The surgical treatment and outcomes of high-pressure injection injuries of the hand

High-pressure injection injuries to the hand are uncommon soft tissue traumas of the hand which are frequently underestimated. They are, however, not uncommon among workers in industry using paint, automotive grease, solvents and diesel oil. The prognostic factors are the type, amount and temperature of the material and the pressure of injection. The results of 14 surgically treated high-pressure injection injuries of the hand with a minimum of two years follow-up are reported. Ten cases required soft tissue debridement and foreign body removal. Six required reconstructive microsurgical procedures and one underwent digital tip amputation, which followed major and devastating soft tissue problems. In the present study, we describe the mechanism of the soft tissue damage and the principles of treatment. This study confirms the fact that high-pressure injection injury to the hand is a significant problem, which can easily lead to serious sequelae and, even, amputation.     

Comparison of granisetron with granisetron plus droperidol combination prophylaxis in post-operative nausea and vomiting after laparoscopic cholecystectomy

The aim of this study was to evaluate the effects of granisetron and granisetron plus droperidol combination therapy on post-operative nausea and vomiting (PONV) in 60 patients who had undergone elective laparoscopic cholecystectomy. Induction of anaesthesia was achieved using 5 mg/kg thiopentone, 2 micrograms/kg fentanyl and 0.5 mg/kg atracurium, and anaesthesia was maintained with 2-2.5% sevoflurane. The patients were randomly assigned to two groups: group G (granisetron) (n = 30) patients received 3 mg granisetron and group GD (granisetron plus droperidol) (n = 30) patients received 3 mg granisetron and 1.25 mg droperidol shortly before the induction of anaesthesia. PONV incidence was recorded post-operatively at 15 min, 30 min, 60 min, 2 h, 4 h, 12 h and 24 h. While PONV prophylaxis provided almost complete emetic control in patients who received the granisetron plus droperidol combination, patients who received granisetron prophylaxis alone experienced PONV more frequently at 30 min and 60 min post-operatively. We conclude that addition of a low dose of droperidol to granisetron prophylaxis is more effective than granisetron prophylaxis alone for successful control of PONV.     

Indications for eye removal surgeries: A 15-year experience at a tertiary military hospital

Objectives:

To analyze the indications and types of eye removals at a military tertiary care hospital in Turkey.

Methods:

The medical records (age, gender, affected eye, type of surgical procedure, indications of surgery) of 123 patients who underwent evisceration and enucleation in the course of a 15-year period (January 2000 to December 2014) at Gulhane Military Medical Academy, Ankara, Turkey were reviewed retrospectively.

Results:

The mean age was 35.61±18.52 (range 3-80 years). The number of male in the patient group was 92 (74.8%) and female was 31 (25.2%). Patients who underwent evisceration were 95 (77.2%), whereas 28 (22.8%) of them underwent enucleation. The mean age of the eviscerated patients was 30.63±13.08, whereas the mean age of the enucleated patients was 52.50±23.92 (p<0.001). The leading indications for eye amputations were trauma (n=62, 50.4%), malignancy (n=20, 16.3%), painful blind eye and absolute glaucoma (n=20, 16.3%), endophthalmitis (n=12, 9.7%), and phthisis bulbi, and cosmetic reasons (n=9, 7.3%).

Conclusion:

Trauma was the most common etiology for evisceration, and malignancy was the most common etiology for enucleation. Using protective eyewear and early detection of intraocular malignancy and glaucoma through routine ophthalmic examinations are essential for providing non-invasive treatment modalities instead of eye removal.Eye removals are performed in cases of severe trauma, eye malignancy, endophthalmitis unresponsive to medical treatment, painful blind eye, and absolute glaucoma, as well as phthisic eyes with severe cosmetic defects.1-4 Evisceration is the removal of intraocular structures other than the sclera, whereas enucleation is the removal of the entire eyeball including the sclera leaving behind only the orbital structures.5 Evisceration surgery is usually preferred in extremely severe trauma cases, while enucleation is used in advanced cases of intraocular malignancy.1,3,6 The aim in such surgeries is to remove the damaged eye, provide sufficient comfort, replace the lost volume, and renew functional and cosmetic appearance.7 Removal is a difficult decision for both patients and physicians, and is considered as the last resort. In addition to clinical indications, the potential sight of the eye and patient’s psychological aspects should also be taken into consideration.1 In developed countries, the most common reasons for eye amputations are malignancy3 and trauma,6 whereas in developing countries, infections are the dominating factors.1,8 In this study, the etiology and surgery methods of 123 eye amputations performed in the Gulhane Military Medical Academy (GATA) between January 2000 and December 2014 were analyzed, and possible public health and preventive programs regarding this matter were evaluated.     

Percutaneous sclerotherapy of peripheral venous malformations in pediatric patients

Purpose  

To report the efficacy of percutaneous puncture and sclerosis using polidocanol in the treatment of venous malformations (VMs) in pediatric patients.     

Preclinical Evaluation Method for Total Knees Designed to Restore Normal Knee Mechanics

The objective was to develop a simple, rapid, and low-cost method for evaluating proposed new total knee arthroplasty (TKA) models and then to evaluate 3 different TKA models with different kinematic characteristics. A “desktop” knee testing rig was used to apply forces and moments over a full flexion range, representing a spectrum of positions and activities; and the positions of the femur on the tibia were measured. The average neutral path of motion (for compressive force only) and the laxities about the neutral path (for superimposed shear and torque) were determined from 8 knee specimens to be used as a benchmark for the TKA evaluations. A typical posterior-stabilized TKA did not display the normal external femoral rotation with flexion and also showed abnormal anterior sliding on the medial side. A medial-pivot type of guided-motion design showed medial stability comparable to anatomical but still did not produce external femoral rotation and posterior lateral displacement with flexion. The addition of a central cam-post produced the rotation and displacement but only after 75° of flexion. It was concluded that the test method satisfied the objective and could be used as a design tool for evaluating new and existing designs, as well as for formulating a TKA with anatomical characteristics.     

Effects of lidocaine with and without epinephrine on plasma epinephrine and lidocaine concentrations and hemodynamic values during third molar surgery.

Lidocaine with epinephrine is currently the most common local anesthetic agent used for impacted third molar surgery. The purpose of the present study was to define the adverse hemodynamic effects and plasma concentrations of lidocaine and epinephrine on 17 healthy patients during the impacted teeth operations. Arterial blood pressure (systolic blood pressure, diastolic blood pressure), heart rate, peripheral oxygen saturation range, and electrocardiography were measured by an automatic noninvasive pressure device and monitor. High-performance liquid chromatography was used to measure the changes of plasma concentrations of epinephrine and lidocaine from blood samples taken 5 different times during the operation. We concluded that lidocaine-epinephrine is effective local anesthetic and had no important adverse events in healthy patients during the third molar surgery.     

Short- and long-term COX-2 inhibition reverses endothelial dysfunction in patients with hypertension

Hypertension is associated with endothelial dysfunction that is attributable to oxidative stress and a proinflammatory state. Under these conditions, enhanced expression of cyclooxygenase-2 might lead to increased production of vasoconstrictor prostanoids and reactive oxygen species that reduce the bioavailability of endothelium-derived nitric oxide. To investigate the contribution of cyclooxygenase-2 activity to endothelial dysfunction in human hypertension, we evaluated brachial artery vasodilator function by ultrasound in 29 hypertensive patients before and after treatment with the selective cyclooxygenase-2 inhibitor celecoxib or placebo in a randomized, double-blind study. Brachial artery flow-mediated dilation improved from a baseline of 7.9+/-4.5% to 9.9+/-5.1% (P=0.005) 3 hours after the first dose and to 10.1+/-6.1% (P=0.006) after 1 week of treatment with celecoxib. In contrast, placebo treatment had no significant effect on flow-mediated dilation (8.1+/-4.4%, 8.3+/-3.5%, and 8.0+/-3.2%, respectively). Neither treatment altered nitroglycerin-mediated dilation, extent of reactive hyperemia, or baseline arterial diameter. Celecoxib treatment had no significant effect on the urinary concentrations of F2 isoprostane or thromboxane metabolites. However, urinary concentrations of the prostacyclin metabolite 2,3-dinor-6-ketoprostglandin F1alpha were significantly lower after 1 week of celecoxib treatment. Thus, cyclooxygenase-2 products contribute to endothelial dysfunction in hypertension, and treatment with a cyclooxygenase-2 inhibitor could have a beneficial effect in this setting. However, cyclooxygenase-2 inhibition also has an adverse effect on prostacyclin production that could promote thrombosis, and the net clinical consequences of improved endothelial function versus loss of prostacyclin merits further investigation.     

Ischemic preconditioning decreases laparoscopy-induced oxidative stress in small intestine

BACKGROUND/AIMS: Laparoscopy is advantageous but its adverse effects have not yet been completely elucidated. Pneumoperitoneum performed to facilitate laparoscopy causes the organ perfusion decrease such as in the intestine. Oxidative stress reflects the tissue injury related to ischemia and reperfusion. We previously showed that laparoscopy causes oxidative stress in intestinal tissues. To assess whether the preconditioning phenomenon could be taken advantage of during laparoscopy we designed this randomized, controlled, experimental study with blind outcome assessment. We evaluated the effect of preconditioning, including sequential periods of pneumoperitoneum and desufflation on laparoscopy-induced tissue injury of small bowel with the help of two important markers of oxidative stress, thiobarbituric acid reactive substances and reduced glutathione. METHODOLOGY: Forty Sprague-Dawley male rats were used. After anesthesia, an intraperitoneal catheter was inserted. Pneumoperitoneum was created in all except controls, by CO2 insufflation under a pressure of 15 mmHg. The rats were randomized into the groups below: Group P was subjected to 60 minutes of pneumoperitoneum; Group P/D was subjected to 60 minutes of pneumoperitoneum followed by 45 minutes of desufflation; Group IP + P was subjected to 10 minutes of pneumoperitoneum, 10 minutes of desufflation and 60 minutes of pneumoperitoneum; Group IP + P/D was subjected to 10 minutes of pneumoperitoneum, 10 minutes of desufflation, 60 minutes of pneumoperitoneum and 45 minutes of desufflation; Group C (Control) was subjected to a sham operation, without pneumoperitoneum. Small bowel tissue malondialdehyde and reduced glutathione activities were measured, as applicable, by investigators blinded to the study design. The results were decoded and statistically analyzed with Kruskal-Wallis test. Mann-Whitney U test was used to compare the paired groups. p < 0.05 was considered significant. RESULTS: Small bowel tissue malondialdehyde levels were increased, whereas glutathione values were decreased in Groups P and P/D, as compared to Groups PRE/P and PRE/P/D; the latter two groups had results similar to the Control Group. CONCLUSIONS: Laparoscopic preconditioning may reduce the oxidative injury in intestine following laparoscopic procedures.