Ayşe Karci has completed her medical education at Ege University, Turkey and was specialized in anesthesiology in Dokuz Eylül University School of Medicine and still working in the same hospital as an Associate Professor. She has worked in the Department of Obstetrics and Labor Unit as anesthesiologist and was also the Director of School of Anesthesia Technicians for about six years. She has 16 publications in reputed journals and 29 Turkish papers in the field of anesthesia.

Tramadol, is a central acting analgesic that possesses weak affinity for the -opioid receptor and modifies transmission of nociceptive impulses through inhibition of monoamine reuptake. This study was designed to determine the effect of tramadol on blood glucose levels and also to investigate whether or not alpha-2 adrenergic receptors were responsible for this effect. A significant rise in blood glucose levels was observed following administration of i.v. tramadol. Pre-treatment with both yohimbine and idazoxan (1 mg.kg-1) significantly attenuated tramadol-induced hyperglycemia. The results of the study indicate that, tramadol administered at an analgesic dose of 1 mg.kg-1 produces hyperglycemia in diethyl ether anesthetized rats. Reversal of this effect with 2-adrenoceptor blocking agents suggests that monoaminergic pathways which contribute to the analgesic action of tramadol may have a role in the hyperglycemic action of the drug.

The novel index of right ventricle isovolumic acceleration (IVA) at cardiac operation was investigated. Several indexes – TAPSE, DTI, MPI, IVA RVFAC using transesophageal echocardiography (TEE) were measured before starting CPB. Also it was evaluated the right ventricle function seeing directly. In the result we confirm that IVA is a good index of right ventricle function.

El Akri Abdelhafid has completed his PhD in medicine at the age of 26 from Hassan II University and started his residency in surgery at CHU IBN ROCH University School of Medicine Morocco in 2009. He is currently preparing a PhD in Medico-legal expertise in surgery from Montreal University Canada after getting a DESS and a Master in Medico-legal expertise in surgery from Montreal University. He has published more than 24 research papers in several reputed journals.

Uterine leiomyoma is the most common tumor in women of reproductive age, but rarely does it lead to fatal hemoperitoneum. An autopsy case in which the cause of death was massive hemoperitoneum due to rupture of a subserosal vein overlying a uterine leiomyoma will be presented. We report the case of a 34-year-old Quebecois woman who had tuberous sclerosis and was gravida 0, para 0. She had a uterine leiomyoma leading to dysmenorrhea. Autopsy revealed a pinhole-sized rupture of a subserosal vein superficial to the leiomyoma that resulted in fatal hemoperitoneum. Rupture of a subserosal vein overlying a uterine leiomyoma may cause sudden and unexpected death.

K V Shivanand Reddy has completed M.B.B.S at the age of 23 years from Rajiv Gandhi University,Bangalore and doing his residency in General Surgery from JSS Medical College ,Mysore. He has published more than 10 papers in reputed journals.

Rapunzels syndrome is a rare presentation of trichobezoar with extension of hair into small bowel. Trichobezoar is a tuft of undigested hair mass commonly found in young females with the psychiatric disorders. Rapunzels syndrome is a rare condition and occurs when gastric trichobezoar extends beyond the pylorus into the small bowel. 28 Cases have been reported in English literature till 2012 the diagnosis of trichobezoar may be difficult due to non specific presentation. We present a case in a 6 year old child who came with history of pain abdomen and features of intermittent gastric outlet obstruction. She was successfully managed by laparotomy which revealed trichobezoar with a tail measuring 48cm in length extending till the proximal ileum. The Child also had transient jejuno-jejunal intussusception.

Mohammad Ghazizadeh has completed his MD in 1975 and Residency in Urologic surgery in 1980. In 1984, he has received his Doctor of Medical Sciences from the University of Tokushima School of Medicine, Japan. He is an Associate Professor and Chief at the Department of Molecular Pathology, Institute of Gerontology and Nippon Medical School, Japan. He has served as the Director of the Central Institute for Electron Microscopy Research at Nippon Medical School, Tokyo, Japan. He has published more than 100 papers in reputed journals. He is Editor-in-Chief of the American Journal of Experimental and Clinical Research and has also served as an Editorial Board Member of the Journal of Nippon Medical School, The Open Dermatology Journal, World Journal of Dermatology, and formerly Journal of Submicroscopic Cytology and Cytopathology.

Wingless type (Wnt) signaling pathways play key roles in various cellular functions including proliferation, differentiation, survival, apoptosis and migration. We studied the role of Wnt signaling pathway in keloid pathogenesis. Primary fibroblast cultures and tissue samples from keloid (KF) and normal appearing dermis (NF) were used. The expression and function of Wnt5a, frizzled4 receptor, ROR2 and the Wnt signaling downstream targets, GSK) 3-beta and beta-catenin were assessed using semi-quantitative RT-PCR, Western blot, or immunohistochemical methods. We found a higher expression of beta-catenin in KF compared to NF. No detectable levels of FZD4 receptor and ROR2 proteins were observed in both NF and KF. Functional analysis showed that treatment of NF and KF with recombinant Wnt5a peptide resulted in an increase in protein levels of total beta-catenin and phosphorylated beta-catenin at Ser33/37/Thr41 but no significant change in phosphorylated beta-catenin at Ser45/Thr41 positions. In addition, the expression of total GSK3-betaprotein was not affected, but its phosphorylated/inactivated form was increased in NF and KF. Inhibition of Wnt5a by specific anti-Wnt5a antibody reversed these effects. Taken together, these findings highlight a potential role for a Wnt/beta-catenin pathway triggered by Wnt5a in keloid pathogenisis. Wnt5a/beta-catenin signaling pathway may provide a new molecular target for developing therapeutic strategies for keloid.

El Akri Abdelhafid has completed his PhD in medicine at the age of 26 from Hassan II University and started his residency in surgery at CHU IBN ROCH University School of Medicine Morocco in 2009. He is currently preparing a PhD in Medico-legal expertise in surgery from Montreal University Canada after getting a DESS and a Master in Medico-legal expertise in surgery from Montreal University. He has published more than 24 research papers in several reputed journals.

Pregnancy-related death is defined by the International Classification of Diseases, Tenth Revision (ICD-10) as the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death. In the year 2000, a collaborative effort involving World Health Organization (WHO), UNICEF, and UNFPA estimated 230 maternal deaths in Canada. This averages 19 maternal deaths per 100,000 live births reported. Many pregnancy-associated deaths are not easily identified as such since the presence of a recent or current pregnancy may not be listed on the death certificate. Thus, the WHO estimates that in Canada, the maternal mortality is approximately 18/100,000 pregnancies. This is significantly higher than the goal set by the Canadian Department of Health and Human Services in Healthy People 2008, which sets the target for maternal mortality at less than 3.6/100,000 live births. The most common causes of maternal death vary somewhat from region to region in Canada. They include pulmonary thromboembolism, amniotic fluid embolism, primary postpartum uterine hemorrhage, infection, and complications of hypertension including preeclampsia and eclampsia. Pulmonary disease, complications of anesthesia, and cardiomyopathy also are significant contributors to maternal mortality in some populations. The death of a pregnant or recently pregnant individual poses a wide scope of challenges to the forensic pathologist and investigator. The pathologist must have a broad knowledge of the physiologic and biochemical changes that occur during pregnancy, as well as the clinical and pathological manifestation of these changes. Conditions that may be “benign” in the nonpregnant individual may be lethal in the puerperal period. In addition, it should be kept in mind that deaths during pregnancy may be due to unnatural causes. Accident, homicide, and suicide must be ruled out in each case. The authors reviewed all forensic cases referred for autopsy to the Forensic Section of the Medical University of Montreal from January 2000 through December 2010. All decedents listed as pregnant or postpartum were analyzed as to maternal age, race, past medical history, previous pregnancies and outcome, prenatal care, gestational age, fetal or neonatal outcome, location of delivery, placental findings, maternal autopsy findings, toxicology, cause of death, manner of death, and fetal or neonatal autopsy findings. The authors present this retrospective study to better determine the factors leading to maternal demise and discuss the autopsy/ancillary techniques useful in determining the cause of death in this challenging area.

Sariya Mohammadi completed her MBBS from KMC, Mangalore under Manipal University in 2013 and now pursuing her masters in general surgery in JSS University, Mysore. She was selected for ICMR STS in 2009 and have a publication titled ‘streptococcus pseudopneumoniae: an emerging respiratory tract pathogen’ in the Indian Journal of Medical Research Nov 2012. She is interested in research work and would like to continue it and wish to publish more articles in the future.

INTRODUCTION: A lymphangioma is a benign proliferation of lymph vessels, producing fluid filled cysts that result from the blockage of lymphatic system. The incidence of abdominal lymphangiomas is unknown, however they account for 3-9.2% of all pediatric lymphangiomas, with retroperitoneal lymphangioma accounting for less than 1% of abdominal lymphangiomas. These tumors are usually asymptomatic until they are large enough to cause obstructive symptoms & due to their rarity, are difficult to diagnose.
AIMS & OBJECTIVES:
1) Lymphangiomas are usually developmental aberrations, this case is an adult presentation
2) The presentation was due to compression of nerve causing radiculopathy along with lymphatic obstruction causing lower limb edema
3) This case is presented due to the rarity of the disease and the peculiarity of the symptoms

MATERIALS & METHODS: A 45 yr old lady presented with h/o edema of the entire left lower limb since 3 mnths & h/o pain in the limb radiating to the knee since 1mnth. On clinical examination, she was afebrile and hemodynamically stable. Per abdomen examination revealed a solitary mass in the left iliac fossa, soft in consistency with superior and lateral borders well made out, non-tender. Left lower limb pitting edema with blanching seen. Lower limb venous Doppler showed normal venous system. CT abdomen & pelvis revealed a solitary cystic lesion in the retroperitoneum, dilated lymphatic vessels in the para-aortic area & multiple lymphangiomatosis in the lungs. Hence, a diagnosis of a retroperitoneal lymphangioma was made & complete surgical excision of the cyst was done. Post-operative period was uneventful & histopathology reported as
CONCLUSION: Retroperitoneal lymphangioma is a rare entity & its identification is important as it can lead to consequences like intestinal obstruction, ureteric compression and complications of neurovascular bundle compression. In any case of limb edema due to DVT or lymphatic obstruction, an attempt should be made to investigate into the etiology and the cause should be treated. In this case, CT scan played an important role in the diagnosis of the disease and surgical excision is the primary mode of treatment.

Wosenyeleh Admasu completed his anesthesia B.Sc. education in 2008 at the age 22 and M.Sc. in 2012 in Gondar University with honors with CGPA of 3.57. He served as the head of anesthesia department in Gondar University for a year before co-developing a curriculum for M.Sc. in anesthesia (the first for the country) and now being run by Leicester Gondar link. He has worked as a lecturer in Gondar University and also now in Addis Ababa university school of anesthesia. He has also been working clinically for 5 years in Gondar university hospital.

Despite advances in medical science there are a large proportion of patients suffering from moderate to severe post surgical painaround the world with several perioperative and preclinical factors contributing to the outcome. Currently there isn’t any evidence that shows how severe the problem is and also what the different perioperative, patient factors are in Ethiopia. We conducted hospital based cross sectional prospective study on 300 patients above the age of 12 selecting them with simple random sampling, and collecting the data via questionnaire and chart review. Numeric rating scale was used to assess pain severity and logistic regression to identify independent risk factors for post operative pain. Moderate to severe pain was reported in 171 (57%) of patients in the immediate post operative period and 234 (78%) in the 1st 12 hours. On multivariate analysis ASA I,II OR (2.7) P=(0.013), age less than 60 OR (2.642) P=(0.042), female gender with an OR (2.580) P=(0.005), general anesthesia OR (3.6) P=(0.000) , type of surgery (Intra-abdominal OR (2.179) P=(0.025)) and incision length >10 cm OR (1.991) P=(0.041) were identified as independent risk factors for post operative pain severity. The formation of effective postoperative pain management programs and protocols which encompass both preventing the risk factors and treating the outcome would be helpful.