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

Headache-like Subarachnoid Hemorrhage After Digital Subtraction Angiography: A Case Report

Subarachnoid hemorrhage (SAH) is a clinical condition with acute-onset, sudden, and severe headache. In addition to headache, severe nausea, vomiting, dizziness, confusion, agitation, focal neurologic deficits, and hypertension can be detected. Findings of meningeal irritation may accompany to these clinical features, 6-24 hours after the hemorrhage. Digital subtraction angiography (DSA) is used for surgical or endovascular treatment planning in order to identify vascular abnormalities, in addition to other imaging studies. After DSA, the frequency of all neurologic complications is between 0.2% and 4.5%. Headache may occur after DSA in an average 50% of patients. This rate is especially higher in female patients. Headache types are usually classified as migraine, tension or postoperative atypical headaches The incidence of severe headache after DSA is low. Vascular wall rupture should be considered first in severe headache after the procedure. It should also be kept in mind that after all other secondary causes are excluded; SAH-like headaches after DSA can be detecte

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

Arka sistem inmeleri nedeniyle oluşan konuşma bozuklukları-ihmal edilen bir fonksiyon bozukluğu

Klinik afazi ile başvuran bir hastada klinik tablodan primer olarak ön system sorumludur. Ancak, son raporlara gore posterior yapılara, özellikle de serebelluma olan hasarlar da lisan oluşturmada (language processing) önemli rol oynayabilir. Bu derlemede literatur ışığında tümü posterior vasküler sistem tarafından desteklenen yapıları değerlendirmek için, önce serebellumun linguistik rolüne, daha sonra ise talamus ve bazı tanımlanmış klinik sendromlara, en son olarak da oksipital lob etkilenmesi ile ortaya çıkan spesifik sendromlara değinilecektir. İnsan beyni, talamus ve oksipital kortekse ek olarak serebellumun da yüksek kortikal fonksiyonlarda rol oynadığı kompleks bir organizasyondur. Posterior sistem inmeleri nörolinguistik komponentleri de içeren kognitif defisitin klinik bulgularına neden olabilir. İnme hastalarında bu bozuklukların tespiti mevcut tedavi stratejilerine katkıda bulunabilir.The anterior system is primarily responsible for the clinical picture in a patient that presents with clinical aphasia. However, recent reports have shown that injuries to posterior structures, the cerebellum in particular, may have a role in language processing. Herein, we will look first at the linguistic role of the cerebellum in light of the literature, then of the thalamus and some described clinical syndromes, and finally, specific syndromes resulting from occipital lobe lesions, all of which are supported by the posterior vascular system. The human brain is such a complex organization that in addition to the thalamus and occipital cortex, we can see the involvement of the cerebellum in high cognitive functions. Posterior system strokes may lead to clinical findings of cognitive deficits, including neurolinguistic components. Determining these defects in stroke patients may precipitate changes in current management strategies

Levobupivacaine for Postoperative Pain Management in Circumcision; Caudal Blocks or Dorsal Penile Nerve Block

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

Kistik İntraserebral Görüntüleme Örneği İle Başvuran Multiple Skleroz Hastalığı: Olgu Sunumu

Multipl skleroz MS tanısında ve ayırıcı tanısında bazı olgularda çeşitli güçlükler yaşanmaktadır. Klinik belirti ve bulgular yanında, manyetik rezonans görüntüleme MRG , beyin omurilik sıvısı BOS incelemesi ve uyarılmış potansiyeller tanıyı kesinleştirmek için önemlidir. Tüm bunlara rağmen bu testlerin tanısal duyarlılık ve özgüllüğü sınırlıdır. Elli yedi yaşında tavuk çiftliği işletmecisi olan erkek hasta, 35 gün önce başlayan sağ yüz yarısında uyuşma ve denge bozukluğu yakınması ile başvurdu. Sağ yüz yarısında objektif hipoestezi ve sağda Babinski bulgusu saptandı. Beyin MRG incelemesindeki; 2 cm çapında, halkasal kontrast tutulumu olan homojen lezyon öncelikle kistik bir oluşumu düşündürdü. BOS ve görsel uyarılmış potansiyel neticesinde hastanın MS olduğu anlaşıldı. Bu hastaların klinik ve nörogörüntüleme ile takibi ayırıcı tanıda değerli bilgiler sağlayabilmektedi

NEUTROPHIL TO LYMPHOCYTE RATIO PREDICTS CARDIOVASCULAR MORTALITY IN PATIENTS WITH HEART FAILURE WITH REDUCED EJECTION FRACTION

The magnetic correlation in the Hubbard model on a two-dimensionalanisotropic triangular lattice is studied by using the determinant quantumMonte Carlo method. Around half filling, it is found that the increasingfrustration $t'/t$ could change the wave vector of maximum spin correlationalong($\pi,\pi$)$\rightarrow$($\pi,\frac{5\pi}{6}$)$\rightarrow$($\frac{5\pi}{6},\frac{5\pi}{6}$)$\rightarrow$($\frac{2\pi}{3},\frac{2\pi}{3}$), indicating the frustration's remarkableeffect on the magnetism. In the studied filling region =1.0-1.3, the dopingbehaves like some kinds of {\it{frustration}}, which destroys the $(\pi,\pi)$AFM correlation quickly and push the magnetic order to a wide range of the$(\frac{2\pi}{3},\frac{2\pi}{3})$ $120^{\circ}$ order when the $t'/t$ is largeenough. Our non-perturbative calculations reveal a rich magnetic phase diagramover both the frustration and electron doping