Evaluation of a local anaesthesia regimen using a subphrenic catheter after gynaecological laparoscopy

BACKGROUND AND OBJECTIVE: The purpose of intraperitoneal local anaesthetic administration is to block visceral nociceptive conduction and to provide an additional route of analgesia. The present study evaluates the effects of sequential injections of bupivacaine on postoperative pain through a subphrenic catheter. METHODS: In this double-blinded controlled study, patients scheduled for gynaecological laparoscopy were randomly divided into two groups. One group received 20 mL of saline with 1:200000 epinephrine through a subphrenic catheter before the incision closure and at 4-hourly intervals for the first postoperative 20 h. The second group received 20 mL of bupivacaine 0.125% with 1:200000 epinephrine at the same injection times. Postoperative pain scores and consumption of analgesics were compared. RESULTS: There were no statistical differences in pain scores at rest or incidence of shoulder pain between the two groups, but the patients of the bupivacaine group reported lower pain scores on coughing only in the first hour postoperatively (P = 0.007). Although the patients consumed comparable amounts of metamizole and ondansetron, the number of patients requiring supplemental meperidine and flurbiprofen in the bupivacaine group were significantly lower than in the saline group (P < 0.05). CONCLUSIONS: This study demonstrates that intraperitoneal bupivacaine may reduce pain on coughing in the early postoperative period and the consumption of analgesics postoperatively. The subphrenic catheter technique had no impact upon pain at rest and shoulder-tip pain after gynaecological laparoscopy.     

Validation of 2001 Partin tables in Turkey: a multicenter study

OBJECTIVE: Although Partin tables were developed in United States to predict the stage of prostate cancer preoperatively, they are used by many clinics throughout the world assuming that these figures apply to their population as well. However the predictive value of current Partin tables, which was updated in 2001, has not been validated in most of the countries as well as in Turkey. Therefore, we evaluated the validity of 2001 Partin tables, for the ability to predict the pathological stage in Turkish patients. PATIENTS AND METHODS: The clinical and pathological findings of 1043 patients who have had radical prostatectomy were assessed. Serum PSA values, clinical stage, biopsy Gleason score and the pathological features of the radical prostatectomy specimens were collected from each clinic and evaluated. The predictive value of Partin nomogram and pathological findings of prostatectomy specimens were compared and analyzed according to Receiver Operating Characteristics (ROC) analysis. RESULTS: Median age of the patients was 60 (45-74). In the presented study, percentage of patients with clinical stage T1c was 43%. Patients with Gleason score of 2-4 in biopsy constituted 23.4% of the study group. In the present study, the ratio of the patients with serum PSA higher than 10 ng/ml was 39.6%. Organ confined disease, seminal vesicle involvement, lymph node metastases ratios were 64.7%, 10.3%, 1.8% respectively. Area Under Curve (AUC) values for organ confined disease, seminal vesicle involvement and lymph node involvement were calculated as 0.665, 0.733 and 0.759 respectively. CONCLUSION: It appears that Partin tables have a reasonable predictive value for the final pathological features like organ confined disease, seminal vesicle and lymph node involvement in Turkish patients. This multicenter study showed that current Partin tables could also be used in Turkish patients with comparable accuracy.     

Can cystatin C be a better marker for the early detection of renal damage in primary hypertensive patients?

In this study, we aimed to compare Cystatin C (Cys C) with other traditional glomerular filtration rate (GFR) markers and to evaluate its superiority over them in detecting early renal involvement in patients with primary hypertension. Fifty-one primary hypertensive patients and 29 healthy control subjects, who were similar in terms of age and gender, were included in the study. In all subjects serum levels of Cys C, beta-2 microglobulin, serum creatinine (SCr), uric acid, BUN, albumin; 24 h urinary levels of protein (Upro), albumin (Ualb) and creatinine were measured. The GFR was calculated according to Creatinine Clearance (CrCl), Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulas. The MDRD was used as the reference method. A GFR<80 mL/min/1.73 m2 was considered as the lower cut-off limit. Mean levels of the serum parameters were found to be significantly higher in the patient group than they were in the control group (p<0.05). Mean CrCl, CG, and MDRD levels were lower in patients than they were in controls but the difference was statistically significant for CG and MDRD. The serum parameter having the best correlation with MDRD was SCr (r = -0.760) in patients and Cys C (r = -0.622) in controls. However, in ROC analysis; the area under curve (AUC) for Cys C was found to be superior (AUC = 0.900) to the other markers. The CrCl was the parameter having the worst diagnostic efficiency (AUC = 0.598). As a conclusion, compared to other traditional markers, measurement of Cys C may be a better parameter to estimate GFR, especially to detect mild reductions of GFR in primary hypertensive patients.     

Early malignant change in a solitary neurofibroma not associated with neurofibromatosis: a case report

A 31-year old woman presented with a mass on the posterolateral aspect of the lower third of the right leg. The mass had undergone fine needle aspiration biopsy previously at another center and was diagnosed as neurofibroma. The patient was evaluated to determine the existence of neurofibromatosis but no positive findings were obtained, thus the mass appeared to be a solitary, local neurofibroma. The mass was totally excised with the involved nerve fascicles. The histopathological evaluation showed foci of malignant transformation of the solitary neurofibroma. The patient was reoperated on, and the surrounding tissues were widely excised together with the tibial nerve; the defect was grafted with the sural nerve. Clear margins were achieved. No complications ocurred and the patient was satisfied. She survived and had neither recurrence nor metastasis during 2 years follow-up. This patient is presented as a case report of a malignant peripheral nerve sheath tumor, specifically the focal malignant degeneration of a solitary neurofibroma.     

Preoperative multimodal administration of morphine in arthroscopic surgery

Introduction The aim of the study was to demonstrate the possible effects of preoperative intra-articular, intravenous, or intrathecal administration of morphine on postoperative pain management.Materials and methods Sixty patients undergoing arthroscopic menisectomy were included. Spinal anesthesia was performed in the lateral decubitus position with 3 ml of 0.5% hyperbaric bupivacaine, and the patients were randomized into 4 groups. The IVM (intravenous, iv, morphine) group received 3 mg of iv morphine after completion of spinal anesthesia, the ITM (intrathecal morphine) group received 0.3 mg of morphine together with bupivacaine during spinal anesthesia, the IAM (intra-articular morphine) group received 3 mg intra-articular morphine diluted in 10 ml of saline after spinal anesthesia had been induced but 15 min before surgery, while the C (control) group did not receive any drugs in addition to spinal anesthesia. The sensory block level was determined 15 min after spinal anesthesia. Pain at rest (by visual analogue scale, VAS) and pain at 30° of flexion (by verbal rating scale, VRS) were evaluated during each of the first 2 h of the postoperative period and once every 4 h thereafter until 24 h. In each group; the number of patients in need of analgesics, the timing of the first analgesic intake (duration of analgesia), and the cumulative dose of analgesics were recorded.Results The mean duration of analgesia in the IAM group was significantly longer and the mean analgesic intake was significantly lower when compared with the other groups (p<0.05). The mean VAS value of the ITM group at the 4th postoperative hour was significantly lower than that of the other groups. Mean VAS values at 8 and 12 h and mean VRS values at 4 and 8 h were significantly lower in the ITM and IAM groups (p<0.05). The ITM group had the highest rates of nausea, vomiting, pruritus, and headache (p<0.05).Conclusion It was concluded that the preoperative administration of morphine, either intrathecally or intra-articularly, provides postoperative pain relief. Of these two, the intra-articular route seems to be superior in terms of fewer side-effects (nausea, vomiting, and pruritus), longer duration of analgesia, and reduction of total need for analgesics.     

Increased expression of epidermal growth factor receptors in the tracheal epithelia after topical mitomycin-C in rabbits

The aim is to examine histopathological changes and expression of epidermal growth factor receptor (EGFR) in tracheal epithelia caused by application of topical mitomycin-C (MMC) in rabbit model after the tracheotomy procedure. The conventional tracheotomy was performed in 16 rabbits. They were randomly divided into two equal groups. The first group was applied MMC at a concentration of 0.4 mg/ml around tracheotomy for 5 min, and the other group was not taken a treatment as a control. The animals were sacrificed at the end of 4 weeks. Their tracheas were evaluated with H&E and Masson's trichrome histochemically, and with antiepidermal growth factor receptor immunohistochemically. Results showed that there was no significant difference between MMC and control group for inflammatory cells (P=0.09). The numbers of fibroblasts and subepithelial tissue thickness in the group exposed to MMC were significantly lower than the control group (P<0.05). In contrast, the percentage of EGFR in the application of MMC group was significantly higher than the control group (P<0.05). The application of topical MMC on airway epithelia after tracheotomy showed significant elevation in the levels of epithelial EGFR expression compared to controls in a rabbit model. The activation of epithelial EGFR may facilitate epithelial healing, but further studies are needed to assess the effect of topical MMC on respiratory epithelia.     

Multiple sclerosis and Hashimoto thyroiditis: two cases

Multiple sclerosis (MS) occurs with immune-mediated mechanisms, but its pathogenesis is not accurately known. The coexistence of MS with other autoimmune diseases has been reported. The hypothesis that MS coexists with other autoimmune diseases has been supported by the reported association of MS with type I diabetes mellitus and inflammatory disorders. Even though there have been only rare reports of associations between Hashimoto thyroiditis and MS, this association is important for its clinical and therapeutic aspects. Proximal muscle weakness, myalgia, and fatigue are symptoms that are common in both MS and hypothyroidism. When MS patients demonstrate these symptoms, thyroid function tests should be performed. The thyroid hormone levels of MS patients being treated with interferon-beta and Campath-1H also should be monitored. The authors report the clinical data of 2 definite MS patients who also fulfilled criteria for Hashimoto thyroiditis.     

Vulnerable plaque: Definition,detection, treatment,and future implications

Atherosclerosis continues to account for significant morbidity and mortality in most of the world. The major proportion of atherosclerosis mortality is related to atherosclerotic coronary artery disease, yet there still is not an optimal method for making the diagnosis of vulnerable plaque in vivo. The search for such an undefined method, along with studies on amelioration of currently available technology, gains special significance when the association between the qualitative definition of lesions in an individual and cardiovascular risks are considered. We, therefore, start by defining the critical lesion of coronary atherosclerosis and review the advantages and potential for clinical use of various methods to detect the vulnerable plaque and comment on possible future implications in this field.     

Immunohistochemical evaluation of p53 expression and proliferative activity in children with Helicobacter pylori associated gastritis

OBJECTIVES: The aim of this study was to evaluate the significance of p53 expression and proliferative activity of glandular epithelium and intestinal metaplasia in Helicobacter pylori associated gastritis of pediatric patients. METHODS: The study included endoscopic gastric biopsies of 54 children with dyspeptic complaints. Immunohistochemistry was performed for evaluation of p53 expression and Ki-67 labeling index, an indicator of proliferative activity. Grading of H. pylori density, intestinal metaplasia and inflammatory cell infiltration were performed in histologic tissue sections stained with hematoxylin-eosin, Giemsa and Alcian-blue. RESULTS: Of 54 children, 35 (64%) were infected by H. pylori. Positive immunostaining for p53 was observed in 11 of 54 cases (20.4%). H. pylori infection was found in 10 (91%) of the p53-positive patients. There was a positive correlation between H. pylori density and Ki-67 labeling index in H. pylori infected children. H. pylori density, Ki-67 labeling index and inflammatory cell infiltration in the p53-positive group were significantly higher than in the p53-negative group. Although intestinal metaplasia was more common in H. pylori infected children (n = 11; 31.4%), there was no difference in the rate of intestinal metaplasia between the p53-positive and p53-negative groups. CONCLUSIONS: The present study shows that p53 mutations and higher proliferative activity of glandular epithelium may be related to H. pylori associated gastritis in children. Because p53 mutation does not appear to be associated with intestinal metaplasia, a precursor for gastric cancer in adults, we think that H.pylori associated p53 alterations do not initiate and promote gastric cancer that may occur in adulthood.