Intravenous versus perineural dexmedetomidine as adjuvant in adductor canal block for total knee arthroplasty / 대한마취과학회지

Background@#The shivering effect after spinal anesthesia in total knee arthroplasty (TKA) is challenging for anesthesiologists. This study aimed to compare two administration routes of dexmedetomidine as a post-neuraxial shivering prevention measure and an adjunctive analgesic and sedative agent. @*Methods@#Fifty-six patients were randomly allocated into two equal groups. The intravenous dexmedetomidine (IV dex) group received an IV infusion of 0.5 µg/kg dexmedetomidine diluted in 20 ml saline and an adductor canal block (ACB) consisting of 20 ml of 0.25% levobupivacaine and 1 ml saline. The adductor canal block dexmedetomidine (ACB dex) group received a 20 ml IV infusion of saline and an ACB consisting of 20 ml 0.25% levobupivacaine and 1 ml of 0.5 µg/kg dexmedetomidine. @*Results@#The incidence of shivering 1 h post spinal anesthesia was equal in both groups (50%); however, the shivering grade was significantly lower in the IV dex group 1 h postoperatively. The onset of sensory block was significantly later in the IV dex group (22.14 ± 2.52 min) than in the ACB dex group (12 ± 3.31 min). Postoperative analgesic duration (h) was significantly longer in the ACB dex group (12.28 ± 4.47) compared to the IV dex group (9.28 ± 1.90). The sedation scores were also significantly higher in the IV dex group in the preoperative, intraoperative, and immediate postoperative periods. @*Conclusions@#While perineural ACB dexmedetomidine had similar intraoperative anti-shivering with less sedative effects as IV dexmedetomidine, it was associated with both less shivering control and superior analgesia post-TKA under spinal anesthesia.

Reparative dentin formation using stem cell therapy versus calcium hydroxide in direct pulp capping: an animal study

Abstract Direct pulp capping process is a therapeutic method aimed at maintenance of pulp vitality and health by using a biocompatible material placed directly over the exposed pulp. The aim of this study was to evaluate and compare the effect of direct pulp capping procedures by dental pulp stem cells (DPSCs) or calcium hydroxide on dentin tissue formation. Three mongrel dogs were used as experimental model. Two access cavities were prepared in the right and left mandibular fourth premolars in all dogs to expose and extirpate the pulp tissues which were processed in the lab to obtain a single-cell suspensions. The isolated cells were cultures in odontogenic medium for subsequent differentiation. The maxillary teeth (3 incisors and one canine) of the corresponding dog number were subjected to class V cavities to expose their pulps which were assigned into 2 groups of 12 teeth each ( group I - pulp capping with calcium hydroxide) and (group II - pulp capping with dental stem cells DPSCs). The operated teeth were collected after 3 months and processed for histological and electron microscopic examinations. Specimens were subjected to elemental analysis of calcium and phosphorus. EDX elemental analysis revealed significant differences in the calcium and phosphorous wt, % in the reparative dentin of calcium hydroxide treated group which confirmed histologically. Direct pulp capping by DPSCs has shown promising generative potential for regaining normal dentin.

Resumo O processo de capeamento pulpar direto é um método terapêutico que visa a manutenção da vitalidade e saúde da polpa, usando um material biocompatível colocado diretamente sobre a polpa exposta. O objetivo deste estudo foi avaliar e comparar o efeito do capeamento pulpar direto usando células-tronco da polpa dentária (CTPDs) ou hidróxido de cálcio sobre o tecido da dentina formação. Três cães sem raça definida foram utilizados como modelo experimental. Duas cavidades de acesso foram preparados nos quartos pré-molares inferiores direito e esquerdo em todos os cães para expor e extirpar os tecidos pulpares que foram processados ​​em laboratório para obter suspensões de uma célula única. As células isoladas foram cultivadas em meio odontogênico para posterior diferenciação. Os dentes superiores (3 incisivos e um canino) do respectivo cão foram submetidos ao preparo de cavidades classe V para expor suas polpas, as quais foram atribuídas a 2 grupos de 12 dentes cada (grupo I - capeamento pulpar com hidróxido de cálcio) e (grupo II - capeamento pulpar com CTPDs). Os dentes operados foram extraídos após 3 meses e processado para exames histológicos e por microscopia eletrônica de varredura. Os espécimes foram submetidos a análises elementares de cálcio e fósforo. Análise elementar por EDX revelaram diferenças significativas no peso de cálcio e fósforo, % na massa reparadora dentina do grupo tratado com hidróxido de cálcio, o que foi confirmado histologicamente. O capeamento pulpar com CTPDs mostrou potencial promissor para recuperar a dentina normal.

Outcome of endovascular treatment of cerebral arteriovenous malformations with ethylene vinyl alcohol coploymer

Background: Cerebral AVMs are very rare lesions, and this rarity contributes to the difficulty of treating them. There is no consensus concerning the method of treatment to be chosen among neurosurgery, radiosurgery or embolization.

Onyx embolization could serve as a curative option with accepted morbidity and mortality. The introduction of Onyx and of catheters with detachable tips has no doubt increased the rate of endovascular occlusion, and decreased the risks associated with treatment in our experience

Objective: The aim of the study was to assess the outcome of the use of Onyx in the treatment of intracranial AVMs as curative embolization or before neuro- or radiosurgery

Patients and Methods: This analytical prospective study was conducted on 25 patients who were diagnosed with cerebral arteriovenous malformations and underwent endovascular embolization with EVOH copolymer with curative intent during the study period. Interventional procedures were done in the neuro - endovascular unit, neurosurgery department Ain Shams University Hospitals and associate neuroendovascular unit in El Matarya Teaching Hospital in the period between September 2014 and April 2017

Results: Actually comparing these results especially concerning the cure rate along with other studies was somewhat confusing and problematic owing to the diversity in results between studies across the last 15 years

Conclusion: For the cases that are not fulfilling these criteria, embolization should be offered as preparing step for other modality of treatment. In our experience, for curative embolization, the AVM should be small sized [< 3 cm], supplied by one vascular territory, with feeders that can tolerate reflux up to 2-3 cm, with clear proximal parts of the draining veins, and not located in deep structures