Effect of electroacupuncture on brachial plexus post-traumatic neuralgia: A case report.

Background: Brachial plexus injury is a serious peripheral nerve injury that severely disables upper limbs and affects patients' daily life and work Acupuncture and Electroacupuncture have traditionally been used to treat neuropathic pain. However, there is still lacking evidence as regard to their effects on pain following traumatic nerve and plexus lesions. Neurotmesis after brachial plexus injury also causes movement disorders of the denervated muscles and loss of sensory function in the skin. Case report: We report a case of a brachial plexus injury due to humeral fracture, predominantly involving the lower trunk and the medial cord, treated with electroacupuncture. Results. We documented a positive significant response, based on clinical examination, pain scores and neurophysiologic findings. Conclusions: Repeated Electroacupuncture can relieve neuropathic pain due to brachial plexus injury. However, additional studies are needed to verify the efficacy and effectiveness of this approach.

PENG block associated with dexmedetomidine sedation for intramedullary femoral fixation in high-risk elderly patients: a case series and review of the literature.

BACKGROUND: Hip fracture is a major cause of hospitalization among the elderly population. The standard surgical treatment involves early repair to reduce mortality and morbidity. One type of treatment in the case of intertrochanteric and subtrochanteric fractures is intramedullary nailing, as it decreases soft tissue damage and permits early weight bearing. The most common anesthesia technique combines spinal anesthesia with a peripheral block. In cases where spinal anesthesia is contraindicated, general anesthesia is preferred. However, both techniques can lead to significant complications, especially in patients with multiple comorbidities. Pain management after hip surgery, particularly in elderly and frail individuals, poses a challenge. The pericapsular nerve group block (PENG) targets the innervation of the anterior portion of the hip joint and is increasingly used for pain management related to hip surgery. CASE SERIES: This paper presents a case series of three elderly patients who underwent pericapsular nerve group block (PENG) block combined with dexmedetomidine sedation for intramedullary femoral fixation. CONCLUSIONS: The PENG block can be effectively used as the sole anesthetic technique for managing elderly patients undergoing intramedullary femoral fixation while on antiplatelet drugs. This procedure effectively controlled pain during both the surgical and postoperative periods. The addition of dexmedetomidine for sedation enables comfortable and safe procedures, minimizing the risk of perioperative neurocognitive dysfunctions and without adverse effects on cardiorespiratory function.

Comparative bench study evaluation of a modified snorkeling mask used during COVID-19 pandemic and standard interfaces for non-invasive ventilation.

PURPOSE: The aim of this bench study is to compare the standard NIV and nCPAP devices (Helmet, H; Full face mask, FFM) with a modified full face snorkeling mask used during COVID-19 pandemic. METHODS: A mannequin was connected to an active lung simulator. The inspiratory and expiratory variations in airways pressure observed with a high simulated effort, were determined relative to the preset CPAP level. NIV was applied in Pressure Support Mode at two simulated respiratory rates and two cycling-off flow thresholds. During the bench study, we measured the variables defining patient-ventilator interaction and performance. RESULTS: During nCPAP, the tested interfaces did not show significant differences in terms of ∆Pawi and ∆Pawe. During NIV, the snorkeling mask demonstrated a better patient-ventilator interaction compared to FFM, as shown by significantly shorter Pressurization Time and Expiratory Trigger Delay (p < 0.01), but no significant differences were found in terms of Inspiratory Trigger Delay and Time of Synchrony between the interfaces tested. At RR 20sim, the snorkeling mask presented the lower ΔPtrigger (p < 0.01), moreover during all the conditions tested the snorkeling mask showed the longer Pressure Time Product at 200, 300, and 500 ms compared to FFM (p < 0.01). A major limitation of snorkeling mask is that during NIV with this interface it is possible to reach maximum 18 cmH2O of peak inspiratory pressure. CONCLUSIONS: The modified snorkeling mask can be used as an acceptable alternative to other interfaces for both nCPAP and NIV in emergencies.

Bench comparative evaluation of a new generation and standard helmet for delivering non-invasive ventilation.

OBJECTIVE: To evaluate the performance of a new helmet (NH) recently introduced into clinical use relative to that of the standard helmet (SH) in terms of delivering non-invasive continuous positive airway pressure (nCPAP) and pressure support ventilation (nPSV). DESIGN: This was a bench study using a mannequin connected to an active lung simulator. The SH was fastened to the mannequin by armpit braces, which are not needed to secure the NH. MEASUREMENTS: The inspiratory and expiratory variations in nCPAP delivered with two different simulated efforts (Pmus), were determined relative to the preset CPAP level. nPSV was applied at two simulated respiratory rates (RR) and two cycling-off flow thresholds. We measured inspiratory trigger delay (Delay trinsp), expiratory trigger delay (Delay trexp), time of synchrony (Time sync), trigger pressure drop (ΔP trigger), airway pressure-time product during the triggering phase (PTPt), the initial 200 ms from the onset of the ventilator pressurization (PTP 200), and the initial 300 and 500 ms from the onset of the simulated effort; this two latter parameters were expressed as the percentage of the area of ideal pressurization (PTP 300-index and PTP 500-index, respectively). RESULTS: In nCPAP, at both Pmus, the differences between the two interfaces at both Pmus were small and clinically irrelevant. In nPSV, regardless of the setting, NH resulted in significantly smaller trigger delays, ΔP trigger, and PTPt. Time sync, PTP 200, PTP 300-index, and PTP 500-index were also significantly higher with the NH compared to the SH, irrespective of the setting. CONCLUSIONS: Compared to the SH, the NH is equally effective in delivering nCPAP and more effective in delivering nPSV, and it is used to avoid the need for armpit braces.

A physiologic comparison of proportional assist ventilation with load-adjustable gain factors (PAV+) versus pressure support ventilation (PSV).

PURPOSE: To compare patient-ventilator interaction during PSV and PAV+ in patients that are difficult to wean. METHODS: This was a physiologic study involving 11 patients. During three consecutive trials (PSV first trial--PSV1, followed by PAV+, followed by a second PSV trial--PSV2, with the same settings as PSV1) we evaluated mechanical and patient respiratory pattern; inspiratory effort from excursion Pdi (swing(Pdi)), and pressure-time products of the transdiaphragmatic (PTPdi) pressures. Inspiratory (delay(trinsp)) and expiratory (delay(trexp)) trigger delays, time of synchrony (time(syn)), and asynchrony index (AI) were assessed. RESULTS: Compared to PAV+, during PSV trials, the mechanical inspiratory time (Ti(flow)) was significantly longer than patient inspiratory time (Ti(pat)) (p < 0.05); Ti(pat) showed a prolongation between PSV1 and PAV+, significant comparing PAV+ and PSV2 (p < 0.05). PAV+ significantly reduced delay(trexp) (p < 0.001). The portion of tidal volume (VT) delivered in phase with Ti(pat) (VT(pat)/VT(mecc)) was significantly higher during PAV+ (p < 0.01). The time of synchrony was significantly longer during PAV+ than during PSV (p < 0.001). During PSV 5 patients out of 11 showed an AI greater than 10%, whereas the AI was nil during PAV+. CONCLUSION: PAV+ improves patient-ventilator interaction, significantly reducing the incidence of end-expiratory asynchrony and increasing the time of synchrony.

Influence of ventilator settings on patient-ventilator synchrony during pressure support ventilation with different interfaces.

OBJECTIVE: To evaluate patient-ventilator interaction during pressure support ventilation (PSV) delivered with three interfaces [endotracheal tube (ET), face mask (FM), and helmet (H)] at different pressurization times (Time(press)), cycling-off flow thresholds (Tr(exp)), and respiratory rates (RR) in a bench study, and with FM and H in a healthy volunteers study. DESIGN: Bench study using a mannequin connected to an active lung simulator, and human study including eight healthy volunteers. MEASUREMENTS: PSV was delivered through the three interfaces with three different RR in the bench study, and through FM and H at two different RR in the human study. The mechanical and the neural RR, Ti, Te, inspiratory trigger delay (Delay(trinsp)), pressurization time, and expiratory trigger delay were randomly evaluated at various ventilator settings (Time(press)/Tr(exp): 50%/25%, default setting; 20%/5%, slow setting; 80%/60%, fast setting). RESULTS: Bench study: patient-ventilator synchrony was significantly better with ET, with lower Delay(trinsp) and higher time of assistance (P < 0.001); the combination Time(press)/Tr(exp) 20%/5% at RR 30 produced the worst interaction, with higher rate of wasted efforts (WE) compared with Time(press)/Tr(exp) 80%/60% (20%, 40%, and 50% of WE versus 0%, 16%, and 26% of all spontaneous breaths, with ET, FM, and H, respectively; P < 0.01). In both studies, compared with H, FM resulted in better synchrony. CONCLUSION: Patient-ventilator synchrony was significantly better with ET during the bench study; in the human study, FM outperformed H.

Prophylactic chemotherapy with fosfomycin trometamol during transurethral surgery and urological manoeuvres. Results of a multicentre study.

The aim of the present open prospective study is to evaluate the efficacy and safety profile of fosfomycin trometamol in the chemoprophylaxis of urinary tract infections following transurethral diagnostic and/or therapeutic manoeuvres. 712 patients were enrolled in 72 urological surgical centres. All the enrolled patients received an initial dose of fosfomycin trometamol (Monuril sachet containing 3 g of active drug in powder) 3 h before and a second dose 24 h after the transurethral manoeuvres. Clinical and microbiological examinations were carried out before the intervention, and then on the second and seventh days after the manoeuvres. 94 patients with positive baseline tests were excluded from the microbiological follow-up for non-compliance with the main inclusion criteria. Out of 618 patients with sterile urine or with bacteriuria less than 10(5) ml on baseline screening, 20 (3.2%) developed UTI on the second day and 22 (3.6%) on the seventh day after treatment. Clinical follow-up is in agreement with these microbiological data. Overall, a total of 24 side effects were observed (3.3%), 16 of which were associated with Monuril treatment. The results of this open study agree with the preliminary observations in the controlled studies.

Tissue levels of ofloxacin in the urogenital system.

The authors evaluated the tissue levels of ofloxacin in 63 patients with urogenital diseases, in comparison to the minimum inhibitory concentrations 80% (MIC80) of some strains. The drug was administered in a single dose (300 mg) about 3 hours before surgery. After washing carefully, the tissue-levels were measured by using the HPLC method. In the normal renal parenchyma of 8 patients, the mean value was 22.10 micrograms/g of tissue; 19.23 micrograms/g in 13 patients with deranged excretory pathways; 10.62 micrograms/g in 25 patients with benign prostatic hypertrophy; 10.90 micrograms/g in 14 deferent duct patients. These results indicate that the drug is promptly distributed in various tissues of the urinary-genital apparatus at high concentrations.

[Neoplasms of the male urethra: diagnosis and therapy]. / Le neoplasie dell'uretra maschile: diagnosi e terapia.

Neoplasms of male urethra are particularly interesting for the diagnostic and therapeutical problems involved, urologist surgeons may be charged to resolve. The authors effected an anatomo-pathologic, diagnostical and especially therapeutical framing, by reviewing the data reported by the literature. The indications the Authors may draw therefrom are favourable to a radical surgery, even in consideration of the extensive nature of such tumours and the poor successes, in terms of survival, got by the conservative therapy.

Radical cystectomy in the treatment of advanced bladder cancer.

Thirty-two cases of advanced bladder cancer (pT3b-pT4) undergoing radical cystectomy are compared with other similar series of patients of the same stages submitted to different treatments (radiotherapy, chemotherapy and combined treatments) reported in the literature. Survival rates at 3 and 5 years are analyzed in relation to the anatomopathological stage, cellular grading, lymph node infiltration, surgical risk and relative mortality. The results confirm that radical cystectomy is presently the most effective treatment.

[Hemitrigonectomy: a personal technic]. / L'emitrigonectomia: tecnica personale.

The Authors show an operation of urological surgery, unusual in relation to the rather limited indications. The operation of hemitrigonectomy, although it is framed in the chapter of the partial resections of bladder, does not get an exact identity in literature; yet, it is peculiar for both technical problems and some basic expedients sheltering surgeons from various complications. Hemitrigonectomy, performed by the Authors in six cases in the last 3 years, supplied excellent anatomic and functional results, and was burdened by no relevant complications.

Ureterocystoneostomy in urinary tuberculosis: a personal technique.

A personal surgical technique in the treatment of the tuberculous stenosis of the juxtavesical and intramural ureter, is described. 62 patients suffering from tuberculosis of the urinary tract underwent surgical treatment. 42 of these cases presented with ureteral stenosis: 14 were submitted to ureterocystoneostomy (UCNS) according to a personal technique. The results confirmed the initial hypotheses.