Prevention of Pain and Infective Complications after Transrectal Prostate Biopsy: A Prospective Study

Aim: To investigate the effects of lidocaine gel and parenteral antibiotics and povidine lavage in the treatment of pain occurring during prostate biopsy in terms of infective complications. Patients and methods: Eighty patients with indications for prostate biopsy were randomized into two groups. One group underwent lavage with povidine iodine solution and lidocaine gel, and the other received cephtriaxon and lavage. Pain experienced by the patients was measured by visual analog scale (VAS). Blood samples were taken 15 and 60 min after the procedure, and urine culture antibiograms were taken 60 min after the procedure. Results: The average pain score was 3.70 in Group 1 and 4.25 in Group 2; the difference between the groups was not statistically significant (P>0.05). Likewise, no statistically significant difference between groups was found by the chi square test in either urine or blood cultures (P>0.05). Conclusions Lavage with betadine prior to transrectal prostate biopsy is adequate in the prevention of infective complications; however, because lidocaine gel is not effective against pain, alternative methods for pain management need to be developed.     

The preparation of leukocyte-poor red blood cells: a comparative study

Thirteen methods of prepararing leukocyte-poor red blood cells were compared for their effectiveness in removing leukocytes. When the starting material was six to ten days old, the residual leukocyte count was three to four times lower than when fresh material was used and no granulocytes could be found. The most effective manual procedure was a single upright sedimentation of six- to ten-day-old saline-diluted red cells. Inverted sedimentation was no more effective in leukocyte depletion than upright sedimentation. Automated cell processors were no more effective than several of the better manual methods. Freezing and deglycerolizing resulted in a ten-fold improvement in leukocyte removal with less red blood cell loss but at higher cost than the nonfreezing methods. The study indicates that unless the minimal leukocyte count of frozen red blood cells is essential, a single upright sedimentation of saline-diluted, six- to ten-day-old red blood cells is currently the most effective procedure for preparing leukocyte-poor red blood cells.     

Complexity of VTA DA neural activities in response to PFC transection in nicotine treated rats

Background  

The dopaminergic (DA) neurons in the ventral tegmental area (VTA) are widely implicated in the addiction and natural reward circuitry of the brain. These neurons project to several areas of the brain, including prefrontal cortex (PFC), nucleus accubens (NAc) and amygdala. The functional coupling between PFC and VTA has been demonstrated, but little is known about how PFC mediates nicotinic modulation in VTA DA neurons. The objectives of this study were to investigate the effect of acute nicotine exposure on the VTA DA neuronal firing and to understand how the disruption of communication from PFC affects the firing patterns of VTA DA neurons.     

Nonoperative management of pancreatic injuries in pediatric patients

Purpose  

Nonoperative management of minor pancreatic injury is the generally accepted approach. However, the management of major pancreatic injury remains controversial in pediatric patients. The aim of the present study was to determine the safety and efficacy of nonoperative management of pancreatic injury in pediatric patients.     

The trypanocidal activity of amidine compounds does not correlate with their binding affinity to Trypanosoma cruzi kinetoplast DNA

Due to limited efficacy and considerable toxicity, the therapy for Chagas' disease is far from being ideal, and thus new compounds are desirable. Diamidines and related compounds such as arylimidamides have promising trypanocidal activity against Trypanosoma cruzi. To better understand the mechanism of action of these heterocyclic cations, we investigated the kinetoplast DNA (kDNA) binding properties and trypanocidal efficacy against T. cruzi of 13 compounds. Four diamidines (DB75, DB569, DB1345, and DB829), eight arylimidamides (DB766, DB749, DB889, DB709, DB613, DB1831, DB1852, and DB2002), and one guanylhydrazone (DB1080) were assayed in thermal denaturation (T(m)) and circular dichroism (CD) studies using whole purified T. cruzi kDNA and a conserved synthetic parasite sequence. The overall CD spectra using the whole kDNA were similar to those found for the conserved sequence and were indicative of minor groove binding. Our findings showed that some of the compounds that exhibited the highest trypanocidal activities (e.g., DB766) caused low or no change in the T(m) measurements. However, while some active compounds, such as DB766, induced profound alterations of kDNA topology, others, like DB1831, although effective, did not result in altered T(m) and CD measurements. Our data suggest that the strong affinity of amidines with kDNA per se is not sufficient to generate and trigger their trypanocidal activity. Cell uptake differences and possibly distinct cellular targets need to be considered in the final evaluation of the mechanisms of action of these compounds.     

ADHD and Drug Holidays: Effects on Anthropometric Changes during Methylpenidate Treatment

Objectives:The current study evaluated the long-term effects of methylphenidate (MPH) discontinuation on growth parameters in Turkish children and adolescents with attention-deficit/hyperactivity disorder (ADHD).Experimental design:432 children and adolescents (aged 6–18 years) with ADHD receiving MPH for at least 1 year between March 2012 and January 2019 were included in a retrospective cohort study. We analyzed weight, height, and body mass index (BMI) standard deviation z scores (SDS) of groups that either did (ADHD-C) or did not (ADHD-DC) discontinue MPH. Growth parameters were converted to z scores as normative values for the Turkish population to compare the measurements at baseline and the last follow-up visit by using the paired sample t-test.Principal observations:In patients from the ADHD-C group, statistically significant negative correlations were found between age at starting MPH and differences in weight and height SDS between baseline and follow-up. Children had a greater reduction in weight and height compared to adolescents. When we evaluated the differences in pre-and post-treatment growth factors, we found no significant differences between the groups in terms of growth parameters.Conclusions:Our data showed that chronic use of MPH was likely responsible for changes in height and weight parameters.     

Interpleural versus epidural analgesia with ropivacaine for postthoracotomy pain and respiratory function

STUDY OBJECTIVE: To evaluate the impact of interpleural analgesia (IP) on postthoracotomy pain and respiratory function as an alternative to thoracic epidural analgesia (TEA). DESIGN: Prospective, randomized study. SETTING: Tertiary-care military hospital. PATIENTS: Sixty young patients scheduled for elective thoracic surgery (correction of aorta coarctation and patent ductus arteriosus). INTERVENTIONS: Patients were randomized into two groups to receive either IP or TEA for postthoracotomy pain management. MEASUREMENTS: Patients in the IP group (n = 30) had a catheter inserted between the parietal and visceral pleura by a surgeon, and 0.2% ropivacaine was given through this catheter. In the TEA group, ropivacaine was administered through a thoracic epidural catheter. The impact of both methods on pain control, respiratory function, and pulmonary complications was analyzed and compared. MAIN RESULTS: The frequency of atelectasis and pleural effusion was also significantly high in the IP group (P < 0.01). Respiratory function and postoperative pain scores were better in the TEA group (P < 0.01). Arterial blood gas analysis on the fifth postoperative day was significantly better in the TEA group. CONCLUSION: Thoracic epidural analgesia has more beneficial effects on respiratory function and postoperative pain after thoracotomy than does IP.     

Reconstruction of the Fibrous Trigone

A 48-year-old man with a history of infective endocarditis and severe aortic regurgitation had undergone prosthetic aortic valve replacement at another institution. Two months later, the patient developed prosthetic valve endocarditis with an aortic root abscess and an aorto–left atrial periprosthetic valvular fistula through the detached posterior annulus of the mitral valve. We repaired the fistula by constructing a fibrous trigone made of bovine pericardium. We also replaced the prosthetic aortic valve with another prosthetic valve, while protecting the native mitral valve.Key words: Aortic valve replacement, endocarditis/complications/surgery, fistula/etiology/surgery, heart valve prosthesis/adverse effects, mitral valve repair, prosthesis-related infections, reoperationThe incidence of prosthetic valve endocarditis (PVE) within 12 months after heart valve replacement is between 1% and 3.1%.^1,2 In the largest PVE case series to date, 20.1% of the cases of infective endocarditis were due to PVE³—a severe and life-threatening infection, particularly when accompanied by a paraprosthetic abscess and progression of fistulous communication.Aorto–left atrial fistula, a rare complication of PVE, is surgically challenging. We report the successful surgical repair of an aorto–left atrial periprosthetic valvular fistula in concordance with re-replacement of the aortic valve, while protecting the native mitral valve.     

Granulocyte colony-stimulating factor mobilizes more dendritic cell subsets than granulocyte-macrophage colony-stimulating factor with no polarization of dendritic cell subsets in normal donors

Dendritic cells (DCs) are effective antigen-presenting cells. We hypothesized that increasing the DC populations in donor lymphocyte infusions (DLIs) may augment the graft versus malignancy effect, particularly if granulocyte-macrophage colony-stimulating factor (GM-CSF) mobilization resulted in increased precursor dendritic cell (pDC) 1 cells. Mature DCs, pDC1 cells, pDC2 cells, and CD34(+) cells from the same donor were compared after granulocyte colony-stimulating factor (G-CSF) mobilized peripheral blood stem cell collections and GM-CSF mobilized DLI collections. Mobilization with G-CSF resulted in up to a 10-fold larger number of CD34(+) cells per kg and a 3-5-fold larger number of mature DCs, pDC1 cells, and pDC2 cells within the same donor compared with GM-CSF. The ratio of pDC1 to pDC2 in each donor remained constant with either cytokine. In this small sample of normal donors, it appears that G-CSF mobilizes more CD34(+) cells, mature DCs, pDC1 cells, and pDC2 cells within the same donor than does GM-CSF, with no significant polarization by G-CSF or GM-CSF for either pDC1 or pDC2 cells.