LigaSure Use Decreases Intraoperative Blood Loss Volume and Blood Transfusion Volume in Sarcoma Surgery.

INTRODUCTION: The LigaSure system has been successfully used in thoracic and abdominal surgery. However, to date, its use in the resection of sarcomas has not been systematically studied. We aimed to determine whether the use of the LigaSure system reduces blood loss and blood transfusion volumes in sarcoma surgery. METHODS: One hundred forty-two consecutive patients who underwent sarcoma surgeries between July 2010 and October 2016 were included. Conventional electrocautery alone (n = 91) and with LigaSure (n = 51) were compared. Case-matched samples (n = 46) from each group were additionally compared. RESULTS: The use of the LigaSure system resulted in a significant decrease in mean intraoperative blood loss (P = 0.02) and blood transfusion volume (P = 0.04). Likewise, a significant decrease in both mean and median intraoperative blood loss (P = 0.003; P < 0.0001) was seen with LigaSure in the case-matched analysis. In the soft-tissue sarcoma subgroup, a significant decrease was observed in mean hemoglobin reduction (P = 0.03) and mean intraoperative blood loss with LigaSure (P = 0.04). No adverse perioperative complications attributed to the LigaSure system were identified. CONCLUSIONS: The LigaSure vessel sealing and dividing system is a safe and effective hemostatic tool for deep dissection in bone and soft-tissue sarcoma surgery. LEVEL OF EVIDENCE: Level III, therapeutic study.

Nucleus accumbens AMPA receptor involvement in cocaine-conditioned place preference under different dietary conditions in rats.

RATIONALE: When ad libitum-fed (AL) rats undergo cocaine place preference conditioning (CPP) but are switched to food restriction (FR) for testing, CPP is enhanced and preference scores correlate with phosphorylation of α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor GluA1 at Ser845 in nucleus accumbens (NAc) core. OBJECTIVES: The present study tested whether a similar association exists in AL rats and whether an inhibitor of Ca(2+)-permeable AMPARs blocks CPP expression in either diet group. MATERIALS AND METHODS: In experiments 1-3, AL rats were conditioned with cocaine (12.0 mg/kg, i.p.). Three weeks later, CPP was tested daily and brains were harvested after the fifth test. Western analyses were used to probe for levels of AMPA receptors in NAc. In experiment 4, AL rats were conditioned, half were switched to FR for testing, and half in each diet group received NAc core microinjection of 1-naphthylacetyl spermine (NASPM (NASPM) (25.0 µg) prior to each test. RESULTS: In experiment 1, CPP expression in AL rats was associated with elevated pSer845-GluA1, GluA1, and GluA2 in NAc. In experiment 2, the correlation between pSer845-GluA1 and CPP was localized to NAc core. In experiment 3, pSer845-GluA1 following a CPP test was higher in NAc synaptic membranes of FR relative to AL rats. In experiment 4, NASPM blocked CPP expression in both diet groups. CONCLUSIONS: Results support a scheme in which pSer845-GluA1 in NAc core underlies expression of cocaine CPP and does so by stabilizing or trafficking Ca(2+)-permeable AMPARs to the synaptic membrane. The more robust CPP of FR rats may result from upregulation of stimulus-induced pSer845-GluA1.

Preoperative cerebral magnetic resonance imaging and white matter changes in pediatric cochlear implant recipients.

INTRODUCTION: Preoperative magnetic resonance imaging (MRI) can yield valuable information regarding the status of the inner ear in pediatric cochlear implant (CI) candidates. Incidentally, cerebral white matter changes are at times noted on these MRI scans. They may indicate post-infectious/postinflammatory changes or progressive neurodegenerative processes. OBJECTIVE: To evaluate the clinical significance of cerebral white matter changes in pediatric CI patients. METHODS: Retrospective chart review of pediatric CI recipients with preoperative MRI between March 2004 and January 2009 was performed. MRI reports along with postoperative audiology and speech and language outcomes were assessed. RESULTS: Fifty-seven patients were included in the study. There were 29 females and 28 males. Mean age was 58 months (range of 12-194 months). Abnormal MRI with varying degrees of white matter changes was noted in 10 (18%) children. Neurological assessments did not reveal any serious central nervous system diseases. Two of the 10 patients demonstrated significant delays and difficulties with postoperative CI performance. CONCLUSIONS: Cerebral white matter abnormalities are not uncommon incidental findings in preoperative MRI scans in pediatric CI candidates. These changes may reflect remote or active pathology which may require neurological assessment. The significance of these findings is still uncertain and should be better clarified as we study more patients.