Comparison of the effects of minimal and high-flow anaesthesia on cerebral perfusion during septorhinoplasty

Objective: The aim of this study was to analyse the effects of minimal-and high-flow anaesthesia on cerebral oxygenation during septorhinoplasty with controlled hypotension using near-infrared spectroscopy. Methods: Eighty patients scheduled for septorhinoplasty under general anaesthesia with controlled hypotension were randomised into two groups: minimal-flow (MF) or high-flow (HF). Both groups received desflurane anaesthesia to maintain bispectral index values at 40%-50% and 0.25-0.5 µg kg?1 min?1 i.v. remifentanyl infusion to maintain mean arterial blood pressure between 55 and 65 mmHg. The MF group received 5 L min?1 of fresh gas flow for the first 10 mins then the gas flow was reduced 0.4 L min?1. The HF group received 2 L min?1 of fresh gas flow throughout. Haemodynamic parameters and cerebral oxygen saturation were measured. Results: There were no statistical differences in demographic variables, duration of anaesthesia and surgery, time to extubation and proceeding to an Aldrete score of 9. There were no statistical differences in haemodynamic parameters, end-tidal CO2 and cerebral oxygen saturation. The amount of desflurane used in the MF group was significantly lower than that used in the HF group (30.5±9.8 mL vs. 48.5±12.1 mL; p<0.05). Conclusion: MF and HF anaesthesia did not lead to any difference in cerebral oxygen saturation in patients undergoing septorhinoplasty with controlled hypotension. MF anaesthesia may thus be used as safely as HF anaesthesia is

Sinonasal tract malignancies: prognostic factors and surgery outcomes

WOS: 000333960400009PubMed: 24693395Background: Cancers of the sinonasal region are rare and its survival rate remains poor because most of the patients are asymptomatic and diagnosed in advanced stages with surrounding important structures. Objectives: This study attempted to analyze the clinical and histological features in addition to survival and prognostic factors of surgical treatment of sinonasal cancers. Patients and Methods: A retrospective cohort study, involving 36 patients with sinonasal cancer who were treated with surgery in our hospital between 2000 and 2010, was performed. Patients were selected based on the convenience sampling. Patients treated with radiotherapy and/or chemotherapy were excluded from the analysis. Clinical symptoms and histologic findings of patients as well as malignant tumor staging and its prognosis were collected from archives. Results: We found that overall 3 and 5-year survival rates of subjects were 52.8%, and 41.6%, respectively. There was a negative correlation between the clinical stage and survival. There was a significant difference between infrastructural and suprastructural localization in 5-year survival rate (P = 0.018). in the present study, there was a strong relationship between the local control and overall survival (P 0.05). Conclusions: the present study has demonstrated that clinical stage, suprastructural tumor, and the presence of tumor-positive resection margins are the most significant prognostic factors affecting local tumor control and survival. As a result of this study, these tumors should be treated in early stages by surgical margin of resection followed by adjuvant radiotherapy

Relatıonshıp between employer brand perceptıon and qualıty of worklıfe ın the context of generatıons ın hospıtalıty enterprıses

Gün geçtikçe değişen teknoloji ve yükselen yaşam kalitesi beraberinde yeni markalar ve iş ortamları ortaya çıkarmıştır. Çağa ayak uydurmak ve mevcut çalışanların gelecekte kaliteli bir iş ortamında çalışabilmeleri için işverenler gelecek kuşakların olası istek ve beklentilerini karşılayabilecek şekilde işe ilişkin unsurları (fiziksel çalışma koşulları, ücret vb.) hazırlamaya çalışmaktadırlar. Bu çalışmada, işveren marka algısının çalışma yaşam kalitesi ile ilişkisi ve bu ilişkinin kuşaklar tarafından farklı algılanıp algılanmadığını ortaya koymak amaçlanmaktadır. Araştırma Eskişehir ilinde hizmet veren dört ve beş yıldızlı konaklama işletme çalışanları örnekleminde gerçekleştirilmiştir. Araştırmada nicel yöntemlerden alan araştırması kullanılmış olup veriler soru formu (anket) tekniği ile toplanmıştır. Elde edilen veriler istatistiki programlar aracılığıyla analiz edilmiştir. Elde edilen verilere göre örneklemin oluşturduğu çalışanlar X ve Y kuşaklarından oluşmaktadır. Dolayısıyla kuşak karşılaştırılması bu iki kuşak arasında yapılmıştır. Yapılan regresyon sonucunda, işveren markasının ana değişken olarak çalışma yaşam kalitesini arasında pozitif bir ilişki ortaya çıkmıştır. Özetle, işveren marka algısının çalışma yaşam kalitesini etkilediği ve kuşaklara göre bu etkide bir farklılaşmanın olmadığı ortaya çıkmıştır.The ever-changing technology and rising quality of life have brought new brands and business environments together. To keep pace and enable current employees to work in a quality business environment in the future, employers are trying to prepare elements of work (physical working conditions, wages, etc.) so that they can meet the expectations and expectations of future generations. In this study, it is aimed to show whether employer brand perception is related to working quality of life and whether this relationship is perceived differently by generations. The research was carried out in the sample of employees of four and five-star hospitality managements serving in Eskisehir. In the research, a field study from quantitative methods was used and data were collected by questionnaire technique. The obtained data were analysed by means of statistical programs. According to the obtained data, the employees formed by the sample are composed of X and Y generations. Therefore, comparison was made between these two generations. As a result of the regression made, there was a positive relationship between working life quality as the main variable of the employer brand. In summary, it was found that employer brand perception affected working quality of work and there was no differentiation in this effect from generation to generation

The effects of astaxanthin on salivary gland damage caused by cisplatin in the rat

Background: Cisplatin is a potent antineoplastic agent widely used for a variety of malignancies. However, it has many dose-limiting side effects such as neurotoxicity, cytotoxicity and ototoxicity. The aim of our study was to determine the effectiveness of astaxanthin (ASX) as a cytoprotective agent against cisplatin-induced cytotoxicity in the submandibular glands of rats.Methods: Thirty-six adult male Wistar albino rats were divided into six groups as follows: group I: saline control; group II: 75 mg/kg/day ASX; group III: 16 mg/kg cisplatin; group IV: 25 mg/kg/day ASX + cisplatin; group V: 75 mg/kg/day ASX + cisplatin; group VI: olive oil + cisplatin. In all groups, submandibular gland histopathological and histochemical investigations were done using a light microscope. Every rat section was semi-quantitatively scored. Neutrophil infiltration density, myoepithelial cell density in the degeneration area, degenerative granular duct cell density, degenerative seromucous acinus cell density, and changes in the content of the secretory granules of seromucous acini and granular ducts of the parenchyma and stroma were calculated.Results: The results of the analysis of the mean acinus area of the submandibular gland revealed that there was a significant decrease in cisplatin group rats when compared to control rats (p0.05, p=0.921). Similarities were observed in the mean ducts area with the group IV and the group V (p>0.05, p=0.571).Conclusions: These results suggest the possibility that the clinical use of ASX could reduce or prevent damage to the salivary gland of patients receiving cisplatin chemotherapy

Comparison of metoprolol and tramadol with remifentanil in endoscopic sinus surgery: a randomised controlled trial

Objective: Controlled hypotension is commonly induced during functional endoscopic sinus surgery to limit mucosal bleeding. This may be detrimental to elderly patients and patients with arterial stenosis. The aim of this pilot study was to determine if a normotensive anaesthetic technique with sufficient analgesia and without profound vasodilation may reduce intraoperative bleeding and incidence of adverse haemodynamic effects associated with vasodilation and variable rate continuous infusions. Methods: In this double-blind randomised controlled trial in a tertiary care centre, a total of 88 patients were randomised to receive intravenously either 0.1 mg kg?1 metoprolol and 1 mg kg?1 tramadol following anaesthesia induction (MT group) or a bolus dose of 0.5 ?g kg?1 remifentanil following anaesthesia induction, followed by 0.25-0.5 ?g kg?1 min?1 remifentanil infusion (R group). The primary outcome was quality of surgical field and incidence of adverse haemodynamic effects. The secondary outcomes were time to achieve intraoperative bleeding score <3, bleeding rate and changes in cerebral regional oximetry. Results: A total of 105 patients were recruited, in which 88 were randomised. The median intraoperative bleeding score was similar (1, interquartile range: 1-1, p=0.69). The mean bleeding rate was lower in the MT group, although the difference was not significant (p=0.052, 95% CI 0 to 8.8). Hypotension, bradycardia and cerebral desaturation in the MT group were not observed compared to hypotension in 3 (7%), bradycardia in 18 (41%) and cerebral desaturation in 2 (5%) patients in the R group (p=0.241, p<0.001, p=0.474, respectively). Conclusion: Providing sufficient analgesia and eliminating stress response can provide stable heart rate and good surgical field with no need for additional hypotension. This normotensive technique may be useful in patients with stenotic arteries or ischaemic organ diseases

Presenting maxillary sinus cholesterol granüloma with diffused bone necrosis

Kolesterol granulomu hemorajiye sekonder gelişen kolesterol kristalleriyle ilişkili yabancı cisim reaksiyonu sonucu oluşan kronik inflamatuar bir proçestir. Vucudun pek çok yerinde görülebilir ancak paranazal sinüslerde nadir olarak görülmekte olup maksiller sinüs yerleşimli olgular literatürde az sayıda yer almaktadır. Bu yazıda 5 yıldır devam eden sol yüzde ağrı, nefes almada güçlük şikayetiyle başvuran , paranazal sinüs bilgisayarlı tomografide sol maksiller sinüsde kemik destrüksiyonuna neden olan ve maksiler sinüs kolesterol granülomu tanısı alan 53 yaşında bir erkek olgu tanı , tedavi ve histopatolojik özellikleri ile birlikte sunulmaktadırCholesterol granuloma is a chronic inflammatory process that occurs as a result of foreign body reaction associated with cholesterol crystals developing secondary to hemorrhage. It can be seen in many parts of the body, but it is rarely seen in the paranasal sinuses and cases located in the maxillary sinus are few in the literature. In this article, a 53-year-old male patient who presented with complaints of pain on the left face and difficulty in breathing for 5 years, and was diagnosed with maxillary sinus cholesterol granuloma, which caused bone destruction in the left maxillary sinus on paranasal sinus computed tomography together with the diagnosis, treatment and histopathological features is offere

Obstrüktif uyku apnesi tan›s›nda periferik arteriyel tonometrinin de¤erlendirilmesi

Objective:Peripheral arterial tonometry (PAT) as a portable method of monitoring sleep quality is a relatively recent innovation. The aim was to compare the results of PAT and polysomnography (PSG) and to evaluate the role of PAT in diagnosing obstructive sleep apnea syndrome (OSAS). Methods: This study included adult patients who admitted to ENT clinic with OSAS complaints (excessive daytime sleepiness, snoring, and witnessed apnea), undergone sleep monitorization using PAT system (WatchPAT 200TM; Itamar Medical Ltd., Caesarea, Israel) and had single-blind, level 1 polysomnography at sleep laboratory of Chest Diseases Department. Results: For the two sleep monitoring sessions as conducted at different times: the apnea-hypopnea index (AHI) and respiratory disturbance index (RDI) values were strongly correlated between sessions (r=0.749, r=0.753; p<0.001). The oxygen desaturation index (ODI) values were very strongly correlated (r=0.861; p<0.001). When the AHI scores calculated using PAT for the patients enrolled in the trial were taken into consideration; 89.7% of the patients were correctly diagnosed with OSAS (AHI?5); for RDI calculated (RDI?5) using PAT, 100% of OSAS diagnoses were correct; for AHI values calculated with the PAT method, taking 15 as cut-off point, the sensitivity was found to be at an extremely high level of 96.1%. Conclusion: PAT and PSG values were highly correlated. This finding demonstrated that the reproducibility of the results obtained with PAT was also high. This study shows that PAT can be used as a screening test for OSAS and in a group of patients who are highly suspected for OSAS.Amaç: Periferik arteriyel tonometrinin (PAT), uyku monitörizasyonunda ta?›nabilir bir yöntem olarak kullan›m› k›smen yeni bir yöntemdir. Bu çal›?mada, PAT sonuçlar› ile polisomnografi (PSG) sonuçlar›n›n kar?›la?t›r›lmas› ve obstrüktif uyku apnesi sendromu tan›s›nda PAT’›n rolününün de¤erlendirilmesi amaçland›. Yöntem: Bu çal›?maya KBB klini¤ine OSAS ?ikayetleri (gündüz uykululuk hali, horlama ve tan›kl› apne) ile ba?vurmu? ve uyku monitörizasyonu PAT sistemi (WatchPAT 200TM; Itamar Medical Ltd., Caesarea, ‹srail) ile yap›lm›?, daha sonra Gö¤üs Hastal›klar› Uyku Laboratuvar›nda kör olarak level 1 polisomnografi uygulanm›? eri?kin hastalar dahil edildi. Bulgular: ‹ki farkl› zamanda yap›lm›? uyku monitörizasyonunda apne hipopne indeksi (AHI) ve solunum bozuklu¤u indeksi (RDI) de¤erleri yüksek oranda korele idi (r=0.749, r=0.753; p<0.001). Oksijen desatürasyon indeksi (ODI) de¤eri ise çok yüksek oranda korele saptand› (r=0.861; p<0.001). Çal›?maya dahil edilen hastalar›n AHI skorlar› PAT yöntemiyle ölçüldü¤ünde; hastalar›n %89.7’si OSAS için (AHI?5) do¤ru tan› ald›; PAT testinde, RDI’ye göre yap›lan de¤erlendirmede (RDI?5) OSAS tan›lar›n›n %100’ü do¤ru idi; PAT yöntemiyle yap›lan ölçümde AHI de¤eri için e?ik de¤eri 15 olarak kabul edildi¤inde, duyarl›l›k %96.1 olarak oldukça yüksek bulundu. Sonuç: PAT ve PSG de¤erleri yüksek oranda korele idi. Bu durum PAT ile elde edilen sonuçlar›n tekrarlanabilirli¤inin de yüksek oldu¤unu göstermi?tir. Çal›?mam›z PAT’›n OSAS’da tarama testi olarak ve yüksek oranda OSAS ?üphesi olan hasta grubunda kullan›labilece¤ini göstermektedir

Atipik hipofiz adenomu olgularının insidansı, hormonal dağılımı ve postoperatif takibi

AMAÇ: Hipofiz adenomu tanısı ile operasyon uygulanan olgularımızdan patoloj ik tanısı atipik hipofiz adenomu olanların görülme sıklığı, hormonal aktivitesi ve postoperatif takipleri araştırılmıştır. YÖNTEM ve GEREÇlER: Kliniğimizde Ocak 2009 - Mayıs 2012 tarihleri arasında endoskopik endonasal transsfenoidal yolla opere edilen 146 hipofiz adenomu olgusundan WHO 2004 kriterlerine göre patoloj isi atipik hipofiz adenomu olarak saptanan 13 olgu çalışmaya dahil edildi. BUlGULAR: Histoloj ik olarak 133 hasta tipik hipofiz adenomu (%91,1), 13 hasta ise atipik hipofiz adenomu (%8,9) idi. Bu hastaların 10 tanesi erkek (%76,9), 3 tanesi kadındı (%23,1). Yaş dağılımı 27 ile 80 arasında idi (ortalama 52.7). Dokuz olgu nonsekretuar adenom (%69,3), 3 olgu prolaktinoma (%23,1), 1 olgu ise somatostatinoma (%7,6) idi. Dört olguda hipofizer apopleksi mevcuttu (%30,7). Tipik hipofiz adenomlu hastalardan 11 tanesinde nüks saptanırken (%8,2), atipik hipofiz adenomlu olgulardan ise 5 tanesinde nüks adenom (%38,4) nedeniyle tekrar operasyon yapıldı. SONUÇ: Atipik hipofiz adenomları iyi bir patoloj ik inceleme yapıldığında çok da nadir görülen adenom tipi değildir. Tümör rekürrensinde tek başına belirleyici olmamakla birlikte tipik adenomlara göre çok daha yüksek oranda rekürrense neden olduğu unutulmamalıdır. Bu yüzden bu hastalarda total tümör eksizyonu, eğer mümkün olmuyorsa postoperatif daha yakın takip ile ek tedavi uygulamalarının kullanılması gereklidir.AIM: To assess the incidence, hormonal activity and postoperative follow up of the cases that are histopathologically diagnosed as atypical pituitary adenoma (APA) in our series. MATERIAL and METHODS: In this study, 13 atypical pituitary adenoma cases, by the WHO 2004 criteria, among the 146 pituitary adenoma patients operated on in our clinic between January 2009 and May 2012 by endoscopic endonasal transsphenoidal approach were included. results: In histological studies, 133 cases were diagnosed as typical pituitary adenoma (91.1%) and 13 cases were APAs (8.9%) of which 10 were male (76.9%) and 3 were female (23.1%), ranged between 27 and 80 (mean 52.7) ages. Histopathological distribution of APAs was 9 non- secretory adenomas (69.3%), 3 prolactinomas (23.1%) and 1 somatostatinoma (7.6%). Asymptomatic pituitary apoplexy was diagnosed in 4 cases (30.7%). Eleven cases of typical pituitary adenomas (8.2%) and 5 cases of the atypical pituitary adenomas (38.4%) were re-operated due to tumor recurrences. CONCLUSION: Accurate histopathological examination shows that atypical pituitary adenoma is not a rare disease. Although it is not the only determinant, APAs are more prone to recurrence than typical adenomas. In our opinion, if total resection is not possible for the patients with APA, close postoperative follow up and additional curative therapy modalities are needed

The protective effect of astaxanthin on cisplatin-induced ototoxicity

Background. Promising studies have been conducted with many substances to reduce the ototoxic effects of cisplatin, but there is no treatment that completely eliminates the ototoxic effect. Objectives. To determine the effectiveness of astaxanthin (ASX) as a protective agent against cisplatin-induced ototoxicity. Materials and methods. Thirty-six rats were randomly divided into 6 groups. Group 1 received no drug injections except for anesthetics; group 2 received intraperitoneal (IP) olive oil only for 8 days; group 3 received only IP ASX 75 mg/kg dissolved in olive oil for 8 days; group 4 received a single dose of only IP 16 mg/kg cisplatin on the 5th day; group 5 received 25 mg/kg ASX IP daily for 8 days and a single 16 mg/kg dose of cisplatin on the 5th day; group 6 received 75 mg/kg ASX IP daily for 8 days and a single 16 mg/kg dose of cisplatin on the 5th day. The animals were tested for distortion product otoacoustic emissions (DPOAE) before and 3 days after cisplatin treatment. The animals in all groups were sacrificed under anesthesia on the 10th day. Before sacrifice, inferior vena cava blood samples were drawn into commercial tubes for biochemical analysis and their cochlea were prepared for histological analysis. Results. The ASX+cisplatin groups demonstrated significantly higher DPOAE thresholds when compared to the cisplatin-only group (p < 0.05). The ASX 25 mg/kg/day+cisplatin group showed a significant increase in total antioxidant capacity compared to the cisplatin-only group, whereas the ASX 75 mg/kg/day+cisplatin group had significantly lower total oxidative stress and oxidative stress index. Histologic results showed that the cortical organ was better preserved in the ASX+cisplatin groups compared to the cisplatin-only group, and the degeneration in the spiral ganglion and inner and outer hair cells was less visible in the ASX groups. Conclusions. Astaxanthin can protect hearing from cisplatin-induced ototoxicity, prevent cellular degeneration and significantly reduce oxidative stress