Investigating antimicrobial features and drug interactions of sedoanalgesics in intensive care unit: an experimental study.

Study Objective: Aim of this study was to evaluate antimicrobial effects and interaction between analgesic combinations of fentanyl citrate, dexmedetomidine hydrochloride and tramadol hydrochloride on Staphylococcus aureus, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Candida albicans which are some of the most common nosocomial infection related microorganisms. Design: In vitro prospective study. Setting: University Clinical Microbiology Laboratory. Measurements: In order to evaluate in vitro antimicrobial effects and interaction between analgesic combinations, tramadol hydrochloride, fentanyl citrate and dexmedetomidin were used against S. aureus ATCC 29213, K. pneumoniae, E. coli ATCC 25922, P. aeruginosa ATCC 27853 and C. albicans ATCC 10231 standard strains by microdilution method. Main Results: According to microdilution assays tramadol has shown the most efficient antimicrobial activity also it has been observed that 10 µg/ml concentrated dexmedetomidine has antimicrobial effects on S. aureus, K. pneumoniae and P. aeruginosa. Fentanyl has displayed evident inhibitory potency on the pathogens except for Klebsiella pneumoniae, nevertheless our predefined minimum concentration inhibited growth by 9.5 %. Fentanyl and dexmedetomidine together exhibited more antimicrobial effect on P. aeruginosa and E. coli growth. Additionally, when the three drugs examined together, microbial inhibition occurred more than expected on E. coli again and also on C. albicans growth. Conclusions: Our results revealed the antimicrobial properties and synergy with the different combinations of fentanyl, dexmedetomidine and tramadol against the most common nosocomial infection agents in the ICU. This is the first study in the literature looking into the microbial "interactions" of opioids and sedative drugs but more research is needed in order to define clinico-laboratory correlation.

[Antimicrobial effects of fentanyl and bupivacaine]. / Efeitos antimicrobianos do fentanil e da bupivacaína: estudo in vitro.

STUDY OBJECTIVE: In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use. DESIGN: In vitro prospective study. SETTING: University Clinical Microbiology Laboratory. MEASUREMENTS: In our study, in vitro antimicrobial effect of 0.05 mg.mL-1 fentanyl citrate, 5 mg.mL-1 bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18-24 hours at 37°C. MAIN RESULTS: In terms of inhibition zone diameters, S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC10231 values obtained after 12 and 24 hours of incubation were significantly higher in Group F than Group B (p < 0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24hours of incubation were significantly higher in Group B than Group F (p < 0.001, E. coli 12ª hour p = 0.005). CONCLUSIONS: Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate, which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against E. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications.

Antimicrobial effects of fentanyl and bupivacaine: an in vitro study / Efeitos antimicrobianos do fentanil e da bupivacaína: estudo in vitro

Abstract Study objective: In this study, we aimed to compare the antimicrobial effects of bupivacaine and fentanyl citrate and to reveal the impact on antimicrobial effect potential in the case of combined use. Design: In vitro prospective study. Setting: University Clinical Microbiology Laboratory. Measurements: In our study, in vitro antimicrobial effect of 0.05 mg.mL-1 fentanyl citrate, 5 mg.mL-1 bupivacaine were tested against Staphylococcus aureus American Type Culture Collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 and Candida albicans ATCC 10231 as Group F (Fentanyl Citrate) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 and Escherichia coli ATCC 25922 were cultured onto Mueller Hinton agar (Oxoid, UK) plates and Candida albicans ATCC 10231 were cultured onto Sabouraud dextrose agar (Oxoid, UK) plates for 18-24 hours at 37 °C. Main results: In terms of inhibition zone diameters, S. Aureus ATCC 29213, P. aeruginosa ATCC 27853, and C. albicans ATCC10231 values obtained after 12 and 24 hours of incubation ​​were significantly higher in Group F than Group B (p < 0.001). In terms of inhibition zone diameters, E. coli ATCC 25922, and K. pneumomiae ATCC 13883 values obtained after 12 and 24 hours of incubation ​​were significantly higher in Group B than Group F (p < 0.001, E. coli 12ª hour p = 0.005). Conclusions: Addition of fentanyl to Local Anesthetics (LAs) is often preferred in regional anesthesia applications in today's practice owing especially to its effect on decreasing the local anesthetic dose and increasing analgesia quality and patient satisfaction. However, when the fact that fentanyl antagonized the antimicrobial effects of LAs in the studies is taken into account, it might be though that it contributes to an increase in infection complications. When the fact that fentanyl citrate which was used in our study and included hydrochloric acid and sodium hydroxide as protective agents, broadened the antimicrobial effect spectrum of LAs, had no antagonistic effect and showed a synergistic antimicrobial effect against E. Coli is considered, we are of the opinion that the addition of fentanyl to LAs would contribute significantly in preventing the increasing regional anesthesia infection complications.

Resumo Objetivo: O objetivo do presente estudo foi comparar os efeitos antimicrobianos da bupivacaína e citrato de fentanil e revelar o impacto no potencial do efeito antimicrobiano no caso de uso combinado. Desenho: Estudo prospectivo in vitro. Local: Laboratório de Microbiologia Clínica da Universidade. Medidas: Em nosso estudo, os efeitos antimicrobianos in vitro do citrato de fentanil na concentração de 0,05 mg.mL-1 - Grupo F e da bupivacaína na concentração de 5 mg.mL-1 - Grupo B foram testados em culturas de Staphylococcus aureus ATCC 29213 (do inglês American Type Culture Collection 29213), Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883, Escherichia coli ATCC 25922 e Candida albicans ATCC 10231. As culturas de S. aureus ATCC 29213, P. aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 13883 e Escherichia coli ATCC 25922 foram semeadas em placas de ágar Mueller Hinton (Oxoid, Reino Unido), e a cultura de Candida albicans ATCC 10231 foi realizada em placa de ágar Sabouraud dextrose (Oxoid, Reino Unido) durante 18-24 horas a 37 °C. Principais resultados: Com relação ao diâmetro da zona de inibição, os valores de S. aureus ATCC 29213, P. aeruginosa ATCC 27853 e C. albicans ATCC10231 obtidos após 12 e 24 horas de incubação foram significantemente maiores no Grupo F do que no Grupo B (p < 0,001). Os valores do diâmetro da zona de inibição das culturas de E. coli ATCC 25922 e K. pneumomiae ATCC 13883 obtidos após 12 e 24 horas de incubação foram significantemente maiores no Grupo B do que no Grupo F (p < 0,001, E. coli na 12ª hora p = 0,005) Conclusões: A preferência atual e frequente pela adição de fentanil aos Anestésicos Locais (AL) para a realização de anestesia regional se deve sobretudo à possibilidade de redução da dose do anestésico local, a melhora na qualidade da analgesia e a satisfação do paciente. No entanto, ao considerar estudos em que o fentanil antagonizou o efeito antimicrobiano dos AL, pode-se pensar que esse fato contribua para aumento de complicação infecciosa. O citrato de fentanil usado em nosso estudo, contendo ácido clorídrico e hidróxido de sódio como agentes conservantes, ampliou o espectro de efeitos antimicrobianos dos AL, não teve efeito antagônico e demonstrou efeito antimicrobiano sinérgico contra a E. coli. Acreditamos que a adição de fentanil aos anestésicos locais traria importante contribuição na prevenção das crescentes complicações por infecção da anestesia regional.

Growth of Microorganisms in Propofol and Mixture of Propofol, Lidocaine and Fentanyl.

OBJECTIVE: To determine the growth of microorganisms in propofol when combined with fentanyl and lidocaine in different temperatures and times in order to find out whether there is any improvement in antimicrobial effect to lengthen the safe duration of time for application of propofol. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Istanbul Aydin University Laboratory, Istanbul, Turkey, from June to September 2018. METHODOLOGY: The studied drugs and thier combination was used to determine their effect on bacterial growth of Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans and Acinetobacter baumanni. Bacterial solutions were prepared at 0.5 MacFarland in sterile 0.9% physiological saline and diluted at 1:100 concentration. Colony numbers were measured as colony forming units mL-1 at 0, 8, and 24 hours and at 4oC, 22oC and 37oC. RESULTS: In general, propofol supported the growth of microorganisms. Fentanyl with propofol also promoted the growth, especially in room and body temperature at 8th and 24th hours but when combined with lidocaine, the number of CFUs was reduced significantly compared with propofol + fentanyl group. Lidocaine inhibited the growth of microorganisms in all the solutions except for candida albicans. CONCLUSION: Lidocaine was shown to have antibacterial effect which carries advantage for inhibiting infections due to propofol; but aseptic technique is essential during preparation of propofol infusions. Fentanyl like propofol also promoted the growth at room and body temperatures.

Antibacterial effects of lidocaine and adrenaline.

The most commonly used local anaesthetics (LAs) for postoperative analgesia and surgical anaesthesia are lidocaine and bupivacaine. Adrenaline is a vasopressor agent, which is widely used in anaesthesia for many purposes. This study aims to determine the antibacterial efficacy of lidocaine, mupirocin, adrenaline, and lidocaine + adrenaline combination. In our study, the in vitro antimicrobial effect of 1 mL of sterile saline, 20 mg/mL mupirocin, 20 mg/mL lidocaine, 1 mg/mL adrenaline, and 20 mg/mL lidocaine and adrenaline were tested against Staphylococcus aureus American-type culture collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, and Escherichia coli ATCC 25922, classified as Group C (control), Group M (mupirocin), Group L (lidocaine), Group A (adrenaline), and Group LA (lidocaine+adrenaline), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, and E. coli ATCC 25922 were cultured on Mueller-Hinton agar (Oxoid, UK) plates for 18 to 24 hours at 37°C. Colonies from these plates were suspended in sterile saline, and a 0.5 McFarland turbidity standard suspension (corresponding to 1.5 × 108 CFU/mL) of each isolate was prepared. In terms of inhibition zone diameters, S. aureus ATCC 29213 values obtained after 12 and 24 hours of incubation were significantly different between groups (P < .001). According to inhibition zone diameters, Group M > Group LA > Group L > Group C = Group A. P. Aeruginosa ATCC 27853 values obtained after 12 and 24 hours of incubation were significantly different between groups (P < .001). According to inhibition zone diameters, Group M > Group LA > Group L = Group C = Group A. E. coli ATCC 25922 values obtained after 12 and 24 hours of incubation were significantly different between groups (P < .001). According to inhibition zone diameters, Group M > Group LA > Group L > Group C = Group A. It is known that LAs have antimicrobial effect potential in addition to their anaesthetic, analgesic, antiarrhythmic, and anti-inflammatory effects. There are also studies showing the antimicrobial effects of vasopressor agents, which are frequently used, particularly in intensive care unit (ICUs). However, it has been observed in the present study that adrenaline alone did not have any antimicrobial effect. Adrenaline, when used in combination with lidocaine, provides a stronger and broad-spectrum antimicrobial activity, suggesting that its combined use in proper indications will be clinically significant. Because the prevention and treatment of wound infections make a positive contribution to wound healing, the potential of antimicrobial effect of LAs can provide successful results in the prevention and treatment of ICU and wound infections. Thus, an important contribution can be made in terms of reducing the costs of antibacterial treatment and reducing morbidity.

Bacterial inhibition efficiency of prilocaine and bupivacaine.

This study aimed to demonstrate the antibacterial effects of bupivacaine and prilocaine on Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa. In our study, the in vitro antimicrobial effects of 20 mg/mL prilocaine and 5 mg/mL bupivacaine were tested against a S. aureus American-type culture collection (ATCC) 29213, P. aeruginosa ATCC 27853, and E. coli ATCC 25922, divided into Group P (Prilocaine) and Group B (Bupivacaine), respectively. S. aureus ATCC 29213, P. aeruginosa ATCC 27853, and E. coli ATCC 25922 were cultured on Mueller Hinton agar (Oxoid, Basingstoke, UK) plates for 18 to 24 hours at 37°C. In terms of inhibition zone diameters, inhibition of S. aureus ATCC 29213 was observed in both groups at the 12th and 24th hours. The 12th- and 24th-hour S. aureus ATCC 29213 value was significantly higher in Group P compared with Group B (P = .008). At the 12th and 24th hours, inhibition of E. coli ATCC 25922 was observed in both groups. The 12th- and 24th-hour E. coli ATCC 25922 value was significantly higher in Group P compared with Group B (P = .008). In our study, it was seen that prilocaine and bupivacaine had an antimicrobial effect on S. aureus and E. coli. In the comparison between these two local anesthetics (LAs), this effect was found to be significantly higher in prilocaine than bupivacaine. Therefore, we are of the opinion that antimicrobial effect potentials should also be taken into account in the selection of an LA agent in order to prevent the complications of an infection that might develop during LA infiltration and might lead to serious morbidity.

Antimicrobial effects of local anaesthetics.

After the introduction of cocaine to the medical practice, local anaesthetics (LA) became essential in pain control. LA infiltration along the incision may be used to provide surgical anaesthesia or postoperative analgesia. This study aimed to compare the antimicrobial effects of the topical antimicrobial agent mupirocine with those of the LA lidocaine and the combination of lidocaine and adrenalin. In our study, the in vitro antimicrobial effects of 1 mL sterile saline, 20 mg/mL mupirocine, 20 mg/mL Lidocaine, and 20 mg/mL Lidocaine and Adrenaline were tested against Staphylococcus aureus American type culture collection (ATCC) 29213, Pseudomonas aeruginosa ATCC 27853, and Escherichia coli ATCC 25922 as Group C (Control), Group M (Mupirocine), Group L (Lidocaine), and Group LA (Lidocaine + adrenaline), respectively. S aureus ATCC 29213, P aeruginosa ATCC 27853, and E coli ATCC 25922 were cultured onto Mueller-Hinton agar (Oxoid, UK) plates for 18 to 24 hours at 37°C. Colonies from these plates were suspended in sterile saline and a 0.5 McFarland turbidity standard suspension (corresponding to 1.5 × 108 CFU/mL) of each isolate was prepared. S Aureus ATCC 29213 inhibition zone diameter values of Group M, Group LA, and Group L were significantly higher compared with the group C (P ˂ 0.05). P aeruginosa ATCC 27853 inhibition zone diameter values of Group M and Group LA were significantly higher compared with the group C (P ˂ 0.05). E coli ATCC 25922 inhibition zone diameter values of Group M, Group LA, and Group L were significantly higher compared to the group C (P ˂ 0.05). LA infiltration along the incision may be used to provide surgical anaesthesia or postoperative analgesia. Considering that LAs show antimicrobial effects besides their analgesic effects, they may contribute to preventing the development and reducing the rate of surgical infections, decreasing the requirement to administer antibiotics. However, caution should be exercised not to antagonise the effective treatment of surgical infections, remembering that controversy on the antimicrobial effects of LAs remains in the literature. Therefore, further comprehensive studies with larger patient populations are warranted to demonstrate the antimicrobial effects of LAs.

Effects of local anesthetics on wound healing / Efeitos dos anestésicos locais na cicatrização de feridas

Abstract Introduction Local anesthetic infiltration is used widely for post-operative analgesia in many situations. However the effects of local anesthetics on wound healing are not demonstrated clearly. This study planned to evaluate the effects of lidocaine, prilocaine, bupivacaine and levobupivacaine on wound healing, primarily on wound tensile strength and on collagen ultrastructure. Methods This study was conducted on male Sprague Dawley rats. On days 0, 8th, 15th, and 21st, all animals were weighed and received a preincisional subcutaneous infiltration of 3 mL of a solution according the group. Control saline (C), lidocaine (L) 7 mg.kg-1, prilocaine (P) 2 mg.kg-1, bupivacaine (B) 2 mg.kg-1 and levobupivacaine (LVB) 2.5 mg.kg-1. The infiltrations were done at the back region 1.5 cm where incision would be performed at the upper, middle and lower part along the midline, under general anesthesia. Wound tensile strengths were measured after 0.7 cm × 2 cm of cutaneous and subcutaneous tissue samples were obtained vertical to incision from infiltrated regions. Tissue samples were also obtained for electron microscopic examination. Evaluations were on the 8th, 15th and 21st days after infiltration. Results There was no difference between groups in the weights of the rats at the 0th, 8th, 15th and 21st days. The collagen maturation was no statistically different between groups at the 8th and 15th days. The maturation scores of the B and L groups at the 21st day was significantly lower than the Group C (1.40, 1.64 and 3.56; respectively). The wound tensile strength was no statistically different between groups at the 8th and 15th days but at the 21st day the Groups B and LVB had significantly lower value than Group C (5.42, 5.54 and 6.75; respectively). Conclusion Lidocaine and prilocaine do not affect wound healing and, bupivacaine and levobupivacaine affect negatively especially at the late period.

Resumo Introdução A infiltração de anestésico local é amplamente usada para analgesia pós-operatória em muitas situações. No entanto, os efeitos dos anestésicos locais na cicatrização de feridas não foram demonstrados claramente. Neste estudo planejamos avaliar os efeitos de lidocaína, prilocaína, bupivacaína e levobupivacaína sobre a cicatrização de feridas, principalmente sobre a força tênsil da ferida e a ultraestrutura do colágeno. Métodos Este estudo foi feito em ratos machos da linhagem Sprague Dawley. Nos dias 0, 8, 15 e 21, todos os animais foram pesados e receberam uma infiltração subcutânea pré-incisional de 3 mL de uma solução, de acordo com a designação dos grupos: Grupo C recebeu salina (controle); Grupo L recebeu lidocaína (7 mg.kg-1); Grupo P recebeu prilocaína (2 mg.kg-1); Grupo B recebeu bupivacaína (2 mg.kg-1); Grupo LVB recebeu levobupivacaína (2,5 mg.kg-1). As infiltrações foram feitas na região posterior a 1,5 cm de onde a incisão seria feita na parte superior, média e inferior ao longo da linha média, sob anestesia geral. A força tênsil da ferida foi medida após amostras de 0,7 × 2 cm de tecido cutâneo e subcutâneo serem obtidas das regiões infiltradas, verticalmente à incisão. Amostras de tecido também foram obtidas para exame microscópico eletrônico. As avaliações foram feitas nos dias 8, 15 e 21 após a infiltração. Resultados Não houve diferença entre os grupos em relação ao peso dos ratos nos dias 0, 8, 15 e 21. A maturação do colágeno não foi estatisticamente diferente entre os grupos nos dias 8 e 15. Os escores de maturação dos grupos B e L no dia 21 foram significativamente inferiores aos do Grupo C (1,40, 1,64 e 3,56, respectivamente). A força tênsil da ferida não foi estatisticamente diferente entre os grupos nos dias 8 e 15, mas no dia 21 os grupos B e LVB apresentaram valores significativamente menores que o Grupo C (5,42, 5,54 e 6,75, respectivamente). Conclusão Lidocaína e prilocaína não afetam a cicatrização de feridas, enquanto bupivacaína e levobupivacaína afetam negativamente, especialmente no período tardio.

[Effects of local anesthetics on wound healing]. / Efeitos dos anestésicos locais na cicatrização de feridas.

INTRODUCTION: Local anesthetic infiltration is used widely for post-operative analgesia in many situations. However the effects of local anesthetics on wound healing are not demonstrated clearly. This study planned to evaluate the effects of lidocaine, prilocaine, bupivacaine and levobupivacaine on wound healing, primarily on wound tensile strength and on collagen ultrastructure. METHODS: This study was conducted on male Sprague Dawley rats. On days 0, 8th, 15th, and 21st, all animals were weighed and received a preincisional subcutaneous infiltration of 3mL of a solution according the group. Control saline (C), lidocaine (L) 7mg.kg-1, prilocaine (P) 2mg.kg-1, bupivacaine (B) 2mg.kg-1 and levobupivacaine (LVB) 2.5mg.kg-1. The infiltrations were done at the back region 1.5cm where incision would be performed at the upper, middle and lower part along the midline, under general anesthesia. Wound tensile strengths were measured after 0.7cm×2cm of cutaneous and subcutaneous tissue samples were obtained vertical to incision from infiltrated regions. Tissue samples were also obtained for electron microscopic examination. Evaluations were on the 8th, 15th and 21st days after infiltration. RESULTS: There was no difference between groups in the weights of the rats at the 0th, 8th, 15th and 21st days. The collagen maturation was no statistically different between groups at the 8th and 15th days. The maturation scores of the B and L groups at the 21st day was significantly lower than the Group C (1.40, 1.64 and 3.56; respectively). The wound tensile strength was no statistically different between groups at the 8th and 15th days but at the 21st day the Groups B and LVB had significantly lower value than Group C (5.42, 5.54 and 6.75; respectively). CONCLUSION: Lidocaine and prilocaine do not affect wound healing and, bupivacaine and levobupivacaine affect negatively especially at the late period.

Agenesis of the isthmus of the thyroid gland.

The thyroid is an endocrine gland composed of two lobes connected by the isthmus tissue. Thyroid isthmus agenesis is a rare condition, and only a few cases have been reported in the literature. Here, we discuss the case of a 56-year-old female patient in whom agenesis of the thyroid isthmus was discovered incidentally during surgery for a multinodular goitre. When agenesis of the isthmus is found, associated thyroid lobe agenesis and the presence of ectopic thyroid tissue must be considered. In addition, associated autoimmune thyroid nodule, thyroiditis, primary thyroid carcinoma, metastasis, and amyloidosis must be considered in the differential diagnosis. Preoperative awareness of potential agenesis of the isthmus and its associated thyroid anomalies in patients with planned thyroid surgery will significantly contribute to safety during surgical procedures and result in fewer surgery-related complications.

Cardioprotective effects of Viscum album L. ssp. album (Loranthaceae) on isoproterenol-induced heart failure via regulation of the nitric oxide pathway in rats.

OBJECTIVE: Viscum album L. has favorable cardiovascular effects including antihypertensive and vasorelaxant activity, and the nitric oxide (NO) pathway upregulation has been proposed to be the underlying mechanism. NO also plays an important role in the pathophysiology of heart failure. However, its effects on cardiac systolic function are unclear. METHODS: A total of 30 male Wistar albino rats at 12 weeks of age were randomly divided into three groups: control, isoproterenol-induced heart failure group (ISO), and isoproterenol-induced heart failure + V. album treatment group (VA) groups (n=10 in each group). V. album was orally given at a dose of 250 mg/kg/day by gavage. Parameters of heart failure were compared among the groups. Tamhane's T2 test, paired sample t-test, and Bonferroni methods were used for statistical analysis. RESULTS: V. album resulted in an improvement in all parameters of heart failure including left ventricular diameters (6.34±0.23 mm, 6.98±0.35 mm, and 6.71±0.10 mm for left ventricular end-diastolic diameter in control, ISO, and VA groups, respectively, p<0.05), ejection fraction (73.3±3.1%, 56.7±2.6%, and 65.2±1.5% for control, ISO, and VA groups, respectively, p<0.05), serum NT-proBNP levels, and histopathological changes. V. album treatment resulted in a statistically significant attenuation of increased levels of NO and iNOS (p<0.0001). The levels of hs-CRP were also found to be lower in the VA group compared with the controls and ISO groups (p<0.01). CONCLUSION: V. album exerted favorable effects on left ventricular function in isoproterenol-induced heart failure rats. Upregulation of the NO pathway seems to be the possible pathophysiological mechanism. Favorable vascular outcomes can also be speculated considering the reduction in serum hs-CRP levels.

Missed retrosternal ectopic thyroid tissue in a patient operated for multinodular goiter.

Ectopic thyroid tissue has been found from the tongue to the diaphragm. The most common ectopic thyroid tissue has been found in the tongue, submandibular region, cervical lymph nodes, larynx, trachea, oesophagus, mediastinum, diaphragm and heart respectively. "Forgotten goiter" is an extremely rare disease which is defined as a mediastinal thyroid mass found after total thyroidectomy. In this case report, we discussed a 49 year-old female patient whose retrosternal ectopic thyroid tissue was detected by thyroid scintigraphy taken in postoperative period after total thyroidectomy performed with diagnosis of multinodular goiter. Papillary carcinoma was determined by the histopathological examination. Ectopic thyroid tissue was removed by performing sternotomy. We did not observe any postoperative surgical complications. 100 mCi dose of radioactive iodine was administered to the patient. Retrosternal ectopic thyroid tissue detected after total thyroidectomy is a rarely encountered condition. Therefore, retrosternal ectopic thyroid tissue existence should be definitely kept in mind in patients with no increase in thyroid stimulating hormone level after total thyroidectomy.

Effects of glutamine on wound healing.

Studies reporting the need for replacing amino acids such as glutamine (Gln), hydroxymethyl butyrate (HMB) and arginine (Arg) to accelerate wound healing are available in the literature. The primary objective of this study was to present the effects of Gln on tissue hydroxyproline (OHP) levels in wound healing. This study was conducted on 30 female Sprague Dawley rats with a mean weight of 230 ± 20 g. Secondary wounds were formed by excising 2 × 1 cm skin subcutaneous tissue on the back of the rats. The rats were divided into three equal groups. Group C (Control): the group received 1 ml/day isotonic solution by gastric gavage after secondary wound was formed. Group A (Abound): the group received 0·3 g/kg/day/ml Gln, 0·052 g/kg/day/ml HMB and 0·3 g/kg/day/ml Arg by gastric gavage after secondary wound was formed. Group R (Resource): the group received 0·3 g/kg/day/ml Gln by gastric gavage after secondary wound was formed. The OHP levels of the tissues obtained from the upper half region on the 8th day and the lower half region on the 21st day from the same rats in the groups were examined. Statistical analysis was performed using the statistics program SPSS version 17.0. No statistically significant differences were reported with regard to the OHP measurements on the 8th and 21st days (8th day: F = 0·068, P = 0·935 > 0·05; 21st day: F = 0·018, P = 0·983 > 0·05). The increase in mean OHP levels on the 8th and 21st days within each group was found to be statistically significant (F = 1146·34, P = 0·000 < 0·001). We conclude that in adults who eat healthy food, who do not have any factor that can affect wound healing negatively and who do not have large tissue loss at critical level, Gln, Arg and HMB support would not be required to accelerate secondary wound healing.

Cystic duct cyst: Report of one case.

Cystic duct cyst is an extremely rare anomaly. The classification developed by Tadoni is used for the other bile duct anomalies, but cystic duct cysts are excluded from this classification. In this case report, acute pancreatitis was diagnosed based on the clinical and laboratory findings of the patient, who presented with a complaint of nonspecific abdominal pain. Cystic duct cyst was determined with magnetic resonance cholangiopancreatography performed after determination of a cystic lesion on the neck of the gallbladder by abdominal ultrasonography. Cystic duct cyst is an extremely rare anomaly, and advanced examination is required for the diagnosis.

A Case of Traumatic Asphyxia due to Motorcycle Accident.

Background. Perthe's syndrome (traumatic asphyxia) is rare, which is caused by sudden compressive chest trauma and characterized by subconjunctival hemorrhage, facial edema, craniocervical cyanosis, and petechiae on the upper chest and face and should always be kept in mind as a possible complication of injuries of the chest and abdomen. Case Report. In this case report a 36-years-old male patient brought to the emergency room due to thorax trauma related to motorcycle accident was discussed. Distinct cyanotic, edematous, and multiple petechiae were present on the face, neck, and upper thorax regions of the patient. Bilateral subconjunctival hemorrhage was determined. Conclusion. Treatment for traumatic asphyxia is supportive and patient recovery is related to the generally associated injuries. Prognosis of the patients is quite good with effective and timely treatment.

Effects of levobupivacaine on wound healing.

BACKGROUND: Local anesthetic infiltration along the incision may be used to provide surgical anesthesia or postoperative analgesia. However, the effect of local anesthetics on wound healing remains controversial. In this investigation, we evaluated the effects of levobupivacaine on wound healing. METHODS: Sixty Wistar albino female rats weighing 230±20 g were included, with 10 rats in each group: group early c (early control): 3 mL isotonic saline; group early l1.25 (early levobupivacaine 1.25): 1.25 mg/kg per 3 mL levobupivacaine; group early l2.5 (early levobupivacaine 2.5): 2.5 mg/kg per 3 mL levobupivacaine; group late c (late control): 3 mL isotonic saline; group late l1.25 (late levobupivacaine 1.25): 1.25 mg/kg per 3 mL levobupivacaine; and group late l2.5 (late levobupivacaine 2.5): 2.5 mg/kg per 3 mL levobupivacaine. Rats in groups early c to early l2.5 were euthanized on the 8th day. Rats in groups late c to late l2.5 were euthanized on the 21st day. Wound tension strength, tissue hydroxyproline, and fibrotic index levels of the tissue samples from the early c and early l2.5 and late c and late l2.5 groups, respectively, on the 8th and 21st days were examined. RESULTS: Levobupivacaine decreased wound tension strength on the 8th day, especially a 2.5 mg/kg dose (P<0.001), and increased it on the 21st day (P<0.001). It also increased the inflammatory response (P<0.001) and collagen synthesis (8th day, P=0.109; 21st day, P=0.103) on both the 8th and 21st days. CONCLUSIONS: While levobupivacaine had a positive effect on wound healing during the early period, negative effects were observed thereafter. Additional studies at the molecular level are necessary to determine the cause of these apparently opposite effects.

Primary cutaneous umbilical endometriosis.

INTRODUCTION: Primary umbilical endometriosis a rare case. It is mostly seen in women in the reproductive age group. CASE REPORT: In this case report, a 38 year old woman is discussed who received antibiotherapy for omphalitis diagnosis established due to many complaints of umbilical secretion but who was diagnosed with primary umbilical endometriosis after histopathological examination. CONCLUSION: Endometriosis must be certainly considered in differential diagnosis in especially inflammatory lesions resistant to noncyclic treatment, determined in umbilical region.

Effects of enteral and parenteral glutamine on intestinal mucosa and on levels of blood glutamine, tumor necrosis factor-alpha, and interleukin-10 in an experimental sepsis model.

OBJECTIVE: To investigate the effects of enteral and parenteral glutamine (Gln) usage on rats in sepsis. METHODS: This study was conducted in Istanbul University Experimental Medical Research Institution (DETAE) laboratory, Istanbul University, Istanbul, Turkey between June and September 2009. The levels of blood Gln, tumor necrosis-alpha (TNF-alpha) and interleukin (IL)-10 was measured. Samples of tissue were obtained from the mesenteric lymph nodes, liver, and lower lobe of the right lung to evaluate the reproduction of bacteria, and samples of tissue were also obtained from the small intestine to evaluate blood and villus atrophy. RESULTS: Bacteremia of Group EP (combined group) were found lower than Group C (control) (p=0.007). Villous atrophy rates of all groups were lower than Group C: between Group E (enteral) and C (p=0.003); between Group P (parenteral alanine) and C (p=0.019); and between Group EP and C (p=0.001). The values of serum TNF-alpha and IL-10 of Group EP and P were lower than the other groups at the 24th and 96th hours (p=0.000). CONCLUSION: In this study we found that the most efficient Gln administration technique in sepsis was enteral administration together with parenteral administration due to trophic effect on the intestinal mucosa, decrease of reproduction in tissue and blood cultures, immunomodulator effect, and approximately the same cost as parenteral application.

Primary cyst hydatid in the neck; report of one case.

Hydatid cyst is a parasitic disease that has been recognized endemically in many countries. Although the liver and lung are the most common organs involved by the disease, it may appear rarely in other tissues as a primary disease. In the ultrasonography of the neck taken from a 17 year old case who attended with a complaint of swelling in the neck, a partly regular, bounded cystic lesion of 33x28 mm in size was reported. When the cyst was thought to be hydatid during surgical exploration, this diagnosis was confirmed by histopathological verification of the specimen obtained. Whole abdomen ultrasonography and PA Chest Radiography were taken in order to determine whether there was another focus during the postoperative period. The Echinococcus ELISA test was performed as an immunological parameter. Treatment with Albendazole began after diagnosis during the postoperative period. Although hydatid cyst most commonly involves the liver and lung, it may be detected in all body tissues. Therefore hydatid cyst must be considered in the differential diagnosis in cystic lesions that are rarely encountered in body localizations in human, living in endemic regions.