A Psychosocial Adjustment Measure for Persons With Upper Limb Amputation.

BACKGROUND: Measurement of psychosocial adjustment after upper limb amputation (ULA) could be helpful in identifying persons who may benefit from interventions, such as psychotherapy and/or support groups. However, available measures of psychosocial adjustment after limb loss are currently designed for prosthetic users only. OBJECTIVE: To create a measure of psychosocial adjustment for persons with ULA that could be completed by individuals regardless of whether a prosthesis is use. METHODOLOGY: We modified items from an existing Trinity Amputation and Prosthesis Experience Survey (TAPES) measure and generated new items pertinent to persons who did not use a prosthesis. Item content was refined through cognitive interviewing and pilot testing. A telephone survey of 727 persons with major ULA (63.6% male, mean age of 54.4) was conducted after pilot-testing. After exploratory and confirmatory factor analyses (EFA and CFA), Rasch analyses were used to evaluate response categories, item fit and differential item functioning (DIF). Item-person maps, score distributions, and person and item reliability were examined. Test-retest reliability was evaluated in a 50-person subsample. FINDINGS: EFA and CFA indicated a two-factor solution. Rasch analyses resulted in a 7-item Adjustment to Limitation subscale (CFI=0.96, TLI=0.95, RMSEA=0.128) and a 9-item Work and Independence subscale (CFI=0.935, TLI=0.913, RMSEA=0.193). Cronbach alpha and ICC were 0.82 and 0.63 for the Adjustment to Limitation subscale and 0.90 and 0.80 for the Work and Independence subscale, respectively. CONCLUSIONS: This study developed the Psychosocial Adjustment to Amputation measure, which contains two subscales: 1) Adjustment to Limitation and 2) Work and Independence. The measure has sound structural validity, good person and item reliability, and moderate to good test-retest reliability.

Hereditary haemorragic teleangectasia and pregnancy: case report.

We report an uncommon case of a 38-years-old pregnant woman affected by HHT (Hereditary haemorrhagic telangiectasia; Osler-Weber-Rendu syndrome) who underwent to a caesarean section (CS) without any complication. The patient at 36th weeks+1 day pregnancy referred to the Emergency Obstetric Unit due to a intercostals pain on left side. On third day after admission the woman started travailing and physicians decided to perform the CS. Considering that no AVMs was found at MRI, a continuous spinal anaesthesia was planned. On postpartum day 4 the patient was discharged. This represents the only case published in the literature. Women with HHT, especially those with arteriovenous malformations (AVM), are at high risk in pregnancy due to physiological haemodynamic changes pregnancy associated. Early screening of patients with HHT for the presence of spinal cord or cerebral AVMs is recommended to optimise perioperative anaesthetic management and to avoid severe complications.

Intracranial hypotension and PRES: case report.

We report a case of a woman presenting, 7 days after epidural analgesia for a caesarean section, to the emergency room for a worsening of the headache and tonico-clonic seizures. MRI showed alterations suggestive of the presence of intracranial hypotension (IH) as well as evidence of posterior reversible encephalopathy syndrome (PRES). She was treated with a blood patch which leads to the prompt regression of the clinical symptoms and follow-up MRI, after 15 days, showed complete resolution of radiological alterations. The possible pathogenetic relationship between IH, secondary to the inadvertent dural puncture, and PRES is discussed. We suggest that venous stagnation and hydrostatic edema, secondary to intracranial hypotension, probably played a crucial role in the pathogenesis of PRES.

Postoperative analgesia after cesarean section by continued administration of levobupivacaine with the On-Q Painbuster system over the fascia vs ketorolac + morphine i.v.

OBJECTIVE: This study aimed to detect if continuous local infusion of levobupivacaine with the On-Q Painbuster system provided postoperative analgesia of similar quality to morphine + ketorolac i.v. in patients undergoing cesarean section. MATERIALS AND METHODS: Using a randomized prospective double-blind study, 20 women undergoing cesarean section with a standardized spinal technique were randomly assigned into two groups to receive either 10 mg morphine + 120 mg ketorolac + saline solution up to 96 ml with an elastomeric pump i.v. (group A) or local infusion of levobupivacaine 0.2% with the On-Q PAINBUSTER system (group B). Both groups were administered ketorolac i.v. in bolus in case of pain. RESULTS: The two groups differed in their VAS scores with group A experiencing significantly less pain than group B; the consumption of analgesics was significantly lower in group A than in group B. CONCLUSIONS: The i.v. system with morphine and ketorolac is more effective than levobupivacaine subcutaneous infusion in reducing postoperative pain associated with cesarean section.

[Plasma levels of beta-endorphins and ACTH in labor with continuous peridural analgesia]. / Dosaggio plasmatico di beta-endorfine e ACTH nel travaglio di parto in analgesia peridurale continua.

In order to investigate whether continuous lumbar epidural analgesia is associated with alterations of plasma levels of beta-endorphins and ACTH, we have studied a group (A) of patients under epidural analgesia and a matched group of control (B) at different stages of labour. Plasma levels of beta-endorphins and ACTH in group A did not significantly change during the labour, while in group B beta-endorphins and ACTH increased in the second stage of labour and decreased thereafter one hour after delivery. The levels of beta-endorphins and ACTH in umbilical cord mix blood were elevated in both groups.

[Comparison of the use of classic diazoanalgesia in surgery and an applicative variant with buprenorphine]. / Confronto sull'uso in chirurgia della diazoanalgesia classica e di una variante applicativa con buprenorfina.

The authors have compared two different techniques of anaesthesia: the classical anaesthesia with benzodiazepine-analgesic (diazepam and fentanyl) and one of its variant obtained by using flunitrazepam and buprenorphine. The 45 patients submitted to gynaecological surgery were causally divided in two groups in connection with the two different anaesthesiological techniques. The clinical and statistical analysis of the collected data demonstrated the real validity of this anaesthesiological variant: either for premedication by perfect anxiolysis and sedation, or for the maintenance by low incidence on cardiocirculation system and perfect analgesia that extended its effects for many hours after surgical operation.