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.

Pulsed radiofrequency in the treatment of coccygodynia.

OBJECTIVES: Coccygodynia is a clinical condition characterized by pain and tenderness around the coccygeal region. Trauma is the most common etiologic factor. We aimed to investigate the effectiveness of pulsed radiofrequency (PRF) treatment in patients with coccygodynia that could not be relieved by classic treatment protocols, and we present our long-term results with caudal epidural PRF. METHODS: The study included 21 patients who were treated for coccygodynia by caudal epidural PRF in our Pain Clinic. Sixteen patients (76%) had a history of trauma, three patients (14%) had previous surgery, and two patients (10%) had idiopathic coccygodynia with no identifiable cause. All patients had been previously treated with conservative methods, but none had pain relief. Pain level of the patients was assessed by visual analog scale (VAS) score. A questionnaire to evaluate subjective patient satisfaction was also used at the 3rd-week and the 6th-month follow-ups. RESULTS: Median VAS score was 8 at baseline, decreased to 2 by the 3rd week and was 2 at the 6th month. VAS at the 3rd week and 6th month were significantly lower compared to baseline (p<0.001). At the 6th month, 12 patients (57%) had excellent results, 5 patients (24%) had good results and only 4 patients (19%) had poor results regarding the subjective patient satisfaction questionnaire. CONCLUSION: Caudal epidural PRF may be an alternative to surgery for coccygodynia patients who are unresponsive to classic treatment methods.

A novel treatment modality in patients with premature ejaculation resistant to conventional methods: the neuromodulation of dorsal penile nerves by pulsed radiofrequency.

Premature ejaculation (PE) is the most common sexual problem experienced by men, and it affects 20%-30% of them. Pulsed radiofrequency (PRF) neuromodulation has been shown to be an effective treatment for a wide range of pain conditions. We used PRF to treat PE by desensitizing dorsal penile nerves in patients resistant to conventional treatments. Fifteen patients with a lifelong history of PE, defined as an intravaginal ejaculatory latency time (IELT) of <1 minute that occurred in more than 90% of acts of intercourse and was resistant to conventional treatments, were enrolled in this study. Patients with erectile dysfunction were excluded. The mean age of the patients was 39 +/- 9 years. Before and 3 weeks after the treatment, IELT and sexual satisfaction score (SSS; for patients and their partners) were obtained. The mean IELTs before and 3 weeks after procedure were 18.5 +/- 17.9 and 139.9 +/- 55.1 seconds, respectively. Side effects did not occur. Mean SSSs of patients before and after treatment were 1.3 +/- 0.3 and 4.6 +/- 0.5, and mean SSSs of partners before and after treatment were 1.3 +/- 0.4 and 4.4 +/- 0.5, respectively. In all cases, IELT and SSS were significantly increased (P < .05). None of the patients or their wives reported any treatment failure during the follow-up period. The mean follow-up time was 8.3 +/- 1.9 months. It is early to conclude that this new treatment modality might be used widely for the treatment of PE; however, because it is an innovative modality, placebo-controlled studies (eg, sham procedure), with larger numbers of patients and including assessment of penile sensitivity (eg, biothesiometry), are needed.

[Pain treatment practice according to the WHO analgesic ladder in cancer patients: eight years experience of a single center]. / Kanser hastalarinda WHO analjezik basamak tedavisine göre agri tedavisi. Bir merkezin sekiz yillik deneyimi.

In this study we evaluated the results of pain treatment practices according to the World Health Organization analgesic ladder treatment. and other treatment modalities in cancer patients who were admitted to an anesthesiology-based pain service. Patient characteristics, distribution of the patients according to the primary pathologic sites, initial and last distribution of the patients according to analgesic ladder treatment, other invasive or non-invasive treatment modalities, side effects, and other data related with the patients were examined. 416 of 475 (87.5%) patients were treated using the WHO analgesic ladder treatment, 57 patients (12 %) were treated by invasive techniques. The number of successfully treated patients in step I, II and III were 49 (11.77%), 307 (73.79%) and 60 (14.42) respectively. 181 of 416 (43.50%) patients used anticonvulsants or neuroleptics, 341 of 416 (81.97%) patients used antidepressants. In 31 of 416 patients (7.5%), non-invasive or invasive treatment modalities had become necessary to augment the WHO analgesic ladder treatment. Over the entire treatment period, side effects were reported in 17.05% of the patients. The follow-up time for the patients was 42 +/- 109.7 days, the mean interview number was 5.6+/-7.6, the longest follow-up time was 1380 days, and the maximum number of the interviews made by the same patient was 68. In conclusion, we think that, using the World Health Organization analgesic ladder treatment and administering appropriate analgesics and adjuvants in appropriate oral doses determined for appropriate subjects could successfully treat a great number of these patients.

Comparison of sciatic psoas compartment block and sciatic femoral 3-in-1 block for knee arthroscopy.

STUDY OBJECTIVES: To compare the clinical effectiveness of two peripheral nerve block techniques combined with sciatic nerve block: sciatic psoas compartment (SPC) and sciatic femoral 3-in-1 (SF 3-in-1) block. DESIGN: Prospective, randomized study. SETTING: Military medical academy hospital. PATIENTS: Thirty-six ASA physical status I patients, aged 20 to 33 years, undergoing elective knee arthroscopy. INTERVENTIONS: Patients having SPC block (n = 19) or SF 3-in-1 block (n = 17) received 40 mL of a mixture of solution containing 15 mL of 0.5% bupivacaine, 15 mL of 2.0% prilocaine, and 10 mL of 0.9% sodium chloride. In both groups, the sciatic nerve was blocked with 20 mL of the same solution. An intravenous bolus injection of fentanyl 0.1 mg was used if patients complained of pain. MEASUREMENTS AND MAIN RESULTS: None of the patients in the SPC group experienced pain owing to the applied tourniquet during the operation, whereas 7 patients from the SF 3-in-1 group (41.2 %) reported tourniquet pain. All SF 3-in-1 group patients but only 5 patients (26.3 %) in the SPC group required fentanyl during the operation. In addition, 7 patients in the SF 3-in-1 group required second doses of fentanyl. Patient satisfaction was significantly higher in the SPC group than in the SF 3-in-1 block group (P < 0.0001). CONCLUSIONS: Both SPC and SF 3-in-1 provided sufficient anesthetic efficacy for knee arthroscopy. However, SPC may be preferable to SF 3-in-1 block owing to better patient satisfaction and less requirement for opioid analgesics.

A typical low-back pain caused by an atypical etiology.

OBJECTIVE: Pain arising in the lumbar spine can have many etiologies, nearly 80% of which cannot be established with certainty. We present a very rare cause of back pain. CASE REPORT: A 54-year-old woman presented with a 2-month history of low-back pain and right-sided sciatica. Conventional analgesics, physiotherapy, and epidural steroid application had failed to provide relief. She had tenderness of the right sacroiliac joint. Diagnostic fluoroscopic-guided sacroiliac-joint injection with lidocaine did not produce symptomatic relief. Pelvic ultrasonography and magnetic resonance imaging showed septated multilocular hydatic cysts along the sciatic nerve. Surgical exploration noted multicystic lesions along the sciatic nerve woven to the nerve. Her low-back pain disappeared completely after the operation. She received oral albendazole for 6 months to prevent any recurrence of the disease and remains asymptomatic. CONCLUSION: Hydatid cyst can be included in the differential diagnosis of lumbar back pain, especially in the endemic areas.

Transforaminal epidural steroid injection for the treatment of severe back pain caused by cement leakage during kyphoplasty procedure.

Kyphoplasty is a minimally invasive procedure that is increasingly used to treat pain caused by compression fractures of vertebral bodies. A 56-year-old woman who had a compression fracture on the vertebral body of L5 vertebra was admitted to the Algology Department with a severe low back and leg pain. Kyphoplasty was planned for pain relief. She suffered severe pain in her back and left leg immediately after the procedure because of a leakage of injected cement through the fracture line. After injection of triamcinolone and bupivacaine transforaminally into the L5-S1 anterior epidural space, her pain complaints ended. If radicular pain symptoms caused by cement leakage are secondary to a chemically mediated non-cellular inflammatory reaction, transforaminal epidural steroid injection should be useful.

MR urography in pediatric uropathies with dilated urinary tracts.

PURPOSE: To determine the diagnostic value of magnetic resonance (MR) urography in children with urinary tract dilatation. MATERIALS AND METHODS: Twenty-five children between the ages of 4 months and 13 years (19 males and 6 females, mean age 6.5 years) were evaluated with T2 weighted and contrast-enhanced T1 weighted MR sequences. Results were compared with findings obtained with ultrasonography (n=25), intravenous urography (n=18), Tc99m- DTPA scintigraphy (n=16), and/or micturating cystouretrography (n=13). RESULTS: MR urography provided a superior imaging of urinary system dilatation, the site and the etiology of obstruction, and both regular and complicated kidney duplication than did conventional imaging methods. MR urography that used T2 weighted sequences was able to demonstrate 29 of 32 (90.6%) abnormal renal collecting systems. Fourteen of 21 (66.7%) normal systems were revealed by heavily T2 weighted images. Forty-six of 51 (90.2%) renal collecting systems could be shown by T1 weighted sequences. With this sequence, however, five collecting systems (9.8%) could not be shown secondary to poor renal function and/or dilution of contrast agent within the dilated urinary tract. CONCLUSION: In children, MR urography may replace conventional uroradiological methods.

[Epidural steroid injections and low back pain]. / Bel agrilarinda epidural steroid uygulamalari.

Low-back pain nearly affects all the people in the population; male or female, at any period of their lives and continues with spontaneous regressive attacks. In 10% of the patients, the pain persists despite conservative treatments and causes significant decrements of life quality. For this reason, the patients with chronic low back-pain are applying to pain specialists and treated with different invasive pain therapies. Epidural steroid injections are the most common invasive procedures in the treatment of low-back pain. However, the effects and outcomes are contradictory. Epidural steroid injections should be performed absolutely under fluoroscopic guidance. Pain selection should be made carefully and algorithms should be performed fastidiously.

Accuracy of caudal epidural injection: the importance of real-time imaging.

Caudal epidural steroid injections are often used for low back pain. Fluoroscopic guidance has been frequently cited as a requirement for this procedure. In this preliminary report, we demonstrate that fluoroscopic guidance for caudal epidural Tuohy needle placement without real-time imaging may result in inadvertent intravenous injection of the drug. We detected intravenous leakage of the drug in 4 cases of 10 when real-time fluoroscopic imaging was used. Thus, real-time imaging may be recommended in addition to routine fluoroscopic guidance for caudal epidural procedures, as it may improve efficacy and safety by assuring accurate drug deposition.