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AIMS: Comparison of the use of I-gel and Laringeal Mask Airway (LMA) Protector in laparoscopic cholecystectomy regarding the time and ease of insertion for supraglottic airway devices (SAD) and gastric tube (GT), airway sealing capacity, and postoperative complications. PATIENTS AND METHODS: Sixty-four American Society of Anaesthesiologists (ASA) I-III patients undergoing laparoscopic cholecystectomy were randomly allocated into two groups. After anesthesia induction, LMA Protector was inserted in Group LPRO (LMA Protector) (n = 33) and I-gel was inserted in Group IGEL (I-gel) (n = 31) patients. Time of SAD insertion, number of attempts, time, and ease of GT insertion were recorded. The peak inspiratory pressure (PIP) and oropharyngeal leak pressure (OLP) were measured at the time of SAD insertion, 10 min after insertion, 10 min after pneumoperitoneum, and just before the termination of pneumoperitoneum. The presence of bloodstains on SAD, sore throat, hoarseness, nausea, and pain in swallowing was assessed postoperatively. A P value of < 0.05 was accepted as statistically significant. RESULT: Two patients in Group LPRO needed endotracheal intubation and were excluded from the study. The SAD insertion time was shorter in Group IGEL than in Group LPRO (13 ± 7.4 s vs. 18.8 ± 9.8 s). The number of attempts and success rate on the first attempt were similar in both groups. GT insertion time was shorter in Group IGEL than Group LPRO (11 ± 7.7 s vs. 21 ± 11 s). The insertion of GT was easier in Group IGEL. The OLP levels decreased during the pneumoperitoneum in Group LPRO while they remained constant in Group IGEL. CONCLUSION: We observed that I-gel offers more stable airway sealing and easier GT insertion advantages when compared with LMA Protector in laparoscopic cholecystectomy.
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Colecistectomía Laparoscópica , Máscaras Laríngeas , Faringitis , Humanos , Intubación Intratraqueal , Estudios ProspectivosRESUMEN
INTRODUCTION: Renal transplantation is undoubtedly considered the best renal replacement therapy. Graft nephrectomy can be performed in patients with renal transplantation because of complications associated with the failed graft. We aimed to retrospectively investigate the characteristics of patients who underwent graft nephrectomy. MATERIALS AND METHODS: Between January 2000 and November 2013, the records of 757 patients who had renal transplantation in Ege University Faculty of Medicine Hospital Nephrology-Transplantation outpatient clinic were examined. Sixty-four patients who underwent graft nephrectomy were included in the study. Patients were divided into 2 groups according to the timing of graft nephrectomy. The group of 30 patients who underwent graft nephrectomy in the first 56 days after the renal transplantation was referred to as the "early group" and the group of 34 patients who underwent graft nephrectomy after 56 days was referred to as "late group." RESULTS: In our study, we found the body mass index to be significantly higher in those with early graft loss (P = .02). We found that there was a difference between the groups in terms of sex (P = .012). When the mortality and morbidity rates after graft nephrectomy were examined, mortality was observed in 3 of the 64 patients in the study and morbidity in 1 patient. CONCLUSION: According to our study, the body mass indices and ages of the subjects who need early graft nephrectomy are higher. However, male sex was significantly more prevalent in patients who underwent graft nephrectomy in the late period compared with the early period.
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Rechazo de Injerto/cirugía , Trasplante de Riñón/efectos adversos , Nefrectomía , Adulto , Factores de Edad , Índice de Masa Corporal , Femenino , Supervivencia de Injerto , Humanos , Estimación de Kaplan-Meier , Trasplante de Riñón/mortalidad , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Adulto JovenRESUMEN
OBJECTIVE: An examination was conducted of the number, level, clinical association and treatment approaches for vertebral arterial loop formation in patients with this condition with and without concurrent cervicogenic dizziness, and classified them according to the vertebral artery segment in which it was present. METHOD: A cross-sectional retrospective study. RESULTS: Thirty-seven patients who had undergone double-sided magnetic resonance angiography were examined; vertebral arterial loop formation was observed at only 1 level in 26 patients and at several levels in 9 patients. Segment one (V1) was involved in 78.3 per cent of cases and segment two (V2) was involved in 21.6 per cent. Symptoms in patients with vertebral arterial loop formation included: positional vertigo, in 100 per cent; and pulsatile tinnitus, in 83.7 per cent. CONCLUSION: Loop formation at the vertebral artery was observed most often on the proximal side in patients with cervicogenic dizziness (78.3 per cent). The incidence on the left side was twice as high as on the right side.
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Vértebras Cervicales/diagnóstico por imagen , Mareo/diagnóstico por imagen , Acúfeno/diagnóstico por imagen , Arteria Vertebral/diagnóstico por imagen , Vértigo/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Nistagmo Patológico , Nistagmo Fisiológico , Radiografía , Estudios Retrospectivos , Arteria Vertebral/anomalías , Adulto JovenRESUMEN
BACKGROUND: Double-J (DJ) stents play an important role in modern urology to prevent undesirable side effects after surgery. We aimed to investigate the relationship of DJ stents with the demographic characteristics, surgical complications, urinary tract infection (UTI), and hematuria in the patients who underwent renal transplantation (Tx). METHODS: Data of 354 patients who underwent renal Tx between 2008 and 2011 at Ege University were evaluated retrospectively; 331 patients were included in this study. The term DJ (-) represents patients in whom a DJ stent was not placed. "Primary DJ term" represents patients in whom the DJ stent was placed during the first Tx. "Secondary DJ term" represents the patients who had DJ after Tx for any complication. RESULTS: Two hundred fifty-four (76.7%) patients were in the DJ (-) group, 52 (15.7%) were in the primary DJ group, and 25 (7.6%) were in the secondary DJ group. There were significant differences between the groups in terms of anastomosis type (P = .000), stay-in-hospital time (P = .000), surgical complication (P = .000), re-operation (P = .000), percutaneous nephrostomy (P = .000), UTI (P = .000), first-time UTI (P = .000), recurrent UTI (P = .000), positive hemoculture (P = .000), hematuria (P = .000), duration of dialysis before Tx (P = .000), live/deceased donor (P = .000), and delayed graft function (P = .009). CONCLUSIONS: Our choice is to use the DJ stent in selected high-risk patients and to keep the indications for DJ stent wider in deceased donor transplants by considering possible surgical complications. The use of the stent only in selected cases will decrease surgical complications due to stent placement.
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Trasplante de Riñón/efectos adversos , Complicaciones Posoperatorias/epidemiología , Stents , Adulto , Anciano , Funcionamiento Retardado del Injerto/epidemiología , Funcionamiento Retardado del Injerto/etiología , Funcionamiento Retardado del Injerto/prevención & control , Femenino , Estudios de Seguimiento , Hematuria/epidemiología , Hematuria/etiología , Hematuria/prevención & control , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Nefrostomía Percutánea/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Resultado del Tratamiento , Uréter/cirugía , Infecciones Urinarias/epidemiología , Infecciones Urinarias/etiología , Infecciones Urinarias/prevención & controlRESUMEN
The objective of this study was to report on a 34-year-old woman who presented with tethered cord syndrome due to dermal sinüs tract. A 34-year-old woman had got dermal sinüs tract admitted to our hospital with swelling on the neck, pain and numbness on the left upper limb. She was treated by surgical removal of dermal sinuses and untethering the spinal cord which is stretched by the dermal sinus. Congenital dermal sinus tracts are uncommon types of cranial and spinal dysraphisms. They can occur in the midline of the craniospinal axis from the occiput to the sacral region. For dermal sinuses, cervical region is very rare location that is reported in the literature. They are diagnosed usually in childhood with skin signs, neurological deficits, local infections and meningitis. We present a rare case of dermal sinus tract located in cervical region. Early diagnosis and treatment of cervical dermal sinus tract are important to prevent neurological deficits.
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BACKGROUND: After the achieved high cure rates, the survivors of medulloblastoma have come to face other complications associated with treatment regimes. One of these complications is secondary malignant neoplasm (SMN), which is rare but generally fatal. CASE HISTORY: We report a case of an 8-year-old girl in whom a pilocytic astrocytoma developed at the site of previously excised medulloblastoma 26 months earlier. The patient had then received postoperative radiotherapy and chemotherapy for the treatment of medulloblastoma. Twenty-five months after the cessation of treatment, she had no complaint and physical examination was unremarkable, but a mass in the operation region was detected. Surgical excision of the secondary pilocytic astrocytoma was performed with a good clinical recovery without any evidence of residue or recurrence at 9-month follow-up. CONCLUSION: Clinicians must be vigilant for the risk of expected SMNs. Rigorous and prolonged follow-up of patients with central nervous system (CNS) tumors is warrant.
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Astrocitoma/patología , Neoplasias Encefálicas/patología , Meduloblastoma/cirugía , Neoplasias Primarias Secundarias/patología , Astrocitoma/cirugía , Neoplasias Encefálicas/tratamiento farmacológico , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirugía , Niño , Femenino , Humanos , Meduloblastoma/tratamiento farmacológico , Meduloblastoma/radioterapia , Neoplasias Primarias Secundarias/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: To evaluate the correlation between magnetic resonance imaging (MRI) findings and 99mTc-hexamethylpropyleneamine oxime (HMPAO) brain single photon emission computed tomography (SPECT) during the subacute stage in ischemic stroke patients. MATERIAL AND METHODS: The T1 and T2-weighted images and brain SPECT findings of 84 patients (mean age 60.69 +/- 12.47 years) with subacute cerebral ischemia during the period 1998-2004 were reviewed. All HMPAO SPECT and MRI studies were performed between 3 and 7 days (mean time delay 4.76 +/- 1.29 days) after the onset of stroke symptoms. RESULTS: An ischemic lesion was seen both in T1 and T2-weighted images with perfusion defects above 60% (severe defect) according to count/pixel data of the lesion in HMPAO SPECT studies in 30 (90.9%) of 33 patients. Otherwise, the ischemic lesion was seen only on T2-weighted images with perfusion defects between 30% and 60% (moderate defect) in HMPAO SPECT studies in 25 (89.3%) of 28 patients. In 20 (87%) of 23 patients who had perfusion defects below 30% (mild defect) on HMPAO SPECT, only non-specific findings such as cerebral atrophy and/or periventricular ischemic-gliotic lesions could be seen in MRI. The difference between these ratios was statistically significant (P < 0.01). CONCLUSION: Brain 99mTc-HMPAO SPECT findings indicate good correlation with MRI findings. When the ischemic lesions could be seen in both T1 and T2-weighted images, the patients frequently had severe perfusion defects. When only seen in T2-weighted images, the perfusion defect was moderate. When only non-specific findings were revealed by MRI, only mild perfusion defects were found by SPECT.
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Isquemia Encefálica/diagnóstico , Encéfalo/diagnóstico por imagen , Imagen por Resonancia Magnética/métodos , Oximas , Radiofármacos , Accidente Cerebrovascular/diagnóstico , Tomografía Computarizada de Emisión de Fotón Único/métodos , Adulto , Anciano , Anciano de 80 o más Años , Isquemia Encefálica/etiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perfusión , Índice de Severidad de la Enfermedad , Accidente Cerebrovascular/etiologíaRESUMEN
OBJECTIVE: In the present study, the effects of magnesium sulfate (MgSO4) on tissue lactate and malondialdehyde (MDA) levels after spinal cord trauma (SCT) in rabbits were studied. SUBJECTS: Thirty New Zeland rabbits. Interventions. The rabbits were divided equally into three groups: group I was the sham- operated group, group II suffered from SCT but received no treatment, group III was given a dose of 100 mg/kg of magnesium sulfate intravenously at 5th minute after SCT. MEASUREMENTS. The lactate and MDA levels were measured in contused spinal cord tissue at 60 minutes after SCT. There was a significant increase of lactate and MDA levels in group II (p < 0.05) when compared with groups I and III, and a significant increase in the level of MDA in group III compared with group I, and also a significant decrease compared with group II, which was the trauma group without treatment (p < 0.05). CONCLUSION: The findings of this study showed that magnesium sulfate can attenuate the increase of tissue MDA and supply a normalization of lactate levels following SCT which may be related to the neuroprotective effects of (MgSO4).
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Ácido Láctico/metabolismo , Sulfato de Magnesio/metabolismo , Malondialdehído/metabolismo , Traumatismos de la Médula Espinal/metabolismo , Médula Espinal , Animales , Presión Sanguínea , Dióxido de Carbono/sangre , Frecuencia Cardíaca , Oxígeno/sangre , Conejos , Distribución Aleatoria , Médula Espinal/metabolismo , Médula Espinal/patología , Traumatismos de la Médula Espinal/patologíaRESUMEN
BACKGROUND: A failure of the Na(+),K(+)-ATPase activity (which is essential for ion flux across the cell membranes) occurs in many pathological conditions and may lead to cell dysfunction or even cell death. By altering the concentration of specific opioid peptides, gamma-hydroxybutyric acid (GHB) may change ion flux across cell membranes and produce the 'channel arrest' which we assumed will inhibit the failure of Na+,K(+)-ATPase activity and therefore lead to energy conservation and cell protection. Therefore we planned this study to see the effects of GHB at two different doses on Na(+),K(+)-ATPase activity in an experimental head trauma model. METHODS: Forty New Zealand rabbits were divided equally into four groups: group I was the sham-operated group, group II (untreated group), group III received head trauma and intravenous (i.v.) 500 mg/kg GHB and group IV received head trauma and i.v. 50 mg/kg GHB. Head trauma was delivered by performing a craniectomy over the right hemisphere and dropping a weight of 10 g from a height of 80 cm. The non-traumatized (left) side was named as 'a' and the traumatized (right) side as 'b'. One hour after the trauma in groups II and III and craniotomy in group I, brain cortices were resected from both sides and in group I only from the right side was the tissue Na-K-ATPase activity determined. RESULTS: The mean +/- SD of Na(+),K(+)-ATPase levels of each group are as follows: group I - 5.97 +/- 0.55; group IIa - 3.90 +/- 1.08; group IIb - 3.58 +/- 0.90; group IIIa - 5.53 +/- 0.60; group IIIb - 5.33 +/- 0.88; group IVa - 5.05 +/- 0.72; group IVb - 4.93 +/- 0.67. The Na(+),K(+)-ATPase levels of group IIa, IIb, IVa and IVb were significantly different from group S (P < 0.05). There were also significant differences between group IIa and groups IIIa and IVa; group IIb and groups IIIb and IVb (P < 0.05). CONCLUSIONS: We conclude that GHB is effective in suppressing the decrease in Na(+),K(+)-ATPase levels in brain tissue at two different dose schedules after head trauma.
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Lesiones Encefálicas/enzimología , Hidroxibutiratos/farmacología , ATPasa Intercambiadora de Sodio-Potasio/efectos de los fármacos , Agonistas alfa-Adrenérgicos/administración & dosificación , Analgésicos/administración & dosificación , Análisis de Varianza , Animales , Análisis de los Gases de la Sangre , Presión Sanguínea/efectos de los fármacos , Peso Corporal/fisiología , Lesiones Encefálicas/etiología , Modelos Animales de Enfermedad , Relación Dosis-Respuesta a Droga , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Presión Intracraneal/efectos de los fármacos , Ketamina/administración & dosificación , Masculino , Conejos , Factores de Tiempo , Xilazina/administración & dosificaciónRESUMEN
OBJECTIVE: To determine the role of hyperoxic and hyperbaric therapy following experimental subarachnoid hemorrhage (SAH). DESIGN: Prospective, randomized, controlled animal study. SUBJECTS: Thirty male Wistar rats. INTERVENTIONS: Thirty rats were assessed for an initial neurologic status as double-blinded by two different neurosurgeons using a neurologic severity score (NSS) and then underwent an initial angiographic examination. Two days later, 0.3 ml of homologous blood was injected into the cisterna magna to produce a SAH-induced cerebral vasospasm. The NSS and angiographic examination were then repeated. The rats having no spasm or a spasm under 50% (n=8) and 50% or over 50% (n=22) were grouped separately, as groups 1 and 2, respectively. The rats having 50% or more spasm were further divided randomly into group 2A and 2B. The rats in groups 1 and 2A (n=11) underwent a 60-min course of 100% oxygen at the atmospheric pressure 1 atmosphere absolute (ata), and group 2B (n=11) received 100% oxygen at 3 ata for 1 h. Neurologic assessment was repeated on the next day and 7 days later. MEASUREMENTS AND MAIN RESULTS: The animals having no spasm or less than 50% spasm had a better NSS and outcome when compared with the animals having 50% or more spasm. But the animals with 50% or more spasm which underwent hyperbaric therapy were shown to have a better outcome compared to the animals having hyperoxic therapy. CONCLUSION: Exposure to hyperbaric oxygen therapy seemed to accelerate the recovery of neurologic deficits secondary to experimental SAH.
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Modelos Animales de Enfermedad , Oxigenoterapia Hiperbárica/métodos , Terapia por Inhalación de Oxígeno/métodos , Hemorragia Subaracnoidea/terapia , Análisis de Varianza , Animales , Análisis de los Gases de la Sangre , Presión Sanguínea , Angiografía Cerebral , Distribución de Chi-Cuadrado , Método Doble Ciego , Frecuencia Cardíaca , Masculino , Distribución Aleatoria , Ratas , Ratas Wistar , Recuperación de la Función , Índice de Severidad de la Enfermedad , Hemorragia Subaracnoidea/complicaciones , Hemorragia Subaracnoidea/diagnóstico por imagen , Hemorragia Subaracnoidea/fisiopatología , Factores de Tiempo , Vasoespasmo Intracraneal/etiologíaRESUMEN
The possibility for maxillary artery (MA) to petrous internal carotid artery (ICA) bypass was investigated. Five adult cadavers were dissected bilaterally. After zygomatic arch osteotomy, the coronoid process was sectioned at its base. An extensive infratemporal craniotomy was performed at the level of foramina ovale, rotundum and spinosum. The petrous portion of the ICA was exposed by drilling away the floor of the middle fossa, posterior to the foramen ovale and medial to the foramen spinosum. The MA was identified medial to the infratemporal crest and was followed in the pterygopalatine fossa, then transected at the origin of the infraorbital artery. The MA graft was brought posteromedially to reach the petrous ICA. The mean caliber of the MA before the origin of the infraorbital artery was 2.54+/-0.31 mm, 2.76+/-0.14 mm at the site of anastomosis, and 3.46+/-0.32 mm after giving off the middle meningeal artery. The average length of the MA between the middle meningeal artery and the infraorbital artery was 43.4+/-2.35 mm, and up to the site of anastomosis was 37.64+/-1.68 mm. We conclude that the length and diameter of the MA are sufficient for a tension-free anastomosis between MA and petrous ICA, and such a procedure could be used in the treatment of patients with tumors of the infratemporal fossa invading the high cervical ICA.
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Arteria Carótida Interna/cirugía , Revascularización Cerebral , Arteria Maxilar/cirugía , Anastomosis Quirúrgica , Arteria Carótida Interna/anatomía & histología , Estudios de Factibilidad , Humanos , Arteria Maxilar/anatomía & histología , Hueso PetrosoRESUMEN
In the present study, the effects of deferoxamine on tissue lactate and malondialdehyde (MDA) levels after cerebral ischemia in rabbits was studied. Rabbits were divided equally into three groups: group 1: sham-operated group; group 2: cerebral ischemia produced by clamping bilateral common carotid arteries for 60 min; and group 3: deferoxamine 100 mg/kg i.v. administered within 5 min after opening the clamps. EEG recordings were obtained in all groups before clamping and in group 2 and 3 60 min after clamping and 60 min after opening the clamps. One hour after opening the clamps and taking EEG recordings, brain cortices were resected and the concentrations of lactate and MDA were determined using the spectrophotometric enzymatic and thiobarbituric acid methods, respectively. There were significant differences between group 1 and the other groups in MDA and lactate levels (p < 0.05). There were no significant differences in lactate levels between groups 2 and 3. Preischemic EEG grades were the same in all groups. Preischemic and postischemic EEG values were significantly different (p < 0.05), but there were no significant differences between postischemic EEG grades in groups 2 and 3. There was also a correlation between postischemic EEG grades and lactate levels, but no correlation between postischemic EEG grades and MDA levels. These results demonstrate that cerebral ischemia leads to an increase in brain tissue lactate and MDA levels and deferoxamine suppresses the increase of MDA, but not lactate. Deferoxamine treatment caused no significant EEG changes. EEG grades correlated well with lactate levels.
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Isquemia Encefálica/metabolismo , Deferoxamina/farmacología , Quelantes del Hierro/farmacología , Ácido Láctico/metabolismo , Malondialdehído/metabolismo , Enfermedad Aguda , Animales , Encéfalo/metabolismo , Electroencefalografía , Masculino , ConejosRESUMEN
PURPOSE: The aim of this study was to determine whether omental transposition at the time of focal cerebral ischemia can decrease ischemic brain damage produced in dogs, in a new ischemia model, which had been described by us. METHODS: In group 1 (n = 5), the left internal carotid artery and arterial circle of the brain (posterior communicating artery in humans) were occluded permanently. In group 2 (n = 5), additionally to this ischemia model, omental transposition was performed simultaneously. In the postoperative early period (first 24 h), single photon emission computed tomography (SPECT) and in the late period (72-96 h) SPECT and magnetic resonance imaging (MRI) of the brain were performed. Mann-Whitney U, paired t and Wilcoxon signed rank tests were used for statistical analyses, and p < 0.05 was considered significant. RESULTS: The dogs had a neurological score (NS) of 3.6 +/- 0.5 and 3.4 +/-0.5 in groups 1 and 2, respectively, in the early period (p > 0.05). In the late period, the dogs had an NS of 4.4 +/- 0.5 and 5.6 +/- 0.5 in groups 1 and 2, respectively (p < 0.05). The NS of each group differed significantly between the early and late period (p < 0.05). Early SPECT imaging showed 50 +/- 7.0% and 52 +/- 8.4% hypoperfusion corresponding to the left middle cerebral artery territory in groups 1 and 2, respectively (p > 0.05). In the late period, the degree of hypoperfusion decreased to 34 +/- 5.5% and 12 +/- 4.8% in groups 1 and 2, respectively (p < 0.05). The degree of hypoperfusion in both groups changed significantly between the early and late period (p < 0.05). In T(1)- and T(2)-weighted MRI images, the volume of the lesion in group 1 was significantly greater than in group 2 (p < 0.001). CONCLUSION: In our new ischemia model, simultaneous omental transposition is helpful in reversing the neurologic deficit and cerebral ischemic damage.
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Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/cirugía , Revascularización Cerebral/métodos , Epiplón/cirugía , Animales , Encéfalo/irrigación sanguínea , Encéfalo/diagnóstico por imagen , Circulación Cerebrovascular , Modelos Animales de Enfermedad , Perros , Masculino , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/cirugía , Tomografía Computarizada de Emisión de Fotón ÚnicoRESUMEN
In the present study, the effects of magnesium sulfate on tissue lactate and malondialdehyde (MDA) levels after cerebral ischemia in rabbits were studied. The rabbits were divided equally into three groups. Group 1 (n = 8) was the sham-operated control group, in group 2 (n = 8) only cerebral ischemia was induced by clamping bilaterally the common carotid arteries for 60 min, and in group 3 (n = 8) magnesium sulfate was administered at a dose of 100 mg/kg i.v. within 5 min after opening the clamps. In group 1 EEG recordings were obtained immediately and 60 and 120 min after craniectomy. In groups 2 and 3 EEG recordings were obtained immediately after craniectomy but before clamping and 60 min after clamping. One hour after opening the clamps and taking EEG recordings, brain cortices were resected, and the concentrations of lactate and MDA were determined using spectrophotometric/enzymatic and thiobarbituric acid methods, respectively. In all groups, there were significant differences between MDA and lactate levels (p < 0.05). There were no significant differences in lactate levels between groups 2 and 3 (p > 0.05), and also the preischemic EEG grades were the same in all groups. Preischemic and postischemic EEG values were significantly different (p < 0.05), and there were also significant differences between postischemic EEG grades in groups 2 and 3 (p < 0.05). There was a correlation between postischemic EEG grades and MDA and lactate levels. These results demonstrate that cerebral ischemia-reperfusion injury leads to an increase in brain tissue lactate and MDA levels, that magnesium sulfate suppresses the increase of MDA and lactate concentrations, and that magnesium sulfate treatment improves the EEG changes. The EEG grades correlated well with MDA and lactate levels.
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Isquemia Encefálica/metabolismo , Lactatos/metabolismo , Sulfato de Magnesio/farmacología , Malondialdehído/metabolismo , Animales , Presión Sanguínea/efectos de los fármacos , Química Encefálica/efectos de los fármacos , Electroencefalografía , Frecuencia Cardíaca/efectos de los fármacos , Sulfato de Magnesio/uso terapéutico , Masculino , Conejos , Daño por Reperfusión/metabolismoRESUMEN
The use of a saphenous vein graft for bypass of the maxillary artery (MA) to the supraclinoid internal carotid artery (ICA) in internal carotid occlusions is investigated. Five adult cadaver sides were used. Dissection required zygomatic arch osteotomy and a pterional craniotomy with extensive removal of the floor of the middle cranial fossa. The MA was found easily medial to infratemporal crest. The clinoidal segment of the ICA was exposed with the removal of the anterior clinoid process intradurally. The bypass graft was 4 to 5 cm long and was sutured end-to-end to the MA and end-to-side to the supraclinoid ICA. When high blood flow is needed in cases with ICA occlusion, such a bypass may be an alternative to superficial temporal (STA)-to-middle cerebral artery (MCA) bypass as well as to common carotid-to-MCA or-ICA bypass, which needs a long vein graft. This type of bypass will provide the opportunity to clip the ICA proximal to the origin of ophthalmic artery, which may inhibit distal embolization.
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Arteria Carótida Interna/cirugía , Arteria Maxilar/cirugía , Vena Safena/trasplante , Adulto , Estenosis Carotídea/cirugía , Humanos , Modelos AnatómicosRESUMEN
We studied the effects of nimodipine on brain tissue lactate and malondialdehyde (MDA) levels one hour after experimental head trauma in 25 New Zealand rabbits. Group 1 (n=5) was the sham operated group. Group 2 (n=10) received head trauma without treatment and in group 3 (n=10) nimodipine was administered for 30 minutes intravenously (2 microg/kg/min) immediately after head trauma. In groups 2 and 3, tissue samples from the non-traumatized side was named as "a" and traumatized side as "b". The lactate and malondialdehyde contents were significantly higher in groups 2a, 2b, 3a and 3b when compared with to group 1 (P<0.05). The differences between non-treated groups (2a, 2b) and nimodipine treated groups (3a, 3b) were not significant (P>0.05). The differences between the traumatized sides (2b, 3b) and non-traumatized sides (2a, 3a) were significant (P<0.05). These results demonstrated that nimodipine is ineffective in suppressing the increase of tissue lactate and malondialdehyde levels in the early period of experimental head trauma.
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Bloqueadores de los Canales de Calcio/uso terapéutico , Traumatismos Craneocerebrales/tratamiento farmacológico , Ácido Láctico/metabolismo , Malondialdehído/metabolismo , Nimodipina/uso terapéutico , Animales , Traumatismos Craneocerebrales/metabolismo , Femenino , Masculino , ConejosRESUMEN
Six patients received 1 g and six other patients received 2 g of cefoperazone and sulbactam 15 minutes before lumbar disc surgery. Liquid chromatographic analysis of disc tissue revealed that only patients receiving the 2-g dose had mean tissue levels above the minimum inhibitory concentration for Staphylococcus aureus and epidermidis.
Asunto(s)
Antibacterianos/farmacocinética , Cefoperazona/farmacocinética , Cefalosporinas/farmacocinética , Disco Intervertebral/metabolismo , Sulbactam/farmacocinética , Quimioterapia Combinada , Humanos , Vértebras Lumbares/metabolismoRESUMEN
BACKGROUND: The aim of this study was to investigate whether enhanced stimulation voltage could be a predictor of the extent of injury in acute compressive peripheral nerve trauma. METHODS: The femoral nerves were exposed on both sides, in 11 anesthetized rabbits. Supramaximal stimulation voltage was used to produce a maximal-amplitude compound muscle action potential (CMAP) from the quadriceps femoris muscle. Afterward, the left femoral nerve was clipped for 1 minute, and the right femoral nerve for 5 minutes to produce an acute compressive injury. Immediately after removal of the clip, the proximal and distal sides of the clippage site were stimulated by gradually increased voltage until CMAPs were obtained. The same procedure was repeated at the 30th and 60th minutes. The ratio of the CMAP amplitudes obtained from proximal and distal stimulation was measured to establish a classification. RESULTS: The stimulation voltages and amplitudes of the CMAPs before clippage were similar with the after-clippage values obtained from distal stimulation (p > 0.05), but the after-clippage values obtained from proximal stimulation were different in both sides (p < 0.05). Doubled stimulation voltage was enough to obtain CMAPs on the left side, but eightfold the initial level was required on the right side. The amplitude ratios recovered to preinjury levels in all of the subjects on the left side, but only two showed recovery on the right side (p < 0.001). Histopathologically, there was axonal compression without discontinuity on the left side, whereas the fibers were dispersed on the right side. CONCLUSION: Stimulation voltage was found to discriminate the severity of the lesion in experimental peripheral nerve injury. Proximal to distal amplitude ratio seems to be a prognostic factor when the injury is less severe.
Asunto(s)
Potenciales de Acción , Nervio Femoral/lesiones , Músculo Esquelético/fisiología , Animales , Estimulación Eléctrica , Nervio Femoral/patología , Conejos , Índices de Gravedad del TraumaRESUMEN
BACKGROUND: This study aims to evaluate the effects of deferoxamine on tissue superoxide dismutase (SOD) and glutathione peroxidase (GPx) brain levels after head trauma. METHODS: Thirty rabbits were divided equally into three groups: group 1 was the sham-operated group, group 2 suffered head trauma (no treatment was given), and group 3 received deferoxamine 50 mg/kg after the trauma. Head trauma was applied unilaterally. One hour after trauma, brain cortices were resected and SOD and GPx levels were determined. One-way analysis of variance and Tukey-HSD tests were used for analysis. Significance was defined as p < 0.05. RESULTS: Baseline SOD levels are preserved in the traumatized side of the deferoxamine-treated group. Although GPx level of the traumatized side of the deferoxamine-treated group decreased significantly, the decrease was significantly less than the nontreated group. CONCLUSION: Trauma leads to a decrease in brain tissue SOD and GPx levels. Deferoxamine suppresses this decrease completely in SOD level and partially in GPx level when given after trauma.