Effects of anesthesia and perioperative management on mortality in geriatric orthopedic surgery: a retrospective study of 451 patients.

OBJECTIVE: We aimed to investigate the effects of anesthesia methods and perioperative procedures on mortality in geriatric patients operated for hip fracture. PATIENTS AND METHODS: This retrospective study included patients over 65 years of age who underwent hip fracture surgery. Demographic data, risk scores, perioperative and anesthesia management were analyzed in terms of mortality. RESULTS: Data from 451 patients who were eligible for the study were analyzed. It was determined that there was no difference in mortality between the anesthesia methods administered to the patients in hip fracture surgery (p>0.05).  Being male increased the mortality risk by 4.568 times (95% CI: 1.215-17.168), and a one-unit increase in the number of erythrocyte suspensions given perioperatively increased the mortality risk by 2.801 times (95% CI: 1.509-5.197). Additionally, an American Society of Anesthesiologists (ASA) II score increased the mortality risk by 0.120 times (95% CI: 0.021-0.690), and a higher modified Charlson comorbidity index (mCCI) of 5-7 increased the mortality risk by 0.052 times (95% CI: 0.009-0.289). CONCLUSIONS: Although high ASA and mCCI scores, male sex, and blood transfusion were associated with mortality in geriatric hip fracture surgery, we found that the method of anesthesia did not affect mortality.

Factors affecting survival in stage 2-3 colorectal cancer: a single-center retrospective study.

OBJECTIVE: The principal aim of this research is to investigate the variables that exert a discernible impact on the overall survival (OS) of individuals afflicted with colorectal cancer (CRC) harboring pathologic stages 2-3, as delineated within the TNM staging schema tailored to CRC, an established framework governed by the American Joint Committee on Cancer (AJCC). PATIENTS AND METHODS: Patients with preoperative stages 1 and 4, patients with a history of other organ malignancy, patients who could not undergo curative resection, patients with systemic malignant diseases (leukemia, lymphoma, etc.), patients with synchronous tumors, and patients with positive surgical margins were excluded from the study. Notable pathological parameters, including tumor grade, perforation status, lymphovascular invasion, perineural invasion, the presence of mucinous components, and tumor size, were ascertained through pathological examination of resected specimens. RESULTS: Curative resection was performed on 241 patients. The mean age of all patients was calculated to be 65.67±16.04. The average tumor size was measured as 5.03±2.22 cm. The 1-year survival rate of the patients was found to be 84.3%, 3-year survival rate was 69.0%, and 5-year survival rate was 52.9%. According to the COX regression analysis, the categorical variables that were found to be significantly associated with OS were grade (p=0.046), emergency surgery (p<0.001), and tumor localization (p=0.015). CONCLUSIONS: The initial patient and tumor characteristics at baseline have demonstrated substantial predictive capacity regarding patient outcomes following disease recurrence. Survival analyses showed that undergoing emergency surgery, having the tumor located in the rectum, and having a "poor" tumor grade adversely affected survival.

Medial pivot total knee arthroplasty: Mid-term results.

This study aims to evaluate the mid-term results of patients who underwent medial pivot total knee arthroplasty at a single center. A total of 304 knees of 236 patients (40 males, 196 females; mean operation age and standard deviation : 66,64 ±7,09 years; range, 45 to 82 years) treated with medial pivot total knee prosthesis in our center between January 2010 and December 2014 were retrospectively analyzed. The American Knee Society Score, Oxford Knee Score, and especially flexion angles were recorded during pre- and postoperative follow-up. Of the operated knees, 71.2% were unilateral and 28.8% were bilateral. The mean follow-up was 79.30±14.76 months. The postoperative results with the Functional Score, Knee Score, Oxford Score, Total Knee Society Score, and flexion angles were significantly higher compared to baseline (p<0.01). All postoperative scores were significantly lower inpatients aged ≥65years, compared to those aged <65 years (p<0.01). In patients who underwent resection of anterior and posterior the cruciate ligaments, only the mean flexion angles were found to increase (p<0.01). Our study results suggest that medial pivot knee prostheses are reliable in the mid-term and provide favorable results in terms of function and patient satisfaction. Level of Evidence: Level IV retrospective study.

Confusing effect of concurrent endoscopy and colonoscopy on histopathologic findings in dyspeptic patients: a nested case-control study.

OBJECTIVE: Esophagogastroduodenoscopy (EGD) is recommended for patients over 60 years old with dyspeptic complaints, treatment-resistant dyspepsia, and alarming symptoms such as vomiting, weight loss, and dysphagia. However, colonoscopy is recommended for patients with abnormal colonic loops in their imaging, lower gastrointestinal bleeding-iron deficiency anemia, or patients with symptoms related to the lower gastrointestinal tract. This study aimed to analyze the possibility of performing concurrent colonoscopy when it is indicated and whether this may affect endoscopic and histological findings. PATIENTS AND METHODS: One hundred and two patients who underwent EGD and colonoscopy (Group CC) at the same time due to dyspeptic symptoms and 146 patients who underwent EGD alone (Group EA) at SBU Kartal City Hospital between December 2020 and December 2021 were included in the study. All gastric biopsies were taken by the Sydney system. The specimens were assessed in terms of helicobacter pylori positivity, inflammation, neutrophilic activity, intestinal metaplasia, and lymphoid aggregate. RESULTS: Helicobacter pylori positivity was 46.5% and 50.7% (p=0.521), inflammation was 93.1% and 98.6% (p=0.023), neutrophilic activity was 50.0% and 65.8% (p=0.013), intestinal metaplasia was 20.6% and 24.0% (p=0.531), and the presence of lymphoid aggregate was 46.1% and 58.9% (p=0.046) in Group CC and Group EA, respectively. CONCLUSIONS: The present study comparatively evaluated the histopathological findings of patients who underwent EGD due to dyspeptic symptoms and those who underwent bidirectional endoscopy. Notably, no false positive results were observed that would necessitate a change in the treatment applied to the patients.

Is atrial fibrillation a risk factor for hearing loss?

OBJECTIVE: In the present study, we sought to evaluate the results of hearing loss in AF patients. PATIENTS AND METHODS: This study involved 50 patients with AF, as determined by means of electrocardiogram, and 50 patients without AF. The pure-tone audiometry (PTA) threshold values were measured at low, medium and high frequencies for both ears. The signal-to-noise ratio (SNR) DPOAEs and TEOAEs were also analyzed for both ears separately. RESULTS: Both the airway and bone conduction PTA thresholds at 3, 4 and 6 kHz (kilohertz) were significantly lower in the AF group than in the control group (p<0.05). The AF patients exhibited worse hearing and worse TEOAE results at 1, 2, 3 and 4 kHz. In fact, the TEOAE amplitudes of the AF group were significantly lower in both the right and left ears at 2, 3 and 4 kHz when compared with the control group (p<0.05). Moreover, the DPOAE amplitudes in the AF group were statistically significantly lower at 3.4 kHz in both ears when compared with the control group (p<0.05). CONCLUSIONS: In light of these findings, we believe that AF is a risk factor for hearing.

Evaluation of retinal and optic nerve vasculature by optic coherence tomography angiography in Migraine with Aura.

PURPOSE: This study aimed to evaluate the retina by optic coherence tomography angiography (OCTA) in patients with migraine with aura (MA) in comparison with healthy controls. MATERIALS AND METHODS: A total of 60 patients with MA and 56 control subjects who applied to the Ophthalmology Clinic of Dicle University between January 2020 and February 2020 were included in this study. In all patients, the vascular density (VD) of the radial peripapillary capillaries (RPCs) and optic nerve head (ONH), the VD of deep and superficial macular vascular networks, and foveal avascular zone (FAZ) were measured. RESULTS: Patients with MA showed reduced VD measurements of the nasal and inferotemporal ONH, inferonasal RPCs, and deep macular plexus. No statistically significant difference was observed in the superficial macular VD values between the study groups. The majority of patients with MA showed hypertrophy in the deep FAZ. CONCLUSION: There was a decrease in VD measurements in the deep macular capillary plexus, ONH, and peripapillary capillaries and hypertrophy in the deep FAZ in patients with MA. According to these results, patients with MA may have an increased risk of developing ocular and systemic vascular complications. Therefore, OCTA can be used to evaluate systemic and ocular hypoperfusion in patients with MA.

Systemic inflammation in both open-angle and angle-closure glaucoma: role of platelet-to-lymphocyte ratio.

AIM: To analyse the effect of systemic inflammatory status in patients with primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) by calculating platelet-to-lymphocyte ratio (PLR) and neutrophil-to-lymphocyte ratio (NLR). METHODS: This retrospective case-control study included 200 patients with POAG, 22 patients with PACG and 100 healthy subjects. The participants' white-blood-cell, lymphocyte, neutrophil, and platelet counts were recorded from previous blood assays. NLR and PLR were calculated manually. Results were compared among the groups. RESULTS: Both the POAG and PACG groups had higher platelet counts and PLR values than the control group (p=0.001 and p=0.001; respectively). The difference in NLR between POAG, PACG and control groups was not statistically significant (p=0.076). The POAG group had higher NLR values than the control (p=0.035). CONCLUSION: Both the POAG and the PACG groups exhibited higher platelet and PLR levels than the control. These results indicate a potential role of systemic inflammation in the pathogenesis of POAG and PACG (Tab. 4, Fig. 1, Ref. 35).

Investigating the efficacy and safety of oral spironolactone in patients with central serous chorioretinopathy.

OBJECTiVE: The goal of this study was to investigate the efficacy and safety of oral spironolactone in patients with central serous chorioretinopathy (CSC). MATERiALS AND METHODS: In our study, acute CSC patients were divided into two groups: those who received spironolactone 25mg twice a day as the study group, and those who were not treated as the control group. Fundus fluorescein angiography was performed in all patients. Subretinal fluid (SRF) height and central macular thickness (CMT) spectral area were measured by optical coherence tomography as well as subfoveal choroid thickness (CT) in enhanced depth imaging (EDI) mode. The best-corrected visual acuity (BVCA) was measured with the Snellen chart. Side effects of spironolactone were evaluated. RESULTS: There were 31 eyes in the study group and 28 eyes in the control group. The mean follow-up was 2.4±0.5 months. The average SRF height of 240.26±92.89µm in the study group decreased to 26.77±39.52µm (P<0.05) at the last follow-up. SRF height was completely improved in 18 eyes (58.06%). On the first evaluation, the mean CMT of 453.26±147.73 was reduced to 276.19±109.29µm at the last follow-up. (P<0.05). While the initial mean subfoveal CT was 482.10±86.36µm, it decreased to 427.10±83.32µm at the last follow-up (P<0.01). The mean baseline BCVA of 0.5±0.23 was increased to 0.9±0.16 (P<0.01) at the last follow-up. At the last follow-up, BCVA was 10/10 (1.0) in 21 eyes (67.74%). In the control group, the mean SRF height of 277.71±108.83µm was 172.96±93.88µm (P<0.05) at the last follow-up. The mean CMT in the control group was 464.5±131.14µm at the first evaluation and 349.82±111.45µm (P<0.05) at the last follow-up. The initial mean subfoveal CT was 487.93±88.9µm; at the last follow-up, it was 447.71±71.32µm (P<0.01). While the mean BCVA of the control group was initially 0.53±0.19, it was found to be 0.64±0.19 (P<0.01) at the final control. The decrease in SRF height in the 3rd month was significantly greater in the study group compared to the control group (P<0.01). However, the decrease in CMT at 3 months and an increase in BCVA were also significant in the study group compared to the control group (P<0.01). CT decreased significantly in the third month in both groups compared to the first month, but there was no difference between the two groups. In a patient who developed palpitations and nausea, treatment was discontinued because he could not tolerate oral spironolactone. CONCLUSiON: In our series, effective visual improvement and subretinal fluid resorption were achieved in acute CSC patients who were given spironolactone. Side effects are rare.

Influence of Infraspinatus and Subscapularis Pathologies on Supraspinatus Muscle Atrophy - A Retrospective Cohort Study.

INTRODUCTION: Many factors could affect the supraspinatus (SSP) muscle after tendon rupture. We aimed to determine how infraspinatus and subscapularis tendon problems affect supraspinatus muscle atrophy associated with tears, in a retrospective cohort study conducted in a tertiary-level centre. MATERIAL AND METHODS: Fifty-eight patients with a full-thickness SSP tendon tear who fulfilled the inclusion criteria were enrolled in the study. They were evaluated for tear retraction, fatty degeneration, and other rotator cuff tendon pathologies. Supraspinatus muscle was assessed using the Goutallier classification, and its average area was also measured. Accompanying lesions of the subscapularis and infraspinatus tendons and degree of supraspinatus muscle atrophy were evaluated using magnetic resonance imaging. RESULTS: Our results showed that supraspinatus tendon tears ranged between 3mm and 41mm, and the estimated average cross-sectional area of the SSP muscle was 247.6mm2. Any degree of infraspinatus tendon pathology, ranging from tendinosis to full-thickness tears, was significantly correlated with the SSP muscle area (P < 0.05). The subscapularis tendon pathologies did not show a similar correlation. The interobserver and intraobserver reliabilities of the measurements were graded as excellent. CONCLUSION: Impairment of any of the rotator cuff muscles may affect the other muscles inversely. Our study showed that all infraspinatus tendon pathologies and partial subscapularis tears affect and alter the SSP muscle belly. We suggest early intervention for supraspinatus tears to avoid further fatty degeneration, as muscle atrophy and fatty degeneration progress in combination with the accompanying lesions.

Do interictal EEG findings reflect cognitive function in juvenile myoclonic epilepsy?

PURPOSE: This study investigated the relationship between frontal lobe cognitive function and frontal focal electroencephalography (EEG) findings in patients with juvenile myoclonic epilepsy (JME). METHODS: The study enrolled 60 patients diagnosed with JME and followed at the Epilepsy Outpatient Clinic of the University of Health Sciences, Bakirkoy Psychiatric Hospital, and 30 healthy volunteers. Demographic and clinical features were recorded. Frontal lobe cognitive functions were tested in both groups. Video-EEG recordings of patients with JME were evaluated. The presence and duration of generalized discharges, the presence and lateralization of focal findings, and the presence of generalized discharges during hyperventilation and photic stimulation were recorded during EEG. Cognitive function test results were compared between the two groups, and the relationship between the EEG findings and cognitive function was investigated. RESULTS: The study included 35 (58.3%) female and 25 (41.6%) male patients and 17 (56.7%) female and 13 (43.3%) male healthy controls. The mean ages of the group with JME and controls were 28.3 ±â€¯8.6 (16-50) and 31.3 ±â€¯7.9 (17-45) years, respectively. Patients with JME performed more poorly on the frontal lobe cognitive tests than controls (p < 0.05). Patients whose generalized discharges were longer than 1 s performed more poorly on tests evaluating attention and made more perseverative errors (p < 0.05). There was no significant correlation between the presence of focal EEG findings and the scores on frontal lobe cognitive functions tests in the group with JME (p > 0.05). CONCLUSION: Frontal lobe cognitive functions are affected in patients with JME. The cognitive effects were more pronounced in patients with prolonged generalized discharges on EEG.

Oxidative DNA Damage Is Increased in Living Kidney Donors.

BACKGROUND: Long-term consequences of donor nephrectomy might be reduced kidney function, increased risk for cardiovascular disease, and impaired quality of life. The purpose of the current cross-sectional study was to evaluate the relationship between clinical, laboratory, and donation-specific outcomes of living kidney donors and systemic oxidative DNA damage. METHODS: We conducted a cross-sectional study and assessed retrospectively pre- and postdonation data from 60 donors who donated between 2010 and 2015. Plasma malondialdehyde levels and 8-hydroxy-2'-deoxyguanosine/deoxyguanosine ratio (8-OHdG/dG ratio) were determined as oxidative stress markers. Catalase, carbonic anhydrase, and paraoxonase (PON) activities were measured as antioxidants. RESULTS: Approximately 3 years after donation, the hypertensive donor ratio was 12%, and 11% of the donors had glomerular filtration rate <60 mL/min/1.73 m2. Mean serum urea (P = .001) and serum creatinine levels (P = .001) were increased; creatinine clearance level (126.2 ± 35.5 vs 94.6 ± 26.8, P = .001) was decreased in the postdonation period. There was a significant positive correlation between predonation serum urea and 8-0HdG/dG ratio (r = 0.338, P = .016) and predonation serum creatinine and 8-0HdG/dG ratio (r = 0.442, P = .001), while there was a significant negative correlation between serum creatinine and PON activity (r = -0.545, P < .001). CONCLUSION: Our data have demonstrated that kidney donors exhibit increased oxidative DNA damage and decreased antioxidant activity. We propose that predonation serum creatinine is positively correlated with 8-0HdG/dG ratio and negatively correlated with antioxidant PON activity. This is the first study to demonstrate that plasma oxidative DNA damage increases in healthy kidney donors.

Impact of right ventricular diastolic dysfunction on clinical outcomes in inferior STEMI.

BACKGROUND: The aim of this study was to investigate the prognostic value of restrictive right ventricular filling pattern (RRVFP) in patients with the first acute inferior wall myocardial infarction (IWMI) complicated by right ventricular myocardial infarction (RVMI) undergoing primary percutaneous coronary intervention (p-PCI). METHOD: A total of 152 patients with acute IWMI complicated by RVMI undergoing p­PCI were divided into two groups according to the presence of RRVFP. RRVFP was defined as tricuspid diastolic early/late flow velocities (Et/At) > 2 and Et deceleration time (DT) < 120 ms. RESULTS: There were 23 patients with RRVFP in the study cohort. At, DTt, isovolumetric relaxation time (IVRT), and tissue Doppler tricuspid annular late velocity (A't) were reduced significantly in patients with RRVFP than in those without RRVFP (At 19.6 ± 2.7 vs. 39.1 ± 7.4 cm/s, p < 0.001; DTt 106 ± 13 vs.156 ± 21 ms, p = 0.001; IVRT 59 ± 6.7 vs. 62 ± 7.4 ms, p = 0.01; A't 4.6 ± 1.1 vs. 8.6 ± 1.05, p = 0.001). Et/At ratios were higher in patients with RRVFP than in those without RRVFP (Et/At 2.20 ± 0.2 vs. 1.15 ± 0.37, p < 0.001). Et, tissue Doppler tricuspid annular early velocity (E't), E't/A't ratio, and Et/E't ratio were not significantly different between groups (Et 43.3 ± 5.4 vs. 40.7 ± 9.2 cm/s p = 0.18; E't 8.8 ± 1.4 vs. 9.5 ± 2.3, p = 0.15; E't/A't 1.08 ± 0.24 vs. 1.13 ± 0.30, p = 0.52; Et/E't ratio 5.0 ± 1.1 vs. 4.5 ± 1.5 p = 0.09). Presence of E't/A't > 2, short DTt, RRVFP, unsuccessful p­PCI, and cardiogenic shock on admission were independent predictors of in-hospital mortality (p < 0.05) in multivariable logistic regression analysis. CONCLUSION: Presence of RRVFP is associated with in-hospital mortality in patients presenting with their first IWMI complicated by RVMI.

Increased Oxidative Stress in Living Kidney Donors: Correlation of Renal Functions With Antioxidant Capacity.

BACKGROUND: Substantial attention has recently been paid to the possibility of an increased risk of chronic kidney disease (CKD) in living kidney donors. It has been demonstrated that CKD patients suffer from increased oxidative stress, which have been reported to show a strong association with several clinical problems such as accelerated atherosclerosis. The purpose of the current cross-sectional, single-center study was to evaluate the relationship between renal functions of living kidney donors and systemic oxidative stress. METHODS: A total of 55 living kidney donors operated at least 1 year ago and 40 age- and sex-matched healthy individuals were enrolled in this study. Plasma malondialdehyde (MDA) levels were determined as oxidative stress marker. Superoxide dismutase (SOD) and glutathione peroxidase (GPx) activities were measured as antioxidants. Renal function parameters and proteinuria were also assessed. RESULTS: Mean serum creatinine levels were higher (P = .022) and 24-hour creatinine clearance was lower (P = .016) in living kidney donors compared with healthy controls. Serum MDA levels were higher (P = .034), and SOD and GPx activities were lower (P = .023 and P < .001, respectively). There was a significant positive correlation between serum GPx activity and 24-hour creatinine clearance levels (r = 0.524, P < .01). A linear regression analysis showed that serum GPx activity was still significantly and positively correlated with creatinine clearance (regression coefficient = 0.416, P < .001). CONCLUSION: Our data demonstrated that living kidney donors exhibit slightly reduced kidney function, increased oxidative stress, and decreased antioxidant activity. We propose that 24-hour creatinine clearance is positively correlated with antioxidant enzyme GPx. To our knowledge, this is the first study to demonstrate the association between renal functions and antioxidant activity in kidney donors.

The Relationship between Angiotensin-II Type 1 Receptor Gene Polymorphism and Repolarization Parameters after a First Anterior Acute Myocardial Infarction.

BACKGROUND AND OBJECTIVES: Genetic influence on T-wave peak to End (Tpe) time in patients with a first anterior acute myocardial infarction (AMI) is uncertain. A polymorphism in the angiotensin-II type 1 receptor (AT1R) gene was discovered recently. The polymorphism consists of an A or C variant, given three different possible genotypes: AA, AC, CC. The purpose of this study was to determine the effects of polymorphism of the AT1R gene polymorphism on Tpe after a first anterior AMI. SUBJECTS AND METHODS: The subjects were 142 patients (110 men, 32 women, 58±13 years) with a first anterior AMI; ten patients were excluded from this study. Based on the polymorphism of the AT1R gene, they were classified into two groups: Group 1 (AA genotype) of 91 patients and group 2 (AC and CC genotype) of 41 patients. A 12-lead resting ECG was recorded at admission to the coronary care unit in patients with anterior AMI and were manually measured with a ruler. QTc, QTd, QTcd, Tpe, Tpe/QT parameters were measured. RESULTS: There was no significant difference in the baseline characteristics of patients (p>0.05). We found significant reduction in QTc, QTd, QTcd, Tpe, Tpe/QT indices Group 1 (AA genotype) (mean 66±28 ms) than group 2 (AC and CC genotype) (mean 95±34 ms) (p<0.05). CONCLUSION: In patients with a first anterior AMI, AT1R gene polymorphisms may influence on repolarization parameters. Although further studies are required.

The administration sequence of propofol and remifentanil does not affect the ED50 and ED95 of rocuronium in rapid sequence induction of anesthesia: a double-blind randomized controlled trial.

OBJECTIVE: The topic of drug administration sequence in rapid sequence induction (RSI) is still an object of interest in terms of rocuronium effectiveness. The aim of this prospective, randomized trial was to evaluate the effect of administration sequence of propofol and remifentanil on ED50 and ED95 of rocuronium in a RSI model. PATIENTS AND METHODS: Eighty-four patients were randomized into Group Remifentanil (Group R, n = 43), where induction of general anesthesia started with remifentanil (2 µg/kg) and followed by propofol (2 mg/kg) and rocuronium administrations; and Group Propofol (Group P, n = 41), where induction of general anesthesia started with propofol and followed by remifentanil and rocuronium. First patients in each group were paralyzed by 0.8 mg/kg rocuronium. In case of acceptable intubation as evaluated according to the criteria described by Viby-Mogensen et al, rocuronium dose was decreased by 0.1 mg/kg for the next patient; otherwise, rocuronium dose was increased by 0.1 mg/kg. After three crossover points, increments or decrements in rocuronium dosage were set to 0.05 mg/kg. The process was repeated until a total of ten crossover points were obtained. RESULTS: The ED50 and ED95 doses of rocuronium were similar in Group R (0.182 mg/kg, and 0.244 mg/kg, respectively) and Group P (0.121 mg/kg, and 0.243 mg/kg, respectively) according to 95% CI of the estimates. There was no statistically significant difference in terms of clinically acceptable intubation conditions between the two groups (56.1% in Group R vs. 59% in Group P, p = 0.795). CONCLUSIONS: The choice of administration sequence of propofol and remifentanil does not have an impact on estimated ED50 and ED95 of rocuronium in providing acceptable intubation conditions in the RSI technique.

Curcumin and dexmedetomidine prevents oxidative stress and renal injury in hind limb ischemia/reperfusion injury in a rat model.

Curcumin and dexmedetomidine have been shown to have protective effects in ischemia-reperfusion injury on various organs. However, their protective effects on kidney tissue against ischemia-reperfusion injury remain unclear. We aimed to determine whether curcumin or dexmedetomidine prevents renal tissue from injury that was induced by hind limb ischemia-reperfusion in rats. Fifty rats were divided into five groups: sham, control, curcumin (CUR) group (200 mg/kg curcumin, n = 10), dexmedetomidine (DEX) group (25 µg/kg dexmedetomidine, n = 10), and curcumin-dexmedetomidine (CUR-DEX) group (200 mg/kg curcumin and 25 µg/kg dexmedetomidine). Curcumin and dexmedetomidine were administered intraperitoneally immediately after the end of 4 h ischemia, just 5 min before reperfusion. The extremity re-perfused for 2 h and then blood samples were taken and total antioxidant capacity (TAC), total oxidative status (TOS) levels, and oxidative stress index (OSI) were measured, and renal tissue samples were histopathologically examined. The TAC activity levels in blood samples were significantly lower in the control than the other groups (p < 0.01 for all comparisons). The TOS activity levels in blood samples were significantly higher in Control group and than the other groups (p < 0.01 for all comparison). The OSI were found to be significantly increased in the control group compared to others groups (p < 0.001 for all comparisons). Histopathological examination revealed less severe lesions in the sham, CUR, DEX, and CUR-DEX groups, compared with the control group (p < 0.01). Rat hind limb ischemia-reperfusion causes histopathological changes in the kidneys. Curcumin and dexmedetomidine administered intraperitoneally was effective in reducing oxidative stress and renal histopathologic injury in an acute hind limb I/R rat model.

The contribution of each anterior cruciate ligament bundle to the Lachman test: a cadaver investigation.

The clinical diagnosis of a partial tear of the anterior cruciate ligament (ACL) is still subject to debate. Little is known about the contribution of each ACL bundle during the Lachman test. We investigated this using six fresh-frozen cadaveric lower limbs. Screws were placed in the femora and tibiae as fixed landmarks for digitisation of the bone positions. The femur was secured horizontally in a clamp. A metal hook was screwed to the tibial tubercle and used to apply a load of 150 N directed anteroposteriorly to the tibia to simulate the Lachman test. The knees then received constant axial compression and 3D knee kinematic data were collected by digitising the screw head positions in 30° flexion under each test condition. Measurements of tibial translation and rotation were made, first with the ACL intact, then after sequential cutting of the ACL bundles, and finally after complete division of the ACL. Two-way analysis of variance analysis was performed. During the Lachman test, in all knees and in all test conditions, lateral tibial translation exceeded that on the medial side. With an intact ACL, both anterior and lateral tibial landmarks translated significantly more than those on the medial side (p < 0.001). With sequential division of the ACL bundles, selective cutting of the posterolateral bundle (PLB) did not increase translation of any landmark compared with when the ACL remained intact. Cutting the anteromedial bundle (AMB) resulted in an increased anterior translation of all landmarks. Compared to the intact ACL, when the ACL was fully transected a significant increase in anterior translation of all landmarks occurred (p < 0.001). However, anterior tibial translation was almost identical after AMB or complete ACL division. We found that the AMB confers its most significant contribution to tibial translation during the Lachman test, whereas the PLB has a negligible effect on anterior translation. Section of the PLB had a greater effect on increasing the internal rotation of the tibia than the AMB. However, its contribution of a mean of 2.8° amplitude remains low. The clinical relevance of our investigation suggests that, based on anterior tibial translation only, one cannot distinguish between a full ACL and an isolated AMB tear. Isolated PLB tears cannot be detected solely by the Lachman test, as this bundle probably contributes more resistance to the pivot shift.

Effect of mitomycin-C on post-operative adhesions in tendon surgery: an experimental study in rats.

We investigated the effect of mitomycin-C on the reduction of the formation of peritendinous fibrous adhesions after tendon repair. In 20 Wistar albino rats the tendo Achillis was cut and repaired using a modified Kessler technique. The rats were divided into two equal groups. In group 1, an injection of mitomycin-C was placed between the tendon and skin of the right leg. In group 2, an identical volume of sterile normal saline was injected on the left side in a similar fashion. All the rats received mitomycin-C or saline for four weeks starting from the day of operation. The animals were killed after 30 days. The formation of peritendinous fibrous tissue, the inflammatory reaction and tendon healing were evaluated. The tensile strength of the repaired tendons was measured biomechanically. Microscopic evidence of the formation of adhesions and inflammation was less in group 1. There was no significant difference in the tensile load required to rupture the repaired tendons in the two groups. Mitomycin-C may therefore provide a simple and inexpensive means of preventing of post-operative adhesions.