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1.
Mymensingh Med J ; 33(1): 160-167, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38163788

RESUMEN

Mastectomy is very common surgical procedure for breast cancer. The closure of transverse elliptical mastectomy incisions has been represented with numerous modifications since 1915. The technical challenge is to avoid a fold of skin dogging laterally ("dog-ear"). This might lead to off future discomfort and poor cosmetic result. However, various surgical techniques are reported to tackle this lateral dog ear, there is no standardized technique. We therefore conduct a systematic review of the surgical techniques with the aim of comparing the merits and limitations of every technique. The comparative study among 72 patients was performed in Bangabandhu Sheikh Mujib Medical University, Anower Khan Modern Medical College & Hospital and Care Medical College & Hospital, Bangladesh from July 2017 to January 2020. Patients were divided randomly into two groups: Group I underwent fishtail technique group (36 patients), Group II underwent modified suturing technique group (36 patients). The follow up periods were 1 month and 3 months post-operatively for determination of the presence of dog ear and patient's satisfaction regarding cosmetic outcome and comfortability. Incidence of dog ear in fish-tail plasty group patients was less than that for Group II yet the difference is not significant less (p value 0.001). In consideration of patient satisfaction, doctor satisfaction and patient comfortability were significantly higher in Group I than Group II (p value 0.476 and 0.001 respectively). Fish-tail plasty was significantly better in patient satisfaction, comfortability and doctor satisfaction than modified suturing techniques and it might be recommended following mastectomy in obese patients for improving cosmesis and avoiding discomfort due to redundant skin.


Asunto(s)
Neoplasias de la Mama , Cicatriz , Mastectomía , Femenino , Humanos , Bangladesh , Neoplasias de la Mama/cirugía , Cicatriz/prevención & control , Mastectomía/métodos , Obesidad/complicaciones , Ensayos Clínicos Controlados Aleatorios como Asunto
2.
Preprint en Inglés | medRxiv | ID: ppmedrxiv-21264593

RESUMEN

The emergence and the widespread of Coronavirus disease 2019 (COVID-19) demands an accurate detection method to establish a diagnosis. Real-time polymerase chain reaction (real-time PCR) is accounted for the perfect point of reference in detecting this virus. The notion that this virus also invades the male reproductive tract requires further investigation to prove the presence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the semen. This investigation was designed to detect SARS-CoV-2 in COVID-19 survivors semen. This study design was a cross-sectional examination and conducted between November 2020 and March 2021 in the Andrology Unit of Dr. Soetomo General Hospital and Professor Nidom Foundation, both located in the City of Surabaya, Indonesia. The sample was 34 male participants aged above 18 years old and had been confirmed COVID-19 by nasopharyngeal swab PCR test. Part of the semen was taken for real-time PCR testing with the QuantStudio 5 Applied Biosystem (AB) PCR machine and the kits utilized were the STANDARD M nCOV Real-Time Detection Kit and mBioCov-19 RT-PCR Kit. Furthermore, the mean of participants ages was 35.74 years old with 25% of them had had a history of primary infertility and 21.8% of secondary infertility. From the real-time PCR COVID-19 of the semen examination, this investigation found that 27 participants had been negatives (74.4%), six inconclusive (17.6%), and one positive (3%) of SARS CoV-2. In summary, SARS-CoV-2 could be found in the semen of COVID-19 survivors. This should be a concern for the potential impact of COVID-19 in male fertility and the possibility of transmission reproductively.

3.
Int J Colorectal Dis ; 32(1): 119-124, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-27695932

RESUMEN

BACKGROUND AND AIMS: Evidence has shown that a positive resection margin (R1) is a key determinant of subsequent local recurrence and a poor prognostic factor in rectal cancer. The aim of this study was to evaluate the outcomes and prognosticators in patients with R1 resection of rectal cancer. MATERIAL AND METHODS: Retrospective study of all patients operatively managed within our institution between April 2008 and April 2013 for rectal cancer. Baseline demographics and multiple outcome measures recorded. Overall survival (OS), disease-free survival (DFS) and recurrence were the primary outcome measures. RESULTS: Overall, there were 306 primary rectal cancers. Seventy-six percent were grade T3/4 tumours. OS was 30 months. R1 rate was 16 % (48 patients). Thirty-one patients underwent APR and 17 AR. In patients who responded to neoadjuvant chemotherapy (NAC), overall survival was 55 months, with no extramural venous invasion (EMV) seen in this cohort. In non-responders OS was 29 months, with EMV in 48 %. In patients who did not receive NAC, OS was 23 months, with EMV in 74 %. EMV is a strong predictor for poor survival following R1 (p = 0.001). We also found a correlation between number of positive nodes and OS/DFS (p = 0.004). CONCLUSIONS: In this small cohort of patients with R1 positive rectal cancers, response to NAC is the strongest predictor of poor overall and disease-free survival. In patients who respond to NAC, OS and DFS has been shown to be positive, with a reduced rate of EMV.


Asunto(s)
Márgenes de Escisión , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Venas/patología , Supervivencia sin Enfermedad , Humanos , Estimación de Kaplan-Meier , Ganglios Linfáticos/patología , Terapia Neoadyuvante , Invasividad Neoplásica , Recurrencia Local de Neoplasia/patología , Neoplasias del Recto/tratamiento farmacológico
4.
Science ; 337(6097): 949-51, 2012 Aug 24.
Artículo en Inglés | MEDLINE | ID: mdl-22859817

RESUMEN

Supermassive black holes (SMBHs; mass is greater than or approximately 10(5) times that of the Sun) are known to exist at the center of most galaxies with sufficient stellar mass. In the local universe, it is possible to infer their properties from the surrounding stars or gas. However, at high redshifts we require active, continuous accretion to infer the presence of the SMBHs, which often comes in the form of long-term accretion in active galactic nuclei. SMBHs can also capture and tidally disrupt stars orbiting nearby, resulting in bright flares from otherwise quiescent black holes. Here, we report on a ~200-second x-ray quasi-periodicity around a previously dormant SMBH located in the center of a galaxy at redshift z = 0.3534. This result may open the possibility of probing general relativity beyond our local universe.

5.
Anesth Analg ; 109(4): 1225-31, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-19762752

RESUMEN

BACKGROUND: Practitioners often presuppose that obesity will increase neuraxial technique difficulty in pregnant patients, but few investigators have systematically examined this population for risk factors associated with difficult epidural or spinal needle placement. We designed this study to prospectively identify factors that predict neuraxial technique difficulty in pregnant patients. METHODS: Using a prospective, observational format, pregnant patients were examined for multiple potential risk factors for neuraxial technique difficulty, including current body mass index, ability to palpate spinous processes, maximum back flexion, scoliosis, and experience of the practitioner. Neuraxial technique difficulty was then assessed using two measures: 1) the number of needle passes needed to reach the desired space, and 2) the placement time from skin infiltration to either spinal injection or epidural catheter threading. Predictors of total needle passes were determined by fitting the data to a generalized linear model with negative binomial error. Predictors of neuraxial anesthetic time were determined by fitting a linear model to the log of neuraxial anesthetic placement time. A survival model was used to account for bias introduced when attending physicians intervened in resident physician procedures. RESULTS: Neuraxial procedures in 427 pregnant patients were studied. For both the number of needle passes and the neuraxial anesthetic placement time, the significant predictors of difficulty were the practitioner's ability to palpate the patient's bony landmarks and the patient's ability to flex her back. Obesity, as measured by body mass index, was not an independent predictor of either end point. Obesity did, however, strongly predict both the ability to palpate landmarks and flex the back. CONCLUSIONS: Despite concerns that obesity may cause difficulty with neuraxial technique, some obese patients have surprisingly easy neuraxial block placements. When approaching any neuraxial anesthetic in a pregnant patient, and especially in the obese parturient, back flexion and landmark palpation predict neuraxial technique difficulty.


Asunto(s)
Índice de Masa Corporal , Inyecciones Epidurales/efectos adversos , Inyecciones Espinales/efectos adversos , Obesidad/complicaciones , Palpación , Adulto , Competencia Clínica , Femenino , Humanos , Internado y Residencia , Modelos Lineales , Modelos Logísticos , Cuerpo Médico de Hospitales , Contracción Muscular , Músculo Esquelético/fisiopatología , Obesidad/fisiopatología , Embarazo , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Medición de Riesgo , Factores de Riesgo , Escoliosis/etiología , Escoliosis/fisiopatología , Factores de Tiempo
9.
Neurol India ; 44(3): 163-164, 1996.
Artículo en Inglés | MEDLINE | ID: mdl-29542642
11.
Reg Anesth ; 18(4): 222-5, 1993.
Artículo en Inglés | MEDLINE | ID: mdl-8398955

RESUMEN

BACKGROUND AND OBJECTIVES: Postdural puncture headache (PDPH) is a frequent complication of spinal anesthesia. Some investigators have recommended the use of the Sprotte needle to reduce the incidence of this serious complication. This study prospectively compared the incidence of PDPH with two spinal needles of different size and design: the 24-gauge Sprotte (noncutting point) versus the 25-gauge Quincke (diamond, cutting point). The hypothesis that subarachnoid fentanyl will reduce the incidence of PDPH, as suggested in the literature, was also studied. METHODS: Only patients for emergency or elective cesarean delivery were studied. One hundred ninety four patients were randomly assigned to receive spinal anesthesia with one of the two needles (Sprotte, n = 96; Quincke, n = 98). Simultaneously, each patient was assigned to receive hyperbaric 0.75% bupivacaine local anesthetic or a combination of the same concentration of local anesthetic with 20 micrograms of fentanyl (Sprotte with fentanyl, n = 47; Sprotte without fentanyl, n = 49; Quincke with fentanyl, n = 49; Quincke without fentanyl, n = 49). All patients were evaluated during the first 4 postoperative days, and follow-up telephone interviews were conducted 3 weeks after discharge. RESULTS: Four patients (4.2%) in the Sprotte group and seven (7.1%) in the Quincke group developed PDPH. Three out of four patients with headache in the Sprotte and four out of seven in the Quincke group received fentanyl as an adjunct for spinal anesthesia. Two patients in the Sprotte group required an epidural blood patch as a therapy for PDPH. Two patients in the Quincke group had severe headache and required an epidural blood patch. CONCLUSIONS: In the current study, the use of the 24-gauge Sprotte spinal needle resulted in a low incidence of severe PDPH, but was not significantly different when compared with the use of a 25-gauge Quincke needle (oriented parallel to the longitudinal dural fibers). The addition of fentanyl to hyperbaric bupivacaine spinal anesthesia did not reduce the risk of PDPH.


Asunto(s)
Anestesia Obstétrica , Anestesia Raquidea , Cesárea , Fentanilo/uso terapéutico , Cefalea/etiología , Agujas , Punción Espinal/efectos adversos , Adulto , Método Doble Ciego , Femenino , Fentanilo/administración & dosificación , Cefalea/epidemiología , Cefalea/prevención & control , Humanos , Incidencia , Embarazo , Estudios Prospectivos , Punción Espinal/instrumentación , Espacio Subaracnoideo
12.
Can J Anaesth ; 38(6): 767-71, 1991 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-1914062

RESUMEN

While Horner's syndrome is a rare but occasionally reported side-effect of epidural block administered for labour, trigeminal nerve palsy has been described only once. The cases described in this report confirmed the benign nature of these neurological complications of epidurally administered anaesthetics which were not detrimental to fetal viability. The complications may be attributed to extensive cephalad spread of local anaesthetic, sometimes via unexplained routes and with surprisingly selective targeting effect (unilateral trigeminal nerve palsy). The atypical and unusually high cephalad spread of local anaesthetic in pregnant women at term is believed to be due to pregnancy-related altered anatomy and physiology of the epidural space.


Asunto(s)
Anestesia Epidural/efectos adversos , Anestesia Obstétrica/efectos adversos , Parálisis Facial/etiología , Síndrome de Horner/etiología , Nervio Trigémino , Adulto , Anestésicos Locales/efectos adversos , Bupivacaína/efectos adversos , Femenino , Humanos , Embarazo , Procaína/efectos adversos , Procaína/análogos & derivados
13.
Pain ; 10(3): 323-330, 1981 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-6168996

RESUMEN

In order to identify those chronic pain patients unlikely to improve from nerve blocks, preadmission questionnaires of 337 patients were studied and various pre-existing factors were analyzed against short term treatment results. Factors associated with significant reductions in treatment success (P less than 0.05) included: being injured at work, being out of work because of pain, receiving financial compensation, involvement in legal action, previous surgery for pain, long duration of pain, high pain severity ratings, frequent analgesic use and use of tranquilizers.


Asunto(s)
Bloqueo Nervioso , Dolor Intratable/terapia , Cuidados Paliativos , Adolescente , Adulto , Factores de Edad , Anciano , Analgésicos/uso terapéutico , Etanol/uso terapéutico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/tratamiento farmacológico , Factores Sexuales , Factores Socioeconómicos , Encuestas y Cuestionarios
14.
Experientia ; 34(5): 562-3, 1978 May 15.
Artículo en Inglés | MEDLINE | ID: mdl-658223

RESUMEN

The plasma fibrinogen level of maternal blood has been estimated in 30 cases of pre-eclampsia, 60 cases of eclampsia and 35 cases of normal pregnancy of 3rd trimester. The plasma fibrinogen value increased by about 70% and 145% in pre-eclampsia and eclampsia, respectively. In essential hypertension, the fibrinogen level remains more or less the same as in normal pregnancy.


Asunto(s)
Eclampsia/sangre , Fibrinógeno/análisis , Preeclampsia/sangre , Femenino , Humanos , Hipertensión/sangre , Embarazo , Complicaciones Cardiovasculares del Embarazo/sangre
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