Effectiveness of ultrasonography-guided caudal epidural steroid injection compared to the fluoroscopic application.

BACKGROUND: Caudal epidural steroid injection (CESI) has been increasingly used for treating lower back pain. However, there is still significant controversy about the efficacy and safety of different imaging techniques used to guide CESI. In this context, the objective of this study is to compare the efficacies of fluoroscopy- and ultrasonography-guided CESI in patients with chronic lower back pain. METHODS: The population of this retrospective, observational study consisted of all consecutive patients who underwent CESI for lower back pain between 2018 and 2020. Of the 371 patients included in the study sample, 192 had undergone fluoroscopyguided CESI (Group F) and 179 ultrasonography-guided CESI (Group U). Patients' pain and functional statuses were evaluated using the visual analog scale (VAS) and Oswestry Disability Index (ODI) immediately before (baseline) and after the procedure (postintervention day 0-D0), during the second week (D15), the first month (D30), and the third month (D90) after the procedure. RESULTS: The mean age of Group F was significantly higher than that of Group U (p < 0.001). The number of patients with lumbar dischernia was significantly higher in Group U, whereas the number of patients with spinal stenosis and lumbar disc hernia + spinal/lumbar stenosis was significantly higher in Group F (p = 0.001). The baseline and D0 ODI scores were significantly lower in Group U than in Group F (p = 0.006 and p = 0.017, respectively). There was no significant difference between the groups in other VAS and ODI scores (p > 0.05). Intragroup analyses revealed significant reductions in VAS and ODI scores over the follow-up period till D30 compared to the baseline scores in each group (p < 0.001). The decrease recorded in the ODI score between the D15 and baseline measurements was significantly higher in Group F than in Group U (p = 0.006). DISCUSSION: The study findings indicated that ultrasound-guided CESI was as effective as fluoroscopy-guided CESI in treating chroniclower back pain.

The management of children aged 0-5 years with suspected foreign body aspiration: a prospective study.

INTRODUCTION: A simple algorithm for bronchoscopy was prepared in very young children. METHODS: The patients aged 0-5 years who were applied with bronchoscopy because of suspected foreign body aspiration (FBA) analysed. RESULTS: Evaluations were made of 89 patients, as 55 (61.7%) in the FBA (+) group and 34 (38.3%) in the FBA (-) group. FBA was determined most in the 1-2 years age group (28 patients, 50.9%, p = 0.04) due to organic hard foodstuffs (94.5%, p < 0.001). The parameters found to be significant were witnessing the event (OR 12.133, 95% CI 3.147-46.774, p < 0.001) and not obtaining unilateral respiratory sounds (OR 7.556, 95% CI 2.681-21.292, p < 0.001). The most significant diagnostic finding was the determination of unilateral hyperventilation on X-ray (OR 16.730, 95% CI 4.541-61.632, p < 0.001). The operating time and length of stay in hospital was significantly shorter in the FBA (-) patients (p < 0.001). CONCLUSION: The presence of a witness, not obtaining unilateral respiratory sounds, and unilateral hyperventilation seen on X-ray are indications for bronchoscopy. In FBA (-) patients applied with bronchoscopy, the complication rate associated with the procedure is low, and the operating time and length of stay in hospital are short.

The effect of transversus abdominis plane block application on postoperative analgesia quality and patient satisfaction after varicocele surgery: a randomized clinical trial.

Background: Postoperative pain management is an important aspect of anesthesia care and multimodal analgesic techniques are generally recommended. Objective: To compare the effect of spinal anesthesia + transversus abdominis plane (TAP) block application on postoperative analgesia quality and patient satisfaction with spinal anesthesia + intrathecal morphine (ITM) application. Methods: A total of 70 patients were randomly separated into 2 groups as spinal anesthesia + TAP block (TAP block group, n = 34) and spinal anesthesia + ITM group (ITM group, n = 36). The groups were compared in respect of age, body mass index values, and visual analog scale (VAS) values at 0 h, 2 h, 6 h, 12 h, and 18 h, and patient satisfaction was scored by Quality Improvement in Postoperative Pain Management at 24 h. Results: The mean age of the patients was 32.52 ± 6.50 years in the TAP block group and 30.11 ± 5.62 years in the ITM group, with no statistically significant difference determined. There was no statistically significant difference in terms of VAS values at 0 h, 2 h, 6 h, 12 h, and 18 h. When the factors affecting postoperative patient satisfaction were evaluated, feeling fatigue after the surgery (r = -0.811, P = 0.001) and postoperative complications such as nausea, vomiting, and itching (r = -0.831, P = 0.001) were found to have a negative effect on patient satisfaction. Conclusion: Due to low complication rates, TAP block is an effective application for postoperative analgesia management in varicocele operations that increases patient satisfaction postoperatively.

Immature Granulocyte Count and Delta Neutrophil Index as New Predictive Factors for Axillary Metastasis of Breast Cancer.

OBJECTIVE: To determine the diagnostic value of preoperative immature granulocyte (IG) count and delta neutrophil index (DNI) level before clinical detection of axillary lymph node metastasis. STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Department of General Surgery, Kahramanmaras Sutcu Imam University, Onikisubat, Turkey from February 2015 to February 2020. METHODOLOGY: Patients older than 18 years and operated for breast pathologies in the study period were evaluated retrospectively. Patients without axillary or distant organ metastasis, and who did not receive neoadjuvant chemotherapy were examined by dividing them into two groups as pathologically non-metastatic axilla (Group NM) and metastatic axilla (Group M). They were retrospectively evaluated for DNI, IG, white blood cell count (WBC), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR) and mean platelet volumes (MPV). RESULTS: All of the 83 patients, who met the inclusion criteria, were females (100%). Forty-six patients (55.42%) were in the Group-NM and 37 (44.58%) were in Group-M. Statistically significant difference was observed between the groups in terms of WBC, NLR, PLR, MPV, DNI and IG count (p<0.05), while there was no difference in age (p = 0.862). As a result of the univariate and multivariate analysis, WBC, NLR, PLR, MPV, DNI and IG count were determined as predictive factors. The discriminatory power of the DNI for diagnosing clinically negative pathologically positive axillary metastasis of breast cancer at the cut-off value ≥0.35% (ARUC:0.903; 95% confidence interval [CI]: 0.84-0.967) showed 86.5% sensitivity, 80.4% specificity, positive predictive value (PPV) 86.5%, negative predictive value (NPV) 80.4%. The discriminatory power of the IG count for diagnosing clinically negative pathologically positive axillary metastasis of breast cancer, at the cut-off value ≥25/mm3 (ARUC:0.976; 95% CI:0.953-1.000) showed 100% sensitivity, 82.6% specificity, 100% PPV, and 82.6% NPV. CONCLUSION: DNI and IG count may be new predictive factors with high sensitivity and specificity in detecting axillary metastasis of breast cancer. Key Words: Delta neutrophil index, Immature granulocyte count, Neutrophil lymphocyte ratio, Breast cancer, Axillary metastasis.

IS BODY MASS INDEX AND OBESITY SURGERY MORTALITY SCORE IMPORTANT IN PERIOPERATIVE COMPLICATIONS OF LAPAROSCOPIC SLEEVE GASTRECTOMY BEFORE DISCHARGE?

BACKGROUND: Morbid obesity surgery and related complications have increased with time. AIM: To evaluate the relationship between perioperative complications before discharge and preoperative body mass index and obesity surgery mortality score in laparoscopic sleeve gastrectomy. METHOD: 1617 patients who met the inclusion criteria were evaluated retrospectively. The patients were examined in terms of demographic data, presence of comorbidities, whether there were complications or not, type of complications and obesity surgery mortality score. RESULTS: Complications were seen in 40 patients (2.5%) and mortality wasn't seen in the early postoperative period before discharge. The mean age of patients with complications was 36.3±10.02 years (19-57) and without complications 34.12±9.54 (15-64) years. The preoperative mean BMI values of patients with and without complications were 45.05±3.93 (40-57) kg/m2 and 44.8±3.49 (35-67) kg/m2 respectively. According to BMI groups 40-45 kg/m2, 45-50 kg/m2 and 50 and over, there was not any statistical significance seen in three groups in terms of complication positivity and major-minor complication rates. There was not any statistical significance seen between the patients with and without major-minor complications and obesity surgery mortality score. CONCLUSION: There was not any relation between perioperative laparoscopic sleeve gastrectomy complication rates before discharge and BMI and obesity surgery mortality scores.

Is body mass index and obesity surgery mortality score important in perioperative complications of laparoscopic sleeve gastrectomy before discharge? / Os índices de mortalidade, de massa corporal e da cirurgia da obesidade são importantes nas complicações perioperatórias de gastrectomia vertical laparoscópica antes da alta?

ABSTRACT Background: Morbid obesity surgery and related complications have increased with time. Aim: To evaluate the relationship between perioperative complications before discharge and preoperative body mass index and obesity surgery mortality score in laparoscopic sleeve gastrectomy. Method: 1617 patients who met the inclusion criteria were evaluated retrospectively. The patients were examined in terms of demographic data, presence of comorbidities, whether there were complications or not, type of complications and obesity surgery mortality score. Results: Complications were seen in 40 patients (2.5%) and mortality wasn't seen in the early postoperative period before discharge. The mean age of patients with complications was 36.3±10.02 years (19-57) and without complications 34.12±9.54 (15-64) years. The preoperative mean BMI values of patients with and without complications were 45.05±3.93 (40-57) kg/m2 and 44.8±3.49 (35-67) kg/m2 respectively. According to BMI groups 40-45 kg/m2, 45-50 kg/m2 and 50 and over, there was not any statistical significance seen in three groups in terms of complication positivity and major-minor complication rates. There was not any statistical significance seen between the patients with and without major-minor complications and obesity surgery mortality score. Conclusion: There was not any relation between perioperative laparoscopic sleeve gastrectomy complication rates before discharge and BMI and obesity surgery mortality scores.

RESUMO Racional: A cirurgia da obesidade mórbida e complicações relacionadas aumentaram com o tempo. Objetivo: Avaliar a relação entre as complicações perioperatórias antes da alta e o índice de massa corporal pré-operatório e o escore de mortalidade da cirurgia de obesidade na gastrectomia vertical laparoscópica. Método: 1.617 pacientes que atenderam aos critérios de inclusão foram avaliados retrospectivamente. Os pacientes foram examinados quanto aos dados demográficos, presença de comorbidades, ocorrência ou não de complicações, tipo de complicações e escore de mortalidade cirúrgico da obesidade. Resultados: Complicações foram observadas em 40 pacientes (2,5%) e mortalidade não foi observada no período pós-operatório imediato antes da alta. A média de idade dos pacientes com complicações foi de 36,3±10,02 anos (19-57) e sem complicações de 34,12±9,54 (15-64) anos. Os valores médios de IMC pré-operatórios dos pacientes com e sem complicações foram 45,05±3,93 (40-57) kg/m2 e 44,8±3,49 (35-67) kg/m2, respectivamente. De acordo com os grupos de IMC 40-45 kg/m2, 45-50 kg/m2 e 50 e mais, não houve qualquer significância estatística observada em três grupos em termos de positividade de complicações e taxas de complicações maiores-menores. Não houve significância estatística entre os pacientes com e sem complicações maiores e menores e o escore de mortalidade da cirurgia de obesidade. Conclusão: Não houve qualquer relação entre as taxas de complicações da gastrectomia vertical laparoscópica perioperatória antes da alta e os escores de mortalidade da cirurgia de obesidade e IMC.