Background/aim: The negative effects of surgery and anesthesia on cognitive functions and their relationships with many factors are well known. In the present study we aimed to investigate the effect of the total intravenous anesthesia (TIVA) method on the postoperative cognitive functions between young and elderly patients scheduled to undergo lumbar disk surgery. Materials and methods:The TIVA method was applied to 40 patients less than 65 years old (young, Group Y) and ≥65 years old (old, Group O), whose Mini Mental State Examination (MMSE) results and serum S-100 beta protein levels were compared preoperatively and postoperatively at the 24th hour.Results: Postoperative cognitive dysfunction was not observed in any of the groups in the early stage. MMSE results and mean S-100 beta protein levels determined before and after the operation did not have statistically significant differences between the groups over time. Conclusion:In the present study, the TIVA method did not affect postoperative early cognitive functions in either old or young patients who underwent lumbar disk surgery.

IntroductionClinicians use either direct or indirect (Seldinger) techniques for internal juguler or subclavian vein catheterization. This report aims to point out that the success rate of the direct technique where the catheter is inserted directly through the cannula may be higher particularly in catheterization of pediatric cases.Case presentationA 7.5-month-old female infant weighing 7200 gm was operated on for liver transplantation. The patient suffered jaundice at one month of age and was diagnosed with neonatal colestatic hepatitis. After routine monitoring, via indirect technique, central catheterization was attempted through internal jugular vein. However, the attempt failed. Therefore, again via indirect technique, catheterization was achieved through the right subclavian vein and fixed at 8 cm. After the operation started, fluid replacement and central venous pressure monitoring were performed with this catheter. Immediately after the operation, a control postero-anterior chest radiograph of the patient was obtained. This graph revealed that the tip of the catheter was fixed in the right internal jugular vein. Since the vital symptoms of the patient were not stable, the catheter was not removed and fluid replacement was performed via this technique. The catheter was removed on the postoperative 2nd day.ConclusionThe J wire advanced via the indirect technique advances anatomically following the upper wall of subclavian vein. Because of the smaller vessel dimensions and sharper, more angulated routes the subclavian and internal jugular veins make in infants, the rigid J wire may advance in the cephalic direction. However, in the technique where the catheter (Cavafix ® catheter) is inserted directly through the cannula, this probability is less since J wire is not used and the catheter employed is flexible. We concluded that especially in pediatric cases, employment of the technique where the catheter is inserted directly through the cannula would be more convenient in order to decrease the catheter malpositioning probability.

Amaç: Total kalça protezi son 30 yıl içinde fonksiyonel ve radyolojik olarak başarılı sonuçları bildirilen ortopedik cerrahilerindendir. Bu cerrahi sırasın da meydana gelen periprostetik femur kırıklarının ilerleyen dönemde hastada yarattığı fonksiyonel sonuçları incelemek çalışmamızın ana konusuydu. Yöntemler: 2005-2011 yılları arasında merkezimizde tedavi edilmiş ve periprostetik femur kırığı geçirmiş olan 91 hastanın 94 kalçası çalışmaya dahil edildi. Oluşan kırık tipleri Vancouver sınıflamasına göre sınıflandırıldı. Kırık tedavisinde kullanılan yöntemler kaydedildi ve yine açılım şekilleri, kırığın ameliyatın hangi basamağında (raspalama, oyma, stem çakma, redüksiyon sırasında) oluştuğu not edildi. Hastalar, kontrole çağrılarak pelvis AP ve opere olan taraf femur AP grafileri çekildi. Yine aynı zamanda son muayenelerin de WOMAC skorlaması yapıldı. Daha önceki kontrollerinde çekilmiş olan grafileri ile son kontrollerinde ki grafileri arasında femoral stemde çökme olup olmadığı incelendi. Bulgular: Kırıkların çoğu femoral stemin çakılma aşamasında oluştuğu gözlemlendi (Hastaların %81'i). Hastaların son kontrollerinde ki WOMAC skoru ortalama 27 (8-81) olarak belirlendi. Kalçalardan 12 sinde (%13) ilerleyen zamanlar da protezde çökme tespit edilmiş ve bu kalçalardan 6'sı revizyon cerrahisi geçirmişti. Çökme görülen hastaların kırık tipleri ile olan ilişkilerine bakıldığın da istatistiksel olarak anlamlı fark bulunamadı (p=0,2). Yine çökme görülen hastaların ortalama WOMAC skorları 57'ye yükseldi ve istatistiksel olarak anlamlı bulundu (p<0,0001). Sonuç: TKP sırasında oluşan intraoperatif femur kırıkları, hastalarda uzun dönemde femoral stemde çökmeye yol açarak implant yetmezliğine yol açabilmektedir. Bu çökmenin oluşan kırık tipi ilişkisi çalışmamızda ortaya konamamıştır. Çökme nedeniyle hastalarda fonksiyonel açıdan anlamlı olarak bozulma görülmektedir.