New data on the use of lithium, divalproate, and lamotrigine in rapid cycling bipolar disorder

The rapid cycling variant of bipolar disorder is defined as the occurrence of four periods of either manic or depressive illness within 12 months. Patients suffering from this variant of bipolar disorder have an unmet need for effective treatment. This review examines two major studies in an attempt to update understanding of the current therapies available to treat rapid cycling patients. The first trial compares lamotrigine versus placebo in 182 patients studied for 6 months. The second is a recently completed, 20-month trial comparing divalproate and lithium in 60 patients. Both trials had a double-blind, randomized parallel-group design. The data from the latter study indicate that there are no large differences in efficacy between lithium and divalproate in the long-term treatment of rapid cycling bipolar disorder. In addition, lamotrigine has the potential to complement the spectrum of lithium and divalproate through its greater efficacy for depressive symptoms.

Gossypiboma in abdomen: retained surgical gauze after a cesarean section

A mass formed around a cotton matrix left within the body is termed gossypiboma or textiloma. It is a rare complication of surgery most commonly seen after abdominal surgery. The time of presentation may range from early post-operative period to several decades later. We herein report on a case of gossypiboma. A 42-year old woman admitted to our hospital with abdominal mass. She had undergone a caesarean operation 2 years previously. The mass in the right quadrant was suspected by abdominal ultrasound and magnetic resonance imaging. The mass was removed by laparoscopy excision and the final diagnosis was gossypiboma.

A clinical case of perineal invasion from rectal carcinoma

We report a case of 62-year old women with skin infiltration in the perineal area after anterior rectal resection due to upper rectal cancer. Computed Tomography (CT) shows an intense infiltrative aspect of the lesion. The patient had a diffuse perineal infiltration predominantly at Levator Ani muscles and adhesions to the posterior parts of urinary bladder, uterus, vagina and perineal skin. The patient underwent surgery with colostomy to relieve the colonic tract due to obstruction and later was treated with chemo-radiation.

Alterations in homeostasis after open surgery. A prospective randomized study

INTRODUCTION

Alterations in homeostasis, and a subsequent increased risk for postoperative thromboembolic complications, are observed as a result of open surgery. Additionally, the stress response to surgical trauma precipitates a transient hypercoagulable state as well as inflammation. This study was conducted to evaluate the patterns in postoperative alterations of blood coagulation, and to detect their correlations with inflammatory markers.

PATIENTS AND METHODS

The study included 50 patients with comparable demographic data, who were randomly assigned to undergo abdominal surgery. No previous coagulation disorders were noted. Blood samples were collected preoperatively and 72 h postoperatively. The following parameters were measured: prothrombin time (PT) and activated partial thromboplastin time (APTT); fibrinogen (FIB), D-dimer (D-D), and C-reactive protein (CRP) levels; and platelet (PLT) count. Prophylactic doses of low molecular weight heparin were administered to all patients.

RESULTS

The PT mean value significantly changed from 90.38% before surgery to 81.25% after surgery. No statistical difference was observed between APTT values before and after surgery. FIB levels significantly increased from 381.50 mg/dL preoperatively to 462.57 mg/dL postoperatively. Mean D-D levels also significantly increased from 235.54 μg/L preoperatively to 803.59 μg/L postoperatively. PLT count significantly declined after surgery. Mean CRP levels significantly increased from 12.33 mg/L preoperatively to 44.28 mg/L postoperatively. A strong correlation was observed between D-D and C-RP levels after surgery.

CONCLUSION

These results indicate that, despite administering antithromboembolic prophylaxis, a hypercoagulable state was observed following surgery. This state was enhanced by inflammation.

Anorectal manometry: are fatigue rate and fatigue rate index of any clinical importance?

BACKGROUND

Loss of voluntary contraction of the external anal sphincter is thought to be a factor in fecal incontinence. During anal manometry, computerized systems produce several parameters including fatigue rate (FR), which is the basis for calculating the fatigue rate index (FRI). Our aim was to evaluate FR and FRI and their clinical importance in patients suffering from fecal incontinence or severe constipation.

MATERIALS AND METHODS

All patients scheduled for an anal physiology work-up were included in the study. FR was determined by a computer program and FRI was calculated manually with the following equation: FRI (minutes) = [squeeze pressure (mm Hg) - resting pressure (mmHg)] / - FR (mmHg/min). FR and FRI were compared in patients suffering from fecal incontinence (group I) and severe constipation (group II). Furthermore, subgroups (<50 and > or = 50 years of age) were compared. Lastly, a possible relation between length of the high-pressure zone (HPZ) and FR and FRI was assessed.

RESULTS

Between January 2000 and December 2004, 131 patients (96 with fecal incontinence, 35 with constipation) were studied. Both FR and FRI were similar between groups I and II; no significant differences were found when younger and older patients were compared within the same group. We also did not find any relation between HPZ length and either FR or FRI.

CONCLUSIONS

FR and FRI do not seem to be helpful in routine colorectal practice for evaluating the strength of the external anal sphincter.