Cross-sectional, hospital-based analysis of headache types using ICHD-3 criteria in the Middle East, Asia, and Africa: the Head-MENAA study.

BACKGROUND: Headaches are frequent neurological disorders that are yet to be unveiled and treated comprehensively worldwide. Bearing in mind that the distribution of headache subtypes in neurology clinics (NC) is essential for planning appropriate diagnostic and therapeutic approaches, the primary goals of this multi-centric study are to carry out inter-regional comparisons by using current diagnostic criteria with evaluations of neurologists to delineate headache burden. METHODS: A cross-sectional study between April 1 and May 16, 2022 was conducted with the participation of 13 countries from the Middle East, Asia, and Africa. Patients were included in the study on a specific day each week during five consecutive weeks. All volunteers over the age of 18 and whose primary cause for admission was headache were examined. The patients admitted to NC or referred from emergency services/other services were evaluated by neurologists by means of the International Classification of Headache Disorders (ICHD-3) criteria. RESULTS: Among the 13,794 patients encountered in NC, headache was the primary complaint in 30.04%. The headache patients' mean age was 42.85 ± 14.89 (18-95 years), and 74.3% were female. According to the ICHD-3 criteria, 86.7% of the main group had primary headache disorders, 33.5% had secondary headaches, 4% had painful cranial neuropathies along with other facial and headaches, and 5.2% had headaches included in the appendix part showing some overlapping conditions. While the most common primary headache was migraine without aura (36.8%), the most common secondary headache was medication-overuse headache (MOH) (9.8%). Headaches attributed to COVID-19, its secondary complications, or vaccines continue to occur at rates of 1.2%-3.5% in current neurology practice. Pain severity was significantly lower in Ivory Coast and Sudan than in Türkiye, Turkish Republic of Northern Cyprus, Iran, Egypt, Senegal, Tatarstan, and Azerbaijan (p < 0.001). CONCLUSIONS: The study showed that migraine is still the most common motive for admissions to NC in different regions. Furthermore, MOH, an avoidable disorder, is the most common secondary headache type and appears to be a significant problem in all regions. Remarkably, pain perception differs between regions, and pain intensity is lower in Africa than in other regions.

An evaluation of ursodeoxycholic acid treatment in prolonged unconjugated hyperbilirubinemia due to breast milk.

Background/Aim: Prolonged jaundice is one of the most common problems during neonatal period. The aim of this study was to evaluate the efficiency of ursodeoxycholic acid (UDCA) treatment in newborn infants with prolonged unconjugated hyperbilirubinemia. Materials and Methods: The present study included 27 patients who were fed by breast milk and followed up in the outpatient clinic due to prolonged jaundice without any underlying etiological factor; 10 mg/kg/day UDCA was administrated in two doses for 7 days. Furthermore, 20 newborns diagnosed with prolonged jaundice with same characteristics were enrolled as the control group. The control group was also given a placebo; demographic characteristics, liver functions tests before and after the treatment, bilirubin decrease rates, and hemogram parameters of groups were compared. Results: Total bilirubin levels in the study and control groups before the treatment were 16.02 ± 1.41 mg/dL and 15.93 ± 1.66 mg/dL, respectively (P = 0.84). Total bilirubin levels in the study and control groups at day 7 after UDCA treatment were detected 8.18 ± 2.31 mg/dL and 13.92 ± 2.66 mg/dL, respectively (P < 0.001), and at day 14 after the treatment were 5.45 ± 2.59 mg/dL and 11.91 ± 2.83 mg/dL, respectively (P < 0.001). Furthermore, serum aspartate aminotransferase (AST) was detected <21 U/L in the ROC analysis after UDCA treatment (P = 0.04). Conclusion: The study outcomes indicated that an efficient reduction in total bilirubin levels may be achieved, and outpatient clinic follow-up period may be reduced in patients whom UDCA was administrated. Moreover, it may be speculated that AST can be used to evaluate the efficacy after treatment. However, studies with larger sample sizes are needed for the routine use of UDCA in the treatment of prolonged jaundice.

Is methyl methacrylate fixator reliable for the treatment of gartland type IV supracondylar fractures?

Background: In childhood supracondylar fractures of the humerus, fixation with percutaneous Kirschner wire is the standard treatment. In the case of irreducible-unstable fractures, these can be defined as fractures in which reduction is not well-achieved or in which fixation cannot be achieved with the K-wire. Intraoperative management of these types of fractures may be difficult. Treatment with a methyl methacrylate fixator consisting of K-wire and methyl methacrylate cement, as defined by the senior author of the article, may be a good option for Gartland type IV supracondylar humeral fractures where the fracture is unstable in flexion and extension due to complete periosteal tearing. Materials and Methods: The short-term and mid-term results of 27 patients between the ages of 4-12 with Gartland type IV supracondylar fracture of the humerus treated with methyl methacrylate fixation were reviewed. The patients were scored in terms of function and cosmetic satisfaction. Results: A total of 19 of the 27 patients treated with the methyl methacrylate fixator had full elbow motion function and rated the outcome of the treatment as excellent, which was judged by orthopedic surgeons on the basis of Flynn's criteria. Six patients had nearly full elbow motion and evaluated their recovery outcome as good. Two patients reported nearly full range of motion (ROM) and evaluated the method as moderate in terms of treatment. Discussion: Treatment with the methyl methacrylate fixation method is an inexpensive method that allows early joint mobilization, provides strong biomechanical stability, ensures good outcomes, and should be considered in the treatment of irreducible and unstable supracondylar fractures of the humerus.

Is it possible to predict the outcome of endovascular thrombectomy for hyperdense middle cerebral artery sign at the time of first admission?

Background: The hyperdense middle cerebral artery sign (HMCAS) on admission non-contrast computed tomography (NCCT) is a well-characterized phenomenon in acute ischemic stroke. Aim: The purpose of this study is to determine the impact of HMCAS on the outcome of patients who underwent endovascular thrombectomy. Materials and Methods: A retrospective analysis of a prospectively collective database included 136 consecutive patients with anterior circulation acute ischemic stroke who underwent endovascular thrombectomy. We collected the demographics, and clinical and brain imaging as well as functional and imaging outcomes data at baseline. Patients were divided into two groups with hyperdense artery sign and those without the sign. The difference between the two groups in terms of mortality and prognosis was analyzed. Results: There were 136 patients, 50.7% of them were women. The mean age was 59.1 years. The subgroup with HMCAS present consisted of 93 patients. There were no differences in demographics and clinical characteristics between the two groups; however, tobacco use is more common in patients with HMCAS. No significant difference was observed in clinical outcomes and mortality between the two groups at 3 months. Patients with HMCAS had statistically more new territory emboli during the procedure (9.7%) compared to patients without HMCAS. Conclusion: We showed that the presence of HMCAS in initial CT was not helpful in predicting good clinical outcomes in patients undergoing endovascular therapy patients. However, the presence of HMCAS is related to more new territory embolism during the procedure. Different endovascular strategies may be applied to these patients.

Olfactory bulb volume in patients with normal-pressure hydrocephalus: an MRI evaluation.

AIM: To investigate changes in olfactory bulb (OB) volume in patients with idiopathic normal-pressure hydrocephalus (NPH). MATERIALS AND METHODS: This multicentric retrospective study included a test group of 23 patients with NPH (10 male and 13 female patients) and a control group of 27 healthy participants without hydrocephalus. The OB volume in all participants had been measured using cranial magnetic resonance imaging (MRI). In the NPH group, positivity for disproportionately enlarged subarachnoid space hydrocephalus (DESH) was also evaluated. RESULTS: The OB volumes of the NPH group (R 38.29 ± 9.34 mm3 and L37.52 ± 9.59 mm3) were significantly lower than those of the control group (R 45.87 ± 7.33 mm3 and L48.41 ± 7.62 mm3) bilaterally. There were no significant differences between right and left OB volumes in the NPH group. Nine of the 23 patients were DESH positive and 14 were DESH negative. There were no significant differences between OB volumes of the DESH positive and DESH vpatients in the NPH group. In both groups, there was a positive correlation between right and left OB volumes. There were no significant correlations between OB volumes and age or gender. In the NPH group, there were no significant correlations between DESH positivity and OB volumes. CONCLUSION: OB volume decrease and olfactory problems should be taken into account in idiopathic NPH patients. When expanded ventricles and decreased OB volume are observed at cranial MRI, a diagnosis of idiopathic NPH should be considered.

The effect of kangaroo care on maternal attachment in preterm infants.

AIM: The study was conducted to determine the effect of kangaroo care on maternal attachment in preterm infants in Turkish mothers. SUBJECTS AND METHODS: The study was conducted a quasi-experimental research design between October 2015 and February 2016 in the neonatal intensive care units (NICU) of two state hospitals located in the east and west of Turkey. The study population consisted of preterm infants hospitalized in the NICU at the time of the research and met the study-group selection criteria. The study population was divided into two groups as an experimental and control group. Kangaroo care (n = 30) was provided to the infants in the experimental group by their mothers. No intervention was applied to the infants in the control group (n = 30) other than the routine practice. Data were collected by the researcher using the 'Introductory Information Form' and the 'Maternal Attachment Inventory'. Data analysis was performed with SPSS (Statistical Package for Social Sciences) 18 software package. The data were analyzed using percentile distributions, mean, standard deviation, t-test, and Chi-square test. Official permissions and ethical approval were obtained to conduct the study. RESULTS: It was determined that the experimental and control group included in the study were similar in terms of the characteristics of the baby and the mother (P> 0.05). In the study, the mean maternal attachment scale score (MAS) of the group in which the kangaroo care was provided was higher than the control group with a statistically significant difference between the groups (P < 0.05). CONCLUSION: As a result of the study, it was concluded that kangaroo care positively affects maternal attachment and it is suggested that further studies should be conducted to evaluate the effect of kangaroo care on mother-infant attachment in Turkey.

IS IRON DEFICIENCY A RISK FACTOR FOR THE DEVELOPMENT OF THYROID AUTOANTIBODIES IN EUTHYROID WOMEN WITH REPRODUCTIVE AGES?

CONTEX: The first trimester of pregnancy is the most sensitive period in terms of thyroid hypofunction. Iron deficiency has been associated with both thyroid function and thyroid autoimmunity. OBJECTIVE: We aimed to investigate whether iron deficiency is a risk factor for thyroid autoimmunity in non-pregnant women at childbearing age. DESIGN: This cross- sectional study was conducted in non-pregnant women who presented to the Internal Medicine Policlinic between January 2018 and December 2018 in the University of Health Sciences "Fatih Sultan Mehmet" Training and Research Hospital. METHODS: Three hundred fifty-eight non-pregnant women of reproductive ages (203 iron deficient-ID, 155 control) participated in this study. Women with known thyroid disease, currently undergoing treatment for thyroid disease or whose thyroid function tests were outside the reference range were excluded from the study. Blood sample was taken after at least 8-10 hours of fasting for measurement of serum iron (Fe), total iron binding capacity (TIBC), serum ferritin (SF), whole blood count, thyroid function tests (fT4, TSH), anti-thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibody (TgAb). The patients with SF levels ≤ 15 ng/dL were accepted as iron deficiency. RESULTS: The group with ID had higher TSH and lower T4 values that did not reach statistical significance compared to the control group (p=0.101 and p=0.098, respectively). Antibody positivity was more frequent in the ID group than in the control group (35.96% vs. 20.65%, p = 0.002). CONCLUSIONS: Iron deficiency is associated with thyroid autoimmunity and it should be considered as a risk factor for screening thyroid antibody, particularly in pregnancy planning women.

SERUM IRISIN LEVEL INCREASES THROUGHOUT THE GESTATIONAL PERIOD AND IT DOES NOT PLAY A ROLE IN DEVELOPMENT OF GESTATIONAL DIABETES MELLITUS.

INTRODUCTION: Irisin is a recently discovered novel adipomyokine that induces an increase in total body energy expenditure, improves insulin sensitivity and glucose tolerance. It has been shown that circulating levels of irisin are low in patients with obesity, diabetes mellitus and impaired glucose tolerance. However, the information about the level of circulating irisin in gestational diabetes mellitus (GDM) is controversial. MATERIAL AND METHODS: Serum irisin was measured by an ELISA in a longitudinal prospective cohort study in 221 women. There were 156 healthy pregnant and 65 women with GDM. RESULTS: Circulating irisin levels were significantlly higher in the middle pregnancy compared with early pregnancy levels in healthy pregnant women and in women with GDM. Serum irisin levels were found to be lower in GDM compared to healthy pregnant women during first trimester but the difference was not observed throughout the pregnancy and it was comparable in middle pregnancy. There was a significant inverse correlation of BMI with serum irisin (r = -0.193, p = 0.004) and between HbA1c and mean glucose of OGTT with serum irisin (r =-0.377, p =0.0001) and (r = -0.147, p:0.03) in the early pregnancy of pregnant women repectively. CONCLUSIONS: The present study shows that serum irisin level increases throughout the gestational period from early to middle pregnancy in women with GDM, but there is no effect of irisin on the development of GDM.

Undifferentiated pleomorphic sarcoma with focally rhabdomyosarcomatous differentiation of the ovary.

PURPOSE OF INVESTIGATION: Primary sarcomas account for of 2-3% of all female genital tract cancers and ovaries are unusual sites for sarcomas. The authors aimed to report a case of primary ovarian sarcoma. MATERIALS AND METHODS: A 46-year-old woman presented with abdominal pain and distention. Abdominal MRI revealed a 20-cm-sized complex mass in the right adnexa and ascites. Preoperative CA-125 was 289 U/ml. She underwent optimal debulking surgery and diagnosed with undifferentiated pleomorphic sarcoma with focally rhabdomyosarcomatous differentiation. RESULTS: The patient presented with severe abdominal pain and distention 32 days after the operation and recurrent disease was diagnosed. First cure of adjuvant chemotherapy was administered, but she died 15 days later. CONCLUSION: Coexistence of undifferentiated pleomorphic sarcoma and rhabdomyosarcoma shows highly aggressive behavior and its prognosis is extremely poor. To the best of the authors' knowledge, this is the second case report of the coexistence of these type tumors in the literature.

Management of cervical cancer during pregnancy.

Cervical cancer (CC) is the most common gynaecological cancer during pregnancy. The rarity of the disease and lack of randomised control studies have prevented the establishment of treatment guidelines. The management of CC mainly follows the guidelines for the non-pregnant disease state, expert opinions and limited case reports. Although the management of CC diagnosed during pregnancy appears to be a significant dilemma for the patients and specialists, the prognosis of CC is not influenced by pregnancy. The treatment decision should be made collaboratively with a multidisciplinary team consisting of an obstetrician, gynaecologist, oncologist and paediatrician. The concerns of the patient should be taken into account.

[Ouabain induces Rho-dependent rock activation and membrane blebbing incultured endothelial cells].

Small G protein Rho and its most studied effectors, ROCK I and ROCK II, are involved in several cellular fuctions including smooth muscle and non-muscle cell contractions, cell migration and apoptosis. Activation of ROCK I by caspase-3 and activation of ROCK II by granzyme B are essential for membrane blebbing in the execution phase of apoptosis. In contrast, it has been demonstrated that Rho signaling is critical for blebbing developed after serum removal. As it was shown by us previously, ouabain induces membrane blebbing and proteolitic cleavage of ROCK I and ROCK II via caspases in human umbilical endothelial cells. However, caspase inhibitors do not prevent ouabain-induced blebs. Ouabain induces concentration-dependent cell death and membrane blebbing in endothelial cells. The aim of this study was to identify the possible role of Rho in ouabain-induced membrane blebbing. Pretreatment of endothelial cells with a Rho inhibitor CT04 did not inhibit the ouabain-induced cell death but prevented the development ofbleb formation. These results indicate that bleb formation is dependent on Rho activity in ouabain-induced cell death in HUVECs. Taken together, these results suggest that the mechanism of membrane bleb formation might be different depending on cell type and cell death-stimuli.

En-bloc pelvic resection with concomitant rectosigmoid colectomy and immediate anastomosis as part of primary cytoreductive surgery for patients with advanced ovarian cancer.

OBJECTIVE: To assess the authors' experiences in en bloc pelvic resection with concomitant rectosigmoid colectomy and primary anastomosis as a part of primary cytoreductive surgery for patients with advanced ovarian cancer. MATERIALS AND METHODS: Atotal of 22 patients with FIGO Stage IIB-IV epithelial ovarian cancer who underwent en bloc pelvic resection with anastomosis were retrospectively reviewed. Data analyses were carried out using SPSS 10.0 and descriptive statistics, Kaplan-Meier survival curves, and Log Rank (Mantel-Cox) test were used for statistical estimations. RESULTS: Median age was 58.8 years. FIGO stage distribution of the patients was; one (4.5%) IIB, three (13.7%) IIC, three (13.7%) IIIA, six (27.3%) IIIB, and nine (40.9%) IIIC. Median peritoneal cancer index (PCI) was 8 (range 5-22) and optimal cytoreduction was achieved in 18 patients (81.8%) of whom 13 (59.1%) had no macroscopic residual disease (complete cytoreduction). There was no perioperative mortality. A total of nine complications occurred in seven (31.8%) patients. Anastomotic leakage was observed in one (4.5%) patient. There was no re-laparotomy. Mean follow-up time was 60 months. There were 15 (68.2%) recurrences of which 12 (80%) presented in extra-pelvic localizations. Mean disease-free survival (DFS) and overall survival (OVS) were estimated as 43.6 and 50.5 months, respectively. Patients with complete cytoreduction had a better DFS (p = 0.006) and OVS (p = 0.003) than those with incomplete cytoreduction. CONCLUSION: En bloc pelvic resection, as a part of surgical cytoreduction, seems to be a safe and effective procedure in many patients with advanced ovarian cancer if required. Despite relatively high general complication rate, anastomosis-related morbidity of this procedure is low as 0.8%. Nevertheless, surgical plan and perioperative care should be personalized according to medical and surgical conditions of the patient.

Uterine preservation in placenta percreta complicated by unscarred uterine rupture at second trimester in a patient with repeated molar pregnancies: a case report and brief review of the literature.

Placenta-percreta causing uterine rupture in unscarred uterus is a rare obstetric surgical emergency that can cause maternal and perinatal morbidity and mortality. A 25-year-old woman presented with abdominal pain for four days. Previously, she had undergone two suction curettages for complete hydatiform moles. Ultrasound revealed a non-viable fetus with an estimated gestational age of 21 weeks and free fluid and coagulum in the abdominal cavity. An emergency laparotomy was performed because of the acute abdomen. At exploration, the placenta had invaded the entire thickness of the myometrium and the non-viable fetus was in the abdominal cavity. The uterus was closed with a double-layer of interrupted sutures and uterine-sparing surgery was performed. The patient was discharged on postoperative day seven. The authors present a case of placenta-percreta in an unscarred uterus complicated with uterine rupture during the second-trimester that was managed successfully with uterine repair. They also review the literature briefly and discuss similar cases managed conservatively in the second-trimester.

Arterial blood gas analysis predicts futile recanalization in mechanical thrombectomy-treated acute ischemic stroke patients: a multicenter study.

OBJECTIVE: It is known that providing recanalization alone in large vessel occlusions is not sufficient to provide a good 90-day clinical outcome. It is advocated that neuroprotection should be increased before endovascular treatment and that the penumbra should be protected from reperfusion damage after recanalization. However, the effects of blood gas parameters before and after mechanical thrombectomy on clinical outcomes are not clear. The objective of this study is to assess the effectiveness of serial blood gas measures in accurately predicting futile recanalization at an early stage. PATIENTS AND METHODS: This study is a multicenter inquiry that collected data in a prospective manner and analyzed it retrospectively. Patients with a 2b-3 thrombolysis in cerebral infarction (TICI) score after mechanical thrombectomy for recanalization were consecutively analyzed from July 2022 to March 2023. Arterial blood gas parameters, including pH, oxygen saturation (SaO2), partial carbon dioxide pressure (PaCO2), partial oxygen pressure (PaO2), lactate, and bicarbonate (HCO3), were measured at four time points: before mechanical thrombectomy treatment (preoperative), immediately after recanalization (postoperative 1st), during the 3rd hour (postoperative 3rd), and at the 5th hour (postoperative 5th). The patients were categorized into groups based on their modified Rankin Scale (mRS) scores. RESULTS: The study included 136 patients with an average age of 69.71±11.22. The postoperative 1st-hour SaO2 values were lower in the mRS 3-6 group (p=0.038). The postoperative pH and lactate mean were greater in the mRS 3-6 group than in the 0-2 group (p=0.038 and 0.018, respectively). In logistic regression, a unit rise in lactate increased poor functional outcomes 1,632 times (p=0.024). Early neurological recovery was associated with decreased postoperative 3rd-hour lactate (p=0.014). The mean postoperative PaO2 (average of 1, 2, 3 PaO2) was higher in those with symptomatic cerebral bleeding (p=0.044). CONCLUSIONS: Monitoring lactate and pH levels in AIS patients who have had mechanical recanalization can be utilized to predict mortality and morbidity, especially in the first five hours after the procedure. Graphical Abstract: https://www.europeanreview.org/wp/wp-content/uploads/Graphical-abstract-8.jpg.

An experimental model of aortic surgery and the effect of Iloprost on lung injury.

OBJECTIVES: Ischemia/reperfusion (I/R) damage of the lung is a frequently encountered complication following aortic surgery. The aim of the present study is to investigate the histopathological effects of Iloprost on pulmonary damage developed after I/R. DESIGN: Twenty-four Sprague-Dawley rats were randomly divided into 3 groups. In the control group, aortas were not clamped. In the I/R group, aortas were occluded, and after 1 h of ischemia, clamps were removed. After 2 h of reperfusion period, lungs of the rats were extracted. In the I/R + Iloprost group after 1 h of ischemia, Iloprost infusion was initiated, and maintained for the duration of 2 h reperfusion period. For histopathological scoring, density of polymorphonuclear leucocytes, congestion, interstitial edema, and bleeding were semiquantitatively evaluated, and histopathological changes were scored. RESULTS: In the I/R group, multifocal-marked histopathological changes in 5 (62.5%), and multifocal-moderate histopathological changes in 3 (37.5%) rats were detected. In the I/R + Iloprost group, multifocal-moderate histopathological changes in 4 (50%), and multifocal-mild changes in 4 (50%) rats were detected. CONCLUSIONS: In the experimental rat model, administration of Iloprost has been shown to have preventive effects for pulmonary damage occurring after I/R generated by infrarenal aortic occlusion.

Is cardioembolic stroke more frequent than expected in acute ischemic stroke due to large vessel occlusion?

INTRODUCTION: Cardioembolic and atherosclerotic occlusions are two leading causes of acute ischemic stroke with large artery occlusion. Cardioembolic cause is more frequent in strokes due to large vessel occlusion among strokes of all types. In this study, we aimed to analyze and determine the rate of cardioembolic cause in patients with LVO treated with mechanical thrombectomy. PATIENTS AND METHODS: This study is a retrospective analysis of 1,169 patients with LVO that were treated with mechanical thrombectomy in 2019. Both anterior and posterior circulation occlusions eligible for thrombectomy were included. RESULTS: Among the 1,169 patients who performed mechanical thrombectomy, there were 52.6 % males with a mean age of 63.2 ± 12.9 years and 47.4% females with a mean age of 67.4 ± 13.3 years. The average NIHSS score was 15.3 ± 4.8. The successful revascularization (mTICI 2b-3) rate was 85.2%, the 90-day good functional outcome rate (mRS 0-2) was 39.8% and mortality (mRS 6) rate was 22.9%. Most common causes of ischemic stroke were cardioembolism in 532/1,169 (45.5%), followed by 461/1,169 (39.5%) undetermined etiologies and others, 175/1,169 (15%) large vessel disease. Atrial fibrillation is found to be the most common cause of cardioembolic stroke with 76.3% incidence. We identified 11 (0.9%) acute stroke patients treated with MT who had recurrent LVO and received repeated MT. A cardioembolic cause was found to cause the recurrent LVO in 7 (63.6%) patients. CONCLUSIONS: In this retrospective study, cardioembolic source seems to constitute majority of causes in acute ischemic strokes due to large vessel occlusions. Further exploration is needed especially in cryptogenic strokes to reveal possible cardioembolic source of emboli.

The effects of dexmedetomidine on early acute kidney injury in severely burned rats.

OBJECTIVE: Burns are a global medical and economic problem. In addition to high costs, the lengthy therapeutic process and the emotional trauma experienced by patients and their families indirectly worsen the socioeconomic damage caused. Kidney failure observed after burns is highly correlated with mortality. MATERIALS AND METHODS: Twenty-eight male Sprague-Dawley rats (age four months, weight 250-350 g) were included in the study. They were randomly assigned into four groups consisting of seven rats each with similar mean weights. Group 1 (n=7) represented the healthy control group (C), Group 2 (n=7) the Sham+dexmedetomidine (DEX) 100 mcg/kg (three doses) (S+DEX100) group, Group 3 (n=7) the 30% Burn (B), and Group 4 (n=7) the 30% Burn+DEX 100 mcg/kg/day group (B+DEX100) (three doses). Thiobarbituric acid reactive substances (TBARS), total thiol (TT), interleukin-1 (IL-1) and tumor necrosis factor-α (TNF-α) values in kidney tissues were investigated biochemically, and histopathological analyses were also performed. Nuclear factor κB (NF-κB)/p65 was measured using immunohistochemistry, and the TUNEL assay was applied to indicate apoptotic tubular epithelial cells. RESULTS: TBARS, IL-1, and TNF-α in kidney tissues decreased in the B+DEX100 group compared to the 30% burn group, while total thiol values increased. Histopathologically, atypical glomeruli, particularly necrotic tubules, and inflammation in peritubular areas decreased in the B+DEX100 group compared to the 30% burn group. In addition, apoptotic tubular epithelial cells exhibiting TUNEL positivity and tubular epithelial cells exhibiting NF-кß/p65 positivity also decreased in the B+DEX100 group compared to the 30% burn group. CONCLUSIONS: Dexmedetomidine reduced apoptotic activity in rats and exhibited anti-inflammatory antioxidant effects in the burn model in this study.

Robotic-assisted laparoscopic nephroureterectomy and bladder cuff excision.

BACKGROUND AND OBJECTIVES: Our aim was to show that bladder cuff excision and distal ureterectomy can be safely performed by using the LigaSure device during robotic-assisted laparoscopic nephroureterectomy. METHODS: A 60-year-old man presented with gross hematuria. He was diagnosed with upper urinary tract transitional cell carcinoma (TCC) on the left side and was scheduled for robot-assisted laparoscopic surgery. Without changing the patient's position, sealing with the LigaSure atlas for bladder cuff excision and distal ureterectomy was performed. RESULTS: The operating time was 140 minutes from the initial incision to skin closure of all incisions. The estimated blood loss during the surgery was 120 mL. There were no intraoperative or postoperative complications. The Foley drain was removed on day 3 after normal cystographic findings, and the patient was discharged from the hospital on the fourth postoperative day. CONCLUSION: Robot-assisted nephroureterectomy with distal ureterectomy in the same position using a LigaSure device is a safe alternative for upper tract transitional cell carcinoma.