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Pheochromocytomas or paragangliomas are rare and the diagnosis remains a challenge for clinicians. We present a woman suffering from recurrent myocardial infarction and cardiomyopathy, who was finally diagnosed with paraganglioma. Pheochromocytomas or paraganglioma should be considered in the differential diagnosis of a patient with symptoms possibly referring to acute coronary syndrome and cardiomyopathy.
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Hypoxemia after general anesthesia is not uncommon. For patients after thoracotomy, the differential diagnosis is usually difficult. Surgical, anesthetic, and patient-associated factors may contribute to postoperative hypoxemia. We described two patients who underwent video-assisted thoracoscopic thymectomy and developed hypoxemia immediately after extubation. Phrenic nerve injury was suspected in both patients. One case recovered spontaneously without intervention. The second case who had been demonstrated as bilateral phrenic nerve injury after the operation was continuously on ventilator after physical therapy and respiratory training for 2 months.
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Objectives This study aim to evaluate patient's perception about anesthesiologists' job roles and investigate their expectations for anesthesia care.Methods We designed a self-administered questionnaire for this cross-sectional survey study and delivered questionnaire forms to adult in-patients who were scheduled for elective surgery before pre-operative anesthetic visit the day before surgery. We collected information of respondents' demographic data, education background, health literacy and previous experience of anesthesia, perception of anesthesiologist's job, the expectation on anesthesia care. Descriptive analyses, test and multiple linear regression analysis were used for data analysis. Results Of 550 participants, 521（94.7%）completed the questionnaire. In these respondents, 335 (64.3%) considered anesthesiology as an independent medical discipline, 225 (43.2%) believed that anesthesiology department was an independent clinical department, and 243 (46.6%) recognized anesthesiologists as qualified doctors. Only 21.5% of them knew that anesthesiologists also work in the intensive care unit and 26.9% of them knew that anesthesiologists also work in pain clinic as well. Younger patients (=-0.044<0.001) those with higher education (=1.200<0.001), or with better health literacy (=0.781=0.005) had significant more knowledge about the job roles of anesthesiologists. Most patients demanded pre-anesthetic visit (80.5%), expected availability of preoperative anesthetic clinic (74.1%), wished to receive more information about anesthesia (91.3%) and anesthesiologist (77.4%).Conclusions Patients' perception about anesthesiologists might be limited. Efforts should be made on education about anesthesia, especially for elderly patients and those under-educated patients. Preoperative anesthetic clinic is expected by most in-patients.
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Objective To analyze the perioperative safety of patients undergoing unilateral or simultaneous bilateral total knee arthroplasty(TKA). Methods Totally 500 patients who had undergone unilateral or simultaneous bilateral TKA between December 2014 to December 2015 were retrospectively reviewed. They were divided into two groups:unilateral group(n=310)and bilateral group(n=190).The general data,perioperative transfusion,and complications were compared between these two groups. Results Patients in unilateral group had significantly higher ASA scores(χ=8.344,P=0.015) and NYHA grade(χ=7.537,P=0.023)than in bilateral group.Patients in bilateral group had significantly higher posterior drainage volume(t=44.984,P=0.000). Transfusion rate(χ=42.896,P=0.000) was significantly higher and the lowest postoperative hemoglobin was significantly lower(t=0.006,P=0.000)in the bilateral group. The episodes of transfusion(χ=1.025,P=0.599) and the amount of transfused packed red blood cells(χ=3.836,P=0.429) were similar between two groups. There was no significant difference in the length of postoperative hospital stay(t=0.310,P=0.756),admission to intensive care unit(χ=0.317,P=0.895),and incidences of complications(χ=0.047,P=0.475). Conclusions For patients with low ASA scores and NYHA grade,simultaneous bilateral TKA is recommended. For older patients with high ASA score,poor cardiac function,and high incidences of complications,unilateral TKA is recommended.
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The Freeman-Sheldon syndrome (FSS) is a rare congenital syndrome, characterized with myopathy and dysplasia. The musculoskeletal and soft-tissue manifestations often require orthopedic and plastic surgery. We reported a case of 8-year-old girl with FSS operated on for scoliosis.
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Child , Female , Humans , Anesthetics , Therapeutic Uses , Craniofacial Dysostosis , Diagnosis , General Surgery , Scoliosis , General SurgeryABSTRACT
<p><b>BACKGROUND</b>Gabapentin has been widely and successfully used in the clinic for many neuropathic pain syndromes since last decade, however its analgesic mechanisms are still elusive. Our study was to investigate whether Ca(2+)/calmodulin-dependent protein kinase II (CaMKII) contributes to the analgesic effect of gabapentin on a chronic constriction injury (CCI) model.</p><p><b>METHODS</b>Gabapentin (2%, 100 mg/kg) or saline (0.5 ml/100 g) was injected intraperitoneally 15 minutes prior to surgery and then every 12 hours from postoperative day 0 - 4 to all rats in control, sham and CCI groups. The analgesic effect of gabapentin was assessed by measuring mechanical allodynia and thermal hyperalgesia of rats. Expression and activation of CaMKII were quantified by reverse-transcriptional polymerase chain reaction and Western blotting.</p><p><b>RESULTS</b>The analgesic effect of gabapentin on mechanical allodynia and thermal hyperalgesia was significant in the CCI model, with maximal reduction reached on postoperative day 8. Gabapentin decreased the expression of the total CaMKII and phosphorylated CaMKII in CCI rats.</p><p><b>CONCLUSION</b>The analgesic effect of gabapentin on CCI rats may be related to the decreased expression and phosphorylation of CaMKII in the spinal cord.</p>