Hypotension Induced by Lateral Decubitus or Supine Spinal Anaesthesia in Elderly With Low Ejection Fraction Undergone Hip Surgery

Summary Objective The aim of the study was to assess the effect of low ejection fraction (EF) on hypotension during lateral or supine position of spinal anaesthesia in patients older than 75 years old. Methods We analyzed 41 patients who had undergone hip surgery between August 2000 and October 2001 in the Aydin SSK State Hospital retrospectively. Patients older than 75 years of age and an EF less than 50% were selected and spinal anaesthesia was performed with hyperbaric bupivacaine 0.5%, lateral decubitus or supine position. The patients were divided into two groups: Group I (unilateral group, n = 23) and Group II (supine group, n = 18). History of hypertension, diabetes mellitus, and ASA status, preoperative value of EF and cardiac index, and intraoperative hypotension, bradycardia, ephedrine use, and maximal sensorial block levels were recorded. Results The age range of patients was between 75 and 103. The maximal sensorial block level was evaluated due to lower or higher than thoracic sixth segment for each patient in intraoperative period. The sensorial block level higher than thoracic sixth segment were determined 2 patient in Group I and 14 patients in Group II (p = 0.001). Hypotension was observed in five patients in Group I and 10 patients in Group II (p = 0.015). In Group I, the number of ephedrine used patient was lower than Group II (p = 0.015). Conclusions Elderly patients with low EF were more likely to predispose to higher sensorial block level and hypotension was more common during spinal anaesthesia with supine position compared to lateral decubitus position. Sen S, Aydin K, Discigil G. Hypotension induced by lateral decubitus or supine spinal anaesthesia in elderly with low ejection fraction undergone hip surgery.     

Transplantation for severe combined immunodeficiency with HLA-A,B,D,DR incompatible parental marrow cells fractionated by soybean agglutinin and sheep red blood cells

Three patients with severe combined immunodeficiency (SCID) received transplants of HLA haplotype-mismatched parental bone marrow depleted of T lymphocytes by differential agglutination with soybean agglutinin (SBA) and subsequent E-rosette depletion. Two patients achieved durable engraftment with reconstitution of both humoral and cell-mediated immunity. Neither of these patients developed graft versus host disease (GVHD). The third patient achieved only a transient engraftment with concomitant development of mitogen-responsive lymphocytes of paternal origin. Our experience indicates that depletion of T lymphocytes by this technique can abrogate the potential of histoincompatible marrow grafts to induce lethal GVHD without limiting immunologic reconstitution. It also provides further evidence of nonimmune mechanisms of graft resistance that may necessitate preparative treatment of patients with SCID before transplantation with HLA- mismatched marrow cells.     

Surgical treatment of chronic subdural haematoma under monitored anaesthesia care

QUESTIONS UNDER STUDY: General and local uses of anaesthesia are the preferred common methods in the surgical treatment of chronic subdural haematoma (CSDH). The literature provides no information regarding monitored anaesthesia care during surgery of CSDH. In this report we evaluate the clinical results of surgical treatment for CSDH under monitored anaesthesia care. METHOD: Between 2001 and 2006 twenty consecutive patients with 24 CSDHs were surgically treated under monitored anaesthesia care at one institution. The clinical success of the procedure under monitored anaesthesia care, patient satisfaction, length of hospitalisation, anaesthesia-related complications and neurological outcome were analysed. RESULTS: Mean age was 60.9 years, with 15 patients aged over 60. ASA physical condition score was IV in 11 patients, III in 1, II in 4 and I in 4. In all patients CSDH was successfully drained by burr hole craniotomy under monitored anaesthesia care. There was no anaesthesia-related morbidity or mortality. Mean hospital stay was 4.5 days. CONCLUSION: Preliminary results indicate that surgery for CSDH under monitored anaesthesia care is safe and effective. Conscious sedation using monitored anaesthesia care, that is a middle ground between general anaesthesia and local anaesthesia, may facilitate patient comfort and surgical competence during surgery for CSDH.     

Primary cerebral intraventricular hydatid cyst: a case report and review of the literature

Intracranial hydatid cysts, which are common in certain areas worldwide, almost always develop at an intraparenchymal site. However, the literature on intraventricular hydatid cysts consists of only 6 independent case reports and about 30 cases that are described in large series. We report on a 10-year-old girl who was admitted with an intracranial cyst. She complained of headache of 10 months' duration that had intensified significantly over the 3 weeks immediately before her admission. The results of a neurologic examination showed bilateral papilledema and slight left hemiparesis. Magnetic resonance imaging revealed a right temporo-parieto-occipital cystic lesion that was causing the shifting of the midline structures to the contralateral side. The giant cyst was successfully removed without rupture. The possibility of infection with Echinococcus granulosus should be included in the differential diagnosis of unspecific neurologic symptoms such as a progressively worsening headache, especially in pediatric patients from the geographic areas in which that parasite is endemic.     

Age and Duration of Disease as Factors Affecting Clinical Findings and Sacroiliitis in Brucellosis

Abstract Objective: Brucellosis may be seen in any age group, but it still involves young and middle aged adults more frequently. Our aim was to investigate the relationship between age and the duration of disease on clinical findings of brucellosis in adults in this study. Patients and Method: One hundred and sixty-three patients with brucellosis, treated in our hospital, between 1997 and 2003, were evaluated retrospectively. Results: Fever was found in 60.7% of the patients, and it was significantly higher when the duration of disease was less than one month (p = 0.03). Fever was significantly lower in the ≥ 65 age group (p = 0.01). Sacroiliitis was detected in 44.1% of patients. Sacroiliitis was significantly higher in the 15–35 age group (p = 0.03). There were no differences between age groups and other clinical and laboratory findings. Conclusions: Sacroiliac involvement was noted particularly in young adults who manifested lumbar pain and fever, but this might not be a major symptom of brucellosis in the elderly, or in patients showing symptoms for more than a month.