1051 The Effect of Ginger Oil on Postoperative Nausea and Vomiting (PONV) After Breast Augmentation Surgery

Aim

Postoperative nausea and vomiting (PONV) is one of the commonest complaints following general anaesthetic. Poorly controlled due to its multifactorial nature most current antiemetics are not effective and have an undesirable side effect profile. As such we have studied the effect of Ginger (Zingiber Officinale), a relatively inert yet powerful antiemetic and its properties in managing PONV.

Method

A double-blind (surgeon/anaesthetist), randomised, placebo-controlled, single-centre study was carried out in a homogenous 30 female patient cohort undergoing breast augmentation surgery. Participants were randomly allocated to have 3 drops of either Ginger oil (110mg Zingiber officinale) or a simple control oil on the laryngeal mask before insertion. PONV and visual analogue scales (VAS) were used as outcome measures and were plotted against the dose of morphine used in the patient.

Results

Multivariate analysis of variance (MANOVA) was conducted on the data. Using Pillai’s trace, there was a significant effect of ginger on PONV/VAS, V = 0.87, F(3,16)=34.78, P < 0.001. Separate univariate ANOVAs showed: PONV Mean=1.70, PONVSD=0.48 compared with no ginger treatment plan group; PONV Mean=4.20, PONVSD=0.79. VAS Mean= 5.0, VASSD=1.63 for the ginger treatment plan group; and VAS Mean=5.9, VASSD=2.33 for the no ginger treatment plan group.

Conclusions

This study has found that ginger has an important role in preventing postoperative vomiting, reducing postoperative nausea, and is useful in breast augmentation. We have demonstrated a novel application of ginger oil during induction of anaesthesia and have provided evidence of its use in opioid-induced PONV.

1039 Assessing the Efficacy of The Modified S-PECS Anaesthetic Block in Patients Undergoing Breast Augmentation Surgery – A Randomised Double-Blind Control Trial

Aim

Postoperative acute on chronic pain following breast surgery is a common complication which needs resolving to allow for improved patient outcomes. Previously thoracic epidurals and paravertebral blocks (PVB) have been the gold standard administered intra-operatively. However, more recently the introduction of the Pectoral nerve block (PECS and PECS-2 blocks) has looked promising to control the pain more effectively, but further robust analysis is required to prove its efficacy. The authors aim to study the efficacy of a new block S-PECS that comprises a serratus anterior and a PECS-2 block associated.

Method

In this study we performed a prospective, single-centre randomised controlled double-blind group trial in 30 female patients undergoing breast augmentation surgery with silicone breast implants and the S-PECS block. Divided into groups of 15, the S-PECS group received local anaesthetics with the no-PECS control group receiving a saline injection. All participants were followed up at recovery (REC), 4, 6 and 12 (4H, 6H and 12H) hourly postoperatively.

Results

Our results showed that the pain score in the S-PECS group was significantly less than the no-PECS group across all time points REC, 4H, 6H and 12H. Furthermore, the patients that received the S-PECS block were 74% less likely to request pain medications compared to the no-PECS group (p < 0.05).

Conclusions

Overall, the modified S-PECS block is an effective, efficient, and safe method of controlling pain in patients undergoing breast augmentation surgery with additional applications yet to be explored.

1058 DVT And Abdominoplasty: A Holistic 8-Point Protocol-Based Approach to Prevent DVT

Aim

Plastic surgery as a speciality is afflicted with one of the highest incidence rates of thromboembolic events, with abdominoplasty procedures known to assimilate the greatest rates of Deep Vein Thrombosis (DVT).

Method

A total of 1078 abdominoplasty patients were enrolled onto an 8-point prophylaxis protocol with an inclusive holistic approach over a 7- year period. A 4-week smoking, HRT and COC cessation period was imposed on all patients and a maximum BMI score of 40 was required of all preoperative patients. Participants were administered with compression stockings, flowtrons and enoxaparin. Individuals with a DVT history were also required to be 1-year treatment free prior to surgery. Furthermore, the protocol necessitated post-operative deambulation of fit patients within 4 hours.

Results

Between 2008 and 2013, no incidence of DVT was recorded in all 1078 abdominoplasty surgery patients, indicating the potential for this protocol to lead to a significantly lower incidence than any previously published methodology. Due to the zero-incidence rate of DVT, different hypotheses of DVT proportions were tested to find out the rates that could be statistically consistent with our sample, thereby providing conservative incidence rate estimates.

Conclusions

This 8-point DVT prophylaxis protocol is the first non-criteria based inclusive protocol aimed at preventing abdominoplasty-associated DVT. As a result, not a single incident of DVT was recorded over the seven-year period of this study. We therefore believe that a holistic and procedure-specific approach to prophylaxis can drastically reduce the occurrence of DVT in abdominoplasty surgery

Efficient preconcentration and determination of traces of aluminum ion using silica-bonded glycerol sorbent

A solid-phase extraction system was proposed for the determination of aluminum after preconcentration with glycerol-bonded silica gel. The method is rapid and efficient for the enrichment of aluminum ions at trace levels. Optimal sorption conditions were found for sorption and desorption of aluminum ions. The effects of diverse ions on the sorption and recovery of aluminum have been studied and it was shown that the selectivity of the sorption process was very good. A very satisfactory preconcentration factor of 500 was achieved by this method. The lowest concentration of aluminum ions for quantitative recovery was 2ngml(-1). The capacity of sorbent was 400microg per gram of sorbent. The method showed good reproducibility (R.S.D.=2.2% for n=7) and was applied to the determination of aluminum in mineral water, hair and green tea samples.

Sensitive indirect spectrophotometric determination of isoniazid

A simple, rapid, sensitive and accurate indirect spectrophotometric method for the microdetermination of isoniazid (INH) in pure form and pharmaceutical formulations is developed. The procedure is based on the reaction of copper(II) with isoniazid in the presence of neocuproine (NC). In the presence of neocuproine, copper(II) is reduced easily by isoniazid to a Cu(I)-neocuproine complex, which shows an absorption maximum at 454 nm. By measuring the absorbance of the complex at this wavelength, isoniazid can be determined in the range 0.3-3.5 microgml-1. This method was applied to the determination of isoniazid in pharmaceutical formulation and enabled the determination of the isoniazid in microgram quantities (0.3-3.5 microgml-1). The results obtained for the assay of pharmaceutical preparations compared well with those obtained by the official method and demonstrated good accuracy and precision.

Biochemical characterisation of a hydrophobic ligand binding protein from the tapeworm Hymenolepis diminuta

The cestode Hymenolepis diminuta contains an abundant, cytoplasmic, hydrophobic ligand, binding protein (H-HLBP). Studies with polarity sensitive probes suggest a single hydrophobic binding site, the results also indicate that the single tryptophan in the molecule (Trp41) is involved in ligand binding. Of the possible physiological ligands tested, only haematin and retinoids (retinol and retinoic acid) show appreciable binding in addition to fatty acids. H-HLBP also binds a range of anthelmintics, again with K(D) values in the nM range. The interaction of anthelmintics with hydrophobic binding proteins may be important in determining drug specificity and site of action and could have a role in the development of drug resistance.

Ocular findings in aplastic anemia

OBJECTIVE

To analyze the ocular findings in aplastic anemia.

DESIGN

Eighteen patients with aplastic anemia were examined.

RESULTS

Ocular findings included cotton wool spots (38%), nerve fiber layer or preretinal hemorrhages (67%), vitreous hemorrhages (13%), a picture resembling central retinal vein occlusion (13%) and optic disk edema (6%). Preretinal hemorrhages were the presenting sign of aplastic anemia in 2 patients (13%).

CONCLUSIONS

A blood profile is needed in patients with unexplained retinal hemorrhages. Patients with aplastic anemia need to avoid ocular massage and Valsalva maneuvers to decrease ocular morbidity.

A new diagnostic tool for neurocysticercosis is a member of a cestode specific hydrophobic ligand binding protein family

A protein of unknown function has been identified as a key serological tool for diagnosis of human tapeworm neurocysticercosis, a major worldwide neurological disease. Our own sequence analysis predicts that this protein is a member of a newly identified cestode specific oligomeric hydrophobic ligand binding protein family. In this report, using a rat cestode model, we confirm that homologues of this protein can bind fatty acids and their derivatives, and thus suggest a biological function for this key diagnostic tool.

Tamoxifen and endometrial pathologies: a prospective study

OBJECTIVE

The purpose of this study was to prospectively follow a group of women with breast cancer, on tamoxifen, for the development of endometrial pathologies.

MATERIALS AND METHODS

Eighty women with breast cancer, on tamoxifen, were prospectively followed every 6 months with pelvic examination, Pap smear, vaginal ultrasound, and endometrial biopsy.

RESULTS

Nine women were lost to follow-up prior to initiation of treatment and 4 refused biopsies, leaving 67 patients for evaluation. Fifty (74.6%) of the 67 patients were already on tamoxifen for a mean duration of 15.8 +/- 16.6 months and had a baseline benign, unremarkable endometrium at the time of entry into the study. The total duration of treatment was 32.5 +/- 19.6 months (median 30 months). The mean age of the patients was 51.7 +/- 9.9 years (median 52 years). Of the patients, 56.7% were postmenopausal. Sixty-three patients had a benign endometrium (mean age 51.8 +/- 10.1 years, mean duration 33.1 +/- 19.6 months). Two patients had simple hyperplasia (mean age 43.5 years, duration 28.5 +/- 33.2 months), 1 patient had complex hyperplasia with atypia (age 57 years, duration 13 months), and another patient developed adenocarcinoma (grade 3) after 22 months. These 4 patients had abnormal vaginal bleeding. Seven patients developed endometrial polyps (mean age 54.0 +/- 8.5 years, duration 36 +/- 24.2 months). The mean endometrial thickness for patients with histologically unremarkable and abnormal endometrium was not significantly different (7.6 +/- 3.9 vs 8.8 +/- 5.0 mm, respectively) (median 7.0 mm for both groups). No endometrial thickness cutoff point reached statistical significance. The patient who developed endometrial cancer had a thickness of only 3 mm.

CONCLUSION

All patients who developed an abnormal endometrium had abnormal vaginal bleeding. There was no correlation between endometrial thickness and endometrial pathology; thus the value of routine screening remains controversial.

Acquired protein C deficiency following cisplatinum-navelbine administration for locally advanced breast cancer. Case report

Thromboembolic events have recently been reported following diverse regimens of chemotherapy for breast cancer. This is a report of a 39-year-old woman, a diagnosed case of locally advanced breast cancer, who received many regimens of chemotherapy. She presented with deep venous thrombosis 2 months after starting the cisplatinum-navelbine regimen. Protein C deficiency was the only abnormal coagulation test that normalized after cessation of chemotherapy.

Characterisation and properties of an intracellular lipid-binding protein from the tapeworm Moniezia expansa

The tapeworm Moniezia expansa contains an extremely abundant cytoplasmic lipid-binding protein (LBP). It is a small protein consisting of 66 amino acids with a molecular mass of 7943 +/- 1.5 Da. The amino acid sequence has been established by Edman degradation and confirmed by PCR analysis. The Moniezia LBP shows no sequence similarity with any previously described binding protein, but does show similarity with antigen B from Echinococcus glanulosus and Echinococcus multilocularis and with Taenia crassiceps antigen. The predicted structure for Moniezia LBP shows four helices and a putative tyrosine kinase site on the loop between helix 1 and 2. Each of the four helices has a well defined hydrophobic face. Studies with fluorescent probes suggest a single hydrophobic binding site. Results indicate that the single tryptophan residue in the molecule (Trp41) is involved in ligand binding, and calculation of the Stern-Volmer quenching constant shows that Trp41 is in a relatively hydrophobic environment.