Effect of superior trunk block on diaphragm function and respiratory parameters after shoulder surgery

BackgroundThe interscalene brachial plexus block has been used effectively for intraoperative and postoperative analgesia in patients undergoing shoulder surgery, but it is associated with high rates of diaphragmatic dysfunction. Performing the block more distally, at the level of the superior trunk, may reduce the incidence of phrenic nerve palsy. We hypothesized that superior trunk block would result in diaphragmatic paralysis rate of less than 20%.Methods30 patients undergoing arthroscopic shoulder surgery received superior trunk block under ultrasound guidance. Measurements of diaphragm excursion were determined with ultrasound prior to the block, 15 min after the block, and postoperatively in phase II of postanesthesia care unit, in conjunction with clinical parameters of respiratory function.Results10 patients (33.3%, 95% CI 17.3% to 52.8%) developed complete hemidiaphragmatic paralysis at the postoperative assessment. An additional eight patients (26.7%) developed paresis without paralysis. Of the 18 patients with diaphragm effects, seven (38.9%) reported dyspnea. 83.3% of patients with abnormal diaphragm motion (56.7% of the total sample) had audibly reduced breath sounds on auscultation. Oxygen saturation measurements did not correlate with diaphragm effect and were not significantly reduced by the postoperative assessment.ConclusionAlthough injection of local anesthetic at the superior trunk level is associated with less diaphragmatic paralysis compared with traditional interscalene block, a significant portion of patients will continue to have ultrasonographic and clinical evidence of diaphragmatic weakness or paralysis.

Postoperative assessment of malignant melanoma aggressiveness for further treatment personalization

The aim of the study was to develop, implement and evaluate a method for predicting the aggressiveness of primary melanoma after surgical removal.It was established that the method for predicting tumor aggressiveness allows to determine the degree of aggressiveness, life expectancy, and to identify patients with poor prognosis in order to individualize treatment. The survival rate of patients was found to depend on the degree of aggressiveness of the tumor. A group of patients with stages 0-IIa (16,4 %) and tumor aggressiveness Grade II was identified as having a potentially high risk of progression, which can help individualize treatment for this category of patients. Using the method for predicting disease progression may potentially expand the scope of indications for further personalized treatment.

Psychological assessment

Although research relating to the psychology of the cosmetic surgery patient is still in its infancy, there is a consensus among researchers that various combinations of psychological factors play a key role in the recent increase in demand for cosmetic surgery, in the motivation of prospective patients to undergo surgery, in their expectations of outcome, and in their postoperative adjustment. An appreciation of the psychological aspects of cosmetic surgery is therefore crucial and places the surgeon in a stronger position to evaluate a patient’s appropriateness for surgery. Indeed, appropriate patient selection is considered a vital part of a surgeon’s role in ensuring effective care and treatment. This chapter addresses why an understanding of psychological factors contributing to all stages of the treatment process is important to the provision of appropriate care and offers a framework for pre- and postoperative assessment.

Postoperative Assessment of Gustatory Activity Following Surgical Removal of Mandibular Third Molars

BACKGROUND The study focused on prospectively determining the incidence and severity of taste changes after surgical removal of mandibular third molar and correlating difficulty index of impaction and incidence of gustatory changes. METHODS 96 patients who required lower third molar extraction were included in the study. Their difficulty of impaction was measured using Pell and Gregory Difficulty Index and their gustatory activity was measured using a spatial taste test and a whole mouth wash test. The tests were carried out using 5 different stimuli, i.e., sweet, salt, bitter, umami and sour, in different concentrations and the subjects were asked to identify the stimuli preoperatively, postoperatively on day 7 and after 1 month.Tastes were scored from 1 - 9 for decreasing and altered taste sensations. RESULTS The results of our study showed that with increased difficulty index, taste sensation was altered. While most patients belonged to the Class II and Class I group as well as position A and B, taste changes were still noted due to difficulty in impaction, especially in the patients belonging to Class III and position C groups. The taste changes felt at POD - 7 were similar and unresolved in the one month follow up. The scores had a statistically significant difference (P < 0.05). CONCLUSIONS With a higher difficulty score, gustatory changes are felt due to the increased surgical manipulation required to remove the tooth from its socket. This is indicative of nerve damage during surgical extraction. KEY WORDS Postoperative, Assessment, Gustatory, Mandibular, Third Molar

Comparison between Conventional Microdissection and CO2 Laser in the Treatment of Vocal Cord Polyp

Background: Vocal cord polyp usually arises from the epithelium and the lamina propria. Minimally invasive dissection procedures are employed to treat these vocal cord polyp for an effective outcome. Two types of microsurgical techniques were developed gradually and practiced namely, the conventional laryngeal microsurgery, which involves the use of cold instruments and the laryngeal laser micro-surgery. Objective: To compare the conventional cold dissection and CO2 laser methods in treatment of vocal cord polyp. Methods: A randomized prospective study was conducted at the Department of Otolayngology- Head & Neck Surgery, at Bangabondhu Sheikh Muzib Medical University (BSMMU) between July 2017 and June 2019. A total of 60 cases were studied on the following parameters: a. Visual analysis on stroboscopy b. Voice analysis –GRBAS (grade, roughness, breathiness, asthenia, strain) indices c. Duration of surgery d. Peroperative bleeding. Results: During first postoperative assessment, both groups had the normal symmetrical waves, while 50% of cases still had aperiodicity but all patients had the near normal periodicity in the second postoperative assessment. Regarding glottic closure, during preoperative assessment, almost all patients had incomplete glottic closure due to mass lesion as polyps. During first postoperative assessment, glottic closure was found to be better in group B (83% of cases) than group A (76% of cases), while during second postoperative assessment, all patients of both groups had around 95% glottic closure. The mean duration oflaser technique (7.1 ± 1.1 minutes) was less than the conventional technique time (15.6 ± 1.9 minutes), also mean of operative bleeding of laser technique (zero pack) is less than the conventional two(2 packs). Conclusion: There is no significant difference between both groups in all parameters except operative time and bleeding, as laser technique has less time and clear field. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 17-24

Tendon‐to‐bone healing after repairing full‐thickness rotator cuff tear with a triple‐loaded single‐row method in young patients

Background Arthroscopic repair is recommended for young patients with full-thickness rotator cuff tears (RCTs), but the healing rates have raised concerns. The Southern California Orthopedic Institute (SCOI) row method has been developed based on greater than 3 decades of experience with excellent clinical outcomes; however, studies with a focus on the younger patient population are limited in number. The current study assessed the short-term clinical outcome and the initial tendon-to-bone healing in a young cohort after repair of a full-thickness RCT using the SCOI row method. Methods A retrospective cohort study was performed. Patients < 55 years of age who had a full-thickness RCT and underwent an arthroscopic repair using the SCOI row method were reviewed. Clinical outcomes were assessed at baseline, and 3 and 6 months post-operatively. The visual analog scale (VAS), University of California at Los Angeles (UCLA) scale, and Constant-Murley score were completed to assess pain and function. Active range of motion was also examined, including abduction and flexion of the involved shoulder. A preoperative MRI was obtained to assess the condition of the torn tendon, while 3- and 6-month postoperative MRIs were obtained to assess tendon-to-bone healing. Repeated measurement ANOVA and chi-square tests were used as indicated. Results Eighty-nine patients (57 males and 32 females) with a mean age of 44.1 ± 8.6 years who met the criteria were included in the study. Compared with baseline, clinical outcomes were significantly improved 3 and 6 months postoperatively based on improvement in the VAS, UCLA score, and Constant-Murley score, as well as range of motion. Greater improvement was also noted at the 6-month postoperative assessment compared to the 3-month postoperative assessment. Three- and six-month postoperative MRIs demonstrated intact repairs in all shoulders and footprint regeneration, which supported satisfactory tendon-to-bone healing. The mean thickness of regeneration tissue was 7.35 ± 0.76 and 7.75 ± 0.79 mm as measured from the 3- and 6-month MRI (P = 0.002). The total satisfactory rate was 93.3 %. Conclusions Arthroscopic primary rotator cuff repair of a full-thickness RCT using the SCOI row method in patients < 55 years of age yields favorable clinical outcomes and early footprint regeneration.