Influence of suturing material on wound healing - An experimental study on dogs.

BACKGROUND/AIM: The most common materials implanted in the human organism are suture materials that are classified on the basis of several criteria, usually the origin, structure, and properties. The properties of suture materials are related to its absorbability and non-absorbability. When using resorbable materials it is of great importance to determine whether its absorbability and tensile strength help wound healing in function of time. Sutures themselves can become a source of inflammation, that may reduce or compromise the potential of reparation and regeneration. The aim of this experimental study on dogs was to ascertain whether the absorption rate and the degree of local tissue reactions differ from information provided by the manufacturers, whether there are differences between the applied suture materials and which of the used suture materials have better effect on wound healing. METHODS: Experimental testing of the selected suture materials basic characteristics was performed on 6 German Shepherd dogs, which, after induction of general anesthesia, were made 3 identical incisions each in all 4 quadrants (left and right side of the upper and lower jaws), so that 12 horizontal incisions were formed, 10 mm long, 20-25 mm distant from one another, on each animal. Randomly, incisions were stitched up in the following order, starting from back to front: catgut, Dexon®, Vicryl-Rapid®. The experiment was terminated by histopathological examination of tissue samples, taken on postoperative day 3, 7, 14 and 21 in order to identify the effect of healing and the degree of local reaction. RESULTS: The obtained results suggest that catgut has the highest absorption rate, while Dexon® the lowest. Vicryl- Rapid® causes the lowest level of local reactions, while Dexon® the highest. CONCLUSION: There is no ideal suture material because various patient factors also influence the wound healing process.

Ejection experience in Serbian Air Force, 1990-2010.

BACKGROUND/AIM: Ejection injuries are the problem for air forces. The present risk for injuries is still too high, approximately 30-50%. The aim of this study was to determine factors responsible for and contributing to injuries in the Serbian Air Force (SAF) in the last two decades. METHODS: All ejection cases in the SAF between 1990 and 2010 were analyzed. The collected data were: aircraft type, ejection seat generation, pilots" age and experience, causes of ejection, aeronautical parameters, the condition of aircraft control and types of injuries. For ease of comparison the US Air Force Safety Regulations were used to define major injuries: hospitalization for 5 days or more, loss of consciousness for over 5 min, bone fracture, joint dislocation, injury to any internal organ, any third-degree burn, or second-degree burn over 5% of the body surface area. RESULTS: There were 52 ejections (51 pilots and 1 mechanic) on 44 airplanes. The ejected persons were from 22 to 46 years, average 32 years. Major injuries were present in 25.49% cases. Of all the ejected pilots 9.61% had fractures of the thoracic spine, 11.53% fractures of the legs, 3.48% fractures of the arms. Of all major injuries, fractures of the thoracic spine were 38.46%. None of the pilots had experienced ejection previously. CONCLUSION: Our results suggest that taking preventive measures is obligatory. Namely, magnetic resonance imaging (MRL) scan must be included in the standard pilot selection procedure and procedure after ejection, physical conditioning of pilots has to be improved, training on ejection trainer has to be accomplished, too.

Differences in the bioenergetic potential of athletes participating in team sports.

BACKGROUND/AIM: In modern training technology, assessment of aerobic bioenergetic potential in athletes is commonly performed by standard laboratory procedures to determine basic or specific functional abilities for specific sport activity or discipline. The aim of study was to assess the aerobic bioenergetic potential of athletes participating in basketball, football and handball. METHODS: The study included 87 athletes (29 basketball players, 29 football players, and 29 handball players) aged 21-24. Evaluation of the aerobic bioenergetic potential of athletes participating in basketball, football and handball was performed followed by both univariate (ANOVA) and multivariate (MANOVA) statistical methods to determine differences among the athletes in relative (VO2 mL/kg/min) and absolute oxygen consumption (VO2 L/min). RESULTS: Statistically significant differences between absolute and relative oxygen consumption were found in basketball players (Mb), football players (Mf), and handball players (Mh) (MANOVA, p = 0.00). ANOVA also revealed significant differences in relative oxygen consumption (VO2 mL/kg/min) (p = 0.00). The football players (55.32 mL/kg/min) had the highest relative oxygen consumption, followed by the handball players (51.84 mL/kg/min) and basketball players (47.00 mL/kg/min). The highest absolute oxygen consumption was recorded in the basketball players (4.47 L/min), followed by the handball players (4.40 L/min) and footballers (4.16 L/min). CONCLUSION: Statistically significant differences in the aerobic bioenergetic potential, expressed by the relative oxygen consumption were found among atletes participating in different team sports. It can be assumed that the player from the sports in which it is necessary to cross greater distance in total during the match have a greater need for aerobic capacity.

Psychological assessment of persons following suicide attempt by self-poisoning.

BACKGROUND/AIM: Urgent psychiatric help and effective psychotherapeutic treatments are required soon after revival of a person after suicide attempt by self-poisoning. The aim of this article was to define an assessment of actual psychological characteristics of a person after suicide attempt by self-poisoning in order to apply psychotherapeutic crisis intervention after suicide attempt, as well as to show an approach to the treatment guided by the assessment that uses a psychodynamic model of suicidal crisis intervention based on our clinical experience. METHODS: Hamilton Depression Rating Scale (HAMD), Center for Epidemiological Studies-Depression Scale (CES-D), Defensive Questionnaire Scale (DSQ-40), Scaling of Life Events (Paykel), and Pierce Suicide Intent Scale (SIS) were applied in 30 hospitalized persons following suicide attempt by self-poisoning and in 30 patients who had asked for psychiatric examination at the outpatient clinic due to various life crises not resulting in suicide attempt. The examinees of both groups were matched by sex, age, and education, professional and marital status. Comparison of the patient groups was done by the t-test. Logistic regression analysis was used for suicidal risk assessment. RESULTS: The suicide attempters were depressed (HAMD = 22.60 +/- 5.93, CES-D = 29.67 +/- 7.99), with medium suicide risk factor (SIS = 4.5 +/- 4.17), using immature (projection, dissociation, devaluation, acting-out) and neurotic (altruism) defense mechanisms. The most important motives for suicide attempt were separation problems, problems with parents and a problem of loneliness. The commonest feelings and thoughts of a subject preceding suicide attempt were a wish to escape an unbearable situation, loss of control, desire to show love for a partner and wish to be helped. After a suicide attempt, 90% of the persons felt relief because the attempt failed, although almost half of them intend to repeat it. The risk of repeated suicide attempt was 1.8 (90% CI = 0.09-37.70, p < 0.001) times higher if values on the SIS Total Score were increased and 1.62 (90% CI = 0.03-81.39, p < 0.001) times higher if values on the SIS 1 (Circumstances Score) subscale were increased, too. CONCLUSION: Before starting with psychotherapy for persons after suicide attempt by self-poisoning it is very important to define psychological assessment of a person, choose the treatment (out-patient clinic or inpatient/hospital), assess indications for pharmacotherapy and psychotherapy that also must include a selection of patients for application of this therapeutic method. Assessment of conscientious and unconscientious conflicts leading to a suicide attempt represents initial basis for a therapist's work with a patient after suicide attempt and for application of psychotherapeutic crisis intervention.

Effect of transcutaneous electrical nerve stimulation for the management of postoperative surgical pain after lower extremity amputation: a pilot study / Efeito da estimulação elétrica nervosa transcutânea (TENS) no tratamento de dor pós-cirúrgica após amputação de membro inferior: estudo piloto

A estimulação elétrica nervosa transcutânea (TENS) é uma modalidade não-médica e não-invasiva. Há muita controvérsia e atitudes contrárias em relação ao lugar que a TENS ocupa no tratamento da dor após amputação de membro inferior. Objetivo: Avaliar o papel da TENS no tratamento de dor cirúrgica pós-operatória após amputação de membro inferior. Material e métodos: Teste controlado randomizado, conduzido com 46 indivíduos submetidos à amputação de membro inferior, que foram aleatoriamente divididos em grupo controle e grupo tratado. O grupo controle recebeu cuidados-padrão no pós-operatório; o grupo tratado recebeu cuidados-padrão e aplicação de TENS. Quarenta indivíduos completaram efetivamente o estudo de acordo com o protocolo de estudo. A maior parte das amputações consistiu de amputação transtibial devido a complicações da diabete. Foram utilizados cinco dispositivos portáteis Ultima TENS XL-A1 com eletrodos auto-adesivos. Esta é a aplicação convencional da TENS, caracterizada pela aplicação de impulsos elétricos com a duração de 200 microssegundos, freqüência de 110 Hz e amplitude de 44 V. O tratamento foi administrado durante 10 dias, 2 horas por dia. A avaliação da eficácia da TENS foi feita utilizando-se a escala visual analógica (EVA) horizontal (0-100 mm). O teste t de Student foi usado na análise estatística. Resultados: A intensidade da dor estava significantemente diminuída em ambos os grupos no 10º dia em comparação ao 1º dia de pós-operatório. Não houve diferenças significantes entre o grupo controle (EVA = 4,18±1,48) e o grupo tratado (EVA= 3,59±1,44), de acordo com a intensidade média diária da dor (t = 1,25; df=38). A intensidade da dor no 10º dia de pós-operatório foi significantemente menor no grupo tratado (EVA = 1,65± 0,80 ) versus o grupo controle (EVA = 3,2± 1,15; t = 5; df = 38; p< 0,01 ). Conclusão: A TENS convencional (dose: 200 microssegundos, 110 Hz, 44 V), administrada 2 horas por dia, durante 10 dias, significantemente reduziu a dor cirúrgica pós-operatória em 20 indivíduos com amputação de membro inferior.

Transcutaneous electrical nerve stimulation (TENS) is a noninvasive, nonmedical modality. There are a lot of dilemmas and opposing attitudes regarding the use of TENS in pain management after lower limb amputations. Objective: To establish the role of TENS for the management of postoperative surgical pain after lower limb amputations. Material and methods: Randomized controlled trial, which included forty-six subjects who had undergone lower limb amputations, randomly divided into control and treatment group. The control group received standard postoperative care, whereas the treatment group received standard postoperative care plus TENS. Forty subjects successfully completed the study according to the study protocol. The majority of the individuals had undergone transtibial amputation due to complication of diabetes. Five Ultima TENS XL-A1 portable devices with four self-adhesive electrodes were used. This was the conventional TENS mode, characterized by the delivery of electrical impulses with a duration of 200 microseconds, frequency of 110 Hz, and amplitude of 44V. Treatment was carried out for 2 hours a day, during 10 days. The evaluation of TENS efficacy was performed using the horizontal VAS (0-100 mm). Student T test was used in the statistical analysis. Results: Pain intensity was significantly diminished in both groups at the tenth in comparison with the first postoperative day. There was no significant difference between the control (VAS = 4.18±1.48) and the treatment group (VAS= 3.59±1.44) according to the daily mean pain intensity (t = 1.25; df =38). Pain intensity on the tenth postoperative day was significantly lower in the treatment (VAS = 1.65± 0.80) when compared with the control group (VAS = 3.2± 1.15; t = 5; df = 38; p< 0.01). Conclusion: Conventional TENS (dose: 200 microseconds, 110 Hz, 44V), administered two hours a day during ten days, significantly reduced postoperative surgical pain in twenty subjects who had undergone lower limb amputations.