Postoperative analgesia after total abdominal hysterectomy: Is the transversus abdominis plane block effective?

BACKGROUND: Analgesic protocol is needed following gynecologic surgery to ensure early mobilization, decrease the duration in the post-anesthetic care unit and hospitalization, and provide patient comfort. Transversus abdominis plane (TAP) blocks are used in the treatment of acute postoperative pain after lower abdominal surgery. TAP block may be a better choice of postoperative pain control. In the present study, the efficacy of ultrasound-guided TAP block on pain control and postoperative opioid consumption was evaluated in patients undergoing a total abdominal hysterectomy. METHODS: Fifty patients undergoing total abdominal hysterectomy were included in this study. Patients were divided into TAP block (n = 25) and control groups (n = 25). Both groups postoperative patient-controlled analgesia (PCA) was planned during 24 h postoperatively. Patients were assessed 1, 2, 4, 6, 12, 18, and 24 h postoperatively using the Visual Analog Scale (VAS), Ramsey Sedation Score, PCA demand, morphine consumption, first analgesic requirement time, and adverse reactions. RESULTS: When compared with the control group, the time to first analgesic requirement in the TAP block group was significantly lower (P < 0.05). The amount of additional analgesia also differed significantly (P < 0.001). In the TAP group, the VAS was significantly lower at 2, 4, 6, 12, 18, and 24 h postoperatively compared to the control group (P < 0.05). There was no statistically significant difference in adverse reactions. CONCLUSION: TAP block can effectively treat postoperative pain as part of multimodal analgesia in patients undergoing total abdominal hysterectomy.

Intentional re-plantation of a vertically fractured tooth repaired with an adhesive resin.

AIM: To present the successful treatment of a vertically fractured tooth by intentional re-plantation after root canal treatment and repair with an adhesive resin. SUMMARY: Vertical root fracture is a challenging problem in respect of diagnosis and management options. In this case, a vertically fractured maxillary premolar was treated by intentional re-plantation after repairing it with 4-Methacryloxyethyl trimellitate anhyride/methacrylate-tri-n-butyl borane (4-META/MMA-TBB) resin cement. At the 36-month follow-up, the tooth was asymptomatic, radiographically sound with reduced deep periodontal pockets and vertical bone loss. KEY LEARNING POINTS: • Intentional replantation after repairing fractured fragments with an adhesive resin extraorally is a treatment option. • Long-term follow-up is necessary to evaluate the outcome of this technique.

Effect of chronic exposure to cellular telephone electromagnetic fields on hearing in rats.

OBJECTIVE: To study the effects of the electromagnetic field emitted by cellular telephones upon the inner ear of rats, using distortion product otoacoustic emissions. METHODS: Forty Wistar Albino rats were used. Twenty newborn and 20 adult rats were divided into two groups of 10, one to participate in the study and one as a control. The rats were exposed to the electromagnetic field for 6 hours per day, for 30 consecutive days. Before and after the 30 day exposure period, distortion product otoacoustic emissions were measured in each group and a signal-to-noise ratio calculated, which was later used in statistical analysis. RESULTS: For both the newborn and adult rat groups, there was no significant difference in distortion product otoacoustic emissions recorded before and after exposure to the cellular telephone electromagnetic field (p>0.05). CONCLUSION: Exposure to the electromagnetic field emitted by cellular telephones, for 6 hours a day for 30 consecutive days, had no effect on the hearing of newborn or adult rats, at the outer ear, middle ear or cochlear level.

Vena cava superior syndrome developing in a dialysis patient with antithrombin III deficiency following temporary catheterization.

Despite being widely reported in patients with neoplasms, vena cava superior (VCS) syndrome linked to thrombosis is a major catheter complication that can be encountered during the use of the hemodialysis catheter. Antithrombin III (AT-III), responsible for a large part of thrombin inactivation capacity in plasma, is the most powerful inhibitor of the thrombosis process. This report describes a case of VCS syndrome developing two weeks following the extraction of a right-sided subclavian catheter in a patient transferred from peritoneal dialysis to hemodialysis for one week due to leakage. The patient presented complaining of swelling and pain in the right arm. At Doppler examination, total thrombosis was observed in the subclavian and internal jugular vein. At advanced examinations due to lack of response to heparin and clinical worsening, VCS and AT-III deficiency were determined. Following thrombolytic therapy with streptokinase, AT-III levels were raised by the administration of plasma, and clinical and radiological stabilization was established by continuing heparin and continuous oral anticoagulant therapy.

Reference values of umbilical cord and third-day cystatin C levels for determining glomerular filtration rates in newborns.

The aim of this study was to determine reference values for serum cystatin C at, and 3 days after, birth, and to determine if the concentration was influenced by gender, gestational age or bilirubin level. Umbilical cord and peripheral venous blood was taken, and serum cystatin C, creatinine, and total and direct bilirubin levels were measured. The mean concentration of cystatin C was not significantly different between cord blood and blood taken on day 3 (1.36 +/- 0.35 mg/l and 1.35 +/- 0.33 mg/l, respectively). Comparison of subgroups, divided by gender, duration of gestation and bilirubin levels, using the Mann-Whitney U-test and Wilcoxon analysis, showed no effect of these parameters on cystatin C levels.

Investigation of Helicobacter pylori colonization in adenotonsillectomy specimens by means of the CLO test.

OBJECTIVES: Investigation of Helicobacter pylori (HP) colonization in adenoid and tonsil tissues by using the CLO (Campylobacter-like organism) test. STUDY DESIGN: Prospective clinical study. Included in the study were 19 patients aged 4 to 38 who had undergone an adenoidectomy, tonsillectomy, or adenotonsillectomy procedure under local or general anesthesia. METHODS: Tissue pieces with diameters of 2 mm, which had been obtained from each adenoid and tonsil specimens in the early postoperative stage, were placed in kits specially prepared for HP (CLO test). Color changes were noted after 20 minutes and after periods of 1, 3, and 24 hours. RESULTS: Eleven (57.89%) of the 19 patients included in the study were shown to be HP positive, and 8 (42.11%) were negative, regardless of the type of specimen. CONCLUSION: It was shown that there was a high rate of HP colonization in tonsil and adenoid tissues.

[The determination of the protective potency of the diphtheria component in combined vaccines by the indirect hemagglutination (IHA) method]. / Kombine asilarda difteri komponentinin koruyucu gücünün indirekt hemaglutinasyon (IHA) yöntemiyle belirlenmesi.

The sheep erythrocytes which were coated with diphtheria toxoid by formaldehyde-tannic acid method are used to identify the specific antibody response in guinea-pigs that were immunized by adsorbed DPT and DT. It has been demonstrated that this antibody response detected by IHA is highly correlative with protective antibody response detected by Lethal Challenge Test. It has also been determined by IHA method that the immunization potency of diphtheria component can be detected by testing only one immunized guinea-pig.