When it comes to pain, the clinicians know that men and women are not the same. There are conspicuous sex differences in response to experimental painful stimulation, in pain attitude such as reporting pain and pain coping behaviors, in symptoms and signs of painful disorders and in response to pain treatment.

When it comes to pain, the clinicians know that men and women are not the same. There are conspicuous sex differences in response to experimental painful stimulation, in pain attitude such as reporting pain and pain coping behaviors, in symptoms and signs of painful disorders and in response to pain treatment.

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Amaç: Bu tanýmlayýcý çalýþma geriatrik aðrý hastalarýnýn aðrýyla baþa çýkma yollarýný belirlemek amacýyla yapýlmýþtýr.
Gereç ve Yöntem: Tanýmlayýcý tipte yapýlan araþtýrma, bir üniversite hastanesinin Algoloji Servisi’nde yatan, 60 yaþ ve üzerinde olan 28 Kasým 2014–28 Ocak 2015 tarihleri arasýnda 100 hastayla yürütülmüþtür. Veriler; araþtýrmacýlar tarafýndan ilgili literatür taranarak hazýrlanan Tanýmlayýcý Özellikler Veri Formu ve Aðrýyla Baþa Çýkma Ölçeði kullanýlarak yüz yüze görüþme yöntemiyle toplanmýþtýr. Verilerin deðerlendirilmesinde tanýmlayýcý istatistiksel metodlar, t testi, One-way Anova testi kullanýlmýþtýr.
Bulgular: Hastalarýn aðrý yaþama süresi 1 ay ile 40 yýl arasýnda deðiþmekte olup, ortalama aðrý yaþama stresi 63.57±82.65 aydýr. Hastalarýn aðrýyla baþa çýkma ölçek alt boyutundan aldýklarý puan ortalamalarý; kendi kendine baþa çýkma 19.22±6.54, çaresizlik 13.45±3.86, bilinçli biliþsel giriþimler 11.90±3.97 ve týbbi çare arama 12.62±3.98’dir. Aðrý kontrolünün kendisinde olduðu inancýna sahip hastalarýn kendi kendine baþa çýkma ölçek puanlarý (p<0.05), aðrý kontrolünün hemþirede olduðuna inancýna sahip olanlarýn týbbi çare arama ölçek puanlarý (p<0.05) anlamlý düzeyde yüksek bulunmuþtur.
Sonuç: Sonuç olarak geriatrik bireyin aðrýyla baþa çýkma yollarý deðiþiklik göstermekte ve uygulanacak hemþirelik giriþimlerinde bu farklýlýklarýn göz önüne alýnmasý önerilmektedir.

Objectives: This study was planned as a guide for nurses in order to define the coping methods of elderly pain patients.
Methods: This descriptive survey was carried out on the geriatric patients (n=100) aged 60 and above in the inpatient Algol- ogy Unit of a University Hospital between November 28th, 2014 and January 28th, 2015. The data were collected using De- scriptive Characteristics Questionnaire which was prepared by scanning the literature and via one-on-one interviews by using Pain Coping Questionnaire (PCQ). The data were evaluated through descriptive statistical methods, Independent sample t test, One way Anova test and Pearson correlation test.
Results: The duration of the pain of the patients ranged from 1 month to 40 years, and the mean duration of pain was 63.57±82.65 months. The mean subscale scores of the patients received from PCQ were self-management (mean=19.22±6.54), helplessness (mean=13.45±3.86), conscious coping attempts (mean=11.90±3.97) and medical remedies (mean=12.62±3.98). The self-management scores (p<0.05) of the patients with the belief that they are able to control pain on their own, and the medical remedies scores (p<0.05) of the patients believing that pain control is in the nurses were significantly higher.
Conclusion: The ways for coping with the pain varies on geriatric patients and it is recommended that these variations and differences are taken into account in nursing interventions.

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Amaç: Alt ekstremitenin iskemik aðrý tedavisi için radyofrekans termokoagülasyon’un (RFT) güvenle kullanýlabileceði bildirilmiþtir. Bu çalýþmanýn amacý alt ekstremitenin iskemik aðrý tedavisi için RFT’un etkinliðini deðerlendirmek ve monopolar ve bipolar RFT modlarýný karþýlaþtýrmaktý.
Gereç ve Yöntem: Etik komite kabulünü takiben alt ekstremite iskemik aðrýsý olan, yaþlarý 18-65 yaþ arasý, ASA I-III grubu, 30 hasta çalýþmaya alýndý. Hastalar MRT grubunda (n = 15) L2-3 düzeyinden 2 dakika monopolar RFT (80°C), BRT grubunda (n = 15) ise L2-3 düzeyinden 2 dakika bipolar RFT (80°C) almak üzere rastgele iki gruba ayrýldý. Sistolik ve diastolik kan basýnçlarý, kalp atým hýzý, aðrý skorlarý (NRS) ve ek analjezik ihtiyaçlarý hastaneden taburcu edildikten 24 saat ve 7, 30 ve 90. günlerde kaydedildi.
Bulgular: Her iki grupta NRS skorlarýnýn zaman içerisinde önemli derecede azaldýðý ve BRT grubunda MRT grubuna göre 30 ve 90. günlerde istatistiksel olarak önemli derecede daha düþük olduðu tespit edildi (p<0.05). Bununla birlikte, ek analjezik ihtiyacýnýn iki grupta benzer olduðu ve iki grup arasýnda çalýþma periyodlarýnda istatistiksel fark oluþturmadýðý tespit edildi (p>0.05). Ýþlem veya tedaviye iliþkin yan etki veya komplikasyon bildirilmedi.
Sonuç: Alt ekstremitenin iskemik aðrý tedavisinde hem monopolar hem de bipolar radyofrekans termokoagülasyon tedavi modalitelerinin aðrý düzeylerini önemli derecede azalttýðý bulundu. Bununla birlikte, bipolar RFT’un monopolar RFT’a göre 30 ve 90. günlerde daha düþük aðrý skorlarýna ve daha uzun analjezi süresine neden olduðu belirlendi.

Objective: Radiofrequency thermocoagulation (RFT) has been reported to be used safely for the treatment of ischemic lower extremity pain. The object of the present study was to evaluate the efficiency of RFT for the treatment of lower extremity ischemic pain and compare the effectivity of monopolar RFT and bipolar RFT mode.
Material and Methods: Following Ethic committee approval, 30 ASA I-III patients with ischemic lower extremity pain, between 18 and 65 years aged were recruited. Patients were randomly allocated into two groups to receive monopolar radiofrequency thermocoagulation (80°C) for 2 minutes from L2-3 level in group MRT (n = 15) or bipolar radiofrequency thermocoagulation (80°C) for 2 minutes from L2-3 level in group BRT (n=15). Systolic and diastolic blood pressures, heart rate, pain scores and supplement analgesic requirements were recorded at 24 hour, and 7, 30 and 90 days after discharge.
Results: NRS values in both group significantly decreased over time and it was found significantly lower in group BRT than in group MRT only after the first and third months (p<0.05). However, supplement analgesic requirements were similar and there was no significant difference between the two groups at any study period (p>0.05). No adverse event or complication regarding the procedure or treatment was reported.
Conclusion: In patients with ischemic lower extremity pain, both monopolar and bipolar radiofrequency thermocoagulation treatment modalities were found to decrease significantly pain levels. However, bipolar mod led to lower pain scores at the 30 and 90 days and longer duration of analgesia than monopolar mode.

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Amaç: Saðlýk çalýþanlarýnda bel aðrýsý prevalansýný, etkileyen kiþisel, iþle iliþkili ve psikososyal risk faktörlerini incelemektir.
Gereç ve Yöntem: Çalýþmamýza Denizli Devlet Hastanesi’nde görev yapan, çalýþmaya katýlmayý kabul eden 1010 kadýn ve 672 erkek toplam 1682 katýlýmcý dâhil edilmiþtir. Nokta ve yýllýk prevalansýn deðerlendirilmesinde Standardize Nordik Muskuloskeletal Anketinin (SNMA) genel bölümünde yer alan bel aðrýsý ile ilgili kýsým kullanýlmýþtýr. Psikososyal faktörlerin deðerlendirilmesi kapsamýnda, katýlýmcýlarýn stres düzeyi ‘Algýlanan Stres Ölçeði’, iþ memnuniyeti ‘Ýþ Doyum Ölçeði’ kullanýlarak gerekli veriler elde edilmiþtir.
Bulgular: Saðlýk çalýþanlarýnda yaþam boyu bel aðrýsý prevalansý %53 olarak saptanmýþtýr. En fazla bel aðrýsýnýn týbbi sekreterlerde (%56,9) olduðu tespit edilmiþtir. Ýleri yaþ, kadýn cinsiyet, Vücut Kitle Ýndeksinin (VKÝ) yüksek olmasý (p=0,002), evli olmak ve egzersiz alýþkanlýðýnýn olmamasý (p=0,009), ayakta durarak (p=0,012) ve oturarak 4 saatten fazla çalýþma (p=0,021), 4 saatten fazla bilgisayar kullanma (p=0,001), artmýþ hizmet yýlý (p=0,001) ve iþ memnuniyetinin az olmasý (p=0,001) bel aðrýsý riskini artýran faktörler olarak saptanmýþtýr.
Sonuç: Çalýþmamýz saðlýk çalýþanlarýnýn bel aðrýsý açýsýndan yüksek risk grubunda olduðunu göstermiþtir.

Objectives: The purpose of the study is examining the personal, occupational and psychosocial risk factors affecting the low back pain prevalence in healthcare workers.
Methods: Our study included a total of 1682 participants (1010 female, 672 male) working at Denizli State Hospital. Low back pain part in the general section of Standardized Nordic Musculoskeletal Questionnaire (SNMA) is used in the evaluation of point and annual prevalence. Stress levels were used as Perceived Stress Scale and the job satisfaction was used as Job Satisfaction Scale.
Results: Life-time low back pain prevalence of healthcare workers was determined as 53%, and based on SNMA. It was determined that the low back pain was most common among medical secretaries (56.9%). Elder age, female gender, high Body Mass Index (BMI) (p=0.002), being married and lack of exercise habit (p=0.009), working for more than 4 hours by standing (p=0.012) and sitting at the desk (p=0.021), using computer for more than 4 hours (p=0.0001), increased years of service (p=0.001) and low job satisfaction (p=0.001) were determined as factors increasing the low back pain risk.
Conclusion: Our study has demonstrated that healthcare workers are among the group with high risk of low back pain.

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Tetikleyici faktörlerle ortaya çýkan baþaðrýlarý onyýllardýr bilinmektedir. Birçok hastada, bu tür baþaðrýlarý altta yatan bir patolojiye sekonder olarak geliþmektedir. Ancak, bazý hastalarda herhangi bir sorun tespit edilememektedir. Seksüel aktiviteyle iliþkili primer baþ aðrýsý (SAPB) primer baþaðrýlarýnýn bir alt grubudur. SAPB selim bir baþaðrýsýdýr ve genel populasyonda yaþam boyu prevelansý %1–1.6’dýr. 38 yaþýnda erkek hasta, 2 aydýr olan cinsel aktivite sýrasýnda ortaya çýkan ciddi baþaðrýsý nedeniyle polikliniðimize baþvurdu. Aðrýsý orgazm sonrasý her iki oksipital bölgede ortaya çýkýyor ve yaklaþýk 2 saatte sonlanýyordu. Hastaya 40 mg/gün propranolol baþlandý ve 2 hafta içinde dramatik þekilde düzelme bildirdi, tedaviye 6 ay devam edildi. Bir yýldýr düzenli kontrollerine devam eden hastada yeniden baþaðrýsý olmadý. Bu olguda nadir görülen SAPB ve düþük doz propranolol ile baþarýlý tedaviyi bildirmek istedik.

Headaches provoked by triggering factors have been recognized for many decades. In many cases, the development of such headaches is secondary to an underlying pathology. However, in some cases, no abnormality can be identified. Primary headache associated with sexual activity (PHASA) is one of the subgroups of primary headaches. PHASA is a benign form of headache and lifetime prevalence is estimated to be 1% to 1.6% in the general population. A 38-year-old man was admitted to outpatient clinic reporting history of severe headaches during sexual intercourse for the last 2 months. Headaches occurred bilaterally in occipital area just after orgasm and lasted for about 2 hours. Propranolol 40 mg/ day was initiated and on follow-up, patient reported dramatic improvement in 2 weeks. Treatment was maintained for 6 months. Patient has been on regular follow-up for a year and had no recurrence of headache. This is a rare case PHASA. In this patient, prophylactic treatment with low dosage of propranolol was successful.

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Sfenoid sinüs hastalýklarýnýn tanýsý nonspesifik öykü ve fizik muayene bulgularý nedeniyle zordur. Sfenoid sinüs, aspergillomalarýn en nadir görüldüðü lokalizasyondur ve tanýdaki gecikmeler ciddi komplikasyonlar ile sonuçlanabilir. Burada uzun yýllardýr uyku bozukluðu ve baþ aðrýsý nedeni ile Psikiyatri bölümünce takip edilmekte olan bir sfenoid sinüs aspergillomasý olgusunu sunuyor ve bu nadir olgu ile beraber sfenoid sinüs aspergillomalarýnýn klinik ve radyolojik özelliklerini tartýþýyoruz.

The diagnosis of sphenoid sinus diseases is difficult due to nonspecific history and physical examination findings. Sphenoid sinus is a rare localization for aspergilloma. Delay in diagnosis and treatment can result in serious complications. Presently described is case of sphenoid sinus aspergilloma. Patient had been treated by department of psychiatry for many years due to sleep disturbances and headache. Clinical and radiological features of rare case of sphenoid sinus aspergilloma are discussed.

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Reversibl serebral vazokonstriksiyon sendromu (RSVS), Call-Fleming sendromu olarak da bilinen, genellikle 20–40 yaþlarýnda ve kadýnlarda görülen, nörolojik defisitlere neden olabilen gök gürültüsü baþ aðrýsýnýn nadir nedenlerinden biridir. RSVS nedeni muhtemelen serebral vasküler tonustaki geçici disregülasyonun neden olduðu multifokal arteriyal konstriksiyon ve dilatasyondur. 63 yaþýnda kadýn hasta baþýnýn sol tarafýnda belirgin, ani geliþen, tekrarlayýcý baþ aðrýsý þikayeti ile baþvurdu. Fizik ve nörolojik muayenesi normaldi. Kranial MRI angio incelemelerinde MCA ve PCA’da belirgin olmak üzere damarlarýn distallerinde belirgin vazokonstriksiyon saptandý. Ayýrýcý tanýda ilk olarak düþünülen primer SSS anjitisi Kranial MRI’da parankim lezyonu ve beyin omurilik sývýsýnda (BOS) protein artýþý olmamasý nedeniyle dýþlandý. Deksametazon sodyum fosfat 4 mg/ml (4 mg/gün) ve nimodipin 90 mg/gün tedavisi baþlandý. Nimodipin dozu kademeli olarak 120 mg/gün’e çýkarýldý. Ek olarak, antihistaminik ajanlarýn kesilmesi ile baþ aðrýsý belirgin olarak geriledi. RSVS sendromunun vurgulanmasý gereken en önemli özelliðinin benzer klinik prezentasyon gösteren subaraknoid kanama veya primer santral sinir sistemi (SSS) anjitisinden farklý olarak klinik bulgularýnýn reversibl olmasýdýr. Klinik bulgular çoðunlukla düzelmekle birlikte, kalýcý nörolojik defisitler de olabileceði göz önünde bulundurulmalýdýr.

Reversible cerebral vasoconstriction syndrome (RCVS), also known as Call-Fleming syndrome, is one of the rare causes of thunderclap headaches, which are most often seen in females aged 20–40 years and which can cause neurological deficits. The cause of RCVS is thought to be multifocal arterial constriction and dilatation caused by transient disregulation of cerebral vascular tonus. Presently described is case of 63-year-old female patient who presented with complaint of sudden onset of recurrent headaches located on the left side. Physical and neurological examinations were normal. Cranial magnetic resonance imaging (MRI) angiography examination showed vasoconstrictions in the distal, particularly in middle cerebral arteries and posterior cerebral arteries. Primary angitis of central nervous system (CNS), first considered in differential diagnosis, was excluded because no parenchymal lesion was seen in cranial MRI and no protein increase was observed in cerebrospinal fluid. Dexamethasone sodium phosphate 4 mg/mL (4 mg/day) and nimodipine 90 mg/day treatment was initiated. Nimodipine dose was gradually increased to 120 mg/day. Headache resolved significantly after discontinuation of antihistaminic agents. The most important feature of RCVS to be highlighted is that clinical signs are reversible, unlike subarachnoid hemorrhage or primary angitis of CNS, which have similar clinical presentations. Although clinical signs of RCVS usually resolve, it should be considered that permanent neurological deficits may occur.

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Anestezinin nadir komplikasyonu: Tek taraflý spinal myoklonus

An unusual complication of anesthesia: Unilateral spinal myoclonus

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Ýnfraklavikular bölgede, brakiyal pleksus ve dallarýnýn daðýlým ve düzenlerinde varyasyonlar sýk görülür. Arter ve sinirlere göre venin pozisyonu da belirgin varyasyon gösterebilir. Ýnfraklavikular bölgede, ultrason eþliðinde infraklavikular blok yapýlýken saptanan olaðandýþý damarsal varyasyonu bildirmek istedik.

Variations in the arrangement and distribution of brachial plexus and its branches at the infraclavicular region are common The vein position is also markedly variable with respect to the artery and nerves. We report an unusual anatomic variation of vasculature at infraclavicular region determined by ultrasound during infraclavicular block.

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