ABSTRACT
BACKGROUND: Post-extubation negative pressure pulmonary oedema is a rare, potentially life-threatening complication associated with general anaesthesia. Chest radiography is used as a diagnostic tool, but it implies a non-negligible radiation exposure, a very important consideration, especially for the paediatric population. However, lung ultrasound can overcome this problem and can be used to detect postoperative pulmonary complications. CASE REPORT: A 16-year-old male was scheduled for tympanoplasty. General anaesthesia was conducted, and after extubation, the patient developed a laryngospasm. On arrival at the post-anaesthetic care unit, the patient started to cough, a pink frothy sputum and hypoxemia were noticed, and auscultation revealed crepitations. A bedside lung ultrasound showed more than three B-lines per intercostal window, suggesting an alveolar-interstitial syndrome. DISCUSSION: With this case report, we would like to raise awareness to this clinical entity and demonstrate bedside ultrasound has an important role in the diagnostic and therapeutic assessment during the perioperative period.
ABSTRACT
Depressive disorders have a major impact on occupational health and are costly to the economy and the healthcare system. Probiotics are live, non-pathogenic micro-organisms that, when ingested in adequate amounts, can colonize the intestinal tract and confer health benefits on the patient. In recent years, numerous studies have described the potential usefulness of certain probiotic strains in the treatment and prevention of depressive disorders, with differing results. In order to evaluate the possible efficacy and safety of these microorganisms in preventing or ameliorating these disorders, we systematically searched the bibliographic databases MEDLINE (via Pubmed), EMBASE, the Cochrane library, Scopus and Web of science, using the descriptors "Occupational health", "Probiotics", "Depressive Disorder" and "Depression" and filters "Humans" and "Clinical Trials". After applying our inclusion and exclusion criteria, 18 studies were accepted for review and critical analysis. Our analysis suggests that a combination of different probiotic strains, most of them from the genus Bifidobacterium sp. and Lactobacillus sp., could be a good mixture as an adjuvant in the treatment of depressive disorders for the working population.
Subject(s)
Adjuvants, Immunologic , Probiotics , Humans , Bifidobacterium , Lactobacillus , MEDLINE , Probiotics/therapeutic useABSTRACT
This study aimed to explore the empirical trajectories of body mass index (BMI) 1 year following bariatric surgery (BS) and to identify the risk factors for each trajectory. The study included 115 patients with severe obesity who underwent BS. Assessment included metabolic variables, psychopathological and personality measures. Growth mixture modelling identified four separated trajectories for the percentage of total weight loss course shape (namely, T1 'good-fast', T2 'good', T3 'low' and T4 'low-slow'). After adjusting for BS subtype and metabolic baseline state, T1 and T2 registered less eating and general psychopathology. T1 was characterized by the lowest scores in novelty seeking and self-transcendence, whereas T4 was defined by the highest scores in novelty seeking and the lowest scores in persistence. Our findings suggest that psychological state prior to BS is predictive of BMI trajectories during the 12 months following BS. These results could be useful in developing more efficient interventions for these patients. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Subject(s)
Bariatric Surgery/psychology , Obesity, Morbid/psychology , Obesity, Morbid/surgery , Weight Loss , Adolescent , Adult , Aged , Body Mass Index , Female , Humans , Male , Middle Aged , Psychopathology , Risk Factors , Treatment Outcome , Young AdultABSTRACT
Abstract Background and objectives: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. Case report: Male patient, 61 years old, 83 kg, with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25 mL) and depot (vial) methylprednisolone (20 mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. Conclusions: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.
Resumo Justificativa e objetivos: O bloqueio da fáscia do músculo quadrado lombar foi descrito por R. Blanco nas suas duas abordagens (I e II). A deposição de anestésico local nessa localização pode conferir bloqueio dos dermátomos T6-L1. Os autores fizeram esse bloqueio de fáscia, guiado por ultrassom, para tratamento de uma dor crônica neuropática da parede abdominal. Relato de caso: Paciente do gênero masculino, 61 anos, 83 kg, com antecedentes de trombocitopenia por hepatopatia alcoólica, entre outros, apresentava dor crônica da parede abdominal após hernioplastias abdominais múltiplas havia um ano e meio, com má resposta ao tratamento com neuromoduladores e opioides. No exame clínico, apresentava uma dor neuropática, com predomínio de alodinia ao toque, que abrangia toda a parede abdominal anterior, desde os dermátomos T7 a T12. Optou-se pela realização de um bloqueio do quadrado lombar tipo II bilateral, guiado por ultrassom, com administração de 25 mL de ropivacaína 0,2% e 20 mg de metilprednisolona depot (ampola) em cada um dos lados. O procedimento conferiu alívio imediato da sintomatologia e, após seis meses, o paciente mantinha redução significativa da alodinia, sem compromisso da qualidade de vida. Conclusões: Os autores consideram que a realização do bloqueio do quadrado lombar tipo II foi uma opção analgésica relevante no tratamento de um paciente com dor crônica pós-hernioplastia abdominal e salientaram os efeitos da dispersão do anestésico local até o espaço paravertebral torácico. A técnica mostrou ser segura e bem tolerada. É desejável a publicação de mais casos clínicos que reproduzam a eficácia desse bloqueio no contexto de dor crônica.
Subject(s)
Humans , Male , Hernia, Abdominal/surgery , Chronic Pain/prevention & control , Herniorrhaphy/methods , Nerve Block/methods , Ultrasonography, Interventional , Muscle, Skeletal/innervation , Lumbosacral Plexus , Middle Aged , Neuralgia/prevention & controlABSTRACT
BACKGROUND AND OBJECTIVES: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. CASE REPORT: Male patient; 61 years old; 83kg; with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25mL) and depot (vial) methylprednisolone (20mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. CONCLUSIONS: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.
ABSTRACT
BACKGROUND AND OBJECTIVES: The quadratus lumborum blockade was described by R. Blanco in its two approaches (I and II). The local anesthetic deposition in this location can provide blockade to T6-L1 dermatomes. We performed this fascia blockade guided by ultrasound for treating a chronic neuropathic pain in the abdominal wall. CASE REPORT: Male patient, 61 years old, 83kg, with a history of thrombocytopenia due to alcoholic cirrhosis, among others; had chronic pain in the abdominal wall after multiple abdominal hernia repairs in the last year and a half, with poor response to treatment with neuromodulators and opioids. On clinical examination, he revealed a neuropathic pain, with prevalence of allodynia to touch, covering the entire anterior abdominal wall, from T7 to T12 dermatomes. We opted for a quadratus lumborum block type II, guided by ultrasound, with administration of 0.2% ropivacaine (25mL) and depot (vial) methylprednisolone (20mg) on each side. The procedure gave immediate relief of symptoms and, after six months, the patient still had a significant reduction in allodynia without compromising the quality of life. CONCLUSIONS: We consider that performing the quadratus lumborum block type II was an important analgesic option in the treatment of a patient with chronic pain after abdominal hernia repair, emphasizing the effects of local anesthetic spread to the thoracic paravertebral space. The technique has proven to be safe and well tolerated. The publication of more clinical cases reporting the effectiveness of this blockade for chronic pain is desirable.
Subject(s)
Chronic Pain/prevention & control , Hernia, Abdominal/surgery , Herniorrhaphy/methods , Nerve Block/methods , Humans , Lumbosacral Plexus , Male , Middle Aged , Muscle, Skeletal/innervation , Neuralgia/prevention & control , Ultrasonography, InterventionalABSTRACT
Se realizó un estudio comparativo de las malformaciones congénitas presentadas en dos instituciones de salud, en el Hospital "Carlos Andrade Marín" y la Maternidad "Isidro Ayora", en el quinquenio 1976-1980. El estudio fue retrospectivo y se utilizó como fuente las historias clínicas. En el quinquenio se registraron un total de 567 casos en las dos instituciones. Se identifica que los estratos socio-económicos bajo son los más afectados con este problema de salud. Las tasas de niños malformados en relación al total de nacidos vivos oscilan entre 7.4 por ciento y 16.6 por ciento respectivamente...
