Lütfi Yavuz

Removal of a laryngeal leech: A safe and effective method.

This article presents a case of hoarseness, dysphagia, and hemoptysis caused by the laryngeal localization of a leech. This pathological condition is extremely rare in urban areas but is frequent in endemic rural areas. Laryngoscopic evaluation of our patient has shown a leech lodged on the left arytenoid region hanging down to larynx. We present a patient living in an urban area with laryngeal leech that was removed under general induction anesthesia of sevoflurane via a face mask without endotracheal intubation.

Effects of Vitamin C and E Combination on Element and Oxidative Stress Levels in the Blood of Operative Patients Under Desflurane Anesthesia

We investigated effects of vitamin C and E (VCE) administration on desflurane-induced oxidative toxicity and element changes in the blood of operative patients under desflurane general anesthesia. Forty American Society of Anesthesiologists I or II Physical Status adult patients were scheduled for elective surgery. The patients were randomly divided into two groups. Control and VCE group was introduced to anesthesia with desflurane. VCE was administreted to patients in the control and VCE group before 1 hour of anesthesia with desflurane. Baseline (preoperative) and postoperative (at the 1st, the 24th, and 72th h), blood samples were taken from the first and second groups. Erythrocyte and plasma lipid peroxidation levels at the 1st, 24th, and 72th hours were higher in the control than in baseline group, although their levels at the same periods were lower in the VCE group than in the control. Vitamin E levels at the postoperative 1st and 24th hours and erythrocyte glutathione peroxidase (GSH-Px) activity at the postoperative 1st, 24th, and 72th hours was lower than in baseline values. Erythrocyte GSH-Px activity and plasma vitamins A, C, and E levels at the postoperative 1st, 24th, and 72th hours were higher in the VCE group than in the control group. Erythrocyte and plasma reduced glutathione, plasma β-carotene, and serum copper, while zinc, selenium, aluminum, iron, magnesium, and calcium levels did not differ between preoperative and postoperative periods in both groups. In conclusion, VCE combination prevented the desflurane-induced vitamin E and GSH-Px consumptions to strengthen the antioxidant levels in the blood of operative patients.

The Effects of Adjuvant Immunoglobulin M-Enriched Immunoglobulin Therapy on Mortality Rate and Renal Function in Sepsis-Induced Multiple Organ Dysfunction Syndrome: Retrospective Analysis of Intensive Care Unit Patients

OBJECTIVE: To determine the effect of immunoglobulin (Ig)M-enriched Ig therapy on mortality rate and renal function in sepsis-induced multiple organ dysfunction syndrome (MODS), using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. METHODS: Retrospective study of patients with sepsis-induced MODS treated with standard antibiotic plus supportive therapy (control group) or IgM-enriched Ig therapy adjuvant to control group therapy (IVIg group). Total length of stay in the intensive care unit (ICU), overall mortality rate and 28-day case fatality rate (CFR), as well as APACHE II scores and renal function parameters at day 1 and day 4 of therapy, were recorded. RESULTS: A total of 118 patients were included (control group, n = 62; IVIg group, n = 56). In both groups, day 4 APACHE II scores decreased significantly compared with day 1 scores; the effect of treatment on renal function was minimal. Length of ICU stay, overall mortality rate and 28-day CFR were significantly lower in the IVIg group compared with the control group. CONCLUSIONS: Adding IgM-enriched Ig therapy to standard therapy for MODS improved general clinical conditions and significantly reduced APACHE II scores, overall mortality rate and 28-day CFR, although effects on renal function were minimal.

New volatile anesthetic, desflurane, reduces vitamin E level in blood of operative patients via oxidative stress.

It has been well known that some volatile anesthetic agents produce oxidative stress. Desflurane as a new volatile agent might have limited oxidative toxic effect because it is relatively a new short‐acting anesthetic characterized by a short duration of action and a quick postanesthetic recovery. We investigated effect of desflurane on serum glutathione peroxidase (GSH‐Px), lipid peroxidation (LP), vitamin E, and erythrocyte superoxide dismutase (SOD) values in patients. Fifteen adult patients are scheduled for elective surgery, ASA I or II physical status. Tidal volume and ventilation frequency were kept unchanged during the operation. Baseline values in venous blood samples were preoperatively taken and blood was also taken postoperatively at the 1st and the 12th hours of desflurane exposure. LP levels were significantly (p < 0.05) higher postoperatively at 1st hour than in preoperative values while α‐tocopherol concentration was significantly (p < 0.001) lower in postoperative period at 1st hour than in preoperative period. Erythrocyte SOD and serum GSH‐Px activities did not differ between pre‐ and postoperative periods. In conclusion, we observed that desflurane produced oxidative stress by decreasing α‐tocopherol levels. Use of vitamin E may be possible to reduce the oxidative effect of desflurane. Copyright

Prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy

Objective: We investigated the prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy. Material and Methods: Sixty American Society of Anesthesiologists Grade II and III patients scheduled for spinal anesthesia were randomized into one of two groups. Patients in Group I ( n r = r 30) received oral ephedrine 50 r mg in addition to premedication whilst those in Group II ( n r = r 30) received only premedication 30 r min before spinal anesthesia. Pre-infusion values were measured in order to obtain baseline readings after oral ephedrine administration in Group I and after premedication in Group II. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before and after infusion, during and 5 r min after spinal anesthesia and intraoperatively. Hypotension was defined as SAP <100 r mmHg and <20% of baseline value. Hypotension was treated with 3 r mg ephedrine and bradycardia was corrected with atropine 0.5 r mg, given as an i.v. bolus. Results: SAP values were significantly lower in Group II during the spinal anesthesia, post-spinal and intraoperative periods ( p r < r 0.0001). Fifteen patients received ephedrine in Group II and seven in Group I. Supplemental ephedrine was used at doses of 3.42 r - r 0.97 r mg in Group I and 8.86 r - r 1.24 r mg in Group II. The incidence of hypotension was halved in Group I compared to Group II (23.33% vs 50%, p r = r 0.003). Six patients received atropine in Group II because of severe bradycardia. Mean HR values were lower in Group II than Group I during the spinal anesthesia, post-spinal and intraoperative periods. Conclusions: We conclude that a prophylactic oral dose of ephedrine 50 r mg is effective for minimizing and managing spinal anesthesia-induced hypotension during transurethral prostatectomy.

The effect of colloidal fluid replacement on wound healing in an experimental sublethal hemorrhagic shock model.

Objective The aim of the study was to evaluate the effects of different resuscitation solutions on wound healing in an animal model of sublethal hemorrhagic shock. Methods Sublethal hemorrhagic shock was established by blood withdrawal until the mean arterial pressure fell to 40 mmHg within 15 min. Animals were resuscitated with four different solutions: group I (n=19) 0.9% NaCl, group II (n=20) 10% dextran 40, group III (n=20) 6% hydroxyethyl starch, group IV (n=18) 4% modified fluid gelatin. Following inhalation anesthesia, a full thickness skin incision of 2 cm in length was made on the abdominal wall and sutured primarily. The incision wound on the abdominal wall was excised on the fifth day. The breaking strength of the incision and hydroxyproline content of dry tissue were evaluated. Results Differences in breaking strength values were observed between groups I–III and I–IV (P<0.05). Hydroxyproline values were significantly lower in group IV (58.47 μg/ml) and group II (69.17 μg/ml) (P<0.05). The gelatin-resuscitated group had lower breaking strength and hydroxyproline values than the other groups. Conclusion It can be concluded that resuscitation with modified fluid gelatin may have detrimental effects on wound healing in an experimental model of sublethal hemorrhagic shock.

Comparison of Granisetron with Granisetron Plus Droperidol Combination Prophylaxis in Post-Operative Nausea and Vomiting after Laparoscopic Cholecystectomy

The aim of this study was to evaluate the effects of granisetron and granisetron plus droperidol combination therapy on post-operative nausea and vomiting (PONV) in 60 patients who had undergone elective laparoscopic cholecystectomy. Induction of anaesthesia was achieved using 5 mg/kg thiopentone, 2 μg/kg fentanyl and 0.5 mg/kg atracurium, and anaesthesia was maintained with 2–2.5% sevoflurane. The patients were randomly assigned to two groups: group G (granisetron) (n = 30) patients received 3 mg granisetron and group GD (granisetron plus droperidol) (n = 30) patients received 3 mg granisetron and 1.25 mg droperidol shortly before the induction of anaesthesia. PONV incidence was recorded post-operatively at 15 min, 30 min, 60 min, 2 h, 4 h, 12 h and 24 h. While PONV prophylaxis provided almost complete emetic control in patients who received the granisetron plus droperidol combination, patients who received granisetron prophylaxis alone experienced PONV more frequently at 30 min and 60 min post-operatively. We conclude that addition of a low dose of droperidol to granisetron prophylaxis is more effective than granisetron prophylaxis alone for successful control of PONV.

Kalça Kırıklı Yaşlı Türk Hasta Grubunda Bir ve İki Yıllık Mortaliteyi Etkileyen Faktörler

Amac: Kalca kiriklari ileri yaslarin fonksiyon kaybi ve olum ile sonuclanabilen ciddi saglik sorunlarindandir. Bu calismada amac kalca kirigi sonrasi yasli Turk has- talarda degisik risk faktorlerinin mortalite uzerine etkisini ortaya koymaktir.

Relevance of Nutritional Route and Intercellular Adhesion Molecule-1 in Patients With Acute Renal Failure and Its Prognostic Implications

OBJECTIVE Nutritional support and the route of nutrition are important conditions for patients with acute renal failure (ARF) in intensive care units (ICUs). Enteral nutrition (EN) is the primary route of nutrition in these patients because of a lower rate of complications. A lack of enteral feeding was reported to increase intercellular adhesion molecule-1 (ICAM-1) in experimental models. Serum soluble ICAM-1 (sICAM-1) level is an independent predictor of mortality in predialysis patients. However, the effect of nutritional route on serum ICAM-1 level is unknown in ARF patients. The aim of this study was to investigate the relationship between route of nutrition and serum ICAM-1 level and its prognostic implications in ICU ARF patients. METHODS In total, 64 ICU patients with ARF were assessed according to their clinical features, route of nutrition, laboratory parameters, serum sICAM-1 levels, presence of infection, Acute Physiology and Chronic Health Evaluation (APACHE) III scores, and outcomes on their first nephrology consultation day. RESULTS Thirty-two patients died during the follow-up period. The mortality rate and infection rate were higher in the parenteral nutrition (PN) group compared with the EN group (64% vs 42%, P = .05, and 84% vs 64%, P = .05, respectively). The route of nutrition influenced the serum sICAM-1 level. Parenteral nutrition was associated with a higher serum sICAM-1 level compared to EN (434 ng/mL [range 255 to 1,240] vs 217 ng/mL [range 123 to 296], respectively, P = .0004). The APACHE III score was found to be an independent prognostic factor among the parameters of nutritional route, presence of infection, serum albumin level, and serum sICAM-1 level. CONCLUSIONS Patients with ARF as supported by PN had a lower serum albumin level, and a higher APACHE III score, sICAM-1 level, and mortality and infection rate. Serum sICAM-1 levels did not independently predict mortality in the present set of ARF patients.

T142 DOES WOUND INFILTRATION OF TRAMADOL REDUCE POSTOPERATIVE PAIN IN LAPAROSCOPIC OR OPEN HERNIOGRAPHY

Introduction: The laparoscopic approach may be associated with more postoperative pain initially. The aim of this study was to evaluate the effects of administered tramadol at wound closure on postoperative pain and analgesic requirements under spinal anesthesia in laparoscopic inguinal herniorrhaphy (LH) or tension free open inguinal herniorrhaphy (TFOH). Methods: Twenty patients were randomly divided into two groups (n= 10 in each) as LH or TFOH. Patients received infi ltration of 200 mg tramadol with 40 mL of 0.9% saline solution at wound closure procedure. Postoperative pain was assessed with a Visual Analog Scale (VAS) at 3, 6, 12, and 24 hours postoperatively. Additional requirements of tramadol for postoperative pain releif were registered. Results: VAS scores at postoperative 12 and 24 hours were signifi cantly higher according to 3rd hour VAS scores in both groups. The VAS scores at 12 hours after operation signifi cantly lower in LH group than in TFOH group (1.5 ± 0.97 vs 5.1 ± 0.99). Additional requirements of tramadol for postoperative pain releif were signifi cantly lower in LH group. Conclusion: We conclude that wound infi ltration of 200 mg tramadol reduce postoperative pain in LH group.