Biomedical subjects
Publications and source records attributed to S Tuncer.
A case of calcinosis cutis caused by calcium extravasation around the wrist is presented. During excision, the lesion was seen to be surrounding the dorsal branch of the ulnar nerve. The possibility of peripheral nerve involvement in extravasation injuries is emphasized.
We have recently shown that experimental traumatic brain injury (TBI) results in ultrastructural damage in heart tissue. The aim of this study was to determine the two antiapoptotic signals "survivin" and "aven" in rat heart tissue following TBI, and comparing the effects of erythropoietin (EPO) and methylprednisolone (MPS). Thirty-six Wistar-Albino female rats weighing 190 to 230 g were randomly allocated into six groups: group 1 underwent head trauma with no treatment; group 2 and group 3, head trauma and intraperitoneally delivered EPO (1000 IU/kg) and MPS (30 mg/kg), respectively; group 4 (vehicle), head trauma and intraperitoneal albumin (0.4 mL/rat); groups 5 and 6, control and sham-operated groups, respectively. Three-hundred g-cm impact trauma was produced by the method of weight-drop. Real-time quantitative polymerase chain reactions were used to estimate survivin and aven gene expression at the total RNA level. Both survivin and aven were higher among the treatment than the trauma group (P = .0006, .0001 and P = .0038, .0033, respectively). Comparing survivin and aven between EPO and MPS treatment groups showed no significance (P = .3027, .2171, respectively). Also, both survivin and aven were significantly higher among the treatment than the vehicle, the control, or the sham-operated groups. These findings suggested that both EPO and MPS may play important roles in the expression of antiapoptotic survivin and aven genes in heart tissue after TBI.
The possible potential role of several infectious agents in atherosclerosis has been shown. Several infectious agents DNA in atheromatous plaques have been displayed by PCR. In patients with atheromas antibody levels against Hsp65 were higher. Vaccination of mice with recombinant Hsp65 and Hsp65-rich M. tuberculosis resulted in formation of atheromatous plaques. We attempted to detect M. tuberculosis DNA in atherosclerotic plaque samples by PCR. In endarterectomy tissue samples obtained from patients during coronary artery bypass graft surgery DNA was prepared by proteinase-K digestion, phenol/chloroform extraction and ethanol precipitation. After amplification with M.tuberculosis complex IS6110 region specific primers, the products were analyzed on electrophoresis. M. tuberculosis DNA was negative in all tissue samples. More data on etiological studies with mycobacteriaceae will be yield information on atherosclerosis pathogenesis.
Two patients with limited elbow motion due to tumoral calcinosis underwent resection of calcified masses around the elbow joints. This necessilated removal of the distal two thirds and three fourths of the biceps muscles. The resulting defects were reconstructed with homologous Achilles tendon grafts. Both patients regained M4 muscle power and no recurrences were observed.
A brachioradialis muscle rerouting procedure was used to restore active supination in five children with cerebral palsy and a pronation deformity. Following release and lengthening of the pronator quadratus and pronator teres muscles, respectively, the brachioradialis tendon was divided as a Z plasty and the distal part of the tendon was passed through the interosseous space in a dorsal to palmar direction, and then sutured to its proximal end. The procedure resulted in a gain of 81 degrees of active supination.
In this study, the effects of indomethacin (prostaglandin synthase inhibitor), propranolol (beta adrenergic receptors blocker), tetraethylammonium (TEA) (calcium-dependent potassium channel blocker) and glibenclamide (ATP-sensitive potassium channel blocker), NG nitro-L-arginine (NO synthetase inhibitor) and naloxane (nonselective opioid receptor antagonists) on the responses induced by sufentanil and remifentanil were investigated in the isolated perfused rat kidney. Renal arter was cannulated. Then the kidney was perfused continuously with warmed (37 degrees C) and aerated (95% O2 and 5% CO2). Krebs Henselieit solution by using a peristaltic pump delivering a constant flow (8-10 ml/min). Vascular responses were detected as changes in perfussion pressure, which was monitored continuously with a pressure transuder and recorded on polygraph. After phenilephrine (PE)-induced vasoconstriction had reached a platoe, sufentanil or remifentanil were given. Vasodilatation was recorded. Antagonists or inhibitors were added and responses were recorded. At the end of each experiment; papaverine was used to obtain the maximum dilatation. None of the used antagonists or inhibitors were not effected the submaximum PE construction. The used opioids were not alter in basal perfusion pressure. Antagonists or inhibitors had no effect on papaverine-induced dilatation. Bolus addition of sufentanil and remifentanil produced concentration dependent vasodilation. Indomethacine L-NAME, propranolol, naloxone and glibenclamide did not significantly alter responses of both of the opioids (p > 0.05). But, sufentanil and remifentanil induced dilatation were significantly affected by TEA (p < 0.05). The present results demonstrated that sufentanil and remifentanil decrease perfusion pressure in the isolated rat kidney and such mechanism may involve the calcium active K+ channels activation.
Epidural analgesia (EA) is one of the most commonly used techniques in obstetric analgesia. Our objective was to evaluate patients who experienced EA during labour as well as to find out their knowledge, attitude and behaviour in this matter, prospectively. Between 1997 and 2002, a questionnaire, "patient evaluation form for EA", was delivered to 190 obstetric patients. The patients were divided into two groups. In Group I there were 100 patients who were evaluated between 1997 and 1999, and Group II was comprised of 90 patients who were evaluated between 2000 and 2002. Demographic data of the patients were similar in both groups. The question "How have you been informed about EA?" was replied as "TV or newspaper" by 50% of the patients in Group I while the answer was "from someone who experienced it before" by 60% of the patients in Group II (p < 0.01). With these information about EA, 30% and 40% of the patients in Group I were found out to be worried about neural paralysis and some possible disorders related to their babies, respectively. However, 40% of the patients in Grup II worried about back pain and headache (p < 0.01). As a result, considering the mother candidates' high information rate from someone who experienced EA before (60%), interest to the labour analgesia will increase as the mothers are satisfied with the results of EA.
In this in vitro study on the human umbilical artery, the effects of N(omega)-nitro-L-arginine methyl ester (L-NAME), indomethacin, prazosin, yohimbine and propranolol on the responses induced by bupivacaine and ropivacaine were investigated. Arteries isolated from umbilical cords from women who did not exhibit systemic diseases, who were not on medication and who had normal full-term deliveries, were cut into spiral strips 12 x 3 mm. Strips were mounted in organ baths at 37 degrees C continuously gassed with 5% CO(2) in oxygen. The responses to the drugs were recorded isometrically on a polygraph. In the bupivacaine study, when we administered cumulative concentrations of bupivacaine (10(-9) - 10(-4) M; n = 6) on basal tonus, there was no relaxation or contraction response on the tissue. Strips were precontracted with serotonin (10(-6)M 5-HT) then bupivacaine (10(-9) - 10(-4) M) was directly administered cumulatively. In the ropivacaine group, when cumulative concentrations of ropivacaine (10(-9) - 10(-4) M; n = 6) were administered on the tissue, preconstricted with 5-HT, ropivacaine did not alter the contraction response. Ropivacaine (10(-9) - 10(-4) M) was directly administered to the bath. Though bupivacaine produced relaxation, ropivacaine produced contraction (P < 0.05). Indomethacin, prazosin, yohimbine and propranolol did not significantly alter these responses. In addition, it was demonstrated that L-NAME did not affect the relaxation responses induced by bupivacaine. Thus adrenergic receptors, nitric oxide syntenaze and prostaglandins do not appear to affect the responses induced by these two local anesthetics.
BACKGROUND AND OBJECTIVE: To compare, using prilocaine, the effects of continuous spinal anaesthesia (CSA) and continuous epidural anaesthesia (CEA) on haemodynamic stability as well as the quality of anaesthesia and recovery in patients undergoing transurethral resection of the prostate gland. METHODS: Thirty patients (>60 yr) were randomized into two groups. Prilocaine, 2% 40 mg, was given to patients in the CSA group, and prilocaine 1% 150mg was given to patients in the CEA group. Incremental doses were given if the level of sensory block was lower than T10 or if needed during surgery. RESULTS: There was a significant decrease in mean arterial pressure in Group CEA compared with Group CSA (P < 0.01). The decrease in heart rate in Group CSA occurred 10 min after the first local anaesthetic administration and continued through the operation (P < 0.05). The level of sensory anaesthesia was similar in both groups. The times to reach the level of T10 and the upper level of sensory blockade (Tmax) were 18.0 +/- 4.7 and 25.3 +/- 7.0 min in Groups CSA and CEA, respectively, and were significantly longer in Group CEA. The duration of anaesthesia was 76.8 +/- 4min and was shorter in Group CSA (P < 0.01). CONCLUSIONS: Spinal or epidural anaesthesia administered continuously was reliable in elderly patients undergoing transurethral resection of the prostate. Continuous spinal anaesthesia had a more rapid onset of action, produced more effective sensory and motor blockade and had a shorter recovery period. Prilocaine appeared to be a safe local anaesthetic for use with either continuous spinal anaesthesia or continuous epidural anaesthesia.
Ketoprofen is a NSAIDs of the 2-aryl propionic acid class commonly used in the treatment of inflammatory rheumatic disease, acute pain and fever. Clinically, ketoprofen seems to reduce morphine requirements by 33 to 40% with ketoprofen's supposed central mechanism of analgesia. We evaluated the efficacy and safety of intravenous (IV) ketoprofen as an adjuvant to IV PCA (patient controlled analgesia) with tramadol after major gynecological cancer surgery for postoperative analgesia. Fifty patients were enrolled in this double-blinded, randomized, placebo-controlled study. Patients were allocated randomly to two groups: group I (25 patients) served as a control group, with patients receiving saline; group II (25 patients) received ketoprofen. Patients received an intravenous bolus of saline or 100 mg ketoprofen at the end of surgery. Then, PCA was given as a 20 mg tramadol bolus and 10 min lockout time. Pain relief was regularly assessed using a visual analog scale. Tramadol consumption, side-effects, and patient satisfaction were noted during the 24 hours after the surgery. No significant difference was observed in pain score, side-effects and patient satisfaction between the groups (p > 0.05). The cumulative PCA-tramadol consumption was lower in the ketoprofen-treated patients than placebo-treated patients (p < 0.05). Our results demonstrate that a single dose of 100 mg ketoprofen reduced tramadol consumption for treatment of postoperative pain after major gynecological cancer surgery.
BACKGROUND AND OBJECTIVE: Epidural analgesia is the most effective method for pain relief during labour. The aim was to elucidate the efficacy of ropivacaine 0.05% and bupivacaine 0.05%, which were both combined with fentanyl 0.00015% to provide analgesia in labour. METHODS: Forty nulliparous females were enrolled into the study. After insertion of an epidural catheter, patients were randomly assigned into two groups. Once the os uteri had dilated to 4-5 cm, a bolus of bupivacaine 0.125% 10mL + fentanyl 50 microg (1 mL) in Group 1 patients, and ropivacaine 0.125% 10mL + fentanyl 50 microg (1 mL) in Group 2 patients was administered via the epidural catheter. Then, patient-controlled epidural analgesia was started with a basal infusion of bupivacaine 0.05% 10 mLh(-1) + fentanyl 0.00015% 1.5 pgmL(-1) in Group 1, and ropivacaine 0.05% + fentanyl 1.5 microgmL(-1) in Group 2. When needed, a 10 mL bolus infusion could be given and the lockout time was 20 min. Maternal and fetal haemodynamic variables were monitored before induction and subsequently at 5 min intervals. Using a visual analogue scale assessed the degree of pain. RESULTS: Maternal haemodynamic variables and Apgar scores were not different between the two groups. The second stage of the labour was shorter in Group 2 (P < 0.01). There were no significant differences in patients' assessment of motor block or mode of delivery between groups. CONCLUSIONS: An epidural infusion (10 mLh(-1)) of bupivacaine 0.05% or ropivacaine 0.05% together with fentanyl 1.5 microg mL(-1) provided good and safe analgesia during labour.
BACKGROUND: The aim of the present study was to compare the hemodynamic and metabolic effects of extraperitoneal carbon dioxide (CO(2)) and nitrous oxide (N(2)O) insufflation. MATERIAL AND METHODS: Fourteen dogs were used in the experiment. All the animals were intubated under general anesthesia. A catheter was placed into the right jugular vein for central venous pressure (CVP), pulmonary artery pressure (PAP), pulmonary wedge pressure (PWP), and heart rate (HR) monitorization. End-tidal CO(2) pressure was measured by a capnometer connected to the endotracheal tube. Another catheter was inserted into the left femoral artery for arterial blood gas analysis and blood pressure monitorization. The preperitoneal dissection was made from a 1.5 cm subumbilical incision by using a preperitoneal dissection balloon. A laparoscope was placed in the preperitoneal space and the gas insufflation was kept at a constant pressure of 12 mm Hg throughout the experiment. All the study parameters were measured at the beginning of the insufflation and at every 15 minutes for 1 hour. RESULTS: Mean artery pressure increased with time in both groups, but the increase was only significant in the CO(2) group. PWP, CVP, PAP, and HR increased slightly in both groups, but there was no significant difference between the groups. The end-tidal CO(2) increased in the CO(2) group but decreased from the baseline in the N(2)O group. A significant acidosis was observed in only the CO(2) group. PaCO(2) significantly increased in the CO(2) group; hence, PaCO(2) slightly decreased in N(2)O group. The difference between the groups was significant. CONCLUSIONS: N(2)O insufflation of the extraperitoneal space in dogs avoided the unwanted metabolic and hemodynamic side effects of CO(2) insufflation. Thus, N(2)O insufflation in the extraperitoneal space is a safer alternative to CO(2) insufflation experimentally, and can be preferred especially in patients with cardiac and pulmonary diseases.
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Since 1996, 13 patients have undergone the reconstruction of facial skin defects with subcutaneous bipedicle island skin flaps. The reasons for the surgery were basal cell carcinoma in 10 patients and benign skin tumor excision in three patients. All defects were reconstructed with subcutaneous bipedicle skin flaps without significant complications. Bipedicle subcutaneous skin flaps are a useful alternative for facial reconstruction.
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In the present study the toxic effects of ropivacaine and bupivacaine on the cardiovascular and respiratory systems of rabbits were studied. Both drugs were administered intravenously at doses of 0.5, 1, 2.5, 5 and 10 mumol/kg. The effects of the two drugs on blood pressure, ECG and respiration rate were evaluated by considering the changes occurring 30 sec after intravenous bolus injection. High doses (5 and 10 mumol/kg) of bupivacaine and ropivacaine significantly reduced the heart rate and systolic pressure (p < 0.05). Five and 10 mumol/kg of bupivacaine significantly reduced diastolic pressure (p < 0.05), but only the 10 mumol/kg dose of ropivacaine had the same effect. Low doses of bupivacaine and high doses of ropivacaine significantly increased the PR interval, QRS duration and QT interval (p < 0.05). The 5 mumol/kg dose of bupivacaine caused ventricular tachycardia in 3 of 6 rabbits, whereas ropivacaine caused tachycardia in 1 of 5 rabbits. Neither drug had a significant effect on respiration rate or blood gas values (p > 0.05). The results indicate that ropivacaine is less cardiodepressive and arrhythmogenic than bupivacaine.
PURPOSE: The purpose of this study was to investigate the cellular quality of prefabricated bone grafts. MATERIALS AND METHODS: Small pieces of iliac bone were placed around the neurovascular bundle on the dorsal aspect of the ear of 11 one-month-old baby rabbits to create a prefabricated vascularized graft. In five animals, the prefabricated bone grafts were harvested for histologic examination 12 months later. In a second group of 6 rabbits, the prefabricated bone grafts, with the neurovascular bundle as a pedicle, were transferred after 30 days to a defect created by removing 1 cm of the midportion of zygoma on the right side of the face. The transferred bone was removed for histologic examination 11 months later. RESULTS: In both groups, microscopic examination showed the presence of a rich, vascular network and similar histologic characteristics to those of normal iliac bone. CONCLUSION: The findings support the concept that prefabricated bone grafts are a potentially useful source for bony reconstruction.