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Işın Güneş,1 Nuran Süngü,2 Aydan Kılıçarslan,2 Volkan Şıvgın,3 Metin Alkan,3 Ayşegül Küçük,4 Hakan Boyunağa,5 Yusuf Ünal,3 Mustafa Arslan3 1Department of Anaesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey; 2Department of Pathology, Yıldırım Beyazıt University Medical Faculty, Ankara, Turkey; 3Department of Anaesthesiology and Reanimation, Gazi University Medical Faculty, Ankara, Turkey; 4Department of Physiology, Dumlupinar University Medical Faculty, Kütahya, Turkey; 5Department of Biochemistry, Kirikkale University Medical Faculty, Kirikkale, Turkey Objective: This study was conducted since the effects of colloid solutions on the renal system remain controversial and need to be adequately studied in animals. We aimed to evaluate the effects of hydroxyethyl starch (Voluven) on the kidney tissue of rats with late renal failure due to ureteral obstruction. Materials and methods: Rats were divided into four groups: Group C, control; Group HES, hydroxyethyl starch solution (HES) 130/0.4 (Voluven®); Group UUO, unilateral ureteral obstruction (UUO); and Group UUO-HES, UUO-HES 130/0.4 (Voluven®). In the groups with ureteral obstruction, the distal part of the right ureter was accessed and sutured through a lower abdominal incision under ketamine anesthesia. Any signs of late-stage renal failure were evaluated after three weeks. Rats in the HES group and the renal failure-HES group were administered with HES 130/0.4 as a single intravenous dose of 20 mL/kg. After a follow-up of 24 hours, intra-abdominal blood sample was collected, and the rats were sacrificed. Biochemical and histopathological parameters were then evaluated. Results: Ureteral obstruction significantly increased urea and creatinine levels. In addition, when the UUO-HES and HES groups were compared, the administration of HES increased urea and creatinine levels in the UUO-HES group. Nitric oxide enzyme activity and malondialdehyde levels have significantly increased in the UUO groups. In addition, HES significantly increased nitric oxide activity and malondialdehyde levels in the UUO-HES group, in comparison with the HES group. The activity of caspases 3 and 8 was significantly increased in the UUO groups. In addition, HES significantly increased the activity of caspases 3 and 8 in the UUO-HES group, in comparison with the HES group. Light microscopy revealed significant changes in the UUO groups, especially in the obstructed kidneys. Conclusion: If indicated, HES should be used with caution in cases of UUO, but not in the cases of bilateral ureteral obstruction. Other aspects of these findings, including the clinical significance and practical applications, merit further experimental and clinical investigation. Keywords: unilateral ureteral obstruction, hydroxyethyl starch solution 130/0.4, caspase 3, caspase 8, malondialdehyde, nitric oxide

Hande Arpacı,1,* Faruk Metin Çomu,2 Ayşegül Küçük,3 Bahadır Kösem,4 Seyfi Kartal,4 Volkan Şıvgın,5 Hüseyin Cihad Turgut,6,* Muhammed Enes Aydın,5 Derya Sebile Koç,5 Mustafa Arslan5 1Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, 2Department of Medical Physiology, Faculty of Medicine, Kırıkkale University, Kırıkkale, 3Department of Medical Physiology, Faculty of Medicine, University of Dumlupınar, Kütahya, 4Department of Anesthesiology and Reanimation, Turgut Özal University Hospital, 5Department of Anesthesiology and Reanimation, Faculty of Medicine, Gazi University, 6Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Gazi University, Ankara, Turkey *These authors contributed equally to this work Background: Change in blood supply is held responsible for anesthesia-related abnormal tissue and organ perfusion. Decreased erythrocyte deformability and increased aggregation may be detected after surgery performed under general anesthesia. It was shown that nonsteroidal anti-inflammatory drugs decrease erythrocyte deformability. Lornoxicam and/or intravenous (iv) ibuprofen are commonly preferred analgesic agents for postoperative pain management. In this study, we aimed to investigate the effects of lornoxicam (2 mg/kg, iv) and ibuprofen (30 mg/kg, iv) on erythrocyte deformability, as well as hepatic and renal blood flows, in male rats.Methods: Eighteen male Wistar albino rats were randomly divided into three groups as follows: iv lornoxicam-treated group (Group L), iv ibuprofen-treated group (Group İ), and control group (Group C). Drug administration was carried out by the iv route in all groups except Group C. Hepatic and renal blood flows were studied by laser Doppler, and euthanasia was performed via intra-abdominal blood uptake. Erythrocyte deformability was measured using a constant-flow filtrometry system.Results: Lornoxicam and ibuprofen increased the relative resistance, which is an indicator of erythrocyte deformability, of rats (P=0.016). Comparison of the results from Group L and Group I revealed no statistically significant differences (P=0.694), although the erythrocyte deformability levels in Group L and Group I were statistically higher than the results observed in Group C (P=0.018 and P=0.008, respectively). Hepatic and renal blood flows were significantly lower than the same in Group C.Conclusion: We believe that lornoxicam and ibuprofen may lead to functional disorders related to renal and liver tissue perfusion secondary to both decreased blood flow and erythrocyte deformability. Further studies regarding these issues are thought to be essential. Keywords: rat, lornoxicam, iv ibuprofen, erythrocyte deformability, blood flow

Aydin Tuncay,1 Volkan Sivgin,2 Aycan Ozdemirkan,2 Saban Cem Sezen,3 Hakan Boyunaga,4 Aysegul Kucuk,5 Isin Gunes,6 Mustafa Arslan2 1Faculty of Medicine, Department of Cardiovascular Surgery, Erciyes University, Kayseri, Turkey; 2Faculty of Medicine, Department of Anesthesiology and Reamination, Gazi University, Ankara, Turkey; 3Faculty of Medicine, Department of Histology and Embryology, Kırıkkale University, Kırıkkale, Turkey; 4Faculty of Medicine, Department of Medical Biochemistry, Kırıkkale University, Kırıkkale, Turkey; 5Faculty of Medicine, Department of Physiology, Kütahya Health Science University, Kütahya, Turkey; 6Faculty of Medicine, Department of Anesthesiology and Reamination, Erciyes University, Kayseri, TurkeyCorrespondence: Mustafa Arslan Gazi University, Faculty of MedicineDepartment of Anesthesiology and Reanimation, Ankara 06510, TurkeyTel +90 533 422 85 77Email mustarslan@gmail.comIntroduction: We aimed to investigate the effects of cerium oxide, applied before the sevoflurane anesthesia, on lung tissue in rats with lower extremity ischemia-reperfusion (IR).Materials and Methods: A total of 30 rats were randomly divided into five groups as; control (C), IR, cerium oxide-IR (CO-IR), IR-sevoflurane (IRS), and cerium oxide-IR-sevoflurane (CO-IRS). In the CO-IR group, 30 minutes after the injection of cerium oxide (0.5 mg/kg, intraperitoneal (i.p)), an atraumatic microvascular clamp was placed on the infrarenal abdominal aorta for 120 minutes. Then, the clamp was removed and reperfused for 120 minutes. Sevoflurane was applied in 100% oxygen at a rate of 2.3% at 4 L/min during IR. The blood samples were taken for biochemical analysis and the lung tissue samples were taken for histological analysis.Results: Neutrophil infiltration/aggregation was significantly higher in the IR group than in the C and CO-IRS groups. The alveolar wall thickness and total lung injury scores were significantly higher in the IR group than in the C, IRS, CO-IR and CO-IRS groups.Discussion: We determined that the administration of 0.5 mg/kg dose of cerium oxide with sevoflurane reduces the oxidative stress and corrects IR-related damage in lung tissue. Our results show that the administration of cerium oxide before IR and the administration of sevoflurane during IR have a protective effect in rats.Keywords: cerium oxide, sevoflurane, ischemia reperfusion, biochemical analysis, histopathological analysis

Background/aims:  Gastric outlet obstruction (GOO) is a rare condition in childhood, with the exception of infantile hypertrophic pyloric stenosis (IHPS). However, no classification exists from a pediatric gastroenterologist's perspective., Materials and Methods:  The patients with a diagnosis of GOO between 2009 and 2020 were reviewed retrospectively. We classified the patients according to GOO: presence of clinical findings accompanied by radiological and/or endoscopic findings; clinical status: intractable nonbilious postprandial vomiting alone or with abdominal pain, early satiety, weight loss, postprandial abdominal distension, and malnutrition; radiology: delayed gastric emptying and dilated stomach; endoscopy: nonbilious gastric contents after 6-8 hours of emptying and/or failed pyloric intubation; physical examination: visible gastric peristalsis., Results:  A total of 30 GOO patients (15 patients with IHPS, 1 patient with annular pancreas, 4 patients with gastric volvulus, 2 patients with duodenal atresia, 2 patients with antral web, 1 patient with late-onset hypertrophic pyloric stenosis (LHPS) had surgical treatment, and remaining 5 patients had medical treatment) were enrolled to the study. The median age was 8 months (range: 3 months-16 years), and 14 patients were female. Mitochondrial disorders, LHPS, metabolic disorders, and eosinophilic gastrointestinal system diseases were added to Sharma's GOO classification, and the classification has been expanded., Conclusion:  This is the first and largest study of GOO in children. From the perspective of pediatric gastroenterology, new diseases will be addressed, and definitions will be highlighted with our classification for GOO in childhood.

Objective: The circadian rhythm is the most important of the main rhythms that affect our daily lives and has a significant role in the efficiency of a lot of drugs used in anesthesia. The aim of this study is to prove whether circadian rythm has an effect on spinal anesthesia and, if any, its effect on postoperative analgesic request by retrospectively studying the patients operated under spinal anesthesia., Methods: We conducted the study on patients operated on inguinal hernia and anorectal surgery under spinal anesthesia in general surgery room. The patients were divided into two groups according to the time when they were taken into surgery: between 06.00-12.00 (Group 1) and 12.00- 18.00 (Group 2). Time to first analgesic request, time to start walking, time to first urination, intraoperative and postoperative side effects, intraoperative hemodynamic data, and patient satisfaction were detected and recorded., Results: The time to first analgesic request in Group 1 was longer than in Group 2, and this difference was statistically significant. The mean heart rate of the groups was found significantly lower in Group 2 than in Group 1 during measurements at the 25. and 30. minute when compared with their changes over time. There were no statistically significant differences between the groups in terms of side effects and the most common side effect was detected to be nausea - vomiting., Conclusions: We found out that the time to first analgesic request after spinal anesthesia was significantly longer in Group 1 than in Group 2.

Objective: Diabetic complications and lipid peroxidation are known to have a close association. Lipid peroxidation commonly occurs at sites exposed to ischaemia, but distant organs and tissues also get damaged during ischaemia/reperfusion (I/R). Some of these targets are vital organs, such as the lung, liver, and kidney; the lung is the most frequently affected. The aim of our study was to investigate the effects of dexmedetomidine on I/R damage in lung tissue and on the oxidant/anti-oxidant system in diabetic rats., Material and Methods: Diabetes was induced with streptozotocin (55 mg/kg) in 18 Wistar Albino rats, which were then randomly divided into three groups (diabetes control (DC), diabetes plus ischaemia-reperfusion (DIR), and diabetes plus dexmedetomidine-ischaemia/reperfusion (DIRD)) after the effects of diabetes were clearly evident. The rats underwent a left thoracotomy and then ischaemia was produced in the myocardium muscle by a left anterior descending artery ligation for 30 min in the DIR and DIRD groups. I/R was performed for 120 min. The DIRD group received a single intraperitoneal dose of dexmedetomidine (100 µg/kg); the DIR group received no dexmedetomidine. Group DC was evaluated as the diabetic control group and also included six rats (C group) in which diabetes was not induced. These mice underwent only left thoracotomy and were closed without undergoing myocardial ischaemia. Histopathological changes, activities of catalase (CAT) and glutathione-S-transferase anti-oxidant enzymes, and malondialdehyde (MDA) levels were evaluated in the lung tissues of all rats., Results: Neutrophil infiltration/aggregation was higher in the DIR group than in the C, DC, and DIRD groups (p=0.001, p=0.013, and p=0.042, respectively). The lung injury score was significantly higher in the DIR group than in the C and DC groups (p<0.0001 and p=0.024, respectively). The levels of MDA were significantly higher in the DIR group than in the C and DIRD groups. CAT activity was significantly higher in the DIR group than in the DIRD and C groups., Conclusion: Our results confirm that dexmedetomidine has protective effects against the lung damage resulting from I/R in diabetic rats. Future studies conducted to evaluate the effects of the use of dexmedetomidine on damage to various organs following different I/R durations may help understanding possible protective effects of dexmedetomidine and underlying mechanisms in tissue damage related to I/R injury.

Background: It is known that diabetic complications and lipid peroxidation are closely associated. During ischemia and reperfusion (IR), injury may occur in distant organs, as well as in tissues next to the region exposed to the ischemia, and the lungs can be one of the most affected of these organs. Therefore, this study investigated the effects of levosimendan on lung tissue and the oxidant-antioxidant system in diabetic rats., Materials and Methods: The study was conducted in 24 Wistar albino rats that were separated into four groups (C, control; DC, diabetic control; DIR, diabetic IR; and DIRL, diabetic IR levosimendan). Diabetes was induced in 18 rats using streptozotocin (55 mg/kg), and the animals were randomly separated into three groups after the effects of the diabetes became apparent. After a left thoracotomy, ischemia was performed on the myocardial muscle with the left main coronary artery (LAD) for 30 min in the DIR and DIRL groups. After ischemia, the LAD ligation was removed, and reperfusion was applied for 120 min. Single-dose intraperitoneal 12 μg/kg levosimendan was administered to group DIRL before the ischemia. Group DC was evaluated as the diabetic control group, and six rats were considered to be the control group (group C), in which thoracotomy was performed and then closed with no induction of myocardial ischemia. We measured the levels of malondialdehyde, as a lipid peroxidation end product, as well as catalase and glutathione S-transferase activities, as antioxidant enzymes in the lung tissue. Tissue samples were also examined histopathologically., Results: Neutrophil infiltration or aggregation in lung tissue was significantly higher in the DIR group compared with the C, DC, and DIRL groups (P = 0.003, P = 0.026, and P = 0.026, respectively). Alveolar wall thickening in lung tissue was significantly higher in the DIR group compared with the C, DC, and DIRL groups (P = 0.002, P = 0.002, and P = 0.006, respectively). In addition, the lung tissue damage score was significantly higher in the DIR group compared with the C, DC, and DIRL groups (P = 0.001, P = 0.004, and P = 0.007, respectively). Finally, catalase and glutathione S-transferase activity levels were significantly higher in the DIR group compared with those observed in the C, DC, and DIRL groups., Conclusions: Although diabetes increases lipid peroxidation, it suppresses antioxidant activity. Our results showed that levosimendan had a protective effect against lung damage secondary to IR in the rats with induced diabetes. We recommend that experimental and clinical studies be conducted to examine the effects of levosimendan at different doses and different IR durations on various organs for clinical use., (Copyright © 2015 Elsevier Inc. All rights reserved.)