Local anaesthetic for pain post rubber band ligation of haemorrhoids: a prospective, single-blinded randomised controlled trial.

BACKGROUND: Rubber band ligation (RBL) is a widely accepted intervention for the treatment of haemorrhoids. However, post procedure pain is a common complaint. The aim of this study was to determine whether the addition of local anaesthetic (LA) to the haemorrhoid pedicle base, post RBL, aids in reducing early post-procedure pain. Additionally, to compare perceived perianal numbness, oral analgesia usage and total consumption, and adverse events. METHODS: This study was a prospective, single-blinded randomised controlled trial. Patients were recruited from colorectal clinics in two Australian hospitals between 2018-2019. Patients randomised to the intervention (LA) group received 2mls bupivacaine 0.5% with adrenaline 1:200,000 to each haemorrhoid base. Patients in the control group were not administered LA. Pain scores were recorded over 48 h using visual analogue scales. Analgesia consumption was documented and other secondary objectives were recorded dichotomously (yes/no). RESULTS: At 1 h post-procedure, patient reported pain scores were significantly lower in the LA group compared to the control group (p = 0.04). There were no significant differences in pain scores between the groups at 4, 24 or 48 h. Additionally, there were no significant differences between groups with respect to oral analgesia usage, perianal numbness or adverse events. CONCLUSIONS: LA to the haemorrhoid pedicle post RBL may significantly reduce early post procedure pain without any increased risk of adverse effects.

A short review on cervical cancer cell lines characterization and their corresponding human leukocyte antigen (HLA) type expression.

Cervical cancer is one of the leading causes of death in women worldwide. Extensive research is ongoing to develop efficient diagnostics and therapeutic approaches for cervical cancer, which rely on the preliminary studies based on cervical cell lines. It is essential to characterize these cell lines to ensure the suitability of the cells for each study. In this review, the human leukocyte antigen (HLA) molecule expressed on each cervical cancer line is presented. HLA characterization of the cervical cancer cell lines is essential to increase the specificity of treatment towards certain type of cervical cancer, allowing accurate therapy. HLA characterization is also important for the generation of novel diagnostics and/or therapeutics molecules, especially for HLA-based strategies.

Tomographic entanglement indicators from NMR experiments.

In recent years, the performance of different entanglement indicators obtained directly from tomograms has been assessed in continuous-variable and hybrid quantum systems. In this paper, we carry out this task in the case of spin systems. We compute the entanglement indicators from actual experimental data obtained from three liquid-state nuclear magnetic resonance (NMR) experiments and compare them with standard entanglement measures calculated from the corresponding density matrices, both experimentally reconstructed and numerically computed. The gross features of entanglement dynamics and spin squeezing properties are found to be reproduced by these entanglement indicators. However, the extent to which these indicators and spin squeezing track the entanglement during time evolution of the multipartite systems in the NMR experiments is very sensitive to the precise nature and strength of interactions as well as the manner in which the full system is partitioned into subsystems. We also use the IBM quantum computer to implement equivalent circuits that capture the dynamics of the multipartite system in one of the NMR experiments and carry out a similar comparative assessment of the performance of tomographic indicators. This exercise shows that these indicators can estimate the degree of entanglement without necessitating detailed state reconstruction procedures, establishing the advantage of the tomographic approach.

Bioaccumulation of sediment-associated dinonylnaphthalene sulfonates in the freshwater mussel Lampsilis siliquoidea and oligochaete Tubifex tubifex.

Naphthalene sulfonic acids (NSAs) are used primarily as additives in a wide range of industrial products (e.g., rubber materials, coatings, sealants, fuels, paints). Based on modeled physicochemical properties, NSAs would likely partition into sediments or the tissues of biota in an aquatic system. This study examined the potential for three NSAs, dinonylnaphthalene disulfonic acid (DNDS), barium dinonylnaphthalene sulfonate (BaDNS), and calcium dinonylnaphthalene sulfonate (CaDNS), to accumulate in the tissue of a freshwater mussel (Lampsilis siliquoidea) and oligochaete worm (Tubifex tubifex). The ability of L. siliquoidea to depurate accumulated chemical was also assessed. Mussels were exposed via sand spiked with CaDNS for 25 d, and then transferred to clean water where their ability to depurate the chemical over an additional 28 d was monitored. Worms were exposed to each of the three NSAs via spiked sediment for 28 d. NSA concentrations were measured separately in gill, foot, and remaining soft tissues (viscera) for mussels and in whole body tissue samples of worms. For L. siliquoidea, the largest concentration of CaDNS was measured in the gill tissue; once removed from CaDNS exposure, mussels were able to depurate up to 87% of the CaDNS from their tissues in 28 days. The biota-sediment accumulation factors (28-d BSAFs) for T. tubifex were 2.8-5.2, 0.53-0.76, and 0.83-1.11 for DNDS, BaDNS, and CaDNS, respectively. For mussel gill and viscera, BCFK values were 14.07 and 16.39, respectively. When BAFKs were calculated using the concentration of CaDNS in sand, they were 1.11 and 1.29 for mussel gill and viscera, respectively. These values are much lower than what would be necessary to classify this chemical as bioaccumulative; however, the BSAFs for DNDS in T. tubifex indicated a potential biomagnification concern if this compound were to occur in the aquatic environment.

The influence of organic carbon on the toxicity of sediment-associated dinonylnaphthalene sulfonic acids to the benthic invertebrates Tubifex tubifex and Hyalella azteca.

Naphthalene sulfonic acids (NSAs) are used extensively in industrial applications as dispersants in dyes, rubbers, and pesticides, and as anti-corrosive agents in coatings, gels, and sealants. This study examined the toxicity of three NSA congeners, barium dinonylnaphthalene sulfonate (BaDNS), calcium dinonylnaphthalene sulfonate (CaDNS), and dinonylnaphthalene disulfonic acid (DNDS), to two benthic species, Tubifex tubifex and Hyalella azteca. Two substrates with different levels of organic carbon (sediment [2%] and sand [0%]) were used in toxicity tests. Juvenile production was the most sensitive endpoint for T. tubifex: the 28-d EC50s were <18.2, 22.2, and 64.0 µg/g dw in sand and 281.3, 361.6, and 218.9 µg/g dw in sediment for BaDNS, CaDNS, and DNDS, respectively. The 28-d LC50s for H. azteca were similar among compounds: 115.3, 82.1, and 49.0 µg/g dry weight (dw) in sand, and 627.3, 757.9, and >188.5 µg/g dw in sediment, for BaDNS, CaDNS, and DNDS, respectively. However, when LC50s were estimated based on concentrations of NSAs measured in overlying water (which can be an important route of exposure for H. azteca), BaDNS and CaDNS were 3-4 orders of magnitude more toxic than DNDS. The NSAs examined were >3-fold more toxic when present in substrates with no organic carbon (e.g., sand) for all H. azteca endpoints where LC/EC50s could be calculated and for sublethal endpoints for T. tubifex. The organic carbon content of the sediment appears to have acted as a sink and reduced NSA toxicity by decreasing bioavailability. Environmental sediment samples were collected from 12 river sites across southern Ontario. The maximum concentration of CaDNS observed in sediment collected from this region was 2.8 µg/g dw in sediment with 2% organic carbon; 100-fold lower than the lowest EC10 in the current study.

Toxicity of dinonylnaphthalene sulfonates to Pimephales promelas and epibenthic invertebrates.

Dinonylnaphthalene sulfonic acids (NSAs) are high production volume chemicals that are used primarily as additives in a wide range of industrial products (i.e., coatings, sealants, fuels, metal-extractants, paints, rubber materials). This study examined the effect of three NSA congeners on freshwater organisms: barium dinonylnaphthalene sulfonate (BaDNS), calcium dinonylnaphthalene sulfonate (CaDNS), and dinonylnaphthalene disulfonic acid (DNDS). Chronic effects were characterized by exposing fertilized fathead minnow eggs to sediment-associated NSAs and measuring various developmental and growth endpoints for 21 d. No effects in hatch success and larval growth were observed when fathead minnow eggs were exposed to CaDNS and DNDS concentrations up to 246 and 798 µg/g dry weight, respectively, in spiked sediment (~2% organic carbon). However, when NSAs were associated with substrate containing no organic carbon (sand), EC50s for fathead minnow hatch success, larval growth, biomass production, and overall survival were 58.3, 18.8, 15.5, and 13.8 µg/L, respectively, for CaDNS. Acute effect characterization was also conducted in water-only exposures for the three NSA congeners using the freshwater amphipod Hyalella azteca, the pulmonate snail Planorbella pilsbryi, and larval freshwater mussels Lampsilis cardium and Lampsilis siliquoidea. The sulfonate salts (BaDNS and CaDNS) were significantly more acutely toxic to all tested invertebrates in the water-only exposures, with LC50s ranging from 0.47 to 12.1 µg/L, compared to DNDS (LC50s ≥ 98.2 µg/L). This is the first study to provide empirical data on the aquatic toxicity of three NSA congeners.

Sub-lethal effects of calcium dinonylnaphthalenesulfonate on Western clawed frog embryos.

Naphthalene sulfonic acids (NSAs) are used as additives in lubricants, dyes, and greases and commonly act as surfactants in many industrial processes. The calcium salt of dinonyl NSA (calcium dinonylnaphthalenesulfonate; CaDNS) is listed among thousands of chemicals identified as priorities for assessment by the Government of Canada's Chemical Management Plan due to the limited toxicity data. The purpose of this study was two-fold: 1) to establish the toxicity of CaDNS to Western clawed frog (Silurana tropicalis) embryos and 2) to assess the sub-lethal effects and mechanisms of toxicity of CaDNS in amphibians through targeted gene expression and metabolite analyses. Frog embryos were exposed to water overlying sand spiked with a range of concentrations of CaDNS (17-1393 µg/g) over a 72-h period. Results indicated significantly higher mortality and presence of malformations in frog larvae exposed to over 672 µg/g CaDNS in the sand (14 ng/mL CaDNS in the water) compared to control treatments. An overall decrease in the glutathione redox cycle was observed, including decreases in relative mRNA levels of enzymes (glutathione S-transferase (gst), glutathione reductase (gsr), glutathione peroxidase (gpx)) and decreases in the glutathione (GSH) and glutathione disulfide (GSSG) metabolite concentrations. In addition, transcript levels of genes involved in antioxidant capacity and essential amino acid metabolites decreased significantly in embryos exposed to low levels of CaDNS. This is the first study to assess the toxicity of NSAs in amphibians, contributing important data to aid in the assessment of NSAs.

Subtotal colectomy and ileorectal anastomosis for slow transit constipation: clinical follow-up at median of 15 years.

BACKGROUND: Slow transit constipation is characterised by prolonged colonic transit and reliance on laxatives. The pathophysiology is poorly understood and in its most severe form, total colectomy with ileorectal anastomosis is the final treatment option. We present a follow-up study of the long-term function in patients who had surgery for laxative-resistant slow transit constipation. METHODS: A postal survey was sent to assess bowel frequency, abdominal pain, St Mark's continence score, satisfaction with procedure, likelihood to choose the procedure again, and long-term rates of small bowel obstruction and ileostomy. Longitudinal data from a subgroup studied 23 years previously are reported. RESULTS: Forty-two patients (male = 2) were available for follow-up out of an initial cohort of 102. Mean time since surgery was 15.9 years (range 1.7-29.7) years. Fifty percent had < 4 bowel motions per day, most commonly Bristol stool 6, mean St Mark's score 7.45. Twenty-one percent had severe incontinence. Satisfaction and likelihood to choose surgery were high (median 10/10). There was a high rate of small bowel obstruction, suggesting pan-intestinal dysmotility in some cases. Conversion to ileostomy occurred in 8 patients. In the longitudinal follow-up in 15 subjects, continence deteriorated (p < 0.01), stool consistency softened (p < 0.01), and stool frequency fell (p < 0.01). CONCLUSIONS: Satisfactory stool frequency was achieved in the long term, and although 21% had incontinence scores > 12, patient satisfaction was high. This is the longest reported follow-up of colectomy for slow transit constipation, with longitudinal outcomes reported. There was considerable attrition of patients, so larger, longitudinal studies are required to better ascertain the functional outcomes of these patients.

First-passage properties of mortal random walks: Ballistic behavior, effective reduction of dimensionality, and scaling functions for hierarchical graphs.

We consider a mortal random walker on a family of hierarchical graphs in the presence of some trap sites. The configuration comprising the graph, the starting point of the walk, and the locations of the trap sites is taken to be exactly self-similar as one goes from one generation of the family to the next. Under these circumstances, the total probability that the walker hits a trap is determined exactly as a function of the single-step survival probability q of the mortal walker. On the nth generation graph of the family, this probability is shown to be given by the nth iterate of a certain scaling function or map q→f(q). The properties of the map then determine, in each case, the behavior of the trapping probability, the mean time to trapping, the temporal scaling factor governing the random walk dimension on the graph, and other related properties. The formalism is illustrated for the cases of a linear hierarchical lattice and the Sierpinski graphs in two and three Euclidean dimensions. We find an effective reduction of the random walk dimensionality due to the ballistic behavior of the surviving particles induced by the mortality constraint. The relevance of this finding for experiments involving travel times of particles in diffusion-decay systems is discussed.

Bioaccumulation of sediment-associated substituted phenylamine antioxidants in Tubifex tubifex and Lampsilis siliquoidea.

Substituted phenylamine antioxidants (SPAs) are additives in a variety of commercial polymers (e.g., lubricants, plastics, etc.). Based on their physicochemical properties, if SPAs were to enter an aquatic system, they would likely partition into sediment and have the capacity to bioaccumulate in biota. This study investigated the potential of four sediment-associated SPAs, diphenylamine (DPA), N-phenyl-1-naphthalene (PNA), N-(1,3-dimethylbutyl)-N'-phenyl-1,4-phenylenediamine (DPPDA), and 4,4'-methylene-bis[N-sec-butylaniline] (MBA) to accumulate in the tissues of freshwater mussels (Lampsilis siliquoidea) and oligochaete worms (Tubifex tubifex). Mussels and worms were exposed to sediment spiked with individual SPAs for 28 d. The concentration of SPAs was measured in the gill, gonad, and remaining viscera of the mussels and entire body of the worms. The majority of biota-sediment accumulation factors (28-d BSAFs) for the different tissues of mussels were < 1. The highest concentrations of SPAs were consistently observed in the gill tissue of mussels relative to the gonad and viscera. The 28-d BSAFs for DPPDA and MBA for worms were < 1, and for DPA and PNA, they ranged from 0.38-2.13 and 1.54-33.24, respectively. The higher 28-d BSAFs observed for worms compared to mussels were likely because worms are endobenthic and feed on sediment-associated organic matter. PNA and DPPDA have similar octanol-water partition coefficients (Kow) but greater 28-d BSAFs were observed for PNA compared to DPPDA for both species. This observation provides evidence that biota may be able to metabolize and/or excrete SPAs with similar physicochemical properties at considerably different rates. The 28-d BSAFs observed for sediment-associated SPAs are lower than those typically required for a chemical to be classified as bioaccumulative.

Effect of substituted phenylamine antioxidants on three life stages of the freshwater mussel Lampsilis siliquoidea.

Substituted phenylamines (SPAs) are incorporated into a variety of consumer products (e.g., polymers, lubricants) in order to increase the lifespan of the products by acting as a primary antioxidant. Based on their physicochemical properties, if SPAs were to enter the aquatic environment, they would likely partition into sediment. No studies to date have investigated the effect of sediment-associated SPAs on aquatic organisms. The current study examined the effect of four SPAs (diphenylamine (DPA); N-phenyl-1-napthylamine (PNA); N-(1,3-dimethylbutyl)-N'-phenyl-1,4-phenylenediamine (DPPDA); 4,4'-methylene-bis[N-sec-butylaniline] (MBA)) on three different life stages of the freshwater mussel, Lampsilis siliquoidea. The viability of larvae (glochidia) of L. siliquoidea and Lampsilis fasciola was assessed after 48 h of exposure to SPAs in water. The 48-h EC50s for glochidia viability of L. siliquoidea were 5951, 606, 439, and 258 µg/L for DPA, PNA, DPPDA, and MBA, respectively, and 7946, 591, 137, and 47 µg/L, respectively, for L. fasciola. Juvenile (7-15 months) and adult L. siliquoidea were exposed to sediment-associated SPAs for 28 d. LC50s for juvenile mussels were 18, 55, 62, and 109 µg/g dry weight (dw) of sediment for DPA, PNA, DPPDA, and MBA, respectively. Adult mussels were exposed to sub-lethal concentrations of sediment-associated SPAs in order to investigate reactive oxygen species (ROS), lipid peroxidation and total glutathione in the gill, gonad, and digestive gland tissue, and viability and DNA damage in hemocytes. No significant concentration-dependent trend in any of these biochemical and cellular endpoints relative to the concentration of sediment-associated SPAs was observed in any tissues. Investigations into the concentration of SPAs in the aquatic environment are required before a conclusion can be made on whether these compounds pose a hazard to the different life stages of freshwater mussels.

Variation in the toxicity of sediment-associated substituted phenylamine antioxidants to an epibenthic (Hyalella azteca) and endobenthic (Tubifex tubifex) invertebrate.

Substituted phenylamine antioxidants (SPAs) are produced in relatively high volumes and used in a range of applications (e.g., rubber, polyurethane); however, little is known about their toxicity to aquatic biota. Therefore, current study examined the effects of chronic exposure (28 d) to four sediment-associated SPAs on epibenthic (Hyalella azteca) and endobenthic (Tubifex tubifex) organisms. In addition, acute (96-h), water-only exposures were conducted with H. azteca. Mortality, growth and biomass production were assessed in juvenile H. azteca exposed to diphenylamine (DPA), N-phenyl-1-napthylamine (PNA), N-(1,3-dimethylbutyl)-N'-phenyl-1,4-phenylenediamine (DPPDA), or 4,4'-methylene-bis[N-sec-butylaniline] (MBA). Mortality of adult T. tubifex and reproduction were assessed following exposure to the four SPAs. The 96-h LC50s for juvenile H. azteca were 1443, 109, 250, and >22 µg/L and 28-d LC50s were 22, 99, 135, and >403 µg/g dry weight (dw) for DPA, PNA, DPPDA, and MBA, respectively. Reproductive endpoints for T. tubifex (EC50s for production of juveniles > 500 µm: 15, 9, 4, 3.6 µg/g dw, for DPA, PNA, DPPDA, and MBA, respectively) were an order of magnitude more sensitive than endpoints for juvenile H. azteca and mortality of adult worms. The variation in toxicity across the four SPAs was likely related to the bioavailability of the sediment-associated chemicals, which was determined by the chemical properties of the SPAs (e.g., solubility in water, Koc). The variation in the sensitivity between the two species was likely due to differences in the magnitude of exposure, which is a function of the life histories of the epibenthic amphipod and the endobenthic worm. The data generated from this study will support effect characterization for ecological risk assessment.

Effect of in ovo supplementation of nano forms of zinc, copper, and selenium on post-hatch performance of broiler chicken.

BACKGROUND AND AIM: Nanoparticles can bypass conventional physiological ways of nutrient distribution and transport across tissue and cell membranes, as well as protect compounds against destruction prior to reaching their targets. In ovo administration of nanoparticles, may be seen as a new method of nano-nutrition, providing embryos with an additional quantity of nutrients. The aim of the study is to examine the effect of in ovo supplementation of nano forms of zinc, copper and selenium on the hatchability and post hatch performance of broiler chicken. MATERIALS AND METHODS: Nano form of zinc at 20, 40, 60 and 80 µg/egg, nano form of copper at 4, 8, 12 and 16 µg/egg and nano form of selenium at 0.075, 0.15, 0.225 and 0.3 µg/egg were in ovo supplemented (18(th) day incubation, amniotic route) in fertile broiler eggs. Control group in ovo fed with normal saline alone was also maintained. Each treatment had thirty replicates. Parameters such as hatchability, hatch weight and post hatch performance were studied. RESULTS: In ovo feeding of nano minerals were not harmful to the developing embryo and did not influence the hatchability. Significantly (p<0.05) best feed efficiency for nano forms of zinc (2.16), copper (2.46) and selenium (2.51) were observed, when 40, 4 and 0.225 µg/egg respectively were in ovo supplemented. Except in nano form of copper at 12 µg per egg which had significantly (p<0.05) highest breast muscle percentage there was no distinct trend to indicate that dressing percentage or breast muscle yield was influenced in other treatments. CONCLUSION: Nano forms of zinc, copper and selenium can be prepared at laboratory conditions. In ovo feeding of nano forms of zinc, copper and selenium at 18(th) day of incubation through amniotic route does not harm the developing embryo, does not affect hatchability.

Delayed refractory hyperventilation following endoscopic third ventriculostomy in a 5-year-old boy.

We present the case of a 5-year-old boy who developed a delayed onset intractable hyperventilation following endoscopic third ventriculostomy. The proposed aetiology of this exceptionally rare phenomenon is discussed. To our knowledge, previous cases have only been reported in the adult population.

Zinc/copper ratio: a predictor of pancreatic function in chronic pancreatitis?

Background: The role of trace elements in the maintenance of normal pancreatic function is unclear. Aim: To estimate trace elements (zinc and copper) in chronic pancreatitis (CP) patients and study their relationship with exocrine and endocrine insufficiency. Methods: The study involved 101 CP patients and 113 healthy controls. Disease characteristics and imaging features were recorded. Erythrocyte zinc (Zn) and copper (Cu) were estimated by flame atomic absorption spectrophotometry. Fecal pancreatic elastase1 was estimated by polyclonal antibody ELISA method as a marker of pancreatic exocrine function. Results: The mean erythrocyte Zn level and Zn/Cu ratio were significantly lower whereas the copper level was significantly higher in CP patients than controls. The mean Zn level and Zn/Cu ratio was significantly lower in CP patients with diabetes and those with low elastase1 as compared to non-diabetics and those with normal elastase1 respectively. Erythrocyte Cu level was significantly higher in CP patients with diabetes and with low elastase1 than those without diabetes and with normal elastase1 levels respectively. There was a significant positive correlation between elastase1 and Zn/Cu ratio (r = 0.396, p < 0.001). Receiver operating characteristic curve (ROC) analysis was performed to predict the development of exocrine insufficiency and it indicated an area under curve (AUC) of 0.838 ± 0.047 (95% CI: 0.746-0.93). The optimal cutoff value was 9.03 (sensitivity 86.5%, specificity 73.5%). When the same was performed to predict the development of diabetes, the AUC was 0.710 ± 0.05 (95% CI: 0.607-0.812). The optimal cutoff value was 7.2 (sensitivity 69.1%, specificity 69.7%). Conclusion: Low erythrocyte Zn/Cu ratio was found to be associated with exocrine and endocrine insufficiency in CP patients.

Two episodes of ventriculoperitoneal shunt migration in a patient with idiopathic intracranial hypertension.

Introduction. Ventriculoperitoneal shunts are often placed as treatment for refractory idiopathic intracranial hypertension. Dislodgement and migration of the distal portion of the shunt are more common in obese patients and can be difficult to detect. We report the case of a woman with two separate episodes of shunt migration into her abdominal wall. Case Presentation. We report a case of a 37-year-old female with history of obesity eventually diagnosed with idiopathic intracranial hypertension (IIH) as the cause. She failed outpatient therapy and, through neurosurgery, had a VP shunt placed for symptom control. She had subsequent development of worsened symptoms that were found to be due to shunt migration. This happened not once but twice to the same patient. Conclusion. Shunt dislodgement, migration, and subsequent failure are common in obese patients who have shunts placed for IIH. The medical provider should maintain a high index of suspicion for shunt malfunction in these patients, particularly because clinical evaluation may be challenging due to habitus.

Analytic expression for the mean time to absorption for a random walker on the Sierpinski fractal. III. The effect of non-nearest-neighbor jumps.

We present exact, analytic results for the mean time to trapping of a random walker on the class of deterministic Sierpinski graphs embedded in d≥2 Euclidean dimensions, when both nearest-neighbor (NN) and next-nearest-neighbor (NNN) jumps are included. Mean first-passage times are shown to be modified significantly as a consequence of the fact that NNN transitions connect fractals of two consecutive generations.

Benefits of combined modality treatment of Merkel cell carcinoma of the head and neck: single institution experience.

BACKGROUND: There is ongoing debate surrounding the roles of surgery and adjuvant radiotherapy in the management of primary and recurrent Merkel cell carcinoma of the head and neck. This study assessed the influence of local excision, margin status, adjuvant radiotherapy and chemotherapy on locoregional recurrence and survival. METHOD: A retrospective review of 54 consecutive cases of head and neck Merkel cell carcinoma at a single institution. RESULTS: Median disease-specific survival time was 120 months. Forty-four per cent of patients developed locoregional recurrence. Combined treatment with surgery and locoregional radiotherapy improved diseasespecific survival. Radiotherapy was associated with longer time to recurrence and regional recurrence. Irradiation of the regional nodes improved regional control, irrespective of clinical status. Margin-negative excision was not associated with improved local control. Combined modality treatment of recurrent disease resulted in a four-fold improvement of local control, but small numbers prevented this trend from reaching statistical significance. CONCLUSION: Surgical excision of the primary disease and clinically involved regional nodes, plus adjuvant radiotherapy to the surgical bed and regional nodes are recommended for all patients with Merkel cell carcinoma of the head and neck, irrespective of clinical status. Recurrent disease should be aggressively treated with combined modality treatment.

Short versus long-acting local anaesthetic in open carpal tunnel release: which provides better preemptive analgesia in the first 24 hours?

Open carpal tunnel release is commonly performed under local anaesthesia. No study has compared intra-operative short- versus long-acting local anaesthetics as preemptive analgesics in carpal tunnel surgery. In this single-blinded prospective study, 100 consecutive carpal tunnel releases were performed by a single surgeon at one institution with either lignocaine (n = 50) or ropivacaine (n = 50). Allocation was performed via the method of alternation. Subjects were given a questionnaire to answer the following: (1) time to first incidence of pain, (2) quality of first night's sleep, and (3) mean numerical pain scores in the first 24 hours. The time to the first postoperative pain was significantly shorter in the lignocaine group (5.58 vs. 9.17 hours, p < 0.035). There were no significant difference in the incidence of poor first night's sleep (16% vs. 26%, p = 0.28) or mean pain scores in the first day (3.6 vs. 2.9, p = 0.16). Existing evidence advocates for long-acting intraoperative local anaesthetic because it results in a longer duration of postoperative analgesia, however, our study suggests that it may also result in a poorer first night's sleep.