Quadratus lumborum and erector spinae plane blocks are effective for analgesia in laparoscopic hysterectomy: a randomized controlled trial.

OBJECTIVE: Total laparoscopic hysterectomy is the preferred technique for hysterectomy in obstetrics and gynecology clinics. However, patients who undergo these procedures often experience acute pain that may progress to chronic pain over time. Erector spinae plane block (ESPB) and anterior quadratus lumborum block (QLB) under ultrasound guidance are reported to be effective as part of the multi-modal analgesia protocol. Therefore, this study aimed to compare the effectiveness of erector spinae plane block and anterior quadratus lumborum block in reducing postoperative opioid consumption and pain scores in patients undergoing total laparoscopic hysterectomy. PATIENTS AND METHODS: Eighty-one patients who met the inclusion criteria were divided into three groups: the erector spinae plane block, anterior quadratus lumborum block, and control groups. All patients received general anesthesia and tramadol-based patient-controlled analgesia (PCA) during the postoperative period. Tramadol consumption and pain scores during the first 24 h were evaluated by a blinded researcher. Postoperative opioid consumption was the primary outcome of the study. RESULTS: Postoperative tramadol consumption was lower in the erector spinae plane block and quadratus lumborum block groups than that in the control group, with no significant differences observed between the two interventional groups. Postoperative pain scores were lower for at least 12 h in both block groups, with no significant differences observed between both groups. CONCLUSIONS: Erector spinae plane block and quadratus lumborum block improved postoperative pain management as part of the multi-modal analgesia protocol; however, erector spinae plane block may be preferable due to its rapid procedure time. The findings suggest that incorporating erector spinae plane block and quadratus lumborum block into multi-modal analgesia protocols for laparoscopic hysterectomy would have important implications for the development and standardization of pain management protocols.

The effect of epidural analgesia added to general anesthesia on systemic immune-inflammation index in radical prostatectomy surgery: A retrospective study.

Background: Systemic immune-inflammation index (SII) is increasingly valued for its simplicity and predictability. Anesthesia/analgesia technique may affect cancer survey. Aims: The primary aim of this study is to offer a comparative evaluation for the effect of different anesthesia/analgesia techniques employed in radical prostatectomy surgery on SII, a new inflammatory index. Patients and Methods: Eighty-one patients who underwent radical prostatectomy between January 1, 2012, and December 31, 2020, were included in the study. We recorded oncological demographic data of Group G (n = 45) and Group GE (n = 36), preoperative and postoperative (within the first 4 hrs and 24th hr) SII values, perioperative surgical bleeding, and amount of blood transfusion. Results: Despite the lack of significant difference in the SII values between the groups, both the peak SII level and the SII change in the postoperative period became higher in Group G than in Group GE. In addition, the amount of surgical bleeding and blood transfusion was observed to be significantly lower in Group GE (P < 0.001, P = 0.092, respectively). Conclusions: GE in radical prostatectomy surgery in terms of SII, the SII change in the postoperative period was more pronounced in Group G. However, a significant difference was noted in surgical bleeding in Group GE. We can conclude that comparing the SII values of different anesthesia techniques with prospective studies might thus create a difference in survival and metastasis at the micro-level.

Combined suprascapular nerve block and axillary nerve block approach vs. peri-articular infiltration analgesia for postoperative pain management following arthroscopic shoulder surgery: a randomized clinical trial.

OBJECTIVE: Postoperative pain following shoulder surgery is a devastating situation. Several approaches, including regional nerve blocks such as combined suprascapular nerve block and axillary nerve block (SSNB+ANB) and peri-articular infiltration (PAI) analgesia, have been investigated to manage postoperative pain. This study aimed to compare the effects of PAI and SSNB+ANB on postoperative pain scores and analgesic consumption after arthroscopic shoulder surgery. PATIENTS AND METHODS: A single-center prospective, randomized interventional study with a two-arm parallel design was performed. Sixty patients with arthroscopic shoulder surgery were randomized to SSNB+ANB (n=30) and PAI (n=30) group. Postoperative pain scores, analgesic requirements, and complications were evaluated in the postoperative anesthesia recovery unit and during the postoperative 24 hours. RESULTS: The age of patients in Group PAI was significantly higher than in Group SSNB+ANB (p<0.001). Groups were similar, considering demographic and clinical characteristics (p>0.05). The length of anesthesia and surgery was significantly longer in Group PAI (p=0.009 and p=0.025). Although there was no significant difference in the amount of change in pain scores for postoperative 24 hours (p=0.537), postoperative pain scores were significantly higher in Group SSNB+ANB group than Group PAI during postoperative 24 hours except for the 12th-hour evaluation (p<0.05). Postoperative opioid requirement and rescue analgesic medications were significantly higher in Group SSNB+ANB (p<0.001 and p=0.001). The number of postoperative nausea and vomiting attacks was similar (p=0.317). CONCLUSIONS: PAI seems to be a more feasible and practical analgesic approach for managing postoperative pain after arthroscopic shoulder surgery regarding pain score and cumulative analgesic requirement.

Cirugía retrógrada intrarrenal para el tratamiento de cálculos renales bajo anestesia espinal, un método mínimamente invasivo. Análisis retrospectivo de 1.467 casos / Retrograde intrarenal surgery for stone disease under spinal anaesthesia, a minimally invasive technique. A retrospective analysis of 1,467 cases

Introducción y objetivos: El objetivo del presente estudio ha sido comparar los procedimientos de CRIR realizados bajo anestesia general (AG) y anestesia espinal (AE) con respecto a las tasas de éxito y las tasas de complicaciones. Materiales y métodos: Se ha realizado una evaluación retrospectiva de los datos de los pacientes tratados con CRIR bajo AG y AE en 2 centros, entre octubre del 2014 y enero del 2018. Los grupos de AG y AE han sido evaluados con respecto a los parámetros: libre de cálculos, tasa de complicaciones, control del dolor postoperatorio y duración de la estancia en el hospital. Los cirujanos que participaron en el estudio examinaron las tasas de ausencia de cálculos de los procedimientos de CRIR bajo AE. Resultados: Un total de 1.361 pacientes fueron incluidos en el estudio. Se obtuvo una tasa libre de cálculos del 84,4% en toda la muestra, el 85,3% pertenecientes al grupo tratado con AE y el 83,5% al grupo de AG (p = 0,364). No se determinaron diferencias estadísticamente significativas entre los cirujanos que llevaron a cabo la CRIR bajo AE con respecto a las tasas de éxito y complicaciones y el tiempo quirúrgico (p = 0,676). El tiempo quirúrgico se determinó como 44,2 ± 14,2 min en el grupo de AE y 49,7 ± 19,1 min en el grupo de AG (p = 0,014). Conclusiones: La CRIR se puede llevar a cabo de forma segura, tanto con AE como con AG. Se observó que el éxito de la CRIR bajo AE era independiente del factor relacionado con el cirujano, por lo que esta puede considerarse una buena alternativa a la AG

Introduction and objectives: The aim of the present study was to compare RIRS procedures applied under general anaesthesia (GA) and spinal anaesthesia (SA) regarding success and complication rates. Materials and methods: A retrospective evaluation was conducted with the data obtained from patients treated with RIRS under SA and GA at 2 centres from October 2014 until January 2018. The SA and GA groups were evaluated according to the parameters of stone-free and complication rates, postoperative pain control and length of in-hospital stay. The stone-free rates from the RIRS procedures applied with SA were evaluated by the surgeons who participated in the study. Results: A total of 1361 patients were included in the study. A stone-free rate of 84.4% was obtained in the global results: 85.3% in the SA group and 83.5% in the GA group (P = .364). No statistically significant difference was determined regarding surgeons who practiced RIRS under SA with respect to success/complication rates and operating time (P = .676). Operating time was determined as 44.2 ± 14.2 mins in the SA group and 49.7 ± 19.1 mins in the GA group (P = .014). Conclusions: The RIRS method can be applied safely, either under spinal anaesthesia, or under general anaesthesia. The success of RIRS under spinal anaesthesia has been shown as an independent factor regarding surgeon. It can be considered a good alternative to general anaesthesia

Retrograde intrarenal surgery for stone disease under spinal anaesthesia, a minimally invasive technique. A retrospective analysis of 1,467 cases. / Cirugía retrógrada intrarrenal para el tratamiento de cálculos renales bajo anestesia espinal, un método mínimamente invasivo. Análisis retrospectivo de 1.467 casos.

INTRODUCTION AND OBJECTIVES: The aim of the present study was to compare RIRS procedures applied under general anaesthesia (GA) and spinal anaesthesia (SA) regarding success and complication rates. MATERIALS AND METHODS: A retrospective evaluation was conducted with the data obtained from patients treated with RIRS under SA and GA at 2centres from October 2014 until January 2018. The SA and GA groups were evaluated according to the parameters of stone-free and complication rates, postoperative pain control and length of in-hospital stay. The stone-free rates from the RIRS procedures applied with SA were evaluated by the surgeons who participated in the study. RESULTS: A total of 1361 patients were included in the study. A stone-free rate of 84.4% was obtained in the global results: 85.3% in the SA group and 83.5% in the GA group (P=.364). No statistically significant difference was determined regarding surgeons who practiced RIRS under SA with respect to success/complication rates and operating time (P=.676). Operating time was determined as 44.2±14.2 mins in the SA group and 49.7±19.1 mins in the GA group (P=.014). CONCLUSIONS: The RIRS method can be applied safely, either under spinal anaesthesia, or under general anaesthesia. The success of RIRS under spinal anaesthesia has been shown as an independent factor regarding surgeon. It can be considered a good alternative to general anaesthesia.

[THE REGIONAL MATERNAL CAPITAL AND DIRECTIONS OF ITS USAGE IN THE SIBERIAN FEDERAL OKRUG].

The research institute of complex problems of hygiene and occupational diseases of the Siberian branch of of the Russian academy of medical sciences, 654041 Novokuznetsk, Russia; 2The institute of economics and organization of industrial manufacture of the Siberian branch of the Russian academy of sciences, 630090 Novosibirsk, Russia The maternal capital as a measure of stimulation of birth (adoption) of second child functions in Russia since 2007. During following years the local subventions were introduced in the form of maternal capital for birth (adoption) of third child or subsequent children. The article considers characteristics of this measure of social support in the Siberian federal okrug and possible ways of extension of practice of its application as well.

CD34 expression of chorionic villous in pre-eclamptic placenta: an immunohistochemical and ultrastructural study.

In this study, pre-eclampsia, proteinuria, and edema associated with hypertension in pregnancy were assessed at the Dicle University School of Medicine Department of Obstetrics and Gynecology Clinic. One group included 20 pre-eclamptic pregnant women with gestational age 20-35 weeks of pregnancy and the same in the control group that included; however, 20 normotensive pregnant women. Histochemistry, immunohistochemistry, and electron microscopy techniques were used. Histopathological examination of syncytial nodes and stromal cells were observed in the increase in hyperplasia and hyalinization. The evaluation immunohistochemical of chorionic villi, placenta, and hematopoietic stem cell markers showed a positive reaction with CD34. Ultrastructural examination showed endoplasmic reticulum dilatation, degeneration of mitochondria in endothelial cells, and capillary vessel edema.

Genetics analysis with down syndrome and histopathological examination of buccal epithelial cells / Análisis genético y examen histopatológico de las células epiteliales bucales en pacientes con síndrome de down

Down syndrome is primarily caused by trisomy of chromosome 21. We reviewed cytogenetic studies performed on 1048 patients who were referred to the Cytogenetics Unit at Dicle University Hospital, Diyarbakir, Southeast Turkey, between 2000 and 2009. The cases were grouped according to the reason of referral for cytogenetic analysis. The highest frequencies of abnormal karyotypes were found among cases that were referred due to suspicion of Down syndrome (84.8 percent). For histologic examination to persons with Down syndrome and normal, buccal mucosa smear was prepared by rubbing. Down syndrome are disabled and control groups were compared statistically buccal epithelial cells and nuclei (p<0.05). Periphery of the nucleus in some patients with Down's syndrome, while the bud structures in the form of micronuclei was observed in the karyolytic cells.

El síndrome de Down es causado principalmente por la trisomía del cromosoma 21. Se revisaron los estudios citogenéticos realizados en 1.048 pacientes que fueron remitidos a la Unidad de Citogenética del Dicle University Hospital, Diyarbakir, sudeste de Turquía, entre los años 2000 y 2009. Los casos se agruparon de acuerdo a la razón de referencia para el análisis citogenético. Las frecuencias más altas de cariotipos anormales se encontraron ent los casos que fueron remitidos por sospecha de síndrome de Down (84,8 por ciento). Para el estudio histológico de las personas con y sin síndrome de Down, se realizó el frotis de mucosa oral por hisopado. Los grupos con síndrome de Down y de control (sin síndrome) se compararon estadísticamente en relación a las células epiteliales orales y los núcleos (p <0,05). Se observaron núcleos periféricos en algunos pacientes con síndrome de Down, mientras que estructuras de tipo brotes en la forma de micronúcleos se observaron en las células cariolíticas.

Ultrastructural changes in the kidney cortex of rats treated with lead acetate / Cambios ultraestructurales en la corteza renal de ratas tratadas con acetato de plomo

The purpose of this study was to investigate the ultrastructural effects of lead on the kidney cortex of rats. Wistar Albino rats (180-200g body weight) were divided into a controlled and lead acetate-exposed group. Rats received lead acetate at 500 ppm in their drinking water for 60 days. Both groups were fed with the same standard food, but lead acetate was added to the drinking water. During the experimental period, blood samples were taken from the abdominal aorta of the anesthetised animals. At the end of exposure, body weight and blood lead levels were measured. The kidney tissue samples were prepared and analyzed by light and transmission electron microscopy. Cortical renal tubules show various degenerative changes with focal tubular necrosis invaded by inflammatory cells. The ultrastructural alterations found in lead acetate-treated rats were a diminution in the amount of filtration slits, increased fusion of foot processes in epithelial cells of the glomeruli, increase of lysosomal structures and pinocytic vesicles as well as large mitochondria in proximal tubule cells.

El propósito de este estudio fue investigar los efectos ultraestructurales del plomo en la corteza renal. Ratas Wistar albinas (180-200g de peso corporal) fueron divididas en grupo control y grupo experimental. Las ratas recibieron 500 ppm de acetato de plomo en el agua potable durante 60 días. Ambos grupos fueron alimentados con el mismo alimento estándar, pero acetato de plomo se le añadió al agua potable al grupo experimental. Durante el período experimental, se tomaron bajo anestesia muestras sanguíneas desde la parte abdominal de la aorta. Al final de la exposición, fueron medidos el peso corporal y los niveles de plomo en la sangre. Fueron preparadas las muestras de tejido renal y se analizaron mediante microscopía de luz y electrónica de transmisión. Los túbulos renales corticales mostraron varios cambios degenerativos con necrosis tubular focal invadida por células inflamatorias. Las alteraciones ultraestructurales encontradas en las ratas tratadas con acetato de plomo correspondieron a una disminución en la cantidad de ranuras de filtración, aumento de la fusión de los procesos podales en las células epiteliales de los glomérulos, aumento de la estructura lisosomal y las vesículas pinocíticas, así como grandes mitocondrias en las células del túbulo proximal.

Tumor grade-related thallium-201 uptake in chondrosarcomas.

OBJECTIVES: Diagnosis of low-grade chondrosarcoma, especially discrimination between enchondroma and low-grade chondrosarcoma, may be difficult pathologically. The aim of this study was to evaluate the value of thallium-201 (Tl-201) scintigraphy in the diagnosis of chondrosarcoma and to investigate whether there was a correlation between Tl-201 uptake and tumor grade. METHODS: We retrospectively evaluated 121 patients with pathologically proven bone and soft tissue tumors diagnosed between the years 1999 and 2007. All patients were followed by the Bone and Soft Tissue Tumor Working Group in our hospital. Twenty-three patients, mean age 44 +/- 15 (range 17-72) years, with a diagnosis of cartilaginous tumors were included. Increased Tl-201 uptake at the lesion sites greater than background was evaluated as malignant tumor. For the pathologic classification, a grading system (grade 1-3) based on the histopathologic findings was used. Pearson correlation coefficient was used to determine whether there was any correlation between Tl-201 uptake and tumor grade in chondrosarcoma. RESULTS: There were 7 enchondromas and 16 chondrosarcomas. Four of 16 patients with chondrosarcoma had lesions pathologically classified as grade 3, 5 as grade 2, and 7 had grade 1 chondrosarcoma. Increased Tl-201 uptake was observed in all patients with grade 3 chondrosarcoma and 2 patients with grade 2 chondrosarcoma. Of 10 patients with chondrosarcoma, 3 grade 2 chondrosarcomas and 7 grade 1 chondrosarcomas, there was no Tl-201 uptake in the tumor region. A significant correlation was found between Tl-201 uptake and tumor grade in chondrosarcoma (p = 0.002, r = 0.71). Only a few reports in literature have demonstrated false negative results in low-grade chondrosarcoma. CONCLUSION: Tl-201 uptake was related to tumor grade in chondrosarcoma. If there is a possibility of chondrosarcoma, Tl-201 scintigraphy should be reported with caution.

Effect of sedation with midazolam or propofol on patient's comfort during cancer chemotherapy infusion: a prospective, randomized, double-blind study in breast cancer patients.

Nausea, vomiting and anxiety related to administration of cancer chemotherapy remain significant problems. This randomized, clinical trial was undertaken to evaluate the effect of sedation on the patient's comfort during chemotherapy infusion in patients with breast cancer. Forty-five breast cancer patients were randomized into three groups: Group I--chemotherapy, control, Group II--midazolam+chemotherapy, and Group III--propofol+chemotherapy. Nausea occured in 87% and vomiting in 13% of the patients in the control group, while none of the sedated subjects had these side-effects, although 76% of them had experienced then during previous cycles of chemotherapy. Compared with the control group, post-chemotherapy anxiety scores also improved with the addition of midazolam or propofol. Eighty percent of the subjects declared that they would prefer the sedative-containing regimen for their further cycles. Sedation with midazolam or propofol may improve the patient's comfort, and provide better control of chemotherapy-related side effects during chemotherapy infusion in breast cancer patients.

Effect of heparin on tendon degeneration: an experimental study on rats.

This study investigated the local effects of heparin on locally administered corticosteroid-induced experimental Achilles tendinitis. After performing Achilles degeneration, 28 rats were divided into two groups; one was treated with local heparin and the other with saline injections at 3 and 6-day intervals. The tendons and paratenons were excised after 60 or 75 days and evaluated histopathologically and statistically. Heparin-injected tendons and paratenons demonstrated significantly higher scores for most compared groups, thus worsening the degeneration. At the second part of the research, eight healthy tendons were injected with heparin at 3-day intervals for 1 month, and seven of them showed various degrees of degeneration. Heparin itself thus has a degenerative effect on the tendon and should not be used in the treatment of Achilles tendon degeneration.

Deleterious effects of local corticosteroid injections on the Achilles tendon of rats.

The purpose of this study was to examine the pathological changes in the Achilles tendon and its paratenon after intratendinous corticosteroid injections and to reveal the effects of this drug on healthy tendon. We also sought for the effects of these injections compared with compression with a clamp on the Achilles tendons of the rats. Fifty-two Achilles tendons in 26 male Wistar rats were included in the study. Betamethasone injections were applied to the left tendons at different intervals, while the right tendons served for compression with mosquito clamps for varied periods. At the end of 30 days, all of the tendons were excised and examined histopathologically according to a semiquantitative scoring system. Histopathologic evaluation demonstrated some degree of degeneration in both groups. Statistical analysis showed no significant difference among the two groups, but in macroscopic evaluation, the tendons in the betamethasone group demonstrated enlargement and strong adhesion to the subcutaneous tissue. We conclude that intratendinous betamethasone injections are as harmful as compression with a clamp and can be used as a degeneration-producing model in further studies. Enlargement of the tendon mass and strong adhesion to the subcutaneous tissue can be due to injection of the betamethasone partly outside the tendon.

Primary intramuscular hydatidosis of supraspinatus muscle.

Hydatid disease of the muscle is very rare and represents approximately 3% of all patients with hydatidosis. Since the infection closely resembles a soft-tissue tumor on clinical examination, the preoperative radiologic diagnosis is very important to avoid biopsy. We report an unusual case of primary intramuscular hydatidosis with its magnetic resonance imaging appearance, clinical and pathological findings.

Pigmented villonodular synovitis of the knee presenting as a popliteal cyst.

Pigmented villonodular synovitis is a locally aggressive tumor of the synovium of joints and tendon sheaths. It is commonly seen in the synovial lining of the flexor tendons of the hand and in the synovium of the knee and less commonly in other joints. A case of pigmented villonodular synovitis of the knee in a 60-year-old man, with an intra-articular origin extending extra-articularly, is presented. The interesting point is that the initial diagnosis was a Baker cyst.

Lengthening of congenital below-elbow amputation stumps by the Ilizarov technique.

Patients with short congenital amputations below the elbow often function as if they have had a disarticulation of the elbow. We have reviewed the results in six patients who had lengthening of such stumps by the Ilizarov technique to improve the fitting of prostheses. The mean lengthening was 5.6 cm (3.4 to 8.4), and in two patients flexion contractures of the elbows were corrected simultaneously. Additional lateral distraction was used in one patient to provide a better surface on the stump. There were no major complications. All six patients were able to use their prosthesis at the latest follow-up after 39 to 78 months.