Histological composition of lumbar disc herniations related to the type of herniation and to the age.

OBJECTIVES: To compare the data for histologic composition of the herniated disc material between different types of disc herniations and between patients of different age. BACKGROUND: Lots of studies have investigated the histologic composition of disc herniations. Few studies have examined the presence of granulation tissue related to the type of herniations and age of the subjects. METHODS: 120 patients divided in to two age groups underwent MR imaging before microsurgical removal of the herniations. Disc herniations were divided in to two groups, non migrated and large migrated disc herniations. The histologic assessment of the herniated material is done by dividing the intercellular matrix into four types. The existence of areas of granulation tissue and hyaline cartilage is evaluated too. RESULTS: The tissue composition showed significant differences between patients of different age. Areas of granulation tissue and neovascularisation are found in 12% of 64 protrusions and contained extrusions, and in 29% of 56 large migrated disc extrusions (p=0.029 ). In elderly patients the tissue composition changed with a significant decrease of prevailing nucleus pulposus composition in 7% of 60 (p=0.000) and a significant increase of prevailing fibrous tissue composition in 40% of 60 patients (p=0.000). Areas of granulation tissue and neovascularisation were found in 27% of 60 patients aged ≤ 50 and in 13% of 60 patients aged >50. CONCLUSIONS: The tissue composition of the herniated material showed more expressed differences between subjects of different age. Granulation tissue and neovascularisation were more frequent findings in large migrated disc herniations and in patients aged 35 to 50 years (Fig. 8, Ref. 22).

Evaluation of changes in serum concentration of sodium in a transurethral resection of the prostate.

INTRODUCTION AND OBJECTIVES: The purpose of this study was to evaluate changes in serum electrolytes during Transurethral resection of the prostate (TURP) and to evaluate the degree of correlation of hyponatremia and the factors that affect the incidence of TURP syndrome and to show the impact of the duration of the procedure on the severity of hyponatremia due to absorption of irrigation fluid in the systemic circulation. MATERIALS AND METHODS: This study examined 60 male patients planned for elective TURP. The level of serum electrolytes are determined by taking venous blood samples preoperatively and Postoperatively and when the duration of the operation was longer than 60 minutes, the level of serum electrolytes was determined intraoperative. The amount of used irrigation fluid, the weight of resection prostate, and duration of surgery, were also followed. Patients were divided in two groups according to the length of the surgical procedure: Group 1 (30-60 min) and Group 2 (> 60 min). RESULTS: Statistically significant reduction of serum sodium and the elevation of the potassium level in serum observed postoperatively and was directly proportional to the volume of of the used irrigation fluid, the duration of the procedure and volume of the resected prostate. CONCLUSIONS: To evaluate changes in serum electrolyte during TURP is simple and economical method for the indirect estimation of irrigation fluid absorption into the systemic circulation during TURP and opportunity for early identification of TURP syndrome.

Correlation of serum leptin with anthropometric parameters and abdominal fat depots determined by ultrasonography in overweight and obese women.

Leptin is an adipocytokine that has an important role in energy homeostasis and therefore in the patho-physiology of obesity. Leptin levels are influenced by many factors such as gender, race, energy intake, fat mass, etc. The aim of our study is to investigate the relationship of circulating leptin levels to anthropometric parameters and to the subcutaneous and visceral fat tissue determined by ultrasonography in healthy overweight and obese women. The study included 50 healthy women, with body mass index (BMI) above 25 kg/m2. Measurements of anthropometric parameters were performed with a standardized technique. The subcutaneous and visceral fat tissue was measured with ultrasound 1 cm above the umbilicus. Leptin was determined by radioimmunoassay. The serum leptin levels presented a positive correlation between the levels of leptin and BMI (r-0.73, p<0.05) waist circumference (r-0.73, p<0.05) hip circumference (r-0.74, p<0.05), thigh circumference (r-0.56, p<0.05) and abdominal subcutaneous fat tissue (r- 0.46, p<0.05). There was no correlation between leptin and visceral fat tissue, waist to hip and waist to thigh ratio. The results of our study confirmed the correlation between leptin and BMI. The correlation between leptin and all measured circumferences cannot be attributed to a particular fat depot, but rather reflect the correlation between this adipocytokine and the total body fat. The subcutaneous fat depot determined by ultrasound showed a correlation with leptin, while this kind of connection was not established for the visceral fat tissue.

The role of gastroesophageal reflux disease questionnaire in the Republic of Macedonia.

THE AIM OF THE STUDY: Gastroesophageal reflux disease is a common disease with a multifactorial pathogenesis. Our aim was to analyse the role of the Gastroesophageal Disease Questionnaire in diagnosing reflux disease in the population of the Republic of Macedonia. METHODS: The questionnaire on the severity of the symptoms related to GERD was used. An evaluation of the distal portion of the oesophagus was carried out in all patients with positive questionnaire results. All mucosal injury was classified by the Los Angeles criteria (LA). RESULTS: 642 patients were included. 58.73% females, with an average age of 37.5±8.2. Females had a higher BMI than males 26.8±4.1 vs. 24.9±3.8 p<0.001. Of the total number of examinees (642 patients), in those with erosive reflux disease and also in those with nonerosive reflux disease, as shown respectively in endoscopy, the sensitivity of the RDQ was 100%, and the specifity was 0%. The100 sensitivity means that the questionnaire verified/diagnosed patients with erosive reflux disease with 100% certainty. CONCLUSIONS: RESULTS were found in some studies comparing the positive Reflux Disease Questionnaire and the level of erosive esophagitis (LA classification). This study provides evidence that the RDQ represents a viable instrument for assessing symptom severity and response to treatment in clinical trials of patients with GERD, but in patients with a high score, endoscopic evaluation should not be excluded.

The effect of a small dose of ketamine on postoperative analgesia and cytokine changes after laparoscopic cholecystectomy.

BACKGROUND AND OBJECTIVES: In this study we assesed the effect of a small dose of ketamine on the production of TNFα, IL-1ß and IL-6 and the postoperative pain in patients undergoing laparoscopic cholecystectomy. METHODS: Fifty patients undergoing laparoscopic cholecystectomy were randomized in two equal groups. Patients in the ketamine group after induction in anesthesia received ketamine--025 mg/kg(-1). At the same time patients from the control group received sodium chloride. Postoperatively, the pain was assessed with VAS at periods of 30 min at 1, 2, 4, 8, 18, 24 and 48 hours. TNFα, IL-1ß and IL-6 were evaluated before surgery at 4, 18 and 24h after the operation. RESULTS: Differences of mean values of TNFα and IL-1ß between the two groups in the postoperative period were not significant. Mean values of IL-6 in the investigated group A were significantly lower than the mean values of IL-6 in the investigated group B after the 4th hour (p=0.00990), after the 18th hour (p=0.00133) and as after the 24th hour following surgery (p=000860). the difference in pain intensity according to the VAS scale was also statistically significantly smaller in group A after 30 min, 1,2,8 and 12 hours after surgery. CONCLUSIONS: The addition of a small-dose of ketamine in patiens undergoing laparoscopic cholecystectomy resulted in attenuation of secretion of TNFα, IL-1ß, IL-6 and reduction of postoperative pain.