Predictive value of prognostic factors at multiple trauma patients in intensive care admission.

PURPOSE: We aimed to evaluate the relationship between trauma patients' mortality and neutrophil/lymphocyte ratio (NLR) at intensive care units admission. METHODS: We examined 107 ICU trauma patients. Patients were divided into two groups as those who survived (Grup I) and deceased (Grup II). Patients' age, NLR, mean platelet volume (MPV), lactate value, length of stay in the intensive care unit, acute physiology and chronic health evaluation 2 (APACHE II) scores were examined. The effects of these factors on mortality were examined. RESULTS: 83 (77.58 %) patients were male, 24 (22.42 %) patients were female. The patients' mean age was 46.89 ± 19.06 years. The mean value of the lactate level was 3.25 ± 2.92, the mean value of MPV was 10.34 ± 1.02, the average value of NLR was 8.23 ± 8.11, the average score of APACHE II was 22.8 ± 8.75, and the average length of stay in the ICU was 11.33 ± 22.98 days. The relationship with mortality was evaluated between the groups, there was a statistically significant difference in APACHE II scores. There was no statistically significant difference between other variables. CONCLUSIONS: NRL, MPV, lactate levels were not suitable for the evaluation of trauma patients as an early prognostic factor like APACHE II during admission to ICU (Tab. 2, Fig. 1, Ref. 23).

Ultrasound-guided erector spinae block versus mid-transverse process to pleura block for postoperative analgesia in lumbar spinal surgery.

BACKGROUND: In recent years, promising results were achieved with the use of ultrasound (US)-guided interfascial plane blocks for effective postoperative analgesia in several surgeries. Erector spina plane (ESP) block and mid-transverse to pleura plane (MTP) block are the latest techniques in this area. The aim of this prospective and randomized study was to compare the postoperative analgesic efficacy of bilateral ESP and MTP blocks in patients undergoing lumbar spinal surgery under general anesthesia (GA). METHODS: A total of 120 adult patients were included in the study and randomized into 3 groups: group ESP (n = 40), group MTP (n = 40) and group Control (n = 40). The patients in the group ESP received a bilateral block by injecting 20 ml of 0.25% bupivacaine at a vertebrae level in the mid-point of the incision before GA. The same LA was administrated bilaterally at the T12/L1 level in the group MTP. Postoperatively, a multimodal analgesic regimen including an intravenous tramadol patient-controlled analgesia (PCA), paracetamol and dexketoprofen was used in all groups. Postoperative pain was assessed using a visual analogue scale (VAS) during the first 48 postoperative hours. Pethidine was used as a rescue analgesic when VAS score was >3. Primary outcome measure was mean pain scores. Secondary outcome measures were consumption of rescue analgesic and the amount of tramadol delivered by PCA. A p < 0.05 was considered statistically significant. RESULTS: Mean VAS scores were significantly higher in the group Control than in the group MTP and group ESP at all-time points during 48 h (Control > MTP > ESP; p < 0.001). Mean VAS scores were lower in group ESP than group MTP in postoperative 12 h (p < 0.001). Rescue analgesic consumption, number of bolus demand on PCA, PCA bolus demand dose, total PCA dose, and complications related to opioid consumption were highest in control group and lowest in ESP group (Control > MTP > ESP; p < 0.001). CONCLUSION: Both ESP and MTP blocks provided effective pain relief after lumbar spinal surgery but the ESP block was superior to MTP block regarding postoperative analgesia in the first 24 h.

Reduced expression of carbonic anhydrase III in skeletal muscles could be linked to muscle fatigue: A rat muscle fatigue model.

BACKGROUND: Carbonic anhydrase III (CAIII) is expressed abundantly in slow skeletal muscles, adipocytes, and the liver. It plays a critical role in maintaining intracellular pH, antioxidation, and energy metabolism, which are further involved in fatigue. However, its function and mechanism in maintaining the physiological function of muscles or antifatigue are still ambiguous. We hypothesized that changes of CAIII in skeletal muscles might be related to the occurrence of muscle fatigue. METHOD: After establishing a rat soleus muscle fatigue model, we measured the protein expression of the CAIII in muscles. And the muscle intracellular biochemical indices [malondialdehyde (MDA), adenosine triphosphate (ATP), and lactic acid] were also measured using assay kits. After transfected by CAIII-overexpressing and knockdown lentiviral vectors, the rat soleus muscles were induced to fatigue to investigate the effects and possible molecular mechanisms of CAIII in antifatigue. RESULTS: The expression of CAIII in fatigued soleus muscles was significantly decreased compared with that of the control group (P â€‹< â€‹0.001). Moreover, the ATP level in the fatigued muscle also significantly decreased, whereas lactic acid and MDA levels were significantly increased (P â€‹< â€‹0.001). After posttransfection for 21 days, CAIII levels in muscles were significantly reduced in the CAIII-interfering lentivirus group, but increased in the CAIII-overexpressed lentivirus group (P â€‹< â€‹0.001). In addition, CAIII knockdown muscles showed more reduction of the maximal muscle force and ATP levels â€‹and more increase of MDA and lactic acid levels during the fatigue test than the control group, (P â€‹< â€‹0.05). On the other hand, CAIII-overexpressed muscles showed less reduction of the maximal muscle force and ATP levels and less increase of MDA and lactic acid levels during muscle fatigue than the control group (P â€‹< â€‹0.05). CONCLUSIONS: Our study showed that soleus muscle fatigue induced by electrical stimulation could result in downregulation of CAIII and ATP levels â€‹and accumulation of lactic acid and MDA. Further study showed that CAIII knockdown led to more reduction of the maximal muscle force, whereas CAIII overexpression showed less reduction of the maximal muscle force, which suggested that CAIII levels in muscles might be related to the occurrence of muscle fatigue. TRANSLATIONAL POTENTIAL: CAIII plays an important role in muscle fatigue. Up-regulating the expression of CAIII might contribute to dissipating fatigue, which would provide a new method to solve the difficulties in eliminating muscular fatigue.

Comparison of the effect of the rotation palatoplasty and V-Y pushback palatoplasty techniques on palate elongation with magnetic resonance imaging.

Most surgical techniques used in cleft palate repair require the extension of the palate to the pharynx. However, no adequate information exists regarding the extent to which this elongation obtained during operation continues in late postoperative period. In this study, we compared and measured palate elongation in patients with a cleft palate who underwent a V-Y pushback or rotation palatoplasty, by means of magnetic resonance images obtained before and 1 year after surgery. The hard palate, soft palate, and total palate lengths were measured for all of the patients, and the velopharyngeal opening area width was calculated. In patients who underwent the V-Y pushback technique (n=13), the total palate and soft palate lengths were shortened by an average of 0.10 and 0.14cm after surgery, respectively. However, the hard palate length was elongated by an average of 0.13cm. In the rotation palatoplasty group (n=13), the total palate, hard palate, and soft palate lengths were elongated by 0.57, 0.10, and 0.49cm, respectively. The velopharyngeal opening was narrowed by 0.06cm(2) using the V-Y pushback technique and by 0.29cm(2) using the rotational palatoplasty. This study demonstrated that the palate does not elongate during the V-Y pushback technique, as expected. However, rotational palatoplasty elongates the soft palate.

Buried and trapped penis: a case report.

While buried penis cases are characterised by congenital normal attachments to penis, trapped penis cases are characterised by insufficiency of penile skin occurring as a complication after surgical operations such as circumcision. Unless diagnosed, circumcision procedures should be avoided in congenital concealed penis cases. Here we present a case of congenital buried penis with deteriorated clinical findings after two circumcision procedures at 1.5 years of age. The surgical treatment applied in this case is discussed.

Report of a girl with Klippel-feil syndrome and Poland anomaly.

Report of a girl with Klippel-feil syndrome and Poland anomaly: Klippel-Feil syndrome, consisting of the triad of a short neck, low posterior hairline, and limitation of neck movement, is a congenital anomaly characterized by the fusion of cervical vertebrae, Poland anomaly consists of unilateral aplasia of the chest wall muscles and ipsilateral anomalies of upper extremity. We report a 7-year-old girl with typical findings of Klippel-Feil syndrome and Poland anomaly. To the best of our knowledge a case of Klippel-Feil syndrome and Poland anomaly has not been described before, although a combination of Poland, Klippel-Feil and Moebius anomalies has been reported in the literature.