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Patients with de Winter syndrome, also termed anterior ST-segment elevation myocardial infarction (STEMI)-equivalent, represent 2% of all patients with acute anterior myocardial infarctions admitted to emergency departments (EDs). STEMI-equivalents do not present with classical electrocardiogram (ECG) changes but exhibit a critical stenosis of the left anterior descending (LAD) coronary artery. This is under-recognized by clinicians and is therefore associated with high morbidity and mortality. Here, we report a rare case of a novel, typical, STEMI-equivalent ECG pattern without obvious ST-segment elevation in a 34-year-old female who presented to our ED with substantial chest pain and a large, acute, transmural anterior myocardial infarction caused by acute occlusion of the LAD coronary artery. However, she presented as a non-STEMI case. A definite diagnosis of de Winter syndrome was made on the basis of clinical and ECG findings. Cardiol Res. 2017;8(4):165-168 doi: https://doi.org/10.14740/cr576w

The purpose of this study was to investigate the effects of theophylline and methylprednisolone on the mechanical response and histopathology of hemidiaphragm muscle in rats. In the current study, we aimed to investigate the effects of theophylline and methylprednisolone, which are frequently used in clinics and which have different effects on the respiratory system and on the biomechanics and histopathology of the diaphragm muscle. The study included four groups of rats. Group T received 1 mg/kg of intraperitoneal theophylline, group M received 2 mg/kg of intraperitoneal methylprednisolone, group TM received 1 mg/kg of intraperitoneal theophylline plus 2 mg/kg of intraperitoneal methylprednisolone, and group K received of 1 mL intraperitoneal isotonic solution (of 0.9 % NaCl). The medications were continued for 7 days in each group. The rats underwent cervical dislocation under anesthesia on the eighth day, and their diaphragm samples were extracted. The left hemidiaphragm was used for the investigation of biomechanical parameters, and the right hemidiaphragm was used for the histopathological evaluation. It was observed that the medication administered in group T increased the contraction strength and duration compared with that in group M. Additionally, the duration of semi-relaxation was prolonged in group T compared with group M. The highest contraction strength and the longest contraction period among all of the groups were observed in group TM. It was concluded that the combined use of theophylline and methylprednisolone had positive effects on the contraction strength and the durations of contraction and semi-relaxation of the diaphragm muscle. In addition, both drugs had synergistic effects on each other.

Aim: Good pain management is provided via spinal and general anesthesia during knee joint drainage to treat septic arthritis, but the side effects are greater than those associated with local anesthesia, and the preparation process is long. Arthroscopic drainage under local anesthesia for knee septic arthritis treatment have been described, but this method requires special equipment. In this study, we aimed to evaluate the applicability of mini-open surgery under local anesthetic infiltration in cases of septic knee arthritis. Material and Method: 14 consecutive patients (eight men, six women) were admitted for knee septic arthritis treatment. Patient age ranged from 18 to 56 years, with an average age of 33 years. Drainage procedure was performed under local anesthesia, and the results were evaluated clinically. Results: The visual analog scale scores were between two and four (mean 2.8). The follow-up period was 10-21 months (mean 14.3). The Tegner and International Knee Documentation Committee scores were acceptable except for one patient. Discussion: This prospective study included mini-open surgery performed under local anesthesia on 14 septic knees, and showed that this method is safe, effective, well tolerated and be alternative to conventional techniques.

Objective: Inflammatory reaction, which causes tissue damage in Acute Coronary Syndrome (ACS), leads to deterioration. White Blood Cell (WBC), Neutrophil (N), Lymphocyte (L) and Neutrophil/ Lymphocyte (N/L) ratios were used to refer to the inflammation. High neutrophil levels show us acute inflammatory situation and low lymphocyte levels show us physiological stress. That is why N/L ratio is a valuable parameter which enables us to guess patient prognosis in Emergency Department (ED). In this study, white cell and NLR relations with ACS in patients with chest pain is evaluated. Material and Method: Patients referring to ED with chest pain within 3 months were investigated retrospectively. 100 patients were included in the study. Patients' WBC count, NLR and WBC values, gender, Troponin-I and CK-MB positivity, history of Coronary Heart Disease (CHD) and additional diseases were examined according to the final diagnoses. All the patients were divided into three groups according to ACS: Unstable Angina Pectoris (USAP), Non-ST Elevated Myocardial Infarction (NSTEMI), and ST-Elevated Myocardial Infarction (STEMI). Mortality and morbidity levels in hospital and after discharge were also examined in the study. Findings: WBC values in patients with positive Troponin-I were found statistically higher than patients with negative Troponin-I (p

Cytomegaloviruses are opportunistic pathogens that cause lung infection in immunocompromised individuals. A 24-year-old male was admitted to the hospital with complaints of cough, fever and dyspnoea. He was receiving immunosuppressive therapy for polyarteritis nodosa. A chest X-ray showed heterogeneous right-sided opacity in the middle and lower lung zones. The diagnosis of cytomegalovirus pneumonia was confirmed by positive testfor serum cytomegalovirus IgM antibodies.Oneday after admission, haemoptysis developed and patient with hemoptysis who had shortness of breath was intubated. Computed tomography (CT) showed bilateral alveolar opacity.

To investigate the effects of occupational exposure to anaesthetic gases on myeloperoxidase activity, oxidative and antioxidative parameters in operating room personnel.The cross-sectional study was conducted at Yuzuncu Yil University, Van, Turkey, in May 2011, and comprised equal number of operating room and non-operating room personnel. Serum myeloperoxidase activity, sulfhydryl group levels, lipid hydroperoxide levels and catalase activity were determined. SPSS 11 was used for data analysis.There were 64 subjects; 32(50%) each in the two groups. Myeloperoxidase activity and lipid hydroperoxide levels were significantly higher in operating room personnel than in the non-operating room personnel (p0.001; p0.001), while catalase activity and sulfhydryl group levels were significantly lower (p0.009; p0.003). Catalase activity negatively correlated with lipid hydroperoxide levels in operating room personnel (r=-0.293; p=0.018). Myeloperoxidase activity negatively correlated with sulfhydryl group levels in operating room personnel (r=-0.267; p=0.031).Operating room personnel exhibited higher oxidative stress, which may be due to the oxidative effect of anaesthetic gases.

Spinal anesthesia is a regional anesthetic technique applied by the anesthesiologist, more than a hundred years. The growing popularity of ambulatory surgical procedures have led to more frequent use of spinal anesthesia. This is an anesthetic technique which enhances the satisfaction of the patient and surgeon with this aspect. Chordoma is a rare, slow growing primary malignant tumor of the axial skeleton. It is seen at sacrum and skull base in the spine especiallay sacrococcygeal area (%50). In this paper, we presented a rare case of sacral chordoma up our spinal anesthesia. Perioperative potential risks can be minimized by close monitoring and good preoperative evaluation. Thus; anesthesic technique which even thought as an unappropriate method can be prefered and we believe that diagnosis can remain in the secondary plan in this decision.

Background Neostigmine, the currently commonly used agent for reversal of neuromuscular blockade. Sugammadex is a novel and unique compound designed as an antagonist of steroidal neuromuscular blockers. In this study, we evaluated the effects of sugammadex or neostigmine on kidney functions in patients scheduled for elective surgery. Material/methods Patients scheduled for a surgical procedure under desflurane/opioid anesthesia received an intubating dose rocuronium. Patients were divided into 2 groups receiving either sugammadex or neostigmine atropine to reverse neuromuscular blockade. Cystatin C, creatinine, urea, blood urea nitrogen, sodium, potassium, and calcium levels in the blood and α1microglobulin, β2microglobulin, and microalbumin levels in the urine were measured. Results There was no significant difference between the groups with regard to the demographic data. In the Neostigmine Group, although β2microglobulin and microalbumin were similar, a significant increase was found in the postoperative α1microglobulin and cystatin C values. In the Sugammadex Group, although β2-microglobulin and cystatin C were similar, a significant increase was found in the postoperative α1-microglobulin and microalbumin values. The only significant difference was cystatin C value variation in the Neostigmine Group compared to the Sugammadex Group. Conclusions We believe that the use of more specific and sensitive new-generation markers like cystatin C to evaluate kidney function will provide a better understanding and interpretation of our results. Sugammadex has more tolerable effects on kidney function in patients than does neostigmine. However, when compared to preoperative values, there is a negative alteration of postoperative values. Neostigmine and sugammadex do not cause renal failure but they may affect kidney function.

Aim: Biological effects of electromagnetic field (EMF) and their consequences on human health have been the subject of much interest and research in recent years. The aim of this study was to investigate the effects of 900 MHz EMF on femur fracture healing in a rat model. Material and Method: After sixty male Sprague-Dawley rats were exposed to a closed right femur fracture under anesthesia, the reduction and fixation were done with a 21 g needle. Then, 900 MHz radiation (2 W peak output power and 1.04 mW/cm2 power density) was applied to EM group for one hour/day for seven days. The healing was assessed using radiological (Lane and Sandhu classification), histological (Huo scale for callus evaluation), and biomechanical (3-point bending) measures at 2nd, 4th and 6th weeks after fracture. Results: Fracture healing, as assessed radiologically and histopathologically, in Group EM and control animals was similar at 2nd, 4th and 6th weeks. Fracture healing, as assessed biomechanically, was significantly better in Group EM compared to controls in those sacrificed at 2nd week post-procedure (p

Resumo Miastenia grave (MG) e uma doenca autoimune caracterizada por fraqueza muscular que flutua, piora com o esforco fisico e melhora com o repouso. O diagnostico de MG e feito apos exame clinico e fisico e confirmado por imunoensaios sericos para medir os niveis de autoanticorpos. MG, especialmente quando associada a gravidez, e uma doenca de alto risco e de curso imprevisivel. Descrevemos o segundo relato sobre o uso de sugamadex apos rocuronio para uma cesariana com miastenia grave, mas, ao contrario de nosso caso, que foi previamente diagnosticado com miastenia grave, a paciente foi extubada com sucesso no pos‐operatorio sem qualquer problema respiratorio.

The effects of many intravenous drugs, which are used for sedation anesthesia, on free radicals are well known. Two of these drugs are propofol and dexmedetomidine. This study was designed to investigate the effects of dexmedetomidine and propofol on the oxidant and antioxidant systems. Subjects were divided into two groups. Propofol were given to the first group (n=19) and dexmedetomidine to the second group (n=13) for sedation. Blood pressure and heart rate were recorded and serum ALT (alanine aminotransferase), AST (aspartate aminotransferase), creatinine, BUN (blood urea nitrogen), MDA (malondialdehyde), catalase and GSH-Px (glutathione peroxidase) were measured before and 2 hours and 2 days after the drug administration. When propofol and dexmedetomidine groups were compared in terms of blood pressure, heart rate, serum AST, ALT, BUN and creatinin values no statistically significant difference was detected. In propofol group MDA values decreased significantly (p

Acute mountain sickness (AMS) is a pathological reaction, occurring as a result of failure to adapt to altitude. The main symptoms reported are headache, nausea, vomiting and fatigue. However, high altitude cerebral and pulmonary edema, occurring in AMS, cause potentially fatal consequences. In our 31-year-old case, who is the group leader and activity organizer among nine mountaineers, who climbed Mt. Aĝri{dotless} for winter climbing, nausea, vomiting, unconsciousness, lack of appetite and severe headache have occurred in connection with high altitude at 4200 m. Brain MRI of the patient revealed wide-spread hyperintense lesions at subcortical white matter, corpus callosum, globus pallidi, and bilateral cerebellar peduncles on T2 and FLAIR series. The patient was referred to anesthesia-intensive care unit of our hospital. Since the appearances are demonstrative, MRI findings are presented. © 2010 Elsevier Ireland Ltd.

Background Scant information exists about the epidemiological characteristics and outcome of patients in the intensive care unit (ICU) at risk of acute respiratory distress syndrome (ARDS) and how ventilation is managed in these individuals. We aimed to establish the epidemiological characteristics of patients at risk of ARDS, describe ventilation management in this population, and assess outcomes compared with people at no risk of ARDS. Methods PRoVENT (PRactice of VENTilation in critically ill patients without ARDS at onset of ventilation) is an international, multicentre, prospective study undertaken at 119 ICUs in 16 countries worldwide. All patients aged 18 years or older who were receiving mechanical ventilation in participating ICUs during a 1-week period between January, 2014, and January, 2015, were enrolled into the study. The Lung Injury Prediction Score (LIPS) was used to stratify risk of ARDS, with a score of 4 or higher defining those at risk of ARDS. The primary outcome was the proportion of patients at risk of ARDS. Secondary outcomes included ventilatory management (including tidal volume [VT] expressed as mL/kg predicted bodyweight [PBW], and positive end-expiratory pressure [PEEP] expressed as cm H2O), development of pulmonary complications, and clinical outcomes. The PRoVENT study is registered at ClinicalTrials.gov, NCT01868321. The study has been completed. Findings Of 3023 patients screened for the study, 935 individuals fulfilled the inclusion criteria. Of these critically ill patients, 282 were at risk of ARDS (30%, 95% CI 27–33), representing 0·14 cases per ICU bed over a 1-week period. VTwas similar for patients at risk and not at risk of ARDS (median 7·6 mL/kg PBW [IQR 6·7–9·1] vs 7·9 mL/kg PBW [6·8–9·1]; p=0·346). PEEP was higher in patients at risk of ARDS compared with those not at risk (median 6·0 cm H2O [IQR 5·0–8·0] vs 5·0 cm H2O [5·0–7·0]; p

Objective: Outpatient anesthesia requires a safe anesthetic method and an anesthetic agent that provides a rapid anesthesia depth and hemodynamic stability. To provide an uneventfully recovery, the anesthetic must also be rapidly metabolized, and its metabolites should not accumulate in the body. This study compared sedo-analgesia effects, recovery times, postoperative complications, Modified Aldrete Scale, Visual Analog Scores, and patient and surgeon satisfaction between propofol and ketofol, administered as anesthetics during the probe curettage procedure.Methods: A total of 60 female patients included in the study. Group P was administered 2 mg/kg of propofol and a 1 μg/kg intravenous bolus of fentanyl for induction and 100 μg/kg/min of propofol for maintenance. Group K was administered a 600 µg/kg IV bolus of ketofol for induction and 100 µg/kg/min of ketofol for maintenance. Additional fentanyl (50 µg) was administered to Group P, and 25 µg/kg/min of ketofol was administered to Group K according to autonomic and hemodynamic responses.Results: Demographic data of the 2 groups were similar. A significant decrease in hemodynamic values was detected in patients in Group P after induction. No change in these values was detected during or after induction in Group K. The additional analgesia requirement was 66.6% in Group P. Nausea was detected in 2 patients in Group K. Additionally, hallucination was detected in 2 patients in Group K. Patient and surgeon satisfaction were complete in both groups.Conclusion: According to our findings, ketofol anesthesia may be a good option in uterine curettage, patients recover quickly and comfortably, and ketofol both provides sufficient analgesia for the minor surgical intervention and reduces complications. J Clin Exp Invest 2015; 6 (3): 244-250Key words: Ketofol, propofol, sedo-analgesia, uterine curettage, Amaç: Günübirlik anestezi, hemodinamik stabiliteyi koruyacak ve anestezi derinliğini hızla sağlayacak bir anestezik ajan ile güvenli bir anestezi metodu gerektirir. Sorunsuz bir uyanma sağlamak için anestezik ilaçlar hızla metabolize olmalıdır ve metabolitleri vücutta birikmemelidir. Bu çalışma da; probe küretaj işlemi uygulanacak hastalarda, propofol ve ketofol anestezisinin sedoanaljezik etkisine, uyanma zamanına, postoperatif komplikasyonlara, Modifiye Aldrete Skalasına, Visüel Analog Skoruna, hasta ve cerrah memnuniyetine bakmayı amaçladık.Yöntemler: Çalışmaya 60 kadın hasta alındı. Grup p’ye indüksiyonda intravenöz 2 mg/kg propofol ve 1μg/kg fentanyl uygulandı. İdamede propofol 100 μg/kg/dk ile devam edildi. Grup K’ya ise indüksiyonda intravenöz 600 µg/kg ketofol ve idamede 100µg/kg/dk ketofol verildi. Otonomik ve hemodinamik cevaplara göre Grup P’ye 50 µg fentanyl, Grup K’ya ise 25µg/kg/dk ketofol ek doz yapıldı. Bulgular: Her iki grupta demografik veriler benzerdi. Grup P’de indüksiyondan sonra hemodinamik parametrelerde belirgin bir düşme görüldü. Grup K’da indüksiyondan sonra hemodinamik parametrelerde herhangi bir değişiklik gözlemlenmedi. Grup P’de ek analjezik gereksinimi %66,6 idi. Grup K’da 2 hastada bulantı ve 2 hastada halüsinasyonlar görüldü. Hasta ve cerrah memnuniyeti her iki grupta tamdı. Sonuç: Bizim bulgularımıza göre küçük cerrahi girişim olan uterin küretaj da Ketofol anestezisi iyi bir seçenektir. Hasta da rahat ve hızlı bir uyanma sağlar, ayrıca minör cerrahi girişimlerde analjezi gereksinimini azaltarak postoperatif komplikasyonları da azaltır

Objectives: In the current study, we compared the effects of low- and high-flow anesthesia techniques on hemorheology and coagulation parameters in patients who received sevofluran. Methods: Forty patients classified as Risk Group I–II according to American Society of Anesthesiologists’ (ASA) guidelines who were scheduled to undergo general anesthesia were randomly assigned to one of two groups. Low-flow anesthesia was administered to the first group, and high-flow anesthesia was used in the second group. Blood samples were obtained in the preoperative and peroperative periods (at 60 and 120 min) for determination of blood and plasma viscosity, plasma oncotic pressure, international normalized ratio (INR), phorotrombin time (PT), activated partial phorotrombin time (aPTT) and fibrinogen. Blood was also drawn for analysis of factor VIII (FVIII) activity, which was measured in the preoperative period and at postoperative six hour. Results: The peroperative plasma viscosity was significantly low in Group 1 relative to Group 2. aPTT was significantly elevated at 60 minutes in Group 1 relative to Group 2, but the increase at 120 minutes was not significant. Conclusion: The effects of low-flow anesthesia on hemorheology were greater than those of high-flow anesthesia.

Preoperative risk assessment may fail in most patients who may be exposed to postoperative neurological sequelae. The aim of this study was to assess the effects of Fentanyl added to epidural levobupivacaine on cerebral oxygenation and cognitive functions. There was a negative correlation between age and MMT, and a positive correlation between SpO2 and MMT. MMT scores of Group 2 at postoperative first hour and fifth hours were lower than those of Group 1. It was concluded that while fentanyl added to epidural local anesthetic had no effect on hemodynamic parameters, SpO2, and right-left cerebral oxygen saturation, and although it may have caused a decrease in MMT scores in the early postoperative period, it did not cause impairment in cognitive functions., Postoperatif nörolojik sekele maruz kalabilen çoğu hastada preoperatif risk değerlendirmesi yetersiz kalabilir. Bu çalışmanın amacı epidural levobupivakaine fentanilin eklenmesinin serebral oksijen ve kognitif fonksiyonlara etkisini araştırmaktır. Yaş ile MMT arasında negatif, SPO2 ile MMT arasında pozitif korelasyon vardı. Postoperatif 1 ve 5. saatte Grup 2 MMT skorları Grup birinkinden düşüktü. Epidural lokal anesteziye fentanilin eklenmesi hemodinamik parametreleri, oksijenasyonu ve sağ-sol serebral oksijenasyonu etkilemediği, erken postoperatif peryodda MMT skorlarında azalma neden olmasına rağmen kognitif fonksiyonlarda bir bozukluk meydana getirmedi

Yoğun bakım üniteleri daha ayrıntılı gözlem ve tedavilerden fayda görebilecek, yaşamsal destek alma ihtiyacı olan hastaların izlendiği ünitelerdir. Bu özellikleriyle ölüm riskinin azaltılması ve erken iyileşmenin sağlanmasında hasta ve aileleri için umut kaynağı olmuştur. Bu ünitelere en sık organ yetmezliklerine yönelik destek tedavisi gerektiren kritik hastalar yatmaktadır. Bununla birlikte yoğun bakım üniteleri kritik hastaların tedavi sürecinde etik sorunlarla da karşılaşılabilen ortamlardır. Sağlık çalışanları, birtakım etik kavramlarla karşı karşıya kalmakta, hatta bazen karar verme durumunda da olabilmektedir. Böyle bir durumda etik kavramların, kişilerin değer ve görüşlerinin önemi ortaya çıkmaktadır. Bu yazıda, yoğun bakım ünitesinde yatan terminal dönemdeki, çoklu kateterizasyon (7 adet) uygulanmış ve yeni bir kateter takılması gereken bir olguda; kateter takılıp takılmaması konusunda yaşanan etik belirsizlik tartışılmıştır Intensive care units are units where patients, who have the need for life support that may benefit from observation and treatment, are monitored. With these characteristics, decrease in risk of death and providence of early recovery have been a source of hope for patients and their families. In these units, most commonly the critically ill patients, who require organ failure treatment, are treated. Additionally, intensive care units environment are the places where ethical issues may be encountered in the treatment of critically ill patients. Health care workers are faced with a number of ethical issues; even they may be in the position of decision maker sometimes. In such cases, importance of the ethical concepts and, values and opinions of the people appears. In this article, ethical uncertainties of catheter insertion of a case that is at terminal period, staying at intensive care unit, has multi-catheterization (7 units) and a new catheter had to be inserted, are criticized.

Amaç: Bu çalışmada bir tıp fakültesi hastanesinin dış anestezi uygulamalarına ait son 2 yıllık verilerini sunmayı amaçladık. Yöntemler: Erişkin ve pediatrik kardiyoloji, gastroenteroloji ve radyoloji anabilim dallarına ameliyathane dışında anestezi verilen hastaları incelenmiştir. Olgular yaş, cinsiyet, ASA, girişim nedeni, yoğun bakım ihtiyacı, sigara öyküsü açısından incelendi. Bulgular: Dış anestezi uygulamalarında 528 olguya anestezi verildi. Bu olguların 336 (%64)’sı kadın, 192 (%36)’si erkek idi. ADA verilen tüm vakaların yaş ortalamaları 29,6±20,6yıl idi. Olguların ortalama anestezi uygulama süresi 22,57±11,7dk olarak bulundu. En kısa işlem süresi gastroskopi (13,2±8,6dk) sırasında, en uzun işlem süresi balon valvuloplasti (67,9±18,4dk) sırasında gerçekleşti. Olguların ortalama derlenme süresi 10,1±7,2dk olarak bulundu. Sonuç: Dış anestezi uygulamaları taşıdığı riskler açısından ameliyat odasındaki uygulamalarla benzerdir. Anestezist gün geçtikçe sayısı artan dış anestezi uygulamaları için iyi bir preoperatif değerlendirme yapmalı ve bu alanlarda uygun fiziksel koşulları sağlanmaya çalışılmalıdır. Objective: In this research, we aimed to present the latest data of a medical faculty’s outpatient anesthesia applications. Methods: The patients of the adult and pediatric cardiology, gastroenterology and radiology departments, applied with anesthesia outside of the operation room, were examined. The cases were analyzed in terms of age, sex, ASA, appliance and recovery duration, intensive care need, smoking history. Results: 528 patients were administered with anesthesia during outpatient anesthesia applications. 336 (64%) of the patients were women and 192 (36%) of them were men. The mean ages of all the patients were 29.6±20.6year. years in outpatient anesthesia. The mean anesthesia administration duration of all the patients were defined as 22.57±11.76 min. The shortest processing time took place during gastroscopy (13.2±8.66min) and the longest processing time took place during balloon valvuloplasty (67.9±18.4). The mean recovery duration was found as 10.1±7.26min. Conclusion: The outpatient anesthesia applications are similar to the applications in operation rooms in terms of the risks. The anesthesiologist should carry out a good preoperative evaluation for the increasing number of outpatient anesthesia applications and appropriate physical conditions should be provided

Chylothorax, which is a rare complication of central venous catheterization, is an accumulation of lymphatic fluid in the pleural space as a result of impairment of the integrity of ductus thoracicus. In this case report, we will look over chylothorax related to thrombus developing following subclavian vein catheterization.

A carbamazepine intoxication with suicide attempt is a relatively common clinical problem that presenting with coma, respiratory depression, arrhythmia, hemodynamic instability and even death. We report a case of severe carbamazepine poisoning that was successfully treated with one session charcoal hemoperfusion. On admission, the patient was comatose and required ventilator support. Hemoperfusion with coated activated charcoal successfully decreased the serum carbamazepine concentration from 45 mu g mL(-1) to 21 mu g mL(-1) within 2 h, with subsequent clinical improvement.

This study aimed to compare the effects of combined and noncombined lidocaine with adrenaline infiltration in general an- esthesia (GA) procedures, in which the standard anesthesia depth is monitored by Bispectral Index monitoring, on minimum alveolar concentration (MAC) levels and the costs. Following approval by the local ethics committee, an American Society of Anesthesiologists physical status IYII group of 40 adult patients for whom elective rhinoplasties under GA were planned was divided into 2 double- blind randomized groups. In group 1, GA and lidocaine + adrenaline were administered, whereas in group 2, only GA and adrenaline were administered. All the patients who had been taken to the op- eration room underwent electrocardiography and measurements of the peripheral oxygen saturation, end-tidal carbon dioxide, heart rate, mean blood pressure, and Bispectral Index monitoring. Using the operation time and the MAC% values, the total consumed inhalation agent amounts were calculated, and the cost difference was determined. The mean blood pressure values were lower in group 1 (P G 0.05). In group 1, the MAC% was 20.83% lower than that of group 2; the consumed desflurane amount was 20.29%, and the cost was 20.29% lower than that of group 2 (P G 0.05). In rhinoplasties under GA, the lidocaine + adrenaline combination infiltration not only decreased inhaled anesthetic requirement and cost but also supported the hemodynamic stability. In addition, surgical satisfaction increased in the lidocaine + adrenaline group because of small number of agitated patients during the recovery period.

Anesthesia mumps is characterized by acute transient swelling of the parotid gland association with general anesthesia. We presented a 25 years old pregnant woman with anesthesia mumps after 24 hours Cesarean section, and discussed treatment of anesthesia mumps and differential diagnosis. 25 years old woman underwent to operation for Cesarean section. Her Medical history had no chronic disease, and no allergies. Her mental and psychological status, neurological, other systematical examination findings and laboratory values were normal. General anesthesia was administered. Twenty four hours after the extubation, a large swelling of right more than left parotid region expanding down to the mandibular angle was noted. In conclusion we suggest that especialy obstetrical cases should be performed gently intubation and extubation and used medications should be attention. In additioal, anesthesia mumps of patients may fully recover within a few days without any treatment or with treatment.

Myasthenia gravis is an autoimmune disorder that is characterized by muscle weakness that fluctuates, worsening with exertion, and improving with rest. Diagnosis of myasthenia gravis is made following clinical and physical examination and is confirmed by serum immunoassays to measure autoantibody levels. Myasthenia gravis especially when associated with pregnancy is a high-risk disease, and its course is unpredictable. We described the second report about use of sugammadex after rocuronium for a caesarean delivery with myasthenia gravis, but, unlike our case that formerly was diagnosed with myasthenia gravis, the patient was extubated on postoperative successfully and we did not encounter any respiratory problems. Resumo: Miastenia grave (MG) é uma doença autoimune caracterizada por fraqueza muscular que flutua, piorando com o esforço físico e melhorando com o repouso. O diagnóstico de MG é feito após exame clínico e físico e confirmado por imunoensaios séricos para medir os níveis de autoanticorpos. MG, especialmente quando associada à gravidez, é uma doença de alto risco e de curso imprevisível. Descrevemos o segundo relato sobre o uso de sugamadex após rocurônio para um parto cesário com miastenia grave, mas, ao contrário de nosso caso que foi previamente diagnosticado com miastenia grave, a paciente foi extubada com sucesso no pós-operatório sem qualquer problema respiratório. Keywords: Myasthenia gravis, Sugammadex, Pregnancy, Palavras-chave: Miastenia grave, Sugammadex, Gravidez

We present a pregnant developed cardiac arrest due to a severe anaphylactic reaction to i.v. sulbactam-ampicillin, who had no history of allergy to penicillin and cephalosporin. Ampicillin is one of the most common drugs to elicit a rash, with an overall incidence of 3% to 8%. Five to ten percent of people on ampicillin develop eruptions between the 5th and 14th day following initiation of therapy. The incidence of immediate hypersensitivity reaction or anaphylactic reaction to cephalosporin antibiotics has been estimated at 0.02% and most of these patients have a history of allergy to penicillin and/or adverse reactions to cephalosporins. We present a case of immediate systemic reaction to sulbactam-ampicillin in a pregnant women whom exposed to intravenous sulbactam-ampicillin several times in past. The patient manifested a severe reaction which included anaphylactic shock, requiring orotracheal intubation and epinephrine. In this case, we emphasized the importance of early, fast, effective,and proper cardiac resusitation for anaphylaxis which may improve the prognosis.

of BD include neurological (seizures, ataxia, hypotonia, developmental delay, hearing and vision loss), neuromuscular (muscle weakness, spinal cord diseases), dermatological (seborrheic dermatitis, alopecia, skin rash), and metabolic abnormalities (chronic lactic acidosis, organic aciduria). It is also associated with respiratory problems (apnea, dyspnea, tachypnea) and immune deficiency findings. [1-4] Treatment with biotin results in a rapid clinical and biochemical improvement. However, if untreated, the disease can lead to coma and death. A 2-year-old boy weighing 12 kg was scheduled for a probing procedure due to lacrimal duct obstruction. BD was diagnosed and treated with biotin when the patient was 4-month-old. Patient has no episode of seizure over the last year and has used biotin 20 mg/day without antiepileptic drug. Physical examination was normal except the crusted lesions on skin and scalp of recent chicken pox infections. Laboratory findings were normal except anemia due to

DOI: 10.4328/JCAM.719 Received:15.06.2011 Accepted: 07.07.2011 Printed: 01.09.2013 J Clin Anal Med 2013;4(5): 415-7 Corresponding Author: Mehmet Fethi Ceylan, Hafiziye Mah. Kazim Karabekir Cad., Arastirma Hastanesi Ortopedi Klinigi, Van, Turkiye. T.: +905359524440 F.: +90 4322168352 E-Mail: mfethiceylan@hotmail.com Ozet Opere edilecek hastalarin preoperatif kanama diyatezi acisindan degerlendirilmesi bir zorunluluktur. Bu degerlendirme; anamnez, fizik muayene ve hemostaz testlerini icermektedir. Bu testler arasinda rutin olarak kullanilanlar; platelet sayisi, protrombin zamani, aktive parsiyel tromboplastin zamani ve INR degerleridir. Bu degerlendirmelere ragmen kanama-pihtilasma bozukluklarinin tamami tespit edilememektedir. Bu nedenle tanisi atlanmis kanama diyatezi sebebiyle ortopedik girisimlerde postoperatif donemde hemartroz, kas ici hematom ve abondan kanamalar gelisebilir. Bu komplikasyonlar morbidite ve mortalite sebepleridir. Femur diafizinde osteokondromu bulunan ayrica preoperatif anamnezi, fizik muayenesi ve belirtilen hemostaz testleri dogal olan bir olgumuzda, postoperatif donemde cerrahi sahada tekrarlayan kanama ve hematom gelisti. Kanama diyatezi dusunulerek yapilan incelemede von Willebrand hastaligi saptandi. Sonuc olarak, toplum taramasinda % 1 oraninda gorulen, en sik kalitsal kanama diatezi olan von Willebrand hastaliginin subklinik olgularinda erken tani konabilmesi ve komplikasyonlarin onlenebilmesi icin iyi bir hasta anamnezi alinmali ayrica taniya yonelik gerekli testler yapilmalidir.

Background In this article, a new surgical procedure that can be used for reconstruction of lower lip defects of any size is described. Methods In this prospective study, the surgical procedure was applied in 16 patients. In this procedure, the mucosa and the orbicularis oris muscle of the lower lip are repaired with a composite flap, and the skin defect is closed using local skin flaps. The patients were assessed in terms of complications, mouth opening, sphincter function of the mouth, and sensation in the lower lip. Results The aesthetic results obtained in all patients were satisfactory. Sufficient oral sphincter function was achieved in all patients. Conclusion Reconstruction of lower lip defects using the procedure described here can be performed in patients with lower lip defects of any size as long as the mucosal and skin repair lines are not superimposed. This procedure yielded good sphincter function and aesthetic results. © 2011 Wiley Periodicals, Inc. Head Neck, 2011

Tetanus is a rare disease caused by the exotoxins of Clostridium tetani. Higher mortality rates have been reported among the elderly and in the newborn. In this report of a tetanus case, the treatment and prognosis of contractions resistant to diazepam, midazolam, and atracurium infusion has been evaluated.

The delay phenomenon is a surgical procedure performed to raise a wider skin flap and to improve the survival of skin flaps. Surgery, chemicals, sutures, and lasers can be used for the delay procedure. In this study, delayed forehead flaps created by suturing were used for coverage of nasal skin defects in eleven patients. In 7 patients, the cross-paramedian forehead flap was used to increase the extent of flap lengthening. In the first session, suture delay was performed on both sides of the forehead flap margin. In the second session, the flap was elevated and sutured to its new position, 7 to 10 days after the initial surgery. All flaps were completely viable, and patient satisfaction was optimal in all cases. The positive effect of surgical delay on flap survival has been shown in experimental and clinical studies. However, experimentally, suture delay or chemical delay procedures have been shown to be beneficial in flap survival only. Suture delay seems to be an inexpensive, effective, easily performed, atraumatic, and safe technique, especially among patients with systemic diseases such as diabetes or cardiovascular diseases, smoking patients who may lose the flap, or patients who need very wide and long flaps.

Nasoalveolar fistula and oropharyngeal fistula of the anterior palatal region are very commonly seen in cases when there are concomitant clefts of the lip and the palate. Absence of adequate tissue in that region complicates the treatment and necessitates new tissue transfers from near or distant tissues. Today, the techniques used for correcting cleft lip cannot successfully solve these 2 problems. In this study, we describe a technique that depends on the principle of using the lip mucosal tissues that remains during the Tennison cleft lip correction technique, with a flap designation, to correct the tissue defect of the cleft between the foramen incisivum and lip and the alveolar region. Twenty-two patients (13 boys and 9 girls), with ages ranging from 3 to 53 months (mean, 24 mo), with unilateral cleft lip and palate underwent surgery with this new technique. In all these patients, clefts in the anterior palatal and alveolar regions were successfully corrected. Fistula was observed in none of these patients in these regions. Through this method, clefts in the anterior palatal and alveolar regions can be corrected during repair of cleft lips.

Spondyloepiphyseal dysplasia congenita (SEDC) is an inherited disorder of bone growth that results in short-trunk dwarfism, skeletal abnormalities, disorders in vision and hearing, atlanto-axial instability, and cleft palate. This important anomaly of the cervical vertebrae carries the risk of tetraplegia during cleft palate operations. In this case report, we discuss a case of spondyloepiphyseal dysplasia congenita, the perioperative and postoperative measures, and the risk of tetraplegia.

Carbamazepine (CBZ) is a commonly used antiepileptic agent. Common toxic effects include neurological abnormalities; ataxia, seizures, coma, cardiorespiratory problems; dysrhythmias; conduction disorders; respiratory depression; and eye abnormalities, such as nystagmus and ophthalmoplegia. Carbamazepine is highly protein bound. There is no antidote for the medication. Carbamazepine is not removed effectively through conventional hemodialysis. Supportive measures and charcoal hemoperfusion have been regarded as efficient treatment methods. We herein report a 17-year old girl to whom continuous venovenous hemodiafiltration lacking the albumin-enhance after suicidal overdose of CBZ was performed. We suggest continuous venovenous hemodiafiltration lacking the albumin-enhance as an alternative emergency treatment modality for cases who had ingested CBZ in toxic levels.

Intraoral synechia is a rarely seen intraoral anomaly. As a result of intraoral synechiae, fusion of the palatal shelves may be prevented because of the abnormal interposition of the tongue. Hence, cleft palate anomaly accompanies intraoral synechiae in many patients. The main problem for these patients is the inadequate oral opening for feeding. Flexible nasopharyngeal examination before intubation may help the anesthetist for simple excision of synechiae in the newborn period. In this article, a newborn who had a congenital synechia between the mandible and the maxilla has been presented, and the etiopathogenesis of intraoral synechia and the importance of flexible nasal endoscopy before endotracheal intubation are discussed.