The effect of the menstrual cycle on the optic nerve head analysis of migrainous women

PURPOSE: To determine the effect of the menstrual cycle on the optic nerve head topographic analysis of normally menstruating migrainous women. MATERIAL AND METHODS: Randomly selected one eye of 44 migrainous and 49 healthy control women with regular menstrual cycles were included in the study. All subjects underwent complete ocular examination. Optic nervehead topographic analysis were performed using a confocal scanning laser ophthalmoscope, HRT II (Heidelberg Retinal Tomograph II, software version 1.6;Heidelberg Engineering, Heidelberg, Germany). They were repeated for two times during the menstrual cycle: in follicular phase (7th to 10th day of the cycle) and in the luteal phase (days 3 to 4 before the menstrual bleeding). Serum estradiol, progesterone, and luteinizing hormone measurements were repeated at each menstrual phase. Results: The mean age of migrainous and control subjects were 31.5 + 5.1 years and 33.4 +/- 3.7 years, respectively (P > 0.05). Their mean disc areas were 2.26 +/- 0.46 mm(2) and 1.95 +/- 0.39 mm(2), respectively(P < 0.05). Control subjects did not demonstrate any difference in the disc topography (P > 0.05). The parameter rim volume decreased, while the parameters cup volume and cup shape measure increased significantly in the luteal phase of the migrainous women (all P values <0.05). Mean intraocular pressure of the migrainous women decreased significantly in luteal phase (P < 0.05). CONCLUSION: Significant differences exist in the optic rim and cup parameters during the menstrual cycle of the migrainous women. Further clinical trials on ocular blood flow changes during the menstrual cycle of the migrainous women may highlight the role of sex steroids in the optic nerve head of the migrainous women.     

Total intravenous anesthesia versus single breath technique and anesthesia maintenance with sevoflurane for bariatric operations

Background: The choice of anesthetic technique for general anesthesia in morbidly obese patients remains controversial. We aimed to compare blood gases, recovery and hemodynamic parameters using TIVA and sevoflurane anesthesia in bariatric surgery. Methods: The study was performed with permission of the ethics committee.We studied 40 morbidly obese patients allocated to 2 groups. The total I.V. anesthesia (TIVA) group was named Group T, and the sevoflurane group was named Group S. In Group T, anesthesia induction was achieved with propofol. In Group S, anesthesia induction was achieved by sevoflurane with single breath technique, with maintenance provided with 1-2% volume sevoflurane. Student t, Chi square and ANOVA tests were used for data analysis; p-value <0.05 was considered statistically significant. Results: There was no significant difference between the 2 groups in demographic data, blood gas values and recovery characteristic. Hemodynamic values were significantly lower in Group T than Group S, during and after the operative period. Conclusion: While sevoflurane induction and maintenance is a suitable anesthetic modality for obese patients, TIVA can be applied easily in those patients possessing no extra risk factors other than morbid obesity.     

Systemic Inflammatory Response after Laparoscopic and Open Application of Adjustable Banding for Morbidly Obese Patients

Background: Surgical injury induces a systemic inflammatory metabolic-endocrine response that is proportional to the severity of the surgical stress. Compared with the conventional open method, laparoscopic surgery is mini-invasive and has decreased postoperative pain and length of hospitalization. The aim of this study was to investigate the systemic inflammatory response, after laparoscopic and open stoma-adjustable silicone band application, which is thought to be mediated by cytokines. Method: 30 morbidly obese patients underwent Swedish adjustable gastric banding (SAGB). 15 patients underwent laparoscopic (group 1) and 15 open SAGB (group 2). Mean operative time for the laparoscopic group was 70-110 min and for the laparotomy group 80-120 min. Gallbladders were not removed,and there were no systemic diseases in the patients.The intensity of surgical trauma was evaluated by measurement of metabolic and hormonal responses to the surgery. Plasma levels of C-reactive (CRP), haptoglobin, ceruloplasmin, albumin, transferrin, IL-6, malonic dialdehyde (MDA) and creatinine were measured before and after the operation. Results: CRP and IL-6 levels increased during and after laparoscopic and open SAGB. However, postoperative responses were significantly greater after open SAGB (group 2) (p<0.05). MDA level, an indicator of an oxidative trauma, was elevated in group 1 at the 6th postoperative hour but was significantly higher in group 2 at the 6th and 12th postoperative hours. The results were more significant in group 2 (p<0.05).There was no statistical difference between groups 1 and 2 in terms of albumin, creatinine, and transferrin levels before and after surgery. Conclusion: The systemic inflammatory res ponses after laparoscopic SAGB were significantly reduced compared with those after open SAGB.     

Laparoscopic repair of congenital diaphragmatic hernias

Diaphragm rupture is an infrequently encountered but well-documented injury in the multiply injured patient. Only a few cases in which minimally invasive techniques were used for repair have been reported thus far. Herein we describe the repair of a diaphragm rupture in a 36-year-old man who was injured in a motor vehicle accident. In a 10-year review of the literature, we were able to locate seven journal articles reporting 10 patients. We conclude that in appropriate stable patients with diaphragm rupture, minimally invasive techniques offer a reasonable alternative to open laparotomy or thoracotomy.     

External and endoscopic dacryocystorhinostomy in chronic dacryocystitis: comparison of results

To compare external and endoscopic dacryocystorhinostomy outcomes in patients with chronic dacryocystitis, a total of 103 patients with the complaint of epiphora and diagnosed as chronic dacryocystitis were included in the study. We performed external dacryocystorhinostomy on 55 patients under local anesthesia and endoscopic dacryocystorhinostomy on 48 patients under general anesthesia by means of drill and placed silicon stents to all the patients. The patients were examined endoscopically, at postoperative intervals of 1 week, first month, third month, sixth month and the first year. The patency of the tubes and nasolacrimal ducts were evaluated by irrigation and complaints of the patients were noted. Silicon stents were harvested at the sixth week postoperatively. Outcomes were classified as successful when epiphora diminished, no recurrent infection was noted and minimal or no reflux from the canaliculis during or after lacrimal irrigation was seen. A prospective endoscopic surgery group was compared to a prospective control group (external dacryocystorhinostomy). Full success was achieved in 69.9% of the patients with external dacryocystorhinostomy group whereas the full success rate of endoscopic dacryocystorhinostomy was 89.7%. Recently popularized endoscopic dacryocystorhinostomy is a safe and reliable procedure with high success rates.     

Co-expression of cyclooxygenase-2 and vascular endothelial growth factor in inflamed human pulp: an immunohistochemical study

Recent data from the medical literature indicates that cyclooxygenase-2 (COX-2) plays a key role in the production of vascular endothelial growth factor (VEGF), a glycoprotein that has the ability to increase the permeability of blood vessels and to induce angiogenesis. This study was undertaken to investigate the immunohistological co-expression of COX-2 and VEGF in inflamed human pulp, in conjunction with the expression of CD34, a transmembrane glycoprotein expressed in endothelial cells. Pulp tissue of extracted carious human third molars with a recent history of spontaneous pain were collected and processed for immunostaining of COX-2, VEGF, and CD34 using the biotin-streptoavidin method. Healthy pulp samples served as controls. COX-2 expression was not observed in healthy pulps, whereas all inflamed pulps demonstrated COX-2-expressing cells. Similarly, VEGF was not expressed in normal pulp tissue, but was strongly positive in inflamed pulps. CD34 was expressed in the endothelium of both normal and inflamed pulp tissues. Co-expression of COX-2 and VEGF in all consecutive sections of inflamed pulps could be suggestive of a possible release of VEGF via a COX-2-dependent pathway.     

Ureterovesical junction obstruction causes increment in smooth muscle contractility,and cholinergic and adrenergic activity in distal ureter of rabbits

Background/Purpose

The controversy in management of primary obstructed megaureter necessitates further elucidation of the underlying pathophysiology. We evaluated smooth muscle contractility, and cholinergic, adrenergic and serotonergic activity of rabbit distal ureters after ureterovesical junction (UVJ) obstruction.

Methods

Sham (SH) operation, partial obstruction (PO) and complete obstruction (CO) of the right UVJ were performed in rabbits. Three weeks later, distal ureters were isolated; spontaneous contractions (SC), contractile responses to electrical field stimulation (EFS), high KCl, carbachol, phenylephrine and serotonin were recorded.

Results

SC amplitudes increased in CO compared to PO and SH (p < 0.001). SC frequency was higher in CO (p < 0.05). EFS-induced contraction amplitudes were greater in CO than other groups (p < 0.05). High KCl-induced contractions were greater in CO (p < 0.001) and PO (p < 0.01). Carbachol-induced contractility was enhanced in CO and PO (p < 0.05). Contractile response to phenylephrine was greater in CO than other groups (p < 0.05). Serotonin induced contractile responses in CO and PO, greater in CO (p < 0.05). UVJ obstruction also increased spontaneous contractility in contralateral PO and CO ureters.

Conclusions

UVJ obstruction increased spontaneous and neurotransmitter-induced contractions in an obstruction grade-dependent manner. Obstruction also altered contractility of the contralateral ureters. Our findings may serve to provide further understanding of the pathophysiology of megaureter.