Inadvertent hypothermia in paediatric radiotherapy practices under sedation: a single centre observational study.

OBJECTIVE: To detect changes in body temperature during outpatient procedures and to identify factors associated with hypothermia in the paediatric population undergoing radiotherapy under sedation. METHODS: The observational study was conducted between July and October 2022 at Ankara City Hospital, Turkey, and comprised paediatric cancer patients aged from 1 month to 18 years who needed sedation or general anaesthesia during radiotherapy. Baseline body temperature T1 was measured before transportation to the radiotherapy room, while body temperature T2 was taken after radiotherapy. Data was analysed using SPSS 20. RESULTS: A total of 152 radiotherapy sessions related to 13 children were evaluated. There were 8(61%) boys and 5(38%) girls with overall mean 4.46±3.45 years (range: 2-13 years). The mean body surface area as 0.70±0.212. Radiotherapy was performed in 9(69%) patients, while 4(31%) patients underwent tomotheraphy. The dose used was 180cGy in 12(92.3%) patients. Hypothermia was observed in at least one session in 12(92.3%) patients. There was significant difference in body temperature at baseline and post-radiotherapy (p<0.05). CONCLUSIONS: There were significant changes in body temperature during outpatient procedures in the paediatric population undergoing radiotherapy under sedation.

Naples Prognostic Score for Graft Functions After Renal Transplantation: A Retrospective Analysis.

BACKGROUND The Naples prognostic score is a comprehensive measure of patients' inflammation and nutritional status, consisting of serum albumin, total cholesterol, neutrophil/lymphocyte ratio (NLR), and lymphocyte/monocyte ratio (LMR). We compared the Naples prognostic scores of kidney transplant patients with a creatinine reduction ratio of less than 30% vs those with greater than 30%. MATERIAL AND METHODS We conducted a retrospective study on 93 patients who received kidney transplants at our hospital from January 2020 to January 2023. Naples prognostic scores were used to calculate the preoperative condition of transplant recipients. The patients were divided into 2 groups based on their creatinine reduction ratio on the second day after surgery. Group A consisted of patients with a ratio above 30%, while group B consisted of those with a ratio below 30%. RESULTS Our analysis revealed that the total cholesterol and albumin values of groups A and B showed no substantial difference. Group B had clearly more patients with Naples prognostic score 3-4 compared to the other group (P=0.032). Multivariate analysis determined that patients with Naples prognostic score 3-4 had a 3.151-fold higher likelihood of experiencing creatinine reduction below 30% (95% CI 1.209-8.215, P value 0.019). CONCLUSIONS The preoperative inflammatory and nutritional status of patients may have an impact on the functioning of grafts during the postoperative period. A high Naples prognostic score may be linked with a decrease in creatinine reduction ratio in post-transplant kidneys, which could lead to graft dysfunction.

Inadvertent hypothermia in patients undergoing brachytherapy under monitored anesthesia care: A prospective observational cohort study.

Brachytherapy, which is often performed under anesthesia, is one of the main treatment options for cervical cancer. It is unclear whether hypothermia and its associated negative outcomes are encountered during this procedure. This prospective observational cohort study aimed to investigate the prevalence and adverse effects of hypothermia during serial brachytherapies under deep sedation for cervical cancer. Female patients over the aged > of 18 years who underwent were taken to serial brachytherapy sessions under deep sedation on alternate dates at most twice a week for the treatment of cervical cancer were included. A total of 23 female were screened for initial and post-procedural hypothermia using infrared thermometers without contact to the skin at forehead between July and October 2022 at tertiary education and research hospital. Hypothermia was detected in 2 2 (8.7%) of the 23 patients and 5 5 (5.4%) of the 92 sessions. A negative correlation was found between the anesthesia time and post-procedural body temperature values (r = -0.385, P < .001). It was observed that there was a decrease in body temperature of at most -1.3 degrees and at least -0.1 degrees during the sessions. A decrease of ≥ 0.4°C was detected in any session in 16 (69.9%) of the 23 patients. A decrease of ≥ 0.4°C was detected in 34 (37%) of the 92 sessions. Involuntary hypothermia may occur during brachytherapy sessions performed under sedation. Institutions should encourage routine temperature monitoring and active warming to prevent hypothermia and adverse outcomes.

A randomized, controlled simulation study comparing single and double operator ultrasound-guided regional nerve block techniques using a gelatine-based home-made phantom.

BACKGROUND: The aim of this study was to compare anesthesiology residents' acquisition of gripping and needling skills in either single-or double-operator ultrasound-guided nerve block using a hand-made phantom. DESIGN: Prospective, randomized controlled study. METHODS: After a tutorial session, 47 ultrasound-novice residents performed needling with double and single operator (Jedi, Bedforth, On-lock) grip techniques in each of the 3 interventional task sessions. RESULTS: The time to perform the correct grip and needling decreased significantly between sessions for each technique (P < .001). While the double operator tasks required a shorter time than the single operator tasks in all 3 sessions (P < .001), there was no significant difference between the single-operator techniques. The number of needling attempts was similar between techniques and sessions. Participants rated the workload higher for the single-operator techniques on the National Aeronautics and Space Administration Task Load Index. CONCLUSION: Hands-on training of phantom models may be beneficial for the acquisition of single-operator grip skills.

Should the Erector Spinae Plane Block Be Applied in the Pain Management of Percutaneous Nephrolithotomy?

Introduction This prospective, randomized controlled study aimed to investigate the efficacy and respiratory effects of postoperative pain management with an erector spinae plane block in patients undergoing percutaneous nephrolithotomy. Methods Sixty American Society of Anesthesiologists (ASA) I-II patients aged 18-65 years, scheduled to undergo percutaneous nephrolithotomy, were randomized either to the erector spinae plane block (ESPB) or control group. Fifteen mL 0.5% bupivacaine at the T11 level was administered preoperatively using the in-plane technique in the ESPB group. In both groups, 1 gr of intravenous paracetamol was administered intraoperatively. Postoperative pain and agitation were evaluated using the visual analog scale (VAS), dynamic VAS at zero, six, and 24 hours, and the Riker sedation-agitation scale at the 0th hour after surgery. Peak expiratory flow rate (PEFR) and oxygen saturation (SpO2) were measured in preoperative examination and at the 0th, 6th, and 24th hours postoperatively. The time and number of the analgesic requirement, mobilization, and discharge time were also recorded. Results A significantly lower VAS and dynamic VAS were observed at the 0th, 6th, and 24th hours in the ESPB group (p<0.05 for each timepoint). The postoperative/preoperative PEFR ratio was lower and there were more agitated patients in the control group (p<0.05). Conclusion An erector spinae plane block may have additional clinical advantages while providing effective analgesia in patients who underwent percutaneous nephrolithotomy compared to intravenous analgesia.

Determination of the minimum effective volume of bupivacaine for ultrasound-guided infraclavicular brachial plexus block: a prospective, observer-blind, controlled study.

BACKGROUND: We aimed to determine the minimum effective volume (MEV) of 0.5% bupivacaine for infraclavicular brachial plexus block. METHODS: We assigned patients to volume groups consisting of five consecutive patients. Local anesthetic was sequentially reduced from a starting dose of 30 mL by 2 mL to form the volume groups. Five patients were included in each volume group, and at least 3 of 5 injections had to be successful to consider the volume of the anesthetic as sufficient. The study ended when the anesthetic volume of a group was determined to be unsuccessful (two or fewer successful blocks). Block was successful if the patient reported a sensorial block score of 7 or more on an 8-point scale and sensorial and motor block's total score of 14 on a 16-point scale. RESULTS: The MEV of 0.5% bupivacaine for infraclavicular brachial plexus block was 14 mL. A successful block was achieved in all patients (n = 45) in 9 volume groups, which received 30 mL down to 14 mL. Three blocks were unsuccessful in the 12-mL group. Time to onset of block and time to first postoperative anesthetic administration was 15 (10-15) min and more than 24 h in the 30-mL bupivacaine group, but 40 (30-45) min and 14 (10-24) h were determined for the 14-mL group, respectively. CONCLUSIONS: The MEV of 0.5% bupivacaine for ultrasound-guided infraclavicular brachial plexus block was 14 mL. However, this low-dose block has a long onset time of 40 (30-45) min on average.

Is Jedi Grip efficient and effective in ultrasound-guided peripheral nerve blocking? A prospective, randomized, observer-blinded study.

BACKGROUND: In this prospective, randomized, controlled observer-blinded study, we aimed to compare the efficacy of a single-operator technique called the Jedi Grip and a conventional technique requiring a double operator in ultrasound-guided axillary brachial plexus blocking. METHODS: Ninety-two patients (ASA I-II; aged 18-65 years old) who underwent elective hand, wrist and forearm surgery were randomly assigned to Group Conventional (C) or Group Jedi (J). In both groups, axillary plexus blockade was performed by applying 5 cc of a mixture of 10 cc of 0.5% bupivacaine and 10 cc of 2% prilocaine to the ulnar, radial, median, and musculocutaneous nerves. Parameters such as the performance time and number of needle passes were recorded during the procedure. Subsequently, a blinded observer evaluated and recorded parameters related to the blockade success. The main outcome variables were the performance time and success rate (surgical anesthesia). RESULTS: The block performance time of the Jedi technique was slightly longer than that of the conventional technique (220 (50), 202 (78) s, respectively) (median (IQR); p = 0.05). No significant difference was found between groups in terms of blocking success; 9 (20%) from the conventional group and 3 (6.4%) from the Jedi group were unsuccessful (p = 0.053). No differences were found in terms of arterial puncture, and no other complications occurred in either group. The motor-sensory block onset and termination times and initial analgesia requirements were similar. CONCLUSION: The Jedi technique may be applied safely with similar block success and performance results as the conventional technique.

Comparison of Postoperative Cognitive Decline Using the Mini-Mental State Examination and Montreal Cognitive Assessment After Minor Elective Surgery in Elderly.

Introduction and aim Postoperative cognitive dysfunction (POCD) is an important complication associated with increased morbidity, mortality, and reduced quality of life. Generally, studies have focused on major surgery so there is little evidence of the incidence of cognitive dysfunction in minor surgery. We aimed to compare the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in terms of detecting cognitive decline in elderly patients after elective inguinal herniorrhaphy procedure with general or spinal anesthesia. Material and methods This observational study was conducted from June 2014 to March 2015 at Ankara Numune Education and Research Hospital. The type of anesthesia was determined according to the anesthesiologist's preference who is blind to the study. Patients were grouped according to anesthesia received: general or spinal anesthesia. The MMSE and MoCA were evaluated presurgery and 24 hours after the operation. Results The postoperative (24th hour) MMSE scores of patients (26.23±2.77) were significantly lower than the preoperative scores (27.17±1.93) in only the general anesthesia group (p =0.003). The postoperative (24th hour) MoCA scores (22.87±3.88 for general and 23.13±4.08 for spinal anesthesia) were significantly lower than the preoperative scores (24.32±3.19 for general and 24.35±2.84 for spinal anesthesia) in both the general and spinal anesthesia groups (p =0.000 and 0.019, respectively). The incidence of postoperative cognitive dysfunction was 32.9% using the MoCA and 15.2% using the MMSE (p=0,018). Conclusion Early POCD is an important problem after elective minor surgeries, even with spinal anesthesia, in elderly patients. The MoCA is an alternative tool that can be more sensitive than the MMSE to identify cognitive decline in elderly patients undergoing minor surgeries under both general and spinal anesthesia.

Comparison of intraoral mask and classic face mask in terms of ventilation success and practitioners' workload assessments: A randomised crossover study.

AIM: Providing effective ventilation of the unconscious patient is an essential skill in every specialty dealing with airway management. In this randomised crossover study aimed to compare intraoral and classic face mask in terms of ventilation success of patients, practitioners' workload and anxiety assessments. Also we analysed potential risk factors of difficult mask ventilation for both masks. METHODS: In all, 24 anaesthesiology residents and 12 anaesthesiologists participated in the study. Each of the practitioners ventilated four patients with both masks at settled pressure and frequency. Practitioners rated their workload and anxiety related to masks with National Aeronautics and Space Administration Task Load Index score and State Trait Anxiety Inventory scale. Ventilation success was evaluated with Han scale, expiratory tidal volume and leak volume. We analysed potential risk factors of difficult mask ventilation with anthropometric characteristics and STOP-Bang score. RESULTS: Ventilation success rate was superior with intraoral mask comparing to classic face mask in terms of successful ventilation (P = .000) and tidal volume (P = .000). Leak volume in in intraoral mask ventilation was significantly lower than classic face mask (P = .000). Difficult mask ventilation risk factors for classic face mask were high weight (P = .011), neck circumference (95% CI, OR = 1.180, P = .002), Mallampati score (P = .029) and high risk of OSAS (P = .001). Difficult mask ventilation risk factors for intraoral mask were high body mass index (95% CI, OR 1.162 P = .006) and Mallampati score (P = .043). The anxiety ratings of practitioners were similar between two masks. The workload rating is higher with intraoral mask comparing to classic face mask. CONCLUSION: Intraoral mask may be an effective alternative device for bag-valve mask ventilation.

Value of Hounsfield Units in the Evaluation of Isolated Sphenoid Sinus Lesions.

Radiologic findings of fungal sinus disease are generally opacification in paranasal computed tomography (CT) images. The Hounsfield unit (HU) is a standardized objective unit that is also suitable for measuring remodeling and opacifications on CT scans of bone sections of patients with chronic rhinosinusitis. We hypothesized that HU values could provide valuable information in isolated sphenoid sinus lesions before surgery. Between 2012 and 2019, 35 patients underwent functional endoscopic sinus surgery for sphenoid sinus lesions. Tissues obtained from the sphenoid sinus were divided into two groups, fungal and nonfungal, according to the findings of histopathologic examinations. HU values were measured in sphenoid sinus sections on paranasal CT scans of these two groups. Differences in mean and maximum HU values between the two groups were statistically significant (p < .05). The maximum HU values calculated from the sphenoid sinus were 435.08 and 196.23 (p ≤ .05) in the fungal group and nonfungal group, respectively. The mean HU values calculated from the sphenoid sinus were 64.31 and 29 (p ≤ .05) in the fungal and nonfungal groups, respectively. At the maximum cutoff value of 241, the sensitivity and specificity of the HU maximum were 84.6% and 77.3%, respectively. At the mean cutoff value of 41.5, the sensitivity and specificity of the HU mean were 76.9% and 86.4%, respectively. HU is an objective value used in radiographic density measurement. The HU values were higher in fungal lesions than in nonfungal inflammations, and they are useful in preoperative measurement.

Anxiety and Depression in the Relatives of COVID-19 and Non-COVID-19 Intensive Care Patients During the Pandemic.

Background and aim In the literature, there is no study on the anxiety and depression status of the relatives of intensive care COVID-19 and non-COVID-19 patients during the pandemic period. In this study, we aimed to compare the risk of developing anxiety and depression in the relatives of COVID-19 and non-COVID-19 intensive care patients during the pandemic, and also to determine the factors that may cause anxiety and depression. Materials and methods Relatives of patients admitted to Ankara City Hospital COVID-19 (n=45) and non-COVID-19 (n=45) intensive care units between 15 May and 31 July 2021 were included in this prospective study. The Hospital Anxiety and Depression Scale (HADS) questionnaire was administered to the relatives of the patients within the first 48 hours of their admission to the intensive care unit. The answers were recorded and HADS, HADS-A (anxiety) and HADS-D (depression) scores were calculated accordingly. Demographics, education and marital statuses of both the patients and their relatives were recorded. Logistic regression analysis was performed to determine the factors associated with depression and anxiety. Receiver operator characteristics (ROC) curves were drawn for the factors affecting depression and anxiety, and the area under the curve values were calculated. Results Demographics, APACHE II score, and patient affiliation were similar in both groups. The mean HADS scores of the relatives of COVID-19 and non-COVID-19 patients were 24.76 and 16.04 (p<0.001). The mean HADS-A scores were 12.89 and 7.78 (p<0.001), and the mean of HADS-D scores were 11.87 and 8.27 (p=0.001). Moderate and high-risk anxiety and depression were significantly higher in relatives of COVID-19 patients (p=0.018, p=0.001, respectively). The area under curve (AUC) values were 0.727 in the ROC curve plotted for the independent risk factor Q3 responses that reduced anxiety, and 0.791 and 0.785 in the ROC curve drawn for the independent risk factor Q1 and Q3 responses that reduced the development of depression. Conclusion We found that the anxiety and depression risk of the relatives of COVID-19 patients in the intensive care unit during the pandemic period is significantly higher than the relatives of non-COVID-19 patients in the intensive care unit. In addition, regardless of the diagnosis, younger intensive care patients may increase the anxiety and depression of the relatives of the patients during the pandemic. The higher-education level of the relatives of patients was determined as a factor reducing anxiety and depression.

A novel method: can stapedial acoustic reflex have a role in the diagnosis of minimal hepatic encephalopathy?

OBJECTIVE: Stapedial acoustic reflex is an easily accessible and applicable test which is also valuable for the clinical conditions which affect the various locations of the central nervous system. Searching the diagnostic value of stapedial acoustic reflex at minimal hepatic encephalopathy is the aim of this research. METHODS: Diagnosis of minimal hepatic encephalopathy was conducted by mini-mental state and critical flickered frequency tests. Minimal hepatic encephalopathy diagnosed patients were established in the first group. Cirrhosis (without minimal hepatic encephalopathy or overt hepatic encephalopathy) diagnosed patients were created the control group. The stapedial acoustic reflex test was applied for minimal hepatic encephalopathy and the control group by audiologists in a soundproof room. RESULTS: In total, 221 patients were screened and 97 patients meet the inclusion criterions. Out of 97 patients, 52 were the minimal hepatic encephalopathy patients and the remaining patients were the control group. Acoustic reflex tests battery includes the evaluation of two pathways called ipsilateral and contralateral. Ipsilateral way test results were found positive in all minimal hepatic encephalopathy patients and 95% positive in the control group. Contralateral acoustic reflex test results were found 36% positive in minimal hepatic encephalopathy patients and 95% positive in the control group, respectively. A comparison of ipsilateral and contralateral acoustic reflex test results was displayed a statistical significance. CONCLUSION: Stapedial acoustic reflex test results of cirrhosis patients may cover additional parameters for the diagnosis of minimal hepatic encephalopathy.

Anterior Skull Base Surgery via Endoscopic Endonasal Approach: Outcomes and Analysis.

BACKGROUND: This study was retrospectively conducted to evaluate the postoperative surgical results of our patients with anterior skull base mass, defect, and/or cerebrospinal fluid rhinorrhea who underwent reconstruction via endoscopic endonasal approach and to share our experiences. METHODS: Sociodemographic features of patients who had undergone endoscopic surgery in our clinic due to anterior skull base mass, defect, or rhinorrhea were evaluated in terms of etiological factors, surgical method, pathology, postoperative complications, need for revision surgery and comorbid disease. RESULTS: A total of 131 patients were included; 76 were male and mean age was 36.2 years. Endoscopic endonasal surgery was performed for nasal mass (70.2%) in 92 cases, rhinorrhea (17.6%) in 23 cases, chronic sinusitis (7.6%) in 10 cases, and gunshot injury (4.6%) in 6 cases. After surgery, benign mass pathology was detected in 75 patients and malignant mass pathology was detected in 23 patients. Osteoma was the most common among benign formations, and squamous cell carcinoma was the most common among malignant formations. The most common cause of surgical revision was nasal masses (25 cases, 77.4%). CONCLUSION: Endoscopic intracranial interventions and increased anterior skull base surgery are garnering increased interest of physicians as endoscopic approaches are gaining popularity in recent years. Successful results are achieved through appropriate diagnostic methods and endoscopic approaches. Success rates will be further increased due to developing technology and imaging methods, while the risk of complications and revision surgery will be further reduced.

Pre- and postoperative quality of life and emotional/behavioural problems in children with PFAPA.

OBJECTIVE: This study aimed to evaluate the effects of surgical intervention on quality of life, emotional/behavioural problems and school absenteeism in children with periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA.) METHOD: A total of 56 children aged between 4 and 12 years, diagnosed with PFAPA and undergoing tonsillectomy with/without adenoidectomy at a tertiary hospital were included in the study. The Questionnaire for Quality of Life Assessment for Children and Adolescents Parent Form (Kid-KINDL) and the Strengths and Difficulties Questionnaires (SDQ) were used to evaluate quality of life and emotional/behavioural problems, respectively. The cases were assessed before and three months after surgery. RESULTS: The mean (SD) age of the children was 6.64 (3.03) years, and 58.9% (n = 33) were boys. The numbers of pre- and post-operative periodic fever episodes were 3.0 (1.7) and 0.6 (0.9) (p < 0.001), those for school absenteeism were 10.28 (5.53) and 2.85 (2.95) days (p < 0.001) and those for hospital presentations were 3.8 (2.5) and 1.1 (1.1) (p < 0.001), respectively, all of which were significantly lower in children with PFAPA at three months after the operation. The surgical procedures were effective in improving quality of life and emotional/behavioural problems, as evidenced by the significant differences between the pre- and post-treatment scores in outcome measures, including SDQ and Kid-KINDL (p < 0.001). CONCLUSIONS: This study demonstrated that the surgical approach exhibited positive effects in terms of improving quality of life and reducing emotional/behavioural problems and school absenteeism in children with PFAPA.

Giant ethmoidal mucocele leading to proptosis and hypertelorism in a pediatric patient with cystic fibrosis: a case report.

BACKGROUND: Chronic sinusitis and its complications are common in patients with cystic fibrosis. Mucoceles are one of these complications and can have life-threatening consequences if left untreated. CASE: We present the case of a giant ethmoid mucocele leading to proptosis and hypertelorism in a 5-year-old child with cystic fibrosis. CONCLUSION: Chronic sinusitis and its complications are common in patients with CF. Mucoceles are a rare complication of sinusitis that can be treated surgically. As seen in this case if left untreated mucoceles can lead to orbital pathologies such as proptosis, hypertelorism. To the best of our knowledge, we report the first case report of giant ethmoidal mucocele leading to proptosis and hypertelorism in a patient with cystic fibrosis.

Maxillofacial Trauma in Geriatric Population.

BACKGROUND/AIM: The worldwide population is increasingly aging. Maxillofacial fractures of the geriatric population have been increased. Evaluation of the demographic variables, causes and the patterns of maxillofacial traumas in the elderly population is the main aim of this study. MATERIALS AND METHODS: Seven hundred thirteen maxillofacial tomography images which were scanned between 2010 and 2019 were evaluated. Data from 50 patients aged 65 years old and/or older, who were treated for maxillofacial fracture at the Department of Otorhinolaryngology, Gaziantep University, were retrospectively analyzed. Two groups were created according to the facial fracture pattern. Facial fractures were reclassified into 2 groups; mandibula, orbital, zygomaticomaxillary complex group fractures and the other group of frontal, naso-orbito-ethmoid fractures and were used as a comparison. RESULTS: The mean age of the patients was 72.5 (min 65- max 93). The gender distribution was 17 females (34%) and 33 males (66%). The most common fractured bone was the nasal bone and the least one is the frontal bone. Approximately one-quarter of 50 fractures were seen in 70 to 79 years old. Falling is more common in females and men are more prone to work-related accidents than home-related accidents. CONCLUSION: Facial fractures in the elderly often seen in midface location. Falling is the common etiology of facial fracture in all genders at elderly. However, male dominance is seen in other etiological factors. Additional diseases in the elderly seem to increase the severity of facial fracture.

Pediatric Maxillofacial Trauma Patterns Among Different Types of Road Traffic Accidents.

BACKGROUND: Traffic accidents are one of the most leading cause of maxillofacial trauma. Defining the bone fracture patterns in different type of traffic accidents may enable for appropriate surgical approach. OBJECTIVES: This study research the pattern of pediatric maxillofacial fractures in terms of different type of traffic road accidents and age groups. METHODS: The data on road traffic accidents that caused maxillofacial trauma between May 2014 and January 2019 was gained from the University of Gaziantep hospital data system. Road accident type, age groups, and the type of fractures were the evaluation parameters. RESULTS: A total of 61 patients meet the criteria and 41 of those were boys. The midface bones of orbital, maxillar, and frontal are the most fractured structures with a total number of 48. The least fractured bone was mandibula with a number of 4. The comparisons of these fractures among the different type of road traffic accidents and age groups were found to be statistically significant. CONCLUSION: Car-pedestrian and car-passengers type of road traffic accident mostly seem to cause midface fractures at the primary and secondary school-aged children.

Relationship between otorhinologic trauma and Attention Deficit Hyperactivity Disorder symptoms in children.

OBJEVTIVES: Otorhinologic trauma is an important condition at the ear, nose and throat (ENT) outpatient clinic in children. Attention deficit hyperactivity disorder (ADHD) has been identified as a potential risk factor that may contribute to the incidence of traumatic injuries. The aim of the study was to investigate whether there is an association between otorhinologic trauma and ADHD symptoms in children. METHODS: A prospective study was conducted between September 2017 and March 2018. Fifty-six pediatric patients admitted to the Ear Nose and Throat (ENT) outpatient clinic of a research and training hospital aged between 4 and 18 years were included. The control group consisted of 56 age- and gender-similar children without otorhinologic trauma. Conner's parent Rating Scale (CPRS) was used to evaluate the ADHD symptoms. RESULTS: The children with otorhinologic trauma had significantly higher mean scores in all subscales, including inattentiveness, hyperactivity, oppositional defiant disorder (ODD) (p < 0.05). Furthermore, analysis of the study group showed that the hyperactivity score in the subgroup with a history of repetitive injuries were significantly higher than those of the subgroup without a history of repetitive injuries (p < 0.05). CONCLUSIONS: These findings suggest that patients admitted to the ENT outpatient clinic for otorhinologic trauma had a higher number of ADHD and ODD symptoms than those who did not have otorhinologic trauma. Psychiatric evaluation for ADHD and ODD should be considered for patients admitted to clinics with similar injuries, especially those who have a history of repetitive injuries.

Comparison of ultrasound and ultrasound plus nerve stimulator guidance axillary plexus block.

OBJECTIVE: To evaluate the characteristics of axillary plexus blockade applied using ultrasound only and using ultrasound together with nerve stimulator in patients undergoing planned forearm, wrist or hand surgery. METHODS: This randomised, prospective, double-blinded, single-centre study was conducted at Ankara Numune Training and Research Hospital, Ankara, Turkey, from November 2014 to August 2015, and comprised patients undergoing forearm, wrist or hand surgery. Participants were separated into 2 groups. In Group 1, the nerve roots required for the surgical site were located one by one and local anaesthetic was applied separately to each nerve for the block. In Group 2, the vascular nerve bundle was located under ultrasound guidance and a total block was achieved by administering all the local anaesthetic within the nerve sheath. In the operating room, standard monitorisation was applied. Following preparation of the skin, the axillary region nerve roots and branches and vascular structures were observed by examination with a high-frequency ultrasound probe. In both groups, a 22-gauge, 5cm block needle was entered to the axillary region with visualisation of the whole needle on ultrasound and 20ml local anaesthetic of 0.5% bupivacaine was injected. SPSS 19 was used for data analysis. RESULTS: Of the 60 participants, there were 30(50%) in each group. The mean age was 39.1±15 years in the group 1 which was the ultrasound nerve stimulation group, and 41.5±14.3 years in group 2. The duration of the procedure was longer in group I than in group 2 (p<0.05). Patient satisfaction values during the procedure were higher in group 2(p<0.05). In the ulnar sensory examination, the values of the patients in group 1were higher at 10, 15, 20 and 25 minutes (p<0.05). In the median, radial and ulnar motor examination, the values of the patients in group 1were higher at 15 and 20 minutes (p<0.05). CONCLUSIONS: Brachial plexus blockade via axillary approach guided by ultrasound offered excellent quality of sensory and motor block equivalent to that of the nerve stimulator-guided technique.