Izvanbolnička istodobna operacija ventralne i preponske hernije u lokalnoj anesteziji: prikaz slučaja

Umbilical and epigastric hernias are occasionally seen in patients with groin hernias, however, there is almost no published evidence about their simultaneous repair. In a 3-year period, 10 patients were subjected to simultaneous repair of groin hernias (7 unilateral, 2 bilateral inguinal and 1 femoral) and ventral hernias (7 primary, 2 recurrent umbilical and 1 epigastric) with local infiltration anesthesia and intravenous sedation. The mean total bupivacaine dose was 18 (10- 30) mL and mean total lidocaine dose 21 (14-30) mL. The mean time to resuming normal daily activity was 5.5 days, whereas the time to car driving was 3-7 days. The oral analgesic (naproxen sodium) requirement was 6-10 tablets for 3-5 days. Patient acceptance was excellent. Simultaneous repair of groin and ventral hernias with local anesthesia in outpatient setting is feasible and associated with a low complication rate and maximum patient comfort.Umbilikalne i epigastrične hernije ponekad se nalaze u bolesnika s preponskom hernijom, međutim, gotovo da nema objavljenih podataka o njihovom istodobnom operacijskom liječenju. Tijekom 3-godišnjeg razdoblja istodobna operacija preponskih hernija (7 jednostranih, 2 obostrane ingvinalne i 1 femoralna) i ventralnih hernija (7 primarnih i 2 opetovane umbilikalne i 1 epigastrična) u lokalnoj infiltracijskoj anesteziji i intravenskoj sedaciji izvedena je u 10 bolesnika. Srednja ukupna doza bupivakaina bila je 10 (10-30) mL, a srednja ukupna doza lidokaina 21 (14-30) mL. Srednje vrijeme do povratka normalnih svakodnevnih aktivnosti bilo je 5,5 dana, a za upravljanje motornih vozilima 3-7 dana. Potreba za oralnim analgeticima (naproksen natrij) bila je 6-10 tableta kroz 3-5 dana. Bolesnici su izvrsno prihvatili ove zahvate. Istodobno rješavanje preponske i ventralne hernije uz lokalnu anesteziju u izvanbolničkim uvjetima izvedivo je, ima nisku stopu komplikacija i najvišu razinu udobnosti za bolesnika

Intraocular medulloepithelioma: case series

Background: The purpose of this study was to report the outcomes of an extremely rare and misdiagnosed embryonalneuroepithelial intraocular tumor. Material and methods: The medical records of 28 nucleated eyes with unilateral vision loss in childhood and young adults were reviewed retrospectively. Demographic information, clinical history, visual acuity, indication for surgery, and histopathological findings were all noted. Cases of visual loss related to ocular trauma or endophthalmitis were not included in this study. B-scan ultrasonography was performed on patients due to media opacity. Results: A total of 7 eyes of 28 patients, age between 1–18 years, who were underwent enucleation surgery for intraocular malignancy were included in the study. The mean follow-up period was 29.4 ± 10.2 months (range, 15–60 months ). The mean age of the patients was 5.85 ± 7.33 years. There were four females and three males with equal eye distribution. The patients had no light perception. Five of 7 patients were operated on for retinoblastoma in the early period of life with easily recognized clinical signs. The other two patients wanted surgery just because they were uncomfortable with the appearance of their eyes. One of them was a 15-year-old girl with a history of blind eye and glaucoma. She had been treated for congenital glaucoma since the age of 5. At the time of the research she was complaining about the painful, blind eye as an aesthetic defect. Histopathological diagnosis was reported as medulloepithelioma. As a long-term complication, submandibular lymph node metastasis was detected duringthe follow-up period. Otolaryngologists performed the radical neck dissection. The patient received radiotherapyand chemotherapy. She is now in her 30s. No other complication was observed during the follow-up period. Theother patient was an 18-years-old boy, who had lost his vision for an unknown cause in childhood, and wanted tohave surgery for aesthetic purposes due to opaque cornea. Ultrasonography detected a mass in the ciliary body. Theenucleation surgery was performed, and histopathological diagnosis was reported as medulloepithelioma. The patientreceived radiotherapy, and no metastasis developed during the follow-up period. Conclusion: Ophthalmologists need to be more familiar with early diagnoses and screening of the eye, especiallydetecting tumor cases “medulloepithelioma” which is often misdiagnosed and treated as glaucoma

Izvanbolnička istodobna operacija ventralne i preponske hernije u lokalnoj anesteziji: prikaz slučaja

Umbilical and epigastric hernias are occasionally seen in patients with groin hernias, however, there is almost no published evidence about their simultaneous repair. In a 3-year period, 10 patients were subjected to simultaneous repair of groin hernias (7 unilateral, 2 bilateral inguinal and 1 femoral) and ventral hernias (7 primary, 2 recurrent umbilical and 1 epigastric) with local infiltration anesthesia and intravenous sedation. The mean total bupivacaine dose was 18 (10- 30) mL and mean total lidocaine dose 21 (14-30) mL. The mean time to resuming normal daily activity was 5.5 days, whereas the time to car driving was 3-7 days. The oral analgesic (naproxen sodium) requirement was 6-10 tablets for 3-5 days. Patient acceptance was excellent. Simultaneous repair of groin and ventral hernias with local anesthesia in outpatient setting is feasible and associated with a low complication rate and maximum patient comfort.Umbilikalne i epigastrične hernije ponekad se nalaze u bolesnika s preponskom hernijom, međutim, gotovo da nema objavljenih podataka o njihovom istodobnom operacijskom liječenju. Tijekom 3-godišnjeg razdoblja istodobna operacija preponskih hernija (7 jednostranih, 2 obostrane ingvinalne i 1 femoralna) i ventralnih hernija (7 primarnih i 2 opetovane umbilikalne i 1 epigastrična) u lokalnoj infiltracijskoj anesteziji i intravenskoj sedaciji izvedena je u 10 bolesnika. Srednja ukupna doza bupivakaina bila je 10 (10-30) mL, a srednja ukupna doza lidokaina 21 (14-30) mL. Srednje vrijeme do povratka normalnih svakodnevnih aktivnosti bilo je 5,5 dana, a za upravljanje motornih vozilima 3-7 dana. Potreba za oralnim analgeticima (naproksen natrij) bila je 6-10 tableta kroz 3-5 dana. Bolesnici su izvrsno prihvatili ove zahvate. Istodobno rješavanje preponske i ventralne hernije uz lokalnu anesteziju u izvanbolničkim uvjetima izvedivo je, ima nisku stopu komplikacija i najvišu razinu udobnosti za bolesnika

Clinical Study Spinal Anaesthesia with Hyperbaric Prilocaine in Day-Case Perianal Surgery: Randomised Controlled Trial

Background. The local anaesthetics used in day-case spinal anaesthesia should provide short recovery times. We aimed to compare hyperbaric prilocaine and bupivacaine in terms of sensory block resolution and time to home readiness in day-case spinal anaesthesia. Methods. Fifty patients undergoing perianal surgery were randomized into two groups. The bupivacaine-fentanyl group (Group B) received 7.5 mg, 0.5% hyperbaric bupivacaine + 20 g fentanyl in total 1.9 mL. The prilocaine-fentanyl group (Group P) received 30 mg, 0.5% hyperbaric prilocaine + 20 g fentanyl in the same volume. Results. Time to L1 block and maximum block was shorter in Group P than in Group B (Group P 4.6 ± 1.3 min versus Group B 5.9 ± 01.9 min, = 0.017, and Group P 13.2 ± 7.5 min versus Group B 15.3 ± 6.6 min, = 0.04). The time to L1 regression and S3 regression of the sensorial block was significantly shorter in Group P than in Group B (45.7 ± 21.9 min versus 59.7 ± 20.9 min, = 0.024, and 133.8 ± 41.4 min versus 200.4 ± 64.8 min, < 0.001). The mean time to home readiness was shorter for Group P than for Group B (155 ± 100.2 min versus 207.2 ± 62.7 min ( < 0.001)). Conclusion. Day-case spinal anaesthesia with hyperbaric prilocaine + fentanyl is superior to hyperbaric bupivacaine in terms of earlier sensory block resolution and home readiness and the surgical conditions are comparable for perianal surgery

The interrelations of radiologic findings and mechanical ventilation in community acquired pneumonia patients admitted to the intensive care unit: a multicentre retrospective study

BACKGROUND: We evaluated patients admitted to the intensive care units with the diagnosis of community acquired pneumonia (CAP) regarding initial radiographic findings. METHODS: A multicenter retrospective study was held. Chest x ray (CXR) and computerized tomography (CT) findings and also their associations with the need of ventilator support were evaluated. RESULTS: A total of 388 patients were enrolled. Consolidation was the main finding on CXR (89%) and CT (80%) examinations. Of all, 45% had multi-lobar involvement. Bilateral involvement was found in 40% and 44% on CXR and CT respectively. Abscesses and cavitations were rarely found. The highest correlation between CT and CXR findings was observed for interstitial involvement. More than 80% of patients needed ventilator support. Noninvasive mechanical ventilation (NIV) requirement was seen to be more common in those with multi-lobar involvement on CXR as 2.4-fold and consolidation on CT as 47-fold compared with those who do not have these findings. Invasive mechanical ventilation (IMV) need increased 8-fold in patients with multi-lobar involvement on CT. CONCLUSION: CXR and CT findings correlate up to a limit in terms of interstitial involvement but not in high percentages in other findings. CAP patients who are admitted to the ICU are severe cases frequently requiring ventilator support. Initial CT and CXR findings may indicate the need for ventilator support, but the assumed ongoing real practice is important and the value of radiologic evaluation beyond clinical findings to predict the mechanical ventilation need is subject for further evaluation with large patient series

Erratum of "Addition of lidocaine to levobupivacaine reduces intrathecal block duration: randomized controlled trial"

AbstractBackgroundThe duration of the spinal block is a concern for anesthetists. Low dose intrathecal lidocaine has vasodilatory effects and increases the local anesthetic clearance from the intrathecal space. The aim was to investigate whether this effect of lidocaine can be used to increase the resolution of levobupivacaine spinal anesthesia.MethodAfter obtaining ethical approval and informed patient consent, 40 patients underwent transurethral prostate resection were studied. Patients were randomized into two groups and patients received either levobupivacaine 6.75mg+0.3mL 2% lidocaine (Group L) or levobupivacaine 6.75mg+saline (Group C). The main outcome measures were the difference between groups regarding the duration of the spinal block and PACU stay. Secondary outcome measures were the difference between groups in onset and resolution of the spinal block, adverse events and treatments were also investigated.ResultsSpinal block resolved faster in Group L than Group C; 162.43±39.4min vs 219.73±37.3min (p=0.000). PACU time was shorter in Group L (109±49.9min in Group L vs 148±56.8min in Group C) (p=0.036). There was no difference between groups with respect to the incidence of adverse events and treatments. Groups were also similar regarding complications. PDPH and TNS were not observed in any group.ConclusionAddition of low dose lidocaine to hyperbaric levobupivacaine reduces the duration of the intrathecal block provided by hyperbaric levobupivacaine. This technique can be used to reduce the spinal block duration for relatively short procedures like TUR-P

Lung tissue apoptosis in abdominal hypertension

Objectives The aim of this study was to evaluate lung tissue histopathologic changes and the number of apoptosis with the increase of abdominal pressure. Methods The study rats were randomly assigned into the following five groups: a sham operated group and groups 1, 2, 3 and 4, in which the intra-abdominal pressure was increased to 11, 15, 18 and 22 mmHg for 60 min, respectively. Lungs were harvested for histopathologic changes and the tissue apoptotic analysis were carried out in a blinded manner. Results All of the data showed that the number of apoptotic cells and necrosis were increased in accordance with the pressure level. However, this increase was statistically significant, especially in groups 3 and 4 (18 and 22 mmHg, respectively; p < 0.05) when compared to the sham operated rats. There were no differences observed between groups 1 and 2 (11 and 15 mmHg, respectively) and the sham operated rats. There was also no difference between groups 1 and 2. There were findings of coagulation necrosis and the number of apoptotic cells linearly increased when the abdominal pressure was increased. The cut-off value was 15 mmHg. Conclusion The available findings suggest that intra-abdominal pressure greater than 15 mmHg could irreversibly damage pulmonary cells and both coagulation necrosis parameters and the number of apoptosis increase in accordance with the pressure level

Spinal Anaesthesia with Hyperbaric Prilocaine in Day-Case Perianal Surgery: Randomised Controlled Trial

Background. The local anaesthetics used in day-case spinal anaesthesia should provide short recovery times. We aimed to compare hyperbaric prilocaine and bupivacaine in terms of sensory block resolution and time to home readiness in day-case spinal anaesthesia. Methods. Fifty patients undergoing perianal surgery were randomized into two groups. The bupivacaine-fentanyl group (Group B) received 7.5 mg, 0.5% hyperbaric bupivacaine + 20 μg fentanyl in total 1.9 mL. The prilocaine-fentanyl group (Group P) received 30 mg, 0.5% hyperbaric prilocaine + 20 μg fentanyl in the same volume. Results. Time to L1 block and maximum block was shorter in Group P than in Group B (Group P 4.6±1.3 min versus Group B 5.9±01.9 min, P=0.017, and Group P 13.2±7.5 min versus Group B 15.3±6.6 min, P=0.04). The time to L1 regression and S3 regression of the sensorial block was significantly shorter in Group P than in Group B (45.7±21.9 min versus 59.7±20.9 min, P=0.024, and 133.8±41.4 min versus 200.4±64.8 min, P<0.001). The mean time to home readiness was shorter for Group P than for Group B (155±100.2 min versus 207.2±62.7 min (P<0.001)). Conclusion. Day-case spinal anaesthesia with hyperbaric prilocaine + fentanyl is superior to hyperbaric bupivacaine in terms of earlier sensory block resolution and home readiness and the surgical conditions are comparable for perianal surgery