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1.
Distal nerve blocks at the wrist for outpatient carpal tunnel surgery offer intraoperative cardiovascular stability and reduce discharge time 总被引:2,自引:0,他引:2
Gebhard RE Al-Samsam T Greger J Khan A Chelly JE 《Anesthesia and analgesia》2002,95(2):351-5, table of contents
Carpal tunnel release is often performed as an outpatient procedure. We designed this retrospective study to assess the effect of different anesthesia techniques on intraoperative cardiovascular stability and discharge time. According to the anesthesia technique received, 62 consecutive patients were categorized in Group BIER (IV regional anesthesia), Group BLOCK (distal nerve blocks), and Group GENERAL (general anesthesia). Incidences of intraoperative periods of tachycardia or bradycardia and hyper- or hypotension were studied, as were tourniquet, surgical, operating room, and discharge times. Cardiovascular stability was better achieved in Group BLOCK, as indicated by a significantly smaller incidence of periods of hypertension compared with Group BIER (5% vs 25%) and a significantly less frequent incidence of periods of hypotension compared with Group GENERAL (14% vs 42%). Patients in Group BLOCK spent significantly less time in the hospital after surgery than patients in Group BIER (65 vs 88 min) or patients in Group GENERAL (65 vs 133 min). We conclude that distal nerve blocks for outpatient carpal tunnel surgery are associated with greater intraoperative cardiovascular stability than general anesthesia. After surgery, patients in Group BLOCK could be discharged earlier than patients who received IV regional anesthesia or general anesthesia; this could be related to the superior postoperative analgesia provided by this technique. IMPLICATIONS: This retrospective analysis of three different anesthetic techniques for ambulatory carpal tunnel surgery shows that nerve blocks performed at the wrist provided excellent intraoperative cardiovascular stability and allowed for earlier discharge. 相似文献
2.
Willemieke S. Tummers Sarah E. Miller Nutte T. Teraphongphom Adam Gomez Idan Steinberg David M. Huland Steve Hong Sri-Rajasekhar Kothapalli Alifia Hasan Robert Ertsey Bert A. Bonsing Alexander L. Vahrmeijer Rutger-Jan Swijnenburg Teri A. Longacre George A. Fisher Sanjiv S. Gambhir George A. Poultsides Eben L. Rosenthal 《Annals of surgical oncology》2018,25(7):1880-1888
Background
Operative management of pancreatic ductal adenocarcinoma (PDAC) is complicated by several key decisions during the procedure. Identification of metastatic disease at the outset and, when none is found, complete (R0) resection of primary tumor are key to optimizing clinical outcomes. The use of tumor-targeted molecular imaging, based on photoacoustic and fluorescence optical imaging, can provide crucial information to the surgeon. The first-in-human use of multimodality molecular imaging for intraoperative detection of pancreatic cancer is reported using cetuximab-IRDye800, a near-infrared fluorescent agent that binds to epidermal growth factor receptor.Methods
A dose-escalation study was performed to assess safety and feasibility of targeting and identifying PDAC in a tumor-specific manner using cetuximab-IRDye800 in patients undergoing surgical resection for pancreatic cancer. Patients received a loading dose of 100 mg of unlabeled cetuximab before infusion of cetuximab-IRDye800 (50 mg or 100 mg). Multi-instrument fluorescence imaging was performed throughout the surgery in addition to fluorescence and photoacoustic imaging ex vivo.Results
Seven patients with resectable pancreatic masses suspected to be PDAC were enrolled in this study. Fluorescence imaging successfully identified tumor with a significantly higher mean fluorescence intensity in the tumor (0.09?±?0.06) versus surrounding normal pancreatic tissue (0.02?±?0.01), and pancreatitis (0.04?±?0.01; p?<?0.001), with a sensitivity of 96.1% and specificity of 67.0%. The mean photoacoustic signal in the tumor site was 3.7-fold higher than surrounding tissue.Conclusions
The safety and feasibilty of intraoperative, tumor-specific detection of PDAC using cetuximab-IRDye800 with multimodal molecular imaging of the primary tumor and metastases was demonstrated.3.
We report our experience with a five-year-old child with d-transposition of great arteries (d-TGA), ventricular septal defect (VSD), and severe pulmonary arterial hypertension (PAH). A fenestrated unidirectional-valved patch was used to close the VSD and a standard arterial witch operation (ASO) was performed. Difficulties in assessment of operability and the choice of procedures in such patients are briefly discussed. 相似文献
4.
Tameem HZ Ardekani S Seeger L Thompson P Sinha US 《Journal of magnetic resonance imaging : JMRI》2011,34(2):372-383
Purpose:
To create an average atlas of knee femoral cartilage morphology, to apply the atlas for quantitative assessment of osteoarthritis (OA), and to study localized sex differences.Materials and Methods:
High‐resolution 3D magnetic resonance imaging (MRI) data of the knee cartilage collected at 3 T as part of the Osteoarthritis Initiative (OAI) were used. An atlas was created based on images from 30 male Caucasian high‐risk subjects with no symptomatic OA at baseline. A female cohort of age‐ and disease‐matched Caucasian subjects was also selected from the OAI database. The Jacobian determinant was calculated from the deformation vector fields that nonlinearly registered each subject to the atlas. Statistical analysis based on the general linear model was used to test for regions of significant differences in the Jacobian values between the two cohorts.Results:
The average Jacobian was larger in women (1.2 ± 0.078) than in men (1.08 ± 0.097), showing that after global scaling to the male template, the female cartilage was thicker in most regions. Regions showing significant structural differences include the medial weight bearing region, the trochlear (femoral) side of the patellofemoral compartment, and the lateral posterior condyle.Conclusion:
Sex‐based differences in cartilage structure were localized using tensor based morphometry in a cohort of high‐risk subjects. J. Magn. Reson. Imaging 2011;. © 2011 Wiley‐Liss, Inc. 相似文献5.
6.
Detection and phylogenetic analysis of human pegivirus (GBV‐C) among blood donors and patients infected with hepatitis B virus (HBV) in Qatar
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7.
Continuous lumbar plexus block for acute postoperative pain management after open reduction and internal fixation of acetabular fractures 总被引:1,自引:0,他引:1
Chelly JE Casati A Al-Samsam T Coupe K Criswell A Tucker J 《Journal of orthopaedic trauma》2003,17(5):362-367
OBJECTIVE: To assess the efficacy of postoperative continuous lumbar plexus blocks for postoperative pain control in patients undergoing open reduction and internal fixation of an acetabular fracture. PATIENTS/PARTICIPANTS: Twenty-six patients who underwent open reduction and internal fixation of an acetabular fracture. DESIGN/PERSPECTIVE: According to a case-control study design, patients were divided into 2 groups: Group 1 (n = 13) received postoperatively a continuous lumbar plexus block with 0.2% ropivacaine (10 mL/hr for 48 hours), and group 2 (n = 13) received postoperatively patient-controlled analgesia with morphine (1 mg; lock-out time, 10 minutes; total 6 mg/hr). MAIN OUTCOME MEASUREMENTS: Postoperative morphine consumption, time to unassisted ambulation, and clinical and radiographic outcomes. RESULTS: No significant differences in demographics, surgical procedure, or duration of surgery were reported between the two groups. The lumbar plexus catheter group showed a lower requirement for morphine in the postanesthesia care unit (6 mg [0-14 mg]) and during the first 2 days (20 mg [6-55 mg] on day 1 and 29 mg [4-56 mg] on day 2) than the control group (51 mg [20-100 mg] on day 1 and 50 mg [10-93 mg] on day 2) (P = 0.001 and P = 0.021). Effective unassisted ambulation was recovered earlier in patients with the lumbar plexus catheter (3 days; range 2-4 days) than in the control group (4 days; range 3-7 days) (P = 0.015). CONCLUSIONS: Continuous lumbar plexus block represents an interesting alternative for postoperative pain control in patients undergoing open reduction and internal fixation of an acetabular fracture. 相似文献
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9.
目的:探讨完全性左束支传导阻滞(LBBB)与冠状动脉病变的关系。方法:回顾分析完成冠状动脉造影检查的LBBB患者的临床和冠状动脉造影资料。结果:77例LBBB患者25例诊断冠心病,其中左前降支病变21例,回旋支病变9例,右冠状动脉病变11例;合并冠心病患者心血管危险因子数目明显增加。结论:心血管危险因子数目增多的LBBB患者冠心病的可能性大,冠状动脉造影有助于冠心病的诊断;冠心病患者LBBB的出现可能与前降支病变有关。 相似文献
10.
Kulik LM Atassi B van Holsbeeck L Souman T Lewandowski RJ Mulcahy MF Hunter RD Nemcek AA Abecassis MM Haines KG Salem R 《Journal of surgical oncology》2006,94(7):572-586
PURPOSE: To present the clinical data of 35 patients with T3 unresectable hepatocellular carcinoma (HCC) that were treated with (90)Y with the specific intent of downstaging to resection, radiofrequency ablation (RFA) candidate, United Network for Organ Sharing (UNOS) stage T2 or liver transplantation. MATERIALS AND METHODS: One hundred fifty patients with unresectable HCC were treated with (90)Y microspheres. Of these, 35 patients were UNOS stage T3 at the time of treatment. Patients were followed for clinical toxicities, alterations in model for end-stage-liver disease (MELD) score, tumor response, downstaging to RFA, resection, transplantation, and survival. RESULTS: Nineteen of 34 patients (56%) were successfully downstaged from T3 to T2 following treatment. 11 of 34 (32%) patients treated were downstaged to target lesions measuring 3.0 cm or less. Twenty-three of 35 (66%) were downstaged to either T2 status, lesion < 3.0 cm (RFA candidate), or resection. Seventeen of 34 (50%) had an objective tumor response by WHO criteria. Eight patients (23%) were successfully downstaged and underwent OLT following treatment. 1, 2, and 3-year survival was 84%, 54%, and 27%, respectively. Median survival by Kaplan-Meier analysis for the entire cohort was 800 days. CONCLUSION: These data suggest that intra-arterial (90)Y microspheres can be used as a bridge to transplantation, surgical resection, or RFA. 相似文献