Background: Intravenous infusion of lidocaine decreases postoperative pain and speeds the return of bowel function. The authors therefore tested the hypothesis that perioperative lidocaine infusion facilitates acute rehabilitation protocol in patients undergoing laparoscopic colectomy.
Methods: Forty patients scheduled to undergo laparoscopic colectomy were randomly allocated to receive intravenous lidocaine (bolus injection of 1.5 mg/kg lidocaine at induction of anesthesia, then a continuous infusion of 2 mg [middle dot] kg-1 [middle dot] h-1 intraoperatively and 1.33 mg [middle dot] kg-1 [middle dot] h-1 for 24 h postoperatively) or an equal volume of saline. All patients received similar intensive postoperative rehabilitation. Postoperative pain scores, opioid consumption, and fatigue scores were measured. Times to first flatus, defecation, and hospital discharge were recorded. Postoperative endocrine (cortisol and catecholamines) and metabolic (leukocytes, C-reactive protein, and glucose) responses were measured for 48 h. Data (presented as median [25-75% interquartile range], lidocaine vs. saline groups) were analyzed using Mann-Whitney tests. P < 0.05 was considered statistically significant.
Results: Patient demographics were similar in the two groups. Times to first flatus (17 [11-24] vs. 28 [25-33] h; P < 0.001), defecation (28 [24-37] vs. 51 [41-70] h; P = 0.001), and hospital discharge (2 [2-3] vs. 3 [3-4] days; P = 0.001) were significantly shorter in patients who received lidocaine. Lidocaine significantly reduced opioid consumption (8 [5-18] vs. 22 [14-36] mg; P = 0.005) and postoperative pain and fatigue scores. In contrast, endocrine and metabolic responses were similar in the two groups. 相似文献
A case study is presented in which a focal hand dystonia seems to have developed in the right hand of a classical guitarist as a result of a neuromuscular peripheral defect caused by trauma. The trauma was a near total perforation of the first web space by a splinter. Healing was uneventful without apparent functional complications. Two years later the patient noticed difficulties in extending the index in playing, for which he received various unsuccessful treatments during seven years. However, we found more severe dystonic symptoms (cocontractions) in the thumb than in the index during playing, which correlated with an undiagnosed insufficiency in the flexor pollicis brevis (FPB). This defect allowed proposing a biomechanical analysis of compensations for diminished thumb control in playing, which would explain the dysfunction in the index in playing as overcompensation for the thumb problem. If this analysis is correct, the etiology of the case can be traced back to underlying multiarticular control problems in the thumb caused by an insufficient FPB. This defect was considered irrepairable. It was concluded that even with knowledge of the underlying cause, a potentially successful treatment of the dystonia might not exist in this case. The case would demonstrate that task-specific hand dystonias can arise as overcompensations for (peripheral) neuro-musculoskeletal defects. The case is illustrated by videos of playing and functional thumb tests. 相似文献
A method for producing carrier free 66Ga (T1/2:9.4h; +) by 4He bombardment of natural copper targets is presented. 66Ga is formed by means of the 63Cu (4He, n) 66Ga reaction. Production yields are given in the 17.5 to 8 MeV 4He energy range. Chemical purification of 66Ga from the copper target is described. The only radionuclidic impurity found in the final product was 67Ga. Albumin colloids from commercially available kits designed for use with 99mTc could easily be labeled with 66Ga and employed for studies of the lymphatic system by positron emission tomography. 相似文献
Transient receptor potential (TRP) channels provide an enormous variability of Ca(2+) influx mechanisms triggered by a wide range of stimuli. In this review, we discuss the activation properties of the Ca(2+)- and Mg(2+)-permeable TRP channel of the vanilloid subfamily TRPV4. This channel is activated by various physical and chemical stimuli, such as cell swelling, heat, phorbols and, probably, by endogenous ligands, which are able to induce Ca(2+) entry. Not much is known about the regulation of this channel. We will refer only to a mechanism of Ca(2+)-dependent inhibition of TRPV4. Possible functional roles of this channel will be correlated with its observed expression pattern. Finally, we discuss the structural determinants of TRPV4 channel function. 相似文献
Prior to intracytoplasmic sperm injection (ICSI), seminal fluid is
currently washed out from the ejaculated semen and further sperm selection
is carried out by a discontinuous Percoll gradient. Possible deleterious
effects from the sperm-separating substance Percoll on sperm function or
embryo cleavage after in-vitro fertilization (IVF) have, to our knowledge,
not yet been reported and the use of Percoll has been widely accepted in
IVF. In this study, we examined whether the omission of the Percoll step in
the sperm preparation has any influence on the outcome of the ICSI
procedure. Two methods of sperm preparation for ICSI were compared in a
controlled study on sibling oocytes: washing the semen sample once,
followed by a Percoll gradient centrifugation versus washing the sperm
sample twice without a Percoll gradient centrifugation. The mean
fertilization rates were similar for the two sperm preparation methods:
78.2 +/- 21.4 and 75.0 +/- 24.1% respectively of the intact oocytes
displaying two pronuclei. Cleavage rates did not differ statistically
between the two groups. Whereas in both groups similar percentages of
excellent, good and poor quality embryos were obtained, the percentage of
fair quality embryos was significantly higher in the group without Percoll
(16.3 +/- 20.1 versus 9.1 +/- 15.7%). However, no statistical differences
were observed in either the percentage of transferable embryos or in the
percentage of embryos actually transferred or frozen in the two groups. In
conclusion, spermatozoa from ejaculates that are washed out from the
seminal fluid without any further selection can be used for ICSI without
any adverse effect on fertilization and embryo cleavage.
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