Pneumocephalus after lumbar epidural catheter: a case report

Various complications have been associated with epidural block; pneumocephalus is one of the rare complications. We report a case of pneumocephalus following epidural catheter placement in a 58 years old female patient referred to our pain clinic for pain hypogastrium. After careful history and physical examination the diagnosis of neuropathic pain was established. The pain did not relieve with the pharmacological treatment, so superior hypogastric ganglion block was performed. The patient remained pain free for a week, after which the complaints recurred. Then an epidural catheter was attempted twice but abandoned after two failed attempts. The catheter perforated the dura mater leading to flow of CSF. After a few hours the patient developed a complaint of severe headache. The patient was hospitalised and intravenous NSAID's were started. However, the headache did not relieve, so CT scan brain was ordered, which determined the presence of pneumocephalus. The patient was offered symptomatic treatment and after a week was discharged home without any complication

Comparision of retroperitoneal and transperitoneal procedures in aortoiliac occlusive diseases

Comparision of transperitoneal [TP] and retroperitoneal procedures at the surgical treatment of aortiliac occlusive diseases [AIOD] was aimed in this study. Advantages and disadvantages of the procedures were also evaluated. From October 2003 to March 2009, 110 patients underwent aortic surgery. TP technique was performed to 50 patients and retroperitoneal[RP] technique was performed to 60 patients. Demographic datas, risk factors, peroperative and postoperative medical datas [24 parameters] were analyzed and compared between two groups. No statistically significiant difference was observed in demographic datas and risk factors. Five of eight operative parameters resulted in favor of RP procedure. Length of intensive care unit [ICU] stay [p<0.01] length of hospital stay [p<0.01], return of bowel functions [p<0.01], time of beginning oral feding [p<0.01], effort pain score [p<0.01] were significiantly different in RP group and, results were better than TP group. Pulmonary complications were analyzed as lesser in RP group [p=0.02] There was no statistically significant difference at the rest of complication datas [wound complications p=0.09, paralitic ileus p=0.14, re-operation p=0.46, 30 day mortality p=0.30]. Comparision of Medical datas showed that RP procedure is more advantegous than TP procedure at the surgical treatment of AIOD

Brachial plexus injury due to median sternotomy and lima harvesting

Brachial plexus injury is an unusual and under-recognised complication of coronary artery bypass grafting especially when internal mammary artery harvesting takes place. It is believed to be due to sternal retraction resulting in compression of the brachial plexus. Although the majority of cases are transient, there are cases where the injury is permanent and may have severe implications as illustrated in the accompanying case history. We investigated that injury to the brachial plexus was retrospectively assessed in the results of eight patients who underwent median sternotomy for open heart surgery. Between March 2006 and October 2008, 455 patients underwent cardiac surgery with median sternotomy. In post operative period peripheric neuropathy symptoms were observed in eight [1.7%] patients. All patients were placed in the hands up position after right internal jugular vein cannulation, and internal mammary artery was prepared for all those patients. The symptoms were classified as pain, sensory impairment and motor impairment. Brachial plexus injury was detected postoperatively in these eight patients. The patients with injured nerves were older and had undergone longer operation times. There were no differences between the patients with injured nerves and the others with respect to mammary artery harvesting or other operative variables. Full recovery occured in seven of eight [87%] patients after six monthes, one [13%] patient suffered from disesthesia. It is known that heart surgery sometimes causes partial brachial plexus injury, especially in the lower trunk. However, these peripheral nerve problems are usually not considered clinically important and are not investigated. Patients undergoing open heart surgery must be closely followed up for peripheral nerve injury during the postoperative period

Association between the left atrial diameter and radiofrequency ablation procedure at restoring sinus rhythm [mid term and long term results]

Atrial fibrillation [AF] is the most common arhythmia type among other arythmias. In this study, we aimed to search the effect of left atrium diameter in AF treatment with radiofrequency ablation procedure. Preoperative left atrium diameter and postoperative sinus rhythm restoration was prospectively studied in 84 patients who had undergone valve surgery and radiofrequency [RF] ablation procedure in Department of Cardiovascular Surgery from January 2004 to March 2009. The patients were classified in two groups. Group-I consisted of the patients with left atrial diameter less than 5 cm, and Group II consisted of the ones whose left atrial size was more than 5cm. Normal sinus rhytm restoration was followed by electrocardiography [ECG]. ECG monitoring was done in early postoperative period, 12[th], 24[th] and 36[th] monthes following the operation. In early post-operative period normal sinus rhythm [NSR] was recorded in 34 patients [Group I: 20, Group II: 14] in which unipolar RFA was performed. Supraventricular tachycardia [SVT] was observed in 20 patients [Group I: 10, Group II: 10] and NSR was restored with medical treatment in these patients. AF was permanent in 26 patients [Group I: 8, Group II: 18] and nodal rhythm was observed in 4 patients [Group I: 2, Group II: 2]. The ECG monitoring was done in the patients in early postoperative period at 12[th], 24[th] and 36[th] monthes. Datas were evaluated with statistical studies, too. Radiofrequency [RF] ablation is a feasible, efficient and safe method for the treatment for Atrial fibrillation [AF]. In our study we found that left atrial diameter is an important factor in restoring sinus rhythm. However, AF treatment with extended left atrium is more difficult