Particulated wisdom teeth as an autologous bone substitute for grafting/filling material in bone defects : case Report

Introduction: Bone augmentation material using permanent teeth are confirmed in many articles to provide good histological and clinical results. Advances in osteoconduction and osteoinduction, low cost of material, no risk of disease transmission and elimination of foreign body reaction are important aspects not only to the clinician but to patient as well. Many techniques and devices to obtain graft material for bone augmentation out of teeth are found in the literature. Material and Methods: The wisdom teeth crush technique developed in our office and described in this case report is simple and no specific devices for teeth grinding were used. The graft material was obtained from impacted in-tact wisdom teeth without chemical conditioning of the particles with preservation of the dental pulp and the cells found in it. This study presents crushed autologous maxillary wisdom tooth as filling material in two bone defects in premaxilla caused by cysts removal. Results: The clinical results and Panoramic X-ray evaluation at three months postoperatively were very promising. Conclusions: Although further clinical researches are necessary to evaluate this substitutive for bone augmentation technique, the authors believe it can be safely used by oral/maxillofacial surgeons

Risk Factors for the Development of LARS in Anterior Rectal Resection for Rectal Carcinoma and the Quality of Life of Patients with Developed LARS

INTRODUCTION: Laparoscopic surgery has been established as a treatment method for patients with colorectal carcinoma. Thanks to the minimally invasive approach, patients with rectal carcinoma receive all the advantages of laparoscopic surgery without violating oncological principles.Low anterior resection syndrome (LARS) is a symptom complex seen in patients operated on for rectal carcinoma. It includes the following symptoms: fecal incontinence, increased frequency of bowel movements or urgency of defecation, tenesmus. These symptoms can have a significant negative impact on the patient’s quality of life.AIM: The purpose of this study is to determine the risk factors for the development of LARS and the degree of manifestation of this syndrome in different groups of patients.MATERIALS AND METHODS: As inclusion criteria in the present study, we defined patients with histologically verified adenocarcinoma of the rectum. A retrospective analysis was made of 44 patients for the period of 2019–2023 operated on in the Prof. Alexander Stanishev Clinic of Surgery. In all patients, individual characteristics were considered: gender, age, accompanying diseases, performed non-adjuvant treatment, distant carcinoma from LAR, stage of the disease, and type of anastomosis performed. Exclusion criteria of the study were: unresectable carcinoma, patients operated conventionally, laparoscopy with conversion to laparotomy, amputation a.m. Miles.RESULTS: From the conducted research regarding risk factors, the following were related: gender (women have a higher risk of developing major LARS); age (between 50–69 years with a higher risk of developing LARS); the distance of the carcinoma from the LAR (at 0–6 cm from the LAR—a higher risk for the development of major LARS); radiotherapy (higher risk of developing major LARS); concomitant diseases (in all patients with diabetes—manifestation of major LARS); the advanced stage of the disease (at T3 >= according to TNM—the risk of developing LARS is higher).CONCLUSION: According to our study, risk factors for the development of LARS are: female gender, low location of the rectal carcinoma, conducted radiotherapy, diabetes mellitus, and advanced stage of the disease

Topical intranasal analgesia with EMLA for closed rhinoplasty

Background: Rhinoplasty is a traumatic procedure associated with postoperative pain. The purpose of this study is to determine the effect of topically administered intranasal EMLA 5% cream (lidocaine 25 mg/ prilocaine 25 mg) on the pain experienced in the postoperative period by patients who underwent closed rhinoplasty.Materials and methods: The study was conducted between October 2014 and May 2016 and included 66 patients divided in two groups, all of whom underwent closed rhinoplasty. In the first group (n = 33) when packaging and placing the nasal splint, each intranasal tampon (with Gelaspon) was applied with 2 ml EMLA 5% cream, and in the control group (n = 33) 2 ml Deflamol ointment was applied on each tampon. All patients were operated under general anesthesia after introduction with intravenous Propofol and maintenance of the anesthesia with Sevoflurane and opioid analgesic. After placing the patient under general anesthesia, the otorhinolaryngologist carries on with local infiltration anesthesia with a solution of lidocaine 0.5%and adrenaline 1: 100,000 4-6 ml. All patients received oral antibiotic treatment (with Klacid or Zinnat) for the period of the packaging. No corticosteroids were included in the therapeutic scheme. Post-operative pain was assessed on a visual analog scale on the 1, 3, 6, 12, 24, 48 hour in the patients of both groups.Results: The statistical analysis shows that there is a significant differencein reported results for the treatment of post-operative pain on the 1, 6 and 12 hour period in both groups studied. Four of the patients (12%) in the EMLA group had results from the VAS > 40 mm and required administration of a non-opioid analgesic in the first 24 hours, whilst in the control group this number of patients was 13 (39%).Conclusion: Intranasal application EMLA 5% cream in the packaging for reducing postoperative pain in patients who underwent closed rhinoplasty proves to be a simple and effective technique, in which we have not found adverse side effects in the study group patients despite this off label usage

Eccentric Contraction-Induced Muscle Fibre Adaptation

Hard-strength training induces strength increasing and muscle damage, especially after eccentric contractions. Eccentric contractions also lead to muscle adaptation. Symptoms of damage after repeated bout of the same or similar eccentrically biased exercises are markedly reduced. The mechanism of this repeated bout effect is unknown. Since electromyographic (EMG) power spectra scale to lower frequencies, the adaptation is related to neural adaptation of the central nervous system (CNS) presuming activation of slow-non-fatigable motor units or synchronization of motor unit firing. However, the repeated bout effect is also observed under repeated stimulation, i.e. without participation of the CNS. The aim of this study was to compare the possible effects of changes in intracellular action potential shape and in synchronization of motor units firing on EMG power spectra. To estimate possible degree of the effects of central and peripheral changes, interferent EMG was simulated under different intracellular action potential shapes and different degrees of synchronization of motor unit firing. It was shown that the effect of changes in intracellular action potential shape and muscle fibre propagation velocity (i.e. peripheral factors) on spectral characteristics of EMG signals could be stronger than the effect of synchronization of firing of different motor units (i.e. central factors)

Surgical Methods for Minimizing the Incidence of Paracolostomy Hernias

INTRODUCTION: Regardless of the advances in surgical techniques, parastomal hernia continues to be a frequent and serious complication after colostomy construction. The outcomes after surgical treatment are often not satisfactory, and the recurrence rate is high.AIM: The study aims to present modern surgical methods for the prevention of paracolostomy hernias.MATERIALS AND METHODS: The study included 77 patients with formed colostomies in the Clinic of Surgery of Alexandrovska University Hospital during the period from 2017 to 2022, analyzed with a follow-up period of at least six months. Group A includes 35 patients whose stoma was constructed by the extraperitoneal route. Group B consists of 42 patients with the traditional transperitoneal technique. In addition, 2 patients in whom synthetic mesh was used to treat and prevent paracolostomy hernia are reported.RESULTS: In group A only one patient was diagnosed with parastomal hernia, while in group B there were 9. The difference between the two groups was found to be statistically significant (p < 0.05). In the cases where a prophylactic synthetic mesh was utilized, no complications we observed.CONCLUSION: Improving surgical techniques for preventing paracolostomy hernias is crucial, as they represent an inevitable complication, in most cases, after colostomy formation. The results of the conducted study as well as the available literature data highlight the benefits of methods such as the extraperitoneal route for stoma construction and the prophylactic use of synthetic meshes

Advantages and Limiting Factors in Laparoscopic Colorectal Surgery

INTRODUCTION: Laparoscopic surgery has become the gold standard for surgical treatment of diseases of the gastrointestinal tract. In terms of results, it is comparable and has established itself as a reliable alternative to conventional surgery, both in benign and malignant diseases. The minimally invasive approach enjoys all the short-term advantages, such as less postoperative pain, better cardiopulmonary function, faster recovery of the gastrointestinal passage, faster mobilization and recovery, shorter intensive care, and hospital stay. Long-term oncological outcomes still remain debatable.AIM: Our study aims to demonstrate the advantages of the laparoscopic approach and highlight some of its limiting factors in terms of operative time and postoperative stay in the conditions of the Clinic of Anesthesiology and Intensive Care (CAIL).MATERIALS AND METHODS: A total of 42 patients with histologically proven colorectal cancer (CRC) and resection with primary anastomosis were retrospectively included. We divided the patients into two groups according to the surgical technique: Group A: 21 patients operated by laparoscopic surgery (LS), and Group B: 21 patients operated by conventional open surgery (OS). Some of the basic characteristics: sex, age, body mass index (BMI), preoperative staging, mean operative time, postoperative period in CAIL, and analgesia, were examined.RESULTS: The mean operative time (MOT) in the LS group was 201 min and 189 min in the OS group. With respect to the gender factor, the MOT in LS was 211 min in men and 185 min in women, while in OS, there was no difference in MOT in relation to the gender factor. The mean operative time in patients compared to BMI was examined. In patients with normal weight, it was 160 min in LS and 351 min in OS, 220 min and 164 min in overweight patients, and 218 min and 197 min in obese patients, respectively. In the OS group, all patients had a stay in CAIL of more than 72 hours, while in LS only 57% of patients stayed for 72 hours. Regarding intraoperative and postoperative analgesia, natural opioid analgesics, including morphine, were administered to 10% of the LS group and 100% of the OS patients. Semi-synthetic opioid analgesics were administered in 60% of LS patients and 100% of OS patients.CONCLUSION: Laparoscopic colorectal surgery does not show an advantage in terms of mean operative time, but patients have a shorter stay in the CAIL setting, less postoperative pain, and enjoy all the advantages of a minimally invasive approach with equivalent oncological outcome

High-kinetic inductance NbN films for high-quality compact superconducting resonators

Niobium nitride (NbN) is a particularly promising material for quantum technology applications, as entails the degree of reproducibility necessary for large-scale of superconducting circuits. We demonstrate that resonators based on NbN thin films present a one-photon internal quality factor above 10$^5$ maintaining a high impedance (larger than 2k$\Omega$), with a footprint of approximately 50x100 $\mu$m$^2$ and a self-Kerr nonlinearity of few tenths of Hz. These quality factors, mostly limited by losses induced by the coupling to two-level systems, have been maintained for kinetic inductances ranging from tenths to hundreds of pH/square. We also demonstrate minimal variations in the performance of the resonators during multiple cooldowns over more than nine months. Our work proves the versatility of niobium nitride high-kinetic inductance resonators, opening perspectives towards the fabrication of compact, high-impedance and high-quality multimode circuits, with sizable interactions.Comment: 12 pages, 8 figure

Late Diagnosis of Urinary Peritonitis Due to a Lesion of the Left Ureter During Laparoscopic Anterior Resection of the Rectum—Laparoscopic Solution. Clinical Case and Literature Review

Ureteral lesions are a rare complication of colorectal surgery. This type of surgical procedure is the second most common cause of such complications, second only to gynecological operations, which account for around 50%. According to the localization of the lesion, they аre grouped into three types: injury to the proximal, middle, and distal part of the ureter, with the latter being the most common—around 80–90%. Most of the lesions are not recognized intraoperatively and sometimes the diagnosis can be delayed significantly. The time of diagnosis and the localization of the injury are crucial to the choice of treatment. We present a case of a patient, with a late diagnosis of lesion of the left ureter after the laparoscopic anterior resection of the rectum, which was treated with a laparoscopic uretero-ureteral anastomosis with simultaneous double-J catheterization. We also present a short literature review on the subject