Which agent should be used to reduce ischemia-reperfusion injury after testicular torsion: a comparative animal experiment.

INTRODUCTION: Testicular torsion is an acute urological emergency that causes severe damage of testis. In order to prevent testicular damage, early diagnosis and surgical intervention is essential. Also pain management in both pre-operative and postoperative periods remains a challenging entity. OBJECTIVE: In this study, we aimed to determine the possible positive effects of three different analgesics (ibuprofen, metamizole, and paracetamol), which are widely used in clinical practice on testicular tissue, in addition to pain control. STUDY DESIGN: Forty prepubertal rats (180-210 g) were divided into five experimental groups. Group 1 was sham group in which the left testis was brought out through a scrotal incision and then replaced in the scrotum without torsion. Group 2 was control group (only 0.9% NaCl was applied). Also in group 3, paracetamol, in group 4, ibuprofen, and in group 5, metamizole sodium was applied 1 h after the torsion. Torsion duration was planned as 4 h for all groups. RESULTS: In the biochemical evaluation, malondialdehyde (MDA), myeloperoxidase (MPO), and total nitrate (NO) levels were measured in the testicular tissue. All groups were compared with group 2 (control group). In group 3, although the MDA level was lower and the MPO level was found to be higher, these were not statistically significant. In group 4, the NO level was low but statistically significant. Histological findings were evaluated due to Cosentino's classification, and the scores of group 4 were better than all groups. DISCUSSION: In this study, severe damage was observed at the end of torsion period of 4 h. This is in line with previous published data. The beneficial effects of all three drugs have been observed. CONCLUSIONS: Biochemical results did not clearly highlight any agents. According to pathology results, metamizole was better than paracetamol and the most ideal analgesic preparation was observed as ibuprofen.

Oral misoprostol does not protect the kidneys from diclofenac induced toxicity: data from an unilateral ureteral obstructive rat model.

OBJECTIVE: Ureteral obstruction leads to permanent changes in the structure of the kidney by several mechanisms. In this study, it was hypothesized that there would be a protective effect of misoprostol against diclofenac in rats with unilateral ureteral obstruction (UUO). MATERIALS AND METHODS: Twenty-two female rats were randomized into 5 groups of 4 and 2 rats for the control group. The right ureter was sutured. The rats were grouped as control, contrast agent, contrast agent +N-acetylcysteine (NAC),  diclofenac and diclofenac + misoprostol groups.Radiographic contrast agent was given iv on the 3rd day and other agents were administered orally for 1 week. The rats were sacrified after 1 week and histopathological and biochemical oxidative stress markers were evaluated. RESULTS: The contrast agent and NAC  group  had lower rates of hemorrhage, inflammation, obstructive dilatation and fatty degeneration compared to the contrast agent only group (p < 0.05). No differences were seen in the normal kidneys. Between all the groups, there was no difference for tubule epithelium damage (p > 0.05). The contrast agent and NAC group had higher rates of antioxidant SH level compared to the contrast agent only group (p < 0.05) and lower rates of oxidative end product carbonyl groups (p < 0.05). For normal kidneys no difference was seen. No statistical difference was seen in MDA levels (p > 0.05). Statistically no difference was seen between the diclofenac group and the diclofenac and misoprostol group neither pathologically nor chemically (p > 0.05). CONCLUSIONS: These results showed that NAC is protective against radiographic contrast agent toxicity when given before and after administration in obstructed kidneys as in previous data. Misoprostol was not observed to have any protective effect against diclofenac in obstructed kidneys.

Oral fluvastatin reduces the severity of peritoneal adhesions in rats.

BACKGROUND: The aim of the study was to investigate the effect of fluvastatin on peritoneal adhesion formation. METHODS: 48 female Wistar-albino rats weighing 200-220 g were divided into four groups each containing 12 rats. Group I was sham, Group II was the control group, while Group III was given 10 mg/kg/day (28 days) oral fluvastatin. In Group IV, 10 mg/kg fluvastatin was administered intraperitoneally at the time of laparotomy but the rats died from that dose. After laparotomy on day 14, caecal serosal abrasions and punctuate haemorrhagies were performed. On day 28, laparotomies were repeated. Adhesions were graded and tissue samples were taken from incisions and adhesions. Hydroxyproline contents representing adhesions were measured quantitatively. On the 28th day, blood samples were taken to measure the tissue-type plasminogen activator (t-PA) activity. RESULTS: There were significant differences between the groups for adhesion severity (p < 0.0001), hydroxyproline content and t-PA activity of the adhesions (p < 0.0001). Analysis of the grading of adhesions documented significant differences between all groups. When the hydroxyproline content and t-PA activity of the adhesions was analyzed, there were significant differences between groups II, I and III, but the difference between group I and group III was not statistically significant. CONCLUSIONS: The data presented in this study demonstrate that the oral administration of the HMG-CoA reductase inhibitor fluvastatin reduced intra-abdominal adhesion formation.

Multidetector computed tomographic angiography findings of splenic artery steal syndrome in liver transplantation.

AIMS: Splenic artery steal syndrome, a common complication in liver transplantation, is diagnosed by conventional angiography showing an enlarged splenic artery and by dynamic findings. The aim of this study was to determine multidetector computed tomographic angiography (MDCTA) findings of splenic artery steal syndrome to develop diagnostic criteria. MATERIALS AND METHODS: Ten patients were diagnosed as displaying splenic artery steal syndrome among 198 liver transplant patients. The diagnosis was confirmed by celiac angiography. In eight of them, MDCTA was performed. Axial and coronal maximum-intensity projection images were obtained in arterial and portal phases. We measured the diameter of the celiac trunk and of the splenic, left gastric, common hepatic, superior mesenteric artery, and transplant hepatic arteries. We also measured the diameter of the proximal and the distal segments of the abdominal aorta, along with the size of the spleen, the ratio of the splenic artery to the common hepatic artery, the ratio of splenic artery to transplant hepatic artery, the diameter of portal vein and superior mesenteric vein. The control group consisted of liver transplant patients with normal liver enzyme levels. We performed Student t test for statistical examination. RESULTS: The diameter of the splenic artery (P<.05), the size of the spleen (P<.01), and the ratio of the splenic to the transplant hepatic arteries (P<.05) was significant between the two groups. The diameter of the splenic artery was larger than 4 mm in all patients in the study group. CONCLUSIONS: Conventional angiography was mandatory for the diagnosis of splenic artery steal syndrome. MDCTA is a noninvasive method. Some computed tomography criteria are important for early diagnosis and treatment.

The preventive effects of thiopental and propofol on testicular ischemia-reperfusion injury.

BACKGROUND: Testicular torsion is a urological emergency that requires immediate surgical intervention to prevent testicular damage. The aim of the study was to investigate the preventive effects of thiopental and propofol as anesthetics on testicular ischemia-reperfusion injury. METHODS: Forty male Wistar Albino rats were randomly assigned to four groups of 10 rats each. During 5 h, anesthesia was induced and maintained with thiopental in groups 1 and 2 and with propofol in groups 3 and 4. Groups 2 and 4 received left testicular ischemia (torsion) during 1 h and reperfusion (detorsion) during 4 h. Groups 1 and 3 (control groups) had no testicular torsion and detorsion. At the end of 5 h, animals were killed and both ipsilateral and contralateral testes were removed for histopathologic examination and measurement of tissue MDA (malondialdehyde) and NO (nitric oxide) levels. RESULTS: In the contralateral testes of all the groups, MDA and NO measurements were not different from ipsilateral testes of the control groups. Between the groups 1 and 3, there were no differences in MDA and NO levels. Although torsion/detorsion of testes in group 4 caused significantly increased levels of tissue MDA and NO values compared with group 3, ischemia-reperfusion in group 2 caused a further increase in these levels compared with group 4. The ipsilateral testes in the control groups did not show any morphological changes. Testicular torsion/detorsion in rats with thiopental anesthesia (group 2) caused significantly greater histopathologic injury levels than rats with propofol anesthesia (group 4). CONCLUSION: Our results suggest that propofol as an anesthetic agent may prevent testicular damage by scavenging reactive oxygen and nitrogen species and inhibiting lipid peroxidation in an animal model of testicular torsion and detorsion.

Complete blood count parameters for healthy, small-for-gestational-age, full-term newborns.

No previous study has investigated the full range of complete blood count (CBC) parameters in small-for-gestational-age (SGA) newborns. The main aim of this study was to compare CBC and peripheral smear parameters in term, healthy SGA neonates and appropriate-for-gestational-age (AGA) neonates, and to establish CBC reference values for full-term SGA newborns. One hundred thirty-two healthy, term newborns (73 SGA and 59 AGA) were included. On day 1, we obtained 109 samples and on day 7 we obtained 77 samples. A CBC and peripheral smear were analyzed for each sample collected and group data were compared. We observed higher mean values for normoblast count, hemoglobin, hematocrit, and red blood cell (RBC) count in the SGA babies than in the AGA babies on day 1. The mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration values for the SGA babies were decreased because of the relatively high RBC count and relatively high mean corpuscular volume we observed in this group. Of the SGA newborns, 21.9% had neutropenia and 4.7% had absolute neutrophil counts lower than 1500/microl on day 1. On both day 1 and day 7, the SGA newborns had higher mean absolute metamyelocyte counts and higher mean I : T (immature : total neutrophil ratio) values than the AGA group. The SGA babies had a lower mean absolute lymphocyte count on day 7 than the AGA group. We detected thrombocytopenia in almost one-third of the 64 SGA newborns tested on day 1. In summary, our study clearly demonstrates that CBC parameters for healthy, full-term, SGA newborns are different from those of healthy, term AGA newborns. This is the first study that has documented different mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, metamyelocyte counts, lymphocyte counts, and I : T in SGA babies compared with AGA babies.

Effects of testicular fixation on oxidative stress-related parameters in prepubertal rat testis.

The goal of orchiopexy is to provide adequate scrotal fixation to prevent recurrent torsion of the testis and the spermatic cord or ascent of the testis, to be achieved with minimal trauma to the testis. Forty-two prepubertal male Sprague-Dawley rats were equally distributed into 6 groups (1 SHAM + 5 Operation). In operational groups, two lateral sutures were placed near the upper and lower pole of the testis passing through the tunica albuginea with 4-zero polyglactin suture in the transverse axis of the testis. At the 1st-3rd-7th-15th and 30th postoperative days, bilateral orchiectomy was performed, then malondialdehyde (MDA), nitrite, superoxide dismutase (SOD) and glutathion peroxidase (GPx) values were measured in testicular tissue homogenates. MDA and nitrite levels increased, while GPx and SOD levels diminished, statistically significant in both ipsilateral and contralateral testicular tissue homogenates. Prepubertal testicular fixation causes overproduction of the lipid peroxidation end product and free radicals while heavy consuming anti-oxidant reserve systems in both ipsilateral and contralateral testicular tissue. These results clearly reveal the extent of the testicular deterioration due to suture fixation technique.

Which is responsible for the haemodynamic response due to laryngoscopy and endotracheal intubation? Catecholamines, vasopressin or angiotensin?

BACKGROUND AND OBJECTIVE: We have investigated the concentrations of epinephrine, norepinephrine, vasopressin and angiotensin converting enzyme activity to explore the role of these mediators in the neuroendocrine response to laryngoscopy and tracheal intubation. METHODS: One hundred (50 male, 50 female) ASA I patients aged 20-50 yr (mean+/-SEM; 35.59+/-0.99) were included in the study. They were undergoing elective surgery under standard anaesthesia induction and maintenance using tracheal intubation. Plasma concentrations of epinephrine, norepinephrine and vasopressin as well as plasma angiotensin converting enzyme activity were determined at four time points, before (T1) and after (T2) induction, and 2 (T3) and 5 min (T4) after intubation. Blood pressure and heart rate were recorded at corresponding times to reveal if any correlation existed between haemodynamic parameters and neuroendocrine response. RESULTS: Heart rate increased after induction and intubation (P<0.05) and decreased significantly at T4 (P<0.05). Systolic blood pressure decreased significantly (P<0.05) after induction and increased slightly after intubation decreasing to below baseline value (P<0.05) at T4. Diastolic blood pressure increased slightly after intubation and decreased significantly (P<0.05) at T4. Plasma epinephrine and norepinephrine concentrations decreased after induction and increased at T3 and T4 without reaching significance. Vasopressin concentrations increased slightly at T2 and T3 and decreased significantly at T4 (P<0.05). Angiotensin converting enzyme activity was unaffected when compared with baseline values. CONCLUSIONS: Blood pressure, heart rate, plasma epinephrine, norepinephrine and vasopressin concentrations increased slightly in response to laryngoscopy and intubation, all returning to or below baseline 5 min later with no change in angiotensin converting enzyme activity in normotensive patients.

The role of free oxygen radicals in the aetiopathogenesis of rosacea.

A possible link between superoxide dismutase activity and malondialdehyde level with the clinical manifestations of rosacea was investigated. We found differences in superoxide dismutase activities between mild rosacea (stages I and II) and severe involvement (stage III) groups, as well as between disease and control groups that were statistically significant (P < 0.05). In the mild involvement group (stages I and II), the superoxide dismutase activity was higher than in the control group (P < 0.05), while the malondialdehyde levels did not differ from the control. In the severe involvement group (stage III), the superoxide dismutase activity was lower than in the control group (P < 0.05), and this was coupled to a raised level of malondialdehyde (P < 0.05). These findings clearly show that in the mild involvement phase of rosacea patients, superoxide dismutase activity was stimulated to protect the skin against reactive oxygen species so that the malondialdehyde levels were maintained. In contrast, in more severe disease, due to a decrease in the capacity of the antioxidant defence system, the malondialdehyde levels were increased. These findings support the 'antioxidant system defect hypothesis' in rosacea patients.

Burnout and social support systems among ward nurses.

This study examined the relationships between stress and social support systems in dealing with burnout among medical and surgical ward nurses. Multiple regression analyses demonstrated main effects for amount of and satisfaction with social support, with burnout as the criterion. That is, nurses with high sources of social support and high levels of satisfaction with that support reported less burnout than nurses with few supports and less satisfaction with those supports, regardless of level of work stress. No buffering effects were found for family support. That is, nurses with high work stress and high family support did not experience lower burnout than nurses with high work stress and low family support. Implications of the results are discussed.