Patients were dissatisfied with frequency and communication, and they had high levels of avoidance before operation. In the postoperative period, sexual dissatisfaction increased. Although depression and anxiety decreased after the operation, we found that hysterectomy and/or oophorectomy had negative effects on sexual satisfaction.
In this study, the psychological effects of single-dose corticosteroids administered to patients who had undergone rhinoplasty were assessed. A total of 30 rhinoplasty patients were included in the study and were randomly assigned to 1 of 2 groups. Preoperatively, patients completed the Bech Rafaelsen Mania Scale and the Beck Depression Inventory. Dexamethasone 10 mg was given intravenously just before surgery to the first group, but no medication was administered to the second group. On the first postoperative day, patients were seen again, and the Bech Rafaelsen Mania Scale and the Beck Depression Inventory were again completed. Periorbital edema and ecchymosis were graded, and psychological well-being was measured on a standard visual analog scale. All patients and physicians were blinded to treatment until the end of the study. Results show that administration of a single-dose of dexamethasone 10 mg caused neither euphoria nor depression. No significant differences were observed between steroid and control groups in terms of patients' psychological well-being. With single-dose dexamethasone, periorbital edema was significantly reduced on the first 2 postoperative days, and upper eyelid ecchymosis was significantly decreased only on the first postoperative day. However, reoperative steroid administration had no influence on ecchymosis of the lower eyelid. The authors conclude that single-dose dexamethasone 10 mg can be used safely to reduce periorbital edema and ecchymosis in rhinoplasty patients.
Single photon emission computed tomography (SPECT) with 99mTc-HMPAO was used to compare regional cerebral blood flow (rCBF) in patients with bipolar disorder and in healthy controls. The sample of this study consisted of 16 euthymic bipolar patients who met the DSM-IV criteria and 10 healthy control subjects. The mean regional cerebral blood flow values of the bipolar euthymic patients were significantly lower than those of the controls in the bilateral medial-basal temporal, occipital; medial frontal; parietal regions and in the cingulate gyrus; the hypoperfusion in the cingulate had the highest significant P value (.001, Bonferroni correction). No significant differences in rCBF emerged between right and left-brain regions. The most important findings of the current study are the presence of regional cerebral perfusion alterations, particularly in the cingulate gyrus in the euthymic bipolar patients. Our results imply that underlying brain dysfunction may be independent from manic or depressive episodes in bipolar disorder. Because of the small number of subjects, however, this finding should be viewed as preliminary.
Excessive potassium (K + ) loss is frequently seen post-transplant following platinum containing high-dose chemotherapy (HDC) regimens such as STAMP-I (cyclophosphamide + carmustine + cisplatin), STAMP-V (cyclophosphamide + thiotepa + carboplatin), ICE (ifosfamide + carboplatin + etoposide) and TMCb (thiotepa + melphalan + carboplatin). 1-3 Nephrotoxic antibiotics which are commonly used in the post-transplant period may also cause hypokalemia. In general, the etiology of posttransplant hypokalemia is multi-factorial. Manifestations of hypokalemia seldom occur unless the plasma K + is <Ͻ 3 mEq/l. Profound K + depletion is associated with an increased risk of cardiac arrhythmias and also rhabdomyolysis. Smooth-muscle function might also be affected and might manifest as paralytic ileus. 4 The main reasons for profound hypokalemia after HDC are renal and gastrointestinal K + loss due to nephrotoxicity from platinum or antibiotics and diarrhea associated with gastro-intestinal (GI) mucositis, due to alkylating agents such as thiotepa, melphalan and cyclophosphamide. Therefore, close followup of K + levels is crucial for the first 2-3 weeks after transplantation. Daily K + requirements in this setting may reach as much as 150-200 mEq/l/day. Whole day K + replacement can be a time-consuming process and must be carried out with care. We therefore attempted to investigate the effect of spironolactone (100 mg tablet, twice daily), which is a potent aldosterone antagonist, on K + loss following HDC. We hypothesized that administration of spironolacone during the post-transplant period may counterbalance the renal K + loss by antagonizing aldosterone, thus decreasing K + requirements. Between 1999 and 2001, 40 consecutive patients meeting the eligibility criteria, with hematologic malignancies and solid tumors, were entered into a study evaluating the effect of spironolactone on daily potassium requirements following the TMCb conditioning regimen which causes excessive potassium loss. Patient characteristics are listed in Table 1. Oral and written informed consent for PBSC collection and transplantation was obtained from all patients or their guardians. All patients received thiotepa 250 mg/m 2 /day (on days Ϫ9 and Ϫ8), melphalan 50 mg/m 2 /day (on days Ϫ7 and Ϫ6) and carboplatin 400 mg/m 2 /day (on days Ϫ5, Ϫ4 and Ϫ3) (TMCb regimen). 3 Patients rested on days Ϫ2 and Ϫ1 and PBSCs were infused on day 0.Two sequential groups of patients participated this study. The first 20 patients did not receive spironolactone and the second 20 patients received spironolactone 100 mg tablet twice daily per orum starting on day 0 and continuing up to post-transplant day +15. Because of the close association of hypokalemia with hypomagnesemia, daily serum K + and magnesium (Mg) levels were followed. 5 We attempted to keep serum K + and Mg ++ levels у3.5 mEq/l and у1.5 mEq/l in every patient, respectively. Median total K + requirements over 15 days in patients receiving and not receiving spironolactone were 710 mEq (range
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