The effectiveness of erector spinae plane block in patients with chronic low back pain.

OBJECTIVE: The erector spinae plane block (ESPB) has been widely used as a treatment strategy for a variety of acute and chronic painful conditions. The purpose of this study was to determine the analgesic efficacy of ESPB in patients with chronic low back pain and radicular symptoms who had lumbar disc herniation. PATIENTS AND METHODS: Patients aged 18 to 80 years who had chronic low back pain with radicular symptoms associated with pain from lumbar disc herniation and had undergone ESPB were included in the study retrospectively. As part of a routine clinical procedure, the patient's age, gender, weight, height, body mass index, injection site, level of the injection, disc herniation level and visual analog scale score, Oswestry Disability Index, and five-point patient satisfaction questionnaire were recorded before and following the procedure. RESULTS: A total of 96 patients were included in this study. The mean age was 52.28±14.12 and 55 (57.3%) of the patients were female. The mean visual analog scale value and Oswestry Disability Index score were significantly decreased consecutively after the procedure (p<0.05). The mean patient satisfaction questionnaire score increased gradually compared to the baseline scores (p<0.05). CONCLUSIONS: Our results suggest that ESPB is an effective strategy to reduce the intensity of chronic low back pain with radicular symptoms in patients with lumbar disc herniation.

Effect of prenatal temperature conditioning of laying hen embryos: Hatching, live performance and response to heat and cold stress during laying period.

This study was designed to determine the effect of prenatal temperature conditioning on hatching and live performance of laying chickens, and response to heat and cold stress during laying period. A total of 3600 eggs obtained from ATAK-S brown parent stock were incubated at control (37.5°C, CONT-Inc), cyclic low (36.5°C/6h/d from 10 to 18d of incubation, LOW-Inc) or high (38.5°C/6h/d from 10-18d of incubation, HIGH-Inc) incubation temperatures. Hatched chicks per incubation temperature were reared under standard rearing conditions up to 26wk. From 27 to 30wk, hens from each incubation temperature were divided into 3 environmentally controlled rooms and reared at control (20±2°C, CONT-Room), low (12±2°C, COLDS) or high (32±2°C, HEATS) temperatures. Hatching performance, body weight, egg production, and plasma triiodothyronine (T3) and thyroxine (T4) levels and oxidant and antioxidant activities were evaluated. The highest hatchability was for LOW-Inc chicks while HIGH-Inc chick had similar hatchability to CONT-Inc. There was no effect of incubation temperatures on plasma MDA, GSH-Px, activities and T4 concentrations on day of hatch. LOW- Inc chicks had higher SOD activities and T3 concentrations compared to the other groups. Although chick weight was similar among incubation temperature groups, CONT-Inc chicks were heavier than those cyclic incubation temperature groups until 12wk of age. Incubation temperature had no effect on sexual maturity age and weight and egg production of laying hens. From 27 to 30wk, regardless of incubation temperature, HEATS hens lost weight from day 0 to 10, had the highest cloacal temperatures and lowest feed consumption and egg production while COLDS hens had the lowest cloacal temperatures. At day 5, T4 level was higher in LOW-Inc hens at COLDS but it was higher in HIGH-Inc hens at HEATS compared to CONT-Inc. These data may suggest a modification in thyroid activity of hens that were conditioned during the incubation period. Moreover under COLDS condition, SOD production of LOW-Inc hens was higher than those of CONT- and HIGH-Inc hens indicating an induction in antioxidant enzyme activity. Nonetheless, prenatal temperature conditioning of laying hen embryos had no advantage on laying performance of hens under temperature stress conditions.

Bolus fluorouracil induced syncope and pulseless ventricular tachycardia: a case report.

5-fluorouracil is an anti-cancer drug commonly used in oncology practice. Typical side effects are myelosupression, nausea, vomiting, diarrhea and stomatitis. Cardiotoxicity is the other toxicity. Cardiac side effects are ST segment changes, rhythm abnormalities, supraventricular and ventricular dysrhytmias. Pulseless ventricular tachycardia and ventricular fibrillation releated with bolus fluorouracil were not detected in the literature. Here we discussed a 46 year-old male patient that has no known cardiac history. After bolus fluorouracil administration, syncope and pulseless ventricular tachycardia developed in this patient. There are a few explanations about the cardiotoxicity of fluorouracil. One of these is the effect on nitric oxide. It causes a reduction in the levels of endothelial NO and this leads coronary vasospasm. Another explanation is protein kinase C mediated vasospasm. In animal studies toxic myocarditis like lesions were detected with fluorouracil infusions. Finally both myocardit and vasospasm may lead cardiac problems like sudden cardiac deaths. Bolus 5-fluorouracil is as cardiotoxic as 5-fluorouracil infusion and we must be careful about the arrhytmia after the bolus administration.

Age-related diseases; degenerative aortic valve disease and osteoarthritis.

OBJECTIVE: To examine the relationship between degenerative aortic valve disease and osteoarthritis Background: Degenerative aortic valve disease (DAVD) and osteoarthritis (OA) are age-related degenerative diseases whose pathogenesis involves mechanical stress and local inflammation. METHODS: Forty-four patients with DAVD (Group 1) and 21 controls (Group 2) were included in this study, which was intended to investigate the similarity between the two conditions. The two groups were similar in terms of age, sex, body mass index, a history of hypertension, cholesterol levels, diabetes mellitus and cigarette consumption. RESULTS: The average age + standard deviation of the DAVD patients were 71.3 +/- 7.5, compared to 67.5 +/- 10.6 in the control group. In radiological OA analysis, the Lane scale was employed in the lumbar region and the Kellgren-Lawrence scale in the knee joint. Comparison of Groups 1 and 2 revealed no difference in radiological OA in the lumbar region and knee joint. CONCLUSION: Our study has shown that there is no relationship between these diseases that increased with age. However, extensive studies examining pathogenic mechanisms are needed (Tab. 2, Ref. 11).

Effect of low-dose metoprolol in combination with sibutramine therapy in normotensive obese patients: a randomized controlled study.

OBJECTIVE: Sibutramine is an effective appetite suppresser agent, but treatment is often complicated with side effects, including palpitations and hypertension. In this study, we aimed to assess the effect of low-dose cardio-selective beta blocker combination with sibutramine treatment. METHODS: In total, 57 obese subjects were enrolled in the study and separated into two groups in order to receive sibutramine 10 mg/day plus placebo (group P) or sibutramine 10 mg/day plus metoprolol 25 mg/day (group M). Patients were evaluated in the beginning and at the end of the third month with anthropometric measurements, biochemical analysis, peripheral insulin resistance, and ambulatory 24 h blood pressure monitoring. Side effects were evaluated with a visual analog scale. RESULTS: During the study period, the drop-out rate was significantly higher in group P compared with group M (55 and 21%, respectively, P=0.014). Palpitations and headache were prominent symptoms in group P. Diastolic blood pressure (78.6+/-11.6 and 70.6+/-4.8 mmHg, respectively, P=0.013) and mean heart rate (84.3+/-6.1 and 75.8+/-8.4 beats/min, respectively, P=0.003) were significantly higher in group P compared with group M at the end of the third month. Weight loss was similar between the two groups (100.9+/-11.5 to 91.8+/-12.8 kg for group P, P<0.0001 and 97.9+/-13.2 to 88.9+/-13.8 kg for group M, P<0.0001). We did not find any deleterious effect of metoprolol on metabolic parameters. CONCLUSION: Addition of low-dose metoprolol to sibutramine therapy increased patient compliance to the treatment, and decreased the frequency and severity of side effects including hypertension and palpitations, without decreasing the drug efficacy or causing significant deleterious changes in metabolic parameters.

C-Reactive protein as a risk factor for left ventricular thrombus in patients with acute myocardial infarction.

BACKGROUND: Elevated C-reactive protein (CRP) has been found to correlate with higher risk for cardiac events in patients with acute myocardial infarction (AMI). It has been suggested that CRP may be involved in initiation process of coagulation; however, the role of CRP level in the formation of left ventricular (LV) thrombus has not been studied. HYPOTHESIS: This study investigated whether CRP is a risk factor for LV thrombus in patients with AMI. METHODS: Clinical, echocardiographic, and biochemical data were analyzed in 141 consecutive patients (aged 57 +/- 13 years; 33 women) with first anterior AMI. Two-dimensional and Doppler echocardiographic examinations were performed on Days 1, 3, 7, 15, and 30. Blood samples were obtained every day during hospitalization. Serum CRP concentrations were measured by an ultrasensitive immunonephelometry method. RESULTS: Left ventricular thrombus was detected in 33 (23.4%) patients. Univariate analysis showed that patients with LV thrombus had a higher peak creatine kinase (CK) level (2,879 +/- 742 vs. 1,693 +/- 1,210 I/U, p = 0.001), higher peak CRP level (14.9 +/- 7.1 vs. 9.2 +/- 6.8 mg/dl, p = 0.001), higher wall motion score index (1.8 +/- 0.2 vs. 1.5 +/- 0.3, p = 0.002), higher apical wall motion score index (2.35 +/- 0.72 vs. 2.07 +/- 0.70, p = 0.001), larger end-diastolic volume (145.2 +/- 43.7 vs. 116.5 +/- 44.2 ml, p = 0.002), larger end-systolic volume (85.4 +/- 37.2 vs. 62.9 +/- 31.6 ml, p = 0.003), and lower ejection fraction (42.1 +/- 12 vs. 47.3 +/- 13, p = 0.04). In multivariate analyses, only peak CK level (p = 0.0001), LV apical wall motion score index (p = 0.001), and CRP levels (p = 0.001) were independent predictors of LV thrombus formation. CONCLUSIONS: These results suggest that CRP is a risk factor for LV thrombus in patients with AMI.

Echocardiographic evaluation in patients with hypogonadotropic hypogonadism.

OBJECTIVE: To assess cardiac function in patients with hypogonadotropic hypogonadism. STUDY DESIGN: We studied heart structure and left ventricular systolic and diastolic function by echocardiography in 38 patients with hypogonadotropic hypogonadism (34 men and 4 women, mean age 24 +/- 4 years) and in 30 healthy subjects (25 men and 5 women, mean age 22 +/- 3 years). Left ventricular end-diastolic diameter, end-systolic diameter, left ventricular septal wall thickness, posterior wall thickness and ejection fractions were measured by M-mode echocardiography. Parameters of mitral flow were measured by pulsed wave Doppler echocardiography. RESULTS: Between patients with and without hypogonadotropic hypogonadism, there were no significant differences in echocardiographic measurements. CONCLUSION: Cardiac function is normal in patients with hypogonadotropic hypogonadism.

Factor V Leiden and its relation to left ventricular thrombus in acute myocardial infarction.

OBJECTIVE: The genetic defect of coagulation factor V, known as factor V Leiden, produces a resistance to degradation by activated protein C (APC) and increases the risk of venous thrombosis. However, the role of factor V Leiden in the formation of left ventricular (LV) thrombus has not been studied. We investigated whether factor V Leiden is a risk factor for LV thrombus in patients with acute myocardial infarction (AMI). METHODS AND RESULTS: We have analyzed clinical, echocardiographic and biochemical data in 135 consecutive patients (aged 58 +/- 13 years; 31 women) with first anterior AMI. Two-dimensional echocardiographic examination was performed on days 1, 3, 7, 15 and 30; LV thrombus was detected in 33 (24.4%) of 135 patients with AMI. The study also included 95 control subjects. Healthy age and sex-matched subjects without a personal or family history of ischaemic heart disease, stroke or thromboembolic disease served as a control group. Blood samples from the patients and controls were analyzed for the factor V Leiden mutation by DNA analysis, using the polymerase chain reaction. In addition, concentrations of fibrinogen, von Willebrand factor (vWF), tissue plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1) and D-dimer were measured in 135 patients. There was no significant difference in the prevalence of factor V Leiden between patients and control subjects. The prevalence of the factor V mutation was 9% (3/33) in patients with thrombus, and 7.7% (8/103) in patients without thrombus. The prevalence of factor V Leiden was 7.3% (7/95) in control subjects. No significant differences in plasma fibrinogen (480 +/- 195 vs. 444 +/- 179 mg/dl, p = 0.6), D-dimer (471 +/- 256 vs. 497 +/- 293 ng/dl, p = 0.7), vWF (112 +/- 18 vs. 103 +/- 15%, p=0.5), PAI-1 (26.7+/- 9.8 vs. 28.1 +/- 10.2 ng/dl, p = 0.6), and t-PA (19.8 +/- 8.7 vs. 17.2 +/- 9.1 ng/dl, p = 0.7), levels are found in patients with LV thrombus when compared with those without LV thrombus. Multivariate analyses showed that peak creatine kinase level (p = 0.002) and LV wall motion score index (p = 0.003) were independent predictors of LV thrombus formation. CONCLUSION: Factor V Leiden mutation is not a risk factor for LV thrombus formation in patients with AMI.

Behçet's disease with a large intracardiac thrombus: a case report.

Behçet's disease is recognised as a chronic multisystem disorder with vasculitis as its underlying pathological process. Cardiac involvement is rare and often associated with poor prognosis. A case of a 33 year old man with Behçet's disease, presenting with a large right ventricle and right atrial thrombus, is reported. Two dimensional (cross sectional), colour Doppler, and transoesophageal echocardiography, angiography, computed tomography, and magnetic resonance imaging were used to diagnose the disease. With cyclophosphamide and dexamethasone treatment, the cardiac lesions progressively resolved.

Doppler-derived mitral deceleration time as an early predictor of left ventricular thrombus after first anterior acute myocardial infarction.

BACKGROUND: The relation between left ventricular (LV) diastolic function and LV thrombus has not yet been fully investigated. The aim of this study was to determine whether early assessment of Doppler-derived mitral deceleration time (DT), a measure of LV compliance and filling, may predict LV thrombus formation after acute myocardial infarction. METHODS AND RESULTS: Two-dimensional and Doppler echocardiographic examinations were performed in 98 consecutive patients (aged 57 +/- 12 years; 8 women) with first acute myocardial infarction. The patients were studied within 24 hours and at days 3, 7, 15, and 30 after arrival to the coronary care unit. Mitral flow velocities were obtained from the apical 4-chamber view with pulsed Doppler. LV thrombus was detected in 20 of 98 patients. Patients were divided into 2 groups according to LV thrombus formation: group 1 (n = 20) with thrombus and group 2 (n = 78) without thrombus. Mitral E-wave DT was significantly shorter in group 1 than group 2 (134 ms vs 175 ms; P <.001). Patients in group 1 had significantly larger LV end-diastolic and end-systolic volumes and a higher wall motion score index than patients in group 2 (133 +/- 39 mL vs 112 +/- 41 mL, P =.03; 83 +/- 34 mL vs 59 +/- 30 mL, P =.003; and 1.8 +/- 0.3 mL vs 1.5 +/- 0.3 mL, P =.007, respectively). The LV ejection fraction was significantly lower in group 1 than in group 2 (39% +/- 13% vs 48% +/- 12%; P =.004). In a multivariate regression analysis, mitral E-wave DT was identified as an independent variable related to development of LV thrombus (P =.04). CONCLUSIONS: Doppler-derived mitral DT is superior to conventional clinical and 2-dimensional echocardiographic assessment in estimating the risk of left ventricular thrombosis after myocardial infarction.

Mitral valve prolapse and mitral insufficiency in two siblings with Gaucher's disease.

Gaucher's disease is an autosomal recessive storage disorder. We report two siblings with Gaucher's disease, both of which had mitral valve prolapse and mitral insufficiency. One of the siblings died of bacterial endocarditis and pneumonia, while the other continues under followup.