Is music the food of the anesthesia in children?

Background: The noise in an operating room may have a detrimental effect on human cognitive functions, and it may cause perioperative anxiety with prolonged exposure. The aim of this study was to investigate the effects of music therapy and use of earplugs and normal noise level in the operating room under general anesthesia of pediatric patients on hemodynamic parameters and postoperative emergence delirium. Methods: One hundred and five pediatric patients were involved in this study. The patients were randomly divided into three groups. Group N was exposed to the ambient operating room noise, group S received earplugs from an independent anesthesiologist, and group M used a CD player. The preoperative anxiety levels of children were evaluated with the Modified Yale Preoperative Anxiety Scale (M-YPAS). Mean arterial pressure (MAP) and heart rate were recorded at 30-minute periods until the completion of surgery, end of surgery and postoperatively. During each measurement, noise level recordings were performed using sonometer. Pediatric Anesthesia Emergency Delirium (PAED) score was evaluated after postoperative extubation. Results: M-YPAS was similar between groups. The MAP at 30 and 60 min intraoperatively, at end of surgery, and at 5, 10, and 15 min postoperatively was significantly lower in group S than in group N. There were no differences in heart rate among the groups. Postoperative PAED score was not significantly different among the groups. Conclusions: The music therapy was not more effective than silence and operating noise room in reducing PAED score postoperatively in pediatric patients. Trial registration number: ClinicalTrials.gov Registry (NCT03544502).

Pulmonary Embolism During Hepatoblastoma Resection.

Although hepatoblastoma is rare, it is the most malignant tumour of childhood. Treatment is usually done by surgical resection and chemotherapy. The mortality and morbidity have decreased due to improvements in the treatments. In this process, hepatic resection has a risk of pulmonary embolism, and this condition could be fatal. In this case, a 9-month-old patient who was treated with chemotherapy and then underwent hepatectomy was presented. We used non-invasive methods such as the perfusion index (PI), the plethysmographic variability index (PVI) (Massimo Radical 7) and non-invasive total haemoglobin measurement (SpHb) rather than invasive measurements. During closure of the surgical skin incision, the end-tidal CO2 (ETCO2) value dropped, after which arrhythmia and bradycardia resulted in cardiac arrest. Cardiopulmonary resuscitation (CPR) was initiated. However, the patient did not respond to CPR. We concluded that heparin may be administered to reduce the risk of thrombosis in patients undergoing liver surgery.

Successful sleeve lobectomy of pediatric inflammatory myofibroblastic tumor.

Inflammatory myofibroblastic tumor (IMT) is an uncommon solid tumor that was originally described in the lung. A 4-year-old girl was admitted to hospital with urticarial rash. On chest radiographs, an opacity was seen in the inferior zone of the left lung, and computed tomography showed a mass in the left lower lobe. Left lower sleeve lobectomy was performed, and the diagnosis was confirmed as IMT. Sleeve resection is the best option in lesions located in the mainstem bronchus or secondary carina. Herein, we present a rare case of IMT of the lung that was successfully treated with sleeve lobectomy. There have been fewer than 15 childhood cases of IMT reported in the literature, and the present 4-year-old patient is one of the youngest.

The effect of methylene blue treatment on aspiration pneumonia.

BACKGROUND: The study aimed to examine whether methylene blue (MB) prevents different pulmonary aspiration materials-induced lung injury in rats. METHODS: The experiments were designed in 60 Sprague-Dawley rats, ranging in weight from 250-300 g, randomly allotted into one of six groups (n = 10): saline control, Biosorb Energy Plus (BIO), hydrochloric acid (HCl), saline + MB treated, BIO + MB treated, and HCl + MB treated. Saline, BIO, and HCl were injected into the lungs in a volume of 2 mL/kg. After surgical procedure, MB was administered intraperitoneally for 7 days at a daily dose of 2 mg/kg per day. Seven days later, rats were killed, and both lungs in all groups were examined biochemically and histopathologically. RESULTS: Our findings show that MB inhibits the inflammatory response reducing significantly (P < 0.05) peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation in different pulmonary aspiration models. Pulmonary aspiration significantly increased the tissue hydroxyproline content, malondialdehyde levels, and decreased (P < 0.05) the antioxidant enzyme (superoxide dismutase and glutathione peroxidase) activities. MB treatment significantly (P < 0.05) decreased the elevated tissue hydroxyproline content and malondialdehyde levels and prevented the inhibition of superoxide dismutase and glutathione peroxidase (P < 0.05) enzymes in the tissues. Furthermore, there is a significant reduction in the activity of inducible nitric oxide synthase (iNOS), terminal deoxynucleotidyl transferase dUTP nick end labeling, and arise in the expression of surfactant protein D in lung tissue of different pulmonary aspiration models with MB therapy. CONCLUSIONS: MB treatment might be beneficial in lung injury and therefore shows potential for clinical use.

A novel approach for preventing esophageal stricture formation: olmesartan prevented apoptosis.

Accidentally ingested corrosive substances can cause functional and structural damage to the esophageal tissue resulting in stricture formation. It has been reported that the administration of olmesartan (OLM) can have anti-inflammatory, antifibrotic and antiapoptotic effects on injured tissue. The aim of our study was to check if OLM could prevent formation of scars in the corrosive esophageal burn model. Fifty-one Wistar Albino rats were divided into six groups: Control, Sham, OLM, Sham + OLM, Burn, and Burn + OLM. Olmesartan (5 mg/kg) was given by gavage once per day for 21 consecutive days after injury. The morphology of the esophagus was assessed after Masson trichrome staining, and apoptosis was evaluated using the terminal deoxynucleotidyl transferased UTP nick end labeling (TUNEL) method. The serum nucleosomes (as an indicator of apoptosis), serum p53 protein, and esophageal tissue p53 protein levels of each group were measured by immunoassays. Muscularis mucosa damage, submucosal collagen deposition, and tunica muscularis injury in the Burn + OLM group decreased significantly compared with the Burn group (p < 0.05). Similarly, the number of apoptotic cells in the Burn + OLM group decreased compared with the Burn group (p < 0.05). Serum levels of nucleosomes and p53 and tissue of p53 protein did not differ between the groups. Exogenously administered OLM can effectively prevent the occurrence of esophageal strictures caused by corrosive esophageal burns.

Desferrioxamine effectively attenuates testicular tissue at the end of 3 h of ischemia but not in an equal period of reperfusion.

OBJECTIVE: To investigate the effect of desferrioxamine (DFX) on ipsilateral and contralateral testis damage caused by experimental testis torsion and detorsion. MATERIALS AND METHODS: Forty rats were divided into five groups (n = 8): control, torsion (T), torsion + desferrioxamine (T + DFX), torsion/detorsion (T/D), and torsion/detorsion + desferrioxamine (T/D + DFX). The right testes of the rats were subjected to torsion and detorsion for 3 h each. Thirty minutes before the application of torsion and detorsion, DFX (100 mg/kg) was administered intramuscularly. Blood samples and testicular tissues were examined using specific biochemical and histopathological methods. RESULTS: Ipsilateral and contralateral testis tissue glutathione levels in the T group decreased compared with the control and T + DFX groups. Plasma glutathione peroxidase activity in the T, T/D, and T/D + DFX groups was lower than in the control group. Plasma catalase activity in the T and T/D groups decreased compared with the control group. Ipsilateral mean seminiferous tubule diameter of the T group was lower than that of the T + DFX group. The ipsilateral mean testis biopsy scores in the T and T/D groups were lower than in the control group. CONCLUSION: The administration of DFX prior to torsion may be useful only for preventing ischemic damage in ipsilateral and contralateral testes.

Desferrioxamine reduces oxidative stress in the lung contusion.

Our hypothesis in this study is that desferrioxamine (DFX) has therapeutic effects on experimental lung contusions in rats. The rats were divided into four groups (n = 8): control, control+DFX, contusion, and contusion+DFX. In the control+DFX and contusion+DFX groups, 100 mg/kg DFX was given intraperitoneally once a day just after the contusion and the day after the contusion. Contusions led to a meaningful rise in the malondialdehyde (MDA) level in lung tissue. MDA levels in the contusion+DFX group experienced a significant decline. Glutathione levels were significantly lower in the contusion group than in the control group and significantly higher in the contusion+DFX group. Glutathione peroxidase (GPx) and superoxide dismutase (SOD) levels in the contusion group were significantly lower than those in the control group. In the contusion+DFX group, SOD and GPx levels were significantly higher than those in the contusion group. In light microscopic evaluation, the contusion and contusion+DFX groups showed edema, hemorrhage, alveolar destruction, and leukocyte infiltration. However, histological scoring of the contusion+DFX group was significantly more positive than that of the contusion group. The iNOS staining in the contusion group was significantly more intensive than that in all other groups. DFX reduced iNOS staining significantly in comparison to the contusion group. This study showed that DFX reduced oxidative stress in lung contusions in rats and histopathologically ensured the recovery of the lung tissue.

Preventive effects of hyperbaric oxygen treatment on glycerol-induced myoglobinuric acute renal failure in rats.

Myoglobinuric acute renal failure (ARF) is a uremic syndrome caused by traumatic or non-traumatic skeletal muscle breakdown and intracellular elements that are released into the bloodstream. We hypothesized that hyperbaric oxygen (HBO) therapy could be beneficial in the treatment of myoglobinuric ARF caused by rhabdomyolysis. A total of 32 rats were used in the study. The rats were divided into four groups: control, control+hyperbaric oxygen (control+HBO), ARF, and ARF+hyperbaric oxygen (ARF+HBO). Glycerol (8 ml/kg) was injected into the hind legs of each of the rats in ARF and ARF+HBO groups. 2.5 atmospheric absolute HBO was applied to the rats in the control+HBO and ARF+HBO groups for 90 min on two consecutive days. Plasma urea, creatinine, sodium, potassium, calcium, aspartate aminotransferase, alanine aminotransferase, lactic dehydrogenase, creatinine kinase and urine creatinine and sodium were examined. Creatinine clearance and fractional sodium excretion could then be calculated. Superoxide dismutase, catalase, glutathione and malondialdehyde (MDA) levels were assessed in renal tissue. Tissue samples were evaluated by Hematoxylin-eosin, PCNA and TUNEL staining histopathologically. MDA levels were found to be significantly decreased whereas SOD and CAT were twofold higher in the ARF+HBO group compared to the ARF group. Renal function tests were ameliorated by HBO therapy. Semiquantitative evaluation of histopathological findings indicated that necrosis and cast formation was decreased by HBO therapy and TUNEL staining showed that apoptosis was inhibited. PCNA staining showed that HBO therapy did not increase regeneration. Ultimately, we conclude that, in accordance with our hypothesis, HBO could be beneficial in the treatment of myoglobinuric ARF.

Congenital Spigelian hernia associated with undescended testis.

BACKGROUND: A Spigelian hernia (SH) is a ventral interstitial hernia through a defect in the Spigelian fascia; an undescended testis is sometimes associated with this clinical entity in male newborns. The etiopathogenesis, surgical anatomy, diagnostic methods, and treatment for this rare condition are discussed with a review of the literature. METHODS: A 20-day-old newborn was admitted to our hospital for a swelling in the right lower abdomen and undescended testis. Physical examination of the abdomen and scrotum revealed a congenital SH associated with cryptorchidism. RESULTS: Herniotomy, herniorrhaphy, and orchidopexy were performed. In the post-operative period, scrotal abscess occurred and was drained. After drainage, the fixed testis was found to be atrophic. CONCLUSIONS: This association may be a distinct clinical syndrome. The operation time in cases of neonatal SH with undescended testis should be well planned because of probable surgical complications such as vascular damage, tension, or compression.

The effect of hyperbaric oxygen treatment on aspiration pneumonia.

We have studied whether hyperbaric oxygen (HBO) prevents different pulmonary aspiration materials-induced lung injury in rats. The experiments were designed in 60 Sprague-Dawley rats, ranging in weight from 250 to 300 g, randomly allotted into one of six groups (n = 10): saline control, Biosorb Energy Plus (BIO), hydrochloric acid (HCl), saline + HBO treated, BIO + HBO treated, and HCl + HBO treated. Saline, BIO, HCl were injected into the lungs in a volume of 2 ml/kg. A total of seven HBO sessions were performed at 2,4 atm 100% oxygen for 90 min at 6-h intervals. Seven days later, rats were sacrificed, and both lungs in all groups were examined biochemically and histopathologically. Our findings show that HBO inhibits the inflammatory response reducing significantly (P < 0.05) peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation in different pulmonary aspiration models. Pulmonar aspiration significantly increased the tissue HP content, malondialdehyde (MDA) levels and decreased (P < 0.05) the antioxidant enzyme (SOD, GSH-Px) activities. HBO treatment significantly (P < 0.05) decreased the elevated tissue HP content, and MDA levels and prevented inhibition of SOD, and GSH-Px (P < 0.05) enzymes in the tissues. Furthermore, there is a significant reduction in the activity of inducible nitric oxide synthase, TUNEL and arise in the expression of surfactant protein D in lung tissue of different pulmonary aspiration models with HBO therapy. It was concluded that HBO treatment might be beneficial in lung injury, therefore, shows potential for clinical use.

Preventive effects of curcumin on different aspiration material-induced lung injury in rats.

PURPOSE: We have studied whether curcumin protects different pulmonary aspiration material-induced lung injury in rats. MATERIALS AND METHODS: The experiments were designed in 60 Sprague-Dawley rats, randomly allotted into one of six groups (n=10): normal saline (NS, control), enteral formula (Biosorb Energy Plus, BIO), hydrochloric acid (HCl), NS+curcumin-treated, BIO+curcumin-treated, and HCl+curcumin-treated. NS, BIO, HCl were injected in to the lungs. The rats received curcumin twice daily only for 7 days. Seven days later, both lungs in all groups were examined histopathologically, immunohistochemically, and biochemically. Histopathologic examination was performed according to the presence of peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation. Immunohistochemical assessments were examined for the activity of inducible nitric oxide synthase (iNOS) and the expression of surfactant protein D (SP-D). Malondialdehyde (MDA), hydroxyproline (HP), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) activity were measured in the lung tissue. RESULTS: Our findings show that curcumin inhibits the inflammatory response reducing significantly (P<0.05) all histopathological parameters in different pulmonary aspiration models. Pulmonary aspiration significantly increased the tissue HP content, MDA levels and decreased the antioxidant enzyme (SOD, GSH-Px) activities. Curcumin treatment significantly decreased the elevated tissue HP content, and MDA levels and prevented inhibition of SOD, and GSH-Px enzymes in the tissues. Furthermore, our data suggest that there is a significant reduction in the activity of iNOS and a rise in the expression of SP-D in lung tissue of different pulmonary aspiration models with curcumin therapy. CONCLUSION: Our findings support the use of curcumin as a potential therapeutic agent in acute lung injury.

Personal characteristics of enuretic children: an epidemiological study from South-East Europe.

INTRODUCTION: This study examined the personal characteristics of enuretic children and investigated the risk factors of nocturnal enuresis among schoolchildren. METHODS: It was a cross-sectional and descriptive questionnaire study and 2,000 children were stratified according to school population, age and gender. The questionnaire was designed for parents to collect information about the prevalence and associated factors as well. RESULTS: Nocturnal enuresis was reported in 159 cases (9.8%). The parameters of bladder control after 2 years of age, urination more than 5 times a day, urinary infection history, history of psychological or physical trauma, siblings with health problems, large family size, lack of a private bedroom, and constipation were more frequent in enuretics (p < 0.05). The parameters of having fecal incontinence, parents and siblings with nocturnal enuresis, low educational level of the mother and poor school performance seem to be risk factors for nocturnal enuresis. However, the parental concern level was high, approximately half of the enuretic children did not visit a physician for management of the problem. CONCLUSION: Nocturnal enuresis could be a multifactorial problem originating from bladder dysfunction, deranged sleep patterns and psychological and hereditary predisposition. Hereditary disposition and having fecal incontinence may be important risk factors for enuresis.

Protective effects of S-methylisothiourea sulfate on different aspiration materials-induced lung injury in rats.

OBJECTIVES: The aim of this study was to evaluate the efficiency of inducible nitric oxide synthase (iNOS) specific inhibitor, S-methylisothiourea sulfate (SMT) in preventing lung injury after different pulmonary aspiration materials in rats. MATERIAL AND METHODS: The experiments were performed in 80 Sprague-Dawley rats, ranging in weight from 220 to 250 g, randomly allotted into one of the eight groups (n=10): normal saline (NS, control), Biosorb Energy Plus (BIO), sucralfate (SUC), hydrochloric acid (HCl), NS+SMT treated, BIO+SMT treated, SUC+SMT treated, and HCl+SMT treated. NS, BIO, SUC, HCl were injected in to the lungs in a volume of 2 ml/kg. The rats received twice daily intraperitoneal injections of 20 mg(kg day) SMT (Sigma Chemical Co.) for 7 days. Seven days later, rats were killed, and both lungs in all groups were examined immunohistochemically and histopathologically. RESULTS: Our data show that SMT inhibits the inflammatory response significantly reducing (p<0.05) peribronchial inflammatory cell infiltration, alveolar septal infiltration, alveolar edema, alveolar exudate, alveolar histiocytes, interstitial fibrosis, granuloma, and necrosis formation in different pulmonary aspiration models. Furthermore, our data suggest that there is a significant reduction in the activity of iNOS and arise in the expression of surfactant protein D in lung tissue of different pulmonary aspiration models with SMT therapy. CONCLUSION: It was concluded that SMT treatment might be beneficial in lung injury, therefore shows potential for clinical use.

Effect of curcumin on ipsilateral and contralateral testes after unilateral testicular torsion in a rat model.

OBJECTIVE: The aim of the study was to determine the protective effect of curcumin on testicular ischemia-reperfusion (I/R) injury. MATERIALS AND METHODS: 32 male rats were divided into four groups (n = 8): group 1: control; group 2: ischemia; group 3: I/R, and group 4: I/R+CUR. Curcumin (150 mg/kg, p.o.) was administered before 30 min of reperfusion in group 4. Malondialdehyde (MDA) levels, Johnsen's testicular biopsy scores, and mean seminiferous tubule diameter measurements were evaluated in testes. In addition, endothelial nitric oxide synthase (eNOS) and inducible nitric oxide synthase (iNOS) expressions were evaluated immunohistochemically. RESULTS: MDA levels in control groups were significantly lower than other groups in ipsilateral and contralateral testes. Johnsen's scores in the control group were significantly higher than in other groups. MDA levels and Johnsen's scores in the I/R+CUR group were similar to the ischemia and I/R groups in ipsilateral and contralateral testes. The immunoreactivity of iNOS and eNOS were increased in I/R ipsilateral testicular groups. After I/R, iNOS and eNOS expression increased slightly in contralateral groups. Additionally, the curcumin treatment decreased iNOS and eNOS immunoreactivity in ipsilateral and contralateral testes. CONCLUSION: The results suggest that curcumin did not protect the unilateral nor contralateral testes. This observation may depend on inhibition of iNOS and eNOS due to inhibition of the antioxidant, anti-inflammatory effects of nitric oxide.

Protective effects of ibuprofen on testicular torsion/detorsion-induced ischemia/reperfusion injury in rats.

The aim of this study was to investigate the protective effect of ibuprofen on testicular torsion/detorsion-induced ischemia/reperfusion (I/R) injury. A total of 48 prepubertal male Wistar albino rats were divided into two models: early and late orchiectomy. Testicular torsion was created by rotating the right testis 720 degrees in a clockwise direction. The ischemia period was 5 h and orchiectomy was performed after 5 h of detorsion in the early orchiectomy model (EOM). In the late orchiectomy model (LOM), the ischemia period was 5 h and orchiectomy was performed after 7 days of detorsion. In the EOM, ibuprofen (70 mg/kg, po) was administrated only once, 40 min prior to detorsion. In the LOM, ibuprofen (70 mg/kg, po) was administered 40 min before detorsion, once daily for 7 days. Bilateral orchiectomy was performed in all groups to measure the tissue levels of malondialdehyde (MDA) and to microscopically investigate light and electrons. The presence of endothelial nitric oxide synthase (eNOS) activity was shown with immunohistochemical studies. Spermatogenesis and mean seminiferous tubule diameter (MSTD) were significantly decreased in ipsilateral and contralateral testis when both early and late I/R groups were compared to the sham groups. Furthermore, ibuprofen-treated animals showed an improved histological appearance in both models of testicular torsion. Ibuprofen treatment prevented lipid peroxidation resulting in decreased MDA accumulation in the testes of both models. After I/R, eNOS immunoreactivity was increased in the testicular tissues. Ibuprofen treatment decreased eNOS immunoreactivity in the germ cells of the tubules in the contralateral testes, but intense eNOS immunoreactivity was shown in the ipsilateral testes of the LOM. Electron microscopy of the testes of rats demonstrated that ibuprofen pretreatment was particularly effective in preventing the mitochondrial degeneration in both Sertoli and spermatid cells in the LOM. Because of its anti-inflammatory and antioxidant effects, ibuprofen pretreatment may have protective effects in the experimental testicular torsion/detorsion model in rats.

The effect of melatonin on protein oxidation and nitric oxide in the brain tissue of hypoxic neonatal rats.

Melatonin is a potent antioxidant agent that can scavenge oxy- and nitroradicals generated under hypoxic conditions in the brain. In this study, we investigated the effect of melatonin on protein oxidation and nitric oxide (NO) during hypoxia. Seven-day-old Sprague-Dawley newborn rats were divided into three groups. Hypoxic (n=9) and melatonin (n=11) groups were subjected to 2h of hypoxic exposure (a humidity mixture of gases consisting of 92% nitrogen and 8% oxygen). Melatonin (at a dose of 10mg/kg) was administrated 30 min before the onset hypoxia and then at 24th and 48th hours after the end of the hypoxic exposure. Control (n=10) and hypoxic groups received the isotonic sodium chloride according to the same schedule. The brain tissue concentration of advanced oxidation protein products (AOPP) and protein thiol (P-SH) was used as an index of protein oxidation. In our study, although AOPP and NO increased significantly, the levels of P-SH decreased in the hypoxic group. The level of AOPP was declined by melatonin treatment. However, perturbed thiol status could not be recovered by melatonin treatment. There was no relationship between the levels of NO and protein oxidation markers. These results indicate that exogenous melatonin could prevent AOPP, but that it is inadequate in recovering perturbed thiol status. Therefore, melatonin alone was observed to be an incomplete treatment to prevent protein oxidation in hypoxia-induced brain damage.

Protective effect of L-carnitine on testicular ischaemia-reperfusion injury in rats.

Testicular torsion is a urological emergency referred to as 'acute scrotum', because inappropriate treatment can lead to male subfertility and infertility. A possible cause of testicular damage is the ischaemia-reperfusion (I/R) injury attributed to oxygen free radicals. L-carnitine, a vitamin-like antioxidant, plays a pivotal role in the maturation of spermatozoa within the reproductive tract. The aim of the present paper was to determine the protective effect of L-carnitine on testicular I/R-induced injury. Thirty-two male rats were divided into 4 groups (n = 8). Testicular torsion was created by rotating the right testis 720 degrees in a clockwise direction. Group 1: sham-operated control; group 2: ischaemia; group 3: I/R; group 4: ischaemia-L-carnitine treatment-reperfusion group. L-carnitine (500 mg kg(-1), intraperitoneally) was administered before 30 min of detorsion in Group 4. After torsion (5 h) and detorsion (5 h), bilateral orchidectomy was performed. The malondialdehyde (MDA) level was evaluated in testes. Histopathologically, Johnsen's spermatogenesis criteria and mean seminiferous tubule diameter (MSTD) measurements were used. Testicular MDA levels were higher in the torsion group compared to the sham-control group (p < 0.05). Detorsion (reperfusion) caused a further increase in MDA levels (p < 0.05). Pretreatment with L-carnitine prevented a further increase in MDA levels (p < 0.05). Histologically, torsion caused some separation among germinal cells in the seminiferous tubules, which became much more prominent in the I/R group but was attenuated with L-carnitine pretreatment. In conclusion, L-carnitine pretreatment may have a protective effect in experimental testicular torsion-detorsion model in rats by its well-known antioxidant potential.