Intercostal nerve blockade versus thoracic epidural analgesia for post thoracotomy pain relief

Background Post thoractomy pain is a major source of concern in the postoperative period. The purpose of this study was to evaluate the effectiveness of intraoperative temporary intercostal nerve blockade versus thoracic epidural analgesia for control of post thoracotomy pain. Methods 40 patients undergoing elective pulmonary resection through a postero lateral thoractomy were randomly allocated to receive epidural analgesia using 0.25% bupivicaine (Group A, n=20) or temporary intercostal nerve blockade using 0.25% bupivicaine (Group B, n=20). Adequacy of analgesia was assessed over a period of 24 hours using a visual analogue score and an observer verbal ranking scale. Results Pain scores were similar in both the groups for the first 4 hours after surgery. Thereafter, the pain scores were significantly higher (p<0.05) in Group B as compared to Group A for the remainder of the observation period. There was significantly higher (p<0.01) usage, of nonsteroidal analgesic consumption in Group B. No neurological complications were encountered, in both the study groups. Conclusion We conclude that in the early postoperative period there is no significant difference in pain relief in both the techniques but there after, epidural analgesia significantly reduces post thoracotomy pain.     

Thoracic epidural infusions for post thoracotomy pain relief: a clinical study to compare the efficacy of fentanyl — bupivicaine mixtures versus fentanyl alone

Background: Optimum pain relief following thoracotomy is essential for patient comfort and to reduce the incidence of postoperative pulmonary complications. Methods: A randomized clinical trial was conducted on 90 patients scheduled for pulmonary resection. The patients were randomly divided into three groups. Group 1 received 0.125% bupivicaine with fentanyl 10μg.ml⁻¹, Group 2 received 0.25% bupivicaine with fentanyl 10μg.ml⁻¹ and Group 3 received only fentanyl 10μg.ml⁻¹ in a calculated dose as a continuous thoracic epidural infusion. Adequacy of anglesia was assessed at rest and during movement over 24 hours. Analgesic efficacy was assessed using a visual analogue score and an observer verbal ranking scale. Results: Pain scores were significantly higher in Group 3 during the assessment period. (p<0.01) as compared to the other groups. The use of intraoperative vasopressors was significantly higher (p<0.05) in Group 2 as compared to the other groups. No neurological complications were encountered in any of the study groups. Conclusion: We conclude that in the early postoperative period, the use of 0.125% bupivicaine improves fentanyl epidural analgesia in patients undergoing lung resection.     

Successful therapy with tetracycline and nicotinamide in cicatricial pemphigoid

We describe a case of cicatricial pemphigoid in a 92-year-old female with extensive mucocutaneous involvement. She developed extensive hemorrhagic blistering with severely bleeding lesions, that healed with scarring. The conjunctivae showed extensive synechia. The diagnosis was based on clinical and histopathological features as well as immunofluorescence findings and immunoblot analysis. There was no clinical response to topical corticosteroids. The patient was given tetracycline and nicotinamid and showed rapid improvement of the mucocutaneous lesions within a few weeks. The clinical features, differential diagnosis and various treatment modalities of cicatricial pemphigoid are briefly reviewed, whereby the use of tetracycline and nicotinamide is discussed as an alternative effective and safe therapy for this potentially incapacitating condition.     

Leserbrief Zum Beitrag von W. Harth und R. Linse: “Botulinophilie” Der Hautarzt (2001) 52:312–316

Ohne Zusammenfassung     

Botulinumtoxin: Vom Gift zum Medikament Ein historischer Rückblick

Botulinumtoxin (BTX) is a neurotoxin produced from Clostridium botulinum under anaerobic conditions and is responsible for botulism, a notifiable, bacterial form of food poisoning. The first case of botulism is believed to have occurred in 1735. An epidemic in Southern Germany in 1793 claimed the death of over the half of those patients who had become ill through eating uncooked blood sausages. The term "pharmakon" is Greek and implicates that a drug originates from poison (potion, remedy). Theophrastus Bombast von Hohenheim known as Paracelsus (1493/94-1541) first described this duality with his dictum "alle ding sind gift und nichts on gift; alein die dosis macht das ein ding kein gift ist" (only the dose makes a remedy poisonous). In Baden-Württemberg in 1817, the poet and physician Dr. Justinus Christian Kerner described the symptoms of botulism, so that at this time botulism was also called Kerner disease. Until the turn of the century the reason for poisoning was not known. Van Ermengem succeeded in isolating the anaerobic bacterium causing botulism, but the specific mechanism of BTX was only established after the second World War. In the late seventies the ophthalmologist Dr. Alan Scott used BTX the first time in the treatment of strabismus. The drug was then used in the treatment of several muscle spasticities such as, for example, torticollis or hemifacial spasm. Only recently BTX has been successfully used for focal hyperhidrosis. We review the history of botulinum toxin from its discovery in the nineteenth century and the research into its effect in the middle of the 20th century up to its clinical use at the present time.     

Fallbericht zur Therapie mit Granulozyten stimulierendem Faktor beim diabetischen Fu?

Der diabetische Fu? entsteht durch das Zusammenwirken mehrerer pathogenetischer Faktoren: Periphere Neuropathie, Vaskulopathie und erh?hte Infektanf?lligkeit. Ein entscheidender Faktor des erh?hten Infektrisikos beim zuckerkranken Patienten stellt ein Funktionsdefekt der neutrophilen Granulozyten dar. Dabei ist die neutrophile Chemotaxis sowie die oxidative Reaktion mit Bildung von bakteriziden und fungiziden Super- und Peroxiden vermindert. Der rekombinante humane Granulozyten-Kolonien stimulierende Faktor (G-CSF) f?rdert die Neubildung funktionsf?higer neutrophiler Granulozyten und deren Ausschüttung aus dem Knochenmark. Wir berichten über einen 78j?hrigen Patienten mit nicht-insulin-pflichtigem Diabetes mellitus Typ II und eitrig infizierten Ulzerationen im Bereiche der Gro?zehen. Der Patient zeigte sowohl eine generalisierte Arteriosklerose als auch eine Polyneuropathie mit trockenem Fu?, sensiblen Ausf?llen sowie als Ausdruck der motorischen Nervensch?digung die typische Fu?fehlstellung mit Krallenzehenbildung. Im Bereiche des Metatarsalek?pfchen plantar rechts fand sich ein Malum perforans. Trotz intensiv lokaltherapeutischen Ma?nahmen zeichnete sich nach 35 Behandlungstagen keine Besserung der Hautl?sionen ab. Unter Anwendung von insgesamt 165 Mio E G-CSF (Neupogen^?) subkutan über 11 Behandlungstage (15–30 Mio E/d, je nach Leukozytenzahl im peripheren Blut) appliziert in Kombination mit Ciprofloxacin (Ciproxin^?) 500 mg 2/d, peroral verabreicht, konnte in der Folge eine praktisch vollst?ndige Abheilung der L?sionen erzielt werden. Wir berichten erstmalig im deutschen Schrifttum über eine erfolgreiche Abheilung diabetischer Fu?ulzerationen unter Anwendung von G-CSF und stellen eine Kostenanalyse im Vergleich zu einer konservativen Therapie auf. G-CSF kann die Behandlungszeit des infizierten diabetischen Fu?es signifikant verkürzen und somit die Behandlungskosten senken. Es k?nnte somit in der Behandlung diabetischer Fu?ulzerationen eine Kosten-effektive Erg?nzung zur antimikrobiellen Therapie darstellen.