Mixture Of Saline Research Articles

Enhanced visualization of female squirting.

Squirting is the involuntary expulsion of fluid from the female urethra following stimulation of the anterior vaginal wall before or during orgasm. The mechanism underlying squirting has not been established. To elucidate the mechanism of squirting. The subjects in the current study were women who were able to squirt. They were not sex workers. A urethral catheter was inserted before sexual stimulation and the bladder was emptied. Then, a mixture of indigo carmine (10 ml) and saline (40 ml) was injected into the bladder. Sexual stimulation was provided tofacilitate squirting, which was videotaped and verified. The secretions were collected in sterile cups, and prostate specific antigen (PSA) and glucose levels were measured. Five women (2 in the 30s, 2 in the 40s, and 1 in the 50s) participated in this study. All women were able to squirt; three squirted only with manual sexual stimulation and two with penetrative sexual stimulation. The discharged fluid was blue in all cases, confirming the bladder as the source. The fluid was PSA-positive in four patients. The main component of squirt fluid is urine, but may also contain fluid from Skene's glands (female prostate). This is the first report in which visualization of squirting was enhanced.

Ropivacaine with Dexmedetomidine or Dexamethasone in a Thoracic Paravertebral Nerve Block Combined with an Erector Spinae Plane Block for Thoracoscopic Lobectomy Analgesia: A Randomized Controlled Trial.

ObjectiveThis study aimed to investigate the effect of ropivacaine with dexmedetomidine or dexamethasone in a thoracic paravertebral nerve block (TPVB) combined with an erector spinae plane block (ESPB) for thoracoscopic lobectomy analgesia.MethodsA total of 97 patients undergoing thoracoscopic lobectomy under general anesthesia were enrolled in this study and randomly divided into three groups, ie, a ropivacaine group (Group R), a ropivacaine + dexmedetomidine group (Group R1), and a ropivacaine + dexamethasone group (Group R2). Ultrasound-guided TPVB combined with an erector spinae plane block was given after anesthesia induction. The following were applied to each group: Group R received 30 mL of 0.5% ropivacaine + 5 mL of a normal saline mixture; Group R1 received 30 mL of 0.5% ropivacaine + 5 mL of a 1 μg/kg dexmedetomidine mixture; Group R2 received 30 mL of 0.5% ropivacaine + 5 mL of an 8 mg dexamethasone mixture. The primary observation index was the time to the first postoperative remedial analgesia. The secondary observation indexes were the intraoperative consumption of propofol and sufentanil, time to waking from anesthesia, time to extubation, postoperative numerical rating scaltpe (NRS) score, postoperative sufentanil consumption, remedial analgesic dosage, and adverse reactions.ResultsWhen compared with Group R, the time to first postoperative remedial analgesia was longer, the intraoperative and postoperative sufentanil consumption and flurbiprofen axetil remedial analgesic dose were lower, and the time to waking from anesthesia and time to extubation were shorter in groups R1 and R2 (P < 0.05). The NRS scores at 1, 6, 12, and 24 h postoperatively in groups R1 and R2 were lower than in Group R at the same time points (P < 0.05).ConclusionRopivacaine with dexmedetomidine or dexamethasone in TPVB combined with ESPB could prolong the time to first postoperative remedial analgesia, reduce perioperative sufentanil and postoperative remedial analgesic drug consumption, and decrease the postoperative NRS score in patients undergoing thoracoscopic lobectomy.

Pre-exposure to Aerosolized Polyvalent Bacterial Lysates Protects Against Bleomycin-Induced Pulmonary Fibrosis in Mice.

Idiopathic pulmonary fibrosis (IPF) is a chronic fibrosing interstitial pneumonia of unknown cause. No therapeutic modalities can reverse or stop its ever-deteriorating course. The stimulation of lung innate immunity using bacterial lysates was found to protect against lethal pulmonary infection. Hence, this study aimed to explore whether the immune-stimulating enhancement by pretreatment with bacterial lysates led to protection against bleomycin-induced pulmonary fibrosis. C57BL/6 mice were randomly divided into 4 groups with 20 mice in each group. The mice were exposed to an aerosolized mixture of polyvalent bacterial lysates (PVBL) or phosphate-buffered saline (PBS) three times on separate days. Twenty-four hours after the last exposure, the lungs were intratracheally infused with bleomycin (BLM) or normal saline (NS). The pulmonary morphology, Ashcroft's scale of pulmonary fibrosis, and levels of pro-inflammatory cytokines such as interferon (IFN)-γ and interleukin (IL)-4 were evaluated 14 days after the intratracheal infusion. The exposure to PVBL did not induce any discernible structural abnormalities in the lungs, while the IFN-γ/IL-4 ratio increased. BLM-induced pulmonary fibrosis was associated with an overwhelming downregulation of IFN-γ and IL-4 expression. Pre-exposure to PVBL protected against BLM-induced pulmonary fibrosis, which was demonstrated by a greater reduction of Ashcroft's fibrotic score and a greater decrease in the hydroxyproline level in the lungs. Although the PVBL pre-exposure did not restore the BLM-induced downregulation of IL-4 and IFN-γ levels, the IFN-γ/IL-4 ratio was still maintained greater than the animals with BLM infusion. BLM-induced murine pulmonary fibrosis is associated with downregulation of IFN-γ and IL-4 levels. Pre-exposure to the aerosolized PVBL protects against BLM-induced pulmonary fibrosis.

Maximum volume of nasal administration using a mucosal atomization device without aspiration in Japanese White rabbits.

Recently, a mucosal atomization device (MAD) has been applied in veterinary medicine. In the present study, the maximum volume of nasal atomization without aspiration using MAD was examined in eight healthy female Japanese White (JW) rabbits. Each rabbit had their head and neck examined by computed tomography before and after nasal atomization with four different doses (0.15, 0.3, 0.45, and 0.6 ml per nostril) of diluted contrast medium (1:2 mixture of iohexol and saline). This was done under general anesthesia by an intramuscular administration of alfaxalone 2.5 mg/kg, medetomidine 40 μg/kg, and butorphanol 0.4 mg/kg, with a 7-day washout period between each treatment. The diluted contrast medium was distributed in the nasal cavity, external nares, and/or oral cavity in all rabbits receiving each treatment. The intranasal distribution volumes of the contrast medium were 287 (250–333) mm3 [median (interquartile range)] for 0.15 ml, 433 (243–555) mm3 for 0.3 ml, 552 (356–797) mm3 for 0.45 ml, and 529 (356–722) mm3 for 0.6 ml of treatment. The intranasal distribution volume for 0.15 ml treatment tended to be lower than that for 0.6 ml treatment (P=0.083). The contrast medium was deposited in the trachea in one rabbit (12.5%) and four rabbits (50%) receiving treatments of 0.45 and 0.6 ml per nostril, respectively. The maximum volume of nasal atomization without aspiration into the trachea was 0.3 ml per nostril for the JW rabbits.

Experimental Study on the Treatment of Gallbladder Distention by Dahuang Lingxian Prescription

Objective: To investigate the mechanism of inhibiting the secretion of “lithogenic bile” and treating gallbladder distention with the TCM prescription Dahuang Lingxian. Methods: Forty SPF-grade SD male mice were randomly divided into blank control group, model group, ursodeoxycholic acid group and TCM group, 10 mice in each group. The blank control group was kept normally, and the model group, ursodeoxycholic acid group and TCM group were established as gallbladder distention models. The blank control group and the model group were given 1.5 ml of saline by gavage daily; the ursodeoxycholic acid group was given 100 mg/kg/d of a mixture of saline and ursodeoxycholic acid capsules by gavage daily; the TCM group was given 39 g/kg/d of aqueous decoction of Dahuang Lingxian Prescription by gavage daily. After 6 weeks of continuous intervention, all mice were executed and the lithogenesis rate, ultrastructure and mRNA expression were observed. Results: The lithogenesis rate of mice in the TCM group was significantly reduced (P β1/Smads pathway was significantly improved (P < 0.05), which could achieve the same therapeutic effect as ursodeoxycholic acid capsules. Conclusion: Dahuang Lingxian Prescription can reduce the secretion of “lithogenic bile” by inhibiting the inflammatory reaction and fibrosis of biliary system. Dahuang Lingxian Prescription has certain advantages in the treatment of gallbladder distention.

Do High-Volume Injections Affect the Ultrasonographic Neovascularization in Chronic Achilles Tendinopathy? A Randomized Placebo-Controlled Clinical Trial.

High-volume injections (HVIs) are thought to target neovascularization in chronic midportion Achilles tendinopathy (AT), yet the mechanism has not been clarified. Therefore, we aim to evaluate whether a HVI decreases ultrasonographic Doppler flow in patients with chronic midportion AT. A double-blind, randomized, placebo-controlled clinical trial. Sports medicine department at a district general hospital. Sixty-two patients with clinically diagnosed chronic midportion AT were included and randomized into the intervention group (HVI-group, n = 30) and placebo group (n = 32). A daily calf-muscle exercise program combined with either (1) a HVI (HVI-group: 50 mL) or (2) a placebo-injection (placebo-group: 2 mL) with a mixture of saline and lidocaine. Primary outcome was the surface area quantification (SAQ) score (%) of the Doppler flow during a 24-week follow-up period. Secondary outcome was the association between SAQ scores and symptoms [Victorian Institute of Sports Assessment-Achilles (VISA-A)]. Outcomes were measured before, directly after, and 1 hour after the injection and at 2, 6, 12, and 24 weeks of follow-up. There was no significant between-group difference at 24 weeks [-0.1%; 95% confidence interval (CI), -4.9 to 4.7] or at any of the other time points. Change in SAQ score did not correlate with the change in VISA-A score (P = 0.93). A HVI does not affect Doppler flow in patients with chronic midportion AT. Also, changes in Doppler flow were not associated with the clinical outcome. These findings challenge the theoretical basis of a HVI. NCT02996409.

Emergency cricothyrotomy in morbid obesity: comparing the bougie-guided and traditional techniques in a live animal model

Cricothyrotomy is a rare, time sensitive procedure that is more challenging to perform when anatomical landmarks are not easily palpated before the initial incision. There is a paucity of literature describing the optimal technique for cricothyrotomy in patients with impalpable airway structures, such as in morbid obesity. In this study, we used a live sheep model of morbid obesity to compare the effectiveness of two common cricothyrotomy techniques. We randomly assigned emergency medicine residents to perform one of two cricothyrotomy techniques on a live anesthetized sheep. To simulate the anterior soft tissue neck thickness of an adult with morbid obesity we injected 120mL of a mixture of autologous blood and saline into the anterior neck of the sheep. The traditional technique (as described in the New England Journal Video titled "Cricothyroidotomy") used a Shiley tracheostomy tube and no bougie, and the bougie-guided technique used a bougie and a standard endotracheal tube. The primary outcome was the total procedure time; the secondary outcome was first attempt success. 23 residents were included, 11 assigned to the bougie-guided technique and 12 to the traditional technique. After injection of blood and saline, the median depth from skin to cricothyroid membrane was 3.0cm (IQR 2.5-3.4cm). The median time for the bougie technique was 118s (IQR 77-200s) compared to 183s (IQR 134-270s) for the traditional technique (median difference 62s, 95% CI 10-144s). Success on the first attempt occurred in 7/11 (64%) in the bougie group and 6/12 (50%) in the traditional technique group. In this study, which simulated morbid obesity on a living animal model complete with active hemorrhage and time pressure caused by extubation before the procedure, the bougie-guided technique was faster than the traditional technique using a tracheostomy tube without a bougie.

Could a Simple Nerve Block be Considered as a Treatment Option for Occipital Neuralgia with Both Short-Term and Long-Term Effects?

Objective: The study aims to show both the short- and long-term treatment outcome of occipital nerve block (ONB) patients with occipital neuralgia (ON).Methods: Patients who visited our hospital between 2013 and 2020 were reviewed retrospectively. Patients were excluded if the medical records were incomplete, if they had received a cervical operation, if they had a traumatic event prior to the symptom onset, or if the follow-up period was less than 3 months. ONB targeted the greater occipital nerve, the lesser occipital nerve or both. Short term follow-up period was defined as 3 months and long term was defined as 12 months. Injection consisted of a mixture of triamcinolone acetonide, lidocaine, and normal saline. Visual analogue scale (VAS) was recorded and compared before and during the follow-up to period to assess treatment outcome.Results: Clinical charts of 309 candidates were reviewed and 72 patients were excluded, making it 237 patients. VAS scores significantly decreased in both 3-month follow-up (from 7.20±0.94 to 3.48 ±1.66, p&lt;0.05) and after 1 year follow-up (from 7.20±0.94 to 2.71±1.07, p&lt;0.05). Only 8 patients (3.3%) were refractory to ONB and the procedure was found to be relatively safe since only 2 patients (0.8%) showed transient side effects.Conclusion: There are many treatment options for ON. However, from the results of our study, conservative treatment via ONB may have sufficient effect in controlling symptoms of ON in both short and long term.

Injection Site Pain, Onset and Duration of Action of Botulinum Toxin Reconstituted in Normal Saline With and Without Sodium Bicarbonate: A Prospective, Single Center, Randomized, Double-Blind Interventional Study.

Purpose: This study was designed to investigate the effects of botulinum toxin type A injections diluted with the mixture of sodium bicarbonate and normal saline on pain reduction, onset of action, and duration of action. Methods: This is a prospective, randomized, double-blind clinical study, which included 30 female patients (age >25). The patients were randomized to receive botulinum toxin injections diluted with normal saline and sodium bicarbonate on one side of the face and saline control injections on the other side. Pain severity was assessed using visual analogue scale. The onset and duration of action were recorded according to the patients' subjective opinions after 1 week and 3 months, respectively. Results: Lower pain intensity ratings were observed when botulinum toxin was diluted with 0.05 and 0.1 mL of sodium bicarbonate as compared to saline. Regarding the onset of action, the botulinum toxin injections diluted with saline and 0.1-mL sodium bicarbonate side showed faster response in many patients than other dilutions (P < .001). Both the 0.05-mL and 0.1-mL sodium bicarbonate concentrations showed longer duration effects on patients than other concentrations. Conclusion: The use of sodium bicarbonate and saline in a mixture for the dilution of botulinum toxin can decrease patients' discomfort and provide a faster action with longer duration effects.

Does Immobilization Post Injection Reduce Contrast Extravasation in MR Arthrography of the Shoulder?

Contrast leakage after arthrography is common. We sought to investigate if immobilization could prevent it. The purpose of this study was to determine the effects on contrast extravasation and image quality produced by strict immobilization of the shoulder between arthrography puncture and subsequent MR imaging. Fifty patients underwent shoulder MR arthrography using a standard shoulder puncture in the anteroinferior quadrant. Ten milliliters of contrast mixture of saline, iodinated contrast, and gadolinium contrast was injected by a senior musculoskeletal (MSK) radiologist using a 21G needle. Half of the patients were immediately immobilized using a shoulder sling, and the other half were allowed to move their shoulder and arm freely during the time before MR imaging. MR arthrography was performed with a 3 T system using standard T1 and PD weighted sequences. The MR images were reviewed independently by 2 MSK radiologists and graded for extravasation using a five-point scale (1: none, 2: less than 2 cm, 3: 2-5 cm, 4: 5-10 cm, 5: more than 10 cm) and for image quality using a 5 point scale (1: poor, 5: good). The Pearson correlation was calculated to assess the correlation between leakage and image quality. There was no significant difference in amount of leakage between both groups, and global image quality was found equal in both groups. A negative correlation was found between leakage and quality assessment. This study shows that it cannot be avoided by strict shoulder immobilization and that it negatively affects image quality and interpretation.

Combined femoral and sciatic nerve blocks for lower limb surgeries

The peripheral nerve blocks can be used to interrupt the nerve pathways at multiple locations without undue sedation or loss of consciousness. Low incidence of pre and postoperative complications, good postoperative analgesia and increased operating room efficiency, all have accounted for the resurgence of interest in these techniques. The main aim of this study was to assess the suitability of this simple and safe technique for various unilateral lower limb surgeries and to assess the hemodynamic stability of the patients after this procedure.This prospective randomized study involved 50 patients, in the age group of 20-80 years, scheduled to undergo elective and emergency lower limb surgeries under combined femoral and sciatic nerve blocks. A sciatic nerve block was given by the posterior approach of Labat, and a femoral (3 in 1) block was given by Winnie's inguinal perivascular approach using a mixture of lidocaine, ropivicaine, and saline. Complete block was achieved in 92% of the patients. None of the patients had any complications and there was no significant difference between the pre-operative and post- operative vitals (pulse and blood pressure). 84% of the patients preferred to undergo the same anesthetic technique, if required in the future. Combined femoral(3-in-1) and sciatic nerve block is a simple, safe, and efficient technique with very low incidence of sideeffects and a negligible failure rate.

Nalbuphine Vs Midazolam for Prevention of Shivering in Patients Undergoing Lower Limb Surgery under Spinal Anesthesia; Prospective, Randomized and Double Blinded Controlled Study

Background: Shivering is an involuntary, repetitive contractions of skeletal muscles, which commonly occurred after spinal block and it is an uncomfortable problem to the patients and the anesthetists. Shivering is considered as a complication of anesthesia. Shivering has deleterious effects on the cardiac function especially in patients who have limited cardiopulmonary reserve and coronary disease, which could be explained by increased oxygen consumption, production of carbon dioxide and lactic acidosis caused by shivering. Objective: Our study was aiming at evaluating the effect of intrathecal nalbuphine versus intrathecal midazolam in the prevention of shivering during subarachnoid block. Patients and Methods: Ninety patients (ASA physical status I or II) scheduled for lower limb surgeries under spinal anesthesia were randomly allocated into three groups using sealed envelopes technique; Control group receiving mixture of bupivacaine and saline, Nalbuphine (N) group receiving nalbuphine and bupivacaine, and Midazolam group receiving midazolam and bupivacaine. Upon arrival to the operation room basic monitoring was applied and lactated ringer solution at room temperature was infused through peripheral venous catheter. Results: Shivering occurred in 20 patients (66.7%) in control group, 7 patients in nalbuphine group (23.3%), and 10 in midazolam group (33.3%). The incidence of shivering and core temperature differed significantly between group N and the other two groups (P values in saline and midazolam groups > 0.05, while that of nalbuphine < 0.05). Conclusion: Intrathecal nalbuphine is more effective than intrathecal midazolam in prevention of post-spinal shivering for patients undergoing lower limb surgery.

Comparison of four peribulbar anaesthetic techniques: a preliminary study in equine cadavers

ObjectiveTo compare the peribulbar injectate distribution and probability of regional anaesthesia of four peribulbar anaesthetic techniques in equine cadavers. Study designProspective experimental cadaver study. AnimalsA total of 12 isolated equine cadaver heads and 24 eyes. MethodsThe 24 orbits underwent one of four injection techniques (six orbits each) with a mixture (1:4) of contrast medium and saline (CM): 20 mL ventrolateral peribulbar injection (V-20), 20 mL dorsolateral peribulbar injection (D-20), combined ventrolateral and dorsolateral peribulbar injections 10 mL each (VD-20) or 20 mL each (VD-40). To evaluate and score CM distribution at the base of, within the extraocular muscle cone (EOMC), and around the optic nerve (before and after pressure application to the periorbital area), computed tomography was performed. To assess the probability of achieving locoregional anaesthesia, two criteria were applied and both scored as ‘likely’, ‘possible’ or ‘unlikely’. To compare CM distribution scores between injection techniques, Kruskal-Wallis analysis of variance was used. Mann-Whitney U test was used for post hoc comparisons between groups when needed. A p value < 0.05 was considered significant. ResultsThe CM distribution within the EOMC and around the optic nerve circumference was detected as ‘possible’ only after pressure application in seven out of 24 orbits (V-20, 3; D-20, 1; VD-40, 3). It was never considered ‘likely’ either before or after pressure application. The CM distribution at the EOMC base was considered ‘likely’ to provide regional anaesthesia in 50% (V-20), 0% (D-20), 33% (VD-20), 100% (VD-40) and in 66% (V-20), 16% (D-20), 50% (VD-20), 100% (VD-40) before and after applying pressure, respectively. Conclusions and clinical relevanceComplete regional anaesthesia seems more likely using the VD-40 technique, although the authors advise caution due to the risk of potential complications. Future studies are necessary to evaluate the efficacy of the technique in vivo.

EFFECT OF TOPICAL USE OF TRANEXAMIC ACID IN PATIENTS WITH THORACOLUMBAR FRACTURE UNDERGOING POSTERIOR SPINAL FIXATION AND FUSION

Thoracic and lumbar spine trauma (TLST) is frequently associated with chest and abdominal injuries. Multilevel spinal fusions require a longer operative time, with significant soft tissue stripping as well as blood loss, which frequently leads to allogenic blood transfusion. Topical TXA might enhance patient safety, reducing excessive postoperative bleeding. To evaluate effect of topically applied 1 g TXA on postoperative whole blood transfusion and blood loss in neurologically intact patients with thoracolumbar spine fracture. A clinical prospective randomized study is done on 30 patients with thoracolumbar fracture, undergoing primary posterior instrumented fixation and fusion. Patients were randomized to 2 groups, first group (15 patients) was injected with saline only and second group (15 patients) was injected with mixture of tranexamic acid and saline. Patients were operated under general anesthesia, using a standard midline incision. Wounds are closed in layers over a 16 gauge suction drain; injection cocktail was delivered retrograde into the drain which was then closed for 2 hours. There was a highly significant decrease in blood loss in Group 2. The decrease in Hb level is less in the 2nd group than in the 1st group, indicating less postoperative anemia in the blood count (highly significant). Use of topically administered 1 g of TXA (20 mL) in thoracic and lumbar spinal trauma cases undergoing posterior instrumented fixation and fusion effectively decreased postoperative transfusion requirements. Treatment also reduced total drainage volume, time until drain removal, and length of postoperative hospital stay.

A comparison of the delivery of inhaled drugs by jet nebulizer and vibrating mesh nebulizer using dual-source dual-energy computed tomography in rabbits: a preliminary in vivo study.

BackgroundRadionuclide imaging is the primary method of visually evaluating drug deposition in the lungs. Here, we used a new imaging technique, dual-source dual-energy computed tomography (DSDECT), to compare the ability of two nebulizers commonly used in clinical practice to deposit drugs in the lungs.MethodsMale New Zealand White rabbits were randomly divided into a vibrating mesh nebulizer group and a small volume jet nebulizer group. First, two rabbits received methylene blue-iohexol-normal saline by inhalation to confirm that DSDECT was a feasible method of assessing aerosol inhalation. Then, 10 rabbits were subjected to DSDECT scan before and after receiving a iohexol-normal saline mixture by inhalation. All images were transferred and reconstructed on a workstation computer equipped with dedicated software.ResultsDSDECT revealed the same iodine distribution as tracheobronchial methylene blue staining on dissection. Significant differences between the groups in average CT value and iodine concentration were noted in the right upper lobe (P<0.05), but no other lobes showed statistically significant differences. The regional distribution of drugs in different lobes of the lung varied by nebulizer.ConclusionsDSDECT is a useful method of evaluating drug deposition in the lungs, and vibrating mesh nebulizers deposit more drugs than small volume jet nebulizers.

Contrast Saline Mixture DualFlow Injection Protocols for Low-Kilovolt Computed Tomography Angiography: A Systematic Phantom and Animal Study.

The aim of this study was to evaluate a contrast media (CM)-saline mixture administration with DualFlow (DF) to adapt injection protocols to low-kilovolt (kV) computed tomography angiography (CTA). In both a circulation phantom and animal model (5 Goettingen minipigs), 3 injection protocols were compared in dynamic thoracic CTA: (a) DF injection protocol at 80 kV with a iodine delivery rate (IDR) of 0.9 gI/s, a flowrate of 5 mL/s injected with a 60%/40% ratio of iopromide (300 mgI/mL) and saline (dose contrast medium 180 mgI/kg body weight [BW]); (b) reference CTA was performed at 120 kV and a 40% higher iodine dose applied at higher IDR (1.5 gI/s, 5 mL/s iopromide [300 mgI/mL]; no simultaneously administered saline; 300 mgI/kg BW); and (c) conventional single-flow (SF) protocol with identical IDR as the DF protocol at 80 kV (0.9 gI/s, 3 mL/s iopromide [300 mgI/mL]; no simultaneously administered saline; 180 mgI/kg BW). All 3 injection protocols are followed by a saline chaser applied at the same flow rate as the corresponding CM injection. Time attenuation curves representing the vascular bolus shape were generated for pulmonary trunk and descending aorta. In the circulation phantom, pulmonary and aortic time attenuation curves for the 80 kV DF injection protocols do not significantly differ from the 80 kV SF and the 120 kV SF reference. In the animal model, the 80 kV DF protocol shows similar pulmonal and aortic peak enhancement when compared with the 120 kV SF and 80 kV SF protocols. Also, the bolus length above an attenuation level of 300 HU reveals no significant differences between injection protocols. However, the time to peak was significantly shorter for the 80 kV DF when compared with the 80 kV SF protocol (15.78 ± 1.9 seconds vs 18.24 ± 2.0 seconds; P = 0.008). DualFlow injection protocols can be tailored for low-kV CTA by reducing the IDR while overall flow rate remains unchanged. Although no differences in attenuation were found, DF injections offer a shorter time to peak closer to the reference 120 kV protocol.This allows the use of DF injection protocols to calibrate bolus density in low-kV CTA and yields the potential for a more individualized CM administration.

Determining anatomic accuracy of shoulder field injection: triangular injection technique does adequately reach pain transmitters

BackgroundControlling pain after shoulder surgery is a critical component of postsurgical care. Several recent studies have described the use of periarticular, local infiltration anesthesia, and field blocks (FBs) with clinical efficacy after shoulder surgery. The anatomic accuracy and safety of these FBs have not been well described. The purpose of this study was to determine the accuracy of a surgeon performed shoulder field injection. We hypothesized that our field injection would adequately reach the pain transmitters responsible for postsurgical shoulder pain.MethodsA total of 10 cadaveric specimens were used in the study. A mixture of liposomal bupivacaine, normal saline, and methylene blue totaling 60 cc was prepared. After injection, the specimens were left for 4 hours to allow medication diffusion. The dissection of specimens was performed to identify 4 areas: axillary nerve, suprascapular nerve, supraclavicular nerves, and joint capsule. On dissection, accuracy rates were determined for each area.ResultsAll 10 cadaveric specimens were injected and dissected to completion. The dissection of the axillary nerve showed methylene blue dye surrounding the nerve in 10 of 10 (100%) specimens, the suprascapular nerve in 9 of 10 (90%), and the supraclavicular nerves in 10 of 10 (100%). Zero of 10 (0%) specimens had any dye penetrate into the glenohumeral joint or capsule.ConclusionThe accuracy rates of the injection of the mixture into the shoulder specimens suggest potential to reproduce an FB to the tissues that are responsible for postoperative pain after shoulder surgery. This may represent an option when interscalene nerve block is not desired or contraindicated.

A prospective study of local infiltration analgesia for post-operative pain control following total hip replacement

Objective: Local infiltration analgesia has gained popularity in recent past using mixture of drugs for various surgeries. This study was planned to assess the efficacy of local infiltration, which is a mixture of ropivacaine, clonidine, adrenaline, ketorolac, adrenalin and normal saline, for total hip replacement based on postoperative outcomes like Visual Analogue Score (VAS), mobilization time and hospital stay. Materials and methods: A prospective study was conducted with 30 patients of both the gender of all age groups, fit for total hip replacement. During the operative procedure local infiltration analgesia was infused at 3 stages. Patient was assessed for post operative pain based on visual analogue score, mobilization time and hospital stay. Results: Among 30 patients included in the study, 23 (76.7%) were male and 7 (23.3%) were female. Of total 30 patients 83% of the patients had a VAS of 0-3 at rest for 6th,12th, 18th and 24th hour intervals and on movements 80% of the patients had a VAS of 0-3 at rest for 12th, 18th and 24th hour intervals. The age of patients ranged from 17yrs to 83 years. The mean duration of hospital stay was 3.53 days. The mean time duration of first walk was 14.1467hrs. Conclusion: Local infiltration analgesia can be considered as safe practice in efficiently controlling pain after total hip arthroplasty.

Pain during intravenous Propofol injection and its prevention in the pediatric population. A randomized controlled trial.

Objectives: The aim of our study is to observe the pain difference as experienced by the pediatric patient when administered different preparations of propofol utilizing the verbal rating scale. Study Design: Prospective double-blind randomized control trial. Setting: A large tertiary care hospital in Karachi, Pakistan. Period: 6 months from June 2016 to November 2016. Material &amp; Methods: The final patient population included in the study was n= 180 and were divided into six groups. These patients received general anesthesia and underwent surgery. Patients in Group A received 2ml of normal saline and a mixture of propofol and normal saline after waiting for half a minute. Group B patients received 0.5mg/kg Lidocaine followed by normal saline after waiting for half a minute. Group C received 2ml of normal saline followed by a mixture of propofol and Lidocaine after half a minute. Group D received 0.2mg/kg of Ketamine followed by a mixture of normal saline and propofol. Group E patients received 2ml of normal saline followed by a mixture of propofol and Ketamine half a minute later. And finally, patients belonging to group F received 2ml of normal saline followed by a mixture of propofol M/LCT and normal saline half a minute later respectively. Results: The gender, age, body weight and ASA grade of all the pediatric patients were similar having a P value of &gt;0.05. The incidence rate of propofol injection pain in the groups were found to be Group A= 76.66%, Group B= 66.66%, Group C= 50%, Group D= 60%, Group E= 63.33%, Group F= 60% respectively. The incidence rate for adverse events was significantly lower in all the groups as compared to Group A that is the normal saline and propofol group having a p-value of less than 0.01. And the incidence rate of adverse events was lower in Groups C, D, E, and F were significantly lower than Group B having a p-value of less than 0.05. All the experimental groups had significantly lower scores of the VRS scale as compared to the control group (Group A) and the intergroup differences were found to be statistically significant having a p-value of less than 0.01. Conclusion: In our study, we found that the injection pain of propofol administration in the pediatric population was significantly reduced when using M/LCT pre-injection, 0.5mg/kg lidocaine or 0.2mg/kg of Ketamine. Another good combination is mixing 180mg propofol with 40mg of lidocaine or mixing propofol with 16mg of Ketamine.

2131 Endoscopic Mucosal Resection of a Proximal Esophageal Pyogenic Granuloma

INTRODUCTION: Pyogenic Granuloma (PG), also known as lobular capillary hemangioma, is usually seen as a polypoid red lesion found on the skin or the mucosal surface of the oral cavity. PG of the gastrointestinal tract is rare, in particular involving the esophagus, only 14 cases have been reported in the English literature. CASE DESCRIPTION/METHODS: We present an 80-year-old male who underwent endoscopy for evaluation of dysphagia and was found to have a single, red, bilobed 10 mm polyp with adherent white exudate approximately 19 cm from the incisors (Figure 1). Endoscopic ultrasound was performed with a 20 mHz miniprobe which showed the lesion contained to the mucosal layer with no muscularius propria invasion. A decision was made to perform endoscopic mucosal resection (EMR). A mixture of saline and methylene blue was injected into the submucosal plane to raise the lesion with subsequent successful mucosal hot snare resection (Figure 2). The resection defect was then approximated and closed with a hemostatic clip to prevent bleeding. Pathology of the specimen revealed small capillary vessels growing in a lobular architecture with an edematous stroma and a florid inflammatory infiltrate representing a pyogenic granuloma (Figure 3). DISCUSSION: EMR allows for an en bloc resection of mucosal lesions with tumor-free margins thereby providing both diagnostic and prognostic information. Comparing EMR with the novel technique of endoscopic submucosal dissection (ESD), the incidence of bleeding and perforation is much lower; making EMR the best and safest resection option for this rare hemangioma. In this case, we demonstrate that EMR is a safe technique in removing a pyogenic granuloma in the esophagus.