The effect of simultaneous administration of occipital nerve block and cervical myofascial trigger point injection (MTrPI) on headache parameters in chronic migraine patients

BACKGROUND AND AIM

Peripheral myofascial mechanisms have been identified as contributors to migraine pathophysiology. The specific comorbid relationship between migraine and cervical trigger points may exacerbate the occurrence and severity of migraine attacks. Trigger point injections (TPIs) are frequently employed to address headaches and alleviate migraine symptoms. The current study explores the impact of concurrent myofascial trigger point injection (MTrPI) and occipital nerve block (greater occipital nerve block [GONB] + lesser occipital nerve block [LONB]) on the severity of headaches and the number of migraine attacks in individuals with chronic migraine (CM) and cervical myofascial trigger points (MTrPs), with a comparison of occipital nerve block alone (GONB + LONB). During trigger point examination and injection, trapezius, levator scapulae, splenius capitis, temporalis, and sternocleidomastoid muscles were targeted. We planned the treatment based on whether they were in the muscle groups we determined, rather than the number of trigger points.

MATERIALS AND METHOD

This study enrolled 62 individuals experiencing CM with bilateral headache and cervical MTrP who sought care at the Algology Unit within the Departments of Neurology and Physical Therapy and Rehabilitation at Siirt Training and Research Hospital between 2020 and 2022. The CM cohort was stratified into two groups: group 1 received trigger point injections (TrPI), while group 2 underwent concurrent bilateral occipital nerve block (GONB + LONB) and TrPI. Both groups underwent three treatment sessions with bupivacaine 0.5% (1 ml = 5 mg) in weeks 1, 2, and 4. Visual analog scale (VAS) was used to measure the patients' pain intensity. The evaluation included the assessment of the monthly migraine frequency and visual analog scale (VAS) p score for pain before treatment (BT) and after treatment (AT), conducted at baseline and during follow-up visits. Analysis of the data was conducted utilizing IBM SPSS Statistics for Windows version 28.0 software.

RESULTS

Among patients diagnosed with CM and MTrPs, 32 individuals (51.6%) underwent GONB and LONB, while 30 patients (48.4%) received simultaneous GONB, LONB, and cervical MTrPI. Within the entire sample, 51 participants (82.3%) were female, and 11 (17.7%) were male, with a mean age of 32.81 ± 10.75 years. With an average age of 32.81 ± 10.75 years, there was no statistically significant variance between the two groups (p = 0.516). Of the total cohort, 45 individuals (72.6%) reported experiencing headaches persisting for 12 months or longer. Among CM patients, 80% had active trigger points, while 20% had latent trigger points. No statistically significant difference was observed between the groups concerning TrPs (p = 0.158), and the distribution of TrPs was homogenous across the two groups. In group 1, the median (min-max) monthly frequency of migraines reduced from 18.5 days (range: 15.0 to 25.0 days) before treatment to 12.0 days (range: 7.0 to 17.0 days) after treatment (p = 0.000). In group 2, the median monthly frequency of migraines reduced from 16.5 days (range: 15.0 to 22.0 days) before treatment to 4.0 days (range: 2.0 to 8.0 days) after treatment (p = 0.000). The median (min-max) VAS score in group 1 was 8.0 (range: 5.0 to 9.0) before treatment, 4.0 (range: 2.0 to 6.0) at week 1, and 5.0 (range: 4.0 to 8.0) at week 4 (p = 0.000). In group 2, the median VAS score was 7.0 (range: 5.0 to 9.0) before treatment, 0.0 (range: 0.0 to 0.3) at week 1, and 2.0 (range: 0.0 to 0.3) at week 4 (p = 0.000). There were significant distinctions between the groups in terms of both the monthly count of migraine days and the severity of headaches (p = 0.000).

CONCLUSION

The combination of repeated MTrPIs and ONB proves more effective than ONB alone in managing patients with CM and cervical MTrP. In patients with CM, performing TrPs examination and adding treatments for this may contribute to the treatment. In cases where patients endure prolonged episodes of headache associated with chronic migraine, the inclusion of trigger point injections alongside peripheral nerve blocks may offer enhanced therapeutic benefits.

Evaluation of chromosomal abnormalities in the postnatal cohort: A single-center study on 14,242 patients

BACKGROUND AND AIM

Chromosomal analysis is a laboratory technique used to examine the chromosomes of an individual, offering insights into chromosome numbers, structures, and arrangements to diagnose and comprehend genetic diseases. This retrospective study provides a comprehensive understanding of the distribution by indications in a large cohort of 14,242 patients and the frequency of chromosomal abnormalities in different clinical populations.

METHOD

The study examined various indications for karyotype evaluation, with recurrent pregnancy loss being the most common indication, followed by intellectual disability, dysmorphic features, congenital anomalies, and developmental delay.

RESULTS

The overall chromosomal abnormality rate was found to be 5.4%, with numerical abnormalities accounting for the majority of cases (61.7%). Trisomies, particularly trisomy 21, were the most frequent numerical abnormalities. In terms of structural abnormalities, inversions and translocations were the most commonly identified. The rates of chromosomal anomalies varied in specific indications such as amenorrhea, disorders of sex development, and Turner syndrome. The study also highlighted significant differences between males and females in the presence of chromosomal abnormalities across certain indications. Males exhibited a higher incidence of chromosomal abnormalities in cases of Down syndrome and infertility, whereas females showed higher abnormalities in terms of recurrent pregnancy loss.

CONCLUSION

While this study provides valuable insights into the frequency and distribution of chromosomal abnormalities, it has limitations, including its retrospective design and reliance on data from a single medical genetics department. Nevertheless, the findings emphasize the importance of karyotype analysis in diagnosing chromosomal disorders and providing appropriate management, while also pointing to potential gender-related variations in chromosomal abnormalities that warrant further investigation.

Influence of grafting on fatty acid profile and some physicochemical properties of watermelon seed and seed oil

This study aimed to investigate the effects of grafting on the fatty acid profile and some physicochemical properties of watermelon seed and seed oil. The ‘Crimson Tide’ cultivar was used as the scion while two wild watermelon (Citrullus lanatus var. citroides (A1 and A2)), one Lagenaria siceraria (A3) and one Cucurbita maxima Duchesne x Cucurbita moschata Duchesne (A4) were used as rootstocks. The use of rootstock significantly influenced the fatty acid profile and the physical parameters of seeds and seed oils. The highest linoleic acid ratio was found in the seed oil from A1 and A2, the oil from A3 had the highest oleic acid ratio. The results showed that the content and acid value in seed oils were improved, and that total phenolic compounds and antioxidant activity of both seed and oil were decreased by grafting. Wild rootstocks can be used in watermelon cultivation to obtain a watermelon seed which is rich in linoleic acid.

Suppression of Experimental Pain by Auriculopressure

In a controlled trial at a University Clinic of Physical Therapy and Rehabilitation, healthy student volunteers were given auriculopressure to investigate its analgesic effect. There were two study groups, each containing 30 volunteers. The first group was given auriculopressure to the toe somatic point on the ear, with pressure sensitivity being measured on the skin of the toe with an algometer device before and after ear stimulation. The control group had the same measurements with placebo stimulation to the ear. In the auriculopressure group the increase in pain threshold was statistically significant. In the placebo control group there was no significant change. These results suggest that auriculopressure could be a useful method for suppression of post-traumatic somatic pain.

Acute intestinal obstruction due to a non-involuted uterus after cesarean section: case report

The involution of the uterus is influenced by a number of factors such as advanced childbearing age, electrolyte disturbances, multiparity, repeated cesarean sections, and vaginal infections. The authors report the management of a clinical case of a 41-year-old female who presented with acute intestinal obstruction due to a non-involuted uterus after cesarean section.

Effect of vegetation change from native broadleaf forest to coniferous plantation on selected soil properties

The objective of this study was to examine the effects of vegetation change from a native broadleaf forest to a coniferous plantation on selected soil properties, including soil texture, pH, organic matter, total nitrogen (N), total phosphorus (P), exchangeable cations (Ca(2+), K(+), Na(+)), and cation exchange capacity (CEC). Results showed that the amount of clay particles, Ca(2+), and K(+) values significantly increased, whereas Na(+), total N, and organic matter and soil pH values decreased on the treatment plot after vegetation change. Soil acidity also increased and soil textural group changed from moderately fine-textured soils (clay loam) to medium-textured soils (loam) under both control and treatment plots. Organic matter, total N, and Na(+) values increased, whereas Ca(2+) concentration decreased through time on the control plot. Soil pH, total P, K(+), and CEC did not show significant changes through time on the control plot.

Management of hepatic artery aneurysms

BACKGROUND

Hepatic artery aneurysm (HAA) is a rare clinical entity that can lead to potentially life threatening complications. We reported our personal experience of 4 cases, in which we used different procedures.

METHODS

The first case had a pseudo-aneurysm involving the right hepatic artery. The second case had a pseudo-aneurysm, which was localized distal to the accidentally ligated right hepatic artery from the previous cholecystectomy operation. The third case had multiple aneurysms with accompanying dissecting abdominal aortic aneurysm. The fourth case had a pseudo-aneurysm originating from the proper hepatic artery. A covered stent was successfully placed in the case 1. In the second case, the right hepatic artery was ligated distal to the aneurysm. In the third case, vascular structures were not appropriate for vascular reconstruction, and a covered stent placement and embolization were unsuccessful. In the fourth case, ligation of the proper hepatic artery and cholecystectomy was performed.

RESULTS

The third case with multiple aneurysms died from multi-organ failure due to sepsis. The remaining cases (case 1, 2, and 4) are disease free and alive.

CONCLUSION

HAAs are more commonly observed clinical entities, and their treatment should be handled for each patient separately. Computerized tomography-Angiography and intraoperative Doppler ultrasound are useful radio-diagnostics for determination of aneurysm and planning the operative procedure (Fig. 5, Ref. 15).

Role of plasma viscosity and plasma homocysteine level on hyperinsulinemic obese female subjects

Obesity is associated with atherosclerotic risk factors, including reduced blood flow, endothelial dysfunction, lipid disorders and hyperinsulinemia. In recent years, several studies have demonstrated that elevated homocysteine is a risk factor for atherosclerosis. This study was aimed at determining whether any relationship between plasma viscosity and homocysteine levels in patients with normo and hyperinsulinemic obese patients. Obese women (n=75) and healthy, age-matched non-obese women (n=70) was included in our study. Plasma viscosity, tHcy, insulin level, total-C, LDL-C, HDL-C, triglyceride and glucose level were significantly higher in obese subjects than in non-obese subjects. Obese subjects were also divided into two groups, according to the basal insulin levels as normo and hyper insulinemic. Hyperinsulinemic obese subjects had significantly higher PV level compared with normoinsulinemic subjects. When correlation analyses were performed normoinsulinemic obese subjects, significant correlations were found between PV and total-C (r: 0.776) and insulin level (r: 0.752), BMI (r: 0.580), HOMA-IR (r: 0.510). PV was positively correlated with total-C (r: 0.485), insulin level (r: 0.624), BMI (r: 0.624) and HOMA-IR ratio (r: 0.707), in hyperinsulinemic obese subjects. Hcy was positively correlated BMI in both groups. In conclusion that, it is point out that elevated homocysteine and increased PV are two factors that may act separately and probably do not affect each other.

Plasma viscosity, an early cardiovascular risk factor in women with subclinical hypothyroidism

OBJECTIVE

It is controversial, if subclinical hypothyroidism increases cardiovascular risk. Plasma viscosity is a hemorheological parameter, which is accepted as an early cardiovascular risk factor. We investigated the alterations in plasma viscosity in women with subclinical hypothyroidism.

DESIGN

40 female patients with subclinical hypothyroidism and 31 age- and weight-matched healthy women were included. Free thyroxine (FT4), thyroid stimulating hormone (TSH), lipid parameters, fibrinogen, C-reactive protein (CRP) levels, hematocrit and plasma viscosity were measured in all subjects.

MAIN OUTCOME

Plasma viscosity, total cholesterol and low density lipoprotein were significantly increased and high density lipoprotein was significantly decreased in patients with subclinical hypothyroidism. No significant correlation was found among the parameters.

CONCLUSION

Increased plasma viscosity in patients' group suggests that cardiovascular risk might be increased in patients with subclinical hypothyroidism. As far as we could reach, this is the first study concerning plasma viscosity in subclinical hypothyroidism.

Plasma viscosity in female patients with hypothyroidism: effects of oxidative stress and cholesterol

Hypothyroidism is associated with atherosclerotic events, however, the mechanism is unclear. We investigated the effects of oxidative stress and cholesterol on plasma viscosity in female patients with hypothyroidism (n = 20; mean age: 45.5 +/- 5.5 years) at baseline and after L-thyroxine replacement therapy (average daily dose being 0.1 to 0.15 mg). Two blood samples were taken after 2.3 +/- 1.2 months. In hypothyroid state plasma viscosity and thiobarbituric acid reactive substance (TBARS; marker of oxidative stress were significantly higher (p < 0.001 and p < 0.001), and plasma protein thiol (antioxidants) levels were significantly lower (p < 0.001) than in the healthy state (female; n = 15). After L-thyroxine replacement therapy, patients reached to euthyroid state. In this state, the levels of plasma viscosity and TBARS were decreased (p < 0.001 and p < 0.001), and protein thiol levels were significantly elevated (p < 0.001). There was a significant correlation between plasma cholesterol and viscosity (r = 0.64, p < 0.001), as well as plasma protein thiol (r = -0.59, p < 0.001) in the patients. The correlation between viscosity and TBARS was weak (r = 0.29, p < 0.01). Therefore hypothyroidism may be associated with atherosclerotic process by different mechanisms.

Impaired plasma viscosity via increased cholesterol levels in peripheral occlusive arterial disease [correction of disase]

The aim of this study was to investigate the relationship between plasma viscosity and lipoprotein and apolipoprotein pattern in normo- and hypercholesterolemic patients with peripheral occlusive arterial disease (POAD). 40 patients with POAD have been selected (8 females and 32 males, mean age: 54+/-3.2 years) with clinically evident superficial femoral occlusive artery disease. They were separated into two groups as normocholesterolemic (plasma total cholesterol <200 mg/dl) and hypercholesterolemic (plasma total cholesterol >200 mg/dl). Plasma total cholesterol, high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), triglycerides, total protein, and albumin levels were determined by enzymatic methods using commercial kits. Levels of apolipoprotein AI (apo AI), and apolipoprotein B (apo B) were measured using a immunoturbidometric method. Plasma viscosity (PV) was measured by capillary viscometer. Classifying the patients with PAOD according to the cholesterol levels; hypercholesterolemic (mean total-cholesterol: 227.90+/-26.97 mg/dl) patients had significantly higher LDL-C, PV and triglyceride levels compared with nornocholesterolemic patients (p<0.001, p<0.001, p<0.001, respectively). HDL-C and apo B were significantly lower in hypercholesterolemic patients than in normocholesterolemic patients (p<0.001, p<0.001, respectively). PV was positively correlated with total cholesterol (r=0.485, p<0.05), atherogenic index (r=0.624, p<0.01), total-C/HDL-C ratio (r=0.624, p<0.05), and LDL-C/HDL-C ratio (r=0.707, p<0.001) in hypercholesterolemic patients with POAD. PV was higher in hypercholesterolemic patients with POAD than in normocholesterolemic patients with POAD. We suggest that POAD patients should be regarded as a heterogenous group with lipid and lipoprotein parameters in order to assess the microcirculation in the affected limb. In case of dyslipidemia in POAD patients an elevated plasma viscosity should be considered as coexisting risk factor.

Plasma viscosity as a cardiovascular risk marker in patients with proteinuria

Plasma viscosity is a major determinant of capillary blood flow. It has been suggested that alteration in plasma viscosity contributes to impaired blood flow and to increased cardiovascular risk. The aim of this study was to investigate the plasma viscosity levels and its possible role in the cardiovascular risk in patients with low grade nephrotic proteinuria. 20 patients with low-grade nephrotic proteinuria (mean age: 35+/-5 years) and 20 healthy controls (mean age: 33+/-4 years) were participated in the study. Plasma viscosity was measured by Harkness capillary viscometer. Biochemical analysis were measured by commercial enzymatic kits. Plasma viscosity, plasma levels of creatinine, fibrinogen and triglyceride were increased in patients with proteinuria than in the healthy controls (p<0.001, p<0.001, p<0.001, and p<0.001, respectively). The plasma levels of total protein and albumin were significantly lower in patients with low grade nephrotic proteinuria than in healthy controls (p<0.001 and p<0.001, respectively). Plasma viscosity was negatively correlated with plasma albumin (r= -0.835, p<0.001) and total protein (r= -0.862, p<0.001) in proteinuric patients. When the correlation analyses were performed a significant positive correlation was found between plasma viscosity and fibrinogen (r=0.636, p<0.001). In the stepwise multiple regression analysis plasma viscosity was found to be related with plasma total protein (t= -6.456, p<0.001) in the patients. When the stepwise multiple regression analysis were performed in healthy controls, the significant relationship was only found between plasma viscosity and fibrinogen (t= +2.202, p<0.01). These results suggested that altered plasma composition associated with low-grade nephrotic proteinuria may be involving the determination of plasma viscosity. Thus, the plasma viscosity in patients with low-grade nephrotic proteinuria may have a prognostic value in assessing cardiovascular risk in this group.

Hemorrheological variables in critical limb ischemia

BACKGROUND

Impaired hemorrheological properties may worsen the tissue hypoxia distal to an arterial narrowing in patients with peripheral arterial occlusive disease (PAOD). The objective of this study was to investigate the changes in red blood cell rigidity, blood viscosity and plasma viscosity as contributing factors in the development of hypoxia in patients with critical limb ischemia (CLI).

METHODS

Forty patients with critical limb ischemia and 40 healthy subjects were included in the study. The subjects included in the study were non-diabetic with blood pressure measurements within the normal range. Compound known to interfere with hemorrheological parameters were not taken by the patients for at least 7 days prior to investigation. Routine blood counts (WBC, RBC, Hb, Hct), plasma fibrinogen levels, plasma total cholesterol levels, red blood cell rigidity, blood and plasma viscosity were determined in both groups. Statistical evaluation of the results of both groups was compared by student's "t"-test. The level of significance was set at p<0.05.

RESULTS

Blood viscosity at a shear rate of 6.00 sec(-1) was found to be significantly lower in the CLI group (p<0.001), whereas no significant difference was encountered when blood viscosity was measured at a shear rate of 225 sec(-1). Plasma viscosity and plasma fibrinogen levels were comparable. Plasma total cholesterol levels were found to be significantly higher in the CLI group (p<0.05) and red blood cell rigidity significantly lower (p<0.001).

CONCLUSIONS

These findings may provide new insights into the role of blood viscosity in patients with CLI contrary to the previous reports in the literature. Therapies that address red blood cell rigidity more directly may decrease tissue hypoxia distal to arterial narrowing by preventing hemolysis, improving microcirculation, and increasing oxygen carrying capacity and may be more beneficial for these patients.

Nimodipine attenuates lipid peroxidation during the acute phase of head trauma in rats

Oxygen free radical-mediated lipid peroxidation is one of the major mechanisms of secondary damage in traumatic brain injury. We assessed the effects of nimodipine on lipid peroxidation 1 h after head trauma in rats. Nimodipine (1.5 microg/kg IV bolus injection) was given immediately after head trauma by either the carotid artery or the jugular vein. Placebo treated rats received saline by the same routes. Control rats received head trauma only. Sham-operated rats were the group without head trauma. Malondialdehyde (MDA), which is the end product of lipid peroxidation, was measured as an indicator of oxygen free radical formation in the brain tissue. The mean values for MDA in sham operated rats were 92.4 +/- 4.9 nanomoles/gram wet weight (nmol/gww) of brain tissue. In the control group, MDA content of the brain tissue was 120.8 +/- 9.4 nmol/gww. In placebo treated rats, the results were similar. In the groups receiving nimodipine via carotid artery or jugular vein, the mean values were 101.1 +/- 6.9 and 106.5 +/- 6.0 nmol/gww, respectively. These results indicate that nimodipine caused a significant decrease in lipid peroxidation when given in the acute phase of head trauma in rats. This occurred regardless of the route of injection.

The relationship between plasma viscosity and cholesterol in postmenopausal women on hormone replacement therapy

In women, cardiovascular morbidity and mortality sharply increase after the onset of menopause. There is substantial evidence that hormone replacement therapy (HRT) may decrease the risk of coronary heart disease; however the mechanism is unclear. We investigated the relationship between HRT and plasma viscosity as well as cholesterol levels in postmenopausal women. 30 women were using HRT (HRT users), and 30 women were not using HRT (non-users). According to the classification of their plasma cholesterol levels, 30 women were hypercholesterolemic levels (hypercholesterolemic users n = 15, and hypercholesterolemic non-users n = 15), and the others were normocholesterolemic levels. While the highest plasma viscosity was measured in hypercholesterolemic users (1.291 +/- 0.053 cP), the lowest plasma viscosity was measured in normocholesterolemic users (1.127 +/- 0.056 cP). There was a significant correlation between plasma viscosity and cholesterol levels in the women on HRT (r = 0.76, p < 0.001). We have not found a difference neither in fibrinogen levels nor in triglycerides between users and non-users. These data demonstrated that HRT has beneficial effect on plasma viscosity; mainly in normocholesterolemic post menopausal women.

Plasma and erythrocytes antioxidant status and trace element levels in proteinuric patients with moderate glomerular function

The objective of the study was to investigate the effect of moderate glomerular dysfunction on oxidative stress. We determined the plasma and erythrocyte malondialdehyde (MDA) levels, as a marker of lipid peroxidation, erythrocyte glutathione (GSH) levels and activities of GSH-Px, GSH Red and SOD as an antioxidant enzymes, and plasma trace element levels containing Fe, Cu and Zn in twenty proteinuric patients (6.8 +/- 5.1 g/day) with moderate glomerular function and in 20 anemic control subjects. We found that the erythrocyte and plasma MDA levels and erythrocyte GSH-Px activities were significantly higher (p < 0.001, p < 0.001, p < 0.001, respectively) and the erythrocyte GSH levels and activities of GSH-Red and SOD activities were significantly lower (p < 0.001, p < 0.001, p < 0.001, respectively) in the patients than in the anemic subjects. Plasma Fe and Zn levels were not to be found significantly different in the patients compared to the anemic subjects. But plasma Cu levels were significantly higher in the patients (p < 0.05) when compared with the levels of anemic subjects. This study was concluded that cellular antioxidant activity decreases in proteinuric patients with moderate glomerular function. This may increase lipid peroxidation reactions by causing oxidative stress in erythrocyte membranes.

Trace element levels in the experimental peritonitis

Electron transfer from iron or copper ions to oxygen is an important example of cellular free radical initiation. Oxygen derived free radicals have been implicated as mediators of cellular injury in several model systems. To evaluate the importance of iron, copper and zinc levels on lipid peroxidation in peritonitis, we measured peritoneum malondialdehyde (MDA) as a marker of lipid peroxidation, zinc, copper, and iron levels during an animal model of intraperitoneal sepsis. Additionally the effects of the free radical scavenger alpha-tocopherol administration was studied. The peritoneum MDA, iron, copper and zinc levels were increased after induction of peritonitis with Escherichia Coli. The treatment with alpha-tocopherol was decreased the peritoneum MDA, iron and copper levels significantly, except the zinc level (p < 0.001, p < 0.001, p < 0.001, respectively). Additionally the alpha-tocopherol treatment for three days prior to injection of E.Coli more decreased MDA, copper and iron levels than that of the treatment with alpha-tocopherol at the time of injection of E. Coli (p < 0.001, p < 0.001, p<0.001, respectively). Our results indicated that copper, iron and zinc had important effects on peroxidation events in E. Coli induced peritonitis, and alpha-tocopherol treatment can improve the oxidant status.

Plasma leptin levels in obese and non-obese postmenopausal women before and after hormone replacement therapy

OBJECTIVE

the aim of this study was to investigate the effect of hormone replacement therapy (HRT) on plasma leptin levels in postmenopausal women, and the relationship between the plasma leptin levels and obesity.

METHODS

premenopausal women with normal cycles (n=30; mean ages, 35.4+/-8.3 years) and postmenopausal women (n=45; mean ages, 49.5+/-4.7 years) were randomly selected. Women were classified as obese (BMI>27 kg/m(2)) and as non-obese (BMI<27 kg/m(2)). Blood samples were obtained from the premenopausal women at the beginning of cycle, and from the postmenopausal women before and 6 months after HRT. Plasma leptin levels were measured by radioimmunassay.

RESULTS

plasma leptin levels were significantly higher in premenopausal women than in postmenopausal women (18. 60+/-5.0; 3.67+/-2.44 ng/ml, respectively, P<0.001). Obese premenopausal women (n=15) had significantly higher plasma leptin levels (24. 60+/-7.81 ng/ml) in comparison with the levels of the non-obese premenopausal women (n=15; 12.50+/-4. 63 ng/ml) (P<0.001). Although there was no significant difference in the plasma leptin levels between obese (n=25) and non-obese (n=20) postmenopausal women before HRT, plasma leptin levels were significantly elevated in both obese and non-obese postmenopausal women after HRT (P<0.001), and the obese women had significantly higher plasma leptin levels than the non-obese (29.05+/-10.53; 14.78+/-6.76 ng/ml, respectively, P<0.001).

CONCLUSION

HRT is effective in the elevation of the plasma leptin levels in postmenopausal women, and in obese women the increase of the plasma leptin levels are more marked than the non-obese women after HRT.

Sleep quality and pain threshold in patients with fibromyalgia

The purpose of the study was to examine the association between the subjective sleep quality and pain threshold in fibromyalgia. Sixteen patients with fibromyalgia were included in the study. The pain threshold was determined using a manual algometer. The Pittsburgh Sleep Quality Index (PSQI) was used to assess sleep quality. The pain threshold was negatively correlated with the scores for subjective sleep quality, habitual sleep efficiency, and sleep disturbance and the PSQI global score. We conclude that there is a negative correlation between pain and sleep disturbance: increased pain sensitivity is associated with greater sleep disturbance.

Hypnotizability, pain threshold, and dissociative experiences

BACKGROUND

There may be an association between pain threshold, hypnotizability, and dissociative experiences. The purpose of the present study was to examine this association.

METHODS

Forty-one healthy subjects were included in the study. Pain thresholds were determined using a manual algometer. The Dissociative Experiences Scale was administered to all subjects. Hypnotizability of the subjects was assessed by the eye roll sign of the Hypnotic Induction Profile. There were 14, 15, and 12 subjects in the Grade 1, 2, and 3 groups, respectively.

RESULTS

Highly hypnotizable subjects had lower pain thresholds and were more likely to report dissociative experiences than the less hypnotizable subjects.

CONCLUSIONS

There is an association between pain threshold, hypnotizability, and dissociative experiences. It may be suggested that dissociative and somatic symptoms may be integrally linked and related to hypnotic suggestibility.

Acupuncture and hypnotic suggestions in the treatment of non-organic male sexual dysfunction

We have examined the effects of acupuncture and hypnotic suggestions, and compared them with placebo in the treatment of male sexual dysfunction with no detectable organic cause. The study comprised 15 men (mean age 36.7 +/- 10.43 years) who received acupuncture treatment, 16 men (mean age 38.4 +/- 10.75 years) who underwent hypnosis (mean age 35.3 +/- 11.52 years) and 29 men (mean age 36.2 +/- 11.38 years) who served as controls. They were interviewed periodically; the patients' reports were verified by interviewing their partners. Men who received placebo had a 43-47% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of acupuncture and hypnotic suggestions were 60% and 75% respectively. Although the improvement was not statistically significant, treatment with acupuncture could be used as an adjuvant therapy in non-organic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.

Intraarticular morphine administration provides pain relief after knee arthroscopy

This present study investigated the effects of intraarticular morphine administration in 1 mg and 5 mg doses on post-operative pain relief and analgesic requirements for patients undergoing arthroscopic procedures. At the end of the operation patients were randomly allocated in a double-blinded fashion into three groups. The control group (Group 1) received normal saline 20 mL intraarticularly. The patients in the second and third groups received intraarticular morphine sulphate 1 and 5 mg in saline 20 mL, respectively. Post-operative pain was assessed on the 1st, 6th and 24th hour by visual analogue scale (VSA). Supplementary analgesic requirement and possible complications were also followed. The intensity of pain and analgesic requirement were reduced more in the morphine 5 mg group than in the control group. It is concluded, that the administration of intraarticular morphine 5 mg provides long-lasting and effective analgesia after knee arthroscopy.

Anaesthetic management in maple syrup urine disease

Two children with maple syrup urine disease undergoing emergency and elective surgery are reported. The administration of ketamine to a 12-month-old boy without neurological problems and propofol infusion to a 5-year-old girl with a history of convulsions, was uneventful. We believe that a full knowledge of the pathophysiology of maple syrup urine disease and potential peri-operative problems associated with the disease are essential, so that patients are not subjected to unnecessary risks.

Effects of vitamin A on immunological deficiencies in rats with obstructive jaundice

OBJECTIVE

To investigate the ability of an immunostimulant, vitamin A, to reverse dysfunction of the mononuclear phagocyte system and impaired peritoneal neutrophil chemotaxis in rats with obstructive jaundice.

DESIGN

Open laboratory study.

SETTING

Medical School, Turkey.

MATERIAL

60 male Wistar-Albino rats.

INTERVENTIONS

Two different experimental studies with 30 rats each were performed. Ten of the 20 rats in which the common bile duct was ligated and divided, were given vitamin A (vitamin A group) and the other 10 were given saline (saline group). Ten rats which underwent laparotomy with mobilisation of the common bile duct (sham group) were given saline. Rats in the vitamin A group were given 200 IU/g/day vitamin A and other groups of rats had an equal volume of saline intraperitoneally for 20 days.

MAIN OUTCOME MEASURES

Function of the mononuclear phagocytic system was studied by the use of 99mTc sulphur colloid uptake, peritoneal neutrophil chemotaxis was measured by the Boyden chamber method, and liver function tests were studied 21 days after operation.

RESULTS

Hepatic uptake of 99mTc sulphur colloid decreased, and lung uptake increased in the saline group compared with the sham and vitamin A groups (p < 0.05). Neutrophil chemotaxis was reduced in the saline and vitamin A groups compared with the sham group (p < 0.05). Serum aspartate aminotransferase and alanine aminotransferase activities and unconjugated bilirubin concentrations in the saline group were higher than in the vitamin A and sham groups (p < 0.05).

CONCLUSION

Vitamin A stimulates mononuclear phagocytic function in jaundiced rats. It also improves liver function and may enhance peritoneal neutrophil chemotaxis.

Efficacy of testosterone, trazodone and hypnotic suggestion in the treatment of non-organic male sexual dysfunction

OBJECTIVE

To examine the effects of hypnotic suggestions or the administration of testosterone or trazodone to impotent men with no detectable organic cause for the impotence.

PATIENTS AND METHODS

The study comprised 79 men in whom clinical and laboratory examinations revealed no organic cause for their impotence: 20 men (mean age 38.7 +/- 11.47 years) received testosterone, 21 men (mean age 39.5 +/- 10.73 years) received trazodone, 20 men (mean age 34.2 +/- 11.69 years) underwent hypnosis and 18 men (mean age 39.1 +/- 11.46 years) served as controls. They were assessed by interview 4, 6 and 8 weeks after starting treatment: the patient's reports were verified by interviewing their partners.

RESULTS

Men who received a placebo had a 39% improvement in sexual function, while the rates of improvement in the treated groups were higher, but not significantly so. The success rates of testosterone and trazodone treatment and hypnotic suggestions were 60%, 67% and 80%, respectively.

CONCLUSION

Although the improvement was not statistically significant, treatment with testosterone and trazodone could be used as an adjuvant therapy in nonorganic male sexual dysfunction. The only treatment superior to placebo seemed to be hypnosis. A more effective treatment may be obtained by combining these therapeutic modalities, but this needs further study.

Anaesthetic management of a patient with von Hippel-Lindau disease: a combination of bilateral phaeochromocytoma and spinal cord haemangioblastoma

The management of patients with Hippel-Lindau disease is discussed and illustrated using a case report. The importance of associated phaeochromocytoma and spinal involvement is stressed.

Blood flow determination in contralateral ovary with 133 Xe in unilateral ovarian torsion (experimental study in rabbits)

Clinical and experimental studies have shown that, in unilateral testicular torsion, some structural and hormonal changes may occur in the contralateral testis. The present study was designed to determine the effect of unilateral ovarian torsion on the blood flow in the contralateral ovary using #133Xe. Basal blood flow of the bilateral ovaries was determined in 40 prepubertal, female New Zealand rabbits. Right ovaries were then torsioned 720 degrees in all groups with the exception of the control group, where only laparotomy was performed. Bilateral ovarian blood flows were measured in the first group one hour after torsion, in the second group 8 hours after torsion, in the third group 24 hours after torsion and at the same times after laparotomy in the control group. Basal and post torsional blood flow measurements were analyzed. Contralateral ovarian blood flow was reduced after unilateral torsion in all of the groups. In the control group, there were no changes in these criteria.

In vivo and in vitro studies with omega-[rho-123I-phenyl]-pentadecanoic acid in rats

Biodistribution, plasma clearance and urinary excretion of omega-[p-123I-phenyl]-pentadecanoic acid were investigated in rats. The affinity of this radiopharmaceutical to red blood cells and to the plasma proteins was determined in vitro. Various radioactive metabolites were analysed by paper electrophoresis both in blood and urine at various intervals after administration of the compound. Protein-binding in plasma was determined by both electrophoresis and TCA precipitation. In vitro studies showed 30% uptake by red blood cells at equilibrium (30 min post-injection). 48% of the activity in the red cells could be removed after repeated washing with saline. The maximum uptake by myocardium occurred at 1 min and the maximal heart-to-blood ratios at 3 min. Although in vitro protein-binding was high, in vivo studies showed a very rapid plasma clearance (94% in 3 min) which indicated a weak binding. The amount of free iodine in plasma was less than 1% at any time after injection, thus not presenting a background problem or unnecessary radiation dose to thyroid and whole body. The major radioactive metabolites were 123I-p-hippuric acid and 123I-p-benzoic acid. In urine 123I-p-hippuric acid was excreted almost quantitatively. The metabolism was very fast, even 3 min post-injection the first metabolites could be found in the blood stream. Urinary excretion did not reach a plateau until 48 h. The total amount of radioactivity excreted was 56% within 48 h.

Hepatic blood flow during rapid intravenous glucose tolerance test

Twenty-nine dogs anesthetized with Na-pentobarbital were laparatomized and liver blood flow was measured by 133Xe clearance method. Fifteen dogs of the experimental group were subjected to rapid i.v. glucose tolerance test whereas 14 animals of the control group were treated identically except for infusion of glucose. It was found that the arterial and the portal venous blood glucose rose significantly during the glucose tolerance test. Liver blood flow in the experimental group was 123.8 ml/100 g L/min after operative procedures. It reached 171.9 ml/100 g L/min at 10 min after infusion of glucose (P < 0.01). At 20, 30, and 40 min of the test it was 145.4 (P < 0.05), 143.4 (P < 0.01), 135.1 (P < 0.05) mg/100 g L/min, respectively. Liver blood flow did not change significantly during the observation period in the control series. It is concluded that glucose loading may produce some metabolic effects secondary to rising liver blood flow in addition to changes induced by its rising concentration.