ورم الغدد اللمفاوية غير هودجكين (NHL) في البطن هو العرض الأكثر شيوعا في الاماكن الموجودة خارج الغدد الليمفاوية في الأطفال. هدفنا هو تقييم دور الجراحة كعامل خطر وتقييم تأثير العلاج الكيميائي الممنتظم المعدل حسب المخاطر على بقاء المرضى الذين يعانون من المراحلة الثانية والثالثة لمرض. وشملت هذه الدراسة 35 مريضا أطفال مع NHL البطن العلاج لأكثر من خمس سنوات في معهد جنوب مصر للسرطان (SECI)، جامعة أسيوط، بين يناير 2005 ويناير 2010. وشملت البيانات من كل مريض: العمر، والجنس، والعرض، تحديد مراحل الورم لكي نحدد مدى انتشار المرض ونوع اللأستئصال الذي اجري، فحص الأنسجة، وتفاصيل العلاج الكيميائي، البقاء على قيد الحياة خالية من الأمراض والبقاء على قيد الحياة عموما. وشملت الدراسة 25 بنين و 10 بنات وكان متوسط أعمارهم من ست سنوات (المدى: 2.5:15). ثلاثون مريضا (86٪) شكوا من ألم في البطن، و23 مريضا (66٪) ٪) شكوا من كتلة في البطن وانتفاخ، 13 مريضا (34٪) ٪) شكوا من فقدان الوزن، وانسداد معوي وقعت في ستة مرضى (17٪). كانت منطقة اللفائفي الأعور والغدد الليمفاوية في البطن أشيع مواقع (48.5٪، 21٪ على التوالي). وكان سرطان الغدد الليمفاوية بيركيت نوع النسيجي الأكثر شيوعا في 29 مريضا (83٪). عشرة (28.5٪) المرحلة الثانية (المجموعة أ) و 25 (71.5٪) المرحلة الثالثة (المجموعة ب). أجريت عملية استئصال كاملة في 10 (28.5٪)، أستأصال جزئ في 6 (17٪) أخذ عينة تحت الأشعة في 19 (54٪). 11 مريض تلقى المرضى العلاج الكيميائي النظامية.متوسط المتابعة كان مدة 63 شهرا (المدى 51-78 شهرا). وكانت الدلائل التي تؤثر تأثيرا كبيرا على البقاء الإجمالي للحياة مرحلة الورم في البداية الأستئصال الكامل للورم. في الختام، مدى انتشار المرض في البداية هو العامل النذير الأكثر أهمية في ورم الغدد الليمفاوية القير هوجكن في البطن عند الأطفال. يقتصر التدخل الجراحي في حالات محددة مثل؛ حالات الطوارئ في البطن، أخذ عيتة للتشخيص واستئصال ورم محدد في مكان واحد. ويعتبر العلاج الكيميائي هو حجر الزاوية في علاج ورم الغدد اللمفاوية غير هودجكين (NHL) في البطن لدى الأطفال.

ورم الغدد اللمفاوية غير هودجكين (NHL) في البطن هو العرض الأكثر شيوعا في الاماكن الموجودة خارج الغدد الليمفاوية في الأطفال. هدفنا هو تقييم دور الجراحة كعامل خطر وتقييم تأثير العلاج الكيميائي الممنتظم المعدل حسب المخاطر على بقاء المرضى الذين يعانون من المراحلة الثانية والثالثة لمرض. وشملت هذه الدراسة 35 مريضا أطفال مع NHL البطن العلاج لأكثر من خمس سنوات في معهد جنوب مصر للسرطان (SECI)، جامعة أسيوط، بين يناير 2005 ويناير 2010. وشملت البيانات من كل مريض: العمر، والجنس، والعرض، تحديد مراحل الورم لكي نحدد مدى انتشار المرض ونوع اللأستئصال الذي اجري، فحص الأنسجة، وتفاصيل العلاج الكيميائي، البقاء على قيد الحياة خالية من الأمراض والبقاء على قيد الحياة عموما. وشملت الدراسة 25 بنين و 10 بنات وكان متوسط أعمارهم من ست سنوات (المدى: 2.5:15). ثلاثون مريضا (86٪) شكوا من ألم في البطن، و23 مريضا (66٪) ٪) شكوا من كتلة في البطن وانتفاخ، 13 مريضا (34٪) ٪) شكوا من فقدان الوزن، وانسداد معوي وقعت في ستة مرضى (17٪). كانت منطقة اللفائفي الأعور والغدد الليمفاوية في البطن أشيع مواقع (48.5٪، 21٪ على التوالي). وكان سرطان الغدد الليمفاوية بيركيت نوع النسيجي الأكثر شيوعا في 29 مريضا (83٪). عشرة (28.5٪) المرحلة الثانية (المجموعة أ) و 25 (71.5٪) المرحلة الثالثة (المجموعة ب). أجريت عملية استئصال كاملة في 10 (28.5٪)، أستأصال جزئ في 6 (17٪) أخذ عينة تحت الأشعة في 19 (54٪). 11 مريض تلقى المرضى العلاج الكيميائي النظامية.متوسط المتابعة كان مدة 63 شهرا (المدى 51-78 شهرا). وكانت الدلائل التي تؤثر تأثيرا كبيرا على البقاء الإجمالي للحياة مرحلة الورم في البداية الأستئصال الكامل للورم. في الختام، مدى انتشار المرض في البداية هو العامل النذير الأكثر أهمية في ورم الغدد الليمفاوية القير هوجكن في البطن عند الأطفال. يقتصر التدخل الجراحي في حالات محددة مثل؛ حالات الطوارئ في البطن، أخذ عيتة للتشخيص واستئصال ورم محدد في مكان واحد. ويعتبر العلاج الكيميائي هو حجر الزاوية في علاج ورم الغدد اللمفاوية غير هودجكين (NHL) في البطن لدى الأطفال.

Background: Thoracic epidural analgesia (TEA) has a well-known effect on neurohormonal response. Attenuation of stress response by post-operative epidural analgesia has shown beneficial effects such as lower pain scores and less immunological alterations. Objectives: Investigation of the combined effects of TEA and protective lung ventilation on proinflammatory cytokines and patients’ outcome after Ivor Lewis esophagectomy. Study Design: A randomized controlled study. Setting: Academic medical center. Methods: Thirty patients of the American Society of Anesthesiologists (ASA) I and II were randomly allocated into 2 groups: G1 (n = 15) patients received general anesthesia and were mechanically ventilated with 9 mL/kg during 2 lung ventilations, reduced to 5 mL/kg and 5cm H2O positive end expiratory pressure (PEEP) during one lung ventilation (OLV) or GII) (n = 15) patients received TEA and the same general anesthesia and mechanical ventilation used in G1. Assessment parameters included hemodynamics, pain severity, total analgesic consumption, and measurement of interleukins (IL) (IL-6 and IL-8) at baseline time after anesthetic induction (TBaseline,); at the end of the abdominal stage of the operation (TAbdo,); 15 minutes after initiation and at the end of OLV (TOLV 15) and (TOLV End) respectively; one and 20 hours after the end of the surgical procedure (TPostop1 and TPostop20), respectively, and patient’s outcome also recorded. Results: There was a significant reduction in mean arterial blood pressure (MAP) and pulse rate in GII during the intraoperative period, at Tabdo, TOLV15, and TOLV End (P 0.05). The mean of systolic blood pressure (SBP) values were significantly lower in GII over all 3 post-operative days (P = 0.001), and the mean diastolic blood pressure (DBP) showed a significant reduction in GII for 16 hours post-operatively (P = 0.001). The mean of heart rate values showed a significant reduction in GII over all 3 post-operative days in comparison to GI (P = 0.001). The mean resting and dynamic VAS scores were significantly reduced in GII at all time periods studied in comparison to G1 (P = 0.001). The daily PCA morphine consumption was markedly decreased in GII compared to GI in the first 3 days post-operatively (P = 0.001). There were significant reductions in blood level of IL-6 and IL-8 in GII compared to G1 over the entire study period (P 0.05). There were no significant differences in post-operative adverse effects between the 2 groups (P > 0.05). The duration of stay in PACU was significantly decreased in GII (10 ± 2 days) compared to GI (15 ± 3 days) (P = 0.001). Limitations: This study is limited by its sample size. Conclusion: Our study concluded that TEA reduced the systemic pro-inflammatory response and provided optimal post-operative pain relief. Although there were no significant differences in adverse events, there was a trend towards improved outcome. Further clinical studies with larger numbers of patients are required.

Background: There is little systematic research on the efficacy and tolerability of the addition of adjunctive analgesic agents in paravertebral analgesia. The addition of adjunctive analgesics, such as fentanyl and clonidine, to local anesthetics has been shown to enhance the quality and duration of sensory neural blockades, and decrease the dose of local anesthetic and supplemental analgesia. Objectives: Investigation of the safety and the analgesic efficacy of adding 1 μg/kg dexmedetomidine to bupivacaine 0.25% in thoracic paravertebral blocks (PVB) in patients undergoing modified radical mastectomy. Study Design: A randomized, double-blind trial. Setting: Academic medical center. Methods: Sixty American Society of Anesthesiologists physical status –I – III patients were randomly assigned to receive thoracicPVB with either 20 mL of bupivacaine 0.25% (Group B, n = 30), or 20 mL of bupivacaine 0.25% + 1 μg/kg dexmedetomidine (Group BD, n= 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 48 hours. Results: There was a significant reduction in pulse rate and diastolic blood pressure starting at 30 minutes in both groups, but more evidenced in group BD (P 0.001). Intraoperative Systolic blood pressure showed a significant reduction at 30 minutes in both groups (P 0.001) then returned to baseline level at 120 minutes in both groups. There was a significant increase in pulse rate starting 2 hours postoperative until 48 hours postoperatively in group B but only after 12 hours until 48 hours in group BD (P 0.001). The time of the first rescue analgesic requirement was significantly prolonged in the group BD (8.16 ± 42 hours) in comparison to group B (6.48 ± 5.24 hours) (P = 0.04). The mean total consumption of intravenous tramadol rescue analgesia in the postanesthesia care unit in the firtst 48 hours postoperatively was significantly decreased in group BD (150.19 ± 76.98 mg) compared to group B (194.44 ± 63.91 mg) (P = 0.03). No significant serious adverse effects were recorded during the study. Limitations: This study is limited by its sample size. Conclusion: The addition of dexmedetomidine 1 μg/kg to bupivacaine 0.25% in thoracic PVB in patients undergoing modified radical mastectomy improves the quality and the duration of analgesia and also provides an analgesic sparing effect with no serious side effects.

Background: There is little systematic research on the efficacy and tolerability of the addition of adjunctive analgesic agents in paravertebral analgesia. The addition of adjunctive analgesics, such as fentanyl and clonidine, to local anesthetics has been shown to enhance the quality and duration of sensory neural blockades, and decrease the dose of local anesthetic and supplemental analgesia. Objectives: Investigation of the safety and the analgesic efficacy of adding 1 μg/kg dexmedetomidine to bupivacaine 0.25% in thoracic paravertebral blocks (PVB) in patients undergoing modified radical mastectomy. Study Design: A randomized, double-blind trial. Setting: Academic medical center. Methods: Sixty American Society of Anesthesiologists physical status –I – III patients were randomly assigned to receive thoracicPVB with either 20 mL of bupivacaine 0.25% (Group B, n = 30), or 20 mL of bupivacaine 0.25% + 1 μg/kg dexmedetomidine (Group BD, n= 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 48 hours. Results: There was a significant reduction in pulse rate and diastolic blood pressure starting at 30 minutes in both groups, but more evidenced in group BD (P 0.001). Intraoperative Systolic blood pressure showed a significant reduction at 30 minutes in both groups (P 0.001) then returned to baseline level at 120 minutes in both groups. There was a significant increase in pulse rate starting 2 hours postoperative until 48 hours postoperatively in group B but only after 12 hours until 48 hours in group BD (P 0.001). The time of the first rescue analgesic requirement was significantly prolonged in the group BD (8.16 ± 42 hours) in comparison to group B (6.48 ± 5.24 hours) (P = 0.04). The mean total consumption of intravenous tramadol rescue analgesia in the postanesthesia care unit in the firtst 48 hours postoperatively was significantly decreased in group BD (150.19 ± 76.98 mg) compared to group B (194.44 ± 63.91 mg) (P = 0.03). No significant serious adverse effects were recorded during the study. Limitations: This study is limited by its sample size. Conclusion: The addition of dexmedetomidine 1 μg/kg to bupivacaine 0.25% in thoracic PVB in patients undergoing modified radical mastectomy improves the quality and the duration of analgesia and also provides an analgesic sparing effect with no serious side effects.

Background: There is little systematic research on the efficacy and tolerability of the addition of adjunctive analgesic agents in paravertebral analgesia. The addition of adjunctive analgesics, such as fentanyl and clonidine, to local anesthetics has been shown to enhance the quality and duration of sensory neural blockades, and decrease the dose of local anesthetic and supplemental analgesia. Objectives: Investigation of the safety and the analgesic efficacy of adding 1 μg/kg dexmedetomidine to bupivacaine 0.25% in thoracic paravertebral blocks (PVB) in patients undergoing modified radical mastectomy. Study Design: A randomized, double-blind trial. Setting: Academic medical center. Methods: Sixty American Society of Anesthesiologists physical status –I – III patients were randomly assigned to receive thoracicPVB with either 20 mL of bupivacaine 0.25% (Group B, n = 30), or 20 mL of bupivacaine 0.25% + 1 μg/kg dexmedetomidine (Group BD, n= 30). Assessment parameters included hemodynamics, sedation score, pain severity, time of first analgesics request, total analgesic consumption, and side effects in the first 48 hours. Results: There was a significant reduction in pulse rate and diastolic blood pressure starting at 30 minutes in both groups, but more evidenced in group BD (P 0.001). Intraoperative Systolic blood pressure showed a significant reduction at 30 minutes in both groups (P 0.001) then returned to baseline level at 120 minutes in both groups. There was a significant increase in pulse rate starting 2 hours postoperative until 48 hours postoperatively in group B but only after 12 hours until 48 hours in group BD (P 0.001). The time of the first rescue analgesic requirement was significantly prolonged in the group BD (8.16 ± 42 hours) in comparison to group B (6.48 ± 5.24 hours) (P = 0.04). The mean total consumption of intravenous tramadol rescue analgesia in the postanesthesia care unit in the firtst 48 hours postoperatively was significantly decreased in group BD (150.19 ± 76.98 mg) compared to group B (194.44 ± 63.91 mg) (P = 0.03). No significant serious adverse effects were recorded during the study. Limitations: This study is limited by its sample size. Conclusion: The addition of dexmedetomidine 1 μg/kg to bupivacaine 0.25% in thoracic PVB in patients undergoing modified radical mastectomy improves the quality and the duration of analgesia and also provides an analgesic sparing effect with no serious side effects.

BACKGROUND: Studies have demonstrated that vitamin C supplementation enhances the immune system, prevents DNA damage, and decreases the risk of a wide range of diseases. Other study reported that leukocyte vitamin C level was low in diabetic individuals compared with nondiabetic controls. AIM OF THE WORK: To study the effect of vitamin C on oxidative stress, blood lipid profile, and T-cell responsiveness during streptozotocin (STZ)-induced type I diabetes mellitus. METHODS: Thirty male Sprague-Dawley rats were randomly split into three groups. The first served as a control group (n = 10) in which rats were injected with the vehicle alone. The second (n = 10) and the third groups (n = 10) were rendered diabetic by intraperitoneal (i.p.) injection of single doses of STZ (60 mg/kg body weight). The third group was supplemented with vitamin C (100 mg/kg body weight) for 2 months. RESULTS: T lymphocytes from the diabetic rats were found to be in a stunned state, with a decreased surface expression of the CD28 costimulatory molecule, low levels of phosphorylated AKT, altered actin polymerization, diminished proliferation and cytokine production, and, eventually, a marked decrease in abundance in the periphery. Vitamin C was found to significantly decrease the elevated levels of blood hydroperoxide, glucose, cholesterol, triglycerides and low-density lipoprotein (LDL) in diabetic rats. Furthermore, it was found to restore CD28 expression, AKT phosphorylation, actin polymerization, and polyfunctional T cells (IFN-γ- and IL-2-producing cells that exhibit a high proliferation capacity). CONCLUSION: Vitamin C treatment restores and reconstitutes polyfunctional, long-lived T cells in diabetic rats.

BACKGROUND: Studies have demonstrated that vitamin C supplementation enhances the immune system, prevents DNA damage, and decreases the risk of a wide range of diseases. Other study reported that leukocyte vitamin C level was low in diabetic individuals compared with nondiabetic controls. AIM OF THE WORK: To study the effect of vitamin C on oxidative stress, blood lipid profile, and T-cell responsiveness during streptozotocin (STZ)-induced type I diabetes mellitus. METHODS: Thirty male Sprague-Dawley rats were randomly split into three groups. The first served as a control group (n = 10) in which rats were injected with the vehicle alone. The second (n = 10) and the third groups (n = 10) were rendered diabetic by intraperitoneal (i.p.) injection of single doses of STZ (60 mg/kg body weight). The third group was supplemented with vitamin C (100 mg/kg body weight) for 2 months. RESULTS: T lymphocytes from the diabetic rats were found to be in a stunned state, with a decreased surface expression of the CD28 costimulatory molecule, low levels of phosphorylated AKT, altered actin polymerization, diminished proliferation and cytokine production, and, eventually, a marked decrease in abundance in the periphery. Vitamin C was found to significantly decrease the elevated levels of blood hydroperoxide, glucose, cholesterol, triglycerides and low-density lipoprotein (LDL) in diabetic rats. Furthermore, it was found to restore CD28 expression, AKT phosphorylation, actin polymerization, and polyfunctional T cells (IFN-γ- and IL-2-producing cells that exhibit a high proliferation capacity). CONCLUSION: Vitamin C treatment restores and reconstitutes polyfunctional, long-lived T cells in diabetic rats.

STUDY OBJECTIVES: To investigate the analgesic effect of adding clonidine to topical bupivacaine for acute and chronic postmastectomy pain. DESIGN: Randomized, prospective, double-blinded study. SETTING: Cancer institute and university hospital. PATIENTS: 140 ASA physical status 1 and II women, aged 30 to 50 years, scheduled for modified radical mastectomy with axillary dissection for breast carcinoma. INTERVENTIONS: Patients were divided into 4 groups of 35 patients each, to receive either saline 0. 9% (control group), plain bupivacaine 0.5% (Bupivacaine group), plain bupivacaine 0.5% and 150 μg of clonidine (Clonidine150 group), or plain bupivacaine 0.5% and 250 μg of clonidine (Clonidine250 group). Study drugs were irrigated into the surgical field before skin closure. MEASUREMENTS AND MAIN RESULTS: Pain severity, time to first request of rescue analgesia, analgesic consumption, hemodynamics, and side effects were recorded in the first 48 hours postoperatively. The frequency of neuropathic pain was assessed using the Douleur Neuropathique 4-question survey (DN4) in the first and second postoperative months. Mean time to first postoperative analgesic request was significantly prolonged in the Bupivacaine (5.76 ± 0.85 hrs), Clonidine150 (11.6 ± 2.38 hrs), and Clonidine250 (17.4 ± 3.27 hrs) groups compared with the control group (1.86 ± 0.65 hrs). Postoperative tramadol consumption and visual analog scores (VAS) were significantly reduced in the Bupivacaine, Clonidine150, and Clonidine250 groups. Clonidine250 group patients had the lowest VAS scores from 2 to 48 hours postoperatively. Lower mean DN4 scores (P = 0.000) and a significantly reduced frequency of neuropathic pain (P 0.04) were recorded in the Bupivacaine, Clonidine150, and Clonidine250 groups, with a nonsignificant difference noted among the treatment groups. CONCLUSIONS: The addition of clonidine to topical bupivacaine accentuated its early postoperative analgesic efficacy.