-
1
المؤلفون: David Martin, Ronald M. Stewart, Martin A. Schreiber, Nicole T. Gordon, Belinda H. McCully, Samantha J. Underwood, Laszlo N. Kiraly, Bryce R.H. Robinson, Bryan A. Cotton, Rondi K. Dean, Joseph P. Minei, Connor Wiles, Nathan W. Anderson, John B. Holcomb, Elizabeth A. Rick
المصدر: Journal of Trauma and Acute Care Surgery. 84:104-111
مصطلحات موضوعية: Adult, Male, Erythrocytes, Red Blood Cell Transfusion, 030204 cardiovascular system & hematology, Hematocrit, Critical Care and Intensive Care Medicine, Cryopreservation, Hemoglobins, 03 medical and health sciences, Injury Severity Score, 0302 clinical medicine, Trauma Centers, medicine, Humans, Obesity, Prospective Studies, Prospective cohort study, Randomized Controlled Trials as Topic, Analysis of Variance, medicine.diagnostic_test, business.industry, 030208 emergency & critical care medicine, Middle Aged, Oxygen, Red blood cell, medicine.anatomical_structure, Tissue oxygenation, Anesthesia, Wounds and Injuries, Female, Surgery, Erythrocyte Transfusion, Packed red blood cells, business
الوصف: Low tissue oxygenation (StO2) is associated with poor outcomes in obese trauma patients. A novel treatment could be the transfusion of cryopreserved packed red blood cells (CPRBCs), which the in vitro biochemical profile favors red blood cell (RBC) function. We hypothesized that CPRBC transfusion improves StO2 in obese trauma patients.Two hundred forty-three trauma patients at five Level I trauma centers who required RBC transfusion were randomized to receive one to two units of liquid packed RBCs (LPRBCs) or CPRBCs. Demographics, injury severity, StO2, outcomes, and biomarkers of RBC function were compared in nonobese (body mass index [BMI]30) and obese (BMI ≥ 30) patients. StO2 was also compared between obese patients with BMI of 30 to 34.9 and BMI ≥ 35. StO2 was normalized and expressed as % change after RBC transfusion. A p value less than 0.05 indicated significance.Patients with BMI less than 30 (n = 141) and BMI of 30 or greater (n = 102) had similar Injury Severity Score, Glasgow Coma Scale, and baseline StO2. Plasma levels of free hemoglobin, an index of RBC lysis, were lower in obese patients after CPRBC (125 [72-259] μg/mL) versus LPRBC transfusion (230 [178-388] μg/mL; p0.05). StO2 was similar in nonobese patients regardless of transfusion type, but improved in obese patients who received CPRBCs (104 ± 1%) versus LPRPCs (99 ± 1%, p0.05; 8 hours after transfusion). Subanalysis showed improved StO2 after CPRBC transfusion was specific to BMI of 35 or greater, starting 5 hours after transfusion (p0.05 vs. LPRBCs). CPRBCs did not improve clinical outcomes in either group.CPRBC transfusion is associated with increased StO2 and lower free hemoglobin levels in obese trauma patients, but did not improve clinical outcomes. Future studies are needed to determine if CPRBC transfusion in obese patients attenuates hemolysis to improve StO2.Therapeutic, level IV.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::655f234232e56273f3799835e1533a46
https://doi.org/10.1097/ta.0000000000001717 -
2
المصدر: The American Journal of Surgery. 211:919-925
مصطلحات موضوعية: Male, Vitamin K, 030204 cardiovascular system & hematology, Severity of Illness Index, Cohort Studies, Factor IX, chemistry.chemical_compound, 0302 clinical medicine, Aged, 80 and over, Factor VII, General Medicine, Middle Aged, Blood Coagulation Factors, Drug Combinations, Venous thrombosis, Treatment Outcome, Anesthesia, Female, Prothrombin, medicine.drug, Hemorrhage, macromolecular substances, Risk Assessment, Drug Administration Schedule, Statistics, Nonparametric, Traumatic Hemorrhage, 03 medical and health sciences, Severity of illness, medicine, Coagulopathy, Humans, International Normalized Ratio, cardiovascular diseases, Aged, Retrospective Studies, Chi-Square Distribution, Dose-Response Relationship, Drug, business.industry, Warfarin, 030208 emergency & critical care medicine, Retrospective cohort study, medicine.disease, chemistry, Factor X, Wounds and Injuries, bacteria, Surgery, Emergencies, business, Chi-squared distribution, Follow-Up Studies
الوصف: Reversal of warfarin-induced coagulopathy after traumatic injury may be done exclusively with prothrombin complex concentrates (PCCs). No direct comparisons between different PCC regimens exist to guide clinical decision-making. Our institution has used 2 distinct PCC strategies for warfarin reversal; a 3-Factor PCC (Profilnine) combined with activated Factor VII (3F-PCC+rVIIa), and a 4-Factor PCC (Kcentra) given without additional factor supplementation.Retrospective review of all PCC administrations to trauma patients with acute bleeding who were taking warfarin before injury. Primary endpoints were international normalized ratio (INR) reduction, in-hospital mortality, and diagnosis of deep venous thrombosis (DVT).Eighty-seven patients were identified from 2011 to 2015. Fifty-three were treated with 3F-PCC+rVIIa and 34 with 4F-PCC. Patient demographics, injury severity, and presenting laboratory data were similar. The 3F-PCC+rVIIa produced a lower median (IQR) INR postreversal compared with 4F-PCC (.75 (.69, 1.00) vs 1.28 (1.13, 1.36), P.001). Both regimens were able to obtain an INR lower than 1.5 immediately after administration (3F+rVIIA 93.9% vs 4F 97.1%, P =.51). In the 4F-PCC group, there was a significant decrease in the incidence of DVT (2.9% vs 22.6%), P .01), and a nonsignificant reduction in mortality (2.9% vs 17.0%, P = .08).Use of 4F-PCC for warfarin reversal after traumatic hemorrhage is associated with a less severe decrease in INR, a significant reduction in DVT rates and a trend toward reduced mortality when compared with similar patients treated with 3F-PCC+rVIIa.
-
3
المؤلفون: Bill Kaiser, Ian James Palmer, Michael Leunig, Keith Champlin, Bryan T. Kelly, Hal David Martin
المصدر: Arthroscopy: The Journal of Arthroscopic & Related Surgery. 28:1365-1372
مصطلحات موضوعية: Male, medicine.medical_specialty, medicine.diagnostic_test, business.industry, medicine.medical_treatment, Arthroscopy, Femoral vein, Superficial peroneal nerve, Blood flow, Traction (orthopedics), Surgery, Traction, Somatosensory evoked potential, Popliteal vein, Anesthesia, Humans, Medicine, Female, Hip Joint, Orthopedics and Sports Medicine, Hip arthroscopy, business
الوصف: To evaluate the physiological effects of hip arthroscopy using traction on venous blood flow, nerve conduction, soft-tissue injury, fibrinolysis, and patient pain.Thirty subjects were prospectively analyzed in an institutional review board-approved study. The visual analog scale pain score, creatine phosphokinase (CPK)-MM level, and D-dimer test were obtained preoperatively, postoperatively, and 5 days postoperatively. Doppler ultrasound (group A) (n = 15) of femoral and popliteal venous blood flow and somatosensory evoked potentials (SSEPs) (group B) (n = 15) of the posterior tibial nerve and superficial peroneal nerve were monitored intraoperatively.Mean operation and traction times were 131.7 and 27.3 minutes, respectively. During traction (mean, 57.7 lb), decreased blood flow was determined at the popliteal vein (15 of 15 subjects) and femoral vein (4 of 15 subjects). Blood flow returned to baseline after traction in all subjects. Mean CPK-MM levels were 86.0 ± 29.6 mU/mL preoperatively, 232.1 ± 224.6 mU/mL postoperatively, and 138.1 ± 109.3 mU/mL at 5 days postoperatively. The number of subjects positive for D-dimer was 7 preoperatively, 12 postoperatively, and 21 at 5 days postoperatively. SSEPs showed a greater than 50% decrease in amplitude on the operative (8 of 15) and nonoperative (9 of 15) limbs. No significant correlations were determined between visual analog scale pain score, body mass index, CPK-MM level, traction time, or operating room time.Doppler ultrasound showed decreased blood flow of the popliteal vein with traction, which returned to normal after traction. SSEPs showed changes with and without traction on operative and nonoperative legs. Consideration should be given for knee flexion of the contralateral leg after traction to protect nerve function. Hip arthroscopy resulted in an increase in a positive D-dimer test from immediately postoperatively to postoperative day 5. There is variability in the soft-tissue damage with hip arthroscopy, which is independent of time (2 hours), body mass index, or pain. Traction affects the vascular and neurologic structures of the operative and nonoperative extremity independent of time.Level IV, therapeutic case series.
-
4
المؤلفون: Silviu Brill, Yaniv Warschawski, Matan Paret, Zachary T. Sharfman, Eyal Amar, Hal David Martin, Efi Kazum, Ehud Rath, Amir Shlaifer, Michael Drexler
المصدر: Arthroscopy : the journal of arthroscopicrelated surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 33(1)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Visual analogue scale, medicine.medical_treatment, Arthroplasty, Replacement, Hip, Analgesic, Preoperative care, law.invention, Injections, Intra-Articular, 03 medical and health sciences, 0302 clinical medicine, Intra articular, Randomized controlled trial, 030202 anesthesiology, law, Preoperative Care, medicine, Humans, Orthopedics and Sports Medicine, Anesthetics, Local, Acetaminophen, Pain Measurement, Bupivacaine, Postoperative Care, 030222 orthopedics, Pain, Postoperative, business.industry, Arthroplasty, Surgery, Drug Combinations, Treatment Outcome, Anesthesia, Female, Hip arthroscopy, business, Oxycodone, medicine.drug
الوصف: To evaluate and compare the efficacy of intra-articular and periacetabular blocks for postoperative pain control after hip arthroscopy.Forty-two consecutive patients scheduled for hip arthroscopy were randomized into 2 postoperative pain control groups. One group received preemptive intra-articular 20 mL of bupivacaine 0.5% injection, and the second group received preemptive periacetabular 20 mL of bupivacaine 0.5% injection. Before closure all patients received an additional dose of 20 mL of bupivacaine 0.5% intra-articularly. Data were compared with respect to postoperative pain with visual analog scale (VAS) and analgesic consumption, documented in a pain diary for 2 weeks after surgery.Twenty-one patients were treated with intra-articular injection, and 21 patients with peri-acetabular injection. There were no significant differences with regards to patient demographics or surgical procedures. VAS scores recorded during the first 30 minutes postoperatively and 18 hours after surgery were significantly lower in the periacetabular group compared with in the intra-articular group (0.667 ± 1.49 vs 2.11 ± 2.29; P .045 and 2.62 ± 2.2 vs 4.79 ± 2.6; P.009). There were no differences between the groups with regard to analgesic consumption.Periacetabular injection of bupivacaine 0.5% was superior to intra-articular injection in pain reduction after hip arthroscopy at 30 minutes and 18 hours postoperatively. However, total analgesic consumption over the first 2 postoperative weeks and VAS pain measurements were not significantly affected.Level I, randomized controlled trial.
-
5
المصدر: Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 22(4)
مصطلحات موضوعية: Straight leg raise, Adult, Male, Adolescent, Physical examination, Likelihood ratios in diagnostic testing, Sensitivity and Specificity, Piriformis syndrome, Young Adult, Medicine, Humans, Orthopedics and Sports Medicine, Buttocks, Child, Physical Examination, Probability, Retrospective Studies, Sciatica, medicine.diagnostic_test, business.industry, Nerve Compression Syndromes, Reproducibility of Results, Endoscopy, Middle Aged, medicine.disease, Sciatic Nerve, medicine.anatomical_structure, Anesthesia, Diagnostic odds ratio, Surgery, Female, Sciatic nerve, medicine.symptom, business, Nuclear medicine
الوصف: The purpose of this study was to determine the diagnostic accuracy of the straight leg raise (SLR), active piriformis, and seated piriformis stretch tests in identifying individuals with sciatic nerve entrapment. Thirty-three individuals (female = 25 and male = 8) with a mean age of 43 years (range 15–64; SD ± 11 years) were included in the study. Twenty-three subjects had endoscopic findings of sciatic nerve entrapment. Ten subjects without entrapment during endoscopic assessment were used as a control group. The results of the SLR, active piriformis, and seated piriformis stretch tests were retrospectively reviewed for each subject and compared between both groups. The accuracy of these tests for the endoscopic finding of sciatic nerve entrapment was determined by calculating the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. The SLR had sensitivity of 0.15, specificity of 0.95, positive likelihood ratio of 3.20, negative likelihood ratio of 0.90, and diagnostic odds ratio of 3.59. The active piriformis test had sensitivity of 0.78, specificity of 0.80, positive likelihood ratio of 3.90, negative likelihood ratio of 0.27, and diagnostic odds ratio of 14.40. The seated piriformis stretch test had sensitivity of 0.52, specificity of 0.90, positive likelihood ratio of 5.22, negative likelihood ratio of 0.53, and diagnostic odds ratio of 9.82. The most accurate findings were obtained when the results of the active piriformis test and seated piriformis stretch test were combined, with sensitivity of 0.91, specificity of 0.80, positive likelihood ratio of 4.57, negative likelihood ratio of 0.11, and diagnostic odds ratio of 42.00. The active piriformis and seated piriformis stretch tests can be used to help identify patients with and without sciatic nerve entrapment in the deep gluteal region. II.
-
6
المؤلفون: Michael Hull, Roy M. John, David Martin, Geoffrey H. Tofler, David M. Shahian, Ferdinand J. Venditti
المصدر: Circulation. 94:1607-1612
مصطلحات موضوعية: Male, Heart disease, Defibrillation, medicine.medical_treatment, Electric Countershock, Differential Threshold, Sudden cardiac death, Defibrillation threshold, Physiology (medical), Humans, Medicine, Myocardial infarction, Circadian rhythm, Aged, Morning, business.industry, Arrhythmias, Cardiac, Heart, Middle Aged, medicine.disease, Circadian Rhythm, Electrophysiology, Anesthesia, Shock (circulatory), Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business
الوصف: Background Reports have demonstrated a circadian variation in the incidence of acute myocardial infarction, ventricular arrhythmias, and sudden cardiac death. We tested the hypothesis that a similar circadian variation exists for defibrillation energy requirements in humans. Methods and Results We reviewed the time of defibrillation threshold (DFT) measurements in 134 patients with implantable cardioverter-defibrillators (ICDs) who underwent 345 DFT measurements. The DFT was determined in 130 patients at implantation, in 121 at a 2 months, and in 94 at 6 months. All patients had nonthoracotomy systems. The morning DFT (8 am to 12 noon) was 15.1±1.2 J compared with 13.1±0.9 J in the midafternoon (12 noon to 4 pm ) and 13.0±0.7 J in the late afternoon (4 to 8 pm ), P P =.02). Conclusions There is a morning peak in DFT and a corresponding morning peak in failed first shock frequency. This morning peak resembles the peaks seen in other cardiac events, specifically sudden cardiac death. These findings have important implications for appropriate ICD function, particularly in patients with marginal DFTs.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::333991d4b5fe8a4cc6ef51daa518610c
https://doi.org/10.1161/01.cir.94.7.1607 -
7
المؤلفون: David Martin, Ferdinand J. Venditti, David M. Shahian, Mark O'connell
المصدر: Pacing and Clinical Electrophysiology. 18:711-715
مصطلحات موضوعية: Male, medicine.medical_specialty, Cost effectiveness, Defibrillation, Cost-Benefit Analysis, medicine.medical_treatment, media_common.quotation_subject, Ventricular tachycardia, Veins, Internal medicine, Methods, medicine, Humans, Thoracotomy, Aged, media_common, business.industry, Convalescence, General Medicine, Length of Stay, Middle Aged, Implantable cardioverter-defibrillator, medicine.disease, Hospital Charges, Defibrillators, Implantable, Anesthesia, Ventricular fibrillation, Cardiology, Female, Implant, Cardiology and Cardiovascular Medicine, business
الوصف: To assess the economic impact of a transvenous lead system for an implantable cardioverter defibrillator (ICD), we evaluated the hospital charges for two groups of patients: group I patients (n = 23) underwent implantation of an ICD generator with an epicardial lead system via a thoracotomy and group II patients (n = 25) underwent implantation of the same generator using transvenous leads. There was no difference in demographics between the two groups. There was a 15% decrease in total charges for the transvenous group compared to the thoracotomy group ($54,142 vs $63,359, P < 0.05). Evaluation of the component charges revealed that the decline could be attributed to a reduction in implant ($27,328 vs $29,285, P < 0.02) and convalescent charges ($7,703 vs $15,179, P < 0.01) for the transvenous group. There was a corresponding decrease in length of stay for the transvenous group (22 vs 29 days, P < 0.05) largely secondary to a 38% reduction in convalescent length of stay (8 vs 13 days, P < 0.05). We conclude that the use of transvenous lead systems for the ICD results in a significant reduction in hospital charges as well as hospital length of stay.
-
8
المصدر: The Journal of craniofacial surgery. 22(5)
مصطلحات موضوعية: Male, medicine.medical_specialty, Blood Loss, Surgical, Statistics, Nonparametric, Craniosynostosis, Craniosynostoses, Blood loss, medicine, Humans, Minimally Invasive Surgical Procedures, Adverse effect, Child, Retrospective Studies, Chi-Square Distribution, Intraoperative Care, Red Cell, business.industry, Incidence (epidemiology), General Medicine, Potential measurement, medicine.disease, Antifibrinolytic Agents, Treatment Outcome, Otorhinolaryngology, Tranexamic Acid, Anesthesia, Orthopedic surgery, Surgery, Female, business, Monte Carlo Method, Tranexamic acid, medicine.drug
الوصف: BACKGROUND Intraoperatively administered tranexamic acid (TXA) lessens blood loss during orthopedic and cardiovascular surgery. Its use for craniosynostosis surgery warrants investigation. Therefore, we analyzed our use of TXA during minimally invasive (MI) and open craniosynostosis procedures. METHODS Fifty-six patients were retrospectively studied: 20 in the MI group, 10 receiving TXA; 36 in the open group, 16 receiving TXA. Study variables were weight-adjusted estimated blood loss (EBL) and calculated blood loss (CBL), transfusion and incidence, transfusion volume, and complications. Calculated blood loss was determined by a novel formula based on red cell mass. RESULTS In the MI group, median EBL was significantly lower for TXA recipients (9.62 vs 15.94 mL/kg, P = 0.0231), whereas median CBL was not (36.59 vs 34.12 mL/kg, P = 0.7976). Transfusion incidences were 80% TXA versus 100% control (P = 0.4737). Median transfusion volume trended lower (10.76 vs 19.43 mL/kg, P = 0.0723).In the open group, median EBL and CBL for TXA recipients were lower but not significantly different than for nonrecipients (21.86 vs 23.40 mL/kg, P = 0.7416; 53.54 vs 80.13; P = 0.3137). All patients had a transfusion. Median transfusion volume for TXA recipients versus nonrecipients was 34.01 versus 40.35 mL/kg (P = 0.3137). Tranexamic acid greatly minimized the range of EBL and CBL in both surgical groups. There was a significant correlation between the CBL and EBL (P < 0.0001). There were no adverse events. CONCLUSIONS Intraoperative TXA administration is safe with modest benefit suggested, especially in the MI group. Calculated blood loss correlated well with EBL at lower blood loss volumes, implicating it as a potential measurement of true blood loss.
URL الوصول: https://explore.openaire.eu/search/publication?articleId=doi_dedup___::8c05355c6227429a0460216b5eb213b4
https://pubmed.ncbi.nlm.nih.gov/21959429 -
9
المصدر: The Journal of Hand Surgery. 18:455-458
مصطلحات موضوعية: Adult, Male, musculoskeletal diseases, medicine.medical_specialty, Exacerbation, Wrist, Recurrence, Risk Factors, medicine.artery, Catheterization, Peripheral, medicine, Humans, Orthopedics and Sports Medicine, Prospective Studies, Radial artery, Carpal tunnel syndrome, Aged, Aged, 80 and over, business.industry, Perioperative, Middle Aged, medicine.disease, Carpal Tunnel Syndrome, Surgery, body regions, Catheter, medicine.anatomical_structure, Anesthesia, Acute Disease, Radial Artery, Upper limb, Female, business, Artery
الوصف: Acute carpal tunnel syndrome that follows radial artery cannulation has been described. To determine the incidence and predisposing factors, we prospectively studied 151 patients who had perioperative radial artery cannulation. Postoperatively 9 of the 151 patients had symptoms of carpal tunnel syndrome with positive Phalen and Tinel signs on the side on which the radial artery catheter had been inserted. Eight of 12 patients with a prior history of carpal tunnel syndrome had acute exacerbation of symptoms postoperatively. By contrast, only 1 of 139 patients with no prior history of the disorder had symptoms. Fourteen patients had multiple arterial artery punctures or perforations of the posterior wall of the radial artery. In three of these, postoperative symptoms of carpal tunnel syndrome developed but did not reach statistical significance. The only patient with postoperative acute carpal tunnel syndrome but no prior history of the syndrome had multiple arterial punctures. The use of perioperative anticoagulation, the use of wrist-extension splints, and the duration of radial artery cannulation did not influence acute exacerbation of carpal tunnel syndrome. Patients with a prior history of carpal tunnel syndrome are at increased risk of recurrent symptoms after radial artery cannulation. We found no statistically significant relationship between traumatic cannulations and the development of symptoms of carpal tunnel syndrome.
-
10
المصدر: Arthroscopy : the journal of arthroscopicrelated surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 27(2)
مصطلحات موضوعية: Adult, Male, medicine.medical_specialty, Decompression, Radiography, Physical examination, Entrapment, Young Adult, Deep gluteal syndrome, medicine, Humans, Orthopedics and Sports Medicine, Young adult, Physical Examination, Aged, Pain Measurement, medicine.diagnostic_test, business.industry, Nerve Compression Syndromes, Endoscopy, Middle Aged, Decompression, Surgical, Surgery, Treatment Outcome, Anesthesia, Female, Sciatic nerve, Sciatic Neuropathy, business
الوصف: Purpose The purpose of this study was to investigate the historical, clinical, and radiographic presentation of deep gluteal syndrome (DGS) patients, describe the endoscopic anatomy associated with DGS, and assess the effectiveness of endoscopic surgical decompression for DGS. Methods Sciatic nerve entrapment was diagnosed in 35 patients (28 women and 7 men). Portals for inspection of the posterior peritrochanteric space (subgluteal space) of the hip were used as well as an auxiliary posterolateral portal. Patients were treated with sciatic nerve decompression by resection of fibrovascular scar bands, piriformis tendon release, obturator internus, or quadratus femoris or by hamstring tendon scarring. Postoperative outcomes were evaluated with the modified Harris Hip Score (MHHS), verbal analog scale (VAS) pain score, and a questionnaire related specifically to sciatic hip pain. Results The mean patient age was 47 years (range, 20 to 66 years). The mean duration of symptoms was 3.7 years (range, 1 to 23 years). The mean preoperative VAS score was 6.9 ± 2.0, and the mean preoperative MHHS was 54.4 ± 13.1 (range, 25.3 to 79.2). Of the patients, 21 reported preoperative use of narcotics for pain; 2 continued to take narcotics postoperatively (unrelated to initial complaint). The mean time of follow-up was 12 months (range, 6 to 24 months). The mean postoperative MHHS increased to 78.0 and VAS score decreased to 2.4. Eighty-three percent of patients had no postoperative sciatic sit pain (inability to sit for >30 minutes). Conclusions Endoscopic decompression of the sciatic nerve appears useful in improving function and diminishing hip pain in sciatic nerve entrapment/DGS. Level of Evidence Level IV, therapeutic case series.
إعادة تعيين المنقحات
عرض المنقحات (%%عد%%)
Full Text via ClinicalKey