Δευτέρα 5 Σεπτεμβρίου 2016

Laparoscopic surgery for the treatment of a ruptured aneurysm of the right gastric artery: a case report

Abstract

Laparoscopic surgery for the treatment of a ruptured visceral artery aneurysm is recognized as a challenging procedure. Here, we describe our experience with laparoscopic surgery to treat a ruptured aneurysm of the right gastric artery. A 72-year-old woman was diagnosed with intra-abdominal hemorrhage caused by a ruptured aneurysm of the right gastric artery. Transcatheter arterial embolization failed because the right gastric artery could not be cannulated. Therefore, we performed laparoscopic surgery. Using laparoscopy, we detected that the bleeding from the aneurysm had ceased; thus, the planned procedure was successful. The operative time and intraoperative blood loss were 100 min and 5 mL, respectively. The patient was discharged 7 days after surgery. Laparoscopic surgery after the failure of transcatheter arterial embolization is a suitable and safe procedure for ruptured visceral artery aneurysms, provided the circulatory dynamics are stable as a result of the temporary cessation of bleeding from the ruptured aneurysm.



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The Optimal Approach to Symptomatic Paraesophageal Hernia Repair: Important Technical Considerations

Abstract

While the asymptomatic paraesophageal hernia (PEH) can be observed safely, surgery is indicated for symptomatic hernias. Laparoscopic repair is associated with decreased morbidity and mortality; however, it is associated with a higher rate of radiologic recurrence when compared with the open approach. Though a majority of patients experience good symptomatic relief from laparoscopic repair, strict adherence to good technique is critical to minimize recurrence. The fundamental steps of laparoscopic PEH repair include adequate mediastinal mobilization of the esophagus, tension-free approximation of the diaphragmatic crura, and gastric fundoplication. Collis gastroplasty, mesh reinforcement, use of relaxing incisions, and anterior gastropexy are just a few adjuncts to basic principles that can be utilized and have been widely studied in recent years. In this article, we present a comprehensive review of literature addressing key aspects and controversies regarding the optimal approach to repairing paraesophageal hernias laparoscopically.



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Current Practice of Duodenoscope Reprocessing

Abstract

Numerous outbreaks of duodenoscope-associated transmission of multi-drug resistant bacteria have recently been reported. Unlike prior episodes of endoscope-transmitted infections, the latest outbreaks have occurred despite strict adherence to duodenoscope reprocessing guidelines. The current standard for all flexible endoscope reprocessing includes pre-cleaning, leak testing, an additional manual cleaning step, and high-level disinfection. When these steps are strictly followed, the risk of infection transmission during endoscopy is exceedingly rare. However, due to its complex design, the duodenoscope may not be able to be adequately disinfected using the current reprocessing standards. Supplemental measures to enhance scope reprocessing have subsequently been recommended to reduce the infection risk in patients undergoing endoscopic retrograde cholangiopancreatography. These methods are likely short-term solutions that have yet to be validated regarded their effectiveness. Additional approaches to monitor the quality of duodenoscope reprocessing may also be useful. Ultimately, a definitive, yet logistically feasible, method of duodenoscope reprocessing is required to ensure the safety of our patients.



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Does a dual attending surgeon strategy confer additional benefit for posterior selective thoracic fusion in lenke 1 and 2 adolescent idiopathic scoliosis (AIS)? a prospective propensity matching score analysis

With an increased cost of AIS surgery over the past 10 years, improvement of patient safety and optimize the surgical management of AIS is a need. A dual attending surgeon strategy resulted in reduction of blood loss and complication rate.

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Use the 24-hour news cycle to your EMS agency's advantage

Ever wonder how sometimes seemingly routine media messages seem to proliferate on broadcast and social media" Putting an EMS story into this 24-hour orbit is not rocket science. It just requires understanding the 24-hour news cycle.

The 24-hour news cycle is the unending stream of investigative reporting on all-news radio stations, television channels and websites. Stories have to be told, re-told and re-packaged to be told again because of the continuous need to keep the cycle fed.

An important phenomena resulting from 24-hours news stations and online news is the speed at which news outlets want content to maintain a competitive advantage in the market. This means that the media outlets have three goals:

  1. Be the first to get information out to their audience
  2. Have a unique angle for telling the story
  3. Have a differentiating perspective to re-tell the story

Case Study: Heat emergencies
Here's a case study to demonstrate using the 24-hour news cycle to position your agency as a go-to source for the media to satisfy their appetite for early and unique content. This case also illustrates how content can continue to be used over time to fill the media's need for 24-hour news.

It's HOT in Texas.

This is not news, but the heat is a topic every year that we know will get media time as the first triple-digit temperatures are forecast. Assignment editors, producers and reporters will be clamoring to be the first to broadcast a heat-related story and tell their story with a unique angle to illustrate the hazards of the hot weather.

In anticipation of the rise in temperatures, we ran a report on the number of heat-related calls from our computer aided dispatch data from the previous summer. We filtered the data to answer these questions:

  • What date did we begin to see a spike in heat-related calls"
  • How many heat emergencies did we respond to last year"
  • What percent of patients were transported"
  • Were there any common themes"

We also wanted to provide our media partners advice on hot weather safety. In addition, we sought out the expertise of two medical professionals. Our release included quotes from a paramedic, one of the most trustworthy professionals and our medical director.

Even though we were prepared with great insight and important messaging, we also knew we needed a hook, which is that one thing which will generally get everyone's attention, leading to actionable information the media can share with their viewers.

For our hook we chose the devastating occurrence of leaving kids in hot cars. The Kids and Cars website proved to be a valuable resource to gather statistics and authoritative information about how to prevent leaving kids in hot cars. We included this information, as well as the number of kids in hot cars we responded to last year, in our early information release.

A day before the first triple-digit weather was to arrive we emailed the previous year's data, quotes from a paramedic and medical director and preventing hot car deaths as a media release to all our media partners. We also posted the release on our website and tweeted a link to the release on our website.

Within minutes there was a plethora of activity. Retweets, emails and phone calls seeking for interviews and examples. We even received requests for ride alongs to chronicle actual heat related calls. We met the first goal for our media partners, be the first to get out information.

We then moved into achieving the second goal by providing daily updates on the number of heat-related calls we had responded to, how many of those patients were transported to the hospital and how many patients were not transported.

We put extra emphasis on kids in hot cars responses and outcomes. Continual reminders of the safety tips were also included.

A daily report of the number of heat-related calls, along with the tips of how to stay safe in the heat, became a regular part of virtually every evening news broadcast. The second goal, a unique angle, was achieved.

As the hot weather droned on for days achieving the third goal, having a differentiating perspective, required a lot of creativity. We pitched an idea to put a well-known evening news reporter into car in direct sunlight on a 100+ degree day, live, on the evening news, to see how the heat impacts him. Even better we offered to put him on a cardiac monitor, body temperature gauge, pulse oximetery and capnography with real-time monitoring by a MedStar crew standing next to the car.

So that's what we did.

First, we had to select the right crew. A crew that was seasoned, well spoken, extroverted (to a point), had a camera friendly appearance (yes, it matters) and wanted to do it.

Once the crew was selected, they reported to the studio 30 minutes before the planned broadcast start. They met the news reporter turned patient, the news broadcast anchors and the production crew that would be part of the live shot. This meeting was important to build some familiarity and trust between the participants.

The live broadcast started with the MedStar crew in studio, with their equipment, explaining live how heat effects the body, what they will be looking for when monitoring the patient and what parameters they will use to decide when it is no longer safe for the reporter to be in the car. They then moved outside, took baseline vital signs on the reporter before he entered the black car, in direct sunlight, attached to the paramedic's monitoring equipment.

And so it began, live, with over 250,000 viewers.

During the 30-minute news cast, they went live to the parking lot to interview reporter in the car and the MedStar crew standing by. Viewers also saw an on-screen, digital inset displaying the elapsed time, the temperature outside and the temperature inside the car.

After 17 minutes, the MedStar crew determined it was no longer safe for the reporter in the car and in dramatic fashion they removed the reporter from the car. Once out the car they immediately began rapid cooling with ice packs, an important treatment demonstration, and started IVs to rehydrate him.

The video, complete with slow-motion effects, were replayed on newscasts for the following 24 hours. The third goal, a differentiating perspective, was satisfied.

Educate and promote
Here are the keys to creating a media partnership that educates your community and promotes your agency and its personnel.

1. Be available.
This means 24/7/365. When you demonstrate reliability, you will become the first call for any busy reporter or assignment editor when they are on a deadline (hint: they are always on deadline)

2. Be a story source.
Carry a list of story ideas for the media that you can pull from when they call and say "we got nothing and we go on the air two hours – what do ya got for us"" Always have an updated list of ideas and you will be their hero.

3. Be opportunistic.
It's perfectly fine to tag onto events happening and pitch an EMS angle. We used the heat example here, but there are many examples:

Also, if something big is happening on a national level, what is the local angle" Local media outlets often want to take national stories, like the Pokémon Go craze, to the local level.

4. Be prepared.
Most of the time, a PIO speaking on camera or being quoted in print is fine. Sometimes, it's best to use EMTs or paramedics, dispatchers or other personnel. Ask them if they would like to be interviewed. It's unusual for anyone to decline, because of the cool factor. Yes, they will be nervous, so take the time before the interview to prep them. Find out what questions the reporter will be asking and role play with the employee. Hone their answers to help them be comfortable.

5. Be supportive of your staff.
If field personnel are going to be interviewed, in addition to preparing them, be there with them. In the unlikely event the interview is not going well, you can step in and either get it back on course or take over for them. Believe me, they appreciate the support.

6. Be proud.
Subscribe to a broadcast news clipping services. When stories air about your agency you can download the stories and share on your web page, Facebook page and with the personnel involved. The clips also become a great training tool as well as a library of your media involvement.

7. Be grateful.
Send your media partners with hand-written notes to thank them for including your agency and personnel in the story. Also text them right after the story airs to tell them they did a good job. If the story didn't turn out the way you hoped, stay connected, provide feedback and keep supplying story ideas.



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Efficacy of Neck Stabilization Exercises for Neck Pain Complicating Pregnancy

2016-09-05T10-58-48Z
Source: International Journal of Therapies and Rehabilitation Research
Asmaa Mahmoud Elbandrawy, Hassan Omer Ghareeb.
ABSTRACT Aims: To determine the efficacy of neck stabilization exercises on neck pain during pregnancy. Place and Duration of Study: Department of obstetrics and gynecology, Kasr El-Aini University Hospital, and outpatient clinic of faculty of Physical Therapy, Cairo University, between November 2014 and June 2015. Methodology: Forty pregnant women at the third trimesters (26-35weeks' gestation) with a mean value of (28.2±1.36 weeks' gestation), previously diagnosed with neck pain and their age ranged from 25-35 years with a mean value of (30.00±3.82 yrs). Neck pain was defined as non-specific neck pain without specific, identifiable etiology (i.e. infection, inflammatory disease). A detailed medical history was obtained to screen for other pathological conditions. Patients were excluded if they had a history of cervical spine injury or surgery, if their neck pain was secondary to other conditions (including neoplasm, neurological diseases or vascular diseases), if they had a radiculopathy presenting neurological deficit, infection or inflammatory arthritis in the cervical spine, poor general health status that would interfere with the exercises during the study. These exclusion criteria were verified by history and physical examination. The patients were informed about the study, and written consent was obtained from all patients. Patients were randomly assigned into two equal groups (A& B). Group (A) consisted of twenty patients who received neck stabilizing exercises in addition to TENS. Group (B) consisted of twenty patients, who received TENS only. Treatment program was performed three times per week for eight weeks, for both groups A&B. Assessment of all subjects in both groups (A& B) was carried out before and after the treatment program throughout visual analogue scale and neck disability scale. Results: Showed a statistically significant decrease (P


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The Efficacy of Low Level Laser Therapy on Herpes Simplex Lesions in Children

2016-09-05T10-58-48Z
Source: International Journal of Therapies and Rehabilitation Research
Nesrin Afify Abd-ElRashid, Hamada El-Sayed Ayoub.
Background: Recurrent HSV1 is a continuous challenge in alternative medicine. Despite some recent advances in underlying its basic problems that may cause morbidity and mortality. Objective: To evaluate the efficacy of low level laser therapy in the treatment of recurrent herpes simplex (improving cutaneous manifestations and prevent recurrence) in children. Methods: Forty children with recurrent Herpes Simplex Type I (oral and peri-oral Herpes Simplex Type I) infection. The patients were randomly divided into two equal groups, study group (Gallium Arsenide laser irradiation group) and control group. Lab assessment (IgM) had been measured within 48 hours from the appearance of the cutaneous manifestations (pre) and after 14 days (post) from the beginning of treatment for both groups. Results: The results of the study revealed that there were a significant improvement of cutaneous manifestations and normalization of Lab findings in group B (study group) compared with group A patients (control group). Conclusion: Low level laser therapy was effective in treating children with recurrent Herpes Simplex I.


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Localized Fusariosis Caused by Fusarium Verticillioides – A Case Report

2016-09-05T09-51-03Z
Source: International Journal of Medical Research
MANGAIYARKARASI THIYAGARAJAN, SARANYA. D, GOPAL.R..
The genus Fusarium contains several species which are sapro-phytic moulds present in the soil and air. They can cause lo-cal cutaneous infections and in-fections of surgical & burns wounds as well as disseminated infection. It has emerged as an important pathogen in immuno-compromised patients causing significant morbidity and mor-tality. The species most fre-quently associated with human infections are F. Solani, F. Ox-ysporum, F. Verticillioides. This case of a fusariosis presented as lupus vulgaris caused by Fusarium verticillioides in a male patient who is also infect-ed with mycobacterium.


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FFamily-Member Variant of Directory Observed Therapy Short Course (DOTS) in Current Pulmonary Tuberculosis (PTB) Management: A Way Out in Resource-Constrained Settings – A Case Report

2016-09-05T09-51-03Z
Source: International Journal of Medical Research
Terhemen Joseph Igbudu, Livinus Egwuda, Tsav Peter Mbaave.
Appreciation of patients family dynamics may be very crucial in deciding the appropriate treat-ment option aimed at reducing treatment failures and drug re-sistance in the management of pulmonary tuberculosis espe-cially in the resource-constrained settings. We reported a case of a 62 year old retiree with pulmonary tu-berculosis who had financial challenges and was successfully treated using the family-member variant of DOTS. This modality of treatment was easi-ly accepted and eventually ad-dressed some of the financial challenges the patient had. Family-member variant of DOTS was successfully demon-strated in the management of PTB and was seen to have re-duced the variable cost of treatment, distortion of family dynamics and enhanced family harmony.


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Evaluation of patterns and predictors of off-label prescribing of antidepressants in psychiatry at a tertiary care hospital - An analytical cross-sectional study

2016-09-05T09-12-18Z
Source: National Journal of Physiology, Pharmacy and Pharmacology
Debdipta Bose, Sushma Muraraiah, Hongali Chandrashekar.
Background: Off-label drug prescribing is commonly seen all medical fields including psychiatry. A regular auditing and publishing of off-label drug prescribing is important as it provides strong scientific evidence for the clinicians on the effectiveness and acceptability of these proposed treatments. Aims and Objective: To evaluate the pattern and predictors of off-label prescribing of antidepressants in psychiatry was taken up. Materials and Methods: After obtaining the permission from Institutional Ethics Committee, an analytical cross-sectional study was conducted among patients attending psychiatry outpatient department for 6 months. Demographic and drug data were noted and analyzed for off-label drug use as per Food Drug Administration approved indication. Chi-square test and Students t-test were used to compare the off-label and approved indication groups. Multivariate binary logistic regression model was used to determine the predictors of offlabel prescribing. Results: A total of 238 antidepressants were prescribed for 200 patients, of which 42.8% were used for off-label indication. Fluoxetine 44.1% and escitalopram 42.1% were the most frequently prescribed antidepressants in offlabel manner. The off label indications noted was somatoform disorder (12.5%), followed by generalized anxiety disorder (8.5%). There was significant causal association between off-label prescribing and number of antidepressant (odds ratio [OR] - 15.43, 95% confidence interval [CI] - 3.49-89.02, P

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Successful laparoscopic treatment of a giant solitary fibrous tumor of the mesorectum: A case report and literature review

Abstract

A solitary fibrous tumor is a ubiquitous mesenchymal fibroblastic tumor that was previously considered limited to the pleural cavity. Here, we report a rare case of a large solitary fibrous tumor of the mesorectum, which was successfully resected laparoscopically. A 56-year-old woman was referred to our hospital for a giant pelvic mass. Pelvic MRI showed a well-circumscribed mass, 12 cm in diameter, with heterogeneous signal intensity on T2-weighted images. It was diagnosed as a benign mesorectal tumor of unknown origin. We successfully resected the entire tumor laparoscopically. Histological examination revealed it to be an extrapleural solitary fibrous tumor. For large tumors in the pelvis, the laparoscopic approach is preferable in terms of intraoperative hemorrhage, as long as they do not invade surrounding tissues.



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