Post-operative wound infiltration with dexmedetomidine and magnesium sulphate as adjuvant to levobupivacaine for lumbar laminectomy: a prospective, double blinded, randomized controlled study

Background: Wound infiltration with local anaesthetic is safe and effective technique for providing postoperative analgesia following lumbar laminectomy. The objective of this study was to compare the efficacy of local wound infiltration on postoperative analgesia with levobupivacaine, levobupivacaine plus magnesium sulphate and levobupivacaine plus dexmedetomidine in patient undergoing lumbar laminectomy.Methods: Ninety adult patients were randomly allocated into three groups. After the completion of lumbar laminectomy, the drug was locally infiltrated into the paravertebral muscles on either side. Group L received 10 ml of 0.5% levobupivacaine plus 10 ml normal saline, group LM received 10 ml of 0.5% levobupivacaine plus 500 mg magnesium sulphate (1 ml) plus 9 ml normal saline, group LD received 10 ml of 0.5% levobupivacaine plus 50 µg dexmedetomidine (0.5 ml) plus 9.5 ml normal saline. Postoperative visual analogue scale (VAS) pain score at 0, 1, 2, 4, 6, 8, 12 and 24 hours, time to first rescue analgesic drug and its total dose, quality of recovery score (QoR) and side effects were noted.Results: Postoperative VAS was significantly higher in group L as compared to group LM and LD (p<0.05). The time to first rescue analgesic drug was significantly longer in group LD (11.07±7.20 hr) than group LM (6.20±2.64 hr) and group L (3.93±2.70 hr) (p<0.001). The QoR score was significantly better in group LD as compared to group LM and L postoperatively (<0.01).Conclusions: Addition of magnesium sulphate or dexmedetomidine to levobupivacaine for local wound infiltration demonstrated enhanced postoperative analgesia.

Comparison of two different doses of dexmedetomidine (0.25 mcg/kg and 0.5 mcg/kg) in prolonging duration of spinal anaesthesia and postoperative analgesia in patients undergoing trans urethral resection of prostate: a prospective randomized double blinded study

Background: Trans urethral resection of prostate (TURP) under spinal anaesthesia (SAB) in elderly with associated cardio-pulmonary, endocrine or other co-morbidities induces detrimental physiological and psychological stress response to surgery and anaesthesia. Proper sedation during spinal anaesthesia can reduces this response. Aim of this study was to compare the characteristics of spinal block, hemodynamic changes, and postoperative analgesia, following administration of intravenous DMT (0.25 mcg/kg and 0.5 mcg/kg) in elderly patients undergoing TURP under SAB.Methods: Sixty-eight patients were randomly allocated to two groups of 34 patients each. After giving spinal anaesthesia patients received two different doses of dexmedetomidine intravenously; 0.25 mcg/kg (Group D25) and 0.50 mcg/kg (Group D50) respectively. Drugs were given slowly in dilution of 10ml normal saline. Patients were monitored for intraoperative haemodynamics, sensory and motor block characteristics and postoperative analgesia in terms of VAS (visual analogue scale) and first and total dose of rescue analgesic.Results: Mean value of lowest HR in Group D50 and D 25 was comparable (p=0.11) and time taken to achieve lowest HR was also comparable (p=0.13). Mean value of lowest SBP, DBP and MAP were lower in Group D50 than in Group D25 but the difference did not reach statistical significance (p=0.52,0.95 and 0.41 respectively). Onset of sensory block was comparable between the two groups, p=0.62. Maximum sensory block was achieved significantly earlier in Group D50 (10.64±2.75 min versus 12.94±3.04 min in Group D25), p=0.0012. Group D50 patients achieved Bromage score 3 earlier (10.735±1.797 min) than group D25 (12.794±2.52 min) (p=0.00). Recovery from motor block was found earlier in Group D25 group (141.325±4.97 mins) compared to Group D50 (154.41±8.143 mins). Group D50 reported significantly higher sedation than group D25 (p=0.00). Group D25 reported more pain at 4 hours compared to Group D50 (VAS -4.705±0.462 versus 2.588±1.478). Time of requirement of first rescue analgesia was delayed in Group D50 (270.59±50.78 mins) than in Group D25 (172.50±10.46 mins), p=0.000.Conclusions: Dexmedetomidine is effective in relieving anxiety in elderly patients undergoing TURP under spinal anaesthesia. Dose of 0.50 mcg/kg is more effective than 0.25 mcg/kg without increasing the risk of adverse effect.

Comparison of 2D and 3D gamma evaluation method in patient specific intensity-modulated radiotherapy quality assurance

Background: In this study we have compared 2D and 3D gamma pass percentage for a variety of acceptance criteria for 40 step-and-shoot IMRT (intensity-modulated radiotherapy) plans. Methods: Treatment planning was done for 40 patient including head and neck, abdomen and pelvis simulated on the Siemens Healthcare GmBH CT simulator with images of 3 mm slice thickness using treatment planning system (TPS) (Monaco Version 5.11.03, Elekta medical system) using Monte Carlo algorithm. The gamma evaluation was done using PTW VeriSoft 8.1 which allowed us to perform 2D and 3D gamma index calculation, slice-by-slice comparison of measured and calculated dose distributions, measured dose was compared against the calculated DICOMRT dose on the OCTAVIUS 3D phantom from TPS. Results: The average 3D and 2D gamma passing in coronal planes were 96.61±0.45% and 96.27±0.78% for 5 mm/5% criteria, 93.74±4.17% and 91.9±4.88% for 3 mm/3% criteria, 85.83±7.58% and 82.41±8.06% for 2 mm/2% criteria and 62.8±9.42% and 59.18±9.52% for 1 mm/1% criteria respectively for all cases. The average gamma passing rate for 3D gamma analysis was 0.35%, 1.97 %, 3.97% and 5.78% higher when compared with 2D coronal planar analyses for 5 mm/5%, 3 mm/3%, 2 mm/2% and 1 mm/1% DTA criteria respectively. Conclusions: It is concluded in the study that 3 D gamma passing rate is higher compared to 2D gamma passing for head and neck, abdomen and pelvis cases

ICAR: endoscopic skull‐base surgery

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Physiological and biochemical aspects of growth and yield stimulation of bean (Phaseolus vulgaris L.) plants by 2, 4-D-mineral sprays

Recent reports have emphasized that foliar applications of stimulatory concentrations of 2,4-dichlorophenoxyacetic acid (2,4-D) induce greater growth and productivity of several crop plants. This stimulatory action of the hormone has been found to be augmented by simultaneous application of such micronutrients as iron, manganese, zinc, copper, and boron (Wort, 1964). However, no systematic attempt has so far been made to investigate physiological and biochemical changes induced in a relatively short period following these treatments. A correlation of such changes with final improvements in growth and yield may provide a better understanding of the mechanism of action of the hormone. In addition, the biochemical nature of the augmentory role played by micronutrients on 2,4-D action is yet undefined. It was therefore felt desirable to investigate these aspects. Bean plants (Phaseolus vulgaris L. Var. Top Crop) were grown in plastic cans under controlled environment in a growth room. When the plants were 2 weeks old, the following treatments were applied as foliar sprays: (1) 2,4-D (1 ppm), (2) micronutrient solution (Fe, Mn, Zn, Cu, B; 5x10⁻⁴ M) and (3) 2,4-D-mineral solution, with the same components as (2) plus 1 ppm 2,4-D. Measurements of juvenile growth, chemical composition of the plants, respiration and photosynthetic rates and activities of some of the key enzymes of carbohydrate and nitrogen metabolism were made 5, 10, and 15 days after the treatment, to determine the course and basis of stimulation. Yield of pods and seeds and the vitamin C content of pods were also determined. The results revealed that: (1) maximum stimulation resulted from the use of hormone-mineral spray, (2) treatments involving 2,4-D resulted in progressive increase in plant height, leaf number, and leaf area; fresh and dry weights of root, stem and leaves; chlorophyll content and total sugar in leaves, (3) sucrose and reducing sugars were lower in stems and roots of treated plants; (4) moisture content was not affected significantly by any treatment; (5) quantitative chromatographic determination of the free, ethanol-soluble amino acids revealed a reduction in amino acid content in 2,4-D-treated plants, particularly in leaves, and an increase in plants to which micro-nutrient spray had been applied. The amino acid content of plants treated with 2,4-D plus minerals was intermediate between those resulting from the other two treatments; (6) measurement made with intact plants using an infrared CO2 analyzer revealed increases in rates of respiration and photosynthesis of the aerial portions 10 and 15 days after treatment; (7) significant increases in the activity of phosphorylase, phosphoglyceryl kinase, succinic dehydrogenase, catalase, nitrate reductase, and transaminase in all organs were also apparent at 10 and 15 days after treatments involving 2,4-D; (8) treatments involving 2,4-D also resulted in significant increases (P=0.05) in number and fresh weight of green pods, in seed number, and in total seed weight. Weight of the individual seed was not significantly altered; (9) the green pods from treated plants had higher vitamin C content at harvest time, but the moisture content was not altered by treatment. The green pods of plants which had received 2,4-D alone or 2,4-D plus minerals lost less ascorbic acid and moisture during 4 days storage at room temperature. The stimulation of enzyme activities is explained on the basis of hypothesis proposed by Wort (1964) that 2,4-D may participate in the formation of substrate-enzyme-regulator complex. Minerals may affect the activity of formation of this complex. In proposing a physiological and biochemical basis for the stimulation in growth and yield under 2,4-D action, the following points are emphasized: (1) the stimulated rate of photosynthesis produced a larger amount of photosynthate which could be utilized in the biosynthesis of all cell constituents or serve as substrate for respiration; (2) the stimulated rate of respiration and activity of such enzymes as phosphoglyceryl kinase and succinic dehydrogenase resulted in an increased supply of available energy, as ATP and reduced nucleotides, for biosynthesis, and in larger amounts of keto acids which provide the carbon skeletons of amino acids; (3) the greater activity of nitrate reductase and transaminase resulted in an augmented supply of amino acids responsible for the enhanced synthesis of protein evident in greater growth and productivity.Science, Faculty ofBotany, Department ofGraduat

A computational methodology for estimating the detected energy spectra of the gamma-ray flux from irradiated nuclear fuel

Gamma-ray spectrometry using collimated detectors is a well-established examination method for irradiated nuclear fuel. However, the feasibility of examining a particular nuclide of interest is subject to constraints; the peak must be statistically determinable with the desired precision and the total spectrum count rate in the detector should not cause throughput issues. Methods were assembled for gamma spectrum prediction to optimize instruments for gamma emission tomography and to enable a priori feasibility evaluation of determination of single peaks of irradiated nuclear fuel. The aim was to find reliable results (~10% accuracy) regarding total spectrum and peak count rates with faster computation time than a full-Monte Carlo approach. For this purpose, the method is based on depletion calculations with SERPENT2, a point-source kernel method for the collimator response, a rig response matrix and a detector response matrix, both computed with MCNP6. The computational methodology uses as input the fuel properties (dimensions, materials, power history, and cooling time), and the instrumental setup (collimator and detector dimensions and materials). The prediction method was validated using measured data from a high-burnup, short-cooled test fuel rodlet from the Halden reactor. Absolute count rates and ratios of characteristic peaks were compared between predicted and measured spectra, showing a total count rate overestimation of 7% and discrepancies between 2-20% for the single peaks (same order of magnitude of the uncertainty). This level of agreement is deemed sufficient for measurement campaigns planning, and the optimization of spectroscopic instruments for use in gamma scanning and tomography of nuclear fuel