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surface required for assembly of the platelet-bound coagulation enzymes, and the production of enough thrombin to cause substantial fibrin formation. Plateletderived micro-particles such as P-selectin, which are formed during the process provide a mechanistic route for amplifying thrombus formation on a thrombogenic surface [4,7].Leukocyte activation (CD11b upregulation) also occurs within minutes leading to adhesion while tissue factor expression occurs over hours. Complement activation occurs at all these time scales [3].Researchers should be aware that the choice of the storage tube can influence TEG s variables. The advice is that reference intervals for TEG s variables be established, and this is likely to be specific for the nature of the tube used. The values for r and MA obtained during this study fell within the references ranges for our own analyser for citrated samples.Our results suggest that glass is a more potent surface for activation of the coagulation cascade than plastic. This is reflected in lower r values and greater MA values for glass tubes when compared to plastic tubes.In conclusion, both glass and plastic tubes show no significant effect between 45 min and 4 h. Glass tubes are associated with shorter r values and higher MA when compared with plastic tubes. References 1. Willschke H, Bräunlich P, Zimpfer M, Varady S, Kozek S. Prevention of storage-induced clot strength reductions. Eur J Anaesthesiol 2001; A207. 2. Camenzind V, Bombeli T, Seifert B et al. Citrate storage affects Thromboelastograph s Analysis. Anesthesiology 2000; 92: 1242-1249. 3. Gorbet M, Sefton M. Biomaterial-associated thrombosis: roles of coagulation factors, complement, platelets and leukocytes. Biomaterials 2004; 25(26): 5681-5703. 4. Siedlecki CA, Wang IW, Higashi JM, Kottke-Marchant K, Marchant RE. Platelet-derived microparticles on synthetic surfaces observed by atomic force microscopy and fluorescence microscopy. Biomaterials 1999; 20(16): 1521-1529. 5. Otto M, Franzen A, Hansen T, Kirkpatrick CJ. Modification of human platelet adhesion on biomaterial surfaces by protein preadsorption under static and flow conditions. J Mater Sci -Mater Med 2004; 15(1): 35-42. 6. Gemmell CH. Assessment of material-induced procoagulant activity by a modified viper venom coagulation time test.EDITOR: Aluminium phosphide is used to control rodents and pests in grain-storage facilities. When aluminium phosphide comes into contact with water, it releases large quantities of phosphine (PH 3 ), a very toxic gas and a mitochondrial poison. We present a case report of suspected inhalation exposure to phosphine gas in a manufacturing facility for aluminium phosphide fumigants. Case reportA 45-yr-old male was admitted to the hospital with a history of severe diarrhoea, nausea and vomiting for 3 days. He was treated with intravenous saline without improvement and his clinical picture deteriorated with the appearance of dyspnoea. His symptoms had started soon after he had used an insecticide (Fosguard which contains phosphine) to clean a smal...

In this study, levobupivacaine wound infiltration with adjuvant intravenous lornoxicam administration was associated with better postoperative analgesia during the early postoperative hours after varicocoele surgery than that induced by lornoxicam alone or levobupivacaine wound infiltration alone.

Hyperthyroidism is not a rare entity in pregnancy and 85% of these cases attributed to Graves' disease (GD). There is no therapeutic modality for GD considered as totally safe in pregnancy. Fetal and neonatal risks of maternal hyperthyroid disease are related to the hyperthyroidism itself and/or to the medical treatment of the disease. There are no data supporting an association between congenital anomalies in the fetus and propylthiouracil (PTU). Hepatotoxicity, cytopenias--especially agranulocytosis and quite rarely, angioedema, may be seen as side effects of PTU. In this case report, we examine an instance of Graves' hyperthyroidism diagnosed during pregnancy. In this case, a serious side effect during anti-thyroid drug usage was encountered, eventually resulting in surgery in the second trimester. This intervention was assisted by the use of plasmapheresis to obtain rapid normalization of serum thyroid hormone levels.

Purpose:We provide the application of modified radial mastectomy in perioperative treatment under awake thoracic epidural block in breast cancer operations. Methods: Twelve women who underwent modified radical mastectomy in elective breast cancer surgery were included in the study. All patients were treated without tracheal intubation using thoracic epidural anesthesia and sedation. The epidural catheter was placed in the T 4-5 level and the mixture of 0.5% bupivacaine and fentanyl was gradually administered with careful haemodynamic monitoring. Target-controlled propofol infusion was used. Pain intensity was evaluated by using a 10 cm VAS, where zero represented no pain and 10 cm represented worst possible pain. The primary endpoint was pain. A VAS score of 4 cm or less was considered to be an acceptable level of pain. The sedation situation was focused and calm in Wilson 2 level and in cooperation with sedation. Preoperative comorbidity and perioperative therapy were recorded. Results: We observed 4 hypotensive patients treated by increasing intravenous fluid infusion rate and initiating dopamine infusion. One patient had bradycardia, one patient had nausea and three patients had vomiting. There were no respiratory complications or pruritus. The mean duration of hospitalization is 5 days postoperatively. The patient had no intraoperative or postoperative complications. Conclusion: Epidural block in axillary lymph node dissection and oncologic mastectomy may be considered as a safe anesthetic option. Key words: Thoracic epidural anesthesia. Modified radical mastectomy. Non-intubated thoracic epidural anesthesia for modified radical mastectomy as an alternative to general anaesthesia Sağıroğlu G, et al J Surg Cl Res -Vol. 8 (2) 2017:140-150 141 OBJETIVO Objetivo: Fornecer a aplicação bem sucedida de mastectomia radial modificada em tratamento perioperatório sob anestesia peridural torácica acordada em operações de câncer mama. Métodos: Doze mulheres submetidas a mastectomia radical modificada em cirurgia eletiva de câncer de mama foram incluídas no estudo. Todas as pacientes foram tratados sem intubação traqueal com anestesia peridural torácica e sedação. O cateter epidural foi colocado no nível T 4-5 e a mistura de bupivacaína a 0,5% e fentanil foi gradualmente administrado com monitorização hemodinâmica cuidadosa. A infusão de propofol controlada por alvo foi utilizada. A intensidade da dor foi avaliada com 10 cm VAS; zero dor e 10 cm dor pior. O desfecho primário foi a dor. A situação de sedação foi focada e calma no nível Wilson 2 e em cooperação com sedação. Comorbidade pré-operatória e terapia perioperatória foram registradas. Resultados: Observamos 4 pacientes hipotensas tratadas pelo aumento da infusão de fluidos intravenosos e inciao da infusão de dopamina. Uma paciente apresentou bradicardia, uma paciente apresentou náuseas e três pacientes apresentaram vômitos. Não houve complicações respiratórias ou prurido. A duração média da hospitalização foi de 5 dias após a cirurgia. As pacientes não apresentaram...