Genetics of perioperative pain management

Purpose of review The current review will discuss the current literature on genetics of pain and analgesia, with special emphasis on perioperative setting. We will also discuss pharmacogenetics-based management guidelines, current clinical status and future perspectives. Recent findings Recent literature suggests that the interindividual variability in pain and postoperative analgesic response is at least in part because of one's genetic make-up. Some of the well characterized polymorphisms that are associated with surgical pain and opioid-related postoperative adverse outcomes are described in catechol-O-methyl transferase, CYP2D6 and μ-opioid receptor (OPRM1), ATP-binding cassette subfamily B member 1, ABCC3, organic cation transporter 1 genes. Clinical Pharmacogenetics Implementation Consortium has put forth recommendations on CYP2D6 genotype-based opioid selection and dosing. The list of drug–gene pairs studied continue to expand. Summary Pharmacogenetic approach marks the dawn of personalized pain medicine both in perioperative and chronic pain settings. Correspondence to Senthilkumar Sadhasivam, MD, MPH, Gopal Krishna Professor and Chief of Anesthesia, Department of Anesthesia, Riley Hospital for Children at Indiana University Health, RH 2835, 705 Riley Hospital Drive, Indianapolis, IN 46202, USA. Tel: +1 317 948 3845; fax: +1 317 944 0282; e-mail: ssadhasivam@iuhealth.org Copyright © 2018 YEAR Wolters Kluwer Health, Inc. All rights reserved.

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False negative computed tomography scan due to pelvic binder in a patient with pelvic disruption: a case report and review of the literature

Pelvic binders are routinely used in the prehospital setting for stabilization of pelvic injuries in patients with trauma. Emergency department trauma management relies on primary and secondary survey assessme...

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Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Treatment-free survival, which is living without the need for treatment for recurrent cancer, is an important outcome for thyroid cancer patients. The goal of this study was to understand factors associated with treatment-free survival in the general population, because this will enable the care teams to tailor long term follow up to a particular situation, and, many times, help decrease patient worry. Read More…

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Clinical Thyroidology®for the Public – Highlighted Article

From Clinical Thyroidology^® for the Public: Treatment-free survival, which is living without the need for treatment for recurrent cancer, is an important outcome for thyroid cancer patients. The goal of this study was to understand factors associated with treatment-free survival in the general population, because this will enable the care teams to tailor long term follow up to a particular situation, and, many times, help decrease patient worry. Read More…

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Is skip metastases associated with tumor thickness and tumor size in tongue carcinoma patients?

Abstract

Objective

To assess the correlation of skip metastases associated with increase in tumor thickness and size of the tumor.

Material and methods

A retrospective analysis was carried out from August 2009 to August 2015. In this study, a total number of 33 carcinoma tongue patients having T1, T2, and T3 sizes with N0 and N+ clinical necks who were treated by supraomohyoid neck dissection, extended supraomohyoid neck dissection, and modified radical neck dissection were analyzed. The data was assessed using Shapiro-Wilk W test, Nagelkerke R² regression model, mean, and standard deviation.

Results

Metastasis to lymph nodes was present in 75% of patients. Level I and level II were the commonest sites to be involved, i.e., 20 patients. Three patients had skip metastasis out of which two patients had metastasis at level III (6%), and one patient had skip metastasis at level IV (3%).

Conclusion

The incidence of skip metastasis increases with tumor thickness and tumor size in tongue carcinoma patients.

Clinical relevance

The article reveals the positive relationship between tumor thickness, tumor size, and skip metastasis. The analysis shows tumor thickness as a higher predictor for skip metastasis with odds ratio of 5.5 compared to the tumor size having odd ratio 2.

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Changes in Serum Immunoglobulin G4 Levels in Patients with Newly Diagnosed Graves’ Disease

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0669-9333

Objective Immunoglobulin G4 (IgG4)-related disease (IgG4-RD) is an immune-mediated condition that can affect almost any organ. We investigated the association between IgG4-RD and the main characteristics of Graves' disease (GD) at the time of diagnosis. Additionally, we evaluated whether serum IgG4 levels change during treatment. Design and patients Twenty-eight patients with newly diagnosed GD were enrolled into this longitudinal follow-up study. Serum IgG4 levels and thyroid function were measured in all the participants at the time of diagnosis. Further, the serum IgG4 levels of nine of 28 patients with untreated GD were measured after the achievement of euthyroid state (through the use of methimazole). Results Two (7.1%) of 28 patients with untreated GD had elevated serum IgG4 levels of >135 mg/dL. There was no significant difference in the average IgG4 levels before and after the achievement of euthyroid state (66.2±74.0 mg/dL vs. 50.5±47.3 mg/dL). In two patients, the elevated serum IgG4 levels returned to normal after treatment. However, one patient had an elevated serum IgG4 level of 136.6 mg/dL after treatment. Conclusions This study showed that serum IgG4 levels varied with treatment in patients with GD, independent of thyroid function, suggesting that IgG4 might be indirectly related to GD.
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© Georg Thieme Verlag KG Stuttgart · New York

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Altered TEG Parameters Identify Hypercoagulablilty and are of Diagnosis Value for Papillary Thyroid Carcinoma Patients

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0723-3295

Objective The goal of this study was to clarify the changes and clinical significance of thromboelastography (TEG) parameters in papillary thyroid carcinomas and nodular goiters. Methods 62 nodular goiter (NG) patients and 53 papillary thyroid carcinoma (PTC) patients were included. Coagulation indicators, together with a series of TEG parameters were collected and analyzed, compared with results of 61 healthy controls (HC). Correlation analysis was conducted between routine coagulation indicators and TEG parameters. ROC curves were used to evaluate the potential diagnosis value of the TEG parameters that were altered in papillary thyroid carcinoma patients. Results APTT and PT in papillary thyroid carcinoma group were statistically significant higher than that in control group (p<0.05). MPV was found to be higher in PTC than NG and healthy controls.R, K and SP levels were significantly lower in PTC group than that in HC group; Angle, CI and TPI levels were significantly higher in PTC group than that in HC group. Areas under the ROC curve of CI, TPI, and angle were 0.725, 0.714, and 0.687 for distinguishing PTC from HC, 0.662, 0.668 and 0.591 for distinguishing PTC from NG. Conclusion TEG parameters are altered and indicate hypercoagulablilty status of papillary thyroid carcinoma patients; CI, TPI, and angle could be potential diagnosis indicators for detecting papillary thyroid carcinoma.
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© Georg Thieme Verlag KG Stuttgart · New York

Article in Thieme eJournals:
Table of contents  |  Abstract  |  Full text

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