Background: In postoperative pain management, using a patient-controlled analgesia (PCA) device, the number of requests and total infusing dose of analgesics can be measured. Therefore, it is more objective to compare the pain intensity among different types of operation when a PCA device is used. Using PCA fentanyl consumption as a parameter, an attempt was made to elucidate the differences in the intensity of pain associated with total hip and total knee replacements by comparing the fentanyl requirements. Methods: Sixty female patients, with ages greater than 50 yrs, undergoing an elective total hip replacement (THR, n = 20), total knee replacement (TKR, n = 20) or posterolateral lumbar spinal fusion (PLF, n = 20), were enrolled to the present study. Fentanyl was administered in a calculated loading dose before the end of surgery, in order to achieve acceptable analgesia (VNRS = 5), which was followed by fentanyl-ketorolac PCA. Patients were followed up for 2 days postoperatively. The verbal numeric rating scale (VNRS), total dose, rescue dose and side effects of PCA were all checked. Results: The fentanyl consumption was greater in the TKR than in either the THR or PLF groups at each assessment (P
Infected pelvic hematoma is a serious complication of hysterectomies. Pelvic drainage can help reduce complications. In this study, we evaluated the efficacy and safety of vaginal vault drainage in patients who underwent laparoscopic hysterectomy for benign gynecological diseases.Patients who underwent laparoscopic hysterectomy and pelvic drain insertion for benign gynecological diseases between January 2008 and December 2015 were enrolled retrospectively in the study. They were grouped according to drain insertion sites, that is, through the abdomen (group 1) and vaginal vault (group 2). The postoperative outcomes were compared between the two groups.A total of 504 women were included. No significant differences were observed in the prevalence of postoperative fever, readmission, and reoperation between the two groups.Given the discomfort associated with holding and removing the abdominal drain, inserting a closed pelvic gravity drain through the vaginal vault appears to be a feasible alternative to an abdominal drain.
A considerable number of patients complaining of pain after spinal surgery reportedly have adhesions and fibrosis in the epidural space [1,2]. Also, patients with chronic low back pain and/or radicular pain may have perineural adhesions due to perineural and neurogenic inflammation from mechanical or chemical irritation, while they don't have any history of surgery [3,4]. Parke and Watanabe [5] dissected the cadavers of such patients and reported that a number of anterior epidural adhesions, which were not detached even when pulled with threads of about 60 g, were found between L4 and S1. This finding indicates that the adhesions might have been the cause of chronic low back pain.
Objective A scoring system based on clinicohematologic parameters in cervical cancer patients receiving chemoradiation has not been reported to date. The aim of this study was to determine the prognostic value of clinicohematologic parameters in patients with cervical cancer undergoing chemoradiation and to develop a prediction scoring system based on these results. Methods A total of 107 patients who received definitive chemoradiation for cervical cancer were enrolled in this study. The clinical data and hematologic parameters were retrospectively reviewed, and their prognostic value in predicting survival was analyzed. The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) and the changes in these hematologic parameters (ΔNLR, ΔPLR, and ΔLMR) between pre- and post-treatment were calculated to determine the specific value of these parameters for predicting patient survival. Results The median follow-up time was 39.9 (range 2.7–114.6) months. The 3-year overall survival rate and progression-free survival rate were 80.9% (95% CI 72.7 to 90.0) and 53.4% (95% CI 44.1 to 64.8), respectively. The median progression-free survival was 67.5 months and the median overall survival was not reached. According to multivariable analysis, a ΔNLR≥0 was significantly associated with decreased progression-free survival (HR=2.91, 95% CI 1.43 to 5.94) and overall survival (HR=3.13, 95% CI 1.18 to 8.27). In addition, age (age <58.5 years; progression-free survival: HR=2.55, 95% CI 1.38 to 4.70; overall survival: HR=4.49, 95% CI 1.78 to 11.33) and the International Federation of Gynecology and Obstetrics (FIGO) stage (Ⅲ-Ⅳ; progression-free survival: HR=2.49, 95% CI 1.40 to 4.43; overall survival: HR=3.02, 95% CI 1.32 to 6.90) were identified as predictors of poor survival. Conclusions Both the age and FIGO stage, as clinical parameters, and the ΔNLR, as a hematologic parameter, were independent prognostic factors for survival for cervical cancer patients treated with chemoradiation. Based on these results, we developed a risk score-based classification system for predicting survival.
Abstract Aims: We compared the bone mineral density (BMD) of spinal bone and the femur between patients with cervical cancer and a control group. Methods: We retrospectively analyzed the BMD of spinal bone and the femur in 40 patients with cervical cancer and 72 control women. The control women were patients treated with surgery for benign disease. Results: Age, height, bodyweight and body mass index were not significantly different between the two groups. Total femoral BMD in patients with cervical cancer was significantly lower ( P = 0.006) than that of control women. In multiple regression analysis, the bodyweight of patients with cervical cancer was a statistically significant predictor positively correlated with the BMD of the total femur. Conclusion: The results suggest that patients with cervical cancer have low bone mass, especially in the femur, and an increased risk of developing osteoporosis.
Background Experimental studies have shown that ischemic postconditioning can reduce neuronal injury in the setting of cerebral ischemia, but the mechanisms are not yet clearly elucidated. This study was conducted to determine whether ischemic postconditioning can alter expression of heat shock protein 70 and reduce acute phase neuronal injury in rats subjected to transient focal cerebral ischemia/reperfusion. Methods Focal cerebral ischemia was induced by intraluminal middle cerebral artery occlusion for 60 min in twenty male Sprague-Dawley rats (250-300 g). Rats were randomized into control group and an ischemic postconditioning group (10 rats per group). The animals of control group had no intervention either before or after MCA occlusion. Ischemic postconditioning was elicited by 3 cycles of 30 s reperfusion interspersed by 10 s ischemia immediately after onset of reperfusion. The infarct ratios, brain edema ratios and motor behavior deficits were analyzed 24 hrs after ischemic insult. Caspase-3 reactive cells and cells showing heat shock protein 70 activity were counted in the caudoputamen and frontoparietal cortex. Results Ischemic postconditiong did not reduce infarct size and brain edema ratios compared to control group. Neurologic scores were not significantly different between groups. The number of caspase-3 reactive cells in the ischemic postconditioning group was not significantly different than the value of the control group in the caudoputamen and frontoparietal cortex. The number of cells showing heat shock protein 70 activity was not significantly different than the control group, as well. Conclusions These results suggest that ischemic postconditioning may not influence the early brain damage induced by focal cerebral ischemia in rats. Keywords: Focal cerebral ischemia; Neuroproctection; Postconditioning; Rat.
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