Sezaryen uygulanan trombositopenik gebelerde anestezi yöntemlerinin retrospektif incelenmesi

Aim: Studies investigating a minimum “safe” platelet level for regional block are on going. Our aim is to evaluate methods of anesthesia and limits of regional anesthesia practice of pregnant patients with a history of thrombocytopenia under going cesarean section. Materials and Methods: The data of pregnant patients with thrombocytopenia under going cesarean section between 2006-2011, were analyzed retrospectively. The data of 51 patients, including maternal age at delivery, gestational age at delivery, gravidity, parity, nature of cesarean, and obstetric additional diseases were recorded. Also, information including hemoglobin, hematocrite, platelet levels, coagulation parameters, steroid or IVIG use, blood and/or thrombocyte placement treatment during preoperative and postoperative period, the method of anesthesia and postoperative complications were collected. Results: In the study, a total number of 51 pregnant women with thrombocytopenia gave birth to 51 healthy babies by cesarean delivery. Elective and emergency cesareans comprised 52.9% and of 47.1% all cesareans, respectively. The onset time of thrombocytopenia among the 51 cases, i.e, 3 cases (5.9%), 4 cases (7.8%), 1 case (2%), 43 cases (84.3%) of thrombocytopenia were detected in the pregestational time, first, second and third trimester, respectively. Of these 51 pregnant patients, 78.4% and 21.6% of received general anesthesia or spinal anesthesia, respectively. -1 -1The lowest platelet count for spinal anesthesia was 87,000;amp;#956;L comparing to the level of 24,000;amp;#956;L for general anaesthesia during the preoperative period. Conclusion: We suggest that regional anestesia may be a safe method with careful monitoring for pregnant patients with severe trombocytopenia. However, decisions on the safest method of anesthesia in preparation for delivery should be made with a multidisciplinary team involving the obstetrician, hematologist, and anesthesiologist.Amaç: Rejyonal blok açısından gebelerde güvenli en düşük trombosit düzeyi konusunda araştırmalar sürmektedir. Amacımız, trombositopenik gebelerde sezaryende kullanılan anestezi yöntemlerini retrospektif olarak değerlen- dirmektir. Gereç ve Yöntem: 2006-2011 tarihleri arasında sezaryen uygulanan trombositopenik gebelerin kayıtları retrospektif olarak incelendi. Bu 51 hastanın gebelik yaşı, gebelik haftası, gebelik sayısı, paritesi, sezaryen tipi, obstetrik ek hastalıkları kaydedildi. Ayrıca preoperatif ve postoperatif dönemde hemoglobin, hematokrit, trombosit düzeyleri, koagülasyon parametreleri, steroid ve/veya intravenöz immunglobulin (IVIG) kullanımı, kan ve/veya trombosit replasman tedavisi, uygulanan anestezi yöntemi ve postoperatif dönemde görülen komplikasyonlarla ilgili bilgiler toplandı. Bulgular: Çalışmaya dahil edilen 51 trombositopenik gebe sezaryenle 51 sağlıklı bebek doğurdu. Yapılan sezaryen operasyonlarının %52,9’u elektif, %47,1’i acil olarak yapıldı. Trombositopeni başlama zamanı, hastaların 3’ünde (%5,9) pregestasyonel dönemde, 4’ünde (%7,8) 1. trimesterde, 1’inde (%2) 2. trimesterde ve 43’ünde (%84,3) 3.trimesterde tespit edildi. Sezaryen uygulanan 51 kadının %78,4’üne genel anestezi %21,6’sına spinal anestezi uygulanmıştı. Spinal uygulanan hastalarda preoperatif en düşük trombosit değeri 87,000 ?L-1 iken genel anestezi uygulananlarda bu değer 24,000 ?L-1/ idi. Sonuç: Ciddi trombositopenisi olan gebelerde yakın izlem ile rejyonal anestezinin güvenle uygulanabilecek bir yöntem olduğunu düşünmekteyiz. Ancak, doğuma hazırlık sürecinde en uygun anestezi yöntemi konusunda kararlar anestezist, obstetrisyen ve hematoloğun olduğu multidisipliner bir ekip tarafından alınmalıdır

Tracing curvilinear structures in live cell images

Tracing of curvilinear structures is one of the fundamental tools in the quantitative analysis of biological images, for extracting information about structures such as blood vessels, neurons, microtubules, and similar entities. Due to the limitations in biological sample preparation and fluorescence imaging, typical images in live cell studies exhibit severe noise and considerable clutter. These images are manually analyzed through a laborious and approximate set of quantification tasks. In this paper, we describe a constrained optimization method for extracting curvilinear structures from live cell fluorescence images. We show that the proposed method is largely insensitive to frequent intersections, intensity variations along the curve, and generates successful traces within noisy regions. We demonstrate the results of our approach on live cell microtubule images. Index Terms — Biomedical image processing, biomedical measurement

The evaluation of applied anaesthetic techniques for caesarean in parturients with cardiac diseases: Retrospective analysis [Kalp hastalığı olan gebelerde sezaryende uygulanan anestezi yöntemlerinin retrospektif değerlendirilmesi]

Objective: In this study, the effects of anaesthetic technique on mother and newborn were investigated in a retrospective analysis of parturients with cardiac diseases undergoing Caesarean section between 2006-2012.Methods: Our hospital’s medical information system records were analyzed, and we found 107 parturients with cardiac disease and were undergoing Caesarean section, and their demographic data and obstetric, anaesthetic, and neonatal record forms were inspected.Results: Fifty-three (49.5%) pregnant women received general anaesthesia, and 54 (50.5%) received regional anaesthesia (34 spinal, 19 epidural and 1 combined-spinal-epidural (CSE) (p=0.05). Week of pregnancy was lower for the group of general anaesthesia (p=0.007). Among cardiac parturients, valvular lesion rates were higher (75.7%). The relationship between existing cardiac disease and anaesthetic management was not significant (p=0.28). However, we determined that parturients with higher NYHA (New York Heart Association) classifications had higher general anaesthesia rates. (p=0.001). A rate of 39% of 74 NYHA I patients were undergoing general anaesthesia; this rate was 64% for NYHA II and 100% for NYHA III. The patients with cardiac surgery or medical treatment history had higher general anaesthesia rates (p=0.009). Although the general anaesthesia group newborn weights were lower (p=0.03), there was no difference between groups for APGAR scores. With regard to postoperative complications and hospital stay, the groups were similar.Conclusion: We determined that general and epidural rates in parturients with cardiac diseases were similar, general anaesthesia was preferred for parturients who had higher NYHA classifications and surgical or medical treatment history. We considered that general anaesthesia criteria should reduce the anaesthesia management of parturients with cardiac disease; epidural or CSE anaesthesia applications should increase according to the patient’s physical state, haemodynamic parameters, and obstetric indications. © 2014 by Turkish Anaesthesiology and Intensive Care Society