Sufentanil sublingual tablet system for enhanced recovery after total knee arthroplasty: a prospective observational case study.

BACKGROUND: Postoperative pain is one of the main factors that delays recovery after prosthetic knee surgery. The use of sufentanil sublingual tablet systems (SSTS) can effectively relieve postoperative pain, but their value in facilitating early mobilization has been little studied so far. Our aim here was to assess whether their use could facilitate recovery after knee arthroplasty in an enhanced recovery program. CASE PRESENTATION: In a prospective observational single-center study, thirty patients operated on for primary knee arthroplasty in the enhanced recovery pathway were included. Patients who received the SSTS (n=15) were compared with those who received an intravenous morphine patient-controlled analgesia (PCA) (n=15). Our recovery program included in particular the use of an adductor canal block, periarticular infiltration of local anesthetic by the surgeon, removal of the venous cannula from the recovery room if possible, the use of an SSTS when available or an IV morphine PCA otherwise, and early physiotherapy. Recovery parameters including the Timed-Up and Go test, pain scores at rest and on exertion, knee flexions, complications, and lengths of hospital stay were not significantly different between the two groups. However, the postoperative opioid consumption in morphine equivalents was significantly greater in the SL-sufentanil group and these patients had their venous cannula removed earlier than in IV-morphine group. CONCLUSION: In our center, the use of a SSTS was suitable for treating postoperative pain after knee arthroplasty, but it did not improve early recovery in comparison with a morphine PCA.

Evaluation of Clinical Parameters in Implant Maintenance Phase for Prevention of Peri-implantitis.

AIMS AND OBJECTIVES: Peri-implant mucositis and peri-implantitis are one of the common biological complications affecting implant success. The present study aimed to evaluate various clinical parameters during implant maintenance phase. MATERIALS AND METHODS: The study included patients undergoing implant maintenance phase for 1-year follow-up. The study consists of a total of forty individuals with age ranging from 35 to 65 years. They were further categorized into two subgroups on the basis of their history, i.e., Group 1: patients with no history of periodontitis before implant placement and Group 2: patients with a history of periodontitis before implant placement. Among the selected patients, a total of 98 implants were studied. All were individually evaluated for clinical parameters such as gingival index, pocket probing depth (PPD), and bleeding on probing (BOP). All the data obtained were tabulated and analyzed using statistical software SPSS version 18.0 for Windows (SPSS Inc., Chicago, USA). Quantitative analysis was done using t-test and Mann-Whitney U-test. RESULTS: The mean age of the patients in Group 1 and Group 2 was 58.6 and 62.8 years, respectively, with not much gender difference. The mean plaque index for Group 1 was 0.17 ± 0.20, while for Group 2, it was 0.24 ± 0.14. The mean PPD and mean BOP for Group 1 came to be 2.60 ± 0.42 and 0.42 ± 0.15, respectively, whereas for Group 2, it was 4.08 ± 0.30 and 0.39 ± 0.48, respectively. Only PPD was found to be statistically significantly different between both the groups. Group 1 showed 2.0% peri-implantitis, whereas Group 2 showed 28% peri-implantitis. CONCLUSION: Due to increased prevalence of peri-implantitis cases with the increase in usage of implants, it becomes imperative to look up to the etiological factors and contributing factors so that the incidence of these can be minimized.

A Comparative Evaluation of Apical Leakage using Three Root Canal Sealants: An in vitro Study.

AIM: Apical leakage is one of the drawbacks leading to endodontic failure. Various root canal sealants have been tried in endodontics. The present study was conducted to compare root canal sealants such as Endorez, Realseal, and Metaseal in preventing apical leakage. MATERIALS AND METHODS: Sixty mandibular single-canal premolars were divided into three groups of 20 each. Group I teeth were sealed with Endorez, group II teeth with Realseal, and group III teeth with Metaseal. After completing endodontic treatment in all teeth and sealing with above sealants, glucose leakage value was assessed at 1st, 8th, and 15th day. RESULTS: At day 1 [mean ± standard deviation (SD)], leakage was 0.416 ± 0.011 in group I, 0.234 ± 0.09 in group II, and 0.328 ± 0.19 in group III. On 8th day, it was 2.124 ± 0.108 in group I, 0.624 ± 0.102 in group II, and 1.31 ± 0.24 in group III. On 15th day, it was 5.178 ± 0.125 in group I, 3.122 ± 0.150 in group II, and 4.25 ± 0.28 in group III. The mean apical leakage in all groups in different days was statistically significant (p < 0.05). CONCLUSION: Endorez sealant showed highest apical leakage, whereas Realseal had minimum leakage. There was significant increase in leakage in all groups with the progression of time. CLINICAL SIGNIFICANCE: With the advent of different root canal sealants, the success rate of the root canal-treated teeth can be confirmed.

Effect of Periodontal Therapy on Crevicular Fluid Interleukin-18 Level in Periodontal Health and Disease in Central Maharashtra (India) Population.

AIM: The incidence and progression of the periodontal disease depend on periodontal microflora and the multifaceted response of the host, and these interactions are mediated by cytokines and chemokines. Interleukin-18 (IL-18) is a proinflammatory cytokine of the IL-1 superfamily. The aim of the present study was the assessment of the periodontal therapy in IL-18 level in periodontal disease and health. MATERIALS AND METHODS: Based on clinical attachment loss (CAL), probing pocket depth (PPD), gingival index (GI), and plaque index (PI) patients were divided into three groups: Group I with healthy patients, group II with chronic periodontitis, and group III with posttreatment patients having periodontitis. RESULTS: Mean PI, PPD, CAL, and gingival crevicular fluid (GCF) volume were significantly higher in groups II and III compared with group I. However, there were no significant differences between GI in groups I, II, and III. The total amount of IL-18 in GCF was significantly higher in group II when compared with groups I and III (p < 0.05). CONCLUSION: The present study confirmed that the IL-18 level in GCF was lower in healthy patients, higher in periodontally involved patients, and reduced at baseline, 3 and 6 weeks after nonsurgical periodontal therapy. CLINICAL SIGNIFICANCE: The IL-18 might be hypothetically beneficial in distinguishing health from disease and monitoring periodontal disease activity.

Patient Blood Management in Major Orthopedic Surgery: Less Erythropoietin and More Iron?

Erythropoietin (EPO) is proposed preoperatively to reduce blood transfusion in anemic patients (hemoglobin < 13 g/dL) scheduled for a major orthopedic surgery. New intravenous iron formulations allow infusion of higher doses, increasing EPO response. In that context, we evaluated in a before-after study (n = 62 and 65 patients for each period) a new EPO administration protocol (2 injections 4 and 3 weeks before surgery, and a third if hemoglobin <13 g/dL instead of <15 g/dL 2 weeks before surgery). After this protocol implementation, the mean (standard deviation) number of EPO injections decreased from 2.8 (0.5) to 2.2 (0.4)/patient (P < .0001) without changing transfusion rates (3% in the 2 periods).

Oral propranolol therapy for benign capillary hemangiomas in a series of adult and pediatric patients

OBJECTIVE: To describe outcomes of oral propranolol therapy in a series of adult and pediatric patients diagnosed with benign capillary hemangioma of the head and neck.METHODS:Design: Prospective Case SeriesSetting: Tertiary Government Teaching HospitalParticipants: Ten (10) patients representing all patients clinically diagnosed with benign capillary hemangioma of the head and neck enrolled in the study from 2012 to 2015.RESULTS: Two (2) adults and eight (8) children were enrolled in the study. Although a decrease in lesion size was observed in half of the participants starting at three months, only one (1) attained complete resolution of the lesion-- a 12-year-old girl with hemangioma of the right parotid gland that attained clinical resolution of symptoms after four months of treatment. The remaining nine out of ten (9/10) participants did not attain complete clinical resolution; but there was a decrease in lesion size in four (4) of these participants. For the remaining five (5) participants, there was neither a decrease nor an increase in lesion size. Altogether, of the two adult participants, only one responded to therapy while only 4 out of 8 pediatric participants responded to therapy. There were no noticeable differences between adult and pediatric patients in terms of resolution and plateau. Aside from mild bradycardia expected with propranolol, no adverse reactions were observed during the course of treatment.CONCLUSIONS: Although half of our participants responded to oral propranolol therapy whether these observations may be attributable to oral propranolol alone cannot be concluded.

Animated demonstration of selected ORLHNS concepts and surgeries: A potential adjunct to learning

@#OBJECTIVE: To create visual animated demonstrations of certain otorhinolaryngologic concepts and surgeries that can aid learning of students and ORL residents.METHODS: Several otorhinolaryngologic surgical procedures and pathophysiologic concepts were represented through two dimensional images. For every concept or procedure, a series of images was drawn and manipulated using the software Adobe Photoshop CS4. The series of images were then put into animation using the software Morpheus Photo Animation Suite v3.15.RESULT: The end results were demonstrations of otorhinolaryngologic concepts and surgical procedures in movie (.AVI) format.CONCLUSION: Concepts and surgeries in the field of otorhinolaryngology are usually explained or documented using texts or simple images. The generated animated demonstration of these ideas can aid in the learning of the ORL specialist.

Glottal function index and GRBAS scale of patients undergoing vocal cord medialization: A series of five patients

@#<p><strong>OBJECTIVE: </strong>Vocal cord paralysis or immobility is debilitating condition that may result from neural or mechanical fixation of the vocal cord (VC). When permanent, therapy is aimed at improving closure by modifying the position of the vocal cord. Whatever surgical intervention is chosen, pre-and post-operative voice evaluation is important. This study aimed to investigate the usefulness of the Glottal Function Index (GFI) and Grade, Roughness, Breathiness, Asthenia, Strain (GRBAS) Scale in the evaluation of treatment outcomes in patients with unilateral vocal cord paralysis (UVCP) who underwent medialization thyroplasty type 1 with a modified lock-in soft silicone implant.<br /><br /><strong>METHODS:<br />Design:</strong> Descriptive Case Series<br /><strong>Setting:</strong> Tertiary Government Hospital<br /><strong>Patient:</strong> Five<br /><br /><strong>RESULTS:</strong> Five patients (3 females, 2 males) consulted due to hoarness underwent rigid endoscopy. Four (2 right, 2 left) had unilateral paramedian VC paralysis while one had bilateral paresis with bowing of the left vocal cord. One of those with left VC paralysis was diagnosed as idiopathic; the four were iatrogenic (3 form thyroid surgery, 1 from multiple surgical procedures). All patients underwent medialization thyroplasty type 1 using locked-in soft silicone implant. The GFI and GRBAS scale were utilized for pre-operative and post-operative perceptual evaluation of voice. The GFI showed severe glottic insufficiency among all five patients prior to surgery with improvement of the subjective symptoms one day and one week post-surgery in four patients. Likewise, the Hirano GRBAS scale showed improvement of voice quality and correlated the improvement of the patient's subjective symptoms from the from GFI scores. However, 5 cases with bilateral vocal cord paresis, showed no improvement of voice quality despite recovery from subjective symptoms.<br /><br /><strong>CONCLUSIONS:</strong> For glottal insufficiency, perceptual voice evaluation using self-administered GFI and GRBAS scale assessment are important parameters in determining the quality of life among patients with glottal insufficiency undergoing medialization laryngoplasty.</p>