Effects of sugammadex and rocuronium mast cell number and degranulation in rat liver.

We investigated the effect of rocuronium- and sugammadex-induced mast cell increase and degranulation in rat portal triads. Forty-two rats, in six groups, received either rocuronium 1 mg.kg(-1); sugammadex 15 mg.kg(-1); sugammadex 100 mg.kg(-1); rocuronium 1 mg.kg(-1) and 5 min later, sugammadex 15 mg.kg(-1); rocuronium 1 mg.kg(-1) and 5 min later, sugammadex 100 mg.kg(-1); or isotonic saline. Total mast cell numbers were significantly higher with rocuronium only, than in all other groups (p<0.003), although in all active groups, the number was greater than the control. Total mast cell number was significantly higher with rocuronium and low-dose sugammadex compared with low-dose sugammadex only. The number of tryptase-positive mast cells with rocuronium only was significantly higher than in all other groups (p<0.003). Tryptase-positive mast cell numbers in both groups receiving both rocuronium and sugammadex were significantly higher compared with both groups receiving sugammadex only. Rocuronium increased mast cell numbers, and degranulation was mitigated by sugammadex. These results suggest that sugammadex may be beneficial in treatment of rocuronium-induced anaphylaxis.

The management of cubitus varus and valgus using the Ilizarov method.

Cubitus varus and valgus are the most common complications of supracondylar and lateral condylar fractures. Various combinations of osteotomy and fixation have been described to correct these deformities but each is associated with significant complications. In this study, we used distraction osteogenesis and Ilizarov frame fixation to treat 24 elbows in 23 patients with cubitus varus or valgus. Their clinical outcome was evaluated using the protocol of Bellemore et al. The mean time to follow-up was 18.3 months (10 to 36) and the mean time to frame removal was 13.5 weeks (8 to 20). The mean carrying angle was corrected from -18.7 degrees (-10 degrees to -30 degrees ) to 6.1 degrees (2 degrees to 10 degrees ) in patients with cubitus varus and from 36.5 degrees (25 degrees to 45 degrees ) to 9.4 degrees (4 degrees to 15 degrees ) in patients with cubitus valgus. There were 18 excellent and six good results. The Ilizarov method with gradual distraction is a safe, stable, adjustable and versatile method of treating deformities at the elbow without the problems of an unsightly scar or limited range of movement, and gives a good clinical and radiological outcome. Tardy ulnar nerve palsy should be treated first by anterior transposition.

Reversal of neuromuscular blockade with sugammadex or neostigmine/atropine: Effect on postoperative gastrointestinal motility.

STUDY OBJECTIVE: To compare sugammadex with conventional reversal of neuromuscular block in terms of postoperative gastrointestinal motility. DESIGN: Double blinded, randomized, controlled clinical trial. SETTING: Operating room, postoperative recovery area. PATIENTS: Seventy-two patients with ASA physical status I or II, scheduled for total thyroid surgery were studied. INTERVENTIONS: When 4 twitches were observed on train-of-four stimulation, neuromuscular block was reversed conversatively in the control group, and with sugammadex in the study group. MEASUREMENTS: Time to first flatus and feces, incidence of postoperative nausea, vomiting, diarrhea and constipation were collected. MAIN RESULTS: Median time of first flatus was 24 hours (18-32 [10-36]) in the neostigmine group, and 24 (18-28 [12-48]) in the sugammadex group (P > .05). Median (IQR) time of first feces was 24 hours (18-36 [10-48]) in neostigmine group, 32 hours (28-36 [12-72]) in sugammadex group (P > .05). There were no occurrences of nausea, vomiting, diarrhea, or constipation. CONCLUSIONS: Sugammadex may be safely used in cases where postoperative ileus is expected.

Mesh repair of a pelvic bone defect caused by a migrated acetabular cup.

Conventional transacetabular removal of the migrated acetabular cup can be hazardous due to intraoperative injury to iliac vessels. We present a case of a migrated acetabular cup, in which we used a combined preperitoneal and acetabular approach for its removal. With a bimanual approach, the procedure was safer and easier and allowed mesh repair of the pelvic bone defect. The preperitoneal mesh repair is a well-known method for inguinofemoral hernias. However, it has not been used before in the repair of an acetabular defect after removal of a migrated cup.

Femoral fixation of patellar tendon grafts using the bone-block locking technique in ACL reconstruction. A biomechanical study.

Anterior cruciate ligament (ACL) reconstruction relies on the security of graft fixation. K-wire fixation, heavy non-absorbable sutures tied to a screw staple post or endo-button are currently used for graft fixation. Kurosaka screw fixation may cause rupture of the graft due to excessive stress at the screw-graft interface in the femoral tunnel. To avoid inherent complications, a new bone-tendon-bone graft fixation technique for ACL reconstruction is described and biomechanically compared with the classical interference screw fixation in sheep knee models. A total of 13 pairs of fresh sheep knee specimens, obtained from a local slaughterhouse, were used in this study. Sheep knee specimens (n = 13) were divided into two groups. The right knees were Group I and the left knees were Group II. The right knees in Group I received interference screw systems and the left knees in Group II received the Bone Block Locking system (BBL). The average maximum load was found to be 275.01 +/- 10.75 N for the interference screw system and 389.92 +/- 7.54 N for the BBL system (p = 0.02). Our results indicate that the BBL technique allows a more secure fixation than interference screw fixation. The complications and technical pitfalls of interference screw fixation are not seen in BBL technique. We believe that the BBL technique is more advantageous in comparison to other fixation systems.

Hydatid disease of the left femur: a case report.

Osseous hydatid disease is a rare but serious condition. Treatment is difficult because of the progressive course of the bone involvement and generally admitted algorithm about osseous hydatid disease. We report a six-year follow-up of a case with involvement of the left femur, treated with an unconnected surgical method and albendazole. In this patient a 1 cm segment of the cortex between the trochanteric region to supracondylar area of the left femur was removed. The medullary cavity of the left femur was irrigated for 5 minutes with 20% hypersaline solution, and removed without causing any damage. The medullary cavity was curettaged meticulously and irrigated for 6 minutes with 0.9% saline solution. The bone defect was filled with bone cement. Albendazole was administered during the postoperative period. At the sixth year postoperatively, the patient was pain free. All serological tests were normal. Radiologic evaluation showed no evidence of disease recurrence. Meticulous preoperative planning, excision of all the cysts, and an effective regimen of chemotherapy will reduce recurrence. Bone scintigraphy is an important diagnostic method during the follow-up period.

Hepatic effects of ketamine administration for 2 weeks in rats.

The aim of the present study was to investigate the long-term and high-dose application of ketamine on the liver by employing histologic and biochemical methods. A total of 30 male rats were randomly assigned to control and four treatment groups (n: 6). Saline for control group and different doses of ketamine for four treatment groups (40, 60, 80 and 100 mg kg⁻¹) were administered intraperitoneal twice a day for 2 weeks. Immunohistological staining, light and electron microscopy were used to study tissue specimens. Histopathological changes were more severe and diverse in groups 80 and 100 mg kg⁻¹ day⁻¹, and the least significant change was observed in groups 40 and 60 mg kg⁻¹ day⁻¹. The most important ultrastructural changes were seen in mitochondria and in the rough endoplasmic reticulum. The immunoreactivity of calcineurin was determined as different. Prolonged use of ketamine caused hepatocellualar toxicity and histological changes in hepatocytes in a dose-dependent manner in all experimental groups.

Influence of intracoronary shunt on myocardial ischemic injury during off-pump coronary artery bypass surgery.

AIM: The aim of the study was to evaluate the role of intracoronary shunt during off-pump coronary artery bypass surgery in patients with isolated left anterior descending coronary artery lesion. METHODS: Forty patients undergoing off-pump coronary artery bypass using the left internal mammary artery to bypass the left anterior descending coronary artery were randomly assigned to have the bypass performed with intracoronary shunt or by occlusive snaring. Potential damage from the shunt or from snaring was monitored by clinical follow-up, monitoring of cardiac enzymes (cardiac troponin I, CK, CK-MB), electrocardiography, and echocardiography before and 24 h. after the surgery. Left ventricular myocardial biopsies were performed during surgery for histopathological analysis. RESULTS: None of the patients in this study died during or after the surgery. Duration of the anastomosis was significantly longer in the shunt group. No significant difference concerning the preoperative and postoperative CK levels between groups. The preoperative CK-MB levels of the groups were not significantly different, whereas postoperative levels was significantly lower in the shunt group. The preoperative troponin I levels of the groups were not significantly different, whereas postoperative levels was significantly higher in the snare group. Myocardial edema was significantly less in shunt group compared with snare group. There were no electrocardiographic abnormalities, severe CK-MB elevation, or hemodynamic deterioration after the operation in both groups. CONCLUSION: Intracoronary shunt may have beneficial effects due to the reduction of postoperative troponin I levels and myocardial edema during grafting of the left anterior descending coronary artery. However, further trials need to be performed for the documentation of their impacts precisely.

Treatment of humeral shaft non-unions by the Ilizarov method.

Thirty-five humeral shaft non-unions treated by the Ilizarov external fixator were studied after an average of 39 months. Bone union was achieved in all but one. The mean time to union was 5.5 months (range: 3-10 months). Major pin tract problems leading to removal of the Schanz screws occurred in three patients. A radial nerve palsy developed in three patients, two recovered spontaneously and one was treated with a triple tendon transfer.

Late detachment modular femoral component after primary total hip replacement.

Three years after total hip replacement surgery, a patient's modular femoral head separated from the stem portion of a primary total hip replacement while the patient was rising from a chair. The modular femoral head was in a polyethylene acetabular socket. Modular femoral and acetabular components now widely are used in hip replacement. The use of modular components greatly increases the flexibility during primary or revision total hip arthroplasty, but introduces the risks of component dissociation and intraoperative errors in matching. We report an unusually late dislocation of a primary modular total hip replacement.

Severe pelvic pain and extrinsic compression of the rectum: late complication of total hip arthroplasty.

Various pelvic and visceral complications have been reported resulting from total hip arthroplasty. Most of these complications are known to be related to the intrapelvic migration of the acetabular cup or the cement, or to the heat generated by polymerization of the methylmethacrylate. Complications involving almost every pelvic structure have been described. We report a case of progressive limb shortening and severe pelvic pain beginning 6 months after total hip arthroplasty. To close the acetabular defect after removal of the displaced acetabular component, we used a modified extraperitoneal approach adapted from Stoppa's technique, which is commonly used for inguinal, femoral, and obturator hernias. In this article, we aim to describe this modified extraperitoneal approach and to offer advice for the diagnosis and treatment of this serious complication.

The extended V-Y flap for coverage of a mid-planatar defect.

A mid-plantar ulcer was successfully reconstructed with an extended V-Y flap incorporating part of the flexor digitorum brevis muscle to achieve more volume and increase the safety of the flap. This flap can be used as a reliable alternative to other techniques to repair a moderately sized defect of the plantar midfoot.