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Pre-medication with controlled-release oxycodone in the management of postoperative pain after ambulatory laparoscopic gynaecological surgery 预用药控释羟考酮在门诊腹腔镜妇科手术后疼痛的管理
Pub Date : 2013-06-01 DOI: 10.13172/2052-0077-2-4-581
B. Lim, S. Thong, H. Zhu, Y. Lim
ability to walk unassisted. ROC curves showed specificity of 88%, 90%, 92% and 50% for, Knee, Hip, Ankle and Bromage respectively and Prediction probabilities of 0.901, 0.948 , 0.958 and 0.752 in the same order P< 0.001. The possible explanation is the fact that lower degree of muscle weakness could not be fully detected by the Bromage test. Conclusion(s): Quantitative measurements of the degree of recovery of the motor power of the Knee, Hip, or Ankle flexors are more accurate and superior to Bromage score, as predictors of patient ability to safely ambulate af ter spinal anesthesia. References: 1 .Graham A. C and McClure J. H. Quantitative assessment of motor block in labouring women receiving epidural analgesia. Anesthesia 2001; 56:470-76 2 .Imarengiaye CO, Song D, Prabhu AJ. Spinal anesthesia functional balance is impaired af ter clinical recovery. Anesthesiology. 2003 Feb;98(2):511-5
独立行走的能力。ROC曲线显示,膝关节、髋关节、踝关节和Bromage的特异性分别为88%、90%、92%和50%,预测概率分别为0.901、0.948、0.958和0.752,同阶P< 0.001。可能的解释是,较低程度的肌肉无力不能被布罗米奇试验完全检测出来。结论:定量测量膝关节、髋关节或踝关节屈肌运动力量的恢复程度比Bromage评分更准确,更优于预测脊髓麻醉后患者安全行走的能力。参考文献:1 . graham A. C . McClure J. H.硬膜外镇痛对分娩妇女运动阻滞的定量评价。麻醉2001;[2]张建军,张建军,张建军。临床恢复后,脊髓麻醉功能平衡受损。麻醉学杂志。2003年2月;98(2):511-5
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引用次数: 1
Pancreatic tuberculosis: a case report 胰腺结核1例
Pub Date : 2013-06-01 DOI: 10.13172/2052-0077-2-5-587
Umesh Jethwani, G. Singh, R. Mohil, V. Kandwal, J. Chouhan, R. Saroha, N. Bansal
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引用次数: 0
Enthesophyte on the radius: a case report 桡骨内生菌1例
Pub Date : 2013-06-01 DOI: 10.13172/2052-0077-2-5-634
R. Singh
Introduction Radius is a lateral bone of the fore- arm. The upper end of the radius consists of head, neck and radial tuberosity. Tendon of the biceps bra- chi muscle is inserted into the poste- rior rough part of radial tuberosity. The anterior smooth part of radial tuberosity is separated from the posterior part by bursa. In this case, bony projection from the posterior rough part of radial tuberosity was observed. Case report During examination of radii in the osteology lab of King George's Medi- cal University, three radii (two radii of left hands and one of right hand) out of 100 assorted radii were observed having longitudinal and trans- verse enthesophytes. The lengths, heights and thicknesses of these longitudinal enthesophytes in the left two radii were 2.2/0.7/0.2 cm, 1.9/0.7/0.4 cm and 2.2/0.6/0.4 cm in one right radius. The lengths, heights and thicknesses of these transverse enthesophytes in the left two radii were 1.1/0.3/0.2 cm, 0.8/0.2/0.2 cm and 0.7/0.1/0.1 cm in one right radius. Discussion Enthesophytes may be formed due to overuse of the biceps brachi muscle. This extra bony growth may impinge on the surrounding structures lead- ing to neurovascular complications and restriction of biomechanical movements of forearm.
桡骨是前臂的外侧骨。桡骨上端包括头、颈和桡骨粗隆。肱二头肌胸肌肌腱插入桡骨粗隆后后粗糙部分。桡骨粗隆的前部光滑部分与后部被滑囊隔开。在本例中,观察到桡骨粗隆后粗糙部分的骨突出。在乔治国王医学院骨学实验室对桡骨进行检查时,在100个不同的桡骨中,有3个桡骨(2个左手桡骨和1个右手桡骨)存在纵向和横向内生菌。纵向内生菌的长度、高度和厚度在左两个半径分别为2.2/0.7/0.2 cm、1.9/0.7/0.4 cm和2.2/0.6/0.4 cm。这些横向内生菌的长度、高度和厚度在左两个半径分别为1.1/0.3/0.2 cm、0.8/0.2/0.2 cm和0.7/0.1/0.1 cm。内生性真菌可能由于过度使用肱二头肌而形成。这种额外的骨骼生长可能会冲击周围的结构,导致神经血管并发症和限制前臂的生物力学运动。
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引用次数: 1
Ceruminous gland adenoma of the external auditory canal: A case report 外耳道耵聍腺瘤1例
Pub Date : 2013-06-01 DOI: 10.13172/2052-0077-2-5-632
K. Koulia, A. Tsavari, D. Myoteri, A. Zisi, E. Skafida, X. Grammatoglou, T. Vasilakaki
Ceruminous gland adenoma is a very rare bening neoplasm of the external auditory canal. This tumour composed of the ceruminous gland cell (modified apocrine sweat glands). We report a case of a 39 year old man who presented with signs of scratching at the left ear. Otoscopic examination revealed an exophytic skin covered smooth nodule 1,2 cm in greatest dimension on the posterior wall of the external auditory canal. Local wide resection of the lesion was performed. Microscopically the lesion composed of oxyphil glands and small cysts in a hyalinized stroma. The glandular epithelium was bilayered. In the immunohistochemical study the luminal cells were strongly positive with CK7 while the basal cells were highlighted with CK5/6, p63 and S100 protein. The diagnosis was ceruminous gland adenoma. Three years later there was no evidence of recurrence. Complete surgical excision is therefore the treatment of choise.
摘要耵聍腺瘤是一种非常罕见的外耳道良性肿瘤。该肿瘤由耵聍腺细胞(修饰的大汗腺)组成。我们报告一个39岁的男子谁提出的迹象抓挠在左耳。耳镜检查发现外耳道后壁有一个外生皮肤覆盖的光滑结节,最大尺寸为1.2厘米。局部广泛切除病变。镜下病变由嗜氧腺和透明基质中的小囊肿组成。腺上皮呈双层结构。在免疫组化研究中,管腔细胞强烈表达CK7,基底细胞则表达CK5/6、p63和S100蛋白。诊断为耵聍腺瘤。三年后没有复发的迹象。因此,完全手术切除是治疗的选择。
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引用次数: 0
The different clinical scenarios of left ventricular non-compaction: report of three cases 左心室不压实的不同临床表现:附3例报告
Pub Date : 2013-06-01 DOI: 10.13172/2052-0077-2-5-629
M. Bolognesi, D. Bolognesi
Abstract Introduction Left ventricular non-compaction is a morphological abnormality of exces-sive trabeculation of the left ventricle, and often, but not always, complicated by cardioembolism, arrhythmias and ventricular dysfunction. Since its irst mention in the 1980s, left ventricular non-compaction cardiomyopathy has gained increasing awareness and atten-tion. Thirty or more years of research and an ever-increasing number of published articles have improved our understanding of this rare cardiomyo-pathy, yet many issues remain unre-solved. In particular, the phenotypic and clinical expression of the same genetic cardiomyopathy assumes dif-ferent forms depending on the type of subjects involved. These case reports describe the different clinical evolu-tions of the same cardiomyopathy inde-pendently of the anatomical substrate and illustrate two aspects of the same disease in different types of patients. Case report Isolated left ventricular non-com-paction cardiomyopathy has been observed both as a sporadic and a familiar form, but newly diagnosed patients have been stratiied for symp-toms found at the time of diagnosis.
左室不压实是左室过度小梁的形态学异常,通常但并非总是合并心栓塞、心律失常和心室功能障碍。自20世纪80年代首次被提及以来,左室非压实性心肌病越来越受到人们的关注和重视。三十多年的研究和越来越多的发表文章提高了我们对这种罕见心肌病的理解,但许多问题仍未解决。特别是,相同的遗传性心肌病的表型和临床表现根据所涉及的受试者类型而呈现不同的形式。这些病例报告描述了同一种心肌病独立于解剖学基础的不同临床演变,并说明了不同类型患者同一种疾病的两个方面。孤立性左室非紧张性心肌病是一种散发性和常见的形式,但新诊断的患者已根据诊断时发现的症状进行分层。
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引用次数: 0
The wide awake approach to ulnar nerve entrapment: results of an integrated one stop wide awake surgical pathway 尺神经卡压的全清醒入路:综合一站式全清醒手术路径的结果
Pub Date : 2013-06-01 DOI: 10.13172/2052-0077-2-5-631
Qmk Bismil, S. Lowe, L. Viner, Msk Bismil
Introduction The wide awake approach to hand surgery is gaining increasing popularity worldwide, but PubMed search does not reveal any publications on wide awake ulnar nerve surgery. In this research study, we describe our surgical experience, techniques and results of the wide awake management of ulnar nerve entrapment at both elbow and wrist. This study is based on a background of having established the world’s first totally one stop wide awake (OSWA) hand surgery service, with published outcomes. Materials and methods We performed a retrospective review of our 2011/12 ulnar nerve entrapment cases, which comprised 40 patients with ulnar nerve dysfunction. Results The main outcome measures were sensorimotor improvement, including improvement of the QuickDASH score, patient satisfaction and cost-effectiveness and efficiency. Discussion No surgical complications were experienced by the patients and all of them were satisfied with their treatment. All patients were followed-up to a good outcome including objective sensorimotor improvement in ulnar nerve function. Conclusion The wide awake approach to ulnar nerve decompression is safe, effective and comparable to the historical approach; and is amenable to a one stop patient pathway. Introduction Wide awake hand surgery enables treatment in one management stop, through a patient-centric pathway, which is broadly more akin to dental treatment than a traditional multistop surgical approach. The one stop wide awake (OSWA) hand surgery service is now well-described in the worldwide published literature1,2. Wide awake hand surgery, is hand surgery, without general anaesthesia or regional anaesthesia or sedation or tourniquets. There have been great advances in the technique(s) for hand surgery, over the last decade. It is now over 30 years, since the first peer reviewed publications on wide awake hand surgery3, and despite inherent potential advantages (lower risk, a more convenient pathway for the patient and costsavings for national state-funded healthcare)1,2, the worldwide transition to the technique has been slow, according to the published literature1–22. The published literature on ulnar nerve compression/decompression, reflects that there are two encouraging case series, each comprising 20 cases, which were performed using a local anaesthetic technique in 2001 and 198223,24. However, a contemporaneous search on PubMed for the relevant terms is instructive: Ulnar Nerve and Local An(a)esthesia or local an(a)esthetic; or wide awake ulnar nerve; or wide awake cubital tunnel; or wide awake ulnar tunnel; or ulnar nerve entrapment. This demonstrates that there has been little recent progress with wide awake ulnar nerve surgery as would have been expected; despite the recent advances with wide awake hand surgery. There is no previous description of an all-encompassing or totally OSWA surgical pathway for the totality of ulnar nerve entrapment, irrespective of site. The aim of this research study was to d
在全球范围内,完全清醒的手外科手术越来越受欢迎,但PubMed搜索并没有显示任何关于完全清醒的尺神经手术的出版物。在这项研究中,我们描述了我们的手术经验,技术和结果在肘部和腕部的尺神经卡压的完全清醒管理。本研究的背景是建立了世界上第一个完全一站式全醒(OSWA)手部手术服务,并发表了结果。材料和方法我们对2011/12年度尺神经卡压病例进行回顾性分析,其中包括40例尺神经功能障碍患者。结果主要观察指标为感觉运动改善,包括QuickDASH评分、患者满意度、成本效益和效率的改善。讨论本组患者均无手术并发症,治疗满意。所有患者随访结果良好,包括尺神经功能的客观感觉运动改善。结论完全清醒入路对尺神经减压安全、有效,可与传统入路相媲美;并且适合于一站式病人途径。宽醒手手术使治疗在一个管理停止,通过一个以患者为中心的途径,这更类似于牙科治疗,而不是传统的多站手术方法。一站式完全清醒(OSWA)手外科服务现在在世界范围内发表的文献中得到了很好的描述1,2。全醒手外科手术,是指不需要全身麻醉、局部麻醉、镇静或止血带的手外科手术。在过去的十年里,手部手术技术有了很大的进步。自首次同行评议的手外科手术发表以来,已经有30多年了,尽管有其固有的潜在优势(风险更低,为患者提供了更方便的途径,为国家资助的医疗保健节省了成本)1,2,但根据已发表的文献1 - 22,全世界向该技术的过渡一直很缓慢。已发表的关于尺神经压迫/减压的文献表明,2001年和1988年有两个令人鼓舞的病例系列,每个病例包括20例,使用局部麻醉技术进行。然而,同时在PubMed上搜索相关术语是有指导意义的:尺神经和局部An(a)感觉或局部An(a)美学;或者完全清醒的尺神经;或宽醒肘管;或宽醒尺管;或者尺神经卡压。这表明,最近在尺神经手术方面的进展不大,这是预期的;尽管最近有了完全清醒的手部手术。对于尺神经卡压的全部,不论其位置如何,以前没有关于全包或全OSWA手术通路的描述。本研究的目的是讨论我们在英国率先采用的尺神经卡压的全清醒方法。材料与方法本研究所有患者均按照OSWA尺神经卡压路径进行处理,临床诊断为单侧孤立性尺神经功能障碍(图1)。临床评价临床评价的传导包括:病史:在卡压部位观察远端感觉运动尺神经功能障碍。比罗测试:交感神经功能障碍导致少(尺神经)出汗减少,而指数(正中神经)牙髓比罗滑动在受累手指上更容易。划伤塌陷试验:要求患者抵抗双侧肩关节外旋,肘部完全屈曲。然后轻微划伤怀疑尺神经受压的区域,然后立即重复抵抗肩关节外旋。尺神经功能障碍时,患侧有短暂的肩关节外旋阻力丧失。作者简介:作者简介:作者简介:enquiries@expertorthopaedics.com 1骨科顾问医生,安妮皇后街医疗中心,伦敦哈利街外安妮皇后街18-22号,w1g8hu 2全科医生,波士顿Sleaford路西区外科,pe218eg 3主任,收费公路医疗广泛清醒骨科手术,林肯郡洛斯霍恩堡路,LN11 9QT 4骨科顾问医生,ExpertOrthopaedics.Com Ltd. 2,林肯郡波士顿阿林顿花园,pe219dp的研究研究第2页的5 Co . m .的研究是在研究中进行的。我想,如果我不喜欢你,我就不喜欢你。你盟th或者s公司nt肋ut ed th e公司数控ep ti o n, n d es搞笑,和p再保险pa ra ti o n th e m我们cr ip t, s w el l s再保险广告和pp ro ve d th e fi n al t m我们cr ip。我非盟th e或年代ab id由党卫军oc th e ia ti o n fo r m ed ic al e th ic s (A m e) e th ic al俄文的d s cl os ur e。
{"title":"The wide awake approach to ulnar nerve entrapment: results of an integrated one stop wide awake surgical pathway","authors":"Qmk Bismil, S. Lowe, L. Viner, Msk Bismil","doi":"10.13172/2052-0077-2-5-631","DOIUrl":"https://doi.org/10.13172/2052-0077-2-5-631","url":null,"abstract":"Introduction The wide awake approach to hand surgery is gaining increasing popularity worldwide, but PubMed search does not reveal any publications on wide awake ulnar nerve surgery. In this research study, we describe our surgical experience, techniques and results of the wide awake management of ulnar nerve entrapment at both elbow and wrist. This study is based on a background of having established the world’s first totally one stop wide awake (OSWA) hand surgery service, with published outcomes. Materials and methods We performed a retrospective review of our 2011/12 ulnar nerve entrapment cases, which comprised 40 patients with ulnar nerve dysfunction. Results The main outcome measures were sensorimotor improvement, including improvement of the QuickDASH score, patient satisfaction and cost-effectiveness and efficiency. Discussion No surgical complications were experienced by the patients and all of them were satisfied with their treatment. All patients were followed-up to a good outcome including objective sensorimotor improvement in ulnar nerve function. Conclusion The wide awake approach to ulnar nerve decompression is safe, effective and comparable to the historical approach; and is amenable to a one stop patient pathway. Introduction Wide awake hand surgery enables treatment in one management stop, through a patient-centric pathway, which is broadly more akin to dental treatment than a traditional multistop surgical approach. The one stop wide awake (OSWA) hand surgery service is now well-described in the worldwide published literature1,2. Wide awake hand surgery, is hand surgery, without general anaesthesia or regional anaesthesia or sedation or tourniquets. There have been great advances in the technique(s) for hand surgery, over the last decade. It is now over 30 years, since the first peer reviewed publications on wide awake hand surgery3, and despite inherent potential advantages (lower risk, a more convenient pathway for the patient and costsavings for national state-funded healthcare)1,2, the worldwide transition to the technique has been slow, according to the published literature1–22. The published literature on ulnar nerve compression/decompression, reflects that there are two encouraging case series, each comprising 20 cases, which were performed using a local anaesthetic technique in 2001 and 198223,24. However, a contemporaneous search on PubMed for the relevant terms is instructive: Ulnar Nerve and Local An(a)esthesia or local an(a)esthetic; or wide awake ulnar nerve; or wide awake cubital tunnel; or wide awake ulnar tunnel; or ulnar nerve entrapment. This demonstrates that there has been little recent progress with wide awake ulnar nerve surgery as would have been expected; despite the recent advances with wide awake hand surgery. There is no previous description of an all-encompassing or totally OSWA surgical pathway for the totality of ulnar nerve entrapment, irrespective of site. The aim of this research study was to d","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79881068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Giant intrathoracic goitre: a case report 巨大胸内甲状腺肿1例
Pub Date : 2013-05-01 DOI: 10.13172/2052-0077-2-4-564
Y. Lin, Hc Chang
Introduction Goitre, an enlargement of the thyroid gland, is a common endocrine abnormality. Goitres can result from biosynthetic defects, iodine deficiency, autoimmune disease or nodular diseases. If left untreated, they can compress the trachea or oesophagus and cause clinical symptoms such as dyspnea or dysphagia. We present a case of a giant intrathoracic goitre. Case report A 68-year-old woman presented a slowly growing mediastinal mass for three years. The huge mass was surgically removed without complications, proven pathologically an intrathoracic goitre. The possible optimal surgical approach for this kind of huge mass and postoperative medical treatment were discussed. Conclusion Given that most intrathoracic goitres arise from and maintain some attachment to the cervical thyroid gland and most of its blood supply would originate from the neck, the optimal surgical approach should start with a cervical approach to reduce the possibility of uncontrollable bleeding.
甲状腺肿大是一种常见的内分泌异常。甲状腺肿可由生物合成缺陷、碘缺乏、自身免疫性疾病或结节性疾病引起。如果不及时治疗,它们会压迫气管或食道,引起呼吸困难或吞咽困难等临床症状。我们报告一例巨大的胸内甲状腺肿。病例报告一名68岁女性,因患有缓慢生长的纵隔肿块三年。手术切除巨大肿块,无并发症,病理证实为胸内甲状腺肿。讨论了这种巨大肿块可能的最佳手术入路和术后药物治疗。结论胸内甲状腺肿多起源于颈部甲状腺并与颈部甲状腺保持一定的附着关系,且其血液供应主要来源于颈部,最佳手术入路应从颈部入路开始,以减少无法控制出血的可能性。
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引用次数: 2
Native aortic valve endocarditis and multisystem embolization despite adequate antibiotic treatment: a case report 原生主动脉瓣心内膜炎和多系统栓塞,尽管充分的抗生素治疗:1例报告
Pub Date : 2013-05-01 DOI: 10.13172/2052-0077-2-4-558
S. Datta, P. Takahashi
our patient experienced endocarditis. Ultimately, there has been little evidence that restricting antibiotic use has resulted in increased rates of endocarditis. Providers must remember that there are inherent risks of antibiotic use including allergy, microbial resistance, cost and Clostridium dif�‘ icile infection, among other potential side effects. Conclusion Medical providers and scientists must continue to evaluate the potential risks and benefits of antibiotic prophylaxis in patients with native valvular disease. This case report adds to that discussion.
我们的病人患有心内膜炎。最终,几乎没有证据表明限制抗生素的使用会导致心内膜炎发病率的增加。提供者必须记住,使用抗生素存在固有风险,包括过敏、微生物耐药性、成本和艰难梭菌感染,以及其他潜在副作用。结论医疗服务提供者和科学家必须继续评估原生瓣膜病患者使用抗生素预防的潜在风险和益处。本病例报告为这一讨论增添了新的内容。
{"title":"Native aortic valve endocarditis and multisystem embolization despite adequate antibiotic treatment: a case report","authors":"S. Datta, P. Takahashi","doi":"10.13172/2052-0077-2-4-558","DOIUrl":"https://doi.org/10.13172/2052-0077-2-4-558","url":null,"abstract":"our patient experienced endocarditis. Ultimately, there has been little evidence that restricting antibiotic use has resulted in increased rates of endocarditis. Providers must remember that there are inherent risks of antibiotic use including allergy, microbial resistance, cost and Clostridium dif�‘ icile infection, among other potential side effects. Conclusion Medical providers and scientists must continue to evaluate the potential risks and benefits of antibiotic prophylaxis in patients with native valvular disease. This case report adds to that discussion.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"25 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73625811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Post-traumatic retrocaecal appendicitis 创伤后盲肠后阑尾炎
Pub Date : 2013-05-01 DOI: 10.13172/2052-0077-2-4-556
I. Wani
Introduction Blunt abdominal trauma (BAT) leading to appendicitis is rare. This can be challenging for diagnosis. The aim of this study was to investigate appendicitis occurring after BAT. Materials and methods A three-year study was performed to investigate appendicitis developing after BAT. Results A total of 8 patients were studied. All had isolated post-traumatic appendicitis without any other associated abdominal injury. Retrocaecal position was observed in all; one patient had perforated appendicitis and one had an appendicular lump. Fecalith was present in 5 patients. Grossly, all patients had characteristics of appendicitis. Conclusion BAT leading to appendicitis is rare. Retrocaecal position of the appendix is commonly affected.
钝性腹部创伤(BAT)导致阑尾炎是罕见的。这可能对诊断具有挑战性。本研究的目的是调查BAT术后发生的阑尾炎。材料与方法对BAT术后阑尾炎的发生情况进行了为期三年的研究。结果本组共8例患者。所有患者均为孤立的创伤后阑尾炎,无其他相关的腹部损伤。所有病例均观察到盲肠后位;1例阑尾炎穿孔,1例阑尾肿块。5例患者存在粪石。大体来看,所有患者均具有阑尾炎的特征。结论BAT导致阑尾炎少见。阑尾的盲肠后位置常受影响。
{"title":"Post-traumatic retrocaecal appendicitis","authors":"I. Wani","doi":"10.13172/2052-0077-2-4-556","DOIUrl":"https://doi.org/10.13172/2052-0077-2-4-556","url":null,"abstract":"Introduction Blunt abdominal trauma (BAT) leading to appendicitis is rare. This can be challenging for diagnosis. The aim of this study was to investigate appendicitis occurring after BAT. Materials and methods A three-year study was performed to investigate appendicitis developing after BAT. Results A total of 8 patients were studied. All had isolated post-traumatic appendicitis without any other associated abdominal injury. Retrocaecal position was observed in all; one patient had perforated appendicitis and one had an appendicular lump. Fecalith was present in 5 patients. Grossly, all patients had characteristics of appendicitis. Conclusion BAT leading to appendicitis is rare. Retrocaecal position of the appendix is commonly affected.","PeriodicalId":19393,"journal":{"name":"OA Case Reports","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84739316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
The use of McGrath ® Mac for awake laryngoscopy and intubation in an obese patient with a predicted diffi cult airway McGrath®Mac用于预测气道困难的肥胖患者的清醒喉镜检查和插管
Pub Date : 2013-05-01 DOI: 10.13172/2052-0077-2-4-560
S. Thong, S. Chong, S. Goh
Introduction We present a case in which the McGrath® Mac videolaryngoscope was used for awake intubation. Case report An obese 38-year-old female, planned for elective surgery, was assessed to have a possible difficult airway. Awake intubation using the McGrath® Mac was planned. An antisialogogue was administered and the airway was anaesthetised. Remifentanil infusion was used for conscious sedation. Laryngoscopy was performed, which showed a Cormack and Lehane grade 1 view of the larynx. Intubation, performed without complications, was followed by the induction of anaesthesia. In the recovery, the patient reported that the intubation process was not unpleasant. Conclusion McGrath® Mac is able to facilitate awake intubation well. Introduction Awake fiberoptic intubation is the gold standard for a difficult airway. However, there are recent reports of awake intubation facilitated by videolaryngoscopes1,2. We present a case in which the McGrath® Mac (Aircraft Medical Limited, Edinburgh, UK) videolaryngoscope was used for awake intubation in an obese patient with an anticipated difficult airway. Case report The patient was a 38-year-old -female planned for elective orthopaedic surgery in an ambulatory facility within a tertiary hospital. Her medical history included obesity (body mass index 36 kgm-2, body weight 89 kg) and hypertension. Assessment of the airway indicated a possible difficult intubation–she had a receding chin and a short neck. Treatment, intervention and outcome Awake intubation using the McGrath® Mac videolaryngoscope was planned. After the application of routine monitoring, oxygen was administered via a nasal cannula. Intravenous glycopyrrolate at a dose of 0.2 mg and midazolam at a dose of 1.5 mg were administered. Lignocaine gel 2%, 10 mL was gargled and lignocaine 10% was sprayed twice on the tongue and in the hypopharynx via an atomisation device (Long Flexi Nozzle, ENT Technologies, Victoria, Australia). Remifentanil target-controlled infusion at a dose of 2 ng/mL was commenced. Verbal contact was maintained throughout. Laryngoscopy performed with minimal force and without cervical manipulation showed a Cormack and Lehane grade 1 view of the larynx. After two sprays of lignocaine 10% on the vocal cords, a 7.0 mm tracheal tube was passed through the larynx over a malleable stylet. There were no complications such as coughing, gagging or bleeding. Capnographic confirmation of successful tracheal intubation was followed by the induction of anaesthesia with intravenous propofol. In the post anaesthetic care unit, she reported that she could recall the intubation process; however, it was not unpleasant. Discussion As visualisation of the glottis during videolaryngoscopy is not dependent on aligning the oral-pharyngeallaryngeal axes, there is less airway and cervical manipulation. This allows better patient tolerance and less cervical spine movements. These are obvious advantages in difficult airways or unstable cervical spines req
我们报告一例使用McGrath®Mac视频喉镜进行清醒插管的病例。病例报告一名肥胖的38岁女性,计划择期手术,被评估可能有气道困难。计划使用McGrath®Mac进行清醒插管。给予抗涎剂并麻醉气道。瑞芬太尼输注用于清醒镇静。行喉镜检查,显示Cormack和Lehane 1级喉片。插管,执行无并发症,随后诱导麻醉。在康复过程中,患者报告插管过程并不令人不快。结论McGrath®Mac能够很好地促进清醒插管。清醒光纤插管是困难气道的金标准。然而,最近也有视频喉镜辅助清醒插管的报道1,2。我们报告了一例使用McGrath®Mac (Aircraft Medical Limited, Edinburgh, UK)视频喉镜对预期气道困难的肥胖患者进行清醒插管的病例。患者为一名38岁的女性,计划在一家三级医院的门诊设施进行择期骨科手术。病史包括肥胖(体重指数36 kg -2,体重89 kg)和高血压。对气道的评估表明插管可能有困难——她的下巴后缩,脖子短。治疗、干预和结果:计划使用McGrath®Mac视频喉镜进行清醒插管。应用常规监测后,通过鼻插管给氧。静脉注射剂量为0.2 mg的甘罗酸酯和剂量为1.5 mg的咪达唑仑。2%的利多卡因凝胶,10 mL漱口,10%的利多卡因通过雾化装置(Long Flexi Nozzle, ENT Technologies, Victoria, Australia)在舌头和下咽上喷两次。开始瑞芬太尼靶控输注剂量为2ng /mL。双方始终保持着口头接触。在没有颈椎操作的情况下,以最小的力进行喉镜检查显示喉部为Cormack和Lehane 1级。在声带上喷两次10%的利多卡因后,一根7.0 mm的气管管通过可塑导管穿过喉部。没有咳嗽、呕吐或出血等并发症。气管插管成功后,用静脉异丙酚诱导麻醉。在麻醉后的护理病房,她报告说她能回忆起插管过程;然而,这并不令人不愉快。由于视频喉镜检查时声门的显像不依赖于口咽轴的对齐,因此很少有气道和颈部的操作。这样可以提高患者的容忍度,减少颈椎活动。这些在气道困难或需要清醒插管的不稳定颈椎中具有明显的优势。与直接喉镜相比,柔性纤维内窥镜插管的主要缺点是学习曲线陡峭,插管时间增加。视频喉镜比纤维内窥镜插管的优势在于它与传统的麦金塔喉镜相似。它更容易学习和使用。插管可以在更短的时间内完成,考虑到困难的气道情况有时发生在最紧急和意想不到的场合,这是一个重要的优势。大多数视频喉镜都便于携带,安装起来也很快。在整个插管过程中,可以很容易地通过鼻插管给予补充氧气。补充氧气的管理是可能的,但更麻烦的是,当纤维内窥镜用于清醒插管。清醒视像喉镜检查也可用于评估疑似困难气道5。这种技术可以使病人免于进行清醒插管的不适。能够看到清醒的脊髓,使麻醉师确信在诱导全身麻醉后能够确保气道的安全。McGrath®Mac在使用传统喉镜检查技术的同时提高了喉镜检查的等级。*通讯作者Email: thongszeying@gmail.com 1新加坡总医院麻醉与重症监护副顾问,新加坡2新加坡总医院麻醉与重症监护副顾问,新加坡3新加坡总医院麻醉与重症监护副顾问
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