The comparison of preincisional peritonsillar infiltration of ketamine and tramadol for postoperative pain relief on children following adenotonsillectomy

Objective

To investigate and compare the effectiveness of preincisional peritonsillar infiltration of ketamine and tramadol for post-operative pain on children following adenotonsillectomy.

Study design

Prospective randomized double blind controlled study.

Methods

Seventy-five children aged 3–10 years undergoing adenotonsillectomy were included in study. Patients received injections in peritonsillar fossa of tramadol (2 mg/kg-2 ml), ketamine (0.5 mg/kg-2 ml) or 2 ml serum physiologic. During operation heart rate, oxygen saturation, average mean blood pressures were recorded in every 5 min. Operation, anesthesia and the time that Alderete scores 9–10, patient satisfaction, analgesic requirements were recorded. Postoperatively nausea, vomiting, sedation, dysphagia, bleeding scores were recorded at 0, 10, 30, 60 min and 2, 4, 8, 12, 18, 24 h postoperatively. Pain was evaluated using modified Children's Hospital of Eastern Ontario Pain Scale (mCHEOPS) at fixed intervals after the procedure (15 min and 1, 4, 12, 16, and 24 h postoperatively).

Results

The recordings of heart rate, mean arterial pressure, nausea, vomiting, sedation and bleeding scores were similar in all groups (p > 0.05). The mCHEOPS scores at 10 min, 30 min, 1 h, 8 h were significantly lower in both tramadol and ketamine group when compared with control (p < 0.05). Use of additional analgesia at 10 min and 18 h were higher in control group than ketamine, tramadol group (p < 0.05). Dysphagia scores were significantly lower for both ketamine and tramadol group when compared with control group (p < 0.05). mCHEOPS, additional analgesia, dysphagia, patient satisfaction scores were similar in tramadol, ketamine groups (p > 0.05).

Conclusions

Preincisional injection of ketamine and tramadol prior to tonsillectomy is safe, effective method and equivalent for post-tonsillectomy pain, patient satisfaction, postoperative nausea, vomiting, dysphagia.     

The incidence of mesothelioma has not decreased for the last twenty years in Southeast region of Anatolia

Background

Malignant pleural Mesothelioma (MPM) is a very rarely encountered tumor in the normal population.

Objectives

To investigate the variations in incidence of MPM in Southeast region of Turkey.

Methods

We retrospectively investigated the data of 161 MPM patients who were diagnosed from January 2000 to December 2009. The residential areas were determined according to asbestos exposure which plays a role in MPM etiology; previously reported as having asbestos (Region 1) and asbestos has not been determined previously (Region 2).

Results

One hundred nine (109) of the patients (67.7%) included from the Region 1 and 52 of them (32.3%) included from the Region 2. MPM incidence of the last decade was 3.9/100,000 person/year for the whole region. In Region 1, 2000–2004 incidences was 12.6/100,000 person/year and 2005–2009 incidences was 14.9/100,000 person/year. In Region 2, 2000–2004 incidences was 0.4/100,000 person/year and 2005–2009 incidences was 1.0/100,000 person/year. According to the recently conducted incidence studies in our region, MPM incidence increased in region 1 and decreased in region 2. The number of patients applying to our hospital has increased in the last three years.

Conclusion

This increase, in Region 1 may be associated with continuous use of asbestos.     

Reduction Mammaplasty Using the Free-Nipple-Graft Vertical Technique for Severe Breast Hypertrophy: Improved Outcomes with the Superior Dermaglandular Flap

Background  

Management of severe mammary hypertrophy is a challenge. The limitations of most dermal pedicle techniques include insufficient breast projection with severe hypertrophy. The authors have designed a free-nipple-graft vertical technique with a superior demaglandular flap to provide acceptable breast projection and an attractive, smooth breast contour for patients with severe hypertrophy and gigantomastia who are not suitable for pedicle breast reduction techniques.     

Tongue abscess with actinomycosis

Actinomycosis of the tongue is uncommon, but without proper treatment, it causes extensive tissue destruction. A mass that may mimic both benign and malignant neoplasms can be seen at clinical presentation and may mislead the diagnosis. Early diagnosis is critical but usually difficult with cultures or imaging. We report a patient who presented with a tumor-like deeply localized primary actinomycosis of the tongue with its magnetic resonance imaging findings.     

FIBROLAMELLAR HEPATOCELLULAR CARCINOMA WITH SKELETAL METASTASES

Skeletal metastases is relatively rare in hepatocellular carcinoma and accounts for 4-16% of extrahepatic metastases. The authors report a 13-year-old girl with fibrolamellar hepatocellular carcinoma, who rejected further systemic chemotherapy following hepatic lobectomy and experienced sternal and vertebral painful metastases nearly 5 years after the operation. The sternal metastatic lesion was removed surgically, whereas external irradiation was delivered to the lumbar vertebral lesion. The patient received no systemic treatment following metastases and died with widespread disease. Despite metastatic disease, the patient survived 6.5 years following the initial diagnosis.     

Rate of elongation provided by multiple subcutaneous pedicle rhomboid flaps-an experimental study in the rat inguinal skin

PURPOSE: To investigate the rate of elongation provided by multiple subcutaneous pedicle rhomboid flaps. MATERIALS AND METHODS: Lower extremities of 20 male Sprague-Dawley rats were strained and fixed on a table to provide a tension line over the inguinal area. Two rhomboid shaped adjacent flaps with subcutaneous pedicles were designed over the tension line. Each flap was 1cm long and the distance between two flaps was 0.5 cm. The total pre-operative length was 2.5 cm. Flaps were incised and freed from the stretched skin. Tension line over the inguinal area was relieved by relaxation incisions. The resulting defects were then closed by suturing the rhomboid flaps in V-Y advancement along the tension line and in Y-V advancement along the relaxation incisions. The final elongation was measured and the results were analysed statistically. RESULTS: All relaxation incisions were effective in relief of tension over the inguinal area and in lengthening the tension line. Pre-operative 2.5 cm lengths ranged between 5.7 and 6.3 cm post-operatively (mean +/- standard deviation = 5.99 +/- 17 cm). The mean difference between pre- and post-operative measurements was 3.49 cm (139.6% gain in length). The subcutaneous pedicle rhomboid flaps easily closed all defects generated by relaxation and elongation. Statistical analysis revealed that two adjacent subcutaneous pedicle rhomboid flaps were efficient to close the defects generated by the relaxation incisions that produced a 139% gain in length (P < 0.001). CONCLUSION: The results of this experimental study show that multiple subcutaneous pedicle rhomboid flaps promise to be a good alternate technique in the treatment of long contracture bands in terms of rate of elongation and simplicity.