No abstract

SummaryIn this prospective randomised study, we compared two techniques for i-gel TM insertion. One hundred and eighty-one anaesthetised, paralysed adult patients were randomly allocated into one of two groups. In the standard group (n = 91), the i-gel was inserted using the standard technique. In the rotation group (n = 90), the i-gel was rotated 90°a nticlockwise in the mouth and re-rotated in the hypopharynx to the original alignment. The success rate, insertion time, air leak pressure and complications were assessed. The success rate for insertion at the first attempt was lower for the standard technique, 78 (86%) vs 87 (97%; p = 0.016). The mean (SD) insertion time was longer (26.9 (14.5) s vs 22.4 (10.2) s; p = 0.016) and air leak pressure was lower (22.5 (10.4) cmH 2 O vs 27.1 (9.4) cmH 2 O; p = 0.002) in the standard group. The incidence of bloodstaining was higher with the standard technique (8 (9%) vs 1 (1%); p = 0.034). This study suggests that the rotational technique is superior to the standard technique for i-gel insertion.

Study design: Review and analysis of seven cases of syringomyelia treated surgically. Objective: To demonstrate the bene®cial role of decompressive surgery for the altered cerebrospinal¯uid (CSF)¯ow dynamics in syringomyelia not associated with Chiari I malformation. A comparison between the pre-and post-operative syrinx size and CSF¯ow in the subarachnoid space was made using cine-mode magnetic resonance imaging (cine-MRI) and then correlated with clinical improvement. Setting: University Hospital, Seoul, Korea. Methods: Conventional spinal MRI and cine-MRI were performed in the region of CSF¯ow obstruction preoperatively in seven patients with syringomyelia not associated with Chiari I malformation. The group consisted of one case of syrinx with post-traumatic compression fracture, one case of post-traumatic arachnoiditis, two cases of holocord syrinx associated with hydrocephalus without Chiari malformation, one case of syrinx with post-traumatic pseudomeningeal cyst, one case of post-laminectomy kyphosis-associated syringomyelia and one case of post-tuberculous arachnoiditis syringomyelia. Based on the preoperative cine-MRI, the types of surgery appropriate to correct the CSF¯ow obstruction were chosen: decompressive laminectomy-adhesiolysis and augmentation duraplasty in arachnoiditis cases, ventriculoperitoneal shunt for hydrocephalus, cyst extirpation in pseudomeningeal cyst and both anterior and posterior decompression-fusion in the case of post-laminectomy kyphosis. A syrinx-draining shunt operation was performed in three cases; where the syringomyelia was associated with posttraumatic compression fracture refractory to a previous decompression, where hydrocephalus was present in which the decompression by ventriculoperitoneal shunt was insu cient and where post-traumatic arachnoiditis was present in which the decompression was impossible due to di use adhesion. Change in syrinx size was evaluated with post-operative MRI in all seven cases and restoration of¯ow dynamics was evaluated with cine-MRI in three of the cases, two patients with clinical improvement and one patient with no change of clinical status, respectively. Results: Four out of seven patients showed symptomatic improvement after each decompressive operation. In the remaining three cases, reconstruction of the spinal subarachnoid space was not possible due to di use adhesion or was not the main problem as in the patient with syrinx associated with hydrocephalus who had to undergo a shunt operation. One of these three patients showed clinical improvement after undergoing syringosubarachnoid shunt. A decrease of syrinx size was observed in only two out of the ®ve patients who showed clinical improvement after treatment. Of these ®ve patients, two patients underwent post-operative cine-MRI and the restoration of normal CSF¯ow dynamics was noted in both patients. Of the remaining two patients, one underwent post-operative cine-MRI and there was no change in the CSF¯ow dynamics evident. Conclusion: These results suggest that the restoration of ...

Our study demonstrates that DHEA has no toxic effect on chondrocytes up to 100 micro M of concentration and has an ability to modulate the imbalance between MMPs and TIMP-1 during OA at the transcription level, which suggest that it has a protective role against articular cartilage loss.

Our finding of the thalamic rCBF decrease in PTSD patients may be a strategy to reduce re-experience symptom, by evading the process of external and internal information which can evoke traumatic memory. In addition, the parietal rCBF increase in our PTSD patients might be related to altered information processing in PTSD.