Nitrous Oxide for the Treatment of Chronic Low Back Pain.

BACKGROUND: Neuropathic back pain is mediated, at least partially, by N-methyl-D-aspartate (NMDA) receptors. Nitrous oxide (N2O) is an NMDA receptor antagonist. We therefore tested the primary hypothesis that patients receiving N2O have lower pain scores after epidural steroid injection than patients not receiving N2O. METHODS: Patients with recurrent low back pain scheduled for epidural steroid blocks were randomly assigned to receive either oxygen (O2, n = 39) or the combination of 50% O2 and 50% N2O during and after each block (N2O, n = 39). Before each injection and at a 3-month follow-up visit, patients completed questionnaires: Oswestry survey, 12-Item Short Form Health Survey questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs pain scale, and Visual Analog Scale. Total opioid use per 24 hours was recorded. The serum samples for tumor necrosis factor-α, interleukin (IL)-6, interferon-γ, IL-10, IL-17A, and IL-1ß assays were collected at every visit and evaluated. Standard descriptive statistics were used to compare the randomized groups on baseline variables. Any imbalanced covariates with an absolute standardized difference >0.44 were adjusted for in both primary and secondary analyses. Both modified intention-to-treat and per-protocol analyses were conducted for our outcomes. Our secondary analyses were per protocol. RESULTS: in patients given N2O (mean [SD], -1.6 [3.0] cm) and O2 (-1.2 [2.6] cm), with difference -0.13 (95% confidence interval: -1.43, 1.17), N2O - O2; P = 0.84. No difference was found between the 2 randomized groups on changes in Leeds Assessment of Neuropathic Symptoms and Signs pain score, Oswestry score, or 12-Item Short Form Health Survey from baseline, or in satisfaction with the procedure, satisfaction with pain treatment, or use of opioid overtime. Overall, no significant differences on any cytokine were found between the 2 groups. The estimated odds ratios of taking opioid was 0.46 (0.12, 1.84) (N2O versus O2; P = 0.12). CONCLUSIONS: N2O administration did not improve pain or psychological or physical aspects of health-related quality of life. N2O does not appear to be an effective treatment for chronic neuropathic back pain.

Ultrasound-guided pulsed radio frequency treatment in Morton's neuroma.

BACKGROUND: Morton's neuroma is a perineural fibrosis of an intermetatarsal plantar nerve. Burning, numbness, paresthesia, and tingling down the interspaces of involved toes may also be experienced. Taking into account all of this information, we designed a prospective open-label study to evaluate the efficacy of pulsed radio frequency on Morton's neuroma. METHODS: Twenty patients with Morton's neuroma were experiencing symptomatic neuroma pain in the foot not relieved by routine conservative treatment. All of the patients had been evaluated by a specialized orthopedist and were offered pulsed radio frequency as a last option before having surgery. Initially, pain level (numerical rating scale), successful pain control (a ≥50% pain decrease was accepted as successful pain control), comfort when walking (yes or no), and satisfaction level (satisfied or not satisfied) were evaluated. RESULTS: We found a decrease in the pain level in 18 of 20 patients, successful pain control in 12, and wearing shoes and walking without pain in 16. Overall, satisfaction was rated as excellent or good by 12 patients with Morton's neuroma in this series. CONCLUSIONS: This evidence indicates that ultrasound-guided pulsed radio frequency is a promising treatment modality in the management of Morton's neuroma pain.

Treatment of compensatory hyperhidrosis of the trunk with radiofrequency ablation.

OBJECTIVES: Although Endoscopic Thoracic Sympathectomy is a widely accepted treatment method for patients with palmar hyperhidrosis, compensatory hyperhidrosis of the trunk remains a challenging side effect of the procedure. No satisfactory treatment options for this side effect were available until now. In this study, we aimed to define a new procedure for the treatment of compensatory hyperhidrosis of the trunk. METHODS: A total of 10 patients admitted our institution for the treatment of compensatory hyperhidrosis of the trunk were enrolled in the study between November 2010 and January 2012 in a prospective manner. Sympathetic blockage was achieved via radiofrequency thermo-ablation technique. The results of treatment were evaluated via telephone calls. RESULTS: Ten patients (2 females, 8 males) underwent radiofrequency thermo-ablation of T6 sympathetic ganglion for compensatory hyperhidrosis of the trunk. The mean age was 29.2 years and the median duration of symptom was 10.5 months. The median follow-up period was 14 months. Six of ten patients (60%) were treated successfully. There was no procedure related complication. CONCLUSION: The radiofrequency treatment for patients with compensatory hyperhidrosis of the trunk is an alternative option with promising results.

Comparison of three techniques for ultrasound-guided femoral nerve catheter insertion: a randomized, blinded trial.

BACKGROUND: Ultrasound guidance for continuous femoral perineural catheters may be supplemented by electrical stimulation through a needle or through a stimulating catheter. The authors tested the primary hypothesis that ultrasound guidance alone is noninferior on both postoperative pain scores and opioid requirement and superior on at least one of the two. Second, the authors compared all interventions on insertion time and incremental cost. METHODS: Patients having knee arthroplasty with femoral nerve catheters were randomly assigned to catheter insertion guided by: (1) ultrasound alone (n = 147); (2) ultrasound and electrical stimulation through the needle (n = 152); or (3) ultrasound and electrical stimulation through both the needle and catheter (n = 138). Noninferiority between any two interventions was defined for pain as not more than 0.5 points worse on a 0 to 10 verbal response scale and for opioid consumption as not more than 25% greater than the mean. RESULTS: The stimulating needle group was significantly noninferior to the stimulating catheter group (difference [95% CI] in mean verbal response scale pain score [stimulating needle vs. stimulating catheter] of -0.16 [-0.61 to 0.29], P < 0.001; percentage difference in mean IV morphine equivalent dose of -5% [-25 to 21%], P = 0.002) and to ultrasound-only group (difference in mean verbal response scale pain score of -0.28 [-0.72 to 0.16], P < 0.001; percentage difference in mean IV morphine equivalent dose of -2% [-22 to 25%], P = 0.006). In addition, the use of ultrasound alone for femoral nerve catheter insertion was faster and cheaper than the other two methods. CONCLUSION: Ultrasound guidance alone without adding either stimulating needle or needle/catheter combination thus seems to be the best approach to femoral perineural catheters.

Comparison of the postoperative analgesic efficacy of an ultrasound-guided fascia iliaca compartment block versus 3 in 1 block in hip prosthesis surgery.

OBJECTIVES: In this study, we aimed to compare the postoperative analgesic efficiency of an ultrasound-guided fascia iliaca compartment block and a 3 in 1 block in patients who underwent hip prosthesis surgery as a result of hip fracture. METHODS: With approval from the local ethics committee, 70 patients, aged 20 to 80, undergoing hip prosthesis surgery under elective conditions were included in this randomized, prospective, controlled study. They were informed of the patient-controlled analgesia (PCA) device and visual analog scale (VAS). All patients were separated randomly into three groups. Anaesthesia induction was standardized for all groups. An ultrasound guidance fascia iliaca compartment block (FICB) was applied to the first group before anaesthesia induction. For the second group, a 3 in 1 block was applied, while for the control group no block was applied. After incision on all patients, 20 mg tenoxicam and 1 mg/kg tramadol were injected intravenously. Following surgery, IV tramadol PCA was begun on all patients routinely. In our study, the presence of cortisol and ACTH levels, hemodinamical parameters, nausea and sedation were determined. RESULTS: We observed a decrease in VAS values and opioid consumption, no adverse effects on nausea and sedation, and a suppression of stress hormones in both the ultrasound-guided FICB and 3 in 1 block groups. CONCLUSION: We believe that the safe and efficient application of the ultrasound-guided 3 in 1 block and the FICB is necessary in multimodal analgesic treatment in order to enable postoperative analgesia in hip prosthesis surgery.

Preoperative angiotensin-converting enzyme inhibitor use is not associated with increased postoperative pain and opioid use.

AIM/OBJECTIVES/BACKGROUND: Angiotensin-converting enzyme inhibitors (ACEIs) increase potent proinflammatory and pain mediators in local tissues. Consistent with these observations, animal and human studies demonstrate that ACEIs have hyperalgesic and proinflammatory properties. However, there is no information in literature whether or not the use of ACEIs is associated with increased postoperative pain. Specifically, we tested the primary hypothesis that use of ACEIs is independently associated with increased opioid requirements and pain scores during the initial 72 hours after surgery. METHODS: Data from 9993 patients undergoing colorectal resection, hysterectomy, nephrectomy, or open prostatectomy were obtained from the Cleveland Clinic Perioperative Health Documentation System. A propensity-matching procedure was used to pair ACEI users to similar nonusers. Corresponding estimates and Bonferroni-adjusted 95% confidence intervals for the effect of ACEIs on each outcome were also estimated. The exact matching procedure, based on type of surgery and propensity score, identified 1038 matched pairs. The final analyzed subsample size was 212. RESULTS AND CONCLUSIONS: The adjusted difference in mean 72-hour postoperative using a time-weighted average pain score was estimated at +0.17 [-0.40, +0.74] units on the verbal response scale. This was not statistically significant (P=0.50). Opioid use was estimated by the percent difference in mean 72-hour total postoperative intravenous morphine equivalent dose at -8.1% [-46%, +56%], which was not statistically significant (P=0.72). In conclusion, after controlling for all available factors, we found no significant difference that postoperative pain-as defined by either pain scores or opioid requirements-differed between patients taking ACEIs and patients not taking ACEIs.

Results of the assessment of the council of multidisciplinary pain.

OBJECTIVES: The aim of this study was to emphasize the necessity of multidisciplinary pain council by demonstrating the patient profile, treatment approaches, outcomes, and patient satisfaction levels obtained from our council. METHODS: In this study, the age, gender, number of council evaluations, diagnoses and recommended therapies of patients were determined retrospectively. The status of the patients >1 year, outcomes of the therapies, and satisfaction levels of the patients were questioned on the phone. RESULTS: The patients were most commonly diagnosed as chronic low back pain (35%) and vertebral tumor or metastasis (10%). 74 % of the patients were evaluated because of vertebral causes. 23% of the patients had good, 27% had moderate and 35% had poor benefit; beneficence was calculated as 85%. Patient satisfaction was found as 24%, 23%, and 32%, respectively; satisfaction was calculated as 79%. CONCLUSION: Evaluation of complex patients by physicians from different disciplines has better diagnostic and treatment outcomes. In addition, multidisciplinary approach offer and perform different therapy options and this has positive effects on treatment efficiency and patient satisfaction. We are in the opinion that instead of standard treatment protocols, determining individualized multidisciplinary treatment protocols should be useful.

A new target of percutaneus sympathic radiofrequency thermocoagulation for treatment of palmar hyperhidrosis: T4.

OBJECTIVES: Hyperhidrosis is thought to result from a functional impairment of the sympathic nervous system. In this study, percutaneous T4 sympathic radiofrequency (RF) thermocoagulation was used to treat palmar hyperhidrosis which does not respond to conservative treatment. The results were evaluated in terms of safety, efficiency and patient satisfaction. METHODS: In this study, 15 patients aged 16-48 years were retrospectively evaluated from prior records. Patient satisfaction scores (very satisfied, satisfied, not satisfied), after treatment of the hand condition (dry, mild dry, no improvement), and whether the most common complication and most patients expressed by the compensatory hyperhidrosis (CH) degree (none, mild, moderate, severe) were analyzed. RESULTS: No complications were observed except a coughing crisis that lasted for 2 hours in one patient, transient bradycardia in 1 patient and transient injection site pain in all cases. Two patients 1 per week and three patients 1, 2 and 6 months developed recurrence. CONCLUSION: Sympathic T4 ablation with RF thermocoagulation was found to have long term (6 months) patient satisfaction (80%). It was also effective in reducing the hand sweating (80% dry or mild dry). The CH rate was 27%. According to our results, sympathic T4 ablation with RF thermocoagulation is a safe and effective treatment with a high degree of patient satisfaction.

Effect of radiofrequency ablation and comparison with surgical sympathectomy in palmar hyperhidrosis.

OBJECTIVES: Hyperhidrosis is a the disorder of excessive sweating in certain regions of the body. It is usually treated with surgical sympathectomy. Radiofrequency therapy has been successfully used for sympatholysis. We tested the primary hypothesis that radiofrequency therapy is independently associated with decreased palmar hyperhidrosis and compared results for patients receiving this treatment with patients who underwent surgical sympathectomy. METHODS: We included all the patients undergoing treatment for hyperhidrosis between March 2010 and April 2012. Patients who underwent either surgical sympathectomy or radiofrequency ablation for palmar hyperhidrosis were included and analysed. The outcomes studied included complications, success of the procedure, patient satisfaction with their procedure and compensatory hyperhidrosis. RESULTS: There were 94 patients who met our criteria, of whom 46 (49%) had surgical sympathectomy and 48 (51%) had radiofrequency ablation performed. Radiofrequency had a success rate of 75% in treating hyperhidrosis, but this was found to be statistically lower than for surgical sympathectomy (95%; P < 0.01). The groups were similar regarding patient satisfaction (P = 0.26) and compensatory hyperhidrosis (P = 0.78). CONCLUSIONS: This is the first clinical study to evaluate the role of radiofrequency ablation and compare it with the surgical treatment option for palmar hyperhidrosis. Radiofrequency ablation significantly decreased hyperhidrosis, but it had a lower success rate than surgical sympathectomy.

[A comparison of the efficacy of bupivacaine and levobupivacaine in patient-controlled epidural analgesia for postoperative pain in patients undergoing knee arthroplasty]. / Diz artroplastisi yapilan hastalarda ameliyat sonrasi agri için hasta kontrollü epidural analjezide bupivakain ve levobupivakainin etkinliginin karsilastirilmasi.

OBJECTIVES: In this study, we aimed to compare the efficacy of bupivacaine and levobupivacaine in the patient-controlled epidural analgesia (PCEA) in patients who underwent total knee arthroplasty (TKA), particularly with cardiac diseases. PATIENTS AND METHODS: Forty-four patients (16 males, 28 females; mean age 70.2±6.3 years; range 18 to 80 years) who were scheduled for TKA surgery under combined spinal and epidural anesthesia were included. Patients were randomly divided into two groups. Bupivacaine 15 mg 0.5% for group 1 (n=23) and levobupivacaine 15 mg 0.5% for group (n=23) were administered via spinal route. The amount of local anesthetics, PCEA starting times and bolus/demand ratio of local anesthetics were recorded. The level of pain, need for additional analgesic, total amount of analgesic, degree of motor block, complications were asked for patient satisfaction at postoperative 6, 12, 24 and 48 hours. RESULTS: No statistical differences were determined between group 1 and group 2 in terms of the operation times, PCEA starting times, bolus number/demand ratios, visual analog scale (VAS) scores and numerical rating scores (NRS) at the postoperative 6, 12, 24 and 48 hours, need for additional analgesic, total amount of analgesic, degree of motor block and patient satisfaction. Although the incidence of side effects was lower in the group 1 compared to group 2, it was not statistically significant. CONCLUSION: We concluded that it would be proper using levobupivacaine rather than bupivakaine for patients with cardiac diseases, as the cardiotoxic and neurotoxic effects of levobupivacaine is lower then bupivacaine with a similar analgesic efficacy.

Chemotherapy within 30 days before surgery does not augment postoperative mortality and morbidity.

BACKGROUND: Preoperative chemotherapy is frequently given to shrink or decrease the chance of metastasis. However, chemotherapy has well-recognized side effects that may complicate the perioperative period. We therefore tested the hypotheses that chemotherapy within 30 days before cancer surgery is associated with an increased risk of mortality and with a composite of major morbidities within 30 postoperative days. METHODS: We evaluated 971,455 patients from the American College of Surgeons National Surgical Quality Improvement Program database. Patients were defined as having chemotherapy when they were given any chemotherapy for malignancy within 30 days before surgery. We successfully matched 1,348 pairs of chemotherapy recipients and non-recipients. RESULTS: Twenty-one of the 1,348 (1.6%) non-chemotherapy patients died within 30 days after surgery compared with 30 of the 1,348 (2.2%) chemotherapy patients. The odds of mortality were not statistically different between groups based on our logistic regression model [odds ratio (OR) = 1.47; 95% confidence interval (CI) 0.82 to 2.64; P = 0.19]. The most common complication observed was wound infection in 13.1% of non-chemotherapy patients compared with 14.2% of the chemotherapy patients. There was similarly no difference between groups for the collapsed composite of major morbidities [OR = 1.17; 95% CI 0.97 to 1.42; P = 0.09]. CONCLUSION: Preoperative use of neoadjuvant chemotherapy in cancer patients undergoing resection surgeries was not associated with a higher rate of early postoperative complications or mortality.

A novel treatment of chronic orchialgia.

We evaluated the effectiveness of pulsed radiofrequency (PRF) denervation of spermatic cord for the treatment of chronic orchialgia. Five patients diagnosed with chronic orchialgia were evaluated with a thorough medical and psychiatric history, physical examination, and scrotal Doppler ultrasound, urinary system x-ray film, and urine analyses. One of the patients had bilateral chronic orchialgia. All of the patients had pain for a period of at least 3 months, and multiple conservative therapies failed to alleviate the pain. The patients, who had temporary pain relief after undergoing outpatient diagnostic cord block, were determined to be candidates for PRF denervation. PRF denervation of spermatic cord was performed for 6 testicular units. Visual analog scores were noted before and after the procedure. There were no pathologic conditions that indicated chronic orchialgia in any of the patients. No complications, including testicular atrophy or hypoesthesia of the scrotal or penile skin, occurred after the procedure. Mean visual analog scores before and after the procedure were 9 and 1, respectively. None of the patients needed any analgesics after the procedure or during the follow-up period. Mean follow-up period was 20 ± 2.5 weeks. No recurrence was noted, and none of the patients needed additional therapy. This is a limited case report on the short-term use of PRF. Randomized, placebo-controlled, and long follow-up period studies are needed to better assess the efficacy of this procedure for chronic orchalgia.

[Assessment of the effectiveness of lumbar transforaminal epidural steroid injection for low back pain]. / Terapotik lomber transforaminal epidural steroid enjeksiyonu uygulamasinin etkinliginin degerlendirilmesi.

OBJECTIVES: Transforaminal epidural steroid injection (TFESI) is a minimally invasive technique used for low back pain. We aimed to assess the efficiency of TFESI in patients with low back pain who did not respond to conservative or surgical methods. METHODS: This study was a retrospective analysis of the records of 37 patients (range: 24-80 years) who presented to our clinic with low back pain and were treated by TFESI. Outcomes were assessed by Visual Analog Scale (VAS) measured at the 3rd week and 6th month. RESULTS: Median age of the patients was 50 years, and mean duration of symptoms was 48 months. Diagnosis was lumbar disc herniation (LDH) in 51%, failed back surgery syndrome (FBSS) in 38%, and spinal stenosis (SS) in 11% of the patients. Baseline VAS scores were similar between the three groups. The 3rd week and 6th month VAS scores of LDH and FBSS cases were significantly decreased compared to baseline scores (p<0.001, p=0.001), and no significant change was observed between the VAS scores at the 3rd week and 6th month (p>0.05). If success is defined as 50% or more decrease in VAS scores, the success rate of TFESI was 84% at the 3rd week and 78% at the 6th month. CONCLUSION: TFESI significantly reduced the intensity of low back pain in most of the patients with LDH, FBSS or SS; thus, it may be considered as an effective method in the treatment of low back pain.

Pulsed radiofrequency in the treatment of coccygodynia.

OBJECTIVES: Coccygodynia is a clinical condition characterized by pain and tenderness around the coccygeal region. Trauma is the most common etiologic factor. We aimed to investigate the effectiveness of pulsed radiofrequency (PRF) treatment in patients with coccygodynia that could not be relieved by classic treatment protocols, and we present our long-term results with caudal epidural PRF. METHODS: The study included 21 patients who were treated for coccygodynia by caudal epidural PRF in our Pain Clinic. Sixteen patients (76%) had a history of trauma, three patients (14%) had previous surgery, and two patients (10%) had idiopathic coccygodynia with no identifiable cause. All patients had been previously treated with conservative methods, but none had pain relief. Pain level of the patients was assessed by visual analog scale (VAS) score. A questionnaire to evaluate subjective patient satisfaction was also used at the 3rd-week and the 6th-month follow-ups. RESULTS: Median VAS score was 8 at baseline, decreased to 2 by the 3rd week and was 2 at the 6th month. VAS at the 3rd week and 6th month were significantly lower compared to baseline (p<0.001). At the 6th month, 12 patients (57%) had excellent results, 5 patients (24%) had good results and only 4 patients (19%) had poor results regarding the subjective patient satisfaction questionnaire. CONCLUSION: Caudal epidural PRF may be an alternative to surgery for coccygodynia patients who are unresponsive to classic treatment methods.

Extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy in a patient with osteogenesis imperfecta.

Osteogenesis imperfecta (OI) patients represent a challenge to all physicians, as they do for anesthetists and urologists, when they develop symptomatic stones in the urinary tract. We recently treated an OI patient with renal pelvic stone by extraperitoneal laparoscopy-assisted percutaneous nephrolithotomy (PCNL). To our knowledge, this combined treatment modality has not been reported previously in OI. An 18-year-old paraplegic girl with OI presented to our urology department because of right-sided flank pain. She pointed out that she had right kidney stone for the previous 2 years, and because of risks of general anesthesia and surgical procedures, surveillance was recommended. Intravenous pyelography was performed and an 11.9-mm stone at the pelvis of the right kidney and grade 1-2 hydronephrosis at the same side with normal kidney functions and severe left-sided scoliosis were detected. After explanation of risks of the treatment modality and general anesthesia to the patient, extraperitoneal laparoscopy-assisted PCNL was performed. No complications occurred due to general anesthesia or surgical procedure. The operation time was 95 min and no blood transfusion was required. The nephrostomy tube and retroperitoneal drain were removed 2 and 3 days after the procedure, respectively. The patient was doing well at a follow-up of 6 months. Extraperitoneal laparoscopy-assisted PCNL approach may decrease the risk of surgery as an alternative treatment modality for OI patients. Such cases should be operated on at centers with significant experience in the field of endourology, where all the equipment and specialized personnel are readily available.

A novel treatment modality in patients with premature ejaculation resistant to conventional methods: the neuromodulation of dorsal penile nerves by pulsed radiofrequency.

Premature ejaculation (PE) is the most common sexual problem experienced by men, and it affects 20%-30% of them. Pulsed radiofrequency (PRF) neuromodulation has been shown to be an effective treatment for a wide range of pain conditions. We used PRF to treat PE by desensitizing dorsal penile nerves in patients resistant to conventional treatments. Fifteen patients with a lifelong history of PE, defined as an intravaginal ejaculatory latency time (IELT) of <1 minute that occurred in more than 90% of acts of intercourse and was resistant to conventional treatments, were enrolled in this study. Patients with erectile dysfunction were excluded. The mean age of the patients was 39 +/- 9 years. Before and 3 weeks after the treatment, IELT and sexual satisfaction score (SSS; for patients and their partners) were obtained. The mean IELTs before and 3 weeks after procedure were 18.5 +/- 17.9 and 139.9 +/- 55.1 seconds, respectively. Side effects did not occur. Mean SSSs of patients before and after treatment were 1.3 +/- 0.3 and 4.6 +/- 0.5, and mean SSSs of partners before and after treatment were 1.3 +/- 0.4 and 4.4 +/- 0.5, respectively. In all cases, IELT and SSS were significantly increased (P < .05). None of the patients or their wives reported any treatment failure during the follow-up period. The mean follow-up time was 8.3 +/- 1.9 months. It is early to conclude that this new treatment modality might be used widely for the treatment of PE; however, because it is an innovative modality, placebo-controlled studies (eg, sham procedure), with larger numbers of patients and including assessment of penile sensitivity (eg, biothesiometry), are needed.

Proanthocyanidin protects intestine and remote organs against mesenteric ischemia/reperfusion injury.

BACKGROUND: Intestinal ischemia/reperfusion (IR) induces a systemic inflammatory response and releases harmful substances that may affect the function and integrity of distant organs such as lung, liver, and kidney. We conducted this study to find out if proanthocyanidins (PA) has protective effects against mesenteric IR injury and mesenteric IR-induced intestinal and distant organ injury. MATERIALS AND METHODS: Thirty-two Sprague-Dawley rats were divided into four groups: control, control + PA, IR, IR + PA. The IR and IR + PA groups were subjected to mesenteric arterial ischemia for 60 min and reperfusion for 6 h. The Control + PA and IR + PA groups were administered PA (100 mg/kg/day via oral gavage) for 7 days prior to injury insult. We collected ileal and distant organ tissues, such as pulmonary, hepatic, and kidney specimens to measure tissue levels of malondialdehyde (MDA), superoxide dismutase (SOD), glutathione peroxidase (GPx), and nitrite plus nitrate (NO(x)), and we then evaluated histological changes. RESULTS: In the IR group, significant increases in MDA and NO(x) levels and significant increases in SOD and GPx activities of intestine, liver, kidney, and lung were observed. The MDA and NO(x) levels were significantly lower, as were the SOD and GPx activities in the IR + PA group than that in the IR group. Although the intestine and distant organs damage scores were significantly higher in the IR group, these injuries were prevented by PA in the IR + PA group. CONCLUSIONS: This study demonstrates that PA has a significant effect in the protection of the intestine and the remote organs against mesenteric IR injury.

[A clinic's experiences in postoperative patient controlled analgesia]. / Postoperatif hasta kontrollü analjezide bir klinigin deneyimleri.

OBJECTIVES: Postoperative analgesia technique varies depending on the operation, patient, anesthetist, and circumstances. PCA (patient controlled analgesia) is an effective way of supporting postoperative analgesia. In this study, we aimed to present the efficacy and safety of our postoperative PCA treatment and the patient profile along with the requirements, preferences and decision-making process. METHODS: We discuss herein the PCA protocols of our clinic, the overall distribution of operations for which PCA was applied and the principles by which a pain team works. RESULTS: The operations for which PCA was applied included knee prosthesis, cesarean section, hip prosthesis, lower extremity trauma surgery, painless delivery, gastrointestinal surgery, multiple trauma surgery, thoracotomy, hysterectomy, laminectomy, and urogenital surgery. Postoperative PCA alone was successful in 89% of the patients, and with the supplemental analgesic agent, it was successful in an additional 6% of the patients, thus achieving a total success rate of 95%. CONCLUSION: We believe the epidural and intravenous PCA protocols applied in our clinic for postoperative analgesia are effective and safe.

Ameliorative effects of proanthocyanidin on renal ischemia/reperfusion injury.

INTRODUCTION: Several natural products have been reported to have beneficial effects on ischemia/reperfusion (I/R) injury, particularly from a preventative perspective. Therefore, this study was designed to investigate the efficiency of proanthocyanidin (PA), a natural product derived from grape seed, on renal dysfunction and injury induced by I/R of rat kidney. MATERIALS AND METHODS: Twenty-four male Sprague-Dawley rats were divided into three groups: sham-operated, I/R, I/R+PA. Rats were given PA (100 mg/kg/day peroral) 7 days prior to I/R. All rats except sham-operated underwent 60 min of bilateral renal ischemia followed by 6 h of reperfusion. After reperfusion, kidneys and blood were obtained for evaluation. Superoxide dismutase, glutathione peroxidase, malondialdehyde, protein carbonyl content, and nitrite/nitrate level (NO(x)) were determined in the renal tissue. Serum creatinine (S(Cr)), blood urea nitrogen (BUN), and aspartate aminotransferase (AST) were determined in the blood. Additionally, renal sections were used for histological grade of renal injury. RESULTS: PA significantly reduced the I/R-induced increases in S(Cr), BUN, and AST. In addition, PA markedly reduced elevated oxidative stress product, restored decreased antioxidant enzymes, and attenuated histological alterations. Moreover, PA attenuated the tissue NO(x), levels indicating reduced NO production. CONCLUSIONS: The pretreatment of rats with PA reduced the renal dysfunction and morphological changes, ameliorated cellular injury, and restored renal antioxidant enzymes caused by renal I/R.