Efficacy of axillary versus infraclavicular brachial plexus block in preventing tourniquet pain: A randomised trial

BACKGROUND Axillary and infraclavicular brachial plexus blocks are commonly used for upper limb surgery. Clinicians require information on the relative benefits of each to make a rational selection for specific patients and procedures. OBJECTIVES The main objective of the study was to compare axillary and infraclavicular brachial plexus block in terms of the incidence and severity of tourniquet pain. DESIGN Single blinded, randomised trial. SETTING University affiliated hospital, level-1 trauma centre. PATIENTS Age more than 18 years, ASAI-III patients undergoing orthopaedic surgery distal to the elbow, with an anticipated tourniquet duration of more than 45 min were recruited. INTERVENTIONS Patients underwent either ultrasound guided axillary brachial plexus block or infraclavicular block (ICB). MAIN OUTCOME MEASURES Incidence of tourniquet pain (onset, severity, associated haemodynamic changes) and block characteristics (block performance/onset times, distribution, incidence of adverse events, patient satisfaction) were recorded. RESULTS Eighty two patients (40 in the axillary block and 42 in the ICB group) were recruited. The incidence (5/36 and 3/35; P = 0.71), onset time mean (SD) were 73.0 (14.8) and 86.6 (5.7) min (P = 0.18) and severity (mild/moderate; 4/1 and 1/2; P = 0.51) of tourniquet pain were similar in the two groups. The incidence of paraesthesia during block performance, and block performance time were greater in the axillary block group (P = 0.0054 and 0.012, respectively). The volume of local anaesthetic administered was greater in the ICB group (P 

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Reversible dilated cardiomyopathy as a complication of adrenal cortex insufficiency: a case report

Cardiovascular manifestations associated with Addison's disease are previously documented. We described a case of an 11-year-old girl who developed dilated cardiomyopathy as a complication to Addison's disease...

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Detection of Asherman’s syndrome after conservative management of placenta accreta: a case report

We present a case involving conservative treatment of placenta accreta, with a subsequent diagnosis of Asherman's syndrome.

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Gallbladder volvulus—acute cholecystitis ‘with a twist’

Abstract

A Caucasian 92-year-old female was admitted to hospital with acute epigastric pain associated with vomiting. Initial investigations revealed mildly raised inflammatory markers, normal liver function tests but a markedly distended gallbladder with prominent wall thickening. The patient was managed with intravenous antibiotics for acute cholecystitis but deteriorated significantly on Day 2 of admission. An emergency laparoscopic cholecystectomy was performed and we found a gangrenous gallbladder secondary to gallbladder volvulus. The patient recovered well in the postoperative period and was discharged home 7 days later.

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Paradoxical embolism through PFO leading to stroke in a gunshot victim with IVC injury

Abstract

A 23-year-old man presented to the emergency department with multiple gunshot wounds to the chest and abdomen, and was taken to the operating room emergently for exploratory laparotomy due to hemodynamic instability. The patient underwent inferior vena cava (IVC), bowel and ureter repair during the procedure, requiring massive amounts of blood products. The patient transferred to the surgical intensive care unit with a routine post-operative course for approximately the next 7 days before presenting with signs of stroke. The patient was diagnosed with deep vein thrombosis in IVC at the repair site on a follow-up venogram. Upon further work-up with echocardiography, the patient was determined to have a patent foramen ovale (PFO), with paradoxical embolism as the most likely cause of the stroke. We present this unusual case of a GSW leading to stroke due to embolism from a venous source through a PFO.

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Solitary fibrous tumor of the stomach with high-grade sarcomatous dedifferentiation

Abstract

Solitary fibrous tumors (SFT) are uncommon fibroblastic mesenchymal neoplasms that display a wide range of histologic behaviors. These tumors, which are estimated to account for 2% of all soft tissue neoplasms, typically follow a benign clinical course. However, it is estimated that 10–30% of SFTs are malignant and demonstrate aggressive behavior with local recurrence and metastasis up to several years after surgical resection. We report a case of SFT arising from the stomach, which is an exceptionally rare finding and has been reported only six times in the literature. Our case was complicated by diagnostic dilemma with GIST, highlighting the challenges of diagnosing and characterizing SFTs. Additionally, this tumor was associated with dedifferentiation into undifferentiated pleomorphic sarcoma. To our knowledge, there are no documented cases of a malignant SFT arising from the stomach to demonstrate dedifferentiation into an undifferentiated pleomorphic sarcoma.

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Posterior interosseous nerve palsy caused by synovial osteochondromatosis of the elbow analyzed by three-dimensional reconstruction: a case report

Synovial osteochondromatosis, a benign tumor consisting of cartilage and bone, generally presents as multiple osteochondral or chondral nodules. Peripheral nerve palsy caused by synovial osteochondromatosis is...

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