Comparison of the postoperative effects of the erector spinae plane block and local infiltration analgesia in patients operated with lumbotomy surgery incision: Randomized clinical study.

BACKGROUND: Our aim was to observe the effects of local infiltration analgesia (LIA) or erector spinae plane block (ESPB) methods, which we applied preemptively in patients who were scheduled for surgery with a lumbotomy surgical incision and on intraoperative remifentanil consumption, and to compare the postoperative numerical rating scale (NRS), morphine demand, consumption, and pain degrees. METHODS: Sixty American Society of Anesthesiologists I to III patients aged 18 to 75 years who were due to be operated on with a lumbotomy surgical incision were included in the study. The present study was conducted via prospective, randomized controlled, double-blind trials. After the induction of standard anesthesia, LIA was applied to 30 patients and ESPB was applied to 30 patients preemptively. The dose of remifentanil consumed in the intraoperative period was measured, and the hemodynamic parameters were measured every 5 minutes. Morphine bolus treatment with the postoperative patient-controlled analgesia and rescue analgesia with paracetamol were planned for the patients. Postoperative morphine and additional analgesia consumption, NRS, hemodynamic parameters, and complications were recorded for 48 hours. RESULTS: There was no difference between the groups in terms of demographic and hemodynamic data. The mean consumption of remifentanil was measured as 455 ±â€…165.23 µg in the intraoperative ESPB group and 296.67 ±â€…110.59 µg in the LIA group, and a statistical difference was observed (P = .001). In the postoperative follow-ups, the ESPB group drug consumption and NRS score averages were significantly lower at all times (P = .01; patient-controlled analgesia-morphine, 41.93 ±â€…14.47 mg vs 57.23 ±â€…15.5 mg and additional analgesic-paracetamol: 2.1 ±â€…1.06 vs 4.27 ±â€…1.14 g). The mean duration of additional analgesic intake of the groups was 10.6 ±â€…8.1 in the LIA group, while it was 19.33 ±â€…8.87 in the ESPB group, a significant difference. The patient satisfaction questionnaire was also significantly in favor of ESPB (P = .05). CONCLUSIONS: In conclusion, it has been shown that the intraoperative LIA method is more effective in terms of remifentanil consumption and in controlling pain in operations performed with a flank incision, but the ESPB method provides longer and more effective pain control in postoperative follow-ups.

Efficacy of topical halofuginone in myringotomy patency.

The objective of the study is to determine whether topical halofuginone (HF) application has an impact on prolonging the time for healing of myringotomy incision, and to investigate histopathologic effects of HF on tympanic membrane (TM) in rat model. Forty rats with normal eardrums were involved in this study. The study group and control group consisted of 30 and 10 rats, respectively. A posterior incision 1 mm in diameter was made on healthy eardrums of the rats. Following incision, gelfoam soaked with HF hydrobromide of 30 mg/dl was applied on the perforation in study group, whereas gelfoam soaked with isotonic saline was applied on the perforation in control group. On days 1, 3, 7, 10, 14, 18, 21, 24, 27, and 30, otoendoscopic evaluation of eardrums under general anesthesia was conducted and perforations were screened. A rat of each group was killed in control days and TMs were dissected to evaluate histopathological changes. The average times for patency of perforation in study and control groups were 21.43 and 7.50 days, respectively. The difference was found to be statistically significant (p < 0.05). Histopathological evaluation revealed that HF reduces hyalinisation and fibrosis in eardrum, when compared with the control group. In conclusion, HF significantly delays closure time of myringotomies in rat model. However, this delay may not be enough for recovery of otitis media with effusion.

Histologic analysis of the effects of three different support materials within rat middle ear.

OBJECTIVE: To investigate histologic changes in the mucosa of rat middle ear after implantation of three different support materials. STUDY DESIGN: A prospective, controlled animal study. SUBJECTS AND METHODS: Three types of absorbable materials were implanted into the middle ear cavity of rats: (1) Gelfoam (purified gelatin) (Pharmacia & Upjohn Company, New York, NY), (2) Sepragel (viscoelastic gel composed of cross-linked polymers of hyaluronan) (GENZYME Corp, Ridgefield, NJ), and (3) Nasopore (a biodegradable/fragmentable, synthetic polyurethane foam) (Polyganics, Groningen, The Netherlands). Rats were sacrificed after 3 and 20 days to ascertain early and late histologic changes. The bulla of each rat was excised and prepared for microscopic examination. The histologic changes were evaluated by observation of the middle ear cavity and mucosa in terms of polymorphonuclear leucocytes (PMNL), macrophages, giant cells, fibroblasts and other cells, fibrosis, and remnant materials. RESULTS: The histologic appearance of gelfoam-treated middle ears was characterized by more severe acute inflammation in the short-term and prominent fibrosis in the long-term in comparison with sepragel- and nasopore-treated groups. Nasopore appeared to be prone to remnant formation and reorganization by means of fibroblastic activity. CONCLUSION: Compared with gelfoam, both sepragel and nasopore caused less histologic alterations.

Comparison of paper-patch, fat, and perichondrium myringoplasty in repair of small tympanic membrane perforations.

OBJECTIVE: To compare the effectiveness of paper-patch, fat, and perichondrium myringoplasty in the treatment of chronic tympanic membrane perforations smaller than 3 mm. SUBJECTS AND METHODS: This investigation included 45 patients with chronic tympanic membrane perforations smaller than 3 mm. The patients were equally divided into 3 main groups according to surgical procedures. Each group consisted of 3 subgroups, which had 1-mm, 2-mm, and 3-mm perforations. The patients underwent paper-patch, fat, or perichondrium myringoplasty via transcanal approach under local anesthesia. Healing of perforation, hearing improvement, and complications were investigated. RESULTS: Closure rates of the perforations in the paper-patch, fat, and perichondrium myringoplasty groups were 66.7%, 86.7%, and 86.7%, respectively. There were no statistically significant differences in tympanic membrane closure rates between techniques with regard to size. CONCLUSION: Three techniques were found to be feasible for tympanic membrane perforations smaller than 3 mm.

An uncommon presentation of malignant fibrous histiocytoma of the calcaneus.

Malignant fibrous histiocytoma of bone is the osseous counterpart of the tumor in soft tissue. It is a rare primary bone tumor, and there have been conflicting reports on its grades of malignancy. The appendicular skeleton, especially the femur, is the most common site of involvement, whereas the calcaneus is rarely involved. We describe a primary malignant fibrous histiocytoma of the calcaneal bone in a 21-year-old man. The patient underwent neoadjuvant and adjuvant chemotherapy and below-the-knee amputation, and no local recurrence or metastasis was noted after 2 years of follow-up.

Tissue engineered cartilage on collagen and PHBV matrices.

Cartilage engineering is a very novel approach to tissue repair through use of implants. Matrices of collagen containing calcium phosphate (CaP-Gelfix), and matrices of poly(3-hydroxybutyric acid-co-3-hydroxyvaleric acid) (PHBV) were produced to create a cartilage via tissue engineering. The matrices were characterized by scanning electron microscopy (SEM) and electron diffraction spectroscopy (EDS). Porosity and void volume analysis were carried out to characterize the matrices. Chondrocytes were isolated from the proximal humerus of 22 week-old male, adult, local albino rabbits. For cell type characterization, Type II collagen was measured by Western Blot analysis. The foams were seeded with 1x10(6) chondrocytes and histological examinations were carried out to assess cell-matrix interaction. Macroscopic examination showed that PHBV (with or without chondrocytes) maintained its integrity for 21 days, while CaP-Gelfix was deformed and degraded within 15 days. Cell-containing and cell-free matrices were implanted into full thickness cartilage defects (4.5 mm in diameter and 4 mm in depth) at the patellar groove on the right and left knees of eight rabbits, respectively. In vivo results at 8 and 20 weeks with chondrocyte seeded PHBV matrices presented early cartilage formation resembling normal articular cartilage and revealed minimal foreign body reaction. In CaP-Gelfix matrices, fibrocartilage formation and bone invasion was noted in 20 weeks. Cells maintained their phenotype in both matrices. PHBV had better healing response than CaP-Gelfix. Both matrices were effective in cartilage regeneration. These matrices have great potential for use in the repair of joint cartilage defects.

Comparison of some raspberry cultivars' herbal features by repeated random complete design statistic technique.

The aim of this study was comparatively to examine herbal traits of the cultivars such as Rubin, Summit, Holland Dwarf, Heritage, Tulameen, Aksu Red, Nuburg, Canby and Willamette red raspberries cultivated at Ankara Condition, in the capital of Turkey between 2002 and 2005. According to Repeated Random Complete Design (RRCD) (which was composed of four random plot design experiments) used in the experiment, the effects of cultivar, year and cultivar by year interaction on herbal traits such as the height of shoot, diameter of shoot, number of shoot, fruitfulness of shoot and weight of fruit were further more significant (p < 0.0001). Besides, determination coefficients of RRCD for traits ranged from 95.60 to 99.94% (very-high). As a result, we concluded in Ankara condition that as to herbal traits such as the height of shoot, diameter of shoot, number of shoot, fruitfulness of shoot and weight of fruit, Willamette cultivar were more superior to others. In addition, we can suggest that researchers should analyze using RRCD because Determination Coefficients of RRCD for all traits were much more found.