The effectiveness of analgesics in traumatic injuries of the extremities

In this study, the effectiveness of different analgesics was investigated in patients who presented to the emergency room with traumatic injuries or fractures of the extremities. We observed 100 patients (42 male, 58 female) who presented to the Konya State Hospital emergency service with isolated traumatic injuries of the extremities. We used different analgesics intravenously or intramuscularly in those patients with a high or moderate level of pain according to a visual analog pain scale. Patient pain levels were assessed 15, 30, and 45 minutes after administration of the analgesics. Metamizole sodium 1 g IV was used in 36 patients and diclofenac sodium 75 mg IM was given to 40 patients; tramadol hydrochloride 100 mg IV was administered to 24 patients. Pain became less severe after 15 minutes in 92% of patients who received tramadol IV; pain became less severe after 30 minutes in 72% of those who received metamizole IV. In contrast, pain became less severe after 45 minutes in 65% of patients who received diclofenac IM. Tramadol was the most effective analgesic and was also more effective earlier than the other analgesics tested.     

An algorithmic approach for the management of hand deformities in dystrophic epidermolysis bullosa

Treatment of hand deformities in epidermolysis bullosa patients represents a challenging field in hand surgery practice, thus a systematic approach by a team is mandatory for a successful result. A simple and practical algorithm for the surgical treatment of hand deformities in EB was employed by the authors where the deformities of each digit in EB patients was categorized according to pseudosyndactyly and interphalangeal joint contracture severity for guidance during the surgical treatment. The current study retrospectively reviewed the medical records and photographic data of 13 EB patients followed in our department, for whom a systematic approach to the management and treatment was used. Mild cases were treated by surgical release and secondary healing with non-adhesive dressing while moderate cases were treated with autologous dermal grafts harvested with a special technique that were fixed on denuded areas on the proximal interphalageal joints after release. The remaining areas were treated similarly to the mild group. Additional K-wires were applied for two weeks in severe cases. A total of 21 procedures were performed on 13 EB patients with hand deformities according to the proposed treatment strategy. Functional recovery was satisfactory for each patient and the outcomes were dependent upon the severity of deformity. A multidisciplinary and conscious approach followed by an algorithmic surgical treatment protocol described in the study has been beneficial in providing consistent and successful long-term results for these patients.     

Comparison of the differences in circadian autonomic function in hyperlipidemic men with and without erectile dysfunction

Background  

We aimed to investigate differences in circadian autonomic changes in patients suffering from hyperlipidemia with and without erectile dysfunction and compared results to control cases.     

Upper-extremity deep vein thrombosis and downhill esophageal varices caused by long-term pacemaker implantation

Upper-extremity deep vein thrombosis is common after pacemaker or cardioverter-defibrillator implantation. Only 1% to 3% of patients with upper-extremity deep vein thrombosis become symptomatic. Downhill esophageal varices develop in the upper third of the esophagus as a result of the obstruction of the superior vena cava. Herein, we report the case of a 54-year-old man--a recipient of multiple implanted cardiac pacemakers--who presented with bilateral upper-extremity deep vein thrombosis. This severely symptomatic condition was complicated by very rare and life-threatening downhill varices of the upper esophagus, but without bleeding. To the best of our knowledge, this is the 1st report of this array of conditions.     

Dexmedetomidine attenuates the hemodynamic and neuroendocrinal responses to skull-pin head-holder application during craniotomy

We tested dexmedetomidine, an alpha2 agonist, for its ability to decrease heart rate, arterial blood pressure, and neuroendocrinal responses to skull-pin head-holder application during craniotomy. In a randomized, double-blinded, placebo-controlled study, 40 patients undergoing craniotomy with attachment of a pin head-holder were randomly assigned to one of 2 equal groups. The placebo group received saline, whereas the treatment group (DEX group) received a single bolus dose of dexmedetomidine (1 microg/kg) intravenously over 10 minutes before induction of anesthesia. Arterial blood pressure, heart rate, and sequential concentrations of circulating cortisol, prolactin, insulin, and blood glucose were measured. Relative to baseline and the other group, arterial blood pressure and heart rate decreased significantly after the administration of dexmedetomidine through skull pinning (P<0.05). In the placebo group, patients' heart rate and arterial blood pressure measures increased at 1 and 5 minutes after skull-pin insertion, compared with baseline and the DEX group (P<0.05). In both groups, plasma cortisol, prolactin, and blood glucose increased significantly relative to baseline after skull-pin insertion. However, the values were significantly higher in the placebo group compared with the DEX group (P<0.05). Although insulin levels were not significantly altered in the DEX group, the plasma concentrations of insulin decreased significantly after pin insertion in the placebo group. Our results suggested that, a single bolus dose of dexmedetomidine before induction of anesthesia attenuated the hemodynamic and neuroendocrinal responses to skull-pin insertion in patients undergoing craniotomy.     

Cigarette smoking and the haemodynamic response to tracheal intubation

This study investigated the effects of smoking and gender on the haemodynamic response after tracheal intubation. Patients were assigned to one of four groups: female non-smokers, female smokers, male non-smokers and male smokers. After tracheal intubation, the highest mean (SD) increase in heart rate (30 (18) %) and rate–pressure product (40 (29) %) was seen in male smokers. The increases in heart rate and rate–pressure product in male smokers were significantly greater than those in female non-smokers, p < 0.05. The increase in rate–pressure product was significantly greater in male smokers than in male non-smokers, p = 0.022.