B ackground: Intractable pain occurs as a result of extensive damage to soft tissue, bones and muscles after fusion of lumbar spondylolisthesis. Although different drugs and protocols have been suggested for postoperative pain management, the best method of treatment has not been proposed yet. Therefore, this study tried to compare the efficacy of ketamine infusion and routine opioid administration on postoperative pain. Methods: A double-blind prospective randomized clinical trial was performed on 45 patients candidate for fusion of lumbar spondylolisthesis. Patients were divided into two groups of A (treatment) and B (control). In group A, pain was controlled by intravenous infusion of ketamine. Morphine was also administrated when the patients scored their pain above 4 on a visual analogue scale (VAS). In group B, intravenous infusions of morphine were performed every 6 hours. VAS and whole dosage of morphine were compared between two groups every 6 hours. Results: Morphine and ketamine were both effective on pain control. Mean values of pain intensity at the first to fourth time points were 2.1, 1.8, 1.6, and 1.7 in group A and 3.9, 3.4, 3.5, and 3.5 in group B, respectively (p < 0.01 for all periods). However, ketamine was more efficient in pain reduction during the first 24 hours (p < 0.001). Conclusion: Ketamine could be a good alternative analgesic after fusion of lumbar spondylolisthesis. However, the probable side effects should also be considered. Ketamine infusion is more effective than morphine on postoperative pain control. In addition, tolerance to drug application is not a challenging problem at least during 24 hours after operation.

Secondary lymphedema (SL)is a frequent and devastating complication of modern oncological therapy and filarial infections. A lack of a reliable preclinical model to investigate the underlying mechanism of clinical stage progression has limited the development of new therapeutic strategies. Current first line treatment has shown to be merely symptomatic and relies on lifetime use of compression garments and decongestive physiotherapy. In this study, we present the development of a secondary lymphedema model in 35 rats using preand intraoperative fluorescence-guided mapping of the lymphatics and microsurgical induction. In contrast to the few models reported so far, we decided to avoid the use of radiation for lymphedema induction. It turned out, that the model is nearly free of complications and capable of generating a statistically significant limb volume increase by water displacement measurements, sustained for at least 48 days. A translational, accurate lymphatic dysfunction was visualized by a novel VIS-NIR X-ray ICG-Clearance-Capacity imaging technology. For the first-time SL stage progression was validated by characteristic histological alterations, such as subdermal mast cell infiltration, adipose tissue deposition, and fibrosis by increased skin collagen content. Immunofluorescence confocal microscopy analysis suggested that stage progression is related to the presence of a characteristic α SMA + /HSP-47 + /vimentin + fibroblast subpopulation phenotype. These findings demonstrate that the invivo model is a reliable and clinically relevant SL model for the development of further secondary lymphedema therapeutic strategies and the analysis of the veiled molecular mechanisms of lymphatic dysfunction.

Background:The A5 segment aneurysms of the anterior cerebral artery are rare, approximately 0.5% of all intracranial aneurysms. They are small with a wide base located in the midline, with the domes mostly projecting upward or backward.Case Description:The authors describe a unique case of A5 segment aneurysm, with the dome embedded into the body of the corpus callosum. This 41-year-old female was admitted to the neurology department for possible multiple sclerosis investigation. Computed tomography angiogram (CTA) revealed a 4-mm right-sided pericallosal artery aneurysm, with rare configuration, which was caudally projected, embedded into the body of the corpus callosum. Considering the family history, patient underwent a prophylactic ligation surgery. The postoperative CT and CTA showed no complication and successful occlusion of the aneurysm with no ischemia or hemorrhage in the corpus callosum.Conclusion:To the best of our knowledge, this is the first case of an aneurysm with this configuration. Our rare case of A5 segment aneurysm demonstrates the importance of planning of the surgery, choosing the appropriate approach, and knowing the detailed anatomy of the region, as well as the necessity of microsurgical clipping of small unruptured AdistAs.

Smaller diameter of the internal carotid artery and superior location, as well as a large and irregular aneurysm wall, are radiological characteristics of ruptured paraclinoid aneurysms, which CT angiography can measure easily.