Manutenção do equilíbrio entre a pressão das vias aéreas e a pressão intracraniana em paciente com estenose traqueal submetido à craniotomia: relato de caso

ResumoJustificativa e objetivosEstenose traqueal é uma doença rara, mas de risco, e a anestesia em paciente com estenose traqueal é um desafio para os anestesiologistas. Manter os parâmetros hemodinâmicos estáveis e a ventilação são questões importantes em neuroanestesia. Qualquer aumento da pressão de pico das vias aéreas e da ETCO2 resultará em aumento da pressão intracraniana, o que deve ser evitado durante craniotomias. A estenose traqueal pode ser uma razão para o aumento da pressão das vias aéreas.Relato de casoDescrevemos o caso de um paciente submetido à craniotomia com estenose traqueal.ConclusãoA preparação detalhada para a intubação, estabilizar a dinâmica das vias aéreas e tomar a decisão certa para a cirurgia foram pontos importantes. Manter um bom equilíbrio entre a dinâmica cerebral e a dinâmica das vias aéreas foi a pérola deste caso.AbstractBackground and objectivesTracheal stenosis is a rare but a life‐threatening condition and anesthesia of a patient with tracheal stenosis is challenging for anesthesiologists. Maintaining stable hemodynamics and ventilation parameters are important issues in neuroanesthesia. Any increase in airway peak pressure and ETCO2 will result in increase in intracranial pressure which must be avoided during craniotomies. Tracheal stenosis could be a reason for increased airway pressure.Case reportWe described a patient undergoing craniotomy with tracheal stenosis.ConclusionDetailed preparation for intubation, to stabilize airway dynamics and to make the right decision for the surgery were important points. To maintain a good balance between cerebral dynamics and airway dynamics were the pearls of this case

Long-term results of chronic achilles tendon ruptures repaired with V-Y tendon plasty and fascia turndown

Background: This study aimed to evaluate the long-term follow-up results of V-Y tendon plasty with fascia turndown, for repairing chronic Achilles tendon ruptures. Methods: Seventeen patients (12 males, 5 females), who were diagnosed with chronic Achilles tendon rupture and met the inclusion criteria, were included in the study. These patients received treatment by means of V-Y tendon plasty with fascia turndown from January 1995 to December 2001. Clinical outcomes of the patients were assessed by using isokinetic strength testing, questioning the patient regarding residual discomfort, pain, or swelling and having the ability to perform heel rises and using American Orthopaedic Foot & Ankle Society’s (AOFAS’s) Ankle-Hind Foot Scale score. Mean followup duration was 16 years (13-18 years). Results: Mean time from the injury to operative treatment was 7 months. Mean operative defect of Achilles tendon in neutral position after debridement was 6 cm. During the follow-up, the mean calf atrophy was 3.4 cm. The mean 30 degrees/s plantarflex and 120 degrees/s plantarflex peak torques were 89 and 45 Nm, respectively. The mean 30 degrees/s plantarflex peak torque deficiency was 16%. The mean 120 degrees/s plantarflex peak torque deficiency was 17%. The average peak torque deficiency was 17%. The pre- and postoperative mean AOFAS Ankle-Hindfoot Scale scores were 64 and 95, respectively. No patient had a rerupture. Superficial wound infection was treated with oral antibiotic therapy in 2 patients (11%). Conclusions: The V-Y tendon plasty with fascia turndown for repairing chronic Achilles tendon ruptures yielded results comparable with the literature regarding clinical outcomes. This method did not require synthetic materials for augmentation and was an economic alternative compared to other repair methods. Level of Evidence: Level III, retrospective comparative study

Outcomes for revision total knee replacement after unicompartmental knee replacement

Objective: The aim of this retrospective, observational study was to describe the outcomes of total knee replacement (TKR) after failed Oxford phase 3 medial unicompartmental knee replacement (UKR). Methods: The study included 24 revision TKRs (20 females, 4 males; mean age: 61 years) performed following failed aseptic UKR. Outcomes were assessed using the Knee Society Score (KSS). Results: The most common causes for revision were mobile bearing dislocation and unexplained pain. Mean preoperative KSS was 50.3 (range: 37 to 66) and 82.2 (range: 58 to 97) after TKR. There were 17 excellent, 4 good, 2 fair and 1 poor results. Conclusion: The type of UKR performed (cemented versus uncemented) had no effect on TKR success. Revision for failed UKR with TKR appears to be a technically straightforward procedure with satisfactory early clinical results

Izazovi opstetricijske anestezije: otežana vizualizacija larinksa

Obstetric anesthesia is one of the high risk subspecialties of anesthesia practice. Anesthesia related complications are the sixth leading cause of maternal mortality. Difficult or failed intubation following induction of general anesthesia for CS remains the major contributory factor to anesthesia-related maternal complications. The airway management of obstetric patients is a challenging issue for several reasons. Anatomic and physiologic changes related to pregnancy may increase the difficult and failed intubation rates compared to the general surgical population. Proper evaluation of the airway anatomy and airway structures is vital to prevent airway management related catastrophes. In addition to basic airway and intubation equipment, each anesthesia department must have difficult intubation equipment cart including fiber optic laryngoscope, video laryngoscopes, and different types of laryngeal masks. It is essential that all anesthesiologists have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient.Opstetricijska anestezija je visokorizična anesteziološka supspecijalnost. Komplikacije vezane uz anesteziju su šesti vodeći uzrok majčine smrtnosti. Otežana ili nemoguća intubacija nakon uvoda u opću anesteziju je glavni čimbenik koji doprinosi komplikacijama vezanim uz anesteziju rodilja. Zbrinjavanje dišnoga puta u rodilja je izazov iz više razloga. Anatomske i fiziološke promjene u trudnoći povećavaju učestalost otežane i nemoguće intubacije u odnosu na opću kiruršku populaciju. Zadovoljavajuća evaluacija anatomije dišnoga puta i dišnih struktura je životno važna da bi se spriječile katastrofe vezane uz zbrinjavanje dišnoga puta. Uz osnovnu opremu za dišni put i intubaciju svaki anesteziološki odjel mora imati kolica s opremom za otežani dišni put koja uključuju fiberoptički laringoskop, videolaringoskop i različite vrste laringealnih maski. Nužno je da svi anesteziolozi imaju unaprijed osmišljene i dobro razrađene algoritme i opremu za hitno zbrinjavanje dišnoga puta kako bi postupali s hitnoćama dišnoga puta u otežanoj ili nemogućoj intubaciji rodilja

İngiliz Arşiv Belgeleri'ne Göre Osmanlı-İngiliz İlişkileri, 1578-1800

Yapılması amaçlanan bu çalışma, İstanbul özelinde Osmanlı-İngiliz ilişkilerini çalışmayı hedeflemektedir. 1578-1800 yıllarını kapsayan çalışma Osmanlı-İngiliz ticari ve politik ilişkileri tarihsel gelişim sürecini inceleyecekti

Co-Design Practice in Industrial Design Education in Turkey A Participatory Design Project

The evolution in design research has shifted from a user-centered design approach to co-design approach. With co-designing, roles of designers and users have changed. In growing co-creation and co-design notions, user is seen as a partner, not as a passive object of study. In current undergraduate industrial design education in Turkey, user research is done in limited steps during design process. User observations that are required for students during their design processes are done outside of studio courses with the students' own opportunities. Yet students face difficulties in design process of the products especially the ones they have not experienced before. This study aims to apply 'designing with users' notion instead of 'designing for users' into a practice in education field. The goals of this study are; to benefit from users who are experts of their experiences as teammates during the design process and to satisfy user's expectations with the end product by using an alternative approach in design education. Two design projects were conducted with 12 third-year industrial design students from Gazi University and six volunteer users in 302 Industrial Design course. Three groups, each consisting of six (four students and two users), were formed to design products according to project briefs. Users participated in the problem definition and idea generation sessions as codesigners during design process. A questionnaire and interviews were used to collect data about students' remarks on participation of users. Students evaluated what they learned from co-designing and how users contributed to design process. The results of the surveys reflect that efficiency of design process can be improved with participation and collaboration of users. Users can play large roles from idea generation to concept development. Consequently, it was observed that co-designing can be efficiently implemented into undergraduate industrial design education. (C) 2015 The Authors. Published by Elsevier Ltd

EXAMINING SCHOOL CULTURE IN TERMS OF STRONG AND WEAK CULTURAL FEATURES

Bu çalışmanın temel amacı okulların güçlü ve zayıf kültürel özelliklerini incelemektir. Alanyazın, güçlü kültürel özellikleri üyelerin çoğunun üzerinde uyum sergilediği unsurlar olarak tanımlamaktadır. Zayıf kültürel özellikler ise üyelerin tercihlerindeki uyumsuzluk olarak belirtilmektedir. Bu iki yaklaşımın uygulamadaki yansıması uyum ve alt kültür şeklinde belirmektedir (Hofstede, Hofstede ve Minkov, 2010). Bu çalışmada veri toplama aracı olarak araştırmacılar tarafından geliştirilen Okul Kültürü Ölçme Aracı kullanılmıştır. Tabakalı ve tesadüfi örnekleme tekniğinin kullanıldığı bu çalışmada Aksaray il merkezinde bulunan toplam 51 okuldan 912 öğretmene anket uygulanmıştır. Veriler, tanımlayıcı istatistikler ve açımlayıcı faktör analizi ile incelenmiştir. Çalışma sonunda toplam 44 maddeden 17 madde güçlü kültürel özellik; beş madde ise zayıf kültürel özellik olarak belirlenmiştir. Bulgular, Türk okullarında uyum yaklaşımının baskın olduğunu desteklemektedir. Güçlü kültürel özelliklerin faktör yapısı beş başlık altında sınıflandırılmıştır: Öğrenci odaklılık, mesleki gelişim, sorumlulukları yerine getirme ve okulun misyonunu gerçekleştirme. Zayıf kültürel özellikler ise semboller ve kahramanlara ilişkin özelliklerdir

Tuberculous epididymitis: A case report and review of the literature

Tüberküloz epididimit tanısı güç olan nadir bir hastalıktır. Epididimitin, testis tümörü ve torsiyonu gibi diğer skrotum hastalıklarından ayırt edilmesi önemlidir. Konvesiyonel tanı metodları genellikle invazif ve zaman alıcı yöntemlerdir. Mikobakteriyal DNA’nın saptanmasına yönelik polimeraz zincir reaksiyonu (PCR) testi, tüberküloz epididimitin hızlı tanısı amacıyla kullanılan değerli bir tanı metodudur. Ayırıcı tanıda biyopsinin önemini vurgulamak amacıyla başlıca öksürük, ateş, bilateral skrotal şişlik ve ağrı yakınmalarıyla başvuran bu vakayı sunuyoruz.Tuberculous epididymitis is a rare disease difficult to diagnose. It is important to differentiate epididymitis from other causes for acute scrotum, such as testicular torsion and tumor. The conventional methods for diagnosis are often time-consuming and invasive. Polymerase chain reaction (PCR)-based assay for mycobacterial DNA is a valuable method for rapid diagnosis of tuberculous epididymitis. We report this case who was admitted with the chief complaints of cough, fever, bilateral scrotal swelling and pain to emphasize that biopsy are of the importance in the differantial diagnosis

T10 vertebraya metastaz yapmış estezyonöroblastom: vaka sunumu ve literatür taraması

Estezyonöroblastom olfaktuar epitelden köken alan nadir görülen malign bir tümördür. 52 yaşındaki erkek hasta kliniğimize 3 aydır devam eden ilerleyici burun tıkanıklığı, burun kanaması ve nazal radikste kitle ile başvurdu. Rinoskopik muayenede her iki nazal kavitede polipoid kitle görüldü ve lokal anestezi ile biyopsi yapıldı. Histopatolojik analiz sonucunda estezyonöroblastom tanısı konuldu. Tümör Kadish evre B olarak değerlendirildi. Endoskopik endonazal ve lateral rinotomi ile yaklaşımları ile kitle eksizyonu yapıldı. Postoperatif radyoterapi uygulandı. Takiplerinde cerrahiden 10 ay sonra submandibuler lenf nodu metastazı saptandı ve hastaya bilateral tip 3 modifiye radikal boyun diseksiyonu yapıldı ve sonrasında radyoterapi uygulandı. Cerrahiden 12 ay sonra ise T10 vertebrada uzak metastaz saptandı. Hastanın uzak metastazı olduğu halde primer bölgede rekürrens saptanmadı. Sonuç olarak estezyonöroblastomalarda lokal nüksler sık olduğu için hastaların dikkatli bir şekilde takip edilmeleri gereklidir ve aynı zamanda lokal rekürrens olmadan da uzak metastaz olabileceği de akılda tutulmalıdır.Esthesioneuroblastoma is a rare malignant tumor orginating from the olfactory epithelium. A 52–year-old man admitted to our clinic with a 3 months history of progressive nasal obstruction, epistaxis and mass on the nasal radix. On rhinoscopy, a polypoid mass was seen in the both nasal cavity and we performed an intranasal biopsy with local anesthesia. On histopathologic analysis the tumor was identifed as an esthesioneuroblastoma. The tumor was classified as Kadish stage B. The mass was excised via bilateral endoscopic endonasal resection and lateral rhinotomy approach. Radiotherapy was performed postoperatively. During the follow up, submandibuler lymph node metastasis occured ten months after surgery. The patient underwent bilateral type III modified radical neck dissection followed by radiotherapy to the neck. Distant metastasis developed on the T 10 vertebra 12 months after the initial treatment. Although he had distant metastasis he was free of local recurrence 13 th month after surgery. In conclusion because of locoregional recurrences are common in esthesioneuroblastomas, patients must be followed carefully but also we have to remember that distant metastasis may appear without local recurrence