GÝRÝÞ ve AMAÇ: Çalýþmamýzda izofluran ve sevofluranýn saðlýklý rat akciðerindeki inflamatuar etkilerini incelenmeyi amaçladýk.
YÖNTEM ve GEREÇLER: Yirmibir adet rat rastgele üç gruba ayrýldý. Kontrol Grubu (n=6); %50 oksijen + %50 hava; Ýzofluran Grubu (n=7) % 1.2 Ýzofluran + %50 oksijen + %50 hava, Sevofluran Grubu (n=6) % 2.5 Sevofluran + %50 oksijen + %50 hava ile 2 saat mekanik ventilatör ile solutuldu. Gruplarýn MPO aktiviteleri, TBARS düzeyleri, alveoler makrofaj sayýlarý ve alveoler epiteliyal apoptotik hücre sayýlarý istatistiksel olarak deðerlendirildi. p<0.05 deðeri istatistiksel olarak anlamlý kabul edildi.
BULGULAR: Sevofluran Grubu’nda, Kontrol ve Ýzofluran Grubu’na göre MPO aktivitesi ve TBARS düzeyi anlamlý derecede düþük saptandý. Ýzofluran Grubu’nda, Kontrol ve Sevofluran Grubu’na göre alveoler makrofaj sayýsý ve M-30 pozitif hücre sayýsý anlamlý yüksek, Sevofluran Grubu’nda ise Kontrol Grubu’na göre anlamlý yüksek olarak saptandý. Iþýk mikroskobik incelemede Sevofluran grubu ve daha fazla olmak üzere Ýzofluran Grubu’nda yaygýn mononükleer hücre infiltrasyonu, diffüz alveoler hasar, alveoler ödem, alveoler septumlarda kalýnlaþma, alveol lümeninde yoðun alveoler makrofaj ve daha az miktarda nötrofil ve tip II pnömositler gözlendi.
TARTIÞMA ve SONUÇ: Bu çalýþmanýn sonuçlarý bize, sevofluranýn saðlýklý rat akciðeri üzerine inflamatuar etkisinin izoflurana göre daha az olduðunu düþündürdü.

INTRODUCTION: We aimed to investigate the effects of isoflurane and sevoflurane on lung inflammation and alveolar epithelial apoptosis in rat model.
METHODS: Twenty-one rats were randomly allocated into three groups. The subjects were mechanically ventilated for 2 hours in Control group (n=7) with 50 % oxygen + 50 % air mixture; in Isoflurane group (n=7) with % 1.2 isoflurane + 50 % oxygen + 50 % air and in Sevoflurane Group (n=7) with %2.4 sevoflurane + 50 % oxygen + 50 % air mixture. The MPO activities of the groups, TBARS levels, alveolar macrophage counts and alveolar epithelial apoptotic cell counts were.evaluated statistically.
RESULTS: MPO activity in Sevoflurane group compared to isoflurane and control groups were significantly low. Furthermore, TBARS levels in Sevoflurane group compared to the other groups were also significantly low. MPO activity in Isoflurane group were significantly high compared to control group. Alveolar macrophage counts and M-30 positive cell counts in Isoflurane group were significantly high compared to sevoflurane and control groups. On the other hand, the alveolar macrophage counts and M-30 positive cell counts in sevoflurane group were significantly high compared to control group. Light microscopic findings observed in sevoflurane group and any more in isoflurane group were; diffuse mononuclear cell infiltration, diffuse alveolar injury, alveolary oedema, thickening of alveolar septums, dense alveolar macrophage and light neutrophil and type II pneumocytes infiltration in alveol lumen.
DISCUSSION AND CONCLUSION: According to the results of this study, sevoflurane was found to cause less alveolar injury in healthy lung than isoflurane.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Abdominal obezite metabolik hastalýklar ve kardiyovasküler hastalýklar gibi birçok saðlýk problemine sebep olmaktadýr. Vücut kitle indeksi (VKÝ) bize vücut yað daðýlýmý ile ilgili bilgi vermemektedir. Bel çevresi ölçümleri abdominal obeziteyi daha doðru göstermektedir. Bu nedenle mortaliteyi belirlemede yoðun bakým skorlama sistemlerinde bel çevresini kullanmanýn daha doðru olacaðýný düþünmekteyiz.
YÖNTEM ve GEREÇLER: Bu çalýþmamýzda hastalarýn yaþlarýný, VKÝ'lerini, bel çevrelerini, göðüs çevrelerini, bel çevresi/göðüs çevresi oranýný, APACHE 2 skorlarýný, SOFA skorlarýný, mekanik ventilasyon sürelerini ve yoðun bakým ünitesinde yatýþ sürelerini inceledik. Bel çevresi/göðüs çevresi oranýnýn mortalite üzerine etkisini, bu oranýn mortaliteyi belirlemede VKÝ'den daha duyarlý olup olmadýðýný ve yoðun bakýmda kalma süresi ve mekanik ventilasyon süresi ile iliþkisini araþtýrdýk.
BULGULAR: Bel çevresi, göðüs çevresi ve mortalite arasýnda istatistiksel olarak anlamlý bir fark saptamadýk. Benzer þekilde, VKÝ ve mortalite arasýnda da anlamlý bir fark saptamadýk.
TARTIÞMA ve SONUÇ: Yoðun bakým ünitelerinde bel çevresi, göðüs çevresi ve mortalite arasýndaki iliþkiyi belirleyebilmek için geniþ, çok merkezli çalýþmalara ihtiyacýmýz olduðunu düþünüyoruz.

INTRODUCTION: Abdominal obesity causes many health problems such as cardiovascular diseases and metabolic disorders. BMI does not give us information about body fat distribution. Waist circumference measurement demonstrates abdominal obesity more clearly. Therefore, we believe that it will be more accurate to use waist circumference in intensive care scoring systems in predicting mortality.
METHODS: In this study we investigated the patients’ ages, BMIs, waist circumference, chest circumference, waist circumference/chest circumference, APACHE 2 scores, SOFA scores, duration of mechanical ventilation and length of stay in ICU. We searched the effects of waist circumference/chest circumference ratio on mortality, whether this ratio is more sensitive than body mass index by itself in determining mortality and its relationship between length of stay in ICU and duration of mechanical ventilation.
RESULTS: We found no statistically significant difference between waist circumference, chest circumference and mortality. Similarly, there was not a significant difference between BMI and mortality.
DISCUSSION AND CONCLUSION: We think that we need large, multi-centered studies to find the exact relationship between waist circumference and mortality in ICU.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Bu çalýþmada; Þubat 2011-Aralýk 2014 tarihleri arasýnda kliniðimizde PTE ameliyatý yapýlan 235 hastada uyguladýðýmýz anestezi yönetimini ve klinik sonuçlarýmýzý sunmayý amaçladýk.
YÖNTEM ve GEREÇLER: Operasyon odasýnda full monitörizasyon (serebral rejional oksijen satürasyonu (rSO2), EKG, periferik doku oksijen saturasyonu (SpO2), invaziv arteryel ve santral venöz basýnç, ortalama pulmoner arter basýnç, CO, CÝ ve PVR ölçümü için termodilüsyon katereri takýldý. Hastalara kardiyopulmoner bypass ve derin hipotermik total sirkulatuvar arrest eþliðinde pulmoner tromboendarterektomi (PTE) yapýldý.
Hastalarýn ortalama arter basýncý (OAB), kardiak output (CO), kardiyak indeks (CI), pulmoner vasküler rezistans (PVR) ve ortalama pulmoner arter basýncý (OPAB) deðerleri anestezi indüksiyon sonrasý ve pompa çýkýþý ölçülerek kaydedildi.
Hastalarýn YBÜ’de kalýþ süreleri, hastanede kalýþ süreleri, nörolojik semptomlar, total mortalite, ECMO kullanýmý ve ECMO ile mortalite kaydedildi.

BULGULAR: Hastalarýn indüksiyon sonrasý ölçüm deðerlerine göre pompa çýkýþý ölçülen OPAB ve PVR deðerlerinde anlamlý olarak azalma, CÝ ve CO deðerlerinde ise anlamlý olarak artma saptandý (p<0,05)
Hastalarýn YBÜ’de kalýþ zamaný 6,7±4,6 gün, hastanede kalýþ zamaný 12,5±6,8 gün olarak bulundu. Toplam mortalite %11,9, ECMO kullanýmý %12,8, ECMO ile mortalite % 6,4 olarak saptandý. Hiçbir hastada kalýcý nörolojik defisit geliþmedi.

TARTIÞMA ve SONUÇ: Sonuç olarak; PTE komplike bir kardiyotorasik cerrahidir. Ýyi bir anestezi yönetimi ile hastalarda komplikasyon riski azalmakta ve yaþam kaliteleri artmaktadýr.

INTRODUCTION: We aimed to present anesthetic management and clinical results in 235 patients who underwent pulmonary thromboendarterectomy (PTE) surgeries between February 2008 and December 2014.
METHODS: A thermodulation catheter was inserted for complete monitorization (cerebral regional oxygen saturation, rSO2) ECG peripheral tissue oxygen saturation (SpO2), invasive arterial and central venous pressure, cardiac output (CO), cardiac index (CI) pulmonary vascular resistance (PVR) measurements in the operation theater.
Pulmonary thromboendarterectomy (PTE) was performed accompanied by cardiopulmonary bypass and deep hypothermic total circulatory arrest.
The mean arterial pressure, (mAP), CO, CI, PVR, and the mean pulmonary artery pressure (mPAP) pulmonary artery pressure (mPAP) v were recorded by measuring after pump following anesthesia induction.
The length of ICU and hospital stay, neurological symptoms, total mortality, and mortality during ECMO were recorded.

RESULTS: Significant decrease in mPAP and PVR values and a significant increase in CI and CO values were detected after pump according to the measurements after induction. (p<005). The ICU stay was 6.7 + - 4.6 days and a hospital stay 12.5 = + - 6.8 days.
Total mortality was 11.9%, ECMO was 12.8% and mortality associated with ECMO was 6.4%. No permanent neurological deficit developed in any patient.

DISCUSSION AND CONCLUSION: In conclusion, PTE is a complicated cardiothoracic surgery. With competent anesthesia management, the risk of complications is reduced and the quality of life is increased.

Abstract | Full Text PDF

GÝRÝÞ ve AMAÇ: Bu araþtýrmada elektif koroner arter baypas greftleme cerrahisi uygulanan eriþkin hastalarda laktat düzeyleri ile komplikasyonlar arasýndaki iliþkinin ve yüksek laktata neden olan faktörlerin araþtýrýlmasý amaçlandý.
YÖNTEM ve GEREÇLER: Hastalarýn preoperatif, intraoperatif ve postoperatif verileri retrospektif olarak hasta dosya bilgilerinden tarandý. Hastalarýn bazal, kardiyopulmoner baypas (KPB) soðuma, KPB ýsýnma, sternum kapatýlmasý, postoperatif 0.saat, postoperatif 6.saat, postoperatif 12.saat, postoperatif 24.saatte alýnan arteriyel kan gazlarýnda laktat, glukoz ve diðer kan gazý parametreleri deðerlendirildi. Hastalarýn herhangi bir zaman da ölçülen laktat deðerleri 0-3.9 mmol/L arasý laktat (Grup 1, n=125 hasta); 4 ve üzeri mmol/L laktat (Grup 2, n=55 hasta) olacak þekilde iki gruba ayrýldý. Her iki grup ile komplikasyonlar arasýnda anlamlý iliþki olup olmadýðý araþtýrýldý.
BULGULAR: Çalýþmaya alýnan 180 hastanýn ortalama yaþlarý 61.7±9.6 yýl olup, %80’i erkek idi. Hastalarýn %3.3’üne tek koroner, %20.6’sýna iki koroner, %40.1’ine üç koroner, %26.1’ine dört koroner ve %3.9’una ise beþ koroner anastamozu uygulandý. Grup 1’de laktat seviyeleri sternum kapanýrken, postoperatif 0.saat, 6.saat, 12.saat, 24.saatte Grup 2’den anlamlý olarak daha düþüktü (p<0,001). Gruplar arasýnda çoklu organ yetmezliði (MODS, p=0.027) dýþýnda komplikasyonlar ve mortalite açýsýndan fark saptanmadý.
TARTIÞMA ve SONUÇ: Koroner arter cerrahisi geçiren hastalarda laktat intraoperatif ve postoperatif dönemde yükselebilmektedir ve postoperatif 12. saatte en yüksek deðerine ulaþmaktadýr. Fakat, MODS dýþýnda, yüksek laktat seviyeleri ile komplikasyonlar arasýnda anlamlý iliþki saptanamamýþtýr.

INTRODUCTION: In this study, we aimed to determine the relationship between lactate levels and complications in adult patients undergoing elective coronary artery bypass grafting surgery and the factors that cause high lactate.
METHODS: Preoperative, intraoperative and postoperative data of patients were retrospectively scanned from their file information. In addition to this, parameters of lactate, glucose and other arterial blood gases were evaluated in patients with basal, cardiopulmonary bypass cooling, cardiopulmonary warming, sternal closure, postoperative zeroth hour, postoperative sixth hour, postoperative twelfth hour, and postoperative twenty-fourth hour arterial blood gases. Lactate values measured at any time in patients between 0-3.9 mmol / L lactate (Group 1, n=125 patients); and 4≥mmol / L lactate (Group 2, n=55 patients). It was investigated whether there was a significant relationship between complications and either group.
RESULTS: The mean age of the 180 patients taken to work was 61.7 + 9.6 years and 80% were male. The 3.3% of the patients had single coronary, 20.6% had two coronaries, 40.1% had three coronaries, 26.1% had four coronaries and 3.9% had five coronary anastomoses. Group 1 was significantly lower than the group 2’s lactate values at the sternal closure, zeroth hour, sixth hour, twelveth hour, twenty fourth hour (p<0.001). There were no differences in complications and mortality except multiorgan failure (MOF, p=0.027) among the groups.
DISCUSSION AND CONCLUSION: Lactate in patients undergoing coronary artery surgery may increase intraoperatively and postoperatively and reach the highest value at 12 hours postoperatively. However, excluded in MOF, there was no significant relationship between high lactate levels and complications.

Abstract | Full Text PDF

Perikardiyal kistler nadir görülen, iyi huylu, konjenital kardiyak anomalilerdendir ve sýklýkla asemptomatik seyrederler. Bu olgu raporunda, perikardiyal kistlerin önemi ve nadir bir komplikasyonu olarak kardiyak kompresyona baðlý geliþen nefes darlýðý olgusu sunulmuþtur.

Pericardial cysts are uncommon benign congenital cardiac anomalies and they are usually asymptomatic. This case demonstrates the importance of pericardial cysts and its rare complications such as cardiac compression and shortness of breath.

Abstract | Full Text PDF

Abstract | Full Text PDF

Yabancý cisim aspirasyonlarý çocuklara oranla yetiþkinlerde daha az görülebilen ve bazen ölümle sonuçlanabilen ciddi bir klinik durumdur. En sýk bulgu yabancý cisim aspirasyonu sonrasýnda devam eden þiddetli öksürüktür. Belirtileri nefes darlýðý, ateþ, hemoptizi, kronik öksürük ve tekrarlayan pnömonidir. Yabancý cisim uzun süre kaldýðýnda atelektazi, kronik akciðer enfeksiyonu, apse, bronþiektazi gibi komplikasyonlar geliþebilir. Yabancý cismin hýzlý ve güvenli bir yöntemle çýkarýlmasý ciddi komplikasyonlardan korunmasý açýsýndan oldukça önemlidir. Bronkoskopi taný ve tedavi için önerilmektedir.
76 yaþýnda 22 yýldýr larenjektomili olan erkek hastanýn trakeostomi kanülünü evde temizlerken trakeostomi fýrçasýný aspire etmiþtir. Yapýlan rijit ve fleksibl bronkoskobi ile oluþan granulasyon dokusuna baðlý trakeostomi fýrçasý çýkarýlamayan olgunun sað torakotomi ile çýkarýlmasý sunulmuþtur.

Foreign body aspirations are rare in adults compared with children and sometimes could be fatal. The most common symptom is severe coughing which appears after choking. Symptoms include shortness of breath, fever, hemoptysis, chronic cough and recurrent pneumonia. Foreign body stays too long when atelectasis, chronic pulmonary infections, abscess, bronchiectasis may develop complications such as. Removal of the foreign body in a fast and secure method is very important in terms of protection from serious complications. Bronchoscopy is recommended for diagnosis and treatment.
76-year-old male patient 22 years laryngectomy with tracheostomy cannula tracheostomy home cleaning brush has aspirated. Made rigid and flexible bronchoscope is connected to a tracheostomy granulation tissue formed by ejecting a brush can not be removed right thoracotomy patients is presented.

Abstract | Full Text PDF