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Opioids are often used for obstetric analgesia. Ideal obstetric analgesia is attained with optimal pain relief and minimal risk for the parturient. Therefore, investigators in the present study explored the effects of different opioids on the myometrium of pregnant rats. Myometrial strips were exposed to increased concentrations of fentanyl (10(-8) M to 10(-6) M), alfentanil (10(-8) M to 10(-4) M), remifentanil (10(-8) M to 10(-4) M), and meperidine (10(-8) M to 10(-4) M). Decreased contractile activity was observed in myometrial strips isolated from pregnant rats at cumulative concentrations of fentanyl, alfentanil, remifentanil, and meperidine. The amplitude of contractions was reduced with increasing concentrations of opioids; this effect was statistically significant at a concentration of 10(-4) M. When administered at higher concentrations, opioids may decrease contractions in pregnant rat myometrium. [ABSTRACT FROM AUTHOR]

Objctive: The present study, investigates the analgesic effects and complications of intra-articular neostigmine, tramadol, tenoxicam and bupivacaine on postoperative pain in patients undergoing day case knee arthroscopy. Subjects: Group 1 received 0.5 mg neostigmine, Group 2 received 100 mg tramadol, Group 3 received 20 mg tenoxicam, Group 4 received 20 ml 0.5% bupivacaine (control) in 20 ml normal saline intra-articularly at the end of the surgery. All patients had the same anaesthetic technique. Patients were observed in the recovery room with respect to pain scores, haemodynamic changes and postoperative analgesia at 1, 2 and 4 h postoperatively. Analgesic therapy in the recovery room was managed with 25 mg bolus doses of meperidine when the patients had visual analosue scale (VAS) scores higher than three points. The patients were discharged from hospital with a prescription for diclofenac 75 mg to be used as required. They were asked to complete their pain measures at 24 h and record their analgesic consumption. Results: There were no significant differences among the study groups regarding pain scores, haemodynamic changes, the first analgesic requirement time and complications. All patients in our study had adequate postoperative analgesia without any severe complication. Conclusion: Intra-articular administration of neostigmine, tramadol, tenoxicam or bupivacaine is a simple and effective postoperative analgesic technique after outpatient arthroscopic knee procedures. [ABSTRACT FROM AUTHOR]

In our case report, we present a case of successful antegrade balloon angioplasty performed via the femoral vein on a 980-gram neonate with severe coarctation of the aorta. Upon reviewing the literature, we found no cases of balloon angioplasty for coarctation performed via the femoral vein in infants with a lower birth weight than in our case. Our aim is to underline that each patient may require individual evaluation and management options., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Aim: The aim of this paper was to determine whether laparoscopic adrenalectomy (LA) is a safe and effective treatment for the management of large adrenal tumors., Methods: We retrospectively evaluated the data of patients who underwent LA at our institution between September 2002 and September 2012. Seventy-six transperitoneal LA were performed by the same surgical team. Patients with invasive tumors to adjacent organs or distant metastasis were excluded from the study. All patients were operated using the 450 oblique position as transperitoneal approach., Results: The mean age of the patients was 48.3 years (range 20-68 years). The mean tumor size was 5.37 cm (range 2-15 cm). Sixteen patients had tumor size over 8 cm. The mean tumor weight was 31.2 gr (range 2-156 g). The lesions were localized on the right side in 42 (55%) patients and on the left side in 34 (45%) patients. The mean intraoperative blood loss was 114 mL (range 20-400 mL) and the mean operative time was 112 min (range 55-300 min). Six patients (7%) required conversion to open procedure. The mean hospitalization time was 2.5 days (range 1-4 days). Five patients (6%) had post-operative minor complications. There were no incidents of capsular invasion or adverse cardiovascular events., Conclusion: LA is safe and feasible for both malign and benign adrenal lesions. Good preoperative assessment, surgical skills, team work and adherence to anatomical and surgical principles are the key to success for large adrenal masses.

Background: To evaluate the early and long-term outcomes of acute tracheobronchial injuries (TBI)., Methods: Twelve patients (10 males, 2 females; mean age 28; range 10 to 65 years) diagnosed as tracheobronchial injury and managed during between December 1997 and December 2004 were evaluated retrospectively. Clinical presentation, diagnostic evaluation, associated traumas, surgical management and outcome were reviewed. Follow-up ranged from 1 to 7 years., Results: All patients underwent surgical debridement and primary repair (anastomosis). There were three tracheal, eight bronchial and one laryngotracheal injury. Accompanying simultaneous traumas were treated at the same session in all cases. One case was discharged from the hospital with permanent tracheostomy. Control bronchoscopies were performed one week and one month after the surgical repair. Bronchiectasia developed in one case after five years and left lower lobectomy was performed. One case died 23rd day after the primary repair. In the remaining ten cases no complication was determined., Conclusion: In all cases with a suspicion of TBI, bronchoscopy should be performed immediately by specialist physicians. Early recognition of tracheobronchial injury and expedient institution of appropriate surgical intervention are lifesaving in these potentially lethal injuries. Concomitant injuries are the most important mortality factor.

Purpose: To evaluate the long-term systemic toxicity of tacrolimus (FK-506) administered by various routes, and to assess the effect of dose reduction on toxicity., Methods: The study animals were 120 experimentally naive adult female Wistar rats weighing 200-250 g each. The rats were randomly divided into 10 equal groups (n=12 in each) and treated with tacrolimus administered topically (in drops, 0.3%, q.i.d.), intravitreally (0.5 mg/kg bodyweight/week), intramuscularly (1 mg/kg bodyweight/week), low-dose intravenously (1 mg/kg bodyweight/week) and in high-dose intravenously (2 mg/kg bodyweight/week) for 3 months. The rats in the control groups (one for each different route of administration) were treated with 0.9% NaCl. The blood concentration of tacrolimus, complete blood count and biochemistry parameters were measured each month for the 3-month study period., Results: The rats in the control groups and experimental groups administered topical and intravitreal tacrolimus did not demonstrate any systemic toxic effects. The rats that developed certain toxic effects (hyperglycaemia, hyperkalaemia and nephrotoxicity) in the groups given low-dose or high-dose i.v. tacrolimus responded well to dose reduction. Following dose reduction, blood glucose concentrations decreased from 247.4 +/- 42.3 mg/dL to 189.6 +/- 37.9 mg/dL (P <0.05), and from 237.4 +/- 41.1 mg/dL to 182.3 +/- 22.7 mg/dL (P <0.05) in the low- and high-dose i.v. tacrolimus-treated rats, respectively. The rats that developed impaired hepatic function after high-dose tacrolimus did not respond to dose reduction. Baseline cholesterol concentrations for the intramuscular and low- and high-dose i.v. tacrolimus-treated groups, demonstrated decreases, respectively, from 87.4 +/- 14.0 mg/dL, 86.4 +/- 14.0 mg/dL and 90.4 +/- 14.3 mg/dL to 53.6 +/- 9.8 mg/dL, 52.1 +/- 12.5 mg/dL and 63.5 +/- 11.7 mg/dL by the end of the second month. The differences were found to be statistically significant (P <0.05 for each result)., Conclusion: Topical or intravitreal administration of tacrolimus seems to be systemically safe whereas parenteral administration can cause some systemic haematological changes such as dose-dependent decreased serum cholesterol concentrations. Dose reduction may prevent such adverse effects.

In this study, we studied 45 healthy parturients with singleton vertex presentation. Patients were allocated randomly to receive either 0,125 % bupivacaine with 2 micro g/ml fentanyl or 0,125 % bupivacaine with 1,5 micro g/ml clonidine for epidural labour analgesia. A patient controlled epidural analgesia (PCEA) pump was programmed as follows: basale infusion rate: 6 ml/h, demand bolus: 5 ml, lockout interval: 10 min. Efficacy of analgesia was evaluated using visual analogue scale. Maternal and fetal cardiovascular variables, Apgar scores of the newborn at 1-5 min and umbilical arterial blood gas measurements were recorded. The duration of stages of labour and total analgesic consumption were also noted. Systolic blood pressure decreased significantly at 3rd h in bupivacaine plus fentanyl group. Although all patients experienced a good analgesia, pain scores in bupivacaine plus clonidine group were lower than bupivacaine plus fentanyl group. The analgesic requirement in bupivacaine plus clonidine group was less than the other group. There were no significant differences in fetal heart rate, Apgar scores or umbilical blood gases. In conclusion, the addition of clonidine to epidural bupivacaine for PCEA was superior to bupivacaine plus fentanyl for analgesia and analgesic requirement during labour.

One of the most commonly performed outpatient procedure is colonoscopy. The pain and anxiety is frequently associated with colonoscopy. The aim of this study was to compare the effectiveness of remifentanil/midazolam, and tramadol/midazolam for iv sedation and analgesia during colonoscopy. Twentysix patients (age range 18-65 years) scheduled for ambulatory colonoscopy were included to study. All patients received midazolam 1 mg intravenous. After two minutes in Group R (remifentanil/midazolam, n=18) remifentanil bolus (10 microg) and infusion 0.03 microg kg(-1) min(-1) were administered until adequate sedation level was achieved. In Group T (tramadol/midazolam, n=18) iv tramadol 50 mg was given concurrently. During procedure 2 L/min oxygen was supplemented via face mask to all patients. Haemodynamic variables, respiratory depression, level of sedation, postoperative recovery, patient and gastroenterologist satisfaction were surveyed. Patients were asked to verbally rate their level of pain, on an 10-point numerical rating scale (1=no pain, 10=severe pain). Chi-square, student t test, and mann whitney U test were used for statistical analysis. Colonoscopy was carried out successfully in all patients. There were no episodes of desaturation or airway compromise. Haemodynamic parameters were similar in both groups. Sistolic arterial and diastolic arterial pressures were increased at 10 and 15 minutes in all patients (P<0.05). There were no significant changes in heart rate in both groups. The level of sedation in group R was higher than group T during colonoscopy. The patients in group T had higher pain scores. Gastroenterologist satisfaction and patient satisfaction were similar in both groups. Our results suggests that, sedoanalgesia with midazolam/remifentanil may be an alternative to sedoanalgesia with midazolam/tramadol for colonoscopy.

Organophosphates are the most common group of chemicals in the southern part of Turkey. Although organophosphate poisoning (OPP) may occur due to skin exposure or inhalation, severe poisoning is usually the result of ingestion to attempt suicide. Despite the fact that there have been a lot of experimental studies using intravenous or percutaneous injection of organophosphates, reports of human poisoning due to percutaneous injection are rare. The systemic signs of OPP have not been described in these reported patients. We report 2 cases having systemic signs of OPP due to percutaneous injection. In our first case, we noticed a 17-day muscle weakness and a 12-day muscarinic syndrome, which required prolonged atropinization. In the second patient, atropine infusion had to be continued for 2 days. Both cases also had severe swelling of the affected limb and wound infection. In conclusion, in cases of percutaneous injection of organophosphates systemic toxicity may develop in addition to local findings such as necrosis and abscesses. Close observation for evidence of systemic involvement is required, and the patient should be carefully monitored for secondary abscess formation and any delayed impairment of neurologic function., (Copyright 2002 S. Karger AG, Basel)

In this study, we investigated the blood flow velocity changes in orbital arteries by using Doppler sonography in eight patients with brain death. Peak-systolic and end-diastolic velocities and resistive indices of the ophthalmic and central retinal arteries were evaluated. We observed the absence or reversal of end-diastolic blood flow in these arteries. To our knowledge, this finding has not been previously reported to be associated with brain death.