Effects of anesthesia and perioperative management on mortality in geriatric orthopedic surgery: a retrospective study of 451 patients.

OBJECTIVE: We aimed to investigate the effects of anesthesia methods and perioperative procedures on mortality in geriatric patients operated for hip fracture. PATIENTS AND METHODS: This retrospective study included patients over 65 years of age who underwent hip fracture surgery. Demographic data, risk scores, perioperative and anesthesia management were analyzed in terms of mortality. RESULTS: Data from 451 patients who were eligible for the study were analyzed. It was determined that there was no difference in mortality between the anesthesia methods administered to the patients in hip fracture surgery (p>0.05).  Being male increased the mortality risk by 4.568 times (95% CI: 1.215-17.168), and a one-unit increase in the number of erythrocyte suspensions given perioperatively increased the mortality risk by 2.801 times (95% CI: 1.509-5.197). Additionally, an American Society of Anesthesiologists (ASA) II score increased the mortality risk by 0.120 times (95% CI: 0.021-0.690), and a higher modified Charlson comorbidity index (mCCI) of 5-7 increased the mortality risk by 0.052 times (95% CI: 0.009-0.289). CONCLUSIONS: Although high ASA and mCCI scores, male sex, and blood transfusion were associated with mortality in geriatric hip fracture surgery, we found that the method of anesthesia did not affect mortality.

The administration sequence of propofol and remifentanil does not affect the ED50 and ED95 of rocuronium in rapid sequence induction of anesthesia: a double-blind randomized controlled trial.

OBJECTIVE: The topic of drug administration sequence in rapid sequence induction (RSI) is still an object of interest in terms of rocuronium effectiveness. The aim of this prospective, randomized trial was to evaluate the effect of administration sequence of propofol and remifentanil on ED50 and ED95 of rocuronium in a RSI model. PATIENTS AND METHODS: Eighty-four patients were randomized into Group Remifentanil (Group R, n = 43), where induction of general anesthesia started with remifentanil (2 µg/kg) and followed by propofol (2 mg/kg) and rocuronium administrations; and Group Propofol (Group P, n = 41), where induction of general anesthesia started with propofol and followed by remifentanil and rocuronium. First patients in each group were paralyzed by 0.8 mg/kg rocuronium. In case of acceptable intubation as evaluated according to the criteria described by Viby-Mogensen et al, rocuronium dose was decreased by 0.1 mg/kg for the next patient; otherwise, rocuronium dose was increased by 0.1 mg/kg. After three crossover points, increments or decrements in rocuronium dosage were set to 0.05 mg/kg. The process was repeated until a total of ten crossover points were obtained. RESULTS: The ED50 and ED95 doses of rocuronium were similar in Group R (0.182 mg/kg, and 0.244 mg/kg, respectively) and Group P (0.121 mg/kg, and 0.243 mg/kg, respectively) according to 95% CI of the estimates. There was no statistically significant difference in terms of clinically acceptable intubation conditions between the two groups (56.1% in Group R vs. 59% in Group P, p = 0.795). CONCLUSIONS: The choice of administration sequence of propofol and remifentanil does not have an impact on estimated ED50 and ED95 of rocuronium in providing acceptable intubation conditions in the RSI technique.

Determine the difficulties of home care in children following haematopoietic stem cell transplantation.

The aim of this study was to determine the difficulties regarding the home care of children following haematopoietic stem cell transplantation (HSCT). The sample of the study includes the families of 73 children in a bone marrow transplant unit between 2010 and 2013, Turkey. Data were collected using a form included descriptive information and questions about the difficulties and complications of home care. Families were telephoned and problems they had encountered were recorded. Mann-Whitney U-test and the logistic regression analysis were used. The average age of the children was 10.65 ± 5.03 years, the average age was 8.89 ± 4.9 when HSCT was performed, and the average year after HSCT was 1.79 ± 0.74. 41.1% of the children underwent transplantation with diagnoses of anaemia. Primary physical problems that were found after discharge from the hospital were fever (43.8%), decreased appetite (37%), rash (34.2%) and pain (26%). Socially, 43.8% of families reported that their children had difficulties with school. Primary difficulties regarding care and follow-up were reported as skin care (34.2%) and catheter care (33.3%). In the post-transplantation period, it is important to provide information about potential problems and care to patients and families in order to increase the quality of life.

Effects of end tidal CO2 and venous CO2 levels on postoperative nausea and vomiting in paediatric patients.

OBJECTIVE: Postoperative nausea and vomiting (PONV) is a common complaint of paediatric surgical patients. The aim of this prospective study was to compare the effects of end tidal CO2 (PeCO2) and venous CO2 (PvCO2) in laryngeal mask (LMA) and face mask (FM) ventilation on the occurrence of PONV in paediatric patients with surgical interventions in the inguinal region. To date, no data regarding these parameters on PONV are available. PATIENTS AND METHODS: Ninety children were randomized using the sealed-envelope method. Group 1 consisted of 45 patients whose airway was managed with LMA; Group 2 consisted of 45 patients whose airway was managed with FM. Induction of anaesthesia was performed via administration of 8% sevoflurane in a mixture of air/oxygen in all patients. In both groups, manually controlled ventilation was applied. Five (t1) and fifteen (t2) min after the start of surgery, venous blood samples were obtained and PeCO2 was determined. RESULTS: PeCO2 (t2) and PvCO2 (t2) levels and the occurrence of PONV were significantly increased in Group 2 compared to Group 1 (p < 0.005 for all). In both groups, the occurrence of PONV was positively correlated with BMI, PeCO2 (t2), and PvCO2 (t2) levels (p < 0.05 for all), whereas it was inversely correlated with SpO2 levels (p < 0.05 for all) in a bivariate analysis. We found that the PeCO2 (t2) and PvCO2 (t2) levels were independently associated with the occurrence of PONV in both groups. CONCLUSIONS: Our results showed that elevated levels of PeCO2 (t2) and PvCO2 (t2) are independent risk factors for PONV, and these parameters may be used as adjunctive tools to assess the occurrence of PONV.

Anesthetic management in hydatid disease: a review of 435 cases.

BACKGROUND AND AIMS: Hydatid cyst diseases are still a problem in Turkey, especially in the east and southeast of Anatolian Region, as well as in many other places in the world. In this study a retrospective review was made of the anesthetic management for surgical and interventional treatment of 435 patients with hydatid cysts. The study data were collected between January 1997 and December 2012 at Harran University Hospital, Sanliurfa, Turkey. MATERIALS AND METHODS: Patients' demographics and localization of the cysts were recorded. Suitable anesthetic and surgical management were performed to the cysts according to their locations. Four hundred thirty-five patients had general anesthesia with a midazolam premedication and one of them was treated by sedation. RESULTS: Of the 435 patients, 251 were females (57.7%) and 184 males (42.3%) and ages ranged from 1 to 74 years (mean: 36.3 ± 25.4). These include; preoperative using of steroids and antihistamines to prevent the allergy possibility, intraoperative hypotension and tachycardia and administration of colloids, and improvement of postoperative anaphylaxis. Anaphylaxis was observed in only two patients who undertook percutaneous aspiration. Also bronchospasm was developed in four patients during the postoperative period and successfully treated with standard bronchodilatators. CONCLUSIONS: Anaphylactic reaction during operation is a serious complication, but a very rare one. Prophylactic use of antihistamine and steroid drugs were reduced allergy and anaphylaxis.

Optimal wrist position for long and short axis ultrasound guided radial artery cannulation.

BACKGROUND: The radial artery is the most common site for arterial cannulation. Procedures for improving radial artery cannulation have involved direct visualization of the vessel with ultrasonography (US). The aim of this study evaluate the short axis and long axis radial artery measurements at 0º, 45º, 60º wrist joint angle and find out the optimal wrist joint angle for long and short axis US guided radial artery cannulation. MATERIALS AND METHODS: This study was approved by the Institutional Ethical Committee and the study was performed in accordance with the ethical principles for human investigations, as outlined by the Second Declaration of Helsinki. One hundred fifty-two (90 men and 62 women, 18-48 years of age, mean age: 32.9 ± 6.1) healthy volunteers were recruited. The radial artery distance between skin and height, width, area in short axis and radial artery distance between skin and height was measured in long axis at 0º, 45º, 60º wrist joint angle were measured. Results. Short axis radial artery distance between skin, width, height, area and long axis radial artery distance between skin, height were statistically significantly different among 0º, 45º, 60º (p< 0.05; for all comparisons). Short axis width was statistically significantly increased at 45º compared to at 0º (p< 0.001;). Short axis radial artery distance between skin and height at 45º were statistically significantly decreased than at 0º (p< 0.001; for all comparisons) and long axis skin distance and height at 45º were also statistically significantly decreased than at 0º (p< 0.001; for both comparisons). Short axis radial artery skin distance and area at 60º is statistically significantly decreased than at 45º (p< 0.001; for both comparisons) and also long axis height of radial artery at 60º is statistically significantly decreased than at 45º (p< 0.001;). CONCLUSIONS: Angle increment up to 45º might help clinicians for radial artery cannulation in short axis plane whereas this angle increment maneuver decreased the arterial height in long axis which might be a potential disadvantage for cannulation.

Infected primary hydatid cyst located in the Sartorius muscle.

Primary intramuscular hydatid cyst should be considered for the differential diagnosis of cystic soft tissue masses especially in the endemic areas though primary muscular hydatidosis is a rare clinical entity. We aimed to report the case of a 30-year-old female patient with infected primary intramuscular hydatid cyst located in the sartorius muscle.

Do additional intramedullary elastic nails improve the results of definitive treatment with external fixation of open tibia fractures? A prospective comparative study.

PURPOSE: External fixation has been associated with a high incidence of complications and poor outcomes due to the instability and difficulty in treating open tibia fractures. We use intramedullary (IM) elastic nails to supplement the external fixator. We compared the results of fractures treated by external fixation with and without IM-elastic nail. HYPOTHESIS: The combination of external fixation with IM-elastic nails may be used as an alternative to solve problems due to the external fixators alone in open tibia fractures. METHODS: Group 1 included prospectively 26 cases (15 males and 11 females, mean age 37.5 ± 12.4 years) treated with external fixation and IM-elastic nails, whereas group 2 consisted of 28 cases (23 males and five females, mean age 30.7 ± 14.0 years) treated with standard external fixation. Functional and bone results were made using the criteria proposed by ASAMI. RESULTS: The mean follow-up period was 3.96 ± 2.0 years in group 1 and 3.32 ± 2.1 years in group 2. The mean duration to external fixation and mean time to union were significantly lower in group 1 (P<0.001). In addition, bone and functional results were significantly higher in group 1 (P<0.01), however, pin track infections were lower in group 1 (P<0.01). CONCLUSION: Our results showed the improvement in outcomes with IM-elastic nails: decreased duration of external fixation need and decreased bone healing delay. Therefore, this method may be a superior alternative for preventing complications related to external fixation in open tibia fractures. LEVEL OF EVIDENCE: Level III: prospective comparative study.

Comparison of intracompartmental pressures in a rabbit model of open and closed tibial fractures: an experimental study.

We compared the intracompartmental pressures (ICPs) of open and closed tibial fractures with the same injury pattern in a rabbit model. In all, 20 six-month-old New Zealand White male rabbits were used. They were randomised into two equal groups of ten rabbits; an open fracture group (group 1) and a closed fracture group (group 2). Each anaesthetised rabbit was subjected to a standardised fracture of the proximal half of the right tibia using a custom-made device. In order to create a grade II open fracture in group 1, a 10 mm segment of fascia and periosteum was excised. The ICP in the anterior compartment was monitored at six-hourly intervals for 48 hours. Although there was a statistically significant difference in ICP values within each group (both p < 0.001), there was no significant difference between the groups for all measurements (all p ≥ 0.089). In addition, in both groups there was a statistically significant increase in ICP within the first 24 hours, whereas there was a statistically significant decrease within the second 24 hours (p < 0.001 for both groups). We conclude that open tibial fractures should be monitored for the development of acute compartment syndrome to the same extent as closed fractures.

Patellar denervation in total knee arthroplasty without patellar resurfacing: a prospective, randomized controlled study.

BACKGROUND: Anterior knee pain is still a major problem in total knee arthroplasty (TKA). Although the most widely accepted opinion is that anterior knee pain is often associated with a patellofemoral etiology, there is no clear consensus as to etiology or treatment. Disabling pain receptors by electrocautery could theoretically achieve denervation of the anterior knee region. The present prospective randomized controlled study aimed to evaluate results after patellar denervation with electrocautery in TKA at a minimum follow-up of 2 years. HYPOTHESIS: Patellar denervation provides some benefit in terms of pain and clinical outcomes after TKA without patellar resurfacing. PATIENTS AND METHODS: Clinical and radiological results for 35 patients with single-stage bilateral TKA (70 knees; 26 women, nine men; mean age, 68 years [range, 58 to 77 years]) were reviewed. In addition to removal of all osteophytes, patellar denervation by electrocautery was performed on one patella; and debridement alone, removing all osteophytes, was performed on the contralateral patella, as a control. KSS score and a visual analog scale (VAS) were used to assess pre- and postoperative anterior knee pain. RESULTS: Mean follow-up was 36 months (24 to 60 months). No revisions or re-operations were performed. There were no patellar fractures. On all parameters (KSS score, range of motion and VAS), there was a statistically significant pre- to postoperative difference in favor of the denervation group. DISCUSSION: Patellar denervation with electrocautery can reduce anterior knee pain, with satisfactory clinical and radiological outcome, in TKA without patellar resurfacing. LEVEL OF EVIDENCE: Level II: low-powered prospective randomized trial.

Space-regaining treatment for a submerged primary molar: a case report.

The aetiology of submerged primary molars is not known and optimal treatment has still not been established. If submerged primary teeth are left untreated, the occlusal consequences are space-loss due to tipping of adjacent teeth and/or overeruption of the opposing teeth. Normally, treatment consists of extraction of the deciduous teeth or observation for normal exfoliation. Here we report a case where the submerged primary molar was extracted surgically after space-loss had been regained.

A retrospective study of dento-alveolar injuries of children in Ankara, Turkey.

Information concerning age and sex distribution, etiology, types, place and extent of trauma as well as seasonal variations, time difference between traumatic injury and seeking of dental care and number of traumatic injuries was recorded retrospectively from 150 patients. The study comprised 91 boys and 59 girls representing 246 dental injuries and 332 injured teeth (72 primary and 260 permanent teeth). The most common injuries were uncomplicated crown fracture (23.57%), subluxation (15.85%), avulsion (10.16%), lateral luxation (9.75%), complicated crown fracture and intrusion (8.4% and 8.94%, respectively). The occurrence of uncomplicated crown fractures was significantly higher (P<0.05) in the 10-12 years age group than other age groups. Lateral luxation and intrusion were significantly higher in the 1-6 and 7-9 years age groups (P<0.05, respectively).

Fluoride content of infant formulas and market milk in Turkey.

The aim of the present study was to test the fluoride contents of infant formulas and market milk in Turkey. Fifteen formulas and nine market milks were prepared according to manufacturers' instructions with deionized water. Fluoride contents were analyzed with a spectrophotometer (CADAS 50S) and results were obtained as ppm (microgF/ml). Mean fluoride content of the formulas was 0.101 ppm F and of the milks was 0.08 ppm F. Formulas reconstituted with water containing < 0.3 ppm F do not provide a daily fluoride intake at any age. To decrease dental caries among children in Turkey, fluoride supplements could be prescribed at minimal dosages according to the ADA fluoride schedule.

Effects of a nonrinse conditioner and 17% ethylenediaminetetraacetic acid on the etch pattern of intact human permanent enamel.

The purpose of this study was to evaluate the effects of 2 new acid-etching solutions, nonrinse conditioner (NRC) and 17% ethylenediaminetetraacetic acid (EDTA), on enamel surface morphology, and to compare the new solutions with traditional 37% phosphoric acid. The effect of prolonged etching time was also investigated. The buccal surfaces of 80 extracted third molars were etched with one of the 3 acids for 15, 30, or 60 seconds. The central regions of the specimens were examined with a scanning electron microscope. Shorter etching time with phosphoric acid resulted in a relatively smooth enamel surface compared with longer treatments. Irrespective of treatment time, NRC produced an aprismatic etch pattern, which suggested a potentially retentive morphological character. EDTA treatment had the least effect of all etchants tested.

Three-year clinical evaluation of a polyacid-modified resin composite in minimally invasive occlusal cavities.

OBJECTIVE: The aim of this study was to evaluate the 3-year clinical performance of one polyacid-modified resin composite material (PMRC). Dyract, in minimally invasive occlusal cavities and its neighbouring fissures. METHODS: One hundred and sixteen restorations of the material investigated were placed by a single operator in a group of selected children under controlled conditions. Isolation of the restorations was accomplished with the use of cotton rolls and aspiration. Using modified US Public Health Service (USPHS) codes and criteria, the restorations were reviewed clinically within 1 week of placement (baseline), and thereafter at 6 months, 1, 2 and 3 years. RESULTS: After 3 years, marginal discolouration was present in 8.6% of the restorations. The marginal adaptation was rated as partly sealed (Oscar-Alpha) in 107 (92.2) of the restorations. Five restorations had lost their sealant components, while four restorations were partly sealed with explorer-catch after 3 years. Although wear of the restorations was considerable, restorations rated as 'partly sealed' had at least two-thirds of their sealant components fully retained. Recurrent caries was associated with four (3.4%) restorations. CONCLUSION: In this clinical study, the retention rate of the tested PMRC material was good, although a marked occlusal wear was evident. The marginal adaptation of the PMRC at the enamel site would probably have been better by the use of enamel-etching. Provided the marginal adaptation and wear resistance of the material is further improved, clinical use of PMRCs in minimally invasive occlusal cavities can be advocated.

Pulpal tissue in bilateral talon cusps of primary central incisors: report of a case.

Talon cusp is a tooth anomaly that affects both the primary and the permanent dentitions. However, the occurrence of this anomalous cusp is rather infrequent in the primary dentition. Only 7 cases of bilateral talon cusps affecting the primary teeth have been reported in the dental literature. This is a case report of bilateral talon cusps on primary maxillary central incisors whose histologic evaluation revealed the existence of pulpal tissue in the anomalous cusps.

Etching effect of 17% EDTA and a non-rinse conditioner (NRC) on primary enamel and dentin.

PURPOSE: To investigate the effect of a new non-rinse conditioner (NRC) and 17% EDTA as etchants on the micromorphology of primary tooth enamel and dentin, in comparison with 36% phosphoric acid (PA) when applied for 15 s and 7 s. MATERIALS AND METHODS: Enamel specimens obtained from 40 extracted primary second molars were used to create four groups (n=10) which received the following treatments on unground enamel surface: Group 1: 36% PA/15 s, Group 2: 36% PA/7 s, Group 3: NRC 20 s, Group 4: 17% EDTA/60 s. The same treatments were applied on flattened primary tooth dentin specimens (four groups/n=10). All treated surfaces were examined by SEM. RESULTS: For enamel specimens, a Type II etching pattern was evident in Groups 1 and 3. In Group 2, an uneven Type II pattern was present with prism peripheries partially intact. A mixture of Type II and Type III etching patterns were observed in Group 4. Although all conditioners removed dentin smear to varying degrees, the overall performance of 17% EDTA was weaker than PA and NRC.

Ectopic eruption of maxillary first permanent molars: treatment options and report of two cases.

Irreversible ectopic eruption of maxillary first permanent molars may lead to crowded permanent dentition when it is overlooked. The situation usually requires active treatment. In the presented irreversible ectopic eruption cases, distalization and uprighting of maxillary first permanent molars were achieved using removable orthodontic appliances.

Dentinogenesis imperfecta: influence of an overdenture on gingival tissues and tooth mobility.

Case report of a child demonstrating severely-worn primary dentition with dentinogenesis imperfecta is presented. Overdentures were fabricated in order to preserve clinical crowns, re-establish the clinical dimension of occlusion and provide esthetics. The patient underwent monthly recall visits for a 6-month period, during which most rapid changes concerning the gingival tissues and tooth mobility were expected.