COVID-19 Pandemi Sırasındaki Acil Cerrahi Bakım ve Ameliyathane Uygulamalarında Perioperatif Uygulama ve Rehberlik; Deneyimlerimiz

Aim: The novel coronavirus SARS-CoV-2 (COVID-19) can infect healthcare workers. We developed an institutional algorithm to protect operating room team members during the COVID-19 pandemic and rationally conserve personal protective equipment (PPE). We aimed to review the latest data on the COVID-19 pandemic and essential information for practice in emergency surgery and the operating room.Materials and Methods: An interventional platform (operating room, interventional suite, and endoscopy) with our committee formed with our doctors consisting of different branches, we developed our guidelines based on potential patterns of spread, risk of exposure, and conservation of PPE. We aimed to share our experiences with 128 patients who were taken into operation in a 2-month period.Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in Medical Faculty of Namık Kemal University.Results: A decision tree algorithm describing our institutional guidelines for precautions for operating room team members was created. This algorithm is based on the urgency of operation, anticipated viral burden at the surgical site, the opportunity for a procedure to aerosolize virus, and the likelihood a patient could be infected based on symptoms and testing.Conclusion: Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision algorithm for the interventional platform teams, we can ensure optimal healthcare worker safety.Amaç: Yeni koronavirüs SARS-CoV-2 (COVID-19) sağlık çalışanlarını enfekte edebilir. COVID-19 salgını sırasında ameliyathane ekip üyelerini korumak ve rasyonel olarak kişisel koruyucu ekipman (KKE) için kurumsal bir algoritma geliştirdik. Acil cerrahi ve ameliyathanede COVID-19 salgını ile ilgili en güncel bilgileri gözden geçirmeyi amaçladık. Materyal ve Metot: Farklı branşlardan oluşan doktorlarımızla oluşturduğumuz komitemiz ile girişimsel bir platform (ameliyathane, girişimsel ve endoskopi), potansiyel yayılma örüntüleri, maruz kalma riski ve KKE'nin korunmasına dayanan kılavuzlarımızı geliştirdik. Deneyimlerimizi 2 aylık bir sürede ameliyat edilen 128 hasta ile paylaşmayı amaçladık. 2019-nCoV şüphesi olan hastalar için acil durum prosedürleri için anestezi yönetimi ve enfeksiyon kontrol kılavuzları Namık Kemal Üniversitesi Tıp Fakültesi'nde hazırlanmış ve uygulanmıştır. Bulgular: Ameliyathane ekibi üyelerine yönelik önlemler için kurumsal yönergelerimizi açıklayan bir karar algoritması oluşturuldu. Bu algoritma ameliyatın aciliyetine, cerrahi bölgede beklenen viral yüke, virüsü aerosol haline getirme prosedürü fırsatına ve hastanın semptomlara ve testlere dayanarak enfekte olma olasılığına dayanır. Sonuç: COVID-19'un yeni bir tehdit olmasına rağmen, girişimsel platform ekipleri için izlemesi kolay bir karar algoritması geliştirerek, optimum sağlık çalışanı güvenliğini sağlayabildiğimizi gösterdik

ATYPICAL CT FINDINGS AND CLINICAL CORRELATION OF COVID-19 PNEUMONIA

Aim: Our study aimed to evaluate the atypical CT findings and concomitant pathologies of COVID-19 pneumonia and clinical and laboratory findings and compare them with typical CT findings.Materials and Methods: A total of 69 patients were diagnosed with COVID-19, 14 of which were atypical (20.2%), and 55 of which were typical (79%) chest computed tomography (CT) findings. CT images and clinical and laboratory data of patients with atypical findings were retrospectively analyzed. Lesions of the typical and atypical group and CT severity scores were compared.Results: Atypical CT findings were centrilobular nodule, tree in bud, pleural effusion, lobar/segmental consolidation, bronchiectasis, pulmonary embolism, and mosaic attenuation by typical lesions with ground-glass opacity with/without consolidation. CT severity score was significantly higher in the atypical group (p <0.001). CRP, procalcitonin, the neutrophil rate increased, and the lymphocyte count decreased in patients with a high CT severity score. Comorbidity was common in the atypical group (50%).Conclusion: High CT severity score and widespread lung involvement of the patient group with atypical CT findings may be due to disease progression or other concomitant diseases. Atypical lesions accompanying typical lesions may cause false negativity in reporting. As radiologists' experience with COVID-19 pneumonia increases, it may improve that they categorize these images as typical or atypical

Morphological and Clinical Aspects of Aberrant Subclavian Artery: Single Center Multidedector Computed Tomography Based Study

Aim: Aberrant subclavian artery (ASA) anomalies are the most common aortic arch malformations. Incidence of these malformations increases with widespread use of computed tomography (CT). Our aim in this study was to investigate the relationship between ASA malformations, gender, age and reasons for admission, and arcus aorta (AA), ASA diameters and AA/ASA diameter ratios.Materials and Methods: A total 74 patients with ASA were evaluated by thorax CT retrospectively. Patients were divided into aberrant right (ARSA) and left (ALSA) subclavian artery groups. Age, gender, reasons for application, ASA and AA diameters and AA/ASA ratios were evaluated between the groups. Correlations of ASA and AA diameters with age were also evaluated.Results: 70 of the patients (94.5%) had ARSA, 4 of the patients (5.4%) had ALSA. There was no statistical relationship between gender (p=0.394), age (p=0.443) and reasons for application (p=0.322) between groups. There was no statistical relationship between ASA diameter (p=0.127), AA diameter (p=0.728) and AA/ASA ratio (p=0.339) between groups. There was weak positive correlation with ageand diameter of AA (r=0.379, p=0.001), but not with ASA diameter (p=0.059). Moderate positive correlation (r=0.573, p<0.001) was detected between diameters of AA and ASA.Conclusion: ASA malformations are the most common incidentally detected malformations with increased use of CT. These malformations are not related to age, gender and reasons for application.Amaç: Aberran subklavian arter(ASA) anomalileri en sık görülen aortik ark malformasyonlarıdır. Bilgisayarlı tomografi (BT) kullanımının artması ile bu malformasyonların görülme sıklığı artmaktadır. Bizim bu çalışmadaki amacımız ASA malformasyonlarının cinsiyet, yaş ve hastaneye başvuru nedenleri arasındaki ilişkiyi araştırmak; arkus aorta (AA), ASA çapları ve AA/ASA çap oranlarının arasındaki ilişkiyi değerlendirmekti. Materyal ve Metot: ASA’sı olan 74 hastanın toraks BT’leri retrospektif olarak incelendi. Hastalar, aberran sağ subklavian arteri (ARSA) olan ve aberran sol subklavian arteri (ALSA) olanlar şeklinde ikiye ayrıldı. İki grup; yaş, cinsiyet, başvuru nedenleri, ASA ve AA çapları ve AA/ASA oranları açısından karşılaştırıldı. Ayrıca ASA ve AA çaplarının yaş ile korelasyonu değerlendirildi. Bulgular: Hastaların 70’inde (%94.5) ARSA, 4’ünde (%5.4) ALSA mevcuttu. İki grup arasında cinsiyet (p=0.394), yaş (p=0.443) ve başvuru nedenleri (p=0.322) arasında istatistiksel ilişki bulunmadı. İki grup arasında ASA çapı (p=0.127), AA çapı (p=0.728) ve AA/ASA oranı (p=0.339) arasında istatistiksel ilişki saptanmadı. Yaş ile AA çapı arasında zayıf pozitif korelasyon (r=0.379, p=0.001) izlenirken; yaş ile ASA çapı arasında korelasyon saptanmadı (p=0.059). AA çapı ile ASA çapı arasında orta şiddette pozitif korelasyon (r=0.573, p<0.001) bulundu. Sonuç: ASA malformasyonları BT kullanımının artmasıyla birlikte daha sık görülen, genellikle insidental olarak saptanan malformasyonlardır. Bu malformasyonların yaş, cinsiyet ve başvuru nedenleri ile ilişkisi bulunmamaktadır

Atypical CT Findings and Clinical Correlation Of COVID-19 Pneumonia

Aim: Our study aimed to evaluate the atypical CT findings and concomitant pathologies of COVID-19 pneumonia and clinical and laboratory findings and compare them with typical CT findings.Materials and Methods: A total of 69 patients were diagnosed with COVID-19, 14 of which were atypical (20.2%), and 55 of which were typical (79%) chest computed tomography (CT) findings. CT images and clinical and laboratory data of patients with atypical findings were retrospectively analyzed. Lesions of the typical and atypical group and CT severity scores were compared.Results: Atypical CT findings were centrilobular nodule, tree in bud, pleural effusion, lobar/segmental consolidation, bronchiectasis, pulmonary embolism, and mosaic attenuation by typical lesions with ground-glass opacity with/without consolidation. CT severity score was significantly higher in the atypical group (p <0.001). CRP, procalcitonin, the neutrophil rate increased, and the lymphocyte count decreased in patients with a high CT severity score. Comorbidity was common in the atypical group (50%).Conclusion: High CT severity score and widespread lung involvement of the patient group with atypical CT findings may be due to disease progression or other concomitant diseases. Atypical lesions accompanying typical lesions may cause false negativity in reporting. As radiologists' experience with COVID-19 pneumonia increases, it may improve that they categorize these images as typical or atypical

Covid -19 Pnömonisinin Atipik BT Bulguları ve Klinik Korelasyonu

Aim: Our study aimed to evaluate the atypical CT findings and concomitant pathologies of COVID-19 pneumonia and clinical and laboratory findings and compare them with typical CT findings.Materials and Methods: A total of 69 patients were diagnosed with COVID-19, 14 of which were atypical (20.2%), and 55 of which were typical (79%) chest computed tomography (CT) findings. CT images and clinical and laboratory data of patients with atypical findings were retrospectively analyzed. Lesions of the typical and atypical group and CT severity scores were compared.Results: Atypical CT findings were centrilobular nodule, tree in bud, pleural effusion, lobar/segmental consolidation, bronchiectasis, pulmonary embolism, and mosaic attenuation by typical lesions with ground-glass opacity with/without consolidation. CT severity score was significantly higher in the atypical group (p <0.001). CRP, procalcitonin, the neutrophil rate increased, and the lymphocyte count decreased in patients with a high CT severity score. Comorbidity was common in the atypical group (50%).Conclusion: High CT severity score and widespread lung involvement of the patient group with atypical CT findings may be due to disease progression or other concomitant diseases. Atypical lesions accompanying typical lesions may cause false negativity in reporting. As radiologists' experience with COVID-19 pneumonia increases, it may improve that they categorize these images as typical or atypical.Amaç: Çalışmamızın amacı COVİD-19 pnömonisinin atipik BT bulgularını, eşlik eden ek patolojileri klinik ve laboratuar bulgularıyla birlikte değerlendirmek ve tipik BT bulguları ile karşılaştırmaktır. Materyal ve Metot: Çalışmamıza 14’ü atipik (%20,2), 55’i tipik (%79) toraks bilgisayarlı tomografi (BT) bulguları olan COVID-19 tanısı almış toplam 69 hasta dahil edildi. Toraks BT görüntüleri, atipik bulguları olan hastaların klinik ve laboratuar verileri retrospektif incelendi. Tipik ve atipik grubun lezyonları ve BT şiddet skoru karşılaştırıldı. Bulgular: Atipik BT bulguları sentrilobüler nodül, tomurcuklanmış ağaç, plevral effüzyon, lober/segmenter konsolidasyon, bronşiektazi, pulmoner emboli ve mozaik atenüasyon olup, periferik dağılım gösteren buzlu cam opasitesi ve/veya konsolidasyon gibi tipik lezyonlara eşlik etmekteydi. BT şiddet skoru atipik grupta belirgin yüksekti (p<0,001). BT şiddet skoru yüksek olguların CRP, prokalsitonin, nötrofil oranı artmış, lenfosit sayısı azalmıştı. Atipik grupta komorbidite daha sık görüldü (%50). Sonuç: Atipik BT bulguları olan hasta grubunun yüksek BT şiddet skoru ve yaygın akciğer tutulumu hastalığın progresyonu ya da eşlik eden diğer hastalıklara bağlı olabilir. Tipik lezyonlara atipik lezyonların eşlik etmesi raporlamada yanlış negatifliğe neden olabilir. Radyologların COVID-19 pnömonisi ile deneyimi arttıkça bu görüntüleri tipik veya atipik olarak kategorize etmeleri gelişebilir

Can Ultrasound-Guided Regional Anesthesia Techniques For Tracheostomy Be An Alternative To General Anesthesia?

Introduction The cervical plexus block (CPB) has been used for a long time for both analgesia and anesthesia in carotid endarterectomy and thyroid operations. To be unfamiliar with the technique and its perceived difficulty, potential risks, and possible adverse effects such as intravascular injection has limited broader use before the practical use of ultrasound. We hypothesize that the cervical plexus block can provide adequate anesthesia in tracheostomy cases and provide excellent anesthesia comfort when combined with a translaryngeal block. Methods This double-blinded, randomized 29 patients undergoing primary tracheostomy operation to receive either CPB (Group S) or CPB with translaryngeal block (Group ST). The primary outcome was cumulated analgesic consumption during the first 24 postoperative hours. Secondary outcomes were as follows: pain related to incision, patient tolerance as assessed by tracheostomy cannula comfort score, cough and gag, pain at rest, nausea and vomiting, and time to first analgesic demand. Results The patient tolerance for tracheostomy was higher in Group ST than Group S. The median tracheostomy cannula comfort score was 4.0 in Group S. In contrast, the median score was significantly lower in group ST (P<.001). The cough and gag reflex scores were significantly lower in Group ST than Group S (1.0 vs 4.0, P<.001). Conclusion This trial supported the hypothesis that the CPB combined with the translaryngeal block yields excellent anesthesia for tracheostomies. The technique we briefly described, in a way, is the equivalent of awake fiberoptic intubation to awake tracheostomy with minimal sedation adjusted according to airway patency

Corrigendum to “A new method for diagnosis of anterior cruciate ligament tear: MRI with maximum flexion of knee in the prone position: A case control study” (International Journal of Surgery (2019) 68 (142–147), (S1743919119301451), (10.1016/j.ijsu.2019.06.017))

The authors regret that the figure captions in this article appeared incorrectly and should have been displayed as follows: Fig. 3. First patient's suspected partial tear in the sagittal section in the supine position with the knee in extension (knee MRI image) Fig. 4. The first patient's total tear image in a sagittal section in the prone position with the knee in maximum flexion (knee MRI image) Fig. 5. The second patient's suspected partial tear in a sagittal section in the supine position with the knee in extension (knee MRI image) Fig. 6. The second patient's total tear image in a sagittal section in the prone position with the knee in maximum flexion (knee MRI image) Fig. 7. The third patient's suspected partial tear in a sagittal section in the supine position with the knee in extension (knee MRI image) Fig. 8. The third patient's partial tear image in a sagittal section in the prone position with the knee in maximum flexion (knee MRI image)The authors would like to apologise for any inconvenience caused

A new method for diagnosis of anterior cruciate ligament tear: MRI with maximum flexion of knee in the prone position: A case control study (vol 68, pg 142, 2019)

The authors regret that thefigure captions in this article appearedincorrectly and should have been displayed as follows:Fig. 3. First patient's suspected partial tear in the sagittal section inthe supine position with the knee in extension (knee MRI image)Fig. 4. Thefirst patient's total tear image in a sagittal section in theprone position with the knee in maximumflexion (knee MRI image)