Seconds In Group Research Articles

Outcomes of coaxial microincision cataract surgery versus conventional phacoemulsification surgery

Aim: To compare surgical parameters and visual outcomes of coaxial microincision cataract surgery (MICS) with standard phacoemulsification.
 Methods: A prospective randomized study was conducted on 60 eyes of 60 patients with age-related uncomplicated cataract who underwent: standard phacoemulsification surgery (30 eyes) i.e., Group 1, or coaxial MICS (30 eyes) i.e., Group 2. Intraoperative parameters were mean effective phacoemulsification power (EPP), effective phacoemulsification time (EPT), and total volume of balanced salt solution (BSS) used. Best-corrected visual acuity (BCVA) and surgically induced astigmatism (SIA) were evaluated pre- and postoperatively.
 Results: Mean BCVA at 6 weeks was 0.04 ± 0.07 in Group 1 and 0.05 ± 0.08 in Group 2. No significant difference was observed in SIA between the two groups. Mean EPT was 29.80 ± 3.67 seconds in Group 1 and 31.93 ± 4.08 seconds in Group 2. The mean total EPP in Group 1 was 35.77 ± 5.17%, whereas it was 33.70 ± 3.05% in Group 2. There was a significant statistical difference between mean EPP and EPT in the two groups. Mean total BSS volume used in Group 1 was 128.83 ± 19.81 ml, whereas it was 139.33 ± 13.57 ml in Group 2.
 Conclusion: Although EPT and BSS volume used were significantly higher in coaxial MICS, the postoperative results of the two techniques were comparable.

A comparative study of stereoacuity in patients with various grades of cataract and bilateral pseudophakia.

Purpose:To compare the stereopsis in patients with various grades of cataract and bilateral pseudophakia.Methods:A cross-sectional observational study was conducted at a tertiary care center in South India from December 2016 to September 2018, wherein the stereoacuity of patients having bilateral senile cataract or bilateral pseudophakia, was measured using the Titmus Fly chart. Those with any form of squint, glaucoma or retinal pathology were excluded. The patients were divided into three groups based on the severity of cataract, determined by the Lens Opacification Classification System (LOCS)-III. Group 4 included those with bilateral pseudophakia. Statistical analysis was performed using one-way ANOVA test with post hoc analysis using the Bonferroni test, to study the difference of stereoacuity between the groups.Results:A total of 200 patients were evaluated. The mean stereoacuity was 65.2 ± 18.2, 114.8 ± 83.42, 402.4 ± 223.7 and 107.2 ± 71.68 arc seconds in groups 1, 2, 3 and 4, respectively (P < 0.001). The mean best corrected visual acuity (BCVA) in LogMAR units was 0.19 ± 0.15, 0.37 ± 0.24, 0.82 ± 0.26 and 0.14 ± 0.13 in groups 1, 2, 3 and 4, respectively (P = 0.01). On comparison between four groups, there was a generalised decrease in BCVA and stereoacuity with increasing grades of cataract except for group 4 which included the bilateral pseudophakics. On post hoc analysis to analyse intergroup variation a statistically significant difference in stereo acuity was noticed when group 3 was compared to other groups.Conclusion:Stereoacuity decreases with increasing grades of cataract. Better stereoacuity is seen in patients with bilateral pseudophakia when compared with high grades of cataract.

Suprapubic pressure facilitates the procedure of office hysteroscopy: A randomized controlled trial.

To minimize the experienced pain during office hysteroscopy, a number of technical approaches and maneuvers are used. The aim of the study was to assess the effect of suprapubic pressure (SuPuP) applied during hysteroscopy. The impact of this maneuver on experienced pain (assessed by visual analog scale [VAS]) and duration of passage through the cervical canal was measured and compared to a reference group with no SuPuP. Hysteroscopy was performed in study subjects as part of their infertility work-up. Patients were randomized into two groups as part of a controlled trial. In group 1, SuPuP was applied while inserting the scope; in group 2, SuPuP was not applied. Pain experienced during the procedure was measured on a 0-10 VAS. Duration of passage through the cervical canal was measured by analyzing the video of the procedure. The effect of SuPuP was estimated by testing for between-groups differences in these outcomes. The number of patients included the study was 60. Mean (SD) VAS score was 3.40 (1.276) in group 1 compared to 3.33 (0.802) in group 2 (P = 0.809). Mean (SD) time of passage through the cervical canal in group 1 was 30.5 (18.37) seconds compared to 43.0 (24.51) seconds in group 2 (P = 0.029). Applying suprapubic pressure could facilitate the procedure by significantly shortening the duration of the passage through the cervical canal, but significantly not reduces the pain experienced during hysteroscopy. Further studies are to be undertaken to investigate the advantages of suprapubic pressure during office hysteroscopy.

Development of the Modified Lenticule Edge Dissection Technique for Small Incision Lenticule Extraction.

To identify and develop an efficient technique to separate the lenticule edge in small incision lenticule extraction (SMILE). Four hundred eyes of 400 consecutive patients with myopia assigned to receive SMILE were included in the study. Eyes with poor-quality laser treatment were excluded, and the second eye of the same patient was included. Two skilled surgeons performed SMILE in the Zhongshan Ophthalmic Center. Each surgeon was allotted 200 patients. One surgeon used the modified technique, whereas the other surgeon used the conventional technique to identify and separate the lenticule edge. All intraoperative complications associated with lenticule edge dissection and the duration of lenticule dissection were recorded. There were 200 eyes each in the modified technique group (group A) and the conventional technique group (group B). The mean lenticule dissection time was 49 ± 10 seconds in group A and 59 ± 43 seconds in group B (P = 0.002). Within 70 seconds, lenticule dissection was completely finished in 96.5% of eyes in group A and 86.0% in group B. Difficult lenticule dissection was experienced in 3.5% (7/200) of cases in group A and in 14.0% (28/200) of cases in group B. The modified lenticule edge dissection technique of SMILE is simpler and faster in identifying the correct dissection plane. It is efficient in reducing surgical manipulation, shortening the learning curve required for lenticule dissection, and allows surgeons to perform SMILE more safely and efficiently.

Dexmedetomidine as an Additive to Local Anesthesia: A Step to Development in Dentistry

The study aimed to compare the effect of dexmedetomidine added to lidocaine against epinephrine added to lidocaine on local anesthetic potency and to look for future prospects of dexmedetomidine as an additive to local anesthesia in dentistry. The study included 25 healthy volunteers in whom extraction of all first premolars was scheduled as part of their orthodontic treatment plan. In this split-mouth, double-blind, crossover, randomized controlled trial, patients were randomized into 2 groups: Group 1 received injection lidocaine plus dexmedetomidine, and group 2 was administered lidocaine plus epinephrine. Patients were assessed for the onset of action of anesthesia, duration of analgesia, pain perception, and vital signs. The mean values (±standard deviations) for the onset of anesthetic action in groups 1 and 2 were 113±24.9 and 141±34.8seconds, respectively, for the mandible. For the maxilla, the mean values were 113±24.9seconds for group 1 and 165±43.8seconds for group 2. The duration of anesthesia was longer in group 1 (lidocaine plus dexmedetomidine), in which the requirement for the first analgesic on request was seen after a longer time interval, when compared with group 2 (lidocaine plus epinephrine).Pain perception elicited statistically significant results with less perception of pain in group 1 (lidocaine plus dexmedetomidine). The vital parameters remained stable, and the results were not statistically significant. In this study, we observed that the addition of dexmedetomidine to lidocaine for maxillary and mandibular nerve blocks significantly prolonged the block duration and shortened the onset of action, as well as improved postoperative analgesia in terms of the need for fewer analgesics in the postoperative period. Furthermore, the vital parameters remained stable and no complications were encountered. The findings were supportive of the use of dexmedetomidine as an adjunct to local anesthetics in dental procedures.

Video Laryngoscopy or Macintosh Laryngoscopy: Which One Is More Successful in Patients With Bilateral Mandibular Fractures?

Successful intubation is challenging in patients with bilateral mandibular fractures. The aim ofthis study was to compare the video laryngoscope (VL) with the Macintosh laryngoscope (ML) for intubation of patients with bilateral mandibular fractures. In this randomized controlled trial study, patients who had bilateral mandibular fractures (angle or subcondylar) were studied. Patients were randomly assigned to 1 of 2 groups using computerized randomization. Laryngoscopy was performed by the ML in group 1 and the VL in group 2. Intubation device (ML or VL) was the predictive factor of the study and age, maximum mouth opening (MMO), incisor fracture, and gender were the variables. Intubation time and successful intubation at the first attempt were the study outcomes. Independent t test was applied to compare intubation time, MMO, and age between the 2 groups. Seventy-eight patients were studied (40 in group 1 and 38 in group 2). Mean intubation time was 33.02±9.68seconds in group 1 and 39.16±7.40seconds in group 2. Comparison of the data showed a significant difference between the 2 groups (P=.002). Twenty-four patients in group 1 and 31 in group 2 were successfully intubated at the first attempt. There was a significant difference in the number of successful or failed intubation attempts between the 2 groups (P=.03). According to the present findings, use of the VL increased the first-attempt success rate of intubation in patients with bilateral mandibular fractures. Time of intubation could be longer when using the VL than when using the ML.

Esophageal transit time in patients with chagasic megaesophagus: Lack of linear correlation between dysphagia and grade of dilatation.

The aim of this study was to determine the esophageal transit time in control individuals and in chagasic patients with or without megaesophagus.A total of 148 patients were allocated in 6 groups according to serological diagnostic of Chagas disease and the degree of esophageal dilatation: A, control healthy individuals (n = 34, 22.9%); B, indeterminate form (n = 23, 15.5%); C, megaesophagus I (n = 37, 25.0%); D, megaesophagus II (n = 19, 12.8%); E, megaesophagus III (n = 21, 14.2%); and F, megaesophagus IV (n = 14, 9.5%). After 8-hour fasting, patients were asked to swallow 75 mL of barium sulfate solution. x-Rays were obtained after 8, 30, 60, and 90 seconds, 5, 10, 30, 60, and 90 minutes, 2, 6, 12, 24 hours, and at every 12 hours until no more contrast was seen in the esophagus. This was the transit time.The transit time varied from 8 seconds to 36 hours (median = 90 seconds). A linear correlation was observed between transit time and megaesophagus grade: 8 seconds in groups A and B, 5 minutes in C, 30 minutes in D, 2 hours in E, and 9:15 hours in F. Dysphagia was not reported by 60 of 114 (52.6%) patients with positive serological tests for Chagas disease (37/91—40.7%—of patients with megaesophagus I–IV grades). The esophageal transit time increased with the grade of megaesophagus.The esophageal transit time has a direct correlation with the grade of megaesophagus; dysphagia complaint correlates with the grade of megaesophagus. However, many patients with megaesophagus do not report dysphagia.

Bleeding during veno-venous ECMO cannot reliably be predicted by rotational thrombelastometry (ROTEM™).

Veno-venous extracorporeal membrane oxygenation (vvECMO) used for respiratory support is associated with clinical bleeding in at least one third of patients. Mechanisms promoting bleeding, like acquired von Willebrand syndrome, cannot be identified by routine coagulation tests. This study was performed to evaluate rotational Thrombelastography (ROTEM™) for specific results predicting bleeding events during vvECMO. Five hundred and thirty-four ROTEM™ analyses of 57 patients over 574 days have been evaluated. Patients were graded into three groups according to the severity of bleeding, following the Freiburg ECMO bleeding assessment. ROTEM™ results and basic as well as comprehensive laboratory coagulation tests have been compared among the three groups and overall between defined time points. Fourteen patients (25 %) presented without bleeding, 22 patients (39 %) showed mild bleeding and 21 patients (36 %) became evident with relevant clinical bleeding. No bleeding shock and no fatal bleeding event occurred. No case of hyperfibrinolysis was observed. Neither a statistical difference for ECMO blood flow nor duration of therapy among the groups could be shown. The only significant difference was clotting time (CT) in the InTEM analysis, with a median (IQR) of 175 (37.5) seconds in Group 1, 190 (54.5) seconds in Group 2 and 204 (90) seconds in Group 3. When comparing overall ROTEM™ analyses between defined time points, continuous worsening of CT can be found in ExTEM, FibTEM and ApTEM. Reduced A10, A20 and congruently maximum clot firmness, especially, developed in ExTEM and ApTEM and with a minor characteristic in InTEM, but not in FibTEM. ROTEM™ and coagulation-parameter results before 19 clinical relevant bleeding episodes compared to all other results only showed differences in FibTEM. ROTEM™ as a functional viscoelastic analysis does not provide additional information to basic and comprehensive laboratory tests during vvECMO. Bleeding events cannot be predicted by the means of specific ROTEM™ results.

Effect of Submucosal Mesna Application on Mucoperichondrial Elevation in Septoplasty.

It was revealed that the thiol compound named mesna chemically softens the connective tissue with submucosal injection, and facilitates the endoscopic submucosal dissection. The authors aimed to investigate the effect of mesna injection on mucoperichondrial elevation during septoplasty operation. This study was planned as a patient-control study and performed. Fifty-six patients who had septoplasty operation were divided into 2 groups that are submucosal mesna (group 1) and submucosal saline (group 2) applied ones. In both groups, the measurement was initiated by a timer during the start of septal incision and elevation processes. After bilateral subperichondrial and subperiostal elevation were finished, timer was stopped and time was recorded. After that, mucosal integrity was reviewed and mucosal damage status was recorded. The difficulty of mucoperichondrial elevation for the surgeon was recorded for each patient. Twenty-five (44.7%) of the patients who participated in our study were females while 31 (55.3%) were males. The average elevation periods were 201.4 ± 74.3 seconds in group 1 and 260.2 ± 84.1 seconds in group 2. In mesna applied patients, elevation period was statistically and significantly shorter (P = 0.009). Impairment in mucosal integrity was observed as 33.3% in group 1 and 58.8% in group 2. In mesna applied patients, significantly less impairment in mucosal integrity was observed (P = 0.031). The average mucoperichondrial elevation difficulty for the surgeon is observed as 4.83 ± 2.47 in group 1 and 6.5 ± 1.9 in group 2. Mesna applied patients were defined as significantly easier patients for the surgeon (P = 0.006). Submucosal mesna application is an approach that provides a convenient, fast, and effective mucoperichondrial elevation in septoplasty and protects the mucosal integrity.

EFFECT OF DIFFERENT ETCHING TIMES ON SEALANT PROPERTIES APPLIED TO FLUORIDE TREATED TEETH: AN IN VITRO STUDY

This study aimed to investigate the effect of fluoride varnish on microleakage and the interfacial micromorphology of pit and fissure nano sealant after different etching times.Materials and methods: One hundred freshly extracted third molars were used in this study. They were randomly allocated into control group (20 teeth) and test group (80 teeth) which was further subdivided into 4 subgroups each one contained (20 teeth) according to the etching time. Teeth of the test group were subjected to fluoride varnish application. The next day, each subgroup was acid etched according to its specific time (20, 40, 60, and 120 seconds for groups I, II, III and IV respectively). Nano fissure sealant was then applied to all teeth according to the manufacturer instructions. Teeth in the control group received the nano sealant without fluoride application. Ten teeth from each subgroup were used for interfacial micromorphology scanning, and the other 10 teeth were used for microleakage evaluation. Results: The scanning electron microscopic examination revealed that the formed tags varied between the groups. The shortest tags were found in subgroup I (between 2.24-3.22 µm), while the largest were in subgroup IV (35.19- 35.24 µm). Score 0 microleakage was the significantly highest one in all groups. The comparison between test groups and control group revealed significant differences in score 1 and 3 only.Conclusion: Application of fluoride did not affect the sealant application especially for the etching times 40 and 60 seconds.

Test-retest Reliability of the Hip Abductor Endurance Test Depending on Two Different Uses of the Borg Scale

Objectives: The purpose of the present study was to compare the test-retest reliability of the hip abductor isometric endurance test in healthy females when using the Borg scale in two different ways. In one group (group A), every 15 seconds and at the end of the test, the subject was asked to give an overall perception about how hard the exercise felt according to the Borg scale. In the other group (group B), the subject was asked to give an overall perception about how hard the exercise felt according to the Borg scale, but only at the end of the test. Method: Seventy-one healthy females (34 in group A and 37 in group B) were recruited. In two identical sessions, spaced by seven days, the participants performed the hip abductor isometric endurance test attended two identical assessment sessions. Results: Both groups demonstrated good test-retest reliability (ICC = 0.83 for group A and 0.77 for group B). The SEM was 11.7 seconds and the MDC, 32.4 seconds for group A. For group B, the SEM and the MDC were 14.6 and 40.4 seconds, respectively. Conclusions: These findings support the use of the Borg scale every 15 s and at the end of the hip abductor isometric endurance test in order to enhance the test-retest reliability.

Rabbit model of tracheal stenosis using cylindrical diffuser.

Variable methods of animal model have been introduced to develop tracheal stenosis. However, none of the prior models allow for predictable determination of the grade of stenosis. This study sought to establish an animal model of tracheal stenosis by using a cylindrical diffuser and to evaluate the feasibility of a reproducible model. A cylindrical diffuser was developed to have a 5 mm active segment to emit laser light circumferentially. Twenty one New Zealand white rabbits were enrolled in this study. The cylindrical diffuser was inserted transorally under bronchoscopic view and the diffused light was delivered to tracheal mucosa 2 cm below the level of vocal cord. Input power of irradiation was 10 W, 5 seconds in group A (n = 7), 10 W, 7 seconds in group B (n = 7), and 8 W, 5 seconds in group C (n = 7). The degree of tracheal stenosis was observed weekly and the rabbits were euthanized 4 weeks after the laser irradiation. The degree of stenosis in group B (90-98%) was significantly larger than that of group A (75-92%) (P = 0.004), while degree in group C (24-35%) was significantly smaller than that of group A (P < 0.001). Two rabbits of group A were euthanized at 3 weeks due to costal retraction. In group B, six rabbits died within 3 weeks after laser irradiation due to severe tracheal stenosis and tracheal malacia, while one rabbit was euthanized 16 days after the irradiation. All rabbits in group C survived up to 4 weeks. Survival between three groups showed significant difference (P = 0.001). The degree of stenosis was significantly different according to the delivered optical energy to tracheal mucosa. Therefore, the proposed model may be used in animal studies to emulate variable grades of tracheal stenosis. Lasers Surg. Med. 49:372-379, 2017. © 2016 Wiley Periodicals, Inc.

Comparative Study of the Localisation of the Epidural Space Using Epidural Balloon Technique versus Saline Filled Syringe Technique – A Prospective, Randomised Study

Background and aims:The success of epidural anaesthesia begins with proper identification of epidural space. There are different techniques used for identification of the epidural space. In this study we compare the localisation of epidural space using epidural balloon technique versus normal saline filled syringe technique .Method: 200 adult patents of ASA I &II status posted for elective lower abdominal and lower limb surgery were randomly allocated in two groups of 100 each. After taking consent and IV access epidural anaesthesia was given to the patients. In group I epidural space was localised by epidural balloon technique while in group II epidural space was located by normal saline filled syringe technique using the loss of resistance method. The parameters studied were time taken for epidural space localisation, the number of attempts,the ease of passing the epidural catheter after localisation, success or failure rate of the localisation of the epidural space by resident anaesthesiologistsand the incidence of complications if any.Student unpaired ‘t’ test and chi square test were used for statistical analysis. Results:90% cases from group I(epidural balloon group) had localisation of epidural space in first attempt which was significantly more as compared to 78% in group II(saline filled syringe group). Mean duration of procedure in group I was 20.74 seconds which was significantly less as compared to 43.54 seconds in group II. 12% of cases from group II had complications during the procedure which was significantly more as compared to none from group I. Conclusion: For epidural space localisation epidural balloon technique is better than saline filled syringe technique in terms of number of attempts, mean duration of procedure, incidence of complications and ease of technique.

The Effect of Intravenous Dexamethasone on Sugammadex Reversal Time in Children Undergoing Adenotonsillectomy.

Dexamethasone has been shown to cause inhibition of sugammadex reversal in functionally innervated human muscle cells. In this prospective, double-blind, randomized, controlled study, we evaluated the effect of dexamethasone on the reversal time of sugammadex in children undergoing tonsillectomy and/or adenoidectomy. We recruited 60 patients with ASA physical status I to II, between the ages of 3 and 8 years, scheduled for elective tonsillectomy and/or adenoidectomy. After the induction of anesthesia, patients in group D received IV dexamethasone at a dose of 0.5 mg/kg within a total volume of 5 mL saline, whereas patients in group S received only 5 mL IV saline as the control group. At the end of surgery, all patients were given a single bolus dose (2 mg/kg) of sugammadex at reappearance of T2. Demographic data, hemodynamic variables, time to recovery (a train-of-four ratio of 0.9), time to tracheal extubation, and adverse effects were recorded. There was no statistical significance between 2 groups in time to recovery and time to extubation. Time to recovery was 97.7 ± 23.9 seconds in group D and 91.1 ± 39.5 seconds in group S (P = 0.436; 95% confidence interval, -10.3 to 23.5). Time to extubation was 127.9 ± 23.2 seconds and 123.8 ± 38.7 seconds in group D and in group S, respectively (P = 0.612; 95% confidence interval, -11.9 to 20.05). IV dexamethasone, given after induction of anesthesia, at a dose of 0.5 mg/kg, does not substantively affect the reversal time of sugammadex in pediatric patients undergoing adenoidectomy and/or tonsillectomy.

MP10-01 ASSOCIATION BETWEEN VAGINAL PRESSURE AND TRANSVERSUS ABDOMINIS MUSCLE THICKNESS IN PATIENTS WITH PELVIC ORGAN PROLAPSE

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Pelvic Prolapse1 Apr 2016MP10-01 ASSOCIATION BETWEEN VAGINAL PRESSURE AND TRANSVERSUS ABDOMINIS MUSCLE THICKNESS IN PATIENTS WITH PELVIC ORGAN PROLAPSE Tomohiro Matsuo, Akihiro Asai, Kojiro Ohba, Yasuyoshi Miyata, and Hideki Sakai Tomohiro MatsuoTomohiro Matsuo More articles by this author , Akihiro AsaiAkihiro Asai More articles by this author , Kojiro OhbaKojiro Ohba More articles by this author , Yasuyoshi MiyataYasuyoshi Miyata More articles by this author , and Hideki SakaiHideki Sakai More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2331AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Decreased vaginal pressure (VP) due to weakened pelvic floor muscles caused by parturition, aging, and decreased female hormone production is a major factor of urinary incontinence and pelvic organ prolapse (POP). It is suggested that transversus abdominis muscle thickness (TAMT) may be used as a marker to estimate pelvic floor muscle strength. However few study has investigated the association between VP and TAMT in patients with POP, which our study aims to do. METHODS The subjects were assigned to two groups: POP (Group P, n = 56, mean age 71.4±7.2 years) and non-POP (controls; Group C, n = 52, mean age 70.1±6.8 years). TAMT was measured in the supine position with an ultrasound system (HITACHI Aloka Medical, Ltd. HI VISION Avius®, 7.5MHz, B mode). The measurement position was the middle of the costal margin and the iliac crest on the right anterior axillary line, with reference to previous reports. TAMT was measured at four time points: at rest; at the peak inspiratory flow; at the peak expiratory flow (PEF); and at the maximum TAM contraction. We examined the association between POP and the TAMT. VP was measured with a perineometer (PERITRON®, Cardio Design Pty Ltd, Oakleigh, Victoria, Australia). RESULTS In Group P, the TAMT was significantly less at the PEF and the maximum TAM contraction (3.6±1.2 mm in Group P and 4.2±1.2 mm in Group C at the PEF; P = 0.021, 3.8±1.2 mm in Group P and 5.3±1.3 mm in Group C at the maximum TAM contraction). In addition, Group P showed a significantly lower vaginal contraction pressure (9.5±4.5 cmH2O in Group P; 20.3±7.5 cmH2O in Group C; P < 0.001) and significantly shorter duration of vaginal contraction (4.3±1.7 seconds in Group P; 6.9±2.9 seconds in Group C; P < 0.001). For the association between the TAMT and VP, only the TAMT at the maximum TAM contraction showed a significantly positive correlation with VP (P < 0.001; r = 0.441). Similarly, during vaginal contraction, only the TAMT at the maximum TAM contraction showed a significant positive correlation with VP (P < 0.001; r = 0.328). There was no correlation of the stage of POP with VP or with the TAMT. CONCLUSIONS In patients with POP, VP is lower and there is a correlation between VP and the TAMT at the maximum TAM contraction. Recently, drawing in the abdominal muscles is being regarded as a method to strengthen the pelvic floor muscles. The measurement of VP and the TAMT may be a predictor for POP and be useful to determine the therapeutic effect of rehabilitation. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e102 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Tomohiro Matsuo More articles by this author Akihiro Asai More articles by this author Kojiro Ohba More articles by this author Yasuyoshi Miyata More articles by this author Hideki Sakai More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evaluation of Dexmedetomidine as an Adjuvant to Intrathecal Bupivacaine in Infraumbilical Surgeries.

Various adjuvants like morphine, buprenorphine and fentanyl, clonidine, ketamine are being used in anaesthetic practice since long for improvement of peri-operative analgesia following spinal anaesthesia. Such adjuvants have been helpful in induction of early ambulation but at the cost of their associated adverse effects. Therefore search for an effective adjuvant is still going on. Currently Dexmedetomidine, a highly selective α2-adrenoreceptor agonist is being studied for its adjuvant action in spinal anaesthesia. The present study aims to evaluate the efficacy of intrathecal Dexmedetomidine as an adjuvant to Bupivacaine in spinal anaesthesia in patients undergoing infra-umbilical surgeries. It was a prospective, double blind study among 60 patients undergoing infraumbilical surgeries under spinal anaesthesia. The patients were randomly allocated to 2 groups (Group I and Group II) of 30 each. Group I received hyperbaric bupivacaine (15 mg) alone and Group II received hyperbaric bupivacaine (15 mg) with Dexmedetomidine (5mcg). The onset time of sensory and motor block, regression time of sensory and motor block, duration of analgesia, haemodynamic parameters were recorded both intra and postoperatively. The primary efficacy parameters were to determine the onset and duration of sensory block, motor block and duration of postoperative analgesia. Secondarily any associated haemodynamic changes and adverse effects of Dexmedetomidine were also recorded. Continuous data were analysed using the Student's t-test and categorical variables by two-tailed Fisher-exact test or Chi-square test. Onset of sensory block was 129.33±14.8 seconds in Group II as compared to 208.33±19.18 seconds in Group I with total duration of sensory block as 317.70±16.16 minutes in Group II and 188±11.86 minutes in Group I. Similarly, onset of motor block was 226.33±31.86 minutes and 320.33±29.81 minutes, with total duration of motor block as 286.33±15.15 minutes and 166.5±12.11 minutes in Group II and in Group I respectively. Duration of analgesia was 333.6±20.67 minutes with Dexmedetomidine but 193.67±7.06 minutes in bupivacaine alone group. Dexmedetomidine as an adjuvant had shown early onset of sensory and motor block with longer duration of analgesia and haemodynamic stability in the present study as compared to bupivacaine alone.

Comparative Study of Circular Opening and Concentric Suturing Cesarean Section with Standard Lower Segment Cesarean Section

Introduction: Cesarean section is one of the most commonly performed surgeries in the world. Because of the huge numbers, even a small improvement in technique can cause a significant impact on the morbidity rates and cost burden. Objectives: (1) To study the feasibility of an innovative technique, circular opening and concentric suturing (COCS) method of cesarean operation. (2) To compare this novel technique with standard lower segment cesarean section (LSCS). (3) To study the merits and demerits of this technique. Design: A prospective comparative study was performed in a single unit of Obstetrics and Gynecology Department at a tertiary hospital for 3 years. Materials and Methods: Patients were recruited with well-defined inclusion and exclusion criteria and they were divided into two groups with 30 patients in each group: one operated by standard LSCS and the other operated by the “circular opening method.” Result: The time to baby delivery after uterine incision measured in seconds was 18.7±2.95 seconds in group 1 and 19.0±2.76 seconds in group 2 and the difference was not statistically significant (p=0.720), whereas the time to uterine closure after baby delivery was less in the COCS group (8.2±1.41 minutes) than in the LSCS group (9.6±1.74 minutes) and was statistically significant (p=0.001). This suggests that the innovative technique of COCS does not delay the baby delivery and it requires less uterine closure time. Conclusion: From this study we conclude that this novel method is feasible. There are no demerits, but the subsequent behavior of scar in future pregnancies needs to be studied. (J GYNECOL SURG 31:318)

English

OBJECTIVES: Percutaneous nephrolithotomy is one of the procedures of choice for renal calculi, and there are several techniques for tract dilatation. However there is a paucity in Indian literature on single dilatation techniques. This study aims to analyse the feasibility and morbidity of single step acute dilatation and to compare it with Amplatz sequential dilatation technique, for tract creation in percutaneous nephrolithotomy. MATERIALS & METHODS: This study was a randomized controlled trial conducted in Urology department of Govt Stanley Hospital between August 2014 and March 2015. 60 patients satisfying the inclusion criteria were selected and were randomized into two groups of 30 patients each, and for tract creation during percutaneous nephrolithotomy, serial dilatations were done in one group A and single dilatation was done in group B. X-ray exposure time, blood loss, post-operative complications, duration of stay and need for ancillary procedures like ESWL were taken into account to measure the outcome. STATISTICAL ANALYSIS: Analysis was done using Chi-Square and Fisher's Exact tests. RESULTS: Mean X-ray Exposure Time was 92.9 seconds in group A, and 29.43 seconds in group B. 4 patients in group A and 2 Patients in group B required transfusions. Mean hospital stay was 4.5 days in group A and 4.3 days in group B. 3 patients in group A and 2 patients in group B, required ESWL. CONCLUSION: X-ray exposure was significantly less in single step acute dilatation technique, while there was no significant difference in other outcome measures, between the two groups.

Comparison of extramedullary and intramedullary devices for treatment of subtrochanteric femoral fractures at tertiary level center

ObjectiveThe treatment of subtrochanteric fractures is challenging and treatment modalities and implants are constantly evolving. This study attempts to revisit and compare extramedullary vs. intramedullary devices in relatively young population. MethodsThirty patients with subtrochanteric fractures were enrolled and treated with extramedullary or intramedullary devices and follow-up continued one year for clinico-radiological assessment. ResultsThe mean age of patients was 37.53 years. Most were males between 21-40 years old. The dominant mode of injury was traffic accidents (66%). Fractures were classified according to Russell-Taylor classification. Forty percent were Russell-Taylor type IA, 37% type IB and 23% type IIA. Average time to surgery was 3.6 days from the time of admission to hospital. Mean duration of surgery was 45 minutes for intramedullary device (group A) and 105 minutes for extramedullary device (group B). Average blood loss was 100ml in group A and 200ml in group B. Mean duration of radiation exposure was 130 seconds and 140 seconds for groups A and B, while average duration of hospital stay was 12 days and 16 days respectively. Excellent results were seen in 47% of cases in group A and 33% of cases in group B. ConclusionIntramedullary device is a reliable implant for subtrochanteric fractures. It has high rates of union with minimal soft-tissue damage. Intramedullary fixation has biological and biomechanical advantages, but surgery is technically demanding. Gradual learning and patience is needed to make this method truly rewarding.

Reduction in Fluoroscopy Time, Radiation Dosage, and Complications Using an Innovative Guide Wire for Percutaneous Pedicle Screws

Introduction Despite the benefits of minimally invasive spine surgery (MIS), inherent risks to the patient and surgeon exist. Numerous studies demonstrate increased radiation exposure with MIS secondary to the need for increased fluoroscopy, thereby increasing the risk of cataracts and malignancy. Additionally, inadvertent advancement of standard guide wires through the vertebral body can occur, placing vital ventral structures at risk. This study evaluates the benefit of utilizing a novel split-tip guide wire for percutaneous pedicle screw placement. Methods A total of 30 consecutive cases of MIS transforaminal lumbar interbody fusion (TLIF) at L5–S1 were retrospectively evaluated. Group 1: Standard straight guide wire, 15 patients; group 2: split-tip guide wire, 15 patients. Except for the type of guide wire utilized, the same operative technique was used in each case, including bicortical S1 screw fixation. Total fluoroscopy time, radiation dosage, operative time, and complications were evaluated. Technique: (1) S1 pedicles are cannulated with standard Jamshidi needles. (2) Y-wires are placed through Jamshidi needles. (3) A cannulated Steffee probe cannulates the distal sacral promontory over the Y-wire. (4) The Steffee probe is retracted 50% and Y-wire is repositioned (Y-wire design prevents inadvertent advancement through sacral promontory). (5) The proximal S1 pedicle can be tapped over the Y-wire (not required). (6) Cannulated pedicle screws are placed over the Y-wire, engaging the distal sacral promontory for bicortical S1 purchase. Results Mean total fluoroscopy time per case for group 1 was 231.1 seconds versus 154.2 seconds for group 2 ( p = 0.017). Mean radiation dosage for group 1 was 16.22 versus 8.69 rads in group 2 ( p &lt; 0.001). There was no significant difference in operative time ( p = 0.18). Inadvertent advancement of two S1 guide wires occurred in two different patients in group 1. Postoperative abdominal CT scans with contrast were negative. Conclusion Utilizing a split-tip guide wire for percutaneous pedicle screw placement significantly decreased fluoroscopy time by 33% and radiation dosage by 46%. Cannulating the sacral promontory allows for bicortical S1 screw purchase, but removes the mechanical stop preventing inadvertent guidewire advancement. The split-tip guidewire may prevent wire advancement and decreases the need for fluoroscopic surveillance. This, in turn, reduces the risk of injury to structures ventral to the spine, while reducing the exposure to harmful radiation.