Postoperative pain relief and functional outcome following total knee arthroplasty - a prospective comparative audit of three analgesic regimes.

Pain control plays a key role in joint-replacement -surgery. As a surgeon the challenge is to reduce pain to an acceptable level in the post-operative period. The aim of the study was to assess the efficacy of bolus -local anaesthesia, infusion in to the surgical site and nerve blocks with femoral nerve catheter and its functional outcome. A prospective audit of 114 patients undergoing total knee arthroplasty were carried out.The patients were divided in to three groups : Group 1 (n = 27) received a bolus injection of 20 ml 0.25% levobupivacaine + 10 ml 0.25%bupivacaine + adrenaline + 30 ml saline. Group 2 (n = 39) received a bolus injection as on group 1 with 240 ml 0.25% bupivacaine infusion and 5 ml/hour using a Pain Buster pump. Group 3 (n = 48) received 30 ml 0.125% levobupivacaine to femoral (3-in-1) block with 30 ml 0.25% levobupivacaine to -sciatic nerve and introduction of a femoral nerve catheter. All patients were prescribed paracetamol 1 g QDS, Oxycontin 20 mg BD and Ibuprofen post -operatively. Pain was assessed with a Visual Analog Scale (VAS). The incidence of PONV was measured by PONY intensity score. The mean post-op VAS score for Group 3 was 4. The demand of oxynorm and NSAID were minimal in Group 3. The mean in patient stay for Group 3 was 3.1 days. The PONV intensity score was > 50 for 9 (36%) in Group 1, 15 (40%) in Group 2 and 9 (20%) in Group 3. There was loss of 20-30 degrees of flexion movements in Group 3 in the first 4 to 6 days post-op. Our study demonstrated that Regime 3 with the use of nerve blocks and femoral nerve catheter has given the maximum pain relief and good functional outcome following total knee replacement.

Reference frames in saccadic targeting.

We attempt to determine the egocentric reference frame used in directing saccades to remembered targets when landmark-based (exocentric) cues are not available. Specifically, we tested whether memory-guided saccades rely on a retina-centered frame, which must account for eye movements that intervene during the memory period (thereby accumulating error) or on a head-centered representation that requires knowledge of the position of the eyes in the head. We also examined the role of an exocentric reference frame in saccadic targeting since it would not need to account for intervening movements. We measured the precision of eye movements made by human observers to target locations held in memory for a few seconds. A variable number of saccades intervened between the visual presentation of a target and a later eye movement to its remembered location. A visual landmark that allowed for exocentric encoding of the memory target appeared in half the trials. Variable error increased slightly with a greater number of intervening saccades. The landmark aided targeting precision, but did not eliminate the increase in variable error with additional intervening saccades. We interpret these results as evidence for a representation that relies on knowledge of eye position with respect to the head and not one that relies solely on updating in a retina-centered frame. Our results allow us to set an upper bound on the standard deviation of an eye position signal available to the saccadic system during short memory periods at 1.4 degrees for saccades of about 10 degrees.

Use of a whole blood substitute, Fluosol-DA 20%, after massive postpartum hemorrhage.

Two patients with severe postpartum hemorrhage refused blood product transfusion for religious reasons. The patients' hemoglobin level had dropped to 3.0% or less after operative intervention, and the cardiac indexes on transfer to the tertiary care center were 8.0 and 7.3 L/minute per m2, respectively. Each received an infusion of Fluosol-DA 20% according to research protocol after obtaining informed written consent. Pulse rates and cardiac outputs dropped after the infusions. They were discharged from the hospital 17 and 15 days later with hemoglobins of 7.0 and 5.1%, respectively. Fluosol-DA 20% may be a useful adjunct for therapy of postpartum hemorrhage in women who refuse blood products for religious reasons.

Topographic classification of deformities of the alveolar process.

A system of nomenclature for deformities of the alveolar process is presented. Descriptive, familiar topographic terms are used (crater, trench, moat, ramp and plane), and specific criteria are given for each term. Two hundred randomly selected osseous deformities in dry skulls were classified by two examiners at independent sessions using the proposed system. One hundred ninety of these defects were given identical descriptions. The nomenclature system is proposed to facilitate communication among practitioners concerning osseous deformities of the alveolar process, as well as to permit comparison of the effectiveness of various therapeutic modalities directed toward bone regeneration in periodontics.

Fetal heart block associated with congenital cytomegalovirus infection. A case report.

A case of fetal heart block occurred that was associated with acute maternal and fetal cytomegalovirus infection. Only a few case reports on fetal cardiovascular abnormalities associated with cytomegalovirus have been published.