Risk factors influencing inadvertent hypothermia in infants and neonates during anesthesia

Background : The factors affecting the thermal status in neonates and infants undergoing general anesthesia are not yet investigated in detail. We evaluated the factors leading to intraoperative hypothermia in 60 neonates and infants. Methods : The initial body temperatures and the core temperatures at the 10th, 30th, 60th and 90th minute of anesthesia, as well as at the end of the operation were recorded. The patients were divided into the groups according to the age, type of surgery (minor vs major), operating room (OR) temperatures (low ‘<23°C’ vs high ‘>23°C’) and the initial core temperature of the patients. Results : In 31 neonates and 29 infants, the mean core temperatures decreased 10 min after anesthesia induction. In all neonates and in infants with ‘low OR temperature’ (<23°C), these decreases continued to the end of the surgery. Except infants undergoing minor surgery, in all patients, the core temperatures at the end of surgery were lower than the baseline temperature. The greatest decrease in core temperatures occurred in neonates undergoing major surgery and with low OR temperature. In low OR temperature, the decrease of core temperature is higher in patients with major surgery. In patients undergoing minor surgery, the decrease of core temperature is more in neonates than infants. Major surgery increased the chance of decrease of the core temperature by 2.66 times and operating room temperature less than 23°C by 1.96 times. Conclusion : The type of surgery and the OR temperature are the main factors for decrease of the core temperature in neonates and infants. In neonates, the core temperatures are less stable, regardless of OR temperature and type of surgery. In high OR temperature, infants can stabilize their core temperature better than neonates.     

The effects of carnitine on distally-burned dorsal skin flap: an experimental study in rats

OBJECTIVE: In ischemia and burn injuries, there are major alterations threatening tissue survival. Increased energy flow requirements are among the major problems in these disorders. Carnitine is an endogenous cofactor, which has a regulatory action on the energy flow from different oxidative sources. The purpose of this study was to determine the effects of carnitine in an experimental flap model. Biochemically, nitric oxide (NO), malondialdehyde (MDA), and acetylcholinesterase levels, and histopathologically tissue examination under light microscope were studied. METHODS: In the rat dorsal skin, a 10 cm x 3 cm flap was marked. The most distal 3 cm x 3 cm of the flap was burned to full-thickness. The dorsal flap was elevated, and sutured back to its original site. Sixteen rats were divided into two groups (a control (1) and a study group (2)), consisting of eight rats in each. While the animals in the control group were just followed, the animals in the study group were administrated carnitine with a dose of 100 mg/kg per day for 7 days. RESULTS: At the end of the experiment: the mean surviving areas of the flaps were 15.22 cm(2) (50.73%) in group 1, 20.53 cm(2) (68.43%) in group 2, and the difference was statistically significant (P=0.008). In the analysis of blood samples; the mean levels of NO were 22.63 and 40.78 micromol/l; of MDA were 6.74 and 3.79 ng/ml; and of acetylcholinesterase were 136.14 and 222.85 U/l in groups 1 and 2, respectively. The differences in the levels of NO (P=0.001), MDA (0.027) and acetylcholinesterase (P=0.006) were statistically significant. Histopathological examination revealed a full-thickness muscle necrosis in addition to skin tissue in the control group, while healing tissue was present with marked cellularity including mixed inflammatory cells and fibroblast proliferation with an increased vascularity in the form of capillary budding in the study group. CONCLUSION: Carnitine has a positive effect in such a model, particularly in preventing the progressive effect of burn, and limiting the necrosis in the full-thickness burned part.     

Versatile anterolateral thigh perforator flap: case of tailored reconstruction for a large temporal and parotidectomy defect

Perforator flaps have introduced an advance in microsurgical reconstruction, by allowing the design of flaps that are tailored for a specific defect. In this report, the reconstructive technique in a case of temporal squamous-cell carcinoma is presented as an example of this trend. Following wide resection of the skin tumor, superficial parotidectomy was performed as a part of the lymph-node dissection. An anterolateral thigh perforator flap was harvested, including a segment of the vastus lateralis muscle in connection with the skin perforators, to reconstruct both the skin defect and the parotidectomy-related soft-tissue deficit. The muscle segment was reinnervated by the greater auricular nerve to diminish atrophy. The aesthetic result was satisfactory. Minor's starch-iodine test demonstrated prevention of Frey's syndrome. The anterolateral thigh flap is a versatile donor that allows individual variations in design for custom-made flaps.     

The potential of microscopic sterile sponge particles to induce foreign body reaction

The sterile sponges may lose a significant amount of lint during their routine use in surgery, which is usually neglected. We designed an experimental model to evaluate the potential of sterile sponges to lose lint and to induce foreign body reaction in surgically created wounds. In 15 Wistar rats, separate subcutaneous pockets were created. Left-sided pockets were temporarily packed with sterile sponges, while the right-sided pockets remained empty. All the pockets were then irrigated with sterile saline. The presence of microscopic sponge particles was evaluated in the irrigation materials. After 4 weeks, the presence of inflammation and foreign body reaction were evaluated histologically. Microscopic sponge remnants were present in 14 of 15 samples collected from the left sides. The presence of foreign body giant cells with ingested sponge particles and formation of well-defined foreign body granulomas were observed only in samples collected from the left sides. A statistically significant difference was observed between the two sides when the intensity of inflammation was graded (P= 0.012). Cotton sponges used in surgery are shown to have a potential of losing invisible microscopic particles that have a potential to induce foreign body reaction.     

Bisphosphonate treatment and radiotherapy in metastatic breast cancer

Patients with advanced breast cancer frequently develop metastasis to bone. Bone metastasis results in intractable pain and high risk of pathologic fractures due to osteolysis. The treatment of breast cancer patients with bone metastases requires a multidisciplinary approach. Radiotherapy is an established treatment for metastatic bone pain. It may be delivered either as a localized low dose treatment for localized bone pain or systemically for more widespread symptoms. Bisphosphonates have been shown to reduce morbidity and bone pain from bone metastases when given to patients with metastatic bone disease. In vivo studies indicate that early bisphosphonates administration in combination with radiotherapy improves remineralization and restabilization of osteolytic bone metastases in animal tumor models. This review focused on a brief discussion about biology of bone metastases, the effects of radiotherapy and bisphosphonate therapy, and possible mechanisms of combination therapy in metastatic breast cancer patients.     

Does dexmedetomidine affect intraoperative blood loss and clotting tests in pediatric adenotonsillectomy patients?

BackgroundWe hypothesize that dexmedetomidine (DEX), a selective α₂ adrenergic receptor agonist, may affect the intraoperative blood loss and clotting tests such as prothrombin time, activated partial thromboplastin time, and international normalized ratio in children undergoing adenotonsillectomy (ADT).MethodsSixty patients scheduled for elective ADT under general anesthesia. The patients were randomly assigned to receive either DEX 0.5 μg/kg (group D) or placebo bolus (group C) with a total volume of 10 mL, 10 min before the induction of anesthesia. Mean arterial pressure (MAP), heart rate, blood loss, preoperatively and immediately after awakening clotting tests, agitation, sedation, visual analog scale, and analgesic requirement, were assessed and recorded.ResultsThe postoperative hemoglobin was significantly lower than the preoperative value in both groups (P < 0.05). The postoperative agitation scale and analgesic requirement and visual analog scale at the 15th min were significantly lower in group D than those in group C (P < 0.05). Total blood loss and postoperative sedation score in group D was significantly higher than that in group C (P < 0.05). The postoperative prothrombin time, activated partial thromboplastin time, international normalized ratio tests between the groups, additionally pre-postoperative MAP, heart rate, and clotting tests were similar in each group.ConclusionsThe premedication with DEX 0.5 μg/kg decreased postoperative agitation, pain, and analgesic requirement without significant change in the clotting tests and MAP but increased bleeding slightly during ADT.     

Does the Routine Echocardiographic Exam Have a Role in the Detection and Evaluation of Cholelithiasis and Gallbladder Wall Thickening?

Cholelithiasis is a very common disease in the United States. Most cases remain asymptomatic but a fraction of these patients can develop serious complications such as cholecystitis which may lead to gallbladder perforation and gallbladder cancer which is much less common. Here, we present three cases of cholelithiasis where transthoracic echocardiography was performed routinely. In each case, echocardiography detected cholelithiasis which prompted three-dimensional (3D) echocardiographic evaluation. Three-dimensional echocardiography allowed for more comprehensive examination of the gallbladder shape, size, and wall thickening and the measurement and composition of the stones in three dimensions, measurement of stone volumes, and minimized shadowing produced by stone calcifications. These cases suggest that routine echocardiography has value in detecting gallstones and that 3D echocardiography has incremental value over two-dimensional echocardiography due to pyramidal data sets which allow sequential slicing through the gallbladder and full gallbladder examination without a technologist who is trained in gallbladder imaging. These pyramidal data sets can be further viewed and cropped by a radiologist specialized in abdominal ultrasound.     

Clinical and radiological findings in macroprolactinemia

Hyperprolactinemia is the most common abnormality of the hypothalamic-pituitary axis. The aim of this study was to investigate the clinical and radiological features of patients with macroprolactinemia. The study population consisted of patients with elevated serum prolactin (PRL) concentrations who presented to our Endocrinology outpatient clinic. Detection of macroprolactin (macroPRL) was performed using the polyethylene glycol precipitation method. Patients in which macroPRL made up more than 60% of total PRL levels were stratified into the macroPRL group, while the remaining patients were placed in the monomeric prolactin (monoPRL) group. A total of 337 patients were enrolled with a mean age of 33.8?±?10.8 (16-66) years and a male/female ratio of 29/308. Eighty-eight of the patients (26.1%) had an elevated macroPRL level. The mean age in the monoPRL group was higher than in the macroPRL group (35.0?±?10.1 vs. 30.7?±?9.8, P?=?0.016). The mean PRL levels (ng/ml) in the macroPRL and monoPRL groups were similar (168.0?±?347.0 vs. 238.8?±?584.9, P?=?0.239). Frequency of amenorrhea, infertility, irregular menses, gynecomastia, and erectile dysfunction were also similar in both groups. More patients in the macroPRL group were asymptomatic compared to the monoPRL group (30.2 vs. 12.0%, P?=?0.006). Compared to the macroPRL group, the monoPRL group had a higher frequency of galactorrhea (39.2 vs. 57.1%, P?=?0.04) and abnormal magnetic resonance imaging findings (65.3 vs. 81.1%, P?=?0.02). Elevated macroPRL levels should be considered a pathological biochemical variant of hyperprolactinemia that may present with any of the conventional symptoms and radiological findings generally associated with elevated PRL levels.     

Factors affecting recurrence rate of ingrown toenail treated with marginal toenail ablation

This retrospective study analyzed marginal toenail ablation for ingrowing toenails and the factors affecting recurrences. Recurrence was defined as a return of the previous symptoms, regrowth of the nail edge, or patient dissatisfaction with the clinical outcome. Based on these criteria, nine patients (10.7%) were considered to have had a failed operation. There were significant differences for recurrence rate (p <.05) in the patients operated on under local anesthesia and in previously treated patients. Full exposure and excision of the germinal matrix were essential to avoid recurrence.