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    Complications and toxicities after cytoreductive surgery and hyperthermic intraperitoneal chemotherapy
    (2013) Canda A.E.; Sokmen S.; Terzi C.; Arslan C.; Oztop I.; Karabulut B.; Ozzeybek D.; Sarioglu S.; Fuzun M.
    Introduction: The purpose of our study was to evaluate the perioperative complications, toxicity, mortality rates after cytoreductive surgery (CRS), and effects of hyperthermic intraperitoneal chemotherapy (HIPEC) used in the treatment of peritoneal surface malignancies. Methods: Between September 2007 and March 2012, we performed 118 CRS and HIPEC with the closed abdominal technique on 115 patients with peritoneal carcinomatosis (PC). Systemic toxicities were graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 criteria and were analyzed from a prospectively collected database. Results: The mean age of patients was 53.4 (range, 20-82) years; 76.3 % were female. PC was synchronous to primary cancer in 53.4 % of patients, metachronous in 41.5 %, and recurrent in 5.1 % of the patients. PCI was ?15 in 53.4 % of the patients, and CC-0 cytoreduction was achieved in 68.5 % of the patients. Perioperative mortality was observed in 9 (7.6 %) patients. A total of 98 complications were observed in 46 (39.0 %) patients, and 4 patients underwent 6 reoperations for perioperative surgical complications. We observed toxicity in 25.4 % of the patients, nephrotoxicity in 18.6 %, and hematological toxicity in 13.6 % of patients. No significant difference was observed among age, gender, PCI and CC scores, origin of the primary tumor, and occurrence of toxicity and surgical complications. Prolonged operation times resulted in higher complication and/or toxicity rates (P < 0.01). Conclusions: Cytoreductive surgery and HIPEC is a combined treatment strategy for peritoneal surface malignancies with acceptable complication and toxicity rates. © 2013 Society of Surgical Oncology.
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    Neuromuscular effect of pipecuronium bromide
    (1994) Ozzeybek D.; Elar Z.; Celebi G.; Tutan A.
    'Onset of action', 'duration of action', 'recovery index' and 'reversibility with anticholinesterases' of pipecuronium bromide, a new muscle relaxant, were studied on 24 cases with ASA physical status 1 who received thiopental, N2O-O2 and isoflurane anesthesia. Neuromuscular function was monitored with mechanomyography (MMG) and train-of-four (TOF) stimulation model of 3 groups each containing 8 patients; group I was given 70 µg.kg-1; group II 85 µg.kg-1 and group III 100 µg.kg-1 pipecuronium bromide. There was no statistically significant difference between 3 groups on the basis of 'onset of action' which was found to be 2.7 min; 2.8 min, 2.2 min in the groups I, II and III, respectively (p > 0.05). Statistically significant difference between groups on the basis of 'duration of action' which was found to be 73.3 min in the group I, 77.1 min in the group II and 104.8 min in the group III, was recognized to be due to the significantly longer action of the agent on 100 µg.kg-1 dose group (p < 0.01). 'Recovery index' and % T1 values before and 2, 5, 8 and 10 min after decurarization showed no statistically significant difference between groups (p > 0.05). TOF ratios before decurarization which were found to be 10.1% in the group I, 20.3% in the group II and 10.0% in the group III showed statistically significant difference between groups (p < 0.01). According to data obtained from this study, it was concluded that: by using the suggested doses for clinical practice, action of pipecuronium bromide, which started in 2-3 min and lasted 73-105 min, might be easily reversed by anticholinesterases (reversal time being dose dependent) and might be preferred for surgical procedures especially requiring long periods of muscle relaxation.