Impact of Aortic Cross-Clamping Time on Peripheral Nerves: Experimental Model

Purpose: The present study investigated the correlation between extend aortic cross-clamping time and peripheral nerve injury on rats.Methods: 24 male, Sprague Dawley rats were divided into 3 groups; (a) control group: abdomen was directly closed after reached aorta, and followed by 72 hours, (b) short-term ischaemia-reperfusion group: peripheral nerve ischemia was induced in rats by supraceliac aortic occlusion for 20 min followed by 72 h of reperfusion, (c) long-term ischaemia-reperfusion group: peripheral nerve ischemia was induced for 30 min followed by 72 h of reperfusion. Preoperative and postoperative, electromyography (EMG) recordings were done. End of 72 h, the sciatic nerves were harvested from each animal for histopathological and biochemical analysis.Results: The mean compound muscle action potential (CMAP) amplitude of long-term ischaemia-reperfusion group was statically significant reduced when compared to the control group (p <0.01). However, the mean distal latency value of long-term ischaemia-reperfusion group was statically significant increased (p <0.01). On the other hand, there were statically significant differences between the results of malondialdehyde, edema and ischemia fiber degeneration grades on control and long-term ischaemia-reperfusion group (p <0.001).Conclusion: This study demonstrated that the extending cross clamping time directly harms the peripheral nerve of rats.     

Polyarteritis nodosa and Henoch–Schönlein purpura nephritis in a child with familial Mediterranean fever: a case report

Familial Mediterranean fever is an autosomal recessive disease characterized by recurrent self-limited attacks of fever accompanied by peritonitis, pleuritis, and arthritis. Approximately 5% of individuals with familial Mediterranean fever have been reported to have Henoch–Schonlein purpura and about 1% to have polyarteritis nodosa. A 7-year-old girl presenting with complaints of purpuric rash, abdominal pain, arthritis, hematuria, and proteinuria and having IgA depositions on renal biopsy was diagnosed as Henoch–Schönlein nephritis. She had a history of recurrent fever, abdominal and joint pain and M694 V compound homozygote mutation. Colchicine treatment was started for the diagnosis of FMF. When constitutional symptoms such as myalgia, weight loss, fatigue, fever, and hypertension were added to the clinical picture, the diagnosis of polyarteritis nodosa HSP was thought and confirmed by the demonstration of microaneurisms on renal arteries. There was no response to corticosteroid and cyclophosphamide treatments; however, the symptoms were rapidly and dramatically reduced after the administration of intravenous immunoglobulin. In conclusion, polyarteritis nodosa and Henoch–Schonlein purpura can be seen together with familial Mediterranean fever. It is also suggested that IVIG might be an important adjunct therapy in selected patients with polyarteritis nodosa, especially in the lack of response to steroids and immunsuppressive drugs.     

Tramadol and levobupivacaine wound infiltration at Cesarean delivery for postoperative analgesia

Purpose

The aim of the present study was to investigate whether levobupivacaine and tramadol wound infiltration decreases postoperative pain following Cesarean section and reduces the need for analgesics in the immediate post-delivery period.

Methods

Ninety patients (aged 18–40 years) scheduled for elective Cesarean section under general anesthesia were randomly allocated to one of the three groups: the placebo group (group P) received 20 mL local wound infiltration with 0.9 % saline solution; the levobupivacaine group (group L) received 20 mL local wound infiltration with levobupivacaine 0.25 %; and the tramadol group (group T) received 20 mL local wound infiltration with 1.5 mg/kg tramadol within 0.9 % saline solution. Following the closure of the uterine incision and the rectus fascia, 20 mL solution was infiltrated subcutaneously along the skin wound edges. The primary outcome was 24-h tramadol consumption. Secondary outcomes were recorded VAS scores, diclofenac requirement, fever, vomiting, and wound infection.

Results

At 15 min postoperatively, VAS values were lower in groups T and L than group P (P = 0.0001). The mean 24-h tramadol consumption was lowest in group T (P = 0.0001) and it was lower in the group L compared to group P (P = 0.007) (401.6, 483.3, and 557.5 mg for T, L, and P groups, respectively). There was no difference among groups regarding the need for supplemental analgesia (rescue diclofenac doses) (P > 0.05).

Conclusions

We conclude that wound infiltration with tramadol and levobupivacaine in patients having Cesarean section under general anesthesia may be a good choice for postoperative analgesia.     

Dehiscence and fenestration in patients with different vertical growth patterns assessed with cone-beam computed tomography

Abstract Objective: To test the null hypothesis that the presence of alveolar defects (dehiscence and fenestration) was not different among patients with different vertical growth patterns. Materials and Methods: A total of 1872 teeth in 26 hyper-divergent (mean age: 24.4 ± 4.8?years), 27 hypo-divergent (mean age: 25.1 ± 4.5?years), and 25 normo-divergent (mean age: 23.6 ± 4.1?years) patients with no previous orthodontic treatment were evaluated using cone-beam computed tomography. Axial and cross-sectional views were evaluated with regard to whether dehiscence and/or fenestration on buccal and lingual surfaces existed or not. For statistical analysis, the Pearson chi-square test was used at a P < .05 significance level. Results: According to the statistical analysis, the hypo-divergent group (6.56%) had lower dehiscence prevalence than the hyper-divergent (8.35%) and normo-divergent (8.18%) groups (P = .004). Higher prevalences of dehiscence and fenestration were found on buccal sides in all vertical growth patterns. While fenestration was a common finding for the maxillary alveolar region, dehiscence was a common finding in the mandible in all groups. Conclusion: The null hypothesis was rejected. Although the prevalence of fenestrations was not different, significant differences for dehiscences were found in patients with different vertical growth patterns.     

The effects of long- and short-term interdisciplinary treatment approaches in women with fibromyalgia: a randomized controlled trial

We investigated the effects of long- and short-term interdisciplinary treatment approaches for reducing symptoms and improving health-related quality of life (HRQoL) and physical functions of patients with fibromyalgia and compared the effects of two different interdisciplinary treatment approaches. We conducted a prospective, randomized, controlled trial involving 66 women with fibromyalgia eligible for the study at a university hospital setting. The patients were randomized into three groups (allocation ratio 1:1:1) using a computer-generated random numbers: a long-term interdisciplinary treatment group (LG, n = 22) that participated in 10 sessions (3-h once-weekly session for 10 weeks) of cognitive behavioral therapy (CBT) together with exercise training and other fibromyalgia related educational programs (two full days); a short-term interdisciplinary treatment group (SG, n = 22) that received two full days of educational, exercise, and CBT programs; and a control group (CG, n = 22). The patients were evaluated at baseline and 6 months after treatment using the visual analog scale (pain, fatigue, and sleep), Fibromyalgia Impact Questionnaire, Beck Depression Inventory, Short Form-36, tender point numbers, and pressure algometry as primary outcomes. The statistical analysis was confined to the ‘per-protocol’ set. No blinding was performed. The number of patients analyzed was 21 in the LG, 19 in the SG, and 19 in the CG. The intensity of pain (p < 0.001), severity of fatigue (p = 0.048), number of tender points (p = 0.002), and pressure pain threshold (p = 0.012) decreased significantly in both the LG and SG groups compared with controls. Moreover, physical functions (p = 0.017) and physical components of the HRQoL (p = 0.036) improved significantly in the intervention groups compared with the controls. However, there was no significant difference between intervention groups and the control group at the end of study in terms of quality of sleep (p = 0.055), severity of depressive symptoms (p = 0.696), and mental components of the HRQoL (p = 0.229). Finally, with the exception of the severity of fatigue and physical components of the HRQoL, there was no obvious significant difference between the efficacies of the two treatment approaches when compared with controls; the long-term treatment was found more effective in reducing pain than the short-term. Both, long- and short-term interdisciplinary treatments were effective in reducing the severity of some symptoms and disease activity in patients with fibromyalgia. The short-term program well meets the needs of women with fibromyalgia particularly in relation to pain and health status as measured using FIQ; however, a long-term program may be beneficial in reducing fatigue and improving physical function to a higher extent.     

Can core biopsy reliably diagnose mucinous lesions of the breast?

Mucinous lesions in the breast are uncommon. They constitute a wide spectrum of lesions ranging from extravasated mucin associated with fibrocystic change to mucinous carcinoma. There are limited data on the reliability of core biopsy in the diagnosis of mucinous lesions of the breast. We reviewed the core biopsy and surgical biopsy diagnoses in 32 mucinous lesions of the breast. We conclude that core biopsy is highly reliable for accurate diagnosis of mucinous lesions of the breast.     

A favourable response to surgical intervention and hyperbaric oxygen therapy in pyoderma gangrenosum

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised with ulcerations. Inflammatory bowel diseases (ulcerative colitis and Crohn's disease) and haematologic diseases (leukaemia, preleukaemia and monoclonal gammopathy) have been reported in about 40–50% of PG patients in whom the treatment of the underlying disease is important for the improvement of the lesions. We herein report a colorectal adenocarcinoma patient with PG, who responded partially to topical treatments and systemic immunosuppressants and healed completely with the aid of surgical wound repair and hyperbaric oxygen therapy.