Evaluation of the effects of insulin resistance on ECG parameters in obese children.

OBJECTIVE: Obese people are at increased risk of arrhythmia and sudden death, even in the absence of heart dysfunction. Increased insulin resistance, neurohumoral and autonomic changes in obesity can cause atrial and ventricular repolarization abnormalities. This study aimed to investigate the effect on ventricular repolarization parameters and to show the increased risk of ventricular arrhythmia in obese children. PATIENTS AND METHODS: The data of 50 obese children aged 2-18 who applied to the Pediatric Endocrinology Outpatient Clinic were evaluated prospectively. In 12-lead ECGs, heart rate, Pmax, Pmin, P-wave dispersion (Pwdisp), QTmax, QTmin, QT dispersion (QTd), QTcmax, QTcmin, QTc interval dispersion (QTcd), Tpeak-Tend interval (Tp-e), Tp-e/QT, Tp-e/QTc were calculated electronically. RESULTS: Tp-e time (0.041 ± 0.004/0.049 ± 0.015/p=0.018) and Tp parameters were measured in obese children with and without insulin resistance. Tp-e/QT ratio was also found to be high (p=0.035). There is a negative correlation between BMI SDS values and QTcmax and QTcmin values in patients with insulin resistance (p=0.015). CONCLUSIONS: In our study, the Tp-e interval and Tp-e/QT ratios, which had been revealed in literature to be more sensitive in demonstrating ventricular arrhythmias, were found to be higher in obese individuals with insulin resistance than in those without insulin resistance. Obese individuals with or without insulin resistance should be carefully evaluated in terms of atrial and ventricular depolarization and repolarization parameters with 12-lead ECG during their outpatient controls, and annual 24-hour Holter control should be performed to detect arrhythmias.

Closure of transcatheter ventricular septal defect using LifetechTM Konar-MF Occluder in children weighing less than 10 kilograms: mid-term results, a tertiary single center experience.

OBJECTIVE: Transcatheter closure of medium and large ventricular septal defects (VSDs) in young children is limited due to the use of over-sized devices that can cause hemodynamic instability and arrhythmia. In this study, we aimed to retrospectively evaluate the safety and efficacy of the device in the mid-term in children weighing less than 10 kg whose transcatheter VSD was closed only with the Konar-MFO device. PATIENTS AND METHODS: Among 70 children whose transcatheter VSD was closed between January 2018 and January 2023, 23 patients weighing less than 10 kg were included in the study. Retrospectively, the medical records of all patients were reviewed. RESULTS: The mean age of the patients was 7.3 (4.5-26) months. 17 of the patients were females, 6 of them were males, F/M: 2.83. The average weight was 6.1 (3.7-9.9) kg. The mean the pulmonary blood flow/ systemic blood flow (Qp/Qs) was 3.3 (1.7-5.5). The mean defect diameter was 7.8 mm (5.7-11) for the left ventricle (LV) side, and 5.7 mm (3-9.3) for the right ventricle (RV) side. Based on the utilized device dimensions, the measurements on the LV side were recorded as 8.6 mm (range 6-12), while those on the RV side were recorded as 6.6 mm (range 4-10). Antegrade technique was applied to 15 (65.2%) patients and retrograde technique was applied to 8 (34.8%) patients in the closure procedure. The procedure success rate was 100%. The incidence of death, device embolization, hemolysis, or infective endocarditis was zero. CONCLUSIONS: Perimembranous and muscular VSDs in children under 10 kg can be successfully closed under the management of an experienced operator with the Lifetech Konar-MFO device. This is the first study in the literature to evaluate the efficacy and safety of the device in children under 10 kg in whom only Konar-MFO VSD occluder device is used for transcatheter VSD closure.

The alpha-2 receptor agonist dexmedetomidine attenuates vancomycin­induced acute kidney injury.

OBJECTIVE: This study was conducted to evaluate the protective effect of dexmedetomidine on nephrotoxicity and the mechanism of renoprotection following vancomycin-induced nephrotoxicity in rats. METHODS: Thirty-two albino Wistar rats were divided into four groups. The control group received intraperitoneal (IP) physiological saline solution, the vancomycin (VMC) group received IP 200 mg/kg vancomycin, the dexmedetomidine (DEX) group received IP 5 µg/kg dexmedetomidine, and the vancomycin and dexmedetomidine (VMC+DEX) group received IP 200 mg/kg vancomycin followed by IP 5 µg/kg dexmedetomidine 20 min after the vancomycin injection. On the 8th day of the experiment, histopathological and biochemical parameters were assessed. RESULTS: Creatinine levels were significantly higher in VMC and VMC+DEX groups. The endothelin-1 level was significantly higher in VMC group. Nitric oxide levels were statistically lower in VMC and VMC+DEX groups. Histopathologic assessments revealed that the extent of renal damage was significantly higher in group VMC (n = 4 with damage of Grade 3) compared to group VMC+DEX (n = 0 with damage of Grade 3). CONCLUSION: It was determined that dexmedetomidine can reduce the extent of renal damage by preventing the elevation of vasoconstrictor agents (Tab. 2, Fig. 1, Ref. 36).

Comparison of myotoxic effects of levobupivacaine, bupivacaine and ropivacaine: apoptotic activity and acute effect on pro-inflammatory cytokines.

We investigated the myotoxic effects of bupivacaine, ropivacaine and levobupivacaine on rat skeletal muscle and compared its apoptotic activity and acute effects on pro-nflammatory cytokines. We divided 40 Wistar albino rats into four equal groups. Rats were injected intramuscularly with 0.5% bupivacaine (group B), 0.5% ropivacaine (group R), 0.5% levobupivacaine (group L) or 0.9% normal saline (group SF). Animals were sacrificed on the second day after the injection. TNF-α, IL-1 and IL-6 levels were examined in muscle tissue using immunohistochemistry and immunofluorescence. Apoptotic cells were visualized by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay. We found that levobupivacaine caused the lowest TNF-α, IL-1 and IL-6 expression levels, while the bupivacaine group caused the highest level compared to the other two agents. The greatest number of apoptotic cells was found in the bupivacaine group. Bupivacaine was more myotoxic than other anesthetic agents and increased apoptosis. The number of TUNEL positive apoptotic cells was lowest in the SF group. The greatest IL-1 immunoreactivity was found in the bupivacaine group. Bupivacaine and ropivacaine produced greater IL-6 expression than the SF group. Bupivacaine and ropivacaine caused greater TNF-α expression than the SF group, whereas the immunoreactivity of TNF-α was similar in the bupivacaine and ropivacaine groups.

Posterior tibial slope measurement on lateral knee radiographs as a risk factor of anterior cruciate ligament injury: A cross-sectional study.

INTRODUCTION: The posterior tibial slope (PTS) is believed to be a risk factor for anterior cruciate ligament (ACL) injury. The aim of this study was to reveal the differences in terms of PTS measurements on lateral knee radiographs between ruptured and non-injured cases as well as between males and females in regard to ACL alignment. METHODS: The study cohort included 92 patients (61 males and 31 females) with ACL rupture and 101 individuals (59 males and 42 females) who visited the Orthopedics Department but had no ACL injury. PTS measurements on lateral knee radiographs were compared by two blinded reviewers. The results were analyzed in terms of ACL injury and sex differences. The intraclass correlation coefficient was used to calculate interobserver agreements. RESULTS: Notably, there was an excellent agreement between the reviewers with regard to PTS measurements. In addition, although a statistically significant difference existed in terms of PTS measurements between the patient and control groups (p < 0.0001), a significant difference was not observed between males and females (p = 0.179). CONCLUSION: Lateral knee radiographs are useful for PTS measurements to estimate the risk of ACL injury.

A reliable pancreaticojejunal anastomosis with V-Loc 180 wound closure device for soft pancreatic stump.

BACKGROUND/AIMS: Although mortality rates decreased in recent years, pancreaticoduodenectomy is still associated with high morbidity rates. Pancreatic fistula is the leading cause of morbidity after pancreaticojejunal anastomosis and commonly occurs in soft pancreas. The objective of this study is to compare outcomes of conventional modified invaginated end to side pancreaticojejunostomy with a new practical method using V-Loc 'rM 180 wound closure device in soft pancreas. METHODOLOGY: Between December 2011 and August 2013, a total of 90 pancreaticoduodenectomy procedures were performed in our hospital. 28 of them were defined as soft pancreas according to attending surgeon and included in this study. Patients were divided into two groups consecutively and analysed for postoperative pancreatic fistula (POPF) rate, length of stay, operation time, cost and particular duration of anastomosis. Pancreatic fistulas were classified according to International Study Group on Pancreatic Fistula (ISGPF) definition. RESULTS: 1 grade A and 2 grade B fistulas appeared in V-Loc group (Group 1), whereas 1 grade A, 2 grade B and 1 grade C fistulas appeared in conventional anastomosis group (Group 2). CONCLUSIONS: Pancreaticojejunostomy with V-Loc suture is a convenient method in soft pancreas and can be performed safely.

Association of calcium channel blocker use with lower hemoglobin levels in chronic kidney disease.

AIM: To search whether calcium channel blockers (CCBs) are associated with lower hemoglobin levels in chronic kidney disease (CKD) patients who are not on renal replacement therapy (RRT), vitamin D and anti-anemic treatment. PATIENTS AND METHODS: CKD patients were classified into two groups. Patients on CCBs treatment (103 patients) and patients not using CCBs (104 patients) were compared cross-sectionally regarding clinical findings, complete blood count (CBC), biochemistry and regular medication use. Patients with polycystic kidney disease, comorbidities that could influence CBC other than iron deficiency of obscure origin, patients receiving RRT, erythropoietin (EPO), vitamin D, phosphate binders and drugs that could influence CBC were excluded. Under dependent variable of CCB use, all significantly different independent variables were subjected to multivariate binary logistic regression analysis (MBLRA). RESULTS: Lower hemoglobin, lower bilirubinemia, higher serum EPO, higher systolic blood pressure were observed in CCB users. Two groups were similar concerning age, gender, BMI, CKD etiology, CKD stage, pretibial edema prevalence, cardiothoracic index, diastolic blood pressure, corrected reticulocyte count, BUN, creatinine, eGFR, proBNP, parathormone, alkaline phosphatase, phosphorous, corrected calcemia, sCRP, relative EPO deficiency and prevalence of relative EPO deficient patients. Groups were comparable regarding comorbidities, types and usage frequencies of all antihypertensive medications other than CCBs. Higher systolic blood pressure and lower hemoglobin were significantly associated with CCB use after MBLRA. CONCLUSIONS: Hemoglobin was significantly lower in CCB users compared to non-users, among CKD patients who did not receive RRT, EPO, phosphate binders, vitamin D, iron, vitamin B12 and folic acid.

Effects of iloprost on bleomycin-induced pulmonary fibrosis in rats compared with methyl-prednisolone.

OBJECTIVE: Prostacyclin (PGI2) has been shown to inhibit the expression of pro-inflammatory and pro-fibrotic mediators in pulmonary fibrosis. In this study, we aimed to test the preventive effects of intraperitoneally administered iloprost, a stable PGI2 analog, on bleomycin-induced pulmonary fibrosis in rats and to compare the effects of iloprost with the effects of methyl-prednisolone, a traditional therapy. METHODS: Rats were randomly allocated into four groups: 1. Saline alone (n=6); 2. Bleomycin+placebo (n=7); 3. Bleomycin+methyl-prednisolone (n=7); 4. Bleomycin+iloprost (n=7). Fibrotic changes in the lungs were demonstrated by analyzing the cellular composition of bronchoalveolar lavage fluid, histological evaluation and lung hydroxyproline content. RESULTS: Fibrosis was made in the lungs of rats by bleomycin experimentally. Fibrosis scores in the methyl-prednisolone and the iloprost groups were significantly lower than in the placebo group (p<0.05). Furthermore, the score of the iloprost group was significantly lower than the score of the methyl-prednisolone group. The hydroxyproline content was significantly less in the methyl-prednisolone and the iloprost groups (p<0.05). In the placebo group, the neutrophil percentage in bronchoalveolar lavage was significantly higher than in the other groups, whereas the macrophage percentage in placebo group was significantly lower (p<0.05). CONCLUSION: Iloprost has protective effect on the pulmonary fibrosis induced by bleomycin and it may be more effective in decreasing fibrotic changes than methyl-prednisolone.

Advantages of single-stage surgical treatment with salter innominate osteotomy and Pemberton pericapsular osteotomy for developmental dysplasia of both hips.

OBJECTIVE: This study retrospectively compared the clinical and radiological outcomes of patients with bilateral developmental dysplasia of the hip who underwent either a single-stage operation (using a Salter innominate osteotomy for one hip and a Pemberton pericapsular osteotomy for the other hip) or a two-stage procedure comprising consecutive operations. METHODS: Extensive pre- and postoperative clinical, surgical and radiological examinations were undertaken. RESULTS: A total of 63 patients received the single-stage operation (group A), and 55 patients received consecutive operations (group B). There were no significant between-group differences in acetabular index or centre-edge angle correction. Group A had significantly reduced anaesthetic exposure, duration of hospitalization, blood transfusion volume, antibiotic costs and hospitalization costs. Group A also had a lower rate of surgical complications and avascular necrosis than group B. CONCLUSIONS: The single-stage surgical procedure was more economical and allowed more rapid recovery than two consecutive operations. The surgical and anaesthesia team must be highly proficient in order to perform single-stage operations successfully.

Alteration in blood gases in cats naturally infected with Aelurostrongylus abstrusus.

Four cats were presented with respiratory signs and first-stage larvae of Aelurostrongylus abstrusus were found in faecal samples. Anthelmintic treatment was given to the infected cats and venous blood gases were analysed during the treatment period. Blood gas analysis suggested hypoventilation and respiratory acidosis in infected cats. Hypoventilation may be the result of airway obstruction by adults and larvae in respiratory bronchioles and the alveolar canals. The blood gas values had returned close to the physiological range by two months after treatment. Assessment of respiratory acidosis may aid development of additional treatment methods in cats infected with A. abstrusus.

Immunophenotypical profiles of salivary gland tumours: a new evidence for their histogenetic origin.

The histogenetic origin of salivary gland tumours is not clear. In normal tissues smooth muscle actin (SMA) is expressed in myoepithelial cells, CK14 immunoreactivity is seen in myoepithelial and basal cells and CK10 in keratinized squamous epithelium. In this study, we examine the immunophenotypic properties of salivary gland tumours in order to obtain further insight into their histogenesis. 30 cases of salivary gland tumours (18 pleomorphic adenomas, 8 Warthin's tumours, 2 basal cell adenomas, 2 acinic cell carcinomas) were included in our study. Cytokeratin (CK) 10, CKI4, CKI7, CK18, CK 19, and smooth muscle actin (SMA) immunostains were applied to the sections. Immunoreactivities were detected and the statistical significance was evaluated by chi square test. SMA was not detected in Warthin's tumour (p < 0.0001). CK14 was found in all tumours except acinic cell carcinomas (p < 0.0001). CK10 immunoreactivity was observed in 5 Warthin's tumour. In conclusion, pleomorphic adenomas and basal cells adenomas originate from stem cells. Immunophenotypic profile of Warthin's tumour is suggestive of an embryological remnant origin.

Nightmare of lumbar disc surgery: iliac artery injury.

Intra-operative injuries of pelvic vessels are quite infrequent but serious complications of lumbar disc surgery. Injury may cause laceration of the vessel with acute life threatening retroperitoneal haemorrhage, formation of pseudoaneurysms or arteriovenous fistulae in the late phase. It is important for surgeons to be aware of these potentially fatal complications. Authors reported a case of major vascular injury recognised intra-operatively during posterior lumbar discectomy and repaired immediately.

Inhibitory effects of desflurane and sevoflurane on oxytocin-induced contractions of isolated pregnant human myometrium.

BACKGROUND: In this study, we investigated the inhibitory effects of desflurane and sevoflurane on oxytocin-induced contractions of isolated human myometrium. METHODS: Following delivery of the infant and placenta, a small segment of myometrium was excised from the upper incisional surface of the lower uterine segment and 20 strips, randomly assigned into two groups (n = 10), were obtained from 20 non-laboring term parturients. The study protocol consisted of a 60-min period of spontaneous contractions, control recording with oxytocin 2 x 10(9) m (10-min period), washout interval of 10 min, volatile administration (three times per 15-min period) of 0.5, 1 and 2 minimum alveolar concentration (MAC), response to oxytocin (10-min period), a further washout interval (10-min period) and subsequent control recording with oxytocin without anesthetics. RESULTS: After oxytocin administration, the frequency and amplitude of contractions increased (P < 0.05) and the duration decreased (P < 0.05). The frequency and amplitude of contractions induced with oxytocin decreased significantly at 0.5, 1 and 2 MAC of desflurane and sevoflurane (P < 0.05). The amplitude of contractions was significantly different at 1 MAC between the two groups (P < 0.05). The duration of contractions at 2 MAC decreased in both groups (P < 0.05). CONCLUSIONS: Desflurane and sevoflurane at 0.5, 1 and 2 MAC inhibit the frequency and amplitude of myometrial contractions induced with oxytocin in a dose-dependent manner. However, desflurane inhibits the amplitude less than sevoflurane at 1 MAC. We suggest that 0.5 MAC of both agents and 1 MAC of desflurane may be safely used in the presence of oxytocin following delivery of the infant and placenta during Cesarean section without fear of uterine atony and hemorrhage.

Comparison of recovery properties of desflurane and sevoflurane according to gender differences.

BACKGROUND: The aim of this study was to investigate the recovery properties of desflurane and sevoflurane in patients undergoing elective surgery, according to the gender differences. METHODS: In the study, 160 ASA class I-II patients aged between 20 and 60 years were included. The patients were assigned into two groups according to their gender, and these groups were randomly divided into two groups according to a selected volatile anaesthetic agent. Intraoperative bispectral index, time of postoperative achievement for end-tidal concentrations of volatile agents to decline 50% (ET-AA%50), time for extubation, time for eye opening and orientation, and time for bispectral index values to reach control values were recorded. Aldrete scores and error points of a delayed memory recall test were determined. RESULTS: Desflurane groups had a shorter ET-AA%50 time, extubation and eye-opening time in male and female patients compared to the sevoflurane groups, and these results were statistically significant (P < 0.05). In both the desflurane and sevoflurane groups, ET-AA%50 time, extubation and eye-opening time were shorter in male patients than in female patients, and these results were also statistically significant (P < 0.05). There were no significant differences among the groups in terms of Aldrete scores and error points of delayed memory recall test (P > 0.05). CONCLUSION: In conclusion, early recovery time was shorter in male patients compared to female patients in both the desflurane and sevoflurane groups. Additionally, in the desflurane groups it was shorter in the sevoflurane groups for both genders.

Massive cystic tetrathyridiosis in a dog.

This report describes a case of massive cystic tetrathyridiosis in a four-year-old female dobermann. The larvae were distributed in both the peritoneal and pleural cavities, as well as in the lumen of the small intestine along with adult Mesocestoides species. These parasites were identified as tetrathyridia. Numerous cysts were dispersed on the peritoneal, pleural and mesenteric surfaces. The same cysts were seen both on subcapsular surfaces and within sections of the spleen, liver, kidneys and lungs. Histopathological examination also revealed characteristics of tetrathyridium of Mesocestoides species.

Prevalence of hydatidosis and fertility of hydatid cysts in sheep in Kirikkale, Turkey.

This study was conducted in order to determine the prevalence and fertility of hydatid cysts in sheep in Kirikkale, Turkey. A total of 3.2% of 553 lambs and 50.9% of 1320 adults were found to be infected with hydatid cysts. The most common locations of cysts were in the liver and lung. Liver cysts tended to be more fertile than lung cysts (81.53% v. 76.47%), though the difference was not significant. The mean number of viable protoscoleces in the liver and lung cysts were 12,400 and 5,800, respectively. In general, 1-10 cysts were found in liver (51.8%) and lung (64.7%). The findings of this study indicate that hydatid cysts are common in sheep and the fertility rate of cysts is quite high. Sheep play an important role in the life cycle of Echinococcus granulosus in this region.

Inhibitory effects of desflurane and sevoflurane on contractions of isolated gravid rat myometrium under oxytocin stimulation.

BACKGROUND: We studied the inhibitory effects of desflurane and sevoflurane on oxytocin-induced contractions of isolated gravid rat myometrium. METHODS: Twenty strips were obtained from rats and these were randomly assigned into two groups. The effects of desflurane and sevoflurane were evaluated by treating strips with oxytocin alone 2x10-9 M or with oxytocin after desflurane and sevoflurane at 0.5, 1, and 2 MAC. RESULTS: Oxytocin significantly increased the amplitude and duration of contractions (P< 0.05), but it did not increase the frequency. The duration (84%, 79%), amplitude (90%, 84%) and frequency (88%, 75%) were inhibited at 2 MAC of desflurane and sevoflurane, respectively. CONCLUSION: These results suggest that the in vitro application of desflurane and sevoflurane similarly inhibit oxytocin-induced myometrial contractions of gravid rat in a dose-dependent manner.

Sedation for outpatient endometrial biopsy: comparison of remifentanil-propofol and alfentanil-propofol.

The purpose of the study was to compare the clinical activity of remifentanil or alfentanil under propofol sedation with regard to respiratory rate, sedation and recovery rate when used for outpatient endometrial biopsy. Patients were randomized to receive intravenously either bolus remifentanil 0.4 microgram/kg and propofol 1 mg/kg in the remifentanil group (n = 30), or bolus alfentanil 20 micrograms/kg and propofol 1 mg/kg in the alfentanil group (n = 30). Patients were monitored for heart rate, systolic and diastolic arterial pressure, peripheral O2 saturation (SpO2), respiration rate, and Aldrete sedation score. Pulse oximetry was used to monitor heart rate and SpO2 during endometrial biopsy. Apnoea was observed in five patients from the remifentanil group, and in three patients from the alfentanil group. The groups did not differ with regard to apnoea incidences. Times were recorded for orientation and Aldrete score > 8, and were similar between the two groups (13.20 +/- 3.64 min and 14.0 +/- 3.87 min in the remifentanil group, 14.7 +/- 3.64 min and 15.9 +/- 3.15 min in the alfentanil group, respectively). The sedative and analgesic combination of remifentanil-propofol does not offer any advantages compared with a combination of alfentanil-propofol with regards to respiration and recovery during sedation for outpatient endometrial biopsy.

The direct depressant effects of desflurane and sevoflurane on spontaneous contractions of isolated gravid rat myometrium.

Our purpose was to investigate the direct depressant effects of desflurane and sevoflurane at 0.5, 1 and 2 minimum alveolar concentrations (MAC) on spontaneous contractions of isolated gravid rat myometrium. Ten gravid, albino Wistar rats, weighing 240-310 g and at 19-20 days' gestation were used. Sixty myometrial strips were obtained from 10 rats, and randomly assigned into six groups of 10. After obtaining spontaneous myometrial contractions in de Jalon solution for 45 min, 0.5, 1 or 2 MAC of desflurane or sevoflurane were continuously bubbled in the bath for 15 min and myometrial contractions evaluated during the last 10 min. Desflurane 0.5 MAC did not affect duration or amplitude of spontaneous contractions, but frequency was significantly decreased (P < 0.05). Duration, amplitude and frequency were all significantly decreased by desflurane 1 and 2 MAC (P < 0.05). Sevoflurane did not affect duration, amplitude or frequency at 0.5 MAC, but amplitude and frequency were significantly decreased at 1 MAC and all were significantly decreased at 2 MAC (P < 0.05). The frequency of contractions was decreased 21.2% with 1 MAC desflurane versus 17.1% with 1 MAC sevoflurane. The amplitude and frequency of contractions were decreased 48.2% and 48.7% with 2 MAC desflurane versus 58.9% and 49.3% with 2 MAC sevoflurane, respectively. We suggest that due to tocolytic activity, desflurane and sevoflurane can be useful in non-obstetric surgery during pregnancy.