Comparing lignocaine-adrenaline-tetracaine gel with lignocaine infiltration for anesthesia during repair of lacerations: A randomized trial

BACKGROUND:

This study aimed to compare the topical anesthetic lignocaine, adrenaline, and tetracaine (LAT) (4% lignocaine, 1:2 000 adrenaline, 1% tetracaine) with the conventional lignocaine infiltration(LI) for repair of minor lacerations, for the comfort of anesthetic administration, efficacy, adverse effects and cost.

METHODS:

This was a prospective randomized clinical trial. Forty Asian patients who required toilet and suture for minor lacerations in the emergency department of the Singapore General Hospital over a 4-month period. The patients were assigned randomly to 2 arms of treatment. The first was the LAT gel group who had LAT gel applied to the laceration prior to suturing. The second was the control group in whom the anesthetic administered was lignocaine infiltration (LI) via a syringe. The pain of the process of administering anesthetic and efficacy of anesthesia were scored using the visual pain scale included within. The efficacy of LAT vs. lignocaine infiltration as an anesthetic prior to the toilet and suture of minor lacerations and complications of therapy.

RESULTS:

Twenty patients were randomized to LAT gel and 16 to LI on an intention to treat analysis. The mean pain score by patients in the LAT gel group was 2.5 (0.52 SE), and 2.5 (0.58 SE) in the LI group. The pain score for pain during application of the anesthetic was 1.5 (0.40) in the LAT gel group, and 3.5 (0.46) in the LI group. There was no difference in complications between the LAT and LI groups

CONCLUSION:

LAT gel prior to the toilet and suture of minor lacerations is proven to be as efficacious as LI in terms of patient comfort and effectiveness of anesthesia. The complications are also comparable to those treated with LI.KEY WORDS: Lignocaine infiltration, Lacerations, Emergency department, Pain score     

Self-reported occupational injuries among industrial beef slaughterhouse workers in the Midwestern United States

Although workers in meatpacking facilities in the U.S. experience high rates of occupational injury, their injury experiences have received limited research attention. Prior research indicates underreporting in injury rates in this industry as well significant variation in injury rates among facilities. To add detail to the rates and circumstances surrounding occupational injury among meatpacking workers, we conducted a cross-sectional study of workers employed at an industrial beefpacking plant in Nebraska (n = 137) and interviewed workers about recent injury experiences. We assessed frequency, cause and nature of self-reported injury. We estimated annual incidence rates of self-reported injuries using the OSHA formula and compared these rates to industry-wide data. We also evaluated psychological distress in this workforce as measured by the Kessler-6 scale to assess whether distress was associated with recent occupational injury. In this study, 15.1% of workers experienced occupational injuries that required time off work, job transfer, or restriction during the past three months. The estimated annual incidence rate was 15.2 injuries per 100 full-time workers for these injuries at this plant. Rushing was identified as the cause of nearly 50% of injuries, and repetitive work as the cause of an additional 20% of injuries. Use of metal mesh sleeves (POR: 0.10 (p = 0.008)) and metal mesh gloves (POR: 0.41 (p = 0.05) were associated with reduced risk of injury. Use of a carbon steel for knife sharpening (POR: 5.2 (p = 0.02)) was associated with elevated risk of moderate and severe injury. There were no associations between self-reported occupational injury and overall measures of psychological distress. Self-reported incidence rate of severe injury in this plant was more than twice official industry estimates. Worker self-reports may illustrate key areas for injury prevention.     

肺撕裂伤的影像诊断

目的探讨肺撕裂伤的影像表现。方法10例肺撕裂伤患者，均于伤后1-5h行X线和CT检查，其中7例行X线和CT复查。结果10例肺撕裂伤患者累及10侧14叶肺，共21个病灶。其中右肺上叶1例1个病灶，右肺下叶2例2个病灶，右肺上下叶受累1例2个病灶，左肺下叶受累3例9个病灶，左肺上下叶受累3例7个病灶。X线片表现：9个病灶呈边缘光滑的空洞样团块影，12个病灶呈边缘模糊的团片状密度增高影，其内夹杂或不夹杂密度减低区。16-32d大多呈小斑片或索条影。CT表现为：高密度肺血肿6个、气液囊腔15个。21个病灶中，15个病灶内见到16个囊腔，其中单腔14个，双腔1个。16个囊腔内均可见气-液平面。动态观察，气囊在伤后1-5h初诊时最大，肺出血则在伤后2-3d复诊时最大，血肿吸收速度明显慢于气囊。16-32d后大多呈小斑片或索条影。结论影像检查是发现、诊断和动态观察肺撕裂伤的最佳方法，CT优于X线片。气液囊腔是肺撕裂伤的特征性影像表现。     

肩袖滑囊侧部分撕裂的关节镜手术治疗

目的 探讨关节镜治疗肩袖滑囊侧部分撕裂的手术方法 和临床效果.方法 对2002年6月至2007年12月行关节镜手术的57例肩袖滑囊侧部分撕裂患者进行回顾性分析.男性34例,女性15例,年龄25～71岁,平均年龄49.7岁.左肩15例,右肩34例,涉及优势侧41例.根据Ellman分类标准,Ⅰ度7例,Ⅱ度6例,Ⅲ度36例.术前均拍摄肩关节正位和冈上肌出口位X线片,29例行B超检查,36例行MRI或磁共振血管造影检查.Ⅰ度及Ⅱ度患者行肩峰下间隙减压及肩袖清理术;Ⅲ度患者行肩峰下间隙减压及肩袖修复术.肩袖修复方式:3例直接行断端缝合,26例应用缝合锚钉行肩袖止点重建,7例联合应用断端缝合及缝合锚钉技术.分别在术前和最终随访时采用UCLA肩关节评分标准进行评价.手术前UCLA评分平均为(16.5±2.4)分.其中疼痛评分平均为(2.9±1.0)分,功能评分平均为(5.4±1.2)分,肩关节主动前屈评分平均为(4.3±1.1)分,前屈肌力评分平均为(4.0±0.4)分.结果 49例患者均获得随访,随访时间2～7年,平均48个月.手术后平均UCLA评分为(32.1±3.8)分.其中疼痛评分平均为(8.4±1.7)分,功能评分平均为(9.1±1.4)分,肩关节主动前屈评分平均(4.9±0.2)分,前屈肌力评分平均为(4.8±0.4),与术前比较差异均具有统计学意义(均为P=0.000).优16例,良31例,差2例.47例患者对手术效果表示满意.结论 关节镜手术是治疗肩袖滑囊侧部分撕裂的有效方法 .手术创伤小、恢复快.     

膝关节半月板放射状撕裂的MRI表现

目的 探讨MRI对膝关节半月板放射状撕裂的检出能力.方法 回顾性分析1085例经关节镜证实的膝关节半月板损伤中的半月板放射状撕裂107例(9.9%)患者的MRI资料,同时按住院号顺序采用等足巨抽样方法 ,抽取100例经关节镜证实的非放射状撕裂的半月板损伤患者作为对照组.所有患者均经MR检查,观察裂隙征及裂隙行走征、半月板分离征、半月板消失征及小半月板征4种征象,与关节镜结果 比较.结果 (1)107例半月板放射状撕裂患者中,最常见的发生部位是外侧半月板体部(71例,66.4%)和前体交界部(25例,23.4%).(2)107例半月板放射状撕裂中,MRI诊断放射状撕裂102例.100例半月板非放射状撕裂的半月板损伤中,MRI诊断11例为放射状撕裂,MRI诊断半月板放射状撕裂的敏感度、特异度、阳性预测值、阴性预测值分别为95.3%(102/107)、89.0%(89/100)、90.3%(102/113)、94.7%(89/94).(3)裂隙征和半月板分离征出现频率最高,102例中分别出现59例(57.8%)和43例(42.2%),是诊断放射状撕裂最重要的MRI征象.结论 MRI诊断半月板放射状撕裂的准确率较高,是目前术前无创诊断的最佳方法 .     

关节镜下双排固定治疗肩袖损伤

目的 观察关节镜下单排、双排固定治疗肩袖损伤的近期效果. 方法 对8例肩袖损伤采用单排固定,7例肩袖损伤进行双排固定,观察术后功能恢复情况,进行UCLA评分. 结果 双排固定术后恢复时间短,功能恢复快,UCLA评分明显优于单排固定.单排固定组2例锚钉拔出,行再次手术固定;2例术后锻炼时出现疼痛和术前症状,再次手术时发现缝合线断裂,予再次固定. 结论 肩袖损伤的关节镜下双排固定效果明显优于单排固定,双排固定不仅增加了固定强度,同时使肩袖肌腱断端与肱骨大结节的接触面积大大增加,更有利于腱骨愈合.     

Physical characterisation and component release of poly(vinyl alcohol)-tetrahydroxyborate hydrogels and their applicability as potential topical drug delivery systems

Poly(vinyl alcohol)-tetrahydroxyborate (PVA-THB) hydrogels are dilatant formulations with potential for topical wound management. To support this contention, the physical properties, rheological behaviour and component release of candidate formulations were investigated. Oscillatory rheometry and texture profile analysis were used at room temperature and 37 °C. Results showed that it was possible to control the rheological and textural properties by altering component concentration and modifying the type of PVA polymer used. Hydrogels made using PVA grades with higher degrees of hydrolysis displayed favourable characteristics from a wound healing perspective. In vitro release of borate and PVA were assessed in order to evaluate potential clinical dosing of free species originating from the hydrogel structure. Component diffusion was influenced by both concentration and molecular weight, where relevant, with up to 5% free PVA cumulative release observed after 30 min. The results of this study demonstrated the importance of poly(vinyl alcohol) selection for ensuring appropriate gel formation in PVA-THB hydrogels. The benefits of higher degrees of hydrolysis, in particular, included lower excipient release and reduced bioadhesion. The unique physical characteristics of these hydrogels make them an appealing delivery vehicle for chronic and acute wound management purposes.     

肩袖撕裂术后康复治疗中的高频超声评价分析

目的 探讨高频超声在肩袖撕裂术后康复治疗中的应用价值.方法 对临床疑诊肩袖损伤的87例患者进行超声检查,对肩袖部分及完全撕裂的54例患者进行手术治疗,术后患者中对照组27例(进行自主功能锻炼),康复组27例(进行正规的康复训练),两组患者于术后2周、4周、8周、12周和16周进行临床功能评分及超声评分,评价康复治疗效果,1年后进行临床疗效评定.结果 患者在肩袖撕裂术后不同时期的临床症状与超声表现相符.临床功能及超声评分术后2周、4周时两组间差异无统计学意义(P＞0.05),术后8周、12周、16周时康复组明显优于对照组(P＜0.05或P＜0.01).康复组1年后的疗效评定结果优于对照组(P＜0.01).结论 高频超声在肩袖撕裂术后的康复治疗中有较高的应用价值.     

半月板损伤及撕裂的MRI与关节镜或手术对照研究

目的评价不同观察者对膝关节半月板损伤MRI诊断一致性及撕裂形态学MRI诊断分级的准确性。方法由两位有经验的影像科医生回顾性对82例82个疑有半月板损伤的MRI图像,所得两次诊断结果进行Kappa统计量分析。本研究中用关节镜或手术结果作为诊断参考标准,确诊撕裂的内侧半月板有29例,外侧半月板有40例,分别分析内外侧半月板经参考标准确诊的撕裂的两次诊断的诊断价值。结果对内侧半月板Kappa值为0.71,对外侧半月板Kappa值为0.65,两次诊断均有好的诊断一致性。对内侧半月板可修复撕裂两次诊断的灵敏性、特异性、准确性分别为95%、38%、79%;100%、38%、83%。对外侧半月板可修复撕裂两次诊断的灵敏性、特异性、准确性分别为93%、65%、75%;93%、77%、93%。结论MRI两次诊断对内外侧半月板诊断一致性良好,对内外侧半月板可修复撕裂准确性、灵敏度较高,对外侧半月板可修复撕裂特异度较高。     

胸大肌的超声解剖及其撕裂的声像图特点

目的：探讨胸大肌的正常声像图表现及超声诊断胸大肌撕裂的临床价值。方法：应用高频超声获取20例健康志愿者的双侧共40条胸大肌的系列长轴及短轴切面声像图,观察胸大肌的走行及其声像图表现。回顾性分析北京大学第三医院18例胸大肌撕裂患者的声像图资料,进行分型诊断,并对照其磁共振成像（magnetic resonance imaging, MRI）、外科手术和超声随访结果。结果：高频超声可以清晰显示正常胸大肌的位置、走行和结构。18例胸大肌撕裂患者平均年龄（37.2±15.6）岁,均有不同原因和程度的外伤史,如举重、篮球和撞击等,其中3例有MRI结果,9例行外科手术治疗,6例为超声随访。18例胸大肌撕裂病例中,超声均给出了损伤的解剖学定位和损伤范围,其中11例发生于左侧,7例发生于右侧。按照损伤部位可以分为3类：7例为肱骨端肌腱损伤（其中1例发生于胸骨头,2例发生于锁骨头,4例为锁骨头和胸骨头联合损伤）,5例累及肌肉肌腱连接处,6例累及肌腹;部分撕裂者为12例,表现为回声减低,内部结构不清晰;完全断裂者为6例（其中3例发生于肱骨端肌腱,1例为肌肉肌腱连接处,2例位于胸大肌肌腹内）,表现为纤维断裂,回缩,伴有或不伴有血肿形成,通过动态实时观察可以判断胸大肌撕裂范围及断端情况。结论：高频超声可以清晰显示胸大肌走行及其相关结构,超声检查能够诊断胸大肌及其肌腱的损伤程度和范围,可以用来指导胸大肌撕裂的临床治疗。