Cysts of parathyroid origin are sometimes encountered and can easily be mistaken as thyroidal cysts. Functional parathyroid cysts, with symptoms and signs of hyperparathyroidism, are rare and may be a diagnost...
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Τρίτη 28 Νοεμβρίου 2017
Unusual presentations of functional parathyroid cysts: a case series and review of the literature
Online education improves pediatric residents’ understanding of atopic dermatitis
Abstract
Background/Objectives
Pediatricians manage skin conditions such as atopic dermatitis (AD) but report that their dermatologic training is inadequate. Online modules may enhance medical education when sufficient didactic or clinical teaching experiences are lacking. We assessed whether an online module about AD improved pediatric residents' knowledge and changed their clinical management of AD.
Methods
Target and control cohorts of pediatric residents from two institutions were recruited. Target subjects took a 30-question test about AD early in their residency, reviewed the online module, and repeated the test 6 months and 1 year later. The control subjects, who had 1 year of clinical experience but had not reviewed the online module, also took the test. The mean percentage of correct answers was calculated and compared using two-sided, two-sample independent t tests and repeated-measures analysis of variance. For a subset of participants, clinical documentation from AD encounters was reviewed and 13 practice behaviors were compared using the Fisher exact test.
Results
Twenty-five subjects in the target cohort and 29 subjects in the control cohort completed the study. The target cohort improved from 18.0 ± 3.2 to 23.4 ± 3.4 correctly answered questions over 1 year (P < .001). This final value was greater than that of the control cohort (20.7 ± 4.5; P = .01). Meaningful differences in practice behaviors were not seen.
Conclusion
Pediatric residents who reviewed an online module about AD demonstrated statistically significant improvement in disease-specific knowledge over time and had statistically significantly higher scores than controls. Online dermatology education may effectively supplement traditional clinical teaching.
http://ift.tt/2hYb2Fl
Enniatin B and ochratoxin A in the blood serum of workers from the waste management setting
Abstract
The waste management occupational environment is recognized by the simultaneous presence of several substances and biologic agents. Therefore, workers are exposed simultaneously to multiple contaminants. Occupational exposure to aflatoxin B1 in one Portuguese waste sorting plant was already reported. However, besides this mycotoxin, data regarding fungal contamination showed that exposure to other mycotoxins could be expected. A study was developed to analyze if exposure to other mycotoxins besides aflatoxin B1 was occurring in the workers from the waste sorting plant previously assessed and to discuss how these findings need to be considered in the risk assessment process. In addition to aflatoxin B1 detected previously by ELISA, two additional mycotoxins and one mycotoxin degradation product were detected and quantified by a multi-mycotoxin HPLC-MS/MS approach: Enniatin B and ochratoxin A as well as 2'R-ochratoxin A. Besides the confirmation of co-exposure to several mycotoxins, results probably indicate different exposure routes for the mycotoxins reported.
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Efficacy and safety of topical depigmenting agent in healthy human fair skin female volunteers: A single-arm study
Summary
Background
Skin hyperpigmentation is the darkening of skin due to the increased production of melanin in the body.
Objectives
To evaluate the efficacy and safety of a botanical-based Rosa E pigmentation serum in healthy fair skin female volunteers with wrinkles, skin tone, and pigmentation.
Methods
This was a single-arm, open label study conducted in healthy Indian females; 18 subjects aged 30-55, having fair Caucasian-like skin with at least 2 dark skin pigments with facial wrinkles diagnosed by dermatologist were selected. Rosa E pigmentation serum was applied twice a day for 84 days. Effect was evaluated by (i) instrumental technique (spectrophotometer® 2600D), (ii) clinically by dermatologist regarding product efficacy (skin tone, antiwrinkle, pigmentation), and (iii) volunteers self-evaluation.
Results
The L* value of spectrophotometer reading represents lightness in the skin pigment. Reduction in the pigment was reported from day 14, with significant reductions observed till day 84 compared with baseline. Significant (P < .0001) skin pigmentation lightening was seen on day 14 (1.11) vastly improving on day 84 (1.94) based on photographic assessments. The significant reduction in skin pigment was 76.85%, Felix von Luschan skin color score was 30.24% (P < .0001) with a 7.38-fold reduction in skin tone and 57% reduction in facial wrinkles at day 84 from baseline.
Conclusions
Rosa E pigmentation serum was found safe and effective in significant reduction in skin pigments, improvement of skin tone, and antiwrinkle properties instrumentally, clinically, and self-evaluation by volunteers. In these evaluations, best results were seen the longer the Rosa E was used.
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Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method
Source:American Journal of Otolaryngology
Author(s): Anindya Nayak, Sunil Kumar, Rubeena Arora, Gautam Bir Singh
PurposeTo diagnose Laryngopharyngeal Reflux by observing colour (Red, Green, Blue) at the interarytenoid area during 70° laryngeal endoscopy.Materials and methodsEndoscopic images from 50 normal controls and 50 patients of LPR were obtained in this observational study. LPR patients were selected on the basis of RSI and RFS. Images were analysed using ImageJ, a free image analysis software, developed by the National Institute of Health (NIH). Colour changes in the form of RGB (red, green, blue) values were calculated and analysed at the interarytenoid area. The values in the normal and patient group were compared and correlated with RSI and RFS.ResultsRGB values of the LPR group and the normal group were statistically different (P value<0.01). Strong correlation was also found between R and G values and both RFS and RSI. However, no correlation was seen with B values.ConclusionImage analysis is an easy, economical and objective method to diagnose LPR.
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Letter to the editor
Source:American Journal of Otolaryngology
Author(s): Satvinder Singh Bakshi
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Nicotinamide and skin cancer chemoprevention: The jury is still out
Abstract
Following the publication of the results of a Phase III trial, the administration of oral nicotinamide has been widely advocated as effective in non-melanoma skin cancer chemoprevention in high-risk individuals. However, I performed a Bayesian analysis of the reported findings and show there is insufficient evidence to demonstrate its efficacy, highlighting the significant probability that the positive conclusions drawn will not be reproducible. Given the potential widespread use of oral nicotinamide, future position statements regarding its efficacy are likely to require higher standards of evidence.
http://ift.tt/2Bl4TL5
Comparison of atopy patch testing to skin prick testing for diagnosing mite-induced atopic dermatitis: a systematic review and meta-analysis
Atopic dermatitis (AD) can occur after contact with aeroallergens like house dust mites, pollen, and animal dander. Despite its controversial diagnostic value, the atopy patch test (APT) has been used as an im...
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Letter to the editor
This is in reference to a very well written article titled 'Effects of surgical treatment of hypertrophic turbinates on the nasal obstruction and the quality of life' by Katharina Stölzel et al. [1]. The study has been well planned and tackles an important and clinically relevant condition, namely inferior turbinate hypertrophy. However there are some concerns regarding the methodology which I would like to bring out.
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Image analysis of interarytenoid area to detect cases of Laryngopharyngeal Reflux: An objective method
To diagnose Laryngopharyngeal Reflux by observing colour (Red, Green, Blue) at the interarytenoid area during 70° laryngeal endoscopy.
http://ift.tt/2AcDtKa
Leaflets and continual educational offerings led to increased coverage rate of newborn hearing screening in Akita
Newborn hearing screening (NHS) has been actively performed in Japan since 2001. The NHS coverage rate has increased each year in Akita Prefecture. We analyzed the details of the NHS program and how the Akita leaflets and the many educational offerings about the importance of NHS led to the high NHS coverage rate.
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Anesthetic management of a parturient with hemolysis, elevated liver enzyme levels, and low platelet syndrome complicated by renal insufficiency and coagulopathy
Anesthesia: Essays and Researches 2017 11(4):1126-1128
The objective of this study is to describe the anesthetic management of a parturient with hemolysis, elevated liver enzyme levels, and low platelet (HELLP) syndrome and renal insufficiency. A 28-year-old female patient, gestational age of 35 weeks, with hypertensive crisis (blood pressure 190/110 mmHg), was admitted for an emergency cesarean section after diagnosis of HELLP syndrome and renal insufficiency. We performed total intravenous general anesthesia with rapid sequence induction. During the surgical procedure, reduced urine output and coagulopathy were detected. After the treatments of transfusion, diuresis, and anticoagulation, the surgery finished uneventfully. The patient was taken to the Intensive Care Unit without extubation and discharged on the 6th postoperative day. This case report revealed a successful anesthetic management applied to a pregnant woman with HELLP syndrome complicated by renal insuffciency and coagulopathy. There are several case reports about HELLP syndrome, but the patient in this paper is complicated with renal insuffciency and coagulopathy which made the treatment diffcult to handle.
http://www.aeronline.org/text.asp?2017/11/4/1126/207075
Intravenous dexmedetomidine infusion compared with that of fentanyl in patients undergoing arthroscopic shoulder surgery under general anesthesia
Anesthesia: Essays and Researches 2017 11(4):1070-1074
Background: Anesthesia for arthroscopic shoulder surgery is challenging due to the need for oligaemic surgical field as well as a good postoperative recovery profile. Aim: The present study was prospective, randomized to evaluate the efficacy of dexmdetomidine infusion compared to that of fentanyl in patients undergoing arthroscopic shoulder surgery under general anesthesia. Patients and Methods: A total of 60 patients aged from thirty to fifty years, American Society of Anesthesiologists Class I/II of either sex for arthroscopic shoulder surgery, were included. The patients were divided into two groups of 30 patients each. Group I received dexmedetomidine loading 1 μg/kg over 10 min followed by maintenance 0.5 μg/kg/h and Group II Fentanyl loading 1 μg/kg followed by maintenance 0.5 μg/kg/h. Measurements: Hemodynamic readings (Heart rate HR, and mean arterial blood pressure MAP) were recorded after the start of the study drug infusion (T1), after intubation (T2), then every 15 minutes till the end of surgery (T15, T30, T45, T60, T75, T90). In the PACU , MAP, and HR were recorded on arrival, after 30 min, 1 hr, and 2 hrs (R0, R30, R1 hr, R2 hr) Postoperative analgesia was assessed by visual analogue scale (VAS), Modified Observers's Assessment of Alertness and Sedation OAA/S was recorded on arrival to PACU. Results: This study showed that in the dexmedatomidine group there was statistically significant decrease of MAP and HR after drug infusion up to two hours in the recovery period, more sedation, better control of pain and surgeon satisfaction. Conclusion: Iv infusion of dexamedatomidine may be an attractive option during arthroscopic shoulder surgery as it provided a better hypotensive anesthesia by lowering MAP and HR which leads to better surgical field and surgeon satisfaction than iv infusion fentanyl along with a better postoperative VAS.
http://www.aeronline.org/text.asp?2017/11/4/1070/216038
Application of discharge criteria for home readiness using bispectral and supraglottic airway devices in day-care surgery without using muscle relaxants
Anesthesia: Essays and Researches 2017 11(4):816-820
Introduction: The availability of rapid and short-acting intravenous and volatile anesthetics has facilitated early recovery that is why nowadays ambulatory surgery is becoming more common. If the criteria used to discharge patients from the Postanesthesia Care Unit (PACU) are met in the operating room (OR), it would be appropriate to consider bypassing the PACU and transferring the patient directly to the step-down unit. This process is known as "fast-tracking" after ambulatory surgery. Aims: To compare hemodynamic characteristics and recovery profile as per fast-track criteria (FTC) of recovery and postanesthesia discharge scoring system (PADSS) between sevoflurane and desflurane. Materials and Methods: One hundred American Society of Anesthesiologists Class I–II patients aged 20–50 years were randomly divided into two groups. Following anesthesia induction with injection propofol and injection dexmedetomidine airway was secured with i-gel, Group D (n = 50) received desflurane + dexmedetomidine + O2 + N2O and Group S (n = 50) received sevoflurane in place of desflurane. Emergence time was noted and FTC was evaluated in the OR, Score >12 is considered as shifting criteria for ambulatory surgery unit (ASU). PADSS was noted in ASU at an interval of 15 min for 3 h and Score >9 is considered as ready to discharge home. Results: Response to pain, verbal commands, and spontaneous eye opening in Group D was shorter than that in Group S (P = 0.001). Mean time to achieve FTC score >12 was 15 min in both the groups. Eighty-six percent of patients were ready to go home between 60 and 90 min using PADSS. Conclusion: We concluded that early recovery is faster for desflurane, and there is no difference in ready to go home time between desflurane and sevoflurane.
http://www.aeronline.org/text.asp?2017/11/4/816/207070
Postoperative ultrasound guided continuous femoral nerve blockade for unilateral total knee arthroplasty: A comparison of 0.125% bupivacaine and 0.2% ropivacaine
Anesthesia: Essays and Researches 2017 11(4):1026-1029
Context: Total knee arthroplasty (TKA) is associated with severe postoperative pain which increases morbidity and mortality. Aims: The aim of the study was to compare the analgesic efficacy and motor blockade of continuous infusion of 0.125% bupivacaine and 0.2% ropivacaine in femoral nerve block following unilateral TKA and to assess the effectiveness of femoral nerve block. Settings and Design: One hundred and fifty patients undergoing unilateral total knee replacement surgery were included in this prospective observational comparative study. Subjects and Methods: Patients are divided into two groups of 75 each. Femoral nerve catheter was placed at the end of surgery using ultrasound. Postoperative analgesia and motor blockade were compared for the next 24 h using visual analog scale (VAS) score, additional analgesic requirement, and Bromage scale. Statistical Analysis: Student's t-test and Chi-square test were applied. Results: There was no statistically significant difference in pain between the two groups though VAS score (during rest and movement) and opioid consumption were lower in bupivacaine group. Nearly 28.6% patients experienced pain and required additional analgesics. Seventy-two percent among them complained of pain in the popliteal region supplied by sciatic nerve. Eight patients excluded from the study also had pain in the popliteal fossa. There was a statistically significant difference in motor blockade between the two groups at 12, 18, and 24 h after starting infusion. Bupivacaine group had a higher percentage of type three blocks compared to ropivacaine group. Conclusion: Continuous femoral nerve block (CFNB) with 0.125% bupivacaine infusion provided better analgesia with denser motor blockade compared to 0.2% ropivacaine infusion. CFNB alone is not sufficient to provide adequate analgesia following unilateral TKA.
http://www.aeronline.org/text.asp?2017/11/4/1026/214440
Preemptive epidural analgesia for postoperative pain relief revisited: Comparison of combination of buprenorphine and neostigmine with combination of buprenorphine and ketamine in lower abdominal surgeries, a double-blind randomized trial
Anesthesia: Essays and Researches 2017 11(4):821-827
Context: Postoperative pain relief provides subjective comfort to patient in addition to blunting of autonomic and somatic reflex responses to pain, subsequently enhancing restoration of function by allowing the patient to breathe, cough, and move easily. Aims: The aim is to evaluate and compare the effects of neostigmine + buprenorphine and ketamine + buprenorphine for preemptive epidural analgesia for postoperative pain relief in patients undergoing abdominal surgeries under general anesthesia (GA). Settings and Design: A double-blind randomized trial. Subjects and Methods: A total of 60 American Society of Anesthesiologists physical status Classes I and II patients undergoing abdominal surgeries under GA were taken up for the study. They were randomly allocated into two groups, Group A and Group B of thirty patients each. Preemptive epidural analgesia for postoperative pain relief was provided by a combination of neostigmine 1 μg/kg + buprenorphine 2 μg/kg in Group A patients and ketamine 1 mg/kg + buprenorphine 2 μg/kg in Group B patients after induction of GA but before surgical incision. Postoperatively, vital parameters, pain score, requirement of top up doses, and side effects in the two groups were observed and recorded at 2, 4, 6, 10, 18, and 22 h. Statistical Analysis Used: Mean values within each of the Group A and Group B were compared using one-way analysis of variance (one-way ANOVA). Mean values between Group A and Group B were compared using double analysis of variance (two-way ANOVA). Results: Group A patients had a significant analgesia (visual analog scale [VAS] pain scores reduced significantly from 54.6 ± 6.3 at 2 h to 8.1 ± 8.9 at 22 h postoperatively). Group B patients had significant analgesia too (VAS pain scores reduced significantly from 36 ± 12.5 at 2 h to 5.3 ± 10.9 at 22 h postoperatively). There was however no significant difference between the two groups with respect to the degree of postoperative analgesia on comparison of VAS scores, effect on vital parameters, and incidence of side effects. Conclusions: Either of the two combinations, neostigmine 1 μg/kg + buprenorphine μg/kg or ketamine 1 mg/kg + buprenorphine 2 μg/kg can be safely used for preemptive epidural analgesia for postoperative pain relief in patients undergoing abdominal surgeries under GA.
http://www.aeronline.org/text.asp?2017/11/4/821/207809
Anesthetic management for prolonged incidental surgery in advanced liver disease
Anesthesia: Essays and Researches 2017 11(4):1101-1104
In spite of advances in perioperative management, operative procedures in patients with chronic liver disease pose a significant challenge for the anesthesiologist due to multisystem involvement, high risk of postoperative hepatic decompensation, and mortality. We describe the anesthetic management of an elderly patient with advanced liver disease (model for end-stage liver disease 16) for prolonged abdominal surgery. The use of invasive hemodynamic monitoring, point-of-care biochemical, and hematological surveillance coupled with prompt correction of all abnormalities was responsible for good outcome. The patient's inguinal swellings turned out to be extensions of a large peritoneal mesothelioma, necessitating a large abdominal incision and blood loss. Analgesia was provided by bilateral transversus abdominis plane blocks, which helped to reduce opioid use and rapid extubation.
http://www.aeronline.org/text.asp?2017/11/4/1101/212901
Comparison of dexmedetomidine and midazolam for sedation in mechanically ventilated patients guided by bispectral index and sedation-agitation scale
Anesthesia: Essays and Researches 2017 11(4):828-833
Background: Mechanical ventilation and sedation are inextricably linked components of critical care that represent, what we do for the patients during their vulnerable course in Intensive Care Unit (ICU). Aims: The aim of this study is to compare the efficacy and safety of midazolam and dexmedetomidine in patients on mechanical ventilator with the help of Bispectral Index (BIS) monitoring and correlation of BIS with Sedation-Agitation Scale (SAS). Settings and Design: Prospective, observational, and comparative study. Materials and Methods: In this study, recruited patients were allocated into two groups of 14 patients each. Group A and Group B patients received injection dexmedetomidine and injection Midazolam, respectively. Hemodynamic parameters, time of extubation, duration of mechanical ventilation, and mortality were compared between two groups. Statistical Analysis: Mean and the standard deviation were calculated. Test of analysis between two groups was performed using unpaired t-test. We applied correlation technique, that is, Pearson product-moment correlation coefficient (r) to assess the correlation between BIS and SAS. It varies from + 1–0 to −1. Results: Heart rate and blood pressure were more stable and less in Group A than Group B. Duration of mechanical ventilation was found extremely significant between Group A (77.86 ± 5.71 h) and Group B (95.64 ± 17.00 h) (P = 0.001). There was significant difference found in the time of extubation between Group A (21 ± 6.44 h) and Group B (30.4 ± 10.62 h) P = 0.008. Conclusion: It is concluded in this study that sedation with dexmedetomidine resulted in quick extubation and decreased the duration of mechanical ventilation in comparison to midazolam in ICU patients. There was found moderate to high correlation between BIS index and SAS.
http://www.aeronline.org/text.asp?2017/11/4/828/207078
Comparison of analgesic efficacy of caudal dexamethasone with intravenous dexamethasone as an adjuvant to caudal block in pediatric patients undergoing urogenital surgeries
Anesthesia: Essays and Researches 2017 11(4):1009-1012
Context: Caudal block is one of the most common regional anesthetic techniques employed in pediatric urogenital surgeries. Adjuvants play an important role to improve postoperative analgesia. Aims: The aim of this study was to evaluate the analgesic effect of dexamethasone when given systemically as against caudally as an adjuvant to caudal block. Subjects and Methods: In this randomized controlled study, sixty American Society of Anesthesiologists Physical Status I and II patients aged 3–6 years were randomly allocated into two groups of thirty each. Group D received caudal block with local anesthetic solution and 0.1 mg/kg injection dexamethasone. Group I received a caudal block with local anesthetic solution. They received intravenous injection dexamethasone 0.1 mg/kg after the block. Both the groups were compared for the duration of postoperative analgesia and analgesic requirement. Statistical Analysis Used: Statistical analysis was done with unpaired t-test and Chi-square test as was appropriate. Results: Group D showed a significant prolongation of postoperative analgesia (626.33 ± 59.39 min) as compared to Group I (194.67 ± 27.76 min). Similarly, requirement of analgesic was reduced on 1st postoperative day in group receiving caudal dexamethasone. Conclusions: Dexamethasone significantly prolongs the duration of postoperative analgesia of a caudal block when given caudally than when given intravenously.
http://www.aeronline.org/text.asp?2017/11/4/1009/214437
To evaluate the efficacy of intravenous infusion of dexmedetomidine as premedication in attenuating the rise of intraocular pressure caused by succinylcholine in patients undergoing rapid sequence induction for general anesthesia: A randomized study
Anesthesia: Essays and Researches 2017 11(4):834-841
Context: Laryngoscopy and intubation performed during RSI lead to choroidal blood volume increase and an eventual rise in intraocular pressure (IOP). Use of succinylcholine (SCh) causes an undesirable rise in IOP which is further aggravated by laryngoscopy and endotracheal intubation. Dexmedetomidine is a highly selective centrally acting α2adrenergic agonist that has IOP lowering properties. Aims: This study aims to evaluate the efficacy of intravenous (i.v.) infusion of dexmedetomidine (0.5 μg/kg) as premedication in attenuating the rise of IOP and adverse effect if any caused by SCh in patients undergoing RSI for general anesthesia. Settings and Design: This was a double-blind, randomized trial. Subjects and Methods: Sixty adult patients in the age group of 20–50 years scheduled for elective surgeries under general anesthesia. Group I (dexmedetomidine group) (n = 30) received i.v. infusion of dexmedetomidine (0.5 μg/kg) and Group II (control group) (n = 30) received i.v. infusion of 50 ml normal saline as premedication Statistical Analysis Used: The analysis was done using Statistical Package for Social Sciences Version 15.0 statistical Analysis Software. Results: It was observed that Group I (dexmedetomidine group) had a better attenuating effect over the increases in IOP in patients undergoing RSI for general anesthesia using SCh. An increase in IOP was seen in Group II (control group) patients with RSI. Conclusions: The findings in the present study indicate that i.v. dexmedetomidine effectively attenuates the increases in IOP with an additional advantage of control on hemodynamic responses following RSI.
http://www.aeronline.org/text.asp?2017/11/4/834/209977
Optimal dose of dexmedetomidine retrobulbar anesthesia during phacoemulsification cataract surgery
Anesthesia: Essays and Researches 2017 11(4):1046-1050
Background: The cataract surgery anesthesia should be to make the procedure as safe and as satisfactory as possible for all concerned. The recent progress in anesthesia and surgery now allow cataract extraction to be done with minimal physiological changes to the patient. We aimed in the study to compare between two different doses of dexmedetomidine combined with lidocaine and bupivacaine during retrobulbar anesthesia for cataract extraction by phacoemulsification. Materials and Methods: This study was done on forty patients with cataract. The patients were enrolled in two groups: Group (A):Twenty patients were received 1.5 ml 2% lidocaine + 1.5 ml 0.5% bupivacaine + 0.25 μg/kg of dexmedetomidine and Group (B): Twenty patients were received 1.5 ml 2% lidocaine + 1.5 ml 0.5% bupivacaine + 0.5 μg/kg of dexmedetomidine. Results: The globe anesthesia duration, globe, and lid akinesia were significantly longer in the Group B than in the Group A (P < 0.05). Intraocular pressure decreased through the first 15 min after anesthesia in the two groups, and the changes were not significant between the two groups but highly significant in every group when compared to its baseline reading. As regards the conscious level in the two groups, there was a significant difference (P < 0.001). Group A is higher regarding score 2 and 3, and Group B higher in score 4. Conclusions: We concluded that dexmedetomidine 0.25 μg/kg, when added to retrobulbar block for cataract surgery, will significantly increase the duration of retrobulbar block and improve both the surgeon and the patient satisfaction.
http://www.aeronline.org/text.asp?2017/11/4/1046/212898
Cardiopulmonary resuscitation: Evaluation of knowledge, efficacy, and retention in young doctors joining postgraduation program
Anesthesia: Essays and Researches 2017 11(4):842-846
Background: High-quality cardiopulmonary resuscitation (CPR) and rapid defibrillation the cornerstone for resuscitation from cardiac arrest and increase the incidence of return of spontaneous circulation. Regular CPR training imparted to health-care personnel increases knowledge and helps in skill enhancing. Aims: The aim of this study is to evaluate background knowledge, percentage improvement in the skills, and residual knowledge after a period of 6 months of postgraduate (PG) students as well as the efficacy of the designed teaching program for CPR. Design: The study type was interventional, nonrandomized with end point classification as efficacy study. Study Interventional model was single group assignment. Methods: A questionnaire-based study was conducted on 41 first year PG students. Their educational qualification was Bachelor of Medicine and Bachelor of Surgery. The study was conducted; 3 months after, these PG students joined hospital for their PG studies. The questionnaire designed by the Department of Anesthesiology and Critical Care was given as the pretest (before the CPR training program was initiated), posttest (immediately after the CPR training program was concluded), and residual knowledge test (conducted after 6 months of the CPR training program). After collection of data, a descriptive analysis was performed to evaluate results. Statistical Analysis: Statistical analysis was conducted for determining the test of significance using two-tailed, paired t-test. Results: The average overall score was 25.58 (±5.605) marks out of a maximum of 40 marks in the pretest, i.e., 63.97%. It improved to 33.88 (±3.38) marks in posttest, i.e., 84.74%. After 6 months in the residual knowledge test, the score declined to 26.96 (±6.09) marks, i.e., 67.4%. Conclusion: The CPR training program being conducted was adequately efficacious, but a refresher course after 6 months could help taking the knowledge and skills acquired by our PG students a long way.
http://www.aeronline.org/text.asp?2017/11/4/842/205226
Postoperative chylothorax of unclear etiology in a patient with right-sided subclavian central venous catheter placement
Anesthesia: Essays and Researches 2017 11(4):1088-1090
A young male underwent decompressive craniotomy for an intracerebral bleed. A right-sided subclavian central venous catheter was placed in the operating room after induction of anesthesia. Postoperatively, he was shifted to Intensive Care Unit (ICU) for mechanical ventilation due to low Glasgow coma scale. He had an episode of severe agitation and straining on the tracheal tube in the evening same day. On the 2nd postoperative day in ICU, his airway pressures were high, and chest X-ray revealed massive pleural effusion on right side. Under ultrasound guidance, 1400 milky white fluid was aspirated. It was sent for analysis (triglycerides) that confirmed chyle and hence, chylothorax was made as diagnosis. A duplex scan was done which ruled out thrombosis in subclavian vein. The catheter had normal pressure tracing with free aspiration of blood from all ports. Enteral feeding was continued as it is a controversial matter in the literature and he was monitored clinically and radiologically.
http://www.aeronline.org/text.asp?2017/11/4/1088/207807
To Compare the effects of different doses of dexmedetomidine on intrathecal bupivacaine in infraumbilical surgeries: A prospective, randomized, double-blind clinical study
Anesthesia: Essays and Researches 2017 11(4):847-853
Introduction: Spinal anesthesia is preferred technique of choice in infraumbalical surgeries. Limitation of this technique is shorter duration of analgesia, so various adjuvants have been used with intrathecal bupivacaine such as fentanyl, clonidine, and dexmedetomidine. Dexmedetomidine is a highly selective alpha 2 adrenergic agonist. The aim of our study was to know the effect of different doses of dexmedetomidine on intrathecal bupivacaine. Materials and Methods: The prospective, randomized, double-blind study was conducted in tertiary health care center, on ninety patients of the American Society of Anesthesiology Class I and II, of age group 18–60 years of either sex. They were randomly allocated into three groups. Group BD5 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 5 μg (0.5 ml), Group BD10 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 10 μg (0.5 ml), Group BD15 (n = 30): intrathecal bupivacaine 12.5 mg (2.5 ml) + dexmedetomidine 15 μg (0.5 ml) administered intarthecally. The onset and maximum level of sensory block, time to reach maximum level of sensory block, time of two-segment sensory regression, the total duration analgesia, time of rescue analgesia, onset and duration of motor block and heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure, respiratory rate, and oxygen saturation were recorded at various intervals. Moreover, any adverse effects such as bradycardia, hypotension, nausea, vomiting, and sedation were recorded. Results: The onset time of sensory block in Group D5-2.76 ± 1.32, Group D10-2.45 ± 1.50, and Group D15-1.86±0.93, which is statistically significant (P = 0.025). The time taken for two-segment sensory regression Group D5-96.66 ± 33.67, Group D10-116.80 ± 36.27, and Group D15 120.96 ± 30.24, (P = 0.014). The time taken for complete sensory recovery in Group D5-319.83 ± 61.41, Group D10-336.13 ± 61.38, and Group D15-415.20 ± 96.6, which is statistically highly significant (P = 0.000). Time for rescue analgesia in Group D5-377.46 ± 60.05, in Group D10-401.60 ± 61.11, and in Group D15-517.96 ± 97.30, which is statistically highly significant (P < 0.000). Conclusion: We concluded that there was decrease in onset of sensory and motor blockade with the prolongation of duration of anesthesia and analgesia in a dose-dependent manner.
http://www.aeronline.org/text.asp?2017/11/4/847/219354
Anaesthetic implications of severe hyperthyroidism secondary to molar pregnancy: A case report and review of literature
Anesthesia: Essays and Researches 2017 11(4):1115-1117
Pregnant women with gestational trophoblastic disease have an increased likelihood to develop hyperthyroidism secondary to increased secretion of human chorionic gonadotropin. Most of these cases of hyperthyroidism remain undiagnosed and may present as a thyrotoxic crisis during the perioperative period. Pregnant patients with gestational trophoblastic disease should be always evaluated for hyperthyroidism, and in cases of severe hyperthyroidism, antithyroid treatment should be initiated before evacuation of the mole. Anesthetic management of these cases is challenging in view of the emergency nature of the surgery and potential for thyroid crisis. Spinal anesthesia can be safely administered and has a protective role in preventing thyroid crisis.
http://www.aeronline.org/text.asp?2017/11/4/1115/207077
Efficacy of oral transmucosal fentanyl citrate for premedication in patients for surgery under general anesthesia
Anesthesia: Essays and Researches 2017 11(4):854-858
Background: Oral transmucosal fentanyl citrate (OTFC), a water soluble salt when mixed in saliva is 80% nonionized; making it the only opioid suitable for transmucosal absorption. OTFC has rapid onset of action (3–5 min) with peak effect at 20–40 min and total duration of activity is 2–3 h. Aims: This study aims to determine the efficacy of OTFC as premedicant in patients scheduled for surgery under general anesthesia (GA) and to assess the effects of OTFC on anxiety, sedation. Settings and Design: A prospective randomized study. Subjects and Methods: Patients between 21 and 60 years of age in American Society of Anesthesiologists physical status Classes I and II scheduled for elective surgery under GA were randomly assigned to three groups of 30 each: OTFC, placebo, and control. Mean arterial blood pressure (MAP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO2) along with anxiety and sedation scores were recorded as baseline and upon entering the operation theater. Adverse effects were also recorded. Statistical Analysis Used: Statistical analysis was done using Statistical Package for Social Sciences Version 15.0 Statistical Analysis Software. Results: No significant differences were found in MAP, HR, RR, or SpO2among the groups. OTFC group demonstrated significantly higher levels of anxiolysis than the control group (P < 0.05). No significant difference in sedation score was found. No remarkable adverse effects were observed. Conclusions: OTFC is an effective anxiolytic in adult with minimal risks and side effects. It is readily acceptable by the patients in its given form.
http://www.aeronline.org/text.asp?2017/11/4/854/211949
Evaluation of effectiveness of dexmedetomidine and fentanyl-midazolam combination on sedation and safety during awake fiberoptic intubation: A randomized comparative study
Anesthesia: Essays and Researches 2017 11(4):998-1003
Background: Awake fiberoptic intubation (AFOI) is a recommended technique for anticipated difficult airway. An ideal regime should provide patient comfort, cooperation, amnesia, hemodynamic stability, and blunt airway reflexes and maintain a patent airway with spontaneous ventilation. The aim of our study was to compare intubation conditions between dexmedetomidine and fentanyl–midazolam combination during AFOI. Methods: This prospective, randomized study was conducted on a total of sixty patients of the American Society of Anesthesiologists physical status I and II of either sex, in the age group of 18–60 years having predicted difficult intubation undergoing elective surgeries and the patients were allocated to two groups of thirty patients each. After premedication and topicalization of airways, dexmedetomidine group (Group I, n = 30) received dexmedetomidine 1 μg/kg over 10 min and midazolam–fentanyl group (Group II, n = 30) received fentanyl 2 μg/kg plus midazolam 0.02 mg/kg over 10 min. Adequacy of intubation condition was evaluated by cough score and postintubation score. Incidence of desaturation, hemodynamic changes, and sedation using Ramsay sedation scale were noted and compared between two groups. Results: The demographic characteristics were comparable in the two groups (P > 0.05). The mean Ramsay sedation score in Group I was 3.13 ± 0.937 and Group II was 3.16 ± 0.949, and the comparison between two groups was statistically insignificant (P = 0.891). Cough scores and postintubation scores were favorable in dexmedetomidine group than midazolam–fentanyl group and were statistically significant with P < 0.001 and 0.0001, respectively. Group I also showed better hemodynamics and less episodes of desaturation than Group II. Conclusions: Dexmedetomidine is more effective than midazolam–fentanyl during AFOI, as it provides better intubation condition, hemodynamic stability, and preservation of airway and spontaneous ventilation.
http://www.aeronline.org/text.asp?2017/11/4/998/214438
“Comparison of nalbuphine hydrochloride and fentanyl as an adjuvant to bupivacaine for spinal anesthesia in lower abdominal surgeries:” A randomized, double-blind study
Anesthesia: Essays and Researches 2017 11(4):859-863
Background and Aims: Opioids have been favored as adjuvants to local anesthetics during spinal anesthesia. Nalbuphine, a μ-receptor antagonist and ĸ-receptor agonist, seems to be a suitable adjuvant to local anesthetics. The aim of this study was to compare postoperative analgesia and adverse effects of nalbuphine and fentanyl when used as an adjuvant to hyperbaric bupivacaine during spinal anesthesia. Materials and Methods: Sixty patients belonging to the American Society of Anesthesiologists Physical Status I and II were randomly allocated into two groups of thirty each. Patients in bupivacaine nalbuphine group (Group BN) received 0.8 mg (0.3 ml) of nalbuphine with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine diluted to 3 ml and bupivacaine-fentanyl group (Group BF) received 25 μg (0.5 ml) of fentanyl with 12.5 mg (2.5 ml) of 0.5% hyperbaric bupivacaine. Patients were assessed for hemodynamic changes, sensory and motor block, early postoperative analgesia, and adverse effects. Results: Onset, duration of sensory and motor block, and duration of effective analgesia were comparable between both groups. Postoperative visual analog scale score was 4.8 ± 1.12 in Group BN, and in Group BF, it was 3.86 ± 1.04 which was statistically highly significant (P = 0.0007). The number of patients demanding rescue analgesia in early postoperative period was 18 (60.0%) in Group BN and 7 (23.33%) in Group BF which was statistically significant (P = 0.004). Conclusion: Fentanyl was more efficient than nalbuphine in providing early postoperative analgesia when used as an adjuvant to hyperbaric bupivacaine.
http://www.aeronline.org/text.asp?2017/11/4/859/205230
Short-term outcome of patients with infective endocarditis: A single-center prospective study
Anesthesia: Essays and Researches 2017 11(4):1018-1021
Objectives: To investigate the short-term outcome of patients with infective endocarditis (IE). Patients and Methods: We analyzed data from 42 patients with active endocarditis which underwent different cardiac surgeries. An active endocarditis was considered due to urine analysis and/or blood culture and acute inflammation Gram stains of sample tissue and/or blood culture and acute inflammation Gram stains of sample tissue. Design: Collecting data of 42 patients prospectively. Setting: University hospital single center. Participants: Patients with IE from July 2014 to June 2016. Interventions: None. Measurement and Main Results: We collected data of 42 patients in Imam Hospital which is a university-based 1700-bed center. Twelve patients experienced a redo operation; in which, 2 of them have had the second redo. Five patients underwent an aortic valve replacement operation, 2 mitral valve repair, and only one patient had experienced a subaortic web resection. Seven cases were addict; in which, 5 of them were intravenous abusers. There was 1 porphyric patient which suffered from pethidine reliability. Most of our cases underwent Bentall or tricuspid valve repair operation, and multivalve operation was more scarce. Conclusions: We have presented the therapeutic strategies and outcome of patients with IE and evaluated their short-term outcome.
http://www.aeronline.org/text.asp?2017/11/4/1018/211953
Effect of clonidine as adjuvant in thoracic paravertebral block for patients undergoing breast cancer surgery: A prospective, randomized, placebo-controlled, double-blind study
Anesthesia: Essays and Researches 2017 11(4):864-870
Background and Aims: Postoperative pain after breast cancer surgery is unavoidable. Thoracic paravertebral block (TPVB), a locoregional anesthetic technique, has been proven successful for postoperative pain management in different thoracic surgical procedures, such as thoracotomy, breast cancer surgeries. Clonidine, an adjuvant, in TPVB may enhance the quality and prolong the duration of analgesia. This prospective study was to evaluate the effectiveness of clonidine; administered with TPVB; in addition to conventional local anesthetic solution. Materials and Methods: Fifty-two patients (25–55 years) scheduled for breast cancer surgery under general anesthesia were randomly divided into Group A (n = 26) receiving preoperative TPVB at T3with clonidine added to local anesthesia solution and Group B (n = 26) receiving identical TPVB with local anesthesia but without any adjuvant. This was followed by balanced general anesthesia. A visual analog scale was used to assess pain postoperatively up to 48 h. Meantime to administration of the first dose of rescue analgesic was noted. Total dose of fentanyl consumption, hemodynamic parameters, and side effects were all recorded for each patient. Results: The dosage of fentanyl required in the intraoperative period was significantly lower in Group A. Mean time to administration of rescue analgesic was found to be significantly longer in clonidine group. Hemodynamics and side effects were quite comparable among two groups. Conclusion: Clonidine as adjuvant in TPVB provided profound analgesia for up to 48 h postoperatively for patients undergoing breast cancer surgery without any appreciable side effects.
http://www.aeronline.org/text.asp?2017/11/4/864/216043
Comparative study of clonidine with ropivacaine versus ropivacaine alone in epidural anesthesia for lower limb orthopedic surgery
Anesthesia: Essays and Researches 2017 11(4):1035-1039
Background: Epidural anesthesia has been well established as a safe and effective technique not only for perioperative anesthesia but also for postoperative analgesia. Various adjuvants have been added to local anesthetic agent in an effort to prolong this duration. Aims: The aim of this study was to compare and evaluate the anesthesia and analgesic property of ropivacaine to its combination with clonidine for lower limb orthopedic surgery under epidural. Materials and Methods: In a prospective, randomized, double-blind study, eighty adult patients undergoing lower limb surgeries received either 0.75% ropivacaine or 75 μg clonidine with 0.75% ropivacaine through epidural route. Patients were compared for hemodynamic variability, quality of motor and sensory block, intra- and post-operative analgesia, and the side effects associated. Statistical Analysis: Data analysis was done by Student's paired t-test, Chi-square test, and Mann–Whitney test. P < 0.05 was considered statistically significant. Results: The time taken for onset of the motor as well as the sensory block was significantly shorter in ropivacaine with clonidine group as compared to ropivacaine alone group. Mean duration of analgesia was significantly higher in patients who received clonidine as an adjunct (P < 0.001). There was no significant difference observed in the incidence of hemodynamic changes or side effects. Conclusion: The study demonstrated that use of clonidine as an adjuvant to ropivacaine through epidural route provides a hemodynamically stable, faster, and prolonged epidural block and a longer analgesic effect as compared to ropivacaine alone.
http://www.aeronline.org/text.asp?2017/11/4/1035/211954
Citation for the 2016 Down Surgical Prize – Michael Thomas Simpson
I am honoured to give the supporting citation for Michael Thomas Simpson for the 2016 BAOMS Downs Prize. The Prize is awarded to a colleague for outstanding services to Oral and Maxillofacial Surgery throughout his or her career. While it is impossible to do justice to a lifetime of service in a few minutes, I hope to show you why Mike is a worthy recipient of the Downs Prize.
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Ultrasound examination of the antrum to predict gastric content volume in the third trimester of pregnancy as assessed by MRI: A prospective cohort study
BACKGROUND Ultrasound examination of the gastric antrum allows reliable pre-operative assessment of gastric contents and volume in adult patients. However, during pregnancy, the change in the anatomical position of the stomach due to the gravid uterus leads to a change in the measured value of the antral area. Therefore, current mathematical models predicting gastric content volume (GCV) in the adult may not apply in term pregnant women. OBJECTIVE To propose a mathematical model which is predictive of GCV in pregnant women and to assess the performance of an ultrasound qualitative grading scale (0 to 2) for the diagnosis of clear fluid volumes more than 0.8 and 1.5 ml kg−1. DESIGN Prospective cohort study. SETTING Hospices Civils de Lyon, Hôpital Femme Mère Enfant, Lyon and Assistance Publique – Hôpitaux de Marseille, Hôpital Nord, Marseille, France. PATIENTS Pregnant women in the third trimester of pregnancy. MAIN OUTCOME MEASURES Comparison of the GCV as measured by MRI and the ultrasound measured antral cross-sectional area, and an assessment of gastric contents according to a 0 to 2 qualitative grading scale. RESULTS Data from 34 women were analysed. A linear model predictive of GCV was constructed with a 95% agreement band of ±95 ml, with a mean polar angle of −8.7°. Performance of the qualitative grading scale to detect fluid volumes >0.8 and >1.5 ml kg−1 was improved when used in a composite scale including a 505 mm2 antral area cut-off value in the semirecumbent supine position. CONCLUSION We report a new mathematical model predictive of GCV in women in the third trimester of pregnancy. Furthermore, the combination of the qualitative and the quantitative ultrasound examination of the gastric antrum might be useful to assess gastric fluid volume in pregnant women. TRIAL REGISTRATION ANSM Register N°2015-A00800-49 Correspondence to Lionel Bouvet, MD, PhD, Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, 59, Boulevard Pinel, Bron, 69500 Lyon, France Tel: +33 4 72 12 97 63; e-mail: lionel.bouvet@chu-lyon.fr © 2017 European Society of Anaesthesiology
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Does a hypnosis session reduce the required propofol dose during closed-loop anaesthesia induction?: A randomised controlled trial
BACKGROUND Hypnosis has a positive effect on peri-operative anxiety and pain. OBJECTIVE The objective of this study was to assess the impact of a formal deep hypnosis session on the consumption of propofol for anaesthetic induction using automated administration of propofol guided by the bispectral index (BIS) in a closed loop. DESIGN A 1 : 1 randomised, usual-care-controlled, single-centre trial. SETTING Tertiary care centre in France from April 2014 to December 2015. PATIENTS Female adult patients scheduled for outpatient gynaecological surgery under general anaesthesia. INTERVENTION Before surgery, patients were randomised to receive either a deep hypnosis session or routine care. Anaesthetic induction was performed automatically by propofol without opioids and was assisted by the BIS in a closed loop. MAIN OUTCOME MEASURES The primary endpoint was the propofol dose required for anaesthesia induction, defined as a BIS less than 60 for at least 30 s. RESULTS Data for 31 patients in the hypnosis group and 35 in the control group were analysed. There was no evidence of a difference in the mean required propofol dose for anaesthetic induction between the hypnosis and the control groups (2.06 mg kg−1 (95% confidence interval [1.68 to 2.43]) versus 1.79 mg kg−1 (95% CI [1.54 to 2.03]), P = 0.25, respectively). CONCLUSION The current study, which was designed to determine the effect of a deep hypnosis session on anaesthesia induction using an automated tool for propofol administration, failed to detect a difference in the required dose of propofol. TRIAL REGISTRATION ClinicalTrials.gov, NCT02249364. Correspondence to: Prof Marc Fischler, Department of Anaesthesiology, Hôpital Foch, 40, rue Worth, 92151 Suresnes, France E-mail: m.fischler@hopital-foch.org © 2017 European Society of Anaesthesiology
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Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery: An observational study
BACKGROUND Perioperative acute kidney injury (AKI) is common and increases the risk of morbidity and mortality. OBJECTIVES To determine the association between intraoperative hypotension, defined as an individual decrease from baseline and the risk of perioperative AKI. DESIGN Observational cohort study. SETTING Karolinska University Hospital, Stockholm, Sweden, from October 2012 to May 2013 and October 2015 and April 2016. PATIENTS All adult patients undergoing major elective noncardiac surgery who were scheduled for an overnight admission in the postoperative unit were included. Patients undergoing phaeochromocytoma surgery were excluded. DATA COLLECTION Preoperative risk factors (comorbidities), intraoperative events (hypotension defined as a more than 40 or 50% decrease in SBP relative to each patient's baseline and lasting more than 5 min) and postoperative data were collected from medical records. MAIN OUTCOME MEASURES AKI within the first two postoperative days. RESULTS Of the final cohort of 470 patients, 127 (27%) developed AKI in the perioperative period. AKI was associated with male sex [(66 vs. 48%) P 40%, 70 vs. 57%, P = 0.013; >50%, 20 vs. 12%, P = 0.024) and greater blood loss (800 vs. 400 ml, P
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Quality of life outcomes after endoscopic approaches to intracranial tumors
Purpose of review To review the literature on quality of life (QOL) in endoscopic approaches to anterior and central intracranial skull-base disease. As endoscopic surgical techniques have gained widespread acceptance and complications and morbidity remain low and comparable with microscopic and open approaches, a shift to focusing on patients' perception of their own well being as an important outcome parameter has been made. In addition to the traditional measurements of surgical outcomes (extent of resection, recurrence rate, morbidity, survival, and complication rate), the success of a surgery can now be assessed using QOL measures. Recent findings The main tools for assessing QOL in endoscopic skull-base surgery (anterior skull-base questionnaire and 22-item sinonasal outcome test) were not specifically designed for endoscopic skull-base approaches, and recently, a new tool was introduced and validated, the skull-base inventory, adding to our armamentarium, but it has not yet been widely employed. Endoscopic skull-base surgery leads to improved or sustained long-term QOL overall but it is significantly influenced by tumor disease. Specific endoscopic surgical technique (such as nasoseptal flap closure) appears to have less impact on QOL. Summary It is becoming critical to assess therapeutic interventions in terms of impact on a patient's QOL. QOL can be useful in comparing efficacy of surgical interventions, and in the future, it will likely become a reportable indicator of surgical outcome and guide our surgical technique recommendations. Large-scale prospective multicenter trials would be beneficial. Correspondence to Assistant Prof Madeleine R. Schaberg, MD, MPH, Department of Otorhinolaryngology Head and Neck Surgery, The New York Eye and Ear Infirmary of Mount Sinai, The Icahn School of Medicine at Mount Sinai, 310 East 14th Street 6th Floor, New York NY 10003, USA. Tel: +1 646 943 7931; e-mail: mschaberg@nyee.edu Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.
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Selective Serotonin Reuptake Inhibitors and Serotonin–Norepinephrine Reuptake Inhibitors Are Not Associated With Bleeding or Transfusion in Cardiac Surgical Patients
BACKGROUND: Selective serotonin reuptake inhibitor (SSRI) and serotonin–norepinephrine reuptake inhibitor (SNRI) use is known to alter platelet activation and aggregation leading to impairment in hemostasis. Previous studies are ambiguous with regard to bleeding, transfusion, and perioperative complications in patients undergoing cardiac surgery. The purpose of this study was to evaluate the risk of perioperative bleeding, transfusion, morbidity, and mortality in cardiac surgical patients taking SSRI/SNRIs compared with propensity-matched controls. METHODS: Adult patients undergoing cardiac surgery with cardiopulmonary bypass at our institution between January 1, 2004, and December 31, 2014, were eligible for study inclusion. Patients taking SSRI/SNRI medications at the time of surgery were identified and compared against all other patients not taking SSRI/SNRI medications to produce well-matched groups via propensity score analysis. Patients taking SSRI/SNRI medications were matched in a 1:1 ratio to control patients not taking these medications based on an internally estimated propensity score. Primary outcomes included perioperative blood transfusion, chest tube output, and reoperation for bleeding. Secondary outcomes included postoperative complications (renal failure, stroke or transient ischemic accident, prolonged mechanical ventilation, and perioperative myocardial infarction), intensive care unit (ICU) and hospital length of stay (LOS), and 30-day mortality. RESULTS: A total of 1417 pairs of SSRI/SNRI patients and matched controls were retained for analysis. Between SSRI/SNRI patients and matched controls, there was no significant difference in postoperative chest tube output (median, 750.0 vs 750.0 mL; P = .860) or reoperation for bleeding (2.8% vs 2.5%; P = .892). Perioperative transfusion rates across all time points and blood product type were not significantly different between groups, with the overall perioperative transfusion rate for SSRI/SNRI patients 66.5% vs 64.9% for matched controls (P = .697). Patients in the SSRI/SNRI group had a higher rate of prolonged mechanical ventilation (13.1% vs 8.6%; P = .002), longer ICU LOS (median, 25.5 vs 23.8 hours; P
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Predicting Severity of Acute Pain After Cesarean Delivery: A Narrative Review
Cesarean delivery is one of the most common surgical procedures in the United States, with over 1.3 million performed annually. One-fifth of women who undergo cesarean delivery will experience severe pain in the acute postoperative period, increasing their risk of developing chronic pain and postpartum depression, and negatively impacting breastfeeding and newborn care. A growing body of research has investigated tools to predict which patients will experience more severe pain and have increased analgesic consumption after cesarean delivery. These include quantitative sensory testing, assessment of wound hyperalgesia, response to local anesthetic infiltration, and preoperative psychometric evaluations such as validated psychological questionnaires and simple screening tools. For this review, we searched MEDLINE, the Cochrane database, and Google Scholar to identify articles that evaluated the utility of various tools to predict severe pain and/or opioid consumption in the first 48 hours after cesarean delivery. Thirteen articles were included in the final review: 5 utilizing quantitative sensory testing, including patient responses to pressure, electrical, and thermal stimuli; 1 utilizing hyperalgesia testing; 1 using response to local anesthetic wound infiltration; 4 utilizing preoperative psychometric evaluations including the State-Trait Anxiety Inventory, the Pain Catastrophizing Scale, the Pittsburgh Sleep Quality Index, the Hospital Anxiety and Depression Scale, and simple questionnaires; and 2 utilizing a combination of quantitative sensory tests and psychometric evaluations. A number of modalities demonstrated statistically significant correlations with pain outcomes after cesarean delivery, but most correlations were weak to modest, and many modalities might not be clinically feasible. Response to local anesthetic infiltration and a tool using 3 simple questions enquiring about anxiety and anticipated pain and analgesic needs show potential for clinical use, but further studies are needed to evaluate the utility of these predictive tests in clinical practice. Accepted for publication October 9, 2017. Funding: None. The authors declare no conflicts of interest. Reprints will not be available from the authors. Address correspondence to Ashraf S. Habib, MBBCh, MSc, MHSc, FRCA, Duke University Medical Center, Box 3094, Durham, NC 27710. Address e-mail to ashraf.habib@dm.duke.edu. © 2017 International Anesthesia Research Society
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Management of 1-Lung Ventilation—Variation and Trends in Clinical Practice: A Report From the Multicenter Perioperative Outcomes Group
BACKGROUND: Lung-protective ventilation (LPV) has been demonstrated to improve clinical outcomes in surgical patients. There are very limited data on the current use of LPV for patients undergoing 1-lung ventilation (1LV) despite evidence that 1LV may be a particularly important setting for its use. In this multicenter study, we report trends in ventilation practice for patients undergoing 1LV. METHODS: The Multicenter Perioperative Outcomes Group database was used to identify patients undergoing 1LV. We retrieved and calculated median initial and overall tidal volume (VT) for the cohort and for high-risk subgroups (female sex, obesity [body mass index >30 kg/m2], and short stature), percentage of patients receiving positive end-expiratory pressure (PEEP) ≥5 cm H2O, LPV during 1LV (VT ≤ 6 mL/kg predicted body weight [PBW] and PEEP ≥5 cm H2O), and ventilator driving pressure (ΔP; plateau airway pressure − PEEP). RESULTS: Data from 5609 patients across 4 institutions were included in the analysis. Median VT was calculated for each case and since the data were normally distributed, the mean is reported for the entire cohort and subgroups. Mean of median VT during 1LV for the cohort was 6.49 ± 1.82 mL/kg PBW. VT (mL/kg PBW) for high-risk subgroups was significantly higher; 6.86 ± 1.97 for body mass index ≥30 kg/m2, 7.05 ± 1.92 for female patients, and 7.33 ± 2.01 for short stature patients. Mean of the median VT declined significantly over the study period (from 6.88 to 5.72; P
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Design and Evaluation of a Closed-Loop Anesthesia System With Robust Control and Safety System
BACKGROUND: Closed-loop control of anesthesia involves continual adjustment of drug infusion rates according to measured clinical effect. The NeuroSENSE monitor provides an electroencephalographic measure of depth of hypnosis (wavelet-based anesthetic value for central nervous system monitoring [WAVCNS]). It has previously been used as feedback for closed-loop control of propofol, in a system designed using robust control engineering principles, which implements features specifically designed to ensure patient safety. Closed-loop control of a second drug, remifentanil, may be added to improve WAVCNS stability in the presence of variable surgical stimulation. The objective of this study was to design and evaluate the feasibility of a closed-loop system for robust control of propofol and remifentanil infusions using WAVCNS feedback, with an infusion safety system based on the known pharmacological characteristics of these 2 drugs. METHODS: With Health Canada authorization, research ethics board approval, and informed consent, American Society of Anesthesiologists I–III adults, requiring general anesthesia for elective surgery, were enrolled in a 2-phase study. In both phases, infusion of propofol was controlled in closed loop during induction and maintenance of anesthesia, using WAVCNS feedback, but bounded by upper- and lower-estimated effect-site concentration limits. In phase I, remifentanil was administered using an adjustable target-controlled infusion and a controller was designed based on the collected data. In phase II, remifentanil was automatically titrated to counteract rapid increases in WAVCNS. RESULTS: Data were analyzed for 127 patients, of median (range) age 64 (22–86) years, undergoing surgical procedures lasting 105 (9–348) minutes, with 52 participating in phase I and 75 in phase II. The overall control performance indicator, global score, was a median (interquartile range) 18.3 (14.2–27.7) in phase I and 14.6 (11.6–20.7) in phase II (median difference, −3.25; 95% confidence interval, −6.35 to −0.52). The WAVCNS was within ±10 of the setpoint for 84.3% (76.6–90.6) of the maintenance of anesthesia in phase I and 88.2% (83.1–93.4) in phase II (median difference, 3.7; 95% confidence interval, 0.1–6.9). The lower propofol safety bound was activated during 30 of 52 (58%) cases in phase I and 51 of 75 (68%) cases in phase II. CONCLUSIONS: Adding closed-loop control of remifentanil improved overall controller performance. This controller design offers a robust method to optimize the control of 2 drugs using a single sensor. The infusion safety system is an important component of a robust automated anesthesia system, but further research is required to determine the optimal constraints for these safe conditions. Accepted for publication September 27, 2017. Funding: This work was supported by funds received from the Collaborative Health Research Projects (CHRP 446511–13) (Principal Investigator: G.A.D.), a joint initiative between the Natural Sciences and Engineering Research Council of Canada and the Canadian Institutes of Health Research. NeuroWave Systems Inc provided loan equipment for use in this study. Conflicts of Interest: See Disclosures at the end of the article. Trial Registration: clinicaltrials.gov (NCT01771263). Reprints will not be available from the authors. Address correspondence to Nicholas West, MSc, Department of Anesthesiology, Pharmacology, and Therapeutics, University of British Columbia, V3-350, Clinical Support Bldg, 950 W 28th Ave, Vancouver, BC V5Z 4H4, Canada. Address e-mail to nicholas.west@cw.bc.ca. © 2017 International Anesthesia Research Society
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Effect of Remote Ischemic Preconditioning on Outcomes in Adult Cardiac Surgery: A Systematic Review and Meta-analysis of Randomized Controlled Studies
BACKGROUND: Remote ischemic preconditioning (RIPC) has been demonstrated to prevent organ dysfunction in cardiac surgery patients. However, recent large, prospective, multicenter, randomized controlled trials (RCTs) had controversial results. Thus, a meta-analysis of RCTs was performed to investigate whether RIPC can reduce the incidence of acute myocardial infarction (AMI), acute kidney injury (AKI), and mortality in adult cardiac surgery patients. METHODS: Study data were collected from Medline, Elsevier, Cochrane Central Register of Controlled Trials and Web of Science databases. RCTs involving the effect of RIPC on organ protection in cardiac surgery patients, which reported the concentration or total release of creatine kinase-myocardial band, troponin I/troponin T (TNI/TNT) after operation, or the incidence of AMI, AKI, or mortality, were selected. Two reviewers independently extracted data using a standardized data extraction protocol where TNI or TNT concentrations; total TNI released after cardiac surgery; and the incidence of AKI, AMI, and mortality were recorded. Review Manager 5.3 software was used to analyze the data. RESULTS: Thirty trials, including 7036 patients were included in the analyses. RIPC significantly decreased the concentration of TNI/TNT (standard mean difference [SMD], −0.25 ng/mL; 95% confidence interval [CI], 0.12 to −0.04 ng/mL; P = .004), creatine kinase-myocardial band (SMD, −0.22; 95% CI, 0.07–0.35 ng/mL; P = .46), and the total TNI/TNT release (SMD, −0.49 ng/mL; 95% CI, 0.93 to −0.55 ng/mL; P = .03) in cardiac surgery patients after a procedure. However, RIPC could not reduce the incidence of AMI (relative risk, 0.89; 95% CI, 0.77–1.03; P = .12) and AKI (relative risk, 0.88; 95% CI, 0.72–1.06; P = .18), and there was also no effect of RIPC on mortality in adult cardiac surgery patients. Interestingly, subgroup analysis showed that RIPC reduced mortality of cardiac surgery patients who received volatile agent anesthesia. CONCLUSIONS : Our meta-analysis demonstrated that RIPC reduced TNI/TNT release after cardiac surgery. RIPC did not significantly reduce the incidence of AKI, AMI, and mortality. However, RIPC could reduce mortality in patients receiving volatile inhalational agent anesthesia. Accepted for publication October 10, 2017. Funding: Supported by Clinical Medicine Science and Technology program of Jiangsu Province (BL2013030). The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Reprints will not be available from the authors. Address correspondence to Haibo Qiu, MD, PhD, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China. Address e-mail to haiboq2000@163.com. © 2017 International Anesthesia Research Society
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Perioperative Steroid Use for Tonsillectomy and Its Association With Reoperation for Posttonsillectomy Hemorrhage: A Retrospective Cohort Study
BACKGROUND: Steroids reduce postoperative complications after tonsillectomy such as nausea and vomiting, pain, and delayed recovery. However, steroids may also increase the risk of severe posttonsillectomy bleeding requiring reoperation. METHODS: To evaluate the risk of postoperative bleeding requiring reoperation related to perioperative steroid use, we conducted a retrospective cohort study of 6149 patients treated at 68 hospitals using a hospital-based claims database. The primary outcome was reoperation for bleeding within 14 postoperative days. We estimated odds ratios (ORs) between perioperative steroid use and reoperation by multivariable logistic regression analysis adjusted for confounders. We also estimated differences in the adjusted risk. Subgroup analyses after dividing patients into adults and children were also performed. RESULTS: The incidence of reoperation did not differ significantly between patients who received steroids on the day of tonsillectomy and those who did not (1.8%, n = 15 vs 1.5%, n = 79; adjusted OR 0.81, 95% confidence interval [CI], 0.45–1.43; P = .46). We also found nonsignificant associations in both adults (OR, 0.73; 95% CI, 0.38–1.38; P = .33) and children (OR, 1.18; 95% CI, 0.34–4.11; P = .80). The adjusted risk differences estimated by the logistic regression model were −0.30% (95% CI, −1.05 to 0.45) in all patients, −0.64% (95% CI, −1.82 to 0.54) in adults, and 0.13% (95% CI, −0.93 to 1.19) in children. CONCLUSIONS: Steroid use on the day of tonsillectomy was not associated with an increased risk of reoperation for bleeding. Although the wide range of CIs for the ORs could not eliminate the possibility of increased risk, especially in children, the incremental risks of reoperation for steroid use were within an acceptable range for both adults and children. Our results support the safety of perioperative steroid use for tonsillectomy, considering the magnitude of risk of reoperation because of bleeding. Accepted for publication October 20, 2017. Funding: Support was provided solely from institutional and/or departmental sources. Conflicts of Interest: See Disclosures at the end of the article. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). Yoshihisa Miyamoto, MD, MPH, is currently affiliated with the Department of Anesthesia, Kanagawa Children's Medical Center, Yokohama, Japan. Maki Shinzawa, MD, PhD, is currently affiliated with the Department of Nephrology, Graduate School of Medicine, Osaka University, Suita, Japan. Shiro Tanaka, PhD, is currently affiliated with the Department of Clinical Biostatistics, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Sachiko Tanaka-Mizuno, PhD, is currently affiliated with the Department of Medical Statistics, Shiga University of Medical Science, Otsu, Japan. Reprints will not be available from the authors. Address correspondence to Koji Kawakami, MD,hD, Department of Pharmacoepidemiology, Graduate School of Medicine and Public Health, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto 606–8501, Japan. Address e-mail to kawakami.koji.4e@kyoto-u.ac.jp. © 2017 International Anesthesia Research Society
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http://ift.tt/2hYUxJj
Large Variability in the Diversity of Physiologically Complex Surgical Procedures Exists Nationwide Among All Hospitals Including Among Large Teaching Hospitals
BACKGROUND: Multiple previous studies have shown that having a large diversity of procedures has a substantial impact on quality management of hospital surgical suites. At hospitals with substantial diversity, unless sophisticated statistical methods suitable for rare events are used, anesthesiologists working in surgical suites will have inaccurate predictions of surgical blood usage, case durations, cost accounting and price transparency, times remaining in late running cases, and use of intraoperative equipment. What is unknown is whether large diversity is a feature of only a few very unique set of hospitals nationwide (eg, the largest hospitals in each state or province). METHODS: The 2013 United States Nationwide Readmissions Database was used to study heterogeneity among 1981 hospitals in their diversities of physiologically complex surgical procedures (ie, the procedure codes). The diversity of surgical procedures performed at each hospital was quantified using a summary measure, the number of different physiologically complex surgical procedures commonly performed at the hospital (ie, 1/Herfindahl). RESULTS: A total of 53.9% of all hospitals commonly performed 3-fold larger diversity (ie, >30 commonly performed physiologically complex procedures). Larger hospitals had greater diversity than the small- and medium-sized hospitals (P 30 procedures (lower 99% CL, 71.9% of hospitals). However, there was considerable variability among the large teaching hospitals in their diversity (interquartile range of the numbers of commonly performed physiologically complex procedures = 19.3; lower 99% CL, 12.8 procedures). CONCLUSIONS: The diversity of procedures represents a substantive differentiator among hospitals. Thus, the usefulness of statistical methods for operating room management should be expected to be heterogeneous among hospitals. Our results also show that "large teaching hospital" alone is an insufficient description for accurate prediction of the extent to which a hospital sustains the operational and financial consequences of performing a wide diversity of surgical procedures. Future research can evaluate the extent to which hospitals with very large diversity are indispensable in their catchment area. Accepted for publication October 3, 2017. Funding: Departmental funding. The authors declare no conflicts of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (http://ift.tt/KegmMq). The Division of Management Consulting, Department of Anesthesia, University of Iowa, performs the calculations described in the Introduction and Discussion of this article. F.D. receives no funds personally other than his salary and allowable expense reimbursements from the University of Iowa and has tenure with no incentive program. He and his family have no financial holdings in any company related to his work, other than indirectly through mutual funds for retirement. Income from the Division's consulting work is used to fund Division research. Reprints will not be available from the authors. Address correspondence to Franklin Dexter, MD, PhD, Division of Management Consulting, Department of Anesthesia, University of Iowa, 200 Hawkins Drive, 6 JCP, Iowa City, IA 52242. Address e-mail to Franklin-Dexter@UIowa.edu. © 2017 International Anesthesia Research Society
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http://ift.tt/2hXGFiv
Electroencephalographic evaluation of acoustic therapies for the treatment of chronic and refractory tinnitus
To date, a large number of acoustic therapies have been applied to treat tinnitus. The effect that produces those auditory stimuli is, however, not well understood yet. Furthermore, the conventional clinical p...
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Correlation between subjective and objective hearing tests after unilateral and bilateral cochlear implantation
There are many methods for assessing hearing performance after cochlear implantation. Standard evaluations often encompass objective hearing tests only, while patients' subjective experiences gain importance i...
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Endoscopic repair of lateral sphenoid Encephaloceles: a case series
Lateral sphenoid encephaloceles present a surgical challenge. These encephaloceles may be difficult to access given their lateral location and proximity to the neural and vascular structures of the sphenoid fl...
http://ift.tt/2idcZlk
Evaluation of the efficacy of tongue-lip adhesion in Pierre Robin sequence
Source:European Annals of Otorhinolaryngology, Head and Neck Diseases
Author(s): H. Broucqsault, M.-D. Lamblin, G. Hosana, P. Fayoux
ObjectiveTongue-lip adhesion may be used to relieve obstructive sleep apnoea in infants with Pierre Robin sequence (PRS), but only a few studies have objectively evaluated its efficacy. The purpose of this study was to evaluate the results of tongue-lip adhesion by polysomnography.Materiel and methodsA single-centre retrospective study was conducted in infants with PRS treated by tongue-lip adhesion from 2004 to 2015, in whom at least laryngotracheal endoscopy and polysomnography were performed. The variables collected were the syndromic diagnosis, demographic data, respiratory management before tongue-lip adhesion, symptoms, and additional airway interventions. Obstructive sleep apnoea was classified into 3 groups according to severity. Polysomnography was performed one month after tongue-lip adhesion. Statistical analysis was performed with Wilcoxon signed-rank test with a limit of statistical significance of P<0.005.ResultsThirty-seven subjects in whom tongue-lip adhesion was performed at a mean age of 45 days (8 to 210 days) were included. Thirty-one patients had isolated PRS and 6 patients had associated anomalies. All patients had confirmed severe obstructive sleep apnoea. All patients required respiratory support prior to surgery: 8 intubated patients, 15 patients with noninvasive ventilation and 14 patients with nasopharyngeal airways. Eight patients had bradycardia before tongue-lip adhesion. All parameters were improved on postoperative polysomnography: oxygen saturation, hypercapnia, apnoea-hypopnoea index, bradycardia (P<0.005). Only 8 patients had persistent severe obstructive sleep apnoea and required tracheostomy (n=5) or noninvasive ventilation (n=3). No significant correlation was observed between treatment success and any predictive variables.ConclusionTongue-lip adhesion improved airway obstruction in all infants with PRS and resolved obstructive sleep apnoea in 29 patients. However, 8 patients required additional airway interventions.
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Characterisation of Ras k 1 a novel major allergen in Indian mackerel and identification of parvalbumin as the major fish allergen in 33 Asia-Pacific fish species
Abstract
Background
Fish is a well-recognised cause of food allergy and anaphylaxis. The evolutionary and taxonomic diversity of the various consumed fish species poses a challenge in the identification and characterisation of the major fish allergens critical for reliable diagnostics. Globally, fish is a rising cause of food allergy complicated by a large under-investigated variety of species as well as increasing global tourism and trade. This is the first comprehensive study on allergen profiles of heat-processed fish from Vietnam.
Objective
The aim of this study was to identify the major heat-stable allergens from frequently exported Asia-Pacific freshwater and marine fish, and characterise the major allergen parvalbumin (PV) from one of the most consumed and exported fish species from Asia, the Indian mackerel (Rastrelliger kanagurta).
Methods
Heated protein extracts from 33 fish species were separated by gel-electrophoresis. PV isoforms were identified by immunoblotting utilising three different PV-specific monoclonal and polyclonal antibodies and further characterised by mass spectrometry. IgE reactivity was investigated using sera from 21 patients with confirmed fish allergy.
Results
Heat stable IgE-reactive PVs, with up to five isoforms per species, were identified in all 33 analysed fish species. In the Indian mackerel, seven PV isoforms were identified by 2D-gel electrophoresis combined with mass spectrometric analyses. The amino acid sequence deduced from cDNA of the most expressed isoform showed a high identity (>90%) to PVs from two other mackerel species.
Conclusions & Clinical Relevance
Different PVs were identified as the major heat-stable allergens in all 33 analysed freshwater and marine fish species from Vietnam, many of which are exported worldwide and 21 species that have never been investigated before. The Indian mackerel PV represents a novel fish allergen, now officially registered as Ras k 1. Improved diagnostics for fish allergy against Asia-Pacific species should be developed with focus on PV.
This article is protected by copyright. All rights reserved.
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Adjuvant Nivolumab After Salvage Resection in Head and Neck Cancer Patients Previously Treated With Definitive Therapy
Condition: Head and Neck Cancer
Intervention: Drug: Nivolumab
Sponsors: Sulsau-Ul Haque; Bristol-Myers Squibb
Not yet recruiting
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Intervention: Drug: Nivolumab
Sponsors: Sulsau-Ul Haque; Bristol-Myers Squibb
Not yet recruiting
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The Effect of Binasal Occlusion on Balance Following a Concussion
Condition: Concussion Post Syndrome
Interventions: Device: Binasal occlusion; Device: No binasal occlusion
Sponsor: University of Ottawa
Not yet recruiting
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Interventions: Device: Binasal occlusion; Device: No binasal occlusion
Sponsor: University of Ottawa
Not yet recruiting
http://ift.tt/2hWdqfP
Dupilumab with concomitant topical corticosteroids in adult patients with atopic dermatitis who are not adequately controlled with or are intolerant to ciclosporin A, or when this treatment is medically inadvisable: a placebo-controlled, randomized phase 3 clinical trial (LIBERTY AD CAFÉ)
Abstract
Background
Atopic dermatitis (AD) is a chronic inflammatory skin disease that may require systemic therapy. Ciclosporin A (CsA) is a widely-used, potent immunosuppressant for AD. CsA is not effective in all patients, and side effects limit its use. Dupilumab, a fully human anti-interleukin (IL)-4 receptor-alpha monoclonal antibody, inhibits signaling of IL-4 and IL-13, key drivers of type 2/Th2-mediated inflammation, and is approved in the U.S.A. and the E.U. for the treatment of adults with moderate-to-severe AD.
Objectives
To evaluate efficacy and safety of dupilumab with concomitant topical corticosteroids (TCS) in adults with AD with inadequate response to/intolerance of CsA, or for whom CsA was medically inadvisable.
Methods
In this 16-week, double-blind, randomized, placebo-controlled, phase 3 trial, patients were randomized 1:1:1 to subcutaneous dupilumab 300 mg weekly (qw):every two weeks (q2w):placebo. All received concomitant medium-potency TCS from Week −2 through Week 16; dosage could be tapered if lesions cleared, or stopped for adverse reactions to TCS.
Results
390 patients were screened; 325 were randomized and 318 completed the trial. Treatment groups had similar baseline characteristics. Significantly more patients on dupilumab qw+TCS/q2w+TCS achieved ≥75% improvement from baseline in Eczema Area and Severity Index at Week 16 vs placebo+TCS (primary endpoint) (59.1%/62.6% vs 29.6%; P<0.0001 vs placebo+TCS, both doses). Dupilumab qw+TCS/q2w+TCS significantly improved other clinical outcomes and AD symptoms, including pruritus, pain, sleep disturbance, symptoms of anxiety and depression, and quality of life (QOL). Treatment groups had similar overall rates of adverse events (69.1%/72.0%/69.4%; qw+TCS/q2w+TCS/placebo+TCS) and serious adverse events (1.8%/1.9%/1.9%). Conjunctivitis was more frequent with dupilumab+TCS; skin infections were more frequent with placebo+TCS.
Conclusions
Dupilumab+TCS significantly improved signs and symptoms of AD and QOL in adults with history of inadequate response to/intolerance of CsA, or for whom CsA treatment was medically inadvisable. No new safety signals were identified.
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Mosaic pathogenic HRAS variant in a patient with nevus spilus with agminated Spitz nevi and parametrial-uterine rhabdomyosarcoma
Abstract
The role of HRAS mutations in the pathogenesis of various human cancers has been long established. Recent studies indicate that cutaneous nevi can also harbor HRAS, KRAS and NRAS mutations, and this group of RAS mutation positive birthmarks has been referred to as the mosaic RASopathies.1
This article is protected by copyright. All rights reserved.
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Optical coherence tomography of basal cell carcinoma: influence of location, subtype, observer variability and image quality on diagnostic performance
Abstract
Background
We previously described the principal results from an observational, prospective, multi-centre, clinical trial of the diagnostic value of optical coherence tomography (OCT) for basal cell carcinoma (BCC) in a clinical setting. In this trial, much additional useful information was gathered that warranted further analysis, presented here.
Objectives
To investigate the influence of candidate diagnostic criteria, OCT image quality, lesion location, and observer confidence and inter-observer variability on the diagnostic performance, and to assess potential for diagnosis of BCC subtypes.
Methods
A total of 234 clinically unclear "pink lesions" were evaluated in three steps: after clinical examination, after adding dermoscopy and finally after adding OCT. In addition to the diagnoses (including lesion subtype), observers also recorded which of 15 diagnostic criteria the OCT image contained, their confidence in the diagnoses, the OCT image quality, and the anatomical location of the lesion.
Results
Diagnostic performance of OCT did not depend on the lesion anatomical location. Good OCT image quality was correlated with improved diagnostic performance; but diagnostic performance for lesions with mediocre image quality was still better than by clinical and dermoscopic examination. The main reason for reduced image quality was superficial scales and crusting. Observer confidence in their diagnosis was correlated with diagnostic performance. Inter-observer diagnostic performance was consistently higher than clinical examination and dermoscopy across all sites. BCC subtype could be determined with moderate accuracy but further independent image markers are required.
Conclusion
This work supports the conclusion that OCT is useful for aiding the diagnosis of BCC.
This article is protected by copyright. All rights reserved.
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The minor allele HCP5 rs3099844 A, PSORS1C1 rs3131003 G are associated with allopurinol-induced severe cutaneous adverse reactions in Han Chinese: a multicentre retrospective case-control clinical study
Abstract
allopurinol-induced severe cutaneous adverse reactions (SCARs), which includes drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), are life threatening conditions and occur almost exclusively in HLA-B*5801 positive individuals in Han Chinese1-4.
This article is protected by copyright. All rights reserved.
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Can Early Dissection of Cervical Lymph Nodes Improve Prognosis in Squamous Cell Carcinomas of the Hard Palate?
ORL 2017;79:314-322
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Differential Expression of the Aryl Hydrocarbon Receptor and Transforming Growth Factor Beta 1 in Chronic Rhinosinusitis with Nasal Polyps with Allergic Rhinitis
ORL 2017;79:295-305
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Transoral Robotic Surgery with Sialendoscopy for a Plunging Ranula
ORL 2017;79:306-313
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Management of childhood psoriasis in France. A national survey among general practitioners, pediatricians, and dermatologists
Abstract
Psoriasis affects 0.5–2% of children. Severe forms required use of systemic treatments. Few studies are published on efficiency and tolerance of systemic treatments in children. We conducted a survey in France to better understand management of children with psoriasis. A survey on childhood psoriasis management was sent by e-mail to GPs, pediatricians, and dermatologists. The survey included 384 physicians. Respectively 53.1%, 49.8%, and 83.3% of GPs, pediatricians, and dermatologists declare to have seen at least one child with psoriasis during the 3 previous months. Less than 5% of GPs and pediatricians used severity score versus 23.7% of dermatologists. If most of physicians declare to use local treatments, less than 5% of GPs and pediatricians used systemic treatments. 32.4% of dermatologists declared to use at least one systemic treatment, but only 2.9% to use the 4 systemic treatments available in France. This survey shows that only half of GPs and pediatricians see children with psoriasis, but most of dermatologists. However, the management of severe forms seems limited by the underuse of severity scores and systemic treatments. These results should stimulate dermatology societies to promote prospective studies and guidelines in young populations with psoriasis.
http://ift.tt/2AgVpRI
Use of adapalene in alopecia areata: Efficacy and safety of mometasone furoate 0.1% cream versus combination of mometasone furoate 0.1% cream and adapalene 0.1% gel in alopecia areata
Abstract
Alopecia areata (AA) is an autoimmune disease characterized by non-cicatricial hair loss. No definitive therapy currently exists for AA. To compared the efficacy and safety of the mometasone furoate 0.1% cream alone with the mometasone furoate 0.1% cream plus adapalene 0.1% gel in treatment of AA. Twenty patients with AA and with mean age of 27.4 ± 9.2 years were enrolled. Patches with a diameter of < 5 cm were treated with mometasone furate 0.1% cream (M), and patches with a diameter of ≥5 cm were treated with mometasone furate 0.1% cream plus adapalene 0.1% gel (M + D) for a period of 12 weeks. Hair regrowth was evaluated using a Re-growth score (RGS). Mean RGSs of M + D group were higher than M group for 4th week (2.60 vs. 1.45); 8th week (3.85 vs. 2.40) and 12th week (4.40 vs. 3.30). Mean percentages of hair re-growth in M + D group were statistically higher than M group for 4th (50.2% vs. 23.5%), 8th (78.5% vs. 50.7%), and 12th week (90.5% vs. 71%). Study revealed the efficacy and safety of adapalene and mometasone furoate combination in AA. Adapalene can be used as a new therapeutic modality in AA.
http://ift.tt/2zwnymG
High-voltage electrical injury: Modified surgical technique for optimal defect closuring of extra-large cranial defect
Abstract
Electrical burns are group of traumatic injuries with a mortality rate of 3–15%. High-voltage induced extensive electric burns are rarely seen in the cranial area, compared to upper and lower limbs, but extremely difficult for treatment, due to the limited flexibility in this area. The spectrum of therapeutic interventions in electrical burns in general, evolving initial necrectomy, decompression, and aggressive debridement with early skin coverage is usually not enough in cases of extensive cranial defects. The performance of a suitable flap combined with skin graft in donor site, and further implantation of expander is challenging in this area. We present a case of a high-voltage induced extra-large cranial injury in a 38-year-old man, treated with modified single large rotation flap and a split skin-thickness graft technique, for optimal defect closuring with satisfied aesthetic result.
http://ift.tt/2AgVg0C
Complete cure of Fusarium solani sp. complex onychomycosis with Qs NdYAG treatment
Abstract
The incidence of non dermatophytic mould (NDM) onychomycosis (OM) has been steadily increasing Fusarium spp is the most common cause of NDM OM in most geographical locations. Fusarium spp and other NDMs are largely resistant to commonly used anti-fungals. The successful use of laser and light based devices has been demonstrated in dermatophytic OM, but there is no previous report of their successful use in any NDM OM. We describe a patient with OM caused by Fusarium solani spp, who was clinically (with a normal appearing nail) and mycologically (with negative microscopy and culture on repeated samples) cured of her infection following treatment with 2 sessions of Qs NdYAG (532nm and 1064nm) given 1 month apart.
http://ift.tt/2zwnof4
Styling without shedding: Novel topical formula reduces hair shedding by contracting the arrector pili muscle
Abstract
Approximately 40% of women experience excessive hair shedding during styling (e.g., hair brushing). Previously, we demonstrated that topically applied phenylephrine, a potent α1 adrenergic receptor agonist, can be used to contract the arrector pili muscle of the follicular unit; thus, increasing the force required to pluck hair and reducing shedding during brushing. While demonstrating efficacy, phenylephrine has several drawbacks when applied to the scalp, including the possibility cardiovascular events. We hypothesized that a high concentration of a weak α1 agonist would allow for: (a) rapid penetration through the stratum corneum eliciting a quick response; (b) a low probability of cardiac adverse events owing to the low receptor binding affinity; and (c) an efficacy of the weak α1 agonist similar to that of phenylephrine at the local site of application. Accordingly, we developed a novel topical solution, AB-102, containing a high concentration of a weak α1 agonist. Several studies were conducted to test the safety and efficacy of AB-102. In a dose escalating safety study, utilizing a wearable holter monitor, we observed no cardiac or hemodynamic adverse events. In addition, in a controlled efficacy study, AB-102 reduced the number of hairs shed during brushing by up to 77% (average of 38%).
http://ift.tt/2AhJHq5
The role of zinc in the treatment of acne: A review of the literature
Abstract
Acne vulgaris is a chronic disease of the pilosebaceous units presenting as inflammatory or noninflammatory lesions in individuals of all ages. The current standard of treatment includes topical formulations in the forms of washes, gels, lotions, and creams such as antibiotics, antibacterial agents, retinoids, and comedolytics. Additionally, systemic treatments are available for more severe or resistant forms of acne. Nevertheless, these treatments have shown to induce a wide array of adverse effects, including dryness, peeling, erythema, and even fetal defects and embolic events. Zinc is a promising alternative to other acne treatments owing to its low cost, efficacy, and lack of systemic side effects. In this literature review, we evaluate the effectiveness and side-effect profiles of various formulations of zinc used to treat acne.
http://ift.tt/2zwn5AW
Right heart transiting thrombi caused by endovenous sclerotherapy: the treatment is not consensual
Description
A 69-year-old woman without medical history, was admitted in our emergency department for acute respiratory distress. Two weeks prior to admission, she had undergone an endovenous foam sclerotherapy of a right saphenous branch with aetoxisclerol 2%. Afterwards, she complained of progressive dyspnoea and right thoracic pain. On arrival at the emergency department, the patient was noted to have cyanosis, a respiratory rate of 35 breaths/min and oxygen saturation of 90% despite high-flow face mask oxygen administration. Heart rate was 115 beats/min and blood pressure was 140/65 mm Hg. On physical examination, superficial thrombosis of a right saphenous branch was noted (figure 1). Laboratory studies demonstrated an elevation of markers of myocardial injuries and right ventricular dysfunction with a troponin I level of 1968 ng/L (reference value <16 ng/L) and brain natriuretic protein level of 541 ng/L (reference value <100 ng/L). Arterial blood gas showed the following: pH, 7.42; Po2, 86 mm Hg; Pco2, 37 mm Hg. ECG revealed sinus...
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