Micro-pharmacokinetics of lidocaine and bupivacaine transfer across a myelinated nerve fiber.

Background: The aim of the present study was to predict the time to onset and duration of action of two local anesthetics (lidocaine and bupivacaine) based on experimental dimensions of a typical nerve and experimental octanol/water partition coefficients.

Methods: We began our compilation of experimental data with a numerical solution of the Smoluchowski equation for the transfer of lidocaine and bupivacaine across the axon membrane in the region of the node of Ranvier (axolemma) and across the Schwann cell. The difference between the aqueous and lipid environments of the neuron was simulated by including the coordinate-dependent chemical potential.

How Azide Ion/Hydrazoic Acid Passes Through Biological Membranes: An Experimental and Computational Study.

Hydrazoic acid (HN) and its deprotonated form azide ion (N) (AHA) are toxic because they inhibit the cytochrome c oxidase complex IV (CoX IV) embedded in the inner mitochondrial membrane that forms part of the enzyme complexes involved in cellular respiration. Critical to its toxicity is the inhibition of CoX IV in the central nervous system and cardiovascular system. Hydrazoic acid is an ionizable species and its affinity for membranes, and the associated permeabilities, depend on the pH values of aqueous media on both sides of the membranes.

Cervical Intraepithelial Neoplasia Grade 3 in a HPV-Vaccinated Patient: A Case Report.

Persistent infection with human papillomavirus (HPV) causes almost all cervical precancerous lesions and cancers. Bivalent, quadrivalent, and nonavalent HPV vaccines effectively prevent high-grade cervical intraepithelial neoplasia (CIN3). The effectiveness of HPV vaccination against CIN3 is 97-100% in HPV-naïve populations and 44-61% in the overall population.

The Reliability and Medical Students' Appreciation of Certainty-Based Marking.

Certainty-Based Marking (CBM) involves asking students not only the answer to an objective question, but also how certain they are that their answer is correct. In a mixed method design employing an embedded approach with a quasi-experimental design, we have examined the use of CBM during a 5-week Gynaecology and Obstetrics course. The study was conducted as a non-mandatory revision exam with two additional questionnaires on Moodle.

Overview of Immune Checkpoint Inhibitors in Gynecological Cancer Treatment.

In the last ten years, clinical oncology has been revolutionized by the introduction of oncological immunotherapy, mainly in the form of immune checkpoint inhibitors (ICIs) that transformed the standard of care of several advanced solid malignancies. Using ICIs for advanced gynecological cancers has yielded good results, especially for endometrial cancer. In ovarian or cervical cancer, combining ICIs with other established agents has shown some promise.

Is tissue augmentation a reality in biosurgery? An experimental study of endothelial cell invasion into tissue filler.

New therapeutic approaches for wound treatment are evolving. Non healing wounds in oncology and after trauma may be cured by a novel technique of tissue augmentation with soft tissue fillers. The principle resides in filling the wound with collagen filler in order to seal the defect and promote healing.

An unusual case of high cervical spinal cord injury.

Isolated spinal cord injuries can rarely be found in patients with no traumatic radiological abnormalities of the spine. Stenoses of the medullary canal and degeneration of cervical spine are the predisposing factors. A case report of a 68-year-old patient is described, who developed quadriplegia with cardiac arrest due to isolated cervical spinal cord injury while jumping on a trampoline.

The wound healing process: an overview of the cellular and molecular mechanisms.

Wound healing remains a challenging clinical problem and correct, efficient wound management is essential. Much effort has been focused on wound care with an emphasis on new therapeutic approaches and the development of technologies for acute and chronic wound management. Wound healing involves multiple cell populations, the extracellular matrix and the action of soluble mediators such as growth factors and cytokines.

Percutaneous versus open repair of the ruptured Achilles tendon: a comparative study.

Background: Controversy regarding the optimal treatment of the fresh total Achilles tendon rupture remains.

Purpose: To compare the results of percutaneous and open Achilles tendon repair.

Study Design: Cohort study; Level of evidence, 2.

Percutaneous suturing of the ruptured Achilles tendon under local anesthesia.

A prospective study of modified percutaneous Achilles tendon repair performed from 1991 to 1997 under local anesthesia with a minimum 2-year follow-up is presented. There were 134 procedures in 124 men and 8 women (mean age, 37 years) treated within 7 days after acute total rupture. Postoperative care consisted of wearing a cast or soft-cast immobilization for 6 weeks.

[Aortic valve insufficiency due to rupture of the cusp in a patient with multiple trauma].

Lesions of the heart valve caused by blunt chest trauma is rare, but when it does occur it can significantly injure the patient. On the basis of autopsy studies, research shows that heart valves are injured in less than 5% of patients who have died due to impact thoracic trauma. Among the heart valves, the aortic valve is the most often lacerated, which has been proved by relevant autopsy and clinical studies.

[Traumatic jejunal entrapment in a patient with Bechterew disease].

We report an unusual case of incarceration of small bowel between the 4th and 5th lumbar vertebrae in a patient with rheumatoid spondylitis. Incarceration of the loop of jejunum within the fracture or between dislocated lumbar vertebrae is an uncommon entity. The cases of traumatic jejunal entrapment have been previously reported in the literature [1, 2, 3, 4, 5, 6, 7, 8, 9, 11]: 2 cases occurred in adults and 8 in children.

[Percutaneous tibiotalar arthrodesis].

We report on a 50-year-old female patient with bimalleolar fracture and subsequent posttraumatic arthrosis who was treated by minimally invasive nonresection tibiotalar compression arthrodesis using internal fixation and cancellous bone grafting. The advantages of this technique include minimal exposure of tissues, good control of the relationship between the tibia and the talus, and short hospital stay.

The strength of percutaneous methods of repair of the Achilles tendon: a biomechanical study.

Purpose: A study on 36 cadaveric Achilles tendons was undertaken to compare different Achilles tendon repairs.

Methods: The strength of the repair and the gapping resistance were tested under different standardized experimental conditions. Each matched pair of cadaveric Achilles tendons was randomly repaired in the original Ma-Griffith configuration and in the new modified configuration and loaded to failure.

Recurrent adrenocortical carcinoma in a child.

An 8-month-old girl presented with clitoromegaly, cushingoid features and a large abdominal tumour. Ultrasonography (US) and computed tomography (CT) of the abdomen revealed a tumour of the left suprarenal gland, 12x11x7 cm in size. Serum levels of cortisol, testosterone and DHEA-S, and urinary extretion of 17-ketosteroids and 17-hydroxycorticoids were increased.

Results of treatment of 17 patients with heart tumour.

Background: Between 1989 and 1997, 17 patients underwent surgery for excision of primary cardiac tumour at the Department for Cardiovascular Surgery in Ljubljana.

Patients And Methods: There were 13 female (76.5%) and four male (23.

[Successful surgical revascularization after 18 hour ischemia below the knee due to complete avulsion of the popliteal artery].

We report the case of a 33-year-old man after knee luxation and disruption of a popliteal artery, which was missed after repositioning at the first clinic. Eighteen hours later complete discontinuity of the popliteal artery was confirmed by arteriography and an immediate reversed, end-to-end auto-venous graft was interposed under general anesthesia with anterior and posterior fasciotomy prior to blood flow restoration. Forced diuresis with a diuretic mixture and balanced fluid intake were used, and the patient was discharged from the intensive care unit on the 10th postoperative day in good condition with normal diuresis.

[Bridging an extensive bone defect with cortico-spongious transplants in femoral fracture caused by gunshot injury].

The treatment of a 12-cm bone defect after shotgun fracture of the femur is described. Semitubular corticospongious bone grafts from both iliac crests, 6 cm long and 0.8 cm wide, were tied into two bundles with an absorbable suture and were laid successively into the diaphyseal defect.

The path of a wounding missile along the spinal canal: a case report.

Study Design: The authors report a penetrating gunshot injury to the cervical spine at the C6 level, with retention of the missile within the spinal canal at the T10 level.

Objectives: The treatment of this patient involved debridement of entrance wound on the day of admission and laminectomies in the cervical and thoracic levels 3 days after the incident.

Summary Of Background Data: The migration of a foreign body along the intracranial part of the central nervous system has been reported in the literature, but we have found no report of an intercanal gunshot wound measuring 30 cm with complete liquefaction of the cord.

An unusual lawn mower injury.

The authors report a case of foot trauma produced by a piece of the lawn mower blade, which was fired projectile-wise from the machine while it was in operation. At hit the calcaneous and remained trapped in the bone. The wound healed after removal of the foreign body, wound debridement and systemic and local antibiotic prophylaxis.

Comminuted avulsion fractures of the inferior pole of the patella.

Treatment of comminuted avulsion fractures of the inferior pole of the patella is still an unsolved problem. Different methods of treatment have been introduced, some quite controversial, including immediate total patellectomy; a variety of partial patellectomies, and fixation by tension band wiring. Yet the problem of early development of arthrosis and a certain degree of limitation of motion due to the changed biomechanics, retropatellar incongruity and postoperative immobilization must still be resolved.

Intracranial injuries by a screwdriver.

Two patients with unusual intracranial foreign bodies are presented. Intracranial injuries produced by a piece of screwdriver as a wounding agent have not yet been reported in the literature. In one of our two cases we had to deal with homicide and in another with accidental self-inflicted injury.

[Repeat fracture of the femur shaft in Gaucher disease].

A case of pathologic femoral fracture in a patient with Gaucher's disease is presented. The fracture occurred at the site of bioptic trepanation performed 1 month previously. After fracture healing and removal of a Küntscher nail, pathologic fracture recurred at the same site.

Avulsion of the anterior superior iliac spine in two adolescent sisters: operative versus conservative treatment.

We compared the results of treatment of identical injuries to the anterior superior iliac spine in two adolescent sisters, one treated conservatively and the other operatively. The functional results of both treatments were good, but the rehabilitation period was shorter with operative treatment, allowing an earlier return to athletic activity. Treatment by open reduction and internal fixation should be considered in patients requiring a short convalescence.