Effects of anesthesia methods applied in ureter upper end stone operations on early postoperative quality of life

Objective: Urinary system Stone disease (urolithiasis) is a disease that changes and is increasingly prevalent depending on many factors, and nowadays, monitoring, medical removal therapy, shock wave lithotripsy (SWL), ureterorenoscopy (URS), laparoscopic surgeries and open surgery to treat proximal ureter stones. In our study, we aimed to investigate the comparison of intraoperative tolerance and early postoperative quality of life levels of general anesthesia, spinal anesthesia and spinal anesthesia with adjuvant agent in patients to be operated for upper ureteral calculi. Materials and methods: This study was  conducted  prospectively. In our study, we aimed to investigate the comparison of intraoperative tolerance and early postoperative life quality levels of patients with general anesthesia, spinal anesthesia and adjuvant spinal anesthesia in patients who will be operated on for upper ureteral stones, and for this purpose, 75 patients who were operated on and met the inclusion criteria were recruited. In our study, patients who were operated under general anesthesia were named as group 1, those who were operated under spinal anesthesia using only bupivacaine, group 2, and those who were operated using bupivacaine + fentanyl were named as group 3. Each group consisted of 25 patients. Statistical analyses were performed using SPPS v.20.0. Results: It was observed that the duration of anesthesia, operation time, VAS pain scale, intraoperative heart rate change and intraoperative diastolic blood pressure did not show statistically significant difference between the groups. İt was determined that intraoperative systolic blood pressure was higher inboth groups that underwent spinal anesthesia compared to the group that was applied general anesthesia, and the spo2 level was lower. Conclusions: In this study, in which we evaluated spinal anesthesia as an alternative to general anesthesia, we found that spinal anesthesia is also safe and effective in proximal ureter stone operations. Therefore we think that spinal anesthesia should be preferred more frequently due to the lower risk of postoperative nausea and vomiting, postoperative analgesia, early mobilization and early nutrition compared to general anesthesia

A Case of Cerebral Sinus Venous Thrombosis Resulting in Mortality in Severe Preeclamptic Pregnant Woman

Cerebral venous sinus thrombosis (CVST) is a rarely encountered condition during pregnancy. A 21-year-old pregnant woman with labour pains was hospitalized in our clinic. Diagnosis of severe preeclampsia was made based on her clinical and laboratory findings. She suffered from convulsive episodes during postpartum period which lead to initiation of treatment for eclampsia. However neurological and radiological examinations were performed after emergence of additional neurological symptoms disclosed the diagnosis of CVST. In this paper, we aimed to present a case with CVST which diagnosis was confused with eclampsia and resulting in maternal mortality

Długoterminowe wyniki radykalnej i zachowawczej chirurgii w późno rozpoznanych ciążach jajowodowych

Objective: To investigate long-term postoperative outcomes of conservative and radical surgery in ectopic tubal pregnancies, and evaluate the results of these techniques. Methods: A total of 145 patients that operated for tubal pregnancy between January 2006 and January 2009 were reviewed. Data on patient age, reproductive and surgical history, history of ectopic pregnancies, serum hCG levels at the time of diagnosis and intraoperative observation were retrospectively obtained from hospital records. Telephone interviews were used to obtain information about exact postoperative time interval in which the patients were trying to get pregnant, and the time when they spontaneously became pregnant. Results: There was no significant difference in cumulative spontaneous intrauterine pregnancy rate for a 2-year of conception period subsequent to conservative (64.3%) and radical (58.3%) surgery (p=0.636). During the same time interval, the rates of development of ectopic pregnancy for the conservative and radical surgery groups were 17.9% and 4.2%, respectively (p= 0.093). The patients who developed ectopic pregnancy after conservative surgery had significantly higher levels of serum hCG levels (7413+/-3155 IU/L) compared with those of patients who not-developed ectopic pregnancy (3436+/-2668 IU/L) (p=0.007). Conclusion: In late-diagnosed cases with higher serum hCG levels, conservative treatment should not be the first choice. Indeed, our results suggested that the cumulative pregnancy rates are not significantly higher, and the risk of ectopic pregnancy recurrence may be increased with conservative surgery in late tubal pregnancies.Cel: Badanie długoterminowych pooperacyjnych wyników leczenia zachowawczego i radykalnego w ekotopowych ciążach jajowodowych i ocena rezultatów tych metod. Metody: Przeanalizowano grupę 145 pacjentek operowanych z powodu ciąży jajowodowej pomiędzy styczniem 2006 i styczniem 2009. Dane dotyczące wieku pacjentek, przeszłości położniczej, operacji, ciąż ektopowych, poziomu hCG w surowicy w momencie postawienia diagnozy oraz obserwacje z przebiegu operacji zostały retrospektywnie uzyskane z dokumentacji szpitalnej. Informacje na temat dokładnego czasu po operacji, w którym pacjentka starała się zajść w ciążę oraz czas do zajścia w ciążę uzyskano w rozmowie telefonicznej. Wyniki: Nie znaleziono istotnej różnicy w skumulowanym wskaźniku spontanicznych ciąż wewnątrzmacicznych w ciągu 2 lat obserwacji po zachowawczym (64,3%) i radykalnym (58,3%) leczeniu operacyjnym (p=0,636). W tym samym przedziale czasu, odsetek ciąż ektopowych wynosił dla zachowawczej i radykalnej chirurgii odpowiednio, 17,9% i 4,2%, p=0,093. Pacjentki, u których doszło do rozwoju ciąży pozamacicznej po zachowawczej operacji miały istotnie wyższe poziomy surowiczego hCG (7413+/-3155 IU/L) w porównaniu do tych pacjentek, u których nie doszło do ciąży pozamacicznej (3436+/-2668 IU/L), p=0,007. Wnioski: W późno rozpoznanych przypadkach ciąży ektopowej z wyższym poziomem hCG, zachowawcze postępowanie nie powinno być leczeniem z wyboru. Nasze wyniki wskazują na to, że skumulowany wskaźnik ciąż nie jest istotnie wyższy a ryzyko ponownej ciąży pozamacicznej może być zwiększone w przypadkach późnego rozpoznania ciąży jajowodowej leczonej zachowawczą chirurgią

Unusual Suspect After Spinal Anesthesia: Herpetic Encephalitis

Herpes simplex virus (HSV) is the most common cause of acute, sporadic viral encephalitis. Usually occurs with the activation of the latent virus. Sudden onset fever and especially temporal lobe involvement are typical clinical features of HSV encephalitis. In this article, we aimed to present a case of herpetic encephalitis, which is an unusual factor in meningitis after spinal anesthesia. Severe headache and convulsion developed at postoperatively. Body temperature of the patient was 38.3 °C and neck stiffness developed. The patient was diagnosed with herpes encephalitis by clinical, laboratory and cranial magnetic resonance, and acyclovir treatment was started immediately. The patient was discharged home with recovery on the 14th day. Loss of consciousness and convulsions with fever seen at the postoperative period after spinal anesthesia, may not always be due to bacterial meningitis but sometimes due to HSV-associated acute herpetic meningoencephalitis. Rapid diagnosis and treatment is life-saving

Relaparotomia po pierwotnym leczeniu chirurgicznym w położnictwie i ginekologii: analiza 113 przypadków

Condensation: Even though relaparotomy is unavoidable in some cases, several measures such as careful surgical technique, meticulous hemostasis and aseptic conditions must be undertaken to prevent unnecessary interventions in obstetrics and gynecology. Objective: To assess the indications, procedures, risk factors and outcome for relaparotomy after obstetric and gynecological operations. Study Design: A retrospective observational study during a four-year period in a tertiary care center was performed. Demographics such as age, parity, and indications for relaparotomy as well as outcome measures in terms of complications and mortality rates were assessed in 113 patients who had undergone a relaparotomy after the initial obstetric or gynecological surgery. Results: The overall incidence of mortality after relaparotomy was 3.5%. Leading indications for the initial operation included placental abruption in 10 cases (8.8%), followed by the HELLP syndrome and previous cesarean section both in 5 cases (4.4%), and postpartum atonia in 4 (3.5%). The most common operations performed initially were cesarean section in 78 cases (69.0%) and 31 hysterectomies (27.5%). Principal indications for relaparotomy were bleeding and hematoma in 80 cases (70.8%) and abscess in 10 cases (8.8%). The most frequently performed procedures at relaparotomy were drainage and resuturing of hematomas (n=42, 37.1%), hypogastric artery ligation (n=32, 28.3%), hysterectomy (n=31, 27.5%), and drainage of abscess (n=7, 6.2%). A second relaparotomy was performed in 4 cases (3.5%). Complications were encountered in 4 patients and 4 cases ended up with mortality. Conclusion: Hemorrhagic and infectious complications were the main indications for relaparotomy after obstetric and gynecologic surgeries. Cases with a history of placental abruption, HELLP Syndrome and previous cesarean section were under risk for relaparotomy. Despite favourable outcome, preventive measures such as careful surgical technique, meticulous hemostasis and aseptic conditions should be undertaken.Chociaż relaparotomia jest w niektórych przypadkach nie do uniknięcia, powino się podjąć wszelkie środki, takie jak: dokładna technika operacyjna, skrupulatna hemostaza i warunki aseptyczne, aby zapobiec niepotrzebnym interwencjom w położnictwie i ginekologii. Cel: Ocena wskazań, procedur, czynników ryzyka i wyników leczenia relaparotomią po operacjach ginekologicznych i położniczych. Metoda: Przeprowadzono retrospektywne badanie obserwacyjne w ciągu 4 lat w ośrodku III stopnia referencyjności. Dane demograficzne, takie jak: wiek, rodność, wskazania do relaparotomii oraz jej wynik w postaci powikłań i śmiertelności, oceniono u 113 pacjentek operowanych ponownie po pierwotnej operacji położniczej lub ginekologicznej. Wyniki: Ogólna częstość zgonów po relaparotomii wynosiła 3,5%. Wiodącym wskazaniem do pierwotnej operacji było oddzielenia łożyska w 10 przypadkach (8,8%), następnie zespół HELLP i cięcie cesarskie w wywiadzie – oba po 5 przypadków (4,4%), oraz atonia poporodowa w 4 (3,5%). Najczęściej wykonaną pierwotną operacją było cięcie cesarskie – 78 przypadków (69%) i usunięcie macicy – 31 (27,5%). Głównym wskazaniem do relaparotomii było krwawienie i krwiak w 80 przypadkach (70,8%) oraz ropień w 10 przypadkach (8,8%). Najczęściej wykonywanymi procedurami podczas relaparotomii były: drenaż i ponowne założenie szwów na miejsca krwawiące (n=42, 37,1%), podwiązanie tętnicy podbrzusznej (n=32, 28,3%), usunięcie macicy (n=31, 27,5%), i ewakuacja ropnia (n=7, 6,2%). Ponowna relaparotomia była przeprowadzona w 4 przypadkach (3,5%). Powikłania dotyczyły 4 pacjentek i 4 pacjentki ostatecznie zmarły. Wnioski: Powikłania krwotoczne i infekcyjne były głównym wskazaniem do relaparotomii po pierwotnych operacjach ginekologicznych i położniczych. Przypadki z przedwczesnym oddzieleniem łożyska, zespołem HELLP i cięciem cesarskim w wywiadzie były związane z większym ryzykiem relaparotomii. Pomimo korzystnych wyników, powinno się podjąć środki zaradcze w postaci dokładnej techniki operacyjnej, skrupulatnej hemostazy oraz zapewnienie warunków aseptycznych

Evaluation of the anatomical and electrical axis of the heart after pneumonectomy

Aim: To investigate the position of the heart after pneumonectomy and, also to find out how the changes in the electrical axis of the heart contribute for the possible electrocardiographic and echocardiographic changes. Methods: Ninety-eight patients with pneumonectomy were included to this observational study. To calculate the rotation of the heart and angle measurement two perpendicular lines, one septal and another atrioventricular, were drawn on the images acquired from thoracic computed tomography. Thoracic CT were taken at every 3 months for the first two years. On electrocardiograms net QRS vectors, amplitudes of p waves, findings of right and left ventricular hypertrophy, and other possible changes were recorded. Results: The mean age of all patients was 55.51 ± 8.9. Right pneumectomy was performed in 40 (57%) and left pneumonectomy in 30 cases (43%) cases. There was no significant change regarding both the angle of rotation and the amount of pleural effusion between the findings of the second and first year after the operation. The QRS shift was significantly more pronounced in patients with left pneumonectomies than right pneumonectomies. On echocardiography these cases showed right ventricular hypertrophy and increased pulmonary artery pressures in the second year when compared to the preoperative period. Conclusions: The current study showed that many significant changes occurred in the electrocardiographic and echocardiographic parameters of the heart after pneumonectomy

A comparative study of the standart surgical technique versus mini-ıncision in the treatment of Carpal Tunnel Syndrome

Amaç: Median sinirin el bileği düzeyindeki tuzak nöropatisi olan karpal tünel sendromunun (KTS) sağaltımında farklı cerrahi teknikler bildirilmiştir. Bu çalışmada KTS olgularında 2 farklı cerrahi teknik kullanılarak uygulanan sağaltımın sonuçları karşılaştırılmıştır. Yöntem: ılk guruptaki 11 olgunun 12 eline standart teknik ile cerrahi dekompresyon uygulanmış, ikinci guruptaki 10 olgunun 12 elinde ise mini insizyon yöntemi uygulanmıştır. Bulgular: Postoperatif izlem süresi, komplikasyon sıklığı, klinik ve elektronörofizyolojik bulgular yönünden değerlendirildiğinde iki gurup arasında X ve Fisher'in exact testleri ile istatistiksel olarak anlamlı bir fark olmadığı belirlenmiştir. Sonuç: Bu sonuçlar bize KTS cerrahisinde kullanılan standart ve mini insizyon tekniklerinin birbirlerine üstünlüklerinin olmadığını düşündürmüştür.Aim: Various surgical treatment alternatives exist for carpal tunnel syndrome which is the the entrapment of the median nerve at the wrist level. In this study two different surgical techniques were comparatively evaluated in terms oftime needed forpostoperative follow-up, complications, clinical and electrodiagnostic improvement. Method: Surgical decompression utilising the standard technique was used in 12 hands of the 11 patients in the first group and the mini-incision technique was employed in 12 hands of the 10 patients in the second group. Results: No statistical difference in any one of the above mentioned parameters was found with the X2 and Fisher's exacttests. Conclusion: Thus, we conclude that neither of the two techniques utilised for carpal tunnel syndrome surgery can be considered superior to the other

The effect of smoking on cardiac diastolic parameters including Vp, a more reliable and newer parameter

Background: Previous studies have focused mainly on the acute effects of smoking on the diastolic function of the heart. The present study was conducted to demonstrate the chronic effects of smoking on the diastolic functional parameters of the heart, including transmitral M- mode coloured flow propagation velocity (Vp), among relatively younger asymptomatic adults. Method: Hundred smokers with histories of incessant smoking for at least one year prior to the time of the investigation were included in the prospectively designed study as group I. Group II consisted of 35 non-smokers, matched for age and gender. Addiction to smoking was graded according to the modified Fagerström test for nicotine dependence (M-FNDT). Each smoker was designated by a nicotine dependence index (NDI) according to the M-FNDT. Groups I and II were compared with respect to major diastolic functional parameters on transthoracic echocardiography (TTE), including the E/A ratio, deceleration time (DT), isovolumic relaxation time (IVRT) and Vp, along with basic clinical and echocardiographic parameters. Results: Thirty one smokers in group 1 and 5 non-smokers in group 2 were excluded from the study according to the pre-defined exclusion criteria. Therefore 69 smokers (mean age: 30 &#177; 4.9 years, M/F: 32/37) in group I were compared with 30 non-smokers (mean age: 31.4 &#177; 4.8 years, M/F: 15/15) in group II. In group I the mean values of E/A and Vp were significantly lower (p < 0.001), whereas the mean values of IVRT and DT were significantly higher (p < 0.001) than in group II. In group I the value of NDI was positively correlated with the values of DT and IVTR (p < 0.001) and negatively correlated with the value of Vp (p < 0.001). Conclusion: Conventional and relatively new parameters of cardiac diastolic function, in particular Vp, were found to be impaired in smokers demonstrating the chronic adverse effects of smoking on the diastolic function of the heart. The severity of this impairment was closely correlated with the degree of addiction to smoking. (Cardiol J 2007; 14: 281-286

Lenalidomide-based treatment results in patients with relapsed/refractory lymphoma (excluding mantle cell lymphoma): A multi-centre experience

Amaç: Lenfomalar, çoğunlukla B hücre kökenli heterojen bir hastalık grubunu temsil eder. Lenalidomid, kemo-immünoterapötik ajanlara talidomidin yapısal bir analoğu olarak dahil edilmiştir. Bu çalışmada amaç, mantle hücreli lenfoma dışı lenfomalarda, lenalidomid ile ilgili gerçek yaşam verilerimizi ortaya çıkarmaktır. Hastalar ve Yöntem: Ocak 2018- Ocak 2020 tarihleri arasında lenfoma tanısı alan hastalar geriye dönük olarak incelendi. Lenalidomid kombine rejimleri şu şekilde gruplandırılmıştır: Lenalidomi -deksametazon (Len-D); lenalidomid-bendamustin (Len-B); lenalidomid-rituksimab (Len-R). Bulgular: On beş (%60.9) hasta Len-D, 6 (%30.4) hasta Len-B ve 2 (%8.7) hasta Len-R aldı. En yaygın yanıt 13 (%56.5) hasta ile progresif hastalık idi, sadece 2 (%8.7) hastada tam yanıt vardı. Sonuç: Lenalidomid, diffüz büyük B hücreli lenfomalar (DBBHL), folliküler lenfoma (FL) ve indolen relaps/refrakter lenfomalar ile relaps/refrakter Hodgkin lenfomada (HL) yeni tedavi seçenekleri arasında yer almaktadır.Objective: Lymphomas represent a heterogeneous group of diseases, mostly of B-cell origin. Lenalidomide is included in chemo-immunotherapeutic agents as a structural analog of thalidomide. In this study, the goal is to reveal our real-life data on lenalidomide. Patients and Methods: Patients diagnosed with lymphoma between January 2018-2020, were retrospectively analyzed. Lenalidomide combined regimens were grouped as: Lenalidomidedexamethasone (Len-D); lenalidomide-bendamustine (Len-B); lenalidomide-rituximab (Len-R). Results: Fifteen (60.9%) patients received Len-D, 6 (30.4%) patients received Len-B and 2 (8.7%). patients received Len-R Most common response was progressive disease with 13 (56.5%) patients, only 2 (8.7%) patients had a complete remission. Conclusion: Lenalidomide appears as new treatment options in relapsed/refractory Hodgkin lenfoma (HL), diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL) and indolent lymphomas