Comparison of lornoxicam versus tramadol analgesia for transrectal prostate biopsy: a randomized prospective study.

INTRODUCTION: We compared the efficacy of lornoxicam and tramadol to provide analgesia and comfort during transrectal ultrasound-guided biopsy of the prostate (TRUSP) as a noninvasive method. MATERIALS AND METHODS: A total of 62 men undergoing TRUSP were enrolled in this study. Patients were randomized to three groups. Group 1 (n = 21) received 8 mg of lornoxicam, group 2 (n = 21) received 100 mg of tramadol, and group 3 (n = 20) received saline as a control. The drugs were given intramuscularly half an hour prior to the procedure. All patients were asked to indicate the level of pain experienced after the procedure by visual analog score (VAS), and the patient's comfort level was scored by a comfort score. Additionally, the patients were asked if they were willing to undergo a future TRUSP. RESULTS: The data obtained revealed that both experimental groups receiving lornoxicam and tramadol had lower VAS scores compared to the control group (3.4 and 2.4 vs. 6.4, respectively; P < 0.0001). There were also significant differences in VAS scores between group 1 and group 2 (P = 0.027). There was a significant difference in the comfort score between the drug groups and control (P > 0.0001) and between the lornoxicam and tramadol group (P < 0.05). Pain and discomfort were least in the tramadol group. The percentage of patients who would not consent to future TRUSP was lower in the drug groups compared to control (P < 0.0001). But there were not any differences between the drug groups. CONCLUSIONS: The use of lornoxicam or tramadol for pain relief in TRUSP is a practical, effective and comfortable method compared to the results of the control group. In addition, tramadol was found to be more effective than lornoxicam.

Investigation of the toxic effects of ropivacaine corneal endothelium by the impression cytological method.

OBJECTIVE: To investigate the toxic effects of ropivacaine on corneal endothelium by using the impression cytological method. METHODS: The study was performed between October and December 2004 in Dicle University Hospital, Diyarbakir, Turkey. Twenty-four eyes from 12 rats were used for the research. They were divided into 4 groups, each containing 3 different ropivacaine concentrations and a control. Immediately after enucleation, the corneas were excised and the endothelium was exposed to unpreserved ropivacaine 0.01, 0.1, or 1% and balanced salt solutions (BSS) as a control (6 corneas/group) for 20 minutes. The specimens were obtained by impression cytology method and stained with periodic acid shift. Then, they were examined under light microscope. RESULTS: Blurring at cell membrane borders, vacuolization at cell cytoplasm, hydropic degeneration and increase in toxic granulation were observed in the 1% ropivacaine group. Cytoplasmic hydropic degeneration was determined in the 0.1% ropivacaine group. Cell structures were normal and almost identical to the control group in the 0.01% ropivacaine group. CONCLUSION: In this study, 2 major conclusions were determined. The impression cytology method can be used in examination of corneal endothelium, and exposure of rat corneal endothelium to 0.01% ropivacaine solutions in vitro appears to be non-toxic.

The effects of systemically administered methylprednisolone and recombinant human erythropoietin after acute spinal cord compressive injury in rats.

The study design was to decrease the damage of spinal cord on the experimentally induced acute spinal cord injury in rats. The objective of this study was to evaluate whether recombinant human erythropoietin (rHu-EPO) and methylprednisolone (MPSS) improve neurological function and histopathological changes if systemically administered after traumatic spinal cord injury. This study included 48 rats that underwent experimental SCI. Forty-eight animals were randomly divided into six groups. Animals constituted a moderate compression of 0.6 N that was produced by application of an aneurysm clip at level T3 for 1 min. rHu-EPO (1,000 and 3,000 U (Unit) per kg of body weight i.p.) and MPSS (30 mg/kg) were administered 5 min after injury, and control group was saline treated. (1) Control group (n=8), (2) MPSS group (n=8), (3) rHu-EPO 1,000 U group (n=8), (4) MPSS + rHu-EPO 1,000 U group (n=8), (5) rHu-EPO 3,000 U group (n=8), and (6) MPSS + rHu-EPO 3,000 U group (n=8). The neurological function and histopathology were evaluated at 24 and 72 h. According to the neurological functional test scores significant improvements between the control group and the other groups that had taken medical treatment were observed (P<0.001). Histopathologically severe ischemic findings were observed in the control group. A significant decrease in ischemic damage was detected in MPSS + rHu-EPO 3,000 U group (P<0.001). The most significant neurological functional and histopathological improvements were observed after systemical administration of MPSS + rHu-EPO 3,000 U and rHu-EPO 3,000 U. Furthermore, the MPSS + rHu-EPO 3,000 U group provides the most improved neurological functional and histopathological recovery.

Surgical technique and postoperative complications in congenital cataract surgery.

BACKGROUND: We evaluated cases that underwent congenital cataract surgery in terms of the surgical technique, post-operative complications, and visual prognosis. MATERIAL/METHODS: We retrospectively evaluated 132 eyes in 76 patients with congenital cataracts who underwent cataract surgery between January 1995 and December 2000. The patient age at surgery, surgical technique, post-operative complications, and final visual prognosis were evaluated. RESULTS: Thirty eyes underwent aspiration, posterior capsulotomy, and intraocular lens (IOL) implantation; 22 eyes underwent aspiration and posterior capsulotomy; 39 eyes underwent aspiration, posterior capsulotomy, and anterior vitrectomy; and 41 eyes underwent aspiration, posterior capsulotomy, anterior vitrectomy, and IOL implantation. The most frequent complications were secondary cataract (24.2%), posterior synechiae (9.1%), and glaucoma (3%). Groups were compared according to surgical technique and incidence of complications. Complications occurred most frequently with aspiration and posterior capsulotomy and occurred less frequently with aspiration, posterior capsulotomy, and anterior vitrectomy; these differences were statistically significant (p<0.05). The difference in the final visual prognosis was statistically significant in the aspiration, posterior capsulotomy, anterior vitrectomy, and IOL implantation groups as compared with the other groups (p<0.05). The mean follow up times was 15.5+/-1.78 months. CONCLUSIONS: The most frequent complication of congenital cataract surgery is secondary cataract formation. Today, posterior capsulotomy with anterior vitrectomy is the preferred method for decreasing the incidence of this complication.

Clinical investigation: thyroid function test abnormalities in cardiac arrest associated with acute coronary syndrome.

INTRODUCTION: It is known that thyroid homeostasis is altered during the acute phase of cardiac arrest. However, it is not clear under what conditions, how and for how long these alterations occur. In the present study we examined thyroid function tests (TFTs) in the acute phase of cardiac arrest caused by acute coronary syndrome (ACS) and at the end of the first 2 months after the event. METHOD: Fifty patients with cardiac arrest induced by ACS and 31 patients with acute myocardial infarction (AMI) who did not require cardioversion or cardiopulmonary resuscitation were enrolled in the study, as were 40 healthy volunteers. The patients were divided into three groups based on duration of cardiac arrest (<5 min, 5-10 min and >10 min). Blood samples were collected for thyroid-stimulating hormone (TSH), tri-iodothyronine (T3), free T3, thyroxine (T4), free T4, troponin-I and creatine kinase-MB measurements. The blood samples for TFTs were taken at 72 hours and at 2 months after the acute event in the cardiac arrest and AMI groups, but only once in the control group. RESULTS: The T3 and free T3 levels at 72 hours in the cardiac arrest group were significantly lower than in both the AMI and control groups (P < 0.0001). On the other hand, there were no significant differences between T4, free T4 and TSH levels between the three groups (P > 0.05). At the 2-month evaluation, a dramatic improvement was observed in T3 and free T3 levels in the cardiac arrest group (P < 0.0001). In those patients whose cardiac arrest duration was in excess of 10 min, levels of T3, free T3, T4 and TSH were significantly lower than those in patients whose cardiac arrest duration was under 5 min (P < 0.001, P < 0.001, P < 0.005 and P < 0.05, respectively). CONCLUSION: TFTs are significantly altered in cardiac arrest induced by ACS. Changes in TFTs are even more pronounced in patients with longer periods of resuscitation. The changes in the surviving patients were characterized by euthyroid sick syndrome, and this improved by 2 months in those patients who did not progress into a vegetative state.

Comparison of the effects of remifentanil andalfentanil on cardiovascular response to nasotracheal intubation: A prospective, randomized, double-blind study.

BACKGROUND: Nasotracheal intubation is often necessary in patients undergoingelective or emergency maxillofacial surgery. Previous studies have suggested that the increase in blood pressure after nasotracheal intubation is significantly greater than the increase after orotracheal intubation. Many drugs, including narcotic analgesics, are effective in modifying cardiovascular responses to orotracheal intubation. OBJECTIVE: The effects of remifentanil and alfentanil on the cardiovascularresponses to nasotracheal intubation were compared in healthy patients scheduled to undergo surgery. METHODS: This prospective, randomized, double-blind study was conductedat the Department of Anesthesiology and Reanimation, Faculty of Medicine, Dicle University, Diyarbakir, Turkey. Patients aged 16 to 65 years scheduled to undergo elective maxillofacial surgery and who were American Society of Anesthesiologists status I or 11 were randomly assigned to receive remifentanil 1 µg/kg in 10 mL saline over 30 seconds followed by an infusion of 0.5 µg/kg · min, or alfentanil 10 µg/kg in 10 mL saline over 30 seconds followed by an infusion of saline. Anesthesia was then induced with propofol, cisatracurium, and 1% isoflurane with 66% nitrous oxide in oxygen. Heart rate (HR) and systolic and diastolic arterial pressures (SAP and DAP, respectively) were measured noninvasively at 2 minutes before general anesthesia induction (baseline); 2 minutes after induction; and 1, 3, and 5 minutes after nasotracheal intubation. Patients were monitored for cardiac changes using electrocardiography. RESULTS: Forty consecutive patients were enrolled in the study. Twenty patients (11 males, 9 females; mean [SD] age, 27.7 [12.6] years) received remifentanil, and 20 patients (12 males, 8 females; mean [SD] age, 31.5 [17.2] years) received alfentanil. Two minutes after anesthesia induction, mean (SD) arterial pressures decreased significantly from baseline in the remifentanil group (changes, 22 [8]/11 [6] mm Hg) and the alfentanil group (changes, 10 [9]/12 [8] mm Hg) (both, P < 0.05). Changes in SAP and DAP followed a similar pattern in both groups, but SAP was significantly lower in the remifentanil group compared with that in the alfentanil group throughout the study period (all, P < 0.05). After 1 minute of intubation, DAP was significantly lower in the remifentanil group compared with that in the alfentanil group (66 [9] mm Hg vs. 73 [20] mm Hg; P < 0.05). Compared with baseline, HR was decreased significantly in both groups throughout the study (all, P < 0.05). Except SAP in the alfentanil group, SAP, DAP, and HR were increased 1 minute after intubation compared with preintubation values. However, SAP, DAP, and HR remained significantly lower compared with baseline values throughout the study period in both groups (all, P < 0.05) except DAP at 1 minute after incubation in the alfentanil group. Five patients in the remifentanil group and 2 patients in the alfentanil group required treatment of hypotension. None of the patients in either group required treatment of bradycardia. CONCLUSIONS: In this study in healthy surgical patients aged 16 to 65 years, remifentanil 1 µg/kg given over 30 seconds, followed by a remifentanil infusion of 0.5 µg/kg · min, was similarly effective compared with alfentanil 10 µg/kg in attenuating the pressor response to nasotracheal intubation, but the incidence of hypotension in patients administered remifentanil was high.

Effects of intravitreal ropivacaine on retinal thickness and integrity in the guinea pig.

BACKGROUND: Retrobulbar anesthesia is widely used for ocular surgery.Ocular complications are possible when retrobulbar anesthesia is accidentally injected intravitreally. OBJECTIVE: The aim of this study was to determine the relative retinal toxicitiesof ropivacaine hydrochloride, a local anesthetic, using various concentrations in guinea pigs. METHODS: This randomized, investigator-masked, experimental study wasconducted at the Department of Anesthesiology, Dicle University, Diyarbakir, Turkey. The right eyes of 18 guinea pigs were assigned to 1 of 3 treatment groups: 1%, 0.75%, or 0.5% ropivacaine. The right eye of each animal was injected intravitreally with 0.1 mL of 1%, 0.75%, or 0.5% ropivacaine. The left eye of each animal was injected with a balanced saline solution (control). The guinea pigs were euthanized 7 days after injection, and the retinal structures were examined using light microscopy. The total thickness of each retina was measured using an ocular micrometer. RESULTS: No histologic abnormalities were observed in the control eyes.Retinal damage of most of the retinal section was seen in the eyes receiving study drug. The eyes injected with 0.5% ropivacaine had a generally intact appearance, with the exception of some atrophy and disorganization. Overall, the eyes injected with 1% ropivacaine had significantly more extensive retinal thinning compared with the eyes injected with 0.75% or 0.5% ropivacaine (both, P < 0.01). In the eyes injected with 0.75% or 1% ropivacaine, disorganization of the structure of the retinal layers and atrophy were noted on histopathology. The mean total thicknesses of the retina were significantly less in all ropivacaine-treated eyes compared with that in the controls (P < 0.001). CONCLUSIONS: In this small experimental study, ropivacaine had concentration-dependent toxic effects on guinea pig retinas.

Intraocular pressure and quality of blockade in peribulbar anesthesia using ropivacaine or lidocaine with adrenaline: a double-blind randomized study.

The aim of this study was to compare the effects of ropivacaine with those of lidocaine on the intraocular pressure (IOP) and the quality of the blockade in peribulbar anesthesia for cataract surgery. Fifty patients were allocated randomly into two groups and received 7-10 ml of 0.75% ropivacaine or 2% lidocaine with adrenaline, though the peribulbar two-point injection. The quality of the blockade was assessed by ocular and eyelid akinesia, pain during the peribulbar injection, and surgical satisfaction. The duration of the motor block was also evaluated after surgery. The IOP was measured using a Tonopen before the blockade (control) and at 1, 5, and 10 min after injection of the anesthetic. Lidocaine induced significantly lower akinesia scores at 6, 8, and 10 min post-injection than did ropivacaine. The mean IOP (mmHg) was significantly lower with respect to the baseline level at 10 min after blockade in the ropivacaine group compared with the lidocaine group. Ropivacaine also caused less pain on injection. There was no difference in surgical satisfaction between the groups. The duration of the motor block obtained with ropivacaine was longer than that obtained with lidocaine. Our data indicate that ropivacaine has efficacy similar to lidocaine, with slightly longer onset and duration of the motor blockade. In addition, ropivacaine (0.75%) induces lower IOP and less pain on injection than does lidocaine (2%) when used in peribulbar anesthesia for cataract surgery.

Preventive effects of intracisternal alphatochopherol on cerebral vasospasm in experimental subarachnoid haemorrhage.

Vasospasm is an important cause of morbidity and/or mortality with a subarachnoid haemorrhage (SAH). The roles of lipid peroxidation in a vasospasm caused by a SAH remain to be investigated. The effect of an intracisternal administration of alphatochopherol on a cerebral vasospasm was investigated in an experimental model. The authors assessed whether the administration of alphatochopherol reduced the vasospasm. By means of an intracisternal blood injection model, a SAH was induced in 30 rats, which were randomly divided into three groups, as follows: group I (G1), without a SAH and drug, group II (G2), a SAH alone, group III (G3), a SAH and alphatochopherol. Following the withdrawal of cerebrospinal fluid (CSF), a fresh unheparinized arterial blood was injected into the cisterna magna to induce a SAH. In G3, 20 U (0.4ml) alphatochopherol was intracisternally injected forty-five hours after induction of the SAH. All rats were sacrificed 72 hours after the induction. The basilar artery, with surrounding tissue, was removed from the cranium. The cross-sectional diameter of the lumen and vessel wall of the rat basilar artery was assessed from a planimetric analysis, and changes compared with G1 and G2. The reduction in the luminal cross-sectional diameter of the vessels exposed to subarachnoid blood was found to be 29.01 % (p=0.001). The group treated with alphatochopherol had a 9% reduction (p=0.004). The role of lipid peroxidation on a vasospasm caused by SAH is well known to be critical. Data from the present study indicated that antioxidant therapy, with topical alphatochopherol, may be promising on a vasospasm caused by a SAH.