Saban Yalcin

Isolated type I pelvic cystic echinococcosis mimicking ovarian tumor

Context: Cystic echinococcosis is an endemic infestation with unique clinical and laboratory manifestations. Isolated pelvic type 1 cystic echinococcosis is a rare form of the disease with diagnostic pitfalls mainly based on non-diagnostic imaging findings. Case Report: We present an isolated pelvic cystic echinococcosis resembling ovarian tumor which was diagnosed during operation. Conclusions: Characteristic findings of hydatid disease lacks in type 1 and cause diagnostic difficulties. This rare entity should be considered for differential diagnosis due to varied examination findings especially in type 1 cystic echinococcosis.

Effects of sevoflurane and desflurane on oxidative stress during general anesthesia for elective cesarean section

SummaryBackgroundAnesthetic agents might considerably influence maternal-fetal oxidative stress and antioxidants during cesarean section (CS). The aim of this study was to investigate the effects of desflurane and sevoflurane on oxidative stress parameters both in mothers and newborns undergoing elective CS.Materials and methodsEighty ASA physical status I–II, term parturients undergoing elective CS under general anesthesia were randomized to desflurane (Group D) and sevoflurane (Group S) groups. Blood samples were collected from mothers before operation and postoperatively and umbilical artery samples were obtained at delivery. Total oxidant status (TOS), total antioxidant capacity (TAC) status, lipid hydroperoxide (LOOH), and free sulfhydryl (–SH) levels were measured and oxidative stress index was calculated. Secondary outcomes included maternal hemodynamics.ResultsPreoperative LOOH, TOS, OSI, TAC, and –SH levels were similar among groups. Postoperative maternal serum LOOH, TOS, and OSI levels were significantly increased in Group D compared to Group S (p = 0.003, p = 0.005, p = 0.04; respectively). Postoperative umbilical artery LOOH, TOS, OSI levels were also significantly increased in Group D compared to Group S (p = 0.04, p = 0.02, p = 0.01; respectively). Postoperative TOS (p = 0.001, < 0.001 respectively) and OSI (p = 0.003, < 0.001 respectively) levels in both Group D and Group S were statistically significantly decreased compared to preoperative levels. Postoperative LOOH and –SH levels in Group S (p = 0.04, 0.029 respectively) were statistically significantly decreased compared to preoperative levels. There were no significant differences in TAC and –SH levels among groups (p = nonsignificant [n.s.]). Maternal perioperative mean blood pressure and heart rate were similar among groups (p = n.s.).ConclusionOxidative stress indices might be modified with preferred anesthetic agent and sevoflurane showed more favorable effects than desflurane in view of oxidative stress.ZusammenfassungHintergrundAnästhetika könnten den materno-fötalen oxidativen Stress und Antioxidantien während einer Sectio Caesarea (CS) erheblich beeinflussen. Ziel der vorliegenden Studie war es, die Wirkungen von Desfluran und Sevofluran auf Parameter des oxidativen Stresses sowohl bei Müttern, die sich einer elektiven CS unterziehen, als auch bei deren Neugeborenen zu untersuchen.Material und MethodenAchtzig zum Termin mittels elektiver CS unter Allgemeinnarkose Gebärende im ASA physikalischen Status I–II wurden randomisiert entweder Desfluran (Gruppe D) oder Sevofluran (Gruppe S) zugeteilt. Blutproben wurden von den Müttern prä- und postoperativ abgenommen, Nabelschnurblut bei der Geburt. Der Gesamt-Oxidations-Status (TOS), die totale antioxidative Kapazität (TAC), Lipid Hydroperoxid (LOOH) sowie die freien Sulfhydrylgruppen (–SH) wurden bestimmt. Der oxidative Stress Index (OSI) wurde berechnet. Die Hämodynamik der Mutter war ein sekundäres Outcome.ErgebnisseDie präoperativen LOOH, TOS, OSI, TAC und –SH Konzentrationen waren bei beiden Gruppen ähnlich. Die postoperativen mütterlichen LOOH, TOS, OSI Serum Konzentrationen waren in Gruppe D im Vergleich zur Gruppe S signifikant erhöht (p = 0,003, p = 0,005, p = 0,04; respektive). Postoperative Nabelschnur-Arterien Werte von LOOH, TOS, OSI waren in Gruppe D im Vergleich zur Gruppe S auch signifikant erhöht (p = 0,04, p = 0,02, p = 0,01; respektive). Postoperative TOS (p = 0,001, < 0,001 respektive) und OSI (p = 0,003,< 0,001 respektive) Werte waren sowohl in Gruppe D als auch Gruppe S statistisch signifikant im Vergleich zu den präoperativen Werten erniedrigt. Postoperative LOOH und –SH Konzentrationen waren in Gruppe S (p = 0,04, 0,029 respektive) im Vergleich zu präoperativen Werten statistisch signifikant erniedrigt. Auch die postoperative LOOH und –SH Werte der Gruppe S (p = 0,04, 0,029 respektive) waren im Vergleich zu den präoperativen Werten statistisch signifikant erniedrigt. Es bestand kein signifikanter Unterschied der TAC und –SH Werte zwischen den Gruppen (p = nicht signifikant [n.s.]). Auch der mittlere perioperative Blutdruck und die Herzfrequenz waren bei beiden Gruppen ähnlich (p = n.s).SchlussfolgerungenOxidative Stress Indikatoren können durch das bevorzugte Anästhetikum beeinflusst werden. Sevofluran zeigte bezüglich oxidativen Stress günstigere Wirkungen als Desfluran.

Oxigênio Suplementar em Cesariana Eletiva sob Raquianestesia: Manejar um Punhal com Cuidado

BACKGROUND AND OBJECTIVES We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1st and 5th minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Prophylaxis with recombinant-activated factor VII (rFVIIa) for minimally invasive surgery in a patient with congenital factor VII deficiency: a case report with a single-low dose of rFVIIa.

Congenital factor VII deficiency is a rare autosomal-recessive disorder and surgery in patients with factor VII deficiency has been reported to be endangered by intraoperative or postoperative bleeding, unless a replacement therapy is used. In this paper, we report a successful prophylaxis with single and low dose rFVIIa (12.5 μg kg−1) in a 22-year-old homozygote factor VII deficient patient who underwent laparoscopic gynecologic surgery. Minimally invasive surgeries, such as laparoscopic surgery, could be safely performed in patients with congenital factor VII using single and low dose rFVIIa combined with vigilant clinical observation and laboratory examination.

Curcumin and dexmedetomidine prevents oxidative stress and renal injury in hind limb ischemia/reperfusion injury in a rat model

Abstract Curcumin and dexmedetomidine have been shown to have protective effects in ischemia–reperfusion injury on various organs. However, their protective effects on kidney tissue against ischemia–reperfusion injury remain unclear. We aimed to determine whether curcumin or dexmedetomidine prevents renal tissue from injury that was induced by hind limb ischemia–reperfusion in rats. Fifty rats were divided into five groups: sham, control, curcumin (CUR) group (200 mg/kg curcumin, n = 10), dexmedetomidine (DEX) group (25 μg/kg dexmedetomidine, n = 10), and curcumin–dexmedetomidine (CUR–DEX) group (200 mg/kg curcumin and 25 μg/kg dexmedetomidine). Curcumin and dexmedetomidine were administered intraperitoneally immediately after the end of 4 h ischemia, just 5 min before reperfusion. The extremity re-perfused for 2 h and then blood samples were taken and total antioxidant capacity (TAC), total oxidative status (TOS) levels, and oxidative stress index (OSI) were measured, and renal tissue samples were histopathologically examined. The TAC activity levels in blood samples were significantly lower in the control than the other groups (p < 0.01 for all comparisons). The TOS activity levels in blood samples were significantly higher in Control group and than the other groups (p <  0.01 for all comparison). The OSI were found to be significantly increased in the control group compared to others groups (p < 0.001 for all comparisons). Histopathological examination revealed less severe lesions in the sham, CUR, DEX, and CUR–DEX groups, compared with the control group (p < 0.01). Rat hind limb ischemia–reperfusion causes histopathological changes in the kidneys. Curcumin and dexmedetomidine administered intraperitoneally was effective in reducing oxidative stress and renal histopathologic injury in an acute hind limb I/R rat model.

Supplemental oxygen in elective cesarean section under spinal anesthesia: Handle the sword with care.

BACKGROUND AND OBJECTIVES We aimed to investigate the effect of 21% and 40% oxygen supplementation on maternal and neonatal oxidative stress in elective cesarean section (CS) under spinal anesthesia. METHODS Eighty term parturients undergoing elective CS under spinal anesthesia were enrolled in the study. We allocated patients randomly to breathe 21% (air group) or 40% (oxygen group) oxygen from the time of skin incision until the end of the operation. We collected maternal pre- and post-operative and umbilical artery (UA) blood samples. Total antioxidant capacity (TAC), total oxidant status (TOS) and the oxidative stress index (OSI) were measured. RESULTS Age, weight, height, parity, gestation week, spinal-skin incision time, skin incision-delivery time, delivery time, operation time, 1(st) and 5(th) minutes Apgar scores, and birth weight were similar between the groups (p > 0.05 for all comparisons). There were no differences in preoperative TAC, TOS, or OSI levels between the groups (p > 0.05 for all comparisons). Postoperative maternal TAC, TOS and OSI levels significantly increased in the oxygen group (p = 0.047, < 0.001 and 0.038, respectively); umbilical artery TAC levels significantly increased in the oxygen group (p = 0.003); and umbilical artery TOS and OSI levels significantly increased in the air group (p = 0.02 and < 0.001, respectively). CONCLUSIONS The difference in impact on maternal and fetal oxidative stress of supplemental 40% compared to 21% oxygen mandates further large-scale studies that investigate the role of oxygen supplementation during elective CS under spinal anesthesia.

Adição de 75 mg de pregabalina ao regime analgésico reduz escores de dor e consumo de opiáceos em adultos após nefrolitotomia percutânea

BACKGROUND AND OBJECTIVES Adding novel adjunctive drugs like gabapentinoids to multimodal analgesic regimen might be reasonable for lessening postoperative pain scores, total opioid consumption and side effects after percutaneous nephrolithotomy. We aimed to evaluate the effect of pregabalin on postoperative pain scores, analgesic consumption and renal functions expressed by creatinine clearance (CrCl) and blood neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels in patients undergoing percutaneous nephrolithotomy (PCNL). METHODS 60 patients undergoing elective PCNL were enrolled in the study. Patients were randomized to oral single dose 75 mg pregabalin group and a control group. Visual Analog Scale pain scores (VAS), postoperative intravenous morphine consumption during the first 24 postoperative hours, serum NGAL, Cys C levels and creatinine clearance (CrCl) was measured preoperatively and post-operatively at 2nd and 24th hour. RESULTS Postoperative VAS scores were significantly decreased in the pregabalin group at the postoperative 30th min, 1st, and 2nd hour (p = 0.002, p = 0.001 and p = 0.027, respectively). Postoperative mean morphine consumption was statistically significantly decreased for all time intervals in the pregabalin group (p = 0.002, p = 0.001, p = 0.001, p = 0.001, p < 0.001, respectively). No statistically significant differences were found between the two groups with regard to CrCl, or Cys C at preoperative and postoperative 2nd and 24th hour. Postoperative 24th hour NGAL levels were significantly decreased in the pregabalin group (p = 0.027). CONCLUSIONS Oral single-dose preemptive 75 mg pregabalin was effective in reducing early postoperative pain scores and total analgesic consumption in patients undergoing PCNL without leading to hemodynamic instability and side effects.

Propofol and Additives Please Consider Zebras Besides Horses When You Hear Hooves

To the Editor: We read with great interest the article by Schilling et al. dealing with effects of sevoflurane and desflurane as volatile anesthetics compared with propofol as an intravenous anesthetic and the relationship between pulmonary and systemic inflammation in patients undergoing open thoracic surgery. Authors remarked that proinflammatory cytokines increased in the ventilated lung after one lung ventilation. Mediator release was more enhanced during propofol anesthesia compared with desflurane or sevoflurane administration. Postoperatively, the proinflammatory cytokines tumor necrosis factor(P 0.001), interleukin-1 (IL-1 ) (P 0.002), and interleukin 8 (IL-8) (P 0.025) were more increased in patients during propofol administration compared with both volatile anesthesia groups, and postoperative serum concentration of IL-6 was increased in all patient groups after thoracic surgery (P 0.001). The authors concluded that onelung ventilation increases the alveolar concentrations of proinflammatory mediators in the ventilated lung. Both desflurane and sevoflurane suppress the local alveolar, but not the systemic, inflammatory responses to one-lung ventilation and thoracic surgery. Lung injury after thoracic surgery is a relatively uncommon but major complication with high mortality. Many factors, including cytokine imbalance, ischemia reperfusion injury, and the use of one-lung ventilation, are involved in this process apart from the surgical insult itself. In our opinion, a point of this work is not sufficiently clear. EDTA and sulfite might be added as antimicrobial agents to several formulations of propofol, which may have different physiologic responses. Herr et al. showed that the patients in the surgical intensive care unit receiving propofol with EDTA had significantly reduced mortality rates at 7 and 28 days compared with those receiving propofol without EDTA. Haitsma et al. compared the effects of propofol with EDTA, propofol with sulfite, and ketamine/midazolam on tumor necrosis factor, interleukin-6 (IL-6), and macrophage inflammatory protein-2 in an animal study. They showed that bronchoalveolar lavage IL-6 was significantly higher in the propofol with sulfite group compared with both the ketamine/ midazolam and the propofol with EDTA groups. They also remarked that pulmonary IL-6 can be modulated by additives in systemic anesthesia. Accordingly, we think that reporting detailed formula of propofol in studies evaluating the effect of propofol on inflammatory responses would be crucial, and we hope that the previously mentioned comments might add to the value of the manuscript by Schilling et al.

Caudal anesthesia in Hurler's syndrome.

agement should be based on individual and thorough preanesthesia airway assessment for each patient; it should be noted that not all children and adolescents with alpha-mannosidosis would be able to perform a lung function test and this introduces a bias in our observations. All patients should be carefully observed postoperatively, e.g., for airway edema (which in comparable disorders poses a high risk). Premedication with an anxiolytic drug (e.g., midazolam) and prophylaxis for postoperative nausea and vomiting should be considered. We recommend that anesthesia for patients with alpha-mannosidosis should be performed in centers experienced in anesthesia for patients with rare metabolic disorders.

Rocuronium-sugammadex as an alternative to succinylcholine in electroconvulsive therapy

To the Editor:We read with great interest the article by Hoshi et al. [1]dealing with the recovery time from neuromuscularblockade induced by rocuronium combined with sug-ammadex versus succinylcholine during electroconvulsivetherapy (ECT). Sugammadex has recently been introducedas a fast-acting, selective relaxant-binding agent that wasspecifically designed to rapidly reverse rocuronium-induced neuromuscular blockade. This study is interestingfor anesthesiologists who frequently encounter ECT ses-sions in their operating rooms and are waiting for safeagents that rapidly reverse neuromuscular blockade in thissubgroup of patients. The authors revealed that recoverytime of T1 to 10 and 90% in the rocuronium–sugammadexgroup was shorter than in the succinylcholine groupalthough the difference was not statistically significant. Theauthors also revealed that seizure duration with succinyl-choline (33 ± 8 s) was shorter than that with rocuronium–sugammadex (39 ± 4 s) and reported a potential benefit ofthe use of rocuronium–sugammadex as an alternative tosuccinylcholine for muscle relaxation during ECT [1]. Inour opinion, some points of this work are not sufficientlyclear.The authors reported a tendency to shorter time torecovery of T1 to 10 and 90% with rocuronium–sug-ammadex compared with succinylcholine but the differ-ence was not statistically significant (p = 0.26, p = 0.07)and no significant differences in time to first spontaneousbreath and eye opening in response to verbal commandswere found with either muscle relaxant (p = 0.94,p = 0.48). Absence of such a statistically significant dif-ference might be because of the small sample size (n = 5in this clinical report) and/or increased variability of thetime to recovery of T1 to 10 and 90% and the time to thefirst spontaneous breath between the first case and theremaining group. Not only the absence of statisticallysignificant differences between the two medications—possibly—formethodologicalreasons,butalsotheincreasedpercentage of elderly ([65 years) subjects (2/5: 40%)weakens the findings of this report, because reversal ofrocuronium neuromuscular blockade with sugammadex wasfound to be slightly slower in elderly patients [2].Further large-scale prospective studies on sugammadexare mandatory, especially for patients with contraindica-tions to the use of succinylcholine, although the cost ofsugammadex may preclude such trials.References