Outcomes of total hip arthroplasty in pancytopenia

2016-02-21T19-08-33Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Dragan Radoicic, Zarko Dasic, Srdan Starcevic, Danica Radoicic.
Objective: Pancytopenia is a hematological entity, it confronts surgeons from time to time, and the purpose was to determine the risks, difficulties and complications involved in performing total hip arthroplasty in pancytopenic patients. Materials and methods: single centre review of 15 patients with pancytopenia, who underwent THA. 5 patients had decreased bone marrow function, 9 increased peripherial destruction, 8 of them had chronic hepatitis with liver cirrhosis (hepatitic C in 6 and B in 2 cases). Results: 18 THA procedures, three patients had staged bilateral THA. Average age was 63.9 years. 12 women and 3 men, 14 cementless and 4 hybrid THA-s. Average intraoperative blood loss was 930 ml, average operative time 72 min. Conclusion: THA in pancytopenia may be challenging and burdened by higher risks and costs, than in cases of some other comorbidities. THA can be safely performed, if thorough preoperative assessment is conducted, proven and safe surgical technique used and adequate postoperative restoration of hematological imbalances achieved.


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Unilateral gynecomastia: The assessment of 23 patients

2016-02-21T19-08-33Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Salih Onur Basat, Fatih Ceran, Ilker Uscetin, Ismail Mithat Akan, Oguzhan Demirel, Mehmet Bozkurt.
Background: Gynecomastia is a benign enlargement of breast tissue that occurs especially during adolescence in males and generally requires treatment. Although most of cases are idiopathic and bilateral, there are instances that require spe- cial attention and be given unilateral status. In this study, the aim was to evaluate management of unilateral gynecomastia. Methods: For this study, 23 male patients admitted to the authors clinic between 2010 and2013 diagnosed with grade 2A and 2B unilateal gynecomastia were reviewed retrospectively. The patients detailed medical history and physical exami- nation notes, laboratory test results, history of medication use and photographs were examined. Mean follow-up time was 13.4 months. Results: 11 patients were treated by strictly gland excision, four patients with only liposuction and eight patients with gland excision combined with liposuction. Gynecomastia was seen on the left side of the chest in 13 patients and on the right side in 10 patients. There were no complications. The specimens did not reveal any malignant causes. Conclusion: Although most cases gynecomastia are idiopathic and bilateral, there are instances that require special at- tention and should be given unilateral status. Detailed evaluation including physical examination, history of drug use and concomitant medical disorders should be considered.


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The management of Fournier’s gangrene: A review of 60 patients

2016-02-21T19-08-33Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Salih Onur Basat, Tumay Ipekci, Fatih Ceran, Mehmet Kisaarslan, Mehmet Bozkurt.
Background: Fourniers gangrene (FG) is a rapidly progressive, destructive, necrotizing fasciitis of perianal, perineal,and genital region. The common clinical symptoms include sudden intense pain in the scrotum, prostration,fever, and pallor. In this study, it was aimed to assess FG in a wider angle. Methods: 60 patients with the mean age of 55 (ranged between 48-62) that presented with FG in our hospital over a 6 year period between April 2008 and March 2014 were retrospectively reviewed. Age, gender, site of gangrene, risk factors, symptoms, microbiology, treatment modalities, FGSI score, and mortality datas were evaluated. Results: 60 male patients with the mean age of 55 (ranged between 48-62) were included to the study. 50 patients survived, mortality rate was 16.6%. Septic shock (n: 4), cardiogenic shock (n:4) and pneumonia (n:2) were causes of death. As a risk factor, 45 (75%) patients had DM, 40 (66.6%) patients had HT, and 35 (58.3%) patients had both DM and HT. There were no other co-morbid situation for 10 (16.6%) patients. All the survived 50 patients were suitable for surgical reconstruction. STSG procedure was performed for 46 (76.6%) patients and flap reconstruction was performed for 4 (6.6%) patients. None of the patients had hyperbaric oxygen therapy (HBO). Length of hospitalization was 16 days (5-58) for all patients. A mean FGSI score at admission was of 5.02 ± 2.45 for survivors compared with 13.8 ± 4.53 for non-survivors. A mean FGSI score was of 4.56 ± 2.28 for survivors and 11.50 ± 2.63 in non-survivors during hospitalization. Conclusion: Although FG has high mortality rates, appropriate management of the disease can reduce rates. Early diagnosis, surgical debridement, VAC application and antibiotherapy are the essentials for FG.


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Coherence in children with AD/HD and excess alpha power in their EEG

Attention-Deficit/Hyperactivity Disorder (AD/HD) affects an estimated 3-10% of school-aged children, making it the most common psychiatric disorder of childhood (Polanczyk et al., 2007; Skounti et al., 2006; Froehlich et al., 2007; Biederman and Faraone, 2005; American Psychiatric Association [APA], 1994). AD/HD is characterised by symptoms of inattention, hyperactivity and impulsivity that impact on many aspects of a child's life (Polanczyk et al., 2007; APA, 1994).

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Evaluation of pH in the removed i-gel after general anesthesia: a prospective observational study

The i-gel (i-gel; Intersurgical, Wokingham, United Kingdom) is a supraglottic device made of a thermoplastic elastomer [1]. Previous studies have shown that the i-gel has sufficient airway sealing pressure and can be used for mechanical ventilation under general anesthesia [2]. However, as the i-gel does not secure the trachea completely, there is a possibility that regurgitation of gastric fluid might occur during general anesthesia. Thus, we performed a prospective observational study to evaluate pH in the i-gel after removal.

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Evaluation of gum-elastic bougie with direct and indirect laryngoscope for infant difficult airway management: a Pierre Robin simulation model

Pierre Robin sequence is a collection of rare clinical findings including micrognathia, glossoptosis, and cleft palate, and airway management of these patients is generally difficult [1]. The tracheal tube introducer (gum-elastic bougie; GEB) is a commonly used airway tool for difficult intubation. We recently reported on the GEB utility for simulated infant difficult airway management modulated by cervical stabilization or anteflexion [2]. We hypothesized the GEB would facilitate tracheal intubation with direct and indirect laryngoscopes for difficult infant airway associated with congenital disease.

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The history of the nurse anesthesia profession

Despite the fact that anesthesia was discovered in the United States, we believe that both physicians and nurses are largely unaware of many aspects of the development of the nurse anesthetist profession. A shortage of suitable anesthetists and the reluctance of physicians to provide anesthetics in the second half of the 19th century encouraged nurses to take on this role.We trace the origins of the nurse anesthetist profession and provide biographical information about its pioneers, including Catherine Lawrence, Sister Mary Bernard Sheridan, Alice Magaw, Agatha Cobourg Hodgins, and Helen Lamb.

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IMPORTANCE OF SERATONIN GENE RELATED PEPTIDE (SGRP) IN MIGRAINE

2016-02-21T11-56-54Z
Source: International Journal of Health and Rehabilitation Sciences (IJHRS)
Sivanandan Ramar, Sankaran Ponnusamy, Salameh Al Dajah.
Migraine is a neurovascular disorder involving trigeminal ganglion characterized by recurrent episodic headache and rise in levels of Serotonin Gene Related Protein (SGRP) in plasma. SGRP is a neuropeptide present in the central and peripheral nervous system that has diverse functions as primary afferent neurotransmitter which is important in nociception. In this study expression of SGRP studied in neurons of trigeminal ganglion in male wistar albino rats. SGRP is expressed in cytoplasm of neurons mainly in the small sized neurons indicating that small sized neurons are mainly involved in nociception. Keyword:.


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Frequent Flyers: Rookie dinner duties

See all of Lenwood Brown's comics.

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Fecal calprotectin: its scope and utility in the management of inflammatory bowel disease

Abstract

Gastrointestinal symptoms such as abdominal pain, dyspepsia, and diarrhea are relatively nonspecific and a common cause for seeking medical attention. To date, it is challenging for physicians to differentiate between functional and organic gastrointestinal conditions and it involves the use of serological and endoscopic techniques. Therefore, a simple, noninvasive, inexpensive, and effective test would be of utmost importance in clinical practice. Fecal calprotectin (FC) is considered to be a reliable biomarker that fulfills these criteria. FC can detect intestinal inflammation, and its level correlates well with macroscopic and histological inflammation as detected by colonoscopy and biopsies, respectively. FC has a decent diagnostic accuracy for differentiating organic diseases and functional disorders because of its excellent negative predictive value in ruling out inflammatory bowel disease (IBD) in symptomatic undiagnosed patients. There is accumulating evidence that FC has been effectively used to monitor the natural course of IBD, to predict relapse, and to see the response to treatment. This novel biomarker has the ability to assess mucosal healing (MH), which is a therapeutic goal in IBD management. A literature search was carried out using PubMed with the keywords FC, IBD, intestinal inflammation, and MH. In our review, we provide an overview of the utility and scope of FC as a biomarker in patients with IBD as well as undiagnosed patients with lower gastrointestinal symptoms.

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Adventurous Physical Activity Environments: A Mainstream Intervention for Mental Health

Abstract

Adventurous physical activity has traditionally been considered the pastime of a small minority of people with deviant personalities or characteristics that compel them to voluntarily take great risks purely for the sake of thrills and excitement. An unintended consequence of these traditional narratives is the relative absence of adventure activities in mainstream health and well-being discourses and in large-scale governmental health initiatives. However, recent research has demonstrated that even the most extreme adventurous physical activities are linked to enhanced psychological health and well-being outcomes. These benefits go beyond traditional 'character building' concepts and emphasize more positive frameworks that rely on the development of effective environmental design. Based on emerging research, this paper demonstrates why adventurous physical activity should be considered a mainstream intervention for positive mental health. Furthermore, the authors argue that understanding how to design environments that effectively encourage appropriate adventure should be considered a serious addition to mainstream health and well-being discourse.

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