Exogenous application of platelet-leukocyte gel during open subacromial decompression contributes to improved patient outcome

Background: Platelet-leukocyte gel (PLG) is being used during various surgical procedures in an attempt to enhance the healing process. We studied the effects of PLG on postoperative recovery of patients undergoing open subacromial decompression (OSD). Methods: PLG was produced from platelet-leukocyte-rich plasma (P-LRP), prepared from a unit of whole blood. Forty patients were included in the study. Self-assessed evaluations, using the American Shoulder and Elbow Surgeons scoring system of activities of daily living (ADL), joint instability, pain levels, pain medications, and clinical evaluations for range of motion were conducted. Results: Platelet and leukocyte counts were significantly increased in the P-LRP compared to baseline counts. Treated patients demonstrated decreased visual analog scales for pain and used significantly less pain medication, had an improved range of motion during passive forward elevation, external rotation, external rotation with arm at 90 degrees abduction, internal rotation, and cross body adduction compared to control patients (p < 0.001). No differences in the instability score were observed between the groups. Furthermore, treated patients performed more ADL (p < 0.05). Conclusion: In the PLG-treated group, recovery was faster and patients returned earlier to daily activities and also took less pain medication than control subjects

Ophthalmic loco-regional anaesthesia: Reducing discomfort during injection

Loco-regional anaesthesia is commonly used for both intraocular and extraocular surgical procedures, although the provision and use of the anaesthetic technique varies worldwide. Injection techniques (retrobulbar, peribulbar and sub-Tenon’s blocks) are associated with significant pain; indeed, many patients have a fear of pain. Discomfort during injection can, however, be reduced and patients can be made comfortable through reassurance, careful performance of the technique and the provision of sedation and/or analgesia. In this article, the authors describe common loco-regional anaesthetic techniques and measures to reduce discomfort during injection, thus improving patient satisfaction

Нейросекреторная активность супраоптического ядра переднего гипоталамуса кроликов под действием транскутанной электростимуляции зрительного анализатора

На 8 кролях породи Метелик вивчали вплив непрямої черезшкірної електростимуляції зорового аналізатора на нейросекреторну активність магноцелюлярних клітин супраоптичного ядра переднього гіпоталамусу. На мікропрепаратах інтактних тварин переважали нейрони II морфофункціонального типу, що перебувають у стадії синтезу нейросекрету. Показано, що за дії электростимуляції спостерігається перерозподіл головних морфо-функціональних типів нейронів. Відзначено збільшення змісту клітин I й III типів, відповідно у стадіях спокою після виведення секрету й накопичення, що вказує на активацію процесів звільнення нейросекрету і його акумуляції. Виразність реакції нервової тканини однакова при силі стимулюючого струму 100 мкА й 300 мкА.The influence of indirect through-skin electrostimulation (different doses) of the optical analyser on neurosecretory activity of anterior hypothalamus magnocellular nucleus was stading during chronic experiment. The stady was carried out on rabbits. Five morphological types of neurons was exposed in the supraoptical nucleus of control animal groop: I type- phase of rest after neurosecrets leading, II- phase of synthesis, III- phase of accumulation, IV - leading phase, V - phase of degerneration, but neurons of II types was prevalenced (51%). The indirect electrostimulation of the optical analyser provokes quantitative changes of keeping same neurons types. The number of I and III types neurons increases (on 20% and 7%) . The kind of changes is indicative of electrostimulation activation influense on neurosecrets leading and accumulation. Expression of nervous tissue reaction was identical under different doses (100 mkA and 300 mkA) of afferent electrostimulation

Cost effectiveness of epidural steroid injections to manage chronic lower back pain

Background The efficacy of epidural steroid injections in the management of chronic low back pain is disputed, yet the technique remains popular amongst physicians and patients alike. This study assesses the cost effectiveness of injections administered in a routine outpatient setting in England. Methods Patients attending the Nottingham University Hospitals’ Pain Clinic received two injections of methylprednisolone plus levobupivacaine at different dosages, separated by at least 12 weeks. Prior to each injection, and every week thereafter for 12 weeks, participants completed the EQ-5D health-related quality of life instrument. For each patient for each injection, total health state utility gain relative to baseline was calculated. The cost of the procedure was modelled from observed clinical practice. Cost effectiveness was calculated as procedure cost relative to utility gain. Results 39 patients provided records. Over a 13-week period commencing with injection, mean quality adjusted life year (QALY) gains per patient for the two dosages were 0.028 (SD 0.063) and 0.021 (SD 0.057). The difference in QALYs gained by dosage was insignificant (paired t-test, CIs -0.019 – 0.033). Based on modelled resource use and data from other studies, the mean cost of an injection was estimated at £219 (SD 83). The cost utility ratio of the two injections amounted to £8,975 per QALY gained (CIs 5,480 – 22,915). However, at costs equivalent to the tariff price typically paid to providers by health care purchasers, the ratio increased to £27,459 (CIs 16,779 – 70,091). Conclusions When provided in an outpatient setting, epidural steroid injections are a short term, but nevertheless cost effective, means of managing chronic low back pain. However, designation of the procedure as a day case requires the National Health Service to reimburse providers at a price which pushes the procedure to the margin of cost effectiveness