A Bullet Lying Next to the Common Carotid Artery in the Neck of a Young Boy.

Penetrating neck trauma is most commonly caused by firearm discharge, and is potentially very dangerous, being associated with a high risk of mortality. A 12-year-old patient with a recent history of a gunshot wound to the neck was evaluated in detail; a bullet was located in close proximity to the left common carotid artery. Neck exploration was performed and the foreign body was removed without any complications. The management of the patient is discussed, as are contemporary approaches to the treatment of penetrating neck trauma. However, the choice of treatment for a stable patient with a penetrating neck injury remains controversial. (C) 2016 by Mutaz B. Habal, MD.

http://ift.tt/2fNpfpS

Periocular Basal Cell Carcinoma Predictors for Recurrence and Infiltration of the Orbit.

Purpose: To present the proportion of patients with periocular basal cell carcinoma (BCC) who underwent orbital exenteration and to evaluate the significance of the risk factors. Design: Retrospective, comparative, interventional case series. Methods: Data of all patients with BCC between 2008 and 2014 were reviewed for patient demographics, previous treatment options, tumor localization, and histopathologic subtype. Results: In group of 256 patients, orbital exenteration underwent 7 patients (2.7%). For 2 patients (5.1%), orbital exenteration was the first procedure performed. In the exenterated group, the most common tumor site was the medial cantus and lower eyelid, whereas in the overall group, it was the lower eyelid (P = 0.011). The proportion of patients initially treated with histopathologic result of infiltration of 1 margin was significantly higher in patients undergoing exenteration (P = 0.282). During the 7-year period observership, the authors have seen 13 recurrences (5.08%). In patients with recurrent BCC after surgery, the authors applied adjuvant high dose rate 192Ir brachytherapy. Neoadjuvant therapy with Vismodegib was effective in patient with biorbital infiltration after 1 side exenteration. Conclusions: Orbital invasion may be clinically silent. Recurrence rate of BCC in our group 5% corresponds to date in the literature. The exenteration for BCC may be significantly higher when the lesion involves a medial canthal location and lower eyelid and initial surgery does not include margin-controlled excision. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://ift.tt/OBJ4xP (C) 2016 by Mutaz B. Habal, MD.

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Comparison of Resorbable Plating Systems: Complications During Degradation.

Introduction: Several bioresorbable plating systems have become standard in pediatric craniosynostosis reconstruction. A comparison of these systems is needed to aid surgeons in the preoperative planning process. The authors aim to evaluate 1 institution's experience using Resorb-X by KLS Martin and Delta Resorbable Fixation System by Stryker (Stryker Craniomaxillofacial, Kalamazoo, MI). Methods: A sample of patients with single-suture nonsyndromic craniosynostosis treated at St Louis Children's Hospital between 2007 and 2014 using either Resorb-X or Delta bioresorbable plating systems were reviewed. Only patients with preoperative, immediate, and long-term 3-dimensional photographic images or computed tomography scans were included. A comparison of plating system outcomes was performed to determine the need for clinic and emergency room visits, imaging obtained, and incidence of subsequent surgical procedures due to complications. Results: Forty-six patients (24 Resorb-X and 22 Delta) underwent open repair with bioabsorbable plating for single suture craniosynostosis. The mean age at each imaging time point was similar between the 2 plating systems (P > 0.717). Deformity-specific measures for sagittal (cranial index), metopic (interfrontotemporale), and unicoronal (frontal asymmetry) synostosis were equivalent between the systems at all time points (0.05

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The Transplantation Journal on Social Media: The @TransplantJrnl journey from impact factor to Klout Score.

No abstract available

http://ift.tt/2gTq8cy

Selection of Patients for Initial Clinical Trials of Solid Organ Xenotransplantation.

Several groups have reported extended survival of genetically-engineered pig organs in nonhuman primates, varying from almost 10 months for life-supporting kidney grafts and >2 years for nonlife-supporting heart grafts to less than 1 month for life-supporting liver and lung grafts. We have attempted to define groups of patients who may not have an option to wait for an allograft. These include kidney, heart, and lung candidates who are highly-allosensitized. In addition, some kidney candidates (who have previously lost at least 2 allografts from rapid recurrence of native kidney disease) have a high risk of further recurrence and will not be offered a repeat allotransplant. Patients with complex congenital heart disease, who may have undergone previous palliative surgical procedures, may be unsuitable for ventricular assist device implantation. Patients dying of fulminant hepatic failure, for whom no alternative therapy is available, may be candidates for a pig liver, even if only as a bridge until an allograft becomes available. When the results of pig organ xenotransplantation in nonhuman primates suggest a realistic potential for success of a pilot clinical trial, highly-selected patients should be offered participation. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2fNoZr5

Living uterus donors: the role of future research in addressing ethical considerations.

No abstract available

http://ift.tt/2gToHuU

Factors associated with Short and Long Term Liver Graft Survival in the United Kingdom: Development of a UK Donor Liver Index.

Background: A measure of donor liver quality, the donor liver index, was developed and validated for the UK population of transplant recipients. Unlike previously proposed measures, this index is only based on variables that are available at the point of retrieval, and so does not include cold ischaemic time. Methods: Indices of liver quality were based on data from the UK Transplant Registry on all 7929 liver transplants between January 2000 and December 2014. Results: The donor liver index (DLI) was based on factors shown to affect graft survival, which included donor age, sex, height, type (donor after brain death or circulatory death), bilirubin, smoking history, and whether the liver was split. A separate index (DLI1) looking at 1 year survival showed donor cardiac disease, black ethnicity, and steatosis to be additional risk factors. A strong association was found between DLI and whether or not a surgeon accepts an offered liver for transplant, with a marked fall in acceptance rates for livers with an index greater than 1.31. Since 2000, there has been a notable reduction in the quality of livers transplanted, coupled with variation between the 7 UK liver transplant centres in risk appetite. Conclusion: The DLI is an index of liver quality which enables analysis of the changing trends in liver quality and centre behaviour. DLI1 enables identification of factors affecting shorter term survival, and perhaps identifies a cohort of livers that may benefit from novel preservation technologies. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2fNmGV4

Cross-talk between T and B Cells in the Germinal Center following Transplantation.

Cross-talk between B and T cells in transplantation is increasingly recognized as being important in the alloimmune response. T cell activation of B cells occurs by a 3-stage pathway, culminating with costimulation signals. We review the distinct T cell subtypes required for B cell activation, and discuss the formation of the Germinal Center (GC) after transplantation, with particular reference to the repopulation of the GC following depletional induction, and the subsequent effect of immunosuppressive manipulation of T-B cell interactions. Additionally, ectopic GCs are seen in transplantation, but their role is not fully understood. Therapeutic options to target T-B cell interactions are of considerable interest, both as immunosuppressive tools, and to aid further understanding of these important alloimmune mechanisms. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2gTre8w

Presence of Cytotoxic Extracellular Histones in Machine Perfusate of Donation after Circulatory Death Kidneys.

Background: Extracellular histones are cytotoxic molecules that are related to cell stress and death. They have been shown to play a crucial role in multiple pathophysiologic processes like sepsis, inflammation, vascular dysfunction and thrombosis. Their role in organ donation and graft function and survival is still unknown. The aim of this study was to assess whether an association exists between the presence of extracellular histones in machine perfusates and deceased donor kidney viability. Methods: Machine perfusates of 390 donation after circulatory death kidneys were analysed for histone concentration and corresponding graft function and survival were assessed. Results: Extracellular histone concentrations were significantly higher in perfusates of kidneys with posttransplant graft dysfunction (primary non function (PNF) and delayed graft function (DGF)) and were an independent risk factor for DGF (OR=2.152 (1.199-3.863)) and one year graft failure (HR=1.386 (1.037-1.853)), but not for PNF (OR=1.342 (0.900-2.002). One year graft survival was 12% higher in the group with low histone concentrations (p=.008) as compared to the group that contained higher histone concentrations. Conclusions: This study warrants future studies to probe for a possible role of cytotoxic extracellular histones in organ viability and suggests that quantitation of extracellular histones might contribute to assessment of posttransplant graft function and survival. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2fNo2Pm

Evidence for CD16a-mediated NK Cell Stimulation in Antibody-mediated Kidney Transplant Rejection.

BACKGROUND: Natural killer (NK) cells localize in the microcirculation in antibody-mediated rejection (ABMR) and have been postulated to be activated by donor-specific anti-HLA antibodies triggering their CD16a Fc receptors. However, direct evidence for NK cell CD16a triggering in ABMR is lacking. We hypothesized that CD16a-inducible NK cell-selective transcripts would be expressed in human ABMR biopsies and would offer evidence for CD16a triggering. METHODS: We stimulated human NK cells through CD16a in vitro, characterized CD16a-inducible transcripts, and studied their expression in human kidney transplant biopsies with ABMR and in an extended human cell panel to determine their selectivity. RESULTS: In NK cells, CD16a-stimulation induced increased expression of 276 transcripts (FC>2x, FDR

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Heterotopic Abdominal Rat Heart Transplantation as a Model to Investigate Volume Dependency of Myocardial Remodeling.

Heterotopic abdominal rat heart transplantation has been extensively used to investigate ischemic/reperfusion injury, immunological consequences during heart transplantations and also to study remodeling of the myocardium due to volume unloading. We provide a unique review on the latter and present a summary of the experimental studies on rat heart transplantation to illustrate changes that occur to the myocardium due to volume unloading. We divided the literature based on whether normal or failing rat heart models were used. This analysis may provide a basis to understand the physiological effects of mechanical circulatory support therapy. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2gTrhRr

BOS is Associated with Increased Cytotoxic Pro-inflammatory CD8 T, NKT-like and NK Cells in the Small Airways.

BACKGROUND: Immunosuppression therapy following lung transplantation fails to prevent bronchiolitis obliterans syndrome (BOS) in many patients, primarily a disease of the small airways. We have reported that BOS is associated with a lack of suppression of cytotoxic mediators, and pro-inflammatory cytokines, in peripheral blood T, NKT-like (particularly CD8+) and NK cells. We also showed a loss of glucocorticoid receptor (GCR) in pro-inflammatory lymphocytes following transplant. It is unknown whether these pro-inflammatory lymphocytes target the small and/or large airways in BOS. METHODS: Blood, bronchoalveolar lavage, large proximal and small distal airway brushings were collected from patients with BOS (n=10), stable lung transplant patients (n=18) and healthy aged-matched controls (n=10). Intracellular cytotoxic mediators (perforin/granzyme B), pro-inflammatory cytokines (IFN[gamma]/TNF[alpha]) and expression of GCR were determined in lymphocytes subsets from cultured blood using flow cytometry. RESULTS: Increases in CD8 T-cells, NKT-like cells and NK cells were found in the small distal airways in BOS compared with stable patients and controls. An increase in perforin, granzyme b, IFN[gamma], TNF[alpha] and a loss of GCR from these lymphocyte subsets was also found in BOS. GCR expression by CD8+ T cells from small airways correlated with FEV1 (R=.834, p=.039). Many of these changes significantly differed from those in the large airways. CONCLUSIONS: BOS is associated with increased cytotoxic/pro-inflammatory CD8+ T, NKT-like and NK cells in the small airways. Treatments that increase GCR in these lymphocyte subsets may improve graft survival. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

http://ift.tt/2gTogR5

Clinical Validation of Simultaneous Analysis of Tacrolimus, Cyclosporine A and Creatinine in Dried Blood Spots in Kidney Transplant Patients.

Backround: Monitoring of creatinine and immunosuppressive drug concentrations such as tacrolimus (TaC) and cyclosporin A (CsA) is important in the outpatient follow-up of kidney transplant recipients. Monitoring by Dried Blood Spot (DBS) provides patients the opportunity to sample a drop of blood from a fingerprick at home, which can be send to the laboratory by mail. Methods: We performed a clinical validation in which we compared measurements from whole blood samples obtained by venapuncture with measurements from DBS samples simultaneously obtained by fingerprick. After exclusion of 10 DBS for poor quality, and 2 for other reasons, 199, 104 and 58 samples from a total of 172 patients were available for validation of creatinine, TaC and CsA respectively. Validation was performed by means of Passing & Bablok regression and bias was assessed by Bland-Altman analysis. Results: For creatinine we found y = 0.73x - 1.55 (95% Confidence Interval [95%CI] slope 0.71,0.76), giving the conversion formula: [creatinine plasma concentration in [mu]mol/L] = [creatinine concentration in DBS in [mu]mol/L] / 0.73, with a nonclinically relevant bias of -2.1 [mu]mol/L (95%CI -3.7,-0.5 [mu]mol/L). For TaC we found y = 1.00x - 0.23 (95%CI slope 0.91,1.08), with a nonclinically relevant bias of -0.28 [mu]g/L (95%CI -0.45,-0.12 [mu]g/L). For CsA we found y = 0.99x - 1.86 (95%CI slope 0.91,1.08) and no significant bias. Therefore, for neither TaC nor CsA a conversion formula is required. Conclusions: DBS sampling for the simultaneous analysis of immunosuppressants and creatinine can replace conventional venous sampling in daily routine. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Message From the Editor.

No abstract available

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Successful continuation of HCV treatment following liver transplantation.

Background: Guidelines recommend that patients with hepatitis C virus (HCV)-related liver disease be treated for HCV before liver transplant (LT) to eliminate the virus prior to surgery. However, the unpredictability of donor organ availability may limit treatment duration. Interruption of HCV treatment with resumption post-LT is one potential solution which has not been investigated widely. Methods: Patients from 5 clinical centres included in the large, national, noninterventional Hepa-C registry who started treatment with direct-acting antiviral agents (DAAs) while awaiting LT were identified retrospectively and followed up prospectively. Fifteen patients who had treatment interruptions around LT were identified. Results: The majority of patients (12/15) received interferon-free regimens, most commonly sofosbuvir+daclatasvir (8/12), for a total of 24 weeks (13/15). Treatment was discontinued temporarily for a median of 5 (range 2-33) days. Fourteen patients completing 12 weeks of follow-up achieved a sustained virological response (SVR). One patient who died prior to Week 12 posttreatment achieved a response at posttreatment Week 4. Treatment was generally well tolerated. Serious adverse events (SAEs) were recorded in 2/15 patients (anaemia in 1 patient; pneumonia in 1 patient); all arose after LT. Conclusions: Resumption of DAA therapy after a temporary interruption around LT was highly effective, achieving SVR in all patients who completed 12 weeks of posttreatment follow-up. Treatment was generally well tolerated pre and posttransplantation, with a low rate of SAEs. Such a strategy may offer an important new approach to the treatment of patients awaiting LT which may be assessed in future studies. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.

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Awards in Transplantation Science Recognize the Best Manuscripts Published in Transplantation.

No abstract available

http://ift.tt/2gTlH1N

Electrical stimulation (ES) of the upper airway (UAW) dilator muscles for patients with obstructive sleep apnoea (OSA)

http://gsfakia.blogspot.com/2016/12/electrical-stimulation-es-of-upper.html

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com

A case of melanoma seeding along a biopsy tract

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Necrotizing eosinophilic folliculitis: a new manifestation of the atopic diathesis?

http://ift.tt/2gTvjt6

Treatment of severe, chronic hand eczema: results from a UK-wide survey

Summary

Treatment of severe hand eczema (HE) that is resistant to topical potent corticosteroid treatment is challenging. In 2013, we surveyed 194 UK dermatologists to obtain information about their usual treatment pathways to inform the choice of the comparator in a trial of alitretinoin in severe HE (ALPHA trial); the results indicated that the treatment approaches favoured by UK dermatologists differ. Psoralen combined with ultraviolet A (PUVA) and alitretinoin were identified as the most frequent first-line treatment options for hyperkeratotic HE, whereas oral corticosteroids were identified as the most frequent first-line treatment for vesicular HE, followed by PUVA and alitretinoin. In terms of potential adverse effects of long-term or repeated use, oral steroids and ciclosporin A were reported to cause most concern. There is uncertainty about which treatment gives the best short and long-term outcomes, because of a lack of definitive randomised controlled trials evaluating the effectiveness of different treatment pathways in severe HE.

http://ift.tt/2fNiILU

Amelanotic naevoid melanoma in a 16-month-old albino infant

Summary

Melanoma in individuals with oculocutaneous albinism has been reported in the literature to be rare compared with the more common occurrence of squamous cell carcinoma and basal cell carcinoma. We present a singular case of amelanotic naevoid melanoma arising from a small congenital naevus in a 16-month old albino boy, the youngest reported to date.

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Reply letter

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Issue Information - JEB

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Is the Dermatophyte Test Strip truly useful for the diagnosis of tinea unguium? Inquiry into “Clinical study of Dermatophyte Test Strip, an immunochromatographic method, to detect tinea unguium dermatophytes”

http://ift.tt/2gGIpux

Volume Contents

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Issue Information - PI

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Novel use of cranial epidural space in rabbits as an animal model to investigate bone volume augmentation potential of different bone graft substitutes

Abstract

Background

The success of bone augmentation to a major degree depends on the biomechanics and biological conditions of the surrounding tissues. Therefore, an animal model is needed providing anatomical sites with similar mechanical pressures for comparing its influence on different biomaterials for bone regeneration. The present report describes the new bone formation associated to biomaterial in a bursa created in the epidural space, between dura mater and cranial calvaria, under the constant pressure of cerebrospinal fluid.

Methods

Five adult California rabbits were used for the trial. In each animal, two bursae were created in the epidural spaces, in the anterior part of the skull, below both sides of the interfrontal suture. The spaces between dura mater and cranial calvaria were filled with in-situ hardening biphasic calcium phosphate containing hydroxyapatite and beta tricalcium-phosphate (BCP), in-situ hardening phase-pure beta-tricalcium phosphate (β-TCP) or without any biomaterials (sham). After 90 days, the animals were sacrificed, and the defect sites were extracted and processed for histomorphometric analysis by optical and backscattered electron microscopy.

Results

The cranial epidural spaces created (n = 10) could be preserved by the application both BCP (n = 3) and β-TCP biomaterials (n = 3) in all experimental sites. The sites augmented with BCP showed less new bone formation but a trend to better volume preservation than the sites augmented with β-TCP. However, the bone in the BCP sites seemed to be more mature as indicated by the higher percentage of lamellar bone in the sites. In contrast, the created space could not be preserved, and new bone formation was scarce in the sham-operated sites (n = 4).

Conclusion

The experimental bursae created bilaterally in the epidural space allows comparing objectively bone formation in relation to biomaterials for bone regeneration under permanent physiological forces from cerebrospinal fluid pressure.

http://ift.tt/2h1xnU0

Secondary correction of nasal deformities in cleft lip and palate patients: surgical technique and outcome evaluation

Abstract

Background

Nasal deformity associated with cleft lip and palate is a highly challenging reconstructive problem in rhinoplasty. In the literature, several operative solutions and evaluation methods have been described, however these do not offer a standard procedure for the surgeon. Our aim was to standardize our surgical technique—as much as the uniqueness of each case allowed it—based on the most frequent deformities we had faced; and to evaluate our results via a postoperative patient satisfaction questionnaire.

Between 2012 and 2014 12 consecutive patients with combined cleft lip and palate deformities underwent secondary nasal and septal correction surgery with the same method by the same surgeon. The indications of surgery were, on one hand, difficult nasal breathing and altered nasal function (tendency for chronic rhinosinusitis) and on the other hand the aesthetic look of the nose. No exclusion criteria were stated. In our follow-up study we evaluated our results by using a modified Rhinoplasty Outcome Evaluation (ROE) questionnaire: patients answered the same four questions pre- and postoperatively. Data were statistically analyzed by t-test.

Results

Based on the questionnaire, all patients experienced improvement of nasal breathing function, improved appearance of the nose and less stigmatization from the society. According to the t-test, all scores of the four questions improved significantly in the postoperative 4–6 months, compared with the preoperative scores.

Conclusions

In our opinion with our standardized surgical steps satisfactory aesthetic and functional results can be achieved. We think the modified ROE questionnaire is an adequate and simple method for the evaluation of our surgical results.

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Open access to research data: the two sides of the coin

No abstract available

http://ift.tt/2gN96Rk

Psychological distress, burnout and personality traits in Dutch anaesthesiologists

No abstract available

http://ift.tt/2fS4Z1w

The European Board of Anaesthesiology recommendations for safe medication practice: First update

These European Board of Anaesthesiology (EBA) recommendations for safe medication practice replace the first edition of the EBA recommendations published in 2011. They were updated because evidence from critical incident reporting systems continues to show that medication errors remain a major safety issue in anaesthesia, intensive care, emergency medicine and pain medicine, and there is an ongoing need for relevant up-to-date clinical guidance for practising anaesthesiologists. The recommendations are based on evidence wherever possible, with a focus on patient safety, and are primarily aimed at anaesthesiologists practising in Europe, although many will be applicable elsewhere. They emphasise the importance of correct labelling practice and the value of incident reporting so that lessons can be learned, risks reduced and a safety culture developed.

http://ift.tt/2gNlcts

Thrombin generation tests and viscoelastic testing in cirrhosis: comparing apples and oranges?

No abstract available

http://ift.tt/2fS6I7b

Diaphragmatic and intercostal electromyographic activity during neostigmine, sugammadex and neostigmine–sugammadex-enhanced recovery after neuromuscular blockade: A randomised controlled volunteer study

BACKGROUND: Electromyographic activity of the diaphragm (EMGdi) during weaning from mechanical ventilation is increased after sugammadex compared with neostigmine. OBJECTIVE: To determine the effect of neostigmine on EMGdi and surface EMG (sEMG) of the intercostal muscles during antagonism of rocuronium block with neostigmine, sugammadex and neostigmine followed by sugammadex. DESIGN: Randomised, controlled, double-blind study. SETTING: Intensive care research unit. PARTICIPANTS: Eighteen male volunteers. INTERVENTIONS: A transoesophageal EMGdi recorder was inserted into three groups of six anaesthetised study participants, and sEMG was recorded on their intercostal muscles. To reverse rocuronium, volunteers received 50 μg kg−1 neostigmine, 2 mg kg−1 sugammadex or 50 μg kg−1 neostigmine, followed 3 min later by 2 mg kg−1 sugammadex. MAIN OUTCOME MEASURES: We examined the EMGdi and sEMG at the intercostal muscles during recovery enhanced by neostigmine or sugammadex or neostigmine–sugammadex as primary outcomes. Secondary objectives were the tidal volume, PaO2 recorded between the onset of spontaneous breathing and extubation of the trachea and SpO2 during and after anaesthesia. RESULTS: During weaning, median peak EMGdi was 0.76 (95% confidence interval: 1.20 to 1.80) μV in the neostigmine group, 1.00 (1.23 to 1.82) μV in the sugammadex group and 0.70 (0.91 to 1.21) μV in the neostigmine–sugammadex group (P 

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Regional or general anaesthesia for carotid endarterectomy

No abstract available

http://ift.tt/2gNfMPb

Influence of preoperative oral rehydration on arterial plasma rocuronium concentrations and neuromuscular blocking effects: A randomised controlled trial

BACKGROUND: The influence of preoperative rehydration on the action of rocuronium has not yet been investigated. OBJECTIVE: The objective is to evaluate the hypothesis that preoperative rehydration lowers arterial rocuronium plasma concentrations and changes its associated neuromuscular blocking effects during induction of anaesthesia. DESIGN: Randomised, single-blinded study. SETTING: A secondary hospital from October 2013 to July 2014. PATIENTS: In total, 46 men undergoing elective surgery were eligible to participate and were randomly allocated into two groups. Exclusion criteria were severe hepatic, renal or cardiovascular disorder; neuromuscular disease; history of allergy to rocuronium; BMI more than 30 kg m−2; receiving medication known to influence neuromuscular function. INTERVENTION: Participants received 1500 ml of oral rehydration solution (rehydration group) or none (control group) until 2 hours before anaesthesia. Arterial blood samples were obtained 60, 90 and 120 s and 30 min after rocuronium (0.6 mg kg−1) administration during total intravenous anaesthesia. Responses to 0.1-Hz twitch stimuli were measured at the adductor pollicis muscle using acceleromyography. MAIN OUTCOME MEASURES: Arterial plasma rocuronium concentrations. RESULTS: Arterial plasma rocuronium concentrations at 60, 90 and 120 s in the rehydration and control groups were 9.9 and 13.7, 6.8 and 9.5 and 6.2 and 8.1 μg ml−1, respectively (P = 0.02, 0.003 and 0.02, respectively); the onset times in the rehydration and control groups were 92.0 and 69.5 s (P = 0.01), and the times to twitch re-appearance were 25.3 and 30.4 min (P = 0.004), respectively. CONCLUSION: Preoperative rehydration significantly reduces arterial plasma rocuronium concentrations in the first 2 minutes after administration, prolonging the onset time and shortening the duration of effect. A higher dose or earlier administration should be considered for patients who receive preoperative rehydration. TRIAL REGISTRATION: Umin identifier: UMIN000011981.

http://ift.tt/2gNj8lb

Assessment of haemostasis in patients with liver cirrhosis

No abstract available

http://ift.tt/2fS2jRC

Postoperative intermediate care unit and life-threatening complications: How much and how are they linked?

No abstract available

http://ift.tt/2gNj9FL

Are transdermal opioids contraindicated in patients at risk of suicide?

No abstract available

http://ift.tt/2gNd38D

Reply to: postoperative intermediate care unit and life-threatening complications: How much and how are they linked?

No abstract available

http://ift.tt/2fS5Cs7

Preoperative fluid loading in major abdominal surgery

No abstract available

http://ift.tt/2gN8ElO

Does deep neuromuscular block affect pain after laparoscopic surgery?

No abstract available

http://ift.tt/2fS9v0a

Peritonsillar morphine infiltration to prevent early postoperative pain after tonsillectomy

No abstract available

http://ift.tt/2gNgb48

Reply to: does deep neuromuscular blockade affect pain after laparoscopic surgery?

No abstract available

http://ift.tt/2fScWDZ

Reply to: survival after long-term isoflurane sedation in critically ill surgical patients

No abstract available

http://ift.tt/2gNfIPD

Postoperative shoulder pain after laparoscopic hysterectomy with deep neuromuscular blockade and low-pressure pneumoperitoneum

No abstract available

http://ift.tt/2fS1lov

Reply to: assessment of haemostasis in patients with liver cirrhosis

No abstract available

http://ift.tt/2gN91gu

Reply to: postoperative shoulder pain after laparoscopic hysterectomy with deep neuromuscular blockade and low-pressure pneumoperitoneum

No abstract available

http://ift.tt/2fSd5Hv

Reply to: thrombin generation tests and viscoelastic testing in cirrhosis: comparing apples and oranges?

No abstract available

http://ift.tt/2gNck74

Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT.

Background: The mechanisms leading to neurological deterioration and the devastating course of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are still not well understood. Bedside xenon-enhanced computerized tomography (XeCT) enables measurements of regional cerebral blood flow (rCBF) during neurosurgical intensive care. In the present study, CBF characteristics in the early phase after severe SAH were explored and related to clinical characteristics and early clinical course outcome. Materials and Methods: Patients diagnosed with SAH and requiring mechanical ventilation were prospectively enrolled in the study. Bedside XeCT was performed within day 0 to 3. Results: Data from 64 patients were obtained. Median global CBF was 34.9 mL/100 g/min (interquartile range [IQR], 26.7 to 41.6). There was a difference in CBF related to age with higher global CBF in the younger patients (30 to 49 y). CBF was also related to the severity of SAH with lower CBF in Fisher grade 4 compared with grade 3. rCBF disturbances and hypoperfusion were common; in 43 of the 64 patients rCBF

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Buttressing the Pediatric Endotracheal Tube in Neonates: A Simple but Useful Technique.

No abstract available

http://ift.tt/2gOWXZF