Fas/FasL gene polymorphism in patients with Hashimoto's thyroiditis in Turkish population

OBJECTIVE

Hashimoto's disease is a polygenic disorder with complex etiopathogenesis. Apoptosis is proposed as one of its mechanisms. The Fas/Fas ligand cascade represents a major pathway initiating apoptosis. This study aims to evaluate the influence of Fas and FasL gene polymorphism in Hashimoto's thyroiditis in Turkish population.

MATERIALS AND METHODS

A total of 112 patients with Hashimoto's thyroiditis and 112 cases of healthy control people were included in this study. The evaluation of genotype for Fas -670 A/G and FasL 843 C/T gene polymorphism was performed by using PCR-RFLP method.

RESULTS

The FAS genotype and gene allele frequency distribution did differ between the control group (AA 36.6 %, AG 50.0 %, GG 13.4 %, A 61.6 %, G 38.4 %) and the Hashimoto's thyroiditis patients (AA 21.4 %, AG 50.9 %, GG 27.7 %, A 46.9 %, G 53.1 %) (p < 0.01). The evaluation of FasL genotype and gene allele frequency did not show statistically significant difference between the patient group (CC 27.7 %, CT 45.5 %, TT 26.8 %, C 50.4 %, T 49.6 %) and control group (CC 33.9 %, CT 44.6 %, TT 21,4 %, C 56.3 %, T 43.8 %) (p > 0.05).

CONCLUSIONS

Gene polymorphism of Fas and G allele frequency may play a role in the regulation of apoptosis in thyroid autoimmune disorders. There is a need for further studies to clarify the genetic role of apoptosis in HT.

Metabolic syndrome prevalence in subclinic and overt hypothyroid patients and the relation among metabolic syndrome parameters

OBJECTIVE

One of the common features of hypothyroidism is weight gain or failure to lose weight. Bradycardia and mild hypertension can be seen as well. Impact of thyroid hormone deficiency on glucose and insulin metabolism is not fully understood. Thyroid hormones play a role in lipid synthesis, metabolism and mobilization. Metabolic syndrome is a status where most features of hypothyroidism can be seen. Our aim is to investigate the frequency of metabolic syndrome in hypothyroid patients.

METHODS

One hundred overt hypothyroid patients, 100 subclinical hypothyroid patients and 200 healthy controls enroled in this study. The Third Adult Treatment Panel of the National Cholesterol Education Program (NCEP-ATP III) criteria were used for metabolic syndrome diagnosis.

RESULTS

Body mass index was similar among the groups. Waist circumference was lower in the control group than in the hypothyroid patients (p=0.0001). Homeostasis model assessment (HOMA) insulin resistance was higher in the hypothyroid group than in the control (p=0.008) and subclinical hypothyroid (p=0.014) groups. Metabolic syndrome prevalence was 44% in the hypothyroid group, 35% in the subclinical hypothyroid group and 33% in the control group (p=0.016 for the hypothyroid group vs controls and p=0.002 for the hypothyroid group vs subclinical hypothyroid group). Waist circumference was larger in the hypothyroid metabolic syndrome patients than in the subclinical hypothyroid group and controls (p=0.001). Blood glucose, lipid parameters and blood pressure were similar among the groups.

CONCLUSIONS

Metabolic syndrome is increased in patients with hypothyroidism, therefore hypothyroidism should be considered in newly diagnosed metabolic syndrome patients.

Partial neuromuscular blockage levels with mivacurium during mastoidectomy allows intraoperative facial nerve monitoring

BACKGROUND

Facial nerve monitoring during otologic surgery is helpful for facial nerve preservation, but its usage is closely related to anesthetic procedures.

OBJECTIVES

The aim of this study was to investigate the effectiveness of mivacurium-based partial neuromuscular blockade on facial nerve monitoring during otologic surgery.

METHODS

Forty-three patients scheduled for elective otologic surgery (mastoidectomy with and without tympanoplasty) participated in the study. After induction with propofol 2-3 mg x kg(-1), remifentanil 1 microg x kg(-1) and mivacurium 0.2 mg x kg(-1), anesthesia was maintained with isoflurane 0.6-1.6 minimum alveolar concentration and remifentanil 0.25 microg x kg(-1) x min(-1). Following complete recovery of neuromuscular blockade during induction, mivacurium infusion was initiated at 6 microg x kg(-1) x min(-1) in an adjusted dose to reflect adductor pollicis activity of 50, 75 or 100% of normal. The minimum stimulation thresholds obtained from each case were recorded.

RESULTS

Pre- and postoperatively, all 43 patients demonstrated clinically normal facial nerve function. In all cases, intraoperative facial nerve monitoring was performed successfully. There were no differences in threshold levels of the facial nerve stimulation between group I (1.84 +/- 0.4 mA ) and group II (1.97 +/- 0.2 mA). However, the stimulation thresholds of group III (1.53 +/- 0.4 mA ) were found to be lower than those of groups I and II (p < 0.05).

CONCLUSION

We conclude that partial neuromuscular blockade with mivacurium permits intraoperative facial nerve monitoring.

Prediction of difficult tracheal intubation in Turkish patients: a multi-center methodological study

BACKGROUND AND OBJECTIVE

Preoperative evaluation is important in the detection of patients at risk for difficult airway management. It is still unclear whether true prediction is possible and which variables should be chosen for evaluation. The aim of this prospective, multi-centre study was to investigate the incidence of difficult intubation, the sensitivity and positive predictive values of clinical screening tests and whether combining two or more of these tests will improve the prediction of difficult intubation in Turkish patients.

METHODS

Seven study sites from six regions in Turkey participated in this study. One thousand six hundred and seventy-four ASA physical status I-III patients, scheduled to undergo elective surgery under general anaesthesia, were included.

RESULTS

The incidence of difficult intubation was 4.8% and increased with age (P < 0.05). The incidence of difficult intubation was significantly higher in patients who had a Mallampati III or IV score, a decreased average thyromental and sternomental distance, decreased mouth opening, or decreased protrusion of the mandible (P < 0.05). Mouth opening and Mallampati III-IV were found to be the most sensitive criteria when used alone (43% and 35%, respectively). Combination of tests did not improve these results.

CONCLUSIONS

There is still no individual test or a combination of tests that predict difficult intubations accurately. Tests with higher specificity despite low positive predictive value are needed.

The comparison of two lower extremity block techniques combined with sciatic block: 3-in-1 femoral block vs. psoas compartment block

The objective of this study was to compare clinical and postoperative analgesic effects of femoral or psoas compartment blocks in patients undergoing arthroscopies. Fifty patients were randomly assigned to one of the two groups. Either femoral (group F) or psoas compartment (group P) block was applied followed by sciatic nerve block. All nerve blocks were provided with a 15 ml of bupivacaine 0.5% + 10 ml of lignocaine (lidocaine) 2%. Systolic and diastolic blood pressure (SBP and DBP), heart rate, and pulse oxymetry (SpO2) were recorded. Quality of anaesthesia, time to first analgesic use, verbal pain scores (VPS), sensorial and motor blockade resolution times and side effects were also recorded. Quality of anaesthesia, complete sensory blockade of obturator and lateral cutaneous nerves were higher in the group P than in group F. However, complete motor blockade findings were similar in both groups. In the group P, VPS values measured at 10 and 15 min were lower than that of group F. These values decreased at 10 min and thereafter as to baseline values. VPS values of the group F declined at 20 min and following measurement times as to baseline values. Durations of motor and sensorial block, and time to first analgesic use were similar between two groups. Total analgesic consumption at first 24 h in group P was lower than those of group F. Regarding heart rates, SpO2, SBP and DBP values, no significant differences were found between the groups. Combined psoas-sciatic technique provided more comfortable intraoperative anaesthesia and better postoperative analgesia when compared with femoral-sciatic technique for arthroscopic procedures.

Effect of ephedrine on the onset time of succinylcholine

BACKGROUND

The aim of this study was to evaluate the effect of ephedrine administered prior to induction of anaesthesia on the onset time of succinylcholine for endotracheal intubation.

METHODS

Patients were randomly assigned to receive intravenously (i.v.) either 70 microg kg(-1) of ephedrine (Group I; n = 25) or saline (Group II; n = 25) 3 min before induction of anaesthesia. Induction of anaesthesia was provided with propofol 2 mg kg(-1) plus remifentanil 1 microg kg(-1). Onset time and duration of muscle fasciculation and onset time of succinylcholine were recorded. Intubation was attempted after establishment of 100% thumb relaxation and difficulties were recorded. Heart rate, pulse oxymetry (SpO2) and mean arterial pressure (MAP) were also recorded.

RESULTS

The onset time of succinylcholine were significantly (P < 0.001) shorter in Group I (26 +/- 4 s), when compared with Group II (43 +/- 6 s). Patients in Group I were intubated at 49 +/- 7 s compared with 68 +/- 10 s in Group II. The score of intubation was similar in both groups. Duration of muscle fasciculation was longer in Group II. Heart rate and MAP increased significantly (P < 0.05) after ephedrine injection, compared with the baseline value in Group I.

CONCLUSIONS

The onset time of succinylcholine can be shortened with ephedrine pretreatment.

Comparison of ropivacaine with a combination of ropivacaine and fentanyl for the caudal epidural anaesthesia of mares

Two groups of six mares aged from eight to 18 years were anaesthetised by caudal epidural injections of ropivacaine (0.5 per cent, 0.1 mg/kg) or a combination of ripovacaine (0.08 mg/kg) and fentanyl (100 microg) in a randomised study. The onset of anaesthesia was significantly more rapid (P<0.001) and it lasted significantly longer (P<0.001) in the group anaesthetised with the combination of drugs. The surgical comfort scores of the group anaesthetised with the combination were higher than those of the group anaesthetised with ropivacaine alone (P<0.001), and the quality of intraoperative analgesia, as assessed by the surgeon, was significantly improved. There were no differences between the groups in their average scores for the levels of ataxia and sedation, in their behaviour, or in the incidence of side effects.