Transfusion requirement, ASA grade 4 and having more than two comorbidities are risk factors for mortality in geriatric hip fractures. Type of surgical intervention and fracture type had similar mortality rates in our patient population.

Osteoid osteoma (OO) is a benign tumor that is frequently seen in young people usually in the second and third decade. Tumor localization may be in cortical or cancellous bone. [1] Radiologically, a surrounding sclerotic lesion and a structure called "nidus" are present. Clinically, night pain is typical and frequently responds well to nonsteroidal drugs. There are many treatment modalities for OO including medical treatment, percutaneous radiofrequency ablation (RFA) treatment, and open surgical procedures. [1] However, despite all these different treatment methods, recurrence of OO is a significant problem. The protocol for a successful treatment should be planned in a different way for each patient. The multidisciplinary approach is an appropriate method for the treatment of various diseases that decreases the rate of morbidity in radiologic interventions as well as in many other fields of medicine. The synergy created by multiple disciplines Objectives: This study aims to present the importance of a multidisciplinary approach to radiofrequency ablation (RFA) treatment in osteoid osteoma (OO) patients by a team of experts in their field in preventing recurrence and complications. Patients and methods: For this retrospective study, a team of two orthopedists, two interventional radiologists, and one anesthesiologist was established in January 2013 to manage the diagnosis, follow-up, and treatment process of patients with OO at Bakırköy Dr. Sadi Konuk Training and Research Hospital. A total of 27 patients (15 males, 12 females; mean age 22.9 years; range, 9 to 54 years) were treated by this team between February 2013 and September 2016. The anatomic localization included iliac crest in four patients, the femur in 12 patients, fibula in two patients, humerus in three patients, radius in one patient, tibia in three patients, talus in one patient, and metacarpal in one patient. The procedures were carried out by the same interventional radiologists, same orthopedic surgeons, and same anesthesiologist in the computed tomography (CT) unit under aseptic conditions. After appropriate anesthesia for the localization of OO, the patient was positioned on the CT bed and the localization of the lesion was confirmed with a CT scan mapping. Then, a bone penetration cannula was advanced and bone cortex was penetrated with a charged motor and Kirschner (K)-wire. When the cannula reached the nidus, it was replaced with RFA probe. Ablation of the nidus was performed for five minutes at 90°C. Results: The mean follow-up period was 46 months (range, 25 to 66 months). Patients were evaluated with visual analog scale (VAS) scores preoperatively and at postoperative 15 th day, sixth month, and first year. In the last evaluation of the study data, the patients were called by telephone and questioned whether there were any changes in their final status. The mean preoperative VAS score was 7.2. The mean postoperative VAS scores of the 15 th day, sixth month, and first year were 1.3, 0.6, and 0, respectively. In the last follow-up, the OO...

Background: The main objective was to evaluate and compare the local genotoxicity of sevoflurane and desflurane in bronchoalveolar cells, while the secondary outcome was to detect systemic oxidative DNA damage. To our knowledge, our study is the first one to evaluate the local effects of inhalation anesthetics in human bronchoalveolar cells in patients. Methods: American Society of Anesthesiologists group I-II patients scheduled for lumbar discectomy surgery were enrolled in this randomized prospective study. Patients were randomized to sevoflurane or desflurane for anesthesia maintenance. Bronchoalveolar lavage samples and peripheral blood samples were taken at 2-time points: the first point (baseline, T1); and the second point (postexposure, T2). Final number of 48 samples were the sevoflurane (n = 22) and desflurane (n = 26) groups. Comet assay was applied to examine genotoxic properties. Oxidative DNA damage in plasma was measured with 8-hydroxy-2′-deoxyguanosine (8-OHdG). Results: T2 values were higher than baseline values in both the desflurane group (tail-length: 66 ± 24, %DNA in tail: 72 ± 60, tail moment: 47.52 ± 14.4; P = .001, P = .005, P = .001, respectively) and the sevoflurane group (tail-length: 58 ± 33, %DNA in tail: 88 ± 80, tail moment: 51.04 ± 26.4; P = .001, P = .012, P = .001, respectively). T2 plasma 8-OHdG levels were also higher than baseline levels in the desflurane group (3.91 ± 0.19 ng/ml vs 1.32 ± 0.20 ng/ml, P = .001) and sevoflurane group (3.98 ± 0.18 ng/ml vs 1.31 ± 0.11 ng/ml, P = .001). There were no differences between the 2 groups in comet parameters and 8-OHdG levels. Conclusion: Our results indicate that both inhalation agents cause DNA damage in the bronchoalveolar cells. Also, we detected increases in plasma 8-OHdG concentrations. Local genotoxicity and systemic oxidized DNA damage were similar in both groups.

This study aimed to determine the appropriate anesthetic technique for patients who underwent amputation due to peripheral vascular disease. The anesthetic technique to be applied during lower extremity amputations in geriatric patients with limited functional capacity may be important in terms of clinical outcomes and mortality rates. Patients aged older than 65 years who had undergone major lower extremity amputation were retrospectively evaluated. The patients were divided into 2 groups: regional anesthesia (RA) and general anesthesia (GA). Demographic characteristics, comorbidities, medications used, anesthesia technique, the durations of anesthesia and surgery, need for blood transfusion, 30-day mortality, postoperative cardiac and pulmonary complication rates were recorded from the medical records of the patients. Among the 441 patients, 244 had received RA, while 197 had received GA. The average length of stay in the hospital was longer in the GA group (P ¼ 0.001). The use of antiplatelet drugs (P ¼ 0.001) and the number of transfusions were higher (P ¼ 0.045) in the GA group. No

The results show that US guidance is more effective in maintenance of successful ICB than neurostimulation guidance alone and a reduction of LA doses even to 70% of conventionally used doses seems possible with US guidance. This article is published in English.

Öz Metformin biguanid sınıfından, Tip 2 diyabetiklerde, özellikle böbrek fonksiyonları normal hastalarda ilk basamakta kullanılan oral antidiyabetiktir. Metforminin en ciddi ve ölümcül yan etkisi laktik asidozdur. Böbrek yetersizliği laktat atılım bozukluğunun en sık sebebidir. Acil serviste, suisid amaçlı ilaç alımından sonra yüksek anyon açıklı metabolik asidoz varlığı olan hastalarda metformin intoksikasyonu düşünülmelidir. 44 yaşında kadın hasta intihar amaçlı 50 gram metformin alımından 3 saat sonra acil servise bulantı ve karında şişkinlik şikâyeti ile başvurdu. Hastada metformin ilişkili laktik asidoz (pH<7.35, laktat düzeyi>5 mmol/L ve bikarbonat<22 mmol/L) tanımlandı. Erken tanı ve hemodiyaliz veya hemofiltrasyon yöntemleri ile metabolik asidozun hızlı düzeltilmesi, destek tedavisi ve kan glikoz düzeyinin ayarlanması pozitif sonuçlara neden olacaktır.

Objectives:The aim of this prospective, randomized study was to investigate the effect of magnesium added to midazolam on the hemodynamics, transition time to a T-piece, mechanical ventilation duration, additional sedative-analgesic requirement using bispectral index (BIS) monitorization and sedation scales. Methods: Fifty critically ill patients receiving mechanical ventilation support in the intensive care unit were randomly assigned to 2 groups. Group I received a 0.03-0.3 mg/kg bolus loading dose+0.03-02 mg/kg/hour midazolam infusion; Group II received a 2 g bolus at 30 minutes, 16 mg/24-hour magnesium infusion+0.03-02 mg/kg/hour midazolam infusion. BIS levels and sedation levels were continuously monitored. Results: The duration of mechanical ventilation in Group I was longer than that of Group II (31±12 hours, 19±11 hours, respectively; p<0.01). The length of time to start spontaneous breathing trials with a T-piece was greater in Group I than in Group II (27±11 hours, 16±11 hours, respectively; p<0.01). The 48-hour insulin requirement of Group I was greater than that of Group II (p<0.05). Conclusion: Adding intravenous magnesium to the traditional sedation protocols in the intensive care unit decreased midazolam use as well as the additional analgesic requirement and mechanical ventilatory support duration without any side effects. ÖzetAmaç: Bu prospektif randomize çalışmada, midazolama eklenen magnezyumun hemodinami, T-parçasına geçiş süresi, mekanik ventilasyon süresi ile BIS monitorizasyonu ve sedasyon ölçekleri kullanılarak ek sedatif analjezik gereksinimi üzerine etkisini araştırmayı amaçladık. Gereç ve Yöntem: Yoğun bakım ünitesinde mekanik ventilasyon desteği alan 50 hasta rasgele olarak iki gruba ayrıldı. Grup I, 0.03-0.3 mg/kg bolus yükleme dozu +0.03-02 mg/kg/saat midazolam infüzyonu aldı; Grup II, 30 dakikada. 2 gr bolus, 16 mg/24 saat magnezyum infüzyonu +0.03-02 mg/kg/saat midazolam infüzyonu aldı. BIS seviyeleri ve sedasyon seviyeleri sürekli olarak monitörize edildi. Bulgular: Grup I'de mekanik ventilasyonun süresi grup II'den daha uzundu (sırasıyla 31±12 saat; 19±11 saat; p<0.01). T-parçası ile spontan solunum denemelerine başlama zamanı, grup I'de grup II'den (27±11 saat; 16±11 saat) daha uzundu (p<0.01). Grup I'in 48 saatlik insülin gereksinimi grup II'den yüksekti (p<0.05). Sonuç: Yoğun bakım ünitesinde, geleneksel sedasyon protokollerine intravenöz magnezyumun eklenmesi, midazolam ve ek analjezi gereksinimini, mekanik ventilasyon destek süresini herhangi bir yan etkisi olmaksızın azaltmıştır.Anahtar sözcükler: Bispectral index; intensive care unit; magnesium; midazolam; sedation-analgesia.

No abstract