Mortality of adult intensive care units in Turkey using the APACHE II and SOFA systems (outcome assessment in Turkish intensive care units).

INTRODUCTION: The aim of this study was to evaluate intensive care unit (ICU) performance using risk-adjusted ICU mortality rates nationally, assessing patients who died or had been discharged from the ICU. For this purpose, this study analyzed the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) databases, containing detailed clinical and physiological information and mortality of mixed critically ill patients in a medical ICU at secondary and tertiary referral ICUs in Turkey. MATERIAL AND METHODS: A total of 690 adult intensive care units in Turkey were included in the study. Among 690 ICUs evaluated, 39.7% were secondary and 60.3% were tertiary ICUs. A total of 4188 patients were enrolled in this study. Intensive care units of ministry, university, and private hospitals were evaluated all over Turkey. During the study period, clinical data that were collected concurrently for each patient contained demographic details and the diagnostic category leading to ICU admission. APACHE II and SOFA scores following ICU admission were calculated and recorded. Patients were followed up for outcome data until death or ICU discharge. RESULTS: The mean age of patients was 68.8 ±19 and 54% of them were male. The mean APACHE II score was 20 ±8.7. The ICUs' mortality rate was 46.3%, and mean predicted mortality was 37.2% for APACHE II. The standardized mortality ratio was 1.28 (95% confidence interval: 1.21-1.31). CONCLUSIONS: There was a wide difference in outcome for patients admitted to different ICUs and severity of illness using risk adjustment methods. The high mortality rate in patients could be related to comorbid diseases, high mechanical ventilation rates and older ages.

The beneficial effects of ozone therapy in acetaminophen-induced hepatotoxicity in mice.

BACKGROUND: The aim of the present study was to determine the therapeutic effects of medical ozone therapy on acute acetaminophen (APAP)-induced hepatotoxicity which were not clearly demonstrated in prior studies. METHOD: Twenty-four mice were randomly assigned into three equal groups: Group 1 (control), Group 2 (APAP) and Group 3 (APAP +ozone). Hepatotoxicity was induced by APAP given as a single dose of 300mg/kg intraperitoneally in Groups 2 and 3. Additionally, Group 3 received 20mcg/0.5mL ozone intraperitoneal twice a day for the remaining of the study. Other groups received saline injections. On the fourth day of the study, biochemical variables (AST, ALT, ALP) and liver histopathology was assessed. RESULTS: Intraperitoneal administration of a single dose of APAP induced hepatocellular damage that was shown by both liver enzymes and histopathological changes (p<0.001). AST, ALT, ALP levels were elevated in both groups 2 and 3 and the difference from group 1 was statistically significant (p<0.01).Mean ALT and AST levels of group 2 were statistically significantly higher versus group 3 (p<0.01). In histopathological examinations; necrosis and inflammation were more prominent in Group 2 compared to Group 3 (p<0.01). CONCLUSION: Ozone showed beneficial effects on APAP hepatotoxicity at a statistically significant level. It is known that ozone has therapeutic effects in various diseases owing to its antioxidant effects. The present study suggests that ozone may be utilized as a routine supplementary therapy in acute APAP hepatotoxicity.

Evaluation of the relationship between the topographical anatomy in the axillary region of the brachial plexus and the body mass index.

To investigate the topographic anatomy of the median, musculocutaneous, radial and ulnar nerves with respect to the axillary artery and to seek whether these configurations are associated with baseline descriptive data including age, gender, and body-mass index. This cross-sectional trial was carried out on 199 patients (85 women, 114 men; average age: 46.78 ± 15.45 years) in the department of anaesthesiology and reanimation of a tertiary care center. Topographic anatomy of the median, musculocutaneous, radial and ulnar nerves was assessed with ultrasonography. Localization of these nerves with respect to the axillary artery was marked on the map demonstrating 16 zones around the axillary artery. Frequencies of localizations of every nerve in these zones were recorded, and the correlation of these locations with descriptive data including age, gender and BMI was investigated. There was no difference between women and men for the distribution of the median (p = 0.74), ulnar (p = 0.35) and radial (p = 0.64) nerves. However, the musculocutaneous nerve was more commonly located in Zone A13 in men compared to women (p = 0.02). The localization of the median (p = 0.85), ulnar (p = 0.27) and radial (p = 0.88) nerves did not differ remarkably between patients with BMI < 25 kg/m2 and patients with BMI ≥ 25 kg/m2. Notably, the musculocutaneous nerve was more often determined in Zone A10 in cases with BMI ≥ 25 kg/m2 (p = 0.001). Our results imply that the alignment of the musculocutaneous nerve may vary in men and overweight people. This fact must be considered by the anaesthetist before planning the axillary block of brachial plexus. All these informations may enlighten the planning stages of the brachial plexus blockade.

Importance of the Upper Extremity Position for a Safe and Effective Axillary Block: a Comparative Study.

OBJECTIVE: Our aim was to determine the ideal position of upper extremities during ultrasonography guidance for axillary block. The position that provides the shortest distance between the median and musculocutaneous nerves was assumed to be the most appropriate position for axillary block. METHODS: In this cross-sectional study, 120 (45 female and 75 male) patients were placed in a position with a shoulder at 90° / elbow 90° (position 1) and a shoulder 90° / elbow 0° (position 2). The intersection point of the biceps brachii muscle with the lower border of the pectoralis major muscle is defined as the proximal level (P). Distal level (D) is reffered as 5 cm below the proximal level. In the positions described above, the distance between median and musculocutaneous nerves was measured proximal (positions 1P and 2P) and distal levels (positions 1D and 2D). It was investigated whether these measurements differed between the groups and whether the body mass index or the gender. RESULTS: The shortest mean distance (10.24±3.95 mm) between the two nerves was determined when the shoulder position 90°/elbow position 0° at the distal level (1D) and the longest mean distance (13.41±4.26 mm) was determined when shoulder position 90°/elbow position 90° at the proximal level (2P). In all four cases, there was no difference in the results between men and women. There was no relationship between the measurement results and the body mass indexes and age of the patients. CONCLUSION: Appropriate positioning of the upper extremities is important for achieving optimal position during axillary block. Thereby, the procedure can be safely and effectively performed with lesser amounts of local anaesthetic solution and a decreased number of manoeuvres with needle during infiltration.

Propofol attenuates cytokine-mediated upregulation of expression of inducible nitric oxide synthase and apoptosis during regeneration post-partial hepatectomy.

PURPOSE:: To determine the effects of propofol and ketamine anesthesia on liver regeneration in rats after partial hepatectomy (PHT). METHODS:: Male Wistar albino rats were assigned randomly to four groups of 10. Anesthesia was induced and maintained with propofol in groups 1 and 2, and with ketamine in groups 3 and 4. PHT was undertaken in groups 1 and 3. Rats in groups 2 and 4 (control groups) underwent an identical surgical procedure, but without PHT. At postoperative day-5, rats were killed. Regenerated liver was removed, weighed, and evaluated (by immunohistochemical means) for expression of inducible nitric oxide synthase (iNOS), endothelial NOS (eNOS), apoptosis protease-activating factor (APAF)-1, and proliferating cell nuclear antigen (PCNA). Also, blood samples were collected for measurement of levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6. RESULTS:: Between groups 2 and 4, there were no differences in tissue levels of iNOS, eNOS, and APAF-1 or plasma levels of TNF-α and IL-6. eNOS expression was similar in group 1 and group 3. Expression of iNOS and APAF-1 was mild-to-moderate in group 1, but significantly higher in group 3. Groups 1 and 3 showed an increase in PCNA expression, but expression in both groups was comparable. Plasma levels of TNF-α and IL-6 increased to a lesser degree in group 1 than in group 3. CONCLUSION:: Propofol, as an anesthetic agent, may attenuate cytokine-mediated upregulation of iNOS expression and apoptosis in an animal model of liver regeneration after partial hepatectomy.

Propofol attenuates cytokine-mediated upregulation of expression of inducible nitric oxide synthase and apoptosis during regeneration post-partial hepatectomy

Abstract Purpose: To determine the effects of propofol and ketamine anesthesia on liver regeneration in rats after partial hepatectomy (PHT). Methods: Male Wistar albino rats were assigned randomly to four groups of 10. Anesthesia was induced and maintained with propofol in groups 1 and 2, and with ketamine in groups 3 and 4. PHT was undertaken in groups 1 and 3. Rats in groups 2 and 4 (control groups) underwent an identical surgical procedure, but without PHT. At postoperative day-5, rats were killed. Regenerated liver was removed, weighed, and evaluated (by immunohistochemical means) for expression of inducible nitric oxide synthase (iNOS), endothelial NOS (eNOS), apoptosis protease-activating factor (APAF)-1, and proliferating cell nuclear antigen (PCNA). Also, blood samples were collected for measurement of levels of tumor necrosis factor (TNF)-α and interleukin (IL)-6. Results: Between groups 2 and 4, there were no differences in tissue levels of iNOS, eNOS, and APAF-1 or plasma levels of TNF-α and IL-6. eNOS expression was similar in group 1 and group 3. Expression of iNOS and APAF-1 was mild-to-moderate in group 1, but significantly higher in group 3. Groups 1 and 3 showed an increase in PCNA expression, but expression in both groups was comparable. Plasma levels of TNF-α and IL-6 increased to a lesser degree in group 1 than in group 3. Conclusion: Propofol, as an anesthetic agent, may attenuate cytokine-mediated upregulation of iNOS expression and apoptosis in an animal model of liver regeneration after partial hepatectomy.

Effect of ozone and methylprednisolone treatment following crush type sciatic nerve injury.

PURPOSE:: To assess and compare the histopathological effects of ozone therapy and/or methylprednisolone (MPS) treatment on regeneration after crush type sciatic nerve injury. METHODS:: Forty Sprague-Dawley male rats were randomly allocated into four groups. Four groups received the following regimens intraperitoneally every day for 14 days after formation of crush type injury on sciatic nerve: Group I: ozone (20mcg/ml); Group II: methylprednisolone (2mg/kg); Group III: ozone (20 mcg/ml) and methylprednisolone (2mg/kg); Group IV: isotonic saline (0.9%). The histomorphological evaluation was made after biopsies were obtained from the sites of injury. RESULTS:: Significant differences were noted between groups in terms of degeneration (p=0.019), nerve sheath cell atrophy (p=0.012), intraneural inflammatory cellular infiltration (p=0.002), perineural granulation tissue formation (p=0.019), perineural vascular proliferation (p=0.004), perineural inflammatory cellular infiltration (p<0.001) and inflammation in peripheral tissue (p=0.006). Degeneration was remarkably low in Group III, while no change in nerve sheath cell was noted in Group II. CONCLUSION:: The combined use of methylprednisolone and ozone treatment can have beneficial effects for regeneration after crush type nerve injury.

Effect of ozone and methylprednisolone treatment following crush type sciatic nerve injury

ABSTRACT PURPOSE: To assess and compare the histopathological effects of ozone therapy and/or methylprednisolone (MPS) treatment on regeneration after crush type sciatic nerve injury. METHODS: Forty Sprague-Dawley male rats were randomly allocated into four groups. Four groups received the following regimens intraperitoneally every day for 14 days after formation of crush type injury on sciatic nerve: Group I: ozone (20mcg/ml); Group II: methylprednisolone (2mg/kg); Group III: ozone (20 mcg/ml) and methylprednisolone (2mg/kg); Group IV: isotonic saline (0.9%). The histomorphological evaluation was made after biopsies were obtained from the sites of injury. RESULTS: Significant differences were noted between groups in terms of degeneration (p=0.019), nerve sheath cell atrophy (p=0.012), intraneural inflammatory cellular infiltration (p=0.002), perineural granulation tissue formation (p=0.019), perineural vascular proliferation (p=0.004), perineural inflammatory cellular infiltration (p<0.001) and inflammation in peripheral tissue (p=0.006). Degeneration was remarkably low in Group III, while no change in nerve sheath cell was noted in Group II. CONCLUSION: The combined use of methylprednisolone and ozone treatment can have beneficial effects for regeneration after crush type nerve injury.

Enteral nutrition preference in critical care: fibre-enriched or fibre-free?

BACKGROUND AND OBJECTIVES: This study's main aim was to observe the effects of a fibre-enriched nutrition solution on requisite feeding volume, which is directly proportional to energy intake in mechanically ventilated patients with enteral nutrition. METHODS AND STUDY DESIGN: Some 120 patients who required mechanical ventilation and enteral nutrition with a nasogastric tube were studied. Upon ICU admission, the patient's age, gender, weight, height, comorbidities, diagnosis and APACHE II score were recorded. We assigned two diets to the patients randomly. The control group received the fibre-free nutrition solution. The study group, received the fibreenriched nutrition solution. Prescribed feeding volume and administered feeding volume, gastric residual volume (GRV), volume ratio (VR), diarrhoea score and gastrointestinal complications (GIC) were recorded, along with daily biochemistry. RESULTS: The two groups did not differ with respect to age, sex, weight, BMI, APACHE II score, target caloric intake or GRV (p>0.05). On days four and five, the study group had higher VR values (p<0.05). Seventy-one (59%) patients had at least one gastrointestinal complication; 44 (73%) of them were controls and 27 (45%) of them study patients. The most commonly observed GIC was diarrhoea. Thirty-eight patients had diarrhoea in control group, and twenty-two patients had diarrhoea in study group, and this difference was statistically significant (p<0.001). There were no significant differences between the groups about vomiting and regurgitation. CONCLUSIONS: We suggest that ICU staff initiate enteral nutrition with fibre-enriched formulas rather than fibre-free formulas to avoid frequent feeding interruptions that cause protein energy malnutrition in ICU patients.

Diphenylhydantoin Induced DRESS Syndrome: A Case Report.

Drug Rash with Eosinophilia and Systemic Symptoms" (DRESS) syndrome is a severe adverse drug reaction. The drugs most often implicated are anti-convulsants, bupropion, sulfonamides, sulfasalazine, allopurinol, minocycline, abacavir and neviparine. There are also immune and infectious causes that can lead to DRESS syndrome. A 70-year-old female patient had undergone endovascular coil embolization for intracranial aneurysm and experienced a generalised seizure postoperatively. She had been given diphenylhidantoin (DPH). Six days after DPH therapy, the patient had complained of widespread skin rash. Although DPH was replaced with levetiracetam afterwards, the skin rash deteriorated, causing facial oedema and swelling of the tongue. She had severe facial oedema with swelling of the tongue, causing disturbance of breathing. On the second day in the critical care unit, the patient's breathing deteriorated, leading successively to intubation and mechanical ventilation. The patient's rash was still persistent and the results of a punch biopsy taken from the lesions revealed superficial perivascular dermatitis involving spongiotic eosinophils compatible with spongiotic drug eruption. As a result, it is important to realise that medications we use can be the cause of a range of reactions ranging from simple rash to life threatening syndromes.

Wernicke's Encephalopathy After Longterm Feeding with Parenteral Nutrition.

Wernicke's encephalopathy occurs due to thiamine (vitamin B1) deficiency which is characterized by occulomotor dysfunction, confusion and ataxia. Although it is most common with alcoholism, can also be seen due to hyperemesis caused by chemotherapy, Crohn's disease, gastrointestinal system surgery, AIDS, bariatric surgery and longterm feeding with parenteral nutrition. In this case, a 51-year-old woman who was treated with longterm total parenteral nutrition due to hyperemesis and had the diagnosis of Wernicke's encephalopathy after admission to the intensive care unit is presented.

Phosphodiesterase 5 inhibitors attenuate renal tubular apoptosis after partial unilateral ureteral obstruction: an experimental study.

The aim of the present study was to evaluate the effects of phosphodiesterase 5 inhibitors on renal tubular apoptosis and also on expressions of endothelial and inducible nitric oxide synthases (eNOS and iNOS) in the ipsilateral kidney after partial unilateral ureteral obstruction (PUUO) in a rat model. Forty Wistar albino rats were divided into five groups. In Groups 1-4, left experimental PUUO was created. Sildenafil, vardenafil, and tadalafil were administrated to the rats of Groups 2-4, respectively. The pills were orally given to the rats for 30 days. Group 5 was defined as sham. After 30 days, all rats were sacrificed, and nephrectomy was performed. The renal specimens were examined histopathologically. Left hydroureteronephrosis was observed in Groups 1-4. Mean apoptotic cell count and eNOS and iNOS levels were significantly increased in Group 1 when compared with the other groups. The rats in Groups 2-4 showed significantly decreased apoptotic cell count and eNOS and iNOS values in the renal tubular tissue in accordance with Group 1 (p<0.05). There were significant differences in apoptotic cell counts between sildenafil group and the other two study groups. The sildenafil group demonstrated lesser apoptotic cell count than the vardenafil (p=0.021) and tadalafil (p=0.009) groups. PUUO increases the renal tubular apoptosis and elevates NOS concentrations in renal tubular tissue after PUUO. Phosphodiesterase 5 inhibitors have a protective effect against the tubular apoptosis.

The effects of carbohydrate-rich drink on perioperative discomfort, insulin response and arterial pressure in spinal aesthesia.

BACKGROUND: The aim of this study was to investigate the role of carbohydrate-rich drink (CHO) on perioperative discomfort, hemodynamic changes, and insulin response in patients undergoing surgery with spinal anesthesia. METHODS: Forty-four adult patients were assigned to one of the two groups of 22, namely preparation with CHO (CHO group) or fasting from midnight (control group). Ten different discomfort variables, blood glucose and insulin concentrations, and hemodynamic changes were recorded during the perioperative period. RESULTS: Preparation with CHO was effective in reducing hunger, thirst, malaise, unfitness, and, to some extent, anxiety (p < 0.05). Plasma glucose and insulin concentrations were increased in the CHO group (p < 0.05). Plasma glucose increased and insulin decreased in the control group (p < 0.05). In the control group, mean arterial pressure was lower compared to the CHO group (p < 0.05). CONCLUSIONS: Preparation with CHO before spinal anesthesia is advantageous due to reducing perioperative discomfort, improving insulin response and stabilizing mean arterial pressure.

Preventive effects of propofol and ketamine on renal injury in unilateral ureteral obstruction.

PURPOSE: The aim of the present study was to investigate the preventive effects of propofol and ketamine as anesthetics on renal injury in unilateral ureteral obstruction (UO). METHODS: Twenty-four male New Zealand white rabbits were randomly assigned to four groups of six rabbits each. Anesthesia was induced and maintained with propofol in groups 1 and 2 and with ketamine in groups 3 and 4. Groups 2 and 4 received complete left ureteral ligation. Groups 1 and 3 (control groups) underwent an identical surgical procedure without ureteral ligation. At 14 days of obstruction, animals were sacrificed and ipsilateral kidneys were removed for determination of tissue nitric oxide (NO) levels and immunohistochemical evaluation of endothelial nitric oxide synthase (eNOS), inducible NOS (iNOS), and apoptosis protease-activating factor 1 (APAF-1). RESULTS: Between groups 1 and 3, there were no differences in tissue NO levels and eNOS, iNOS, and APAF-1 expressions. iNOS and APAF-1 expressions were at the mild to moderate levels in group 2, but these parameters were markedly increased in group 4 at 14 days of obstruction. Also, elevated expression of iNOS was accompanied by a high NO production in group 4 compared with group 2. Although eNOS expressions were increased in both groups 2 and 4, there were no significant differences between these groups. CONCLUSIONS: Propofol as an anesthetic agent may attenuate NO-induced renal tubular cell apoptosis by downregulating the expression of iNOS in an animal model of unilateral UO.

Ginkgo biloba (EGB 761) affects apoptosis and nitric-oxide synthases in testicular torsion: an experimental study.

INTRODUCTION: We investigated the effect of ginkgo biloba on germ cell apoptosis and also on expressions of endothelial (eNOS) and inducible (iNOS) nitric oxide synthases after testicular torsion. MATERIALS AND METHODS: Thirty-two Wistar albino rats were randomly assigned into four groups. Torsion/detorsion (T/D) was performed on the rats in group 1, group 2 received ginkgo biloba for a month before T/D, group 3 received only gingko biloba for a month, and group 4 was the sham group. Left testicular torsion was created in group 1 and group 2, and the testes were untwisted and replaced in the scrotum for reperfusion. No procedure was applied to group 3, and after 1 month, testes were removed in all groups. RESULTS: Mean apoptotic cell, eNOS, and iNOS were increased in group 1. Group 2 showed significantly decreased apoptotic cells, eNOS, and iNOS in testes compared to group 1 (P < 0.05). The rats in group 3 had significantly decreased apoptotic cell, eNOS, and iNOS values, like the sham group (P < 0.05), and this group provided basal values. CONCLUSIONS: Ginkgo biloba, as a free radical scavenger, seems to have a protective role against apoptosis in testicular ischemia reperfusion injury.

Dexmedetomidine reduces the ischemia-reperfusion injury markers during upper extremity surgery with tourniquet.

PURPOSE: We examined the effect of dexmedetomidine on ischemia-reperfusion injury due to tourniquet application during upper-extremity surgery by determining blood malondialdehyde and hypoxanthine levels. Alterations in aspartate aminotransferase, alanine aminotransferase, creatine phosphokinase, lactate dehydrogenase, uric acid, and creatinine levels were also assessed. METHODS: Forty patients of American Society of Anesthesiologists physical status I to II having hand and forearm surgery with tourniquet were randomly allocated into 2 groups. Brachial plexus anesthesia via axillary approach was performed for upper-limb block in all patients. In the dexmedetomidine group, a continuous infusion of dexmedetomidine (1 microg/kg for 10 minutes, followed by 0.5 microg kg(-1) h(-1)) was used until the end of surgery, whereas the control group received an equivalent volume of saline. Venous blood samples were obtained before brachial plexus anesthesia, at 1 minute before tourniquet release, and 15 minutes after tourniquet release for biochemical analysis. RESULTS: Dexmedetomidine significantly attenuated plasma hypoxanthine production in the ischemia and plasma malondialdehyde production in the reperfusion periods. Blood creatine phosphokinase and uric acid levels were significantly lower in the dexmedetomidine group compared with those in the control group after reperfusion. CONCLUSIONS: Our results suggest that dexmedetomidine may offer advantages by inhibiting lipid peroxidation in the case of anticipated ischemia-reperfusion injury, such as would occur in upper-extremity surgery requiring tourniquet application. TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.

Dexmedetomidine attenuates the hemodynamic and neuroendocrinal responses to skull-pin head-holder application during craniotomy.

We tested dexmedetomidine, an alpha2 agonist, for its ability to decrease heart rate, arterial blood pressure, and neuroendocrinal responses to skull-pin head-holder application during craniotomy. In a randomized, double-blinded, placebo-controlled study, 40 patients undergoing craniotomy with attachment of a pin head-holder were randomly assigned to one of 2 equal groups. The placebo group received saline, whereas the treatment group (DEX group) received a single bolus dose of dexmedetomidine (1 microg/kg) intravenously over 10 minutes before induction of anesthesia. Arterial blood pressure, heart rate, and sequential concentrations of circulating cortisol, prolactin, insulin, and blood glucose were measured. Relative to baseline and the other group, arterial blood pressure and heart rate decreased significantly after the administration of dexmedetomidine through skull pinning (P<0.05). In the placebo group, patients' heart rate and arterial blood pressure measures increased at 1 and 5 minutes after skull-pin insertion, compared with baseline and the DEX group (P<0.05). In both groups, plasma cortisol, prolactin, and blood glucose increased significantly relative to baseline after skull-pin insertion. However, the values were significantly higher in the placebo group compared with the DEX group (P<0.05). Although insulin levels were not significantly altered in the DEX group, the plasma concentrations of insulin decreased significantly after pin insertion in the placebo group. Our results suggested that, a single bolus dose of dexmedetomidine before induction of anesthesia attenuated the hemodynamic and neuroendocrinal responses to skull-pin insertion in patients undergoing craniotomy.

Ginkgo biloba (EGb 761) usage attenuates testicular injury induced by testicular ischemia/reperfusion in rats.

INTRODUCTION: We investigated the effect of ginkgo biloba on testicular ischemia-reperfusion (IR) injury. MATERIALS AND METHODS: Thirty-two Wistar Albino rats were randomly assigned into four groups. Torsion/detorsion (T/D) performed to the rats in group 1, group 2 received ginkgo biloba (50 mg/day) for a month before T/D, group 3 received only gingko biloba (50 mg/day) for a month and group 4 was defined as sham group. After 1 month the testes were removed. RESULTS: Mean testicular malondialdehyde, nitrate and nitrite levels were significantly increased in group 1 compared to groups 2, 3 and 4 (P<0.05). The rats in group 3 provided basal histological appearance. In group 1, edema, congestion and hemorrhage between seminiferous tubules were predominant. In group 2, histopathologic features were markedly less than group 1. CONCLUSIONS: Malondialdehyde, nitrate and nitrite levels were increased after unilateral testicular torsion. EGb 761 has a protective effect on testicular injury induced by IR.

Effect of phospodiesterase 5 inhibitors on apoptosis and nitric oxide synthases in testis torsion: an experimental study.

To investigate the effects of phosphodiesterase (PDE) 5 inhibitors, sildenafil citrate and vardenafil HCl, on testicular germ cell apoptosis and also on the expressions of eNOS and iNOS within the bilateral testis after a unilateral torsion in a rat model. Forty-eight Wistar Albino rats, weighing between 210 and 262 g, were housed in individual cages. The rats were randomly assigned into four main groups and each group received drugs. Saline, sildenafil citrate and vardenafil HCl were given to each for 1 month and the last received no drug. After 1 month, testicular torsion was created for 1 h of ischemia and the left testis was untwisted and replaced to the scrotum for 2 h of reperfusion. At the end of 3 h, contralateral and ipsilateral testes were removed for histopathologic and biochemical examinations. Under light microscopy; the histopathological patterns of the contralateral testes in all groups were not affected. Mean apoptotic cell, eNOS and iNOS levels were increased in saline study group. The rats treated with vardenafil and sildenafil (groups 2s and 3s) showed significantly increased apoptotic cell, eNOS and iNOS values in ipsilateral testis (P < 0.05). Sildenafil citrate and vardenafil HCl caused an exaggerated testicular apoptosis after IR injury in rats. Additionally these drugs increased the NOSs levels in the testicular tissue.

The protective effects of intravenous anesthetics and verapamil in gut ischemia/reperfusion-induced liver injury.

BACKGROUND: We investigated the protective effects of IV anesthetics and verapamil in gut ischemia/reperfusion-induced liver injury. METHODS: Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. Anesthesia was induced and maintained with propofol in Groups 1 and 3 and with thiopental in Groups 2 and 4 during the experiment. All animals developed intestinal ischemia after occlusion of the superior mesenteric artery for 30 min. Reperfusion was induced by removal of the microvascular clamp and was allowed to continue for 120 min. The animals in Groups 3 and 4 were given verapamil 10 min before reperfusion. Liver and ileum samples were taken for measurement of malondialdehyde (MDA) and histopathologic examination before ischemia and 30 and 120 min after reperfusion. Blood samples were also obtained for measurement of plasma tumor necrosis factor-alpha and interleukin-6 levels. RESULTS: Gut ischemia/reperfusion-induced significant increases in MDA contents of liver and gut and serum cytokines, consistent with histopathologic injury scores. Propofol effectively stabilized the MDA levels and decreased the tissue injury scores of the liver and gut. Tumor necrosis factor-alpha and interleukin-6 levels increased less in the propofol groups than in the thiopental groups. There was no additive preventive effect of verapamil on propofol. The addition of verapamil to thiopental was effective in decreasing the serum cytokines and liver MDA content. CONCLUSION: Propofol may offer advantages by inhibiting lipid peroxidation and inflammatory cytokine production in an animal model of gut ischemia/reperfusion-induced liver injury.