Patient Knowledge, Attitudes, and Behaviors Associated with Organ Donation.

BACKGROUND This study compared the knowledge, attitudes, and behaviors associated with organ donation and transplantation among patients undergoing dialysis versus those visiting family health centers (FHCs). MATERIAL AND METHODS This cross-sectional study included patients undergoing hemodialysis treatment at the Meram Medical Faculty and those visiting FHCs in Meram district for other reasons. RESULTS The study participants were 128 individuals visiting FHCs and 111 patients undergoing dialysis. Of these, 169 individuals (70.7%) correctly answered the question "What is brain death?" The knowledge level in the FHC group was higher than that in the dialysis group. Less than half of the individuals indicated willingness to donate an organ. Furthermore, subjects in the dialysis group were more likely than those in the FHC group to answered "no" to the question "Would you be willing to donate an organ to someone of a different religion?" CONCLUSIONS Positive attitude towards organ transplantation and donation does not necessarily reflect positive behavior these 2 groups.

Effects of fasting and preoperative feeding in children.

AIM: To investigate whether children should undergo surgery without a long period of fasting after feeding. METHODS: Eighty children with inguinoscrotal disorders (aged 1-10 years) were studied prospectively. They were divided into eight groups that each contained 10 children who were fed normal liquid food (NLF) and a high-calorie diet (HCD) 2, 3, 4 and 5 h before surgery, in two doses at 6-h intervals. NLF was given to four groups and HCD to the other four. In all groups, glucose, prealbumin and cortisol levels in the blood were measured twice: just after oral feeding and just before the operation. After the establishment of adequate anesthesia, gastric residue liquid was measured with a syringe. RESULTS: Blood glucose levels in all patients fed NLF and HCD were high, except in patients in the HCD-4 group. There was no significant difference in the blood prealbumin levels. There was a significant increase in the blood cortisol levels in the NLF-2 (14.4 +/- 5.7), HCD-2 (13.2 +/- 6.0), NLF-3 (10.9 +/- 6.4), and HCD-5 (6.8 +/- 5.7) groups (P < 0.05). CONCLUSION: The stress of surgery may be tolerated by children when they are fed up to 2 h before elective surgery.

Serum and cerebrospinal fluid magnesium levels, Glasgow Coma Scores, and in-hospital mortality in patients with acute stroke.

The aim of this study was to determine the relationship between serum and cerebrospinal fluid (CSF) magnesium(Mg+2) levels, Glasgow Coma Scores (GCS), and 7-day mortality in acute stroke patients. Patients with acute ischemic or hemorrhagic stroke arriving within the first 3 h of symptoms were included in the study. The control group consisted of healthy volunteers. GCS was determined, and blood and CSF samples were taken in order to establish serum and CSF glucose, Mg+2, sodium, potassium, calcium, and chlorine levels.Mortality was recorded at 7 days after admission. CSF Mg+2 in the ischemic infarct group was significantly lower than in the control group (p=0.006). CSF Mg+2 in the ischemic infarct patients with a GCS < or = 8 were significantly lower (p=0.002) than controls and in ischemic infarct patients with a GCS > or = 9. In the ischemic stroke patients, CSF Mg+2 and GCS were significantly correlated (r=55, p=0.031). CSF Mg+2 levels in ischemic stroke patients who died within 7 days were significantly lower than controls, ischemic stroke patients who survived, and hemorrhagic stroke patients who died (p=0.002, p=0.042, and p=0.005,respectively). Low CSF Mg+2 levels in patients with acute ischemic stoke at admission predicted a higher 1-week mortality.

Left ventricular diastolic function evaluated with tissue Doppler imaging in children with familial Mediterranean fever.

The aim of this study was to assess the left ventricular diastolic function using conventional echocardiography and tissue Doppler imaging in children with familial Mediterranean fever. This study included 29 (13 males and 16 females) patients and 30 healthy subjects as controls. Body mass index was calculated and arterial blood pressure was monitored. After an overnight fast, venous blood samples were taken and serum amyloid A protein, C-reactive protein, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol levels were measured. A complete 2-dimensional, M-mode, pulse wave Doppler, and pulse wave tissue Doppler echocardiographic examination was performed. There were no significant differences between the groups regarding age, body mass index values, systolic and diastolic blood pressures, heart rates, serum-fasting glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, very low density lipoprotein cholesterol, and serum low-density lipoprotein cholesterol. Serum levels of inflammatory markers were higher in patients' group (C-reactive protein and serum amyloid A protein levels were 10.84 mg/dl, 22.32 mg/l in patients' group, respectively, and 4.11 mg/dl, 3.65 mg/l, respectively, in the healthy controls.) Peak mitral A wave, E and A wave ratio differed significantly in both groups. There were statistically significant differences regarding parameters observed by tissue Doppler imaging such as E'm, A'm, E'm, and A'm ratio between patients' group and controls. Tissue Doppler imaging provided additional information on left ventricular diastolic function. While systolic functions were in normal range, some of the diastolic function parameters were impaired in patients with familial Mediterranean fever during childhood.

Effect of cooling on the responses of human saphenous vein to fentanyl, remifentanil and sufentanil.

We studied the vasodilatory effects of fentanyl, remifentanil and sufentanil on the human saphenous vein strips at 37, 32 and 28 degrees C. Fentanyl produced concentration-dependent relaxation of human saphenous vein strips precontracted with 5-hydroxytryptamine (5-HT) at every temperature studied. Compared with vein strips at 37 degrees C, relaxant responses to each one concentration of fentanyl were significantly reduced at 32 and 28 degrees C. Remifentanil relaxed vein strips in a concentration-dependent way and the relaxation for all concentrations were significantly greater at 32 and 28 degrees C compared with 37 degrees C. Sufentanil produced concentration-dependent relaxation in saphenous vein strips precontracted with 5-HT. These relaxant responses were similar at 32 degrees C compared with 37 degrees C. When bath temperature was lowered from 37 to 28 degrees C, the relaxant responses to sufentanil were significantly reduced. In summary, the present study suggests that cooling reduces the relaxation caused by fentanyl and sufentanil on human saphenous veins but augments the relaxation with remifentanil. The augmented vasodilatory effect of remifentanil with cooling may be useful on systemic vascular resistance and organ preservation under hypothermic conditions like cardiopulmonary bypass surgery.

Cooling and response to hydrogen peroxide in human saphenous vein: role of the endothelium.

In the present work we studied the responses of human saphenous vein to H2O2 and effects of moderate cooling on these responses with analysis of the role of endothelium. H2O2 (10(-7)-10(-2) M) induced concentration-dependent contraction in the intact human saphenous vein strips at both temperatures. At 28 degrees C, the maximal contraction induced by H2O2 was significantly lower than that at 37 degrees C. Compared with intact strips, the sensitivity and the maximal contraction to H2O2 were significantly enhanced in endothelium-denuded strips at 37 and 28 degrees C. However, pD2 values and maximal contractions were not significantly different in endothelium-denuded strips at different temperatures. Pretreatment with N(G)-nitro-L-arginine methyl ester (L-NAME) increased significantly the maximal contraction and sensitivity to H2O2 at 37 and 28 degrees C. The contractions increased by L-NAME were restored by the pre-incubation of l-arginine (10(-3) M) at every temperature studied. The contractile responses of intact human saphenous veins to H2O2 were reduced significantly by 10(-5) M indomethacin at both temperatures. Our results suggest that H2O2-induced contraction of human saphenous vein are mediated by its direct effect on the smooth muscle and by the generation of products of the cyclooxygenase pathway from the endothelium. Signalling pathways of these contractile effects are the same at 37 and 28 degrees C. Under normal temperature conditions, the contraction to H2O2 is possibly modulated by endothelial nitric oxide. Cooling reduces the contraction to H2O2 by increasing release of nitric oxide.

The mechanisms of the direct vascular effects of fentanyl on isolated human saphenous veins in vitro.

OBJECTIVE: The purpose of this study was to determine the mechanism of the direct effects of fentanyl on human veins in vitro. DESIGN: In vitro, prospective with repeated measures. SETTING: University research laboratory. INTERVENTIONS: Dose-response curves were obtained for cumulative doses of fentanyl (10(-9)-10(-5) mol/L) on saphenous vein strips precontracted with (10(-6) mol/L) 5-hydroxytryptamine incubated with either naloxone (10(-4) mol/L), Nomega-nitroL-arginine-methyl ester (L-NAME) (10(-4) mol/L), indomethacin (10(-5) mol/L), glibenclamide (10(-4) mol/L), tetraethylammonium (10(-4) mol/L), or ouabain (10(-5) mol/L). Vein strips were also exposed to a Ca++-free solution and 0.1 mmol/L of ethylene glycol-bis-(b-aminoethylether) N,N'-tetraacetic acid; 5-hydroxytryptamine (10(-6) mol/L) was added to the bath before cumulative Ca++ (10(-4)-10(-2) mol/L). The same procedure was repeated in the presence of fentanyl (10(-6) , 3 x 10(-6) , or 10(-5) mol/L) (p < 0.05 = significant). MEASUREMENTS AND MAIN RESULTS: Preincubation of vein strips with naloxone, L-NAME, or indomethacin did not influence the relaxant responses to fentanyl (p > 0.05). Tetraethylammonium, glibenclamide, and ouabain reduced the relaxation response to fentanyl (p < 0.05). A stepwise increase in tension was recorded with cumulative doses of Ca++ (p < 0.05). CONCLUSIONS: The present results show that fentanyl causes vasodilatation via both endothelium- and opioid receptor-independent mechanisms in the human saphenous vein. The relaxant effects of fentanyl are probably via activation of K+ channel and Na+K+-adenosine trisphosphatase and inhibition of Ca++ channel.