Calismamizda kunt gogus yaralanmasi ve pulmoner kontuzyon mevcut olgularda erken donemde pentoksi... more Calismamizda kunt gogus yaralanmasi ve pulmoner kontuzyon mevcut olgularda erken donemde pentoksifilin uygulamasinin pulmoner disfonksiyon ve akut akciger hasarlanmasi (Adult Respiratory Distress Syndrome=ARDS) gelisimi uzerine etkileri degerlendirildi. Kunt gogus travmasi ve pulmoner kontuzyona bagli akut solunum yetmezligi mevcut 21 eriskin hasta iki grupta ele alindi, 1.grupta (n=11) olgularin yogun bakim unitesine kabullerinden itibaren 72 saat suresince pentoksifilin 1-1.5 mg/kg/saat dozda IV infuzyon olarak uygulanirken II. grup (n=10) kontrol kabul edildi. Tum olgularda yogun bakim unitesine kabullerinden itibaren 72 saat suresince; 8 saatlik periyodlarla hemodinamik parametreler; (kardiyak indeks (CI), doku oksijen sunumu (DO 2 ), sistemik vaskuler rezistans indeks (SVRI) ve pulmoner vaskuler rezistans indeks (PVRI); yerlestirilen pulmoner arter kateteri ile olculdu. Pik havayolu basinci, ortalama havayolu basinci, statik komplians ve ekspire edilen tidal volumler 8 saatlik ...
Mersin Universitesi Tip Fakultesi Dergisi, Mar 21, 2012
OZET Kardiyopulmoner bypass (KPB) uygulamalarinda tromboembolik komplikasyonlar ve kanama egilimi... more OZET Kardiyopulmoner bypass (KPB) uygulamalarinda tromboembolik komplikasyonlar ve kanama egiliminde artisa neden olabilen hemostaz bozukluklari ortaya cikmaktadir. Koagulasyon sistemindeki denge prokoagulan tarafa kaymakta ve pihtilasmayi onlemek icin heparin uygulanmaktadir. Antikoagulasyon ve heparinizasyonun monitorizasyonu aktive edilmis pihtilasma zamani (ACT) olculerek yapilmaktadir. Ancak kardiyak cerrahi uygulamalarinda koagulasyon sistemindeki degisiklikler cok hizli gelistiginden hasta basinda monitorizasyon imkani saglayan "point of care" (POC) monitorizasyon sistemleri gelistirilmistir. POC sistemleri klinisyenin yaygm kanamaya daha uygun mudahale etmesine olanak saglamaktadir. Kanama egilimi uzerine uc grup ilacin yararli etkisi oldugu tespit edilmistir; aprotinin, desmopressin ve sentetik antifibrinolitik olan traneksamik asit ile -aminokaproik asit. Teknolojik gelismeler ile birlikte, yaygin kanama icin risk altinda bulunan hastalarin yeni metodlar ile tespiti ve bu hastalara uygun farmakolojik ajanlar ile mudahale mumkun olabilmektedir. Anahtar kelimeler: kardiyak cerrahi, koagulasyon, monitorizasyon sistemleri, farmakolojik ajanlar SUMMARY CARDIAC SURGERY AND COAGULATION SYSTEM Cardiopulmonary bypass (CPB) is associated with impaired haemostasis, which can lead to thromboembolic complications and increased perioperative bleeding tendency. Under the conditions of CPB the balance of the coagulation system is shifted towards the procoagulant state and heparine is employed to avoid clotting during CPB. Monitoring of anticoagulation and heparinization is stili based on the principles of the activated clotting time (ACT). Because changes in coagulation may occur rapidly in cardiac surgery "point of care" (POC) monitoring systems have been developed. POC tests may help physicians establish more appropriate management of excessive bleeding. Three classes of drugs have been proven beneficial impact on bleeding tendency; aprotinin, desmopressin and synthetic antifibrinolytics tranexamic acid and -aminocaproic acid. With new technological developments, an optimal approach would involve utilization of several new methods that can identify patients at risk for excessive blood loss and facilitate appropriate treatment with these pharmacological agents. Key words: Cardiac surgery, coagulation, monitoring systems, pharmacological agents
Mersin Universitesi Tip Fakultesi Dergisi, Mar 21, 2012
OZET Norolojik hasarlar kardiyak cerrahiyi takiben olusan ciddi komplikasyonlardandir.Bu derlemed... more OZET Norolojik hasarlar kardiyak cerrahiyi takiben olusan ciddi komplikasyonlardandir.Bu derlemede kardiyak cerrahi ve kardiyopulmoner bypass girisiminin beyin uzerine olan etkileri ve postoperatif norolojik defisit insidansi ile serebral hasar olusturabilecek risk faktorleri tartisilmistir. Anahtar sozcukler: kardiyak cerrahi, serebral disfonksiyon SUMMARY CARDIAC SURGERY AND CEREBRAL DISFUNCTION Neurologic injuries are one of those severe complications after cardiac surgery.The effects of cardiac surgery and cardiopulmonary bypass on the brain and the incidence of postoperative neurological deficits and risk factors are discussed in this review. Key Words: cardiac surgery,cerebral disfunction
Mersin Universitesi Tip Fakultesi Dergisi, Feb 28, 2012
OZET Tramadol hidroklorid sentetik bir mu-opioid agonistidir.Analjezik etkinliginin baslamasi ile... more OZET Tramadol hidroklorid sentetik bir mu-opioid agonistidir.Analjezik etkinliginin baslamasi ile ilgili olarak farkli gorusler one surulmektedir. Calismamizda laparoskopik kolesistektomi uygulanan olgularda tramadolun postoperatif agri uzerine etkilerinin arastirilmasi amaclandi. Calisma grubuna (ASA I-II) 30 hasta alindi.Hastalar preoperatif ve peroperatif tramadol uygulanmak uzere rastgele 2 gruba ayrildi. Premedikasyon amaciyla her iki gruptaki hastalara 0.03 mg/kg midazolam ve 4 mg/kg ondansetron uygulandi.Anestezi induksiyonu 2g/kg fentanil , 2mg/kg propofol ve 0.1 mg/kg vekuronyum ile saglandi.Anestezinin idamesinde %50 02 +%50 N20 ve %2 sevofluran karisimi kullanildi. Operasyon suresince intraabdominal basinc 13mm/hg duzeyinde tutuldu. Postoperatif analjezi icin; I.gruptaki hastalara anestezi induksiyonundan 15 dk once,II.gruptaki hastalara da operasyon sonunda, cilt suturasyonuna baslandigi anda 1.5mg/kg tramadol uygulandi. Her iki gruptaki hastalarin 15,30 ve 45. dk.larda visual analogue scale(VAS) ve 5,15,30 ve 45. dk.larda severe emetic sequelae(SES) skorlari tespit edildi. Grup I'de 15,30 ve 45. dk VAS degerleri ile 5,15,30 ve 45.dk SES degerleri arasinda istatistiksel farklilik saptanmadi.Grup Il'de 15.dk VAS degerleri 30.dk degerlerine gore yuksek bulundu.Bu fark istatistiksel olarak anlamli bulundu(p<0.05).30 ve 45.dk degerleri arasinda fark saptanmadi.SES degerlendirmelerinde grup ici zaman araliklarinda fark saptanamadi. Gruplararasi degerlendirmede;VAS degerleri I.grupta Il.gruba oranla butun olcum zamanlarinda dusuk bulundu.Bu farkin istatistiksel olarak anlamli oldugu saptandi(p<0.05) SES degerlerinin de I.grupta II. gruba oranla butun olcum zamanlarinda istatistiksel olarak anlamli olacak sekilde dusuk oldugu belirlendi(p<0.05) Calismamizda preoperatif uygulamanin postoperatif agri uzerine daha etkili oldugu saptandi.Bu bulgunun nedeninin tramadolun maksimum analjezik etkisinin baslamasi icin zaman kazanilmis olmasi ve preemptif analjezi olabilecegi dusunuldu. Anahtar sozcukler: Laparoskopik kolesistektomi,postoperatif agri,tramadol SUMMARY EFFECT OF TRAMODOL ON POSTOPERATIVE PAIN IN LAPAROSCOPIC CHOLECYSTECTOMIES Tramadol hydrochlorid is a synthetic mu-receptor agonist.There are different reports about the mean onset time of its analgesic efficiency. We aimed to investigate the effects of tramadol on pain relief in laparoscopic cholecystectomies. Thirty ASA physical status I-II patients were randomly allocated into two groups to receive tramadol either preoperatively or postoperatively.Anesthesia was induced with 2g/kg fentanyl ,2mg/kg propofol and 0.1 mg/kg vecuronium and maintained with % 50 02 % 50 N2O and %2 sevoflurane mixture. For postoperative analgesia;1.5 mg/kg tramadol was administered 15 min.before anesthesia induction in group I and at wound closure in group II. Visual Analogue Score (VAS) at 15,30 and 45.min and Severe Emetic Sequelae (SES) scores were assessed at 5,15,30 and 45.min for ali patients. No statistically difference was found between group I VAS and SES scores. In group II, VAS score on 15.min was higher than 30.min.This difference was important statistically(p<0.05) There were no difference between 30 and 45. min. scores. VAS and SES scores were significantly lower in group I than group II.This was found statistically important(p<0.05). Pprophylactic administration of tramadol was found more effective on postoperative pain relief. It was concluded that this finding may be the result of preemptive effect and the sufficient time for onset of analgesia of tramadol. Key words: Laparoscopic cholecystectomy,postoperative pain, tramadol
Mersin Universitesi Tip Fakultesi Dergisi, Feb 15, 2012
OZET Nitrik oksit (NO) kalpte endokardda, koroner endotelinde ve miyositlerde sentez edilir. NO h... more OZET Nitrik oksit (NO) kalpte endokardda, koroner endotelinde ve miyositlerde sentez edilir. NO hizla superoksit radikal ile reaksiyona girerek potent oksidan peroksinitrit (ONOO") olusturur. ONOO" miyokardda negatif inotropik etki gosterir ve hasara sebep olur. ONOO"'nun yuksek konsantrasyonlari protein, lipit, karbonhidrat, nukleik asit ve bazi diger biyomolekulleri okside edebilmektedir. ONOO 'nun inflamasyon, ateroskleros, iskemi-reperfuzyon injury'si, sepsis ve adult respiratuar distres sendromu gibi bir cok hastaliklarin patofizyolojilerinde rol oynadigi ve klinik pratikte peroksinitrit temizleyicilerindeki gelismelerin yeni tedavi yaklasimlarina yol acabilecegi dusunulmektedir. Anahtar Kelimeler: Peroksinitrit, myokardiyum SUMMARY PEROXYNITRITE AND MYOCARDIUM In the heart, NO is synthesized in endocardium, coronarry endothelium and cardiac myocytes. NO reacts rapidly with superoxide radical and forms potent oxidant peroxynitrite(ONOO"). ONOO" shows negative inotropic effect on myocardium and causes myocardial injury. High concentration of ONOO" is capable of oxidizing proteins, lipds, carbohydrates, nucleic acids and other biomoecules. ONOO" has been implicated in the pathophysiology of a variety of diseases including inflammation, atheroslerosis, ischemia-reperfusion injury, sepsis and acute respiratory distress syndrome and in the clinical practise, development of peroxynitrite scavengers may provide new therapeutic approaches. Key Words: Peroxynitrite, myocardium
Human beta-defensin 2 (hBD-2) is a cationic antimicrobial peptide. HBD-2 is inducible by bacteria... more Human beta-defensin 2 (hBD-2) is a cationic antimicrobial peptide. HBD-2 is inducible by bacterial infection and proinflammatory stimuli which play an important role in innate immune and infectious disease. HBD-2 is also a chemotractant for immature dentritic cells and memory T cells. However, the inducibility of hBD-2 in peripheral blood cells was downregulated in sepsis patients. Since IL-10 possesses immunosuppressive properties in the pathophysiological process of sepsis, we investigated whether IL-10 downregulated the expression level of hBD-2 mRNA in peripheral blood cells. Meanwhile, recent studies showed that histone acetylation/deacetylation could regulate transcriptional activity of several genes involved in innate immunity. We further investigated whether histone deacetylases (HDAC) were involved in this downregulation. Methods: Peripheral blood from healthy blood donors was incubated with 100ng/ml LPS or 100ng/ml LPS and 10ng/ml IL-10 or left untreated. To investigate the possible role of HDAC in transcriptional regulation, the blood cells were cocultured with 1000ng/ml trichostatin A, the specific HDAC inhibitor, 100ng/ml LPS and 10ng/ml IL-10. After incubation for 12 hours, total RNA was extracted from the cells. Relative expression level of hBD-2 mRNA was compared to a housekeeping gene, human hypoxanthine phosphoribosyl transferase (hHPRT), and quantified by means of real-time PCR. Results: No constitutive expression of hBD-2 mRNA was detected in healthy peripheral blood cells. In peripheral blood cells, after LPS stimulation, the expression level of hBD-2 mRNA was upregulated. When the cells were costimulated by LPS and IL-10, the expression level significantly reduced. However, inhibiting of HDAC did not recover the expression level of hBD-2 mRNA. Conclusions: IL-10 downregulates transcriptional level of the hBD-2 gene, which may compromise the innate immune and contribute to immunosuppressive response in sepsis. HDAC was not responsive for the transcriptional repression. The molecular mechanism of this downregulation need further investigation 474
BACKGROUND: The aim of the study was to compare the effect of postoperative analgesia between the... more BACKGROUND: The aim of the study was to compare the effect of postoperative analgesia between the morphine and tramadol added lidocaine groups in brachial plexus blockade. METHODS: Seventy-five patients (ASA I-II) scheduled for arm and forehand surgery were included in the study. The surgery was performed under general anaesthesia and brachial plexus blockade was performed at the end of surgery for postoperative analgesia. The patients were randomly allocated into three groups. In group L (n=25), 40 ml lidocaine 1%, in group M (n=25), 40 ml lidocaine 1% with 5 mg morphine, and in group T (n=25) 40 ml lidocaine 1% with 50 mg tramadol were given. Visual analog scale (VAS) was used for pain evaluation and motor blockade scale was used to evaluate motor blockade at 5, 10, 15, 30, 60 minutes and 2, 3, 4, 5, 6, 12 and 24. hours. Respiratory and hemodynamic changes were also recorded at the same intervals. RESULTS: There was no statistical difference between the groups by means of demograp...
Apoptosis of tissues may contribute to ischaemia-reperfusion injury. The aim of the present study... more Apoptosis of tissues may contribute to ischaemia-reperfusion injury. The aim of the present study was to determine whether administration of a colloid solution would prevent apoptosis after liver ischaemia-reperfusion. New Zealand rabbits, weighing 1.5-2 kg, were randomized to receive either 4% SG (20 ml kg (-1)h(-1) ) by 30 min of intravenous (i.v.) infusion (Group I, n= 7) or equivalent volumes of 0.9% sodium chloride (Group II, n= 6) i.v. before a 45 min interruption of the portal vein blood flow and then 45 min of reperfusion. The animals were killed following the reperfusion period. Their livers were processed for histopathological examination and paraffin sections of these tissues were examined. The expression of Bcl-2, Bax and caspase 3 were analysed by immunohistochemistry. ANOVA and the Wilcoxon W -test were used for statistical analysis, and mean values were expressed +/-sd. Histologically, the foci of ischaemic necrosis were observed in liver specimens of the periportal area in one of the animals in Group I and in two in Group II. Immunhistochemical analysis demonstrated an increase in Bcl-2 protein levels in Group I compared to Group II ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Bax expression was lower in Group I than in Group II. Immunoreactivity for caspase 3 did not differ significantly between the two groups (47.0 +/- 35.93 in Group I, 32.83 +/- 23.63 in Group II). Our results indicate that gelofusine did not protect the liver tissue against ischaemia-reperfusion-induced apoptosis.
Medical science monitor : international medical journal of experimental and clinical research, 2010
Postoperative nausea and vomiting (PONV) are some of the most-common and undesirable adverse effe... more Postoperative nausea and vomiting (PONV) are some of the most-common and undesirable adverse effects after surgery performed under general anesthesia. We investigated the prophylactic value of dexamethasone as an alternate to ondansetron or metoclopramide to prevent PONV after gynecologic surgery. One hundred sixty ASA I-II patients scheduled for elective gynecologic surgery were enrolled. Before induction of anesthesia, patients were randomly allocated to receive intravenously dexamethasone (8 mg) in group D, ondansetron (4 mg) in group O, metoclopramide (10 mg) in group M, and saline (2 mL) in group P. Total incidence of nausea and vomiting, rescue antiemetic requirement, pain scores, and any adverse effects were recorded at 3 observational periods (0-2 hours, 2-12 hours, and 12-24 hours). Total rates of PON, POV, and PONV were significantly higher in group P at 0-2 hours and 2-12 hours compared with group D, O, and M (P<.05). There was no difference in PON, POV, and PONV among...
Effect of ornithine which is known to inhibit L-arginine uptake via cationic amino acid transport... more Effect of ornithine which is known to inhibit L-arginine uptake via cationic amino acid transport system has been tested, and compared to aminoguanidine, an iNOS inhibitor in lypopolysaccharide (LPS)-induced endotoxemia in rats. Serum nitrite/nitrate and malondialdehyde (MDA) level have been measured, and ileal histology has also been examined. Endotoxin increased serum nitrite/nitrate and MDA levels from 15.7+/- 2.4 micromol/ml and 2.1 +/-0.2 nmol/ml to 23.1 +/- 1.0 micromol/ml and 5.2+/- 0.3 nmol/ml (both P<0.05), respectively. In addition, LPS caused ileal degeneration. L-ornithine (500 mg/kg) did not improve septic manifestations, i.e., serum nitrite/nitrate and MDA levels did not differ from those in endotoxemia. Neither does it have an improving action on ileal histology. However, higher dose of L-ornithine (2,500 mg/kg) lowered the increased level of nitrite/nitrate and MDA by LPS. Moreover, it restored ileal histology from grade 3 (median) to 0 (median) (P<0.05). On th...
Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II ce... more Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II cells (A549). To study in vitro the direct influence of alveolar type II cells on mechanical stretch. Methods A549 were treated with different doses of lipopolysaccharide (LPS), 0 ng/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1000 ng/ml, and then A549 were lengthened 5%, 15%, 30% using a FLEXCELL tension unit 4000, a vacuum-driven device that applies strain to cells, which were cultured in six-well plates coated with collagen-I, and 12 cycles/min for 4 hours. Apoptosis was measured using the flow cytometry method that measures annexin V and propidium iodide (PI) staining. The morphological changes of apoptotic cells were observed by transmission electron microscope. Results Apoptosis could be induced in alveolar type II cells (A549) by mechanical stretch. The percentage of annexin V + PI cells increased after being treated with cyclic stretch for 4 hours by 5%, 15%, 30% in all groups. The morphological features of apoptotic cells demonstrated by transmission electron microscope were as follows: shrinkage of the cell, chromatin condensation and aggregation under the nuclear membrane as a crescent or lump, membrane-encapsulated nuclear fragment or cell organ formed by invagination of the cell membrane, and apoptotic body formation followed by vacuolization. Conclusion Apoptosis induced by mechanical stretch and LPS is dose dependent. Mechanical stretch aggravates apoptosis especially in cells treated with LPS. Annexin V and PI double staining is a specific, sensitive, and quantitative method for analyzing apoptotic cells. It is also helpful to clarify the protective mechanism of low-volume ventilation in ARDS. Acknowledgement The study was funded by the 'One Hundred People' project of Shanghai Sanitary Bureau (03-77-20).
Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated ... more Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ®. A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality. P2 Closed endotracheal suction system without periodic change versus open endotracheal system
Objectives: To examine in a prospective, randomized, double-blind, placebo-controlled study the a... more Objectives: To examine in a prospective, randomized, double-blind, placebo-controlled study the analgesic effect of periprostatic nerve block and/or intravenous synthetic opioid administration during a 12-core prostate biopsy. Patients and Methods: Patients were prospectively randomized to receive unilateral periprostatic lidocaine administration and/or intravenous synthetic opioid (meperidine or tramadol) administration. Placebo groups received sterile normal saline. Unilateral infiltration was performed and biopsy was begun on this side. The degree of pain was recorded using the visual analog scale/numeric analog scale (VAS/NAS) score before the procedure, during probe introduction into the rectum, during unilateral periprostatic nerve blockade, during the first 6-core biopsy and during the second 6-core biopsy, and 30 min after biopsy completion. Results: Most of the patients had mild or moderate pain (VAS/NAS <6) during the actual biopsy procedure. However, no significant dif...
ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is... more ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is a frequent cause of cerebral embolim on young patients. In this report, we describe a young woman who presented with postpartum tonic clonic seizures after an uncomplicated labor. Case. A 28 years old woman who suffered unexplained neurological symptoms on 10th day of the postpartum period was admitted to the neurology clinic. Investigations demonstrated a previously unknown patent foramen ovale and paradoxical embolism was diagnosed as the cause of symptoms. The diagnosis was based on established criteria and the failure to identify an arterial or cardiac embolic source. Discussion and Conclusion. Paradoxical cerebral embolisation only occurs in patients with a shunt and it is a severe complication that causes high morbidity and mortality.
Histopathologic changes in rat brain due to chronic use of morphine and/or tramadol in progressiv... more Histopathologic changes in rat brain due to chronic use of morphine and/or tramadol in progressively increased doses were investigated in this study. Thirty male Wistar rats (180-220 g) were included and divided into three groups. Normal saline (1 ml/kg) was given intraperitoneally as placebo in the control group (n = 10). Morphine group (n = 10) received morphine intraperitoneally at a dose of 4 mg/kg/day for the first 10 days, 8 mg/kg/day between 11-20 days, and 12 mg/kg/day between 21-30 days. The tramadol group (n = 10) received the drug intraperitoneally at doses of 20, 40, and 80 mg/kg/day in the first, second, and the third 10 days of the study, respectively. All rats were decapitated on the 30th day and the brain was removed intact for histology. The presence and the number of red neurons, which are a histologic marker of apoptosis, were investigated in the parietal, frontal, temporal, occipital, entorhinal, pyriform, and hippocampal CA1, CA2, CA3 regions. Red neurons were found in morphine and tramadol groups but not in the control group. The total number of red neurons was not different in morphine and tramadol groups, but the numbers of red neurons were significantly higher in the temporal and occipital regions in tramadol group as compared with the morphine group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). In conclusion, chronic use of morphine and/or tramadol in increasing doses is found to cause red neuron degeneration in the rat brain, which probably contributes to cerebral dysfunction. These findings should be taken into consideration when chrome use of opioids is indicated.
The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physi... more The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II scoring systems for organophosphate poisoning (OPP) in an intensive care unit (ICU). The following data were collected on all consecutive patients who were admitted to the ICU between June 1999 and December 2004. Demographic data, GCS, APACHE II and SAPS II scoring systems were recorded. Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was computed with 95% confidence intervals (CI). The sensitivity and specificity for each scoring system were evaluated by calculating the Area Under the Receiver Operating Characteristic Curves. The actual mortality in OPP was 21.9%. Predicted mortality by all systems was not significantly different from actual mortality [SMR and 95% CI for GCS: 1.00 (0.65-1.35), APACHE II: 0.87 (0.54-1.03), SAPS II: 1.40...
ABSTRACT Although effective analgesia is provided for many patients, some complications may occur... more ABSTRACT Although effective analgesia is provided for many patients, some complications may occur due to the catheter delivery system. A rare complication, subcutaneous-epidural connection due to the long-term use of an epidural catheter and subcutaneous injection port in a patient is presented in this paper.
Calismamizda kunt gogus yaralanmasi ve pulmoner kontuzyon mevcut olgularda erken donemde pentoksi... more Calismamizda kunt gogus yaralanmasi ve pulmoner kontuzyon mevcut olgularda erken donemde pentoksifilin uygulamasinin pulmoner disfonksiyon ve akut akciger hasarlanmasi (Adult Respiratory Distress Syndrome=ARDS) gelisimi uzerine etkileri degerlendirildi. Kunt gogus travmasi ve pulmoner kontuzyona bagli akut solunum yetmezligi mevcut 21 eriskin hasta iki grupta ele alindi, 1.grupta (n=11) olgularin yogun bakim unitesine kabullerinden itibaren 72 saat suresince pentoksifilin 1-1.5 mg/kg/saat dozda IV infuzyon olarak uygulanirken II. grup (n=10) kontrol kabul edildi. Tum olgularda yogun bakim unitesine kabullerinden itibaren 72 saat suresince; 8 saatlik periyodlarla hemodinamik parametreler; (kardiyak indeks (CI), doku oksijen sunumu (DO 2 ), sistemik vaskuler rezistans indeks (SVRI) ve pulmoner vaskuler rezistans indeks (PVRI); yerlestirilen pulmoner arter kateteri ile olculdu. Pik havayolu basinci, ortalama havayolu basinci, statik komplians ve ekspire edilen tidal volumler 8 saatlik ...
Mersin Universitesi Tip Fakultesi Dergisi, Mar 21, 2012
OZET Kardiyopulmoner bypass (KPB) uygulamalarinda tromboembolik komplikasyonlar ve kanama egilimi... more OZET Kardiyopulmoner bypass (KPB) uygulamalarinda tromboembolik komplikasyonlar ve kanama egiliminde artisa neden olabilen hemostaz bozukluklari ortaya cikmaktadir. Koagulasyon sistemindeki denge prokoagulan tarafa kaymakta ve pihtilasmayi onlemek icin heparin uygulanmaktadir. Antikoagulasyon ve heparinizasyonun monitorizasyonu aktive edilmis pihtilasma zamani (ACT) olculerek yapilmaktadir. Ancak kardiyak cerrahi uygulamalarinda koagulasyon sistemindeki degisiklikler cok hizli gelistiginden hasta basinda monitorizasyon imkani saglayan "point of care" (POC) monitorizasyon sistemleri gelistirilmistir. POC sistemleri klinisyenin yaygm kanamaya daha uygun mudahale etmesine olanak saglamaktadir. Kanama egilimi uzerine uc grup ilacin yararli etkisi oldugu tespit edilmistir; aprotinin, desmopressin ve sentetik antifibrinolitik olan traneksamik asit ile -aminokaproik asit. Teknolojik gelismeler ile birlikte, yaygin kanama icin risk altinda bulunan hastalarin yeni metodlar ile tespiti ve bu hastalara uygun farmakolojik ajanlar ile mudahale mumkun olabilmektedir. Anahtar kelimeler: kardiyak cerrahi, koagulasyon, monitorizasyon sistemleri, farmakolojik ajanlar SUMMARY CARDIAC SURGERY AND COAGULATION SYSTEM Cardiopulmonary bypass (CPB) is associated with impaired haemostasis, which can lead to thromboembolic complications and increased perioperative bleeding tendency. Under the conditions of CPB the balance of the coagulation system is shifted towards the procoagulant state and heparine is employed to avoid clotting during CPB. Monitoring of anticoagulation and heparinization is stili based on the principles of the activated clotting time (ACT). Because changes in coagulation may occur rapidly in cardiac surgery "point of care" (POC) monitoring systems have been developed. POC tests may help physicians establish more appropriate management of excessive bleeding. Three classes of drugs have been proven beneficial impact on bleeding tendency; aprotinin, desmopressin and synthetic antifibrinolytics tranexamic acid and -aminocaproic acid. With new technological developments, an optimal approach would involve utilization of several new methods that can identify patients at risk for excessive blood loss and facilitate appropriate treatment with these pharmacological agents. Key words: Cardiac surgery, coagulation, monitoring systems, pharmacological agents
Mersin Universitesi Tip Fakultesi Dergisi, Mar 21, 2012
OZET Norolojik hasarlar kardiyak cerrahiyi takiben olusan ciddi komplikasyonlardandir.Bu derlemed... more OZET Norolojik hasarlar kardiyak cerrahiyi takiben olusan ciddi komplikasyonlardandir.Bu derlemede kardiyak cerrahi ve kardiyopulmoner bypass girisiminin beyin uzerine olan etkileri ve postoperatif norolojik defisit insidansi ile serebral hasar olusturabilecek risk faktorleri tartisilmistir. Anahtar sozcukler: kardiyak cerrahi, serebral disfonksiyon SUMMARY CARDIAC SURGERY AND CEREBRAL DISFUNCTION Neurologic injuries are one of those severe complications after cardiac surgery.The effects of cardiac surgery and cardiopulmonary bypass on the brain and the incidence of postoperative neurological deficits and risk factors are discussed in this review. Key Words: cardiac surgery,cerebral disfunction
Mersin Universitesi Tip Fakultesi Dergisi, Feb 28, 2012
OZET Tramadol hidroklorid sentetik bir mu-opioid agonistidir.Analjezik etkinliginin baslamasi ile... more OZET Tramadol hidroklorid sentetik bir mu-opioid agonistidir.Analjezik etkinliginin baslamasi ile ilgili olarak farkli gorusler one surulmektedir. Calismamizda laparoskopik kolesistektomi uygulanan olgularda tramadolun postoperatif agri uzerine etkilerinin arastirilmasi amaclandi. Calisma grubuna (ASA I-II) 30 hasta alindi.Hastalar preoperatif ve peroperatif tramadol uygulanmak uzere rastgele 2 gruba ayrildi. Premedikasyon amaciyla her iki gruptaki hastalara 0.03 mg/kg midazolam ve 4 mg/kg ondansetron uygulandi.Anestezi induksiyonu 2g/kg fentanil , 2mg/kg propofol ve 0.1 mg/kg vekuronyum ile saglandi.Anestezinin idamesinde %50 02 +%50 N20 ve %2 sevofluran karisimi kullanildi. Operasyon suresince intraabdominal basinc 13mm/hg duzeyinde tutuldu. Postoperatif analjezi icin; I.gruptaki hastalara anestezi induksiyonundan 15 dk once,II.gruptaki hastalara da operasyon sonunda, cilt suturasyonuna baslandigi anda 1.5mg/kg tramadol uygulandi. Her iki gruptaki hastalarin 15,30 ve 45. dk.larda visual analogue scale(VAS) ve 5,15,30 ve 45. dk.larda severe emetic sequelae(SES) skorlari tespit edildi. Grup I'de 15,30 ve 45. dk VAS degerleri ile 5,15,30 ve 45.dk SES degerleri arasinda istatistiksel farklilik saptanmadi.Grup Il'de 15.dk VAS degerleri 30.dk degerlerine gore yuksek bulundu.Bu fark istatistiksel olarak anlamli bulundu(p<0.05).30 ve 45.dk degerleri arasinda fark saptanmadi.SES degerlendirmelerinde grup ici zaman araliklarinda fark saptanamadi. Gruplararasi degerlendirmede;VAS degerleri I.grupta Il.gruba oranla butun olcum zamanlarinda dusuk bulundu.Bu farkin istatistiksel olarak anlamli oldugu saptandi(p<0.05) SES degerlerinin de I.grupta II. gruba oranla butun olcum zamanlarinda istatistiksel olarak anlamli olacak sekilde dusuk oldugu belirlendi(p<0.05) Calismamizda preoperatif uygulamanin postoperatif agri uzerine daha etkili oldugu saptandi.Bu bulgunun nedeninin tramadolun maksimum analjezik etkisinin baslamasi icin zaman kazanilmis olmasi ve preemptif analjezi olabilecegi dusunuldu. Anahtar sozcukler: Laparoskopik kolesistektomi,postoperatif agri,tramadol SUMMARY EFFECT OF TRAMODOL ON POSTOPERATIVE PAIN IN LAPAROSCOPIC CHOLECYSTECTOMIES Tramadol hydrochlorid is a synthetic mu-receptor agonist.There are different reports about the mean onset time of its analgesic efficiency. We aimed to investigate the effects of tramadol on pain relief in laparoscopic cholecystectomies. Thirty ASA physical status I-II patients were randomly allocated into two groups to receive tramadol either preoperatively or postoperatively.Anesthesia was induced with 2g/kg fentanyl ,2mg/kg propofol and 0.1 mg/kg vecuronium and maintained with % 50 02 % 50 N2O and %2 sevoflurane mixture. For postoperative analgesia;1.5 mg/kg tramadol was administered 15 min.before anesthesia induction in group I and at wound closure in group II. Visual Analogue Score (VAS) at 15,30 and 45.min and Severe Emetic Sequelae (SES) scores were assessed at 5,15,30 and 45.min for ali patients. No statistically difference was found between group I VAS and SES scores. In group II, VAS score on 15.min was higher than 30.min.This difference was important statistically(p<0.05) There were no difference between 30 and 45. min. scores. VAS and SES scores were significantly lower in group I than group II.This was found statistically important(p<0.05). Pprophylactic administration of tramadol was found more effective on postoperative pain relief. It was concluded that this finding may be the result of preemptive effect and the sufficient time for onset of analgesia of tramadol. Key words: Laparoscopic cholecystectomy,postoperative pain, tramadol
Mersin Universitesi Tip Fakultesi Dergisi, Feb 15, 2012
OZET Nitrik oksit (NO) kalpte endokardda, koroner endotelinde ve miyositlerde sentez edilir. NO h... more OZET Nitrik oksit (NO) kalpte endokardda, koroner endotelinde ve miyositlerde sentez edilir. NO hizla superoksit radikal ile reaksiyona girerek potent oksidan peroksinitrit (ONOO") olusturur. ONOO" miyokardda negatif inotropik etki gosterir ve hasara sebep olur. ONOO"'nun yuksek konsantrasyonlari protein, lipit, karbonhidrat, nukleik asit ve bazi diger biyomolekulleri okside edebilmektedir. ONOO 'nun inflamasyon, ateroskleros, iskemi-reperfuzyon injury'si, sepsis ve adult respiratuar distres sendromu gibi bir cok hastaliklarin patofizyolojilerinde rol oynadigi ve klinik pratikte peroksinitrit temizleyicilerindeki gelismelerin yeni tedavi yaklasimlarina yol acabilecegi dusunulmektedir. Anahtar Kelimeler: Peroksinitrit, myokardiyum SUMMARY PEROXYNITRITE AND MYOCARDIUM In the heart, NO is synthesized in endocardium, coronarry endothelium and cardiac myocytes. NO reacts rapidly with superoxide radical and forms potent oxidant peroxynitrite(ONOO"). ONOO" shows negative inotropic effect on myocardium and causes myocardial injury. High concentration of ONOO" is capable of oxidizing proteins, lipds, carbohydrates, nucleic acids and other biomoecules. ONOO" has been implicated in the pathophysiology of a variety of diseases including inflammation, atheroslerosis, ischemia-reperfusion injury, sepsis and acute respiratory distress syndrome and in the clinical practise, development of peroxynitrite scavengers may provide new therapeutic approaches. Key Words: Peroxynitrite, myocardium
Human beta-defensin 2 (hBD-2) is a cationic antimicrobial peptide. HBD-2 is inducible by bacteria... more Human beta-defensin 2 (hBD-2) is a cationic antimicrobial peptide. HBD-2 is inducible by bacterial infection and proinflammatory stimuli which play an important role in innate immune and infectious disease. HBD-2 is also a chemotractant for immature dentritic cells and memory T cells. However, the inducibility of hBD-2 in peripheral blood cells was downregulated in sepsis patients. Since IL-10 possesses immunosuppressive properties in the pathophysiological process of sepsis, we investigated whether IL-10 downregulated the expression level of hBD-2 mRNA in peripheral blood cells. Meanwhile, recent studies showed that histone acetylation/deacetylation could regulate transcriptional activity of several genes involved in innate immunity. We further investigated whether histone deacetylases (HDAC) were involved in this downregulation. Methods: Peripheral blood from healthy blood donors was incubated with 100ng/ml LPS or 100ng/ml LPS and 10ng/ml IL-10 or left untreated. To investigate the possible role of HDAC in transcriptional regulation, the blood cells were cocultured with 1000ng/ml trichostatin A, the specific HDAC inhibitor, 100ng/ml LPS and 10ng/ml IL-10. After incubation for 12 hours, total RNA was extracted from the cells. Relative expression level of hBD-2 mRNA was compared to a housekeeping gene, human hypoxanthine phosphoribosyl transferase (hHPRT), and quantified by means of real-time PCR. Results: No constitutive expression of hBD-2 mRNA was detected in healthy peripheral blood cells. In peripheral blood cells, after LPS stimulation, the expression level of hBD-2 mRNA was upregulated. When the cells were costimulated by LPS and IL-10, the expression level significantly reduced. However, inhibiting of HDAC did not recover the expression level of hBD-2 mRNA. Conclusions: IL-10 downregulates transcriptional level of the hBD-2 gene, which may compromise the innate immune and contribute to immunosuppressive response in sepsis. HDAC was not responsive for the transcriptional repression. The molecular mechanism of this downregulation need further investigation 474
BACKGROUND: The aim of the study was to compare the effect of postoperative analgesia between the... more BACKGROUND: The aim of the study was to compare the effect of postoperative analgesia between the morphine and tramadol added lidocaine groups in brachial plexus blockade. METHODS: Seventy-five patients (ASA I-II) scheduled for arm and forehand surgery were included in the study. The surgery was performed under general anaesthesia and brachial plexus blockade was performed at the end of surgery for postoperative analgesia. The patients were randomly allocated into three groups. In group L (n=25), 40 ml lidocaine 1%, in group M (n=25), 40 ml lidocaine 1% with 5 mg morphine, and in group T (n=25) 40 ml lidocaine 1% with 50 mg tramadol were given. Visual analog scale (VAS) was used for pain evaluation and motor blockade scale was used to evaluate motor blockade at 5, 10, 15, 30, 60 minutes and 2, 3, 4, 5, 6, 12 and 24. hours. Respiratory and hemodynamic changes were also recorded at the same intervals. RESULTS: There was no statistical difference between the groups by means of demograp...
Apoptosis of tissues may contribute to ischaemia-reperfusion injury. The aim of the present study... more Apoptosis of tissues may contribute to ischaemia-reperfusion injury. The aim of the present study was to determine whether administration of a colloid solution would prevent apoptosis after liver ischaemia-reperfusion. New Zealand rabbits, weighing 1.5-2 kg, were randomized to receive either 4% SG (20 ml kg (-1)h(-1) ) by 30 min of intravenous (i.v.) infusion (Group I, n= 7) or equivalent volumes of 0.9% sodium chloride (Group II, n= 6) i.v. before a 45 min interruption of the portal vein blood flow and then 45 min of reperfusion. The animals were killed following the reperfusion period. Their livers were processed for histopathological examination and paraffin sections of these tissues were examined. The expression of Bcl-2, Bax and caspase 3 were analysed by immunohistochemistry. ANOVA and the Wilcoxon W -test were used for statistical analysis, and mean values were expressed +/-sd. Histologically, the foci of ischaemic necrosis were observed in liver specimens of the periportal area in one of the animals in Group I and in two in Group II. Immunhistochemical analysis demonstrated an increase in Bcl-2 protein levels in Group I compared to Group II ( P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Bax expression was lower in Group I than in Group II. Immunoreactivity for caspase 3 did not differ significantly between the two groups (47.0 +/- 35.93 in Group I, 32.83 +/- 23.63 in Group II). Our results indicate that gelofusine did not protect the liver tissue against ischaemia-reperfusion-induced apoptosis.
Medical science monitor : international medical journal of experimental and clinical research, 2010
Postoperative nausea and vomiting (PONV) are some of the most-common and undesirable adverse effe... more Postoperative nausea and vomiting (PONV) are some of the most-common and undesirable adverse effects after surgery performed under general anesthesia. We investigated the prophylactic value of dexamethasone as an alternate to ondansetron or metoclopramide to prevent PONV after gynecologic surgery. One hundred sixty ASA I-II patients scheduled for elective gynecologic surgery were enrolled. Before induction of anesthesia, patients were randomly allocated to receive intravenously dexamethasone (8 mg) in group D, ondansetron (4 mg) in group O, metoclopramide (10 mg) in group M, and saline (2 mL) in group P. Total incidence of nausea and vomiting, rescue antiemetic requirement, pain scores, and any adverse effects were recorded at 3 observational periods (0-2 hours, 2-12 hours, and 12-24 hours). Total rates of PON, POV, and PONV were significantly higher in group P at 0-2 hours and 2-12 hours compared with group D, O, and M (P<.05). There was no difference in PON, POV, and PONV among...
Effect of ornithine which is known to inhibit L-arginine uptake via cationic amino acid transport... more Effect of ornithine which is known to inhibit L-arginine uptake via cationic amino acid transport system has been tested, and compared to aminoguanidine, an iNOS inhibitor in lypopolysaccharide (LPS)-induced endotoxemia in rats. Serum nitrite/nitrate and malondialdehyde (MDA) level have been measured, and ileal histology has also been examined. Endotoxin increased serum nitrite/nitrate and MDA levels from 15.7+/- 2.4 micromol/ml and 2.1 +/-0.2 nmol/ml to 23.1 +/- 1.0 micromol/ml and 5.2+/- 0.3 nmol/ml (both P<0.05), respectively. In addition, LPS caused ileal degeneration. L-ornithine (500 mg/kg) did not improve septic manifestations, i.e., serum nitrite/nitrate and MDA levels did not differ from those in endotoxemia. Neither does it have an improving action on ileal histology. However, higher dose of L-ornithine (2,500 mg/kg) lowered the increased level of nitrite/nitrate and MDA by LPS. Moreover, it restored ileal histology from grade 3 (median) to 0 (median) (P<0.05). On th...
Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II ce... more Objective To examine the effects of short-term cyclic stretch on apoptosis in alveolar type II cells (A549). To study in vitro the direct influence of alveolar type II cells on mechanical stretch. Methods A549 were treated with different doses of lipopolysaccharide (LPS), 0 ng/ml, 1 ng/ml, 10 ng/ml, 100 ng/ml, 1000 ng/ml, and then A549 were lengthened 5%, 15%, 30% using a FLEXCELL tension unit 4000, a vacuum-driven device that applies strain to cells, which were cultured in six-well plates coated with collagen-I, and 12 cycles/min for 4 hours. Apoptosis was measured using the flow cytometry method that measures annexin V and propidium iodide (PI) staining. The morphological changes of apoptotic cells were observed by transmission electron microscope. Results Apoptosis could be induced in alveolar type II cells (A549) by mechanical stretch. The percentage of annexin V + PI cells increased after being treated with cyclic stretch for 4 hours by 5%, 15%, 30% in all groups. The morphological features of apoptotic cells demonstrated by transmission electron microscope were as follows: shrinkage of the cell, chromatin condensation and aggregation under the nuclear membrane as a crescent or lump, membrane-encapsulated nuclear fragment or cell organ formed by invagination of the cell membrane, and apoptotic body formation followed by vacuolization. Conclusion Apoptosis induced by mechanical stretch and LPS is dose dependent. Mechanical stretch aggravates apoptosis especially in cells treated with LPS. Annexin V and PI double staining is a specific, sensitive, and quantitative method for analyzing apoptotic cells. It is also helpful to clarify the protective mechanism of low-volume ventilation in ARDS. Acknowledgement The study was funded by the 'One Hundred People' project of Shanghai Sanitary Bureau (03-77-20).
Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated ... more Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ®. A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality. P2 Closed endotracheal suction system without periodic change versus open endotracheal system
Objectives: To examine in a prospective, randomized, double-blind, placebo-controlled study the a... more Objectives: To examine in a prospective, randomized, double-blind, placebo-controlled study the analgesic effect of periprostatic nerve block and/or intravenous synthetic opioid administration during a 12-core prostate biopsy. Patients and Methods: Patients were prospectively randomized to receive unilateral periprostatic lidocaine administration and/or intravenous synthetic opioid (meperidine or tramadol) administration. Placebo groups received sterile normal saline. Unilateral infiltration was performed and biopsy was begun on this side. The degree of pain was recorded using the visual analog scale/numeric analog scale (VAS/NAS) score before the procedure, during probe introduction into the rectum, during unilateral periprostatic nerve blockade, during the first 6-core biopsy and during the second 6-core biopsy, and 30 min after biopsy completion. Results: Most of the patients had mild or moderate pain (VAS/NAS <6) during the actual biopsy procedure. However, no significant dif...
ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is... more ABSTRACT Introduction and Objective. Paradoxical embolism through a patent foramen ovale (PFO) is a frequent cause of cerebral embolim on young patients. In this report, we describe a young woman who presented with postpartum tonic clonic seizures after an uncomplicated labor. Case. A 28 years old woman who suffered unexplained neurological symptoms on 10th day of the postpartum period was admitted to the neurology clinic. Investigations demonstrated a previously unknown patent foramen ovale and paradoxical embolism was diagnosed as the cause of symptoms. The diagnosis was based on established criteria and the failure to identify an arterial or cardiac embolic source. Discussion and Conclusion. Paradoxical cerebral embolisation only occurs in patients with a shunt and it is a severe complication that causes high morbidity and mortality.
Histopathologic changes in rat brain due to chronic use of morphine and/or tramadol in progressiv... more Histopathologic changes in rat brain due to chronic use of morphine and/or tramadol in progressively increased doses were investigated in this study. Thirty male Wistar rats (180-220 g) were included and divided into three groups. Normal saline (1 ml/kg) was given intraperitoneally as placebo in the control group (n = 10). Morphine group (n = 10) received morphine intraperitoneally at a dose of 4 mg/kg/day for the first 10 days, 8 mg/kg/day between 11-20 days, and 12 mg/kg/day between 21-30 days. The tramadol group (n = 10) received the drug intraperitoneally at doses of 20, 40, and 80 mg/kg/day in the first, second, and the third 10 days of the study, respectively. All rats were decapitated on the 30th day and the brain was removed intact for histology. The presence and the number of red neurons, which are a histologic marker of apoptosis, were investigated in the parietal, frontal, temporal, occipital, entorhinal, pyriform, and hippocampal CA1, CA2, CA3 regions. Red neurons were found in morphine and tramadol groups but not in the control group. The total number of red neurons was not different in morphine and tramadol groups, but the numbers of red neurons were significantly higher in the temporal and occipital regions in tramadol group as compared with the morphine group (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .05). In conclusion, chronic use of morphine and/or tramadol in increasing doses is found to cause red neuron degeneration in the rat brain, which probably contributes to cerebral dysfunction. These findings should be taken into consideration when chrome use of opioids is indicated.
The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physi... more The purpose of this study was to evaluate the impact of the Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation (APACHE) II and Simplified Acute Physiology Score (SAPS) II scoring systems for organophosphate poisoning (OPP) in an intensive care unit (ICU). The following data were collected on all consecutive patients who were admitted to the ICU between June 1999 and December 2004. Demographic data, GCS, APACHE II and SAPS II scoring systems were recorded. Predicted mortality was calculated using original regression formulas. Standardized mortality ratio (SMR) was computed with 95% confidence intervals (CI). The sensitivity and specificity for each scoring system were evaluated by calculating the Area Under the Receiver Operating Characteristic Curves. The actual mortality in OPP was 21.9%. Predicted mortality by all systems was not significantly different from actual mortality [SMR and 95% CI for GCS: 1.00 (0.65-1.35), APACHE II: 0.87 (0.54-1.03), SAPS II: 1.40...
ABSTRACT Although effective analgesia is provided for many patients, some complications may occur... more ABSTRACT Although effective analgesia is provided for many patients, some complications may occur due to the catheter delivery system. A rare complication, subcutaneous-epidural connection due to the long-term use of an epidural catheter and subcutaneous injection port in a patient is presented in this paper.
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