L-carnitine reduces acute lung injury in experimental biliary obstruction

Objectives:

To investigate the protective effects of L-carnitine (LC) on lungs in an experimental obstructive jaundice (OJ) model.

Methods:

This was conducted for 2 months between May 2011 and July 2011 at Suleyman Demirel University School of Medicine Experimental and Clinical Research Center, Isparta, Turkey. Thirty-eight Wistar-Albino rats with an average weight of 250-300 g were divided into 3 groups of control, OJ, and OJ + L-carnitine treatment (LCT). L-carnitine was injected intravenously into the tail vein at a dose of 50 mg/kg/day for 10 days to the LCT group. Animals were sacrificed 10 days later. Enzyme levels were measured in the lung tissue; malondialdehyde, myeloperoxidase (MPO), glutathione peroxidase (GSH-Px), catalase, and superoxide dismutase. Tumor necrosis factor-alfa, interleukin 6 (IL-6), IL-8, and C-reactive protein levels were studied in plasma samples. Histopathological changes in the lungs were examined.

Results:

There was a decreased in GSH-Px, MPO, and IL-8 levels (p<0.05) in the LCT group. The histopathological examination showed that neutrophil leukocyte infiltration and edema formation decreased and destruction of lung parenchyma disappeared following the treatment with LC (p<0.05).

Conclusion:

L-carnitine has a protective effect against lung damage due to experimental obstructive jaundice, possibly by altering anticytokine and antioxidant activity, and by decreasing the neutrophil migration.Obstructive jaundice (OJ) is one of the most important problems in gastroenterology and general surgery due to negative effects on many systems, high incidence and high morbidity, and mortality rates despite advances in operative techniques, and the development of broad-spectrum antibiotics.1 Obstructive jaundice can be created experimentally by ligation of the main bile duct in rats.2 Endotoxemia is a major complication, which aggravates the inflammatory response.3 Thus, the increased level of free oxygen radicals may cause oxidative damage and multiple organ dysfunctions, including dysfunction of the lungs.4,5 There is also a decrease in antioxidant activity.6 Lipid peroxidation, formed by free oxygen radicals, and protein oxidation causes structural and functional cell damage.7 The accumulation of stimulated inflammatory cells in the small airways and interstitial region of the lung form alveolar epithelial injury, microcirculatory damage, and alveolar interstitial edema. The continuation of this process results in acute respiratory distress syndrome. There have been many studies, which have identified OJ damage to organs such as the liver, kidneys, and the heart, but studies on “lung injury” are few with only 2 articles identified from scanning PubMed literature in English.8 L-carnitine (LC) is a basic transporter that functions in the energy production of mammalian metabolism, detoxification of organic acids, and mitochondrial membrane transport of long-chain fatty acids. It is known that LC has a detoxifying effect, inhibiting tissue damage, and increasing antioxidant enzyme activities.9 The aim of this study was to determine whether LC prevents lung injury that occurs in OJ.     

A modified surgical approach of the hip in children: is it safe and reliable in patients with developmental hip dysplasia?

PurposeTreatment is easier and complications are less likely to occur if developmental dysplasia of the hip (DDH) is diagnosed early. In this study, we examined the early results of open reduction using a medial approach which we had modified for DDH and analyzed the success of this technique and the associated complication rates, with a focus on avascular necrosis (AVN).Methods This is an Institutional Review Board-approved retrospective review of all patients diagnosed with DDH and treated with a modified medial approach at a single institution from July 1999 to December 2010. The patients'' charts were analyzed for clinical and radiographic features.Results Fifty-five hips of 41 patients, all of whom were treated by open reduction using a modified medial approach due to DDH, were evaluated retrospectively. The mean age of the patients at surgery was 19 (range 11–28) months, and the average follow-up was 5.5 (range 3–9.5) years. AVN was the most important complication in terms of radiological outcomes as assessed according to the Kalamchi–McEwen classification. Radiologic results were excellent or good in 51 hips (92.7 %) and fair–plus in four (7.3 %). Type 1 temporary AVN was detected in only two hips (3.6 %), and the lesions had disappeared completely in the final control graphs of these two patients. A secondary intervention was needed for two hips (3.6 %) of the same patients who were operated on due to bilateral DDH. No other complications, such as infection, re-dislocation, or subluxation, were seen in the operated patients.Conclusions We believe that treatment for DDH using a modified medial approach during early childhood is an effective and reliable method with low AVN rates. As shown here, this method achieves great success in radiological and clinical outcomes after a minimum 3-year follow-up.     

Calcar Preservation Arthroplasty for Unstable Intertrochanteric Femoral Fractures in Elderly

Background

The treatment of unstable intertrochanteric fractures in elderly is still controversial. The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using standard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment.

Methods

Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospective cohort study. All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems. Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system. Follow-up evaluations were performed at least 24 months and later. Palmer and Parker mobility score and visual analogue scale (VAS) pain score were assessed. We also analyzed radiographs of the operated hip at each follow-up visit.

Results

The patients were 15 males and 39 females with a mean age of 81.3 years (range, 75 to 93 years). The average operative time was 86.6 minutes. The mean transfused blood units were 1.2 units. The average duration of hospital stay was 5.3 days. The preoperative mean mobility score was 6.20. This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively. The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days. Radiological interpretation revealed no loosening in the cable-grip systems, and no significant subsidence (> 5 mm) of prosthesis was observed.

Conclusions

Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis, frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures.     

Evaluation of the corpus callosum shape in patients with obstructive sleep apnea

Sleep and Breathing - The aim of this study was to examine whether or not there was a difference in corpus callosum shape between patients with mild to moderate and severe obstructive sleep apnea...