A randomized comparison between interscalene block and dexmedetomidine for arthroscopic shoulder surgery / Una comparación aleatoria entre el bloqueo interescalénico y dexmedetomidina para la cirugía artroscópica de hombro

Abstract Introduction: Management of intraoperative hemodynamics and postoperative analgesia during arthroscopic shoulder surgeries remains a challenge. Although interscalene brachial plexus block (ISB) is considered ideal for shoulder anesthesia it requires skill and proficiency unlike intravenous (IV) dexmedetomidine. Objective: This randomized trial was performed to observe the efficacy of dexmedetomidine infusion which is less invasive and demands lesser skills than plexus block. Methodology: All patients scheduled for elective arthroscopic shoulder surgery under general anesthesia were assigned either to group DEX, which received an IV dexmedetomidine bolus of 0.5 mcg/kg over 20 minutes, followed by an infusion of 0.5 mcg/kg/hour that was stopped 30 minutes before surgery the end of surgery or to group BLOCK which received ultrasound guided ISB with 20ml of 0.25% bupivacaine. The primary outcome assessed was intraoperative hemodynamics; the secondary outcomes were immediate postoperative pain, operating condition as assessed by the surgeon, recovery time, and patient satisfaction after 24 hours. Blinded investigator and composite scores were used for the assessment. Results: Both groups displayed equivalent scores for intraoperative hemodynamics whereas ISB resulted in a better post-operative analgesia (p < 0.001). Surgeon's opinion and recovery time were comparable. Overall, the patients had a satisfactory experience with both techniques, according to the quality assessment. Conclusions: IV dexmedetomidine infusion is an effective alternative to ISB for reconstructive shoulder surgeries under general anesthesia.

Resumen Introducción: El manejo hemodinámico intraoperatorio y la analgesia postoperatoria durante la cirugía artroscópica de hombro sigue siendo un desafío. Aun cuando el bloqueo interescalénico del plexo braquial (BIE) se considera ideal para la anestesia del hombro, a diferencia del uso de la dexmedetomidina intravenosa (IV), el BIE requiere destreza y maestría. Objetivo: El presente estudio aleatorizado se llevó a cabo para observar la eficacia de la infusión de dexmedetomidina que es menos invasiva y exige menos destreza que el bloqueo del plexo. Metodología: Todos los pacientes programados para cirugía artroscópica electiva de hombro bajo anestesia general, se asignaron o bien al grupo DEX, para recibir un bolo de dexmedetomidina IV de 0,5 mcg/kg en 20 minutos, seguido de una infusión de 0,5 mcg/kg/hora que se detuvo 30 minutos antes del final de la cirugía; o, al grupo BLOQUEO al cual se le administró un BIE ecoguiado con 20ml debupivacaína 0,25%. El desenlace primario evaluado fue la hemodinamia intraoperatoria; los desenlaces secundarios fueron el dolor postoperatorio inmediato, la condición operatoria evaluada por el cirujano, el tiempo de recuperación y la satisfacción del paciente después de 24 horas. Para la evaluación se utilizaron el investigador ciego y puntajes compuestos. Resultados: Ambos grupos mostraron puntajes equivalentes en la hemodinamia intraoperatoria, en tanto que el BIE dio como resultado una mejor analgesia en el postoperatorio (p < 0.001). La opinión del cirujano y el tiempo de recuperación fueron comparables. En general, la experiencia de los pacientes fue satisfactoria con ambas técnicas, de acuerdo con la evaluación de calidad. Conclusiones: La infusión de dexmedetomidina IV es una alternativa efectiva al BIE para cirugías reconstructivas de hombro bajo anestesia general.

Uterine Fibroid: Isolation, Culture and Characterization

Present study was carried out to establish uterine fibroid primary culturesystem for screening of natural/synthetic compounds against uterine fibroid. For invitro culture, enzymatic isolation method was used. To characterize, histochemistry (H& E, Masson’s Trichrome and Periodic Acid Schiff) staining and immunocytochemistryusing marker antibodies (Versican) were performed in vitro. Uterine fibroid tissueshowed much intense staining of Masson’s Trichrome and Periodic Acid Schiff stain ascompared to adjacent myometrium tissue. The primary cultured cells showedsignificantly higher proliferation, sub-culture efficiency and expression of Versicanprotein. In conclusion, our results suggest that in vitro cultured uterine fibroid cells mayoffer a suitable alternative model to evaluate natural or synthetic compounds havingantitumor properties for uterine fibroid treatment.

Localized Pigmented Villonodular Synovitis of Knee: A Mimicker.

Pigmented villonodular synovitis is a benign neoplastic condition arising from the synovium. The synovium is pigmented (loaded with increased mitochondria siderosomes), metaplatic, pedicled or non-pedicled, and hypertrophied. It commonly arises from mensicocapsular junction. It presents as a localized or diffuse variety. Localized variety presents with locking, effusion, pain, reduced range of motion, palpable mass, or pain over the joint line which mimics different pathological conditions. We present a case of localized pigmented villonodular synovitis which led to diagnostic dilemma and mimicked common pathological conditions. Very few case reports are reported in which the lesion is only diagnosed with arthroscopy when other imaging and clinical findings are misleading.