Comparison of the efficacy of kinesiotaping and extracorporeal shock wave therapy in patients with newly diagnosed lateral epicondylitis: A prospective randomized trial

Objective

This study aimed to evaluate the efficacy of kinesiotaping (KT) and Extracorporeal Shock Wave therapy (ESWT) for patients with acute/subacute (complaints exist <3 months) lateral epicondylitis(LE) in terms of pain control, hand grip strength, and functionality.

Methods

In total, 40 patients with newly diagnosed LE (27 females and 13 males with a mean age of 42.6 ± 8.4 years) were randomly allocated to receive a 3-week treatment of either KT for 5 days a week (n = 20) or ESWT once a week (n = 20). Patients were evaluated by the visual analog scale (VAS), hand grip strength (HGS), Roles and Maudsley scale (RMS), and quick DASHat baseline, after 4 weeks, and after 8 weeks of the treatment.

Results

Both KT and ESWT could achieve significant improvements in VAS, HGS, RMS, and Q-Dash after 4 and 8 weeks of treatment. However, these improvements were more prominent in the KT group compared with ESWT after 4 and 8 weeks. KT group achieved lower VAS scores, higher HGS, lower RMS compared with ESWT (all P < 0.05).

Conclusion

Both KT and ESWT could significantly improve pain, hand strength, and functionality in patients with newly diagnosed LE. However, these improvements were more prominent in the KT group. Considering the feasibility and the low cost of KT compared with ESWT, we recommend that KT should be considered for treating patients with newly diagnosed LE.

Asymptomatic bacteriuria screened by catheterized samples at pregnancy term in women undergoing cesarean delivery

OBJECTIVE

The objective of this study was to assess the frequency of urinary tract infection (UTI) with urine samples obtained via catheterization among women undergoing cesarean delivery at term pregnancy.

MATERIALS AND METHODS

A cross-sectional study involving 159 women in whom cesarean delivery was conducted at term pregnancy after a regular follow-up from first to third trimester. For screening and diagnosis of UTI during antenatal period, the authors used dipstick test and microscopic urinalysis, and urine culture was used in the presence of symptomatic UTI unresponsive to initial antibiotic therapy. A urine sample was obtained immediately after insertion of Foley catheter for urine dipstick test, microscopic urinalysis, and culture during cesarean delivery. Obstetric and UTI data were recorded.

RESULTS

Of 159 pregnant women, 95 (59.8%) did not develop UTI during antenatal care. There was no patient with symptomatic UTI at the admission for cesarean delivery. The authors found UTI with urine dipstick and microscopic urinalysis in 12 patients and of them, four patients had no history of UTI, and all the remaining eight patients had asymptomatic UTI during antenatal follow-up. UTI according to urine culture was encountered in three patients, two of them had one episode of UTI, and one had two episodes of UTI during antenatal follow-up.

CONCLUSIONS

After regular antenatal follow-up screening with urine dipstick, microscopic urinalysis, and counseling of pregnant women regarding UTIs, the frequency of bacteriuria decreases considerably during cesarean delivery.

Treatment of uterine prolapse with bilateral hydronephrosis in a young nulliparous woman; a new minimally invasive extraperitoneal technique

A 37-year-old nulligravid woman presented with a 2-year history of uterine prolapse along with mixed incontinence. Gynecological examination confirmed third degree cystocele and uterine prolapse. Renal ultrasonography showed enlarged kidneys and marked dilation of the bilateral pelvicalyceal system. She was hospitalized and a ring pessary was inserted after bladder catheterization. Her preoperative evaluation was performed and the patient was operated one month after her first admission. Anterior colporrhaphy along with Kurt Extraperitoneal Ligamentopexy was performed without any complication. A control visit on second postoperative month revealed recovery of incontinence symptoms and no prolapse was observed. To our knowledge this is the first reported treatment of a case with bilateral hydronephrosis due to uterine prolapse that were corrected and overcame with a novel minimally invasive extraperitoneal approach by fixation of bilateral round ligaments to the rectus fascia sheet.

An analysis of Turkey's scientific contribution in ovarian cancer research

AIM

Bibliometric studies can be used to evaluate the performance of a country in contributing to the accumulation of medical evidences on a specific topic. The authors aimed to evaluate the contribution of Turkey to the scientific repertory in the field of ovarian cancer.

METHODS AND MATERIALS

The authors retrospectively searched papers published in the field of ovarian cancer between 1980 and 2012 by using the Web of Science software.

RESULTS

Turkish authors published 400 papers in Science Citation Index (SCI) Expanded indexed journals ranking Turkey 25th globally. Turkey's first publications in this field appeared at the beginning of the 1990s and showed a distinctive acceleration after 2000. Overall, publications from Turkey were cited 2,987 times and the trend of citations increased in 2000. Most of the papers from Turkey in this field were published in the European Journal of Gynaecological Oncology.

CONCLUSION

The authors observed a significant improvement in the scientific activity of Turkey in the field of ovarian cancer during last decade.

Comparative efficacy of reduced or standard doses of lenograstim for peripheral blood stem cell mobilization and transplantation: A randomized study in patients undergoing autologous peripheral stem cell transplantation

7099

Background: 10 microg/kg/day of filgrastim and lenograstim have been recommended for mobilization of CD34+ cells without associated chemotherapy. However,in our previous randomized study we demonstrated that a 7.5 microg/kg/day dose of lenograstim has been as efficacious as 10 microg/kg/day of filgrastim. In this study, we investigated whether a reduced dose of lenograstim is equavalent to standard dose for autologous peripheral blood stem cell (PBSC) mobilization and transplantation. Methods: A total of 49 consecutive patients were randomized to either low dose (7.5 microg/kg/day, n = 24) or standard dose (10 microg/kg/day, n = 25) of lenograstim. These two groups were similar in regard to disease, sex, body weight, body surface area, conditioning regimens, previous chemotherapy cycles and radiotherapy. Each dose of lenograstim was administered for 4 consecutive days. The first PBSC apheresis was done on the 5th day. In the posttransplant period, lenograstim was given at 5 microg/kg/day until leukocyte engraftment. Results: Successful mobilization with the first apheresis, was achieved in 10/24 (42%) patients in low dose group versus 14/25 (56%) patients in standard dose group. No significant difference was seen in the median number of CD34+cells mobilized, as well as the median number of apheresis, median volume of apheresis, percentage of CD34+ cells, and CD34+ cell number. Leukocyte and platelet engraftments, the number of days requiring G-CSF and parenteral antibiotics, the number of transfusions were similar in both groups in the posttransplant period. Conclusions: Lenograstim 7.5 microg/kg/day is as efficious as Lenograstim 10 microg/kg/day for autologous PBSC mobilization and transplantation.

No significant financial relationships to disclose.

Comparison of intrathecal magnesium, fentanyl, or placebo combined with bupivacaine 0.5% for parturients undergoing elective cesarean delivery

BACKGROUND

Intrathecal (i.t.) administration of magnesium has been reported to potentiate opioid antinociception in rats and humans. In this prospective, randomized, double-blind, study, we investigated the sensory, motor, and analgesic block characteristics of i.t. magnesium 50 mg compared with fentanyl 25 microg and saline when added to 0.5% bupivacaine (10 mg).

METHODS

Ninety ASA I or II adult patients undergoing cesarean section were randomly allocated to receive 1.0 ml of 0.9% sodium chloride in group S, 50 mg of magnesium sulfate (1.0 ml) 5% in group M, or 25 microg of fentanyl (1.0 ml) in group F following 10 mg of bupivacaine 0.5% i.t. We recorded the following: onset and duration of sensory and motor block, maximal sensory block height, the time to reach the maximal dermatomal level of sensory block, and the duration of spinal anesthesia.

RESULTS

Magnesium did not shorten the onset time of sensory and motor blockade or prolong the duration of spinal anesthesia. The duration of sensory (P<0.032) and motor (P<0.002) blockade was significantly shorter in M and S groups than in the F group. The time to reach the maximal dermatomal level of sensory block was significantly shorter in the F group than in the S and M groups (P<0.002).

CONCLUSION

In patients undergoing cesarean section with spinal anesthesia, the addition of magnesium sulfate (50 mg) i.t. to 10 mg of spinal bupivacaine (0.5%) did not shorten the onset time of sensory and motor blockade or prolong the duration of spinal anesthesia, as seen with fentanyl.

Remifentanil-induced mechanical responses and membrane potential changes in human umbilical arteries

BACKGROUND

The aim of this study was to evaluate the characteristic features of the mechanical responses and membrane potential changes induced by remifentanil in human umbilical arteries (HUAs). The ionic mechanisms underlying the electrophysiological responses were pharmacologically assessed using two K(+) channel blockers.

METHODS

Thirty-eight HUAs were obtained. Contraction-relaxation, membrane potential changes and electrical responses of the HUAs were recorded.

RESULTS

Remifentanil produced concentration-dependent relaxation in both endothelium-intact and endothelium-denuded HUA rings. Remifentanil produced a significantly greater relaxation response in intact than in denuded HUA rings. In endothelium-intact rings, pre-treatment with L-nitroarginine [N(w)-NITRO-(L)-ARGININE (L-NO-ARG)] or indomethacin decreased the degree of remifentanil-induced relaxation. Remifentanil (10(-9)-10(-6) mol/l) produced a transient concentration-dependent membrane hyperpolarization, which was not decreased by pre-treatment with L-NO-ARG or indomethacin. It also produced a small concentration-dependent hyperpolarization in the presence of charybdotoxin or tetraethylammonium.

CONCLUSION

In both endothelium-intact and endothelium-denuded HUAs, remifentanil induces concentration-dependent vasorelaxation and simultaneously releases nitric oxide, prostaglandins and possibly an endothelium-derived hyperpolarizing factor. In addition, it produces hyperpolarization in a dose-dependent manner. Hyperpolarization induced by remifentanil involves the activation of Ca(2+)-dependent and Ca(2+)-independent potassium channels regulated by intracellular Ca(2+).

The effect of adding intrathecal magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia

BACKGROUND

The addition of intrathecal (IT) magnesium to spinal fentanyl prolongs the duration of spinal analgesia for vaginal delivery. In this prospective, randomized, double-blind, controlled study, we investigated the effect of adding IT magnesium sulphate to bupivacaine-fentanyl spinal anaesthesia.

METHODS

One hundred and two ASA I or II adult patients undergoing lower extremity surgery were recruited. They were randomly allocated to receive 1.0 ml of preservative-free 0.9% sodium chloride (group S) or 50 mg of magnesium sulphate 5% (1.0 ml) (group M) following 10 mg of bupivacaine 0.5% plus 25 microg of fentanyl intrathecally. We recorded the following: onset and duration of sensory block, the highest level of sensory block, the time to reach the highest dermatomal level of sensory block and to complete motor block recovery and the duration of spinal anaesthesia.

RESULTS

Magnesium caused a delay in the onset of both sensory and motor blockade. The highest level of sensory block was significantly lower in group M than in group S at 5, 10 and 15 min (P < 0.001). The median time to reach the highest dermatomal level of sensory block was 17 min in group M and 13 min in group S (P < 0.05). The mean degree of motor block was also lower in group M at 5, 10 and 15 min (P < 0.001). The median duration of spinal anaesthesia was longer in group M (P < 0.001).

CONCLUSION

In patients undergoing lower extremity surgery, the addition of IT magnesium sulphate (50 mg) to spinal anaesthesia induced by bupivacaine and fentanyl significantly delayed the onset of both sensory and motor blockade, but also prolonged the period of anaesthesia without additional side-effects.

The effect of pre-anaesthetic administration of intravenous dexmedetomidine on postoperative pain in patients receiving patient-controlled morphine

BACKGROUND AND OBJECTIVE

This prospective, randomized, double-blind, controlled study was designed to test the effect of pre-anaesthetic administration of dexmedetomidine, given as a single intravenous (i.v.) dose, on postoperative pain scores and morphine consumption in patients receiving patient-controlled morphine after abdominal surgery.

METHODS

Sixty patients were randomly allocated to receive dexmedetomidine (1 microg kg(-1)) or saline 10 min before induction of anaesthesia. Twenty minutes before the end of surgery, all patients received a standardized (0.1 mg kg(-1)) loading dose of morphine. They were then allowed to use a patient-controlled analgesia (PCA) device giving bolus doses of morphine (0.02 mg kg(-1)). Pain, discomfort and sedation scores; cumulative morphine consumption; time to extubation; time to recovery; and any side-effects were recorded after recovery and at 1, 2, 6, 12 and 24 h after the start of PCA.

RESULTS

The mean time to extubation at the end of anaesthesia and recovery time were similar in both groups. There were no significant differences between groups with regard to mean pain, discomfort, sedation and nausea scores. Cumulative morphine consumption was significantly lower in the dexmedetomidine group at 6, 12 and 24 h (P < 0.05). The incidence of side-effects did not differ between the groups.

CONCLUSIONS

A single i.v. dose of dexmedetomidine (1 microg kg(-1)) given 10 min before induction of anaesthesia significantly reduced postoperative morphine consumption at identical pain scores compared to control, but had no effect on postoperative recovery time.

Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period

BACKGROUND AND OBJECTIVE

To compare the antiemetic efficacy of ondansetron with two different hypnotic drugs (propofol 15 mg, midazolam 1 and 2 mg) for the treatment of established postoperative nausea and vomiting (PONV).

METHODS

Four-hundred-and-fifty-three patients scheduled for elective gynaecological or abdominal surgery were enrolled. One-hundred-and-twenty patients (26%) experienced postoperative emesis, and when nausea scores reached 2 or greater on a five-point scale, they were randomized to receive intravenously: propofol 15 mg (1.5 mL) in Group P, midazolam 1 mg in Group M1, midazolam 2 mg in Group M2 and ondansetron 4 mg in Group O.

RESULTS

Four patients (13.3%) in Group P, 13 patients (43.3%) in Group M1, five patients (16.6%) in Group M2 and one patient (3.3%) in Group O required a second dose of the study drug. After administration of the study drugs, nausea scores were significantly lower in all groups than before these drugs were given. No patient had a sedation score over 3 (the patients remained awake and/or responded to verbal contact). The sedative effects of midazolam and propofol lasted for a much shorter time than the antiemetic effects of these drugs.

CONCLUSIONS

Propofol and midazolam used in subhypnotic doses were as effective as ondansetron in treating PONV in patients undergoing abdominal or gynaecological surgery without untoward sedative or cardiovascular effects.

Comparative study of the antiemetic efficacy of ondansetron, propofol and midazolam in the early postoperative period

BACKGROUND AND OBJECTIVE

To compare the antiemetic efficacy of ondansetron with two different hypnotic drugs (propofol 15 mg, midazolam 1 and 2 mg) for the treatment of established postoperative nausea and vomiting (PONV).

METHODS

Four-hundred-and-fifty-three patients scheduled for elective gynaecological or abdominal surgery were enrolled. One-hundred-and-twenty patients (26%) experienced postoperative emesis, and when nausea scores reached 2 or greater on a five-point scale, they were randomized to receive intravenously: propofol 15 mg (1.5 mL) in Group P, midazolam 1 mg in Group M1, midazolam 2 mg in Group M2 and ondansetron 4 mg in Group O.

RESULTS

Four patients (13.3%) in Group P, 13 patients (43.3%) in Group M1, five patients (16.6%) in Group M2 and one patient (3.3%) in Group O required a second dose of the study drug. After administration of the study drugs, nausea scores were significantly lower in all groups than before these drugs were given. No patient had a sedation score over 3 (the patients remained awake and/or responded to verbal contact). The sedative effects of midazolam and propofol lasted for a much shorter time than the antiemetic effects of these drugs.

CONCLUSIONS

Propofol and midazolam used in subhypnotic doses were as effective as ondansetron in treating PONV in patients undergoing abdominal or gynaecological surgery without untoward sedative or cardiovascular effects.

Pre-emptive analgesic efficacy of tramadol compared with morphine after major abdominal surgery

BACKGROUND

Studies of pre-emptive analgesia in humans have shown conflicting results. This prospective, randomized, double-blind, controlled study was designed to test the hypothesis that a reduction in postoperative morphine consumption can be achieved by tramadol administered after induction of anaesthesia.

METHODS

Ninety patients were allocated randomly to receive i.v. tramadol (1 mg kg(-1)) (Group T), morphine (0.1 mg kg(-1)) (Group M) or saline 2 ml (Group S) after induction of anaesthesia. At peritoneal closure, a standardized (0.1 mg kg(-1)) morphine loading dose was given to all patients for postoperative pain management. Patients were allowed to use a patient-controlled analgesia (PCA) device giving bolus doses of morphine 0.025 mg kg(-1). Discomfort, sedation, pain scores, cumulative morphine consumption, and side-effects were recorded at 1, 2, 6, 12 and 24 h after the start of PCA.

RESULTS

There were no significant differences between groups in mean pain, discomfort, and sedation scores at any study period. Cumulative morphine consumption was significantly lower in Group M at 12 and 24 h after starting the PCA than in Group S. In Group T, it was lower only after 24 h (28% less in Group M and 17% less in Group T; P<0.017). There were no significant differences in morphine consumption between Groups T and M.

CONCLUSIONS

Tramadol (1 mg kg(-1)), administered after induction of anaesthesia, offered equivalent postoperative pain relief, and similar recovery times and postoperative PCA morphine consumption compared with giving morphine 0.1 mg kg(-1). These results also suggest that presurgical exposure to systemic opioid analgesia may not result in clinically significant benefits .

Effect of preoperative oral use of erythromycin and nizatidine on gastric pH and volume

This randomized controlled trial examined the effects of preoperative oral erythromycin or nizatidine on gastric pH and volume. Sixty patients, ASA 1 and 2 status scheduled for elective surgery were studied. All subjects received oral study medication with 10 ml of water 60 minutes prior to surgery. Patients in Group 1 (n=20) were given erythromycin 200 mg, in Group 2 (n=20) nizatidine 300 mg, and in Group 3 (n=20) placebo capsule. A nasogastric tube was inserted immediately after anaesthesia induction. Gastric content was aspirated, and volume and pH recorded. pH values determined in Group 1 were 5.6+/-1.87; in Group 2, 5.65+/-1.92 and in Group 3, 3.5+/-1.93. There was no statistical difference between Groups 1 and 2, but there was a statistically significant difference between Group 3 and Groups 1 and 2 (P<0.001). The volume of gastric content was 10.25+/-6.65 ml in Group 1, 10.3+/-6.29 ml in Group 2 and 20.25+/-16.72 ml in Group 3. Again, there was no statistical difference between Groups 1 and 2, but there was a statistically significant difference between Group 3 and Groups 1 and 2 (P<0.05). The proportion of patients considered "at risk" of significant lung injury should aspiration occur was 10% of Group 1, 5% of Group 2 and 20% of Group 3 (not statistically different). We conclude that oral erythromycin and nizatidine given one hour prior to surgery are effective in reducing gastric pH and volume.