ABSTRACT Inappropriate acute postoperative pain management after breast cancer surgery has been associated with the development of chronic postmastectomy pain syndrome 'PMPS'. The aim of this study was to investigate the analgesic effect of tramadol versus tramadol and bupivacaine locally administered postoperatively before skin closure in patients undergoing surgery for cancer breast. Ninety female patients randomly assigned into three groups (30 patients each); group Control received 20 ml 0.9% saline, group Tramadol received 100 mg tramadol in 20 ml 0.9% saline and group Tramadol+ received 100 mg tramadol in 20 ml plain bupivacaine 0.25%.The study drugs were irrigated by a 20-ml syringe locally postoperatively before skin closure. Pain severity, time to first request of rescue analgesic, analgesic consumption and incidence of side effects were recorded in the 1st 48 hours postoperative. The incidence of neuropathic pain was assessed using DN4 Questionnaire scores in the 1st,2nd,and 3rd months postoperative. Pain score in Tramadol and Tramadol+ group was reduced at 4,6,12,24,36,and 48 hours postoperative compared to the Control group (p0.001). The time to 1st request of rescue analgesia was prolonged in Tramadol and Tramadol+ groups compared to Control group (p0.001). The total consumption of rescue analgesia was reduced in Tramadol and Tramadol+ groups compared to Control group (p0.01).There was no difference in the incidence of side effects in the three groups .The incidence of neuropathic pain (NP) was significantly reduced in Tramadol and Tramadol+ groups compared to Control group. Study parameters showed no difference between Tramadol and Tramadol+ groups. Postoperative local administration of tramadol significantly reduces early acute postoperative pain and the incidence of development of chronic neuropathic pain after cancer breast surgery, to a level comparable to the combined use of tramadol and bupivacaine

ABSTRACT Inappropriate acute postoperative pain management after breast cancer surgery has been associated with the development of chronic postmastectomy pain syndrome 'PMPS'. The aim of this study was to investigate the analgesic effect of tramadol versus tramadol and bupivacaine locally administered postoperatively before skin closure in patients undergoing surgery for cancer breast. Ninety female patients randomly assigned into three groups (30 patients each); group Control received 20 ml 0.9% saline, group Tramadol received 100 mg tramadol in 20 ml 0.9% saline and group Tramadol+ received 100 mg tramadol in 20 ml plain bupivacaine 0.25%.The study drugs were irrigated by a 20-ml syringe locally postoperatively before skin closure. Pain severity, time to first request of rescue analgesic, analgesic consumption and incidence of side effects were recorded in the 1st 48 hours postoperative. The incidence of neuropathic pain was assessed using DN4 Questionnaire scores in the 1st,2nd,and 3rd months postoperative. Pain score in Tramadol and Tramadol+ group was reduced at 4,6,12,24,36,and 48 hours postoperative compared to the Control group (p0.001). The time to 1st request of rescue analgesia was prolonged in Tramadol and Tramadol+ groups compared to Control group (p0.001). The total consumption of rescue analgesia was reduced in Tramadol and Tramadol+ groups compared to Control group (p0.01).There was no difference in the incidence of side effects in the three groups .The incidence of neuropathic pain (NP) was significantly reduced in Tramadol and Tramadol+ groups compared to Control group. Study parameters showed no difference between Tramadol and Tramadol+ groups. Postoperative local administration of tramadol significantly reduces early acute postoperative pain and the incidence of development of chronic neuropathic pain after cancer breast surgery, to a level comparable to the combined use of tramadol and bupivacaine

Abstract Neuraxial opioids provide excellent postoperative analgesia, but their use is associated with a frequent incidence of troublesome side effect such as pruritus, nausea and vomiting. The aim of this study was to evaluate the efficacy of intrathecal nalpuphine alone or combined with magnesium sulphate on postoperative analgesia after major abdominal cancer surgery. Ninety patients randomly assigned into three groups 30 patients each; group control received intrathecal 1ml saline 0.9% , group nalpuphine received intrathecal 0.8 mg nalpuphine and group nalpuphine+ received 0.8 mg nalpuphine + 100 mg magnesium sulphate 10% . Patients were monitored for vital signs ( heart rate, non invasive blood pressure , SaO2 and respiratory rate) , pain severity , sedation score , time to first request of rescue analgesic , total analgesic consumption and incidence of side effects were recorded in the first 24 hours postoperative. The mean VAS scores immediately and at 2,4,6,12 and 18 hours postoperative were significantly reduced in nalpuphine and nalpuphine+ groups compared to control group (p=0.01). The time to first rescue analgesic requirement was significantly prolonged in nalpuphine and nalpuphine+ groups compared to control group (p=0.001). The mean total consumption of tramadole IV rescue analgesia significantly reduced in nalpuphine and nalpuphine+ groups compared to control group (p=0.01). There was no significant difference in the incidence of adverse effect in the three groups. Intrathecal 0.8 mg nalpuphine alone or combined with intrathecal 100 mg magnesium sulphate improved the quality and the duration of post operative analgesia also provide an analgesic sparing effect without increasing the incidence of adverse effects.

Abstract Neuraxial opioids provide excellent postoperative analgesia, but their use is associated with a frequent incidence of troublesome side effect such as pruritus, nausea and vomiting. The aim of this study was to evaluate the efficacy of intrathecal nalpuphine alone or combined with magnesium sulphate on postoperative analgesia after major abdominal cancer surgery. Ninety patients randomly assigned into three groups 30 patients each; group control received intrathecal 1ml saline 0.9% , group nalpuphine received intrathecal 0.8 mg nalpuphine and group nalpuphine+ received 0.8 mg nalpuphine + 100 mg magnesium sulphate 10% . Patients were monitored for vital signs ( heart rate, non invasive blood pressure , SaO2 and respiratory rate) , pain severity , sedation score , time to first request of rescue analgesic , total analgesic consumption and incidence of side effects were recorded in the first 24 hours postoperative. The mean VAS scores immediately and at 2,4,6,12 and 18 hours postoperative were significantly reduced in nalpuphine and nalpuphine+ groups compared to control group (p=0.01). The time to first rescue analgesic requirement was significantly prolonged in nalpuphine and nalpuphine+ groups compared to control group (p=0.001). The mean total consumption of tramadole IV rescue analgesia significantly reduced in nalpuphine and nalpuphine+ groups compared to control group (p=0.01). There was no significant difference in the incidence of adverse effect in the three groups. Intrathecal 0.8 mg nalpuphine alone or combined with intrathecal 100 mg magnesium sulphate improved the quality and the duration of post operative analgesia also provide an analgesic sparing effect without increasing the incidence of adverse effects.

Novelty and Impact: This first study compares the survival of HCV-positive DLBCL treated with and without rituximab which showed in toxicity and the outcome. Background: The effect of hepatitis C virus (HCV) infection on prognosis and hepatic toxicity in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era is unclear. The treatment and the outcome of patients with DLBCL and HCV infection are still a matter of debate. Methods: We analyzed 137 DLBCL patients positive to HCV, treated with chemotherapy regimens include cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) ± rituximab. Survival outcomes and hepatic toxicity were compared in DLBCL patients positive to HCV infection according to CHOP ± rituximab. Result: Our result showed that the group of patients treated with R-CHOP has significant high incidence of hepatic toxicity grade (3–4) (28 vs. 18%, P value 0.001) and worse progression-free survival (55 vs. 80%, P value 0.002) in comparison with the group treated with CHOP, and also there is significant difference between both groups in overall survival. This first study compares the survival of HCV-positive DLBCL treated with and without rituximab which showed significant differences. Conclusion:We conclude that HCV-positive patients with DLBCL treated with rituximab plus CHOP have high incidence in hepatic toxicity. Specific protocols evaluating antiviral therapy should be designed for these patients

Novelty and Impact: This first study compares the survival of HCV-positive DLBCL treated with and without rituximab which showed in toxicity and the outcome. Background: The effect of hepatitis C virus (HCV) infection on prognosis and hepatic toxicity in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era is unclear. The treatment and the outcome of patients with DLBCL and HCV infection are still a matter of debate. Methods: We analyzed 137 DLBCL patients positive to HCV, treated with chemotherapy regimens include cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) ± rituximab. Survival outcomes and hepatic toxicity were compared in DLBCL patients positive to HCV infection according to CHOP ± rituximab. Result: Our result showed that the group of patients treated with R-CHOP has significant high incidence of hepatic toxicity grade (3–4) (28 vs. 18%, P value 0.001) and worse progression-free survival (55 vs. 80%, P value 0.002) in comparison with the group treated with CHOP, and also there is significant difference between both groups in overall survival. This first study compares the survival of HCV-positive DLBCL treated with and without rituximab which showed significant differences. Conclusion:We conclude that HCV-positive patients with DLBCL treated with rituximab plus CHOP have high incidence in hepatic toxicity. Specific protocols evaluating antiviral therapy should be designed for these patients

Novelty and Impact: This first study compares the survival of HCV-positive DLBCL treated with and without rituximab which showed in toxicity and the outcome. Background: The effect of hepatitis C virus (HCV) infection on prognosis and hepatic toxicity in patients with diffuse large B-cell lymphoma (DLBCL) in the rituximab era is unclear. The treatment and the outcome of patients with DLBCL and HCV infection are still a matter of debate. Methods: We analyzed 137 DLBCL patients positive to HCV, treated with chemotherapy regimens include cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) ± rituximab. Survival outcomes and hepatic toxicity were compared in DLBCL patients positive to HCV infection according to CHOP ± rituximab. Result: Our result showed that the group of patients treated with R-CHOP has significant high incidence of hepatic toxicity grade (3–4) (28 vs. 18%, P value 0.001) and worse progression-free survival (55 vs. 80%, P value 0.002) in comparison with the group treated with CHOP, and also there is significant difference between both groups in overall survival. This first study compares the survival of HCV-positive DLBCL treated with and without rituximab which showed significant differences. Conclusion:We conclude that HCV-positive patients with DLBCL treated with rituximab plus CHOP have high incidence in hepatic toxicity. Specific protocols evaluating antiviral therapy should be designed for these patients

Objectives: The study design aimed to examine the differences in the clinical and pathologic features after vascular anastomoses of a rat femoral artery using four different suture techniques. Methods: Sixty Sprage-Dawely rats were divided randomly into four groups. Fifteen bisected arteries (one from each animal) in groups I, II, III, and IV were sutured with the simple interrupted suture, continuous suture, sleeve suture, and cuff suture, respectively. Results: The anastomosis times in groups I, II, III and IV were 28.67, 14.67, 15.47, and 15.93 minutes, respectively. Immediate bleeding that stopped without intervention (grade I) was observed in 67%, 73%, and 60% of the anastomosed vessels in groups II, III, and IV, respectively, whereas 60% of the vessels in group I showed light bleeding that was inhibited by gentile pressure (grade II). All vessels examined appeared to be patent at 5 and 15 minutes after the anastomosis. On the seventh day postoperatively, the vessels of group I showed the highest patency rate (93%) compared with groups II (67%), III (73%), and IV (87%). Moreover, there were more pronounced pathologic changes in group I than in the other groups. These changes included endothelial loss, endothelial proliferation, degeneration, and necrosis of the tunica media. Suture materials surrounded by an inflammatory reaction were also observed. Conclusions: The simple interrupted suture is preferable for vascular anastomosis due to its highest patency rate. The other techniques investigated can be good alternatives because of their short anastomotic time and moderate pathological changes.

Background: Despite the advances in the cure rate for acute leukemia, approximately 25% of affected patients suffer from relapses. Expression of genes for the multiple drug resistance (MDR-1) and breast cancer related protein (BCRP) may confer the phenotype of resistance to the treatment of acute leukemia. Objective: To analyze the expression of the MDR-1 and BCRP genes in new cases of acute leukemia via the real time polymerase chain reaction (RT-PCR) and to determine the correlation between their expression and overall survival. Patients and methods: Total number of patients diagnosed as AML (n = 15), ALL (n = 35) and 20 blood donors as a control group included in this study. The expression of messenger RNA for the MDR-1and BCRP genes by RT-PCR were assessed. Myeloid surface markers as (CD34, CD33, CD13 and CD14) and lymphoid surface markers as (CD3,CD5, CD2, CD4 ,CD8 and CD19)were analyzed by flow cytometry (FACS can, Becton Dickinson, Mountain View, CA, USA). Results: The studied groups with MDR gene, BCRP gene show highly significant difference compared to the control (P0.000). The relation between MDR & BCRP in both AML and ALL groups shows no significant difference. There was a significant difference between BCRP expression in AML, ALL groups (P0.01). No significant difference as regards overall survival between MDR +ve cases and MDR negative cases in AML and ALL. In contrast Overall survival in BCRP +ve cases and BCRP negative cases shows a significant difference between AML and ALL groups (P0.01). No significant difference was detected between O.S in AML (MDR +ve , CD34 +ve) and AML (MDR +ve, CD34 negative). In contrast, O.S between AML (BCRP +ve ,CD34 +ve)and AML (BCRP +ve ,CD34 negative) shows a significant difference (P0.01). The difference between O.S in ALL (MDR +ve, CD34 +ve) and ALL (MDR +ve, CD34 negative) was not significant. In contrast a significant difference was detected between O.S in ALL (BCRP +ve, CD34 +ve) and ALL (BCRR +ve, CD34 negative) (P0.01). Overall survinal in AML group with BCRP +ve (CD13 +ve) shows a significant difference (P0.01). In ALL group the association between (MDR +ve and CD19 +ve) or (BCRP +ve and CD19 +ve) cannot significantly affect the survival. Conclusion: We concluded that the evaluation of the expression of genes for resistance to antineoplastic drugs in acute leukemia upon diagnosis, and particularly the expression of the BCRP gene, may be of clinical relevance.