Cem Sayilgan

Limberg flap repair for pilonidal sinus disease.

PURPOSE: There are many methods described for the treatment of sacrococcygeal pilonidal sinus disease, and none of them has been accepted as an optimal modality. Plastic procedures have some advantages, such as short duration of hospitalization, quick healing time, low risk of wound infection, and lower recurrence rates. Our choice is Limberg flap repair; we present here our experience with this procedure. METHODS: From August 1998 to July 2000, 147 male patients were treated with Limberg flap repair under regional anesthesia in a soldier’s hospital. RESULTS: No major anesthetic complication or wound infection developed. Three patients (2 percent) had a seroma (with negative culture) and six patients (4.1 percent) had partial wound detachment. Patients returned to full activity on the 10th to 25th postoperative day (mean, 18.8). Patients were followed from 1 to 40 (mean; 13.1) months. Seven patients (4.8 percent) had a recurrence. CONCLUSION: The Limberg flap procedure is an easy and effective technique. Patient comfort, quick healing time, early return to full activity, and low complication and recurrence rates are the important advantages of this procedure.

The effects of sevoflurane and desflurane on lipid peroxidation during laparoscopic cholecystectomy

Background and objective: To compare the effects of sevoflurane and desflurane anaesthesia on lipid peroxidation. Methods: We studied 40 healthy patients undergoing elective laparoscopic cholecystectomy. Patients were randomly allocated to be anaesthetized either with sevoflurane (n = 20) or desflurane (n = 20). Anaesthesia was maintained with inspiratory concentrations of sevoflurane 1-1.5 MAC (n = 20) or desflurane (n = 20). Samples were taken for plasma malondialdehyde and superoxide dismutase assays before induction of anaesthesia, before skin incision and at the end of surgery. Alveolar cell samples were obtained from the lungs using the technique of protective blind bronchoalveolar lavage, after induction of anaesthesia and at the end of surgery for malondialdehyde and superoxide dismutase concentrations. Results: Plasma malondialdehyde increased more after the administration of desflurane than after sevoflurane: after induction 5.9 ± 0.6 nmol mL−1 for desflurane vs. 3.8 ± 0.5 nmol L−1 for sevoflurane (P < 0.001); at the end of the surgery: 6.7 ± 0.4 nmol mL−1 for desflurane vs. 4.2 ± 0.3 nmol mL−1 for sevoflurane (P < 0.001). There was a small but significant increase in plasma superoxide dismutase concentration after desflurane - from 24.2 ± 1.2 to 24.9 ± 0.9 U mL−1 after induction and 25 ± 1 U mL−1 at the end of the surgery (P < 0.01) - but no increase with sevoflurane. Malondialdehyde concentrations increased significantly in the cells obtained by protective blind bronchoalveolar lavage at the end of surgery in the desflurane group (from 0.3 ± 0.1 to 1.7 ± 0.2 nmol mL−1 (P < 0.001)), but not in the sevoflurane group. There were no significant differences between the two anaesthetics in the amounts of superoxide dismutase in the samples obtained by protective blind bronchoalveolar lavage. Conclusions: Desflurane may cause more systemic and regional lipid peroxidation than sevoflurane during laparoscopic cholecystectomy in healthy human beings.

Effects of sevoflurane and desflurane on cytokine response during tympanoplasty surgery

Background:  This study was devised to compare the effects of sevoflurane and desflurane anaesthesia on the cytokine response.

The effects of different weaning modes on the endocrine stress response

IntroductionThe aim of the present study was to investigate the effects of the stress response on plasma insulin, cortisol, glucose, and urinary vanilmandelic acid during weaning and after extubation, using pressure support (PS), continuous positive airway pressure (CPAP) and T-piece modes.MethodsSixty patients were randomly divided into three groups (n = 20). The PS group received FiO2 ≤ 0.4, PS ≤ 10 cmH2O, and positive end expiratory pressure ≤ 5 cmH2O for 2 hours. The CPAP group was given FiO2 ≤ 0.4 and CPAP 5 ≤ cmH2O for 2 hours. The T-piece group (group T) received 4 l/min oxygen via a T-piece for 2 hours. After 1 hour and 2 hours in their respective weaning modes, blood and urine samples were taken for insulin, cortisol, glucose and vanilmandelic acid measurements. Forty-eight hours after extubation, blood and urine samples were again taken.ResultsPlasma insulin was greater in group T than in the PS and CPAP groups (P < 0.01 and P < 0.01). The plasma cortisol concentration was greater in group T than in group PS during weaning (P < 0.05) and after extubation (P < 0.05). Blood glucose concentrations were greater in group T than in the other groups (both P < 0.01) both during weaning and post extubation. Urine vanilmandelic acid was greater in group T than in the other groups during weaning and after extubation (both P < 0.001).ConclusionWeaning via the T-piece caused a greater stress response than the PS and CPAP modes.

Anesthesia in a child with Maroteaux-Lamy syndrome undergoing mitral valve replacement

Mucopolysaccharidoses (MPSs) are a group of metabolic diseases transmitted in an autosomal recessive fashion. MPSs are due to deficiencies of the specific enzymes responsible for the catabolism of dermatan sulfate, heparin sulfate, and keratan sulfate, resulting in the accumulation of glycosaminoglycans (GAGs). MPSs have a chronic, progressive course with multisystemic involvement. The incidence of MPSs is approximately 1/50,000 (1). As GAGs begin to accumulate in lysosomes, functional disturbances occur in cells, tissues, and organs. Diagnosis is based on elevated mucopolysaccharide levels in the urine and enzyme deficiencies in the serum or in fibroblast cultures (2). MPS type VI (Maroteaux-Lamy syndrome) is characterized by a deficiency of N-acetylgalactosamine-4-sulfatase, which is responsible for the catabolism of dermatan sulfatase. The clinical features of MPSs include coarse face, short stature, kyphoscoliosis, upper airway thickening, hearing loss, corneal opacity, hepatosplenomegaly (3), and symptoms that vary according to the GAG accumulation sites (1). Sinus tachycardia, atrial dilatation, valve involvement, endocarditis, myocarditis, and ventricular aneurysms might be observed due to cardiovascular system involvement (4,5). In contrast to the other types of MPSs, there is no mental retardation in patients with MPS type VI. There are only a limited number of reports of heart surgery in patients with MPSs (6,7). To the best of our knowledge, the literature is devoid of any reports of pediatric patients with Maroteaux-Lamy syndrome undergoing valve replacement surgery. Herein, we present the anesthetic management of a pediatric patient with Maroteaux-Lamy syndrome during mitral valve replacement surgery and a discussion based on the literature.

Minimally invasive repair of pectus excavatum (MIRPE) in adults: is it a proper choice?

Introduction The Nuss procedure is suitable for prepubertal and early pubertal patients but can also be used in adult patients. Aim To determine whether the minimally invasive technique (MIRPE) can also be performed successfully in adults. Material and methods Between July 2006 and January 2016, 836 patients (744 male, 92 female) underwent correction of pectus excavatum with the MIRPE technique at our institution. The mean age was 16.8 years (2–45 years). There were 236 adult patients (28.2%) (> 18 years) – 20 female, 216 male. The mean age among the adult patients was 23.2 years (18–45 years). The recorded data included length of hospital stay, postoperative complications, number of bars used, duration of the surgical procedure and signs of pneumothorax on the postoperative chest X-ray. Results The MIRPE was performed in 236 adult patients. The average operative time was 44.4 min (25–90 min). The median postoperative stay was 4.92 ±2.81 days (3–21 days) in adults and 4.64 ±1.58 (2–13) in younger patients. The difference was not statistically significant (p = 0.637). Two or more bars were used in 36 (15.8%) adult patients and in 44 (7.5%) younger patients. The difference was not statistically significant either (p = 0.068). Regarding the overall complications, complication rates among the adult patients and younger patients were 26.2% and 11.8% respectively. The difference was statistically significant (p = 0.007). Conclusions MIRPE is a feasible procedure that produces good long-term results in the treatment of pectus excavatum in adults.

Effects of systemic inflammatory response syndrome on intraabdominal pressure and lung compliance

In Systemic Inflammatory Response Syndrome (SIRS) model in rabbits we aim to investigate the relationship between increased intraabdominal pressure (IAP) and lung compliance during mechanical ventilation.