Sünnetlerde postoperatif ağrı kontrolünde levobupivakain; kaudal blok veya dorsal penil sinir bloğu

Objectives: In this study, we evaluated the analgesic efficacy and adverse effect profile of levobupivacaine in caudal and DPNB in postcircumcision pediatric patients. Methods: Sixty boys between 2-10 years of age undergoing circumcision were enrolled. The patients were divided into two groups: Group C (n=30) and Group P (n=30) were applied caudal block or dorsal penile nerve block (DPNB), respectively. Blocks were performed before surgery as a supplement to general anesthesia with 1 mL kg-1 0.25% levobupivacaine. Postoperative pain and sedation scores were assessed on the 10th and 30th minutes, and hours 1-6. The number of pain free patients in the first 6 hours, the duration of analgesia, time to first analgesic administration, walking, micturition, and total paracetamol demands, and length of stay were recorded. Results: Demographic data were similar between groups. The number of children who spent the first 6 hours pain-free was larger in Group C than Group P (p=0.0001). The time to first analgesic (p=0.000033) and walking (p=0.004) were longer in Group C. There were 14 patients with motor block in Group C (p=0.00007). In view of AUC, FPRS, OPS and MPOPS were significantly better in Group C on the first postoperative 6 hours. Conclusion: Caudal block done using levobupivacaine for postoperative pain management in circumcision is more successful than penile block, however there is a significant delay in time to first walking and as might be expected there is an increased risk of motor block

Evaluation of the informed consent procedure for total knee arthroplasty patients in Turkey

The purpose of this research is to evaluate the ethical aspects of informed consent process of total knee arthroplasty (TKA) patients in Turkey. The study included 50 patients undergoing TKA in Gazi Mustafa Kemal State Hospital Orthopedics Clinic. A face to face survey was conducted to determine the ethical appropriateness of the main components of informed consent process such as, disclosure of material information about the disease and alternative treatment options, understanding the disclosed information, comprehending the written consent form and voluntariness in deciding. The survey revealed that all TKA patients signed informed consent form, 80% of the participants received material information about their disease, 62% were disclosed information about TKA operation, 56% read (in personal or with the assistance of a relative) the written informed consent form, 28% received information regarding possible complications of TKA and 85% were not given any information about the alternative treatments. Informed consent process in TKA patients have flourished compared to previous years, but still there are some aspects in need of improvement. Using short and understandable language, developing multi-media sources and involving patients to informed consent form development process would contribute to the process

The Relationship Between Pituitary Gland Dimensions, Thyroid Functions, and Seizure Activity in Patients with Epilepsy

Objective:Morphological and functional changes in hormonal systems may present as the cause and/or result of epileptic seizures. The purpose of the present research is to evaluate the relationship between the structure of the pituitary gland, thyroid functions, and seizure activity in patients with epilepsy.Methods:It was designed as a hospital-based, retrospective, and case–control study. No secondary epilepsy patients (18-65 years) were included in the study. Disease duration, seizure frequency, and antiepileptic treatments were questioned. Electroencephalography findings were grouped as normal, nonspecific, slow wave activity, and epileptic activity. Seizure types were determined. The pituitary gland was measured with coronal T2-magnetic resonance imaging sequences. Pituitary gland width, height, and intercavernous distance were obtained. Thyroid-stimulating hormone, free triiodothyronine, and free thyroxine results were recorded.Results:There were 63 patients (mean age of 43.11 ± 12.38 years) and 44 healthy volunteers in the study. Pituitary gland width and intercavernous distance were lower in epilepsy patients compared to the control group (P = .012 and P = .006). Thyroid function test results were similar in the patient and control groups (P > .05). There was a negative correlation between the number of seizures in the last 1 month and the width of the pituitary gland (P = .008, r = −0.331). There was no relationship between other clinical features, antiepileptic therapy, and pituitary measurements and thyroid functions.Conclusion:The lower width of the pituitary gland and its relationship with the frequency of seizures support that seizure activity is associated with structural features of the hormonal system in patients with epilepsy

Saf duyusal inme sendromu şeklinde ortaya çıkan talamik bölge serebrovasküler hastalığı: olgu sunumu

Saf duyusal inme, derin ya da yüzeyel duyuların ayrı ayrı veya beraber tutulduğu, duysal veya irritatif bozukluklar ile kendini gösteren klinik sendromdur. Bu sendromda en sık talamusun ventro-posterior nükleusu etkilenir. Talamik etkilenmeleri olan hastalarda yukarı bakış felci, hemiparezi, hemihipoestezi, konfüzyon, uykuya meyil, duygusal labilite olabilmektedir. Talamus tüm duyu modalitelerinin koku hariç ortak kesişim noktası olduğundan tat, işitme, dokunma ve ağrı gibi duyusal modaliteler saf duyusal inmelerde etkilenebilmektedir. 56 yaşında erkek hasta sol kol, bacak, yüz ve gövde yarısında uyuşma yakınması ile başvurdu. Manyetik rezonans görüntülemede sağ talamusta iskemi ile uyumlu lezyon belirlendi. Sonrasında santral nörojenik ağrı sendromu gelişti. Nadir görülmesi, ek belirti olmadan hemihipoestezi ile başvurabilmesi ve hızla tanınıp tedavi başlanması gerektiğinden sunulmaya değerli görülmüştü