Coeliac Plexus Neurolysis for Upper Abdominal Malignancies Using an Anterior Approach: Review of the Literature

Background: Coeliac plexus neurolysis (CPN) helps to diminish pain arising from malignancy of upper abdominal viscera. Imaging modalities have increased the success rates by enhancing technical accuracy including fluoroscopy, computed tomography and ultrasound. Advancement in the imaging modalities used has helped in the accurate depiction of anatomy and position of the needle tip.Methods: In an anterior approach, the patient lies supine and the needle is inserted through the anterior abdominal wall into the retropancreatic space. The needle often traverses the stomach, liver or pancreas before reaching the coeliac plexus due to anatomical considerations. The literature has been reviewed regarding various imaging modalities using an anterior approach to coeliac plexus block with regard to success rate, improvement in pain scores, duration of pain relief and analgesic consumption.Results: Successful pain relief in abdominal malignancies with an anterior approach using various imaging modalities varies between 54% and 94% of patients. Following neurolysis, many patients can be weaned off opioids. This procedure improves quality of life and reduces the risk of drug-related side effects. The duration of pain relief after an anterior approach is six to eight weeks.Conclusion: The use of various imaging modalities in an anterior approach has improved the technical accuracy in reaching the coeliac plexus, thereby avoiding the needle piercing crucial structures and avoiding deposition of drug in the retrocrural space, thereby reducing the risk of neurological complications. Coeliac plexus neurolysis via an anterior approach using different imaging modalities does not completely abolish pain, rather it diminishes pain, helping to reduce opioid requirements and improving survival in patients with upper abdominal malignancy.Keywords: Coeliac Plexus, Coeliac Plexus Block, Imaging Modalities, Neurolytic Techniques, Pancreatic Pain, Upper Abdominal Malignanc

Mediastinitis after oesophagoscopy: A case report

A 50-year-old male presented with signs and symptoms of oesophageal perforation after a biopsy. Suggestive symptoms and signs were pain in the neck radiating to the back, a rise in temperature and pulse, emphysema in the neck and widening of the mediastinum or a pneumothorax revealed by a chest X-ray. He survived with medical managemen

Addition of adenosine to hyperbaric bupivacaine in spinal anaesthesia does not prolong postoperative analgesia in vaginal hysterectomy

Background: Systemic administration of adenosine produces anti-nociception. Although literature supports intrathecal adenosine for neuropathic pain, its efficacy in postoperative pain remains unproven. There has been no study on the efficacy of adenosine on postoperative pain when administered with hyperbaric bupivacaine. The aim of our present study was to evaluate the efficacy of two different doses of intrathecal adenosine as an adjunct to 0.5% hyperbaric bupivacaine in patients undergoing vaginal hysterectomy under spinal anaesthesia. Method: Seventy-five women, aged 40-60 years and scheduled for vaginal hysterectomy under spinal anaesthesia, were included. Patients were allocated to three groups of 25 patients each to receive 500 μg adenosine (group I), 1000 μg adenosine (group II) and normal saline (group III) with 2.6 ml of 0.5% hyperbaric bupivacaine. Postoperative analgesia was provided with patient-controlled fentanyl. Time of administration of rescue analgesia and total dose of fentanyl were recorded. The times to full recovery of sensory and motor block were noted. Results: There were no differences in time to rescue analgesia and postoperative fentanyl consumption over 24 hours among the groups. There was no significant difference in onset of sensory and motor block or regression of sensory block, although statistically significant difference was noted in the time taken for regression of motor block. Conclusion: Intrathecal adenosine does not affect the postoperative analgesic requirement when administered with hyperbaric bupivacaine.Keywords: spinal anaesthesia, intrathecal adenosine, vaginal hysterectomy,postoperative analgesia, patient-controlled analgesi

Antitumor activity of colloidal silver on MCF-7 human breast cancer cells

<p>Abstract</p> <p>Background</p> <p>Colloidal silver has been used as an antimicrobial and disinfectant agent. However, there is scarce information on its antitumor potential. The aim of this study was to determine if colloidal silver had cytotoxic effects on MCF-7 breast cancer cells and its mechanism of cell death.</p> <p>Methods</p> <p>MCF-7 breast cancer cells were treated with colloidal silver (ranged from 1.75 to 17.5 ng/mL) for 5 h at 37°C and 5% CO₂atmosphere. Cell Viability was evaluated by trypan blue exclusion method and the mechanism of cell death through detection of mono-oligonucleosomes using an ELISA kit and TUNEL assay. The production of NO, LDH, and Gpx, SOD, CAT, and Total antioxidant activities were evaluated by colorimetric assays.</p> <p>Results</p> <p>Colloidal silver had dose-dependent cytotoxic effect in MCF-7 breast cancer cells through induction of apoptosis, shown an LD₅₀(3.5 ng/mL) and LD₁₀₀(14 ng/mL) (*P < 0.05), significantly decreased LDH (*P < 0.05) and significantly increased SOD (*P < 0.05) activities. However, the NO production, and Gpx, CAT, and Total antioxidant activities were not affected in MCF-7 breast cancer cells. PBMC were not altered by colloidal silver.</p> <p>Conclusions</p> <p>The present results showed that colloidal silver might be a potential alternative agent for human breast cancer therapy.</p

Omega-3 polyunsaturated fatty acids favourably modulate cardiometabolic biomarkers in type 2 diabetes: a meta-analysis and meta-regression of randomized controlled trials

BACKGROUND: Randomized controlled trials (RCTs) suggest that supplementation with omega-3 polyunsaturated fatty acids (n-3PUFAs) may favourably modify cardiometabolic biomarkers in type 2 diabetes (T2DM). Previous meta-analyses are limited by insufficient sample sizes and omission of meta-regression techniques, and a large number of RCTs have subsequently been published since the last comprehensive meta-analysis. Updated information regarding the impact of dosage, duration or an interaction between these two factors is therefore warranted. The objective was to comprehensively assess the effect of n-3PUFAs supplementation on cardiometabolic biomarkers including lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control, in people with T2DM, and identify whether treatment dosage, duration or an interaction thereof modify these effects. METHODS: Databases including PubMed and MEDLINE were searched until 13th July 2017 for RCTs investigating the effect of n-3PUFAs supplementation on lipid profiles, inflammatory parameters, blood pressure, and indices of glycaemic control. Data were pooled using random-effects meta-analysis and presented as standardised mean difference (Hedges g) with 95% confidence intervals (95% CI). Meta-regression analysis was performed to investigate the effects of duration of supplementation and total dosage of n-3PUFAs as moderator variables where appropriate. RESULTS: A total of 45 RCTs were identified, involving 2674 people with T2DM. n-3PUFAs supplementation was associated with significant reductions in LDL [ES: - 0.10, (95% CI - 0.17, - 0.03); p = 0.007], VLDL (ES: - 0.26 (- 0.51, - 0.01); p = 0.044], triglycerides (ES: - 0.39 (- 0.55, - 0.24; p ≤ 0.001] and HbA1c (ES: - 0.27 (- 0.48, - 0.06); p = 0.010]. Moreover, n-3PUFAs supplementation was associated with reduction in plasma levels of TNF-α [ES: - 0.59 (- 1.17, - 0.01); p = 0.045] and IL-6 (ES: - 1.67 (- 3.14, - 0.20); p = 0.026]. All other lipid markers, indices of glycaemic control, inflammatory parameters, and blood pressure remained unchanged (p > 0.05). CONCLUSIONS: n-3PUFAs supplementation produces favourable hypolipidemic effects, a reduction in pro-inflammatory cytokine levels and improvement in glycaemia. Neither duration nor dosage appear to explain the observed heterogeneity in response to n-3PUFAs. Trial registration This trial was registered at http://www.crd.york.ac.uk as CRD42016050802

Active multiple myeloma suppresses and typically eliminates coexisting MGUS

Background: Myeloma is consistently preceded by premalignant monoclonal gammopathy of undetermined significance (MGUS). In >5% of MGUS patients there is a second MGUS clone (biclonal gammopathy of undetermined significance; BGUS), yet, at myeloma diagnosis, presentation of biclonal gammopathy myeloma (BGMy) is considered less frequent, implying that myeloma eradicates coexisting MGUS. Methods: In the largest study of its kind, we assessed BGMy frequency amongst 6399 newly diagnosed myeloma patients enrolled in recent UK clinical trials. Results: Compared to expected prevalence (i.e., >5% of MGUS have BGUS), only 58 of 6399 (0.91%) newly diagnosed myeloma patients had BGMy, indicating myeloma typically eliminates coexistent MGUS. In these 58 BGMy cases, the MGUS plasma cell clone was greatly suppressed in size compared to typical levels observed in conventional MGUS; contrarily, the MGUS clone did not inhibit the myeloma plasma cell clone in BGMy. Conclusion: Myeloma eliminates the majority of competing MGUS, and when it does not, the MGUS clone is substantially reduced in size

Colour as a cue to eat : effects of plate colour on snack intake in pre-school children

Environmental cues, such as the colour of food and dishware, have been shown to influence food and drink consumption in adult populations. This proof of concept study investigated whether plate colour could be utilised as a strategy to reduce intake of high energy density (HED) snacks and increase intake of low energy density (LED) snacks in pre-school children. In a between and within-subjects design, children were randomly assigned to either a control group (no colour message) or intervention group (received a colour message: red = stop, green = go) and were provided a snack at nursery on three occasions on differently coloured plates (red, green and white), for each snack type (HED, LED). Snack intake, colour preference, colour association, and anthropometrics were recorded for each child. The results showed that there was no effect of group (control vs intervention) on HED (p=0.540) and LED intake (p=0.575). No effect of plate colour on HED (p=0.147) or LED snack intake (p=0.505) was evident. Combining red and green plates for a chromatic versus achromatic comparison showed that there was no significant effect of chromatic plate on HED (p=0.0503) and LED (p=0.347) intakes. Despite receiving a brief learning intervention, the use of plate colour was found in the present study to be an ineffective strategy to control snack food intake in pre-school aged children. Rather, we suggest that food intake in young children may best be predicted by portion size, energy density and eating behaviour traits