Introduction and Objective: Caudal block has been used in children for many years and is considered the gold standard for multimodal analgesia in the pediatric age group. Caudal block belongs to the category of central neuraxial blocks, which can provide both visceral and somatic analgesia. With the introduction of ultrasound into the clinical practice of anaesthesia, the caudal block is now performed under USG guidance. In our study, we aimed to compare the efficacy of a single caudal block in postoperative acute pain management, the need for additional analgesics, the incidence of side effects, the timing of initial analgesic administration, and the need for rescue analgesic administration (paracetamol 10 mg/kg) in circumcision surgery. Materials and Methods: 120 patients undergoing circumcision surgery were divided into 3 groups. The caudal block was performed in all cases under USG guidance. Only the caudal block was applied for cases in the Caudal group (Group C). The Caudal + paracetamol group (Group CP) received paracetamol 10 mg/kg intravenously (i.v.) and the caudal block. Patients in the Caudal + meperidine group (Group CM) received 1 mg/kg meperidine intravenously. The caudal block was performed in each case with a 0.5 ml/kg volume of 0.125% bupivacaine. Results: As a result of our study, it was found that the least postoperative pain occurred in 12.50% of the CM group (p=0.011). Significant results were obtained when weight and age variables were analyzed according to the groups (p-values p=0.011 and p=0.003, respectively). Significant differences were found between the input pulse values, 5-minute pulse values, 15-minute pulse values, and input SpO2 values (p values p < 0.001, p < 0.001, p=0.011, p=0.037, respectively). Only Wong-Baker pain scores at the 24th hour differed significantly from the periods measured after the groups (p < 0.001). There was no significant difference between the FLACC and Wong-Baker pain scores in the other periods. There was no difference between the groups regarding the time when postoperative analgesics were administered and the total amount of analgesics administered (rescue analgesic 10 mg/kg oral paracetamol) (p=0.408, p=0.238). Conclusion: Caudal block can be safely applied during circumcision. Ultrasound guidance increases the chances of success and reduces the complication rate. Caudal block can be safely used in pediatric surgery since it does not cause serious complications, has low postoperative pain scores, and reduces the number of postoperative analgesics.

Intussusceptive pillars, regarded as a hallmark of intussusceptive angiogenesis, have been described in developing vasculature of many organs and organisms. The aim of this study was to resolve the question about pillar formation and their further maturation employing zebrafish caudal vein plexus (CVP). The CVP development was monitored by in vivo confocal microscopy in high spatio-temporal resolution using the transgenic zebrafish model Fli1a:eGPF//Gata1:dsRed. We tracked back the formation of pillars (diameter ≤4µm) and intercapillary meshes (diameter >4µm) and analysed their morphology and behaviour. Transluminal pillars in the CVP arose by a combination of sprouting, lumen expansion, and/or by creation of intraluminal folds, and those mechanisms were not associated directly with blood flow. The follow-up of pillars indicated that one third of them disappeared between 28-48 hours post fertilisation (hpf) and of the remaining ones only 1/17 changed their cross-section area by >50%. The majority of the bigger meshes (39/62) increased their cross-section area by >50%. Plexus simplification and establishment of hierarchy was dominated by the dynamics of intercapillary meshes, which formed mainly by sprouting angiogenesis. These meshes were observed to grow, reshape, and merge with each other. Our observations suggested an alternative view on intussusceptive angiogenesis in the CVP.

Caudal regression syndrome (CRS) is a congenital abnormality characterized by an incomplete development of the spinal cord (SC) and other abnormalities. We studied a 9-months old CRS child presenting: interruption of SC at L2-L3 level, sacral agenesis, lack of innervation of the inferior limbs (flaccid paraplegia) and neurogenic bladder and bowel. Given the effects of growth hormone (GH) on the proliferation, differentiation and migration of neural stem cells (NSCs), we treated him with GH and rehabilitation, trying to induce the recovery of main sequelae. GMFM-88 test score was 12.31%. After a blood analysis, GH treatment (0.3 mg/day, 5 days/week, 3 months and then 15 days without GH) and rehabilitation commenced. This protocol was followed during 5 years, being the last GH dose 1 mg/day. Blood analysis and physical exams were performed every 3 months initially and every 6 months later. Six months after commencing the treatment GMFM-88 score increased to 39.48%. Responses to sensitive stimuli appeared in most of the territories explored; 18 months later sensitive innervation was complete and the patient moved any muscle over the knees and controlled his sphincters. Three years later he walked with the help of canes, there was plantar flexion and GMFM-88 score was 78.48%. In summary, GH plus rehabilitation may be useful for innervating distal territories, below the level of the incomplete spinal cord in CRS. Most likely, GH acts on ependymal SC NSCs, as the hormone does in the neurogenic niches in the brain.

This study examined the ventral process of C6 in extinct and extant Equus (sister taxa to Equus ferus caballus only) with the purpose of describing normal morphology and identifying anomalous variations relevant to recent studies describing a congenital malformation in E. ferus caballus. Overall, 83 specimens from 9 museums and 3 research/educational facilities were examined – 71 extinct specimens from 12 species and 12 extant specimens from 5 species. The lateral view revealed a large convexity existed in the ventral process between the cranial ventral tubercle (CrVT) and the caudal ventral tubercle (CVT) in the earliest ancestor Hyracotherium grangeri 55mya that receded throughout the millennia to a smaller convexity in E. ferus caballus and sister taxa. The CrVT was visibly shorter and narrower than the CVT with a constricted section directly ventral to the transverse process essentially demarcating the CrVT and CVT. No congenital malformations were evident. As the ventral process of C6 is an integral component for muscle attachment in supporting the head/neck during posture and locomotion, this would indicate the caudal module in the cervical column might be compromised when a partial or complete absence of the CVT is detected via radiographs in modern E. ferus caballus.

Eight amniote genera (representing four clades) became aquatic during the Permian. The four clades were mesosaurids, tangasaurids, the neodiapsid Claudiosaurus, and the procolophonid Barasaurus. Two of eight genera survived the end-Permian mass extinction, but did not last long into the Mesozoic. A previously undescribed specimen of Claudiosaurus germaini, preserved in a lacustrine concretion from the Sakamena Formation, Madagascar, bears seventeen vertebrae that has been split along an approximate horizontal plane to reveal sections of neural canal casted in white calcite. Enlargement of the neural canal in the sacral region of this specimen of Claudiosaurus (vertebral segments 22-26) is more similar to that of Tupinambis (segments 24-28) than it is to Testudo (segments 16-23). Claudiosaurus skeletal anatomy provides evidence for swim propulsion by both hind limbs and by undulation of a dorsal-ventrally flattened tail. Evidence for the latter includes elongate transverse processes on distal tail vertebrae. Other Permian aquatic reptile genera (Mesosaurus, Hovasaurus, Barasaurus) used snake-like side-to-side tail undulation, whereas Claudiosaurus used cetacean-like up-down tail undulation in the vertical plane. It seems unlikely that any of these animals were particularly fast swimmers.