Local Edema Research Articles

Efficiency of various methods of surgical treatment of chronic diseases of lower limb veins (analysis of our experience)

The article deals with classification issues, the current state of medical and surgical treatment of chronic diseases of the veins of the lower extremities, widely used in world practice, innovative domestic developments based on electrocoagulation and electric welding technologies, as well as their comparative characteristics among themselves and with laser methods based on their own experience. The aim — to compare effectiveness of open and minimally invasive surgical techniques in patients with varicose disease (VD) and post‑thrombotic disease (PTD) of the lower extremities, to assess the possibility of Ukrainian high‑tech developments using. Materials and methods. Analysis was conducted of surgical treatment of 94 patients with VD for the period from 2014 to 2017 and 81 patients with PTD (the period from 2002 to 2010) in the «Olexandrivska» clinical hospital in Kyiv. Results and discussion. The results of treatment were evaluated at 4 weeks, 3 months, and 6 months after surgery by sonographic criteria, the presence of local edema, the dynamics of the trophic changes in soft tissue of the shin. After 1 month, a slight improvement was fixed at 18 % of the patients of the main group, moderate improvement — at 74 %, significant improvement — at 8 %. In 3 months the estimated effectiveness was 2 %, 12 %, 86 %, in 6 months — 2 %, 6 %, 92 %, respectively. The average length of hospital stay for patients in the main group was 2.4 ± 0.4 days, whereas in the control group this indicator was 5.2 ± 1.2 days. Conclusions. Endovenous laser coagulation and subfascial endoscopic dissection are effective, low‑impact methods for treating lower limb varicose and post‑thrombotic diseases of the lower extremity veins and should actively supplant open methods of surgical treatment. Ukrainian developments using high‑frequency electric welding and electrocoagulation technologies could take leading positions in phlebology.

Intravenous meloxicam for the treatment of moderate to severe acute pain: a pooled analysis of safety and opioid-reducing effects

Background and objectivesTo describe the safety and tolerability of intravenous meloxicam compared with placebo across all phase II/III clinical trials.MethodsSafety data and opioid use from subjects with moderate to severe...

Real-World Experience With 100 Consecutive Patients Undergoing Neck Contouring With ATX-101 (Deoxycholic Acid): An Updated Report With A 2-Year Analysis.

BACKGROUNDDeoxycholic acid (DCA; ATX-101) injection was approved for the treatment of mild-to-moderate convexity associated with submental fat in 2015.OBJECTIVETo evaluate the experience with DCA injections in a clinical practice setting.MATERIALS AND METHODSThis ongoing, prospective, single-center, single-arm, observational study evaluated 100 consecutive patients treated with subcutaneous DCA (2 mg/cm2) injections (maximum 6 sessions at ≥1-month intervals). Treatment response was assessed using the clinician-reported submental fat rating scale (CR-SMFRS) and confirmed by independent physician review of photographs at 1 and 5 to 7 weeks after treatment.RESULTSSince the previous published report, 17 patients have undergone additional treatment sessions, with a total of 100 patients having undergone 195 treatment sessions: 41, 36, 14, 6, 2, and 1 patient underwent 1, 2, 3, 4, 5, and 6 sessions, respectively. Overall, 91.7% of patients in the single treatment session group and 100% in the multiple treatment session group had an improvement of ≥1 point on the CR-SMFRS. The mean (SD) duration of local edema, numbness, and tenderness after treatment was 7.1 (5.1), 27.9 (11.3), and 3.5 (3.5) days, respectively.CONCLUSIONDeoxycholic acid injections were generally well tolerated, and ≥2 treatment sessions were required to achieve the desired aesthetic goal in a private practice setting.

Deep venous thrombosis of lower limbs in adolescents: a study in a tertiary hospital.

Venous thromboembolism (VTE) - which includes deep venous thrombosis (DVT) and pulmonary embolism (PE) - has been increasingly recognized in the pediatric population. The estimated incidence is 0.07-0.14 cases per 10,000 children. Most cases are associated with two or more risk factors. Medium and long-term complications include recurrence and post-thrombotic syndrome (PTS). To characterize the adolescent population with the diagnosis of DVT of lower limbs in a tertiary hospital, regarding its clinical presentation, associated risk factors, treatment and outcome. Retrospective analysis of adolescents with the diagnosis of DVT of lower limbs in our hospital for a period of 7 years. Eight patients were identified; seven were females; median age was 15 years. The main symptoms were local pain and edema. Left lower limb was affected in six patients. PE occurred in two cases. Positive family history of venous thromboembolism was found in five patients. Seven patients had at least two identifiable risk factors. Combined oral contraceptive pill use was the most common (seven patients). Factor V Leiden mutation was found in three patients and protein C deficiency in one. Iliac vein compression syndrome was diagnosed in one patient. The median time for discharge was 8 days. Election treatment was enoxaparin followed by warfarin, for a median period of 10.9 months. Three patients developed PTS. Although uncommon, VTE is an emerging reality in adolescents, particularly in females using oral contraceptive pills. Appropriated prevention strategies and treatment are required as most orientations are extrapolated from adults.

Inhibitory effects of Morus nigra L. (Moraceae) against local paw edema and mechanical hypernociception induced by Bothrops jararacussu snake venom in mice

BackgroundBothropic venoms cause intense local damage, pain, edema, and myonecrosis. Morus nigra L. (Moraceae) has several uses in folk medicine and can be a promising candidate for the treatment of several inflammatory disorders. Hypothesis/PurposeThe present study aims to evaluate the anti-inflammatory and antinociceptive effects of the ethanolic extract of Morus nigra L. (Mn-EtOH) on paw lesions induced by Bothrops jararacussu snake venom (BjcuV) in mice. MethodsUV–vis absorption of BjcuV was evaluated. A phytochemical study was performed, which led to the isolation and characterization of three compounds. These compounds were identified using spectrometric methods, namely LC–MS and NMR (1D and 2D), followed by the validation of their spectra with the data available in the literature. Further, the flavonoids i.e. rutin and quercetin (chemical markers of M. nigra), Mn-EtOH or Mn-EtOH-encapsulated electrospun fibers of Eudragit L100 (FB/Mn-EtOH), and Mn-EtOH-encapsulated microparticles of Eudragit L100 (MP/Mn-EtOH) were evaluated, in paw edema test induced by BjcuV. ResultsUV–vis spectra showed the presence of phospholipases A2 as component of BjcuV. The chemical examination resulted in the isolation of β-sitosterol, quercetin-3-O-glucopyranoside, and kaempferol-3-O-glucopyranoside. Mn-EtOH, FB/Mn-EtOH, MP/Mn-EtOH, rutin, and quercetin reduced the local edema induced by BjcuV. The Mn-EtOH also prevented edema provoked by serotonin and bradykinin. Moreover, it reduced paw edema and peritoneal leukocyte infiltration induced by carrageenan, and decreased the mechanical hypernociception of BjcuV. Mn-EtOH exerted anti-inflammatory and antinociceptive effects, possibly by the inhibition of leukocyte migration and the modulation of serotonin and bradykinin actions. This anti-inflammatory activity was maintained even upon incorporation of the M. nigra extract into the drug delivery systems (i.e., Mn-EtOH-encapsulated FBs and MPs of Eudragit L100). ConclusionThese results reinforce the therapeutic potential of M. nigra in the treatment of inflammatory conditions, in addition to, its role as a complementary treatment of snakebites.

Early and Delayed Alteration of Atrial Electrograms Around Single Radiofrequency Ablation Lesion.

Purpose: The acute effect of radiofrequency (RF) ablation includes local necrosis and oedema. We investigated the spatiotemporal change of atrial electrograms in the area surrounding the site of single standardized pulse of RF energy.Methods: The study enrolled 12 patients (45–67 years, 10 males) with paroxysmal atrial fibrillation (AF) undergoing ablation procedure with irrigated-tip ablation catheter and 3D navigation. The high-density mapping/remapping (129 ± 63 points) within the circular area with radius of ~10 mm, centered at the pre-specified posterior left pulmonary vein antrum ablation site was performed at baseline, immediately after single RF energy delivery (25 W, 30 s, 20 ml/min) and after 30 min waiting period. Bipolar voltages of atrial electrograms (A-EGM-biV) were averaged within the central and 12 adjacent left atrium segments and their relative change was studied.Results: After the ablation, overall A-EGM-biV within the mapping zone (3.51 ± 1.89 mV at baseline) reduced to 2.83 ± 1.77 mV (immediately) and to 2.68 ± 1.58 mV (after 30 min waiting period). In per-segment pair-wise comparison, we observed highly significant change in A-EGM-biV that extended up to the distance of 8.8 mm from the lesion core. The maximum early A-EGM-biV attenuation by 39–49% (P < 0.001) was registered in segments adjacent to pulmonary vein ostia. The subsequent (delayed) A-EGM-biV reduction by 17–24% (P < 0.05) was observed in opposite direction from the lesion center.Conclusions: Significant alteration of atrial electrograms was detectable rather distant from the central lesion. Spatiotemporal development of ablation lesion was eccentric/asymmetric. While acute A-EGM-biV reduction can be attributed predominantly to direct thermal injury, delayed effects are probably due to oedema progression.

Mirroring preeclampsia: the molecular basis of Ballantyne syndrome

Objectives: The purpose of this article was to further elucidate the pathophysiology of Mirror (Ballantyne) syndrome within the context of known biomarkers for preeclampsia.Methods: This novel insight from clinical practice involved a case of post-twin-to-twin transfusion syndrome-laser hydrops in an ex-donor twin, corroborated by histopathologic placental territory edema and maternal sequelae of Mirror syndrome. We serially measured the levels of activin A, follistatin, endothelin-1 (ET-1), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), soluble fms-like tyrosine kinase 1 (sFlt), and von Willebrand factor (vWF) in the maternal serum from disease evolution through to recovery.Results: The paired finding of hydropic ex-donor twin and placenta, supports the theory of placental injury as the source of potential molecular mediators, leading to local placental edema, associated fetal hydrops and the maternal preeclamptic picture. Notably, we elucidated a temporal spectrum of maternal serum mediators (soluble Flt-1, endothelin-1, 8-isoprostane, activin-A, ICAM-1, and vWF) involved in the pathogenesis of Mirror syndrome.Conclusion: Better understanding of the pathogenesis of Mirror syndrome has important implications for clinical management.

OSTEONECROSIS OF THE KNEE

Spontaneous osteonecrosis of the knee (SONK) is the most common type of knee osteonecrosis. It causes subchondral bone damage and in the majority of cases leads to cartilage damage and secondary osteoarthritis. The etiology is commonly explained with two main theories, vascular and traumatic. Vascular theory is based on disrupture of bone blood supply which causes local ischaemia and subchondral bone necrosis. Traumatic theory suggests the development of subchondral insufficiency fractures due to mechanical overload, which causes local oedema, ischaemia and necrosis. SONK typically appears in middle age and older women, with acute onset of sharp pain in the medial femoral condyle without predisposing trauma. Considering that the characteristic radiological signs are not seen on conventional radiography until advanced stage, magnetic resonance imaging is the gold standard in diagnostics. Treatment depends on the size and stage of the osteonecrotic lesion. Small osteonecrotic lesions are usually successfully treated non-operatively, which is based primarily on protected weight bearing and physical therapy. Medium osteonecrotic lesions are treated either non-operatively or operatively, while large osteonecrotic lesions are almost always treated operatively. Most commonly used joint preserving procedures include arthroscopic bone marrow stimulation using microfracture technique, core decompression, osteochondral autologous or homologous transplantation, artificial graft transplantation, and medial opening-wedge high tibial osteotomy. The treatment of choice after subchondral bone collapse is knee arthroplasty.

Photodynamic therapy of gunshot wounds soft tissue

Introduction. An important component of the treatment of gunshot wounds is antibiotic therapy. Unfortunately, due to the antibiotic resistance of many strains of microorganisms, there remains a risk of purulent- infectious complications even with prolonged antibiotic therapy. In recent years, methods of physical action, in particular, photodynamic therapy (PDT), have been used to accelerate bacterial decontamination of wounds. Gunshot wounds have their own characteristics that create certain difficulties for the application of the method of photodynamic therapy. Purpose. Аnalyzes the results of the application of the developed PDT method in the complex treatment of gunshot wounds of soft tissues. Materials and methods. A comparison was made of the main indicators of the wound healing process between the wounded of the main group who used PDT (n = 52) and the comparison group (n = 32) who used treatment with complex water-soluble ointments. To increase the effectiveness of the method, the «Photolon» photosensitizer was administered in two ways: by injection infiltration of tissues around the wound and by application directly to the wound surface. The wavelength of laser radiation is 660 nm. The dose of laser energy was 20 J/cm2. Results. The results of the study showed an improvement in the course of the wound process in all respects when using PDT: the period of regression of local edema in the main group on (3.7 ± 0.4) days in the comparison group (6.2 ± 0.5), the period of wound cleansing (4.7 ± 0.6) days (7.3 ± 0.8) days, respectively; the timing of the start of granulation (4.6 ± 0.5) days and (7.8 ± 0.6). At the beginning of treatment, 45 pathogenic strains were isolated in 38 (73.1 %) wounded main groups and 26 strains in 22 (68.7 %) wounded comparison groups. A day after the use of PDT, pathogenic wound microflora was isolated in 5 (9.6 %) wounded main groups — 5 strains and 23 strains in 19 (59.4 %) wounded comparison groups. Conclusions. The effects of PDT were observed: rapid inactivation of pathogenic wound microflora, reduction of edema, pain syndrome and stimulation of granulation growth, which contributes to early closure of wounds.

Efficacy of compression hosiery and elastic bandaging after surgical treatment of varicose veins

The purpose of the study was to compare the results of using compression knitwear and elastic bandaging in the postoperative period after endovasal laser coagulation in patients with varicose veins. A total of forty 20-to-55-year-old women with a body mass index of ≤ 35 kg/m2 and CEAP class C2-C3 lower limb varicose veins were randomized into two numerically equal groups. The Study Group included those receiving postoperative compression on the operated leg with the help an elastic stocking, whereas in the Comparison Group compression was achieved by laying an elastic bandage. Both group women underwent laser coagulation of the great saphenous vein and removal of separate veins with the help of Mueller hooks. Efficacy of compression therapy was comparatively assessed based on the results of interviewing the patients prior to intervention and 1 month thereafter, as well as by the level of pain syndrome according to the visual analogue scale at 24 and 48 postoperative hours, by the time spent by the personnel for bandaging of the limb or putting on the compression stocking intraoperatively and at the first dressing, by the degree of lower limb oedema and dynamics of regression thereof, by the area of postoperative haematoma and its dynamics after 2, 7 days and at 1 month. Besides, we evaluated the findings of ultrasonographic angioscanning of lower limb veins at one month postoperatively. The obtained findings demonstrated that efficacy of using a medical compression stocking after the procedure of endovasal laser coagulation in women with varicose veins was comparable to that of elastic bandaging. By the incidence rate and area of extension of postoperative haematomas, degree of pain syndrome, patient-oriented assessment using the Chronic Venous Insufficiency Quality of Life Questionnaire (CIVIQ), condition of veins according to the findings of ultrasonographic angioscanning no significant differences were revealed between the two methods of elastic compression of the leg. However, using a medical stocking appeared to promote a statistically significant 1.4-1.6-fold reduction in the time spent for formation of elastic compression of the lower limb, as well as a decrease in the incidence rate and degree of local oedema of the lower limb in the postoperative period.

Free nasal floor mucosal grafting after endoscopic total ethmoidectomy for severe nasal polyposis: a pilot study.

We report a novel surgical technique based on an endonasal free mucosal graft (mucoplasty) for improving clinical results and local healing in chronic rhinosinusitis with nasal polyps (CRSwNP). Patients diagnosed with bilateral CRSwNP scheduled for endoscopic sinus surgery were included. They underwent complete removal of anterior and posterior ethmoid cells, in addition to bilateral type III frontal sinusotomy. An endoscopic mucoplasty was performed in the left nasal cavity, whereas the right nasal cavity served as control. Patients were evaluated before surgery and 6 months after operation, including Sino-Nasal Outcome Test (SNOT-22), Visual Analogue Scale (VAS) for olfaction, endoscopic evaluation using the Modified und-Kennedy (MLK) scoring system and healing evaluation. Ten patients (mean age 53.6 years) were included. A significa t decrease of SNOT-22 score from 57.0 (21.1) to 20.3 (20.6) (P = 0.024) and a non-significa t decrease of VAS for olfaction score from 9.3 (0.5) to 4.6 (3.9) were found. Preoperative mean MLK score was 4.9 (0.7) in the right nostril and 4.8 (1.0) in the left one. After operation, there was a greater decrease of MLK score in the left nostril than in the right (1.9 [1.0] vs. 1.3 [0.8], P = 0.034). Better healing was proved in the nostril with the mucoplasty. Endonasal mucoplasty could be an effective, safe and feasible complementary surgical procedure in the treatment of CRSwNP. The reduced local edema associated with lower amount of secretions may confer a better control in the frontal recess, orbital wall and nasal roof.

Much Ado about N…atrium: modelling tissue sodium as a highly sensitive marker of subclinical and localized oedema.

Hypertonic Na+ accumulation in peripheral tissues is a recently described phenomenon: it has been associated with ageing, hypertension, diabetes, chronic kidney disease and heart failure, but its clinical meaning has yet to be determined. This concept conflicts with the classic physiological paradigm of constant balance between salt intake and excretion, and its water-independent nature is still a matter of debate.We developed a theoretical model explaining changes in the chemical composition of tissues as a function of extracellular volume fraction and excess extracellular fluid, i.e. oedema. The model suggests that the proportional increase in absolute Na+ content and concentration due to different degrees of oedema is higher than the parallel increase in water content, thus making Na+ a more sensitive index to detect this oedema.Our model would explain some of the recent findings of high tissue Na+ content in pathological conditions. More importantly, it prompts the reappraisal of tissue Na+ analysis from being a topic of niche interest to a potential diagnostic tool with broad applicability in the investigation of subclinical systemic and localized oedema.

Cluster-Like Headache Secondary to Sphenoid Sinus Mucocele

Background The great majority of cases of cluster headache (CH) are primary, but there are several reported cases of CH secondary to underlying structural lesions. The identification of these lesions is crucial for the achievement of an effective treatment and favorable outcome, although the determination of a cause-effect relationship between the two entities may be challenging. Case Report We present the first case of CH secondary to sphenoid sinus mucocele. Discussion This case reinforces the need to perform neuroimaging studies in CH patients in order to identify lesions that can constitute its cause, especially if atypical features are present. Activation of the trigeminovascular system due to direct contact between the lesion and the trigeminal nerve or by local edema and inflammation possibly plays a role in the pathophysiology of this CH secondary to sphenoid sinus mucocele.

Laser ablation for complete obstruction of bronchus\u2014an anaesthetic challenge (two case report)

BackgroundPrecise tissue destruction, minimal local inflammation and oedema with laser play useful role in the treatment of life-threatening paediatric airway lesions. Risk of fire in O2-enriched atmosphere makes anaesthesia challenging. Fewer options are available for anaesthetic management of laser ablation for bronchial obstruction in children. Very few reports regarding the use of laser for bronchial obstruction in children are available.Case presentationTwo paediatric patients admitted with difficulty in breathing and coughing. They were diagnosed having unilateral bronchial obstruction. They were posted for bronchoscopic laser ablation of blocked tissue. Anaesthesia was managed with total intravenous anaesthesia and ventilation through side arm of bronchoscope. Complications bleeding and pneumothorax happened in one child. Temporary rise in PaCO2 with fall in PH and PaO2 was also observed. Successful management is presented.ConclusionCareful preoperative evaluation, use of low Fio2, measures to avoid fire hazards due to laser, monitoring SpO2 and EtCO2 and maintaining haemodynamic parameters play key role for successful management of laser for bronchial obstruction.

Anti-adipogenic effect of mastoparan B analogue peptide on 3T3-L1 preadipocytes

Mastoparan B (MP-B), a cationic tetradecapeptide isolated from the venom of the Vespa basalis, exhibits cardiovascular effects, local edema and antibacterial activity. In this study, the anti-adipogenic effect of an MP-B analogue and its mechanism of action in 3T3-L1 preadipocytes were studied. The MP-B analogue (MP-B12) inhibited preadipocyte differentiation and decreased the expression of adipogenic transcription factors, including CCAAT/enhancer binding protein-alpha (C/EBPα), nuclear receptor peroxisome proliferator-activated receptor gamma (PPARγ) and sterol regulatory element-binding protein-1 (SREBP-1). Moreover, MP-B12 regulated the phosphorylation of Akt and glycogen synthase kinase-3 beta (GSK-3β), both of which play a role in preadipocyte differentiation, in which insulin and certain growth factors stimulated adipogenesis. This study demonstrates that MP-B12 inhibits preadipocyte differentiation and the accumulation of lipid droplets in 3T3-L1 preadipocytes and could potentially be used to treat obesity.Video Clip of Methodology:4 min 11 sec Full Screen Alternate

Lethal manifestations of angioedema

An 86-year-old woman with a history of angioedema was found dead at her home address. She had recently complained of a swollen tongue. At autopsy the tongue was grossly edematous, protruding from the mouth. There was also marked edema of the tonsillar fossae, epiglottis and glottic inlet, causing critical obstruction. Histology of the tongue and upper airway demonstrated marked submucosal edema. Death was attributed to upper airway obstruction due to angioedema of the tongue, oropharynx and glottic inlet. Angioedema is characterized by localized non-pitting edema of the deep dermis and subcutaneous/submucosal tissues. It may be acute or chronic, acquired or inherited. Sudden death may result from critical airway occlusion, although both stroke and ischemic heart disease are known to occur. Post mortem genetic testing for hereditary variants can be conducted for SERPING1 gene and F12 gene/THR328 mutations.

Échographie des fractures de stress

Accurate assessment of bones is essential in every musculoskeletal US examination. Several articles reported the US appearance of SF of knees, legs, ankles and feet. The US hallmarks of a SF at this level are: (1) local soft tissues oedema; (2) hypoechoic thickening of the periosteum; (3) hyperaemia located into the soft tissues, periosteum and frequently inside the bone cortex; (4) normal appearance of other local structures. The US diagnosis of a SF necessitates a careful correlation with clinical findings, since US appearance although suggestive is aspecific. If US indicate a SF, an attending attitude including rest and avoidance of charge and clinical follow-up can be proposed in most patients. If the patient does not improve or in case presenting a discrepancy between US and clinical findings a MRI examination must be obtained.

Field Diagnostics and Seasonality of Ophidiomyces ophiodiicola in Wild Snake Populations

Snake fungal disease (SFD) is an emerging disease caused by the fungal pathogen, Ophidiomyces ophiodiicola. Clinical signs of SFD include dermal lesions, including regional and local edema, crusts, and ulcers. Snake fungal disease is widespread in the Eastern United States, yet there are limited data on how clinical signs of SFD compare with laboratory diagnostics. We compared two sampling methods for O. ophiodiicola, scale clip collection and swabbing, to evaluate whether collection method impacted the results of polymerase chain reaction (PCR). In addition, we evaluated the use of clinical signs to predict the presence of O. ophiodiicola across seasons, snake habitat affiliation (aquatic or terrestrial) and study sites. We found no significant difference in PCR results between sampling methods. Clinical signs were a strong predictor of O. ophiodiicola presence in spring and summer seasons. Snakes occupying terrestrial environments had a lower overall probability of testing positive for O. ophiodiicola compared to snakes occupying aquatic environments. Although our study indicates that both clinical signs of SFD and prevalence of O. ophiodiicola vary seasonally and based on habitat preferences of the host, our analysis suggests that clinical signs can serve as a reliable indicator of O. ophiodiicola presence, especially during spring and summer.

Reduction of post-operative pain after tonsillectomy by a local mucosal flap – a prospective, randomized, controlled clinical trial on 100 adult patients

Background: Tonsillectomy is one of the most frequent operations in otorhinolaryngology being associated with intense post-operative pain and an impairment of swallowing and speech.Aims: To determine whether wound sealing with a local mucosal flap can improve patient rehabilitation.Materials and methods: The study was designed as a prospective, randomized, monocentric, controlled clinical trial including 100 patients. Patients were operated on using either conventional extracapsular tonsillectomy (n = 50) or a modified technique with a local mucosal flap prepared from the posterior surface of the tonsil (n = 50). Number of requested pain medications, local oedema, patient-reported pain level, post-operative haemorrhage, impairment of speech, swallowing and general condition were assessed. The study was registered at the German Clinical Trials Register.Results: The mucosal flap technique significantly reduced post-operative pain [2.94 (intervention group) vs. 4.61 (control group) in an numerical analogue scale, p < .001] and the number of pain medications [6 (intervention group) vs. 1 (control group), p < .001].Conclusions: Wound sealing with a local mucosal flap can reduce post-operative pain in tonsillectomy patients and is recommended whenever anatomically feasible.Significance: This new tonsillectomy technique can help to reduce post-operative pain and thereby improve the patients’ post-operative rehabilitation.

Use of EDTA in the treatment of local tissue damage caused by the Bothrops alternatus venom

ABSTRACT Twelve adult rabbits were distributed in three groups and received on the femoral biceps region, via intradermal injection (ID), 25µg of Bothrops alternatus venom dissolved in NaCl 0.9% and diluted in 0.25mL of phosphate buffered saline (PBS). Thirty minutes later, the group G1 received 0.25mL of phosphate buffered saline (PBS) ID while to G2 and G3 25mg of ethylenediamine tetraacetic acid (EDTA) dissolved in 0.25mL of PBS were administered via intramuscular (IM) and intravenous (IV) injection, respectively. Evaluations included local lesion and blood profile of all animals, before (time zero) and at 1, 2, 3, 4, 5, 6, 12, 18 and 24h after venom administration. All animal treated with PBS (G1) and EDTA IV (G3) presented increase of nociceptive stimuli at the site of inoculation of the venom, followed by moderate edema that persisted for 24h. Animals treated with IM EDTA (G2) only manifested increase of nociceptive stimuli at the site of injection 1h after treatment with discrete local edema between 12 and 24h. In relation to the local hemorrhagic halo no differences were found amongst the studied groups. Blood profile revealed significant decrease of segmented neutrophils in all groups. There was also increase in triglycerides and decrease in total protein and albumin in all groups. The local lesion was not altered by the treatments.