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1.
Anesth Analg ; 129(6): 1468-1473, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31743165

RESUMO

BACKGROUND: Pain after cardiac surgery is largely treated with opioids, but their poor safety profile makes nonopioid medications attractive as part of multimodal pathways. Anti-inflammatory drugs reduce acute postoperative pain, but the role of steroids in reducing acute poststernotomy pain is unclear. We evaluated the association between the intraoperative administration of methylprednisolone and postoperative analgesia, defined as a composite of pain scores and opioid consumption, during the initial 24 hours after cardiac surgery. METHODS: We conducted a post hoc retrospective analysis of a large clinical trial in which adults having cardiac surgery were randomized 1:1 to receive 2 intraoperative doses of 250 mg IV methylprednisolone or placebo. Pain scores and opioid consumption were collected during the initial 24 hours after surgery. Methylprednisolone was considered to be associated with better pain control than placebo if proven noninferior (not worse) on both pain scores (defined a priori with delta of 1 point) and opioid consumption (delta of 20%) and superior to placebo in at least 1 of the 2 outcomes. This test was repeated in the opposite direction (testing whether placebo is better than methylprednisolone on postoperative pain management). RESULTS: Of 251 eligible patients, 127 received methylprednisolone and 124 received placebo. Methylprednisolone was noninferior to placebo on pain with difference in mean (CI) pain scores of -0.25 (-0.71 to 0.21); P < .001. However, methylprednisolone was not noninferior to placebo on opioid consumption (ratio of geometric means [CI]: 1.11 [0.64-1.91]; P = .37). Because methylprednisolone was not noninferior to placebo on both outcomes, we did not proceed to superiority testing based on the a priori stopping rules. Similar results were found when testing the opposite direction. CONCLUSIONS: In this post hoc analysis, we could not identify a beneficial analgesic effect after cardiac surgery associated with methylprednisolone administration. There are currently no data to suggest that methylprednisolone has significant analgesic benefit in adults having cardiac surgery.

2.
Cureus ; 11(6): e4822, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31404378

RESUMO

Pregnancy is a hypercoagulable state that increases the risk of thrombotic complications. A 32-year-old gravida 4 para 3 (G4P3) had a dural puncture during epidural catheter placement for labor analgesia. A positional headache started after delivery and continued for several days. A week after the delivery, she developed non-positional headaches along with seizures. Magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) lead to the diagnosis of cerebral venous thrombosis (CVT). A factor V Leiden mutation was also found; that was suspected to contribute to the development of CVT along with dural puncture and pregnancy. CVT can present with non-positional headaches a week after the dural puncture.

3.
Cureus ; 11(5): e4602, 2019 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-31309025

RESUMO

Otorrhagia during cardiac surgery is rare. Otorrhagia combined with other signs of increased venous pressure in the upper body indicates the development of superior vena cava (SVC) syndrome. In this case, ear bleeding, facial engorgement, and conjunctival edema were noticed. The SVC cannula was displaced, leading to SVC syndrome. Repositioning of the cannula led to rapid recovery of the symptoms and an uneventful postoperative course. Providers should be vigilant about signs of SVC obstruction. Transparent coverings and surgical shelves should be used for constant examination of the head and neck to immediately detect changes.

4.
Anesth Analg ; 2019 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-30801356

RESUMO

BACKGROUND: Pain after cardiac surgery is largely treated with opioids, but their poor safety profile makes nonopioid medications attractive as part of multimodal pathways. Anti-inflammatory drugs reduce acute postoperative pain, but the role of steroids in reducing acute poststernotomy pain is unclear. We evaluated the association between the intraoperative administration of methylprednisolone and postoperative analgesia, defined as a composite of pain scores and opioid consumption, during the initial 24 hours after cardiac surgery. METHODS: We conducted a post hoc retrospective analysis of a large clinical trial in which adults having cardiac surgery were randomized 1:1 to receive 2 intraoperative doses of 250 mg IV methylprednisolone or placebo. Pain scores and opioid consumption were collected during the initial 24 hours after surgery. Methylprednisolone was considered to be associated with better pain control than placebo if proven noninferior (not worse) on both pain scores (defined a priori with delta of 1 point) and opioid consumption (delta of 20%) and superior to placebo in at least 1 of the 2 outcomes. This test was repeated in the opposite direction (testing whether placebo is better than methylprednisolone on postoperative pain management). RESULTS: Of 251 eligible patients, 127 received methylprednisolone and 124 received placebo. Methylprednisolone was noninferior to placebo on pain with difference in mean (CI) pain scores of -0.25 (-0.71 to 0.21); P < .001. However, methylprednisolone was not noninferior to placebo on opioid consumption (ratio of geometric means [CI]: 1.11 [0.64-1.91]; P = .37). Because methylprednisolone was not noninferior to placebo on both outcomes, we did not proceed to superiority testing based on the a priori stopping rules. Similar results were found when testing the opposite direction. CONCLUSIONS: In this post hoc analysis, we could not identify a beneficial analgesic effect after cardiac surgery associated with methylprednisolone administration. There are currently no data to suggest that methylprednisolone has significant analgesic benefit in adults having cardiac surgery.

5.
Cureus ; 10(9): e3263, 2018 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-30430052

RESUMO

Pseudo-pneumothorax occurs after inappropriately diagnosing a pneumothorax based on a chest X-ray. This can be attributed to skin folds, bed sheets, previous pneumothorax, heating blankets, clothes, and other circumstances that may mimic the radiographic findings of a pneumothorax. We present a case where a patient underwent a tube thoracostomy due to the diagnosis of a pneumothorax that was not, in fact, present. The unnecessary intervention was complicated by hemoptysis and cardiac arrest.

6.
Cureus ; 10(8): e3173, 2018 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-30357060

RESUMO

Takotsubo cardiomyopathy (TC) is a non-ischemic cardiomyopathy that is accompanied by sudden left ventricular myocardial stunning, dilation and dysfunction. It often results from severe emotional or physical stress. We present the case of a 41-year-old female patient who had general anesthesia induced uneventfully for an elective bladder sling procedure. After an intravaginal injection of local anesthesia (lidocaine 2%; epinephrine 1:100,000) just prior to the surgical incision, the patient had cardiovascular collapse for which cardiopulmonary resuscitation (CPR) was performed. The patient was eventually stabilized but transesophageal echocardiography showed impairment in cardiac motion and remarkably reduced ejection fraction. Troponin levels were elevated but coronary angiography was unremarkable. The ejection fraction returned to normal the next day. Local anesthetic with epinephrine administration can lead to TC, and with optimal management, long-term cardiac sequela can be avoided.

7.
Cureus ; 8(7): e707, 2016 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-27588228

RESUMO

Cholangiocarcinoma (bile ducts cancer) is a rare and aggressive form of cancer. It metastasizes frequently to liver, peritoneum, and lungs. Colon metastasis is extremely uncommon. We report here a 70-year-old male who was diagnosed with cholangiocarcinoma for which he underwent a Whipple procedure. Fifteen months later, a CT scan revealed mural thickening in the colon; this was supplemented with a PET scan, which confirmed this mass. Histological diagnosis of metastatic cholangiocarcinoma to the colon was made and the patient was treated with chemotherapy. Although rare, cholangiocarcinoma metastasis can be found in the colon. A high index of suspicion is required to diagnose and treat early. More cases need to be reported to find out further about the prognosis of the disease.

8.
Curr Pediatr Rev ; 12(3): 209-221, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27357084

RESUMO

The outcomes of liver transplantation in the pediatric population have improved significantly over the past two decades. As long-term survival improves, potential complications related to immunosuppression, delayed growth and development, and metabolic issues have started to be seen more commonly in long-term survivors. Hence, general pediatricians should to be aware of these potential complications in order to optimize the medical care and the quality of life for children with liver transplantation.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Falência Hepática/cirurgia , Transplante de Fígado , Síndrome Metabólica/prevenção & controle , Obesidade/complicações , Complicações Pós-Operatórias/prevenção & controle , Insuficiência Renal/prevenção & controle , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Criança , Desenvolvimento Infantil , Humanos , Imunossupressores/uso terapêutico , Falência Hepática/mortalidade , Falência Hepática/fisiopatologia , Transplante de Fígado/mortalidade , Assistência de Longa Duração/métodos , Síndrome Metabólica/mortalidade , Síndrome Metabólica/fisiopatologia , Monitorização Fisiológica , Obesidade/metabolismo , Obesidade/fisiopatologia , Pediatras , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/fisiopatologia , Padrões de Prática Médica , Qualidade de Vida , Insuficiência Renal/mortalidade , Insuficiência Renal/fisiopatologia
9.
Anticancer Res ; 34(5): 2547-50, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24778074

RESUMO

BACKGROUND: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasm of the gastrointestinal tract. GISTs originate from cells of Cajal and related stem cells. Surgery and imatinib therapy are the main lines of treatment. CASE REPORT: We report on a case with GIST in the colon treated with surgical resection followed by adjuvant imatinib therapy. This treatment showed no side-effects, and subsequent colonoscopy was unremarkable. CONCLUSION: The diagnosis was delayed for 12 months after initial presentation of vague abdominal pain, thus highlighting the need to improve clinical suspicion in order to detect GISTs in earlier stages when resection may be curative. Colonic GIST, in particular, may mimic presentation similar to ovarian cyst, as seen in the present case. This case report corroborates that patients with high-grade GISTs can be effectively treated with imatinib therapy. However, duration of treatment may vary depending on the grade of the tumor and side-effects.


Assuntos
Neoplasias do Colo/patologia , Tumores do Estroma Gastrointestinal/patologia , Antineoplásicos/uso terapêutico , Benzamidas/uso terapêutico , Neoplasias do Colo/terapia , Terapia Combinada , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Tumores do Estroma Gastrointestinal/terapia , Humanos , Mesilato de Imatinib , Pessoa de Meia-Idade , Piperazinas/uso terapêutico , Pirimidinas/uso terapêutico
10.
J Coll Physicians Surg Pak ; 23(6): 388-91, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23763796

RESUMO

OBJECTIVE: To evaluate the symptom profile, course and prognosis of patients with irritable bowel syndrome (IBS) over a 15 years period. STUDY DESIGN: An observational study. PLACE AND DURATION OF STUDY: Shifa International Hospital, Islamabad, Pakistan, from 1996 to 2011. METHODOLOGY: Patients diagnosed with IBS at the study centre were followed for their clinical features, course over the period of time, management and its results. Only those patients were included in the study who completed the follow-up period. RESULTS: A total of 292 patients with mean age of 40.44 ± 13.69 years were inducted. There were 156 (53.4%) males and 136 (46.6%) females. Nearly all male and female patients had abdominal pain and bloating. However, constipation was seen in 79.4% females and 71.6 males. Diarrhea was seen in 46.5% females and 42.7% males. Both constipation and diarrhea were seen in 27.3% female and 15.6% males. A high number of patients had concomitant illnesses and a large proportion of them had sleep disturbances, exacerbations with stress and had food sensitivities. CONCLUSION: This longitudinal follow-up study showed that, in our setting, there were more males suffering from this illness; females had more constipation-dominant features. Prognosis over the course of illness was excellent in all patients.


Assuntos
Dor Abdominal/etiologia , Constipação Intestinal/complicações , Diarreia/complicações , Síndrome do Intestino Irritável/diagnóstico , Dor Abdominal/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Constipação Intestinal/diagnóstico , Constipação Intestinal/epidemiologia , Diarreia/diagnóstico , Diarreia/epidemiologia , Feminino , Seguimentos , Humanos , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/epidemiologia , Masculino , Pessoa de Meia-Idade , Paquistão/epidemiologia , Prognóstico , Estudos Prospectivos , Índice de Gravidade de Doença , Distribuição por Sexo , Inquéritos e Questionários , Adulto Jovem
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