Heterotopic ossification as rare complication of hemiplegia following stroke: two cases.

BACKGROUND: Heterotopic ossification (HO), characterized by new bone formation in the periarticular regions of large joints, is frequently seen after spinal cord injury, traumatic brain injury, burn and trauma. It is a rare complication of hemiplegia following stroke, with a reported incidence of 1% or less. CASE REPORTS: This study reports two unusual presentations of HO: (1) A 56-year-old male with a history of atrial fibrillation on warfarin developed sudden-onset left hemiplegia. Eight months after the event, he was diagnosed with HO of the hip joint including both the affected and unaffected sides. (2) A 55-year-old female with left hemiplegia due to subarachnoid bleeding developed HO on the left hip joint 7 months later. In both cases, spasticity around the hip muscle groups, especially hip flexors, adductors and knee extensors, and limited range of motion accompanied by pain were present. X-ray and pelvic computed tomography revealed HO around the hip joints. After 4 weeks of inpatient rehabilitation, the ranges of hip joint motion improved, without exceeding 10° in the direction of flexion and rotations, and ambulation levels were wheelchair-bound for the first case and dependent on a cane for the second case. CONCLUSIONS: Considering the presented cases, it is suggested that HO should be kept in mind in the differential diagnosis in stroke patients presenting with spontaneous joint pain or limitation. The clinical importance of HO development on both the affected and unaffected sides in post-stroke hemiplegia is emphasized, since it may worsen the patient's functional status.

Prevention of pain on injection of propofol: a comparison of lidocaine with different doses of paracetamol.

BACKGROUND AND OBJECTIVE: The aim of this study was to compare the efficacy of pretreatment with paracetamol 0.5 mg kg(-1), 1 mg kg(-1), 2 mg kg(-1) and lidocaine 0.5 mg kg(-1) for prevention of propofol induced pain. METHODS: In this double-blind, placebo-controlled study, 250 adult patients ASA I or II, scheduled to undergo elective surgery, were randomly assigned into five groups of 50 each. Group P0.5, group P1 and group P2 received 0.5, 1 and 2 mg kg(-1) paracetamol respectively; group L received 0.5 mg kg(-1) lidocaine; and the control group, group C, received isotonic saline pretreatment in the dorsum of the hand, followed by propofol 1 min later. A blinded researcher assessed the patient's pain level via a four-point scale. RESULTS: There were no significant differences in patient characteristics among the groups. The incidence of propofol injection pain in all treatment groups was significantly lower than in the control group (P < 0.001). When the paracetamol 0.5 mg kg(-1) group was compared with both the paracetamol 1 mg kg(-1) group (P < 0.01) and the paracetamol 2 mg kg(-1) group (P < 0.001), significant differences were observed. In the lidocaine 0.5 mg kg(-1) group propofol injection pain was significantly reduced compared with the paracetamol 0.5 mg kg(-1) group (P < 0.01). However, in the paracetamol 2 mg kg(-1) group pain was more significantly reduced than in the lidocaine 0.5 mg kg(-1) group (P < 0.001). In the paracetamol 2 mg kg(-1) group the incidence of pain was significantly less than in paracetamol 1 mg kg(-1) group (P < 0.001). CONCLUSION: When given as venous retention pretreatments 1 min before propofol, paracetamol 1 mg kg(-1) and lidocaine 0.5 mg kg(-1) were equally effective in attenuating pain during intravenous (i.v.) injection of propofol whereas pretreatment with paracetamol 2 mg kg(-1) was shown to be the most effective treatment.

Splenic artery embolization with Ankaferd blood stopper in a sheep model.

PURPOSE: Splenic artery embolization is a minimally invasive therapeutic procedure utilized in a number of disorders. Ankaferd blood stopper (ABS) is a novel hemostatic agent with a new mechanism of action independent of clotting factors. We aimed to investigate the safety and efficiency of ABS for splenic artery embolization in a sheep model. METHODS: Seven adult female sheep were included in the study. Selective celiac angiography was performed using a 5F diagnostic catheter and then a 2.7F hydrophilic coating microcatheter was advanced coaxially to the distal part of the main splenic artery. Under fluoroscopic guidance, 6 mL mixture composed of half-and-half ABS and contrast agent was slowly injected. Fluoroscopy was used to observe the deceleration and stagnation of the flow. Control celiac angiograms were obtained immediately after the embolization. After the procedure, the animals were observed for one day and then sacrificed with intravenous sodium thiopental. RESULTS: Technical success rate was 100%. None of the animals died or experienced a major systemic adverse event during the procedure. All of the spleens appeared dark on macroscopic examination due to excessive thrombosis. Microscopically, the majority of the splenic sinusoids (90%-95%) were necrotic. CONCLUSION: In our study, splenic artery embolization by ABS was found to be safe and effective in the short-term. Further studies are needed to better understand the embolizing potential of this novel hemostatic agent.

A novel modified PAIR technique using a trocar catheter for percutaneous treatment of liver hydatid cysts: a six-year experience.

PURPOSE: We aimed to demonstrate the success and reliability of a novel puncture, aspiration, injection, and reaspiration (PAIR) technique in liver hydatid cysts. METHODS: Percutaneous treatment with ultrasonographic guidance was performed in 493 hepatic hydatid cysts in 374 patients. Patients were treated with a new PAIR technique by single puncture method using a 6F trocar catheter. The results of this novel technique were evaluated with regards to efficacy and safety of the procedure and complication rates. RESULTS: Out of 493 cysts, 317 were Gharbi type I (WHO CE 1) and 176 were Gharbi type II (WHO CE 3A). Of all cysts, 13 were referred to surgery because of cystobiliary fistulization. Recurrence was observed in 11 cysts one month later. Therefore, the success rate of the PAIR technique was 97.7% (469/480). Minor complications (fever, urticaria-like reactions, biliary fistula) were seen in 44 treated patients (12%, 44/374); the only major complication was reversible anaphylactic shock which was observed in two patients (0.5%, 2/374). CONCLUSION: This novel modified PAIR technique may be superior to catheterization by Seldinger technique due to its efficiency, easier application, lower severe complication rate, and lower cost. Further comparative studies are required to confirm our observations.