Cemile Oztin Ogun

Gabapentin Is a First Line Drug for the Treatment of Neuropathic Pain in Spinal Cord Injury

Study Design. Prospective, randomized, double blind, placebo-controlled, crossover clinical trial. Objectives. To determine the efficacy of gabapentin in the treatment of neuropathic pain related to spinal cord injury. Summary of Background Data. Neuropathic pain is initiated or caused by a primary lesion or dysfunction in the nervous system. Neuropathic pain associated with spinal cord injury is quite refractory, and current treatments are not effective. Gabapentin, an anticonvulsant, has become the first choice in the treatment of neuropathic pain. The place of gabapentin in the treatment of spinal cord injury-related neuropathic pain was questioned in only a few recent reports; however, they are retrospectively designed, nonstandardized, and uncontrolled studies, or involve a very small series of patients using less than optimum doses. Methods. A total of 18-week study period included a 4-week medication/placebo titration period. This was followed by a 4-week stable dosing period when the patients continued to receive maximum tolerated doses, a 2-week washout period, then a crossover of 4 weeks of medication/placebo titration, and another 4 weeks of stable dosing period. Twenty paraplegic patients (female/male: 7/13) with complete spinal cord injury at the thoracic and lumbar level, aged between 20 and 65 years, with neuropathic pain for more than 6 months were recruited for the study. Results. All patients completed the study. Gabapentin reduced the intensity as well as the frequency of pain, relieved all neuropathic pain descriptors except the itchy, sensitive, dull, and cold types, and improved the quality of life (P < 0.05). Conclusions. Gabapentin can be added to the list of first-line medications for the treatment of chronic neuropathic pain in spinal cord injury patients. It is a promising new agent and offers advantages over currently available treatments.

Effects of nimodipine and magnesium sulfate on endogenous antioxidant levels in brain tissue after experimental head trauma.

To examine the effects of calcium antagonists nimodipine and magnesium sulfate (MgSO4) on tissue endogenous antioxidant levels, the authors studied superoxide dismutase (SOD) and glutathione peroxidase (GPx) levels in rabbit brain 1 hour after experimental head trauma. Forty New Zealand rabbits were anesthetized and randomly divided into four groups. Group 1 (n = 10) was the sham operated group. Group 2 (n = 10), the control group, received head trauma and no treatment. Group 3 (n = 10) received head trauma and intravenous (IV) 2 &mgr;gr/kg nimodipine. Group 4 (n = 10) received head trauma and IV 100 mg/kg MgSO4. Head trauma was delivered by performing a craniectomy over the right hemisphere and dropping a weight of 20 g from a height of 40 cm. In the right (traumatized) hemisphere, SOD and GPx decreased by 57.60% ± 9.60% and 72.93% ± 5.51% respectively from sham values. Magnesium sulfate, but not nimodipine, reduced the magnitude of decrease of SOD and GPx to 19.43% ± 7.15% and 39.01% ± 7.92% respectively from sham values. In the left (nontraumatized) hemisphere, MgSO4 increased SOD to 42.43% ± 24.76% above sham values. The authors conclude that MgSO4 treatment inhibited the decrease in SOD and GPx levels in experimental brain injury.

The effect on intraocular pressure of tracheal intubation or laryngeal mask™ insertion during sevoflurane anaesthesia in children without the use of muscle relaxants

Background: We studied the effects of sevoflurane on intraocular pressure after induction in children undergoing either tracheal tube (TT) or laryngeal mask airway (LMA™) insertion without a muscle relaxant

Vertebral artery loop formation: A frequent cause of cervicobrachial pain

Study Design. Patients with cervicobrachial pain were examined in detail with special attention to vertebral artery loop formation. Objectives. To determine the incidence, short-time natural course and response to a conservative approach to vertebral artery loop formation in a group of patients with cervicobrachial pain. Summary of the Background Data. Vertebral artery loop formation is reported to be a rare cause of cervicobrachial neuralgia, discovered incidentally during the search for its cause. It can be congenital or acquired, occurring equally in both sexes. Surgical decompression has been the preferred method in the majority of reported cases, with favorable results. Methods. One hundred seventy-three patients with cervicobrachial pain were examined in a period of 7 months using physical examination, radiography, and magnetic resonance imaging with or without angiography. Results. Thirteen patients with a mean age of 43.9 ± 13.5 years were diagnosed with vertebral artery loop formation. The most common level was C6–C7. Four patients presented with loop formation at two levels. None of the patients had symptoms attributable to intervertebral disc pathology. The complaints were in accordance with the level of the vascular pathology. Complete relief or decrease in pain was observed in all patients with the conservative approach. Conclusions. In patients with cervicobrachialgic symptoms and without established discopathy, during the examination of sagittal magnetic resonance images, vertebral artery loop formation should be kept in mind, and in suspected cases, the vertebral artery should be visualized using three-dimensional time of flight magnetic resonance angiography. Vertebral artery-nerve root relation should also be demonstrated using the multiplanar reformatting method from time of flight images. A conservative course of treatment has a favorable outcome.

The effects of 45 degree head up tilt on the lumbar puncture success rate in children undergoing spinal anesthesia

Background:  There are few studies for procedural techniques of lumbar puncture (LP) for spinal anesthesia in children. There are no controlled studies on the effect of patient positioning. We designed this prospective, randomized study to compare the success rates of LP of the lateral decubitus and lateral decubitus position with a 45 degree head up tilt in children undergoing spinal anesthesia.

The Concomitant Presence of Two Anomalous Muscles in the Forearm

This article describes the concomitant presence of two anomalous forearm muscles in a 20-year-old man, discovered accidentally during an operation for a forearm injury. The first one was similar to a reverse palmaris longus muscle except for its direction to the Guyon’s canal. The second one originated from the radial antebrachial fascia, superficial to all other forearm muscles in the lower half of the forearm, then diverged medially and extended into the Guyon’s canal and was innervated by the ulnar nerve. The patient had no symptoms related to overcrowding of the Guyon’s canal before the injury. A hand surgeon should be well informed about the anatomic variations of the hand to be comfortable during surgical practice.

The effect of 45‐degree head up tilt on bloody tap during lumbar puncture in children

at the lower lumbar spinal levels (the site of lumber puncture) than at the other levels (4). Though Monro–Kellie may not be truly applicable for spinal canal anatomy but magnetic resonance imaging in patients with intra cranial hypotension syndrome revealed dilation of the anterior internal vertebral (epidural) venous plexus in response to low CSF pressure (5). Data collected by Yousry, et al. further support these conclusions (6). A reciprocal relationship was found between the width of the dilated venous plexus and that of subdural fluid collections, consistent with the idea that venous engorgement and fluid collection are compensatory mechanisms to maintain intraspinal volume in the face of decreased CSF volume. So, it needs to be studied whether higher CSF pressures predominates over increased epidural vein engorgement or vice versa in children in 45 head up tilt. The higher CSF pressure may compress the radicular vessels and thus decreased chances of bloody tap. If bloody tap is due to puncture of epidural venous plexus, then the reduced incidence in the head-up positioning is in contrast to the previous reported studies (7,8). Engorgement of the plexus of epidural veins secondary to the effects of gravity and high-rate of blood tap in the sitting position has been reported (7). Raised epidural space pressures with resultant vein engorgement that vary with patient position have been mentioned. Increased venous cannulation has been reported in the sitting position (15.7%) as compared to lateral position (3.7%) for epidural catheter placement (7). The incidence of unintentional vessel puncture by the epidural catheter was less with the patient in the lateral recumbent, head-down position (2.0%), than in the sitting position (10.7%) (9). They commented that in the sitting patient, the increased epidural venous pressure would increase the incidence of vessel puncture and a head-down tilt in the lateral recumbent position would reduce the incidence of venous puncture as rich plexus of veins filling the lumbar epidural space would be less engorged and dilated with the patient in the head-down, left lateral recumbent position and therefore less likely to be punctured either by the epidural needle or by the catheter itself (9). Though these studies were done in pregnant patient but it gives us clue of the effect of position on epidural venous plexus. So if author can provide further data as mentioned above it will be give possible etiology of the bloody LP. The author mentions the cephalad orientation of needle during injecting the drug. It will be informative if they can provide data relating to its effect on spinal block using Atraucan needle (double bevel spinal needle) in children.