Prevention of epidural catheter migration: a comparative evaluation of two tunneling techniques / 대한마취과학회지

Background@#Epidural analgesia failure episodes can be reduced by catheter fixation techniques with a lower incidence of catheter migration. In this clinical study, we compared the roles of two epidural catheter tunneling techniques for the prevention of epidural catheter migration. @*Methods@#Patients undergoing major abdominal surgery were randomized into three groups of 50 patients each based on the method used to secure the epidural catheter. In the control group (CG), the epidural catheter was secured without tunneling. Tunneling groups 1 and 2 (TG1 and TG2) were defined as tunneling with and without a catheter loop, respectively. The primary outcome measure was the migration of the epidural catheter, while the secondary outcome measures were the adequacy of analgesia and signs of inflammation. All patients were followed up by the acute pain service team twice daily in the postoperative period until the epidural catheter was removed. The results were analyzed by the one-way analysis of variance (ANOVA), chi-square test, and Fisher’s exact test. P values 0.050). @*Conclusions@#Catheter migration was significantly reduced by tunneling without a catheter loop in TG2 as compared to the other two groups. Therefore, we suggest routine use of tunneling without a catheter loop technique in anesthesia practice and look forward to future studies with larger sample sizes.

Anesthetic management of pulmonary endarterectomy in a patient with suprasystemic pulmonary pressure: a case report

Pulmonary endarterectomy (PEA) is a potentially curative procedure for chronic thromboembolic pulmonary hypertension. A 34-year Indian male presented with supra-systemic pulmonary pressure was taken for PEA after achievable optimization. A successful PEA was performed with the help of total cardiac arrest. Patient developed reperfusion pulmonary edema post operatively, which was managed medically. The problems encountered by anesthesiologists in this case were preoperative pulmonary hypertension with chronic hypoxia and postoperative management of reperfusion pulmonary edema.

Clinical And Cytogenetic Study Of Turner Syndrome And Its Variants

62 cases of Turner syndrome (T.S) were clinically diagnosed and sent to cytogenetic laboratory for confirmationof the diagnosis through karyotyping from 2012 to 2018. Out of 62 cases, 43 turned out to be T.S & its variants.Most commonly observed karyotype was 45,X (62.79%), followed by 45,X/ 46,XX (23.25%), 45,X/ 46,Xi (6.97%)mosaicism, 4.65% of 46,Xi & 2.32% of a very rare type of variant of T.S i,e 45,X/ 46,XY.Patients with 45,X karyotype had typical features of T.S such as short stature (< 5feet or 150cms), delayedappearance of secondary sexual characters & dysmorphic facies, the main complaint of these patients wasprimary amenorrhoea. Patients were younger at diagnosis & had a significant shorter mean adult height thanthose with 45,X/ 46,XX mosaicism. Those with mosaicism had mild dysmorphic features & presented withprimary or secondary amenorrhoea. The rarest type of T.S (45,X/ 45,XY) was presented in a new born withambiguous genitalia (suspected for CAH).Short stature with sexual infantilism & primary or secondary amenorrhoea in a young female should suggest thepossibility of Turner syndrome, which should be confirmed by chromosome analysis.

Estimation of Stature from Radiological Length of Femur among South - Indian Adult Population

Introduction: Stature estimation by analyzing skeletalremains or body parts is an essential part of humanidentification. One critical role of stature estimation todaylies in the forensic identification of crime victims andmissing persons. Femur, being the longest and strongest bonein the body, plays a crucial role while estimating stature ofan individual. In this study, we tested a new approach topredict the stature of a person by radiologically measuringthe femur length.Material and methods: Our study was conducted on 100South Indian subjects (50 males and 50 females) with an aimof obtaining regression formulae for estimation of stature ofmales and females, from maximum femur length and anotherindividual sample consisting of 20 male and 20 femaleparticipants belonging to the same criteria as the preliminarysubject group was used for validating the obtained equations.Results: It was observed that femur length showedstatistically significant correlation with stature in both thegroups (p=0.0001). Regression equations specific togeographical (South-Indian) population were statisticallyanalyzed for femur lengths in males (r=0.880) and females(r=0.862) and significantly proved reliable in estimatingthe living stature of an individual.Conclusion: In our study, the mean stature value of maleswas higher than that of females contributing to theinference that males are generally taller than females.

An epidemiological study on the prevalence of temporomandibular disorder and associated history and problems in Nepalese subjects

BACKGROUND: Temporomandibular disorder (TMD) represents a subgroup of painful orofacial disorders involving pain in the temporomandibular joint (TMJ) region, fatigue of the cranio-cervico-facial muscles (especially masticatory muscles), limitation of mandible movement, and the presence of a clicking sound in the TMJ. TMD is associated with multiple factors and systemic diseases. This study aimed to assess the prevalence of TMD in Nepalese subjects for the first time. METHODS: A total of 500 medical and dental students (127 men and 373 women) participated in this study from May 2016 to September 2016. The Fonseca questionnaire was used as a tool to evaluate the prevalence of TMD, and Fonseca's Anamnestic Index (FAI) was used to classify the severity of TMD. RESULTS: The majority of the participants with TMD had a history of head trauma, psychological stress, and dental treatment or dental problems. The prevalence of TMD in Nepalese students was mild to moderate. CONCLUSIONS: The prevalence of TMD in Nepalese subjects was mild to moderate. The majority of the study subjects had eyesight problems, history of head trauma, psychological stress, and drinking alcohol and had received dental treatments.

A prospective study on drug utilization pattern & rationality in treatment of type II diabetes mellitus: a population based analysis.

Background: Diabetes a chronic disease is associated with significant morbidity, complications with poor glycemic control. Hence, meticulous management is necessary. Comorbid conditions increase chances of polypharmacy and irrational prescriptions in diabetic patients. This prospective non interventional study aimed to gather and study the drug utilization pattern in diabetic patients. Methods: The study was conducted in 50 diabetic patients admitted in medicine ward. Patients were included in the study only after obtaining written informed consent form; all relevant data were collected from case record forms and were analyzed. Results: Diabetes mellitus was observed to be highest in patients with the age group of 60-70 years, affecting 66% males and 34% females. Among the participants 42 (84%) were already on treatment for diabetes while 8 (16%) were diagnosed at the time of admission. We observed that 27 (54%) patients were treated with insulin + oral hypoglycemic agents, 13 (26%) were treated with only Insulin while 10 (20%) patients were prescribed only oral hypoglycemic agents. The most common comorbid conditions observed by us were hypertension, chronic renal disease, diabetic foot, septicemia, urinary tract infections and other susceptible infections. Conclusion: To conclude, the study reveals that Metformin continues to be the choice of oral hypoglycemic agents with least adverse effects and insulin was used to treat uncontrolled state, where physicians have greatly considered the socio-economic status while prescribing which is obvious with least use of costly insulin preparations.

Evaluation of the Efficacy of Methylprednisolone, Etoricoxib and a Combination of the Two Substances to Attenuate Postoperative Pain and PONV in Patients Undergoing Laparoscopic Cholecystectomy: A Prospective, Randomized, Placebo-controlled Trial

BACKGROUND: Establishment of laparoscopic cholecystectomy as an outpatient procedure has accentuated the clinical importance of reducing early postoperative pain, as well as postoperative nausea and vomiting (PONV). We therefore planned to evaluate the role of a multimodal approach in attenuating these problems. METHODS: One hundred and twenty adult patients of ASA physical status I and II and undergoing elective laparoscopic cholecystectomy were included in this prospective, randomized, placebo-controlled study. Patients were divided into four groups of 30 each to receive methylprednisolone 125 mg intravenously or etoricoxib 120 mg orally or a combination of methylprednisolone 125 mg intravenously and etoricoxib 120 mg orally or a placebo 1 hr prior to surgery. Patients were observed for postoperative pain, fentanyl consumption, PONV, fatigue and sedation, and respiratory depression. Results were analyzed by the ANOVA, a Chi square test, the Mann Whitney U test and by Fisher's exact test. P values of less than 0.05 were considered to be significant. RESULTS: Postoperative pain and fentanyl consumption were significantly reduced by methylprednisolone, etoricoxib and their combination when compared with placebo (P0.05). The methylprednisolone and methylprednisolone + etoricoxib combination significantly reduced the incidence and severity of PONV and fatigue as well as the total number of patients requiring an antiemetic treatment compared to the placebo and etoricoxib (P<0.05). CONCLUSIONS: A preoperative single-dose administration of a combination of methylprednisolone and etoricoxib reduces postoperative pain along with fentanyl consumption, PONV, antiemetic requirements and fatigue more effectively than methylprednisolone or etoricoxib alone or a placebo.

New atraumatic easy removal technique for permanently cemented crown.

Removal of a permanently cemented crown or fixed partial denture is a cumbersome procedure for a prosthodontist, especially when there is no purchase point available to remove it. The technique described in this article consists of sectioning of a crown on facial surface followed by removal of the crown with orthodontic plier. This technique does not damage the gingival/periodontal tissues or underlying tooth structure as the crown need not to be removed with jerky back-action force.

A hollow definitive obturator fabrication technique for management of partial maxillectomy

Maxillary obturator prosthesis is the most frequent treatment option for management of partial or total maxillectomy. Heavy weight of the obturators is often a dislocating factor. Hollowing the prosthesis to reduce its weight is the well established fact. The alternate technique to hollow-out the prosthesis has been described in this article which is a variation of previously described processing techniques. A pre-shaped wax-bolus was incorporated inside the flasks during packing of the heat-polymerized acrylic resin to automatically create the hollow space. The processing technique described is a single step flasking procedure to construct a closed-hollow-obturator prosthesis as a single unit. To best understand the technique, this article describes management of a patient who had undergone partial maxillectomy secondary to squamous cell carcinoma rehabilitated with a hollow-obturator prosthesis.

Effects of naringenin on allodynia and hyperalgesia in rats with chronic constriction injury-induced neuropathic pain / 中西医结合学报

To study the analgesic effects of naringenin on chronic constriction injury (CCI) model of neuropathic pain.

A modified technique for retention of orbital prosthesis.

An orbital defect (congenital or acquired) causes severe facial asymmetry and disfigurement, which results in psychological and social disturbances to the patient. It becomes a challenging task for a maxillofacial prosthodontist to fabricate a prosthesis that replicates the healthy side of the face. Success of the prosthesis depends primarily on satisfactory retention of the same. This clinical report illustrates rehabilitation of a patient with an orbital defect by fabricating a hollow orbital prosthesis, utilizing anatomical undercuts for retention using an acrylic resin template relined by a resilient denture liner.

A comparative evaluation of fracture resistance of endodontically treated teeth restored with different post core systems: an in-vitro study

PURPOSE: To compare the fracture resistance and the mode of failure of endodontically treated teeth restored with different post-core systems. MATERIALS AND METHODS: Root canal treatment was performed on 40 maxillary incisors and the samples were divided into four groups of 10 each. For three experimental groups post space preparation was done and teeth were restored with cast post-core (Group B), stainless steel post with composite core (Group C) and glass fiber post with composite core using adhesive resin cement (Group D). Control group (A) samples were selected with intact coronal structure. All the samples were prepared for ideal abutment preparation. All the samples were subjected to a load of 0.5 mm/min at 130degrees until fracture occurred using the universal testing machine. The fracture resistance was measured and the data were analyzed statistically. The fracture above the embedded resin was considered to be favorable and the fracture below the level was considered as unfavorable. The statistical analysis of fracture resistance between different groups was carried out with t-test. For the mode of failure the statistical analysis was carried out by Kruskal-Wallis test and Chi-Square test. RESULTS: For experimental group Vs control group the fracture resistance values showed significant differences (P<.05). For the mode of failure the chi-square value is 16.1610, which means highly significant (P=.0009) statistically. CONCLUSION: Endodontically treated teeth without post core system showed the least fracture resistance demonstrating the need to reinforce the tooth. Stainless steel post with composite core showed the highest fracture resistance among all the experimental groups. Teeth restored with the Glass fiber post showed the most favorable fractures making them more amenable to the re-treatment.

A simple technique to fabricate a surgical obturator restoring the defect in original anatomical form

Oral cancer treatment involves the surgical removal of all or part of the maxilla, leaving the patient with a defect that compromises the integrity and function of the oral cavity. The postoperative restoration of esthetics, deglutition, and speech shortens recovery time in the hospital and expedites the patient's return to the community as a functioning member. The surgical obturator is the proven treatment option in such situations. This article describes a simple technique to fabricate a surgical obturator that restores patient's original dentition and facial and palatal tissue form. The obturator fabricated with this technique utilizes the vacuum formed index of patient's original tissue form and duplicated partly in heat and partly in auto polymerizing acrylic resin. Duplication of the original tissue form helps patient to minimize the immense physiological trauma immediately after the surgical resection. The obturator fabricated with this technique supports soft tissues after surgery and minimizes scar contracture and disfigurement, and thus may have a positive effect on the patients' psychology.

Modified soft tissue cast for fixed partial denture: a technique

In process of fabrication of a fixed partial denture, dies are trimmed to expose margins of the preparations. The need for the soft tissue cast is quite evident as the soft tissue emergence profile that surrounds the prepared tooth is destroyed in the process of fabrication. This article describes a modified technique to fabricate the soft tissue cast for the conventional fixed partial denture. The impression made with the polyvinylsiloxane was first poured to prepare the die cast. After retrieval of the cast, the same impression was poured second time with the resin based resilient material to cover the facial and proximal gingival areas. The remaining portion of the impression was poured with the gypsum material. This technique does not require additional clinical appointment, second impression procedure, technique sensitive manipulations with impression, or cumbersome laboratory procedures. The simplicity of this technique facilitates and justifies its routine use in fabrication of the fixed partial denture.

Guide flange prosthesis for early management of reconstructed hemimandibulectomy: a case report

Surgical resection of the mandible due to presence of benign or malignant tumor is the most common cause of the mandibular deviation. Depending upon the location and extent of the tumor in the mandible, various surgical treatment modalities like marginal, segmental, hemi, subtotal, or total mandibulectomy can be performed. The clinicians must wait for extensive period of time for completion of healing and acceptance of the osseous graft before considering the definitive prosthesis. During this initial healing period prosthodontic intervention is required for preventing the mandibular deviation. This case report describes early prosthodontic management of a patient who has undergone a reconstructed hemi-mandibulectomy with modified mandibular guide flange prosthesis. The prosthesis helps patient moving the mandible normally without deviation during functions like speech and mastication.

Modified measuring compass as an intraoral paralleling device.

This article describes a simple technique of useful modification of measuring compass, procured from a school compass box, to make an intraoral paralleling device. This device is useful in examining parallelism of tooth or implant abutment preparations for a common path of placement in fixed dental prostheses. It can be used to examine the parallelism of guiding planes in removable partial denture patients as well.

Modified technique to fabricate a hollow light-weight facial prosthesis for lateral midfacial defect: a clinical report

Large oro-facial defects result from cancer treatment consequences in serious functional as well as cosmetic deformities. Acceptable cosmetic results usually can be obtained with a facial prosthesis. However, retention of a large facial prosthesis can be challenging because of its size and weight. This article describes prosthetic rehabilitation of a 57-year-old man having a right lateral mid-facial defect with intraoral-extraoral combination prosthesis. A modified technique to fabricate a hollow substructure in heat-polymerizing polymethyl-methacrylate to support silicone facial prosthesis was illustrated. The resultant facial prosthesis was structurally durable and light in weight facilitating the retention with magnets satisfactorily. This technique is advantageous as there is no need to fabricate the whole prosthesis again in case of damage of the silicone layer because the outer silicone layer can be removed and re-packed on the substructure if the gypsum-mold is preserved.