Efficacy of platelet-rich plasma lysate in the treatment of patients with post-traumatic eyelid scarring: an overview of clinical cases

Purpose: to evaluate the effectiveness of platelet-rich plasma lysate (PRP) in the treatment of patients with post-traumatic eyelid scarring by clinical examples. Material and methods. Patients with post-traumatic scarring changes in eyelid tissues causing a damage in the functional and cosmetic state of the auxiliary apparatus of the eye were treated in the Department of Plastic Surgery and Eye Prosthetics at the Helmholtz National Medical Research Center of Eye Diseases. Two of the patients, who had been traumatized shortly before the examination and one patient who had rejected surgery were offered treatment by PRP lysate manufactured at the Sklifosovsky Medical Research Institute of Emergency Medicine. After local infiltration anesthesia, each patient received a single injection of PRP lysate (2 ml) into the scar tissue. The result was evaluated at a follow-up that took place 3 months after the injection. Results. The clinical picture of the three patients showed a pronounced positive dynamic of the functional and cosmetic state of the auxiliary eye apparatus, which made the patients reject subsequent (additional) surgical treatment. Conclusion. An improvement tissue repair and regeneration processes after PRP lysate injection allows us to assess this method as an applicable alternative of reconstructive operations in certain cases.

EVALUATION OF ACUTE PAIN SYNDROME IN PATIENTS AFTER SEPTOPLASTY AND VARIOUS ANESTHETIC STRATEGIES

The aim of the study was to evaluate acute pain syndrome in patients after septoplasty and various strategies of general anesthesia. Materials and Methods. All patients received local infiltration anesthesia with 2 % procaine solution. In group 1 (n=105), a 2 % solution of promedol and 60 mg of ketorolac were used as evening premedication; in group 2 (n=108), fentanyl, propofol, cisatracuria besylate, tranexamic acid, atropine and metoclopramide were used; in group 3 (n=78), atracuria besylate, sodium thiopental, nitrous oxide and halothane were used. In groups 2 and 3, 100 mg of ketoprofen was injected intramuscularly in the evening of the postsurgical day. Anterior tamponade was carried out with foam tampons. The tamponade was removed on the 2nd day in the groups 1 and 2, and in group 3 it was removed one day after the surgery. Pain syndrome was assessed in 1, 3, and 6 hours, 1 and 2 days after surgery using a visual analogue scale (VAS), a verbal “lightning” scale (VLS), and a numeric rating scale (NRS). Pain was also assessed 1 hour after tamponade removal. Results. At all stages of the examination (except Day 2), the pain syndrome was less pronounced in group 2. A day after surgery, the patients of group 3 had more severe pain if compared with those of other groups. Conclusion. During septoplasty, the least painful reaction is provoked by the general anesthesia scheme as used in group 3: fentanyl, propofol, cisatracuria besylate, tranexamic acid, atropine and metoclopramide. In case of nasal tamponade after septoplasty, the tampons should be removed on the 2nd day after surgery. Key words: septoplasty, anesthesia, analogue scales, pain. Цель исследования заключалась в оценке острого болевого синдрома у пациентов после септопластики при применении различных тактик общей анестезии. Материалы и методы. Ко всем пациентам применяли местную инфильтрационную анестезию 2 % раствором прокаина. В 1-й группе (105 чел.) использовали премедикацию 2 % раствором промедола и 60 мг кеторолака вечером, во 2-й группе (108 чел.) – фентанил, пропофол, цисатракурия безилат, транексамовую кислоту, атропин и метоклопрамид, в 3-й группе (78 чел.) – атракурия безилат, тиопентал натрия, закись азота и галотан. Во 2-й и 3-й группах вечером в день операции внутримышечно вводили 100 мг кетопрофена. Переднюю тампонаду осуществляли поролоновыми тампонами в резиновой перчатке. В 1-й и 2-й группах тампонаду удаляли на 2-й день, а в 3-й группе – через сутки после операции. Болевой синдром оценивали через 1, 3 и 6 ч, 1 и 2 сут после операции с помощью визуально-аналоговой шкалы, вербальной шкалы-«молнии», цифровой рейтинговой шкалы. После удаления тампонов боль оценивали через 1 ч. Результаты. На всех этапах обследования, кроме 2-го дня, болевой синдром был менее выражен во 2-й группе. Через сутки у пациентов 3-й группы боль была выше, чем в остальных. Выводы. При проведении септопластики наименьшую болевую реакцию провоцирует схема общей анестезии, примененная в 3-й группе: фентанил, пропофол, цисатракурия безилат, транексамовая кислота, атропин и метоклопрамид. В условиях тампонады носа после септопластики тампоны необходимо удалять на 2-й день после операции. Ключевые слова: септопластика, анестезия, аналоговые шкалы, боль.

Cesarean Section in Cattle: A Review

Cesarean section is one of the oldest surgical procedure performed on cows for delivery of the fetus at parturition. Depending upon the health status of dam and fetus cesarean section has been classified as emergency, non emphysematous and emphysematous procedure. The common maternal indications for performing cesarean section include pelvic fractures, cervical dilation failure and uncorrectable uterine torsion whereas the fetal indication include oversized fetuses and maldisposed calves. Many anesthetic protocols are available for cow however, most cesarean section in cattle can be satisfactorily performed under mild sedation and local infiltration anesthesia using 2% lidocaine. Operative sites for cesarean section in cattle include right and left flank, midline, paramedian, parammary and oblique ventrolateral. The choice of operative sites depends upon facility and patient condition. Peri-operative (before, during and after the operation) care appears to be of utmost significance, post-operative complications of cesarean section include peritonitis, seroma formation, hernia and poor fertility. On the successful outcome of cesarean section in cows in terms of dam and calf survival and future fertility of cows underdoing cesarean section. Previous handling, delay in presentation to referral centers results in poor outcome and thus animal owners must be explained the benefits of prompt presentation of cow to cesarean section for optimal benefits.

Volumetric osteoconchoplasty method

Introduction. Pathology of the inferior turbinates (IT) was found in 76.1% of patients with difficulty in nasal breathing. If nasal breathing cannot be restored with conservative measures, surgical intervention becomes the method of choice.Materials and methods. Under local infiltration anesthesia, the IT is fractured and retracted medially (medialization). In the anterior section of the HHP, a vertical incision 0.5 cm long to the bone is made, through which the mucosa is peeled off from the bone base of the concha with a raspator-suction and a small tunnel from 2 to 3 cm long is created. shell surfaces and a small area of the mucosa of the lateral surface of the IT and the lateral wall of the nasal cavity. After insertion into the created tunnel of the required size of the "spreader-implant" plate, treated with a thin layer of LTK glue, the shell is slightly pressed with a self-inflating latex-foam rubber swab introduced into the IT for 10–15 minutes. At the end of the operation, after removing the tampon, the edges of the incision are processed with LTK glue.Results. The results of the study demonstrate the effectiveness of the developed method for the rapid restoration of nasal breathing after rhinosurgical interventions. We use this technique in the overwhelming majority of cases of fibrous and bone forms of IT hypertrophy. In cases of the cavernous form, we perform a submucous conchotomy with a shaver, which makes it possible to very accurately remove exactly that part of the concha that violates the patency of the nasal cavity. In all cases, we consider it compulsory to carry out the IT lateroposition according to our method, which significantly improves the result of the operation. The surface of the shell remains completely covered with mucosa and as a result of matching the edges of the incision, the wound surface is absent. At the same time, after the operation, the shell remains full anatomically and functionally, i.e. consists of the bone skeleton and the corresponding volume of soft tissues.Conclusion. The question of how to predict in the long-term postoperative period the normal size of the modeled IT, apparently, is currently not answered even by highly qualified rhinosurgeons. In this regard, there remains a need to search for new technologies for treating patients with chronic hypertrophic rhinitis.

Ultrasound-guided supraclavicular nerve block for implantable port catheters: Does it show a significant difference in pain control?

Background: Nerve blocks have been used for decades at head and neck region interventions and recently introduced as an alternative option for subcutaneous port implantation. This study aimed to compare two different local anesthesia techniques used during subcutaneous port implantation. Methods: This retrospective study was conducted with 107 patients who were categorized into two groups according to the local anesthesia techniques used during port implantations. Group 1 underwent local infiltration anesthesia and Group 2 received an ultrasound-guided supraclavicular nerve block. In both groups, prilocaine 2% was used for skin anesthesia and no other systemic anesthetic drugs or additional local anesthetics were administered during port implantation. Local anesthetic doses were 400 mg in Group 1 and 200 mg in Group 2. The time required for adequate cutaneous anesthesia, procedure time, complication rate and visual analog scale (VAS) score were recorded for each patient. Results: Groups 1 and 2 contained 58 and 49 patients respectively. Both groups showed similar demographic distributions of patients ( p > 0.05). Mean procedure times and the time required for adequate cutaneous anesthesia were longer in Group 2 ( p < 0.05). Group 2 also showed 12 immediate complications, although they were temporary and recovered without any intervention under surveillance. Mean VAS scores during port implantation were similar in both groups [Group 1: 1.17(±0.60), Group 2: 1.1(±0.62)] ( p > 0.05). Conclusions: The VAS scores did not differ significantly between groups. Although a supraclavicular nerve block may require lower local anesthetic doses for similar cutaneous anesthesia, it is associated with higher immediate complication rates due to unintended blockade of the peripheral nerves. Thus, if the nerve block is preferred over local infiltration anesthesia during port implantation, to prevent life-threatening complications, caution needed especially for the patients with contralateral vocal cord or diaphragm paralysis.

Perforation of the oesophagus in animals and methods of their treatment (сlinical case)

The purpose of the work was to research the etiological factors of perforation of esophagus, the clinical condition of animals, and also to perform a technique for surgical intervention to restore the function of the esophagus. The technique of operative access and the imposition of strong, airtight sutures was developed to contribute to the restoration of the esophagus function. The investigation object was three goats with bitten lacerations complicated by perforation of the esophagus in the cranioventral part of the neck, a horse with perforation of the esophagus in the middle part of the neck. The operating field in animals with damage of esophagus was prepared taking into account mechanical and chemical antiseptics, and local infiltration anesthesia was performed. The necrotic edges of the wounds excised, the skin dissected by 12-15 cm, and the neck muscles moved and separated in relation to each other, fixed with wound hooks and provided access to the perforated section of the esophagus. On the detected defects of the esophagus a polymer tube inserted into the cavity of the esophageal tube through the wound openings in the cranial direction until it exited the oral cavity by 10-15 cm, and then along the esophagus, than shifted towards the stomach. Thus, we obtained such a configuration and clear contours of the esophagus, which would facilitate the possibility of controlling the layer-by-layer application of surgical sutures and closing the perforation of the esophageal walls. The first level of Schmiden sutures applied to the mucous and muscle layers. Subsequently, for reliability three intermittent knotted seams imposed on the same layers. The second floor of the sutures – intermittent knotty was placed on the muscles and the adventitious layer of the esophagus (polymer suture material No. 4-6). Thus, a hermetic closure of the perforated defects of the esophagus was achieved. The wound was treated with antibacterial drugs and, first, an interrupted knotted suture was placed on the muscles and then on the muscles and skin. The resin tube removed through the oral cavity. In the postoperative period the neck was restricted in movement by applying wooden corsets for 5-6 days. The wound was treated with antibacterial drugs for 7 days. Feeding was carried out with chopped food, watering in small doses for two weeks. Regeneration of the operating wounds took place without complications due to primary intention. In 6-8 weeks after surgery the clinical condition of the animals was within normal limits, the animals were fed normally.

Local infiltration anesthesia by the creeping infiltrate method

In modern surgery, there are a large number of different types of general anesthesia and local anesthesia. This most clearly indicates that there is still no such method of pain relief that could be completely satisfied.