Purpose of review: MRI is becoming an indispensable diagnostic tool. The need for prolonged motion-free periods has substantially increased the need for deep sedation or anesthesia in a challenging environment. This review summarises recent literature with respect to pharmacological sedative strategies, nonpharmacological alternative approaches, airway management and safety issues in the ambulatory setting. Recent findings: Most literature researches the pediatric patient population. The American Society of Pediatrics published guidelines for monitoring and management of pediatric patients during sedation for diagnostic procedures. Dexmedetomidine is the most researched agent for sedation. It remains uncertain what the clinical implications are of the potential neurotoxicity of repeat sedation or anesthesia in young children. Airway strategies highlight the use of end-tidal carbon dioxide monitoring. Technical imaging advancement and nonpharmacological sedation alternatives allow for shorter procedures with a lower need for sedation. Summary: The anesthetic management of ambulatory patients in the MRI environment has its specific challenges and safety issues. However, the implementation of safety guidelines, new pharmacological and alternative nonpharmacological sedation strategies offer interesting perspectives to tackle these challenges. Copyright (C) 2017 YEAR Wolters Kluwer Health, Inc. All rights reserved.
http://ift.tt/2w7aQMA
Πέμπτη 17 Αυγούστου 2017
Super pulse CO2 laser therapy for benign eyelid tumors
Summary
Background
Benign eyelid tumors occur commonly in daily outpatient services.
Objectives
The aim of this study was to evaluate the treatment of benign eyelid lesions with a super pulse CO2 laser as an alternative to surgical excision.
Methods
This retrospective clinical study included 80 patients with 99 benign eyelid lesions treated with super pulse CO2 laser photocoagulation. The following areas were involved: the upper eyelid in 38 cases, the lower eyelid in 39 cases, and the angulus oculi in seven cases (the eyelid margin was included in 18 cases). The laser spot size ranged from 120 to 200 μm and the super pulse CO2 laser power density varied between 0.6 and 21.1 W/mm2. The mean follow-up period was 14.0±7.1 months (range five to 30). Histological diagnoses were obtained in 62 of the 80 patients.
Results
The cosmetic outcomes of all of the patients were satisfactory after treatment, and the wounds formed dry scabs, with no infections. They were epithelialized within 2-4 weeks with normal-appearing epithelium. Temporarily, the treated area had less hyperpigmentation than the surrounding normal skin, showing no obvious scars or notches. No complications were observed, with no relapses during the follow-up.
Conclusions
The super pulse CO2 laser therapy of the benign eyelid tumors provided satisfactory cosmetic results in this study. It is a convenient, cheap, accessible, and well-tolerated alternative to traditional surgery, especially for diffuse tumors, or those positioned close to the lacrimal papillae.
http://ift.tt/2w7A7q9
Myricetin protects keratinocyte damage induced by UV through IκB/NFκb signaling pathway
Summary
Objective
The aim of this study was to evaluate the potential molecular mechanism of myricetin that protecting cells from photodamage.
Methods
Myricetin had broadly chemopreventive effects and anti-inflammatory properties. The effect of myricetin was assessed on HaCaT cells. Cell viability assay was carried out. Reactive oxygen species (ROS) level was measured. The expression of pro-inflammatory factor COX2 was determined by real-time PCR and Western blot. The protein levels of p-IκBa and IκBa were determined by Western blot.
Results
Myricetin attenuated UV-induced keratinocyte death in a dose-dependent manner as determined by cell viability assay. Pretreatment with myricetin also reduced the UV-induced ROS levels. Myricetin suppresses the upregulation of COX2 induced by UV in keratinocyte as demonstrated by real-time PCR and Western blot. Furthermore, signal transduction studies confirmed that myricetin attenuates the upregulation of COX2 induced by UV via suppression of IκB/NFκB pathways.
Conclusion
These results showed that antioxidant property of myricetin can effectively attenuate UV-caused cell damage and suppress the expression of COX2 through the IκB/NFκB signaling pathways. Myricetin had potential protective effects on UV-induced skin cell damages, which might be used in cosmetic and pharmaceutical industries.
http://ift.tt/2vNIX9P
Nationwide skin cancer screening in Germany: Evaluation of the training program
Abstract
Background
In July 2008, the German statutory health insurance introduced a nationwide skin cancer screening program. Before the introduction, eligible physicians had to qualify to perform the screening test and counsel their patients on skin cancer screening. To educate physicians, a curriculum and training materials were developed. Since 2015 a revised curriculum and training materials have been used. The purpose of this paper is to provide information about the curriculum and to evaluate the revised training program.
Methods
A total of 573 completed pre- and posttests were analyzed with regard to changes in the identification of skin cancer, diagnostic accuracy, knowledge, and physicians' self-assessed-confidence. For statistical analysis, Mann-Whitney U test, Cohen's d, and chi-square test were used.
Results
General practitioners (GPs) diagnosed 7.45 of 12 skin lesions correctly before and 9.26 after the training course (P < 0.001). Compared to GPs, dermatologists' accuracy was higher at pre- and posttest (pre: 10.03, post: 10.21, P = 0.160).
The mean of correctly answered questions increased significantly in knowledge on screening and early detection (4.46–5.14, P < 0.001) as well as skin cancer and skin cancer screening (5.51–6.39, P < 0.001).
Conclusion
Participating physicians got a comprehensive understanding of skin cancer screening and counseling through the training and increased their diagnostic skills. In particular, GPs identified and diagnosed significantly more skin lesions correctly after the training compared to before the training, while dermatologists' diagnostic skills were high at both times, before and after.
http://ift.tt/2v6MrCE
Effect of Maternal Antibody Transfer on Antibody Dynamics and Control of Porcine Circovirus Type 2 Infection in Offspring
Viral Immunology , Vol. 0, No. 0.
http://ift.tt/2vIVpJS
Nanomechanical Assessment of Bone Surrounding Implants Loaded for 3 Years in a Canine Experimental Model.
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Rodolfo B. Anchieta, Márcia V.M. Guimarães, Marcelo Suzuki, Nick Tovar, Estevam A. Bonfante, Pablo Atria, Paulo G. Coelho
PurposeThis work evaluated bone nanomechanical properties around submerged and immediately loaded implants after 3 years in vivo. It was hypothesized that bone nanomechanical properties would significantly increase in immediately and functionally loaded implants compared to submerged.MethodsThe second, third, and fourth right premolars and the first molar of ten adult Doberman dogs were extracted. After six months, four implants were placed in one side of the mandible. The mesial implant received a cover screw and remained unloaded. The remaining three implants received fixed prostheses within 48 hours after surgery which remained in occlusal function for three years. After sacrifice, the bone was prepared for histological and nanoindentation analysis. Nanoindentation was carried out under wet conditions on bone areas within the plateaus. Indentations (n=30 per histological slide) were performed with a maximum load of 300 μN (loading rate: 60 μN/s) followed by a holding and unloading time of 10s and 2s, respectively. Elastic modulus (E) and hardness (H) were computed in GigaPascal (GPa). The amount of bone-to-implant contact (BIC) was also evaluated.ResultsThe E and H values for cortical bone regions were higher than trabecular bone regardless of load condition, but not statistically significant (p>.05). The E and H values were higher for loaded implants than submerged (p<.05), for cortical and trabecular bone. For the same load condition, the E and H values for cortical and trabecular bone were not statistically different (p>.05). The loaded and submerged implants presented (mean ± SD) 57.4 ± 12.1 % and 62 ±7.5% BIC (p>.05).ConclusionThe elastic modulus and hardness of bone around dental implants, measured by nanoindentation, were higher for immediately loaded compared to submerged implants.
http://ift.tt/2icnsfE
The use of antibiotics in odontogenic infections: what is the best choice? A systematic review
Source:Journal of Oral and Maxillofacial Surgery
Author(s): João Roig Martins, Otacílio Luiz Chagas Júnior, Bibiana Dalsasso Velasques, Ângelo Niemczewski Bobrowski, Marcos Britto Correa, Marcos Antonio Torriani
PurposeOdontogenic infections are a common problem in dentistry and their treatment often requires the use of antibiotics besides the removal of the source of infection, which frequently makes it more difficult for clinicians to take a decision regarding the choice of antibiotic. This study aimed to answer the following questions through the PICO format: When should antibiotics be used in dental infections (DIs), which are the most effective drugs and for how long should they be administered?MethodsThis was a systematic review using PubMed, Scopus and Cochrane databases without restriction as to the period of time researched. The variables analyzed in each studied article were number of odontogenic infections in each study, type of study, surgical intervention performed, antibiotic administered, statistical differences between groups studied and patient's evolution after treatment.ResultsThe search included 1109 articles. After the full reading of 46 articles, 16 of them were included in the final review and 30 were excluded. A sample of 2197 dental infection cases was obtained, in which 15 different antibiotics were used, with a 98.2 % overall cure rate.ConclusionThe studies showed that antibiotics were prescribed only in situations of regional and / or systemic body manifestations. In the case of dental infections, once drainage has been performed and / or the cause of infection has been removed, all antibiotics tested are equally effective with respect to clinical cure, and the choice of antibiotics is not as successful as the local intervention treatment procedure. When a real need of antibiotic therapy is detected, antibiotics should be used for the shortest time possible until the patient's clinical cure is achieved.
http://ift.tt/2fR3giH
Mandibular coronoidectomy could significantly accelerate the healing process of infratemporal fossa abscess
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Yi-Wen Liu, Krishna Prasad Regmi, Ming-Chao Ding, Yan Li, Lei Tian, Bo-Lei Cai
PurposeThe management of an infratemporal fossa abscess (IFA), which is a specific form of severe and advanced deep fascial space infections (DFIs), is mainly based on the traditional methods. The purpose of this study is to investigate the role of mandibular coronoidectomy in accelerating IFA healing.MethodsThis research is a single center retrospective study which composed of 23 IFA patients. The predictor variables were sex, age, diabetes, severity score and mandibular coronoidectomy. The outcome variables included hospitalization time (HT), and irrigating time (IT). A compare of treatment outcomes between the improved and the traditional surgical intervention of IFA was performed.ResultsCompared to patients in NC group (who did not receive mandibular coronoidectomy; HT/IT=17.54±1.80 / 38.54±3.73 days), our results showed that patients in AC group (who accepted mandibular coronoidectomy) had significantly decreased HT/IT (7.20±1.19 / 15.10±1.27 days; P<0.01). We also found 4 (31%) patients in NC group received reoperation for osteomyelitis, but no osteomyelitis and DFIs recurrence happened to patients in AC group.ConclusionsMandibular coronoidectomy with extra intraoral drainage could significantly accelerate the healing process of IFA patients and obviously decrease the reoperation rate for osteomyelitis.
http://ift.tt/2icmTT4
Effect of piezoelectric sutural ostectomies on accelerated bone-borne sutural expansion
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Akram S. Alyessary, Adrian U.J. Yap, Siti Adibah Othman, Mohammad T. Rahman, Zamri Radzi
PurposeThis study investigated the effect of piezoelectric sutural ostectomies on accelerated bone-borne sutural expansion.MethodsSixteen male New Zealand white rabbits (20-24 weeks old) were randomly divided into the following four experimental groups (n=4): group 1, conventional rapid sutural expansion; group 2, accelerated sutural expansion; group 3, accelerated sutural expansion with continuous ostectomy; and group 4, accelerated sutural expansion with discontinuous ostectomy. All sutural ostectomies were performed using a piezoelectric instrument (Woodpecker DTE, DS-II., Guangxi, China) prior to expander application under anesthesia. Modified hyrax expanders were placed across the midsagittal sutures of the rabbits and secured with miniscrew implants located bilaterally in the frontal bone. The hyrax expanders were activated 0.5 mm/day for 12 days (group 1) or 2.5 mm initial expansion followed by 0.5 mm/day for 7 days (groups 2 to 4). After 6 weeks of retention, bone volume fraction, sutural separation and new bone formation were evaluated using micro-computed tomography and histomorphometry. Statistical analysis was performed using Kruskal-Wallis / Mann-Whitney U tests and Spearman's rho correlation (p<0.05).ResultsRanking of median sutural separation was as follows: group 1 (3.05 mm), group 2 (3.97 mm), group 4 (4.78 mm) and group 3 (5.66 mm). The least and most bone formation were observed with groups 1 (63.63%) and 3 (75.93%), respectively. Spearman's correlation showed strong, positive and significant correlation (r= 0.932, p<0.01) between the new sutural bone formation and amount of sutural separation.ConclusionPiezoelectric sutural ostectomies increase the rate of sutural separation and promotes new sutural bone formation / osteogenesis. Continuous ostectomy gave better results than discontinuous ostectomy.
http://ift.tt/2fQgyw4
Closed approach for horizontal augmentation of the maxilla
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Michael S. Block
The narrow ridge in the anterior maxilla often requires horizontal augmentation for ideal implant placement. This article reviews the historical use of a closed, tunnel approach to augment deficient alveolar ridges and describes its application for augmentation of the narrow ridge in the anterior maxilla. The use of a tunnel approach through a vertical incision in the unattached mucosa provides access to the ridge while maintaining crestal attachments without displacement of the crestal attached gingiva. This approach is atraumatic and provides excellent access for placement of graft material for ridge augmentation.
http://ift.tt/2fQhuAw
Effect of application sequence of fluoride and CPP-ACP on remineralization of white spot lesions in primary teeth: An in-vitro study
Source:Archives of Oral Biology, Volume 83
Author(s): Ola B. Al-Batayneh, Reem A. Jbarat, Susan N. Al-Khateeb
ObjectiveTo explore how application sequence of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride influences remineralization of enamel white spot lesions (WSL) in primary teeth.DesignIn this in-vitro study, artificial WSLs were created in 130 primary teeth. Teeth were divided into 4 groups (n=27) and a control group (n=22) and exposed to one of the following remineralization regimens for 10 weeks: Group-1; 500ppm fluoride dentifrice; Group-2; 10% w/v CPP-ACP; Group-3; fluoride applied first, then CPP-ACP; Group-4; CPP-ACP applied first, then fluoride, and Group-5 was control. All groups were kept in a remineralizing solution. Mineral changes (ΔF) were quantified weekly using quantitative light-induced fluorescence. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS version 20.0).ResultsRemineralization occurred in all groups to different degrees; changes from baseline were significant in groups 1–4 (P≤0.05). Group-4 showed the earliest significant remineralization (after 2 weeks) among groups, (P<0.001). Group-4 showed maximum changes in ΔF among groups; however, only differences with Groups 1 and 5 were significant (P<0.05 and P<0.01, respectively). Group-3 showed better remineralization than Groups 1, 2 and 5; however, the difference was only significant with Group-5 (P<0.001). There were no significant differences between Group 1and 2, however, only Group 2 showed better remineralization than Group 5, (P<0.01).ConclusionCombined treatment with CPP-ACP followed by fluoride exhibited the best remineralization of white spot lesions in primary teeth in this study. Combined treatment with fluoride followed by CPP-ACP showed a tendency towards better remineralization than fluoride or CPP-ACP alone.
http://ift.tt/2icks2S
Amelogenin induces M2 macrophage polarisation via PGE2/cAMP signalling pathway
Source:Archives of Oral Biology, Volume 83
Author(s): Kensuke Yamamichi, Takao Fukuda, Terukazu Sanui, Kyosuke Toyoda, Urara Tanaka, Yuki Nakao, Karen Yotsumoto, Hiroaki Yamato, Takaharu Taketomi, Takeshi Uchiumi, Fusanori Nishimura
ObjectivesAmelogenin, the major component of the enamel matrix derivative (EMD), has been suggested as a bioactive candidate for periodontal regeneration. Apart from producing a regenerative effect on periodontal tissues, amelogenin has also been reported to have an anti-inflammatory effect. However, the precise molecular mechanisms underlying these effects remain unclear. In the present study, we examined the immunomodulatory effects of amelogenin on macrophages.DesignHuman phorbol 12-myristate 13-acetate (PMA)-differentiated U937 macrophages and CD14+ peripheral blood-derived monocytes (PBMC)-derived macrophages were stimulated with recombinant amelogenin (rM180). After performing a detailed microarray analysis, the effects of rM180 on macrophage phenotype and signal transduction pathways were evaluated by real-time polymerase chain reaction, enzyme-linked immunosorbent assay, confocal microscopy and flow cytometry.ResultsThe microarray analysis demonstrated that rM180 increased the expression of anti-inflammatory genes in lipopolysaccharide (LPS)-challenged macrophages after 24h, while it temporarily up-regulated inflammatory responses at 4h. rM180 significantly enhanced the expression of M2 macrophage markers (CD163 and CD206). rM180-induced M2 macrophage polarisation was associated with morphological changes as well as vascular endothelial growth factor (VEGF) production. rM180 enhanced prostaglandin E2 (PGE2) expression, and the activation of the cAMP/cAMP-responsive element binding (CREB) signaling pathway was involved in amelogenin-induced M2 macrophage polarisation. Blocking of PGE2 signaling by indomethacin specifically abrogated rM180 with or without LPS-induced M2 shift in PBMC-derived macrophages.ConclusionAmelogenin could reprogram macrophages into the anti-inflammatory M2 phenotype. It could therefore contribute to the early resolution of inflammation in periodontal lesions and provide a suitable environment for remodeling-periodontal tissues.
http://ift.tt/2wfEYWM
Effect of application sequence of fluoride and CPP-ACP on remineralization of white spot lesions in primary teeth: An in-vitro study
Source:Archives of Oral Biology, Volume 83
Author(s): Ola B. Al-Batayneh, Reem A. Jbarat, Susan N. Al-Khateeb
ObjectiveTo explore how application sequence of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) and fluoride influences remineralization of enamel white spot lesions (WSL) in primary teeth.DesignIn this in-vitro study, artificial WSLs were created in 130 primary teeth. Teeth were divided into 4 groups (n=27) and a control group (n=22) and exposed to one of the following remineralization regimens for 10 weeks: Group-1; 500ppm fluoride dentifrice; Group-2; 10% w/v CPP-ACP; Group-3; fluoride applied first, then CPP-ACP; Group-4; CPP-ACP applied first, then fluoride, and Group-5 was control. All groups were kept in a remineralizing solution. Mineral changes (ΔF) were quantified weekly using quantitative light-induced fluorescence. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS version 20.0).ResultsRemineralization occurred in all groups to different degrees; changes from baseline were significant in groups 1–4 (P≤0.05). Group-4 showed the earliest significant remineralization (after 2 weeks) among groups, (P<0.001). Group-4 showed maximum changes in ΔF among groups; however, only differences with Groups 1 and 5 were significant (P<0.05 and P<0.01, respectively). Group-3 showed better remineralization than Groups 1, 2 and 5; however, the difference was only significant with Group-5 (P<0.001). There were no significant differences between Group 1and 2, however, only Group 2 showed better remineralization than Group 5, (P<0.01).ConclusionCombined treatment with CPP-ACP followed by fluoride exhibited the best remineralization of white spot lesions in primary teeth in this study. Combined treatment with fluoride followed by CPP-ACP showed a tendency towards better remineralization than fluoride or CPP-ACP alone.
http://ift.tt/2icks2S
Amelogenin induces M2 macrophage polarisation via PGE2/cAMP signalling pathway
Source:Archives of Oral Biology, Volume 83
Author(s): Kensuke Yamamichi, Takao Fukuda, Terukazu Sanui, Kyosuke Toyoda, Urara Tanaka, Yuki Nakao, Karen Yotsumoto, Hiroaki Yamato, Takaharu Taketomi, Takeshi Uchiumi, Fusanori Nishimura
ObjectivesAmelogenin, the major component of the enamel matrix derivative (EMD), has been suggested as a bioactive candidate for periodontal regeneration. Apart from producing a regenerative effect on periodontal tissues, amelogenin has also been reported to have an anti-inflammatory effect. However, the precise molecular mechanisms underlying these effects remain unclear. In the present study, we examined the immunomodulatory effects of amelogenin on macrophages.DesignHuman phorbol 12-myristate 13-acetate (PMA)-differentiated U937 macrophages and CD14+ peripheral blood-derived monocytes (PBMC)-derived macrophages were stimulated with recombinant amelogenin (rM180). After performing a detailed microarray analysis, the effects of rM180 on macrophage phenotype and signal transduction pathways were evaluated by real-time polymerase chain reaction, enzyme-linked immunosorbent assay, confocal microscopy and flow cytometry.ResultsThe microarray analysis demonstrated that rM180 increased the expression of anti-inflammatory genes in lipopolysaccharide (LPS)-challenged macrophages after 24h, while it temporarily up-regulated inflammatory responses at 4h. rM180 significantly enhanced the expression of M2 macrophage markers (CD163 and CD206). rM180-induced M2 macrophage polarisation was associated with morphological changes as well as vascular endothelial growth factor (VEGF) production. rM180 enhanced prostaglandin E2 (PGE2) expression, and the activation of the cAMP/cAMP-responsive element binding (CREB) signaling pathway was involved in amelogenin-induced M2 macrophage polarisation. Blocking of PGE2 signaling by indomethacin specifically abrogated rM180 with or without LPS-induced M2 shift in PBMC-derived macrophages.ConclusionAmelogenin could reprogram macrophages into the anti-inflammatory M2 phenotype. It could therefore contribute to the early resolution of inflammation in periodontal lesions and provide a suitable environment for remodeling-periodontal tissues.
http://ift.tt/2wfEYWM
Omalizumab for hypersensitive reaction to seminal plasma: A case report
Publication date: Available online 15 August 2017
Source:Allergology International
Author(s): Maria Teresa Burguete-Cabanas, Oscar R. Fajardo-Ramirez, Roberta Yesaki, Raul Estrada-Maganas, Sandra Salazar-Meza, Olga Rios-Chavez, Irene Meester, Julio C. Salas-Alanis
http://ift.tt/2iabzqL
Necrotic mucosal CD30-positive ulcer on the oral mucosa: a self-healing lymphoma
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Molinari, I.S. Prabhu
http://ift.tt/2w786Px
Trapezoidal mandibular osteotomy for augmentation of the airway in sleep apnoea
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J.T. Carneiro, E.L. de Souza Cruz, A.K. da Silva Tabosa, P.H. de Moraes
http://ift.tt/2vNJTv5
Use of buccal cortex as interpositional graft in mandibular setbacks
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Ross Elledge, Rohit Chandegra, Peter Stockton
http://ift.tt/2iaxEp7
Postoperative complications after head and neck operations that require free tissue transfer- prevalence, morbidity, and cost
Publication date: Available online 12 August 2017
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): J. McMahon, T.P.B. Handley, A. Bobinskas, M. Elsapagh, H.S. Anwar, P.V. Ricciardo, A. McLaren, R. Davis, N. Syyed, C. MacIver, C. Wales, W.S. Hislop, E. Thomson, S. Thomson, K. Fitzpatrick, A. Rae, R. Campbell
To understand and reduce the impact of postoperative complications, we studied 568 patients who had had operations over 72 months in our hospital. Multivariate analysis indicated that factors indicative of coexisting conditions (including activated systemic inflammation) and the complexity of the operation are primary determinants of postoperative complications. The enhanced recovery after surgery (ERAS) care pathway did not have an effect on their occurrence or severity. Systematic study of patients' toleration of major head and neck operations is required, as optimal perioperative care pathways remain elusive.
http://ift.tt/2fQdHDb
Association of STOP-Bang Questionnaire as a Screening Tool for Sleep Apnea and Postoperative Complications: A Systematic Review and Bayesian Meta-analysis of Prospective and Retrospective Cohort Studies.
BACKGROUND: The risk of postoperative complications increases with undiagnosed obstructive sleep apnea (OSA). The high-risk OSA (HR-OSA) patients can be easily identified using the STOP-Bang screening tool. The aim of this systematic review and meta-analysis is to determine the association of postoperative complications in patients screened as HR-OSA versus low-risk OSA (LR-OSA). METHODS: The following data bases were searched from January 1, 2008, to October 31, 2016, to identify the eligible articles: Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Cochrane Databases of Systematic Reviews, Medline-in-Process & other nonindexed citations, Google Scholar, Embase, Web of Sciences and Scopus. The search included studies with adult surgical patients screened for OSA with STOP-Bang questionnaire that reported at least 1 cardiopulmonary or any other complication requiring intensive care unit admission as diagnosis of outcome. We used a Bayesian random-effects analysis to evaluate the existing evidence of STOP-Bang in relation to OSA and to assess the association of postoperative complications with the identified HR-OSA patients by study design and methodologies. RESULTS: This systematic review and meta-analysis was conducted using 10 cohort studies: 23,609 patients (HR-OSA, 7877; LR-OSA, 15,732). The pooled odds of perioperative complications were higher in the HR-OSA versus LR-OSA patients (odds ratio 3.93, 95% credible interval, 1.85-7.77, P= .003; 6.86% vs 4.62%). The length of hospital stay was longer in HR-OSA by 2 days when compared with LR-OSA (5.0 +/- 4.2 vs 3.4 +/- 2.8 days; mean difference 2.01; 95% credible interval, 0.77-3.24; P= .005). Meta-regression to adjust for baseline confounding factors and subgroup analysis did not materially change the results. CONCLUSIONS: This systematic review and meta-analysis suggests that HR-OSA is related with higher risk of postoperative adverse events and longer length of hospital stay when compared with LR-OSA patients. Our findings support the implementation of the STOP-Bang screening tool for perioperative risk stratification. (C) 2017 International Anesthesia Research Society
http://ift.tt/2x9pobD
http://ift.tt/2x9pobD
Impact of Simulator-Based Training in Focused Transesophageal Echocardiography: A Randomized Controlled Trial.
BACKGROUND: The aim of the study was to determine if training in transesophageal echocardiography (TEE) using a TEE simulator improves the ability of novice operators to perform and interpret a focused critical care TEE. METHODS: In this prospective, randomized, controlled study with blinded outcome assessment, 44 intensive care unit trainees were randomly assigned to a control group receiving 4 hours of lecture-based training only, or an intervention group which was additionally trained for 4 hours using a TEE simulator. After the training intervention, each participant performed 2 TEEs in intensive care unit patients which were evaluated by blinded assessors. The imaging quality of TEEs was measured using a predefined examination quality score ranging from 0 to 100 points. The correct quantification of pathologies and the interpretation of the TEEs were evaluated by blinded assessors using focused and comprehensive expert TEEs as comparators. RESULTS: A total of 114 TEEs were assessed. The mean examination quality score was 55.9 (95% confidence interval [CI], 50.3-61.5) for TEEs of the control group, 75.6 (95% CI, 70.1-81.0) for TEEs of the intervention group, and 88.5 (95% CI, 79.3-97.7) for TEEs in the expert group. The multiple comparisons revealed significant differences between all groups (19.7 [95% CI, 12.8-26.6], P
http://ift.tt/2wftiDy
http://ift.tt/2wftiDy
Young Age and Male Sex Are Predictors of Large-Volume Central Neck Lymph Node Metastasis in Clinical N0 Papillary Thyroid Microcarcinomas
http://ift.tt/2wVCfyH
A Systematic Review of the Methods of Diagnostic Accuracy Studies of the Afirma Gene Expression Classifier
http://ift.tt/2fQcQCL
COMPARISON BETWEEN BURNING MOUTH SYNDROME WITH AND WITHOUT PSYCHOLOGICAL PROBLEMS
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): MOON-JONG KIM, JIHOON KIM, HONG-SEOP KHO
http://ift.tt/2fQb30i
A PILOT STUDY OF PD-1 AND PD-L1 EXPRESSION IN A SPECTRUM OF ORAL DYSPLASIAS AND ORAL SQUAMOUS CELL CARCINOMAS
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): S. GLASS, R. REICH, P. FREEDMAN
http://ift.tt/2ibcUxp
Editorial Board
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
http://ift.tt/2fQjOYq
CHITOSAN IN THE TREATMENT OF RADIOTHERAPY INDUCED ORAL MUCOSITIS IN HEAD AND NECK CANCER PATIENTS: A RANDOMISD CLINICAL TRIAL
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): ARVIND MUTHUKRISHNAN, G. SHANMUGHAPRIYA
http://ift.tt/2ibCse0
Society Page
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
http://ift.tt/2fQ3SVR
HISTOCHEMICAL ASSESSMENT FOR VASCULAR ENDOTHELIAL CELLS AND PERIVASCULAR CELLS DURING ENDOCHONDRAL OSSIFICATION
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): ERIKA TSUCHIYA, TOMOKA HASEGAWA, NORIO AMIZUKA, YOSHIMASA KITAGAWA
http://ift.tt/2iaChzB
Information for Readers
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
http://ift.tt/2fQ3s1O
16S METAGENOMIC ANALYSIS OF INTRATUMORAL BACTERIAL FLORA IN ORAL CANCER PATIENTS
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): RIE TESHIMA, TAKASHI MATSUMOTO, KENJI KAWANO, YOSHIO YAMAOKA
http://ift.tt/2ibcIOH
The efficacy of diagnostic imaging should guide oral and maxillofacial radiology research
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): James R. Geist
http://ift.tt/2vInqAW
Table of Contents
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
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WILLINGNESS TO PAY, HEALTH UTILITY AND QUALITY OF LIFE IN ORAL LICHEN PLANUS – A COMPARATIVE STUDY ACROSS HEATH ECONOMIES
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): RICHEAL NI RIORDAIN, CHRISTINE MCCREARY, TIM HODGSON
http://ift.tt/2vIDnaE
EXPRESSION ANALYSIS OF CANONICAL WNT PATHWAY GENES IN ORAL SQUAMOUS CELL CARCINOMA AND THEIR POSSIBLE ROLE AS BIOMARKERS
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): MADHULAXMI MARIMUTHU, P.U. ABDUL WAHAB, ANANDAN BALAKRISHNAN, SAMBANDHAM SHANMUGAM, VINOD NARAYANAN, M.R. MUTHUSEKHAR
http://ift.tt/2wUINgZ
IMPACT OF SALIVARY FLOW RATE ON FUNGAL INFECTIONS ASSOCIATED WITH STEROID TREATMENT OF ORAL LICHEN PLANUS
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): MARY HIL EDENS, MICHAEL CARPENTER, JOEL NAPENAS, MICHAEL BRENNAN
http://ift.tt/2vIaqeA
PRESCRIPTION OF POTENTIALLY INAPPROPRIATE MEDICATIONS TO GERIATRIC PATIENTS AT A DENTAL SCHOOL
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): JESSACA YORK, ARWA FARAG, BHAVIK DESAI
http://ift.tt/2wUIOl3
Oral health status and risk of bacteremia following allogeneic hematopoietic cell transplantation
Publication date: September 2017
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): Ahmed S. Sultan, Yvette Zimering, Gloria Petruzziello, Edwin P. Alyea, Joseph H. Antin, Robert J. Soiffer, Vincent T. Ho, Stephen T. Sonis, Sook-Bin Woo, Francisco M. Marty, Nathaniel S. Treister
ObjectivesThe aim of this study was to evaluate the impact of oral health status on bacteremia risk in a cohort of patients with acute myeloid leukemia (AML) who underwent chemotherapy followed by myeloablative allogeneic hematopoietic cell transplantation (allo-HCT).Study DesignA retrospective study was conducted in patients with AML from 2007 to 2011. Oral health status was determined from a pre–allo-HCT dental evaluation. Positive blood cultures were recorded from AML induction to post–allo-HCT day +60. Organisms that caused bacteremia were classified as "of possible oral source" by a blinded microbiologist. Two-sided Fisher's exact test was used to compare the oral health status of the entire cohort with that of patients with blood cultures of potential oral source.ResultsPre–allo-HCT dental evaluations were completed in 91 (99%) of 92 patients. Of these 91 patients, 13 (14%) with dental pathology (13 of 13 [100%]) completed all required dental treatment before allo-HCT. Bacteremias occurred in 63 of 92 patients (68%), and 12 (19%) of 63 patients had positive blood cultures of potential oral source. Of these, 1 of 12 patients developed bacteremia during AML induction, and 11 of 12 developed bacteremia during allo-HCT.ConclusionsOral health status was not associated with risk of bacteremia of potential oral source either at AML induction or consolidation or at allo-HCT.
http://ift.tt/2vIDmU8
ALVEOLAR SOFT PART SARCOMA METASTATIC TO THE MANDIBLE: A REPORT AND REVIEW OF LITERATURE
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): S. PETERS, M. PERRINO, A. YOON, E. PHILIPONE
http://ift.tt/2wUXxwq
Salivary and serum levels of tumor necrosis factor-alpha in oral lichen planus: a systematic review and meta-analysis study
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): Hamid Reza Mozaffari, Mazaher Ramezani, Mohammad Mahmoudiahmadabadi, Neda Omidpanah, Masoud Sadeghi
ObjectiveTumor necrosis factor-α (TNF-α) has a role in the progression of the oral lichen planus (OLP). The aim of this meta-analysis study was to evaluate the salivary and serum TNF-α levels in patients with OLP.Study DesignWe searched in the databases of PubMed/Medline, Science direct, Scopus, Web of Science, and Cochrane Library for studies reported from 1983 to 2016. All studies were checked for evaluation of salivary and serum levels of TNF-α in patients with OLP compared with healthy controls.ResultsTwelve studies were included in the meta-analysis. The mean difference of 7 studies reporting salivary TNF-α levels in patients with OLP versus healthy controls was 25.90 pg/mL (95% confidence interval [CI] 15.31-36.49; P < .00001) and 7 studies reporting serum TNF-α levels was 1.65 pg/mL (95% CI −0.82 to 4.11; P = .19).ConclusionsIn patients with OLP, the higher levels of TNF-α in saliva compared with serum suggest that measurement of this marker in saliva may be more useful than in serum for determining diagnostic and therapeutic aims.
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TINNITUS AND TEMPOROMANDIBULAR JOINT DISORDER SUBTYPES
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): SUSEE PRIYANKA RAVURI
http://ift.tt/2wf0MSx
OUTCOMES AFTER PHYSICAL THERAPY FOR THE TREATMENT OF TEMPOROMANDIBULAR DISORDERS
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): YASSER KHALED, JESSICA K. QUACH, MICHAEL T. BRENNAN, JOEL J. NAPEÑAS
http://ift.tt/2vNybQZ
THE RELATIONSHIP BETWEEN RADIOGRAPHIC DENTAL ABNORMALITIES AND AGE AT INITIAL TREATMENT OF PEDIATRIC CANCER
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology, Volume 124, Issue 3
Author(s): VERA MONICA LIM, HALEY FREYMILLER, ADI SAX, ADEPITAN OWOSHO, JOSEPH HURYN, SAEHEE YOM, CHERRY ESTILO
http://ift.tt/2v6v7gM
Morphoproteomics, E6/E7 in-situ hybridization, and biomedical analytics define the etiopathogenesis of HPV-associated oropharyngeal carcinoma and provide targeted therapeutic options
Human papillomavirus (HPV) has been identified as an etiopathogenetic factor in oropharyngeal squamous cell carcinoma. The HPV E6 and E7 oncogenes are instrumental in promoting proliferation and blocking differen...
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A two-year follow-up of surgical and non-surgical treatments in patients with masticatory muscle tendon-aponeurosis hyperplasia
This study re-examined the usefulness of surgery for the management of masticatory muscle tendon-aponeurosis hyperplasia (MMTAH) through a comparison of the outcomes between patients who underwent surgery and those who did not. The duration of follow-up was 2 years. Twenty-eight patients who attended the study hospital and were given a diagnosis of MMTAH were included. Nineteen patients underwent surgery (surgical group) and nine patients were instructed to open their mouths wide once a day and did not undergo surgery (non-surgical group).
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The difference between registered natural head position and estimated natural head position in three dimensions
This study determined the intra-rater and inter-rater reliability of re-orientating three-dimensional (3D) facial images into the estimated natural head position. Three-dimensional facial images of 15 pre-surgical class III orthognathic patients were obtained and automatically re-orientated into natural head position (RNHP) using a 3D stereophotogrammetry system and in-house software. Six clinicians were asked to estimate the NHP of these patients (ENHP); they re-estimated five randomly selected 3D images after a 2-week interval.
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Marginal or segmental mandibulectomy: treatment modality selection for oral cancer: a systematic review and meta-analysis
Surgery is the most well established mode of initial definitive treatment for the majority of oral cancers. The most important decision in terms of tumour ablation in oral cancers when the jaws are potentially involved is the management of the mandible. The aim of this study was to explore the differences in survival rate and disease control between patients undergoing marginal mandibulectomy and patients undergoing segmental mandibulectomy using a systematic review and meta-analysis approach. A total of 15 cohort studies, including 1672 participants, were identified.
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Virtual quad zygoma implant placement using cone beam computed tomography: sufficiency of malar bone volume, intraosseous implant length, and relationship to the sinus according to the degree of alveolar bone atrophy
The objective of this study was to investigate the malar bone volume and length that a zygomatic implant can engage, and the relationship to the sinus according to the degree of alveolar bone atrophy. A three-dimensional evaluation was performed using cone beam computed tomography scans from 23 patients with a totally edentulous maxilla; quad zygoma implants were virtually placed. The predictor variable was the amount of malar bone volume and length that a zygomatic implant can engage. The primary outcome variable was the relationship to the sinus according to the degree of alveolar bone atrophy.
http://ift.tt/2w7eFlc
Measurements of ionic concentrations along with endocochlear potential in wild-type and claudin 14 knockout mice
Publication date: Available online 12 August 2017
Source:Auris Nasus Larynx
Author(s): Yuka Shiraiwa, Eriko Daikoku, Masahisa Saito, Yui Yamashita, Takaya Abe, Fumihito Ono, Takahiro Kubota
ObjectiveTo examine whether the changes in endolymphatic ion concentrations were involved in hair cells degeneration in claudin-14 knockout (KO) mice (Cldn14−/−), we measured the endocochlear potential (EP) along with concentrations of K+, Na+, H+, or Ca2+ ([K]e, [Na]e, pHe, [Ca]e) in Cldn14−/−, in which hair cells were selectively damaged, and compared with measurements in wild type mice (Wt).MethodsWe used the Cldn14−/− from 3 weeks of age, in which the auditory brain responses (ABR) was severely diminished. Using double-barreled ion-selective microelectrodes, we measured [K]e, [Na]e, pHe, and [Ca]e in both Wt and Cldn14−/− at 8–10 weeks of age.Results(1) In Wt, the EP was +92mV. [K]e, [Na]e, pHe, and [Ca]e were 169mM, ∼1.0mM, 7.50, and 395nM, respectively. In the Cldn14−/−, the EP was +96mV. [K]e, [Na]e, pHe, and [Ca]e were 167mM, ∼1.0mM, 7.73, and 179nM, respectively. No significant differences in the above values were observed between Wt and Cldn14−/−. (2) A significant linear correlation between EP and [Ca]e (R=0.93) was observed for both Wt and Cldn14−/−, but no correlation was observed between EP and K+, Na+, or H+.ConclusionThese findings suggest that (1) the changes in endolymphatic ion concentrations might not be involved in hair cells degeneration in Cldn14−/−, (2) [Ca]e might be regulated by EP in both Wt and Cldn14−/−.
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Does CT help in predicting preepiglottic space invasion in laryngeal carcinoma?
Source:Auris Nasus Larynx
Author(s): Gülpembe Bozkurt, Özlem Ünsal, İrfan Çelebi, Burak Ayhan, Umman Guliyev, Pınar Akova, Tülay Başak, Berna Uslu Coşkun
ObjectiveEvaluating preepiglottic space involvement in laryngeal cancer by CT may lead misinterpretation. We sought to understand the causes of misinterpretation in evaluating the preepiglottic space by CT and assessed the effects of misinterpretation in treatment plans of patients with laryngeal squamous cell carcinomas.MethodsSpecimen histopathology reports of 102 (99 male, 3 female) patients who underwent total or partial laryngectomy due to supraglottic and/or transglottic laryngeal carcinoma were reviewed. Neck CTs were also re‐assessed for preepiglottic space involvement by three radiologists. The initial surgical treatment choices were re-examined according to the current radiological evaluation in combination with pathological results of the specimens and physical examination findings in the patients. Interobserver agreement regarding image interpretation was based on a kappa analysis.ResultsThe interclass correlation coefficient in predicting preepiglottic space invasion was 0.74; this was considered 'good.' Among the three radiologists, sensitivity, specificity, accuracy of CT in detecting preepiglottic space involvement were 86–93%, 75–93%, and 77–93%, respectively, while the negative and positive predictive values were 97–98% and 38–50%, respectively. Given the previous treatments applied, false-positive diagnoses for PES involvement resulted in overtreatment in 2.9% of cases. False-negative diagnoses of PES involvement (1.9% of cases) did not result in any undertreatment.ConclusionsAlthough CT is a practical and inexpensive imaging tool for evaluating laryngeal carcinomas, the PPV of CT in assessing preepiglottic space invasion, especially in advanced tumors, is low and may lead to overtreatment.
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Clinical course of incidental parathyroidectomy: Single center experience
Source:Auris Nasus Larynx
Author(s): Sabri Özden, Ahmet Erdoğan, Besir Simsek, Baris Saylam, Baris Yıldız, Mesut Tez
ObjectiveThyroidectomy is a very common surgical procedure. Regardless of surgeon experience, incidental parathyroidectomy is a complication of thyroidectomy. The aim of this study was to identify the clinical course of incidental parathyroidectomies after thyroidectomy.MethodsPatients who underwent thyroidectomy between January 2010 and June 2014 were evaluated retrospectively. Pathology reports were reviewed for the presence of parathyroid tissue in the thyroidectomy pathology specimens. Information regarding demographic, laboratory variables, operative details, and postoperative complications were collected.ResultsIncidental parathyroidectomy was found in 178 out of 3022 patients who had thyroidectomy (5.8%). Types of surgeries performed for 178 patients were total thyroidectomy (TT) in 132(74.2%) cases, TT and central lymph node dissection(CLND) in 30 (16.9%) cases, lobectomy in seven cases (3.9%), completion thyroidectomy in five (2.8%) patients and modified cervical lymph node dissection in four (2.2%)patients. One and two parathyroid glands were accidentally removed in 152 (85.3%) and 26 (14.7%) patients, respectively.In the entire series, biochemical temporary postoperative hypocalcemia occurred in 75(42.1%) patients and permanent hypocalcemia occured in 12 (6.7%) patients with incidental parathyroidectomy. There was not a statistically significant difference regarding the occurrence of postoperative permanent hypocalcemia between the patients who had incidental parathyroidectomy of one gland and the patients with two incidental parathyroidectomies (p=0.114).ConclusionIncidental parathyroidectomy is not uncommon during thyroidectomy. No association between inadvertent parathyroidectomy and postoperative permanent hypocalcemia was found.
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Correlation of soft palate length with velum obstruction and severity of obstructive sleep apnea syndrome
Source:Auris Nasus Larynx
Author(s): Ju-Shin Lim, Jae Woo Lee, Chun Han, Jang-Woo Kwon
ObjectiveOur aim in this study was to analyze whether soft palate length and velum obstruction during sleep are correlated and to determine the effects of related parameters on obstructive sleep apnea syndrome (OSAS) severity. We used computed tomography to measure soft palate length and drug-induced sleep endoscopy (DISE) to evaluate velum obstruction severity. Patients also underwent polysomnography (PSG) for evaluation of OSAS severity.MethodsA retrospective cohort of 67 patients with OSAS treated between May 1st, 2013 and July 31st, 2016 was analyzed. Each patient underwent DISE, PSG, and computed tomography. Using DISE, velum obstruction was categorized by the VOTE classification method. Using computed tomography, soft palate length was measured as the length of the posterior nasal spine to the uvula. Correlations of velum obstruction in DISE and PSG parameters (obstructive apnea, hypopnea, apnea hypopnea index (AHI), respiratory effort related arousal (RERA), respiratory disturbance index (RDI), baseline SaO2, and minimum SaO2) with soft palate length were also analyzed.ResultsAmong the 67 patients, the average PNS-U length was 39.90±4.19mm. Length was significantly different by age but not by other demographic characteristics such as sex, past history, or BMI. DISE revealed a statistically significant difference of velum obstruction degree; the cutoff value for PNS-U was 39.47mm. The PSG results, obstructive apnea, AHI, RDI, baseline SaO2, and minimum SaO2 were correlated with PNS-U length, while other results such as hypopnea and RERA showed no correlation.ConclusionAnalysis of soft palate length showed that increased PNS-U length was associated with higher rates of obstructive apnea, AHI, and RDI as assessed by PSG. In contrast, lower baseline SaO2 and minimum SaO2 values were seen by PSG; more severe velum obstruction was seen by DISE. We propose that when a soft palate is suspected in OSAS, computed tomography measurement of soft palate length is a valid method for estimating the degree of velum obstruction and the severity of OSAS.
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Cervical mass as the first clinical manifestation of unsuspected metastatic seminoma
Source:Auris Nasus Larynx
Author(s): Emanuele Ferri, Barbara Pedruzzi, Pierpaola Gasparin, Marcello Lunghi
The authors reported a case of a 27‐year‐old man with a nontender left neck mass that had grown quite rapidly within few weeks. FNAB and CT were not consistent to establish the definite diagnosis. After excisional biopsy, the histopathological examination and the immunohistochemical study of the specimen revealed a cervical metastasis of seminoma. The patient was treated with chemotherapy with a complete clinical remission. This uncommon case-report can represent a great diagnostic and therapeutic challenge and should be considered in the differential diagnosis of every cervical masses occurring in young males patients. Diagnostic delays are unfortunately common and may lead to metastatic spread and worse prognosis.
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Long-term safety of crisaborole ointment 2% in children and adults with mild to moderate atopic dermatitis
Long-term topical treatment is often required for atopic dermatitis (AD), a chronic inflammatory skin disease.
http://ift.tt/2x9gtqq
Repigmentation in vitiligo using the Janus kinase inhibitor tofacitinib may require concomitant light exposure
Vitiligo is an autoimmune disease in which cutaneous depigmentation occurs. Existing therapies are often inadequate. Prior reports have shown benefit of the Janus kinase (JAK) inhibitors.
http://ift.tt/2weZbvY
A comparative study for the analgesic efficacy and safety profile of fentanyl versus clonidine as an adjuvant to epidural ropivacaine 0.75% in lower abdominal surgeries
Anesthesia: Essays and Researches 2017 11(3):692-696
Context: Different adjuvants are coadministered with local anesthetics to improve the speed of onset and duration of analgesia, and to reduce the dose, the selection of which is often left to the choice of an anesthesiologist. Aim: The aim of this study was to compare the analgesic efficacy and safety profile of fentanyl and clonidine as an adjuvant to epidural ropivacaine anesthesia. Setting and Design: With institutional ethical committee clearance, a prospective, randomized, placebo-controlled double-blind clinical study was conducted at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow. Material and Methods: Two groups with thirty patients each were randomly allocated to receive 15–20 ml of 0.75% ropivacaine with 75 μg clonidine or 15–20 ml of 0.75% ropivacaine with 75 μg fentanyl, respectively. Block characteristics such as onset of analgesia, maximum level of sensory blockade, complete motor blockade, hemodynamic, time to two-segment regressions, time for rescue analgesia, time to complete motor recovery, and side effects were analyzed. Results: Results showed that the onset of blockade is faster when fentanyl is used as additives. Time for two-segment regression was earlier in fentanyl group but time for rescue analgesia was longer in clonidine group. Statistical Analysis: Two groups were compared by Student's t-test and Chi-square test; ANOVA and significance of mean difference bet were done by Newman–Keuls test. Conclusion: Addition of clonidine to epidural ropivacaine provides superior analgesia than the addition of fentanyl to epidural ropivacaine without much difference in side effect profile.
http://ift.tt/2x8Ouar
Laparoscopic cholecystectomy under segmental thoracic spinal anesthesia: A feasible economical alternative
Anesthesia: Essays and Researches 2017 11(3):781-783
Laparoscopic surgery is normally performed under general anesthesia, but regional techniques like thoracic epidural and lumbar spinal have been emerging and found beneficial.We performed a clinical case study of segmental thoracic spinal anaesthesia in a healthy patient.We selected an ASA grade I patient undergoing elective laparoscopic cholecystectomy and gave spinal anesthetic in T10-11 interspace using 1 ml of bupivacaine 5 mg ml−1 mixed with 0.5 ml of fentanyl 50 μg ml−1. Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension,or pruritus during or after surgery. The patient was reviewed 2 days postoperatively in ward.The thoracic spinal anesthetia was performed easily in the patient.Some discomfort which was readily treated with 1mg midazolam and 20 mg ketamine intravenously.There was no neurological deficit and hemodynamic parameters were in normal range intra and post-operatively and recovery was uneventful. We used a narrow gauze (26G) spinal needle which minimized the trauma to the patient and the chances of PDPH, which was more if 16 or 18G epidural needle had been used and could have increased further if there have been accidental dura puncture. Also using spinal anesthesia was economical although it should be done cautiously as we are giving spinal anesthesia above the level of termination of spinal cord.
http://ift.tt/2x9mXG0
Role of anesthesiologist in the management of a child with cerebral palsy
Anesthesia: Essays and Researches 2017 11(3):544-549
Cerebral palsy (CP) refers to a spectrum of nonprogressive neurological disorders with disturbances in posture and movement, resulting from perinatal intrauterine insult to developing infant brain. Many conditions associated with CP require surgery. Such cases pose important gastrointestinal, respiratory, and other perioperative considerations. Anesthetic management in these cases is delicate. Intraoperative complications including hypovolemia, hypothermia, muscle spasms, seizures, and delayed recovery might complicate the anesthetic management. A thorough preanesthetic evaluation allows for a better intra- and post-operative care. Postoperative analgesia is important, particularly in orthopedic surgeries one for pain relief. This review highlights the clinical manifestations in CP and anesthetic considerations in such child presenting for various surgeries.
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A comparative study of intravenous esmolol, labetalol and lignocaine in low doses for attenuation of sympathomimetic responses to laryngoscopy and endotracheal intubation
Anesthesia: Essays and Researches 2017 11(3):745-750
Background: Direct layngoscopy and endotracheal intubation is a noxious stimuli and induces sympathomimetic responses. Although well tolerated in healthy subjects, it may impose life threatening arrhythmias, left ventricular failure or rupture of cerebral aneurysm in susceptible patients. Esmolol, Labetalol and Lignocaine attenuate these responses but are associated with side effects of bradycardia, hypotension etc. In lower doses, chances of these side effects are comparatively low. So we designed this prospective clinical trial to assess the efficacy of intravenous esmolol, labetalol and lignocaine in low doses for attenuation of sympathomimetic responses to endotracheal intubation. Materials and Methods: Seventy-five consenting patients of ASA physical status I or II of age range 20 to 60 years, scheduled for different general surgical procedures were randomly assigned to one of the three groups; group ES, group LB and group LG. Participants of group ES, group LB and group LG was given esmolol HCL 0.5 mg/Kg, labetalol HCL 0.25 mg/kg and lignocaine HCL 1 mg/Kg body weight respectively. Outcome variables were HR, SBP, DBP, MAP and RPP. These variables were recorded just after intubation and thereafter at 1,3,5, 7 and 10 minutes of intubation. Results: There was no statistically significant difference regarding the demographic characteristics of the groups. Heart rate and systolic blood pressure was lower throughout the study period in labetalol group. But the values of study parameters were always higher than the baseline in esmolol and lignocaine group. Values of mean arterial pressure was slightly higher in labetalol group but it was much higher in two other groups throughout the study period. Diastolic blood pressure was higher in all the groups. Values of rate pressure product was higher during intubation and at 1minute after intubation in labetalol group but thereafter it was always lower than baseline values. Conclusion: Labetalol 0.25 mg Kg-1 is an effective and safe drug to be used for attenuation of sympathomimetic responses to endotracheal intubation. Esmolol 0.5 mg Kg-1 and lignocaine 1 mg Kg-1 are also effective to some extent and are safe.
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Nasogastric tube insertion in anesthetized intubated patients undergoing laparoscopic hysterectomies: A comparative study of three techniques
Anesthesia: Essays and Researches 2017 11(3):550-553
Background: Insertion of a nasogastric tube (NGT) in an anesthetized, comatose intubated patient is not always as easy as in a conscious, cooperative patient. Various techniques have been tried with varying success. The aim of this randomized study was to compare and evaluate the two techniques of NGT insertion with the conventional technique of insertion with respect to success rate, time taken for insertion and adverse effects. Materials and Methods: Patients admitted for laparoscopic hysterectomy were chosen and then were divided into three equal groups of forty each, by randomized technique. Group C included patients in whom conventional method was used to insert NGT. Group R where reverse Sellick's technique was used. Group F where neck flexion with lateral pressure was used. Results: Both the techniques were better than the conventional method. Among both the techniques, reverse Sellick's technique was the best method but not without adverse effects. The required insertion time was very less and success in the first attempt was more in the group where reverse Sellick's was used. Conclusion: Modified techniques of NGT insertion were better than the conventional method. Further studies after eliminating major limitations are required to really find a superior technique.
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Hyperparathyroid crisis: It's not all about calcium!
Anesthesia: Essays and Researches 2017 11(3):804-806
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Influence of addition of dexmedetomidine or fentanyl to bupivacaine lumber spinal subarachnoid anesthesia for inguinal hernioplasty
Anesthesia: Essays and Researches 2017 11(3):554-557
Background: No drug, used as adjuvant to spinal bupivacaine, has yet been identified that specifically inhibits nociception without its associated side effects. Aim of the Work: The purpose of this study is to compare the efficacy of dexmedetomidine and fentanyl with spinal bupivacaine in inguinal hernioplasty. Patients and Methods: Sixty patients of inguinal hernioplasty were randomly allocated to one of three groups, Group C (n = 20) – the patients received 15 mg hyperbaric bupivacaine + 0.5 ml saline. Group D – (n = 20) the patients received 15 mg hyperbaric bupivacaine + 10 μg dexmedetomidine diluted with 0.5 ml saline. Group F (n = 20) – the patients received 15 mg hyperbaric bupivacaine + 25 μg fentanyl (0.5 ml). Onset, duration of anesthesia, degree of sedation, and side effects were recorded. Results: The onset of anesthesia was shorter in Groups D and F as compared with the control Group C, but it was shorter in Group D than in Group F. The duration of sensory and motor block was prolonged in Group D and F as compared with the control Group C, but it was longer in Group D than in Group F. The postoperative analgesic consumption in the first 24 h was lower in Groups D and F than in Group C, and it was lower in Group D than in Group F. Conclusion: Onset of anesthesia is more rapid and duration is longer with less need for postoperative analgesia in patients undergoing inguinal hernioplasty under spinal anesthesia with dexmedetomidine and fentanyl than those with spinal alone with tendency of dexmedetomidine to produce faster onset, longer duration, and less analgesic need than fentanyl with similar safety profile.
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A prospective, observational study to evaluate the role of gabapentin as preventive analgesic in thyroidectomy under general anesthesia
Anesthesia: Essays and Researches 2017 11(3):718-723
Background: Effective management of postoperative pain is a part of well-organized perioperative care, which helps in reduced morbidity and improved patient satisfaction. Preventive analgesia can reduce acute and chronic pain by blocking the noxious inputs to pain pathways, preventing sensitization. Studies have reported efficacy of gabapentin as a preventive analgesic in perioperative pain. In this study, we aimed to determine whether preoperative gabapentin reduced postoperative pain and tramadol consumption after thyroidectomy under general anesthesia. Materials and Methods: Sixty patients scheduled for thyroidectomy were allocated to two groups of thirty each for this prospective, observational study. Patients in Group A and Group B received oral gabapentin 600 mg (6 × 10−4 kg) and diazepam 10 mg (1 × 10−5 kg), respectively, 2 h prior to surgery. Tramadol was given as rescue analgesic for postoperative pain with a verbal rating score of two. The analgesic efficacy of preoperative gabapentin was assessed in terms of postoperative pain scores at rest or swallowing, time to first rescue analgesic, and total tramadol consumption for 24 h. Ramsay sedation score and side effects of drug were also looked into. Results: Postoperative pain scores and total tramadol consumption were significantly lower in Group A during 24 h (P = 0.00). Time to first rescue analgesic was significantly prolonged in Group A (P = 0.001). Side effects were comparable. Conclusion: Oral gabapentin is effective as a preventive analgesic in reducing postoperative pain and tramadol consumption after thyroidectomy under general anesthesia.
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Comparative study of oral gabapentin, pregabalin, and clonidine as premedication for anxiolysis, sedation, and attenuation of pressor response to endotracheal intubation
Anesthesia: Essays and Researches 2017 11(3):558-560
Introduction: The aim of the present study was to evaluate and compare the effect of clonidine 200 μg and gabapentin 900 mg and pregabalin 150 mg in attenuation of the hemodynamic response to laryngoscopy and intubation in normotensive patients undergoing elective surgery. Methods: Ninety adult patients between 18 and 60 years are enrolled in the study. Patients with American Society of Anesthesiologists Grade-I and Grade-II are included which are posted for elective surgery under general anesthesia. Patients were divided into three groups: A, B, and C and received oral drugs 90 min before induction of general anesthesia, pregabalin 150, gabapentin 900mg, and clonidine 200 μg, respectively. Hemodynamic parameters such as heart rate and blood pressure were noted just before the (basal) administration of the drug, and in operation room, readings were recorded before intubation (T0) and after intubation at 1, 3, 5, and 10 min. Sedation and anxiety score were noted after 1 h of oral administration of the drug. Results: Mean arterial pressure was well attenuated by pregabalin than others, and mean heart rate following laryngoscopy and intubation was attenuated by clonidine group significantly. Conclusion: We conclude that oral pregabalin and gabapentin attenuate blood pressure response fairly well and heart rate significantly attenuated by clonidine. All three drugs are very effective for relieving anxiety and improving sedation.
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Postoperative analgesic efficacy of bilateral transversus abdominis plane block in patients undergoing midline colorectal surgeries using ropivacaine: A randomized, double-blind, placebo-controlled trial
Anesthesia: Essays and Researches 2017 11(3):767-772
Background: Ultrasound-guided transversus abdominis plane (TAP) block is done as a part of multimodal analgesia for pain relief after abdominal surgeries. This prospective randomized, double-blind, placebo-controlled trial was conducted to evaluate the postoperative analgesic efficacy of bilateral TAP block in patients undergoing midline colorectal surgeries using ropivacaine. Materials and Methods: Eighty patients scheduled for elective colorectal surgeries involving midline abdominal wall incision under general anesthesia were enrolled in this prospective randomized controlled trial. Group A received TAP block with 20 ml of 0.2% ropivacaine on either side of the abdominal wall, and Group B received 20 ml of normal saline. The time to request for rescue analgesia, total analgesic consumption in 24 h, and satisfaction with the anesthetic technique were assessed. Results: The mean visual analog scale scores at rest and on coughing were higher in control group (P > 0.05). Time (min) to request for the first rescue analgesia was prolonged in study group compared to control group (P < 0.001). The total tramadol consumption in 24 h postoperatively was significantly high in control group (P < 0.001). Nausea/vomiting was more common in control group (P > 0.05). The level of satisfaction concerning postoperative pain control/anesthetic technique was higher in study group (P < 0.001). Conclusion: TAP block produces effective and prolonged postoperative analgesia in patients undergoing midline colorectal surgery. It is a technically simple block to perform with a high margin of safety. It produces a considerable reduction in mean intravenous postoperative tramadol requirements, reduction in postoperative pain scores, and increased time to first request for further analgesia, both at rest and on movement.
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A prospective comparative observational study of clinical efficacy of isobaric ropivacaine 0.75% with of isobaric bupivacaine 0.5% intrathecally in elective inguinal hernia repair surgeries
Anesthesia: Essays and Researches 2017 11(3):561-566
Aims: To evaluate the efficacy of intrathecal isobaric Ropivacaine and its comparison with intrathecal isobaric Bupivacaine in elective inguinal hernia repair surgeries. Settings and Design: A prospective, randomized study was conducted in a tertiary care hospital with 80 patients of ASA grade I-III undergoing elective inguinal hernia repair surgery under spinal anaesthesia .Ethical committee clearance and written consent taken. The patients were randomly divided into two equal groups to the Ropivicaine group (Group R) and to theBupivicaine group (Group B). Parameters observed were onset and duration of sensory and motor block, maximum sensory level achieved degree of motor blockade, two segment regression, and haemodynamic changes. Results: The development of sensory block was faster with Isobaric Ropivicaine (12.1 ± 4.9 minutes) as than isobaric Bupivicaine (13.94 ± 4.52 minutes) but the difference was not statistically significant. Onset of Grade III Motor block was longer with Isobaric Ropivicaine (8.51 ± 3.39 minutes) as compared to isobaric Bupivicaine ( 8.51 ± 3.39 minutes), but the difference was not statistically significant. Time of Complete Sensory Regression was significantly shorter with Isobaric Ropivicaine (212.69 ± 27.31 minutes) with statistical significance. Time to complete motor recovery was significantly shorter in Ropivacaine group (253.38 ± 27.13 minutes)as compared to Bupivacaine group (258.55 ± 35.81min), with statistical significance.Time to achieve discharge criteria was relatively shorter with Isobaric Ropivicaine. Haemodynamic Parameters did not differ significantly in both the groups during the entire study period. Conclusion: Intrathecal administration of isobaric Ropivacaine (0.75%) 15 mg provides similar quality of spinal anaesthesia but of significantly shorter duration, maintaining similar hemodynamic stability and discharge criteria without significant adverse effects when compared to isobaric Bupivicaine (0.5%) 10 mg.
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A complication after percutaneous nephrolithotomy: Anesthesia mumps
Anesthesia: Essays and Researches 2017 11(3):794-796
Some surgical procedures performed under moderate and sometimes extreme positions expose patients to nonphysiological changes. Especially, the manipulations of a patient in prone and lateral decubitus position might increase complications. Anesthesia mumps has been reported as one of these complications. It has been found to be rare but known entity associated with patients of all age groups and all surgical positions. We herein describe an early noticed acute case of unilateral anesthesia mumps that developed after endotracheal intubation in prone position in a 54-year-old female. Anesthesia mumps may occur in the immediate postoperative period with no suspicious predisposing factor. The reports of such cases would increase the awareness among anesthesiologists and postoperative caregivers regarding this benign complication.
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Efficacy of tramadol or dexamethasone as an adjuvant to levobupivacaine in ultrasound-guided supraclavicular plexus block for upper limb surgery: A randomized double-blinded controlled study
Anesthesia: Essays and Researches 2017 11(3):567-571
Aims and Objectives: To evaluate the efficacy of tramadol or dexamethasone as an adjuvant to levobupivacaine in ultrasound-guided supraclavicular brachial plexus block in terms of onset time of complete sensory and motor blockade, duration of motor blockade, duration of analgesia, and any complication. Settings and Design: This was a randomized controlled trial conducted in the Department of Anesthesiology, a tertiary care hospital. Materials and Methods: Sixty consecutive patients of the American Society of Anesthesiologists physical status Class I and II who were posted for upper limb surgeries were recruited. Patients were divided into two groups of thirty patients each. Group T (tramadol) received 20 ml of 0.5% levobupivacaine with 100 mg tramadol, and Group D (dexamethasone) received 20 ml of 0.5% levobupivacaine with 8 mg dexamethasone under ultrasound guidance. Sensory and motor block assessment was done every 2 min until the development of complete sensory and motor block till 45 min. Verbal numerical rating scale score was assessed in postoperative ward at regular intervals. Patients were followed up to check for any residual neurological deficits. Results: There was no statistical difference in demographic data between the two groups. The onset time of sensory and motor blockade shows no significant difference between groups. The mean time duration of motor blockade in Group T was 764.63 min and for Group D was 1150.27 min which was statistically significant (P < 0.05). The duration of analgesia in Group D was 1300.83 min and in Group T was 820.47 min which was statistically significant (P < 0.05). Side effects such as nausea, vomiting, pruritis, hypoxemia, and long-term neurological deficits were not reported in any of the patients in either group. Conclusion: Dexamethasone 8 mg as an adjuvant to 0.5% levobupivacaine for supraclavicular brachial plexus block using ultrasound guidance increases the duration of analgesia in comparison to 100 mg tramadol and provides excellent postoperative pain-free period without any neurological deficits.
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