Jinekolojik operasyonlarda postoperatif bakım ünitesinde kalış süresini etkileyen faktörler

Amaç: Bu retrospektif çalışmada elektif jinekolojik operasyon geçiren hastaların postoperatif bakım ünitesinde (POBÜ) kalma sürelerinin ve bunları etkileyen faktörlerin incelenmesi hedeflenmiştir.Gereç ve yöntem: Genel anestezi altında jinekolojik nedenlerle laparotomi yapılan, operasyonu 60 dakika ve üzerinde süren, rutin genel anestezi ve postoperatif analjezi uygulanmış, 18-80 yaş arası hastaların anestezi ve POBÜ kayıtları incelenmiştir. Hedef parametre olan POBÜ’nde kalış süresinin 60 dakika altında ya da üstünde oluşuna göre hastaların yaş, vücut kitle indeksi, operasyon süresi, ASA değeri, operasyon nedeninin patolojik özelliği, intraoperatif sıvı ve anestezik tüketimi, POBÜ’ne giriş Aldrete skoru, POBÜ’nde tedavi gereksinimi incelenmiştir.Bulgular: POBÜ’nde kalış süresinin ≥ 60 dakika olma olasılığının “American Society of Anesthesiologist” (ASA) fizik durum sınıflamasına göre ASA değeri ≥ III olanlarda 3,27, malign nedenli operasyonlarda 2,38, POBÜ’ne giriş Aldrete skoru < 9 olması halinde 3,28, solunum fizyoterapisi ve invazif mekanik ventilasyon gereksinimi durumunda sırasıyla 3,37 ve 14,6 kat arttığı bulunmuştur.Sonuç: Postoperatif bakım ve POBÜ kullanımı planlanırken, jinekolojik operasyon geçirecek hastalarda, ASA değeri ≥ III, patolojinin malign, POBÜ’ne giriş Aldrete skoru < 9 olmasının, solunum fizyoterapisi ve invazif mekanik ventilasyon gereksiniminin POBÜ’nde ≥ 60 dakika kalışa neden olabileceği göz önüne alınmalıdır.Anahtar kelimeler: Postoperatif derlenme, postoperatif bakım ünitesinde kalış, genel anestezi, jinekolojik operasyon

Predictive Factors for Response to a Standard Dose of Intravenous Immunoglobulin Therapy in Children with Immune Thrombocytopenia

Objective: Acute immune thrombocytopenic purpura (ITP) is a common acquired bleeding disorder. Intravenous immunoglobulin (IVIG) therapy is commonly given as initial treatment to pediatric patients with ITP. Factors that can predict the response to IVIG have not been fully determined. We retrospectively evaluated whether the clinical and laboratory findings of pediatric patients with ITP at the time of diagnosis could predict the response to IVIG and progression to chronic ITP. Methods: A total of 45 patients with newly diagnosed ITP who were initially treated with IVIG were evaluated between January 2016 and December 2019. Short-term response was estimated by platelet counts 2 weeks after IVIG, and long- term response was assessed by thrombocytopenia-free survival (TFS). TFS was defined as the probability of survival without treatment failure after initial IVIG, such as relapse, requiring additional therapeutic interventions, or progression to chronic ITP. Results: In univariate analysis, age ≥25 months (p=0.002), platelet count ≤6.9x109 /L (p=0.034), and hemoglobin (Hb) level >12.4 g/dl (p=0.001) were considered to be unfavourable factors for short-term response. Univariate analysis of unfavourable factors for longterm response showed that age ≥25 months (p=0.002), platelet count ≤6.9x109 /L (p=0.034), and Hb level >12.4 g/dl (p=0.001) were significant factors. Conclusion: These results suggest that in newly diagnosed ITP patients older than 25 months and/or with platelet count <6.9x109 /L, other therapeutic options such as corticosteroids alone or in combination with IVIG may be considered as initial therap

Pediatric Liver Transplantation Outcomes for Metabolic and Non-metabolic Diseases in Turkey: A Single Center Experience

Aim: Liver transplantation (LT) is performed for several indications in the pediatric population, including malignancy and acute hepatic failure among others. LT has become an important treatment alternative for metabolic diseases. in most pediatric transplant centers, metabolic liver disease is the second most common indication for LT after biliary atresia. Our studies aim is to compare the post-transplant outcomes of those patients with metabolic and other liver diseases in our transplant program. Materials and Methods: One hundred eighty-nine patients who underwent LT between 1997 and 2015 due to metabolic diseases and acute or chronic liver failure were included in the study. This study was performed retrospectively. Results: We enrolled 189 patients in our study. 54% (n=102) male and 46% (n=87) female patients were included in the study. the metabolic disease group included 56 patients and the non-metabolic disease group contained 133 patients. Progressive familial intrahepatic cholestasis is the most common disease among metabolic diseases resulting in LT and Wilson disease is the second most common. Post-transplant immunosuppression was similar for both groups. There was no difference in both groups regarding the onset of post-transplant complications for graft type or recipient age. Biliary and portal vein complications were most particularly defined in the group with non-metabolic diseases. There was no significant difference in survival between the two groups. Conclusion: LT is an important treatment option for acute hepatic failure and end-stage liver diseases. in addition, LT is an alternative treatment option for some metabolic diseases