We present the results of 13 patients who suffered severe injuries to the lower leg. Five sustained a traumatic amputation and eight a Gustilo-Anderson type IIIC open fracture. All were treated with debridement, acute shortening and stabilisation of the fracture and vascular reconstruction. Further treatment involved restoration of tibial length by callus distraction through the distal or proximal metaphysis, which was commenced soon after the soft tissues had healed (n = 8) or delayed until union of the fracture (n = 5). All patients were male with a mean age of 28.4 years (17 to 44), and had sustained injury to the leg only. Chen grade II functional status was achieved in all patients. Although the number of patients treated with each strategy was limited, there was no obvious disadvantage in the early lengthening programme, which was completed more quickly.
Objective: To prevent pressure ulcer, detecting risk factors and planning how to act with respect to patients provide to find solution. Thus, Braden Scale is the most common tool that is used in Turkey. This study aimed to measure Braden Scale effectiveness at detecting the risk groups of level 3 intensive care unit patients.Methods: This prospective, single-center study includes 206 level 3 intensive care unit patients whose risk factors were standardized as much as possible in the intensive care unit between January 2014 and May 2015. Routine clinical care was applied to the patients whose risk groups were determined by Braden Scale, and the patients were divided into two groups depending on the presence of a pressure ulcer before discharging from the hospital. Demographic findings, hospitalization duration, mental status, Apache II score, expected/actual mortality, blood albumin levels, and Braden Scale score were compared. Results:Comparison of the groups showed that patients' age, length of stay in intensive care unit, mental status, and blood albumin levels are significantly different between patients with and without pressure ulcers. Furthermore, scores of patients with pressure ulcers were not significantly different from those of patients without pressure ulcers. Data also illustrated that pressure ulcers occurred in no risk patients with the ratio of 7.14%; in low-risk patients with the ratio of 27.8%; in moderate-risk patients with the ratio of 29.73%; in high-risk patients with the ratio of 17.72%.Conclusion: Data evaluation demonstrates that Braden Scale is not effective to detect the risk factors, and parameters related to pressure ulcer development are not sufficiently represented by Braden Scale. Modification of an existing scale or a new risk assessment scale that includes all other risk parameters and that is more suitable for the patients of our country is required. (JAREM 2016; 6: 98-104)
Çalışmamızda tanısal kolonoskopide bilinçli sedasyonda uygulanan 1:3 Ketamin / Propofol (Grup-I) ve Petidin / Propofol (Grup-II) kombinasyonlarını; toplam ilaç dozu, indüksiyon, sedasyon-derlenme süreleri, hasta-endoskopist açısından işlem memnuniyeti, hemodinamik, solunumsal parametrelere etkileri ve saptanan diğer yan etkiler açısından karşılaştırdık. ASA I-II 60 hasta çalışmaya katıldı. G-I' de indüksiyon süresi 2,15±0,38 dk., derlenme süresi 22,12±6,23 dk. olarak saptandı. Toplam 67,81±14,38 mg. propofol kullanıldı. G-II' de ise indüksiyon süresi 3,97±1,26 dk., derlenme süresiyse 12,85±3,79 dk. olarak ölçüldü. Propofol dozu 79,88±17,59 mg. oldu. G/I-II arasında toplam propofol dozu, indüksiyon-derlenme süreleri açısından istatistiksel anlamlı fark varken, kolonoskopi-sedasyon süresi açısından fark saptanmadı. OAB' da G-I' de grup içi karşılaştırmada hiçbir ölçümde istatistiksel anlamlı düşüş saptanmazken G-II' de 5. dakikadaki ölçüm işlem öncesine göre istatistiksel anlamlı azaldı. Gruplar arası karşılaştırma da ise herhangi bir fark saptanmadı. KAH ve SpO2' de ise her iki grupta da grup içi ve sonrasında yapılan gruplar arası karşılaştırmada istatistiksel anlamlı fark yoktu. G I' de kolonokopi sırasındaki VAS değerleri 1,36±1,14 iken G-II' de 2,13±1,49 olarak bulundu. Aradaki fark istatistiksel olarak anlamlı olmasına karşın her iki değerde ağrı sınırının altında kaldı. İşlem sırasında RSS' de G-I ve II arasında istatistiksel olarak anlamlı fark görülmesine karşın her iki grupta da çalışma öncesi hedeflenen sınırlar
This study presents the surgical and functional outcomes of below-knee total leg amputation and Gustilo type III C open fracture cases that were considered appropriate for salvage treatment according to a more proactive approach, despite being candidates for amputation according to the current scoring systems. Nineteen patients (21 legs) underwent replantation-revascularization surgery. At least Chen Grade II functional level was the aim. A limb salvage operation was performed in 21 legs in 19 patients (18 male, 1 female). The mean age was 28.5 years (range: 11 to 42 years). Six legs in four patients presented with total amputation, and 15 legs in 15 patients had Gustilo Type III C open fractures. A successful replantation/revascularization was performed in 20 legs, with a Chen Grade I and Grade II functional outcome in 3 and 17 legs, respectively. None of these patients were eligible for salvage operation according to currently used scoring systems. Limb-preserving surgery performed upon the assessment of local and general conditions of the patients with traumatic below-knee amputations or Gustilo Type III C open fractures seems to be a viable therapeutic option that can serve to achieve Chen Grade II functional level in most patients.
Background/aim: The Analgesia Nociception Index (ANI) is a new method of identifying nociception-analgesia balance. In this study, we investigate the correlation between the ANI and numeric rating scale (NRS) values immediately before and after extubation. The NRS values were recorded in the postanesthesia care unit, in a group of patients who underwent laparoscopic cholecystectomy, with the aim of evaluating the potential use of ANI values in the prediction of postoperative pain levels. Materials and methods: The ANI and NRS values, heartbeat rate (HR), systolic and diastolic arterial pressure (SAP/DAP), and oxygen saturation (SpO 2) values of the patients were recorded into three groups based on the initial NRS values recorded in the postanesthesia care unit (group I: NRS ≤ 3, group II: NRS 4-6, group III: NRS ≥ 7). Patients whose ANI values were lower than 47, considered as the pain threshold, and the groups to which these patients belonged were also recorded. Results: Statistically significant increases were noted in HR, SAP, and DAP after extubation, while there was no significant change in ANI values. A weak correlation was identified between the ANI and NRS values of all patient groups. Conclusion: We failed to identify a correlation between ANI and NRS values before and after extubation. Previous studies suggested that the ANI provides more valuable information in anesthetized patients, whereas our findings show that it is ineffective in the prediction of potential postoperative pain.
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