Opioids Inhibit Angiogenesis in a Chorioallantoic Membrane Model.

BACKGROUND: Angiogenesis is an important characteristic of cancer. Switching from the avascular phase to the vascular phase is a necessary process for tumor growth. Therefore, research in cancer treatment has focused on angiogenesis as a drug target. Despite the widespread use of opioids to treat pain in patients with cancer, little is known about the effect of these drugs on vascular endothelium and angiogenesis. OBJECTIVES: We aimed to investigate the efficacies of morphine, codeine, and tramadol in 3 different concentrations on angiogenesis in hens' eggs. STUDY DESIGN: This is a prospective, observational, controlled, in-vivo animal study. SETTING: Single academic medical center. METHODS: This study was conducted on the chorioallantoic membrane (CAM) of fertilized hens' eggs. The efficacies of morphine, codeine, and tramadol in 3 different concentrations were evaluated on angiogenesis in a total of 165 hens' eggs. RESULTS: Statistically significant differences were found between drug-free agarose used as a negative control and concentrations of morphine of 10 µM and 1 µM, a concentration of tramadol of 10 µM, and concentrations of codeine of 10 µM and 1 µM. Concentrations of morphine of 10 µM and 1 µM showed strong antiangiogenic effects. While codeine had strong antiangiogenic effects at high concentrations, at 0.1 µM it was shown to have weak antiangiogenic effects. However, tramadol at a concentration of 10 µM had only weak antiangiogenic effects. LIMITATIONS: This is just a CAM model study. CONCLUSION: In this study, we tested the effects of 3 different opioid drugs on angiogenesis in 3 different concentrations, and we observed that morphine was a good anti-angiogenic agent, but tramadol and codeine only had anti-angiogenic effects at high doses.Key Words: Morphine, codeine, tramadol, opioid, bevacizumab, chorioallantoic membrane (CAM), angiogenesis.

The use of thymoquinone in nephrotoxicity related to acetaminophen.

AIM: We aimed to investigate efficacy of intraperitoneally administered Thymoquinone (TQ) in acetaminophen (APAP) induced renal toxicity. MATERIAL AND METHOD: Forty Wistar Albino rats were randomly divided into 4 groups of ten rats each. Control group was untreated group while rats in TQ group were treated with single dose TQ. In APAP group rats were treated with single dose acetaminophen. In TQ + APAP group TQ and APAP were administered respectively. Rats were sacrificed at 24th hour; urea, creatinine and nitric oxide levels were measured also malondialdehyde activity were assessed in renal tissue specimens. Tissue damage scores were recorded in histopathological assessment. RESULTS: Urea and creatinine levels were found significantly higher in APAP group than control group (p < 0.003). Urea and creatinine levels in APAP + TQ treated group were significantly lower than APAP treated group (p < 0.01). Serum NO activity and tissue MDA levels were higher in APAP group than control group (p ≤ 0.002). In contrast to APAP treated group serum NO activity and tissue MDA levels were found significantly lower in TQ + APAP group (p ≤ 0.03). In APAP group significant histopathological change was found compared with control group (p ≤ 0.001) where there was no significant change between control and TQ treated groups (p > 0.05). In APAP group we found significantly higher tissue damage scores than control group (p ≤ 0.001). In APAP + TQ group lower tissue damage scores were found compared with APAP group (p ≤ 0.001) while higher scores were found compared with control group (p ≤ 0.001). CONCLUSION: We can conclude that TQ treatment has therapeutical effect in APAP induced nephrotoxicity in rats.

Perforation of Meckel's diverticulum by foreign body.

Meckel's diverticulum (MD) is a congenital disorder of the gastrointestinal tract that is usually asymptomatic. Perforation of an MD by foreign bodies is an extremely rare cause of acute abdomen in children. We present a rare case of perforation of an MD in a child after eating melon seeds. The patient was treated successfully with segmental resection and primary anastomosis and had an uneventful postoperative recovery.

Thymoquinone treatment against acetaminophen-induced hepatotoxicity in rats.

AIM: In this study, we aimed to examine the efficacy of thymoquinone (TQ) treatment in acetaminophen-induced liver toxicity in rats. METHODS: Forty Wistar Albino rats were used for the study (four groups, with 10 rats for each group). Animals in the control group were not given any medication. In the thymoquinone (TQ) group, animals were given three times 5 mg/kg oral thymoquinone for every six hours, which equals to a total dose of 15 mg/kg. In the acetaminophen (APAP) group, animals were given APAP at a single dose of 500 mg/kg orally. In the APAP + TQ group, animals were given 500 mg/kg APAP orally followed by three doses of TQ at a 15 mg/kg total dose in an 18-h time interval. All animals were sacrificed at the 24th hour. Alanine amino transferase (ALT), aspartat amino transferase (AST), superoxide dismutase (SOD), oxidized glutathione (GSSG), glutathione peroxides (GSH-Px), and malondialdehyde (MDA) activities were measured in rat blood. Histopathological examination was also performed. RESULTS: Serum ALT, AST levels, GSSG, and SOD activity as well as the serum and tissue MDA levels were found to be higher in the APAP group than in the control group (p ≤ 0.001). Likewise, serum GSH-Px activity was found to be lower in the APAP group (p ≤ 0.001). In contrast, in the APAP + TQ group, serum ALT, AST levels, GSSG, SOD activity and the serum and tissue MDA levels were found to be lower compared to that of the APAP group. This difference was statistically significant (p ≤ 0.001). In the APAP + TQ group, the GSH-Px activity was found to be significantly higher compared to the APAP group (p < 0.05). In contrast to this finding, the GSH-Px activity in the APAP + TQ group was found to be lower than that of the control group (p ≤ 0.001). Histopathological analysis revealed significant liver necrosis and toxicity with a high dose of APAP where TQ treatment was related with significantly lower liver injury scores. CONCLUSION: TQ treatment may have an important therapeuthic effect via the upregulation of antioxidant systems in the APAP-induced liver hepatotoxicity in rats.

Infraclavicular brachial plexus block in Wilson's disease.

Wilson's disease (WD) is characterized by progressive copper accumulation with hepatic and neurological impairment. Anesthesia and surgical practices may exacerbate WD and liver damage, and even cause life-threatening liver failure. Due to this existing liver damage, anesthetic management is important in WD cases in terms of drug choice, dose, and technique used. This study reports an emergency surgical procedure for trauma in a 24-year-old WD patient suffering the disease for 18 years. The operation was planned under infraclavicular brachial plexus block because of a right supracondiller/proximal humerus fracture. The selected type of anesthetic technique and agents in WD is specific. The pharmacokinetic changes in these cases are difficult to predict and require attention to drug choice and dose.

Inhalation anesthesia with sevoflurane during intravitreal bevacizumab injection in infants with retinopathy of prematurity.

BACKGROUND: To investigate the anesthetic management in premature infants with retinopathy of prematurity (ROP) treated with intravitreal bevacizumab (IVB) injections. METHODS: A retrospective chart review was performed for the patients with ROP who had IVB injection. Clinical characteristics, demographic variables, anesthetic medications, operation techniques, time intervals, and complications were recorded. RESULTS: Sixty-six eyes of 33 patients (23 males, 10 females) with type 1 ROP who were treated with IVB were included. A total of 66 anesthetic applications were performed. Mean gestational age at birth was 28.3 weeks (range 25-33). Mean birth weight was 1,300 g (range 600-1850). Serious ocular and systemic complications were not observed in any infant. CONCLUSION: Inhalation anesthesia with sevoflurane during IVB treatment in premature infants with ROP may be appropriate for anesthetic management.

Current attitudes of Turkish anesthesiologists to radiation exposure.

PURPOSE: The aim of this study was to investigate the attitudes of anesthesiologists to radiation exposure and current safety practice in Turkey. METHODS: The study enrolled anesthesiologists from all over Turkey, including all levels of academic degrees and all types of different institutions. Questionnaire forms were sent via e-mail to 505 anesthesiologists. The survey collected demographic data such as age, gender, position, and the institution at which the participant worked, and data about the frequency of radiation exposure during procedures and the participant's attitudes concerning radiation safety measures during these procedures. RESULTS: The questionnaire forms were delivered to 491 anesthesiologists, and 301 (61.3 %) of these were returned. Of these, 9 had not completed the questionnaire because of a lack of exposure to radiation. Among the remaining 292 personnel, the weekly frequencies of radiation exposure were more than five times (36.7 %), one to five times (50.3 %), and less than once (13 %) per week, respectively. Only a few anesthesiologists regularly wore a lead apron (30.11 %) and a thyroid shield (11.3 %) during procedures involving radiation exposure. CONCLUSIONS: This study demonstrated that nearly all anesthesiologists are regularly exposed to radiation and that few anesthesiologists in Turkey wear protective clothing, which is essential for radiation protection. Therefore, if it is not, increasing awareness about radiation protection should be an integral part of medical training and education.

The protective effect of dexmedetomidine on bupivacaine-induced sciatic nerve inflammation is mediated by mast cells.

PURPOSE: This study was designed to assess the correlation between the neuroprotective effect of dexmedetomidine and oxidative stress, neural inflammation and mast cell stability in rats with bupivacaine-induced sciatic nerve toxicity. METHODS: Forty adult Wistar Albino rats, eight rats per group, were used. Saline (0.3 ml of 0.9%), dexmedetomidine (20 µg/kg), 0.5% bupivacaine or 0.5% bupivacaine+dexmedetomidine (20 µg/kg) was injected into the sciatic nerve. A control group of rats received no injection. Fourteen days after injection, the sciatic nerves were harvested and total oxidant status, total anti-oxidant status, paraoxonase-1, galectin-3 and matrix metalloproteinase 2 and 9 levels were measured in the sciatic nerves. In addition, the presence and status of inflammation, edema, and mast cells were evaluated histopathologically. RESULTS: The combination of dexmedetomidine and bupivacaine alleviated oxidative stress. In addition, it decreased matrix metalloproteinase 9 and galectin-3 levels and increased matrix metalloproteinase 2 levels. Moreover, it stabilized recruited mast cells at the injury site; however, it did not significantly decrease inflammation or edema. CONCLUSION: Dexmedetomidine may ameliorate bupivacaine-induced neurotoxicity by modulating mast cell degranulation. The neuroprotective effect of dexmedetomidine may make it a suitable adjuvant agent to local anesthetics in peripheral nerve blocks.

The comparison of neuroprotective effects of intrathecal dexmedetomidine and metilprednisolone in spinal cord injury.

BACKGROUND: The purpose of this study is the investigation of the effects of intrathecally injected dexmedetomidine and methylprednisolone and their dominancy over one another in rats with generated Spinal Cord Injury (SCI). METHODS: 40, female, adult Wistar Albino rats weighing 220-260 g were included in the study. The rats were fixed with Intrathecal catheter (IT) and divided into four groups. All subjects were applied T7-10 laminectomy after catheter. Group S (n:10) was injected with IT 10 µL isotonic saline; Group C (n:10) with IT 10 µL isotonic saline after SCI; Group D (n:10) with IT one doze 10 µL of dexmedetomidine after SCI; Group M (n:10) IT one dose 10 µL of methylprednisolone. The subjects were sacrificed 72 h after this operation. The damaged area was removed biochemically and histopathologically examined. RESULTS: Antioxidant and inflammatory parameters searched for in all damages tissue were statistically different in all groups from group S. They were different in group M and group D than group C (p < 0.001). After the comparison of group D and group M, PON and IL6 values were higher in group D (p = 0.003, p = 0.035) while the other two biochemical parameters were similar in both groups (Table 1). After histopathologic trials, edemas, bleeding and necrosis were found less in group S while at the most in group C (p < 0.001). In group M and group D, however, they were higher than group S and lower than group C (p < 0.001). After the comparison of group D and group M, while there was no difference in terms of edema necrosis, the amount of bleeding was lower in group D (p < 0.001) (Table 2). CONCLUSIONS: It has been discovered that intrathecal use of dexmedetomidine caused neuroprotective effects similar to methylprednisolone.

The protective effects of dexmedetomidine on the liver and remote organs against hepatic ischemia reperfusion injury in rats.

AIM: To investigate the protective effects of dexmedetomidine against hepatic ischemia/reperfusion (IR) injury and hepatic IR induced remote organ injury. METHODS: Forty Wistar albino rats were divided into the following four groups: sham, dexmedetomidine, IR, and IR + dexmedetomidine. Hepatic ischemia was created by the Pringle maneuver for 30 min followed by a 30 min reperfusion period in the IR and IR + dexmedetomidine groups. The dexmedetomidine and IR + dexmedetomidine groups were administered dexmedetomidine (100 µg/kg, single dose) intraperitoneally after the anesthesia insult. Blood samples and hepatic, renal, and lung tissue specimens were obtained to measure serum and tissue total oxidative activity (TOA), total antioxidant capacity (TAC), paraoxonase (PON-1), and oxidative stress index (OSI) after 60 min in all groups. RESULTS: According to the biochemical analyses of the samples taken from the serum and the liver, lung, and kidney tissues, when comparing the sham group and the IR group, TOA and OSI values were higher in the IR group, while TAC and PON-1 values were lower (p < 0.05). It was observed that TOA and OSI values were significantly lower, while TAC and PON-1 values increased with dexmedetomidine treatment (p < 0.05). In addition, dexmedetomidine ameliorated hepatic histopathological changes inducing IR, but there were no significant histopathological changes in the remote organs. CONCLUSION: This study demonstrated that dexmedetomidine markedly reduced the oxidative stress in serum, liver, and remote organs induced by hepatic IR injury, and ameliorated the histopathological damage in the liver.

Retrograde intubation in the patient with cystic tumor located at the base of tongue.

Retrograde intubation is one of the methods used to maintain an airway in the event of a difficult intubation. Retrograde intubation has been successfully carried out on patient for whom intubation was not possible with a direct laryngoscope and fiber optic bronchoscope. The central venous catheter needle and guide wire are the materials that are the most practical to prepare and access for the retrograde intubation. To conclude, In conclusion, retrograde intubation may be good alternative to invasive airway management such as surgical tracheostomy for difficult or impossible intubations because it can be performed easily, quickly, and successfully.

Immediate cardiac arrest after neostigmine administration.

Many drugs used in anaesthesia have some potential fatal consequences; for example complete heart block and Q-Tc interval prolongation. Since the parasympathetic system in children is not fully developed, electrical transmission of the heart is not stable. Neostigmine is used in order to reverse neuromuscular block but it may also lead to prolongation of Q-Tc interval. We present a case of an 18-month-old male patient weighing 12kg subjected to a surgical operation because of congenital glaucoma. In order to reverse neuromuscular block at the end of operation, atropine and neostigmine were injected intravenously. However, cardiac arrest developed immediately after administration.

The effect of I-gel ™ airway on intraocular pressure in pediatric patients who received sevoflurane or desflurane during strabismus surgery.

OBJECTIVES: The aim of this study was to investigate the effect of I-gel(TM) laryngeal mask airway on intraocular pressure (IOP) in children with strabismus undergoing balanced anesthesia with sevoflurane or desflurane. METHODS: Forty-seven children, ASA physical status I, were scheduled for elective strabismus surgery. Patients were randomly assigned to one of the two inhalation anesthetic groups. Sevoflurane group comprised of 27 children, and desflurane group comprised of 20 children. Anesthesia was induced and maintained with sevoflurane or desflurane. No muscle relaxant was used. IOPs were measured before anesthesia, at 2 and 5 min after insertion of I-gel(TM) and after removal of I-gel(TM) . IOP measurements were obtained by Tonopen(®). RESULTS: Intraocular pressure significantly decreased 2 min after insertion of I-gel(TM) in both sevoflurane and desflurane groups (P < 0.001). Measurements 5 min after I-gel(TM) insertion were also significantly lower than those of before insertion in both groups (P < 0.01). However, no significant differences were found between the preoperative measurement and the measurement after removal of I-gel(TM) within two groups (P = 0.072 and P = 0.547, respectively). No significant differences were found in all IOP measurements between sevoflurane and desflurane groups. CONCLUSION: Insertion of I-gel(TM) laryngeal mask airway with giving sevoflurane or desflurane inhalation anesthetics seemed not to cause any increase in IOPs in pediatric ophthalmic surgery.

Protective effects of beta glucan and gliclazide on brain tissue and sciatic nerve of diabetic rats induced by streptozosin.

There have not been yet enough studies about effects of beta glucan and gliclazide on oxidative stress created by streptozotocin in the brain and sciatic nerve of diabetic rats. The aim of this paper was to investigate the antioxidant effects of gliclazide and beta glucan on oxidative stress and lipid peroxidation created by streptozotosin in brain and sciatic nerve. Total of 42 rats were divided into 6 groups including control, diabetic untreated (DM) (only STZ, diabetic), STZ (DM) + beta glucan, STZ (DM) + gliclazide, only beta glucan treated (no diabetic), and only gliclazide treated (no diabetic). The brain and sciatic nerve tissue samples were analyzed for malondialdehyde (MDA), total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), and paraoxonase (PON-1) levels. We found a significant increase in MDA, TOS, and OSI along with a reduction in TAS level, catalase, and PON-1 activities in brain and sciatic nerve of streptozotocin-induced diabetic rats. Also, this study shows that in terms of these parameters both gliclazide and beta glucan have a neuroprotective effect on the brain and sciatic nerve of the streptozotocin-induced diabetic rat. Our conclusion was that gliclazide and beta glucan have antioxidant effects on the brain and sciatic nerve of the streptozotocin-induced diabetic rat.

Caudal epidural block in children and infants: retrospective analysis of 2088 cases.

BACKGROUND AND OBJECTIVES: Regional anesthesia is usually preferred as caudal block via the epidural space. However, the number of large-scale studies including pediatric caudal blocks is small. The objective of this study was to evaluate complications and side effects of local anesthetics and adjuvant drugs. DESIGN AND SETTING: Retrospective, descriptive study of cases occurring during the period December 2007 to October 2009. METHODS: Of 4815 medical records were screened, 2088 pediatric cases were identified and included in this study. RESULTS: As a local anesthetic, we preferred mostly levobupivacaine in 1669 (79.9%) patients and bupivacaine in 419 (20.1%) patients. As adjuvant drug, we preferred mostly morphine (41 patients), fentanyl (7 patients) and adrenaline (6 patients) in 54 (2.5%) patients. For general anesthesia induction, we preferred mostly propofol (1996 patients, 94.2%); for maintenance, sevoflurane (1773 patients, 84.9%). For airway control, we preferred mostly the ProSeal laryngeal mask (PLMA), in 1008 (48.2%) patients. One thousand six hundred five (76.9%) patients were from outpatient clinics and 483 (23.1%) patients were from inpatient clinics. No permanent complication was encountered after caudal blocks. CONCLUSION: We conclude that caudal epidural blocks are a safe and effective method for subumbilical day-case pediatric surgeries when performed by anesthetists.

A case of pneumothorax after phrenic nerve block with guidance of a nerve stimulator.

Hiccups have more than 100 etiologies. The most common etiology has gastrointestinal origins, related mainly to gastric distention and gastroesophageal reflux disease. Intractable hiccups are rare but may present as a severe symptom of various diseases. Hiccups are mostly treated with non-invasive or pharmacological therapies. If these therapies fail, invasive methods should be used. Here, we present a patient on whom we performed a blockage of the phrenic nerve with the guidance of a nerve stimulator. The patient also had pneumothorax as a complication. Three hours after intervention, a tube thoracostomy was performed. One week later, the patient was cured and discharged from the hospital. In conclusion, a stimulator provides the benefit of localizing the phrenic nerve, which leads to diaphragmatic contractions. Patients with thin necks have more risk of pneumothorax during phrenic nerve location.

Cooled radiofrequency application for treatment of sacroiliac joint pain.

BACKGROUND: The unavailability of an effective and long-lasting treatment for sacroiliac-based pain has led researchers to study the efficacy of radiofrequency in denervation. In this study, we aimed to investigate the efficacy and safety of novel cooled radiofrequency application for sacral lateral-branch denervation. METHODS: Patients experiencing chronic sacroiliac pain were selected for our observational study. Fluoroscopy guidance cooled radiofrequency denervation was applied on the L5 dorsal ramus and the S1-3 lateral branches on patients who had twice undergone consecutive joint blockages to confirm the diagnosis and obtained at least 75% pain relief. At the 1st, 3rd and 6th month postoperatively, the patients' pain was evaluated using a visual analog scale (VAS), and their physical function was evaluated with the Oswestry Disability Index (ODI). RESULTS: Cooled radiofrequency was applied on a total of 15 patients. Prior to the procedures, the median VAS score (interquartile range) was 8 (7-9), but at the 1st, 3rd and 6th month, this had fallen to 3 (1-4), 2 (1-3) and 3 (2-4). The baseline median ODI score (interquartile range) was 36 (32-38), while at the 1st, 3rd and 6th month, it was 16 (8-20), 12 (9-18) and 14 (10-20), respectively. At the final control, while 80% of the patients reported at least a 50% decline in pain scores, 86.7% of those reported at least a ten-point reduction in ODI scores. CONCLUSION: It was seen that the cooled radiofrequency used for sacroiliac denervation was an effective and safe method in the short to intermediate term.