An alternative anterior tension free preperitoneal patch technique by help of the endoscope for femoral hernia repair

AbstractBackgroundFemoral hernias are relatively uncommon and have a higher risk for strangulation and incarceration. We introduce an alternative anterior tension free inlay patch technique by help of the endoscope for femoral hernia repair.MethodCharacteristics of patients undergoing femoral hernia repair between March 2006–April 2011 and description of the surgical technique is presented.ResultsWe analyzed our experience with this technique in 26 consecutive patients with femoral hernias (1 bilateral, 15 right, 10 left femoral hernia) in 5 year period. Seven of these 26 femoral hernias were recurrent and 2 of them were concomitant with inguinal hernia. Mean operation time was 30.0 ± 12.1 min. Seroma was seen in 2 patients at postoperative 1st week. There were no; hematoma, wound infection and separation of wound edges and early recurrence at postoperative 1st week and 1st month. The mean follow up period was 41.8 ± 18.2 months. All of 22 patients who were contacted were satisfied with the operation. There was no recurrence, chronic pain and foreign body feeling in any patient at the end of the follow-up period.ConclusionThis feasible and safe alternative anterior inlay patch repair might be used in all femoral hernias with the exception of the ones requiring intestinal resection

Discovery of a small molecule that selectively destabilizes Cryptochrome 1 and enhances life span in p53 knockout mice

Cryptochromes are negative transcriptional regulators of the circadian clock in mammals. It is not clear how reducing the level of endogenous CRY1 in mammals will affect circadian rhythm and the relation of such a decrease with apoptosis. Here, we discovered a molecule (M47) that destabilizes Cryptochrome 1 (CRY1) both in vitro and in vivo. The M47 selectively enhanced the degradation rate of CRY1 by increasing its ubiquitination and resulted in increasing the circadian period length of U2OS Bmal1-dLuc cells. In addition, subcellular fractionation studies from mice liver indicated that M47 increased degradation of the CRY1 in the nucleus. Furthermore, M47-mediated CRY1 reduction enhanced oxaliplatin-induced apoptosis in Ras-transformed p53 null fibroblast cells. Systemic repetitive administration of M47 increased the median lifespan of p53−/− mice by ~25%. Collectively our data suggest that M47 is a promising molecule to treat forms of cancer depending on the p53 mutation

Anesthesia For Maternal – Fetal Surgery

review articleFetal surgery is performed on pregnant patient and fetal patient and could be called maternal-fetal surgery. Surgery is on the pregnant women for fetal benefit and anesthesia is necessary for these two patients whose physilogic characteristics are extremly different. Providing anesthesia for fetal surgery necessitates integration of obstetric and pediatric anesthesia integration and many disciplines colloboration and cooperation. The researches are going on about the possibility of anesthetic drugs neurotoxicity on developing nervous system of fetus. The fetus reacts to painfull stimuli and these painfull interventions may cause long term effects . Fetal surgery issues are, minimally invazive interventions, open midgestation surgery and EXIT procedures. An anesthetic plan can range from local anesthetic infiltration to sedation to neuroaxial or general anesthesia. Surgical technique, risk and benefit ratio and potential need are important for optimal anesthetic plan. In this article, we reviewed the maternal physiology, fetal physiology, ethic issues, anesthetics effects on the fetus, anesthetic managements for different types of surgical techniques.Fetal cerrahi anne ve fetal hastayı ilgilendirdiği için fetal-maternal cerrahi olarak adlandırılabilir. Fetusun tedavisi için fizyolojik özellikleri birbirinden farklı iki hastaya anestezi uygulanmaktadır. Fetal cerrahide anestezi uygulamaları doğum ve pediatrik anestezi eğitimi ile farklı disiplinlerin beraber çalışmasını gerektirir. Anestezik ajanların gelişen beyin dokusuna nörotoksik etkileri üzerine ileri araştırmalar devam etmektedir. Ağrılı uyaranlara bağlı olarak fetusun gelişen sinir sistemindeki değişikliklerin uzun dönem etkileri olduğu bilinmektedir. Fetal cerrahi işlemler midgestasyon intrapartum cerrahiler, minimal invaziv girişimler, ve ex utero intrapartum tedaviler (EXIT) olmak üzere üç grupta toplanır. Anestezi teknikleri, lokal anestezi ve sedasyondan, genel anestezi ve nöroaksiyel anesteziye kadar değişebilir. Cerrahi teknik, anne fetus için risk fayda dengesi, ve önceliklş gereksinimler optimal anestezi planının yapılmasında önemlidir. Bu derlemede; gebedeki fizyolojik değişikliler, fetusun anestezi açısından fizyolojik özellikleri, etik konular, anestezinin fetusa etkileri, cerrahi tekniklere göre anestezi ugulamaları gözden geçirilecektir

COVID-19 and Coagulopathy

Critical COVID-19 patients caused by coronavirus 2 (SARS-CoV-2) is characterised by hypoxia, hyperinflamation besides coagulopathy and thrombosis. Venous, arterial and microvascular thrombosis are associated with poor prognosis. For the critical COVID-19 patients admittted to intensive care unit, the incidence of thrombotic complications were reported as 16-64%. Initial elevated Ddimer and fibrinogen levels are associated with thrombocytopenia and mild elevated prothrombin time. As the disease progress, disseminated intravasculary coagulopathy can develop in severe COVID-19 patients. Anticoagulant treatment with heparin is important for improving prognosis in COVID-19 patients who have high D-dimer levels and coagulopathy criterions. Monitoring of coagulopathy related parameters more than viral parameters and interventions related to coagulopathy prophylaxis and treatment managements are more important in terms of prognosis and mortality of COVID-19 patients than antiviral treatments.Koronavirüs 2 (SARS-CoV-2)'nin neden olduğu kritik COVID-19 hastalarında hipoksi ve aşırı inflamasyon beraberinde sıklıkla koagülopatiye bağlı trombotik olaylar gelişir. Venöz , arteriyel ve mikrovasküler tromboz gelişimi ile karakterize koagülopati, prognozu ağırlaştırır. Yoğun bakımda izlenen COVID-19 hastalarının %16-64'ünde trombotik komplikasyonlar rapor edilmiştir. Başlangıçta artmış Ddimer ve fibrinojen beraberinde trombositopeni ve protrombin zamanında hafif uzama gelişebilir. Hastalığın ilerlemesi ile yaygın damar içi koagülasyon gelişir.Antikoagülan tedavi belirgin D-dimer artışı ve COVID-19 ilişkili koagülopati kriterleri gösteren hastalarda daha iyi prognoz açısından önemlidir.Bu hastalığın laboratuvar izleminde viral parametrelerden daha fazla koagülopati ile ilgili parametrelerin izlenmesi; antiviral tedavilerden çok koagülopati proflaksisi ve tedavisi ile ilgili girişimler prognoz ve mortalite açısından daha önemli görülmektedir

Anaesthesiologist's Approach to Awake Craniotomy

Awake craniotomy, which was initially used for the surgical treatment of epilepsy, is performed for the resection of tumours in the vicinity of some eloquent areas of the cerebral cortex which is essential for language and motor functions. It is also performed for stereotactic brain biopsy, ventriculostomy, and supratentorial tumour resections. In some institutions, avoiding risks of general anaesthesia, shortened hospitalization and reduced use of hospital resources may be the other indications for awake craniotomy. Anaesthesiologists aim to provide safe and effective surgical status, maintaining a comfortable and pain-free condition for the patient during surgical procedure and prolonged stationary position and maintaining patient cooperation during intradural interventions. Providing anaesthesia for awake craniotomy require scalp blockage, specific sedation protocols and airway management. Long-acting local anaesthetic agents like bupivacaine or levobupivacaine are preferred. More commonly, propofol, dexmedetomidine and remifentanyl are used as sedative agents. A successful anaesthesia for awake craniotomy depends on the personal experience and detailed planning of the anaesthetic procedure. The aim of this review was to present an anaesthetic technique for awake craniotomy under the light of the literature.Uyanık kraniyotomi tekniği ilk olarak epilepsi cerrahisinde başlamışken günümüzde hassas beyin korteksine yakın beyin tümörlerinin rezeksiyonunda, stereotaktik beyin biyopsisi, ventrikülostomi, derin beyin stimülasyonu, supratentorial tümör rezeksiyonu işlemlerinde uygulanmaktadır. Ayrıca genel anestezi risklerini önlemek, hastanede kalış sürelerini azaltarak hastane kaynak kullanımında tasarruf sağlamak için tercih edilmektedir. Bu teknikte anestezistin hedefi ameliyatın güvenli ve etkin şartlarda yapılması bunun yanında, hastanın işlemin ağrılı bölümlerine ve uzamış immobilizasyona toleransını sağlamak, intradural testler sırasında kooperasyonunu devam ettirmektir. Anestezi uygulaması kafa cildi anestezisi ile beraber olmak zorundadır. Uzun etkili yüksek hacimde bupivakain ve levobupivakain tercih edilir. Sedasyon için sıklıkla propofol, deksmedetomidin ve remifentanil tercih edilir. Başarılı bir uyanık kraniotomi ekibin tecrübesi ve anestezi işleminin detaylı olarak planlanmasına bağlıdır. Bu derlemenin amacı, yazılı kaynaklara dayalı olarak uyanık kraniotomi uygulamalarında anestezi teknikleri hakkında bilgi paylaşımıdır

Effectiveness of Preemptive Analgesia Using a Frequency Rhythmic Electrical Modulation System in Patients Having Instrumented Fusion for Lumbar Stenosis

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Licens

Yehova Şahitleri ve Travma

[No abstract available

Kafa travmasında anestezi

[No abstract available

Spinal Kord travmaları ve Anestezi

[No abstract available

Travma ve Anestezi

[No description available