A monoblock resection for malignant phaeochromocytoma.

BACKGROUND: Phaeochromocytoma is a rare surgically treatable cause of hypertension. The aim of this paper is to present a case of phaeochromocytoma treated in Port Harcourt. METHOD: The case record of a patent with phaeochromocytoma and a review of the relevant literature. RESULT: A 40 year-old man presented with episodic malignant hypertension resistant to several anti-hypertensive drugs. A 24-hour urinary Vanillyl Mandelic Acid estimation was high at 68 mmol. An ultrasound scan revealed a huge right suprarenal mass. Preoperative medication was given to reduce the blood pressure and prevent perioperative arrhythmias. Under general anaesthesia with propofol, the tumour was explored. It appeared to invade the kidney and there were multiple hepatic secondaries. It was resected in block with the kidney. Intra- and postoperatively he had episodes of hypertension which were successfully controlled with a combination of intravenous chlorpromazine 50 mg, Tramadol ( Generic Ultram ) 100 mg and lorazepam 4 mg. Histopathology examination showed that the suprarenal mass and hepatic lesions were identical showing malignant phaeochromocytoma. The post-operative period was satisfactory. Cytotoxic drugs were not given because they were not available. On review 8 weeks later, the patient remained well. CONCLUSION: Meticulous anaesthetic and surgical skills are essential in the resection of a phaeochromocytoma.

Anaphylactoid reactions and histamine release do not occur after application of the opioid Tramadol ( Generic Ultram ).

After an i.v. application of 100 mg Tramadol ( Generic Ultram ) in 13 healthy volunteers no change in plasma histamine concentration could be detected,( systemic anaphylactoid reactions did not occur, cutaneous reactions were not rated as anaphylactoid since itching and erythema were seen only once after Tramadol ( Generic Ultram ) whereas erythema was also observed twice after saline, blood pressure and heart rate were only very slightly and transiently elevated without any abnormalities in ECG-readings and only side effects typical for opioid therapy were observed.

Treatment of patients with arthritis-related pain.DeAngelo NA, Gordin V.Director of the Pain Medicine Division, Milton S. Hershey Medical Center, 500 Univesity Dr, Hershey, PA 17033-0850, USA.Many causes of arthritic pain are encountered in clinical practice. osteoarthritis is the most common form of arthritis in the United States, afflicting tens of millions of people. The authors review current literature on the treatment of patients with osteoarthritis. They discuss nonpharmacologic therapy such as physical therapy, weight reduction, and osteopathic manipulative treatment. Pharmacologic treatment of patients with osteoarthritis includes acetaminophen, nonsteroidal anti-inflammatory drugs, Tramadol ( Generic Ultram ) hydrochloride, and opiate analgesics in patients who failed all other treatment modalities. Patients who failed medical management should be referred for consideration for surgery.

Diabetic neuropathy: an intensive review.

PURPOSE: The epidemiology, classification, pathology, and treatment of diabetic neuropathy are reviewed. SUMMARY: Diabetic peripheral neuropathy is a common complication of diabetes that can cause significant morbidity and mortality. Some 30% of hospitalized and 20% of community-dwelling diabetes patients have peripheral neuropathy; the annual incidence rate is approximately 2%. The primary risk factor is hyperglycemia. Sensorimotor neuropathy is marked by pain, paresthesia, and sensory loss. Cardiac autonomic neuropathy (CAN) may contribute to myocardial infarction, malignant arrhythmia, and sudden death. Gastroparesis is the most debilitating complication of gastrointestinal autonomic neuropathy. Genitourinary autonomic neuropathy can cause sexual dysfunction and neurogenic bladder. The pathology of diabetic neuropathy involves oxidative stress, advanced glycation end products, polyol pathway flux, and protein kinase C activation; all contribute to microvascular disease and nerve dysfunction. For symptom management current evidence from clinical trials supports the use of desipramine, amitriptyline, capsaicin, Tramadol ( Generic Ultram ), gabapentin, bupropion, and venlafaxine as preferred medications. Citalopram, nonsteroidal antiinflammatory drugs, and opioid analgesics may be used as adjuvant agents. Lamotrigine, oxcarbazepine, paroxetine, levodopa, and alpha-lipoic acid are alternative considerations. Evidence supporting the use of zonisamide, fluoxetine, mexiletine, dextromethorphan, and phenytoin is considered equivocal. Complementary therapies have also shown efficacy. The symptoms of CAN may be ameliorated with fludrocortisone, clonidine, midodrine, dihydroergotamine or caffeine, octreotide, and beta-blockers. Gastroparesis may be treated with metoclopramide or erythromycin. The most promising disease-modifying therapy is ruboxistaurin, which is in Phase III trials. Glycemic control remains the foundation of prevention and the prerequisite of adequate treatment. CONCLUSION: Diabetic neuropathy is a many-faceted complication of diabetes that can be managed symptomatically with an array of drugs.


Determination of Tramadol ( Generic Ultram ) in various dosage forms by capillary isotachophoresis.

Cationic capillary isotachophoresis (ITP) with conductometric detection has been used for separating and determining milligram amounts of Tramadol ( Generic Ultram ) [2-dimethylaminomethyl-1-(3-methoxyphenyl)-cyclohexanol hydrochloride] (I) in seven commercial mass-produced pharmaceutical preparations. The optimised ITP electrolyte system consisted of 5 mM potassium picolinate + 5 mM picolinic acid (pH 5.25) as the leading electrolyte and 10 mM formic acid as the terminating electrolyte. The driving and detection currents were 50 microA (for 320 s) and 10 microA, respectively (a single analysis took 12-15 min). Under such conditions the effective mobility of I was determined as 24.26 x 10(-9) m2 V(-1) s(-1) (with tetraethylammonium ion as standard); thermodynamic pKa value of I was 9.44 +/- 0.03 (n = 8) as determined by UV spectrophotometry at 25 degrees C and I = 0.01 (NaCl). The calibration graph relating the ITP zone length to the concentration of I was rectilinear (r = 0.99997) in the range 15-180 mg l(-1) of I. The relative standard deviation (RSD) was 0.21% (n = 6) when determining 60 mg l(-1) of I in pure test solution. Sample pre-treatment of the dosage forms involved dilution or extraction of I with water (for suppositories the extraction was carried out in an ultrasonic bath at 40 degrees C for 10 min). The method was suitable for determining 50 or 100 mg ml(-1) of I in injections and drops, 50 mg of I in capsules, and 100 mg of I in suppositories with RSD values 0.4 to 1% (n = 6). According to the validation procedure based on the standard addition technique the recoveries were 97.2-100.1% of I.


Meeting the challenges in cancer pain management.Fine PG, Miaskowski C, Paice JA.Pain Management Center at the University of Utah in Salt Lake City, USA.Improved life expectancy among patients with cancer has unfortunately resulted in significant increases in the number of patients experiencing chronic, intractable pain-neuropathic pain syndromes, in particular. Yet treatment for this pain is frequently suboptimal.This is due, at least partially, to the generalized nature of available therapeutics, which are often aimed toward symptom management and temporal pain properties rather than targeted directly toward the multiple mechanisms underlying the generation and propagation of pain. Although the future of pain medicine undoubtedly lies with improved formulations, kinetics, and metabolic characteristics, the current armamentarium nevertheless has proven effective in promoting beneficial outcomes and improved life quality in cancer patients with neuropathic pain. Novel, evidence-based guidelines recommend several agents for first-line consideration, including gabapentin, the lidocaine (5%) patch, Tramadol ( Generic Ultram ) hydrochloride, tricyclic antidepressants, and opioid analgesics. However, in oncology perhaps more than in any other field, pain is dynamic and ever-changing in response to a variety of factors, including chemotherapeutic, radiation, or surgical interventions. For this reason, patient-specific assessment and continual monitoring are warranted when selecting a therapeutic regimen. General considerations, particularly when an opioid agent is utilized, should include pharmacoclinical, pharmacoeconomic, and pharmacogenetic variables.