Berit Gökçe Ceylan

Tezosentan reduces the renal injury induced by abdominal aortic ischemia-reperfusion in rats.

BACKGROUND Renal injury induced by aortic ischemia-reperfusion (IR) is an important factor in the development of postoperative acute renal failure following abdominal aortic surgery. Endothelin (ET) is involved in the development of renal injury induced by aortic IR and tezosentan (R0 61-0612) is a specific ET receptor antagonist. The aim of this study was to examine the effect of tezosentan on renal injury induced by abdominal aortic IR in rats. MATERIAL AND METHODS Twenty-four Wistar-Albino rats were randomized into three groups (eight per group). Control group underwent laparotomy and dissection of the infrarenal abdominal aorta (IAA) without occlusion. The aortic IR group underwent laparotomy and clamping of the IAA for 120 min followed by 120 min of reperfusion. Aortic IR + tezosentan group underwent same aortic IR periods, and received a bolus intravenous injection of 10 mg/kg tezosentan before ischemia plus continuous intravenous infusion of 1 mg/kg/h tezosentan during 120 min ischemia and 120 min reperfusion. At the end of the experiment, blood and kidney tissue specimens were obtained for biochemical analysis. Histological evaluation of the rat kidney tissues was also done. RESULTS Biochemical analysis showed that aortic IR significantly increased (P < 0.05 versus control) while tezosentan significantly decreased (P < 0.05 versus aortic IR) the tissue levels of malondialdehyde, superoxide dismutase, catalase and myeloperoxidase. Histological analyses showed that aortic IR significantly increased (P < 0.05 versus control) while tezosentan significantly decreased (P < 0.05 versus aortic IR) focal glomerular necrosis, dilatation of Bowmans capsule, degeneration of tubular epithelium, necrosis in tubular epithelium and tubular dilatation in the renal tissue samples. CONCLUSION The results of this study indicate that tezosentan reduces renal injury induced by aortic IR in rats. We think that tezosentan exerted this beneficial effect via reducing oxidative stress and lipid peroxidation, inhibition of leukocyte infiltration into renal tissue and acting cytoprotective on renal tubular cells after aortic IR.

Effects of Vitamin C and E Combination on Element and Oxidative Stress Levels in the Blood of Operative Patients Under Desflurane Anesthesia

We investigated effects of vitamin C and E (VCE) administration on desflurane-induced oxidative toxicity and element changes in the blood of operative patients under desflurane general anesthesia. Forty American Society of Anesthesiologists I or II Physical Status adult patients were scheduled for elective surgery. The patients were randomly divided into two groups. Control and VCE group was introduced to anesthesia with desflurane. VCE was administreted to patients in the control and VCE group before 1 hour of anesthesia with desflurane. Baseline (preoperative) and postoperative (at the 1st, the 24th, and 72th h), blood samples were taken from the first and second groups. Erythrocyte and plasma lipid peroxidation levels at the 1st, 24th, and 72th hours were higher in the control than in baseline group, although their levels at the same periods were lower in the VCE group than in the control. Vitamin E levels at the postoperative 1st and 24th hours and erythrocyte glutathione peroxidase (GSH-Px) activity at the postoperative 1st, 24th, and 72th hours was lower than in baseline values. Erythrocyte GSH-Px activity and plasma vitamins A, C, and E levels at the postoperative 1st, 24th, and 72th hours were higher in the VCE group than in the control group. Erythrocyte and plasma reduced glutathione, plasma β-carotene, and serum copper, while zinc, selenium, aluminum, iron, magnesium, and calcium levels did not differ between preoperative and postoperative periods in both groups. In conclusion, VCE combination prevented the desflurane-induced vitamin E and GSH-Px consumptions to strengthen the antioxidant levels in the blood of operative patients.

β-Glucan Protects against Lung Injury Induced by Abdominal Aortic Ischemia-Reperfusion in Rats

BACKGROUND Aortic ischemia-reperfusion (IR) is an important factor in the development of postoperative acute lung injury following abdominal aortic surgery. The aim of our study was to examine the effect of β-glucan on lung injury induced by abdominal aortic IR in rats. MATERIAL AND METHODS Thirty-two Wistar-albino rats were randomized into four groups (eight per group) as follows: the control group (sham laparotomy), aortic IR (120 min ischemia and 120 min reperfusion), aortic IR + β-glucan (β-glucan 50 mg/kg/d for 10 d was administered orally before IR), and control + β-glucan. Lung tissue samples were obtained for biochemical analysis. Protein concentrations in bronchoalveolar lavage fluid and lung wet/dry weight ratios were measured. Histologic evaluation of the rat lung tissues was also performed. RESULTS Aortic IR significantly increased the levels of MDA, superoxide dismutase, catalase, and myeloperoxidase (P < 0.05 versus control).Whereas, β-glucan significantly decreased the lung tissue levels of MDA, superoxide dismutase, catalase, myeloperoxidase, (P < 0.05 versus aortic IR), and protein concentration in bronchoalveolar lavage fluid as well as wet/dry lung weight ratio. Histologic evaluation showed that β-glucan attenuated the morphological changes associated with lung injury. CONCLUSIONS The results of this study indicate that β-glucan attenuates lung injury induced by aortic IR in rats. We propose that this protective effect of β-glucan is due to (1) reduced systemic inflammatory response, (2) reduced oxidative stress and lipid peroxidation in the lung tissue, (3) reduced pulmonary microvascular leakage, and (4) inhibition of leukocyte infiltration into the lung tissue.

The Effects of Adjuvant Immunoglobulin M-Enriched Immunoglobulin Therapy on Mortality Rate and Renal Function in Sepsis-Induced Multiple Organ Dysfunction Syndrome: Retrospective Analysis of Intensive Care Unit Patients

OBJECTIVE: To determine the effect of immunoglobulin (Ig)M-enriched Ig therapy on mortality rate and renal function in sepsis-induced multiple organ dysfunction syndrome (MODS), using the Acute Physiology and Chronic Health Evaluation II (APACHE II) score. METHODS: Retrospective study of patients with sepsis-induced MODS treated with standard antibiotic plus supportive therapy (control group) or IgM-enriched Ig therapy adjuvant to control group therapy (IVIg group). Total length of stay in the intensive care unit (ICU), overall mortality rate and 28-day case fatality rate (CFR), as well as APACHE II scores and renal function parameters at day 1 and day 4 of therapy, were recorded. RESULTS: A total of 118 patients were included (control group, n = 62; IVIg group, n = 56). In both groups, day 4 APACHE II scores decreased significantly compared with day 1 scores; the effect of treatment on renal function was minimal. Length of ICU stay, overall mortality rate and 28-day CFR were significantly lower in the IVIg group compared with the control group. CONCLUSIONS: Adding IgM-enriched Ig therapy to standard therapy for MODS improved general clinical conditions and significantly reduced APACHE II scores, overall mortality rate and 28-day CFR, although effects on renal function were minimal.

[The efficacy of low- and high-molecular-weight hyaluronic acid applications after arthroscopic debridement in patients with osteoarthritis of the knee].

OBJECTIVES We evaluated the efficacy of viscosupplementation with low- or high-molecular-weight hyaluronic acid (HA) preparations following arthroscopic debridement (AD) in patients with osteoarthritis of the knee. METHODS The study included 45 patients (19 men, 26 women; mean age 53 years; range 41 to 66 years) with Kellgren-Lawrence grade 2-3 osteoarthritis of the knee. Following AD, the patients were randomized to three groups to receive three intra-articular injections of 2 ml hylan G-F 20 (Synvisc, n=16), five intra-articular injections of 2 ml sodium hyaluronate (Hyalgan, n=14), and no injections (controls, n=15). Injections were administered at one-week intervals. All the patients were evaluated with pain, stiffness, and functional capacity scores of the WOMAC (Western Ontario and McMaster Universities) osteoarthritis index before and 6 and 12 months after AD. RESULTS Two patients and three patients complained of transient pain in Synvisc and Hyalgan groups, respectively. WOMAC scores showed significant decreases in all the groups at 6 and 12 months. There were no significant differences between the three groups with respect to improvement in WOMAC scores at 6 months. However, compared to the control group, differences between pre- and posttreatment scores at 12 months were significantly greater in the Synvisc (p=0.004) and Hyalgan (p=0.003) groups, with no significant difference between the two HA groups (p>0.05). CONCLUSION Our findings show that AD is beneficial in osteoarthritis of the knee in patients with appropriate indications, viscosupplementation increases the efficacy of treatment, and that low- and high-molecular-weight HA preparations have similar efficacy.

New volatile anesthetic, desflurane, reduces vitamin E level in blood of operative patients via oxidative stress.

It has been well known that some volatile anesthetic agents produce oxidative stress. Desflurane as a new volatile agent might have limited oxidative toxic effect because it is relatively a new short‐acting anesthetic characterized by a short duration of action and a quick postanesthetic recovery. We investigated effect of desflurane on serum glutathione peroxidase (GSH‐Px), lipid peroxidation (LP), vitamin E, and erythrocyte superoxide dismutase (SOD) values in patients. Fifteen adult patients are scheduled for elective surgery, ASA I or II physical status. Tidal volume and ventilation frequency were kept unchanged during the operation. Baseline values in venous blood samples were preoperatively taken and blood was also taken postoperatively at the 1st and the 12th hours of desflurane exposure. LP levels were significantly (p < 0.05) higher postoperatively at 1st hour than in preoperative values while α‐tocopherol concentration was significantly (p < 0.001) lower in postoperative period at 1st hour than in preoperative period. Erythrocyte SOD and serum GSH‐Px activities did not differ between pre‐ and postoperative periods. In conclusion, we observed that desflurane produced oxidative stress by decreasing α‐tocopherol levels. Use of vitamin E may be possible to reduce the oxidative effect of desflurane. Copyright

Prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy

Objective: We investigated the prophylactic effects of systemic oral ephedrine in spinal anesthesia-induced hypotension during transurethral prostatectomy. Material and Methods: Sixty American Society of Anesthesiologists Grade II and III patients scheduled for spinal anesthesia were randomized into one of two groups. Patients in Group I ( n r = r 30) received oral ephedrine 50 r mg in addition to premedication whilst those in Group II ( n r = r 30) received only premedication 30 r min before spinal anesthesia. Pre-infusion values were measured in order to obtain baseline readings after oral ephedrine administration in Group I and after premedication in Group II. Systolic arterial pressure (SAP) and heart rate (HR) were recorded before and after infusion, during and 5 r min after spinal anesthesia and intraoperatively. Hypotension was defined as SAP <100 r mmHg and <20% of baseline value. Hypotension was treated with 3 r mg ephedrine and bradycardia was corrected with atropine 0.5 r mg, given as an i.v. bolus. Results: SAP values were significantly lower in Group II during the spinal anesthesia, post-spinal and intraoperative periods ( p r < r 0.0001). Fifteen patients received ephedrine in Group II and seven in Group I. Supplemental ephedrine was used at doses of 3.42 r - r 0.97 r mg in Group I and 8.86 r - r 1.24 r mg in Group II. The incidence of hypotension was halved in Group I compared to Group II (23.33% vs 50%, p r = r 0.003). Six patients received atropine in Group II because of severe bradycardia. Mean HR values were lower in Group II than Group I during the spinal anesthesia, post-spinal and intraoperative periods. Conclusions: We conclude that a prophylactic oral dose of ephedrine 50 r mg is effective for minimizing and managing spinal anesthesia-induced hypotension during transurethral prostatectomy.

A Giant Scrotal Cavernous Hemangioma Extending to the Penis and Perineum: A Case Report

Cavernous hemangioma is a congenital, benign vascular tumor that occurs in the deep dermis and subcutaneous tissue. Scrotal hemangiomas are rare entities and are usually diagnosed in childhood. Adult scrotal hemangiomas are also extremely rare. They are infrequently encountered in adults because they are usually removed in childhood. Urologists often face difficulties in deciding surgery to treat a genital cavernous hemangioma. Here, we report a case of scrotal cavernous hemangioma that involved the entire penis and scrotum, and extended to the perineum in a 44‐year‐old man, and we review the literature.

Kalça Kırıklı Yaşlı Türk Hasta Grubunda Bir ve İki Yıllık Mortaliteyi Etkileyen Faktörler

Amac: Kalca kiriklari ileri yaslarin fonksiyon kaybi ve olum ile sonuclanabilen ciddi saglik sorunlarindandir. Bu calismada amac kalca kirigi sonrasi yasli Turk has- talarda degisik risk faktorlerinin mortalite uzerine etkisini ortaya koymaktir.

SPİNAL ANESTEZİDE SEDASYON AMAÇLI UYGULANAN DEKSMEDETOMİDİNİN YÜKLEMELİ VE YÜKLEMESİZ İNFÜZYONUNUN HEMODİNAMİ VE SEDASYON ÜZERİNE ETKİLERİNİN RETROSPEKTİF İNCELENMESİ

AMAC: Bu calismanin amaci rejyonel anestezide sedasyon amacli uygulanan deksmedetomidinin spinal anestezide yuklemeli ve yuklemesiz infuzyonunun hemodinami ve sedasyon uzerine etkilerinin retrospektif olarak karsilastirilmasidir. GEREC VE YONTEM: Kasim 2003 - Şubat 2015 tarihleri arasinda spinal anestezi ile alt abdominal ve alt ekstremite cerrahisi uygulanmis ve sedasyon amacli intravenoz deksmedetomidin infuzyonu yapilmis toplam 60 hastanin medikal ve anestezi kayitlari retrospektif olarak degerlendirildi. Hastalar deksmedetomidinin yuklemeli, grup A (n=40) ve deksmedetomidinin yuklemesiz idame, grup B (n=20) uygulananlar olarak iki gruba ayrildi. Taranan olgularda hemodinamik veriler Kalp Atim Hizi (KAH), Ortalama Arter Basinci (OAB) ve Ramsey Sedasyon Skoru (RSS) retrospektif olarak degerlendirildi. BULGULAR: KAH; grup A’ da, spinal anestezinin 10. dk’sindan operasyonun 50. dk’ya kadar, Grup B’ de ise spinal anestezinin 20. dk’sindan operasyonun 50. dk’ sina kadar kontrol degerine oranla, istatistiksel olarak anlamli oranda azaldi. OAB; grup A’ da, spinal anestezinin 15. dk’sindan operasyonun 50. dk kadar grup B’ de ise spinal anestezinin 10.dk’sindan operasyonun 50. dk kadar kadar tum zaman araliklarinda kontrol degerine oranla istatistiksel olarak anlamli oranda azaldi. RSS degerleri her iki grup arasinda kontrol, 5. dk, 25. dk, 30. dk’daki kayit araliklarinda istatiksel olarak anlamli fark bulundu. SONUC: Spinal anestezili olgularda; deksmedetomidin yukleme dozu yapmadan idame deksmedetomidin infuzyonuyla hemodinamik dengesizligi daha aza indirerek RSS’da uygun sedasyon duzeyine ulasilabilinecegi retrospektif olarak gozlemlendi.