Lateral Trendelenburg with the injected side down after the block improves the efficacy of the axillary approach to brachial plexus block.

PURPOSE: We hypothesized that, after axillary block, positioning the patient in a lateral position with the injected side down and simultaneously in a 20° Trendelenburg position will increase the success rate and quality of the block. METHODS: Fifty patients with chronic renal failure (ASA 2-3) scheduled for arteriovenous fistula surgery were included in this study. In all patients, 30-40 ml of 0.25 % levobupivacaine were injected into the axillary sheath. The block was performed as three injections (multiple injection technique) with the arm in 90° abduction and 90° flexion in the supine position. Patients were randomly allocated to two groups. Group I (n = 25) patients were kept in the supine position after the block. Group II (n = 25) patients were positioned laterally after the block with the injected arm down and in a 20° Trendelenburg position. Sensory and motor block were evaluated at 2, 4, 6, 8, 10, 15, 20, and 25 min after the administration of the block. Thus, the patients in group II were evaluated in a lateral position during the first 30 min. Throughout the surgery and the recovery period, sensory and motor block were evaluated at 30-min intervals. RESULTS: There were no significant intergroup differences in the effects on radial, ulnar, median, and musculoskeletal nerve blockade. Thirty minutes after the injection, the patients in group II had higher levels of sensory axillary nerve blockade. Subscapular and thoracodorsal nerve motor block were not detected in group I, while 84 % of the patients in group II experienced blockade of both of these nerves (p < 0.01). CONCLUSION: We conclude that, for patients undergoing an axillary block, positioning the patient laterally with the injected side down and in a 20° Trendelenburg position increases the success rate and quality of the block.

A large outbreak of enteritis in goat flocks in Marmara, Turkey, by G8P[1] group A rotaviruses.

Group A rotaviruses are regarded as major enteric pathogens of large ruminants, while their impact on the health of small ruminants is not well documented. We report the detection of group A rotavirus from a large outbreak of enteritis that occurred in two goat flocks in the town of Kirklareli, Marmara Region, Turkey, in 2007. The disease was observed in young kids, with high morbidity and mortality rates, but not in adult animals. Rotavirus antigen was detected in the stools of the examined animals, and rotaviruses were isolated in MA104 cells. Upon sequencing of the VP4, VP6, VP7 and NSP4 genes, the strain (RVA/goat-tc/TUR/Kirklareli/2007/G8P[1]) was characterized as G8P[1], with E2 NSP4 and VP6 I2 genotype. These findings indicate that group A rotavirus should be included in the diagnostic algorithms for enteric disease in small ruminants.

The amount of comorbidities as a single parameter has no effect in predicting the outcome in appendicitis patients older than 60 years.

BACKGROUND: Retrospective analysis of acute appendicitis patients older than 60 and statistical evaluation of the association between the accompanying illnesses, severity of peritonitis, morbidity, and mortality rates. INTRODUCTION: Although acute appendicitis is not frequent among aged populations, accompanying comorbidities of the geriatric patients are always fear factors before an emergency abdominal surgery even for acute appendicitis. METHODS: The data of the 27 patients older than 60 years who underwent appendectomy were retrospectively analyzed. The patients were grouped according to the total number of their comorbidities, Mannheim peritonitis index scores, and the period between the onset of abdominal pain and the admission to the hospital. RESULTS: The mean age of the patients was 73 years. The morbidity and mortality rates were statistically significantly higher in perforated cases. The comparison of patients with or=2 comorbidities did not show any statistical difference in morbidity and mortality. The sensitivity, specificity, positive predictive value, and negative predictive values for mortality in geriatric acute appendicitis patients with Mannheim peritonitis index scores greater than 26 were found to be 75%, 86%, 50%, and 95%, respectively. DISCUSSION: Retrospective evaluation of geriatric patients with acute appendicitis, according to the total number of their comorbidities, surprisingly revealed no statistical difference between groups. We thought that a high Mannheim peritonitis index score is a more reliable criteria than the total number of comorbidities in predicting the prognosis of patients with acute appendicitis in the geriatric population.

The first clinical case due to AP92 like strain of Crimean-Congo Hemorrhagic Fever virus and a field survey.

BACKGROUND: Crimean-Congo Hemorrhagic Fever (CCHF) is a fatal infection, but no clinical case due to AP92 strain was reported. We described the first clinical case due to AP92 like CCHFV. METHODS: A case infected by a AP92 like CCHFV was detected in Balkanian part of Turkey. Diagnosis was confirmed by RT-PCR and sequencing. A human serologic and tick survey studies were performed in the region, where the case detected. RESULTS: Thirty eight individuals out of 741 were found to be anti CCHFV IgM positive. The attack rate for overall CCHFV was calculated as 5.2%. In univariate analyses, CCHFV IgM positivity was found to be associated with the age (p < 0.001), male gender (p = 0.001), agricultural activity (p = 0.036), and history of tick bite (p = 0.014). In multivariate analysis, older age (OR: 1.03, CI:1.01-1.05, p < 0.001), male gender were found to be the risk factors (OR: 2.5, CI:1.15-5.63, p = 0.020) for CCHFV infection. CONCLUSION: This is the first human case with AP92 like CCHFV infection. Furthermore, this is the first report of AP92 like strain in Turkey. In the region, elderly males carry the highest risk for CCHFV infection.

Hypersensitivity pneumonitis of a bagpipe player: Fungal antigens as trigger?

Here we present a 79-year old man with chronic hypersensitivity pneumonitis probably caused by fungal contamination of a bagpipe. Several samples were taken from the patient's bagpipe. Four potential fungal antigens (Exophiala phaeomuriformis, Kwoniella europaea, Pyrenochaeta unguis-hominis and Aureobasidium melanogenum) as potential trigger of hypersensitivity pneumonitis were identified. A serum ELISA test with Exophiala phaeomuriformis indicated reactivity. Cessation of playing the bagpipe and application of glucocorticoids lead to an improvement of the patient's symptoms.

Transradial versus transfemoral approach for coronary angiography and intervention in patients above 75 years of age.

AIMS: The transradial (TR) approach has potentially lower complication rates than transfemoral (TF) approach coronary angiography. However, it may be technically more challenging, especially in elderly patients with alterations in vascular anatomy. We thus determined success rates, procedural data, and complication rates of TR angiography in comparison to the TF approach in elderly patients in a randomized, prospective trial. METHODS AND RESULTS: Four hundred consecutive patients >or=75 years with known or suspected coronary artery disease were included in the study. After exclusion of 93 patients with contraindications to the radial approach, 152 patients were randomized to the TR and 155 to TF coronary angiography and intervention. In 13 patients randomized to TR, cross-over to TF was necessary (9%). Total examination time was significantly longer for the TR approach (18.1 vs. 15.0 min, P = 0.009), but no difference was found for fluoroscopy time, number of catheters used, or amount of contrast agent. The rate of major complications (bleeding requiring surgery or transfusion, stroke) was 0% for TR and 3.2% for TF approach (P < 0.001). Minor complications occurred in 1.3% versus 5.8% of patients (P < 0.001). CONCLUSION: In elderly patients, TR coronary angiography and intervention has a high technical success rate and lower complication rates than the TF approach.

Methylene blue increases contralateral testicular ischaemia-reperfusion injury after unilateral testicular torsion.

1. Testicular ischaemia-reperfusion injury is commonly seen in childhood. Infertility occurs in 25% of patients after unilateral testicular ischaemia. It is has been reported that methylene blue has a positive effect in the reparation of ischaemia-reperfusion injury in different tissues. Therefore, we hypothesized that methylene blue may prevent the hazardous effects of ischaemia-reperfusion injury in testicular tissue after unilateral testicular torsion. 2. Thirty-two prepubertal Wistar-albino rats were divided into four groups. Testicular torsion was created by rotating the right testis 720 degrees in a clockwise direction for 5 h in all groups except for Group C, which was the sham control group. In Group T, bilateral orchiectomy was performed following the torsion period. In Group TD, both testes were removed 5 days after the torsion period. In Group MB, methylene blue (1 mg/kg, i.p.) was administered 40 min before detorsion and once daily over 5 days; then, both testes were harvested. Tissue levels of malondialdehyde (MDA), serum levels of creatine kinase (CK), mean testicular biopsy score (MTBS) and mean seminifer tubule diameter (MSTD) were determined. 3. There was a significant difference in MTBS between Groups T and TD (P < 0.05) in both ipsilateral and contralateral testes. In the contralateral testis, treatment with methylene blue decreased MTBS and MSTD (P < 0.05) and increased MDA levels (P < 0.05). In Group T, mean serum CK concentrations were higher than in any of the other groups (P < 0.05). 4. After 5 h of unilateral testicular torsion and a 5 day reperfusion period, serious tissue damage occurred on both the ipsilateral and contralateral sides. Serum CK concentrations may be an indicator for ischaemia, but not for ischaemia-reperfusion injury. Contrary to our hypothesis, methylene blue increased contralateral testicular damage after unilateral testicular torsion and exacerbated oxidative events.

Effect of curcumin on ipsilateral and contralateral testes after unilateral testicular torsion in a rat model.

OBJECTIVE: The aim of the study was to determine the protective effect of curcumin on testicular ischemia-reperfusion (I/R) injury. MATERIALS AND METHODS: 32 male rats were divided into four groups (n = 8): group 1: control; group 2: ischemia; group 3: I/R, and group 4: I/R+CUR. Curcumin (150 mg/kg, p.o.) was administered before 30 min of reperfusion in group 4. Malondialdehyde (MDA) levels, Johnsen's testicular biopsy scores, and mean seminiferous tubule diameter measurements were evaluated in testes. In addition, endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) expressions were evaluated immunohistochemically. RESULTS: MDA levels in control groups were significantly lower than other groups in ipsilateral and contralateral testes. Johnsen's scores in the control group were significantly higher than in other groups. MDA levels and Johnsen's scores in the I/R+CUR group were similar to the ischemia and I/R groups in ipsilateral and contralateral testes. The immunoreactivity of iNOS and eNOS were increased in I/R ipsilateral testicular groups. After I/R, iNOS and eNOS expression increased slightly in contralateral groups. Additionally, the curcumin treatment decreased iNOS and eNOS immunoreactivity in ipsilateral and contralateral testes. CONCLUSION: The results suggest that curcumin did not protect the unilateral nor contralateral testes. This observation may depend on inhibition of iNOS and eNOS due to inhibition of the antioxidant, anti-inflammatory effects of nitric oxide.

Association between Beta-Sympathomimetic Tocolysis and Risk of Autistic Spectrum Disorders, Behavioural and Developmental Outcome in Toddlers.

AIM: To investigate whether maternal intravenous beta-mimetic tocolytic therapy increases the risk of autistic spectrum disorders (ASD) and poorer behavioural and developmental outcomes. METHOD: Our study is a prospective case-control study among 90 children between 1.5 and three years old. Cases (n = 46) were toddlers with betamimetic tocolytic exposure; control group toddlers (n = 44) were tocolytic untreated. Treated and untreated groups were also divided into subgroups: term and preterm delivered. The gestational age of tocolytic treatment start, the dose and duration of exposure in hours were obtained from obstetric medical records. The Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the Modified Checklist for Autism in Toddlers (M-CHAT) and the Denver Developmental Screening Test (DDST) tests were applied for evaluation of social, emotional problems, autism and developmental disorders. RESULTS: Term and preterm born toddlers treated tocolytically in utero didn't demonstrate a higher risk of autistic disorders or poorer behavioural and developmental results than controls. In the preterm group, the earliest start of tocolytic treatment was correlated with toddlers lower score of the Competencies Scale (p = 0.009) and a higher score of the Problems Scale (p = 0.048). Also, we concluded that preterm membrane rupture was associated with higher ASD risk in the untreated group (p = 0.043). CONCLUSION: Exposure to betamimetics during pregnancy was not associated with an increased risk of autism, behavioural and developmental disorders.

The Probable Prevalence and Sociodemographic Characteristics of Specific Learning Disorder in Primary School Children in Edirne.

INTRODUCTION: The aim of this study was to research the probable prevalence of Specific Learning Disorder (SLD) in primary school children in Edirne City and the relationships with their sociodemographic characteristics. METHODS: The sample of our study was composed of 2,174 children who were educated in primary schools in second, third, and fourth grades in the academic year 2013-2014 in Edirne City. The teachers and parents of these children were given Specific Learning Difficulties Symptom Scale, Learning Disabilities Symptoms Checklist (teacher and parent forms), and sociodemographic data forms to fill in. Binary logistic regression analysis was used to assess the risk factors for SLD. RESULTS: Our study revealed that the probable prevalence of SLD was 13.6%; 17% for boys and 10.4% for girls. Reading impairment was 3.6%, writing impairment was 6.9%, and mathematic impairment was 6.5%. We determined that consanguineous marriages, low income, history of neonatal jaundice were found as risks for SLD; born by caesarean, developmental delay of walking, and history of neonatal jaundice were found as risks for mathematic impairment. A history of learning difficulties of parents was a risk factor for forming SLD and subtypes. CONCLUSION: Our findings were consistent with other study results about the prevalence of SLD. The relationships between the probable prevalence rates and sociodemographic data were discussed.

A Comparison of the Effects of Different Types of Laryngoscope on the Cervical Motions: Randomized Clinical Trial.

BACKGROUND: The rate of cervical injury among all trauma patients is 3.1%. The most important point during intubation of those patients is not to increase the cervical injury. AIMS: In this study, we hypothesize that there will be a minimal cervical extension during a laryngoscopy with the use of optical view laryngoscopes. STUDY DESIGN: Prospective, randomized clinical trial. METHODS: One hundred and fifty adult patients with ASA physical status I to III were enrolled in our study. After routine anesthesia induction, we randomly assigned the patients into three groups according to the type of laryngoscope. Macintosh type, Truview EVO2(®) type and Airtraq® type laryngoscopes were used in Group DL (n=50), Group TW (n=50) and Group ATQ (n=50), respectively. After applying general anesthesia induction and mask ventilation, all of the patients were positioned in the neutral position. An inclinometer was placed on the forehead of the patients. Then, the extension angle during intubation and the Cormack-Lehane Score were measured and the time to intubation was recorded. RESULTS: One of the 50 patients in the DL Group, 2 of the 50 patients in the TW Group, and 4 of the 50 patients in the ATQ Group were excluded from the study because of the failure of intubation at defined times. The angle of cervical extension during laryngoscopy was found to be 27.24±6.71, 18.08±7.53, and 14.54±4.09 degrees in the Groups DL, TV and ATQ, respectively; these differences also had statistical significance (p=0.000). The duration of intubation was found to be 13.59±5.49, 23.60±15.23, and 29.80±13.82 seconds in Groups DL, TV and ATQ, respectively (p=0.000). CONCLUSION: A minimal cervical motion was obtained during tracheal intubation with the use of Truview EVO2® and Airtraq® types of laryngoscope compared with the Macintosh laryngoscope. (ClinicalTrials.gov Identifier: NCT02191904).

Cardiac and Liver Marker Alterations After Laparoscopic Gynaecologic Operations.

OBJECTIVE: In our study, we aimed to investigate the effect of laparoscopic procedures in which the abdominal cavity at a Trendelenburg position of 15 degrees was insufflated with CO2 on cardiac and liver markers. METHODS: Forty patients scheduled for laparoscopic gynaecological surgery were included in the study. Venous blood samples were taken the day before operation and 6 hours after surgery, and later, lactate dehydrogenase (LDH), creatine kinase (CK), creatine kinase-MB (CK-MB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), myoglobin (MY) and d-dimer (d-D) were measured. RESULTS: There was no statistically significant difference in the values of preoperative and postoperative ALT (16.8±9.4 and 17.8±9.3; p=0.579), AST (19.4±7 and 20.9±7.6; p=0.361) and ALP (65.2±16.2 and 63.3±16.9; p=0.609), but LDH (385.1±117.3 and 460.6±156.3; p=0.003), CK (113.8±138.5 and 247.9±283.5; p=0.0001), CK-MB (22.8±13.3 and 28.7±16; p=0.011), MY (28.1±12.9 and 138.8±129; p=0.0001) and d-D (509.5±815: 1026±1054; p=0.0001) increased significantly. CONCLUSION: After laparoscopic operations in the Trendelenburg position, postoperative serum ALT, AST and ALP levels, remained unchanged, when compared to preoperative values, but LDH, CK, CK-MB, myoglobin and d-dimer values increased significantly.

Reinsertion of the stylet does not affect incidence of Post Dural Puncture Headaches (PDPH) after spinal anesthesia.

BACKGROUND AND OBJECTIVES: This study was conducted to investigate the effects of reinsertion of the stylet after a spinal anesthesia procedure on the Post Dural Puncture Headache (PDPH) METHODS: We have enrolled into this study 630 patients who were undergoing elective operations with spinal anesthesia and randomized them to Group A (stylet replacement before needle removal) and Group B (needle removal without stylet replacement). These patients were observed for the duration of 24 hours in the hospital and they were checked for PDPH on the 3(rd) and the 7(th) day of the study. RESULTS: Overall, the PDPH incidence was at 10.8% (68 patients). Thirty-three of these patients (10.5%) who were in Group A (stylet replacement before needle removal) and the other 35 patients (11.1%) who were in Group B (needle removal without stylet replacement) experienced PDPH. There was no significant difference between the two groups with respect to the PDPH. CONCLUSIONS: In contrary to the diagnostic lumbar puncture, reinsertion of the stylet after spinal anesthesia with 25-gauge Quincke needles does not reduce the incidence of PDPH.

Reinsertion of the stylet does not affect incidence of post dural puncture headaches (PDPH) after spinal anesthesia.

BACKGROUND AND OBJECTIVES: This study was conducted to investigate the effects of reinsertion of the stylet after a spinal anesthesia procedure on the Post Dural Puncture Headache (PDPH). METHODS: We have enrolled into this study 630 patients who were undergoing elective operations with spinal anesthesia and randomized them to Group A (stylet replacement before needle removal) and Group B (needle removal without stylet replacement). These patients were observed for the duration of 24 hours in the hospital and they were checked for PDPH on the 3rd and the 7th day of the study. RESULTS: Overall, the PDPH incidence was at 10.8% (68 patients). Thirty-three of these patients (10.5%) who were in Group A (stylet replacement before needle removal) and the other 35 patients (11.1%) who were in Group B (needle removal without stylet replacement) experienced PDPH. There was no significant difference between the two groups with respect to the PDPH. CONCLUSIONS: In contrary to the diagnostic lumbar puncture, reinsertion of the stylet after spinal anesthesia with 25-gauge Quincke needles does not reduce the incidence of PDPH.

Radiation-induced chronic oxidative renal damage can be reduced by amifostine.

In the current study, amifostine is evaluated for its radioprotective role in serum and kidney tissue by oxidative (malondialdehyde-MDA, advanced oxidation protein product-AOPP) and antioxidative markers (catalase, glutathione-GSH, free-thiols-F-SH). Thirty Wistar albino 3-4 months old, female rats, were randomly divided into Group I (n = 10): Control, Group II (n = 10): Irradiation-alone, Group III (n = 10): Amifostine before irradiation. In Group II and III, right kidneys of the rats were irradiated with a single dose of 6 Gy using a 60Co treatment unit. Rats in Group III received 200 mg/kg amifostine intraperitoneally, 30 min prior to irradiation. Following sacrification at 24th week, blood and kidney tissue samples were collected. Statistical analysis was done by One-way ANOVA, Post hoc Bonferroni, Dunnett T3, and Mann-Whitney U tests. Administration of amifostine significantly decreased the serum AOPP and MDA levels when compared to the irradiation-only group (P = 0.004, P = 0.006; respectively). Also amifostine significantly increased serum catalase activities and GSH levels, when given 30 min prior to irradiation (P = 00.02, P = 0.000; respectively). In the kidney tissue, administration of amifostine significantly decreased AOPP and MDA levels (P = 0.002, P = 0.016; respectively). Tissue GSH activity was increased following amifostine administration (P = 0.001). There was no statistically significant result on histopathological evaluation. Amifostine may reduce radiation-induced nephropathy by inhibiting chronic oxidative stress. Biomarkers of oxidative stress in serum and kidney tissue may be used for evaluation of the radiation-induced nephropathy.

Postmastectomy irradiation in breast in breast cancer patients with T1-2 and 1-3 positive axillary lymph nodes: is there a role for radiation therapy?

BACKGROUND: We aimed to evaluate retrospectively the correlation of loco-regional relapse (LRR) rate, distant metastasis (DM) rate, disease free survival (DFS) and overall survival (OS) in a group of breast cancer (BC) patients who are at intermediate risk for LRR (T1-2 tumor and 1-3 positive axillary nodes) treated with or without postmastectomy radiotherapy (PMRT) following modified radical mastectomy (MRM). METHODS: Ninety patients, with T1-T2 tumor, and 1-3 positive nodes who had undergone MRM received adjuvant systemic therapy with (n = 66) or without (n = 24) PMRT. Patient-related characteristics (age, menopausal status, pathological stage/tumor size, tumor location, histology, estrogen/progesterone receptor status, histological grade, nuclear grade, extracapsular extension, lymphatic, vascular and perineural invasion and ratio of involved nodes/dissected nodes) and treatment-related factors (PMRT, chemotherapy and hormonal therapy) were evaluated in terms of LRR and DM rate. The 5-year Kaplan-Meier DFS and OS rates were analysed. RESULTS: Differences between RT and no-RT groups were statistically significant for all comparisons in favor of RT group except OS: LRR rate (3% vs 17%, p = 0.038), DM rate (12% vs 42%, p = 0.004), 5 year DFS (82.4% vs 52.4%, p = 0.034), 5 year OS (90.2% vs 61.9%, p = 0.087). In multivariate analysis DM and lymphatic invasion were independent poor prognostic factors for OS. CONCLUSION: PMRT for T1-2, N1-3 positive BC patients has to be reconsidered according to the prognostic factors and the decision has to be made individually with the consideration of long-term morbidity and with the patient approval.

Ventricular repolarization in overweight and normal weight healthy young men.

OBJECTIVE: The effects of body mass index (BMI) on ventricular repolarization in young men have not been studied in detail. The QT and JT intervals are measured to estimate the duration of the ventricular repolarization. As new repolarization parameters, the time intervals between the J point to the apex of the T wave (JTa), the apex and the end of T wave (TaTe) may be associated with arrhythmogenesis in clinical conditions. The aim of this study was to compare ventricular repolarization parameters in overweight and normal weight healthy young men. METHODS: Thirty-six overweight men (BMI--26.3+/-1.5 kg/m2, mean age--20.6+/-1.5 years) and 149 men within normal limits (BMI--21.9+/-1.5 kg/m2, mean age--20.4+/-1.4 yrs) were included in this cross-sectional controlled study. The body mass index of 25 to 29.9 kg/m2 was defined as overweight and scores of 18.5 to 24.9 kg/m2 were accepted as normal. Ventricular repolarization parameters including QT, JT, JTa, TaTe, RR intervals duration and heart rate-corrected values of QT (QTc), JT (JTc), JTa (JTac), and TaTe (TaTec) intervals duration were obtained from lead V2 and considered to be representative of the ventricular repolarization process. RESULTS: We found similar ventricular repolarization parameters (QT, JT, JTa, TaTe, RR, QTc, JTc, JTac, and TaTec) in overweight and normal groups. Uncorrected and corrected ventricular repolarization parameters were not correlated with BMI. CONCLUSION: Ventricular repolarization features in young men who are overweight in terms of BMI seem to show no significant difference when compared to normal weight men.

A reinserção do estilete não afeta a incidência de cefaleia pós-punção dural (CPPD) após raquianestesia / Reinsertion of the stylet does not affect incidence of post dural puncture headaches (PDPH) after spinal anesthesia / La reinserción del estilete no afecta la incidencia de cefalea pos punción dural (CPPD) posteriormente a la raquianestesia

JUSTIFICATIVA E OBJETIVOS: Este estudo foi conduzido para investigar os efeitos da reinserção do estilete em cefaleia pós-punção dural (CPPD) após raquianestesia. MÉTODOS: Foram selecionados para este estudo 630 pacientes submetidos a cirurgia eletiva com raquianestesia. Os pacientes foram randomicamente designados para dois grupos: Grupo A (reinserção do estilete antes da retirada da agulha) e Grupo B (retirada da agulha sem reinserção do estilete). Os pacientes foram observados durante 24 horas no hospital e avaliados quanto à CPPD no terceiro e sétimo dias do estudo. RESULTADOS: No geral, a incidência da CPPD foi de 10,8% (68 pacientes). Trinta e três desses pacientes (10,5%) que estavam no Grupo A e 35 (11,1%) no grupo B tiveram CPPD. Não houve diferença significativa entre os dois grupos em relação à CPPD. CONCLUSÕES: Ao contrário da punção lombar diagnóstica, a reinserção do estilete após raquianestesia com agulhas tipo Quincke de calibre 25 não reduz a incidência de CPPD.

BACKGROUND AND OBJECTIVES: This study was conducted to investigate the effects of reinsertion of the stylet after a spinal anesthesia procedure on the Post Dural Puncture Headache (PDPH). METHODS: We have enrolled into this study 630 patients who were undergoing elective operations with spinal anesthesia and randomized them to Group A (stylet replacement before needle removal) and Group B (needle removal without stylet replacement). These patients were observed for the duration of 24 hours in the hospital and they were checked for PDPH on the 3rd and the 7th day of the study. RESULTS: Overall, the PDPH incidence was at 10.8% (68 patients). Thirty-three of these patients (10.5%) who were in Group A (stylet replacement before needle removal) and the other 35 patients (11.1%) who were in Group B (needle removal without stylet replacement) experienced PDPH. There was no significant difference between the two groups with respect to the PDPH. CONCLUSIONS: In contrary to the diagnostic lumbar puncture, reinsertion of the stylet after spinal anesthesia with 25-gauge Quincke needles does not reduce the incidence of PDPH.

JUSTIFICATIVA Y OBJETIVOS: Este estudio fue hecho para investigar los efectos de la reinserción del estilete en la cefalea pos punción dural (CPPD) después de la raquianestesia. MÉTODOS: Un total de 639 pacientes sometidos a la cirugía electiva con raquianestesia se seleccionaron para este estudio. Los pacientes fueron aleatoriamente designados para dos grupos: Grupo A (reinserción del estilete antes de la retirada de la aguja) y Grupo B (retirada de la aguja sin la reinserción del estilete). Los pacientes fueron observados durante 24 horas en el hospital y evaluados CPPD en el tercero y en el séptimo día del estudio. RESULTADOS: En general, la incidencia de CPPD fue de un 10,8% (68 pacientes). Treinta y tres de ellos (10,5%) que estaban en el Grupo A (reinserción del estilete antes de la retirada de la aguja) y 35 (11,1%) en el grupo B (retirada de la aguja sin la reinserción del estilete) tuvieron CPPD. No hubo diferencia significativa entre los dos grupos con relación a la CPPD. CONCLUSIONES: Al contrario de la punción lumbar diagnóstica, la reinserción del estilete posterior a la raquianestesia con agujas tipo Quincke de calibre 25 no reduce la incidencia de CPPD.

Rosiglitazone, an agonist of peroxisome proliferator-activated receptor-gamma, prevents contralateral testicular ischaemia-reperfusion injury in prepubertal rats.

1. Rosiglitazone plays a positive role in the reparation of ischaemia-reperfusion (I/R) injury in different tissues. Thus, we examined its biochemical and histological effects on the contralateral testes to determine whether exogenous rosiglitazone affords any protection against testicular damage. 2. Forty-eight prepubertal male Wistar-Albino rats were divided into six groups. Testicular torsion was created by rotating the right testis 720 degrees in a clockwise direction for 5 h in all groups except group I, which was the sham-control group. In group II, bilateral orchiectomy was performed following the torsion period. After detorsion both testes were removed in the fifth hour in group III and on the seventh day in group IV. In group V, one-shot rosiglitazone (4 mg/kg) was administered 40 min before detorsion and both testes were removed following the torsion period. In group VI, rosiglitazone was administered (4 mg/kg) 40 min before detorsion and for 7 days, and then both testes were harvested. The tissue levels of malondialdehyde (MDA) were measured and mean testicular biopsy score (MTBS) and mean seminiferous tubule diameter (MSTD) were examined. Immunoexpression of endothelial nitric oxide synthase (eNOS) in testes tissues was investigated by immunohistochemical studies. 3. In the contralateral testis, the MTBS and MSTD values of group VI were significantly higher than those in group IV. Immunohistochemically, mild eNOS immunostaining was present in the germ cells of the contralateral testes in group IV after I/R. In group VI, intense eNOS immunoreactivity was seen in the contralateral testes. 4. Rosiglitazone reduces contralateral testicular damage formed after unilateral testicular torsion and alleviates the oxidative events.

A granulomatous conjunctivitis associated with Morexella phenylpyruvica in an ostrich (Struthio camelus).

The aim of study was to evaluate a case of granulomatous conjunctivitis, clinically and pathologically, in the right eye of a 2-year-old, female ostrich. A mass measuring 5 cm x 3 cm x 4 cm was removed surgically from the eye of the ostrich. Morexella phenylpyruvica was recovered from the mass. On histopathological examination, hyperplasia or squamous metaplasia in some area of conjunctival palpebra, and a granulomatous inflammation in the submucosa were observed. The lesion was described as a granulomatous conjunctivitis caused by M. phenylpyruvica. The lesion was located in the lower eyelid conjunctiva and was not only restricted to the gl. lacrimalis, but also present in the connective tissue. After excision of the mass, the ostrich was treated with topical and systemic antibiotics and corticosteroid. The ostrich recovered fully and the function of the eye appeared to be normal.