Malignant melanoma of the urethra: a rare histologic subdivision of vulvar cancer with a poor prognosis

Malignant melanoma of the urethra is a rare tumour that is difficult to diagnose and treat, resulting in a poor prognosis. In this paper, we present the case of a 65-year-old woman who was referred to a gynaecologist because of a urethral mass that mimicked a caruncle. The tumour was removed by local excision, and a pathological analysis revealed a malignant melanoma. Distal urethrectomy was performed after three months with no evidence of residual tumour. There was no evidence of disease at a six-year followup. In this paper, we compare the epidemiology, treatment, staging, and prognosis of vulvar cancer in general to malignant melanoma of the vulva in particular

Attenuation of systemic inflammatory stress response after preoperative analgesia with clonidine compared to levobupivacaine-a randomised clinical trial

Background and purpose: Use of analgetics before the pain stimulus (preventive analgesia) obstruct development of neuroplastic changes in central nervous system, and reduces pain. Furthermore, preventive analgesia can block harmful central nervous system response and inflammation as an early consequence of operation as well. Investigation hypothesis is that preoperative central clonidine will reduce systemic inflammatory stress response better than levobupivacaine. Materials and methods:. Patients were allocated to three groups, according to preoperative epidural use of 5 μg/kg clonidine (n=17), 0.25% levobupivacaine (n=12) or saline as control group (n=13). Before operation, 1 h after the beginning, 1 h, 6 h, 12 h and 24 h after the operation following parameters were analyzed: procalcitonin (PCT), interleukine-6 (IL-6), C-reactive protein (CRP) and lactate. Results: There were no significant differences between groups in age, gender, body mass index and operation time. We demonstrated significant reduction in PCT, IL-6, CRP and lactate levels in preoperative clonidine group, compared to preoperative levobupivacaine group and controle group. Conclusion. These results support importance of clonidine central effect on pain pathways and systemic inflammatory stress response blockade

Attenuation of systemic inflammatory stress response after preoperative analgesia with clonidine compared to levobupivacaine-a randomised clinical trial

Background and purpose: Use of analgetics before the pain stimulus (preventive analgesia) obstruct development of neuroplastic changes in central nervous system, and reduces pain. Furthermore, preventive analgesia can block harmful central nervous system response and inflammation as an early consequence of operation as well. Investigation hypothesis is that preoperative central clonidine will reduce systemic inflammatory stress response better than levobupivacaine. Materials and methods:. Patients were allocated to three groups, according to preoperative epidural use of 5 μg/kg clonidine (n=17), 0.25% levobupivacaine (n=12) or saline as control group (n=13). Before operation, 1 h after the beginning, 1 h, 6 h, 12 h and 24 h after the operation following parameters were analyzed: procalcitonin (PCT), interleukine-6 (IL-6), C-reactive protein (CRP) and lactate. Results: There were no significant differences between groups in age, gender, body mass index and operation time. We demonstrated significant reduction in PCT, IL-6, CRP and lactate levels in preoperative clonidine group, compared to preoperative levobupivacaine group and controle group. Conclusion. These results support importance of clonidine central effect on pain pathways and systemic inflammatory stress response blockade

The Use of Color Duplex Ultrasound and Magnetic Resonance Imaging in the Dissolution of Idiopathic Recurrent Priapism in Patient with Congenital Penile Curvature – A Case Report

Priapism, penile erection characterized as prolonged and devoid of sexual stimulation or excitement is a rare condition. It is critical to distinguish between low- and high-flow priapism, because the treatment algorithm differs markedly for these 2 conditions. The diagnosis is made clinically and confirmed with color Doppler ultrasonographic imaging (CDUS). We present a 21 year old men with high-flow priapism and left lateral congenital penile curvature. A duplex Winter shunt procedure was employed with corporeal irrigation of heparin solution and adrenalin solution instillation, but the priapism returned 12 hours after. Following several days slow instillation of phenilephrine or adrenaline solution accompanied by oral flutamide therapy resulted in complete detumescence. We used both CDUS and magnetic resonance imaging (MRI) before and after treatment of priapism. Although CDUS has been the primary modality for cross-sectional imaging of the penis, the superior soft-tissue contrast and spatial resolution afforded by MRI provide an opportunity to advance imaging evaluation of this organ

Effect of bispectral index monitoring on extubation time and analgesic consumption in abdominal surgery: a randomised clinical trial

PRINCIPLES: The aim of this study was to investigate the effect of bispectral index (BIS) monitoring on intra-operative anaesthesia consumption and extubation time. Design: Randomised controlled study. METHODS: The study included 45 patients undergoing major abdominal surgery under general anaesthesia in a six month period (February – July 2011), aged 18 years or older, and classified as ASA (American Society of Anaesthesiologists) physical status II or III. Patients were randomly assigned to receive BIS-guided anaesthesia or routine anaesthesia care as a non BIS-guided group. At the induction of anaesthesia, and during the operation the following parameters were continuously recorded: BIS level, heart rate (HR), systolic blood pressure (sBP), end-tidal CO2 (etCO2).Operation time and time to extubation were also recorded. On the first post-operative day all patients were visited and interviewed about intra-operative recall. RESULTS: BIS levels in the non BIS-guided group were significantly lower from 30 minutes further to the end of the operation, compared to the BIS-guided group (p <0.05). Time to extubation was significantly shorter in the BIS-guided group (17.5 min vs. 75 min, p <0.001). There were no statistically significant differences in the required amounts of anaesthetics. In the post-operative interview, none of the patients reported an episode of intra-operative awareness. CONCLUSION: Guiding anaesthesia according to BIS level will result in significantly faster recovery after anaesthesia. The investigation was registered on ClinicalTrials.gov (NCT01470898)