The erector spinae plane block for obstetric analgesia: a case series of a novel technique.

The management of pain during labour is central to obstetric anaesthetic practice. While epidural analgesia has long been considered the gold standard for intrapartum analgesia, neuraxial techniques can be challenging to perform, are contra-indicated in circumstances such as coagulopathy. The erector spinae plane block is an interfascial plane block that has generated interest because of a needle tip position away from the neuraxis. This has the potential to mitigate the risks of nerve injury and epidural haematoma formation. The mechanism of action is linked to both paravertebral and epidural distribution of local anaesthetic, providing both somatic and visceral analgesia, with potential utility in obstetric settings. Four women in active labour received either unilateral or bilateral erector spinae plane blocks. All experienced a reduction in pain, ranging from 3 to 6 points measured on a 10-point numerical rating scale. The duration of analgesia ranged from 60 to 120 min. In this report, we discuss potential for using the erector spinae plane block in the management of obstetric pain.

Effects of preoperative dexamethasone on postoperative pain, nausea, vomiting and respiratory function in women undergoing conservative breast surgery for cancer: Results of a controlled clinical trial.

The objective was to evaluate whether preoperative administration of dexamethasone improved postoperative nausea and vomiting (PONV), pain and respiratory function tests in women undergoing conservative surgery for breast cancer. This was a controlled clinical trial conducted between June 2013 and October 2014. Eighty patients were evaluated. Patients received a preoperative dose of 8 mg of dexamethasone (n = 40) or placebo (n = 40). The data on PONV and pain intensity was obtained and forced spirometry tests were performed, 1 hr before and at 1, 6, 12 and 24 hr after surgery. Any use of additional analgesic/antiemetic drugs was recorded. Patients were followed until 30 days after surgery for any surgical or medical complications. The pain intensity was lower in the treatment group for all periods; PONV was lower at 6, 12 and 24 hr; Additional analgesics/antiemetics were required less frequently (all p < .05). Both groups exhibited a restrictive ventilatory pattern immediately after surgery, which was reversed in the following hours. However, spirometric values were higher in the dexamethasone group. There were no pulmonary or metabolic complications after surgery. Our conclusions were that dexamethasone significantly reduced the incidences of PONV, pain and improved respiratory parameters, and reduced the need for additional postoperative analgesic and antiemetic drugs.

Body weight changes after adjuvant chemotherapy of patients with breast cancer: results of a Mexican cohort study.

Weight gain is observed in breast cancer patients receiving chemotherapy and is a well-known complication. Several factors that contributing to weight gain have been identified. However, there is a lack of information about factors associated with weight changes following adjuvant chemotherapy. A retrospective cohort of 200 pre- and post-menopausal Mexican patients treated for breast cancer was made. Anthropometric variables were measured before/after treatment. Biomarkers, cellular differentiation and chemotherapy were similar between groups. Weight gain occurred in 85.6% of pre-menopausal and 72.6% of post-menopausal women (p = .03). At the end of chemotherapy, weight and body mass index (BMI) did not differ significantly between pre-menopausal (69.3 ± 12.6 kg; 26.6 ± 4.8 kg/m2 ) and post-menopausal women (69.5 ± 10.9 kg; 27.3 ± 4.4 kg/m2 ) (p = .91 and 0.34). Dexamethasone doses were higher in pre-menopausal (85.7 ± 39.1 g) than post-menopausal patients (79.2 ± 22.5 g; p = .13). Weight loss was observed in 9.2% of pre-menopausal and 20.2% of post-menopausal patients (p = .04). A multivariate analysis revealed that age (OR = 2.7; 95% CI = 1.26-5.79; p = .01), menopausal status (OR = 2.29; 95% CI = 1.09-4.80; p = .03), dexamethasone dosage (OR = 2.1; 95% CI = 1.04-4.23; p = .03) and daily caloric intake (OR = 2.3; 95% CI = 1.12-5.10; p = .02) were independent variables that inducted weight gain. Pre- and post-menopausal women gained weight, but more pre-menopausal patients showed gain. An effort should be made to administer lower steroid doses to reduce weight gain.

Unusual relationship between skin lesions and esophageal cancer: a case report and review of literature.

Esophageal cancer is a rare disease. In Spain, this tumor is the third most common gastrointestinal malignancy after colorectal and gastric cancer. Esophageal adenocarcinoma metastasizes to the skin with an incidence of 1 %, generally located in the neck, head and abdomen. It usually occurs in the overlying skin of the primary tumor, but may also appear in a distant site, the scalp being the most common place. Although the pathogenesis of esophageal adenocarcinoma is not well known, the existence of genetic alterations, such as the suppressor gene, has been proved and the involvement of oncogene c-erbB-2 amplified. Cytokeratin 20 and 7 are expressed in esophageal adenocarcinoma. Typically, cutaneous metastases from internal malignancy present as firm asymptomatic nodules. These nodules usually occur in multiple arrays on the skin adjacent to the primary tumor; however, they can occasionally become painful spontaneously. The main diagnostic test of esophageal cancer is the upper endoscopy, along with histopathology for confirmation of the tumor. The developments in surgery and the discovery of new cytotoxic agents have considerably decreased the locoregional recurrence. To date, the combination of these treatment modalities for advanced adenocarcinoma revealed that the recurrences mainly occur from hematic spread. Excision of the skin lesions produces pain palliation. In patients diagnosed with esophageal cancer who have responded satisfactorily to treatment with chemotherapy, radiation and surgery while having a long history of remission, and dermatology outpatient visits by the appearance of skin lesions, should make us think among the different differential diagnoses, the possibility of cutaneous metastases.

1994: the health reform puzzle comes together.

Policy decisions to help the health care reform puzzle come together in the upcoming year require key information about hospitals and health care. The information contained in this year's annual data article illustrate the current status and the historical trends in hospitals and health care in Michigan. In addition, issues surrounding health care reform and measures of health status in Michigan are highlighted.

Valvular dysfunction due to the obstruction of the ventricular catheter caused by cysticercus cyst.

Five patients were studied with the diagnosis of secondary hydrocephaly to neurocysticercosis. Valvular dysfunction was observed due to the obstruction of the ventricular catheter caused by cysticercus cysts. The Biomed System was used in four cases and the Hakim System in one. Valvular dysfunction was observed in patients within a period of 18 to 24 months after derivation, they also had a history of several valvular dysfunctions. The diagnosis was made upon extraction of the catheter where the cyst was found to be attached to the ventricular brush. Subsequent evolution has not been satisfactory. The reasons for this complication are of a hydrodynamic and pharmacological nature and are also due to the growth of the cyst. This complication is not often suspected, therefore we recommend that in cases of frequent valvular dysfunction and asymmetrical hydrocephaly, studies like iodine-tomography or magnetic resonance be carried out in order to rule out this factor.

Obstruction of the ventricular catheter of a CSF shunt system due to the own cyst of Taenia solium

Se estudiaron cinco pacientes con el disgnóstico de hidrocefalia secundaria a neurocisticercosis, que presentaron disfunción valvular por obstrucción del catéter ventricular debido a quistes de cisticercos. En cuatro casos se utilizaron sistemas Biomed (Mex) y en un caso sistema tipo Hakim. Los pacientes presentaron la disfunción valvular entre 18 y 24 meses posterior a la derivación, ellos tenían historia de múltiples disfunciones valvulares. El diagnóstico se realizó al momento de la extracción del catéter en que se encontró el quiste adherido al cepillo ventricular. La evolución clínica posterior ha sido poco satisfactoria. Las causas de esta complicación parecen relacionarse con factores relacionados a la hidrodinámica (a pesar de haberse cambiado el sistema derivativo), al tratamiento farmacológico y al crecimiento propio del quiste. Esta complicación por su rareza, es poco sospechosa por lo que recomendamos que en casos de pacientes cisticercosos con disfunción valvular con hidrocefalia asimétrica se realicen estudios (yodotomografía o resonancia magnética nuclear) para descartar esta posibilidad

Obstruction of the ventricular catheter of a CSF shunt system due to the own cyst of Taenia solium.

Five patients were studied who suffered secondary hydrocephalus due to neurocysticercosis. Shunt dysfunction was due to the obstruction of the ventricular catheter caused by the own cysticercus cysts. The Biomed system was used in four cases and the Hakim system in one. Valvular dysfunction was observed in patients within a period of 18 to 24 months after surgery, they had a history of several valvular dysfunctions. The diagnosis was made upon of extracting the catheter where the cyst was found to be attached to the ventricular brush. Subsequent evolution has not been satisfactory. The reasons for this complication are of a hydrodynamic and pharmacological nature and are also due to the growth of the cyst. This complication is not often suspected, therefore we recommend that in case of frequent valvular dysfunctions and asymmetrical hydrocephalus, studies like iodinetomography or magnetic resonance imaging be carried out in order to discard this possibility.

Intraventricular cysticercosis.

The authors review their experience with 21 cases of intraventricular cysticercosis, which corresponded to 28% of all cases of neurocysticercosis in their department during an 18-month period. The surgical approach depends on the cyst's location; one uses the transcortical microsurgical approach to reach the lateral ventricles, the transcortical or transcallosal approach to reach the 3rd ventricle, and direct exploration to reach the 4th ventricle. Cysticercus cysts should be removed because they may produce acute or chronic hydrocephalus and, if the parasite dies within the ventricles, it will generate an inflammatory reaction with local and generalized ventriculitis, which produces irreversible neurological damage.

Tuberculoma intramedular cervical (informe de un caso). / Cervical intramedullary tuberculoma (report of a case)

Se informa del caso numero 24 en la literatura mundial de tuberculoma intramedular tratado quirurgicamente con exito.Se hacen consideraciones clinicas y revision de la literatura

Diagnosis of intraventricular and cisternal cysticercosis by computerized tomography with positive intraventricular contrast medium.

Computerized tomography (CT) has replaced pneumoencephalography and ventriculography in the diagnosis of intraventricular cysticercosis. The authors present a refinement in the use of CT by introducing a positive contrast medium into the ventricles to increase the definition of plain and contrast-enhanced scans in the diagnosis of intraventricular cysticercosis. Eleven cases of Cysticercus cyst are presented, 10 or which were precisely delineated by CT-iodoventriculography. In the remaining case, lack of definition was due to obstruction of the cerebral aqueduct. Surgical confirmation was obtained in all cases.

Transorbital ventricular puncture for emergency ventricular decompression. Technical note.

A transorbital technique for emergency ventricular drainage has been used successfully in comatose hydrocephalic patients. The technique is described.

[Lipoma of the corpus callosum]. / Lipoma del cuerpo calloso.

A case of-lipoma of the corpus callosum is presented. This is a rare intracranial lesion, perhaps congenital and often asymptomatic. Review of the literature disclosed 85 cases including our case, which is the first in Latin America.