Effects of thoracic epidural or intravenous analgesia on the neutrophil-to-lymphocyte ratio in thoracotomy cases

Background and Purpose

Postoperative pain is a significant problem in thoracotomy patients. Our aim in this study was to investigate the relationship between postoperative pain and neutrophil-to-lymphocyte ratio (NLR) which is a marker of acute inflammatory response.

Materials and Methods

Thoracic epidural or intravenous analgesia was administered to thoracotomy patients who elected to undergo a planned surgery. Patients were divided into two groups according to the analgesia method applied postoperatively. Thoracic epidural analgesia was recorded as Group 1 and intravenous analgesia as Group 2. Whole blood counts were recorded from preoperative and postoperative 24^th- and 48^th-hour routine blood samples, and NLRs were recorded as retrospective file scanning. Postoperative 24^th- and 48^th-hour NLRs and preoperative NLR values were recorded.

Results

Demographic data of the patients included in the study were similar except for age. Preoperative NLR was significantly higher in Group 1 at 3.50 (P = 0.004) than in Group 2 at 2.51. Postoperative NLRs were similar among both groups. Postoperative NLR values at both the 24^th- and 48^th-hour increased by4.9 times in Group 1 and 9.23 times in Group 2 from the 24^th-hour preoperative period, when the preoperative NLRs were evaluated. The rate of increase in Group 1 was significantly lower than in Group 2 (P = 0.006).

Conclusion

Postoperative NLR alterations when compared with preoperative values were related to the analgesic regimen used.

Investigation of the effects of thymoquinone on erythrocyte deformability in sepsis treatment which created by cecal perforation in rat

AIM

We aimed to study the effects of thymoquinone on erythrocyte deformability in an experimental model of sepsis given before or after the initiation of the sepsis model.

METHOD

The animals were grouped as (n = 6) control, nigella sativa, sepsis, sepsis group with administration of nigella sativa before sepsis development and sepsis group with nigella sativa administration after sepsis development. Cecal ligation and puncture model (CLP) was used to induce sepsis in the animals. The thymoquinone was given 1 hour before or after the CLP in the study groups with a dose of 500 mg·kg(-1). Erythrocyte deformability and relative resistance was calculated.

RESULT

Relative resistance was increased in the sepsis groups when compared to the control group (p < 0.0001). Deformability index was increased in the sepsis group when compared to the other groups (p < 0.0001 in all groups). Sepsis group with after nigella sativa groups deformability index was significantly different from the deformability index in control group (p = 0.002). The use of nigella sativa before the initiation of sepsis corrected the deformability index significantly and the results were comparable to the control group (p = 0.078).

CONCLUSION

Thymoquinone administration before induction of CLP was observed to have protective effects on these alterations in CLP sepsis (Tab. 1, Fig. 1, Ref. 26).

Investigating the effects of two different pump heads (Centrifugal vs. Roller Pump) on hematological and immunological mechanisms

Background and Aim

Technological developments and enhancement of knowledge level enable heart surgery with low mortality rates in most centers. On the other hand, increased systemic inflammatory response against cardiopulmonary bypass (CPB) plays a critical role in the development of postoperative complications. We aimed to compare the effects of centrifugal pump where it is claimed that blood is exposed to minimal trauma and roller pump techniques on inflammatory response and oxidant status during CPB.

Materials and Methods

: A total of 40 patients, who had coronary artery disease and underwent coronary artery bypass graft (CABG) surgery using either roller or centrifugal pump between June 2012 and June 2013 were enrolled in this study. Patients over 40 years old and without any known immunologic, infectious, or inflammatory incidents and hematological problems for the past 6 months were included in the study. Two study groups (Group R: roller pump group and Group C: centrifugal pump group) were created. During CABG surgery tumor necrosis factor (TNF) alpha, interleukin (IL)-6, IL-8, superoxide dismutase (SOD), catalase (CAT), and nitric oxide levels were measured before and after CPB.

Results

TNF alpha, IL-6, and IL-8 levels measured before and after CPB were found to be similar between groups. SOD, CAT and Nitric oxide levels were also similar between groups. After the CPB period, glutathione peroxidase enzyme activities in Group R measured after CPB were significantly lower than those measured in Group C. The platelet-activating factor (PAF) levels before CPB usage period were same in both groups, where PAF levels after CPB were found to be significantly higher in roller pump group than centrifugal pump group. At inter-group comparisons, the levels of PAF were same at each group before and after CPB.

Conclusion

The study findings indicate that usage of the centrifugal pump does not have a clear superiority in terms of the effects on inflammatory response and oxidant status during CPB when compared to roller pump. Nevertheless, we believe that our results should be supported by further clinical and experimental studies.

Treatment of Metastatic Pancreatic Cancer with a Combination of Gemcitabine and 5-Fluorouracil: A Single Center Phase II Study

Aim

To determine the activity and toxicity of a combination of weekly gemcitabine and 5-fluorouracil bolus intravenously in patients with metastatic pancreatic cancer.

Patients and methods

Twenty-one patients with previously untreated metastatic pancreatic cancer were included in this phase II study. The schedule was gemcitabine (1000 mg/m2 iv) and 5-fluorouracil (500 mg/m2 bolus iv) weekly for 3 weeks every month.

Results

Four patients (19%) achieved a partial response and three stable disease. A clinical benefit was obtained in 7 patients (33%). Median survival for all the patients was 6 months. The treatment was well tolerated and toxicity was mild. WHO grade 3 leukopenia occurred in 2 (9.5%) patients, grade 3 anemia in 4 (19%) patients, grade 3-4 thrombocytopenia in 4 (19%) patients, grade 1 diarrhea in 1 (4.7%) patient and grade 1 mucositis in 3 (14.2%) patients.

Conclusion

The weekly administration of gemcitabine combined with 5-fluorouracil bolus iv is an active and well-tolerated regimen in metastatic pancreatic cancer. However, its efficacy is relatively limited.

Comparison of Clinical Outcomes of Different Erythropoietin Usage Strategies

Aim

There is no comprehensive study that compares the different usage strategies of recombinant human erythropoietin (rHuEPO) in platinum-induced anemia. In order to clarify this issue, we conducted a prospective clinical study.

Material and methods

Seventy-seven patients were studied in three main groups. Group 1 (n = 17) consisted of cancer patients without anemia. These patients received rHuEPO starting from the first chemotherapy cycle. Group 2 (n = 26) consisted of patients whose hemoglobin (Hb) values decreased by at least 1 g/dL after the first cycle of chemotherapy. Group 3 (n = 34) consisted of patients whose Hb values dropped below 10.5 g/dL after the second chemotherapy cycle. Groups 2 and 3 were each divided into two subgroups. In groups 1, 2A and 3A rHuEPO (5000 U/day subcutaneously three times a week) treatment was continued until three weeks after the completion of chemotherapy. In groups 2B and 3B, rHuEPO was given for 12 weeks only.

Results

There were no prominent differences between the Hb values of these groups throughout the chemotherapy cycles. Transfusion rates and the number of patients who became anemic were also not different between groups.

Conclusion

No rHuEPO usage strategies are superior to others in terms of Hb levels and transfusion requirements. The decision as to when rHuEPO is to be added to platinum-containing therapy should be tailored to the health conditions of individual patients.

Single-Agent Irinotecan as Second-Line Treatment for Advanced Gastric Cancer

Aim

To investigate the activity and toxicity of irinotecan (CPT-11) as a single agent in patients with advanced gastric cancer after failure of previous 5-fluorouracil-based combination chemotherapy.

Patients and methods

Sixteen patients with advanced gastric received CPT-11, 350 mg/m2 every 21 days. The median age of the patients was 54.6 years; ECOG performance status was 0-1 in 14 patients and 2 in 2 patients. Dominant metastatic sites included liver, lung, lymph nodes and peritoneum.

Results

No complete response was observed. Two patients (12.5%) achieved a partial response to treatment. One patient (6.25%) had a minor response. Ten patients (62.5%) had progressive disease on therapy, and 3 patients (18.75%) had stable disease. The median survival of all 16 patients was 5 months. Grade 3 neutropenia was observed in 3 patients (18.75%), grade 4 thrombocytopenia in 1 patient (6.25%), and grade 3 anemia in 1 patient (6.25%). Three patients (18.75%) suffered from grade 3 diarrhea.

Conclusions

CPT-11 is moderately active and a well-tolerated regimen for selected advanced gastric cancer patients who experience disease progression after receiving first-line treatment.

Effect of apelin-13 on erythrocyte deformability during ischaemia-reperfusion injury of heart in diabetic rats

OBJECTIVES

Erythrocyte deformability and plasma viscosity are of crucial importance for the perfusion of tissues and organs. The aim of this study was to evaluate the effect of apelin-13 on erythrocyte deformability during IR heart injury in diabetic rats.

METHODS

Eighteen Wistar Albino rats were included in the study after streptozotocin (55 mg/kg) treatment for four weeks of observation for diabetes existence. The animals were randomly assigned to one of five experimental groups. In the Group C, DC (sham-control group) and DCA (sham-control group-apelin-13), the coronary artery was not occluded or re-perfused. In the Group DIR, a branch of the left coronary artery was occluded for 30 minutes followed by 90 minutes of re-perfusion to produce IR. In the Group DIRA, a branch of the left coronary artery was occluded for 30 minutes followed by 90 minutes of re-perfusion to produce IR, and apelin-13 was administrated via 10 µg.kg-1 IP route 30 minutes before ligating the left coronary artery.Deformability measurements were performed in erythrocyte suspensions containing Htc 5% in a PBS buffer.

RESULTS

The deformability index was significantly increased in diabetic rats; however, it was similar in Group DC, DCA and DIRA. It was significantly increased in the Group DIR when compared to the Group C, DIRA, DCA and DC. The relative resistance was increased in IR models.

CONCLUSION

Erythrocyte deformability was decreased in rats having diabetes and IR injury. This injury might lead to further problems in microcirculation. It was shown that apeline-13 may be useful in enhancing the adverse effects of this type of injury (Fig. 1, Ref. 35).

Effect of different doses of pregabalin on skeletal muscle ischaemia-reperfusion injury in rats

AIM/INTRODUCTION

Analgesic, anti-inflammatory and anti-apoptotic effects of pregabalin have been shown previously. In this study, we investigated the protective effect of different doses of pregabalin on skeletal muscle IR injury in rats.

MATERIALS AND METHODS

24 rats were randomly divided into 4 groups (Control, Ischaemia-Reperfusion (IR), IR-Pregabalin 50 mg, IR-Pregabalin 200 mg). Following IR, serum Ischemia Modified Albumin (IMA) and tissue Paraoxonase (PON) were studied and gastrocnemius muscle tissue was removed for histopathologic examination.

RESULTS

Interstitial inflammation was higher in the IR group than in the control and Pregabalin 200 mg groups (p = 0.037, p = 0.037, respectively). Congestion was higher in the IR group than in the control, Pregabalin 50 and 200 mg groups (p = 0.001, p = 0.004, p = 0.004, respectively). PON was lower in the IR group than in the Control, Pregabalin 50 and 200 mg groups (p = 0.001, p = 0.007, p = 0.015, respectively). IMA was higher in the IR group than in the Control, Pregabalin 50 and 200 mg groups (p < 0.0001, all).

CONCLUSION

We think that administration of pregabalin, more prominent at 200 mg, can reverse the injury that occurs in the skeletal muscle of IR-induced rats. Pregabalin can be safely used for analgesia in cases of IR (Tab. 2, Fig. 9, Ref. 41).

Synchronous penoscrotal implantation of penile prosthesis and artificial urinary sphincter after radical prostatectomy

OBJECTIVES

To evaluate the results of synchronous dual implantation of penile (PP) and artificial urinary sphincter prosthesis (AUSP) in patients with severe erectile dysfunction (ED) and urinary incontinence (UI) after radical prostatectomy (RP).

METHODS

Between January 2006 and March 2015, patients who underwent synchronous dual implantation of PP for severe post-RP ED and AUSP for moderate to severe post-RP UI in our clinic were screened retrospectively. The erectile function and the continence status were evaluated by the questionnaires of IIEF-5 and ICIQ-SF. Results for the preoperative period and for the 1st postoperative year were revealed from patient charts. Long term results were evaluated by telephone interviews. Comorbidities, infection rates and complications were noted.

RESULTS

A total of 14 patients underwent synchronous dual implantation; out of which, 11 had a long enough follow up period for a sufficient long term evaluation. 3/11 had MPP and 8/11 had two-piece IPP implantation together with an AUSP. All of the implantations were carried out through an upper transverse scrotal incision. Mean follow up time was 61.3 ± 20 months. In 1 patient who had received adjuvant radiotherapy, both of the devices were removed due to infection and cuff erosion. Mean daily usage of pads diminished from 4 to 1 while ICIQ-SF score decreased from 19 to 2 and IIEF-5 score increased from 3 to 23.

CONCLUSION

Synchronous implantation of PP and AUSP is a safe and effective treatment option for patients with severe ED and moderate to severe UI after RP.

Physiological changes and reproductive performance of Sterlet sturgeon Acipenser ruthenus injected with thiamine

To evaluate the effects of thiamine on physiological changes and spawning performance of Sterlet sturgeon Acipenser ruthenus, 45 farmed female fish (698.6±8.9g) were randomly distributed in 9 tanks (1000L) and fed a diet with 1g/kg of an anti-thiamine drug. This was provided for 5 months prior to spawning. Thiamine hydrochloride was intraperitoneally injected to fish at three different doses: 0 (T₀, as control), 5 (T₅) and 50 (T₅₀) mg/kg body weight at days 30, 90 and 150 after the experiment started. After five months, the results showed no significant differences in weight gain and hemoglobin level, but hematocrit significantly increased in T₅ group. There was no significant difference in glucose-6-phosphate dehydrogenase and estradiol-17β, but testosterone was significantly increased in the T₅₀ group. Total thiamine concentration in the eggs was significantly higher in T₅₀ than that detected in the control group. Fecundity and larval mortality at 6day post hatch (dph) showed no significant differences among treatments, while the number of eggs per gram was significantly lower in T₀ than that observed in T₅₀. Larval weights at 1 (11.6mg) and 6 (23.1mg) dph and larval lengths at 6 (15.6mm) dph were significantly affected by the treatment with the highest level of thiamine injection (T₅₀). Diseases symptoms such as yolk sac deformation, erratic pattern of swimming, and loss of equilibrium were observed at 4 dph in T₀ and T₅ groups. The overall results revealed that thiamine injection has positive effects on reproductive performance in the sturgeon and the negative impacts of anti-thiamine in the offspring can be reduced by the injection of this vitamin to the broodstock.

Effects of intravenous ibuprofen and lornoxicam on erythrocyte deformability in rats undergoing hind limb ischemia reperfusion injury

BACKGROUND AND AIM

Acute hind limb ischemia reperfusion (I/R) injury is a common consequence of abdominal aorta cross‑clamping during aortic surgery. Erythrocyte deformability is affected by I/R process and may lead to increased tissue and organ injury. Lornoxicam and intravenous ibuprofen are becoming commonly used as non-steroidal anti-inflammatory drugs (NSAID) for postoperative analgesia. In this study, we aimed to investigate the effects of lornoxicam (2 mg/kg iv) and intravenous ibuprofen (30 mg/kg iv) on erythrocyte deformability in I/R model in rats.

MATERIALS AND METHODS

Four study groups, each containing 6 Wistar rats were created. Laparotomy was performed in all groups under general anesthesia with ketamine and xylazine. In all groups except sham group, ischemia and reperfusion were achieved by clamping and declamping the infrarenal abdominal aorta for 120 minutes. Rats in Group IR+L received intravenous infusion of lornoxicam (2 mg/kg) while rats in Group IR+I received intravenous infusion of ibubrofen (30 mg/kg) following 2 hours of ischemic period. At the end of reperfusion period, erythrocyte packs were prepared from heparinized blood samples. Erythrocyte suspensions with hematocrit at a concentration of 5% in a phosphate‑buffered saline (PBS) were used in order to perform deformability measurements. The value of p<0.05 was considered statistically significant.

RESULTS

Relative resistance has increased in ischemia reperfusion group when compared to control group (p < 0.0001). Lornoxicam or ibuprofen intravenous treatments did not change the erythrocyte deformability during ischemia reperfusion period in rats (p=0.851, p=0.690).

CONCLUSION

Intravenous ibuprofen or lornoxicam administrations during ischemia reperfusion period in rats have no negative effect on erythrocyte deformability. The findings of the study should be supported with more detailed and extensive clinical/experimental studies in the future (Fig. 1, Ref. 18).

SERUM OMENTIN-1 LEVELS AND ENDOTHELIAL DYSFUNCTION IN OBESITY

Introduction

Our aim was to investigate the relationship between serum omentin-1 levels and endothelial dysfunction in obese patients.

Material and Methods

We evaluated 50 obese patients, and age/gender matched 45 healthy non-obese subjects as controls. Oral glucose tolerance test, lipid parameters, uric acid levels, homeostatic model assessment-insulin resistance (HOMA-IR) index, serum omentin-1 levels and flow mediated dilatation (FMD) % were measured in all subjects. Body compositions were analyzed with bioelectrical impedance method using a Tanita Body Composition Analyzer and ViScan.

Results

Serum omentin-1 levels were found significantly lower in obese population compared to the control subjects. FMD response was significantly decreased in obese population. There was a significant positive correlation between serum omentin-1 levels and FMD response (r=0.359, p<0.001). Serum omentin-1 levels were negatively correlated with body mass index (BMI), waist circumference, total fat percentage, visceral fat, fasting insulin and HOMA-IR index.

Conclusion

Lower serum omentin-1 levels and decreased FMD response may be an early marker of endothelial dysfunction in obese patients.

Laparoscopic heminephrectomy for benign and malignant diseases of the horseshoe kidney

Objectives: In the current study, we present our pure laparoscopic heminephrectomy experience in 13 patients with horseshoe kidney (HK). Material and Methods: A total of 13 patients with HK underwent pure laparoscopic heminephrectomy (Transperitoneal= 7, Retroperitoneal = 6) due to benign and malign renal conditions (non-functional hydronephrotic and/or infected kidney = 12, kidney mass = 1). Results: The mean age of the patients was 45.8 years. The mean operating time was 140 minutes, and estimated blood loss was 131 ml. The mean hospital stay was 2.3 days. Division of istmus was performed with stapler in 5 patients, ultrasonic scalpel in 3, 15 mm Hem-o-lok clip in 3, 10 mm LigaSure vessel seal system in one and endoscopic suture by 0 polyglactin in one patient without bleeding. Twelve patients underwent pure laparoscopic heminephrectomy due to nonfunctional hydronephrotic and or infected kidney. One patient underwent transperitoneal laparoscopic right heminephrectomy due to kidney mass. According to modifies Clavien classification, Grade I complication (wound infection) occurred in one patient (7.7%) who underwent heminephrectomy due to non-functional kidney. Conclusions: Laparoscopic heminephrectomy seems to be technically feasible and safe for benign and malignant diseases in patients with HK.

Unenhanced computed tomography findings of renal papillae in patients with a ureteral stone

Purpose: In some patients with a ureteral stone without uretero-hydronephrosis, it is difficult to determine the location of the stone. The objective of the present study was to investigate the changes in renal papillae using unenhanced computerized tomography (uCT) and determine the side of calculi using the renal papillary findings in patients with a ureteral stone. Methods: uCT data from 81 patients were retrospectively reviewed for this study. The inclusion criteria were unilateral ureteral calculi, no renal calculi and no hydronephrosis. For each patient, three measurements of CT attenuation of 0.05 cm2 area were made in the tip of the interested renal papillae, both stone side and non-stone side. Student’s t test was used for statistical analysis. Results: Forty-one right-sided and 40 left- sided isolated unilateral ureteral calculi patients were evaluated by uCT exam. The average attenuations of the tip of the papillae in stone side and non-stone side were 34.1 Hounsfield units (HU) and 30.6 HU, respectively. There was a statistically significant difference between stone and non-stone sides (p< 0.05). Conclusion: During routine practical uCT applications, it can be difficult to distinguish phleboliths, ureteral stone or the existence of non-opaque ureteral stone, so papillae density measurements can be a practical method to identify the existence of ureter stone and its location (side).

Unenhanced computed tomography findings of renal papillae in patients with a ureteral stone

PURPOSE

In some patients with a ureteral stone without uretero-hydronephrosis, it is difficult to determine the location of the stone. The objective of the present study was to investigate the changes in renal papillae using unenhanced computerized tomography (uCT) and determine the side of calculi using the renal papillary findings in patients with a ureteral stone.

METHODS

uCT data from 81 patients were retrospectively reviewed for this study. The inclusion criteria were unilateral ureteral calculi, no renal calculi and no hydronephrosis. For each patient, three measurements of CT attenuation of 0.05 cm2 area were made in the tip of the interested renal papillae, both stone side and non-stone side. Student's t test was used for statistical analysis.

RESULTS

Forty-one right-sided and 40 left- sided isolated unilateral ureteral calculi patients were evaluated by uCT exam. The average attenuations of the tip of the papillae in stone side and non-stone side were 34.1 Hounsfield units (HU) and 30.6 HU, respectively. There was a statistically significant difference between stone and non-stone sides (p< 0.05).

CONCLUSION

During routine practical uCT applications, it can be difficult to distinguish phleboliths, ureteral stone or the existence of non-opaque ureteral stone, so papillae density measurements can be a practical method to identify the existence of ureter stone and its location (side).

A retrospective analysis of blood gases with two different insulin infusion protocols in patients undergoing cardiovascular surgery

AIM

Intraoperative blood glucose concentration is known to be an independent risk factor for morbidity and mortality in patients undergoing cardiovascular surgery. Arterial blood gas analysis is an important investigation to monitor the acid-base balance and gas exchange in these patients. Hyperglycemia leads to a series of metabolic changes which affect acid-base balance and serum electrolytes. In this study, we aimed to look into the effect of glycemic control on arterial blood gas parameters, serum electrolytes, and hemoglobin (Hb).

MATERIALS AND METHODS

We collected data from diabetic patients who underwent cardiovascular surgery between 2010 and 2014. The patients were divided into two groups according to the insulin infusion protocols applied such as with conventional (180-250 mg/dl) (n = 17) (Group 1) and tighter glycemic targets (121-180 mg/dl) (n = 51) (Group 2). We retrospectively analyzed arterial blood gas results taken at different perioperative time points from these patients.

RESULTS

We found that pH HCO3and base excess, serum sodium, potassium, calcium, and Hb were similar in both groups.

CONCLUSION

Our study showed that a tighter intraoperative glycemic control does not affect arterial blood gas parameters, serum electrolytes, or Hb when compared to the conventional glycemic control.

Are there any effects of Sevoflurane and Desflurane anaesthesia on blood glucose levels in acute hyperglycemic diabetic rats?

AIM

The aim of this study was to investigate blood glucose level of desflurane and sevoflurane on blood glucose in diabetic rats undergoing acute hyperglycemia.

MATERIALS AND METHODS

In this study, 30 male Wistar albino rats were included. Diabetes was induced by a single IP injection of streptozotocin. After the effects of chronic diabetes encountered, diabetic rats were randomly assigned into diabetic control (group DC), diabetic hyperglycemia group (group DH), diabetic hyperglycemia group with desflurane (group DH-D), and diabetic hyperglycemia group with sevoflurane (group DH-S) groups. The normoglycemic groups received an IP injection of the same amount of saline. Hyperglycemic diabetic rats were anaesthetized by desflurane 6 % or sevoflurane 2 % at a dose, by which minimal alveolar concentration (MAC) for rats would be one. The drugs were given for 4 hours within 100 % oxygen at a rate of 6 L.min-1. One hour after cessation of inhalation anesthesia, blood glucose levels were determined at 1st, 4th and 24th hours. 24 hours after the anaesthesia.

RESULTS

Serum glucose was detected to be significantly lower in Group C, when compared to Groups DC, DH, DH-D and DH-S (p = 0.002, p = 0.001, p = 0.002, p = 0.003, respectively). Blood glucose levels in the diabetic groups were similar at the end of 6 weeks period, after hyperglycemia and anaesthesia induction.

CONCLUSION

We found out that sevoflurane and desflurane administrations in hyperglycemic rats were both related with insignificant blood glucose level increase at early post anaesthesia period and at post anaesthesia 24th hours. We still think that patients undergoing anaesthesia protocols with acute hyperglycemia need relatively longer follow up periods (Tab. 1, Ref. 28).