Incidence of thyroid malignancy among goitrous thyroid lesions from the Sarawak General Hospital 2000-2004.

INTRODUCTION: Thyroid cancer is the most common among all endocrine malignancies. The worldwide prevalence of goitre in the general population is estimated at 4-7 percent and the incidence of malignancy in goitrous thyroid is about ten percent. It is postulated that goitrous thyroid is a precursor lesion to the development of malignant thyroid diseases. As Sarawak is a state well known for endemic goitre, this study focused on establishing the incidence of thyroid malignancy among goitrous thyroid swellings. METHODS: This study was a hospital-based retrospective study on the archived collection of the surgically-removed thyroid specimens from the Sarawak General Hospital, Malaysia. Cases were grouped into cancer and non-cancer groups. The cancer group included papillary thyroid carcinoma (PTC), PTC follicular variant, follicular carcinoma and anaplastic carcinoma (ANA). RESULTS: A total of 820 thyroid cases which underwent surgical removal in years 2000 to 2004 were collected. Of these, 143 (17.4 percent) were male and 677 (82.6 percent) female. It was observed that the highest prevalence of thyroid swelling cases occurred in the age group 41-60 years while the lowest prevalence occurred in the age group under 21 years, 371 (45.2 percent) vs. 31 (3.8 percent). By ethnicity, the Ibans and Malays were found to have a higher prevalence at 275 (33.5 percent) and 196 (23.9 percent), respectively, while the lowest prevalence was observed in Indians, 11 (1.3 percent). 55 cases (6.7 percent) were found to be cancerous and the rest (93.3 percent) were non-cancerous thyroid swellings. Histologically, the highest incidence of carcinoma was PTC (4.0 percent) and the lowest was ANA (0.2 percent). CONCLUSION: Based on our observations, although goitrous thyroid swelling is quite a common problem in Sarawak, thyroid malignancy is not a major issue. Among thyroid malignancies, PTC is the most common histological type of malignancy.

Post-traumatic pericallosal artery aneurysm presenting with subdural haematoma without subarachnoid haemorrhage.

A 27-year-old patient presented with severe headache and seizures about a month after the initial head trauma. Computed tomography (CT) brain scan revealed acute subdural bleed continuous into the interhemispheric region, with no subarachnoid haemorrhage. This was due to rupture of a traumatic pericallosal artery aneurysm. This represents a rare case of traumatic pericallosal artery aneurysm presenting with subdural haematoma without subarachnoid haemorrhage.

Comparison of oral controlled-release morphine with transdermal fentanyl in terminal cancer pain.

BACKGROUND: Controlled-release morphine (MST) given twice daily provides a simpler and more convenient treatment regimen than 4-hourly opioid administration for the control of cancer pain. Recently, a new formulation of transdermal fentanyl (TDF) has been developed which provides a new route for the treatment of cancer pain. The present study was designed to compare the analgesic efficacy, safety and adverse effects of MST and TDF in the management of chronic cancer pain. METHODS: In this open, comparative and randomized study, patients were treated with oral morphine hydrochloride immediate-release (MHIR) in the stabilization phase and then the prescription was switched to MST or TDF for 14 days in the treatment phase. Oral MHIR was provided as rescue medication for breakthrough pain. Assessments of the pain intensity, pain frequency, degree of pain improvement, profile of mood states, quality of sleep, activity status and adverse effects were performed before and after the stabilization phase and before and after the treatment phase. RESULTS: Forty of 47 cancer patients completed the study with 20 patients in each group. There were significant (p < 0.05) improvements in pain intensity, pain frequency, mood states and quality of sleep in both groups before and after treatment, while improvement in the activity status was not significant. No specific adverse effects were encountered except for drowsiness which occurred in 6 patients treated with MST and 5 treated with TDF (p < 0.05). Insomnia was significantly improved (p < 0.05) with both regimens compared with that in the period before treatment. There were no significant differences between the two study groups in analgesic efficacy or adverse effects. CONCLUSIONS: These results suggest that TDF and MSt are safe and effective analgesics for the management of chronic cancer pain. However, TDF provides a simpler and more convenient treatment for those patients with severe nausea, vomiting or dysphagia.

[The effect of needleless electroacupuncture in general anesthesia during laparoscopic surgery].

BACKGROUND: Three kinds of pain-relieving substances, namely, endorphins, enkephalins and dynorphins, can be released by stimulating the relevant acupoints with the dense-disperse mode of nerve stimulator. The neurochemical mechanisms of pain relief by acupoint stimulation have been widely studied and proved. In the present study, we investigated the modulatory effect of needleless electroacupuncture on the inhaled general anesthesia during laparoscopic surgery. METHODS: Forty gynecologic patients of ASA class I-II status, scheduled for elective laparoscopic surgery, were randomly allocated to study and control groups. Induction and intubation were performed in the same fashion and anesthesia was maintained with inhaled general anesthetics: 50% N2O in oxygen and isoflurane, which was adjusted to keep the hemodynamic changes within +/- 10% of their preoperated level. HANS (LY 257), a special nerve stimulator with 2 Hz and 100 Hz dense-disperse wave, was used to stimulate the bilateral Yang Ling Chuan (G34), Zusanli (S36) acupoints in patients of the study group during the surgery. RESULTS: We found that needleless electroacupuncture significantly lowered the volume concentration of isoflurane from 1.0 +/- 0.33% to 0.74 +/- 0.19% (p < 0.05) at 30 min after the start of operation. Furthermore, it also significantly shortened the recovery time from 11.4 +/- 3.3 min to 8.8 +/- 3.2 min (p < 0.05). CONCLUSIONS: Under general anesthesia, the application of needleless electroacupuncture can reduce the volume concentration of isoflurane and shorten the post-anesthetic recovery time during laparoscopic surgery.

The effect of nifedipine on fentanyl-induced analgesia in rats.

We investigated the modulatory effect of subcutaneous administration of different doses of nifedipine (1.5 or 15 mg/kg), a calcium channel blocker, on fentanyl (15 micrograms/kg), an opioid mu-agonist, in rats. The drugs were tested individually as well as in combination. Normal saline and dimethyl sulfoxide were used as controls. Nociceptive sensitivity was assessed by tail-flick technique. No analgesic effect by nifedipine alone at any of the three doses was observed. A slight analgesic effect by fentanyl alone, lasting up to 60 minutes, was noted in the tail-flick responses only (p < 0.05). The combination of both drugs did not enhance or prolong the analgesic effect of fentanyl. The same results were obtained in a supplementary study using higher doses of fentanyl (30 micrograms/kg) with nifedipine (15 mg/kg). Our results suggested that, unlike other calcium channel blockers, nifedipine injected subcutaneously does not enhance fentanyl analgesia.

Enhancement of antinociceptive effect of fentanyl by KB-2796 at spinal level.

Opioids inhibit the voltage-dependent calcium channel conductance, which is one of the mechanisms of opioid analgesia on the opioid receptor. According to the hypothesis that calcium antagonists can potentiate the analgesic effect of opioids, we designed a study to investigate the effects of KB-2796, a new calcium channel blocker, on the antinociception of fentanyl at the level of the spinal cord in rats. PE-10 catheters were chronically implanted in the lumbar intrathecal space of the rats. Tail-flick test was used to assess the nociceptive sensitivity. Fentanyl (1 microgram) and KB-2796 (50, 150 or 250 micrograms) were tested individually as well as in combination. Dimethyl sulfoxide (10%) was used as a control. All drugs were injected intrathecally. Fentanyl alone produced a significant but short duration (15-30 minutes) of antinociception. KB-2796 by itself did not show any antinociception at any of the doses tested. However, when KB-2796 at the higher doses (150 and 250 micrograms) was administered with fentanyl, the antinociceptive effect was significantly (P < 0.05) enhanced over that of fentanyl alone from 30 to 180 minutes after the injection. In conclusion, our results suggest that KB-2796 potentiates the analgesic effect of fentanyl at the spinal level. These data also support our hypothesis that calcium channel blockers may involve in the antinociception of opioids.

The effects of KB-2796 and BAY K 8644 on fentanyl-induced analgesia in rats.

We investigate the modulatory effects of subcutaneous administration of different doses of KB-2796 (1, 5 and 15 mg/kg), a new calcium channel blocker, and BAY K 8644 (0.25, 0.5 and 1 mg/kg), a calcium agonist, on fentanyl-induced analgesia (20 micrograms/kg) in rats. The drugs were tested individually as well as in combination with fentanyl. Dimethyl sulfoxide (DMSO) was used as a control. Nociceptive sensitivity was assessed by the tail-flick technique. When KB-2796 and BAY K 8644 were used alone, only KB-2796 at the dose of 15 mg/kg produced an effect that was significantly different from that of DMSO (p < 0.01). The effect was antinociceptive. When administered with fentanyl, KB-2796 at 5 and 15 mg/kg potentiated the analgesic effect of fentanyl (p < 0.05), but suppression of fentanyl analgesia by BAY K 8644 was not significant at any of the doses tested. Our data supports the hypothesis that the calcium ion is partially involved in fentanyl-induced analgesia.

The effect of nifedipine and verapamil on nicotine-induced antinociception in rats.

We examined the modulatory effect of nifedipine (NIF, 0.04, 2, 5 and 15 mg/kg i.p.) and verapamil (VER, 2.5 and 10 mg/kg s.c.) on nicotine-induced antinociception in male rats, employing the tail-flick (TF) test. All rats were divided according to their responses to nicotine (1 mg/kg s.c.) alone, and classified as responders and nonresponders; both types were used. Both tested drugs were injected simultaneously with nicotine (NIC). In responders, NIC (1 mg/kg s.c.) alone produced a ceiling TF latency (15 sec) within 2.5 min lasting for 2.5 - 7.5 min. NIF, at the dose of 15 mg/kg i.p., prolonged this effect up to 40-50 min. Lower doses (5, 2 and 0.04 mg/kg) were not effective. VER in either dose did not prolong NIC-induced antinociception. In nonresponders, NIF also potentiated NIC-induced antinociception, and this effect appeared to be dose-related, lasting from 10 up to 40 min. VER was ineffective in either dose. These data support our hypothesis that calcium is involved, at least in part, in nicotine-induced antinociception. The potential risk for smoking patients treated with NIF is discussed.

[The distance from the skin to the epidural space in general population].

Epidural block is a common regional anesthetic technique in surgical procedures. The depth of the epidural space beneath the skin surface varies at different levels of the spinal column in the same patient. It also varies from patient to patient at the same vertebral level. We studied the distance from the skin to the different lumbar epidural space in general population to determine whether there is any systematic relationship between patient age, height, weight and the distance from the skin to the epidural space. Data were gathered from 159 patients (excluded all obstetric cases) having epidural anesthesia for surgical procedures. All blocks were performed using a midline approach with lateral and knee-chest position. They divided into 3 group according to different lumbar area: (1) Group A: L1-2 interspace, 33 cases; (2) Group B:L3-4 interspace, 54 cases; (3) Group C: L4-5 interspace, 72 cases. Data were analyzed by single linear regression and one-way ANOVA with p less than 0.05 considered statistically significant. The results revealed that: In Group A, there were relationship between patient age [r2 = 0.137, p less than 0.05], weight [r2 = 0.35, P less than 0.0003] and weight-height ratio.[r2 = 0.36, P less than 0.0002] with the distance from the skin to the epidural space (depth); but no relationship between body height.(ABSTRACT TRUNCATED AT 250 WORDS)