Evaluation of ultrasound-guided suprazygomatic maxillary nerve block in functional endoscopic sinus surgery for postoperative pain relief: A randomised controlled trial.

Background and Aims: Postoperative pain can impede functional recovery and delay hospital discharge after functional endoscopic sinus surgery (FESS). The study aimed to assess the efficacy of ultrasound (USG)-guided suprazygomatic maxillary nerve block (SZMNB) for postoperative pain in FESS. Methods: Forty-eight adult patients between 18 and 65 years of age with American Society of Anesthesiologists physical status I and II and scheduled to undergo FESS were enroled in this randomised controlled study. Patients were randomly allocated to either receive USG-guided SZMNB with general anaesthesia (n = 24) or general anaesthesia alone (n = 24). The numerical rating scale (NRS) pain score in the immediate postoperative period was recorded as the primary outcome. A total of 24 h postoperative rescue analgesic consumption, surgeon satisfaction score, postoperative haemodynamics, and postoperative complications were noted as secondary outcomes. Results: The median (interquartile range) of the NRS pain score in the immediate postoperative period was 0 (0-0.25)[95% confidence interval (CI): 0, 0.08] in the block group compared to 2 (1.75-3) [95% CI: 1.60, 2.40] in the control group, P < 0.001]. Pain scores were significantly reduced at all time intervals till 24 h after surgery (P < 0.001). None of the patients required rescue analgesia in the block group. In contrast, eight patients required diclofenac 75 mg intravenous as rescue analgesia within 1 h of surgery and ten patients within 1-6 h of surgery in the control group. Other secondary outcomes were comparable between groups (P > 0.05). Conclusion: The USG-guided SZMNB provides excellent postoperative analgesia for patients undergoing FESS without significant side effects.

Arthroscopic Coracoid Transfer in the Lateral Decubitus Position is Safe and Effective at Short-Term Follow-Up.

Purpose: To report on operative and clinical outcomes in a series of shoulders treated with arthroscopic Latarjet performed in the lateral decubitus position. Methods: Patients with shoulders that underwent arthroscopic Latarjet in the lateral decubitus position were identified. Data were retrospectively collected, including patient demographics, operative times, intra- and postoperative complications, and clinical and functional outcomes. Descriptive statistics were performed. Results: Eighteen shoulders in 17 patients were included in the study with a mean follow-up of 14 ± 12.1 months (range, 4-39 months). The mean operative time for all procedures was 132.2 ± 18.0 minutes, and the mean operative time for the first half of the cohort was significantly longer than that of the second half (141.6 ± 14.2 minutes vs 122.8 ± 17.0 minutes, P = .02). There were no intraoperative complications, and no patients required a conversion to open surgery. One patient experienced a recurrent dislocation after a traumatic event but was able to be treated nonoperatively. Preoperative and postoperative patient-reported outcome measures (PROMs) were able to be collected on 8 of 18 patients (44.4%). Although all PROMs demonstrated improvements postoperatively, only the Single Assessment Numeric Evaluation score and American Shoulder and Elbow Surgeons Shoulder Index displayed a statistically significant increase (P < .05). Five of 8 (62.5%) shoulders demonstrated bony fusion on postoperative computed tomography scan. Of those eligible, 100% of patients returned to sport or felt that they could return if they wanted to. Conclusions: The arthroscopic Latarjet is an effective procedure for managing glenohumeral instability and can safely be performed in the lateral decubitus position. Level of Evidence: Level IV, therapeutic case series.

Functional Outcomes and Return to Sport After Cartilage Restoration of the Knee in High-level Athletes.

Articular cartilage injuries of the knee are being observed with increasing frequency in athletes and have proven to be difficult to treat given the limited regenerative ability of cartilage and the potential for progressive joint degeneration. A wide range of surgical treatments such as microfracture, autologous chondrocyte implantation, and osteochondral autograft and allograft have demonstrated promising results in these high-demand individuals. These procedures permit healing of cartilage defects while decreasing pain and restoring function with patient-reported outcomes demonstrating significant improvement at short-, mid-, and long-term follow-up. Most athletes are able to return to play after cartilage restoration of the knee, regardless of the surgical technique used. Although there is a large degree of heterogeneity across the literature and no consensus as to the optimal technique, osteochondral autograft transfer seems to offer the highest rate of return to sport and return to play at preinjury level. However, autologous chondrocyte implantation and osteochondral allograft transplantation are often used for larger defects or salvage after previous procedures, so results may be confounded. In addition, a multitude of factors including patient history, characteristics of the chondral lesion, and postoperative management may affect functional outcomes in athletes.

Patterns of spinal cord injury in automobiles versus motorcycles and bicycles.

STUDY DESIGN: Retrospective case series. OBJECTIVES: To examine the patterns and relative rates of occurrence of spinal cord injury (SCI) in automobiles compared to motorcycles and bicycles. SETTING: Los Angeles County, California. METHODS: A retrospective chart review of SCI consults at Rancho Los Amigos National Rehabilitation Center in Los Angeles County, California between 2003 and 2013 were selected and screened for a mechanism of injury involving a vehicular accident. Chart review was performed to determine neurological levels and extent of impairment, which were graded according to the International Standards for Neurological Classification of Spinal Cord Injury. RESULTS: We identified 398 cases of SCI from 2003 to 2013 that fit the inclusion criteria. Overall, the relative percentages of ASIA impairment scale (AIS) A/B/C/D did not differ statistically across automobiles, motorcycles, or bicycles. When stratified by spinal region, motorcycles had a higher percentage of thoracic SCIs compared to automobiles. Automobiles resulted in more cervical SCIs with few injuries in the lumbar region. Bicycle patterns followed automobiles, not motorcycles. Thoracic SCIs were more likely graded motor complete than cervical or lumbar injuries, regardless of the mechanism. CONCLUSIONS: Automobile, motorcycle, and bicycle related SCIs occur primarily in the cervicothoracic region. SCIs due to motorcycle accidents have a higher predilection for the thoracic region, and there is a statistically higher percentage of motor complete injuries. A higher percentage of cervical SCIs occur as a result of automobile and bicycle accidents. Extrapolations from motor vehicle usage data suggest that the relative rate of occurrence of SCI for motorcycles is higher than for automobiles.

Studies on biogas-fuelled compression ignition engine under dual fuel mode.

Experimental investigation has been carried out to utilize biogas as an alternative source of energy in compression ignition (CI) engine under dual fuel operational mode. Biogas was inducted into the inlet manifold at different flow rates along with fresh air through inlet manifold and diesel was injected as a pilot fuel to initiate combustion under dual fuel mode. The engine performance and emission characteristics of dual fuel operational mode were analyzed at different biogas flow rates and compared with baseline conventional diesel fuel. Based upon the improved performance and lower emission characteristics under the dual fuel operation, the optimum flow rate of biogas was observed to be 2.2 kg/h. The lower brake thermal efficiency (BTE) and higher brake-specific energy consumption (BSEC) were noticed with biogas-diesel fuel under dual fuel mode when compared with neat diesel operation. Test results showed reduced NO x emissions and smoke opacity level in the exhaust tailpipe emissions. However, higher hydrocarbon (HC) and carbon monoxide (CO) emissions were noticed under dual fuel mode at entire engine loads when compared with baseline fossil petro-diesel. Hence, the use of low-cost gaseous fuel such as biogas would be an economically viable proposition to address the current and future problems of energy scarcity and associated environmental concerns.

Steroid vs. Platelet-Rich Plasma in Ultrasound-Guided Sacroiliac Joint Injection for Chronic Low Back Pain.

BACKGROUND: Despite widespread use of steroids to treat sacroiliac joint (SIJ) pain, their duration of pain reduction is short. Platelet-rich plasma (PRP) can potentially enhance tissue healing and may have a longer-lasting effect on pain. OBJECTIVES: To assess the efficacy and safety of PRP compared with methylprednisolone in ultrasound-guided SIJ injection for low back pain. STUDY DESIGN: Prospective randomized open blinded end point (PROBE) study. METHODS: Forty patients with chronic low back pain diagnosed with SIJ pathology were randomly allocated into 2 groups. Group S received 1.5 mL of methylprednisolone (40 mg/mL) and 1.5 mL of 2% lidocaine with 0.5 mL of saline, while Group P received 3 mL of leukocyte-free PRP with 0.5 mL of calcium chloride into ultrasound-guided SIJ injection. Visual analog scale (VAS) scores, Modified Oswestry Disability Questionnaire (MODQ) scores, Short Form (SF-12) Health Survey scores, and complications (if any) were evaluated at 2 weeks, 4 weeks, 6 weeks, and 3 months. RESULTS: Intensity of pain was significantly lower in Group P at 6 weeks (median [interquartile range (IQR)] = 1 [1 to 1] vs. 3.5 [2 to 5]; P = 0.0004) and 3 months (Median [IQR] = 1 [1 to 3] vs. 5 [3 to 5]; P = 0.0002) as compared to Group S. The efficacy of steroid injection was reduced to only 25% at 3 months in Group S, while it was 90% in Group P. A strong association was observed in patients receiving PRP and showing a reduction of VAS ≥ 50% from baseline when other factors were controlled. The MODQ and SF-12 scores were improved initially for up to 4 weeks but deteriorated further at 3 months in Group S, while both the scores improved gradually for up to 3 months in Group P. CONCLUSION: The intra-articular PRP injection is an effective treatment modality in low back pain involving SIJ.

Examining QRS amplitude criteria for electrocardiographic left ventricular hypertrophy in recommendations for screening criteria in athletes.

BACKGROUND: Current guidelines for interpretation of the ECGs of athletes recommend that isolated R and S wave amplitudes that exceed traditional criteria for left ventricular hypertrophy be accepted as a physiological response to exercise training. This is based on training and echocardiographic studies but not on long term follow up. Demonstration of the prognostic characteristics of the amplitude criteria in a non-athletic population could support the current guidelines. OBJECTIVE: To evaluate the prognostic value of the R and S wave voltage criteria for electrocardiographic left ventricular hypertrophy (ECG-LVH) in an ambulatory clinical population. SUBJECTS AND METHODS: The target population consisted of 20,903 ambulatory subjects who had ECGs recorded between 1987 and 1999 and were followed for cardiovascular death until 2013. During the mean follow up of 17 years, there were 881 cardiovascular deaths. RESULTS: The mean age was 43 ± 10, 91% were male and 16% were African American. Of the 2482 (12%) subjects who met the Sokolow-Lyon criteria, 241 (1.2%) subjects with left ventricular (LV) strain had an HR of 5.4 (95% CI 4.1-7.2, p<0.001), while 2241 (11%) subjects without strain had an HR of 1.4 (95% CI 1.2-1.8, p<0.001). Of the 4836 (23%) subjects who met the Framingham voltage criteria, 350 (2%) subjects with LV strain had an HR of 5.1 (95% CI 4.0-6.5, p<0.001), while 4486 (22%) subjects without strain had an HR of 1.1 (95% CI 0.9-1.3, p=0.26). The individual components of the Romhilt-Estes had HRs ranging from 1.4 to 3.6, with only the voltage component not being significant (HR 1.1, 95% CI 0.9-1.5, p=0.35). CONCLUSIONS: This study demonstrates that the R and S wave voltage criteria components of most of the original classification schema for electrocardiographic left ventricular hypertrophy are not predictive of CV mortality. Our findings support the current guidelines for electrocardiographic screening of athletes.

A new electrocardiographic left ventricular hypertrophy prognostic score.

This report determines if the classic Romhilt-Estes score would predict better if points for its components were determined using a Cox hazard model and if the Cornell voltage criteria should replace the original criteria. Of the 20,903 subjects, the mean age was 43 ± 10 years and 90.6% were men. The mean follow-up for the population was 17 years, with 881 cardiovascular deaths; they were tested from 1987 to 1999 and followed until 2013. The new score was created with multipliers based on the Cox hazards of its elements with age bracket and gender included. The Cornell criteria were analyzed individually using Cox hazards with and without adjustments for age, gender, and African-American ethnicity and subsequently incorporated into the new score for analysis. For the new score, all 7 components were significant predictors of cardiovascular mortality with gender producing the greatest hazard ratio (HR) and left axis deviation and QRS duration >110 ms producing the lowest. For the original Romhilt-Estes score, 367 patients (1.8%) met the "definite" cutoff and had an HR of 5.6 (95% confidence interval 4.3 to 7.1). For the new score, 208 patients (1.0%) met the "definite" left ventricular hypertrophy cutoff and had an HR of 13.6 (95% confidence interval 10.8 to 17.3). The Romhilt-Estes had an area under the curve of 0.63, whereas the new score and new score with Cornell voltage both had an area under the curve of 0.7. In conclusion, our modified Romhilt-Estes score with new multipliers and without voltage criteria outperformed the original score.