Establishment of 3D cell culture systems with decellularized lung-derived extracellular matrix hydrogel scaffold.

Decellularized tissue hydrogels, especially that mimic the native tissue, have a high potential for tissue engineering, three-dimensional (3D) cell culture, bioprinting, and therapeutic agent encapsulation due to their excellent biocompatibility and ability to facilitate the growth of cells. It is important to note that the decellularization process significantly affects the structural integrity and properties of the extracellular matrix, which in turn shapes the characteristics of the resulting hydrogels at the macromolecular level. Therefore, our study aims to identify an effective chemical decellularization method for sheep lung tissue, using a mixing/agitation technique with a range of detergents, including commonly [Sodium dodecyl sulfate (SDS), Triton X-100, and 3-((3-cholamidopropyl) dimethylammonio)-1-propanesulfonate] (CHAPS), and rarely used (sodium cholate hydrate, NP-40, and 3-[N,N-Dimethyl(3-myristoylaminopropyl)ammonio]propanesulfonate) (ASB-14). After the effectiveness of the used detergents on decellularization was determined by histological and biochemical methods, lung derived decellularized extracellular matrix was converted into hydrogel. We investigated the interactions between lung cells and decellularized extracellular matrix using proliferation assay, scanning electron microscopy, and immunofluorescence microscopy methods on BEAS-2B cells in air-liquid interface. Notably, this study emphasizes the effectiveness of ASB-14 in the decellularization process, showcasing its crucial role in removing cellular components while preserving vital extracellular matrix biological macromolecules, including glycosaminoglycans, collagen, and elastin. The resulting hydrogels demonstrated favorable mechanical properties and are compatible with both cell-cell and cell-extracellular matrix interactions.

Transscleral Delivery of Bevacizumab-Loaded Chitosan Nanoparticles.

Purpose: The aim of this study was to synthesize bevacizumab-loaded nanoparticles and evaluate their effects on the treatment of posterior segment diseases via subtenon injections. Methods: Bevacizumab-loaded chitosan nanoparticles (BLCNs) were synthesized by the ionic gelation method, and their physicochemical characteristics and in vitro release profile were studied. The BLCNs were characterized using atomic force microscopy (AFM), FTIR spectroscopy, dynamic light scattering, and scanning electron microscopy. The BLCNs were delivered into rabbits' eyes via posterior subtenon injections. An immunohistochemical evaluation of the ocular tissues was performed, and the vitreous humor and serum bevacizumab levels were measured by ELISA. Results: Bevacizumab-loaded chitosan nanoparticles with a diameter of 80 to 380 nm were prepared and characterized. In vitro studies showed that after the first 5 days of the experiment, a significant increase in the drug release maintained the desired drug dosage for 3 weeks. Immunohistochemical in vivo studies revealed that there were BLCNs penetrating through the sclera. Furthermore, the intravitreal bevacizumab concentration reached a maximum concentration of 18 µg/ml, and it decreased to 6 µg/ml after only a week. Conclusion: The results revealed that subtenon injection of BLCNs is a promising alternative to intravitreal injections. In addition to the ELISA studies, immunohistochemical experiments confirmed that BLCNs enable transscleral bevacizumab penetration, and BLCN usage may provide the required bevacizumab levels for the treatment of posterior segment diseases.

Downregulation of ABCE1 via siRNA affects the sensitivity of A549 cells against chemotherapeutic agents.

ATP-binding cassette E1 (ABCE1) is involved in several biological functions in cancer cells such as tumor proliferation, antiapoptotic pathway and chemoresistance mechanism. This work aimed to investigate the alterations in chemosensitivity of A549 lung cancer cells for 5-Fluorouracil (5-FU) and irinotecan by silencing ABCE1 using specific small interfering RNAs (siRNA). The cells were treated with low doses of drugs, alone and also their combinations with ABCE1 siRNA. Cytotoxicity, cell proliferation and apoptosis/necrosis evaluations were performed in order to examine the effects of the combined treatment. Reverse transcriptase polymerase chain reaction (RT-PCR) was used to confirm the downregulation of ABCE1. We also investigated the levels of B cell lymphoma 2 (Bcl-2) and mammalian target of rapamycin (mTOR) after the treatments by RT-PCR. Downregulation of ABCE1 improved the anticancer effects of 5-FU in inducing cell viability/proliferation inhibition and apoptosis/necrosis, whereas interestingly, almost did not change or slightly reduced the anticancer effects of irinotecan. ABCE1 expression significantly decreased by transfecting the cells with ABCE1 siRNA. Moreover, Bcl-2 and mTOR levels changed after the single or combined therapy in parallel with the apoptotic and antiproliferation effect. In conclusion, the simultaneous treatment of lung cancer cells with ABCE1 siRNA and 5-FU exhibited synergistic or additive effects; however, ABCE1 siRNA and irinotecan had unexpected antagonistic effects. Our findings demonstrate that the strategy of downregulation of ABCE1 may be included in conventional 5-FU chemotherapy for lung cancer, minimizing the usage of 5-FU at high dosages.

[The role of magnesium in preventing postoperative hyperalgesia]. / Postoperatif hiperaljezinin önlenmesinde magnezyumun rolü

OBJECTIVES: Intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain, opioid requirement and specifically periincisional hyperalgesia. The aim of this study was to investigate the effect of magnesium in preventing remifentanil-induced hyperalgesia. METHODS: This study was performed on 60 (ASA I-II) patients planned for abdominal hysterectomy. Sixty patients were randomized into two equal groups. Before anesthesia, saline solution was given to the patients in group I (control group), 50 mg/kg i.v. Magnesium in group II (magnesium group). Anesthesia was induced with 1 µg/kg remifentanil combined with 4-5 mg/kg thiopental and 0.5 mg/kg atracurium, maintained with 0.5 MAC sevoflurane and 0.4 µg/kg/min remifentanil in both groups. Sevoflurane concentration was titrated according to autonomic responses. Thirty minutes before the anticipated end of surgery, a 0.15 mg/kg bolus dose of morphine was intravenously. At the end of surgery, patients received tramadol i.v via a PCA device. Pain score, tramadol demand and delivery were assessed at 2, 4, 6, 12, 24 h after surgery. Total tramadol consumption were recorded for 24-48 h after surgery. Periincisional hyperalgesia was assessed by measuring pain threshold to pressure by using an algometer and electronic von Frey filaments before operation and at 28-48 h postoperatively. RESULTS: The pain scores and cumulative tramadol consumption were significantly lower in the magnesium group compared with the control group (p<0.05). Pressure and mechanical pain threshold were significantly less at 24-48 h postoperatively in control group than magnesium group. CONCLUSION: Magnesium administered preemptively reduced remifentanil-induced hyperalgesia.

[The effects of preemptive dexketoprofen use on postoperative pain relief and tramadol consumption]. / Preemptif deksketoprofen kullaniminin postoperatif agri ve tramadol tüketimine etkisi.

OBJECTIVES: In this study, the efficacy of preemptive dexketoprofen usage on postoperative pain relief and tramadol consumption was evaluated. METHODS: Fifty American Society of Anesthesiologists (ASA)-I or ASA-II patients undergoing plastic surgery were randomized into two groups. Group 1 received dexketoprofen 25 mg and Group 2 received placebo tablets 1 hour (h) before surgery. All patients received a standard anesthetic protocol. At the end of the surgery, all patients received intravenous tramadol with Patient Controlled Analgesia (PCA) device. Pain scores was evaluated with visual analog scale during the postoperative 1st, 8th and 24th h. Tramadol consumption, adverse effects and patient satisfaction were recorded. RESULTS: The pain scores and tramadol consumption were significantly lower in Group 1 (p<0.05). Nausea and vomiting were observed more in Group 2 than Group 1, and patient satisfaction was better in Group 1 (p<0.05). CONCLUSION: Preemptive use of dexketoprofen reduced postoperative tramadol consumption and incidence of adverse events.

[The effects of intravenous dexketoprofen on postoperative analgesia and morphine consumption in patients undergoing abdominal hysterectomy]. / Abdominal histerektomi uygulanan olgularda intravenöz deksketoprofenin postoperatif analjezi ve morfin tüketimine etkisi.

OBJECTIVES: Dexketoprofen trometamol is a water-soluble salt of the dextrorotatory enantiomer of the nonsteroidal anti-inflammatory drug ketoprofen. The aim of this study was to investigate the effect of intravenous dexketoprofen on postoperative pain. METHODS: This study was performed on 50 (ASA I-II) patients scheduled for abdominal hysterectomy. Fifty patients were randomized into two equal groups. Patients received saline solution (Group I) or 50 mg intravenous dexketoprofen (Group II) 1 hour (h) before surgery and 8-16 h after surgery. All patients received a standard anesthetic protocol. At the end of surgery, all patients received intravenous (IV) morphine via a PCA (patient- controlled analgesia) device. Pain scores were assessed at 2, 6, 12 and 24 h after surgery. Morphine consumption and adverse effects were noted during the first 24 h after the surgery. The pain scores were significantly lower in the dexketoprofen group compared with the control group (p<0.05). RESULTS: The cumulative morphine consumption was also lower in the dexketoprofen group than the control group (p<0.05). No significant difference was observed in adverse effects between the groups (p>0.05). CONCLUSION: We conclude that the administration of IV dexketoprofen provided a significant analgesic benefit and decreased the morphine requirements in patients undergoing abdominal hysterectomy.

[The effects of the administration of subfacial levobupivacaine infusion with the ON-Q pain pump system on postoperative analgesia and tramadol consumption in cesarean operations]. / Sezaryen cerrahisinde ON-Q agri pompa sistemi ile uygulanan subfasiyal levobupivakain infüzyonunun postoperatif analjezi ve tramadol tüketimine etkisi.

OBJECTIVES: In this study, the effects of administration of subfacial levobupivacaine infusion with the ON-Q pain pump system were investigated in elective cesarean operations for postoperative pain control and tramadol-sparing effect. METHODS: Fifty ASA I-II patients scheduled for cesarean operation were enrolled into this study. Patients were randomly divided into two groups: Group I served as a control group, without the ON-Q pain pump system, whereas Group II received the ON-Q pain pump system with subfacial 0.25% levobupivacaine infusion for 24 hours at 4 ml/hour. All patients received a standard anesthetic protocol. At the end of the surgery, all patients received tramadol i.v. Via a PCA (Patient Controlled Analgesia) device. Pain scores were assessed at 2, 6, 12 and 24 hours postoperatively. Tramadol consumption and adverse effects were noted in the first 24 hours following surgery. RESULTS: The pain scores were significantly lower in the levobupivacaine group when compared with the control group (p<0.05). The cumulative tramadol consumption was lower in the levobupivacaine group than in the control group (p<0.05). Group II used less antiemetic and had less postoperative nausea and vomiting, and the difference was statistically significant (p<0.05). CONCLUSION: No complication occurred as a result of the ON-Q pain pump system. Subfacial levobupivacaine infusion with the ON-Q pain pump system diminished postoperative pain and the need for tramadol use following cesarean operations.

[The effects of intravenous paracetamol on postoperative analgesia and tramadol consumption in cesarean operations]. / Sezaryen cerrahisinde intravenöz parasetamolün postoperatif analjezi ve tramadol tüketimine etkisi.

OBJECTIVES: In this study, the effects and side effects of intravenous paracetamol application, combined with patient-controlled intravenous tramadol analgesia, were investigated in elective cesarean operations for postoperative pain control and its tramadol-sparing effect. METHODS: Fifty ASA I-II patients scheduled for cesarean operation were enrolled in this study. Patients were randomly divided into two groups: group I served as a control group, with saline administration (100 ml) 15 min before the end surgery and every 6 h for 24 h, whereas group II received paracetamol (1 g/100 ml) at the stated time points. All patients received a standard anesthetic protocol. At the end of surgery, all patients received tramadol i.v. via a PCA (patient-controlled analgesia) device. Pain and sedation scores were assessed at 1, 3, 6, 12 and 24 h postoperatively. RESULTS: Tramadol consumption and adverse effects were noted in the first 24 hours following surgery. The pain scores were significantly lower in the paracetamol group when compared with the control group (p<0.05). The cumulative tramadol consumption was lower in the paracetamol group than the control group (p<0.05). No significant difference was observed in sedation scores and nausea-vomiting scores between the groups (p>0.05). CONCLUSION: We conclude that paracetamol is a safe and effective treatment option in post-cesarean pain for combination with tramadol, as it produces effective analgesia and reduces tramadol consumption.

Effects of preoperative oral melatonin medication on postoperative analgesia, sleep quality, and sedation in patients undergoing elective prostatectomy: a randomized clinical trial.

PURPOSE: Our intention was to assess the effectiveness of preoperative oral melatonin medication on sedation, sleep quality, and postoperative analgesia in patients undergoing elective prostatectomy. METHODS: Fifty-two ASA I-II patients undergoing elective prostatectomy were included in this study, randomly divided into two groups. Patients received an oral placebo (n = 26) or 6 mg melatonin (n = 26) the night before and 1 h before surgery. All patients received a standard anesthetic protocol. At the end of surgery, all patients received tramadol i.v. via a PCA device. Extubation time, intraoperative fentanyl consumption, and recovery time were assessed at the end of the operation. Pain scores, tramadol consumption, and sedation scores were assessed at 1, 2, 4, 6, 12, 18, and 24 h postoperatively, and sleep quality and subjective analgesic efficacy were assessed at 24 h after surgery. RESULTS: There were no significant differences in demographic data between the groups. Extubation time and recovery time from anesthesia were significantly longer in the melatonin group (P < 0.05). Intraoperative fentanyl usage, pain scores, and tramadol consumption were significantly lower in the melatonin group (P < 0.05). The postoperative sleep quality of patients was significantly better in the melatonin group than in the control group (P < 0.05). Postoperative VAS of pain was significantly lower in the melatonin group compared with the control group at 1, 2, 4, 6, 12, 18, and 24 h postoperatively (P < 0.05). Subjective analgesic efficacy of patients was significantly different between groups (P < 0.05). The sedation scores were significantly higher in the melatonin group than in the control group at 1 h and 2 h after surgery (P < 0.05). CONCLUSIONS: Preoperative oral melatonin administration decreased pain scores and tramadol consumption and enhanced sleep quality, sedation scores, and subjective analgesic efficacy during the postoperative period.

[The effects of lornoxicam in preventing remifentanil-induced postoperative hyperalgesia]. / Remifentanile bagli gelisen postoperatif hiperaljezinin önlenmesinde lornoksikamin etkisi.

OBJECTIVES: Intraoperative remifentanil administration results in acute opioid tolerance that is manifested by increased postoperative pain, opioid requirement and specifically peri-incisional hyperalgesia. The aim of this study was to investigate the effect of lornoxicam in preventing remifentanil-induced hyperalgesia. METHODS: Patients were randomly divided into two groups. Fifteen minutes before surgery, saline solution was given to the patients in group I and 16 mg i.v. Lornoxicam in group II. Anesthesia was induced with 1 microg/kg remifentanil combined with 1.5-2 mg/kg propofol and maintained with 0.5 MAC desflurane and 0.4 microg/kg/dk remifentanil in both groups. Desflurane concentration was titrated according to autonomic responses. All patients were given i.v. 0.15 mg/kg morphine 30 min before the end of surgery. At the end of surgery, patients received morphine i.v. Via a PCA (Patient Controlled Analgesia) device. Pain score, morphine demand and delivery were assessed at 2, 4, 6, 12 and 24 h after surgery. Total morphine consumption was recorded for 24-48 h. Peri-incisional hyperalgesia was assessed by measuring pain threshold to pressure using an algometer before operation and at 24-48 h postoperatively. RESULTS: The pain scores and cumulative morphine consumption were significantly lower in the lornoxicam group when compared with the control group (p<0.05). Pain thresholds were significantly less at 24-48 h postoperatively in the control group than in the lornoxicam group. No significant difference was observed in side effects (p>0.05). CONCLUSION: Lornoxicam administered preemptively prevented remifentanil-induced hyperalgesia.

[Gabapentin for neurophatic pain in children: a case report]. / Nöropatik agrilibir çocukta gabapentin kullanimi: Olgu sunumu.

Gabapentin is used as an analgesic in neuropathic pain. In this report a children with nerophatic pain because of mercury poising was followed-up for pain and side effects with the use of gabapentin. Pain reduction was good throughout the patient treatment. Severe side effects did not occur. Gabapentin was effective and well tolerated in the treatment of neuropathic pain in children.

Caudal anesthesia for minor subumbilical pediatric surgery: a comparison of levobupivacaine alone and levobupivacaine plus sufentanil.

STUDY OBJECTIVES: To compare the postoperative analgesic efficacy and duration of analgesia after caudal levobupivacaine 0.20% with and without the addition of sufentanil 0.5 microg kg(-1). DESIGN: Prospective, randomized study. SETTING: University teaching hospital. PATIENTS: 40 ASA physical status I pediatric patients, aged one to 7 years, who were scheduled for elective minor subumbilical surgery. INTERVENTIONS: Patients were divided into two groups to receive either a single caudal injection of one mL kg(-1) levobupivacaine 0.20% (Group L) or levobupivacaine 0.20% plus sufentanil 0.5 microg kg(-1) (Group LS). MEASUREMENTS: Analgesia (Children and Infants Postoperative Pain Scale score), motor block (Motor Blockade Scoring), and side effects were assessed at predetermined time points during the first 24 postoperative hours. MAIN RESULTS: The Children and Infants Postoperative Pain Scale scoring at the first hour was significantly lower in Group LS than in Group L. No significant differences were found between the two groups for pain scores at two, three, 4, 5, 6, 9, 12, and 24 hours. Degree of motor block was comparable between the two groups. CONCLUSION: The effect of adding sufentanil to caudal levobupivacaine on postoperative pain scores is brief after elective minor subumbilical surgery in children.

Addition of sufentanil to bupivacaine in caudal block effect on stress responses in children.

BACKGROUND: The aim of the present randomized study was to determine the effect of adding sufentanil to bupivacaine, compared with bupivacaine alone in caudal block, on the surgical stress response in children. METHODS: The children were premedicated with midazolam 0.5 mg/kg. All children received induction with nitrous oxide and sevoflurane. Anesthesia was maintained with the same volatile agents in the both groups. The children were randomly allocated to two groups. Group I received bupivacaine alone (n = 17) and group II received bupivacaine + sufentanil (n = 16). Caudal block was performed with 0.25% bupivacaine 2 mg/kg (group I) or 0.25% bupivacaine 2 mg/kg with sufentanil 0.5 microg/kg (group II) after induction of anesthesia. Blood samples were obtained after induction of anesthesia (T(0)) to measure baseline concentrations of cortisol, prolactin, glucose and insulin. Additional samples were obtained 30 min after the start of surgery (T(1)), and 60 min after the end of surgery (T(2)). RESULTS: All of the basal values (T(0)) were within the normal ranges of the authors' laboratory for children of this age group and there were no differences between the groups (P > 0.05). In both groups, glucose concentration increased at T(1), compared with T(0) and T(2) (P < 0.05). The glucose concentration was unchanged at T(2) compared with T(0) in both group (P > 0.05). In both groups, prolactin concentration increased at T(1), compared with T(0) and decreased at T(2), compared with T(1) (P < 0.05). Cortisol decreased at T(1) and T(2), compared with T(0) in both groups. (P < 0.05). Insulin concentration remained unchanged at T(0) and T(2), but increased slightly at T(1) in both groups (P > 0.05). There were no significant differences in plasma prolactin, cortisol, glucose and insulin levels between the two groups at T(1) and T(2) (P > 0.05). CONCLUSION: There is no advantage in adding 0.5 microg/kg sufentanil to bupivacaine over bupivacaine alone in the caudal block, with regard to the surgical stress response in children.

Prevention of postoperative nausea and vomiting after thyroidectomy: combined antiemetic treatment with dexamethasone and ginger versus dexamethasone alone.

BACKGROUND: The aim of this study was to compare the prophylactic effects of dexamethasone plus ginger and dexamethasone alone on postoperative nausea and vomiting (PONV) in patients undergoing thyroidectomy. METHODS: One hundred and twenty patients undergoing general anaesthesia for thyroidectomy were enrolled in this randomised, double-blind study. Patients received oral diazepam 10mg with either oral placebo (group I) or 0.5g of ginger (group II) as premedication 1 hour prior to surgery. Standard general anaesthetic techniques and postoperative analgesia were employed. Both group I and group II received intravenous dexamethasone 150 microg/kg immediately before the induction of anaesthesia. Data were recorded over a 24-hour observation period after surgery. RESULTS: In the dexamethasone-treated group, 14 patients experienced nausea, two patients retched, three patients vomited once, two patients vomited repeatedly, and 14 patients required a rescue antiemetic. In the dexamethasone-plus-ginger-treated group, 12 patients experienced nausea, one patient retched, four patients vomited once, no patients vomited repeatedly, and 13 patients required a rescue antiemetic. Dexamethasone plus ginger did not significantly reduce nausea and vomiting compared with dexamethasone alone during the observation period. CONCLUSION: In conclusion, the prophylactic combination of antiemetic treatment with dexamethasone and ginger was not clinically or statistically superior to dexamethasone alone in preventing PONV in patients undergoing thyroidectomy.

[Postoperatif agrida deksketoprofen kullanimi]. / Dexketoprofen for postoperative pain relief.

Dexketoprofen trometamol is a water-soluble salt of the dextrorotatory enantiomer of nonsteroidal anti-inflamatory drug ketoprofen. The aim of the study was to investigate the effect of dexketoprofen on postoperative pain. This study was performed on 50 (ASA I-II) patients planned for abdominal hysterectomy. Fifty patients were randomized into two equal groups. Patients received oral placebo (group I) and 25 mg dexketoprofen (group II) 1h before surgery and 8 -16 h after surgery. All patients received a standard anesthetic protocol. At the end of surgery, all patients received tramadol IV via a PCA (Patient Controlled Analgesia) -device. Pain scores and sedation scores were assessed at 3, 6, 12 and 24 h after surgery. Tramadol consumption, adverse effects, and patient satisfaction were noted during 24 h after the surgery. The pain scores were significantly lower in the dexketoprofen group compared with the placebo group (p<0.05). The cumulative tramadol consumption was lower in the dexketoprofen group than placebo group (p<0.05). No significant difference was observed in sedation scores, adverse effects and patient satisfaction between the groups (p>0.05). We conclude that the preoperative and postoperative administration of dexketoprofen provided a significant analgesic benefit and decreased the opioid requirements in patients undergoing abdominal hysterectomy.

Effect of dexmedetomidine on haemodynamic responses to laryngoscopy and intubation : perioperative haemodynamics and anaesthetic requirements.

BACKGROUND: Dexmedetomidine reduces the dose requirements for opioids and anaesthetic agents. The purpose of this study was to evaluate the effect of a single pre-induction intravenous dose of dexmedetomidine 1 microg/kg on cardiovascular response resulting from laryngoscopy and endotracheal intubation, need for anaesthetic agent and perioperative haemodynamic stability. METHODS: Fifty patients scheduled for elective minor surgery were randomised into two groups (dexmedetomidine group and placebo group, n = 25 in each group). During and after drug administration, the Ramsey sedation scale was applied every 5 minutes. Fentanyl 1 microg/kg was administered to all patients and thiopental was given until lash reflex disappeared. Anaesthesia continuation was maintained with 50% : 50%, oxygen : nitrous oxide. Sevoflurane concentration was adjusted to maintain systolic blood pressure within 20% of preoperative values. After extubation, the Steward awakening score was applied at 5 and 10 minutes. Haemodynamic parameters and adverse effects were recorded every 10 minutes for 1 hour after surgery. RESULTS: During intubation the need for thiopental and sevoflurane concentration were decreased by 39% and 92%, respectively, in the dexmedetomidine group compared with the placebo group. In all groups, blood pressure and heart rate increased after tracheal intubation; both were significantly lower in the dexmedetomidine group than in the placebo group (p < 0.05). Fentanyl requirement during the operation was 74.20 +/- 10.53microg in the dexmedetomidine group and 84.00 +/- 27.04microg in the placebo group (p < 0.05). At 5 minutes, the Steward scores were >6 in 56% of the dexmedetomidine group and in 4% of the placebo group (p < 0.05). At 10 minutes, sedation scores were > or =4 in all patients in the dexmedetomidine group (p < 0.05). Arterial blood pressure and heart rate in the postoperative period were significantly lower in the dexmedetomidine group compared with the placebo group (p < 0.05). CONCLUSION: Preoperative administration of a single dose of dexmedetomidine resulted in progressive increases in sedation, blunted the haemodynamic responses during laryngoscopy, and reduced opioid and anaesthetic requirements. Furthermore, dexmedetomidine decreased blood pressure and heart rate as well as the recovery time after the operation.

[Transdermal fentanyl for neuropathic pain: a case report]. / Nöropatik agrida transdermal fentanil kullanimi: Olgu sunumu.

The mechanisms responsible for neuropathic pain are not fully understood. Most treatment modalities are ineffective or insufficient for this important clinical condition. Better understanding of pain mechanisms and opioid drug action has widened the indications for opioids in pain therapy of non-malignant pain including neuropathic pain. In this report of a female patient with chronic non-malignant neuropathic pain was followed-up for pain and side effects, for approximately fourteen months with the use of transdermal fentanyl (TDF). Pain reduction was good throughout the study. Severe side effects did not occur. TDF was effective and well tolerated in the treatment of chronic neuropathic pain of non-malignant origin.

Effects of isoflurane and sevoflurane on the survival of skin flaps in rats.

The effects of inhalational anaesthetic agents on survival of flaps are not well known. We investigated the effect of isoflurane and sevoflurane anaesthesia on survival of flaps using a caudally-based McFarlane skin flap in 20 male Wistar rats. Sevoflurane 1 minimum alveolar concentration (MAC) and isoflurane (1 MAC) in oxygen mixture was given to the animals. A 4 x10 cm caudally-based standard McFarlane flap was raised. There were no differences in any haemodynamic values or blood gases between the sevoflurane group and the isoflurane group. Skin flaps were assessed on the seventh day. The isoflurane group had a significantly smaller area of skin flap necrosis and an increased area of flap surviving than the sevoflurane group. We conclude that survival is significantly improved when isoflurane is used as the inhalational anaesthetic rather than sevoflurane.

Long-term follow-up of patients with atypical facial pain treated with amitriptyline.

OBJECTIVE: The aim of this study was to assess the efficacy of low-dose amitriptyline in patients with atypical facial pain for one-year follow-ups. PATIENTS AND METHODS: Sixteen patients, ten females and six males, ranging in age from 15 to 77 years (mean 46.6 +/- 15.95 years), participated in the study. The onset, duration and temporal pattern of pain, events related to pain, drugs used before treatment and side effects of amitriptyline were recorded. The severity of pain was evaluated by using the visual analogue scale (VAS). Patients were followed for up to 12 months. RESULTS: The results showed that the onset of pain was related to dental pain in half of patients; and 10 patients had continuous pain. The mean VAS scores for pretreatment, post treatment, and 1, 3, 6, and 12 months were 9.6, 4.8, 2, 0.8, 0.3 respectively. In 12 patients, pain was reduced at the first month (p<0.05). All patients, except one, were pain-free at 12 months. It was statistically significant in achieving pain relief for 12 months (p<0.05). The common side effects of the drug were dry mouth and drowsiness. CONCLUSION: Data obtained from this study suggested that amitriptyline may be preferred in patients with atypical facial pain for rapid, satisfying analgesic effects. Long-term follow-up should be conducted to determine the analgesic effects and to prevent recurrence, even if the analgesic effect occurs in a short time.

Effect of gamma-hydroxybutyric acid on lipid peroxidation and tissue lactate level in experimental head trauma.

BACKGROUND: This study was designed to determine the effects of gamma-hydroxybutyric acid (GHB) on tissue lactate and malondialdehyde (MDA) levels in rabbit brain after experimental head trauma. METHODS: Thirty New Zealand rabbits were divided equally into three groups: group S was the sham-operated group, group C, and group GHB received head trauma, where group C was the untreated and group GHB was the treated group. Head trauma was delivered by performing a craniectomy over the right hemisphere and dropping a weight of 10 g from a height of 80 cm. GHB was administered 400 mg/kg intravenously for 10 minutes after the head trauma to group GHB. The nontraumatized side was named "1" and the traumatized side was named "2." One hour after trauma, brain cortices were resected from both sides and the concentrations of lactate and MDA were determined. RESULTS: There were significant differences between lactate and MDA levels of group S and all other groups (C1, C2, GHB1, and GHB2) except between lactate levels of group S and group GHB1, the nontraumatized and traumatized sides of groups C and group GHB, group C2 versus group GHB2, and group C1 versus group GHB1 (p < 0.05). Rectal temperature after the administration of GHB in group GHB was found lower than in groups S and C (p < 0.05). CONCLUSION: These results demonstrate that head trauma leads to an increase in brain tissue lactate and MDA levels, and GHB effectively suppresses the increase of lactate and MDA.