Ömür Öztürk

Importance of the Upper Extremity Position for a Safe and Effective Axillary Block: a Comparative Study

OBJECTIVEnOur aim was to determine the ideal position of upper extremities during ultrasonography guidance for axillary block. The position that provides the shortest distance between the median and musculocutaneous nerves was assumed to be the most appropriate position for axillary block.nnnMETHODSnIn this cross-sectional study, 120 (45 female and 75 male) patients were placed in a position with a shoulder at 90° / elbow 90° (position 1) and a shoulder 90° / elbow 0° (position 2). The intersection point of the biceps brachii muscle with the lower border of the pectoralis major muscle is defined as the proximal level (P). Distal level (D) is reffered as 5 cm below the proximal level. In the positions described above, the distance between median and musculocutaneous nerves was measured proximal (positions 1P and 2P) and distal levels (positions 1D and 2D). It was investigated whether these measurements differed between the groups and whether the body mass index or the gender.nnnRESULTSnThe shortest mean distance (10.24±3.95 mm) between the two nerves was determined when the shoulder position 90°/elbow position 0° at the distal level (1D) and the longest mean distance (13.41±4.26 mm) was determined when shoulder position 90°/elbow position 90° at the proximal level (2P). In all four cases, there was no difference in the results between men and women. There was no relationship between the measurement results and the body mass indexes and age of the patients.nnnCONCLUSIONnAppropriate positioning of the upper extremities is important for achieving optimal position during axillary block. Thereby, the procedure can be safely and effectively performed with lesser amounts of local anaesthetic solution and a decreased number of manoeuvres with needle during infiltration.

A Mild Type Propofol Infusion Syndrome Presentation in Critical Care

Propofol infuzyon sendromu (PRIS) nadir ama olumcul bir hastaliktir. Bu sendrom cogunlukla ilacin yuksek dozda uzun sureli infuzyonundan sonra olusur. Metabolik asidoz, hipotansiyon, miyoglobinuri, artmis karaciger ve kas enzimleri, kardiyak aritmiler ve kalp durmasi sendromun genel ozellikleridir. Bu olgu sunumunda uzun sureli dusuk doz (25–50 mcg/kg/dk) ilac infuzyonundan sonra ortaya cikan hafif tipte bir PRIS tartisilmistir. Bu olguda ilac infuzyonu esnasinda ciddi metabolik asidoz, hipotansiyon yada aritmi gozlenmemistir. Sadece AST, ALT, CK, CKMB, LDH duzeylerinde artis saptanmistir. Propofol infuzyonu boyunca hastanin hic klinik durumunda bozulma olmadan sadece bahsedilen parametrelerdeki bozuklugun devam etmesi olguyu hafif tipte bir PRIS olarak tanimlamamiza neden oldu. Ek olarak ilacin kesilmesi sonrasi bozulan kimyasal parametrelerdeki duzelmeler teshisimizin dogrulugunu da kanitlamis oldu.

The Role of Lower Extremity Venous Insufficiency in Plantar Fasciitis Etiology

Amac: Plantar (PF) topuk agrisinin en onemli sebeplerinden birisidir. Patofizyolojisi tam anlasilmamakla birlikte guncel gorus plantar fasya ile kalkaneusun yapisma yerinde dejeneratif bozuklugun olmasidir. Cesitli konservatif ve cerrahi tedavi yontemleri mevcuttur. Etyolojisi multifaktoriyeldir. Bu calismada, PF etyopatogenezinde alt ekstremite venoz yetmezligin yeri olup olmadiginin arastirilmasi amaclanmistir. Materyal ve Metot: PF tanisi olan atmis yedi hasta (n=67) (Grup-1, erkek/kadin: 20/47) ve alt ekstremite venoz yetmezlik tanisi olan elli iki hasta (n=52) (Group-2, male/female: 26/26) iki ayri grupta incelendi. Iki grup arasindaki iliskinin istatistiksel analizi, Minitap-17 normalite testi ve sonrasinda paired t-test ile yapildi.xa0 Bulgular: Grup-1 hastalarinin Doppler ultrasonografi incelemelerinde, atmisyedi hastanin hicbirinde venoz yetmezlik saptanmadi. Grup-2’deki elli iki hastada yapilan incelemelerde ise sadece iki kiside PF tespit edildi.xa0 Sonuc: Alt ekstremite venoz yetmezliginin, PF etiyolojisi uzerine bir etkisi olmadigi bulundu.

Evaluation of the relationship between the topographical anatomy in the axillary region of the brachial plexus and the body mass index

To investigate the topographic anatomy of the median, musculocutaneous, radial and ulnar nerves with respect to the axillary artery and to seek whether these configurations are associated with baseline descriptive data including age, gender, and body-mass index. This cross-sectional trial was carried out on 199 patients (85 women, 114 men; average age: 46.78u2009±u200915.45xa0years) in the department of anaesthesiology and reanimation of a tertiary care center. Topographic anatomy of the median, musculocutaneous, radial and ulnar nerves was assessed with ultrasonography. Localization of these nerves with respect to the axillary artery was marked on the map demonstrating 16 zones around the axillary artery. Frequencies of localizations of every nerve in these zones were recorded, and the correlation of these locations with descriptive data including age, gender and BMI was investigated. There was no difference between women and men for the distribution of the median (pu2009=u20090.74), ulnar (pu2009=u20090.35) and radial (pu2009=u20090.64) nerves. However, the musculocutaneous nerve was more commonly located in Zone A13 in men compared to women (pu2009=u20090.02). The localization of the median (pu2009=u20090.85), ulnar (pu2009=u20090.27) and radial (pu2009=u20090.88) nerves did not differ remarkably between patients with BMIu2009<u200925xa0kg/m2 and patients with BMIu2009≥u200925xa0kg/m2. Notably, the musculocutaneous nerve was more often determined in Zone A10 in cases with BMIu2009≥u200925xa0kg/m2 (pu2009=u20090.001). Our results imply that the alignment of the musculocutaneous nerve may vary in men and overweight people. This fact must be considered by the anaesthetist before planning the axillary block of brachial plexus. All these informations may enlighten the planning stages of the brachial plexus blockade.

COULD OZONE TREATMENT BE A PROMISING ALTERNATIVE FOR OSTEOMYELITIS? AN EXPERIMENTAL STUDY

ABSTRACT Objective: The aim of the present study was to investigate the biochemical and histopathological impact of ozone treatment in an experimental model of osteomyelitis in rats. Methods: A total of 24 adult male Sprague-Dawley rats (3 months old, each weighing 300 to 400 g) were randomly allocated into three groups. Group I (n=8) served as a control and received no interventions or medications. In Group II (n=8), osteomyelitis was induced in the femur and no treatment was applied. Group III (n=8) received intraperitoneal ozone treatment for 3 weeks after the formation of osteomyelitis in the femur. Serum samples were taken to assess total antioxidant capacity (TAC), protein carbonyl content (PCO), and lactate dehydrogenase (LDH). Bone specimens obtained from the femur were histopathologically evaluated for inflammation, necrosis, osteomyelitis, and abscess formation. Results: Serum TAC levels were notably higher (p<0.001), while LDH levels were lower (p=0.002) in Group III than Group II. No significant difference was detected between groups with respect to PCO level. Similarly, Group III displayed more favorable histopathological outcomes with respect to osteomyelitis (p=0.008), inflammation (p=0.001), necrosis (p=0.022), and abscess formation (p=0.022). Conclusion: Ozone may be a useful adjunct treatment for osteomyelitis. Further studies in animals and humans are needed to clarify and confirm these preventive effects, understand the underlying pathophysiology, and establish guidelines. Level of Evidence II; Prospective comparative study.

The beneficial effects of ozone therapy in acetaminophen-induced hepatotoxicity in mice

BACKGROUNDnThe aim of the present study was to determine the therapeutic effects of medical ozone therapy on acute acetaminophen (APAP)-induced hepatotoxicity which were not clearly demonstrated in prior studies.nnnMETHODnTwenty-four mice were randomly assigned into three equal groups: Group 1 (control), Group 2 (APAP) and Group 3 (APAP +ozone). Hepatotoxicity was induced by APAP given as a single dose of 300mg/kg intraperitoneally in Groups 2 and 3. Additionally, Group 3 received 20mcg/0.5mL ozone intraperitoneal twice a day for the remaining of the study. Other groups received saline injections. On the fourth day of the study, biochemical variables (AST, ALT, ALP) and liver histopathology was assessed.nnnRESULTSnIntraperitoneal administration of a single dose of APAP induced hepatocellular damage that was shown by both liver enzymes and histopathological changes (p<0.001). AST, ALT, ALP levels were elevated in both groups 2 and 3 and the difference from group 1 was statistically significant (p<0.01).Mean ALT and AST levels of group 2 were statistically significantly higher versus group 3 (p<0.01). In histopathological examinations; necrosis and inflammation were more prominent in Group 2 compared to Group 3 (p<0.01).nnnCONCLUSIONnOzone showed beneficial effects on APAP hepatotoxicity at a statistically significant level. It is known that ozone has therapeutic effects in various diseases owing to its antioxidant effects. The present study suggests that ozone may be utilized as a routine supplementary therapy in acute APAP hepatotoxicity.