Nasal septal perforation repair with an inferior turbinate flap and acellular dermal matrix

Nasal septal perforation is an uncommon disorder that can cause disturbance of nasal physiology. The perforations can vary widely in size, location, and symptomatology. Many different closure techniques have been described in the literature; however, no gold standard has been recognized. The choice of surgical technique usually depends on the characteristics of the perforation and surgeon experience. Due to the goal of perforation repair being restoration of normal nasal physiology, techniques with the best outcomes have been those resurfacing the septum with nasal respiratory mucosa. Here we present our novel surgical method for large (\u3e 2 cm) septal perforation closure using a modification of the inferior turbinate flap repair using a polydioxanone plate and the acellular dermal matrix allograft (Alloderm, Allergan Inc.)

The room temperature phosphine-free synthesis of near-infrared emitting HgSe quantum dots

Luminescent mercury selenide (HgSe) quantum dots have been synthesised by a phosphine-free method using oleic acid as a capping agent. The modification of experimental conditions such as temperature resulted in particles of various sizes (15–100 nm) and morphologies not previously seen in HgSe, with emission tuneable between 1000 nm and 1350 nm

Starve to Sustain - An Ancient Syrian Landrace of Sorghum as Tool for Phosphorous Bio-Economy?

Phosphorus (P) is an essential macronutrient, playing a role in developmental and metabolic processes in plants. To understand the local and systemic responses of sorghum to inorganic phosphorus (Pi) starvation and the potential of straw and ash for reutilisation in agriculture, we compared two grain (Razinieh) and sweet (Della) sorghum varieties with respect to their morpho-physiological and molecular responses. We found that Pi starvation increased the elongation of primary roots, the formation of lateral roots, and the accumulation of anthocyanin. In Razinieh, lateral roots were promoted to a higher extent, correlated with a higher expression of SbPht1 phosphate transporters. Infrared spectra of straw from mature plants raised to maturity showed two prominent bands at 1371 and 2337 cm−1, which could be assigned to P-H(H2) stretching vibration in phosphine acid and phosphinothious acid, and their derivates, whose abundance correlated with phosphate uptake of the source plant and genotype (with a higher intensity in Razinieh). The ash generated from these straws stimulated the shoot elongation and root development of the rice seedlings, especially for the material derived from Razinieh raised under Pi starvation. In conclusion, sorghum growing on marginal lands has potential as a bio-economy alternative for mineral phosphorus recycling

JOURNAL OF SPINAL DISORDERS & TECHNIQUES

Objective: In this prospective, observer-masked clinical study, we evaluated if insertion of a drain had a significant role in decreasing the existence and the size of postoperative epidural hematoma, which is believed to be a factor causing epidural fibrosis in patients undergoing lumbar discectomy. Method: Fifty patients undergoing lumbar disc surgery were randomly assigned to two groups: with or Without insertion of a drain in the epidural space. A drain was inserted in 22 patients, whereas 28 were left without a drain. All patients were evaluated, by means of magnetic resonance imaging (MRI) oil the first postoperative day, specifically looking for the existence and the size of epidural hematoma. The size of epidural hematoma was graded as none, minimal, moderate, or prominent. The patients were clinically examined preoperatively and at the follow-up of 6 months by Oswestry Disability Index and recurrence of pain. A follow-up MRI was repeated at 6 months, and the subsequent development of epidural fibrosis was evaluated. Results: Epidural hematoma was detected in 36% of patients with a drain and in 89% of patients without a drain (P = 0.000). There were significant less number of minimum, moderate, and prominent sized hematomas in the group with a drain (P = 0.000). On the 6-month follow-up, epidural fibrosis was found in 58.3% of patients without a drain and in 31.6% of patients with a drain (P = 0.08). Late clinical outcome (improvement in Oswestry Index and no recurrent pain) was better in the group with drain, but not statistically significant (P = 0.4). Conclusions: Occurrence of hematoma in the epidural space is common after lumbar disc surgery even if meticulous hemostasis has been achieved. Insertion of a drain decreases both the incidence and the size of hematoma on the first postoperative day as detected by MRL This may have practical implications for the prevention of significant postoperative fibrosis and obtaining better surgical outcome

SPINE JOURNAL

BACKGROUND CONTEXT: Nucleoplasty is a minimally invasive, percutaneous procedure that uses radiofrequency energy to ablate nuclear material and create small channels within the disc. PURPOSE: To evaluate the efficacy of nucleoplasty technique in patients with leg pain caused by radicular encroachment. STUDY DESIGN/SETTING: A prospective clinical study of subjects with lumbar disc herniation, and radicular pain resistant to previous medical treatment and physiotherapy for a period of at least 3 months. PATIENT SAMPLE: Fifty-two consecutive patients with leg pain and magnetic resonance imaging evidence of small and medium-sized herniated discs correlating with the patient's symptoms (contained disc herniation = 50% in comparison to normal adjacent discs) were included. OUTCOME MEASURES: Visual analogue scale (VAS) was administered and Oswestry disability questionnaires were filled out at preprocedure and postprocedure 2 weeks, 6 months, and 1 year. Reduction of analgesic treatment and the patients' satisfaction were also recorded. METHODS: All procedures were performed under local anesthesia and fluoroscopic guidance on an outpatient basis. Patients underwent discography to evaluate annular integrity just before nucleoplasty. Channels were created in the nucleus by advancing the radiofrequency probe (ablating) and withdrawing it (coagulation). In all patients six channels were created. RESULTS: Thirty-four patients had one and 18 had two discs treated; a total of 70 procedures were performed. Mean age of patients was 44.8 +/- 8.6 years. The mean follow-up period was 12.1 +/- 1.6 months. Mean VAS reduced from preprocedure 7.5 to 3.1 at postprocedure 6 months and to 2.1 at the latest follow-up. Mean Oswestry index decreased from 42.2 to 24.8 at 6 months and to 20.5 at the latest examination. Analgesic consumption was stopped or reduced in 42 patients (85%) at 6 months and in 46 patients (94%) 1 year after the procedure. Overall patient satisfaction was 81% at 2 weeks, 85% at 6 months, and 88% at the latest follow-up. There were no complications related to the procedures. CONCLUSIONS: Our results encourage us to use nucleoplasty in carefully selected patients with leg pain caused by radicular encroachment. We recommend applying this minimally invasive technique only in those patients with small (= 50% and with annular integrity. (C) 2007 Elsevier Inc. All rights reserved

JOURNAL OF SPINAL DISORDERS & TECHNIQUES

A previously healthy, HIV-negative, 40-year-old man presented with a 2-month history of progressive weakness of his left arm. Magnetic resonance imaging revealed an intradural, extra medullary plaque-shaped lesion at C6-T1 levels with high contrast enhancement. Based on the patient's clinical and radiologic findings, it was believed that the patient had an en plaque meningioma, and he was operated on. Histologic examination of the mass revealed granulomas with multinucleated and Langhans-type giant cells, typical of a tuberculoma. Intradural extramedullary tuberculomas should be considered in the differential diagnosis of en plaque meningioma as a rare entity

JOURNAL OF NEUROSURGICAL ANESTHESIOLOGY

This study was designed to evaluate the effects of propofol alone and propofol-clonidine combination on human middle cerebral artery blood flow velocity (Vmca) and cerebrovascular carbon dioxide (CO,) response by using transcranial Doppler ultrasonography. Mean Vmca in response to changes in arterial partial pressure of CO2 (Paco(2)) was determined under the following conditions: awake (group 1), propofol anesthesia (group 2), and combined propofolclonidine anesthesia (group 3). Nonnocapnic, hypercapnic, and hypocapnic values of heart rate, mean arterial pressure, partial end-tidal CO2 pressure, Paco(2), and Vmca were obtained. The mean Vmca in groups 2 and 3 was significantly lower than that in group 1 at each level of Paco(2). The calculated Vmca at each level of Paco(2) was not different between groups 2 and 3. There was a correlation between Paco(2), and Vmca in all groups, but in the anesthetized groups the effect of Paco(2) on Vinca was attenuated. The present data demonstrated that clonidine-propofol does not change CO2 reactivity compared with propofol alone, but both anesthetics attenuate cerebral blood flow compared with awake controls

SPINE

Study Design. A prospective and controlled study of perioperative use of combined local anesthetic and corticosteroid in lumbar disc surgery. Summary of Background Data. The anti-inflammatory mechanism of corticosteroids is considered to be caused by the inhibition of phospholipase A(2), which plays an important role in the pain mechanism of lumbar disc problems. Although some authors have demonstrated that the use of intramuscular bupivacaine during lumbar discectomy resulted in a marked reduction of postoperative back pain, others have reported that the key intervention was probably the administration of epidural corticosteroid. The coadministration of these two drugs in lumbar disc surgery for the relief of postoperative back pain has yet not been studied adequately. Objectives. Assessment of the combined use of perioperative corticosteroids and bupivacaine for the relief of postoperative pain after lumbar disc surgery. Methods. Forty-four selected patients had acute-onset single-level unilateral herniated nucleus pulposus that were refractory to conservative management. All patients underwent lumbar disc surgery under standard general anesthesia. Before surgical incision, the skin and subcutaneous tissues were infiltrated with 10 mL of 1% lidocaine with 1:200,000 adrenaline to produce local vasoconstriction. During wound closure, 20 mL 0.9% saline in Group 1 (n = 22) and 20 mL 0.25% bupivacaine in Group 2 (n = 22) were injected into the paravertebral muscles band subcutaneus tissues. In addition, a piece of autologous fat taken from the wound was first soaked in 40 mg of methylprednisolone for 10 minutes, then placed over the exposed nerve root, and the remaining steroid was flushed into the wound in Group 2. The wound was closed after drug administration in both groups. In the postoperative period, all patients received 100 mg of meperidine intramuscularly when needed and were allowed to receive a second dose at least 4 hours later than the first dose for postoperative analgesia. Postoperative back pain intensity, heart rate, and mean arterial pressure were assessed 1, 3, 6, and 12 hours after the conclusion of surgery. Results. Visual analog scale pain scores for the postoperative recordings were lower in Group 2 than in Group 1, but these findings were not statistically significant. Patients in Group 1 received 77.3 +/- 48.8 mg meperidine, and those in Group 2 received 31.8 +/- 45.5 mg meperidine, for pain medication in the first 12 hours (P < 0.05). Heart rate and mean arterial pressure were not significantly different between the two groups in all recording periods. Conclusion. It is concluded that the perioperative use of bupivacaine and corticosteroids during lumbar discectomy maintains effective postoperative analgesia and decreases opioid usage without complications