Early assessment of extremity compartment syndrome by biochemical markers in a rat model.

BACKGROUND: This experimental study aimed to define a biochemical marker that will enable early diagnosis of acute compartment syndrome (ACS) of extremities, a mortal condition that occurs due to trauma. METHODS: A total of 15 Wistar rats were included in the study in which saline infusion technique, a clinically compatible ACS model, was applied. After the rats were anesthetized with ketamine-xylazine, the in-compartment pressure of the hind limb was slowly increased with saline delivered through the angiocatheter, and after reaching the target compartment pressure, the pressure level was kept with a rubber tourniquet. The in-compartment pressure level was continuously monitored with a pressure transducer. The rats were divided into three groups. No intervention was applied to the control group (CG) (n = 3). In study group 1 (SG1) (n = 6), ACS was created using the saline infusion technique, keeping the in-compartment pressure between 30 and 40 mmHg for 45 min. In study group 2 (SG2) (n = 6), ACS was created using the saline infusion technique, keeping the in-compartment pressure between 30 and 40 mmHg for 90 min. Fasciotomy was performed on all rats. Tissue samples were obtained for histopathological examination and blood samples for biochemical analysis. RESULTS: Total oxidant status (TOS) (p = 0.004), ischemia-modified albumin (IMA) (p = 0.030), aspartate transferase (AST) (p = 0.003) and neopterin (p = 0.012) levels differed significantly between groups in the early period of muscle ischemia. In fact, TOS levels differed significantly between the groups even in the cellular phase where signs of ischemia were not observed (p = 0.048, p = 0.024). According to histopathological evaluation, there was no significant difference between the groups. DISCUSSION: TOS can be detected in the early reversible stage of ischemia, when the histopathological findings of ACS do not occur.

Noninvasive Treatment of Acquired Subglottic Stenosis.

A 23-day-old infant referred to the neonatal intensive care unit with difficulty breathing and inspiratory stridor increasing with exercise. Medical history included a cardiothoracic surgery for transposition of the great arteries, patent ductus arteriosus, atrial septal defect, and a history of intensive care unit from surgery. Flexible fiberoptic transnasal laryngoscopy revealed subglottic stenosis that was probably caused by prolonged intubation with a higher airway pressure. Computed tomographic scan of the neck showed a tiny stenosis without cartilage deformity and limited in subglottic region. Tracheotomy and external open surgery was found risky for sternal wound infection or mediastinitis as the neonate had newly thoracotomy. The patient had a balloon dilation under general anesthesia without intubation. Presenting symptoms of the neonate were fully improved with balloon dilation.

Ultrasound validation of Trendelenburg positioning to increase internal jugular vein cross-sectional area in chronic dialysis patients.

BACKGROUND AND AIM: Trendelenburg positioning (TP) is a common approach used during internal jugular vein (IJV) cannulation. No evidence indicates that TP significantly increases the cross-sectional area (CSA) of the IJV or decreases the overlap between the carotid artery (CA) and the IJV in dialysis patients. The primary aim of this study was to investigate the effects of the TP on the CSA of the right IJV and on its relationship to the CA. METHODS: Thirty-seven consecutive hemodialysis patients older than 18 years of age were enrolled. We measured the CSA of the right IJV and overlap rate (at end-expiration at the level of the cricoid cartilage) between the CA and the IJV in two positions: State 0, table flat (no tilt), with the patient in the supine position; State T, in which the operating table was tilted to 15° of TP. RESULTS: Data were collected for all of the 37 patients enrolled in the study. The change in CSA and overlap between the CA and the IJV from the supine to the TP was not significantly different. The CSA was paradoxically decreased in 11 of 37 patients when changed from State 0 to State T. CONCLUSIONS: TP does not significantly increase the CSA of the right IJV or decrease the overlap between the CA and the IJV in dialysis patients. In fact, in some patients, it reduces the CSA. Therefore, the use of the TP for IJV cannulation in dialysis patients can no longer be supported.