Comparison of effects on the oxidant/antioxidant system of sevoflurane, desflurane and propofol infusion during general anesthesia / Comparação dos efeitos da perfusão de sevoflurano, desflurano e propofol sobre o sistema oxidante/antioxidante durante anestesia geral / Comparación de los efectos de la perfusión de sevoflurano, desflurano y del propofol sobre el sistema oxidante/antioxidante durante la anestesia general

BACKGROUND AND OBJECTIVES: Desflurane and sevoflurane are frequently used for maintenance of anesthesia and studies have shown that these anesthetics cause a variety of changes to the oxidative stress and antioxidative defense mechanisms. This study aims to compare the effects of sevoflurane, desflurane and propofol infusion anesthesia on the oxidant and antioxidant systems of patients undergoing laparoscopic cholecystectomy. METHODS: 45 patients between 18 and 50 years with planned laparoscopic cholecystectomy under general anesthetic were included in the study. Patients were divided into three groups on the way to surgery: propofol (group P n: 15), sevoflurane (group S n: 15) and desflurane (group D n: 15). All groups were given hypnotic 2 mg/kg propofol IV, 1 mcg/kg fentanyl IV and 0.1 mg/kg vecuronium IV for induction. For maintenance of anesthesia group S were ventilated with 2% sevoflurane, group D cases were given 6% desflurane and group P were given propofol infusions of 12 mg/kg/h for the first 10 min, 9 mg/kg/h for the second 10 min and 6 mg/kg/h after that. Before induction and after the operation venous blood samples were taken to evaluate the levels of glutation peroxidase, total oxidants and antioxidants. RESULTS AND CONCLUSIONS: The 45 patients included in the study were 22 male and 23 female patients. The demographic characteristics of the groups were similar. In the postoperative period we observed that while sevoflurane and propofol increased antioxidants by a statistically significant level, desflurane increased the total oxidants level by a significant amount compared to levels before the operation. .

JUSTIFICATIVA E OBJETIVOS: Desflurano e sevoflurano são usados com frequência para a manutenção da anestesia e estudos mostraram que esses anestésicos causam alterações variadas nos mecanismos de defesa antioxidante contra o estresse oxidativo. Este estudo teve como objetivo comparar os efeitos de anestesias com perfusão de sevoflurano, desflurano e propofol sobre os sistemas oxidante/antioxidante de pacientes submetidos à colecistectomia laparoscópica. MÉTODOS: Foram incluídos no estudo 45 pacientes entre 18 e 50 anos, agendados para colecistectomia laparoscópica sob anestesia geral. Os pacientes foram divididos em três grupos para receberem propofol (Grupo P, n = 15), sevoflurano (Grupo S, n = 15) e desflurano (Grupo D, n = 15). Todos os grupos receberam 2 mg/kg de propofol IV, 1 mcg/kg de fentanil IV e 0,1 mg/kg de vecurônio IV para indução. Para manutenção da anestesia, o Grupo S recebeu ventilação com sevoflurano a 2%, o Grupo D recebeu desflurano a 6% e o Grupo P recebeu propofol em perfusões de 12 mg/kg/h nos primeiros 10 minutos, 9 mg/kg/h nos 10 minutos seguintes e 6 mg/kg/h subsequentemente. Antes da indução e depois da cirurgia, amostras de sangue venoso foram colhidas para avaliar os níveis de glutationa peroxidase e o total de oxidantes e antioxidantes. RESULTADOS E CONCLUSÕES: Dos 45 pacientes incluídos no estudo, 22 eram do sexo masculino e 23 do feminino. As características demográficas dos grupos eram semelhantes. No período pós-operatório, observamos que enquanto sevoflurano e propofol aumentaram os antioxidantes a um nível de significância estatística, desflurano aumentou o nível total de oxidantes em quantidade significativa, em comparação com os níveis pré-operação. .

JUSTIFICACIÓN Y OBJETIVOS: El desflurano y el sevoflurano son usados a menudo para el mantenimiento de la anestesia, y hay estudios que mostraron que esos anestésicos causan diversas alteraciones en los mecanismos de defesa antioxidante contra el estrés oxidativo. El objetivo de este estudio es comparar los efectos de las anestesias con perfusión de sevoflurano, desflurano y propofol sobre los sistemas oxidante/antioxidante de pacientes sometidos a colecistectomía laparoscópica. MÉTODOS: Fueron incluidos en el estudio 45 pacientes entre 18 y 50 años programados para colecistectomía laparoscópica bajo anestesia general. Los pacientes fueron divididos en 3 grupos para recibir propofol (grupo P, n = 15), sevoflurano (grupo S, n = 15) y desflurano (grupo D, n = 15). Todos los grupos recibieron 2 mg/kg de propofol IV, 1 µg/kg de fentanilo IV y 0,1 mg/kg de vecuronio IV para inducción. Para el mantenimiento de la anestesia, el grupo S recibió ventilación con sevoflurano al 2%, al grupo D se le administró desflurano al 6% y el grupo P recibió propofol en perfusiones de 12 mg/kg/h en los primeros 10 min, 9 mg/kg/h en los 10 min siguientes y 6 mg/kg/h subsecuentemente. Antes de la inducción y después de la cirugía, fueron extraídas muestras de sangre venosa para evaluar los niveles de glutatión peroxidasa y el total de oxidantes y antioxidantes. RESULTADOS Y CONCLUSIONES: De los 45 pacientes incluidos en el estudio, 22 eran del sexo masculino y 23 del femenino. Las características demográficas de los grupos eran similares. En el período postoperatorio observamos que mientras el sevoflurano y el propofol aumentaron los antioxidantes a un nivel de significación estadística, el desflurano aumentó el nivel total de oxidantes en una cantidad significativa, en comparación con los niveles preoperatorios. .

The relationship between ischemic stroke and weather conditions in Duzce, Turkey / 世界急诊医学杂志（英文）

BACKGROUND: Weather conditions are thought to increase the risk of stroke occurrence. But their mechanism has not yet been clarified. We investigated possible relationships between ischemic stroke and weather conditions including atmospheric pressure, temperature, relative humidity, and wind speed. METHODS: One hundred and twenty-eight patients with ischemic stroke who had been admitted to our hospital between January 1 and December 31, 2010 were enroled in this study. We investigated the relationship between daily cases and weather conditions the same day or 1, 2, and 3 days before stroke. RESULTS: A negative correlation was found between maximum wind speed and daily cases 3 days before stroke. As the relationship between daily cases and changes of weather conditions in consecutive days was evaluated, a negative correlation was found between daily cases and change of atmospheric pressure in the last 24 hours. CONCLUSIONS: The maximum wind speed 3 days before stroke and change of atmospheric pressure in the last 24 hours were found to increase the cases of ischemic stroke. We recommend that individuals at risk of ischemic stroke should pay more attention to preventive measures, especially on days with low maximum wind speed, on subsequent 3 days, and on days with low atmospheric pressure in the last 24 hours.

Acute intoxication cases admitted to the emergency department of a university hospital / 世界急诊医学杂志（英文）

@#BACKGROUND: This study aimed to describe the clinical and socio-demographic aspects of acute poisoning in 2010 in Duzce City, Northwest Anatolian Region of Turkey. METHODS: Acute poisoning was due to the intentional ingestion of drugs in young and adult people (≥16), who were treated at the Emergency Service of Duzce University Medical Hospital, Turkey from January 1, 2010 to December 31, 2010. In this retrospective and descriptive study, 95 patients were diagnosed with intoxications and 30 of them intentionally ingested drugs to commit suicide. Records of the patients diagnosed with intoxication were obtained from the Clinical Archive of the hospital. Their diagnoses were established according to the International Statistical Classification of Diseases and Related Health Problems. Codes X60-X84 of this classification were used to classify self-infringed drug injuries and drug poisoning. RESULTS: In this series, 35 (36.8％) patients were male and 60 patients (63.2％) female. The male/female ratio was 1.0/1.7. The mean age of the patients was 33.1±14.2 years; 17 (17.9％) patients were below 20 years old and 9 (9.5％) were older than 50 years. Of these patients, 29 (30.5％) were single, 7 (7.4％) divorced or separated, and 59 (62.1％) married. Their mean time for admission to the emergency service after the incident was 208±180 (15–660) minutes. The mean time for admission to the emergency service for patients with food intoxication after the incident was 142±160 minutes, for those with drug intoxication 173±161 minutes, for those with carbon monoxide (CO) intoxication 315±209 minutes, and for those with undefined intoxication 289±166 minutes (P=0.005). Most of the intoxication cases occurred in winter (41.1％, 39 of 95 patients). Admissions to the emergency service were most common in December and April (21 and 16 of 95 patients, respectively). Sixty-five (68.4％) cases were involved in non-deliberate poisoning, whereas 30 (31.6％) were involved in deliberate poisoning. Twenty-six of the 95 patients with acute poisonings had mortality risk at admission, however only one died from CO intoxication in the emergency service (1.1％). Suicide attempts were more common in females than in males (21 of 30 patients, 70％, P<0.05). CONCLUSION: In Duzce City of Turkey, most intoxication cases occurred in winter, especially in December. They had non-deliberate poisoning, but deliberate poisoning in suicide attempts was more common in females than in males.

Suicidal ingestion of potassium permanganate / 世界急诊医学杂志（英文）

BACKGROUND: Potassium permanganate is used clinically as an antiseptic and antifungal agent. Ingestion of potassium permanganate may result in damage to the upper gastrointestinal tract. Burns and ulceration of the mouth, esophagus and stomach occur due to its action. Emergency endoscopy is useful to assess the severity of damage and also to guide management.METHODS: We reported a patient presenting to the emergency department after suicidal ingestion of potassium permanganate.RESULTS: After treatment, the patient was discharged home on the 7th day after admission.CONCLUSION: Early emergency endoscopy should be considered to determine the extent of upper gastrointestinal damage in the emergency department.

Combined bilateral asymmetric hip dislocation and anterior shoulder dislocation / 世界急诊医学杂志（英文）

BACKGROUND: Traumatic bilateral hip dislocation is a rare condition. Anterior shoulder dislocation combined with this condition is even a rare occurrence. A 57-year-old man had bilateral asymmetric hip dislocation with a posterior wall fracture of the left acetabulum associated with right shoulder anterior dislocation caused by falling down from a cherry tree. Traumatic hip dislocation and anterior shoulder dislocation represent a true orthopedic emergency. METHODS: Closed reduction was performed immediately for three of the dislocated joints. Posterior wall fracture of the left acetabulum was treated with open reduction and internal fixation by screws. Because of the severity of associated complications like aseptic necrosis or posttraumatic osteoarthritis, efforts were made to ensure prompt diagnosis, therapy and prognosis. RESULTS: The patient was successfully treated by open reduction and internal fixation of the left acetabulum, and discharged from the hospital. CONCLUSION: Traumatic asymmetric hip dislocation and anterior shoulder dislocation are an orthopedic emergency and early diagnosis with immediate reduction of the dislocation is the key determinants of excellent result of treatment.

Effects of Urtica dioica on hepatic ischemia-reperfusion injury in rats

OBJECTIVES: To evaluate the effects of Urtica dioica on hepatic ischemia-reperfusion injury. METHODS: Thirty adult male Wistar albino rats were divided into three groups: sham group (group 1), control group (group 2), and Urtica dioica group (group 3). All the rats were exposed to hepatic ischemia for 60 min, followed by 60 min of reperfusion. In group 2, a total of 2 ml/kg 0.9 percent saline solution was given intraperitoneally. In group 3, a total of 2 ml/kg Urtica dioica was given intraperitoneally. At the end of the procedure, liver tissue and blood samples were taken from all rats. Serum aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, ceruloplasmin, catalase, paraoxonase, arylesterase, and lipid hydroperoxide levels were measured. Liver tissue histopathologies were also evaluated by light microscopy. RESULTS: Serum aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase levels were significantly higher in group 2 than in group 1, and significantly lower in group 3 than in group 2. Also, group 2 had higher serum lipid hydroperoxides and ceruloplasmin levels but lower catalase, paraoxonase, and arylesterase levels than group 1. In group 3, serum lipid hydroperoxides and ceruloplasmin levels were significantly lower, and catalase, paraoxonase, and arylesterase levels were higher than those in group 2. Histopathological examination showed that liver tissue damage was significantly decreased in group 3 compared with group 2. CONCLUSIONS: Urtica dioica has a protective effect on the liver in hepatic ischemia-reperfusion-injured rats.