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Backround Establishing venous outflow in liver transplantation for patients with Budd-Chiari syndrome is crucial and requires various surgical techniques. The outcomes of these patients exibits distinct problems including vasculary thrombosis and biliary complications. Methods In this single center study, the outcomes and surgical features of 33 patients with Budd-Chiari syndrome who were carried out liver translantation (27 patients from living donor). Another group was formed among patients underwent liver transplantation due to other etiologies and the outcomes were compared. Results The most-seen type was the classical type of Budd-Chiari syndrome (25, 75.8%). For twenty-six patients inherited or acquired prothrombotic disorders were identified (78.2%) in Budd-Chiari group. Average follow-up was 29.7 ± 15.5 months. We have observed no recurrence of disease in our BCS patients. When the two groups was compared in terms of thrombotic complications, there was a significantly increased risk in BCS group (p = 0.014). Our 1 and 3-year survival rates for the BCS group were 81.8% and 78.8%, respectively. In the control group, 1 and 3-year survival rates were 93.3% and 88.9%, respectively. Log-rank test analyses showed no statistically significant results. Conclusion Liver transplantation with individual surgical and postoperative treatment strategy for patients with Budd-Chiari syndrome provides comparable outcomes.

Amaç: Bu çalışmanın amacı nöromusküler monitörizasyon ve anestezi derinliği monitorizasyonu yapılan hastalarda sigara içimi ile nondepolarizan bir nöromusküler bloker olan rokuronyum bromidin etki süresindeki değişimin araştırılmasıdır.Materyal ve metod: Çalışmaya, her grupta 29 olmak üzere toplam 58 hasta dahil edildi. Hastalar, hiç sigara kullanmayan hastalar (n=29) ve bir günde en az 10 adet sigarayı en az 2 yıl süreyle devamlı kullanan hastalar (n=29) olmak üzere iki gruba ayrıldı. Tüm hastalarda hedef kontrollü infüzyon yöntemi ile total intravenöz anestezi yöntemi uygulandı. Hastaların intraoperatif hemodinamik parametreleri ve BİS değerleri takip edildi. Doz ihtiyaci, “lag time”, “onset time”, “derin nöromusküler blok süresi”, “T1 %10 süresi”, “klinik etki süresi”, “derlenme indeksi”, “komplet derlenme aralığı” değerleri her hasta için kaydedildi.Bulgular: Çalışmamızda lag-time değerlerinde sigara içmeyenler ve sigara içenler arasında anlamlı fark gözlenmedi (60±17 saniye ve 60±11saniye, p>0.05). Onset-time değerleri sigara içmeyen ve içenlerde 105±34 saniye ve 120±46 saniye iken , derin nöromusküler blok zamanı yine sigara içmeyen ve içenlerde 28±13.7 dakika ve 33.7±9.3 dakika idi. T1 10% suresi ve klinik etki suresi değerleri de sigara içmeyen ve sigara içenlerde 15.5±7.6/17.2±5.8 dakika ve 16.5±11.1/18.25±7.3 dakika idi (p>0.05). Benzer şekilde derlenme indeksi de sigara içmeyenler (12.7±7.3) ve içenler (12.4±6.6) arasinda anlamlı fark göstermedi. Sonuç: Çalışmamızda "lag-time", "onset-time", "derin nöromusküler blok süresi", "klinik etki süresi", "T1 %10 süresi", "derlenme indeksi", "komplet derlenme aralığı" değerleri karşılaştırıldığında gruplar arasında istatistiksel olarak anlamlı bir fark saptanmadı.

ÖZET Amaç: Adenoidektomi ve adenotonsillektomi operasyonları çocukluk çağında sıklıkla yapılan günübirlik cerrahi işlemlerdendir. Kan,doku ve yağda düşük çözünürlüğe sahip inhalasyon anestezikleri, hızlı indüksiyon ve derlenme sağlaması ile günübirlik cer rahi için iyi bir seçenektir.Bu çalışmamızda desfluran ve sevofluran inhalasyon anestezik ilaçlarının çocuk olgularda hemodinamik etkileri ve derlenme kalitelerinin karşılaştırılması amaçlanmıştır. Hastalar ve Yöntemler: Adenoidektomi ve adenotonsillektomi operasyonu uygulanacak ASA I grubuna dahil, 3-10 yaşlarında, 52 olgu çalışmaya alındı. Tüm olgular rastgele iki gruba ayrıldı: Grup D ve Grup S. Standard anestezi indüksiyonu uygulandıktan sonra anestezi idamesi için %40 Oksijen (O2) - %60 Azot protoksit (N2O) ile birlikte Grup D’de %4 desfluran uygulanırken Grup S’de %2 sevofluran uygulandı. İndüksiyon zamanı, entübasyon zamanı, operasyonun 1., 5., 15. ve 30. dakikalarında, cerrahi bitiş ve ekstü basyon zamanında kalp atım hızı (KAH), ortalma arteryel basınç (OAB) ve periferik oksijen satürasyon (SpO2) değerleri kaydedildi. Olguların cerrahi, anestezi ve ekstübasyon süreleri kaydedildi. Olgular Derlenme Ünitesinde 20 dakika gözlendi. Modifiye Aldrete skalası ve Ağrı-konfor skalası ile anesteziden derlenmenin kalitesi değerlendirildi. Bulgular: Her iki grupta demografik özellikler ve hemodinamik etkiler benzer bulundu. Ekstübasyon zamanı Grup D’de daha kısa bulundu (p

Objective: The main purpose of our study is to categorize starting doses of recombinant follicle-stimulating hormone (recFSH) based on various cutoff values of anti-Mullerian hormone (AMH) and to determine the effectiveness of serum AMH levels in the prediction of poor ovarian response. Material and methods: Prospective data analysis was conducted at IVF center. A total of 323 patients were included. All patients were divided into four groups according to the patients’ serum AMH concentrations: Group 1 (AMH < 1 ng/ml; 450 IU/day n = 157); Group 2 (AMH 1–2 ng/ml; 375 IU/day, n = 55); Group 3 (AMH 2–3 ng/ml; 225 IU/day, n = 48); and Group 4 (AMH > 3 ng/ml; 150 IU/day, n = 63). Collected data included age, total gonadotropin dosage, duration of stimulations, the total number of oocytes retrieved, ovarian response, cancelation rate, and cPRs. Results: As serum AMH levels increased, there were significant decreases in the starting recFSH dose and total gonadotropin dosage, and a significant increase in the total number of oocytes retrieved. There was a significant trend toward increasing cycle cancelation rates and decreasing cPRs with decreasing serum AMH levels. Although there were no significant differences with regard to the proportion of cycles with hypo-response between all groups. A result of ?0.83 was considered the cutoff value of AMH to predict a hypo-response to ovarian stimulation. Conclusions: AMH is a useful marker in selecting the starting dose of recFSH and prediction of poor ovarian response. Our protocol may allow clinicians to modulate the starting dose of recFSH according to these cutoff values for serum AMH levels. © 2017 Informa UK Limited, trading as Taylor & Francis Group.

To determine which type of blunt expansion of a low transverse uterine incision during operative delivery is associated with decreased blood loss and intra- and post-operative morbidity for a caesarean section (CS).The prospective randomised-controlled trial was conducted at the Department of Obstetrics and Gynecology, Bezmialem University Hospital. The patients were randomly assigned to a group that received a cephalad-caudad (n = 55) or transverse (n = 57) blunt expansion of the low transverse uterine incision. Intra- and post-operative morbidity at caesarean delivery in short-term including blood loss, operating time, post-operative pain with the faces pain rating scale, and post-operative morbidity were analysed.The changes in both haemoglobin (p 0.01) and haematocrit (p 0.01) from the pre-operative to post-operative values, estimates of blood loss (p 0.01) were significantly lower in cephalad-caudad group and the post-operative haematocrit concentrations (p = 0.02) were significantly greater in cephalad-caudad group when compared with the transverse group. The damage of parametrial and uterine vessels into lateral edges were recorded in 11 (19.6%) patients in transverse group and 7 (12.9%) patients in cephalad-caudad group and there is no statistical significance between groups in terms of these parameters (p 0.05, 95% CI 0.19, 1.63).Our findings suggest that cephalad-caudad blunt expansion of the low transverse uterine incision decreases blood loss compared to transverse blunt dissection.

Background: The most common treatment modality for postoperative pain relief following laparoscopic surgery is multimodal, using nonsteroidal antiinflammatory drugs (NSAID), opioids, and infiltration of local anesthetics. Because NSAIDs are nephrotoxic, local infiltration does not relieve deep tissue pain, and opioids have an adverse effects profile including pruritus, nausea, vomiting, oversedation, apnea, and decreased gastrointestinal motility. Therefore, the use of a regional analgesic technique can lead to an improved quality of recovery. The aim of this prospective, randomized, placebo-controlled study was to evaluate the effect of TAP block on postoperative verbal analog scale (VAS) scores and total morphine requirements in the first 24 hours after laparoscopic live donor nephrectomy. Material/Methods: After obtaining approval from the hospital ethics committee and written informed consent from the patients, 49 ASA I-II patients undergoing laparoscopic donor nephrectomy, aged 18 years or over, were included in this prospective, randomized, controlled study. In this clinical trial patients were divided into 2 groups: TAP block group (group T) and placebo group (group P). The demographic variables, pain scores, morphine consumption, level of sedation, presence of postoperative nausea, vomiting, pruritus, and average length of postoperative stay were reviewed. Results: The pain scores were significantly lower after TAP block with bupivacaine at most but not all time points. Patients receiving the TAP block with bupivacaine required less morphine up to 24 hours after surgery compared with the saline group. Conclusions: USG-guided TAP block as part of a balanced analgesia regimen is of benefit in reducing postoperative pain and morphine consumption after laparoscopic donor nephrectomy. © Ann Transplant, 2015.

BACKGROUND Benzodiazepines are the most popular premedication drugs thought to act through the GABA/benzodiazepine receptor complex and alprazolam is one of the most potent benzodiazepines that have a quick onset. While there is a growing body of evidence supporting alprazolam in the amelioration of redox status in animals, no study has been performed concerning its antioxidant activity in humans. The purpose of this investigation was to determine the effect of alprazolam on redox status. MATERIAL AND METHODS This study was a four-group randomized controlled trial. Participants were recruited from Acibadem University Acibadem International Hospital and included a convenience sample of 82 donors and recipients undergoing renal transplantation. Patients were randomly divided into four groups. While donors and recipients in experimental groups (G1 and G3) were administered alprazolam 0.5 mg orally one hour before the operation, those in control groups (G2 and G4) were not. Serum advanced oxidative protein products, total thiol, free hemoglobin, ischemic modified albumin, and sialic acid levels at different time points were measured to evaluate the redox status. RESULTS All oxidative stress parameters were higher in the alprazolam premedication groups (G1, G3) at all time points than in the control groups (G2, G4). Basal values of oxidative parameters (at time point T1) in patients with CKD (G3, G4) were lower than in healthy donors (G1, G2). CONCLUSIONS Alprazolam premedication in donors and end-stage renal failure patients undergoing renal transplantation does not improve redox homeostasis but further experimental studies are needed.

Objective: The purpose of this investigation was to compare the effect of alprazolam and melatonin on oxidative stress, glicocalyx integrity and neurocognitive function in patients undergoing coronary artery bypass grafting (CABG). Methods: Overall, 42 patients undergoing CABG were retrospectively included in this study. Blood samples which preserved at -70 degrees C for a previous study were used for this study. The participants were divided into two groups. Patients in the Group A were administered alprazolam before the operation, whereas melatonin was used for premedication in the Group M. Blood samples were collected at three time points {[}T0: before anaesthesia induction, T1: admittance to intensive care unit (ICU), T2: 24 h after ICU admission], and oxidative stress parameters and glicocalyx integrity were evaluated. Furthermore, Mini-Mental State Examination was recorded to measure neurocognitive function. Results: The total thiol levels which were measured as an antioxidant parameter were significantly higher, and free Hb values were significantly lower in the Group M compared to the Group A (p0.05). Conclusion: In light of positive effects on oxidatif stress parameters, melatonin may be considered as a good and safe premedication agent with its anxiolytic, antioxidant and minimal haemodynamic and respiratory effects.

Modified ultrafiltration is used to ameliorate the deleterious effects of cardiopulmonary bypass in pediatric cardiac surgery patients. The ideal duration of modified ultrafiltration has not been established yet. We investigated the effects of extended duration of modified ultrafiltration on pulmonary functions and hemodynamics in the early postoperative period in newborns and infants who had transposition of great arteries operations.Single-center prospective randomized study.Pediatric cardiac surgery operating room and ICU.Sixty newborns and infants who had been scheduled to undergo transposition of great arteries operation.None.Modified ultrafiltration was applied to all patients following the termination of cardiopulmonary bypass (for 10, 15, and 20 min in groups 1, 2, and 3, respectively). Pulmonary compliance, gas exchange capacity, hemodynamic measurements, inotropic support, blood loss, transfusion requirements, hematocrit level, and duration of ventilatory support were measured after intubation, at termination of cardiopulmonary bypass, at the end of modified ultrafiltration, and in the 1st, 6th, 12th, and 24th hours after admission to ICU. The amount of fluid removed by modified ultrafiltration in groups 2 and 3 was larger than that of group 1 (p0.01). Systolic blood pressure was significantly increased at the end of modified ultrafiltration in group 3 compared to groups 1 and 2 (p0.05). Hematocrit levels were significantly increased at the end of modified ultrafiltration in groups 2 and 3 compared to group 1 (p0.01). Therefore, RBCs were transfused less after modified ultrafiltration in groups 2 and 3 compared to group 1 (p0.05). Static and dynamic compliance, oxygen index, and ventilation index had improved similarly in all three groups at the end of modified ultrafiltration (p0.05) CONCLUSIONS:: Modified ultrafiltration acutely improved pulmonary compliance and gas exchange in all groups. Increased hematocrit and blood pressure levels were also observed in the longer modified ultrafiltration group. However, extended duration of modified ultrafiltration did not have a significant impact on duration of intubation or the stay in ICU.