The efficacy of transversus abdominis plane block for postoperative analgesia in laparoscopic cholecystectomy cases: a retrospective evaluation of 515 patients.

OBJECTIVE: To compare patients that received intravenous (i.v.) analgesics with those that received transversus abdominis plane (TAP) block for pain relief after laparoscopic cholecystectomy. METHODS: This retrospective study enrolled patients that had undergone laparoscopic cholecystectomy and divided them into two groups: the i.v. analgesic group (controls; group A) and the TAP block group (group T). Data retrieved from the medical records included postoperative visual analogue scale (VAS) pain scores, duration of intensive care unit (ICU) stay, total hospital stay, additional analgesic requirements and the occurrence of nausea and vomiting. RESULTS: A total of 515 patients were included (group A, n = 247; group T, n = 268). Postoperative VAS pain scores at 0, 2, 4 and 6 h and the need for additional analgesics were significantly lower in group T than in group A. Postoperative VAS pain scores at 12 and 24 h were significantly higher in group T than in group A. Postoperative nausea and vomiting were significantly lower in group T than in group A. The rate of ICU admission in group T was significantly lower than in group A. CONCLUSIONS: Effective postoperative analgesia can be achieved with TAP block and undesirable effects can be reduced.

Complications associated with carotid body tumor excision.

BACKGROUND: This study aims to evaluate associated complications of carotid tumor excisions and outcomes. METHODS: Between January 2013 and April 2016, a total of 29 patients (2 males, 27 females; mean age 55.2±4.4 years; range, 17 to 76 years) were operated with the preliminary diagnosis of a carotid body tumor. According to the Shamblin classification of carotid body tumors, 12 patients were type 1, 13 patients were type 2, and four patients were type 3. RESULTS: Main symptoms were dizziness, pain in the neck area, tinnitus, and headache. Headache was the most common symptom among them. Neurological and surgical complications developed in 10 patients (34.4%). Of operated patients, dysphagia developed in three (8.7%), facial hemiparesis in two (6.8%), hemorrhage in two (6.8%), hematoma-related respiratory distress in one (3.4%), left hemiparesis in one (3.4%), and transient bradycardia in one (3.4%). The patient who had respiratory distress associated with bleeding following extubation was reoperated. In the patients with facial and left hemiparesis, paresis was transient. Dysphagia also resolved in the subsequent follow-up outpatient visits. None of the patients experienced a permanent complication. CONCLUSION: Surgical excision is the most appropriate choice of treatment in carotid body tumors, and postoperative complications can be minimized through careful dissections and retractions. A special attention should be paid to nerve-preserving surgery.

Isovolumic contraction acceleration before and after percutaneous closure of atrial septal defects.

AIM: To compare systemic right ventricular function by isovolumic myocardial acceleration before and 6 months after the percutaneous closure of atrial septal defects (ASD). MATERIAL AND METHODS: Patients admitted to our tertiary center for the percutaneous closure of atrial septal defects between January 2010 and August 2012 constituted the study group. Right ventricular function of patients was assessed by tissue Doppler echocardiography before and after surgery. Echocardiographic data in patients were compared to age-matched controls without any cardiac pathology and studied in identical fashion mentioned below. RESULTS: A total of 44 patients (24 males, 20 females) and 44 age-matched controls (25 males, 19 females) met the eligibility criteria for the study. Right ventricular end-diastolic and end-systolic volume, right ventricular end-diastolic diameter measurements on echocardiogram, and pulmonary artery pressures in both pre- and post-ASD groups were significantly higher than in controls. Tricuspid annular plane systolic excursion and isovolumic myocardial acceleration measurements significantly increased after the percutaneous closure of the defect; however, post-ASD measurements were still significantly lower than the controls. CONCLUSIONS: Atrial septal defect device closure resulted in a significant increase of isovolumic myocardial acceleration measurements. Tissue Doppler analysis of regional myocardial function offers new insight into myocardial compensatory mechanisms for acute and chronic volume overload of both ventricles.

Red cell distribution width as a prognostic indicator in pediatric heart disease and after surgery.

BACKGROUND: Red cell distribution width (RDW) is an important marker which reflects inflammatory activity in many chronic diseases. The objective of this study is to investigate the impact of RDW on morbidity and mortality before and after pediatric congenital heart surgery. METHODS: 107 patients with congenital heart disease, cardiac case group, and 70 patients, control group, without heart disease were retrospectively analyzed. Pre-, and postoperative and at discharge RDW of the cardiac patients were determined. Lengths of hospital and intensive care unit (ICU) stay and exited patients were determined. RESULTS: Mean lengths of ICU and hospital stay were 3.3 ± 2.7 and 7.3 ± 2.9 days. In control group, mean preoperative RDW was 12.6 ± 1.4, while in cardiac case group it was significantly higher (15.1 ± 3.5). In cardiac case group, postoperative RDW were significantly higher than preoperative period, while RDW at discharge were significantly lower than postoperative estimates. A significant and a positive correlation was detected between lengths of ICU and hospital stay and RDW. RDW of the exited patients were significantly higher than the survivors. CONCLUSIONS: This study demonstrates that RDW can be used as an important indicator in the prediction of morbidity and mortality during pre-, and postoperative period of the pediatric congenital heart disease surgery.

Repair of rheumatic tricuspid valve stenosis with autologous pericardium.

The aim of the present study was to describe a successful method for treating rheumatic tricuspid valve stenosis with autologous pericardium, commissurotomy, and a Kalangos ring without replacing the tricuspid valve.

Isolated subclavian vein injury: a rare and high mortality case.

Isolated subclavian vein injuries are rarely seen without concomitant arterial injury, bone fracture, damage to brachial plexus, and thoracal traumas. Our case was brought to the emergency service 6 hours after he had been shot at the shoulder with a firearm. After detection of extravasation from the left axillary and subclavian vein on arteriographic and venographic examinations, he was operated on. An autogenous saphenous vein graft was interposed between subclavian and axillary veins. Cardiac arrest developed twice because of hypovolemia, which was resolved with medical therapy. Subclavian vein injuries have a more mortal course when compared with the injuries to the subclavian arteries. Its most important reason is excessive blood loss and air embolism because of delayed arrival to hospital. As is the case in all vascular injuries, angiography is the most important diagnostic examination. If the general health state of the patient permits, arteriography and venography should be performed in patients potentially exposed to vascular injuries. In patients with extreme blood loss and deteriorated health state, direct surgical exploration of the injury site, containment of the bleeding, and venous repair are life-saving approaches.