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The relationship between obesity, sex difference, and fatigue in patients with multiple sclerosis

Aim: Obesity is a risk factor for autoimmune disorders and worsens the disease process. The purpose of this study was to investigate the association between

the body mass index (BMI), sex differences and fatigue in MS patients compared to healthy controls. Material and Method: Our study consisted of 59 MS

patients (37 females, 22 males) and 45 healthy controls. Medical history of MS patients, including the duration of illness, BMI, Fatigue Severity Scale (FSS)

number of annual episodes, demographic data (sex, age) and BMI and fatigue severity of healthy control group were recorded. Results: The female MS patients

had a significantly higher mean BMI than the control group and a significant positive correlation between BMI and Extended Disability Scale Score (EDSS)

and fatigue. There was no significant difference between the male MS patients’ BMI and that of controls. Obese MS patient group had a significantly higher

mean fatigue level than the normoweight and overweight ones and significantly higher mean annual attack number than the normoweight MS group. In the

female MS patients group, the mean BMI and EDSS of Fatigue Severity Scale (FSS) ≥4 group were significantly higher than of FSS <4 group but there was no

significant correlation between the FSS ≥4 and FSS <4 groups in the male MS patients. Discussion: These findings suggest that being obese in MS patients

may affect attacks via inflammatory pathway as well as disability, particularly so in women; they also show the necessity of approaches encouraging weight

loss for MS treatment

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Effectivity of local bupivacaine infusion in the prevention of postoperative ileus

Aim: Inflammation is the predominant factor in the development of gastrointestinal dysmotility or postoperative ileus although dissection and neurological

and inflammatory factors secondary to intestinal manipulation have been blamed. In this study, we investigated the effectivity of local bupivacaine infusion for

prevention of postoperative ileus. Material and Method: This retrospective study included patients that underwent median laparotomy and received conventional

analgesia alone or conventional analgesia followed by local bupivacaine. Patients that received conventional analgesia (nonsteroidal anti-inflammatory

drugs [NSAIDs] + opioids) followed by local bupivacaine infusion (15 mg/h during 48h) with Pain buster pump system were classified as Group 1 (n=30) and

the patients that received conventional analgesia alone ( [NSAIDs] + opioids) were classified as Group 2 (n=31). Results: The groups were similar in terms of

age, gender, preoperative ASA score, surgical technique, and operative time. The Visual Analog Scale (VAS) scores during the periods 8-24 and 24-48 h and

the analgesic requirement during the periods 0-8, 8-24, and 24-48 h were significantly decreased in Group 1 compared to Group 2 (p<0.05). In Group 1, active

postoperative bowel sounds started earlier (38 vs. 47 h) and mean time to first flatus/defecation was significantly lower than in Group 2 (64.13 ± 9.06 vs. 77.90

± 10.25 h) (p<0.05). Discussion: Transfascial bupivacaine infusion appears to be an effective technique since it reduced early postoperative pain and postoperative

analgesic requirement and also provided favorable effects in the prevention of postoperative ileus, thereby leading to shorter intensive care unit stay.

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Does hepatic visualisation show residual/metastatic thyroid tissue in differentiated thyroid cancer?

Aim: Diffuse homogen hepatic uptake in whole-body scan (WBS) after radioiodine remnant ablation (RRA) suggests that there is occult or visible remnant

thyroid tissue and/or tumor tissue. It is thought that the reason is hepatic metabolization of radioiodine (131I) marked thyroglobulin fragments which are

secreted by remnant/tumor tissue. The aims of this study were to investigate whether the hepatic visualisation after radioiodine remnant ablation showed the

presence of metastatic or residual disease in patients with differentiated thyroid cancer and also to investigate whether early or late WBS after RRA (RxWBS)

had an effect on the physiological hepatic uptake. Material and Method: 201 DTC patients were evaluated (F/M: 152/49; mean age: 49.61±13 years (range:

18–85 years)) who referred for RRA. The therapeutic 131I dose ranged from 100mCi to 200mCi. RxWBS was performed earlier (in 1-4th-day after RRA) in 106

patients (Group 1) and was performed later (in 5-9th-day after RRA) in 95 patients (Group 2). Results: Diffuse hepatic uptake were seen only in three patients

(2.8%) and was not seen in 103 patients (97.2%) in Group 1. However, in Group 2 diffuse hepatic uptake was seen in 93 patients (97.9%) (p<0.05) and not seen

only in 2 patients (2.1%). There is not a statistically significant relationship between the hepatic uptake and serum Tg, LT4 and TSH level. There is a statistically

significant relationship between anti-Tg level and hepatic uptake. Discussion: Physiological diffuse hepatic uptake of radioiodine in WBS after RRA may

not be seen during the early WBS. Thus, metastatic foci may be missed with early scanning. We conclude that RxWBS after RRA should be done in late period.

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