Magnesium sulfate infusion prevents shivering during transurethral prostatectomy with spinal anesthesia: a randomized,double-blinded,controlled study

Study ObjectiveTo determine whether magnesium sulfate (MgSO₄) infusion during surgery reduces shivering during spinal anesthesia.DesignDouble-blinded placebo-controlled, randomized trial.SettingOperation room of a university hospital.Patients60 patients, aged 40 to 70 years, scheduled for elective transurethral resection of the prostate (TURP) during spinal anesthesia.InterventionsSubarachnoid anesthesia consisting of hyperbaric bupivacaine three mL 0.5% was injected using a 25-G Quincke spinal needle. Patients received either saline (Group C, n = 30) or MgSO₄ (Group Mg, n = 30). Group Mg received an intravenous (IV) bolus of MgSO₄ 80 mg/kg via syringe pump over a 30-minute period, followed by a two g/hr infusion during the intraoperative period. Group C received an equal volume of saline.MeasurementsMotor blockade was evaluated by Bromage motor scale. Sensory block level was assessed by pinprick test. Shivering was assessed after the completion of subarachnoid drug injection. Side effects were recorded.Main ResultsHypothermia was observed in all patients (100%) in Group Mg and in 24 patients (80%) in Group C (P = 0.024). The decrease in core temperature in Group Mg was significantly greater (P < 0.005). Shivering was observed in two patients (6.7%) in Group Mg and 20 patients (66.7%) in Group C (P = 0.0001).ConclusionsMgSO₄ infusion in the perioperative period significantly reduced shivering during TURP with spinal anesthesia. MgSO₄ infusion prevents shivering in patients receiving spinal anesthesia but increases the risk of hypothermia.     

Gabapentin, A GABA analogue, enhances cognitive performance in mice

Gabapentin is one of the new antiepileptic drugs (AEDs) launched recently. The advantage of new AEDs includes newer mechanism of action, broad spectrum of antiseizure effects, lesser drug interactions and fewer side effects. Gabapentin (GBP) a GABA analogue, is efficacious in several neurological and psychiatric conditions and it is conventionally used in the treatment of partial epilepsies. In this study, we aimed to evaluate the effects of GBP on learning and memory processes of naive mice in Morris water maze (MWM), passive avoidance (PA) and modified elevated plus maze (mEPM) tests. GBP (5 and 10mg/kg, i.p.) was administered on the probe trial of MWM and on the acquisation session of PA and mEPM tests. In the MWM test, GBP (10mg/kg) significantly increased the time spent in target quadrant and GBP (5 and 10mg/kg) significantly decreased the distance to platform compared to control group. In the mEPM test, GBP (5 and 10mg/kg) significantly decreased the transfer latency compared to control group on the second day and in the PA test, GBP (5 and 10mg/kg) significantly prolonged retention latency compared to control group. Our results indicate that GBP has improving effects on spatial and emotional cognitive performance of naive mice in MWM, PA and mEPM tasks.     

Postpartum-onset major depression is associated with personality disorders

OBJECTIVES: The objective of the study was to investigate the incidence rate of postpartum-onset major depression (PPMD) and to examine associated sociodemographic characteristics, obstetric factors, and personality disorders. METHOD: The study data were obtained from 302 women who delivered at a child and maternity hospital. We interviewed the new mothers on the first day of their childbirth and at 6 weeks postpartum. Major depression and axis II diagnoses were determined by means of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, Personality Disorders, respectively. RESULTS: Nineteen (6.3%) women had new-onset major depression during 6 weeks postpartum. Postpartum-onset major depression was unrelated to age, educational level, employment status, planned or unplanned pregnancy, history of abortion and gestational complications, term of delivery, type of delivery, sex of the baby, and mother's breast-feeding. Frequency of primiparity and of avoidant, dependent, and obsessive-compulsive personality disorders was higher in women with PPMD than that in women without PPMD. As a result of logistic regression analysis, the independent predictor of PPMD was the presence of avoidant, dependent, and obsessive-compulsive personality disorders. CONCLUSION: Our results suggest that childbearing women with avoidant, dependent, and obsessive-compulsive personality disorders have increased risk of new-onset major depression during the postpartum period.     

Bilateral basal ganglia lesions after hypoglycemic coma in a 6-year-old child

Imaging findings of brain damage due to neonatal hypoglycemia are known; however, the effect of childhood hypoglycemia on the brain has not been described well. The authors present the case of a 6-year-old girl who had seizures secondary to hypoglycemia followed up for 1 year as epilepsy. The patient had experienced a hypoglycemic coma attack about 1 year before. Brain magnetic resonance imaging showed atrophy of the cerebrum and cerebellum and bilateral symmetrically hyperintense lesions in the putamina. The patient was diagnosed with hypoglycemia due to hyperinsulinism.     

White matter alteration in a patient with Graves' disease

A case of Graves' disease with white matter abnormalities is presented here. The diagnosis as Graves' disease was made when the patient was 5 years old, and a subtotal thyroidectomy was performed when she was 10. Her neurological symptoms began at age 19 with paresthesia of her legs and lower body. Cranial magnetic resonance imaging was normal; thoracic magnetic resonance imaging revealed demyelinating lesions. Intravenous pulse steroid therapy improved her symptoms. Ten months later she described dizziness, lower body paresthesia, and ataxia. Both her cranial and thoracic magnetic resonance imagings revealed demyelinating lesions. After pulse steroid therapy, glatiramer acetate therapy was initiated with diagnosis of an autoimmune multiphasic demyelinating syndrome. Five months later, she presented with right-sided mild optic neuritis followed by rapid spontaneous remission. Antithyroglobulin antibody levels remained normal; antithyroid peroxidase antibody level was high. This presents a rare case of Graves' disease associated with multiphasic demyelinating autoimmune syndrome.     

Prevalence patterns of gastric cancers in Turkey: model of a developing country with high occurrence of Helicobacter pylori

AIM: In developed countries, there has been a recent increase in the prevalence of adenocarcinoma of the esophagus and cardia, along with a decrease in distal gastric cancers. Little is known regarding the prevalence of these diseases in developing countries. The aim of the present study was to evaluate changes in the prevalence of gastric adenocarcinomas in Turkey as a function of anatomic location. METHODS: Data were retrospectively collected from 16 centers from January 1990 to December 2000. Owing to the exclusion criteria, a total of 4065 cases of tumors of the stomach and distal esophagus were included. Tumors localized to the body, the antrum and pyloric channel were considered distal cancers. Helicobacter pylori (H. pylori) was also detected. RESULTS: Patients' mean age was 60.7 +/- 9 years, with a male : female ratio of 68:32. The ratio of distal/proximal adenocarcinoma was 2:1 for the western part of Turkey and 3:8 for the eastern part of the country (P < 0.0001), and this did not change during the 11 years. H. pylori was detected significantly less in the west compared to the east for distal tumors (65.7 vs 38.7%, respectively, P = 0.02). CONCLUSION: In Turkey, a developing country with a high H. pylori prevalence, contrary to the state of developed countries, the ratio of distal versus proximal gastric adenocarcinomas has not changed. Geographical distribution should be taken into the account in projecting the changing patterns of gastric cancers.     

Nitric oxide synthesis inhibition attenuates iron-induced neurotoxicity: a stereological study

Iron overload and enhanced hydroxyl radical formation have been implicated as the causative factors of some neurodegenerative disorders. Therefore, iron is commonly used as a metal to induce neuronal hyperactivity and oxidative stress. A body of evidence indicates a relationship between iron-induced neuronal death and nitric oxide (NO). Data are, however, controversial because it is not clear whether NO has neuroprotective or neurotoxic effects on neurotoxicity. To determine the contribution of NO to iron-induced hippocampal cell loss, l-arginine, the NO synthesis precursor, and a nonselective nitric oxide synthase inhibitor N(G)-nitro-l-arginine methyl ester (l-NAME) were used. Animals were divided into four groups as follows: control, iron, iron+l-NAME and iron+l-arginine. Neurotoxicity was produced by microinjection of iron chloride (200 mM, 2.5 microl) into the left cerebral ventricle in iron-treated groups while control group rats received same amount of saline. After the intracerebroventricular injection, all animals were kept alive for 10 days. During this period, animals in iron+l-NAME and iron+l-arginine groups received intraperitoneal (i.p.) l-NAME (30 mg/kg) and l-arginine (1000 mg/kg) injections once a day, respectively. Rats belonging to control group also received the same amount of saline intraperitoneally. After 10 days, rats were perfused intracardially under deep urethane anesthesia. Removed brains were processed using the standard histological techniques. The total numbers of neurons in hippocampus of all rats were estimated with stereological techniques. It was found that l-NAME decreased iron-induced cell loss from 44.7 to 13.7%, while l-arginine increased cell loss from 44.7 to 57.5%. Results of the present study suggest that inhibition of NO synthesis may attenuate the neurotoxic effects of iron.