OBJECTIVE: The effects of preoperative history, physical examination, chest X-ray, arterial blood gas (ABG) analysis, and pulmonary function test (PFT) in determining the risk of postoperative pulmonary complications (PPC) of elective abdominal and extremity surgery were investigated. PFT and ABG changes in the postoperative period, effect of anesthesia type and operation site with respect to PPC were also evaluated.
METHODS: Sixty (30 abdominal, 30 extremity) cases were prospectively analyzed. Preoperative and postoperative clinical, radiological and laboratory data in both groups were analyzed regarding PPC. Chi-square, Mann-Whitney U and Wilcoxon tests were used in the statistical analysis.
RESULTS: The mean age of 36 (60%) male and 24 (40%) female patients was 42.62±16.61. Abdominal surgery, body mass index (BMI) >27, smoking >20 pack-years, comorbidity, respiratory symptoms, chest X-ray abnormalities, ASA>1, advanced age, decreased maximal voluntary ventilation (MVV), and increased residual volume/total lung capacity (RV/TLC) were associated with increased PPC risk. Eight (26.7%) patients in the abdominal group had PPC compared to only 1 (3.3%) patient in the extremity group. After abdominal surgery, FVC, FEV1, FEF25-75, PEF, RV, diffusion lung capacity for carbon monoxide (DLCO), and PEmax, PaO2, SaO2 showed significant postoperative decrease, whereas only DLCO decreased following extremity surgery.
CONCLUSION: Following abdominal surgery, PPC risk is significantly increased. In order to determine PPC risk, ASA classification, BMI, respiratory symptoms, smoking habit, and chest X-ray are sufficient, and there is no need for more sophisticated tests such as PFT and ABG. Whenever needed, MVV and RV/TLC values may help in the risk determination.

OBJECTIVE: We aimed to investigate dorsal lumbotomy incision with respect to the duration of the operation, postoperative pain, analgesic requirement, and wound complications, and results were compared with respect to flank incision.
METHODS: Dorsal lumbotomy incision was performed in 22 patients who underwent operation with different indications between 2005 and 2008, and patient files were scanned retrospectively. Operation indication, operation duration, the postoperative first 24-hour analgesic medication requirement, and hospitalization time were examined. Fifty patients who underwent flank incision in the same period taking into account the same criteria were retrospectively reviewed and compared with the dorsal lumbotomy patient group.
RESULTS: Lumbotomy incision was applied in 22 patients (13 male, 9 female). The mean age of patients was 34 years (range: 3-70 years). Indications for dorsal lumbotomy were ureteropelvic junction obstruction in 8 patients; renal pelvis calculi in 11 patients, lower pole renal calculi in 2 patients, and proximal ureteral calculi in 1 patient. Indications for flank incision were simple nephrectomy, ureteropelvic junction obstruction, and proximal ureteralcalculi. When operation times were evaluated, operation time with dorsal lumbotomy incision was 30 minutes shorter for proximal ureteral calculi and 25 minutes shorter for pyeloplasty operations. The postoperative first 24-hour analgesic medication need of patients operated via dorsal lumbotomy incision was distinctly less. No surgical lesion complication was observed in any of the patients.
CONCLUSION: Although minimally invasive approaches (PCNL, ESWL, URS) are performed today in upper urinary tract surgeries when open surgery is needed, we think dorsal lumbotomy incision will be the first choice.

OBJECTIVE: We compared the results of tonsillectomy performed by classical dissection and bipolar cautery dissection in pediatric patients.
METHODS: A total of 185 pediatric patients were randomly assigned to two tonsillectomy groups.
Ninety-five patients (52 boys, 43 girls; mean age 8±4 years) underwent bipolar cautery tonsillectomy, and 90 patients (47 boys, 43 girls; mean age 8±4 years) underwent classical dissection tonsillectomy. Patients were compared with respect to bleeding during tonsillectomy, operation time, primary and secondary bleeding, and severity of pain at the second hour and on the tenth day.
RESULTS: With bipolar cautery tonsillectomy, the mean operation time, amount of perioperative bleeding and pain score at the second hour were significantly lower (p<0.001). However, the mean pain score on the tenth day was significantly higher with cautery tonsillectomy,
which significantly prolonged initiation of solid food intake (p<0.001). In the late postoperative period, three patients in each group required intervention under general anesthesia to control bleeding.
CONCLUSION: Bipolar dissection tonsillectomy is a safe technique. It significantly reduces the operative time and intraoperative blood loss. Merits and demerits of both techniques should be taken into consideration for appropriate patient selection for the two tonsillectomy methods.

OBJECTIVE: The aim of this study was to evaluate the transport condition of pediatric patients who were admitted to the pediatric emergency unit of a medical faculty hospital.
METHODS: The present study included 166 children (76 [45.7%] female, 90 [54.3%] male) who were referred to the pediatric emergency unit of a medical faculty hospital from different
state hospitals between September 2004 and November 2004. The exclusion criteria were traumatic patients and newborns. Twenty-six patients (15.6%) had no medical insurance.
RESULTS: One hundred forty-one (84.9%) of 166 patients were transported to our emergency unit based on the decision of specialists. It could not be determined who gave the transport decision in six (3.6%) patients. Referral information about 130 (59%) patients was inadequate for transportation. Seventy-two (43%) patients were transported by ambulance; of these, only 10 (6%) ambulances were fully equipped. Accompanying persons during transportation included 5 (3%) doctors and 14 (8.4%) nurses. The others persons were inexperienced or uneducated. One hundred fifty-two (91.5%) of the patients were treated by hospitalization. Twenty-nine (17%) patients were in severe distress when they were admitted to the emergency department.
CONCLUSION: It was concluded that current patient transportation procedures are unorganized and insufficient, and detailed arrangements should be carried out during this period.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzyme deficiency, causes a spectrum of disease including neonatal hyperbilirubinemia, acute hemolysis or chronic hemolysis. In red cells, defense against oxidative damage is essentially dependent on G6PD enzyme activity. This enzyme catalyzes the first step in the pentose phosphate pathway, leading to antioxidants that protect cells against oxidative damage. A G6PD-deficient patient, therefore, lacks the ability to protect red blood cells against oxidative stresses from certain drugs, metabolic conditions and infections. This report presents a case of general anesthesia management in a patient with G6PD deficiency. A 10-month-old male with G6PD deficiency was scheduled for
neurosurgical operation under general anesthesia. The intraoperative and postoperative course was uneventful with respect to hemolytic problems, malignant hyperthermia or methemoglobinemia. We think that general anesthesia can be performed successfully with special attention in patients with G6PD deficiency.

A 76-year-old male patient with decreased vision starting two days before in the right eye was referred to our clinic. He had total hyphema in the right eye and the anterior chamber could not be seen clearly. Hematology and internal medicine consultations with detailed examinations were performed. Hematological and rheumatological examinations revealed no pathology. We examined the patient with anterior chamber angiography, fundus fluorescein angiography and anterior chamber ultrasonographic biomicroscopy, and again no pathology was evident. The patient had uveitis, which was treated with high-dose topical steroid. Uveitis is an ocular pathology that must be kept in mind as the cause of spontaneous hyphema.

Reexpansion pulmonary edema (RPE) is a rarely seen clinical complication and seems due to expansion of the lung. This condition develops due to hemopneumothorax, wide pleural effusion pneumothorax, after lobectomy, and during one-lung ventilation. Our case was a 30-year-old man who presented with chest pain on the right side and dyspnea. Chest roentgenogram revealed a right-sided spontaneous pneumothorax. Tube thoracostomy was performed. A right-sided RPE was seen on the roentgenogram after tube thoracostomy. After two hours, tube thoracostomy RPE developed, and he was then transferred to intensive care. During this period fluid restriction, diuretic and oxygen support therapy were applied. His clinical condition improved with continuous positive airway pressure (CPAP) therapy. With this case, we aimed to present the treatment steps and clinical progress of a patient with RPE.

Brucellosis is a still frequently encountered disease in developing countries. Brucella infection is seen endemically in East and Southeast Turkey. Each year approximately 18.000 new cases are reported in our country. Brucellosis infects multiple systems within the body. Many organs and systems may be involved in brucella infection. Gastrointestinal involvement in brucellosis may rarely result in hepatitis. We present herein an acute hepatitis case due to brucella. A 14-year-old male patient presented with diffuse myalgia, weight loss, fever, vomiting, and fatigue. Physical examination revealed that skin, sclera and mucosal surfaces were all icteric, and the liver was palpable 4-5 cm below the costal margin. Laboratory investigations revealed aspartate aminotransferase (AST) 1310 U/L, alanine aminotransferase (ALT) 682 U/L, gamma glutamyl transpeptidase (GGT) 744 U/L, alkaline phosphatase (ALP) 402 U/L, total bilirubin 4.2 mg/dl, and conjugated bilirubin 1.9 mg/dl. Viral markers for hepatitis A, B and C were all negative. Brucella tube agglutination test was positive (1/320) and hemoculture revealed Brucella spp. Streptomycin and doxycycline treatment was initiated. Clinical response was noted within the 3rd day of treatment, and ALT, AST and total bilirubin levels returned to their normal levels on the 21st day of the treatment. Treatment lasted for 8 weeks. We present this case to underline that brucellosis should be kept in mind in the differential diagnosis of acute hepatitis, especially in regions where brucellosis is endemic.