Does the vitamin C level affect postoperative analgesia in patients who undergo orthognathic surgery?

Vitamin C has a critical role in pain management because of its antioxidative, neuroprotective, and anti-nociceptive properties. Oxidative stress caused by surgery increases the requirement for vitamin C. The aim of this study was to evaluate the change in vitamin C level and its effect on postoperative pain in patients undergoing orthognathic surgery. Thirty patients were included in the study. The relationships between the postoperative plasma vitamin C level, duration of surgery, postoperative analgesic consumption, and pain scores (visual analogue scale) were analysed. The difference between the mean pre- and postoperative vitamin C levels was found to be statistically significant (7.5 ± 2.9 mg/l vs 4.9 ± 2.3 mg/l, respectively; P = 0.001). There was no significant relationship between the duration of surgery and the vitamin C level decrease (P > 0.05). There was an inverse correlation between the postoperative vitamin C level and the amount of analgesic requested via patient-controlled analgesia (r = -0.699, P < 0.001). The findings suggest that, in patients who undergo orthognathic surgery, plasma vitamin C levels decrease significantly (34.6%), and an increase in the duration of surgery is not associated with any decrease in the vitamin C levels. A low postoperative plasma vitamin C level was found to be associated with greater postoperative analgesic consumption. In patients with preoperative plasma vitamin C levels ≤ 42 µmol/l, perioperative vitamin C administration may be considered for postoperative pain management.

Neuroprotective effects of amantadine for experimental acute carbon monoxide poisoning.

OBJECTIVE: Amantadine is known to have a neuroprotective effect in many neurological diseases. This study aims at investigating the neuroprotective effect of amantadine in rats exposed to carbon monoxide (CO) poisoning. MATERIALS AND METHODS: Rats were maintained under standard experimental laboratory conditions and randomized into 4 different groups of 7 each namely control, amantadine only, CO exposure, and amantadine + CO exposure. For immunohistochemical analysis, tissues taken from the prefrontal and hippocampal regions were taken into formalin and kept for at least one day. Afterward, the tissue was followed and blocked for paraffin blocking. N-Methyl D-Aspartate (NMDA) levels in homogenates were studied by the Enzyme-Linked Immunosorbent Assay (ELISA) method. Superoxide dismutase (SOD) and catalase (CAT) activities in the supernatants were studied with commercial kits. Nitric oxide (NO) and Asymmetric Dimethyl Arginine (ADMA) levels were studied by the ELISA method. Enzyme activity values were calculated by dividing the protein values in the supernatants and normalizing them. RESULTS: CAT, SOD, NMDA, ADMA, and NO levels were statistically significantly different between the groups (p < 0.05). According to post-hoc pairwise comparison test results, the values of the control and amantadine groups for CAT, SOD, NMDA, ADMA, and NO parameters were significantly higher than that of CO group. Similarly, values in the control and amantadine groups were considerably higher than values for the amantadine + CO group. NMDA values were significantly lower in group amantadine + CO than in CO group (p: 0.049). CONCLUSIONS: Apoptosis and endothelial damage after CO poisoning is a complex process, and amantadine administration has a limited contribution in preventing this process.

Determination of ecologically sensitive areas in Denizli province using geographic information systems (GIS) and analytical hierarchy process (AHP).

Ecological sensitivity is defined as the ecosystem's reaction to environmental change caused by internal and external factors. The degree of ecological sensitivity varies in spatial dimension depending on the natural and cultural features. Ecological sensitivity analysis is based on basis of mapping these differences. As a result of the analysis, an important data that can be a base for spatial plans at different scales is provided. In accordance with this aim, Denizli province was selected for the study area in this research. The factors affecting sensitivity were determined by the literature survey, which was conducted by considering the characteristics of the study area. In this context, elevation, slope, aspect, the proximity to water surface, land cover, and vegetation coverage were evaluated as natural factors, and the proximity to primary traffic roads and residential areas as cultural factors. Each factor was spatially grouped by means of geographic information systems (GIS) according to the degree of impact on ecological sensitivity. Scale 1 (lowest ecological sensitivity) to 5 (highest ecological sensitivity) was used for the spatial grouping. A analytical hierarchy process (AHP) was applied to weight the factors. The overlay method was used in line with the weighted scores in order to determine the composite ecological sensitivity. As a result of the study, the area of 286.26 sq km (2.37%) as highly and more sensitive, 5267.47 sq km (43.50%) as moderately sensitive, and 6554.56 sq km (54.13%) as mildly and less sensitive was determined. In line with the results, suggestions for protection-utilization balance were developed.

Simultaneous Cardiac Surgery and Renal Transplantation Compared With Renal Transplantation After Cardiac Surgery.

Patients with end-stage renal disease (ESRD) have a high prevalence of coronary artery disease and cardiovascular death. The mortality and the morbidity rates of cardiac surgery are particularly high in these patients with end-stage renal disease. Performing cardiac surgery and kidney transplantation in the same session can reduce these complications in the early postoperative period by normalizing renal function. We compared the mortality and morbidity rates between patients who had undergone cardiac surgery and kidney transplantation separately and patients who had combined surgeries. This retrospective study consisted of 75 patients. One group of 60 patients underwent cardiac surgery and kidney transplantation in separate sessions, and the other group of 15 patients had combined surgeries in the same session, between March 2008 and September 2012. Patients who had combined surgeries achieved fluid electrolytic balance more easily, had shorter extubation times, used less blood and blood products, and had fewer major complications. The patients recovered faster and thus had shorter stays in the intensive care unit and hospital. This combined surgical approach allows normalized kidney function in patients with end-stage renal disease, so mortality and morbidity in the early postoperative period could be significantly reduced.

Evaluation of corneal endothelial cell damage after vitreoretinal surgery: comparison of different endotamponades.

PURPOSE: We evaluated corneal endothelial cell (EC) damage after vitreoretinal surgery and compared the results using different tamponades. MATERIALS AND METHODS: This prospective controlled study included 45 eyes of 45 patients (24 females, 21 males) who underwent pars plana vitrectomy with gas (sulphur hexafluoride, SF6, 20%) or silicone oil (SO) tamponade. Patients were assigned to one of the three groups: group 1 (phakic, 20% SF6 gas), group 2 (pseudophakic, 20% SF6 gas), and group 3 (phakic, SO). Mean endothelial cell density (MCD), mean cell area (MCA), coefficient of variation in cell size (CV), and percentage of hexagonal cells (HC) values were measured using a non-contact specular microscope (SP-2000P; Topcon, Japan) at baseline and at 3 months after surgery. The fellow eye of each patient was used as a control. RESULTS: Group 2, which had the lowest baseline MCD and MCA values, was found to be different than groups 1 and 3 (P=0.028 and 0.022, respectively). At 3 months postoperatively, all groups showed significantly lower MCD, HC and CV values than at baseline (all P<0.05). The mean changes in MCD at 3 months after surgery were 3.8±2.8% (mean±SD), 8.0±7.5%, and 4.6±5.4% in groups 1-3, respectively. The mean MCD changes in the fellow eyes were 0.31±1.41% in group 1, -0.63±1.90% in group 2, and 0.14±0.52 in group 3 at 3 months postoperatively (P>0.05 for all). CONCLUSIONS: Our findings revealed that corneal EC damage may occur after vitreoretinal surgery with gas or SO tamponade. Eyes that had undergone previous cataract surgery were more vulnerable to EC loss than phakic eyes, supporting the protective effect of an intact lens.

Association of choroidal thickness with eye growth: a cross-sectional study of individuals between 4 and 23 years.

BACKGROUND AND AIMS: We aimed to evaluate the association of subfoveal choroidal thickness (SFCT) with age and to determine its relationship with axial length (AL) and ocular biometric parameters, in children and young adults during growth period. METHODS: One hundred and sixty patients (80 male, 80 female) aged between 4 and 23 years were included. Patients were classified into five groups according to their ages as group 1 (4-7 years of age), group 2 (8-11 years), group 3 (12-15 years), group 4 (16-19 years), and group 5 (20-23 years). SFCT was assessed using spectral-domain optical coherence tomography (3D OCT-2000). The measurements were taken at the same daytime (1000-1200 hours) to avoid diurnal fluctuation. Ocular AL and anterior segment parameters were measured using optical biometry (Lenstar LS900)). RESULTS: The average SFCT was 308.1±47.6 µm, ranging from 206 to 410 µm. The mean SFCT values in group 1 to 5 were measured as 306.8±42.0, 297.8±48.1, 283.2±38.9, 326.9±57.4, and 325.8±35.9 µm, respectively. The mean CT of group 3 was significantly thinner than group 4 and 5 (P<0.05 for two groups), however, there was no statistical significance compared with group 1 (P=0.227) and group 2 (P=0.693). On stepwise regression analysis, age exhibited a positive association with SFCT (B=2.8, P<0.001) and AL exhibited a negative association with choroidal thickness (B=-16.7, P<0.001). CONCLUSIONS: We found that SFCT shows no age-related difference until age of 15, whereas 16-23-year old participants had thicker SFCT compared with the younger ones. In that aspect, a thicker choroid associated with age in certain age groups suggests an age period of SFCT increase to a plateau in young adulthood. Larger studies are warranted to elucidate the age-related changes in SFCT in childhood, as improved evaluation of normal choroidal thicknesses during eye growth should assist in the diagnosis of choroidal abnormalities associated with eye disease.

Participatory evaluation of monitoring and modeling of sustainable land management technologies in areas prone to land degradation.

Examples of sustainable land management (SLM) exist throughout the world. In many cases, SLM has largely evolved through local traditional practices and incremental experimentation rather than being adopted on the basis of scientific evidence. This means that SLM technologies are often only adopted across small areas. The DESIRE (DESertIfication mitigation and REmediation of degraded land) project combined local traditional knowledge on SLM with empirical evaluation of SLM technologies. The purpose of this was to evaluate and select options for dissemination in 16 sites across 12 countries. It involved (i) an initial workshop to evaluate stakeholder priorities (reported elsewhere), (ii) field trials/empirical modeling, and then, (iii) further stakeholder evaluation workshops. This paper focuses on workshops in which stakeholders evaluated the performance of SLM technologies based on the scientific monitoring and modeling results from 15 study sites. It analyses workshop outcomes to evaluate how scientific results affected stakeholders' perceptions of local SLM technologies. It also assessed the potential of this participatory approach in facilitating wider acceptance and implementation of SLM. In several sites, stakeholder preferences for SLM technologies changed as a consequence of empirical measurements and modeling assessments of each technology. Two workshop examples are presented in depth to: (a) explore the scientific results that triggered stakeholders to change their views; and (b) discuss stakeholders' suggestions on how the adoption of SLM technologies could be up-scaled. The overall multi-stakeholder participatory approach taken is then evaluated. It is concluded that to facilitate broad-scale adoption of SLM technologies, de-contextualized, scientific generalisations must be given local context; scientific findings must be viewed alongside traditional beliefs and both scrutinized with equal rigor; and the knowledge of all kinds of experts must be recognised and considered in decision-making about SLM, whether it has been formally codified or not. The approach presented in this paper provided this opportunity and received positive feedback from stakeholders.

Hydatid cyst of the abdominal aorta and bilateral common iliac arteries. A case report.

Hydatid disease, a parasitic infestation, is endemic in live-stock raising countries where the custom of feeding offal to dogs prevails. Though infestation of any part of the human body can occur, arterial involvement is a rare affliction. We report here the first case in which abdominal aorta and bilateral iliac arteries were totally occluded with intraluminal cysts.

Echocardiography and magnetic resonance imaging of sinus of Valsalva aneurysm with rupture into the ventricle.

A 53 year-old man with rupture of sinus of Valsalva aneurysm into the right ventricle diagnosed by two dimensional echocardiography (2DE), magnetic resonance imaging (MRI), and catheterisation study is reported in this paper. Despite the fact that its incidence is low, early diagnosis is very important in this illness because of the possibility of complete cure with surgery. In this study it was shown that MRI as well as 2DE is an excellent diagnostic method for this illness. The diagnosis was also confirmed with surgery in this patient.

Congenital lobar emphysema. A case report.

One infant, age 19 days, with congenital lobar emphysema whose main symptoms included dyspnea, cyanosis and severe infant Respiratory Distress Syndrome, was presented in this paper. The most reliable diagnostic tool was chest x-ray films with anteroposterior and lateral views. As additional diagnostic method, thorax computerized tomography was also used. The affected lobe was the left upper lobe. Resection of the affected lobe was performed with good results.

Relationship between histologic grading and serum prostate specific antigen in prostatic carcinoma.

Prostate specific antigen (PSA) is the most important tumour marker which, used routinely, proved to have a positive correlation with tumour volume and pathological stage. To evaluate the relationship between serum PSA and histologic grading of prostatic carcinoma, preoperative PSA determinations were made in 25 patients with prostatic cancer. Biopsy materials were evaluated and the Gleason scores were adjusted for histologic grading. The higher values of PSA were proportional to the Gleason scores of the primary prostatic biopsy.

Thromboangiitis obliterans (Buerger's disease) in women (a reevaluation).

Thromboangiitis obliterans (TAO) is an occlusive vascular disease traditionally known to be almost exclusive to young male smokers. The disease was considered to be extremely rare in women, seen only as isolated, novel case reports in the literature. In the past decade, however, a dramatic increase in the incidence of female TAO has been observed. In this paper the authors report 7 cases of clinically and angiographically verified female TAO. The world literature in regard to the diagnostic criteria, changing incidence, and etiology is reviewed. They conclude that the increased use of tobacco among young women in the past two to three decades is responsible for this dramatic change.

Primary muscular hydatid cyst causing arterial insufficiency: case report and literature review.

Hydatid disease, though known to occur in most organs and areas of the body, is extremely rare in skeletal muscle. In this article the authors present a case of a primary muscular hydatid cyst, originating from the adductor muscle group, causing obstruction of the femoral artery and vein.

Fistulous communication of aortic sinuses into the cardiac chambers. Fifteen years surgical experience and a report of 23 patients.

Over the past 15 years 23 patients, aged 14-50, with aortic sinus-cardiac chamber fistulous communication have been operated upon. All were symptomatic and had angiographic evaluation before surgery. The last 5 were diagnosed by two-dimensional echocardiography. The origin of the fistula was the right aortic sinus in 22 and the non-coronary sinus in 1. The involved cardiac chamber was the right ventricle in 18, right atrium in 3 and left ventricle in 2. Associated lesions were ventricular septal defect (VSD) in 9, ventricular septal defect + atrial septal defect (VSD + ASD) in 1, ventricular septal defect + pulmonary stenosis (VSD + PS) in 1, atrial septal defect (ASD) in 3 and congenital aortic stenosis (AS) in 1. At surgery both the aorta and involved cardiac chamber were opened. No recurrence was encountered when the fistula was repaired using teflon felts on both ends. Three patients, 2 of whom had been operated upon before the use of cardioplegic arrest, died (13%).