This randomized clinical trial compared the effectiveness of intra-articular lidocaine versus intravenous meperidine/diazepam for pain relief in patients with anterior shoulder dislocations. 48 patients were randomly assigned to receive either intra-articular lidocaine or intravenous meperidine/diazepam. Pain levels were recorded before and after the interventions and closed reduction of the shoulder. Both groups experienced a significant decline in pain with no severe complications reported. Intra-articular lidocaine provided comparable pain relief to intravenous meperidine and diazepam for reduction of anterior shoulder dislocations.
1. This study compared general anesthesia (GA) and spinal anesthesia (SA) for 100 patients undergoing lumbar disk surgery through a randomized controlled trial.
2. Intraoperatively, mean blood loss was less with GA but not significantly. Surgeon satisfaction was higher with GA. No major complications occurred with either.
3. Postoperatively, hypertension was more common after GA, and nausea/vomiting were more frequent after SA.
4. Contrary to previous studies, the findings revealed SA had no advantages over GA, and GA may reduce risks and complications.
Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...Peter Millett MD
Arthroscopic treatment of the unstable shoulder has evolved rapidly and significantly in recent years. Better understanding of the pathoanatomy, advancements in technology, and improved surgical techniques have led to dramatic improvements in outcome. An arthroscopic approach includes significant advantages. Arthroscopy provides better identification of concomitant pathology, lower morbidity, less soft tissue dissection, maximal preservation of motion, shorter surgical time, and improved cosmesis. There is less pain, and many patients have an easier functional recovery, with greater returns in motion compared with traditional open techniques. Finally, some of the inherent risks of open procedures, such as postoperative subscapularis rupture, are virtually eliminated. Surgeons can now routinely expect results that are at least comparable, if not better than, those achieved with open techniques. For more shoulder surgery and instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
1) Acute traumatic anterior shoulder dislocation is common in athletes and occurs most often in the anterior direction.
2) For a first-time dislocation, a systematic clinical evaluation and prompt closed reduction are important, followed by consideration of immobilization, rehabilitation, and possible surgical repair depending on factors like timing in the athletic season.
3) Pathoanatomic lesions vary based on factors like age, mechanism of injury, and can include labral tears, rotator cuff tears, and ligament injuries like Bankart lesions or HAGL lesions.
This document provides an overview of regional anesthesia techniques for total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA). It discusses the evidence regarding general versus regional anesthesia, as well as various regional techniques for intraoperative anesthesia and postoperative analgesia. While regional anesthesia is associated with improvements in some outcomes like pain control and reduced side effects, the evidence on other outcomes like infection rates and length of stay is mixed compared to general anesthesia. A variety of regional techniques can provide effective analgesia after TJA, including neuraxial blocks, peripheral nerve blocks, and extended-release epidural morphine, but they each have specific risks and benefits to consider.
Role of the new imaging modalities in the investigation of meniere diseaseCristian Yañez
The study evaluated imaging findings in 23 patients with definite Meniere's disease (MD) compared to 50 control subjects. High-resolution CT scans found that the vestibular aqueduct (VA) was nonvisualized more frequently in the MD group (27.8% of diseased ears vs 3.4% in controls), as was the endolymphatic duct-endolymphatic sac complex on MRI (39.1% vs 64.1%). Pneumatization around the VA was also lower in the MD group. The results suggest impaired flow of endolymph toward the endolymphatic sac may be involved in the pathophysiology of MD at different disease stages.
This document summarizes clinical studies and cost analyses that demonstrate the importance of maintaining perioperative normothermia. Several studies show that hypothermia can lead to increased surgical site infections, longer hospital stays, more blood loss and transfusions, prolonged drug effects, and increased mortality. Additionally, meta-analyses found that maintaining normothermia results in cost savings of $2495 to $7073 per patient in the US due to reductions in complications. Prewarming patients for 30 minutes before surgery can help prevent inadvertent perioperative hypothermia.
This document provides guidelines for myocardial perfusion imaging (MPI), including:
1. MPI utilizes radiopharmaceuticals and imaging techniques to identify areas of reduced blood flow in the heart associated with ischemia or scar.
2. Common indications for MPI are to assess for presence, location, and severity of perfusion abnormalities; determine significance of angiographic findings; and detect viable ischemic myocardium.
3. Common clinical settings are for known or suspected coronary artery disease, follow-up of patients with known CAD, and evaluation of congestive heart failure.
1. This study compared general anesthesia (GA) and spinal anesthesia (SA) for 100 patients undergoing lumbar disk surgery through a randomized controlled trial.
2. Intraoperatively, mean blood loss was less with GA but not significantly. Surgeon satisfaction was higher with GA. No major complications occurred with either.
3. Postoperatively, hypertension was more common after GA, and nausea/vomiting were more frequent after SA.
4. Contrary to previous studies, the findings revealed SA had no advantages over GA, and GA may reduce risks and complications.
Arthroscopic Management of Anterior, Posterior, and Multidirectional Shoulder...Peter Millett MD
Arthroscopic treatment of the unstable shoulder has evolved rapidly and significantly in recent years. Better understanding of the pathoanatomy, advancements in technology, and improved surgical techniques have led to dramatic improvements in outcome. An arthroscopic approach includes significant advantages. Arthroscopy provides better identification of concomitant pathology, lower morbidity, less soft tissue dissection, maximal preservation of motion, shorter surgical time, and improved cosmesis. There is less pain, and many patients have an easier functional recovery, with greater returns in motion compared with traditional open techniques. Finally, some of the inherent risks of open procedures, such as postoperative subscapularis rupture, are virtually eliminated. Surgeons can now routinely expect results that are at least comparable, if not better than, those achieved with open techniques. For more shoulder surgery and instability studies, visit Dr. Millett, Orthopedic Surgeon, Vail Colorado http://drmillett.com/shoulder-studies
A C S0105 Postoperative Management Of The Hospitalized Patientmedbookonline
This document discusses postoperative management of surgical patients. It describes the different levels of postoperative care including same-day surgery, the surgical floor, telemetry ward, and intensive care unit. Factors determining a patient's disposition include their preoperative health, procedure performed, and postoperative clinical status. The document also discusses common postoperative orders related to tubes, drains, oxygen therapy, and wound care to guide nursing staff.
1) Acute traumatic anterior shoulder dislocation is common in athletes and occurs most often in the anterior direction.
2) For a first-time dislocation, a systematic clinical evaluation and prompt closed reduction are important, followed by consideration of immobilization, rehabilitation, and possible surgical repair depending on factors like timing in the athletic season.
3) Pathoanatomic lesions vary based on factors like age, mechanism of injury, and can include labral tears, rotator cuff tears, and ligament injuries like Bankart lesions or HAGL lesions.
This document provides an overview of regional anesthesia techniques for total joint arthroplasty (TJA), including total hip arthroplasty (THA) and total knee arthroplasty (TKA). It discusses the evidence regarding general versus regional anesthesia, as well as various regional techniques for intraoperative anesthesia and postoperative analgesia. While regional anesthesia is associated with improvements in some outcomes like pain control and reduced side effects, the evidence on other outcomes like infection rates and length of stay is mixed compared to general anesthesia. A variety of regional techniques can provide effective analgesia after TJA, including neuraxial blocks, peripheral nerve blocks, and extended-release epidural morphine, but they each have specific risks and benefits to consider.
Role of the new imaging modalities in the investigation of meniere diseaseCristian Yañez
The study evaluated imaging findings in 23 patients with definite Meniere's disease (MD) compared to 50 control subjects. High-resolution CT scans found that the vestibular aqueduct (VA) was nonvisualized more frequently in the MD group (27.8% of diseased ears vs 3.4% in controls), as was the endolymphatic duct-endolymphatic sac complex on MRI (39.1% vs 64.1%). Pneumatization around the VA was also lower in the MD group. The results suggest impaired flow of endolymph toward the endolymphatic sac may be involved in the pathophysiology of MD at different disease stages.
This document summarizes clinical studies and cost analyses that demonstrate the importance of maintaining perioperative normothermia. Several studies show that hypothermia can lead to increased surgical site infections, longer hospital stays, more blood loss and transfusions, prolonged drug effects, and increased mortality. Additionally, meta-analyses found that maintaining normothermia results in cost savings of $2495 to $7073 per patient in the US due to reductions in complications. Prewarming patients for 30 minutes before surgery can help prevent inadvertent perioperative hypothermia.
This document provides guidelines for myocardial perfusion imaging (MPI), including:
1. MPI utilizes radiopharmaceuticals and imaging techniques to identify areas of reduced blood flow in the heart associated with ischemia or scar.
2. Common indications for MPI are to assess for presence, location, and severity of perfusion abnormalities; determine significance of angiographic findings; and detect viable ischemic myocardium.
3. Common clinical settings are for known or suspected coronary artery disease, follow-up of patients with known CAD, and evaluation of congestive heart failure.
The study evaluated the efficacy of paraffin bath therapy for hand osteoarthritis. 56 patients were randomly assigned to either a treatment group receiving paraffin baths or a control group. Outcome measures including pain, hand function, range of motion and strength were assessed at baseline, 3 weeks and 12 weeks. At 12 weeks, the treatment group showed significantly greater improvements in pain, range of motion and strength compared to the control group. Paraffin bath therapy appeared effective in reducing pain and maintaining strength for hand osteoarthritis over 12 weeks.
Ct scan , self care, rehab after traumatic brain injuryConnie Dello Buono
This study examined the association between early CT scan findings and needs for assistance with ambulation, self-care, and supervision at rehabilitation discharge and 1 year after traumatic brain injury (TBI). The study analyzed CT scans from 1839 TBI patients taken during the first week after injury and recorded findings such as midline shift, subcortical contusions, and bilateral frontal or temporal contusions. It found that a midline shift greater than 5mm or subcortical contusions were associated with greater needs for assistance at discharge, and subcortical contusions were also associated with needs at 1 year. Bilateral frontal or temporal contusions were associated with needs for greater supervision at discharge but not for ambulation or self-care
This document summarizes anorectal surgeries performed at Nova Medical Centers in Bangalore, India between August 2009 and August 2011. A total of 110 surgeries were performed, including stapled hemorrhoidectomies, fistulectomies, and abscess drainages. Most patients were discharged on the same day. Post-operative outcomes were good, with only 3 patients experiencing urinary retention and all patients following up regularly. The aim was to evaluate operating anorectal procedures in an outpatient surgery center.
This document discusses frozen shoulder, also known as adhesive capsulitis. It begins by describing frozen shoulder and its prevalence, then discusses its classification. The etiology is unclear but patients typically show characteristic histories and presentations. The document proposes two classification systems, one based on primary versus secondary causes, and another based on patient irritability levels. Non-operative treatments discussed include corticosteroid injections, exercise, and joint mobilization. Corticosteroid injections, in particular glenohumeral intra-articular injections, provide improved short and long term outcomes compared to other treatments. Manipulation or surgery may be considered for recalcitrant cases.
This document provides an introduction to guidelines for the surgical management of traumatic brain injury (TBI). TBI affects up to 2% of the population per year and is a major cause of death and disability, especially in young people. Intracranial hematomas complicate 25-45% of severe TBI cases and are the most important complication, as they can transform an otherwise mild injury into death or permanent disability if not treated effectively and promptly. The guidelines were created by a group of neurosurgeons to provide evidence-based recommendations for surgical management of post-traumatic intracranial mass lesions based on a review of over 700 publications from 1975-2001. However, there are no controlled clinical trials, so recommendations
Effectiveness of intra-articular dexmedetomidine as postoperative analgesia i...iosrphr_editor
Background And Objectives: To study the effect of inj.Ropivacaine (0.25%) 2mg/kg with and without Inj.Dexmedetomidine (1-2μg/kg) intraarticularly for postoperative analgesia in arthroscopic knee surgery.1:To Evaluate Onset, Duration and analgesic efficacy of Intraarticular Dexmedetomidine2: To monitor the safety of Dexmedetomidine and Ropivacaine.
Methods: A prospective randomized double blind study, was conducted in 50 patients undergoing elective arthroscopy of knee joint under spinal anaesthesia. At the completion of the surgery, all patients were divied into two groups;GroupP(n=25):received Inj. Ropivacaine 0.25% and GroupD(n=25):received Inj.Ropivacaine(0.25%)+Inj. Dexmedetomidine(1μg/kg) total volume 20 ml was deposited intra-articularly.Patients were monitored in the postoperative ward for the hemodynamic parameters and their Sedation score was assessed.. The efficacy of the drug was determined by improvement in VAS score, duration of analgesia and total number of rescue analgesics during 24 hr in post operative period.
Results: There was no statistically significant differences observed in heart rate except changes at 6 and 8 hr. At 6 and 8 hr in group P pulse (82.48 ± 7.49, 81.44 ± 8.78) as compared to group D (75.38 ± 6.52, 74.96 ± 5.70),because of duration of action of ropivacaine with or without dexmedetomidine.There was no statistically significant difference in blood pressure was found, except at 12 hour and 24 hour (p=0.018), because of longer duration of action of intrarticular dexmedetomidine with ropivacaine in group D.At 6 hrs patients in Group P had a mean VAS score of 3.2 as compared to VAS score values of 1.8 in Group D which is statistically significant..At 2 , 4, 6 and 8 hour VAS score in P group was 1.64, 2.44, 3.24, 2.84 respectively. As compared to group P, in group D VAS score at 2, 4, 6 and 8 hour was 0.92, 1.04, 1.79 and 2.08 respectively. So VAS score lower in group D as compared to group P at 2, 4, 6 and 8 hrs.
This document summarizes a presentation on whether early surgery improves outcomes for patients with poor-grade aneurysmal subarachnoid haemorrhage compared to delayed surgery. No randomized controlled trials have evaluated this question directly. The presentation reviews several observational studies that found early surgery (within 24 hours) was associated with mortality rates around 30% and favorable outcome rates around 50% for poor-grade patients. While the evidence is limited, indirect comparisons across studies suggest early surgery may reduce risks of rebleeding compared to delayed surgery, though individual patient factors still need consideration.
A 28-year-old male patient with pemphigus vulgaris was given 7 pulses of dexamethasone therapy. He later developed avascular necrosis of the head of the femur in both hips, confirmed by x-ray and MRI. Long-term corticosteroid use is a known risk factor for avascular necrosis. The patient's condition was assessed as a severe adverse drug reaction likely caused by the dexamethasone therapy based on standardized causality scales. MRI is an important tool for early diagnosis of avascular necrosis to prevent complications.
Percutaneous Sclerotherapy For Spongiform Venous Malformations- Analysis of Patient-evaluated Outcome And Satisfaction.
Percutaneous sclerotherapy for spongiform venous malformations - analysis of patient-evaluated outcome and satisfaction.
Clemens RK, Baumann F, Husmann M, Meier TO, Thalhammer C, MacCallum G, Ruth Amann-Vesti B, Alomari AI. Vasa. 2017 Aug 25:1-7.
doi: 10.1024/0301-1526/a000650.
This document discusses venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Some key points:
- DVT occurs in about 2.5 million Americans annually and risks of PE are reduced with prophylaxis for high-risk patients, like those having surgery.
- Prophylaxis methods discussed include anticoagulants like heparin, low molecular weight heparin, and fondaparinux as well as compression devices.
- Superficial thrombophlebitis is differentiated from DVT and algorithms are provided for evaluating and treating sterile vs. septic superficial phlebitis.
This study retrospectively analyzed 163 patients treated for spondylodiscitis (spinal infection) between 1992-2000. Patients were divided into 3 treatment groups:
Group A (70 patients) received non-operative treatment including antibiotics and bracing. 8 later required surgery.
Group B (56 patients) underwent posterior decompression alone. 24 later required additional surgery for debridement and stabilization.
Group C (37 patients) received decompression and internal stabilization. Only 6 later required re-operation.
Non-operative treatment was effective for most patients. Decompression alone had a higher re-operation rate compared to decompression with internal stabilization. Overall, surgical treatment improved neurological outcomes compared to non-
The document describes a study that classified 21 patients with brain stem gliomas into 5 groups based on clinical features and radiological findings. Group 1 had diffuse gliomas and a relatively better prognosis. Group 2 also had diffuse gliomas but a worse prognosis. Group 3 consisted of patients with focal pontine or midbrain gliomas. Group 4 contained patients with cervicomedullary gliomas. The study analyzed each group's clinical features, treatment responses, and outcomes to better understand patterns in brain stem gliomas.
Dialysis is not indicated immediately after administration of nonionic contra...AngeLica Abad
This study examined whether immediate dialysis is necessary after administering nonionic contrast agents to patients with end-stage renal disease undergoing hemodialysis. The researchers studied 10 patients receiving hemodialysis who underwent 11 radiographic procedures with nonionic contrast. No significant changes in blood pressure, ECG results, or lab tests occurred after contrast administration, and no patients required emergent dialysis. The study concludes that nonionic contrast can be safely administered to these patients, and immediate post-procedure dialysis is unwarranted as a routine practice.
This study aimed to determine if preoperative hematological parameters and risk factors could predict in-hospital mortality for patients undergoing surgery to repair Type A aortic dissection. The study reviewed data from 78 patients who underwent deep hypothermic circulatory arrest surgery. Only preoperative creatinine levels were higher in patients who died. Total circulatory arrest time and cross-clamp time during surgery were found to be factors affecting mortality, with times over 44.5 minutes and 71 minutes respectively predicting higher risk of death. The study concluded that hematological biomarkers alone may be insufficient for estimating mortality risk, and intraoperative factors like longer circulatory arrest and clamp times impact outcomes for Type A aortic dissection surgery.
Inestabilidad congenita de_hombro_opciones_de_ev_y_ttoIsrael Kine Cortes
This clinical commentary discusses the assessment and treatment of congenital instability of the shoulder joint, also known as multidirectional instability (MDI). MDI is difficult to diagnose due to a lack of understanding of its pathogenesis. It is believed to be caused by excessive joint laxity present from birth rather than trauma. Physical examination focuses on measuring translation beyond normal limits in two or more directions using tests like the sulcus sign and load-and-shift test to identify MDI. Current preferred treatment is extensive physical rehabilitation to strengthen dynamic restraints, though surgery may be needed for recalcitrant cases to restore stability.
EuroPCR 2012 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1406723.do
For the latest on FFR, TAVI, renal denervation, and more, view our slideshow for an overview of the leading news from EuroPCR 2012.
The document summarizes a study that investigated whether adding hyaluronidase to ropivacaine reduces the time to achieve complete sensory block after axillary brachial plexus block. Patients were randomly assigned to receive ropivacaine with or without hyaluronidase. The study found that the group receiving ropivacaine with hyaluronidase had a significantly shorter mean time to achieve complete sensory block, sensory block onset time, and time to reach surgical anesthesia compared to the control group receiving ropivacaine alone. Addition of hyaluronidase to ropivacaine resulted in faster blockade times for axillary brachial plexus blocks.
This study compared the effects of subcutaneous wound infiltration versus intravenous administration of tramadol after pyelolithotomy surgery. Sixty patients were randomly assigned to receive either subcutaneous tramadol infiltration at the wound site or intravenous tramadol. Patients who received subcutaneous infiltration had lower sedation scores, less severe pain, and required less opioid pain medication compared to those who received intravenous tramadol. Subcutaneous administration also resulted in fewer reports of nausea and vomiting. The study concluded that subcutaneous wound infiltration of tramadol provides superior postoperative analgesia and fewer side effects than intravenous administration after this type of surgery.
An Easy Access Social Media Marketing Method for Japanese EnterprisesGosuke Kumamura
This document outlines Microsoft Japan's approach to developing an easy access social media marketing method for Japanese enterprises. It discusses establishing a Social Media Centers of Excellence (SMCOE) task force to create a social media handbook. The handbook provides an overview of social media, guidance on strategy formulation, and rules/guidelines. It considers differences between US and Japanese social media cultures, like the emphasis on bonding over finding relationships online in Japan. The handbook aims to help employees leverage social media strategically without overly relying on case studies or detailed rules. The conclusion emphasizes the importance of collaboration, objective advice, ongoing training, and participating in social media.
1. Alzheimer's disease is a progressive brain disorder that destroys memory and thinking skills.
2. Risk factors include age over 65, family history, gender, lifestyle, education levels, and certain genetic mutations.
3. Symptoms include memory loss, problems with language, poor judgment, and changes in mood and personality. Diagnosis involves ruling out other causes through medical exams, tests, and brain imaging. While there is no cure, lifestyle changes and certain drugs may help reduce risks.
The study evaluated the efficacy of paraffin bath therapy for hand osteoarthritis. 56 patients were randomly assigned to either a treatment group receiving paraffin baths or a control group. Outcome measures including pain, hand function, range of motion and strength were assessed at baseline, 3 weeks and 12 weeks. At 12 weeks, the treatment group showed significantly greater improvements in pain, range of motion and strength compared to the control group. Paraffin bath therapy appeared effective in reducing pain and maintaining strength for hand osteoarthritis over 12 weeks.
Ct scan , self care, rehab after traumatic brain injuryConnie Dello Buono
This study examined the association between early CT scan findings and needs for assistance with ambulation, self-care, and supervision at rehabilitation discharge and 1 year after traumatic brain injury (TBI). The study analyzed CT scans from 1839 TBI patients taken during the first week after injury and recorded findings such as midline shift, subcortical contusions, and bilateral frontal or temporal contusions. It found that a midline shift greater than 5mm or subcortical contusions were associated with greater needs for assistance at discharge, and subcortical contusions were also associated with needs at 1 year. Bilateral frontal or temporal contusions were associated with needs for greater supervision at discharge but not for ambulation or self-care
This document summarizes anorectal surgeries performed at Nova Medical Centers in Bangalore, India between August 2009 and August 2011. A total of 110 surgeries were performed, including stapled hemorrhoidectomies, fistulectomies, and abscess drainages. Most patients were discharged on the same day. Post-operative outcomes were good, with only 3 patients experiencing urinary retention and all patients following up regularly. The aim was to evaluate operating anorectal procedures in an outpatient surgery center.
This document discusses frozen shoulder, also known as adhesive capsulitis. It begins by describing frozen shoulder and its prevalence, then discusses its classification. The etiology is unclear but patients typically show characteristic histories and presentations. The document proposes two classification systems, one based on primary versus secondary causes, and another based on patient irritability levels. Non-operative treatments discussed include corticosteroid injections, exercise, and joint mobilization. Corticosteroid injections, in particular glenohumeral intra-articular injections, provide improved short and long term outcomes compared to other treatments. Manipulation or surgery may be considered for recalcitrant cases.
This document provides an introduction to guidelines for the surgical management of traumatic brain injury (TBI). TBI affects up to 2% of the population per year and is a major cause of death and disability, especially in young people. Intracranial hematomas complicate 25-45% of severe TBI cases and are the most important complication, as they can transform an otherwise mild injury into death or permanent disability if not treated effectively and promptly. The guidelines were created by a group of neurosurgeons to provide evidence-based recommendations for surgical management of post-traumatic intracranial mass lesions based on a review of over 700 publications from 1975-2001. However, there are no controlled clinical trials, so recommendations
Effectiveness of intra-articular dexmedetomidine as postoperative analgesia i...iosrphr_editor
Background And Objectives: To study the effect of inj.Ropivacaine (0.25%) 2mg/kg with and without Inj.Dexmedetomidine (1-2μg/kg) intraarticularly for postoperative analgesia in arthroscopic knee surgery.1:To Evaluate Onset, Duration and analgesic efficacy of Intraarticular Dexmedetomidine2: To monitor the safety of Dexmedetomidine and Ropivacaine.
Methods: A prospective randomized double blind study, was conducted in 50 patients undergoing elective arthroscopy of knee joint under spinal anaesthesia. At the completion of the surgery, all patients were divied into two groups;GroupP(n=25):received Inj. Ropivacaine 0.25% and GroupD(n=25):received Inj.Ropivacaine(0.25%)+Inj. Dexmedetomidine(1μg/kg) total volume 20 ml was deposited intra-articularly.Patients were monitored in the postoperative ward for the hemodynamic parameters and their Sedation score was assessed.. The efficacy of the drug was determined by improvement in VAS score, duration of analgesia and total number of rescue analgesics during 24 hr in post operative period.
Results: There was no statistically significant differences observed in heart rate except changes at 6 and 8 hr. At 6 and 8 hr in group P pulse (82.48 ± 7.49, 81.44 ± 8.78) as compared to group D (75.38 ± 6.52, 74.96 ± 5.70),because of duration of action of ropivacaine with or without dexmedetomidine.There was no statistically significant difference in blood pressure was found, except at 12 hour and 24 hour (p=0.018), because of longer duration of action of intrarticular dexmedetomidine with ropivacaine in group D.At 6 hrs patients in Group P had a mean VAS score of 3.2 as compared to VAS score values of 1.8 in Group D which is statistically significant..At 2 , 4, 6 and 8 hour VAS score in P group was 1.64, 2.44, 3.24, 2.84 respectively. As compared to group P, in group D VAS score at 2, 4, 6 and 8 hour was 0.92, 1.04, 1.79 and 2.08 respectively. So VAS score lower in group D as compared to group P at 2, 4, 6 and 8 hrs.
This document summarizes a presentation on whether early surgery improves outcomes for patients with poor-grade aneurysmal subarachnoid haemorrhage compared to delayed surgery. No randomized controlled trials have evaluated this question directly. The presentation reviews several observational studies that found early surgery (within 24 hours) was associated with mortality rates around 30% and favorable outcome rates around 50% for poor-grade patients. While the evidence is limited, indirect comparisons across studies suggest early surgery may reduce risks of rebleeding compared to delayed surgery, though individual patient factors still need consideration.
A 28-year-old male patient with pemphigus vulgaris was given 7 pulses of dexamethasone therapy. He later developed avascular necrosis of the head of the femur in both hips, confirmed by x-ray and MRI. Long-term corticosteroid use is a known risk factor for avascular necrosis. The patient's condition was assessed as a severe adverse drug reaction likely caused by the dexamethasone therapy based on standardized causality scales. MRI is an important tool for early diagnosis of avascular necrosis to prevent complications.
Percutaneous Sclerotherapy For Spongiform Venous Malformations- Analysis of Patient-evaluated Outcome And Satisfaction.
Percutaneous sclerotherapy for spongiform venous malformations - analysis of patient-evaluated outcome and satisfaction.
Clemens RK, Baumann F, Husmann M, Meier TO, Thalhammer C, MacCallum G, Ruth Amann-Vesti B, Alomari AI. Vasa. 2017 Aug 25:1-7.
doi: 10.1024/0301-1526/a000650.
This document discusses venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). Some key points:
- DVT occurs in about 2.5 million Americans annually and risks of PE are reduced with prophylaxis for high-risk patients, like those having surgery.
- Prophylaxis methods discussed include anticoagulants like heparin, low molecular weight heparin, and fondaparinux as well as compression devices.
- Superficial thrombophlebitis is differentiated from DVT and algorithms are provided for evaluating and treating sterile vs. septic superficial phlebitis.
This study retrospectively analyzed 163 patients treated for spondylodiscitis (spinal infection) between 1992-2000. Patients were divided into 3 treatment groups:
Group A (70 patients) received non-operative treatment including antibiotics and bracing. 8 later required surgery.
Group B (56 patients) underwent posterior decompression alone. 24 later required additional surgery for debridement and stabilization.
Group C (37 patients) received decompression and internal stabilization. Only 6 later required re-operation.
Non-operative treatment was effective for most patients. Decompression alone had a higher re-operation rate compared to decompression with internal stabilization. Overall, surgical treatment improved neurological outcomes compared to non-
The document describes a study that classified 21 patients with brain stem gliomas into 5 groups based on clinical features and radiological findings. Group 1 had diffuse gliomas and a relatively better prognosis. Group 2 also had diffuse gliomas but a worse prognosis. Group 3 consisted of patients with focal pontine or midbrain gliomas. Group 4 contained patients with cervicomedullary gliomas. The study analyzed each group's clinical features, treatment responses, and outcomes to better understand patterns in brain stem gliomas.
Dialysis is not indicated immediately after administration of nonionic contra...AngeLica Abad
This study examined whether immediate dialysis is necessary after administering nonionic contrast agents to patients with end-stage renal disease undergoing hemodialysis. The researchers studied 10 patients receiving hemodialysis who underwent 11 radiographic procedures with nonionic contrast. No significant changes in blood pressure, ECG results, or lab tests occurred after contrast administration, and no patients required emergent dialysis. The study concludes that nonionic contrast can be safely administered to these patients, and immediate post-procedure dialysis is unwarranted as a routine practice.
This study aimed to determine if preoperative hematological parameters and risk factors could predict in-hospital mortality for patients undergoing surgery to repair Type A aortic dissection. The study reviewed data from 78 patients who underwent deep hypothermic circulatory arrest surgery. Only preoperative creatinine levels were higher in patients who died. Total circulatory arrest time and cross-clamp time during surgery were found to be factors affecting mortality, with times over 44.5 minutes and 71 minutes respectively predicting higher risk of death. The study concluded that hematological biomarkers alone may be insufficient for estimating mortality risk, and intraoperative factors like longer circulatory arrest and clamp times impact outcomes for Type A aortic dissection surgery.
Inestabilidad congenita de_hombro_opciones_de_ev_y_ttoIsrael Kine Cortes
This clinical commentary discusses the assessment and treatment of congenital instability of the shoulder joint, also known as multidirectional instability (MDI). MDI is difficult to diagnose due to a lack of understanding of its pathogenesis. It is believed to be caused by excessive joint laxity present from birth rather than trauma. Physical examination focuses on measuring translation beyond normal limits in two or more directions using tests like the sulcus sign and load-and-shift test to identify MDI. Current preferred treatment is extensive physical rehabilitation to strengthen dynamic restraints, though surgery may be needed for recalcitrant cases to restore stability.
EuroPCR 2012 research highlights: A slideshow presentation theheart.org
http://www.theheart.org/editorial-program/1406723.do
For the latest on FFR, TAVI, renal denervation, and more, view our slideshow for an overview of the leading news from EuroPCR 2012.
The document summarizes a study that investigated whether adding hyaluronidase to ropivacaine reduces the time to achieve complete sensory block after axillary brachial plexus block. Patients were randomly assigned to receive ropivacaine with or without hyaluronidase. The study found that the group receiving ropivacaine with hyaluronidase had a significantly shorter mean time to achieve complete sensory block, sensory block onset time, and time to reach surgical anesthesia compared to the control group receiving ropivacaine alone. Addition of hyaluronidase to ropivacaine resulted in faster blockade times for axillary brachial plexus blocks.
This study compared the effects of subcutaneous wound infiltration versus intravenous administration of tramadol after pyelolithotomy surgery. Sixty patients were randomly assigned to receive either subcutaneous tramadol infiltration at the wound site or intravenous tramadol. Patients who received subcutaneous infiltration had lower sedation scores, less severe pain, and required less opioid pain medication compared to those who received intravenous tramadol. Subcutaneous administration also resulted in fewer reports of nausea and vomiting. The study concluded that subcutaneous wound infiltration of tramadol provides superior postoperative analgesia and fewer side effects than intravenous administration after this type of surgery.
An Easy Access Social Media Marketing Method for Japanese EnterprisesGosuke Kumamura
This document outlines Microsoft Japan's approach to developing an easy access social media marketing method for Japanese enterprises. It discusses establishing a Social Media Centers of Excellence (SMCOE) task force to create a social media handbook. The handbook provides an overview of social media, guidance on strategy formulation, and rules/guidelines. It considers differences between US and Japanese social media cultures, like the emphasis on bonding over finding relationships online in Japan. The handbook aims to help employees leverage social media strategically without overly relying on case studies or detailed rules. The conclusion emphasizes the importance of collaboration, objective advice, ongoing training, and participating in social media.
1. Alzheimer's disease is a progressive brain disorder that destroys memory and thinking skills.
2. Risk factors include age over 65, family history, gender, lifestyle, education levels, and certain genetic mutations.
3. Symptoms include memory loss, problems with language, poor judgment, and changes in mood and personality. Diagnosis involves ruling out other causes through medical exams, tests, and brain imaging. While there is no cure, lifestyle changes and certain drugs may help reduce risks.
1. The document discusses the debate around prostate cancer screening in elderly men over age 65, with arguments on both sides.
2. Screening may detect cancers early that would not have progressed or caused harm in a man's lifetime given his life expectancy. However, screening also risks overdiagnosis and overtreatment of biologically unimportant cancers.
3. Guidelines in the US do not recommend routine screening for low-risk, elderly patients due to the scientific uncertainties around the balance of benefits and harms. Patient-clinician discussion is important to make informed, individual decisions.
Potatoes and sweet potatoes have several medicinal uses according to traditional and modern medicine. Potatoes can help treat high blood pressure, rheumatism, burns, and kidney stones. Applying raw potato to burns, sprains, and rheumatism draws out pain. Potatoes also aid in weight control and preventing kidney and bladder problems. Sweet potatoes provide many vitamins and minerals, and can help regulate blood sugar and lower heart disease risk. Both vegetables should be cooked and consumed in moderation.
Marshmallow is a perennial plant native to Europe and parts of Asia. It has medicinal properties and can be used to treat wounds, respiratory illnesses, gastric ailments, and urinary diseases. The roots, leaves, and flowers contain mucilage, polysaccharides, and antioxidants that soothe mucous membranes and reduce inflammation. Marshmallow tea or extracts can be applied topically to wounds or taken internally to treat coughs, sore throats, digestive issues, and urinary problems. It may interact with blood sugar medications, so people with diabetes should use it cautiously.
The document discusses plastic surgery, its benefits and risks. It interviews a plastic surgeon, Dr. Ali Manafi, about his experience and views on plastic surgery. He notes that the most important factors for a successful procedure are choosing the right patient and surgical technique. While cosmetic surgery can improve self-esteem if done correctly, psychological disorders often underlie the desire for it and surgery will not satisfy patients with body dysmorphic disorder. Rhinoplasty is currently the most common cosmetic procedure performed.
1st Place Presentation on a Ten Year Sustainability Planaargue
The document summarizes the activities and accomplishments of the Beta Alpha Psi Lambda Beta Chapter for the 2008-2009 year. It discusses initiatives related to recruiting and maintaining members, fundraising, community service projects, and institutional support. Key points included a 70% increase in membership through interest meetings and scholarships, mentoring programs, fundraisers, tutoring hours provided to students, and updates made to organizational documents and bylaws to ensure sustainability.
Peppermint is a hybrid mint plant that grows in Europe, Asia, and other regions. It has fragrant leaves and flowers that contain menthol and other compounds. Peppermint has many traditional medicinal uses, such as relieving nausea, stomachaches, gas, and supporting digestion. It can also help symptoms of colds, headaches, muscle pain, and skin irritations when consumed as tea, applied as an essential oil, or inhaled. However, peppermint should be used in moderation and cautiously during pregnancy due to possible side effects.
This study evaluated the effect of heparin on the patency of arteriovenous fistulas in 198 patients undergoing surgery for hemodialysis access. Patients were randomly assigned to receive either intraoperative intravenous heparin (n=96) or no heparin (n=102). Early patency rates were similar between groups, but at 2 weeks follow up, the patency rate was higher in the heparin group (85%) compared to the control group (74%), a statistically significant difference. The study concludes that intraoperative heparin administration improves short-term arteriovenous fistula patency.
Fenugreek is an ancient herb that was used by Greek and Roman physicians as a digestive aid. The article discusses the botanical details of fenugreek, the parts used medicinally, its constituents, and its many traditional medicinal uses such as stimulating appetite, increasing breast milk production, and lowering blood sugar and cholesterol. However, fenugreek can also cause side effects like diarrhea and nausea if taken in large amounts, and it may interact adversely with some medications.
Valerian is a perennial plant that has been used as a medicinal herb since ancient times to treat insomnia, anxiety, and other conditions. The root and rhizome are most commonly used in teas, tinctures, and supplements for their sedative properties. While generally safe for short term use, valerian can cause side effects like headaches, dizziness, and gastrointestinal issues at high doses or with long term use. It may also interact with other sedative drugs.
Ambientes escolares libres de discriminación 2016 men unicef pnud unfpa Wilbur Acevedo
Este documento presenta lineamientos para que los establecimientos educativos actualicen sus manuales de convivencia y rutas de atención desde un enfoque de orientaciones sexuales e identidades de género no hegemónicas. Propone conceptos clave como sexo, género e identidad y ofrece recomendaciones para que los comités escolares revisen el contexto, actualicen los manuales incorporando este enfoque y construyan una estrategia de socialización. El objetivo final es que las escuelas sean espacios garantizadores de derech
The University of Tampa Beta Alpha Psi chapter won four major awards at the 2010 National Beta Alpha Psi conference, making it the most decorated chapter that year. The awards won were: 1st place for Chapter Sustainability, 2nd place for Service Learning, the KPMG GOLD Chapter award (one of 15 chapters to win), and the Ernst & Young Diversity award (one of 10 chapters to win). The chapter was recognized for its focus on developing members' talents through diversity training, leadership activities, and ensuring student success. A Pace University faculty advisor said the big accounting firms would be wrong not to recruit from the University of Tampa given its success.
This study compared the success rates of traditional intraoral versus a new extraoral technique for reducing temporomandibular joint dislocations. 58 dislocation reduction attempts were randomly allocated to the two methods. The traditional intraoral method was successful in 86.2% of cases, while the new external method was only successful in 55.2% of cases, a statistically significant difference. While the external method has benefits of avoiding hand bites, the study found it had a lower success rate than the traditional intraoral approach and often required additional techniques for reduction. More research is needed to better evaluate the potential advantages and disadvantages of the new external reduction method.
This document summarizes a study comparing laparoscopic and open surgical repair of incisional hernias using mesh. 101 patients underwent either laparoscopic (n=25) or open (n=76) repair between 1996-2000. Postoperative infection occurred in 1 patient (4%) after laparoscopic repair versus 11 patients (14%) after open repair, though the difference was not significant. Median hospital stay was 4 days for laparoscopic versus 5 days for open, also not a significant difference. Recurrence rates at 2 years were 15% for laparoscopic versus 18% for open repair, which was not significantly different.
40%-80% of auto accident claimants have overlooked diagnoses. The most commonly overlooked are thoracic outlet syndrome, cervical disc damage mistakenly called sprain or whiplash, post-concussion syndrome, slipping rib syndrome, Tietze syndrome and Tempro-mandibular joint syndrome. This article tells readers the clinical sign and symptoms of each and the correct medical tests to use, which are employed by doctors at Johns Hopkins Hospital. It also described an on-line questionnaire at www.DiagnoseThePains.com which gives diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors.
Missed Diagnoses association in Rear end collisions Nelson Hendler
There are a number of overlooked diagnoses which occur after a rear-end accident. This paper shows an attorney how to convert a misdiagnosed 'soft tissue injury case" into damaged cervical disc,TMJ, thoracic outlet syndrome,and post concussion syndrome using a diagnostic paradigm to get diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors. This improves patient care and increases recovery.
Artigo - Acupuncture and physiotherapy for painful shoulderRenato Almeida
This randomized controlled trial evaluated the efficacy of single-point acupuncture combined with physiotherapy compared to physiotherapy alone for the treatment of painful shoulder. 425 patients with subacromial syndrome received 15 sessions of physiotherapy over 3 weeks along with either weekly acupuncture at point ST38 or sham TENS. Patients receiving acupuncture showed significantly greater improvement in shoulder function scores and reported less analgesic use compared to the control group receiving only physiotherapy. The study demonstrates that adding acupuncture to physiotherapy can more effectively treat painful shoulder conditions.
This collective review analyzed 20 studies on mesh-based repair of umbilical and epigastric hernias. The recurrence rate was found to be 2.0% with mesh repair. Polypropylene and ePTFE meshes had the lowest recurrence rates between 1.7-2.5%. An overall 12.4% complication rate was reported. Laparoscopic repair had a lower 1.0% recurrence rate compared to 2.6% for open repair, and was associated with less postoperative pain. However, the review did not conclusively establish laparoscopic repair's benefits due to potential bias in reported operation times and complications. Further research is needed to compare outcomes between the two approaches.
1) Anesthesia safety has greatly improved over time, with mortality decreasing from 1 in 5,000 anesthetics in the 1970s to 1 in 200,000-300,000 in 1999. Current trends show further decreases in complication rates.
2) Factors influencing anesthesia risk include patient status, procedure invasiveness, facility resources and equipment, and the skills of the anesthesiologist and surgeon. Monitoring equipment, safer drugs and equipment, airway management skills, and adherence to guidelines have all contributed to increased safety.
3) Anesthesiology is considered a high-risk specialty, but patients have a higher chance of dying from a car accident than from general anesthesia according to WHO statistics. Contin
This study compared outcomes of fasciocutaneous flaps versus biplanar (muscle and fasciocutaneous) flaps for reconstructing pressure ulcers in 90 immobile patients with spinal cord injuries. The biplanar flap group had a significantly lower wound recurrence rate of 25% compared to 53% for the fasciocutaneous flap group. Both groups had similar follow-up times and times to recurrence. While postoperative complications like infection were similar, the addition of muscle flaps in biplanar reconstruction significantly reduced recurrence of pressure ulcers in this high-risk patient population.
The main findings of upper endoscopy in 133 patients with laryngopharyngeal reflux were:
1. Gastritis was found in 77% of patients, esophagitis in 59%, and hypofunction of the cardia in 40%.
2. Hiatal hernia was identified in 32% of patients.
3. Barrett's esophagus and neoplasms were found in 9% and 2.2% of patients respectively.
4. Only 12% of patients had a normal endoscopy.
5. Helicobacter pylori was positive in 30% of patients.
The dry needling of myofascial pain syndrome trigger points provided pain relief compared to sham needling.
The document discusses procedural sedation and the importance of monitoring patients receiving sedation. It notes that procedural sedation aims to provide analgesia, amnesia and reduce anxiety during medical procedures. It recommends capnography as the gold standard for monitoring ventilation during sedation, as capnography can detect abnormalities in exhaled carbon dioxide levels before oxygen desaturation occurs. The document outlines various medical procedures that commonly involve procedural sedation and stresses the importance of screening patients and having proper monitoring procedures in place to protect at-risk patients during sedation.
A Systematic Review on the Efficacy of Iontophoresis
as a Treatment for Lateral Epicondylitis by James McKivigan*, Brent Yamashita and Derek Smith in Research & Investigations in Sports Medicine
The Anesthesiologist, especially young, faces a major challenge when faced with very ill/ severly moribund, elderly, cachwexic patients with history of fall and lower extremity fractures for elective or ortho surgical procedure. Prof. mridul m. panditrao, explains various problems faced especially with GA, and the best alternatives. Two different approaches of Combined spinal epidual are discussed, with use of adjuvants and also his own randomizede trial and experience.
Introduction true vertigo is a type of vertigo identifieniraj57
This study compared the effectiveness of hyoscine and diazepam in treating true vertigo in 69 patients in an emergency department. Patients were randomly assigned to receive either 5 mg of hyoscine or 10 mg of diazepam. Vertigo severity was assessed before and 1 and 2 hours after drug administration in different positions. Diazepam was significantly more effective at relieving vertigo in all positions compared to hyoscine based on treatment success rates. Complete relief of vertigo occurred in 40-63% of patients given diazepam but only 2.6-12.5% of those given hyoscine. The study suggests that diazepam is a better option than hyoscine for
Clinical effect and safety of pulsed radiofrequency treatment for pudendal ne...Jason Attaman
The document describes a prospective, randomized controlled clinical trial that compared the clinical effect and safety of pulsed radiofrequency (PRF) treatment combined with pudendal nerve block (NB) to NB alone for treating pudendal neuralgia. Eighty patients were randomly assigned to receive either PRF+NB or NB. Pain levels, depression scores, treatment effects, analgesic use, and adverse events were assessed over 3 months. The results showed that PRF+NB provided significantly greater pain relief and improved depression scores compared to NB alone, with no severe adverse events reported for either group.
Prospective, randomized comparison of two biphasicalatawi2
This study compared the effectiveness and safety of two biphasic waveforms - biphasic truncated exponential (BTE) and biphasic rectilinear (BR) - for external cardioversion of atrial fibrillation. 141 patients were randomized to receive transthoracic shocks using either the BTE or BR waveform. The success rate was similar between the two waveforms (93% for BR vs 97% for BTE), though cumulative energy delivered was lower in the BTE group. Only duration of atrial fibrillation was significantly associated with cardioversion success. No significant complications occurred with either waveform. The study found no significant difference in efficacy between the BR and BTE waveforms for transthoracic cardio
1) A 50-year-old male presented with left leg pain and swelling for 3 months prior to a falling accident. Imaging showed a pathologic fracture of the left tibia.
2) Biopsy revealed high-grade conventional osteosarcoma. The patient received neoadjuvant chemotherapy with cisplatin and adriamycin.
3) After mid-cycle evaluation, the patient underwent surgery for resection of the tumor followed by adjuvant chemotherapy.
More harm than benefit of perioperative dexamethasone on recovery following ...Dibya Falgoon Sarkar
1. A prospective double-blind randomized trial found that perioperative dexamethasone provided minor pain relief but significantly increased insulin requirements and risk of infections in patients undergoing reconstructive head and neck cancer surgery.
2. Dexamethasone did not accelerate recovery or shorten hospital stay and its use in head and neck cancer reconstruction provided no clear clinical benefits while increasing complications.
3. A randomized controlled trial of corticosteroids after transoral robotic surgery found extended perioperative dexamethasone was safe and may allow for earlier improvement in diet consistency and decreased hospital stay, though it minimally affected postoperative pain.
Tollerabilità e sicurezza delle attuali terapie biologiche per la psoriasi ne...Merqurio
This study evaluated the safety and tolerability of biological therapies for psoriasis in 103 patients in Italy over 6 years. Four biological therapies were studied: efalizumab, etanercept, infliximab, and adalimumab. Infliximab had a significantly higher rate of being discontinued due to severe adverse events compared to etanercept and efalizumab. Efalizumab and etanercept demonstrated more favorable safety profiles compared to infliximab. While more patients responded to infliximab initially, long-term tolerability was higher for efalizumab and etanercept due to their better safety profiles and compliance with therapy.
WHY LAP INGUINAL HERNIA REPAIR IS PROGRESSING AT SLOW MOMENTUM ? OUR E...Aymen Ahmad Khan
This study evaluated factors contributing to the slow adoption of laparoscopic inguinal hernia repair compared to open repair. Of 60 hernia patients, 93.3% were unaware of the laparoscopic option. While post-operative pain was lower with laparoscopy and cosmesis was better, its costs were higher due to use of mesh and tackers. If suturing was used instead to reduce costs, it required more time and strain for surgeons. Complication and recurrence rates did not significantly differ between the two approaches. However, laparoscopic repair has a steeper learning curve for surgeons to acquire skills. Adoption of laparoscopic repair depends more on surgeon confidence and motivation than clear advantages over open
In hospital complications after total joint arthroplastyFUAD HAZIME
The study prospectively collected data on systemic and local complications from 15,383 joint arthroplasty procedures performed over 6 years. There were 486 major systemic complications, most commonly pulmonary embolism (152 cases), tachyarrhythmia (92), and acute myocardial infarction (36). There were also 109 major local complications, including 16 vascular injuries and 29 peripheral nerve injuries. The incidence of complications was higher after knee arthroplasty, bilateral procedures, and revision surgery. This study provides baseline data on the range and frequency of potential in-hospital complications following elective joint arthroplasty.
This document discusses natural remedies that can treat chronic wounds, which do not often respond well to standard medical treatments. It describes how plant-derived ointments can help stimulate tissue formation and healing. Specifically, it outlines how honey, maggots, leeches, arnica, foxglove, comfrey, hypericum, echinacea, and marigold can aid the wound healing process through their antibacterial, debriding, or tissue-growth promoting properties.
The document provides recommendations for foods to eat during Ramadan for Muslims who are fasting from dawn to sunset. It recommends eating a light meal before dawn called a sahari to avoid fatigue during the day, and a light iftar meal after sunset that includes soup or stew and fruits. It also discusses common issues like constipation, indigestion, and low blood sugar that can occur during fasting and recommends a balanced diet with enough water, fiber, complex carbohydrates and minerals to prevent problems. Certain high-risk groups like diabetics are only allowed to fast if they closely monitor their condition and medication.
This study evaluated the use of sterile water as an irrigating fluid for 1600 patients undergoing transurethral resection of the prostate (TURP). The study found:
1) No statistically significant changes in serum sodium, blood urea nitrogen, creatinine, or hematocrit levels before and after surgery when using sterile water.
2) The most common complications were hypotension (8.3%), hypertension (7.8%), nausea (6.4%), and vomiting (2.8%). Rarely, hyponatremia (<2.5%), decreased hematocrit (<1%), and increased BUN/creatinine (<0.9%) were reported.
3) Absor
The health system in Iraq has deteriorated significantly since 1991 due to war, sanctions, and ongoing violence. The 2003 US/UK invasion exacerbated existing problems and added new issues like widespread mental health problems among soldiers and civilians. Rates of infant mortality, cancer, and birth defects have risen sharply due to exposure to depleted uranium, pollution, and lack of healthcare infrastructure and resources. The Iraqi health system that was once strong has been crippled by neglect, war, and violence, leaving the country facing a major public health crisis if issues are not addressed.
The document summarizes the health benefits of carrots. It details that carrots get their orange color from beta-carotene, an antioxidant that converts to vitamin A. Carrots contain many vitamins, minerals, and antioxidants that are good for vision, heart health, cancer prevention, and immune system support. The document outlines the traditional uses of carrots and their parts to treat various health conditions.
The document summarizes the health benefits of apples. It discusses how apples contain various vitamins, minerals, and antioxidant compounds that can help treat conditions like diabetes, lower cholesterol, reduce cancer risk, and aid digestion. Regular apple consumption is linked to various health benefits like supporting heart health, brain function, skin health, and living a longer life. Both eating fresh apples and drinking apple cider vinegar have traditional medicinal uses to boost immunity and treat issues like arthritis.
The document discusses various causes and treatments for male infertility. It covers endocrine disorders like hypogonadotropic hypogonadism, hyperprolactinemia, congenital adrenal hyperplasia, and anabolic steroid abuse. It also discusses conditions like pyospermia (leukocytospermia), antisperm antibody infertility, retrograde ejaculation, and anejaculation. For each condition, it provides details on diagnostic criteria and potential medical therapies aimed at improving sperm parameters and fertility outcomes.
The document summarizes the medicinal uses and health benefits of cinnamon. It describes cinnamon as the inner bark of an evergreen tree native to Sri Lanka and South India. It then lists various therapeutic effects of cinnamon including helping to treat arthritis, diabetes, and infections. The document also provides preparation methods for using cinnamon to aid conditions like heart disease, insect bites, hair loss, and bad breath.
Borage is an annual plant native to Europe that is used in alternative medicine. It contains nutrients like potassium, calcium, and vitamin C. Medicinally, it is used to treat stress, anxiety, insomnia, lung complaints, fever, jaundice, and eye inflammation. Borage tea can be made from the leaves and flowers and consumed after meals. The flowers can also be made into jam to aid recovery from illness. Excess use may lead to addiction, so borage should be used in moderation.
Nanotechnology involves controlling and manipulating matter on the nanometer scale (1-100 nm) to develop novel materials and devices. It has grown significantly with many medical applications such as targeted drug delivery using smart nanostructures to treat diseases like cancer and cardiovascular issues. Nanomedicine also enables diagnostic tools to detect conditions and toxins in the body through methods that could be used in hospitals, law enforcement, and homeland security.
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This study assessed the effectiveness of journal clubs for anesthesiology residents in improving critical appraisal skills and knowledge of research methodology. Over 24 sessions, residents discussed research papers and were taught about study design, statistics, and use of the CONSORT checklist. Tests before and after showed the journal clubs significantly improved residents' understanding of applying study information and overall methodology. Their ability to critically appraise papers using the CONSORT checklist also increased significantly. The study concludes that journal clubs are an effective way to engage residents in developing research and critical thinking skills.
This document reports on three cases of Kaposi's sarcoma (KS) in renal transplant recipients that developed concurrently with cytomegalovirus (CMV) infection within the first year after transplantation. The first case involved a 50-year-old man who developed KS lesions on the skin and gastrointestinal tract 3 months after being diagnosed with CMV infection. The second case was a 53-year-old man who developed KS skin lesions 5 months after transplantation accompanied by CMV infection. The third case was a 45-year-old woman who was diagnosed with KS skin lesions 8 months after transplantation during treatment for suspected CMV infection. All three patients presented with KS shortly after being diagnosed and treated for CMV infection, suggesting C
Dr. Sean Hu is the founder and chairman of Beike Biotechnology, a Chinese stem cell research and treatment center. Beike has treated over 2,000 patients using stem cells for diseases like multiple sclerosis, cerebral palsy, and limb ischemia. The success rates vary by disease but are around 80% on average. Dr. Hu believes stem cell therapy will revolutionize medicine in the future by helping people live longer and altering many aspects of life.
This article examines the effects of gabapentin on uremic pruritus in hemodialysis patients. A double-blind clinical trial assigned patients to receive gabapentin 100 mg or a placebo after hemodialysis sessions. Patients receiving gabapentin experienced a significant reduction in pruritus compared to the placebo period, as measured by a visual analogue scale. No significant correlations were found between patient characteristics and response to gabapentin. The study concludes that gabapentin is an effective treatment for uremic pruritus.
Caraway has long been used as a herbal remedy to treat conditions like dyspepsia and hysteria. It is a biennial plant native to Europe and Asia, with seeds that contain oils like carvone and limonene. Caraway can help treat gastrointestinal issues, liver and gallbladder problems, bronchitis, and more. It possesses tonic properties and can improve appetite as well as lower blood cholesterol. Caraway tea or essential oil can provide medicinal benefits, but large amounts of the purified oil should be avoided, especially by children and pregnant women.
1. Downloaded from emj.bmj.com on 26 April 2008
Intra-articular lidocaine versus intravenous
meperidine/diazepam in anterior shoulder
dislocation: a randomised clinical trial
R Shariat Moharari, P Khademhosseini, R Espandar, H Asl Soleymani, M T
Talebian, P Khashayar and A Nejati
Emerg. Med. J. 2008;25;262-264
doi:10.1136/emj.2007.051060
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2. Downloaded from emj.bmj.com on 26 April 2008
Original article
Intra-articular lidocaine versus intravenous
meperidine/diazepam in anterior shoulder dislocation:
a randomised clinical trial
R Shariat Moharari,1 P Khademhosseini,1 R Espandar,1 H Asl Soleymani,1 M T Talebian,1
P Khashayar,2 A Nejati1
c Consort flowchart is available ABSTRACT the dislocations are believed to be painful, difficult
online only at http://emj.bmj. Background: Anterior shoulder dislocation is one of the for medical staff, and potentially traumatic (theo-
com/content/vol25/issue5 retically, neurovascular injuries could be caused or
most common complaints of patients referred to
1
Imam Khomeini Hospital, emergency departments. Intravenous opiates and benzo- exacerbated).2 3 Administration of a combination
Medical Sciences/University of diazepines are traditionally prescribed in order to relieve of different sedatives, hypnotics and analgesics has
Tehran, Tehran, Iran; 2 Research
and Development Center, Sina the pain in this group of patients; however, complications brought about successful results, while accompa-
Hospital, Medical Sciences/ always pose a problem. nying complications have always proved challen-
University of Tehran, Tehran, Objective: To compare the pain relief and complications ging.
Iran following intra-articular lidocaine and intravenous meper- Many studies have tried to find out an alter-
idine/diazepam in patients with anterior shoulder dis- native to the above combinations. Intra-articular
Correspondence to:
Dr R Shariat Moharari, Imam location. injection of lidocaine is one such alternative.4
Khomeini Hospital, Keshavarz Methods: 48 patients with non-habitual traumatic Several studies have reported the pain relief
Blvd, Tehran, Iran; naeem. anterior dislocation of the glenohumoral joint admitted to following intra-articular administration of lido-
moharari@gmail.com
Imam Khomeini hospital emergency department were caine as being similar to that achieved with
enrolled in this randomised clinical trial. They were divided intravenous morphine/diazepam or intravenous
Accepted 17 October 2007
into two groups: one group of patients received intra- midazolam/fentanyl. According to these studies,
articular lidocaine 1%, while the other received intrave- the reduction process was easier for both patients
nous meperidine and diazepam. Closed reduction using and physicians using intra-articular injection.5 6
the countertraction–traction method was performed by a In contrast, other studies have reported that this
single person in all the patients. Utilising a 100 mm visual method of administration does not result in the
analogue scale, each patient’s pain was recorded before same degree of pain relief as is achieved using
injection, before reduction, and after reduction. intravenous opiates and benzodiazepines.7
Results: Mean pain (mm) recorded before injection, The objective of our study was to compare the
before reduction, and after reduction in the intra-articular level of pain relief and resulting complications
lidocaine group was 84.3 (95% confidence interval (CI) following intra-articular lidocaine and intravenous
79.8 to 88.8), 52.6 (95% CI 45.2 to 60.1), and 27.3 (95% meperidine/diazepam in patients with anterior
CI 19.9 to 34.7), respectively. The corresponding rates in shoulder dislocation.
the intravenous meperidine/diazepam group were 83.2
(95% CI 79.2 to 87.2), 57.9 (95% CI 53.8 to 62.0), and PATIENTS AND METHODS
23.9 (95% CI 18.9 to 28.8), respectively. Both groups This non-blind, randomised clinical trial was
demonstrated a similar significant decline in pain after performed at Imam Khomeini hospital, a univer-
injection (p,0.005). No severe complications were sity affiliated hospital. The human clinical research
reported in either of the groups. ethics committee of Tehran University of Medical
Conclusion: Intra-articular injection of lidocaine before Sciences approved the study. Patients who pre-
closed reduction of anterior shoulder dislocation produces sented to the emergency department with acute
the same pain relief as intravenous meperidine and non-habitual traumatic anterior dislocation of the
diazepam. glenohumoral joint, confirmed at x ray, from May
2005 until 2006 were eligible for inclusion in the
study. The patients selected were aged between 18
The shoulder is the most commonly dislocated and 80 years. Those patients with a simultaneous
joint. Often, little or no trauma is involved and the fracture, multisystem multiple traumas, distal
arm position alone has resulted in dislocation. The neural injury in the upper extremity, dermal
clinical diagnosis of anterior shoulder dislocation is infection of the shoulder, haemorrhagic disorders,
simple. Patients typically present the dislocation and allergies to the drugs administered during this
with one arm slightly abducted and extended with study, as well as those requiring reduction in more
the elbow flexed and the opposite arm supporting than a joint, were excluded. Addicted individuals,
it. Most shoulder dislocations are anterior, and in who used opioids regularly, were also excluded.
most such dislocations, the humeral head assumes The procedures and the objectives of the study
a subcoracoid position. Subglenoid, infraclavicular, were described for all the patients and they all
and intrathoracic dislocations are uncommon signed an informed consent form.
variants of anterior dislocation.1 2 The patients were randomly assigned into two
Different reduction methods are applied in groups using a computer random number gen-
patients with anterior shoulder dislocation. All of erator. In the first group, intravenous meperidine
262 Emerg Med J 2008;25:262–264. doi:10.1136/emj.2007.051060
3. Downloaded from emj.bmj.com on 26 April 2008
Original article
25 mg and diazepam 5 mg was slowly injected over 1–2 min, Table 1 Mean (SD) pain scores and 95% confidence
and the reduction was performed in 5 min. In the second group, intervals, based on 100 mm analogue visual scale, before
an intra-articular injection of lidocaine 1% was administered via injection, before reduction, and after reduction
the anterior method, as it was much easier. Initially, 1 ml of IVMD IAL
lidocaine 1% was used to achieve skin anaesthesia, and then a
needle was inserted in the inferior lateral site of the coracoid in a Before injection 83.2 (9.5) 84.3 (10.8)
79.2 to 87.2 79.8 to 88.8
posterior direction, until it reached the glenoid hole. Then 20 ml Before reduction* 57.9 (9.7) 52.6 (17.7)
of lidocaine 1% was injected into the shoulder joint. At least 53.8 to 62.0 45.2 to 60.1
15 min were allowed to elapse before the reduction attempt. A After reduction 23.9 (11.8) 27.3 (17.5)
traction–countertraction method was applied to reduce the 18.9 to 28.8 19.9 to 34.7
dislocation. In this method, traction is applied along the IAL, intra-articular lidocaine; IVMD, intravenous meperidine/
abducted arm while an assistant applies countertraction using diazepam.
a folded sheet by wrapping it across the chest. It should be *15 min after IAL injection.
noted that the physician and the resident, who were respec-
tively responsible for undertaking the injections and performing group; however, a second attempt was required in five (20.8%)
the reductions, had both gone through the necessary learning and four (16.7%) cases in the IVMD and IAL groups,
curve and participated in this study only when they had reached respectively. It should be noted that six patients (25%) in the
an adequate level of skill in performing the procedures. IAL group required a third attempt at reduction. The Mann–
All the patients were monitored with ECG, pulse oximetry Whitney test did not reveal a significant difference between the
and capnography throughout the reduction period. Closed two groups in the number of attempts required for a successful
reduction was performed via traction–countertraction by a reduction to be achieved (Z = 1.894; p = 0.058). In addition,
single physician in all of the patients. In the event of a reduction reduction was performed more rapidly in the IVMD group
failure, the protocol allowed the crossover into the other group. (t = 3.660, p = 0.001), while patients in the IAL group had to
Complications such as hypotension (systolic blood pressure stay in the emergency department for a shorter period of time
,90 mm Hg), bradycardia, respiratory depression (SPO2 ,92%, (t = 2.454, p = 0.018) (table 3).
Et CO2 .40), pain and drowsiness were recorded by a technician Complications were reported in 14 (58.3%) and three (12.5%)
blind to the study objectives and the patient’s group. Pain was patients in the IVMD and IAL groups, respectively (x2 = 11.021,
measured subjectively using a 100 mm visual analogue scale p = 0.001). These complications are listed in table 4. Respiratory
(VAS). Each patient was interviewed by the technician and was depression requiring intervention occurred in five of the patients
asked to rate their pain before injection, before reduction, and in the IVMD group, whose situation improved following bag
after reduction. Drowsiness was calculated based on the mask ventilation. Intubation was performed in none of these
Ramsay Sedation Scale (RSS). An RSS level of 3 was the goal cases.
sedation level in the group who received intravenous diazepam/ All the patients were reported to have an RSS level of 1
meperidine. In this group, drowsiness was considered as a (anxious, agitated or restless) at the time of admission. Three of
complication when the patient presented with an RSS level of the patients in the IAL group had an RSS level of 3 and were
>4. In the intra-articular lidocaine group, as no sedation was considered to be drowsy. On the other hand, this complication
expected, drowsiness was considered as a complication in those was more frequent in the IVMD group; five patients were
patients with an RSS level of 3 (responds to commands only). reported to have an RSS level of 4.
During the pilot study, the difference between the pain score Joint infection, discomfort or any other complications
(VAS) of the two groups were calculated (mean difference 7.5); secondary to injury to the joint surface was not reported during
according to this finding, and with a = 0.05 and a power of 80%, the study period. No further medication was prescribed in any
a sample size of 48 (24 patients in each group) was required. The of the cases.
statistical analyses were performed using SPSS10 software. We
used repeated measurements analysis of variance (ANOVA) and
Student’s t test, if indicated, to compare pain scores between DISCUSSION
and within the groups. If the data series were not normally The results of the present study revealed that the administra-
distributed, non-parametrical tests were used. Fisher’s exact test tion of intra-articular lidocaine has the same pain relieving
was also used to compare the complications between the two effects as intravenous meperidine and diazepam; in addition, it
groups. A value of p,0.05 was considered significant. resulted in fewer complications. In other words, intra-articular
lidocaine did not have any significant sedative, musculo-
relaxant or anxiolytic effects compared to diazepam; moreover,
RESULTS
according to the present study, it provided pain relief before
Forty-eight patients were enrolled in the study and were divided
into two groups, each compromising 24 patients, including 22
males (91.7%). Mean (SD) age in the intravenous meperidine/ Table 2 Changes in pain scores (mean difference between two times
diazepam (IVMD) and intra-articular lidocaine (IAL) groups and 95% confidence intervals) from before injection to after reduction
were 38.9 (15.6) and 31.7 (9.2) years, respectively (t = 1.941, t test
p = 0.058). The mean weight of the patients was 73 (4.)6 kg IVMD IAL t p
(range 58–93 kg).
Before injection to before 29.4 36.3 1.257 0.219
Pain assessment based on the 100 mm VAS is outlined in reduction 23.3 to 35.5 26.7 to 46.0
table 1. As shown in table 2, significant pain relief was achieved Before injection to after 70.2 66.2 0.728 0.470
in both groups (F = 207.493, p,0.001), and the duration of pain reduction 63.5 to 77.0 57.0 to 75.4
relief was similar (F = 3.077, p = 0.056). Before reduction to after 58.4 49.8 1.305 0.199
The first attempt at reduction was successful in 19 cases reduction 49.8 to 66.9 39.3 to 60.3
(79.2%) in the IVMD group and in 14 cases (58.3%) in the IAL IAL, intra-articular lidocaine; IVMD, intravenous meperidine/diazepam.
Emerg Med J 2008;25:262–264. doi:10.1136/emj.2007.051060 263
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Original article
Table 3 Reduction time and the period of stay in the Table 4 Reported complications
emergency department (mean and 95% confidence Complication IVMD (%) IAL (%)
intervals)
Drowsiness 5 (20.8) 3 (12.5)
IVMD IAL
Respiratory depression 5 (20.8) –
Reduction time (s) 105.0 284.6 Hypotension 5 (20.8) –
84.0 to 126.1 185.3 to 383.9 Headache 2 (8.3) –
Stay in emergency 216.5 140.6 Nausea 2 (8.3) –
department (min) 164.0 to 269.0 104.2 to 177.1
Localised paraesthesia 1 (4) –
IAL, intra-articular lidocaine; IVMD, intravenous meperidine/
diazepam. IAL, intra-articular lidocaine; IVMD, intravenous meperidine/
diazepam.
reduction similar to that obtained with intravenous meperidine/
was a limitation of the study. The weight of our patients ranged
diazepam.
from 58–93 kg; as a result, lidocaine toxicity following the
In a study conducted by Orlinsky et al, it was shown that,
administration of 210 mg lidocaine was not troublesome in
compared with intra-articular lidocaine, intravenous meperidine
these patients.
and diazepam was more effective in reducing pain score (before
Complications secondary to intra-articular injection of
reduction). The difference between the pain scores following
lidocaine was not seen in any of the studies by Kosnik et al,5
the injection (before reduction) and at the time of discharge,
Suder et al,4 Lippitt et al9 and Matthews and Roberts.10
and also between the time of admission and discharge, was
Complications following intravenous injection in the aforemen-
shown to be the same in the two groups. It also stated that
tioned studies were 5%, 11%, 12%, and 30%, respectively; it
sufficient pain relief was not achieved in 24% and 4% of the
should be noted that, except for the Suder study, none of the
patients who had received intra-articular lidocaine and intra-
complications were reported to be severe.4 5 9 10 Cunningham
venous meperidine/diazepam, respectively. As a result, the
has stated the possibility of joint infection following an intra-
success rate in the two groups was stated to be 44% and 55%,
articular injection of lidocaine, which is not reported in any
respectively.8 In the study by Kosnik et al, failure was reported
other study.11
in five of the patients who had received IAL; four of them were
cured by changing the treatment protocol. As a result, they
documented the success rate to be higher in the group who had CONCLUSION
received intravenous diazepam and morphine (IV: 100%; IA According to our study’s findings, intra-articular lidocaine
83%).5 Conversely, Lippitt et al showed a 100% success rate in appears to be a suitable analgesia alternative to intravenous
the group who had received intra-articular lidocaine, and a 75% opiates and benzodiazepines for the reduction of spontaneous
success rate in the group who received the intravenous drugs.9 anterior shoulder dislocation. Further studies addressing the
Likewise, Suder et al stated a nearly similar success rate in the issues surrounding the associated complications are required
two groups (IV: 94%; IA: 97%).4 Mathews and Roberts did not before definite conclusions regarding safety can be made.
state any failure using either of the above mentioned medica-
Competing interests: None declared.
tions.10
In the current study, an acceptable result was achieved Ethics approval: This study has been approved by the Human Clinical Research
Ethics Committee of Tehran University of Medical Sciences.
despite the number of attempts performed. The first attempt at
reduction was successful in 79% of the cases in the IVMD group Patient consent: Informed consent was obtained from all patients participating in
this study.
and 58% in the IAL group. However, reduction was accom-
plished following a second attempt in the remaining patients in
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