effect of magnesium sulfate clinical, chemical, and immunological responses to surgery

The present study was carried out on 30 adult patients scheduled for elective cholecystectomy under the effect of general anesthesia. Patients were randomly allocated to two equal groups. Patients in group I [GI], received 40-ml intravenuos [i.v.] saline before the induction of anesthesia, Patients in group II [GII], received 60 mg/kg i.v. magnesium sulfate 10% as loading dose before induction of anesthesia then 1 g/h magnesium sulphate 10% for 10 hours starting at the time of induction of anesthesia. The results of this current study showed that, the administration of fentanyl or in combination with magnesium before induction of anesthesia can attenuate the hemodynamic response to tracheal intubation and surgery. There was a significant increase in fasting blood sugar in the studied groups immediately post operative compared with pre operative values. After 24 hours, there was a persistent impairment of glucose utilization in GII. Magnesium decreased significantly in GI and increased significantly in GII immediately postoperative compared with pre operative values. It returned nearly to preoperative values after 24 hours in the studied groups. There was a significant hypokalemia immediately postoperative in GII. Triglycerides decreased significantly at 24hours postoperative compared with preoperative values in the studied groups. Cholesterol decreased significantly immediately and 24h postoperative compared with preoperative value in GII. Cortisol level decreased significantly at 24h postoperative in GII compared with GI. While epinephrine level decreased significantly immediately postoperative in GII compared with GI. There was no significant difference in norepinephrine level between the studied groups. Soluble interleukine 2 receptors did not significantly change at any time postoperative in the same group or in comparison between the two studied groups. In conclusion combination of magnesium and fentanyl before induction of anesthesia can attenuate the hemodynamic response to tracheal intubation and surgery. Hypomagnesemia is a frequent finding immediately postoperative. Magnesium sulfate significantly reduced cholesterol levels up to 24h postoperative but cannot attenuate hyperglycemic response to surgery. Magnesium sulfate can attenuate epinephrine and cortisol release in response to surgery immediately and at 24h post operative respectively. Therefore the co administration of magnesium with fentanyl before anesthesia is highly recommended to attenuate the hemodynamic, endocrinal and metabolic responses to surgery

Some biochemical markers of bone formation and bone resorption in elderly patients with hip fracture

Serum concentrations of some biochemical markers of bone turnover were measured in 40 elderly patients who sustained hip fracture. They were 20 elderly males and 20 postmenopausal females showing different grades of radiological and histopathological osteoporosis. In addition, 20 radiologically free subjects [10 postmenopausal females, and 10 elderly males] served as controls. To all studied subjects the following bone markers were done: serum osteocalcin, serum total and bone specific alkaline phosphatase and urinary hydroxyproline.Serum total and ionized calcium, inorganic phosphorus and urinary calcium were also estimated. Markers of bone formation: osteocalcin and bone specific alkaline phosphatase were significantly increased in postmenopausal female patients and elderly male patients. Urinary hydroxyproline, a marker of bone resorption was also significantly increased in these two groups when compared to the controls. Based on some biochemical data [and not radiological] osteomalacia could be suspected in 20% of postmenopausal female patients and 15% of elderly male patients. These data are suggestive of high rate of bone turnover in such elderly patients where bone resorption exceeds bone formation leading to low skeletal mass which has an essential role in bone fracture

impact of some biliary oxidative parameters and proteins on gallbladder lithogenicity

Gallbladder bile from thirty patients undergoing elective cholecystectomy for calcular and noncalcular chronic cholecystitis were included in this study. Normal bile was also aspirated from gallbladders of 10 subjects undergoing surgery for surgical conditions not involving liver or biliary tract [control group]. The present work aimed at studying some proteins and some oxidative state parameters in gallbladder bile of normal subjects and patients with calcular and noncalcular cholecystitis and their possible contribution in gallbladder lithogenicity. Collected bile was examined for total cholesterol, bilirubin, proteins, mucoproteins and procollagen Ill peptide. Protein and glycoprotein fractionation was done by polyacrilamide gel electrophoresis. In addition some oxidative state parameters were done biliary ferritin, superoxide dismutase [SOD] glutathione and thiobarbituric acid reactive substances [TBARS]. It could be noticed that: there was an increase in total biliary proteins and mucoproteins in gall stone formers than in controls. Pronucleating glycoproteins of 130 KD and 42 KD were found in higher frequency in the calcular than noncalcular and control groups. Antinucleating 58 KD glycoprotein and 120 KD protein were found in higher frequency in controls than in calcular groups. As regards the oxidative state prameters studied, mean values for SOD, glutathione and ferritin were significantly lower in calcular and noncalcular groups when compared to control group and TBARS were significantly higher. It could be concluded that the state of increased oxidative stress in bile of calcular group and also the biliary protein pattern may contribute to the Iithogenicity of bile

Some biochemical aspects associated with accelerated atherosclerosis in chronic renal failure

This study included fifteen patients diagnosed as chronic non-nephrotic renal failure to whom dialysis had never been done and thirty patients diagnosed as chronic non-nephrotic renal failure who were under maintenance hemodialysis for at least one year. In addition a control group of 10 healthy subjects of matched age, sex and socioeconomic status was included in the study. To all subjects the following was done: serum Lp[a], apolipoprotein-B, Thiobarbituric acid reactive substances [TBARS] and lipid profile. Serum Lp[a] was found to be higher in both chronic renal failure groups, either dialyzed or un-dialyzed, when compared to controls. TBARS levels were significantly elevated in both dialyzed and undialyzed group of patients than the control group. The prevalence of cardiovascular diseases was 20% in the non-dialyzed group of patients and 40% in the dialyzed group in-spite of the normal or subnormal serum total cholesterol. This point out to the possibility that other lipoprotein abnormalities such as the increased Lp[a] and increased lipid peroxidation are probably incriminated in the prevalence of accelerated atherosclerosis. It could be concluded that Lp[a] is an independent risk factor for atherosclerosis in chronic renal failure patients. This risk increases with the process of hemodialysis. Increased lipid peroxidation in these patients is an additional factor for the accelerated atherosclerosis