Muhyittin Temiz

Comparison of recovery characteristics, postoperative nausea and vomiting, and gastrointestinal motility with total intravenous anesthesia with propofol versus inhalation anesthesia with desflurane for laparoscopic cholecystectomy: A randomized controlled study

BACKGROUND Clinical effects, recovery characteristics, and costs of total intravenous anesthesia with different inhalational anesthetics have been investigated and compared; however, there are no reported clinical studies focusing on the effects of anesthesia with propofol and desflurane in patients undergoing laparoscopic cholecystectomy. OBJECTIVE The aim of this study was to determine the effects of total intravenous anesthesia with propofol and alfentanil compared with those of desflurane and alfentanil on recovery characteristics, postoperative nausea and vomiting (PONV), duration of hospitalization, and gastrointestinal motility. METHODS Patients classified as American Society of Anesthesiologists physical status I or II undergoing elective laparoscopic cholecystectomy due to benign gallbladder disease were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (2-2.5 mg/kg) and alfentanil (20 μg/kg) or desflurane (4%-6%) and alfentanil (20 μg/kg). Perioperative management during premedication, intraoperative analgesia, relaxation, ventilation, and postoperative analgesia were carried out identically in the 2 groups. Extubation time, recovery time, PONV, postoperative antiemetic requirement, time to gastrointestinal motility and flatus, duration of hospitalization, and adverse effects were recorded. Postoperative pain was assessed using a visual analogue scale. RESULTS Sixty-eight patients were assessed for inclusion in the study; 5 were excluded because they chose open surgery and 3 did not complete the study because they left the hospital. Sixty patients (33 women, 27 men) completed the study. Recovery time was significantly shorter in the propofol group (n = 30) compared with the desflurane group (n = 30) (8.0 [0.77] vs 9.2 [0.66] min, respectively; P < 0.005). Fifteen patients (50.0%) in the propofol group and 20 patients (66.7%) in the desflurane group experienced nausea during the first 24 hours after surgery. The difference was not considered significant. In the propofol group, significantly fewer patients had vomiting episodes compared with those in the desflurane group (2 [6.7%] vs 16 [53.3%]; P < 0.005). Significantly fewer patients in the propofol group required analgesic medication in the first 24 hours after surgery compared with those in the desflurane group (10 [33.3%] vs 15 [50.0%]; P < 0.005). Patients in the propofol group experienced bowel movements in a significantly shorter period of time compared with patients in the desflurane group (8.30 [1.67] vs 9.76 [1.88] hours; P = 0.02). The mean time to flatus occurred significantly sooner after surgery in the propofol group than in the desflurane group (8.70 [1.79] vs 9.46 [2.09] hours; P = 0.01). The duration of hospitalization after surgery was significantly shorter in the propofol group than in the desflurane group (40.60 [3.49] vs 43.60 [3.56] hours; P = 0.03). CONCLUSION Total intravenous anesthesia with propofol and alfentanil was associated with a significantly reduced rate of PONV and analgesic consumption, shortened recovery time and duration of hospitalization, accelerated onset of bowel movements, and increased patient satisfaction compared with desflurane and alfentanil in these patients undergoing laparoscopic surgery who completed the study.

Effectiveness of mesalamine and propolis in experimental colitis.

This study was conducted to investigate the effects of propolis and mesalamine on experimental colitis in rats. Distal colitis was induced in rats by intracolonic instillation of 2 mL of 4% acetic acid. The animals were randomly assigned to 5 groups: group 1, control, (n=8); group 2, colitis, received no treatment (n=8); group 3, colitis+mesalamine, 2 mL once a day via an enema (n=8); group 4, colitis+propolis, 600 mg/kg once a day via intragastric lavage (n=8); and group 5, colitis+ mesalamine+propolis for 1 wk (n=8). Levels of nitric oxide were statistically significantly different in comparisons between groups 1 and 2, groups 2 and 3, and groups 4 and 5. Malondialdehyde levels were significantly different when group 2 was compared with groups 3, 4, and 5. A significant difference was observed when group 3 was compared with group 4 for myeloperoxidase. Most propolis-treated rats had normal histology; mesalamine-treated and propolis+mesalamine-treated rats had inflammatory cell infiltration at rates of 50% and 33%, respectively. The investigators concluded that propolis and mesalamine are efficient independently and in combination, but that their combined effect was not observed to be additive in experimental colitis.

Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy

OBJECTIVE To evaluate and compare intercostal-iliac transversus abdominis plane (TAP) and oblique subcostal TAP (OSTAP) blocks for multimodal analgesia in patients receiving laparoscopic cholecystectomy. DESIGN A prospective, randomized, double-blinded clinical study. SETTING Operating room, postoperative recovery area, and ward. PATIENTS In total, 60 laparoscopic cholecystectomy patients (43 women, 17 men, American Society of Anesthesiologists grades I-II) were enrolled from the general surgery department of our tertiary care center. INTERVENTION The patients were assigned to 1 of the 3 groups. Group 1 received TAP blocks (n=20), group 2 received OSTAP blocks (n=20), and group 3 patients were used as controls and received patient-controlled analgesia (PCA) only (n=20). After the induction of anesthesia, blocks were performed bilaterally in study groups 1 and 2, using 20mL of lidocaine (5mg/mL). PCA with intravenous tramadol was routinely provided for all patients during the first 24hours. MEASUREMENTS The intraoperative use of remifentanil, postoperative visual analog scale (VAS) scores, demand for PCA, and total analgesic consumption were recorded. MAIN RESULTS The patients in the control group had greater analgesic demands and analgesic consumption than did those in groups 1 and 2. However, patients in the OSTAP group had lower VAS scores than did those in groups 1 and 3. RESULTS The demand for analgesia was greater in the control group than in groups 1 and 2. Moreover, lower VAS scores were recorded in the OSTAP group than in groups 1 and 3 and were positively correlated with total PCA consumption among all patients. However, postoperative VAS scores were negatively correlated with the total intraoperative consumption of remifentanil at 24hours. CONCLUSIONS TAP and OSTAP blocks improved postoperative analgesia in patients receiving laparoscopic cholecystectomy, which resulted in lower VAS scores and reduction in total analgesic consumption.

A rare and frequently unrecognised pathology in children: femoral hernia

A femoral hernia is the protrusion of the abdominal contents through the femoral canal. It accounts for less than 1% of all groin hernias in children and is often confused with inguinal hernia or other inguinal pathologies. Preoperative misdiagnosis has been reported to be between 40 and 75%. We believe that misdiagnosis and mistreatment usually occur due to insufficient physical examination, knowledge and experience about childhood femoral hernias. Here, we report and discuss the clinical appearance and treatment approach of three patients operated with the diagnosis of femoral hernias.

Knowledge, Attitudes, and Behaviors of Female Teachers Related to Breast Cancer and Breast Examination in Southern Turkey

Background: The aim of this study was to investigate the knowledge, attitudes, and behaviors of female teachers related to breast cancer in Southern Turkey. Materials and Methods: There are almost 5,000 female teachers working in Hatay, Turkey, and we aimed to reach 10% of this population. Our questionnaire consisted of 14 questions about personal information, 14 questions about knowledge related to breast cancer, and 14 questions about attitudes and behaviors of teachers. Results: In all, 490 female teachers participated in the study. The mean age was 34.6 years, and most were married (77.1%). 62.9% of participants reported to have insufficient knowledge about breast cancer. The source of information was newspaper/TV in 84.6%, and medical health care providers in 22.8%. While all of the participants think that early diagnosis of breast cancer is important; 19% think personal hygiene is protective against breast cancer. Among all the participants, 53.7% have never practiced breast self-examination (BSE). Of those who practice BSE; 80.6% practice it as they remember, 12.5% practice it once a month. 38.4% of these learned BSE from a doctor, and 38.0% from TV. The reason for not practicing BSE was underestimation in 46.7% and lack of knowledge in 37.9%. 152 participants had a clinical breast examination (CBE) done, and 145 of these had it done by an expert doctor. A total of 86 participants had undergone mammography, while 67 of the over-40-year-old group had not. Conclusion: 3/5 of the female teachers think that they do not have enough knowledge related to breast cancer. More than half of them do not practice BSE, and only 12.5% of them practice BSE regularly.

Morganella morganii-associated arthritis in a diabetic patient

This case report involves a 60-year-old diabetic man who developed septic arthritis as a result of the pathogen Morganella morganii. The patient had complaints of elevated body temperature, malaise, rigors and pain in the left knee, despite no history of trauma. On examination of the knee, erythema, warmth, tenderness and swelling was observed. Arthrocentesis performed on his left knee indicated the presence of straw-coloured, cloudy fluid without crystals. Bacterial identification based on biochemical and automated methods indicated the growth of M morganii. M morganii was also isolated sedimentafrom the exudate of a diabetic ulcer in the left foot, with antibiotic susceptibilities identical to those from the knee effusion. This case indicates that M morganii may be considered as a possible cause of septic arthritis in diabetic patients, especially those with diabetic foot infections.

Addition of ketamine to propofol-alfentanil anesthesia may reduce postoperative pain in laparoscopic cholecystectomy.

Objective: The aim of this study was to assess whether intravenous anesthesia supplemented with ketamine reduces postoperative pain after elective laparoscopic cholecystectomy. Materials and Methods: Forty patients were enrolled and randomized 1:1 into one of 2 groups: the propofol group (received propofol and alfentanil supplemented with saline) and the ketamine group (received propofol and alfentanil with ketamine). The study was double-blind. The number and amount of the intraoperative additional alfentanil doses were recorded. Pain assessments and cumulative analgesic consumption at postanesthesia care unit (PACU) admission, PACU discharge, postoperative 24th hour, and hospital discharge were recorded. Results: The visual analog scale scores at PACU admission, PACU discharge, postoperative 24th hour, and hospital discharge were significantly lower in the ketamine group than the propofol group. The pain visual analog scale ≥75 at the postoperative 24th hour for the propofol group was also significantly lower (P<0.035) than that of the ketamine group. The difference in analgesic consumption between groups was statistically significant (P<0.001). Conclusions: Our study showed that ketamine supplemented with propofol and alfentanil produced better analgesia intraoperatively and postoperatively and decreased analgesic consumption compared with the propofol group after laparoscopic cholecystectomy.

Effect of propolis on healing in experimental colon anastomosis in rats

IntroductionPropolis is the generic name for the resinous substance collected by honeybees, which is known to have antioxidant, anti-inflammatory, apoptosis-inducible effects. Anastomotic dehiscence after colorectal surgery is an important cause of morbidity and mortality. We aimed to assess the effect of propolis on healing in an experimental colon anastomosis in rats.MethodsForty adult male Wistar albino rats were randomly assigned into 5 treatment groups with 8 rats in each: Group I, anastomosis+no treatment; Group II, anastomosis+oral propolis (600 mg/kg/d); Group III, anastomosis+oral ethyl alcohol (1 cc/d); Group IV, anastomosis+rectal propolis (600 mg/kg/d); Group V, anastomosis+rectal ethyl alcohol (1 cc/d). The bursting pressures, hydroxiproline levels and histopathological changes in each group were measured.ResultsWhen bursting pressures were compared between groups, we observed that they were increased in the groups treated with propolis in contrast to all other groups. Hydroxiproline levels in the propolis groups were also significantly increased in contrast to the other groups. There was also a statistically significant difference in histopathological changes between the treatment types. When propolis administration methods were compared, we did not observe a statistically significant difference.ConclusionPropolis has a significantly favourable effect on healing in experimental colon anastomosis, independent from the method of administration.

Relationship between the resistance genes to quaternary ammonium compounds and antibiotic resistance in staphylococci isolated from surgical site infections.

Background We aimed to investigate the prevalence of disinfectant resistance genes (qacA/qacB,qacC) and the aminoglycosides resistance genes [(aac(6′)aph(2″),aph(3′)-IIIa,ant(4′)-Ia)] in both S. aureus and coagulase-negative staphylococcal strains (CoNS) isolated from surgical site infections. Material/Methods Totally, 130 staphylococcal strains isolated from surgical site infections between January 2012 and February 2013 were included in the study. The PCR technique was employed to verify any presence of methicillin resistance gene (mecA), aminoglycoside resistance genes [(aac(6′)/aph (2″), aph(3)-III a ant (4′)-1a)], and disinfectant resistance genes (qacA/qacB,qacC) in staphylococci. Results MecA gene was determined in 58 (44.6%) of 130 staphylococcal isolates. A total of 28 (73.7%) of 38 S. aureus isolates were found to be positive for the mecA gene, and 4 (12.9%) of 31 isolates sensitive to amikacin were sensitive to methicillin. Eighteen (47.4%) of 38 amikacin-resistant S. aureus isolates were found to be positive for qacA/qacB genes and 11 (8.9%) of them were positive for qacC gene. Both mecA and qacA/qacB genes were found to be positive at the same time in 19 amikacin-resistant S. aureus strains. Seven (18.4%) S. aureus isolates were determined to be positive for qacA/qacB and qacC genes. Frequency of qacA/B genes was found to be 47.4% among amikacin-resistant S. aureus strains, while qacC gene was found to be 28.9% (p<0.05). The ratio of qacA/B and qacC genes in CoNS was found to be 37.9% and 20.7%, respectively (p<0.05). Conclusions Quaternary ammonium resistance genes were found to be positive at a remarkable ratio in the staphylococcal isolates from surgical wounds. Especially, the high rates of aminoglycosides and methicillin-resistance gene was remarkable in S. aureus isolates. Quaternary ammonium resistance genes were found to be positive.

A rare cause of chronic rectal bleeding in children; solitary rectal ulcer: case report.

Alt gastrointestinal kanamaya neden olan soliter rektal ulser, cocuklarda oldukca nadir gorulur. Nadir gorulmesi, ozgun olmayan bulgularla ortaya cikmasi, bu konuda yeterli deneyimin olmamasi ve cesitli rektal hastaliklari taklit etmesi, bazi cocuk hastalarda yanlis veya gecikmis taniya neden olabilmektedir. Burada, belirtilerin baslangicindan 2 yil sonra tanisi konan, yuksek lifli diyet, laksatif, tuvalet egitimi ve sukralfat lavman tedavisine iyi yanit veren soliter rektal ulserli 10 yasindaki bir olgu sunuldu.