Various surgical modalities for trigeminal neuralgia: literature study of respective long-term outcomes.

BACKGROUND: The literature contains many varying, often conflicting surgical results. However, there is no study comparing long-term effectiveness of all surgical procedures for trigeminal neuralgia (TN). The aim of the present analysis is to report the long-term outcomes of surgical options of TN since the development of electronic databases, to evaluate them with the same clinical and statistical criteria and determine the most appropriate treatment. METHOD: All studies that had a minimum 5 years or more (> or =5 years) mean duration of follow-up were included in the review. The identified studies were evaluated independently by two authors for quality using a modified inclusion criteria. The evaluated outcome measures of this study were, the initial acute pain relief (APR), follow-up pain free period and recurrence rates as well as complications. In comparisons of the data, the Student's t-test, Chi-square followed by Pearson's risk analysis tests were used. Kaplan-Meier actuarial analysis of pain free-survival curves were constructed for each surgical option that had enough data. FINDINGS: Twenty-eight studies, mostly including microvascular decompression (MVD) and radiofrequency thermorhizotomy (RF-TR), that met the inclusion criteria were included in the review. The efficacy of MVD and percutaneous balloon microcompression (PBC) were similar (Odds ratio = 0.15, P > 0.05), and their effects were superior to those of the other modalities (P < 0.001). Although RF-TR provided a high initial pain relief, its average pain free rate was 50.4% for a mean follow-up of 5 years. The recurrence rate was high after RF-TR (46%), while the lowest recurrence rate (18.3%) was after MVD (P < 0.001). Within the long-term follow-up period recurrence of pain affects at least 19% of patients who undergo any surgical treatment for TN. CONCLUSIONS: The study suggests that each surgical technique for treatment of trigeminal neuralgia has merits and limitations. However, MVD provides the highest rate of long-term patient' satisfaction with the lowest rate of pain recurrence.

Zinc and copper in congestive heart failure.

In this study serum zinc (Zn) and copper (Cu) levels in children with congestive heart failure (CHF) were evaluated. The mean serum Zn levels of the patients with CHF were 92.9 +/- 18.9 micrograms/100 ml, and they showed a significant decrease when compared to controls (p less than 0.05). The mean serum Cu levels, which were 173.6 +/- 26.6 micrograms/100 ml, showed a significant increase when compared to controls (p less than 0.001). After digoxin therapy, a significant increase in Zn levels and a significant decrease in Cu levels were observed.

Retrospective analysis of echinococcosis in an endemic region of Turkey, a review of 193 cases.

BACKGROUND: The hydatidosis is endemic in our region. Some of the recent studies revealed that hydatid cyst prevalence is decreasing gradually in Turkey. The aim of this study was to investigate the actual prevalence of hydatidosis in an endemic region of Turkey, and to share our experiences in the medical and surgical management of hydatidosis. METHODS: Data were collected retrospectively from the records of 193 patients who had a diagnosis of hydatidosis, and admitted to Diyarbakir Education and Research Hospital. Imaging techniques, histology and serology were used for diagnosis. RESULTS: From records of 772 cystic patients whose cysts were localized in the lung and liver, 193 (25%) of them were diagnosed with cyst hydatidosis. Lung hydatidosis was found statistically significant among these cases (Chi-square=24.88, P< 0.0001). Postoperative recurrence was detected in seven (3.62%) patients. All postoperative recurrences were observed in the consequent three years period. CONCLUSION: The prevalence of hydatidosis is still high in southeast Turkey and not only in children but also in adult cases in our region lung hydatidosis is frequent corresponding with other organ hydatidosis. We also found that the most risky period in recurrence rates is the consequent post-operative three years. According to our experiences, transthoracic approach in lung hydatidosis, external drainage, and cystectomy in liver hydatidosis is safe and effective choices in surgical treatment.

Comparison of the effectiveness of some pleural sclerosing agents used for control of effusions in malignant pleural mesothelioma: a review of 117 cases.

BACKGROUND AND OBJECTIVES: Management of malignant pleural mesothelioma (MPM) has been an important clinical issue regardless of the treatment modality employed. We aimed to investigate the efficacy of oxytetracycline (OT), Corynebacterium parvum (CP), and nitrogen mustard (NM) in the management of pleural effusion associated with MPM. METHODS: One hundred and seventeen patients who had stage-2 MPM or over according to the Butchart staging system and unilateral or bilateral pleural effusion took part in the study. The patients received either OT (35 mg/kg), CP (7 mg), or NM (0.4 mg/kg) through a chest tube for pleurodesis. The association between several clinical parameters and patient survival was also investigated. RESULTS: OT was applied to 59, CP to 29 and NM to 29 cases. A statistical analysis of the results obtained by these agents have demonstrated that OT (30 days, 81%; 90 days, 76.2%) and CP (30 days, 86.2%; 90 days, 79.3%) led to a significantly higher rate of successful pleurodesis as compared to NM (30 days, 48.2%; 90 days, 41.3%; p <0.05). Although the procedure was generally well tolerated by the patients, the NM-treated group experienced significantly more nausea-vomiting (46.1%) and hypotension (35.8%) compared to patients who received OT (nausea-vomiting and hypotension 4.3%; p < 0.001) and CP (nausea-vomiting and hypotension 5.1%; p < 0.001). Furthermore, we found that thrombocytosis, chest pain and weight loss were significantly associated with poor prognosis, whereas epithelial type had a positive effect on survival. CONCLUSION: These results suggest that OT and CP may be used as effective sclerosing agents for pleurodesis in the control of pleural effusions associated with MPM, without major side effects.

Changes in ovarian function after tubal sterilization.

Changes in ovarian function were evaluated in 43 women, before and after tubal ligation. Midluteal endocrine profiles and endometrial biopsies were investigated before and at 3, 6 and 12 months after the operations. During postoperative follow-up there was significant increase in luteal phase deficiency and midluteal FSH, LH and E2 levels (p < 0.001). Progesterone levels significantly decreased (p < 0.001) and anovulation was observed in 13 (30.2%) of 43 cases. Our data suggest that tubal sterilization carried increased risk in ovarian function, particularly luteal phase deficiency and anovulation.

Menstrual disorders and pelvic pain after sterilization.

Changes in menstrual cycle length, menstrual duration, number of pads, dysmenorrhea and non-cyclic pelvic pain were studied in 43 women following tubal sterilization with three different techniques. One group consisted of 17 women undergoing laparotomy by Pomeroy technique; the second group consisted of 11 women undergoing laparoscopy by Fallope rings; and the third group consisted of 15 women undergoing colpotomy by fimbriectomy. The differences before and after sterilization in cycle length were non-significant in all groups (p > 0.05). After sterilization, menstrual duration and number of pads were significantly increased in the laparotomy (p < 0.001) and laparoscopy (p < 0.01) groups but non-significantly in the colpotomy group (p > 0.05). Comparison of these parameters between the groups did not show any significant differences (p > 0.05). After sterilization, increases in the severity of dysmenorrhea and non-cyclic pelvic pain were non-significant in all groups (p > 0.05). We concluded that there were no significant differences in menstrual disorders after sterilization among these three different techniques.