The effect of remifentanil and dexmedetomidine on dynamic thiol/disulfide balance in patients undergoing coronary artery bypass surgery: a prospective case-control study.

OBJECTIVE: It is established that the balance of serum thiols is disrupted in favor of oxidants in coronary artery disease, and the cardiopulmonary bypass pump used during coronary artery bypass surgery disrupts this balance in favor of oxidants. In this study, we investigated the antioxidant effects of remifentanil or dexmedetomidine on thiol-disulfide balance and paraoxonase-1 (PON-1) levels during on-pump coronary artery bypass surgery. PATIENTS AND METHODS: A total of 100 patients who underwent on-pump coronary artery bypass grafting surgery between May 2018 and December 2018 were included in the study. Patients were divided into two groups: the remifentanil group (Group R) and the dexmedetomidine group (Group D). Venous blood samples were obtained from the patients after induction of anesthesia [Time 1 (T-1)], then after cross-clamping of the aorta (T-2), after removal of the cross-clamp (T-3), 10 minutes after the end of protamine infusion (T-4), and 24 hours postoperatively (T-5). Serum total thiol, native thiol, disulfide, and PON-1 levels were evaluated. RESULTS: Total thiol, disulfide, PON-1, native thiol/total thiol, total thiol/disulfide, and native thiol/disulfide levels were similar between the two groups. Native thiol levels were statistically significantly higher in group D compared to group R at T-3 and T-5 (p = 0.017 and p = 0.027, respectively). When T-1 and T-5 times were compared in intragroup measurements, disulfide levels were significantly lower, and native thiol/total thiol ratios were significantly higher at T-5 (p < 0.001). CONCLUSIONS: In conclusion, in light of the data obtained from this study, it can be concluded that dexmedetomidine used during surgery has a better contribution to oxidant-antioxidant balance than remifentanil in patients undergoing coronary artery bypass surgery with the on-pump method.

Drainless resection of the submandibular gland with facial vessel preservation: A comparative study.

OBJECTIVE: Resection of the submandibular gland (SMG) is a common surgery and many surgeons leave a drainage system in the surgical field. However, surgical drain may increase risk of complication and related prolonged hospitalization time. The purpose of this study was to investigate the safety of SMG resection without any surgical drainage system. METHODS: This retrospective trial on SMG surgery was conducted between 2016 and 2019. Patients were assigned into one of two main groups: surgical drain (+) (n=20) and surgical drain (-) (n=17). All surgical procedures were done via a standardized surgical technique. Facial vessels were dissected and only glandular branches were ligated. Also, non-identification method was applied for marginal mandibular nerve (MMN) protecting. In surgical drain (-) group, before the wound closure, oxidized regenerated cellulose (ORC) was placed in the surgical field. Moreover, a closed suction drain was inserted in surgical drain (+) group. RESULTS: A total of 37 SMG resections were performed: 15 patients had sialolithiasis, 14 patients had pleomorphic adenoma and 8 patients had chronic sialadenitis. There were 20 women (54%) and 17 men (46%), with an age range of 23-70 years. No major complications were observed in surgical drain (-) group. There were two cases with minor complications. One patient (5.8%) occurred transient paralysis of the MMN. Other patient developed seroma and it was easily managed with repeated punctures. ORC related allergic reaction or adverse incident were not detected in any of the patients. On the other hand, in surgical drain (+) group, 2 patients (10%) developed a hematoma on the first postoperative day and local wound infection was detected in 4 patients (20%). We found that the surgical drain usage was related to prolonged hospitalization, worse wound healing and problems with scarring. CONCLUSION: Our findings provide evidence for the safe drainless resection of the SMG using ORC. It may be possible to prevent all of these undesirable conditions by a surgery which performed without drain insertion.

The predictive effect of initial complete blood count of intensive care unit patients on mortality, length of hospitalization, and nosocomial infections.

OBJECTIVE: The mean platelet volume (MPV) can be used as an indicator of platelet activation. However, it has been shown that the platelet/lymphocyte ratio (PLR) can provide useful predictive information about inflammation and aggregation pathways. The neutrophil/lymphocyte ratio (NLR) may also be helpful as a marker of systemic or local inflammation. The main objective of this study evaluated to unselected critically ill patients the relationship of initial MPV, NLR, and PLR with mortality, length of hospitalization, and the risk of developing nosocomial infections in ICU patients. PATIENTS AND METHODS: In this retrospective study, we evaluated consecutive patients at our tertiary nine-bed ICU. One hundred seventy-three patients who were followed up during a 1-year period were included. RESULTS: MPV levels were found to be higher in patients who died in the hospital (p = 0.05). In addition, there was a significant positive correlation between expected mortality rate and MPV among non-survivors (p = 0.009). NLR levels were higher among non-survivors, but this difference was not statistically significant (p = 0.435). PLR levels were similar between non-survivors and survivors (p = 0.173). The initial NLR and PLR were significantly higher in patients with nosocomial infections. NLR and PLR had a significant positive correlation with length of hospitalization (p = 0.006 and p = 0.027, respectively). CONCLUSIONS: In our study, we found that high PLR and NLR may be indicators for the development of nosocomial infections. Moreover, the length of hospitalization may be prolonged in patients with high PLR and NLR.

The effect of preeclampsia on the skin to subarachnoid distance in spinal anesthesia.

BACKGROUND: Preeclampsia is characterized by increased extracellular fluid which manifests as generalized edema due to endothelial injury and subsequent capillary leak. Therefore, preeclampsia may lead to increased skin to subarachnoid distance (SSD) which may influence daily clinical practice in this particular gravid population. METHODS: Age- and height-matched gravidas with and without preeclampsia were enrolled prospectively at an allocation ratio of 1:4. Spinal anesthesia (SA) was performed in a sitting position by a mid-line approach at the L3-L4 interspace using a 25-gauge Quincke spinal needle. An internal pilot study was performed to determine the sample size. When the protocol violations were excluded, 146 gravidas were included in the study (25 preeclamptics and 121 normotensive controls) for final analysis. RESULTS: On average, SSD was 0.89 cm greater in preeclamptics compared to normotensive controls. Mean values of the SSD in preeclamptic and normotensive control group patients at the L3-L4 interspace were 6.187 ± 0.967 and 5.301 ± 0.834 cm, respectively. SSD was significantly correlated with body weight and body mass index (BMI). The regression formula for the estimation of SSD in preeclamptic gravidas with BMI during SA was SSD = 3.696 + 0.075×BMI. The regression formula for the estimation of SSD in the normotensive control group with BMI during SA was SSD = 3.144 + 0.067×BMI - 0.0001×BMI×BMI. CONCLUSION: Knowing that the SSD is increased in preeclamptics compared to normotensive gravidas may be of value in terms of selecting needle, and providing safe and comfortable anesthesia.

The effect of intra-abdominal pressure on sensory block level of single-shot spinal anesthesia for cesarean section: an observational study.

BACKGROUND: Increased intra-abdominal pressure in pregnancy is thought to affect intrathecal drug spread. However this assumption remains largely untested. The aim of this prospective study was to evaluate the association between intra-abdominal pressure and maximum sensory block level in parturients receiving spinal anesthesia for cesarean section. METHODS: Parturients having elective cesarean section with single-shot spinal anesthesia using hyperbaric bupivacaine 12.5mg were included. Intra-abdominal pressure was measured via a bladder catheter after establishing a T4 sensory block and at the end of surgery in the supine position with 10° left lateral tilt. We recorded demographic data, descriptive characteristics of pregnancy, self-reported weight gain and weight of the newborn. As secondary outcomes, we evaluated onset of sensory block, maximum sensory block, motor block, number of hypotensive episodes, fluid and ephedrine requirements, time to first analgesic request, time to one-point recovery of motor block and side effects. RESULTS: The median value of the maximum sensory block level was T2 in 117 parturients. Median [interquartile range] pre-incision and postoperative intra-abdominal pressure were 13 [11-16] and 9 [6-10]mmHg respectively. No association was observed between maximum sensory block level and pre-incision intra-abdominal pressure (P=0.83). Weight was associated with pre-incision intra-abdominal pressure with an estimated odds ratio of 1.04 per kg (99.4% CI: 1.00-1.08). There was a moderate correlation between pre-incision and postoperative intra-abdominal pressure with a Spearman correlation coefficient of 0.67 (99.5% CI: 0.5-0.79). There was no association between pre-incision intra-abdominal pressure and secondary outcomes. CONCLUSIONS: In parturients, intra-abdominal pressure was not associated with spinal block spread, block onset time, recovery or side effects.

Parapharyngeal space tumours: the efficiency of a transcervical approach without mandibulotomy through review of 44 cases.

The aim of this study was to describe our experience with benign parapharyngeal space tumours resected via a transcervical route without mandibulotomy and to investigate associated postoperative sequelae and complications. The study investigated and analysed the retrospective charts of 44 patients who underwent surgery for benign parapharyngeal space tumours over a 10-year period. The diagnosis was reached in all patients with clinical and radiologic findings; preoperative fine-needle aspiration biopsy was not performed in any case. The preferred means of accessing the parapharyngeal space in all patients was a transcervical route. In 5 of these patients, transparotid extension was performed due to the position of the tumour. Tumours were classified radiologically as poststyloid in 27 cases and prestyloid in 17 cases. The final histopathologic diagnosis was vagal paraganglioma in 16 cases, pleomorphic adenoma in 13 cases, schwannoma in 10 cases and comparatively rarer tumours in the remaining 5 cases. In three patients, cranial nerve paralysis was observed during preoperative evaluation. Permanent cranial nerve paralysis occurred in 19 cases (43.2%) in the postoperative period, the majority of which were neurogenic tumours such as vagal paraganglioma (n = 16) and schwannoma (n = 2), and one case of non-neurogenic parapharyngeal tumour. The median duration of follow-up was 61 ± 33 months. There was no local recurrence in any patient during the follow-up period. A transcervical approach should be the first choice for excision of parapharyngeal space tumours, except for recurrent or malignant tumours, considering its advantages of providing direct access to the neoplasm, adequate control of neurovascular structures from the neck and optimal aesthetic outcomes due to preservation of mandibular continuity with minimal morbidity and hospitalisation time.

Is it necessary to remove submandibular glands in squamous cell carcinomas of the oral cavity?

The aim of this study was to determine the frequency and the mechanism of submandibular gland (SMG) involvement in oral cavity squamous cell carcinomas (OCSCC), and to discuss the necessity of extirpation of the gland. The authors investigated and analyzed the retrospective charts of 236 patients who underwent surgery for OCSCC over a 10-year period and the pathology reports of 294 neck dissections with SMG removal. SMG involvement was evident in 13 cases (4%). Eight cases were due to direct invasion, which was the most common mechanism. Four cases had infiltration from a metastatic periglandular lymphadenopathy, and in 1 case, metastatic disease was confirmed. The tongue and floor of the mouth were the most frequent primary sites associated with SMG involvement. The study found no bilateral cases, and in 135 SMG specimens benign pathologies were detected. Involvement of the SMG in OCSCC is not frequent. It is appropriate to preserve the gland unless the primary tumour or metastatic regional lymphadenopathy is adherent to the gland.

The site of the hearing loss in Refsum's disease.

Refsum's disease is a disorder of lipid metabolism with pigmentary retinopathy, demyelinating neuropathy, ataxia, and hearing loss. Previous histological studies have located the site of hearing impairment in the inner ear, but it has never been confirmed audiologicaly in the literature. In this reported case of Refsum's disease, despite hearing loss and absence of response in ABR, robust otoacoustic emissions were measured. Together with these and other audiological findings, we conclude that our case might be the first reported case of Refsum's disease with auditory neuropathy. The site of the hearing abnormality in Refsum's disease may be 'post-outer hair cells' in some cases as in the current case. Because of their limited benefits and risk of noise-induced damage to outer hair cells, the use of hearing aids before otoacoustic emission measurements should be considered cautiously in Refsum's disease.

Resistance to Marek's disease herpesvirus-induced lymphoma is multiphasic and dependent on host genotype.

Genotype-dependent differences in Marek's disease (MD) susceptibility were identified using 14-day-old line N and 6(1) (resistant) and 151 and 7(2) (susceptible) inbred chickens infected with HPRS-16 MD virus (MDV). All line 72 chickens developed progressive MD. Line 15I had fluctuating MD-specific clinical signs and individuals recovered. A novel histologic scoring system enabled indices to be calculated for lymphocyte infiltration into nonlymphoid organs. All genotypes had increased mean lesion scores (MLSs) and mean total lesion scores after MDV infection. These differed quantitatively and qualitatively between the genotypes. Lines 6(1) and 7(2) had a similar MLS distribution in the cytolytic phase, although scores were greater in line 7(2). At the time lymphomas were visible in line 7(2), histologic lesions in line 6(1) were regressing. AV37+ cells were present in similar numbers in all genotypes in the cytolytic phase, suggesting that neoplastically transformed cells were present in all genotypes regardless of MD susceptibility. After the cytolytic phase, AV37+ cell numbers increased in lines 7(2) and 15I but decreased in lines 6(1) and N. In the cytolytic and latent phases, in all genotypes, most infiltrating cells were CD4+. After this time, line 7(2) and 15I lesions increased in size and most cells were CD4+; line 6(1) and N lesions decreased in size and most cells were CD8+. In all genotypes, AV37 immunostaining was weak in lesions with many CD8+ cells, suggesting that AV37 antigen expression or AV37+ cells were controlled by CD8+ cells. The rank order, determined by clinical signs and pathology, for MD susceptibility (highest to lowest) was 7(2) > 15I > 6(1) > N.

Effect of CO2, Nd:YAG, and ArF excimer lasers on dentin morphology and pulp chamber temperature: an in vitro study.

This study compared the effect of three laser systems: CO2 (10.600 nm), Nd:YAG (1.064 nm), and ArF excimer (193 nm) lasers on dentin hard tissue and on temperature increases of the pulp chamber. Sixty-six third molar teeth were used and randomly divided into three groups. A class I cavity was made to expose the dentin, and the pulp in the pulp chamber was removed via a hole bored in the cervical area. The pulp chamber was subsequently refilled with silicon grease, and a NiCr/NiSi thermocouple was inserted through the hole into the pulp chamber. The dentin surface was then lased for 30 s at the same settings (3 W, 2 mm spot size, 20 pps) with each laser. The average internal temperature increases were as follows: CO2, 37 degrees C; Nd: YAG, 28 degrees C; and ArF excimer, 1 degrees C. Scanning electron microscopy of the dentin in the occlusal cavity revealed extensive carbonization, isolated balls of recrystallized material, and the presence of smear layer at some dentinal tubule orifices for the CO2 and Nd:YAG lased teeth. Smear layer was also observed for the ArF excimer samples; however, they exhibited far less surface cavities than the others and seemed to undergo little morphological change on the dentin.

The effect of a varnish with fluoride on the hardness of the exposed human dentine tissue.

The aim of this study was to evaluate the effect of a new varnish with fluoride, Fluoridin N-5, on the exposed dentine tissue in situ. Human incisors which were mounted into intra-oral devices were worn by six volunteers and the test materials were applied three times a day for fourteen days. Three different materials were used as three test groups: Novalite, Fluoridin gel N-5 and Amalgam liner. Although both the control and test groups showed some increases in hardness, the mean hardness increase of all of the test groups was significantly higher than that of the control group (p = 0.007). However, the comparison of mean increases in hardness values showed no significant difference among the test groups.

Smooth coronal surface, resin restoration and microleakage.

The space between the resin and the cavity walls has always become interesting to search. The aim of this study was to evaluate any differences on leakage values of Class 5 type resin restorations prepared on surrounding surfaces of the tooth crown. Ninety human teeth were prepared as Class 5 cavities on buccal, lingual, mesial and distal surfaces and were randomly divided into groups for bevelling, groove preparation and as control. The subgroups were arranged as fluoride gel and/or sealant applications. Fluoride gel was applied following the cavity preparations. Sealant was applied over composite resin restorations. Treated teeth were thermocycled and immersed into dye solution for 96 hours. The restorations were evaluated in a stereo-microscope following the sectioning. Bevelling of the cavosurfaces and/or preparation of a groove addition to cavity procedures did not make any difference on the microleakage scores of the restorations done on either surfaces statistically.

A comparative study of the area of the canal space obturated by thermoplasticized gutta-percha techniques.

Two thermoplasticized gutta-percha techniques were evaluated for the percentage area of canal obturated by gutta-percha and compared with the lateral condensation of gutta-percha technique. All obturation systems were used in conjunction with Grossman's sealer. Single rooted teeth were obturated by either injected thermoplasticized gutta-percha (Ultrafil), thermoplasticized gutta-percha with metal carrier (Thermafil) or lateral condensation of gutta-percha. There were ten specimens in each group. The teeth were embedded in resin, sectioned at 1.5 mm, 3 mm and 4.5 mm from the root apex and examined with a stereomicroscope. Specimens filled by Ultrafil and Thermafil contained a significantly higher percentage of gutta-percha than specimens filled by the lateral condensation technique at every level. However no difference was found between Ultrafil and Thermafil. Three lateral condensation specimens showed voids at the 1.5 mm section; no voids were detected in specimens filled by Ultrafil or Thermafil at any level.