Investigation of the efficacy of systemic N-Acetyl Cysteine therapy preventing nasal mucositis following radiotherapy.

BACKGROUND: Radiotherapy (RT) is one of the main methods used in the treatment of head and neck cancers but may cause mucosal side effects in the tumor area and surrounding structures. These include nasal mucosal disorders and chronic rhinosinusitis due to disruption of the mucociliary system. This situation seriously affects the quality of life of the patients and there is no accepted effective method for its treatment yet. In our study, we aimed to examine the side effects of RT on the nasal mucosa and mucociliary system and to investigate histopathologically and immunohistochemically the effectiveness of N-acetyl cysteine (NAC) in preventing these side effects of RT. METHODOLOGY: The study was carried out with 30 female Sprague Dawley rats devided in three groups. No intervention was made in the control group. On the second day of the experiment, 30 Gy radiotherapy was applied to the head area in the RT group. NAC was administered intraperitoneally at a dose of 1 g/kg/day for 14 days from the first day of the study to the RT+ NAC group. On the second day, 30 Gy of radiotherapy was applied to the head area 1 hour after the NAC application. On the 14th day, 1 hour after NAC was applied to the RT+NAC group, all animals were sacrificed. The nasal mucosa samples were stained with hematoxylin-eosin, and the intensity and extent of staining sentan in the nasopharyngeal tissue samples were evaluated by immunohistochemical staining using anti-SNTN antibody. RESULTS: The loss of cilia in the nasal tissue was lower in the RT+NAC group than in the RT group. The intensity and extent of staining in the nasopharyngeal tissue of Sentan was higher in the RT+NAC group than in the RT group. Mucosal neutrophil and mononuclear inflammatory cell infiltration in the nasal tissue, vascular dilatation, hyperemia and hemorrhage, erosion and shedding of the mucosal epithelium, mucosal ulceration were found to be similar in the RT+NAC group and the control group. It was milder in the RT+NAC group than in the RT group, but not statistically significant. CONCLUSIONS: Radiotherapy caused pathological changes in the nasal mucosa, caused loss of cilia and a decrease in the level of Sentan, the cilia apical protein. The results of our study showed that NAC treatment can reduce the side effects of RT on the nasal mucosa. It also showed that NAC was effective in preventing the loss of cilia, which is the building block of the mucociliary system, and improving the expression of Sentan.

Student tutors are able to teach basic sonographic anatomy effectively - a prospective randomized controlled trial.

PURPOSE: Ultrasound is a widely used diagnostic tool. In medical education, it can be used to teach sonographic anatomy as well as the basics of ultrasound diagnostics. Some medical schools have begun implementing student tutor-led teaching sessions in sonographic abdominal anatomy in order to meet the growing demand in ultrasound teaching. However, while this teaching concept has proven to be feasible and well accepted, there is limited data regarding its effectiveness. We investigated whether student tutors teach sonographic anatomy as effectively as faculty staff sonographers. MATERIALS AND METHODS: 50 medical students were randomly assigned to one of two groups. 46 of these could be included in the analysis. One group was taught by student tutors (ST) and the other by a faculty staff sonographer (FS). Using a pre/post-test design, students were required to locate and label 15 different abdominal structures. They printed out three pictures in three minutes and subsequently labeled the structures they were able to identify. The pictures were then rated by two blinded faculty staff sonographers. A mean difference of one point in the improvement of correctly identified abdominal structures between the pre-test and post-test among the two groups was regarded as equivalent. RESULTS: In the pre-test, the ST (FS) correctly identified 1.6 ± 1.0 (2.0 ± 1.1) structures. Both the ST and FS group showed improvement in the post-test, correctly identifying 7.8 ± 2.8 vs. 8.9 ± 2.9 structures, respectively (p < .0001 each). Comparing the improvement of the ST (6.2 ± 2.8 structures) versus the FS (6.9 ± 3.2) showed equivalent results between the two groups (p < .05 testing for equivalence). CONCLUSION: Basic abdominal sonographic anatomy can be taught effectively by student tutors.

Transport evaluation of alendronate across Caco-2 cell monolayers.

The transport of alendronate through Caco-2 monolayers in the absence and presence of absorption enhancers (sodium taurocholate-STC and dimethyl-beta-cyclodextrin-DM-beta-CD) was studied. The viability of Caco-2 cells was determined by MTT assay. The effects of the experiment period and serum existence in Dubelco's Modified Eagle's Medium (DMEM) on cell viability were examined. The least toxic concentrations of alendronate, STC and DM-beta-CD were found as 0.2% (w/v), 5 mM and 0.3% (w/v), respectively. Transport experiments were performed with these concentrations in DMEM supplemented with serum for an 8 h period. DM-beta-CD increased the transport of alendronate through Caco-2 monolayers significantly. No significance was observed with STC. Cell integrity was determined by measuring the electrical resistance values at the end of the transport experiments and found to be decreased to a greater extent with DM-beta-CD. These results indicate that DM-beta-CD is a promising agent for improving the transport of alendronate.

Ketamine gargle for attenuating postoperative sore throat.

BACKGROUND: Tracheal intubation is a foremost cause of trauma to the airway mucosa, resulting in postoperative sore throat (POST) with reported incidences of 21-65%. We compared the effectiveness of ketamine gargles with placebo in preventing POST after endotracheal intubation. METHODS: Forty-six, ASA I-II, patients undergoing elective surgery for septorhinoplasty under general anaesthesia were enrolled in this prospective, randomized, placebo-controlled, single-blind study. Patients were randomly allocated into two groups of 23 subjects each: Group C, saline 30 ml; Group K, ketamine 40 mg in saline 30 ml. Patients were asked to gargle this mixture for 30 s, 5 min before induction of anaesthesia. POST was graded at 0, 2, 4, and 24 h after operation on a four-point scale (0-3). RESULTS: POST occurred more frequently in Group C, when compared with Group K, at 0, 2, and 24 h and significantly more patients suffered severe POST in Group C at 4 and 24 h compared with Group K (P<0.05). CONCLUSIONS: Ketamine gargle significantly reduced the incidence and severity of POST.

Efficacy of intravenous acetaminophen and lidocaine on propofol injection pain.

BACKGROUND: Different methods and propofol formulations have been used to decrease propofol injection pain, but it remains an unresolved problem. We aimed to investigate the effect of i.v. acetaminophen pretreatment on the propofol injection pain. METHODS: One hundred and fifty ASA I-II patients undergoing general anaesthesia were randomly allocated into three groups. A 20-gauge catheter was inserted into a superficial radial vein of the left hand, and after the occlusion of venous drainage, Groups I, II, and III were pretreated with 40 mg of lidocaine in saline, 50 mg of i.v. acetaminophen, and 5 ml of saline, respectively. The occlusion was released after 2 min and one-fourth of the total propofol dose was injected into the vein over a period of 5 s. During the injection of both pretreatment solution and propofol, patients' pain was assessed and recorded as 0-3, corresponding to no, mild, moderate or severe pain, respectively. Chi2 and Kruskal-Wallis tests were used for the statistical analysis. For all analyses, differences were considered to be significant at P<0.05. RESULTS: Patient characteristics were similar among the groups. Incidence of pain on injection of propofol in control, i.v. acetaminophen, and lidocaine groups was 64%, 22% and 8%, respectively (P<0.05). CONCLUSIONS: Pretreatment with i.v. acetaminophen seems to be effective in attenuating pain during i.v. injection of propofol.

Comparison of dexmedetomidine-propofol vs. fentanyl-propofol for laryngeal mask insertion.

BACKGROUND AND OBJECTIVES: There have been many studies to find the optimum anaesthetics to provide excellent conditions for laryngeal mask insertion. We compared the effects of dexmedetomidine administered before propofol, on laryngeal mask insertion with fentanyl combined with propofol. METHODS: In all, 52 patients, ASA I-II, scheduled to have minor urological procedures were randomized into two groups. Group F received 1 microg kg(-1) fentanyl (in 10 mL normal saline) and Group D received 1 microg kg(-1) dexmedetomidine (in 10 mL normal saline). We used 1.5 mg kg(-1) propofol for induction and 50% N2O and 1.5% sevoflurane in oxygen for maintenance. We observed jaw mobility (1: fully relaxed; 2: mild resistance; 3: tight but opens; 4: closed), coughing or movement (1: none; 2: one or two coughs; 3: three or more coughs; 4: bucking/movement) and other events such as spontaneous ventilation, breath holding, expiratory stridor and lacrimation. In each category, scores <2 were acceptable for laryngeal mask insertion. RESULTS: More patients developed apnoea and their apnoea times were longer in Group F than Group D (P < 0.001). Respiratory rates increased in Group D (P < 0.001). Adverse events during laryngeal mask insertion were similar. The reductions in systolic and mean blood pressures were greater in Group F (systolic: P < 0.05, mean: P < 0.01). Emergence times were shorter in Group F than in Group D (P < 0.001). CONCLUSION: Dexmedetomidine, when used before propofol induction provides successful laryngeal mask insertion comparable to fentanyl, while preserving respiratory functions more than fentanyl.

Topical ketamine and morphine for post-tonsillectomy pain.

BACKGROUND AND OBJECTIVES: Tonsillectomy is frequently associated with postoperative pain of considerable duration, which is usually accompanied by the substantial consumption of both opioid and non-opioid analgesics. Despite the use of different surgical and anaesthetic techniques in the search for safe and effective post-tonsillectomy pain relief, this problem remains a clinical dilemma. The aim of the current study was to evaluate the potential effects of topically administered ketamine and morphine by an oral rinse into the tonsillar fossae. METHODS: In all, 60 children, 15 for each group, aged between 3 and 12 yr scheduled for tonsillectomy were randomly assigned to one of four groups. Study drugs were administered to both tonsillar fossae for 5 min. Group K received 0.4 mL (20 mg) ketamine in 10 mL artificial saliva, Group KM received 0.4 mL (20 mg) ketamine + 5 mL (20 mg) 4 per thousand morphine aqueous solution in 5 mL artificial saliva, Group M received 5 mL (20 mg) 4 per thousand morphine aqueous solution in 5 mL artificial saliva, Group C received only 10 mL artificial saliva. Postoperative pain, nausea, vomiting, sedation and bleeding were evaluated. RESULTS: Pain scores were higher in the control group at arrival in the recovery ward (P < 0.05). Morphine and ketamine groups had longer effective analgesia time than the morphine + ketamine and control groups. The 24-h analgesic consumption was significantly higher in the control group. CONCLUSION: Topical ketamine and morphine seems to be a safe and easy analgesic approach for decreasing adenotonsillectomy pain.

Indoor radon concentrations in Adana, Turkey.

The indoor radon concentration in Adana, Turkey was measured in living rooms of 52 houses during winter 2005 and 57 houses during summer 2005. Forty-four houses were selected for both winter and summer researches for estimating seasonal variations. Indoor radon concentrations were measured seasonally over hotter and colder 2 months over the whole year, using CR-39 passive nuclear track radon detectors. The radon concentrations were ranged from 15 to 97 Bq m(-3) on January-February 2005 for 60 d and from 5 to 70 Bq m(-3) on June-July 2005 for 60 d. The average summer concentration measured was 25.8 Bq m(-3) and the average winter concentration was 48.9 Bq m(-3) in 44 houses that observed seasonal variations. The differences between winter and summer periods were ranged from 1 to 77 Bq m(-3). The average value in both winter and summer periods is 37 Bq m(-3) in 44 houses that observed seasonal variations. This value is below the worldwide indoor radon concentration distribution of 46 Bq m(-3). The annual effective dose equivalent from (222)Rn was 0.9 mSv y(-1).

Radon measurements in the Catalagzi Thermal Power Plant, Turkey.

The Catalagzi Thermal Power Plant (CTPP) (41(0)30'48.4('')N and 0.31(0)53'41.5('')E) is located at nearly 13 km North-east of Zonguldak city, which is located at the West Black Sea coast in Turkey. The middling products with high ash content of bituminous coals are used in this plant. Seasonal radon concentration measurements have been carried out by using CR-39 plastic track detectors in and around the CTPP. The annual average radon concentration has been found to vary from a minimum of 39.8 +/- 28.9 Bq m(-3) in the ash area to a maximum of approximately 75.0 +/- 15.7 Bq m(-3) in the service building of the power plant. The annual average radon concentration in the dwellings of the thermal power plant colony of the plant is 71.0 +/- 33.4 Bq m(-3). The effective dose has been found to vary from 0.38 to 0.71 mSv y(-1) with a mean value of 0.56 mSv y(-1), which is lower than the effective dose values 3-10 mSv given as the range of action levels recommended by International Commission on Radiological Protection: Protection against radon-222 at home and at work, ICRP Publication 65 (1993).

A study of indoor radon levels in rural dwellings of Ezine (Canakkale, Turkey) using solid-state nuclear track detectors.

Indoor radon activity level and radon effective dose (ED) rate have been carried out in the rural dwellings of Ezine (Canakkale) during the summer season using Radosys-2000, a complete set suitable to radon concentration measurements with CR-39 plastic alpha track detectors. The range of radon concentration varied between 9 and 300 Bq m(-3), with an average of 67.9 (39.9 SD) Bq m(-3). Assuming an indoor occupancy factor of 0.8 and 0.4 for the equilibrium factor of radon indoors, it has been found that the 222Rn ED rate in the dwellings studied ranges from 0.4 to 5.2 mSv y(-1), with an average value of 1.7 (1.0) mSv y(-1). There is a possibility that low radon concentrations exist indoors during the summer season in the study area because of relatively high ventilation rates in the dwellings. A winter survey will be needed for future estimation of the annual ED.

Mandibular symphyseal distraction osteogenesis: review of three techniques.

Mandibular symphyseal distraction osteogenesis (MSDO) is an alternative strategy to correct mandibular transverse deficiencies and dental crowding. Only a limited number of practitioners have reported their clinical experience and potential complications of this procedure to widen the mandible in a large case series. This study involved retrospective analysis of 40 patients who underwent mandibular symphyseal distraction osteogenesis. Three different types of distractor were used to widen the mandible: tooth-borne in 21 patients, bone-borne in 5 patients and hybrid (both bone and tooth-borne) in 14 patients. The distraction amount ranged from 7 to 11 mm (mean 7.31 mm). While 39 patients underwent successful mandibular symphyseal distraction, there was one failure. Most of the complications were experienced in bone-borne distractors, such as breakage of the distractor rod, gingival recession, secondary infection and ptosis of the chin. In the light of these findings, it is suggested that a lingually placed tooth-borne hyrax appliance is more suitable and reliable than the other distraction devices. Further larger studies are needed in order to better evaluate the effectiveness of bone-borne or hybrid devices.

Determination of radon concentrations of the Dikili geothermal area in western Turkey.

For this study, a geothermal area around Izmir-Dikili, located in the western part of Turkey, was chosen as a measuring site and the radon concentrations of environmental samples were determined. Indoor radon monitoring was performed for 3 months in dwellings located in different part of the region using passive CR-39 nuclear track detectors. The radon concentrations of water samples drawn from wells, municipal supplies, village fountains and spas in the area were measured using a liquid scintillation detector (Packard Tri-Carb 2770 TR/SL, A-277001). Soil samples collected from each location were analysed and (226)Ra concentrations were determined using a gamma ray spectrometer connected to an HPGe detector. Annual effective doses from radon inhalation and ingestion were calculated.

Natural radioactivity in tap waters of Eastern Black Sea region of Turkey.

In this study, the activity concentrations of some radionuclides in tap water samples of the Eastern Black Sea region of Turkey were measured. The activity concentrations of radionuclides (214)Pb, (214)Bi, (40)K, (226)Ra and (137)Cs were determined using high resolution gamma ray spectrometry. Furthermore, (222)Rn activity concentrations in tap water samples were measured using Liquid Scintillation Counting. The mean specific activities of (214)Pb, (214)Bi, (226)Ra, (40)K, (137)Cs and (222)Rn in tap water samples were 6.73, 6, 19.16, 168.57, 5.45 mBq l(-1) and 10.82 Bq l(-1), respectively. These values are comparable with concentrations reported for other countries. The effective doses were determined due to intake of these radionuclides as a consequence of direct consumption of tap water samples. The estimated effective doses were 6.878 x 10(-4) microSv y(-1) for (214)Pb, 4.800 x 10(-4) microSv y(-1) for (214)Bi, 3.916 microSv y(-1) for (226)Ra, 0.763 microSv y(-1) for (40)K, 0.052 microSv y(-1) for (137)Cs and 5.848 microSv y(-1) for (222)Rn.

Radon measurements in the caves of Zonguldak (Turkey).

There are approximately 20 caves of limestone origin in Zonguldak (Turkey). In this study, the results of atmospheric radon measurements performed for two caves are presented. These caves, Gökgöl and Cehennemagzi, are open to tourism. Gökgöl Cave is the longer, at nearly 3,200 m in length. Cehenennemagzi is a pit-type cave with a total length of 85 m. The radon measurements were performed for 2 months between July 2004 and September 2004 using passive polycarbonate detectors. The mean radon concentrations were recorded as 1,918.8 Bq m(-3) in Gökgöl Cave and 657 Bq m(-3) in Cehennemagzi Cave. The maximum value corresponds to a site located 400 m from the entrance of Gökgöl Cave. Mean effective dose values for tourists of 0.86 microSv per visit to Cehennemagzi Cave and 3.76 microSv to Gökgöl Cave were obtained. These results show that protection against radiological hazards would not be necessary for visitors to these two caves.

Radon concentration measurements in the Amasra coal mine, Turkey.

In this study, the results of atmospheric radon measurements that were performed for the Amasra underground coal mine in Zonguldak bituminous coal basin (Turkey) are presented. The radon measurements were performed for 40 days between November 2004 and December 2004 using passive nuclear etched track detectors. The radon concentrations vary from a minimum value 49 Bq m(-3) in a site located at +40 m to a maximum value 223 Bq m(-3) in a site located at -100 m. Mean concentration is 117 (Bq m(-3)). This value is well below the action level of 500-1,500 Bq m(-3) recommended by the International Commission on Radiological Protection (ICRP) (1993). The mean effective dose value for workers of this mine of 3.4 microSv per day was obtained. This result shows that protection against radiological hazards would not be necessary for workers of this mine((2)).

A lecithin-based microemulsion of rh-insulin with aprotinin for oral administration: Investigation of hypoglycemic effects in non-diabetic and STZ-induced diabetic rats.

The aim of this study was to develop a microemulsion formulation providing an improved efficacy of orally administered insulin. The microemulsions were prepared using Labrafil M 1944 CS, Phospholipon 90 G (lecithin), absolute alcohol and bi-distilled water. The microemulsions of recombinant human (rh)-insulin and aqueous solution (200 IU/kg) were administered intragastrically by a canulla to diabetic and non-diabetic rats. Aprotinin (2500 KIU/g) was added as the enzyme inhibitor to the formulation. Upon the administration of intragastric rh-insulin solution (IS) to non-diabetic rats, the plasma glucose and insulin levels were not changed significantly. Therefore, the hypoglycemic effect caused by subcutaneous rh-insulin solution (SC), microemulsion containing rh-insulin (IME) and microemulsion containing rh-insulin and aprotinin (IMEA) were analyzed in diabetic rats. The area above the plasma glucose levels time curves (AAC), minimum glucose concentration (Cmin) and time to Cmin (tmin) were derived from the plasma glucose profiles. IME and IMEA caused approximately 30% decrease in plasma glucose levels. The decrease in the plasma glucose levels continued after the 90th min. The highest AAC value was obtained when IMEA was administered to rats. The maximum plasma insulin concentration (Cmax), time to reach Cmax (tmax), terminal half-life (t(1/2)), area under the plasma concentration-time curve (AUC), mean residence time (MRT) and elimination rate constant (k(el)) values were also calculated. It was observed that t(1/2) values varied between 0.53 and 1.31h. No significant difference could be found between the pharmacokinetic parameters of the IME and IMEA administered groups. Addition of aprotinin to the microemulsion containing rh-insulin increased bioavailability when compared to those not containing it, although the difference is not significant.

Indoor radon determination in dwellings located at Dikili geothermal area in Western Turkey.

This paper presents the indoor radon concentrations in dwellings located in the Dikili geothermal area in western Turkey. Indoor radon monitoring was performed for 3 mo using 121 detectors installed in the living rooms and bedrooms of 62 houses selected from the region. A passive time-integrating radon measuring technique was applied by using CR-39 solid-state nuclear track detectors. Average indoor radon levels for the houses varied from 31 to 280 Bq m(-3). Corresponding annual effective doses were calculated, and risks for lung cancer due to inhalation of indoor radon were estimated.

Natural radioactivity levels in granitic plutons and groundwaters in Southeast part of Eskisehir, Turkey.

The present work investigated the radioactivity level of the granitoid plutons and its effect on the groundwaters in the southeast part of Eskisehir. Fourteen granitic samples from the Kaymaz and Sivrihisar plutons and 11 groundwater samples from the near vicinity of the pluton were analyzed. The activity concentrations measured for (238)U and (232)Th ranged from 43.59+/-2 to 651.80+/-24 Bq/kg, and 51.16+/-3 to 351.94+/-13 Bq/kg, respectively. The activity concentrations obtained for (40)K varied from 418.50+/-17 to 1618.03+/-66 Bq/kg. The absorbed dose rates in air outdoors ranged from 87.14 to 531.81 nGy/h. All the results obtained from the Kaymaz pluton are higher than those from the Sivrihisar. The U (ave. 16.6 ppm) and Th (ave. 49.9 ppm) values of the Kaymaz pluton are higher than the average concentrations of the magmatic rocks of granitic composition. These results are consistent with high dose rates of the pluton. The gross-alpha activities in the groundwater samples ranged from 0.009 to 1.64 Bq/l and the gross-beta activities from 0.006 to 0.89 Bq/l. The highest gross-alpha value was found in the sample taken from near the Kaymaz pluton. The concentrations of (222)Rn varied from 0.060 to 0.557 Bq/l.

Indoor radon measurements in Turkey dwellings.

In this work, indoor radon radioactivity concentration levels have been measured in dwellings of Turkey within the frame of the National Radon Monitoring Programme. The (222)Rn concentrations were measured with time-integrating passive nuclear etched track detectors in 7293 dwellings in 153 residential units of 81 provinces, and the radon map of Turkey was prepared. Indoor radon concentrations were distributed in the range of 1-1400 Bq m(-3). The arithmetic mean of the radon gas concentration was found to be 81 Bq m(-3); the geometric mean was 57 Bq m(-3) with a geometric standard deviation of 2.3.

The healing effect of TGF-alpha on gastric ulcer induced by acetylsalicylic acid in rats.

The present study was designed to investigate the effects of microemulsion and aqueous solution containing transforming growth factor alpha (TGF-alpha) and/or aprotinin administered intragastrically (i.g.) on healing of acute gastric ulcers induced by acetylsalicylic acid (ASA). The microemulsion was prepared by modification of the microemulsion formulation described in our previous study. Acute gastric lesions were induced by the application of ASA (150 mg/kg in 1.5 ml of 0.2N HCl i.g.). TGF-alpha in solution or microemulsion formulations were administered at a dose of 10 microg/kg per 24h i.g. for 2 days. The effects of TGF-alpha on the healing was evaluated with the measurement of ulcer score, basal gastric acid secretion, total protein content of gastric fluid, gastric mucus level and histological analysis. The results indicated that the highest decrease in ulcer area was observed in group treated with microemulsion containing TGF-alpha plus aprotinin (TA-ME). TGF-alpha in microemulsion formulation was more effective than TGF-alpha in solution formulation in the increase of gastric mucus secretion, in the decrease of gastric acid secretions and ulcer scores. Histological evaluation of the gastric mucosa samples revealed that, best recovery was obtained in the TA-ME treated group.