Gulbin Arici

Systemic toxicity of tacrolimus given by various routes and the response to dose reduction

Purpose: To evaluate the long‐term systemic toxicity of tacrolimus (FK‐506) administered by various routes, and to assess the effect of dose reduction on toxicity.

Systemic Organophosphate Poisoning following the Percutaneous Injection of Insecticide

Organophosphates are the most common group of chemicals in the southern part of Turkey. Although organophosphate poisoning (OPP) may occur due to skin exposure or inhalation, severe poisoning is usually the result of ingestion to attempt suicide. Despite the fact that there have been a lot of experimental studies using intravenous or percutaneous injection of organophosphates, reports of human poisoning due to percutaneous injection are rare. The systemic signs of OPP have not been described in these reported patients. We report 2 cases having systemic signs of OPP due to percutaneous injection. In our first case, we noticed a 17-day muscle weakness and a 12-day muscarinic syndrome, which required prolonged atropinization. In the second patient, atropine infusion had to be continued for 2 days. Both cases also had severe swelling of the affected limb and wound infection. In conclusion, in cases of percutaneous injection of organophosphates systemic toxicity may develop in addition to local findings such as necrosis and abscesses. Close observation for evidence of systemic involvement is required, and the patient should be carefully monitored for secondary abscess formation and any delayed impairment of neurologic function.

In Vitro Effects of Opioids on Pregnant Uterine Muscle

Opioids are often used for obstetric analgesia. Ideal obstetric analgesia is attained with optimal pain relief and minimal risk for the parturient. Therefore, investigators in the present study explored the effects of different opioids on the myometrium of pregnant rats. Myometrial strips were exposed to increased concentrations of fentanyl (10-8 M to 10-6 M), alfentanil (10-8 M to 10-4 M), remifentanil (10-8 M to 10-4 M), and meperidine (10-8 M to 10-4M). Decreased contractile activity was observed in myometrial strips isolated from pregnant rats at cumulative concentrations of fentanyl, alfentanil, remifentanil, and meperidine. The amplitude of contractions was reduced with increasing concentrations of opioids; this effect was statistically significant at a concentration of 10-4 M. When administered at higher concentrations, opioids may decrease contractions in pregnant rat myometrium.

The effect of intra-articular neostigmine, tramadol, tenoxicam and bupivacaine on postoperative pain

Objctive: The present study, investigates the analgesic effects and complications of intra-articular neostigmine, tramadol, tenoxicam and bupivacaine on postoperative pain in patients undergoing day case knee arthroscopy. Subjects: Group 1 received 0.5 mg neostigmine, Group 2 received 100 mg tramadol, Group 3 received 20 mg tenoxicam, Group 4 received 20 ml 0.5% bupivacaine (control) in 20 ml normal saline intra-articularly at the end of the surgery. All patients had the same anaesthetic technique. Patients were observed in the recovery room with respect to pain scores, haemodynamic changes and postoperative analgesia at 1, 2 and 4 h postoperatively. Analgesic therapy in the recovery room was managed with 25 mg bolus doses of meperidine when the patients had visual analosue scale (VAS) scores higher than three points. The patients were discharged from hospital with a prescription for diclofenac 75 mg to be used as required. They were asked to complete their pain measures at 24 h and record their analgesic consumption. Results: There were no significant differences among the study groups regarding pain scores, haemodynamic changes, the first analgesic requirement time and complications. All patients in our study had adequate postoperative analgesia without any severe complication. Conclusion: Intra-articular administration of neostigmine, tramadol, tenoxicam or bupivacaine is a simple and effective postoperative analgesic technique after outpatient arthroscopic knee procedures.

Effects of new local anesthetics on pregnant uterine contractility

Methods: Twenty eight albino rats, each weighing 200-250 g and 18-21 days pregnant were used for the study, that was approved by the Animal Care and Use Committee of the Akdeniz University Medical Faculty. We obtained full-thickness myometrial muscle strips from each animal. Oxytocin (1mU/L) was added to organ bath to stimulate labor. When the contractions became regular, strips were exposed increased concentrations of mepivacaine (Mepihexal, Hexal AG), ropivacaine (Naropin, Astra) and bupivacaine (Marcaine, Astra) at cumulative concentrations. Mepivacaine(n:8), ropivacaine(n:10) and bupivacaine(n:10) were used at cumulative doses of 10-8, 10-7, 10-6, 10-5 and 10-4 M in the study. The myometrial isomeric contractions were continuously measured with a force transducer (FDT 10-A, Commat Ltd), connected to a computer-based data acquisition system (TDA 97, Commat Ltd). The characteristics of the contractions analyzed over 1000 second intervals, immediately before and after the addition of drugs, included frequency, amplitude of each contractions measured. Data were presented as mean and standard deviation and were analyzed by analysis of variance and p 0.05 was considered to be statistically significant.

The effects of intraperitoneal tramadol, tenoxicam and bupivacaine on pain relief after laparoscopic gynecological procedures

Abstract Purpose: Patients undergoing laparoscopic procedures may experience postoperative pain. We conducted a randomized, double-blinded, placebo-controlled trial to evaluate the effectivenesses of peritoneal tramadol as an opioid analgesic, tenoxicam as an anti-imflammatory drug and bupivacaine as a local anesthetic. Methods: Patients were randomly assigned to one of four groups of 20 patients each. Group A received 50 mg tramadol (in 20 ml volume with 0.9% saline), group B received 20 mg tenoxicam (in 20 ml volume with 0.9% saline), group C received 20 ml 0.9% saline and group D received 50 mg bupivacaine HCl in 20 ml volume (10 ml 0.5% bupivacaine with 10 ml 0.9% saline) after surgery. Pain was assessed using a visual analog scale and a verbal rating scale at 30 and 60 min, and 2 and 4 h after surgery. Results: Pain intensity and analgesic requirements were significantly less in the group receiving intraperitoneal tramadol, tenoxicam and bupivacaine compared to placebo group. The pain scores of tenox...