Makale Arama

Aim: In autologous breast reconstruction, there is pain in the recipient site due to rib cartilage intervention in the postoperative period. In this study, we aimed to reveal the effect of the rib-sparing internal mammarian vessel approach on postoperative pain in breast reconstruction by comparing it with the noncostal-sparing approach.
Patients and Methods: Between 2018 and 2022 twenty five patients underwent surgery were included in the study. Groups were divided according to internal mammary artery(IMA) exposure techniques. Group 1: Patients who underwent rib-sparing surgery(n=9), Group 2: Patients who underwent rib cartilage resection(n=16). Patient Controlled Analgesia(PCA) pump usage time, morphine dose used, and early and late pain scores were noted in both groups in the postoperative period.
Results: The mean age of the patients was 49.8 years. No complications were encountered in the early and late postoperative period. All flap transfers were successful. Mean PCA duration was 24±1.41 hours in group 1 and 26.31±1.62 hours in group 2. The dose of morphine was 9.67±1 mg in group 1 and 23.93±3.02mg in group 2. The early pain score was 2.89±1.16 in group 1 and 5.18±1.22 in group 2. Late pain scores were 2.11±0.98 in group 1 and 2.75±0.77 in group 2.
There was a statistically significant difference between the morphine dose and early pain scores of the groups (p<0.01). There was no significant difference between the duration of PCA use (p=0.3) and late pain scores (p=0.07) (p>0.05).
Conclusion: In conclusion, we think that costal sparing surgery significantly reduces pain in the early period during recipient site preparation in autologous breast r econstruction.

It is important to take into consideration of patient expectations and satisfaction in terms of the best utilization of required components that are necessary for the development of health services. The aim of this study was to evaluate the level of the patients’ satisfaction and detect factors affecting the satisfaction, who consulted to Department of Anesthesiology and Reanimation Clinic in Necmettin Erbakan University, Meram Faculty of Medicine. This study was performed on patients who were consulted to the Department of Anesthesiology and Reanimation Clinic, at the Necmettin Erbakan University, Meram Faculty of Medicine for time period of 4 months between November 2015 and February 2016. Within this period, 200 patients who applied to the clinic and accepted to participate in the study by approving informed consent form were included in the study. The survey form was filled by conducting face to face interview. The time duration between patients application to the clinic and their receiving anesthesia consent and ASA scores were recorded. Patient satisfaction coefficient was found as 90.32. Patients who indicated that they did not wait too long for the registration process and assay/analysis tests were 72% and 68.5%, respectively. 98% of the patients stated the physician and 96% of the patients stated the health staff were polite and respectful. The patients having university level and higher education illiterated lower satisfaction coefficients compared with the other levels of education (p = 0.01). The average time duration between patients application to the clinic and their receiving anesthesia consent was 3.00 ±1.014 hours. There was no statistically significant difference between the time duration for receiving anesthesia consent and the ASA score (p=0.08). It was determined that the patients who consulted to the anesthesiology clinic in our hospital had high satisfaction levels, and the patients with an education level of university and higher illutirated lower satisfaction levels compared with the other levels of education. It was concluded that studies that will shorten the waiting time for analysis / examination and the registration process would be useful to increase the level of satisfaction.

Objectives:

Customer satisfaction surveys are a routine device used to assess performance. Surveys are used in hospitals to check physician and patient satisfaction. Hamad Medical corporation’s (HMC) histopathology laboratory is College of American pathologists (CAP) accredited with highly trained pathologists and technical staff that routinely undertake various educational courses and are involved in research related activities. The lab has state of the art staining and immunohistochemistry service as well. However, it was felt that not all clinicians are very comfortable approaching pathologists and some many times experience problems either contacting lab staff or updating histopathology orders. Hence to narrow down the problems encountered by the clinicians and improve the specimen flow through the lab along with the communication between clinician and pathologist, that we deem vital, we designed this pilot survey.

Methods:

The survey questionnaire was made online with 15 questions in total and the link was electronically mailed to all Consultant and Specialist physicians in Hamad medical corporation (HMC). Around 3500 emails were sent out but only 105 surveys were filled in two months’ time. The survey included questions pertaining to multiple facets of quality of histopathology services and information regarding the participant.

Results:

The overall satisfaction was highest for Multidisciplinary presentations (96%) and lowest (77%) for timeliness of reporting. The satisfaction was above 90% for clarity and format, Diagnostic accuracy and pathologists’ responsiveness to problems. Thirty six percent of the people rated MDT presentations as excellent while 46% of the people thought overall quality of professional interaction was good. The areas of improvement, as per this survey, was timeliness of reporting and notifications of significant abnormal results (overall satisfaction 79%). Majority of the people who took the survey (36%) were from internal medicine and half were members of multidisciplinary meetings (49%). Seventy-one of percent of the participants were from Hamad General hospital (HGH), while rest were from the other hospitals under HMC.

Conclusion:

The response rate for the survey was low, hence another survey with a wider reach, preferably by paper, is required to get more representative data. In general, the clinicians at HGH are satisfied with the services provided by the histopathology laboratory. Areas of improvement include Turnaround time (TAT), avoidance of descriptive reports and better communication with the ordering clinician.

Keywords:

Quality control, quality improvement, survey, histopathology, Laboratory

There is no consensus in approach to patients suffered from gunshot injuries since they almost die in scene or on the way to the emegency room. Manegement of the patients with gunshot bullet wounds of thorax is different even among thoracic surgeons. Complication of penetrating chest trauma due to gunshot injuries can occur within days, months even within years. A patient was admitted to the thoracic surgery clinic in bad condition. Foreign body was detected in chest X-ray patient. He had been considered stable and non complicated and discharged from hospital after a penetating gunshot injury of thorax two years ago. We report late presentation of empyema as a late complication of bullet after two years of injury.

This prospective study was carried out on 63 cases operated for the lumbar disc herniation, at the Medical Faculty of Selçuk University in 1996 in the first 9 months. All cases were divided into three equal groups :21 cases who had only disc operation was taken as first group, second group of cases re-ceived topical meperidine at the and of the ope-ration while third group of cases were applied me-peridine injected autolog fat graft. The patients were referred postoperatively 1, 3. 5 and 7 th days _according to "Mc Gill Pain S•ala". In this study we wanted to see the effects of the application method of meperidine on pos-toperative pain and comfortable mohilization.

Inguinal hernia repair surgery is one of the most common procedures. Strangulated inguinal hernia is one of the most widely performed surgical emergencies dealt with by surgeons worldwide. Uncommonly, strangulation of the contents can occur due to other causes like omental band adhesion. We reported a rare case of strangulated inguinal hernia, brought about by an omental band adhesion, causing closed loop small bowel obstruction and perforation within the hernial sac in the inguinal canal.

Meckel’s diverticulum is a rare cause of mechanical intestinal obstruction in adults. Due to non-specific symptoms and preoperative diagnosis of this rare condition, surgeons should keep in mind. A 28-year-old male patient was admitted to our emergency department with abdominal pain, nausea and vomiting for about 8 hours before onset. The patient was diagnosed as acute small bowel obstruction and underwent emergency surgery. At operation a torsioned ileum due to Meckel’s diverticulum 60 cm proximal to ileocecal valve and small bowel distention proximal to this site was seen. Ileum was detorsioned and Meckel’s diverticulum resection was performed. The patient was discharged on postoperative day 3. Histopathologic specimen were reported as Meckel’s diverticulum in 3x2x1cm size.

Single incision laparoscopic surgery is a rapidly evolving laparoscopic surgical approach. We report a comparison of single incision laparoscopic appendectomy (SILA) and standard laparoscopic appendectomy (SLA). Thirty-one patients who applied to a city hospital, and underwent laparoscopic appendectomy were included in this study. Twelve patients received SILA and 19 patients received SLA. Operation time, hospital stay, postoperative pain, diet, and postoperative complication were reviewed. There were no statistically significant differences in patients demographics and no differences between SILA, and SLA patients respectively, in operation time (65.8-58.9 minutes p>0.05), duration of hospitalization (1.8-1.3 days p>0.05), mean visual analogue scale score (2.8-2.6 p>0.05), and return to diet (12-14 hours p>0.05). Single incision laparoscopic appendectomy in experienced centers, can be a serious alternative to conventional laparoscopic appendectomy. Laparoscopy can be applied in each center, because it does not require special tools.

The temporal bone pneumatization is be divided into five section. These sections are as written down: The middle ear, squamomastiod (mastoid), perilabyrinthine, pertros apex and accessory. The accessory. The accessory section is divided as squamosal, zygomatic, occipital and styloid subsections. The volüme of the accessory air cell in temporal bone was measured by using the CT scans. 132 normal ears were observed in total of 66 cases. 34 of the cases were male, while 32 were female. The age average of the male was 39.50 where as it was 42,84 for the female. In our study, the pneumatic mastoid proportion of the male and female was observed as about 75-80 %. The zygomatic and squamoz air cells proportions were, especially, high in both sexes. The visibility of the proportions of the accessory air cells and their volumes were higher in the male when compared with the female however, it was not statistically significant (p>0.05). Our results were compared with sources and they were found adaptive. The result obtained here in should help surgeons in the middle ear planning operations on sections including accessory air cells.

Mechanical intestinal obstructions are frequent clinical problems that the surgeons come across in their daily surgical practices. Although the closed segment obstruction is a rare type of the mechanical intestinal obstruction, it is all the more dangerous because of the rapid increase in distension and its entailing strangulation based on the upset circulation in the intestinal wall. In our study we have discussed two closed segment cases related to colon tumor existence along with literature on the subject. The first case is a 38-year-old female patient who underwent only loop ileostomy without a resection because of inoperable rectosigmoid corner tumor 10 months ago at another health center. The patient presented to our clinic with complaints of abdominalgia and distension.The patient was diagnosed with closed segment obstruction based on the infiltration of the cecum by the tumor in the rectosigmoid area. The patient was treated through opening up a colostomy from the transverse colon.The second case was a 50-year-old male patient. The patient, who had undergone left hemicolectomy because of sigmoid colon tumor three years before, presented to the emergency service with a condition of mechanical ileus.The patient was diagnosed with closed segment obstruction in the small intestine related to the metastatic masses in the small intestinal mesentery, intraoperatively. The patient was treated through subtotal small intestinal resection.Closed segment obstructions are rare causes of mechanical intestinal obstructions that need to be treated rapidly. Closed segment obstructions that develop because of the tumor infiltration on both ends are quite rare. Therefore, we aim at discussing the aforementioned cases of closed segment obstruction that developed because of tumor obstruction on both ends and surgically treated in our clinic, along with literature on the subject.

Abdominal actinomycosis is a rare infectious disease caused by an anaerobic bacterium actinomyces israeli. Pelvic actinomycosis is generally associated with the use of intrauterin devices (IUD). This chronic suppurative infection can mimic pelvic malignancy. The diagnosis of the disease is frequently miss preoperatively. The surgeons must be aware of this rare complication in order to avoid an extensive surgical procedure. Case: We present the case of a 31 year old premenoposal woman with an abdominal pain and a history of IUD us efor 6 years. On physical examination the patient had tenderness on right lower abdomen and a palpable cystic mass 8x10 cm in size on pelvic bimanual examination. A preoperative transvaginal USG showed a 9x9 cm cystic mass originated from right ovary. The patient was taken to the emergency operating suite with the diagnosis of torsion of the right cystic ovary by gynaecologist. During the exploratory laparotomy we observed an extensive diffusely infiltrating process involving right adnexa, sigmoid colon sacrum and right pelvic Wall. A loop of jejunum was adherent to this infiltrating process and a mass 5x6 cm in size was palpated in sigmoid colon. These findings were highly suggestive of a colonic carcinoma and the patient was consulted with a general surgeon intraoperatively. Right salpingo -ooferectomy + sigmoid resection + segmental jejunal resection was performed. Pathologic findings showed chronic inflammatory tissue with evidence of actinomycosis. Conclusion: The case described here underlines that surgeons must be aware of this unusual infectious disease in the differential diagnosis of pelvic mass.

Abstract

Aim: This study was designed to compare the effect of the classical bull horn excision pattern lip lift technique (group I) and the lip suspension technique (group II) which was performed using a dermal flap prepared on the upper lip with the same pattern incision, on patient satisfaction and scar appearance in lip lift surgeries.

Patients and Methods: Twenty-eight female patients aged 48-66 years, operated by the author between 2016 and 2023, were analyzed in two groups. The first group included 14 patients who were operated on with the classical bull horn excision pattern lip lift technique, and the second group included 14 patients who were operated with the lip suspension technique using a dermal flap prepared on the upper lip with the same pattern incision under local anesthesia. At the end of the 6th month, the patients in both groups, who were followed up for 6 months, were asked about their satisfaction with the overall aesthetic result using the global aesthetic improvement scale. In addition, an evaluator surgeon scored the postoperative scar using the Vancouver scar scale. All results were evaluated statistically.

Results: 9 of 14 patients (66%) stated very much improvement in the group 2 in which the dermal suspension flap was used, while 6 of 14 patients (%42.9) stated very much improvement with classical technique in Group 1, in the postoperative assessment at 6th month. Likewise, when the scar score performed by the evaluator surgeon was examined in 6th month. The scar scale was 14 in group 1 and 4 in group 2. In Group 1, the values of the patients ranged from 0 to 4, and the mean value was 1.0. In Group 2, the values ranged between 0-2 and the mean value was 0.3. Overall patient satisfaction was clinically significantly higher in group 2 when compared with group 1 and the scar was found to be clinically significantly less in group 2 when compared with group 1, even though there is no statistical significance (p>0.05) between 2 groups in overall patient satisfaction and scar score, probably due to limited number of patients in groups.

Conclusion:

It has been concluded that lip lift surgeries performed using the dermal suspension flap technique can contribute as a valuable alternative to the classical excision method, due to both higher overall aesthetic patient satisfaction and less scarring in our patients.

Aim: This cross-sectional study aims to determine job satisfaction of research assistants taking medical specialization education at Meram Medical School and factors that may be related to job satisfaction. Patients and Methods: A questionnaire consisting of Minnesota Job Satisfaction Scale and questions regarding demographic information is applied to 244 (80,2% ) physician assistants via face to face meeting. Results: 52.5% of participants were male, 55.3% of them were married and 29.1% had at least one child. Average of age was 28.42±3.02 years. Average number of night duties monthly was 6.53±4.10. 9.8% of research assistants had quitted a specialization education before. 60.6% of physicians were not content with their salaries. Overall satisfaction point average was 3.24±0.53, intrinsic satisfaction point average was 3.40±0.56, extrinsic satisfaction point average was found to be 2.97±0.62. Extrinsic satisfaction point averages of physicians working in basic sciences was found to be significantly higher than averages of physicians working in internal medicine and surgery branches. 33.2% of physicians were satisfied with working conditions, 44.3% with their chiefs’ behaviours towards employees, 84.4% with their colleagues. Overall satisfaction and extrinsic satisfaction points of participants who graduated from medical schools in Konya were meaningfully higher than points of those who graduated from medical schools outside Konya. Conclusions: Improving the working environments and conditions of physicians having busy schedule, enabling them to have a voice in institution policies, increasing the wages will not only increase the job satisfaction level of research assistant physicians, but also the quality of service provided to patients.

The aim at this study is to evaluate women’s experience, opinion about mode of delivery, satisfaction with hospital care after cesarean section. This descriptive, cross-sectional study was carried out at 140 women who had cesarean section. The proposed cut off score for SMMSCB was 146.5 and 48.6% of the women had high level of satisfaction. The mean SMMSCB scale score was 144.9±18.7 (min=90, max=105). When subgroups of the scale was examined, ‘perception of health professionals’ was 20.1±3.4 (min=5, max=25); preparation for caesarean 7.9±1.9 (min=2 max=10); ‘comforting’ score was 7.8±2.9 ( min=3 max=15); ‘information and involvement in decision making’ score was 28.2±6.9 (min=8 max=40), meeting the baby 7.4±3.9 (min=3 max=15), postpartum care 7.5±5.1 (min=7 max=30), hospital room 10.5±3.1 (min=3 max=15), hospital facilities 9.9±2.9 (min=3 max =15), respect for privacy 15.1±3.7 (min=8 max=20), meeting expectations 14.6±2.9 (min=8 max =20). The level of satisfaction was found high in women who had given birth with epidural anesthesia and who were in the age group of 26-30 (p

One of the ways for the child to get familiar with its surrounding environment and to build up relations with the same is bringing any possible object to the mouth for tasting. Thus, the children happen to swallow foreign bodies of sorts and sizes unimaginable. A great portion of the grown up children swallowing foreign bodies demonstrate mental deficiencies or psychological problems. The clinic symptoms may be coughing, dyspnoea, hoarseness, breathing difficulty, weakened respiratory sounds and hyper saliva in the mouth. The foreign bodies are usually coins. We want to share an alternative treatment in foreign body aspirations. In this article is demonstrated an alternative approach for foreign body aspiration in four years old patients with down syndrome. The patient developed no complications during the medical intervention and discharged under recommendations. Foreign body aspiration is common in childhood. The majority of foreign bodies are coins. Approach to foreign body aspiration in a patient’s clinical presentation, type of foreign bodies, inserted in the aspiration time and the response shall be decided to treatment according to the conditions. Approaching treatment is endoscopy, observation or operation. In emergency alternative methods can be used such as balloon extraction with foley catheter by experienced surgeons.

Aim: The aim of the present study was to investigate the medical practitioners' approach to forensic cases and to composing forensic reports and to determine the problems they face regarding these issues and to present suggestions for solutions to problems. Material and Method: Questionnaire forms were administered to practitioners working in emergency services and 112 Hizir Acil (swift emergency ambulance and first aid) services of hospitals affiliated with the Ministry of Health in the Province of Konya and around and who participated in "Emergency Medical Service Certificate Program Basic Module Training" before their training. Results: 85.2 % of the practitioners who participated in the study stated that the undergraduate forensic medicine training was not adequate. It was seen that the percentage of the practitioners who received training on forensic medicine and report after graduation was 20.1 %. Among the subjects, 42.4 % of the practitioners stated that the forensic report should be prescribed by "the medical practitioner who made the first diagnosis", 84.3 % of the practitioners stated that they experienced an uneasiness because of the fact that the patient was a forensic case, 66.8 % stated that a unit which dealt with only forensic cases should be set up in the units they worked, however, they did not want to take part in that group. It was determined that, of the practitioners, the number of the ones who made wrong assessments regarding the issues in the Turkish Penal Code such as "vital danger", "simple medical intervention" and "the effects of bone fractures on life functions" was high. Conclusion: Although the rate of encountering forensic cases is high in practitioners, it is understood that practitioners experience uneasiness about writing forensic reports because of their lack of training and knowledge. It is suggested that practical training should be provided concerning the issues of forensic report writing, concepts used as criteria for severity of injuries and approach to forensic cases, especially to the practitioners who work at emergency services in order to remove the uneasiness experienced and to organize forensic reports according to objective criteria.

Tonsillectomy (with or without adenoidectomy) continious to be a commonly peıformed operation in the practice of otorhinolaryngology. Although the incidance of postonsillectomy haemorrhage has been decreased it is serious problem for surgeons. Bizmut Subgallate is an effective agent in pre-venting hemorrhage after adenotonsillectomy. It is shortened the clotting time of whole blood an activation of coagulation in assays of the partial thromboplastin time. The action of Bizmut Subgallate was localized to an effect on Ilageman Factor. In this report; control of bleding using topical Bismut Subgalltıte in the operation of 39 patients was discussed.

Aim: Platelet-rich plasma (PRP) is thought to exerts its effect through the growth factors present in the alpha granules of the platelets, depending on its high platelet concentration. The increasing feeling of pain in recurrent attempts raises the question that PRP may cause hyperalgesia associated with hypersensitization. There is no publication in the literature reporting peripheral sensitization caused by any recurrent injection of PRP. In this study, we aimed to investigate whether hyperalgesia occurs due to hypersensitization in PRP patients with androgenetic alopecia. Patients and Methods: Between 2016 and 2017, 10 male patients aged 25-35 years who had androgenetic alopecia were included in the study. Autologous PRP was injected intradermally as 1 mL per cm2 in the diseased frontal and parietal area of scalp, and then the injection was repeated at the first, second and sixth months. Patients’ responses to painful stimulus were investigated immediately before all injections and at the first year using Von Frey filaments in variable. Hyperalgesia scores of each measurement were determined by averaging results of the two surgeons. Patients who had hair loss were evaluated with dermoscopy. The number of hair follicles per unit area was detected and the patients’ photographs were taken at each control. Results: The mean age of the participants was 29.4 years. When patients were evaluated for hyperalgesia, it was observed that after each PRP application, pain was felt with less amount of g stimulation compared to before PRP injection (p <0.05). The highest period of hyperalgesia was in the first year after PRP (P <0.05). The increase in hair density was calculated as 6.4, 9.4, 21, and 27,6% at 1st, 2nd, 6th, and 12th months after the first treatment. Conclusion: We determined that hyperalgesia may occur in patients because of repeated PRP injections. The development of hyperalgesia in these patients may be due to growth factors in the PRP content. Further experimental and clinical studies are needed to determine the cause of hyperalgesia occurring after repeated PRP injections.

Between, 1985 - 1986 150 bronchoscopies were perforıned in our ciinic. 60 cases were diagnosed as bronchus carcinoma. Among 90 cases; 25 cases were diagnosed as tuberculosis, 10 cases lober pneumonie, 39 patients chronic bronchitis, 15 cases lung abcess and in one case foreign material aspiration were diagnosed.

The aim of this study was to determine the experiences of emergency critical intensive care unit patients. This descriptive study was conducted at an emergency critical intensive unit in a Teaching and Research Hospital located in Konya. One hundred twenty one intensive care patients were included in the study. A questionnaire and “Intensive Care Experience Scale” were used as data collection tools. Of the patient,50.4%of them were female, 19% of them had elementary school graduates or lower degree education and 66.1% of them were married. Patients’score of intensive care experiences scale was 60.09±6.53. At the end of the study, it was determined that the patients inthe intensive care units lived negative experiences partly.

The Morphometric Analysis of the Brachial Plexus Formation in Human Fetuses. This study was carried out in 100 fetuses (75; 2nd trimester, 25; 3rd trimester) and totally 200 brachial plexus were evaluated under examination stereomlcroscope. After bilateral fine dissection, to perform morphometric stu- dies; the thickness and/or length of the each part that contribute to the formation of the brachial plexus were me- asured by calipers. Photographs of the brachial plexuses were taken after dissection. Data was statistically analy- sed by Pearson correlation and Student t-tests using SPSS softvvare (for vvindovvs 8.0). İn this study, 93 fetuses vvere decided as normal (the brachial plexus consist of the 5th, 6th, 7th, 8th cervical nerves and 1st thoracic nerve). The mean value of the length of the 8th cervical, 1st thoracic, upper trunk and middle trunk showed sta­ tistically significant difference betvveen female and male. The mean value of the thickness of the posterior di­ vision of lower trunk showed statistically significant difference betvveen right and left side. There was no sig­ nificant difference in other parameters. Pegarding to the correlation values betvveen the age and the measured parameters, the grovvth rate of the each part that contribute to the formation of the brachial plexus was higher in 2nd trimester than in 3rd trimester. The reported results may provide useful information about the fetal de- velopment of peripheral nervous system, and in the diagnostic and therapeutic approach of paediatric surgeons for preventing complications.

The Morphometric Analysis of the Brachial Plexus Formation in Human Fetuses. This study was carried out in 100 fetuses (75; 2nd trimester, 25; 3rd trimester) and totally 200 brachial plexus were evaluated under examination stereomlcroscope. After bilateral fine dissection, to perform morphometric stu- dies; the thickness and/or length of the each part that contribute to the formation of the brachial plexus were me- asured by calipers. Photographs of the brachial plexuses were taken after dissection. Data was statistically analy- sed by Pearson correlation and Student t-tests using SPSS softvvare (for vvindovvs 8.0). İn this study, 93 fetuses vvere decided as normal (the brachial plexus consist of the 5th, 6th, 7th, 8th cervical nerves and 1st thoracic nerve). The mean value of the length of the 8th cervical, 1st thoracic, upper trunk and middle trunk showed sta­ tistically significant difference betvveen female and male. The mean value of the thickness of the posterior di­ vision of lower trunk showed statistically significant difference betvveen right and left side. There was no sig­ nificant difference in other parameters. Pegarding to the correlation values betvveen the age and the measured parameters, the grovvth rate of the each part that contribute to the formation of the brachial plexus was higher in 2nd trimester than in 3rd trimester. The reported results may provide useful information about the fetal de- velopment of peripheral nervous system, and in the diagnostic and therapeutic approach of paediatric surgeons for preventing complications.

The aim of this study was to evaluatie of adnexal masses cases that were diagnosed and laparoscopically treated during pregnancy in our clinic. This retrospective study included 18 cases that were diagnosed to have adnexal masses during pregnancy or referred from other clinics to our clinic and treated by laparoscopy between January 2005 and December 2009. Patient’s characteristics such as age, gravidity, parity, symptoms, gestational age at the time of diagnosis, sonographic findings, and type of laparoscopic surgery, operation time and hospitalization time were recorded. Eighteen women with adnexal masses during pregnancy who underwent laparoscopic surgery were included in this study. The average age of the patients was 28.5±4.3 (range 20–37) years and the average gestational age was 13.1±3.3 (range 8–20) weeks. The patients presented usually with pelvic pain. Adnexal cyst was mostly seen by ultrasonographic evaluation. Adnexal torsion was detected in 8 patients. Nine patients were in first trimester, other 9 patients were in second trimester. We performed laparoscopic cystectomy in 10 patients, detorsion and cystectomy in 6 patients and salpingoooferectomy in 2 patient’s. Mean adnexal mass size was 7.8±2.3 (range 5–15) cm. Mean operation time was 37.2±7.1 (25–50) minutes and mean hospitalization time was 1.8±0.6 (1–3) days. Abortion was not detected in our cases. According to these findings, laparoscopic surgery is the most appropriate treatment for patients with adnexal masses during pregnancy in the presence of expert surgeons. Laparoscopic surgery if performed by experienced surgeons seems to be safe and better management method for maternal-fetal health.

ABSTRACT

Introduction: Most of the large defects in the hand are required vascularized skin coverage because they exposed tendons and bones. A pedicled groin flap has been offered as a standard flap for this indication. But immobilization of the upper extremity can be a disadvantage. Raising the groin flap is also possible as a free flap. The disadvantage of free flap is a time-consuming microsurgical procedure. We aimed to compare the pedicled and free groin flap reconstructions in patients with large hand defects based on patient-reported outcomes.

Materials and Methods: Sixteen patients who had groin flaps pedicled or free for the large defects of their hands were included in this study between 2013-2020. This study was performed retrospectively clinical survey work. Patients were divided into two groups: the pedicled groin flap group (n=8) and the free groin flap group (n=8). Patients were followed for 2 years. The patients were subjected to DASH and SF-36 tests after a postoperative period. Pre- and postoperative pain were evaluated with the Visual Analogue Scale. On which day they could walk and sit in the toilet without pain and not needed a second person for daily work, the patients were asked.

Results: Half of the patients with pedicled flaps had serious elbow and shoulder pain and required physical therapy. The wound healing was completed significantly earlier in the free groin flap group (p<0.05). The mean hospital stay in the pedicled group was longer than the free flap group (21 days and 13 days, respectively), which was statistically insignificant. The DASH scores were found to be 92 and 72 in the subacute and chronic stages in the pedicled flap group, whereas 52 and 24 were found in the free flap group, respectively (p = 0.012 and 0.002). According to SF-36 scores, physical functions were impaired significantly in the pedicled flap group (p < 0.001). The number of days needed by the second person for daily work was 79 in the pedicled group and 24 in the free flap group (p = 0.041). Sitting in the toilet without pain was started on the 63rd day in the pedicled group and on the 15th day in the free flap group (p = 0.036).

Conclusions: By transferring the groin flap as a free flap, the problems related to shoulder and elbow joints have disappeared, hand rehabilitation could be started earlier, and the time to return to daily work was shortened. So, if the groin flap is preferred, free style should be considered first.

Aim: To evaluate the efficacy of a single döşe epidural corticosteroid injection in the treatment of lumbosacral radiculopathy secondary to lumbar disc herniation. Methods: We administered single dose epidural injection of steroid and local anestetic mixture in 31 patients with radicular pain due to lumbar disc herniations. Outcome was measured using a visual analog scale ranging from 0 to 10; straight leg raising test (SLR) values; a measurement of finger-to-floor distance; a patient satisfaction scale; and a Roland Morris low back pain questionnaire. Results: Thirty one patients were followed fors ix weeks. We found significant improvement in all parameters in patients at second day, second week and 6th. Week postinjection (p<0.05). Conclusions: We concluded that single-shot epidural corticosteroid injection is effective in the treatment of lumbar radicular pain due to lumbar disc herniations.

Background and objective: Ultrasound (USG)-guided caudal epidural steroid injections (CESI) have the advantage of being more easily applicable without radiation exposure. However, there is limited evidence regarding their use in the treatment of lumbar disc herniation, and no data is available regarding patient satisfaction. The aim of this study is to evaluate the effect of USG-guided CESI on axial or radicular low back pain.
Methods: This study was designed as a retrospective case-control study conducted in an outpatient setting at a tertiary care hospital. Records of the 21 patients who underwent USG-guided CESI due to axial or radicular low back pain and had an assessment with a visual analog scale (VAS pain), degree of pain relief, patient satisfaction scale, sleep quality, and Roland Morris Disability Questionnaire (RMDQ) in the patient files or electronic database were included in the study between December 2022 and May 2023.

Results: There was a significant difference in VAS pain scores between admission and the 2nd week and between admission and the 6th week (p<0.001). The frequency of meaningful pain reduction accepted as more than 50% pain relief was 57.1% and 38.1% at the 2nd and 6th weeks, respectively. A significant difference was found in RMDQ scores between admission and the 2nd week, between admission and the 6th week (p<0.001), and between the 2nd week and the 6th week (p = 0.447). While 71.4% of the patients described poor sleep at presentation, this ratio was 19.0% and 23.8% at the 2nd and 6th weeks, respectively. While 91.5% of the patients declared that they were better in the 2nd week, 71.4% reported that they were better in the 6th week.
Conclusion: Ultrasonography-guided CESI is an effective treatment method for improving pain, sleep quality, and disability by ensuring high patient satisfaction in individuals with axial or radicular low back pain in a short-to-moderate-term follow-up.

Aim: The aim of this study was to evaluate the effects of intraarticular administration of sufentanil and morphine on postoperative pain and analgesic requirements after artroscopic knee procedures. Material and Method: Sixty patients scheduled for artroscopic knee surgery were randomised into three groups. A standart general anesthesia was used for all patients At the end the surgery , before the artroscope was removed the following solutions were administerd in 20 ml of normal saline. Group I:(n:20) 20 ml normal saline, Group II:(n:20) 10mg sufentanil, Group III:(n:20) 2 mg morphine. Awaken time of the patients was estimated as time 0 and Visual Analog Scale (VAS) scores were assesed. IV PCA (Patient Controlled Analgesia) was given as tramadol. The PCA deliveries at 30 min, 2 hours, 12 hours and 24 hours and total tramadol requirements for 24 hours were noted. Result: VAS scores were significantly lower in group II(p< 0.05). The consumption of tramadol at 30 min was also lower in group II when compared to group I and group III (p<0.05). Intraarticular sufentanil significantly reduced the postoperative consumption of analgesics (p<0.05). Conclusion: As a result we concluded that intraarticular sufentanil using in artroscopic knee procedures is simple, effective, safe and well tolerated analgesic techinique. This study showed that the onset of analgesia was faster and stronger with intraarticular sufentanil.

Medical interventions to the patients from whom healing expectations (with the current technological and scientific data) were considered to be lost are being ethically discussed about the benefit and loss to the patient. When it is about the limited sources of the country, particularly like the intensive care units, it becomes an administrative issue. In this study we evaluated the patients in the terminal phase of their diseases with no expectancy of healing, hospitalized in the medical intensive care unit (ICU)of our university hospital. Thirteen terminal phase patients out of 73 patients hospitalized between 25 October 2010 and 30 April 2011 were evaluated retrospectively in ICU. Eleven of the patients had oncological disease (6 lung cancers and 5 other organ cancers). These patients had widespread metastases not responding to therapy. Tree of the other patients had ejection fraction lower than 15% following myocardial infarction with no chance for transplantation due to low health status, one had advanced respiratory muscle involvement due to muscular dystrophy, the another had intersitisyel lung diseases with severe respiratory failure, the other had liver cirrhosis with multiple complications. Fifteen patients died in the intensive care unit, whereas two patient was discharged with home mechanical ventilator support. Medical cost of the patients was 208.200,640/TL. They were hospitalized for 233 bed/days. The number of beds occupied by these terminal phase patients in this period were considered to be high. Foundation of palliative care units or hospice service with necessary law evaluations, is very useful and important not only for optimal use of limited financial sources but also for comfort of patient and relatives.

This descriptive and cross sectional study was conducted to assess the depression and the quality of life (QoL) in cancer patient. The sample of the study consisted of 102 the patients with cancer, treated at Medical Oncology Department of, between 1-30 March 2008. WHOQOL –Brief was used to evaluate the patients’ quality of life. Depression status was evaluated with Beck Depression Inventory (BDI). Of the interviewees, 57.8% were male (n=59), 42.2% were female (n=43), and the mean age was 49.7± 15.2. The mean value of Beck depresyon was found as 12.4±9.9 (min=0, max=48). According to the BDI, 47.1% (n=48) were normal, 21.6% (n=22) mild, 18.6% (n=19) moderate and 12.7% (n=13) were severely depressed respectively. The gender, occupation, education and marital status of the people with cancer had not effected the depression (p>0.05). When we compared the QoL scores and depression status, there was a significant difference in perception of overall health and the satisfaction from life (p=0.000), general health and quality of life (p=0.000), physical health (p=0.011), social relationships (p=0.000), psychological health (p=0.001)) and environmental (p=0.000) between the depressive people and non-depressive ones statistically. Assessing quality of life in cancer patient will provide better understanding of the disease and will improve the evaluation of the therapy response. Anxiety and depression are the major concerns in cancer patient and it is necessary to understand these problems in order to cope with them, and psychological aid is essential.

Despite prophylactic and therapeutic measures, pulmonary embolism still occurs and most orthopaedic surgeons sooner or later suffer the tragic loss of a patient from this life threatening complication. Femur fracture has repeatedly been associated with increases in the risks of pulmonary embolism. As the following case report illustrates, massive pulmonary embolism can occur intraoperatively in a long bone fracture surgery. Acute massive pulmonary embolism usually results in death if not diagnosed early and treated aggressively. Thrombolytic therapy and catheter embolectomy are increasingly used as definitive management. Emergent open embolectomy is often reserved as a last resort when less invasive methods have failed or the patient is in cardiopulmonary arrest.

Between 1983 and 1996 splenic surgerv was peıfonned irr a tatar` of 47 .children in the Research Hospital of Medical Faculty of Selçuk Unive•sity. The age• of the patients were betıveen one and 16 vc'ars. Of the patients 38 under•ent splenectomy. of. which 17 were pelforıned general sur.,!:;eons be-Pre 1991_ Pediatric surgeons have been performin these procedures since rhen. When these two periods are coınpared It is frJldlrfl that. the most U)/i dication.v for ,splenectomy are trannut and he-motological diseases before 1991 aml cıfıer tlıen. respectivelv. Wc' suppusod that. the ı-eason of the (lif-frrence between tvı,o periods is the impo•tance of- the jımetions of the spleen is not elem- in adults as iır (.-hildren and therefrre. .fi)r the menagemenı of the trattmatic children, the methocl used hrgenaral sur-geons i.s different from ılıaı (ıf pedian-k:surgeons_

\r\n ABSTRACT

\r\n

\r\n  

\r\n

\r\n  

\r\n

\r\n Aim : In this study, it was aimed to determine burnout, occupational satisfaction, depression symptom levels and sociodemographic characteristics affecting health personnel working in the operating room.

\r\n

\r\n Patients and Methods:The sample of the study consisted of a total of 230 people, including an anesthesiologist, a surgical nurse and an anesthesia technician working in the Erzurum Regional Training and Research Hospital and Atatürk University Medical Faculty Hospital. In the study, the Sociodemographic Data Form, Maslach Burnout Inventory , Minnesota Satisfaction Scale  and Beck Depression Inventory were requested from participants

\r\n

\r\n Results:Emotional Exhaustion , Desensitization  and Beck Depression Inventory  scores were significantly higher and Personal Achievement scores were lower in operating room personnel working more than 60 hours a week (p <0.05). Desensitization scores were found to be significantly higher (p <0.05). Doctors' Emotional Exhaustion   and Desensitization scores were high. (p <0.05). There was a significant negative correlation between the Beck Depression Inventory  and the Minnesota Satisfaction Scale  and Personal Achievement scale scores of the employees; There was a significant positive correlation between the mean scores of the Emotional Exhaustion   and Desensitization subscales (p <0.05)

\r\n

\r\n Conclusion:The operating room, which is a unit under intensive work pressure that requires effective, accurate and rapid intervention, will be useful in evaluating the mental health and working conditions of employees, reducing the work pressure and burden of employees and increasing the quality of service by increasing mental health and functioning.

\r\n

\r\n  

\r\n

Objective: This paper was aimed ta identify job satisfaction and its sources among health staffs (general practitioners, midwife, nurse, health functionary) working at public health centers. Materials and methods: In 1997, a self-administered questionnaire (Short form of Minnesota Satisfaction Questionnaire) was used for 153 health staffs who were working at 21 public health centers selected with cluster sampling in Konya province. Glo-bal satisfaction score was calculated generally and according ta demographic features. For each item which is constituted job satisfaction the ratio of health staff isafisfied' was calculated. Results: The percentage of health staff satistied was 59.5% and the average of global satisfaction score was 3.75. There was no relation between global satisfaction score and person's age, Bender, marital status, location of practice and job duration. The mid-wifes were less dissatisfied than the others. The working environrrıent and income were the most important fac-fors of dissatisfaction. Conclusion: According to the results health staffs working at public health center have low satisfaction score. The working condition and income salaries should be improved and the other matters which originates dissatisfaction must be considered.

The aim of this study is to compare thermal welding tonsillectomy (TWT), classic dissection tonsillectomy (CDT), and radiofrequency dissection tonsillectomy (RFT). This study included one hundred and thirty five adult and childhood patients undergoing tonsillectomy because of chronic tonsillitis or upper airway obstruction. By the tonsillectomy technique, the patients were divided into thermal welding tonsillectomy (TWT), classic dissection tonsillectomy (CDT), and radiofrequency dissection tonsillectomy (RFT) groups. These groups were assessed in terms of age, gender, duration of surgery, early postoperative pain, time to start normal diet, amount of intraoperative blood loss, postoperative bleeding, tonsillar fossa wound healing on the tenth postoperative day. There was no statistically significant difference between TWT and RFT groups in terms of average duration of surgery (p>0,001). When these two groups were compared with CDT group, a statistically significant difference was found (p0,001). When these two groups were compared with CDT group, a statistically significant difference was found (p

The ideal therapy for sacrococcygeal pilonidal disease (SPD) would be a prompt cure that allowed patients to return quickly to normal activity, with minimal morbidity and a low risk of complications. We report the case operated with excision and primer suture for SPD a month ago had infected and decomposed wound. A 23-year-old male patient was admitted to the emergency room with complaints of intergluteal discharge and pain that last for 10 days. Surgery which was excision and primer suture was applied him in other health center for SPD a month ago. There was infected and decomposed wound and a large cavity under sutured skin on intergluteal area. In the second operation, we excised decomposed wound including cavities and skin as modified equilateral quadrangle shape, a right flap was prepared and rotated to left side for primer suture. Patient was discharged on postoperative 3th day and drain was getting out on postoperative 5th day. Patient recovered completely without any complication on postoperative 20th day. Our case is no not only unique but also rare. However, we think that the most appropriate method for treatment of SPD should be known and applied by all surgeons in our country.

Aim: We aimed to investigate probable effects of inguinal hernia repairing under local anesthesia on duration of hospital stay, postoperative complications and pain. Material and Method: This prospective study was conducted between October 2000 and December 2005. In 193 patients with unilateral inguinal hernia. Prilocain 1% solution was used as local anesthetic maretial. Thiopentone sodium (6 mg/kg), sucsinilycholine chloride (1 mg/kg), atracurium besylate (0.4 mg/kg), isoflurane olumcombination was used for general anesthesia. Analgesia was obtained with diclofenac sodium (75 mg x 2 per day) in postoperative period. The length of hospital stay, postoperative pain, postoperative complications, satisfaction were recorded and relation between used anesthesia method was investigated. The results obtained were compared. Results: A total 193 patients were operated under general or local anesthesia (respectively 18.13%-81.87%). Sixty-nine point seven percent of patients were discharged postoperative first day in operated under local anesthesia group but only 20% of patients were discharged postoperative second day in operated under general anesthesia group. Postoperative pain scores at sixth hour was 2.82±0.93 in local anesthesia group and 6.62±1.57 in general anesthesia group (p<0.05). In the group oparetod under general anesthesia, the postoperative complicaties such as urinery retantion and nausea were recorded more often. Conclusion: Inguinal hernia repairment under local anesthesia is suitable with less length of hospital stay, reduced postoperative pain scor and less complications such as urinary retantion and nausea.

Aim: The aim of the study was to compare combined spinal-epidural (CSE) and epidural (EP) analgesia methods in labor analgesia. Material and Methods: The study was performed with 50 primigravid pregnant women who planned to have vaginal delivery. The patients were randomized into two equal groups: Group I: CSE analgesia group and Group II: EP analgesia group. A solution of 0.05% bupivacaine with 1.5 µg/ml fentanyl was prepared for using patient controlled epidural analgesia for both groups. Epidural catheters were introduced following the spinal administration of 1.25 mg bupivacain plus 12.5 µg fentanyl in patients in CSE analgesia group. Epidural solution infusion have been given to the EP analgesia group after the loading dose (10 ml 0.125% bupivacaine and 50 µg fentanil). Data were collected on maternal and fetal hemodynamic varibles, pain scores, motor blockade and total amount of consumed local anesthetic, the side effects. Results: Analgesia was effective in all patients. ‹nitiation time of analgesia in CSE group was much shorter than EP group (p<0.05). Better preserved maternal hemodynamics without hypotension, lower amounts of local anesthetics and beter patient satisfaction were observes in the CSE group compared with the EP group (p<0.05). Conclusion: Both CSE and EP analgesia methods used in this study were reliable and satisfactory for labor analgesia. Because of the faster initial analgesia, better maternal hemodynamics, shorter labor time in the first and second stage of labor and lower local anesthetic amounts, CSE analgesia method with lower doses of opioid and local anesthetic can be prefered to EP analgesia method.

 

Aim: The aim of this study was to primarily investigate the effects of selected anesthesia method on anxiety, patient satisfaction and pain level in elective caesarean section, and secondarily obtain information about quality of service.

Materials and Methods: The study was carried out as a prospective questionnaire in the Department of Anaesthesiology and Reanimation the Meram Medical Faculty Hospital of Necmettin Erbakan University between June 2017 and August 2017, on 160 volunteers aged between 18 and 45 years for whom elective cesarean section under General Anesthesia (GA) or Spinal Anesthesia (SA) was planned. Demographic data of the patients such as age, place of residence, education level, number of children, and cesarean experiences were recorded. In the preoperative and postoperative period, anxiety levels were measured by State-Trait Anxiety Inventory (STAI-D), pain levels were measured by Visual Analog Scale (VAS) scores and satisfaction levels were evaluated at postoperative 6th and 24th hours by (Quality of Recovery: QoR 40 T) questionnaire.

Results: There was no statistically significant difference between the patients' preoperative and postoperative anxiety scores and demographic data (p> 0.05). Patients with previous cesarean experience had lower preoperative anxiety levels (p <0.05). The STAI-D scores and the numbers of patients with anxiety in the GA and SA groups were similar (p> 0.05).Postoperative anxiety levels were significantly lower in both groups than in the preoperative period (p <0.05). VAS values of the SA group at the 6th and 24th hours were significantly higher than the group treated with GA.(p<0.05). The 24th hour VAS values of the SA group were higher than the VAS values at the 6th hour (p <0.05). In the GA group, VAS values at 24th hour were lower than the VAS values at 6th hour (p <0.05). The satisfaction levels of general anesthesia and spinal anesthesia were similar in the postoperative period (p> 0.05). Complaint of headache was high in SA group while complaint of sore throat was high in GA group(p<0.05). While there was no correlation between anxiety level, VAS values and satisfaction level (p> 0.05), there was a negative correlation between VAS values and pain parameters, which are the subgroup of satisfaction questionnaire, in both groups (p <0.05).

Conclusion: It is concluded that the preferred anesthesia method in elective cesarean section has no effect on anxiety and satisfaction, and the patient satisfaction level and service quality will be improved by providing effective analgesia by reviewing our postoperative pain algorithm.

 

This study was carried out in order to assess the inpatients’ satisfaction levels with physical condition, doctors, nursing, cleaning and food services in Afyon Kocatepe University Ahmet Necdet Sezer Research and Application Hospital. A total of 345 inpatients were participated in this study. A questionnaire was prepared to evaluate the satisfaction levels of inpatients. A face-to-face interview approach was used. The mean satisfaction levels of inpatients were 4.18±0.77 for physical conditions, 4.20±0.90 for doctors, 4.35±0.84 for nursing, 4.14±0.96 for cleaning, and 3.99±1.05 for food services. Statistically significant difference was found between educational status and their satisfaction levels (p

The objective of the study was to evaluate the effect of ketoprofen on after tonsillectomy in patıents. All charts of patıents, who underwent tonsillectomy with or without adenoidectomy, were reviewed. The age at the time of surgery ranged between 3 and 27 years (mean age = 10.0±3.02 years). Patıents were divided into two groups based on the drugs used for postoperative pain relief.Group I received paracetamol after surgery. Group II received Ketoprofen after surgery. A total of 40 patients received ketoprofen and 50 patients were given paracetamol. Posttonsillectomy hemorrhage occurred in one (2.5%) patıent,primary hemorrhage was noted in one patient and secondary hemorrhage occurred in zero patients. While 1 of 40 patıents (2.5%) who were given ketoprofen had postoperative hemorrhage,1 of 50 patients (2.0%) who were given paracetamol had hemorrhage There was no significant difference in hemorrhage rates between these two groups (p[0.05). Hemorrhage following tonsillectomy is rare and frequently occurs in the early postoperative period. There is no significant increased risk of hemorrhage after ketoprofen administration and it can be used safely for posttonsillectomy pain relief.

Aim: Autologous bone harvesting is the gold standard for grafting in a variety of orthopaedic procedures.
The aims of this study were to introduce an alternative technique of K-wire guided, multidirectional
percutaneous bone graft harvesting with Jamshidi from the anterior iliac crest, and to put forward the early
comparative clinical results of this technique.
Patients and Methods: 38 patients, who underwent a variety of hand surgeries in which bone grafting was
required between January and November 2013, were included in this retrospective, comparative study.
The included diagnoses of the patients were; non-unions of hand and wrist bone fractures, and benign
bone tumors. The prospectively collected data of patients were retrospectively evaluated in two groups.
Iliac crest autograft harvesting were performed with a standardized open technique, and with a novel
percutaneous technique -which will be described in the subsequent section- in group I, and II, respectively.
The mean age of the patients was 29.6 +/- 6.4, and 28.6 +/- 8.2 in group I, and II, respectively. The patients’
postoperative pain related with the perception of the pain and surgical scar, were evaluated according to the
graded Visual Analogue Scale; at postoperative 6th months. Statistically , Mann-Whitney U test was used.
Results: There were no major postoperative complications in the percutaneous group. Regarding pain,
mid-term at postoperative 6th months, VAS scores were found to be lower in group II than in group I,
significantly (p< 0.05).
Conclusion: The novel K-wire guided bone graft harvesting with Jamshidi from the iliac crest is a safe and
patient-friendly method in terms of postoperative pain reduction. This technique is useful in small joint and
bone surgeries, requiring bone grafting. The results of this study should be further supported with higher
level of evidence studies.

Anorectal malformations occur in an average of 4000-5000 newborns and are more common in males (1). Congenital malformations of the anus, rectum, and urogenital system were often found together. imperforate antisla, enteric urinary fistulas, renal agenesis, irritable-theropelvic obstruction. iireterovesical darhk. The association of structural genitourinary anomalies such as and-zicoureteral reflux, cryptorchidism, ectopic mourning deferens and hypospadias is well known (2, 3). These pathologies are usually detected by pediatric surgeons. However, urologists play the main role in the diagnosis and treatment of these complex and difficult-to-solve clinical problems. Appropriate treatment: depends on the knowledge of normal and abnormal embryology, the presentation of clinical problems associated with these disorders, and the implementation of diagnostic studies that will determine the exact pathology (4).