Retrospective analysis of stoma-related complications

Objective: One of the few factors, that affect life of peoplehave stoma negatively, are complications developing intissues where placed stomas or near stomas. We aimedto evaluate the stoma practices performed frequently inour clinic.Methods: Between January 2008 and December 2011,the records of 96 patients who had stoma retrospectively.Factors indication for stoma, emergency procedure, preoperativestoma, type of stoma and complications sitingrecorded.Results: Ninety-six stoma patients were examined. Ofthem 66 (68%) of them was male, 30 (32%) of them wasfemale. The mean age was 58.8±12.6 years. The mostcommon colostomy patients were diagnosed obstructionof colon(66%) and ileostomy patients were diagnosedanastomosis protective ((75%). The most common typeof stoma were as follows 54 loop colostomy, 16 end colostomy,10 tube gastrostomy and 7 loop ileostomy. Theoverall complication rate was 48%. Both elective andemergency stomas had similar complication rates. Themost common complication included peristomal skin irritation(63%), peristomal infection (25%) and prolapse(5%) The stoma with the highest complications rate wasloop colostomy (57%).Conclusion: In our opinion, mortality and morbidity ofstomas may be decreased with the meticulous surgicalprinciple, regular follow- up and patient education. J ClinExp Invest 2013; 4 (1): 63-66Key words: Stoma, colostomy, ileostomy, complicatio

The evaluation of Pat-Pat related injuries in the western black sea region of Turkey

BACKGROUND: Accidents caused by motorized vehicle in the agricultural sector are frequently observed. In Turkey; accidents arising from motorized vehicles, named Pat-Pat, which are used by farmers in the Western Black Sea region is not unusual. METHODS: One hundred five patients who were brought into the Emergency Department of Duzce University, Medical Faculty Hospital between September 2009 and August 2010 due to Pat-Pat related accidents were evaluated. RESULTS: The cases consisted of 73 (69.5%) males and 32 (30.5%) females, ranging from 2 to 73 years of age. In the 10-39 age group, a total of 63 (60.0%) cases were determined. The months when the greatest rate of cases applied to the hospital consisted of July, August, September and the season is summer. The cases were exposed to trauma in roads in 54 (51.4%), and 51 (48.6%) occurred in agricultural area without roads. Eighty seven (82.9%) cases were injured due to the overturning of vehicle. The patients were brought to the hospital using a private vehicle in 54 (51.4%) of the cases and in 51 (48.6%) cases, 112 ambulance system was used. The cases were determined to apply to the hospital most frequently between 6 pm-12 am. The injuries frequently consisted of head-neck and spine traumas, thorax traumas and upper extremity traumas. In 55 (52.4%) cases, open wound-laceration was determined. Seventy five (71.4%) cases were treated in the Emergency Department, and 28 (26.7%) were hospitalized. Three (2.9%) cases were deceased. CONCLUSIONS: Serious injuries can occur in Pat-Pat related accidents, and careful systematic physical examination should be conducted. In order to prevent these accidents, education of farm operators and engineering studies on the mechanics and safety of these vehicles should be taken and legal regulations should be created

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 desfiurane (group D n: 15). All groups were given hypnotic 2 mg/kg propofol IV, 1 mcg/kg fentanyl IV and 0.1 mg/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 12 mg/kg/h for the first 10 min, 9 rrig/kg/h for the second 10 min and 6 mg/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, desfiurane increased the total oxidants level by a significant amount compared to levels before the operation. (C) 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved

Sezaryen ile Doğurtulan Bebeklerin Apgar Skoru, Troid ve Karaciğer Fonksiyonları Üzerine Genel ve Spinal Anestezinin Etkileri

Purpose: In our study we aimed to compare the Apgar scores, thyroid and liver functions ofneonates, who were delivered with elective caesarean section undergoing general anesthesia orspinal anesthesia.Methods: 60 patients with age 18–40 were included. Patients were randomized in 3 groups:general anesthesia inducted with propofol or with thiopenthal or spinal anesthesia. In propofolgroup induction was perf ormed with propofol 2 mg/kg and rocuronium 0,6 mg/kg and thenpatients were intubated. In thiopenthal group induction was performed with thiopental 4–5mg/kg and rocuronium 0,6 mg/kg and then patients were intubated. In both groups anesthesiamaintenance was provided with sevoflurane. In spinal anesthesia group, spinal anesthesia wasperformed with bupivacaine intrathecally. In all 3 groups maternal haemodynamic parametersat zero, 5, 10, 15, 20, 25, 30, 35, 40, 45 th minutes were recorded. When the neonate is 5 daysold, tyroid functions and liver functions were evaluated.Results: In thiopenthal group, FT3 values of neonates were significantly decreased (pAmaç: Çalışmamızda, genel ve spinal anestezi uygulanarak elektif sezaryen ile doğurtulanbebeklerin troid ve karaciğer fonksiyonlarının karşılaştırılması amaçlandı.Yöntem: Çalışmaya yaşları 18 – 40 arası 60 gebe alındı. Olgular indüksiyonda propofol vetiyopental uygulanan ile spinal anestezi uygulanan grup olarak üçe ayrıldı. Propofol grubuna,indüksiyonda 2 mg/kg propofol, 0,6 mg/kg roküronyum uygulandıktan sonra, tiyopental grubunaindüksiyonda 4–5 mg/kg tiyopental, 0,6 mg/kg roküronyum uygulandıktan sonra entübasyongerçekleştirildi. İki grupta da anestezi idamesi sevofluran ile sağlandı. Spinal anestezi grubunaintratekal bupivakain verilerek spinal anestezi uygulandı. Gebelerin 0, 5, 10, 15, 20, 25, 30, 35,40, 45. dakikalardaki maternal hemodinamik parametreleri kaydedildi. Bebeklerin doğumunun5. gününde, troid ve karaciğer fonksiyonlarına bakıldı.Bulgular: Tiyopental uygulanan gebelerin bebeklerinde, FT3 düzeyleri anlamlı olarak düşükbulundu (

Postoperatif Kardiyak Arrest Gelişen Bir Çocukta Resusitasyon Sonrası Ortaya Çıkan Antikolinerjik Sendrom

Central anticholinergic syndrome is considered to reveal after blocking of central and peripheral cholinergic muscarinic receptors. Although central anticholinergic syndrome can be diagnosed with its clinical signs, the definitive diagnose can be made according to the response with physostigmin administration. It is aimed to discuss the therapy of a child who revealed the clinical signs of central anticholinergic syndrome (agitation, mydriasis, excitation, tachycardia, flushing, and fever) after resuscitationAntikolinerjik sendrom, kolinerjik muskarinik reseptörlerin santral ve periferik olarak blokajı ile oluşur. Santral antikolinerjik sendrom bulguları klinik olarak tanınabilmesine rağmen, kesin tanı, klinik bulguların oluşmasından sonra, fizostigmin verildiğinde hastanın bulgularının düzelmesiyle konulabilir. Biz de resusitasyon sonrası bir çocuk hastada, tedavi edilemeyen ajitasyon, midriyazis, uyuklama, eksitasyon, taşikardi, kızarıklık ve ateş gibi klinik bulguların tespit edilmesi ile santral antikolinerjik sendrom düşündüğümüz olguyu sunmayı amaçladı

The comparison of tecniques of different sedo-analgesia in the outpatient gynaecologic operations

AMAÇ: Kısa süreli jinekolojik işlemler genellikle sedo-analjezi ile yapılmaktadır. Bu çalışmamızda günübirlik anestezi uygulanan bu küçük cerrahi girişimlerde sedo-analjezik olarak kullanılan propofol, etomidat ve ketaminin etkilerinin karşılaştırılmasını amaçladık YÖNTEMLER: Amerikan Anesteziyoloji Derneği (ASA) I-II risk grubu, 25-50 yaş arası toplam 75 hasta çalısmaya dahil edildi. hastalara operasyondan 30 dakika önce midazolam 0.04 mg/kg im premedikasyon amacıyla uygulandı. Grup P’ deki hastalara 0,5mg/kg propofol, grup E ‘deki hastalara 0,1mg/kg etomidat, Grup K’daki hastalara 0,5mg/kg ketamin IV bolus yapıldı. Hastaların Ramsey Sedasyon Skorları, uyanma zamanı, derlenmeye alınma süreleri, ek ilaç dozları, total ilaç miktarı, oluşan yan etkiler kaydedildi.BULGULAR: Propofol grubundaki hastaların %60’ında apne, %13.3’ünde hipotansiyon, %33.3’ünde bradikardi, %33.3’ünde enjeksiyona bağlı kolda ağrı,Etomidat grubundaki hastaların %6.7’sinda apne, %40’ınde bulantı-kusma, %33.3’ünde myoklonik hareketler, Ketamin grubundaki hastaların %6.7 ’sinde myoklonik hareketler, %13.3’ünde bulantı-kusma görüldü.SONUÇ: Hastaların hızlı ve rahat uyanmasını en iyi sağlayan etomidat-alfentanil grubu olmakla beraber ek hastalıkları göz önüne alınarak ilaçlar tercih edilmesi gerektiğini düşünüyoruzOBJECTIVE: In general short-term gynaecological operations are performed under sedo-analgesia. In our study, we aimed to compare the effects of propofol, etomidate and ketamine which are frequently used for sedoanalgesia in short-term procedures.METHODS: 75 patients with age between 25-50 and operation risk of ASA I-II were included. Within 30 minutes before the operation, patients were premedicated with midazolam 0,04 mg/kg. Sedo-analgesia was performed with propofol 0,5 mg/kg in group P, with etomidate 0,1 mg/kg in group E and with ketamine 0,5 mg/kg in group K. Ramsay sedation scale, awakening time, time to being transferred to PACU, additional doses, total doses and side effects were recorded.RESULTS: In group P 60% of patients had apnoe, 13,3% had hypotension, 33,3% had bradycardia, 33,3% had pain in injection area. In group E, 6,7% of patients had apnoe, 40% had vomiting, 33,3% had myoclonic movements. In group K, 6,7% of patients had myoclonic movements, 13,3% had vomiting.CONCLUSION: Etomidate-alfentanyl combination was upper when compared with other groups in faster and simplified awakening. In addition to that, we sustaine that additional diseases of patients must be taken in the consideration to make a better drug-combination choice

Geç Teşhis Edilen Konjenital Diyafragma Hernisi: Olgu sunumu

Congenital diaphragmatic hernia CHD is a congenital anomaly characterized by an anatomical defect in the diaphragm, accompanied by various anomalies regarding cardiac, urogenital, chromosomal, genetic and skeletal system. It has not well-known etiology, and causes the intrauterine organs to enter the fetal thoracic cavity in the early stages of the lung development. Its mortality rate in live newborns varies between 10% and 35%. Although recurrent respiratory distress and atypical abdominal pain are commonly observed clinical manifestations in older patients, its prognosis is better than the patients diagnosed in the neonatal period. Its treatment can delay due to the difficulty of establishment of the diagnosis at the advanced age. The most classical form of CHD is encountered as a defect in the left posterolateral diaphragmatic area. The left lobe of liver, spleen and almost all gastrointestinal tract structures pass into the thoracic cavity from this defect. On the other hand, the right lobe of liver and other abdominal organs pass into the thoracic cavity from right-sided hernias. In these cases, hepatic veins can be opened ectopically to the right atrium, which may complicate surgical repair. In this paper, we presented a case of CHD who admitted to the emergency department with severe abdominal pain and diagnosed at lateterm, as well as our experience regarding the performed anesthesia methodKonjenital diyafragma hernisi KDH , diyafragmada anatomik defektle karakterize, akciğer gelişiminin erken dönemlerinde karın içi organların fetal göğüs boşluğuna girmesine neden olan, etyolojisi bilinmeyen sıklıkla kardiyak, ürogenital, kromozomal, genetik ve iskelet sistemine dair çeşitli anomalilerin eşlik ettiği doğumsal bir anomalidir. Canlı doğan yenidoğanlarda mortalite %10-35 arasında değişmektedir. İleri yaş hastalarda sıklıkla tekrarlayan solunum sıkıntısı ve atipik karın ağrısı görülmekle beraber, prognoz yenidoğan döneminde tanı almış hastalara göre daha iyidir. İleri yaşta bulgu veren KDH’de teşhis zor olduğundan, tedavide gecikme olabilir. KDH’nın en klasik formu sol posterolateral diyafragmatik bölgede bir defekt olarak karşımıza çıkar. Bu defektten, karaciğer sol lobu, dalak ve hemen tüm gastrointestinal sistem göğüs boşluğuna geçmiştir. Sağ taraftaki hernilerde ise, karaciğer sağ lobu ve diğer karın içi organlar göğüs boşluğuna geçer. Bu olgularda hepatik venler ektopik olarak sağ atriyuma açılabilir; bu da, cerrahi onarımı güçleştirebilir. Biz bu olgumuzda, şiddetli karın ağrısı ile acil servise başvuran ve geç teşhis edilen KDH’li hastayı ve uygulanan anestezi yöntemi ile ilgili deneyimlerimizi paylaştı