The relationship between intraoperative body temperature and thiol/disulfide balance in geriatric patients undergoing elective transurethral prostate resection surgery with spinal anesthesia.

OBJECTIVE: We aimed to investigate the relationship between intraoperative body temperature and thiol/disulfide balance in geriatric patients scheduled for elective transurethral prostate resection surgery with spinal anesthesia. PATIENTS AND METHODS: 71 patients classified as categories 1 and 2, according to American Society of Anesthesiologists (ASA) classification, were included in the study. The core temperature of the patients was recorded in the operating room after monitoring, at 5 and 30 minutes after spinal anesthesia. Total thiols, native thiols, disulfide amounts, disulfide/native thiol, disulfide/total thiol, and native thiol/total thiol were calculated as percentages after monitorization (Tpreoperative) and at 60 minutes after spinal anesthesia (Tintraoperative). RESULTS: The disulfide levels in the Tintraoperative period (29±8.9 mmol/L) were higher than the disulfide levels measured in the Tpreoperative period (18.2±8.8 mmol/L) (p<0.001). In the Tpreoperative period, the disulfide/native thiol (%) level was 4.6±2, while the disulfide/total thiol (%) level was 4.2±1.6. In the Tintraoperative period, the disulfide/native thiol (%) level was 8±2.3, while the disulfide/total thiol (%) level was 6.8±1.7. Native thiol/total thiol (%) levels for the Tpreoperative and Tintraoperative periods were 91.5±3.3 mmol/L and 86.3±3.4 mmol/L, respectively. A correlation was found between native, total thiol levels and patient age in the Tpreoperative and Tintraoperative periods. CONCLUSIONS: Oxidative stress can be reduced in geriatric patients with the possibility of developing involuntary perioperative hypothermia by regularly monitoring body temperature and applying warming techniques.

Controversy about the protective role of volume in the frontal sinus after severe head trauma: larger sinus equates with higher risk of death.

The "crumple zone" hypothesis suggests that the paranasal sinuses protect the brain as a zone to distribute and absorb energy after trauma to the head. We investigated the relation between the size of the frontal sinus and mortality in patients with cranial trauma. All patients with head trauma admitted to the ICU between 1 January 2016 and 20 December 2017 were reviewed retrospectively. They were divided into two groups (according to their outcome) : died and survived. The volumes of the frontal sinuses and other trauma-related variables were assessed on computed tomographs (CT) on admission. Admission CT of 33 patients (24 male, and nine female, aged between 18-92 years, mean 43) were obtained. Male patients had significantly larger frontal sinuses than female (10.24 compared with 6.6cm3). Larger sinuses were significantly associated with a worse outcome (p=0.005). The size of the frontal sinus correlates with mortality after cranial trauma. Our findings do not confirm the "crumple zone" hypothesis, and suggest that the larger the sinus, the greater the risk of death. To our knowledge this is a new finding that warrants further validation.

Cerebral embolism following thrombolytic therapy for acute myocardial infarction: the second reported case.

ST-elevation myocardial infarction (STEMI), caused by acute occlusion of the infarct-related coronary artery, is an emergency condition. The primary therapy is restoration of full antegrade flow by either percutaneus coronary intervention (PCI) or thrombolytic therapy (TT). Although primary PCI is superior to TT in patients with STEMI, there are many limitations in clinical practice. TT decreases mortality in STEMI patients, but as experience with thrombolytic agents grows, the potential risks of serious side effects become more apparent. The major complications are bleeding, hypotension and skin rash. We report on a case of cerebrovascular accident (CVA) caused by cerebral emboli following TT. We concluded that the fact that the patient was in arterial fibrillation (AF) was a major contributing factor to her CVA. This is an extremely rare condition, and our case appears to be the second one reported on in the literature.

Chronic subdural hematoma in adults: why does it occur more often in males than females? Influence of patient's sexual gender on occurrence.

AIM: Chronic subdural hematoma (CSDH) is a very common condition seen usually in the later stages of life. The goal of this study was to determine whether there is any influence of patient's sexual gender on occurrence of that hematoma. METHODS: The study was carried out on 76 consecutive adult patients (40-93-year-old, main 70.86) who underwent surgery for CSDH. The relationship between sex and occurrence was studied. The CSDH series appeared in the literature was also reviewed. Throughout the analysis, P<0.05 was considered statistically significant. RESULTS: A total of 62 (81.6%) patients were males and 14 (19.1%) females, with the male predominance occurring in all groups. The male to female ratio was 4:21. CONCLUSION: Male preponderance in CSDH provides valuable information about human cerebrum. Identification of this relationship may be useful to elucidate the origin and the pathogenesis of CSDH.

Chronic subdural hygroma with thrombocythemia: first case report.

Subdural hygroma is a frequent delayed complication of head trauma. It is a rare form of bleeding. Most hygromas are clinically silent and a few cases have shown slow deterioration in the chronic stage. We report a case of a 72-years-old male presented with a mild headache, consciousness disturbance and gait ataxia after head injury. Cranial computed tomography revealed subdural hygroma. The hygroma was associated to thrombocythemia. The patient was treated with chemotherapy with hydroxyurea with rapid resolution. In conclusion subdural hygroma may resolve spontaneously. Surgery might be deferred except in emergency conditions or in patients with normal neurological findings. Subdural hygroma in patient with thrombocythemia is first time presenting.