An in vivo study on the effect of scaffold geometry and growth factor release on the healing of bone defects.

The hypothesis of this study was that the extent of bone regeneration could be enhanced by using scaffolds with appropriate geometry, and that such an effect could be further increased by mimicking the natural timing of appearance of bone morphogenetic proteins BMP-2 and BMP-7 after fracture. Bioplotted poly(ε-caprolactone) (PCL) disks with four different fibre organizations were used to study the effect of 3D scaffold architecture on the healing of bone defects in a rat pelvis model. Moreover, one PCL construct was further modified by introducing a nanoparticulate sequential BMP-2/BMP-7 delivery system into this scaffold. Scaffolds and functionalized construct along with free nanocapsules were implanted using a rat iliac crest defect model. Six weeks post-implantation, the defects were evaluated by CT scan and histology. Analysis revealed that the basic architecture, having the highest pore volume for tissue ingrowth, presented the highest bone formation as determined by the bone mineral density (BMD) within the defect (144.2 ± 7.1); about four-fold higher than that of the empty defect (34.9 ± 10.7). It also showed the highest histological analysis scores with a high amount of bone formation within the defect, within the scaffold pores and along the outer surfaces of the scaffold. The basic scaffold carrying the BMP-2/BMP-7 delivery system showed significantly higher bone formation than the growth factor-free basic scaffold at 6 weeks (BMD 206.8 ± 15.7). Histological analysis also revealed new bone formation in close to or in direct contact with the construct interface. This study indicates the importance of open and interconnecting pore geometry on the better healing of bone defects, and that this effect could be further increased by supplying growth factors, as is the case in nature.

Preliminary report on surgical mask induced deoxygenation during major surgery.

OBJECTIVES: This study was undertaken to evaluate whether the surgeons' oxygen saturation of hemoglobin was affected by the surgical mask or not during major operations. METHODS: Repeated measures, longitudinal and prospective observational study was performed on 53 surgeons using a pulse oximeter pre and postoperatively. RESULTS: Our study revealed a decrease in the oxygen saturation of arterial pulsations (SpO2) and a slight increase in pulse rates compared to preoperative values in all surgeon groups. The decrease was more prominent in the surgeons aged over 35. CONCLUSIONS: Considering our findings, pulse rates of the surgeon's increase and SpO2 decrease after the first hour. This early change in SpO2 may be either due to the facial mask or the operational stress. Since a very small decrease in saturation at this level, reflects a large decrease in PaO2, our findings may have a clinical value for the health workers and the surgeons.

Preliminary report on surgical mask induced deoxygenation during major surgery

Objetivos. Este estudio se realizó para determinar si la saturación de oxígeno del cirujano se afectaba por el uso de la mascarilla, durante intervenciones de larga duración .Métodos. Se hizo un estudio longitudinal y prospectivo en 53 cirujanos con medidas de la hemoglogina realizadas con un oxímetro para medir la saturación del pulso arterial. Se hicieron estudios antes y después de la operación. Resultados. Nuestro estudio puso de manifiesto una disminución de la saturación de oxígeno de las pulsaciones arteriales (SpO2) y un ligero aumento de las pulsaciones en comparación con el estado preoperatorio en todos los grupos de cirujanos. La disminución era mayor en el grupo de edad superior a los 35 años. Conclusiones. Según nuestros hallazgos, el ritmo del pulso aumenta y la concentración de SpO2 disminuye después de la primera hora de la operación. Este cambio temprano de SpO2 puede deberse a la mascarilla o al estrés de la intervención. Puesto que un ligero descenso en la saturación a este nivel refleja una mayor disminución de la PaO2, nuestros datos pueden tener un valor clínico para la salud del personal sanitario y para los cirujanos

Objectives. This study was undertaken to evaluate whether the surgeons' oxygen saturation of hemoglobin was affected by the surgical mask or not during major operations. Methods. Repeated measures, longitudinal and prospective observational study was performed on 53 surgeons using a pulse oximeter pre and postoperatively. Results. Our study revealed a decrease in the oxygen saturation of arterial pulsations (SpO2) and a slight increase in pulse rates compared to preoperative values in all surgeon groups. The decrease was more prominent in the surgeons aged over 35.Conclusions. Considering our findings, pulse rates of the surgeon's increase and SpO2 decrease after the first hour. This early change in SpO2 may be either due to the facial mask or the operational stress. Since a very small decrease in saturation at this level, reflects a large decrease in PaO2, our findings may have a clinical value for the health workers and the surgeons

Can facet joint infiltrative analgesia reduce postoperative pain in degenerative lumbar disc surgery?

OBJECTIVE: Perioperative analgesia effects the postoperative course of pain. The purpose of this study was to evaluate its possible relation with the consumption of dolantine and analgesics and the facet-induced pain and postoperative pain score in degenerative disc surgery. METHODS: We employed perioperative intra- and perifacet bupivacaine infiltration technique to reduce the postoperative pain after lumbar disc surgery. The study was randomized and observer blinded enrolling 40 American Society of Anesthesiologists physical status class I-II patients scheduled for elective degenerative lumbar disc surgery. The patients were divided into two groups of 20 of which Group 1 underwent injection of bupivacaine into the subcutaneous and muscular layers around the incision site, while Group 2 underwent additional intra- and perifacetal joint infiltration. Postoperatively, the patients were provided with a programmed patient-controlled pump which was only activated on demand to infuse dolantine for the next 24 hours. In the postanesthesia care unit the delay for analgesia and the dose of dolantine used were recorded. RESULTS: There was no statistical significance between these two groups regarding postoperative visual analoque scale scores. The time before the first analgesic request was significantly longer in facet group (p= 0,006). The cumulative dolantine dose was also significantly lower in the facet group (p= 0,001). CONCLUSION: The results indicate that facet joint infiltrative analgesia may have an effect on the postoperative analgesic requirement and reduce the dolantine consumption.

VACTERL-H associated with central hypothyroidism: a case report.

The VACTERL-H syndrome is a rare combination of vertebral anomalies, anal atresia, congenital heart defects, tracheo-esophageal fistula, abnormalities of kidneys and limb anomalies together with hydrocephalus. This condition is recognized as a hereditary entity with poor prognosis. We present a newborn weighing 3400 g, born by cesarean section to a 27 years old mother who had had an irregular antenatal follow-up. The patient had severe hydrocephalus, proximal esophageal atresia and distal tracheoesophageal fistula, gastric outlet obstruction, imperforated anus and recto-urethral fistula, patent ductus arterious, a bifid scrotum, a vertebral defect, sacral dimple and central hypothyroidism. The patient had no limb defects. The association of central hypothyroidism and VACTERL-H has previously not been reported.

Ganglioglioma with lytic skull lesions: a case report.

Gangliogliomas represent only 0.4% of central nervous system neoplasms and 1.3% of brain tumors. They are benign neoplasms with low morbidity and mortality and the patients usually present with seizures, but there has been no adult ganglioglioma with lytic skull lesion. A 49-year-old right handed woman suffering from generalized epileptic seizures was admitted to our hospital. She had also left hemiparesis with 4/5 motor strength. Magnetic resonance imaging and immunohistochemical studies revealed WHO Grade II ganglioglioma. Skull X-ray showed the lytic skull lesions. We have to consider gangliogliomas in the differential diagnosis of lytic skull lesions.

Ganglioglioma with lytic skull lesions: a case report

Los gangliocitomas representan sólo el 0'4% de lostumores del sistema nervioso y el 1'3% de los tumorescerebrales. Son tumores benignos con baja mortalidad ymorbilidad y los pacientes solían presentarse con crisiscomiciales. Nunca se ha presentado un ganglioglioma enel adulto acompañado de lesión lítica craneal.Presentamos el caso de una mujer de 49 años,diestra, que había presentado crisis generalizadascon hemiparesia izquierda. La RM y el estudiohistopatológico mostraron un ganglioglioma grado II enla clasificación de la OMS y las Rx de cráneo revelaronlesiones líticas, por lo que consideramos que este tumordebe entrar en la lista del diagnóstico diferencial de laslesiones líticas craneales

Gangliogliomas represent only 0.4% of central nervoussystem neoplasms and 1.3% of brain tumors. They arebenign neoplasms with low morbidity and mortalityand the patients usually present with seizures, but therehas been no adult ganglioglioma with lytic skull lesion.A 49-year-old right handed woman sufferingfrom generalized epileptic seizures was admittedto our hospital. She had also left hemiparesis with4/5 motor strength. Magnetic resonance imaging andimmunohistochemical studies revealed WHO GradeII ganglioglioma. Skull X-ray showed the lytic skulllesions.We have to consider gangliogliomas in the differentialdiagnosis of lytic skull lesions

Spontaneous regression of cervical disc herniations.

The spontaneous regression of cervical disc herniations is a rare occurrence. Six herniated cervical discs that had regressed spontaneously are presented. All radiological disc regressions correlated well with clinical improvements. We want to underscore the potential for regression that should be considered in the evaluation and management of any patient with a herniated cervical disc.

Tracing the dural tail with image-guided surgery.

OBJECTIVE: The extent of dural resection is important for preventing recurrence in meningioma management. An image-guidance assisted technique is described to perform adequate dural resection. METHODS: A universal instrument adapter system for image-guidance was used to track the dural extension of the meningioma accurately. RESULTS: The universal instrument adapter offers the surgeon the possibility to image-guide nearly any rigid instrument via the computed calibration method. In this way a surgical marking pen was used to chase and adequately mark the "dural tail". DISCUSSION: Image-guidance systems can be used to avoid incomplete resection of the affected dura that may be responsible for tumour recurrence.

Ceftriaxone-induced symptomatic pseudolithiasis mimicking ICP elevation.

In neurosurgery, ceftriaxone is a widely used, third generation cephalosporin for the treatment of CNS infections and perioperational prophylaxis. Recent studies have demonstrated that ceftriaxone induces reversible precipitates in the gallbladder. This complication is referred to as "biliary pseudolithiasis", and it has symptoms similar to the raised intracranial pressure (ICP) symptoms of the perioperative period. Symptomatic biliary pseudolithiasis should be kept in mind in all pediatric neurosurgery cases under ceftriaxone therapy in order to prevent unnecessary postoperative investigations and surgery.

Pott's puffy tumor of the vertex years after trauma in a diabetic patient: case report.

Pott's puffy tumor is a rare clinical entity characterized by subperiosteal abscess associated with osteomyelitis. It is usually seen as a complication of frontal sinusitis or trauma. This is the unique report of a Pott's puffy tumor located over the vertex of a type 1 diabetic patient with an unusual latency of 14 years following injury. A 27-year old man presented with pain and a soft swelling on his vertex. Magnetic resonance imaging demonstrated subperiosteal abscess in the vertex region associated with dural thickening and perisinusal irregularities of epidural space. Further history revealed that he had a trauma to the same location when he was 13 years old. Considering possible complications due to proximity of the lesion to the sagittal sinus, we retrained from aggressive surgical interventions. We treated our patient with a simple surgical abscess drainage followed by prolonged use of antibiotics and achieved complete therapy. The cellular and humoral elements of the immune system may be disrupted in diabetic patients resulting in such atypical courses and complications of infections. We want to emphasize both importance of the prompt diagnosis of Pott's puffy tumor as intracranial invasion may cause severe neurologic problems, and importance of a surgical intervention tailored for the individual lesion.

Pott’s puffy tumor of the vertex years after trauma in a diabetic patient: case report

El tumor “hinchado” de Pott es una entidad rara, caracterizada por un absceso subperióstico asociado a una osteomielitis. Se ve habitualmente como una complicación de sinusitis frontal o de un traumatismo. Esta es la única comunicación de un tumor hinchado de Pott localizado en el vértex craneal de un paciente diabético con una latencia, poco habitual, de 14 años. Se presenta el caso de un varón de 27 años con dolor e hinchazón en el vértex. La resonancia magnética demostró un absceso subperióstico en la región del vértex, asociado a un engrosamiento de la duramadre e irregularidades en torno al seno longitudinal superior, en el espacio epidural. En la historia posterior se recogió que había sufrido un traumatismo en la misma localización cuando tenía 13 años. Al considerar las posibles complicaciones, debido a la proximidad de la lesión al seno sagital, nos abstuvimos de un tratamiento quirúrgico muy agresivo. Tratamos al paciente con un drenaje simple del absceso, seguido de un tratamiento prolongado con antibióticos y se consiguió la curación completa. Los elementos celulares y humorales del sistema inmunológico pueden estar alterados en los pacientes diabéticos, lo cual da lugar a evoluciones atípicas y a complicaciones infecciosas. Queremos poner de relieve la importancia de un diagnóstico precoz de un absceso de Pott, puesto que la invasión intracraneal puede dar lugar a graves problemas neurológicos, y la importancia de una intervención quirúrgica adecuada a cada tipo de lesión

Pott’s puffy tumor is a rare clinical entity characterized by subperiosteal abscess associated with osteomyelitis. It is usually seen as a complication of frontal sinusitis or trauma. This is the unique report of a Pott’s puffy tumor located over the vertex of a type 1 diabetic patient with an unusual latency of 14 years following injury.A 27-year old man presented with pain and a soft swelling on his vertex. Magnetic resonance imaging demonstrated subperiosteal abscess in the vertex region associated with dural thickening and perisinusal irregularities of epidural space. Further history revealed that he had a trauma to the same location when he was 13 years old. Considering possible complications due to proximity of the lesion to the sagittal sinus, we retrained from aggressive surgical interventions. We treated our patient with a simple surgical abscess drainage followed by prolonged use of antibiotics and achieved complete therapy. The cellular and humoral elements of the immune system may be disrupted in diabetic patients resulting in such atypical courses and complications of infections. We want to emphasize both importance of the prompt diagnosis of Pott’s puffy tumor as intracranial invasion may cause severe neurologic problems, and importance of a surgical intervention tailored for the individual lesion

Spontaneous resolution of "protruded" lumbar discs.

Decreasing size of disc material that has herniated, whether "contained" or "protruded" has previously been described and sometimes this can be so complete that residual material is barely visible. In a retrospective clinical survey, from among almost 2180 consecutive patients admitted during 1994 - 2002 with low back pain; due to our low follow-up ratios and high price of the magnetic resonance imaging (MRI), only 42 patients with a lumbar disc protrusion could be found who had two MRI scans obtained at least five weeks apart. Among these, 4 patients were spotted with a totally resolved disc protrusion. T (2)-weighted MRI images were suggesting shrinkage due to dehydration and regression within the annulus of protruded disc fragments that had not fully migrated. Our patients are further examples for total resolution of the large "protruded" disc without any treatment; and since concomitant disc protrusions at other levels persisted, the resolution of these discs is supposed to be spontaneous.

Diagnostic value of bed-side ultrasonographic evaluation by anterior approach in spine disorders? A preliminary report.

A preliminary investigation was planned so as to evaluate the effectiveness of ultrasonography for bed- side evaluation of patients with suspected spinal pathology. Its application by anterior approach in 37 cases showed that herniated disc material, bone, epidural fat, scar tissue, tumoral masses and their relation to the interspace and dural sac could be visualized. A short description of the sonographic appearance of normal and pathological structures was also given in comparison to Computed Tomography or Magnetic Resonance images. Ultrasonographic examination was inadequate in five of the patients due to obesity, meteorism or diminution of the intervertebral disc space. Advantages of this technique are the availability almost in every hospital, the ease of obtaining images at various angles, avoiding the use of x-rays and the low price. The disadvantages are its relatively poor definition as compared to Computed Tomography or Magnetic Resonance Imaging and its inability to see through bone.

Utilidad diagnóstica de la ultrasonografía empleada en la cabecera del enfermo para evaluar la patología raquimedular por vía anterior / Diagnostic value of bed-side ultrasonographic evaluation by anterior approach in spine disorders? A preliminary report

Se propuso hacer una investigación para valorar la efectividad de la exploración de la patología espinal con ultrasonografía, en la propia cama del paciente. En una exploración por vía anterior, se estudiaron 37 pacientes y se pudo observar la hernia de disco, el hueso, la grasa epidural, tejido cicatricial, tumores y su relación con el saco dural y con el interespacio. Se hace una descripción somera del aspecto ecográfico, tanto de la imagen normal como de la patológica, comparándola con estudios de TAC o RM. El examen con ultrasonografía no fue fiable en cinco casos, debido a obesidad, meteorismo o disminución del espacio distal. Entre las ventajas de esta técnica destaca su disponibilidad en casi todos los hospitales, la posibilidad de obtener imágenes en cualquier ángulo, la ausencia de radiaciones y el bajo precio. Las desventajas son la definición pobre, en relación con la TAC y RM y la imposibilidad de obtener imágenes a través del hueso (AU)

Atrophic and regenerative changes in rabbit mimic muscles after lidocaine and bupivacaine application.

Destruction and denervation atrophy in skeletal muscles caused by the injection of local anaesthetics was investigated by injecting lidocaine or bupivacaine around the rabbit facial nerve to produce facial paralysis. Animals were then sacrificed at 2, 4, 6, and 8 weeks post-injection, and changes in mimic muscle tissue were assessed at each stage by light microscopy and electron microscopy. Atrophic changes were observed at 2-6 weeks after injection, and regeneration started at 6-8 weeks. Compared to bupivacaine, lidocaine caused more dramatic atrophic changes and was associated with slower muscle regeneration.

Long-term degeneration and regeneration of the rabbit facial nerve blocked with conventional lidocaine and bupivacaine solutions.

The alterations due to the long-term degeneration and regeneration of the rabbit facial nerve were investigated. The facial nerve was blocked with conventional lidocaine and bupivacaine solutions. The rabbits were sacrificed and facial nerves were removed 2, 4, 6 and 8 weeks after the administration of normal saline, lidocaine and bupivacaine. The samples were then processed for electron microscopic observation. Degenerations were seen 2-4 weeks after the injection of normal saline, lidocaine and bupivacaine. In the normal saline group the regeneration process was observed after 6 weeks, whereas in the lidocaine and bupivacaine groups this process was first noticed after 8 weeks. In the lidocaine and bupivacaine groups, regeneration was not completed at the end of 8 weeks; however, it was faster in the bupivacaine group. Bupivacaine is therefore suggested as the drug of choice for neural blockade as it caused less damage and a faster regeneration.

Effects of trauma and pain on the acute anterior pituitary hormonal response.

The aim of this study was to compare the effects of trauma and pain on the pituitary gland so as to determine whether pain is a significant component in the general acute hormonal trauma response. Adenohypophysis of rabbits that have undergone either diffuse traumatic brain injury or pain were investigated using immunohistochemistry. The ACTH staining pattern of the pain-administered rabbits was not as strong as the head-trauma-administered group, whereas PRL staining pattern of the former group was not so weak as the later group. As a conclusion, since adrenocorticotrophic hormone and prolactin staining patterns were different in the trauma administered and pain induced groups; it may be postulated that pain alone may not be an important factor in the hormonal response to trauma.

The precise human bioclock, possibly imported.

Contrary to what has long been suggested, the biological clock is not a poor timekeeper. In fact, it has been working in precision for millions of years as a genetically set clock, independent of environmental periodicity. However, as the Earth's rotation has gradually slowed, this internal clock has gone through a relative phase shift. Extrapolating of changes backwards through time shows that the clock was set when mammals first appeared on the planet. Interestingly, primates are the only beings that have a free-running cycle longer than 24 hours. This bioclock may be set by lunar entrainment, or may be set extraterrestrially?

Endoscopy in the 15th century.

The aim of this study was to investigate the contributions of Serefeddin Sabuncuoglu (1385-1468?)--who was born and practiced in Amasya in northern part of central Anatolia--to the field of endoscopy. He was a humble, curious and intelligent surgeon, and also a calligrapher and a miniature artist. This remarkable pioneer used the classification of the Andalusian surgeon, Abdul-Kasim Kalaf Ibni Abbas El Zahravi, known as Albucasis of Cordoba (936-1013); but improved it by adding many important and major new observations and chapters. He described "a thin and hollow tube of almost 35 cm, which was made of silver" and used it to inspect the interior of the bladder.