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.

Are there any effects of Sevoflurane and Desflurane anaesthesia on blood glucose levels in acute hyperglycemic diabetic rats?

AIM: The aim of this study was to investigate blood glucose level of desflurane and sevoflurane on blood glucose in diabetic rats undergoing acute hyperglycemia. MATERIALS AND METHODS: In this study, 30 male Wistar albino rats were included. Diabetes was induced by a single IP injection of streptozotocin. After the effects of chronic diabetes encountered, diabetic rats were randomly assigned into diabetic control (group DC), diabetic hyperglycemia group (group DH), diabetic hyperglycemia group with desflurane (group DH-D), and diabetic hyperglycemia group with sevoflurane (group DH-S) groups. The normoglycemic groups received an IP injection of the same amount of saline. Hyperglycemic diabetic rats were anaesthetized by desflurane 6 % or sevoflurane 2 % at a dose, by which minimal alveolar concentration (MAC) for rats would be one. The drugs were given for 4 hours within 100 % oxygen at a rate of 6 L.min-1. One hour after cessation of inhalation anesthesia, blood glucose levels were determined at 1st, 4th and 24th hours. 24 hours after the anaesthesia. RESULTS: Serum glucose was detected to be significantly lower in Group C, when compared to Groups DC, DH, DH-D and DH-S (p = 0.002, p = 0.001, p = 0.002, p = 0.003, respectively). Blood glucose levels in the diabetic groups were similar at the end of 6 weeks period, after hyperglycemia and anaesthesia induction. CONCLUSION: We found out that sevoflurane and desflurane administrations in hyperglycemic rats were both related with insignificant blood glucose level increase at early post anaesthesia period and at post anaesthesia 24th hours. We still think that patients undergoing anaesthesia protocols with acute hyperglycemia need relatively longer follow up periods (Tab. 1, Ref. 28).

A randomized trial of low-dose, topical mitomycin-C in the treatment of severe vernal keratoconjunctivitis.

OBJECTIVE: To evaluate the efficacy and safety of low-dose, topical mitomycin-C in patients with severe vernal keratoconjunctivitis. DESIGN: Placebo-controlled, double-masked, randomized clinical trial. PARTICIPANTS: Twenty-six patients with vernal keratoconjunctivitis refractory to combination of steroid and mast-cell stabilizer treatment. INTERVENTION: Patients were randomly assigned (2:1) to treatment with topical 0.01% mitomycin-C eye drops (n = 17) or placebo (n = 9) three times daily for 2 weeks. MAIN OUTCOME MEASURES: Symptoms (itching, tearing, photophobia, ropy mucous discharge, foreign body sensation) and signs (conjunctival hyperemia, epithelial punctate keratitis, Trantas' dots, limbal edema, and palpebral conjunctival giant papillae) of vernal keratoconjunctivitis recorded on the day of enrollment and at the end of the treatment period. RESULTS: There was a statistically significant decrease in ropy mucous discharge, photophobia, conjunctival hyperemia, and limbal edema in the mitomycin-C treated group compared with the placebo group at the end of the 2-week treatment period. In addition, none of the 17 treated patients, but all 9 of the placebo patients, required medication during the 4-week posttreatment follow-up period. No adverse effects of treatment with mitomycin-C were observed. CONCLUSIONS: Short-term, low-dose, topical mitomycin-C may be considered in the acute exacerbation periods of patients with severe vernal keratoconjunctivitis refractory to conventional treatment.

Penetration of topical ciprofloxacin by presoaked medicated soft contact lenses.

PURPOSE: To assess the penetration of topical ciprofloxacin by a presoaked medicated disposable soft contact lens without topical drop administration. METHODS: Disposable soft contact lenses were presoaked in 0.3% topical ciprofloxacin (Ciloxan, Alcon Laboratories, Fort Worth,TX) for 10-12 hours. Presoaked lenses were placed on the eyes of patients with senile cataracts for 3 hours in group A, 5-6 hours in group B, and 8-12 hours in group C prior to their scheduled lens extraction surgery. Aqueous humor samples were drawn by paracentesis during the operation. Ciprofloxacin concentrations were determined by high pressure liquid chromatography-fluorescence detection. RESULTS: The mean ciprofloxacin concentration was 2.70 +/- 0.98 microg/mL in group A, 1.22 +/- 1.0 microg/mL in group B, and 0.5 +/- 0.2 microg/mL in group C. CONCLUSIONS: Penetration of topical ciprofloxacin is enhanced through a presoaked disposable soft contact lens, and at 3 hours therapeutic levels are obtained. Significant levels of ciprofloxacin are retained through 8-12 hours. This mode of treatment may increase patient compliance compared to frequent topical drop administration, and as a consequence, assure efficient treatment of keratitis, at least for the first 3 hours.

Risk factors in central retinal vein occlusion and activated protein C resistance.

INTRODUCTION: Central retinal vein occlusion (CRVO) tends to be a disease of older individuals, with some known major risk factors, and activated protein C resistance seems to be one of the causes in younger patients. In this study, we reviewed risk factors including activated protein C resistance in a series of patients with CRVO. METHODS: Twenty-four patients with a diagnosis of CRVO presenting either acutely or for a follow-up visit during the study period, were enrolled. Ages ranged between 31 and 83 years (mean 59.7). The risk factors, presence of ischemia, the results of biochemical serological and hematological tests, especially activated protein C resistance (APC-R), were analysed. RESULTS: In 17 patients (71%) one or more of the following risk factors existed: hypertension, diabetes, oral contraceptive usage, family history of thrombosis, and previous operation. In 40% of the eyes, there were ischemic changes. Serum triglycerides were high in 4 of 21 patients (19%) and cholesterol and urea were high in 10 of 21 patients (19%). APC-R was found in 6 out of 24 patients (25%). CONCLUSIONS: Besides known predisposing factors like hypertension, diabetes, glaucoma and hyperlipidemia, APC-R seems to be a risk factor for CRVO at all ages.

Postoperative topical mitomycin C in conjunctival squamous cell neoplasia.

PURPOSE: To report the efficacy of topical mitomycin C in preventing local recurrences after incomplete surgical excision of conjunctival squamous cell neoplasia. METHODS: Four patients presented with unilateral conjunctival tumors. Excisional biopsy results revealed conjunctival intraepithelial neoplasia with an intact basement membrane. Neoplastic cells were present in at least one of the surgical borders of the excised conjunctiva in all four cases. Patients were treated with topical mitomycin C 0.02% three times daily for 2 weeks to prevent recurrences. RESULTS: All four patients were free of clinically detectable tumors after a mean follow-up period of 20 months (range, 16-23 months). Side effects included mild discomfort, redness, photophobia, and punctate epithelial keratopathy that subsided on discontinuation of the medication. CONCLUSION: Postoperative topical mitomycin C application may be a useful adjunct to prevent recurrences in patients with incompletely excised conjunctival squamous cell neoplasia.

Factor V Leiden and prothrombin 20210 A mutations in patients with central and branch retinal vein occlusion.

PURPOSE: The role of factor V Leiden and prothrombin 20210 A mutations has been investigated in patients with central retinal vein occlusion (CRVO), hemispheric retinal vein occlusion (HRVO), and branch retinal vein occlusion (BRVO). METHODS: Factor V Leiden and prothrombin 20210 A were investigated in DNA obtained from the peripheral blood of 52 patients with retinal vein occlusion. Twenty-five of the patients had either CRVO or HRVO, and 27 patients had BRVO. The control groups for factor V Leiden and prothrombin 20210 A were comprised of two separate groups of 81 and 87 healthy individuals, respectively, who had been previously investigated for the mutations at Hacettepe University Department of Hematology. The frequencies of factor V Leiden and prothrombin 20210 A mutations were compared between the patients and the controls using Fisher's exact test. RESULTS: Factor V Leiden mutation was found in 8% of all patients, 4% of the CRVO-HRVO group and 11% of the BRVO patients. Prothrombin 20210 A mutation was not found in any of the patients. Factor V Leiden and prothrombin 20210 A mutations have been previously found in 7% and 2% of the healthy controls, respectively. The differences of frequencies between the patients and the controls were not statistically significant. CONCLUSION: Factor V Leiden and prothrombin 20210 A mutations have not been found to be risk factors in either type of retinal vein occlusion.

Risk factors in central retinal vein occlusion an activated protein C resistance.

INTRODUCTION: Central retinal vein occlusion (CRVO) tends to be a disease of older individuals, with some known major risk factors, and activated protein C resistance seems to be one of the causes in younger patients. In this study, we reviewed risk factors including activated protein C resistance in a series of patients with CRVO. METHODS: Twenty-four patients with a diagnosis of CRVO presenting either acutely or for a follow-up visit during the study period, were enrolled. Ages ranged between 31 and 83 years (mean 59.7). The risk factors, presence of ischemia, the results of biochemical serological and hematological tests, especially activated protein C resistance (APC-R), were analysed. RESULTS in 17 patients (71%) one or more of the following risk factors existed: hypertension, diabetes, oral contraceptive usage, family history of thrombosis, and previous operation. In 40% of the eyes, there were ischemic changes. Serum triglycerides were high in 4 of 21 patients (19%) and cholesterol and urea were high in 10 of 21 patients (19%). APC-R was found in 6 out of 24 patients (25%). CONCLUSIONS: Besides known predisposing factors like hypertension, diabetes, glaucoma and hyperlipidemia, APC-R seems to be a risk factor for CRVO at all ages. (Eur J Ophthalmol 1999; 9: 43-9).

Synostotic plagiocephaly causing pseudoparalysis of the superior oblique and ocular torticollis: report of a case with unique sensory findings.

PURPOSE: To report a case in which strabismus surgery did not eliminate the abnormal head posture although it did improve the vertical strabismus; and to consider the causes of this situation. CASE REPORT: The patient had a right eso-hypertropia and ocular torticollis to the left shoulder as a result of a right superior oblique mechanical deficiency, secondary to her craniosynostosis. A myectomy of the right inferior oblique muscle and a tucking procedure of the right superior oblique muscle were performed. Postoperatively, the abnormal head posture persisted, although strabismus surgery improved the vertical deviation. However, improvement of the abnormal head posture upon patching the deviated eye only indicated that the origin of the persistent abnormal head posture must be ocular. Further tests revealed that an anomalous retinal correspondence (ARC) with eccentric fixation was responsible. CONCLUSIONS: In patients with ocular torticollis, ARC with eccentric fixation must be ruled out prior to surgery as these may negatively affect the outcome.

Accurate time interval in repeated tonometry.

PURPOSE: Determination of the accurate interval between the measurements in repeated tonometry. METHODS: Two hundred-and-seventy subjects were randomly divided into 6 groups. Two successive intraocular pressure (IOP) measurements were performed with Goldmann-type applanation tonometer at different time intervals in each group. The time intervals between the two measurements were 1, 2, 3, 4, 5 and 10 minutes. The results in each group were statistically analyzed with the significance test for matched observations. RESULTS: We recorded a statistically significant difference between the first and the second IOP measurements at 1, 3, 4 and 5-minute-intervals. The differences were not significant at 2 and 10 minute-groups. CONCLUSION: The time interval between successive IOP measurements should be 2 or 10 minutes for accurate tonometry.

Clinical status, ocular surface changes and tear ferning in patients with cystic fibrosis.

Twenty-three cystic fibrosis patients and 20 controls were examined for ocular surface changes and tear fluid ferning characteristics. The patients were also evaluated systemically and given numerical scores according to Schwachman's scoring system. Frequency of blepharitis, fluorescein staining, and the Schirmer's test values did not differ between patients and controls. Patients with cystic fibrosis had a higher frequency of altered ferning pattern that corresponded to the disease severity as measured by the Schwachman score (r = -0.48, p < 0.05). Although altered ferning pattern was frequent, the rate of type I ferning was also high (30%) in patients with cystic fibrosis. We conclude that the ferning test should not be used as an aid in diagnosis of cystic fibrosis but it may be used as an indicator of clinical status during follow-up.

Penetration of topical 0.3% ciprofloxacin into human aqueous humor.

BACKGROUND AND OBJECTIVE: Investigation of the penetration of topical ciprofloxacin into aqueous humor. PATIENTS AND METHODS: Topical 0.3% ciprofloxacin drops were administered to 17 patients with cataracts before lens extraction surgery. The time interval between the first dose and sampling was 3 hours in 9 patients (group A) and 6 hours in 8 (group B). In both groups, aqueous samples were collected 30 minutes after the last ciprofloxacin application. Ciprofloxacin concentration was determined by high-performance liquid chromatography-fluorescence detection. RESULTS: Mean aqueous concentration was 0.83+/-0.48 microgram/ml in group A and 2.42+/-1.42 micrograms/ml in group B. CONCLUSION: Topical 0.3% ciprofloxacin penetrates into the aqueous in a significant concentration.

Rapid liquid chromatographic assay of ciprofloxacin in human aqueous humor.

A simple, selective and sensitive method has been developed to determine ciprofloxacin in human aqueous humor. Separation of ciprofloxacin was carried out with pipemidic acid as internal standard using a Novapak C18 reversed-phase cartridge column (100 x 8 mm i.d., particle size 4 microns) and a mobile phase consisting of methanol-acetonitrile-citric acid (0.4 M) (3:1:10, v/v/v) at a flow rate of 1 ml min-1. The column effluent was monitored with fluorescence detection at 278 nm (excitation) and 450 nm (emission) after direct injection. The retention times were 4.88 min for pipemidic acid and 7.52 min for ciprofloxacin. The within-day and day-to-day reproducibilities were less than 7% for ciprofloxacin at 0.1 and 1 microgram ml-1 (n = 6). The mean recovery from aqueous humor was found to be 101.37 +/- 6.7% for ciprofloxacin at 0.1 micrograms ml-1 (n = 6 and the detection limit corresponding to a signal-to-noise ratio of 2.5:1 was 250 pg ml-1. The method was shown to be suitable for determining ciprofloxacin levels in human aqueous humor samples.

Rapid diagnosis of herpetic keratitis using direct immunoperoxidase technique.

The direct immunoperoxidase technique was tested for diagnosis of herpetic keratitis. The technique was performed on corneal epithelial specimens from 28 herpetic keratitis cases and 12 controls. Ulcers were stained with rose bengal or fluorescein and examined at the slit-lamp biomicroscope to differentiate between herpetic and nonherpetic etiology. Scrapings obtained from the corneal epithelial ulcers were stained with direct immunoperoxidase technique. The whole procedure, including staining and examination of the slides, took a total of 70 min. The test proved to be accurate, easy to perform and to interpret, rapid and relatively inexpensive with a sensitivity of 93%, and a specificity of 100%.

Contamination in contact lens care systems.

We studied the rate of contamination in the contact lens care systems and conjunctivas of 30 asymptomatic cosmetic soft contact lens wearers. In caring for their lenses, 23 patients used chemical disinfection systems (quaternary ammonium solutions), six patients used hydrogen peroxide, and one used heat. Eighteen patients used unpreserved intravenous saline solution, and only seven patients used commercially prepared preserved saline solutions. Cultures were obtained from lens cases, lens care solutions, and conjunctivas. Contamination was found in 70% of the lens care systems. Fifty-seven percent of the patients had lens case contamination, and 17% had conjunctival contamination. The most frequently isolated bacteria in the lens care systems were Pseudomonas, Staphylococcus epidermidis, and Escherichia coli. We suggest the development of more effective systems for disinfection.