Παρασκευή 8 Δεκεμβρίου 2017
Environmental Health and Resources That We Need
As I write this, we are in the middle of a season of environmental disasters: hurricanes and earthquakes that have wrought incredible destruction in Texas, Florida, Mexico, the Caribbean Islands, and Puerto Rico. And as you read this, the storm names of Harvey, Irma, and Maria may be a distant memory—although I suspect not. Many of us have ties to those affected areas: friends, families, and homes. And, of course, our thoughts are with the children and families—particularly those of poor and vulnerable populations—who may be disproportionately affected by the human and social impact of these environmental catastrophes.
from Health via xlomafota13 on Inoreader http://ift.tt/2A5I65G
via IFTTT
Practice Guidelines for Peanut Allergies
This article reviews the latest recommendations and clinical practice guidelines for peanut allergies among the pediatric population. Recommendations in this paper were compiled using information collected from a variety of publications of accredited professional organizations. Peanut allergies are the body's response to what it sees to be an unwanted substance in the body. This article focuses on the causes, signs and symptoms, prevention, diagnosis, and management of peanut allergies.
from Health via xlomafota13 on Inoreader http://ift.tt/2A6AQqm
via IFTTT
Celebrating the New Year: History and Traditions
I hope that all of you had a beautiful holiday season with your loved ones. The end of the holidays causes me to reflect on my family heritage and the traditions that tie us together. My family holds a Christmas brunch every year. Because I am a nurse practitioner and my brothers own a restaurant, the timing of our celebration varies. Sometimes we gather on the holiday, and sometimes our brunch is in January. Whenever we gather, it is always a special occasion.
from Health via xlomafota13 on Inoreader http://ift.tt/2AIZjDd
via IFTTT
Management of Childhood Functional Constipation
Constipation is a common problem during childhood, and 0.7% to 29.6% of children are constipated worldwide (Mugie, Benninga, & Di Lorenzo, 2011). This condition accounts for 3% to 5% of pediatric primary care visits and up to 25% of gastroenterology consultations (Di Lorenzo, 2000; Youssef & Di Lorenzo, 2001). Children presenting to the emergency department with abdominal pain are most often diagnosed with constipation (Caperell, Pitetti, & Cross, 2013). Constipated children have more outpatient and emergency department visits, and their overall annual medical cost is approximately twice as much as that of children without constipation (Choung et al., 2011).
from Health via xlomafota13 on Inoreader http://ift.tt/2A7qmXV
via IFTTT
Shoe Lifts for Leg Length Discrepancy in Adults with Common Painful Musculoskeletal Conditions: A Systematic Review of the Literature
Publication date: Available online 9 December 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): T Mark Campbell, Bahareh Bahram Ghaedi, Elizabeth Tanjong Ghogomu, Vivian Welch
ObjectiveTo determine whether shoe lifts effectively treat leg length discrepancy (LLD)-associated morbidities in adults with common painful musculoskeletal conditions.Data SourcesTRIP, CENTRAL, PubMed, PEDro and National Guideline Clearinghouse databases. The search was performed in September 2017, limited to English-only, and had no time constraints.Study SelectionTwo reviewers independently determined study eligibility. Inclusion criteria were: (1) participants ≥18 years-old with musculoskeletal-related complaints and LLD, (2) a shoe lift intervention was used, and (3) the study reported on pain, function, range of motion, patient satisfaction, quality of life, or adverse events. Randomized controlled trials (RCTs), controlled intervention, cohort, before-and-after, case-series and case report studies were included. Three-hundred-and-nineteen articles were screened and nine guidelines reviewed.Data ExtractionWe extracted data pertaining to participant demographic characteristics, study setting, recruitment, randomization, method of LLD measurement, shoe lift characteristics, treatment duration, and outcome measures. We included ten studies, including one RCT.Data SynthesisLLD was associated with low back pain, scoliosis, and osteoarthritis of the hip and knee. Description of LLD correction strategy was often inadequate. Study quality was very low or poor. In non-RCT studies reporting on the proportion of participants who improved with a shoe lift, 88±3% of 349 participants treated had partial or complete pain relief (effect size range 66.7-100%). All 22 RCT participants receiving treatment experienced pain relief (mean pain reduction 27±9mm on a 150mm visual analogue scale). Two of nine guidelines recommended shoe lift use based on consensus, and were of moderate-to-high quality.ConclusionsThere is low-quality evidence that shoe lifts reduce pain and improve function in patients with LLD and common painful musculoskeletal conditions. High quality research evaluating a threshold LLD to correct and a strategy to do so is necessary. Developing an appropriate comparison group to test clinically-relevant outcome measures would make a valuable contribution in this regard.
from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2B10oJ3
via IFTTT
Diverse inhibitory and excitatory mechanisms shape temporal tuning in transient OFF alpha ganglion cells in the rabbit retina
Abstract
The twenty to thirty types of ganglion cell in the mammalian retina represent parallel signalling pathways that convey different information to the brain. Alpha ganglion cells are selective for high temporal frequencies in visual inputs, which makes them particularly sensitive to rapid motion. Although alpha ganglion cells have been studied in several species, the synaptic basis for their selective temporal tuning remains unclear. Here, we analyse excitatory synaptic inputs to transient OFF alpha ganglion cells (t-OFF α GCs) in the rabbit retina. We show that convergence of excitatory and inhibitory synaptic inputs within the bipolar cell terminals presynaptic to the t-OFF α GCs shifts the temporal tuning to higher temporal frequencies. GABAergic inhibition suppresses the excitatory input at low frequencies, but potentiates it at high frequencies. TTX-sensitive channels in presynaptic bipolar cells also contribute to boosting responses at high frequencies. Crossover glycinergic inhibition and sodium channel activity in the presynaptic bipolar cells also potentiate high frequency excitatory inputs. We found differences in the spatial and temporal properties, and contrast sensitivities of these mechanisms. These differences in stimulus selectivity allow these mechanisms to generate bandpass temporal tuning of t-OFF α GCs over a range of visual conditions.
This article is protected by copyright. All rights reserved
from Physiology via xlomafota13 on Inoreader http://ift.tt/2A4PuhM
via IFTTT
Presurgical language mapping using event-related high-gamma activity: The Detroit procedure
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Toshimune Kambara, Sandeep Sood, Zahraa Alqatan, Christine Klingert, Diksha Ratnam, Akane Hayakawa, Yasuo Nakai, Aimee F. Luat, Rajkumar Agarwal, Robert Rothermel, Eishi Asano
A number of investigators have reported that event-related augmentation of high-gamma activity at 70–110 Hz on electrocorticography (ECoG) can localize functionally-important brain regions in children and adults who undergo epilepsy surgery. The advantages of ECoG-based language mapping over the gold-standard stimulation include: (i) lack of stimulation-induced seizures, (ii) better sensitivity of localization of language areas in young children, and (iii) shorter patient participant time. Despite its potential utility, ECoG-based language mapping is far less commonly practiced than stimulation mapping. Here, we have provided video presentations to explain, point-by-point, our own hardware setting and time–frequency analysis procedures. We also have provided standardized auditory stimuli, in multiple languages, ready to be used for ECoG-based language mapping. Finally, we discussed the technical aspects of ECoG-based mapping, including its pitfalls, to facilitate appropriate interpretation of the data.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2iFwsaD
via IFTTT
Human subthalamic oscillatory dynamics following somatosensory stimulation
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Saskia Elben, Carlos Trenado, Jan Vesper, Alfons Schnitzler, Lars Wojtecki
ObjectiveElectrical median nerve somatosensory stimulation leads to a distinct modulation of cortical oscillations. Initial high frequency and gamma augmentation, as well as modulation of beta and alpha oscillations have been reported. We aimed at investigating the involvement of the subthalamic nucleus in somatosensory processing by means of local field potential recordings, since recordings during passive movements and peripheral somatosensory stimulation have suggested a prominent role.MethodsRecordings of subthalamic neuronal activity following median nerve stimulation in 11 Parkinson's disease patients were performed. Time-frequency analysis from 1 to 500 Hz was averaged and analyzed.ResultsSeveral oscillatory components in response to somatosensory stimulation were revealed in the time-frequency analysis: (I) prolonged increase in alpha band power, followed by attenuation; (II) initial suppression of power followed by a subsequent rebound in the beta band; (III) early broad-frequency increase in gamma band power; (IV) and sustained increase of 160 Hz frequency oscillations throughout the trial.ConclusionsThese results further corroborate the involvement of the subthalamic nucleus in somatosensory processing.SignificanceThe present results not only support the notion of somatosensory processing in the subthalamic nucleus. Moreover, an improvement of somatosensory processing during subthalamic deep brain stimulation in Parkinson's disease might be accounted for by enhancement of prevailing high frequency oscillations.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2yP31vB
via IFTTT
Erol Başar, 1938–2017
Source:Clinical Neurophysiology
Author(s): Bahar Güntekin, Görsev Yener, Ahmet Ademoğlu, Tamer Demiralp, Canan Başar-Eroğlu
from Physiology via xlomafota13 on Inoreader http://ift.tt/2iIe0OR
via IFTTT
Abnormal functional connectivity of high-frequency rhythms in drug-naïve schizophrenia
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Tetsuya Takahashi, Takashi Goto, Sou Nobukawa, Yuji Tanaka, Mitsuru Kikuchi, Masato Higashima, Yuji Wada
ObjectiveThe "dysconnection hypothesis" has been proposed as a core neural basis for schizophrenia. Although growing neuroimaging-based evidence suggests atypical functional connectivity in patients with schizophrenia, the results are inconsistent and the effects of antipsychotic treatment remain elusive.MethodsWe performed resting-state electroencephalography (EEG) in 21 drug-naïve patients with schizophrenia (14 patients were re-evaluated after administration of antipsychotic treatment) and 31 age-matched healthy control subjects. We estimated functional connectivity, using the phase lag index (PLI), which captures the true synchronization of EEG signals.ResultsThe patients had reduced functional connectivity of the beta band across frontal regions and of the gamma band throughout the scalp when compared to the control subjects. In the schizophrenia group, symptom severity did not seem associated with functional connectivity. Antipsychotic treatment led to no alterations in functional connectivity.ConclusionsSynchronous activity within and across brain areas over multiple frequencies reflect the integration of various types of information processing. Our findings of abnormal frequency- and region-specific functional connectivity patterns may provide further insight into the "dysconnection hypothesis" of schizophrenia.SignificanceThe PLI may serve as a useful measure for the characterization and understanding of the intrinsic pathophysiological mechanisms of schizophrenia, and as a reliable biomarker for this disease.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2yPW79x
via IFTTT
Cramps frequency and severity are correlated with small and large nerve fiber measures in type 1 diabetes
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Alon Abraham, Carolina Barnett, Leif E. Lovblom, Bruce A. Perkins, Vera Bril, Hans D. Katzberg
ObjectivesTo explore the correlations between different muscle cramp characteristics including cramp frequency and severity and clinical and large and small nerve fiber measures in patients with diabetes type 1 (DM 1) and 2 (DM 2).MethodsProspective cross sectional study of healthy controls and patients with DM 1 and DM 2 recruited between April 2009 and November 2012. Participants underwent clinical evaluation and large and small nerve fiber studies, and the frequency and correlations of muscle cramps were explored.Results37 controls, 51 patients with DM 1, and 69 patients with DM 2 were studied. Muscle cramps were the most frequent symptom captured by the Toronto Clinical Neuropathy Score (TCNS) in all groups, up to 78% in patients with DM 2. In patients with DM 1, but not DM 2, muscle cramp frequency and severity were correlated with clinical (TCNS) and both large (electrophysiology and vibration perception thresholds) and small nerve fiber measures.ConclusionsMuscle cramps are frequent in diabetes and are correlated with clinical and both small and large nerve fiber measures in DM 1, suggesting that their origin and propagation might extend beyond the motor nerve.SignificanceMuscle cramps correlate with nerve fiber measures in DM 1.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2iJmS6C
via IFTTT
Detection of proximal conduction blocks using a triple stimulation technique improves the early diagnosis of Guillain–Barré syndrome
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Amandine Sevy, Aude-Marie Grapperon, Emmanuelle Salort Campana, Emilien Delmont, Shahram Attarian
ObjectiveCurrent diagnostic electrophysiological criteria can miss the early stages of Guillain–Barré syndrome (GBS). We evaluated the diagnostic efficiency of the triple stimulation technique (TST) in highlighting proximal conduction blocks (CBs) in patients who do not meet the electrophysiological criteria for GBS.MethodsAll patients with a diagnosis of clinical GBS referred to our center between September 2014 and January 2016 were included in the study. For patients who did not fulfill the electrophysiological criteria of GBS, we performed the TST examination.ResultsAmong the 44 included patients, 86% fulfilled the electrophysiological criteria of GBS during the initial nerve conduction study (NCS). The six remaining patients had proximal CBs revealed by TST examination. Therefore, a combination of a conventional NCS and the TST allowed 100% of the patients to be electrophysiologically diagnosed.ConclusionsTST is useful for the diagnosis of GBS in association with NCS, particularly in the early stages of the disease.SignificanceTST is a useful tool for GBS diagnosis at the early stages of the disease.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2yQ3duU
via IFTTT
Clinical features of otolith organ-specific vestibular dysfunction
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Chisato Fujimoto, Sayaka Suzuki, Makoto Kinoshita, Naoya Egami, Keiko Sugasawa, Shinichi Iwasaki
ObjectiveTo elucidate the clinical features and vestibular symptoms of patients with otolith organ dysfunction in the presence of normal function of the semicircular canals.MethodsWe reviewed the clinical records of 277 consecutive new patients with balance disorders who underwent testing of cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) as well as caloric testing and video head impulse testing (vHIT).ResultsWe identified 76 patients who showed normal caloric responses and normal vHIT findings in each SCC plane, but abnormal responses in cVEMP and/or oVEMP testing. Benign paroxysmal positional vertigo (BPPV) was the most common diagnosis. 37% of patients could not be categorized into any of the established clinical entities that could cause a balance disorder and did not show sensorineural hearing loss. The most common clinical manifestation in the idiopathic cases was recurrent rotatory vertigo with a duration of 1–12 h.ConclusionsThe most common diagnosis of otolith organ-specific vestibular dysfunction was BPPV. The most common clinical manifestation in the idiopathic cases was recurrent rotatory vertigo.SignificanceSpecific dysfunction of the otolith organs occurs in association with some of the undiagnosed patients with recurrent rotatory vertigo.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2iIdSPn
via IFTTT
What is the optimal frequency range for quantifying slow EEG activity in neonates? Insights from power spectra
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Simon Finnigan, Paul B. Colditz
from Physiology via xlomafota13 on Inoreader http://ift.tt/2kC389c
via IFTTT
Four-dimensional map of the human early visual system
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Yasuo Nakai, Akari Nagashima, Akane Hayakawa, Takuya Osuki, Jeong-won Jeong, Ayaka Sugiura, Erik C. Brown, Eishi Asano
ObjectiveWe generated a large-scale, four-dimensional map of neuronal modulations elicited by full-field flash stimulation.MethodsWe analyzed electrocorticography (ECoG) recordings from 63 patients with focal epilepsy, and delineated the spatial-temporal dynamics of visually-elicited high-gamma70-110 Hz amplitudes on a standard brain template. We then clarified the neuronal events underlying visual evoked potential (VEP) components, by correlating with high-gamma amplitude measures.ResultsThe medial-occipital cortex initially revealed rapid neural activation followed by prolonged suppression, reflected by augmentation of high-gamma activity lasting up to 100 ms followed by attenuation lasting up to 1000 ms, respectively. With a number of covariate factors incorporated into a prediction model, the eccentricity representation independently predicted the magnitude of post-activation suppression, which was more intense in regions representing more parafoveal visual fields compared to those of more peripheral fields. The initial negative component on VEP was sharply contoured and co-occurred with early high-gamma augmentation, whose offset then co-occurred with a large positive VEP peak. A delayed negative VEP peak was blunt and co-occurred with prolonged high-gamma attenuation.ConclusionsEccentricity-dependent gradient in neural suppression in the medial-occipital region may explain the functional difference between peripheral and parafoveal/central vision. Early negative and positive VEP components may reflect neural activation, whereas a delayed negative VEP peak reflecting neural suppression.SignificanceOur observation provides the mechanistic rationale for transient scotoma or mild flash-blindness, characterized by physiological afterimage preferentially formed in central vision following intense but non-injurious light exposure.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2y8K6bz
via IFTTT
Short-term intraindividual variability of the posterior dominant alpha frequency in the electroencephalogram
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): A. Khan, W. Paulus, C. Stephani
from Physiology via xlomafota13 on Inoreader http://ift.tt/2y91tsO
via IFTTT
Diagnosing Kernohan-Woltman notch phenomenon by somatosensory evoked potentials in intensive care unit
Source:Clinical Neurophysiology, Volume 129, Issue 1
Author(s): Florent Gobert, Jan H. Baars, Thomas Ritzenthaler, Mehdi Afathi, Sébastien Boulogne, Nathalie André-Obadia, Fréderic Dailler
from Physiology via xlomafota13 on Inoreader http://ift.tt/2kESgaK
via IFTTT
Risk of complications in coeliac patients depends on age at diagnosis and type of clinical presentation
Coeliac disease is characterised by an increased mortality mostly due to its complications.
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2jw6300
via IFTTT
A Hat-Trick Knock-Reversible Triple Organ Injury in a New Mother With HELLP Syndrome
No abstract availablefrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y90TeD
via IFTTT
Mannitol Shower: The Artefactual Air Embolism!
No abstract availablefrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y94rOh
via IFTTT
Sodium Bicarbonate for Control of ICP: A Systematic Review
Objective: Our goal was to perform a systematic review of the literature on the use of intravenous sodium bicarbonate for intracranial pressure (ICP) reduction in patients with neurologic illness. Methods: Data sources: articles from MEDLINE, BIOSIS, EMBASE, Global Health, Scopus, Cochrane Library, the International Clinical Trials Registry Platform (inception to April 2015), reference lists of relevant articles, and gray literature were searched. Data extraction: 2 reviewers independently extracted data including population characteristics and treatment characteristics. The strength of evidence was adjudicated using both the Oxford and Grading of Recommendation Assessment Development and Education methodology. Results: Our search strategy produced a total 559 citations. Three original articles were included in the review. There were 2 prospective studies, 1 randomized control trial and 1 single arm, and 1 retrospective case report. Across all studies there were a total of 19 patients studied, with 31 episodes of elevated ICP being treated. Twenty-one of those episodes were treated with sodium bicarbonate infusion, with the remaining 10 treated with hypertonic saline in a control model. All elevated ICP episodes treated with sodium bicarbonate solution demonstrated a significant drop in ICP, without an elevation of serum partial pressure of carbon dioxide. No significant complications were described. Conclusions: There currently exists Oxford level 4, Grading of Recommendation Assessment Development and Education D evidence to support an ICP reduction effect with intravenous sodium bicarbonate in TBI. No comments on its impact in other neuropathologic states, or on patient outcomes, can be made at this time.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y8ScAX
via IFTTT
Intraoperative Blood Pressure Discrepancy Between Arms During Prone Position!
No abstract availablefrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2yPREnk
via IFTTT
Perioperative and Anesthetic Considerations for Neurosurgical Laser Interstitial Thermal Therapy Ablations
Objective: To describe the anesthetic considerations in patients undergoing laser interstitial thermal therapy (LITT) for neurosurgical procedures. Background: LITT for neurosurgical procedures is being increasingly used in a variety of central nervous system diseases. Several studies have demonstrated promising results including a shorter hospital stay. Given the rising trend for the use of LITT, anesthesiologists need to be familiar with the anesthetic considerations to provide care for patients undergoing these types of procedures. Materials and Methods: PubMed was searched in April 2016 using different combinations of the following MeSH terms: "Central nervous System," "laser therapy," "Ablation Techniques," "Anesthesia," and "Spinal Cord Neoplasms." A total of 54 relevant manuscripts were included in this review article. Conclusions: LITT is a promising therapeutic approach for multiple central nervous system disorders. Anesthesiologists must be familiar with the anesthetic considerations and the technical aspects of the procedure when providing care for patients undergoing LITT. The literature is scarce on the impact of different anesthesia and analgesia techniques on clinical outcomes. Therefore, studies comparing different anesthetic regimens and the impact on outcomes are needed to make relevant recommendations on the anesthesia care of these patients.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2yPRCvI
via IFTTT
Innovations in Functional Neurosurgery and Anesthetic Implications
Functional neurosurgery has undergone rapid growth over the last few years fueled by advances in imaging technology and novel treatment modalities. These advances have led to new surgical treatments using minimally invasive and precise techniques for conditions such as Parkinson's disease, essential tremor, epilepsy, and psychiatric disorders. Understanding the goals and technological issues of these procedures is imperative for the anesthesiologist to ensure safe management of patients presenting for functional neurosurgical procedures. In this review, we discuss the advances in neurosurgical techniques for deep brain stimulation, focused ultrasound and minimally invasive laser-based treatment of refractory epilepsy and provide a guideline for anesthesiologists caring for patients undergoing these procedures.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y94jON
via IFTTT
Complementary Use of Effect Site-Target Controlled Infusion and SmartPilot View for Anesthetic Management in Semi-awake Craniotomy Near BIS 85
No abstract availablefrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y8Sckr
via IFTTT
Ultra–low-dose Naloxone as an Adjuvant to Patient Controlled Analgesia (PCA) With Morphine for Postoperative Pain Relief Following Lumber Discectomy: A Double-blind, Randomized, Placebo-controlled Trial
Background: Lumbar discectomy is one of the most commonly performed neurosurgical procedures. Many patients experience postoperative pain after lumbar discectomy. This study evaluated the effect of ultra–low-dose naloxone infusion on pain intensity after lumbar discectomy in individuals receiving patient-controlled analgesia (PCA) with morphine. Materials and Methods: In a double-blind, randomized, controlled trial, a total of 80 patients scheduled for open discectomy was randomly assigned to receive naloxone (group N) or placebo (group P). After surgery, all patients were connected to a morphine PCA pump. Both groups received 500 mL of normal saline using a continuous infusion pump through a separate intravenous line for 24 hours. However, group N received a total dose of 0.25 μg/kg/h naloxone, which was added to the normal saline infusion. All patients were asked to grade the intensity of their pain, severity of nausea, vomiting, and pruritus on a 0 to 10 visual analog scale before being discharged from the postanesthesia care unit and at 1, 6, 12, and 24 hours postoperatively. Results: It was observed that both groups had a statistically significant (Pfrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y94eKZ
via IFTTT
Intraoperative Mania During Deep Brain Stimulation for Parkinson Disease
No abstract available
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2yPwypg
via IFTTT
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2yPwypg
via IFTTT
Propofol Pharmacodynamics and Bispectral Index During Key Moments of Awake Craniotomy
Background: During awake craniotomy, the patient's language centers are identified by neurological testing requiring a fully awake and cooperative patient. Hence, anesthesia aims for an unconscious patient at the beginning and end of surgery but an awake and responsive patient in between. We investigated the plasma (Cplasma) and effect-site (Ceffect-site) propofol concentration as well as the related Bispectral Index (BIS) required for intraoperative return of consciousness and begin of neurological testing. Materials and Methods: In 13 patients, arterial Cplasma were measured by high-pressure liquid chromatography and Ceffect-site was estimated based on the Marsh and Schnider pharmacokinetic/dynamic (pk/pd) models. The BIS, Cplasma and Ceffect-site were compared during the intraoperative awakening period at designated time points such as return of consciousness and start of the Boston Naming Test (neurological test). Results: Return of consciousness occurred at a BIS of 77±7 (mean±SD) and a measured Cplasma of 1.2±0.4 μg/mL. The Marsh model predicted a significantly (Pfrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2yPre5d
via IFTTT
Posterior Reversible Encephalopathy Syndrome Triggered by Vertebral Artery Angiogram
No abstract availablefrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2yPp997
via IFTTT
The Correlation Between Recordable MEPs and Motor Function During Spinal Surgery for Resection of Thoracic Spinal Cord Tumor
Background: Motor evoked potentials (MEPs) are commonly used during surgery for spinal cord tumor resection. However, it can be difficult to record reliable MEPs from the muscles of the lower extremities during surgery in patients with preoperative weakness due to spinal cord compression. In this study, motor function of patients' lower extremities and their association with intraoperative MEP recording were compared. Patients and Methods: Patients undergoing thoracic spinal cord tumor resection were studied. Patients' motor function was checked immediately before the surgical procedure. MEP responses were recorded from the tibialis anterior and foot muscles, and the hand muscles were used as control. Electrical current with train of eight pulses, 200 to 500 V was delivered through 2 corkscrews placed at C3' and C4' sites. Anesthesia was maintained by total intravenous anesthesia using a combination of propofol and remifentanil after induction with intravenous propofol, remifentanil, and rocuronium. Rocuronium was not repeated. Bispectral Index was maintained between 40 to 50. Results: From 178 lower limbs of 89 patients, myogenic MEPs could be recorded from 100% (105/105) of the patients with 5 of 5 motor strength in lower extremity; 90% (36/40) from the patients with 4/5 motor strength; only 25% (5/20) with 3/5; and 12.5% (1/8) with 2/5 motor strength; none (0/5) were able to be recorded if the motor strength was 1/5. Summary: The ability to record myogenic MEPs is closely associated with the patient's motor function. They are difficult to obtain if motor function is 3/5 motor strength in the lower extremity. They are almost impossible to record if motor function is worse than 3/5.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2yPmLPK
via IFTTT
A Survey of Incidence of Postoperative Visual Loss Associated With Spine Surgery Outside the United States
No abstract available
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y8Agqn
via IFTTT
from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y8Agqn
via IFTTT
Airway Management With a Stereotactic Headframe In Situ—A Mannequin Study
Background: Stereotactic headframe-based imaging is often needed for target localization during surgery for insertion of deep brain stimulators. A major concern during this surgery is the need for emergency airway management while an awake or sedated patient is in the stereotactic headframe. The aim of our study was to determine the ease of emergency airway management with a stereotactic headframe in situ. Materials and Methods: We conducted an observational study using a mannequin. A Leksell stereotactic headframe was placed on a mannequin in the operating room and the frame was fixed to the operating room table. Anesthesia personnel were asked to insert a #4 laryngeal mask and then to intubate the mannequin, using both direct (DL) and video laryngoscopy (VL). In addition, participants were asked to perform the same airway techniques in the mannequin without the headframe. Data were analyzed for time taken for airway management using different devices with and without the headframe. In addition, we compared the time taken to secure the airway between different participant groups. Results: Thirty anesthesia personnel (7 residents, 12 fellows, and 11 consultants) participated in the study. With the headframe in situ, 97% of participants were able to insert a laryngeal mask on their first attempt; 93% and 97% of participants were able to intubate the mannequin using DL and VL respectively on their first attempt. Without the stereotactic headframe, all participants were able to insert the laryngeal mask and intubate on the first attempt. The average time taken to insert a laryngeal mask and intubate the mannequin using DL and VL with the headframe in situ was 39.3, 58.6, and 54.8 seconds, respectively. Conclusions: Our study showed that both laryngeal mask insertion and tracheal intubation can be performed with a stereotactic headframe in situ. A laryngeal mask is the quickest airway device to insert and can be inserted while the mannequin is in the standard surgical position. Further study is needed to validate the results in patients.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y90HMB
via IFTTT
Cortical Arousal With Deep Brain Stimulation After General Anesthesia for Laparoscopic Cholecystectomy
No abstract availablefrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y90Ak9
via IFTTT
Hemodynamic Disturbances in the Early Phase After Subarachnoid Hemorrhage: Regional Cerebral Blood Flow Studied by Bedside Xenon-enhanced CT
Background: The mechanisms leading to neurological deterioration and the devastating course of delayed cerebral ischemia (DCI) after subarachnoid hemorrhage (SAH) are still not well understood. Bedside xenon-enhanced computerized tomography (XeCT) enables measurements of regional cerebral blood flow (rCBF) during neurosurgical intensive care. In the present study, CBF characteristics in the early phase after severe SAH were explored and related to clinical characteristics and early clinical course outcome. Materials and Methods: Patients diagnosed with SAH and requiring mechanical ventilation were prospectively enrolled in the study. Bedside XeCT was performed within day 0 to 3. Results: Data from 64 patients were obtained. Median global CBF was 34.9 mL/100 g/min (interquartile range [IQR], 26.7 to 41.6). There was a difference in CBF related to age with higher global CBF in the younger patients (30 to 49 y). CBF was also related to the severity of SAH with lower CBF in Fisher grade 4 compared with grade 3. rCBF disturbances and hypoperfusion were common; in 43 of the 64 patients rCBFfrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y90Hw5
via IFTTT
Analgosedation With Dexmedetomidine in a Patient With Superior Vena Cava Syndrome in Neurosurgery
No abstract availablefrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y97FRP
via IFTTT
Neonatal Sevoflurane Exposure Induces Adulthood Fear-induced Learning Disability and Decreases Glutamatergic Neurons in the Basolateral Amygdala
Background: Neonatal mice exposed to sevoflurane show certain cognitive and behavioral impairments in adulthood. However, the mechanisms underlying long-term cognitive deficits induced by sevoflurane exposure remain unknown. The present study was performed to investigate whether there is differential neuronal activation between naive mice and sevoflurane-exposed neonates in fear-conditioning tests based on immediate early gene (c-Fos) expression. Methods: Male mice were exposed to 3% sevoflurane (SEVO group) or carrier gas alone (no anesthesia, NA group) for 6 hours on postnatal day 6. The mice were allowed to mature before performing the contextual fear-conditioning test. A reduced freezing response was confirmed in the SEVO group. Neural activation in the regions of the medial prefrontal cortex, hippocampus, and amygdala was investigated using c-Fos immunostaining 2 hours after the test. The types of neurons activated were also identified. Results: The number of c-Fos-positive cells decreased by 27% in the basolateral amygdala in the SEVO group, while no significant changes were observed in other regions. Furthermore, glutamatergic, but not γ-aminobutyric acid (GABA)ergic, neurons expressed c-Fos after the contextual fear-conditioning test in both groups. The number of glutamatergic neurons in the basolateral amygdala in the SEVO group was reduced by 27%. Conclusions: Decreased neural activation in the basolateral amygdala may be associated with reduced freezing time in neonatal sevoflurane-exposed mice. Fewer glutamatergic neurons responding to fear stimuli in the basolateral amygdala may contribute to decreased neural activation and learning deficits in mice exposed to sevoflurane as neonates.from Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y90oRX
via IFTTT
Intravenous Clevidipine for Inducing Hypotensive Challenge During Carotid Balloon Test Occlusion
No abstract availablefrom Anaesthesiology via xlomafota13 on Inoreader http://ift.tt/2y90lWh
via IFTTT
Texas fire department welcomes first female firefighter-paramedic in its 141 years
By Drew Smith Herald Democrat DENISON, Texas — Denison Fire Rescue crews welcomed Hanna Lindemuth to their team last week as not only one of the department's newest employees but as the first female firefighter and paramedic in the department's 141-year history. "We're happy she's here and we're proud of her at the same time," Assistant Fire Chief Mark Escamilla said ...
from EMS via xlomafota13 on Inoreader http://ift.tt/2jbWdDg
via IFTTT
Developing a Telephone Training Program for Adults Using Cochlear Implants
Ellen Giles described the inability to use the telephone as "one of the most serious and restrictive consequences of hearing loss" (2005, p. 219). This restriction is more keenly felt now, with the world population at 7 billion, there are more than 6 billion cell phone subscriptions (International Telecommunication Union, 2012).
from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2kFN6Lr
via IFTTT
from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2kFN6Lr
via IFTTT
Aural Rehabilitation in Private Practice
Aural rehabilitation refers to sensory management, auditory speech perception training, and counseling services provided to those with hearing loss and their communication partners. The goal of aural rehabilitation is to reduce the impact that hearing loss has on communication and daily function. There is ample evidence confirming the effectiveness of aural rehabilitation, however, comprehensive aural rehabilitation services are rarely offered in the private practice setting. Lack of time, compliance, and reimbursement have been suggested as possible reasons for the rare provision of aural rehabilitation services. The purpose of this article is to provide the reader with a simple framework for efficiently incorporating aural rehabilitation services into a busy private practice. It is suggested that both client and clinician compliance will improve when clinicians become proficient with a few select tools in the areas of assessment, education and counseling, auditory training, and follow-up. In today's changing marketplace, it is critical for private practice clinicians to set themselves apart from the commodity options by offering comprehensive aural rehabilitation services.
from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2jyn4GE
via IFTTT
from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2jyn4GE
via IFTTT
SIG 7 Perspectives Vol. 22, No. 2, November 2015: Earn 0.1 CEUs
Download the CE Questions PDF from the toolbar, above. Use the questions to guide your Perspectives reading. When you're ready, purchase the activity from the ASHA Store and follow the instructions to take the exam in ASHA's Learning Center. Available until November 13, 2018.
from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2kBwKn8
via IFTTT
from Rehabilitation via xlomafota13 on Inoreader http://ift.tt/2kBwKn8
via IFTTT
Ambulance simulator teaches EMS providers to drive in dangerous conditions
EMS West began using EMS Virtual Drive to teach EMS providers how to drive with inclement weather, distracted drivers and pedestrians
from EMS via xlomafota13 on Inoreader http://ift.tt/2AFIlWk
via IFTTT
Bill aims to forgive volunteer first responder student loan debt
By EMS1 Staff WASHINGTON — A bill aims to increase volunteer recruitment by forgiving a portion of student loan debt. Williston Herald reported that the Volunteer First Responder Loan Forgiveness Act would add volunteers to the Public Service Loan Forgiveness program, which nullifies outstanding balances and interests for first responders after 120 payments are received. To be considered for the ...
from EMS via xlomafota13 on Inoreader http://ift.tt/2Ao7Iip
via IFTTT
Teen to earn Eagle Scout badge by building first responder statues
By EMS1 Staff RALSTON, Neb. — A teen is hoping to earn his Eagle Scout badge by honoring first responders with three statues. Omaha World-Herald reported that sophomore Tyler Richards is spearheading a project to have three bronze statues placed at Koch Park, including one of an EMS provider, a firefighter and a police officer. "I want to recognize those people for all the hard work they've ...
from EMS via xlomafota13 on Inoreader http://ift.tt/2AJtOLt
via IFTTT
Non-auditory, electrophysiological potentials preceding dolphin biosonar click production
Abstract
The auditory brainstem response to a dolphin's own emitted biosonar click can be measured by averaging epochs of the instantaneous electroencephalogram (EEG) that are time-locked to the emitted click. In this study, averaged EEGs were measured using surface electrodes placed on the head in six different configurations while dolphins performed an echolocation task. Simultaneously, biosonar click emissions were measured using contact hydrophones on the melon and a hydrophone in the farfield. The averaged EEGs revealed an electrophysiological potential (the pre-auditory wave, PAW) that preceded the production of each biosonar click. The largest PAW amplitudes occurred with the non-inverting electrode just right of the midline—the apparent side of biosonar click generation—and posterior of the blowhole. Although the source of the PAW is unknown, the temporal and spatial properties rule out an auditory source. The PAW may be a neural or myogenic potential associated with click production; however, it is not known if muscles within the dolphin nasal system can be actuated at the high rates reported for dolphin click production, or if sufficiently coordinated and fast motor endplates of nasal muscles exist to produce a PAW detectable with surface electrodes.
from Physiology via xlomafota13 on Inoreader http://ift.tt/2yPcQd9
via IFTTT
Why one call was my destiny as a paramedic
By Mike Peach, EMS1 Contributor It was a cold December night, just before Christmas, when the radio tones went off for an OB call. It was Bill's turn to drive, which meant the patient would be mine. I had previously delivered 10 babies so I wasn't too worried about it, my biggest concern became the weather; it was already -10 degrees Fahrenheit and falling, a very bad thing for a newborn ...
from EMS via xlomafota13 on Inoreader http://ift.tt/2jxu5HJ
via IFTTT
Usefulness and limitations of dual-layer spectral detector computed tomography for diagnosing biliary stones not detected by conventional computed tomography: a report of three cases
Abstract
Computed tomography (CT) is useful for diagnosing biliary stones. However, the presence of stones not detected by conventional CT, such as iso-dense stones with CT numbers similar to those of bile or small stones, is problematic. Although conventional CT provides only 120-kVp images corresponding to CT numbers at approximately 70 keV, dual-layer spectral detector CT uses one X-ray source and dual-layer detectors to collect low- and high-energy data simultaneously; retrospective spectral analysis, including virtual monochromatic images with photon energy levels of 40–200 keV, material decomposition images, and spectral curves, can be immediately performed on demand. This technique can immediately discriminate between materials with similar conventional CT numbers. Therefore, prompt and accurate diagnosis of iso-dense stones can be performed. In two out of three of our cases, iso-dense stones were detected in virtual monochromatic images at 40 keV, but in the remaining case a common 4-mm bile duct stone was not detected on 120-kVp and 40-keV images by retrospective spectral analysis. However, this stone was detected by magnetic resonance cholangiopancreatography. Retrospective spectral analysis using dual-layer spectral detector CT was useful for prompt and accurate diagnosis of iso-dense stones, but detection of <5-mm stones may be a limitation of this technique and of conventional CT.
from Gastroenterology via xlomafota13 on Inoreader http://ift.tt/2nIABQF
via IFTTT
Εγγραφή σε:
Αναρτήσεις (Atom)