Low-dose Clonidine and Neostigmine Prolong the Duration of Intrathecal Bupivacaine-Fentanyl for Labor Analgesia

Background: Intrathecal (IT) opioid and local anesthetic combinations are popular for labor analgesia because of rapid, effective pain relief, but the duration of analgesia is limited. This study was undertaken to determine whether the addition of clonidine and neostigmine to IT bupivacaine-fentanyl would increase the duration of analgesia without increasing side effects for patients in labor.

Methods: Forty-five healthy parturients in active labor were randomized to receive a 2-ml IT dose of one of the following dextrose-containing solutions using the combined spinal-epidural technique: (1) bupivacaine 2.5 mg and fentanyl 25 [mu]g (BF); (2) BF plus clonidine 30 [mu]g (BFC); or (3) BFC plus neostigmine 10 [mu]g (BFCN). Pain, sensory levels, motor block, side effects, maternal vital signs, and fetal heart rate were systematically assessed.

Results: Patients administered BFCN had significantly longer analgesia (165 +/- 32 min) than those who received BF (90 +/- 21 min;P < 0.001) or BFC (123 +/- 21 min;P < 0.001). Pain scores, block characteristics, maternal vital signs, Apgar scores, maternal satisfaction, and side effects were similar among groups except for nausea, which was significantly greater in the BFCN group (P < 0.05 as compared with BFC).     

A Current Dilemma in Histopathology: Atypical Spitz Tumor or Spitzoid Melanoma?

Both clinically and histopathologically, melanoma of childhood is a rarely encountered lesion. In addition, it has particular histopathologic diagnostic problems. Differential diagnosis of this lesion and Spitz nevus is at times very problematic, in that distant metastases and death of the patient may be the only diagnostic criteria for some cases. We present a 4-year-old girl with an atypical melanocytic neoplasm with Spitzoid features on the left subscapular region.     

Bilateral Subclavian Arterial Aneurysm and Ruptured Abdominal Aorta Pseudoaneurysm in Behçet's Disease

Behçet's disease is characterized by recurrent ulcers of the mouth and genitalia and relapsing iritis. It is recognized as a chronic multisystem disease affecting the skin, mucous membranes, eye, joints, central nervous system, and blood vessels. About 8% of the patients with Behçet's disease have severe vascular complications such as arterial aneurysm and occlusion. In our patient, there was a massive, painful, pulsatile mass on the clavicle on the right side of neck. A left subclavian artery aneurysm mass was observed on the left apex on a chest X-ray. Through angiography, a lobular giant saccular aneurysm on the proximal side of the right subclavian artery, giant aneurysm on the left subclavian artery, and occlusion on the left subclavian-axillary artery were observed. We treated first the right and then the left subclavian arterial aneurysm with a two-stage operation. The aneurysms were resected and polytetrafluoroethylene (PTFE) graft interposition was performed. Control angiography was performed 6 months postoperatively. Both grafts were open and there was no anastomotic aneurysm. The patient was reoperated on for a ruptured abdominal aorta pseudoaneurysm 13 months after the first operation. The aortic defect was repaired using a Dacron patch.     

Melanoma metastasis to the breast: A diagnostic pitfall

Background: Breast metastasis is an extremely rare phenomenon. While nearly every malignancy has been described to metastasize to the breast; melanoma, lymphoma and leukemia tend to be the most common. Among these primary tumors, melanoma metastasis represents a diagnostic pitfall for both the clinicians and histopathologists. Methods: We report a case of widely metastatic malignant melanoma with diagnostic difficulties in both clinical and histopathological evaluation. Thorax CT, Abdominal MRI, tumor marker screening and two biopsies were performed to conclude the primary. Results: In clinical evaluation, there were rapidly proliferating multiple nodular lesions at the skin, breasts, lungs, ovaries and peritoneum accompanied by only increased CA 125 in tumor marker panel. The initial biopsy performed from a skin nodule was concordant with a metastatic carcinoma suggesting breast as the primary. The diagnosis was made by immunohistochemical staining of the second biopsy performed from a breast nodule. Conclusion: Although no strict clinical criteria exist to differentiate a melanoma metastasis to the breast from a primary breast carcinoma atypically rapid growth, normal Ca 15-3 level, and a history of prior melanoma may be helpful. However, it may be still misdiagnosed in some cases even histopathologically if the immunohistochemical staining is not performed.     

Acquired digital fibrokeratoma

Acquired digital fibrokeratoma (ADF) is an uncommon benign tumor of fibrous tissue that presents as smooth, dome-shaped or fingerlike, flesh-colored papules that are mostly located on the distal extremities. As it can easily be misdiagnosed for other common benign lesions such as viral warts, which usually are not subject to routine histopathologic examination, it might be underreported. We report 13 patients with ADF diagnosed in our clinic in the past 4 1/2 years.     

Unintentional non-fatal home-related injuries in Central Anatolia, Turkey: frequencies, characteristics, and outcomes

Injuries constitute a major public health problem worldwide. Homes are an important setting for non-fatal unintentional injuries. The aim of this study is to determine the frequency, the characteristics, and the outcome of unintentional non-fatal injuries in the household, and to describe the related risk factors through a community-based survey.

The study was conducted using a household-based survey design. Eight hundred inhabitants were sampled from the entire population in the city centre by a stratified sampling method in 2004. All unintentional non-fatal home-related injuries occurring in the previous year were registered and examined, making special note of the mechanism of the injuries, the time and place of the incidents and their outcomes.

The frequency of unintentional non-fatal home-related injuries requiring some form of medical attention was established as 10.8%. Falls were the most common injuries among all the study groups. Injury rates were highest among the oldest (aged ≥65) and youngest (aged <15) age groups, females, adults having incomes under € 500, individuals living alone, or the unemployed. Contact with hot objects/substances or hot liquid/gas was the leading mechanism in children 4 years of age or younger, falls ranking second. Falls are a significant problem particularly among older adults.

Multiple analysis revealed that participants with low incomes, living alone and single or divorced had a high risk for injury at home. The findings related to disability highlighted a need to focus attention on the prevention of residential falls among the elderly, and the burns and falls among young children. Preventive measures should be prioritised to risk groups such as individuals with low incomes and those living alone.     

Do we have to pay more attention to vitiligo patients? Peculiar histopathological features of primary cutaneous melanoma preceded by vitiligo

Vitiligo is an acquired depigmenting skin disease characterized by the loss of functioning epidermal melanocytes. Vitiligo can be associated with an autoimmune disorder. An unusual and important aspect of vitiligo is its relationship to melanoma. We present herein a 34-year-old man who developed regional lymph node metastases of malignant melanoma 2 years after the diagnosis of vitiligo.     

Desmoplastic trichilemmoma: a rare tumor of the eyelid

PURPOSE: To report an upper eyelid mass which proved to be a desmoplastic trichilemmoma. METHODS: A 60-year-old man had a slowly enlarging upper eyelid mass. The tumor was excised. The pathologic evaluation of the tumor was centered on the differential diagnosis. RESULTS: The clinical appearance of this lesion is nonspecific and can simulate a verruca, follicular keratosis, or basal cell carcinoma. Central desmoplasia, outer root sheath differentiation of the tumor cells, and CD34 positivity are the main characteristics that allow differentiation from basal cell carcinoma. CONCLUSIONS: Proper recognition of a benign neoplasm that may be misdiagnosed as basal cell cancer can prevent aggressive surgical treatment.