The first case of thrombocytopenia, anasarca, fever, renal impairment or reticulin fibrosis, and organomegaly (TAFRO) syndrome with unilateral adrenal necrosis: a case report

TAFRO syndrome, which was first reported in 2010 in Japan, is a relatively rare disease characterized by thrombocytopenia, anasarca, fever, renal impairment, reticulin fibrosis, and organomegaly. Although this...

https://ift.tt/2ypoSbC

Massive hemothorax due to two bleeding sources with minor injury mechanism: a case report

Massive hemothorax resulting from a minor injury mechanism is considered to be rare particularly when the diaphragm is injured. We report a case of massive hemothorax with bleeding from the intercostal artery ...

https://ift.tt/2pG3jzB

How neuraxial labor analgesia differs by approach: dural puncture epidural as a novel option

Abstract

Background and aim

Neuraxial analgesia techniques are not limited to just standard epidural and CSE blocks. A novel approach called dural puncture epidural (DPE) which is a modification of CSE in terms of practice has gained popularity after its description and use in the obstetric population.  The aim of this review is to address the practice of DPE technique as a novel option by reviewing its benefits as well as side and/or adverse effects and to understand how neuraxial labor analgesia differs by approach based on the information available in the current literature

Discussion

Despite controversies and concerns, more rapid onset of analgesia, early bilateral sacral analgesia, lower incidence of asymmetric block and fewer maternal and fetal side effects are provided with DPE when compared to epidural.

Conclusion

DPE offers a favorable risk–benefit ratio for management of neuraxial analgesia as a novel option.

https://ift.tt/2BXteu5

Angiotensin II-mediated suppression of synaptic proteins in mouse hippocampal neuronal HT22 cell was inhibited by propofol: role of calcium signaling pathway

Abstract

Purpose

Angiotensin II (Ang II) has been shown to be involved in neurological disorders. Propofol demonstrated neuroprotective effects in neurons.

Methods

Mouse hippocampal HT22 cells were pre-treated with propofol, followed by Ang II treatment. The expression of synaptic proteins (synapsin I and PSD95) was examined. The effects of propofol on Ang II-induced NADPH oxidase expression and superoxide anion generation were examined. The effects of propofol on intracellular calcium concentration, the activation of calcium/calmodulin-dependent protein kinase II (CaMKII), and protein kinase C (PKC) were measured.

Results

Ang II reduced the expression of synapsin I and PSD95, which was attenuated by propofol. Ang II-induced effects were blocked by Ang II type 1 receptor (AT1 receptor) blocker. Ang II induced the expression of NADPH oxidase and caused superoxide anion accumulation, which were attenuated by propofol. In addition, propofol induced intracellular calcium concentration, and activated CaMKII as well as PKCβ. Importantly, the Ang II-mediated effects were diminished by α-tocopherol, and the propofol-mediated effects were alleviated by calcium chelator, CaMKII inhibitor, and PKCβ inhibitor.

Conclusion

Ang II, via AT1 receptor, induced oxidative stress and reduced the expression of synapsin I and PSD95 in HT22 cells. Propofol may increase synapsin I and PSD95 expression by inhibiting oxidative stress and stimulating calcium signaling pathway.

https://ift.tt/2Nohi6x

A rare case of large pyosalpinx in an elderly patient with well-controlled type 2 diabetes mellitus: a case report

Pyosalpinx, which is one of the pelvic inflammatory diseases, is usually observed in young women; it is rarely found in older women. Possible causative agents are thought to be Chlamydia trachomatis and Neisseria...

https://ift.tt/2BZkqnl

Ultrasound-guided quadratus lumborum block in pediatrics: trans-muscular versus intra-muscular approach

Abstract

Purpose

Quadratus lumborum (QL) block has four approaches. However, there is difference between the four approaches regarding efficacy, safety and adverse effects. The primary objective of this study is to compare the analgesic effect between trans-muscular and intra-muscular approaches of the QL block in pediatric patients for elective lower abdominal surgery.

Methods

54 patients aged between 1 and 6 years were enrolled. Patients of both genders were selected. The patients were randomly classified into two groups: Group TQL includes patients (27 patients) in whom bilateral QL block was performed using trans-muscular approach, and Group IQL (27 patients), which underwent bilateral QL block using an intra-muscular approach. The primary outcome measure was the number of patients who require rescue analgesia in the first 24 h. The secondary outcome measures were FLACC score, heart rate, non-invasive blood pressure at 2, 4, 6, 12, and 24 h postoperatively, and postoperative complications (e.g., quadriceps muscle weakness, local hematoma).

Results

In the first 24 h after surgery, 13 patients in the IQL group (48.1%) required rescue analgesia, whereas only five patients in the TQL group (18.5%) required rescue analgesia. The FLACC score was lower in the TQL group than the IQL group at all time intervals up to 24 h postoperatively. In the TQL group, eight patients (29.6%) developed quadriceps weakness; whereas, only one patient (3.7%) in the IQL group developed quadriceps weakness.

Conclusion

TQL is better than IQL in the analgesic efficacy following the pediatric lower laparotomy.

https://ift.tt/2pzwioS

Bite injuries caused by transcranial electrical stimulation motor-evoked potentials’ monitoring: incidence, associated factors, and clinical course

Abstract

Purpose

The incidence of bite injuries associated with transcranial electrical stimulation motor-evoked potentials monitoring reportedly ranges from 0.13 to 0.19%. However, in clinical practice, bite injuries appear to occur more frequently than previously reported. Our aim was to identify the incidence of and perioperative risk factors associated with bite injuries caused by transcranial electrical stimulation motor-evoked potential monitoring.

Methods

Patients who underwent elective surgery with transcranial electrical stimulation motor-evoked potential monitoring at a single tertiary hospital in Japan between June 2017 and December 2017 were included in this study. All patients were assessed by oral surgeons preoperatively and postoperatively. The associated factors with bite injuries were explored by the univariate analysis.

Results

12 of 186 patients experienced 13 bite injuries, including three lip, six oral mucosa, and four tongue injuries. No patient required suture repair. 11 of 12 patients had uneventful postoperative courses and were cured within 12 postoperative days. One patient with a tongue ulcer and a hematoma had difficulty in oral intake and persistent dysgeusia. Patient severe movement during transcranial electrical stimulation motor-evoked potential monitoring was associated with bite injuries (p = 0.03).

Conclusions

The incidence of bite injuries assessed by oral surgeons was 6.5% in patients with transcranial electrical stimulation motor-evoked potential monitoring, and the patients with severe movement during the monitoring tended to incur bite injuries. In rare cases, transcranial electrical stimulation motor-evoked potential monitoring may cause difficulty in oral intake and dysgeusia.

https://ift.tt/2QwltPU