Comparison of Lidocaine Gel-Assisted Transconjunctival and Transcutaneous Local Anesthesia for Outpatient Eyelid Surgery.

PURPOSE: Determine whether transconjunctival local anesthesia using 2% lidocaine gel decreases pain perception in comparison with transcutaneous anesthesia in patients undergoing outpatient eyelid surgery. METHODS: This is a randomized controlled clinical trial. This study approved by an institutional review board and adhered to the Declaration of Helsinki and the Health Insurance Portability and Accountability Act. A total of 120 patients undergoing bilateral upper or lower eyelid surgery were enlisted. Topical 2% lidocaine gel was administered to the palpebral conjunctiva for 1 minute, followed by a local transconjunctival injection. Local anesthetic was administered to the contralateral eyelid by a transcutaneous approach without use of topical anesthetic. Both injections were 1 ml of 1% lidocaine with epinephrine 1:100,000 on a 30-gauge needle. After each injection, patients rated the pain on a 0-to-10 visual analog scale. Patients were also asked for preference between the 2 sides. RESULTS: The mean pain scores were 2.33 (standard deviation 0.98) for the transconjunctival side and 3.42 (standard deviation 0.88) for the transcutaneous side. The reduction in pain scores for lidocaine gel-treated sides was statistically significant (p < 0.001) when controlling for side of intervention, upper versus lower eyelid procedures, sex of participants, and type of procedure. In addition, 85% of participants found the transconjunctival injection to be less painful than the transcutaneous (p < 0.001). CONCLUSIONS: Transconjunctival local anesthesia in conjunction with topical anesthesia with 2% lidocaine gel provides a clinically and statistically significant decrease in perceived pain when compared with transcutaneous anesthesia in patients undergoing outpatient eyelid surgery.

Increased preoperative white blood cell count predicts postoperative atrial fibrillation after coronary artery bypass surgery.

OBJECTIVE: To better understand the relationship between humoral and cellular markers of inflammation and postoperative atrial fibrillation (AF). DESIGN: A prospective and descriptive study. SETTING: Academic institution. PARTICIPANTS: Sixty adult patients > or = 60 years of age presenting for elective coronary artery bypass surgery with cardiopulmonary bypass (CPB). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: With institutional review board approval, serial measurements for high sensitivity C-reactive protein (CRP) and white blood cell count (WBC) were performed before the induction of anesthesia, on arrival in the intensive care unit, and on the mornings of postoperative days 1 and 2. Continuous telemetry and daily 12-lead electrocardiographs were used to confirm new-onset AF. AF occurred in 17 of 60 (28%; 95% confidence interval, 17%-41%) patients. A history of preoperative myocardial infarction was more frequent among patients who developed AF (p = 0.049). Patients with or without AF did not differ in CRP values at any of the 4 study time points (p = 0.61 to p = 0.81). Preoperative WBC values were higher for patients who developed AF, and, according to stepwise logistic regression, it was the sole independent predictor of postoperative AF (odds ratio = 6.7; 95% confidence interval, 1.6-29.0; p = 0.01). A 2-fold higher preoperative WBC was associated with a nearly 7-fold higher risk of developing AF, and WBC >7 x 10(9)/L was associated with a nearly 4-fold higher risk of AF (odds ratio = 3.8, p = 0.03). CONCLUSION: In this cohort of patients undergoing CABG surgery, preoperative leukocytosis was a significant predictor of AF independent of CRP.

Atherosclerotic lesions in genetically modified mice quantified in vivo by non-invasive high-resolution magnetic resonance microscopy.

We have previously shown that magnetic resonance microscopy (MRM) accurately quantifies atherosclerosis in Apolipoprotein E deficient (ApoE(-/-)) mice aged 36-84 weeks. The present study tests MRM in the quantification of aortic atherosclerosis over a broader range of lesion severity. Younger mice with less advanced disease were imaged in order to evaluate sensitivity, specificity and maximum practical resolution of MRM. Nineteen mice underwent in vivo MRM. Wall area measurements by MRM and light microscopy (LM) (n=43) were highly correlated (r=0.85, slope=0.88, P<0.0001). Wall areas by MRM ranged from 0.114 to 0.934 (median, 0.334) mm(2). A threshold of 0.35 mm(2), for the upper limit of normal, gave MRM positive predictive value (PPV) for detecting abnormally thickened arteries=89.5% and negative predictive value (NPV)=75%, referred to LM. Lesion shape assessed by LM and MRM were also well correlated (r=0.72, P<0.001). Increased wall area in atherosclerosis was found by MRM (P=0.01) and LM (P<0.0001) to be accommodated entirely by 'positive remodeling', confirming the importance of determining plaque size directly. MRM accurately quantifies mouse aortic atherosclerosis and will enhance studies in this important animal model.

Basic fibroblast growth factor impact on retinoblastoma progression and survival.

PURPOSE: Chemotherapy resistance is a problem in the treatment of advanced retinoblastoma (RB). Since basic fibroblast growth factor (bFGF) is a survival factor for neural precursor cells, bFGF was evaluated as a growth and chemoresistance factor in RB. METHODS: bFGF expression was analyzed in the LH-betaTag transgenic mouse model of RB and human RB cell lines by immunofluorescence, RT-PCR, and Western blot. Proliferation and apoptosis (TUNEL) assays were performed. RESULTS: bFGF levels significantly increased during tumorigenesis in transgenic RB, as a function of tumor status (P = 0.005). PCR and confocal microscopy confirmed that the human cell lines and primary tumors expressed bFGF. bFGF was localized to vascular and tumor cells and rarely to glial cells. Exogenous 18-kDa bFGF induced proliferation in two RB cell lines (WERI and Y79). Western blot analysis demonstrated 34-, 22-, and 18-kDa isoforms in transgenic RB and both cell lines. In TUNEL assays, chemoresistance to carboplatin-induced apoptosis was observed in the Y79 line, which expressed a higher ratio of high (34 kDa)- to low-molecular-weight bFGF isoforms, compared with the WERI line. Similar to other bFGF tumor studies, exogenous low-molecular-weight (18 kDa) bFGF (1 ng) significantly enhanced carboplatin-induced apoptosis in the more chemosensitive WERI, but not the chemoresistant Y79 line. CONCLUSIONS: RB tumors produce significant amounts of bFGF, and the differential production and response to isoforms of bFGF may have implications for invasive tumor growth and chemoresistance.