Addition of sufentanil to bupivacaine in caudal block effect on stress responses in children

BACKGROUND: The aim of the present randomized study was to determine the effect of adding sufentanil to bupivacaine, compared with bupivacaine alone in caudal block, on the surgical stress response in children. METHODS: The children were premedicated with midazolam 0.5 mg/kg. All children received induction with nitrous oxide and sevoflurane. Anesthesia was maintained with the same volatile agents in the both groups. The children were randomly allocated to two groups. Group I received bupivacaine alone (n = 17) and group II received bupivacaine + sufentanil (n = 16). Caudal block was performed with 0.25% bupivacaine 2 mg/kg (group I) or 0.25% bupivacaine 2 mg/kg with sufentanil 0.5 microg/kg (group II) after induction of anesthesia. Blood samples were obtained after induction of anesthesia (T(0)) to measure baseline concentrations of cortisol, prolactin, glucose and insulin. Additional samples were obtained 30 min after the start of surgery (T(1)), and 60 min after the end of surgery (T(2)). RESULTS: All of the basal values (T(0)) were within the normal ranges of the authors' laboratory for children of this age group and there were no differences between the groups (P > 0.05). In both groups, glucose concentration increased at T(1), compared with T(0) and T(2) (P < 0.05). The glucose concentration was unchanged at T(2) compared with T(0) in both group (P > 0.05). In both groups, prolactin concentration increased at T(1), compared with T(0) and decreased at T(2), compared with T(1) (P < 0.05). Cortisol decreased at T(1) and T(2), compared with T(0) in both groups. (P < 0.05). Insulin concentration remained unchanged at T(0) and T(2), but increased slightly at T(1) in both groups (P > 0.05). There were no significant differences in plasma prolactin, cortisol, glucose and insulin levels between the two groups at T(1) and T(2) (P > 0.05). CONCLUSION: There is no advantage in adding 0.5 microg/kg sufentanil to bupivacaine over bupivacaine alone in the caudal block, with regard to the surgical stress response in children.     

Emphysematous pyelonephritis and renal amoebiasis in a patient with diabetes mellitus

Emphysematous pyelonephritis is an uncommon and life-threatening infection of the kidney that is characterized by gas formation within or around the kidney and is associated with diabetes mellitus and urinary tract infection. Amoebiasis is a protozoal infection caused by Entamoeba histolytica. In its invasive forms, the disease is characterized by visceral abscess formations. We present a case of concomitant emphysematous pyelonephritis and renal amoebiasis in a 42-year-old female with uncontrolled diabetes mellitus. The patient did not respond well to initial supportive treatment and antibiotherapy. Therefore, nephrectomy was performed. She did extremely well after the operation and was discharged with antidiabetics and antibiotics.     

Pharyngeal airway dimensions after chin cup treatment in Class III malocclusion subjects

Summary  The objective of this study was to examine if chin cup therapy have any adverse effect on the sagittal pharyngeal dimensions in Class III malocclusion patients. Twenty patients (10 girls and 10 boys; mean age 10·31 ± 1·15 years) with skeletal Class III malocclusion, and an untreated control group (8 girls and 10 boys, mean age 9·89 ± 1·55 years) were evaluated. The chin cup appliance and an occlusal bite plate with 600 grams totally was used for 9·78 ± 0·93 months. Linear, angular and area measurements were evaluated on the cephalometric radiographs taken before and after observation and treatment periods. Treatment changes showed significant increases in maxillary forward position, effective length of the maxilla and the mandible, and vertical facial height measurements. The mandible showed a clockwise rotation revealed by the decrease in SNB and the increase in mandibular plane angles. Significant increase in the nasopharyngeal area was found when the treatment and control groups were compared. The nasopharyngeal airway area was affected by chin cup treatment, without any adverse effect on the pharyngeal airway dimensions in the short term.     

QTc Dispersion in Hyperthyroidism and Its Association with Pulmonary Hypertension

Background: Several studies have reported that hyperthyroidism is associated with prolonged QT interval corrected by the heart rate (QTc) and pulmonary hypertension (PHT). Methods: Forty‐seven patients with newly diagnosed overt hyperthyroidism and 20 healthy people were enrolled in the study. Transthoracic echocardiography, 12‐lead surface electrocardiogram, and thyroid hormone levels were studied at the time of enrollment and after achievement of euthyroid state with propylthiouracil treatment. Results: Baseline clinical characteristics were similar. However, heart rate (90.5±19.6 vs 79.2±13.7 bpm, P = 0.024), pulmonary artery systolic pressure (PASP) (26.0±12.0 vs 10.6±4.0 mmHg, P < 0.001), E deceleration time (DT) (191.8±25.6 vs 177.0±10.7 ms, P = 0.016), isovolumetric relaxation time (IVRT) (91.38±12.3 vs 79.6±10.5 ms, P < 0.001), and QTc dispersion (QTcD) (50.3±17.2 vs 38.9±11.6 ms, P = 0.009) were significantly higher in hyperthyroid patients compared to control group. Heart rate (to 74.1±13.8, P < 0.001), QTcD (to 37.3±10.1 ms, P < 0.001), DT (to 185.3±19.7 ms, P = 0.008), IVRT (to 88.6±10.3 ms, P = 0.056), and PASP (23.1±10.1 mmHg P < 0.001) were significantly decreased after achievement of euthyroid state. Although PHT was present in 16 patients before treatment only six patients still had PHT during euyhyroid state. Compared to patients with normal PASP, QTcD was significantly longer in patients with PHT (56.5±15.8 vs 37.9±12.8 mmHg P < 0.001). There were also significant correlations between QTcD and presence of PHT (r = 0.516, P < 0.001) and PASP (r = 0.401, P = 0.009). Conclusions: Hyperthyroidism is a reversible cause of PHT and diastolic dysfunction. Increased QTcD observed in hyperthyroidism may be associated with PHT and diastolic dysfunction. These abnormal findings in hyperthyroidism often normalize with the achievement of euthyroid state.     

Pulmonary hydatid disease diagnosed by bronchoscopy: A report of three cases

Pulmonary hydatid disease is an important clinical problem where echinococcal infection is endemic. Bronchoscopy is unnecessary in patients with pulmonary hydatid disease who present with a typical clinical picture and radiological appearance. However, it may be performed when a tumour is suspected or when the radiological picture is atypical. This case report presents three patients with pulmonary hydatid disease diagnosed by bronchoscopy. All patients were male, aged between 24 and 30 years, presented with pulmonary symptoms and had an abnormal CXR. Bronchoscopy showed whitish membraneous material in all three patients and biopsy confirmed the diagnosis of hydatid disease. Cystectomy was performed in two patients and right pneumonectomy was performed in the third because of pulmonary artery involvement. Bronchoscopy may be valuable in the diagnosis of pulmonary hydatid cyst disease in patients with atypical clinical and radiological presentations.     

Advanced oxidative protein products are independently associated with endothelial function in peritoneal dialysis patients

Aim:   Oxidative stress (OS) and asymmetric dimethylarginine (ADMA) are accepted as non-classical cardiovascular risk factors in end-stage renal disease patients. To clarify the role of these factors in the atherosclerotic process, we investigated if OS and ADMA are associated with endothelial function (EF) in peritoneal dialysis (PD) patients.
Methods:   Fifty-two non-diabetic PD patients without known atherosclerotic disease as well as 30 age- and sex-matched healthy individuals were included. We measured serum thiobarbituric acid-reactive substances (TBARS), malondialdehyde (MDA), advanced glycation end-product (AGE), pentosidine, advanced oxidation protein products (AOPP), ADMA and EF as described by Celermejer et al. in all subjects.
Results:   TBARS, MDA, AOPP, AGE, pentosidine and ADMA levels were significantly higher in PD patients than in controls ( P  < 0.001). Flow-mediated dilatation (FMD)% and nitrate mediated dilatation (NMD)% in PD patients were lower than in the control group (7.7 ± 4.0% vs 11.70 ± 5.50%, P  < 0.01 and 17.6 ± 8.3% vs 26.4 ± 4.6%, P  < 0.01). Additionally, it was found that AOPP are independently correlated with FMD% and NMD% in PD patients (β = −463, P  < 0.01 and β = −420, P  < 0.05).
Conclusion:   This study shows that PD patients without known atherosclerotic disease can also be characterized by endothelial dysfunction and AOPP levels independently predict endothelial function level in PD patients.     

Effect of oral and inhaled salbutamol in infants with bronchiolitis

The response of bronchiolitis to bronchodilator drugs is controversial. The present study was designed to evaluate the efficacy of oral or metered dose inhaler (MDI) salbutamol using a coffee cup as a spacer device in bronchiolitis. In the trial, 31 hospitalized patients between 6 and 24 months of age, who exhibited the first episode of acute bronchiolitis without any other predisposing illness such as cystic fibrosis, congenital heart disease etc., were randomly assigned to receive oral salbutamol (n=11, 0.1 mg/kg per dose, four times a day), or MDI salbutamol (n = 12, 200 μg per dose, every 3 h) or formed the control group without any bronchodilator therapy (n = 8). All of the patients were given supplemental oxygen as needed and adequate hydration was maintained. The patients were evaluated with clinical symptom scores. There were no differences in the beneficial or side effects of salbutamol, or the number of days in hospital between the treatment groups and the control group. It was concluded that there is no beneficial effect in using bronchodilators in infants with bronchiolitis. Supplemental oxygen and maintenance of normal hydration may be adequate.     

Neutrophil chemotaxis in acutely infected and clinically stable cystic fibrosis patients*

Abstract Purpose : The aim of the present study was to evaluate the role of neutrophil chemotaxis in cystic fibrosis (CF) and to also determine whether an acute bacterial infection and the nutritional status of a child can affect neutrophil chemotaxis.
Methods : Twelve acutely infected and 12 clinically stable CF patients and 10 healthy age-matched controls were studied. Neutrophil chemotaxis and random migration were investigated in vitro in the peripheral blood of subjects by the Boyden chamber method and the results were expressed as chemotactic index (CI). The nutritional status of the cases was evaluated as body mass index (BMI).
Results : The CI values in the acutely infected group were found to be significantly lower than the clinically stable and healthy control groups ( P <0.05 and P <0.005, respectively). There was no significant difference between the clinically stable CF group and the healthy control group ( P >0.1). No significant correlation was detected between the CI and BMI of the two groups of CF patients ( P >0.05).
Conclusions : The present study confirms that neutrophil chemotaxis and random migration are normal in clinically stable CF patients. The decreased CI in the acutely infected patients indicates the possible role of infection itself on neutrophil chemotaxis.     

Assessment of Atrial Conduction Time in Patients with Familial Mediterranean Fever

Background: Increased inflammatory activity is known to be a pathophysiologic characteristic of atrial fibrillation. Familial Mediterranean fever (FMF) is a disease characterized by recurrent and sustained increased inflammatory activity. Atrial conduction abnormalities in these patients have not been investigated in terms of P‐wave duration, P‐wave dispersion (Pd), and atrial electromechanical delay measured by tissue Doppler echocardiography (TDE). We aimed to assess atrial conduction time in patients with FMF. Methods: A total of 33 patients with FMF (13 males/20 females, 28.4 ± 12.5 years), and 33 controls (13 males/20 females, 28.5 ± 12.1 years) were included. Atrial electromechanical coupling (PA) and intra‐ and interatrial electromechanical delay were measured with TDE. From the 12‐lead electrocardiogram Pd was calculated. Results: Atrial electromechanical coupling at the left lateral mitral annulus (PA lateral) was significantly higher in FMF patients (58.0 ± 9.0 vs 51.0 ± 5.8, P < 0.001). Interatrial (PA lateral–PA tricuspid) and intraatrial electromechanical delay (PA septum–PA tricuspid) were significantly longer in FMF patients (21.3 ± 7.4 vs 12.9 ± 4.6, P < 0.001 and 4.7 ± 5.5 vs 2.1 ± 1.7, P = 0.01, respectively). Also, Pd and maximum P‐wave duration were significantly higher in FMF patients (42.8 ± 7.9 vs 35.3 ± 6.1, P < 0.001 and 98.6 ± 9.0 vs 93.1 ± 8.5, P = 0.01, respectively). A positive correlation was detected between interatrial electromechanical delay and Pd (r = 0.622, P < 0.001). Plasma level of C‐reactive protein (CRP) correlated with interatrial electromechanical delay and Pd (r = 0.733, P < 0.001; and r = 0.427, P < 0.001, respectively). Conclusion: This study shows that atrial electromechanical delay and Pd are prolonged in FMF patients. Atrial electromechanical delay is closely associated with Pd and plasma level of CRP.