Solvent-dehydrated fascia lata allograft for covering intraoral defects: our experience.

Mucosal defects in the oral cavity as a result of tumors, preprosthetic surgical procedure, or trauma are always a concern for surgeons. The aim of this study is to present our experience and discuss the advantages and problems arising with the use of solvent-dried human fascia lata allografts in oral mucosal defects, thus evaluating its clinical efficacy. Sixteen intraoral lesions were removed from 15 patients. The rehabilitation of the mucosal defects was achieved using solvent-dehydrated human fascia lata allografts. No graft rejection or infections were detected. The material was effective for enhancing the hemostasis, relieving the pain, and inducing rapid epithelization. The final result was excellent, even though in 2 cases complications were experienced. Hence, the use of the material proved to be reliable, practical, and safe.     

Thoracic paravertebral spread using two different ultrasound‐guided intercostal injection techniques in human cadavers

The continuity between the intercostal and paravertebral space has been established by several studies. In this study, the paravertebral spread of a colored dye was attempted with two different ultrasound‐guided techniques. The posterior area of the trunk was scanned with a linear probe between the level of the fifth and the seventh thoracic vertebrae in eleven embalmed human cadavers. In the first technique, the probe was placed transversely below the inferior margin of the rib, and a needle was inserted between the internal intercostal membrane and the pleura. In the second technique, the probe was placed longitudinally at the intercostal space 5 cm lateral to the spinous processes, and the needle was inserted between the internal intercostal membrane and the pleura. In both techniques, 1 ml of methylene blue was injected, and both the intercostal and paravertebral spaces were prepared. In total, 33 injections were performed: 19 with the transverse technique and 14 with the longitudinal technique. Successful spread of the dye to the thoracic paravertebral space was recorded in 89.5% cases using the transverse technique and 92.8% cases using the longitudinal technique. No intrapleural spread of the dye was recorded in either technique. Ultrasound‐guided injection into the intercostal space may offer an alternative approach to the thoracic paravertebral space. Clin. Anat. 23:840–847, 2010. © 2010 Wiley‐Liss, Inc.     

Effect of various stress models on lidocaine pharmacokinetic properties in the mandible after masseter injection.

PURPOSE: The aim of this study was to investigate the role of stress (trauma, cold swimming, and adjuvant rheumatoid arthritis) on lidocaine concentrations as well as lidocaine's protein binding in the mandible. MATERIALS AND METHODS: Forty male Wistar rats were used. The animals were divided into four groups. Group A served as control. Group B underwent mandible osteotomy. Group C was submitted to cold swimming stress. Group D was subjected to experimental arthritis. Additionally, all the groups received 5 doses of lidocaine, 1 dose of lidocaine (3 mg/kg) intramuscularly every 2 hours. Two hours after the last dose, the animals were killed. Lidocaine concentrations were estimated in plasma. Furthermore, the mandible was isolated, and both lidocaine concentrations and lidocaine protein binding were assessed. RESULTS: In groups under stress, lidocaine concentrations in serum showed a marked elevation. In addition, these animals demonstrated a significant decrease in the percent of lidocaine binding in the mandible. CONCLUSIONS: Stress can modify local anesthetics pharmacokinetic properties, resulting in alterations both in their concentration in serum and their protein binding in mandibular bone.     

The influence of clonidine co-administration on the extent of lidocaine protein binding to rat serum and tissues

Lidocaine is an amide local anesthetic and clonidine is an antihypertensive (α2-adrenergic agonist). The use of these two drugs in combination is recommended to enhance the analgesic effect of lidocaine. The aim of this study was to investigate the influence of clonidine co-administration on the extent of lidocaine binding to rat serum, heart and maxillofacial tissues in vivo and in vitro. Thirty-two Wistar rats received either lidocaine alone, or lidocaine and clonidine, in the masseter muscle, and were then sacrificed 15 or 30 min after treatment. Serum, masseter, mandible and heart samples were then isolated and incubated in 0.9% NaCl solution for 12 h at 8°C. The extent of binding in the incubation medium and the serum was estimated by ultrafiltration, and the free lidocaine fraction was determined by the radioscopic method in a β-counter. An in vitro procedure was also performed. Serum, heart, masseter and mandible samples were incubated at 37°C for 15 or 30 min in Ringer's solution containing either lidocaine or lidocaine and clonidine, and the samples were similarly subjected to ultrafiltration. The percentage binding of lidocaine was again estimated by the radioscopic method. Lidocaine levels were found to be increased by clonidine co-administration in vivo and the free lidocaine fraction was enhanced in vitro as well in the examined tissues, obviously through mechanisms related to protein binding alterations.     

New insights into weaning from mechanical ventilation: left ventricular diastolic dysfunction is a key player

Purpose  

To investigate the diagnostic performance of Doppler echocardiography (DE) in predicting the outcome of weaning from mechanical ventilation in patients without overt cardiac disease.     

Transthoracic echocardiography for the diagnosis of left ventricular thrombosis in the postoperative care unit

Introduction  

Transthoracic echocardiography (TTE) is a reliable, noninvasive imaging method that is useful in the evaluation of cardiovascular thrombosis. We conducted a retrospective study of all the echocardiograms from patients in the postoperative care unit to assess the role of TTE in thrombus identification in the left ventricle.     

Risk factors affecting the survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy

STUDY OBJECTIVES: Surgical subxiphoid drainage of the pericardial cavity has been established as a safe and effective method of treatment of pericardial effusion; however, the risk factors affecting survival of these patients have not been clarified. The aim of this study was to investigate the risk factors affecting the short-term and long-term survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy. DESIGN: Retrospective study. PATIENTS: The records of all patients who underwent subxiphoid pericardiostomy for treatment of pericardial effusion from January 1991 to December 2001 were reviewed. According to underlying pathology the patients were classified into four groups: (1) hematologic malignancies (n = 17); (2) other malignant diseases (n = 29); (3) AIDS (n = 5); and (4) other benign diseases (n = 53). Multivariate Cox regression analysis was used to test the relationship of short-term and long-term survival to age, sex, cardiac tamponade, pericardial malignant invasion, postoperative low cardiac output syndrome (PLCOS), and underlying pathology. RESULTS: There were 104 patients (59 men) with a mean age of 53.6 years (range, 13 to 85 years). Follow-up was complete in 99 patients (95.2%) for a mean of 23.9 months (range, 0 to 92 months). Overall 30-day mortality was 16.3%, while operation-related mortality was 4.8%. The underlying disease was the main risk factor for short-term and long-term survival (p < 0.00001), while PLCOS was a major predictor of early mortality (p = 0.029). Patients with AIDS showed the worst prognosis. On the contrary, patients with hematologic malignancies presented significantly longer survival compared to all other patients with malignant diseases (p < 0.05). CONCLUSIONS: The underlying disease was the main risk factor for short-term and long-term survival, while PLCOS was a major predictor of early mortality. The prognosis of AIDS patients with pericardial effusion was grave; therefore, surgical intervention in such patients should be reevaluated. Patients with hematologic malignancies had significantly longer survival compared to all other patients with malignant diseases.     

The Effect of Biliopancreatic Diversion with Pylorus-Preserving Sleeve Gastrectomy and Duodenal Switch on Fasting Serum Ghrelin, Leptin and Adiponectin Levels: Is there a Hormonal Contribution to the Weight-Reducing Effect of this Procedure?

Background: Ghrelin is a peptide hormone with orexigenic properties, primarily produced by the stomach. Different changes in fasting ghrelin levels have been reported following bariatric surgery. In this study, we investigate the hypothesis that because ghrelin is mainly produced by the fundus of the stomach, biliopancreatic diversion with sleeve gastrectomy with total resection of the gastric fundus and duodenal switch (BPD-DS) will cause substantial decrease in circulating ghrelin levels. Methods: Serum fasting ghrelin, leptin and adiponectin concentrations were measured by ELISA in 13 patients with morbid obesity who achieved weight loss by BPD-DS, before the operation and 18 months after. Results: After BPD-DS, BMI decreased significantly, from 59.15±15.82 kg/m² to 32.91±6.46 kg/m² (P=0.001). Serum fasting ghrelin level decreased from 1.44±0.77 ng/ml to 0.99±0.35 ng/ml (P=0.019). Serum leptin level decreased from 1.81±0.38 ng/ml to 1.65±0.32 ng/ml, (P=0.196), and adiponectin level increased from 37.85±11.24 μg/ml to 39.84±16.27 μg/ml (P=0.422). Conclusions: BPD-DS is associated with markedly suppressed ghrelin levels, possibly contributing to the longlasting weight-reducing effect of the procedure. Leptin levels decreased and adiponectin increased, as expected, after weight loss. Sleeve gastrectomy with resection of the gastric fundus seems to be the main cause of the postoperative reduction in ghrelin levels.