The effect of cryotherapy on pain in patients with total knee replacement surgery: a meta-analysis.

Cryotherapy is used to reduce edema and pain after total knee replacement surgery. This study was conducted as a meta-analysis study to determine the effect of cryotherapy on pain in patients undergoing total knee arthroplasty. The words 'total knee prosthesis,' 'pain,' 'cryotherapy,' 'cold application,' and 'orthopedic surgery' were searched in Turkish and English in scientific articles in the last 20 years from Scopus, Science Direct, Google Scholar, Pubmed databases. As a result of the research, a total of 8.406 studies were identified. Funnel Plot, Rosenthal's Secure N, and Orwin's Secure N methods were used to demonstrate that the meta-analysis study was reliable and valid and to determine publication bias. The sample size of the studies included in the analysis was 1462. The total effect size was 2.929, with a lower bound of 1.641 and an upper bound of 5.223 at a 95% confidence interval. The study determined that patients who underwent cryotherapy in total knee replacement surgery had 2.9 times less pain than patients who did not undergo cryotherapy.

Kinematic analysis of scapular movements in patients with facioscapulohumeral muscular dystrophy.

The purpose of this study is to evaluate scapular movements by the three-dimensional electromagnetic system during shoulder elevation in FSHMD patients, and to compare the results with healthy individuals. 10 patients with FSHMD and 10 healthy individuals were included in the study. Scapular anterior-posterior tilt, upward-downward rotation and internal-external rotation at 30°, 60° and 90° were evaluated using the three-dimensional electromagnetic system during the elevation of the upper limbs in the scapular plane. Humerothoracic elevation levels on the dominant and non-dominant sides were found to be lower in the patients than healthy individuals (p < .001). Both scapula were rotated downwards at 30° (dominant/non-dominant p < .001) and 60° (dominant p = .009, non-dominant p = .04) of humerothoracic elevation, the scapula was rotated internally at 30° of humerothoracic elevation on the non-dominant side (p = .03), and the scapula was tilted posteriorly at 90° of humerothoracic elevation on the non-dominant side (p = .009) in patients. These existing abnormal patterns of the scapula in the patients increase the risk of impairment, pain, impingement and instability especially in the activities that require arm elevation. It is thought that physiotherapy approaches should first be emphasized to improve scapular stabilization and strengthening exercises should then be performed for the shoulder girdle muscles.

A comparison of the intensive care experiences of emergency and elective cardiac surgery patients.

PURPOSE: The study was planned to review the experiences of patients in the intensive care units (ICUs) and determine their states of awareness following an emergency or elective cardiac surgery. MATERIALS AND METHODS: This was a multicenter and descriptive study. Approval was granted by the Institutional Ethics Committee and informed consent for participation in the study was obtained from all the patients. The study included a total of 300 patients who underwent emergency or elective cardiovascular surgery and were then transferred to the ICU. Data were gathered from the demographic data form and the intensive care experience scale, which was developed by the researchers and applied through face-to-face interviews with the patients. The independent-samples t-test, Mann-Whitney U (Exact) test, one-way ANOVA (Robust Test: Brown-Forsythe), and multivariate analysis of variance were used in the analysis of the data. RESULTS: The study included 300 patients, comprising 108 (36%) females and 192 (64%) males. No difference was found between the groups in respect of total intensive care points of emergency (57.9 ± 4.92) and elective (56.6 ± 4.58) operations (P = 0.32). The environmental awareness level and patient satisfaction of the elective group were seen to be higher, and the emergency group reported more bad experiences. Patients who had undergone emergency cardiac valve surgery were more satisfied (P < 0.001) and remembered more (P = 0.001). CONCLUSION: Patients who had undergone urgent and elective cardiac surgery were seen to have had a relatively negative intensive care experience. When there was more environment awareness in patients with ICU experience, it was determined that as the duration of stay in the ICU lengthens out, the pessimistic experiences increased and ICU satisfaction decreases.

Modified Limberg flap technique in the treatment of pilonidal sinus disease in teenagers.

BACKGROUND: Pilonidal sinus disease (PSD) is most common in young adults but can also affect teenagers. Although many techniques have been used to treat pilonidal sinus disease in adults, few studies have compared treatment methods for the condition in teenagers. In this study, we aimed to compare the modified Limberg flap technique with the excision and primary closure technique, both of which are used routinely in adults and teenage patients. MATERIALS AND METHODS: This study was a retrospective review of 40 teenaged patients who underwent surgery in a single pediatric surgery center over ~2 years. The patients' age, gender, body mass index (BMI), number of sinuses, surgery technique and any complications were recorded. The patients underwent excision and primary repair or rhomboid excision and a modified Limberg flap. RESULTS: Of the 40 patients, 22 (55%) were female, and 18 (45%) were male. The mean age of all the patients was 15.20 ± 1.31 (12-17) years. The average number of sinuses was 3.18 ± 0.90 (1-5). Of the patients, 52.5% (n=21) had a high body mass index. These patients were obese (n=4) and overweight(n=17). Pilonidal sinus excision and primary repair were performed in 8 (20%) of the patients, while the remaining 32 (80%) underwent the modified Limberg flap technique. Complications were observed in 87.5% of the patients undergoing excision and primary repair, and in 15.6% of those who underwent the modified Limberg flap technique. Recurrence was observed with only the primary repair technique (37.5%). DISCUSSION: When compared with adults, teenage pilonidal sinus disease occurs more frequently in females. In this study, no correlation existed between the number of sinuses, symptoms, BMI and postoperative complications. Based on the results of this study, the modified Limberg flap technique has a low complication rate when used to treat pilonidal sinus disease in teenagers.

Heavy metal concentration in deepwater rose shrimp species (Parapenaeus longirostris, Lucas, 1846) collected from the Marmara Sea coast in Tekirdag.

Zn, Cd, Cr, Hg, As (total), Cu, Pb, and Ni levels of the deepwater rose shrimp (Parapenaeus longirostris, Lucas 1846), which were collected from the Tekirdag coast of the Marmara Sea, were evaluated. The Marmara Sea is the recipient of discharges from both land-based sources and the Black Sea Bosphorus stream. There are large numbers of anthropogenic activities in the coastal region of the northern Marmara Sea that include urban effluent, discharges from touristic resorts, agricultural runoff, fishing, and transportation. Heavy metal contamination of water resources may cause critical health problems for the people living around these water bodies. In deepwater rose shrimp (P. longirostris), the highest concentration level detected for Zn was 22.4 ± 24.4 mg/kg in winter 2012, Cd 0.106 ± 0.01 mg/kg in summer 2012, Cr 0.77 ± 0.05 mg/kg in winter 2012, Hg 0.18 ± 0.04 mg/kg in summer 2011, As 9.93 ± 1.4 mg/kg in spring 2012, Cu 25.48 ± 0.3 mg/kg in winter 2012, Pb 2.12 ± 0.8 mg/kg in spring, and Ni 19.25 ± 7.1 mg/kg in spring. The values of heavy metal analysis were compared to both the Turkish Food Codex (TFC) limits and international standards for human consumption. The Pb, As, and Cu levels were found to be higher than the maximum allowable limits.

Tracheal intubation in morbidly obese patients: a comparison of the Intubating Laryngeal Mask Airway™ and Laryngeal Mask Airway CTrach™.

The aim of this study was to evaluate the efficacy of the Intubating Laryngeal Mask Airway™ (ILMA) and Laryngeal Mask Airway CTrach™ (LMA CTrach) in facilitating tracheal intubation in morbidly obese patients. Eighty patients (body mass index >40 kg x m(-2)) were randomly allocated to the ILMA or the LMA CTrach. The median (IQR [range]) total time taken for tracheal intubation was shorter with the ILMA than with the LMA CTrach (78 (63-105 [40-265]) s vs 128 (98-221 [60-423]) s, respectively; p<0.001). Significantly more manoeuvres were applied for the satisfactory ventilation and viewing of the glottis with the LMA CTrach (25% vs 55% with the ILMA; p=0.006). During the postoperative period, there was more sore throat with the LMA CTrach (p<0.02). We conclude that the ILMA results in shorter intubation times with fewer manoeuvres and sore throat compared with the LMA CTrach in the morbidly obese.

Tracheal intubation in patients with rigid collar immobilisation of the cervical spine: a comparison of Airtraq and LMA CTrach devices.

The aim of this study was to evaluate the effectiveness of the Airtraq and CTrach in lean patients with simulated cervical spine injury after application of a rigid cervical collar. Eighty-six consenting adult patients of ASA physical status 1 or 2, who required elective tracheal intubation were included in this study in a randomised manner. Anaesthesia was induced using 1 microg kg(-1) fentanyl, 3 mg kg(-1) propofol and 0.6 mg kg(-1) rocuronium, following which a rigid cervical collar was applied. Comparison was then made between tracheal intubation techniques using either the AirTraq or CTrach device. The mean (SD) time to see the glottis was shorter with the Airtraq than the CTrach (11.9 (6.8) vs 37.6 (16.7)s, respectively; p < 0.001). The mean (SD) time taken for tracheal intubation was also shorter with the Airtraq than the CTrach (25.6 (13.5) and 66.3 (29.3)s, respectively; p < 0.001). There was less mucosal damage in the Airtraq group (p = 0.008). Our findings demonstrate that use of the Airtraq device shortened the tracheal intubation time and reduced the mucosal damage when compared with the CTrach in patients who require cervical spine immobilisation.

Prediction of difficult tracheal intubation in Turkish patients: a multi-center methodological study.

BACKGROUND AND OBJECTIVE: Preoperative evaluation is important in the detection of patients at risk for difficult airway management. It is still unclear whether true prediction is possible and which variables should be chosen for evaluation. The aim of this prospective, multi-centre study was to investigate the incidence of difficult intubation, the sensitivity and positive predictive values of clinical screening tests and whether combining two or more of these tests will improve the prediction of difficult intubation in Turkish patients. METHODS: Seven study sites from six regions in Turkey participated in this study. One thousand six hundred and seventy-four ASA physical status I-III patients, scheduled to undergo elective surgery under general anaesthesia, were included. RESULTS: The incidence of difficult intubation was 4.8% and increased with age (P < 0.05). The incidence of difficult intubation was significantly higher in patients who had a Mallampati III or IV score, a decreased average thyromental and sternomental distance, decreased mouth opening, or decreased protrusion of the mandible (P < 0.05). Mouth opening and Mallampati III-IV were found to be the most sensitive criteria when used alone (43% and 35%, respectively). Combination of tests did not improve these results. CONCLUSIONS: There is still no individual test or a combination of tests that predict difficult intubations accurately. Tests with higher specificity despite low positive predictive value are needed.

Comparison of laryngeal tube with laryngeal mask airway in anaesthetized and paralysed patients.

BACKGROUND AND OBJECTIVE: The laryngeal mask has become a widely accepted alternative to endotracheal intubation and mask ventilation. The laryngeal tube is a relatively new supraglottic airway device for airway management. We compared the new version of the laryngeal tube with the laryngeal mask. METHODS: In a randomized design, either a laryngeal tube (n = 66) or a laryngeal mask (n = 66) were inserted. Ease of insertion, oxygenation and ventilation, spirometry data and postoperative airway morbidity were determined. RESULTS: After successful insertion, it was possible to maintain oxygenation and ventilation in all the patients. Insertion success rates after the first, second and third attempts were 84.8% (n = 56), 12.1% (n = 8) and 3% (n = 2) for the laryngeal tube compared with 56.1% (n = 37), 25.8% (n = 17) and 18.2% (n = 12) for the laryngeal mask (P = 0.001). There was no significant difference in peak airway pressure, and dynamic compliance between the groups (P > 0.05). Blood on the cuff after removal of the device was noted in one patient with the laryngeal tube and in 10 patients with the laryngeal mask. Six patients in the laryngeal mask group complained of hoarseness (P = 0.012). CONCLUSION: With respect to clinical function, the new version of the laryngeal tube and the laryngeal mask are similar and either device can be used to establish a safe and effective airway in paralysed patients.

Clonidine addition prolongs the duration of caudal analgesia.

BACKGROUND: In this study, using a dose-ranging design, we examined the effects of clonidine with 0.125% bupivacaine on the duration of post-operative analgesia in caudal anaesthesia in children. METHODS: We conducted a controlled, prospective study of clonidine in caudal anaesthesia in 60 children, aged 1-10 years, undergoing elective inguinal hernia repair. Induction and maintenance of anaesthesia were performed by inhalation of sevoflurane and nitrous oxide. The children were randomized in a double-blind fashion to four groups, and were given a caudal anaesthetic with either 0.125% plain isobaric bupivacaine (1 ml/kg) or bupivacaine plus 1, 1.5 or 2 microg/kg of clonidine. The blood pressure and heart rate were recorded peri-operatively. Analgesia was evaluated by the modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) or a visual analogue scale (VAS). Paracetamol was given when the mCHEOPS score was greater than five or when the VAS score was greater than 30 mm. The monitoring of scores for pain, haemodynamic changes and post-operative nausea and vomiting was performed by nurses blind to the study allocation. RESULTS: The duration of analgesia was found to be significantly longer in the group given bupivacaine plus 2 microg/kg of clonidine (median, 650 min; range, 300-900 min). Peri-operative hypotension and bradycardia, post-operative respiratory depression and motor block were not recorded in any patient. CONCLUSIONS: The addition of clonidine to 0.125% bupivacaine prolongs the duration of post-operative analgesia without any respiratory or haemodynamic side-effects.

Urinary thioether excretion and erythrocyte glutathione S-transferase activities in smokers and patients with squamous-cell laryngeal cancer.

Various biomarkers exist for assessment of exposure to cigarette smoke. The aim of this study is to evaluate whether the urinary thioethers (UT) and erythrocyte glutathione S-transferase (GST) enzyme activities can be used as a biomarker or indicator of a higher risk of laryngeal cancer among smokers. In the present study, the concentration of UT and erythrocyte CST activities were measured in a sample of 84 subjects: controls, smokers, and smokers with squamous-cell carcinoma of the larynx (SLC). For this study, cases were restricted to men, since the number of women was not sufficient for statistical comparisons. Smoking significantly increased UT levels without a marked change in GST activity. However, in SLC smoking patients both UT levels and GST activity were significantly elevated. The use of nonspecific UT levels with GST activity determination seems to be a reliable indicator for the presence of laryngeal cancer in smokers.

Excimer laser phototherapeutic keratectomy for recurrent pterygium.

PURPOSE: To analyze the results of excimer laser phototherapeutic keratectomy (PTK) combined with simple excision in recurrent pterygium to minimize the recurrence rate and obtain a smooth corneal surface. SETTING: Veni Vidi Eye Health Centre, Istanbul, Turkey. METHODS: Combined pterygium excision and excimer laser PTK was performed in 22 eyes with recurrent pterygium (22 patients). Both spot and scan modes of the Meditec MEL 60 excimer laser were used to produce a wide ablation layer (depth 40 to 80 microns). RESULTS: During the mean follow-up of 16.5 months (range 6 to 27 months), visual acuity, refraction, slitlamp, and corneal topography examinations were recorded. Pterygium recurred in only 1 eye (4.5%). Postoperative visual acuity improved in 15 eyes (68.2%). Keratometric readings were not accurately measured preoperatively because of corneal surface irregularities but could be easily taken after the surgery. Corneal astigmatism ranged from 0 to 2.00 diopters (D) (mean 1.23 D). Three months after surgery, no haze persisted in any eye. No significant intraoperative or postoperative complication was detected. CONCLUSIONS: Excimer laser PTK appears to simplify pterygium surgery because a superficial keratectomy is sufficient to remove pterygium. The excimer laser can be used to ablate the visible residual tissues and smooth the corneal surface, resulting in good postoperative refraction and visual acuity. Consequently, this procedure seems to be effective and safe.

The evaluation of eustachian tube function in patients with chronic otitis media.

In this study we evaluated eustachian tube function in patients with chronic otitis media and compared the results with normal subjects. Two different eustachian tube function tests were applied to 60 ears of the chronic otitis media group and 146 ears of the control group. While eustachian tube dysfunction was observed in 71.7% of the chronic suppurative otitis media group, it was only seen in 34.9% of the control group.