Amaç: Çalýþmamýzda, yaþlý eriþkinlerde fibromiyalji (FM) varlýðýný araþtýrmak ve FM hastalýk þiddetinin yaþam kalitesi üzerine etkisini deðerlendirmeyi amaçladýk.
Gereç ve Yöntem: Çalýþmamýza 65– 80 yaþ arasý 100 hasta dahil edildi. FM varlýðý 1990 Amerikan Romatoloji Derneði [American College of Rheumatology (ACR)] kriterleri baz alýnarak deðerlendirildi. Hastalarýn ana baþvuru tanýlarý kaydedildi. Bu kriterleri karþýlayan 31 hasta FM grubunda, geri kalan 69 hasta ise FM olmayan grupta yer aldý. Hassas nokta sayýsý [tender point count (TPC)] ve sýk görülen semptomlar kaydedildi. FM hastalýk þiddeti, Fibromiyalji Etki Ölçeði [Fibromyalgia Impact Questionnaire (FIQ)] ile deðerlendirildi. Yaþam kalitesini deðerlendirmede Nottingham Saðlýk Profili [Nottingham Health Profile (NHP)] kullanýldý. Aðrý þiddeti Görsel Analog Skala-aðrý (Visual Analog Scale [VAS]-pain) ile ölçüldü.
Bulgular: Çalýþmamýzda FM oraný %31 olarak bulundu. FM hastalarý kontrollerle karþýlaþtýrýldýðýnda NHP’nin aðrý, uyku, sosyal izolasyon ve emosyonel reaksiyon alt gruplarýnda belirgin olarak daha yüksek skorlama gösterdiler (p<0.05). TPC ve FIQ; cinsiyet farklýlýðýndan etkilenmedi, ancak yaþ ile azalma gösterdi (p<0.01). FIQ ve TPC; NHP’nin sadece aðrý ve emosyonel reaksiyonlar alt gruplarý ile korele bulundu (p<0.01). FIQ ve TPC ile NHP’nin fiziksel mobilite, uyku, enerji ve sosyal izolasyon alt gruplarý arasýnda istatistiksel olarak anlamlý korelasyon yoktu (p>0.05).
Sonuç: FM genç ve orta yaþlý kadýnlarýn hastalýðý olarak bilinmesine raðmen, çalýþmamýz prevalansýnýn yaþ ile arttýðýna dikkat çekmektedir. FM, yaþlý popülasyona aðrý, uyku, sosyal ve emosyonal fonksiyonlar açýsýndan kötü yaþam kalitesi ile iliþkilidir.

Objectives: The aim of the present study was to examine the presence of fibromyalgia (FM) in elderly adults and to evaluate the impact of the severity of FM on quality of life.
Methods: A total of 100 patients between 65 and 80 years of age were included. The main admission diagnosis of the patients was recorded. Presence of FM was evaluated based on 1990 American College of Rheumatology (ACR) diagnostic criteria. The FM group was comprised of 31 patients fulfilling these criteria, and the remaining 69 patients composed the non-FM group. Tender point count (TPC) and common symptoms were recorded. FM disease severity was assessed using Fibromyalgia Impact Questionnaire (FIQ). Nottingham Health Profile (NHP) was used to evaluate quality of life. Pain severity was measured using Visual Analog Scale (VAS).
Results: Rate of FM was found to be 31%. FM patients scored significantly higher on pain, sleep, social isolation, and emotional reactions subgroups of NHP when compared to controls (p<0.05). TPC and FIQ were not affected by gender difference (p>0.05), but reduced with increasing age (p<0.01). FIQ and TPC were found to be correlated with only the pain and emotional reactions subgroups of NHP (p<0.01). There was no statistically significant correlation between FIQ and TPC and the physical mobility, sleep, energy, and social isolation subgroups of NHP (p>0.05).
Conclusion: Although FM is known as a disease of young and middle-aged women, our study indicates that its prevalence increases with age. FM is associated with poor quality of life in terms of pain, sleep, social, and emotional functions.

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Amaç: Aðrý, palyatif bakým kliniklerinde kanser hastalarýnýn yaþam kalitesini belirgin olarak etkileyen önemli semptomlardan biridir. Geliþmekte olan ülkelerde opioidlere ulaþýlabilirlikteki güçlükler ve iyi organize edilmiþ palyatif bakým merkezlerinin azlýðý aðrý tedavisinin yetersiz olmasýna neden olmaktadýr.Türkiye, kiþi baþýna düþen opioid tüketiminin istatistiksel olarak yetersiz olduðu ülkelerden biridir. 2010 yýlýnda kiþi baþýna düþen opioid miktarý 14.31 mg morfin eþdeðeri olup, opioid analjezik tüketiminin yeterliliði %7 olarak bulunmuþtur. Bu çalýþmada palyatif bakým kliniðinde yatan hastalarda opioid kullanýmý araþtýrýldý.
Gereç ve Yöntem: 2014 yýlýnda, palyatif bakým kliniðimizde palyatif bakým verilen 418 kanser hastasýnýn verileri retrospektif olarak deðerlendirildi.
Bulgular: Hastalarýn 183’ü (%44) kadýn, 235’i (%56) erkek olarak bulundu. Yaþlar 18 ve 93 yýl arasýnda deðiþmekteydi (61±15). Hastalarýn %9’una opioid verilmemiþti, %26’sý zayýf opioid, %65’i güçlü opioid kullanmaktaydý. Hasta baþýna düþen günlük oral morfin eþdeðer dozu 172±58 mg (40–328) olarak bulundu. Opioid kullanýmý için endikasyonlar %61 oranýnda aðrý, %19 oranýnda dispne ve %20 oranýnda ise hem dispne hem de aðrýydý.
Sonuç: Ülkemizde opioid çeþitleri kýsýtlý olmakla beraber tüm saðlýk personelinin aðrý tedavisi ve opioid kullanýmý hakkýnda eðitimi ile daha etkin ve yeterli aðrý tedavisi saðlanabileceði düþünüldü. Rölatif olarak zayýf opioidlerin yüksek kullaným insidansý, ülkemizde hýzlý salýnýmlý opioidlerin eksikliðiyle iliþkili olabilir.

Objectives: Pain is one of the most important symptoms in palliative care, and has a major impact on the quality of life of cancer patients. In developing countries, difficult access to opioids and the lack of well-established palliative care organizations result in undertreatment of pain. Turkey is one of the countries with statistical evidence of inadequate morphine consumption per capita. In 2010, the adequacy of opioid analgesic consumption was only 7%, based on a per capita consumption of 14.31 mg morphine equivalents. The present study analyzed and described patterns of opioid use among cancer patients in the palliative care clinic.
Methods: The data of 418 cancer patients who received palliative care at the palliative care clinic in 2014 were evaluated retrospectively.
Results: Of the total, 183 (44%) of the patients studied were female and 235 (56%) were male. Age ranged from 18 to 93 years (61±15 years). No opioids had been prescribed for 9% of patients, 26% of patients were using weak opioids, and 65% were using strong opioids. Daily oral morphine equivalent dosage per patient was 172±58 mg (range: 40–328 mg). Indications for opioid use were pain (61%), dyspnea (19%), and both dyspnea and pain (20%).
Conclusion: Although there is a limited variety of opioids currently available in this country, it is thought that a more effective and adequate level of pain management can be obtained through education of health practitioners about pain management and opioid use. The relatively high incidence of weak opioid use may be associated with the lack of available rapid release opioids in the country.

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Amaç: Bu çalýþma karpal tünel sendromu tanýsý koyulan hastalarýn yaþadýklarý aðrýnýn þiddetini ölçmek ve aðrý ile baþ etmede kullandýklarý yöntemlere iliþkin bilgileri saptamak amacýyla planlandý.
Gereç ve Yöntem: Tanýmlayýcý nitelikteki bu çalýþma bir üniversite hastanesinin nöroloji polikliniðinde karpal tünel sendromu tanýsý koyulan hastalarýn (n=99) katýlýmý ile Aðustos 2014–Aralýk 2015 tarihleri arasýnda gerçekleþtirildi. Veri toplamada “Hasta tanýtým formu” ‘‘Visual analog skala’’ ve “Aðrý yönetim envanteri” kullanýldý.
Bulgular: Hastalarýn %64.6’sý aðrý deneyimlemekteydi. Aðrý kontrolünde en çok reçeteli ilaç kullanýmý, masaj ve egzersizin kullanýldýðý belirlenirken, en yararlý yöntemlerin sýrasýyla egzersiz yapmak, masaj yapmak ve reçeteli aðrý kesici ilaç kullanmak olduðu saptandý.
Sonuç: Karpal tünel sendromlu hastalarýn aðrýyý azaltmada yararlandýðý yöntemlerin saptanmasý ile bu yöntemlerin diðer hastalarýn kullanýmýna sunulmasý ve saðlýk bakým uygulayýcýlarýnýn farmakolojik olmayan yöntemlerle hastalarý desteklemesi önerilmektedir.

Objectives: This study sought to evaluate pain severity and pain management methods of patients with carpal tunnel syndrome.
Methods: This descriptive study was conducted with patients who were diagnosed with carpal tunnel syndrome (n=99) in the neurology clinic of the university hospital between August 2014 and December 2015. Patient data form, visual analog scale (VAS) and a pain management inventory were used to collect data.
Results: Of the total, 64.6% of the patients experienced pain. Patients used prescription medication, massage, and exercise to control pain, and reported that the most useful method was exercise, followed by massage and, finally, prescription medication.
Conclusion: Healthcare professionals may share the findings of relative benefit according to method of pain management and encourage patients to use non-pharmacological methods.

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Amaç: Bu çalýþmada intravenöz lornoksikam ve tramadolun analjezik ve yan etkilerini karþýlaþtýrdýk. Amacýmýz lornoksikamýn tiroidektomi sonrasý aðrý kontrolünde opioidlere alternatif olarak kullanýlabilirliðini araþtýrmaktýr.
Gereç ve Yöntem: ASA I ve II olan 18–65 yaþ arasý 50 hasta tiroidektomi sonrasý randomize bir þekilde iki gruba ayrýldý. Grup L 8 mg IV lornoksikam ve Grup T 1 mg/kg IV tramadol aldý. Aðrý yoðunluðu 15 ve 30. dakika, 1, 2, 3, 4, 6, 12, 24. saatlerde Sayýsal Derecelendirme ve Ramsey Sedasyon Ölçekleri sayesinde deðerlendirildi. Hastalar monitörize edilerek elektrokardiyogram, kalp hýzý, sistolik/diyastolik kan basýncý ve ortalama kan basýncý, periferal oksijen saturasyonu deðerleri takip edildi. Hasta memnuniyet anketi 24. saatte yapýldý.
Bulgular: Her iki ilaç yeterli analjeziyi saðlamakla birlikte sadece birkaç hastada bulantý/kusma gibi yan etkiler geliþti. 15 ve 30. dakika ile 1. saat NRS skorlarý Grup L de daha düþük iken (p<0.05), 1. saatten sonra bakýlan ölçeklendirmelerde iki grup arasýnda anlamlý farklýlýk saptanmamýþtýr. Ýlk analjezik gerekme zamaný Grup L de daha uzundu. (p<0.001). Hiçbir hastada önemli bir komplikasyon geliþmedi.
Sonuç: Intravenöz lornoksikam, tramadola göre orta-aðýr aðrý yönetiminde kullanýþlý bir alternative olarak görünmektedir.

Objectives: The present study sought to compare the analgesic efficacy and adverse effects of intravenous (IV) lornoxicam and tramadol to investigate if lornoxicam is a reasonable alternative to a weak opioid for post-thyroidectomy pain.
Methods: Fifty patients of American Society of Anesthesiologists class I or II, 18 to 65 years of age, and who underwent thyroidectomy were assigned to 2 groups in a randomized manner. Group L received 8 mg of lornoxicam IV and Group T received 1 mg/kg of tramadol IV at conclusion of the operation. Pain intensity of patients was recorded at 15 and 30 minutes, and at 1, 2, 3, 4, 6, 12, and 24 hours after the initial dose with Numerical Rating Scale (NRS) and Ramsey Sedation Scale. Electrocardiogram, heart rate, systolic/diastolic and average artery pressure and peripheral oxygen saturations were monitored continuously during this period. Patients completed satisfaction questionnaires at 24th hour.
Results: Both drugs produced acceptable analgesia; however, significantly fewer patients reported 1 or more adverse events with lornoxicam than with tramadol. Most commonly seen in Group T was nausea/vomiting. NRS scores at 15 minutes, 30 minutes, and 1 hour were lower in Group L than in Group T (p<0.05), but there was no significant difference between groups after postoperative first hour. First analgesic requirement time was significantly longer in Group L compared to Group T (p<0.001). No serious complications were seen in either group.
Conclusion: Lornoxicam is a safe and effective analgesic that may be used with fewer complications than low-dose tramadol for treatment of moderate to severe postoperative pain.

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Son yýllarda, brakiyal pleksus anestezi teknikleri çocuklarýn üst ekstremite cerrahisinde daha sýk kullanýlmaktadýr. Rejyonal bloklar ile kooperasyon kurulabilen çocuklarda sedasyon eþliðinde cerrahi uygulanabilmektedir. Bu yazýda, ultrason (US) rehberliðinde infraklavikülar blok ile el ve ön kol cerrahisi geçiren uyanýk beþ olgu sunuldu. Tüm hastalarda cerrahi anestezi saðlandý ve cerrahi sadece brakiyal pleksus anestezisi ile tamamlandý. Sonuç olarak, US rehberliðinde brakiyal pleksus anestezisinin uygun çocuk hastalarda genel anestezi olmaksýzýn ameliyat için baþarýlý bir anestezi saðlayabileceðini düþünüyoruz.

In recent years, brachial plexus anesthesia techniques for upper limb surgery have been used more and more commonly on children; however, the patient is typically under deep sedation or general anesthesia. For eligible, cooperative children, surgery can also be performed using regional blocks while the patient is awake. We present 5 cases in which Ultrasound (US)-guided infraclavicular brachial plexus blocks (ICB) were used on children for hand or forearm surgery. Surgical anesthesia was achieved in all patients and surgery was completed uneventfully using brachial plexus anesthesia, without need for deep sedation.

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Kanser üreme çaðýndaki kadýnlarda daha sýk görülür. Bu hastalarda taný, tedavi yöntemleri ve tanýsal tedavinin güvenirliliði çok önemlidir. Bu olguda, malign mezenkimal tümörlü bir gebenin aðrý tedavisinin yönetimi sunuldu. Malign mezenkimal tümör tanýsý olan 30 haftalýk gebe (23 yaþ) sað arka uyluk ve sað kalça aðrýsý nedeniyle ayaktan tedavi amacýyla baþvurdu. Tanýsal priformis bloðu uygulamasý sonrasý aðrýda azalma oldu. Radyofrekans uygulamalarý kanserli gebelerde anne-bebek güvenliði olan ve nörodestrüktif olmayan bir yöntem olduðundan tercih edilebilir.

Cancer is frequently seen in women of reproductive age. Diagnosis, management of treatment, and safety of the therapeutic approach are particularly important for these patients. Presently described is pain management in a case of pregnancy with malignant mesenchymal tumor. A 23-year-old woman in 30th gestational week presented with severe pain in right hip and back of the right thigh. Piriformis block successfully decreased pain and was followed by pulsed radiofrequency (PRF) to the piriformis muscle. PRF, as a non-neurodestructive method, is a safe and effective method to treat cancer pain in a pregnant patient.

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Beyin omurilik sývýsý (BOS) lenfositozu ve geçici nörolojik bulgularýn eþlik ettiði baþ aðrýsý sendromu (‘The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis: HaNDL’) nadir görülen, iyi seyirli, kendini sýnýrlayan ve az tanýnan bir sendromdur. Zengin nörolojik semptomatolojisi ile morbidite ve mortaliteye yol açan çok sayýda hastalýðý taklit edebilen bu sendrom için, klinik þüphe ile yapýlan BOS incelemesi tanýsal deðer taþýr. Etiyopatogenezi tam olarak bilinmese de, otoimmünite ön planda düþünülmektedir. Bu yazýda, ilk klinik prezentasyonu geçici iskemik ataðý taklit eden, geçici ve tekrarlayýcý nörolojik bulgular gösteren epizodlarý ve normal BOS basýncýna eþlik eden papilödem bulgusu ile bir HaNDL olgusu tartýþýldý, sendromun tanýmý, klinik tablo ve epidemiyolojisi, etiyopatogenezi, ayýrýcý tanýsý ve tedavisi literatür eþliðinde gözden geçirildi.

The syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL), is a rare, benign, self-limiting syndrome that is not well known. Cerebrospinal fluid examination (CSF) on clinical suspicion has diagnostic value for this syndrome, which has a rich neurological symptomatology that can mimic many diseases causing mortality and morbidity. Although the ethiopathogenesis of this syndrome is not fully known, autoimmunity is thought to be in the foreground. Described in this article is a HaNDL case that on first clinic presentation appeared to be a transient ischemic attack (TIA) with temporary but recurring neurological findings and normal CSF pressure accompanied by papilledema. Clinical features, epidemiology, ethiopathogenesis, differential diagnosis, and treatment of this syndrome are reviewed according to the literature.

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This is a letter to editor and it does not require an abstract.

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