Yavuz Demiraran

The effects of topical levobupivacaine on morbidity in pediatric tonsillectomy patients

OBJECTIVE To reduce the post-tonsillectomy morbidity by swab soaked with 5 ml levobupivacaine hydroclorur (25 mg/10 ml). STUDY DESIGN A double-blind prospective randomized controlled clinical study. METHODS In this randomized double-blind study in group I (30 children, mean age 7.5+/-2.6) we tightly packed swab soaked with 5 ml levobupivacaine hydroclorur (25mg/10 ml) and in group II (21 children, mean age 7.9+/-3.7) we used 5 ml saline swabs into each of the two tonsillar fossae after tonsillectomy for 5 min. We used McGraths face scale to compare the two groups in respect of pain control. RESULTS There was statistically significant pain relieving effect in the levobupivacaine group in the first 24h (p<0.05). But after 24h pain relieving effect of levobupivacaine was not significant (p>0.05). We did not see any serious complications for both groups. Postoperative morbidity mean results (nausea, vomiting, fever, bleeding, halitosis and ear pain) were not statistically different between the two groups (p>0.05). CONCLUSION Topical levobupivacaine seems to be a safe and easy medication for postoperative pain control in pediatric tonsillectomy patients.

Post‐partum haemorrhage from the lower uterine segment secondary to placenta praevia/accreta: Successful conservative management with Foley balloon tamponade

Profuse bleeding from the lower uterine segment secondary to placenta praevia/accreta during caesarean delivery is a challenging problem in obstetrics. We present our experiences using intrauterine Foley balloon tamponade for the conservative management of post‐partum haemorrhage from the lower uterine segment. Intraoperative haemostasis was achieved in all women who were unresponsive to other conservative methods. Foley balloon tamponade may be considered in the management of lower uterine segment bleeding at caesarean delivery.

Ghrelin, acylated ghrelin, leptin and PYY-3 levels in hyperemesis gravidarum

Abstract Objective: To assess the serum levels of gut and adipocyte-derived metabolic hormones that control appetite, adipocity, weight gain and energy hemostasis, namely total ghrelin (TG), acylated ghrelin (AG), leptin and PYY-3 in hyperemesis gravidarum (HG). Methods: Plasma samples of 86 women in their first trimester pregnancies with HG (n = 30), morning sickness of pregnancy (MSP) (n = 34) and control (n = 22) groups were obtained. Serum levels of TG, AG, leptin and PYY-3 were compared between the groups, and the correlations with severity of symptoms using modified PUQE (Pregnancy Unique Quantification of Emesis) scoring, BMI, E2, hCG and TSH were calculated. Results: Levels of TG, AG, PYY-3 and the TG/leptin ratio were significantly higher in HG group compared to MSP and the control groups (p ≤ 0.017). AG/TG ratio was significantly lower in the HG group compared to both MSP and control groups (p ≤ 0.017). There were either weak or no significant statistical correlations between the gut and adipose-related hormones and the modified PUQE scores, BMI, E2, hCG and TSH. Conclusion: Gut-derived metabolic hormones ghrelin, AG and PYY-3 may be involved in the HG pathophysiology.

Does postoperative misoprostol use induce intestinal motility? A prospective randomised double-blind trial.

Background:  Misoprostol has been shown to increase colonic activity and decrease colonic transit time in chronic constipation patients.

Comparação dos efeitos da perfusão de sevoflurano, desflurano e propofol sobre o sistema oxidante/antioxidante durante anestesia geral

BACKGROUND AND OBJECTIVES Desflurane and sevoflurane are frequently used for maintenance of anesthesia and studies have shown that these anesthetics cause a variety of changes to the oxidative stress and antioxidative defense mechanisms. This study aims to compare the effects of sevoflurane, desflurane and propofol infusion anesthesia on the oxidant and antioxidant systems of patients undergoing laparoscopic cholecystectomy. METHODS 45 patients between 18 and 50 years with planned laparoscopic cholecystectomy under general anesthetic were included in the study. Patients were divided into three groups on the way to surgery: propofol (group P, n=15), sevoflurane (group S, n=15) and desflurane (group D, n=15). All groups were given hypnotic 2mg/kg propofol IV, 1mcg/kg fentanyl IV and 0.1mg/kg vecuronium IV for induction. For maintenance of anesthesia group S were ventilated with 2% sevoflurane, group D cases were given 6% desflurane and group P were given propofol infusions of 12mg/kg/h for the first 10minutes, 9mg/kg/h for the second 10minutes and 6mg/kg/h after that. Before induction and after the operation venous blood samples were taken to evaluate the levels of glutation peroxidase, total oxidants and antioxidants. RESULTS AND CONCLUSIONS The 45 patients included in the study were 22 male and 23 female patients. The demographic characteristics of the groups were similar. In the postoperative period we observed that while sevoflurane and propofol increased antioxidants by a statistically significant level, desflurane increased the total oxidants level by a significant amount compared to levels before the operation.

B-Lynch suture after the failure of hypogastric artery ligation to control post-partum hemorrhage due to placenta increta in a patient with the factor V Leiden mutation

Post‐partum hemorrhage may be a life‐threatening condition. A case of a patient receiving antithrombotic therapy for the factor V Leiden mutation, in whom post‐partum hemorrhage had occurred due to placenta increta, is described. In this case, the post‐partum hemorrhage did not respond to bilateral hypogastric artery ligation, while the B‐Lynch surgical technique was successful in obtaining hemostasis.