A systematic chart review of pharmacological interventions in patients with clozapine-induced hypersalivation.

OBJECTIVES: To investigate the efficacy and tolerability of medications, such as mouthwash use of 1 % atropine sulfate and tropicamide drops, oral amitriptyline and amisulpride used for clozapine-induced hypersalivation (CIH). METHODS: The medical charts of inpatients with psychotic disorders between 2010 and 2022 were reviewed retrospectively. We detected 161 patients with eligible data who received or commenced clozapine. Primary outcome was defined as the percentage change in the diameter of a wet patch on the pillow (DWP) for improvements in CIH. RESULTS: The frequency of CIH was 42 % (n = 68). The first step medications for CIH were tropicamide drops (49 %), atropine drops (43 %) and amitriptyline (3 %). After the first step, the median DWP significantly decreased by -33 %. During the index hospitalization, in 18 patients with persistent CIH, the median DWP significantly decreased by -42 % with the second step medications which also included amisulpride. There were no reported serious adverse events. The change in DWP was significantly correlated with the duration of clozapine treatment (r = 306) and clozapine serum level at discharge (r = 0.294). A linear regression model showed a link between the change in DWP and reduced Positive and Negative Syndrome Scale scores. CONCLUSIONS: Our findings emphasize that mouthwash use of atropine or tropicamide drops has a satisfying and tolerable effect in treating CIH. Switching medications for CIH seems to be effective when CIH persists despite a first step agent. Controlled follow-up studies are needed to understand the relationship between CIH, clozapine serum levels, illness severity, and functioning.

Anxiety, depression, and knowledge level in postpartum women during the COVID-19 pandemic.

PURPOSE: This study aimed to assess anxiety, depression, and knowledge level in postpartum women during the COVID-19 pandemic. DESIGN AND METHODS: This cross-sectional study was conducted on 212 postpartum women using a web-based online survey in Ankara, Turkey. FINDINGS: The prevalence of depression was 34.0%. The mean anxiety and COVID-19 knowledge scores were 42.69 ± 9.93 and 9.69 ± 1.94, respectively. There was a statistically significant difference between the anxiety scores and depression status (p < 0.001) of women. There were statistically significant differences between fear about being infected with COVID-19 for themselves (p = 0.01) and for babies (p = 0.01) and the postpartum depression (PPD). PRACTICE IMPLICATIONS: During the COVID-19 pandemic, early detection and appropriate and timely intervention to prevent and detect anxiety and PPD are crucial to the well-being of a woman.

Targeted MicroRNA Profiling in Gastric Cancer with Clinical Assessement.

Although several microRNAs (miRNAs) have been associated with gastric cancer there is still the need for identification of stable and validated biomarkers. The purpose of this study was to determine the alterations of a specific set of miRNA levels in gastric adenocarcinoma tissues to identify and validate gastric cancer-specific miRNAs using paired normal and tumor samples in an independent patient cohort. Gastric adenocarcinoma and normal stomach tissue samples of 20 patients who underwent surgery for gastric cancer were studied. The miRNA expression profiling was performed for eight miRNAs in a total of 40 tissue samples using quantitative reverse transcription polymerase chain reaction (RT-qPCR). Six out of these eight miRNAs, namely, miR-375-3p, hsamiR-129-5p, miR-196a-5p, miR-376c-3p, miR-34c-5p and miR-767-5p, were significantly underexpressed in malignant tissues of our cohort. Furthermore, the expression of miR-662 although not significantly different between normal and tumor tissues, was inversely associated with age (r = -0.440, p = 0.049). The levels of miR-129-3p and miR34c-5p were correlated with an increase in the number of metastatic lymph nodes (r = 0.470, p = 0.036; r = 0.510, p = 0.020), while and miR-376c-3p levels were negatively associated with smoking (p = 0.043). In addition, we found that the variability of miRNA expression in cancerous tissues was lower than that in normal tissues. Alterations in miRNA expression in gastric adenocarcinoma tissues in comparison to healthy tissues of each individual serves for identification of consistent biomarkers that can be used for development of diagnostic tools for gastric cancer.

The temperature induced current transport characteristics in the orthoferrite YbFeO3-δ thin film/p-type Si structure.

The perovskite ytterbium ferrite is a new ferroelectric semiconductor material. We presented the temperature induced current-voltage (I-V) characteristics of the Al/YbFeO3-δ/p-Si/Al hetero-junction. The orthoferrite YbFeO3-δ thin films were deposited on a single crystal p-type Si substrate by a radio frequency magnetron sputtering system. The potential barrier height (BH) [Formula: see text] and ideality factor n of the heterojunction were obtained by thermionic emission current method based on the recommendations in the literature. The fact that the calculated slopes of I-V curves become temperature independent implying that the field emission current mechanism takes place across the device, which has been explained by the presence of the spatial inhomogeneity of BHs or potential fluctuations. Moreover, a tunneling transmission coefficient value of 26.67 was obtained for the ferroelectric YbFeO3-δ layer at the Al/p-Si interface.

How much apoptosis does carbon monoxide poisoning cause? Primary clinical soluble TWEAK protein level study.

Carbon monoxide (CO) is an important cause of deaths via poisoning. CO poisoning causes inhibition of O2 transport and development of tissue hypoxia, which then causes cell apoptosis. A significant indicator of cell apoptosis, soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) protein, is important for the stimulation of apoptosis. The primary purpose of this study is to determine whether apoptosis occurs during acute CO poisoning and to show that sTWEAK protein is an indicator of apoptosis that can be analyzed as a marker in the peripheral blood sample. The secondary aim is to determine the diagnostic and prognostic values of sTWEAK protein. The study was performed prospectively on 43 patients with CO poisoning and 30 healthy volunteer control individuals. The anamneses were taken from all patients, who also underwent physical examination. Complete blood count, biochemical markers, cardiac enzymes, and arterial blood gas measurements were analyzed. All the patients' sTWEAK protein levels were also analyzed. The sTWEAK protein level of patients with CO poisoning was 2278 pg/mL (1197-7234), while the level of the control group was 1609 pg/mL (310-3721). The patients' sTWEAK levels were significantly higher than the controls (area under the curve: 0.77 (0.66-0.89); p < 0.001), and the cutoff value was determined as 1895.50 pg/mL. The cutoff level had a sensitivity of 74.4%, a specificity of 76.7%, a positive predictive value of 82.0%, and a negative predictive value of 67.6%. sTWEAK is a significant indicator of apoptosis in CO poisoning that can be analyzed in the peripheral blood. However, further clinical trials are needed in terms of prognostic criteria.

The electrical modulus and other dielectric properties by the impedance spectroscopy of LaCrO3 and LaCr0.90Ir0.10O3 perovskites.

We have prepared LaCrO3 (LCO) and 10% Ir doped LCO samples by the solid state reaction method and studied the electrical modulus and the other dielectric properties of the samples by means of the impedance spectroscopy in the -100 °C to 100 °C range, with steps of 20 °C. It has been clearly observed that the dielectric properties change due to Ir doping. The absolute dielectric constant value of Ir doped LCO has decreased and this reduction was attributed to decreasing Cr6+ ions which may play a vital role in space charge polarization and charge hopping. A plateau region appeared in the temperature-dependent real electrical modulus M' versus f curves of the pure LCO sample while almost no plateau region is visible in the Ir doped LCO sample. The temperature-dependent imaginary modulus M'' versus f curves has two peaks at each temperature; one of the peaks is at low frequency and the other at the high frequency region, which shifts through higher frequency region with increasing temperature. This originates from free charge accumulation at the interface with the increase of the temperature. Furthermore, it has been seen that the Ir doped LCO sample has higher impedance and resistance values than the undoped LCO sample at the same frequency and temperature. This phenomenon was attributed to doped Ir ions behaving like a donor in LCO because LCO is a p-type compound. Moreover, the activation energy values of 0.224 eV and 0.208 eV for LCO and of 0.161 eV and 0.265 eV for the Ir doped LCO have been obtained from the slopes of the ρ dc vs. (kT)-1 curves, respectively. Also the activation energies were calculated from the slopes of the f max vs. (kT)-1 curves and the obtained results from low frequency region were in good agreement with ρ dc vs. (kT)-1 ones.

Association between red cell distribution width and mean platelet volume with appendicitis: a myth or a fact?

OBJECTIVES: The aim of our study was to identify if there was a relation between red cell distribution width, mean platelet volume, platelet distribution width, leukocyte count and thrombocyte count at the time of presentation to hospital and acute appendicitis. BACKGROUND: Acute appendicitis is one of the most common surgical emergencies. Misinterpretation of symptoms and findings in acute appendicitis may lead to removal of normal appendix and delayed diagnosis can result in perforation and peritonitis. Many studies tried to delineate the relation between acute appendicitis and laboratory findings. Latest studies focused on components of complete blood count such as red cell distribution width and mean platelet volume. METHODS: This was a retrospective clinical study that enrolled 638 patients with abdominal pain and open appendectomy for acute appendicitis. Complete blood count results including red cell distribution width were retrieved from medical charts of patients and analyzed. RESULTS: There was no statistically significant difference between appendicitis, non pathological appendix and perforated appendicitis in terms of red cell distribution width or other blood count components except leukocyte level. CONCLUSION: Despite current findings in medical literature indicating predictive value of red cell distribution width in acute appendicitis; its utility for differential diagnosis might be overestimated (Tab. 1, Ref. 22).

Red cell distribution width, gamma glutamyl transpeptidase and anticoagulant use affect mortality in acute arterial mesenteric ischemia.

BACKGROUND: Despite advances in surgery and intensive care, mortality in acute mesenteric ischemia remains between 50% and 90%. In this study, we evaluated factors affecting mortality in acute arterial mesenteric ischemia. METHODS: This is a retrospective cohort study involving 73 patients with an initial diagnosis of arterial acute mesenteric ischemia admitted to Ankara Numune Teaching Hospital between January 2008 and December 2013. We retrospectively collected data about demographic variables, co-morbidities, medications, extent of surgical resection, laboratory values, pathology results and outcome. RESULTS: The mean age of the patients was 69.3±12.6. Thirty one patients were female (42.46%) and 42 (57.53%) were male. We divided the patients into two groups: Group 1 (n=40); those who died and Group 2 (n=33); those who were discharged. In multivariate analysis of high gamma glutamyl transpeptidase and red cell distribution width levels, the presence of anticoagulant use was statistically significant (p<0.05) in favor of Group 1. CONCLUSION: High red cell distribution width and gamma glutamyl transpeptidase levels and anti-coagulant use are factors affecting mortality in arterial acute mesenteric ischemia. The assessment of these variables could help predict the extent of arterial acute mesenteric ischemia and the mortality associated with it.

Significant correlation between uric acid levels and flow-mediated dilatation in patients with masked hypertension.

BACKGROUND: Serum uric acid (UA) level is associated with prognosis in cardiovascular disorders such as sustained hypertension, diabetes mellitus and chronic kidney diseases. Increased UA levels in sustained hypertension may reflect early renal vascular alterations. However, it remains unclear if serum UA is associated with endothelial dysfunction in masked hypertensive patients. METHODS: A total of 100 individuals (57% men and 43% women; mean 45 ± 8 years) with masked hypertension were included in the present study. The clinical and laboratory data were collected. Endothelial function was estimated by flow-mediated dilatation (FMD) of the brachial artery and expressed as percentage change relative to baseline diameter. RESULTS: Univariate regression analysis showed that the FMD was significantly negative correlated with uric acid (r = -0.300, p = 0.002), ambulatory 24-h systolic blood pressure (SBP) (r = -0.275, p = 0.008), hs-CRP (r = -0.222, p = 0.033) and diastolic aortic diameter (r = -0.243, p = 0.019). In multivariate linear regression analysis, only uric acid levels and ambulatory 24-h SBP were significantly associated with FMD. CONCLUSION: There was an independent correlation between UA and FMD, and a higher UA level was related to worse endothelial function which may contribute to hypertension and cardiovascular morbidity.

Determinants of dynamic hyperinflation during metronome-paced tachypnea in COPD and normal subjects.

In COPD, dynamic hyperinflation (DH) occurs during exercise and during metronome-paced tachypnea (MPT). We investigated the relationship of DH with breathing pattern and ventilation (V˙E) in COPD and normal subjects (NS). In 35 subjects with moderate COPD and 17 younger healthy volunteers we measured inspiratory capacity (IC), breathing frequency (fR), expiratory time (TE), ventilation (V˙E) and end-tidal carbon dioxide tension (PETCO2) at baseline and after 30s of MPT at 40breaths/min with metronome-defined I:E ratios of 1:1 and 1:2. A reduction in IC (ΔIC) was taken to indicate DH. In COPD subjects, DH correlated with TE but not with V˙E or PETCO2, and was best predicted by total lung capacity. NS also showed DH (although less than in COPD), which correlated with PETCO2 but not with fR, TE or V˙E. We conclude that MPT evokes DH in both NS and patients with COPD. TE is the most important determinant of DH during MPT in patients with COPD.

Association of collagen type I alpha 1 gene polymorphism with inguinal hernia.

PURPOSE: A positive family history is an important risk factor for inguinal hernia development, suggesting a genetic trait for hernia disease. However, gene mutations responsible for abdominal wall hernia formation in humans have not yet been studied. We aimed to evaluate whether the functional Sp1 binding site polymorphism within intron 1 of the collagen type I, alpha 1 (COL1A1) gene was associated specifically with inguinal hernia disease. METHODS: 85 participants with surgically diagnosed inguinal hernia disease, and 82 physically active controls without any history of connective tissue disease and hernia were recruited for this case-control genetic association study. Polymerase chain reaction and restriction fragment length polymorphism and agarose gel electrophoresis techniques were used to detect these polymorphisms. RESULTS: Significantly, more patients gave a positive family history for an inguinal hernia compared to healthy controls (OR 3.646, 95 % CI 1.375-9.670, P = 0.006). COL1A1 Sp1 SNP (rs 1800012) was identified. Results demostrated statistically significant deviation from HWE for cases (P = 0.007), but not for the controls (P = 0.276). Our results revealed an increased frequency of COL1A1 Sp1 Ss genotype in inguinal hernia patients (OR 3.593, 95 % CI 1.867-6.915, P = 0.000). CONCLUSIONS: This results suggest that polymorphism of the COL1A1 Sp1 binding site is associated with an increased risk for developing inguinal hernias. So, rs 1800012 locus is a potential candidate region for susceptibility in molecular mechanism of inguinal hernia pathophysiology.

Distinguishing between acute appendicitis and appendiceal mucocele: is this possible preoperatively?

PURPOSE: Mucocele of the appendix is an infrequent event, characterized by a cystic dilatation of the lumen. It is often diagnosed clinically from signs and symptoms of acute appendicitis or, if it is asymptomatic, as an incidental finding during ultrasonography, computed tomography, or laparotomy. METHODS: We evaluated the histological data of patients who were believed to have mucocele of the appendix. These patients (n = 23) were compared with sex- and age-matched control subjects (n = 79) with appendicitis. RESULTS: The main reason for emergency surgery was lower right abdominal pain in 15 patients, and intestinal obstruction in three. Univariate analysis using sonography demonstrated that the larger appendiceal outer diameter was positively correlated with the diagnosis of appendiceal mucocele (p = 0.001) and the mean white blood cell count was negatively correlated (p = 0.023). In urine analysis, 41.7 % of the mucocele patients and 10 % of the appendicitis patients had microscopic hematuria, respectively (p = 0.019). An outer diameter of 10 mm or more was predictive of appendiceal mucocele diagnosis, with a sensitivity of 76.5 %, specificity of 81 %, positive predictive value of 76.5 %, and negative predictive value of 94.12 %. The overall diagnostic accuracy was 80.2 %. One point was given for the presence of each of these factors to develop a new score. The resulting area under the receiver operator characteristic curve was 0.855 (95 % CI 0.741-0.969) for the score. The histological examination of the specimens revealed mucocele in 15 cases, mucinous cystadenoma in seven cases and mucinous cystadenocarcinoma in one case. Twenty patients underwent appendectomy, and three patients were treated with right colectomy. CONCLUSIONS: A threshold 10-mm diameter of the appendix under compression is a useful preoperative measurement for differentiating between appendiceal mucocele and acute appendicitis. Microhematuria is simple test that can provide a significant role in supporting the clinical diagnosis of appendiceal mucocele in the emergency department.

Comparison of the therapeutic effects of tri-iodothyronine and methylprednisolone during early sepsis in laboratory animals.

BACKGROUND: Despite major advances, the treatment of sepsis is still a challenging problem for surgeons. This study was aimed to compare the therapeutic effects of methylprednisolone and tri-iodothyronine replacement therapy during an early sepsis. MATERIAL AND METHODS: Forty male Wistar albino rats weighing 300-340 g were divided into the Control, CLP, CLP/MP, CLP/T3 and CLP/MP/T3 groups. The Control group underwent a sham operation. Only cecal ligation and puncture was performed in the CLP group. The CLP/MP groups received an intramuscular injection of (MP) methylprednisolone (30 mg/kg) at one and half hour before CLP. The CLP/T3 group was given an intraperitoneal (IP) injection of tyroid hormone (T3) 0.4 µg/100 g immediately after CLP. The CLP/MP/T3 group was given IM injection of MP 30 mg/kg before CLP and IP injection of T3 0.4 µg/100 g after CLP. Hemavet changes, blood cultures, peritoneal bacteria content, hormonal alterations and histopathologic changes of intestinal, lung and liver tissue were used to asses the possible therapeutic effects of MP and T3 during early sepsis. RESULTS: A septic insult resulted in significant alterations on hemavet values, free T3, free T4 and cortisol levels, peritoneal bacteria content and intestinal lung and liver tissue samples of the CLP group. Hemavet changes and peritoneal inflammation findings were significantly limited in the CLP/T3 and CLP/MP/T3 groups. Histopathologic changes had no significant difference between the groups during an early sepsis. CONCLUSION: Compared to the MP replacement therapy, therapeutic effects of T3 replacement therapy have been found significantly more promising (Tab. 1, Fig. 10, Ref. 49).

Could vital signs predict carbon monoxide intoxication?

OBJECTIVE: This retrospective study examined the correlation between carboxy haemoglobin (COHb) levels and vital signs in patients with carbon monoxide (CO) intoxication. METHODS: Over a 10-year period, patients>16 years of age who presented to the emergency department due to CO intoxication were included. Age, gender, comorbidities, month/year of presentation, presenting symptoms, vital signs, blood pH, COHb level, treatment and outcome were recorded. RESULTS: In total, 476 patients were included. The mean±SD age was 36.22±13.65 years; 96.4% of the patients had a normal Glasgow Coma Scale score, 91.0% had normal blood pressure and 80.0% had a normal heart rate. COHb levels were stratified into three groups: <10% (n=39), 10-20% (n=106) and >20% (n=205); levels could not be obtained in the remaining 126 patients. In patients with COHb levels>20%, 34 (16.6%) had alkalosis and nine (4.4%) had acidosis. Among patients with COHb levels>20%, 140 (68.3%) had normal vital signs. CONCLUSIONS: Vital signs cannot be used as a prognostic marker of CO intoxication and, therefore, patients must be monitored closely.

The beneficial effects of preperitoneal catheter analgesia following colon and rectal resections: a prospective, randomized, double-blind, placebo-controlled study.

BACKGROUND: Preperitoneal catheter analgesia following abdominal surgery has attracted interest in the last decade. We conducted this study to evaluate the benefits of preperitoneal catheter analgesia in managing pain after abdominal colon and rectal resections. METHODS: A total of 50 patients undergoing colon and rectal resections for benign and malignant diseases received analgesic medicines via an epidural catheter placed just prior to surgery and a preperitoneal catheter placed at the end of the surgical procedure. Patients were instructed to use the epidural patient-controlled analgesia (PCA) device freely and were randomized into two groups after obtaining the approval of the Institutional Review Board: Group A received 10 ml of levobupivacaine twice a day postoperatively via preperitoneal catheter and group B received only 10 ml of saline. Demographics, surgical characteristics, pain scores recorded four days following surgery, analgesic volume used from the epidural PCA, clinical outcomes (length of stay, time to first bowel movement, time to first passage of gas or stool, time to first oral intake) and respiratory function test results (preoperative vs. postoperative) were compared. RESULTS: There were no significant differences in demographics or surgical characteristics between both groups. Pain scores were similar. Clinical outcomes and respiratory functions were comparable. The use of analgesic volume via epidural catheter was significantly lower in group A than in group B (P = 0.032). CONCLUSIONS: Preperitoneal catheter analgesia significantly decreased the need for epidural drug consumption and proved to be a beneficial adjunct for postoperative pain management of patients who underwent colon and rectal resections.

Carcinoid tumor of the appendix: report on ten cases.

AIM: To conduct a retrospective analysis of the incidence and long-term outcomes of carcinoid tumor of the appendix in emergency appendectomies. METHODS: From a histopathologic database of 2197 appendectomies from a single center, all appendiceal carcinoid tumors were identified and case notes reviewed. Demographic data, clinical presentation, histopathology, operative reports, and survival were scored and compared with those reported in the literature. RESULTS: Ten patients (0.45%) with appendiceal carcinoid tumor were identified (2 male, 8 female; mean age, 29.2 years; age range, 14-56 years). In all cases, the clinical presentation resembled the symptoms of acute appendicitis. Open appendectomy was performed in all patients. All tumors were located at the tip of the appendix, with a mean diameter of 0.4 cm (range, 0.1-0.9 cm), and the mesoappendix was invaded in one patient. No patient had repeat surgery after the initial operation. After a mean follow-up period of 55 months (range, 26-82 months), all patients were alive and disease- and symptom-free. CONCLUSION: To conclude, carcinoid tumors are extremely rare, and the diagnosis is often made after surgery. We emphasise the value of obtaining histopathological analysis of every removed appendix because visual examination does not always correlate with later pathological examination. Furthermore, small appendiceal carcinoids (<1 cm) have an excellent prognosis after appendectomy.

Dexmedetomidine and postoperative shivering in patients undergoing elective abdominal hysterectomy.

BACKGROUND: Post-anaesthetic shivering is one of the most common complications, occurring in 5-65% of patients recovering from general anaesthesia and 33% of patients receiving epidural anaesthesia. Our objective was to investigate the efficacy of intraoperative dexmedetomidine infusion on postoperative shivering. METHODS: Ninety female patients, ASA I-II, 35-60 yr old, scheduled for elective total abdominal hysterectomy with or without bilateral salpingo-oophorectomy were randomized into two groups. After endotracheal intubation one group received normal saline infusion and the other received dexmedetomidine as a loading dose of 1 microg kg(-1) for 10 min followed by a maintenance infusion of 0.4 microg kg(-1) h(-1). In the recovery room, pain was assessed using a 100 mm visual analogue scale and those patients who had a pain score of more than 40 mm were administered 1 mg kg(-1) intramuscular diclofenac sodium. Patients with shivering grades more than 2 were administered 25 mg intravenous meperidine. Patients were protected with passive insulation covers. RESULTS: Post-anaesthetic shivering was observed in 21 patients in the saline group and in seven patients in the dexmedetomidine group (P = 0.001). Shivering occurred more often in the saline group. The Ramsay Sedation Scores were higher in the dexmedetomidine group during the first postoperative hour. Pain scores were higher in the saline group for 30 min after the operation. The need for intraoperative atropine was higher in the dexmedetomidine group. Intraoperative fentanyl use was higher in the saline group. Perioperative tympanic temperatures were not different between the groups whereas postoperative measurements were lower in the dexmedetomidine group (P < 0.05). CONCLUSION: Intraoperative dexmedetomidine infusion may be effective in the prevention of post-anaesthetic shivering.

Subhypnotic doses of midazolam prevent nausea and vomiting during spinal anesthesia for cesarean section.

BACKGROUND: We aimed to evaluate the efficacy of subhypnotic doses of midazolam and propofol for peripartum nausea and vomiting during regional anesthesia for elective cesarean section in order to prevent emesis in at least 50% of patients. METHODS: A prospective, double blind, placebo-controlled study was carried out. Patients were randomly allocated to one of three groups to receive placebo (saline, N=28), propofol (20 mg bolus and 1.0 mg x kg(-1) x h(-1) infusion, N=30), and midazolam (1 mg bolus and 1.0 mg x h(-1) infusion, N=30) at subhypnotic doses intravenously (i.v.) immediately after the umbilical cord was clamped. Bupivacaine hydrochloride (8-10 mg) and fentanyl (10 microg) were injected into the intervertebral space for spinal anesthesia. Blood pressure was monitored at 2 min intervals and intraoperative postdelivery emetic episodes and ephedrine consumption were recorded. The study was carried out at the Anesthesiology Department, Hacettepe University, Turkey, hospitalized care. We included 90 parturients with ASA physical status I and II between the ages of 20 and 38 years undergoing spinal anesthesia for elective cesarean delivery to evaluate the efficacy of subhypnotic doses of propofol and midazolam and, in particular, the incidence of nausea, retching, and vomiting intraoperatively. RESULTS: The incidence of nausea, retching, and vomiting was significantly higher in the control group, compared to the propofol and midazolam groups. Total ephedrine consumption was significantly higher in the control group compared to the propofol and midazolam groups. CONCLUSION: A subhypnotic dose of midazolam (1 mg x h(-1)) was as effective as the subhypnotic dose of propofol (1 mg x kg(-1) x h(-1)) for the prevention of nausea and vomiting in parturients undergoing cesarean section under spinal anesthesia.

Bacillus spp. among hospitalized patients with haematological malignancies: clinical features, epidemics and outcomes.

Between April 2000 and May 2005, 350 bacteraemic episodes occurred among patients treated in our haematology unit. Two hundred and twenty-eight of these episodes were caused by Gram-positive pathogens, most commonly coagulase-negative staphylococci and Staphylococcus aureus. One hundred and twenty-two episodes were due to Gram-negative pathogens, with a predominance of Escherichia coli, Acinetobacter baumannii and Pseudomonas aeruginosa. Bacillus bacteraemias constituted 12 of these episodes occurring in 12 patients, and accounted for 3.4% of all bacteraemic episodes. Of the 12 strains evaluated, seven were Bacillus licheniformis, three were Bacillus cereus and two were Bacillus pumilus. Seven episodes presented with bloodstream infection, three with pneumonia, one with severe abdominal pain and deterioration of liver function, and one with a catheter-related bloodstream infection. B. licheniformis was isolated from five patients who had been hospitalized at the same time. This outbreak was related to non-sterile cotton wool used during skin disinfection. B. cereus and B. licheniformis isolates were susceptible to cefepime, carbapenems, aminoglycosides and vancomycin, but B. pumilus isolates were resistant to all antibiotics except for quinolones and vancomycin. Two deaths were observed. In conclusion, Bacillus spp. may cause serious infections, diagnostic and therapeutic dilemmas, and high morbidity and mortality in patients with haematological malignancies. Both B. cereus and B. licheniformis may be among the 'new' Gram-positive pathogens to cause serious infection in patients with neutropenia.

Restaging in gynaecological cancers.

Regardless of recent technical developments in the scientific arena, stage is still the most important prognostic factor in gynaecological cancers. Surgical staging is performed in all types of gynaecologic cancers except for cervical cancer. Adjuvant therapies that contribute to survival are planned in the light of information obtained from staging procedures. Therefore, necessary information for further therapeutic management should be revealed by the end of surgical staging. A staging surgery that is not completed for any reason will not only deprive the patient of necessary treatments, but can also cause administration of unnecessary adjuvant treatments. This is especially important, given the undesired effects and cost of both chemotherapy and radiotherapy. A particularly relevant case in point is tumours that look like early stage; this is because upstaging up to 30% has been reported in ovarian and endometrial cancers. As for vulvar cancer, clinical staging has been reported to lead to about 15% over-diagnosis in comparison to surgical staging. Thus, the first step in all gynaecological cancers, except cervical cancer, should be to perform surgical staging when possible and unveil all surgical-pathological prognostic factors in the light of data obtained. Accordingly, restaging surgery should be considered in all cases that had incomplete staging. However, care should be taken to evaluate the benefits to be reaped together with the operative morbidity risk associated with the restaging procedure. This will both ensure accurate planning of postoperative treatment and provide a universal standard of approaching cancer patients and their treatments.