The clinicopathological features and survival of Castleman disease: a multicenter Turkish study.

OBJECTIVE: In this study, we aimed to investigate the clinicopathological features and survival of CD, which is quite rare and has many unknowns. PATIENTS AND METHODS: This study was conducted by retrospectively evaluating patients diagnosed with CD in six different centers in Turkey. RESULTS: The median age of 33 patients included in the study was 49 and 51.5% (n = 17) of these patients were women. 18 (54.5%) patients were in the hyaline vascular subtype and most of the patients were UCD (n = 20, 60.6%). The most common involvement region was head and neck (n = 19, 57.5%). The UCD group was younger than the MCD group (p=0.027). Visceral lymph node involvement was higher in MCD than in UCD (p=0.001). Similarly, it was observed that there was more hepatomegaly (p=0.035) and splenomegaly (p=0.013) in the MCD group. During the median 19.5 months follow-up period, there were no patients who died. CONCLUSIONS: It was observed that UCD and MCD are different clinical entities. Promising survival times can be achieved with surgical and systemic treatments in both subtypes of this extremely rare disease. However, this result should be supported by well-designed prospective comprehensive studies.

Train-of-four guard-controlled sugammadex reversal in patients with multiple sclerosis.

OBJECTIVE: Multiple sclerosis (MS) is a chronic inflammatory and demyelinating autoimmune disease of the central nervous system. It is known that the disease, which is manifested by a wide variety of symptoms, may exacerbate after anesthesia and show different responses to muscle relaxants in the normal population. It is planned to measure train-of-four (TOF) values of MS patients to be operated under general anesthesia before sugammadex application. MATERIALS AND METHODS: With the approval of the local ethics committee of the University of Health Sciences Bagcilar Training and Research Hospital and with written consents of participants, we anesthetized ten patients (from April 2014 to March 2017) with MS and ten American Society of Anesthesiologists I-III patients without MS. Neuromuscular conduction was assessed by the acceleromyometric method using a TOF-Guard apparatus (Organon, Holland). The patients were extubated after recovery of TOF higher than 0.9. The primary efficacy variable was the time from the start of administration of sugammadex to recovery of the TOF ratio to 0.9. RESULTS: The demographic characteristics of both groups, the type and duration of surgery and anesthesia applied, and the temperature of the operation room were similar. Similar characteristics of both groups were of concern for postoperative residual paralysis, and therefore we did not notice any difference between time to TOF> 90/s for both groups. CONCLUSION: Sugammadex and TOF patients will increase patient safety in general anesthesia practice.

Postoperative pain management after inguinal hernia repair: lornoxicam versus tramadol.

BACKGROUND: In this randomized and prospective study, we compared the analgesic effects of lornoxicam and tramadol in patients after inguinal hernia repair. METHODS: A total of 160 patients were assigned in a randomized manner into two groups. Group L received 8 mg lornoxicam i.v. at the end of the operation, followed by 8 mg 12 h after the operation. Group T received 1 mg/kg tramadol at the end of the operation and every 6 h up to 24 h postoperatively. The visual analog scale (VAS) score was assessed at 0, 2, 4, 8, 12, and 24 h after surgery. RESULTS: All patients completed the study. All vital signs were within normal ranges. The mean VAS score in Group L and in Group T was 21.66 +/- 14.64 and 19.75 +/- 11.82, respectively. No significant differences were found between groups with respect to VAS score. Eight (10%) patients in Group T had nausea. CONCLUSION: Lornoxicam 8 mg i.v. and b.i.d., tramadol 1 mg/kg at the end of the surgery and every 6 h up to 24 h after inguinal hernia repair provided rapid and effective analgesia and was well tolerated.

Experimental study of the effect of different meshes on bacterial translocation.

Implantation of intraabdominal biomaterials promotes bacterial translocation (BT). In this study we planned to determine the effect of different types of mesh on the induction of BT. Swiss albino mice were divided into four groups: control, polypropylene (PP), polyglactin 910 (PG), and dura mater (DM). At hour 0, an abdominal wall defect was created in all animals. In the control group the defect was closed primarily. PP, PG, and DM meshes were used to repair the defects such that the intestines were in contact with the mesh in the remaining three groups. BT was evaluated 4, 24, and 48 hours later. At 4 hours total BT increased in the PP group compared with that in the control (p = 0.0321) and DM (p = 0.0098) groups. At 24 hours the PG group had increased BT compared with the controls (p = 0.0392) and the DM group (p = 0.0274), whereas the PP group had increased BT compared with the DM group only (p = 0.0477). At 48 hours both PG and PP groups had increased BT compared with controls (p = 0.0431 and p = 0.0001, respectively); the PP group had also increased BT compared to the DM group (p = 0.001) and the PG group (p = 0.017). In the control, DM, and PP groups there was no intragroup statistical difference. In the PG group there was a significant increase in BT at 24 hours compared to that at 4 hours (p = 0.0274). Prosthetic meshes led to increased BT compared to that with the DM mesh. This effect might be attributed to the different organic and physical properties of the meshes.