Makale Arama

Aim: To compare patients applied with tracheotomy because of prolonged intubation before the COVID-19
pandemic and during the pandemic.
Patients and Methods: A retrospective examination was made of the records of 179 patients with a tracheotomy
opened following prolonged intubation in the Intensive Care Unit of Karaman Training and Research Hospital
between September 2018 and August 2021. The patients were separated into two groups as group 1 (n:80)
of patients with tracheotomy in the 18-month period before the COVID-19 pandemic (September 2018 –
February 2020) and group 2 (n:99) of patients with tracheotomy during the COVID-19 pandemic (March
2020-August 2021). The two groups were compared in respect of demographic characteristics, duration of
intubation, early and late complications associated with tracheotomy, and patient outcomes (exitus, discharge
to home, transfer to palliative and other wards).
Results: Group 1 comprised 45% females and 55% males and group 2 comprised 51% females and 49%
males, with no statistically significant difference determined between the groups in respect of gender. A
statistically significant difference was determined between the groups in respect of age and the duration
of intubation (p<0.05). Tracheotomy-related complications were not determined to be significantly different
between the groups (p>0.05).
Conclusion: The patients in this study with a tracheotomy opened during the COVID-19 pandemic were
observed to be younger than patients with tracheotomy applied before the pandemic. In addition, the duration
of intubation was determined to be longer during the pandemic t han in the pre-pandemic period.

\r\n Purpose: Mesh erosions that necessitates excision can develop in Trans Obturator Tape (TOT) surgeries which are widely used in the treatment of stress urinary incontinence.

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\r\n In our study, we described a method of vaginal flap placed under suburethral sling to prevent urethral mesh erosion related with TOT surgery and evaluated the patients for postoperative complications.

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\r\n Materials and methods: In our study, 22 patients who had TOT and cystocele operations simultaneously and to whom flaps composed of vaginal tissue were placed in front of the urethra under the mesh between December 2014 and May 2018 were evaluated retrospectively. Patients were evaluated for urethral mesh erosion, vaginal mesh erosion, complaints of urgency and dyspareunia, urinary retention, and need for secondary surgery.

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\r\n Results: The mean postoperative follow-up of the patients were 8,95±8,45 months. 20 patients had simultaneous TOT and cystocele operations (%90,9), 2 patient had vaginal hysterectomy, TOT and cystocele operations simultaneously (%9,1). Urethral mesh erosion developed in none of the patients during the follow-up period. Vaginal mesh erosion and dyspareunia was observed in only one menopausal patient. Urinary retention and overflow incontinence developed in another patient. Vaginal hysterectomy, TOT and cystocele operations were made simultaneously in this patient. Mesh of this patient was cut later on.

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\r\n Coclusion: The surgical technique we used in our cases kept urgency and vaginal mesh erosion in a minimal level besides totally preventing urethral mesh erosion in a mean short-term follow-up period of 9 months.

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ABSTRACT

Aim: Sternal dehiscence is one of the most troublesome complications following cardiac surgery. Although it can be corrected by simple methods if detected earlier, treatment failure or delay in sternal dehiscence may result in mediastinitis, which is highly lethal.  In this study, we aimed to investigate alternative sternal closure systems, mainly sternal talon (STalon) and titanium sternal plates (SPlate). Patients and Methods: In between April 2015 and January 2018, patients with sternal dehiscence after any kind of open cardiac surgery were included in this study. These patients were retrospectively evaluated according to the their demographic data, risk factors for sternal dehiscence, type of operations, techniques used for fixation of the sternum, mainly focusing on the STalon and titanium SPlate fixation. Results: A total of 45 patients were taken into surgical correction because of sternal dehiscence.  Thirty-four (75.6%) of the patients male, whereas 11 (24.4%) were female. Mean time interval after the first operation to sternal dehiscence was 68.5 days (1-780 days). Mean body-mass-index (BMI) was 31.52 kg/m² (22.03-43.69 kg/m²). Before the sternal fixation, mean CRP value was 68.34, whereas it was 75.55 before discharge. Confounding risk factors were internal mammarian artery (IMA) harvesting for coronary artery disease, diabetes mellitus, bronchial asthma, chronic pulmonary artery disease and advanced age. Mean post-operative intensive care unit (ICU) length-of-stay (LOS) was 5.02 days (1-29 days), whereas hospital LOS was 17.18 days (2-74 days). Early mortality was observed in 3 patients (6.67%). The first choice of operation was simple closure and/or Robicsek closure. Apart from simple and Robicsek closure techniques, sternal talon and/or titanium plates were used in 24 patients (53.3%). DM was found to be related to extanded total hospital LOS, ICU LOS, and postoperative time to discharge. DM also increased the risk of both superficial and deep sternal infection rates (p<0.05).  Conclusion: Ideal sternal closure should stabilize the sternum, be cost-effective and provide shortest hospital LOS with minimal post-operative complications. In patients with intact intercostal spaces, sternal talon may eliminate serious complications, such as cardiac rupture mainly caused by dense adhesions. Sternal plates are mainly effective in fragmented fractures without stable intercostal spaces. All patients should be individualized according to type of lesions and sternal fractures.

\r\n Colloid cysts are rare benign tumors of the third ventricle and have a wide range of clinical representations from incidentomas to acute death.  The growth of these cysts is an uncommon event and may cause obstructive hydrocephalus that lead to sudden deterioration in the patient's condition and may cause life-threatening complications. The large colloid cyst of third ventricle caused sudden death of children due to clogging, diagnosed in vivo is a very rare case in literature. We are representing here a case which patient admitted to emergency room for sudden loss of consciousness. Even he had urgent ventriculostomy due to acute hydrocephalus development, brain death has occured because of 3rd ventricle colloid cyst.

Introduction and Objective

Brucellosis is a zoonotic infection seen as an endemic in Turkey and is a public health problem at the same time. The objective of this study was to evaluate demographic/epidemiologic, clinic, laboratory features, complications and treatments in brucellosis patients followed-up in our clinic.

Material & Methods

In this study, features of patients followed-up between 01/01/2010 and 31/12/2018 in our clinic were retrospectively evaluated. Descriptive data were expressed as number and percentage. Categorical variables were analyzed with Chi-square test and numerical variables with Student’s t test.

Results

Of the total of 365 brucellosis patients, 159 (43.56%) were female and 206 (56.44%) were male. The mean age of the patients was 45.9±14.51 (18-82) years. The most common time of presentation was summer season with 137 (37.5%) patients. The most common transmission route of the disease was a history of animal husbandry with 252 (69%) patients. Of all cases 168 (46%) were acute, 96 (26.3%) were subacute, and 101 (27.7%) were chronic brucellosis. The most common complaint of the patients was fatigue in 302 (82.7%) patients with being higher in acute brucellosis (p=0.0015). Anemia was found in 53 (33.3%) male and 114 (55.3%) female patients with being significantly higher in female patients (p=0.0283). Leukopenia was found in 7.9%, leukocytosis in 16.2%, thrombocytopenia in 9.6%, neutropenia in 4.1%, neutrophilia in 9% and lymphomonocytosis in 12% of the patients. Wright agglutination test was performed in 26 (7.1%) and brucella immunocapture agglutination test in 361 (98.9%) patients and all results were positive. Of all patients, 172 (47.1%) developed complications with spondylodiscitis being the most commonly found in 58 (15.9%) patients. Sixty-one (31.8%) of patients developed relapse.

Conclusion: Since brucellosis is endemic in our country, it should be considered in presumed diagnosis of patients presenting with complaints such as fatigue, articular pain and fever.

Background: Facelift surgery is a frequently preferred aesthetic surgery procedure to reduce the signs of aging and achieve a more youthful appearance. The incidence of complications such as hematoma is quite high among patients undergoing facelift surgery. This study aims to compare the efficacy of TXA and hemostatic net technique in terms of preventing hematoma formation in facelift surgery patients.

Patients and Method: The study included 65 patients (56 F, 9 M) who underwent deep plan facelift and face and neck lift between October 2019 and February 2023. Patients were evaluated in four different groups: TXA given, those applied hemostatic net, those applied both, and the control group applied neither. Demographic information, follow-up findings, any hematoma or other complications in the postoperative period were recorded. Differences between the groups were evaluated statistically.

Results: The mean age of the patients was 54 years. The patient group using only TXA consisted of 17 patients, the group hemostatic net applied consisted of 9 patients, the group applied both consisted of 21 patients, and the control group consisted of 18 patients. Hematoma was observed in 6 patients in total. Although a numerical decrease in the incidence of haematoma was observed in patients in whom only haemostatic net was used and in patients in whom only TXA was used, it was not statistically significant (p>0.05). The incidence of haematoma decreased that is statistically significant in patients in whom TXA and haemostatic net were used together (p<0.05).

Conclusion: Tranexamic Acid and hemostatic net both together showed to be effective in reducing the incidence of hematoma. It is thought that these measures may improve surgical outcomes and accelerate the recovery process of patients.

Aim: Chest radiography and thoracic computed tomography (CT) play an important role in the diagnosis and
prognosis of sarcoidosis, a systemic granulomatous disease characterized by non-caseating granulomas.
Pulmonary hypertension, a rare complication of the disease, can be seen in all stages. There is a strong
correlation between pulmonary hypertension (PH) and an increase in the diameter of the main pulmonary
artery (MPAD). In this study, we aimed to evaluate MPAD with multislice computed tomography (CT)
examination for the early diagnosis of PH in patients with stag e II sarcoidosis.
Patients and Methods: We measured the diameter of the main pulmonary artery on thorax CT in patients
with stage II sarcoidosis, who were followed up in our hospital with a diagnosis of sarcoidosis between
January-2018 and December-2021, with hilar lymphadenopathy and parenchymal changes in their imaging,
and compared them with the control group, whose chest X-ray was normal and thorax CT scan was performed
with nonspecific symptoms. We evaluated the relationship between the pulmonary artery pressures obtained
by echocardiography and the diameter of the main pulmonary arte ry in patients with stage II sarcoidosis
Results: We found a significant correlation between the increase in MPAD and pulmonary artery pressure
measured by ECHO in patients with sarcoidosis compared to the control group, and the pulmonary artery
diameter measured by CT in this patient group.
Conclusion: We think that CT evaluation of pulmonary artery diameter in patients with sarcoidosis can guide
the development of PH and therefore of fer an opportunity for early intervention.

Aim:

The present study was undertaken to evaluate the prevalence, height and location of maxillary sinus septa in patients with a dentate and an edentulous maxilla using cone beam computed tomography imaging.

Patients and Methods:

This descriptive study was conducted on a retrospective evaluation of cone beam computed tomography images of 1322 maxillary sinus with 661 subjects from January 2016 to February 2018. The study consisted of 1322 maxillary sinuses: 1092 from patients with a dentate and 230 from patients with an edentulous maxilla.

Results:

The mean age of the 661 patients (373 women, 288 men) was 42.1 ± 18.2 years. A total of 468 (35.4%) septa was recorded in 1322 maxillary sinuses  with a mean height was 7.95 ± 4.03 mm. Of 468 sinus septa, the majority was located in the posterior region of the maxillary sinus. Of these, 121 (25.8%) were in the anterior, 140 (29.9%) were in the middle and 207 (44.2%) were in the posterior region.

Regarding the status of the dentition in the maxilla in relation to the distribution of sinus septa, septa were present in 387 (35.4%) dentate and in 81 (35.2%) edentulous regions.

Conclusion:

The prevalence of septa is high in all parts of the maxillary sinus. For this reason, comprehensive evaluation should be performed with an appropriate radiographic technique to prevent possible complications during sinus surgery.

Aim: Bites are an essential cause of injury since the world. Treatment of bites is made according to specific guides and principles. The study's purpose is to examine the demographic characteristics of patients hospitalized due to bite wounds and to be a guide for new studies and treatments by sharing surgical treatment experiences.

Material and Method: Patients who were bitten and required surgical treatment were included in the study. Demographic characteristics, tetanus, and rabies prophylaxis applications, infection agents isolated from the wound site, antibiotherapies applied, and surgical treatments were recorded.

Results: Of the patients, 43 were male and mean age (±SD) of 34.5±23.8years (range, 3-85 years). Bites were in the head and neck region in 13(65%) of patients under 15 years old and in 12(27.3%) of the patients over 15 years old. In extremities, the injury was present in 7(35%) patients under 15 and in 28(63.6%) patients over 15 years old. Of the injuries, 50(78.1%) were caused by dogs, 8(12.5%) by wild animals (7 pigs, one wolf), 4(6.3%) by other pet species (horse, donkey, cow), and 2(3.1%) by humans. The intervention was made to all the patients according to guide of rabies prophylaxis specified by the Ministry of Health, General Directorate of Public Health. Irrigation was applied to the wound site with plenty of pressurized and soapy water. Forty patients received tetanus prophylaxis, 62 patients received rabies prophylaxis, and rabies immunoglobulin was applied to patients considered as suitable. Prophylactic amoxicillin clavulanate treatment was started in 38 of the patients, crystalline penicillin-G in 12, sultamicillin in 6, the combination of sultamicillin and aminoglycoside in 6, and cefazolin treatment in 2. 12(18.8%) patient underwent an urgent operation for repair process without any microbiological examination on the date of arrival. Among the patients to whom repair was applied on the first day, 7 had primary saturation, 3 had a local flap, 1 underwent ear, and 1 underwent nasal replantation, one patient had femoral artery repair, and one patient had peroneal nerve repair. Among 52 patients who underwent late repair, primary suturation was applied to 35, skin graft to 4, local flap to 17, and paramedian forehead flap to 2. No complication was seen in any of the patients who underwent early and late repairs.

Conclusion: Bacterial burden of the wound can be reduced enough to allow urgent repair owing to the irrigation of the wound with plenty of pressurized and soapy water in bites. 

Aim: The aim of this study is to evaluate the versatility of the use of FDMA flaps in soft tissue defects in
the fingers.
Patients and methods: Patients who underwent reconstruction due to soft tissue defect in the upper
extremity between May 2018 and May 2021 were scanned over the file. Among these patients, patients
who had a finger defect and were reconstructed with the first dorsal metacarpal artery flap were included
in the study .
Results: 12 patients were included in the study. The etiology of the defect was trauma in all patients.
Tunneling technique was used in 5 patients for flap adaptation. No patient experienced total flap or graft
loss. Age, gender, comorbidity, defect localization, defect size and operation time were examined in terms
of complications. No statistically significant difference was detected. Smokers and non-smokers were
examined, no statistically significant difference was found. The use of tunnel for flap adaptation did not
make a statistically significant dif ference in terms of complications.
Conclusion: First dorsal metacarpal artery flap is a very reliable option for defects in the 1st and 3rd
fingers. If the tunnel technique is used, it should be ensured that the tunnel width is suf ficient.

\r\n Prognostic importance of thrombocyte indices in children with carbon monoxide poisoning

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\r\n Abstract

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\r\n Objective: Carbon monoxide (CO) poisoning is still being a major cause of morbidity and mortality all over the world. Although the role of platelet functions in CO poisoning is not clear, increased platelet activation and aggregation had been reported previously. Increased thrombotic tendency due to endothelial damage, increased platelet stickiness, and alterations in the fibrinolytic pathway occurs in CO poisoning. The aim of our study was to determine whether platelet indices provide clinical benefit or not in children with CO poisoning.

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\r\n Materials and Methods: We retrospectively reviwed the records of children with the diagnosis of CO poisoning who admitted to the pediatric emergency departments of Konya Beyhekim State Hospital and Necmettin Erbakan University Meram Medical Faculty. A total of 92 children with CO poisoning and 62 age- and gender-matched healthy controls were included in the study.

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\r\n Results: While mean platelet volume (MPV) and platelet distribution width (PDW) levels were significantly higher (9,34±0,55 vs 9,78±0,97fL, p=0.001 ; 11,46±2,64 vs 10,57±1,41, retrospectively, p=0.007), platelet count and plateletcrit (PCT) (324,05±82,07 vs 357,27±89,70 x10⁹ p=0.015 ; 0,31±0,06 vs 0,33±0,07, retrospectively, p=0.039) were significantly lower in patients with CO poisoning. MPV levels were also significantly higher in patients with a carboxy hemoglobin (COHb) level higher than 20, when compared with COHb levels between 10-20 (9,40±0,84 vs 10,08±1,22 fL, p=0.003).

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\r\n Conclusion: Our results showed that platelet indices MPV and PDW are markedly elevated in patients with CO poisoning while platelet count and PCT were decreased. MPV and PDW levels, which reflect the changes in platelet activation and function, may predict the development of especially thromboembolic complications in the course of CO poisoning.  MPV and PDW levels may be useful in prognostic estimation of CO poisoning.

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\r\n Keywords: carbon monoxide; children; platelet indices; poisoning

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Bone wax is a commonly used hemostatic agent derived from beeswax. It is used widely in neurosurgery, orthopaedic surgery, maxillofacial and orthognathic surgery.  Although few case reports have emerged regarding complication due to the bone wax, the use of it continues in various surgical sites.  We report an unusual case of a non-healing ulcer over the iliac crest appearing one year after bone harvest was done for alveolar bone grafting

ANTEGRAD URETERAL STENTING; INDICATIONS - METHODS - COMPLICATIONS AND RADIOLOGICAL APPROACH TO  COMPLICATIONS

Abstract:

Objectives

The aim of this study is to evaluate the indications, success rate, complications, technical success enhancing method, methods of antegrad ureteral stenting and the radiological management of complications due to retrograde and antegrade ureteral stenting in the treatment of ureteral obstructions and ureteral leaks caused by malignant and benign etiologies.

Materials and Methods

In this retrospective study, fluoroscopy and US-guided antegrade ureteral stenting procedures between January 2016 and December 2018 were examined. The study included 110 antegrade ureteral stenting and percutaneous nephrostomy in a total of 78 patients with 25 female patients (32.05 %), a mean age of 65.87 (20-90) and 53 male patients (67.94%) with a mean age of 68.73 (30-90).  Demographic data, antegrade ureteral stenting indications, procedure results and complications were evaluated for each patient.

Results

Antegrade ureteral stenting is a good alternative for patients with retrograde ureteral stent placement and already with percutaneous nephrostomy catheters. It has a high technical success rate and low complication risk. The use of the equipment used in other radiological procedures in antegrade ureteral stenting increases the technical success. Malposition,  perforation, hemorrhage, urinoma, abscess complications such as retrograde or antegrade ureteral stenting can be managed by radiological methods.

Key Words: Double J Ureteral stent, Ureteral obstruction, Percutaneous, Antegrade, Hydronephrosis,

Aim: In this study, we aimed to discuss our experience and results of non-operating room anesthesia.

Materials and Methods: Anesthesia records of patients older than 18 years who underwent sedo-analgesia outside the operating room for diagnosis and treatment between May 2017 and December 2017 were retrospectively screened. The records were examined in terms of demographic data, applied procedure, duration of the procedure, sedation grade, medications used, developing minor and major complications, chronic obstructive pulmonary disease story and intensive care need. Relationships between complications with demographic data and categorical variables were analyzed.

Results: Totally 2562 patients underwent sedo-analgesia. 1428 (55.7%) of these cases were female and 1134 (44.3%) of them were male. The average age of patients was 53.08±16.55. 268 (10.5%) of the cases were ASA I, 1683 (65.7%) were ASA II, 598 (23.3%) were ASA III and 13 (0.5%) were ASA IV. 519 (20.3%) patients were minimally sedated, 1541 (60.1%) were moderate sedated and 502 (19.6%) deep sedated. The longest procedure time in endoscopic retrograde cholangiopancreatography was 28.7 ± 16.3 min, and the shortest procedure time in endoscopy was 10.3 ± 3.1 min. The most commonly performed procedure was colonoscopy with 31%. The most commonly used drug combination was midazolam + propofol + fentanyl applied to 1231 patients (48%). 148 (5.76%) patients had minor complication, and 10 (0.37%) patients had major complication. A total of 15 (0.58%) patients underwent intensive care after the procedure. Desaturation was statistically significantly higher in patients with ASA III and above, in procedures take longer than 15 minutes, in patients older than 65 years, and in the presence of chronic obstructive pulmonary disease. The intensive care need after the procedure was also significantly higher in these patient groups.

Conclusion: The incidence of non-operating room anesthesia is increasing steadily. The risks associated with these practices are similar to the anesthesia in the operating room. In order to increase patient safety and reduce complications, it is important to carry out a thorough evaluation before the procedure, to provide proper monitored anesthesia care in appropriate physical conditions, and to establish healthy communication between the teams.