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Anesthesia for proteus syndrome

Proteus syndrome is a complex disorder comprising malformations and overgrowth of multiple tissues. The disorder is highly variable affecting tissues in a mosaic pattern. A 2‐year‐old boy with Proteus syndrome, with epidermal verrucal naevus, hyperplastic lesions of connective tissue, hyperostosis, overgrowth of tubular bones, bilateral inguinal hernia, and juvenile intestinal polyposis was scheduled for vertebral magnetic resonance imaging (MRI) for further evaluation of malignancies. In addition to the pathological findings of this syndrome, potential complications such as difficult intubation, pulmonary hypertension, and pulmonary thromboembolism necessitate a careful preoperative and anesthetic preparation. MRI was performed under general anesthesia. There were no anesthetic complications. There are few previous reports on anesthesia in a patient with Proteus syndrome.

Ciprofloxacin-induced severe thrombocytopenia.

Thrombocytopenia may be induced by numerous factors, whereas ciprofloxacin-induced severe thrombocytopenia rarely occurs [1,2]. Starr et al. [3] reported that a 72-year-old patient developed thrombocytopenia after ciprofloxacin treatment for a urinary tract infection. Tuccori et al. [4] observed abdominal pain, hepatitis, thrombocytopenia, and hemolysis in a 30-year-old patient after ciprofloxacin treatment for urinary tract infection. In addition to this, Chaudhry etal. [5] observed that thrombocytopeniaoccurredasa result of ciprofloxacin treatment for urinary tract infection. A 61-year-old unconscious patient who was treated at home for chronic diarrhea for 5 years was admitted to the emergency room. The patient was given ciprofloxacin 500 mg, twice daily after she did not respond to antipyretic treatment. She was also diagnosed with Parkinson’s disease and was treated with levodopa and baclofen on regular basis. She was brought to the emergency room because her health in general was deteriorating. She was experiencing diarrhea, nausea and vomiting, hypotension, tachycardia, tachypnea, and fever. When she was diagnosed with hypoxemia, she was intubated and taken to the intensive care unit for mechanical ventilation. Pancultures were obtained and eventually the patient was placed on intravenous piperacillin-tazobactam 4.5 g. Her laboratory work-up revealed a white blood cell count of 23,000 per mm, thrombocyte count of 119,000 per mm, and C-reactive protein level of 116 mg/L. Physical examination revealed decreased lung sounds and crepitant rales on both lungs. The patient’s thrombocyte count at 24 hours was 16,000 per mm. At that time, antiaggregant treatment was stopped and 12 units of thrombocyte suspension were given to the patient. The thrombocyte count at 48 hours was 96,000 per mm. A purpuric skin rash on the extremities and

Do the Patients Read the Informed Consent

BACKGROUND Informed consent is a process which consists of informing the patient about the medical interventions planned to be applied to the patients body and making the patient active in the decision making process. AIMS The aim of this study was to evaluate whether the patients read the informed consent document or not and if not, to determine why they did not read it. This was achieved via a questionnaire administered at the pre-anaesthetic visit to assess the perception of patients to the informed consent process. STUDY DESIGN Survey study. METHODS The patients were given a questionnaire after signing the informed consent document at the pre-anaesthetic visit. We studied whether the patients read the informed consent document or not and asked for their reasons if they did not. RESULTS A total of 522 patients were included during the two month study (mean age: 38.1 years; 63.8% male, 36.2% female). Overall, 54.8% of patients reported that they did not read the informed consent. Among them, 50.3% did not care about it because they thought they would have the operation anyway, 13.4% did not have enough time to read it, 11.9% found it difficult to understand, 5.9% could not read because they had no glasses with them, and 5.2% found it frightening and gave up reading. Inpatients, older patients and patients with co-morbidities were less likely to read the informed consent document than outpatients, and younger and healthy patients (p<0.05). Also, 57.9% of parents whose children would be operated on had read the document. CONCLUSION This study shows that the majority of our patients did not understand the importance of the informed consent. It is therefore concluded that informed consent documents should be rearranged to be easily read and should be supported with visual elements such as illustrations or video presentations, as informed consent is a process rather than just simply signing a form.

Tracheal compression during shoulder arthroscopy in the beach-chair position

BACKGROUND Respiratory distress is a rare complication of outpatient shoulder arthroscopy and mostly associated with general anesthesia, pneumothorax, anaphylaxis, or phrenic nerve paralysis. OBJECTIVE We report on a shoulder arthroscopy complicated by tracheal compression caused by extravasation of irrigation fluid into soft tissues of the upper airway while the patient was in the beach-chair position under general anesthesia. CASE SUMMARY A 33-year-old male was scheduled for shoulder arthroscopy for impingement syndrome of the right shoulder under general anesthesia combined with interscalene brachial plexus block. During the operation, the patients neck, right chest, and shoulder were observed to be swollen and tense on palpation. A fiberoptic bronchoscopic evaluation through the endotracheal tube revealed that the trachea was compressed to the left, but not completely obstructed. It was determined that the irrigation fluid had leaked subcutaneously from the shoulder joint to the neck. Vital signs were stable and the patient could be adequately ventilated despite the airway obstruction. The patient was transferred to the ward 16 hours after the operation with stable vital signs and discharged from the hospital on the second day. CONCLUSIONS We report a case of airway obstruction due to tracheal compression from extravasation of irrigation fluid during shoulder arthroscopy under general anesthesia combined with peripheral nerve block in the beach-chair position. General anesthesia with endotracheal intubation protected the patient from a possibly fatal complication.

Respiratory and Cranial Complications during Anaesthesia in PfeifferSyndrome

Pfeiffer syndrome (PS) is rarely encountered, even at major craniofacial centers. Published reports indicate high mortality rates (25-85%) for severely affected subtypes. PS is characterized by bilateral coronal craniosynostosis, midface hypoplasia, beaked nasal tip, broad and medially deviated thumbs and great toes. We present a case of a 12-monthsold male infant with PS type 2 who underwent a craniosynostosis and advancing a supraorbital bar operations during general anesthesia. For simple procedures, a safe anesthetic plan can be formulated if the anatomic factors affecting the airway are carefully considered. More extensive and prolonged patient diagnosed to have PS require more monitoring and include all the problems associated with difficult intubation, hazardous airway management, massive blood loss and fluid shift, shunt-dependent hydrocephalus, and long anesthetic times. This case is presented since anaesthesiologists should be aware of the high incidence of respiratory and cranial complications in PS.

Does early removal of double J stents reduce urinary infection in living donor renal transplantation

Introduction Prophylactic use of double J (DJ) stents in recipients is highly accepted in renal transplantation. In this study, the association between the frequency of urologic complications (UC) and urinary tract infections (UTI), and the early or late removal of DJ stents was investigated. Material and methods A total of 116 live-donor renal transplant patients were included in the study during a 4-year period, with a mean follow-up of 29.2 ±15.3 months. In all, DJ stents were used. All patients were clinically monitored for graft function by assessment of the complete blood count, renal biochemistry, urine analysis and blood drug level according to our follow-up protocol. Results The patients were divided into 2 groups according to the time of their stent removal: group I (n = 44), removal within the first 14 days; and group II (n = 72), removal after 14 days. No urinary leaks were detected in either of the groups. Three patients suffered from anastomotic stricture (group I, n = 1; group II, n = 2). The rates of UTI were similar in groups I and II (13.6% vs. 16.6%, respectively, p = 0.79). The rate of UTI in women was found to be 3.8 times higher than in men. Conclusions The results of our study demonstrated that DJ stent removal within 14 days did not reduce the risk of UTI when compared to stent removal after 14 days. Similar effects on complication rates for ureteral stenting for these 2 removal periods were observed.

Lymph node evaluation and survival after resection of colorectal cancer

Recent studies have demonstrated that lymph nodes ratio (LNR) might provide a significant prognostic role for colorectal cancer. We retrospectively analyzed the data of the patients with colorectal cancer and assessed a possible correlation between lymph node parameters and survival. We conducted a retrospective chart review of patients who underwent a radical colon surgery involving removal of mesocolic lymph nodes due to colorectal cancer. Prognostic significance of the removed lymph node number (LNs), metastatic LNs, lymph node ratio (LNR) and other factors were compared. This retrospective study included 190 patients (117 males and 73 females). The estimated survival period was found to be 87.70 months [confidence interval (CI) of 95% (80.64-94.76)]. LNR, LNs and N stage were found to have significant correlation with survival. Among these factors, LNR had the biggest correlation (r = 0 .138, P =0.028). Multivariate regression analysis of survival with lymph node parameters showed that LNR and N stage were significantly correlated with survival. However, LNR was found to be the most significant prognostic factor [P >0.0001, 95% CI; 3.12 (1.55-5.75)]. LNR is a better prognostic factor in patients with colorectal cancer compared to lymph node stage and number.