Comparison of Siccoral® spray,Stomatovis® gargle,and Strefen® lozenges on postoperative sore throat

Purpose

Postoperative sore throat (POST) is a frequent complication caused by mucosal trauma to the pharyngeal, laryngeal, and tracheal airway after endotracheal intubation. We compared the effectiveness of Siccoral, Strefen, and Stomatovis treatments in alleviating POST.

Methods

This prospective, randomized, single-blinded, controlled trial compares the incidence of POST with Strefen lozenges, Siccoral spray, or Stomatovis gargle. Three hundred and twenty American Society of Anesthesiologists class I–III patients undergoing elective genitourinary surgery under general orotracheal anesthesia were randomly allocated to four groups of 80 patients each. In the postoperative awakening unit and during related services, POST was evaluated by a blinded anesthesiologist at 0, 1, 6, and 24 h post extubation.

Results

The highest incidence of POST occured at 0 and 1 h post extubation in all groups (P = 0.002 × 10^?7, P = 0.004 × 10^?6, respectively). A significantly lower incidence of POST was observed in Strefen and Siccoral groups at 0 and 1 h compared to Control group (Strefen: P = 0.004 × 10^?2, P = 0.007 × 10^?4; Siccoral: P = 0.003 × 10^?8, P = 0.007 × 10^?5, respectively). A significantly lower incidence of POST was observed with Siccoral treatment at 0 h post extubation (P = 0.002 vs. Strefen treatment). Although POST incidence was not significantly different between the Stomatovis and Control groups, it was lower in the Stomatovis group at 0 and 1 h (P = 0.026 and 0.013, respectively). The incidence of POST was similar in all groups at 6 and 24 h post extubation (P = 0.141 and 0.426, respectively).

Conclusion

Siccoral and Strefen can be effective in relieving POST in the early hours after extubation.     

Three-dimensional Morphologic Study of the Child’s Hip: Which Parameters Are Reproducible?

Background

Biplanar x-ray images obtained with patients in a standing weightbearing position allow reconstruction of three-dimensional (3-D) bone geometries, with lower radiation exposure than CT scans and better bone definition than MRI.

Questions/Purposes

We determined the reproducibility of 3-D parameter values of the hips and pelves of healthy children, using biplanar x-ray images.

Methods

We built 3-D models of the hips of 33 children without musculoskeletal problems: 10 subjects younger than 9 years and 23 who were 9 years or older. Three anatomic landmarks and nine hip and pelvic parameters were computed for each reconstruction. To determine the reliability of these landmarks and parameters, each bone was reconstructed four times by two independent observers, leading to a total of 264 reconstructions, and parameters were studied for the two age groups and compared between dancers and nondancers.

Results

Taking into account all reconstructions, the interobserver reproducibility ranged from 2 to 4 mm for landmark positions or distance parameters, and 2° to 6° for angular parameters. The most reproducible point was the center of the femoral head (range, 0.2–17 mm). The distance between this center and its projection on the plane fitting the edge of the acetabulum, and the pelvic tilt were the most reproducible parameters.

Conclusions

Reproducible 3-D reconstructions of hips and pelves of children were possible using biplanar x-ray images, regardless of the children’s ages. Although we report preliminary values for 3-D parameters in healthy children’s hips, further work is needed to obtain direct validation of our parameters using CT reconstructions of cadaveric specimens to avoid high doses of radiation.     

Erratum to: What is the Difference in Morphologic Features of the Thoracic Pedicle Between Patients With Adolescent Idiopathic Scoliosis and Healthy Subjects? A CT-based Case-control Study

Clinical Orthopaedics and Related Research® -     

Weight Loss Comparison of Gastric Bypass and Silastic® Ring Vertical Gastroplasty

Thirty-five patients who had undergone primary bariatric surgery between 14 January 1988 and 16 September 1990 were selected for retrospective analysis based on the availability of 3-month and 1-year (+/- 3 months) follow-up visit records. Fourteen patients had undergone a Roux-en-Y gastric bypass (RGB), and 21 patients had undergone a Silastictrade mark ring vertical gastroplasty (SRVG). Weight loss, pre- and postoperative body mass index (BMI), and the postoperative incidence of dumping syndrome, anemia, and food intolerance were compared. At 1 year (+/- 3 months), the average weight loss was 40 kg for the entire group. The RGB patients lost an average of 41.7 kg, while the SRVG patients lost an average of 39.4 kg (not significant). The average preoperative BMI was 46.4 kg/m(2) for both the RGB and SRVG patients. The 1-year postoperative BMI was 30.6 kg/m(2) for the RGB patients and 32.4 kg/m(2) for the SRVG patients (not significant). One RGB patient developed a dumping syndrome, and one RGB patient showed evidence of a nutritional anemia. Neither complication was incapacitating. The SRVG patients had far more difficulty in advancing the consistency and variety of their diet in the early postoperative period, with only 62% (13/21) of the SRVG patients demonstrating an ability to tolerate a regular consistency diet at the end of 1 year. Seventy-six percent (16/21) of the SRVG patients reported occasional vomiting at 1 year, compared to only 7% (1/14) of the RGB patients. This retrospective analysis documented comparable weight loss for the RGB and SRVG operations. A greater incidence of eating problems up to 1 year postoperatively was observed in patients following SRVG in comparison to RGB.     

What is the Difference in Morphologic Features of the Thoracic Pedicle Between Patients With Adolescent Idiopathic Scoliosis and Healthy Subjects? A CT-based Case-control Study

Background

Describing the morphologic features of the thoracic pedicle in patients with adolescent idiopathic scoliosis is necessary for placement of pedicle screws. Previous studies showed inadequate reliability owing to small sample size and heterogeneity of the patients surveyed.

Questions/Purposes

To use CT scans (1) to describe the morphologic features of 2718 thoracic pedicles from 60 female patients with Lenke Type 1 adolescent idiopathic scoliosis and 60 age-, sex-, and height-matched controls; and (2) to classify the pedicles in three types based on pedicle width and analyze the distribution of each type.

Methods

A total of 2718 pedicles from 60 female patients with Lenke Type 1 adolescent idiopathic scoliosis and 60 matched female controls were analyzed via CT. All patients surveyed were diagnosed with adolescent idiopathic scoliosis, Lenke Type 1, at the First Affiliated Hospital of Sun Yat-sen University, and all underwent pedicle screw fixation between January 2008 and December 2013 with preoperative radiographs and CT images on file. We routinely obtained CT scans before these procedures; all patients who underwent surgery during that period had CT scans, and all were available for analysis here. Control subjects had CT scans for other clinical indications and had no abnormal findings of the spine. The control subjects were chosen to match patients in terms of age (15 ± 2.6 years versus 15 ± 2.6 years) and sex. Height of the two groups also was matched (154 ± 9 cm versus 155 ± 10 cm; mean difference, −1.06 cm; 95% CI, −1.24 to −0.81 cm; p < 0.001). Pedicle width and length were measured from T1 to T12. The thoracic spine was classified in four regions: apical vertebra in the structural curve (AV-SC), nonapical vertebra in the structural curve (NAV-SC), apical vertebra in the nonstructural curve (AV-NSC), and nonapical vertebra in the nonstructural curve (NAV-NSC). Pedicles were classified in three types: pedicle width less than 2 mm as Type I, 2 mm to 4 mm as Type II, and greater than 4 mm as Type III. Types I and II were defined as dysplastic pedicles. Paired t test, independent samples t test, one-way ANOVA, followed by Bonferroni’s post hoc test and chi-square or Fisher’s exact tests were used for statistical comparisons between patients and controls, as appropriate.

Results

No difference was found between pedicle width on the convex side (PWv) and in controls (PWn), but pedicle width on the concave side (PWc) (4.99 ± 1.87 mm) was found to be narrower than PWv (6 ± 1.66 mm) and PWn (6 ± 1.45 mm). The variation degree of pedicle width (VDPW) was greatest in the AV-SC region (34% ± 37%), in comparison to AV-NSC (20% ± 25%) (mean difference, 14%; 95% CI, 1.15%–27%; p = 0.025), NAV-SC (17% ± 30%) (mean difference, 17%; 95% CI, 7%–27%; p < 0.001), and NAV-NSC (11% ± 24%) (mean difference, 24%; 95% CI, 13%–34%; p < 0.001). Dysplastic pedicles appeared more in patients with adolescent idiopathic scoliosis (22%; 293 of 1322) compared with controls (13%; 178 of 1396) (odds ratio [OR] = 0.51; 95% CI, 0.42–0.63; p < 0.001). In patients with adolescent idiopathic scoliosis, they commonly occurred on the concave side 34% (228 of 661) and on the AV-SC region (32%; 43 of 136).

Conclusions

Pedicle width on the concave side was narrower than pedicle width on the convex side and pedicle width in healthy control subjects. The apical vertebra in the structural curve was the most variegated region of the curve with the highest prevalence of dysplastic pedicles.

Clinical Relevance

Our study can help surgeons perform preoperative assessments in females with adolescent idiopathic scoliosis, and with preoperative and intraoperative management for difficult pedicle screw placement. In particular, our results suggest that surgeons should exercise increased vigilance when selecting pedicle screw dimensions, especially in the concave aspect of the mid-thoracic curve, to avoid cortical breeches. Future studies should evaluate other Lenke types of adolescent idiopathic scoliosis, and males with adolescent idiopathic scoliosis.

     

Assessment of the axial rotation of the pelvis with the EOS® imaging system: intra- and inter-observer reproducibility and accuracy study

Purpose

A source of radiological bias occurs when the axial rotation of the pelvis is disregarded in hip and spine biomechanics analyses. The EOS imaging system (EOS Imaging, France) offers the possibility of detecting and measuring the axial rotation of bones. Reproducibility and accuracy have not been documented in the case of the pelvis.

Methods

A dry pelvis has been X-rayed with the EOS system every 5° from 30° left to 30° right according to a laser line reference goniometer. Three observers have measured the rotation. One observer did it 3 times. The intra- and inter-observer reproducibility and the accuracy have been calculated using the root mean square standard deviation calculation. The relationship between the axial rotation and the offset between the left and right acetabulae on the lateral view was investigated.

Results

The 95 % CI was ±0.23° for the intra-observer and ±0.33° for the inter-observer reliability. The mean of signed differences between the software calculation and the actual axial rotation of the pelvis was ?0.39° (SD 0.77°). The lateral acetabular offset was proportional to the sin of the rotation. Approximately, 30 mm offset corresponded to about 10° rotation.

Conclusions

The 3D slot scanning imaging system demonstrated significant reproducibility and accuracy for the assessment of the axial rotation of the pelvis.     

Comparison of the GlideScope® videolaryngoscope and the Macintosh laryngoscope for double-lumen tube intubation

Intubation with a double‐lumen tube is important for achieving one‐lung ventilation and facilitating thoracic surgery. The GlideScope^® videolaryngoscope (Verathon Inc., Bothell, WA, USA) is designed to assist tracheal intubation for patients with a difficult airway. We wished to compare the GlideScope and direct laryngoscopy for double‐lumen tube intubation. Sixty adult patients requiring a double‐lumen tube for thoracic surgery and predicted uncomplicated laryngoscopy were randomly assigned to a direct Macintosh laryngoscopy group (n = 30) or a GlideScope group (n = 30). The mean (SD) duration of intubation was longer in the Macintosh group (62.5 (29.7) s) than in the GlideScope group (45.6 (10.7) s; p = 0.007). There was no difference in the success of the first attempt at intubation (26/30 (87%) and 30/30 (100%) for Macintosh and GlideScope groups, respectively; p = 0.112). The incidence of sore throat and hoarseness was higher in the Macintosh group (18 (60%) and 14 (47%), respectively) than in the GlideScope group (6 (20%) and 4 (13%), respectively; p = 0.003 and 0.004). We conclude that double‐lumen tube intubation in patients with predicted normal laryngoscopy is easier using the GlideScope videolaryngoscope than the Macintosh laryngoscope.     

Comparison of oropharyngeal leak pressure between the Ambu® AuraGain™ and the LMA® Supreme™ supraglottic airways: a randomized-controlled trial

Purpose

Studies comparing the recently introduced Ambu® AuraGain? (Auragain) with the LMA® Supreme? (Supreme) supraglottic airway (SGA) have reported conflicting results regarding differences in oropharyngeal leak pressure (OLP). This randomized-controlled trial investigated the OLP of the Auragain compared with the Supreme in patients undergoing ambulatory surgery.

Methods

Adult patients with a body mass index ≤ 40 kg·m^?2 presenting for ambulatory surgery and requiring an SGA were randomized to receive either the Auragain or the Supreme. Anesthesia was induced with lidocaine (1 mg·kg^?1), fentanyl (1-2 μg·kg^?1), and propofol (2-3 mg·kg^?1). The SGA was inserted using a standard technique with the cuff inflated to 60 cmH₂O. The groups were compared for the primary outcome of OLP.

Results

One hundred sixty-five patients (n = 81, Auragain; n = 84, Supreme) completed the study. Demographics were similar between the groups. The mean (standard deviation [SD]) OLP was significantly higher in the Auragain than in the Supreme group [26.4 (2.8) cmH₂O vs 21.6 (3.4) cmH₂O, respectively; difference in means (MD), 4.8 cmH₂O; 95% confidence interval (CI), 3.9 to 5.8; P < 0.001]. The mean (SD) insertion time was longer in the Auragain than in the Supreme group [13 (4) sec vs 11 (3) sec, respectively; MD, 2 sec; 95% CI, 1 to 3 sec; P < 0.001].

Conclusion

In patients undergoing ambulatory anesthesia, the OLP was higher but took longer to insert with the Auragain than with the Supreme. A higher OLP may allow for SGAs to be utilized in a wider range of patients and procedures.

Trial registration

www.clinicaltrials.gov (NCT02816463). Registered 28 June 2016.

     

Comparison of Coagulation Parameters for Healthy Subjects and Behçet Disease Patients with and without Vascular Involvement

Beh?et disease (BD) is an inflammatory illness that may attack several systems. Vascular involvement with thrombosis is one of the basic characteristics of this disease. The etiology of thrombosis tendency in BD has not been understood well. In this study, the role of primary coagulation parameters in patients with BD who have thromboembolic events was evaluated. In addition, the relation between the clinical activity of the disease and these parameters was compared. A total of 96 patients with a diagnosis of BD were studied at Ankara University, Medical School, Department of General Surgery and Beh?et Center. BD patients were separated into two groups with respect to vascular involvement. Group A contained 22 patients with vascular attacks, and group B contained 74 patients without vascular attacks. In addition, 25 healthy persons comprised the control group (group C). The coagulation parameters assessed included protein C, protein S, antithrombin III activity, fibrinogen level, prothrombin time (PT), and partial thromboplastin time (PTT). There were no differences among the three groups with respect to protein C, protein S, fibrinogen, PT, and PTT values (p > 0.05). The antithrombin III value was found to be high in BD patients compared to those in the control group (p = 0.011). There was no difference regarding the antithrombin III value between BD patients with or without vascular attacks (p = 0.954). There was no correlation between the activity of disease and coagulation parameters (p > 0.05), but a positive correlation was seen between the duration of illness and vascular involvement. Fifty percent of patients who had had BD more than 8 years had vascular involvement (p = 0.002). We could not determine a specific pathology in relation to coagulation parameters that could explain the etiology of thrombosis in patients with BD. The elevated antithrombin III levels in patients with BD (compared to controls) may be due to a compensatory defense mechanism against increased procoagulant activity. There was a correlation between the duration of illness and vascular involvement.     

Erratum to: What Differences in Morphologic Features of the Knee Exist Among Patients of Various Races? A Systematic Review

Clinical Orthopaedics and Related Research® -     

Comparison of the EasyTube® and endotracheal tube during general anesthesia in fasted adult patients

Study ObjectiveTo evaluate the effectiveness, safety, ease of placement, and ventilatory parameters of a new alternate airway device, the EasyTube® (EzT; Teleflex Ruesch, Research Triangle Park, NC), in comparison to the endotracheal tube (ETT).DesignProspective, randomized controlled trial.SettingUniversity Hospital.Subjects200 adult ASA physical status I and II patients scheduled for surgery.InterventionsPatients were randomized to two groups, one to receive ventilation via the EzT (n = 100) or the ETT (n = 100). After preoxygenation and induction with fentanyl and propofol, patients received muscle relaxation. The respective airway device was then inserted and mechanical ventilation was instituted.MeasurementsEase of insertion, number of insertion maneuvers, time until airtight seal of the airway was achieved, duration of surgery, leak pressure as well as arterial oxygen saturation (SpO₂), and end-tidal carbon dioxide (ETCO₂) data, were recorded.Main ResultsMallampati airway class was higher in the EzT group (P < 0.029), while thyromental distance showed no difference between the two groups. Ease of insertion was noted in the EzT group (P < 0.043). Number of insertions was equal in both groups; insertion time was shorter with the EzT (15.5 ± 3.6 sec vs. 19.3 ± 4.6 sec; P < 0.0001). Leak pressure and SpO₂ were not significantly different, while ETCO₂ was lower with the ETT (P < 0.024). Adjustments had to be made for two EzT group patients. No difference in frequency of laryngo-pharyngeal discomfort was observed in either group.ConclusionInsertion of an EzT appears to reduce time and facilitate placement of an airway device when compared with direct laryngoscopy and tracheal intubation.     

Comparison of Buccal Infiltration of 4% Articaine With 1?:?100,000 and 1?:?200,000 Epinephrine for Extraction of Maxillary Third Molars With Pericoronitis: A Pilot Study

We compared the buccal infiltration of 4% articaine with 1 : 100,000 or 1 : 200,000 epinephrine without a palatal injection for the extraction of impacted maxillary third molars with chronic pericoronitis. This prospective, double-blind, controlled clinical trial involved 30 patients between the ages of 15 and 46 years who desired extraction of a partially impacted upper third molar with pericoronitis. Group 1 (15 patients) received 4% articaine with 1 : 100,000 epinephrine and group 2 (15 patients) received 4% articaine with 1 : 200,000 epinephrine by buccal infiltration. None of the patients in group 1 reported pain, but 3 patients in group 2 reported pain, which indicated a need for a supplementary palatal injection. The palatal injections were all successful in eliminating the pain. Two additional patients in group 2 experienced pain when the suture needle penetrated their palatal mucosa. Based on these results, 4% articaine with 1 : 100,000 epinephrine was found to be more effective for the removal of upper third molars in the presence of pericoronitis than 4% articaine hydrochloride with 1 : 200,000 epinephrine when only a buccal infiltration was used.Key Words: Articaine, Epinephrine, Molar extractionMaxillary third molar extraction is generally straightforward, due to the plasticity of the maxillary bone and to the low resistance to extraction movements. Nevertheless, the anesthetic technique needed for such extraction may be extremely uncomfortable because it requires palatal mucosal anesthesia.^1,2Studies have suggested that articaine has good diffusion through the hard and soft tissues, eliminating the need for the palatal injection in maxillary third molar extractions.^3–6 However, the anesthetic effect may be decreased or neutralized because the inflammation and low tissue pH affects tissue diffusion of the anesthetic, making the drug less effective.^7–9Pericoronitis is the most frequent inflammatory pathology associated with third molars and is caused by a combination of factors including trauma and food impaction with subsequent bacterial colonization and infection.^1,10–13 Clinically, it is characterized by the presence of erythema, swelling, and even ulceration in some cases.^1,14 The management of pericoronitis varies. Many authors have recommended using antibiotic therapy when there are signs of acute infection with systemic involvement such as fever. In cases of chronic or nonacute clinical manifestations, treatment should be limited to antiseptic mouthwashes, irrigation, and anti-inflammatory and/or anesthetic medication. Surgically, the usual treatment is the extraction of the impacted tooth.^1,11–15The aim of the present study was to evaluate the differences between articaine hydrochloride with 1 : 100,000 and 1 : 200,000 epinephrine (adrenaline) administered by buccal infiltration alone (without palatal infiltration) for the removal of impacted upper third molar teeth with pericoronitis.     

Morphologic Features of Conventional Squamous Cell Carcinoma of the Oropharynx: ‘Keratinizing’ and ‘Nonkeratinizing’ Histologic Types as the Basis for a Consistent Classification System

Morphologic assessment is one of the most basic tools that pathologists use to classify tumors. Human papillomavirus (HPV)-related squamous cell carcinoma of the oropharynx has unique morphologic features that can be readily recognized under the microscope. Yet, these features are not widely recognized or uniformly reported. In our practice, we group oropharyngeal squamous cell carcinomas into ‘nonkeratinizing’, ‘nonkeratinizing with maturation’, and ‘keratinizing’ histologic types. The ‘nonkeratinizing’ type has a very strong association with HPV, while the ‘keratinizing’ type has a weaker association with the virus. ‘Nonkeratinizing with maturation’ is intermediate but much more closely related to the ‘nonkeratinizing’ type. This classification system parallels that of sinonasal and nasopharyngeal squamous cell carcinomas where nonkeratinizing squamous cell carcinomas are widely recognized histologic variants. This review will discuss this classification system and its utility in routine clinical practice.