Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery

Purpose

We hypothesized that cooling hyperbaric bupivacaine from 23 to 5 °C may limit the intrathecal spread of bupivacaine and therefore increase the success rate of unilateral spinal anesthesia and decrease the rate of hemodynamic complications.

Methods

A hundred patients scheduled for elective unilateral inguinal hernia surgery were randomly allocated to receive 1.8 ml of 0.5 % hyperbaric bupivacaine intrathecally at either 5 °C (group I, n = 50) or at 23 °C (group II, n = 50). Following spinal block at the L2-3 interspace, the lateral decubitus position was maintained for 15 min. Unilateral spinal anesthesia was assessed and confirmed at 15 and 30 min. The levels of sensory and motor block on the operative side were evaluated until complete resolution.

Results

The rate of unilateral spinal anesthesia at 15 and 30 min was significantly higher in group I (p = 0.015 and 0.028, respectively). Hypotensive events and bradycardia were significantly rarer in group I (p = 0.014 and 0.037, respectively). The density and viscosity of the solution at 5 °C was significantly higher than at 23 °C (p < 0.0001). Compared with group II, sensory block peaked later in group I (17.4 vs 12.6 min) and at a lower level (T9 vs T7), and two-segment regression of sensory block (76.4 vs 84.3 min) and motor block recovery was shorter (157.6 vs 193.4 min) (p < 0.0001).

Conclusions

Cooling of hyperbaric bupivacaine to 5 °C increased the density and viscosity of the solution and the success rate of unilateral spinal anesthesia, and decreased the hemodynamic complication rate.

     

A less invasive surgical approach in the lumbar lateral recess stenosis: direct approach to the medial wall of the pedicle

The lateral recess is one of the main compression sites in lumbar spinal canal stenosis. Lumbar nerve root is mainly entrapped by bony tissue in compression syndrome. The patient has a long history of back pain in conjunction with claudication symptoms. Besides laminotomy and facetectomy techniques, several specific surgical approaches to treat the lateral recess stenosis have been described. The surgical technique of bilateral lateral recess decompression via subarticular fenestrations used in this study is a less invasive technique, which enables to decompress the neural structures while preserving as much of the bony structures and ligamentum flavum as preferred. In 16 patients, we measured lateral recess heights with computerized tomography. The number of involved lumbar segments was one in 11 patients and two in 5 patients. The visual analogue scale (VAS) results were maintained before, 3 and 12 months after the operation. All patients benefited from the operations. Mean VAS scores were 7.0, 5.5, and 4.0, respectively. There were not any surgery-related complications. Mean follow-up period is 22.6 months. The surgical technique described and used in this study provides easy access to every zone of lateral recess and is safe and effective in treating the lumbar lateral recess stenosis syndrome.     

Iatrogenic aortic dissection during right coronary artery stenting

Aortic dissection limited to one sinus of Valsalva has been observed as an iatrogenic complication during coronary intervention. We report on a 65-year-old female patient who had a diagnosis of acute inferior myocardial infarction and experienced type A aortic dissection during stenting of the right coronary artery (RCA). Dissection was seen during aortic injection. There were no associated diseases in the sinuses of Valsalva or the aortic valve. An opening was seen intraoperatively in the right sinus of Valsalva. The opening was immediately and successfully sutured. The RCA was bypassed.     

Free radical damage as a biomarker of bladder dysfunction after partial outlet obstruction and reversal

OBJECTIVE

To investigate the use of free‐radical generation as a result of protein carbonylation and nitrotyrosination to characterize the level of bladder dysfunction after partial bladder outlet obstruction (PBOO) and reversal.

MATERIALS AND METHODS

We surgically created PBOO in male New Zealand White rabbits; after 4 weeks of PBOO, one group of six rabbits was assessed, while the PBOO was relieved in two additional groups of six rabbits each that were assessed at 4 and 8 weeks after relieving the PBOO. Six sham‐operated rabbits served as controls. Sedated rabbits were assessed by cystometry and the bladders were then removed for contractile, histological and molecular studies. Western blotting was used to determine the level of carbonylation and nitrotyrosination at the protein level.

RESULTS

The PBOO group had significant decreases in the contractile responses to field stimulation, ATP, carbachol and KCl. The responses to all forms of stimulation increased significantly at 4 weeks after reversal, and further increased to near normal levels by 8 weeks. Similarly, compliance and cystometric values also returned to near normal values after reversal. The hypertrophied smooth muscle of the obstructed bladders regressed to near‐normal size. There was a significant increase in the level of carbonylation and nitrotyrosination after PBOO, and a progressive decrease in the 4‐week reversal groups, nearing control values by 8 weeks.

CONCLUSIONS

Significantly increased carbonylation and nitrotyrosination levels after PBOO correlated with the severe dysfunction in the obstructed rabbits. Similarly, decreased levels of oxidation and nitration correlated with the functional recovery after reversal.     

Short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction

Purpose

This study aims to analyse the short-term effects of partial meniscectomy on the clinical results of anterior cruciate ligament reconstruction surgery.

Methods

Clinical outcomes of 19 patients who had partial medial meniscectomy and anterior cruciate ligament reconstruction during the same surgery (Group 1) were compared with the outcomes of 25 patients who had also reconstruction but did not have any meniscal lesion (Group 2). Median follow-up time was 29 months (range 12–67 months) in Group 1 and 27 months (range 12–70 months) in Group 2. Feeling of apprehension in sports activities, International Knee Documentation Committee (IKDC) score, KT-2000 Arthrometer^® measurements and post-operative time to return to sports activity were the criteria for data analysis.

Results

Eight patients (42 %) in Group 1 and 5 patients (20 %) in Group 2 stated feeling of apprehension in sports activities. IKDC score improved to A in 11 patients (58 %) from Group 1, and 18 patients (72 %) from Group 2. Mean anterior translation according to KT-2000 arthrometer measurements was 5.2 ± 1.3 mm in Group 1, and 4.6 ± 1.3 mm in Group 2. Post-operative time to return to sports activity was 8.5 ± 3.0 months in Group 1, and 6.5 ± 2.2 months in Group 2.

Conclusion

Partial meniscectomy for irreparable medial meniscal tears, applied during the same surgery with anterior cruciate ligament reconstruction, negatively affects the clinical outcomes in the short-term follow-up. This study may be a reference for long-term clinical trials and also future investigations of new methods in the treatment of similar cases.

Level of evidence

IV.

     

Subureteral dextranomer/hyaluronic acid copolymer injection for vesicoureteral reflux in transplant candidates

BACKGROUND AND PURPOSE: Endoscopic subureteral injection of tissue-augmenting substances has become an alternative to antibiotic prophylaxis and open surgery for the management of vesicoureteral reflux (VUR). Several injectable materials have been tried for this purpose. In this study, we tried to determine the efficacy of dextranomer/hyaluronic acid copolymer (Dx/HA) injection for the treatment of VUR in renal-transplant candidates. PATIENTS AND METHODS: A total of 21 transplant candidates (29 ureteral units; 13 females, 8 males) with a mean age of 20.2 years (range 14-26 years) underwent endoscopic correction of VUR with Dx/HA. Diagnosis of VUR was made by voiding cystourethrography. The efficacy of the treatment was assessed with voiding cystourethrography at 3 months and 1 year postoperatively. Renal transplantation with living related donor organs was performed in 11 of the 21 patients. RESULTS: Endoscopic treatment was performed without complication in all cases. Higher success rates were obtained in patients with low-grade reflux, the overall success rate in the series being 82.7%. The mean follow- up after renal transplantation was 21.8 months (range 5-45 months). In one patient, reflux recurred after renal transplantation and was treated successfully by a repeat Dx/HA injection. The urine cultures of all patients remained sterile. CONCLUSION: Transplant candidates with VUR can be treated with Dx/HA, which cured the majority of our patients after one or two treatments with few low side effects. Endoscopic subureteral injection of Dx/HA has become an alternative treatment for VUR in transplant candidates. Long-term results are needed before making a final statement about its value.     

Transcervical video-assisted resection of Zenker's diverticulum

We report a novel technique for resection of symptomatic Zenker's diverticulum. Two consecutive patients underwent a transcervical video-assisted dissection and resection of Zenker's diverticular pouch. Both patients exhibited good anatomical and functional results at 10 months follow-up.     

Ultrastructural evaluation of pulsed radiofrequency and conventional radiofrequency lesions in rat sciatic nerve

BackgroundPRF treatment has recently been described as minimally neurodestructive alternative to radiofrequency heat lesions. Patients with some pain syndromes in whom the pain could not be controlled by alternative techniques may be treated using PRF. In the present study, our main goal was to evaluate and compare the ultrastructure of peripheral nerve tissue that was heated by PRF, CRF with 42°C, and CRF with 70°C.MethodsForty-five male rats were divided into 5 groups. In PRF group and CRF with 42°C group, the sciatic nerve was heated at a temperature of 42°C for 120 seconds. As a positive control, some rat sciatic nerves were treated with CRF lesions at 70°C. The rats were kept alive for 21 days and then killed. Tissue was evaluated with transmission electron microscope, and grading was done to the groups.ResultsThe unmyelinated nerve fibers were ultrastructurally normal in all groups. The results of myelinated axons indicated that PRF group had better grades, and CRF with 70°C group had the worst grade. Especially, comparison of the group of PRF and CRF with 42°C revealed significant difference. In PRF group, none of the myelinated axons showed severe degeneration findings, and most of the damaged myelinated axons showed only separation in myelin configuration.ConclusionsPRF treatment may cause separation in myelinated axons. However, it seems that all changes were reversible. The present study supports the hypothesis that pulsed RF treatment does not rely on thermal injury of neurologic tissue to achieve its effect.     

Does Low Molecular Weight Heparin Impair Anastomotic Wound Healing?

Background  Enoxaparin is an important molecule which had been using in prophylaxis and treatment of deep venous thrombosis. Also, it is showed that it prevents postsurgical peritoneal adhesions in rats. It is aimed to evaluate its effects on gastrointestinal wound healing. Methods  Thirty Wistar albino rats were divided into three groups as control, subcutan, and intraperitoneal enoxaparin groups. Left colon anastomoses were performed. On postoperative seventh day, anastomotic healing was evaluated by measuring anastomotic bursting pressure, tissue hydroxyproline levels, and histopathological examination. Results  The anastomotic bursting pressure was highest in subcutan enoxaparin group (p < 0.001), intraperitoneal enoxaparin group (p < 0.01) came the second, and the control group has the worst value. The hydroxyproline results were found nearly similar to the bursting pressure values (subcutan (p < 0.001) > intraperitoneal (p < 0.05) > control). Neovascularization in subcutan group (p < 0.001) has a statistically significant difference to other groups. Conclusion  Enoxaparin did not interfere with colonic anastomotic resistance but improved the intestinal wound healing.     

Timing of surgical treatment for type III supracondylar humerus fractures in pediatric patients

Background  Type III supracondylar humeral fracture is a common cause of emergency hospitalization among children requiring surgical treatment. The configuration of the internal fixation material, surgical technique, and optimal timing of surgery (TS) have always been popular topics of debate. The TS in uncomplicated cases is usually determined by surgeons. Methods  In this study, we prospectively followed children with type III supracondylar fractures. We aimed to clarify the effects of injury side, gender, and post-injury delay on switching to open surgery and the ease of the reduction. Results  Based on our results, the probability of switching to open surgery increased by a factor of 4 every 5 h beginning 15 h after injury. Open surgery was necessary after 32 h. Conclusion  Reduction became technically more difficult as TS increased.