Bel ve bacak aðrýsý epidural boþlukta oluþan skar dokusu da dahil olmak üzere birçok sebepten kaynaklanabilir. Skar dokusu sýklýkla hassas, ödemli ve inflamasyonlu sinirlere neden olur ve bu da aðrýya neden olabilir. Epidural adezyolizis, skar dokusundan sinirin serbestlenmesi veya dekompresyonu ile skar dokusunun aðrýya neden olan etkilerini ortadan kaldýrýr. Perkütan adhesiyolizis güvenli ve etkili bir prosedür iken, epiduroskopik adezyolizis kronik bel aðrýsý ve radikülopati vakalarýnda tanýsal ve terapötik avantajlar da sunan minimal invaziv bir tekniktir. Bu derlemenin amacý epidural fibrozis’te adezyolizis yöntemi olan perkütan ve endoskopik prosedürlerin endikasyonlar, kontrendikasyonlar, komplikasyonlar, teknik ve etkinlik açýsýndan karþýlaþtýrýlmasýný tanýmlamaktýr.

Low back and leg pain may be due to many causes including scarring in the epidural space. Scar tissue often causes irritated swollen and inflamed nerves, which can cause pain. Adhesiolysis eliminate the pain-causing effects of scar tissue by releasing or decompression of a nerve from scar tissue. Percutaneous adhesiolysis is a safe and effective procedure, while epiduroscopy is a minimally invasive technique that offers diagnostic and therapeutic advantages in cases of chronic low back pain and radiculopathy. The aim of this review is to describe the comparison of percutaneous and endoscopic procedures in the lysis of adhesions in epidural fibrosis in terms of indications, contraindications, complications, technique and efficacy..

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Giriþ: Lenfatik damarlarýn kasýlma fonksiyonunun sempatik regülasyonu, günümüzde hayvan çalýþmalarýnda metastaz mekanizmasý açýsýndan çok dikkat çekmektedir. Bu çalýþmanýn amacý, mesane tümör cerrahisi geçiren hastalarda spinal veya genel anestezinin malign lenf nodlarýndaki akým üzerine etkisini doppler ultrason ile deðerlendirmektir.
Yöntemler: Bu prospektif, gözlemsel, pilot çalýþma, Temmuz 2018'den Aðustos 2019'a kadar spinal veya genel anestezi altýnda elektif mesane tümör cerrahisi planlanan hastalarda (ASA II ve III, 45-85 yaþlarýnda) yapýldý. Hastalar iki gruba ayrýlarak, spinal ve genel anestezi. uygulamasýndan önce ve sonra Doppler ultrason ile inguinal lenf nodlarýnda rezistivite indeksi, pulsatilite indeksi, pik sistolik hýz ve end diyastolik hýz ölçümleri kaydedildi.
Bulgular: Malign lenf nodlarýnda pulsatilite indeks deðeri spinal anestezi (n = 12) ile ameliyat öncesi döneme (p = 0.002) göre azaldý, ancak genel anestezi grubunda (n = 11) arttý (p = 0.003). Ýki grup arasýnda postoperatif pulsatilite indeksinde anlamlý bir fark vardý (p = 0.0001) (cut off 5.49, duyarlýlýk% 81.82, özgüllük% 91.67). Postoperatif pik sistolik hýz deðerleri sadece genel anestezi grubunda preoperatif deðerlerden anlamlý derecede yüksekti (p = 0.021).
Sonuç: Çalýþmamýzda doppler ultrasonografi ile deðerlendirilen metastatik lenf nodlarýndaki lenfatik akým spinal anestezi uygulamasýnda genel anesteziye göre azalmaktadýr. Her ne kadar bu mekanizma kanser cerrahisi sýrasýnda lenfatik metastazýn azaltýlmasýnda yeni olsa da, bu konuda uzun süreli nüks ve saðkalýmý deðerlendiren prospektif randomize çalýþmalar gereklidir.

Introduction: The sympathetic regulation of contractile function of lymphatic vessels has received much attention in terms of metastasis mechanism nowadays in animal studies. The aim of the study to evaluate the effect of spinal or general anesthesia on flow in malignant lymph nodes in patients undergoing bladder tumor surgery with doppler ultrasound.
Methods: This prospective, observational, pilot study was performed on the patients (ASA II and III, aged 45–85) who scheduled for elective bladder tumor surgery under spinal or general anesthesia from July 2018 to August 2019. Patients were divided into two groups, spinal anesthesia and general anesthesia. Resistivity index, pulsatility index, peak systolic velocity and end diastolic velocity measurements were recorded preoperatively and postoperatively n the inguinal lymph nodes by doppler ultrasound.
Results: In the malignant lymph nodes, the pulsatility index value decreased with the spinal anesthesia (n=12) compared to the preoperative period (p = 0.002) but increased in the general anesthesia group (n=11) (p = 0.003). There was a significant difference in postoperative pulsatility index between the two groups (p = 0.0001) (cut off => 5.49, sensitivity 81.82%, specificity 91.67%). Postoperative peak systolic velocity values were significantly higher than preoperative values only in general anesthesia group (p = 0.021).
Conclusions: Lymphatic flow in metastatic lymph nodes decreased by spinal anesthesia compared to general anesthesia evaluated by using doppler ultrasound in our study. Although this new mechanism is new in the reduction of lymphatic metastasis during cancer surgery, prospective randomized studies evaluating long-term recurrence and survival are warranted.

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Amaç: Bu çalýþman amacý kardiyak hastalarda ýsý ve soðuk terapi uygulamasýnýn nitrogliserine baðlý migren tipi baþ aðrýsý þiddeti üzerine etkilerini karþýlaþtýrmaktý.
Gereç ve Yöntem: Bu randomize kontrollü çalýþma, ön test ve son test olarak üç grup tasarýmýnda (ýsý veya soðuk terapi ve kontrol grubu) toplam 75 kardiyak hasta üzerinde gerçekleþtirilmiþtir. Müdahale grubundaki hastalar 25 dakika boyunca, iki kez (1 saatlik aralýklarla) ýsý veya soðuk terapi aldý, kontrol grubundaki hastalar herhangi bir terapi almadý. Baþ aðrýsý þiddeti, aðrý için sayýsal derecelendirme ölçeði (NRS Aðrý) ile, üç çalýþma grubunda 3 kez (çalýþmadan hemen önce, ilk terapinin uygulanmasýnýn sonunda ve ikinci terapinin uygulanmasýnýn sonunda) ölçülmüþtür.
Bulgular: Çalýþmadan hemen önce üç grup arasýnda ortalama aðrý skalasý skoru (P = 0.781) için bazal fark yoktu; ancak ýsý ve soðuk terapi uygulandýktan sonra üç grup arasýndaki fark istatistiksel olarak anlamlý idi (p = 0.000).
Sonuç: Bu çalýþma, ýsý ve soðuk terapi uygulanmasýnýn kardiyak hastalarda nitrata baðlý migren tipi baþ aðrýsýnýn þiddetini azaltabildiðini göstermiþtir. Hastalarýn yaklaþýk% 10'unun dayanýlmaz baþ aðrýsýndan dolayý nitrat tedavilerine tahammül edemediði gerçeði göz önüne alarak, nitrata baðlý migren tipi baþ aðrýsý olan hastalarda ýsý veya soðuk terapi uygulamasý, hastanýn tedaviye uyumunu artýrmak için önerilmektedir.

Objective: This study aimed to compare the effect of heat and cold therapy on the intensity of nitroglycerine induced migraine type headache in cardiac inpatients.
Methods: This randomized controlled trial was conducted on a total of 75 cardiac inpatients in three groups design (heat or cold therapy,and control group) as pre-test and post-test. Patients in the intervention group received heat or cold therapy for25 minutes, two times (at 1-hour interval), Patients in the control group did not receive any heat or cold therapy. Headache intensity was measured by the numeric rating scale for pain (NRS Pain), in three groups of study for 3 times (just before the study, at the end of applying the first therapy, and at the end of applying the second therapy).
Results: No baseline differences existed among the three groups for the mean pain scale score (P=0.781) just before the study; but the difference between three groups after applying heat and cold therapy was statistically significant (p=0.000).
Conclusion: This study demonstrated applying heat and cold therapy may reduce the intensity of nitrate induced migraine type headache in cardiac inpatients. Considering this fact that approximately 10% of patients cannot tolerate nitrate therapies due to unbearable headache, applying heat or cold therapy in patients with nitrate induced migraine type headache is recommended to improve patient’s adherence to treatment.

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Objective – To evaluate if a current smoking status and a higher nicotine dependence were associated with chronic low back pain and/or radicular neuropathic pain.

Materials and methods- A cross-sectional study was conducted on the first eligible consecutive 120 patients. Demographic data, pain intensity, worst pain location, most distal pain radiation, the DN4 questionnaire, STarT back tool, and the Fagerström Test were collected during the initial examination. An age- and gender-matched control group (n=50), free from chronic low back pain was recruited.

Results- In the chronic pain group, there was a significant difference between smokers and lifetime non-smokers in the average pain intensity (p=0.037), total DN4 score (p=0.002), STarT Back tool (p=0.006), worst pain location (p=0.023) and the most distal pain radiation (p=0.049). The mean total DN4 score increased with a corresponding increase in the number of cigarettes smoked daily (p=0.002). Current smokers had an OR of 3.071 (p=0.013) (95% CI 1.268-7.438) for developing chronic low back pain and lumbar related leg pain and an OR of 6.484 (p<0.001) (95% CI 2.323-18.099) for developing chronic radicular neuropathic leg pain. For every one-unit increase in the Fagerström test score, the likelihood for chronic low back pain and lumbar related leg pain increased by 40.71% (p=0.008) (95% CI 1.095-1.809) and for chronic radicular neuropathic leg pain increased by 71.3% (p<0.001) (95% CI 1.292-2.272).

Conclusion- A current smoking status and a higher nicotine dependence were both independently associated with an increased risk for chronic low back pain and/or chronic radicular neuropathic pain.

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Amaç: Sirkadiyen ritim günlük yaþamýmýzda etkisi altýnda kaldýðýmýz baþlýca ritimlerden en önemlisidir ve anestezide kullandýðýmýz birçok ilacýn etkinliðinde önemli rol oynamaktadýr Bu çalýþmanýn amacý spinal anestezi altýnda opere olan hastalarý retrospektif olarak inceleyerek sirkadiyen ritmin spinal anestezi uygulanan hastalarda postoperatif analjezi gereksinimi üzerine olan etkisini ortaya koymaktýr.
Gereç ve Yöntem: Çalýþmamýz spinal anestezi altýnda genel cerrahi ameliyathanesinde ingüinal herni ve anorektal cerrahi operasyonu geçiren hastalarda gerçekleþtirildi. Hastalar cerrahiye alýndýklarý saate göre iki gruba ayrýldý: Saat 06.00- 12.00 (Grup 1) ve 12.00-18.00 (Grup 2). Postoperatif ilk analjezik gereksinim süreleri, ilk yürüme zamanlarý, ilk idrar yapma zamanlarý, intraoperatif hemodinamik veriler, intraoperatif ve postoperatif yan etkiler ve hasta memnuniyetleri belirlenerek kaydedildi.
Bulgular: Postoperatif ilk analjezik ihtiyacý zamaný Grup 1’ de Grup 2’ ye göre daha uzun saptanmýþ olup, bu fark istatistiksel olarak anlamlý bulundu. Gruplara ait kalp atým hýzý ortalamalarý, zaman içerisindeki deðiþimleri açýsýndan karþýlaþtýrýldýðýnda 25. ve 30. dk ölçümlerinde Grup 2’ de Grup 1’e göre anlamlý olarak düþük bulundu. Yan etkilere bakýldýðýnda gruplar arasý istatistiksel olarak anlamlý bir fark olmadýðý, iki grupta da en sýk görülen yan etkinin bulantý-kusma olduðu tespit edildi.
Sonuç: Spinal anestezi sonrasý ilk analjezi gereksinim zamanýnýn Grup 1‘ de Grup 2‘ ye göre anlamlý derecede uzun olduðunu saptadýk.

Objective: The circadian rhythm is the most important of the main rhythms that affect our daily lives and has a significant role in the efficiency of a lot of drugs used in anesthesia. The aim of this study is to prove whether circadian rythm has an effect on spinal anesthesia and, if any, its effect on postoperative analgesic request by retrospectively studying the patients operated under spinal anesthesia.
Methods: We conducted the study on patients operated on inguinal hernia and anorectal surgery under spinal anesthesia in general surgery room. The patients were divided into two groups according to the time when they were taken into surgery: between 06.00-12.00 (Group 1) and 12.00- 18.00 (Group 2). Time to first analgesic request, time to start walking, time to first urination, intraoperative and postoperative side effects, intraoperative hemodynamic data, and patient satisfaction were detected and recorded.
Results: The time to first analgesic request in Group 1 was longer than in Group 2, and this difference was statistically significant. The mean heart rate of the groups was found significantly lower in Group 2 than in Group 1 during measurements at the 25. and 30. minute when compared with their changes over time. There were no statistically significant differences between the groups in terms of side effects and the most common side effect was detected to be nausea - vomiting.
Conclusions: We found out that the time to first analgesic request after spinal anesthesia was significantly longer in Group 1 than in Group 2.

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Amaç: Son zamanlarda, lomber ve servikal disk hernisi (SDH) tedavisinde plazma disk koagülasyon tedavisi (PDCT) kullanýlmýþtýr, ancak PDCT' nin uzun dönem etkileri tam olarak belgelenmemiþtir. Bu çalýþmanýn amacý, servikal disk hernili hastalarda PDCT' nin aðrý skoru, disk hacmi ve hasta memnuniyeti üzerindeki uzun dönem etkilerini deðerlendirmektir.
Gereç ve Yöntem: PDCT tedavisi uygulanan 80 SDH hastasý çalýþmaya alýndý. Hastalarýn demografik özellikleri ve aðrý skorlarý (görsel analog skala-VAS) baþlangýçta ve PDCT tedavisinden sonraki 1., 3., 6. ve 12. aylarda kaydedildi. PDCT'den sonraki 12. ayda hasta memnuniyeti ve disk hacmi deðerlendirildi.
Bulgular: VAS skorunda zaman baðýmlý ve istatistiksel olarak anlamlý azalma saptandý. Baþlangýçtaki VAS skoru 6.5 ± 0.9 iken, son takipte 3.4 ± 0.2 olarak tespit edildi (p <0.01). Manyetik rezonans görüntüleme patolojisine göre, PDCT sonrasý VAS skoru ekstrüde diski olan hastalarda, bulging ve protrüzyon olan hastalara göre daha yüksekti (p <0.05). Tedaviden 12 ay sonra Odom kriterlerine göre hastalarýn % 50'si mükemmel olduðunu bildirirken, % 8,7’si kötü olduðunu rapor etti. PDCT tedavisinden sonra Odom kriterlerine göre mükemmel olduðunu bildiren hastalarda disk hacminin azaldýðý tespit edildi. (p <0.01).
Sonuç: Bu çalýþma PDCT'nin seçilmiþ SDH’li hastalar için güvenli, etkili ve minimal invaziv bir tedavi tekniði olduðunu göstermiþtir.

Objectives: Recently, plasma disc coagulation therapy (PDCT) has been used in the treatment of lumbar and cervical disc hernia (CDH), but the long-term effects of PDCT have not been well documented. The aim of this study was to assess the long-term effects of PDCT on pain score, disc volume and patient satisfaction in patients with CDH.
Methods: Eighty patients with CDH, who underwent PDCT treatment, were included in the study. The patients demographics and pain scores (visual analog scale-VAS) were recorded on the baseline and in the 1st, 3rd, 6th and 12th month after PDCT treatment. We evaluated patient satisfaction and disc volume on the 12th month after PDCT.
Results: A statistically significant and time-dependent decrease was determined in VAS score. The initial mean VAS score was 6.5 ± 0.9, and it decreased to 3.4 ± 0.2 on the final follow-up (p<0.01). According to magnetic resonance imaging pathology, VAS score after PDCT was higher in patients with an extruded disc when compared to patients with bulging and protruded discs at all times (p<0.05). After 12 months, 50 % of the patients were reported as excellent and 8.7 % of the patients reported as poor based on the Odoms’ criteria. Disc volume decreased after PDCT treatment in the patients who reported that they were excellent based on the Odoms’ criteria (p<0.01).
Conclusions: This study demonstrated that PDCT is a safe, effective and minimally invasive treatment technique for adequately selected patients with CDH.

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Amaç: Bu çalýþmada amacýmýz protez kullanan, alt ekstremite amputasyonu olan hastalarda fantom aðrýsý (PLP), fantom hissi (PLS) ve güdük aðrýsý (RLP)’nýn deðerlendirilmesi; bu aðrýlarýn protez kullanýmý, lokomotor beceriler ve vücut imajý ile iliþkisinin incelenmesidir.
Gereç ve Yöntem: Çalýþmamýza ampute polikliniðimize baþvuran alt ekstremite amputasyonu olan, en az 3 aydýr ampute alt ekstremite için protez kullanan 57 hasta dahil edildi. Fantom aðrýsý, fantom hissi ve güdük aðrýsý Protez Deðerlendirme Anketi (PEQ) ile ölçüldü. Protez kullanýmý Houghton Skalasý ile, lokomotor becerileri Lokomotor Kapasite Ýndeksi (LCI) ile, vücut imajý Ampute Vücut Ýmaj Skalasý (ABIS) ile, yaþam kalitesi Kýsa Form Saðlýk Anketi (SF-36) ile deðerlendirildi.
Bulgular: PEQ’ya göre hastalarýn %43.9'unda fantom aðrýsý, %63.2'sinde fantom hissi ve %40.4'ünde güdük aðrýsý tespit edilmiþtir. Korelasyon analizleri fantom aðrýsý sýklýðý ve süresi arttýkça hastalarýn temel ve ileri lokomotor becerileri ile yaþam kalitesinin düþtüðünü ortaya koymuþtur. Fantom aðrýsý' nýn yoðunluðu ve neden olduðu stres derecesi arttýðýnda, hastalarýn yaþam kalitesinin düþtüðü; fantom hissi sýklýðý arttýðýnda, hastalarýn emosyonel durumunun kötüleþtiði tespit edilmiþtir. Fantom hissi' nin yoðunluðu ve rahatsýzlýk derecesi arttýðýnda, hastalarýn vücut imajý, emosyonel durumu ve sosyal durumu kötüleþmiþtir. Güdük aðrýsýnýn oraný, sýklýðý, þiddeti veya süresi ile Houghton ölçeði, LCI, ABIS veya SF-36 skorlarý arasýnda korelasyon bulunmamýþtýr.
Sonuçlar: Fantom aðrýsý ve fantom hissi, protez kullaným sýklýðýný azaltmasýnýn yaný sýra ampute hastalarýn vücut imajýný ve yaþam kalitesini de olumsuz etkiler.

Objective: The aim of this study was to investigate phantom limb pain (PLP), phantom limb sensation (PLS), and residual limb pain (RLP) after lower-extremity amputation and their effect on patients’ effective prosthesis use, body image, and quality of life in prosthetic users.
Methods: Fifty-seven patients with lower-extremity amputation who used prosthesis for at least three months were included in our study. PLP, PLS, and RLP were evaluated via the prosthesis evaluation questionnaire (PEQ). Prosthetic use, locomotor skills, body image, quality of life were measured by administering Houghton scale, locomotor capabilities index (LCI), amputee body image scale (ABIS), and short-form health survey (SF-36), respectively.
Results: On the PEQ, 43.9% of the patients reported PLP, while 63.2% reported PLS, and 40.4% reported RLP. Correlation analyses revealed that as the frequency and duration of PLP increased, the patients’ basic and advanced locomotor skills and quality of life decreased. When the intensity of PLP and the degree of distress caused by it increased, the patients’ quality of life decreased, and when the frequency of PLS increased, the patients’ emotional state worsened. When the intensity of PLS and the degree of bother caused by it increased, the patients’ body image, emotional state, and social status worsened. There was no correlation between the rate, frequency, severity, or duration of RLP and scores on Houghton scale, LCI, ABIS, or SF-36.
Conclusions: The presence of PLP and PLS decreases the use of prostheses and impairs body image and quality of life in prosthetic users.

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IHS 2013-beta versiyonunda hipoksi veya hiperkapniye baðlý baþ aðrýlarý 10.1.1 yüksek irtifa baþ aðrýsý, 10.1.2 uçak seyahatine baðlý baþ aðrýsý, 10.1.3 dalma baþ aðrýsý, 10.1.4 uyku apnesi baþ aðrýsý þeklinde alt gruplara ayrýlmaktadýr. Uçak seyahati esnasýnda ortaya çýkan baþ aðrýlarý sýk karþýlaþmadýðýmýz baþ aðrýlarýndandýr. Literatürde ilk vaka 2004 yýlýnda bildirilmiþtir. Uçak seyahatine baðlý baþ aðrýsý patofizyolojisi henüz tam anlaþýlamamýþtýr. Uçak seyahati ve yükseklik baþ aðrýlarýnýn birlikte ayný olguda görülmesi, kranial MR’ da geniþ Virchow-Robin aralýklarýnýn izlenmesi, önleyici atak tedavisi ile bu baþ aðrýlarýnýn gelmemesi yönüyle hastamýzý sunmayý uygun bulduk.

According to International Classification of Headache Disorders (ICHD-III Beta version) headache attributed to hypoxia and/or hypercapnia is classified under the 4 title: 10.1.1 High altitude headache, 10.1.2 Airplane travel associated headache, 10.1.3 Diving headache and 10.1.4 Sleep apnoea headache. Headache associated with airplane travel is encountered infrequently in our clinical practice and firstly reported in 2004 as a case in the literature. The pathophysiology of headache associated with airplane travel is not yet clear. We presented this case in the aspect of the patient having both airplane travel and high altitude headaches and seen giant Virchow-Robin spaces in cranial MRI and disappearence of pain with a preventive treatment.

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Ankilozan spondilit, havayolu ve aksiyel iskelet tutulumu nedeniyle anestezistler açýsýndan zorlu bir hastalýktýr. Ciddi ankilozan spondilit yakýnmasý olan 55 yaþýndaki bir erkek hasta Anesteziyoloji kliniðine baþvurdu. Orta hat açýk ventral herni onarýmý planlanmýþtý. Ameliyatýn tam anestezisi için 4 mcg kg-1 saat-1dexmedetomidine sedasyonu ile birlikte T8 seviyesinden bilateral ultrason rehberlikli erektor spina alan (ESP) bloðu yapmaya karar verdik. ESP bloðunu 25 ml %0.25 bupivakain ile yaptýk ve ayný iþlemi karþý tarafta tekrar ettik. Yirmibeþ dakika sonra cilt insizyonu baþladý. Operasyon boyunca ek bir anestezik veya analjezik ajan uygulamaya gerek duymadýk. ESP bloðu, enjeksiyon seviyesine göre spinal sinirlerde ventral rami ve komünikan ramiyi etkileyerek, farklý dermatomlarda analjezi saðlar. T7-T9 seviyeleri arasýndan uygulandýðýnda, farklý tipte ameliyatlardan sonra etkili þekilde postoperatif aðrýyý azalttýðý bildirilmiþtir.

Ankylosing spondylitis is a challenging disease for anesthesiologist due its airway and axial skeleton involvement. A 55 years old male patient suffering from severe ankylosing spondylitis, admitted to Anesthesiology Clinic. He was planned to receive a midline open ventral hernia repair. We decided to perform bilateral ultrasound-guided erector spinae plane (ESP) block at the level of T8 with 0.4 mcg kg-1 hour-1 dexmedetomidine sedation for complete anesthesia of the surgery. We performed ESP block with 25 mL of 0.25% bupivacaine and repeated the same procedure at the contralateral side. Twenty minutes later, the skin incision was started. We didn’t need to apply an additive anesthetic or analgesic drug throughout the surgery. ESP block provides analgesia for different dermatomes by effecting ventral rami and rami communicantes of spinal nerves depending on the level of injection site. When performed between T7-T9 levels, it has been reported to effectively attenuate postoperative pain after different types of surgeries.

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Senkopal konvülziyonlarýn ve epileptik nöbetlerin klinik olarak ayýrtedilmesi zordur ve tedavi yaklaþýmlarý farklýlýk gösterir. Antiepileptik tedaviye dirençli konvülziyonlarýn ayýrýcý tanýsýnda serebral perfüzyonu bozan kardiyak aritmileri düþünmek önemlidir. Bu yazýda, yutkunma ile iliþkili tekrarlayan senkopal konvülsiyon ataklarý olan 72 yaþýndaki glossofarengeal nevraljili erkek hasta sunuldu. Hasta geçici kalp pili ve karbamazepin ile baþarýlý bir þekilde tedavi edildi. Bu olgu, epileptik nöbetlerin ayýrýcý tanýsýnda nadir görülen glossopharengial nevralji ve buna baðlý asistolinin tetiklediði senkopal konvülziyonlara dikkat çekmektedir.

Syncopal convulsions and epileptic seizures are clinically hard to distinguish and differ in terms of treatment approaches. It is important to consider the cardiac arrhythmias that impair cerebral perfusion in the differential diagnosis of antiepileptic treatment-resistant convulsions. Here we offer a 72 year old male patient glossopharengial neuralgia after swallowing associated with recurrent episodes of syncopal convulsions. The patient was successfully treated with temporary pacemaker and carbamazepine. This phenomenon is noteworthy in terms of both asystole triggered by glossopharengial neuralgia and syncopal convulsions which are rare in the differential diagnosis of epileptic seizures.

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Kemiðe implante iþitme cihazlarýnýn komplikasyonlarý nadirdir. En sýk görülen postoperatif komplikasyon titanyum implant etrafýndaki yumuþak doku reaksiyonlarýdýr. Kronik baþ aðrýsý ise nadir görülen bir komplikasyondur.
Biz bu makalede, kemiðe implante iþitme cihazý uyguladýðýmýz, ancak hastanýn lokal ve sistemik tedavilere raðmen çözemediðimiz kronik baþ aðrýsý, yanma hissi nedeniyle postoperatif birinci yýlýnda cihazýný çýkarmak zorunda kaldýðýmýz hastamýzý sunduk. Baþarýsýzlýk nedenlerini literatür eþliðinde tartýþtýk.

The complications of bone anchored hearing aids are very rare. The most seen postoperative complication is soft tissue reaction locally occuring around the titanium implant. Chronic headache is a rarely seen complication related to bone anchored hearing aids application.
We presented a patient having complaints of chronic headache and burning sensation after bone anchored hearing aids application. Follow up for one year after the operation, despite the local and systemic therapies, there was no improvement of symptoms
and the device was compulsorily removed. This rare complication of bone anchored hearing aids application is reviewied in the literature and probable reasons of failure are discussed

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Aðrý COVID-19 hastalarýnda sýk görülen fakat genellikle göz ardý edilen bir semptomdur. Bu hastalarda ayrýntýlý þekilde aðrýnýn deðerlendirmesi, erken ve yeterli tedavi uygulanmasý, aðrýnýn kronikleþmesi ve duygudurum düzensizliði geliþme riskini azaltabilir. Analjezi saðlamak için, bu hastalarda ilk seçenek olarak parasetamol önerilebilir, sonrasýnda böbrek yetmezliði veya mide kanamasý gibi mutlak bir kontrendikasyon yoksa COVID-19 hastalarýnda aðrý yönetimi için NSAID'ler de güvenilir bir þekilde kullanýlabilir. Kodein de, basit aðrý kesicilere cevap vermeyen ve anksiyetesi olan hastalarda iyi bir alternatiftir.

Pain is a common but often ignored symptom in COVID-19 patients. Early and adequate treatment with detailed pain assessment in these patients may reduce the risk of pain chronicization, and mood dysregulation. To provide analgesia, paracetamol can be listed as the first option in these patients, and then NSAIDs can also be reliably used for pain management in patients with COVID-19 if there are no absolute contraindications such as kidney failure or gastric bleeding. Codeine is also a good alternative for patients with anxiety who do not respond to simple pain-relievers.

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