Comparison of the effect of the different consantrations of bupivacaine on stress response and postoperative analgesia in caudal analgesia Kaudal analjezi̇de i̇ki̇ farkli konsantrasyonda bupi̇vakai̇n'i̇n stres yanit ve postoperati̇f analjezi̇ üzeri̇ne etki̇leri̇ni̇n karşilaştirilmasi

Introduction: Caudal epidural anaesthesia is used worldwide and is an attractive method to provide effective and satisfactory analgesia for perioperative pain in control children. The procedure was administered for caudal block in children scheduled for inguinal hernia operation and designed to compare two different dose regimens of bupivacaine on hormonal reaction according to stress and to asses its effect on post-operative analgesia. Method: 80 ASA I-II, aged betwen 4-10 years old patients were randomly divided into two different groups after the approvel of the ethic committee and parents' informed consent. Anesthesia induction was achieved by sevofluorane and cisatracurium, after intubation, cases were set to lateral decubitus position. Caudal block achieved 0.125 % bupivacaine in the first group (Group A) and 0.25 % in the second group (Group B) at 1 mL kg-1 dosage. Cases were treated with sevufluorane 1-2 % minimum alveolar concentration (MAC) and 50 % O2-N2O without any opioid agents for the anesthesia continuation. Cases were examined for blood glocose, cortisole levels before caudal block and at 30 minutes after the discontinuation of the surgery. Cases were evaluated by objective pain scala (OPS) in the first 24 hours after the surgery and with scores greater than 5 were treated with intrarectal paracetamol (30 mg kg-1) Results: There were no statistically significant differences among the demographic data and surgery time of the cases (p>0.05). Stress hormones levels and pain scores and also avarage supplemental analgesic requirements were less in group B than group A but this was not statistically significant (p>0.05). Conclusion: We believe that 0,125 % bupivacaine can be used in the caudal epidural block of pediatric cases because of its less toxicity and equivalant analgesic properties

Nokturnal enuresis Nokturnal enürezis

Nocturnal enuresis (NE) is defined as a complete or near complete micturition in the bed during the sleep. The pathophysiology of NE is still not fully understood. A conceptual model has been proposed for understanding. The remarkable fact is that the great majority of children sleep dry for 8-9 hours or more while sometimes finding it hard to wait for only a couple of hours during daytime. Thus, nocturnal dryness requires functions that are not present during daytime. The basic pathophysiology of NE is simple in that the bladder gets filled to capacity during sleep and needs to be emptied. However, the child not wakes up. If he/she wakes up, he/she walks to the bathroom and performs the socially acceptable act of nocturia. If he/she does not wake up, the socially unacceptable bedwetting ensues. For the management of a child with NE, the most important diagnostic procedure is to identify monosymptomatic enuresis by history and physical examination. Once the history and physical examination has classified the child as monosymptomatic only minimal additional diagnostic work is needed. Daywetting is the most important symptom to exclude in order to classify the enuresis as monosymptomatic. If there is any amount of daytime incontinence present, the enuresis is definitely not monosymptomatic. A dip stick will exclude protein, glucos, hematuria and most urinary pathogens. If there is a history of previous urinary infections, urinary culture should be added. Management of NE is based on 4 principles: (1) Verify the child's motivation to be treated. (2) Information and instruction about daily habits underlining the importance of having regular fluid intake and voidings and relaxed routines at bedtime. (3) Enuresis alarm (4) Antidiuretic medication

Does zinc pretreatment have a protective effect on the injury severity of the newborn rats small intestine subjected to hypoxia-reoxygenation injury? Çinko tedavisi hipoksi reoksijenasyonun neden oldugu yenidoǧan rat incebarsak hasanna karşi koruyucu mudur?

Aim: It is tought that free radical damage following ischemia reperfusion injury is an important factor for the pathogenesis of necrotizing enterocolitis (NEC). It is demonstrated that metal aspartates reduce free radical damage in many tissues. Thus, in this study, we aimed to evaluate whether zinc pretreatment has a protective effect on injury severity the newborn rats small intestine subjected to experimental necrotizing enterocolitis. Method: A total of 30 newborn Sprague-Dawley rats (from seven different mothers) collected immediately after birth to prevent suckling of maternal milk were divided into three groups. The groups were labeled as group 1, control; group 2, hypoxia-reoxygenation; and group 3, zinc-hypoxia-reoxygenation group. The rats of group 3 were pretreated with "zinc bis DL hydrogen aspartate" (50 mg/kg) one hour before experiments via subcuticular injection then rat pups in group 2 and group 3 were stressed twice daily with asphyxia followed by cold (+4°C for 10 min) to induce hypoxic intestinal injury which is relevant to human necrotising enterocolitis. % 100 CO2, inhalation for ten minutes in a chamber followed 10 minutes of % 100 O2 inhalation was the asphyxia model repeated twice daily. After hypoxia-reoxygenation and cold stres, newborn rats were returned to their mother's cages. This protocol was repeated for the following two days and the rat pups were decapitated on the third day. The entire gastrointestinal tract was removed and examined macroscopically. A 3-cm section of distal ileum and 1 g liver tissues from each animal was taken for histopathological and biochemical examinations. Histologic changes in ileal architecture were scored and gradedjrom 1 to 5 and epidermal growth factor receptors (EGFR) were evaluated immunohistochemically. The remaining intestinal tissues and liver tissues of the animals were used to measure the levels of malondialdehyde (MDA) and nitrit. Also, zinc levels were measured in all tissues by atomic absorbtion spectrophotometry. Results: Typical signs of hypoxia induced intestinal injury were observed in groups 2 and 3, macroscopically. Histopathological grading and immunohistochemical EGFR evaluation showed less damage in group 3 compared to group 2 (p<.05). In group 2, MDA and nitrit levels in all tissues were increased (p<.001) and zinc levels were decreased (p<.001) in comparison to group 3. Conclusion: Zinc pretreatment has a protective effect on hypoxia reoxygenation induced intestinal injury in newborn rats

An overlooked association of brachial plexus palsy: Diaphragmatic paralysis

Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can be overlooked if thorough examination isn't done. We present a two-weeks-old baby with a birth weight of 3800 grams who had a left-sided brachial plexus palsy and torticollis with an undiagnosed left diaphragmatic paralysis even though he was examined by different physicians several times. The role of physical examination, the chest x-rays of patients with brachial paralysis and the treatment modalities of diaphragmatic paralysis due to obstetrical factors are discussed

Pseudoaneurysm of the superficial temporal artery: Report of a case

A 10 year-old boy was seen with an asymptomatic subcutaneous mass on the left frontotemporal region of the skull. The patient gave a history of involving in a traffic accident 20 days before this visit. Physical examination was consistent with an aneurysm of the superficial temporal artery. Histological examination following surgical excision revealed a pseudoaneurysm arising on superficial temporal artery. Pseudoaneurysm of superficial temporal artery is a rarely seen condition, with fewer than 200 cases reported. In this paper we report a case of pseudoaneurysm of superficial temporal artery and the literature was reviewed

Gastric Duplication Cyst in an Infant Presenting with Melena

Background: Gastrointestinal duplication cysts are rare congenital anomalies that are most often localized in the ileum. The condition is usually diagnosed within the first year of life