Milliliters Of Saline Research Articles

COMPARISON OF PROLONGATION OF ANALGESIA AND CONSUMPTION OF OPIOIDS IN PATIENTS GIVEN SAB WITH LOCAL ANESTHESIA ALONE VERSUS WITH TRAMADOL AS ADJUVANT THERAPY UNDERGOING LOWER LIMB SURGERY

The purpose of this study was to determine whether or not adding intrathecal tramadol to bupivacaine for lower limb procedures increased the duration of analgesia and decreased the mean post-operative opioid intake. This research was carried out between June 1 and November 30, 2022, in the Department of Anaesthesiology at Aziz Bhatti Shaheed Teaching Hospital in Gujrat, Pakistan. Non-probabilistic sequential sampling was used to pick the patients. One hundred patients from the ASA I, II, and III categories who met the inclusion criteria and were scheduled for lower limb surgery were randomly assigned to one of two groups. The tramadol-bupivacaine group (T) was given 15 milligrams of tramadol and 10 milligrams of bupivacaine (0.5 percent). In comparison, the bupivacaine-alone group (B) was given 1 milliliter of saline and 10 milligrams of bupivacaine (0.5 percent). The duration of analgesia was recorded by tracking the time until the patient first asked for pain medication. The average amount of opioid analgesia taken by both groups in the first 24 hours after surgery was also compared. SPSS version 22 was used for the data analysis. Anesthesia lasted much longer, 174.26 ± 15.21 minutes in the tramadol group, compared to 132.5 ± 14.48 minutes in the bupivacaine group. (p = 0.006). As expected, there was a significant (p 0.001) reduction in 24-hour opioid intake (308.2 ± 23.8) in group T compared to group B (470.5 ±36.2mg). This research confirmed that intrathecal tramadol (15mg) could be safely used with bupivacaine in subarachnoid blocking to increase the duration of analgesia and reduce the need for opioids in the post-operative period following lower limb procedures.

Effects of Local Administration of Tranexamic Acid on Reducing Postoperative Blood Loss in Surgeries for Closed, Sanders III\u2013IV Calcaneal Fractures: A Randomized Controlled Study

PurposeTo investigate whether local administration of tranexamic acid (TXA) is effective in postoperative blood loss reduction in surgeries for Sanders III–IV calcaneal fractures.MethodsCalcaneal fracture patients who were hospitalized in our hospital from August 2014 to April 2018 and underwent open reduction internal fixation (ORIF) via lateral approach with an L-shaped incision were included in the present study. 53 Patients were randomly divided into three groups, groups A (17), B (17) and C (19). Twenty milliliters of 10 mg/ml and 20 mg/ml TXA solution were perfused into the incision of patients in group A and group B, respectively. Twenty milliliters of saline were perfused into the incision of patients in group C as control. The volume of postoperative drainage, postoperative blood test, coagulation test, and wound complications were analyzed to evaluate the effectiveness of local administration of TXA on blood loss reduction.ResultsThe amount of drainage at 24 and 48 h after the procedure was 110 ± 170, 30 ± 10 ml and 130 ± 160, 20 ± 17 ml for patients in group A and group B, respectively. The corresponding numbers for patients in group C were 360 ± 320, 20 ± 10 ml. The difference between group A and group C was statistically significant, so was the difference between group B and group C. No statistically significant difference was found between group A and group B. Postoperative blood test results revealed that the levels of hemoglobin and hematocrit were significantly higher in group A and group B when each compared to that of group C. In contrast, no difference was found between group A and group B. No significant difference was found between each experimental group and the control group in terms of platelet counts, prothrombin time (P.T.), activated partial prothrombin time (APTT), and wound complications.ConclusionLocal administration of TXA is effective in the reduction of postoperative blood loss in surgeries for Sanders III–IV types of calcaneal fractures without notably associated side effects.

The white banner test. A simple intra-operative leak test during laparoscopic sleeve gastrectomy.

Objective: To evaluate the efficacy of a simple intra-operative test (white banner test) for the detection of a leak during laparoscopic sleeve gastrectomy. Design: A prospective case series study. Setting: Obesity center at Soran private hospital, Erbil, Iraq, during the period from January 2017 to June 2019. Participants: eighty patients underwent the white banner test during laparoscopic sleeve gastrectomy. The records of intraoperative findings and post-operative follow up were analyzed. Patients and methods: After completing the sleeve process and hemostasis, a gauze of 4*12 cm was introduced through the 12mm trocar and displayed along the course of remaining sleeved stomach, nasogastric tube inserted to the upper portion of the stomach, compression of the pylorus by grasper against the vertebrae, 100 milliliters of saline stained by methylene blue dye were injected slowly by the anesthetist through the nasogastric tube, waiting for 30 seconds, any discoloration of the gauze was recorded and the site of leak (if any) was identified and managed. If the gauze appeared white, gauze withdrawn and the procedure finished. Results: In 80 patients, only two patients showed a blue spot at the gauze, which were fixed by suture. In all other patients, the gauzes were completely clean and (white). Postoperatively no early leak was detected. Conclusion: This is a simple and not time-consuming intraoperative procedure that can be used to detect intra-operative leaks during laparoscopic sleeve gastrectomy. Keywords: obesity. Sleeve gastrectomy. Leak. Intraoperative test. Acknowledgment: The author thanks all the staff who works at the obesity center at Soran Private Hospital for their unlimited support for this study. The study received no outside funding and no relevant financial disclosures. The researcher declares that there is no conflict of interest regarding the publication of this research

Effectiveness of ozonated saline in the treatment of VX2 tumors in rabbits

Objective To investigate the efficacy, safety, and associated mechanisms of injected ozonated saline in the treatment of VX2 tumors.Methods A total of 90 rabbits bearing VX2 tumors on their left hind legs were randomly divided into three groups. The control group (A) received normal saline, while groups B and C received 20 μg/mL and 40 μg/mL O3/O2 ozonated saline, respectively. Rabbits were anesthetized and 2 mL of blood was drawn directly from the heart to measure serum concentrations of interleukin (IL-6) and tumor necrosis factor (TNF-α). The skin covering the VX2 tumor was cut in each rabbit and the maximum and vertical diameters of the tumors were measured under direct visualization. Several milliliters of saline, saline pre-treated with 20 μg/mL O3/O2, or saline pre-treated with 40 μg/mL O3/O2 were directly injected into the tumors of groups A, B, and C, respectively (injection volume (milliliter) =1/2 volume of the tumor, V = 1/2ab2). On days 4, 8 and 12 following treatment, 10 rabbits were randomly selected from each group for blood sample collection, and serum IL-6 and TNF-α were measured. The tumor growth rate was calculated by measuring the maximum and vertical diameters of the VX2 tumors under direct visualization. All selected rabbits were euthanized and the tumors, livers, and lungs were removed for pathological examination. The tumor necrosis rate was calculated by cutting the tumors into half along the longitudinal axis and measuring the maximum diameters of the intratumoral necrotic regions.Results The average tumor volume in the three groups increased to different degrees at each time point; however, the average tumor growth rates in groups B and C were substantially lower than that in group A, exhibiting a statistically significant difference. The difference in the tumor growth rate between group B and group C was not statistically significant. The serum concentrations of IL-6 and TNF-α increased in the three groups at each time point, with larger increases occurring in groups B and C; however, the greater increases did not reach statistical significance. Although the diameters of the necrotic areas were larger in both groups B and C than that in group A, significant differences in necrotic area diameters were only found when comparing groups A and C on days 4 and 12 following treatment.Conclusion Direct injection of different concentrations of ozonated saline into VX2 tumors significantly increased intratumoral necrosis and reduced the tumor growth rate. The associated mechanism may be partially mediated by IL-6 and TNF-α, as the serum concentrations of these molecules increased after the treatment.

A Nutritional Eye Washing Solution (NEWS) Concentrated that Could Improve the Sharpness of Vision

The age-related macular degeneration (AMD) caused vision loss for millions of patient worldly. Lutein and Zeaxanthin can reduce the blue light and ultraviolet damage to the retina and decrease rate of AMD. However, lutein is difficult to be dissolved in water, the lutein as a dietary supplement through mouth may be only very small amount that can reach the eyes. This is a try to use two herbs and four vitamins put in a concentrated nutritional eye washing solution, and use two drops of that concentrated eye washing solution mixed in every one milliliter of saline, and put in an eye cup to wash the eyes, that may benefit to the easier absorption of those nutritional elements by the eye. Expectedly, that kind of novel eye washing solution may have some benefit for eye health and a sharp vision.

Evaluation of an investigational wearable injector in healthy human volunteers

ABSTRACTObjectives: Introduction of a wearable device for subcutaneous delivery of larger volume bolus injections would encourage patient compliance and reduce the burden on healthcare services. With one such wearable device commercially available, this study examined the safety and functionality of an investigational device in volunteers.Methods: Four devices were applied to the subject’s abdomen: 1) Investigational Device, 2) Investigational Device: subject movement, 3) Control Device: FDA-cleared syringe driver with FDA-cleared infusion set, 4) Control Device: FDA-cleared syringe driver attached to investigational device. Three milliliters of saline were infused through the four devices over 3 minutes.Results: 84 devices were applied to 21 subjects. Three milliliters of saline were safely delivered subcutaneously from the investigational and control devices. Two control devices had occlusions and in each case the pump reached its high pressure limit of 12 psi. VAS pain measurements showed minimal pain for all subjects. Pain scores were significantly (p < 0.001) higher than baseline at the end of injection: mean pain level ranged from 2.0–22.0 mm.Conclusions: The investigational device performed as intended with minimal pain during needle insertion and infusion, and no leaking of fluid at the skin puncture site. Two occlusions occurred with the control devices.

Simulated cystic renal lesions: quantitative X-ray phase-contrast CT--an in vitro phantom study.

To determine if grating-based x-ray phase-contrast computed tomography (CT) can allow differentiation of simulated simple, protein-rich, hemorrhagic, and enhancing cystic renal lesions in an in vitro phantom. An in vitro phantom specifically designed to simulate simple, protein-rich, hemorrhagic, and enhancing renal cysts was scanned with an experimental grating-based phase-contrast CT setup consisting of a Talbot-Lau interferometer with a rotating anode x-ray tube and a single photon counting detector. Various combinations of serum and saline (100% and 0% to 0% and 100%), blood and saline, blood and serum (100% and 0% to 6.25% and 93.75% for both), and an iodinated contrast agent and saline (7.6-1.6 mg per milliliter of saline) were used to reproduce the chemical composition of the different types of cysts. A thickened solution of an iodinated contrast agent calibrated with a clinical multidetector CT scanner served as contrast agent-enhanced renal parenchyma (195 HU at 80 kVp, 400 mAs and 98 HU at 140 kVp, 200 mAs). Standard attenuation- and phase-contrast images were reconstructed from the raw projection data. Quantitative values for attenuation and phase contrast and image noise were determined. Contrast-to-noise ratios were calculated. Simulated lesions were assessed for visual differentiability by means of pairwise comparison of the attenuation- and phase-contrast images and both images simultaneously. Attenuation-contrast imaging showed large differences in Hounsfield units with increasing concentrations of iodine (118.9 HU for 1.6 mg/mL vs 331.4 HU for 7.6 mg/mL). Values for phase-contrast imaging were substantially distinguishable for saline, serum, and blood (7.9, 23.7, and 52.8 HU, respectively). Both imaging modalities combined allowed differentiation of all four types of simulated cysts (100% saline, 100% serum, 100% blood, and 1.6-7.6 mg of iodine per milliliter of saline) with one imaging acquisition. Grating-based phase-contrast CT allows differentiation of simulated simple, protein-rich, hemorrhagic, and enhancing renal cysts in an in vitro phantom through simultaneous assessment of their distinct attenuation- and phase-contrast signal.

The effects of intra-uterine kerosene infusion on endometrial epithelial cilia concentration

The endometrial muco-ciliary apparatus plays an important role in the clearance of fluid and inflammatory debris from the uterus. It has been documented that there is a significant difference in the distribution of ciliated cells between mares with normal fertility and mares with delayed uterine clearance. The infusion of kerosene into the uterus as a treatment for chronic infertility in mares has been described. Endoscopic, histologic and cytologic examination post infusion reveals severe acute inflammation that gradually resolves over seven to fourteen days. The goal of this study was to determine if the intra-uterine infusion of kerosene had an effect on the concentration of ciliated endometrial epithelial cells detectable via histologic examination of endometrial biopsies. Uterine biopsy samples were obtained from nine reproductively healthy mares the cycle prior to treatment. Four mares served as controls and were infused with saline, and five mares were treated with intra-uterine infusion of kerosene. Two hundred and fifty milliliters of saline or kerosene were infused into the uterus during estrus and uterine biopsy samples were acquired one, four, seven and twenty-one days after administration. The biopsy samples were fixed in Bouin’s solution and standard H&E sections were prepared. The percentage of ciliated endometrial epithelial cells was determined by counting a minimum of 100 endometrial cells and assessing the percentage that possessed tufts of tall cilia. There was no statistical difference between the

Ondansetron, alfentanil and nitrous oxide in the prevention of pain on injection of propofol

Propofol is a widely used intravenous anesthetic with a number of advantages over intravenous anesthetics used so far.The leading side effect is pain on injection. Aim of the study was to determine the impact of ondansetron, nitrous oxide and alfentanil on reducing pain during propofol application. The paper presents a prospective, randomized, single blind study. The study included 120 patients of ASA class I and II, who underwent elective surgery under general anesthesia using propofol for the induction of anesthesia. The patients were divided into four equal groups of 30 patients.The control group received a few milliliters of saline, N group the mixture of nitric oxide and oxygen, O group ondansetron and group A received alfentanil. In all patients, venous occlusion was performed for 60 seconds. Pain assessment was based on the criteria and the score by McCrirrick and Hunter. Pain after the application of propofol was present in 47 (39.2%) patients. The highest frequency of pain was recorded in the control group (18, 60%), and significantly lower (p = 0.009) in the patients who received ondansetron (8; 26.7%) and (p = 0.020), alfentanil (9; 30%).The statistical analysis proved that there was a significant relationship between the groups and the scale of pain (Chi2 = 13.849, p = 0.031). Based on the results of our study we can conclude that intravenous ondansetron and alfentanil with venous occlusion can effectively prevent pain during IV use of propofol.

In vivo effects of intra-articular injection of gelatin hydrogen microspheres containing basic fibroblast growth factor on experimentally induced defects in third metacarpal bones of horses

To evaluate the effect of intra-articular injection of gelatin hydrogel microspheres containing basic fibroblast growth factor (bFGF) on experimentally induced defects in third metacarpal bones (MC3s) of horses, in vivo. 6 healthy adult Thoroughbreds. Horses were anesthetized, and a hole (diameter, 4.5 mm) was drilled into the medial condyle of both MC3s of each horse. One milliliter (100 microg) of a solution of gelatin hydrogel microspheres (2 mg) containing bFGF was injected into the joint capsule of the right metacarpophalangeal joint of each horse (bFGF joint). One milliliter of saline (0.9% NaCl) solution was injected into the left metacarpophalangeal joint (control joint). Radiography was performed 1 day and 4, 8, 12, and 16 weeks after surgery to evaluate bone defect refilling. Sixteen weeks after surgery, multidetector-row computed tomography (MDRCT) was performed to determine the degree of refilling at the bone defect site. Radiography revealed healing of bone defects at 4 to 12 weeks after surgery in bFGF joints and at 8 to 16 weeks after surgery in control joints. In addition, MDRCT revealed a higher degree of healing in bFGF versus control joints. Mean+/-SD MDRCT score for bFGF joints (411.7+/-135.6 Hounsfield units) was significantly higher than that for control joints (240.8+/-133.1 Hounsfield units). Treatment of horses with gelatin hydrogel microspheres that contained bFGF enhanced bone regeneration and healing of experimentally induced defects. This treatment strategy may be useful for treating horses with fractures.

Selected best demonstrated practices in peritoneal dialysis access

Many burdensome interventions that adversely affect the utilization of peritoneal dialysis as renal replacement therapy and patient satisfaction with this treatment modality can be avoided by early peritoneal access placement with embedded catheters, implantation techniques that preempt common catheter complications, and the use of access devices that provide flexibility in exit site location. Catheter embedding consists of subcutaneously burying the external limb of the catheter tubing at the time of the insertion procedure. Interval exteriorization of the catheter is performed when dialysis is needed. Earlier commitment by patients to peritoneal dialysis can be achieved by elimination of catheter maintenance until dialysis is necessary. Catheter embedding is a practical strategy to avoid temporary hemodialysis with vascular catheters and reduces stress on operating room access by allowing more efficient scheduling as non-urgent procedures. Laparoscopic catheter placement enables proactive techniques not available to other conventional insertion methods. These techniques include rectus sheath tunneling to prevent catheter tip migration, selective prophylactic omentopexy to prevent omental entrapment, selective resection of epiploic appendages to prevent catheter obstruction, adhesiolysis to eliminate compartmentalization, and diagnosis and simultaneous repair of previously undiagnosed abdominal wall hernias. Both standard and extended 2-piece catheter systems are necessary to customize the peritoneal access to a variety of body configurations. Catheters should be able to produce lower abdominal, mid-abdominal, upper abdominal, and upper chest exit site locations that facilitate management by the patient without sacrificing deep pelvic position of the catheter tip or resulting in excessive tubing stress during passage through the abdominal wall.

ATP-Sensitive Potassium Channels Mediate the Anti-Ischemic Properties of Ischemic and Pharmacologic Preconditioning in Rat Random-Pattern Skin Flap

Ischemic preconditioning (IPC) and pharmacologic preconditioning by morphine and adenosine may significantly decrease the amount of necrosis in rat random pattern skin flaps. We examined the role of ATP-sensitive potassium channels (K(ATP) channels) in mediating these protective phenomenon by using glibenclamide a nonspecific blocker of these channels. We also investigated whether administration of diazoxide an opener of the K(ATP) channels could mimic the same protective effect. Ninety male Sprague-Dawley rats were randomly divided into either control or treatment groups (n = 6 each). Bipedicled dorsal skin flaps (2 x 8 cm) were elevated at the midline. In pharmacologic preconditioning groups, 1 mL of morphine (5 mg/flap), adenosine (0.5 mg/flap), or different doses of diazoxide (0.5, 1, 5, and 15 mg/flap) were administered locally in the cranial half of the flap, respectively. One milliliter of saline was locally injected in the control group. In the IPC group, 1 hour after local saline injection the cranial pedicle was clamped for 20 minutes, and then 40 minutes' reperfusion was performed. In another experiment, 0.3 mg/kg of glibenclamide was injected intraperitoneally 30 minutes before local administration of saline or drug in ischemic or pharmacologic preconditioning groups. Regardless of the group, all flaps were cut at the cranial side 2 hours after elevation and were sutured back. Flap survival area was evaluated on the seventh postoperative day. IPC and pharmacologic preconditioning with morphine, adenosine, and diazoxide (in higher doses; 1, 5, and 15 mg/flap) improved survival area compared with the control group. Glibenclamide abolished their protective effect. K(ATP) channels may have a key role in anti-ischemic properties of IPC and pharmacologic preconditioning.

The effect of Bosentan on healing of colonic anastomosis

BackgroundIschemia is the most important factor compromises wound healing in colonic anastomosis. Mesenteric vessels are ligated at first while performing colonic resection and following anastomosis. Therefore blood supply of the related segments of colon temporarily interrupted and ischemia can easily occur. This study was carried out to explore whether Bosentan, an endothelin-receptor antagonist, can eliminate vasoconstruction, increase blood flow in the splanchnic area and anastomotic region and therefore possibly facilitate wound healing and prevent intra-abdominal adhesion formation.MetodsStudy is conducted on 30 female Wistar-Albino rats weighing 180–240 gr. Rats were allocated into three groups. Group 1 (n = 10) recevied full-thickness resection of the left colon and end-to-end anastomosis. In Groups 2 (n = 10) and 3 (n = 10), vessels of 2–3 cm segment of the left colon were ligated, indications of necrosis of that segment were expected, followed by resection and end-to-end anastomosis. Two milliliter of saline and 5 mg/kg Bosentan was given intraperitoneally in Group 2 and 3, respectively. On postoperativ day 6, intra-abdominal adhesions were scored. Healing of anastomosis, anastomotic bursting pressures, tissue hydroxyproline levels and histopatologically healing scores were assessed.ResultsMacroscopic adhesion score in Group 3 was lower than the remained groups (p < 0.05). Tissue hydroxyproline levels were significantly higher in Group 3 compared to the Groups 1 and 2 (p < 0.001). Mean anastomotic bursting pressures were 200 mmHg, 164 mmHg and 240 mmHg in Groups 1, 2 an 3, respectively (p < 0.05 between Groups 1 and 3; p < 0.001 between Groups 2 and 3). Histopathologically, healing scores of Group 1 were significantly higher than the other groups (p < 0.05 group 1–3, group 2–3).ConclusionBosentan increases anastomotic healing of ischemic colonic anastomosis and decreases intra-abdominal adhesion formation.

The Effect of Hyperbaric Oxygen Treatment on the Renal Functions in Septic Rats: Relation to Oxidative Damage

To investigate the effects of hyperbaric oxygen (HBO) treatment on renal functions and damage in septic rats. The animals were divided into four groups, each containing ten animals: control, hyperbaric oxygen, sepsis, and sepsis/hyperbaric oxygen. One milliliter of saline containing live Escherichia coli cells (2.1 x 10(9)) was injected intraperitoneally to induce sepsis. The groups treated with HBO were given five sessions of 2 atmospheres absolute of 100% oxygen at intervals of 6 h. Blood, urine, and tissue samples were then collected, and the functional renal parameters, malondialdehyde (MDA) levels, and superoxide dismutase (SOD) and catalase activities were examined. The reduced glomerular filtration rate and urine flow returned to normal levels after HBO treatment; however, the increase in fractionated sodium excretion continued. The increased MDA levels in the renal cortex and medulla also decreased to the level of the control group. In the sepsis group, both the SOD and catalase activities decreased in the renal cortex, while a reduction was observed only in the catalase activity in the medulla. The reduced enzyme activities significantly increased in the sepsis/hyperbaric oxygen group. HBO treatment has a beneficial effect on renal dysfunction in sepsis. The probable reason for this effect is the reduction in oxidative damage because of the increase in antioxidative capacity.

Enzymatic Recontouring of Auricular Cartilage in a Rabbit Model

To evaluate the effectiveness of contouring auricular cartilage in a rabbit model using biologically active enzymes injected subcutaneously. The first phase determined the most effective volume and concentration required to affect the cartilage. To accomplish this task, we used ex vivo rabbit ears from a slaughterhouse. In the second phase, we injected 1 mL of hyaluronidase (150 U per milliliter of isotonic sodium chloride solution [saline]), elastase (1 mg per milliliter of saline), or saline into the ears of live rabbits. The study took place at the Madigan Army Medical Center (Tacoma, Wash), and included 10 animals. In each rabbit, we injected the test compound in one ear and saline in the other ear (control). We injected hyaluronidase in 5 ears and elastase in 5 ears. After injection, the ears were contoured and splinted for 4 weeks. In the third phase, we changed the injection pathway in 5 animals. At 4 weeks, 4 (80%) of the 5 ears injected with hyaluronidase showed full response and 1 (20%) had a partial response. Of the 5 ears injected with elastase, 4 (80%) showed a full response while 1 (20%) demonstrated a partial response. There was a response in all 10 of the ears injected with a test compound. Of the 10 control ears, 3 (30%) showed a partial response. At 6 weeks, approximately 6 (30%) of the ears had maintained contour demonstrating a full response. The difference between the test ears and the control ears was statistically significant (P = .006). Compared with the control ears, the results were statistically significant for elastase (P = .004) and hyaluronidase (P = .02). Overall, both agents demonstrated a subjective and objective response compared with control ears. This study demonstrates that bioactive enzymes and splinting can be effective in correcting ear deformities in a rabbit model.

A porcine model for instruction of lateral canthotomy.

Retrobulbar hemorrhage is a rare condition often necessitating immediate lateral canthotomy for preservation of vision. It is performed infrequently in emergency departments (EDs); therefore, a laboratory-based curriculum using a swine model was developed to teach emergency medicine (EM) residents and pediatric emergency medicine (PEM) fellows the proper technique of lateral canthotomy and to provide them with hands-on training. Anesthetized adult swine are used due to similarity with human anatomy and availability from other concurrent procedure laboratories. Fifteen to twenty milliliters of saline is injected behind the orbit to produce proptosis and mimic retrobulbar hemorrhage. A dissection is performed on one orbit to demonstrate the technique and to illustrate the lateral canthal ligaments. The resident then performs a rapid lateral canthotomy on the contralateral orbit under faculty supervision. Over one year, 19 EM residents and 3 PEM fellows were trained using this model. During the same period no lateral canthotomies were performed in the EDs. A post-laboratory survey demonstrated a high subjective level of comfort with this procedure. Video-based demonstration of this laboratory is publicly available on the World Wide Web. Adult swine can effectively serve as a model for resident training in lateral canthotomy, a rarely performed sight-saving procedure.

Preliminary results of intraoperative mitomycin-C in the treatment and prevention of glottic and subglottic stenosis

Mitomycin-C is an antineoplastic antibiotic that acts as an alkylating agent by inhibiting DNA and protein synthesis. It can inhibit cell division, protein synthesis, and fibroblast proliferation. The purpose of this pilot study is to investigate intraoperative applications of topical mitomycin-C in treatment and prevention of glottic and subglottic stenosis. Eight patients with posterior glottic and/or subglottic stenosis were treated with endoscopic CO2 laser excision followed by topical application of 0.5 cc of 0.4 mg mitomycin-C per milliliter of saline for 4 minutes at the surgical site. After mean follow-up of 15 months (10-20) all patients had clinical improvement of their airway and resolution of their preoperative symptoms. No complications were noted in this study. Although a longer follow-up and further controlled studies are needed, the use of topical mitomycin-C may prove useful in the treatment and prevention of subsequent restenosis and scar formation in the larynx and trachea.

Intraperitoneal exfoliated cancer cells in patients with colorectal cancer.

The aims of this study were to evaluate potential predictors of exfoliated free cancer cells in the peritoneal cavity and to assess intraoperative peritoneal lavage cytology as a prognostic indicator in patients with colorectal cancer. From 1985 to 1987, intraoperative peritoneal lavage cytology was performed in 140 patients with colorectal cancer. Among them, 88 patients underwent curative resection and 52 patients had noncurative surgery. Cytology was examined twice, i.e., immediately after opening the peritoneal cavity (precytology) and just before closing the abdomen (postcytology). One hundred milliliters of saline was poured into the peritoneal cavity and it was retrieved by suction after irrigation. Cytologic examination was performed after staining with Papanicolaou, Giemsa, periodic acid-Schiff, and Alcian blue stains. Among the 140 patients examined, the incidence of positive cytology in the prelavage was 15 percent, and that in the postlavage was 9 percent, although it was 16 percent in either lavage. Among patients with curative resection, 10 percent had positive cytology. Seven characteristics were identified as features of tumors which are prone to exfoliate cells into the peritoneal cavity: 1) macroscopic peritoneal dissemination, 2) liver metastasis, 3) more than 20 ml of ascites, 4) ulcerated tumors without definite borders, 5) invasion of the serosal surface or beyond, 6) semiannular or annular shape, and 7) moderate or marked lymphatic invasion. In patients undergoing curative surgery, among these features, circumferential involvement was the only one correlated closely with positive cytology (P < 0.02). Positive cytology was associated with a worse outcome. In patients who were resected curatively, the postcytology had a stronger influence on local recurrence than the precytology; the local recurrence rate in patients with positive postcytology was higher than in those with negative postcytology, regardless of the precytology. All patients with cancer cells in the peritoneal cavity at the end of surgery had recurrence. Seven characteristics were identified as risk factors for exfoliation of cancer cells into the peritoneal cavity in patients with colorectal cancer. These findings may be helpful for the choice of laparoscopic surgery in this era of increasing port-site metastases after laparoscopic procedure. The results of peritoneal lavage cytology at the end of surgery were correlated with the long-term postoperative outcome of colorectal cancer. Thus, meticulous follow-up and possibly adjuvant chemotherapy may be beneficial for patients with free cancer cells in lavage fluid, even after curative surgery.

Gd-EOB-DTPA and Yb-EOB-DTPA: two prototypic contrast media for CT detection of liver lesions in dogs.

To characterize computed tomographic (CT) attenuation of iodine, gadolinium, and ytterbium in vitro and to study CT liver enhancement after administration of two prototypic hepatocyte-directed contrast media in dogs. Samples with increasing concentrations of iodine, gadolinium, and ytterbium were measured for CT attenuation in a water phantom at tube voltages of 80, 120, and 137 kV. Three groups of five adult beagle dogs each received a 0.5 mmol/kg dose of either gadoxetic acid disodium (gadolinium ethoxybenzyl diethylenetriaminepentaacetic acid [EOB-DTPA]) or Yb-EOB-DTPA as intravenous infusions or Yb-EOB-DTPA as an intravenous bolus injection. At 120 kV, in vitro CT attenuation of gadolinium and ytterbium exceeded that of iodine by 41% and 45%, respectively, when measured at equal mass concentrations (in milligrams per milliliter of saline). In dogs, CT liver enhancement values above the precontrast liver attenuation were 32.6 HU +/- 2.3, 31.4 HU +/- 1.1, and 33.4 HU +/- 5.2 after 0.5 mmol/kg Gd-EOB-DTPA or Yb-EOB-DTPA infusion or Yb-EOB-DTPA bolus, respectively. The values were not significantly different (P > .05) Both Gd-EOB-DTPA and Yb-EOB-DTPA provide excellent CT liver enhancement in dogs. CT liver enhancement is not significantly altered by either the absorbing element (gadolinium vs ytterbium) or the mode of application (infusion vs bolus).

Intraoperative Mitomycin C in the Treatment of Cicatricial Obliterations of Conjunctival Fornices

To investigate whether the intraoperative use of topical mitomycin C improved the postoperative outcome in cases of cicatricial obliteration of conjunctival fornices. Ten eyes of five patients were subjected to surgical lysis of the synechiae followed by intraoperative application of 0.4 mg mitomycin C per milliliter of saline for 3 to 5 minutes. After a follow-up period of 12 to 19 months, no recurrence of synechiae was observed, the conjunctival fornices remained open, and conjunctival overgrowths on the cornea did not recur. No adverse effect was observed. Intraoperative application of mitomycin C proved useful in the surgical treatment of cicatricial shrinkage of conjunctival fornices.