Computed Tomography and Magnetic Resonance Imaging for Congenital Hearing Loss: A Retrospective Study.

OBJECTIVE: The aim of this study is to evaluate the relationship between the cochlear nerve and the anatomical structures of the cochlea and internal acoustic canal in patients with congenital hearing loss. MATERIALS AND METHODS: Temporal tomography and magnetic resonance images of 44 patients (88 ears) with non-syndromic congenital hearing loss were retrospectively analyzed between 2018 and 2021. Patients were divided into 2 groups according to cochlear nerve hypoplasia. Cochlear nerve canal width, cochlear basal/ middle turn widths, and internal auditory canal widths were examined. RESULTS: Cochlear nerve hypoplasia was detected in 18.2% (n=16) of the patients and all of the patients with cochlear nerve hypoplasia had severe hearing loss. A statistically significant difference was found between the structures' widths in patients with and without cochlear nerve hypoplasia, in cochlear nerve canal and coronal width of the internal auditory canal. When stenosis is accepted as <1.4 mm for cochlear nerve canal and <3.80 mm for coronal width of the internal auditory canal, cochlear nerve hypoplasia differs statistically between the groups in measurements (respectively; P < .001, P=.018). CONCLUSIONS: In patients with sensorineural hearing loss, cochlear nerve hypoplasia may accompany. Anatomical structures are important in predicting cochlear nerve hypoplasia from temporal computed tomography. Cochlear nerve hypoplasia should be suspected if the cochlear nerve canal and coronal width of the internal auditory canal are less than 1.4 mm and 3.8 mm, respectively, on temporal computed tomography.

Results of cochlear implant surgery in patients with auditory neuropathy.

OBJECTIVES: The primary aim of this study was to analyze the benefit of cochlear implants for patients with auditory neuropathy. The secondary aim was to identify risk factors for auditory neuropathy. MATERIALS AND METHODS: Patients with cochlear implants (CIs) who were educated in hearing rehabilitation schools were included in the study. A total of 175 children were operated on for cochlear implantation between August 2019 and August 2021 in the department of otorhinolaryngology at different centers in Turkey, and while 16 (9.1%) of those patients had auditory neuropathy spectrum disorder (ANSD), 159 (90.9%) had sensorineural hearing loss (SNHL). Differences in auditory perception between the two groups were examined. Auditory perception tests were applied for these patients 6 months after CI surgery. The auditory perception performances of the patients were evaluated with the Evaluation of Auditory Responses to Speech (EARS) battery, including the Littlears, Lip, Bis4, Bis12, Cap, Sir, Mtp-3, Mtp-6, Mtp-12, Matrix A1, and Gasp tests. RESULTS: All patients had profound bilateral SNHL. Four auditory perception tests (Littlears, Bis-12, Sir, Matrix A1) showed similar results between patients with ANSD and SNHL, but seven auditory perception tests (Lip, Bis-4, Cap, Mtp-3, Mtp-6, Mtp-12, Gasp) showed significantly higher results among patients with SNHL. Hyperbilirubinemia, prematurity, consanguineous marriage, and family history of hearing loss were found to be common among patients with ANSD. CONCLUSIONS: ANSD patients who do not benefit from hearing aids benefit from CI surgery.

Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation / Efeito da septoplastia no desempenho miocárdico ventricular esquerdo em pacientes com desvio de septo nasal

Abstract Introduction: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. Objective: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. Methods: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. Results: Significantly higher left ventricular myocardial performance index (0.52 ± 0.06 vs. 0.41 ± 0.04, p < 0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p < 0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p < 0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p = 0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p = 0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p < 0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p =0.224). Conclusion: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Resumo Introdução: O desvio do septo nasal é a principal causa de obstrução das vias aéreas superiores. A obstrução crônica das vias aéreas superiores pode causar lesão miocárdica devido à hipóxia crônica. Os efeitos da septoplastia nas funções diastólica e sistólica do ventrículo esquerdo não são bem conhecidos. O índice de desempenho miocárdico é um parâmetro confiável e fácil de aplicar que reflete as funções cardíacas sistólica e diastólica. Objetivo: Investigar o efeito da septoplastia nasal no índice de desempenho miocárdico em pacientes com desvio de septo nasal. Método: Este estudo prospectivo consistiu em 50 pacientes consecutivos submetidos a septoplastia devido a desvio de septo nasal significativo sintomático em S ou C. A ecocardiogarfia transtorácica foi feita em todos os pacientes antes e 3 meses após a septoplastia. Os índices de desempenho miocárdico calculados foram comparados. Resultados: Um valor de indice de desempenho miocárdico ventricular esquerdo significantemente maior (0,52 ± 0,06 vs. 0,41 ± 0,04, p < 0,001), tempo mais longo de relaxamento isovolumétrico (95,0 ± 12,5 vs. 78,0 ± 8,6 ms, p < 0,001), tempo mais longo de contração isovolumétrica (45,5 ± 7,8 vs. 39,5 ± 8,6 ms, p < 0,001), tempo de desaceleração mais longo (184,3 ± 32,5 vs. 163,6 ± 45,4 ms, p = 0,004), maior razão de pico de velocidade transmitral precoce e tardia (E / A) (1,42 ± 0,4 vs. 1,16 ± 0,2, p = 0,006) e menor tempo de ejeção (270,1 ± 18,3 vs. 286,5 ± 25,8 ms, p < 0,001) foram observados antes da septoplastia quando comparados aos valores obtidos 3 meses após a septoplastia. A fração de ejeção sistólica do ventrículo esquerdo foi semelhante antes e após a septoplastia (63,8 ± 2,8% vs. 64,6 ± 3,2%, p = 0,224). Conclusão: A cirurgia de septoplastia não apenas reduz os sintomas em pacientes com desvio de septo nasal, mas também pode melhorar o desempenho ventricular esquerdo. Assim, o tratamento precoce do desvio de septo nasal é sugerido para prevenir possíveis eventos cardiovasculares futuros.

Evaluation of the associations between maxillary sinus dimensions and adenoid hypertrophy using multislice computed tomography.

INTRODUCTION: Adenoid hypertrophy is especially common in childhood, raising the concern that such growth might affect maxillary sinus volumes during the developmental period. This study evaluated the developmental relationships between maxillary sinus volumes and adenoid hypertrophy via computed tomography. MATERIALS AND METHODS: It was examined computed tomographic images of 118 individuals: 61 boys and 57 girls. The participants were divided into a healthy control group (n = 59) and an experimental group (with adenoid hypertrophy) (n = 59). Raw data were recorded in DICOM format and analysed using the ITK-SNA algorithm; it was measured the right, left, and total maxillary sinus volumes and adenoid tissue sizes. RESULTS: It was found significant between-group differences in the three maxillary sinus volumes and adenoid tissue dimensions (linear maximum anterior and posterior depth; maximum upper and lower height, and maximum width to the right and left) (all p<0.001). On the contrary, there was no significant difference according to sex in terms of either maxillary sinus volumes or linear adenoid tissue measurements. Maxillary sinus volumes increased significantly according to age in both groups. CONCLUSION: Adenoid hypertrophy decreases the maxillary sinus volumes, regardless of sex. The impacts of adenoid growth on maxillary sinus aeration and sinus disease should be further investigated.

Evaluation of myocardial performance index in patients with COVID-19: An echocardiographic follow-up study.

Introduction and Objectives: Myocardial performance may be impaired in cytokine-mediated immune reactions. The myocardial performance index (MPI) is a practical parameter that reflects systolic and diastolic cardiac function. We aimed to assess the MPI in patients with COVID-19. Methods: The study population consisted of 40 healthy controls and 40 patients diagnosed with COVID-19 who had mild pneumonia and did not need intensive care treatment. All participants underwent echocardiographic examination. First, the MPI and laboratory parameters were compared between healthy controls and patients in the acute period of infection. Second, the MPI and laboratory parameters were compared between the acute infection period and after clinical recovery. Results: Compared with healthy controls, patients with COVID-19 had a significantly higher MPI (0.56±0.09 vs. 0.41±0.06, p<0.001), longer isovolumic relaxation time (IRT) (112.3±13.4 vs. 90.6±11.2 ms, p<0.001), longer deceleration time (DT) (182.1±30.6 vs. 160.8±42.7 ms, p=0.003), shorter ejection time (ET) (279.6±20.3 vs. 299.6±34.7 ms, p<0.001) and higher E/A ratio (1.53±0.7 vs. 1.21±0.3, p<0.001). Statistically significantly higher MPI (0.56±0.09 vs. 0.44±0.07, p<0.001), longer IRT (112.3±13.4 vs. 91.8±12.1 ms, p<0.001), longer DT (182.1±30.6 vs. 161.5±43.5 ms, p=0.003), shorter ET 279.6±20.3 vs. 298.8±36.8 ms, p<0.001) and higher E/A ratio (1.53±0.7 vs. 1.22±0.4, p<0.001) were observed during the acute infection period than after clinical recovery. Left ventricular ejection fraction was similar in the controls, during the acute infection period and after clinical recovery. Conclusions: Subclinical diastolic impairment without systolic involvement may be observed in patients with COVID-19. This impairment may be reversible on clinical recovery.

Introducão e objetivos: O desempenho miocárdico pode ser prejudicado em reações imunes mediadas por citocinas. O índice de performance miocárdico (IPM) é um parâmetro que reflete a função cardíaca sistólica e diastólica. O nosso objetivo foi avaliar o IPM em doentes com COVID-19. Métodos: O presente estudo consistiu em analisar 40 casos controlo saudáveis e 40 doentes com diagnóstico de COVID-19 que apresentavam pneumonia ligeira e não necessitavam de tratamento intensivo. Todos os participantes foram submetidos a avaliação ecocardiográfica. Primeiro, o IPM e os parâmetros laboratoriais foram comparados entre os casos controlo saudáveis e os doentes com período agudo de infeção. Em segundo lugar, o IPM e os parâmetros laboratoriais foram comparados entre o período agudo de infeção e após a recuperação clínica. Resultados: Em comparação com os casos controlo saudáveis, os doentes com COVID-19 tiveram um IPM significativamente maior (0,56±0,09 versus 0,41±0,06, p<0,001), tempo de relaxamento isovolumétrico (TRI) mais longo (112,3±13,4 versus 90,6±11, 2 ms, p<0,001), tempo de desaceleração maior (TD) (182,1±30,6 versus 160,8±42, 7 ms, p=0,003), tempo de ejeção (TE) menor (279,6±20,3 versus 299,6±34, 7 ms, p<0,001) e razão E/A maior (1,53±0,7 versus 1,21±0,3, p<0,001). Um IPM superior estatisticamente significativo (0,56±0,09 versus 0,44±0,07, p<0,001), um TRI mais longo (112,3±13,4 versus 91,8±12, 1 ms, p<0,001), um TD mais longo (182,1±30,6 versus 161,5±43,5 ms, p=0,003), um TE mais curto (279,6±20,3 versus 298,8±36,8 ms, p<0,001) e razão E/A mais elevada (1,53±0,7 versus 1,22±0,4, p<0,001) foram observados durante o período agudo de infeção em comparação com aqueles após a recuperação clínica. A fração de ejeção do ventrículo esquerdo foi semelhante nos casos controlo saudáveis, período agudo de infeção e após a recuperação clínica. Conclusão: A disfunçao diastólica subclínica sem difunção sistólica pode ser observada em doentes com COVID-19. Esta deficiência pode ser reversível na recuperação clínica.

Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation.

INTRODUCTION: Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. OBJECTIVE: The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. METHODS: This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. RESULTS: Significantly higher left ventricular myocardial performance index (0.52 ±â€¯0.06 vs. 0.41 ±â€¯0.04, p <  0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p <  0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p <  0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p =  0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p =  0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p <  0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p  = 0.224). CONCLUSION: Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.

Assessment of mucociliary clearance as an indicator of nasal function in patients with COVID-19: a cross-sectional study.

PURPOSE: We assessed the effects of COVID-19 infection on nasal mucociliary activity. METHODS: The study was conducted in the pandemic wards of Adiyaman University Training and Research Hospital during April and May 2020. All patients admitted to the COVID-19 pandemic wards during the study period were invited to participate in the study. The study included 40 adults who agreed to participate and underwent a mucociliary clearance test successfully. The primary outcome was mucociliary clearance time and the secondary variables of interest were age, sex, and sino-nasal outcome test-22 scores. The control group included 40 concomitant healthy patients who visited the outpatient ear, nose and throat clinic with non-nasal symptoms. RESULTS: The study included 40 COVID-19-positive patients and 40 healthy controls. The mean mucociliary clearance times of the study (15.53 ± 5.57 min) and control (9.50 ± 3.70 min) groups were significantly different (Z = 4.675, p < 0.001). However, the mucociliary clearance time was not significantly different between males and females (t = 0.590, p = 0.558). CONCLUSIONS: Nasal mucociliary clearance time was prolonged in COVID-19 patients compared to healthy controls. Thus, we conclude that smell and taste are crucial symptoms that should not be overlooked in patients suspected of COVID-19 disease.

How important is the butyrylcholinesterase level for cesarean section?

OBJECTIVES: Butyrylcholinesterase (BChE), commonly known as pseudocholinesterase or non-neural cholinesterase, hydrolyzes neuromuscular blocker agents containing choline esters such as succinylcholine that is widely used in rapid sequence induction (RSI) for general anesthesia. The aim of this study is to compare plasma BChE levels and investigate the affects and relationship of succinylcholine on BChE levels in preeclamptic, gestational diabetic and healthy pregnants. STUDY DESIGN: We designed a prospective, controlled, pilot single-center study. Thirty (n=30) pregnant women who were scheduled for cesarean section under general anesthesia (refusal of regional anesthesia) with RSI involved. Group 1 included ten (n=10) preeclamptic pregnancies, Group 2 included ten (n=10) gestational diabetic (GD) pregnancies and Group 3 included ten (n=10) healthy pregnancies. MAIN OUTCOME MEASURES: BChE levels of all patients were measured prior to the initiation of cesarean section. Train-of-four recovery of 90% (TOF T1) was used to monitor the degree of neuromuscular block beginning from the administration of succinylcholine. RESULTS: No statistically significant difference was found between the groups comparing BChE levels and the duration between tracheal intubation and formation of TOF T1 (p>0.05). CONCLUSIONS: As similar results were gathered from normal and high-risk pregnancies (preeclamptic pregnancy or gestational diabetic pregnancy) who underwent cesarean section under general anesthesia, we believe that succinylcholine is still neuromuscular agent of choice in cesarean section.

Ultrasound-guided pulsed radio frequency treatment in Morton's neuroma.

BACKGROUND: Morton's neuroma is a perineural fibrosis of an intermetatarsal plantar nerve. Burning, numbness, paresthesia, and tingling down the interspaces of involved toes may also be experienced. Taking into account all of this information, we designed a prospective open-label study to evaluate the efficacy of pulsed radio frequency on Morton's neuroma. METHODS: Twenty patients with Morton's neuroma were experiencing symptomatic neuroma pain in the foot not relieved by routine conservative treatment. All of the patients had been evaluated by a specialized orthopedist and were offered pulsed radio frequency as a last option before having surgery. Initially, pain level (numerical rating scale), successful pain control (a ≥50% pain decrease was accepted as successful pain control), comfort when walking (yes or no), and satisfaction level (satisfied or not satisfied) were evaluated. RESULTS: We found a decrease in the pain level in 18 of 20 patients, successful pain control in 12, and wearing shoes and walking without pain in 16. Overall, satisfaction was rated as excellent or good by 12 patients with Morton's neuroma in this series. CONCLUSIONS: This evidence indicates that ultrasound-guided pulsed radio frequency is a promising treatment modality in the management of Morton's neuroma pain.

Treatment of compensatory hyperhidrosis of the trunk with radiofrequency ablation.

OBJECTIVES: Although Endoscopic Thoracic Sympathectomy is a widely accepted treatment method for patients with palmar hyperhidrosis, compensatory hyperhidrosis of the trunk remains a challenging side effect of the procedure. No satisfactory treatment options for this side effect were available until now. In this study, we aimed to define a new procedure for the treatment of compensatory hyperhidrosis of the trunk. METHODS: A total of 10 patients admitted our institution for the treatment of compensatory hyperhidrosis of the trunk were enrolled in the study between November 2010 and January 2012 in a prospective manner. Sympathetic blockage was achieved via radiofrequency thermo-ablation technique. The results of treatment were evaluated via telephone calls. RESULTS: Ten patients (2 females, 8 males) underwent radiofrequency thermo-ablation of T6 sympathetic ganglion for compensatory hyperhidrosis of the trunk. The mean age was 29.2 years and the median duration of symptom was 10.5 months. The median follow-up period was 14 months. Six of ten patients (60%) were treated successfully. There was no procedure related complication. CONCLUSION: The radiofrequency treatment for patients with compensatory hyperhidrosis of the trunk is an alternative option with promising results.

Comparison of the Macintosh and Airtraq Laryngoscopes in Endotracheal Intubation Success.

OBJECTIVE: Endotracheal intubation of patients is an effective method for controlling airway and breathing. However, laryngoscopy and endotracheal intubation is not easy in every case. There is a recent abundance of equipment used for controlling ventilation and intubation. Airtraq is one of those equipments. In this study, our main objective is to compare the success rates of the Airtraq and Macintosh (direct and classic) laryngoscopes in endotracheal intubation. METHODS: In this single-center, prospective, randomized, clinical study was performed on 80 patients who were operated under general anesthesia, ASA I-II, 18-65 years old. Patients were intubated using two different endotracheal intubation tools. Group A was intubated using the Macintosh (direct and classic) laryngoscope, meanwhile Group B was intubated using the Airtraq laryngoscope. Patients' snoring complaints, modified Mallampati scores, sternomental distances, thyromental distances, interincisor distance measurements and Cormack-Lehane (C-L) laryngoscopic classification, upper lip bite test results, intubation time, number of intubation attempts, maneuvers and techniques used for facilitating intubation and complications arising from intubation were recorded. RESULTS: There was a statistically significant difference between the groups in terms of C-L scores (p=0.041). In all, 8 patients in the Macintosh group, and 2 patients in the Airtraq group were C-L grade III. In intubation of the Airtraq group, only 3 patients required facilitating techniques, meanwhile in intubation of the Macintosh group 15 patients we had to use one or more facilitating maneuver. The rate of Mallampati scoring "difficult" was 4/6 in the Macintosh and 2/11 in Airtraq laryngoscopy groups (p=0.553). CONCLUSION: In cases with seemingly difficult intubations, we believe the Airtraq laryngoscope has an advantage over the Macintosh laryngoscope, owing to its better view of the oropharyngeal and glottic areas in addition to facilitating intubation in patients with limited head extension.

Current Approaches in Hip and Knee Arthroplasty Anaesthesia.

Risk assesment, preoperative drug regulation, the anesthesia and analgesia techniques are very important and the effectivity on success of surgery is great. So, these topics in arthroplasty were reviewed under current knowledge.

Do the patients read the informed consent?

BACKGROUND: Informed consent is a process which consists of informing the patient about the medical interventions planned to be applied to the patient's body and making the patient active in the decision making process. AIMS: The aim of this study was to evaluate whether the patients read the informed consent document or not and if not, to determine why they did not read it. This was achieved via a questionnaire administered at the pre-anaesthetic visit to assess the perception of patients to the informed consent process. STUDY DESIGN: Survey study. METHODS: The patients were given a questionnaire after signing the informed consent document at the pre-anaesthetic visit. We studied whether the patients read the informed consent document or not and asked for their reasons if they did not. RESULTS: A total of 522 patients were included during the two month study (mean age: 38.1 years; 63.8% male, 36.2% female). Overall, 54.8% of patients reported that they did not read the informed consent. Among them, 50.3% did not care about it because they thought they would have the operation anyway, 13.4% did not have enough time to read it, 11.9% found it difficult to understand, 5.9% could not read because they had no glasses with them, and 5.2% found it frightening and gave up reading. Inpatients, older patients and patients with co-morbidities were less likely to read the informed consent document than outpatients, and younger and healthy patients (p<0.05). Also, 57.9% of parents whose children would be operated on had read the document. CONCLUSION: This study shows that the majority of our patients did not understand the importance of the informed consent. It is therefore concluded that informed consent documents should be rearranged to be easily read and should be supported with visual elements such as illustrations or video presentations, as informed consent is a process rather than just simply signing a form.

Validity and reliability of Turkish version of family satisfaction in the intensive care unit.

To evaluate the quality of care that is provided in intensive care units, needs and satisfaction of the patient relatives must also be considered. The aim of the study is to test the Turkish version of the Family Satisfaction in the Intensive Care Unit (FS-ICU-24) Survey, which was developed by Heyland et al. This study was planned and applied as a methodological study. Survey was conducted in the intensive care units of a military education and research hospital and a medical faculty hospital, department of anaesthesia and reanimation in the capital city Ankara of Turkey. Sample of the survey was composed of 120 participants. Cronbach's alpha value for the FS-ICU-24 general internal consistency in this study was calculated as 0.95 for total scale. In this study, the Turkish version of the FS-ICU-24 was found to be reliable and valid with Turkish population.

Comparison of the postoperative analgesic efficacy of an ultrasound-guided fascia iliaca compartment block versus 3 in 1 block in hip prosthesis surgery.

OBJECTIVES: In this study, we aimed to compare the postoperative analgesic efficiency of an ultrasound-guided fascia iliaca compartment block and a 3 in 1 block in patients who underwent hip prosthesis surgery as a result of hip fracture. METHODS: With approval from the local ethics committee, 70 patients, aged 20 to 80, undergoing hip prosthesis surgery under elective conditions were included in this randomized, prospective, controlled study. They were informed of the patient-controlled analgesia (PCA) device and visual analog scale (VAS). All patients were separated randomly into three groups. Anaesthesia induction was standardized for all groups. An ultrasound guidance fascia iliaca compartment block (FICB) was applied to the first group before anaesthesia induction. For the second group, a 3 in 1 block was applied, while for the control group no block was applied. After incision on all patients, 20 mg tenoxicam and 1 mg/kg tramadol were injected intravenously. Following surgery, IV tramadol PCA was begun on all patients routinely. In our study, the presence of cortisol and ACTH levels, hemodinamical parameters, nausea and sedation were determined. RESULTS: We observed a decrease in VAS values and opioid consumption, no adverse effects on nausea and sedation, and a suppression of stress hormones in both the ultrasound-guided FICB and 3 in 1 block groups. CONCLUSION: We believe that the safe and efficient application of the ultrasound-guided 3 in 1 block and the FICB is necessary in multimodal analgesic treatment in order to enable postoperative analgesia in hip prosthesis surgery.

Results of the assessment of the council of multidisciplinary pain.

OBJECTIVES: The aim of this study was to emphasize the necessity of multidisciplinary pain council by demonstrating the patient profile, treatment approaches, outcomes, and patient satisfaction levels obtained from our council. METHODS: In this study, the age, gender, number of council evaluations, diagnoses and recommended therapies of patients were determined retrospectively. The status of the patients >1 year, outcomes of the therapies, and satisfaction levels of the patients were questioned on the phone. RESULTS: The patients were most commonly diagnosed as chronic low back pain (35%) and vertebral tumor or metastasis (10%). 74 % of the patients were evaluated because of vertebral causes. 23% of the patients had good, 27% had moderate and 35% had poor benefit; beneficence was calculated as 85%. Patient satisfaction was found as 24%, 23%, and 32%, respectively; satisfaction was calculated as 79%. CONCLUSION: Evaluation of complex patients by physicians from different disciplines has better diagnostic and treatment outcomes. In addition, multidisciplinary approach offer and perform different therapy options and this has positive effects on treatment efficiency and patient satisfaction. We are in the opinion that instead of standard treatment protocols, determining individualized multidisciplinary treatment protocols should be useful.

A new target of percutaneus sympathic radiofrequency thermocoagulation for treatment of palmar hyperhidrosis: T4.

OBJECTIVES: Hyperhidrosis is thought to result from a functional impairment of the sympathic nervous system. In this study, percutaneous T4 sympathic radiofrequency (RF) thermocoagulation was used to treat palmar hyperhidrosis which does not respond to conservative treatment. The results were evaluated in terms of safety, efficiency and patient satisfaction. METHODS: In this study, 15 patients aged 16-48 years were retrospectively evaluated from prior records. Patient satisfaction scores (very satisfied, satisfied, not satisfied), after treatment of the hand condition (dry, mild dry, no improvement), and whether the most common complication and most patients expressed by the compensatory hyperhidrosis (CH) degree (none, mild, moderate, severe) were analyzed. RESULTS: No complications were observed except a coughing crisis that lasted for 2 hours in one patient, transient bradycardia in 1 patient and transient injection site pain in all cases. Two patients 1 per week and three patients 1, 2 and 6 months developed recurrence. CONCLUSION: Sympathic T4 ablation with RF thermocoagulation was found to have long term (6 months) patient satisfaction (80%). It was also effective in reducing the hand sweating (80% dry or mild dry). The CH rate was 27%. According to our results, sympathic T4 ablation with RF thermocoagulation is a safe and effective treatment with a high degree of patient satisfaction.

Effect of radiofrequency ablation and comparison with surgical sympathectomy in palmar hyperhidrosis.

OBJECTIVES: Hyperhidrosis is a the disorder of excessive sweating in certain regions of the body. It is usually treated with surgical sympathectomy. Radiofrequency therapy has been successfully used for sympatholysis. We tested the primary hypothesis that radiofrequency therapy is independently associated with decreased palmar hyperhidrosis and compared results for patients receiving this treatment with patients who underwent surgical sympathectomy. METHODS: We included all the patients undergoing treatment for hyperhidrosis between March 2010 and April 2012. Patients who underwent either surgical sympathectomy or radiofrequency ablation for palmar hyperhidrosis were included and analysed. The outcomes studied included complications, success of the procedure, patient satisfaction with their procedure and compensatory hyperhidrosis. RESULTS: There were 94 patients who met our criteria, of whom 46 (49%) had surgical sympathectomy and 48 (51%) had radiofrequency ablation performed. Radiofrequency had a success rate of 75% in treating hyperhidrosis, but this was found to be statistically lower than for surgical sympathectomy (95%; P < 0.01). The groups were similar regarding patient satisfaction (P = 0.26) and compensatory hyperhidrosis (P = 0.78). CONCLUSIONS: This is the first clinical study to evaluate the role of radiofrequency ablation and compare it with the surgical treatment option for palmar hyperhidrosis. Radiofrequency ablation significantly decreased hyperhidrosis, but it had a lower success rate than surgical sympathectomy.

[A comparison of the efficacy of bupivacaine and levobupivacaine in patient-controlled epidural analgesia for postoperative pain in patients undergoing knee arthroplasty]. / Diz artroplastisi yapilan hastalarda ameliyat sonrasi agri için hasta kontrollü epidural analjezide bupivakain ve levobupivakainin etkinliginin karsilastirilmasi.

OBJECTIVES: In this study, we aimed to compare the efficacy of bupivacaine and levobupivacaine in the patient-controlled epidural analgesia (PCEA) in patients who underwent total knee arthroplasty (TKA), particularly with cardiac diseases. PATIENTS AND METHODS: Forty-four patients (16 males, 28 females; mean age 70.2±6.3 years; range 18 to 80 years) who were scheduled for TKA surgery under combined spinal and epidural anesthesia were included. Patients were randomly divided into two groups. Bupivacaine 15 mg 0.5% for group 1 (n=23) and levobupivacaine 15 mg 0.5% for group (n=23) were administered via spinal route. The amount of local anesthetics, PCEA starting times and bolus/demand ratio of local anesthetics were recorded. The level of pain, need for additional analgesic, total amount of analgesic, degree of motor block, complications were asked for patient satisfaction at postoperative 6, 12, 24 and 48 hours. RESULTS: No statistical differences were determined between group 1 and group 2 in terms of the operation times, PCEA starting times, bolus number/demand ratios, visual analog scale (VAS) scores and numerical rating scores (NRS) at the postoperative 6, 12, 24 and 48 hours, need for additional analgesic, total amount of analgesic, degree of motor block and patient satisfaction. Although the incidence of side effects was lower in the group 1 compared to group 2, it was not statistically significant. CONCLUSION: We concluded that it would be proper using levobupivacaine rather than bupivakaine for patients with cardiac diseases, as the cardiotoxic and neurotoxic effects of levobupivacaine is lower then bupivacaine with a similar analgesic efficacy.

[A commonly seen cause of abdominal pain: abdominal cutaneous nerve entrapment syndrome]. / Abdominal agrinin sik görülen bir nedeni: Abdominal kutanöz sinir tuzak sendromu.

Although abdominal cutaneous nerve entrapment syndrome (ACNES) is accepted as a rare condition, it is a syndrome that should be diagnosed more commonly when the clinical signs cannot explain the cause of abdominal pain. Abdominal pain is commonly considered by physicians to be based on intra-abdominal causes. Consequently, redundant tests and consultations are requested for these patients, and unnecessary surgical procedures may be applied. Patients with this type of pain are consulted to many clinics, and because their definitive diagnoses cannot be achieved, they are assessed as psychiatric patients. Actually, a common cause of abdominal wall pain is nerve entrapment on the lateral edge of the rectus abdominis muscle. In this paper, we would like to share information about the diagnosis and treatment of a patient who, prior to presenting to us, had applied to different clinics for chronic abdominal pain and had undergone many tests and consultations; abdominal surgery was eventually decided.