Comparison of the maternal and neonatal effects of bupivacaine plus fentanyl and ropivacaine plus fentanyl during cesarean delivery

Purpose: The aim of the present study was to compare the anesthetic efficacy, and fetal and maternal effects of 7.5 mg (1 ml) intrathecal 0.75% hyperbaric ropivacaine + 25 ìg (0.5 ml) fentanyl versus 5 mg (l ml) intrathecal 0.5% hyperbaric bupivacaine + 25 ìg (0.5 ml) fentanyl in elective cesarean delivery.Materials and Methods: The study included 40 ASA I–II cases scheduled for cesarean delivery that were randomized into two groups of 20 cases each. Cases in the RF group were administered 0.75% hyperbaric ropivacaine + 25 ìg (0.5 ml) fentanyl and those in the BF group were administered 5 mg (l ml) hyperbaric bupivacaine + 25 ìg (0.5 ml)fentanyl into the spinal space. The time until spinal anesthesia in the T4 dermatome, overall duration of analgesia, hemodynamic parameters, Apgar score of newborns at 1–5 min, fetal blood gas values (pH, PO2, PCO2, HCO3., and BE), maternal side effects, the degree of motor block, maternal need for ephedrine, objective pain scale score, and patient satisfaction were recorded in each group.Results: There were no significant differences between the groups in terms of the parameters evaluated (P > 0.05).Conclusion: In elective cesarean delivery, the combinations of bupivacaine + fentanyl or ropivacaine + fentanyl exhibited similar anesthetic efficacy, and fetal and maternal effects.Key words: Bupivacaine, cesarean, opioid, ropivacain

Locating temporary shelter areas after an earthquake: A case for Turkey

In this study, we propose a mixed integer linear programming based methodology for selecting the location of temporary shelter sites. The mathematical model maximizes the minimum weight of open shelter areas while deciding on the location of shelter areas, the assigned population points to each open shelter area and controls the utilization of open shelter areas. We validate the mathematical model by generating a base case scenario using real data for Kartal, Istanbul, Turkey. Also, we perform a sensitivity analysis on the parameters of the mentioned mathematical model and discuss our findings. Lastly, we perform a case study using the data from the 2011 Van earthquake. © 2014 Elsevier B.V. All rights reserved

Kartal District of Istanbul

Kartal district of Istanbul data set is first discussed in "Locating temporary shelter areas after an earthquake: A case for Turkey" article of Kilci F, Kara BY, Bozkaya B, 2015. (Kılcı F, Kara BY, Bozkaya B, 2015 Locating temporary shelter areas after an earthquake: A case for Turkey. European Journal of Operational Research 243(1):323- 332.) Kartal is specified as the 11th most crowded district among the 39 districts of Istanbul and has nearly $425,000$ inhabitants. There are 20 sub-districts in Kartal and the population of each is assumed to be concentrated in its center. Moreover, there are 25 points of interests (POI) which are determined as emergency rallying points. These POIs include school yards, mall parking lots and some other appropriate points. The locations of 45 nodes are presented in the KARTAL.jpg. Rallying points are the first 25 nodes and the rest are sub-districts. Symmetric node to node distance matrix and a matrix describing ground transportation network existence are also defined

Anaesthesia in a patient with severe ischemic heart disease: Case report [Agir i·skemik kalp hastasina anestezik yaklaşimimiz]

We describe our experience of thorocal epidural anesthesia (TEA) in combination with general anesthesia in a male patient undergoing operation due to adenocarcinoma of the stomach. The patient 65 years old had a coronary angiography revealing that LAD 100%, 1.diagonal 98%, 1. septal 100% and circumflex 100% were occluded. After obtaining written informed consent, he has been taken to the operation room for monitorization. In the sitting position, epidural catheterisation was performed through T7-8 interspace. 200 mg 2% prilocain and 25 mg 5% bupivacain in a total volume of 15 ml were injected via the catheter. Anesthesia was induced with 2 mg/kg lidocain, 2 microgram/kg fentanyl, 2 mg/kg propofol and 0,1 mg/kg vecuronium. Maintanance was provided by 0.5% isoflurane in 50% O2 and N2O mixture. We observed no complication during pertoperative period. The patient has been discharged with coronary artery bypass grafting (CABG) suggestion. Tea in combination with general anesthesia was performed to decrease anesthetic and surgical risks. We aimed not only to increase O2 delivery and decrease of consumption tea by coronary vasodilation due to sympathetic blockage, but also decrease autonomic and endocrine response, obtain a hemodynamic stability and succeed postoperative analgesia. Copyright © 2010 by Türkiye Klinikleri

Management of wet ascitic type of peritoneal tuberculosis: single center experience

OBJECTIVE: We aimed to present our experience with the management of 17 patients with ascites who underwent diagnostic laparoscopy or laparotomy, and histologic confirmation of wet ascitic type of peritoneal tuberculosis (TB). PATIENTS AND METHODS: Between January 2008 and March 2019, 17 patients whose ascites were investigated by a gastroenterologist and who were thought to have non-cirrhotic ascites were referred to our Surgery clinic for peritoneal biopsy. The clinical, biochemical, radiological, microbiological, and histopathological data of the patients who underwent diagnostic laparoscopy or laparotomy were analyzed retrospectively. Histopathological examination of peritoneal tissue samples in hematoxylin-eosin-stained preparations revealed necrotizing granulomatous inflammation with caseous necrosis and Langhans type giant cells. Ehrlich-Ziehl-Neelsen (EZN) staining was studied with the suspicion of TB. Acid-fast bacilli (AFB) were detected in EZN stained slide. Histopathological findings were also considered. RESULTS: Seventeen patients aged 18 to 64 years were included in this study. The most common symptoms were ascites and abdominal distention, weight loss, night sweats, fever and diarrhea. Radiological examination revealed peritoneal thickening, ascites, omental cacking, and diffuse lymphadenopathy. Histopathologically, necrotizing granulomatous peritonitis consistent with peritoneal TB were detected. While direct laparoscopy was preferred in sixteen patients, laparotomy was preferred in the remaining one due to previous surgical procedures.  However, seven were converted to open laparotomy. CONCLUSIONS: Diagnosis of abdominal TB requires high index of suspicion, and the treatment should be prompt to reduce the morbidity and mortality associated with delay in treatment

The case of a cyst hydatid localized within the interatrial septum

The ratio of cardiac involvement of Echinoccocus granulosus is 0.02-2% and although seen rarely. involvement of the interatrial septum has also been reported in the published literature. The present case was a 19-year-old male University student admitted to hospital with complaints of headache and dizziness. Computerized tomography of the cranium revealed a cystic mass located at the frontal region and enucleation of the cyst was performed during surgery. A cystic lesion 5 x 4 cm in size was detected within the interatrial septum on two-dimensional transthoracic echocardiography during the postoperative period and the patient was referred to our clinic. Open heart surgery was performed and a hydatid cyst that involved the interatrial septum was enucleated. The cyst wall was sutured to the interatrial septum. No complications developed during the postoperative period. The patient was discharged oil the fifth day of hospitalization and medical therapy was started with albendazole