Efficiency of the Local Infi ltration Analgesia Method in Total Knee Artroplasty Surgeries.

PURPOSE OF THE STUDY: Postoperative pain after total knee arthroplasty (TKA) is severe because of bone and soft tissue trauma during the surgery and is diffi cult to control with oral analgesics. The primary aim of the study was to investigate the effects of the local infi ltration anesthesia (LIA) method on postoperative analgesia quality and opioid consumption in patients undergoing TKA. The secondary aims were to evaluate knee fl exion angle, side effects, and patient satisfaction. MATERIAL AND METHODS Total 40 patients, who underwent unilateral TKA surgery under spinal anesthesia were included in the prospective randomized study. Patients who underwent patient-controlled intravenous analgesia (PCA) (Group A) or LIA + PCA (Group B), were divided into two groups, randomly. For LIA application, 0.25% bupivacaine solution 150 mg in 60 ml volume was used. The postoperative pain was evaluated in 48th hour after the recovery of motor block, and during exercise at 24, 36, and 48 hours by using the visual analogue scale (VAS). An additional morphine was administered with the PCA device when VAS ≥ 4. The total amount of morphine consumption and the side effects were recorded. The knee fl exion joint angles at the 48th hour and the patients' satisfaction was recorded. RESULTS Resting VAS values were lower in Group B in the fi rst 24 hours (p<0.05). However, the 36 th and 48th hour measurements were not different in groups. The exercises VAS values and the total morphine consumption were signifi cantly higher in Group A at 24, 36 and 48 hours. The knee fl exion joint angles in Group B were higher than Group A in terms of 48th hour. The incidence of side effects was not different in the two groups. Patients' satisfaction was higher in the PCA+ILA group (p<0.05). DISCUSSION In many studies the periarticular injection with multimodal drugs has been shown to reduce the requirements for analgesia, with no apparent risks, following TKA, similar to our results. LIA reduced postoperative opioid use and increased exercise tolerance. CONCLUSIONS In our study, we found that LIA reduced pain scores and opioid consumption during rest and exercise after TKA operation. For TKA patients where post-operative exercise is particularly important, we recommend the easy-to-use LIA method for a pain-free and unrestricted postoperative period. KEY WORDS: total knee arthroplasty, local infi ltration analgesia, postoperative analgesia, knee fl exion angle, opioid consumption.

Optic Nerve Avulsion from Optochiasmal Region Secondary to an Animal Attack: A Case Report.

ABSTRACT: Optic nerve avulsion without bone fracture was observed in four cases in the literature. This case is unique with its cranial effects and complications. A 50-year-old Caucasian female patient attacked by an animal on her left eye was admitted. Traumatic subarachnoid hemorrhage in the suprasellar cistern and epidural hematoma was observed upon brain computed tomography (CT). Enucleation and duraplasty were performed on the patient whose epidural hemorrhage did not increase. Two weeks after being discharged, the patient presented to the emergency room again with numbness on the right side of her face and sensory aphasia. The patient was followed up by medical treatment with left temporoparietal infarction and had completely recovered. Optic nerve avulsion secondary to trauma is a topic that needs to be carefully investigated due to potentially fatal complications. This article was written to share our experience with this rare condition and its case management.

Impact of right ventricular diastolic dysfunction on clinical outcomes in inferior STEMI.

BACKGROUND: The aim of this study was to investigate the prognostic value of restrictive right ventricular filling pattern (RRVFP) in patients with the first acute inferior wall myocardial infarction (IWMI) complicated by right ventricular myocardial infarction (RVMI) undergoing primary percutaneous coronary intervention (p-PCI). METHOD: A total of 152 patients with acute IWMI complicated by RVMI undergoing p­PCI were divided into two groups according to the presence of RRVFP. RRVFP was defined as tricuspid diastolic early/late flow velocities (Et/At) > 2 and Et deceleration time (DT) < 120 ms. RESULTS: There were 23 patients with RRVFP in the study cohort. At, DTt, isovolumetric relaxation time (IVRT), and tissue Doppler tricuspid annular late velocity (A't) were reduced significantly in patients with RRVFP than in those without RRVFP (At 19.6 ± 2.7 vs. 39.1 ± 7.4 cm/s, p < 0.001; DTt 106 ± 13 vs.156 ± 21 ms, p = 0.001; IVRT 59 ± 6.7 vs. 62 ± 7.4 ms, p = 0.01; A't 4.6 ± 1.1 vs. 8.6 ± 1.05, p = 0.001). Et/At ratios were higher in patients with RRVFP than in those without RRVFP (Et/At 2.20 ± 0.2 vs. 1.15 ± 0.37, p < 0.001). Et, tissue Doppler tricuspid annular early velocity (E't), E't/A't ratio, and Et/E't ratio were not significantly different between groups (Et 43.3 ± 5.4 vs. 40.7 ± 9.2 cm/s p = 0.18; E't 8.8 ± 1.4 vs. 9.5 ± 2.3, p = 0.15; E't/A't 1.08 ± 0.24 vs. 1.13 ± 0.30, p = 0.52; Et/E't ratio 5.0 ± 1.1 vs. 4.5 ± 1.5 p = 0.09). Presence of E't/A't > 2, short DTt, RRVFP, unsuccessful p­PCI, and cardiogenic shock on admission were independent predictors of in-hospital mortality (p < 0.05) in multivariable logistic regression analysis. CONCLUSION: Presence of RRVFP is associated with in-hospital mortality in patients presenting with their first IWMI complicated by RVMI.

Variations of the 6th cranial nerve (nervus abducens) in the petroclival region: A microsurgical study.

The aim of this study is to present the variations of nervus abducens in localization and number as it pierces the clival dura mater. The calvaria of 16 cadaveric heads were removed by making horizontal incisions from Glabella to Inion in both sides of the head. The dura mater was dissected. Cerebrum and cerebellum were taken out by obtuse dissection. Dissections of cavernous sinus were made under the stereomicroscope and the findings were photographed. Out of 16 specimens, one of them was excluded. Fifteen heads were bilaterally analyzed. Analysis of these nerves presented four different variations. Variation types a classified CN VI as a single trunk and entering a single dural pore with 77% occurrence. Variation type b classified CN VI with two branches running in the petroclival region and entering a single dural pore with 10% occurrence. Variation type c classified CN VI as 2 trunks and entering 2 separate but close dural pores with 10% occurrence. Variation type d classified CN VI with 2 distinct trunks and 2 branches entering 2 separate but close dural pores with 3% occurrence. CN VI plays a major role in the clinic of the eye. Due to its intracranial and extracranial course, injuries to the head and to the nerve may result in malfunctioning of the lateral muscles of the eye. Therefore, the variations of branching, relations and its course were analyzed.

Peri-implant bone defects: A 1-year follow-up comparative study of use of hyaluronic acid and xenografts.

OBJECTIVE: The aim of this study was to compare the efficacy of hyaluronic acid (HA) and xenografts on the repair of peri-implant dehiscence-type bone defects occur during implant placement. PATIENTS AND METHODS: Forty-two dehiscence Class I type defects located on the buccal surface of the implants were included in this study. Defects were divided into two main groups as small sized (height of <3 mm) and medium sized (height between 3 and 5 mm). Both of the main groups were further divided into two subgroups as HA plus xenograft plus collagen membrane (HAXC) or xenograft plus collagen membrane (XC) applied groups. After grafting, repair of defect site was evaluated with the help of the cross-sectional images on cone-beam computed tomography at 6th and 12th months. RESULTS: In both main groups, vertical bone height (VBH) was higher in defects repaired with HAXC (2.65 ± 1.12 mm) than in the XC (2.45 ± 1.10 mm) groups at the 6th month. However, the difference between two subgroups was not statistically significant (P > 0.05). Reduction in VBH was observed up to 6-12 months after prosthetic loading in all defect sites. This reduction was found statistically significant in medium-sized defects that grafted with XC (P < 0.05, paired t-test). However, in other subgroups, the difference between measurements at 6th and 12th months was not statistically significant (P > 0.05). CONCLUSIONS: According to the data obtained from this study, it can be concluded that HA did not have a significant positive effect on the repair of defects around dental implants.

A comparison of two endoscopic posterior cordotomy techniques: Laser cordotomy vs diathermy-assisted cordotomy.

OBJECTIVES: To compare respiratory function, swallowing and voice quality of bilateral abductor vocal fold paralysis (BAVFP) patients undergoing laser and diathermy-assisted posterior cordotomy. DESIGN: Prospective study. SETTING: Tertiary academic hospital. PARTICIPANTS: Thirty patients were included in the study (groups 1 and 2, 15 patients each). Mean age was 53 ± 14.27 years with a range of 31-78 years (12 [40%] males, 18 [60%] females). MAIN OUTCOME MEASURES: Sufficient airway, complications, FEV1, FEV1/FVC, peak expiratory flow rate (PEF), voice quality VAS, fundamental frequency, jitter, shimmer, NHR, amplitude perturbation quotient (APQ) and pitch perturbation quotient (PPQ) scores. RESULTS: A sufficient laryngeal airway was achieved in all patients. Six patients (20%) developed postoperative granulation tissue (2 in group 1 and 4 in group 2). There was a statistically significant improvement in FEV1, FEV1/FVC and PEF measurements at the postoperative sixth month compared to preoperative measurements in both of the groups (P < .05). Preoperative median voice quality VAS scores in groups 1 and 2 were 8 (IQR = 1) and 8 (IQR = 3), respectively. Postoperative sixth-month voice quality VAS scores in groups 1 and 2 were 6 (IQR = 1) and 6 (IQR = 0), respectively. Postoperative VAS scores were significantly lower in both groups (P < .05). The postoperative changes in fundamental frequency, NHR, jitter, shimmer, APQ and PPQ were not statistically significant in both of the groups (P > .05). CONCLUSIONS: Laser and diathermy-assisted posterior cordotomy are both minimally invasive, effective techniques with a long-term sufficient laryngeal airway. Despite lower quality of voice VAS scores, objective acoustic outcomes were not significantly lower in both of the groups.

Association between attitudes towards Internet usage and health practices in high-school students in 2 schools in Turkey: a cross-sectional study.

Excessive usage of the Internet can negatively affect health and health practices especially among youth. To examine the issue among Turkish students, this study determined the association between high-school students' attitudes towards Internet usage and their health behaviour. The sample (n = 2043) was randomly drawn from all students at two high schools in Turkey: one in Anatolia and one (a vocational school) in Istanbul. Data were collected using the Structured Questionnaire, Attitude Scale towards Internet Usage (ASTIU) and Adolescent Lifestyle Profile (ALP). The mean age of the students was 16.3 years, 77.7% were male and 96.9% used the Internet; mean duration of Internet use was 18.8 h/week. Female students had more positive attitudes towards Internet usage. Mean scores for ASTIU and ALP were 72.58 (SD 17.64) and 111.34 (SD 16.61) respectively, which were average levels. There was a statistically significant but weak overall negative correlation between adolescents' attitudes towards Internet usage and their health behaviour. Our results concur with studies in different cultures which suggest some negative effects, of heavy Internet use.

Evaluation of visual field and ocular surface parameters by clinical comparison after blepharoplasty for dermatochalasis.

PURPOSE: To evaluate the effect of upper eyelid blepharoplasty surgery on corneal topography, visual field, ocular surface, meibography, corneal biomechanics and dry eye parameters. METHODS: This prospective study included a total 80 eyes of 40 patients. Following a detailed ophthalmological examination, standardized patient satisfaction questions were posed to patients before and after upper eyelid blepharoplasty surgery. Visual field test, non-invasive break up time (NIBUT), meibography, and corneal topography parameters were analyzed and evaluated. RESULTS: The mean (+) visible areas in the visual field were found to be 46.20±24.96 preoperatively, 56.73±21.98 at the 1st postoperative month and 65.96±18.5 at the 3rd month, which were statistically significant. NIBUT values preoperatively, at 1 month and at 3 months were 11.26±4.48, 11.16±4.5 and 10.14±4.0, respectively, which were statistically significant. Meibomian gland loss rates on meibography preoperatively and postoperatively at 1 and 3 months were found to be 30.24±8.3, 29.36±8.2 and 28.22±7.7 respectively and were statistically significant. With the scoring system after blepharoplasty, patients reported improvement in their symptoms. CONCLUSION: Upper eyelid blepharoplasty surgery is predicted to increase the quality of vision. It was observed that there was a functional and cosmetic improvement in the complaints of the patients after blepharoplasty. However, blepharoplasty may cause changes in eyelid dynamics and cause dry eye syndrome.

Haematological inflammatory markers for indicating ischemic bowel in patients with incarcerated abdominal wall hernias.

PURPOSE: To reveal the clinical significance of preoperative haematological inflammatory markers in the diagnosis of abdominal wall hernias with strangulation. METHODS: The data of 200 patients who underwent surgery for incarcerated hernia were retrospectively analysed. The patients were grouped into three groups; Group 1; only surgical reduction and hernia repair, Group 2; small bowel resection and Group 3; omentum resection. Age, gender, hernia type, the presence of radiological bowel obstruction and preoperative complete blood count data were obtained. Neutrophil-leukocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), platelet-lymphocyte ratio (PLR), haematological inflammatory index (HII) and systemic immune-inflammation index (SII) values were calculated. RESULTS: The study was consisted of; Group 1: 119 patients (59.5%), Group 2: 46 patients (23%) and Group 3: 35 patients (17.5%). Advanced age (p = 0.001), female gender (p = 0.036), incisional hernias (p = < 0.001) and the presence of bowel obstruction (p = < 0.001) were found to be statistically significant in terms of strangulation. NLR, PLR and SII values were significantly higher in Group 2 compared to Group 1, and PLR values were significantly higher in Group 2 compared with Group 3 (p < 0.05). CONCLUSION: The preoperative elevated NLR, PLR and SII values may indicate strangulation and possible intestinal resection, in incarcerated abdominal wall hernias.

Evaluation of the relationship between the maxillary third molars and pterygomaxillary fissure by cephalometric radiographs.

BACKGROUND: The aim of this study is to evaluate the relationship between the third molars which are determined to be closely related to pterygomaxillary fissure (PTM) in cephalometric radiographs. MATERIALS AND METHODS: The material of this study was panoramic from 200 individuals (101 male, 99 female, mean age 19.02 ± 1.62) with three different skeletal malocclusion in the sagittal direction (class I: 109; class II: 66; class III: 25) and lateral cephalometric radiographs. It was observed that 151 of the patients included in this study had unilateral, 49 bilateral impacted maxillary third molars teeth. Angular and millimetric measurements (SNA°, SNB°, ANB°, PTM [Height-x], PTM [Width-y]) were made in accordance with the parameters determined on the lateral cephalometric radiographs of individuals. In this retrospective study, the relation of impaction with PTM evaluated on cephalometric radiographs, whether the impaction was unilateral or bilateral, was investigated in terms of skeletal anomaly. Chi-square test was used for the analysis. RESULTS: Of the 200 individuals with impacted maxillary third molar, 99 were female and 101 were male. There is no statistical difference between them in terms of unilateral and bilateral impacted third molars (p > 0.05). Of the 200 patients, 109 patients were class I, 66 patients were class II, and 25 patients were class III. There is no statistical difference between unilateral and bilateral impacted cases in facial skeletal classification (p > 0.05). According to chi-square test results, the relationship between genders and PTM variable width and height (PTM-x and PTM-y) measurements were not statistically significant (p > 0.05). CONCLUSIONS: The fact that the third molar teeth are impacted bilaterally or unilaterally is not affected by PTM change.

Association Between HLA Antibodies and Different Sensitization Events in Renal Transplant Candidates.

BACKGROUND: Human leukocyte antigen (HLA) allo-immunization is caused by various events such as blood transfusions, pregnancies, or organ transplantations, which can lead to sensitization. In this retrospective study, we evaluated different sensitization models and their effects on panel-reactive antibody (PRA) profiles of renal transplantation candidates. METHODS: Anti-HLA class I/II antibody screening tests were performed in 906 renal transplantation candidates with the use of a microbead-based assay (Luminex). RESULTS: Two hundred ninety-seven (32.8%) of the patients were determined as positive in terms of PRA, and 609 (67.2%) were negative. Sensitized and non-sensitized patients were compared separately in terms of each sensitization type. The anti-HLA class I, II, and I+II positivity rates in patients sensitized only by blood transfusion were 13.1%, 6.3%, and 14.1%, the rates with pregnancy sensitization were 35.5%, 29%, and 45.2%, and rates with previous transplantation sensitization were 15.6%, 34.4%, and 38.9%, respectively. Prevalence of PRA positivity was significantly higher in patients with previous pregnancy than with transplantation and transfusion (odds ratio, 1.003; 95% confidence interval, 0.441-2.281; P = .031). The risk of developing HLA class I antibodies was higher in pregnancies (P < .001), and the risk of developing anti-HLA class II antibodies was higher in patients who had undergone a previous transplantation (P < .001). The rate of developing HLA-B antibodies in patients sensitized by pregnancy were significantly higher compared with sensitization after transfusion (P = .015), as was the rate of developing HLA-DQ antibodies in patients sensitized by previous transplantation compared with sensitization through pregnancy (P = .042). CONCLUSIONS: In patients who are waiting for kidney transplantation, sensitization by pregnancy and transplantation have a significant impact on development of HLA class I and class II antibodies.

Lactational failure--study of risk factors in Turkish mothers.

Risk factors for lactational failure in puerperium were investigated. Sixty mothers with inadequate daily milk supply for their babies were the lactational failure group, and 60 mothers with similar age having babies with similar age and weight were chosen as the control group. Low prolactin levels, low serum iron and low serum ferritin levels and low aldosterone values and birth in community hospitals were associated with significantly increased risk of deficient lactation. High income of the family, increase osmolality of breastmilk, high systolic blood pressure of the mother, birth by cesarean section were some of the variables that increased the risk that could not reach the level of significance. Prematurity of the baby was not among the risk factors if the gestational ages were more than 30 weeks. It is concluded that physicians awareness of the factors that may adversely effect the initiation and continuation of lactation is vital. Correcting iron deficiency even if it is not overt, sparing more time for the mothers discussing the benefits of breastmilk to their babies, and avoiding cesarean section if possible may help increase the incidence of breastmilk feeding.

[The effect of sulbactam-ampicillin on renal function]. / Sulbaktam-ampisilin'in böbrek fonksiyonlarina etkisi.

In this study, the effect of a beta-lactamase inhibitor sulbactam-ampicillin on renal function of albino mice was investigated and compared with the control and ampicillin groups.

[Urinary tract infections in children]. / Cocukluk yas grubunda idrar yolu enfeksiyonlari.

The diagnosis of urinary tract infections were established on fifty children in our hospital in the last year. Most of the patients were between the age of 1-12 month (28 cases, 56%). The ratio of female/male was 3.5. Fever was the most common symptom (17 cases, 34%). In the routine urinalysis, proteinuria and pyuria were revealed in 11 cases (22%), and 44 cases (88%), respectively. E. coli was the most common microorganism isolated from urine cultures (70%). Twenty-two patients were regularly followed up and recurrence was observed in 7 patients (32%).

[Neonatal sepsis]. / Yenidogan sepsisi.

We noticed coagulase positive staphylococcus is the most common pathogen in the neonatal sepsis in our neonatology unit. We followed 22 cases with neonatal sepsis. Blood cultures revealed coagulase staphylococcus in 9 cases, coagulase negative staphylococcus in 6 cases, Pseudomonas spp. in 5 cases, E. coli in 1 case, Klebsiella spp. in 1 case. The most common symptom was apnea. CRP positivity was noted in 15 cases (68.2%) while increase in immature/total neutrophil ratio was observed in 12 cases (54.5%). However, we detected leukopenia in 2 cases (9.1%). Also, the birthweight of the cases died due to neonatal sepsis were below 2000 gr.

Improving performance using cascade control and a Smith predictor.

Many investigations have been done on tuning proportional-integral-derivative (PID) controllers in single-input single-output (SISO) systems. However, only a few investigations have been carried out on tuning PID controllers in cascade control systems. In this paper, a new approach, namely the use of a Smith predictor in the outer loop of a cascade control system, is investigated. The method can be used in temperature control problems where the secondary part of the process (the inner loop) may have a negligible delay while the primary loop (the outer loop) has a time-delay. Two different approaches, including an autotuning method, to find the controller parameters are proposed. It is shown by some examples that the proposed structure as expected can provide better performance than conventional cascade control, a Smith predictor scheme or single feedback control system.

Prognostic value of the Intermediate QRS prolongation in patients with acute myocardial infarction.

OBJECTIVE: Studies have shown different effect of intermediate QRS prolongation on major cardiovascular events in acute myocardial infarction (AMI) patients. The aim of this study was to investigate the predictive and prognostic value of intermediate QRS prolongation on in-hospital complication rate and long term mortality in patients with AMI. MATERIALS AND METHODS: We performed an observational study that enrolled 114 consecutive patients with AMI. Patient's admission electrocardiography (ECG) were enlarged two fold, and QRS duration (QRSd) was measured manually. Patients were divided into two groups according to the admission EKG QRSd. Group A defined as patient with QRSd between 90-120 msn and group B QRSd <90msn. Echocardiographic, angiographic, clinic and laboratory results were recorded for all patients. Patients were followed next twelve months. RESULTS: In-hospital follow-up period, major adverse cardiac events were higher in group A than group B (0.9 ±0.9 vs. 0.5 ±0.5 p=0.02). There were increased end-diastolic and end-systolic volume in group A (91±15 vs. 82±12 p=0.002; 50±10 vs. 44±9 p=0.002. respectively). Left ventricular ejection fraction (LVEF) was lower in group A. but it did not reach statistical significance (43.5±6.3 vs. 45.5±5.5 p=0.06). Angiographic evaluation was detected severe coronary artery disease (CAD) in group A than group B (1.9±0.8 vs. 1.5±0.7 p=0.013). During 12 months of follow-up period. five patients were died. Although these patients had longer QRSd on admission, it was not statistically significant (96±14 vs. 90±11 p=0.3). CONCLUSIONS: Intermediate QRS prolongation on admission EKG were found to be positively correlated with increased EDV, ESV, major in-hospital cardiovascular events, and multivessel coronary artery disease and inversely correlated with LVEF. Although deceased patients had prolonged QRSd it was not statistically significant.