Total laryngopharyngectomy with circumferential reconstruction: Helsinki institutional study

European Archives of Oto-Rhino-Laryngology - Surgical complications after total laryngopharyngectomy (TLP) are common, reconstruction is challenging, and patients often lose their ability to...     

Short bowel mucosal morphology,proliferation and inflammation at first and repeat STEP procedures

Background

Although serial transverse enteroplasty (STEP) improves function of dilated short bowel, a significant proportion of patients require repeat surgery. To address underlying reasons for unsuccessful STEP, we compared small intestinal mucosal characteristics between initial and repeat STEP procedures in children with short bowel syndrome (SBS).

Progesterone metabolism by rat oral mucosa II. The effect of pregnancy

In order to examine the effect of pregnancy on the gingiva, the metabolism of progesterone in pregnant and non-pregnant rats was studied. Homogenates and mitochondrial, microsomal, and soluble fractions were obtained with differential centrifugation. The subcellular preparations were supplemented with NADPH and incubated with ¹⁴C-progesterone for 30 min at pH 7.4 and 37°C. The metabolites were identified by column and multiple thin-layer chromatography and radioautography and quantified with liquid scintillation counting. The metabolism was significantly reduced in homogenate, mitochondrial, and microsomal incubations of oral mucosae of pregnant rats when compared to those of non-pregnant ones. The decrease of the metabolism in the soluble fraction incubations was not statistically significant. In all subcellular preparations the activities of 20et-and 20 β -hydroxysteroid dehydrogenases, if present, remained rather constant, but the activities of steroid hydrogenases and 3α- and 3 β -hydroxysteroid dehydrogenases decreased markedly. The value of these findings as a contributing factor in pregnancy gingivitis is discussed.     

Fixation properties of a biodegradable "free-form" osteosynthesis plate

The Inion FreedomPlate, a "free-form" osteosynthesis plate, is a biodegradable plate with just pilot holes for drilling. The construction of the plate allows the surgeon a placement of screws in optimal position. The screw heads can either be countersunk into the plate or cut off. Furthermore, the plate can be cut and contoured to match the bone. The aim of this study was to determine the mechanical properties of the Inion FreedomPlate compared to a conventional biodegradable plate. Acrylic pipes were fixed together with plates and screws. Tensile and cantilever bending tests were performed to measure the fixation properties. In the tensile test, the samples were loaded with a constant speed of 5 mm/min until failure of fixation. The yield load, maximum failure load, and initial stiffness were recorded, and the failure mode was visually determined. In the cantilever bending test, the samples were loaded with a constant speed of 50 mm/min (with a moment arm of 45 mm) until failure of fixation. The yield bending moment and initial stiffness were recorded, and the failure mode was determined. The results of the study show that the new free-form plate provides at least as strong fixation as the tested conventional biodegradable plate. No clinically relevant difference was found between free-form plates fixed with into-the-plate countersunk screws and those fixed with screws without heads.     

Dexmedetomidine impairs success of patient-controlled sedation in alcoholics during ERCP: a randomized, double-blind, placebo-controlled study

Background

There is a lack of studies about procedural sedation of alcoholics. Dexmedetomidine is recommended for procedural sedation and reported effective for alcohol withdrawal. We evaluated the suitability of dexmedetomidine for sedation of alcoholics during endoscopic retrograde cholangiopancreatography (ERCP).

Methods

Fifty patients with chronic alcoholism scheduled for elective ERCP were randomized 1:1 to receive dexmedetomidine (Dex group) (loading dose 1 μg kg^?1 over 10 min, followed by constant intravenous infusion 0.7 μg kg^?1 h^?1) or saline placebo (P group). Patient-controlled sedation with propofol–alfentanil was used by patients as a rescue method. Sedation was considered as successful if no intervention of an anesthesiologist was needed. Consumption of sedatives was registered, and sedation levels and vital signs were monitored.

Results

Dexmedetomidine alone was insufficient in all patients. The mean ± SD consumption of propofol was 159 ± 72 mg in the P group, and 116 ± 61 mg in the Dex group (p = 0.028). Sedation was successful in 19 of 25 (76 %) patients in the Dex group and in all patients in the P group (p = 0.022). The incidence of sedation adverse events did not differ between the groups. Dexmedetomidine was associated with delayed recovery.

Conclusions

Patient-controlled sedation with propofol and alfentanil but not dexmedetomidine can be recommended for sedation of alcoholics during ERCP.     

Interference of low frequency magnetic fields with implantable cardioverter-defibrillators

Abstract Objectives. The aim of this study was to find the electromagnetic interference (EMI) thresholds for several commonly used implantable cardioverter-defibrillators (ICD). Design. Seventeen ICDs were exposed to magnetic fields with different intensities produced by the Helmholtz coil system. Sinusoidal, pulse, ramp, and square-waveforms with a frequency range of 2 Hz to 1 kHz were used. Results. ICD malfunctions occurred in 11 of the 17 ICDs tested. The ICD malfunctions that occurred were false detections of ventricular tachycardia (6/17 ICDs) and ventricular fibrillation (3/17 ICDs), false detection of atrial tachycardia (4/6 dual chamber ICDs) and tachycardia sensing occurring during atrial or ventricular refractory periods (1/17 ICD). In most cases, no interference occurred at magnetic field levels below the occupational safety limits of the International Commission on Non-Ionizing Radiation Protection (ICNIRP). Nevertheless, some frequencies using sine, ramp or square waveforms did interfere with certain ICDs at levels below these limits. No EMI occurred with any of the ICDs below the ICNIRP limits for public exposure. Conclusion. Evaluation of EMI should be part of the risk assessment of an employee returning to work after an ICD implantation. The risk assessment should consider magnetic field intensities, frequencies and waveforms.