Gonul Olmez

Clinical investigation: thyroid function test abnormalities in cardiac arrest associated with acute coronary syndrome.

IntroductionIt is known that thyroid homeostasis is altered during the acute phase of cardiac arrest. However, it is not clear under what conditions, how and for how long these alterations occur. In the present study we examined thyroid function tests (TFTs) in the acute phase of cardiac arrest caused by acute coronary syndrome (ACS) and at the end of the first 2 months after the event.MethodFifty patients with cardiac arrest induced by ACS and 31 patients with acute myocardial infarction (AMI) who did not require cardioversion or cardiopulmonary resuscitation were enrolled in the study, as were 40 healthy volunteers. The patients were divided into three groups based on duration of cardiac arrest (<5 min, 5–10 min and >10 min). Blood samples were collected for thyroid-stimulating hormone (TSH), tri-iodothyronine (T3), free T3, thyroxine (T4), free T4, troponin-I and creatine kinase-MB measurements. The blood samples for TFTs were taken at 72 hours and at 2 months after the acute event in the cardiac arrest and AMI groups, but only once in the control group.ResultsThe T3 and free T3 levels at 72 hours in the cardiac arrest group were significantly lower than in both the AMI and control groups (P < 0.0001). On the other hand, there were no significant differences between T4, free T4 and TSH levels between the three groups (P > 0.05). At the 2-month evaluation, a dramatic improvement was observed in T3 and free T3 levels in the cardiac arrest group (P < 0.0001). In those patients whose cardiac arrest duration was in excess of 10 min, levels of T3, free T3, T4 and TSH were significantly lower than those in patients whose cardiac arrest duration was under 5 min (P < 0.001, P < 0.001, P < 0.005 and P < 0.05, respectively).ConclusionTFTs are significantly altered in cardiac arrest induced by ACS. Changes in TFTs are even more pronounced in patients with longer periods of resuscitation. The changes in the surviving patients were characterized by euthyroid sick syndrome, and this improved by 2 months in those patients who did not progress into a vegetative state.

The effects of intracameral ropivacaine on the corneal endothelium.

Topical and intracameral anesthesia have been popularized as new techniques for use in cataract surgery, and these anesthetic routes have potential safety advantages over traditional techniques such as retrobulbar and peribulbar anesthesia. Intracameral techniques have included the use of preservative-free (PF) lidocaine hydrochloride 1% or PF bupivacaine hydrochloride 0.5%. Ropivacaine is a long-acting local anesthetic agent that has a greater margin of safety regarding cardiac and central nervous system toxicity than bupivacaine. Although ropivacaine has started to be used in topical anesthesia, it has not yet been used in intracameral anesthesia. Martini et al. reported that topical ropivacaine 1% performed at least as well as lidocaine 4% in cataract surgery. Moreover, it resulted in better subjective pain scores. Ropivacaine takes longer to become completely effective; however, it provides a longer postoperative analgesic effect.Although the higher incidence of corneal edema with ropivacaine may be a concern, the edema resolves rapidly and the medium-term endothelial data indicate that ropivacaine is safe for the endothelium. Therefore, ropivacaine seems to be a good alternative to lidocaine for topical use in cataract surgery. There is concern about the efficacy and safety of this procedure, particularly toxicity to the corneal endothelium. Animal studies are helpful in indicating potential toxicity, but application and relevance to human in vivo conditions is limited. No studies in the literature have investigated the effects of ropivacaine on ocular tissues. We carried out experimental studies on the effects of intracameral irrigation of ropivacaine on the corneal endothelial ultrastructure using transmission electron microscropy (TEM).

Comparison of the effects of remifentanil andalfentanil on cardiovascular response to nasotracheal intubation: A prospective, randomized, double-blind study.

BACKGROUND Nasotracheal intubation is often necessary in patients undergoingelective or emergency maxillofacial surgery. Previous studies have suggested that the increase in blood pressure after nasotracheal intubation is significantly greater than the increase after orotracheal intubation. Many drugs, including narcotic analgesics, are effective in modifying cardiovascular responses to orotracheal intubation. OBJECTIVE The effects of remifentanil and alfentanil on the cardiovascularresponses to nasotracheal intubation were compared in healthy patients scheduled to undergo surgery. METHODS This prospective, randomized, double-blind study was conductedat the Department of Anesthesiology and Reanimation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey. Patients aged 16 to 65 years scheduled to undergo elective maxillofacial surgery and who were American Society of Anesthesiologists status I or 11 were randomly assigned to receive remifentanil 1 μg/kg in 10 mL saline over 30 seconds followed by an infusion of 0.5 μg/kg · min, or alfentanil 10 μg/kg in 10 mL saline over 30 seconds followed by an infusion of saline. Anesthesia was then induced with propofol, cisatracurium, and 1% isoflurane with 66% nitrous oxide in oxygen. Heart rate (HR) and systolic and diastolic arterial pressures (SAP and DAP, respectively) were measured noninvasively at 2 minutes before general anesthesia induction (baseline); 2 minutes after induction; and 1, 3, and 5 minutes after nasotracheal intubation. Patients were monitored for cardiac changes using electrocardiography. RESULTS Forty consecutive patients were enrolled in the study. Twenty patients (11 males, 9 females; mean [SD] age, 27.7 [12.6] years) received remifentanil, and 20 patients (12 males, 8 females; mean [SD] age, 31.5 [17.2] years) received alfentanil. Two minutes after anesthesia induction, mean (SD) arterial pressures decreased significantly from baseline in the remifentanil group (changes, 22 [8]/11 [6] mm Hg) and the alfentanil group (changes, 10 [9]/12 [8] mm Hg) (both, P < 0.05). Changes in SAP and DAP followed a similar pattern in both groups, but SAP was significantly lower in the remifentanil group compared with that in the alfentanil group throughout the study period (all, P < 0.05). After 1 minute of intubation, DAP was significantly lower in the remifentanil group compared with that in the alfentanil group (66 [9] mm Hg vs. 73 [20] mm Hg; P < 0.05). Compared with baseline, HR was decreased significantly in both groups throughout the study (all, P < 0.05). Except SAP in the alfentanil group, SAP, DAP, and HR were increased 1 minute after intubation compared with preintubation values. However, SAP, DAP, and HR remained significantly lower compared with baseline values throughout the study period in both groups (all, P < 0.05) except DAP at 1 minute after incubation in the alfentanil group. Five patients in the remifentanil group and 2 patients in the alfentanil group required treatment of hypotension. None of the patients in either group required treatment of bradycardia. CONCLUSIONS In this study in healthy surgical patients aged 16 to 65 years, remifentanil 1 μg/kg given over 30 seconds, followed by a remifentanil infusion of 0.5 μg/kg · min, was similarly effective compared with alfentanil 10 μg/kg in attenuating the pressor response to nasotracheal intubation, but the incidence of hypotension in patients administered remifentanil was high.

Granisetron-deksametazon kombinasyonunun jinekolojik girişimlerde postoperatif bulantı ve kusma üzerine etkileri

Brucellosis, is an endemic disease in our country, may lead to bacteremia and cause different clinic manifestations. A 44-year-old male patient admitted to our policlinic with high fever, shivering, chilling, pollacuria, and left costovertebral pain, and interned with diagnosis of acute pyelonephritis. Subsequently, acute pyelonephritis due to acute brucellosis was detected in the clinical and laboratory examination. Antibiotic treatment for brucellosis was given to patient for eight week and after treatment full recovery was seen. Patients with brucellosis may refer with symptoms of acute pyelonephritis in endemic areas for brucellosis. By using brucellos serologies to patients who have the symptoms of acute pyelonephritis may available in the diagnosis of this rare complication in areas where brucellosis is endemic.Objectives: Internal splinting is defined as early tendon transfer performed during or just after nerve repair followsing nerve injury and is a controversial issue. The objecstives of internal splinting are avoiding the use of long term external splinting, avoiding permanent hand deformities until the injured nerve is reinnervated and supporting sensorial recovery. In this paper we present our clinical cases of internal splinting and discuss the results in terms of indications, timing, advantages, and disadvantages of internal splinting. Materials and Methods: We applied internal splinting in 11 patients, 3 patients with radial nerve injury and 8 patients with ulnar nerve injury. Internal splinting was performed contemporarily with the nerve repair in 5 pastients, in 2 weeks following nerve repair in 1 patient and in 4 weeks following nerve repair in 5 patients. Pronator teres was transferred to extensor carpi radialis brevis and flexor carpi radialis was transferred to extensor digitorum communis in radial nerve injuries. Omer\s superficial Y technique and its modification were used for ulnar nerve injuries. Results: Patients were followed up for at least 1 year with physical examination and electroneuromyelography and recovery of sensorial and motor functions were achieved in all of them. Conclusion: We concluded that internal splinting is usesful for avoiding external splint usage and preventing the establishment of hand deformity until recovery of the nerve. The contribution of internal splinting to sensorial recovery was noteworthy as stated in the literature but the lack of control group and the small number of our cases was limited to come to a definite conclusion. We did not experience any disadvantage of internal splinting.

622 EFFICACY OF LORNOXICAM AND TRAMADOL FOR PAIN CONTROL DURING TRANSRECTAL PROSTATE BIOPSY

pediatric cleft lip and palate surgery for determining the efficacy of different doses of Fentanyl. Methods: 40 children aged 3mo-3 yrs were divided in 2 groups randomly (n = 20) after induction of general anesthesia with Thiopental 5mg/kg, Lidocaine 1mg/kg, Midazolam 0.2mg, Patients received 3m/kgfentanyl in group A, and Fentanyl 1m/kg + Acetaminophen rectal 20mg/kg in group B, repeated doses of rectal Acetaminophen was 10mg/kg/2 h. Intra operative pain was measured with change of vital signs from base and need to increase of halothane percentage. Results: Vital signs were more stable in group B than group A (P> 0.05). There was a need to increase halothane percentage during surgery in group A, rather than group B (P< 0.05). Conclusion: We conclude that low dose Fentanyl + repeated rectal Acetaminophen provides more effective analgesia and less side effects in children.

Effects of intravitreal ropivacaine on retinal thickness and integrity in the guinea pig.

BACKGROUND Retrobulbar anesthesia is widely used for ocular surgery.Ocular complications are possible when retrobulbar anesthesia is accidentally injected intravitreally. OBJECTIVE The aim of this study was to determine the relative retinal toxicitiesof ropivacaine hydrochloride, a local anesthetic, using various concentrations in guinea pigs. METHODS This randomized, investigator-masked, experimental study wasconducted at the Department of Anesthesiology, Dicle University, Diyarbakir, Turkey. The right eyes of 18 guinea pigs were assigned to 1 of 3 treatment groups: 1%, 0.75%, or 0.5% ropivacaine. The right eye of each animal was injected intravitreally with 0.1 mL of 1%, 0.75%, or 0.5% ropivacaine. The left eye of each animal was injected with a balanced saline solution (control). The guinea pigs were euthanized 7 days after injection, and the retinal structures were examined using light microscopy. The total thickness of each retina was measured using an ocular micrometer. RESULTS No histologic abnormalities were observed in the control eyes.Retinal damage of most of the retinal section was seen in the eyes receiving study drug. The eyes injected with 0.5% ropivacaine had a generally intact appearance, with the exception of some atrophy and disorganization. Overall, the eyes injected with 1% ropivacaine had significantly more extensive retinal thinning compared with the eyes injected with 0.75% or 0.5% ropivacaine (both, P < 0.01). In the eyes injected with 0.75% or 1% ropivacaine, disorganization of the structure of the retinal layers and atrophy were noted on histopathology. The mean total thicknesses of the retina were significantly less in all ropivacaine-treated eyes compared with that in the controls (P < 0.001). CONCLUSIONS In this small experimental study, ropivacaine had concentration-dependent toxic effects on guinea pig retinas.