Double-blind randomised controlled trial comparing Merocel with Rapid Rhino nasal packs after routine nasal surgery

INTRODUCTION: Nasal packing after routine nasal surgery is commonly practiced in the UK. The most popular pack appears to be Merocel, however this can be associated with significant pain on its removal. AIM: To test the efficacy of a relatively new nasal pack--the Rapid Rhino Goodman pack--introduced to our department, which claims to reduce pain and bleeding after nasal surgery. METHODS: Fourteen patients undergoing routine nasal surgery were recruited into a randomised controlled trial. One nasal cavity was packed with a Merocel pack and the other with a Rapid Rhino Goodman pack. Patients were asked to record pain levels on each side using a visual analogue scale. RESULTS: We found no difference between packs whilst in-situ, with all patients recording low to moderate pain scores. There were significantly higher pain levels associated with Merocel pack removal than with Rapid Rhino pack removal (average pain scores 5.64 vs 1.64, p < 0.001) and less bleeding overall. CONCLUSIONS: Rapid Rhino (Goodman pack) is associated with significantly less pain on removal than Merocel pack, causes less bleeding and is not more painful whilst in-situ. We therefore recommend its use in routine nasal surgery.     

Fibroblast growth factor-2 inhibits myelin production by oligodendrocytes in vivo

Fibroblast growth factor-2 (FGF-2) controls in part the timely differentiation of oligodendrocytes into the myelin-producing cells of the CNS. However, although differentiated oligodendrocytes express FGF receptors (R), the effect of FGF-2 on myelin-producing oligodendrocytes in vivo was unknown. In the present study, we show that delivery of FGF-2 into the cerebrospinal fluid of anaesthetized rat pups, aged postnatal day (P) 6 to 9, induced a severe loss of myelin in the caudal anterior medullary velum (AMV). Furthermore, we show that the caudal AMV was myelinated at the time of treatment, so the effects of FGF-2 represent a loss of myelin and not delayed differentiation. This was confirmed by injection of platelet-derived growth factor-AA (PDGF-AA), a factor known to affect the differentiation of PDGF-alphaR expressing oligodendrocyte progenitors, but which did not induce myelin loss in the caudal AMV and did not affect differentiated oligodendrocytes, which do not express PDGF-alphaR. Compared to controls treated with saline or PDGF-AA, FGF-2 induced an accumulation of PLP protein and MBP mRNA within the somata of myelin-producing oligodendrocytes. The results indicate that FGF receptor signalling disrupts myelin production in differentiated oligodendrocytes in vivo and interrupted the transport of myelin-related gene products from the oligodendrocyte cell body to their myelin sheaths.     

Cardiac and Pulmonary Injury

Cardiac and pulmonary injuries present major challenges in diagnosis and treatment. Distinct differences between penetrating and blunt trauma of these organs exist. Outcomes for severe injuries are still grave. Organized trauma systems can provide optimal care by minimizing prehospital time, allowing easy access to imaging modalities, and offering state-of-the-art treatment strategies. A multidisciplinary approach, including surgeons, intensivists, and others, is absolutely necessary.     

AURICULAR HAEMATOMA—TREATMENT OPTIONS

The acute auricular haematoma following a blow to the external ear presents a number of treatment options. If a satisfactory final cosmetic result is to be obtained a minor surgical procedure of one sort or another must be performed to prevent a ‘cauliflower ear’. Simple needle aspiration is often insufficient to prevent this complication. Different procedures are reviewed and a simple, reliable technique for treating the acute auricular haematoma is described.     

Induction of metallothionein is correlated with resistance to auranofin, a gold compound, in Chinese hamster ovary cells

Metallothioneins (MTs) are low molecular weight, thiol-rich, metal-binding proteins. Auranofin (AF) is a gold compound active in the treatment of rheumatoid arthritis. The effects of AF on regulation of MT gene expression in Chinese hamster ovary cells were studied. AF-resistant cells accumulated substantial amounts of MT mRNA and protein, whereas no induction was observed in AF-sensitive cells. Cells capable of inducing MT in the presence of AF were much less sensitive to AF-mediated cytotoxicity. Induction of MT by low concentrations of Cd protected cells from subsequently administered doses of AF. The level of protection correlated with the level of induced MT. These findings indicate that MT plays a central role in the mechanisms underlying cellular resistance to gold compounds.     

Evaluation of the shelf life of sterile instrument packs.

No published studies have specifically addressed the shelf life of sterile packaging materials commonly used in dentistry. This study examined the effect of time on the sterile integrity: paper envelopes, peel pouches, and nylon sleeves. Seven thousand two hundred sample packs, each containing three glass rods, were prepared and steam sterilized. After sterilization, half the packs (control packs) were immediately opened and the contents were analyzed for bacterial contamination. The other half (test packs) were randomly sorted and stored in dental treatment operatories. At monthly intervals for 12 months, 100 packs of each type were similarly opened and analyzed. The contamination rates between the control packs were not significantly different from one another. Differences in contamination rates between control packs and test packs for both the paper envelopes (0.4% and 0.7%) and the peel pouches (0.2% and 0.2%) were also insignificant. However, a significant difference (p less than 0.01) between control and test packs (0.3% and 1.5%) was found for the nylon sleeves. This increase was not time related and was attributed to difficulty in removing the glass rods from the nylon packs in a sterile manner. The most important finding was the absence of a trend toward an increased rate of contamination over time for any pack type. This indicates that when these materials are placed in covered storage in dental operatories, a 12-month storage period is not detrimental to their sterile integrity.