The diagnostic role of testicular fatty acid-binding protein in testicular ischemia: A randomized controlled experimental study. / El papel de la proteína testicular acido graso en la isquemia testicular: estudio experimental randomizado.

OBJECTIVE: To investigate the diagnostic value of testicular fatty acid-binding protein (T-FABP) in acute testicular ischemia and prolonged ischemia. METHODS: The study included a total of 28 prepubertal male Wistar-Hannover rats. The animals were randomly divided into 4 groups as torsion groups (group I; min 30; 7 rats, group II; min 120; 7 rats, group III; min 240; 7 rats) and control group (group IV; 7 rats). In each group, the left testis was separated from the gubernaculum by blunt dissection together with the tunica vaginalis and spermatic cord, and then exposed. In the control group, the blood samples and left testicular tissues were collected at min 240 after extraction. In torsion groups, the left testis was rotated together with its cord elements,720° in a clockwise direction for the induction of an extravaginal TT model. The blood samples were obtained at min 30, 120, and 240 in the torsion groups. Bilateral testicular tissues were collected via orchiectomy for histopathological examination in all groups. RESULTS: The mean plasma T-FABP level in group III (torsion, min 240) was significantly higher than those of other groups. The T-FABP level at min 240 had a sensitivity and specificity of 100% and 85%, respectively, at a cut-off value of 1.059. A significant difference was found between the torsion groups and the control group with regard to histopathological scores. CONCLUSIONS: The increased T-FABP levels in testicular ischemia seem to be correlated with testicular necrosis rather than acute ischemia.

OBJETIVO: Investigar el valor diagnostico de la proteína testicular acido graso (PTAG) en la isquemia testicular aguda y prolongada. MÉTODOS: El estudio involucró 28 ratas Wastar-Hannover varones prepuberales. Los animales fueron randomizados y divididos en 4 grupos: grupo torsión (grupo I; min 30; 7 ratas, grupo II; min 120; 7 ratas, grupo III; min 240; 7 ratas), grupo control (grupo IV; 7 ratas). En cada grupo, el testículo izquierdo fue separado del gubernáculo con disección, junto con la túnica vaginalis y el cordón espermático, y después fueron expuestos. En el grupo control, la extracción de sangre y tejido testicular izquierdo fueron recolectados a los 240 minutosde la extracción. En el grupo de torsión, el testículo izquierdo se rotó junto con los elementos del cordón espermático, 720 grados en la dirección de las agujas del reloj para la inducción de un modelo TT extravaginal. Las muestras de sangre fueron obtenidas a los 30 minutos, 120 y 240 minutos en los grupos torsión. Tejido testicular bilateral fue recogido vía orquiectomia para examen anatomopatológico en todos los grupos. RESULTADOS: El nivel medio de PTAG en el grupo III (torsión 240 min) fue significativamente superior a los demás grupos. El nivel de PTAG a los 240 minutos tuvo una sensibilidad y especificidad del 100% y 85%, respectivamente a un valor de corte de 1.059. Se encontró una diferencia significativa entre los grupos de torsión y control en relación a los "scores" anatomopatológicos. CONCLUSIONES: Los niveles elevados de PTAG en la isquemia testicular parecen correlacionados con la necrosis testicular más que con la isquemia aguda.

Retrospective study of the effect of sarcopaenia on post-operative outcomes in patients undergoing thoracic surgery.

Background & objectives: Sarcopaenia refers to the pathological loss of muscle mass that may be observed in malnutrition, immobility, chronic disease, particularly chronic obstructive pulmonary disease and malignancies. A relationship has been identified between sarcopaenia and thoracic surgery. The aim of the present study was to investigate the relationship between density and area of the psoas major muscle (PSM), the pectoralis major and minor muscles (PEC) and the post-operative morbidity, mortality and survival of patients undergoing anatomic lung resection. Methods: A retrospective review of the medical record data of the patients who underwent lung resection was conducted in between 2009 and 2018. The study included patients who underwent upper abdominal computed tomography (CT) for the measurement of PSM and thoracic CT for PEC. The demographic data, laboratory test results, radiological findings and the survival data of the patients were recorded. Results: Evaluation was made of 161 patients with available CT data. With the exception of mean PEC density, the PEC parameters (P=0.013-0.026), and PSM density (P=0.015) were significantly lower in the non-survivors than in the survivors. In general, the mean measurements of the PSM and PEC were seen to affect mortality (P=0.001-0.024). Interpretation & conclusions: The mean area and density measurements in the PSM, and particularly in the PEC, were determined to be significantly higher in patients who survived after lung cancer surgery, suggesting that sarcopaenia could be a useful predictor of post-operative mortality risk and survival.

The Diagnostic Values of Ischemia-Modified Albumin in Patients with Acute Abdominal Pain and Its Role in Differentiating Acute Abdomen.

AIM: The aim of this study was to evaluate the diagnostic value of serum ischemia-modified albumin (IMA) levels in patients presenting to the emergency department with acute abdominal pain and its use in differentiating acute surgical abdomen. METHODS: This single-center prospective cross-sectional study included 334 adult patients who presented to the emergency department. These consisted of 194 patients (Group 1) with nontraumatic abdominal pain commencing in the preceding week, who were definitely diagnosed and either hospitalized in a specific department or planned for discharge, and a control group of 140 patients (Group 2). RESULTS: The mean IMA value of the patients diagnosed with acute appendicitis was statistically significantly higher than that of the control group. The mean IMA value of the patients diagnosed with acute appendicitis, ovarian pathologies, and gastritis-peptic ulcer was statistically significantly higher than that of the nonspecific abdominal pain group. CONCLUSION: Serum IMA levels can be used as a diagnostic marker in patients with acute appendicitis. Furthermore, serum IMA levels in patients presenting to the emergency department with abdominal pain may be indicative of patients requiring surgery or of complicated cases, particularly in terms of acute appendicitis and ovarian pathologies.

Psoas Muscle Area Measured with Computed Tomography at Admission to Intensive Care Unit: Prediction of In-Hospital Mortality in Patients with Pulmonary Embolism.

AIM: Sarcopenia, a core component of physical frailty, is an independent risk factor for suboptimal health outcomes in hospitalized patients, especially in the intensive care patients. Psoas muscle areas can be assessed to identify sarcopenia. The aim of this study was to determine the prognostic value of psoas muscle area measured with CT for the prediction of in-hospital mortality in patients with pulmonary embolism at admission to the intensive care unit. METHODS: Patients with an admission abdominal computed tomography scan and requiring intensive care unit (ICU) stay were reviewed. Selected clinical data of patients admitted to intensive care unit for the management of pulmonary embolism were collected. Using CT scan images at the level of L3 vertebra, the psoas muscle area value was obtained by dividing the sum of the right and left psoas muscle areas into the body surface area. RESULTS: In-hospital mortality rate was 22.5% in 89 patients. The pulmonary embolism patients with in-hospital mortality had higher PESI and lower value of psoas muscle area, in addition to the lower systolic blood pressure and arterial oxygen saturation at admission. The increase in the value of psoas muscle area is associated with a decrease in the rate of in-hospital mortality. In patients with in-hospital mortality related to pulmonary embolism, the higher PESI and the lower value of psoas muscle area were considered in accordance with the outcome of patients. CONCLUSIONS: For the prediction of in-hospital mortality risk in patients with pulmonary embolism managed in intensive care unit, the psoas muscle area value has a merit to be used among the routine diagnostic procedures after further studies conducted with different severity of pulmonary embolism.

Evaluation of the attitudes of surgeons about regional anesthesia: a survey study.

BACKGROUND: The intraoperative attending anaesthesiologist ultimately makes decisions about the anaesthesiology technique to be performed, but the attitudes of surgeons and preferences of patients on this subject may affect their choice. In this questionnaire-based study, we aimed to evaluate the attitudes and behaviors of surgeons about the use of regional anaesthesia (RA) in surgical operations. METHODS: Surgeons from different surgical branches with residencies at 4 different hospitals were asked to complete questionnaires that included reasons for preferring (12 reasons) and not preferring (13 reasons) the use of RA techniques for surgeries, using a 5-point Likert scale. RESULTS: A total of 156 surgeons from 4 hospitals, out of 167 surgeons who were approached to participate in the study, completed the questionnaire. The most commonly observed reason for a preference towards regional anaesthesia among the surgeons was the risk of general anaesthesia for patients with an American Society of Anesthesiologists (ASA) risk class of III and above. The second most commonly observed reason was for protection from the complications of general anaesthesia, and the third most commonly observed reason was the lower risk of thromboembolisms with regional anaesthesia. The most commonly observed reasons for not choosing regional anaesthesia were found to be incompatibility of the patients and patients' fears of feeling pain during surgery. CONCLUSION: We conclude that programmes for informing surgeons and educating patients about the advantages of RA may increase the preference ratio among surgeons and decrease patients' refusals to choose this procedure.

The Relation between Sarcopenia and Mortality in Patients at Intensive Care Unit.

BACKGROUND AND AIM: Psoas muscle area (PMA) can reflect the status of skeletal muscle in the whole body. It has been also reported that decreased PMA was associated with postoperative mortality or morbidity after several surgical procedures. In this study, we aimed to investigate the relation between PMA and mortality in all age groups in intensive care unit (UNIT). MATERIALS AND METHOD: The study consists of 362 consecutive patients. The demographic characteristics of patients, indications for ICU hospitalization, laboratory parameters, and clinical parameters consist of mortality and length of stay, and surgery history was obtained from intensive care archive records. RESULTS: The mean age was 61.2 ± 18.2 years, and the percentage of female was 33.3%. The mean duration of stay was 10.3 ± 24.4 days. Exitus ratio, partial healing, and healing were 25%, 70%, and 5%, respectively. The mean right, left, and total PMA were 8.7 ± 3.6, 8.9 ± 3.4, and 17.6 ± 6.9, respectively. The left and total PMA averages of the nonoperation patients were statistically significantly lower (p = 0.021 p = 0.043). The mean PMA between the ex and recovered patients were statistically significantly lower (p = 0.001, p = 0.001, p < 0.001). Dyspnoea, renal insufficiency, COPD, transfusion rate, operation rate, ventilator needy, and mean duration of hospitalization were statistically significant higher in patients with exitus. There is a significant difference in operation types, anesthesia type, and clinic rates. CONCLUSION: Our data suggest that sarcopenia can be used to risk stratification in ICU patients. Future studies may use this technique to individualize postoperative interventions that may reduce the risk for an adverse discharge disposition related to critical illness, such as early mobilization, optimized nutritional support, and reduction of sedation and opioid dose.

Factors Affecting the Length of Stay in the Intensive Care Unit: Our Clinical Experience.

BACKGROUND AND AIM: Long hospital days in intensive care unit (ICU) due to life-threatening diseases are increasing in the world. The primary goal in ICU is to decrease length of stay in order to improve the quality of medical care and reduce cost. The aim of our study is to identify and categorize the factors associated with prolonged stays in ICU. MATERIALS AND METHOD: We retrospectively analyzed 3925 patients. We obtained the patients' demographic, clinical, diagnostic, and physiologic variables; mortality; lengths of stay by examining the intensive care unit database records. RESULTS: The mean age of the study was 61.6 ± 18.9 years. The average length of stay in intensive care unit was 10.2 ± 25.2 days. The most common cause of hospitalization was because of multiple diseases (19.5%). The length of stay was positively correlated with urea, creatinine, and sodium. It was negatively correlated with uric acid and hematocrit levels. Length of stay was significantly higher in patients not operated on than in patients operated on (p < 0.001). CONCLUSION: Our study showed a significantly increased length of stay in patients with cardiovascular system diseases, multiple diseases, nervous system diseases, and cerebrovascular diseases. Moreover we showed that when urea, creatinine, and sodium values increase, in parallel the length of stay increases.

Comparison of Mask Oxygen Therapy and High-Flow Oxygen Therapy after Cardiopulmonary Bypass in Obese Patients.

Background: To clarify the efficiency of mask O2 and high-flow O2 (HFO) treatments following cardiopulmonary bypass (CPB) in obese patients. Methods: During follow-up, oxygenization parameters including arterial pressure of oxygen (PaO2), peripheral oxygen saturation (SpO2), and arterial partial pressure of carbon dioxide (PaCO2) and physical examination parameters including respiratory rate, heart rate, and arterial pressure were recorded respectively. Presence of atelectasia and dyspnea was noted. Also, comfort scores of patients were evaluated. Results: Mean duration of hospital stay was 6.9 ± 1.1 days in the mask O2 group, whereas the duration was significantly shorter (6.5 ± 0.7 days) in the HFO group (p=0.034). The PaO2 values and SpO2 values were significantly higher, and PaCO2 values were significantly lower in patients who received HFO after 4th, 12th, 24th, 36th, and 48th hours. In postoperative course, HFO leads patients to achieve better postoperative FVC (p < 0.001). Also, dyspnea scores and comfort scores were significantly better in patients who received HFO in both postoperative day 1 and day 2 (p < 0.001, p < 0.001 and p=0.002, p=0.001, resp.). Conclusion: Our study demonstrated that HFO following CPB in obese patients improved postoperative PaO2, SpO2, and PaCO2 values and decreased the atelectasis score, reintubation, and mortality rates when compared with mask O2.

Effects of pressure-controlled and volume-controlled ventilation on respiratory mechanics and systemic stress response during prone position.

BACKGROUND: Prone position during general anesthesia for special surgical operations may be related with increased airway pressure, decreased pulmonary and thoracic compliance that may be explained by restriction of chest expansion and compression of abdomen. The optimum ventilation mode for anesthetized patients on prone position was not described and studies comparing volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV) during prone position are limited. We hypothesized that PCV instead of VCV during prone position could achieve lower airway pressures and reduce the systemic stress response. In this study, we aimed to compare the effects of PCV and VCV modes during prone position on respiratory mechanics, oxygenation, and hemodynamics, as well as blood cortisol and insulin levels, which has not been investigated before. METHODS: Fifty-four ASA I-II patients, 18-70 years of age, who underwent percutaneous nephrolithotomy on prone position, were randomly selected to receive either the PCV (Group PC, n = 27) or VCV (Group VC, n = 27) under general anesthesia with sevoflurane and fentanyl. Blood sampling was made for baseline arterial blood gases (ABG), cortisol, insulin, and glucose levels. After anesthesia induction and endotracheal intubation, patients in Group PC were given pressure support to form 8 mL/kg tidal volume and patients in Group VC was maintained at 8 mL/kg tidal volume calculated using predicted body weight. All patients were maintained with 5 cmH2O PEEP. Respiratory parameters were recorded during supine and prone position. Assessment of ABG and sampling for cortisol, insulin and glucose levels were repeated during surgery and 60 min after extubation. RESULTS: P-peak and P-plateau levels during supine and prone positions were significantly higher and P-mean and compliance levels during prone position were significantly lower in Group VC when compared with Group PC. Postoperative PaO2 level was significantly higher in Group PC compared with Group VC. Cortisol levels were increased with surgery in both groups (p < 0.05) and decreased to baseline levels in Group PC while remained high in Group VC in the early postoperative period. Cortisol levels were significantly higher in Group VC during surgery and in the early postoperative period compared with Group PC. CONCLUSION: When compared with VCV mode, PCV mode is associated with lower P-peak and P-plateau levels during both supine and prone positions, better oxygenation postoperatively, lower blood cortisol levels during surgery in prone position and in the early postoperative period. We concluded that PCV mode might be more appropriate in prone position during anesthesia.

Novel hematologic inflammatory parameters to predict acute mesenteric ischemia.

Acute mesenteric ischaemia (AMI) is an emergency condition that requires urgent diagnosis. Neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) have been studied as inflammatory biomarkers in atherosclerosis, but data regarding AMI are lacking. The study population included patients with AMI (n = 46) versus age and sex-matched healthy controls (n = 46). Computed multidetector tomographic angiography was performed to diagnose AMI. NLR and PLR were calculated using complete blood count. C-reactive protein (CRP) levels were also analyzed. Neutrophil levels and lymphocytes were significantly higher in patients with AMI than in the control individuals (P < 0.001 and P = 0.43, respectively). NLR levels were significantly higher in patients with AMI compared with that in the control individuals (P < 0.001). Platelet levels did not reach statistical significance between the groups (P = 0.709). However, patients with AMI had significantly higher PLR levels than the control group (P = 0.039). CRP levels on admission were higher in patients with AMI in comparison with control individuals. There was also a positive correlation between NLR and CRP (r = 0.548, P < 0.001), and between PLR and CRP (r = 0.528, P < 0.001). NLR level greater than 4.5, measured on admission, yielded an area under the curve value of 0.790 (95% confidence interval 0.681-0.799, sensitivity 77%, specificity 72%), and PLR level of greater than 157 yielded an area under the curve value of 0.604 (95% confidence interval 0.486-0.722, sensitivity 59%, specificity 65%). Patients with AMI had increased NLR, PLR, and CRP levels compared with controls. Increased NLR and PLR was an independent predictor of AMI.

Prevention of etomidate-induced myoclonus: which is superior: Fentanyl, midazolam, or a combination? A Retrospective comparative study.

BACKGROUND: In this retrospective comparative study, we aimed to compare the effectiveness of fentanyl, midazolam, and a combination of fentanyl and midazolam to prevent etomidate-induced myoclonus. MATERIAL AND METHODS: This study was performed based on anesthesia records. Depending on the drugs that would be given before the induction of anesthesia with etomidate, the patients were separated into 4 groups: no pretreatment (Group NP), fentanyl 1 µg·kg-1 (Group F), midazolam 0.03 mg·kg-1 (Group M), and midazolam 0.015 mg·kg-1 + fentanyl 0.5 µg·kg-1 (Group FM). Patients who received the same anesthetic procedure were selected: 2 minutes after intravenous injections of the pretreatment drugs, anesthesia is induced with 0.3 mg·kg-1 etomidate injected intravenously over a period of 20-30 seconds. Myoclonic movements are evaluated, which were observed and graded according to clinical severity during the 2 minutes after etomidate injection. The severity of pain due to etomidate injection, mean arterial pressure, heart rate, and adverse effects were also evaluated. RESULTS: Study results showed that myoclonus incidence was 85%, 40%, 70%, and 25% in Group NP, Group F, Group M, and Group FM, respectively, and were significantly lower in Group F and Group FM. CONCLUSIONS: We conclude that pretreatment with fentanyl or combination of fentanyl and midazolam was effective in preventing etomidate-induced myoclonus.

A comparison of the effects of hyperbaric and isobaric bupivacaine spinal anesthesia on hemodynamics and heart rate variability.

AIM: To compare the effects of hyperbaric and isobaric bupivacaine spinal anesthesia on hemodynamics and heart rate variability (HRV) in nonobstetric surgery. MATERIALS AND METHODS: Sixty patients were randomly allocated to 2 groups. Group I (n = 30) received 15 mg (3 mL) of hyperbaric bupivacaine and Group II (n = 30) received 15 mg (3 mL) of isobaric bupivacaine for spinal anesthesia. Hemodynamic parameters were recorded before and after spinal anesthesia over 30 min. Analyses of HRV were performed on the day of surgery, after volume loading, and 20 min after spinal injection. Low frequency (LF) values, high frequency (HF) values, and LF/HF ratios were recorded. The incidences of hypotension and alterations of HRV parameters in both groups were investigated. RESULTS: The incidence ofhypotension was 26.6% and 23.3% in Groups I and II, respectively. There were no significant differences in the LF and HF values and LF/HF ratios between groups. In Group I, LF/HF ratios were significantly lower and HF values were significantly higher at 20 min after spinal anesthesia, in comparison to the baseline value (P < 0.05). CONCLUSION: Hyperbaric bupivacaine caused a significantly greater decrease in LF/HF ratios and a significantly greater increase in HF values.

Spinal anesthesia with hyperbaric bupivacaine: a comparison of hypertensive and normotensive patients.

BACKGROUND: Hypotension is the most common problem with spinal anesthesia. This prospective study aimed to compare normotensive and hypertensive patients with respect to the hemodynamic effects of spinal anesthesia performed with hyperbaric bupivacaine. MATERIAL AND METHODS: Sixty patients who were scheduled to undergo various elective operations under spinal anesthesia were included into the study. The patients were separated into 2 groups: hypertensive patients constituted Group H (n=30) and normotensive patients constituted Group N (n=30). After fluid loading, spinal anesthesia was performed with 3.5 ml 0.5% hyperbaric bupivacaine. Demographic characteristics and incidence of hypotension and bradycardia were compared. Systolic (SBP), diastolic (DBP), and mean blood pressures (MBP) and heart rate (HR) were also compared before and after spinal anesthesia. RESULTS: There was no significant difference between the groups with respect to demographic characteristics, maximal height of sensory block, incidences of hypotension and bradycardia, and the amount of fluids infused (p>0.05). In the hypertensive patient group, the SBP, DBP, and MBP values were significantly higher than in the normotensive patient group at all measurement times (p<0.05). Comparison within the groups did not reveal any significant differences in either group compared to the basal values (p>0.05). There were no significant differences in HR between or within groups (p>0.05). CONCLUSIONS: There was no significant difference between normotensive and hypertensive patients in the incidences of hypotension caused by spinal anesthesia with 0.5% hyperbaric bupivacaine.