Σάββατο, 30 Απριλίου 2016

Variation in the nasal cavity of baboon hybrids with implications for late Pleistocene hominins

Publication date: May 2016
Source:Journal of Human Evolution, Volume 94
Author(s): Kaleigh Anne Eichel, Rebecca Rogers Ackermann
Hybridization is increasingly proving to be an important force shaping human evolution. Comparisons of both ancient and modern genomes have provided support for a complex evolutionary scenario over the past million years, with evidence for multiple incidents of gene exchange. However, to date, genetic evidence is still limited in its ability to pinpoint the precise time and place of ancient admixture. For that we must rely on evidence of admixture from the skeleton. The research presented here builds on previous work on the crania of baboon hybrids, focusing on the nasal cavity of olive baboons, yellow baboons, and first generation (F1) hybrids. The nasal cavity is a particularly important anatomical region for study, given the clear differentiation of this feature in Neanderthals relative to their contemporaries, and therefore it is a feature that will likely differ in a distinctive manner in hybrids of these taxa. Metric data consist of 45 linear, area, and volume measurements taken from CT scans of known-pedigree baboon crania. Results indicate that there is clear evidence for differences among the nasal cavities of the parental taxa and their F1 hybrids, including a greater degree of sexual dimorphism in the hybrids. There is also some evidence for transgressive phenotypes in individual F1 animals. The greatest amount of shape variation occurs in the anterior bony cavity, the choana, and the mid-nasopharynx. Extrapolating our results to the fossil record, we would expect F1 hybrid fossils to have larger nasal cavities, on average, than either parental taxon, with overall nasal cavity shape showing the most profound changes in regions that are distinct between the parental taxa (e.g., anterior nasal cavity). We also expect size and shape differences to be more pronounced in male F1 hybrids than in females. Because of pronounced anterior nasal cavity differences between Neanderthals and their contemporaries, we suggest that this model might be effective for examining the fossil record of late Pleistocene contact.



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The multidisciplinary treatment of bronchobiliary fistula present in a patient with pancreatic neuroendocrine tumor

2016-04-30T18-05-46Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Baris Ozcan, Metin Cevener, Omer Vefik Ozozan, Saim Yilmaz, Alihan Gurkan.
Bronchobiliary Fistula (BBF) is a rare condition that usually occurs after surgical treatments of pancreas, liver and biliary diseases. Clinical findings are bilioptysis, fever and dyspnea. In treating it, initially, drainage should be conducted using minimally invasive or endoscopic methods, such as endoscopic retrograde cholangiopancreatography (ERCP) or percutaneous transhepatic cholangiography (PTK) in cases where these methods failed. Next, treatment through performing surgical operations, like hepatectomy or pulmonary resection, should be carried out. In this work, the diagnostic and therapeutic phases of a female patient at the age of 40 who underwent a whipple procedure (pancreatoduodenectomy) 10 years earlier because of pancreatic neuroendocrine tumor is presented. Their follow-ups exhibited multiple metastases in the liver, and for this reason, specific chemoembolization treatments were applied. After these treatments, bronchobiliary fistula was formed.


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Differentiating Chilaiditi signs from Chilaiditi syndrome

2016-04-30T18-05-46Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Ankit Shukla, Ramesh Bharti, Amar Verma, Rajesh Chaudhary.
Chilaiditi is an extremely rare anatomical condition, which may present asymptomatically or symptomatically with or without complications. Differentiation between chilaiditi signs and chilaiditi syndrome and having knowledge of the possible complications is important so as to decide when to operate and when not to. Here, we present a rare case of a 66-year-old gentleman with chilaiditi syndrome causing complete obstruction of a small bowel loop.


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Primary retroperitoneal hydatid cyst

2016-04-30T18-05-46Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Amit Kumar C Jain, Mohan LN, Prahalad ST.
Hydatid cysts are most common in the liver followed by lungs. Most are asymptomatic for prolonged periods. The other sites where hydatid cysts are found include the spleen, kidneys and brain. Retroperitoneal hydatid cysts are extremely rare. A 45-year-old male presented to the authors emergency room with history of abdominal pain over the previous 7 days. It was insidious at onset and the pain had increased in severity during the 2 days before arriving at the hospital. The pain was radiating to the right lower limb. The abdomen showed a tender vague mass in the right lumbar region and iliac fossa. A CT scan confirmed a hydatid cyst in the retro peritoneum. The patient underwent laparotomy and excision of the cyst.


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When the fan leaves the shit... Norway: detached rotor blades spin in air...

Total loss, 11 found, 2 corpses missing. Time to redo that EC225 Gearbox/Main rotor shaft, i think... R.I.P. Grounded, again ( Norway, U.K. ( World wide i hope... )) ( SAR machines can still fly, on life saving missions ) Airbus FIX IT, OR KILL IT ..! You can better then this ! Why let this machine ( SuperPuma 225 ) ruin your exelent rep. ? ExEMTNor

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When the fan leaves the shit... Norway: detached rotor blades spin in air...

Total loss, 11 found, 2 corpses missing. Time to redo that EC225 Gearbox/Main rotor shaft, i think... R.I.P. Grounded, again ( Norway, U.K. ( World wide i hope... )) ( SAR machines can still fly, on life saving missions ) Airbus FIX IT, OR KILL IT ..! You can better then this ! Why let this machine ( SuperPuma 225 ) ruin your exelent rep. ? ExEMTNor

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Medical Staff Associate - CSL Plasma

CSL Plasma is seeking FT Paramedics to join our Medical Staff Associate Team in our Oklahoma City facility. We offer competitive salary, great benefit package which includes medical, dfental, 401K, career advancement opportunities, tuition reimbursement, and 3 weeks vacation the first year. Apply on line at CSLPLASMA.COM

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When the fan leaves the shit... Norway: detached rotor blades spin in air...

Total loss, 11 found, 2 corpses missing. Time to redo that EC225 Gearbox/Main rotor shaft, i think... R.I.P. Grounded, again ( Norway, U.K. ( World wide i hope... )) ( SAR machines can still fly, on life saving missions ) Airbus FIX IT, OR KILL IT ..! You can better then this ! Why let this machine ( SuperPuma 225 ) ruin your exelent rep. ? ExEMTNor

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Testing brains with burst suppressions

Distinguishing burst suppression (BS) pattern from a "continuous EEG" pattern is perhaps the first and easiest to learn by junior fellows as they start working in units with neurological intensive care (Westhall et al., 2015). Detection of BS is considered the hallmark of severe compromise in brain function, and in the context of brain damage, it is traditionally considered to signify a poor prognosis (Westhall et al., 2016; Hofmeijer et al., 2015). Recognition of BS is important for neurologists when treating status epilepticus using anesthesia that is titrated to keep the EEG at the "BS level", between the levels of continuous EEG and inactive EEG.

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When the fan leaves the shit... Norway: detached rotor blades spin in air...

Total loss, 11 found, 2 corpses missing. Time to redo that EC225 Gearbox/Main rotor shaft, i think... R.I.P. ExEMTNor

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An unusual and unexpected finding in a case of self-poisoning

A 65 year old man with history of severe depression was admitted for impaired consciousness after having ingested 30 tablets of cyamemazine and venlafaxine. The extra-neurological physical examination and the chest X-ray were normal. The day after, the chest X-ray revealed metal foreign bodies in the colon's left angle and the patient declared having ingested sharp pointed metal tools during the past three days. Abdominal X-ray (Fig. 1) and CT-scan revealed the presence of dozens of metal foreign bodies along the digestive tract, including an extra-digestive needle with an inflammation of the surrounding fat.

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Superiority of visual (verbal) vs. auditory test presentation modality in a P300-based CIT: the Complex Trial Protocol for concealed autobiographical memory detection

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Publication date: Available online 29 April 2016
Source:International Journal of Psychophysiology
Author(s): Xiaohong Deng, J. Peter Rosenfeld, Anne Ward, Elena Labkovsky
This paper continues our efforts to determine which modality is best for presentation of stimuli in the P300-based concealed information test (CIT) called the Complex Trial Protocol (CTP). The first part of the CTP trial involves presentation of the key probe or irrelevant stimuli, and is followed by presentation of target (T) or non-target (NT). In Rosenfeld et al. (2015), probes and irrelevants regularly alternated modality over trials, but Ts and NTs were always visual. In the present study, (in both its experiments, EXP1 and EXP2), probes and irrelevants alternated modalities on successive trials, as before. In present EXP 1, Ts and NTs were always auditory, but in EXP 2, they were simultaneously auditory and visual. Probe P300 data were different in each study: In Rosenfeld et al. (2015) and EXP 2 here, the bootstrap-based detection rates based on probe-minus-irrelevant differences, significantly differed favoring visual probe and irrelevant presentation modality. In EXP 1 here, detection rates were the same for the two modalities. In Rosenfeld et al. (2015) there was no main effect of probe modality, visual vs. auditory on probe-minus-irrelevant P300 difference. There were such effects here in EXP 1 (p<0.08, effect size =0.19) and EXP 2 (p<0.02, effect size =0.31), favoring the visual modality. Probe P300 latencies were shorter for visual than for auditory stimuli in Rosenfeld et al. (2015), a trend specifically reversed in the present pair of studies. RT was faster for visual stimuli in the present studies. The T and NT modality appears to interact with probe/irrelevant modality, and the best protocol for detecting concealed information is with the 2015 study protocol or that of EXP 2, using visual stimulus presentation.



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An unusual and unexpected finding in a case of self-poisoning

A 65 year old man with history of severe depression was admitted for impaired consciousness after having ingested 30 tablets of cyamemazine and venlafaxine. The extra-neurological physical examination and the chest X-ray were normal. The day after, the chest X-ray revealed metal foreign bodies in the colon's left angle and the patient declared having ingested sharp pointed metal tools during the past three days. Abdominal X-ray (Fig. 1) and CT-scan revealed the presence of dozens of metal foreign bodies along the digestive tract, including an extra-digestive needle with an inflammation of the surrounding fat.

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Harmonization of Databases: a Step for Advancing the Knowledge about Spinal Cord Injury

Publication date: Available online 30 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Susan Charlifue, Denise Tate, Fin Biering-Sorensen, Stephen Burns, Yuying Chen, Sophia Chun, Lyn B. Jakeman, Robert G. Kowalski, Vanessa K. Noonan, Philip Ullrich
The objective of this manuscript is to provide an overview of existing spinal cord injury (SCI) clinical research databases, their purposes, characteristics and accessibility to users, and present a vision for future collaborations required for cross-cutting research in SCI. This vision highlights the need for validated and relevant data for longitudinal, clinical trials, observational and epidemiological SCI-related studies. Three existing SCI clinical research databases/registries are reviewed and summarized with regard to current formats, collection methods, and uses, including major strengths and weaknesses. Efforts to provide a uniform approach to data collection are also reviewed. The databases reviewed offer different approaches to capture important clinical information on SCI. They vary on size, purpose, data points, inclusion of standard outcomes and technical requirements. Each presents with a set of limitations including lack of population data and of a common platform for data comparisons and exchanges. It is clear that numerous issues need to be considered when planning to establish common ways of collecting data through datasets or patient registries ranging from a carefully crafted implementation plan that lists purposes, cost, resources required and policies to guide such development to establishing a framework for dissemination of data and findings. For the present, taking advantage of the vast but different data already collected over many decades may require a variety of statistical skills and epidemiologic techniques. Ultimately, our ability to speak the same language with regard to variables and assessment tools will facilitate international collaborations, and enhance comparability, data pooling and the ability to generalize findings to a broader population.



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Παρασκευή, 29 Απριλίου 2016

Evaluating the ORSIM(R) simulator for assessment of anaesthetists' skills in flexible bronchoscopy: aspects of validity and reliability

Background

Developing expertise in flexible bronchoscopy is limited by inadequate opportunities to train on difficult airways. The new ORSIM bronchoscopy simulator aims to address this by creating virtual patients with difficult airways. This study aims to provide evidence on the validity and reliability of the ORSIM for assessment of subjects on both normal and abnormal airway simulations.

Methods

Novice, trainee, and expert subjects performed seven simulations of varying difficulty and scored the perceived difficulty for each. Time to completion was measured. Three blinded raters independently scored videos of each subject's performance. We measured inter-rater agreement and the difference in raters' scores between subject groups.

Results

We recruited 28 study subjects, generating 196 videos for analysis. Expert subjects consistently completed the scenarios faster than novices. Overall performance scores showed significant differences between subject groups (P<0.0001). Inter-rater reliability of scores was >0.8.

Conclusions

Our results provide initial evidence on the validity and reliability of the ORSIM bronchoscopy simulator, supporting its potential value in training and assessment.



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Sacral vertebral remains of the Middle Miocene hominoid Nacholapithecus kerioi from northern Kenya

Publication date: May 2016
Source:Journal of Human Evolution, Volume 94
Author(s): Yasuhiro Kikuchi, Masato Nakatsukasa, Yoshihiko Nakano, Yutaka Kunimatsu, Daisuke Shimizu, Naomichi Ogihara, Hiroshi Tsujikawa, Tomo Takano, Hidemi Ishida
This study describes two new sacral specimens of Nacholapithecus kerioi, KNM-BG 42753I and KNM-BG 47687A, from the Aka Aiteputh Formation in Nachola, northern Kenya, excavated in 2002. They are of roughly equal size and are considered to belong to males. When scaled by body mass, the lumbosacral articular surface area of the better preserved specimen, KNM-BG 42753I, is smaller than that in Old World monkeys but similar to that in extant great apes and New World monkeys, as well as Proconsul nyanzae. The relatively narrow dimensions of the first sacral vertebral body in the transverse and sagittal planes are characteristics of N. kerioi and P. nyanzae and similar to those of extant great apes. In N. kerioi, lumbosacral surface area relative to body mass is small. This may simply be an extension of a trend from the previously reported small thoracolumbar vertebrae to the sacrum. ​The first sacral vertebrae of N. kerioi and Epipliopithecus vindobonensis have a higher craniocaudal vertebral body reduction (CVR; a higher CVR indicates a wider cranial width relative to a narrower caudal width), similar to that in Old World monkeys. Old World monkeys have a higher CVR, and usually have three sacral vertebrae, fewer than seen in extant great apes, which have a lower CVR and four to six (sometimes as many as eight) sacral vertebrae. New World monkeys have a lower CVR than Old World monkeys, but generally possess only three sacral vertebrae, and have a large caudal articular surface, which may be related, at least in the Atelidae, to the grasping ability of their tails. The possibility that N. kerioi had only three sacral vertebrae cannot be ruled out, because E. vindobonensis and Old World monkeys, with higher CVRs, have sacra consisting of three sacral vertebrae.



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Assessing sources of error in comparative analyses of primate behavior: Intraspecific variation in group size and the social brain hypothesis

Publication date: May 2016
Source:Journal of Human Evolution, Volume 94
Author(s): Aaron A. Sandel, Jordan A. Miller, John C. Mitani, Charles L. Nunn, Samantha K. Patterson, László Zsolt Garamszegi
Phylogenetic comparative methods have become standard for investigating evolutionary hypotheses, including in studies of human evolution. While these methods account for the non-independence of trait data due to phylogeny, they often fail to consider intraspecific variation, which may lead to biased or erroneous results. We assessed the degree to which intraspecific variation impacts the results of comparative analyses by investigating the "social brain" hypothesis, which has provided a framework for explaining complex cognition and large brains in humans. This hypothesis suggests that group life imposes a cognitive challenge, with species living in larger social groups having comparably larger neocortex ratios than those living in smaller groups. Primates, however, vary considerably in group size within species, a fact that has been ignored in previous analyses. When within-species variation in group size is high, the common practice of using a mean value to represent the species may be inappropriate. We conducted regression and resampling analyses to ascertain whether the relationship between neocortex ratio and group size across primate species persists after controlling for within-species variation in group size. We found that in a sample of 23 primates, 70% of the variation in group size was due to between-species variation. Controlling for within-species variation in group size did not affect the results of phylogenetic analyses, which continued to show a positive relationship between neocortex ratio and group size. Analyses restricted to non-monogamous primates revealed considerable intraspecific variation in group size, but the positive association between neocortex ratio and group size remained even after controlling for within-species variation in group size. Our findings suggest that the relationship between neocortex size and group size in primates is robust. In addition, our methods and associated computer code provide a way to assess and account for intraspecific variation in other comparative analyses of primate evolution.



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Quantitative analysis of surface electromyography: biomarkers for convulsive seizures

In spite of the advances in functional neuroimaging methods, we still know little about the pathomechanisms of the convulsive epileptic seizures in humans, and most of the evidence comes from animal models (Fusco et al., 2008; Zifkin and Dravet, 2008). Limited investigation time makes it unlikely that such an event is recorded in the scanner, and artefacts caused by excessive motor activity make it technically extremely challenging (Moeller et al., 2009). EEG and MEG signals are typically distorted by signals from the head muscle, and also by electrode artefacts.

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Plasmablastic plasmacytoma-like post-transplant lymphoproliferative disorder in an orthotopic liver transplant

A 73-year-old man, with 6-year history of orthotopic liver transplant for end-stage liver disease secondary to chronic hepatitis B, presented with jaundice and pruritis. Laboratory studies revealed cholestasis with elevated total bilirubin (6.4mg/dL) and alkaline phosphatase (>700IU/L). Sonography showed a hypoechoic mass with poor Doppler signal measuring 4–5cm in the left hepatic lobe by the porta-hepatis (Fig. 1A). MR revealed a soft tissue mass with lesser contrast enhancement intensity comparing to surrounding liver parenchyma (Fig.

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Trust in Sources of Advice about Infant Care Practices: The SAFE Study

Abstract

Objectives (1) Determine the prevalence of maternal trust in advice sources on infant care practices; (2) Investigate the association of maternal and infant characteristics with trust in advice sources on infant care practices. Methods Using probability sampling methods, we recruited mothers from 32 U.S. maternity hospitals with oversampling of Black and Hispanic women resulting in a nationally representative sample of mothers of infants aged 2–6 months. Survey questions assessed maternal trust in advice sources (physicians, nurses, family, friends, and media) regarding infant care practices including infant sleep practices (sleep position, bed sharing, and pacifier use), feeding, and vaccination. Weighted frequencies of maternal trust in advice sources were calculated to obtain prevalence estimates. Multivariable logistic regression was used to assess the association of maternal and infant characteristics with maternal trust in advice sources. Results Mothers had the greatest trust in doctors for advice on all infant care practices (56–89 %), while trust was lowest for friends (13–22 %) and the media (10–14 %). In the adjusted analyses, there were significant associations of maternal race/ethnicity, education, and age with trust in advice sources. Conclusions for Practice Maternal trust in advice about infant care practices varied significantly by source. A better understanding of which advice sources are most trusted by mothers, as well as the factors associated with maternal trust, may guide the development of more effective strategies to improve adherence to health promoting infant care practices.



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Risk factor analysis and decision making of surgical strategy for V3 segment anomaly: significance of preoperative CT angiography for posterior C1 instrumentation

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Awareness of vascular anomalies is crucial to avoid iatrogenic injuries during surgical procedure. Although V3 segment anomaly has been well described, the incidence of V3 segment anomaly has been rather variable in the literature and there are few reports regarding the adequate surgical strategy for each type of V3 segment anomaly

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Multilevel thoracic ossification of the ligamentum flavum in a Hispanic woman with achondroplasia

spinee57016-fig-0001.sml

A 45-year old Hispanic woman with history of achondroplasia presented for evaluation of severe lower extremity weakness and spasticity, which had progressed over a 10-month period. Upon physical examination, she was 1.25 m tall (4 feet and 1 inch), wheelchair bound, and with inability to ambulate. Magnetic resonance imaging and computed-tomography scans of her thoracic spine revealed multilevel ossification of the ligamentum flavum (OLF) causing severe spinal cord compression [Figures 1 and 2]. The patient was offered multilevel thoracic decompression and stabilization from T3 to T10, but unfortunately did not return for follow-up.

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Rehabilitation Medicine Assessment of Nursing Home Residents

2016-04-29T14-16-53Z
Source: International Journal of Therapies and Rehabilitation Research
Fahim Anwar, Ahmad Alkhayer.
Abstract: Aims: To assess the disability level, the rehabilitation potential and the service received by young adults (16-65) with neurological disabilities Subjects & Settings: Pilot cross sectional study of 12 Adults with neurological disabilities (mean age 50); originally residents in one nursing home, now living in 1 of 8 nursing homes in Glasgow. Method: Structured medical interview, Barthel Index, Office of Population Census Survey (OPCS) Disability Form, review of drug charts. Results: There were 7 patients with acquired brain injury, 2 multiple sclerosis, 2 peripheral neuropathies, and one dementia. Prior to admission to nursing homes two patients received inpatient rehabilitation; no others had rehabilitation medicine assessment. 5 patients received community rehabilitation input. Planned medical reviews were rare. 6 patients had significant spasticity and 4 had significant pain. OPCS scores ranged from 1 to 10 with 4 patients scoring ≤ 6; Barthel index, 0 to 100, with 4 patients ≥ 90. Conclusion: Larger studies, cognitive assessment and nursing needs measurement are justified. All of these may help some residents to return to community living.


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Improving the rigor of psychophysiology research

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Publication date: Available online 29 April 2016
Source:International Journal of Psychophysiology
Author(s): Scott A. Baldwin
Psychology as a field is in the midst of what is sometimes called a "crisis" because false findings are prevalent. Although the focus of the methodological and substantive criticisms of psychology has focused on social psychology, psychophysiology research is not without its problems. The author discusses (a) researcher flexibility and its impact on the stability of conclusions and (b) the role power plays in the probability that a finding is true and the precision of estimates. The author uses examples and data from psychophysiological research to illustrate the problems. The author concludes with a discussion of ways to shift the practice of science to improve the reliability of findings. Suggestions for improvement include: increased power through collaboration, improved statistical and methodological training, pre-registration of studies, improved reporting standards, and shifting incentives surrounding hiring and promotion.



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Braun Ambulances Debuts First Rollover Ambulance Crash Test

Braun Industries teamed up with CAPE Testing to conduct the Fire/EMS industry's first rollover ambulance crash test. They crashed a 10 year old unit in a test that most closely compares to the anticipated SAE J3057. The test focused on the modular body and roll impact loading, or how well the box holds up in the event of a rollover.

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Braun Ambulances Debuts First Rollover Ambulance Crash Test

Braun Industries teamed up with CAPE Testing to conduct the Fire/EMS industry's first rollover ambulance crash test. They crashed a 10 year old unit in a test that most closely compares to the anticipated SAE J3057. The test focused on the modular body and roll impact loading, or how well the box holds up in the event of a rollover.

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Plasmablastic plasmacytoma-like post-transplant lymphoproliferative disorder in an orthotopic liver transplant

A 73-year-old man, with 6-year history of orthotopic liver transplant for end-stage liver disease secondary to chronic hepatitis B, presented with jaundice and pruritis. Laboratory studies revealed cholestasis with elevated total bilirubin (6.4mg/dL) and alkaline phosphatase (>700IU/L). Sonography showed a hypoechoic mass with poor Doppler signal measuring 4–5cm in the left hepatic lobe by the porta-hepatis (Fig. 1A). MR revealed a soft tissue mass with lesser contrast enhancement intensity comparing to surrounding liver parenchyma (Fig.

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Multisource feedback in professionalism for anesthesia residents

To assess professionalism in anesthesiology residents, it is important to obtain evaluations from people with whom they interact on daily basis. The purpose of this study was to evaluate the effect of a Multisource feedback (MSF) on resident's professional behavior and to assess the effect of faculty feedback on resident performance.

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Cardiac arrest associated with takotsubo cardiomyopathy after tracheal intubation

Here, we report a case of cardiac arrest after tracheal intubation associated with takotsubo cardiomyopathy during the induction of anesthesia.

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Transversus abdominis plane block as a component of multimodal analgesia for laparoscopic cholecystectomy

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To evaluate and compare intercostal-iliac transversus abdominis plane (TAP) and oblique subcostal TAP (OSTAP) blocks for multimodal analgesia in patients receiving laparoscopic cholecystectomy.

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Dose-ranging effect of systemic diphenhydramine on postoperative quality of recovery after ambulatory laparoscopic surgery: a randomized, placebo-controlled, double-blinded, clinical trial

gr1.sml

Diphenhydramine is an antihistamine with previously demonstrated analgesic and antiemetic properties. However, it is unknown if the beneficial perioperative properties of diphenhydramine can translate to a better quality of postsurgical recovery. The main objective of the current investigation was to investigate dose-ranging effects of diphenhydramine on quality of recovery after surgery.

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Anesthetic management of a myotonic dystrophy patient with paraganglionoma

Myotonic dystrophy (DM), though rare, can significantly complicate anesthesia due to muscular and extra-muscular involvement. When this condition is compounded by a pheochromocytoma, anesthetizing such patients becomes extra challenging. We present a case report of a 61-year-old lady with congenital DM, with the whole gamut of associated features, was diagnosed with a noradrenaline secreting paraganglionoma following investigation of refractory hypertension. We anesthetized her for an open resection of the lesion.

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Stuck stylet situation: a rare manufacturing defect of spinal needle

We are reporting an incidence of unusual manufacturing defect in a 25-gauge Qunicke's type spinal needle causing the stylet of the needle to be stacked after introducing in the intrathecal space.

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Comparison of volume-controlled ventilation and pressure-controlled ventilation volume guaranteed during laparoscopic surgery in Trendelenburg position

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To analyze the effects of pressure-controlled ventilation-volume guaranteed (PCV-VG) and volume controlled ventilation (VCV) on airway pressures and respiratory and circulatory indicators during laparoscopic surgery in Trendelenburg position.

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Low-dose butorphanol alleviates remifetanil-induced hyperalgesia in patients undergoing laparoscopic cholecystectomy

gr1.sml

To evaluate the effects of low-dose butorphanol on hyperalgesia induced by high-dose remifetanil in patients undergoing laparoscopic cholecystectomy.

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Oral dexmedetomidine for preoperative sedation in an adult uncooperative autistic patient

We describe preoperative sedation with oral dexmedetomidine 5 mcg/kg in an uncooperative adult with autism and developmental delay. The sedation with oral dexmedetomidine achieved good sedation level (Ramsey 4–5), allowing for calm transfer of the patient to the operating room and uneventful induction of anesthesia.

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I have only D-blade: Is it enough?

gr1.sml

Anticipated difficult airway guidelines recommend awake intubation in the first place [1,2]. In awake approach, the airway is protected against gastric content, blood or secretions. Although this approach is frequently successful, suboptimal intubation conditions may occur such as reflex glottic closure or regurgitation. In case of failure, tracheal intubation under general anesthesia is recommended. However, there is no recommendation for the use of a particular device. We report here the effectivity of C-MAC® D-Blade (Karl Storz, Tuttlingen, Germany, Fig.

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Acute stroke after total joint arthroplasty: a population-based trend analysis

This study aims to determine trends and predictors of acute stroke among total joint arthroplasty (TJA) patients using nationally representative data.

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The effect of sugammadex on steroid hormones: A randomized clinical study

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Sugammadex is an alternative drug to traditional decurarization by cholinesterase inhibitors. It has been examined the effect of sugammadex on steroid hormones in this study.

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Braun Ambulances Debuts First Rollover Ambulance Crash Test

Braun Industries teamed up with CAPE Testing to conduct the Fire/EMS industry's first rollover ambulance crash test. They crashed a 10 year old unit in a test that most closely compares to the anticipated SAE J3057. The test focused on the modular body and roll impact loading, or how well the box holds up in the event of a rollover.

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Braun Ambulances Debuts First Rollover Ambulance Crash Test

Braun Industries teamed up with CAPE Testing to conduct the Fire/EMS industry's first rollover ambulance crash test. They crashed a 10 year old unit in a test that most closely compares to the anticipated SAE J3057. The test focused on the modular body and roll impact loading, or how well the box holds up in the event of a rollover.

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EMS OFFICER I-Paramedic - Durham County EMS

Performs responsible work in rendering emergency and non-emergency medical care and life-saving measures to critically ill or injured persons of all ages on basic and advanced life support levels. Requires successful completion of the North Carolina State Emergency Medical Services training program or an equivalent training program. Employment is contingent on passing a assessment center, physical agility ...

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Inside EMS Podcast: Why EMS needs to get back to helping people

Download this podcast on iTunesSoundCloud or via RSS feed

​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson talk about the week's news, including EMS employees claiming an ambulance company took their paychecks, a dispatcher that obtained patient information and allegedly assaulted that patient and workplace bullying and harassment after firefighter-paramedic Nicole Mittendorff died by suicide.



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Quick Clip: Bullying and workplace harassment in EMS

Download this quick clip on iTunesSoundCloud or via RSS feed

​​In this week's Quick Clip, co-hosts Chris Cebollero and Kelly Grayson discuss the subject of bullying and workplace harassment after Nicole Mittendorff, a firefighter-paramedic with Fairfax County Fire and Rescue, died by suicide. The news comes on the heels of concerns that she was a victim of bullying.



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500lb Patient Calls Big Lake Texas EMS Over 30 Times for Lift Assistance

Big Lake, TX: The Situation: An obese 62 y/o male patient exhibited all the classic signs of needing professional care, but refused to leave the comforts of his home. As a result, he suffered from poor hygiene and lacked the ability to get up on his own after falling. There were days when he would call Big Lake EMS multiple times for lift assistance. "We have some pretty strong guys that work ...

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Parents want CPR training to be mandatory for Michigan students



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Inside EMS Podcast: Why EMS needs to get back to helping people

Download this podcast on iTunes, SoundCloud or via RSS feed

​In this Inside EMS Podcast episode, co-hosts Chris Cebollero and Kelly Grayson talk about the week's news, including EMS employees claiming an ambulance company took their paychecks, a dispatcher that obtained patient information and allegedly assaulted that patient and workplace bullying and harassment after firefighter-paramedic Nicole Mittendorff died by suicide.



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What is the appropriate discipline for driving 17 mph above the speed limit?

The news of an ambulance caught speeding on an interstate highway points to another unwinnable situation for field providers. Is it reasonable to expect any ambulance crew to drive with due regard, rapidly deliver a patient, quickly return to the service area, not rack up overtime and perfectly represent the agency"

The video of the ambulance driving on Interstate 24 toward Nashville appears to be filmed by an opportunistic news crew from WKRN. The reporter uses the video to play a game of "gotcha" with the county EMS director.

As I watch the video, I see an ambulance moving through moderate traffic on a multi-lane highway on dry roads, with clear sky overhead and being passed by some passenger vehicles while passing others.

After viewing the video and analyzing the vehicle data, the EMS agency suspended both crew members without pay for an unreported amount of time.

Do you think the crew members are bad people caught in the act of a bad behavior"

I don't think so. Just culture leads me to believe that they are good people making decisions based on the systems and culture within which they work.

What we don't see or hear in the news report are possible explanations for the ambulance being driven up to 87 miles per hour. I am not excusing the behavior, but four unanswered questions quickly came to mind.

  • Are there organizational forces at play that lead personnel to believe it is OK to drive 15 to 20 miles per hour above the speed limit"
  • Was the crew being held over their shift end time and driving fast to complete a long distance transfer so they could start their time off"
  • What was the call volume in their response area and were they feeling urgency or pressure to complete the transfer so they could support their colleagues"
  • What is the department's policy for lights and sirens use on the freeway" Some departments don't use red lights and sirens on the freeway.

I also have a question for the news crew. Did they call 911 to report the speeding ambulance" If the ambulance posed a danger to civilians on the road, the news crew's first obligation should be to the safety of its audience not trying to get a scoop.

Discipline needs to exist on a continuum with consequences appropriate to the infraction, consistently applied and communicated through training and policies. Were all of the personnel of this agency aware that driving 17 miles per hour over the speed limit punishable with an unpaid suspension" Or is this incident in the "they should have known better" category"

I haven't driven 115 miles per hour since I was 16 and I have been driving slower ever since. My speed decreased as my knowledge, experience and awareness of others increased. As you operate any emergency vehicle, remember as the vehicle's speed increases you have less time to react, vehicle stability decreases and it takes more road to slow or stop.

I want to hear from you in the comments. Is this a punishable offense" Explain why or why not. And how would you have handled this media-driven caught in the act incident"



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Breath Methane Levels Are Increased Among Patients with Diverticulosis

Abstract

Background

Diverticulosis and its complications are important healthcare problems in the USA and throughout the Western world. While mechanisms as to how diverticulosis occurs have partially been explored, few studies examined the relationship between colonic gases such as methane and diverticulosis in humans.

Aim

This study aimed to demonstrate a significant relationship between methanogenic Archaea and development of diverticulosis.

Methods

Subjects who consecutively underwent hydrogen breath test at Rush University Medical Center between 2003 and 2010 were identified retrospectively through a database. Medical records were reviewed for presence of a colonoscopy report. Two hundred and sixty-four subjects were identified who had both a breath methane level measurement and a colonoscopy result. Additional demographic and clinical data were obtained with chart review.

Results

Mean breath methane levels were higher in subjects with diverticulosis compared to those without diverticulosis (7.89 vs. 4.94 ppm, p = 0.04). Methane producers (defined as those with baseline fasting breath methane level >5 ppm) were more frequent among subjects with diverticulosis compared to those without diverticulosis (50.9 vs. 34 %, p = 0.0025). When adjusted for confounders, breath methane levels and age were the two independent predictors of diverticulosis on colonoscopy with logistic regression modeling.

Conclusions

Methanogenesis is associated with the presence of diverticulosis. Further studies are needed to confirm our findings and prospectively evaluate a possible etiological role of methanogenesis and methanogenic archaea in diverticulosis.



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Study of changes in red blood cell indices and iron status during three trimesters of pregnancy

2016-04-29T09-12-48Z
Source: International Journal of Medical Science and Public Health
Shailesh Kumar, Namrata Dubey, Ruchir Khare.
Background: During pregnancy, the hemodynamic and iron requirement changes. Several tests are used to determine iron status and anemia such as hemoglobin, hematocrit or packed cell volume, mean corpuscular volume and mean corpuscular hemoglobin, red cell distribution width, percentage of hypochromic red cells, serum ferritin, and serum transferrin. This study was undertaken with intent to record changes in hematological profile along with transferrin and ferritin during pregnancy. The data obtained may be helpful in establishing reference range of all red blood cell indices along with serum ferritin and transferrin during pregnancy. Objective: To study changes in red blood cell indices and iron status during three trimesters of pregnancy. Materials and Methods: A longitudinal study was conducted on pregnant women reporting antenatal clinic in the first trimester. Data in each trimester of 57 women were collected. Birth weight of newborn delivered was recorded, and statistical analysis was done by paired t-test. Result: Fifty-seven study subjects were divided according to the birth weight of delivered babies. Most of the parameters recorded were within the reference range across trimesters. Except for few, the changes in parameters were in accordance with expected physiological response in pregnancy. Significant drop in hemoglobin and significant rise in transferrin levels across all trimesters resulted in poor outcome of pregnancy. Conclusion: This study suggests that serum transferrin level estimation in all trimesters along with hemoglobin can be advised to avoid possible poor outcome of pregnancy. This study provides additional baseline data for basic hematological parameters in pregnant women. This would benefit especially in the antenatal care and assessment of pregnant women.


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Hypertension in Kerala: A study of prevalence, control, and knowledge among adults

2016-04-29T09-12-48Z
Source: International Journal of Medical Science and Public Health
Sebastian NM, Jesha MM, Sheela P Haveri, Arya S Nath.
Background: Hypertension a silent killer as it is symptomless and remains undiagnosed, and not controlled if diagnosed. Hypertension is on the increase and affects more than 20% of adult population. Prevalence estimates are required to design control measures for hypertension, cardiovascular diseases, and stroke. Objective: This study aims to reveal the prevalence, proportion of hypertension cases treated and controlled, and the knowledge and practice among hypertensives. Materials and Methods: A cross-sectional community-based study was conducted among adults above 30 in the municipal town of Perinthalmanna, Kerala, India. The blood pressures (BPs) of 1154 adults were recorded at their homes along with their personal details, history of earlier diagnosis, treatment, and dietary and lifestyle modification. Data were entered in Microsoft Excel and analyzed using Epi-info. Result: The prevalence of hypertension was 32.3%. Among them 55% were already diagnosed and 45% newly diagnosed during the study. The prevalence increases with age. Prevalence of prehypertension was 43.7%. Among those treated, only 33.9% had their BPs controlled. The percentage of those who were aware of dietary restriction was 79.4% and 76% were practicing. The percentage of subjects aware of a need for regular BP check was 83.6% but 69% were doing so. Only 42.6% were aware of a need for other lifestyle changes and 34.4% were practicing. Age, family history, and sedentary lifestyle were identified as correlates of hypertension. Conclusion: The prevalence of hypertension and prehypertension is high and the control of hypertension among those treated is low.


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The Spinal Cord Injury-Functional Index/Assistive Technology Short Forms

Publication date: Available online 29 April 2016
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Mary D. Slavin, Pengsheng Ni, David S. Tulsky, Pamela A. Kisala, Allen W. Heinemann, Susan Charlifue, Denise C. Fyffe, Daniel E. Graves, Ralph J. Marino, Leslie R. Morse, David Rosenblum, Denise Tate, Lynn A. Worobey, Mary Beth Dawson, Alan M. Jette
ObjectiveEvaluate the psychometric properties of the Spinal Cord Injury Functional Index/Assistive Technology (SCI-FI/AT) short forms (SFs) in the domains of Basic Mobility, Self-Care, Fine Motor Function, and Ambulation based on: internal consistency; correlations between SFs and full item banks, and a 10-item computerized adaptive test (CAT) version; magnitude of ceiling and floor effects; and measurement precision across a broad range of function in a sample of adults with spinal cord injury (SCI).DesignCross-sectional cohort study.ParticipantsA sample of 460 adults with traumatic SCI stratified by level of injury (paraplegia/tetraplegia), completeness of injury, and time since SCI.InterventionsNot applicable.Main outcome measuresSCI-FI/AT full item bank, 10-item CAT, and SFs (with separate Self-Care and Fine Motor Function SFs for persons with tetraplegia and paraplegia).ResultsThe SCI-FI/AT SFs demonstrated very good internal consistency, group-level reliability, excellent correlations between SFs and scores based on the CAT version and the total item bank. Ceiling and floor effects are acceptable (except for unacceptable ceiling effects for persons with paraplegia on the Self-Care and Fine Motor Function SFs). The test information functions are excellent across a broad range of functioning typical of persons with paraplegia and tetraplegia.ConclusionsClinicians and researchers should consider using the SCI-FI/AT SFs to assess functioning with the use of AT when CAT applications are not available.



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A comparative study on awareness about non-communicable diseases and their risk factors among government and private high school students of Davangere city

2016-04-29T09-12-48Z
Source: International Journal of Medical Science and Public Health
Kusum Shrirang Mane, Anurupa Maganalli, Ayesha siddiqua Nawaz.
Background: The burden of non-communicable diseases (NCDs) is emerging as a major public health challenge for developing countries. According to WHO report, NCDs, especially cardiovascular diseases (CVDs), cancer (Ca), and diabetes mellitus (DM) account for 53% of all deaths in India. As highlighted in the WHO report 2002, just a few NCD risk factors account for the majority of NCD burden Objectives: (1) To assess the awareness regarding the NCDs and their risk factors among high school students. (2) To compare the awareness about NCDs and their risk factors among students of government and private high school. Materials and Methods: Cross-sectional study from July 1 to August 31, 2010 (2 months). Total 524 students of 8th, 9th, and 10th standard (226 students from government high school and 298 students from private high school) Pre-structured and pre- tested Questionnaire was used to collect data regarding awareness about common NCDs (DM, CVD, and Ca) and their risk factors among high school students. Results: Total students interviewed were 524. From government school there were 226 (43.1%) students and from private school 298 (56.9%) Out of 406 school children who were aware about DM, 290 were from private school and 116 were from government school. Out of 478 school children who were aware about CVD, 294 were from private school and 184 from government school. Out of 438 school children who were aware about Ca, 282 were from private school and 156 were from government school. Awareness about DM, CVD, and Ca was low among government school children than private school children, which was statically significant. Awareness about risk factors of NCDs was poor in government school children than private school children. Conclusion: Awareness about NCDs and their risk factors was very low in high school students. As compared to private high school students, government students were having poor knowledge about NCDs and their risk factors.


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Assessing the awareness level of breast and cervical cancer: a cross-sectional study in northeast India

2016-04-29T09-12-48Z
Source: International Journal of Medical Science and Public Health
Kangkana Bora, Nijara Rajbongshi, Lipi B Mahanta, Pallabi Sharma, Dipankar Dutta.
Background: Breast and cervical cancers are leading causes of deaths in India among female population. To reduce the mortality rate, awareness is of major concern of current time. Objective: To study the awareness of breast and cervical cancers among common women based on different factors such as age, residence, and occupation. Materials and Methods: A cross-sectional study was performed on 1000 common women who can efficiently represent different age groups, occupation, and place of residence. Study population were subdivided into two equal groups where one group participated in breast cancer survey and another group in cervical cancer survey. The X2 analysis was performed to study the significant association of different factors with various knowledge related to breast and cervical cancers among the study groups. Then, MANOVA test, followed by post hoc Duncan test, was performed to delve deeper into the study. Result: Result showed that there was a high-significant association (p

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Studies on the biochemical and molecular effects of some natural herbs on experimental-induced breast cancer in Wistar rats

2016-04-29T08-35-41Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Mohamed Mohamed Soliman, Alshaimaa Mohammed Said Elfeky.
Background: Breast cancer is the most frequent malignant tumor in women, and its metastatic state represents the second cause of mortality. To treat cancer, we must prevent tumor cell proliferation and angiogenesis. The usage of herbal medication for treatment of some diseases as diabetes is increased nowadays for their wide safety margin. Aims and Objectives: Therefore, the current study was designed to examine the protective effect of ginger extract (GE) and cinnamon extract (CE) in controlling the mammary gland incidence in female Wistar rats. Materials and Methods: A total of 75 female virgin Wistar rats were allocated into 5 groups. Control group without any treatment; mammary gland group administered 7, 12-dimethyl-benz[a]anthracene at a dose of 20 mg/kg orally in corn oil. Rats in 3-5 served as tumor groups and received GE for group 3 (0.125% in water), CE for group 4 (100 mg/kg), and a mixture of GE plus CE for group 5. GE and CE were administered 2 weeks before cancer induction and continued for 4 months. Serum levels of breast cancer biomarker (CA125) and oxidative stress biomarkers were measured. Tissues of tumors were examined at molecular and histopathological levels. Results: There was a significant increase in the serum levels of CA125 in untreated mammary gland tumor group when compared with untreated healthy rats. There was a significant decrease in the serum levels of glutathione (GSH) peroxidase, catalase, superoxide dismutase, and GSH reductase in the untreated mammary gland tumor groups compared to control healthy rats. Administration of ginger and CE normalized the decrease in antioxidants levels. Induction of mammary gland tumor upregulated the genes associated with tumor incidences such as GST-P, CYP1A1, CYP1B1, and vascular endothelial growth factor-receptor 1 and administration of both herbal plants normalized these changes. Coadministration of GE and CE-induced additive inhibitory effect on genes upregulated due to tumor incidence. Bax expression was downregulated in tumor group and increased after GE and CE expression either alone or in combination. At histopathological levels, breast cancer group showed adenocarcinoma that is decreased with plants extracts administration when compared with breast cancer and control group. Conclusion: Results suggest that extracts of ginger and cinnamon have anticarcinogenic protective activities and support the hypothesis that these plants help in the prevention of mammary cancer by controlling the expression of carcinogenesis-associated genes.


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A study on oxygen dependent fitness (aerobic capacity) in pre-collegiate boys of North Karnataka region

2016-04-29T08-35-41Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Mohamed Siddiq, Salim A Dhundasi, Mohammed Aslam.
Background: Aerobic capacity (VO2 max) measures the higher limit of energy content in the muscles. In general, genetics of an individual decides the higher limit of the muscle, but physical training can improve it by up to 20% as compared to nontrained individuals. Aims and Objectives: To evaluate oxygen dependent fitness (aerobic capacity) in pre-collegiate boys (age group of 16-18 years) of North Karnataka region. Materials and Methods: A total of 87 young adolescent healthy pre-collegiate boys volunteered for this study. Physical anthropometric parameters such as body surface area (BSA), body mass index (BMI), and body fat percentage (BF%); physiological parameters such as systolic and diastolic blood pressure; fitness tests such as physical fitness index (PFI) and aerobic capacity (VO2 max) were measured. Correlation analysis and Z-test was used to obtain the data. Results: Physical anthropometric parameters of the subjects were found within normal range. Statistically significant exercise-induced rise in blood pressure was observed in Harvard step test. PFI correlated with aerobic capacity. Aerobic capacity correlated with BSA and did not correlate with BF% and BMI. Conclusion: The PFI was in good category, normal physiological response to exercise, and PFI correlated with aerobic capacity (VO2 max). Aerobic capacity was found within the normal range in pre-collegiate boys of age 16-18 years in the study area. Ideal BMI may not be possible in this age group.


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Effect of aerobic training with diet control program on cases of non alcoholic fatty liver

2016-04-29T08-22-49Z
Source: International Journal of Therapies and Rehabilitation Research
Alaa Ramzy Morgan.
Nonalcoholic fatty liver disease (NAFLD) is now the most common cause of chronic liver disease in children and adolescents in United States. Over the last 2 decades, the rise in the prevalence rates of overweight and obesity likely explains the emergence of NAFLD as the leading cause of liver disease in pediatric populations worldwide . At present, diet and life style modification(physical training) are the best treatment options as pharmacological management of NAFLD has had disappointing results. The current study was conducted to detect the effect of weight reduction alone , or diet compained with aerobic exercise on liver enzymes and lipid profile and fasting glucose in obese children suffering from non-alcoholic fatty liver disease. Thirty children with non-alcoholic fatty liver disease were divided randomly into this study from department of internal medicine, faculty of medicine, Cairo university hospitals, Their ages ranged from 10-16 years, subjects were divided randomly into two equal groups (A&B). Group A (control group) received only diet treatment intervention for 6 months. Group B (study group) received aerobic exercise training in addition to diet regimen for 6 months. All participants were evaluated before the first session of treatment and at the end of treatment through: physical evaluation which include (weight, height, body mass index), lipid profile, liver enzymes. Conclusion: On comparing the pre and post treatment values of all measurement, results revealed significant improvement of both groups, yet the improvement was more obvious and more significant in group B(diet and exercise group).According to the results of the present study it could be concluded that diet companied with exercise significantly reduces blood lipids and improve liver enzymes. There were also reduction in body mass index and obesity more in group (B)


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ASSISTANT CHIEF-CLINICAL AFFAIRS - Durham County EMS

As one of North Carolina's fastest growing EMS agencies, we are seeking an experienced paramedic clinician and educator for the position of Assistant EMS Chief – Clinical Affairs. The successful candidate will be responsible for leading the department's clinical improvement and enhancement efforts, and will provide significant input and leadership to our in-house education and training ...

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Parents want CPR training to be mandatory for Michigan students



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Parents want CPR training to be mandatory for Michigan students



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Mich. lawmakers urged to make CPR training mandatory for high school students

Thirty-one states have already passed laws requiring students to learn CPR before they graduate

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Editorial: Newborn's death reveals dispatcher shortage

Parents of a 3-day-old baby, bitten by the family dog, drove their baby to the hospital themselves after two 911 calls went unanswered

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Parents want CPR training to be mandatory for Michigan students



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Apathy Evaluation Scale (includes three forms – self, informant and clinician versions)

Acronym:
AES
Purpose:
The measure addresses characteristics of goal directed behavior that reflects apathy including behavioral, cognitive and emotional indicators.
Description:
  • 18 items
  • 18-72 (higher scores reflect more apathy)
  • Items are scored on 4-point Likert scale with descriptors for the "self" version (not at all true, slightly true, somewhat true, very true) and those for the clinician and informant version (not at all characteristic, slightly characteristic, somewhat characteristic, very characteristic)
  • Some items must be reverse scored because of the way they are written
  • Two open questions are also asked (number of items reported, details offered in response to questions) to characterize apathy
  • Administration instructions are provided in the Marin et al 1991 reference; pages 161-162.
ICF Domain: Activity, Participation
Length of Test: 06 to 30 Minutes
Time to Administer:
10-20 minutes
Number of Items: 18 items
Equipment Required:
No equipment required
Training Required:
Marin recommends bachelor's level training with two years clinical experience in psychological settings with 4-6 hours of exposure to apathy to ensure reliable use.
Cost: Free
Actual Cost:
No charge for the measure
Diagnosis: Acquired Brain Injury, Geriatrics, Parkinson's Disease, Stroke, Traumatic Brain Injury
Populations Tested:
  • Alzheimer's Disease
  • Depression
  • Older adults
  • Stroke
  • Hypoxic brain damage
  • Traumatic brain injury
  • Parkinson's Disease
  • Schizophrenia
Standard Error of Measurement (SEM):
Not Established
Minimal Detectable Change (MDC):
Not Established
Minimally Clinically Important Difference (MCID):
Not Established
Cut-Off Scores:

Young adult controls: (Kant et al, 1998; n=108, age range 20-65 years, 94.5% in 20-49 age range, 49% male) Mean AES-S was 24.4 (4.5), therefore cutoff score of >34 indicating apathy (2 SD above mean)

Acquired brain injury: (Andersson et al, 1999a; n=72; mean age = 30.1 (ages 16-60 years old); mean time post injury = 12.6 months ; TBI, CVA and hypoxic brain damage)

  • Score greater than 34 indicates apathy on AES-C

Traumatic brain injury: Andersson et al, 1999b (n=30; mean age = 30.1( ages 16-64); mean time post injury = 10.5 months; inpatient TBI)

  • Score greater than 34 indicates apathy on AES-C

Glenn et al, 2002 (n=46; mean age 43.1(14.9) years; mean time since injury 43.0 months; initial injury severity 52% mild, 18% moderate, 30% severe)

  • Investigators were not able to identify a reasonable cut-off score of AES-I (area under ROC curve was 0.62) or AES-S (area under ROC curve was 0.74). AES-C score of >32 had the best combination of sensitivity and specificity (area under ROC curve 0.82), with sensitivity of 95% but specificity of 0% to predict an ordinal rating of presence of behaviors that reflect apathy (a 7 point scale developed for the study).

(Lane-Brown & Tate, 2009; n=34, mean age=34.4(9.4); mean time post injury= 80.6 months; mean duration of PTA 53.2 (33.5) days)

  • Adequate diagnostic accuracy, with score greater than 36.5 resulted in ROC of .8, with sensitivity of 83% and specificity of 67%. A higher cutpoint could be used to increase specificity if desired (see Lane-Brown for values). It is likely that there is some overlap of symptoms related to fatigue and/or depression in this population that should be considered for clinical management.
Normative Data:

Young adult controls: (Kant et al, 1998)

  • Mean AES-S = 24.4 (4.5)

Traumatic brain injury: (Glenn et al, 2002)

  • Mean AES-S scores  = 37 (8.6), no difference between levels of injury severity

(Kant et al, 1998; n=83; mean age 38 (12.3) years; TBI referrals to neuropsychiatric outpatient clinic)

  • Mean AES-scores = 40.5 (6.3), 71% met criteria for apathy
Test-retest Reliability:

Mixed sample: (Marin 1991; n=123; aged 53-85, mixed sample of stroke, AD, depression, community dwelling well older adults)

  •  Excellent test-retest reliability (Pearson= .88 (AES-C); Pearson = .94 (AES-I); Pearson= .76 (AES-S))
Interrater/Intrarater Reliability:

Mixed sample: (Marin et al, 1991)

  • Excellent interrater reliability (ICC= .94)
Internal Consistency:

Acquired brain injury: (Andersson, 1999a)

  • Excellent internal consistency (Chronbach's alpha of AES-C=.84)

TBI: (Andersson 1999b)

  • Excellent internal consistency(Chronbach's alpha of AES-C=.89)

(Andersson & Bergedalen, 2002; n= 53; mean age = 28.3 years (2.38); mean time post injury= 12.2 months (10.6))

  • Excellent internal consistency (Chronbach's alpha of AES-C=.87)

(Lane-Brown, 2009)

  • Excellent internal consistency (Chronbach's alpha of AES-I= .89)
Criterion Validity (Predictive/Concurrent):

Predictive validity:

Mixed sample: (Marin et al, 1991)

  • AES-C predicts average scores and time spontaneously engaged on videogame at levels of significance p<.002)
Construct Validity (Convergent/Discriminant):

Mixed sample: (Marin et al, 1991)

  • Excellent convergent validity of AES-C with other forms (r= .62-.72); Adequate discriminant validity differentiating apathy from depression and anxiety (r=.35-.39); Excellent differentiation between patients with Alzheimer's disease, right and left hemisphere stroke and major depression (F=18.86, p<.001)

Acquired BI: (Andersson et al, 1999a)

  • AES-C correlates as expected with items on depression scale (excellent levels with positive items, insignificant correlation with items reflecting depression).
  • Differentiates between hypoxia and other forms of acquired brain injury.

TBI: (Andersson et al, 1999b)

  • Significant relationships between AES-C and heart rate/blood pressure reactivity and mean arterial pressure (beta values reported, p<.01). Significant inverse relationships between AES-C and emotional discomfort.

(Andersson and Bergedalen, 2002)

  • Adequate negative correlation between AES-C and acquistion/memory (r=-.50).

(Lane-Brown, 2009)

  • Excellent correlation with the Frontal Systems Behavior Scale-Apathy items (r=.71)
Content Validity:
Possible items for inclusion, described as hundreds, were gleaned from literature review and reduced via expert review based on items that were most clear and demonstrated item to total score correlations of >.4 in pilot testing. (Marin et al, 1991)
Face Validity:
Face validity supported by expert review during development.
Floor/Ceiling Effects:
Not Established
Responsiveness:
Not Established
Considerations:
Some items on the AES-I and AES-C involve judging philosophical intention (e.g. "S/he approaches life with intensity", which may be difficult to judge as an observer. The self-rated version of the AES may be problematic if there are issues with insight into deficits as can occur with TBI.

Translated AES:

Spanish (slide 62-63): 
http://ift.tt/1T9Xjnu

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Bibliography:

Andersson, A. F. S. (2000). "Coping strategies in patients with acquired brain injury: relationships between coping, apathy, depression and lesion location." Brain Injury 14(10): 887-905.

Andersson, S. and Bergedalen, A. M. (2002). "Cognitive correlates of apathy in traumatic brain injury." Neuropsychiatry, Neuropsychology, and Behavioral Neurology 15(3): 184-191. Find it on PubMed

Andersson, S., Gundersen, P. M., et al. (1999). "Emotional activation during therapeutic interaction in traumatic brain injury: effect of apathy, self-awareness and implications for rehabilitation." Brain Injury 13(6): 393-404. Find it on PubMed

Andersson, S., Krogstad, J. M., et al. (1999). "Apathy and depressed mood in acquired brain damage: relationship to lesion localization and psychophysiological reactivity." Psychological Medicine 29(2): 447-456. Find it on PubMed

Clarke, D. E., Van Reekum, R., et al. (2007). "An appraisal of the psychometric properties of the Clinician version of the Apathy Evaluation Scale (AES-C)." Int J Methods Psychiatr Res 16(2): 97-110. Find it on PubMed

Glenn, M. (2005). "The Apathy Evaluation Scale." The Center for Outcome Measurement In Brain Injury.

Glenn, M. B., Burke, D. T., et al. (2002). "Cutoff score on the apathy evaluation scale in subjects with traumatic brain injury." Brain Injury 16(6): 509-516. Find it on PubMed

Kant, R., Duffy, J. D., et al. (1998). "Prevalence of apathy following head injury." Brain Injury 12(1): 87-92. Find it on PubMed

Lane-Brown, A. T. and Tate, R. L. (2009). "Measuring apathy after traumatic brain injury: Psychometric properties of the Apathy Evaluation Scale and the Frontal Systems Behavior Scale." Brain Injury 23(13-14): 999-1007. Find it on PubMed

Marin, R. S., Biedrzycki, R. C., et al. (1991). "Reliability and validity of the Apathy Evaluation Scale." Psychiatry Research 38(2): 143-162. Find it on PubMed

Instrument in PDF Format: Yes


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Πέμπτη, 28 Απριλίου 2016

Regional cerebral oxygen saturation guided cerebral protection in a parturient with Takayasu's arteritis undergoing cesarean section: a case report

The objective of this case report is to present the successful use of regional cerebral oxygen saturation (rScO2) monitoring guided cerebral protection for cesarean delivery in a parturient with Takayasu's arteritis at 38weeks' gestation. The parturient presented with impaired cerebral and renal perfusion. Titrated epidural anesthesia was performed. During the procedure, we used rScO2 guided cerebral protection strategies, which helped to optimize cerebral oxygen delivery and prevent cerebral complications.

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Influence of dexmedetomidine on cognitive function in volunteers

gr1.sml

Some outpatient procedures are performed under sedation with dexmedetomidine, although the effect of dexmedetomidine on cognitive function remains unclear. This study investigated the effect of dexmedetomidine on cognitive function in healthy volunteers.

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Triple A to triple S: From diagnosis, to anesthetic management of Allgrove syndrome

gr1.sml

Allgrove syndrome (AS) is a rare autosomal recessive disorder characterized by achalasia cardia, alacrimia, and adrenocorticotropic hormone–resistant adrenal insufficiency which is sometimes associated with autonomic dysfunction. It has also been referred to as the triple A syndrome in view of the cardinal symptoms described above. First described by Allgrove et al in 1978, the disorder usually presents mostly during the first decade of life. These patients have the threat of adrenal crisis, shock, and hypoglycemia and are usually on steroid supplementation.

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What it takes to be an EMT

In the first episode of this small online series, we meet Gabe. Learn how Gabe went from a small town volunteer EMT to a Navy Corpsman and emergency dispatcher. What journey will you take?

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Ambulance rollover crash test video

Braun Industries teamed up with CAPE Testing to conduct the Fire/EMS industry's first rollover ambulance crash test. They crashed a 10 year old unit in a test that most closely compares to the anticipated SAE J3057. The test focused on the modular body and roll impact loading, or how well the box holds up in the event of a rollover.

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What it takes to be an EMT

In the first episode of this small online series, we meet Gabe. Learn how Gabe went from a small town volunteer EMT to a Navy Corpsman and emergency dispatcher. What journey will you take?

from EMS via xlomafota13 on Inoreader http://ift.tt/1rlr6DT
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Ambulance rollover crash test video

Braun Industries teamed up with CAPE Testing to conduct the Fire/EMS industry's first rollover ambulance crash test. They crashed a 10 year old unit in a test that most closely compares to the anticipated SAE J3057. The test focused on the modular body and roll impact loading, or how well the box holds up in the event of a rollover.

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The role of single-balloon colonoscopy for patients with previous incomplete standard colonoscopy: Is it worth doing it?

Abstract

Background

The rate of cecal intubation is a well-recognized quality measure of successful colonoscopy. Infrequently, the standard colonoscopy techniques fail to achieve complete examination. The role of single-balloon overtube-assisted colonoscopy (SBC) in these situations has only been sparsely studied. This prospective single-center study aimed to investigate the technical success (rate of cecal intubation) and the diagnostic gain of SBC.

Methods

The study recruited consecutive patients with previous incomplete standard colonoscopy who were admitted for SBC at our tertiary center in Eastern Switzerland between February 2008 and October 2014. The primary outcome was defined as successful cecal intubation. Data on patient characteristics, indication, technical details of procedure, and outcome were collected prospectively. The Olympus enteroscope SIF-Q180 was used.

Results

The study included 100 consecutive patients (median age 70 years; range 38–87 years; 54 % female) who were examined using a single-balloon overtube-assisted technique. The cecal intubation rate was 98 % (98/100). The median time of total procedure was 54 min (range 15–119 min); the median time to reach the cecal pole was 27.5 min (range 4–92 min). Passage of the sigmoid colon was not possible in two cases with a fixed, angulated sigmoid colon. The diagnostic gain was 21 % regarding adenomatous polyps in the right colon. The complication rate was 2 % (2/100, minor) without need for surgery.

Conclusions

This prospective patient cohort study shows that single-balloon colonoscopy is a safe and effective procedure to achieve a complete endoscopic examination in patients with a previous failed standard colonoscopy. A significant diagnostic and therapeutic gain in the right colon justifies additional procedure time.



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The impact of postoperative complications on the recovery of elderly surgical patients

Abstract

Background

While the negative impact of postoperative complications on hospital costs, survival, and cancer recurrence is well known, few studies have quantified the impact of postoperative complications on patient-centered outcomes such as functional status. The objective of this study was to estimate the impact of postoperative complications on recovery of functional status after elective abdominal surgery in elderly patients.

Methods

Elderly patients (70 years and older) undergoing elective abdominal surgery, with a planned length of stay >1 day, were prospectively enrolled between July 2012 and December 2014. The primary outcome was time to recovery to the preoperative functional status measured by the short physical performance battery (SPPB) preoperatively and at 1 week, 1, 3, and 6 months after surgery. The comprehensive complication index was calculated to grade the severity and number of postoperative complications. A Weibull survival model with interval censoring was performed, controlling for age, sex, body mass index (BMI), comorbidities (Charlson comorbidity index−CCI), frailty, presence of cancer, nutritional status, wound class, preoperative functional status, and surgical approach.

Results

Hundred and forty-nine patients (79 men and 70 women) were included in the analysis. Mean age was 77.7 ± 4.9 years, mean BMI was 27.2 ± 5.5 kg/m2, and the median CCI was 3 (IQR 2–6). The mean preoperative SPPB score was 9.62 ± 2.33. A total of 52 patients (34.9 %) experienced one or more postoperative complications, including four mortalities, and a total of 72 complications. The mean comprehensive complication index score for these patients was 25.7 ± 23.8. In the presence of all other variables included in the model, a higher comprehensive complication index score was found to significantly decrease the hazard of recovery (HR 0.96, CI 0.94–0.98, p value = 0.0004) and hence increase the time to recovery.

Conclusion

Following elective abdominal surgery, elderly patients who experience a greater number and more severe postoperative complications take longer to return to their preoperative functional status.



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Esophagogastric junction distensibility measured by a functional lumen imaging probe with incremental gastric myotomy lengths in achalasia



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Fluorocholangiography: reincarnation in the laparoscopic era—evaluation of intra-operative cholangiography in 3635 laparoscopic cholecystectomies

Abstract

Background

The introduction of laparoscopic cholecystectomy (LC) resulted in the decline of routine intra-operative cholangiography (IOC). Common bile duct stones are being diagnosed preoperatively using magnetic resonance cholangiopancreatography (MRCP). We aim to evaluate the use and benefits of IOC during laparoscopic biliary surgery at a high-volume biliary surgery unit.

Methods

Prospective data from 4088 patients undergoing LC over 22 years were analysed. Referral protocols allow one firm to receive the great majority of biliary emergencies and all suspected ductal stones. All patients with gall stones on ultrasound scanning, fit for surgery, will undergo LC during the index admission. MRCP and ERCP are not part of preoperative investigation. A four-port LC is performed with a size 5Fr ureteric catheter within an open cannula to obtain an IOC through right sub-costal port.

Results

Of 4088 patients, IOC was attempted in 3691 (90.2 %) and 3635 had a successful IOC (98.4 %). 75 % were females. The mean age was 59 years. Patients presented with one or more of the following: chronic biliary pain in 60 %, acute pain 26.7 %, acute cholecystitis 8.4 %, gallstone pancreatitis 7.8 % and jaundice with or without cholangitis in 19.2 %. A total of 1328 patients (36.5 %) had risk factors for CBD stones. The IOC was abnormal in 975 cases (26.8 %), recording 1599 abnormalities. IOC identified 774 patients with CBD stones (21.3 %), including previously unsuspected CBD stones in 4.7 %. IOC was false negative in 20 cases (0.5 %) found to have stones on basket exploration. A decision not to perform IOC in 453 cases (11 %) was made preoperatively in 74.2 % and intra-operatively in 12.3 %.

Conclusion

IOC can be safely and routinely performed in LC. It helps to identify CBD stones, even in patients with no known risk factors, delineate bile duct anatomy and facilitate single-stage management of CBD stones.



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Application of clips assisted with foreign body forceps in defect closure after endoscopic full-thickness resection

Abstract

Background

This study was designed to evaluate the feasibility and efficacy of metallic clips assisted with foreign body forceps closing the gastric wall defect after endoscopic full-thickness resection (EFR) for gastric submucosal tumors (SMTs).

Methods

Eighteen patients with gastric SMTs originated from the muscularis propria were treated by EFR between September 2012 and June 2014. Twelve patients underwent endoscopic closure of the gastric wall defects after EFR with endoloop and metallic clips (endoloop string suture method, ESSM), and six patients with clips and foreign body forceps (clips assisted with foreign body forceps clip method, CFCM).

Results

No significant differences existed between the two groups in terms of demographics, clinical characteristics, and the size of the gastric wall defects. The average time spent in closing the gastric wall defects (14.83 ± 1.94 min for the CFCM group and 22.42 ± 5.73 min for the ESSM group) and hospitalization fees of the CFCM group were significantly lower than those of the ESSM group. The average hospitalization time of the two groups had no statistical significance. No single case had surgical intervention or complications, such as gastric bleeding, perforation, peritonitis, or abdominal abscess.

Conclusion

The CFCM and the ESSM are safe and effective techniques for gastric defect closure after EFR for gastric SMTs. Because of the "chopsticks effect," the CFCM more suitable for the lesions located at the gastric fundus, the greater curvature or anterior wall of the gastric body and gastric antrum.



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Trans-oral cricomyotomy using a flexible endoscope: technique and clinical outcomes

Abstract

Introduction

Zenker's diverticulum (ZD) is a rare upper esophageal pathology that is most prevalent in the sixth and seventh decade. Three different therapeutical options are available: (1) open trans-cervical approach, (2) rigid endoscopy and (3) flexible endoscopy. Our hypothesis is that a flexible endoscopic cricomyotomy represents a safe and effective treatment of ZD as well as cricopharyngeal spasm.

Methods

A retrospective analysis of all patients that underwent a flexible endoscopic cricomyotomy at our institution between October 2008 and May 2014 was performed. Preoperative and postoperative (1 month and long-term follow-up) symptom scores and clinical outcomes were collected. Briefly, the ZD is carefully identified endoscopically and the common wall is divided using needle knife cautery with the help of an endoscopic cap. Clips are used to close the mucosal defect starting with the apex.

Results

Twenty-six patients underwent a flexible endoscopic myotomy for a ZD. Of 26 patients, five (19.2 %) had a history of previous open or stapled trans-oral myotomy and four (15.4 %) underwent a concomitant foregut procedure. Mean length of stay was 1.5 days (range 1–11). Mean operative time was 68 min (range 28–149). One patient presented with a postoperative leak, and one patient presented with a retained clip. Both were treated endoscopically. Recurrent weekly dysphagia was present in 3/26 (11.5 %). One patient (3.8 %) underwent an endoscopic bougie dilatation postoperatively. With regard to clinical outcomes, there was a statistically significant improvement in both short-term (1 month) and long-term (median follow-up 21.8 months; range 1–68.2 months) dysphagia (p < 0.001; p < 0.001), regurgitation (p = 0.001; p = 0.017), cough (p = 0.006; p = 0.025) and aspiration (p = 0.013; p = 0.013).

Conclusion

Flexible endoscopic cricomyotomy offers durable relief of dysphagia, regurgitation, cough and aspiration in ZD patients. It appears to have a good safety profile with symptomatic recurrence occurring in up to 11.5 % of cases.



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Outcome of laparoscopic gastrectomy with D1 plus lymph node dissection in gastric cancer patients postoperatively diagnosed with locally advanced disease or lymph node metastasis

Abstract

Background

Some laparoscopic gastrectomy (LG) patients are postoperatively diagnosed with locally advanced disease or lymph node metastasis. Few reports have reviewed the outcomes or validity of LG in such patients.

Methods

We retrospectively compared the outcomes of LG for gastric cancer patients postoperatively diagnosed with T3 (subserosal invasion) or higher or N1 (metastasis in 1–2 regional lymph nodes), or higher disease (n = 36), with open gastrectomy (OG) for c-stage I gastric cancer patients (n = 62).

Results

D1 plus lymph node dissection was performed in all patients in the LG group. Blood loss was significantly lower in the LG group than in the OG group (P < 0.0010). The mean postoperative hospital stay duration was significantly shorter in the LG group than in the OG group (P = 0.0016). In the LG group, lymph node metastasis occurred in 1 patient, peritoneal dissemination in 2 patients, and liver metastasis in 1 patient. The 5-year survival rate did not significantly differ between the LG and OG groups (90.00 vs. 94.52 %; P = 0.6517).

Conclusions

Given the similarity in long-term outcomes between the LG and OG groups, LG is an appropriate indication for gastric cancer patients postoperatively diagnosed with locally advanced disease or lymph node metastasis.



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Single-site laparoscopic approach of Kraske procedure for a presacral local recurrence of rectal adenocarcinoma



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The uncinate process first approach: a novel technique for laparoscopic right hemicolectomy with complete mesocolic excision

Abstract

Background

Current evidence suggests that complete mesocolic excision (CME) for right-sided colon cancer could be beneficial in terms of long-term survival. However, CME is a considerably more complex operation than standard right hemicolectomy; this is especially true for the laparoscopic approach. Consequently, we have explored a new laparoscopic approach that provides surgical radicality at the mesenteric root on the one hand and maximum safety on the other hand.

Methods

The key feature of the uncinate process first approach (UFA) is the commencement of the dissection at the fourth part of the duodenum using a medial to lateral approach, thus mobilizing the whole mesenteric root posteriorly before the central parts of the mesenteric vessels are accessed. Twenty-eight selected patients with right-sided colon cancer underwent surgery using the UFA and were compared with 51 patients who underwent an open CME procedure (CON). In 11/28 and 51/51 patients in the UFA and CON groups, respectively, a planimetric assessment of the specimen was performed.

Results

Surgical time was longer (144.8 vs. 202.5 min; p < 0.000) and postoperative stay shorter (8.0 vs. 10.5 days; p < 0.01) for the laparoscopic approach. The area of the resected mesentery (UFA, 15,097 mm2; CON, 15,788 mm2; p = 0.47) and the lymph node count (UFA, 59.0; CON, 51.0; p = 0.09) was not significantly different; additionally, no difference was observed regarding anastomotic leakage (both n = 0) and postoperative mortality (UFA, 0/28; CON, 1/51; p = 1.0).

Conclusion

Laparoscopic right hemicolectomy with CME using the UFA provides adequate radicality according to the CME principles and seems feasible and as safe as an open technique. However, future trails will have to demonstrate whether the theoretical advantages of the UFA, with a higher degree of mobility and accessibility of the mesenteric root, translate into a significant clinical benefit, especially relative to the other laparoscopic techniques.



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Percutaneous aspiration of the gall bladder for the treatment of acute cholecystitis: a prospective study

Abstract

Background

Urgent laparoscopic cholecystectomy has been established as the best treatment for acute cholecystitis. However, conservative treatment is advocated for high-risk patients. Failure of conservative treatment can result in high-risk operations with relatively high rates of operative morbidity. Percutaneous cholecystostomy is a good option for these patients. Recently, percutaneous aspiration of the gall bladder without drain has been described.

Methods

A protocol of initial conservative management in high-operative-risk patients admitted with acute cholecystitis was prospectively assessed. Patients who did not respond to antibiotics were treated with percutaneous trans-hepatic aspiration of the gall bladder under ultrasound guidance. Following discharge, the patients were seen in the outpatient clinic and elective laparoscopic cholecystectomy was considered and scheduled as necessary.

Results

Between January 2011 and December 2012, 33 patients with persistent clinical and sonographic signs of acute cholecystitis after failure of initial antibiotic treatment underwent gall bladder aspiration under ultrasound guidance. No complications related to the procedure were reported. In 25 patients (76 %), the procedure was successful and they were discharged. Seven patients needed repeated aspiration. Eight patients (24 %) who did not improve underwent percutaneous cholecystostomy and were discharged with a drain and later reevaluated for elective surgery. The mean hospital stay of patients with successful aspiration was 3 days. During the follow-up period, 23 patients underwent elective interval laparoscopic cholecystectomy. Two were converted to open surgery (8.7 %).

Conclusions

Conservative treatment and delayed operation is an acceptable option for acute cholecystitis. Percutaneous gall bladder aspiration is a simple and effective procedure, with a high success rate and low morbidity. Laparoscopic cholecystectomy after drainage of the gall bladder has low morbidity with a relatively low conversion rate.



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Lap band outcomes from 19,221 patients across centers and over a decade within the state of New York

Abstract

Introduction

We sought to determine the rate of revision and explant of the laparoscopic adjustable gastric banding (LAGB) over a ten-year period in the state of New York.

Methods

Following IRB approval, the SPARCS administrative database was used to identify LAGB placement from 2004 to 2010. We tracked patients who underwent band placement with subsequent removal/revision, followed by conversion to either Roux-en-Y gastric bypass (RYBG) or sleeve gastrectomy (SG) between 2004 and 2013. McNemar test and Chi-square test were used to compare complications between primary procedure and subsequent revision and to compare complication rates and mortality rates, respectively. Log-rank test was used to assess patient characteristics and comorbidities. p < 0.05 was considered significant.

Results

During a 7-year period, there were 19,221 records of LAGB placements and 6567 records of revisions or removal. We were able to follow up 3158 (16.43 %) who subsequently underwent a band removal or revision over the course of this period. An additional 3606 patients had no records in the state of New York following the procedure, thus making the rate of revision 20.22 %. Initial revision procedures were coded as band removal in 32.77 % (n = 1035), band revision in 30.53 % (n = 964), band removal and replacement in 19.09 % (n = 603), removal and conversion to SG in 5.64 % (n = 178), or removal and conversion to RYGB in 11.97 % (n = 378). From the 3158 patients, 2515 (79.64 %) required only one revision. Six hundred and forty-three patients underwent two or more revisions. Thirty-one out of 3158 (0.0098 %) patients had complications at their initial operation, but 919 (29.1 %) had complications during revision (p < 0.0001).

Conclusions

Over a 7-year period, at least 20.22 % of LAGB required removal or revision. Based on all case numbers, total revision rate may be as high as 34.2 %. Although the band is believed to be a reversible procedure, revisional procedures are significantly more morbid than the initial procedure.



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Eleven years of primary closure of common bile duct after choledochotomy for choledocholithiasis

Abstract

Background

The choice of surgical technique to extract stones from the common bile duct (CBD) depends on local experience, anatomical characteristics and also on the size, location and number of stones. Most authors consider choledochotomy an alternative to failed transcystic exploration, although some use it exclusively. Although the CBD is traditionally closed with T-tube drainage after choledochotomy, its use is associated with 11.3–27.5 % morbidity. This study examined the efficacy of laparoscopic CBD exploration (LCBDE) with primary closure for the treatment of CBD stones using intraoperative cholangiography (IOC).

Methods

Retrospective study of 160 patients who underwent LCBDE with primary closure after choledochotomy between January 2001 and December 2012.

Results

The diagnosis of choledocholithiasis was definitively made in all cases by IOC. The overall complication rate was 15 % and the biliary complication rate was 7.5 %. Bile leakage was reported in 11 patients (6.8 %). In over half the cases (63.6 %), no further action was required and the leak closed spontaneously. Six patients were reoperated (3.75 %), two for bile peritonitis and four for haemoperitoneum. The success rate for stone clearance was 96.2 %. The mortality rate and CBD stricture rate were 0 %.

Conclusion

Primary closure after choledochotomy to clear stones from the CBD is a safe technique that confers excellent results and allows one-stage treatment.



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Long-term outcomes of percutaneous endoscopic intragastric surgery in the treatment of gastrointestinal stromal tumors at the esophagogastric junction

Abstract

Background

The treatment options for gastrointestinal stromal tumors (GITSs) at the esophagogastric junction (EGJ) are controversial. There have been reports on enucleation for EGJ GISTs in order to avoid gastrectomy. But the number of patients is too small, or the follow-up period is too short to evaluate it. The purpose of this study was to review our experience of 59 patients with EGJ GISTs treated by enucleation by percutaneous endoscopic intragastric surgery (PEIGS) and assess the clinical outcomes.

Methods

PEIGS is performed as described below. Access ports are placed through the abdominal wall and the anterior wall of the stomach. Through the access ports, an endoscope and surgical instruments are inserted into the gastric lumen and tumor enucleation and closure of the defect are carried out. In this study, 59 patients with EGJ GISTs treated by PEIGS between 2005 and 2013 were enrolled. Their hospital records were reviewed, and follow-up data for 8 years were collected to analyze the outcomes.

Results

En-bloc enucleation was achieved without tumor rupture in all. Average operation time was 172.3 min. Postoperative complications occurred in 3 (one localized peritonitis, one bleeding, and one surgical site infection). Average tumor size was 35.6 mm. Pathological findings confirmed negative margin in all specimens. The maximum follow-up period was 101 months. Multiple liver metastases were detected in two patients (at 12 and 29 months). The survival rate was 100 %. The disease-free rate was 98.3 % at 12 months and 96.6 % at 29 months, respectively.

Conclusions

As far as the short- and long-term outcomes of our experience are reviewed, PEIGS seems as curative as other aggressive resection methods such as proximal gastrectomy. Tumor enucleation by PEIGS, offering a chance to preserve the stomach, can be a preferable option in carefully selected patients with EGJ GISTs, when performed by a skilled surgeon.



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