Single and double injection paravertebral block comparison in reduction mammaplasty cases: a randomized controlled study

Background This study compares the analgesic effects and dermatomal blockade distributions of single and double injection bilateral thoracic paravertebral block (TPVB) techniques in patients undergoing reduction mammaplasty. Methods After obtaining ethics committee approval, 60 patients scheduled for bilateral reduction mammaplasty were included in the study. Preoperatively, the patients received one of single (Group S: T3–T4) or double (Group D: T2–T3 & T4–T5) injection bilateral TPVBs using bupivacaine 0.375% 20 ml per side. All patients were operated under general anesthesia. The T3–T6 dermatomal blockade distributions on the midclavicular line were followed by pin-prick test for 30 min preoperatively and 48 h postoperatively. All patients received paracetamol 1 g when numeric rating scale (NRS) pain score was ≥ 4, and also tramadol 1 mg/kg when NRS was ≥ 4 again after 1 h. The primary endpoint was NRS pain scores at postoperative 12th h. The secondary endpoints were dermatomal blockade distributions and NRS scores through the postoperative first 48 h, time until first pain and the analgesic consumption on days 1 and 2. Results Fifty-two patients completed the study. The NRS pain scores at 12th h were similar (right side: P = 0.100, left side: P = 0.096). The remaining NRS scores and other parameters were also comparable within the groups (P ≥ 0.05). Only single injection TPVB application time was shorter (P < 0.001). Conclusions The single injection TPVB technique provided sufficient dermatomal distribution and analgesic efficacy with the advantages of being faster and less invasive

Myositis Ossificans Traumatica of the Medial Pterygoid Muscle After Third Molar Tooth Extraction: A Case Report and Review of Literature

Myositis ossificans (MO) is a rare non-neoplastic disorder characterized by heterotopic ossification in soft tissues, mainly muscles. MO traumatica is characterized by ossification of the soft tissues after acute or repetitive trauma, burns, or surgical intervention. Muscular or soft tissue trauma is usually present as the underlying etiology. MO traumatica usually involves the extremity muscles. The number of reported cases involving the masticatory muscles is extremely low. The most common clinical sign of this condition is progressive limitation of mouth opening. Surgical resection of the ossified tissue has been the most commonly used treatment for this disorder, with a high postoperative recurrence rate. We report a case of traumatic MO of the medial pterygoid muscle to draw attention to the possibility of the condition in patients with a limited mouth opening and to review the reported data about MO traumatica involving the medial pterygoid muscle. (C) 2018 American Association of Oral and Maxillofacial Surgeon

A rare case in Turkey: Cutaneous myiasis after traveling

Cutaneous myiasis is a localized infectious disease which affects humans and vertebrate animals. Most common causes of cutaneous myiasis worldwide are dipterous larvae of “Dermatobia hominis” and “Cordylobia anthropophaga.” Clinical presentations include nodules, ulcers, creeping eruption, and wound infections which may be localized anywhere on skin including trunk, scalp, and extremities. Here, we present a 30-year-old female patient consulted to our clinic who presented with erythematous lesions on her lower extremities after a visit to South America. According to her travel history, laboratory and imaging results, she was diagnosed with cutaneous myiasis. Etiology, clinical presentation, and surgical treatment options of myiasis, which is very rare in Turkey, are discussed

A Novel Training Alternative in Orthognathic Mandibular Osteotomy: Air Dried Clay Model

Objective: Patient safety and low complication rates are indispensa ble in surgical training and models are among the main educational tools. The aim of this study is to assess the efficiency of a novel model for orthognathic mandibular osteotomy.Material and Methods: A template and seventeen partial mandibular models (MM-17) were manufactured with air dried clay. The dimensions of the models were feasible for sagittal split ramus osteotomy (SSRO). Model surgery was performed by surgeons with a minimum of three years’ experience in orthognathic surgery. Each surgeon operated four separate models and the following data were recorded: corticotomy and SSRO completion time, MM-17 fracture type, similarity value of MM-17 with native mandible, representation value of MM-17, and the training compatibility value of MM-17.Results: IThe cost was 0.6 American Dollars. The mean corticotomy time was 126.75 seconds (110-150). Mean cortical resistance similarity value was 8.75 (8-10). The mean SSRO time was 288 seconds (205-401). Sixty percent of the fractures were seen in the outer cortex. The mean medullary resistance similarity value was 5 (4-6) and mean mandibular representation value was 5.25 (4-7). The training compatibility value was 8.25 (7-10)

Changes in the inflammatory markers with advancing stages of diabetic nephropathy and the role of pentraxin-3

Background: Immunological and inflammatory mechanisms have been shown to have role in both the development and progression of diabetic nephropathy (DNP). There is need for more specific markers for inflammation as the ones commonly used are influenced by many factors. Pentraxin-3 (PTX-3) seems to be a potential candidate. We aimed in our study to evaluate the changes of PTX-3 levels in different stages of DNP and its relationship with other inflammatory markers.Methods: This is a cross sectional study in which patients with DNP at different stages were involved. Patient were divided into three groups according to estimated glomerular filtration rate (eGFR), microalbuminuria and proteinuria levels: Group-1: eGFR >60mL/min and microalbuminuria, Group-2: eGFR >60mL/min and macroalbuminuria, Group-3: eGFR <60mL/min and macroalbuminuria. Besides the routine biochemical parameters, levels of PTX-3, high sensitivity C-reactive protein (hsCRP), interleukin (IL)-1 and tumor necrosis factor (TNF)- was measured. Groups were compared with each other regarding the study parameters and correlation of PTX-3 with other markers was evaluated.Results: The mean PTX-3 level in Group-2 (0.940.26ng/mL) and -3 (1.35 +/- 1.55ng/mL) were higher than in Group-1 (0.81 +/- 0.25ng/mL) (p=0.009 and p=0.012). There was a significant correlation of PTX-3 with proteinuria (r=0.266, p=0.016), microalbuminuria (r=0.304, p=0.014) and hypoalbuminemia (r=0.197, p=0.043). PTX-3 was not correlated with other markers of inflammation (IL-1, TNF- and hsCRP) and diabetic metabolic parameters (hbA1c, C-peptide, insulin and HOMA-IR). PTX-3, IL-1 and TNF- levels increased with the advancing stage of DNP while hsCRP level did not change.Conclusion: PTX-3 that increases similar to other markers of inflammation (IL-1, TNF-) is a better inflammatory marker than hsCRP. Furthermore, there is a relationship between PTX-3 and proteinuria independent from eGFR

Relationship Between Left Ventricule Hypertrophy and inflammation and Albuminuria in Patients with Type 2 Diabetes Mellitus

The strong association between diabetes mellitus and the cardiac left ventricular hypertrophy can be partially explanatory for the cardiovascular complications and end organ damage in diabetes, In our study we planned to compare the levels of inflammatory markers and albuminuria, the index for renal failure, between type 2 diabetic patients with and without LVH, with the purpose to find out if the following up of the inflammatory markers in Type 2 diabetic patients can be important for the prevention of the development of cardiac and renal complications