Establishing an Acute Pain Service in Private Practice and Updates on Regional Anesthesia Billing

Publication date: September 2018

Source: Anesthesiology Clinics, Volume 36, Issue 3

Author(s): Christopher A.J. Webb, T. Edward Kim

https://ift.tt/2Mq02yn

Enhanced Recovery After Shoulder Arthroplasty

Publication date: September 2018

Source: Anesthesiology Clinics, Volume 36, Issue 3

Author(s): Taras Grosh, Nabil M. Elkassabany

https://ift.tt/2OQ6u3i

Forthcoming Issues

Publication date: September 2018

Source: Anesthesiology Clinics, Volume 36, Issue 3

Author(s):

https://ift.tt/2KxFGkY

Contents

Publication date: September 2018

Source: Anesthesiology Clinics, Volume 36, Issue 3

Author(s):

https://ift.tt/2OR4t71

Contributors

Publication date: September 2018

Source: Anesthesiology Clinics, Volume 36, Issue 3

Author(s):

https://ift.tt/2MqnUBV

Copyright

Publication date: September 2018

Source: Anesthesiology Clinics, Volume 36, Issue 3

Author(s):

https://ift.tt/2M6S54e

Regional Anesthesia

Publication date: September 2018

Source: Anesthesiology Clinics, Volume 36, Issue 3

Author(s): Nabil M. Elkassabany, Edward R. Mariano

https://ift.tt/2MoOZp2

Conservative management of pelvic sepsis with severe shock and multiple organ dysfunction syndrome after rubber-band ligation of internal haemorrhoids: surgery is not the only option

Abstract

Rubber-band ligation (RBL) is a safe and cost-effective approach to internal haemorrhoids. Potential side effects include pain, bleeding, urinary retention and occasionally pelvic sepsis and systemic inflammatory response syndrome (SIRS). At-risk patients are mainly those with immunocompromising conditions. Although aggressive surgical debridement or diverting colostomy appear to be obvious options when patients' life is threatened, their superiority to conservative measures has not been proven. We present the case of a 58-year-old female patient who presented 48 h after a RBL with pelvic pain, dysuria and leukocytosis. Her condition deteriorated rapidly that ventilator and inotropic support were required for a severe SIRS for almost 10 days. Laparoscopic exploration and imaging showed a rectosigmoiditis, ascites and superficial rectal necrosis with no transmural damage requiring an emergent surgery. Conservative management could possibly be a valid option in post-RBL pelvic sepsis even when severe associated multiple organ failure is present.

https://ift.tt/2nnH9RP

Primary greater omental torsion as a cause of acute abdomen—a rare case report

Abstract

Greater omental torsion is a rare entity that can cause acute abdominal pain, may mimick other abdominal pathologies, and is difficult to be diagnosed preoperatively. We present a case of a male patient with greater omental torsion mimicking the symptoms of acute appendicitis. A 31-year-old male patient presented with right scrotal pain, initially treated by the urologists, however, 24 h later, he presented right lower quadrant pain, with characteristics of acute appendicitis. After finding in ischemic inflammatory mass on McBurney incision, an exploratory laparotomy was performed, revealing torsion of the greater omentum. Torsion of the greater omentum can be a cause of acute abdomen and could be misdiagnosed with acute appendicitis. Preoperative diagnosis is not easy and resection of the affected tissue is the preferred treatment of choice.

https://ift.tt/2Kv3vtC

Adenomyomatous hyperplasia of distal common bile duct: a case report and review of the literature

Abstract

Adenomyomatous hyperplasia (AH) is commonly found in the gallbladder and is considered a tumor-like inflammatory lesion arising from Rokitansky-Aschoff sinus. It is extremely rare in the extrahepatic bile duct and only 15 cases have been reported to date. We describe a 63-year-old male patient who presented with cholangitis, underwent an extensive diagnostic workup, and ultimately had a Whipple procedure. Final pathology showed a 2.0 × 1.5 × 0.5 cm³ granular lesion in the distal common bile duct. There was prominent biliary epithelial proliferation with tubular–papillary architecture and minimal nuclear atypia in association with chronic inflammation, stroma reaction and smooth muscle proliferation. AH of the extrahepatic bile duct is a benign process but often requires a major operation to definitively diagnose.

https://ift.tt/2nnH8NL

Fulminant descending mediastinitis secondary to infectious mononucleosis

Abstract

Descending mediastinitis is a rare, life-threatening condition caused by contiguous spread of oropharyngeal or cervical infection into the mediastinum. Infectious mononucleosis generally results in a self-limited illness characterized by fever, pharyngitis and lymphadenopathy. We present an exceptional case of an 18-year-old with infectious mononucleosis complicated by progressive bacterial superinfection and fulminant descending mediastinitis. After resuscitation, broad spectrum antibiotics, critical care support and definitive surgical management, they made a full recovery.

https://ift.tt/2KABv7T

Tracheal segmental resection for tracheal cancer: comparison of cervical collar incision with median sternotomy and posterolateral incision

Abstract

We compare two surgical approaches for segmental tracheal resection for tracheal cancer: cervical collar incision with median sternotomy and right posterolateral incision. In case one, a 46-year-old woman presented with adenoid cystic carcinoma, measuring 4.5 cm longitudinally, located at the junction of the cervical and mediastinal trachea. Cervical collar incision with median sternotomy provided a good exposure of the entire trachea. Although a relatively long tracheal resection (5.0 cm) was required, sufficient mobilization of the entire trachea facilitated low-tension anastomosis. In case 2, a 39-year-old man presented with squamous cell carcinoma, measuring 1.8 cm longitudinally, located at the lower trachea 1.8 cm from the carina to the proximal side. Right posterolateral incision provided a good exposure of the lower trachea. Although the required tracheal resection was relatively short (3.0 cm), the anastomotic tension was high. The high anastomotic tension was likely attributed to the limited mobilization of the proximal trachea.

https://ift.tt/2M0n6Yf

Acute appendicitis as the first presentation of appendiceal metastasis of gastric cancer—report of a rare case

Abstract

Metastatic tumors of the appendix is a rare entity, whereas only limited data involving metastasis arising from gastric cancer has been reported. Herein, the case of gastric adenocarcinoma metastasis presenting as acute appendicitis is reported. A 53-year-old male, with a history of subtotal gastrectomy due to gastric adenocarcinoma 3 years before, was referred to the Emergency Department with symptoms of acute appendicitis. While this condition was confirmed intraoperatively, histology examination and comparison with the previously excised gastric specimen indicated that metastasis of gastric adenocarcinoma to the appendix was present. Metastatic appendiceal carcinoma arising from the stomach is an extremely rare condition, associated with poor prognosis. Aggressive treatment of the solitary lesion may present favorable results.

https://ift.tt/2Ky6rpe

Subacute carbon monoxide poisoning presenting as vertigo and fluctuating low frequency hearing loss

Abstract

It is estimated that up to 25 000 UK residents are exposed to small amounts of carbon monoxide (CO) annually. Symptoms of chronic exposure to CO are vague and non-specific and include dizziness and hearing loss. We describe a case of 38-year-old lady presenting with a 4-month history of vertigo and hearing loss. Initially diagnosed as Meniere's disease, the patient was investigated and followed up in the clinic. She reported leakage of carbon monoxide from her gas fire identified during a routine safety check. Her symptoms fully resolved after disconnecting the faulty gas fire. A rare cause of fluctuating hearing loss and vertigo is described, and the diagnostic challenges are discussed.

https://ift.tt/2ndYzQy

Necrotizing fasciitis of the lower extremity caused by perforated sigmoid diverticulitis—a case report

Abstract

Diverticulosis of the sigmoid colon is a common condition and occurs more often in elderly patients. A well-known complication is infection or even perforation which often requires surgery. Necrotizing fasciitis as a complication of perforated diverticulitis is very rare. Here, we present a case of a covered perforated diverticulitis in an immunosuppressed patient leading to life-threatening necrotizing fasciitis requiring extracorporeal membrane oxygenation. Either hematogenous or local dissemination via the inguinal canal seemed the most probable mechanism of leg infection leading to hip articulation.

https://ift.tt/2KEdhtC

Co-occurring superior mesenteric artery syndrome and nutcracker syndrome requiring Roux-en-Y duodenojejunostomy and left renal vein transposition: a case report and review of the literature

The duodenum and the left renal vein occupy the vascular angle made by the superior mesenteric artery and the aorta. When the angle becomes too acute, compression of either structure can occur. Each type of co...

https://ift.tt/2M5a1fs

Can folate replacement induce lymphoma progression?

A 43-year-old Japanese man with a low haemoglobin level of 1.3 g/dL and multiorgan dysfunction syndrome (MODS) was admitted to our hospital. He was diagnosed with folate deficiency, which was initially attributed to his malnutrition. He was transfused with several units of packed red blood cells and treated with folate, thiamine and vitamin B₁₂ supplements; he showed a prompt haematological response and recovery from MODS. However, 3 weeks after the initial recovery, he had a relapse of pancytopenia and developed high-grade fever along with rapidly enlarging, generalised lymphadenopathy. Bone marrow biopsy revealed hemophagocytosis, and lymph node biopsy revealed peripheral T-cell lymphoma, not otherwise specified. Folate supplementation may have promoted lymphoma progression.

https://ift.tt/2ONnw1H

A Case of Neurosarcoidosis-Induced Syndrome of Inappropriate Secretion of Antidiuretic Hormone Diagnosed with Neuroendoscopy

We treated a patient with neurosarcoidosis, which caused the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), in whom diagnosis was performed using neuroendoscopy. The patient was a 56-year-old female who was hospitalized for hyponatremia and diagnosed with SIADH based on a detailed examination. During the course, she developed impaired consciousness due to acute hydrocephalus, which improved after ventricular drainage. Head magnetic resonance imaging (MRI) confirmed nodular lesions at the floor of the third ventricle and the cerebral aqueduct. Neuroendoscopic biopsy led to the diagnosis of neurosarcoidosis. Her hyponatremia improved after steroid therapy. Neurosarcoidosis can cause SIADH, and complication of hydrocephalus may lead to a poor prognosis. Neuroendoscopy appears to be effective for the diagnosis of neurosarcoidosis with hydrocephalus and helps in deciding the treatment modality.

https://ift.tt/2KwFEtE