Heat Generation and Temperature Control during Bone Drilling for Orthodontic Mini-Implants: An In Vitro Study

Background: The purpose of our in vitro study was to evaluate the impact of different irrigation fluid temperatures in combination with different drilling speeds on intraosseous temperature changes during mini-implant site preparation. Methods: Porcine ribs were used as bone specimens. Grouping determinants were as follows: irrigation fluid temperature (10 and 20 °C) and drilling speed (200, 600, 900, and 1200 RPM). The axial load was controlled at 2.0 kg. Temperature measurements were conducted using K-type thermocouples. Results: Extreme increments were observed only in the unirrigated groups. Irrigation invariably made a significant difference within groups defined by the same drilling speed. The comparison of the different temperature irrigation fluids (10 and 20 °C) in combination with the same drilling speed (200, 600, 900, or 1200 rpm) resulted in a statistically significant difference between the two different temperatures, whereas the use of irrigation fluid at a controlled room temperature of 20 °C showed significantly higher temperature changes. Conclusions: Based on the results of the study, we conclude that irrigation while preparing a pilot hole for a self-tapping orthodontic miniscrew is of utmost importance, even at low drilling speeds. The temperature of the cooling fluid does influence local temperature elevation to a significant extent.

The use of tranexamic acid for the prevention of hemorrhagic complications in percutaneous nephrolithotripsy

Introduction. The problem of urolithiasis remains relevant throughout the world. The widespread prevalence of the disease is the reason for the search for new and effective methods of dealing with various complications of surgical treatment in order to improve the efficiency of patient treatment. Materials and methods. The material was searched in the following databases: PubMed, Google Scholar, Scopus by keywords such as Tranexamic acid and percutaneous nephrolithotripsy . When searching in the above databases, 18 articles were found and analyzed. The results of preoperative, intra – and postoperative use of tranexamic acid (TA) in various dosages, and the frequency of the drug use, including the addition of TA to the irrigation fluid, are described. Indicators such as the average level of hemoglobin, the time of surgery, the need for blood transfusion, and the volume of irrigation fluid were evaluated. In all these cases, the control group consisted of patients for whom TA was not used either before the operation or in the postoperative period. Results. The article presents an analysis of the literature data on the correction of hemorrhagic complications by the use of TА. The data on intra- and postoperative hemorrhagic complications of percutaneous nephrolithotripsy (PNLT) and the effect of TА on them are presented. The results of preoperative, intra- and postoperative use of TА in various dosages, and the frequency of use of the drug, including the addition of TА to the irrigation fluid, are described. Indicators such as the average hemoglobin level, operation time, the need for blood transfusion, and the volume of irrigation fluid were assessed. In all the above cases, the control group consisted of patients in whom TА was not used either before the operation or in the postoperative period. Conclusions. The results obtained make it possible to judge the safety and appropriateness of the use of TА in order to reduce the degree of hemorrhagic complications both during the operation and in the postoperative period. Assessment of the hemostatic system and the effect of hemostatic drugs during the surgical treatment of urolithiasis on the upper urinary tract, in our opinion, is a key moment in improving the effectiveness of patient treatment.

Should We Suture Arthroscopic Portals? Effects on Intra-articular Fluid Retention

Knee arthroscopy is one of the most common surgical procedures in orthopaedics and especially in sports medicine. Portal problems and effusion after knee arthroscopy have been reported. The fluid retention within the joint in knee arthroscopy can affect clinical outcomes, but there is no consensus on portal management. The studies of portal management in knee arthroscopy have mainly addressed wound healing and cosmetic problems. There is insufficient information in the literature about whether the irrigation fluid used in this effusion contributes to the process. This study investigates whether arthroscopic irrigation fluid is retained in the joint and whether portal-closure management has an effect on effusion. In this randomized, prospective study, 91 patients (46 [50.5%] sutured-portal group and 45 [49.5%] open-portal group) were included. Suprapatellar knee-diameter measurement and the number of times the dressing was changed were used to assess intra-articular fluid collection. The visual analog scale (VAS) score, Oxford knee score, and Knee Society score were used to evaluate knee problems. All portal wounds in both groups healed without any problems. Superficial or deep infection was not observed in either group. There was no statistically significant difference in VAS score, Oxford knee scores, and Knee Society scores between groups. Although there was a decrease in the knee diameter of both groups between the early postoperative period and first postoperative day, a statistically significant difference in knee diameter was found, especially in the open-portal group. There was a significant difference between the groups in terms of the number of dressings used in the first 24 hours after surgery. Leaving portals open may be effective in preventing intra-articular fluid retention. We thus advise leaving the arthroscopy portals open with just a simple dressing for selected patients.

Hyperchloremic metabolic acidosis during bipolar transurethral resection of the prostate: a report of two cases

Compared with monopolar transurethral resection of the prostate (TURP), which requires electrolyte-free irrigation fluid, normal saline can be used as the irrigation solution in bipolar and laser TURP. The risk of TURP syndrome and severe electrolyte disturbance is minimized when normal saline is used as the irrigation fluid. However, the use of isotonic saline also causes acid-base imbalance and electrolyte disturbance. We experienced two patients who developed hyperchloremic metabolic acidosis during bipolar TURP. After proper intervention, hemodynamic instability resolved, and laboratory test results normalized. Anesthesiologists must pay attention to acid-base and electrolyte status when rapid absorption of excessive isotonic solution is suspected, even during bipolar and laser TURP, which use normal saline as the irrigation fluid.