The effect of buzzy®, DistrACTION® cards on reducing pediatric pain and fear during blood collection in the rheumatology polyclinic: A randomized controlled trial.

PURPOSE: The aim of this study was to compare the effectiveness of Buzzy® and DistrACTION® Cards in reducing children's pain and fear while taking venous blood samples. METHODS: This research was designed as a randomized controlled experimental study. The study population consisted of children aged 6-12 years admitted to the Pediatric Rheumatology Diseases Polyclinic in a Faculty of Medicine in Germany. The sample of the study consisted of 96 children (Buzzy® = 32, DistrACTION® Cards = 32, control = 32) who met the patient selection criteria and agreed to participate in the study. The data were obtained using a Child and Family Information Form, the Children Fear Scale (CFS), and the Faces Pain Scale-Revised (FPS-R). The data were evaluated using the Pearson chi-square test, Kruskal-Wallis test, One-way ANOVA test with Bonferroni correction, and Fisher-Freeman-Halton. FINDINGS: In the study, the average age of the children was 9.21 ± 2.15 years. The Buzzy® group had the lowest pain and procedural fear scores (self-report = 0.88 ± 1.13, 0.31 ± 0.47; parent report = 0.75 ± 0.98, 0.34 ± 0.48, and researcher report = 0.81 ± 1.00, 0.31 ± 0.54, respectively) than the DC, and control groups. CONCLUSIONS: The Buzzy® method was effective in reducing venipuncture pain and fear in children. PRACTICE IMPLICATIONS: Nurses can use the Buzzy® methods to help reduce venipuncture pain and fear in children. The clinical trial registration number is NCT05560074. (https://clinicaltrials.gov/ct2/show/study/NCT05560074).

Bowel dysfunction and irritable bowel syndrome in fibromyalgia patients.

Fibromyalgia and irritable bowel syndrome are both common conditions which account for most of the referrals to physical medicine and rehabilitation-rheumatology and gastroenterology clinics, and they frequently coexist. In this study, we utilized a previously validated questionnaire to assess the prevalence of symptoms of bowel dysfunction and irritable bowel syndrome, and to survey the range of bowel pattern in 75 patients with fibromyalgia as compared to 50 normal controls. Symptoms associated with irritable bowel syndrome (p < 0.05) were reported in 41.8% of the fibromyalgia patients and 16% of the normal controls. In conclusion, we found that patients with fibromyalgia have a high prevalence of gastrointestinal complaints confirming the results indicating that fibromyalgia and irritable bowel syndrome frequently coexist. This may suggest a common pathogenic mechanism for both conditions.

A prospective randomized trial from Turkey comparing octreotide versus injection sclerotherapy in acute variceal bleeding.

BACKGROUNDS/AIMS: Bleeding from gastroesophageal varices continues to be a life threatening complication of chronic liver diseases and portal hypertension. The purpose of this randomized prospective study is to compare the efficacy of octreotide administration and emergency injection sclerotherapy for the control of actively bleeding esophageal varices and prevention of early rebleeding in patients with cirrhosis. METHODOLOGY: A total of 66 episodes of endoscopically proven active variceal bleeding in 52 patients were included in this study. Following admission to the hospital, the patients were resuscitated with blood and plasma, and fiberoptic endoscopy was performed within 2 hours. Thirty-six bleeds in 28 patients and 30 bleeds in 24 patients were randomized to endoscopic variceal sclerotherapy (1% polidocanol) and to octreotide infusion (at 50 micrograms/h for 12 hours following the initial 50 micrograms i.v. bolus), respectively. RESULTS: Bleeding was initially controlled within 6 hours in 75% of episodes by endoscopic variceal sclerotherapy and in 73.3 by octreotide infusion (P > 0.05). There were no significant differences between the 2 groups in early rebleeding (within 72 hours of randomization) (22% vs. 22.7%), blood transfusion (4.2 +/- 1.8 units vs. 4.8 +/- 2.9 units), or hospital mortality (3.6% vs. 3.3%). Treatment failed in 9 episodes (25%) in the sclerotherapy group and in 8 episodes (26.7%) in the octreotide group. CONCLUSIONS: We consider that Octreotide would appear to be as effective as sclerotherapy in both the early control of variceal hemorrhage and in the prevention of early recurrent bleeding and should therefore be considered the treatment of choice in those centers where 24-hour endoscopy is not available. Furthermore, even in hospitals that do have a 24-hour endoscopy service there is good evidence that octreotide therapy should be commenced as soon as a patient enters hospital with a suspected variceal bleed to achieve rapid homeostasis. When initial hemostasis is achieved, elective endoscopic therapies can be undertaken with greater success.

Percutaneous drainage of hepatic abscesses: therapy does not differ for those with identifiable biliary fistula.

BACKGROUND/AIMS: Surgical drainage of pyogenic and amoebic hepatic abscesses has been an accepted therapy for decades. Modern imaging modalities have changed both the diagnostic and therapeutic management of many hepatic lesions, particularly abscesses. Specifically, percutaneous aspiration and drainage with either ultrasound or computed tomography guidance has been reported as an alternative treatment for hepatic abscesses in recent years. Little is known about aspiration of hepatic abscesses that communicate with the biliary tree. MATERIAL AND METHODS: Fifteen patients with hepatic abscesses treated by percutaneous aspiration and drainage are herein reported. Six had a demonstrable fistulous communication between the abscess and the biliary tree. RESULTS: During a four year period of follow-up, only two of these 15 patients experienced a recurrence. Neither had a biliary fistula complicating their abscess initially. CONCLUSIONS: Based upon this experience, it is suggested that percutaneous aspiration and drainage should be the initial treatment of choice of both pyogenic and amoebic liver abscesses even when large. Abscesses with demonstratable biliary fistulas have a larger mean volume than do those without fistulous involvement. The finding of a communication between the abscess and the biliary tree should not change this treatment approach.

Congenital hepatic fibrosis associated with cavernous transformation of the portal vein.

BACKGROUND/AIMS: Congenital hepatic fibrosis (CHF), which is one of the fibropolycystic diseases, occurs in various forms. Portal hypertension, a very common clinical feature of this condition, has been attributed to the compression of portal vein radicles in the fibrous bands. We investigated whether there are any other contributing factors in the development of portal hypertension in patients with CHF. METHODOLOGY: A total of 1285 patients with portal hypertension of different etiologies were studied using ultrasonography as the screening test. Forty-seven (including portal vein involvement and/or CHF) of these 1285 patients were prospectively studied to evaluate the etiology of the portal hypertension by portography, abdominal computed tomography, exploratory laparotomy, peritonoscopy, liver biopsy and laboratory tests. The patients with CHF were divided into two groups, according to whether or not they had portal vein involvement. RESULTS: Eleven (0.8%) of the 1285 patients with portal hypertension had CHF, and 41 (3.2%) had cavernous transformation of the portal vein (CTPV), resulting from different or unknown etiologies. Five patients had both pathologies (CTPV and CHF). In the 11 patients with CHF, there was CTPV in 5 patients, Caroli's disease in 2 patients, cholangiocarcinoma in 1 patient, inferior vena caval obstruction in 1 patient, and CHF in only 2 patients. There were statistically significant differences in the age of the CHF patients at clinical onset, the incidence of bleeding from esophageal varices, and laboratory findings between the 2 groups with and without CTPV. Despite a thorough investigation, we could not distinguish any predisposing factor in 25 of the 41 patients with CTPV. The incidence of CTPV was 48% in patients with CHF and 3.2% in patients with portal hypertension. CONCLUSIONS: These results suggest that the association of CTPV with CHF is not coincidental, but that CTPV may be associated with CHF and a new possible factor in portal hypertension, and that it can be a major factor in the manifestation of esophageal bleeding from varices.

Vasculitis of breast in Behçet's disease--a case report.

This is the case report of a thirty-one-year-old woman who presented with a large skin lesion on a breast that was first thought to be a malignant or inflammatory process. After a biopsy, the lesion was diagnosed as nonspecific vasculitis. No similar case has been found in a review of the literature.

[Campylobacter bacteremia]. / Bir Campylobacter bakteriemisi.

In this article, Campylobacter bacteremia in a diabetic and last stage kidney patient has been reported.

The effect of enalapril on renal resistive index, urine electrolyte levels and TGF-ß1 levels of kidney tissues in rats with unilateral partial ureteropelvic junction obstruction.

BACKGROUND: This study aimed to investigate renal arterial resistive index measurements and urine electrolytes before and after enalapril therapy in a rat model of unilateral ureteropelvic obstruction. The transforming growth factor (TGF)-ß1 response of the renal tissue was also investigated. MATERIALS AND METHODS: 30 Wistar albino rats were randomly allocated into 5 groups (n=6). Group C rats served as controls. Group S rats had only laparotomy. Group E rats were only treated with enalapril. Rats in group UP and group UPE underwent laparotomy to create a left unilateral moderate partial obstruction. 2 weeks after establishing partial ureteropelvic junction obstruction, group UPE rats were treated with enalapril. Urine was collected over 24 h in all groups. Intrarenal arterial resistive index measurements were performed before and 2 weeks after surgery and after enalapril treatment in group UPE, and before and after enalapril treatment in group E. Rats were sacrificed by intracardiac puncture and left kidneys were harvested to evaluate levels of mRNA TGF-ß1. RESULTS: There was no significant difference in ARI values in group E. In group UPE, the difference between ARI values before and after surgery was statistically significant; the difference between ARI values after surgery and after enalapril treatment was also statistically significant. There was no statistically significant intra-group difference in urine electrolyte levels for UP group or UPE group. There was no difference in renal mRNA TGF-ß1 levels. CONCLUSION: Enalapril maintained renal blood flow by decreasing the arterial resistive index and maintained renal tubular function by protecting urine concentration and dilution ability in a rat model with unilateral ureteropelvic junction obstruction.

Effectiveness of pre-emptive metoclopramide infusion in alleviating pain, discomfort and nausea associated with nasogastric tube insertion: a randomised, double-blind, placebo-controlled trial.

Aim of this study was to demonstrate that intravenous metoclopramide can reduce pain, nausea and discomfort during nasogastric tube (NGT) insertion in ED. This prospective, randomised, double-blind, placebo-controlled trial was conducted in the university-based ED. One-hundred patients were enrolled. Before NGT insertion, each eligible patient was randomised to one of the two treatment arms: one group received 2 cc of 10 mg IV metoclopramide, whereas others received 2 cc of normal saline. Before and after the procedure, pain, nausea and discomfort were evaluated using 100-mm visual analogue scale (VAS). This study was analysed using the paired sample test, the independent sample test and the chi(2) test. Forty-nine patients received metoclopramide, and 51 received normal saline. Although initial VAS levels elicited for pain, nausea and discomfort were similar, consequent VAS levels of those in the metoclopramide group were significantly lower as compared with those in the normal saline group. The mean differences of VAS levels were statistically significant for three symptoms (p < 0.001). Mean VAS levels of nausea, discomfort and pain during NGT insertion were significantly lower following administration of IV metoclopramide as compared with normal saline.

What has the surgeon to know about pathophysiology of reflux disease?

Much has been learned about the pathophysiology of gastro-esophageal reflux (GER) since it was initially described by Asher Winkelstein in 1935. With the development and refinement of esophageal function tests in the past decades, the diagnostic modalities have become available for a deliberate and systematic evaluation of antireflux mechanisms. Some of the newer concepts of the pathogenesis of reflux esophagitis are reviewed in this article.

Reverse-perfused sleeve: an improved device for measurement of sphincteric function of the crural diaphragm.

The sphincteric function of the crural diaphragm has been difficult to measure in humans. The authors recently reported the use of a Dent sleeve device to measure esophagogastric junction pressure during contraction of the crural diaphragm. However, the major limitation of the conventional sleeve device is its slow response rate, and sustained diaphragmatic contractions of 6-8 seconds must be induced to measure the true pressure. In this article, the principles of a reverse-perfused sleeve device and the theoretical basis for its fast response rate are reported. The reverse-perfused sleeve is validated in an in vitro model of the lower esophageal sphincter. Furthermore, in vivo studies were performed in seven healthy human subjects. Standardized Muller maneuvers and straight-leg raises were performed to induce diaphragmatic contractions. Pressure increases of 50-150 mm Hg during diaphragmatic contractions were attained in less than 1 second. The delay between the actual contraction of the diaphragm as measured by simultaneously recorded crural diaphragm electromyography and pressure recorded by the sleeve was only 0.25-0.50 seconds. Increasing the rate of infusion of the sleeve from 0.5 to 1.0 mL/min did not further improve the response rate of the reverse perfused sleeve. It was concluded that the reverse-perfused sleeve is a considerable improvement over the conventional sleeve for quantitating the sphincteric function of the crural diaphragm. The role of the crural diaphragm in reflux esophagitis may be easily investigated using a reverse-perfused sleeve device.

Effect of crural myotomy on the incidence and mechanism of gastroesophageal reflux in cats.

BACKGROUND: Esophagogastric junction (EGJ) pressure is the major barrier to gastroesophageal reflux. Recent studies suggest that contraction of the crural diaphragm increases esophagogastric junction pressure. Whether this increase in EGJ pressure is important in the prevention of gastroesophageal reflux is not known. Our aim in this study was to determine the effects of crural myotomy on the occurrence of gastroesophageal reflux. METHODS: The spontaneous and stress gastroesophageal reflux before and after a surgical crural myotomy in four cats was studied. Spontaneous gastroesophageal reflux was recorded in the awake cats through a pH probe, placed via an esophagostomy, for periods of 12-24 hours. Stress reflux was studied during periods of airway obstruction and abdominal compression in anesthetized animals using the technique of simultaneous esophageal manometry and pH monitoring. RESULTS: There was a significant increase in the frequency of spontaneous acid reflux after crural myotomy. In anesthetized animals, there was an increase in the EGJ pressure during airway obstruction, which was abolished by a crural myotomy. Abdominal compression caused a reflex contraction at the EGJ that was not affected by crural myotomy. The crural myotomy resulted in a significant increase in the frequency of acid reflux during airway obstruction but not during abdominal compression. CONCLUSIONS: It is concluded that the crural diaphragm is important in the prevention of gastroesophageal reflux and its dysfunction leads to an increased incidence of gastroesophageal reflux.

The expanding spectrum of a disease. Behçet's disease associated with amyloidosis.

In this report, we present a series of 6 patients with Behçet's disease (BD) associated with amyloidosis whose illnesses date back at least 4 years. In all the cases, nephrotic syndrome heralded the onset of amyloidosis, which was diagnosed by percutaneous kidney biopsies. After the diagnosis of amyloidosis, all subjects received colchicine, and steroids were discontinued. Three patients have benefited from treatment. It was suggested that amyloidosis may be an intrinsic feature of BD or that the suppurative lesions may play a role in the accumulation of amyloid in the tissues. The literature was reviewed and discussed.

Interferon-alpha does not cause significant cardiac dysfunction in patients with chronic active hepatitis.

The cardiac adverse effects of interferon (INF) treatment have been reported recently in various clinical trials of INF. In this study, the cardiac effects of recombinant INF-alpha treatment were evaluated prospectively in a group of patients with chronic active viral hepatitis (CAH). Sixteen patients with CAH type B, 14 patients with CAH type C and one patients with CAH type D were included in this study, and 4.5, 3 and 9 MU of recombinant INF-alpha-2a was administrated three times a week to these patients, respectively. The durations of treatment were 6 months for CAH type B and C, and 12 months for type D. The cardiac status of all patients was evaluated and monitored with a detailed medical history, physical examination, electrocardiography (ECG), telecardiography, echocardiography and heart rate variability tests at the beginning of the study and at the first and sixth months of INF therapy and also 6 months after ceasing the therapy. The clinical evaluation of patients before the treatment revealed that three had hypertension, one had a past medical history of myocardial infarction, one had a prosthetic mitral valve replacement and another had left hemiblock in her ECG record. No significant changes and adverse effects were detected in clinical examination and cardiovascular tests of all patients, either in pre-existing cardiovascular diseases, during therapy and after stopping the treatment. The cardiac adverse effects of INF reported in previous studies are questionable and we conclude that it can be used safely in CAH patients. Therefore, it should be kept in mind that fever and tachycardia may occur during the first and second weeks of INF therapy and patients with high risk for cardiac disease should be monitored closely in this period of treatment.

Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis.

Patients with gastroparesis frequently present challenging clinical, diagnostic, and therapeutic problems. Data from 146 gastroparesis patients seen over six years were analyzed. Patients were evaluated at the time of initial diagnosis and at the most recent follow-up in terms of gastric emptying and gastrointestinal symptomatology. The psychological status and physical and sexual abuse history in female idiopathic gastroparesis patients were ascertained and an association between those factors and gastrointestinal symptomatology was sought. Eighty-two percent of patients were females (mean age: 45 years old). The mean age for onset of gastroparesis was 33.7 years. The etiologies in 146 patients are: 36% idiopathic, 29% diabetic, 13% postgastric surgery, 7.5% Parkinson's disease, 4.8% collagen vascular disorders, 4.1% intestinal pseudoobstruction, and 6% miscellaneous causes. Subgroups were identified within the idiopathic group: 12 patients (23%) had a presentation consistent with a viral etiology, 48% had very prominent abdominal pain. Other subgroups were gastroesophageal reflux disease and nonulcer dyspepsia (19%), depression (23%), and onset of symptoms immediately after cholecystectomy (8%). Sixty-two percent of women with idiopathic gastroparesis reported a history of physical or sexual abuse, and physical abuse was significantly associated with abdominal pain, somatization, depression, and lifetime surgeries. At the end of the follow-up period, 74% required continuous prokinetic therapy, 22% were able to stop prokinetics, 5% had undergone gastrectomy, 6.2% went onto gastric electrical stimulation (pacing), and 7% had died. At some point 21% had required nutrition support with a feeding jejunostomy tube or periods of parenteral nutrition. A good response to pharmacological agents can be expected in the viral and dyspeptic subgroups of idiopathics, Parkinson's disease, and the majority of diabetics, whereas a poorer outcome to prokinetics can be expected in postgastrectomy patients, those with connective tissue disease, a subgroup of diabetics, and the subset of idiopathic gastroparesis dominated by abdominal pain and history of physical and sexual abuse. Appreciation of the different etiologies and psychological status of the patients may help predict response to prokinetic therapy.

Influence of viral load and alanine aminotransferase on viral genetic heterogeneity in patients with chronic hepatitis C virus infection.

BACKGROUND/AIM: Hepatitis C virus (HCV) populations in vivo consist of genetically different heterogeneous mixtures defined as 'quasispecies', which vary in the hypervariable region 1 (HVR1) mostly. To further address the role of quasispecies diversity in hepatitis C infection, this study aimed to evaluate the influence of ALT, viral load and genotypes on quasispecies heterogeneity in patients with HCV infection. METHODS: Thirty-six chronic hepatitis C patients with high levels of alanine aminotransferase (ALT) were studied. None of them received any antiviral therapy. HCV RNA serum levels, genotype and genetic heterogeneity were determined by branched-chain DNA assay, restriction fragment length patterns and RT-PCR single-strand conformational polymorphism analysis of HVR1, respectively. RESULTS: Twenty-eight patients had genotype 1b (28/36; 78%), 6 patients had genotype 1a (6/36; 17%), 1 patient was 2a (1/36; 3%) and genotype could not be determined in 1 patient. The patients were categorized into two groups according to the number of bands representing the dominant strains in the circulation: group A with 2 bands having 1 strain (14/36 patients; 39%) and group B with more than 2 bands indicating more than 1 strain (22/36 patients; 61%). The serum viremia and ALT levels for these groups were 11 +/- 8.8 and 5.3 +/- 4.6 mEq/ml (p < 0.05), and 79 +/- 20, and 127 +/- 80 IU/l (p < 0.05), respectively. CONCLUSION: The results of this study suggest that hepatitis C patients having 1 dominant strain in the circulation may show a relatively weaker immune response resulting in lower ALT and higher viremia levels, whereas patients with high degrees of virus quasispecies diversity have higher ALT levels and a more active immune response causing the selection of new genome variants and depressing viral replication partly.