A comparative study evaluating the role of adductor canal block catheter versus intraarticular analgesic infusion on knee pain and range of motion in the immediate postoperative period: a prospective multicenter trial.

Postoperative pain after total knee arthroplasty (TKA) is an important determinant of hospital stay and rehabilitation and thereby functional outcome. Adductor canal block (ACB) and intraarticular analgesic infiltration through catheters (IAC) are techniques of multimodal analgesia which have shown to control postoperative pain satisfactorily. The aim of this study is to evaluate the efficacy of ACB versus IAC in reducing immediate postoperative pain and thereby allow early rehabilitation. A multicenter quasi-experimental study was conducted on 511 patients undergoing unilateral primary TKA from March 2016 to April 2017 who either received ACB with catheter (Group I, n = 350 patients) or IAC (Group II, n = 172 patients) for postoperative pain control. All the patients were assessed for severity of pain by Visual Analogue Scale at 8, 24, 48, 72 h postoperatively and knee range of motion (ROM) on the day of discharge. There was no significant difference in pain scores on postoperative day (POD) 0 (1.09 ± 0.30 vs. 0.98 ± 0.46, p = 0.45) and POD 1 (1.21 ± 0.45 vs. 1.00 ± 0.00, p = 0.11) and in mean ROM on the day of discharge between ACB and IAC (88.40° ± 7.96° vs. 88.34° ± 5.74°; p = 0.93) groups. This study shows that both ACB and IAC provide satisfactory postoperative analgesia with sparing of quadriceps function and good knee ROM leading to early rehabilitation and reduced hospital with no advantage of one technique over another.

Magnetic resonance imaging findings in brain resulting from high-voltage electrical shock injury of the scalp.

We report a case of high-voltage electrical injury to scalp, focusing on the magnetic resonance imaging (MRI) findings in brain. A 51-year-old male suffered burns to the right side of scalp and loss of consciousness following electric shock. Brain abnormalities were detected on MRI taken 4 days after the insult. Right parietal lobe neuroparenchyma beneath the scalp burn defect demonstrated homogeneous hypointensity on T1-weighted MR images, while T2-weighted images depicted hyperintensity mainly in white matter forming finger-like projections. Follow-up MRI showed that the abnormality had disappeared, indicating that the cerebral edema was reversible.

Resurfacing arthroplasty of the hip for avascular necrosis of the femoral head: a minimum follow-up of four years.

We performed 96 Birmingham resurfacing arthroplasties of the hip in 71 consecutive patients with avascular necrosis of the femoral head. A modified neck-capsule-preserving approach was used which is described in detail. The University of California, Los Angeles outcome score, the radiological parameters and survival rates were assessed. The mean follow-up was for 5.4 years (4.0 to 8.1). All the patients remained active with a mean University of California, Los Angeles activity score of 6.86 (6 to 9). Three hips failed, giving a cumulative survival rate of 95.4%. With failure of the femoral component as the endpoint, the cumulative survival rate was 98.0%. We also describe the combined abduction-valgus angle of the bearing couple, which is the sum of the inclination angle of the acetabular component and the stem-shaft angle, as an index of the optimum positioning of the components in the coronal plane. Using a modified surgical technique, it is possible to preserve the femoral head in avascular necrosis by performing hip resurfacing in patients with good results.

Tailoring fatty food simulants made from solvent mixtures (1): comparison of methanol, ethanol and isopropanol behaviour with polystyrene.

To investigate the use of solvent mixtures as test media replacing olive oil in migration tests, the interaction of polystyrene with mixtures composed of various amounts of tert.butyl acetate (mimicking the ester functions of oil) and of a low molecular weight alcohol (methanol, ethanol and isopropanol as inert co-solvent) was studied, using FTIR. Isopropanol, which has a lesser tendency to form hydrogen bonds in the plastic, can be used as main component of alternative fatty test media, its aggressiveness to polystyrene being tailored by adjusting the concentration of tert.butyl acetate. Concentrations below 20% seem useful on the basis of the mechanism of displacement of the alcohols.

Electroporation of mammalian skin: a mechanism to enhance transdermal drug delivery.

Mammalian skin owes its remarkable barrier function to its outermost and dead layer, the stratum corneum. Transdermal transport through this region occurs predominantly through intercellular lipids, organized largely in bilayers. Electroporation is the creation of aqueous pores in lipid bilayers by the application of a short (microseconds to milliseconds) electric pulse. Our measurements suggest that electroporation occurs in the intercellular lipid bilayers of the stratum corneum by a mechanism involving transient structural changes. Flux increases up to 4 orders of magnitude were observed with human skin in vitro for three polar molecules having charges between -1 and -4 and molecular weights up to slightly more than 1000. Similar flux increases were observed in vivo with animal skin. These results may have significance for drug delivery and other medical applications.