incluido no estudo. No 15° minuto apos a chegada a sala de recuperacao pos‐anestesia, a dor dos pacientes foi avaliada em uma escala numerica de 0–10 pontos. Os escores de frequencia cardiaca, pressao arterial e o indice de analgesia/nocicepcao dos pacientes foram medidos simultaneamente naquele momento. A correlacao entre o indice de analgesia/nocicepcao, frequencia cardiaca, pressao arterial e a Escala de Classificacao Numerica foi avaliada. Resultados O estudo foi concluido com 107 pacientes, dos quais 46 eram do sexo masculino (43%). Os valores da media (DP) do indice de analgesia/nocicepcao foram significativamente maiores nos pacientes com valor inicial na Escala de Classificacao Numerica ≤ 3, em comparacao com valor na mesma escala > 3 (69,1 [13,4] vs. 58,1 [12,9], respectivamente, p Conclusao As mensuracoes do indice de analgesia/nocicepcao no pos‐operatorio apos anestesia com agente volatil e opioides mostraram boa correlacao com os escores subjetivos da Escala de Classificacao Numerica.

A biomarker is an objectively measured characteristic that indicates normal or pathological state. Biomarkers of pulmonary function are clinical signs, radiological findings, or laboratory findings that reflect lung functions. In this chapter, we have classified biological markers of pulmonary functions in seven groups as clinical markers, lung volume and pressure markers, radiological markers, lung tissue, blood, sputum, and exhaled breath markers.

Background Appendicitis is the most frequent acute abdominal disease and there are actual effective diagnostic tools for its detection. Objectives The objective of this study was to determine whether a thermal imaging camera is a useful tool for diagnosing acute appendicitis on the basis of abdominal skin surface temperature changes which reflect intra-abdominal inflammation. Material and methods The prospective data consisting of surgical and pathological findings of 51 patients who had undergone appendectomy between January 2013 and December 2014 with the diagnosis of acute appendicitis was collected, as well as thermal imaging camera recordings. A handheld infrared (IR) thermal imaging camera (ITIC) was used to take measurements. Results Of the 51 patients studied, 30 were male and 21 were female. Of these, 12 had their highest temperature measurement in the epigastric and 17 in the umbilical areas. These 2 groups constituted 56.9% of the patients. Regarding the lowest temperature measurement, 10 patients had the lowest temperature in the right inguinal and 15 in the hypogastric area. These 2 numbers constituted 49% of the patients. Conclusions This is the first report concerning the use of a thermal camera as a diagnostic tool for the evaluation of acute abdominal illness. Considering the results of our study, ITIC is not feasible as a new diagnostic tool for acute appendicitis. It may be suitable for determining superficial inflammation; however, it is not suitable for determining deep inflammation.

Amaç: Acil anestezi planlı olmayan cerrahi işlemler için verilen anestezidir. Bölgelerin acil cerrahi profilinin belirlenmesi ameliyat ekibinin gelebilecek olgulara hazırlıklı olmasına ve hastaların daha iyi şartlarda ameliyata alınmasına imkân sağlayacaktır. Bu çalışmada, Adıyaman ilinde acil kliniğine başvurup acil şartlar altında ameliyat olan hastaların sıklık ve dağılımının belirlenmesi amaçlandı.Yöntem: Adıyaman Üniversitesi Eğitim ve Araştırma Hastanesi ameliyathanesinde 01.01.2014-31.12.2014 tarihleri arasında acil cerrahi operasyon geçiren hastalar retrospektif olarak incelendi. Hastaların yaş, cinsiyet, tanı, operasyonu gerçekleştiren klinik, kullanılan anestezi yöntemi ve operasyonun yapıldığı tarih kaydedildi. Veriler SPSS 21.0 programı kullanılarak değerlendirildi. p˂0,05 değeri istatistiksel olarak anlamlı kabul edildi.Bulgular: Toplamda 583 hastanın verileri incelendi. Bunların 370’i (%63,5) erkek, geri kalanı kadındı. En çok acil cerrahi uygulanan bölümler genel cerrahi, çocuk cerrahisi, ortopedi ve beyin cerrahisiydi. Hastaların %96,4’ü endotrakeal entübasyon, %1,2’si laringeal maske (LMA), %2,2’si spinal anestezi, %0,2’si de rejyonel intravenöz anestezi (RİVA) ile anestezi aldı. Acil operasyonların mevsimsel dağılımı incelendiğinde, en fazla vakanın yaz, en az vakanın ise kış aylarında alındığı gözlemlendi. Sonuç: Adıyaman ilinde yılda 500’ün üzerinde hasta acil cerrahi geçirmektedir. En fazla acil cerrahi yapan bölümler genel cerrahi, çocuk cerrahisi, ortopedi ve beyin cerrahisidir. En fazla acil cerrahi yaz aylarında yapılmaktadır.

Tricyclic antidepressants are widely used drugs for treatment of depression despite serious mortality and morbidity in higher doses. They can cause severe cardiac arrhythmias, hypotension and central nervous system depression. Some patients may remain unresponsive in spite of conventional therapies such as gastric lavage and activated charcoal administration, benzodiazepines, volume replacement, lidocaine and sodium bicarbonate infusion. In this paper we report a 20-year-old female patient who had severe amitriptyline intoxication with a Glasgow Coma Scale score 4 and severe cardiac arrhythmias and was treated with hemodiafiltration. Conventional therapy was inadequate and hemodiafiltration was applied to the patient for 36 hours. At the end of the 36-hours the patient was conscious and became stabilized in terms of hemodynamics. In case of serious intoxication that does not respond to conventional therapy, approaches like hemodialysis, plasmapheresis, hemoperfusion and hemodiafiltration can be a rescue therapy and they should be considered.

ResumoObjetivoA lesão de isquemia‐reperfusão é uma das consequências da aplicação do torniquete em cirurgias de extremidades. O objetivo do estudo foi determinar o efeito de dexmedetomidina em lesão pulmonar aguda após modelo experimental de isquemia‐reperfusão em extremidade inferior de ratos.MétodosVinte e oito ratos albinos Wistar foram recrutados após aprovação do Comitê de Ética e alocados em quatro grupos, cada um com sete indivíduos. O Grupo 1 (Sham) recebeu apenas anestesia. O Grupo 2 (IR) foi submetido a 3 horas de isquemia e 3 horas de reperfusão com o uso de torniquete em extremidade inferior após a aplicação da anestesia. Os grupos 3 (D‐50) e 4 (D‐100) foram submetidos aos mesmos procedimentos do Grupo 2, exceto por receberem 50 e 100mg.kg−1 de dexmedetomidina, respectivamente, por via intraperitoneal uma hora antes da liberação do torniquete. Amostras de sangue foram coletadas para análise de TNF‐α e Interleucina‐6 (IL‐6). Amostras de tecido pulmonar foram coletadas para análise histológica.ResultadosNão houve diferença significativa quanto aos valores sanguíneos de TNF‐α e IL‐6 entre os grupos, enquanto os escores de lesão em tecidos pulmonares revelaram diferença significativa. Os escores histológicos obtidos no Grupo 2 foram significativamente maiores do que os dos grupos 1, 3 e 4, com valores‐p de 0,001 para cada comparação. Além disso, os escores do Grupo 1 foram significativamente menores do que os dos grupos 3 e 4, com valores‐p de 0,001 e 0,011, respectivamente. Não houve diferença significativa entre os grupos 3 e 4.ConclusãoDexmedetomidina mostrou eficácia na redução de lesão em tecido pulmonar induzida por isquemia‐reperfusão experimental em ratos, ocasionada por aplicação de torniquete em extremidade.AbstractObjectivIschemia‐reperfusion injury is one of the consequences of tourniquet application for extremity surgery. The aim of the study was to establish the effect of dexmedetomidine on the acute lung injury following lower extremity experimental ischemia–reperfusion model in rats.MethodsTwenty‐eight Wistar‐Albino breed rats were recruited after Ethics Committee approval and allocated into 4 groups, each with 7 subjects. Group 1 (SHAM) received only anesthesia. Group 2 (IR) had experienced 3h of ischemia and 3h of reperfusion using left lower extremity tourniquet after anesthesia application. Groups 3 (D‐50) and 4 (D‐100) had undergone the same procedures as in the Group 2, except for receiving 50 and 100mg.kg−1, respectively, dexmedetomidine intraperitoneally 1h before the tourniquet release. Blood samples were obtained for the analysis of tumor necrosing factor‐α and interleukin‐6. Pulmonary tissue samples were obtained for histological analysis.ResultsNo significant difference regarding blood tumor necrosing factor‐α and interleukin‐6 values was found among the groups, whereas pulmonary tissue injury scores revealed significant difference. Histological scores obtained from the Group 2 were significantly higher from those in the Groups 1, 3 and 4 with p‐values 0.001 for each comparison. Moreover, Group 1 scores were found to be significantly lower than those in the Groups 3 and 4 with p‐values 0.001 and 0.011, respectively. No significant difference was observed between the Groups 3 and 4.ConclusionDexmedetomidine is effective in reduction of the experimental ischemia–reperfusion induced pulmonary tissue injury in rats, formed by extremity tourniquet application.

Introduction Caudal epidural anesthesia, when used as a sole method for surgical anesthesia, has favorable effects on the recovery duration and the time spent in the recovery unit. In this study we made a retrospective analysis of pediatric surgery operations under local, regional and general anesthesia. We aimed to find shorter postoperative recovery times with local and regional anesthesia. Materials and methods Data of the pediatric patients undergone subumbilical surgery during the two-year period in Pediatric Surgery clinic were collected. The patients’ age, sex, surgery type, anesthesia and airway control routes, as well as duration of anesthesia, operation and recovery were obtained. Results Data of 937 patients were analyzed, of whom 811 (86.6%) were males. Caudal anesthesia was performed in 240 patients (25.6%) and the mean age of these patients was 3.83 ± 3.00 years. The patients with caudal and local anesthesia spent significantly less time in the postoperative recovery unit, compared with general anesthesia groups (P < 0.001). Conclusion Caudal anesthesia as a sole method for pediatric subumbilical surgery is a relatively safe method. Patients having operation under caudal anesthesia have faster discharge times from postoperative recovery units, compared with general anesthesia. This probably reduces recovery unit expenditures.

Objectives: To evaluate and compare the performances of new types of supraglottic airway devices (SADs) with endotracheal intubation regarding their ease of insertions, perioperative complications, and effects on hemodynamic parameters and peak airway pressures in laparascopic cholecystectomy (LC). Methods : One hundred and fourteen patients with ASA 1-2 physical status scheduled for elective LC were recruited for this prospective randomized controlled trial. The study was completed between January 2016 and January 2017 in Adiyaman University Research and Educational Hospital, Adiyaman, Turkey. The patients were divided into AuraGain(Ambu, Ballerup, Denmark) (n=38), i-Gel® (Intersurgical Ltd, UK) (n=35), and endotracheal tube (ETT)(n=32) groups. Ease of insertion, airway pressures, complications, and hemodynamic variables were compared. Results : The trial was completed with 105 patients. Ease of insertion for SADs which was evaluated with insertion procedure duration, attempts, first insertion success rates, and oropharyngeal leak pressures were similar between the groups. Heart rate, systolic and diastolic arterial pressures, and peak airway pressures were significantly lower in the AuraGain and i-Gel® groups, compared with the ETT, p less than 0.017. Conclusion : Both AuraGain and i-Gel® SADs are comparable with ETT used for airway control in general anesthesia for LC, regarding application ease and perioperative complications. Favorable hemodynamic responses to AuraGain and i-Gel® SADs may put them in a better place than ETT.

Background and objectives: Patient self-rating based scales such as Numerical Rating Scale, Visual Analog Scale that is used for postoperative pain assessment may be problematic in geriatric or critically ill patients with communication problems. A method capable of the assessment of pain in objective manner has been searched for years. Analgesia nociception index, which is based on electrocardiographic data reflecting parasympathetic activity, has been proposed for this. In this study we aimed to investigate the effectiveness of analgesia nociception index as a tool for acute postoperative pain assessment. Our hypothesis was that analgesia nociception index may have good correlation with Numerical Rating Scale values. Methods: A total of 120 patients of American Society of Anesthesiologists (ASA) physical status I and II undergoing any surgical procedure under halogenated-based anesthesia with fentanyl or remifentanil were enrolled for the study. At the 15th minute of arrival to the Postoperative Care Unit the patients’ pain was rated on a 0–10 point Numerical Rating Scale. The patients’ heart rate, blood pressure, and analgesia nociception index scores were simultaneously measured at that time. The correlation between analgesia nociception index, heart rate, blood pressure and Numerical Rating Scale was examined. Results: The study was completed with 107 patients, of which 46 were males (43%). Mean (SD) analgesia nociception index values were significantly higher in patients with initial Numerical Rating Scale ≤3, compared with Numerical Rating Scale >3 (69.1 [13.4] vs. 58.1 [12.9] respectively, p 3 (69,1 [13,4] vs. 58,1 [12,9], respectivamente, p

Hereditary Sensorial Autonomic Neur opathy (HSAN) type IV or congenital insensitivity to pain and anhidrosis (CIPA) is a rare congenital disorder characterized by recurrences of unexplained fever, extensive anhidrosis, insensitivity to pain, hypotonia and mental retardation in some cases. These patients develop corneal scarring, teeth eruptions, multiple fractures, osteomyelitis, buccal and lower limb wounds, injuries of finger tips so they undergo surgery. In this paper we report a patient with HSAN-IV, who developed tibia fracture and undergone successful operation under monitored anesthesia care. A 7 year old patient with HSAN-IV, admitted with left tibia fracture, obviously painless. He was operated under monitored anesthesia care without any complications and discharged home after a night follow-up. No anesthetic or analgesic drugs had been used for the surgery. Anesthetic considerations for the management of these patients are adequate perioperative sedation to reduce tactile hyperesthesia and excitement, close monitoring of cardiac rhythm and blood pressure, monitoring of body temperature and observation of nausea and vomiting.

Background Physicians’ adherence to guideline-recommended therapy is associated with short-term clinical outcomes in heart failure (HF) with reduced ejection fraction (HFrEF). However, its impact on longer-term outcomes is poorly documented. In this analysis we assessed the longer-term association of physicians’ adherence with clinical outcomes, including mortality and unplanned hospitalisations, at 18-month follow-up of the QUALIFY registry (Clinical trial registration ISRCTN87465420) Method and results Data at 18 months were available for 6118 ambulatory HFrEF patients from this international prospective observational survey. Adherence was measured as a continuous variable, ranging from 0 to 1, and was assessed with regard to five classes of recommended HF medications and dosages. Most deaths were cardiovascular (CV) (228/394) and HF-related (191/394) and the same was true for unplanned hospitalisations (1175 CV and 861 HF-related hospitalisations, out of a total of 1541). According to univariable analysis, CV and HF deaths were significantly associated with physician adherence to guidelines. In multivariable analysis, HF death was associated with adherence level [subdistribution hazard ratio (SHR) 0.93, 95% confidence interval (CI) 0.87–0.99 per 0.1 unit adherence level increase; P = 0.034] as was composite of HF hospitalisation or CV death (SHR 0.97, 95% CI 0.94–0.99 per 0.1 unit adherence level increase; P = 0.043), whereas unplanned all-cause, CV or HF hospitalisations were not (all-cause: SHR 0.99, 95% CI 0.9–1.02; CV: SHR 0.98, 95% CI 0.96–1.01; and HF: SHR 0.99, 95% CI 0.96–1.02 per 0.1 unit change in adherence score; P = 0.52, P = 0.2, and P = 0.4, respectively). Conclusion These results suggest that physicians’ adherence to guideline-recommended HF therapies is associated with improved outcomes in HFrEF. Practical strategies should be established to improve physicians’ adherence to guidelines.

Justificativa e objetivos A dor relacionada ao torniquete é um dos maiores obstáculos para a anestesia regional intravenosa (ARIV). Nosso objetivo foi comparar tramadol e lornoxicam usados em ARIV em relação aos seus efeitos sobre a qualidade da anestesia, dor relacionada ao torniquete e dor no pós‐operatório Métodos Após a aprovação do Comitê de Ética, 51 pacientes com estado físico ASA I‐II entre 18‐65 anos foram inscritos. Os pacientes foram divididos em três grupos. Grupo P (n = 17) recebeu 3 mg/kg de prilocaína a 0,5%; Grupo PT (n = 17) 3 mg/kg de prilocaína a 0,5% + 2 mL (100 mg) de tramadol e Grupo PL (n = 17) de 3 mg/kg de prilocaína a 0,5% + 2 mL (8 mg) de lornoxicam para ARIV. O início do bloqueio sensorial e motor e os tempos de recuperação foram registrados, bem como a dor relacionada ao torniquete e o consumo de analgésico no pós‐operatório. Resultados Os tempos de início do bloqueio sensorial foram mais curtos nos grupos PT e PL, enquanto que os tempos de recuperação correspondentes foram mais longos do que os do Grupo P. Os tempos de início do bloqueio motor nos grupos PT e PL foram menores do que no Grupo P, enquanto que o tempo de recuperação do grupo PL foi maior do que os dos grupos P e PT. O tempo para início da dor relacionada ao torniquete foi menor no Grupo P e maior no Grupo PL. Não houve diferença em relação à dor relacionada ao torniquete entre os grupos. O Grupo PL apresentou o menor consumo de analgésicos no pós‐operatório. Conclusão A adição de tramadol e lornoxicam à prilocaína para ARIV produz efeitos favoráveis sobre o bloqueio sensorial e motor. O consumo de analgésicos no pós‐operatório pode ser reduzido com a adição de tramadol e lornoxicam à prilocaína em ARIV. Background and objectives: Tourniquet pain is one of the major obstacles for intravenous regional anesthesia. We aimed to compare tramadol and lornoxicam used in intravenous regional anesthesia as regards their effects on the quality of anesthesia, tourniquet pain and postoperative pain as well. Methods: After the ethics committee approval 51 patients of ASA physical status I-II aged 18-65 years were enrolled. The patients were divided into three groups. Group P (n= 17) received 3 mg/kg 0.5% prilocaine; group PT (n= 17) 3 mg/kg 0.5% prilocaine + 2 mL (100 mg) tramadol and group PL (n= 17) 3 mg/kg 0.5% prilocaine + 2 mL (8 mg) lornoxicam for intravenous regional anesthesia. Sensory and motor block onset and recovery times were noted, as well as tourniquet pains and postoperative analgesic consumptions. Results: Sensory block onset times in the groups PT and PL were shorter, whereas the corresponding recovery times were longer than those in the group P. Motor block onset times in the groups PT and PL were shorter than that in the group P, whereas recovery time in the group PL was longer than those in the groups P and PT. Tourniquet pain onset time was shortest in the group P and longest in the group PL. There was no difference regarding tourniquet pain among the groups. Group PL displayed the lowest analgesic consumption postoperatively. Conclusion: Adding tramadol and lornoxicam to prilocaine for intravenous regional anesthesia produces favorable effects on sensory and motor blockade. Postoperative analgesic consumption can be decreased by adding tramadol and lornoxicam to prilocaine in intravenous regional anesthesia. © 2014 Sociedade Brasileira de Anestesiologia.

Objective Appendicitis is one of the most common cause of the emergent surgery. Studies showing that specific seasonal distribution of appendicitis are available in the current literature. In this study, we aimed to investigate the seasonal distribution the diagnosis of appendicitis in Adiyaman province.

Background/aim: Postdural puncture backache (PDPB) is the most frequent complaint after spinal anesthesia. In the literature its importance is generally overshadowed by postdural puncture headache. We studied two different kinds of spinal anesthesia needles to compare their technical handling capacities and incidences of PDPB. Materials and methods: Data of 256 pregnant female patients undergoing cesarean delivery under spinal anesthesia were collected for the study. Patients were divided into two groups as Group A (n = 109) and Group Q (n = 147) according to the spinal needle used for spinal anesthesia (i.e. 26-gauge atraumatic and 26-gauge Quincke needles, respectively). Backache incidences during a 1-week period postoperatively and handling characteristics of the needles were noted. Results: Spinal anesthesia was successfully performed at one attempt in 92.7% and 86.4% of patients in Groups A and Q, respectively. PDPB was encountered in 62.4% and 44.2% of patients in Groups A and Q, respectively, and the difference was statistically significant (P = 0.037). Conclusion: Both 26-gauge Atraucan and Quincke needles have excellent handling characteristics. PDPB seems to be less common with the 26-gauge Quincke needle than with the Atraucan needle.

Selective observation method has started to replace routine laparotomy application for abdominal penetrating trauma patients after Shaftan's selective observation method applied in the 1960s. In this respect, there is a possibility of bowel perforations healing without operations. An experimental model was established in this study in order to clarify this possibility.Fifty Wistar-Albino rats were divided into five groups, ten in each. While one group served as the control, distal part of the small bowel of the rats in the other four groups was perforated 1, 2, 3, and 4 mm in diameter with appropriate cutters. After a week of observation, test rats were sacrificed and relaparotomy was applied. The test material consisting of the perforated bowel, covering 1 cm of proximal and distal margins, and some peritoneal tissue was taken for histopathological examination.Small bowel perforations with a diameter of 2 mm or below healed spontaneously without any operation. Peritonitis intensity increased in direct ratio with perforation diameters. Wall repair capacity of the bowel diminished with increasing perforation diameters.It was observed that small perforations in the small bowel of rats could be limited by the organism itself without a necessity of any surgical intervention.

ResumoJustificativa e objetivosA traqueotomia percutânea tornou‐se uma boa alternativa para os pacientes com previsão de intubação prolongada em unidades de terapia intensiva. Os benefícios mais importantes da traqueotomia são alta precoce da unidade de terapia intensiva e menos tempo de permanência no hospital. As complicações da intubação intratraqueal prolongada são: lesão da laringe, paralisia das pregas vocais, estenose glótica e subglótica, infecção e lesão traqueal. O objetivo deste estudo foi avaliar as potenciais vantagens da traqueotomia percutânea precoce versus traqueotomia percutânea tardia em unidade de terapia intensiva.MétodosTraqueotomias percutâneas foram realizadas em 158 pacientes em unidade de terapia intensiva para adultos e analisadas retrospectivamente. Os pacientes foram alocados em dois grupos para traqueotomia precoce e tardia, de acordo com o tempo de intubação intratraqueal antes da traqueotomia percutânea. As traqueotomias consideradas precoces foram realizadas nos dias 0‐7 de intubação intratraqueal e as tardias realizadas após o sétimo dia de intubação intratraqueal. Os pacientes com infecção no local da traqueotomia, intubação difícil ou potencialmente difícil, idade inferior a 18 anos, pressão positiva ao final da expiração acima de 10cmH2O e aqueles com diátese hemorrágica ou contagem de plaquetas em 50.000dL−1 foram excluídos do estudo. Os tempos de ventilação mecânica e internação em UTI foram registrados.ResultadosNão houve diferença estatística entre os dados demográficos dos pacientes. Os tempos de ventilação mecânica e de internação em unidade de terapia intensiva do grupo traqueotomia precoce foram menores e a diferença foi estatisticamente significativa (p

ResumenIntroducción y objetivosLa traqueotomía percutánea se ha convertido en una buena alternativa para los pacientes con previsión de intubación prolongada en unidades de cuidados intensivos (UCI). Los beneficios más importantes de la traqueotomía son el alta precoz de la UCI y menos tiempo de permanencia en el hospital. Las complicaciones de la intubación endotraqueal prolongada son: lesión de la laringe, parálisis de las cuerdas vocales, estenosis glótica y subglótica, infección y lesión traqueal. El objetivo de este estudio fue evaluar las potenciales ventajas de la traqueotomía percutánea precoz versus traqueotomía percutánea tardía en la UCI.MétodosSe realizaron traqueotomías percutáneas en 158 pacientes en la UCI para adultos, siendo analizadas retrospectivamente. Los pacientes fueron divididos en 2 grupos para traqueotomía precoz y tardía, de acuerdo con el tiempo de intubación endotraqueal antes de la traqueotomía percutánea. Las traqueotomías consideradas precoces fueron realizadas en los días 0-7 de intubación endotraqueal, y las tardías, después del séptimo día de intubación endotraqueal. Los pacientes con infección en la región de la traqueotomía, intubación difícil o potencialmente difícil, con una edad inferior a 18años, presión positiva al final de la espiración por encima de 10cmH2O y los que tenían diátesis hemorrágica o conteo de plaquetas en 50.000dl–1 fueron excluidos del estudio. Se registraron los tiempos de ventilación mecánica y de ingreso en la UCI.ResultadosNo hubo diferencia estadística entre los datos demográficos de los pacientes. Los tiempos de ventilación mecánica y de ingreso en la UCI del grupo traqueotomía precoz fueron menores, y la diferencia fue estadísticamente significativa (p

Background and objectives: Percutaneous tracheotomy has become a good alternative for patients thought to have prolonged intubation in intensive care units. The most important benefits of tracheotomy are early discharge of the patient from the intensive care unit and shortening of the time spent in the hospital. Prolonged endotracheal intubation has complications such as laryngeal damage, vocal cord paralysis, glottic and subglottic stenosis, infection and tracheal damage. The objective of our study was to evaluate potential advantages of early percutaneous tracheotomy over late percutaneous tracheotomy in intensive care unit. Methods: Percutaneous tracheotomies applied to 158 patients in adult intensive care unit have been analyzed retrospectively. Patients were divided into two groups as early and late tracheotomy according to their endotracheal intubation time before percutaneous tracheotomy. Tracheotomies at the 0–7th days of endotracheal intubation were grouped as early and after the 7th day of endotracheal intubation as late tracheotomies. Patients having infection at the site of tracheotomy, patients with difficult or potential difficult intubation, those under 18 years old, patients with positive end-expiratory pressure above 10 cmH2O and those with bleeding diathesis or platelet count under 50,000 dL−1 were not included in the study. Durations of mechanical ventilation and intensive care stay were noted. Results: There was no statistical difference among the demographic data of the patients. Mechanical ventilation time and time spent in intensive care unit in the group with early tracheotomy was shorter and the difference was statistically significant (p < 0.05). Conclusion: Early tracheotomy shortens mechanical ventilation duration and intensive care unit stay. For that reason we suggest early tracheotomy in patients thought to have prolonged intubation. Justificativa e objetivos: A traqueotomia percutânea tornou-se uma boa alternativa para os pacientes com previsão de intubação prolongada em unidades de terapia intensiva. Os benefícios mais importantes da traqueotomia são alta precoce da unidade de terapia intensiva e menos tempo de permanência no hospital. As complicações da intubação intratraqueal prolongada são: lesão da laringe, paralisia das pregas vocais, estenose glótica e subglótica, infecção e lesão traqueal. O objetivo deste estudo foi avaliar as potenciais vantagens da traqueotomia percutânea precoce versus traqueotomia percutânea tardia em unidade de terapia intensiva. Métodos: Traqueotomias percutâneas foram realizadas em 158 pacientes em unidade de terapia intensiva para adultos e analisadas retrospectivamente. Os pacientes foram alocados em dois grupos para traqueotomia precoce e tardia, de acordo com o tempo de intubação intratraqueal antes da traqueotomia percutânea. As traqueotomias consideradas precoces foram realizadas nos dias 0-7 de intubação intratraqueal e as tardias realizadas após o sétimo dia de intubação intratraqueal. Os pacientes com infecção no local da traqueotomia, intubação difícil ou potencialmente difícil, idade inferior a 18 anos, pressão positiva ao final da expiração acima de 10 cmH2O e aqueles com diátese hemorrágica ou contagem de plaquetas em 50.000 dL−1 foram excluídos do estudo. Os tempos de ventilação mecânica e internação em UTI foram registrados. Resultados: Não houve diferença estatística entre os dados demográficos dos pacientes. Os tempos de ventilação mecânica e de internação em unidade de terapia intensiva do grupo traqueotomia precoce foram menores e a diferença foi estatisticamente significativa (p < 0,05). Conclusão: Traqueotomia precoce reduz o tempo de ventilação mecânica e de internação em unidade de terapia intensiva. Portanto, sugerimos a traqueotomia precoce em pacientes com suspeita de intubação prolongada. Introducción y objetivos: La traqueotomía percutánea se ha convertido en una buena alternativa para los pacientes con previsión de intubación prolongada en unidades de cuidados intensivos (UCI). Los beneficios más importantes de la traqueotomía son el alta precoz de la UCI y menos tiempo de permanencia en el hospital. Las complicaciones de la intubación endotraqueal prolongada son: lesión de la laringe, parálisis de las cuerdas vocales, estenosis glótica y subglótica, infección y lesión traqueal. El objetivo de este estudio fue evaluar las potenciales ventajas de la traqueotomía percutánea precoz versus traqueotomía percutánea tardía en la UCI. Métodos: Se realizaron traqueotomías percutáneas en 158 pacientes en la UCI para adultos, siendo analizadas retrospectivamente. Los pacientes fueron divididos en 2 grupos para traqueotomía precoz y tardía, de acuerdo con el tiempo de intubación endotraqueal antes de la traqueotomía percutánea. Las traqueotomías consideradas precoces fueron realizadas en los días 0-7 de intubación endotraqueal, y las tardías, después del séptimo día de intubación endotraqueal. Los pacientes con infección en la región de la traqueotomía, intubación difícil o potencialmente difícil, con una edad inferior a 18 años, presión positiva al final de la espiración por encima de 10 cmH2O y los que tenían diátesis hemorrágica o conteo de plaquetas en 50.000 dl−1 fueron excluidos del estudio. Se registraron los tiempos de ventilación mecánica y de ingreso en la UCI. Resultados: No hubo diferencia estadística entre los datos demográficos de los pacientes. Los tiempos de ventilación mecánica y de ingreso en la UCI del grupo traqueotomía precoz fueron menores, y la diferencia fue estadísticamente significativa (p < 0,05). Conclusión: La traqueotomía precoz reduce el tiempo de ventilación mecánica y de ingreso en la UCI. Por tanto, sugerimos la traqueotomía precoz en pacientes con sospecha de intubación prolongada.

Meckel's diverticulum (MD) is the most common congenital anomaly of small intestine. It is the most common end result of the spectrum of omphalomesenteric duct anomalies, which also include umbilicoileal fistula, umbilical sinus or cyst, and a fibrous cord connecting the ileum to the umbilicus. Besides this, abnormal remnants of the urachus can present as patent urachus, vesicourachal diverticulum, urachal sinus or urachal cyst (UC). Urachal cysts represent an incomplete closure of the urachus, a cord-like structure connecting the primitive bladder to the umbilicus in early embryonic formation. Primary aim of this study was to present and share an orginal case of enterocutaneous fistula formation of MD via the UC in an adult patient, which is the first in literature. A 39-year-old male applied to the emergency surgery service with complaints of increasing abdominal pain, nausea, vomiting and fecal discharge from the umbilicus. Laparotomy was carried out with a suspicion of intrabdominal mass and enterocutaneous fistula formation. The surgical exploration revealed enterocutaneous fistula formation of MD via the UC. The patient was treated successfully with resection of UC and MD, and had an uneventful postoperative recovery. We conducted a literature review of studies published in the English language on

Perforation of the gastrointestinal system by a foreign body is seldom observed in clinical practice; however, it has great importance because it is preventable and can usually be easily treated. In this case report, we present a young male patient, who mistakenly swallowed a foreign body and presented to the emergency service one day later with acute abdomen. The 23-year-old patient was diagnosed with acute appendicitis and underwent emergency laparotomy. During the operation, a plastic object that perforated the terminal ileum lumen and protruded into the abdominal cavity was identified. Along with appendectomy, the foreign body was removed and the ileum was repaired. The detailed history of the patient revealed that he had mistakenly swallowed something one day before the onset of abdominal pain. The patient was discharged on the postoperative seventh day following an uneventful course.

continuous infusion) was administered to Group 2 for sedation. Just before the surgical procedure, all patients received IV propofol in a subhypnotic dose of 0.5 mg kg -1 ; the dose was repeated if adequate sedation could not be achieved. Observer’s assessment of alertness/sedation (OAA/S) scale and Bispectral index (BIS) were used to evaluate the sedation level during the procedure. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), peripheral oxygen saturation (SpO 2 ) and end-tidal carbon dioxide pressure (ETCO 2 ) were monitored before and after induction and every 5 minutes thereafter. Propofol requirement was noted for each group. Results: Sedation in the dexmedetomidine group was as effective and adequate as that observed in the midazolam group. BIS values were significantly lower in the dexmedetomidine group, especially after 10 minutes and thereafter. RR, SpO2, and ETCO2 were similar in both groups, whereas clinically insignificant decreases in HR and MAP were observed in the dexmedetomidine group. Propofol requirements were similar in both groups.

BACKGROUND Spinal anesthesia has become appropriate for many surgical procedures. Neuraxial anesthesia can result in acute and late complications like hypotension, bradycardia, local anesthetic toxicity, postdural-puncture headache, backache and spinal nerve damage. Although the body's physiological responses to spinal anesthesia are well understood, its effects on intraocular pressure (IOP) haven't been mentioned before. OBJECTIVES The aim of this study was to investigate the effects of spinal anesthesia on IOP. MATERIAL AND METHODS Forty patients receiving spinal anesthesia for subumblical surgery were recruited for the study, after ethics committee approval and patients' written informed consent. IOP was measured by Icare PRO tonometer (Icare, Finland) before spinal anesthesia (BS), immediately after spinal anesthesia (AS) and finally on the first postoperative day (PO1). Both eyes of the patients were included in the study. RESULTS Thirty-eight patients completed the study. Mean BS, AS and PO1 intraocular pressures were 16.53±3.17 (9.40-24.00), 17.08±3.16 (10.00-24.00) and 16.76±2.80 (10.20-23.00) mm Hg, respectively. Mean IOP measurements were not statistically different among the three groups (p=0.104). CONCLUSIONS Spinal anesthesia alone has no acute or subacute effects on IOP. Studies can be made to evaluate the chronic effects. Further studies must be focused on the relationship between postdural puncture headache and intraocular pressure changes after spinal anesthesia.

Background and objectives: Many conditions such as bacterial and viral infectious diseases, mechanical obstruction due to air and calculi and drugs can cause parotitis. We present a case of unusual bilateral parotitis in a patient under non-invasive continuous positive airway pressure (CPAP) therapy for chronic obstructive pulmonary disease exacerbation in intensive care unit. Case report: A 36-year-old patient was admitted to intensive care unit with the diagnosis of chronic obstructive pulmonary disease exacerbation. Antibiotherapy, bronchodilator therapy and non-invasive positive pressure ventilation were applied as treatment regimen. Painless swellings developed on the 3rd day of admission on the right and a day after this on the left parotid glands. Amylase levels were increased and ultrasonographic evaluation revealed bilateral parotitis. No intervention was made and the therapy was continued. The patient was discharged on the 6th day with clinical improvement and regression of parotid swellings without any complications. Conclusions: Parotitis may have occurred after retrograde air flow in the Stensen duct during CPAP application. After the exclusion of possible viral and bacteriological etiologies and possible drug reactions we can focus on this diagnosis. Resumo: Justificativa e objetivos: Muitas condições podem causar parotidite, incluindo doenças infecciosas virais e bacterianas, obstrução mecânica por causa da presença de ar, cálculos e medicamentos. Apresentamos um caso de parotidite bilateral incomum em um paciente sob tratamento com pressão positiva contínua não invasiva das vias aéreas (PPCVA) para exacerbação da doença pulmonar obstrutiva crônica em unidade de terapia intensiva. Relato de caso: Paciente de 36 anos, internado em unidade de terapia intensiva com diagnóstico de exacerbação da doença pulmonar obstrutiva crônica. Antibioterapia, terapia broncodilatadora e ventilação com pressão positiva não invasiva foram aplicadas como regime de tratamento. No terceiro dia de internação, inchaços indolores desenvolveram-se à direita da glândula parótida e, depois, à esquerda. Os níveis de amilase aumentaram e o exame ultrassonográfico revelou parotidite bilateral. Nenhuma intervenção foi feita e o tratamento foi continuado. O paciente recebeu alta no sexto dia, com melhoria clínica e regressão do inchaço da parótida, sem complicações. Conclusões: A parotidite pode ter ocorrido após o fluxo retrógrado de ar do duto de Stensen durante a aplicação de PPCVA. Após a exclusão de possíveis etiologias virais e bacteriológicas e possíveis reações medicamentosas, podemos focar no diagnóstico. Keywords: Parotitis, Bilateral parotitis, Pneumoparotitis, Continuous positive airway pressure, Palavras-chave: Parotidite, Parotidite bilateral, Pneumoparotidite, Pressão positiva contínua das vias aéreas

Objective: The aim of this study was to compare two spinal needles with different bevel designs regarding their technical handling capacities and complication rates. Materials and Methods: After the clinical trials Ethics Committee approval and informed consents from the patients, 220 pregnant female patients undergoing elective cesarean delivery under spinal anesthesia were recruited in the study. Patients were divided into two groups as, Group A (n = 110) and Group Q (n = 110); who received spinal anesthesia via 26 gauge (26-G) atraumatic spinal needle (Atraucan® , B. Braun Melsunger, Germany) and via 26-G Quincke spinal needle (Spinocan® , B. Braun Melsunger, Germany), respectively. Procedure duration, puncture attempts and postdural puncture headache (PDPH) incidence were recorded. The costs of the spinal needles were also noted. Results: There were no significant differences between the two groups in spinal puncture attempts and procedure durations. Similarly, incidence, severity, onset time and duration of headache were not found to be significantly different between the two groups. Ten patients (9.2%) in Group A and 11 (10.3%) in Group Q had developed PDPH. Conclusion: Both spinal needles offer good handling characteristics with comparable incidence of PDPH. Taking into account economical factors 26-G Quincke needle may be preferred to 26-G Atraucan® .

AIM: To study possible gynecological organ pathologies in the differential diagnosis of acute right lower abdominal pain in patients of reproductive age. METHODS: Following Clinical Trials Ethical Committee approval, the retrospective data consisting of physical examination and laboratory findings in 290 patients with sudden onset right lower abdominal pain who used the emergency surgery service between April 2009 and September 2013, and underwent surgery and general anesthesia with a diagnosis of acute appendicitis were collated. RESULTS: Total data on 290 patients were obtained. Two hundred and twenty-four (77.2%) patients had acute appendicitis, whereas 29 (10%) had perforated appendicitis and 37 (12.8%) had gynecological organ pathologies. Of the latter, 21 (7.2%) had ovarian cyst rupture, 12 (4.2%) had corpus hemorrhagicum cyst rupture and 4 (1.4%) had adnexal torsion. Defense, Rovsing’s sign, increased body temperature and increased leukocyte count were found to be statistically significant in the differential diagnosis of acute appendicitis and gynecological organ pathologies. CONCLUSION: Gynecological pathologies in women of reproductive age are misleading in the diagnosis of acute appendicitis.

With the developments in medical technology and increased surgical experience, advanced laparoscopic surgical procedures are performed successfully. Laparoscopic abdominal surgery is one of the best examples of advanced laparoscopic surgery (LS). Today, laparoscopic abdominal surgery in general surgery clinics is the basis of all abdominal surgical interventions. Laparoscopic abdominal surgery is associated with systemic and splanchnic hemodynamic alterations. Inadequate splanchnic perfusion in critically ill patients is associated with increased morbidity and mortality. The underlying pathophysiological mechanisms are still not well understood. With experience and with an increase in the number and diversity of the resulting data, the pathophysiology of laparoscopic abdominal surgery is now better understood. The normal physiology and pathophysiology of local and systemic effects of laparoscopic abdominal surgery is extremely important for safe and effective LS. Future research projects should focus on the interplay between the physiological regulatory mechanisms in the splanchnic circulation (SC), organs, and diseases. In this review, we discuss the effects of laparoscopic abdominal surgery on the SC.