Anatolian Clinic Journal of Medical Science / Anadolu Kliniği Tıp Bilimleri Dergisi

6-11

Authors: Erkan Kilinc , Yasar Dagistan , Emine Dagistan , Zeliha Cosgun

Aim: Inflammatory mechanisms play a key role in the pathogenesis of back pain related to disc hernia. Mean platelet volume (MPV) and red cell distribution width (RDW) are novel and promising inflammatory markers in routine hemogram tests. In this study, we aimed to compare the MPV and RDW values of patients with lumbar disc herniation (LDH) to those of healthy subjects and symptomatic patients suffering from sciatica without radiological evidence of lumbar disc herniation. Materials and Methods: This retrospective cohort study was carried out in the Neurosurgery Department of the Abant Izzet Baysal University Education and Research Hospital. Three groups as the controls (n=57) and LDH (n=73) and sciatica (n=20) groups were designed. Hemogram parameters including white blood cell count (WBC), hemoglobin (Hb), hematocrit (Htc), mean corpuscular volume (MCV), RDW, platelet count (PLT) and MPV were evaluated for each group. Results: The mean MPVs of the LDH, sciatica, and control groups were 9.3±1.8 fL, 8.2±1.1 fL, and 8.4±1.0 fL, respectively. The mean MPV was significantly higher for the LDH group, compared to the sciatica and control groups (p=0.001). The mean RDWs of the LDH, sciatica, and control groups were 14.8±1.8, 13.8±1.0, and 13.7±1.2, respectively. The mean RDW was also significantly higher for the LDH group in comparison to the sciatica and control groups (p=0.001). Discussion and Conclusion: We think that elevated MPV and RDW values might be strong indicators of LDH in patients with sciatica and that such patients should be prioritized for imaging studies. However, further prospective studies are needed to support our results.

20-25

Authors: Ahmet Selim Özkan , Sedat Akbaş , Nihat Polat , Mehmet Rıdvan Yalın

Aim: In this study, we aimed to evaluate the mean changes in the corneal endothelial cells and pachymetry values of patients who underwent general anesthesia with sevoflurane with N2O or O2. Materials and Methods: Forty eyes of 40 patients who had extraocular surgery under general anesthesia were included in this prospective study. The patients were divided into two groups as the O2 and N2O groups, for which %50 O2 (total flow rate; 2 L/min in O2-air mixture) and %50 O2 (total flow rate; 2 L/min in O2–N2O mixture) were used, respectively. The duration of the surgery was recorded. The CD (cell density), CV (cell variation), Hex (hexagonality rate) and pachymetric specular microscopy results were evaluated before surgery, and at the first and fourth weeks after surgery. Results: The surgical duration and demographic data of the groups were similar, and there was no statistically significant difference between the two groups. The value of CV was 26±2 cell/mm2 for the O2 group and 30 cell/mm2 for the N2O group at the first week. There was a statistically significant increase in the N2O group values, compared to the preoperative values (p=0.008). The Hex value was 52±10% for the O2 group and 62±11% for the N2O group at the first postoperative week, and there was a statistically significant increase in the N2O group values in comparison to the preoperative values (p=0.007). There was no significant difference between the two groups in terms of CD, CV, Hex, and pachymetry at other times. Discussion and Conclusion: Statistically significant change was observed at the first postoperative week in the corneal variation and hexagonality rate values of the pediatric patients who underwent general anesthesia with nitrous oxide. More studies need to be done for further assessments.

34-41

Authors: Kayahan Karaytuğ , Eren Yıldız , Sefa Giray Batıbay

Aim: Hallux rigidus is a disease characterized by degeneration of the first metatarsophalangeal(MTF-1) joint. The choice of arthroplasty instead of arthrodesis in the surgical treatment of advanced hallux rigidus is still controversial. In this study, we aimed to report the early treatment results of a number of patients who had advanced hallux rigidus and underwent newgeneration three-component press-fit total joint arthroplasty. Materials and Methods: The patients were evaluated in terms of degrees of MTF-1 joint dorsiflexion, plantar flexion, and total joint range of motion (ROM), scores of AOFAS, VAS, SF-12 PCS, and satisfaction survey results. The preoperative and postoperative values were analyzed statistically. Radiologically, anteroposterior (AP) and lateral radiographs were taken and examined for loosening, wear, and alignment. Results: Nineteen joints (14 female, 5 male) of 17 patients were included in the study. The mean age was 59 (49–67) years. The mean patient follow-up was 15 (12–22) months. The mean dorsiflexion degree was 12.7° (range 2.1°–22.1°) preoperatively and 30.1° (11.6°–47.3°) postoperatively. The mean plantar flexion degree was 16° (7.8°–24.2°) preoperatively and 9.2° (2.3°–16.5°) postoperatively. The total range of motion (ROM) of the MTF-1 joint improved from a preoperative 28.4° to a postoperative 39.4°. The mean postoperative AOFAS, VAS, and SF-12 PCS scores were calculated as 85.3 (57–96), 1.3 (0–5), and 57.7 (53.7–59.9), respectively. The increase in the patients’ AOFAS and SF-12 PCS scores and the decrease in the VAS scores were found to be statistically significant. Discussion and Conclusion: Advanced MTF-1 joint osteoarthritis is a disease that causes severe pain and loss of motion. The method for a standard surgical treatment is still controversial. It has been reported in the literature that satisfactory results have been achieved in applications of three-component cementless press-fit total prostheses, in contrast to older prosthetic applications that cause serious complications. The pain relief and the increase in AOFAS scores are considered the most successful aspects of the treatment. Based on the information obtained from this study, we think that application of new-generation three-component press-fit total prostheses is an effective method in the treatment of advanced hallux rigidus, and that the early results are satisfactory when it has been applied to appropriate patients

48-50

Authors: Aysun Çaglar Torun

The most severe complications developed in patients with dyskeratosis congenita (DKC) are bone marrow failure (BMF), difficult airway, and pulmonary fibrosis. Accordingly, in DKC patients to be operated, the clinical and laboratory data should be evaluated for presence of BMF-related pancytopenia, difficult airway and opportunistic infections, and the systemic examination prior to the administration of general anesthesia should be made carefully. The preoperative preparation should include thorough examination of the lungs as well as assessment for postoperative respiratory distress. The operation should be attempted when the patient’s clinical and laboratory values are optimal. Supportive equipment should be prepared in advance for patients expected to suffer difficult airway. This paper will discuss the preoperative preparation and anesthetic management in a pediatric case of DKC complicated with bone marrow failure where the patient was scheduled for dental treatment under general anesthesia.

55-58

Authors: Mehmet Sargın, Mehmet Selçuk Uluer

Peripheral nerve blockade is a good alternative technique in cases where general anesthesia is not required or there are high risks. When regional anesthesia is required in more than one region in the body, the risk of toxicity will proportionally increase as the dose of the local anesthetics used is increased. In recent years, increased diversity of anesthetic applications and easier access in clinics to medical tools such as ultrasonography equipment have provided a significant decrease in the required doses of local anesthetics. Discussing in the light of the current literature, this paper reports a bilateral infraclavicular block performed on a patient with bilateral distal radius fracture by using low doses of local anesthetic agents.