The alpha-2 receptor agonist dexmedetomidine attenuates vancomycin­induced acute kidney injury.

OBJECTIVE: This study was conducted to evaluate the protective effect of dexmedetomidine on nephrotoxicity and the mechanism of renoprotection following vancomycin-induced nephrotoxicity in rats. METHODS: Thirty-two albino Wistar rats were divided into four groups. The control group received intraperitoneal (IP) physiological saline solution, the vancomycin (VMC) group received IP 200 mg/kg vancomycin, the dexmedetomidine (DEX) group received IP 5 µg/kg dexmedetomidine, and the vancomycin and dexmedetomidine (VMC+DEX) group received IP 200 mg/kg vancomycin followed by IP 5 µg/kg dexmedetomidine 20 min after the vancomycin injection. On the 8th day of the experiment, histopathological and biochemical parameters were assessed. RESULTS: Creatinine levels were significantly higher in VMC and VMC+DEX groups. The endothelin-1 level was significantly higher in VMC group. Nitric oxide levels were statistically lower in VMC and VMC+DEX groups. Histopathologic assessments revealed that the extent of renal damage was significantly higher in group VMC (n = 4 with damage of Grade 3) compared to group VMC+DEX (n = 0 with damage of Grade 3). CONCLUSION: It was determined that dexmedetomidine can reduce the extent of renal damage by preventing the elevation of vasoconstrictor agents (Tab. 2, Fig. 1, Ref. 36).

A reliable pancreaticojejunal anastomosis with V-Loc 180 wound closure device for soft pancreatic stump.

BACKGROUND/AIMS: Although mortality rates decreased in recent years, pancreaticoduodenectomy is still associated with high morbidity rates. Pancreatic fistula is the leading cause of morbidity after pancreaticojejunal anastomosis and commonly occurs in soft pancreas. The objective of this study is to compare outcomes of conventional modified invaginated end to side pancreaticojejunostomy with a new practical method using V-Loc 'rM 180 wound closure device in soft pancreas. METHODOLOGY: Between December 2011 and August 2013, a total of 90 pancreaticoduodenectomy procedures were performed in our hospital. 28 of them were defined as soft pancreas according to attending surgeon and included in this study. Patients were divided into two groups consecutively and analysed for postoperative pancreatic fistula (POPF) rate, length of stay, operation time, cost and particular duration of anastomosis. Pancreatic fistulas were classified according to International Study Group on Pancreatic Fistula (ISGPF) definition. RESULTS: 1 grade A and 2 grade B fistulas appeared in V-Loc group (Group 1), whereas 1 grade A, 2 grade B and 1 grade C fistulas appeared in conventional anastomosis group (Group 2). CONCLUSIONS: Pancreaticojejunostomy with V-Loc suture is a convenient method in soft pancreas and can be performed safely.

Association of calcium channel blocker use with lower hemoglobin levels in chronic kidney disease.

AIM: To search whether calcium channel blockers (CCBs) are associated with lower hemoglobin levels in chronic kidney disease (CKD) patients who are not on renal replacement therapy (RRT), vitamin D and anti-anemic treatment. PATIENTS AND METHODS: CKD patients were classified into two groups. Patients on CCBs treatment (103 patients) and patients not using CCBs (104 patients) were compared cross-sectionally regarding clinical findings, complete blood count (CBC), biochemistry and regular medication use. Patients with polycystic kidney disease, comorbidities that could influence CBC other than iron deficiency of obscure origin, patients receiving RRT, erythropoietin (EPO), vitamin D, phosphate binders and drugs that could influence CBC were excluded. Under dependent variable of CCB use, all significantly different independent variables were subjected to multivariate binary logistic regression analysis (MBLRA). RESULTS: Lower hemoglobin, lower bilirubinemia, higher serum EPO, higher systolic blood pressure were observed in CCB users. Two groups were similar concerning age, gender, BMI, CKD etiology, CKD stage, pretibial edema prevalence, cardiothoracic index, diastolic blood pressure, corrected reticulocyte count, BUN, creatinine, eGFR, proBNP, parathormone, alkaline phosphatase, phosphorous, corrected calcemia, sCRP, relative EPO deficiency and prevalence of relative EPO deficient patients. Groups were comparable regarding comorbidities, types and usage frequencies of all antihypertensive medications other than CCBs. Higher systolic blood pressure and lower hemoglobin were significantly associated with CCB use after MBLRA. CONCLUSIONS: Hemoglobin was significantly lower in CCB users compared to non-users, among CKD patients who did not receive RRT, EPO, phosphate binders, vitamin D, iron, vitamin B12 and folic acid.

Evaluation of the effects of insulin resistance on ECG parameters in obese children.

OBJECTIVE: Obese people are at increased risk of arrhythmia and sudden death, even in the absence of heart dysfunction. Increased insulin resistance, neurohumoral and autonomic changes in obesity can cause atrial and ventricular repolarization abnormalities. This study aimed to investigate the effect on ventricular repolarization parameters and to show the increased risk of ventricular arrhythmia in obese children. PATIENTS AND METHODS: The data of 50 obese children aged 2-18 who applied to the Pediatric Endocrinology Outpatient Clinic were evaluated prospectively. In 12-lead ECGs, heart rate, Pmax, Pmin, P-wave dispersion (Pwdisp), QTmax, QTmin, QT dispersion (QTd), QTcmax, QTcmin, QTc interval dispersion (QTcd), Tpeak-Tend interval (Tp-e), Tp-e/QT, Tp-e/QTc were calculated electronically. RESULTS: Tp-e time (0.041 ± 0.004/0.049 ± 0.015/p=0.018) and Tp parameters were measured in obese children with and without insulin resistance. Tp-e/QT ratio was also found to be high (p=0.035). There is a negative correlation between BMI SDS values and QTcmax and QTcmin values in patients with insulin resistance (p=0.015). CONCLUSIONS: In our study, the Tp-e interval and Tp-e/QT ratios, which had been revealed in literature to be more sensitive in demonstrating ventricular arrhythmias, were found to be higher in obese individuals with insulin resistance than in those without insulin resistance. Obese individuals with or without insulin resistance should be carefully evaluated in terms of atrial and ventricular depolarization and repolarization parameters with 12-lead ECG during their outpatient controls, and annual 24-hour Holter control should be performed to detect arrhythmias.

Closure of transcatheter ventricular septal defect using LifetechTM Konar-MF Occluder in children weighing less than 10 kilograms: mid-term results, a tertiary single center experience.

OBJECTIVE: Transcatheter closure of medium and large ventricular septal defects (VSDs) in young children is limited due to the use of over-sized devices that can cause hemodynamic instability and arrhythmia. In this study, we aimed to retrospectively evaluate the safety and efficacy of the device in the mid-term in children weighing less than 10 kg whose transcatheter VSD was closed only with the Konar-MFO device. PATIENTS AND METHODS: Among 70 children whose transcatheter VSD was closed between January 2018 and January 2023, 23 patients weighing less than 10 kg were included in the study. Retrospectively, the medical records of all patients were reviewed. RESULTS: The mean age of the patients was 7.3 (4.5-26) months. 17 of the patients were females, 6 of them were males, F/M: 2.83. The average weight was 6.1 (3.7-9.9) kg. The mean the pulmonary blood flow/ systemic blood flow (Qp/Qs) was 3.3 (1.7-5.5). The mean defect diameter was 7.8 mm (5.7-11) for the left ventricle (LV) side, and 5.7 mm (3-9.3) for the right ventricle (RV) side. Based on the utilized device dimensions, the measurements on the LV side were recorded as 8.6 mm (range 6-12), while those on the RV side were recorded as 6.6 mm (range 4-10). Antegrade technique was applied to 15 (65.2%) patients and retrograde technique was applied to 8 (34.8%) patients in the closure procedure. The procedure success rate was 100%. The incidence of death, device embolization, hemolysis, or infective endocarditis was zero. CONCLUSIONS: Perimembranous and muscular VSDs in children under 10 kg can be successfully closed under the management of an experienced operator with the Lifetech Konar-MFO device. This is the first study in the literature to evaluate the efficacy and safety of the device in children under 10 kg in whom only Konar-MFO VSD occluder device is used for transcatheter VSD closure.

Posterior tibial slope measurement on lateral knee radiographs as a risk factor of anterior cruciate ligament injury: A cross-sectional study.

INTRODUCTION: The posterior tibial slope (PTS) is believed to be a risk factor for anterior cruciate ligament (ACL) injury. The aim of this study was to reveal the differences in terms of PTS measurements on lateral knee radiographs between ruptured and non-injured cases as well as between males and females in regard to ACL alignment. METHODS: The study cohort included 92 patients (61 males and 31 females) with ACL rupture and 101 individuals (59 males and 42 females) who visited the Orthopedics Department but had no ACL injury. PTS measurements on lateral knee radiographs were compared by two blinded reviewers. The results were analyzed in terms of ACL injury and sex differences. The intraclass correlation coefficient was used to calculate interobserver agreements. RESULTS: Notably, there was an excellent agreement between the reviewers with regard to PTS measurements. In addition, although a statistically significant difference existed in terms of PTS measurements between the patient and control groups (p < 0.0001), a significant difference was not observed between males and females (p = 0.179). CONCLUSION: Lateral knee radiographs are useful for PTS measurements to estimate the risk of ACL injury.

Comparison of myotoxic effects of levobupivacaine, bupivacaine and ropivacaine: apoptotic activity and acute effect on pro-inflammatory cytokines.

We investigated the myotoxic effects of bupivacaine, ropivacaine and levobupivacaine on rat skeletal muscle and compared its apoptotic activity and acute effects on pro-nflammatory cytokines. We divided 40 Wistar albino rats into four equal groups. Rats were injected intramuscularly with 0.5% bupivacaine (group B), 0.5% ropivacaine (group R), 0.5% levobupivacaine (group L) or 0.9% normal saline (group SF). Animals were sacrificed on the second day after the injection. TNF-α, IL-1 and IL-6 levels were examined in muscle tissue using immunohistochemistry and immunofluorescence. Apoptotic cells were visualized by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. We found that levobupivacaine caused the lowest TNF-α, IL-1 and IL-6 expression levels, while the bupivacaine group caused the highest level compared to the other two agents. The greatest number of apoptotic cells was found in the bupivacaine group. Bupivacaine was more myotoxic than other anesthetic agents and increased apoptosis. The number of TUNEL positive apoptotic cells was lowest in the SF group. The greatest IL-1 immunoreactivity was found in the bupivacaine group. Bupivacaine and ropivacaine produced greater IL-6 expression than the SF group. Bupivacaine and ropivacaine caused greater TNF-α expression than the SF group, whereas the immunoreactivity of TNF-α was similar in the bupivacaine and ropivacaine groups.

Nightmare of lumbar disc surgery: iliac artery injury.

Intra-operative injuries of pelvic vessels are quite infrequent but serious complications of lumbar disc surgery. Injury may cause laceration of the vessel with acute life threatening retroperitoneal haemorrhage, formation of pseudoaneurysms or arteriovenous fistulae in the late phase. It is important for surgeons to be aware of these potentially fatal complications. Authors reported a case of major vascular injury recognised intra-operatively during posterior lumbar discectomy and repaired immediately.

Sedation for outpatient endometrial biopsy: comparison of remifentanil-propofol and alfentanil-propofol.

The purpose of the study was to compare the clinical activity of remifentanil or alfentanil under propofol sedation with regard to respiratory rate, sedation and recovery rate when used for outpatient endometrial biopsy. Patients were randomized to receive intravenously either bolus remifentanil 0.4 microgram/kg and propofol 1 mg/kg in the remifentanil group (n = 30), or bolus alfentanil 20 micrograms/kg and propofol 1 mg/kg in the alfentanil group (n = 30). Patients were monitored for heart rate, systolic and diastolic arterial pressure, peripheral O2 saturation (SpO2), respiration rate, and Aldrete sedation score. Pulse oximetry was used to monitor heart rate and SpO2 during endometrial biopsy. Apnoea was observed in five patients from the remifentanil group, and in three patients from the alfentanil group. The groups did not differ with regard to apnoea incidences. Times were recorded for orientation and Aldrete score > 8, and were similar between the two groups (13.20 +/- 3.64 min and 14.0 +/- 3.87 min in the remifentanil group, 14.7 +/- 3.64 min and 15.9 +/- 3.15 min in the alfentanil group, respectively). The sedative and analgesic combination of remifentanil-propofol does not offer any advantages compared with a combination of alfentanil-propofol with regards to respiration and recovery during sedation for outpatient endometrial biopsy.

A new treatment with bleomycin for complicated cutaneous hemangioma in children.

Cutaneous hemangiomas are the most common tumors of infants and children. Although they frequently resolve spontaneously, approximately 5% produce complications such as bleeding, infection, consumption coagulopathy and unesthetic appearance. Various methods of treatment are described for these complicated hemangiomas. We used a new type of treatment for complicated cutaneous hemangiomas as intralesional bleomycin (BLM) injection, for the first time in the literature. This agent produced extensive fibrosis and spontaneous resolution of hemangiomas. Fourteen patients with complicated hemangiomas (twelve capillary and two cavernous) have been treated with this method during a three-years period. Of these fourteen patients, five had bleeding, three had infection, one had ulceration, and five had unesthetic appearance and continued rapid growth. Lesions of three patients were completely excised after only one BLM injection. In the other eleven patients lesions regressed 60-100% during 6-14 months with two to three BLM injections. We believe that intralesional BLM injection is simple, and very useful for treatment of complicated cutaneous hemangiomas.

Mesenteric fibromatosis.

Two rare cases of mesenteric fibromatosis are presented. The first patient had a right upper quadrant mass and colicky abdominal pain. The tumor originated from the mesentery of the colon and it infiltrated the gallbladder, cystic duct, and the liver. The second patient had severe hematemesis and melena. The origin of the tumor, which infiltrated 3/4 part of the stomach, the gastrohepatic ligament, the first part of the duodenum, and the liver could not be determined. In the first patient, partial colectomy and cholecystectomy were performed and the liver lesion was completely excised. The second patient underwent subtotal gastrectomy and left lobectomy of the liver. The first part of the duodenum was excised. Gastrojejunostomy was performed. No recurrence was recorded in either patients during 16 and 13 months follow-up, respectively. In this report, diagnostic aids, differential diagnosis and treatment of this rare disease are discussed.

Effect of pentoxifylline on the ischemia-reperfusion injury of the intestine.

Intestinal ischemia is a common clinical event and reperfusion results in further tissue damage exceeding that of ischemia alone. The present study was designed to test this and to assess the role of pentoxifylline, (administered intravenously as a bolus dose of 25 mg/kg in 1 ml normal saline, followed by continuous infusion of 0.2 mg/kg/minute for 95 minutes), in ischemia-reperfusion injury of the rat intestine. Intestinal ischemia was produced by occlusion of the superior mesenteric artery (SMA) with interruption of the collateral flow for 30 minutes. Reperfusion was established by declamping the (SMA) for 1 hour and evaluation of the mucosal damage was determined using a grading scale from 0 to 5, with estimation of mean mucosal thickness, villous height and crypt depth. The grade of mucosal damage, mucosal thickness, villous height and crypt depth were 2.2, 407 microns, 210 microns, and 196 microns respectively in the ischemia group, and 3.6, 327 microns, 156 microns, and 171 microns respectively in the ischemia reperfusion group, while these values in ischemia reperfusion with administration of pentoxifylline group were 2.5, 505 microns, 294 microns, and 200 microns respectively. The severity of the tissue injury increased considerably after reperfusion of the ischemic intestine and pentoxifylline was effective in attenuating the reperfusion injury significantly.

Papillary carcinoma in a thyroglossal duct remnant with normal thyroid gland.

Carcinoma in the thyroglossal duct remnant is relatively uncommon. Since the first report by Uchermann (1915), more than 150 cases of carcinoma have been reported, and the majority have been papillary thyroid carcinomas (Li Volsi et al., 1974; McNicol et al., 1988). In this report, we present a case of papillary carcinoma in the thyroglossal duct with a normal thyroid gland.

The direct depressant effects of desflurane and sevoflurane on spontaneous contractions of isolated gravid rat myometrium.

Our purpose was to investigate the direct depressant effects of desflurane and sevoflurane at 0.5, 1 and 2 minimum alveolar concentrations (MAC) on spontaneous contractions of isolated gravid rat myometrium. Ten gravid, albino Wistar rats, weighing 240-310 g and at 19-20 days' gestation were used. Sixty myometrial strips were obtained from 10 rats, and randomly assigned into six groups of 10. After obtaining spontaneous myometrial contractions in de Jalon solution for 45 min, 0.5, 1 or 2 MAC of desflurane or sevoflurane were continuously bubbled in the bath for 15 min and myometrial contractions evaluated during the last 10 min. Desflurane 0.5 MAC did not affect duration or amplitude of spontaneous contractions, but frequency was significantly decreased (P < 0.05). Duration, amplitude and frequency were all significantly decreased by desflurane 1 and 2 MAC (P < 0.05). Sevoflurane did not affect duration, amplitude or frequency at 0.5 MAC, but amplitude and frequency were significantly decreased at 1 MAC and all were significantly decreased at 2 MAC (P < 0.05). The frequency of contractions was decreased 21.2% with 1 MAC desflurane versus 17.1% with 1 MAC sevoflurane. The amplitude and frequency of contractions were decreased 48.2% and 48.7% with 2 MAC desflurane versus 58.9% and 49.3% with 2 MAC sevoflurane, respectively. We suggest that due to tocolytic activity, desflurane and sevoflurane can be useful in non-obstetric surgery during pregnancy.

An enigma: contralateral effects of experimental unilateral testicular torsion.

To investigate the effects of unilateral testicular torsion on both testes, we studied 4 groups of adult male New Zealand rabbits using sham operation, torsion and detorsion after one or eight hours and permanent torsion. Bilateral orchiectomy was performed 9 weeks after the operation, and testicular weights, Johnsen scores, quantitative analyses, tubular diameters were calculated and histopathologic diagnosis was determined. Testicular weights, Johnsen scores, spermatid counts and tubular diameters were all decreased in torsioned testes depending on the duration of torsion. The contralateral testes showed no significant change in any of the study groups when compared with the control group.

Comparison of the effects of surgical and autologous fascial suture materials on testicular histology in rats subjected to orchiopexy.

In this study orchiopexy was performed in 30 Sprague-Dawley rats in order to compare traumatic effects of surgical and autologous fascial suture materials on testicular histology. Abscess formation was observed in 72.7% of the chromic, in 36.3% of the nylon, and in 18.1% of the vicryl fixed groups. There were no abscess formations in the dartos and autologous fascial fixed group. Examination of the testes revealed complete absence of spermatogenesis in the chromic fixed group. Spermatogenesis was normal, 72% in the vicryl, 18.1% in the nylon, 90.9% in the dartos and autologous fascial suture fixed groups. Antisperm antibody was not observed in any rat sera. We consider that it is preferred to use dartos pouch fixation. If necessary, it is advisable to use autologous fascial suture materials.

Prevalence of hydatidosis and fertility of hydatid cysts in sheep in Kirikkale, Turkey.

This study was conducted in order to determine the prevalence and fertility of hydatid cysts in sheep in Kirikkale, Turkey. A total of 3.2% of 553 lambs and 50.9% of 1320 adults were found to be infected with hydatid cysts. The most common locations of cysts were in the liver and lung. Liver cysts tended to be more fertile than lung cysts (81.53% v. 76.47%), though the difference was not significant. The mean number of viable protoscoleces in the liver and lung cysts were 12,400 and 5,800, respectively. In general, 1-10 cysts were found in liver (51.8%) and lung (64.7%). The findings of this study indicate that hydatid cysts are common in sheep and the fertility rate of cysts is quite high. Sheep play an important role in the life cycle of Echinococcus granulosus in this region.

Massive cystic tetrathyridiosis in a dog.

This report describes a case of massive cystic tetrathyridiosis in a four-year-old female dobermann. The larvae were distributed in both the peritoneal and pleural cavities, as well as in the lumen of the small intestine along with adult Mesocestoides species. These parasites were identified as tetrathyridia. Numerous cysts were dispersed on the peritoneal, pleural and mesenteric surfaces. The same cysts were seen both on subcapsular surfaces and within sections of the spleen, liver, kidneys and lungs. Histopathological examination also revealed characteristics of tetrathyridium of Mesocestoides species.

Congenital epulis. Case report.

A newborn baby boy weighing 3100 g was found to have a pinky red solid mass 3 x 2.5 x 2 cm arising from the anterior ridge of the maxilla. This caused difficulty in feeding, and looked ugly. The mass was excised under local anaesthetic when he was 2 days old and histological examination showed congenital epulis. He also had a stage II congenital goitre. His hypothyroidism was treated with L-thyroxine sodium and he was well with no sign of recurrence of the tumour at the age of 1 year.