Effect of platelets-rich plasma on scalp hair diameter

Summary

Objectives

To measure the effects of platelet-rich plasma (PRP) on hair diameter in Pakistani population.

Materials and methods

The study was conducted in a private setup in the adult patients undergoing PRP treatment. Baseline platelets count was noted for each patient. PRP was prepared using a commercial kit. Three PRP injections were administered in the scalp at 0, 1, and 3 months of interval. The hair caliber was measured in the mid-scalp area using a separate stencil for each patient. The diameter of 10 hair (1 cm sq) was measured randomly using the caliper (2 hair on each side of the square and 4 in the center). After 6 months of 3rd injection, the hair caliber was measured and the results were analyzed statistically using Mann-Whitney's test.

Results

Seven men and 3 women were included in the study. The mean age of the patients was 24.2 years (26.3 years in males and 19.3 in females). The average platelets count was found to be 283,580/μL. The mean hair caliber was 37.3 μm (39.1 μm in men and 33.0 μm in women). At the end of the study, the mean hair caliber was found to be 52.3 μm (P < .01). The mean hair caliber was 53.9 μm in men and 48.7 μm in women (P < .01). The increase in the hair caliber was noted to be 27.5% more in men and 31.3% more in women (P < .01).

Conclusion

The PRP injections can increase the hair diameter.

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Level of agreement between laboratory and point-of-care prothrombin time in patients after stopping or continuation of acenocoumarol anticoagulation: A comparison of diagnostic accuracy

BACKGROUND Procedures requiring optimisation of the coagulation status of patients using vitamin K antagonists are frequently postponed due to the late availability of laboratory international normalised ratio (INR) test results. A point-of-care (POC) alternative may facilitate early decision-making in peri-operative patients. OBJECTIVES To assess the level of agreement between the POC-INR and the laboratory INR in patients who continue or stop vitamin K antagonists to determine whether the POC test may be a good alternative to the laboratory INR. DESIGN Study of diagnostic accuracy. SETTING Single-centre study at Zaans Medical Centre, The Netherlands. PATIENTS Included patients were scheduled for cardioversion (these continued taking vitamin K antagonists), or a surgical procedure (these stopped taking vitamin K antagonists). MAIN OUTCOME MEASURES The level of agreement and clinical acceptability of the laboratory and POC-INR results, evaluated by Bland–Altman analysis and error grid analysis. RESULTS The surgical and cardioversion groups consisted of 47 and 46 patients, respectively. The bias in the INR in the surgical group was −0.12 ± 0.09 with limits of agreement of −0.29 to 0.05, whereas the cardioversion group showed a bias in the INR of −0.22 ± 0.36 with limits of agreement from −0.93 to 0.48. The percentage errors between methods in the surgical and cardioversion groups were 16 and 21%, respectively. Error grid analysis showed that the diagnostic accuracy of the POC prothrombin time is clinically acceptable as the difference did not lead to a different clinical decision in the surgical group with INR values less than 1.8. CONCLUSION The current study shows a good level of agreement and clinical accuracy between the laboratory and POC-INR in patients who stopped anticoagulation intake for surgery. However, in patients who continued their anticoagulation therapy, the agreement between the two methods was less accurate. Correspondence to Elisabeth A.J. de Vos, MD, Department of Anesthesiology, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands Tel: +31 20 4443830; e-mail: e.devos@vumc.nl © 2018 European Society of Anaesthesiology

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Improving detection of patient deterioration in the general hospital ward environment

Patient monitoring on low acuity general hospital wards is currently based largely on intermittent observations and measurements of simple variables, such as blood pressure and temperature, by nursing staff. Often several hours can pass between such measurements and patient deterioration can go unnoticed. Moreover, the integration and interpretation of the information gleaned through these measurements remains highly dependent on clinical judgement. More intensive monitoring, which is commonly used in peri-operative and intensive care settings, is more likely to lead to the early identification of patients who are developing complications than is intermittent monitoring. Early identification can trigger appropriate management, thereby reducing the need for higher acuity care, reducing hospital lengths of stay and admission costs and even, at times, improving survival. However, this degree of monitoring has thus far been considered largely inappropriate for general hospital ward settings due to device costs and the need for staff expertise in data interpretation. In this review, we discuss some developing options to improve patient monitoring and thus detection of deterioration in low acuity general hospital wards. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP Correspondence to Dr Jean-Louis Vincent, Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Route de Lennik 808, 1070 Brussels, Belgium E-mail: jlvincent@intensive.org © 2018 European Society of Anaesthesiology

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Opioid-related genetic polymorphisms do not influence postoperative opioid requirement: A prospective observational study

BACKGROUND Among the various factors that may influence the pharmacological response to opioids, genetic polymorphisms [single nucleotide polymorphisms (SNP)] have generated some interest. OBJECTIVES To examine the influence on morphine dose requirements and adverse events in the postoperative period of four SNP [opioid receptor mu1 (OPRM1), ATP-binding cassette subfamily B, member 1 (ABCB1) ex-21 and ex-26, catechol-o-methyltransferase (COMT)] in candidate genes involved in morphine pharmacodynamics and pharmacokinetics. DESIGN A single centre prospective study. SETTING University Hospital, Paris, France, from 2 January 2007 to 15 November 2011. PATIENTS A total of 438 white adults scheduled for major orthopaedic surgery (spine, hip and knee) under general anaesthesia. The main exclusion criteria were receiving opioids for chronic pain, nonopioid drugs within 2 days prior to surgery, pregnancy, renal insufficiency, sleep apnoea obstruction syndrome, morbid obesity, severe hepatic impairment, cognitive dysfunction. INTERVENTIONS Assays of plasma concentrations of morphine and metabolites (morphine 3-glucuronide and morphine 6-glucuronide) were performed and common polymorphisms in four candidate genes [OPRM1 A118G rs1799971; P-glycoprotein (ABCB1) T3435C (rs1045642) and G2677T/A (rs2032582); COMT Val 158 Met (rs4680)] were analysed. Morphine was titrated by staff in the postanaesthesia care unit (PACU) and in the ward patient-controlled intravenous analgesia was used for 24 h. MAIN OUTCOME MEASURES The dose of morphine required to achieve pain relief and the influence of SNP in genes involved in morphine pharmacodynamics and kinetics on morphine dose requirements. Secondary endpoints were the concentrations of morphine, morphine 6-glucuronide and morphine 3-gluguronide, the proportion of patients requiring a rescue analgesic and the proportion of morphine-related adverse events. RESULTS A total of 404 patients completed the study to final analysis. The mean ± SD morphine dose to achieve pain relief was 15.8 ± 8.8 mg in the PACU and 22.7 ± 18.6 mg during patient-controlled intravenous administration. Morphine-related adverse events were observed in 37%. There was no relationship between any genetic polymorphisms and morphine dose, morphine 3-gluguronide and morphine 6-glucuronide concentration, morphine-related adverse events or pain level. In the PACU only, P-glycoprotein polymorphisms (ex-21; ex-26) were significantly associated with morphine concentration but the prediction of the model was poor (R2 = 0.04) CONCLUSION No major relationship has been demonstrated between SNP of OPRM1, ABCB1, COMT and morphine requirement, pain level or adverse effects in the postoperative period. TRIAL REGISTRATION NCT00822549 (www.clinicaltrials.gov). Correspondence to Frédéric Aubrun, Département d'Anesthésie-Réanimation, Hôpital de la Croix-Rousse, 103 Boulevard de La Croix Rousse, 69004 Lyon, France E-mail: frederic.aubrun@chu-lyon.fr Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://ift.tt/2ylyqmW). © 2018 European Society of Anaesthesiology

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Transoral radical tonsillectomy and retropharyngeal lymph node dissection with a flexible next generation robotic surgical system

Abstract

Background

The purpose of this study was to describe the use of a novel flexible, single-arm robot in performing a transoral radical tonsillectomy and retropharyngeal lymph node dissection.

Methods

A 63-year-old man with a T1N2bM0 (American Joint Committee on Cancer seventh edition classification) squamous cell carcinoma (SCC) of the left tonsil underwent a transoral robotic radical tonsillectomy and retropharyngeal lymph node dissection, followed by a left selective neck dissection of levels I to IV.

Results

The tonsillar tumor was removed completely with a negative margin that was followed by a dissection and removal of a retropharyngeal lymph node, completed with primary closure of the site. A left selective neck dissection was then performed. The patient was tolerating an oral diet on postoperative day 1 and had no robotic or surgically related complications at 30-day follow-up.

Conclusion

It is feasible and safe to use this novel, flexible, single-arm robot in performing a transoral robotic radical tonsillectomy and retropharyngeal lymph node dissection.

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Mixed adenoneuroendocrine carcinoma of the tongue arising within a congenital enteric cyst

Abstract

Background

Primary intestinal-type adenocarcinoma of the tongue is rare. This represents the first reported case of a primary mixed adenoneuroendocrine carcinoma (MANEC) of the tongue arising within a congenital enteric cyst.

Methods

A 52-year-old man presented with a midline tongue mass that was connected to the mucosal surface with an epithelial-lined sinus tract. Morphological examination and immunohistochemical profiling of the neoplasm were performed.

Results

Histopathological evaluation showed a primary MANEC arising within a preexisting congenital enteric cyst, comprising both adenocarcinoma and neuroendocrine components. The adenocarcinoma had a colonic-type morphology and coexpressed CK7, CK20, and CDX2. Imaging and colonoscopy excluded a distant primary colorectal neoplasm.

Conclusion

The association of primary MANEC of the tongue with a gastrointestinal heterotopic cyst supports an origin from entrapped endodermal elements as opposed to salivary duct origin. This case raises the awareness of a rare yet prognostically important complication of a gastrointestinal heterotopic cyst.

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Double-blind placebo-controlled multicenter phase II trial to evaluate D-methionine in preventing/reducing oral mucositis induced by radiation and chemotherapy for head and neck cancer

Abstract

Background

The purpose of this study was to test if oral D-methionine (D-met) reduced mucositis during chemoradiotherapy.

Methods

We conducted a placebo-controlled double-blind randomized phase II trial of D-met (100 mg/kg p.o. b.i.d.) testing the rate of severe (grades 3-4) mucositis.

Results

Sixty patients were randomized. Grade 2 + oral pain was higher with placebo (79% vs 45%; P = .0165), whereas grade 2 + body odor was greater with D-met (3% vs 41%; P = .0015). Mucositis was decreased with D-met by the physician (World Health Organization [WHO], P = .007; Radiation Therapy Oncology Group [RTOG], P = .009) and patient functional scales (RTOG, P = .0023). The primary end point of grades 3 to 4 mucositis on the composite scale demonstrated a decrease with D-met (48% vs 24%; P = .058), which was borderline in significance. A planned secondary analysis of a semiquantitative scoring system noted decreased oral ulceration (2.2 vs 1.5; P = .023) and erythema (1.6 vs 1.1; P = .048) with D-met.

Conclusion

Although not meeting the primary end point, results of multiple assessments suggest that D-met decreased mucositis.

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