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101.
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María Gutiérrez Fernández David Carrasco de Andrés Luis Miguel Salmerón Febres Lucas González Herrera Silvia Jiménez Brobeil 《Cirugía espa?ola》2021,99(1):55-61
IntroductionTo analyse the influence of socioeconomic status on the clinical profile of patients undergoing non-traumatic lower-limb amputation.MethodsRetrospective study of 697 lower-limb amputee patients in an Angiology and Vascular Surgery Department during a 5-year period. Patients were classified according to their socioeconomic status (low, medium and high). We analysed demographic (age and gender) and clinical variables (cause of amputation, comorbidity, cardiovascular risk factors and amputation level).ResultsMean age was 70.5 ± 11.9 years, and the median was 72 years. The low socioeconomic status group presented a higher frequency of amputations in men. Cardiovascular risks factors were more frequent in this socioeconomic group, and the difference was statistically significant for diabetes (85.8% low, 69.3% medium, 65% high; P<.01) and obesity (31.4% low, 22.6% medium, 12.5% high, P<.01). Diabetic retinopathy was the only comorbidity with a significant association with low socioeconomic status (21.1% low, 15.3% medium, 12.5% high, P<.03). Regarding the cause for amputation, there was no difference in terms of socioeconomic status. The low socioeconomic level showed a higher frequency of major amputation, which was a significant difference (63.6% low, 41.2% medium, 55% high, P<.04) and a higher predisposition for this amputation level.ConclusionsThe low socioeconomic status has been shown to determine an unfavourable vascular risk profile in lower-limb non-traumatic amputees and a higher predisposition of a major amputation. This socioeconomic level demonstrates a negative influence on these patients’ diabetes, obesity and diabetic retinopathy. 相似文献
103.
I. Gonçalves Morais A. Barreira Martins 《Revista espa?ola de anestesiología y reanimación》2021,68(7):414-419
BackgroundChronic low back pain (CLBP) is a frequent condition, poorly managed with conventional treatments. The ultrasound-guided erector spinae plane block has increasingly been used in the management of acute and chronic pain. We aimed to determine this technique's analgesic efficacy in patients with moderate to severe CLBP.MethodsTen consecutively selected patients: adults, regularly followed in our Pain Clinic with moderate/severe long-term CLBP refractory to pharmacological treatment, VAS > 4. Prospective data collection: before the intervention –demographical data, past medical history, current pain therapies, VAS pain level, Brief Pain Inventory– Short Form and Neuropathic Pain Questionnaire; 30 minutes after – VAS and satisfaction level; 24 and 72 hours, 7 days and 1 month after - complications and pain level.ResultsMajority of females (90%), mean age of 70.3 years-old. All had primary musculoskeletal CLBP. 90% experienced severe pain (VAS > = 7) in the last 24 hours. Half presented neuropathic characteristics. Patients were very satisfied with the technique (mean: 8.75) with immediate pain relief (VAS mean: 2.3). 24 and 72 hours, 7 days and 1 month after the treatment VAS means were 3.2, 3.1, 3.8 and 6.2. We report a 20.8 days duration mean. No short or long-term complications.Discussion and conclusionsUltrasound-guided erector spinae plane block has preliminary advantages in CLBP: easily performed with low complications risk, immediate discharge home with absence of motor block, 100% efficacy at short and medium-terms. Even though pain's relief was shorter than a month, it is a useful tool allowing patients’ well-being, physical rehabilitation and exercise during this period. 相似文献
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Regional anaesthetic techniques are fundamental in the anaesthetic care of orthopaedic patients. They may be used as the primary anaesthetic technique or to provide postoperative pain relief. Compared to general anaesthesia alone, regional techniques can provide superior perioperative analgesia, fewer systemic drug adverse effects such as nausea, vomiting and confusion, and earlier mobilization which can reduce nosocomial complications and facilitate expedited hospital discharge. Disadvantages include block failure, nerve injury, unrecognised injury to the anaesthetised limb, prolonged motor blockade and local anaesthetic toxicity. Preoperative assessment should identify contraindications, document pre-existing neurological deficits, and clarify surgical and perioperative aims. Informed consent should be obtained after a clear explanation of the procedure, its risks, and potential complications. Serious and long-term neurological complications are rare and may be reduced by an awake regional technique, sonographic guidance, regular aspiration and by ensuring low pressure injections. Postoperative follow-up is essential and suspicious neurological findings should be detected, investigated, and managed in an early and timely manner. 相似文献
107.
《Anaesthesia and Intensive Care Medicine》2021,22(12):789-793
The addition of adjuvant agents to intrathecal and epidural anaesthetic techniques is well established, in particular opioids and clonidine. These adjuvants are utilized to improve the quality of anaesthesia and analgesia. Several other adjuvants have been studied but ongoing concerns surrounding safety and efficacy may limit their use in clinical practice. Epinephrine has for many years been administered in combination with local anaesthetic although more recently a diverse range of adjuvants have been added to peripheral nerve block solutions, again with the aim of prolonging surgical anaesthesia. The evidence to support or refute the benefit of these agents is increasing, as is our understanding of which agents have demonstrable efficacy and safety at clinically appropriate doses. Clinicians must be aware that many adjuvants are not licensed for central neuraxial or perineural use and should be aware of the risks, in particular of neurotoxicity and unwanted side effects. 相似文献
108.
《中国整形与重建外科(英文)》2021,3(4):218-223
Laser and light treatments have recently become popular owing to its efficacy in treating laxity, rhytids, hyperpigmentation of the lower eyelids, and drooping of septum fat. For several decades, our department has explored the application of laser and light treatment for eye rejuvenation. This paper summarizes common treatment methods and analyzes the published literature on the indications and outcomes of multiple laser and light treatments for lower eyelid rejuvenation. An extensive survey of peer-reviewed literature was performed using PubMed, with the search terms “noninvasive treatment”, “infraorbital”, “palpebral bags”, “lower eyelid”, “radiofrequency (RF)”, “laser”, “nonsurgical skin tightening”, and “noninvasive fat reduction”. The results showed that the use of lasers, intense pulsed light (IPL), monopolar RF, bipolar RF, AdipoLASER rejuvenation (ALJ), and fractional RF microneedling are safe and effective treatments for palpebral bags. We conclude that using Q-switched lasers, IPL, RF, ALJ, and fractional RF microneedling is safe and effective for lower eyelid rejuvenation, with minimal complications and quick recovery. Further research and development of optoelectronic therapy may encourage breakthroughs in lower eyelid treatment, such as simplified complex surgery and noninvasive methods. 相似文献
109.
Jingqi Zhang Shibo Zhu Liyu Zhang Wen Fu Jinhua Hu Zhao Zhang Wei Jia 《Translational andrology and urology》2021,10(5):2084
BackgroundThe effect of caudal block (CB) on the incidence of urethroplasty complications in hypospadias repair remains controversial. The evidence is conflicting, and some confounding bias issues need to be addressed. We sought to study a more homogenous group of distal hypospadias patients undergoing primary tubularized incised plate (TIP) repair by a senior pediatric urology surgeon in the past 2 years to examine the relationship between urethroplasty complications and the use of CB.MethodsWe reviewed our database to identify consecutive patients who had undergone hypospadias repairs by a senior director surgeon at our Center between January 2018 and November 2020. To be eligible to participate in the study, patients had to meet the following inclusion criteria: (I) have distal hypospadias; (II) have undergone a primary TIP repair; and (III) have attended follow-up appointments for a minimum period of 6 months. The primary outcome was the development of urethroplasty complications during the follow-up period. The principal variable of interest was whether or not CB was used perioperatively. The patients were categorized into a CB group (general anesthesia combined with CB) or a control group (general anesthesia only). Other potential risk factors were analyzed, including patient age at operation, patient weight, glans width, and the length of the urethral plate defect.ResultsThirty (12.2%) of the distal patients developed postoperative surgical complications. The postoperative surgical complication rates were similar between the different anesthesia groups. Weight, the length of the urethral plate length, and glans width did not contribute to the risk. Age was the only independent risk factor for postoperative surgical complications, and the complication rates increased in older patients.ConclusionsOur data from consecutive TIP repairs in distal hypospadias patients indicated no association between the use of CB anesthesia and the postoperative urethroplasty complication rate. Patients who were older in age when they underwent surgery had a higher risk of complications. 相似文献
110.