Both procedures are usually performed percutaneously with considerable failure rates. A subpleural catheter placed in the space posterior to the parietal pleura and alongside the paravertebral area may provide superior postoperative pain relief.\n\nObjective To compare subpleural analgesia with thoracic epidural analgesia in patients undergoing thoracotomy.\n\nDesign Randomised, double-blind

study.\n\nSetting A tertiary care University Medical Centre between 26 June 2008 and 21 March 2011. Patients Forty-two patients scheduled for elective posterolateral thoracotomy.\n\nPatients with American Society of Anesthesiologists physical status >= 4, with a previous history of thoracotomy, on chronic pain medications or with a contraindication to receiving local anaesthetics or thoracic epidural block were excluded from the study.\n\nInterventions this website selleck screening library Patients were randomised to receive either subpleural analgesia or thoracic epidural analgesia for 24-h post-thoracotomy pain control.\n\nMain outcome measures A visual analogue scale was used to assess pain at rest and on coughing during the first 24 h postoperatively and the incidence of hypotension was recorded.\n\nResults Patients

who received subpleural analgesia had higher visual analogue scores at rest and on coughing than those who received thoracic epidural analgesia. Seven patients who started with subpleural analgesia were treated with thoracic epidural analgesia at a mean (SD) of 3.9 (4.8) h. The remaining 14 patients had a median (IQR [range]) visual analogue score of 5 cm (4-5 [3-6]) at rest and were maintained on subpleural analgesia until the end of the study. The visual analogue score at rest was < 7cm in all 21 patients who received

thoracic epidural analgesia and none was switched to subpleural analgesia during the study. None of the patients in the subpleural analgesia group experienced hypotension compared with five of the 21 patients in the thoracic epidural analgesia group (P = 0.047).\n\nConclusion Thoracic epidural analgesia is superior to subpleural analgesia in relieving Fer-1 post-thoracotomy pain. Eur J Anaesthesiol 2012; 29: 186-191″
“The conulariids, an enigmatic fossil group believed to be of cnidarian (scyphozoan) affinity, have four-sided, acutely pyramidal exoskeletons terminated in apertural closures. To date, three main closure types have been recognised in conulariids (plicated, triangular lappets, and lobate lappets) but the first type is poorly illustrated in the literature. Here we present the first photographic illustration of an unequivocal plicated closure in Metaconularia? anomala, based on study of the rich (1700+specimens) material from the Upper Ordovician of the Prague Basin. This closure is formed by inwardly folded, triangular lappets centred on each of the four faces, with kite-shaped elements centred on the four corners forming a webbing between the lappets.