Anesthetic Management in Corpus Callosum Agenesis.

Corpus callosum agenesis develops when the band which connects the two hemispheres of the brain does not occur in utero. It is associated with prenatal infections, genetic factors, toxic exposures, metabolic disorders, and chromosome errors. Mostly seen clinical features are macrocephaly, microcephaly, seizures, motor retardation, hypotonia, eye anomalies, and facial dysmorphisms. Here, we report a case of corpus callosum agenesis syndrome undergoing upper endoscopy under deep sedation with dexmedetomidine. The main anesthetic concerns are difficulty in airway, respiratory problems, gastric reflux, and interaction of the seizures therapy with general anesthetics.

The Comparison of the Efficacy and Safety of Midazolam, Ketamine, and Midazolam Combined with Ketamine Administered Nasally for Premedication in Children.

BACKGROUND: In this prospective, randomized study, we evaluated the intranasal administration of Midazolam ketamine combination, midazolam, and ketamine in premedication for children. MATERIAL AND METHODS: We studied 60 American Society of Anesthesiology physical status Classes I and II children aged between 1 and 10 years undergoing ear nose throat operations. All cases were premedicated 15 min before operation with intranasal administration of 0.2 mg/kg midazolam in Group M, 5 mg/kg Ketamine in Group K, and 0.1 mg/kg Midazolam + 3 mg/kg ketamine in Group MK. Patients were evaluated for sedation, anxiety scores, respiratory, and hemodynamic effects before premedication, 5 min interval between induction and postoperative period. RESULTS: There was no difference with respect to age, sex, weight, the duration of the operation, and for mask tolerance. Sedation scores were significantly higher in Group MK. There was no statistically difference between the groups for heart rate, oxygen saturation, and respiratory rate. CONCLUSION: We concluded that intranasal MK combination provides sufficient sedation, comfortable anesthesia induction with postoperative recovery for pediatric premedication.

What are the Prevalence of Abdominal Aortic Aneurysm in Patients with Chronic Obstructive Pulmonary Diseases and the Characteristics of These Patients?

OBJECTIVE: To determine the prevalence of abdominal aortic aneurysm (AAA) in patients with chronic obstructive pulmonary disease (COPD) and to assess the characteristics of these patients. MATERIALS AND METHODS: Stable COPD patients (age, >40 years) were included in the study between January 2014 and June 2014. Patients with acute exacerbations and a previous lung resection were excluded. Data regarding demographic characteristics were recorded. The modified Medical Research Council (mMRC) dyspnea scale was used to assess the severity of breathlessness. The COPD Assessment Test (CAT) was performed. Abdominal aortic diameter was measured using abdominal ultrasonography (AUS), and AAA was diagnosed as an aortic diameter of ≥30 mm at the renal artery level. RESULTS: In total, 82 patients were examined. AAA was detected in five (6.1%) patients. Diabetes mellitus, hypertension, and coronary artery disease were present in four patients with AAA. The average mMRC score was 3.2±0.4, and the mean CAT score was 18.4±6.0. Aneurysmal diameter was >50 mm in four patients and 37 mm in one patient. Statistically significant differences were found between patient with AAA and those without AAA with respect to the mean abdominal aortic diameters at the renal artery and iliac artery levels (p=0.012 and 0.002, respectively). CONCLUSION: Our findings suggest that AAA is associated with COPD, with a prevalence rate of 6.1%. AAA is usually asymptomatic until a clinical status of rupture, which is associated with a higher mortality risk. Early diagnosis of AAA is lifesaving. In COPD patients, AAA might be easily determined using AUS, which is a noninvasive and relatively cheap procedure.

Comparison of Clinical Effects of Dexketoprofen and Paracetamol Used for Analgesia in Endoscopic Retrograde Cholangiopancreatography.

OBJECTIVE: This study aimed to compare 50 mg dexketoprofen vs. 1 g paracetamol that were parenterally administered before endoscopic retrograde cholangiopancreatography (ERCP) under sedoanalgesia with comparable anaesthesia depth regarding haemodynamic, pain, narcotic analgesic requirement, recovery and post-procedural cognitive functions. METHODS: Overall, 80 ASA I-III patients aged 18-75 years who were undergoing scheduled ERCP were randomly assigned into three groups. In all patients, the mini-mental test (MMT) was conducted before the procedure. No drug was administered to controls (Group C; n=26); patients were transferred to ERCP unite 30 min after parenteral dexketoprofen (50 mg) in group D (n=27) and paracetamol (1 g) in group P (n=27). The standard monitoring was applied. After intravenously administering loading doses of midazolam (0.02 mgkg) and propofol (1 mg kg(-1)), propofol infusion was administered at a dose of 2-4 mg kg(-1) h(-1) to maintain a bispectral index value of 50-70. Fentanyl (0.05 µg kg(-1)) was intravenously administered when patients experienced pain. Haemodynamic effects, additional analgesic requirement, adverse effects during procedure, time to reach Aldrete score of 9 and satisfaction of an endoscopist and patient were recorded. MMT was repeated 3 h after completing the procedure. RESULTS: Fentanyl requirement during the procedure was significantly low in group D (p<0.05). Apnoea during the procedure and nausea after the procedure were least common in group D while significantly lower than group C (p<0.05). There was no significant difference with respect to MMT scores and endoscopist's satisfaction, while patient satisfaction was greater in group P. CONCLUSION: Parenterally administered dexketoprofen provided better haemodynamic effect and pain control, thereby decreasing incidence of adverse events by reducing the requirement for narcotic analgesics.

Prospective comparison of 3 dacryocystorhinostomy surgeries: external versus endoscopic versus transcanalicular multidiode laser.

PURPOSE: To analyze the clinical outcomes of external (EX-), endoscopic (EN-), and transcanalicular multidiode laser (TC-) with dacryocystorhinostomy (DCR). METHODS: Ninety-two patients with primary acquired nasolacrimal duct obstruction were enrolled (divided into EX-DCR [n = 33], EN-DCR [n = 30], and TC-DCR groups [n = 29]) in this prospective study. Primary outcome measures were the anatomical and functional success of operations at the last control examination. Secondary outcome measures were the ostium size, surgical time, and complications. RESULTS: The difference in mean surgical time among the 3 groups was statistically significant (p < 0.0001). External DCR required the longest surgical time (46.6 ± 15.3 minutes), while TC-DCR was the shortest (20.3 ± 7.7 minutes). There were no significant differences between the groups regarding anatomical (81.8%, 75.9%, and 76.7% in EX-, EN-, and TC-DCR groups, respectively; p = 0.824) and functional success rates (81.8%, 72.4%, and 73.3% in EX-, EN-, and TC-DCR groups, respectively; p = 0.626). Final ostium size was the largest with EX-DCR (33.7 ± 17.4 mm) and smallest with EN-DCR (19.0 ± 8.9 mm; p = 0.001). The complication rate was similar in all groups. The most common complications were the formation of granulation tissue (16.3%) and intranasal synechiae (9.8%), all of which led to surgical failure and were more frequent in the EN- and TC-DCR groups. CONCLUSIONS: External DCR, EN-DCR, and TC-DCR had similar success and complication rates in patients with primary acquired nasolacrimal duct obstruction. External DCR resulted in the largest ostium size. Transcanalicular DCR appeared to be effective with the shortest surgical time.

The value of ultrasound elastography in differentiation of malignancy in thyroid nodules.

We aimed to determine the value of ultrasound elastography (US-E) using carotid artery pulsation in differentiation of malignant and benign thyroid nodules. One hundred ten nodules were evaluated by US-E, and stiffness scores were compared to biopsy results. When cutoff for malignancy was determined as score 4, sensitivity, specificity, positive predictive value, and negative predictive value were 100%, 95%, 40%, and 100%, respectively. We suggest fine needle aspiration biopsy to be performed in all score 4 nodules, while biopsy may be unnecessary in score 1 nodules. Benign biopsy result in a score 4 nodule should suggest radiological-pathological disagreement, and repeat biopsy should be recommended.

Evaluation of resistive index by color Doppler imaging of orbital arteries in type II diabetes mellitus patients with microalbuminuria.

OBJECTIVE: Resistive index (RI) is an indirect measurement of blood flow resistance that can be used to evaluate vascular damage in ophthalmologic diseases. The purpose of this study was to evaluate the association between RI values of orbital arteries by using the color Doppler imaging (CDI) in type II diabetes mellitus (DM) patients with microalbuminuria. PATIENTS AND METHODS: We evaluated 91 type II DM patients with microalbuminuria and 27 healthy subjects. The DM patients with microalbuminuria were grouped into two: group 1 consisted of patients with retinopathy (n = 51) and group 2 consisted of patients without retinopathy (n = 40). Healthy subjects constituted group 3 (n = 27). The mean RI values of ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured using CDI. RESULTS: Compared to diabetic group 2, group 1 had significantly higher mean RIs of OA, CRA, PCA, and HbA1c levels (p < 0.001 for all). Besides, there were no statistical differences in mean RIs of OA, CRA, and PCA between the control group and group 2 (p = 1.0; p = 0.44; p = 0.67, respectively). Mean RIs of OA and PCA were significantly correlated with age in group 1 (r = 0.549, p < 0.001; r = 0.407, p = 0.003, respectively). Mean RI of CRA was significantly correlated with the duration of diabetes and age in group 1 (r = 0.296, p = 0.035; r = 0.486, p < 0.001, respectively). CONCLUSION: Our study indicates that RI might be a useful marker for early diagnosis and follow-up of diabetic retinopathy, and orbital RI assessment would be beneficial for diabetic patients with retinopathy.

Kinetic and thermodynamic investigation of mancozeb degradation in tomato homogenate during thermal processing.

BACKGROUND: The kinetic and thermodynamic parameters of mancozeb degradation in tomato homogenates under the conditions prevailing in the manufacture of tomato products (at 60-100 °C for 0-60 min) were investigated. A gas chromatography-mass spectrometry method was used to analyse residual mancozeb in tomato homogenate. Ethylenethiourea (ETU), the main toxic degradation product of mancozeb, was measured by high-performance liquid chromatography (HPLC)-with photodiode array detector (PDA). RESULTS: The degradation of mancozeb and the formation of ETU in tomato homogenates were adequately described as first-order kinetics. Dependence of the rate constant followed the Arrhenius relationship. Apparent activation energies, temperature coefficients, half time and time to reduce to 90% of the initial value of mancozeb were calculated as kinetic parameters. The thermodynamic parameters of mancozeb were also described as Δg(d) = - 2.440 and 7.074 kJ mol⁻¹; Δh(d) = - 32.555 and - 42.767 kJ mol⁻¹; Δs(d) = - 0.090 and - 0.150 kJ mol⁻¹ K⁻¹; K(e) = 0.414 and 9.797 L g⁻¹ for 333 and 373 K respectively. CONCLUSION: Current findings may shed light on the reduction of mancozeb residue and its toxic degradation product during thermal processing of tomatoes and may also be valuable in awareness and prevention of potential risks from dietary exposure.

Determination of ultra trace arsenic species in water samples by hydride generation atomic absorption spectrometry after cloud point extraction.

Cloud point extraction (CPE) methodology has successfully been employed for the preconcentration of ultra-trace arsenic species in aqueous samples prior to hydride generation atomic absorption spectrometry (HGAAS). As(III) has formed an ion-pairing complex with Pyronine B in presence of sodium dodecyl sulfate (SDS) at pH 10.0 and extracted into the non-ionic surfactant, polyethylene glycol tert-octylphenyl ether (Triton X-114). After phase separation, the surfactant-rich phase was diluted with 2 mL of 1M HCl and 0.5 mL of 3.0% (w/v) Antifoam A. Under the optimized conditions, a preconcentration factor of 60 and a detection limit of 0.008 µg L(-1) with a correlation coefficient of 0.9918 was obtained with a calibration curve in the range of 0.03-4.00 µg L(-1). The proposed preconcentration procedure was successfully applied to the determination of As(III) ions in certified standard water samples (TMDA-53.3 and NIST 1643e, a low level fortified standard for trace elements) and some real samples including natural drinking water and tap water samples.

Development of an inexpensive and sensitive method for the determination of low quantity of arsenic species in water samples by CPE-FAAS.

The simple and rapid preconcentration technique using cloud point extraction (CPE) was applied for the determination of As(V) and total inorganic arsenic (As(V) plus As(III)) in water samples by means of FAAS. As(V) has formed an ion-pairing complex with Pyronine B in the presence of cetyl pyridinium chloride (CPC) at pH 8.0 and extracted into the non-ionic surfactant Triton X-114, after centrifugation the surfactant-rich phase was separated and diluted with 1.0 mol L(-1) HNO(3) in methanol. The proposed method is very versatile and economic because it exclusively used conventional FAAS. After optimization of the CPE conditions, a preconcentration factor of 120, the detection and quantification limits of 1.67 and 5.06 µg L(-1) with a correlation coefficient of 0.9978 were obtained from the calibration curve constructed in the range of 5.0-2200 µg L(-1). The relative standard deviation, RSD as a measure of precision was less than 4.1% and the recoveries were in the range of 98.2-102.4%, 97.4-101.2% and 97.8-101.1% for As(V), As(III) and total As, respectively. The method was validated by the analysis of standard reference materials, TMDA-53.3 and NIST 1643e and applied to the determination of As(III) and As(V) in some real samples including natural drinking water and tap water samples with satisfactory results. The results obtained (34.70±1.08 µg L(-1) and 60.25±1.07 µg L(-1)) were in good agreement with the certified values (34.20±1.38 µg L(-1) and 60.45±1.78 µg L(-1)).

Thin-layer chromatographic specification and separation of Cu(1+), Cu(2+), Ni(2+), and Co(2+) cations.

The M(PyDTC)(2) (M: Cu, Co, or Ni) and CuPyDTC complexes, prepared by reactions of ammonium pyrrolidinedithiocarbamate with metal nitrates, are examined for qualitative analysis, speciation, and mutual separation using thin-layer chromatography systems. These complexes and their mixtures are spotted to the activated and non-activated thin layers of silica gel 60GF(254) (Si-60GF(254)) with a 250-microm thickness. Toluene-dichloromethane mixtures (4:1, 1:1, 1:4 v/v) are used as mobile phases for running of the complexes. All of these chromatographic systems are successfully used for speciation of Cu(2+) and Cu(1+) cations. The best analytical separation for the qualitative analysis of corresponding metal cations and mutual separation of components in M(PyDTC)(2) and CuPyDTC complexes are obtained when using pure toluene-dichloromethane (1:1 v/v) on the activated layer. This study shows that it is possible to qualitatively analyze and satisfactorily separate a mixture of Cu(1+), Cu(2+), Ni(2+), and Co(2+) cations on cited chromatographic systems. These results may be also said for the adaptability or validity on column chromatography.

Characterization and adsorption properties of tetrabutylammonium montmorillonite (TBAM) clay: thermodynamic and kinetic calculations.

The montmorillonite has been subjected to modification through ion-exchange reaction by tetrabutylammonium bromide (TBAB). The modified sample was studied by X-ray diffraction (XRD) technique, Fourier transform infrared (FTIR) spectroscopy, and thermogravimetric analysis (TGA) methods. The basal spacing of modified montmorillonite was determined as 14.40 A. The IR spectra of modified montmorillonite showed CH vibrations. The characterization of tetrabutylammonium montmorillonite (TBAM) and the adsorption of p-chlorophenol (p-CP) on organomontmorillonite was studied as a function of the solution concentration and temperature. The observed adsorption rates were found to fit to the pseudo-second-order kinetics. The rate constants were calculated for temperatures ranging between 25.0-35.0 degrees C at constant concentration. The adsorption energy, E, and adsorption capacity, (q(m)), for phenolic compounds adsorbing on organomontmorillonite were estimated using the Dubinin-Radushkevich (D-R) equation. Thermodynamic parameters (delta g(a) = -11.063 and -11.802 kJ/mol, delta h(a) = -30.032 and -30.789 kJ/mol, delta s(a) = -0.0636 and -0.0637 kJ/mol K for 298 and 308 K, respectively) were calculated by a new approximation from the adsorption isotherms of p-CP on organomontmorillonite. These isotherms were modeled according to Freundlich and Dubinin-Radushkevich adsorption isotherms, through which the first-order and second-order coefficients (K(1ads) = 0.0152 and 0.0127 micromol/g min, K(2ads) = 0.0130 and 0.0108 L/min micromol, respectively) were obtained at 298 and 308 K.

The characterization of prepared organomontmorillonite (DEDMAM) and sorption of phenoxyalkanoic acid herbicides from aqueous solution.

The montmorillonite has been subjected to modification through ion-exchange reaction by N,N'-didodecyl-N,N'-tetramethylethanediammoniumdiiodide (DEDMAI). The modified sample was studied by X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, and thermogravimetric analysis (TGA). The basal spacing of modified montmorillonite was determined as 28.72 A. The IR spectra of organomontmorillonite showed changes in C-H vibrations. The characterization of N,N'-didodecyl-N,N'-tetramethylethanediammonium montmorillonite (DEDMAM) and the adsorption of 2,4-dichlorophenoxyacetic acid (2,4-D), 2,4-dichlorophenoxybutyric acid (2,4-DB), 4-chloro-2-methylphenoxyacetic acid (MCPA), and 2,4,5-trichlorophenoxyacetic acid (2,4,5-T) on organomontmorillonite was studied as a function of the solution concentration. The adsorption energy (E) and adsorption capacity (qm) for phenoxyalkanoic acid herbicides adsorbing on organomontmorillonite (DEDMAM) were estimated using the Dubinin-Radushkevic (D-R) equation. These isotherms were modeled according to Freundlich and Dubinin-Radushkevic adsorption isotherms. The sorption of the herbicides on DEDMAM increased in order of MCPA<2,4-D<2,4-DB<2,4,5-T.

Removal of 2,4-dichlorophenoxyacetic acid from aqueous solutions by partially characterized organophilic sepiolite: thermodynamic and kinetic calculations.

The adsorption of 2,4-dichlorophenoxyacetic acid (2,4-D) on organophilic sepiolite (dodecylammonium sepiolite, DAS) was studied as a function of solution concentration and temperature. The observed adsorption rates were found to be equal to the first-order kinetics. The rate constants were calculated for temperatures ranging between 25 and 40 degrees C at constant concentration. The adsorption energies, E, and adsorption capacity, q(m), for 2,4-D adsorption on organophilic sepiolite was estimated using the Dubinin-Radushkevic equation. Thermodynamic parameters (Deltag(a), Deltah(a), Deltas(a)) were determined by a new approximation from the isotherm of 2,4-D adsorption on DAS. Also, DeltaS(0) and DeltaH(0) values were calculated from the van't Hoff equation. These isotherms were modeled according to the Freundlich and Dubinin-Radushkevic adsorption equations. The amount of adsorption of this herbicide on organophilic sepiolite was found to be dependent on the relative energies of adsorbent-adsorbate, adsorbate-solvent, and adsorbate-adsorbate interaction.

Characterization and determination of the thermodynamic and kinetic properties of p-CP adsorption onto organophilic bentonite from aqueous solution.

The characterization of tetraethylammonium bentonite and the adsorption of p-chlorophenol (p-CP) onto organophilic bentonite (tetraethylammonium bentonite) was studied as a function of the solution concentration and temperature. The observed adsorption rates were found to fit first-order kinetics. The rate constants were calculated for temperatures ranging between 15.0 and 35.0 degrees C at constant concentration. The adsorption energy E and adsorption capacity q(m) for the phenolic compound adsorbing on organophilic bentonite were estimated using the Dubinin-Radushkevic equation. Thermodynamic parameters (Deltag(a), Deltah(a), Deltas(a)) were calculated by a new approximation from the isotherms of p-CP adsorption on organophilic bentonite. These isotherms were modeled according to Freundlich and Dubinin-Radushkevic adsorption isotherms. The amount of adsorption of p-chlorophenol on organophilic bentonite was found to be dependent on the relative energies of adsorbent-adsorbate, adsorbate-solvent, and adsorbate-adsorbate interactions.

The removal of phenolic compounds from aqueous solutions by organophilic bentonite.

The adsorption of p-chlorophenol (p-CP) and p-nitrophenol (p-NP) on organophilic bentonite (dodecylammonium bentonite, DDAB) was studied as a function of solution concentration and temperature. The observed adsorption rates were found to be equal to the first-order kinetics. The rate constants were calculated for temperatures ranging between 25.0-35.0 degrees C at constant concentration. The adsorption energies, E and adsorption capacity, (qm), for phenolic compounds adsorbed to organophilic bentonite were estimated by using the Dubinin-Radushkevic equation. Thermodynamic parameters from the adsorption isotherms of p-CP and p-NP on organophilic bentonite were determined. These isotherms were modeled according to Freundlich and Dubinin-Radushkevic adsorption isotherms and followed the V-shaped isotherm category with two steps. The amount of adsorption was found to be dependent on the relative energies of adsorbent-adsorbate, adsorbate-solvent and adsorbate-adsorbate interaction.