A comparison of analgesic efficacy of tramadol and pethidine for management of postoperative pain in children: a randomized,controlled study

Prevention of postoperative pain in children is one of the most important objectives of the anesthesiologist. Opioids have been used as an analgesic for postoperative pain in children for many years. Tramadol has both opioid and monoaminergic agonist actions. The aim of the study was to determine if the analgesic potency and occurrence of adverse effects of tramadol differ from pethidine when administered to children. A total of 110 healthy children, aged 2-12 years, scheduled for elective lower abdominal surgery were randomized to receive either pethidine 1 mg/kg (Group I, n = 60) or tramadol 2 mg/kg (Group II, n = 50) for postoperative pain after anesthesia induction. Pain intensity, adverse effects, heart rate, and systolic and diastolic blood pressure were recorded at regular intervals. The mean pain scores on postoperative 24 h were significantly greater with tramadol than with pethidine. Sedation scores, heart rate and systolic and diastolic blood pressure showed no significant differences between the groups. We conclude that pethidine and tramadol are effective in providing analgesia in pediatric patients, but pethidine provided better postoperative analgesia than tramadol. Changes in blood pressure, heart rate and arterial oxygen saturation were minimal and were similar in both drugs.     

Factors influencing stereoacuity in refractive accommodative esotropia

BACKGROUND: We aimed to investigate factors that promote binocular sensory function in patients with refractive accommodative esotropia (RAE) who have successful optical alignment. METHODS: Charts of 64 patients with RAE were retrospectively reviewed. Clinical factors examined included onset age of RAE, duration of misalignment, history of misalignment in family members, amblyopia, amblyopia treatment, refractive error, anisometropia, ocular movement disorders, visual acuity level, and the presence of intermittent or constant misalignment after optical correction of the hyperopic refractive error. RESULTS: Thirty-two patients (50%) were able to see test figures on any plates of TNO test and were considered to have stereoscopic vision. Intermittent or constant misalignment detected at any visit was found to affect stereoacuity adversely in patients with RAE. INTERPRETATION: Despite successful opitical alignment, as many as 50% of patients with RAE had anomalous binocular sensory function. An intermittent or constant eye misalignment poses a risk for anomalous binocular vision. These finding could promote prompt and appropriate optical corrections in order to minimize the adverse effects of intermittent or constant eye misalignment on binocular sensory function in patients with RAE.     

Diagnosis of perigraft seroma formation by use of echocardiography after modified Blalock-Taussig shunt.

Perigraft seroma is a collection of non-secretory fibrous pseudomembrane surrounding a vascular graft, which is a collection of clear, sterile fluid. Thoracal computed tomography, Magnetic Resonance Imaging, and thoracal ultrasonography have been proposed for diagnosis of this pathology. A consecutive modified Blalock-Taussig (m-BT) shunt complicated by perigraft seroma formation, which is diagnosed using a Doppler ultrasonography (US), is presented here.     

Use of DNA hybridization test for diagnosing bacterial vaginosis in women with symptoms suggestive of infection

The purpose of this study was to evaluate a DNA hybridization test (Affirm VPIII) as an alternative to Gram stain for the rapid diagnosis of bacterial vaginosis in women with clinical signs of vaginal infection. Vaginal specimens were collected from 321 symptomatic women, and analyzed for bacterial vaginosis by both Gram stain using Nugent criteria and DNA hybridization test. Sensitivity, specificity, positive predictive value, and negative predictive value of the DNA hybridization test were determined using the Gram staining as the standard for diagnosis of bacterial vaginosis. Of the 321 patients, 115 (35.8%) were Gram positive for bacterial vaginosis and 126 (39.2%) were negative. 80 patients (25.0%) demonstrated intermediate Gram staining that was also considered negative. The Affirm system detected G. vaginalis in 107 (93.0%) of 115 vaginal specimens positive for bacterial vaginosis diagnosed by Gram stain. Compared to the Gram stain, DNA hybridization test had a sensitivity of 87.7% and a specificity of 96.0%. Positive and negative predictive values of the DNA hybridization test were 93.0% and 92.7%, respectively. In conclusion, Affirm VPIII hybridization test correlated well with Gram stain and may be used as a rapid diagnostic tool to exclude bacterial vaginosis in women with genital complaints.     

Cost of renal replacement therapy in Turkey

BACKGROUND AND RESULTS: By the end 2000, 22224 patients were on renal replacement therapy (RRT) in Turkey. We investigated the cost of RRT in three medical faculties and one private dialysis centre. Yearly expenses were US dollars 22759 for haemodialysis (HD), US dollars 22350 for continuous ambulatory peritoneal dialysis (CAPD), and US dollars 23393 and US dollars 10028, respectively, for the first and second years of transplantation (Tx). In the first year, renal Tx was significantly more expensive than CAPD. However, after the first year of renal transplantation, Tx became significantly more economical than both CAPD and HD. The sum of all yearly RRT expenses for the country was US dollars 488958709, which corresponds to nearly 5.5% of Turkey's total health expenditure. CONCLUSION: Measures such as early construction of vascular access, promoting home dialysis and the reuse of the dialysers, strict control of the use of some expensive drugs like erythropoietin and active vitamin D, and also increasing the number of transplantations, especially if pre-emptive transplantation is possible, should be taken into account in order to reduce these expenses.     

Intrathecal melatonin increases the mechanical nociceptive threshold in the rat

The aim of this investigation was to determine whether intrathecal (i.t.) administration of monodose melatonin provides an increase in mechanical nociceptive threshold in the rat. Twenty-four male Wistar rats were randomly assigned to four groups. Each animal was anesthetized, and a catheter was placed intrathecally via the cisterna magna. The study groups were: untreated controls (n=6); melatonin only (MEL, n=6); melatonin + luzindole (MEL+LZN, n=6); and melatonin + naloxone (MEL+NLX, n=6). Measurements of mechanical nociceptive threshold were made using an electronic algometer. Each animal was tested prior to injection and at 10, 20, 30 and 40 min after injection. In the MEL group, the mean nociceptive thresholds at all post-injection time points were significantly higher than the baseline value (p<0.05 for all). In the control and MEL+LZN groups, none of the four mean nociceptive thresholds recorded after i.t. injection was significantly different from the baseline value (p>0.05 for all). In the MEL+NLX group, the mean nociceptive thresholds at 20, 30 and 40 min post-injection were all significantly lower than the baseline value (p<0.05 for all). Comparison among the group nociceptive thresholds at baseline revealed no significant differences, and the same was true at 10 min after i.t. injection. At the 20, 30 and 40 min stages, the threshold in the MEL group was significantly higher than the threshold in the control group. The results indicate that i.t. injection of melatonin produces a time-dependent increase in mechanical nociceptive threshold in the rat and that the mechanism that underlies these effects involves both melatonin and opioid receptors.