Single Shot Paravertebral Block - A Novel Approach for Post-Operative Analgesia in Breast Surgeries

Advancements in diagnostic sciences have led to increased frequency in detection of cases of breast cancer. After confirmation, majority of these patients undergo definitive surgeries commonly Modified Radical Mastectomy or Lumpectomy under general anaesthesia. In addition to inadequate pain control there is increased incidence of nausea and vomiting during first 24 hrs. of the post-operative period with GA. Parenteral narcotic used routinely in postoperative period further increases nausea and vomiting. The large number of patients hospitalized annually for breast cancer surgeries results in heavy costs and long hospital stays. Regional anaesthesia using prep-incisional paravertebral block (PVB) maybe an ideal alternative to GA alone for breast cancer surgery. Benefits include prolonged postoperative pain relief, reduction in postoperative nausea and vomiting and has potential for early discharge. It results in unilateral sensory, motor and sympathetic blockade with additional advantages of lower side effect profile, early mobilization and fewer contraindications. We wanted to study the efficacy of paravertebral block for postoperative pain relief in breast surgeries. METHODSA prospective, randomized, comparative study involving 60 adult female patients posted for Ca breast surgery was conducted. One group received pre-incisional PVB with GA (group A) and another received GA alone (group B). The efficacy of analgesia and PONV were assessed using Visual Analogue Scale and Numeric Rating Score respectively at T1, 2, 3, 4, 5, 6, 12, 24, 48 hours. Fentanyl 2 mic / Kg as rescue analgesic and ondansetron 0.1 mg / Kg as antiemetic were given at VAS >/= 4 and NRS >/= 2. Total opioid and antiemetic consumption was noted. RESULTSTotal VAS and NRS scores of Group A was significantly lower than Group B. Also significantly reduced consumption of analgesic and antiemetic was observed in Group A. ∑VASA = (3.37 + 2.76) while ∑ VASB = (19.23 + 3.32) while, Group A ∑NRS = (0.47 + 0.67) and Group B ∑NRS = (5.27 + 1.34). CONCLUSIONSPVB provides significant pain relief with decreased incidence of PONV and has the additional advantage of lesser consumption of opioids and antiemetics in the immediate postoperative period.

Pulse Sequence Single Shot Fast Spin Echo for Reducing Motion Artefact on MRI of the Brain

Abstract@# This research was motivated by the increase of brain MRI examinations in emergency medicine. In an emergency, patients are often uncooperative, and they raise motion artefact on the image. Therefore, fast scanning techniques such as pulse Sequence Single Shot Fast Spin Echo (SS-FSE) is required to reduce the artefact. This study was conducted to determine the effectiveness of using SS-FSE technique to minimize motion artefact. Methods: This study was an observational analytic with prospective methods. Scanning was conducted to 16 normal patients (volunteers). Two neuro radiologists retrospectively and independently reviewed all images. Observations used standard diagnostic of brain MR Image by evaluating the anatomical and morphological structure. Results: Based on the results of the analysis of each organ that was assessed, it was obtained that the average of the image for overall organs on the brain; 76% looks sharp, 21% looks moderate (minimum blurred), and 3% looks blurred. Conclusion: SS-FSE technique affects reducing motion artefact due to object movement in MRI brain. The overall image SS-FSE produced has good image quality.

Two-shot compressed sensing techniques accelerate cardiac cine sequence acquisition and quantitative evaluation of the diagnostic efficacy / 第二军医大学学报

Objective To perform cardiac magnetic resonance (CMR) examination with 2-shot compressed sensing (CS) cardiac cine imaging (cine) technique, so as to obtain high-quality images that can quickly and accurately assess cardiac function and are closer to the standard cine sequence. Methods The patients, who underwent CMR examination in Department of Radiology of Peking Union Medical College Hospital of Chinese Academy of Medical Sciences & Peking Union Medical College from Jul. to Sep. 2018, were continuously enrolled. All enrolled patients received the standard cine sequence, single-shot (ss) CS cine sequence and 2-shot CS cine sequence image acquisition. Quantitative analyses of image quality and cardiac function were performed on each cine image acquired from different sequences. Results Twenty-two patients completed the three types of cine sequences. The average acquisition time of standard cine sequence, ss CS cine sequence and 2-shot CS cine sequence was (102.50±18.55), (20.50±3.71) and (30.75±5.57) s, respectively. The median total image quality scores of the standard, ss CS and 2-shot CS cine sequences were 4, 3 and 4, respectively. There was significant difference in the total quality scores between the standard cine sequence and the ss CS cine sequence (Z=-2.828, P=0.005), while there was no significant difference between the standard cine sequence and the 2-shot CS cine sequence (Z=-1.000, P=0.317). In the quantitative study of cardiac function parameters, left ventricular myocardial mass was significantly different between the standard cine sequence and the ss CS cine sequence (100.25 [47.30-136.02] g vs 101.25 [48.30-135.30] g, Z=-2.484, P=0.013), but there were no significant differences in the other parameters. There were no significant differences in the cardiac function parameters between the standard cine sequence and the 2-shot cine sequence. Spearman correlation analysis showed that there were good correlations in the cardiac function parameters between the standard cine and the ss CS cine, and the standard cine and the 2-shot CS cine (all P<0.01). Conclusion The acquisition time of 2-shot CS cine and ss CS cine sequences is significantly shorter than that of standard cine sequence. However, 2-shot CS cine sequence can obtain images closer to the images obatined by standard cine sequence, which can be use d to accurately evaluate the cardiac function.

Analysis of Apparent Diffusion Coefficients of the Brain in Healthy Controls: A Comparison Study between Single-Shot Echo-Planar Imaging and Read-out-Segmented Echo-Planar Imaging

OBJECTIVE: To compare apparent diffusion coefficients (ADCs) of brain segments by using two diffusion-weighted imaging acquisition modes, single-shot echo-planar imaging (ss-EPI) and read-out-segmented echo-planar imaging (rs-EPI), and to assess their correlation and agreement in healthy controls. MATERIALS AND METHODS: T2-weighted (T2W) images, rs-EPI, and ss-EPI of 30 healthy subjects were acquired using a 3T magnetic resonance scanner. The T2W images were co-registered to the rs-EPI and ss-EPI, which were then segmented into the gray matter (GM), white matter (WM), and cerebrospinal fluid (CSF) to generate masking templates. ADC maps of rs-EPI and ss-EPI were also segmented into the GM, WM, and CSF by using the generated templates. ADCs of rs-EPI and ss-EPI were compared using Student's t tests and correlated using Pearson's correlation coefficients. Bland-Altman plots were used to assess the agreement between acquisitions.

MR findings and comparative study of MR sequences in several twin pregnancy with comorbidities / 实用放射学杂志

Objective To compare the applications of half-Fourier acquisition single-shot turbo spin-echo(HASTE)sequence and true fast imaging with steady state precession(True FISP)sequence for the delineation of structures and diseases in several twin pregnancy with comorbidities and to explore the clinical value of two series of fast imaging for MRI of fetus.Methods 27 twin preg-nancy women with comorbidities were imaged with HASTE and True FISP sequences.All images were statistically analyzed in re-spect of imaging qualities and artifacts.MR signs of fetal brain were analysized.Results There were abnormal changes in brains in 7 of 27 cases.Both sequences could demonstrate the structures and lesions of the fatus.Imaging quality scores of HASTE were higher than that of True FISP,but with more respiratory blurring.Conclusion There might be varying abnormalities in central nervous system in twin pregnancy with comorbidities.Combining the demonstration abilities of HASTE and True FISP is needed when de-tecting fetus lesions,especially the brain.

Single shot versus multiple shot antibiotic therapy in patients undergoing laparoscopic surgery: our experience.

The aim of our study was to see the effect of single dose regime versus multi dose regime of antibiotic in laparoscopic surgery; in terms of type of laparoscopic surgery done, type and dose of intravenous antibiotic given and the occurrence of post operative complications like wound gape, stitch abscess, local pain and discharge from the wound in both the groups. The present study was prospective, observational and longitudinal. Protocol of the procedure was formed along with Performa, Patient Information Sheet and Informed Consent Form. The present study was carried out in surgery department of C.U Shah medical college, Surendranagar; Gujarat state. The study was carried out from 1st October 2010 till 31st August 2012. A total of one hundred and twenty patients undergoing emergency and elective laparoscopic surgery were included in our study. Case records of patients was recorded in the Performa containing demographic details, chief complaints, provisional diagnosis, details of operative procedures and drug details during the hospital stay. Follow up of the patients was done after one and three weeks and any change of regime of antibiotics was noted in respect to the symptoms or clinical findings like pain, fever, discharge, stitch abscess, wound gape. Out of 120 patients enrolled mean age was 38.88±14.19. Out of 120 patients in the study; 63 (52.5%) were Male and 57 (47.5%) were Female. Intravenous antibiotics were used in single dose or multiple dose in the patients undergoing laparoscopic procedures. Single dose of antibiotic was given to 65 patients and multiple dosage of antibiotics was given to 48 patients while 7 patients were converted from single to multiple dosage regime of antibiotics. Choice of a dosage of an appropriate antibiotic is of utmost importance in the treatment of the patients and the post operative outcomes. The adverse effects of the used antibiotics must also be kept into consideration while choosing the antibiotics and its dosage. Thus based on our study we conclude that single and multiple dosages of antibiotic regimes can be used for laparoscopic surgeries. However, single dose of antibiotics are more patient compliant, cost effective, less adverse effects and prevents emergence of antibiotic resistance.

Detection of Hepatic Lesion: Comparison of Free-Breathing and Respiratory-Triggered Diffusion-Weighted MR imaging on 1.5-T MR system

PURPOSE: To compare free-breathing and respiratory-triggered diffusion-weighted imaging on 1.5-T MR system in the detection of hepatic lesions. MATERIALS AND METHODS: This single-institution study was approved by our institutional review board. Forty-seven patients (mean 57.9 year; M:F = 25:22) underwent hepatic MR imaging on 1.5-T MR system using both free-breathing and respiratory-triggered diffusion-weighted imaging (DWI) at a single examination. Two radiologists retrospectively reviewed respiratory-triggered and free-breathing sets (B50, B400, B800 diffusion weighted images and ADC map) in random order with a time interval of 2 weeks. Liver SNR and lesion-to-liver CNR of DWI were calculated measuring ROI. RESULTS: Total of 62 lesions (53 benign, 9 malignant) that included 32 cysts, 13 hemangiomas, 7 hepatocellular carcinomas (HCCs), 5 eosinophilic infiltration, 2 metastases, 1 eosinophilic abscess, focal nodular hyperplasia, and pseudolipoma of Glisson's capsule were reviewed by two reviewers. Though not reaching statistical significance, the overall lesion sensitivities were increased in respiratory-triggered DWI [reviewer1: reviewer2, 47/62(75.81%):45/62(72.58%)] than free-breathing DWI [44/62(70.97%):41/62(66.13%)]. Especially for smaller than 1 cm hepatic lesions, sensitivity of respiratory-triggered DWI [24/30(80%):21/30(70%)] was superior to free-breathing DWI [17/30(56.7%):15/30(50%)]. The diagnostic accuracy measuring the area under the ROC curve (Az value) of free-breathing and respiratory-triggered DWI was not statistically different. Liver SNR and lesion-to-liver CNR of respiratorytriggered DWI (87.6+/-41.4, 41.2+/-62.5) were higher than free-breathing DWI (38.8+/-13.6, 24.8+/-36.8) (p value <0.001, respectively). CONCLUSION: Respiratory-triggered diffusion-weighted MR imaging seemed to be better than free-breathing diffusion-weighted MR imaging on 1.5-T MR system for the detection of smaller than 1 cm lesions by providing high SNR and CNR.

Detection of Hepatic Lesion: Comparison of Free-Breathing and Respiratory-Triggered Diffusion-Weighted MR imaging on 1.5-T MR system

PURPOSE: To compare free-breathing and respiratory-triggered diffusion-weighted imaging on 1.5-T MR system in the detection of hepatic lesions. MATERIALS AND METHODS: This single-institution study was approved by our institutional review board. Forty-seven patients (mean 57.9 year; M:F = 25:22) underwent hepatic MR imaging on 1.5-T MR system using both free-breathing and respiratory-triggered diffusion-weighted imaging (DWI) at a single examination. Two radiologists retrospectively reviewed respiratory-triggered and free-breathing sets (B50, B400, B800 diffusion weighted images and ADC map) in random order with a time interval of 2 weeks. Liver SNR and lesion-to-liver CNR of DWI were calculated measuring ROI. RESULTS: Total of 62 lesions (53 benign, 9 malignant) that included 32 cysts, 13 hemangiomas, 7 hepatocellular carcinomas (HCCs), 5 eosinophilic infiltration, 2 metastases, 1 eosinophilic abscess, focal nodular hyperplasia, and pseudolipoma of Glisson's capsule were reviewed by two reviewers. Though not reaching statistical significance, the overall lesion sensitivities were increased in respiratory-triggered DWI [reviewer1: reviewer2, 47/62(75.81%):45/62(72.58%)] than free-breathing DWI [44/62(70.97%):41/62(66.13%)]. Especially for smaller than 1 cm hepatic lesions, sensitivity of respiratory-triggered DWI [24/30(80%):21/30(70%)] was superior to free-breathing DWI [17/30(56.7%):15/30(50%)]. The diagnostic accuracy measuring the area under the ROC curve (Az value) of free-breathing and respiratory-triggered DWI was not statistically different. Liver SNR and lesion-to-liver CNR of respiratorytriggered DWI (87.6+/-41.4, 41.2+/-62.5) were higher than free-breathing DWI (38.8+/-13.6, 24.8+/-36.8) (p value <0.001, respectively). CONCLUSION: Respiratory-triggered diffusion-weighted MR imaging seemed to be better than free-breathing diffusion-weighted MR imaging on 1.5-T MR system for the detection of smaller than 1 cm lesions by providing high SNR and CNR.

Avaliação crítica dos benefícios e limitações da ressonância magnética como método complementar no diagnóstico das malformações fetais / A critical review of benefits and limitations of magnetic resonance imaging as a complementary method in the diagnosis of fetal malformations

OBJETIVO: Avaliar, por meio da ressonância magnética, uma série de fetos com diagnóstico ultra-sonográfico de malformação, a fim de estabelecer os benefícios e limites diagnósticos proporcionados pela técnica de ressonância magnética fetal, em comparação com a ultra-sonografia. MATERIAIS E MÉTODOS: Foram estudadas 40 mulheres entre 15-35 semanas de gestação com diagnóstico de anomalia fetal durante o exame de ultra-sonografia. As pacientes foram encaminhadas para o estudo complementar com ressonância magnética. As indicações para o estudo da ressonância magnética fetal foram: anomalias do sistema nervoso central, do tórax, do abdome, renais, esqueléticas e tumores. A avaliação pós-natal incluiu a revisão das imagens de ultra-sonografia e ressonância magnética, o acompanhamento do nascimento, exames laboratoriais, radiológicos e necropsia. RESULTADOS: Os resultados mostraram que os estudos complementares com ressonância magnética fetal trouxeram informações adicionais em 60 por cento dos casos estudados. Os benefícios da ressonância magnética fetal foram: ampliação da avaliação global, aumento do campo de avaliação, maior resolução tecidual pelo uso de seqüências, e avaliação em pacientes obesas e com oligoidrâmnio. Os limites da ressonância magnética fetal foram: evitar exame no primeiro trimestre, avaliação do fluxo sanguíneo, movimentação fetal, claustrofobia materna, estudo do coração fetal e esqueleto. CONCLUSÃO: A ressonância magnética fetal pode ser utilizada como método complementar para a avaliação das malformações fetais.

OBJECTIVE: The present study was aimed at evaluating by means of magnetic resonance imaging a series of fetuses with sonographic diagnosis of malformation, establishing the diagnostic benefits and limitations of fetal magnetic resonance imaging as compared with ultrasonography. MATERIALS AND METHODS: Forty women between 15-35 gestational weeks and previously diagnosed with fetal abnormality by ultrasonography were referred to undergo complementary fetal magnetic resonance imaging, particularly for evaluating abnormalities in the fetal central nervous system, thorax, abdomen, renal system, skeletal system, and tumors. The whole evaluation process included a review of the fetal ultrasonography and magnetic resonance images, postnatal follow-up, laboratory tests, imaging studies and necropsy. RESULTS: The present study has demonstrated that complementary magnetic resonance imaging did provide further information in 60 percent of cases, with the following benefits: improved information on the fetus as a whole, with a large field of view, higher anatomic resolution provided by fast sequences, superior soft tissue contrast resolution, besides the fact that the visualization of the fetus is not significantly affected by maternal obesity or oligohydramnios. Limitations of the method include contraindication in the first gestational trimester and in cases of maternal claustrophobia, sensitivity to fetal motion, low sensitivity for detecting cardiovascular and skeletal malformations. CONCLUSION: Fetal magnetic resonance imaging plays a significant role as a complementary method for the diagnosis of fetal anomalies.