Immunstimulatory properties of Tramadol mainly affects natural killer cells [NK] , and T- lymphocytes production . No proved evidence that Tramadol affects HLA-DR expression from activated monocytes .This study evaluate a combined approach using I.M tramadol 1.5 mg/kg and I.V paracetamol 15 mg/kg used for treatment of postcraniotomy pain in patients with supratentorial space occupying lesions. The analgesic efficacy and immunological status were our subject of interest. 40 patients ASA I or II scheduled for elective supratentorial craniotomy divided into two groups: Group Paracetamol received paracetamol 15 mg/kg i.v. before end of surgery for postcraniotomy pain relief repeated 6 hours postoperative. Group paracetamol+ received same dose of paracetamol + tramadol 1.5 mg/kg i.m. started 1 hour before end of surgery and repeated 6 hours postoperative. Analgesic efficacy was assessed by visual analogue scale "VAS" at 3, 6, 12 and 24 hours postoperative. Immunological parameters measured were HLA-Dr expression and γ-interferon. Venous blood samples were withdrawn at 4-time points: Preoperative, intraoperative, first and third day postoperative. HLA-Dr expression mean values showed no significant difference inside and in between the two groups. In group paracetamol they were 87.27 ± 1.65 , 86.73 ± 1.79, 85.28 ± 2.33 and 88.12 ± 1.66 at do, doo , d1 and d3, respectively while in group paracetamol+, they were 86.17 ± 1.77, 87.96 ± 1.91, 89.19 ± 1.37 and 89.92 ± 1.81 at d0, d00, d1 and d3, respectively. While γ-interferon mean values significantly decreased after induction of anesthesia in both groups. They were 3.6 ± 0.33 versus 3.55 ± 0.33, 3.25 ± 0.36 versus 3.14 ± 0.44, 3.55 ± 0.29 versus 3.93 ± 0.35 and 3.7 ± 0.41 versus 4.21 ± 0.36 at d0, d00, d1 and d3 in group paracetamol versus group paracetamol+, respectively. γ-interferon release recovered earlier in group paracetamol+ (by first day postoperative) rather in group paracetamol (by third day postoperative). The "VAS" mean values were significantly lower in group paracetamol+ patients than in group paracetamol ; 2.4 ± 0.11 versus 3.2 ± 0.17, 2.55 ± 0.11 versus 3.65 ± 0.18, 2.05 ± 0.05 versus 2.45 ± 0.11 and 1.05 ± 0.08 versus 1.8 ± 0.16 at the 3rd, 6th, 12 and 24 hours postoperative, respectively. In Group paracetamol+, eight patients experienced nausea and two vomited once. Tramadol when combined to paracetamol have yielded a better analgesia for post craniotomy pain and an improved immunological profile as regards to increased levels of γ-interferon. Although it had a negative effect on HLA-Dr expression, no infectious complications were reported in this study.

Abstract: Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line therapy for the majority of urinary tract calculi and requires anesthesia. The purpose of this study is to prospectively evaluate the analgesic effects and safety of lidocaine 1% by local infiltration as a monotherapy during renal ESWL and ensure stone clearance after the procedure. Methods: One hundred patients with renal stones, aged 18 to 65 years, were randomly allocated into two groups; 49 patients in group 1 received intramuscular injection of 20 mg Ketorolac tromethamine, 20 minutes before start of the procedure and 51 patients in group 2 received Lidocaine 1% by local infiltration (5mg/kg) into the 30 cm2 area after localizing the stones site, 10 minutes before the session. A visual analog scale, (0 to 100 mm) was used to evaluate pain every 10 minutes. Results: The visual analog scores for group 2 were significantly lower than (group 1) at 10, 20, 30 and 40 minutes till end of the procedure, (p 0.001). The mean requirements of supplemental fentanyl analgesia (μg) were significantly decreased in group 2 than group 1, (3.34 ± 7.32 versus 15.72 ± 6.41, p0.001). All patients in group 2 were discharged earlier, 1 hour after the end of the procedure while 13 patients (26.5%) in group 1 had delayed discharge. No significant difference was detected between the two groups with regards to complete stone clearance after 1 month, no. of shocks, voltage power or duration of procedure. No patient in group 2 reported neurological side effects of local anesthesia. Conclusions: Lidocaine 1% by local infiltration cannot be used alone for pain relief but effectively reduced the analgesic needs and minimized hospital stay after renal ESWL, without affecting stone clearance.

Abstract: Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line therapy for the majority of urinary tract calculi and requires anesthesia. The purpose of this study is to prospectively evaluate the analgesic effects and safety of lidocaine 1% by local infiltration as a monotherapy during renal ESWL and ensure stone clearance after the procedure. Methods: One hundred patients with renal stones, aged 18 to 65 years, were randomly allocated into two groups; 49 patients in group 1 received intramuscular injection of 20 mg Ketorolac tromethamine, 20 minutes before start of the procedure and 51 patients in group 2 received Lidocaine 1% by local infiltration (5mg/kg) into the 30 cm2 area after localizing the stones site, 10 minutes before the session. A visual analog scale, (0 to 100 mm) was used to evaluate pain every 10 minutes. Results: The visual analog scores for group 2 were significantly lower than (group 1) at 10, 20, 30 and 40 minutes till end of the procedure, (p 0.001). The mean requirements of supplemental fentanyl analgesia (μg) were significantly decreased in group 2 than group 1, (3.34 ± 7.32 versus 15.72 ± 6.41, p0.001). All patients in group 2 were discharged earlier, 1 hour after the end of the procedure while 13 patients (26.5%) in group 1 had delayed discharge. No significant difference was detected between the two groups with regards to complete stone clearance after 1 month, no. of shocks, voltage power or duration of procedure. No patient in group 2 reported neurological side effects of local anesthesia. Conclusions: Lidocaine 1% by local infiltration cannot be used alone for pain relief but effectively reduced the analgesic needs and minimized hospital stay after renal ESWL, without affecting stone clearance.

Abstract: Background and Aims: Extracorporeal shock wave lithotripsy (ESWL) represents first line therapy for the majority of urinary tract calculi and requires anesthesia. The purpose of this study is to prospectively evaluate the analgesic effects and safety of lidocaine 1% by local infiltration as a monotherapy during renal ESWL and ensure stone clearance after the procedure. Methods: One hundred patients with renal stones, aged 18 to 65 years, were randomly allocated into two groups; 49 patients in group 1 received intramuscular injection of 20 mg Ketorolac tromethamine, 20 minutes before start of the procedure and 51 patients in group 2 received Lidocaine 1% by local infiltration (5mg/kg) into the 30 cm2 area after localizing the stones site, 10 minutes before the session. A visual analog scale, (0 to 100 mm) was used to evaluate pain every 10 minutes. Results: The visual analog scores for group 2 were significantly lower than (group 1) at 10, 20, 30 and 40 minutes till end of the procedure, (p 0.001). The mean requirements of supplemental fentanyl analgesia (μg) were significantly decreased in group 2 than group 1, (3.34 ± 7.32 versus 15.72 ± 6.41, p0.001). All patients in group 2 were discharged earlier, 1 hour after the end of the procedure while 13 patients (26.5%) in group 1 had delayed discharge. No significant difference was detected between the two groups with regards to complete stone clearance after 1 month, no. of shocks, voltage power or duration of procedure. No patient in group 2 reported neurological side effects of local anesthesia. Conclusions: Lidocaine 1% by local infiltration cannot be used alone for pain relief but effectively reduced the analgesic needs and minimized hospital stay after renal ESWL, without affecting stone clearance.

Islet damage attributed to impaired exocrine cells during pancreas preservation and isolation procedure remains elusive, although released exocrine enzymes could directly damage islets. The aim of this study is to investigate the cellular mechanisms associated with exocrine cells and their possible impact on the islet cell survival and function after isolation. Mouse pancreata were stored in cold University of Wisconsin preservation solution for 0, 24 and 48 h and incubated with or without collagenase at 37°C for 15 min. During preservation, the percentage of exocrine cells with necrosis, which means impaired cellular membrane that allows intracellular enzymes to be released, remains low (10%) regardless of preservation time; whereas the percentage of exocrine cells with apoptosis, which means impaired nucleus and possible intact cellular membrane, increases over time of preservation. After collagenase-free incubation, however, the percentage of exocrine cells with necrosis became higher in longer preservation time, and more than 60% of the necrotic exocrine cells contained apoptosis as well. Islet cells located in pancreata with intact structure are almost kept away either from necrotic or apoptotic changes even after 48 h preservation followed by collagenase-free incubation. However, when islets are isolated after collagenase-containing incubation, the percentage of islet cells with necrosis increases over time of preservation up to approximately 40%. This study suggests that exocrine cells with necrosis could cause damage of isolated islets when the pancreas is dissociated and that the necrosis in exocrine cells might be induced mainly as the conversion from apoptosis that has already existed during preservation.

Summary Background: Hypomagnesaemia is a frequent complication after liver transplantation (LTx) however; magnesium is not routinely replaced in the perioperative period. Material/Methods: The incidence of hypomagnesaemia before and after pediatric LTx was studied in 673 pediatric patients who underwent living-donor liver transplantation (LDLT). Results: The mean serum Mg levels before LTx was normal, 2.03±0.28 mg/dl, exhibited marked decrease on 5th postoperative (PO) day, 1.79±0.45, p0.001, comparing with the pretransplant value. It reached its nadir in the 1st PO month, p0.001. Up to the 5th PO year, serum Mg did not achieve the lower limit of normal, 1.77±0.24, p0.001 and incidence of hypomagnesaemia was 60.7% (242/399). Univariate analyses of variables that can predict graft loss and patient death after LDLT demonstrated that recipient factors, pre and post transplant serum Mg and blood product transfusions were potentially risk factors significantly affected the outcome. Multivariate analysis of potential risk factors showed that pre transplant serum Mg 1.8 mg/dl, (Hazard ratio (HR) 2.362 [confidence interval (CI) 1.350–4.133]; p=0.003) and pre transplant BUN, (HR 1.046 [CI 1.014–1.079]; p=0.005) were independent predictors of graft loss and patient death. Conclusions: hypomagnesaemia is common before and after pediatric LDLT. Pre transplant hypomagnesaemia and high BUN are independent risk factors for graft loss or patient death. Pre transplant hypomagnesaemia patients exhibited decreased survival of their graft. Post transplant hypomagnesaemia was a potentially risk factor for graft loss.

Abstract: Albumin plasma concentrations are being used as an indicator of nutritional status and hepatic function, based on the assumption that plasma levels reflect its rate of synthesis. However, it has been shown that albumin levels are not reliable markers of albumin synthesis under a variety of clinical conditions including inflammation, malnutrition, diabetes mellitus, liver disease and surgical tissue trauma. To date, only a few studies have measured albumin synthesis in surgical and critically ill patients. This review summarizes the findings from these studies which used different tracer methodology in various surgical or critically ill patient populations. The results indicate that the fractional synthesis rate of albumin appears to decrease during surgery, followed by an increase during the postoperative phase. In the early postoperative phase, albumin fractional synthesis rate can be stimulated by perioperative nutrition, if enough amino acids are being provided and if nutrition is being initiated before the operation. The physiologic meaning of albumin synthesis after surgery, however, still needs to be further clarified.