Comparison of the efficacy of gabapentin and pregabalin for neuropathic pain in patients with spinal cord injury: A crossover study

Objectives: To compare the efficacy and side effects of gabapentin and pregabalin for the treatment of neuropathic pain(NP) in spinal cord injury (SCI). Methods: Twenty eight patients were included in the study. The patients were randomized to receive pregabalin or gabapentin. VAS(Visual analog scale) pain score, neuropathic pain scale(NPS), Lattinen test(LT), Beck Depression Inventory(BDI) pain diary measures were used for the patient evaluation. We assessed patients at 4th and 8th weeks. Treatment groups were crossed over after 2 weeks of wash-out period to receive the other treatment. Results: At the end of the study there was significant improvement in VAS both with gabapentin and pregabalin (p0.05). In NPS, and LT parameters, no difference was present between the two study groups before or after the treatment (p>0.05). In both groups no significant improvement was seen in emotional status as assessed with BDI (p>0.05). Frequency of side effects and exclusion from the study due to side effects were higher for the pregabalin group but it was not significant between the groups (p>0.05). Conclusions: It is concluded that both drugs are effective and safe for the treatment of NP due to SCI but no difference exist between the two drugs. We are in the opinion that large studies that include more patients and placebo control should be carried out for more accurate data about this topic

Surgical treatment of appendiceal adenocarcinoid (goblet cell carcinoid)

Adenocarcinoid of the appendix is an infrequent tumor with histologic features of both adenocarcinoma and carcinoid tumor. Although its malignant potential remains unclear, adenocarcinoids seem to be biologically more aggressive than conventional carcinoids. The aim of this study was to analyze long-term results of surgical treatment for appendiceal adenocarcinoid. A retrospective review (1991-2003) identified seven patients (median age 72, range 27-81 years) treated for appendiceal adenocarcinoid. The clinical data of these patients were reviewed. Follow-up was complete for all patients (median 60 months, range 24-108 months). Most cases presented with associated acute appendicitis (71%). First intention surgery consisted of appendectomy (m = 6) and right hemicolectomy (m = 1). In three patients, additional surgical procedures were performed (right colectomy). Indications for colectomy were tumor size (three cases) associated with appendectomy margin invasion in one case. One patient with lymph node and peritoneal involvement experienced recurrence 9 months after hemicolectomy and died of the disease at 2 years. One patient subsequently died of colon carcinoma 6 years after adenocarcinoid treatment. Five patients were alive without disease at the time of the last follow-up. Synchronous or metachronous colon carcinomas developed in three patients (43%). Our results suggest that appendectomy alone could be used for appendiceal adenocarcinoid provided that the tumor (1) is less than 1 cm; (2) does not extend beyond the appendix adventitia; (3) has less than 2 mitoses/10 high power fields; and (4) has surgical margins that are tumor free. Otherwise, carcinologic right colectomy seems to be indicated. The risk for developing colorectal adenocarcinoma seems to be extremely high in patients treated for appendiceal adenocarcinoid and warrants close follow-up with colonoscopic screening