Antioxidant and Neuroprotective Effects of L-arginine Administration After Traumatic Brain Injury and Hemorrhagic Shock in Rats.

AIM: To investigate the effect of fluid resuscitation and L-arginine administration on oxidant status markers, blood gases, lactate and apoptosis in the brain tissue of a rat model of TBI with hemorrhagic shock. MATERIAL AND METHODS: A total of 60 rats were divided into six groups: control, isotonic saline-treated, 7.5% NaCl-treated (hypertonic saline), L-arginine-treated (100 mg/kg), saline + L-arginine-treated and 7.5% NaCl + L-arginine-treated groups. Closed head contusive weight-drop injuries were performed with hemorrhagic shock in all of the groups. Mean arterial pressure (MAP), pulse rate, lactate, malondialdehyde (MDA), total antioxidant capacity (TAC) and apoptosis were investigated. RESULTS: In a total of 48 rats, MAP levels remained higher than 60 mmHg for 3 hours in all of the treatment groups. The highest MAP values in each group were recorded. Higher MDA and lower TAC levels were observed in the control group than in all of the treatment groups (all p < 0.05). The number of apoptotic cells was highest in the control group and lowest in the L-arginine group. CONCLUSION: L-arginine administration may be an alternative treatment option for individualized fluid resuscitation in patients with TBI and hemorrhagic shock.

Metabolic Characterization of Anterior Mediastinal Masses by 18F-FDG PET/CT

Objectives: To evaluate the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the diagnosis of anterior mediastinal masses. Methods: The oncological 18F-FDG PET/CT images of 41 patients (17 women, 24 men; age: 16-83 years, mean age: 50.5±19.5 years) who attended the nuclear medicine department between November 2016 and September 2017 were retrospectively evaluated for the metabolic characterization of their anterior mediastinal masses. Results: Based on our results, the lesions of 4 patients were benign [maximum standard uptake value (SUVmax) <3] and that of 2 patients were non-tumoral (i.e., tuberculosis and sarcoidosis). The mean dimensions and the SUVmax levels of the malignant lesions were 6.4±3.7 cm and 11.9±9.6, respectively. The pathological results for the malign tumors were thymus tumors (n=8), lymphoma (n=8), lung cancer (n=11), carcinoid metastasis (n=2), thyroid carcinoma (n=2), germ cell carcinoma (n=1), schwannoma (n=1), and sarcoma (n=1). The degree of 18F-FDG accumulation could precisely identify the malign and benign tumors. Conclusion: Thus, contrary to the known causes, it is possible that anterior mediastinal masses originate from structures other than the anterior mediastinal structures. In this study, the lymphoma and lung carcinoma pathology were more frequent than thymic lesions.

Effect of oleanolic acid for prevention of acute lung injury and apoptosis.

BACKGROUND: This study aims to evaluate the efficiency of oleanolic acid on acute lung injury and acute respiratory distress syndrome. METHODS: The study included 70 female Wistar albino rats (weighing 180 to 200 g). We created seven groups, each consisting of 10 rats. Then, we generated acute lung injuries by intra-tracheal peroxynitrite injection in every group except for the control group. We investigated the effect of oleanolic acid. For this purpose, we measured the levels of malondialdehyde, interleukin 1 beta, interleukin 4, interleukin 10 and tumor necrosis factor alpha in the collected blood samples from the rats. In addition, we examined the lung tissue samples histopathologically and assessed the rate of apoptosis. RESULTS: Peroxynitrite injected groups at 24 and 48 h showed a statistically significant increase in interleukin 1 beta, tumor necrosis factor alpha, interleukin 4, interleukin 10 and malondialdehyde levels, which are accepted as mediators of the inflammatory process, compared to the control group. When peroxynitrite injected groups at 24 and 48 h were compared to the treatment groups of the same hour, a statistically significant decrease was detected. According to histopathological examination, peroxynitrite injected groups at 24 and 48 h showed a significant increase of tissue injury scores compared to the control group. However, the groups that were treated with oleanolic acid showed a significant decrease compared to the peroxynitrite groups (p<0.001 for tumor necrosis factor alpha and apoptosis results at 48 h). CONCLUSION: In this study, we confirmed that oleanolic acid can be an effective agent for the prevention of acute lung injury generated via peroxynitrite.

The role of thoracic trauma in inflammatory responses, apoptosis and bacterial translocation following multiple traumas.

BACKGROUND: Blunt chest trauma and its complications are commonly encountered in emergency medicine. Herein, we used a rat model to investigate the role of thoracic trauma in inflammation, apoptosis and bacterial translocation following multiple traumas. METHODS: Ninety Wistar rats were divided equally into nine groups. Rats underwent a standardized blunt thoracic and/or head trauma and were sacrificed 24 or 48 hours after the trauma. Specimens from various organs and blood samples were collected and quantitatively cultured for aerobic organisms. Interleukins, TNF-α, and MCP-1 levels were assessed in the sera and markers of apoptosis were detected in the lungs. RESULTS: Levels of interleukins, TNF-α and MCP-1 in all of the groups undergoing trauma were significantly higher than those of the control group (p=0.001). Levels of apoptotic cells in the groups undergoing head and thoracic trauma (HTT) were significantly higher than those of the control group (p=0.009). Light microscopic evaluation indicated that damage in the HTT groups was significantly higher than that in the control group. The incidence of bacterial translocation was also significantly higher in the HTT groups (p=0.003). CONCLUSION: Multiple inflammatory mediators are activated in multiple traumas (including blunt thoracic trauma), which allow bacterial translocation and apoptotic processes to occur. Our results indicate that thoracic trauma plays a major role in post-traumatic bacterial translocation, inflammation, and apoptosis following multiple traumas.

The effect of octreotide, an analog of somatostatin, on bleomycin-induced interstitial pulmonary fibrosis in rats.

In this study, octreotide (OCT), a synthetic somatostatin analog, was tested for its beneficial effects in the prevention of interstitial pulmonary fibrosis (IPF) induced by bleomycin (BLM) in rats by histological examination and by evaluating tissue OH-proline levels. Thirty male Wistar rats were divided randomly into three groups: group I: intratracheal (i.t.) BLM (7.5 mg/kg, single dose) + saline solution [0.9% NaCl, subcutaneously (s.c.), once-daily for 7 days]; group II: i.t. BLM (7.5 mg/kg, single dose) + OCT acetate (82.5 µg/kg, s.c., once-daily for 7 days); and the control group. At the end of the 7 days, lung tissues were excised and examined by histopathological methods. Levels of tissue hydroxyproline (OH-proline) were determined. BLM administration resulted in prominent histopathologic findings, such as diffuse alveolar damage and interstitial pulmonary fibrosis, as well as a significant increase in OH-proline level, as compared to controls. OCT application explicitly attenuated the histopathologic changes to a significant extent. OCT decreased paranchymal fibrosis and structural deformities in BLM-induced lung fibrosis. These results suggest that OCT administration to rats with BLM-induced IPF has a protective effect. Further studies are necessary to reveal the molecular mechanism(s) of OCT-induced protective effect.

Elastofibroma dorsi: Review of eight cases.

PURPOSE: Elastofibroma dorsi (ED) is a rare, benign soft tissue tumor arising from connective tissue and usually found in the subscapular region. We conducted this retrospective study to contribute to a better understanding of this tumor, the pathogenesis of which is still unclear. METHODS: We reviewed the medical records of eight patients treated for ED at our institution between 2003 and 2008. RESULTS: All patients were right-handed and all except one were female. The tumor was located on the right in two patients, on the left in one, and bilaterally in five. All patients underwent complete marginal resections. The resected tumors ranged in size from 5 cm to 12 cm. The only postoperative complication was seroma, observed in two patients. No recurrences have been observed in follow-up ranging from 15 days to 5 years. CONCLUSIONS: We could not establish a relationship between the side of the dominant hand and the tumor location. If this tumor becomes symptomatic, local excision is the best treatment; however, as malignant transformation has not been reported, follow-up is recommended for asymptomatic lesions.

Efficiency of lornoxicam in lung and trachea injury caused by peroxynitrite.

Peroxynitrite is involved in the pathogenesis of pulmonary diseases such as asthma, occupational pulmonary diseases and acute respiratory distress syndrome (ARDS) due to excessive production of nitric oxide or superoxide or both. Lornoxicam, a new oxicam derivative, is a potent anti-inflammatory agent. In this study, we evaluated the role of lornoxicam in a peroxynitrite-induced pulmonary and tracheal injury model by measuring myeloperoxidase (MPO) activity, malondialdehyde (MDA) and 3-nitrotyrosine (3-NT) levels in lung tissue and bronco-alveolar lavage fluid. The study protocol was based on three experimental groups as treatment (T), control (C) and peroxynitrite (P). Each group was subdivided into three subgroups as 2nd, 24th and 48th hour groups. P and T groups were injected intratracheal peroxynitrite. The T group received intraperitoneal lornoxicam before and 24h after peroxynitrite installation. Tissue and serum MDA, MPO values and tissue 3-NT value of the treatment and control groups were found significantly lower than the peroxynitrite group at the 2nd, 24th and 48th hours (p<0.05). Similarly, values obtained from bronco-alveolar lavage fluid examination in the control and treatment groups were significantly less than those in the peroxynitrite group (p<0.01). Therefore, Lornoxicam has been found to be effective in attenuating peroxynitrite induced pulmonary and tracheal injury in rats.

Blunt thoracic trauma in children: review of 137 cases.

OBJECTIVE: Thoracic injuries are uncommon in children and few report present on blunt ones. METHODS: Between 1994 and 2003, 137 children with blunt thoracic injury were reviewed. RESULTS: The mean age of children was 6.9+/-7.3 (1-16) years. Etiology was falls in 46.7%, traffical accidents in 51% and abuse in 2.2%. Average height in fallen-down cases was 6.4+/-2 (range: 3-11) m. Calculated mean kinetic energy transfer to body was 1923+/-1056 J. When first seen, 70% (82/117) of the patients had vital signs that were within normal limits. Forty-two (35.9%) children had isolated thoracic injury. Associated injuries were present in 75 (64.1%) children. Head injury was the most common associated injury present in 33 (28.2%). Pulmonary contusion was the most common thoracic injury with 68 (49.6%). Seventeen (12.4%) required surgery, 11 (8%) of them were thoracic (4 for diaphragmatic tear, 2 for flail chest, 2 for tracheobronchial injuries, 2 for laceration, 1 for esophageal rupture). Surgical group had higher ISS (26.8 vs 36.2, P = 0.001). Fifteen were lost (10.9%): There were lethal injuries in 7; chest tube treatment in 3; intensive care unit management in 2; mechanical support in 2 and observation in 1 patient. No death occurred for operations. Mortality rate was the lowest at injuries to chest alone and the highest for multi-system injuries (P < 0.05). The hospital length of stay for averaged 13.4+/-8.8 (range: 4-49) days. CONCLUSION: Associated injury is the most important mortality factor. Thoracic operations can be performed with minimal morbidity and without mortality in children with blunt thoracic trauma.

[Flail chest due to blunt trauma: clinical features and factors affecting prognosis]. / Künt travmaya bagli yelken gögüs: Klinik özellikler ve prognozu etkileyen faktörler.

BACKGROUND: We evaluated the clinical features of patients with flail chest, together with treatment results, and the factors affecting prognosis. METHODS: The study included 34 patients (27 males, 7 females; mean age 41 years; range 15-61 years) who underwent treatment for flail chest. A retrospective analysis was made regarding the etiology, injury to the chest wall, pulmonary contusion, hemothorax and pneumothorax requiring chest tube, associated injuries, injury severity score (ISS), the presence of shock on admission, the amount of blood transfusions within the first 24 hours, treatment, and the results. RESULTS: The most common cause of flail chest was traffic accidents (79.4%). Shock was detected in 41.2% and pulmonary contusions in 55.9%. Ventilatory support was required in 70.6%. The mean ISS was 36; mortality occurred in 32.4%. In seven patients without associated injuries and who did not receive ventilatory support, the mean ISS was 22.8 and all survived. However, in 18 patients with associated organ injuries, the mean ISS was 43.6, with mortality being 50% (p<0.05). Factors responsible for prolonged ventilatory support, pneumonia, and septic deaths included ISS above 31, associated fractures and injuries, blood transfusions, the need for chest tube, age equal to or above 50 years, and the presence of bilateral flail chest. The incidences of pneumonia and mortality were significantly less in patients treated with internal fixation (p<0.05). CONCLUSION: Our data show that careful fluid management and effective pain control, stabilization of the chest wall, immediate ventilatory support and early weaning from ventilation are the mainstays of treatment.

Intermittent infusion of 0.25% bupivacaine through an intrapleural catheter for post-thoracotomy pain relief.

BACKGROUND: The present study was designed to evaluate the effectiveness of intrapleural 0.25% bupivacaine delivered by intermittent infusions for post-thoracotomy pain relief. METHODS: Forty patients undergoing elective lobectomy were randomly, but equally, placed into two groups. An intrapleural catheter was inserted under direct vision during surgery. Group I received intrapleural 40 mL of 0.25% bupivacaine, group II was administered 40 mL of saline solution as a control group. Diclofenac sodium was administered as an additional analgesic, if required. Postoperative pain was evaluated using a visual analog scale (VAS), and Prince Henry pain scale. Arterial oxygen saturation, heart rate, and systemic arterial pressures were monitored. All observations were recorded 5, 10, 15, 20, 25, and 30 minutes after the injection, and thereafter at hourly intervals through the postoperative 24 hours. RESULTS: The mean analgesia times were 5 hours and 2 hours in group I and group II, respectively. Therefore, bupivacaine administrations were repeated every 6 hours in group I, and saline with additional analgesic were administered every 4 hours in group II. The heart rate and arterial pressures did not show a significant difference. While the additional analgesic requirement was 180 +/- 10 mg/d in group II, there was no need for additional analgesic administration in the group I patients. Arterial oxygen was significantly higher in group I than in group II. Arterial carbon dioxide tension of group II was significantly higher than that of group I. While the postoperative atelectasis and pneumonia developed in four patients and one, respectively, in group II, no such complication was observed in group I. CONCLUSIONS: The easy placement of an intrapleural catheter and better pain relief observed in the present study suggest that intermittent pleural infusion of 0.25% bupivacaine has proven to be a safe and effective method for relief of post-thoracotomy pain.