Evaluation of the Effects of Immunosuppressive Drugs Following Liver Transplantation on Pregnancy Outcomes: A Retrospective Study.

BACKGROUND: Liver transplantations can be safely performed in women of reproductive age. Women with chronic liver disease may have infertility for various reasons, although fertility returns after recovering >90% of sexual disorders following liver transplantation. The present study examined the effects of immunosuppressive drugs used by women of reproductive age undergoing liver transplantation in our clinic on pregnancy and pregnancy outcomes and evaluated mortality and morbidity in this patient population. METHODS: Among the patients undergoing liver transplantation in our clinic between 1997 and 2020, those conceiving after liver transplantation were evaluated in the present study. Demographic data on maternal and newborn health, as well as mortality and morbidity, were recorded. Maternal transplant indications, graft type, the interval between transplantation and pregnancy, maternal age at pregnancy and the number of pregnancies, the number of living children, complications, delivery mode, immunosuppressive drugs, and blood levels were investigated. RESULTS: A total of 615 liver transplantations (353 from a living donor, 262 from a cadaveric donor) were performed in our clinic. Furthermore, 33 pregnancies occurred in 22 women following transplantation (17 living donor liver transplantations, 5 deceased donor liver transplantations), and the data of these patients were recorded. Tacrolimus and mycophenolate mofetil were used as immunosuppressive therapy. CONCLUSIONS: Liver transplantations can be safely performed in women of reproductive age if indicated, and these patients can be safely followed up throughout the pregnancy and during labor by a multidisciplinary team.

Complications and Long-Term Outcomes in Adult Patients Undergoing Living Donor Liver Transplantation Because of Fulminant Hepatitis.

BACKGROUND: The present study investigates the complications that may occur during long-term follow-up in patients aged 18 years and older undergoing living donor liver transplantation (LDLT) in our clinic because of fulminant hepatitis. METHODS: The study included patients aged 18 years and older with a minimum survival of 6 months who underwent an LDLT between June 2000 and June 2017. The demographic data of the patients were evaluated in terms of late-term complications. RESULTS: Of the 240 patients who met the study criteria, 8 (3.3%) underwent LDLT for fulminant hepatitis. The indication for transplantation in patients with fulminant hepatitis was cryptogenic liver hepatitis in 4 patients, acute hepatitis B infection in 2 patients, hemochromatosis in 1 patient, and toxic hepatitis in 1 patient. Of the 240 patients, 65 (27%) undergoing LDLT underwent a liver biopsy for suspected rejection because of an elevation in liver function test results during follow-up. Histopathologic scoring was carried out according to the Banff scoring system. A diagnosis of late acute rejection was made in only 1 of the 8 patients (12.5%) who underwent LDLT for fulminant hepatitis. CONCLUSION: Patients with fulminant hepatitis must be prepared for an LDLT, if available, while waiting for a cadaveric donor. The results of the present study suggest that LDLTs in patients with fulminant hepatitis are safe, and the outcomes are acceptable in terms of survival and complications.

The risk factors for gastrointestinal anastomotic leak after cytoreduction with hyperthermic intraperitoneal chemotherapy.

BACKGROUND: Gastrointestinal anastomotic leak (GAL) is a major cause of morbidity and mortality after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). The aim of this study is to determine the risk factors associated with GAL in peritoneal metastases (PM) surgery. METHODS: Patients who underwent CRS and HIPEC with gastrointestinal anastomosis were included. Charlson Comorbidity Index (CCI) and Eastern Cooperative Oncology Group (ECOG) performance status were used to assess preoperative condition of the patients. GAL was recorded as gastrointestinal extralumination diagnosed clinically, radiologicaly, or during reoperation. RESULTS: Among 362 patients who were analyzed, the median age was 54 years, 72.6% were female, and the most common histopathologies were ovarian cancer (37.8%) and colorectal (36.2%) cancer. The median Peritoneal Cancer Index was 11 and 80.1% of the patients underwent complete cytoreduction. A single anastomosis was performed in 293 (80.9%) patients, two anastomoses in 51 (14.1%) and three anastomoses in 18 (5%) patients. Diverting stoma was performed in 43 (11.8%) patients. GAL was seen in 38 (10.5%) patients. Smoking (p<0.001), ECOG performance status (p=0.014), CCI score (p=0.009), pre-operative albumin level (p=0.010), and number of resected organs (p=0.006) were significantly associated factors with GAL. Independent risk factors for GAL were smoking (Odds Radio [OR]: 6.223, confidence interval [CI]: 2.814-13.760; p<0.001), CCI score ≥7 (OR: 4.252, CI: 1.590-11.366; p=0.004), and pre-operative albumin level ≤3.5 g/dl (OR: 3.942, CI: 1.534-10.130; p=0.004). CONCLUSION: Patient-related factors such as smoking, comorbidity, and pre-operative nutritional status had an impact on anasto-motic complications. Proper patient selection and prediction of an index patient requiring a prehabilitation program with a high level of care are essential prerequisites to obtaining lower anastomotic leak rates and improving outcomes in PM surgery.

Neglected prognostic importance of ileal resection in patients with peritoneal metastasis.

We aimed to determine the prognostic role of ileal resection on postoperative complications and the final oncological results of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) treatment in patients with peritoneal metastasis (PM). Patients with PM who underwent CRS and HIPEC between 2007 and 2020 were analyzed retrospectively. Ileal resection was defined as the resection of the ileum at 100 cm or below. Patients were divided into ileal-resection and non-ileal resection groups. Besides clinico-pathological variables, peritoneal cancer index (PCI), completeness of cytoreduction (CC-0-1-2), (neo)adjuvant chemotherapy, operative time, need for surgical intensive care unit, and usage of blood products were all evaluated. The data of 664 patients was analyzed. Ileal resection was performed in 346(52.1%) patients. The median follow-up period was 27 months. The ileal resection group had significantly lower 3-and 5-year survival rates (55% and 43% vs. 69% and 52, p = .005, respectively). High PCI score (p < .001), more CC-1-2 cytoreductions (p < .001), more anastomoses (p < .001), prolonged operative time (p < .001), more ostomy creation (p = .001), increased morbidity (p < .001), and more infectious complications (p < .001) were all significantly associated with ileal resection. The loss of ileal function has a potential prognostic role in increased post-operative complications and worsened overall survival in patients with PMs.

Intraoperative Temperature Monitoring with Zero Heat Flux Technology (3M SpotOn Sensor) in Comparison with Tympanic and Oesophageal Temperature and Hypotermia Risk Factors: An Observational Study.

OBJECTIVE: Inadvertent hypothermia (body temperature below 35°C) is a common and avoidable challenge during surgery under anaesthesia. It is related to coagulation (clotting) disorders, an increase in blood loss, and a higher rate of wound infection. One of the methods for non-invasive monitoring of the core body temperature is the 3M SpotOn zero heat flux method. In this approach, sensors placed at the frontal region of the patient measure the skin temperature by creating an isothermic channel. The study aimed to determine the risk factors for hypothermia and compare the 3M SpotOn zero heat flux method with the tympanic membrane (eardrum) and oesophageal (food pipe) temperature measurement methods. DESIGN: Observational. DATA SOURCES: The patients' data were collected, including age, gender, weight, BMI, other illnesses, smoking history, type of anaesthesia, duration of surgery, operating room temperature, pulse rate, blood pressure, blood loss, and transfusions. Body temperature was measured by the tympanic membrane method before and after surgery, oesophageal method during surgery, and SpotOn measurements throughout all three periods were recorded. ELIGIBILITY CRITERIA: Inclusion criteria was: adult patients, both genders, who had undergone major abdominal cancer surgery at the trialists' institution, in whom the SpotOn zero heat flux, tympanic membrane, and oesophageal temperature measurement methods had all been used. Participant exclusion criteria was the absence of recorded data. RESULTS: In this study, inadvertent intraoperative hypothermia incidence was 38.1% in the recovery room. Although gender, presence of comorbidities, history of smoking, administration of epidural anaesthesia, and requirement of blood transfusion [red blood cells (RBCs) and fresh frozen plasma (FFP)] did not affect hypothermia significantly during admission to the recovery room, prewarming the patient throughout the operation prevented the occurrence of hypothermia significantly (p=0.004). Additionally, as the American Society of Anaesthesiologists (ASA) physical status score worsened, the rate of hypothermia increased significantly (Frequency: 1st degree, 29.4%; 2nd degree, 47.5%; 3rd degree, 66.7%; X2 Slope- p=0.047). CONCLUSION: The most significant risk factor was found to be not prewarming the patient as a strict procedure, and as the ASA physical status score worsened, the rate of hypothermia increased significantly. Besides, the SpotOn method provided temperature measurements as good as the oesophageal temperature measurements. Clinical Trial registration: ISRCTN 14027708.

Comparison of Direct and Remote Ischaemic Preconditioning of Renal Ischaemia Reperfusion Injury in Rats.

OBJECTIVE: One of the methods that can be used to prevent ischaemia reperfusion (IR) injury is ischaemic preconditioning. The aim of this study was to evaluate and compare the effects of remote and direct ischaemic preconditioning (RIPC and DIPC) histopathologically in the rat renal IR injury model. METHODS: After obtaining an approval from the Dokuz Eylül University School of Medicine Ethics Committee, 28 Wistar Albino male rats were divided into four groups. In Group I (Sham, n=7), laparotomy and left renal pedicle dissection were performed, but nothing else was done. In Group II (IR, n=7), after 45 minutes of left renal pedicle occlusion, reperfusion lasting 4 hours was performed. In Group III (DIPC+IR, n=7), after four cycles of ischaemic preconditioning applied to the left kidney, renal IR was performed. In Group IV (RIPC+IR, n=7), after three cycles of ischaemic preconditioning applied to the left hind leg, renal IR was performed. All rats were sacrificed, and the left kidney was processed for conventional histopathology. RESULTS: The histopathological injury score of the kidney was significantly lower in the sham group compared with the other groups (p<0.01). The injury scores of the DIPC+IR and RIPC+IR groups were significantly lower than in the IR group (p<0.05). In the RIPC+IR group, the injury score for erythrocyte extravasation was found to be significantly lower than in the DIPC+IR group (p<0.05). CONCLUSION: In the present study, it was demonstrated that both DIPC and RIPC decreased renal IR injury, but RIPC was found to be more effective than DIPC. This protective effect requiresfurther detailed experimental and clinical studies.

Effects of Dexmedetomidine on Renal Ischaemia Reperfusion Injury in Streptozotocin-Induced Diabetic Rats.

OBJECTIVE: The aim of this study was to investigate the effects of dexmedetomidine before and after ischaemia in diabetic rat kidney ischaemia reperfusion (IR) injury in the experimental diabetic rat model. METHODS: Data belonging to 35 rats weighing between 250 and 300 g were analysed. Diabetes mellitus (DM) was induced using streptozotocin. Groups had bilateral renal vasculature clamped for 45 min ischaemia before clamps were removed, and 4 hours reperfusion was applied. Rats were divided into five groups: Group I or nondiabetic sham group (n=7), Group II or diabetic sham group (n=7), Group III or diabetic IR group (n=7), Group IV or diabetic IR+prophylactic Dex P (before ischaemia) (n=7) and Group V or diabetic IR+therapeutic Dex T (following reperfusion) (n=7). Dexmedetomidine was administered at a dose of 100 µg kg-1 intraperitoneally. Histomorphological and biochemical methods were used to assess the blood and tissue samples. RESULTS: The proximal tubule injury score in the control sham group was significantly lower than in other groups. The proximal tubule and total cell damage scores of the diabetic IR group were significantly higher than the diabetic IR+Dex T group, and no significant difference was detected in the diabetic IR+Dex P group. The biochemical parameters of the IR group were significantly increased compared to Groups I and II; however, there was no significant reduction in these parameters in the groups administered dexmedetomidine. CONCLUSION: Although administration of dexmedetomidine after ischaemia in the diabetic rat renal IR model was found to be more effective on the histopathological injury scores compared to preischaemic administration, this study has not shown that dexmedetomidine provides effective and complete protection in DM.

Treatment of intraoperatively detected peritoneal carcinomatosis of colorectal origin with cytoreductive surgery and intraperitoneal chemotherapy.

BACKGROUND: Diagnosis of peritoneal carcinomatosis (PC) may be missed by preoperative imaging. We are presenting our experience with incidentally detected PC of colorectal origin treated with cytoreductive surgery (CRS) and intraperitoneal chemotherapy (IPC) at the same operation. METHODS: Between January 2010 and September 2016, 19 patients underwent CRS and IPC due to incidentally detected PC of colorectal origin. Data were analyzed from a prospectively collected database. RESULTS: The median age was 59 (29-78). In three patients, PC was diagnosed during emergency surgery. The primary tumor was located in the rectum (three patients; one with recurrent disease), left colon (9 patients), and right colon (7 patients). All patients underwent CRS and IPC, and one patient operated laparoscopically. Median peritoneal cancer index (PCI) was 5 (range, 3-14), and complete cytoreduction (CC-0) was achieved in 14 patients. After CRS, 8 patients received early postoperative intraperitoneal chemotherapy (EPIC), 7 patients received hyperthermic intraperitoneal chemotherapy (HIPEC), and 4 patients received both HIPEC and EPIC. The median hospital stay was 9 (6-29) days. Postoperative complications occurred in 6 patients. There was no postoperative mortality. Median follow-up was 40.2 (12-94) months. Five-year overall survival was 63.2%. Estimated mean survival time is longer in patients who underwent complete cytoreduction compared to patients having CC-1 or CC-2 cytoreduction (87.7 vs. 20.3 months; p < 0.001). CONCLUSION: Cytoreductive surgery and IPC can be performed safely in patients with intraoperatively detected incidental PC of colorectal origin.

Readability of internet-sourced patient education material related to "labour analgesia".

We evaluated the readability of Internet-sourced patient education materials (PEMs) related to "labour analgesia." In addition to assessing the readability of websites, we aimed to compare commercial, personal, and academic websites.We used the most popular search engine (http://www.google.com) in our study. The first 100 websites in English that resulted from a search for the key words "labour analgesia" were scanned. Websites that were not in English, graphs, pictures, videos, tables, figures and list formats in the text, all punctuation, the number of words in the text is less than 100 words, feedback forms not related to education, (Uniform Resource Locator) URL websites, author information, references, legal disclaimers, and addresses and telephone numbers were excluded.The texts included in the study were assessed using the Flesch Reading Ease Score (FRES), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), and Gunning Frequency of Gobbledygook (FOG) readability formulae. The number of Latin words within the text was determined.Analysis of 300-word sections of the texts revealed that the mean FRES was 47.54 ±â€Š12.54 (quite difficult), mean FKGL and SMOG were 11.92 ±â€Š2.59 and 10.57 ±â€Š1.88 years of education, respectively, and mean Gunning FOG was 14.71 ±â€Š2.76 (very difficult). Within 300-word sections, the mean number of Latin words was identified as 16.56 ±â€Š6.37.In our study, the readability level of Internet-sourced PEM related to "labour analgesia" was identified to be quite high indicating poor readability.

Protective effects of dexmedetomidine and remote ischemic preconditioning on renal ischemia reperfusion injury in rats.

BACKGROUND: The aim of this study was to evaluate the effects of remote ischemic preconditioning (RIPC) and dexmedetomidine as pharmacological conditioning in a rat renal ischemia/reperfusion (IR) injury model. METHODS: Total of 28 male Wistar Albino rats weighing 250 to 300 g were divided into 4 equal groups. Group I (Sham; n=7): Laparotomy and renal pedicle dissection were performed, and the rats were observed under anesthesia without any intervention. Group II (IR; n=7): Following laparotomy and 45 minutes of left renal pedicle occlusion, 4 hours of reperfusion was performed. Group III (IR+D; n=7): Following laparotomy and ischemia, dexmedetomidine was administrated intraperitoneally (100 µg/kg) at fifth minute of reperfusion. Group IV (RIPC+IR; n=7): Under anesthesia, 3 cycles of ischemic preconditioning were applied to the left hind leg, and after 5 minutes, renal IR was performed. All rats were sacrificed after the left kidney was processed for conventional histomorphology. RESULTS: Total histomorphological renal injury score was significantly lower in the Sham group compared with the other groups (p<0.01). Total renal injury score of IR group was significantly higher than IR+D and RIPC+IR groups (p<0.01). There was no significant difference in the total renal injury score between the dexmedetomidine and RIPC groups (p=0.89). CONCLUSION: In the present study, it was demonstrated histomorphologically that both dexmedetomidine and RIPC decreased renal IR injury significantly. In addition, no significant difference was found between dexmedetomidine and RIPC groups.

Effects of different doses of remifentanil on hemodynamic response to anesthesia induction in healthy elderly patients.

OBJECTIVE: We compared the effects of three different doses of remifentanil infusion, which were performed for the induction of anesthesia in elder patients, on cardiovascular response. RESEARCH DESIGN AND METHODS: The present study was designed as a randomized, prospective and double-blind study. A total of 90 ASA I-II patients over the age of 65 years were enrolled. The patients were randomly (by lot) assigned to receive one of the three doses of remifentanil infusion (0.1, 0.2 or 0.3 µg/kg/min) for two minutes. Subsequently, 0.5 mg/kg propofol was administered via IV route and 0.5 mg/kg rocuronium was administered via IV route at the time eyelash reflex disappeared. Intubation was performed after 2 minutes. Patients who had an allergy against opioids, were chronic substance users, were obese, expected to have difficult airway, had hypertension, or were receiving any drug influencing the cardiovascular system were excluded. MAIN OUTCOME MEASURES: In this study after recording baseline values of heart rate (HR), systolic arterial pressure (SAP), diastolic arterial pressure (DAP) and mean arterial pressure (MAP), these values were recorded at the 1st, 2nd, 3rd, 4th and 5th minutes of induction. RESULTS: A significant increase was observed in heart rate at the 1st and 2nd minutes of induction versus baseline in the Remi 0.1 group and at the 2nd minute of induction versus baseline in the Remi 0.2 group, with no additional significant change in heart rate. A significant decrease was determined in the systolic, diastolic and mean arterial pressures in all groups from the 1st minute of induction of anesthesia to the pre-intubation period compared to baseline (p < .05). CONCLUSIONS: It was determined that each dose of remifentanil used was quite high for patients of this age-group. ClinicalTrials.gov trial number: NCT02763098.

Renal Ischemia/Reperfusion Injury in Diabetic Rats: The Role of Local Ischemic Preconditioning.

BACKGROUND: The aim of this study was to evaluate the effects of local ischemic preconditioning using biochemical markers and histopathologically in the diabetic rat renal IR injury model. METHODS: DM was induced using streptozotocin. Rats were divided into four groups: Group I, nondiabetic sham group (n = 7), Group II, diabetic sham group (n = 6), Group III, diabetic IR group (diabetic IR group, n = 6), and Group IV, diabetic IR + local ischemic preconditioning group (diabetic IR + LIPC group, n = 6). Ischemic renal injury was induced by clamping the bilateral renal artery for 45 min. 4 h following ischemia, clearance protocols were applied to assess biochemical markers and histopathologically in rat kidneys. RESULTS: The histomorphologic total cell injury scores of the nondiabetic sham group were significantly lower than diabetic sham, diabetic IR, and diabetic IR + LIPC groups. Diabetic IR group scores were not significantly different than the diabetic sham group. But diabetic IR + LIPC group scores were significantly higher than the diabetic sham and diabetic IR groups. CONCLUSION: Local ischemic preconditioning does not reduce the risk of renal injury induced by ischemia/reperfusion in diabetic rat model.

[Effects of dexmedetomidine in conjunction with remote ischemic preconditioning on renal ischemia-reperfusion injury in rats]. / Efeitos de dexmedetomidina em conjunto com o pré-condicionamento isquêmico remoto em lesão de isquemia-reperfusão renal em ratos.

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the effects of remote ischemic preconditioning by brief ischemia of unilateral hind limb when combined with dexmedetomidine on renal ischemia-reperfusion injury by histopathology and active caspase-3 immunoreactivity in rats. METHODS: 28 Wistar albino male rats were divided into 4 groups. Group I (Sham, n=7): Laparotomy and renal pedicle dissection were performed at 65th minute of anesthesia and the rats were observed under anesthesia for 130min. Group II (ischemia-reperfusion, n=7): At 65th minute of anesthesia bilateral renal pedicles were clamped. After 60min ischemia 24h of reperfusion was performed. Group III (ischemia-reperfusion+dexmedetomidine, n=7): At the fifth minute of reperfusion (100µg/kg intra-peritoneal) dexmedetomidine was administered with ischemia-reperfusion group. Reperfusion lasted 24h. Group IV (ischemia-reperfusion+remote ischemic preconditioning+dexmedetomidine, n=7): After laparotomy, three cycles of ischemic preconditioning (10min ischemia and 10min reperfusion) were applied to the left hind limb and after 5min with group III. RESULTS: Histopathological injury scores and active caspase-3 immunoreactivity were significantly lower in the Sham group compared to the other groups. Histopathological injury scores in groups III and IV were significantly lower than group II (p=0.03 and p=0.05). Active caspase-3 immunoreactivity was significantly lower in the group IV than group II (p=0.01) and there was no significant difference between group II and group III (p=0.06). CONCLUSIONS: Pharmacologic conditioning with dexmedetomidine and remote ischemic preconditioning when combined with dexmedetomidine significantly decreases renal ischemia-reperfusion injury histomorphologically. Combined use of two methods prevents apoptosis via active caspase-3.

Effects of dexmedetomidine in conjunction with remote ischemic preconditioning on renal ischemia­reperfusion injury in rats / Efeitos de dexmedetomidina em conjunto com o pré-condicionamento isquêmico remoto em lesão de isquemia-reperfusão renal em ratos / Efectos de la dexmedetomidina en conjunto con el precondicionamiento isquémico remoto en la lesión de isquemia-reperfusión renal en ratones

Background and objectives: The aim of this study was to evaluate the effects of remote ischemic preconditioning by brief ischemia of unilateral hind limb when combined with dexmedetomidine on renal ischemia-reperfusion injury by histopathology and active caspase-3 immunoreactivity in rats. Methods: 28 Wistar albino male rats were divided into 4 groups. Group I (Sham, n = 7): Laparotomy and renal pedicle dissection were performed at 65th minute of anesthesia and the rats were observed under anesthesia for 130min. Group II (ischemia-reperfusion, n = 7): At 65th minute of anesthesia bilateral renal pedicles were clamped. After 60 min ischemia 24 h of reperfusion was performed. Group III (ischemia-reperfusion + dexmedetomidine, n = 7): At the fifth minute of reperfusion (100 μg/kg intra-peritoneal) dexmedetomidine was administered with ischemia-reperfusion group. Reperfusion lasted 24 h. Group IV (ischemia-reperfusion + remote ischemic preconditioning + dexmedetomidine, n = 7): After laparotomy, three cycles of ischemic preconditioning (10 min ischemia and 10 min reperfusion) were applied to the left hind limb and after 5 min with group III. Results: Histopathological injury scores and active caspase-3 immunoreactivity were significantly lower in the Sham group compared to the other groups. Histopathological injury scores in groups III and IV were significantly lower than group II (p = 0.03 and p = 0.05). Active caspase-3 immunoreactivity was significantly lower in the group IV than group II (p = 0.01) and there was no significant difference between group II and group III (p = 0.06). Conclusions: Pharmacologic conditioning with dexmedetomidine and remote ischemic preconditioning when combined with dexmedetomidine significantly decreases renal ischemia- reperfusion injury histomorphologically. Combined use of two methods prevents apoptosis via active caspase-3. .

Justificativa e objetivos: Avaliar os efeitos do pré-condicionamento isquêmico remoto, mediante breve isquemia de membro posterior unilateral, em combinação com dexmedetomidina em lesão de isquemia-reperfusão renal por meio de histopatologia e imunorreatividade da caspase-3 ativa em ratos. Métodos: Foram divididos em quatro grupos 28 ratos machos albinos Wistar. Grupo I (Sham cirurgia controle], n = 7): laparotomia e dissecção do pedículo renal foram feitas em 65 minutos de anestesia e os ratos foram observados sob anestesia por 130 minutos. Grupo II (isquemia-reperfusão, n = 7): no 65° minuto de anestesia, os pedículos renais bilaterais foram pinçados; após 60 minutos de isquemia, foi feita reperfusão de 24 horas. Grupo III (isquemia-reperfusão + dexmedetomidina, n = 7): no quinto minuto de reperfusão, dexmedetomidina (100 mg/kg intraperitoneal) foi administrada ao grupo com isquemia-reperfusão. A reperfusão durou 24 horas. Grupo IV (isquemia-reperfusão + pré-condicionamento isquêmico remoto + dexmedetomidina, n = 7): após a laparotomia, três ciclos de pré-condicionamento isquêmico (10minutos de isquemia e 10minutos de reperfusão) foram aplicados no membro posterior esquerdo e depois de cincominutos ao grupo III. Resultados: Os escores de lesão histopatológica e imunorreatividade da caspase-3 ativa foram significativamente menores no grupo Sham em comparação com os outros. Os escores de lesão histopatológica dos grupos III e IV foram significativamente menores do que os do II (p = 0,03 e p = 0,05). A imunorreatividade da caspase-3 foi significativamente menor no grupo IV do que no II (p = 0,01) e não houve diferença significante entre os grupos II e III (p = 0,06). Conclusões: O condicionamento farmacológico com dexmedetomidina e o pré...

Introducción y objetivos: El objetivo de este estudio fue evaluar los efectos del precondicionamiento isquémico remoto mediante breve isquemia del miembro posterior unilateral en combinación con la dexmedetomidina en la lesión de isquemia-reperfusión renal por medio de histopatología e inmunoreactividad de la caspasa-3 activa en ratones. Métodos: 28 ratones machos albinos Wistar fueron divididos en 4 grupos. Grupo I (Sham cirugía control], n =7): se realizó laparotomia y disección del pediculo renal en 65 min de anestesia y los ratones fueron observados bajo anestesia durante 130min. Grupo II (isquemia-reperfusión, n = 7): en el sexagésimo quinto minuto de anestesia, los pídiculos renales bilaterales fueron pinzados; después de 60min de isquemia, se realizaron 24h de reperfusión. Grupo III (isquemia-reperfusión + dexmedetomidina, n = 7): al quinto minuto de reperfusión, la dexmedetomidina (100 μg/kg intraperitoneal) fue administrada en el grupo con isquemia-reperfusión; la reperfusión duró 24 h. Grupo IV (isquemia-reperfusión + precondicionamiento isquémico remoto + dexmedetomidina, n=7): después de la laparotomía, se aplicaron 3 ciclos de precondicionamiento isquémico (10 min de isquemia y 10 min de reperfusión) en el miembro posterior izquierdo y después de 5 min en el grupo in. Resultados: Las puntuaciones de lesión histopatológica e inmunoreactividad de la caspasa-3 activa fueron significativamente menores en el grupo Sham en comparación con los otros grupos. Las puntuaciones de lesión histopatológica de los grupos III y IV fueron significativamente menores que las del grupo II (p = 0,03 y p = 0,05). La inmunorreactividad de la caspasa-3 fue significativamente menor en el grupo IV que en el grupo II (p = 0,01) y no hubo diferencia significativa entre los grupos II ...

Comparison of the effects of dexmedetomidine administered at two different times on renal ischemia/reperfusion injury in rats.

BACKGROUND AND OBJECTIVES: We investigated the effect of dexmedetomidine on ischemic renal failure in rats. METHODS: In the present study, 26 male adult Wistar albino rats weighting 230-300 g were randomly separated into four groups: sham-operated (n=5), ischemia reperfusion (IR) (IR group, n=7), IR/reperfusion treatment with dexmedetomidine (Dex. R group, n=7) and IR/pre-ischemic treatment with dexmedetomidine (Dex. I group, n=7). In the first group, sham operation was achieved and renal clamps were not applied. For the IR group, renal ischemia was induced by occlusion of the bilateral renal arteries and veins for 60 min followed by reperfusion for 24h. For the Dex. R and Dex. I groups, the same surgical procedure as in the IR group was performed, and dexmedetomidine (100 mcg/kg intraperitoneal) was administrated at the 5th min after reperfusion and before ischemia. At the end of reperfusion, blood samples were drawn, the rats were sacrificed, and the left kidney was processed for histopathology. RESULTS: The blood urea nitrogen (BUN) levels in groups Dex. R and Dex. I were significantly lower than in the IR group (p=0.015, p=0.043), although urine flow was significantly higher in group Dex. R (p=0.003). The renal histopathological score in the IR group was significantly higher than in the other groups. There was no significant difference between the Dex. R and Dex. I groups. CONCLUSIONS: The results were shown that administration of dexmedetomidine reduced the renal IR injury histomorphologically. Administration of dexmedetomidine in the reperfusion period was considered as more effective due to increase in urinary output and decrease in BUN levels.

Comparison of the effects of dexmedetomidine administered at two different times on renal ischemia/reperfusion injury in rats / Comparação dos efeitos de dexmedetomidina administrada em dois momentos diferentes para lesão de isquemia/reperfusão renal em ratos / Comparación de los efectos de la dexmedetomidina administrada en 2 momentos diferentes para lesión de isquemia-reperfusión renal en ratones

Background and objectives: We investigated the effect of dexmedetomidine on ischemic renal failure in rats. Methods: In the present study, 26 male adult Wistar albino rats weighting 230-300 g were randomly separated into four groups: sham-operated (n = 5), ischemia reperfusion (IR) (IR group, n = 7), IR/reperfusion treatment with dexmedetomidine (Dex. R group, n = 7) and IR/pre-ischemic treatment with dexmedetomidine (Dex. I group, n = 7). In the first group, sham operation was achieved and renal clamps were not applied. For the IR group, renal ischemia was induced by occlusion of the bilateral renal arteries and veins for 60 min followed by reperfusion for 24 h. For the Dex. R and Dex. I groups, the same surgical procedure as in the IR group was performed, and dexmedetomidine (100 mcg/kg intraperitoneal) was administrated at the 5th min after reperfusion and before ischemia. At the end of reperfusion, blood samples were drawn, the rats were sacrificed, and the left kidney was processed for histopathology. Results: The blood urea nitrogen (BUN) levels in groups Dex. R and Dex. I were significantly lower than in the IR group (p = 0.015, p = 0.043), although urine flow was significantly higher in group Dex. R (p = 0.003). The renal histopathological score in the IR group was significantly higher than in the other groups. There was no significant difference between the Dex. R and Dex. I groups. Conclusions: The results were shown that administration of dexmedetomidine reduced the renal IR injury histomorphologically. Administration of dexmedetomidine in the reperfusion period was considered as more effective due to increase in urinary output and decrease in BUN levels. .

Justificativa e objetivos: Investigar os efeitos de dexmedetomidina sobre a insuficiência renal isquêmica em ratos. Métodos: No presente estudo, 26 ratos machos adultos, albinos Wistar, com peso 230-300 g, foram randomicamente divididos em quatro grupos: pseudo-operado (n = 5), isquemia-reperfusão (grupo IR, n = 7), IR/tratamento de reperfusão com dexmedetomidina (grupo Dex-R, n = 7) e IR/tratamento pré-isquemia com dexmedetomidina (grupo Dex-I, n = 7). No primeiro grupo, uma pseudo-operação foi feita e clampeamentos renais não foram aplicados. No grupo IR, isquemia renal foi induzida por oclusão das artérias e veias renais bilaterais durante 60minutos seguida por reperfusão durante 24horas. Nos grupos Dex-R e Dex-I, o mesmo procedimento cirúrgico destinado ao grupo IR foi feito e dexmedetomidina (100mcg/kg intraperitoneal) foi administrada cinco minutos após a reperfusão e antes da isquemia. No fim da reperfusão, amostras de sangue foram coletadas, os ratos foram sacrificados e os rins esquerdos processado para histologia. Resultados: Os níveis de nitrogênio ureico no sangue (BUN) dos grupos Dex-R e Dex-I estavam significativamente mais baixos do que os do grupo IR (p = 0,015, p = 0,043), embora o fluxo urinário tenha sido significativamente maior no grupo Dex-R (p = 0,003). O escore histopatológico renal do grupo IR foi significativamente maior do que os dos outros grupos. Não houve diferença significativa entre os grupos Dex-R e Dex-I. Conclusões: Os resultados demonstraram que a administração de dexmedetomidina reduziu histomorfologicamente a lesão de IR renal. A administração de dexmedetomidina durante o período de reperfusão foi considerada como mais eficaz por causa do aumento do débito urinário e da diminuição dos níveis de BUN. .

Justificación y objetivos: investigar los efectos de la dexmedetomidina sobre la insuficiencia renal isquémica en ratones. Métodos: en el presente estudio, 26 ratones machos adultos, albinos Wistar, con un peso de 230-300 g fueron divididos aleatoriamente en 4 grupos: seudooperado (n = 5), isquemia-reperfusión (grupo IR, n = 7), IR/tratamiento de reperfusión con dexmedetomidina (grupo Dex-R, n = 7) e IR/tratamiento preisquemia con dexmedetomidina (grupo Dex-I, n = 7). En el primer grupo, se realizó una seudooperación y no se aplicaron pinzamientos renales. En el grupo IR, la isquemia renal fue inducida por oclusión de las arterias y venas renales bilaterales durante 60 min seguida por reperfusión durante 24 h. En los grupos Dex-R y Dex-I, se llevó a cabo el mismo procedimiento quirúrgico destinado al grupo IR, y la dexmedetomidina (100 µg /kg intraperitoneal) fue administrada 5 min después de la reperfusión y antes de la isquemia. Al final de la reperfusión, fueron recogidas muestras de sangre, los ratones fueron sacrificados y el riñón izquierdo procesado para histología. Resultados: los niveles de nitrógeno ureico en la sangre (BUN) de los grupos Dex-R y Dex-I eran significativamente más bajos que los del grupo IR (p = 0,015; p = 0,043), aunque el flujo urinario era significativamente mayor en el grupo Dex-R (p = 0,003). La puntuación histopatológica renal del grupo IR fue significativamente mayor que la de los otros grupos. No hubo diferencia significativa entre los grupos Dex-R y Dex-I. Conclusiones: los resultados demostraron que la administración de dexmedetomidina redujo histomorfológicamente la lesión de IR renal. La administración de dexmedetomidina durante el período de reperfusión fue considerada más eficaz debido al aumento de producción de orina y a la disminución ...

The effects of remote ischemic preconditioning and N-acetylcysteine with remote ischemic preconditioning in rat hepatic ischemia reperfusion injury model.

BACKGROUND: Remote ischemic preconditioning (RIP) and pharmacological preconditioning are the effective methods that can be used to prevent ischemia reperfusion (IR) injury. The aim of this study was to evaluate the effects of RIP and N-Acetylcysteine (NAC) with RIP in the rat hepatic IR injury model. MATERIALS AND METHODS: 28 rats were divided into 4 groups. Group I (sham): only laparotomy was performed. Group II (IR): following 30 minutes of hepatic pedicle occlusion, 4 hours of reperfusion was performed. Group III (RIP + IR): following 3 cycles of RIP, hepatic IR was performed. Group IV (RIP + NAC + IR): following RIP and intraperitoneal administration of NAC (150 mg/kg), hepatic IR was performed. All the rats were sacrificed after blood samples were taken for the measurements of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels and liver was processed for conventional histopathology. RESULTS: The hepatic histopathological injury scores of RIP + IR and RIP + NAC + IR groups were significantly lower than IR group (P = 0.006, P = 0.003, resp.). There were no significant differences in AST and ALT values between the IR, RIP + IR, and RIP + NAC + IR groups. CONCLUSIONS: In the present study, it was demonstrated histopathologically that RIP and RIP + NAC decreased hepatic IR injury significantly.

Evaluating the Readibility of Informed Consent Forms Available Before Anaesthesia: A Comparative Study.

OBJECTIVE: Informed consent forms that are used prior to administering anaesthesia inform patients before any proposed surgical procedure or treatment. They should provide patients with sufficient information about the operation and treatment. Readibility refers to whether it is easy or hard for a reader to read and understand an available text, and this is evaluated via various formulas. The aim of this study was to evaluate the readability of different informed consent forms commonly used in the anaesthesiology departments of different hospitals in our country using different readability formulas. METHODS: After obtaining ethics committee approval, the readability of different consent forms used in the anaesthesiology departments of university hospitals (n=15), Ministry of Health (MOH) education and research hospitals (n=15), and public hospitals (n=15) was analysed. Each consent form was displayed electronically in "Microsoft Word" and the number of words contained was counted automatically. The first 100 words on the first page of the forms were evaluated using the Gunning Fog, Flesch-Kincaid and Atesman readability formulations. The rate of medical terms detected within these 100 words was determined as a percentage (%). RESULTS: Different consent forms obtained from 45 anaesthesia departments were assessed using various readability formulas. According to the Gunning Fog index, the readability of the consent forms obtained from MOH education and research and public hospitals was relatively low. The Flesch-Kincaid index measured very low levels of readability in all institutions. The Atesman index displayed very low readability levels for the consent forms used in university hospitals, and low levels in other institutions. CONCLUSION: We conclude that the readability of the anaesthesia informed consent forms is low. The level of education in our country should be considered in the preparation of anaesthesia consent forms. We believe that physicians should pay more attention to this medical and legal issue.

Evaluation of education, attitude, and practice of the Turkish anesthesiologists in regional block techniques.

BACKGROUND: The demand for regional blocks from both patients and surgeons has significantly increased in anesthesia practice during the last 30 years. Although the studies show that the complications are rare, regional blocks still have serious difficulties which can be prevented by training programs. OBJECTIVES: The purpose of this study was to determine the factors affecting the educational methods, attitude and practice of the Turkish anesthesiologists in regional blocks during and following residency programs. PATIENTS AND METHODS: Anesthesiologists were asked to answer a questionnaire. Educational proficiency was determined by at least 50 spinal, 50 epidural and 50 peripheral block applications during residency. Specialists were asked for the numbers of spinal, epidural and peripheral blocks (PBs) they applied in 2009. The mean and median values were calculated. RESULTS: One hundred and eighty-eight anesthesiologists (84.3 %) agreed to participate in the study. While all participants had made their first attempts in neuraxial blocks (NBs) when they were residents, this ratio was detected as 96.8% for PBs. All participants learned neuraxial and PBs on patients in the operating theater. Education proficiency ratios for spinal, epidural and PBs were 98.1 %, 92.5 % and 62.3 %, respectively. Age, perception of adequate training, nerve block rotation, adequate application in education, following innovations were the factors which significantly affected the number of PBs in practice according to univariate analysis. The participants who consider their applications on NBs were adequate (P = 0.029) and the ones working in state or private hospitals (P = 0.017), applied NBs significantly above the median number. CONCLUSIONS: Anesthesiologists had adequate education and practice of NB applications but a significant proportion of participants (51.8%) lacked both in PBs applications. We believe that NBs are more easily learned than PBs during residency training program.