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Postoperative adhesions (PAs) are usually clinically asymptomatic. Symptomatic cases, however, may present with chronic abdominal and pelvic pain, infertility, and intestinal obstruction; and they may require intensive, costly therapeutic modalities. Various agents have been used to prevent PAs, but the results indicate general suboptimal effectiveness. Our objective was to evaluate the comparative effectiveness of two pharmacologic agents for preventing PA: nadroparine calcium (low-molecular-weight heparin, or LMWH) and aprotinin, as well as a barrier agent, sodium hyaluronate/carboxymethycellulose (SCMC). Our subjects were 40 male Wistar-Albino rats divided into four groups, each consisting of 10 rats, which underwent standard cecal abrasion preceding midline laparotomy. In the control group (group 1) 1 ml of 0.9% NaCl was administered intraperitoneally before abdominal closure. In the three preventive groups, 100 U AXa (anti factor X activity) LMWH, 1800 IU aprotinin, and SCMC were administered intraperitoneally to groups 2, 3, and 4, respectively. Relaparotomy was performed on the 14th postoperative day. Visceral and abdominal wall adhesions were scored in a blinded fashion. The adhesion scores (mean +/- SD) for groups 1, 2, 3, and 4 were 2.00 +/- 0.67, 0.6.00 +/- 0.84, 1.10 +/- 0.74, and 0.20 +/- 0.42, respectively. The differences in the adhesion scores among all three preventive groups (groups 2, 3, 4) were statistically significant when compared with the control group ( p < 0.001, p = 0.017, p < 0.001, respectively). Intraperitoneal SCMC and administration of LMWH were more effective than giving aprotinin.

ObjectiveWe wanted to compare the clinical usefulness of conventional galactography and MR contrast galactography for diagnosing patients with nipple discharge.Materials and MethodsBoth conventional galactography and MR contrast galactography were performed prospectively in 16 patients. Gadopentate dimeglumine (0.1 ml) was mixed with non-ionic contrast medium (0.9 ml) to obtain a resultant volume of 1 ml and this was used for both examinations. Following conventional galactography, MR contrast galactography was performed after direct injection of contrast media into the duct.ResultsConventional galactography and MR contrast galactography were concordant in 13 (81%) of 16 patients; the results were normal in five, ductal dilatation was noted in four and intraductal filling defects were noted in four. The remaining three (19%) patients demonstrated discordant findings on the two examinations. While conventional galactography revealed filling defects, the MR contrast galactography results were normal in two patients. The third patient had kinks-stricture on conventional galactography and MR contrast galactography showed ductal dilatation. This suggested there were false positive results for the three patients' conventional galactography, and all the three patients with discordant results underwent surgery and the histopathologic evaluation showed fibrocystic changes.ConclusionMR contrast galactography may be used as an alternative imaging modality for making the diagnosis of pathologic nipple discharge. However, statistically supported studies with large pools of subjects for comparing the galactography and MR contrast galactography results are needed to confirm our findings.

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ÖzetAmaç: Gereksiz enjeksiyonlar, hatalı uygulama teknikleri ve enjeksiyonların donanımsız (eğitimsiz, yetersiz) personel tarafından yapılması enjeksiyon nöropatisine neden olabilir. Bu çalışmanın amacı enjeksiyon nöropatisi vakalarının özellikleri ile nöropatiye sıklıkla n e d e n o l a n e t k i n m a d d e l e r i b e l i r l e m e k v e s i y a t i k s i n i r yaralanmalarının bir kısmının tıbbi uygulamalara bağlı olduğu göz önüne alındığında enjeksiyon nöropatisinin tıbbi uygulama kusuru olarak değerlendirilip değerlendirilemeyeceğinin tartışılmasıdır.Gereç ve Yöntem: 2008-2010 yılları arasında enjeksiyon nöropatisi iddiası ile Adli Tıp Kurumu 3. Adli Tıp İhtisas Kuruluna gönderilen dosyalar retrospektif olarak incelenmiştir. Tüm vakalarda enjekte edilen ajan, enjeksiyon yapılma nedeni, enjeksiyonu yapan kişi ve nörolojik sekelin ciddiyeti değerlendirilmiştir.Bulgular: Adli Tıp Kurumuna gönderilen 121 vakanın 107'si (%88.4) erkek, 14'ü (%11.6) kadındır. Enjeksiyonları uygulayanların büyük kısmı (n=93,%76.8) hemşire veya sağlık memurudur. En sık rastlanan etken madde diklofenak sodyumdur. Vakaların 47'sinde (%38.8) sadece diklofenak sodyum enjekte edildiği tespit edilmiş, kombine ilaçlara bakıldığında bu sayının 58 olduğu görülmüştür. Diğer yandan ise 10 vakada ağrı kesici enjekte edildiği tespit edilmiş ancak ilaçların isimleri tıbbi evrakta bildirilmemiştir. Bir vakada doktor ve hemşire enjeksiyon nedeniyle tıbben kusurlu olarak bulunmuştur.Sonuç: Enjeksiyon nöropatisinin sadece enjeksiyonun hatalı uygulanmasından değil ilaçların toksik etkisi nedeniyle oluşabildiği hayvan deneyleri ile gösterilmiştir. Enjeksiyon doğru yapılsa bile, çeşitli derecelerde nörolojik sekeller meydana gelebilir ancak enjeksiyon ajanını seçerken dikkatli davranmak ve yardımcı sağlık personelinin eğitimi ile istenmeyen etkilerin oranı azaltılabilir.Anahtar kelimeler: Enjeksiyon nöropatisi, İntramüsküler enjeksiyon, Malpraktis AbstractObjective: Redundant injections, false administration techniques and the injections applied by unqualified personnel can cause injection neuropathy. The purpose of this study is to characterize the postinjection neuropathy cases, to identify the active ingredients used for injection and, knowing the fact that the a number of sciatic nerve injuries are secondary to medical intervention, to discuss if postinjection neuropathy can be considered as malpractice.Materials and Methods: A retrospective study was conducted based on the analysis of 121 cases which were sent to the Council of Forensic Medicine from the courts with a post-injection neuropathy claim in 2008-2010. All patients were evaluated for the agent injected, indication for injection and person who injected the drug and the severity of neurodeficit.Results: It was found that 107 (88.4 %) of 121 cases sent to Council of Forensic medicine were male, 14 (11.6%) of them were female. Majority (n=93, %76.8) of the injections were applied by a nurse or health officer. Diclofenac sodium is the major injection agent. While 47 (38.8%) of the cases had ...