ABSTRACT
Although relatively few studies have compared US guidance with established "blind" techniques, the available evidence suggests that the use of US guidance is a safe and effective way to facilitate correct needle placement and adequate spread of LA for abdominal wall nerve blocks. It improves block effectiveness and safety by reducing LA doses and by detecting anatomic variants or unsuspected pathologies. Different techniques are described and discussed: the transverse abdominal nerve blocks, the paraombilical block, the inguinal field block and the fascia transversalis block. Matched with improving technology, the use of US has significant benefits over conventional techniques to perform classic and new abdominal wall nerve blocks in children. However, more studies are required to evaluate the potential of US to support this finding.
Subject(s)
Abdomen/diagnostic imaging , Nerve Block/methods , Abdominal Muscles/diagnostic imaging , Abdominal Wall/diagnostic imaging , Anesthetics, Local/administration & dosage , Anesthetics, Local/adverse effects , Child , Child, Preschool , Humans , Inguinal Canal/diagnostic imaging , Needles , Nerve Block/adverse effects , Patient Safety , UltrasonographyABSTRACT
Nonoperative treatment was carried out in a 12-year-old girl who presented with biliary fistulas after blunt abdominal trauma with hepatic injury. A computed tomography-guided percutaneous puncture showed biliary peritonitis and permitted the positioning of an efficient intraperitoneal drainage. Endoscopic retrograde cholangiography was very helpful for visualization and accurate localization of biliary injuries. This permitted positioning a nasobiliary drain to reduce intrabiliary pressure and to bypass a lesion of the common hepatic duct. This nonoperative management allowed healing of fistulas within 20 days, without bile duct stricture (noted on the follow-up intravenous cholangiogram 18 months later).
Subject(s)
Abdominal Injuries/therapy , Bile Ducts, Intrahepatic/injuries , Biliary Fistula/therapy , Liver/injuries , Wounds, Nonpenetrating/therapy , Abdominal Injuries/diagnostic imaging , Bile Ducts, Intrahepatic/diagnostic imaging , Biliary Fistula/diagnostic imaging , Child , Cholangiography , Cholangiopancreatography, Endoscopic Retrograde , Diagnosis, Differential , Female , Follow-Up Studies , Humans , Liver/diagnostic imaging , Tomography, X-Ray Computed , Wound Healing/physiology , Wounds, Nonpenetrating/diagnostic imagingSubject(s)
Anesthesia , Cranial Fossa, Posterior/surgery , Propofol , Skull/surgery , Adult , Aged , Brain Neoplasms/surgery , Humans , Middle AgedABSTRACT
Venous contention with elastic bandages is widely used in the treatment of Venous Insufficiency. We have attempted to number the clinical improvement by measuring TcPO2. Our study includes 16 cases; divided as follows: 6 healthy subjects (reference), 5 patients with severe varicose veins of the lower extremities, without ulcer, and 5 patients with varicose veins with ulcer of the leg. Measurements were carried out before and after 10 hours of venous contention. For each patient we have used a light bandage (x) with stretching to 30 and 50% of its length, and a heavy bandage (x) with stretching of 20 and 40%. Our results show, after contention, a decreased TcPO2 in the reference group, but an improvement of this TcPO2 in patients with varicose veins, with or without ulcer. This improvement is more marked with the use of light bandages.
