Çocukluk çaðýnda sýklýkla uygulanan tonsillektomi operasyonlarýnda intraoperatif ketamin ve tramadol uygulamasýnýn postoperatif aðrý ve analjezik ihtiyacý üzerine etkilerini karþýlaþtýrmayý amaçladýk.
Çalýþmaya tonsillektomi operasyonu planlanan, 5-15 yaþ arasý, ASA I-II sýnýfýnda 90 hasta alýndý. Standart genel anestezi sonrasý olgular üç gruba ayrýldý. Kanama kontrolü sýrasýnda Ketamin grubuna 0,5 mg.kg-1 Ketamin, Tramadol grubuna 2 mg.kg-1 Tramadol ve Kontrol grubuna ise SF iv. olarak uygulandý. Anestezi ve operasyon süreleri ile derlenme odasýnda kalýþ zamanlarý kaydedildi. Postoperatif aðrý deðerlendirmesinde NRS ve CHEOPS skalalarý kullanýldý. NRS 3’den, CHEOPS 8’den büyük olduðunda; ilk 6 saatte rektal, sonrasýnda oral 15 mg.kg-1 parasetamol uygulandý. Ýlk analjezik zamaný, uygulanan toplam doz ve komplikasyonlar kaydedildi.
Olgularýn demografik verileri, anestezi ve operasyon süreleri ile derlenme odasýnda kalýþ süreleri istatiksel olarak benzerdi (p>0.05). Kontrol grubunda, Tramadol ve Ketamin grubuna göre ek analjezik gerektiren hasta sayýsý anlamlý olarak yüksekti (p<0.05). Tramadol ve Ketamin gruplarý arasýnda ise fark bulunamadý (p>0.05). Ek analjezik verilme zamaný Kontrol grubunda Tramadol ve Ketamin gruplarýna göre anlamlý olarak kýsa bulunurken (p<0.05), Tramadol ve Ketamin gruplarýnda ek analjezik verilme süreleri benzer olarak hesaplandý (p>0.05). Ek analjezik olarak kullanýlan parasetamol dozu kontrol grubunda Tramadol ve Ketamin grubuna göre anlamlý olarak fazla (p<0.05) iken, Tramadol ve Ketamin grubunda ise benzerdi (p>0.05). Tramadol ve Ketamin gruplarýnda kontrol grubuna göre bulantý-kusma anlamlý olarak yüksek bulundu (p<0.05).
Pediatrik dönem tonsillektomi operasyonlarýnda 2 mg.kg-1 tramadol ve 0.5 mg.kg-1 ketamin uygulamasý ile etkili postoperatif aðrý saðaltýmý saðlanmýþtýr.

We aimed to compare effects of ketamine and tramadol administered intraoperatively on postoperative pain and analgesic demand in children undergoing tonsillectomy operations.
Ninety children undergoing tonsillectomy, aging 5-15 years old, ASA I - II admitted in this study. Cases were arranged in three groups and they were given stadardized general anaesthesia. After coagulation, ketamine 0,5 mg.kg-1 intravenously (iv) in ketamine group, 2 mg.kg-1 tramadol iv in tramadol group and serume physiologic iv in control group were given. Duration of anaesthesia, operation and stay in PACU were recorded. NRS and CHEOPS scales were used to assess postoperative pain. Paracetamol, 15 mg.kg-1, was given rectally in the first 6 hours (hrs) and orally over 6 hrs, if NRS greater than 3 and CHEOPS greater than 8 were assessed. All data were recorded concerning with the first, total dosage of analgesic and complications. within 24 hrs.
Demographic data, duration of anaesthesia, operation and stay in PACU were similar between groups (p>0.05). Number of patients required additive analgesic were higher in control group. No differences were found between tramadol and ketamine groups (p>0.05). The time additive analgesic given was earlier in control group (p<0.05), but similar in tramadol and ketamine groups (p>0.05). Paracetamol dosage was significantly higher in control group (p<0.05), but similar between tramadol and ketamine groups (p>0.05). Frequency of nausea and vomiting was found significantly higher in tramadol and ketamine groups (p<0.05).
Postoperative pain was effectively managed using 2 mg.kg-1 tramadol and 0,5 mg.kg-1 ketamine in pediatric tonsillectomies.

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Amaç: Bu prospektif çalýþmada elektif sezaryen ameliyatlarýnda spinal ve genel anestezinin anne ve yenidoðan üzerine etkilerinin kýyaslanmasý amaçlanmýþtýr.
Gereç ve Yöntem: Elektif sezaryen ameliyatý için rutin spinal (Grup SA, n=95) veya genel anestezi (Grup GA, n=93) ile standart postoperatif analjezi uygulanan miyadýnda gebeler çalýþmaya alýnmýþtýr. Ameliyat süresi, cilt insizyonu-histerotomi (TS-H) ve histerotomi-umbilikal kordona klemp konmasý arasý geçen süre (TH-U), oksitosin gereksinimi, intraoperatif sývý, efedrin gereksinimi, hipotansiyon geliþen hasta sayýsý, ilk analjezik gereksinimine dek geçen sure (Tanalg), petidin tüketimi, yan etkiler, ilk emzirme, annenin oral gýda alýmý (TOI), gaz çýkarma (TF), defekasyon (TD), mobilizasyon ve hastanede kalýþ süresi gruplar arasýnda kýyaslanmýþtýr. Yenidoðanýn Apgar skorlarý, umblikal venöz kan gazý, hastanede kaldýðý süre boyunca hipoglisemi geliþimi, ek gýda, fototerapi ve solunum desteði gereksinimi karþýlaþtýrýlmýþtýr.
Bulgular: Spinal anestezide genel anesteziye oranla daha uzun TS-H, TH-U süreleri gözlenmiþ, oksitosin gereksinimi azalmýþ, hipotansiyon insidansý, efedrin ve sývý gereksiniminde artýþ saptanmýþ, Tanalg süresi uzamýþtýr. Ayrýca spinal anestezi sonrasý TOI, TF, TD ve hastanede kalýþ süresinin genel anesteziye oranla (sýrasýyla 48 ve 52 saat, p<0.01) kýsaldýðý saptanmýþtýr. Postoperatif analjezik tüketimi ve 1. dak Apgar skoru ile umbilikal kan gazý sonuçlarý dýþýnda neonatal veriler açýsýndan gruplar arasýnda fark bulunmamýþtýr.
Sonuç: Elektif sezaryen ameliyatlarýnda spinal anestezi genel anesteziye oranla daha hýzlý gastrointestinal derlenmeyi saðlamakta, hastanede kalýþ süresini kýsaltmaktadýr.

Objectives: This prospective study aims to compare the maternal and neonatal effects of spinal and general anesthesia for elective cesarean section.
Methods: Term parturients receiving routine spinal (Group SA, n=95) or general (Group GA, n=93) anesthesia and standard postoperative analgesia for elective cesarean section are included in the study. Operation time, incision-hysterotomy (TS-H) and hysterotomy-umbilical cord clamping (TH-U) intervals, oxytocine requirement, intraoperative fluids, ephedrine requirement, incidence of hypotension, time to first analgesic requirement (Tanalg), pethidine consumption, adverse events, time to first breastfeeding, oral food intake (TOI), flatulence (TF), defecation (TD), mobilization and postoperative hospital stay were compared between the groups. Newborn Apgar scores, umbilical venous blood gas analysis, incidence of hypoglycemia, nutritional support, phototherapy and ventilatory support were also analyzed.
Results: Spinal anesthesia was associated with longer TS-H and TH-U durations, lower oxytocine requirements, higher incidence of hypotension, increased ephedrine and fluid consumption and delayed Tanalg. Furthermore, TOI, TF, TD and postoperative hospital stay was shorter in spinal anesthesia when compared with general anesthesia (48h vs. 52 h respectively, p<0.01). No difference in postoperative analgesic consumption and neonatal outcomes except 1st min Apgar scores and umbilical blood gas analysis was detected.
Conclusion: Spinal anesthesia when compared to general anesthesia shortens postoperative hospital stay with early return of gastrointestinal functions in elective cesarean section.

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Amaç: Elektrostimülasyon yöntemi kullanýlarak olgularýn duysal algýlama seviyeleri ve aðrý eþik deðerlerini ölçmek ve cinsiyet ile çalýþma koþullarýnýn eþik deðerleri üzerine etkisini araþtýrmaktýr.
Gereç ve Yöntemler: 20-40 yaþ arasý toplam 262 saðlýklý gönüllü üzerinde painmatcher cihazý kullanýlarak duysal algýlama seviyesi ve aðrý eþik deðeri ölçümleri yapýldý. Deðerlendirme aþamasýnda olgular 4 gruba ayrýldý. Grup I kadýn saðlýk personeli (KS) (bayan doktor/hemþire), Grup II erkek saðlýk personeli (ES) (erkek doktor), Grup III kadýn temizlik personeli (KT) ve Grup IV erkek temizlik personeli (ET) olarak gruplandýrýldý.
Bulgular: Duysal seviye ölçümlerindeki deðerler erkek ve kadýn temizlik personelinde kadýn saðlýk personelinden anlamlý derecede yüksek bulundu (p<0.05). Erkek saðlýk personeli ve kadýn temizlik personeli arasýnda aðrý duyusal düzeyi benzerdi (p>0.05). Aðrý eþik deðer ölçümleri; erkek temizlik personelinde, saðlýk personeline oranla yüksek saptandý (p<0.05). Kadýn temizlik personeli ile erkek saðlýk personelinin aðrý eþik deðeri benzerdi (p>0.05). Her grupta bakýlan aðrý eþik deðeri ile duysal seviye korelasyonu KS ve ET gruplarýnda önemsizken, ES ve KT’de önemli idi (p<0.05).
Sonuç: Duysal seviye ve aðrý eþik deðer seviyeleri cinsiyet farkýndan çok çalýþma koþullarýndan etkilenmektedir. Bedenen çalýþanlarda eþik deðerlerin daha yüksek olduðu sonucuna varýldý.
Anahtar Kelimeler: Painmatcher, aðrý eþik deðeri, cinsiyet.

Aim: The aim of this study was to evaluate the sensorial/affective dimension pain levels of patients with electrostimulation method and investigate the effects of gender/working conditions on pain thresholds.
Material and methods: The sensorial dimension of pain and pain threshold levels of 262 healthy volunteers, ages between 20 and 40 years were assessed by using the Painmatcher machine. Patients were divided into four groups during the assessment period; Group I female medical staff (KS) (woman doctors/nurses), Group II male medical staff (ES) (male doctors), Group III female sanitation workers (KT) and Group IV male sanitation workers (ET).
Results: Sensorial dimension of pain was significantly higher in male and female sanitation workers than female medical staff (p<0.05). Sensorial dimension of pain were similar between male medical staff and female sanitation workers (p>0.05). Pain threshold levels were significantly higher in male sanitation workers than male medical staff (p<0.05). Female sanitation workers and female medical staff had similar pain threshold levels (p>0.05). Correlation between pain threshold levels and sensorial dimension of pain were not significant in Groups KS and ET, however it was significant between groups ES and KT (p<0.05).
Conclusion: Sensorial dimension of pain and pain threshold levels are affected by working conditions rather than gender. Threshold level of pain was high in physically working people.
Key words: Painmatcher, pain threshold, gender.

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Amaç: Ortostatik baþaðrýsýnýn nadir bir deneni olan spontan intrakraniyal hipotansiyonun nedenleri, kliniði, tedavi ve prognozunu kliniðimizde izlenen vakalar eþliðinde gözden geçirmek
Yöntem: 1 Ocak 2009-30 Ekim 2011 tarihleri arasýnda kliniðimizde taný alan 6 erkek ve 7 kadýn olmak üzere 13 tane spontan intrakranial hipotansiyon olgusu çalýþmaya dahil edildi. Hastalar geliþ semtomlarý, uygulanan tedavi, kranial mrg bulgularý, uygun hastalarda yapýnla BOS basýnç deðerleri ve klinik iyileþme süreleri deðerlendirilerek incelendi.
Bulgular: Ortostatik baþ aðrýsýnýn ve eþlik eden bulgularýn yatak istirahati, oral sývý alýmýnýn arttýrýlmasý, intravenöz hidrasyon ve kafein tedavisi uygulanan iki hastada (%15,3) 10 günde iki hastada (%15,3)15 günde bir hastada (%7,6) yirmibir günde tamamen düzeldiði görüldü. Benzer tedavi uygulanan dört (%37,6) olguda baþaðrýsý ve diðer klinik özelliklerinin 30 gün içerisinde belirgin olarak gerilediði ancak periyodik takiplerinde hafif þiddette baþ aðrýlarýnýn aralýklý olarak devam ettiði gözlendi. 30 gün sonrasýnda ortostatik baþ aðrýsý gerilemeyen olgulara uygulanan epidural kan yamasý sonrasýnda 10-15 gün içerisinde kliniklerinin tamamen düzeldiði görüldü.
Sonuç: Postural baþ aðrýsý tarifleyen olgularda öncelikle SIH’dan mutlaka þüphe edilmeli ve kontrastlý kranial görüntüleme yapýlmalýdýr. Kranial sinir paralizileri ve piramidal traktus bulgularý olabileceði unutulmamalýdýr. Epidural kan yamalarý konservatif tedavinin yetersiz kaldýðý olgulara uygulanmalýdýr.

To view the causes, clinical picture, treatment and prognosis of spontaneous intracranial hypotension, a rare cause of orthostatic headache, along with the cases followed in our clinic.
Method: Thirteen cases (6 males and 8 females), diagnosed with spontaneous intracranial hypotension in our clinic between January 1st, 2009 and October 30th, 2011, were included in the study. The presenting symptoms, treatment, findings on cranial magnetic resonance imaging, the pressure of cerebrospinal fluid taken at lumbar puncture (in available patients), and healing period of the patients were recorded.
Results: Five patients with orthostatic headache and accompanying symptoms, treated with bed rest, increase in oral fluid intake, intravenous hydration and caffeine, had a complete recovery. Complete recovery was observed in two patients (15.3%) within 10 days, in another two (15.3%) within 15 days and in one patient (7.6%) within 21 days. Headache and other clinical symptoms significantly regressed within 30 days in four patients (37.6%) who received similar treatment, but a mild headache persisted intermittently during follow-up. As the headache had not resolved after 30 days, epidural blood patch was applied in these four cases (37.6%) and the clinical picture completely improved within 10 to 15 days.
Spontaneous intracranial hypotension should primarily be suspected and contrast-enhanced cranial imaging should be performed in cases complaining about postural headache. It should be kept in mind that there might be cranial nerve paralysis and pyramidal tract signs. At first, conservative treatments should be considered, however if conservative treatments fail, epidural blood patches must be applied.

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Amaç: Bu çalýþmada, acil servise primer dismenore nedeni ile baþvuran hastalarýn aðrýlarýnýn giderilmesinde diklofenak sodyum ve parasetamol tedavi etkinliklerinin visual analog scale (VAS) kullanýlarak karþýlaþtýrýlmasý amaçlandý.
Gereç ve Yöntem: Çalýþmaya primer dismenore (Grup 1, n=40) tanýsý konmuþ olan, parasetamol (75mg intramüsküler) tedavisi verilen ve (Grup 2, n=40) primer dismenore, diklofenak sodyum (1 gr intravenöz) tedavisi alan kiþiler dahil edildi. Her iki grupta da 19-30 yaþ arasýndaki hastalar seçildi. Tüm gruplarda hastalarýn aðrý þiddeti Visual Analog Skala (VAS) kullanýlarak 0 (aðrý olmamasý) ile 10 (dayanýlmaz aðrý) arasýnda derecelendirildi.
Gruplarýn visual analog skala (VAS)’ larý karþýlaþtýrýldý.
Bulgular: Ýki grup arasýnda yaþ, OAB ve Nb deðerleri açýsýndan istatistiksel olarak fark yoktu. I. gruptaki bireylerin baþvuru sýrasýndaki VAS deðerleri II. gruptakilerden yüksek iken, onuncu ve otuzuncu dakikalardaki VAS deðerleri II. Gruptaki hastalardan daha düþüktü (p= 0.00, Þekil 1). I. ve II. grubun her birinin kendi içindeki baþlangýçtaki, 10. ve 30. dakikalardaki VAS deðerleri birbirlerinden anlamlý derecede farklýydý. 10. ve 30. dakikadaki VAS deðerleri baþlangýçtaki deðerlere göre, 30. dakikadaki VAS deðerleri 10. dakikaya göre anlamlý derecede düþüktü (p=0.00
Sonuç: Çalýþma sonucunda parasetamolün primer dismenore aðrýsý tedavisinde diklofenak sodyum dan daha hýzlý etki gösterdiði ve daha etkili olduðu söylenebilir.

Purpose: In this study, the aim was to compare the efficiencies of diclofenac sodium and paracetamol cure using visual analog scale in the patients applying to emergency room with primer dysmenorrhea.
Tools and method: Group I (n=40) patients diagnosed with primer dysmenorrhea and treated with paracetamol (75 mg intramuscular) and Group II (n=40) patients diagnosed with primer dysmenorrhea and treated with diclofenac sodium (1 g intravenous) were included in this study. In both groups, patients were between 19-30 years old. In all groups, the intensity of the pain was ranked between 0 (no pain) and 10 (intolerable) by using VAS. VAS score of the groups were compared.
Findings: Between two groups, there was not a significant difference statistically in terms of age, mean arterial pressure and pulse values. The VAS values of the first group were higher than that of 2nd group in the beginning. But after the treatment, in the 10th and 30th minutes, the VAS values were lower than that of 2nd group. (p=0.00). The VAS values of the each group in the beginning, on the 10th and 30th minutes were significantly different from each other. VAS values on the 10th and 30th minutes were lower compared to the values in the beginning and the values in the 30th minute was lower according to the 10th minute. (p=0.00).
Result: We can suggest that paracetamol is more efficient than diclofenac sodium in primer dysmenorrhea pain treatment.

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Episakral lipoma, baþlýca posterior iliak krest bölgede oluþan küçük, hassas subkutan nodüllerdir. Akut ve kronik bel aðrýsýnýn önemli ve tedavi edilebilir bir nedeni olduðu gösterilmiþtir. Episakral lipoma torakodorsal fasiadaki bir yýrtýk ve bunu takiben altta uzanan dorsal yað tabakasýnýn bir kýsmýnýn yýrtýk aracýlýðý ile herniasyonu sonucu oluþur. Yaygýn bir klinik durumdur ve tanýnmasý kolaydýr. Aðrýlý nodül varlýðý ve anestezik solusyonla enjeksiyon sonrasý aðrýnýn kaybolmasý diyagnostiktir. Ýlaçla tedavi ve fizik tedavi faydalý olmayabilir. Episakral lipoma tedavisinde lokal anestezik (LA) ve steroid solüsyonu ile nodülün enjeksiyonu etkilidir.
Burada posterior iliak krest üzerinde aðrýlý nodülü olan iki hasta tanýmladýk. Birinci hasta sol alt ekstremite yayýlan þiddetli bel aðrýsýndan yakýnýyordu ve takiben disk operasyonu geçirmiþti. Diðeri ise büyük trokanterik aðrý sendromu olarak tedavi edilmiþti. Her iki hastada görülen semptomlar LA ve steroid enjeksiyonu ile hafifledi.
Episakral lipoma akut ve kronik bel aðrýsýnýn taný ve ayýrýcý tanýsýnda daha sýk akla getirilmelidir.

Episacral lipoma is a small, tender subcutaneous nodule occuring mainly over posterior iliac crest. It has been shown to be a significant and treatable cause of acute and chronic low back pain. Episacral lipoma occurs as a result of a tear in the thoracodorsal fascia and the subsequent herniation of a portion of the underlying dorsal fat pad through the tear. This clinical entity is common, and its recognition is simple. The presence of a painful nodule, with disappearance of pain after injection with anaesthetic solution, is diagnostic. Medications and physical therapy may not be helpful. Injection of the nodule with local anaesthetic and steroid solution is effective in treating the episacral lipoma.
Here we describe 2 patients with painful nodules over the posterior iliac crest. One patient complained of severe low back pain radiating to the left lower extremity and subsequently underwent disc operation. The other had been treated for greater trochanteric pain syndrome. In both patients,symptoms appeared to be relieved by local anaesthetic and steroid injection.
The episacral lipoma should be considered more often in the workup and in differential diagnosis of acute and chronic low back pain

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Eagle syndrome is an aggregate of symptoms caused by an elongated styloid process, most frequently resulting in headache, facial pain, dysphagia and sensation of foreign body in throat. The proper diagnosis is not difficult with clinical history, physical examination and radiographic assessment if there is a sufficient degree of suspicion. The treatment is very effective.
We report here a typical case of Eagle syndrome which was misdiagnosed as trigeminal neuralgia for many years and was treated with carbamazepine. We aim to point the place of Eagle syndrome in the differential diagnosis of facial pain. We also re-emphasize the usefulness of the three-dimensional computed tomography in the diagnosis of Eagle syndrome.
Even though Eagle syndrome is a rare condition, in cases of facial pain refractory to treatment or unexplained complaints of the head and neck region, it should be considered in the differential diagnosis as it has therapeutic consequences.

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Kompleks bölgesel aðrý sendromu (KBAS) ve Raynaud hastalýðý anormal otonom sinir sistemi ile iliþkili vazomotor bozukluk ile karakterize hastalýklardýr. Biz herhangi bir baþlatýcý olay olmadan geliþen ve tekrarlayýcý özelliði olan bir KBAS I olgusu sunuyoruz. Hastada ayrýca klinik olarak KBAS I’e eþlik eden Raynaud hastalýðý da teþhis edilmiþtir. Bu iki ayrý antitenin birlikteliðinden, her iki hastalýðýnda patofizyolojisinde yer alan, altta yatan bir sempatik disfonsiyonun sorumlu olabileceði düþünülmüþtür. KBAS I’in tekrarlamasý ve herhangi bir etiyolojik faktör olmadan ortaya çýkýþý, sempatik disfonksiyonda meydana gelen geçici deðiþiklikler ile açýklanabilir.

Complex regional pain syndrome (CPRS) and Raynaud’s disease are disorders characterized by vasomotor disturbances associating with abnormal autonomic nervous system. We present a case of CRPS I which had a history of recurrence and no initiating event. Raynaud’s disease accompanying with CRPS I was also diagnosed clinically in the patient. It is considered that a sympathetic dysfunction which underlies the pathophysiologies of both disorders may be responsible for coexistence of these two distinct entities. Recurrence and unknown etiology of CRPS I might be accounted for temporary alterations in the sympathetic dysfunction.

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