ABSTRACT
BACKGROUND: Regional anesthesia (RA) techniques such as femoral nerve block (FNB) or fascia iliaca compartment block (FICB) are effective analgesia techniques in the treatment of pain from proximal femoral fractures (PFF). While in Great Britain (GB) these are already frequently used in the emergency department for preoperative analgesia, in the German-speaking DA-CH area (Germany, Austria, Switzerland) this seems to occur much less frequently. Therefore, the aim of this study was to survey the type and frequency of RA procedures used and to compare international practice. MATERIAL AND METHODS: In the DA-CH area as well as in GB, registered emergency departments were contacted and invited to participate in an online survey. The survey included questions on the frequency and type of RA procedures, reasons for non-use, equipment used, person performing the procedure and medications used. RESULTS: The participation rate was 17.4% (142/818 emergency departments). RA procedures for preoperative analgesia in PFF were used in 18.3% (21/115) of hospitals in the DA-CH region and in 96.3% (26/27) in GB. The most commonly used block was the FICB in GB at 96.2% (25/26) and the FNB in Germany at 66.7% (14/21). In the DA-CH area, RA procedures are primarily performed by anesthesiology specialists 71.4% (15/21), and in GB by emergency department residents 65.4% (17/26). DISCUSSION: RA procedures are still performed too rarely following PFF in emergency departments in the DA-CH area. In international comparison with GB there is potential for improvement.
Subject(s)
Analgesia , Anesthesia, Conduction , Nerve Block , Proximal Femoral Fractures , Humans , Nerve Block/methods , Analgesia/methods , Anesthesia, Conduction/methods , Pain , Emergency Service, Hospital , United KingdomABSTRACT
Pelvic lymph node dissection is an integral part of the radical cystectomy procedure for patients with muscle-invasive bladder cancer. The optimal extent of the lymphadenectomy (LND) and mainly the proximal template boundary remain controversial issues. In view of the existing mapping studies and retrospective analyses, extended LND up to the mid-upper third of the common iliac vessels appears to provide further prognostic and therapeutic benefit and therefore should be defined as standard LND. This applies for all procedures irrespective of the choice of surgical approach (open surgery, minimally invasive approach). In this context total lymph node count is not a quality criterion because nodal yield is overly influenced by the individual patient's anatomy, surgical technique, template applied and pathological work-up. Consecutively, considerable inter-institutional differences result, which render any comparison impossible. Lymph node density is thought to be a superior prognostic factor, but it is similarly influenced by the above-mentioned factors. Concerning molecular techniques to improve the sensitivity of postoperative nodal staging further research is necessary. The two ongoing prospective randomized trials will potentially help to further define the optimal LND template.
Subject(s)
Cystectomy , Lymph Node Excision , Urinary Bladder Neoplasms/surgery , Humans , Laparoscopy , Lymphatic Metastasis/pathology , Neoplasm Invasiveness , Prognosis , Prospective Studies , Randomized Controlled Trials as Topic , Urinary Bladder/pathology , Urinary Bladder Neoplasms/pathologyABSTRACT
In 1991, a 67 year old patient, suffering from an adenocarcinoma of the colon, had to undergo hemicolectomy. In the five following years, isolated metastases developed in the liver and have been surgically removed. In 1997, acute mononeuritis multiplex appeared and nerve biopsy revealed vasculitis. There were no signs of inflammatory rheumatic illness, collagenosis, cryglobulinemia, infection or hypersensitivity to medication. We have therefore postulated a relation between the vasculitis and the malignancy. Tumorous relapse could however not be detected at that time. Under immunosuppressive therapy, the neurological deficiencies receded partially, though the carcinoma of the colon reappeared with systemic metastases in the wake of the vasculitis. Diagnostic measures and the relationship between malignancy and vasculitis are discussed.
Subject(s)
Adenocarcinoma/diagnosis , Colonic Neoplasms/diagnosis , Mononeuropathies/etiology , Paraneoplastic Syndromes/etiology , Vasculitis/etiology , Aged , Diagnosis, Differential , Female , Humans , Mononeuropathies/diagnosis , Paraneoplastic Syndromes/diagnosis , Vasculitis/diagnosisABSTRACT
Technological advances have lengthened our years and, often, the dying process as well. While studies have been conducted of physicians and dying patients concerning their views on assisted suicide, no prior studies have examined the attitudes of hospice volunteers. This survey of 277 hospice volunteers found that overall their attitudes were more supportive of assisted suicide than that of a convenience sample of the public. Thirty-seven percent of the volunteers endorsed the view that there are situations when assisting death may be morally acceptable; 4% had been asked to provide assistance to help a patient end his or her life.
