Introduction: Laparoscopy is mostly performed under general anesthesia (GA) but laparoscopy using anesthesia such as thoracic spinal anesthesia (TSA) is mostly performed by some anesthesiologists and it is very useful when compared to GA.
Method: This paper presents a case report of the use of TSA in healthy pediatric patients who administered anesthesia with TSA in the T10-T11 interspace, using 1 ml of hyperbaric Bupivacaine 5 mg/ml mixed with: 1 ml of Levobupivacaine isobaric 5 mg/ml, Fentanyl 50 μg, Ketamine 10 mg and Dexmedetomidine 10 μg mixed in 1 syringe.
Results: During procedure, hemodynamically stable, no nausea, vomiting, or discomfort. Postoperative recovery process was very smooth, hemodynamically stable, no pain was reported or PDPH (Post Dural Puncture Headache) even though we used a 26G spinal needle. The use of TSA is considered very practical and more economical even though it is still carried out very carefully.
Conclusion: This is only one single case report. TSA can be a better choice compare with general anesthesia. Stable hemodynamic during laparoscope and TSA can avoid systemic effect of general anesthesia like cognitive affect after general anesthesia, longer for recovery from anesthesia, nausea, vomiting, poor control pain and high cost.
Objectives: Hematological toxicity induced by chemotherapy is known to be caused by multiple factors, including genetic factors, such as polymorphisms. The polymorphisms may occur in drug efflux transporter proteins and enzymes involved in drug metabolism. In our study, we investigate the incidence of hematological toxicities and its relation to the haplotype ATP-Binding Cassette B1 (ABCB1) which were polymorphism of C1236T, C3435T, G2677T and Glutathione S-Transferase P1 (GSTP1) A313G gene in Indonesian breast-cancer patients who receives anthracycline during chemotherapy. Methods: One hundred and thirty-eight breast-cancer patients in H. Adam Malik Hospital, Medan, Indonesia who were in the inclusion criteria were recruited in this retrospective cohort study. The DNA of patients was extracted from the peripheral leukocytes. Single nucleotide polymorphism (SNP) ABCB1 and GSTP1 were examined by the PCR-RFLP method. Data on patient characteristics and the incidence of hematological toxicity were obtained from patient medical records after three cycles of chemotherapy. Trend of absolute neutrophil count (ANC) and anemia were analyzed using the Friedmann test and the Wilcoxon signed-rank test. The Kruskal-Wallis test was performed to understand the association of ABCB1 and GSTP1 polymorphisms with the incidence of anemia and neutropenia. The frequency distribution of genotypes and alleles were determined using the Hardy-Weinberg Equilibrium (HWE). Results: A decrease of ANC was found after post chemotherapy on cycles 3 (Mean ± SD: 5644.48± 2962.545/mm3 vs 3034.89±2049.635/mm3 ), and the anemia (12.1478±1.50057 gr/dl vs 11.2746± 1.31221 gr/dl) after the patients underwent three chemotherapy cycles (p <0.05). There was no relation between ABCB1 polymorphism, either in each SNP or in the form of haplotype (the combination of more than one SNP) on the incidence of anemia and neutropenia (p> 0.05). In GSTP1 polymorphisms, no correlation between polymorphisms and anemia and neutropenia incidence (p> 0.05) was found. In our study, the ABCB1 and GSTP1 genotypes and alleles frequency distribution showed no deviation from HWE (p> 0.05). Conclusions: Patients who have performed the three cycles of hemotherapy demonstrated a susceptibility to the side effects of hematological toxicity (such as anemia and neutropenia); however, there was no relationship between ABCB1 and GSTP1 polymorphisms to hematological toxicity.
Oral squamous cell carcinoma (SCC) represents 90 to 95% of all malignant neoplasms of the oral cavity. Squamous cell carcinoma occurs in several well-established intraoral sites, including the floor of mouth, tongue, gingiva, lips, and buccal mucosa. It might also present in the tooth-bearing segment of either the maxilla or mandible. We report a case of a 56-yearold female posthemimandibulectomy, hemimaxillectomy patient secondary to SCC involving the maxilla, mandible, and buccal mucosa. Patient presented with chief complaints of electric shock-like sensation along the distribution of trigeminal nerve. These symptoms were aggravated during exposure with cold winds and during conversation. This facial pain was resistant to medications like carbamazepine. So radiofrequency ablation of Gasserian ganglion via foramen ovale was planned. Patient had near-complete relief of symptoms after culmination of the procedure.
Trigeminal neuralgia (TN) is a neuropathic pain syndrome characterized by severe unilateral paroxysmal facial pain. Pain attacks are usually stimulated by tactile irritation within the region of the trigeminal nerve.Trigeminal neuralgia pain typically remits and relapses, even when patients are on conventionally used treatments, resulting in a major source of disability and poor quality of life. Multiple forms of treatment are available for its management, but it is often resistant to conventional treatments. Radiofrequency (RF) ablation is one of the best treatment modalities to relieve pain in TN but even after successful RF ablation of Gasserian ganglion, there may be relapses. Rarely, patient may present with pain in other distributions of trigeminal nerve. We report a case of a 55-year-old female having relapsing form of TN, switching from V2 to V3 division of trigeminal nerve distribution.
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