This study highlights the use of levobupivacaine as a substitute for lignocaine in the treatment of two patients with documented adverse reactions to lignocaine. Lignocaine, the most widely used local anesthetic, can trigger allergies and other adverse effects.Allergic reactions can be mild, ranging from urticaria, erythema, and pruritus, to severe reactions in the form of angioedema and bronchospasm. In patients with a documented allergy to lignocaine, options for analgesia during nonsurgical rejuvenation include other amide-based local anesthesia, light sedation, or general anesthesia. Two patients with documented allergies to lignocaine underwent nonsurgical rejuvenation with levobupivacaine as the local anesthetic and reconstitution agent for Ellanse M. Levobupivacaine, chosen for its lower central nervous system and cardiovascular toxicity compared to those of racemic bupivacaine, has dual functions: local anesthesia and reconstitution of Ellanse. Ellanse is a collagen stimulator composed of polycaprolactone microspheres embedded in carboxymethylcellulose (CMC) gel distributed by Sinclair Pharmaceutical. It produces a natural aesthetic result through collagen stimulation. The 2 patients tolerated levobupivacaine as the choice of local anesthesia, with no adverse events. The reconstituted Ellanse was treated using a 27 G needle as well as a 25 G 50 mm cannula. The extrusion force was uniform and no needle or cannula jams were found. During 1-month assessment, the injected Ellanse volume decreased owing to resorption of the CMC gel, and during 3-month assessment, neocollagenesis was observed. Levobupivacaine is a suitable alternative to lignocaine as it enables patients with lignocaine allergies to undergo nonsurgical facial rejuvenation with Ellanse. Levobupivacaine offers comparable efficacy and safety profiles, making it a valuable option for anesthesia and reconstitution in such cases.Level of Evidence: Level V (Case Series)

Clinical Trials as Topic ; Humans ; Information Dissemination ; ethics ; methods ; International Cooperation

INTRODUCTION: Psychiatric comorbidity is common in patients with functional dyspepsia (FD) but a good screening tool for psychiatric disorders in gastrointestinal clinical practice is lacking. Aims: 1) Evaluate the performance and optimal cut-off of 12-item General Health Questionnaire (GHQ-12) as a screening tool for psychiatric disorders in FD patients; 2) Compare health-related quality of life (HRQoL) in FD patients with and without psychiatric comorbidities. METHODS: Consecutive patients fulfilling Rome III criteria for FD without medical co-morbidities and gastroesophageal reflux disease were recruited in a gastroenterology clinic. The followings were conducted at 4 weeks after index oesophagogastroduodenoscopy: self-administrated questionnaires on socio-demographics, dyspeptic symptom severity (4-point Likert scale), GHQ-12, and 36-item short-form health survey (SF-36). Psychiatric disorders were diagnosed with Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) by a trained psychiatrist, which served as reference standard. RESULTS: 55 patients underwent psychiatrist-conducted interview and questionnaire assessment. 27 (49.1%) had current psychiatric disorders as determined by SCID (anxiety disorders: 38.2%, depressive disorders: 16.4%). Receiver operating characteristic curve analysis of GHQ-12 revealed an area under curve of 0.825 (95%CI: 0.698-0.914). Cut-off of GHQ-12 at > or =3 gave a sensitivity of 63.0% (95%CI = 42.4-80.6%) and specificity of 92.9% (95%CI = 76.5%-98.9%). Subjects with co-existing psychiatric disorders scored significantly lower in multiple domains of SF-36 (mental component summary, general health, vitality and mental health). By multivariate linear regression analysis, current psychiatric morbidities (Beta = -0.396, p = 0.002) and family history of psychiatric illness (Beta = -0.299, p = 0.015) were independent risk factors for poorer mental component summary in SF-36, while dyspepsia severity was the only independent risk factor for poorer physical component summary (Beta = -0.332, p = 0.027). CONCLUSIONS: Concomitant psychiatric disorders adversely affect HRQoL in FD patients. The use of GHQ-12 as a reliable screening tool for psychiatric disorders allows early intervention and may improve clinical outcomes of these patients.
Area Under Curve ; Axis, Cervical Vertebra ; Comorbidity ; Diagnostic and Statistical Manual of Mental Disorders ; Dyspepsia ; Early Intervention (Education) ; Gastroenterology ; Gastroesophageal Reflux ; Health Surveys ; Humans ; Linear Models ; Mass Screening ; Mental Disorders ; Psychiatry ; Quality of Life ; Surveys and Questionnaires ; Risk Factors ; ROC Curve ; Rome ; Sensitivity and Specificity

No abstract available.
Comorbidity ; Humans