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.

Effectiveness of Perioperative Local Use of Anesthetics and Antiseptics in Patients with Purulent-necrotic Lesions of Lower Extremities in Diabetes Mellitus

Background: Every second patient with the diabetes mellitus (DM) needs surgery due to purulent-necrotic changes in the feet. The aim of the study was comparative morphological examination of the course of the wound process in purulent-necrotic lesions of the lower extremities of patients with DM with different approaches to local treatment in the perioperative period. Materials and Methods: We investigated changes in the histological structure and the nature of the reactions of skin tissues, muscles and fascia during the healing of an ulcer in patients with the diabetes mellitus after various types of local treatment. Then the specimens were photographed and analyzed using the OLIMPUS BX 41 light microscope. Results: In the first comparison group, which used standard anesthesia techniques and locally antiseptic povidon-iodine - granulation tissue was characterized by the complete absence of fibrous structures and the presence of a small number of small-sized neoplastic vessels with swollen endothelium. And in patients of the II observation group who received locally decamethoxin and infiltration anesthesia with a 2% solution of lidocaine after surgery during the study of histological preparations of the affected tissues, a significant decrease in signs of pathological vascular reaction was established compared with the comparison group. Conclusions: In group 1 (control) healing of wounds on the third-seventh day is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic decamethoxin.

Morphological research of the effectiveness of perioperative local use of anesthetics and antiseptics in patients with purulent-necrotic lesions of lower extremities in diabetes mellitus

Ulcer-necrotic lesions of the feet are detected in 5-15% of patients with diabetes mellitus (DM). According to the literature today in Ukraine, patients with DM perform high amputation of the lower extremities with diabetic foot syndrome with a frequency of 19.6-42.6%, at the same time, mortality ranges from 8.9% to 25.0%, and the total mortality rate at the DM varies from 6.6% to 13.5%, often associated with the occurrence of postoperative complications. The aim of the work was to study morphological indicators of reparation of soft tissues of the lower extremities in patients with diabetic foot syndrome on the background of local treatment during the perioperative period. We investigated changes in histologic structure and character of reactions of skin tissues, muscles and fascia during the period of visceral disease in patients with diabetes mellitus after different types of local treatment. Then, samples of skin tissues, muscles and fascia were photographed and analyzed using a light microscope OLIMPUS BX 41. In the first group of the comparison, which used standard methods of anesthesia and local antiseptic povidone-iodine, granulation tissue was characterized by the complete absence of fibrous structures (collagen fibers) and the presence of a small number of newly formed small diameter vessels with blistered endothelium. Vessels of young granulation tissue were dilated, full-blooded, the endothelium was swollen, there was significant perivascular edema. In the second group of patients (where povidone-iodine and infiltration anesthesia with 2% lidocaine solution anesthetic was used locally) there were almost no remains of necrotic tissues in the affected tissues. It should be noted that there was better granulation development with fewer inflammatory-cell elements, more young forms of fibroblasts and a moderate pathological vascular reaction. In the first (control) group, wound healing by 3-7 days is characterized by somewhat slow regeneration. Wound healing was most favorable in patients of the second group, where infiltration anesthesia was used by local anesthetic and antiseptic povidone-iodine.

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.

The effect of PECS-1 block on postoperative pain in total implantable venous access port catheter (TIVAP) insertion

Background: The aim of this prospective, randomized, controlled study was to evaluate the analgesic effect of US-guided Pectoral (PECS) I blocks on postoperative analgesia after TIVAP insertion. Methods: A hundred-twenty patients were included in this study. The patients were divided into two groups: Group PECS and Group INF (infiltration). A total 0.4 mL kg−1 0.25% bupivacaine was injected to below the middle of the clavicle in the interfascial space between the pectoralis major and minor muscles for PECS-1. The skin and deep tissue infiltration of the anterior chest wall was performed with 0.4 mL kg−1 0.25% bupivacaine for INF group. Tramadol and paracetamol consumption, visual analog scale pain scores were recorded at 0, 1, 4, 12, and 24 h postoperatively. Results: The use of the PECS in TIVAP significantly decreased the amount of paracetamol used in the first 24 h postoperatively ( p < 0.001). There was a statistically significant difference in the number of tramadol rescue analgesia administered between the groups ( p < 0.001) There was no significant difference between the groups in terms of the VAS scores at 0 and 24 h. However, VAS scores at 1, 4, and 12 h were found to be significantly lower in patients who underwent PECS than in those who received infiltration anesthesia ( p < 0.001). Conclusions: This study shows that US-guided PECS-1 provides adequate analgesia following TIVAP insertion as part of multimodal analgesia. The PECS-1 significantly reduced opioid consumption.

Effect of virtual reality distraction on pain and anxiety during infiltration anesthesia in pediatric patients: a randomized clinical trial

Background Different distraction techniques have been used in dentistry and have shown great results in managing anxious pediatric patients specially during local anesthesia administration. One of the recently invented techniques is virtual reality. The purpose of the study was to evaluate the effect of virtual reality distraction on anxiety and pain during buccal infiltration anesthesia in pediatric patients. Methods Healthy, cooperative 6- to 12-year-old children requiring buccal infiltration anesthesia were randomly assigned to a test or control group. In the test group, local anesthesia was administered while the subjects were watching a cartoon video using virtual reality goggles. Subjects in the control group watched a cartoon video on a screen during the administration of local anesthesia. To assess anxiety in both groups, heart rate was recorded using a pulse oximeter at five time points: (1) once the subject sets on the dental chair as a baseline; (2) when video is on; (3) at topical anesthesia application; (4) during needle insertion; (5) after the administration of local anesthesia. The face, legs, activity, cry, consolability (FLACC) behavioral pain assessment scale and the Wong–Baker FACES pain rating scale were used to assess pain. Results A total of 50 subjects were included with a mean age of 8.4 ± 1.46 years. Twenty-nine (58.0%) of the subjects were females. The mean heart rate at all time points except baseline was significantly higher among the test group compared to the control group. Multiple regression analysis showed that younger subjects and females had higher mean FLACC behavioral pain assessment scale scores (P = 0.034 and P = 0.004, respectively) regardless of the distraction technique used. Younger subjects and subjects with higher baseline heart rate reported higher mean Wong–Baker FACES pain rating scale score (P = 0.031 and P = 0.010, respectively), controlling for all other variables. Conclusion Female subjects and the younger age group were more likely to report higher pain scores during local anesthesia administration regardless of the type of distraction used. Trial registration The study was retrospectively registered in ClinicalTrials.gov with the identifier: NCT04483336 on 23/07/2020.

Effectiveness of Topical Anesthetics in Pain Management for Dermal Injuries: A Systematic Review

The treatment of dermal injuries is associated with pain in both adult and pediatric populations. We reviewed traditional treatments for controlling the pain of these lesions, such as infiltrated local anesthetics and topical local anesthetics. The objective of this review was to elucidate the efficacy of topical anesthetics in reducing the pain of dermal injuries, as well as the efficacy of topical anesthetics versus other anesthetics, or versus a placebo. Methodology: a systematic review was carried out by searching Medline (PubMED), Scopus, Cinahl, Cochrane, Lilacs, and ENFISPO for randomized clinical trials on the control of pain in dermal lesions through the use of topical anesthetics, versus a placebo or versus another anesthetic. Results: twelve randomized clinical trials with a total of 952 patients were included. Seven studies analyzed the efficacy of topical anesthetics compared to a placebo, and six of them observed statistically significant differences in favor of the experimental group. Five studies analyzed the efficacy of topical anesthetics compared to other anesthetics or sedatives; three of them observed statistically significant differences in favor of the experimental group, and two found no difference between the anesthetics analyzed. Conclusion: topical anesthesia is a useful method for pain control, is safe compared to other traditional methods, and offers a satisfactory form of pain relief in relation to infiltration anesthesia and compared to placebo.