Gönül Ölmez Kavak

The complications of transforaminal lumbar epidural steroid injections.

Study Design. A prospective observational study. Objective. In this study, we aimed to investigate the major and minor complications of transforaminal lumbar epidural steroid injections guided by fluoroscopy and the incidence of vascular penetration encountered during this procedure. Summary of Background Data. Epidural steroid administration is one of the treatment options for lumbar disc hernia accompanied by radiculopathy. This method, initially applied by blind interlaminar technique, has generally been performed by fluoroscopically guided transforaminal method now. The complications of this method cause to a serious concern. The complications of this intervention have been reported by either mostly retrospective studies or case reports until now. Prospective studies with large patient series are needed to determine the types and incidences of the complications. Methods. In this study carried out for more than 5 years, major and minor complications of transforaminal lumbar epidural steroid injections were investigated prospectively. All of the interventions were performed under fluoroscopic guidance by the same physician using a standardized method. A follow-up was made once in the third week. The complications encountered during the procedure and in the third week were prospectively recorded. In addition, the incidence of vascular penetration that is potentially hazardous is included in the study. Results. A total of 562 patients were performed 1305 times transforaminal lumbar epidural steroid. The overall incidence of vascular penetration encountered was 7.4%. Although major complications were not seen, the total rate of all minor complications was 11.5%. Whereas all of the minor complications were transient, the most frequent minor complication was vasovagal reaction (8.7%). Conclusion. On the basis of the results of this study in which only minor complications were encountered, it can be said that the frequency of major complications is pretty rare in transforaminal lumbar epidural steroid injections in expert hands and in the conditions in which safety precautions are taken.

Cooled radiofrequency application for treatment of sacroiliac joint pain

BackgroundThe unavailability of an effective and long-lasting treatment for sacroiliac-based pain has led researchers to study the efficacy of radiofrequency in denervation. In this study, we aimed to investigate the efficacy and safety of novel cooled radiofrequency application for sacral lateral-branch denervation.MethodsPatients experiencing chronic sacroiliac pain were selected for our observational study. Fluoroscopy guidance cooled radiofrequency denervation was applied on the L5 dorsal ramus and the S1-3 lateral branches on patients who had twice undergone consecutive joint blockages to confirm the diagnosis and obtained at least 75% pain relief. At the 1st, 3rd and 6th month postoperatively, the patients’ pain was evaluated using a visual analog scale (VAS), and their physical function was evaluated with the Oswestry Disability Index (ODI).ResultsCooled radiofrequency was applied on a total of 15 patients. Prior to the procedures, the median VAS score (interquartile range) was 8 (7–9), but at the 1st, 3rd and 6th month, this had fallen to 3 (1–4), 2 (1–3) and 3 (2–4). The baseline median ODI score (interquartile range) was 36 (32–38), while at the 1st, 3rd and 6th month, it was 16 (8–20), 12 (9–18) and 14 (10–20), respectively. At the final control, while 80% of the patients reported at least a 50% decline in pain scores, 86.7% of those reported at least a ten-point reduction in ODI scores.ConclusionIt was seen that the cooled radiofrequency used for sacroiliac denervation was an effective and safe method in the short to intermediate term.

Intra-articularly applied pulsed radiofrequency can reduce chronic knee pain in patients with osteoarthritis.

Background: Osteoarthritis (OA) is the most widespread chronic joint disease worldwide. Symptomatic knee OA is observed in approximately 12% of individuals more than 60 years of age. Conservative treatments models may not be effective always, and that some of them have serious adverse effects that prompted the researchers to research different treatment methods. In this study, we investigated short‐ and mid‐term effectiveness of intra‐articular pulsed radiofrequency (PRF) applied in patients with chronic knee pain due to OA. Methods: This study was carried out in the pain management center of a university hospital between January 2009 and June 2009. The patient record files of 31 patients who received intra‐articular PRF were retrospectively reviewed. The antero‐lateral area of the knee, where the intervention would be applied, was anesthetized with 1% lidocaine. An introducer needle was placed intra‐articularly. PRF was started as 42°C at 2 Hz for 15 minutes. The pain of the patients was evaluated by 10 cm Visual Analog Scale (VAS). Furthermore, the ages, the gender, the symptom duration of the patients, the side of the knee on which the intervention was applied, and the complications were collected for statistical evaluation. Results: Although the mean initial VAS scores of the patients were 6.1 ± 0.9 cm, it was found, respectively, to be 3.9 ± 1.9 cm and 4.1 ± 1.9 cm at the first‐ and sixth‐month follow‐ups. In general, a decrease of 32.8% in mean in the VAS scores was achieved in the last follow‐up; whereas the rate of patients reporting a minimum decrease of 2 points in the VAS scores was 64.5% and the rate of patients reporting a decrease of ≥50% in their pain was calculated as 35.5%. Conclusion: PRF applied to the knee joint appears to be an effective and safe method.

Thymoquinone treatment against acetaminophen-induced hepatotoxicity in rats

AIM In this study, we aimed to examine the efficacy of thymoquinone (TQ) treatment in acetaminophen-induced liver toxicity in rats. METHODS Forty Wistar Albino rats were used for the study (four groups, with 10 rats for each group). Animals in the control group were not given any medication. In the thymoquinone (TQ) group, animals were given three times 5 mg/kg oral thymoquinone for every six hours, which equals to a total dose of 15 mg/kg. In the acetaminophen (APAP) group, animals were given APAP at a single dose of 500 mg/kg orally. In the APAP + TQ group, animals were given 500 mg/kg APAP orally followed by three doses of TQ at a 15 mg/kg total dose in an 18-h time interval. All animals were sacrificed at the 24th hour. Alanine amino transferase (ALT), aspartat amino transferase (AST), superoxide dismutase (SOD), oxidized glutathione (GSSG), glutathione peroxides (GSH-Px), and malondialdehyde (MDA) activities were measured in rat blood. Histopathological examination was also performed. RESULTS Serum ALT, AST levels, GSSG, and SOD activity as well as the serum and tissue MDA levels were found to be higher in the APAP group than in the control group (p ≤ 0.001). Likewise, serum GSH-Px activity was found to be lower in the APAP group (p ≤ 0.001). In contrast, in the APAP + TQ group, serum ALT, AST levels, GSSG, SOD activity and the serum and tissue MDA levels were found to be lower compared to that of the APAP group. This difference was statistically significant (p ≤ 0.001). In the APAP + TQ group, the GSH-Px activity was found to be significantly higher compared to the APAP group (p < 0.05). In contrast to this finding, the GSH-Px activity in the APAP + TQ group was found to be lower than that of the control group (p ≤ 0.001). Histopathological analysis revealed significant liver necrosis and toxicity with a high dose of APAP where TQ treatment was related with significantly lower liver injury scores. CONCLUSION TQ treatment may have an important therapeuthic effect via the upregulation of antioxidant systems in the APAP-induced liver hepatotoxicity in rats.

Effectiveness of nucleoplasty applied for chronic radicular pain

Summary Background Over the last several decades there has been a general trend toward reduction and minimalization in surgical treatment of chronic back pain, since open surgery brings complications in small and contained disc herniations instead of achieving expected success. Attention has been focussed on percutaneous nucleoplasty due to the limited success of other minimally invasive methods, as well due to their associated complications. However, there have been few studies in the English literature with a follow-up period of more than 1 year. Material/Methods Patients with chronic disc herniations having more significant radicular leg pain, who did not respond to non-invasive treatment methods and for whom open surgery was not an option were selected for percutaneous nucleoplasty application. Upon intervention, patients were prospectively questioned by an independent physician regarding pain, physical improvement, and operation satisfaction at 1, 6, 12 and 24 months. Pain was evaluated with VAS, and physical improvement was evaluated based on the Oswestry Disability Index. Results Mean VAS that was 8.7±1.1 before the procedure was determined to be 3.4±1.9 at 24 months follow-up. At the latest follow-up, 87.5% of the patients reported a 30% or higher decrease in their pain. While Oswestry scores were 76.1±10.2 in the beginning, they went down to 33.9±14.9 at the end of 2 years. The percent of those stating “good” and “excellent” satisfaction was 66% (23 persons) on the last follow-up. Conclusions While it is once more shown that nucleoplasty is a safe method, it is also shown that its effectiveness continues at the end of 2 years.

Zinc Phosphide Poisoning

Zinc phosphide has been used widely as a rodenticide. Upon ingestion, it gets converted to phosphine gas in the body, which is subsequently absorbed into the bloodstream through the stomach and the intestines and gets captured by the liver and the lungs. Phosphine gas produces various metabolic and nonmetabolic toxic effects. Clinical symptoms are circulatory collapse, hypotension, shock symptoms, myocarditis, pericarditis, acute pulmonary edema, and congestive heart failure. In this case presentation, we aim to present the intensive care process and treatment resistance of a patient who ingested zinc phosphide for suicide purposes.

İleri derece yaşlı hastada mini doz bupivakain ile spinal anestezi

The most patients that are applied hip and lower-extremity surgery are in the elderly group. The presence of cardiac, endocrine, renal, cerebral and respiratory diseases in this age group increases the risk of peroperative, postoperative morbidity and mortality. In this case, it is presented the managing of anesthesia of a 106 year-old man whom the operation of right hip prosthesis is made. J Clin Exp Invest 2010; 1(3): 214-215

Apendektomi operasyonlarında iki farklı intratekal levobupivakain dozunun etkinliğinin karşılaştırılması

Objectives: Spinal anesthesia, especially in the presence of coexisting diseases is preferred to reduce morbidity and mortality in many surgical practices. In this study, we aimed to compare the motor and sensory block characteristics, hemodynamic parameters, side effects and surgical and patient comfort, whom underwent appendectomy with spinal anesthesia in two different doses of levobupivacaine. Material and methods: After Minister of Health ethical committee approval and written consent of the patients who underwent open appendectomy were obtained, fifhty patients between the ages of 18-40 with ASA I-II were enrolled in this study. The patients were randomly allocated to two groups; Group I received 15 mg levobupivacaine 0.5% (total 3 ml) and Group II received 20 mg levobupivacaine 0.5% (total 4 ml Hemodynamic data, surgical and patient comfort and side effects were also recorded. Results: There were statistically significant differences between the two groups for two segment regression time of sensory block. Two-segment regression time was longer the Group II than Group I. In Group II motor block regression time (Group I 120 ± 40 min, Group II 158 ± 54 min) was significantly longer (p= p<0.05). There were statistically significant difference in numbers of side ef fects (hypotension, bradicardia) in Group II than Group I (p<0.05). Conclusions: This study showed that 15 mg levobupivacaine dose provides safe and effective anesthesia for appendectomy surgery. J Clin Exp Invest 2012; 3(1): 33-37 OZET

Unexpected foreign bodies in larynx: two cases report

1 Hammer GB, Fitzmaurice BG, Brodsky JB. Methods for single-lung ventilation in pediatric patients. Anesth Analg 1999; 89: 1426– 1429. 2 Hammer G. Single-lung ventilation in infants and children. Pediatr Anesth 2004; 14: 98– 102. 3 Golianu B, Hammer GB. Pediatric thoracic anestesia. Curr Opin Anaesthesiol 2005; 18: 5–11. 4 Schmidt C, Rellensmann G, Van Aken H et al. Single-lung ventilation for pulmonary lobe resection in a newborn. Anesth Analg 2005; 101: 362–364. 5 Wald SH, Mahajan A, Kaplan MB et al. Experience with the Arndt paediatric bronchial blocker. Br J Anaesth 2005; 94: 92–94.

Queda do pé após raquianestesia

. Júnior Ade P, Erdmann TR, Santos TV, et al. Comparação entre Bloqueios Peridural e Paravertebral Torácicos Contínuos para Analgesia Pós-Operatória em Pacientes Submetidos a Toracotomias: Revisão Sistemática. Rev Bras Anestesiol. 2013;63: 433--42. . Bueno NB. Explorando a heterogeneidade. In: Barbosa FT, editor. Introdução à Revisão Sistemática: A Pesquisa do Futuro. 2013, 3. Higgins JP, Thompson SG, Deeks JJ, et al. Measuring inconsistency in metaanalyses. BMJ. 2003;327:557--60.