OBJECTIVE:To evaluate the effects of three different target-controlled remifentanil infusion rates during target-controlled propofol infusion on hemodynamic parameters, pain, sedation, and recovery score during oocyte retrieval.METHODS:Sixty-nine women were scheduled for oocyte retrieval. Target-controlled propofol infusion at an effect-site concentration of 1.5 µg/mL was instituted. The patients were randomly allocated to receive remifentanil at an effect-site concentration of either 1.5 (group I, n = 23), 2 (group II, n = 23) or 2.5 ng/mL (group III, n = 23). Hemodynamic variables, sedation, pain, the Aldrete recovery score, and side effects were recorded.RESULTS:Hemodynamic variables, sedation and pain scores and the number of patients with the maximum Aldrete recovery score 10 min after the procedure were comparable among the groups. The number of patients in group III with the maximum Aldrete recovery score 5 min after the procedure was significantly lower than that in groups I and II. One patient in group II and one patient in group III suffered from nausea.CONCLUSION:Similar pain-free conscious sedation conditions without significant changes in hemodynamic parameters were provided by all three protocols. However, target controlled infusion of remifentanil at 1.5 or 2 ng/mL proved superior at providing early recovery compared to 2.5 ng/mL.

Clinicians should be skeptic for the serious long-term side effects of bupivacaine and its analogs, even at ultra-low doses.

avoiding any unnecessary compression points of the lower extremities; pulse oximeters on both feet are recommended and prolonged hypotension must be avoided.

Ketamine has been used in combination with a variety of other agents for intra-articular analgesia, with promising results. However, although it has been shown to be toxic to various types of cell, there is no available information on the effects of ketamine on chondrocytes. We conducted a prospective randomised controlled study to evaluate the effects of ketamine on cultured chondrocytes isolated from rat articular cartilage. The cultured cells were treated with 0.125 mM, 0.250 mM, 0.5 mM, 1 mM and 2 mM of ketamine respectively for 6 h, 24 hours and 48 hours, and compared with controls. Changes of apoptosis were evaluated using fluorescence microscopy with a 490 nm excitation wavelength. Apoptosis and eventual necrosis were seen at each concentration. The percentage viability of the cells was inversely proportional to both the duration and dose of treatment (p = 0.002 and p = 0.009). Doses of 0.5 mM, 1 mM and 2mM were absolutely toxic. We concluded that in the absence of solid data to support the efficacy of intra-articular ketamine for the control of pain, and the toxic effects of ketamine on cultured chondrocytes shown by this study, intra-articular ketamine, either alone or in combination with other agents, should not be used to control pain. Cite this article: Bone Joint J 2014; 96-B:989-94.

Background and Objectives: Although all parts of the lung can be affected as a consequence of asbestos exposure, most CT protocols tend to scan only the middle and lower parts of the thorax. The aim of this study was to investigate parenchymal and pleural lesions of persons exposed to environmental asbestos, using a high-resolution computed tomography (HRCT) protocol scanning the whole thorax. Methods: We analyzed the chest radiographs and HRCT scans of 26 patients who presented bilaterally with multiple pleural plaques related to environmental asbestos exposure. Results: Twenty-four cases (92%) had an abnormal HRCT suggestive of asbestosis. Apart from common HRCT changes related to asbestosis, we detected apical pleural thickening (APT) in 9 cases as well as a coarse honeycomb pattern adjacent to APT in 7 of these cases. Cavitary lesions due to pulmonary tuberculosis were observed on HRCT scans from 4 patients in total. Neither apical pulmonary fibrosis nor cavitary lesions were visible on chest radiographs. Conclusions: We suggest that the HRCT protocol for examining asbestos-exposed individuals with pleural plaques on chest X-rays should include the whole thorax, since the asbestos-related pathologies may involve all parts of the lung.

ÖzetAmaç: Maluliyet; sakatlık olarak tanımlanmıştır. Arapça kökenli bir kelime olan maluliyet, sakatlık, hastalık, sağlam olmayan anlamın-daki illet kelimesinden türetilmiştir. Yaralanmalar ya da yapılan meslekle ilgili nedenlerden meydana gelen, fonksiyon kayıplarının, uygulanan tüm tedavilere rağmen iyileşemeyip sekel halinde devam etmesi durumuna maluliyet, hazırlanan cetvellerden yararlanılarak belirlenen orana (Tüm vücudun meslekte kazanma gücüne oranla kayıp miktarının saptanmasına) maluliyet oranı (Meslekte kazanma gücü kayıp oranı) denilmektedir. Bu çalışmada; maluliyet raporlarının içeriği ile sonucunun ortaya konması ve literatür eşliğinde tartışılması amaçlanmaktadır.Gereç ve Yöntem: Çukurova Üniversitesi Adli Tıp Anabilim Dalı'na 01.01.2013 tarihi ile 30.06.2016 tarihleri arasında mahkemeler tarafından gönderilen trafik kazası ve iş kazası gibi diğer nedenler sonrasında sakat kaldığını iddia edenlere düzenlenen maluliyet raporları retrospektif olarak incelenmiştir.Bulgular: Mahkemeler tarafından gönderilen 3835 maluliyet dosyası çalışmamıza dahil edilmiştir. Olguların 2892 erkek(% 75.4), 943'ü (% 24.6) kadındı. Yaş aralığı 1 ila 79 yaş arasında olup yaş grupları açı-sından 30-39 yaş grubunun en yüksek oranda olduğu görüldü. Olguların 3768(% 98.3)'i trafik kazası, 67(% 1,7)'si trafik kazası dışı olaylar nedeniyle yaralanmıştı. Maluliyet oranlarının ortalamaları %17.7'dir. En yüksek maluliyet oran aralığının %10-19.9 grubunda olduğu görüldü. Olgulardan 587(% 15.3)'inin ise meslekte kazanma gücünden azalma oluşturmadığı tespit edildi. Maluliyet raporlarının hesaplanması sırasın-da, 833(% 21.7) olguda ise kısıtlılığı karşılayan bir madde olmaması nedeniyle takdir uygulandığı tespit edildi.Sonuç: Adli Tıp uzmanlarının sıklıkla düzenledikleri maluliyet raporlarında standart bir uygulama sağlayamadıkları düşünülmektedir. Bu standardizasyonun sağlanabilmesi için ortak çalışmaların arttırılmasının gerekli olduğu görülmektedir. Adaletin sağlanmasına yardımcı olabilmek açısın-dan, maluliyet hesaplamasında kullanılan yönetmeliklerin tek başına her birinin yetersiz olduğu bu nedenle daha ayrıntılı, güncel meslekleri içeren yeni bir yönetmeliğin oluşturulmasının gerekli olduğu düşüncesindeyiz.Anahtar Kelimeler: Maluliyet; Mahkeme; Tazminat; Trafik Kazası. AbstractObjective: Disability; is defined as invalidity. Disability, a word in Arabic origin, is derived from the word "malady" which means disablement, illness, unstable condition. The loss of function, due to injuries or occupational reasons, which does not improve and continue in a sequential manner despite all the treatments applied is defined as disability and the disability rate (Profit loss rate in profession) is determined as the rate determined by using prepared scales (Determining the loss amount of the whole body compared to the earning power in the profession). In this study; it was aimed that, revealing the contents and results of disability reports and discussing results in the light of literature.Materials and Methods: Disability reports sent by co...

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Age estimation in forensic medicine practice is of particular importance to the legal systems, and it is one of the current research topics in forensic medicine. Age determination is most frequently performed by radiological methods, but recently, nonionized methods are preferred for nonmedical indications. Therefore, we aimed to examine feasibility of MRI imaging, which provides nonionized, noninvasive, and detailed images, in forensic age estimation and to expand the database on this subject. The MRI images of the patients between the ages of 10 and 25 years, who visited Cukurova University Faculty of Medicine between January 2012 and April 2018 for any reason, were retrospectively analyzed according to the staging method described by Dedouit et al. The stage 5 ossification in distal femoral epiphysis indicated an age over 18 years in both sexes (except for 2 cases of 14 and 15 years). The stage 5 ossification in proximal tibial epiphysis indicated an age older than 18 years (except for 1 male case at the age of 15 years and 2 female cases at the age of 14 and 17 years, respectively). It was determined that stage 1 and stage 2 in both distal femur and proximal tibial epiphysis were last seen in younger than 18 years in both sexes. Our study data show that MRI imaging is a nonionized method that can be used in addition to other radiological methods in determining the age limit of 18 years.