Is it possible that direct rigid laryngoscope-related ischemia–reperfusion injury occurs in the tongue during suspension laryngoscopy as detected by ultrasonography: a prospective controlled study

Abstract

Background: Tongue-related complications can be seen in suspension laryngoscopy (SL) procedures.

Aims/objectives: This study aimed to detect tongue edema associated with the pressure exerted by a rigid direct laryngoscope by measuring the tongue area using ultrasonography (USG) in patients undergoing SL procedures.

Material and methods: The study group included 31 patients and the control group consisted of 33 patients. Submental USG examinations of the tongue in the coronal plane were performed. In the study and control groups, the first examination (TA¹) was done immediately after intubation and the second examination (TA²) was done after the surgery procedure but before extubation. The USG results regarding tongue area for both the groups were compared.

Results: The study and control groups significantly differed in terms of the postoperative tongue area measurements (TA²), as well as tongue edema (based on the TA²???TA¹) values.

Conclusions and significance: Direct rigid laryngoscopes may cause tongue edema in SL procedures which was demonstrated by the USG. This tongue edema can be a result of ischemia–reperfusion injury in the tongue due to the pressure exerted by a direct rigid laryngoscope. This study is the first to demonstrate the possible role of USG examination in determining the side effects of SL procedures on the tongue.

Trial Registration ClinicalTrials.gov Identifier: NCT04205253     

Left Ventricular Dyssynchrony and Its Effects on Cardiac Function in Patients with Newly Diagnosed Hypertension

Objectives: Left ventricular (LV) systolic synchrony, defined as simultaneous peak contractions of corresponding cardiac segments, is well documented to be impaired in hypertension but its effect on LV function is not clear. The aim of this study was to assess the impacts of LV systolic dyssynchrony on LV function in newly diagnosed hypertensives. Methods: Forty-eight newly diagnosed hypertensive patients and 33 controls were enrolled. All study population underwent a comprehensive echocardiographic evaluation including tissue synchrony imaging. The time to regional peak systolic tissue velocity (Ts) in LV by 12 segmental models was measured and two parameters of systolic dyssynchrony were computed. Results: Baseline demographic characteristics were similar in both study groups. Dyssynchrony parameters prolonged in newly diagnosed hypertensive patients compared to controls: the standard deviation (SD) of 12 LV segments Ts (40.2 ± 21 vs. 26.2 ± 13.4, P = 0.003); the maximal difference in Ts between any 2 of 12 LV segments (123.3 ± 61.5 vs. 79.8 ± 37.9, P = 0.001). In multivariable analysis, Ts-SD-12 was found to be an independent predictor for systolic function (β=-0.29, P = 0.008). But, both diastolic and global functions were not independently related to Ts-SD-12. Conclusion: LV synchronization is impaired in newly diagnosed hypertensive patients. LV dyssynchrony is one of the independent predictors of systolic function in hypertensive patients.     

Influence of aquatic and weight-bearing exercises on quantitative ultrasound variables in postmenopausal women

OBJECTIVE: In this prospective, controlled study, the effects of weight bearing and aquatic exercises on the calcaneal ultrasonic scores of postmenopausal sedentary women was investigated. DESIGN: A total of 62 postmenopausal sedentary women (mean age, 54.1 +/- 7 yrs) with broadband ultrasound attenuation (BUA) T-score variables less than -1 were admitted to Ataturk Balneotherapy and Rehabilitation Center and randomized into aquatic exercise (n = 21), weight-bearing exercise (n = 21), and control (n = 20) groups. The subjects were told to perform the aerobic exercises according to the Borg scale. Quantitative ultrasound variables, BUA, and speed of ultrasound were evaluated after the 6-mo training study. RESULTS: Calcaneal BUA increased in aquatic exercise and weight-bearing exercise groups by 3.1% and 4.2% (P < 0.05, P < 0.05) respectively. There was a decrease in BUA by 1.3% in the control group (P > 0.05). Speed of ultrasound did not change in the aquatic exercise, weight-bearing exercise, or the control groups. There were no statistically significant differences between the exercise groups for BUA and speed of ultrasound. The percentage changes in the aquatic exercise and weight-bearing exercise groups were statistically significant when compared with the control group for BUA (P < 0.01, P < 0.01) and speed of ultrasound (P < 0.05, P < 0.05). CONCLUSIONS: Although weight-bearing physical activity is known to be superior to non-weight-bearing activity to increase the bone mass, our present evidence shows that aquatic and weight-bearing exercises both can increase calcaneal BUA.     

Aneurysmal bone cysts of the spine

Purpose

Aneurysmal bone cyst is a benign, relatively uncommon lesion, representing 1.4 % of primary bone tumors. The vertebral column is involved in 3–30 % of cases. This report describes clinical characteristics and treatment results of 18 patients with aneurysmal bone cyst of the spine.

Methods

Between 1991 and 2008, 18 patients with aneurysmal bone cyst of the spine were surgically treated in our department. The clinical records, radiographs, histologic sections, and operative reports were analyzed.

Results

There were 11 male and 7 female patients; mean age was 22.1 years (range 7–46 years). Localizations were cervical (3), cervicothoracic (2), thoracic (3), lumbar (4), and sacrum (6). Tumor was localized on the left side in 11 cases, on the right side in 2 and at midline in 5 patients. The two most common clinical features were axial pain (14 patients) and radicular pain (8 patients). Neurological signs were paraparesis in 3, monoparesis in 6. Mean duration of symptoms was 9 months (range 3 months–3 years). All patients underwent surgery: total removal was performed in 13 patients and subtotal resection in 5. Posterior (11), anterolateral (1), or combined anterior-posterior (6) approaches were used. Mean follow-up duration was 112.3 months (range 4–21 years). We detected four recurrences in subtotal excision group (4/5), and one recurrence in total excision group (1/13).

Conclusion

Treatment options for aneurysmal bone cysts are simple curettage with or without bone grafting, complete excision, embolization, radiation therapy, or a combination of these modalities. Radical surgical excision should be the goal of surgery to decrease the recurrence rate. Recurrence rate is significantly lower in case of total excision.     

Potential role of poly(ADP-ribose) polymerase activation in the pathogenesis of experimental left varicocele

The aim of this study was to evaluate whether the poly(adenosine diphosphate[ADP]-ribose) polymerase (PARP) pathway is activated by experimental left varicocele. Rats underwent partial ligation of the left renal vein to induce experimental varicocele, and left testes were analyzed 13 weeks after surgery. Tubule degeneration was evaluated by Johnsen score. Expression of 4-hydroxy-2-nonenal (4-HNE)-modified proteins, PARP-1, and poly(-ADP-ribose) (PAR) was detected by immunohistochemistry and Western blot. The degree of apoptosis within testes was determined by terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling. Light microscopy revealed testicular damage comprising various degrees of seminiferous tubule degeneration. Germ cell apoptotic index and 4-HNE, PAR, and PARP-1 expression in germ cells increased after varicocele induction. Increased oxidative stress and PARP overactivation in testes might be important with regard to impaired testicular function associated with varicocele.