Arterial cannulation with ultrasound (US) guidance increases the success rate and reduces complications. US-guided vascular access has two main approaches: long axis in-plane (LA-IP) and short axis out-of-plane (SA-OOP) approaches. The purpose of this study was to compare performance time and possible complications between two techniques. After obtaining ethics committee approval and informed patient consent, a prospective and randomized trial was conducted at ASA I-III, patients between the ages of 20-70 years. 108 patients were scheduled for radial arterial cannulaton in patients undergoing elective surgery under general anesthesia. Patients were divided into two groups as LA-IP and SA-OOP approaches with sealed envelope randomized method. After induction of anesthesia, the distance between skin-to-artery and the diameter of radial artery in US-imaging was recorded. The successful cannulation time, the number of attempts, potential complications such as thrombosis, edema, vasospasm, hematoma and posterior wall puncture were recorded. Demographic and hemodynamic parameters were similar in two groups. The diameter and the depth of artery were also similar in both of groups. Cannulation time was shorter in LA-IP Group compared to SA-OOP (24 ± 17 s vs. 47 ± 34 s respectively, p < 0.05). The arterial cannulation by LA-IP approach increased the rate of cannula-insertion success at the first attempt (76 %) compared to SA-OOP approach (51 %). Posterior wall damage during arterial cannulation were found in 30 patients with SA-OOP Group (56 %) and 11 patients with LA-IP Group (20 %), (p < 0.05). In our study, the use of LA-IP approach during US-guided radial artery cannulation has higher success rate at first insertion. We also found LA-IP approach results in shorter cannulation time and decreased the incidence of complications.

Objective: To evaluate the correlation between the reflux symptom index (RSI) and the reflux finding score (RFS) in the patients with voice-related problems and to investigate the reliability of RFS.Methods: Fifty-four patients presenting with the complaint of voice abnormality were included in the study. Patients were asked to complete an RSI score sheet, and they were examined by rigid laryngostroboscopy. Laryngostroboscopic examinations of the patients were evaluated and rated with RFS by three different otolaryngologists blinded to patient information in two different sessions to evaluate intra-rater and inter-rater reliability. The correlations between RSI and RFS, for both total RFS and individual variables from RFS, were investigated.Results: Sixty-three percent were female and 37% were male, with a mean±SD age of 39.09±14.43 years. RSI ranged from 4 to 31, and RFS ranged from 8 to 22. All three raters demonstrated highly consistent intra-rater and inter-rater reliability for both total RFS and individual variables from RFS. There was a highly significant statistical correlation between RSI and total RFS (r=0.696; p=0.0001). Individual variables from RFS, except the posterior commissure hypertrophy, also demonstrated a significant positive correlation with RSI scores (p<0.05).Conclusion: RFS is a simple scale that could easily be administered with high intra-rater and inter-rater reliability for the evaluation of laryngopharyngeal reflux. RSI is highly correlated with both total RFS and all the individual variables from RFS, except posterior commissure hypertrophy. (JAREM 2015; 5: 68-74)

Myopericytoma is a rare benign tumour composed of pericytic cells that show myoid differentiation and have a tendency for concentric perivascular growth. It belongs to a spectrum ofperivascular myoid cell neoplasms. To date, only a small number of cases of myopericytoma involving the oral cavity have been reported. We describe a case of myopericytoma presenting as a slowly growing tongue nodule in a 61-year-old woman. A diagnosis of myopericytoma was established with the histopathological findings combined with immunohistochemical staining. Myopericytoma should be included in the differential diagnosis of well-circumscribed, slow-growing lesions of the oral cavity.

Preoperative care includes a clinical examination before invasive or non-invasive interventions for anaesthesia/analgesia and is the responsibility of the anaesthesiologists. Methemoglobinemia should be considered, as well as cardiac, pulmonary, and peripheral circulatory disorders in patients with central cyanosis and low oxygen saturation despite treatment with sufficient oxygen during anaesthesia. Methemoglobinemia is a serious clinical condition, associated with increased blood methemoglobin levels characterized by clinical signs, such as cyanosis and hypoxia due to lack of oxygen-carrying capacity. Here, we present our anaesthesia management in a patient with unnoticed congenital methemoglobinemia during preoperative evaluation, in whom clinical signs of methemoglobinemia developed after local anaesthesia administration before the surgery.

The aim of this study was to evaluate patients with vocal fold polyps using laryngeal electromyography (LEMG) for the presence of vocal fold paresis and to compare transnasal fiberoptic and rigid stroboscopic findings between polyp patients with normal LEMG and with vocal fold paresis. Thirty-five patients with a vocal fold polyp underwent transnasal fiberoptic laryngoscopy, rigid laryngostroboscopy, and LEMG. The findings were compared between the LEMG-confirmed vocal fold paresis patients and the normal LEMG patients. LEMG resulted in a diagnosis of unilateral or bilateral vocal fold paresis in 17 of 35 patients (48.6 %). More men than women with vocal fold polyps had vocal fold paresis (p < 0.05). The vocal fold paresis group had higher presence of axial rotation and hypomobility of vocal folds, higher asymmetry of vertical height of vocal folds, and less presence of longitudinal stretch of vocal folds (p < 0.05). Medial-lateral compression of the false vocal folds and anterior-posterior approximation of the larynx did not show any difference between the groups. No significant difference was found in vibratory wave characteristics between the groups through rigid laryngostroboscopy. Vocal fold paresis was present in almost half of the patients with vocal fold polyps. Paresis can only be accurately diagnosed with LEMG. Transnasal fiberoptic laryngoscopic examination is helpful to recognize vocal fold paresis in vocal fold polyp patients, while stroboscopic examination is not useful to identify it in vocal fold polyp patients.