Mehmet Kizilkaya

The Effects of Bupivacaine and Neostigmine on Articular Cartilage and Synovium in the Rabbit Knee Joint

We investigated the effects of intraarticular injections of bupivacaine and neostigmine on articular cartilage and the synovial membrane of rabbit knee joints. Saline, bupivacaine or neostigmine were each administered intra-articularly into 15 knee joints. Five joints per drug treatment were prepared for histopathological examination 24 h, 48 h and 10 days after injection. A pathologist examined the histological samples for inflammation of the articular cartilage, inflammatory cell infiltration, hypertrophy and hyperplasia of the synovial membrane, in a blinded manner. There were no histopathological changes in the saline-treated control joints. Joints treated with bupivacaine and neostigmine showed significantly more histopathological changes than control joints. Joints treated with neostigmine showed significantly more histopathological changes than those treated with bupivacaine, except for articular cartilage inflammation on day 10. We conclude that intra-articular bupivacaine and neostigmine cause histopathological changes in rabbit knee joints, with neostigmine having a greater effect than bupivacaine.

Comparisons of analgesic effects of different doses of morphine and morphine plus methylprednisolone after knee surgery

Background: In this double‐blind randomized study, the analgesic effects of morphine alone and with methylprednisolone were examined in 72 patients undergoing arthroscopic knee surgery. Methods: At the end of arthroscopy, patients were allocated randomly to one of four groups to receive intra‐articular administrations of saline, morphine 1 mg, morphine 5 mg or morphine 1 mg with methylprednisolone 40 mg. Preoperative and postoperative pain levels at rest and during movement (active flexion of the knee) were measured by a visual analogue scale (VAS). Postoperative analgesic requirements to alleviate pain were evaluated. Results: Pain scores were significantly lower for the patients who received 5 mg morphine and 1 mg morphine with 40 mg methylprednisolone than for those who received saline or 1 mg morphine. This was accompanied by a decrease in the postoperative consumption of analgesics and prolongation of the duration of pain relief. Conclusions: This study confirms that the analgesic effect of morphine given intra‐articularly is dose dependent and that combination of methylprednisolone with morphine has an additive effect on analgesia.

A Succesful Treatment of Avian Influenza İnfection in Turkey

Abstract Avian influenza is a disease characterized with severe pneumonia caused by virus influenza A. Birds and poultry are vectors for spread of this disease. It is diagnosed by clinical evidence and reverse transcription-polymerase chain reaction. Here, we discuss the treatment procedures of a child diagnosed as avian influenza.

An unusual presentation of hepatitis A virus infection : Guillain-Barré syndrome

Few cases of Guillain–Barré syndrome (GBS) that are secondary to acute hepatitis A virus (HAV) infection have been reported in the literature. Only two of them were on children. GBS, now regarded as a clinical syndrome consisting of acute weakness and reduced or absent tendon reflexes, with or without sensory loss, is often preceded by an infectious disease. Although hepatitis A (HA) itself is commonly reported, we report a case where GBS is preceded by HA.

Meningitis following spinal anaesthesia in an obstetric patient.

Meningitis following lumbar puncture and spinal anaesthesia is a rare but serious complication. A 19-year-old woman was administered spinal anaesthesia at another centre prior to a Caesarean section. The following day she experienced headaches. On the fourth day, she started vomiting and having convulsions, and became agitated. Meningitis was diagnosed based on a clinical examination and analysis of a lumbar puncture sample. After 21 days of treatment, she was discharged. Meningitis should be considered in the differential diagnosis of a patient presenting with headaches following spinal anaesthesia. The causes of meningitis following spinal anaesthesia are debated, and it is difficult to distinguish between aseptic and bacterial meningitis. It should be compulsory to wear a face mask while performing a dural puncture.

Comparison of the clinical and neurotoxic effects of diclofenac and ketorolac given intrathecally in rabbits

Intrathecal (IT) drug administration is commonly used in the treatment of acute or chronic pain, and during anesthesia. This study investigates the neurotoxicity and behavioral changes associated with intrathecal administration of ketorolac and diclofenac in rabbits. Fifty New Zealand rabbits were divided randomly into five groups. 2% Evans Blue, 5 ml/kg, was given intravenously to all animals. Five hours later, we injected into the atlanto-occipital space 0.3 ml saline (control), 8–10 mg/kg and 24–30 mg/kg ketorolac (Ketorolac groups 1 and 2) and 1 mg/kg and 3 mg/kg diclofenac (Diclofenac groups 1 and 2). Blood pressure, heart rate, respiratory rate, urinary excretion, arterial blood gases and behavioral changes were monitored immediately and after vascular cannulation, after the injection of Evans Blue, and at three and 60 min after spinal injection. The hot plate test was performed five times. Appetite and aggression were followed until the 7th day, when the spinal cord was removed, and sections were taken from cervical, thoracic and lumbar levels. The sections were dyed with hematoxylin and eosin, and histopathological neurotoxicity scores determined by light microscopy. Blood-brain barrier scores were determined by immunofluorescence microscopy. The histology suggests that intrathecal diclofenac and ketorolac are neurotoxic. summary

Histopathologic changes in liver induced by diclofenac and ketorolac after isoflurane anesthesia in rabbits

Abstract Objective: We studied the postoperative effects of diclofenac and ketorolac on the histopathology of liver in rabbits that had undergone isoflurane anesthesia. Methods: The rabbits were divided into three treatment groups: control group (C), diclofenac group (D) and ketorolac group (K) each comprised 10 rabbits. Three ml 0.9% NaCl in group C, 10 mg kg−1 in group D, 10 mg kg−1 in group K were administered twice a day for three days. At the end of the experimental period, animals were sacrificed, autopsied and liver tissue samples were prepared for histopathologic assessment. Results: Hepatocyte degeneration, sinusoidal dilatation, central vein dilatation, enlargement of the periportal area, mononuclear cell infiltration, pleomorphism of hepatocytes, limiting plate irregularities, increased fibrous tissue and bile duct proliferation were observed in group D. Central vein dilatation, enlargement of periportal area, mononuclear cell infiltration, hepatocyte degeneration, sinusoidal dilatation, bile d...

The detrimental effect of neck pain followed by solitary plasmacytoma resulting in spontaneous quadriplegia: a case report

After complaining of neck pain for 3 weeks, a 36-year-old man suddenly become quadriplegic during a massage session in a traditional Turkish bath. He was immediately transferred to hospital, where the initial examination consisting in plain radiography and magnetic resonance imaging revealed a compression fracture of the fourth cervical vertebra. The patient was immediately treated by anterior vertebral decompression and bone grafting from the iliac crest. Unfortunately, the patient did not respond to surgical intervention and died. Solitary plasmacytoma of the fourth cervical vertebrae was detected at autopsy during forensic examination. Pain and spinal cord compression resulted from solitary plasmacytoma of the vertebral column. However, paralysis, especially quadriplegia, occurs seldom. In this case report, solitary plasmacytoma of the vertebral column associated with neck pain is presented with the relevant pathological and clinical aspects.

Intra-articular sufentanil for pain relief after knee arthroscopy

AbstractWe studied the effect of intra-articular saline or sufentanil after diagnostic knee arthroscopy. In a double-blind randomized study, 30 patients undergoing diagnostic knee arthroscopy without a therapeutic procedure were randomly allocated to two groups receiving intraarticular saline or intra-articular sufentanil (10 μg) at the end of arthroscopy during general anesthesia. Postoperatively and the day after surgery, pain levels at rest and during movement (i.e. active flexion of the knee), measured by a visual analogue scale, were significantly lower in the sufentanil group than in the control group. Moreover, intra-articular sufentanil significantly reduced the postoperative consumption of analgesics.