Role of immature granulocytes and total bilirubin values in the diagnosis of perforated appendicitis in patients over 65 years

SUMMARY OBJECTIVE: The aim of this study was to investigate the effectiveness of immature granulocyte count, immature granulocyte percentage, and total bilirubin value in predicting complicated and perforated appendicitis in patients aged 65 years and older with a diagnosis of appendicitis. METHODS: In this study, 84 patients, aged 65 years and older, who had appendectomy demographic information, preoperative white blood cell count, neutrophil/lymphocyte ratio, immature granulocyte count and immature granulocyte percentage, operation findings, and pathology results were collected retrospectively. They were grouped into 4 categories: complicated, non-complicated, perforated, and non-perforated, according to the data and surgical findings. RESULTS: Total bilirubin and immature granulocyte count were found to be statistically significant in predicting complicated and perforated appendicitis in patients aged 65 years and older with a diagnosis of appendicitis. The total bilirubin was found to have the following values in differentiating complicated appendicitis: area under the curve=0.883, sensitivity=78.3%, and specificity=88.5%. Total bilirubin had the highest discrimination power with area under the curve=0.804 in differentiating perforation. CONCLUSION: The immature granulocyte percentage and total bilirubin count are the fast, inexpensive, and reliable parameters that can be used to predict complicated and perforated appendicitis in patients aged 65 years and older.

Effect of FMD vaccination schedule of dams on the level and duration of maternally derived antibodies.

Vaccination against Foot and Mouth Disease (FMD) in pregnant cows is crucial to produce greater immunity in new born calves, especially in late gestation, as this directly affects neonatal immunity. Therefore, we aimed to investigate how late gestation FMD vaccination of pregnant cows affects the maternally derived antibodies in their offspring. Pregnant cows were vaccinated with and without booster vaccination during the 3rd months (early gestation vaccination, EGV) or the 6.5th months (late gestation vaccination, LGV). Their offspring were investigated for passive immunity transfer, maternal antibody duration, and the first vaccination age of calves (when the maternal antibody has waned sufficiently to allow the first vaccination). Antibody titers were analyzed by a virus neutralization test (VNT). A digital Brix refractometer (% Brix) was used to estimate passive antibody transfer efficiency measuring total protein (TP) content of calf blood sera and also colostrum IgG content. Two linear mixed effects models were fitted: one for the antibody titer values of the dams, and the other for the antibody titer values of calves before the vaccination. A marginal fixed effects model was also fitted to explore the effects of the dam titers on the antibody titers of the calves after their vaccinations. As a result, the average neutralizing antibody titers did not differ between the EGV and LGV groups nor were any differences detected between dams that received a booster and those that were not boosted. However, the LGV calves' mean maternally derived antibody titers were significantly higher (p-values = 0.0001 for both groups) and the duration was longer than that of the EGV calves (120 days in LGV, 60 days in EGV, p < 0.05). Since no statistical difference was found between the titers of either group of dams at the beginning of the experiment and parturition, it does not appear that the higher VN titers in LGV calves compared to titers in EGV are directly related to the circulating antibody levels in the dams. Furthermore, the TP value (% Brix) of calf blood sera was higher than>8.4% in both calf groups (9.3 ±â€¯0.33 in LGV and 8.6 ±â€¯0.40 in EGV, p > 0.05) indicating that passive immunity transfer had occurred for both groups. In addition, we found that the % Brix mean colostrum IgG content of the LGV (25.8 ±â€¯1.30) was higher than the EGV (21.8 ±â€¯0.58) dams (p < 0.01) and a significant positive correlation found between the colostrum density of LGV dams and TP (% Brix) value of their offspring (r = 0.73, p < 0.01). Our results show that vaccination during the late gestation period increased the colostrum IgG content of dams of LGV in addition to the maternally derived antibody duration and potentially provided greater protection of the offspring.

Effects of thoracic epidural or intravenous analgesia on the neutrophil-to-lymphocyte ratio in thoracotomy cases.

BACKGROUND AND PURPOSE: Postoperative pain is a significant problem in thoracotomy patients. Our aim in this study was to investigate the relationship between postoperative pain and neutrophil-to-lymphocyte ratio (NLR) which is a marker of acute inflammatory response. MATERIALS AND METHODS: Thoracic epidural or intravenous analgesia was administered to thoracotomy patients who elected to undergo a planned surgery. Patients were divided into two groups according to the analgesia method applied postoperatively. Thoracic epidural analgesia was recorded as Group 1 and intravenous analgesia as Group 2. Whole blood counts were recorded from preoperative and postoperative 24th- and 48th-hour routine blood samples, and NLRs were recorded as retrospective file scanning. Postoperative 24th- and 48th-hour NLRs and preoperative NLR values were recorded. RESULTS: Demographic data of the patients included in the study were similar except for age. Preoperative NLR was significantly higher in Group 1 at 3.50 (P = 0.004) than in Group 2 at 2.51. Postoperative NLRs were similar among both groups. Postoperative NLR values at both the 24th- and 48th-hour increased by4.9 times in Group 1 and 9.23 times in Group 2 from the 24th-hour preoperative period, when the preoperative NLRs were evaluated. The rate of increase in Group 1 was significantly lower than in Group 2 (P = 0.006). CONCLUSION: Postoperative NLR alterations when compared with preoperative values were related to the analgesic regimen used.

A retrospective analysis of blood gases with two different insulin infusion protocols in patients undergoing cardiovascular surgery.

AIM: Intraoperative blood glucose concentration is known to be an independent risk factor for morbidity and mortality in patients undergoing cardiovascular surgery. Arterial blood gas analysis is an important investigation to monitor the acid-base balance and gas exchange in these patients. Hyperglycemia leads to a series of metabolic changes which affect acid-base balance and serum electrolytes. In this study, we aimed to look into the effect of glycemic control on arterial blood gas parameters, serum electrolytes, and hemoglobin (Hb). MATERIALS AND METHODS: We collected data from diabetic patients who underwent cardiovascular surgery between 2010 and 2014. The patients were divided into two groups according to the insulin infusion protocols applied such as with conventional (180-250 mg/dl) (n = 17) (Group 1) and tighter glycemic targets (121-180 mg/dl) (n = 51) (Group 2). We retrospectively analyzed arterial blood gas results taken at different perioperative time points from these patients. RESULTS: We found that pH HCO3and base excess, serum sodium, potassium, calcium, and Hb were similar in both groups. CONCLUSION: Our study showed that a tighter intraoperative glycemic control does not affect arterial blood gas parameters, serum electrolytes, or Hb when compared to the conventional glycemic control.

The effects of low and high doses of sugammadex on kidney tissue in streptozotocin-induced diabetic rats.

BACKGROUND: Sugammadex is primarily excreted via renal route. We investigated effects of low and high doses of sugammadex (16 mg/kg versus 96 mg/kg) on renal tissue samples of streptozotocin-induced diabetic rats. MATERIAL AND METHODS: Twenty-four Wistar albino rats were divided into 4 groups. Group C (control - 0.9 % NaCl), Group DC (diabetes control; 55 mg/kg streptozotocin, IP, only), Group DR-16S (diabetes-rocuronium - 16 mg sugammadex, IV.) and Group DR-96S (diabetes- rocuronium - 96 mg sugammadex, IV). Renal tissue histopathological evaluation and antioxidant status (measurements of MDA levels and NO activities) were studied. RESULTS: Significantly higher levels of all inflammation parameters (inflammation, degeneration/necrosis, tubular dilatation, tubular cell degeneration, dilatation in Bowman's space, tubular hyaline casts, and lymphocyte infiltration) were found in the 96 mg/kg sugammadex group. Higher MDA tissue levels and lower NO activity were found in the 96 mg/kg sugammadex group. DISCUSSION: We can conclude that high-dose (96 mg/kg) sugammadex administration resulted in significant renal tissue damage in diabetic rats. As a consequence, low doses of sugammadex have to be preferred in diabetic patients (Tab. 2, Fig. 4, Ref. 26).

The effects of propofol and memantine on erythrocyte deformability.

OBJECTIVE: Propofol is an intravenous general anesthetic with a primary hypnotic effect. Memantine is an NMDA receptor antagonist that has been shown to reverse changes in memory and synaptic plasticity in animal models. This study aims to investigates whether propofol and/or memantine has any effects on erythrocyte deformability. METHODS: 24 Wistar albino rats were divided randomly into four groups. Group P received 150 mg.kg-1 propofol intraperitoneally (ip); Group M received 1 mg.kg-1 memantine (ip); Group PM received 1 mg.kg-1 memantine mg.kg-1 ip 30 minutes before the administration of 150 mg.kg-1 propofol; and the control group (Group C) received saline ip. Euthanasia was performed in all rats by using intraabdominal blood uptake. The heparinized whole blood samples were used to prepare erythrocyte suspensions, from which erythrocyte suspensions were formed with a PBS buffer solution containing 5% htc, and the deformability parameters were measured. RESULTS: Erythrocyte deformability was significantly higher in Groups P, M and PM when compared to the Group C (p = 0.007 and p = 0.001, p <0.0001, respectively); while the erythrocyte deformability indices were similar in groups P, M and PM. CONCLUSION: The administration of propofol and memantine altered the erythrocyte deformability in the rats, which may lead to further problems in microcirculation. The administration of memantine to the propofol-treated rats did not alter the erythrocyte deformability; however the early results should be verified through further experimental and clinical studies (Fig. 1, Ref. 23).

The effects of dexmedetomidine on pulmonary artery pressure in experiment.

AIM: The primary purpose of this study is to assess the effects of dexmedetomidine (DEX) infusion on pulmonary artery pressures (PAP), heart rate (HR), and mean arterial pressure (MAP) in pigs. The secondary purpose is to evaluate whether DEX infusion via the pulmonary artery has any beneficial effect over the peripheral IV route. MATERIALS AND METHODS: Sixteen healthy male pigs (25-35 kg) scheduled for laparoscopy training were used in this study. The animals were randomly allocated into two groups: Group I (n = 9): A loading dose of 1 µg/kg DEX was administered over 10 minutes followed by an infusion of 0.5 µg/kg/hr for one hour via the pulmonary artery catheter. Group II (n = 7): A loading dose of 1 µg/kg DEX was administered over 10 minutes followed by an infusion of 0.5 µg/kg/hr for one hour via the peripheral venous catheter. Mean PAP, HR, MAP, SpO2, and ETCO2 were recorded at 5, 10, 15, 30, 45, and 60 minutes after the initiation of the DEX infusion. RESULTS: Heart rate and MAP were similar in both groups at all time points. Also, neither the HR nor the MAP deviated from the basal values in Groups I and II at any time point. The mean PAP values were similar in Groups I and II, and in Group I, the mean PAP values were similar to Group I's basal value at all time points. However, in Group II, the mean PAP values at 5, 45, and 60 minutes were significantly lower than Group II's basal value (p = 0.023, p = 0.041, p = 0.015, respectively). CONCLUSION: DEX infusion did not elevate the mean PAP and the results from the administration of DEX through the peripheral vein and pulmonary artery were similar (Tab. 3, Ref. 13).

Comparison of effects of anaesthesia with desflurane and enflurane on liver function.

INTRODUCTION: Although most general anaesthesia procedures are performed without any complications, volatile agents may have adverse effects on various living systems. This study aimed to compare the effects of desflurane and enflurane on liver function. METHODS: 40 patients, who were in the ASA I-III risk groups and were planned to undergo head and neck surgery of at least three hours' duration, were randomly divided into two groups: the desflurane (Group D) and enflurane groups (Group E). Venous blood samples (5 ml) of the patients were obtained before anaesthesia induction, in the postoperative first hour and on the first and seventh days. The samples were centrifuged and then stored at -80 degrees Celsius until the determination of glutathione S-transferase (GST) levels. For maintenance of anaesthesia in Group D, desflurane (6 percent) was used, while in Group E, enflurane (1.2 percent) was used. RESULTS: GST levels were significantly higher in Group E in the postoperative first hour (p-value is 0.002), and on the first day (p-value is 0.025) and seventh day (p-value is 0.035), although there were no differences preoperatively (p-value is more than 0.05). When postoperative levels were compared with preoperative levels, the postoperative GST levels of Group E were significantly higher (first hour [p-value is 0.008], first day [p-value is 0.010], seventh day [p-value is 0.038]). CONCLUSION: Subclinical hepatic injury after anaesthesia continues to be an issue of interest, particularly with the development of new, more sensitive methods of measuring GST levels. The increase in GST concentration after anaesthesia is thought to be a result of reduced hepatic blood flow. This study has shown that desflurane has fewer effects than enflurane on liver function tests in lengthy operations of up to 330 minutes.

Inhalation versus total intravenous anesthesia for lumbar disc herniation: comparison of hemodynamic effects, recovery characteristics, and cost.

The clinical effects, recovery characteristics, and costs of total intravenous anesthesia (TIVA), sevoflurane, and isoflurane anesthesia have been measured in various out-patient operations, but have not been evaluated in patients undergoing laminectomy or discectomy. In the current study, the authors assessed the hemodynamic characteristics, recovery, and cost analyzes after laminectomy and discectomy operations, comparing TIVA, sevoflurane, and isoflurane anesthesia. Sixty American Society of Anesthesiologists I and II patients were randomly divided into three groups, each consisting of 20 patients. Group I received propofol-alfentanil, Group 2 received sevoflurane-N2O, and Group 3 received isoflurane-N2O. At the end of surgery, the anesthetics were discontinued, and recovery from anesthesia was assessed by measuring the time until spontaneous eye opening and the time until response to verbal commands. The drug and delivery costs were calculated in United States dollars. No significant differences were found in the demographic data. Heart rate and mean arterial pressure decreased significantly after induction of anesthesia in the TIVA group, compared to the two other groups ( P < .05 for both comparisons). The fastest recovery was seen in the TIVA group. Incidences of postoperative nausea, vomiting, and pain were significantly reduced after TIVA ( P < .05 for both comparisons). Thus, TIVA patients required fewer additional drugs and showed the lowest additional costs in the post-anesthesia care unit. However, the total cost was significantly higher in the TIVA group than in the sevoflurane and isoflurane groups (52.73 dollars, 29.99 dollars, and 24.14 dollars, respectively) ( P < .05). Total intravenous anesthesia was associated with the highest intraoperative cost but provided the most rapid recovery from anesthesia, and the least frequent postoperative side effects.

Factors influencing the variability of SO2 concentrations in Istanbul.

The correlation between sulfur dioxide (SO2) concentrations measured at the European and Asian sides of Istanbul and meteorological parameters is investigated using principal component analysis (PCA) and multiple regression analysis techniques. Several meteorological parameters are selected to represent the atmospheric conditions during two winter periods: 1993-1994 and 1994-1995. Six principal components are found to explain the majority of the observed meteorological variability. Surface pressure, 850-mb temperature, and surface zonal (east-west) and meridional (north-south) winds show high loadings on separate factors identified by PCA. We seek dominant meteorological parameters that control the SO2 levels at each monitoring station. Several multiple regression analysis models are fitted to the data from each monitoring station using six principal components and previous-day SO2 concentrations as independent variables. Results suggest that the most important parameters, highly correlated with SO2 concentrations in the Istanbul metropolitan area, are atmospheric pressure and surface zonal and meridional winds. These components have more influence on the determination of the air pollution levels at the Asian side than at the European side.

Use of alkaline comet assay (single cell gel electrophoresis technique) to detect DNA damages in lymphocytes of operating room personnel occupationally exposed to anaesthetic gases.

Here, we report the possible in vivo induction DNA damage by exposure to various waste anaesthetic gases such as halothane, nitrous oxide and isoflurane. The alkaline comet assay (single cell gel electrophoresis technique) was carried out on 66 operating room personnel (anaesthetists [doctors]; anaesthesia nurses and anaesthesia unit technicians) currently employed at the Ankara Hospital in Turkey. A significant increase in the number of lymphocytes with DNA migration was observed in operating room personnel as compared to controls. Also, the extent of damage in exposed smokers were significantly higher than exposed nonsmokers. This study supports the existence of an association between DNA damage and occupational exposure to inhalation anaesthetics.