Sample records for a-v block complicated

  1. Analysis of complications following augmentation with cancellous block allografts.

    PubMed

    Chaushu, Gavriel; Mardinger, Ofer; Peleg, Michael; Ghelfan, Oded; Nissan, Joseph

    2010-12-01

    Bone grafting may be associated with soft and hard tissue complications. Recipient site complications encountered using cancellous block allografts for ridge augmentation are analyzed. A total of 101 consecutive patients (62 females and 39 males; mean age 44 ± 17 years) were treated with implant-supported restoration of 137 severe atrophic alveolar ridges augmented with cancellous bone-block allografts. Alveolar ridge deficiency locations were classified as anterior maxilla (n = 58); posterior maxilla (n = 32 sinuses); posterior mandible (n = 32); and anterior mandible (n = 15). A total of 271 rough-surface implants were placed. Recipient site complications associated with block grafting (infection, membrane exposure, incision line opening, perforation of mucosa over the grafted bone, partial graft failure, total graft failure, and implant failure) were recorded. Partial and total bone-block graft failure occurred in 10 (7%) and 11 (8%) of 137 augmented sites, respectively. Implant failure rate was 12 (4.4%) of 271. Soft tissue complications included membrane exposure (42 [30.7%] of 137); incision line opening (41 [30%] of 137); and perforation of the mucosa over the grafted bone (19 [14%] of 137). Infection of the grafted site occurred in 18 (13%) of 137 bone blocks. Alveolar ridge deficiency location had a statistically significant effect on the outcome of recipient site complications. More complications were noted in the mandible compared to the maxilla. Age and gender had no statistically significant effect. Failures caused by complications were rarely noted in association with cancellous block grafting. The incidence of complications in the mandible was significantly higher. Soft tissue complications do not necessarily result in total loss of cancellous block allograft.

  2. Complications of fluoroscopically directed facet joint nerve blocks: a prospective evaluation of 7,500 episodes with 43,000 nerve blocks.

    PubMed

    Manchikanti, Laxmaiah; Malla, Yogesh; Wargo, Bradley W; Cash, Kimberly A; Pampati, Vidyasagar; Fellows, Bert

    2012-01-01

    Chronic spinal pain is common along with numerous modalities of diagnostic and therapeutic interventions utilized, creating a health care crisis. Facet joint injections and epidural injections are the 2 most commonly utilized interventions in managing chronic spinal pain. While the literature addressing the effectiveness of facet joint nerve blocks is variable and emerging, there is paucity of literature on adverse effects of facet joint nerve blocks. A prospective, non-randomized study of patients undergoing interventional techniques from May 2008 to December 2009. A private interventional pain management practice, a specialty referral center in the United States. Investigation of the incidence in characteristics of adverse effects and complications of facet joint nerve blocks. The study was carried out over a period of 20 months including almost 7,500 episodes of 43,000 facet joint nerve blocks with 3,370 episodes in the cervical region, 3,162 in the lumbar region, and 950 in the thoracic region. All facet joint nerve blocks were performed under fluoroscopic guidance in an ambulatory surgery center by 3 physicians. The complications encountered during the procedure and postoperatively were evaluated prospectively. This study was carried out over a period of 20 months and included over 7,500 episodes or 43,000 facet joint nerve blocks. All of the interventions were performed under fluoroscopic guidance in an ambulatory surgery center by one of 3 physicians. The complications encountered during the procedure and postoperatively were prospectively evaluated. Measurable outcomes employed were intravascular entry of the needle, profuse bleeding, local hematoma, dural puncture and headache, nerve root or spinal cord irritation with resultant injury, and infectious complications. There were no major complications. Multiple side effects and complications observed included overall intravascular penetration in 11.4% of episodes with 20% in cervical region, 4% in lumbar

  3. Precision aligned split V-block

    DOEpatents

    George, Irwin S.

    1984-01-01

    A precision aligned split V-block for holding a workpiece during a milling operation having an expandable frame for allowing various sized workpieces to be accommodated, is easily secured directly to the mill table and having key lugs in one base of the split V-block that assures constant alignment.

  4. Skin and mucosal ischemia as a complication after inferior alveolar nerve block.

    PubMed

    Aravena, Pedro Christian; Valeria, Camila; Nuñez, Nicolás; Perez-Rojas, Francisco; Coronado, Cesar

    2016-01-01

    The anesthetic block of the inferior alveolar nerve (IAN) is one of the most common techniques used in dental practice. The local complications are due to the failures on the anesthetic block or to anatomic variations in the tap site such as intravascular injection, skin ischemia and ocular problems. The aim of this article is to present a case and discuss the causes of itching and burning sensation, blanching, pain and face ischemia in the oral cavity during the IAN block.

  5. Acquired heart block: a possible complication of patent ductus arteriosus in a preterm infant.

    PubMed

    Grasser, Monika; Döhlemann, Christoph; Mittal, Rashmi; Till, Holger; Dietz, Hans-Georg; Münch, Georg; Holzinger, Andreas

    2008-01-01

    A large patent ductus arteriosus (PDA) is a frequently encountered clinical problem in extremely low birth weight (ELBW) infants. It leads to an increased pulmonary blood flow and in a decreased or reversed diastolic flow in the systemic circulation, resulting in complications. Here we report a possible complication of PDA not previously published. On day 8 of life, a male ELBW infant (birth weight 650 g) born at a gestational age of 23 weeks and 3 days developed an atrioventricular block (AV block). The heart rate dropped from 168/min to 90/min, and the ECG showed a Wenckebach second-degree AV block and intraventricular conduction disturbances. Echocardiography demonstrated a PDA with a large left-to-right shunt and large left atrium and left ventricle with high contractility. Within several minutes after surgical closure of the PDA, the heart rate increased, and after 30 min the AV block had improved to a 1:1 conduction ratio. Echocardiography after 2 h revealed a significant decrease of the left ventricular and atrial dimensions. Within 12 h, the AV block completely reversed together with the intraventricular conduction disturbances. We suggest that PDA with a large left-to-right shunt and left ventricular volume overload may lead to an AV block in an ELBW infant. Surgical closure of the PDA may be indicated. (c) 2007 S. Karger AG, Basel.

  6. Rotary target V-block

    NASA Technical Reports Server (NTRS)

    Mann, C. W. (Inventor)

    1984-01-01

    A device used in the optical alignment of machinery to maintain a measuring scale in the proper position for optical readings to be taken is described. The device consists of a block containing a notch in the shape of an inverted ""v'' and a rotatable plug positioned over the centerline of notch. The block is placed on the object to be aligned, the notch allows the block to be securely placed upon flat or curved surfaces. A weighted measuring scale is inserted through plug so that it contacts the object to be aligned. The scale and plug combination can be rotated so that the scale faces an optical aligning instrument. The instrument is then used in conjunction with the scale to measure the distance of the machinery from a reference plane.

  7. Calibration and temperature correction of a V-block refractometer

    NASA Astrophysics Data System (ADS)

    Le Menn, Marc

    2018-03-01

    V-block refractometers have been used since the 1940s to retrieve the refractive index values of substances or optical glasses. When used outside laboratories, they are submitted to temperature variations which degrade their accuracy by varying the refractive index of the glasses and the length of the prisms. This paper proposes a method to calibrate a double-prism V-block refractometer by retrieving the values of two coefficients at a constant temperature and by applying corrections to these coefficients when the instrument is used at different temperatures. This method is applied to calibrate in salinity a NOSS instrument which can be used at sea on drifting floats, and the results show that measurement errors can be reduced by a factor of 5.8.

  8. Facial blanching after inferior alveolar nerve block anesthesia: an unusual complication.

    PubMed

    Kang, Sang-Hoon; Won, Yu-Jin

    2017-12-01

    The present case report describes a complication involving facial blanching symptoms occurring during inferior alveolar nerve block anesthesia (IANBA). Facial blanching after IANBA can be caused by the injection of an anesthetic into the maxillary artery area, affecting the infraorbital artery.

  9. Facial blanching after inferior alveolar nerve block anesthesia: an unusual complication

    PubMed Central

    2017-01-01

    The present case report describes a complication involving facial blanching symptoms occurring during inferior alveolar nerve block anesthesia (IANBA). Facial blanching after IANBA can be caused by the injection of an anesthetic into the maxillary artery area, affecting the infraorbital artery. PMID:29349355

  10. Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications.

    PubMed

    Wilcox, Susan R; Bittner, Edward A; Elmer, Jonathan; Seigel, Todd A; Nguyen, Nicole Thuy P; Dhillon, Anahat; Eikermann, Matthias; Schmidt, Ulrich

    2012-06-01

    Emergent intubation is associated with a high rate of complications. Neuromuscular blocking agents are routinely used in the operating room and emergency department to facilitate intubation. However, use of neuromuscular blocking agents during emergent airway management outside of the operating room and emergency department is controversial. We hypothesized that the use of neuromuscular blocking agents is associated with a decreased prevalence of hypoxemia and reduced rate of procedure-related complications. Five hundred sixty-six patients undergoing emergent intubations in two tertiary care centers, Massachusetts General Hospital, Boston, MA, and the University of California Los Angeles, Ronald Reagan Medical Center, Los Angeles, CA, were enrolled in a prospective, observational study. The 112 patients intubated during cardiopulmonary resuscitation were excluded, leaving 454 patients for analysis. All intubations were supervised by attendings trained in Critical Care Medicine. We measured intubating conditions, oxygen saturation during and 5 mins following intubation. We assessed the prevalence of procedure-related complications defined as esophageal intubation, traumatic intubation, aspiration, dental injury, and endobronchial intubation. The use of neuromuscular blocking agents was associated with a lower prevalence of hypoxemia (10.1% vs. 17.4%, p = .022) and a lower prevalence of procedure-related complications (3.1% vs. 8.3%, p = .012). This association persisted in a multivariate analysis, which controlled for airway grade, sedation, and institution. Use of neuromuscular blocking agents was associated with significantly improved intubating conditions (laryngeal view, p = .014; number of intubation attempts, p = .049). After controlling for the number of intubation attempts and laryngoscopic view, muscle relaxant use is an independent predictor of complications associated with emergency intubation (p = .037), and there is a trend towards improvement of

  11. Peripheral nerve blocks in shoulder arthroplasty: how do they influence complications and length of stay?

    PubMed

    Stundner, Ottokar; Rasul, Rehana; Chiu, Ya-Lin; Sun, Xuming; Mazumdar, Madhu; Brummett, Chad M; Ortmaier, Reinhold; Memtsoudis, Stavros G

    2014-05-01

    Regional anesthesia has proven to be a highly effective technique for pain control after total shoulder arthroplasty. However, concerns have been raised about the safety of upper-extremity nerve blocks, particularly with respect to the incidence of perioperative respiratory and neurologic complications, and little is known about their influence, if any, on length of stay after surgery. Using a large national cohort, we asked: (1) How frequently are upper-extremity peripheral nerve blocks added to general anesthesia in patients undergoing total shoulder arthroplasty? (2) Are there differences in the incidence of and adjusted risk for major perioperative complications and mortality between patients receiving general anesthesia with and without nerve blocks? And (3) does resource utilization (blood product transfusion, intensive care unit admission, length of stay) differ between groups? We searched a nationwide discharge database for patients undergoing total shoulder arthroplasty under general anesthesia with or without addition of a nerve block. Groups were compared with regard to demographics, comorbidities, major perioperative complications, and length of stay. Multivariable logistic regressions were performed to measure complications and resource use. A negative binomial regression was fitted to measure length of stay. We identified 17,157 patients who underwent total shoulder arthroplasty between 2007 and 2011. Of those, approximately 21% received an upper-extremity peripheral nerve block in addition to general anesthesia. Patients receiving combined regional-general anesthesia had similar mean age (68.6 years [95% CI: 68.2-68.9 years] versus 69.1 years [95% CI: 68.9-69.3 years], p < 0.0043), a slightly lower mean Deyo (comorbidity) index (0.87 versus 0.93, p = 0.0052), and similar prevalence of individual comorbidities, compared to those patients receiving general anesthesia only. Addition of regional anesthesia was not associated with different odds ratios

  12. Efficacy and complications associated with a modified inferior alveolar nerve block technique. A randomized, triple-blind clinical trial

    PubMed Central

    Montserrat-Bosch, Marta; Nogueira-Magalhães, Pedro; Arnabat-Dominguez, Josep; Valmaseda-Castellón, Eduard; Gay-Escoda, Cosme

    2014-01-01

    Objectives: To compare the efficacy and complication rates of two different techniques for inferior alveolar nerve blocks (IANB). Study Design: A randomized, triple-blind clinical trial comprising 109 patients who required lower third molar removal was performed. In the control group, all patients received an IANB using the conventional Halsted technique, whereas in the experimental group, a modified technique using a more inferior injection point was performed. Results: A total of 100 patients were randomized. The modified technique group showed a significantly higher onset time in the lower lip and chin area, and was frequently associated to a lingual electric discharge sensation. Three failures were recorded, 2 of them in the experimental group. No relevant local or systemic complications were registered. Conclusions: Both IANB techniques used in this trial are suitable for lower third molar removal. However, performing an inferior alveolar nerve block in a more inferior position (modified technique) extends the onset time, does not seem to reduce the risk of intravascular injections and might increase the risk of lingual nerve injuries. Key words:Dental anesthesia, inferior alveolar nerve block, lidocaine, third molar, intravascular injection. PMID:24608204

  13. Efficacy and complications associated with a modified inferior alveolar nerve block technique. A randomized, triple-blind clinical trial.

    PubMed

    Montserrat-Bosch, Marta; Figueiredo, Rui; Nogueira-Magalhães, Pedro; Arnabat-Dominguez, Josep; Valmaseda-Castellón, Eduard; Gay-Escoda, Cosme

    2014-07-01

    To compare the efficacy and complication rates of two different techniques for inferior alveolar nerve blocks (IANB). A randomized, triple-blind clinical trial comprising 109 patients who required lower third molar removal was performed. In the control group, all patients received an IANB using the conventional Halsted technique, whereas in the experimental group, a modified technique using a more inferior injection point was performed. A total of 100 patients were randomized. The modified technique group showed a significantly higher onset time in the lower lip and chin area, and was frequently associated to a lingual electric discharge sensation. Three failures were recorded, 2 of them in the experimental group. No relevant local or systemic complications were registered. Both IANB techniques used in this trial are suitable for lower third molar removal. However, performing an inferior alveolar nerve block in a more inferior position (modified technique) extends the onset time, does not seem to reduce the risk of intravascular injections and might increase the risk of lingual nerve injuries.

  14. Retrospective analysis of risk factors and predictors of intraoperative complications in neuraxial blocks at Faculdade de Medicina de Botucatu-UNESP.

    PubMed

    Pereira, Ivan Dias Fernandes; Grando, Marcela Miguel; Vianna, Pedro Thadeu Galvão; Braz, José Reinaldo Cerqueira; Castiglia, Yara Marcondes Machado; Vane, Luís Antônio; Módolo, Norma Sueli Pinheiro; do Nascimento, Paulo; Amorim, Rosa Beatriz; Rodrigues, Geraldo Rolim; Braz, Leandro Gobbo; Ganem, Eliana Marisa

    2011-01-01

    Cardiovascular changes associated with neuraxial blocks are a cause of concern due to their frequency and because some of them can be considered physiological effects triggered by the sympathetic nervous system blockade. The objective of this study was to evaluate intraoperative cardiovascular complications and predictive factors associated with neuraxial blocks in patients ≥ 18 years of age undergoing non-obstetric procedures over an 18-year period in a tertiary university hospital--HCFMB-UNESP. A retrospective analysis of the following complications was undertaken: hypertension, hypotension, sinus bradycardia, and sinus tachycardia. These complications were correlated with anesthetic technique, physical status (ASA), age, gender, and preoperative co-morbidities. The Tukey test for comparisons among proportions and logistic regression was used for statistical analysis. 32,554 patients underwent neuraxial blocks. Intraoperative complications mentioned included hypotension (n=4,109), sinus bradycardia (n=1,107), sinus tachycardia (n=601), and hypertension (n=466). Hypotension was seen more often in patients undergoing continuous subarachnoid anesthesia (29.4%, OR=2.39), ≥ 61 years of age, and female (OR=1.27). Intraoperative hypotension and bradycardia were the complications observed more often. Hypotension was related to anesthetic technique (CSA), increased age, and female. Tachycardia and hypertension may not have been directly related to neuraxial blocks. Copyright © 2011 Elsevier Editora Ltda. All rights reserved.

  15. Needle in the external auditory canal: an unusual complication of inferior alveolar nerve block.

    PubMed

    Ribeiro, Leandro; Ramalho, Sara; Gerós, Sandra; Ferreira, Edite Coimbra; Faria e Almeida, António; Condé, Artur

    2014-06-01

    Inferior alveolar nerve block is used to anesthetize the ipsilateral mandible. The most commonly used technique is one in which the anesthetic is injected directly into the pterygomandibular space, by an intraoral approach. The fracture of the needle, although uncommon, can lead to potentially serious complications. The needle is usually found in the pterygomandibular space, although it can migrate and damage adjacent structures, with variable consequences. The authors report an unusual case of a fractured needle, migrating to the external auditory canal, as a result of an inferior alveolar nerve block. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. The V-Y flap technique in complicated and recurrent pilonidal sinus disease.

    PubMed

    Koca, Yavuz Savas; Yıldız, Ihsan; Ugur, Mustafa; Barut, Ibrahim

    2018-01-01

    This study presents early and long term (5 years) outcome of 61 complicated pilonidal sinus disease cases undergoing V-Y advancement flap method together with the literature data. Data of 336 patients undergoing surgery for pilonidal sinus disease between 2008 and 2012 were retrospectively analyzed. Patients with defect size ≥ 10 cm, and more than one subcutaneous sinus tunnels were assumed to have complicated pilonidal sinus disease. A total of 61 patients were included in the study. Age, gender, type of surgery, duration of hospitalization, time of drain removal, pre-operative complications, and relapse rates at post-operative 5th year were analyzed. Of the 66 patients, 51 underwent unilateral V-Y advancement and 10 patients had bilateral V-Y plasty. Mean duration of operations was 66.87±18.37 minutes for total, 61.02±12.30 minutes for unilateral V-Y plasty, and 96.70±15.04 minutes for bilateral V-Y plasty. Hemovac drains were removed at 5.59±1.91 days averagely, 5.16±1.37 in unilateral group, and 7.80±2.74 in bilateral V-Y plasty group. Of the 4 patients who developed wound site infection, 2 had unilateral and 2 had bilateral V-Y flap advancement. Postoperative hematomas developed in 2 patients with unilateral flap and one patient with bilateral flapss. Seroma occurred in 2 patients with unilateral flap and one patient with bilateral flaps. Dehiscence developed two patients, one patient from each group. The mean duration of hosptalization was 5.98±2.21 days; 5.49±1.52 in unilateral group, and 8.50±3.34 in bilateral group. Early or late relapse was not seen in any groups. V-Y advancement flap technique can be applied as an efficient method in the treatment of complicated pilonidal sinus disease due to low relapse and complication rates. Advancement flap, Complicated pilonidal sinus, Pilonidal sinus, V-Y flap.

  17. 77 FR 42749 - Proposed Change in State Title V Maternal and Child Health Block Grant Allocations

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-20

    ... Change in State Title V Maternal and Child Health Block Grant Allocations AGENCY: Health Resources and... the State Title V Maternal and Child Health (MCH) Block Grant allocations. Through the Health Resources and Services Administration's Maternal and Child Health Bureau (MCHB), Title V MCH Block Grant...

  18. Complete A-V block: incidental or a part of cor triatriatum dexter.

    PubMed

    Guler, Y; Akgun, T; Toprak, C; Guler, A; Esen, A M

    2014-05-01

    Cor triatriatum dexter (CTD) is an extremely rare cardiac anomaly in which the right atrium is divided into two distinct chambers by a membrane. The persistence of the right valve of sinus venosus results in a complete septation of the right atrium. This anomaly is frequently associated with other right-sided cardiac abnormalities. Its clinical manifestation and the need for intervention are determined by the number and the size of the fenestrations on the membrane, associated cardiac anomalies and arrhythmias. We describe a case of CTD in a patient with complete atrioventricular (A-V) block.

  19. Paroxysmal atrioventricular block: Electrophysiological mechanism of phase 4 conduction block in the His-Purkinje system: A comparison with phase 3 block.

    PubMed

    Shenasa, Mohammad; Josephson, Mark E; Wit, Andrew L

    2017-11-01

    Paroxysmal atrioventricular (A-V) block is relatively rare, and due to its transient nature, it is often under recognized. It is often triggered by atrial, junctional, or ventricular premature beats, and occurs in the presence of a diseased His-Purkinje system (HPS). Here, we present a 45-year-old white male who was admitted for observation due to recurrent syncope and near-syncope, who had paroxysmal A-V block. The likely cellular electrophysiological mechanisms(s) of paroxysmal A-V block and its differential diagnosis and management are discussed. Continuous electrocardiographic monitoring was done while the patient was in the cardiac unit. Multiple episodes of paroxysmal A-V block were documented in this case. All episodes were initiated and terminated with atrial/junctional premature beats. The patient underwent permanent pacemaker implantation and has remained asymptomatic since then. Paroxysmal A-V block is rare and often causes syncope or near-syncope. Permanent pacemaker implantation is indicated according to the current guidelines. Paroxysmal A-V block occurs in the setting of diseased HPS and is bradycardia-dependent. The detailed electrophysiological mechanisms, which involve phase 4 diastolic depolarization, and differential diagnosis are discussed. © 2017 Wiley Periodicals, Inc.

  20. Asleep versus awake: does it matter?: Pediatric regional block complications by patient state: a report from the Pediatric Regional Anesthesia Network.

    PubMed

    Taenzer, Andreas H; Walker, Benjamin J; Bosenberg, Adrian T; Martin, Lynn; Suresh, Santhanam; Polaner, David M; Wolf, Christie; Krane, Elliot J

    2014-01-01

    The impact of the patient state at time of placement of regional blocks on the risk of complications is unknown. Current opinion is based almost entirely on case reports, despite considerable interest in the question. Analyzing more than 50,000 pediatric regional anesthesia blocks from an observational prospective database, we determined the rate of adverse events in relation to the patient's state at the time of block placement. Primary outcomes considered were postoperative neurologic symptoms (PONSs) and local anesthetic systemic toxicity (LAST). Secondary outcome was extended hospital stay due to a block complication. The Pediatric Regional Anesthesia Network is a multi-institutional research consortium that was created with an emphasis on rigorous, prospective, and complete data collection including a data validation and audit process. For the purpose of the analysis, blocks were divided in major groups by single injection versus continuous and by block location. Rates were determined in aggregate for these groups and classified further based on the patient's state (general anesthesia [GA] without neuromuscular blockade [NMB], GA with NMB, sedated, and awake) at the time of block placement. Postoperative neurological symptoms occurred at a rate of 0.93/1000 (confidence interval [CI], 0.7-1.2) under GA and 6.82/1000 (CI, 4.2-10.5) in sedated and awake patients. The only occurrence of PONSs lasting longer than 6 months (PONSs-L) was a small sensory deficit in a sedated patient (0.019/1000 [CI, 0-0.1] for all, 0.48/1000 [CI, 0.1-2.7] for sedated patients). There were no cases of paralysis. There were 5 cases of LAST or 0.09/1000 (CI, 0.03-0.21). The incidence of LAST in patients under GA (both with and without NMB) was 0.08/1000 (CI, 0.02-0.2) and 0.34/1000 (CI, 0-1.9) in awake/sedated patients. Extended hospital stays were described 18 times (0.33/1000 [CI, 0.2-0.53]). The rate for patients under GA without NMB was 0.29/1000 (CI, 0.13-0.48); GA with NMB, 0

  1. Abnormal Q waves in right sided chest leads provoked by onset of right bundle-branch block in patients with anteroseptal infarction.

    PubMed Central

    Rosenbaum, M B; Girotti, L A; Lázzari, J O; Halpern, M S; Elizari, M V

    1982-01-01

    In five cases of anteroseptal myocardial infarction complicated by intermittent right bundle-branch block, the onset of right bundle-branch block provoked the appearance of abnormal Q waves in leads V1 and V2, whereas a small initial R wave was present in the same leads during normal conduction. The intermittency of the conduction disturbance indicated that the Q waves were "right bundle-branch block dependent". It was also apparent that right bundle-branch block shifted the electrical location of the infarct towards the right, and made it look much larger. Right bundle-branch block dependent Q waves may arise during the acute stage of an anterior infarct suggesting, fallaciously, that an acute extension has occurred, or during the chronic stage, leading to the erroneous supposition that a new infarct had developed. The abnormal Q waves anteroseptal infarction complicated by fixed right bundle-branch block, though obviously related to the infarct, may be dependent on the right bundle-branch block. PMID:7059400

  2. Sinoatrial block complicating legionnaire's disease.

    PubMed

    Medarov, B; Tongia, S; Rossoff, L

    2003-11-01

    A 59 year old woman presented with acute onset of fever, chills, diaphoresis, vague chest discomfort, and was found to be hypotensive and tachypnoeic. An electrocardiogram demonstrated sinoatrial block with a junctional rhythm between 50 and 80 beats/min. All cultures were negative and imaging studies unrevealing. Her urine tested positive for Legionella pneumophila antigen serotype 1 and she improved with antibiotic therapy.

  3. 31 CFR Appendix A to Chapter V - Information Pertaining to the Specially Designated Nationals and Blocked Persons List

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... Specially Designated Nationals and Blocked Persons List A Appendix A to Chapter V Money and Finance... OF THE TREASURY Ch. V, App. A Appendix A to Chapter V—Information Pertaining to the Specially... the economic sanctions programs in chapter V. 6. Specific licenses previously issued by OFAC may...

  4. 77 FR 22575 - The Auction Block Company, an Alaska Corporation v. the City of Homer, a Municipal Corporation...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-16

    ... FEDERAL MARITIME COMMISSION [Docket No. 12-03] The Auction Block Company, an Alaska Corporation v. the City of Homer, a Municipal Corporation and Its Port of Homer; Notice of Filing of Complaint and...) by The Auction Block Company, an Alaska Corporation, hereinafter ``Complainant,'' against the City of...

  5. K + block is the mechanism of functional asymmetry in bacterial Na v channels

    DOE PAGES

    Ngo, Van; Wang, Yibo; Haas, Stephan; ...

    2016-01-04

    Crystal structures of several bacterial Na v channels have been recently published and molecular dynamics simulations of ion permeation through these channels are consistent with many electrophysiological properties of eukaryotic channels. Bacterial Na v channels have been characterized as functionally asymmetric, and the mechanism of this asymmetry has not been clearly understood. To address this question, we combined non-equilibrium simulation data with two-dimensional equilibrium unperturbed landscapes generated by umbrella sampling and Weighted Histogram Analysis Methods for multiple ions traversing the selectivity filter of bacterial Na vAb channel. This approach provided new insight into the mechanism of selective ion permeation inmore » bacterial Nav channels. The non-equilibrium simulations indicate that two or three extracellular K + ions can block the entrance to the selectivity filter of Na vAb in the presence of applied forces in the inward direction, but not in the outward direction. The block state occurs in an unstable local minimum of the equilibrium unperturbed free-energy landscape of two K+ ions that can be ‘locked’ in place bymodest applied forces. In contrast to K +, three Na + ions move favorably through the selectivity filter together as a unit in a loose “knock-on” mechanism of permeation in both inward and outward directions, and there is no similar local minimum in the two-dimensional free-energy landscape of two Na + ions for a block state. The useful work predicted by the non-equilibrium simulations that is required to break the K + block is equivalent to large applied potentials experimentally measured for two bacterial Na v channels to induce inward currents of K + ions. Here, these results illustrate how inclusion of non-equilibrium factors in the simulations can provide detailed information about mechanisms of ion selectivity that is missing from mechanisms derived from either crystal structures or equilibrium unperturbed

  6. Measles virus V protein blocks Jak1-mediated phosphorylation of STAT1 to escape IFN-{alpha}/{beta} signaling

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Caignard, Gregory; Guerbois, Mathilde; Labernardiere, Jean-Louis

    2007-11-25

    Viruses have evolved various strategies to escape the antiviral activity of type I interferons (IFN-{alpha}/{beta}). For measles virus, this function is carried by the polycistronic gene P that encodes, by an unusual editing strategy, for the phosphoprotein P and the virulence factor V (MV-V). MV-V prevents STAT1 nuclear translocation by either sequestration or phosphorylation inhibition, thereby blocking IFN-{alpha}/{beta} pathway. We show that both the N- and C-terminal domains of MV-V (PNT and VCT) contribute to the inhibition of IFN-{alpha}/{beta} signaling. Using the two-hybrid system and co-affinity purification experiments, we identified STAT1 and Jak1 as interactors of MV-V and demonstrate thatmore » MV-V can block the direct phosphorylation of STAT1 by Jak1. A deleterious mutation within the PNT domain of MV-V (Y110H) impaired its ability to interact and block STAT1 phosphorylation. Thus, MV-V interacts with at least two components of IFN-{alpha}/{beta} receptor complex to block downstream signaling.« less

  7. Reversible second degree atrioventricular block after a severe sickle cell crisis.

    PubMed

    Jaeggi, E; Bolens, M; Friedli, B

    1998-01-01

    Despite the high prevalence of sickle cell disease and trait in the black population and its serious potential for microinfarction, there are only a few reports on acute myocardial damage during vasoocclusive crisis. We report a unique case of transient second degree atrioventricular (A-V) block of Mobitz I and II type during a severe sickle cell crisis. Localized high ventricular septum hypoperfusion demonstrated by a 99mTc-MIBI radionuclide study and reversible echocardiographic wall motion abnormalities in the same area were strong indicators for a local ischemic event in the A-V node and His bundle area, explaining the observed transient conduction abnormalities. The present report draws attention to a potentially lethal complication of sickle cell crisis.

  8. Comparison of Continuous Femoral Nerve Block with and Without Combined Sciatic Nerve Block after Total Hip Arthroplasty: A Prospective Randomized Study.

    PubMed

    Nishio, Shoji; Fukunishi, Shigeo; Fukui, Tomokazu; Fujihara, Yuki; Okahisa, Shohei; Takeda, Yu; Yoshiya, Shinichi

    2017-06-23

    In association with the growing interests in pain management, several modalities to control postoperative pain have been proposed and examined for the efficacy in the recent studies. Various modes of peripheral nerve block have been proposed and the effectiveness and safety have been examined for each of those techniques. We have described our clinical experiences, showing that continuous femoral nerve block could provide a satisfactory analgesic effect after total hip arthroplasty (THA) procedure. In this study, we compared the effectiveness and safety of continuous femoral nerve block with and without sciatic nerve blockade on pain control after THA. Forty patients scheduled for THA were included in the study and randomly divided into 2 groups. Postoperative analgesic measure was continuous femoral nerve block alone, while the identical regimen of continuous femoral nerve block was combined with sciatic nerve block. The amount of postoperative pain was evaluated in the immediate postoperative period, 6 hours, and 12 hours after surgery. Moreover, postoperative complications as well as requirement of supplemental analgesics during the initial 12 hours after surgery were reviewed in the patient record. The obtained study results showed that the supplemental sciatic nerve blockade provided no significant effect on arrival at the postoperative recovery room, while the NRS pain score was significantly reduced by the combined application of sciatic nerve blockade at 6 and 12 hours after surgery. In the investigation of postoperative analgesiarelated complications, no major complication was encountered without significant difference in complication rate between the groups.

  9. Pectoral nerve block (Pecs block) with sedation for breast conserving surgery without general anesthesia

    PubMed Central

    Moon, Eun-Jin; Kim, Seung-Beom; Chung, Jun-Young; Song, Jeong-Yoon

    2017-01-01

    Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries. PMID:28932733

  10. Pectoral nerve block (Pecs block) with sedation for breast conserving surgery without general anesthesia.

    PubMed

    Moon, Eun-Jin; Kim, Seung-Beom; Chung, Jun-Young; Song, Jeong-Yoon; Yi, Jae-Woo

    2017-09-01

    Most regional anesthesia in breast surgeries is performed as postoperative pain management under general anesthesia, and not as the primary anesthesia. Regional anesthesia has very few cardiovascular or pulmonary side-effects, as compared with general anesthesia. Pectoral nerve block is a relatively new technique, with fewer complications than other regional anesthesia. We performed Pecs I and Pec II block simultaneously as primary anesthesia under moderate sedation with dexmedetomidine for breast conserving surgery in a 49-year-old female patient with invasive ductal carcinoma. Block was uneventful and showed no complications. Thus, Pecs block with sedation could be an alternative to general anesthesia for breast surgeries.

  11. Complications with the MICRA TPS Pacemaker System: Persistent Complete Heart Block and Late Capture Failure.

    PubMed

    Holm, Niels; Müller, Andreas; Zbinden, Rainer

    2017-04-01

    A Medtronic MICRA transcatheter pacing system (Medtronic, Minneapolis, MN, USA) was implanted in an 86-year-old patient with sick sinus syndrome and left bundle branch block after transfemoral aortic valve implantation. During implantation she developed a persistent complete heart block due to manipulation with the large-bore delivery catheter. Two weeks later, acute pacemaker dysfunction occurred due to massive increase of pacing threshold and impedance without obvious pacemaker dislocation or myocardial perforation. Recurrent capture failure was seen with pacing output set at 5 V/1.0 ms. Hence, microdislocation or fixation of the tines in the right ventricular trabeculae has to be assumed. © 2016 Wiley Periodicals, Inc.

  12. The selective V1a receptor agonist selepressin (FE 202158) blocks vascular leak in ovine severe sepsis

    PubMed Central

    Wiśniewska, Halina; Traber, Lillian D.; Lin, ChiiDean; Fan, Juanjuan; Hawkins, Hal K.; Cox, Robert A.; Wiśniewski, Kazimierz; Schteingart, Claudio D.; Landry, Donald W.; Rivière, Pierre J.-M.; Traber, Daniel L.

    2014-01-01

    Objective To determine if the selective vasopressin type 1a receptor (V1aR) agonist selepressin (FE 202158) is as effective as the mixed V1a/V2 receptor (V1aR/V2R) agonist vasopressor hormone arginine vasopressin (AVP) when used as a titrated first-line vasopressor therapy in an ovine model of Pseudomonas aeruginosa pneumonia-induced severe sepsis. Design Prospective, randomized, controlled laboratory experiment. Setting University animal research facility. Subjects Forty-five chronically instrumented sheep. Interventions Sheep were anesthetized, insufflated with cooled cotton smoke via tracheostomy, and P. aeruginosa were instilled into their airways. They were then placed on assisted ventilation, awakened, and resuscitated with lactated Ringer's solution titrated to maintain hematocrit ± 3% from baseline levels. If, despite fluid management, mean arterial pressure (MAP) fell by > 10 mm Hg from baseline levels, a continuous i.v. infusion of AVP or selepressin was titrated to raise and maintain MAP within 10 mm Hg of baseline. Effects of combination treatment of selepressin with the selective V2R agonist desmopressin were similarly investigated. Measurements and Main Results In septic sheep, MAP fell by ~30 mm Hg, systemic vascular resistance index (SVRI) decreased by ~50%, and ~7 L of fluid were retained over 24 h; this fluid accumulation was partially reduced by AVP and almost completely blocked by selepressin; combined infusion of selepressin and desmopressin increased fluid accumulation to levels similar to AVP treatment. Conclusions Resuscitation with the selective V1aR agonist selepressin blocked vascular leak more effectively than the mixed V1aR/V2R agonist AVP because of its lack of agonist activity at the V2R. PMID:24674922

  13. Transperitoneal rectus sheath block and transversus abdominis plane block for laparoscopic inguinal hernia repair: A novel approach.

    PubMed

    Nagata, Jun; Watanabe, Jun; Nagata, Masato; Sawatsubashi, Yusuke; Akiyama, Masaki; Tajima, Takehide; Arase, Koichi; Minagawa, Noritaka; Torigoe, Takayuki; Nakayama, Yoshifumi; Horishita, Reiko; Kida, Kentaro; Hamada, Kotaro; Hirata, Keiji

    2017-08-01

    A laparoscopic approach for inguinal hernia repair is now considered the gold standard. Laparoscopic surgery is associated with a significant reduction in postoperative pain. Epidural analgesia cannot be used in patients with perioperative anticoagulant therapy because of complications such as epidural hematoma. As such, regional anesthetic techniques, such as ultrasound-guided rectus sheath block and transversus abdominis plane block, have become increasingly popular. However, even these anesthetic techniques have potential complications, such as rectus sheath hematoma, if vessels are damaged. We report the use of a transperitoneal laparoscopic approach for rectus sheath block and transversus abdominis plane block as a novel anesthetic procedure. An 81-year-old woman with direct inguinal hernia underwent laparoscopic transabdominal preperitoneal inguinal repair. Epidural anesthesia was not performed because anticoagulant therapy was administered. A Peti-needle™ was delivered through the port, and levobupivacaine was injected though the peritoneum. Surgery was performed successfully, and the anesthetic technique did not affect completion of the operative procedure. The patient was discharged without any complications. This technique was feasible, and the procedure was performed safely. Our novel analgesia technique has potential use as a standard postoperative regimen in various laparoscopic surgeries. Additional prospective studies to compare it with other techniques are required. © 2017 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and John Wiley & Sons Australia, Ltd.

  14. Modified round block mastopexy versus traditional round block mastopexy.

    PubMed

    Sterodimas, A; Nicaretta, B; Boriani, F

    2015-01-01

    Breast ptosis may be caused by several factors, including significant weight loss, pregnancy, long breastfeeding periods, and involution of the postmenopausal breast tissue. The authors performed a prospective study to evaluate patient satisfaction and the rate of complications after modified round block mastopexy versus traditional round block mastopexy. Forty-four patients fulfilled the inclusion criteria for undergoing round block mastopexy in a prospective randomized controlled study performed from 2007 to 2008. All the patients received polyurethane silicone implants. Group A included patients who underwent the traditional round block technique described by Benelli. Group B included patients who underwent the traditional round block and 4 cardinal glando-glandular permanent sutures. The overall satisfaction with body appearance after breast mastopexy was rated on a scale of 1 (poor), 2 (fair), 3 (good), 4 (very good), and 5 (excellent). Group A patient ages ranged from 28 to 52 years and in Group B ranged from 29 to 49 years. The mean implant volume was 215 cc in both Groups. The complication and satisfaction rates for both Groups are reported. The combination of the cardinal glandulo-glandular sutures along with the traditional round block appears to be key to preventing the areolar enlargement and persistent breast ptosis. The satisfaction rates in patients who underwent the modified round mastopexy appear superior when compared to the traditional round block mastopexy. Furhter long-term follow-up need to be performed in order to confirm the favorable results seen in this series of cases.

  15. A Characterization of BIB Designs Based on v Treatments in Blocks of Size k Whose Number of Blocks is at Least vCk.

    DTIC Science & Technology

    1981-01-01

    Discrete Math . 6, 189-200. Foody, W. and A. Hedayat, (1977). On theory and applications of BIB designs with repeated blocks. Ann. Statist. 5, i •, 932...945. Corrections: Ann. Statist. 7 (1979). 925. van Lint, J.I1. and H.J. Ryser (1972). Block designs with repeated blocks. Discrete Math ., 3, 381-396

  16. Erector spinae plane (ESP) block in the management of post thoracotomy pain syndrome: A case series.

    PubMed

    Forero, Mauricio; Rajarathinam, Manikandan; Adhikary, Sanjib; Chin, Ki Jinn

    2017-10-01

    analgesic benefit lasting 2 weeks or more. The ESP blocks were combined with optimization of multimodal analgesia, resulting in significant improvement in the pain experience in all patients. No complications related to the blocks were seen. The results observed in this case series indicate that the ESP block may be a valuable therapeutic option in the management of PTPS. Its immediate analgesic efficacy provides patients with temporary symptomatic relief while other aspects of chronic pain management are optimized, and it may also often confer prolonged analgesia. The relative simplicity and safety of the ESP block offer advantages over other interventional procedures for thoracic pain; there are few contraindications, the risk of serious complications (apart from local anesthetic systemic toxicity) is minimal, and it can be performed in an outpatient clinic setting. This, combined with the immediate and profound analgesia that follows the block, makes it an attractive option in the management of intractable chronic thoracic pain. The ESP block may also be applied to management of acute pain management following thoracotomy or thoracic trauma (e.g. rib fractures), with similar analgesic benefits expected. Further studies to validate our observations are warranted. Copyright © 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  17. Dilute group III-V nitride intermediate band solar cells with contact blocking layers

    DOEpatents

    Walukiewicz, Wladyslaw; Yu, Kin Man

    2015-02-24

    An intermediate band solar cell (IBSC) is provided including a p-n junction based on dilute III-V nitride materials and a pair of contact blocking layers positioned on opposite surfaces of the p-n junction for electrically isolating the intermediate band of the p-n junction by blocking the charge transport in the intermediate band without affecting the electron and hole collection efficiency of the p-n junction, thereby increasing open circuit voltage (V.sub.OC) of the IBSC and increasing the photocurrent by utilizing the intermediate band to absorb photons with energy below the band gap of the absorber layers of the IBSC. Hence, the overall power conversion efficiency of a IBSC will be much higher than an conventional single junction solar cell. The p-n junction absorber layers of the IBSC may further have compositionally graded nitrogen concentrations to provide an electric field for more efficient charge collection.

  18. Dilute Group III-V nitride intermediate band solar cells with contact blocking layers

    DOEpatents

    Walukiewicz, Wladyslaw [Kensington, CA; Yu, Kin Man [Lafayette, CA

    2012-07-31

    An intermediate band solar cell (IBSC) is provided including a p-n junction based on dilute III-V nitride materials and a pair of contact blocking layers positioned on opposite surfaces of the p-n junction for electrically isolating the intermediate band of the p-n junction by blocking the charge transport in the intermediate band without affecting the electron and hole collection efficiency of the p-n junction, thereby increasing open circuit voltage (V.sub.OC) of the IBSC and increasing the photocurrent by utilizing the intermediate band to absorb photons with energy below the band gap of the absorber layers of the IBSC. Hence, the overall power conversion efficiency of a IBSC will be much higher than an conventional single junction solar cell. The p-n junction absorber layers of the IBSC may further have compositionally graded nitrogen concentrations to provide an electric field for more efficient charge collection.

  19. Ganglion blocks as a treatment of pain: current perspectives

    PubMed Central

    Gunduz, Osman Hakan; Kenis-Coskun, Ozge

    2017-01-01

    The inputs from sympathetic ganglia have been known to be involved in the pathophysiology of various painful conditions such as complex regional pain syndrome, cancer pain of different origin, and coccygodynia. Sympathetic ganglia blocks are used to relieve patients who suffer from these conditions for over a century. Many numbers of local anesthetics such as bupivacaine or neurolytic agents such as alcohol can be chosen for a successful block. The agent is selected according to its duration of effect and the purpose of the injection. Most commonly used sympathetic blocks are stellate ganglion block, lumbar sympathetic block, celiac plexus block, superior hypogastric block, and ganglion Impar block. In this review, indications, methods, effectiveness, and complications of these blocks are discussed based on the data from the current literature. PMID:29276402

  20. Transformation of the title V maternal and child health services block grant.

    PubMed

    Lu, Michael C; Lauver, Cassie B; Dykton, Christopher; Kogan, Michael D; Lawler, Michele H; Raskin-Ramos, Lauren; Watters, Kathy; Wilson, Lee A

    2015-05-01

    This paper describes the transformation of the Title V Maternal and Child Health (MCH) Services Block Grant. The Maternal and Child Health Bureau of the Health Resources and Services Administration led a 21-month visioning process to engage input from MCH stakeholders and other national, state and local MCH leaders, families and other partners to improve, innovate, and transform the Title V MCH Services Block Grant. The process has helped inform the development of a new grant guidance for the next 5-year cycle beginning in fiscal year 2016. The triple aims of the transformation are to reduce burden, maintain flexibility, and increase accountability. State reporting burden is reduced by aligning and streamlining the needs assessment, annual report and application, reducing the number of forms States have to fill out, eliminating Health Systems Capacity Indicators, and prepopulating the annual report and application with State data using national data sources. State flexibility is maintained through the needs assessment process whereby State needs and priorities drive the selection of National Performance Measures and State-specific Performance Measures, and the development of State Action Plan and Evidence-based/informed Strategy Measures. Accountability is increased through the new three-tiered performance measurement framework, which will help States tell a more coherent and compelling story about the impact of Title V on the health of the Nation's mothers, children, and families. The ultimate success of the transformation will be measured by how much the transformed Title V program moves the needle in MCH in the States and for the Nation.

  1. Analgesia before a spinal block for femoral neck fracture: fascia iliaca compartment block.

    PubMed

    Yun, M J; Kim, Y H; Han, M K; Kim, J H; Hwang, J W; Do, S H

    2009-11-01

    In this prospective randomized study, the authors compared the analgesic effect of a fascia iliaca compartment (FIC) block with that of intravenous (i.v.) alfentanil when administered to facilitate positioning for spinal anaesthesia in elderly patients undergoing surgery for a femoral neck fracture. The 40 patients were randomly assigned to one of two groups, namely, the FIC group (fascia iliaca compartment block, n=20) and the IVA group (intravenous analgesia with alfentanil, n=20). Group IVA patients received a bolus dose of i.v. alfentanil 10 microg/kg, followed by a continuous infusion of alfentanil 0.25 microg/kg/min starting 2 min before the spinal block, and group FIC patients received a FIC block with 30 ml of ropivacaine 3.75 mg/ml (112.5 mg) 20 min before the spinal block. Visual analogue pain scale (VAS) scores, time to achieve spinal anaesthesia, quality of patient positioning, and patient acceptance were compared. VAS scores during positioning (mean and range) were lower in the FIC group than in the IVA group [2.0 (1-4) vs. 3.5 (2-6), P=0.001], and the mean (+/- SD) time to achieve spinal anaesthesia was shorter in the FIC group (6.9 +/- 2.7 min vs. 10.8 +/- 5.6 min; P=0.009). Patient acceptance (yes/no) was also better in the FIC group (19/1) than in the IVA group (12/8)(P=0.008). An FIC block is more efficacious than i.v. alfentanil in terms of facilitating the lateral position for spinal anaesthesia in elderly patients undergoing surgery for femoral neck fractures.

  2. Systemic morphine blocks the seizures induced by intracerebroventricular (i.c.v.) injections of opiates and opioid peptides.

    PubMed

    Urca, G; Frenk, H

    1982-08-19

    Intracerebroventricular (i.c.v.) injections of the endorphins and of morphine in rats produce highly characteristic, naloxone sensitive, electrographic seizures. In contrast, systemic injections of morphine have been shown to exert a marked anticonvulsant effect. The present study demonstrates that systemic morphine pretreatment can prevent the occurrence of electrographic seizures injected by i.c.v. morphine, Leu-enkephalin and beta-endorphin and that the anti-epileptic effect of morphine can be reversed by naloxone. Male albino rats, previously prepared for chronic i.c.v. injections and EEG recordings, were pretreated with 0--100 mg/kg of intraperitoneal (i.p.) morphine. Thirty five minutes later morphine (520 nmol), Leu-enkephalin (80 nmol) or beta-endorphin (5 nmol) were injected i.c.v. Pretreatment with i.p. morphine blocked the occurrence of seizures induced by morphine and both endogenous opioids. Lower doses of systemic morphine (50 mg/kg) were necessary to block i.c.v. morphine seizures than the dose (100 mg/kg) necessary to block seizures induced by i.c.v. Leu-enkephalin and beta-endorphin. Naloxone (1 mg/kg) administered 25 min following 50 mg/kg of i.p. morphine and preceding the injections of i.c.v. morphine reversed the antiepileptic effect of systemic morphine. These results demonstrate the possible existence of two opiate sensitive systems, one with excitatory-epileptogenic effects and the other possessing inhibitory-antiepileptic properties. The possible relationship between these findings and the known heterogeneity of opiate receptors and opiate actions is discussed.

  3. A basic review on the inferior alveolar nerve block techniques.

    PubMed

    Khalil, Hesham

    2014-01-01

    The inferior alveolar nerve block is the most common injection technique used in dentistry and many modifications of the conventional nerve block have been recently described in the literature. Selecting the best technique by the dentist or surgeon depends on many factors including the success rate and complications related to the selected technique. Dentists should be aware of the available current modifications of the inferior alveolar nerve block techniques in order to effectively choose between these modifications. Some operators may encounter difficulty in identifying the anatomical landmarks which are useful in applying the inferior alveolar nerve block and rely instead on assumptions as to where the needle should be positioned. Such assumptions can lead to failure and the failure rate of inferior alveolar nerve block has been reported to be 20-25% which is considered very high. In this basic review, the anatomical details of the inferior alveolar nerve will be given together with a description of its both conventional and modified blocking techniques; in addition, an overview of the complications which may result from the application of this important technique will be mentioned.

  4. A basic review on the inferior alveolar nerve block techniques

    PubMed Central

    Khalil, Hesham

    2014-01-01

    The inferior alveolar nerve block is the most common injection technique used in dentistry and many modifications of the conventional nerve block have been recently described in the literature. Selecting the best technique by the dentist or surgeon depends on many factors including the success rate and complications related to the selected technique. Dentists should be aware of the available current modifications of the inferior alveolar nerve block techniques in order to effectively choose between these modifications. Some operators may encounter difficulty in identifying the anatomical landmarks which are useful in applying the inferior alveolar nerve block and rely instead on assumptions as to where the needle should be positioned. Such assumptions can lead to failure and the failure rate of inferior alveolar nerve block has been reported to be 20-25% which is considered very high. In this basic review, the anatomical details of the inferior alveolar nerve will be given together with a description of its both conventional and modified blocking techniques; in addition, an overview of the complications which may result from the application of this important technique will be mentioned. PMID:25886095

  5. Peripheral nerve block in patients with Ehlers-Danlos syndrome, hypermobility type: a case series.

    PubMed

    Neice, Andrew E; Stubblefield, Eryn E; Woodworth, Glenn E; Aziz, Michael F

    2016-09-01

    Ehlers-Danlos syndrome (EDS) is an inherited disease characterized by defects in various collagens or their post translational modification, with an incidence estimated at 1 in 5000. Performance of peripheral nerve block in patients with EDS is controversial, due to easy bruising and hematoma formation after injections as well as reports of reduced block efficacy. The objective of this study was to review the charts of EDS patients who had received peripheral nerve block for any evidence of complications or reduced efficacy. Case series, chart review. Academic medical center. Patients with a confirmed or probable diagnosis of EDS who had received a peripheral nerve block in the last 3 years were identified by searching our institutions electronic medical record system. The patients were classified by their subtype of EDS. Patients with no diagnosed subtype were given a probable subtype based on a chart review of the patient's symptoms. Patient charts were reviewed for any evidence of complications or reduced block efficacy. A total of 21 regional anesthetics, on 16 unique patients were identified, 10 of which had a EDS subtype diagnosis. The majority of these patients had a diagnosis of hypermobility-type EDS. No block complications were noted in any patients. Two block failures requiring repeat block were noted, and four patients reported uncontrolled pain on postoperative day one despite successful placement of a peripheral nerve catheter. Additionally, blocks were performed without incident in patients with classical-type and vascular-type EDS although the number was so small that no conclusions can be drawn about relative safety of regional anesthesia in these groups. This series fails to show an increased risk of complications of peripheral nerve blockade in patients with hypermobility-type EDS. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. A novel µ-conopeptide, CnIIIC, exerts potent and preferential inhibition of NaV1.2/1.4 channels and blocks neuronal nicotinic acetylcholine receptors

    PubMed Central

    Favreau, Philippe; Benoit, Evelyne; Hocking, Henry G; Carlier, Ludovic; D' hoedt, Dieter; Leipold, Enrico; Markgraf, René; Schlumberger, Sébastien; Córdova, Marco A; Gaertner, Hubert; Paolini-Bertrand, Marianne; Hartley, Oliver; Tytgat, Jan; Heinemann, Stefan H; Bertrand, Daniel; Boelens, Rolf; Stöcklin, Reto; Molgó, Jordi

    2012-01-01

    BACKGROUND AND PURPOSE The µ-conopeptide family is defined by its ability to block voltage-gated sodium channels (VGSCs), a property that can be used for the development of myorelaxants and analgesics. We characterized the pharmacology of a new µ-conopeptide (µ-CnIIIC) on a range of preparations and molecular targets to assess its potential as a myorelaxant. EXPERIMENTAL APPROACH µ-CnIIIC was sequenced, synthesized and characterized by its direct block of elicited twitch tension in mouse skeletal muscle and action potentials in mouse sciatic and pike olfactory nerves. µ-CnIIIC was also studied on HEK-293 cells expressing various rodent VGSCs and also on voltage-gated potassium channels and nicotinic acetylcholine receptors (nAChRs) to assess cross-interactions. Nuclear magnetic resonance (NMR) experiments were carried out for structural data. KEY RESULTS Synthetic µ-CnIIIC decreased twitch tension in mouse hemidiaphragms (IC50= 150 nM), and displayed a higher blocking effect in mouse extensor digitorum longus muscles (IC = 46 nM), compared with µ-SIIIA, µ-SmIIIA and µ-PIIIA. µ-CnIIIC blocked NaV1.4 (IC50= 1.3 nM) and NaV1.2 channels in a long-lasting manner. Cardiac NaV1.5 and DRG-specific NaV1.8 channels were not blocked at 1 µM. µ-CnIIIC also blocked the α3β2 nAChR subtype (IC50= 450 nM) and, to a lesser extent, on the α7 and α4β2 subtypes. Structure determination of µ-CnIIIC revealed some similarities to α-conotoxins acting on nAChRs. CONCLUSION AND IMPLICATIONS µ-CnIIIC potently blocked VGSCs in skeletal muscle and nerve, and hence is applicable to myorelaxation. Its atypical pharmacological profile suggests some common structural features between VGSCs and nAChR channels. PMID:22229737

  7. Understanding Title V of the Social Security Act: A Guide to the Provisions of the Federal Maternal and Child Health Block Grant.

    ERIC Educational Resources Information Center

    Health Resources and Services Administration (DHHS/PHS), Washington, DC. Maternal and Child Health Bureau.

    The Maternal and Child Health (MCH) Services Block Grant (Title V of the Social Security Act) has operated as a federal-state partnership since the Social Security Act was passed in 1935. Through Title V, the federal government pledged its support of state efforts to extend health and welfare services for mothers and children. Title V has been…

  8. The Ultrasound-Guided Retroclavicular Block: A Prospective Feasibility Study.

    PubMed

    Charbonneau, Jasmin; Fréchette, Yannick; Sansoucy, Yanick; Echave, Pablo

    2015-01-01

    The aim of this feasibility study was to determine the success rate (sensory and surgical) of the novel retroclavicular block and to thoroughly describe the technique. In addition, needle tip and shaft visibility, needling time, procedural discomfort, motor block success rate, patient satisfaction at 48-hour follow-up, and complications were also recorded. Fifty patients scheduled for distal upper limb surgery received an in-plane, single-shot, ultrasound-guided retroclavicular block with 40 mL of mepivacaine 1.5% with epinephrine 2.5 μg/mL. Block success was defined as a sensory score of 10/10 for the 5 nerves supplying the distal upper limb at 30 minutes. Surgical success, needle visibility, needling time, axillary artery depth, motor block rate, patient discomfort with technique, satisfaction at 48 hours, and complications were also recorded. All blocks were video-recorded and timed for further independent assessment. A chest x-ray was obtained before discharge. Forty-five patients had a total sensory score of 10/10 at 30 minutes (90% success rate). Surgical success rate was 96%. Mean needling time was 3.77 minutes (25th-75th percentiles, 2.90-6.53 minutes) with a mean axillary artery depth of 3.1 ± 0.7 cm. Procedure-related discomfort (mean visual analog scale, 1.9 ± 1.2) was low. Mean 48-hour patient satisfaction rate (9.2 ± 1.1), mean needle tip (Likert scale, 3.0 ± 0.9), and shaft visibility (3.9 ± 0.9) were high. One vascular puncture and two transient paresthesias were recorded. No pneumothorax was revealed by chest x-ray. In this study, the novel retroclavicular block offered a quick, safe, and reliable alternative for distal arm block. Further studies, comparing this approach with the classic infraclavicular block, are required to validate its efficacy, safety, and reliability.

  9. 31 CFR Appendix A to Chapter V - Alphabetical Listing of Blocked Persons, Blocked Vessels, Specially Designated Nationals...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Alphabetical Listing of Blocked Persons, Blocked Vessels, Specially Designated Nationals, Specially Designated Terrorists, Specially Designated Global Terrorists, Foreign Terrorist Organizations, and Specially Designated Narcotics Traffickers (as of May 13, 2010) A Appendix A to Chapte...

  10. A comparative study of nerve stimulator versus ultrasound-guided supraclavicular brachial plexus block.

    PubMed

    Duncan, Mithun; Shetti, Akshaya N; Tripathy, Debendra Kumar; Roshansingh, D; Krishnaveni, N

    2013-01-01

    With the advent of ultrasound (US) guidance, this technique saw resurgence in the late 1990s. As US guidance provides real-time view of the block needle, the brachial plexus, and its spatial relationship to the surrounding vital structures; it not only increased the success rates, but also brought down the complication rates. Most of the studies show use of US guidance for performing brachial plexus block, results in near 100% success with or without complications. This study has been designed to examine the technique and usefulness of state-of-the-art US technology-guided supraclavicular brachial plexus block and compare it with routine nerve stimulator (NS)-guided technique. To note block execution time, time of onset of sensory and motor block, quality of block and success rates. Randomized controlled trial. A total of 60 patients were enrolled in this prospective randomized study and were randomly divided into two groups: US (Group US) and NS (Group NS). Both groups received 1:1 mixture of 0.5% bupivacaine and 2% lignocaine with 1:200000 adrenaline. The amount of local anaesthetic injected calculated according to the body weight and not crossing the toxic dosage (Inj. bupivacaine 2 mg/kg, Inj. lignocaine with adrenaline 7 mg/kg). The parameters compared between the two groups are block execution time, time of onset of sensory and motor block, quality of sensory and motor block, success rates are noted. The failed blocks are supplemented with general anesthesia. The data were analyzed using the SPSS (version 19) software. The parametric data were analyzed with student "t" test and the nonparametric data were analyzed with Chi-square test A P < 0.05 was considered significant. There was no significant difference between patient groups with regard to demographic data, the time of onset of sensory and motor block. Comparing the two groups, we found that the difference in the block execution time and success rates is not statistically significant. A failure rate of

  11. Ultrasound-Guided Single-Injection Infraclavicular Block Versus Ultrasound-Guided Double-Injection Axillary Block: A Noninferiority Randomized Controlled Trial.

    PubMed

    Boivin, Ariane; Nadeau, Marie-Josée; Dion, Nicolas; Lévesque, Simon; Nicole, Pierre C; Turgeon, Alexis F

    2016-01-01

    Single-injection ultrasound-guided infraclavicular block is a simple, reliable, and effective technique. A simplified double-injection ultrasound-guided axillary block technique with a high success rate recently has been described. It has the advantage of being performed in a superficial and compressible location, with a potentially improved safety profile. However, its effectiveness in comparison with single-injection infraclavicular block has not been established. We hypothesized that the double-injection ultrasound-guided axillary block would show rates of complete sensory block at 30 minutes noninferior to the single-injection ultrasound-guided infraclavicular block. After approval by our research ethics committee and written informed consent, adults undergoing distal upper arm surgery were randomized to either group I, ultrasound-guided single-injection infraclavicular block, or group A, ultrasound-guided double-injection axillary block. In group I, 30 mL of 1.5% mepivacaine was injected posterior to the axillary artery. In group A, 25 mL of 1.5% mepivacaine was injected posteromedial to the axillary artery, after which 5 mL was injected around the musculocutaneous nerve. Primary outcome was the rate of complete sensory block at 30 minutes. Secondary outcomes were the onset of sensory and motor blocks, surgical success rates, performance times, and incidence of complications. All outcomes were assessed by a blinded investigator. The noninferiority of the double-injection ultrasound-guided axillary block was considered if the limits of the 90% confidence intervals (CIs) were within a 10% margin of the rate of complete sensory block of the infraclavicular block. At 30 minutes, the rate of complete sensory block was 79% in group A (90% CI, 71%-85%) compared with 91% in group I (90% CI, 85%-95%); the upper limit of CI of group A is thus included in the established noninferiority margin of 10%. The rate of complete sensory block was lower in group A (proportion

  12. [Neurological complications associated with ultrasound-guided interscalene and supraclavicular block in elective surgery of the shoulder and arm. Prospective observational study in a university hospital].

    PubMed

    Bilbao Ares, A; Sabaté, A; Porteiro, L; Ibáñez, B; Koo, M; Pi, A

    2013-01-01

    The incidence of postoperative neurological symptoms after performing interscalene block varies between 4 and 16%. The majority of cases are resolved spontaneously within a year, but some patients have their symptoms permanently. Our objective was to assess the incidence of postoperative neurological symptoms after performing the ultrasound-assisted interscalene and supraclavicular anaesthetic blocks. A prospective and observational study was conducted on consecutive patients who had undergone upper extremity surgery with an interscalene or supraclavicular block as an isolated technique, or as a complement to general anaesthesia. Seven days after the intervention, a telephone interview was conducted that focused on the detection of neurological symptoms in the operated limb. Further serial interviews were conducted on patients with symptoms (after the first, the third and the sixth month, and one year after surgery) until resolution of symptoms. Neurological evaluation was offered to those patients with persistent symptoms after one year. A total of 121 patients were included, on whom 96 interscalene blocks and 22 supraclavicular blocks were performed. Postoperative neurological symptoms were detected in 9.9% (95% CI, 5-15%) of patients during the first week. No significant differences were observed between interscalene (9%) and supraclavicular block (14%). After 3 months the symptoms persisted in 9 patients (7.4%), with symptoms remaining in 4 patients (3.3%) after 1.5 years. Electromyogram was performed on 3 patients who tested positive for nerve damage. A high incidence of postoperative neurological symptoms was observed, and a worrying percentage of permanence of them. There were no significant differences in incidence according to the type of block, or any features of the patient or the anaesthesia technique that were associated with the incidence of these symptoms, except a marginal relationship with age. These complications must be clearly explained to the

  13. Effect of Administration of Neuromuscular Blocking Agents in Children with Severe Traumatic Brain Injury on Acute Complication Rates and Outcomes: A Secondary Analysis from a Randomized, Controlled Trial of Therapeutic Hypothermia

    PubMed Central

    Chin, Katherine H.; Bell, Michael J.; Wisniewski, Stephen R.; Goundappa, Balasubramani G.K.; Kochanek, Patrick M.; Beers, Sue R.; Brown, S. Danielle; Adelson, P. David

    2014-01-01

    Objective To evaluate the association between neuromuscular blocking agents (NMBA) and outcome, intracranial pressure (ICP) and medical complications in children with severe TBI. Design A secondary analysis of a randomized, controlled trial of therapeutic hypothermia. Setting 17 hospitals in US, Australia, and New Zealand Patients Children (< 18 y) with severe TBI. Interventions None for this secondary analysis. Measurements and Main Results Children received NMBA on the majority of days of the study (69.6%) and the modified Pediatric Intensity Level of Therapy (mPILOT) scores (modified by removing NMBA administration from the score) were increased on days when NMBA were used (9.67 ± 0.21 vs. 5.48 ± 0.26, p < 0.001). Children were stratified into groups based on exposure to NMBA (Group 1 received NMBA each study day; Group 2 did not). Group 1 had increased number of daily ICP readings > 20 mmHg (4.4 ± 1.1 v. 2.4 ± 0.5, p = 0.015) and longer ICU length of stay (LOS) and hospital length of stay (p = 0.003 and 0.07, respectively, Kaplan-Meier). The Glasgow Outcome Score – Extended for Pediatrics at hospital discharge, 3 mo, 6 mo and 12 mo after TBI and medical complications observed during the acute hospitalization were similar between groups. Conclusions Administration of NMBA was ubiquitous and daily administration of NMBA was associated with intracranial hypertension but not outcomes – likely indicating that increased injury severity prompted their use. Despite this, NMBA use was not associated with complications. A different study design – perhaps using randomization or methodologies – of a larger cohort will be required to determine if NMBA use is helpful after severe TBI in children. PMID:25599147

  14. Emergency primary repair of grade V bladder neck injury complicating pelvic fracture

    PubMed Central

    2014-01-01

    We report a case of a grade V bladder injury complicating an open-book pelvic fracture following a road traffic accident. The bladder neck injury was primarily repaired in the emergency setting of a poor-resourced area with successful outcome. The dangers of urinary extravasation are still to be considered of importance and we advocate and encourage immediate/emergency open intervention although it remains controversial to say the least in a lesser resourced healthcare set up. PMID:25076980

  15. [Permanent cardiac pacing for chronic symptomatic atrioventricular block in uremic hemodialysed patients. A prospective study].

    PubMed

    Arsenescu, Cătălina; Georgescu, G I M; Covic, A; Briotă, Laura

    2002-01-01

    Though sudden cardiac death accounts for as much as 15% of all cause mortality in uremia, reports concerning advanced A-V block, requiring permanent cardiac pacing in end-stage renal disease (ESRD) hemodialysed (HD) patients are very few. This is the first long term prospective study reporting on systematic permanent pacemaker implantation, in a cohort of ESRD patients from a single HD unit. Between 01/06/1997 and 30/12/2001, 396 pacemakers were inserted for advanced, symptomatic A-V block in our institution, including 5 in ESRD, HD patients (M/F--4/1, age 47-73, M +/- SD--61 +/- 12 years) from a single dialysis center, treating 137 patients during the study period. Thus, the incidence and prevalence of A-V defects treated by permanent pacing in uremic patients was 0.81% and 3.65% respectively. Conversely, the incidence and prevalence of ESRD treated by hemodialysis, among patients with advanced A-V conduction disturbances, requiring permanent pacing were 0.28% and 1.26%. Mitral valve calcifications were present in all patients; 3 subjects also had extensive aortic valve calcifications. Left ventricular hypertrophy (echocardiographic Framingham criteria) was present in 4 patients, but the systolic function (ejection fraction and fractional shortening index) was normal in all cases, although a clinical picture of chronic heart failure was seen in 3 subjects preoperatively. A-V conduction defects were attributed to extensive metastatic calcifications, involving the cardiac squeleton, consecutive to severe hyperparathyroidism and inadvertent use of calcitriol and calcium carbonate as phosphate binders. No technical difficulties, short or long-term complications related to pacemaker implantation (4 VVI and 1 VVD devices) were encountered. Acute threshold and sensing values were similar with those of non-uremic patients. During follow-up, one patients died from a non cardiac death. If optimal hemodialysis is provided, benefits of permanent pacing are equal in uremic or

  16. A new rule for femoral nerve blocks.

    PubMed

    Schulz-Stübner, Sebastian; Henszel, Angela; Hata, J Steven

    2005-01-01

    Acupuncture points are described by use of a proportional system that is based on the width of the thumb at the level of the distal interphalangeal joint, defined as 1 CUN. Our study tested first the correlation between the CUN and weight and height in 500 Americans and second the hypothesis that the CUN system is superior to the conventional landmarks to localize the femoral nerve 1 or 2 cm lateral to the artery in a prospective, double-blinded, randomized study. Sixty-two patients were randomized to receive a femoral nerve block by a needle entry point either 1 CUN lateral, 1 cm lateral, or 2 cm lateral to the femoral artery at the level of the inguinal crease. The time from needle entry to injection of local anesthetic was measured by an investigator blind to the technique, who also counted the frequency of needle repositioning, graded the ease of the block and its success, and registered complications. Good correlation occurred between weight and CUN (r = 0.79) and height and CUN (r = 0.83), which indicates that the CUN of a normal person (predefined as 175 cm tall and 70 kg weight) is 18.7 +/- 1 mm. In the CUN group, the femoral block was achieved significantly faster (P < .01) with fewer attempts (P < .003). The success rate was the same and complications did not differ significantly between the groups. A needle insertion point 1 CUN lateral to the midpoint of the palpated femoral artery at the level of the inguinal crease makes femoral nerve blocks faster and easier compared with conventional landmark 1 cm to 2 cm lateral to the artery.

  17. CT-guided injection of the anterior and middle scalene muscles: technique and complications.

    PubMed

    Mashayekh, A; Christo, P J; Yousem, D M; Pillai, J J

    2011-03-01

    Anterior scalene block is a helpful diagnostic test for NTOS and a good predictor of surgical outcome. The purpose of this study was to describe the technique, success rate, and complications associated with CT-guided anesthetic and botulinum toxin injection of the ASM/MSM in patients with NTOS symptoms. One hundred six participants (mean age, 41.5 ± 10 years; 80 women) were identified via a retrospective review of medical records for CT-guided scalene blocks. The procedure was evaluated regarding the technical success, defined as satisfactory detection of the ASM/MSM; intramuscular needle placement; intramuscular injection of contrast; appropriate delivery of medication; and frequency of unintended BP block or other complications. We also determined the outcome of patients who underwent surgery following the block. Study participants underwent 146 scalene injections, 83 blocks, and 63 chemodenervations, which were included in this investigation. In all cases, detection of the ASM/MSM and intramuscular needle placement was satisfactory. Postprocedural complications included 5 (3.4%) temporary BP blocks, 1 patient with (0.7%) Horner sign, 7 (4.8%) needle-induced pain reports, 1 (0.7%) case of dysphagia, and 2 (1.4%) instances of muscle weakness. There were no major complications reported. The rate of good outcome following surgery was the same in patients with positive versus negative blocks, 30/43 (70%) versus 5/7 (71%), respectively. CT guidance is a useful adjunct in performing accurate ASM/MSM blocks with a low rate of minor complications.

  18. Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists.

    PubMed

    Cook, T M; Counsell, D; Wildsmith, J A W

    2009-02-01

    Serious complications of central neuraxial block (CNB) are rare. Limited information on their incidence and impact impedes clinical decision-making and patient consent. The Royal College of Anaesthetists Third National Audit Project was designed to inform this situation. A 2 week national census estimated the number of CNB procedures performed annually in the UK National Health Service. All major complications of CNBs performed over 1 yr (vertebral canal abscess or haematoma, meningitis, nerve injury, spinal cord ischaemia, fatal cardiovascular collapse, and wrong route errors) were reported. Each case was reviewed by an expert panel to assess causation, severity, and outcome. 'Permanent' injury was defined as symptoms persisting for more than 6 months. Efforts were made to validate denominator (procedures performed) and numerator (complications) data through national databases. The census phase produced a denominator of 707,455 CNB. Eighty-four major complications were reported, of which 52 met the inclusion criteria at the time they were reported. Data were interpreted 'pessimistically' and 'optimistically'. 'Pessimistically' there were 30 permanent injuries and 'optimistically' 14. The incidence of permanent injury due to CNB (expressed per 100,000 cases) was 'pessimistically' 4.2 (95% confidence interval 2.9-6.1) and 'optimistically' 2.0 (1.1-3.3). 'Pessimistically' there were 13 deaths or paraplegias, 'optimistically' five. The incidence of paraplegia or death was 'pessimistically' 1.8 per 100,000 (1.0-3.1) and 'optimistically' 0.7 (0-1.6). Two-thirds of initially disabling injuries resolved fully. The data are reassuring and suggest that CNB has a low incidence of major complications, many of which resolve within 6 months.

  19. Fan-shaped complete block on helical tomotherapy for esophageal cancer: a phantom study.

    PubMed

    Chang, Chiu-Han; Mok, Greta S P; Shueng, Pei-Wei; Yeh, Hsin-Pei; Shiau, An-Cheng; Tien, Hui-Ju; Lin, Chi-Ta; Wu, Tung-Hsin

    2015-01-01

    Radiation pneumonitis (RP) is a common complication for radiotherapy of esophageal cancer and is associated with the low dose irradiated lung volume. This study aims to reduce the mean lung dose (MLD) and the relative lung volume at 20 Gy (V 20) and at low dose region using various designs of the fan-shaped complete block (FSCB) in helical tomotherapy. Hypothetical esophageal tumor was delineated on an anthropomorphic phantom. The FSCB was defined as the fan-shaped radiation restricted area located in both lungs. Seven treatment plans were performed with nonblock design and FSCB with different fan angles, that is, from 90° to 140°, with increment of 10°. The homogeneous index, conformation number, MLD, and the relative lung volume receiving more than 5, 10, 15, and 20 Gy (V 5, V 10, V 15, and V 20) were determined for each treatment scheme. There was a substantial reduction in the MLD, V 5, V 10, V 15, and V 20 when using different types of FSCB as compared to the nonblock design. The reduction of V 20, V 15, V 10, and V 5 was 6.3%-8.6%, 16%-23%, 42%-57%, and 42%-66% for FSCB 90°-140°, respectively. The use of FSCB in helical tomotherapy is a promising method to reduce the MLD, V 20, and relative lung volume in low dose region, especially in V 5 and V 10 for esophageal cancer.

  20. Safety of Epinephrine in Digital Nerve Blocks: A Literature Review.

    PubMed

    Ilicki, Jonathan

    2015-11-01

    Digital nerve blocks are commonly performed in emergency departments. Health care practitioners are often taught to avoid performing blocks with epinephrine due to a risk of digital necrosis. To review the literature on the safety of epinephrine 1:100,000-200,000 (5-10 μg/mL) with local anesthetics in digital nerve blocks in healthy patients and in patients with risk for poor peripheral circulation. PubMed, Web of Science, and the Cochrane Library were searched in June 2014 using the query "digital block AND epinephrine OR digital block AND adrenaline". The searches were performed without any limits. Sixty-three articles were identified, and 39 of these were found to be relevant. These include nine reviews, 12 randomized control trials, and 18 other articles. Most studies excluded patients with risk for poor peripheral circulation. Two studies described using epinephrine on patients with vascular comorbidities. No study reported digital necrosis or gangrene attributable to epinephrine, either in healthy patients or in patients with risk for poor peripheral circulation. In total, at least 2797 digital nerve blocks with epinephrine have been performed without any complications. Epinephrine 1:100,000-200,000 (5-10 μg/mL) is safe to use in digital nerve blocks in healthy patients. Physiological studies show epinephrine-induced vasoconstriction to be transient. There are no reported cases of epinephrine-induced harm to patients with risk for poor peripheral circulation despite a theoretical risk of harmful epinephrine-induced vasoconstriction. A lack of reported complications suggests that the risk of epinephrine-induced vasoconstriction to digits may be overstated. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. [Ultrasound-guided rectus sheath block for upper abdominal surgery].

    PubMed

    Osaka, Yoshimune; Kashiwagi, Masanori; Nagatsuka, Yukio; Oosaku, Masayoshi; Hirose, Chikako

    2010-08-01

    Upper abdominal surgery leads to severe postoperative pain. Insufficient postoperative analgesia accompanies a high incidence of complications. Therefore, postoperative analgesia is very important. The epidural analgesia has many advantages. However it has a high risk of epidural hematoma in anticoagulated patients. Rectus sheath block provided safer and more reliable analgesia in recent years, by the development of ultrasound tools. We experienced two cases of the rectus sheath block in upper abdominal surgery under ultrasound guidance. Ultrasound guided rectus sheath block can reduce the risk of peritoneal puncture, bleeding, and other complications. Rectus sheath block is very effective to reduce postoperative pain in upper abdominal surgery as an alternative method to epidural anesthesia in anticoagulated patients.

  2. Transversus Abdominis Plane Block versus Ilioinguinal/Iliohypogastric Nerve Block with Wound Infiltration for Postoperative Analgesia in Inguinal Hernia Surgery: A Randomized Clinical Trial.

    PubMed

    Sujatha, Chinthavali; Zachariah, Mamie; Ranjan, R V; George, Sagiev Koshy; Ramachandran, T R; Pillai, Anil Radhakrishna

    2017-01-01

    Various analgesic modalities have been used for postoperative analgesia in patients undergoing inguinal hernia surgery. In this randomized clinical trial, we have compared the analgesic efficacy of transversus abdominis plane (TAP) block with that of ilioinguinal/iliohypogastric (IIIH) nerve block with wound infiltration in patients undergoing unilateral open inguinal hernia repair. The primary objective of this study was to compare the efficacy of postoperative analgesia of ultrasound-guided TAP block and IIIH block with wound infiltration (WI) in patients undergoing open inguinal hernia surgery. This was a randomized clinical trial performed in a tertiary care hospital. Sixty patients scheduled for hernia repair were randomized into two groups, Group T and Group I. Postoperatively, under ultrasound guidance, Group T received 20 ml of 0.25% ropivacaine - TAP block and Group I received 10 ml of 0.25% ropivacaine - IIIH block + WI with 10 ml of 0.25% ropivacaine. The primary outcome measure was the time to rescue analgesia in the first 24 h postoperatively. Fentanyl along with diclofenac was given as first rescue analgesic when the patient complained of pain. Statistical comparisons were performed using Student's t -test and Chi-square test. Mean time to rescue analgesia was 5.900 ± 1.881 h and 3.766 ± 1.754 h ( P < 0.001) and the mean pain scores were 5.73 ± 0.784 and 6.03 ± 0.850 for Group TAP and IIIH + WI, respectively. Hemodynamics were stable in both the groups. One-third of the patients received one dose of paracetamol in addition to the rescue analgesic in the first 24 h. There were no complications attributed to the block. As a multimodal analgesic regimen, definitely both TAP block and IIIH block with wound infiltration have a supporting role in providing analgesia in the postoperative period for adult inguinal hernia repair. In this study, ultrasound-guided TAP block provided longer pain control postoperatively than IIIH block with WI after inguinal

  3. A comparison between caudal block versus splash block for postoperative analgesia following inguinal herniorrhaphy in children

    PubMed Central

    Cheon, Jun Kong; Hwang, Kan Taeck; Choi, Bo Yoon

    2011-01-01

    Background We wanted to determine the postoperative analgesic efficacy of preincisional caudal epidural block versus instillation (splash block) following inguinal herniorrhaphy in children. Methods Thirty children (age range: 1-7 years) who were scheduled to undergo inguinal herniorrhaphy were divided into 2 groups: the caudal block group and the splash block group with 15 children in each group. Tracheal intubation was performed. Fifteen children received caudal block with 1.0 ml/kg of 0.25% ropivacaine (Group 1). Caudal block was performed using the loss of resistance method via the sacral hiatus. Fifteen children in Group 2 received local instillation (splash block) in the surgical site with up to 0.4 ml/kg of 0.25% ropivacaine. The patients were observed for 90 minutes in the postanesthesia care unit and then they were transferred to the ward. The pain scores were taken 4 times. We assessed pain using the Faces pain scores. Results There were no significant differences between the groups regarding the pain scores at 10, 30 and 60 minutes upon entering the postanesthesia care unit. The pain scores of Group 1 were slightly lower at the last evaluation point when compared to that of Group 2. One patient in Group 1 required supplemental postoperative intravenous (IV) tramadol, while all the other patients in both groups did not require supplemental IV tramadol. The intraoperative requirement for sevoflurane was decreased in Group 1 as compared to that of Group 2. There were no major complications related to either type of block. Conclusions We conclude that a splash block can have a similar analgesic effect as that of a caudal block for the postoperative herniorrhaphy pain of children. PMID:21602975

  4. A comparison between caudal block versus splash block for postoperative analgesia following inguinal herniorrhaphy in children.

    PubMed

    Cheon, Jun Kong; Park, Cheon Hee; Hwang, Kan Taeck; Choi, Bo Yoon

    2011-04-01

    We wanted to determine the postoperative analgesic efficacy of preincisional caudal epidural block versus instillation (splash block) following inguinal herniorrhaphy in children. THIRTY CHILDREN (AGE RANGE: 1-7 years) who were scheduled to undergo inguinal herniorrhaphy were divided into 2 groups: the caudal block group and the splash block group with 15 children in each group. Tracheal intubation was performed. Fifteen children received caudal block with 1.0 ml/kg of 0.25% ropivacaine (Group 1). Caudal block was performed using the loss of resistance method via the sacral hiatus. Fifteen children in Group 2 received local instillation (splash block) in the surgical site with up to 0.4 ml/kg of 0.25% ropivacaine. The patients were observed for 90 minutes in the postanesthesia care unit and then they were transferred to the ward. The pain scores were taken 4 times. We assessed pain using the Faces pain scores. There were no significant differences between the groups regarding the pain scores at 10, 30 and 60 minutes upon entering the postanesthesia care unit. The pain scores of Group 1 were slightly lower at the last evaluation point when compared to that of Group 2. One patient in Group 1 required supplemental postoperative intravenous (IV) tramadol, while all the other patients in both groups did not require supplemental IV tramadol. The intraoperative requirement for sevoflurane was decreased in Group 1 as compared to that of Group 2. There were no major complications related to either type of block. We conclude that a splash block can have a similar analgesic effect as that of a caudal block for the postoperative herniorrhaphy pain of children.

  5. How to block and tackle the face.

    PubMed

    Zide, B M; Swift, R

    1998-03-01

    Regional blocking techniques as noted in dentistry, anesthesia, and anatomy texts may result in inconsistent and imperfect analgesia when needed for facial aesthetic surgery. The advent of laser facial surgery and more complicated aesthetic facial procedures has thus increased the demand for anesthesia support. Surgeons should know a fail-safe method of nerve blocks. Fresh cadaver dissections are used to demonstrate a series of eight regional nerve-blocking routes. This sequence of bilateral blocks will routinely provide profound full facial anesthesia. Certain groupings of blocks are effective for perioral or periorbital laser surgery.

  6. Suprascapular and Interscalene Nerve Block for Shoulder Surgery: A Systematic Review and Meta-analysis.

    PubMed

    Hussain, Nasir; Goldar, Ghazaleh; Ragina, Neli; Banfield, Laura; Laffey, John G; Abdallah, Faraj W

    2017-12-01

    Interscalene block provides optimal shoulder surgery analgesia, but concerns over its associated risks have prompted the search for alternatives. Suprascapular block was recently proposed as an interscalene block alternative, but evidence of its comparative analgesic effect is conflicting. This meta-analysis compares the analgesic effect and safety of suprascapular block versus interscalene block for shoulder surgery. Databases were searched for randomized trials comparing interscalene block with suprascapular block for shoulder surgery. Postoperative 24-h cumulative oral morphine consumption and the difference in the area under curve for pooled rest pain scores were designated as primary outcomes. Analgesic and safety outcomes, particularly block-related and respiratory complications, were evaluated as secondary outcomes. Results were pooled using random-effects modeling. Data from 16 studies (1,152 patients) were analyzed. Interscalene block and suprascapular block were not different in 24-h morphine consumption. The difference in area under the curve of pain scores for the 24-h interval favored interscalene block by 1.1 cm/h, but this difference was not clinically important. Compared with suprascapular block, interscalene block reduced postoperative pain but not opioid consumption during recovery room stay by a weighted mean difference (95% CI) of 1.5 cm (0.6 to 2.5 cm; P < 0.0001). Pain scores were not different at any other time. In contrast, suprascapular block reduced the odds of block-related and respiratory complications. This review suggests that there are no clinically meaningful analgesic differences between suprascapular block and interscalene block except for interscalene block providing better pain control during recovery room stay; however, suprascapular block has fewer side effects. These findings suggest that suprascapular block may be considered an effective and safe interscalene block alternative for shoulder surgery.

  7. Intravenous regional anaesthesia (Bier's block) for pediatric forearm fractures in a pediatric emergency department-Experience from 2003 to 2014.

    PubMed

    Chua, Ivan S Y; Chong, S L; Ong, Gene Y K

    2017-12-01

    To evaluate the efficacy (length of stay in the emergency department and failure rate of Bier's block) and safety profile (death and major complications) of Bier's block in its use for manipulation and reduction of paediatric forearm fractures. This is a retrospective cohort study of pediatric patients in KKWomen's and Children's Hospital Children's Emergency Department with forearm fractures between Jan 2003 and Dec 2014 who underwent manipulation and reduction using Bier's block. Demographic data, time from registration to discharge, major complications and success rate were collated in a standardized data collection form. A subanalysis of the Bier's block group from 2009 to 2014 was performed and compared to a corresponding data set of paediatric patients who underwent manipulation and reduction of forearm fractures using ketamine for procedural sedation from 2009 to 2014. 1781 cases of paediatric forearm fractures were analysed. The mean age of patients in the Bier's block group was 12.0 years (range 5.5-17.8 years old). Of all patients undergoing Bier's block, 1471 out of 1781 patients were male (82.7%). The mean length of stay (LOS) in the department was 168±72min, measured from time of registration till departure. From our subanalysis of data from 2009 to 2014, the mean LOS for the Bier's block group was shorter - 170min compared to 238min for the ketamine group (P <0.0001). 2 patients had failed Bier's block which required a repeat procedural sedation using ketamine. 96% of patients who underwent Bier's block were discharged with an outpatient orthopaedic appointment. There were no deaths or major complications identified in our study. Bier's block is a safe technique for reduction of fractures when used in the appropriate population and fracture types, with a low failure rate and no major complications including death. Compared to the ketamine group, it has a shorter length of stay in the emergency department. We recommend the adoption of this practice

  8. Pacemaker rate and depolarization block in nigral dopamine neurons: a somatic sodium channel balancing act

    PubMed Central

    Tucker, Kristal R.; Huertas, Marco A.; Horn, John P.; Canavier, Carmen C.; Levitan, Edwin S.

    2012-01-01

    Midbrain dopamine (DA) neurons are slow intrinsic pacemakers that undergo depolarization (DP) block upon moderate stimulation. Understanding DP block is important because it has been correlated with the clinical efficacy of chronic antipsychotic drug treatment. Here we describe how voltage-gated sodium (NaV) channels regulate DP block and pacemaker activity in DA neurons of the substantia nigra using rat brain slices. The distribution, density and gating of NaV currents were manipulated by blocking native channels with tetrodotoxin and by creating virtual channels and anti-channels with dynamic clamp. Although action potentials initiate in the axon initial segment (AIS) and NaV channels are distributed in multiple dendrites, selective reduction of NaV channel activity in the soma was sufficient to decrease pacemaker frequency and increase susceptibility to DP block. Conversely, increasing somatic NaV current density raised pacemaker frequency and lowered susceptibility to DP block. Finally, when NaV currents were restricted to the soma, pacemaker activity occurred at abnormally high rates due to excessive local subthreshold NaV current. Together with computational simulations, these data show that both the slow pacemaker rate and the sensitivity to DP block that characterizes DA neurons result from the low density of somatic NaV channels. More generally, we conclude that the somatodendritic distribution of NaV channels is a major determinant of repetitive spiking frequency. PMID:23077037

  9. Necrotizing Fasciitis as a Complication of a Continuous Sciatic Nerve Catheter Using the Lateral Popliteal Approach.

    PubMed

    Dott, Daltry; Canlas, Christopher; Sobey, Christopher; Obremskey, William; Thomson, Andrew Brian

    Necrotizing fasciitis is an infection of the soft tissue that is characterized by rapidly spreading inflammation and subsequent necrosis. It is a rare complication of peripheral nerve blocks. We report a rare case of necrotizing fasciitis after placement of a peripheral nerve catheter. A 58-year-old woman presented for an elective right second metatarsal resection and received a sciatic nerve catheter for postoperative pain control. On postoperative day 7, clinical examination and imaging supported the diagnosis of necrotizing fasciitis. Multiple reports have been published of necrotizing fasciitis after single-shot peripheral nerve block injections, neuraxial anesthesia, and intramuscular injections. This case highlights the potential for the rare complication of necrotizing fasciitis after peripheral nerve catheter placement.

  10. Block copolymer battery separator

    DOEpatents

    Wong, David; Balsara, Nitash Pervez

    2016-04-26

    The invention herein described is the use of a block copolymer/homopolymer blend for creating nanoporous materials for transport applications. Specifically, this is demonstrated by using the block copolymer poly(styrene-block-ethylene-block-styrene) (SES) and blending it with homopolymer polystyrene (PS). After blending the polymers, a film is cast, and the film is submerged in tetrahydrofuran, which removes the PS. This creates a nanoporous polymer film, whereby the holes are lined with PS. Control of morphology of the system is achieved by manipulating the amount of PS added and the relative size of the PS added. The porous nature of these films was demonstrated by measuring the ionic conductivity in a traditional battery electrolyte, 1M LiPF.sub.6 in EC/DEC (1:1 v/v) using AC impedance spectroscopy and comparing these results to commercially available battery separators.

  11. A Research Project on the Emulsifying and Homogenizing Properties of Block Copolymers in Polymer Blends.

    DTIC Science & Technology

    1987-06-15

    Chain C.V. Berney Scattering in Heterogeneous P. Kofinas Block Copolymers R.E. Cohen 18. SANS Studies of the Configu- C.V. Berney rations of Single...Studies of the Configuratins C.V. Berney Single Chains in Heterogeneous Block P. Cheng Copolymers, J. Materials Research, P. Dofinas in press (1987) R.E...Cohen 2. A Reexamination of the Configurations C.V. Berney of Single-Chain Scattering in Hetero- P. Kofinas geneous Block Copolymers, R.E. Cohen

  12. Military Curricula for Vocational & Technical Education. Metals Processing Specialist, Blocks V and VI, Classroom Course 13-7.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. National Center for Research in Vocational Education.

    These curriculum materials are the third section of a four-part, secondary-postsecondary-level course in metals processing. The course is one of a number of military-developed curriculum packages selected for adaptation to vocational instruction and curriculum development in a civilian setting. Block V, Inert Gas Shielded Welding of High…

  13. Suprascapular block associated with supraclavicular block: An alternative to isolated interscalene block for analgesia in shoulder instability surgery?

    PubMed

    Trabelsi, W; Ben Gabsia, A; Lebbi, A; Sammoud, W; Labbène, I; Ferjani, M

    2017-02-01

    Interscalene brachial plexus block (ISB) is the gold standard for postoperative pain management in shoulder surgery. However, this technique has side effects and potentially serious complications. The aim of this study was to compare the combinations of ultrasound-guided suprascapular (SSB) associated with supraclavicular nerve block (SCB) and ultrasound-guided ISB for postoperative analgesia after shoulder instability surgery. Sixty ASA physical status I-II patients scheduled to undergo shoulder instability surgery were included. Two groups: (i) the SSB+SCB group (n=30) in which the patients received a combination of US-guided SSB (15mL of bupivacaine 0.25%) and US-guided SCB (15mL of bupivacaine 0.25%) and (ii) the ISB group (n=30) in which the patients received US-guided ISB with 30mL of bupivacaine 0.25%. General anesthesia was administered to all patients. During the first 24h, the variables assessed were time to administer the anesthesia, duration of the analgesia, onset and duration of motor and sensory blockade, opioid consumption, cardiovascular stability, complications, and patient satisfaction. Anesthesia induction took more time for the SSB+SCB group than for the ISB group. However, the onset time of motor and sensory blockade was similar in the two groups. Statistical analysis of the visual analog postoperative pain scoring at H0, H6, H12, and H24 showed nonsignificant differences between the groups. Analgesia, the first request for morphine, and total morphine consumption during the first 24h was similar in both groups. No complication was recorded in the SSB+SCB group. However, phrenic nerve block occurred in all patients in the ISB group. US-guided SCB combined with US-guided SSB was as effective as ISB for postoperative analgesia after shoulder instability surgery without decreasing potential side effects. NCT identifier: NCT02397330. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  14. Complete Atrioventricular Block Complicating Mitral Infective Endocarditis Caused by Streptococcus Agalactiae.

    PubMed

    Arai, Masaru; Nagashima, Koichi; Kato, Mahoto; Akutsu, Naotaka; Hayase, Misa; Ogura, Kanako; Iwasawa, Yukino; Aizawa, Yoshihiro; Saito, Yuki; Okumura, Yasuo; Nishimaki, Haruna; Masuda, Shinobu; Hirayama, Astushi

    2016-09-08

    BACKGROUND Infective endocarditis (IE) involving the mitral valve can but rarely lead to complete atrioventricular block (CAVB). CASE REPORT A 74-year-old man with a history of infective endocarditis caused by Streptococcus gordonii (S. gordonii) presented to our emergency room with fever and loss of appetite, which had lasted for 5 days. On admission, results of serologic tests pointed to severe infection. Electrocardiography showed normal sinus rhythm with first-degree atrioventricular block and incomplete right bundle branch block, and transthoracic echocardiography and transesophageal echocardiography revealed severe mitral regurgitation caused by posterior leaflet perforation and 2 vegetations (5 mm and 6 mm) on the tricuspid valve. The patient was initially treated with ceftriaxone and gentamycin because blood and cutaneous ulcer cultures yielded S. agalactiae. On hospital day 2, however, sudden CAVB requiring transvenous pacing occurred, and the patient's heart failure and infection worsened. Although an emergent surgery is strongly recommended, even in patients with uncontrolled heart failure or infection, surgery was not performed because of the Child-Pugh class B liver cirrhosis. Despite intensive therapy, the patient's condition further deteriorated, and he died on hospital day 16. On postmortem examination, a 2×1-cm vegetation was seen on the perforated posterior mitral leaflet, and the infection had extended to the interventricular septum. Histologic examination revealed extensive necrosis of the AV node. CONCLUSIONS This rare case of CAVB resulting from S. agalactiae IE points to the fact that in monitoring patients with IE involving the mitral valve, clinicians should be aware of the potential for perivalvular extension of the infection, which can lead to fatal heart block.

  15. Complications of wrist arthroscopy.

    PubMed

    Ahsan, Zahab S; Yao, Jeffrey

    2012-06-01

    The purpose of this systematic review was to address the incidence of complications associated with wrist arthroscopy. Given the paucity of information published on this topic, an all-inclusive review of published wrist arthroscopy complications was sought. Two independent reviewers performed a literature search using PubMed, Google Scholar, EBSCO, and Academic Megasearch using the terms "wrist arthroscopy complications," "complications of wrist arthroscopy," "wrist arthroscopy injury," and "wrist arthroscopy." Inclusion criteria were (1) Levels I to V evidence, (2) "complication" defined as an adverse outcome directly related to the operative procedure, and (3) explicit description of operative complications in the study. Eleven multiple-patient studies addressing complications of wrist arthroscopy from 1994 to 2010 were identified, with 42 complications reported from 895 wrist arthroscopy procedures, a 4.7% complication rate. Four case reports were also found, identifying injury to the dorsal sensory branch of the ulnar nerve, injury to the posterior interosseous nerve, and extensor tendon sheath fistula formation. This systematic review suggests that the previously documented rate of wrist arthroscopy complications may be underestimating the true incidence. The report of various complications provides insight to surgeons for improving future surgical techniques. Level IV, systematic review of Levels I-V studies. Copyright © 2012 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  16. Examining the Role of Perioperative Nerve Blocks in Hip Arthroscopy: A Systematic Review.

    PubMed

    Kay, Jeffrey; de Sa, Darren; Memon, Muzammil; Simunovic, Nicole; Paul, James; Ayeni, Olufemi R

    2016-04-01

    This systematic review examined the efficacy of perioperative nerve blocks for pain control after hip arthroscopy. The databases Embase, PubMed, and Medline were searched on June 2, 2015, for English-language studies that reported on the use of perioperative nerve blocks for hip arthroscopy. The studies were systematically screened and data abstracted in duplicate. Nine eligible studies were included in this review (2 case reports, 2 case series, 3 non-randomized comparative studies, and 2 randomized controlled trials). In total, 534 patients (534 hips), with a mean age of 37.2 years, who underwent hip arthroscopy procedures were administered nerve blocks for pain management. Specifically, femoral (2 studies), fascia iliaca (2 studies), lumbar plexus (3 studies), and L1 and L2 paravertebral (2 studies) nerve blocks were used. All studies reported acceptable pain scores after the use of nerve blocks, and 4 studies showed significantly lower postoperative pain scores acutely with the use of nerve blocks over general anesthesia alone. The use of nerve blocks also resulted in a decrease in opioid consumption in 4 studies and provided a higher level of patient satisfaction in 2 studies. No serious acute complications were reported in any study, and long-term complications from lumbar plexus blocks, such as local anesthetic system toxicity (0.9%) and long-term neuropathy (2.8%), were low in incidence. The use of perioperative nerve blocks provides effective pain management after hip arthroscopy and may be more effective in decreasing acute postoperative pain and supplemental opioid consumption than other analgesic techniques. Level IV, systematic review of Level I to Level IV studies. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. Safety of an i.v. β-adrenergic blockade protocol for heart rate optimization before coronary CT angiography.

    PubMed

    Kassamali, Rahil H; Kim, Daniel H; Patel, Hiten; Raichura, Nitin; Hoey, Edward T D; Hodson, James; Hussain, Shahid

    2014-10-01

    The purpose of this study was to assess the safety of heart rate optimization by use of β-adrenergic blockade solely by the i.v. route before coronary CT angiography. The records of 679 patients undergoing CT coronary angiography after receiving i.v. β-adrenergic blockade were retrospectively analyzed. Health screening was completed before scanning, and heart rate was optimized by administration of i.v. metoprolol titrated to a maximum of 70 mg to achieve a heart rate less than 65 beats/min. The median i.v. dose was 20 mg (range, 5-70 mg). The 679 patients analyzed had a total of 10 complications (1.47%). Major complications, defined as not resolving with observation and analgesia alone, occurred in only three patients (0.44%). These complications included a second-degree atrioventricular block. A total of 299 patients (44.0%) needed more than 20 mg of i.v. metoprolol to achieve target heart rate. Only three patients needed the maximum i.v. dose of 70 mg metoprolol. Target heart rate was reached successfully in 666 patients (98.1%) with doses of less than 70 mg. This study did not show a statistically significant association between increasing complication frequency and increasing dose. This study showed that high doses of i.v. metoprolol can be used effectively and with a low rate of major complications to control heart rate before coronary CT angiography in correctly screened patients.

  18. Neuropsychological correlates of complicated grief in older spousally bereaved adults.

    PubMed

    O'Connor, Mary-Frances; Arizmendi, Brian J

    2014-01-01

    Across many research domains, evidence for complicated grief as a distinct psychopathology continues to grow. Previous research from neuropsychology has shown an increased attentional bias to emotionally relevant stimuli in those suffering from complicated grief. This study furthers our understanding of the characteristics that distinguish complicated grief. We expand on previous research by (a) testing older adults, (b) excluding those with comorbid major depressive disorder, (c) using participant-chosen grief-related stimuli, and (d) using a married, nonbereaved control group. We recruited 76 older adults in 3 groups: spousally bereaved with complicated grief, spousally bereaved with noncomplicated grief, and nonbereaved controls. Performance on the Wisconsin Card Sorting Task, Digit Span Backwards, and the emotional counting Stroop was examined. Results indicate longer reaction time across 3 blocks of grief-related words in the complicated grief group but no difference across 3 blocks of the neutral words. The 3 groups performed comparably on the other neurocognitive tasks, indicating no cognitive differences in working memory or set shifting between groups. Furthermore, these effects of complicated grief generalize to older adults and appear independent of major depression. Complicated grief has cognitive interference as a neuropsychological component highlighting it as distinct from noncomplicated grief.

  19. Complete Atrioventricular Block Complicating Mitral Infective Endocarditis Caused by Streptococcus Agalactiae

    PubMed Central

    Arai, Masaru; Nagashima, Koichi; Kato, Mahoto; Akutsu, Naotaka; Hayase, Misa; Ogura, Kanako; Iwasawa, Yukino; Aizawa, Yoshihiro; Saito, Yuki; Okumura, Yasuo; Nishimaki, Haruna; Masuda, Shinobu; Hirayama, Atsushi

    2016-01-01

    Patient: Male, 74 Final Diagnosis: Infective endocarditis Symptoms: Apetite loss • fever Medication: — Clinical Procedure: Transesophageal echocardiography Specialty: Cardiology Objective: Rare co-existance of disease or pathology Background: Infective endocarditis (IE) involving the mitral valve can but rarely lead to complete atrioventricular block (CAVB). Case Report: A 74-year-old man with a history of infective endocarditis caused by Streptococcus gordonii (S. gordonii) presented to our emergency room with fever and loss of appetite, which had lasted for 5 days. On admission, results of serologic tests pointed to severe infection. Electrocardiography showed normal sinus rhythm with first-degree atrioventricular block and incomplete right bundle branch block, and transthoracic echocardiography and transesophageal echocardiography revealed severe mitral regurgitation caused by posterior leaflet perforation and 2 vegetations (5 mm and 6 mm) on the tricuspid valve. The patient was initially treated with ceftriaxone and gentamycin because blood and cutaneous ulcer cultures yielded S. agalactiae. On hospital day 2, however, sudden CAVB requiring transvenous pacing occurred, and the patient’s heart failure and infection worsened. Although an emergent surgery is strongly recommended, even in patients with uncontrolled heart failure or infection, surgery was not performed because of the Child-Pugh class B liver cirrhosis. Despite intensive therapy, the patient’s condition further deteriorated, and he died on hospital day 16. On postmortem examination, a 2×1-cm vegetation was seen on the perforated posterior mitral leaflet, and the infection had extended to the interventricular septum. Histologic examination revealed extensive necrosis of the AV node. Conclusions: This rare case of CAVB resulting from S. agalactiae IE points to the fact that in monitoring patients with IE involving the mitral valve, clinicians should be aware of the potential for perivalvular

  20. Rocuronium-induced neuromuscular block and sugammadex in pediatric patient with duchenne muscular dystrophy: A case Report.

    PubMed

    Kim, Ji Eun; Chun, Hea Rim

    2017-03-01

    Anesthetic management of patients with Duchenne muscular dystrophy (DMD) is complicated because these patients are more sensitive to nondepolarizing neuromuscular blocking agents (NMBAs) and are vulnerable to postoperative complications, such as postoperative residual curarization and respiratory failure. Sugammadex is a new reversal agent for aminosteroidal NMBAs, but its safety in children is controversial. An 11-year-old boy with DMD underwent general anesthesia for a percutaneous nephrolithotomy. We used rocuronium bromide and sugammadex to reverse the deep neuromuscular block. Reversal of neuromuscular block was done 15 minutes after administration of 2 mg/kg of sugammadex. The patient's recovery from anesthesia was uneventful, and he was discharged to the postoperative recovery ward. A delayed recovery was achieved, but no adverse events were observed, such as recurarization or hypersensitivity to sugammadex. We report safe use of 2 mg/kg of sugammadex to reverse a deep neuromuscular block in a child with DMD.

  1. Blocking the interaction between S100A9 protein and RAGE V domain using S100A12 protein.

    PubMed

    Katte, Revansiddha; Yu, Chin

    2018-01-01

    The proteins S100A9 and S100A12 are associated with the human S100 calcium-binding protein family. These proteins promote interaction with target proteins and alter their conformation when they bind to calcium ions in EF-hand motifs. The V domain of RAGE (Receptor for Advanced Glycation End products) is crucial for S100A9 binding. The binding of RAGE with S100 family proteins aids in cell proliferation. In this report, we demonstrate that S100A12 protein hinders the binding of S100A9 with the RAGE V-domain. We used fluorescence and NMR spectroscopy to analyze the interaction of S100A9 with S100A12. The binary complex models of S100A9-S100A12 were developed using data obtained from 1H-15N HSQC NMR titrations and the HADDOCK program. We overlaid the complex models of S100A9-S100A12 with the same orientation of S100A9 and the RAGE V-domain. This complex showed that S100A12 protein blocks the interaction between S100A9 and the RAGE V-domain. It means S100A12 may be used as an antagonist for S100A9. The results could be favorable for developing anti-cancer drugs based on S100 family proteins.

  2. Conjugated block copolymers: A building block for high-performance organic photovoltaics

    NASA Astrophysics Data System (ADS)

    Guo, Changhe

    State-of-the-art organic photovoltaics rely on kinetically trapped, partially phase-separated structures of donor/acceptor mixtures to create a high interfacial area for exciton dissociation and networks of bicontinuous phases for charge transport. Nevertheless, intrinsic structural disorder and weak intermolecular interactions in polymer blends limit the performance and stability of organic electronic devices. We demonstrate a potential strategy to control morphology and donor/acceptor heterojunctions through conjugated block copolymer poly(3-hexylthiophene)- block-poly((9,9-dioctylfluorene)-2,7-diyl-alt-[4,7-bis(thiophen-5-yl)-2,1,3-benzothiadiazole]-2',2''-diyl) (P3HT-b-PFTBT). Block copolymers can self-assemble into well-ordered nanostructures ideal for photovoltaic applications. When utilized as the photovoltaic active layer, P3HT-b-PFTBT block copolymer devices demonstrate thermal stability and photoconversion efficiency of 3% well beyond devices composed of the constituent polymer blends. Resonant soft X-ray scattering (RSOXS) is used to elucidate the structural origin for efficient block copolymer photovoltaics. Energy tuning in soft X-ray ranges gives RSOXS chemical sensitivity to characterize organic thin films with compositionally similar phases or complicated multiphase systems. RSOXS reveals that the remarkable performance of P3HT-b-PFTBT devices is due to self-assembly into nanoscale in-plane lamellar morphology, which not only establishes an equilibrium microstructure amenable for exciton dissociation but also provides pathways for efficient charge transport. Furthermore, we find evidence that covalent control of donor/acceptor interfaces in block copolymers has the potential to promote charge separation and optimize the photoconversion process by limiting charge recombination. To visualize the nanostructure in organic thin films, we introduce low energy-loss energy-filtered transmission electron microscopy (EFTEM) as an important alternative

  3. Ophthalmologic complications after intraoral local anesthesia.

    PubMed

    von Arx, Thomas; Lozanoff, Scott; Zinkernagel, Martin

    2014-01-01

    The first ophthalmologic complication in conjunction with a dental anesthesia was reported in 1936. The objective of the present study was a detailed analysis of case reports about that topic. After conducting a literature search in PubMed this study analyzed 108 ophthalmologic complications following intraoral local anesthesia in 65 case reports with respect to patient-, anesthesia-, and complication- related factors. The mean age of the patients was 33.8 years and females predominated (72.3%). The most commonly reported complication was diplopia (39.8%), mostly resulting from paralysis of the lateral rectus muscle. Other relatively frequent complications included ptosis (16.7%), mydriasis (14.8%) and amaurosis (13%). Ophthalmologic complications were mainly associated with block anesthesia of the inferior alveolar nerve (45.8%) or the posterior superior alveolar nerve (40.3%). Typically, the ophthalmologic complications in conjunction with intraoral local anesthesia had an immediate to short onset, and disappeared as the anesthesia subsided. The increased number of ophthalmologic complications after intraoral local anesthesia in females may suggest a gender effect. Double vision (diplopia) is the most frequently described complication, which is usually completely reversible like the other reported ophthalmologic complications.

  4. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis.

    PubMed

    Albrecht, E; Guyen, O; Jacot-Guillarmod, A; Kirkham, K R

    2016-05-01

    Many consider femoral nerve block the gold standard in pain management following knee arthroplasty. Local infiltration analgesia is an alternate approach that applies the concept of surgical wound infiltration with local anaesthetics. This meta-analysis aims to compare both analgesic treatments for analgesia and functional outcomes after total knee arthroplasty. This meta-analysis was performed according to the PRISMA statement guidelines. The primary outcomes were cumulative i.v. morphine consumption, pain scores at rest and on movement on postoperative day one (analogue scale,0-10). Secondary outcomes included range of motion, quadriceps muscle strength, length of stay and rates of complications (neurologic events, cardiovascular events, falls and knee infections). Fourteen trials, including 1122 adult patients were identified. There was no difference in i.v. morphine consumption (mean difference: -2.0 mg; 95% CI: -4.9, 0.9 mg; I(2)=69%; P=0.19), pain scores at rest (mean difference: -0.1; 95% CI: -0.4, 0.3; I(2)=72%; P=0.80) and pain scores on movement (mean difference: 0.2; 95% CI: -0.5, 0.8; I(2)=80%; P=0.64) on postoperative day one (a negative mean difference favours local infiltration analgesia). The qualities of evidence for our primary outcomes were moderate according to the GRADE system. There were no clinical differences in functional outcomes or rates of complications. Complication rates were captured by three trials or fewer with exception of knee infection, which was sought by eight trials. Local infiltration analgesia provides similar postoperative analgesia after total knee arthroplasty to femoral nerve block. Although this meta-analysis did not capture any difference in rates of complications, the low number of trials that specifically sought these outcomes dictates caution. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. A Randomized Controlled Trial Examining the Effect of the Addition of the Mandibular Block to Cervical Plexus Block for Carotid Endarterectomy.

    PubMed

    Kavrut Ozturk, Nilgun; Kavakli, Ali Sait; Sagdic, Kadir; Inanoglu, Kerem; Umot Ayoglu, Raif

    2018-04-01

    Although the cervical plexus block generally provides adequate analgesia for carotid endarterectomy, pain caused by metal retractors on the inferior surface of the mandible is not prevented by the cervical block. Different pain relief methods can be performed for patients who experience discomfort in these areas. In this study, the authors evaluated the effect of mandibular block in addition to cervical plexus block on pain scores in carotid endarterectomy. A prospective, randomized, controlled trial. Training and research hospital. Patients who underwent a carotid endarterectomy. Patients scheduled for carotid endarterectomy under cervical plexus block were randomized into 2 groups: group 1 (those who did not receive a mandibular block) and group 2 (those who received a mandibular block). The main purpose of the study was to evaluate the mandibular block in addition to cervical plexus block in terms of intraoperative pain scores. Intraoperative visual analog scale scores were significantly higher in group 1 (p = 0.001). The amounts of supplemental 1% lidocaine and intraoperative intravenous analgesic used were significantly higher in group 1 (p = 0.001 and p = 0.035, respectively). Patient satisfaction scores were significantly lower in group 1 (p = 0.044). The amount of postoperative analgesic used, time to first analgesic requirement, postoperative visual analog scale scores, and surgeon satisfaction scores were similar in both groups. There was no significant difference between the groups with respect to complications. No major neurologic deficits or perioperative mortality were observed. Mandibular block in addition to cervical plexus block provides better intraoperative pain control and greater patient satisfaction than cervical plexus block alone. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Reversible chronic acquired complete atrioventricular block.

    PubMed

    Rakovec, P; Milcinski, G; Voga, G; Korsic, L

    1982-01-01

    The return of atrioventricular conduction is reported in a case after nearly four years of complete acquired heart block. After recovery from atrioventricular block, right bundle branch block persisted, but P-R interval and H-V interval were normal. Three months later a relapse of second degree infranodal atrioventricular block was noted. A short review of similar cases from the literature is given.

  7. [Peripheral Regional Anesthesia Without Any Complications - a Dream Comes True?!

    PubMed

    Wiesmann, Thomas; Döffert, Jens; Steinfeldt, Thorsten

    2018-04-01

    Peripheral regional anesthesia procedures, such as femoral nerve block, are relatively safe procedures in clinical anesthesia. Nevertheless, it may lead to typical, usually transient and rarely even persistent complications. This article aims to highlight key aspects of complications in peripheral regional anesthesia and, in particular, strategies to reduce risk. Moreover, beside general complications, which might potentially occur in any peripheral nerve blockade ("bleeding/infection/nerve damage"), accidental co-blockades of other nerval structures are discussed using the example of the brachial plexus. In addition to the presentation of the possible complications, this article discusses improvements in the techniques during the last two decades. Due to the use of ultrasound, some side effects nowadays are supposed to occur less likely. An outlook into the future will inform the reader about improved or more selective blockages. Georg Thieme Verlag KG Stuttgart · New York.

  8. Temporal Evaluation of Neurosensory Complications After Mandibular Third Molar Extraction: Current Problems for Diagnosis and Treatment.

    PubMed

    Akashi, Masaya; Hiraoka, Yujiro; Hasegawa, Takumi; Komori, Takahide

    2016-01-01

    This retrospective study aimed to report the incidence of neurosensory complications after third molar extraction and also to identify current problems and discuss appropriate management of these complications. Patients who underwent extraction of deeply impacted mandibular third molars under general anesthesia were included. The following epidemiological data were retrospectively gathered from medical charts: type of neurosensory complication, treatment for complication, and outcome. A total 369 mandibular third molars were extracted in 210 patients under general anesthesia during this study period. Thirty-one of the 369 teeth (8.4%) in 31 patients had neurosensory complications during the first postoperative week resulting from inferior alveolar nerve damage. Neurosensory complications lasting from 1 to 3 months postoperatively included 17 cases of hypoesthesia and 8 of dysesthesia in 19 patients. Five cases of hypoesthesia and 4 of dysesthesia in 5 patients persisted over 1 year postoperatively. Sixteen of 369 teeth (4.3%) in 16 patients had persistent neurosensory complications after third molar extraction under general anesthesia. Stellate ganglion block was performed in 4 patients. Early initiation of stellate ganglion block (within 2 weeks postoperatively) produced better outcomes than late stellate ganglion block (over 6 months postoperatively). Refractory neurosensory complications after third molar extraction often combine both hypoesthesia and dysesthesia. Current problems in diagnosis and treatment included delayed detection of dysesthesia and the lack of uniform timing of stellate ganglion block. In the future, routinely inquiring about dysesthesia and promptly providing affected patients with information about stellate ganglion block might produce better outcomes.

  9. Temporal Evaluation of Neurosensory Complications After Mandibular Third Molar Extraction: Current Problems for Diagnosis and Treatment

    PubMed Central

    Akashi, Masaya; Hiraoka, Yujiro; Hasegawa, Takumi; Komori, Takahide

    2016-01-01

    Objective: This retrospective study aimed to report the incidence of neurosensory complications after third molar extraction and also to identify current problems and discuss appropriate management of these complications. Method: Patients who underwent extraction of deeply impacted mandibular third molars under general anesthesia were included. The following epidemiological data were retrospectively gathered from medical charts: type of neurosensory complication, treatment for complication, and outcome. Results: A total 369 mandibular third molars were extracted in 210 patients under general anesthesia during this study period. Thirty-one of the 369 teeth (8.4%) in 31 patients had neurosensory complications during the first postoperative week resulting from inferior alveolar nerve damage. Neurosensory complications lasting from 1 to 3 months postoperatively included 17 cases of hypoesthesia and 8 of dysesthesia in 19 patients. Five cases of hypoesthesia and 4 of dysesthesia in 5 patients persisted over 1 year postoperatively. Sixteen of 369 teeth (4.3%) in 16 patients had persistent neurosensory complications after third molar extraction under general anesthesia. Stellate ganglion block was performed in 4 patients. Early initiation of stellate ganglion block (within 2 weeks postoperatively) produced better outcomes than late stellate ganglion block (over 6 months postoperatively). Conclusion: Refractory neurosensory complications after third molar extraction often combine both hypoesthesia and dysesthesia. Current problems in diagnosis and treatment included delayed detection of dysesthesia and the lack of uniform timing of stellate ganglion block. In the future, routinely inquiring about dysesthesia and promptly providing affected patients with information about stellate ganglion block might produce better outcomes. PMID:28217188

  10. Oncoplastic round block technique has comparable operative parameters as standard wide local excision: a matched case-control study.

    PubMed

    Lim, Geok-Hoon; Allen, John Carson; Ng, Ruey Pyng

    2017-08-01

    Although oncoplastic breast surgery is used to resect larger tumors with lower re-excision rates compared to standard wide local excision (sWLE), criticisms of oncoplastic surgery include a longer-albeit, well concealed-scar, longer operating time and hospital stay, and increased risk of complications. Round block technique has been reported to be very suitable for patients with relatively smaller breasts and minimal ptosis. We aim to determine if round block technique will result in operative parameters comparable with sWLE. Breast cancer patients who underwent a round block procedure from 1st May 2014 to 31st January 2016 were included in the study. These patients were then matched for the type of axillary procedure, on a one to one basis, with breast cancer patients who had undergone sWLE from 1st August 2011 to 31st January 2016. The operative parameters between the 2 groups were compared. 22 patients were included in the study. Patient demographics and histologic parameters were similar in the 2 groups. No complications were reported in either group. The mean operating time was 122 and 114 minutes in the round block and sWLE groups, respectively (P=0.64). Length of stay was similar in the 2 groups (P=0.11). Round block patients had better cosmesis and lower re-excision rates. A higher rate of recurrence was observed in the sWLE group. The round block technique has comparable operative parameters to sWLE with no evidence of increased complications. Lower re-excision rate and better cosmesis were observed in the round block patients suggesting that the round block technique is not only comparable in general, but may have advantages to sWLE in selected cases.

  11. Long-term use of nerve block catheters in paediatric patients with cancer related pathologic fractures

    PubMed Central

    BURGOYNE, L. L.; PEREIRAS, L. A.; BERTANI, L. A.; KADDOUM, R. N.; NEEL, M.; FAUGHNAN, L. G.; ANGHELESCU, D. L.

    2013-01-01

    SUMMARY We report three cases of children with osteosarcoma and pathologic fractures treated with long-term continuous nerve blocks for preoperative pain control. One patient with a left distal femoral diaphysis fracture had a femoral continuous nerve block catheter for 41 days without complications. Another with a fractured left proximal femoral shaft had three femoral continuous nerve block catheters for 33, 26 and 22 days respectively. The third patient, whose right proximal humerus was fractured, had a brachial plexus continuous nerve block catheter for 36 days without complication. In our experience, prolonged use of continuous nerve block is safe and effective in children with pathologic fractures for preoperative pain control. PMID:22813501

  12. Liposomal Bupivacaine Does Not Reduce Inpatient Opioid Prescription or Related Complications after Knee Arthroplasty: A Database Analysis.

    PubMed

    Pichler, Lukas; Poeran, Jashvant; Zubizarreta, Nicole; Cozowicz, Crispiana; Sun, Eric C; Mazumdar, Madhu; Memtsoudis, Stavros G

    2018-05-21

    Although some trials suggest benefits of liposomal bupivacaine, data on real-world use and effectiveness is lacking. This study analyzed the impact of liposomal bupivacaine use (regardless of administration route) on inpatient opioid prescription, resource utilization, and opioid-related complications among patients undergoing total knee arthroplasties with a peripheral nerve block. It was hypothesized that liposomal bupivacaine has limited clinical influence on the studied outcomes. The study included data on 88,830 total knee arthroplasties performed with a peripheral nerve block (Premier Healthcare Database 2013 to 2016). Multilevel multivariable regressions measured associations between use of liposomal bupivacaine and (1) inpatient opioid prescription (extracted from billing) and (2) length of stay, cost of hospitalization, as well as opioid-related complications. To reflect the difference between statistical and clinical significance, a relative change of -15% in outcomes was assumed to be clinically important. Overall, liposomal bupivacaine was used in 21.2% (n = 18,817) of patients that underwent a total knee arthroplasty with a peripheral nerve block. Liposomal bupivacaine use was not associated with a clinically meaningful reduction in inpatient opioid prescription (group median, 253 mg of oral morphine equivalents, adjusted effect -9.3% CI -11.1%, -7.5%; P < 0.0001) and length of stay (group median, 3 days, adjusted effect -8.8% CI -10.1%, -7.5%; P < 0.0001) with no effect on cost of hospitalization. Most importantly, liposomal bupivacaine use was not associated with decreased odds for opioid-related complications. Liposomal bupivacaine was not associated with a clinically relevant improvement in inpatient opioid prescription, resource utilization, or opioid-related complications in patients who received modern pain management including a peripheral nerve block.

  13. Patients' and procedural characteristics of AV-block during slow pathway modulation for AVNRT-single center 10year experience.

    PubMed

    Wasmer, Kristina; Dechering, Dirk G; Köbe, Julia; Leitz, Patrick; Frommeyer, Gerrit; Lange, Phillip S; Kochhäuser, Simon; Reinke, Florian; Pott, Christian; Mönnig, Gerold; Breithardt, Günter; Eckardt, Lars

    2017-10-01

    Permanent AV-block is a recognized and feared complication of slow pathway modulation for AVNRT. We aimed to assess incidence of transient and permanent AV-block as well as consequences of transient AV-block in a large contemporary AVNRT ablation cohort. We searched our single center prospective ablation database for occurrence of transient and permanent AV-block during slow pathway modulation between January 2004 and October 2015. We analyzed patients' and procedural characteristics as well as outcome of patients in whom transient or permanent AV-block occurred. Of 9170 patients who underwent a catheter ablation at our institution between January 2004 and October 2015, 2101 patients (64% women, mean age 50±18years) underwent slow pathway modulation. In three patients, permanent AV-block occurred during RF application. Additional two patients had transient AV-block that recovered (after a few minutes and 25min), but recurred within two days of the procedure. All five patients underwent dual chamber pacemaker implantation (0.2%). Transient AV-block related to RF delivery occurred in 44 patients (2%). Transient mechanical AV-block occurred in additional 17 patients (0.8%). In 12 patients, ablation was continued despite transient AV-block. One of these patients developed permanent AV-block. Permanent AV-block following slow pathway modulation is a rare event, occurring in 0.2% of patients in a large contemporary single center cohort. Transient AV-block is more frequent (2%). Copyright © 2017 Elsevier B.V. All rights reserved.

  14. [Early complications following transcatheter occlusion of perimembranous ventricular septal defects in children].

    PubMed

    Li, Jun-jie; Zhang, Zhi-wei; Qian, Ming-yang; Wang, Hui-shen; Li, Yu-fen

    2006-11-01

    To evaluate the early complications during and after transcatheter closure of perimembranous ventricular septal defects (PMVSDs) in children. A total of 223 patients received transcatheter closure of PMVSDs from March 2002 to December 2005 in our hospital were included in this retrospective study. The overall complications rate was 26.9% (60/223). Major complications occurred in 9 patients (4.0%) including III degrees atrioventricular block (AVB) in 2 (0.9%), hemolysis in 3 (1.3%) and surgical interventions in 4 patients (1.8%) because of device malposition (1), mild aortic regurgitation (2) and device embolization (1) and all 4 patients recovered without further complications. The 2 patients with III degrees AVB were completely recovered to normal sinus rhythm after 7 days treatment with temporary pacemaker and corticosteroid. Hemolysis in 3 patients disappeared after corticosteroid treatment. Minor complications occurred in 51 patients (22.8%) including bundle branch block (BBB) in 37 (16.6%), first-degree AVB in 2 (0.9%), second-degree AVB in 1 (0.4%), new-onset mild aortic regurgitation in 5 (2.2%) and new-onset mild to moderate tricuspid regurgitation in 6 patients (2.6%). Except for right bundle branch blocks, other BBBs were treated with albumin and corticosteroid and completely recovered. No treatment was applied for new-onset valve regurgitations. There was no death in all 223 patients. Early complications post PMVSDs in children are mostly minor with good prognosis and the prognosis for major complications post PMVSDs is good after proper treatment.

  15. Femoral Nerve Block versus Adductor Canal Block for Analgesia after Total Knee Arthroplasty.

    PubMed

    Koh, In Jun; Choi, Young Jun; Kim, Man Soo; Koh, Hyun Jung; Kang, Min Sung; In, Yong

    2017-06-01

    Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA.

  16. Benzodiazepine-associated atrioventricular block.

    PubMed

    Arroyo Plasencia, Anna M; Ballentine, Lynn M; Mowry, James B; Kao, Louise W

    2012-01-01

    Dysrhythmias, although common in overdose situations, are not often seen after benzodiazepine exposures. We report two cases of transient atrioventricular block after benzodiazepine misuse. Case 1 is a 4-year-old boy who was found unresponsive after an ingestion of clonazepam. An electrocardiogram (EKG) performed on emergency department presentation demonstrated first-degree atrioventricular block (PR 206 ms). After flumazenil administration, he developed second-degree atrioventricular block (Mobitz Type 1). EKG abnormalities resolved by morning. Serum clonazepam was 478 ng/mL (laboratory clonazepam reference range, 10-75 ng/mL with a dose of up to 6 mg/day) 5 hours after being found unresponsive. Case 2 is a 23-year-old man who presented to the emergency department after ingesting risperidone, combination hydrocodone/acetaminophen, and alprazolam. On arrival, his EKG demonstrated sinus bradycardia with a PR interval of 182 msec. He subsequently developed second-degree atrioventricular block (Mobitz Type I). Sinus bradycardia with resolution of his atrioventricular block (PR 200 ms) was seen on a third EKG performed 5 hours after presentation. These two patients demonstrated transient first- and second-degree atrioventricular block after benzodiazepine exposure. Benzodiazepines have been shown to alter L-type Ca2+ channel function. This alteration in function may account for the dysrhythmias seen in our patients. Together, these cases serve to remind clinicians of this rare but potentially serious complication associated with benzodiazepine exposure.

  17. Tube Thoracostomy: Complications and Its Management

    PubMed Central

    Kesieme, Emeka B.; Dongo, Andrew; Ezemba, Ndubueze; Irekpita, Eshiobo; Jebbin, Nze; Kesieme, Chinenye

    2012-01-01

    Background. Tube thoracostomy is widely used throughout the medical, surgical, and critical care specialities. It is generally used to drain pleural collections either as elective or emergency. Complications resulting from tube thoracostomy can occasionally be life threatening. Aim. To present an update on the complications and management of complications of tube thoracostomy. Methods. A review of the publications obtained from Medline search, medical libraries, and Google on tube thoracostomy and its complications was done. Results. Tube thoracostomy is a common surgical procedure which can be performed by either the blunt dissection technique or the trocar technique. Complication rates are increased by the trocar technique. These complications have been broadly classified as either technical or infective. Technical causes include tube malposition, blocked drain, chest drain dislodgement, reexpansion pulmonary edema, subcutaneous emphysema, nerve injuries, cardiac and vascular injuries, oesophageal injuries, residual/postextubation pneumothorax, fistulae, tumor recurrence at insertion site, herniation through the site of thoracostomy, chylothorax, and cardiac dysrhythmias. Infective complications include empyema and surgical site infection. Conclusion. Tube thoracostomy, though commonly performed is not without risk. Blunt dissection technique has lower risk of complications and is hence recommended. PMID:22028963

  18. A novel combination of peripheral nerve blocks for arthroscopic shoulder surgery.

    PubMed

    Musso, D; Flohr-Madsen, S; Meknas, K; Wilsgaard, T; Ytrebø, L M; Klaastad, Ø

    2017-10-01

    Interscalene brachial plexus block is currently the gold standard for intra- and post-operative pain management for patients undergoing arthroscopic shoulder surgery. However, it is associated with block related complications, of which effect on the phrenic nerve have been of most interest. Side effects caused by general anesthesia, when this is required, are also a concern. We hypothesized that the combination of superficial cervical plexus block, suprascapular nerve block, and infraclavicular brachial plexus block would provide a good alternative to interscalene block and general anesthesia. Twenty adult patients scheduled for arthroscopic shoulder surgery received a combination of superficial cervical plexus block (5 ml ropivacaine 0.5%), suprascapular nerve block (4 ml ropivacaine 0.5%), and lateral sagittal infraclavicular block (31 ml ropivacaine 0.75%). The primary aim was to find the proportion of patients who could be operated under light propofol sedation, without the need for opioids or artificial airway. Secondary aims were patients' satisfaction and surgeons' judgment of the operating conditions. Nineteen of twenty patients (95% CI: 85-100) underwent arthroscopic shoulder surgery with light propofol sedation, but without opioids or artificial airway. The excluded patient was not comfortable in the beach chair position and therefore received general anesthesia. All patients were satisfied with the treatment on follow-up interviews. The surgeons rated the operating conditions as good for all patients. The novel combination of a superficial cervical plexus block, a suprascapular nerve block, and an infraclavicular nerve block provides an alternative anesthetic modality for arthroscopic shoulder surgery. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  19. Disrupted Prefrontal Activity during Emotion Processing in Complicated Grief: an fMRI Investigation

    PubMed Central

    Arizmendi, Brian; Kaszniak, Alfred W.; O’Connor, Mary-Frances

    2015-01-01

    Complicated Grief, marked by a persistent and intrusive grief lasting beyond the expected period of adaptation, is associated with a relative inability to disengage from idiographic loss-relevant stimuli (O’Connor & Arizmendi, 2014). In other populations, functional magnetic resonance imaging (fMRI) studies investigating the neural networks associated with this bias consistently implicate the anterior cingulate cortex (ACC) during emotion regulation. In the present study, twenty-eight older adults were categorized into three groups based on grief severity: Complicated Grief (n=8), Non-Complicated Grief (n=9), and Nonbereaved, married controls (n=11). Using a block design, all participants completed 8 blocks (20 stimuli per block) of the ecStroop task during fMRI data acquisition. Differences in neural activity during grief-related (as opposed to neutral) stimuli across groups were examined. Those with Complicated Grief showed an absence of increased rostral ACC (rACC) and fronto-cortical recruitment relative to Nonbereaved controls. Activity in the orbitofrontal cortex (x=6, y=54, z=−10) was significantly elevated in the Non-Complicated Grief group when compared to Nonbereaved controls. Post hoc analysis evidenced activity in the dorsal ACC in the Complicated Grief and Nonbereaved groups late in the task. These findings, supported by behavioral data, suggest a relative inability to recruit the regions necessary for successful completion of this emotional task in those with Complicated Grief. This deficit was not observed in recruitment of the orbitofrontal cortex and the rACC during processing of idiographic semantic stimuli in Non-Complicated Grief. PMID:26434802

  20. Disrupted prefrontal activity during emotion processing in complicated grief: An fMRI investigation.

    PubMed

    Arizmendi, Brian; Kaszniak, Alfred W; O'Connor, Mary-Frances

    2016-01-01

    Complicated Grief, marked by a persistent and intrusive grief lasting beyond the expected period of adaptation, is associated with a relative inability to disengage from idiographic loss-relevant stimuli (O'Connor and Arizmendi, 2014). In other populations, functional magnetic resonance imaging (fMRI) studies investigating the neural networks associated with this bias consistently implicate the anterior cingulate cortex (ACC) during emotion regulation. In the present study, twenty-eight older adults were categorized into three groups based on grief severity: Complicated Grief (n=8), Non-Complicated Grief (n=9), and Nonbereaved, married controls (n=11). Using a block design, all participants completed 8 blocks (20 stimuli per block) of the ecStroop task during fMRI data acquisition. Differences in neural activity during grief-related (as opposed to neutral) stimuli across groups were examined. Those with Complicated Grief showed an absence of increased rostral ACC (rACC) and fronto-cortical recruitment relative to Nonbereaved controls. Activity in the orbitofrontal cortex (x=6, y=54, z=-10) was significantly elevated in the Non-Complicated Grief group when compared to Nonbereaved controls. Post hoc analysis evidenced activity in the dorsal ACC in the Complicated Grief and Nonbereaved groups late in the task. These findings, supported by behavioral data, suggest a relative inability to recruit the regions necessary for successful completion of this emotional task in those with Complicated Grief. This deficit was not observed in recruitment of the orbitofrontal cortex and the rACC during processing of idiographic semantic stimuli in Non-Complicated Grief. Copyright © 2015 Elsevier Inc. All rights reserved.

  1. Criminal Justice Systems. Block I: Law Enforcement. Block II: The Courts. Block III: Corrections. Block IV: Community Relations. Block V: Proficiency Skills. Block VI: Criminalistics. Instructor Guide.

    ERIC Educational Resources Information Center

    Florida State Dept. of Education, Tallahassee. Div. of Vocational, Adult, and Community Education.

    This instructor guide together with a student guide comprise a set of curriculum materials on the criminal justice system. The instructor guide is a resource for planning and managing individualized, competency-based instruction in six major subject areas or blocks, which are further broken down into several units with some units having several…

  2. Blocking the Interactions between Calcium-Bound S100A12 Protein and the V Domain of RAGE Using Tranilast

    PubMed Central

    Chiou, Jian Wei; Fu, Brian

    2016-01-01

    The receptor for advanced glycation end products (RAGE), a transmembrane receptor in the immunoglobulin superfamily, is involved in several inflammatory processes. RAGE induces cellular signaling pathways upon binding with various ligands, such as advanced glycation end products (AGEs), β-amyloids, and S100 proteins. The solution structure of S100A12 and the V ligand-binding region of RAGE have been reported previously. Using heteronuclear NMR spectroscopy to conduct 1H–15N heteronuclear single quantum coherence (HSQC) titration experiments, we identified and mapped the binding interface between S100A12 and the V domain of RAGE. The NMR chemical shift data were used as the constraints for the High Ambiguity Driven biomolecular DOCKing (HADDOCK) calculation to generate a structural model of the S100A12–V domain complex. In addition, tranilast (an anti-allergic drug) showed strong interaction with S100A12 in the 1H–15N HSQC titration, fluorescence experiments, and WST-1 assay. The results also indicated that tranilast was located at the binding site between S100A12 and the V domain, blocking interaction between these two proteins. Our results provide the mechanistic details for a structural model and reveal a potential precursor for an inhibitor for pro-inflammatory diseases, which could be useful for the development of new drugs. PMID:27598566

  3. ProTx-II, a selective inhibitor of NaV1.7 sodium channels, blocks action potential propagation in nociceptors.

    PubMed

    Schmalhofer, William A; Calhoun, Jeffrey; Burrows, Rachel; Bailey, Timothy; Kohler, Martin G; Weinglass, Adam B; Kaczorowski, Gregory J; Garcia, Maria L; Koltzenburg, Martin; Priest, Birgit T

    2008-11-01

    Voltage-gated sodium (Na(V)1) channels play a critical role in modulating the excitability of sensory neurons, and human genetic evidence points to Na(V)1.7 as an essential contributor to pain signaling. Human loss-of-function mutations in SCN9A, the gene encoding Na(V)1.7, cause channelopathy-associated indifference to pain (CIP), whereas gain-of-function mutations are associated with two inherited painful neuropathies. Although the human genetic data make Na(V)1.7 an attractive target for the development of analgesics, pharmacological proof-of-concept in experimental pain models requires Na(V)1.7-selective channel blockers. Here, we show that the tarantula venom peptide ProTx-II selectively interacts with Na(V)1.7 channels, inhibiting Na(V)1.7 with an IC(50) value of 0.3 nM, compared with IC(50) values of 30 to 150 nM for other heterologously expressed Na(V)1 subtypes. This subtype selectivity was abolished by a point mutation in DIIS3. It is interesting that application of ProTx-II to desheathed cutaneous nerves completely blocked the C-fiber compound action potential at concentrations that had little effect on Abeta-fiber conduction. ProTx-II application had little effect on action potential propagation of the intact nerve, which may explain why ProTx-II was not efficacious in rodent models of acute and inflammatory pain. Mono-iodo-ProTx-II ((125)I-ProTx-II) binds with high affinity (K(d) = 0.3 nM) to recombinant hNa(V)1.7 channels. Binding of (125)I-ProTx-II is insensitive to the presence of other well characterized Na(V)1 channel modulators, suggesting that ProTx-II binds to a novel site, which may be more conducive to conferring subtype selectivity than the site occupied by traditional local anesthetics and anticonvulsants. Thus, the (125)I-ProTx-II binding assay, described here, offers a new tool in the search for novel Na(V)1.7-selective blockers.

  4. Sinus floor elevation with a crestal approach using a press-fit bone block: a case series.

    PubMed

    Isidori, M; Genty, C; David-Tchouda, S; Fortin, T

    2015-09-01

    This prospective study aimed to provide detailed clinical information on a sinus augmentation procedure, i.e., transcrestal sinus floor elevation with a bone block using the press-fit technique. A bone block is harvested with a trephine burr to obtain a cylinder. This block is inserted into the antrum via a crestal approach after creation of a circular crestal window. Thirty-three patients were treated with a fixed prosthesis supported by implants placed on 70 cylindrical bone blocks. The mean bone augmentation was 6.08±2.87 mm, ranging from 0 to 12.7 mm. Only one graft failed before implant placement. During surgery and the subsequent observation period, no complications were recorded, one implant was lost, and no infection or inflammation was observed. This proof-of-concept study suggests that the use of a bone block inserted into the sinus cavity via a crestal approach can be an alternative to the sinus lift procedure with the creation of a lateral window. It reduces the duration of surgery, cost of treatment, and overall discomfort. Copyright © 2015. Published by Elsevier Ltd.

  5. Computing Aerodynamic Performance of a 2D Iced Airfoil: Blocking Topology and Grid Generation

    NASA Technical Reports Server (NTRS)

    Chi, X.; Zhu, B.; Shih, T. I.-P.; Slater, J. W.; Addy, H. E.; Choo, Yung K.; Lee, Chi-Ming (Technical Monitor)

    2002-01-01

    The ice accrued on airfoils can have enormously complicated shapes with multiple protruded horns and feathers. In this paper, several blocking topologies are proposed and evaluated on their ability to produce high-quality structured multi-block grid systems. A transition layer grid is introduced to ensure that jaggedness on the ice-surface geometry do not to propagate into the domain. This is important for grid-generation methods based on hyperbolic PDEs (Partial Differential Equations) and algebraic transfinite interpolation. A 'thick' wrap-around grid is introduced to ensure that grid lines clustered next to solid walls do not propagate as streaks of tightly packed grid lines into the interior of the domain along block boundaries. For ice shapes that are not too complicated, a method is presented for generating high-quality single-block grids. To demonstrate the usefulness of the methods developed, grids and CFD solutions were generated for two iced airfoils: the NLF0414 airfoil with and without the 623-ice shape and the B575/767 airfoil with and without the 145m-ice shape. To validate the computations, the computed lift coefficients as a function of angle of attack were compared with available experimental data. The ice shapes and the blocking topologies were prepared by NASA Glenn's SmaggIce software. The grid systems were generated by using a four-boundary method based on Hermite interpolation with controls on clustering, orthogonality next to walls, and C continuity across block boundaries. The flow was modeled by the ensemble-averaged compressible Navier-Stokes equations, closed by the shear-stress transport turbulence model in which the integration is to the wall. All solutions were generated by using the NPARC WIND code.

  6. Advantages of caudal block over intrarectal local anesthesia plus periprostatic nerve block for transrectal ultrasound guided prostate biopsy

    PubMed Central

    Wang, Na; Fu, Yaowen; Ma, Haichun; Wang, Jinguo; Gao, Yang

    2016-01-01

    Objective: To compare caudal block with intrarectal local anesthesia plus periprostatic nerve block for transrectal ultrasound guided prostate biopsy. Methods: One hundred and ninety patients scheduled for transrectal ultrasound guided prostate biopsy were randomized equally into Group-A who received caudal block (20 ml 1.2% lidocaine) and Group-B who received intrarectal local anesthesia (0.3% oxybuprocaine cream) plus periprostatic nerve block (10 ml 1% lidocaine plus 0.5% ropivacaine) before biopsy. During and after the procedure, the patients rated the level of pain/discomfort at various time points. Complications during the whole study period and the patient overall satisfaction were also evaluated. Results: More pain and discomfort was detected during periprostatic nerve block than during caudal block. Pain and discomfort was significantly lower during prostate biopsy and during the manipulation of the probe in the rectum in Group-A than in Group-B. No significant differences were detected in the pain intensity after biopsy and side effects between the two groups. Conclusions: Caudal block provides better anesthesia than periprostatic nerve block plus intrarectal local anesthesia for TRUS guided prostate biopsy without an increase of side effects. PMID:27648052

  7. A Comparison of Efficacy of Segmental Epidural Block versus Spinal Anaesthesia for Percutaneous Nephrolithotomy

    PubMed Central

    Nandanwar, Avinash S; Patil, Yogita; Baheti, Vidyasagar H.; Tanwar, Harshwardhan V.; Patwardhan, Sujata K.

    2015-01-01

    Introduction Percutaneous nephrolithotomy (PCNL) is done under general anaesthesia in most of the centres. Associated complications and cost are higher for general anaesthesia than for regional anaesthesia. Present study is designed to compare the efficacy of epidural block versus spinal anaesthesia with regards to intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, Postoperative complications and patient satisfaction in patients undergoing PCNL. Materials and Methods After taking Ethical Committee clearance, patients were randomly allocated into 2 groups using table of randomization (n= 40 each) Group E- Epidural block, Group S- Spinal block. Various parameters like intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, postoperative complications and patient satisfaction were studied in these groups. Statistical Analysis Quantitative data was analysed using unpaired t-test and qualitative data was analysed using chi-square test. Results Twenty four times in Epidural as compared to fifteen times in spinal anaesthesia two or more attempts required. Mean time (min) required to achieve the block of anaesthesia in group E and group S was 15.45±2.8 and 8.52±2.62 min respectively. Mean arterial pressure (MAP) at 5 min, 10 min and 15 min were significantly lower in spinal group as compared to epidural group. After 30 minutes, differences were not significant but still MAP was lower in spinal group. After 30 minutes difference in heart rate between two groups was statistically significant and higher rate recorded in spinal group till the end of 3 hours. Postoperative VAS score was significantly higher in spinal group and 4 hours onwards difference was highly significant. Postoperative Nausea Vomiting (PONV) Score was significantly higher in spinal group as compared to epidural group. Conclusion For PCNL, segmental epidural block is better than spinal anaesthesia in terms

  8. A Comparison of Efficacy of Segmental Epidural Block versus Spinal Anaesthesia for Percutaneous Nephrolithotomy.

    PubMed

    Nandanwar, Avinash S; Patil, Yogita; Wagaskar, Vinayak G; Baheti, Vidyasagar H; Tanwar, Harshwardhan V; Patwardhan, Sujata K

    2015-08-01

    Percutaneous nephrolithotomy (PCNL) is done under general anaesthesia in most of the centres. Associated complications and cost are higher for general anaesthesia than for regional anaesthesia. Present study is designed to compare the efficacy of epidural block versus spinal anaesthesia with regards to intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, Postoperative complications and patient satisfaction in patients undergoing PCNL. After taking Ethical Committee clearance, patients were randomly allocated into 2 groups using table of randomization (n= 40 each) Group E- Epidural block, Group S- Spinal block. Various parameters like intraoperative mean arterial pressure, heart rate, postoperative pain intensity, analgesic requirement, postoperative complications and patient satisfaction were studied in these groups. Quantitative data was analysed using unpaired t-test and qualitative data was analysed using chi-square test. Twenty four times in Epidural as compared to fifteen times in spinal anaesthesia two or more attempts required. Mean time (min) required to achieve the block of anaesthesia in group E and group S was 15.45±2.8 and 8.52±2.62 min respectively. Mean arterial pressure (MAP) at 5 min, 10 min and 15 min were significantly lower in spinal group as compared to epidural group. After 30 minutes, differences were not significant but still MAP was lower in spinal group. After 30 minutes difference in heart rate between two groups was statistically significant and higher rate recorded in spinal group till the end of 3 hours. Postoperative VAS score was significantly higher in spinal group and 4 hours onwards difference was highly significant. Postoperative Nausea Vomiting (PONV) Score was significantly higher in spinal group as compared to epidural group. For PCNL, segmental epidural block is better than spinal anaesthesia in terms of haemodynamic stability, postoperative analgesia, patient satisfaction

  9. Organic photosensitive cells having a reciprocal-carrier exciton blocking layer

    DOEpatents

    Rand, Barry P [Princeton, NJ; Forrest, Stephen R [Princeton, NJ; Thompson, Mark E [Anaheim Hills, CA

    2007-06-12

    A photosensitive cell includes an anode and a cathode; a donor-type organic material and an acceptor-type organic material forming a donor-acceptor junction connected between the anode and the cathode; and an exciton blocking layer connected between the acceptor-type organic material of the donor-acceptor junction and the cathode, the blocking layer consisting essentially of a material that has a hole mobility of at least 10.sup.-7 cm.sup.2/V-sec or higher, where a HOMO of the blocking layer is higher than or equal to a HOMO of the acceptor-type material.

  10. Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy: a randomized controlled trial.

    PubMed

    Kulhari, S; Bharti, N; Bala, I; Arora, S; Singh, G

    2016-09-01

    Pectoral nerve (PecS) block is a recently introduced technique for providing surgical anaesthesia and postoperative analgesia during breast surgery. The present study was planned to compare the efficacy and safety of ultrasound-guided PecS II block with thoracic paravertebral block (TPVB) for postoperative analgesia after modified radical mastectomy. Forty adult female patients undergoing radical mastectomy were randomly allocated into two groups. Group 1 patients received a TPVB with ropivacaine 0.5%, 25 ml, whereas Group 2 patents received a PecS II block using same volume of ropivacaine 0.5% before induction of anaesthesia. Patient-controlled morphine analgesia was used for postoperative pain relief. The duration of analgesia was significantly prolonged in patients receiving the PecS II block compared with TPVB [mean (sd), 294.5 (52.76) vs 197.5 (31.35) min in the PecS II and TPVB group, respectively; P<0.0001]. The 24 h morphine consumption was also less in the PecS II block group [mean (sd), 3.90 (0.79) vs 5.30 (0.98) mg in PecS II and TPVB group, respectively; P<0.0001]. Postoperative pain scores were lower in the PecS II group compared with the TVPB group in the initial 2 h after surgery [median (IQR), 2 (2-2.5) vs 4 (3-4) in the Pecs II and TPVB group, respectively; P<0.0001]. Seventeen patients in the PecS II block group had T2 dermatomal spread compared with four patients in the TPVB group (P<0.001). No block-related complication was recorded. We found that the PecS II block provided superior postoperative analgesia than the TPVB in patients undergoing modified radical mastectomy without causing any adverse effect. CTRI/2014/06/004692. © The Author 2016. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Comparison of Ultrasound with Peripheral Nerve Stimulator-guided Technique for Supraclavicular Block in Upper Limb Surgeries: A Randomized Controlled Trial.

    PubMed

    Alfred, Vinu Mervick; Srinivasan, Gnanasekaran; Zachariah, Mamie

    2018-01-01

    The supraclavicular approach is considered to be the easiest and most effective approach to block the brachial plexus for upper limb surgeries. The classical approach using the anatomical landmark technique was associated with higher failure rates and complications. Ultrasonography (USG) guidance and peripheral nerve stimulator (PNS) have improved the success rates and safety margin. The aim of the present study is to compare USG with PNS in supraclavicular brachial plexus block for upper limb surgeries with respect to the onset of motor and sensory blockade, total duration of blockade, procedure time, and complications. Prospective, randomized controlled study. Sixty patients aged above 18 years scheduled for elective upper limb surgery were randomly allocated into two groups. Group A patients received supraclavicular brachial plexus block under ultrasound guidance and in Group B patients, PNS was used. In both groups, local anesthetic mixture consisting of 15 ml of 0.5% bupivacaine and 10 ml of 2% lignocaine with 1:200,000 adrenaline were used. Independent t -test used to compare mean between groups; Chi-square test for categorical variables. The procedure time was shorter with USG (11.57 ± 2.75 min) compared to PNS (21.73 ± 4.84). The onset time of sensory block (12.83 ± 3.64 min vs. 16 ± 3.57 min) and onset of motor block (23 ± 4.27 min vs. 27 ± 3.85 min) were significantly shorter in Group A compared to Group B ( P < 0.05). The duration of sensory block was significantly prolonged in Group A (8.00 ± 0.891 h) compared to Group B (7.25 ± 1.418 h). None of the patients in either groups developed any complications. The ultrasound-guided supraclavicular brachial plexus block can be done quicker, with a faster onset of sensory and motor block compared to nerve stimulator technique.

  12. Femoral Nerve Block versus Adductor Canal Block for Analgesia after Total Knee Arthroplasty

    PubMed Central

    Koh, In Jun; Choi, Young Jun; Kim, Man Soo; Koh, Hyun Jung; Kang, Min Sung; In, Yong

    2017-01-01

    Inadequate pain management after total knee arthroplasty (TKA) impedes recovery, increases the risk of postoperative complications, and results in patient dissatisfaction. Although the preemptive use of multimodal measures is currently considered the principle of pain management after TKA, no gold standard pain management protocol has been established. Peripheral nerve blocks have been used as part of a contemporary multimodal approach to pain control after TKA. Femoral nerve block (FNB) has excellent postoperative analgesia and is now a commonly used analgesic modality for TKA pain control. However, FNB leads to quadriceps muscle weakness, which impairs early mobilization and increases the risk of postoperative falls. In this context, emerging evidence suggests that adductor canal block (ACB) facilitates postoperative rehabilitation compared with FNB because it primarily provides a sensory nerve block with sparing of quadriceps strength. However, whether ACB is more appropriate for contemporary pain management after TKA remains controversial. The objective of this study was to review and summarize recent studies regarding practical issues for ACB and comparisons of analgesic efficacy and functional recovery between ACB and FNB in patients who have undergone TKA. PMID:28545172

  13. Vascular Ehlers-Danlos Syndrome With a Novel Missense COL3A1 Mutation Present With Pulmonary Complications and Iliac Arterial Dissection.

    PubMed

    Gu, Guangchao; Yang, Hang; Cui, Lijia; Fu, Yuanyuan; Li, Fangda; Zhou, Zhou; Zheng, Yuehong

    2018-02-01

    Vascular Ehlers-Danlos syndrome (vEDS) is a life-threatening connective tissue disorder due to its high tendency of arterial and organ rupture. Pulmonary complications in vEDS are rare. We present a young male patient with vEDS who developed severe pulmonary complications and severe rupture of the iliac artery at different stages of his life. Vascular Ehlers-Danlos syndrome was diagnosed based on clinical manifestations and confirmed by the identification of COL3A1 gene mutation. Due to high bleeding tendency and weak cardiopulmonary capacity, conservative treatment was taken for him. To our knowledge, this is the first report of vEDS case in which the patient developed both pulmonary complications and dissection of large arteries. Our report emphasizes the importance of considering vEDS when an adolescent develops unexplained pulmonary cysts with fragility of lung tissues. Genetic counseling and close monitoring should be performed for earlier diagnosis and prevention of severe complications of large arteries. The typical presentations of vEDS were also discussed by means of a review of case reports on vEDS with pulmonary complications.

  14. A novel closed reduction with extension block and flexion block using Kirschner wires and microscrew fixation for mallet fractures.

    PubMed

    Shimura, Haruhiko; Wakabayashi, Yoshiaki; Nimura, Akimoto

    2014-03-01

    Some patients with mallet fractures who undergo extension block pinning complain of exposed wires, which delay their return to sports and causes inconvenience while performing tasks that require the use of hands during the early postoperative period. The purpose of this retrospective study was to present and evaluate a novel surgical procedure for mallet fractures. We treated 20 patients (14 males and six females; mean age, 38.4 years; range 17-68 years) with displaced mallet fractures involving >30 % of the articular surface using the closed reduction and microscrew fixation between January 2009 and January 2012. The distal interphalangeal joint (DIP) joint was immobilized with a splint for 1-3 weeks on an individual case basis. According to Wehbe and Schneider's classification, there were 12 type IB, six type IIB, and two type IA fractures. The mean follow-up duration was 12.6 months (range 6-31 months). Bone union was achieved in all patients within a mean period of 6.8 weeks, with no incidence of infection, skin necrosis, permanent nail deformity, or secondary osteoarthritis. Only two complications-temporary nail ridging in one patient and a dorsal bump caused by the screw in one patient-were observed. Minimum postoperative displacement was observed in one patient, for whom immobilization with a splint was continued for 4 weeks. Articular incongruity was <1.0 mm in four patients and 1.0-2.0 mm in two patients. Mean DIP joint extension loss was 6.5° and mean flexion was 67.8°. The surgical outcomes were excellent in seven patients, good in nine, and fair in four according to Crawford's evaluation criteria. Our novel surgical procedure combining closed reduction with extension block and flexion block using Kirschner wires and microscrew fixation produces good clinical results with relatively few complications.

  15. Ultrasound-guided supraclavicular block: outcome of 510 consecutive cases.

    PubMed

    Perlas, Anahi; Lobo, Giovanni; Lo, Nick; Brull, Richard; Chan, Vincent W S; Karkhanis, Reena

    2009-01-01

    Supraclavicular brachial plexus block provides consistently effective anesthesia to the upper extremity. However, traditional nerve localization techniques may be associated with a high risk of pneumothorax. In the present study, we report block success and clinical outcome data from 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery. After institutional review board approval, the outcome of 510 consecutive patients who received an ultrasound-guided supraclavicular block for upper extremity surgery was reviewed. Real-time ultrasound guidance was used with a high-frequency linear probe. The neurovascular structures were imaged on short axis, and the needle was inserted using an in-plane technique with either a medial-to-lateral or lateral-to-medial orientation. Five hundred ten ultrasound-guided supraclavicular blocks were performed (50 inpatients, 460 outpatients) by 47 different operators at different levels of training over a 24-month period. Successful surgical anesthesia was achieved in 94.6% of patients after a single attempt; 2.8% required local anesthetic supplementation of a single peripheral nerve territory; and 2.6% received an unplanned general anesthetic. No cases of clinically symptomatic pneumothorax developed. Complications included symptomatic hemidiaphragmatic paresis (1%), Horner syndrome (1%), unintended vascular punctures (0.4%), and transient sensory deficits (0.4%). Ultrasound-guided supraclavicular block is associated with a high rate of successful surgical anesthesia and a low rate of complications and thus may be a safe alternative for both inpatients and outpatients. Severe underlying respiratory disease and coagulopathy should remain a contraindication for this brachial plexus approach.

  16. 77 FR 65693 - Notice of Intent To Make Changes in the State Title V Maternal and Child Health Block Grant...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-30

    ... (ACS) poverty estimates. Title V MCH Block Grant funds are currently allocated to states based in part on a calculation of the number of children living in poverty (in an individual state) as compared to the total number of children living in poverty in the United States. Historically, data for the number...

  17. Temporary Blindness after Inferior Alveolar Nerve Block.

    PubMed

    Barodiya, Animesh; Thukral, Rishi; Agrawal, Shaila Mahendra; Rai, Anshul; Singh, Siddharth

    2017-03-01

    Inferior Alveolar Nerve Block (IANB) anaesthesia is one of the common procedures in dental clinic. This procedure is safe, but complications may still occur. Ocular complications such as diplopia, loss of vision, or ophthalmoplegia are extremely rare. This case report explains an event where due to individual anatomic variation of the sympathetic vasoconstrictor nerve and maxillary and middle meningeal arteries, intravascular administration of anaesthetic agent caused unusual ocular signs and symptoms such as temporary blindness.

  18. Bier block regional anesthesia and casting for forearm fractures: safety in the pediatric emergency department setting.

    PubMed

    Aarons, Chad E; Fernandez, Meagan D; Willsey, Matt; Peterson, Bret; Key, Charles; Fabregas, Jorge

    2014-01-01

    Bier block regional anesthesia was first described in 1908; however, it is uncommonly used for fears of cardiac and neurological complications. Although recent studies have documented safe usage in an adult population, no study to date has investigated its use in a pediatric setting. In addition, most emergency departments feel that splint placement is safer than casting after acute forearm fracture reduction in the pediatric population. However, to our knowledge there is no such study that documents the complication rates associated with immediate casting. The goal of this study was to assess the safety and efficacy of Bier block regional anesthesia and immediate cast application after closed reduction of pediatric forearm fractures. A retrospective review was conducted of patients treated for forearm fractures in a 2-year period at a major metropolitan pediatric hospital. Rates of complications and length and costs of the 2 procedures were analyzed. A total of 600 patients were treated with Bier block regional anesthesia and 645 were treated with conscious sedation for displaced fractures of the forearm in the 2-year study period. No complications requiring admission were seen in either group. No patient experienced compartment syndrome or a need for readmission secondary to cast application. 2.2% and 4.3% (P=0.0382) of patients in the Bier block and sedation groups, respectively, needed their cast bivalved secondary to swelling. The average time from initiation of procedural sedation to discharge was 1 hour and 42 minutes, whereas the time to discharge from initiation of Bier block regional anesthesia was 47 minutes (P<0.0001). The average cost for a patient treated with procedural sedation was $6313, whereas the average cost for the Bier block regional anesthesia group was $4956. Bier block regional anesthesia is a safe, efficient, and cost-effective method of reducing pediatric forearm fractures. Immediate cast application can be used without fear of major

  19. Complications in Hip Arthroscopy

    PubMed Central

    Nakano, Naoki; Khanduja, Vikas

    2016-01-01

    Summary Background Recent developments in hip arthroscopic techniques and technology have made it possible in many cases to avoid open surgical dislocation for treating a variety of pathology in the hip. Although early reports suggest favourable results’ using hip arthroscopy and it has been shown to be a relatively safe procedure, complications do exist and can sometimes lead to significant morbidity. Methods This is a review article. The aim of this manuscript is to present the most frequent and/or serious complications that could occur at or following hip arthroscopy and some guidelines to avoid these complications. Conclusion Most complications of hip arthroscopy are minor or transient but serious complications can occur as well. A lot of complication e.g. acetabular labral puncture go unreported. Appropriate education and training, precise and meticulous surgical technique with correct instrumentation, the right indication in the right patient and adherence to advice from mentors and experienced colleagues are all essential factors for a successful outcome. Level of evidence: V. PMID:28066747

  20. Opioid-sparing effects of the thoracic interfascial plane blocks: A meta-analysis of randomized controlled trials

    PubMed Central

    Singh, Preet Mohinder; Borle, Anuradha; Kaur, Manpreet; Trikha, Anjan; Sinha, Ashish

    2018-01-01

    Background: Thoracic interfascial plane blocks and modification (PECS) have recently gained popularity for analgesic potential during breast surgery. We evaluate/consolidate the evidence on opioid-sparing effect of PECS blocks in comparison with conventional intravenous analgesia (IVA) and paravertebral block (PVB). Materials and Methods: Prospective, randomized controlled trials comparing PECS block to conventional IVA or PVB in patients undergoing breast surgery published till June 2017 were searched in the medical database. Comparisons were made for 24-h postoperative morphine consumption and intraoperative fentanyl-equivalent consumption. Results: Final analysis included nine trials (PECS vs. IVA 4 trials and PECS vs. PVB 5 trials). PECS block showed a decreased intraoperative fentanyl consumption over IVA by 49.20 mcg (95% confidence interval [CI] =42.67–55.74) (I2 = 98.47%, P < 0.001) and PVB by 15.88 mcg (95% CI = 12.95–18.81) (I2 = 95.51%, P < 0.001). Postoperative, 24-h morphine consumption with PECS block was lower than IVA by 7.66 mg (95% CI being 6.23–9.10) (I2 = 63.15, P < 0.001) but was higher than PVB group by 1.26 mg (95% CI being 0.91–1.62) (I2 = 99.53%, P < 0.001). Two cases of pneumothorax were reported with PVB, and no complication was reported in any other group. Conclusions: Use of PECS block and its modifications with general anesthesia for breast surgery has significant opioid-sparing effect intraoperatively and during the first 24 h after surgery. It also has higher intraoperative opioid-sparing effect when compared to PVB. During the 1st postoperative day, PVB has slightly more morphine sparing potential that may however be associated with higher complication rates. The present PECS block techniques show marked interstudy variations and need standardization. PMID:29416465

  1. Opioid-sparing effects of the thoracic interfascial plane blocks: A meta-analysis of randomized controlled trials.

    PubMed

    Singh, Preet Mohinder; Borle, Anuradha; Kaur, Manpreet; Trikha, Anjan; Sinha, Ashish

    2018-01-01

    Thoracic interfascial plane blocks and modification (PECS) have recently gained popularity for analgesic potential during breast surgery. We evaluate/consolidate the evidence on opioid-sparing effect of PECS blocks in comparison with conventional intravenous analgesia (IVA) and paravertebral block (PVB). Prospective, randomized controlled trials comparing PECS block to conventional IVA or PVB in patients undergoing breast surgery published till June 2017 were searched in the medical database. Comparisons were made for 24-h postoperative morphine consumption and intraoperative fentanyl-equivalent consumption. Final analysis included nine trials (PECS vs. IVA 4 trials and PECS vs. PVB 5 trials). PECS block showed a decreased intraoperative fentanyl consumption over IVA by 49.20 mcg (95% confidence interval [CI] =42.67-55.74) ( I 2 = 98.47%, P < 0.001) and PVB by 15.88 mcg (95% CI = 12.95-18.81) ( I 2 = 95.51%, P < 0.001). Postoperative, 24-h morphine consumption with PECS block was lower than IVA by 7.66 mg (95% CI being 6.23-9.10) ( I 2 = 63.15, P < 0.001) but was higher than PVB group by 1.26 mg (95% CI being 0.91-1.62) ( I 2 = 99.53%, P < 0.001). Two cases of pneumothorax were reported with PVB, and no complication was reported in any other group. Use of PECS block and its modifications with general anesthesia for breast surgery has significant opioid-sparing effect intraoperatively and during the first 24 h after surgery. It also has higher intraoperative opioid-sparing effect when compared to PVB. During the 1 st postoperative day, PVB has slightly more morphine sparing potential that may however be associated with higher complication rates. The present PECS block techniques show marked interstudy variations and need standardization.

  2. Rocuronium-induced neuromuscular block and sugammadex in pediatric patient with duchenne muscular dystrophy

    PubMed Central

    Kim, Ji Eun; Chun, Hea Rim

    2017-01-01

    Abstract Introduction: Anesthetic management of patients with Duchenne muscular dystrophy (DMD) is complicated because these patients are more sensitive to nondepolarizing neuromuscular blocking agents (NMBAs) and are vulnerable to postoperative complications, such as postoperative residual curarization and respiratory failure. Sugammadex is a new reversal agent for aminosteroidal NMBAs, but its safety in children is controversial. Clinical features: An 11-year-old boy with DMD underwent general anesthesia for a percutaneous nephrolithotomy. We used rocuronium bromide and sugammadex to reverse the deep neuromuscular block. Reversal of neuromuscular block was done 15 minutes after administration of 2 mg/kg of sugammadex. The patient's recovery from anesthesia was uneventful, and he was discharged to the postoperative recovery ward. Conclusion: A delayed recovery was achieved, but no adverse events were observed, such as recurarization or hypersensitivity to sugammadex. We report safe use of 2 mg/kg of sugammadex to reverse a deep neuromuscular block in a child with DMD. PMID:28353578

  3. From global to heavy-light: 5-point conformal blocks

    NASA Astrophysics Data System (ADS)

    Alkalaev, Konstantin; Belavin, Vladimir

    2016-03-01

    We consider Virasoro conformal blocks in the large central charge limit. There are different regimes depending on the behavior of the conformal dimensions. The most simple regime is reduced to the global sl(2,C) conformal blocks while the most complicated one is known as the classical conformal blocks. Recently, Fitzpatrick, Kaplan, and Walters showed that the two regimes are related through the intermediate stage of the so-called heavy-light semiclassical limit. We study this idea in the particular case of the 5-point conformal block. To find the 5-point global block we use the projector technique and the Casimir operator approach. Furthermore, we discuss the relation between the global and the heavy-light limits and construct the heavy-light block from the global block. In this way we reproduce our previous results for the 5-point perturbative classical block obtained by means of the monodromy method.

  4. Pseudomyopia in a patient with blocked ventriculo-peritoneal shunt--a case report.

    PubMed

    Voon, L W; Goh, K Y; Lim, T H; Tan, K K; Yong, V S

    1997-03-01

    Accommodative spasm usually encompasses a classical triad of pseudomyopia, esodeviation and pupillary constriction. Accommodative spasm is most often psychogenic in nature; however, it may be associated with other organic diseases of which a rare cause is that of intracranial catheter complications. We report a case of dorsal midbrain syndrome with pseudomyopia in a patient with a blocked ventriculo-peritoneal shunt inserted for aqueductal stenosis. Clinical presentation was unusual in this patient as pseudomyopia occurred with exodeviation and without pupillary constriction.

  5. Influenza-related postinfectious encephalomyelitis complicated by a perforated peptic ulcer.

    PubMed

    Hsueh, Chang-Wei; Yu, Hui-Ming; Chen, Huan-Sheng; Wu, Chin-Pyng

    2013-08-01

    Influenza virus infection is extremely common and raises global concern due to the increasing prevalence of pandemic H1N1 infection. Influenza may occasionally be associated with neurologic complications and, also, rarely with gastrointestinal complications. Here, we report a rare case complicated with appendicitis, duodenum perforation, and transient delirious behavior after influenza A viral infection in a pediatric patient aged 14 years. The transient delirious behavior could be attributed to postinfectious encephalopathy. The perforated peptic ulcer could have resulted from influenza infection, could have been an adverse event related to oseltamivir administration, or could have been a complication of preceding gastroenteritis. Our case highlights the importance of pediatric healthcare workers to be aware of possible complications arising from both influenza infection and oseltamivir therapy, even though some of these complications may be relatively rare. Copyright © 2013. Published by Elsevier B.V.

  6. Comparison of Paravertebral Block by Anatomic Landmark Technique to Ultrasound-Guided Paravertebral Block for Breast Surgery Anesthesia: A Randomized Controlled Trial.

    PubMed

    Patnaik, Rupali; Chhabra, Anjolie; Subramaniam, Rajeshwari; Arora, Mahesh K; Goswami, Devalina; Srivastava, Anurag; Seenu, Vuthaluru; Dhar, Anita

    2018-05-01

    Paravertebral block (PVB) is an established technique for providing anesthesia for breast surgery. The primary objective was to compare anatomical landmark technique (ALT) to the ultrasound-guided (USG) PVB block for providing surgical anesthesia. Secondary objectives included comparison of perioperative analgesia and complications. This randomized, controlled, observer-blinded study included 72 females, aged 18 to 65 years, American Society of Anesthesiologists physical status I or II, undergoing elective unilateral breast surgery. Study participants were randomized to the ALT group or USG group. Ipsilateral PVB was performed with the respective technique from T1 to T6. Five milliliters of local anesthetic mixture (0.5% ropivacaine, 5 μg/mL adrenaline, 1 μg/kg clonidine) was administered at each level. Paravertebral catheter was inserted at T4/T3 level. After confirming sensory loss, patients were taken up for surgery with propofol sedation (20-50 μg/kg per minute). More patients in the USG group (34/36 [94.44%]) had a successful block as compared with the ALT group (26/36 [72.22%]) (P = 0.024). Difference in proportion was 18.1 (95% confidence interval, 0.15-36.0) (P = 0.024) after adjustment for age. More dermatomes were blocked in the USG group (P = 0.0018) with less sparing of upper T2 and T3 dermatomes (P = 0.003, P = 0.006, respectively). Median time to first postoperative analgesic requirement was 502.5 minutes (range, 195-1440 minutes) in the USG group versus 377.5 minutes (range, 215-1440 minutes) in the ALT group. Pain at rest and movement 2 and 4 hours postoperatively and number of catheter top-ups in 24 hours postoperatively were lesser in the USG group (P = 0.012). Complications were comparable. Ultrasound-guided PVB provided better anesthesia and perioperative analgesia than the landmark technique for breast surgery. The trial was registered retrospectively at the Clinical Trial Registry of India, CTRI/2015/05/005774.

  7. Removal of a fractured needle during inferior alveolar nerve block: two case reports.

    PubMed

    You, Jae-Seek; Kim, Su-Gwan; Oh, Ji-Su; Choi, Hae-In; Jih, Myeong-Kwan

    2017-09-01

    The inferior alveolar nerve block is the most common method of local anesthesia for intraoral surgery at the posterior mandibular region. However, unexpected complications may occur when administering the local anesthesia. One of these uncommon complications is the fracture of the needle. If the injection needle is broken during the surgery, it should be removed immediately. However, this is one of the most difficult procedures. In this report, we present two cases of needle fracture during the procedure, and its successful removal under general/local anesthesia administration.

  8. Radiotherapy as a cause of complete atrioventricular block in Hodgkin's disease. An electrophysiological-pathological correlation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Cohen, S.I.; Bharati, S.; Glass, J.

    1981-04-01

    A 20-year-old man contracted Hodgkin's disease and was treated with mantle radiotherapy. Heart block developed 11 years later. Electrocardiograms revealed predominant atrioventricular (AV) block and occasional AV conduction. Intracardiac electrograms demonstrated that the site of AV block was above the level of the His bundle. A permanent transvenous pacemaker was implanted. Seven months later the patient died of complications from cryptococcal meningitis. Pathological study of the heart revealed marked arteriosclerosis with fibrosis of the epicardium, myocardium, and endocardium. Examination of the conduction system revealed extensive arteriolosclerosis of the sinoatrial node and its approaches. In addition, there was marked fibrosis ofmore » the approaches to the AV node, the AV bundle, and both bundle branches. There was no evidence of Hodgkin's disease. This case documents the rare occurrence of AV block due to tissue destruction by radiotherapy. There was a good correlation between block proximal to the His bundle recording site and fibrosis of the approaches to the AV node.« less

  9. Radiotherapy as a cause of complete atrioventricular block in Hodgkin's disease: an electrophysiological-pathological correlation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Cohen, S.I.; Bharati, S.; Glass, J.

    1981-04-01

    A 20-year-old man contracted Hodgkin's disease and was treated with mantle radiotherapy. Heart block developed 11 years later. Electrocardiograms revealed predominant atrioventricular (AV) block and occasional AV conduction. Intracardiac electrograms demonstrated that the site of AV block was above the level of the His bundle. A permanent transvenous pacemaker was implanted. Seven months later the patient died of complications from cryptococcal meningitis. Pathological study of the heart revealed marked arteriosclerosis with fibrosis of the epicardium, myocardium, and endocardium. Examination of the conduction system revealed extensive arteriolosclerosis of the sinoatrial node and its approaches. In addition, there was marked fibrosis ofmore » the approaches to the AV node, the AV bundle, and both bundle branches. There was no evidence of Hodgkin's disease. This case documents the rare occurrence of AV block due to tissue destruction by radiotherapy. There was a good correlation between block proximal to the His bundle recording site and fibrosis of the approaches to the AV node.« less

  10. Lower-extremity peripheral nerve blocks in the perioperative pain management of orthopaedic patients: AAOS exhibit selection.

    PubMed

    Stein, Benjamin E; Srikumaran, Umasuthan; Tan, Eric W; Freehill, Michael T; Wilckens, John H

    2012-11-21

    The utilization of peripheral nerve blocks in orthopaedic surgery has paralleled the rise in the number of ambulatory surgical procedures performed. Optimization of pain control in the perioperative orthopaedic patient contributes to improved patient satisfaction, early mobilization, decreased length of hospitalization, and decreased associated hospital and patient costs. Our purpose was to provide a concise, pertinent review of the use of peripheral nerve blocks in various orthopaedic procedures of the lower extremity, with specific focus on procedural anatomy, indications, patient outcome measures, and complications. We reviewed the literature and reference textbooks on commonly performed lower-extremity peripheral nerve block procedures in orthopaedic surgery, focusing on those most commonly used. The use of lower-extremity peripheral nerve blocks is a safe and effective approach to perioperative pain management. Different techniques and timing can have an important impact on patient satisfaction, and each technique has specific indications and complications. For major hip surgery, one of the most commonly used is the lumbar plexus block, which can result in early mobilization, reduced postoperative pain, and decreased opioid-associated adverse events. Associated complications include epidural spread of anesthesia, retroperitoneal hematoma formation, and postoperative falls. For arthroscopic and open knee procedures, the femoral nerve block is frequently used adjunctively. It provides improved early postoperative pain control, early mobilization with therapy, and increased patient satisfaction compared with intra-articular or intravenous opioids alone; it also provides cost savings. However, some studies have shown no significant difference in outcome measures compared with intra-articular opioids alone for arthroscopic anterior cruciate ligament reconstruction. Associated complications include nerve injury, intravascular injection, and postoperative falls. The

  11. Peripheral Nerve Block as a Supplement to Light or Deep General Anesthesia in Elderly Patients Receiving Total Hip Arthroplasty: A Prospective Randomized Study.

    PubMed

    Mei, Bin; Zha, Hanning; Lu, Xiaolong; Cheng, Xinqi; Chen, Shishou; Liu, Xuesheng; Li, Yuanhai; Gu, Erwei

    2017-12-01

    Peripheral nerve block combined with general anesthesia is a preferable anesthesia method for elderly patients receiving hip arthroplasty. The depth of sedation may influence patient recovery. Therefore, we investigated the influence of peripheral nerve blockade and different intraoperative sedation levels on the short-term recovery of elderly patients receiving total hip arthroplasty. Patients aged 65 years and older undergoing total hip arthroplasty were randomized into 3 groups: a general anesthesia without lumbosacral plexus block group, and 2 general anesthesia plus lumbosacral plexus block groups, each with a different level of sedation (light or deep). The extubation time and intraoperative consumption of propofol, sufentanil, and vasoactive agent were recorded. Postoperative delirium and early postoperative cognitive dysfunction were assessed using the Confusion Assessment Method and Mini-Mental State Examination, respectively. Postoperative analgesia was assessed by the consumption of patient-controlled analgesics and visual analog scale scores. Discharge time and complications over a 30-day period were also recorded. Lumbosacral plexus block reduced opioid intake. With lumbosacral plexus block, intraoperative deep sedation was associated with greater intake of propofol and vasoactive agent. In contrast, patients with lumbosacral plexus block and intraoperative light sedation had lower incidences of postoperative delirium and postoperative cognitive decline, and earlier discharge readiness times. The 3 groups showed no difference in complications within 30 days of surgery. Lumbosacral plexus block reduced the need for opioids and offered satisfactory postoperative analgesia. It led to better postoperative outcomes in combination with intraoperative light sedation (high bispectral index).

  12. Local infiltration analgesia versus continuous interscalene brachial plexus block for shoulder replacement pain: a randomized clinical trial.

    PubMed

    Bjørnholdt, Karen T; Jensen, Jan M; Bendtsen, Thomas F; Søballe, Kjeld; Nikolajsen, Lone

    2015-12-01

    Shoulder replacement involves significant post-operative pain, which is often managed by continuous interscalene brachial plexus block. Catheter displacement and complications limit the beneficial effect of the block. Local infiltration analgesia (LIA) has provided good results in knee replacement. We aimed to assess the effectiveness of LIA for pain after shoulder replacement. Patients scheduled for primary shoulder replacement under general anaesthesia were randomized to receive either local infiltration analgesia (LIA) (150 ml ropivacaine 0.2 % with epinephrine intra-operatively) or interscalene brachial plexus catheter (ISC) (ropivacaine 0.75 %, 7 ml bolus followed by 48-h 5 ml/h infusion). The primary outcome was opioid consumption during the first 24 post-operative hours. Secondary outcomes were pain ratings, supplementary analgesics, and side effects for 3 days, and complications until 3 months after surgery. Data were analysed for 61 patients (LIA 30, ISC 31). Twenty-four-hour opioid consumption was higher in the LIA group compared with the ISC group: median (IQR) 95 mg (70-150 mg) versus 40 mg (8-76 mg) (P = 0.0001). No significant difference in opioid consumption was found between groups during the following 3 days. The LIA group had higher pain scores at 0, 2, 4, and 8 h. Two patients in the ISC group had long-lasting complications. The LIA technique cannot be recommended for shoulder replacement unless substantially modified. Occurrence of inadequate analgesia and complications following interscalene brachial plexus block prompt further studies into pain management after shoulder replacement.

  13. Microvascular complications associated with injection of cosmetic facelift dermal fillers

    NASA Astrophysics Data System (ADS)

    Yousefi, Siavash; Prendes, Mark; Chang, Shu-Hong; Wang, Ruikang K.

    2015-02-01

    Minimally-invasive cosmetic surgeries such as injection of subdermal fillers have become very popular in the past decade. Although rare, some complications may follow injections such as tissue necrosis and even blindness. There exist two hypothesis regarding source of these complications both of which include microvasculature. The first hypothesis is that fillers in between the tissue structures and compress microvasculature that causes blockage of tissue neutrition and oxygen exchange in the tissue. In another theory, it is hypothesized that fillers move inside major arteries and block the arteries/veins. In this paper, we study these hypotheses using optical coherence tomography and optical microangiography technologies with different hyaluronic-acid fillers in a mouse ear model. Based on our observations, the fillers eventually block arteries/veins if injected directly into them that eventually causes tissue necrosis.

  14. Right bundle branch block and anterior wall ST elevation myocardial infarction.

    PubMed

    Trofin, Monica; Israel, Carsten W; Barold, S Serge

    2017-09-01

    We report the case of an acute anterior wall ST elevation myocardial infarction with new left anterior fascicular block and pre-existing right bundle branch block. Due to a wide right bundle branch block, no ST segment elevation was visible in lead V1. The left anterior fascicular block was caused by proximal occlusion of the left artery descending and disappeared after acute revascularization. However, also the R' of the right bundle branch block became significantly shorter after revascularization, dismanteling a minor ST segment elevation. The ST elevation in lead V1 in anterior wall infarction and right bundle branch block may merge with the R' and cause a further QRS widening as an "equivalent" to the ST elevation.

  15. Atrioventricular and intraventricular block after transcatheter aortic valve implantation.

    PubMed

    Lee, Jane J; Goldschlager, Nora; Mahadevan, Vaikom S

    2018-06-24

    Aortic stenosis is the most common valvular heart disease in industrialized countries and the most common cause of left ventricular outflow tract (LVOT) obstruction. Transcatheter aortic valve replacement (TAVR) is an alternative to surgical aortic valve replacement for intermediate to high-risk surgical candidates with symptomatic severe aortic stenosis. Conduction system abnormalities, including atrioventricular (AV) and intraventricular (IV) block, are the most common complication of TAVR. In this review, we aim to explore the anatomical issues relevant to atrioventricular block, the relevant clinical and procedural aspects, and the management and long-term implications of AV and IV block.

  16. Comparison of the Effect of Continuous Femoral Nerve Block and Adductor Canal Block after Primary Total Knee Arthroplasty.

    PubMed

    Seo, Seung Suk; Kim, Ok Gul; Seo, Jin Hyeok; Kim, Do Hoon; Kim, Youn Gu; Park, Beyoung Yun

    2017-09-01

    This study aimed to compare the effects of femoral nerve block and adductor canal block on postoperative pain, quadriceps strength, and walking ability after primary total knee arthroplasty. Between November 2014 and February 2015, 60 patients underwent primary total knee arthroplasty. Thirty patients received femoral nerve block and the other 30 received adductor canal block for postoperative pain control. Before spinal anesthesia, the patients received nerve block via a catheter (20 mL 0.75% ropivacaine was administered initially, followed by intermittent bolus injection of 10 mL 0.2% ropivacaine every 6 hours for 3 days). The catheters were maintained in the exact location of nerve block in 24 patients in the femoral nerve block group and in 19 patients in the adductor canal block group. Data collection was carried out from these 43 patients. To evaluate postoperative pain control, the numerical rating scale scores at rest and 45° flexion of the knee were recorded. To evaluate quadriceps strength, manual muscle testing was performed. Walking ability was assessed using the Timed Up and Go test. We also evaluated analgesic consumption and complications of peripheral nerve block. No significant intergroup difference was observed in the numerical rating scale scores at rest and 45° flexion of the knee on postoperative days 1, 2, 3, and 7. The adductor canal block group had significantly greater quadriceps strength than did the femoral nerve block group, as assessed by manual muscle testing on postoperative days 1, 2, and 3. The 2 groups showed no difference in walking ability on postoperative day 1, but on postoperative days 2, 3, walking ability was significantly better in the adductor canal block group than in the femoral nerve block group. No significant intergroup difference was observed in analgesic consumption. The groups showed no difference in postoperative pain control. Adductor canal block was superior to femoral nerve block in preserving quadriceps

  17. Anodal tDCS to V1 blocks visual perceptual learning consolidation.

    PubMed

    Peters, Megan A K; Thompson, Benjamin; Merabet, Lotfi B; Wu, Allan D; Shams, Ladan

    2013-06-01

    This study examined the effects of visual cortex transcranial direct current stimulation (tDCS) on visual processing and learning. Participants performed a contrast detection task on two consecutive days. Each session consisted of a baseline measurement followed by measurements made during active or sham stimulation. On the first day, one group received anodal stimulation to primary visual cortex (V1), while another received cathodal stimulation. Stimulation polarity was reversed for these groups on the second day. The third (control) group of subjects received sham stimulation on both days. No improvements or decrements in contrast sensitivity relative to the same-day baseline were observed during real tDCS, nor was any within-session learning trend observed. However, task performance improved significantly from Day 1 to Day 2 for the participants who received cathodal tDCS on Day 1 and for the sham group. No such improvement was found for the participants who received anodal stimulation on Day 1, indicating that anodal tDCS blocked overnight consolidation of visual learning, perhaps through engagement of inhibitory homeostatic plasticity mechanisms or alteration of the signal-to-noise ratio within stimulated cortex. These results show that applying tDCS to the visual cortex can modify consolidation of visual learning. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Comparison of efficacy of transversus abdominis plane block and iliohypogastric/ilioinguinal nerve block for postoperative pain management in patients undergoing inguinal herniorrhaphy with spinal anesthesia: a prospective randomized controlled open-label study.

    PubMed

    Okur, Onur; Tekgul, Zeki Tuncel; Erkan, Nazif

    2017-10-01

    The purpose of this study was to compare the effects of lateral abdominal transversus abdominis plane block (TAP block) and iliohypogastric/ilioinguinal nerve block (IHINB) under ultrasound guidance for postoperative pain management of inguinal hernia repair. Secondary purposes were to compare the complication rates of the two techniques and to examine the effects of TAP block and IHINB on chronic postoperative pain. This was a prospective randomized controlled open-label study. After approval of the Research Ethics Board, a total of 90 patients were allocated to three groups of 30 by simple randomized sampling as determined with a priori power analysis. Peripheral nerve blocks (TAP block or IHINB) were administered to patients following subarachnoid block according to their allocated group. Patient pain scores, additional analgesic requirements and complication rates were recorded periodically and compared. Pain scores were significantly lower in the study groups (p < 0.001, p < 0.001, p < 0.001, p = 0.002, p < 0.001, p < 0.001 for 1, 2, 4, 6, 24, and 48 h and at 1 and 6 months, respectively). First pain declaration times were significantly longer in the study groups (TAP block group [GT] 266.6 ± 119.7 min; IHINB group [GI] 247.2 ± 128.7 min; and control group [GC] 79.1 ± 66.2 min; p < 0.001). At 24 h, the numeric rating scale scores of GT were significantly lower than GI (p = 0.048). Additional analgesic requirements of GT and GI patients were found to be significantly lower than GC patients (p = 0.001, p < 0.001, p = 0.006, p = 0.002, p = 0.001, p < 0.001 for 1, 2, 4, 6, 24, and 48 h, respectively). We conclude that administration of TAP block or IHINB for patients undergoing inguinal herniorrhaphy reduces the intensity of both acute and chronic postoperative pain and additional analgesic requirements.

  19. Ultrasound-guided rectus sheath block in children with umbilical hernia: Case series.

    PubMed

    Alsaeed, Abdul Hamid; Thallaj, Ahmed; Khalil, Nancy; Almutaq, Nada; Aljazaeri, Ayman

    2013-10-01

    Umbilical hernia repair, a common day-case surgery procedure in children, is associated with a significant postoperative pain. The most popular peripheral nerve blocks used in umbilical hernia repair are rectus sheath infiltration and caudal block. The rectus sheath block may offer improved pain relief following umbilical hernia repair with no undesired effects such as lower limb motor weakness or urinary retention seen with caudal block which might delay discharge from the hospital. Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. The aim of this case series is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery. Twenty two (22) children (age range: 1.5-8 years) scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz 50 mm linear probe. An ultrasound-guided posterior rectus sheath block of both rectus abdominis muscles (RMs) was performed (total of 44 punctures). An in-plain technique using Stimuplex A insulated facet tip needle 22G 50mm. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia by means of the modified CHEOPS scale were evaluated. ultrasonograghic visualization of the posterior sheath was possible in all patients. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one patient who postoperatively required morphine 0.1 mg/kg intravenously. There were no complications. Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia. Use of the Stimuplex A insulated facet tip needle 22G 50mm provides easy, less traumatic skin and rectus muscle penetration and satisfactory needle visualiza.

  20. Analgesic effect of a single-dose of perineural dexamethasone on ultrasound-guided femoral nerve block after total knee replacement.

    PubMed

    Morales-Muñoz, C; Sánchez-Ramos, J L; Díaz-Lara, M D; González-González, J; Gallego-Alonso, I; Hernández-Del-Castillo, M S

    2017-01-01

    Total knee replacement is usually a very painful procedure. A single-dose of femoral nerve block has been shown to provide similar analgesia to an epidural, with fewer side effects, but limited in time. To compare the analgesia provided by dexamethasone used at perineural level in the femoral nerve block after total knee replacement with the one used at intravenous level, and with that of a control group. A prospective, randomised, double-blind controlled trial was conducted on 81 patients randomly assigned to one of three groups: 1)IV dexamethasone (8mg); 2)perineural dexamethasone (8mg), and 3)placebo. All patients received 20ml of ropivacaine 0.5% for femoral nerve block. The primary outcome was the duration of the sensory-analgesic block of the femoral nerve block. The secondary outcomes included pain intensity measurements, patient satisfaction, and incidence of complications. Randomisation was effective. Analgesia duration was significantly higher (P<.0001) in the perineural dexamethasone group (mean 1152.2min, 95% confidence interval [95% CI]: 756.9-1547.6) in comparison with the control group (mean 186min, 95%CI: 81.2-292) and dexamethasone IV group (mean 159.4min, 95%CI: 109.8-209). Postoperative pain, complications and side effects were also lower in this group. Dexamethasone prolongs sensory block of single dose of femoral nerve block using ropivacaine. It also provides better analgesia and patient satisfaction, with fewer side effects. Copyright © 2016 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. A Shifted Block Lanczos Algorithm 1: The Block Recurrence

    NASA Technical Reports Server (NTRS)

    Grimes, Roger G.; Lewis, John G.; Simon, Horst D.

    1990-01-01

    In this paper we describe a block Lanczos algorithm that is used as the key building block of a software package for the extraction of eigenvalues and eigenvectors of large sparse symmetric generalized eigenproblems. The software package comprises: a version of the block Lanczos algorithm specialized for spectrally transformed eigenproblems; an adaptive strategy for choosing shifts, and efficient codes for factoring large sparse symmetric indefinite matrices. This paper describes the algorithmic details of our block Lanczos recurrence. This uses a novel combination of block generalizations of several features that have only been investigated independently in the past. In particular new forms of partial reorthogonalization, selective reorthogonalization and local reorthogonalization are used, as is a new algorithm for obtaining the M-orthogonal factorization of a matrix. The heuristic shifting strategy, the integration with sparse linear equation solvers and numerical experience with the code are described in a companion paper.

  2. Epidural space identification: a meta-analysis of complications after air versus liquid as the medium for loss of resistance.

    PubMed

    Schier, Robert; Guerra, Diana; Aguilar, Jorge; Pratt, Gregory F; Hernandez, Mike; Boddu, Krishna; Riedel, Bernhard

    2009-12-01

    The best method for identifying the epidural space for neuraxial blocks is controversial. We conducted this meta-analysis to test the hypothesis that loss of resistance with liquid reduces complications with epidural placement. The MEDLINE, EMBASE, and Cochrane databases were searched for prospective, randomized studies comparing air versus liquid as the medium for loss of resistance during epidural space identification in adults. Data were abstracted from 5 studies (4 obstetric and 1 nonobstetric) (n = 4422 patients) that met inclusion criteria and analyzed for the following 6 outcomes: difficult catheter insertion, paresthesia, intravascular catheter insertion, accidental dural puncture, postdural puncture headache, and partial block. The overall risk differences for adverse outcome between the different mediums were not statistically different for the obstetric population. A small, but statistically significant, risk difference for postdural puncture headache was observed when fluid was used during epidural placement for chronic pain management. Larger studies that overcome limitations of heterogeneity across studies and a relatively infrequent occurrence of complications are required to determine the optimal medium for loss of resistance during epidural block.

  3. Fractured Anterior Chamber Intraocular Lens (ACIOL) Complicating Nd: YAG Laser for Peripheral Iridotomy.

    PubMed

    Farah, Edgard; Koutsandrea, Chryssanthi; Papaefthimiou, Ioannis; Papaconstantinou, Dimitris; Georgalas, Ilias

    2013-01-01

    Laser peripheral iridotomy is the procedure of choice for the treatment of angle-closure glaucoma caused by relative or absolute pupillary block. Nd: YAG laser iridotomy has been reported to have several complications such as Iris bleeding, hyphema, transient IOP elevation, intraocular inflammation, choroidal, retinal detachment and vitreous hemorrhage. We report a case of a 74 year old lady on anticoagulant treatment who developed pupillary block and angle closure glaucoma after cataract surgery and anterior chamber intraocular lens (ACIOL) insertion complicated with intraoperative bleeding. The patient was treated with Nd: YAG laser iridotomy , however, the ACIOL was inadvertently fractured after a single shot of laser and it had to be replaced. Although the incidence is rare. Ophthalmologists and Opticians should be aware that an ACIOL may be fractured even after a single Nd:YAG laser shot and avoid to perform it close to the ACIOL. Pretreatment counseling should include this rare complication.

  4. [Application and research progress of subtalar distraction bone block arthrodesis in treatment of calcaneus fracture malunion].

    PubMed

    Wang, Shanxi; Li, Jun; Huang, Fuguo; Liu, Lei

    2017-05-01

    To review the application and research progress of subtalar distraction bone block arth-rodesis in the treatment of calcaneus fracture malunion. The recent literature concerning the history, surgical technique, postoperative complication, indications, and curative effect of subtalar distraction arthrodesis with bone graft block interposition in the treatment of calcaneus fracture malunion was summarized and analyzed. Subtalar distraction bone block arthrodesis is one of the main ways to treat calcaneus fracture malunion, including a combined surgery with subtalar arthrodesis and realignment surgery for hindfoot deformity using bone block graft. The advantage is on the base of subtalar joint fusion, through one-time retracting subtalar joint, the posterior articular surface of subtalar joint implants bone block can partially restore calcaneal height, thus improving the function of the foot. Compared with other calcaneal malunion treatments, subtalar distraction arthrodesis is effective to correct complications caused by calcaneus fracture malunion, and it can restore the height of talus and calcaneus, correct loss of talocalcaneal angle, and ease pain. Subtalar distraction bone block arthrodesis has made remarkable progress in the treatment of calcaneus fracture malunion, but it has the disadvantages of postoperative nonunion and absorption of bone block, so further study is needed.

  5. A Fully Implanted Drug Delivery System for Peripheral Nerve Blocks in Behaving Animals

    PubMed Central

    Pohlmeyer, Eric A.; Jordon, Luke R.; Kim, Peter; Miller, Lee E.

    2009-01-01

    Inhibiting peripheral nerve function can be useful for many studies of the nervous system or motor control. Accomplishing this in a temporary fashion in animal models by using peripheral nerve blocks permits studies of the immediate effects of the loss, and/or any resulting short-term changes and adaptations in behavior or motor control, while avoiding the complications commonly associated with permanent lesions, such as sores or self-mutilation. We have developed a method of quickly and repeatedly inducing temporary, controlled motor deficits in rhesus macaque monkeys via a chronically implanted drug delivery system. This assembly consists of a nerve cuff and a subdermal injection dome, and has proved effective for delivering local anesthetics directly to peripheral nerves for many months. Using this assembly for median and ulnar nerve blocks routinely resulted in over 80% losses in hand and wrist strength for rhesus monkeys. The assembly was also effective for inducing ambulatory motor deficits in rabbits through blocks of the sciatic nerve. Interestingly, while standard anesthetics were sufficient for the rabbit nerve blocks, the inclusion of epinephrine was essential for achieving significant motor blockade in the monkeys. PMID:19524613

  6. Neurologic complications of vaccinations.

    PubMed

    Miravalle, Augusto A; Schreiner, Teri

    2014-01-01

    This chapter reviews the most common neurologic disorders associated with common vaccines, evaluates the data linking the disorder with the vaccine, and discusses the potential mechanism of disease. A literature search was conducted in PubMed using a combination of the following terms: vaccines, vaccination, immunization, and neurologic complications. Data were also gathered from publications of the American Academy of Pediatrics Committee on Infectious Diseases, the World Health Organization, the US Centers for Disease Control and Prevention, and the Vaccine Adverse Event Reporting System. Neurologic complications of vaccination are rare. Many associations have been asserted without objective data to support a causal relationship. Rarely, patients with a neurologic complication will have a poor outcome. However, most patients recover fully from the neurologic complication. Vaccinations have altered the landscape of infectious disease. However, perception of risk associated with vaccinations has limited the success of disease eradication measures. Neurologic complications can be severe, and can provoke fear in potential vaccines. Evaluating whether there is causal link between neurologic disorders and vaccinations, not just temporal association, is critical to addressing public misperception of risk of vaccination. Among the vaccines available today, the cost-benefit analysis of vaccinations and complications strongly argues in favor of vaccination. © 2014 Elsevier B.V. All rights reserved.

  7. Atrioventricular Block Induced by Mad-Honey Intoxication

    PubMed Central

    Cagli, Kumral Ergun; Tufekcioglu, Omac; Sen, Nihat; Aras, Dursun; Topaloglu, Serkan; Basar, Nur; Pehlivan, Sevil

    2009-01-01

    An unusual type of food poisoning, mad-honey intoxication, can be observed in the Black Sea region of Turkey and various other parts of the world. It can occur after ingestion of grayanotoxin-contaminated honey produced from the nectar of Rhododendron ponticum and other plant species, chiefly of the Ericaceae and Sapindaceae families. Mad-honey intoxication can result in severe cardiac complications, such as complete atrioventricular block. The diagnosis is generally reached on the basis of the patient's history of honey intake. In this report, we describe the case of a patient who had mad-honey–related complete atrioventricular block; in this instance, the diagnosis was confirmed by a pollen analysis of the suspect honey. PMID:19693312

  8. Pyomyositis of the iliacus muscle and pyogenic sacroiliitis after sacroiliac joint block -A case report-.

    PubMed

    Lee, Mi Hyeon; Byon, Hyo-Jin; Jung, Hyun Jun; Cha, Young-Deog; Lee, Doo Ik

    2013-05-01

    Sacroiliac joint block can be performed for the diagnosis and treatment of sacroiliac joint dysfunction. Although sacroiliac joint block is a common procedure, complications have not been reported in detail. We report a case of iliacus pyomyositis and sacroiliac joint infection following a sacroiliac joint block. A 70-year-old female patient received sacroiliac joint blocks to relieve pelvic pain. The patient was admitted to the emergency room two days after the final sacroiliac joint block (SIJB) with the chief complaints of left pelvic pain corresponding to a visual analogue scale (VAS) score of 9 and fever. A pelvic MRI indicated a diagnosis of myositis. After 1 month of continuous antibiotic therapy, the patient's erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level remained elevated. A (67)Ga SPECT/CT was done. Abnormal uptake was seen at the left sacroiliac joint (SIJ), and septic sacroiliitis was suspected. The CRP normalized to 0.29 mg/dl and the ESR decreased to 60 mm/hr, and the patient had no fever after 57 days of antibiotic therapy. She was directed for follow up at an outpatient clinic.

  9. A Review of Perioperative Complications of Outpatient Total Ankle Arthroplasty.

    PubMed

    Borenstein, Todd R; Anand, Kapil; Li, Quanlin; Charlton, Timothy P; Thordarson, David B

    2018-02-01

    Total ankle arthroplasty (TAA) is commonly pursued for patients with painful arthritis. Outpatient TAA are increasingly common and have been shown to decrease costs compared to inpatient surgery. However, there are very few studies examining the safety of outpatient TAA. In this study, we retrospectively reviewed 65 consecutive patients who received outpatient TAA to identify complication rates. The medical records of 65 consecutive outpatient TAA from October 2012 to May 2016 with a minimum 6-month follow-up were reviewed. All patients received popliteal and saphenous blocks prior to surgery and were managed with oral pain medication postoperatively. All received a STAR total ankle. Demographics, comorbidities, American Society of Anesthesiologists (ASA) class, and perioperative complications including wound breakdown, infection, revision, and nonrevision surgeries were observed. Mean follow-up was 16.6 ± 9.1 months (range, 6-42 months). There were no readmissions for pain control and 1 patient had a wound infection. The overall complication rate was 15.4%. One ankle (1.5%) had a wound breakdown requiring debridement and flap coverage. This patient thrombosed a popliteal artery stent 1 month postop. The 1 ankle (1.5%) with a wound infection occurred in a patient with diabetes, obesity, hypertension, and rheumatoid arthritis. This study demonstrates the safety of outpatient TAA. The combination of regional anesthesia and oral narcotics provided a satisfactory experience with no readmissions for pain control and 1 wound infection. The 1 wound breakdown complication (1.5%) was attributed to arterial occlusion and not outpatient management. Level IV, retrospective case series.

  10. Immune response to a mammary adenocarcinoma. V. Sera from tumor-bearing rats contain multiple factors blocking cell-mediated cytotoxicity.

    PubMed

    Huber, S A; Lucas, Z J

    1978-12-01

    Sera from Fischer rats 3 to 13 days after i.p. injection of syngeneic 13762A mammary adenocarcinoma contain three factors specifically blocking cell-mediated cytotoxicity (CMC). The major blocking factor is a 160,000-dalton IgG that combines specifically to cytolytic lymphocytes but not to tumor cells or tumor antigen, and that is not dissociated after treatment with 8 M urea. The other factors have been putatively identified as tumor antigen (less than 70,000 daltons) and as soluble antigen-antibody complexes (greater than 200,000 daltons). Injecting the tumor antigen into tumor-free rats induced spleen cells specifically cytotoxic to the 13762A tumor and provided partial protection to challenge with live tumor cells. Treating soluble antigen-antibody complexes with 8 M urea decreased the size of the blocking activity from greater than 200,000 to less than 70,000 daltons. Although the IgG fraction dissociated from the complex did not block CMC, it did recombine with the tumor antigen fraction to transfer activity to the greater than 200,000-dalton fraction. In contrast, mixing tumor antigen with the IgG fraction that did block CMC did not alter the size of the blocking activities.

  11. Comparison of 0.25% Ropivacaine for Intraperitoneal Instillation v/s Rectus Sheath Block for Postoperative Pain Relief Following Laparoscopic Cholecystectomy: A Prospective Study

    PubMed Central

    Naithani, Udita; Singariya, Geeta; Gupta, Sunanda

    2016-01-01

    Satisfaction Scores (PSS) showed a significant difference among groups with acceptable PSS scores as: Group R (92%) v/s Group I (40%) v/s Group C (20%) p<0.001. Conclusion Pre-emptive administration of rectus sheath block or intraperitoneal instillation of 0.25% ropivacaine was found effective in providing better postoperative analgesia as compared to control group after laparoscopic cholecystectomy. Among these two techniques, rectus sheath block was found to be superior over intraperitoneal instillation. PMID:27656533

  12. Interscalene brachial plexus blocks under general anesthesia in children: is this safe practice?: A report from the Pediatric Regional Anesthesia Network (PRAN).

    PubMed

    Taenzer, Andreas; Walker, Benjamin J; Bosenberg, Adrian T; Krane, Elliot J; Martin, Lynn D; Polaner, David M; Wolf, Christie; Suresh, Santhanam

    2014-01-01

    A practice advisory on regional anesthesia in children in 2008, published in this journal, supported the placement of regional blocks in children under general anesthesia (GA). Interscalene brachial plexus (IS) blocks were specifically excluded, based on case reports (level 3 evidence) of injury, which occurred predominantly in heavily sedated or anesthetized adult patients. Apart from case reports, there is a paucity of data that explore the safety of IS blocks placed in patients under GA, and the level of evidence available on which to base recommendations is limited. Querying the database of the Pediatric Regional Anesthesia Network (PRAN), we report on the incidence of postoperative neurological symptoms, local anesthetic systemic toxicity, and other reported adverse events in children receiving IS blocks under GA or sedated. A total of 518 interscalene blocks were performed, 390 under GA and 123 with the patient sedated or awake (5 cases had missing status); 472 of these were single injection, and 46 involved the placement of infusion catheters. Eighty-eight percent of blocks were placed with ultrasound guidance, 7.7% with no location device, and 2.5% with a nerve stimulator. No local anesthetic systemic toxicity, postoperative neurological symptoms, cardiovascular complications, or dural puncture was reported in this cohort. There were 1 vascular puncture and 1 postoperative infection. These negative results are compatible with 0 to 7.7/1000 events for each of these complications for IS blocks placed under GA. There was no paralysis, motor block, or sensory deficit beyond the expected block duration time. Analyzing interscalene blocks in children placed under GA, we identified no serious adverse events. The upper limit of the confidence interval for these events is similar to that in awake or sedated adults receiving IS blocks. Based on these prospectively collected data, placement of IS blocks under GA in children is no less safe than placement in awake

  13. Complete atrioventricular block following mediastinal irradiation: A report of six cases

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Slama, M.S.; Le Guludec, D.; Sebag, C.

    1991-07-01

    Complete atrioventricular block (AVB) following radiotherapy has been reported rarely, usually after high dose mediastinal irradiation for Hodgkin's disease or lung or breast carcinoma. The authors report six new cases of episodic complete infranodal AVB, requiring permanent pacemaker implantation. The mean age was 48-years old (ranging from 25-60) at the first Adams Stokes attack, mean delay was 12 years after irradiation (10-18), and mean radiation dose was 5,200 rads (4,000-6,500). All patients had abnormal interval electrocardiograms (right bundle branch block in two, left bundle branch block in three, alternating left and right bundle branch block in one). Electrocardiograms during themore » episode of AVB or Holter recordings were consistent with infranodal block in all patients; electrophysiological study performed in five patients confirmed infranodal AVB in four, and one was normal. Pericardial disease was constant, which included pericardial constriction in four patients. Two patients died after failure of pericardiectomy to improve congestive heart failure, due to epicardial, myocardial, and endocardial involvement. Noncardiac mediastinal lesions were present in four cases. Since this delayed complication may occur in patients of such age that the relation between the AVB and the chest irradiation is questionable, they propose the following etiologic criteria; high radiation dose (over 4,000 rads); delay of 10 years or more; abnormal interval tracings; pericardial involvement; and associated cardiac or mediastinal radiation-induced lesions.« less

  14. The clinical spectrum of autoimmune congenital heart block

    PubMed Central

    Brito-Zerón, Pilar; Izmirly, Peter M.; Ramos-Casals, Manuel; Buyon, Jill P.; Khamashta, Munther A.

    2017-01-01

    Autoimmune congenital heart block (CHB) is an immune-mediated acquired disease that is associated with the placental transference of maternal antibodies specific for Ro and La autoantigens. The disease develops in a fetal heart without anatomical abnormalities that could otherwise explain the block, and which is usually diagnosed in utero, but also at birth or within the neonatal period. Autoantibody-mediated damage of fetal conduction tissues causes inflammation and fibrosis and leads to blockage of signal conduction at the atrioventricular (AV) node. Irreversible complete AV block is the principal cardiac manifestation of CHB, although some babies might develop other severe cardiac complications, such as endocardial fibroelastosis or valvular insufficiency, even in the absence of cardiac block. In this Review, we discuss the epidemiology, classification and management of women whose pregnancies are affected by autoimmune CHB, with a particular focus on the autoantibodies associated with autoimmune CHB and how we should test for these antibodies and diagnose this disease. Without confirmed effective preventive or therapeutic strategies and further research on the aetiopathogenic mechanisms, autoimmune CHB will remain a severe life-threatening disorder. PMID:25800217

  15. Block Volume Estimation from the Discontinuity Spacing Measurements of Mesozoic Limestone Quarries, Karaburun Peninsula, Turkey

    PubMed Central

    Elci, Hakan; Turk, Necdet

    2014-01-01

    Block volumes are generally estimated by analyzing the discontinuity spacing measurements obtained either from the scan lines placed over the rock exposures or the borehole cores. Discontinuity spacing measurements made at the Mesozoic limestone quarries in Karaburun Peninsula were used to estimate the average block volumes that could be produced from them using the suggested methods in the literature. The Block Quality Designation (BQD) ratio method proposed by the authors has been found to have given in the same order of the rock block volume to the volumetric joint count (J v) method. Moreover, dimensions of the 2378 blocks produced between the years of 2009 and 2011 in the working quarries have been recorded. Assuming, that each block surfaces is a discontinuity, the mean block volume (V b), the mean volumetric joint count (J vb) and the mean block shape factor of the blocks are determined and compared with the estimated mean in situ block volumes (V in) and volumetric joint count (J vi) values estimated from the in situ discontinuity measurements. The established relations are presented as a chart to be used in practice for estimating the mean volume of blocks that can be obtained from a quarry site by analyzing the rock mass discontinuity spacing measurements. PMID:24696642

  16. Block volume estimation from the discontinuity spacing measurements of mesozoic limestone quarries, Karaburun Peninsula, Turkey.

    PubMed

    Elci, Hakan; Turk, Necdet

    2014-01-01

    Block volumes are generally estimated by analyzing the discontinuity spacing measurements obtained either from the scan lines placed over the rock exposures or the borehole cores. Discontinuity spacing measurements made at the Mesozoic limestone quarries in Karaburun Peninsula were used to estimate the average block volumes that could be produced from them using the suggested methods in the literature. The Block Quality Designation (BQD) ratio method proposed by the authors has been found to have given in the same order of the rock block volume to the volumetric joint count (J(v)) method. Moreover, dimensions of the 2378 blocks produced between the years of 2009 and 2011 in the working quarries have been recorded. Assuming, that each block surfaces is a discontinuity, the mean block volume (V(b)), the mean volumetric joint count (J(vb)) and the mean block shape factor of the blocks are determined and compared with the estimated mean in situ block volumes (V(in)) and volumetric joint count (J(vi)) values estimated from the in situ discontinuity measurements. The established relations are presented as a chart to be used in practice for estimating the mean volume of blocks that can be obtained from a quarry site by analyzing the rock mass discontinuity spacing measurements.

  17. Distribution of bupivacaine hydrochloride after sciatic and femoral nerve blocks in cats: A magnetic resonance imaging study.

    PubMed

    Evangelista, Marina C; de Lassalle, Julie; Chevrier, Christine; Carmel, Eric N; Fantoni, Denise T; Steagall, Paulo V M

    2017-12-01

    The objective of this study was to evaluate the distribution of bupivacaine hydrochloride using magnetic resonance imaging (MRI) after electrical nerve stimulator (ENS)-guided sciatic (ScN) and femoral (FN) nerve blocks in cats. Six adult cats (body weight 4.8±0.6kg) were anesthetized with acepromazine-buprenorphine-propofol-isoflurane. Transverse and sagittal plan sequences of pelvic limbs were obtained using a high-field magnet (1.5T). Afterwards, the ScN and FN blocks (one block per limb) were performed using 0.1mL/kg of bupivacaine 0.5% per site and the MRI sequence was repeated after each block. The injection was considered successful when bupivacaine was in contact with the nerve. Injectate location and complications were recorded. The length (mm) of contact (spread) between bupivacaine and nerves was measured and classified as fair (<15mm) or adequate (≥15mm). Five out of six ScN injections were successful; of these, four had adequate spread over the nerve [26 (13-39) mm]. All FN injections were successful, but in one case bupivacaine was administered over the motor branch of FN, distally to the bifurcation between the femoral and saphenous nerve. It was not possible to measure neither the length of contact between bupivacaine and FN nor to identify iatrogenic trauma caused by the injections. MRI can be used for the evaluation of bupivacaine distribution, but not complications, following ENS-guided ScN and FN blocks in cats. Despite most of the injections were considered successful, individual variability regarding the injectate location may explain differences in efficacy in the clinical setting. Copyright © 2017 Elsevier Ltd. All rights reserved.

  18. Minimum Description Length Block Finder, a Method to Identify Haplotype Blocks and to Compare the Strength of Block Boundaries

    PubMed Central

    Mannila, H.; Koivisto, M.; Perola, M.; Varilo, T.; Hennah, W.; Ekelund, J.; Lukk, M.; Peltonen, L.; Ukkonen, E.

    2003-01-01

    We describe a new probabilistic method for finding haplotype blocks that is based on the use of the minimum description length (MDL) principle. We give a rigorous definition of the quality of a segmentation of a genomic region into blocks and describe a dynamic programming algorithm for finding the optimal segmentation with respect to this measure. We also describe a method for finding the probability of a block boundary for each pair of adjacent markers: this gives a tool for evaluating the significance of each block boundary. We have applied the method to the published data of Daly and colleagues. The results expose some problems that exist in the current methods for the evaluation of the significance of predicted block boundaries. Our method, MDL block finder, can be used to compare block borders in different sample sets, and we demonstrate this by applying the MDL-based method to define the block structure in chromosomes from population isolates. PMID:12761696

  19. Minimum description length block finder, a method to identify haplotype blocks and to compare the strength of block boundaries.

    PubMed

    Mannila, H; Koivisto, M; Perola, M; Varilo, T; Hennah, W; Ekelund, J; Lukk, M; Peltonen, L; Ukkonen, E

    2003-07-01

    We describe a new probabilistic method for finding haplotype blocks that is based on the use of the minimum description length (MDL) principle. We give a rigorous definition of the quality of a segmentation of a genomic region into blocks and describe a dynamic programming algorithm for finding the optimal segmentation with respect to this measure. We also describe a method for finding the probability of a block boundary for each pair of adjacent markers: this gives a tool for evaluating the significance of each block boundary. We have applied the method to the published data of Daly and colleagues. The results expose some problems that exist in the current methods for the evaluation of the significance of predicted block boundaries. Our method, MDL block finder, can be used to compare block borders in different sample sets, and we demonstrate this by applying the MDL-based method to define the block structure in chromosomes from population isolates.

  20. [Interscalene block for total shoulder arthroplasty: comparative study (ultrasound vs. neurostimulation)].

    PubMed

    Mejía-Terrazas, Gabriel Enrique; Ruiz-Suárez, Michell; Gaspar-Carrillo, Sandra Patricia; Valero-González, Fernando; Unzueta-Navarro, David; Encalada-Díaz, Iván

    2014-01-01

    Modern anesthesiology has integrated the use of ultrasonography as a tool that has displaced neurostimulation as a technique for locating peripheral nerves. The aim of this study was to determine which procedure is more effective for guiding interscalene block for total shoulder arthroplasty. We carried out a comparative, prospective non-randomized study comprised of the group guided by neurostimulation interscalene block and the group guided by ultrasound. All patients in both groups were scheduled for total shoulder arthroplasty. Latency, degree of sensory and motor block, success rate, postoperative pain intensity at 6, 12, and 24 h, patient satisfaction and complications were measured. We included 110 patients, 55 per group. Patients were placed in beach chair position and the deltopectoral approach was used. There were no differences in demographic characteristics. Results for neurostimulation vs. ultrasound group: latency 19.11 ± 2.27 vs. 17.24 ± 1.42 min, p= 0.23. Block sensitivity in both groups was grade 0 motor block grade 0 in 76.4% and grade 1 in 23.6% vs. grade 0 to 100%. There was 100% success rate for both groups. Postoperative pain at 6 h was 0.13 ± 0.54 vs. 0.11 ± 0.13 p= 0.90, at 12 h 1.67 ± 1.15 vs. 1.65 ± 0.59 p= 0.89 and at 24 h 3.15 ± 1.66 vs. 2.99 ± 1.15 p= 0.78. Satisfaction 54.5% very satisfied and 45.5% satisfied 96.36% vs 3.6% very satisfied and satisfied. Complications 18.18% vs. 3.6% p= 0.023. Ultrasound-guided interscalene nerve block is the technique of choice in elective total shoulder arthroplasty.

  1. Vertical ridge augmentation using xenogenous bone blocks: a comparison between the flap and tunneling procedures.

    PubMed

    Xuan, Feng; Lee, Chun-Ui; Son, Jeong-Seog; Fang, Yiqin; Jeong, Seung-Mi; Choi, Byung-Ho

    2014-09-01

    Previous studies have shown that the subperiosteal tunneling procedure in vertical ridge augmentation accelerates healing after grafting and prevents graft exposure, with minor postoperative complications. It is conceivable that new bone formation would be greater with the tunneling procedure than with the flap procedure, because the former is minimally invasive. This hypothesis was tested in this study by comparing new bone formation between the flap and tunneling procedures after vertical ridge augmentation using xenogenous bone blocks in a canine mandible model. Two Bio-Oss blocks were placed on the edentulous ridge in each side of the mandibles of 6 mongrel dogs. The blocks in each side were randomly assigned to grafting with a flap procedure (flap group) or grafting with a tunneling procedure (tunneling group). The mean percentage of newly formed bone within the block was 15.3 ± 6.6% in the flap group and 46.6 ± 23.4% in the tunneling group. Based on data presented in this study, when a tunneling procedure is used to place xenogenous bone blocks for vertical ridge augmentation, bone formation in the graft sites is significantly greater than when a flap procedure is used. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Beta-blocking agents during electroconvulsive therapy: a review.

    PubMed

    Boere, E; Birkenhäger, T K; Groenland, T H N; van den Broek, W W

    2014-07-01

    Electroconvulsive therapy (ECT) is associated with at least transient episodes of hypertension and tachycardia. Beta-blocking agents may be indicated to prevent cardiovascular complications and may shorten seizure duration. This review evaluates studies that used beta-blocking agents during ECT to determine which agent has the most favourable outcomes on cardiovascular variables and seizure duration. A Medline database search was made using the combined keywords 'adrenergic beta-antagonists' and 'electroconvulsive therapy'. The search was restricted to double-blind randomized controlled trials and yielded 29 original studies. With the use of esmolol, significant attenuating effects were found on cardiovascular parameters in the first 5 min after stimulation; its shortening effects on seizure duration may be dose-related. With the use of labetalol, findings on cardiovascular effects were inconsistent during the first minutes after stimulation but were significant after 5 min and thereafter; seizure duration was scarcely studied. Landiolol attenuates heart rate but with inconsistent findings regarding arterial pressure (AP); seizure duration was mostly unaffected. Esmolol appears to be effective in reducing the cardiovascular response, although seizure duration may be affected with higher dosages. Landiolol can be considered a suitable alternative, but effects on AP need further investigation. Labetalol has been studied to a lesser extent and may have prolonged cardiovascular effects. The included studies varied in design, methodology, and the amount of exact data provided in the publications. Further study of beta-blocking agents in ECT is clearly necessary. © The Author [2014]. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  3. Neuraxial blocks and spinal haematoma: Review of 166 case reports published 1994-2015. Part 1: Demographics and risk-factors.

    PubMed

    Lagerkranser, Michael

    2017-04-01

    -procedure-related risks such as complicated block, (3) Drug-related risks, i.e. medication with antihaemostatic drugs. The annual number of published cases of spinal haematoma after central neuraxial blocks increased during the last two decades (1994-2015) compared to previous decades. Case reports on elderly women account for this increase. Antihaemostatic drugs, heparins in particular, are still major risk factors for developing post-CNB spinal bleedings. Other risk factors are haemostatic and spinal disorders and complicated blocks, especially "bloody taps", whereas multiple attempts do not seem to increase the risk of bleeding. In a large number of cases, no risk factor was reported. Guidelines issued around the turn of the century do not seem to have affected the number of published reports. In most cases, guidelines were followed, especially during the second half of the study period. Thus, although guidelines reduce the risk of a post-CNB spinal haematoma, and should be strictly adhered to in every single case, they are no guarantee against such bleedings to occur. Copyright © 2017 Scandinavian Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  4. MicroSaw and Piezosurgery in Harvesting Mandibular Bone Blocks from the Retromolar Region: A Randomized Split-Mouth Prospective Clinical Trial.

    PubMed

    Hanser, Thomas; Doliveux, Romain

    The aim of this randomized prospective split-mouth clinical trial was to evaluate the outcome of bone block harvesting from the retromolar region using the MicroSaw and Piezosurgery. Fifty-three patients for extensive bilateral bone grafting procedures with or without concomitant implant placement in the maxilla and/or mandible were scheduled. In each patient, bone blocks were harvested in the retromolar area within the external oblique ridge of the mandible. Using a randomized protocol, bone blocks were harvested with the MicroSaw and Piezosurgery either from the right or the left side. Clinical outcome parameters were the comparison of osteotomy time; volume of block graft; and clinical determination of intraoperative complications such as hemorrhage, nerve injury, pain, swelling, and healing of the donor site. The mean osteotomy time for harvesting including luxating a bone block was 5.63 (± 1.37) minutes using the MicroSaw and 16.47 (± 2.74) minutes using Piezosurgery (P < .05). A mean graft volume of 1.62 (± 0.27) cm 3 was measured with the MicroSaw and 1.26 (± 0.27) cm 3 with the piezoelectric surgical device (P < .05). No heavy bleeding at the donor site occurred in any of the cases. Complications due to injury of adjacent teeth or nerve lesion of the mandibular nerve were not observed in any cases. According to a scale, there was little postoperative pain with both instruments, and it decreased within 14 days postoperatively (P > .05). Swelling did not appear significantly different either (P > .05), and none of the donor sites showed primary healing complications. The data described in this randomized prospective split-mouth clinical trial indicate that the MicroSaw and Piezosurgery allowed efficient and safe bone block harvesting from the external oblique ridge. Clinically, concerning harvesting time and volume of the grafts, the MicroSaw performed significantly better, whereas pain, swelling, and healing did not appear to be considerably different

  5. Capacitor blocks for linear transformer driver stages.

    PubMed

    Kovalchuk, B M; Kharlov, A V; Kumpyak, E V; Smorudov, G V; Zherlitsyn, A A

    2014-01-01

    In the Linear Transformer Driver (LTD) technology, the low inductance energy storage components and switches are directly incorporated into the individual cavities (named stages) to generate a fast output voltage pulse, which is added along a vacuum coaxial line like in an inductive voltage adder. LTD stages with air insulation were recently developed, where air is used both as insulation in a primary side of the stages and as working gas in the LTD spark gap switches. A custom designed unit, referred to as a capacitor block, was developed for use as a main structural element of the transformer stages. The capacitor block incorporates two capacitors GA 35426 (40 nF, 100 kV) and multichannel multigap gas switch. Several modifications of the capacitor blocks were developed and tested on the life time and self breakdown probability. Blocks were tested both as separate units and in an assembly of capacitive module, consisting of five capacitor blocks. This paper presents detailed design of capacitor blocks, description of operation regimes, numerical simulation of electric field in the switches, and test results.

  6. Block of Inactivation-deficient Na+ Channels by Local Anesthetics in Stably Transfected Mammalian Cells

    PubMed Central

    Wang, Sho-Ya; Mitchell, Jane; Moczydlowski, Edward; Wang, Ging Kuo

    2004-01-01

    According to the classic modulated receptor hypothesis, local anesthetics (LAs) such as benzocaine and lidocaine bind preferentially to fast-inactivated Na+ channels with higher affinities. However, an alternative view suggests that activation of Na+ channels plays a crucial role in promoting high-affinity LA binding and that fast inactivation per se is not a prerequisite for LA preferential binding. We investigated the role of activation in LA action in inactivation-deficient rat muscle Na+ channels (rNav1.4-L435W/L437C/A438W) expressed in stably transfected Hek293 cells. The 50% inhibitory concentrations (IC50) for the open-channel block at +30 mV by lidocaine and benzocaine were 20.9 ± 3.3 μM (n = 5) and 81.7 ± 10.6 μM (n = 5), respectively; both were comparable to inactivated-channel affinities. In comparison, IC50 values for resting-channel block at −140 mV were >12-fold higher than those for open-channel block. With 300 μM benzocaine, rapid time-dependent block (τ ≈ 0.8 ms) of inactivation-deficient Na+ currents occurred at +30 mV, but such a rapid time-dependent block was not evident at −30 mV. The peak current at −30 mV, however, was reduced more severely than that at +30 mV. This phenomenon suggested that the LA block of intermediate closed states took place notably when channel activation was slow. Such closed-channel block also readily accounted for the LA-induced hyperpolarizing shift in the conventional steady-state inactivation measurement. Our data together illustrate that the Na+ channel activation pathway, including most, if not all, transient intermediate closed states and the final open state, promotes high-affinity LA binding. PMID:15545401

  7. Placenta associated pregnancy complications in pregnancies complicated with placenta previa.

    PubMed

    Baumfeld, Yael; Herskovitz, Reli; Niv, Zehavi Bar; Mastrolia, Salvatore Andrea; Weintraub, Adi Y

    2017-06-01

    The purpose of our study was to examine the hypothesis that pregnancies complicated with placenta previa have an increased risk of placental insufficiency associated pregnancy complications (IUGR, preeclampsia, placental abruption and perinatal mortality). Our study included all deliveries that occurred at Soroka University Medical Center (Beer Sheva, Israel) between January 1998 and December 2013. Of them 1,249 were complicated by placenta previa and represented our study group. A composite outcome was created to include conditions associated with placental insufficiency. It included hypertensive disorders (i.e. gestational hypertension, mild and severe preeclampsia, HELLP and eclampsia), small for gestational age neonates and placental abruption. Patients with pregnancy complicated by placenta previa had significantly different obstetrical characteristics including bad obstetric history (8% vs. 4%, p < 0.001), recurrent abortions (11% vs. 5%, p < 0.001). Patients with placenta previa had higher rates of vaginal bleeding in the second half of pregnancy (3% vs. 0%, p < 0.001), gestational diabetes (8% vs. 5.5%, p < 0.001), placental abruption (10% vs. 1%, p < 0.001), adherent placenta (4% vs. 0.5%, p < 0.001), preterm delivery (52% vs. 8%, p < 0.001), with a median gestational age of 36 vs. 39 weeks, p < 0.001. The composite outcome was significantly more prevalent in the placenta previa group (21% vs. 13%, p < 0,001). Our study demonstrated an increased rate of placental insufficiency associated complications in women with placenta previa. This is of clinical relevance and suggests that a careful surveillance for women with placenta previa may help in minimizing maternal, fetal and neonatal complications. Copyright © 2017. Published by Elsevier B.V.

  8. JAK2 V617F, MPL, and CALR mutations in essential thrombocythaemia and major thrombotic complications: a single-institute retrospective analysis.

    PubMed

    Pósfai, Éva; Marton, Imelda; Király, Péter Attila; Kotosz, Balázs; Kiss-László, Zsuzsanna; Széll, Márta; Borbényi, Zita

    2015-07-01

    Thrombo-haemorrhagic events are the main cause of morbidity and mortality in essential thrombocythemia. The aim of this study was to estimate the incidence of thrombotic events and the impact of the JAK2V617F, MPL (W515L, W515K, W515R, W515A and S505N) and CALR (type-1, type-2) mutations on 101 essential thrombocythaemia patients (72 females and 29 males with a mean age of 61 years) diagnosed in a Southern Hungarian regional academic centre. The incidence of major thrombosis was 13.86 %. Sixty percent of the patients carried the JAK2V617F mutation. The MPL mutations were analysed by sequencing and the W515L was the only one we could identify with an incidence of 3.96 %. Type-2 CALR mutation could be identified in 3 cases among the patients who had JAK2/MPL-unmutated ET. Statistical analyses revealed that the JAK2V617F mutation was associated with significantly increased levels of platelet (p = 0.042), haemoglobin (p = 0.000), red blood cell (p = 0.000) and haematocrit (p = 0.000) and hepatomegaly (p = 0.045) at diagnosis compared to JAK2V617F negative counterparts, however there was no significant association between the JAK2V617F mutation status (relative risk: 1.297, 95 % CI 0.395-4.258; p = 0.668) and subsequent thrombotic complications. The impact of JAK2V617F, MPL W515L and CALR mutations on the clinical findings at the diagnosis of ET was obvious, but their statistically significant role in the prediction of thrombotic events could not be proven in this study. Our results indirectly support the concept that, besides the quantitative and qualitative changes in the platelets, the mechanisms leading to thrombosis are more complex and multifactorial.

  9. Clinical and electrocardiographic presentations of transient trifascicular block in three cats.

    PubMed

    Oxford, Eva M; Giacomazzi, Flavia B; Moïse, N Sydney; Santilli, Roberto A

    2018-06-01

    This report describes transient trifascicular block in three cats presented with lethargy and inappetence, and elevated cardiac troponin I concentrations. The electrocardiogram (ECG) of cat 1 showed a sinus rhythm with pronounced first-degree atrioventricular (AV) block, right bundle branch block, and left anterior fascicular block. The ECG of cat 2 showed truncular left bundle branch block alternating with left anterior fascicular block coupled with prolonged PR intervals, second-degree heart block, and paroxysmal third-degree AV block. The ECG of cat 3 showed first-degree AV block with concomitant right bundle branch block. The diagnosis of trifascicular block was made when paroxysmal third-degree AV block was documented. All cats recovered with medical management within weeks. Each cat resumed a sinus rhythm. Elevated cardiac troponin I concentrations suggested myocarditis that improved. Copyright © 2018 Elsevier B.V. All rights reserved.

  10. Complications of local anaesthesia. An observational study.

    PubMed

    Brand, H S; Bekker, W; Baart, J A

    2009-11-01

    Local anaesthesia is increasingly used by dental hygienists. As little is known about the incidence of adverse effects during and after the administration of local anaesthetics, we evaluated side-effects associated with local anaesthesia. A prospective observational study was conducted using standard criteria among a group of 103 patients receiving mandibular block anaesthesia. Physical reactions like clenching fists (14.5%), moaning (12.6%) and turning pale (7.8%) were frequently observed. Patients (3.8%) showed a painful reaction because of needle contact with a nerve or the periosteum. Systemic complications were not observed. After the injection, 41.7% said they felt tense during the administration; 4.9% of the patients reported swallowing problems and 3.9% a tachycardia. These results suggest that administration of local anaesthesia has a small risk of adverse events. Complications, if they occur, seem minor and transient in nature.

  11. Production of UT Reference Blocks Containing Artificially Introduced Defects

    NASA Astrophysics Data System (ADS)

    Kaya, A. A.; Ucuncuoglu, S.; Kurkcu, N.; Kandemir, A.; Arslan, H.

    2007-03-01

    Metallic blocks of Inconel 718 and Ti-6A1-4V alloys that contain artificially introduced defects of known type, size, shape and location were prepared to serve as calibration standards in ultrasonic inspection. The synthetic defects employed to serve as reflectors were all pertinent to the specific alloy systems used, i.e. compositional defects termed as `dirty white' `white spot' and `freckle' for Inconel 718; `hard-alpha' for titanium alloy. Furthermore, as a defect type common to all three materials, spherical voids of various sizes were also incorporated into these calibration blocks. The aim of this study is to introduce defects of known type and size into metallic blocks made of superalloy Inconel 718 and titanium Ti-6A1-4V alloy. The scope of the study entailed determination of the correct parameters for manufacturing processes involved. Based on the results of the preceding phases of this study, it was decided that the method of Vacuum Hot Pressing (VHP) was to be used in this project to manufacture the metallic block containing artificial defects.

  12. Highly conductive side chain block copolymer anion exchange membranes.

    PubMed

    Wang, Lizhu; Hickner, Michael A

    2016-06-28

    Block copolymers based on poly(styrene) having pendent trimethyl styrenylbutyl ammonium (with four carbon ring-ionic group alkyl linkers) or benzyltrimethyl ammonium groups with a methylene bridge between the ring and ionic group were synthesized by reversible addition-fragmentation radical (RAFT) polymerization as anion exchange membranes (AEMs). The C4 side chain polymer showed a 17% increase in Cl(-) conductivity of 33.7 mS cm(-1) compared to the benzyltrimethyl ammonium sample (28.9 mS cm(-1)) under the same conditions (IEC = 3.20 meq. g(-1), hydration number, λ = ∼7.0, cast from DMF/1-propanol (v/v = 3 : 1), relative humidity = 95%). As confirmed by small angle X-ray scattering (SAXS), the side chain block copolymers with tethered ammonium cations showed well-defined lamellar morphologies and a significant reduction in interdomain spacing compared to benzyltrimethyl ammonium containing block copolymers. The chemical stabilities of the block copolymers were evaluated under severe, accelerated conditions, and degradation was observed by (1)H NMR. The block copolymer with C4 side chain trimethyl styrenylbutyl ammonium motifs displayed slightly improved stability compared to that of a benzyltrimethyl ammonium-based AEM at 80 °C in 1 M NaOD aqueous solution for 30 days.

  13. A new routing enhancement scheme based on node blocking state advertisement in wavelength-routed WDM networks

    NASA Astrophysics Data System (ADS)

    Hu, Peigang; Jin, Yaohui; Zhang, Chunlei; He, Hao; Hu, WeiSheng

    2005-02-01

    The increasing switching capacity brings the optical node with considerable complexity. Due to the limitation in cost and technology, an optical node is often designed with partial switching capability and partial resource sharing. It means that the node is of blocking to some extent, for example multi-granularity switching node, which in fact is a structure using pass wavelength to reduce the dimension of OXC, and partial sharing wavelength converter (WC) OXC. It is conceivable that these blocking nodes will have great effects on the problem of routing and wavelength assignment. Some previous works studied the blocking case, partial WC OXC, using complicated wavelength assignment algorithm. But the complexities of these schemes decide them to be not in practice in real networks. In this paper, we propose a new scheme based on the node blocking state advertisement to reduce the retry or rerouting probability and improve the efficiency of routing in the networks with blocking nodes. In the scheme, node blocking state are advertised to the other nodes in networks, which will be used for subsequent route calculation to find a path with lowest blocking probability. The performance of the scheme is evaluated using discrete event model in 14-node NSFNET, all the nodes of which employ a kind of partial sharing WC OXC structure. In the simulation, a simple First-Fit wavelength assignment algorithm is used. The simulation results demonstrate that the new scheme considerably reduces the retry or rerouting probability in routing process.

  14. Periodontal ligament and intraosseous anesthetic injection techniques: alternatives to mandibular nerve blocks.

    PubMed

    Moore, Paul A; Cuddy, Michael A; Cooke, Matthew R; Sokolowski, Chester J

    2011-09-01

    and Overview. The provision of mandibular anesthesia traditionally has relied on nerve block anesthetic techniques such as the Halsted, the Gow-Gates and the Akinosi-Vazirani methods. The authors present two alternative techniques to provide local anesthesia in mandibular teeth: the periodontal ligament (PDL) injection and the intraosseous (IO) injection. The authors also present indications for and complications associated with these techniques. The PDL injection and the IO injection are effective anesthetic techniques for managing nerve block failures and for providing localized anesthesia in the mandible. Dentists may find these techniques to be useful alternatives to nerve block anesthesia.

  15. Development of CMOS Imager Block for Capsule Endoscope

    NASA Astrophysics Data System (ADS)

    Shafie, S.; Fodzi, F. A. M.; Tung, L. Q.; Lioe, D. X.; Halin, I. A.; Hasan, W. Z. W.; Jaafar, H.

    2014-04-01

    This paper presents the development of imager block to be associated in a capsule endoscopy system. Since the capsule endoscope is used to diagnose gastrointestinal diseases, the imager block must be in small size which is comfortable for the patients to swallow. In this project, a small size 1.5V button battery is used as the power supply while the voltage supply requirements for other components such as microcontroller and CMOS image sensor are higher. Therefore, a voltage booster circuit is proposed to boost up the voltage supply from 1.5V to 3.3V. A low power microcontroller is used to generate control pulses for the CMOS image sensor and to convert the 8-bits parallel data output to serial data to be transmitted to the display panel. The results show that the voltage booster circuit was able to boost the voltage supply from 1.5V to 3.3V. The microcontroller precisely controls the CMOS image sensor to produce parallel data which is then serialized again by the microcontroller. The serial data is then successfully translated to 2fps image and displayed on computer.

  16. A comparison of take-off dynamics during three different spikes, block and counter-movement jump in female volleyball players.

    PubMed

    Kabacinski, Jaroslae; Dworak, Lecholslaw B; Murawa, Michal; Ostarello, John; Rzepnicka, Agata; Maczynski, Jacek

    2016-12-01

    The purpose of the study was to compare the take-off dynamics in counter-movement jump (CMJ), volleyball block and spikes. Twelve professional female players, representing the highest volleyball league in Poland, participated in the laboratory tests. A force platform was used to record ground reaction force (GRF) during take-off phase in CMJ test, block from a run-up and spikes: front row attack, slide attack, back row attack. Vertical (v) GRF (peak: Rmax and integral mean: ), impulse of vGRF (J) and mechanical power (peak: Pmax and integral mean:

    ) were analyzed. Significant differences (P<0.05) of values of the dynamic parameters (Rmax, , J, Pmax, and

    ) were found between CMJ, block from a run-up and three different technique spikes. The highest values were recorded during take-off in the back row attack: peak vGRF (2.93±0.05 BW), integral mean vGRF (1.90±0.08 BW), impulse of vGRF (354±40 Ns), peak power (5320±918 W) and integral mean power (3604±683 W). Peak power (2608±217 W) and integral mean power (1417±94 W) were determined in CMJ test to evaluate the force-velocity capabilities of the players. In terms of GRF and the mechanical power, high level of dynamics in take-off influences positively the jumping height and significantly increases the effectiveness of attacks during spike of the ball over the block of the opponent.

  17. Dexmedetomidine in a surgically inserted catheter for transversus abdominis plane block in donor hepatectomy: A prospective randomized controlled study.

    PubMed

    Aboelela, Mohamed Adel; Kandeel, Al-Refaey; Elsayed, Usama; Elmorshedi, Mohamed; Elsarraf, Waleed; Elsayed, Eman; Elgawalby, Ahmed; Sultan, Ahmed Mohamed; Wahab, Mohamed Abdel; Yassen, Amr

    2018-01-01

    Transversus abdominis plane (TAP) block is a promising technique for analgesia after abdominal surgery. This prospective, randomized controlled trial assessed the effect of adding dexmedetomidine to bupivacaine in TAP block for donor hepatectomy. We hypothesized that this would improve postoperative morphine consumption and reduce analgesia related complication and inflammation. A total of 50 donor hepatectomy were enrolled in this study. Patients divided into two equal groups according to drugs used for TAP block. Group (B) received 20 ml of bupivacaine hydrochloride 0.25%, Group (BD) received 20 ml of bupivacaine hydrochloride 0.25% and 0.3 μg/kg dexmedetomidine, on both sides at the end of surgery and every 8 h for 48 h at right side only through inserted catheter. Primary outcome objective was morphine consumption at first 72 h. Secondary outcome objectives were morphine requirement, numbers of intake, time to first intake, pain score numerical analog scale (NAS), postoperative analgesia related complications, recovery of intestinal motility, and inflammatory markers. Data were analyzed, rescue morphine analgesia was significantly lower in (BD) group compared with (B) groups as considering total morphine consumption (B 4 ± 1.9, BD 1.5 ± 0.5, P = 0.03), numbers of morphine intake ( P = 0.04), morphine requirement ( P = 0.03), and first time of analgesia intake ( P = 0.04). NAS was significantly lower in group (BD) compared with group (B) group in the first 12 h (NAS 0 - P = 0.001, NAS 1 - P = 0.03). Adding dexmedetomidine improved gut motility, first oral intake without detectable anti-inflammatory effect. Adding dexmedetomidine to bupivacine in a surgically inserted catheter for TAP block in donor hepatectomy reduced morphine consumption without detectable anti-inflammatory effect.

  18. New-Onset Left Bundle Branch Block Induced by Transcutaneous Aortic Valve Implantation.

    PubMed

    Massoullié, Grégoire; Bordachar, Pierre; Ellenbogen, Kenneth A; Souteyrand, Géraud; Jean, Frédéric; Combaret, Nicolas; Vorilhon, Charles; Clerfond, Guillaume; Farhat, Mehdi; Ritter, Philippe; Citron, Bernard; Lusson, Jean-R; Motreff, Pascal; Ploux, Sylvain; Eschalier, Romain

    2016-03-01

    New-onset left bundle branch block (LBBB) is a specific concern of transcutaneous aortic valve implantation (TAVI) given its estimated incidence ranging from 5% to 65%. This high rate of occurrence is dependent on the type of device used (size and shape), implantation methods, and patient co-morbidities. The appearance of an LBBB after TAVI reflects a very proximal lesion of the left bundle branch as it exits the bundle of His. At times transient, its persistence can lead to permanent pacemaker implantation in 15% to 20% of cases, most often for high-degree atrioventricular block. The management of LBBB after TAVI is currently not defined by international societies resulting in individual centers developing their own management strategy. The potential consequences of LBBB are dysrhythmias (atrioventricular block, syncope, and sudden death) and functional (heart failure) complications. Prompt postprocedural recognition and management (permanent pacemaker implantation) of patients prevents the occurrence of potential complications and may constitute the preferred approach in this frail and elderly population despite additional costs and complications of cardiac pacing. Moreover, the expansion of future indications for TAVI necessitates better identification of the predictive factors for the development of LBBB. Indeed, long-term right ventricular pacing may potentially increase the risk of developing heart failure in this population. In conclusion, it is thus imperative to not only develop new aortic prostheses with a less-deleterious impact on the conduction system but also to prescribe appropriate pacing modes in this frail population. Copyright © 2016 Elsevier Inc. All rights reserved.

  19. A study of the complications of small bore 'Seldinger' intercostal chest drains.

    PubMed

    Davies, Helen E; Merchant, Shairoz; McGown, Anne

    2008-06-01

    Use of small bore chest drains (<14F), inserted via the Seldinger technique, has increased globally over the last few years. They are now used as first line interventions in most acute medical situations when thoracostomy is required. Limited data are available on the associated complications. In this study, the frequency of complications associated with 12F chest drains, inserted using the Seldinger technique, was quantified. A retrospective case note audit was performed of consecutive patients requiring pleural drainage over a 12-month period. One hundred consecutive small bore Seldinger (12F) chest drain insertions were evaluated. Few serious complications occurred. However, 21% of the chest drains were displaced ('fell out') and 9% of the drains became blocked. This contributed to high morbidity rates, with 13% of patients requiring repeat pleural procedures. The frequency of drain blockage in pleural effusion was reduced by administration of regular normal saline drain flushes (odds ratio for blockage in flushed drains compared with non-flushed drains 0.04, 95% CI: 0.01-0.37, P < 0.001). Regular chest drain flushes are advocated in order to reduce rates of drain blockage, and further studies are needed to determine optimal fixation strategies that may reduce associated patient morbidity.

  20. Empirical Assessment of the Mean Block Volume of Rock Masses Intersected by Four Joint Sets

    NASA Astrophysics Data System (ADS)

    Morelli, Gian Luca

    2016-05-01

    The estimation of a representative value for the rock block volume ( V b) is of huge interest in rock engineering in regards to rock mass characterization purposes. However, while mathematical relationships to precisely estimate this parameter from the spacing of joints can be found in literature for rock masses intersected by three dominant joint sets, corresponding relationships do not actually exist when more than three sets occur. In these cases, a consistent assessment of V b can only be achieved by directly measuring the dimensions of several representative natural rock blocks in the field or by means of more sophisticated 3D numerical modeling approaches. However, Palmström's empirical relationship based on the volumetric joint count J v and on a block shape factor β is commonly used in the practice, although strictly valid only for rock masses intersected by three joint sets. Starting from these considerations, the present paper is primarily intended to investigate the reliability of a set of empirical relationships linking the block volume with the indexes most commonly used to characterize the degree of jointing in a rock mass (i.e. the J v and the mean value of the joint set spacings) specifically applicable to rock masses intersected by four sets of persistent discontinuities. Based on the analysis of artificial 3D block assemblies generated using the software AutoCAD, the most accurate best-fit regression has been found between the mean block volume (V_{{{{b}}_{{m}} }}) of tested rock mass samples and the geometric mean value of the spacings of the joint sets delimiting blocks; thus, indicating this mean value as a promising parameter for the preliminary characterization of the block size. Tests on field outcrops have demonstrated that the proposed empirical methodology has the potential of predicting the mean block volume of multiple-set jointed rock masses with an acceptable accuracy for common uses in most practical rock engineering applications.

  1. Efficacy of Exclusive Lingual Nerve Block versus Conventional Inferior Alveolar Nerve Block in Achieving Lingual Soft-tissue Anesthesia.

    PubMed

    Balasubramanian, Sasikala; Paneerselvam, Elavenil; Guruprasad, T; Pathumai, M; Abraham, Simin; Krishnakumar Raja, V B

    2017-01-01

    The aim of this randomized clinical trial was to assess the efficacy of exclusive lingual nerve block (LNB) in achieving selective lingual soft-tissue anesthesia in comparison with conventional inferior alveolar nerve block (IANB). A total of 200 patients indicated for the extraction of lower premolars were recruited for the study. The samples were allocated by randomization into control and study groups. Lingual soft-tissue anesthesia was achieved by IANB and exclusive LNB in the control and study group, respectively. The primary outcome variable studied was anesthesia of ipsilateral lingual mucoperiosteum, floor of mouth and tongue. The secondary variables assessed were (1) taste sensation immediately following administration of local anesthesia and (2) mouth opening and lingual nerve paresthesia on the first postoperative day. Data analysis for descriptive and inferential statistics was performed using SPSS (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp. Released 2013) and a P < 0.05 was considered statistically significant. In comparison with the control group, the study group (LNB) showed statistically significant anesthesia of the lingual gingiva of incisors, molars, anterior floor of the mouth, and anterior tongue. Exclusive LNB is superior to IAN nerve block in achieving selective anesthesia of lingual soft tissues. It is technically simple and associated with minimal complications as compared to IAN block.

  2. Efficacy of Exclusive Lingual Nerve Block versus Conventional Inferior Alveolar Nerve Block in Achieving Lingual Soft-tissue Anesthesia

    PubMed Central

    Balasubramanian, Sasikala; Paneerselvam, Elavenil; Guruprasad, T; Pathumai, M; Abraham, Simin; Krishnakumar Raja, V. B.

    2017-01-01

    Objective: The aim of this randomized clinical trial was to assess the efficacy of exclusive lingual nerve block (LNB) in achieving selective lingual soft-tissue anesthesia in comparison with conventional inferior alveolar nerve block (IANB). Materials and Methods: A total of 200 patients indicated for the extraction of lower premolars were recruited for the study. The samples were allocated by randomization into control and study groups. Lingual soft-tissue anesthesia was achieved by IANB and exclusive LNB in the control and study group, respectively. The primary outcome variable studied was anesthesia of ipsilateral lingual mucoperiosteum, floor of mouth and tongue. The secondary variables assessed were (1) taste sensation immediately following administration of local anesthesia and (2) mouth opening and lingual nerve paresthesia on the first postoperative day. Results: Data analysis for descriptive and inferential statistics was performed using SPSS (IBM SPSS Statistics for Windows, Version 22.0, Armonk, NY: IBM Corp. Released 2013) and a P < 0.05 was considered statistically significant. In comparison with the control group, the study group (LNB) showed statistically significant anesthesia of the lingual gingiva of incisors, molars, anterior floor of the mouth, and anterior tongue. Conclusion: Exclusive LNB is superior to IAN nerve block in achieving selective anesthesia of lingual soft tissues. It is technically simple and associated with minimal complications as compared to IAN block. PMID:29264294

  3. Accuracy of the Surgeons' Clinical Prediction of Postoperative Major Complications Using a Visual Analog Scale.

    PubMed

    Woodfield, John C; Sagar, Peter M; Thekkinkattil, Dinesh K; Gogu, Praveen; Plank, Lindsay D; Burke, Dermot

    2017-01-01

    Although the risk factors that contribute to postoperative complications are well recognized, prediction in the context of a particular patient is more difficult. We were interested in using a visual analog scale (VAS) to capture surgeons' prediction of the risk of a major complication and to examine whether this could be improved. The study was performed in 3 stages. In phase I, the surgeon assessed the risk of a major complication on a 100-mm VAS immediately before and after surgery. A quality control questionnaire was designed to check if the VAS was being scored as a linear scale. In phase II, a VAS with 6 subscales for different areas of clinical risk was introduced. In phase III, predictions were completed following the presentation of detailed feedback on the accuracy of prediction of complications. In total, 1295 predictions were made by 58 surgeons in 859 patients. Eight surgeons did not use a linear scale (6 logarithmic, 2 used 4 categories of risk). Surgeons made a meaningful prediction of major complications (preoperative median score 40 mm for complications v. 22 mm for no complication, P < 0.001; postoperative 46 mm v. 21 mm, P < 0.001). In phase I, the discrimination of prediction for preoperative (0.778), postoperative (0.810), and POSSUM (Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity) morbidity (0.750) prediction was similar. Although there was no improvement in prediction with a multidimensional VAS, there was a significant improvement in the discrimination of prediction after feedback (preoperative, 0.895; postoperative, 0.918). Awareness of different ways a VAS is scored is important when designing and interpreting studies. Clinical assessment of major complications by the surgeon was initially comparable to the prediction of the POSSUM morbidity score and improved significantly following the presentation of clinically relevant feedback. © The Author(s) 2016.

  4. [Ultrasound-guided Rectus Sheath Block vs Transversus Abdominis Plane Block in Children Undergoing Umbilical Hernia Repair].

    PubMed

    Torii, Naoko; Tachibana, Kazuya; Iwasaki, Mitsuo; Takeuchi, Muneyuki; Kinouchi, Keiko

    2016-06-01

    Although many reports describe the usefulness of the rectus sheath block (RSB) in the umbilical hernia repair, the efficacy of the transversus abdominis plane block (TAPB) is rarely reported. The purpose of this study was to compare the efficacy and technique of ultrasound-guided RSB and TAPB in children undergoing umbilical hernia repair. Thirty-four children younger than 12 years of age scheduled for umbilical hernia repair were enrolled in this prospective observer-blinded randomized clinical trial. They were randomly assigned either to RSB group (median age, 3.7 years) or TAPB group (median age, 3.8 years). After the induction of general anesthesia with sevoflurane, nitrous oxide, and oxygen children in both groups received regional anesthesia with 0.3 ml x kg(-1) of 0.25% ropivacaine on each side under ultrasound guidance. Hemodynamic changes at the skin incision, postoperative pain scores and parental satisfaction were recorded. Anesthesiologists rated the quality of ultrasound images and easiness of the block performance. The patients' demographics of the two groups were similar. There were no significant differences in the time needed for the block procedure, quality of ultrasound images and the change of the heart rate and blood pressure at the skin incision between the two groups. Postoperative pain score (immediately, 2 and 4 hours after the operation), need for rescue analgesia and satisfaction of the parents also did not differ. There were no major complications in the patients. TAPB provided comparable perioperative analgesia and easiness of block performance to RSB in the pediatric umbilical hernia repair.

  5. Adaptation of a Multi-Block Structured Solver for Effective Use in a Hybrid CPU/GPU Massively Parallel Environment

    NASA Astrophysics Data System (ADS)

    Gutzwiller, David; Gontier, Mathieu; Demeulenaere, Alain

    2014-11-01

    Multi-Block structured solvers hold many advantages over their unstructured counterparts, such as a smaller memory footprint and efficient serial performance. Historically, multi-block structured solvers have not been easily adapted for use in a High Performance Computing (HPC) environment, and the recent trend towards hybrid GPU/CPU architectures has further complicated the situation. This paper will elaborate on developments and innovations applied to the NUMECA FINE/Turbo solver that have allowed near-linear scalability with real-world problems on over 250 hybrid GPU/GPU cluster nodes. Discussion will focus on the implementation of virtual partitioning and load balancing algorithms using a novel meta-block concept. This implementation is transparent to the user, allowing all pre- and post-processing steps to be performed using a simple, unpartitioned grid topology. Additional discussion will elaborate on developments that have improved parallel performance, including fully parallel I/O with the ADIOS API and the GPU porting of the computationally heavy CPUBooster convergence acceleration module. Head of HPC and Release Management, Numeca International.

  6. Quantum integrable systems from conformal blocks

    NASA Astrophysics Data System (ADS)

    Chen, Heng-Yu; Qualls, Joshua D.

    2017-05-01

    In this note, we extend the striking connections between quantum integrable systems and conformal blocks recently found in [M. Isachenkov and V. Schomerus, Phys. Rev. Lett. 117, 071602 (2016), 10.1103/PhysRevLett.117.071602] in several directions. First, we explicitly demonstrate that the action of the quartic conformal Casimir operator on general d-dimensional scalar conformal blocks can be expressed in terms of certain combinations of commuting integrals of motions of the two particle hyperbolic BC2 Calogero-Sutherland system. The permutation and reflection properties of the underlying Dunkl operators play crucial roles in establishing such a connection. Next, we show that the scalar superconformal blocks in superconformal field theories (SCFTs) with four and eight supercharges and suitable chirality constraints can also be identified with the eigenfunctions of the same Calogero-Sutherland system; this demonstrates the universality of such a connection. Finally, we observe that the so-called "seed" conformal blocks for constructing four point functions for operators with arbitrary space-time spins in four-dimensional CFTs can also be linearly expanded in terms of Calogero-Sutherland eigenfunctions.

  7. Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the Treatment of Obesity in the ReCharge Trial.

    PubMed

    Apovian, Caroline M; Shah, Sajani N; Wolfe, Bruce M; Ikramuddin, Sayeed; Miller, Christopher J; Tweden, Katherine S; Billington, Charles J; Shikora, Scott A

    2017-01-01

    The ReCharge Trial demonstrated that a vagal blocking device (vBloc) is a safe and effective treatment for moderate to severe obesity. This report summarizes 24-month outcomes. Participants with body mass index (BMI) 40 to 45 kg/m 2 , or 35 to 40 kg/m 2 with at least one comorbid condition were randomized to either vBloc therapy or sham intervention for 12 months. After 12 months, participants randomized to vBloc continued open-label vBloc therapy and are the focus of this report. Weight loss, adverse events, comorbid risk factors, and quality of life (QOL) will be assessed for 5 years. At 24 months, 123 (76 %) vBloc participants remained in the trial. Participants who presented at 24 months (n = 103) had a mean excess weight loss (EWL) of 21 % (8 % total weight loss [TWL]); 58 % of participants had ≥5 % TWL and 34 % had ≥10 % TWL. Among the subset of participants with abnormal preoperative values, significant improvements were observed in mean LDL (-16 mg/dL) and HDL cholesterol (+4 mg/dL), triglycerides (-46 mg/dL), HbA1c (-0.3 %), and systolic (-11 mmHg) and diastolic blood pressures (-10 mmHg). QOL measures were significantly improved. Heartburn/dyspepsia and implant site pain were the most frequently reported adverse events. The primary related serious adverse event rate was 4.3 %. vBloc therapy continues to result in medically meaningful weight loss with a favorable safety profile through 2 years. https://clinicaltrials.gov/ct2/show/NCT01327976.

  8. Thermoablation of Liver Metastases: Efficacy of Temporary Celiac Plexus Block

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Beck, A.N., E-mail: alexander.beck@charite.de; Schaefer, M.; Werk, M.

    Purpose. To determine the efficacy of celiac plexus block during thermoablation of liver metastases. Methods. Fifty-five consecutive patients underwent thermoablation therapy of liver tumors by laser-induced thermotherapy. Twenty-nine patients received a temporary celiac plexus block, 26 patients acted as control group. In both groups fentanyl and midazolam were administered intravenously upon request of the patient. The duration of the intervention, consumption of opiates, and individual pain sensations were documented. Results. No complications resulting from the celiac plexus block were recorded. Celiac plexus block significantly reduced the amount of pain medication used during thermoablation therapy of liver tumors (with block, 2.45more » {mu}g fentanyl per kg body weight; without block, 3.58 {mu}g fentanyl per kg body weight, p < 0.05; midazolam consumption was not reduced) in patients with metastases {<=}5 mm from the liver capsule. For metastases farther away from the capsule no significant differences in opiate consumption were seen. Celiac plexus block reduced the time for thermoablation significantly (178 min versus 147 min, p < 0.05) no matter how far the metastases were from the liver capsule. Average time needed to set the block was 12 min (range 9-15 min); additional costs for the block were marginal. As expected (as pain medications were given according to individual patients' needs) pain indices did not differ significantly between the two groups. Conclusion. In patients with liver metastases {<=}5 mm from the liver capsule, celiac plexus block reduces the amount of opiates necessary, simplifying patient monitoring. In addition celiac plexus block reduces intervention time, with positive effects on overall workflow for all patients.« less

  9. Treatment of posttraumatic reflex sympathetic dystrophy syndrome (RSDS) with intravenous blocks of a mixture of corticosteroid and lidocaine: a retrospective review of 17 consecutive cases.

    PubMed

    Tountas, A A; Noguchi, A

    1991-01-01

    Seventeen consecutive patients with posttraumatic reflex sympathetic dystrophy syndrome (RSDS) were treated with one or more regional i.v. blocks of methylprednisolone sodium succinate and lidocaine HCL after physical therapy and oral medications had failed to produce satisfactory relief of their symptoms. In 12 of these patients the upper extremity was affected, and in five, it was the lower extremity. A fracture of the distal radius was the most frequent predisposing event. The average delay between injury and the manifestation of RSDS was 2.5 months (range 2 days to almost 6 months). The index treatment in all cases started within 3 months of the onset of symptoms. The number of i.v. blocks given ranged from one to four (average 2.4). The side effects and complications were negligible. The treatment, which in most cases was given exclusively on an outpatient basis, was well tolerated by all patients except one. Assessment of 16 of them at 6 months showed that 11 had total or almost total relief of their symptoms. When 15 of the patients were reassessed at an average follow-up of 28 months (range 12-48 months), it was noted that none of the patients with an early satisfactory response experienced recurrence of their symptoms. The condition of the symptomatic patients in the interim had improved overall. Analysis of the cases with an unsatisfactory outcome suggested that the primary reason for failure was inadequate treatment rather than ineffectiveness of the treatment used. It was concluded that this method is simple, safe, and well tolerated and should be regarded as a first choice for posttraumatic RSDS.

  10. Comparison of ultrasound-guided supraclavicular block according to the various volumes of local anesthetic

    PubMed Central

    Kim, Seok Kon; Kang, Bong Jin; Kwon, Min A; Song, Jae Gyok; Jeon, Soo Mi

    2013-01-01

    Background The ultrasound guidance in regional nerve blocks has recently been introduced and gaining popularity. Ultrasound-guided supraclavicular block has many advantages including the higher success rate, faster onset time, and fewer complications. The aim of this study was to examine the clinical data according to the varied volume of local anesthetics in the ultrasound-guided supraclavicular block. Methods One hundred twenty patients were randomized into four groups, according to the local anesthetic volume used: Group 35 (n = 30), Group 30 (n = 30), Group 25 (n = 30), and Group 20 (n = 30). Supraclavicular blocks were performed with 1% mepivacaine 35 ml, 30 ml, 25 ml, and 20 ml, respectively. The success rate, onset time, and complications were checked and evaluated. Results The success rate (66.7%) was lower in Group 20 than that of Group 35 (96.7%) (P < 0.05). The average onset times of Group 35, Group 30, Group 25, and Group 20 were 14.3 ± 6.9 min, 13.6 ± 4.5 min, 16.7 ± 4.6 min, and 16.5 ± 3.7 min, respectively. There were no significant differences. Horner's syndrome was higher in Group 35 (P < 0.05). Conclusions In conclusion, we achieved 90% success rate with 30 ml of 1% mepivacaine. Therefore, we suggest 30 ml of local anesthetic volume for ultrasound-guided supraclavicular block. PMID:23814648

  11. Evaluating complications of local anesthesia administration and reversal with phentolamine mesylate in a portable pediatric dental clinic.

    PubMed

    Boynes, Sean G; Riley, Amah E; Milbee, Sarah; Bastin, Meghan R; Price, Maylyn E; Ladson, Andrea

    2013-08-01

    This study sought to identify and quantify complications with local anesthetic administration and reversal on consecutive patients seen for comprehensive dental care in a school-based, portable dental clinic, and includes data on the patients seen by the participating portable dental providers. In 923 dental visits where local anesthetic was administered, a standardized form was used to gain further information and identify any complications; this was accompanied by a questionnaire for the student's teacher, in order to quantify the student's distraction and disruption ratings following the dental visit. After statistical analysis of the 923 consecutive cases, the overall complication rate was 5.3%. All of the complications were considered to be mild or moderate, and there were no severe event reports. The complications encountered most frequently (n = 49) were associated with self-inflicted soft tissue injury. The results of this study indicate that comprehensive care with local anesthesia delivered by a school-based portable dental clinic has a low risk of complications. Whereas safe administration of dental care is achievable with or without phentolamine mesylate as a local anesthetic reversal agent, its use was determined to improve safety outcomes. Three factors appeared to directly increase the incidence of complications: the administration of an inferior alveolar nerve block, attention deficit disorder, and obesity. Teacher evaluations demonstrated that children receiving care by a portable dental team were able to reorient back to classwork and were not disruptive to classmates.

  12. Rapid and annealing-free self-assembly of DNA building blocks for 3D hydrogel chaperoned by cationic comb-type copolymers.

    PubMed

    Zhang, Zheng; Wu, Yuyang; Yu, Feng; Niu, Chaoqun; Du, Zhi; Chen, Yong; Du, Jie

    2017-10-01

    The construction and self-assembly of DNA building blocks are the foundation of bottom-up development of three-dimensional DNA nanostructures or hydrogels. However, most self-assembly from DNA components is impeded by the mishybridized intermediates or the thermodynamic instability. To enable rapid production of complicated DNA objects with high yields no need for annealing process, herein different DNA building blocks (Y-shaped, L- and L'-shaped units) were assembled in presence of a cationic comb-type copolymer, poly (L-lysine)-graft-dextran (PLL-g-Dex), under physiological conditions. The results demonstrated that PLL-g-Dex not only significantly promoted the self-assembly of DNA blocks with high efficiency, but also stabilized the assembled multi-level structures especially for promoting the complicated 3D DNA hydrogel formation. This study develops a novel strategy for rapid and high-yield production of DNA hydrogel even derived from instable building blocks at relatively low DNA concentrations, which would endow DNA nanotechnology for more practical applications.

  13. Block Copolymers: Synthesis and Applications in Nanotechnology

    NASA Astrophysics Data System (ADS)

    Lou, Qin

    This study is focused on the synthesis and study of (block) copolymers using reversible deactivation radical polymerizations (RDRPs), including atom transfer radical polymerization (ATRP) and reversible addition-fragmentation chain transfer (RAFT) polymerization. In particular, two primary areas of study are undertaken: (1) a proof-of-concept application of lithographic block copolymers, and (2) the mechanistic study of the deposition of titania into block copolymer templates for the production of well-ordered titania nanostructures. Block copolymers have the ability to undergo microphase separation, with an average size of each microphase ranging from tens to hundreds of nanometers. As such, block copolymers have been widely considered for nanotechnological applications over the past two decades. The development of materials for various nanotechnologies has become an increasingly studied area as improvements in many applications, such as those found in the semiconductor and photovoltaic industries are constantly being sought. Significant growth in developments of new synthetic methods ( i.e. RDRPs) has allowed the production of block copolymers with molecular (and sometimes atomic) definition. In turn, this has greatly expanded the use of block copolymers in nanotechnology. Herein, we describe the synthesis of statistical and block copolymers of 193 nm photolithography methacrylate and acrylate resist monomers with norbornyl and adamantyl moieties using RAFT polymerization.. For these resist (block) copolymers, the phase separation behaviors were examined by atomic force microscopy (AFM). End groups were removed from the polymers to avoid complications during the photolithography since RAFT end groups absorb visible light. Poly(glycidyl methacrylate-block-polystyrene) (PGMA-b-PS) was synthesize by ATRP and demonstrated that this block copolymer acts as both a lithographic UV (365 nm) photoresist and a self-assembly material. The PGMA segments can undergo cationic

  14. Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery.

    PubMed

    Bareka, Metaxia; Hantes, Michael; Arnaoutoglou, Eleni; Vretzakis, George

    2018-02-01

    The purpose of this randomized controlled study is to compare and evaluate the intraoperative and post-operative outcome of PLPS nerve block and that of femoral, obturator and sciatic (FOS) nerve block as a method of anaesthesia, in performing ACL reconstruction. Patients referred for elective arthroscopic ACL reconstruction using hamstring autograft were divided in two groups. The first group received combined femoral-obturator-sciatic nerve block (FOS Group) under dual guidance, whereas the second group received posterior lumbar plexus block under neurostimulation and sciatic nerve block (PLPS Group) under dual guidance. The two groups were comparable in terms of age, sex, BMI and athletic activity. The time needed to perform the nerve blocks was significantly shorter for the FOS group (p < 0.005). Similarly, VAS scores during tourniquet inflation and autograft harvesting were significantly higher (p < 0.005) in the PLPS group and this is also reflected in the intraoperative fentanyl consumption and conversion to general anaesthesia. Finally, patients in this group also reported higher post-operative VAS scores and consumed more morphine. Peripheral nerve blockade of FOS nerve block under dual guidance for arthroscopic ACL reconstructive surgery is a safe and tempting anaesthetic choice. The success rate of this technique is higher in comparison with PLPS and results in less peri- and post-operative pain with less opioid consumption. This study provides support for the use of peripheral nerve blocks as an exclusive method for ACL reconstructive surgery in an ambulatory setting with almost no complications. I.

  15. Surgical anatomy of the retroperitoneal spaces, Part V: Surgical applications and complications.

    PubMed

    Mirilas, Petros; Skandalakis, John E

    2010-04-01

    Knowledge of the surgical anatomy of the retroperitoneum is crucial for surgery of the retroperitoneal organs. Surgery is essential for treatment of retroperitoneal pathologies. The list of these diseases is extensive and comprises acute and chronic inflammatory processes (abscess, injury, hematoma, idiopathic fibrosis), metastatic neoplasms, and primary neoplasms from fibroadipose tissue, connective tissue, smooth and striated muscle, vascular tissue, somatic and sympathetic nervous tissue, extraadrenal chromaffin tissue, and lymphatic tissue. The retroperitoneum can be approached and explored by several routes, including the transperitoneal route and the extraperitoneal route. The retroperitoneal approach to the iliac fossa is used for ectopic renal transplantation. Safe and reliable primary retroperitoneal access can be performed for laparoscopic exploration. The anatomic complications of retroperitoneal surgery are the complications of the organs located in several compartments of the retroperitoneal space. Complications may arise from incisions to the somatic wall, somatic nerves, blood and lymphatic vessels, lymph nodes, visceral autonomous plexuses, and neighboring splanchna.

  16. [Peribulbar block combined with general anesthesia in babies undergoing laser treatment for retinopathy of prematurity: a retrospective analysis].

    PubMed

    Pinho, Daniela Filipa Rodrigues; Real, Cátia; Ferreira, Leónia; Pina, Pedro

    2018-03-12

    Currently there is no agreement regarding which one is the most adequate anesthetic technique for the treatment of retinopathy of prematurity. Peribulbar block may reduce the incidence of oculocardiac reflex and postoperative apnea. The goal of this study was to report the outcomes of peribulbar block, when combined with general anesthesia, for the laser treatment for retinopathy of prematurity, in premature babies. A retrospective analysis of anesthetic records of all babies who underwent laser treatment for retinopathy of prematurity from January 2008 through December 2015 in a tertiary hospital was performed. During that period a total of six babies was submitted to laser treatment for retinopathy of prematurity, all under peribulbar block combined with general anesthesia. A single infratemporal injection of 0.15mL.kg -1 per eye ropivacaine 1% or 0.75% was performed. At the end of the procedure, all babies resumed spontaneous ventilation. No perioperative complications were reported. Peribulbar block was a safe anesthetic technique in our sample considered. Copyright © 2018 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

  17. Laparoscopic repair of non-complicated lumbar hernia secondary to a latissimus dorsi flap.

    PubMed

    Obregón, L; Ruiz-Castilla, M; Binimelis, M M; Guinot, A; García, V; Puig, O; Barret, J P

    2014-03-01

    Lumbar hernia is an unusual complication of the latissimus dorsi flap. Traditionally, it has always been repaired using open-surgery techniques. We present the first description of laparoscopic surgery to treat a non-complicated superior lumbar hernia resulting from the creation of an enlarged latissimus dorsi myocutaneous flap for breast reconstruction following left modified radical mastectomy. The laparoscopic approach substantially reduced the risks associated with open surgery, shortened length of hospital stay and time to recovery and obtained better cosmetic results. Laparoscopic surgery may be considered as a feasible therapeutic option for non-complicated superior lumbar hernias secondary to a latissimus dorsi muscle flap. Therapeutic, V. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Efficacy of popliteal block in postoperative pain control after ankle fracture fixation: a prospective randomized study.

    PubMed

    Goldstein, Rachel Y; Montero, Nicole; Jain, Sudheer K; Egol, Kenneth A; Tejwani, Nirmal C

    2012-10-01

    To compare postoperative pain control in patients treated surgically for ankle fractures who receive popliteal blocks with those who received general anesthesia alone. Institutional Review Board approved prospective randomized study. Metropolitan tertiary-care referral center. All patients being treated with open reduction internal fixation for ankle fractures who met inclusion criteria and consented to participate were enrolled. Patients were randomized to receive either general anesthesia (GETA) or intravenous sedation and popliteal block. Patients were assessed for duration of procedure, total time in the operating room, and postoperative pain at 2, 4, 8, 12, 24, and 48 hours after surgery using a visual analog scale. Fifty-one patients agreed to participate in the study. Twenty-five patients received popliteal block, while 26 patients received GETA. There were no anesthesia-related complications. At 2, 4, and 8 hours postoperatively, patients who underwent GETA demonstrated significantly higher pain. At 12 hours, there was no significant difference between the 2 groups with regard to pain control. However, by 24 hours, those who had received popliteal blocks had significantly higher pain with no difference by 48 hours. Popliteal block provides equivalent postoperative pain control to general anesthesia alone in patients undergoing operative fixation of ankle fractures. However, patients who receive popliteal blocks do experience a significant increase in pain between 12 and 24 hours. Recognition of this "rebound pain" with early narcotic administration may allow patients to have more effective postoperative pain control.

  19. Multi-shape memory polymers achieved by the spatio-assembly of 3D printable thermoplastic building blocks.

    PubMed

    Li, Hongze; Gao, Xiang; Luo, Yingwu

    2016-04-07

    Multi-shape memory polymers were prepared by the macroscale spatio-assembly of building blocks in this work. The building blocks were methyl acrylate-co-styrene (MA-co-St) copolymers, which have the St-block-(St-random-MA)-block-St tri-block chain sequence. This design ensures that their transition temperatures can be adjusted over a wide range by varying the composition of the middle block. The two St blocks at the chain ends can generate a crosslink network in the final device to achieve strong bonding force between building blocks and the shape memory capacity. Due to their thermoplastic properties, 3D printing was employed for the spatio-assembly to build devices. This method is capable of introducing many transition phases into one device and preparing complicated shapes via 3D printing. The device can perform a complex action via a series of shape changes. Besides, this method can avoid the difficult programing of a series of temporary shapes. The control of intermediate temporary shapes was realized via programing the shapes and locations of building blocks in the final device.

  20. Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative pain management: a meta-analysis.

    PubMed

    Hain, E; Maggiori, L; Prost À la Denise, J; Panis, Y

    2018-04-01

    Transversus abdominis plane (TAP) block is a locoregional anaesthesia technique of growing interest in abdominal surgery. However, its efficacy following laparoscopic colorectal surgery is still debated. This meta-analysis aimed to assess the efficacy of TAP block after laparoscopic colorectal surgery. All comparative studies focusing on TAP block after laparoscopic colorectal surgery have been systematically identified through the MEDLINE database, reviewed and included. Meta-analysis was performed according to the Mantel-Haenszel method for random effects. End-points included postoperative opioid consumption, morbidity, time to first bowel movement and length of hospital stay. A total of 13 studies, including 7 randomized controlled trials, were included, comprising a total of 600 patients who underwent laparoscopic colorectal surgery with TAP block, compared with 762 patients without TAP block. Meta-analysis of these studies showed that TAP block was associated with a significantly reduced postoperative opioid consumption on the first day after surgery [weighted mean difference (WMD) -14.54 (-25.14; -3.94); P = 0.007] and a significantly shorter time to first bowel movement [WMD -0.53 (-0.61; -0.44); P < 0.001] but failed to show any impact on length of hospital stay [WMD -0.32 (-0.83; 0.20); P = 0.23] although no study considered length of stay as its primary outcome. Finally, TAP block was not associated with a significant increase in the postoperative overall complication rate [OR = 0.84 (0.62-1.14); P = 0.27]. Transversus abdominis plane (TAP) block in laparoscopic colorectal surgery improves postoperative opioid consumption and recovery of postoperative digestive function without any significant drawback. Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland.

  1. Sciatic nerve block causing heel ulcer after total knee replacement in 36 patients.

    PubMed

    Todkar, Manoj

    2005-12-01

    Femoral and sciatic nerve blocks are often used for postoperative analgesia following total knee replacement surgery. In this report, we focus on cases of heel ulcers which occurred following the implementation of peripheral nerve block in concert with knee replacement surgery. In some instances, heel ulcers have resulted in delayed rehabilitation and prolonged hospital stays in this group of patients, which makes this phenomenon a potential burden on the healthcare system. Pressure points in the foot should be protected after the implementation of nerve blocks to prevent pressure sores. An awareness of this unusual complication related to knee replacement surgery is necessary to prevent its occurrence and avoid delays in patient rehabilitation and recovery.

  2. TIGER: A user-friendly interactive grid generation system for complicated turbomachinery and axis-symmetric configurations

    NASA Technical Reports Server (NTRS)

    Shih, Ming H.; Soni, Bharat K.

    1993-01-01

    The issue of time efficiency in grid generation is addressed by developing a user friendly graphical interface for interactive/automatic construction of structured grids around complex turbomachinery/axis-symmetric configurations. The accuracy of geometry modeling and its fidelity is accomplished by adapting the nonuniform rational b-spline (NURBS) representation. A customized interactive grid generation code, TIGER, has been developed to facilitate the grid generation process for complicated internal, external, and internal-external turbomachinery fields simulations. The FORMS Library is utilized to build user-friendly graphical interface. The algorithm allows a user to redistribute grid points interactively on curves/surfaces using NURBS formulation with accurate geometric definition. TIGER's features include multiblock, multiduct/shroud, multiblade row, uneven blade count, and patched/overlapping block interfaces. It has been applied to generate grids for various complicated turbomachinery geometries, as well as rocket and missile configurations.

  3. Post-traumatic implant-supported restoration of the anterior maxillary teeth using cancellous bone block allografts.

    PubMed

    Nissan, Joseph; Gross, Ora; Mardinger, Ofer; Ghelfan, Oded; Sacco, Roberto; Chaushu, Gavriel

    2011-12-01

    To prospectively evaluate the outcome of dental implants placed in the post-traumatic anterior maxilla after ridge augmentation with cancellous freeze-dried block bone allografts. Patients presenting with a history of anterior dentoalveolar trauma with bony deficiencies in the sagittal (≥3 mm) and vertical (<3 mm) planes according to computed tomography were included. The recipient sites were reconstructed with cancellous bone block allografts. After 6 months of healing, implants were placed. The primary outcomes of interest were 1) bone measurements taken before grafting, at the time of implant placement, and at stage 2 operations; 2) implant survival; and 3) complications. The sample was composed of 20 consecutive patients with a mean age of 25 ± 7 years. We used 28 cancellous allogeneic bone blocks, and 31 implants were inserted. Of the 31 implants, 12 were immediately restored. The mean follow-up was 42 ± 15 months. Graft and implant survival rates were 92.8% and 96.8%, respectively. Mean bone gain in the sagittal and vertical planes was 5 ± 0.5 mm horizontally and 2 ± 0.5 mm (P < .001). Successful restoration was achieved in all patients with fixed implant-supported prostheses. Soft tissue complications occurred in 7 patients (35%). Complications after cementation of the crowns were seen in 3 implants (9.6%). All implants remained clinically osseointegrated at the end of the follow-up examination. There was no crestal bone loss around the implants beyond the first implant thread. Cancellous block allograft can be used successfully for post-traumatic implant-supported restoration in the anterior maxilla. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Determining Surgical Complications in the Overweight (DISCOVER): a multicentre observational cohort study to evaluate the role of obesity as a risk factor for postoperative complications in general surgery.

    PubMed

    Nepogodiev, Dmitri; Chapman, Stephen J; Glasbey, James; Kelly, Michael; Khatri, Chetan; Drake, Thomas M; Kong, Chia Yew; Mitchell, Harriet; Harrison, Ewen M; Fitzgerald, J Edward; Bhangu, Aneel

    2015-07-20

    Obesity is increasingly prevalent among patients undergoing surgery. Conflicting evidence exists regarding the impact of obesity on postoperative complications. This multicentre study aims to determine whether obesity is associated with increased postoperative complications following general surgery. This prospective, multicentre cohort study will be performed utilising a collaborative methodology. Consecutive adults undergoing open or laparoscopic, elective or emergency, gastrointestinal, bariatric or hepatobiliary surgery will be included. Day case patients will be excluded. The primary end point will be the overall 30-day major complication rate (Clavien-Dindo grade III-V complications). Data will be collected to risk-adjust outcomes for potential confounding factors, such as preoperative cardiac risk. This study will be disseminated through structured medical student networks using established collaborative methodology. The study will be powered to detect a two-percentage point increase in the major postoperative complication rate in obese versus non-obese patients. Following appropriate assessment, an exemption from full ethics committee review has been received, and the study will be registered as a clinical audit or service evaluation at each participating hospital. Dissemination will take place through national and local research collaborative networks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Clonazepam-associated Bradycardia in a Disabled Elderly Woman with Multiple Complications

    PubMed Central

    Maruyoshi, Hidetomo; Maruyoshi, Natsue; Hirosue, Motone; Ikeda, Komei; Shimamoto, Masaaki

    2017-01-01

    We herein report an 87-year-old woman who was taking clonazepam at 1.5 mg/day. She was hospitalized with an old cerebral infarction complicated with symptomatic epilepsy, dementia, dyslipidemia, and chronic cholecystitis. Electrocardiogram revealed severe bradycardia at 31 beats/min. The bradycardia disappeared on day 3 after clonazepam withdrawal, although the serum clonazepam level had been within normal limits. She was diagnosed with clonazepam-associated bradycardia, which was likely related to the potential calcium channel-blocking properties of clonazepam. Because of age-related pharmacokinetic and pharmacodynamic changes, the adverse effects of clonazepam should be considered, especially in disabled elderly individuals with multiple comorbidities. PMID:28794360

  6. Clonazepam-associated Bradycardia in a Disabled Elderly Woman with Multiple Complications.

    PubMed

    Maruyoshi, Hidetomo; Maruyoshi, Natsue; Hirosue, Motone; Ikeda, Komei; Shimamoto, Masaaki

    2017-09-01

    We herein report an 87-year-old woman who was taking clonazepam at 1.5 mg/day. She was hospitalized with an old cerebral infarction complicated with symptomatic epilepsy, dementia, dyslipidemia, and chronic cholecystitis. Electrocardiogram revealed severe bradycardia at 31 beats/min. The bradycardia disappeared on day 3 after clonazepam withdrawal, although the serum clonazepam level had been within normal limits. She was diagnosed with clonazepam-associated bradycardia, which was likely related to the potential calcium channel-blocking properties of clonazepam. Because of age-related pharmacokinetic and pharmacodynamic changes, the adverse effects of clonazepam should be considered, especially in disabled elderly individuals with multiple comorbidities.

  7. Complicated infective endocarditis: a case series.

    PubMed

    Kim, Joo Seop; Kang, Min-Kyung; Cho, A Jin; Seo, Yu Bin; Kim, Kun Il

    2017-05-08

    Infective endocarditis is associated with not only cardiac complications but also neurologic, renal, musculoskeletal, and systemic complications related to the infection, such as embolization, metastatic infection, and mycotic aneurysm. We report three cases (the first patient is Chinese and the other two are Koreans) of complicated infective endocarditis; two of the cases were associated with a mycotic aneurysm, and one case was associated with a splenic abscess. One case of a patient with prosthetic valve endocarditis was complicated by intracerebral hemorrhage caused by mycotic aneurysm rupture. A second case of a patient with right-sided valve endocarditis associated with a central catheter was complicated by an abdominal aortic mycotic aneurysm. The third patient had a splenic infarction and abscess associated with infected cardiac thrombi. Complicated infective endocarditis is rare and is associated with cardiac, neurologic, renal, musculoskeletal, and systemic complications related to infection, such as embolization, metastatic infection, and mycotic aneurysm. Infective endocarditis caused by Staphylococcus aureus is more frequently associated with complications. Because the mortality rate increases when complications develop, aggressive antibiotic therapy and surgery, combined with specific treatments for the complications, are necessary.

  8. Universal block diagram based modeling and simulation schemes for fractional-order control systems.

    PubMed

    Bai, Lu; Xue, Dingyü

    2017-05-08

    Universal block diagram based schemes are proposed for modeling and simulating the fractional-order control systems in this paper. A fractional operator block in Simulink is designed to evaluate the fractional-order derivative and integral. Based on the block, the fractional-order control systems with zero initial conditions can be modeled conveniently. For modeling the system with nonzero initial conditions, the auxiliary signal is constructed in the compensation scheme. Since the compensation scheme is very complicated, therefore the integrator chain scheme is further proposed to simplify the modeling procedures. The accuracy and effectiveness of the schemes are assessed in the examples, the computation results testify the block diagram scheme is efficient for all Caputo fractional-order ordinary differential equations (FODEs) of any complexity, including the implicit Caputo FODEs. Copyright © 2017 ISA. Published by Elsevier Ltd. All rights reserved.

  9. Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review.

    PubMed

    Hartmann, Flávia Vieira Guimarães; Novaes, Maria Rita Carvalho Garbi; de Carvalho, Marta Rodrigues

    Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the

  10. [Femoral nerve block versus intravenous fentanyl in adult patients with hip fractures - a systematic review].

    PubMed

    Hartmann, Flávia Vieira Guimarães; Novaes, Maria Rita Carvalho Garbi; Carvalho, Marta Rodrigues de

    Hip fractures configure an important public health issue and are associated with high mortality taxes and lose of functionality. Hip fractures refer to a fracture occurring between the edge of the femoral head and 5cm below the lesser trochanter. They are common in orthopedic emergencies. The number of proximal femoral fractures is likely to increase as the population ages. The average cost of care during the initial hospitalization for hip fracture can be estimated about US$ 7,000 per patient. Femoral fractures are painful and need immediate adequate analgesia. Treating pain femoral fractures is difficult because there are limited numbers of analgesics available, many of which have side effects that can limit their use. Opiates are the most used drugs, but they can bring some complications. In this context, femoral nerve blocks can be a safe alternative. It is a specific regional anesthetic technique used by doctors in emergency medicine to provide anesthesia and analgesia of the affected leg. To compare the analgesic efficacy of intravenous fentanyl versus femoral nerve block before positioning to perform spinal anesthesia in patients with femoral fractures assessed by Pain Scales. A systematic review of scientific literature was conducted. Studies described as randomized controlled trials comparing femoral nerve block and traditional fentanyl are included. Two reviewers (MR and FH) independently assessed potentially eligible trials for inclusion. The methodology assessment was based on the tool developed by the Cochrane Collaboration for assessment of bias for randomized controlled trials. The Cochrane Library, Pubmed, Medline and Lilacs were searched for all articles published, without restriction of language or time. Two studies were included in this review. Nerve blockade seemed to be more effective than intravenous fentanyl for preventing pain in patients suffering from a femoral fracture. It also reduced the use of additional analgesia and made lower the

  11. Four osteotomy methods with piezosurgery to remove complicated mandibular third molars: a retrospective study.

    PubMed

    Ge, Jing; Yang, Chi; Zheng, Jia-Wei; He, Dong-Mei; Zheng, Ling-Yan; Hu, Ying-Kai

    2014-11-01

    Piezosurgery has been used widely in oral and maxillofacial surgery, but there has been no report systematically describing an osteotomy method with piezosurgery for complicated mandibular third molar removal. The aim of this study was to introduce 4 osteotomy methods using piezosurgery and evaluate their effects. A retrospective study was conducted of patients with a complicated impacted mandibular third molar requiring extraction. The predictor variable was the extraction technique. Four osteotomy methods using piezosurgery were tested according to different impaction types: method 1 involved complete bone removal; method 2 involved segmental bone removal; method 3 involved bone removal combined with tooth splitting; and method 4 involved block bone removal. Outcome variables were success rate, operative time, major complications (including nerve injury, mandible fracture, severe hematoma, or severe edema), and serious pyogenic infection. Data were analyzed using descriptive statistics. The study was composed of 55 patients with 74 complicated impacted mandibular third molars. All impacted mandibular third molars were removed successfully. The average surgical time was 15 minutes (range, 8 to 26 minutes). Thirty-eight molars (51.4%) were extracted by method 1, 18 molars (24.3%) by method 2, 12 molars (16.2%) by method 3, and 6 molars (8.1%) by method 4. Two cases (2.7%) developed postoperative infections and recovered within 1 week using drainage and antibiotic administration. The 4 osteotomy methods with piezosurgery provide effective ways of removing complicated impacted mandibular third molars. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Comparison Between the Two-Injection Technique and the Four-Injection Technique in Axillary Brachial Plexus Block with Articaine.

    PubMed

    Ertikin, Aysun; Argun, Güldeniz; Mısırlıoğlu, Mesut; Aydın, Murat; Arıkan, Murat; Kadıoğulları, Nihal

    2017-10-01

    In this study, we aimed to compare axillary brachial plexus block using the two-injection and four-injection techniques assisted with ultrasonography (USG) and nerve stimulator in patients operated for carpal tunnel syndrome with articaine. To evaluate which technique is more effective, we compared the onset time, effectiveness, and duration of block procedures, patient satisfaction, adverse effect of the drug, and complication rates of the motor and sensory blocks. Sixty patients were randomly divided into two groups. A mixture of physiologic serum added to articain with NaHCO 3 (30 mL) was injected into the patients' axilla in both the groups. After the blockage of the musculocutaneous nerve in both the groups, the median nerve in the two-injection group and the median nerve, ulnar nerve, and radial nerve in the four-injection group were blocked. In brachial plexus nerves, sensorial blockage was evaluated with pinprick test, and motor block was evaluated by contraction of the muscles innervated by each nerve. The adverse effects and complications, visual analog scale (VAS) values during the operation, and post-operative patient satisfaction were recorded. Sufficient analgesia and anaesthesia were achieved with no need for an additional local anaesthetics in both the groups. Furthermore, additional sedation requirements were found to be similar in both the groups. A faster rate and a more effective complete block were achieved in more patients from the four-injection group. In the two-injection group, the block could not be achieved for N. radialis in one patient. All other nerves were successfully blocked. Whereas the blockage procedure lasted longer in the four-injection group, the VAS values recorded during the blockage procedure were higher in the four-injection group. No statistical difference was found with regard to patient satisfaction, and no adverse effects and complications were observed in any group. Although the multi-injection method takes more time

  13. Smallest fullerene-like silicon cage stabilized by a V(2) unit.

    PubMed

    Xu, Hong-Guang; Kong, Xiang-Yu; Deng, Xiao-Jiao; Zhang, Zeng-Guang; Zheng, Wei-Jun

    2014-01-14

    We conducted a combined anion photoelectron spectroscopy and density functional theory study on V2Si20 cluster. Our results show that the V2Si20 cluster has an elongated dodecahedron cage structure with a V2 unit encapsulated inside the cage. It is the smallest fullerene-like silicon cage and can be used as building block to make cluster-assembled materials, such as pearl-chain style nanowires.

  14. Smallest fullerene-like silicon cage stabilized by a V2 unit

    NASA Astrophysics Data System (ADS)

    Xu, Hong-Guang; Kong, Xiang-Yu; Deng, Xiao-Jiao; Zhang, Zeng-Guang; Zheng, Wei-Jun

    2014-01-01

    We conducted a combined anion photoelectron spectroscopy and density functional theory study on V2Si20 cluster. Our results show that the V2Si20 cluster has an elongated dodecahedron cage structure with a V2 unit encapsulated inside the cage. It is the smallest fullerene-like silicon cage and can be used as building block to make cluster-assembled materials, such as pearl-chain style nanowires.

  15. Ultramap v3 - a Revolution in Aerial Photogrammetry

    NASA Astrophysics Data System (ADS)

    Reitinger, B.; Sormann, M.; Zebedin, L.; Schachinger, B.; Hoefler, M.; Tomasi, R.; Lamperter, M.; Gruber, B.; Schiester, G.; Kobald, M.; Unger, M.; Klaus, A.; Bernoegger, S.; Karner, K.; Wiechert, A.; Ponticelli, M.; Gruber, M.

    2012-07-01

    In the last years, Microsoft has driven innovation in the aerial photogrammetry community. Besides the market leading camera technology, UltraMap has grown to an outstanding photogrammetric workflow system which enables users to effectively work with large digital aerial image blocks in a highly automated way. Best example is the project-based color balancing approach which automatically balances images to a homogeneous block. UltraMap V3 continues innovation, and offers a revolution in terms of ortho processing. A fully automated dense matching module strives for high precision digital surface models (DSMs) which are calculated either on CPUs or on GPUs using a distributed processing framework. By applying constrained filtering algorithms, a digital terrain model can be derived which in turn can be used for fully automated traditional ortho texturing. By having the knowledge about the underlying geometry, seamlines can be generated automatically by applying cost functions in order to minimize visual disturbing artifacts. By exploiting the generated DSM information, a DSMOrtho is created using the balanced input images. Again, seamlines are detected automatically resulting in an automatically balanced ortho mosaic. Interactive block-based radiometric adjustments lead to a high quality ortho product based on UltraCam imagery. UltraMap v3 is the first fully integrated and interactive solution for supporting UltraCam images at best in order to deliver DSM and ortho imagery.

  16. Testing block subdivision algorithms on block designs

    NASA Astrophysics Data System (ADS)

    Wiseman, Natalie; Patterson, Zachary

    2016-01-01

    Integrated land use-transportation models predict future transportation demand taking into account how households and firms arrange themselves partly as a function of the transportation system. Recent integrated models require parcels as inputs and produce household and employment predictions at the parcel scale. Block subdivision algorithms automatically generate parcel patterns within blocks. Evaluating block subdivision algorithms is done by way of generating parcels and comparing them to those in a parcel database. Three block subdivision algorithms are evaluated on how closely they reproduce parcels of different block types found in a parcel database from Montreal, Canada. While the authors who developed each of the algorithms have evaluated them, they have used their own metrics and block types to evaluate their own algorithms. This makes it difficult to compare their strengths and weaknesses. The contribution of this paper is in resolving this difficulty with the aim of finding a better algorithm suited to subdividing each block type. The proposed hypothesis is that given the different approaches that block subdivision algorithms take, it's likely that different algorithms are better adapted to subdividing different block types. To test this, a standardized block type classification is used that consists of mutually exclusive and comprehensive categories. A statistical method is used for finding a better algorithm and the probability it will perform well for a given block type. Results suggest the oriented bounding box algorithm performs better for warped non-uniform sites, as well as gridiron and fragmented uniform sites. It also produces more similar parcel areas and widths. The Generalized Parcel Divider 1 algorithm performs better for gridiron non-uniform sites. The Straight Skeleton algorithm performs better for loop and lollipop networks as well as fragmented non-uniform and warped uniform sites. It also produces more similar parcel shapes and patterns.

  17. Pudendal nerve stimulation and block by a wireless-controlled implantable stimulator in cats.

    PubMed

    Yang, Guangning; Wang, Jicheng; Shen, Bing; Roppolo, James R; de Groat, William C; Tai, Changfeng

    2014-07-01

    The study aims to determine the functionality of a wireless-controlled implantable stimulator designed for stimulation and block of the pudendal nerve. In five cats under α-chloralose anesthesia, the stimulator was implanted underneath the skin on the left side in the lower back along the sacral spine. Two tripolar cuff electrodes were implanted bilaterally on the pudendal nerves in addition to one bipolar cuff electrode that was implanted on the left side central to the tripolar cuff electrode. The stimulator provided high-frequency (5-20 kHz) biphasic stimulation waveforms to the two tripolar electrodes and low-frequency (1-100 Hz) rectangular pulses to the bipolar electrode. Bladder and urethral pressures were measured to determine the effects of pudendal nerve stimulation (PNS) or block. The maximal (70-100 cmH2O) urethral pressure generated by 20-Hz PNS applied via the bipolar electrode was completely eliminated by the pudendal nerve block induced by the high-frequency stimulation (6-15 kHz, 6-10 V) applied via the two tripolar electrodes. In a partially filled bladder, 20-30 Hz PNS (2-8 V, 0.2 ms) but not 5 Hz stimulation applied via the bipolar electrode elicited a large sustained bladder contraction (45.9 ± 13.4 to 52.0 ± 22 cmH2O). During cystometry, the 5 Hz PNS significantly (p < 0.05) increased bladder capacity to 176.5 ± 27.1% of control capacity. The wireless-controlled implantable stimulator successfully generated the required waveforms for stimulation and block of pudendal nerve, which will be useful for restoring bladder functions after spinal cord injury. © 2013 International Neuromodulation Society.

  18. A discrete event simulation model of clinical and operating room efficiency outcomes of sugammadex versus neostigmine for neuromuscular block reversal in Canada.

    PubMed

    Insinga, Ralph P; Joyal, Cédric; Goyette, Alexandra; Galarneau, André

    2016-11-16

    The objective of this analysis is to explore potential impact on operating room (OR) efficiency and incidence of residual neuromuscular blockade (RNMB) with use of sugammadex (Bridion™, Merck & Co., Inc., Kenilworth, NJ USA) versus neostigmine for neuromuscular block reversal in Canada. A discrete event simulation (DES) model was developed to compare ORs using either neostigmine or sugammadex for NMB reversal over one month. Selected inputs included OR procedure and turnover times, hospital policies for paid staff overtime and procedural cancellations due to OR time over-run, and reductions in RNMB and associated complications with sugammadex use. Trials show sugammadex's impact on OR time and RNMB varies by whether full neuromuscular recovery (train-of-four ratio ≥0.9) is verified prior to extubation in the OR. Scenarios were therefore evaluated reflecting varied assumptions for neuromuscular reversal practices. With use of moderate neuromuscular block, when full neuromuscular recovery is verified prior to extubation (93 procedures performed with sugammadex, 91 with neostigmine), use of sugammadex versus neostigmine avoided 2.4 procedural cancellations due to OR time over-run and 33.5 h of paid staff overtime, while saving an average of 62 min per OR day. No difference was observed between comparators for these endpoints in the scenario when full neuromuscular recovery was not verified prior to extubation, however, per procedure risk of RNMB at extubation was reduced from 60% to 4% (reflecting 51 cases prevented), with associated reductions in risks of hypoxemia (12 cases avoided) and upper airway obstruction (23 cases avoided). Sugammadex impact in reversing deep neuromuscular block was evaluated in an exploratory analysis. When it was hypothetically assumed that 30 min of OR time were saved per procedure, the number of paid hours of staff over-time dropped from 84.1 to 32.0, with a 93% reduction in the per patient risk of residual blockade. In clinical

  19. Short beveled sharp cutting needle is superior to facet tip needle for ultrasound-guided rectus sheath block in children with umbilical hernia: a case series.

    PubMed

    Alsaeed, A; Thallaj, A; Alzahrani, T; Khalil, N; Aljazaeri, A

    2014-10-01

    The most common peripheral nerve blocks used in umbilical hernia repair are rectus sheath block and regional block (caudal block). Ultrasound guidance of peripheral nerve blocks has reduced the number of complications and improved the quality of blocks. The aim of this study is to assess the post rectus sheath block pain relief in pediatric patients coming for umbilical surgery, and to evaluate the easiness of soft tissue puncture and ultrasonic appearance of two different needle types. Twenty two (22) pediatric patients (age range: 1.5-8 years) scheduled for umbilical hernia repair were included in the study. Following the induction of general anesthesia, the ultrasonographic anatomy of the umbilical region was studied with a 5-16 MHz linear probe. An ultrasound-guided rectus sheath block in the lateral edge of both rectus abdominis muscles (RMs) was performed (total of 44 punctures). A 22 gauge short beveled sharp cutting needle 1.1 x 30 mm needle A (BD Insyte--W, Vialon material. Spain) was used in one side, and a Stimuplex A insulated Needle 22G 50mm (needle B) was used on the other side. Surgical conditions, intraoperative hemodynamic parameters, and postoperative analgesia were evaluated. Ultrasonograghic visualization of the posterior sheath was possible in all patients. Needle A scored 72.7% of excellent needle tip and shaft view (16 out of 22) compared to 63.63% for needle B (14 out of 22). None of the needles scored poor view. The ultrasound guided rectus sheath blockade provided sufficient analgesia in all children with no need for additional analgesia except for one child who postoperatively requested morphine 0.1 mg/kg intravenously in recovery room. There were no complications. Ultrasound guidance enables performances of an effective rectus sheath block for umbilical hernia in the lateral edge of the rectus muscle. Use of the sharp short beveled needle of 22 gauge intravenous (IV) cannula stylet provides easy, less traumatic skin and rectus muscle

  20. π-Extended Isoindigo-Based Derivative: A Promising Electron-Deficient Building Block for Polymer Semiconductors.

    PubMed

    Xu, Long; Zhao, Zhiyuan; Xiao, Mingchao; Yang, Jie; Xiao, Jian; Yi, Zhengran; Wang, Shuai; Liu, Yunqi

    2017-11-22

    The exploration of novel electron-deficient building blocks is a key task for developing high-performance polymer semiconductors in organic thin-film transistors. In view of the situation of the lack of strong electron-deficient building blocks, we designed two novel π-extended isoindigo-based electron-deficient building blocks, IVI and F 4 IVI. Owing to the strong electron-deficient nature and the extended π-conjugated system of the two acceptor units, their copolymers, PIVI2T and PF 4 IVI2T, containing 2,2'-bithiophene donor units, are endowed with deep-lying highest occupied molecular orbital (HOMO)/lowest unoccupied molecular orbital (LUMO) energy levels and strong intermolecular interactions. In comparison to PIVI2T, the fluorinated PF 4 IVI2T exhibits stronger intra- and intermolecular interactions, lower HOMO/LUMO energy levels up to -5.74/-4.17 eV, and more ordered molecular packing with a smaller π-π stacking distance of up to 3.53 Å, resulting in an excellent ambipolar transporting behavior and a promising application in logic circuits for PF 4 IVI2T in ambient with hole and electron mobilities of up to 1.03 and 1.82 cm 2 V -1 s -1 , respectively. The results reveal that F 4 IVI is a promising and strong electron-deficient building unit to construct high-performance semiconducting polymers, which provides an insight into the structure-property relationships for the exploration and molecular engineering of excellent electron-deficient building blocks in the field of organic electronics.

  1. Side effects and complications of intraosseous anesthesia and conventional oral anesthesia

    PubMed Central

    Peñarrocha-Oltra, David; Ata-Ali, Javier; Oltra-Moscardó, María J.; Peñarrocha, Miguel

    2012-01-01

    Objective: To analyze the side effects and complications following intraosseous anesthesia (IA), comparing them with those of the conventional oral anesthesia techniques. Material and method: A simple-blind, prospective clinical study was carried out. Each patient underwent two anesthetic techniques: conventional (local infiltration and locoregional anesthetic block) and intraosseous, for respective dental operations. In order to allow comparison of IA versus conventional anesthesia, the two operations were similar and affected the same two teeth in opposite quadrants. Heart rate was recorded in all cases before injection of the anesthetic solution and again 30 seconds after injection. The complications observed after anesthetic administration were recorded. Results: A total of 200 oral anesthetic procedures were carried out in 100 patients. Both IA and conventional anesthesia resulted in a significant increase in heart rate, though the increase was greater with the latter technique. Incidents were infrequent with either anesthetic technique, with no significant differences between them. Regarding the complications, there were significant differences in pain at the injection site, with more intense pain in the case of IA (x2=3.532, p=0.030, Φ2=0.02), while the limitation of oral aperture was more pronounced with conventional anesthesia (x2=5.128, p<0.05, Φ2=0.014). Post-anesthetic biting showed no significant differences (x2=4.082, p=0.121, Φ2=0.009). Conclusions: Both anesthetic techniques significantly increased heart rate, and IA caused comparatively more pain at the injection site, while limited oral aperture was more frequent with conventional anesthesia. Post-anesthetic biting showed no significant differences between the two techniques. Key words:Intraosseous anesthesia, oral anesthesia, mandibular block, heart rate, adrenalin, complications. PMID:22143716

  2. Implant-supported restoration of congenitally missing teeth using cancellous bone block-allografts.

    PubMed

    Nissan, Joseph; Mardinger, Ofer; Strauss, Morris; Peleg, Michael; Sacco, Roberto; Chaushu, Gavriel

    2011-03-01

    Patients with congenitally missing teeth may present with undeveloped alveolar bone morphology, making implant reconstruction a challenge. The aim of the present study was to evaluate the outcome of dental implants after ridge augmentation with cancellous freeze-dried block bone allografts in patients with congenitally missing teeth. Twelve patients with a mean age of 21 ± 4 years, were included. Congenitally missing teeth included maxillary lateral incisors, a maxillary canine, and mandibular central and lateral incisors. A bony deficiency of ≥3 mm horizontally and ≤3 mm vertically according to computerized tomography served as inclusion criteria. Twenty-one implants were inserted after a healing period of 6 months. Five out of 21 implants were immediately restored. Bone measurements were taken before bone augmentation, during implant placement, and at second-stage surgery. Nineteen cancellous allogeneic bone-blocks were used. The mean follow-up time was 30 ± 16 months. Bone block and implant survival rates were 100% and 95.2%, respectively. Mean bone gain was statistically significant (P < .001): 5 ± 0.5 mm horizontally and 2 ± 0.5 mm vertically. All of the patients received a fixed implant-supported prosthesis. Soft tissue complications occurred in 4 patients (30%). Complications after cementation of the crowns were seen in 1 implant (4.8%). All implants remained clinically osseointegrated at the end of the follow-up examination. There was no crestal bone loss around the implants beyond the first implant thread. Cancellous bone block-allografts can be used successfully for implant-supported restorations in patients with congenitally missing teeth. Copyright © 2011 Mosby, Inc. All rights reserved.

  3. Azidated Ether-Butadiene-Ether Block Copolymers as Binders for Solid Propellants

    NASA Astrophysics Data System (ADS)

    Cappello, Miriam; Lamia, Pietro; Mura, Claudio; Polacco, Giovanni; Filippi, Sara

    2016-07-01

    Polymeric binders for solid propellants are usually based on hydroxyl-terminated polybutadiene (HTPB), which does not contribute to the overall energy output. Azidic polyethers represent an interesting alternative but may have poorer mechanical properties. Polybutadiene-polyether copolymers may combine the advantages of both. Four different ether-butadiene-ether triblock copolymers were prepared and azidated starting from halogenated and/or tosylated monomers using HTPB as initiator. The presence of the butadiene block complicates the azidation step and reduces the storage stability of the azidic polymer. Nevertheless, the procedure allows modifying the binder properties by varying the type and lengths of the energetic blocks.

  4. 76 FR 38533 - Alphabetical Listings: Specially Designated Nationals and Blocked Persons; Blocked Vessels...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-30

    ...The Department of the Treasury's Office of Foreign Assets Control (``OFAC'') is amending 31 CFR chapter V to replace the list of persons (which includes individuals and entities) with whom transactions and dealings are prohibited by the various economic sanctions programs administered by OFAC that appears at Appendix A to 31 CFR chapter V with information on how to obtain up-to-date lists of such persons on OFAC's Web site or by other means. OFAC also is removing Appendix B to 31 CFR chapter V, which includes the names of certain blocked vessels. In addition, OFAC is amending its regulations for a number of the sanctions programs it administers to revise references to Appendix A and to remove references to Appendix B. Finally, OFAC is amending the Iranian Transactions Regulations, by republishing in alphabetical order the entire list of persons identified in Appendix A to 31 CFR Part 560, to reflect changes to the list since that appendix was last published.

  5. Synthesis and optoelectronic properties of nanocomposites comprising of poly(9,9-dioctylfluorene)-block-poly(3-hexylthiophene) block copolymer and graphene nanosheets.

    PubMed

    Chiu, Po-Chun; Su, Reagen Ying-Tai; Yeh, Je-Yuan; Yeh, Cheng-Yang; Tsiang, Raymond Chien-Chao

    2013-06-01

    A novel conjugated block copolymer, poly(9,9-dioctylfluorene)-block-poly(3-hexylthiophene) (PFBPT) and its nanocomposite containing graphene sheets were synthesized for enhancing optoelectronic performance. Graphene sheets were in-situ formed in the polymer matrix via a reduction of octadecylamine-functionalized graphite oxide, where the graphite oxide came from acidification and exfoliation of graphite. The blue-green light-emitting poly(9,9-dioctylfluorene) block and red-orange light-emitting poly(3-hexylthiophene) block exhibit a combined white electroluminescence when the composite materials were fabricated as the emitting layer of a polymeric light-emitting diode (PLED). Graphene does not alter the optical characteristics wavelength of PFBPT but electric conductivity increases with the amount of graphene. The HOMO and LUMO were measured and the band gap is smaller with existence of graphene. The threshold voltage decreases with an increase in the graphene content. The device fabricated with PFBPT/graphene nanocomposite containing 1% graphene has a maximum white-light luminescence at a voltage of 9.0 V.

  6. Complications and adverse reactions in the use of newer biologic agents.

    PubMed

    Callen, Jeffrey P

    2007-03-01

    New developments in genetic engineering and biotechnology have allowed the creation of bioengineered molecules that target specific steps in the pathogenesis of several immune-mediated disorders, including Crohn's disease, rheumatoid arthritis, psoriasis and psoriatic arthritis, ankylosing spondylitis, pemphigus, and B-cell lymphoma. These drugs work by eliminating pathogenic T cells (alefacept), blocking T-cell activation and/or inhibiting the trafficking of T cells (efalizumab), changing the immune profile from Th1 to Th2, blocking cytokines (eg, tumor necrosis factor alpha antagonists including etanercept, infliximab and adalimumab, or interleukin-1-receptor antagonists [anakinra]), or eliminating pathogenic B cells (rituximab). This article reviews the complications and adverse reactions associated with these medications.

  7. Diagnostic Accuracy of Selective 3-T MR Neurography-guided Retroperitoneal Genitofemoral Nerve Blocks for the Diagnosis of Genitofemoral Neuralgia.

    PubMed

    Fritz, Jan; Dellon, A Lee; Williams, Eric H; Rosson, Gedge D; Belzberg, Allan J; Eckhauser, Frederick E

    2017-10-01

    Purpose To determine if 3-T magnetic resonance (MR) neurography-guided retroperitoneal genitofemoral nerve (GFN) blocks are safe and effective for the diagnosis of genitofemoral neuralgia. Materials and Methods Following institutional review board approval and informed consent, 26 subjects (16 men, 10 women; mean age, 42 years [range, 24-78 years]; mean body mass index, 28 kg/m 2 [range, 20-35 kg/m 2 ]) with intractable groin pain were included. By using a 3-T MR imaging system, intermediate-weighted turbo spin-echo pulse sequences, and MR-conditional needles, diagnostic MR neurography-guided GFN blocks were performed in the retroperitoneum. Outcome variables included technical success, procedure time, complications, and rates of positive and negative GFN blocks in association with therapeutic outcomes. For the assessment of a learning curve, Mann-Whitney test was used. P values ≤ .05 were considered to indicate a statistically significant difference. Results In 26 subjects, 30 retroperitoneal GFN blocks were performed. Twelve (40%) were performed with an anterior needle path, 12 (40%) with a lateral needle path, and six (20%) with a posterior needle path. GFN blocks were technically successful in 24 of 26 (92%) subjects, achieving appropriate scrotal anesthesia. No complications occurred. The time required for a GFN block was 40 minutes (range, 18-67 minutes). The rate of a successful GFN intervention after a positive GFN block was 88% (14 of 16). The rate of a successful intervention of an alternative target after a negative GFN block was 71% (five of seven). Conclusion Selective retroperitoneally directed MR neurography-guided GFN blocks are safe and effective with high technical success and positive effect on surgical decision making in patients with presumed genitofemoral neuralgia. © RSNA, 2017 Online supplemental material is available for this article.

  8. Thin Film Assembly of Spider Silk-like Block Copolymers

    DTIC Science & Technology

    2011-01-01

    Shipley, N. H.; Lewis, R. V. Int. J. Biol.Macromol. 1999, 24, 271. (c) Thiel, B. L.; Guess, K. B.; Viney, C. Biopolymers 1997, 41, 703. (13) Silk ...Film Assembly of Spider Silk -like Block Copolymers Sreevidhya T. Krishnaji,†,‡ Wenwen Huang,§ Olena Rabotyagova,†,‡ Eugenia Kharlampieva, ) Ikjun Choi...Received November 26, 2010 We report the self-assembly of monolayers of spider silk -like block copolymers. Langmuir isotherms were obtained for a series of

  9. A randomised study of ilio-inguinal nerve blocks following inguinal hernia repair: a stopped randomised controlled trial.

    PubMed

    Walker, Stuart; Orlikowski, Chris

    2008-02-01

    Local anaesthetic use for post-operative pain control is widely used following open inguinal hernia repair but this is not without risk. The aim of this study was to compare ilio-inguinal nerve block and wound irrigation in patients undergoing open inguinal hernia repair under general anaesthetic in a randomised, double blind, placebo controlled trial. Adult patients admitted for unilateral primary open mesh repair of an inguinal hernia were recruited. The patients received a standard general anaesthetic. Prior to skin incision, an ilio-inguinal injection was performed by the anaesthetist with either ropivicaine or normal saline. Prior to closure of the wound, the wound was irrigated with either ropivicaine or normal saline. Post-operatively, all patients received fentynal patient controlled analgesia and regular oral analgesia. Pain scores and visual analogue scores were recorded until discharge. Patients were then contacted by telephone at 24h, 48h, 2weeks and 4weeks post-operatively and asked a standard series of questions, mainly related to post-operative pain. After 12 patients had been recruited the trial was stopped as 5 of the 8 patients who received an ilio-inguinal nerve block suffered a neurological complication. Ilio-inguinal nerve block with ropivicaine should be avoided.

  10. Naming Block Structures: A Multimodal Approach

    ERIC Educational Resources Information Center

    Cohen, Lynn; Uhry, Joanna

    2011-01-01

    This study describes symbolic representation in block play in a culturally diverse suburban preschool classroom. Block play is "multimodal" and can allow children to experiment with materials to represent the world in many forms of literacy. Combined qualitative and quantitative data from seventy-seven block structures were collected and analyzed.…

  11. 31 CFR 510.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Definitions § 510.301 Blocked account; blocked property. The terms blocked account and blocked property shall...

  12. 31 CFR 510.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Definitions § 510.301 Blocked account; blocked property. The terms blocked account and blocked property shall...

  13. 31 CFR 510.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... Definitions § 510.301 Blocked account; blocked property. The terms blocked account and blocked property shall...

  14. Membrane permeable local anesthetics modulate NaV1.5 mechanosensitivity

    PubMed Central

    Beyder, Arthur; Strege, Peter R.; Bernard, Cheryl; Farrugia, Gianrico

    2012-01-01

    Voltage-gated sodium selective ion channel NaV1.5 is expressed in the heart and the gastrointestinal tract, which are mechanically active organs. NaV1.5 is mechanosensitive at stimuli that gate other mechanosensitive ion channels. Local anesthetic and antiarrhythmic drugs act upon NaV1.5 to modulate activity by multiple mechanisms. This study examined whether NaV1.5 mechanosensitivity is modulated by local anesthetics. NaV1.5 channels wereexpressed in HEK-293 cells, and mechanosensitivity was tested in cell-attached and excised inside-out configurations. Using a novel protocol with paired voltage ladders and short pressure pulses, negative patch pressure (-30 mmHg) in both configurations produced a hyperpolarizing shift in the half-point of the voltage-dependence of activation (V1/2a) and inactivation (V1/2i) by about -10 mV. Lidocaine (50 µM) inhibited the pressure-induced shift of V1/2a but not V1/2i. Lidocaine inhibited the tonic increase in pressure-induced peak current in a use-dependence protocol, but it did not otherwise affect use-dependent block. The local anesthetic benzocaine, which does not show use-dependent block, also effectively blocked a pressure-induced shift in V1/2a. Lidocaine inhibited mechanosensitivity in NaV1.5 at the local anesthetic binding site mutated (F1760A). However, a membrane impermeable lidocaine analog QX-314 did not affect mechanosensitivity of F1760A NaV1.5 when applied from either side of the membrane. These data suggest that the mechanism of lidocaine inhibition of the pressure-induced shift in the half-point of voltage-dependence of activation is separate from the mechanisms of use-dependent block. Modulation of NaV1.5 mechanosensitivity by the membrane permeable local anesthetics may require hydrophobic access and may involve membrane-protein interactions. PMID:22874086

  15. 31 CFR 598.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .... 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and blocked property mean any account or property subject to § 598.202 held in the name of a specially...

  16. Addition of dexmedetomidine to bupivacaine in supraclavicular brachial plexus block.

    PubMed

    Aksu, Recep; Bicer, Cihangir

    2017-06-26

    Research is ongoing to determine the lowest dose of local anesthetics in brachial plexus block that provides adequate anesthesia and postoperative analgesia and reduces complications related to local anesthetics. Patients 18-65 years of age who underwent upper limb surgery and who received ultrasound-guided supraclavicular brachial plexus block at the Erciyes University Faculty of Medicine Hospital between February 2014 and January 2015 were included in the study (n=50). Supraclavicular brachial plexus blocks were performed on Group B cases by adding 30 ml 0.33% bupivacaine and on Group BD cases by adding 15 ml 0.33% bupivacaine and 1 µg / kg dexmedetomidine. Block success was evaluated by the onset and block duration of motor and sensory block and the duration of analgesia. The block success of Group B and Group BD was 92.6% and 89.3%, respectively (P = 1.000). Onset time of sensory block, degree of sensory block, duration of sensory block, onset time of motor block, degree of motor block and duration of motor block were similar in both groups in the intergroup comparison (P > 0.05). Duration of analgesia and the operative conditions of groups were similar (P > 0.05). In the implementation of ultrasound-guided supraclavicular brachial plexus block, block success, sensory and motor block and analgesia duration were similar for patients anaesthetized with 30 ml of bupivacaine in comparison with dexmedetomidine+bupivacaine (when the bupivacaine dose was reduced by 50% by the addition of the adjuvant).

  17. Pathway-engineering for highly-aligned block copolymer arrays.

    PubMed

    Choo, Youngwoo; Majewski, Paweł W; Fukuto, Masafumi; Osuji, Chinedum O; Yager, Kevin G

    2017-12-21

    While the ultimate driving force in self-assembly is energy minimization and the corresponding evolution towards equilibrium, kinetic effects can also play a very strong role. These kinetic effects, such as trapping in metastable states, slow coarsening kinetics, and pathway-dependent assembly, are often viewed as complications to be overcome. Here, we instead exploit these effects to engineer a desired final nano-structure in a block copolymer thin film, by selecting a particular ordering pathway through the self-assembly energy landscape. In particular, we combine photothermal shearing with high-temperature annealing to yield hexagonal arrays of block copolymer cylinders that are aligned in a single prescribed direction over macroscopic sample dimensions. Photothermal shearing is first used to generate a highly-aligned horizontal cylinder state, with subsequent thermal processing used to reorient the morphology to the vertical cylinder state in a templated manner. Finally, we demonstrate the successful transfer of engineered morphologies into inorganic replicas.

  18. The efficacy of oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy - a prospective, placebo controlled study.

    PubMed

    Breazu, Caius Mihai; Ciobanu, Lidia; Hadade, Adina; Bartos, Adrian; Mitre, Călin; Mircea, Petru Adrian; Ionescu, Daniela

    2016-04-01

    Pain control after a laparoscopic cholecystectomy can represent a challenge, considering the side effects due to standard analgesia methods. Recently the transversus abdominis plane block (TAP Block) has been used as a part of multimodal analgesia with promising results. The subcostal approach (OSTAP Block), a variant on the TAP block, produces reliable unilateral supraumbilical analgesia. This study evaluated the efficacy of the OSTAP block with bupivacaine in laparoscopic cholecystectomy compared with the placebo OSTAP block. Sixty ASA I/II adult patients listed for elective laparoscopic cholecystectomy were randomly allocated in one of two groups: Group A (OSTAP placebo) received preoperatively bilateral OSTAP block with sterile normal saline and Group B (OSTAP bupivacaine) received bilateral preoperatively OSTAP block with the same volumes of 0.25% bupivacaine. Twenty-four hours postoperative opioid consumption, the dose of opioid required during surgery, opioid dose in the recovery unit (PACU) and PACU length of stay were evaluated. The quality of analgesia was assessed by the Visual Analogue Scale (VAS) at specific interval hours during 24 h, at rest and with movement. The mean intraoperative opioid consumption showed a significant difference between the two groups, (385 ± 72.52 mg in group A vs 173.67 ± 48.60 mg in group B, p < 0.001). The mean 24 h opioid consumption showed a statistically significant difference between groups (32 ± 26.05 mg vs 79 ± 16.68 mg, p < 0.001). PACU length of stay was significantly lower for group B patients compared with group A patients (20.67 ± 11.27 min vs 41.67 ± 12.41 min, p < 0.001). The OSTAP bupivacaine group had a statistically significant lower pain score than the OSTAP placebo group at 0, 2, 4, 6, 12, 24 h, both at rest and with movement. No signs or symptoms of local anaesthetic systemic toxicity or other complications were detected. OSTAP block with bupivacaine 0.25% can provide effective analgesia up to 24

  19. Orally active vasopressin V1a receptor antagonist, SRX251, selectively blocks aggressive behavior.

    PubMed

    Ferris, Craig F; Lu, Shi-Fang; Messenger, Tara; Guillon, Christophe D; Heindel, Ned; Miller, Marvin; Koppel, Gary; Robert Bruns, F; Simon, Neal G

    2006-02-01

    Arginine vasopressin functions as a neurochemical signal in the brain to affect social behavior. There is an expanding literature from animal and human studies showing that vasopressin, through the vasopressin 1A receptor (V1A), can stimulate aggressive behavior. Using a novel monocylic beta lactam platform, a series of orally active vasopressin V1a antagonists was developed with high affinity for the human receptor. SRX251 was chosen from this series of V1a antagonists to screen for effects on serenic activity in a resident-intruder model of offensive aggression. Resident, male Syrian golden hamsters were given oral doses of SRX251 or intraperitoneal Manning compound, a selective V1a receptor antagonist with reduced brain penetrance, at doses of 0.2 microg, 20 microg, 2 mg/kg or vehicle. When tested 90-120 min later, SRX251, but not Manning compound, caused a significant dose-dependent reduction in offensive aggression toward intruders as measured by latency to bite and number of bites. The reduction in aggression persisted for over 6 h and was no longer present 12 h post treatment. SRX251 did not alter the amount of time the resident investigated the intruder, olfactory communication, general motor activity, or sexual motivation. These data corroborate previous studies showing a role for vasopressin neurotransmission in aggression and suggest that V1a receptor antagonists may be used to treat interpersonal violence co-occurring with such illness as ADHD, autism, bipolar disorder, and substance abuse.

  20. Atomic layer deposition of ultrathin blocking layer for low-temperature solid oxide fuel cell on nanoporous substrate

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Yu, Wonjong; Cho, Gu Young; Noh, Seungtak

    2015-01-15

    An ultrathin yttria-stabilized zirconia (YSZ) blocking layer deposited by atomic layer deposition (ALD) was utilized for improving the performance and reliability of low-temperature solid oxide fuel cells (SOFCs) supported by an anodic aluminum oxide substrate. Physical vapor-deposited YSZ and gadolinia-doped ceria (GDC) electrolyte layers were deposited by a sputtering method. The ultrathin ALD YSZ blocking layer was inserted between the YSZ and GDC sputtered layers. To investigate the effects of an inserted ultrathin ALD blocking layer, SOFCs with and without an ultrathin ALD blocking layer were electrochemically characterized. The open circuit voltage (1.14 V) of the ALD blocking-layered SOFC was visiblymore » higher than that (1.05 V) of the other cell. Furthermore, the ALD blocking layer augmented the power density and improved the reproducibility.« less

  1. Blocking of conditioned taste avoidance induced by wheel running.

    PubMed

    Pierce, W David; Heth, C Donald

    2010-01-01

    In Experiment 1, compared to non-reinforced presentation of a food stimulus (A-->no US), the association of a food stimulus with wheel running (A-->US) blocked subsequent avoidance of a distinctive flavor (X), when both the food and flavor were followed by wheel running (AX-->US). Experiment 2 replicated and extended the blocking effect, demonstrating that the amount of avoidance of X after AX-->wheel training depended on the correlation between A-alone trials and wheel running-the predictiveness of the A stimulus. The present study is the first to demonstrate associative blocking of conditioned taste avoidance (CTA) induced by wheel running and strongly implicates associative learning as the basis for this kind of avoidance. 2009 Elsevier B.V. All rights reserved.

  2. A comparison of retrobulbar block, sub-Tenon block, and topical anesthesia during cataract surgery.

    PubMed

    Ryu, Jung-Hee; Kim, Minsuk; Bahk, Jae-Hyon; Do, Sang-Hwan; Cheong, Il-Young; Kim, Yong-Chul

    2009-01-01

    This randomized, double-blinded, prospective study was performed to compare the intraoperative hemodynamic variables and the patient-reported outcomes, such as intra- and postoperative analgesia and patient satisfaction, of retrobulbar block, sub-Tenon block, and topical anesthesia during cataract surgery under monitored anesthesia care. Eighty-one patients, ASA physical status I-III, undergoing elective cataract surgery under monitored anesthesia care, aged between 43 and 78 years, were randomly assigned to three groups: retrobulbar block (group R), sub-Tenon block (group S), or topical anesthesia (group T). Three minutes after the start of monitored anesthesia care with lidocaine-propofol-remifentanil mixture, an ophthalmologist performed regional anesthesia. Intraoperative hemodynamics, pain score, and patients' satisfaction with the anesthetic experiences were recorded by a study-blinded anesthesiologist. Mean arterial pressure and heart rate in group R were significantly higher than those in groups S and T during and just after the regional block (p<0.05). Group R required smaller dosage of patient controlled sedation and fewer supplemental bolus doses than groups S and T (p<0.05). On the other hand, group S showed the highest satisfaction scores among the three groups (p<0.05). Sub-Tenon block seems to be better than retrobulbar block and topical anesthesia in patient satisfaction though adequate analgesia was achieved after retrobulbar block during cataract surgery under monitored anesthesia care.

  3. Fabrication of Carbonate Apatite Block through a Dissolution-Precipitation Reaction Using Calcium Hydrogen Phosphate Dihydrate Block as a Precursor.

    PubMed

    Tsuru, Kanji; Yoshimoto, Ayami; Kanazawa, Masayuki; Sugiura, Yuki; Nakashima, Yasuharu; Ishikawa, Kunio

    2017-03-31

    Carbonate apatite (CO₃Ap) block, which is a bone replacement used to repair defects, was fabricated through a dissolution-precipitation reaction using a calcium hydrogen phosphate dihydrate (DCPD) block as a precursor. When the DCPD block was immersed in NaHCO₃ or Na₂CO₃ solution at 80 °C, DCPD converted to CO₃Ap within 3 days. β-Tricalcium phosphate was formed as an intermediate phase, and it was completely converted to CO₃Ap within 2 weeks when the DCPD block was immersed in Na₂CO₃ solution. Although the crystal structures of the DCPD and CO₃Ap blocks were different, the macroscopic structure was maintained during the compositional transformation through the dissolution-precipitation reaction. CO₃Ap block fabricated in NaHCO₃ or Na₂CO₃ solution contained 12.9 and 15.8 wt % carbonate, respectively. The diametral tensile strength of the CO₃Ap block was 2 MPa, and the porosity was approximately 57% regardless of the carbonate solution. DCPD is a useful precursor for the fabrication of CO₃Ap block.

  4. A randomized trial comparing surgeon-administered intraoperative transversus abdominis plane block with anesthesiologist-administered transcutaneous block.

    PubMed

    Narasimhulu, D M; Scharfman, L; Minkoff, H; George, B; Homel, P; Tyagaraj, K

    2018-04-27

    Injection of local anesthetic into the transversus abdominis plane (TAP block) decreases systemic morphine requirements after abdominal surgery. We compared intraoperative surgeon-administered TAP block (surgical TAP) to anesthesiologist-administered transcutaneous ultrasound-guided TAP block (conventional TAP) for post-cesarean analgesia. We hypothesized that surgical TAP blocks would take less time to perform than conventional TAP blocks. We performed a randomized trial, recruiting 41 women undergoing cesarean delivery under neuraxial anesthesia, assigning them to either surgical TAP block (n=20) or conventional TAP block (n=21). Time taken to perform the block was the primary outcome, while postoperative pain scores and 24-hour opioid requirements were secondary outcomes. Student's t-test was used to compare block time and Kruskal-Wallis test opioid consumption and pain-scores. Time taken to perform the block (2.4 vs 12.1 min, P <0.001), and time spent in the operating room after delivery (55.3 vs 77.9 min, P <0.001) were significantly less for surgical TAP. The 24 h morphine consumption (P=0.17) and postoperative pain scores at 4, 8, 24 and 48 h were not significantly different between the groups. Surgical TAP blocks are feasible and less time consuming than conventional TAP blocks, while providing comparable analgesia after cesarean delivery. Copyright © 2018 Elsevier Ltd. All rights reserved.

  5. Masquerading bundle branch block as a presenting manifestation of complete atrioventricular block that caused syncope.

    PubMed

    Jiao, Zhenyu; Tian, Ying; Yang, Xinchun; Liu, Xingpeng

    2017-10-01

    A 59-year-old male patient was admitted with the main complaints of stuffiness and shortness of breath. An ECG from precordial leads on admission showed masquerading bundle branch block. Syncope frequently occurred after admission. During syncope episodes, ECG telemetry showed that the syncope was caused by intermittent complete atrioventricular block, with the longest RR interval lasting for 4.36 s. At the gap of syncope, ECG showed complete right bundle branch block accompanied by alternation of left anterior fascicular block and left posterior fascicular block. The patient was implanted with a dual-chamber permanent pacemaker. Follow-up of 9 months showed no reoccurrence of syncope.

  6. Peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type: a report of 2 cases.

    PubMed

    Patzkowski, Michael S

    2016-03-01

    Ehlers-Danlos syndrome is an inherited disorder of collagen production that results in multiorgan dysfunction. Patients with hypermobility type display skin hyperextensibility and joint laxity, which can result in chronic joint instability, dislocation, peripheral neuropathy, and severe musculoskeletal pain. A bleeding diathesis can be found in all subtypes of varying severity despite a normal coagulation profile. There have also been reports of resistance to local anesthetics in these patients. Several sources advise against the use of regional anesthesia in these patients citing the 2 previous features. There have been reports of successful neuraxial anesthesia, but few concerning peripheral nerve blocks, none of which describe nerves of the lower extremity. This report describes 2 cases of successful peripheral regional anesthesia in the lower extremity. In case 1, a 16-year-old adolescent girl with hypermobility type presented for osteochondral grafting of tibiotalar joint lesions. She underwent a popliteal sciatic (with continuous catheter) and femoral nerve block under ultrasound guidance. She proceeded to surgery and tolerated the procedure under regional block and intravenous sedation. She did not require any analgesics for the following 15 hours. In case 2, an 18-year-old woman with hypermobility type presented for medial patellofemoral ligament reconstruction for chronic patella instability. She underwent a saphenous nerve block above the knee with analgesia in the distribution of the saphenous nerve lasting for approximately 18 hours. There were no complications in either case. Prohibitions against peripheral nerve blocks in patients with Ehlers-Danlos syndrome, hypermobility type, appear unwarranted. Published by Elsevier Inc.

  7. The Block V Receiver fast acquisition algorithm for the Galileo S-band mission

    NASA Technical Reports Server (NTRS)

    Aung, M.; Hurd, W. J.; Buu, C. M.; Berner, J. B.; Stephens, S. A.; Gevargiz, J. M.

    1994-01-01

    A fast acquisition algorithm for the Galileo suppressed carrier, subcarrier, and data symbol signals under low data rate, signal-to-noise ratio (SNR) and high carrier phase-noise conditions has been developed. The algorithm employs a two-arm fast Fourier transform (FFT) method utilizing both the in-phase and quadrature-phase channels of the carrier. The use of both channels results in an improved SNR in the FFT acquisition, enabling the use of a shorter FFT period over which the carrier instability is expected to be less significant. The use of a two-arm FFT also enables subcarrier and symbol acquisition before carrier acquisition. With the subcarrier and symbol loops locked first, the carrier can be acquired from an even shorter FFT period. Two-arm tracking loops are employed to lock the subcarrier and symbol loops parameter modification to achieve the final (high) loop SNR in the shortest time possible. The fast acquisition algorithm is implemented in the Block V Receiver (BVR). This article describes the complete algorithm design, the extensive computer simulation work done for verification of the design and the analysis, implementation issues in the BVR, and the acquisition times of the algorithm. In the expected case of the Galileo spacecraft at Jupiter orbit insertion PD/No equals 14.6 dB-Hz, R(sym) equals 16 symbols per sec, and the predicted acquisition time of the algorithm (to attain a 0.2-dB degradation from each loop to the output symbol SNR) is 38 sec.

  8. Knockdown of sodium channel NaV1.6 blocks mechanical pain and abnormal bursting activity of afferent neurons in inflamed sensory ganglia

    PubMed Central

    Xie, Wenrui; Strong, Judith A.; Ye, Ling; Mao, Ju-Xian; Zhang, Jun-Ming

    2013-01-01

    Inflammatory processes in the sensory ganglia contribute to many forms of chronic pain. We previously showed that local inflammation of the lumbar sensory ganglia rapidly leads to prolonged mechanical pain behaviors and high levels of spontaneous bursting activity in myelinated cells. Abnormal spontaneous activity of sensory neurons occurs early in many preclinical pain models, and initiates many other pathological changes, but its molecular basis is not well understood. The sodium channel isoform NaV1.6 can underlie repetitive firing and excitatory persistent and resurgent currents. We used in vivo knockdown of this channel via local injection of siRNA to examine its role in chronic pain following local inflammation of the rat lumbar sensory ganglia. In normal DRG, quantitative PCR showed that cells capable of firing repetitively had significantly higher relative expression of NaV1.6. In inflamed DRG, spontaneously active bursting cells expressed high levels of NaV1.6′ immunoreactivity. In vivo knockdown of NaV1.6 locally in the lumbar DRG at the time of DRG inflammation completely blocked development of pain behaviors and abnormal spontaneous activity, while having only minor effects on unmyelinated C-cells. Current research on isoform-specific sodium channel blockers for chronic pain is largely focused on NaV1.8, because it is present primarily in unmyelinated C fiber nociceptors, or on NaV1.7, because lack of this channel causes congenital indifference to pain. However, the results suggest that NaV1.6 may be a useful therapeutic target for chronic pain, and that some pain conditions may be primarily mediated by myelinated A-fiber sensory neurons. PMID:23622763

  9. ["Habitual" left branch block alternating with 2 "disguised" bracnch block].

    PubMed

    Lévy, S; Jullien, G; Mathieu, P; Mostefa, S; Gérard, R

    1976-10-01

    Two cases of alternating left bundle branch block and "masquerading block" (with left bundle branch morphology in the stnadard leads and right bundle branch block morphology in the precordial leads) were studied by serial tracings and his bundle electrocardiography. In case 1 "the masquerading" block was associated with a first degree AV block related to a prolongation of HV interval. This case is to our knowledge the first cas of alternating bundle branch block in which his bundle activity was recorded in man. In case 2, the patient had atrial fibrilation and His bundle recordings were performed while differents degrees of left bundle branch block were present: The mechanism of the alternation and the concept of "masquerading" block are discussed. It is suggested that this type of block represents a right bundle branch block associated with severe lesions of the "left system".

  10. 31 CFR 598.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

  11. 31 CFR 598.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

  12. 31 CFR 598.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

  13. 31 CFR 598.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 598.301 Section 598.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued... REGULATIONS General Definitions § 598.301 Blocked account; blocked property. The terms blocked account and...

  14. Morphine Spinal Block Anesthesia in Patients Who Undergo an Open Hemorrhoidectomy: A Prospective Analysis of Pain Control and Postoperative Complications

    PubMed Central

    Moreira, José PT; Isaac, Raniere R; Alves-Neto, Onofre; Moreira, Thiago AC; Vieira, Tiago HM; Brasil, Andressa MS

    2014-01-01

    Purpose This study evaluated the use of adding morphine to bupivacaine in spinal anesthesia for pain control in patients who underwent an open hemorrhoidectomy. Methods Forty patients were prospectively selected for an open hemorrhoidectomy at the same institution and were randomized into two groups of 20 patients each: group 1 had a spinal with 7 mg of heavy bupivacaine associated with 80 µg of morphine (0.2 mg/mL). Group 2 had a spinal with 7 mg of heavy bupivacaine associated with distilled water, achieving the same volume of spinal infusion as that of group 1. Both groups were prescribed the same pain control medicine during the postoperative period. Pain scores were evaluated at the anesthetic recovery room and at 3, 6, 12, and 24 hours after surgery. Postoperative complications, including pruritus, nausea, headaches, and urinary retention, were also recorded. Results There were no anthropometric statistical differences between the two groups. Pain in the anesthetic recovery room and 3 hours after surgery was similar for both groups. However, pain was better controlled in group 1 at 6 and 12 hours after surgery. Although pain was better controlled for group 1 after 24 hours of surgery, the difference between the groups didn't achieved statistical significance. Complications were more common in group 1. Six patients (6/20) presented coetaneous pruritus and 3 with (3/20) urinary retention. Conclusion A hemorrhoidectomy under a spinal with morphine provides better pain control between 6 and 12 hours after surgery. However, postoperative complications, including cutaneous pruritus (30%) and urinary retention (15%), should be considered as a negative side of this procedure. PMID:24999465

  15. Cutaneous Sensory Block Area, Muscle-Relaxing Effect, and Block Duration of the Transversus Abdominis Plane Block: A Randomized, Blinded, and Placebo-Controlled Study in Healthy Volunteers.

    PubMed

    Støving, Kion; Rothe, Christian; Rosenstock, Charlotte V; Aasvang, Eske K; Lundstrøm, Lars H; Lange, Kai H W

    2015-01-01

    The transversus abdominis plane (TAP) block is a widely used nerve block. However, basic block characteristics are poorly described. The purpose of this study was to assess the cutaneous sensory block area, muscle-relaxing effect, and block duration. Sixteen healthy volunteers were randomized to receive an ultrasound-guided unilateral TAP block with 20 mL 7.5 mg/mL ropivacaine and placebo on the contralateral side. Measurements were performed at baseline and 90 minutes after performing the block. Cutaneous sensory block area was mapped and separated into a medial and lateral part by a vertical line through the anterior superior iliac spine. We measured muscle thickness of the 3 lateral abdominal muscle layers with ultrasound in the relaxed state and during maximal voluntary muscle contraction. The volunteers reported the duration of the sensory block and the abdominal muscle-relaxing effect. The lateral part of the cutaneous sensory block area was a median of 266 cm2 (interquartile range, 191-310 cm2) and the medial part 76 cm 2(interquartile range, 54-127 cm2). In all the volunteers, lateral wall muscle thickness decreased significantly by 9.2 mm (6.9-15.7 mm) during a maximal contraction. Sensory block and muscle-relaxing effect duration were 570 minutes (512-716 minutes) and 609 minutes (490-724 minutes), respectively. Cutaneous sensory block area of the TAP block is predominantly located lateral to a vertical line through the anterior superior iliac spine. The distribution is nondermatomal and does not cross the midline. The muscle-relaxing effect is significant and consistent. The block duration is approximately 10 hours with large variation.

  16. Smallest fullerene-like silicon cage stabilized by a V{sub 2} unit

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Xu, Hong-Guang, E-mail: xuhong@iccas.ac.cn, E-mail: zhengwj@iccas.ac.cn; Kong, Xiang-Yu; Deng, Xiao-Jiao

    We conducted a combined anion photoelectron spectroscopy and density functional theory study on V{sub 2}Si{sub 20} cluster. Our results show that the V{sub 2}Si{sub 20} cluster has an elongated dodecahedron cage structure with a V{sub 2} unit encapsulated inside the cage. It is the smallest fullerene-like silicon cage and can be used as building block to make cluster-assembled materials, such as pearl-chain style nanowires.

  17. Left Ventricular Thrombus as a Complication of Clozapine-Induced Cardiomyopathy: A Case Report and Brief Literature Review.

    PubMed

    Malik, Shahbaz A; Malik, Sarah; Dowsley, Taylor F; Singh, Balwinder

    2015-01-01

    A 48-year-old male with history of schizoaffective disorder on clozapine presented with chest pain, dyspnea, and new left bundle branch block. He underwent coronary angiography, which revealed no atherosclerosis. The patient's workup was unrevealing for a cause for the cardiomyopathy and thus it was thought that clozapine was the offending agent. The patient was taken off clozapine and started on guideline directed heart failure therapy. During the course of hospitalization, he was also discovered to have a left ventricular (LV) thrombus for which he received anticoagulation. To our knowledge, this is the first case report of clozapine-induced cardiomyopathy complicated by a LV thrombus.

  18. Spinal conduction block by intrathecal ketamine in dogs.

    PubMed

    Iida, H; Dohi, S; Tanahashi, T; Watanabe, Y; Takenaka, M

    1997-07-01

    In addition to its use for intravenous (I.V.) anesthesia, ketamine can provide pain relief in humans when administered spinally. To elucidate the mechanisms of intrathecal (I.T.) ketamine analgesia, we observed differences in the effects of I.V. and I.T. ketamine on intraspinal evoked potentials (ISEPs) in 28 dogs anesthetized with pentobarbital. Bipolar extradural electrodes were inserted at the cervical and lumbar regions of the spinal cord for recording descending ISEPs represented by the two negative deflections, Waves I and II. I.V. ketamine 2 and 10 mg/ kg did not affect the amplitude and latency of Wave I, whereas the large dose (10 mg/kg) significantly decreased the amplitude but not the latency of Wave II. I.T. ketamine 1 and 5 mg/kg caused significant dose-dependent decreases in both Wave I and II amplitudes and prolongations of both Wave I and II latencies. These I.T. effects on ISEPs are consistent with previous in vitro observations that ketamine blocks axonal conduction. We conclude that axonal conduction block may contribute to the analgesic mechanism of I.T. ketamine.

  19. Additives to local anesthetics for peripheral nerve blocks: Evidence, limitations, and recommendations.

    PubMed

    Bailard, Neil S; Ortiz, Jaime; Flores, Roland A

    2014-03-01

    The therapeutic rationale, clinical effectiveness, and potential adverse effects of medications used in combination with local anesthetics for peripheral nerve block therapy are reviewed. A wide range of agents have been tested as adjuncts to peripheral nerve blocks, which are commonly performed for regional anesthesia during or after hand or arm surgery, neck or spine surgery, and other procedures. Studies to determine the comparative merits of nerve block adjuncts are complicated by the wide variety of coadministered local anesthetics and sites of administration and by the heterogeneity of primary endpoints. Sodium bicarbonate has been shown to speed the onset of mepivacaine nerve blocks but delay the onset of others. Epinephrine has been shown to prolong sensory nerve blockade and delay systemic uptake of local anesthetics, thus reducing the risk of anesthetic toxicity. Tramadol, buprenorphine, dexamethasone, and clonidine appear to be effective additives in some situations. Midazolam, magnesium, dexmedetomidine, and ketamine cannot be routinely recommended as nerve block additives due to a dearth of supportive data, modest efficacy, and (in the case of ketamine) significant adverse effects. Recent studies suggest that administering additives intravenously or intramuscularly can provide many of the benefits of perineural administration while reducing the potential for neurotoxicity, contamination, and other hazards. Some additives to local anesthetics can hasten the onset of nerve block, prolong block duration, or reduce toxicity. On the other hand, poorly selected or unnecessary additives may not have the desired effect and may even expose patients to unnecessary risks.

  20. Restless legs syndrome and pregnancy or delivery complications in China: a representative survey.

    PubMed

    Liu, Gangqiong; Li, Ling; Zhang, Jinying; Xue, Rui; Zhao, Xiaoyan; Zhu, Kui; Wang, Yunzhe; Xiao, Lili; Shangguan, Jiahong

    2016-01-01

    To perform a detailed epidemiological study of Chinese women and the relationship between restless legs syndrome (RLS) in pregnancy and any associated complications during delivery. A total of 3874 pregnant women (18-40 years) who had delivered babies at The First Affiliated Hospital of Zhengzhou University from May 2011 to May 2014 were enrolled in the study. Using a face-to-face interview questionnaire, data were collected pertaining to RLS incidence in pregnancy and any associated complications during delivery. The relationship between RLS frequency and pregnancy or delivery complications was further investigated. Among 12.3% of the eligible participants, RLS prevalence occurred at least weekly. Older pregnant women were more likely to suffer from RLS. Individuals who experienced RLS at least weekly reported a statistically higher frequency of excessive daytime sleepiness and an increased prevalence of hypertension, cardiovascular disease, and preeclampsia compared with those without RLS. The study revealed that RLS was frequent in Chinese pregnant women, especially in those with pregnancy or delivery complications such as hypertension, cardiovascular disease, and preeclampsia. Restless legs syndrome was also associated with excessive daytime sleepiness. Copyright © 2015 Elsevier B.V. All rights reserved.

  1. Depigmented allergoids reveal new epitopes with capacity to induce IgG blocking antibodies.

    PubMed

    López-Matas, M Angeles; Gallego, Mayte; Iraola, Víctor; Robinson, Douglas; Carnés, Jerónimo

    2013-01-01

    The synthesis of allergen-specific blocking IgGs that interact with IgE after allergen immunotherapy (SIT) has been related to clinical efficacy. The objectives were to investigate the epitope specificity of IgG-antibodies induced by depigmented-polymerized (Dpg-Pol) allergoids and unmodified allergen extracts, and examine IgE-blocking activity of induced IgG-antibodies. Rabbits were immunized with native and Dpg-Pol extracts of birch pollen, and serum samples were obtained. Recognition of linear IgG-epitopes of Bet v 1 and Bet v 2 and the capacity of these IgG-antibodies to block binding of human-IgE was determined. Serum from rabbits immunized with native extracts recognised 11 linear epitopes from Bet v 1, while that from Dpg-Pol-immunized animals recognised 8. For Bet v 2, 8 epitopes were recognized by IgG from native immunized animals, and 9 from Dpg-Pol immunized one. Dpg-Pol and native immunized serum did not always recognise the same epitopes, but specific-IgG from both could block human-IgE binding sites for native extract. Depigmented-polymerized birch extract stimulates the synthesis of specific IgG-antibodies which recognize common but also novel epitopes compared with native extracts. IgG-antibodies induced by Dpg-Pol effectively inhibit human-IgE binding to allergens which may be part of the mechanism of action of SIT.

  2. Heparan sulfate storage in the cardiac conduction system triggers atrioventricular block.

    PubMed

    Kato, Rie; Miyahara, Hiroaki; Kawano, Tatsuya; Matsuzuka, Atsuko; Noda, Kimiko; Izumi, Tatsuro

    2017-05-01

    To elucidate the novel biological functions of heparan sulfate (HS) by clinic-pathologically studying a patient with paroxysmal atrioventricular (AV) block. A long-surviving male patient with Sanfilippo syndrome type A presented with paroxysmal AV block at age 33years. He then survived another 2.5years after the onset of paroxysmal AV block and pacemaker implantation. His cardiac histopathological examination at autopsy showed HS storage in the cardiac conduction system (CCS), especially in the atrioventricular node (AVN)-His bundle branches. HS storage in the CCS might trigger AV block, arising from below the AVN-His bundle branches. This is the first description to indicate that HS might be an essential constituent of life-long CCS plasticity and that its storage in the CCS results in AV block. Copyright © 2017 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  3. A rare stoma-related complication: parastomal evisceration.

    PubMed

    Yucel, Ahmet Fikret; Pergel, Ahmet; Aydin, Ibrahim; Sahin, Dursun Ali

    2014-04-01

    Defunctioning stoma is a commonly used colorectal surgical procedures. The stomal complications recorded are usually classified as early and late complications. Parastomal hernia is a common complication of stomal surgery. We present a very rare stoma-related complication developed after parastomal hernia and described parastomal evisceration.

  4. Prolonged Dyspnea after Interscalene Block: Attributed to Undiagnosed Addison's Disease and Myasthenia Gravis.

    PubMed

    Skedros, John G; Kiser, Casey J; Mendenhall, Shaun D

    2011-01-01

    This report describes a patient who had a series of daily interscalene nerve blocks to treat pain following a shoulder manipulation for postsurgical stiffness. She experienced acute respiratory compromise that persisted for many weeks. All typical and unusual causes of these symptoms were ruled out. Her treating pulmonologist theorized that the ipsilateral carotid body had been injured. However, it was subsequently determined that the constellation of symptoms and their prolonged duration were best explained by a poor stress response from Addison's disease coupled with exacerbation of early onset myasthenia gravis. This patient's case is not a typical reaction to interscalene nerve blocks, and thus preoperative testing would not be recommended for myasthenia gravis or Addison's disease without underlying suspicion. We describe this report to inform physicians to consider a workup for these diagnoses if a typical workup rules out all usual causes of complications from an interscalene block.

  5. Blocking Filters with Enhanced Throughput for X-Ray Microcalorimetry

    NASA Technical Reports Server (NTRS)

    Grove, David; Betcher, Jacob; Hagen, Mark

    2012-01-01

    New and improved blocking filters (see figure) have been developed for microcalorimeters on several mission payloads, made of high-transmission polyimide support mesh, that can replace the nickel mesh used in previous blocking filter flight designs. To realize the resolution and signal sensitivity of today s x-ray microcalorimeters, significant improvements in the blocking filter stack are needed. Using high-transmission polyimide support mesh, it is possible to improve overall throughput on a typical microcalorimeter such as Suzaku s X-ray Spectrometer by 11%, compared to previous flight designs. Using polyimide to replace standard metal mesh means the mesh will be transparent to energies 3 keV and higher. Incorporating polyimide s advantageous strength-to-weight ratio, thermal stability, and transmission characteristics permits thinner filter materials, significantly enhancing through - put. A prototype contamination blocking filter for ASTRO-H has passed QT-level acoustic testing. Resistive traces can also be incorporated to provide decontamination capability to actively restore filter performance in orbit.

  6. Combined adductor canal block with periarticular infiltration versus periarticular infiltration for analgesia after total knee arthroplasty.

    PubMed

    Ma, Jinhui; Gao, Fuqiang; Sun, Wei; Guo, Wanshou; Li, Zirong; Wang, Weiguo

    2016-12-01

    Both adductor canal block (ACB) and periarticular infiltration (PI) have been shown to reduce pain after total knee arthroplasty (TKA) without the motor blockade. However, the efficacy and safety of combined ACB with PI (ACB + PI) as compared to PI alone for analgesia after TKA remains controversial. We therefore performed a meta-analysis to compare the effects of ACB + PI with PI alone on pain controll after TKA. PubMed, Medline, Embase, Web of Science, and the Cochrane Library were searched to identify studies comparing ACB + PI with PI alone for TKA patients. The primary outcomes included pain score with rest or activity and morphine consumption. Secondary outcomes were distance walked, length of hospital stay, and postoperative complications. Relevant data were analyzed using RevMan v5.3. Three studies involving 337 patients were included. Combined ACB with PI was associated with longer distances walked than PI alone (MD = 7.27, 95% CI: 0.43-14.12, P = 0.04) on postoperative day 1. The outcomes of pain, morphine consumption, length of hospital stay, and postoperative complications were not statistically different between the 2 groups (P > 0.05). Our meta-analysis suggests that combined ACB with PI may achieve earlier ambulation for patients after TKA without a reduction in analgesia when compared to PI alone in the early postoperative period. There were no significant differences in morphine consumption, length of hospital stay, and postoperative complications between the 2 groups. However, owing to the variation of included studies, no firm conclusions can be drawn.

  7. Acquired factor V inhibitor in a patient receiving venous-venous extracorporeal membrane oxygenation for Legionella pneumonia.

    PubMed

    Leung, Anne K H; Ng, George W Y; Sin, K C; Au, S Y; Lai, K Y; Lee, K L; Law, K I

    2015-04-01

    We report a rare complication of factor V deficiency in a patient having Legionella pneumonia. This patient also had other complications like severe acute respiratory distress syndrome, acute kidney injury, and septic shock that required venous-venous extracorporeal membrane oxygenation support. This is the first reported case of acquired factor V deficiency in a patient receiving extracorporeal membrane oxygenation for Legionella pneumonia. With the combined use of intravenous immunoglobulin, rituximab and plasma exchange, we achieved rapid clearance of the factor V inhibitor within 1 week so as to allow safe decannulation of extracorporeal membrane oxygenation.

  8. Novel temperature-controlled RFA probe for treatment of blocked metal biliary stents in patients with pancreaticobiliary cancers: initial experience.

    PubMed

    Nayar, Manu K; Oppong, Kofi W; Bekkali, Noor L H; Leeds, John S

    2018-05-01

     Radiofrequency ablation (RFA) is used to treat blocked biliary stents in patients with pancreaticobiliary (PB) tumors with varying results. We report our experience with a novel temperature-controlled probe for treatment of blocked metal stents.  Patients with histologically proven PB cancers and a blocked biliary stents were treated using ELRATM electrode (Taewoong Medical) under fluoroscopic guidance. Demographics, clinical outcome, stricture diameter improvements, complications and mortality at 30 days were prospectively recorded.  Nine procedures were performed on seven patients (4 male, 3 female); mean age 65.33 (range 56 - 82 years). Mean stricture diameter prior to RFA was 1.13 mm (SD ± 0.54) and 4.42 mm (SD ± 1.54) following RFA ( P  < 0.0001). Five of seven patients (71 %) required additional stents to ensure optimal drainage. There were no procedure-related complications. Mean follow-up was 193.55 days (range 31 - 540) and three of nine patients (33 %) died due to terminal cancer. These are the first reported data on use of a temperature-controlled RFA catheter in humans to treat blocked metal biliary stents. The device is safe but further randomized trials are required to establish the efficacy and survival benefits of this probe.

  9. Fire Protection Specialist, Blocks IV and V, 17-3. Military Curriculum Materials for Vocational and Technical Education.

    ERIC Educational Resources Information Center

    Ohio State Univ., Columbus. National Center for Research in Vocational Education.

    This military-developed text contains the fourth and fifth blocks of a five-block course for use in training fire protection specialists. Covered in the individual volumes are the following topics: structural firefighting (operation and maintenance of hydrants, emergency response activities, structural pumpers, vehicle positioning and relay, hose…

  10. Calcium Channel Block by Cadmium in Chicken Sensory Neurons

    NASA Astrophysics Data System (ADS)

    Swandulla, D.; Armstrong, C. M.

    1989-03-01

    Cadmium block of calcium channels was studied in chicken dorsal root ganglion cells by a whole-cell patch clamp that provides high time resolution. Barium ion was the current carrier, and the channel type studied had a high threshold of activation and fast deactivation (type FD). Block of these channels by 20 μ M external Cd2+ is voltage dependent. Cd2+ ions can be cleared from blocked channels by stepping the membrane voltage (Vm) to a negative value. Clearing the channels is progressively faster and more complete as Vm is made more negative. Once cleared of Cd2+, the channels conduct transiently on reopening but reequilibrate with Cd2+ and become blocked within a few milliseconds. Cd2+ equilibrates much more slowly with closed channels, but at a holding potential of -80 mV virtually all channels are blocked at equilibrium. Cd2+ does not slow closing of the channels, as would be expected if it were necessary for Cd2+ to leave the channels before closing occurred. Instead, the data show unambiguously that the channel gate can close when the channel is Cd2+ occupied.

  11. Definition of Two Angiogenic Pathways by Distinct α_v Integrins

    NASA Astrophysics Data System (ADS)

    Friedlander, Martin; Brooks, Peter C.; Shaffer, Robert W.; Kincaid, Christine M.; Varner, Judith A.; Cheresh, David A.

    1995-12-01

    Angiogenesis depends on cytokines and vascular cell adhesion events. Two cytokine-dependent pathways of angiogenesis were shown to exist and were defined by their dependency on distinct vascular cell integrins. In vivo angiogenesis in corneal or chorioallantoic membrane models induced by basic fibroblast growth factor or by tumor necrosis factor-α depended on α_vβ_3, whereas angiogenesis initiated by vascular endothelial growth factor, transforming growth factor-α, or phorbol ester depended on α_vβ_5. Antibody to each integrin selectively blocked one of these pathways, and a cyclic peptide antagonist of both integrins blocked angiogenesis stimulated by each cytokine tested. These pathways are further distinguished by their sensitivity to calphostin C, an inhibitor of protein kinase C that blocked angiogenesis potentiated by α_vβ_5 but not by α_vβ_3.

  12. Epiretinal membrane negative staining and double peeling in a single block with Brilliant Blue G.

    PubMed

    Martins, David; Neves, Pedro

    2018-01-01

    To describe a surgical technique for combined peeling of epiretinal and internal limiting membranes. The authors present their procedure of choice for epiretinal membrane surgery: negative staining effect using Brilliant Blue G and single block removal of the epiretinal and internal limiting membranes in a single step. A total of 26 eyes were operated with the described technique. In all cases, the peeling was performed successfully and with no complications. Minimum postoperative follow-up was 12 months. There were no recurrences of epiretinal membranes. The ideal surgical approach for epiretinal membranes should attempt to reduce mechanical trauma, light exposure, and dye toxicity.

  13. Ultrasound-guided stellate ganglion blocks combined with pharmacological and occupational therapy in Complex Regional Pain Syndrome (CRPS): a pilot case series ad interim.

    PubMed

    Wei, Karin; Feldmann, Robert E; Brascher, Anne-Kathrin; Benrath, Justus

    2014-12-01

    This preliminary and retrospective pilot case series examines a treatment concept consisting of ultrasound-guided stellate ganglion blocks (SGBs) combined with pharmacological and occupational therapy in patients with complex regional pain syndrome (CRPS) of the hand. Efficacy of combined treatment concepts and safety of ultrasound-guided SGB have not been sufficiently investigated yet. A total number of 156 blocks were evaluated in 16 patients with CRPS in a retrospective analysis. All patients received pharmacotherapy and a standard regimen of occupational therapy offered simultaneously to the SGBs. Changes in both spontaneous and evoked pain levels were assessed by numerical pain rating score before and after the last blockade of a series. Side effects were documented. The overall mean pain reduction was 63.2% regarding spontaneous and 45.3% regarding evoked pain. Mild complications, such as hoarseness or dysphagia, occurred in 13.5% of the blocks (21 SGBs). Serious complications, such as plexus paresis or accidental puncture of vessels or other structures, did not occur. Time between symptom onset and start of treatment did not affect the extent of pain reduction. The combination of ultrasound-guided SGB and simultaneous pharmacological and occupational therapy showed encouraging treatment results under conditions of this pilot case series. Assessment of efficacy of this combined treatment concept and safety of ultrasound-guided SGB require further prospective clinical studies with larger number of participants. Wiley Periodicals, Inc.

  14. Possible mechanism of polyspermy block in human oocytes observed by time-lapse cinematography.

    PubMed

    Mio, Yasuyuki; Iwata, Kyoko; Yumoto, Keitaro; Kai, Yoshiteru; Sargant, Haruka C; Mizoguchi, Chizuru; Ueda, Minako; Tsuchie, Yuka; Imajo, Akifumi; Iba, Yumiko; Nishikori, Kyoko

    2012-09-01

    To analyze the fertilization process related to polyspermy block in human oocytes using an in vitro culturing system for time-lapse cinematography. We had 122 oocytes donated for this study from couples that provided informed consent. We recorded human oocytes at 2,000 to 2,800 frames every 10 s during the fertilization process and thereafter every 2 min using a new in vitro culture system originally developed by the authors for time-lapse cinematography. We displayed 30 frames per second for analysis of the polyspermy block during fertilization. Three oocytes showed the leading and following sperm within the zona pellucida in the same microscopic field. The dynamic images obtained during the fertilization process using this new system revealed that once a leading sperm penetrated the zona pellucida and attached to the oocyte membrane, a following sperm was arrested from further penetration into the zona pellucida within 10 s. The present results strongly suggest the existence of a novel mechanism of polyspermy block that takes place at the zona pellucida immediately after fertilization. These findings are clearly different from previous mechanisms describing polyspermy block as the oocyte membrane block to sperm penetration and the zona reaction. The finding presented herein thus represents a novel discovery about the highly complicated polyspermy block mechanism occurring in human oocytes.

  15. TPA induces a block of differentiation and increases the susceptibility to neoplastic transformation of a rat thyroid epithelial cell line.

    PubMed

    Portella, G; Vitagliano, D; Li, Z; Sferratore, F; Santoro, M; Vecchio, G; Fusco, A

    1998-01-01

    The PC Cl 3 cell line is a well-characterized epithelial cell line of rat thyroid origin. This cell line retains in vitro the typical markers of thyroid differentiation: thyroglobulin (TG) synthesis and secretion, iodide uptake, thyroperoxidase (TPO) expression, and dependency on TSH for growth. Although the differentiated phenotype of thyroid cells has been relatively well described, the molecular mechanisms that regulate both differentiation and neoplastic transformation of thyroid cells still need to be investigated in detail. Protein kinase C (PKC), the target of tetradecanoylphorbol acetate (TPA), regulates growth and differentiation of several cell types. Here we show that treatment of PC Cl 3 cells with TPA induces an acute block of thyroid differentiation. TPA-treated PC Cl 3 cells are unable to trap iodide and the expression levels of thyroglobulin, TSH receptor, and TPO genes are drastically reduced by TPA treatment. This differentiation block is not caused by a reduced expression of one of the master genes of thyroid differentiation, the thyroid transcription factor 1 (TTF-1). TPA-treated PC Cl 3 cells display an increased growth rate indicating that, in addition to the differentiation block, TPA also significantly affects the growth regulation of thyroid cells. Finally, TPA treatment dramatically increases the number of transformation foci induced in PC Cl 3 cells by retroviruses carrying v-Ki-ras, v-Ha-ras, and v-mos oncogenes. These findings support the notion that the PKC pathway can influence proliferation, differentiation, and neoplastic transformation of thyroid cells in culture.

  16. The modified Puestow procedure for complicated hereditary pancreatitis in children.

    PubMed

    DuBay, D; Sandler, A; Kimura, K; Bishop, W; Eimen, M; Soper, R

    2000-02-01

    The aim of this study was to evaluate the role of longitudinal pancreaticojejunostomy (modified Puestow procedure) in the treatment of complicated hereditary pancreatitis (HP) in children. The authors reviewed their experience with the modified Puestow procedure for complicated HP in patients less than 18 years of age at a single tertiary care facility between 1973 and 1998. Main study outcomes included surgical morbidity and mortality, pre- and postoperative pancreatic function, number of hospitalizations, and percentile ideal body weight (IBW). Twelve patients (6 boys and 6 girls) with a mean age of 9.3 years were identified. Presenting diagnoses were abdominal pain (n = 10), failure to thrive (n = 4), pancreatic pleural effusion (n = 2), and pancreatic ascites (n = 1). Blood loss was greater in patients who underwent distal pancreatectomy to localize the duct (n = 6) than in those who underwent direct transpancreatic duct localization (n = 6; 29.1+/-6.8 v. 8.3+/-3.7 mL/kg; P = .03). Other complications in patients who underwent distal pancreatectomy included splenic devascularization requiring splenectomy (n = 1) and postoperative intraabdominal bleeding with subsequent left subphrenic abscess (n = 1). There was no surgical mortality. Five patients had steatorrhea preoperatively that resolved in 4 patients postoperatively and was well controlled in the fifth. Mean number of hospitalizations for pancreatitis in the 5 years after surgery were markedly less than in the 5 years preceding surgery (0.4+/-0.2 v. 3.5+/-0.5; P = .01, n = 9). Percentile ideal body weight tended to increase within the first postoperative year (24.6+/-6.8 v. 45.0+/-8.3; P = .07, n = 9), and by the third year this trend was clearly significant (27.0+/-7.2 v. 60.9+/-9.5; P = .01, n = 8). In children with complicated HP, the modified Puestow procedure improves the quality of life by improving pancreatic function, decreasing hospitalizations, and increasing the percentile ideal body weight

  17. Preoperative paravertebral blocks for the management of acute pain following mastectomy: a cost-effectiveness analysis.

    PubMed

    Offodile, Anaeze C; Sheckter, Clifford C; Tucker, Austin; Watzker, Anna; Ottino, Kevin; Zammert, Martin; Padula, William V

    2017-10-01

    Preoperative paravertebral blocks (PPVBs) are routinely used for treating post-mastectomy pain, yet uncertainties remain about the cost-effectiveness of this modality. We aim to evaluate the cost-effectiveness of PPVBs at common willingness-to-pay (WTP) thresholds. A decision analytic model compared two strategies: general anesthesia (GA) alone versus GA with multilevel PPVB. For the GA plus PPVB limb, patients were subjected to successful block placement versus varying severity of complications based on literature-derived probabilities. The need for rescue pain medication was the terminal node for all postoperative scenarios. Patient-reported pain scores sourced from published meta-analyses measured treatment effectiveness. Costing was derived from wholesale acquisition costs, the Medicare fee schedule, and publicly available hospital charge masters. Charges were converted to costs and adjusted for 2016 US dollars. A commercial payer perspective was adopted. Incremental cost-effectiveness ratios (ICERs) were evaluated against WTP thresholds of $500 and $50,000 for postoperative pain control. The ICER for preoperative paravertebral blocks was $154.49 per point reduction in pain score. 15% variation in inpatient costs resulted in ICER values ranging from $124.40-$180.66 per pain point score reduction. Altering the probability of block success by 5% generated ICER values of $144.71-$163.81 per pain score reduction. Probabilistic sensitivity analysis yielded cost-effective trials 69.43% of the time at $500 WTP thresholds. Over a broad range of probabilities, PPVB in mastectomy reduces postoperative pain at an acceptable incremental cost compared to GA. Commercial payers should be persuaded to reimburse this technique based on convincing evidence of cost-effectiveness.

  18. NIFLUMIC ACID BLOCKS NATIVE AND RECOMBINANT T-TYPE CHANNELS

    PubMed Central

    Balderas, E; Arteaga-Tlecuitl, R; Rivera, M; Gomora, JC; Darszon, A

    2012-01-01

    Voltage-dependent calcium channels are widely distributed in animal cells, including spermatozoa. Calcium is fundamental in many sperm functions such as: motility, capacitation and the acrosome reaction, all essential for fertilization. Pharmacological evidence has suggested T-type calcium channels participate in the acrosome reaction. Niflumic acid (NA), a non-steroidal anti-inflammatory drug commonly used as chloride channel blocker, blocks T-currents in mouse spermatogenic cells and Cl− channels in testicular sperm. Here we examine the mechanism of NA blockade and explore if it can be used to separate the contribution of different CaV3 members previously detected in these cells. Electrophysiological patch-clamp recordings were performed in isolated mouse spermatogenic cells and in HEK cells heterologously expressing CaV3 channels. NA blocks mouse spermatogenic cell T-type currents with an IC50 of 73.5 µM, without major voltage-dependent effects. The NA blockade is more potent in the open and in the inactivated state than in the closed state of the T-type channels. Interestingly, we found that heterologously expressed CaV3.1 and CaV3.3 channels were more sensitive to NA than CaV3.2 channels, and this drug substantially slowed the recovery from inactivation of the three isoforms. Molecular docking modeling of drug-channel binding predicts that NA binds preferentially to the extracellular face of CaV3.1 channels. The biophysical characteristics of mouse spermatogenic cell T-type currents more closely resemble those from heterologously expressed CaV3.1 channels, including their sensitivity to NA. As CaV3.1 null mice maintain their spermatogenic cell T-currents, it is likely that a novel CaV3.2 isoform is responsible for them. PMID:21898399

  19. Effects of applying nerve blocks to prevent postherpetic neuralgia in patients with acute herpes zoster: a systematic review and meta-analysis

    PubMed Central

    Kim, Hyun Jung; Ahn, Hyeong Sik; Lee, Jae Young; Choi, Seong Soo; Cheong, Yu Seon; Kwon, Koo; Yoon, Syn Hae

    2017-01-01

    Background Postherpetic neuralgia (PHN) is a common and painful complication of acute herpes zoster. In some cases, it is refractory to medical treatment. Preventing its occurrence is an important issue. We hypothesized that applying nerve blocks during the acute phase of herpes zoster could reduce PHN incidence by attenuating central sensitization and minimizing nerve damage and the anti-inflammatory effects of local anesthetics and steroids. Methods This systematic review and meta-analysis evaluates the efficacy of using nerve blocks to prevent PHN. We searched the MEDLINE, EMBASE, Cochrane Library, ClinicalTrials.gov and KoreaMed databases without language restrictions on April, 30 2014. We included all randomized controlled trials performed within 3 weeks after the onset of herpes zoster in order to compare nerve blocks vs active placebo and standard therapy. Results Nine trials were included in this systematic review and meta-analysis. Nerve blocks reduced the duration of herpes zoster-related pain and PHN incidence of at 3, 6, and 12 months after final intervention. Stellate ganglion block and single epidural injection did not achieve positive outcomes, but administering paravertebral blockage and continuous/repeated epidural blocks reduced PHN incidence at 3 months. None of the included trials reported clinically meaningful serious adverse events. Conclusions Applying nerve blocks during the acute phase of the herpes zoster shortens the duration of zoster-related pain, and somatic blocks (including paravertebral and repeated/continuous epidural blocks) are recommended to prevent PHN. In future studies, consensus-based PHN definitions, clinical cutoff points that define successful treatment outcomes and standardized outcome-assessment tools will be needed. PMID:28119767

  20. High-Performance Polymer Solar Cell with Single Active Material of Fully Conjugated Block Copolymer Composed of Wide-Band gap Donor and Narrow-Band gap Acceptor Blocks.

    PubMed

    Lee, Ji Hyung; Park, Chang Geun; Kim, Aesun; Kim, Hyung Jong; Kim, Youngseo; Park, Sungnam; Cho, Min Ju; Choi, Dong Hoon

    2018-06-06

    We synthesized a novel fully conjugated block copolymer, P3, in which a wide-band gap donor block (P1) was connected to a narrow-band gap acceptor block (P2). As P3 contains P1 block with a wide bandgap and P2 block with a narrow bandgap, it exhibits a very wide complementary absorption. Transient photoluminescence measurement using P3 dilute solution demonstrated intramolecular charge transfer between the P1 block and the P2 block, which was not observed in a P1/P2 blend solution. A P3 thin film showed complete PL quenching because the photoinduced inter-/intramolecular charge transfer states were effectively formed. This phenomenon can play an important role in the photovoltaic properties of P3-based polymer solar cells. A single active material polymer solar cell (SAMPSC) fabricated from P3 alone exhibited a high power conversion efficiency (PCE) of 3.87% with a high open-circuit voltage of 0.93 V and a short-circuit current of 8.26 mA/cm 2 , demonstrating a much better performance than a binary P1-/P2-based polymer solar cell (PCE = 1.14%). This result facilitates the possible improvement of the photovoltaic performance of SAMPSCs by inducing favorable nanophase segregation between p- and n blocks. In addition, owing to the high morphological stability of the block copolymer, excellent shelf-life was observed in a P3-based SAMPSC compared with a P1/P2-based PSC.

  1. Rich Variety of Three-Dimensional Nanostructures Enabled by Geometrically Constraining Star-like Block Copolymers.

    PubMed

    Wang, Chao; Xu, Yuci; Li, Weihua; Lin, Zhiqun

    2016-08-09

    The influence of star-like architecture on phase behavior of star-like block copolymer under cylindrical confinement differs largely from the bulk (i.e., nonconfinement). A set of intriguing self-assembled morphologies and the corresponding phase diagrams of star-like (AB)f diblock copolymers with different numbers of arms f (i.e., f = 3, 9, 15, and 21) in four scenarios (ϕA = 0.3 and V0 > 0; ϕA = 0.3 and V0 < 0; ϕA = 0.7 and V0 > 0; and ϕA = 0.7 and V0 < 0 (where ϕA is the volume fraction of A block) and V0 < 0 and V0 > 0 represent that the pore wall of cylindrical confinement prefers the inner A block (i.e., A-preferential) and B block (i.e., B-preferential), respectively) were for the first time scrutinized by employing the pseudospectral method of self-consistent mean-field theory. Surprisingly, a new nanoscopic phase, that is, perforated-lamellae-on-cylinder (denoted PC), was observed in star-like (AB)3 diblock copolymer at ϕA = 0.3 and V0 > 0. With a further increase in f, a single lamellae (denoted L1) was found to possess a larger phase region. Under the confinement of A-preferential wall (i.e., V0 < 0) at ϕA = 0.3, PC phase became metastable and its free energy increased as f increased. Quite intriguingly, when ϕA = 0.7 and V0 > 0, where an inverted cylinder was formed in bulk, the PC phase became stable, and its free energy decreased as f increased, suggesting the propensity to form PC phase under this condition. Moreover, in stark contrast to the phase transition of C1 → L1 → PC (C1, a single cylindrical microdmain) at ϕA = 0.3 and V0 > 0, when subjected to the A-preferential wall (ϕA = 0.7), a different phase transition sequence (i.e., C1 → PC → L1) was identified due to the formation of a double-layer structure. On the basis of our calculations, the influence of star-like architecture on (AB)f diblock copolymer under the imposed cylindrical confinement, particularly the shift of the phase boundaries as a function of f, was thoroughly

  2. [Conduction block: a notion to let through].

    PubMed

    Fournier, E

    2012-12-01

    Historical study of electrodiagnosis indicates that nerve conduction block is an old notion, used as early as the second century by Galien and then early in the 19th by physiologists such as Müller and Mateucci. Although introduced into the field of human pathology by Mitchell in 1872, who used it to study nerve injuries, and then by Erb in 1874 to study radial palsy, the contribution of nerve conduction blocks to electrodiagnosis was not exploited until the 1980s. At that time, attempts to improve early diagnosis of Guillain-Barré syndrome showed that among the electrophysiological consequences of demyelination, conduction block was the most appropriate to account for the paralysis. At the same time, descriptions of neuropathies characterized by conduction blocks led to considering conduction block as a major electrophysiological sign. Why was it so difficult for this sign to be retained for electrodiagnosis? Since the notion is not always associated with anatomical lesions, it doesn't fit easily into anatomoclinical reasoning, but has to be thought of in functional terms. Understanding how an uninjured axon could fail to conduct action potentials leads to an examination of the intimate consequences of demyelinations and axonal dysfunctions. But some of the difficulty encountered in adding this new old sign to the armamentarium of electrophysiological diagnosis was related to the technical precautions required to individualize a block. Several pitfalls have to be avoided if a conduction block is to be afforded real diagnostic value. Similar precautions and discussions are also needed to establish an opposing sign, the "excitability block" or "inverse block". Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  3. Cellient™ automated cell block versus traditional cell block preparation: a comparison of morphologic features and immunohistochemical staining.

    PubMed

    Wagner, David G; Russell, Donna K; Benson, Jenna M; Schneider, Ashley E; Hoda, Rana S; Bonfiglio, Thomas A

    2011-10-01

    Traditional cell block (TCB) sections serve as an important diagnostic adjunct to cytologic smears but are also used today as a reliable preparation for immunohistochemical (IHC) studies. There are many ways to prepare a cell block and the methods continue to be revised. In this study, we compare the TCB with the Cellient™ automated cell block system. Thirty-five cell blocks were obtained from 16 benign and 19 malignant nongynecologic cytology specimens at a large university teaching hospital and prepared according to TCB and Cellient protocols. Cell block sections from both methods were compared for possible differences in various morphologic features and immunohistochemical staining patterns. In the 16 benign cases, no significant morphologic differences were found between the TCB and Cellient cell block sections. For the 19 malignant cases, some noticeable differences in the nuclear chromatin and cellularity were identified, although statistical significance was not attained. Immunohistochemical or special stains were performed on 89% of the malignant cases (17/19). Inadequate cellularity precluded full evaluation in 23% of Cellient cell block IHC preparations (4/17). Of the malignant cases with adequate cellularity (13/17), the immunohistochemical staining patterns from the different methods were identical in 53% of cases. The traditional and Cellient cell block sections showed similar morphologic and immunohistochemical staining patterns. The only significant difference between the two methods concerned the lower overall cell block cellularity identified during immunohistochemical staining in the Cellient cell block sections. Copyright © 2010 Wiley-Liss, Inc.

  4. Intrahepatic bilioenteric anastomosis after biliary complications of liver transplantation: operative rescue of surgical failures.

    PubMed

    Mercado, Miguel Angel; Vilatobá, Mario; Chan, Carlos; Domínguez, Ismael; Leal, Rafael Paulino; Olivera, Marco Antonio

    2009-03-01

    Biliary complications after orthotopic liver transplantation (OLT) are multifactorial in origin. In most series, the frequency of such complications ranges from 5-20%. Most can be treated by endoscopy and/or interventional radiology. For cases in which this option is not successful, surgical approach is indicated. We report the results of reoperation using an intrahepatic bilioenteric anastomosis. The medical charts of patients with biliary complications after OLT during a 10-year period (1997-2007), who failed to respond to nonsurgical treatment and were surgically treated, were reviewed. Roux-en-Y hepatojejunostomy was performed. Segments IV and V were partially removed after cutting the hilar plate, thus obtaining healthy ducts without ischemic or inflammatory reaction and allowing a wide hepatojejunostomy. Five cases (8.4%) with biliary complications after duct-to-duct anastomosis not amenable to further endoscopic management or interventional radiology were identified. Hepaticojejunostomy was achieved in all cases (wide, tension-free, nonischemic, fine hydrolyzable sutures), and segments IV and V were partially removed. No cholangitis, jaundice, and liver function test abnormalities were present in the postoperative. Mean follow-up was 24 months. Only one patient died of causes not related to bile duct reconstruction during follow-up. Intrahepatic hepatojejunostomy with partial resection of segments IV and V offers an excellent therapeutic alternative for biliary complications that require a surgical approach after OLT.

  5. Ultrasound-guided bilateral greater occipital nerve block for the treatment of post-dural puncture headache

    PubMed Central

    Akyol, Fethi; Binici, Orhan; Kuyrukluyildiz, Ufuk; Karabakan, Guldane

    2015-01-01

    Background and Objective: Post-dural puncture headache (PDPH) is one of the complications frequently observed after spinal or epidural anesthesia with dural penetration. For PDPH patients who do not respond to conservative medical treatment, alternative treatments such as bilateral occipital nerve block should be considered.In this study the efficacy of bilateral occipital nerve block was retrospectively evaluated in patients with post-dural puncture headache. Methods: Ultrasound-guided bilateral occipital nerve block was administrated in 21 patients who developed PDPH after spinal anesthesia, but did not respond to conservative medical treatment within 48 hours between January 2012 and February 2014. The study was conducted at Erzincan University Faculty of Medicine Gazi Mengucek Education and Research Hospital Results: Mean Visual Analog Scale (VAS) pain scores at 10 minutes and 6, 10, 15 and 24 hours after the block were significantly improved compared to the patients with a pre-block VAS score between 4 and 6 as well as patients with a pre-block VAS score between 7 and 9 (p<0.01). After 24 hours of the block applied, VAS pain score dropped to 1 for all 12 patients who had a pre-block VAS score between 4 and 6. Whereas, VAS score decreased to 2 at 24 hours after the block in only one of the patients with a pre-block VAS between 7 and 9. For the patients with a pre-block VAS score between 7 and 9, there was no significant improvement in the mean VAS score 24 hours after the block. Conclusions: For patients with PDPH and a pre-block VAS score between 4 and 6 who do not respond to conservative medical treatment, an ultrasound-guided bilateral occipital nerve block may be effective. PMID:25878625

  6. Comparative study of CAVET with dielectric and p-GaN gate and Mg ion-implanted current blocking layer

    NASA Astrophysics Data System (ADS)

    Mandal, Saptarshi; Agarwal, Anchal; Ahmadi, Elaheh; Mahadeva Bhat, K.; Laurent, Matthew A.; Keller, Stacia; Chowdhury, Srabanti

    2017-08-01

    In this work, a study of two different types of current aperture vertical electron transistor (CAVET) with ion-implanted blocking layer are presented. The device fabrication and performance limitation of a CAVET with a dielectric gate is discussed, and the breakdown limiting structure is evaluated using on-wafer test structures. The gate dielectric limited the device breakdown to 50V, while the blocking layer was able to withstand over 400V. To improve the device performance, an alternative CAVET structure with a p-GaN gate instead of dielectric is designed and realized. The pGaN gated CAVET structure increased the breakdown voltage to over 400V. Measurement of test structures on the wafer showed the breakdown was limited by the blocking layer instead of the gate p-n junction.

  7. How to push a block along a wall

    NASA Technical Reports Server (NTRS)

    Mason, Matthew T.

    1989-01-01

    Some robot tasks require manipulation of objects that may be touching other fixed objects. The effects of friction and kinematic constraint must be anticipated, and may even be exploited to accomplish the task. An example task, a dynamic analysis, and appropriate effector motions are presented. The goal is to move a rectangular block along a wall, so that one side of the block maintains contact with the wall. Two solutions that push the block along the wall are discussed.

  8. Depigmented Allergoids Reveal New Epitopes with Capacity to Induce IgG Blocking Antibodies

    PubMed Central

    López-Matas, M. Angeles; Gallego, Mayte; Iraola, Víctor; Robinson, Douglas; Carnés, Jerónimo

    2013-01-01

    Background. The synthesis of allergen-specific blocking IgGs that interact with IgE after allergen immunotherapy (SIT) has been related to clinical efficacy. The objectives were to investigate the epitope specificity of IgG-antibodies induced by depigmented-polymerized (Dpg-Pol) allergoids and unmodified allergen extracts, and examine IgE-blocking activity of induced IgG-antibodies. Methods. Rabbits were immunized with native and Dpg-Pol extracts of birch pollen, and serum samples were obtained. Recognition of linear IgG-epitopes of Bet v 1 and Bet v 2 and the capacity of these IgG-antibodies to block binding of human-IgE was determined. Results. Serum from rabbits immunized with native extracts recognised 11 linear epitopes from Bet v 1, while that from Dpg-Pol-immunized animals recognised 8. For Bet v 2, 8 epitopes were recognized by IgG from native immunized animals, and 9 from Dpg-Pol immunized one. Dpg-Pol and native immunized serum did not always recognise the same epitopes, but specific-IgG from both could block human-IgE binding sites for native extract. Conclusions. Depigmented-polymerized birch extract stimulates the synthesis of specific IgG-antibodies which recognize common but also novel epitopes compared with native extracts. IgG-antibodies induced by Dpg-Pol effectively inhibit human-IgE binding to allergens which may be part of the mechanism of action of SIT. PMID:24222901

  9. Transforming common III-V/II-VI insulating building blocks into topological heterostructure via the intrinsic electric polarization

    NASA Astrophysics Data System (ADS)

    Zunger, Alex; Zhang, Xiuwen; Abdalla, Leonardo; Liu, Qihang

    Currently known topological insulators (TIs) are limited to narrow gap compounds incorporating heavy elements, thus severely limiting the material pool available for such applications. We show how a heterovalent superlattice made of common semiconductor building blocks can transform its non-TI components into a topological heterostructure. The heterovalent nature of such interfaces sets up, in the absence of interfacial atomic exchange, a natural internal electric field that along with the quantum confinement leads to band inversion, transforming these semiconductors into a topological phase while also forming a giant Rashba spin splitting. We demonstrate this paradigm of designing TIs from ordinary semiconductors via first-principle calculations on III-V/II-VI superlattice InSb/CdTe. We illustrate the relationship between the interfacial stability and the topological transition, finding a ``window of opportunity'' where both conditions can be optimized. This work illustrates the general principles of co-evaluation of TI functionality with thermodynamic stability as a route of identifying realistic combination of common insulators that could produce topological heterostructures. This work was supported by Basic Energy Science, MSE division (Grant DE-FG02-13ER46959).

  10. Prospective study of device-related complications in intensive care unit detected by virtual autopsy.

    PubMed

    Wichmann, D; Heinemann, A; Zähler, S; Vogel, H; Höpker, W; Püschel, K; Kluge, S

    2018-06-01

    There has been increasing use of invasive techniques, such as extracorporeal organ support, in intensive care units (ICU), and declining autopsy rates. Thus, new measures are needed to maintain high-quality standards. We investigated the potential of computed tomography (CT)-based virtual autopsy to substitute for medical autopsy in this setting. We investigated the potential of virtual autopsy by post-mortem CT to identify complications associated with medical devices in a prospective study of patients who had died in the ICU. Clinical records were reviewed to determine the number and types of medical devices used, and findings from medical and virtual autopsies, related and unrelated to the medical devices, were compared. Medical and virtual autopsies could be performed in 61 patients (Group M/V), and virtual autopsy only in 101 patients (Group V). In Group M/V, 41 device-related complications and 30 device malpositions were identified, but only with a low inter-method agreement. Major findings unrelated to a device were identified in about 25% of patients with a high level of agreement between methods. In Group V, 8 device complications and 36 device malpositions were identified. Device-related complications are frequent in ICU patients. Virtual and medical autopsies showed clear differences in the detection of complications and device malpositions. Both methods should supplement each other rather than one alone for quality control of medical devices in the ICU. Further studies should focus on the identification of special patient populations in which virtual autopsy might be of particular benefit. NCT01541982. Copyright © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.

  11. [Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review].

    PubMed

    López Marcano, Aylhin Joana; Ramia, José Manuel; De la Plaza Llamas, Roberto; Alonso, Soledad; Gonzales Aguilar, Johnny David; Kühnhardt Barrantes, Andree Wolfgang

    2017-01-01

    To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015. We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT. In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice.

  12. Effectiveness of Stellate Ganglion Block Under Fuoroscopy or Ultrasound Guidance in Upper Extremity CRPS.

    PubMed

    Imani, Farnad; Hemati, Karim; Rahimzadeh, Poupak; Kazemi, Mohamad Reza; Hejazian, Kokab

    2016-01-01

    Stellate Ganglion Block (SGB) is an effective technique which may be used to manage upper extremities pain due to Chronic Regional Pain Syndrome (CRPS), in this study we tried to evaluate the effectiveness of this procedure under two different guidance for management of this syndrome. The purpose of this study was to evaluate the effectiveness of ultrsound guide SGB by comparing it with the furoscopy guided SGB in upper extermities CRPS patients in reducing pain & dysfuction of the affected link. Fourteen patients with sympathetic CRPS in upper extremities in a randomized method with block randomization divided in two equal groups (with ultrasound or fluoroscopic guidance). First group was blocked under fluoroscopic guidance and second group blocked under ultrasound guidance. After correct positioning of the needle, a mixture of 5 ml bupivacaine 0.25% and 1 mL of triamcinolone was injected. These data represent no meaningful statistical difference between the two groups in terms of the number of pain attacks before the blocks, a borderline correlation between two groups one week and one month after the block and a significant statistical correlation between two groups three month after the block. These data represent no meaningful statistical difference between the patients of any group in terms of the pain intensity (from one week to six months after block), p-value = 0.61. These data represent a meaningful statistical difference among patients of any group and between the two groups in terms of the pain intensity (before the block until six months after block), p-values were 0.001, 0.031 respectively. According the above mentioned data, in comparison with fluoroscopic guidance, stellate ganglion block under ultrasound guidance is a safe and effective method with lower complication and better improvement in patient's disability indexes.

  13. Managing Complications in Abdominoplasty: A Literature Review

    PubMed Central

    Vidal, Pedro; Berner, Juan Enrique; Will, Patrick A.

    2017-01-01

    Background Abdominoplasty, with or without liposuction, is among the most frequently performed aesthetic procedures. Its main objective is to improve the body contour by means of excising redundant skin and fat tissue. Although abdominoplasty is considered a safe procedure with high satisfaction rates, intraoperative and postoperative complications can become a challenge for the surgical team. The aim of this article is to offer a synopsis of the most common complications arising after abdominoplasty, along with evidence-based guidelines about how to prevent and treat them. Methods A systematic MEDLINE search strategy was designed using appropriate Medical Subject Headings (MeSH) terms, and references were scanned for further relevant articles. Results According to the published case series, local complications are considerably more common than complications with systemic repercussions. Approximately 10% to 20% of patients suffer a local complication following abdominoplasty, while fewer than 1% suffer a systemic complication. Prevention and management strategies are critically discussed for complications including seroma, haematoma, infection, skin necrosis, suture extrusions, hypertrophic scars, neurological symptoms, umbilical anomalies, deep venous thrombosis and pulmonary thromboembolism, respiratory distress, and death. Conclusions The complications of abdominoplasty vary in severity and in the impact they have on the aesthetic outcomes. Recommendations for prevention and management are based on various levels of evidence, with a risk of observer bias. However, most complications can be treated appropriately following the current standards, with satisfactory results. PMID:28946731

  14. Epiglottitis and necrotizing fasciitis: a life-threatening complication of infectious mononucleosis.

    PubMed

    Caballero, Miguel; Sabater, Francisco; Traserra, Jose; Alòs, Llucia; Bernal-Sprekelsen, Manuel

    2005-10-01

    Life-threatening cervical complications associated with infectious mononucleosis are rare. The combination of acute epiglottitis and subsequent necrotizing fasciitis of the head and neck in a patient with infectious mononucleosis has not been reported to date.A 47-year-old female with infectious mononucleosis and epiglottitis was admitted to hospital for i.v. therapy. Owing to her poor clinical condition and the spread of the infection to the throat and superior mediastinum, as evidenced by CT, a cervical debridement was performed. After cervical debridement, histological findings were consistent with necrotizing fasciitis. The bacteria identified were Streptococcus viridans, Veilonella spp. and Capnocytophaga spp. The patient was hospitalized for 33 days.Mononucleosis, usually a benign condition, may be associated with life-threatening septic complications in the neck and chest. Serial CT or MRI scans are necessary to assess the development of the infection in the deep layers of the neck. Rapid medical treatment, extensive surgical debridement and intensive care are vital.

  15. Surgical peripheral iridectomy via a clear-cornea phacoemulsification incision for pupillary block following cataract surgery in acute angle closure.

    PubMed

    Fang, Aiwu; Wang, Peijuan; He, Rui; Qu, Jia

    2018-05-18

    To describe a technique of surgical peripheral iridectomy via a clear-cornea tunnel incision to prevent or treat pupillary block following phacoemulsification. Description of technique and retrospective description results in 20 eyes of 20 patients with acute angle closure with coexisting visually significant cataract undergoing phacoemulsification considered at risk of postoperative papillary block as well as two pseudo-phakic eyes with acute postoperative pupillary-block. Following phacoemulsification and insertion of an intraocular lens, a needle with a bent tip was inserted behind the iris through the corneal tunnel incision. A blunt iris repositor was introduced through the paracentesis and placed above the iris to exert posterior pressure and create a puncture. The size of the puncture was enlarged using scissors. For postoperative pupillary block the same technique was carried out through the existing incisions created for phacoemulsification. Peripheral iridectomy was successfully created in all 22 eyes. At a mean follow-up of 18.77 ± 9.72 months, none of the iridectomies closed or required enlargement. Two eyes had mild intraoperative bleeding and one eye a small Descemet's detachment that did not require intervention. No clinically significant complications were observed. Visual acuity and IOP improved or was maintained in all patients. The incidence of pupillary block in our hospital was 0.09% overall, 0.6% in diabetics and 3.5% in those with diabetic retinopathy. This technique of peripheral iridectomy via the cornea tunnel incision can be safely used during phacoemulsification in eyes at high risk of pupillary block or in the treatment of acute postoperative pupillary-block after cataract surgery. The technique is likely to be especially useful in brown iris, or if a laser is not available.

  16. Ankle Block vs Single-Shot Popliteal Fossa Block as Primary Anesthesia for Forefoot Operative Procedures: Prospective, Randomized Comparison.

    PubMed

    Schipper, Oliver N; Hunt, Kenneth J; Anderson, Robert B; Davis, W Hodges; Jones, Carroll P; Cohen, Bruce E

    2017-11-01

    Postoperative pain is often difficult to control with oral medications, requiring large doses of opioid analgesia. Regional anesthesia may be used for primary anesthesia, reducing the need for general anesthetic and postoperative pain medication requirements in the immediate postoperative period. The purpose of this study was to compare the analgesic effects of an ankle block (AB) to a single-shot popliteal fossa block (PFB) for patients undergoing orthopedic forefoot procedures. All patients having elective outpatient orthopedic forefoot procedures were invited to participate in the study. Patients were prospectively randomized to receive either an ultrasound-guided AB or PFB by a board-certified anesthesiologist prior to their procedure. Intraoperative conversion to general anesthesia and postanesthesia care unit (PACU) opioid requirements were recorded. Postoperative pain was assessed using the visual analog scale (VAS) at regular time intervals until 8 am on postoperative day (POD) 2. Patients rated the effectiveness of the block on a 1 to 5 scale, with 5 being very effective. A total of 167 patients participated in the study with 88 patients (53%) receiving an AB and 79 (47%) receiving a single-shot PFB. There was no significant difference in the rate of conversion to general anesthesia between the 2 groups (13.6% [12/88] AB vs 12.7% [10/79] PFB). PACU morphine requirements and doses were significantly reduced in the PFB group ( P = .004) when compared to the AB group. The VAS was also significantly lower for the PFB patients at 10 pm on POD 0 (4.6 vs 1.6, P < .001), 8 am on POD 1 (5.9 vs 4.2, P = .003), and 12 pm on POD 1 (5.4 vs 4.1, P = .01). Overall complication rates were similar between the groups (AB 9% vs PFB 10.1%, P = .51) and there were no significant differences in residual sensory paresthesias (AB 2.3% [2/88] vs PFB 5.1% [4/79], P = .29), motor loss (0% vs 0%), or block site pain and/or erythema (AB 6.9% [6/88] vs PFB 5.1% [4/79], P = .44). The

  17. Characterization of cocaine-induced block of cardiac sodium channels.

    PubMed

    Crumb, W J; Clarkson, C W

    1990-03-01

    Recent evidence suggests that cocaine can produce marked cardiac arrhythmias and sudden death. A possible mechanism for this effect is slowing of impulse conduction due to block of cardiac Na channels. We therefore investigated its effects on Na channels in isolated guinea pig ventricular myocytes using the whole-cell variant of the patch clamp technique. Cocaine (10-50 microM) was found to reduce Na current in a use-dependent manner. The time course for block development and recovery were characterized. At 30 microM cocaine, two phases of block development were defined: a rapid phase (tau = 5.7 +/- 4.9 ms) and a slower phase (tau = 2.3 +/- 0.7 s). Recovery from block at -140 mV was also defined by two phases: (tau f = 136 +/- 61 ms, tau s = 8.5 +/- 1.7 s) (n = 6). To further clarify the molecular mechanisms of cocaine action on cardiac Na channels, we characterized its effects using the guarded receptor model, obtaining estimated Kd values of 328, 19, and 8 microM for channels predominantly in the rested, activated, and inactivated states. These data indicate that cocaine can block cardiac Na channels in a use-dependent manner and provides a possible cellular explanation for its cardiotoxic effects.

  18. Divalent ion block of inward rectifier current in human capillary endothelial cells and effects on resting membrane potential

    PubMed Central

    Jow, Flora; Numann, Randy

    1998-01-01

    Cultured human capillary endothelial cells (HCEC) contain a large inward rectifier current, IK(IR), that can be abolished by removing external K+ or by adding 50 μm Ba2+.We show that IK(IR) is responsible for maintaining the hyperpolarized potential (−60.6 ± 0.5 mV, n = 83) of HCEC. Blocking IK(IR) with 50 μm Ba2+ shifts the zero current level and depolarizes HCEC by 36.5 ± 1.3 mV (n = 4).Increasing external Ca2+ concentration ([Ca2+]o) from 0.5 to 7 mm reduces the magnitude of IK(IR) by 36.5 ± 2.3 % (n = 5) and depolarizes the cells by 10.33 ± 2.4 mV (n = 3), whereas decreasing [Ca2+]o from 1.8 to 0.5 mm increases the amplitude of IK(IR) by 6.9 ± 1.9 % (n = 4). The relationship between [Ca2+]o and the percentage block of IK(IR) gives a Kd value of 5.4 ± 0.6 mm at −120 mV.IK(IR) is also blocked by other divalent ions, with Ba2+ >> Sr2+ > Mg2+ > Mn2+= Ca2+, and the block of peak current at −120 mV being 85.3 ± 3.2 % (n = 5) for 50 μm Ba2+, 62.9 ± 2.2 % (n = 5) for 5 mm Sr2+, 40.7 ± 2.5 % (n = 9) for 5 mm Mg2+, 33.4 ± 2.1 % (n = 5) for 5 mm Mn2+ and 32.9 ± 2.1 % (n = 5) for 5 mm Ca2+.The voltage dependence of Sr2+ block of peak IK(IR) occurred with a Kd value of 1.0 ± 0.09 mm for −140 mV, 1.9 ± 0.16 mm for −130 mV, 3.1 ± 0.28 mm for −120 mV, 4.6 ± 0.34 mm for −110 mV and 6.4 ± 0.5 mm for −100 mV (n = 5), with a calculated electrical distance (δ) of 0.44 from the outside. PMID:9729622

  19. V-type multicylinder internal combustion engine

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Tsuboi, M.

    1986-05-20

    A V-type multicylinder internal combustion engine is described for vehicles comprising front and rear cylinder blocks arrayed in V shape longitudinally of a vehicle body, front and rear cylinder heads fixed on each cylinder block, pistons sliding in the cylinder blocks, a crank and transmission case formed uniformly on the cylinder blocks, a crankshaft extending transversely of the vehicle body borne rotatably on both side walls of the crank and transmission case at journals on both sides, the crankshaft being coupled to the pistons at a crank pin through connecting rods and provided with front and rear driving sprockets, frontmore » and rear cam shafts mounted rotatably on the cylinder heads with driven sprockets fixed thereon, a front timing chain laid between the front driving sprocket and the front driven sprocket and constituting together with the front driving and driven sprockets a front cam driving means, a rear timing chain laid between the rear driving sprocket and the rear driven sprocket and constituting together with the rear driving and driven sprockets a rear cam driving means, and a speed change gear coupled to the crankshaft by way of a primary reduction gear and a clutch.« less

  20. Ultrasound-guided axillary nerve block for ED incision and drainage of deltoid abscess.

    PubMed

    Lyons, Claire; Herring, Andrew A

    2017-07-01

    Deltoid abscesses are common and painful, often a consequence of injection drug use and seen frequently in emergency departments (EDs). The required incision and drainage can be completed successfully with effective pain relief using a peripheral nerve block. The brachial plexus nerve block works well, however it is technically complex with a low, but potentially serious, risk of complications such as phrenic nerve paralysis. Selective blockade of the axillary nerve eliminates the risks associated with a brachial plexus block, while providing more specific anesthesia for the deltoid region. Our initial experience suggests that the axillary nerve block (ANB) is a technically simple, safe, and effective way to manage the pain of deltoid abscesses and the necessary incision and drainage (I&D). The block involves using ultrasound guidance to inject a 20mL bolus of local anesthetic into the quadrangular space surrounding the axillary nerve (inferior to the posterolateral aspect of the acromion, near the overlap of the long head of triceps brachii and teres minor). Once injected the local will anesthetize the axillary nerve resulting in analgesia of the cutaneous area of the lateral shoulder and the deeper tissues including the deltoid muscle. Further research will clarify questions about the volume and concentration of local anesthetic, the role of injected adjuncts, and expected duration of analgesia and anesthesia. Herein we present a description of an axillary nerve block successfully used for deltoid abscess I&D in the ED. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Block LU factorization

    NASA Technical Reports Server (NTRS)

    Demmel, James W.; Higham, Nicholas J.; Schreiber, Robert S.

    1992-01-01

    Many of the currently popular 'block algorithms' are scalar algorithms in which the operations have been grouped and reordered into matrix operations. One genuine block algorithm in practical use is block LU factorization, and this has recently been shown by Demmel and Higham to be unstable in general. It is shown here that block LU factorization is stable if A is block diagonally dominant by columns. Moreover, for a general matrix the level of instability in block LU factorization can be founded in terms of the condition number kappa(A) and the growth factor for Gaussian elimination without pivoting. A consequence is that block LU factorization is stable for a matrix A that is symmetric positive definite or point diagonally dominant by rows or columns as long as A is well-conditioned.

  2. Direct block of native and cloned (Kir2.1) inward rectifier K+ channels by chloroethylclonidine

    PubMed Central

    Barrett-Jolley, R; Dart, C; Standen, N B

    1999-01-01

    We have investigated the inhibition of inwardly rectifying potassium channels by the α-adrenergic agonist/antagonist chloroethylclonidine (CEC). We used two preparations; two-electrode voltage-clamp of rat isolated flexor digitorum brevis muscle and whole-cell patch-clamp of cell lines transfected with Kir2.1 (IRK1).In skeletal muscle and at a membrane potential of −50 mV, chloroethylclonidine (CEC), an agonist at α2-adrenergic receptors and an antagonist at α1x-receptors, was found to inhibit the inward rectifier current with a Ki of 30 μM.The inhibition of skeletal muscle inward rectifier current by CEC was not mimicked by clonidine, adrenaline or noradrenaline and was not sensitive to high concentrations of α1-(prazosin) or α2-(rauwolscine) antagonists.The degree of current inhibition by CEC was found to vary with the membrane potential (approximately 70% block at −50 mV c.f. ∼10% block at −190 mV). The kinetics of this voltage dependence were further investigated using recombinant inward rectifier K+ channels (Kir2.1) expressed in the MEL cell line. Using a two pulse protocol, we calculated the time constant for block to be ∼8 s at 0 mV, and the rate of unblock was described by the relationship τ=exp((Vm+149)/22) s.This block was effective when CEC was applied to either the inside or the outside of patch clamped cells, but ineffective when a polyamine binding site (aspartate 172) was mutated to asparagine.The data suggest that the clonidine-like imidazoline compound, CEC, inhibits inward rectifier K+ channels independently of α-receptors by directly blocking the channel pore, possibly at an intracellular polyamine binding site. PMID:10516659

  3. The efficacy of oblique subcostal transversus abdominis plane block in laparoscopic cholecystectomy – a prospective, placebo controlled study

    PubMed Central

    Breazu, Caius Mihai; Ciobanu, Lidia; Hadade, Adina; Bartos, Adrian; Mitre, Călin; Mircea, Petru Adrian; Ionescu, Daniela

    2016-01-01

    Introduction Pain control after a laparoscopic cholecystectomy can represent a challenge, considering the side effects due to standard analgesia methods. Recently the transversus abdominis plane block (TAP Block) has been used as a part of multimodal analgesia with promising results. The subcostal approach (OSTAP Block), a variant on the TAP block, produces reliable unilateral supraumbilical analgesia. This study evaluated the efficacy of the OSTAP block with bupivacaine in laparoscopic cholecystectomy compared with the placebo OSTAP block. Material and Methods Sixty ASA I/II adult patients listed for elective laparoscopic cholecystectomy were randomly allocated in one of two groups: Group A (OSTAP placebo) received preoperatively bilateral OSTAP block with sterile normal saline and Group B (OSTAP bupivacaine) received bilateral preoperatively OSTAP block with the same volumes of 0.25% bupivacaine. Twenty-four hours postoperative opioid consumption, the dose of opioid required during surgery, opioid dose in the recovery unit (PACU) and PACU length of stay were evaluated. The quality of analgesia was assessed by the Visual Analogue Scale (VAS) at specific interval hours during 24 h, at rest and with movement. Results The mean intraoperative opioid consumption showed a significant difference between the two groups, (385 ± 72.52 mg in group A vs 173.67 ± 48.60 mg in group B, p < 0.001). The mean 24 h opioid consumption showed a statistically significant difference between groups (32 ± 26.05 mg vs 79 ± 16.68 mg, p < 0.001). PACU length of stay was significantly lower for group B patients compared with group A patients (20.67 ± 11.27 min vs 41.67 ± 12.41 min, p < 0.001). The OSTAP bupivacaine group had a statistically significant lower pain score than the OSTAP placebo group at 0, 2, 4, 6, 12, 24 h, both at rest and with movement. No signs or symptoms of local anaesthetic systemic toxicity or other complications were detected. Conclusion OSTAP block with

  4. Transient delayed facial nerve palsy after inferior alveolar nerve block anesthesia.

    PubMed

    Tzermpos, Fotios H; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

    2012-01-01

    Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution.

  5. Block coals from Indiana: Inferences on changing depositional environment

    USGS Publications Warehouse

    Mastalerz, Maria; Padgett, P.L.; Eble, C.F.

    2000-01-01

    Significant differences in coal petrography, palynology and coal quality were found between the Lower Block and Upper Block Coal Members (Brazil Formation, Pennsylvanian) in Daviess County, Indiana. The Lower Block Coal Member ranges in thickness from 51 to 74 cm and the Upper Block Coal Member ranges from 20 to 65 cm. Average sulfur content and ash yield of the Lower Block coal (0.98%, 7.65%) are lower than in the Upper Block coal. Megascopically, the coals show distinct differences. The Lower Block is a banded coal with numerous thin fusain horizons and a thin clay parting in the lower third of the seam. The Upper Block coal has a dulling-upward trend, with a bright clarain found at the base that grades into a clarain and then into a durain in the upper portion of the seam. Vitrinite content of the Lower Block coal ranges from 63% to 78%, with the highest vitrinite content found in the middle portion of the seam. In the Upper Block coal, vitrinite content ranges from 40% to 83%, with the highest values found in the lower part of the seam. Ash yield is higher in the upper part of the Upper Block coal, reaching up to 40%. The Lower Block coal is dominated by lycopod trees and tree ferns. The Upper Block coal shows marked differences in spore assemblages between lower and upper parts of the seam. The lower half is dominated by large lycopod trees and tree ferns, similar to the Lower Block coal. The upper half is dominated by small lycopods, mainly Densosporites and Radiizonates. These differences between the Lower Block and Upper Block Coal Members are significant correlation tools applicable to mining exploration and chronostratigraphy. (C) 2000 Elsevier Science B.V. All rights reserved.Significant differences in coal petrography, palynology and coal quality were found between the Lower Block and Upper Block Coal Members (Brazil Formation, Pennsylvanian) in Daviess County, Indiana. The Lower Block Coal Member ranges in thickness from 51 to 74 cm and the Upper Block

  6. [Ultrasound-guided peripheral nerve block at wrist level for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin].

    PubMed

    Olea, E; Fondarella, A; Sánchez, C; Iriarte, I; Almeida, M V; Martínez de Salinas, A

    2013-12-01

    Evaluation of pain and degree of satisfaction in patients undergoing ultrasound-assisted peripheral regional block for the treatment of idiopathic palmar hyperhidrosis with botulinum toxin. A descriptive, observational study of patients with palmar hyperhidrosis treated with botulinum toxin A, who underwent ultrasound-guided peripheral regional block of the median and ulnar nerves with 3 ml of mepivacaine 1% in each one. The radial nerve block was injected in the anatomical snuffbox. After establishing blocking, the dermatologist performed a mapping and injected around 100 IU of botulinum toxin across the whole palm. The pain experienced during the injection of botulinum toxin was evaluated by verbal numerical scale (from 0 to 10), along with the degree of satisfaction with the anesthetic technique, and the post-anesthetic complications. A total of 40 patients were enrolled in the study, 11 men and 29 women with no significant differences. The pain intensity assessed with verbal numerical scale was 1.03 (standard deviation of 1.37). No patients had a value greater than 5. The degree of patient satisfaction with the anesthetic technique was very good for 85% of the patients, and good for 7.5%. There were no complications related to type of anesthesia. The ultrasound-assisted peripheral regional block could be a simple, effective and safe technique for patients undergoing palmar injection of botulinum toxin. Pain intensity was very low, and it provided a very good level of satisfaction in most patients. Copyright © 2013 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Published by Elsevier España. All rights reserved.

  7. Application of interconnected porous hydroxyapatite ceramic block for onlay block bone grafting in implant treatment: A case report.

    PubMed

    Ohta, Kouji; Tada, Misato; Ninomiya, Yoshiaki; Kato, Hiroki; Ishida, Fumi; Abekura, Hitoshi; Tsuga, Kazuhiro; Takechi, Masaaki

    2017-12-01

    Autogenous block bone grafting as treatment for alveolar ridge atrophy has various disadvantages, including a limited availability of sufficiently sized and shaped grafts, donor site morbidity and resorption of the grafted bone. As a result, interconnected porous hydroxyapatite ceramic (IP-CHA) materials with high porosity have been developed and used successfully in orthopedic cases. To the best of the author's knowledge, this is the first report of clinical application of an IP-CHA block for onlay grafting for implant treatment in a patient with horizontal alveolar atrophy. The present study performed onlay block grafting using an IP-CHA block to restore bone volume for implant placement in the alveolar ridge area without collecting autogenous bone. Dental X-ray findings revealed that the border of the IP-CHA block became increasingly vague over the 3-year period, whereas CT scanning revealed that the gap between the block and bone had a smooth transition, indicating that IP-CHA improved the process of integration with host bone. In follow-up examinations over a period of 5 years, the implants and superstructures had no problems. An IP-CHA block may be useful as a substitute for onlay block bone grafting in implant treatment.

  8. Constructing a molecular theory of self-assembly: Interplay of ideas from surfactants and block copolymers.

    PubMed

    Nagarajan, Ramanathan

    2017-06-01

    Low molecular weight surfactants and high molecular weight block copolymers display analogous self-assembly behavior in solutions and at interfaces, generating nanoscale structures of different shapes. Understanding the link between the molecular structure of these amphiphiles and their self-assembly behavior has been the goal of theoretical studies. Despite the analogies between surfactants and block copolymers, models predicting their self-assembly behavior have evolved independent of one another, each overlooking the molecular feature considered critical to the other. In this review, we focus on the interplay of ideas pertaining to surfactants and block copolymers in three areas of self-assembly. First, we show how improved free energy models have evolved by applying ideas from surfactants to block copolymers and vice versa, giving rise to a unitary theoretical framework and better predictive capabilities for both classes of amphiphiles. Second we show that even though molecular packing arguments are often used to explain aggregate shape transitions resulting from self-assembly, the molecular packing considerations are more relevant in the case of surfactants whereas free energy criteria are relevant for block copolymers. Third, we show that even though the surfactant and block copolymer aggregates are small nanostructures, the size differences between them is significant enough to make the interfacial effects control the solubilization of molecules in surfactant micelles while the bulk interactions control the solubilization in block copolymer micelles. Finally, we conclude by identifying recent theoretical progress in adapting the micelle model to a wide variety of self-assembly phenomena and the challenges to modeling posed by emerging novel classes of amphiphiles with complex biological, inorganic or nanoparticle moieties. Published by Elsevier B.V.

  9. Left bundle branch block, an old-new entity.

    PubMed

    Breithardt, Günter; Breithardt, Ole-Alexander

    2012-04-01

    Left bundle branch block (LBBB) is generally associated with a poorer prognosis in comparison to normal intraventricular conduction, but also in comparison to right bundle branch block which is generally considered to be benign in the absence of an underlying cardiac disorder like congenital heart disease. LBBB may be the first manifestation of a more diffuse myocardial disease. The typical surface ECG feature of LBBB is a prolongation of QRS above 0.11 s in combination with a delay of the intrinsic deflection in leads V5 and V6 of more than 60 ms and no septal q waves in leads I, V5, and V6 due to the abnormal septal activation from right to left. LBBB may induce abnormalities in left ventricular performance due to abnormal asynchronous contraction patterns which can be compensated by biventricular pacing (resynchronization therapy). Asynchronous electrical activation of the ventricles causes regional differences in workload which may lead to asymmetric hypertrophy and left ventricular dilatation, especially due to increased wall mass in late-activated regions, which may aggravate preexisting left ventricular pumping performance or even induce it. Of special interest are patients with LBBB and normal left ventricular dimensions and normal ejection fraction at rest but who may present with an abnormal increase in pulmonary artery pressure during exercise, production of lactate during high-rate pacing, signs of ischemia on myocardial scintigrams (but no coronary artery narrowing), and abnormal ultrastructural findings on myocardial biopsy. For this entity, the term latent cardiomyopathy had been suggested previously.

  10. Preservation of within-compound associations after blocked preexposure to two compound flavors.

    PubMed

    Espinet, Alfredo; Caramés, José M; Cabo, Fernando

    2015-11-01

    Three experiments investigated the extinction of the within-compound A↔X association established when two compound flavors, AX and BX, are preexposed in blocks (i.e., AX, AX, AX, ... BX, BX, BX). In Experiment 1, a group of rats received preexposure to a block of AX trials followed by a second block of BX trials (AX-BX), while a second group received blocked preexposure to the same stimuli in the opposite order (BX-AX). Subsequently, flavor A was paired with lithium chloride. This conditioning resulted in a similar reduction of consumption of flavor X in both groups. In Experiment 2 four groups of rats received blocked preexposure to AX-BX, AX-B, A-BX, or A-X. After aversive conditioning of X, consumption of A and B was significantly lower for the groups which received these flavors paired with X than for the groups for which these flavors were presented isolated. In Experiment 3 a group of rats was preexposed to a block of SaltX presentations followed by a block of BX presentations (SaltX-BX), and a second group received blocked preexposure to (BX-SaltX). After subsequent sodium depletion, consumption of X was high and similar for the SaltX-BX and for the BX-SaltX groups. These results indicate that the within-compound association established in the first block of a blocked preexposure is not extinguished when the preexposure phase is concluded. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Block Transfer Handbook: Constructing and Negotiating Block Transfer Agreements.

    ERIC Educational Resources Information Center

    Finlay, Finola

    The purpose of this handbook is to provide resources for institutions or articulation committees who are engaged in the task of investigating the feasibility of block transfer agreements. Block transfer is the process whereby a block of credits is granted to students who have successfully completed a certificate, diploma, or cluster of courses…

  12. The role of ultrasound guidance in pediatric caudal block

    PubMed Central

    Erbüyün, Koray; Açıkgöz, Barış; Ok, Gülay; Yılmaz, Ömer; Temeltaş, Gökhan; Tekin, İdil; Tok, Demet

    2016-01-01

    Objectives: To compare the time interval of the procedure, possible complications, post-operative pain levels, additional analgesics, and nurse satisfaction in ultrasonography-guided and standard caudal block applications. Methods: This retrospective study was conducted in Celal Bayar University Hospital, Manisa, Turkey, between January and December 2014, included 78 pediatric patients. Caudal block was applied to 2 different groups; one with ultrasound guide, and the other using the standard method. Results: The time interval of the procedure was significantly shorter in the standard application group compared with ultrasound-guided group (p=0.020). Wong-Baker FACES Pain Rating Scale values obtained at the 90th minute was statistically lower in the standard application group compared with ultrasound-guided group (p=0.035). No statistically significant difference was found on the other parameters between the 2 groups. The shorter time interval of the procedure at standard application group should not be considered as a distinctive mark by the pediatric anesthesiologists, because this time difference was as short as seconds. Conclusion: Ultrasound guidance for caudal block applications would neither increase nor decrease the success of the treatment. However, ultrasound guidance should be needed in cases where the detection of sacral anatomy is difficult, especially by palpations. PMID:26837396

  13. Complications and outcomes of JJ stenting of the ureter in urological practice: A single-centre experience☆

    PubMed Central

    Al-Marhoon, Mohammed S.; Shareef, Omar; Venkiteswaran, Krishna P.

    2012-01-01

    Objective To determine the factors affecting the development of complications and the outcomes of JJ stenting. Patients and methods The study included 220 patients (133 males and 87 females, mean age 39.5 years, SD 15.4) who had self-retaining JJ ureteric stents placed while in the authors’ institution. Univariate and multivariate analyses were used to identify the significant variables affecting the development of complications and outcome of stenting (condition ‘improved’ or ‘not improved’). Results Using a modified Clavien classification, there were grade I, II, IIIa, IIIb complications in 67 (30.4%), 39 (17.7%), two (0.9%) and 23 (10.5%) patients, respectively, and none of grades IVa, IVb and V. Loin pain (10.9%) and urinary tract infection (10.9%) were the most common complications, followed by dysuria (7.7%). There were significant complications requiring treatment in 29% of patients, and 71.4% of patients improved after stenting. On multivariate analysis the significant independent factor affecting the complication rate was the stent length (P = 0.016), and the significant independent factor affecting the ‘improved’ outcome was age (P = 0.014). Conclusion Longer stents are associated with increased complication rates, and the older the patient the more likely they are to have a poor outcome after stenting. Future prospective multicentre studies with more patients are needed to confirm the present conclusions. PMID:26558052

  14. Complications and outcomes of JJ stenting of the ureter in urological practice: A single-centre experience.

    PubMed

    Al-Marhoon, Mohammed S; Shareef, Omar; Venkiteswaran, Krishna P

    2012-12-01

    To determine the factors affecting the development of complications and the outcomes of JJ stenting. The study included 220 patients (133 males and 87 females, mean age 39.5 years, SD 15.4) who had self-retaining JJ ureteric stents placed while in the authors' institution. Univariate and multivariate analyses were used to identify the significant variables affecting the development of complications and outcome of stenting (condition 'improved' or 'not improved'). Using a modified Clavien classification, there were grade I, II, IIIa, IIIb complications in 67 (30.4%), 39 (17.7%), two (0.9%) and 23 (10.5%) patients, respectively, and none of grades IVa, IVb and V. Loin pain (10.9%) and urinary tract infection (10.9%) were the most common complications, followed by dysuria (7.7%). There were significant complications requiring treatment in 29% of patients, and 71.4% of patients improved after stenting. On multivariate analysis the significant independent factor affecting the complication rate was the stent length (P = 0.016), and the significant independent factor affecting the 'improved' outcome was age (P = 0.014). Longer stents are associated with increased complication rates, and the older the patient the more likely they are to have a poor outcome after stenting. Future prospective multicentre studies with more patients are needed to confirm the present conclusions.

  15. Pseudoaneurysm as a complication of ankle arthroscopy.

    PubMed

    Mariani, P P; Mancini, L; Giorgini, T L

    2001-04-01

    We describe a case of pseudoaneurysm of the anterior tibial artery as a complication after arthroscopic ankle synovectomy, in which standard anterolateral and anteromedial portals were used. Pseudoaneurysm has been previously reported as a complication in ankle arthroscopy with the use of the anterocentral portal. Previously described anatomic variations of the tibial artery and its close relationship with the anterior ankle capsule may complicate arthroscopic surgery, especially when aggressive synovectomy is performed. Anterior tibial artery aneurysm is a rare complication of ankle arthroscopy, but its potential catastrophic sequelae must not be underestimated.

  16. Polymorphisms in the lcrV gene of Yersinia enterocolitica and their effect on plague protective immunity.

    PubMed

    Miller, Nathan C; Quenee, Lauriane E; Elli, Derek; Ciletti, Nancy A; Schneewind, Olaf

    2012-04-01

    Current efforts to develop plague vaccines focus on LcrV, a polypeptide that resides at the tip of type III secretion needles. LcrV-specific antibodies block Yersinia pestis type III injection of Yop effectors into host immune cells, thereby enabling phagocytes to kill the invading pathogen. Earlier work reported that antibodies against Y. pestis LcrV cannot block type III injection by Yersinia enterocolitica strains and suggested that lcrV polymorphisms may provide for escape from LcrV-mediated plague immunity. We show here that polyclonal or monoclonal antibodies raised against Y. pestis KIM D27 LcrV (LcrV(D27)) bind LcrV from Y. enterocolitica O:9 strain W22703 (LcrV(W22703)) or O:8 strain WA-314 (LcrV(WA-314)) but are otherwise unable to block type III injection by Y. enterocolitica strains. Replacing the lcrV gene on the pCD1 virulence plasmid of Y. pestis KIM D27 with either lcrV(W22703) or lcrV(WA-314) does not affect the ability of plague bacteria to secrete proteins via the type III pathway, to inject Yops into macrophages, or to cause lethal plague infections in mice. LcrV(D27)-specific antibodies blocked type III injection by Y. pestis expressing lcrV(W22703) or lcrV(WA-314) and protected mice against intravenous lethal plague challenge with these strains. Thus, although antibodies raised against LcrV(D27) are unable to block the type III injection of Y. enterocolitica strains, expression of lcrV(W22703) or lcrV(WA-314) in Y. pestis did not allow these strains to escape LcrV-mediated plague protective immunity in the intravenous challenge model.

  17. A Comparison of Jump Height, Takeoff Velocities, and Blocking Coverage in the Swing and Traditional Volleyball Blocking Techniques

    PubMed Central

    Ficklin, Travis; Lund, Robin; Schipper, Megan

    2014-01-01

    The purpose of this study was to compare traditional and swing blocking techniques on center of mass (COM) projectile motion and effective blocking area in nine healthy Division I female volleyball players. Two high-definition (1080 p) video cameras (60 Hz) were used to collect two-dimensional variables from two separate views. One was placed perpendicular to the plane of the net and the other was directed along the top of the net, and were used to estimate COM locations and blocking area in a plane parallel to the net and hand penetration through the plane of the net respectively. Video of both the traditional and swing techniques were digitized and kinematic variables were calculated. Paired samples t-tests indicated that the swing technique resulted in greater (p < 0.05) vertical and horizontal takeoff velocities (vy and vx), jump height (H), duration of the block (tBLOCK), blocking coverage during the block (C) as well as hand penetration above and through the net’s plane (YPEN, ZPEN). The traditional technique had significantly greater approach time (tAPP). The results of this study suggest that the swing technique results in both greater jump height and effective blocking area. However, the shorter tAPP that occurs with swing is associated with longer times in the air during the block which may reduce the ability of the athlete to make adjustments to attacks designed to misdirect the defense. Key Points Swing blocking technique has greater jump height, effective blocking area, hand penetration, horizontal and vertical takeoff velocity, and has a shorter time of approach. Despite these advantages, there may be more potential for mistiming blocks and having erratic deflections of the ball after contact when using the swing technique. Coaches should take more than simple jump height and hand penetration into account when deciding which technique to employ. PMID:24570609

  18. A comparison of jump height, takeoff velocities, and blocking coverage in the swing and traditional volleyball blocking techniques.

    PubMed

    Ficklin, Travis; Lund, Robin; Schipper, Megan

    2014-01-01

    The purpose of this study was to compare traditional and swing blocking techniques on center of mass (COM) projectile motion and effective blocking area in nine healthy Division I female volleyball players. Two high-definition (1080 p) video cameras (60 Hz) were used to collect two-dimensional variables from two separate views. One was placed perpendicular to the plane of the net and the other was directed along the top of the net, and were used to estimate COM locations and blocking area in a plane parallel to the net and hand penetration through the plane of the net respectively. Video of both the traditional and swing techniques were digitized and kinematic variables were calculated. Paired samples t-tests indicated that the swing technique resulted in greater (p < 0.05) vertical and horizontal takeoff velocities (vy and vx), jump height (H), duration of the block (tBLOCK), blocking coverage during the block (C) as well as hand penetration above and through the net's plane (YPEN, ZPEN). The traditional technique had significantly greater approach time (tAPP). The results of this study suggest that the swing technique results in both greater jump height and effective blocking area. However, the shorter tAPP that occurs with swing is associated with longer times in the air during the block which may reduce the ability of the athlete to make adjustments to attacks designed to misdirect the defense. Key PointsSwing blocking technique has greater jump height, effective blocking area, hand penetration, horizontal and vertical takeoff velocity, and has a shorter time of approach.Despite these advantages, there may be more potential for mistiming blocks and having erratic deflections of the ball after contact when using the swing technique.Coaches should take more than simple jump height and hand penetration into account when deciding which technique to employ.

  19. Complications of deep brain stimulation: a collective review.

    PubMed

    Chan, Danny T M; Zhu, Xian Lun; Yeung, Jonas H M; Mok, Vincent C T; Wong, Edith; Lau, Clara; Wong, Rosanna; Lau, Christine; Poon, Wai S

    2009-10-01

    Since the first deep brain stimulation (DBS) performed for movement disorder more than a decade ago, DBS has become a standard operation for advanced Parkinson's disease. Its indications are expanding to areas of dystonia, psychiatric conditions and refractory epilepsy. Additionally, a new set of DBS-related complications have arisen. Many teams found a slow learning curve from this complication-prone operation. We would like to investigate complications arising from 100 DBS electrode insertions and its prevention. We performed an audit in all DBS patients for operation-related complications in our centre from 1997 to 2008. Complications were classified into operation-related, hardware-related and stimulation-related. Operation-related complications included intracranial haemorrhages and electrode malposition. Hardware-related complications included fracture of electrodes, electrode migration, infection and erosion. Stimulation-related complications included sensorimotor conditions, psychiatric conditions and life-threatening conditions. From 1997 to the end of 2008, 100 DBS electrodes were inserted in 55 patients for movement disorders, mostly for Parkinsons disease (50 patients). There was one symptomatic cerebral haemorrhage (1%) and two electrode malpositions (2%). Meticulous surgical planning, use of microdriver and a reliable electrode anchorage device would minimise this group of complications. There were two electrode fractures, one electrode migration and one pulse-generator infection which contributed to the hardware-related complication rate of 5%. There were no sensorimotor or life-threatening complications in our group. However, three patients suffered from reversible psychiatric symptoms after DBS. DBS is, on the one hand, an effective surgical treatment for movement disorders. On the other hand, it is a complication-prone operation. A dedicated "Movement Disorder Team" consisting of neurologists, neurophysiologists, functional neurosurgeons

  20. An Unusual Complication of Ventriculoperitoneal Shunt: Urinary Bladder Stone Case Report and Literature Review.

    PubMed

    Xu, Songtao; Sheng, Weixin; Qiu, Yufa; Wang, Jianguo

    2016-01-01

    Ventriculoperitoneal (V-P) shunt surgery is the most common technique used for the treatment of hydrocephalus. The migration of ventriculoperitoneal shunt to the bladder is rare. Only two cases have been previously reported in the literature. We report on a 38-year-old male who had hydrocephalus and V-P shunt for 12 years. Two years ago, he found himself with recurrent urinary tract infections, haematuria and urges incontinence, and then he was diagnosed with bladder perforation and merge stones. The patient had an abdominal operation to cut off and take out the shunt catheter, as well as a transurethral holmium laser lithotripsy. Bladder perforation and stones are rare examples of complications in V-P surgical procedures. Controlling the effective length of the terminal V-P shunt and modifying it appropriately can effectively reduce these complications.

  1. Dose-Volume Histogram Predictors of Chronic Gastrointestinal Complications After Radical Hysterectomy and Postoperative Concurrent Nedaplatin-Based Chemoradiation Therapy for Early-Stage Cervical Cancer

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Isohashi, Fumiaki, E-mail: isohashi@radonc.med.osaka-u.ac.jp; Yoshioka, Yasuo; Mabuchi, Seiji

    2013-03-01

    Purpose: The purpose of this study was to evaluate dose-volume histogram (DVH) predictors for the development of chronic gastrointestinal (GI) complications in cervical cancer patients who underwent radical hysterectomy and postoperative concurrent nedaplatin-based chemoradiation therapy. Methods and Materials: This study analyzed 97 patients who underwent postoperative concurrent chemoradiation therapy. The organs at risk that were contoured were the small bowel loops, large bowel loop, and peritoneal cavity. DVH parameters subjected to analysis included the volumes of these organs receiving more than 15, 30, 40, and 45 Gy (V15-V45) and their mean dose. Associations between DVH parameters or clinical factors andmore » the incidence of grade 2 or higher chronic GI complications were evaluated. Results: Of the clinical factors, smoking and low body mass index (BMI) (<22) were significantly associated with grade 2 or higher chronic GI complications. Also, patients with chronic GI complications had significantly greater V15-V45 volumes and higher mean dose of the small bowel loops compared with those without GI complications. In contrast, no parameters for the large bowel loop or peritoneal cavity were significantly associated with GI complications. Results of the receiver operating characteristics (ROC) curve analysis led to the conclusion that V15-V45 of the small bowel loops has high accuracy for prediction of GI complications. Among these parameters, V40 gave the highest area under the ROC curve. Finally, multivariate analysis was performed with V40 of the small bowel loops and 2 other clinical parameters that were judged to be potential risk factors for chronic GI complications: BMI and smoking. Of these 3 parameters, V40 of the small bowel loops and smoking emerged as independent predictors of chronic GI complications. Conclusions: DVH parameters of the small bowel loops may serve as predictors of grade 2 or higher chronic GI complications after postoperative

  2. Pharmacological characterization of potent and selective NaV1.7 inhibitors engineered from Chilobrachys jingzhao tarantula venom peptide JzTx-V.

    PubMed

    Moyer, Bryan D; Murray, Justin K; Ligutti, Joseph; Andrews, Kristin; Favreau, Philippe; Jordan, John B; Lee, Josie H; Liu, Dong; Long, Jason; Sham, Kelvin; Shi, Licheng; Stöcklin, Reto; Wu, Bin; Yin, Ruoyuan; Yu, Violeta; Zou, Anruo; Biswas, Kaustav; Miranda, Les P

    2018-01-01

    Identification of voltage-gated sodium channel NaV1.7 inhibitors for chronic pain therapeutic development is an area of vigorous pursuit. In an effort to identify more potent leads compared to our previously reported GpTx-1 peptide series, electrophysiology screening of fractionated tarantula venom discovered the NaV1.7 inhibitory peptide JzTx-V from the Chinese earth tiger tarantula Chilobrachys jingzhao. The parent peptide displayed nominal selectivity over the skeletal muscle NaV1.4 channel. Attribute-based positional scan analoging identified a key Ile28Glu mutation that improved NaV1.4 selectivity over 100-fold, and further optimization yielded the potent and selective peptide leads AM-8145 and AM-0422. NMR analyses revealed that the Ile28Glu substitution changed peptide conformation, pointing to a structural rationale for the selectivity gains. AM-8145 and AM-0422 as well as GpTx-1 and HwTx-IV competed for ProTx-II binding in HEK293 cells expressing human NaV1.7, suggesting that these NaV1.7 inhibitory peptides interact with a similar binding site. AM-8145 potently blocked native tetrodotoxin-sensitive (TTX-S) channels in mouse dorsal root ganglia (DRG) neurons, exhibited 30- to 120-fold selectivity over other human TTX-S channels and exhibited over 1,000-fold selectivity over other human tetrodotoxin-resistant (TTX-R) channels. Leveraging NaV1.7-NaV1.5 chimeras containing various voltage-sensor and pore regions, AM-8145 mapped to the second voltage-sensor domain of NaV1.7. AM-0422, but not the inactive peptide analog AM-8374, dose-dependently blocked capsaicin-induced DRG neuron action potential firing using a multi-electrode array readout and mechanically-induced C-fiber spiking in a saphenous skin-nerve preparation. Collectively, AM-8145 and AM-0422 represent potent, new engineered NaV1.7 inhibitory peptides derived from the JzTx-V scaffold with improved NaV selectivity and biological activity in blocking action potential firing in both DRG neurons and C-fibers.

  3. Pharmacological characterization of potent and selective NaV1.7 inhibitors engineered from Chilobrachys jingzhao tarantula venom peptide JzTx-V

    PubMed Central

    Murray, Justin K.; Ligutti, Joseph; Andrews, Kristin; Favreau, Philippe; Jordan, John B.; Lee, Josie H.; Liu, Dong; Long, Jason; Sham, Kelvin; Shi, Licheng; Stöcklin, Reto; Wu, Bin; Yin, Ruoyuan; Yu, Violeta; Zou, Anruo; Biswas, Kaustav; Miranda, Les P.

    2018-01-01

    Identification of voltage-gated sodium channel NaV1.7 inhibitors for chronic pain therapeutic development is an area of vigorous pursuit. In an effort to identify more potent leads compared to our previously reported GpTx-1 peptide series, electrophysiology screening of fractionated tarantula venom discovered the NaV1.7 inhibitory peptide JzTx-V from the Chinese earth tiger tarantula Chilobrachys jingzhao. The parent peptide displayed nominal selectivity over the skeletal muscle NaV1.4 channel. Attribute-based positional scan analoging identified a key Ile28Glu mutation that improved NaV1.4 selectivity over 100-fold, and further optimization yielded the potent and selective peptide leads AM-8145 and AM-0422. NMR analyses revealed that the Ile28Glu substitution changed peptide conformation, pointing to a structural rationale for the selectivity gains. AM-8145 and AM-0422 as well as GpTx-1 and HwTx-IV competed for ProTx-II binding in HEK293 cells expressing human NaV1.7, suggesting that these NaV1.7 inhibitory peptides interact with a similar binding site. AM-8145 potently blocked native tetrodotoxin-sensitive (TTX-S) channels in mouse dorsal root ganglia (DRG) neurons, exhibited 30- to 120-fold selectivity over other human TTX-S channels and exhibited over 1,000-fold selectivity over other human tetrodotoxin-resistant (TTX-R) channels. Leveraging NaV1.7-NaV1.5 chimeras containing various voltage-sensor and pore regions, AM-8145 mapped to the second voltage-sensor domain of NaV1.7. AM-0422, but not the inactive peptide analog AM-8374, dose-dependently blocked capsaicin-induced DRG neuron action potential firing using a multi-electrode array readout and mechanically-induced C-fiber spiking in a saphenous skin-nerve preparation. Collectively, AM-8145 and AM-0422 represent potent, new engineered NaV1.7 inhibitory peptides derived from the JzTx-V scaffold with improved NaV selectivity and biological activity in blocking action potential firing in both DRG neurons and C

  4. Ureterovaginal fistula: A complication of a vaginal foreign body.

    PubMed

    Lo, Tsia-Shu; Jaili, Sukanda Bin; Ibrahim, Rami; Kao, Chuan Chi; Uy-Patrimonio, Ma Clarissa

    2018-02-01

    To know the diagnostic tools and proper management of ureterovaginal fistula following neglected vaginal foreign body in order to achieve optimal outcome. A case of ureterovaginal fistula associated with a neglected vaginal foreign body. The patient was complaining of a foul-smelling vaginal discharge and lower abdominal pain. On vaginal examination, a hard and large foreign body was found. Examination under anesthesia was performed, and an aerosol cap was removed from her vagina. The patient developed urinary incontinence after removal of the foreign body. Subsequent work-up demonstrated the presence of a right ureterovaginal fistula. The patient underwent an abdominal ureteroneocystostomy. At one year follow up, the patient had fully recovered. Ureterovaginal fistula following neglected vaginal foreign body is a serious condition. Early diagnosis, treatment of infection and proper surgical management can improve the outcome and decrease complications. Copyright © 2018. Published by Elsevier B.V.

  5. Safety measures in hip arthroscopy and their efficacy in minimizing complications: a systematic review of the evidence.

    PubMed

    Gupta, Asheesh; Redmond, John M; Hammarstedt, Jon E; Schwindel, Leslie; Domb, Benjamin G

    2014-10-01

    The purpose of this systematic review was to evaluate the literature to determine complications of hip arthroscopy, with a secondary focus on how to minimize complications and risks. Two independent reviewers performed a search of PubMed for articles that contained at least 1 of the following terms: complications and hip arthroscopy, hip impingement, femoral acetabular impingement and complications, or femoroacetabular impingement (FAI) and complications. The search was limited to articles published between 1999 and June 2013. An additional search was performed for articles evaluating techniques on how to minimize complications. We identified 81 studies (5,535 patients; 6,277 hips). The mean age was 35.48 years, and the mean body mass index was 25.20 kg/m(2). Of the participants, 52% were male and 48% were female. The majority of studies were Level IV Evidence (63%). A total of 285 complications were reported, for an overall rate of 4.5%. There were 26 major complications (0.41%) and a 4.1% minor complication rate. The overall reoperation rate was 4.03%. A total of 94 hips underwent revision arthroscopy. Regarding open procedures, 150 patients (93%) underwent either total hip arthroplasty or a hip resurfacing procedure. The conversion rate to total hip arthroplasty or a resurfacing procedure was 2.4%. Overall, primary hip arthroscopy is a successful procedure with low rates of major (0.41%) and minor (4.1%) complications. The reoperation rate was 4.03% in our review. There is admittedly a learning curve to performing hip arthroscopy, and we present a systematic review of the complications and how to minimize these complications with careful technique and planning. Level IV, systematic review of Level II to V studies. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  6. BCYCLIC: A parallel block tridiagonal matrix cyclic solver

    NASA Astrophysics Data System (ADS)

    Hirshman, S. P.; Perumalla, K. S.; Lynch, V. E.; Sanchez, R.

    2010-09-01

    A block tridiagonal matrix is factored with minimal fill-in using a cyclic reduction algorithm that is easily parallelized. Storage of the factored blocks allows the application of the inverse to multiple right-hand sides which may not be known at factorization time. Scalability with the number of block rows is achieved with cyclic reduction, while scalability with the block size is achieved using multithreaded routines (OpenMP, GotoBLAS) for block matrix manipulation. This dual scalability is a noteworthy feature of this new solver, as well as its ability to efficiently handle arbitrary (non-powers-of-2) block row and processor numbers. Comparison with a state-of-the art parallel sparse solver is presented. It is expected that this new solver will allow many physical applications to optimally use the parallel resources on current supercomputers. Example usage of the solver in magneto-hydrodynamic (MHD), three-dimensional equilibrium solvers for high-temperature fusion plasmas is cited.

  7. [Efficacy and safety of ultrasound-guided or neurostimulator-guided bilateral axillary brachial plexus block].

    PubMed

    Xu, C S; Zhao, X L; Zhou, H B; Qu, Z J; Yang, Q G; Wang, H J; Wang, G

    2017-10-17

    Objective: To explore the efficacy and safety of bilateral axillary brachial plexus block under the guidance of ultrasound or neurostimulator. Methods: From February 2012 to April 2014, 120 patients undergoing bilateral hand/forearm surgery in Beijing Jishuitan Hospital were enrolled and anaesthetized with bilateral axillary brachial plexus block. All patients were divided into two groups randomly using random number table: the ultrasound-guided group (group U, n =60) and the neurostimulator-guidedgroup (group N, n =60). The block was performed with 0.5% ropivacaine. Patients' age, sex and operation duration were recorded. Moreover, success rate, performance time, onset of sensor and motor block, performance pain, patient satisfaction degree and the incidence of related complications were also documented. Venous samples were collected at selected time points and the total and the plasma concentrations of ropivacaine were analyzed with HPLC. Results: The performance time, the onset of sensor block and the onset of motor block of group U were (8.2±1.5), (14.2± 2.2)and (24.0±3.5)min respectively, which were markedly shorter than those in group N( (14.6±3.9), (19.9±3.8), (28.8±4.2)min, respectively), and the differences were statistically significant( t =11.74, 10.09, 6.73, respectively, all P <0.01). The performance pain score of group N was (25.5± 13.2), which was obviously more serious than group U (31.7± 11.2) and a significant statistical difference was detected ( t =2.856, P <0.05). The patient satisfaction degree of group U was 95.0%, which was significantly higher than group N (83.3%) and a markedly statistical difference was detected (χ(2)=4.227, P <0.05). Fifty min after performance, the total plasma concentration of ropivacaine of group U was(1.76±0.48)mg/L, which was significantly lower than group N (1.88±0.53)mg/L and a significant statistical difference was detected ( t =2.43, P <0.05), while no significant differences were detected at the

  8. Tips Under the Skin: A Simple Modification of Extension Block Pinning for Mallet Fractures.

    PubMed

    Shin, Seung-Han; Lee, Yong-Suk; Kang, Jin-Woo; Kang, Wonwoo; Chung, Yang-Guk

    2018-03-01

    Pins exposed out of the skin after surgery for mallet fractures keep patients from washing their hands. The authors buried the tips of all pins under the skin while performing extension block pinning for 14 patients with mallet fractures. The patients were allowed to wash their hands 4 to 5 days postoperatively, without any dressing or splinting. The pins were removed at a mean of 8 weeks postoperatively. Solid union was achieved in all 14 fractures. No pull-out or subsidence of the pin was observed. No patient developed infection or other pin-related complications. Mean extension lag at final follow-up was 4°. [Orthopedics. 2018; 41(2):e299-e302.]. Copyright 2018, SLACK Incorporated.

  9. Ocular complications associated with local anesthesia administration in dentistry.

    PubMed

    Boynes, Sean G; Echeverria, Zydnia; Abdulwahab, Mohammad

    2010-10-01

    The most widely used method for controlling pain during dental procedures is the intraoral administration of local anesthetics in close proximity to a specific nerve or fiber to obtund nerve conduction. The most commonly anesthetized nerves in dentistry are branches or nerve trunks associated with the maxillary and mandibular divisions of the trigeminal nerve (cranial nerve V). However, other nerves may be inadvertently affected by intraoral local anesthesia injections, resulting in anesthetic complications of structures far from the oral cavity. Practitioners should be aware of potential ocular complications following intraoral injections in dentistry. These complications include oculomotor paralysis and vision loss. The knowledge of these conditions and their potential cause should alert the dentist to the importance of appropriate injection techniques and an understanding of management protocol. Copyright © 2010 Elsevier Inc. All rights reserved.

  10. Catheter ablation as a treatment of atrioventricular block.

    PubMed

    Tuohy, Stephen; Saliba, Walid; Pai, Manjunath; Tchou, Patrick

    2018-01-01

    Symptomatic second-degree atrioventricular (AV) block is typically treated by implantation of a pacemaker. An otherwise healthy AV conduction system can nevertheless develop AV block due to interference from junctional extrasystoles. When present with a high burden, these can produce debilitating symptoms from AV block despite an underlying normal AV node and His-Purkinje system properties. The purpose of this study was to describe a catheter ablation approach for alleviating symptomatic AV block due to a ventricular nodal pathway interfering with AV conduction. Common clinical monitoring techniques such as Holter and event recorders were used. Standard electrophysiological study techniques using multipolar recording and ablation catheters were utilized during procedures. A 55-year-old woman presented with highly symptomatic, high-burden second-degree AV block due to concealed and manifest junctional premature beats. Electrophysiological characteristics indicated interference of AV conduction due to a concealed ventricular nodal pathway as the cause of the AV block. The patient's AV nodal and His-Purkinje system conduction characteristics were otherwise normal. Radiofrequency catheter ablation of the pathway was successful in restoring normal AV conduction and eliminating her clinical symptoms. Pathways inserting into the AV junction can interfere with AV conduction. When present at a high burden, this type of AV block can be highly symptomatic. Catheter ablation techniques can be used to alleviate this type of AV block and restore normal AV conduction. Copyright © 2017 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.

  11. The Snack Shop: Block Play in a Primary Classroom.

    ERIC Educational Resources Information Center

    Harris, Teresa

    1994-01-01

    Describes a block play activity undertaken in a kindergarten through second-grade multiage classroom, in which children used blocks and various other props to construct and operate an imaginary snack shop. Discusses the benefits of block play and guidelines for teachers to follow in establishing block play activities. (MDM)

  12. Selective block of late Na+ current by local anaesthetics in rat large sensory neurones

    PubMed Central

    Baker, Mark D

    2000-01-01

    The actions of lignocaine and benzocaine on transient and late Na+ current generated by large diameter (⩾50 μm) adult rat dorsal root ganglion neurones, were studied using patch-clamp techniques.Both drugs blocked whole-cell late Na+ current in a concentration-dependent manner. At 200 ms following the onset of a clamp step from −110 to −40 mV, the apparent K for block of late Na+ current by lignocaine was 57.8±15 μM (mean±s.e.mean, n=4). The value for benzocaine was 24.9±3.3 μM, (mean±s.e.mean, n=3).The effect of lignocaine on transient current, in randomly selected neurones, appeared variable (n=8, half-block from ∼50 to 400 μM). Half-block by benzocaine was not attained, but both whole-cell (n=11) and patch data suggested a high apparent K,>250 μM. Transient current always remained after late current was blocked.The voltage-dependence of residual late current steady-state inactivation was not shifted by 20 μM benzocaine (n=3), whereas 200 μM benzocaine shifted the voltage-dependence of transient current steady-state inactivation by −18.7±5.9 mV (mean±s.e.mean, n=4).In current-clamp, benzocaine (250 μM) could block subthreshold, voltage-dependent inward current, increasing the threshold for eliciting action potentials, without preventing their generation (n=2).Block of late Na+ current by systemic local anaesthetic may play a part in preventing ectopic impulse generation in sensory neurones. PMID:10780966

  13. Compressed-Sensing Reconstruction Based on Block Sparse Bayesian Learning in Bearing-Condition Monitoring

    PubMed Central

    Sun, Jiedi; Yu, Yang; Wen, Jiangtao

    2017-01-01

    Remote monitoring of bearing conditions, using wireless sensor network (WSN), is a developing trend in the industrial field. In complicated industrial environments, WSN face three main constraints: low energy, less memory, and low operational capability. Conventional data-compression methods, which concentrate on data compression only, cannot overcome these limitations. Aiming at these problems, this paper proposed a compressed data acquisition and reconstruction scheme based on Compressed Sensing (CS) which is a novel signal-processing technique and applied it for bearing conditions monitoring via WSN. The compressed data acquisition is realized by projection transformation and can greatly reduce the data volume, which needs the nodes to process and transmit. The reconstruction of original signals is achieved in the host computer by complicated algorithms. The bearing vibration signals not only exhibit the sparsity property, but also have specific structures. This paper introduced the block sparse Bayesian learning (BSBL) algorithm which works by utilizing the block property and inherent structures of signals to reconstruct CS sparsity coefficients of transform domains and further recover the original signals. By using the BSBL, CS reconstruction can be improved remarkably. Experiments and analyses showed that BSBL method has good performance and is suitable for practical bearing-condition monitoring. PMID:28635623

  14. Blocking Losses With a Photon Counter

    NASA Technical Reports Server (NTRS)

    Moision, Burce E.; Piazzolla, Sabino

    2012-01-01

    It was not known how to assess accurately losses in a communications link due to photodetector blocking, a phenomenon wherein a detector is rendered inactive for a short time after the detection of a photon. When used to detect a communications signal, blocking leads to losses relative to an ideal detector, which may be measured as a reduction in the communications rate for a given received signal power, or an increase in the signal power required to support the same communications rate. This work involved characterizing blocking losses for single detectors and arrays of detectors. Blocking may be mitigated by spreading the signal intensity over an array of detectors, reducing the count rate on any one detector. A simple approximation was made to the blocking loss as a function of the probability that a detector is unblocked at a given time, essentially treating the blocking probability as a scaling of the detection efficiency. An exact statistical characterization was derived for a single detector, and an approximation for multiple detectors. This allowed derivation of several accurate approximations to the loss. Methods were also derived to account for a rise time in recovery, and non-uniform illumination due to diffraction and atmospheric distortion of the phase front. It was assumed that the communications signal is intensity modulated and received by an array of photon-counting photodetectors. For the purpose of this analysis, it was assumed that the detectors are ideal, in that they produce a signal that allows one to reproduce the arrival times of electrons, produced either as photoelectrons or from dark noise, exactly. For single detectors, the performance of the maximum-likelihood (ML) receiver in blocking is illustrated, as well as a maximum-count (MC) receiver, that, when receiving a pulse-position-modulated (PPM) signal, selects the symbol corresponding to the slot with the largest electron count. Whereas the MC receiver saturates at high count rates

  15. Epidural block

    MedlinePlus

    ... body. This lessens the pain of contractions during childbirth. An epidural block may also be used to ... extremities. This article focuses on epidural blocks during childbirth. How is the Epidural Given? The block or ...

  16. Basic performance evaluation of a Si-PM array-based LGSO phoswich DOI block detector for a high-resolution small animal PET system.

    PubMed

    Yamamoto, Seiichi

    2013-07-01

    The silicon photomultiplier (Si-PM) is a promising photodetector for PET. However, it remains unclear whether Si-PM can be used for a depth-of-interaction (DOI) detector based on the decay time differences of the scintillator where pulse shape analysis is used. For clarification, we tested the Hamamatsu 4 × 4 Si-PM array (S11065-025P) combined with scintillators that used different decay times to develop DOI block detectors using the pulse shape analysis. First, Ce-doped Gd(2)SiO(5) (GSO) scintillators of 0.5 mol% Ce were arranged in a 4 × 4 matrix and were optically coupled to the center of each pixel of the Si-PM array for measurement of the energy resolution as well as its gain variations according to the temperature. Then two types of Ce-doped Lu(1.9)Gd(0.1)Si0(5) (LGSO) scintillators, 0.025 mol% Ce (decay time: ~31 ns) and 0.75 mol% Ce (decay time: ~46 ns), were optically coupled in the DOI direction, arranged in a 11 × 7 matrix, and optically coupled to a Si-PM array for testing of the possibility of a high-resolution DOI detector. The energy resolution of the Si-PM array-based GSO block detector was 18 ± 4.4 % FWHM for a Cs-137 gamma source (662 keV). Less than 1 mm crystals were clearly resolved in the position map of the LGSO DOI block detector. The peak-to-valley ratio (P/V) derived from the pulse shape spectra of the LGSO DOI block detector was 2.2. These results confirmed that Si-PM array-based DOI block detectors are promising for high-resolution small animal PET systems.

  17. Fluvial entrainment of low density peat blocks (block carbon)

    NASA Astrophysics Data System (ADS)

    Warburton, Jeff

    2014-05-01

    In many fluvial environments low density materials are transported in significant quantities and these form an important part of the stream load and /or have a distinct impact on sedimentation in these environments. However, there are significant gaps in understanding of how these materials are entrained and transported by streams and rivers. Eroding upland peatland environments in particular, frequently have fluvial systems in which large eroded peat blocks, often exceeding 1 m in length; form an important component of the stream material flux. Transport of this material is significant in determining rates of erosion but also has important impacts in terms of damage to infrastructure and carbon loss. This paper describes a field experiment designed to establish for the first time the conditions under which large peat blocks (c. > 0.1 m b axis) are initially entrained from a rough gravel bed. The field site is Trout Beck, in the North Pennines, Northern England which is an upland wandering river channel with occasional lateral and mid channel bars. Mean low flow stage is typically 0.2 m but during flood can rapidly rise, in one to two hours, to over 1.5 m. To study peat block entrainment a bespoke data acquisition system consisting of two pressure transducers, four release triggers and time lapse camera was set up. The pressure transducers provided a record of local depth and the release triggers were embedded in peat blocks to record initial motion and arranged on the rough stream bed. The time lapse camera provided verification of timing of block entrainment (during daylight hours) and also provided information on the mechanism of initial movement. Peat blocks were cut from a local source and were equidimensional, ranging in size from 0.1 to 0.7 m. The derived entrainment function is related to a critical depth of entrainment. Results demonstrate that peat blocks are entrained when the local depth approximates the height of the peat block. Blocks frequently shift

  18. Block Copolymer Nanoparticles Remove Biofilms of Drug-Resistant Gram-Positive Bacteria by Nanoscale Bacterial Debridement.

    PubMed

    Li, Jianghua; Zhang, Kaixi; Ruan, Lin; Chin, Seow Fong; Wickramasinghe, Nirmani; Liu, Hanbin; Ravikumar, Vikashini; Ren, Jinghua; Duan, Hongwei; Yang, Liang; Chan-Park, Mary B

    2018-06-26

    Biofilms and the rapid evolution of multidrug resistance complicate the treatment of bacterial infections. Antibiofilm agents such as metallic-inorganic nanoparticles or peptides act by exerting antibacterial effects and, hence, do not combat biofilms of antibiotics-resistant strains. In this Letter, we show that the block copolymer DA95B5, dextran- block-poly((3-acrylamidopropyl) trimethylammonium chloride (AMPTMA)- co-butyl methacrylate (BMA)), effectively removes preformed biofilms of various clinically relevant multidrug-resistant Gram-positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE V583), and Enteroccocus faecalis (OG1RF). DA95B5 self-assembles into core-shell nanoparticles with a nonfouling dextran shell and a cationic core. These nanoparticles diffuse into biofilms and attach to bacteria but do not kill them; instead, they promote the gradual dispersal of biofilm bacteria, probably because the solubility of the bacteria-nanoparticle complex is enhanced by the nanoparticle dextran shell. DA95B5, when applied as a solution to a hydrogel pad dressing, shows excellent in vivo MRSA biofilm removal efficacy of 3.6 log reduction in a murine excisional wound model, which is significantly superior to that for vancomycin. Furthermore, DA95B5 has very low in vitro hemolysis and negligible in vivo acute toxicity. This new strategy for biofilm removal (nanoscale bacterial debridement) is orthogonal to conventional rapidly developing resistance traits in bacteria so that it is as effective toward resistant strains as it is toward sensitive strains and may have widespread applications.

  19. A comparison of plasma levobupivacaine concentrations following transversus abdominis plane block and rectus sheath block.

    PubMed

    Yasumura, R; Kobayashi, Y; Ochiai, R

    2016-05-01

    Levobupivacaine is commonly used as the local anaesthetic of choice in peripheral nerve blocks, but its pharmacokinetics have not been fully investigated. We compared the changes in plasma concentrations of levobupivacaine following transversus abdominis plane block and rectus sheath block. Fifty woman undergoing laparoscopy were randomly allocated to receive either a transversus abdominis plane block or an rectus sheath block. In both groups, 2.5 mg.kg(-1) levobupivacaine was administered, and blood samples were obtained 15 min, 30 min, 60 min and 120 min after injection. The mean maximum plasma concentration (Cmax) and mean time to reach Cmax (Tmax) as determined by non-linear regression analysis were 1.05 μg.ml(-1) and 32.4 min in the transversus abdominis plane group and 0.95 μg.ml(-1) and 60.9 min in the rectus sheath group, respectively. The plasma concentration of levobupivacaine peaked earlier in the transversus abdominis plane group than in the rectus sheath group and the maximum plasma concentration depended on the dose administered but not the procedure. © 2016 The Association of Anaesthetists of Great Britain and Ireland.

  20. Fractionated laser skin resurfacing treatment complications: a review.

    PubMed

    Metelitsa, Andrei I; Alster, Tina S

    2010-03-01

    Fractional photothermolysis represents a new modality of laser skin resurfacing that was developed to provide a successful clinical response while minimizing postoperative recovery and limiting treatment complications. To review all of the reported complications that develop as a result of fractional ablative and nonablative laser skin resurfacing. A literature review was based on a MEDLINE search (1998-2009) for English-language articles related to laser treatment complications and fractional skin resurfacing. Articles presenting the highest level of evidence and the most recent reports were preferentially selected. Complications with fractional laser skin resurfacing represent a full spectrum of severity and can be longlasting. In general, a greater likelihood of developing post-treatment complications is seen in sensitive cutaneous areas and in patients with intrinsically darker skin phototypes or predisposing medical risk factors. Although the overall rate of complications associated with fractional laser skin resurfacing is much lower than with traditional ablative techniques, recent reports suggest that serious complications can develop. An appreciation of all of the complications associated with fractional laser skin resurfacing is important, especially given that many of them can be potentially prevented. The authors have indicated no significant interest with commercial supporters.

  1. Effect of cooled hyperbaric bupivacaine on unilateral spinal anesthesia success rate and hemodynamic complications in inguinal hernia surgery.

    PubMed

    Tomak, Yakup; Erdivanli, Basar; Sen, Ahmet; Bostan, Habib; Budak, Ersel Tan; Pergel, Ahmet

    2016-02-01

    We hypothesized that cooling hyperbaric bupivacaine from 23 to 5 °C may limit the intrathecal spread of bupivacaine and therefore increase the success rate of unilateral spinal anesthesia and decrease the rate of hemodynamic complications. A hundred patients scheduled for elective unilateral inguinal hernia surgery were randomly allocated to receive 1.8 ml of 0.5 % hyperbaric bupivacaine intrathecally at either 5 °C (group I, n = 50) or at 23 °C (group II, n = 50). Following spinal block at the L2-3 interspace, the lateral decubitus position was maintained for 15 min. Unilateral spinal anesthesia was assessed and confirmed at 15 and 30 min. The levels of sensory and motor block on the operative side were evaluated until complete resolution. The rate of unilateral spinal anesthesia at 15 and 30 min was significantly higher in group I (p = 0.015 and 0.028, respectively). Hypotensive events and bradycardia were significantly rarer in group I (p = 0.014 and 0.037, respectively). The density and viscosity of the solution at 5 °C was significantly higher than at 23 °C (p < 0.0001). Compared with group II, sensory block peaked later in group I (17.4 vs 12.6 min) and at a lower level (T9 vs T7), and two-segment regression of sensory block (76.4 vs 84.3 min) and motor block recovery was shorter (157.6 vs 193.4 min) (p < 0.0001). Cooling of hyperbaric bupivacaine to 5 °C increased the density and viscosity of the solution and the success rate of unilateral spinal anesthesia, and decreased the hemodynamic complication rate.

  2. Resonant soft x-ray GISAXS on block copolymer films

    NASA Astrophysics Data System (ADS)

    Wang, Cheng; Araki, T.; Watts, B.; Ade, H.; Hexemer, A.; Park, S.; Russell, T. P.; Schlotter, W. F.; Stein, G. E.; Tang, C.; Kramer, E. J.

    2008-03-01

    Ordered block copolymer thin films may have important applications in modern device fabrication. Current characterization methods such as conventional GISAXS have fixed electron density contrast that can be overwhelmed by surface scattering. However, soft x-rays have longer wavelength, energy dependent contrast and tunable penetration, making resonant GISAXS a very promising tool for probing nanostructured polymer thin films. Our preliminary investigation was performed using PS-b-P2VP block copolymer films on beam-line 5-2 SSRL, and beam-line 6.3.2 at ALS, LBNL. The contrast/sensitivity of the scattering pattern varies significantly with photon energy close to the C K-edge (˜290 eV). Also, higher order peaks are readily observed, indicating hexagonal packing structure in the sample. Comparing to the hard x-ray GISAXS data of the same system, it is clear that resonant GISAXS has richer data and better resolution. Beyond the results on the A-B diblock copolymers, results on ABC block copolymers are especially interesting.

  3. East Cameron Block 270, a Pleistocene field

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Holland, D.S.; Sutley, C.E.; Berlitz, R.E.

    1974-01-01

    Exploration of the Plio-Pleistocene in the Gulf of Mexico since 1970 has discovered significant hydrocarbon reserves. One of the better gas fields to date has been the Block 270 E. Cameron field. Utilization of a coordinated exploitation plan with Schlumberger has allowed Pennzoil as operator, to develop and put on production the Block 270 field in a minimum time period. Block 270 field is a N.-S. trending faulted nose at 6,000 ft. At G-Sand depth (8,700 ft), the structure has closed, forming an elongated N.-S. structure with dip in all directions from the Block 270 area. Closure is the resultmore » of contemporaneous growth on the E. bounding regional fault. Structural and stratigraphic interpretations from dipmeters were used to help determine the most favorable offset locations.« less

  4. A 0.7-V 17.4- μ W 3-lead wireless ECG SoC.

    PubMed

    Khayatzadeh, Mahmood; Zhang, Xiaoyang; Tan, Jun; Liew, Wen-Sin; Lian, Yong

    2013-10-01

    This paper presents a fully integrated sub-1 V 3-lead wireless ECG System-on-Chip (SoC) for wireless body sensor network applications. The SoC includes a two-channel ECG front-end with a driven-right-leg circuit, an 8-bit SAR ADC, a custom-designed 16-bit microcontroller, two banks of 16 kb SRAM, and a MICS band transceiver. The microcontroller and SRAM blocks are able to operate at sub-/near-threshold regime for the best energy consumption. The proposed SoC has been implemented in a standard 0.13- μ m CMOS process. Measurement results show the microcontroller consumes only 2.62 pJ per instruction at 0.35 V . Both microcontroller and memory blocks are functional down to 0.25 V. The entire SoC is capable of working at single 0.7-V supply. At the best case, it consumes 17.4 μ W in heart rate detection mode and 74.8 μW in raw data acquisition mode under sampling rate of 500 Hz. This makes it one of the best ECG SoCs among state-of-the-art biomedical chips.

  5. Transient Delayed Facial Nerve Palsy After Inferior Alveolar Nerve Block Anesthesia

    PubMed Central

    Tzermpos, Fotios H.; Cocos, Alina; Kleftogiannis, Matthaios; Zarakas, Marissa; Iatrou, Ioannis

    2012-01-01

    Facial nerve palsy, as a complication of an inferior alveolar nerve block anesthesia, is a rarely reported incident. Based on the time elapsed, from the moment of the injection to the onset of the symptoms, the paralysis could be either immediate or delayed. The purpose of this article is to report a case of delayed facial palsy as a result of inferior alveolar nerve block, which occurred 24 hours after the anesthetic administration and subsided in about 8 weeks. The pathogenesis, treatment, and results of an 8-week follow-up for a 20-year-old patient referred to a private maxillofacial clinic are presented and discussed. The patient's previous medical history was unremarkable. On clinical examination the patient exhibited generalized weakness of the left side of her face with a flat and expressionless appearance, and she was unable to close her left eye. One day before the onset of the symptoms, the patient had visited her dentist for a routine restorative procedure on the lower left first molar and an inferior alveolar block anesthesia was administered. The patient's medical history, clinical appearance, and complete examinations led to the diagnosis of delayed facial nerve palsy. Although neurologic occurrences are rare, dentists should keep in mind that certain dental procedures, such as inferior alveolar block anesthesia, could initiate facial nerve palsy. Attention should be paid during the administration of the anesthetic solution. PMID:22428971

  6. Electrically and chemically tunable soft-solid block copolymer structural color (Conference Presentation)

    NASA Astrophysics Data System (ADS)

    Park, Cheolmin

    2016-09-01

    1D photonic crystals based on the periodic stacking of two different dielectric layers have been widely studied due to their potential use in low-power reflective mode displays, e-books and sensors, but the fabrication of mechanically flexible polymer structural color (SC) films, with electro-active color switching, remains challenging. Here, we demonstrate free-standing electric field tunable ionic liquid swollen block copolymer films. Placement of a polymer/ionic liquid (IL) film-reservoir adjacent to a self-assembled poly(styrene-block-quaternized 2vinyl pyridine) (PS-b-QP2VP) copolymer SC film allowed the development of R, G and B full-color SC block copolymer films by swelling of the QP2VP domains by the ionic liquid associated with water molecules. The IL-polymer/BCP SC film is mechanically flexible with excellent color stability over several days at ambient conditions. The selective swelling of the QP2VP domains could be controlled by both the ratio of the IL to a polymer in the gel-like IL reservoir layer and by an applied voltage in the range of -3V to +6V using a metal/IL reservoir/SC film/IL reservoir/metal capacitor type device.

  7. Long-term outcome of catheter ablation for left posterior fascicular ventricular tachycardia with the development of left posterior fascicular block and characteristics of repeat procedures.

    PubMed

    Luo, Bin; Zhou, Gongbu; Guo, Xiaogang; Liu, Xu; Yang, Jiandu; Sun, Qi; Ma, Jian; Zhang, Shu

    2017-06-01

    The present study aimed to retrospectively investigate long-term clinical outcomes of patients undergoing catheter ablation of left posterior fascicular ventricular tachycardia (LPF-VT) with the development of left posterior fascicular block (LPF block) and characteristics of repeat procedures. A total of 195 patients (mean age 29.76±1.03years, 16.4% females) who underwent catheter ablation for LPF-VT were consecutively enrolled. The earliest ventricular potential with a single fused Purkinje potential (PP) during VT and the PP located in the inferior-apical or mid-apical septum during SR were targeted for linear ablation. The endpoint of the procedure was noninducible VT and development of new-onset LPF block. Follow-up with clinic visits or telephonic interviews, electrocardiogram (ECG), or Holter monitoring was performed after the procedure. With a median follow-up of 85 (18,181) months, 20 patients were censored and 152 of 175 (86.86%) patients had long-term freedom from VT after a single procedure. No statistical difference in the outcome of catheter ablation of LPF-VT was found between inducible and non-inducible groups (P=0.89). Twenty-three patients exhibited recurrent LPF-VT. Seven of 23 patients developed new-onset left upper septal ventricular tachycardia that was successfully ablated. All the patients undergoing repeat procedures had freedom from VT. No procedural complications occurred. Ablation of LPF-VT using the development of LPF block as the endpoint is associated with a high procedural success rate. No difference in freedom from LPF-VT was found between inducible and non-inducible patients. New-onset LPF block recovery and non-early PP-QRS interval can be the predictors of LPF-VT repeat procedure. Copyright © 2017 Elsevier B.V. All rights reserved.

  8. Introgression of a Block of Genome Under Infinitesimal Selection.

    PubMed

    Sachdeva, Himani; Barton, Nicholas H

    2018-06-12

    Adaptive introgression is common in nature and can be driven by selection acting on multiple, linked genes. We explore the effects of polygenic selection on introgression under the infinitesimal model with linkage. This model assumes that the introgressing block has an effectively infinite number of loci, each with an infinitesimal effect on the trait under selection. The block is assumed to introgress under directional selection within a native population that is genetically homogeneous. We use individual-based simulations and a branching process approximation to compute various statistics of the introgressing block, and explore how these depend on parameters such as the map length and initial trait value associated with the introgressing block, the genetic variability along the block, and the strength of selection. Our results show that the introgression dynamics of a block under infinitesimal selection are qualitatively different from the dynamics of neutral introgression. We also find that in the long run, surviving descendant blocks are likely to have intermediate lengths, and clarify how their length is shaped by the interplay between linkage and infinitesimal selection. Our results suggest that it may be difficult to distinguish the long-term introgression of a block of genome with a single strongly selected locus from the introgression of a block with multiple, tightly linked and weakly selected loci. Copyright © 2018, Genetics.

  9. Queer (v.) queer (v.): biology as curriculum, pedagogy, and being albeit queer (v.)

    NASA Astrophysics Data System (ADS)

    Broadway, Francis S.

    2011-06-01

    In order to advance the purpose of education as creating a sustainable world yet to be imagined, educationally, queer (v.) queer (v.) expounds curriculum, pedagogy and being, which has roots in sexuality—the public face of the private confluence of sexuality, gender, race and class, are a necessary framework for queer. If queer is a complicated conversation of strangers' eros, then queer facilitates the creation of space, revolution and transformation. In other words, queer, for science education, is more than increasing and privileging the heteronormative and non-heteronormative science content that extends capitalism's hegemony, but rather science as the dignity, identity, and loving and caring of and by one's self and fellow human beings as strangers.

  10. Successful emergency pain control for posterior rib fractures with ultrasound-guided erector spinae plane block.

    PubMed

    Luftig, Josh; Mantuani, Daniel; Herring, Andrew A; Dixon, Brittany; Clattenburg, Eben; Nagdev, Arun

    2017-12-28

    The Eastern Association for the Surgery of Trauma and Trauma Anesthesiology Society Guidelines recommend prompt and effective multimodal analgesia for rib fractures that combines regional anesthesia (RA) techniques with pharmacotherapy to treat pain, optimize pulmonary function, and reduce opioid related complications. However, RA techniques such as epidurals and paravertebral blocks, are generally underutilized or unavailable for emergency department (ED) patients. The recently described serratus anterior plane block (SAPB) is a promising technique, but failures with posterior rib fractures have been observed. The erector spinae plane block (ESPB) is conceptually similar to the SAPB, but targets the posterior thorax making it likely more effective for ED patients with posterior rib fractures. Our initial experience demonstrates consistent success with the ESPB for traumatic posterior rib fracture analgesia. Herein, we present the first description of the ESPB utilized in the ED. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. A novel type of ATP block on a Ca(2+)-activated K(+) channel from bullfrog erythrocytes.

    PubMed

    Shindo, M; Imai, Y; Sohma, Y

    2000-07-01

    Using the patch-clamp technique, we have identified an intermediate conductance Ca(2+)-activated K(+) channel from bullfrog (Rana catesbeiana) erythrocytes and have investigated the regulation of channel activity by cytosolic ATP. The channel was highly selective for K(+) over Na(+), gave a linear I-V relationship with symmetrical 117.5 mM K(+) solutions and had a single-channel conductance of 60 pS. Channel activity was dependent on Ca(2+) concentration (K(1/2) = 600 nM) but voltage-independent. These basic characteristics are similar to those of human and frog erythrocyte Ca(2+)-activated K(+) (Gardos) channels previously reported. However, cytoplasmic application of ATP reduced channel activity with block exhibiting a novel bell-shaped concentration dependence. The channel was inhibited most by approximately 10 microM ATP (P(0) reduced to 5% of control) but less blocked by lower and higher concentrations of ATP. Moreover, the novel type of ATP block did not require Mg(2+), was independent of PKA or PKC, and was mimicked by a nonhydrolyzable ATP analog, AMP-PNP. This suggests that ATP exerts its effect by direct binding to sites on the channel or associated regulatory proteins, but not by phosphorylation of either of these components.

  12. Risk factors for vascular complications and treatment patterns at diagnosis of 2389 PV and ET patients: Real-world data from the Swedish MPN Registry.

    PubMed

    Abdulkarim, Khadija; Samuelsson, Jan; Johansson, Peter; Andréasson, Björn

    2017-06-01

    The study mainly aimed at investigating possible correlations between peripheral blood counts, erythropoietin (EPO), JAK2 V617F mutation, and vascular complications prior to diagnosis of a population-based cohort of newly diagnosed patients with myeloproliferative neoplasms (MPN). The study comprises 1105 patients with polycythemia vera (PV) and 1284 patients with essential thrombocythemia (ET) registered in the Swedish MPN Registry. Vascular complications, prior to diagnosis, were registered in 37% of PV patients. In multivariate analysis, low hemoglobin was the only significant risk factor (P=.0120). Among ET patients, 35% had encountered a vascular complication. Risk factors for thromboembolic complications in ET were identified as age>65 years, white cell count>12×10 9 /L, and the presence of JAK2 V617F mutation (P=.0004, P=.0038, and P=.0016, respectively). A JAK2 V617F mutation was present in 71% of ET patients with vascular complications, compared to 60% in patients without. A majority of complications were thromboembolic, in both PV and ET. We conclude that vascular complications among newly diagnosed patients had affected more than one-third of our study population. Risk factors for vascular complications prior to diagnosis were lower hemoglobin in PV, and the presence of JAK2 V617F mutation, higher age, and leukocytosis in ET. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Radiation-induced complications in prostate cancer patients treated with radiotherapy

    NASA Astrophysics Data System (ADS)

    Azuddin, A. Yusof; Rahman, I. Abdul; Siah, N. J.; Mohamed, F.; Saadc, M.; Ismail, F.

    2014-09-01

    The purpose of the study is to determine the relationship between radiation-induced complications with dosimetric and radiobiological parameters for prostate cancer patients that underwent the conformal radiotherapy treatment. 17 prostate cancer patients that have been treated with conformal radiotherapy were retrospectively analysed. The dosimetric data was retrieved in the form of dose-volume histogram (DVH) from Radiotherapy Treatment Planning System. The DVH was utilised to derived Normal Tissue Complication Probability (NTCP) in radiobiological data. Follow-up data from medical records were used to grade the occurrence of acute gastrointestinal (GI) and genitourinary (GU) complications using Radiation Therapy Oncology Group (RTOG) scoring system. The chi-square test was used to determine the relationship between radiation-induced complication with dosimetric and radiobiological parameters. 8 (47%) and 7 (41%) patients were having acute GI and GU complications respectively. The acute GI complication can be associated with V60rectum, rectal mean dose and NTCPrectum with p-value of 0.016, 0.038 and 0.049 respectively. There are no significant relationships of acute GU complication with dosimetric and radiobiological variables. Further study can be done by increase the sample size and follow up duration for deeper understanding of the factors that effecting the GU and GI complication in prostate cancer radiotherapy.

  14. Is the idea of a fast block to polyspermy based on artifact?

    PubMed

    Dale, Brian

    2014-08-01

    This purpose of this review is to look at the experimental evidence, both kinetic and electrophysiological, that led to the hypothesis of a fast electrical block to polyspermy in sea urchin eggs. The idea of a fast partial block, forwarded in the 1950's, that would reduce the receptivity of the egg surface by 1/20th following its interaction with the fertilizing spermatozoon, was based on experiments that treated fertilization as a first order chemical reaction. Here, I outline the criticisms of the Rothschild theory and demonstrate that the hypothesis of a fast partial block to polyspermy is unfounded. Notwithstanding, it was suggested in the 1970's that the membrane depolarization, induced by the fertilizing spermatozoon, prevented the interaction of supernumerary spermatozoa, the fast electrical block to polyspermy. While trans-membrane voltage recording has permitted a better understanding of the sequence of events occurring at fertilization, there is no evidence that depolarization prevents the interaction of supernumerary spermatozoa. Sperm entry is prevented at positive and negative potentials, in the voltage clamp configuration, however this is an artifact caused by the currents injected into the egg employed to hold the voltage constant in a non-physiological range. At permissive voltages, around -20 mV, where the current required to hold the voltage is minimal, only one spermatozoon normally enters the egg. Thus, irrespective of the egg voltage, the fertilizing spermatozoon is, in any case, attached to a privileged interaction site that permits entry and distinguishes it from supernumerary spermatozoa. Competence for monospermy is acquired during oocyte maturation and data on cortical organization in echinoderm eggs points to the actin filament system for regulating sperm entry. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Medical management of levodopa-associated motor complications in patients with Parkinson's disease.

    PubMed

    Jankovic, Joseph; Stacy, Mark

    2007-01-01

    Parkinson's disease is a neurodegenerative disorder that affects approximately 1% of people over the age of 60 years. Levodopa is standard, and often initial, therapy for patients with this condition; however, with continued treatment and as the disease progresses, up to 80% of patients experience 'wearing-off' symptoms, dyskinesias and other motor complications. These levodopa-associated problems may become disabling and profoundly affect quality of life. Medications commonly used to manage these symptoms include monoamine oxidase type B (MAO-B) inhibitors, catechol-O-methyltransferase (COMT) inhibitors, the NMDA receptor antagonist amantadine and dopamine receptor agonists. Agents that block MAO-B, such as rasagiline and selegiline, are used as both initial and adjunctive therapy in patients with Parkinson's disease. These medications increase concentrations of dopamine in the brain by blocking its reuptake from the synaptic cleft, a mechanism that can slow motor decline, increase 'on' time and improve symptoms of Parkinson's disease. Adverse events with these agents can include confusion, hallucination and orthostatic hypotension. MAO-B inhibition may elicit drug-drug interactions if administered with TCAs, SSRIs or SNRIs. Conventional oral selegiline is associated with potentially harmful plasma concentrations of three major amphetamine metabolites, although metabolite concentrations are significantly lower with a new orally disintegrating tablet (ODT) selegiline formulation. Selegiline ODT is also absorbed more efficiently and shows less pharmacokinetic variability than conventional oral selegiline.COMT mediates peripheral catabolism of levodopa. Therefore, agents that block COMT, such as tolcapone and entacapone, increase the elimination half-life of levodopa. Given adjunctively with levodopa, COMT inhibitors can decrease 'off' time and increase 'on' time, as well as lower the daily levodopa dose. Although more potent than entacapone, tolcapone requires

  16. Acidosis Differentially Modulates Inactivation in NaV1.2, NaV1.4, and NaV1.5 Channels

    PubMed Central

    Vilin, Yury Y.; Peters, Colin H.; Ruben, Peter C.

    2012-01-01

    NaV channels play a crucial role in neuronal and muscle excitability. Using whole-cell recordings we studied effects of low extracellular pH on the biophysical properties of NaV1.2, NaV1.4, and NaV1.5, expressed in cultured mammalian cells. Low pH produced different effects on different channel subtypes. Whereas NaV1.4 exhibited very low sensitivity to acidosis, primarily limited to partial block of macroscopic currents, the effects of low pH on gating in NaV1.2 and NaV1.5 were profound. In NaV1.2 low pH reduced apparent valence of steady-state fast inactivation, shifted the τ(V) to depolarizing potentials and decreased channels availability during onset to slow and use-dependent inactivation (UDI). In contrast, low pH delayed open-state inactivation in NaV1.5, right-shifted the voltage-dependence of window current, and increased channel availability during onset to slow and UDI. These results suggest that protons affect channel availability in an isoform-specific manner. A computer model incorporating these results demonstrates their effects on membrane excitability. PMID:22701426

  17. Comparison of compressive strength of paving block with a mixture of Sinabung ash and paving block with a mixture of lime

    NASA Astrophysics Data System (ADS)

    Hastuty, I. P.; Sembiringand Nursyamsi, I. S.

    2018-02-01

    Paving block is one of the material used as the top layer of road structure besides asphalt and concrete paving block is usually made of mixed material such as Portland cement or other adhesive material, water, and aggregate. People nowadays prefer paving block compared to other pavement such as concrete or asphalt. Their interest toward the use of paving block increase because paving block is an eco-friendly construction which is very useful in helping soil water conservation, can be done faster, has easier installation and maintenance, has a variety of shades that increase the aesthetic value, also costs cheaper than the other. Preparation of the specimens with a mixture of Sinabung ash and a mixture of Sinabung ash and lime are implemented with a mixture ratio of cement : sand : stone ash is 1: 2 : 3. The mixture is used as a substitute material by reducing the percentage amount of the weight of the cement with the composition ratio variation based on the comparative volume category of the paving block aggregate, i.e. 0%, 5%, 10%, 15%, 20%, and 25%. The result of this research shows that the maximum compressive strength value is 42.27 Mpa, it was obtained from a mixture of 10% lime with curing time 28 days. The maximum compressive strength value which is obtained from the mixture of sinabung ash is 41.60 Mpa, it was obtained from a mixture of 15% sinabung ash. From the use of these two materials, paving blocks produced are classified as paving blocks quality A and B (350 - 400 Mpa) in accordance to specification from SNI 03-0691-1996.

  18. Hydrophilic interaction chromatography-multiple reaction monitoring mass spectrometry method for basic building block analysis of low molecular weight heparins prepared through nitrous acid depolymerization.

    PubMed

    Sun, Xiaojun; Guo, Zhimou; Yu, Mengqi; Lin, Chao; Sheng, Anran; Wang, Zhiyu; Linhardt, Robert J; Chi, Lianli

    2017-01-06

    Low molecular weight heparins (LMWHs) are important anticoagulant drugs that are prepared through depolymerization of unfractionated heparin. Based on the types of processing reactions and the structures of the products, LMWHs can be divided into different classifications. Enoxaparin is prepared by benzyl esterification and alkaline depolymerization, while dalteparin and nadroparin are prepared through nitrous acid depolymerization followed by borohydride reduction. Compositional analysis of their basic building blocks is an effective way to provide structural information on heparin and LMWHs. However, most current compositional analysis methods have been limited to heparin and enoxaparin. A sensitive and comprehensive approach is needed for detailed investigation of the structure of LMWHs prepared through nitrous acid depolymerization, especially their characteristic saturated non-reducing end (NRE) and 2,5-anhydro-d-mannitol reducing end (RE). A maltose modified hydrophilic interaction column offers improved separation of complicated mixtures of acidic disaccharides and oligosaccharides. A total of 36 basic building blocks were unambiguously identified by high-resolution tandem mass spectrometry (MS). Multiple reaction monitoring (MRM) MS/MS quantification was developed and validated in the analysis of dalteparin and nadroparin samples. Each group of building blocks revealed different aspects of the properties of LMWHs, such as functional motifs required for anticoagulant activity, the structure of heparin starting materials, cleavage sites in the depolymerization reaction, and undesired structural modifications resulting from side reactions. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. 31 CFR Appendix A to Chapter V - Information Pertaining to the Specially Designated Nationals and Blocked Persons List

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... by OFAC. This Specially Designated Nationals and Blocked Persons List (“SDN List”) is updated..., identification, and delisting actions, all of which are published in the Federal Register. The SDN List is...: http://www.treasury.gov/sdn. Members of the public may also sign up through OFAC's Web site to receive...

  20. 31 CFR Appendix A to Chapter V - Information Pertaining to the Specially Designated Nationals and Blocked Persons List

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... by OFAC. This Specially Designated Nationals and Blocked Persons List (“SDN List”) is updated..., identification, and delisting actions, all of which are published in the Federal Register. The SDN List is...: http://www.treasury.gov/sdn. Members of the public may also sign up through OFAC's Web site to receive...

  1. 31 CFR Appendix A to Chapter V - Information Pertaining to the Specially Designated Nationals and Blocked Persons List

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... by OFAC. This Specially Designated Nationals and Blocked Persons List (“SDN List”) is updated..., identification, and delisting actions, all of which are published in the Federal Register. The SDN List is...: http://www.treasury.gov/sdn. Members of the public may also sign up through OFAC's Web site to receive...

  2. Hospital costs of complications after a pancreatoduodenectomy

    PubMed Central

    Santema, Trientje B; Visser, Annelies; Busch, Olivier R C; Dijkgraaf, Marcel G W; Goslings, J Carel; Gouma, D J; Ubbink, Dirk T

    2015-01-01

    Background A pancreatoduodenectomy (PD) is a highly advanced procedure associated with considerable post-operative complications and substantial costs. In this study the hospital costs associated with complications after PD were assessed. Methods A retrospective cohort study was conducted on 100 consecutive patients who underwent a pylorus-preserving (PP)PD between January 2012 and July 2013. Per patient, all complications occurring during admission or in the 30-day period after discharge were documented. All hospital costs related to the (PP)PD were defined as the costs of all medical interventions and resources during the hospitalisation period as recorded by the electronic supply tracking system. Results The median hospital costs ranged from €17 482 for a patient without complications to €55 623 for a patient with a post-operative haemorrhage. A post-operative haemorrhage was associated with a 39.6% increase in total hospital costs after adjusting for patient characteristics. Other factors significantly associated with an increase in total hospital costs were: the presence of a malignancy other than a pancreatic adenocarcinoma (29.4% cost increase), the severity grade of a complication (34.3–70.6% increase) and the presence of a post-operative infection (32.4% increase). Conclusions This study provides an in-depth analysis of hospital costs and identifies factors that are associated with substantial cost consequences of specific complications occurring after a PD. PMID:26082095

  3. Postsurgical complications in patients with renal tumours with venous thrombosis treated with surgery.

    PubMed

    Caño-Velasco, J; Herranz-Amo, F; Barbas-Bernardos, G; Mayor-de Castro, J; Aragón-Chamizo, J; Arnal-Chacón, G; Lledó García, E; Hernández-Fernández, C

    2018-04-06

    Surgery on renal tumours with venous thrombosis suffers a high rate of complications and non-negligible perioperative mortality. Our objective was to analyse the postoperative complications, their relationship with the level of the thrombus and its potential predisposing factors. A retrospective analysis was conducted of 101 patients with renal tumours with venous thrombosis operated on between 1988 and 2017. Two patients were excluded because of intraoperative pulmonary thromboembolism and exitus (2%). The postsurgical complications were classified according to Clavien-Dindo. To compare the qualitative variables, we employed the chi-squared test. We performed a multivariate analysis using binary logistic regression to identify the independent predictors. Some type of postsurgical complication occurred in 34 (34.3%) patients, 11 (11.1%) of which were severe (Clavien III-V). There were significant differences in the total complications (P=.003) and severe complications (Clavien≥III; P=.03) depending on the level of the tumour thrombus. Copyright © 2018 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  4. Complications leading to surgical revision in implantable cardioverter defibrillator patients: comparison of patients with single-chamber, dual-chamber, and biventricular devices.

    PubMed

    Duray, Gabor Z; Schmitt, Joern; Cicek-Hartvig, Sule; Hohnloser, Stefan H; Israel, Carsten W

    2009-03-01

    Implantable cardioverter defibrillator (ICD) technology has become more complex, particularly with respect to biventricular resynchronization devices. The incidence of hardware-related complications in single (SC)-, dual (DC)-, and triple (BiV)-chamber devices requiring surgical revision has not been investigated systematically. We analysed data from consecutive ICD recipients implanted between January 2000 and December 2007 with respect to the need of surgical re-intervention for device- or lead-related complications. Generator exchanges due to normal battery depletion were not considered. From 816 patients (81% male, 69% ischaemic cardiomyopathy, 48% secondary prevention ICDs) followed for 31 +/- 24 months (2118 cumulative patient-years), 98 patients underwent 110 revisions (5.2% per patient-year). Complications included lead-related revision procedures in 81 cases and generator-related problems in 29 cases. The annual incidence of surgical revision due to complications was 11.8% in BiV compared with 4.9% in SC and 4.1% in DC patients (P = 0.002). This higher revision rate was mainly caused by lead-related complications. Implantation of a BiV system was an independent risk factor of the need for surgical revision (relative risk 2.37, 95% confidence interval 1.38-4.04). Even with long-lasting operator experience, complications requiring surgical revision remain a clinically important problem of ICD therapy. The incidence of complications is significantly higher in BiV resynchronization devices than in SC and DC systems.

  5. 31 CFR Appendixes to Chapter V - Note

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .... Freight forwarders and shippers may not charter, book cargo on, or otherwise deal with blocked vessels. 7. References to regulatory parts in chapter V or other authorities: [BALKANS]: Western Balkans Stabilization... the economic sanctions programs in chapter V. (Please call OFAC Compliance Programs Division for...

  6. Health-related quality of life and social support among women treated for abortion complications in western Uganda.

    PubMed

    Lubinga, Solomon J; Levine, Gillian A; Jenny, Alisa M; Ngonzi, Joseph; Mukasa-Kivunike, Peter; Stergachis, Andy; Babigumira, Joseph B

    2013-07-15

    While the impact of abortion complications on clinical outcomes and healthcare costs has been reported, we found no reports of their impact on Health-Related Quality of Life (HRQoL), nor the role of social support in moderating such outcomes. In this study, we performed an assessment of the relationship between abortion complications, HRQoL and social support among women in Uganda. We interviewed women who were discharged after treatment for abortion complications and, as a comparison, women visiting a regional referral hospital for routine obstetric care. We administered the EuroQol instrument and the Social Support Questionnaire Short-Form, and collected demographic and socioeconomic data. We performed descriptive analyses using t-tests, Wilcoxon rank-sum tests and chi-square tests, and multivariable linear regressions with interaction effects to examine the associations between abortion complications, EQ-5D utility scores and social support. Our study included 139 women (70 with abortion complications, and 69 receiving routine obstetric care). In four out of the 5 dimensions of the EQ-5D, a larger proportion of women with abortion complications reported "some or severe" problems than women receiving routine obstetric care (self-care: 42% v 24%, p=0.033; usual activities: 49% v 16%, p<0.001; pain/discomfort: 68% v 25%, p<0.001; and anxiety/depression: 60% v 22%, p<0.001). After adjusting for age, social support, wealth tertile, employment status, marital status, and HIV status, women with abortion complications had a 0.12 (95% CI: 0.07, 0.18, p < 0.001) lower mean EQ-5D utility score than those receiving routine obstetric care. An analysis of the modifying effect of social support showed that a one-unit higher average number of people providing social support was associated with larger mean difference in EQ-5D utility score when comparing the two groups, while a one unit higher average satisfaction score with social support was associated with smaller mean

  7. Population Blocks.

    ERIC Educational Resources Information Center

    Smith, Martin H.

    1992-01-01

    Describes an educational game called "Population Blocks" that is designed to illustrate the concept of exponential growth of the human population and some potential effects of overpopulation. The game material consists of wooden blocks; 18 blocks are painted green (representing land), 7 are painted blue (representing water); and the remaining…

  8. Complications of hip fractures: A review

    PubMed Central

    Carpintero, Pedro; Caeiro, Jose Ramón; Carpintero, Rocío; Morales, Angela; Silva, Samuel; Mesa, Manuel

    2014-01-01

    Nowadays, fracture surgery represents a big part of the orthopedic surgeon workload, and usually has associated major clinical and social cost implications. These fractures have several complications. Some of these are medical, and other related to the surgical treatment itself. Medical complications may affect around 20% of patients with hip fracture. Cognitive and neurological alterations, cardiopulmonary affections (alone or combined), venous thromboembolism, gastrointestinal tract bleeding, urinary tract complications, perioperative anemia, electrolytic and metabolic disorders, and pressure scars are the most important medical complications after hip surgery in terms of frequency, increase of length of stay and perioperative mortality. Complications arising from hip fracture surgery are fairly common, and vary depending on whether the fracture is intracapsular or extracapsular. The main problems in intracapsular fractures are biological: vascularization of the femoral head, and lack of periosteum -a major contributor to fracture healing- in the femoral neck. In extracapsular fractures, by contrast, the problem is mechanical, and relates to load-bearing. Early surgical fixation, the role of anti-thromboembolic and anti-infective prophylaxis, good pain control at the perioperative, detection and management of delirium, correct urinary tract management, avoidance of malnutrition, vitamin D supplementation, osteoporosis treatment and advancement of early mobilization to improve functional recovery and falls prevention are basic recommendations for an optimal maintenance of hip fractured patients. PMID:25232517

  9. Diplopia after inferior alveolar nerve block: case report and related physiology.

    PubMed

    You, Tae Min

    2015-06-01

    Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management.

  10. Diplopia after inferior alveolar nerve block: case report and related physiology

    PubMed Central

    2015-01-01

    Although inferior alveolar nerve block is one of the most common procedures performed at dental clinics, complications or adverse effects can still occur. On rare occasions, ocular disturbances, such as diplopia, blurred vision, amaurosis, mydriasis, abnormal pupillary light reflex, retrobulbar pain, miosis, and enophthalmos, have also been reported after maxillary and mandibular anesthesia. Generally, these symptoms are temporary but they can be rather distressing to both patients and dental practitioners. Herein, we describe a case of diplopia caused by routine inferior alveolar nerve anesthesia, its related physiology, and management. PMID:28879264

  11. Transient Amaurosis and Diplopia After Inferior Alveolar Nerve Block.

    PubMed

    Odabaşi, Onur; Şahin, Onur; Polat, Mehmet Emrah

    2017-10-01

    A 40-year-old female patient was admitted to the authors' oral and maxillofacial clinic for removal of her lower left second molar under local anesthesia. The patient's medical history revealed that she had cardiac arhythmia and hypertension. Inferior alveolar nerve block was achieved using 2 mL of sefacaine (%3 mepivacaine HCL, without epinephrine). The patient complained of loss of vision in her left eye. All procedures were stopped immediately. Within 2 minutes the patient reported diplopia. All of the symptoms disappeared about 5 minutes after initial observation. Follow-up after 1 day revealed no complications. The procedure was then performed uneventfully.

  12. Adolescent Boys' and Girls' Block Constructions Differ in Structural Balance: A Block-Building Characteristic Related to Math Achievement

    ERIC Educational Resources Information Center

    Casey, Beth M.; Pezaris, Elizabeth E.; Bassi, Julie

    2012-01-01

    Two studies were conducted on block building in adolescents, assessing middle school (Study 1) and high school students (Study 2). Students were asked to build something interesting with blocks. In both samples, the same pattern of gender differences were found; boys built taller structures than girls, and balanced a larger number of blocks on a…

  13. Analysis of the V2 Vasopressin Receptor (V2R) Mutations Causing Partial Nephrogenic Diabetes Insipidus Highlights a Sustainable Signaling by a Non-peptide V2R Agonist*

    PubMed Central

    Makita, Noriko; Sato, Tomohiko; Yajima-Shoji, Yuki; Sato, Junichiro; Manaka, Katsunori; Eda-Hashimoto, Makiko; Ootaki, Masanori; Matsumoto, Naoki; Nangaku, Masaomi; Iiri, Taroh

    2016-01-01

    Disease-causing mutations in G protein-coupled receptor (GPCR) genes, including the V2 vasopressin receptor (V2R) gene, often cause misfolded receptors, leading to a defect in plasma membrane trafficking. A novel V2R mutation, T273M, identified in a boy with partial nephrogenic diabetes insipidus (NDI), shows intracellular localization and partial defects similar to the two mutants we described previously (10). Although non-peptide V2R antagonists have been shown to rescue the membrane localization of V2R mutants, their level of functional rescue is weak. Interestingly, it has been reported that a non-peptide agonist, OPC51803, activates misfolded V2R mutants intracellularly without degradation, thus potentially serving as a therapeutic agent against NDI (14). In our current experiments, however, a peptide antagonist blocked arginine vasopressin (AVP)- or OPC51803-stimulated cAMP accumulation both in COS-7 and MDCK cells, suggesting that OPC51803 mainly stimulates cell surface V2R mutants. In addition, our analyses revealed that OPC51803 works not only as a non-peptide agonist that causes activation/β-arrestin-dependent desensitization of V2R mutants expressed at the plasma membrane but also as a pharmacochaperone that promotes the endoplasmic reticulum-retained mutant maturation and trafficking to the plasma membrane. The ratio of the pharmacochaperone effect to the desensitization effect likely correlates negatively with the residual function of the tested mutants, suggesting that OPC5 has a more favorable effect on the V2R mutants with a less residual function. We speculated that the canceling of the desensitization effect of OPC51803 by the pharmacochaperone effect after long-term treatment may produce sustainable signaling, and thus pharmacochaperone agonists such as OPC51803 may serve as promising therapeutics for NDI caused by misfolded V2R mutants. PMID:27601473

  14. Method for Making a Carbon-Carbon Cylinder Block

    NASA Technical Reports Server (NTRS)

    Ransone, Phillip O. (Inventor)

    1997-01-01

    A method for making a lightweight cylinder block composed of carbon-carbon is disclosed. The use of carbon-carbon over conventional materials. such as cast iron or aluminum, reduces the weight of the cylinder block and improves thermal efficiency of the internal combustion reciprocating engine. Due to the negligible coefficient of thermal expansion and unique strength at elevated temperatures of carbon-carbon, the piston-to-cylinder wall clearance can be small, especially when the carbon-carbon cylinder block is used in conjunction with a carbon-carbon piston. Use of the carbon-carbon cylinder block has the effect of reducing the weight of other reciprocating engine components allowing the piston to run at higher speeds and improving specific engine performance.

  15. View of cell block eight (left), cell block seven, and ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View of cell block eight (left), cell block seven, and southwest guard tower, looking from cell block eight roof - Eastern State Penitentiary, 2125 Fairmount Avenue, Philadelphia, Philadelphia County, PA

  16. Cell block eleven (left) and cell block fifteen, looking from ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Cell block eleven (left) and cell block fifteen, looking from cell block two into the "Death Row" exercise yard - Eastern State Penitentiary, 2125 Fairmount Avenue, Philadelphia, Philadelphia County, PA

  17. State-dependent block of CNG channels by dequalinium.

    PubMed

    Rosenbaum, Tamara; Gordon-Shaag, Ariela; Islas, León D; Cooper, Jeremy; Munari, Mika; Gordon, Sharona E

    2004-03-01

    Cyclic nucleotide-gated (CNG) ion channels are nonselective cation channels with a high permeability for Ca(2+). Not surprisingly, they are blocked by a number of Ca(2+) channel blockers including tetracaine, pimozide, and diltiazem. We studied the effects of dequalinium, an extracellular blocker of the small conductance Ca(2+)-activated K(+) channel. We previously noted that dequalinium is a high-affinity blocker of CNGA1 channels from the intracellular side, with little or no state dependence at 0 mV. Here we examined block by dequalinium at a broad range of voltages in both CNGA1 and CNGA2 channels. We found that dequalinium block was mildly state dependent for both channels, with the affinity for closed channels 3-5 times higher than that for open channels. Mutations in the S4-S5 linker did not alter the affinity of open channels for dequalinium, but increased the affinity of closed channels by 10-20-fold. The state-specific effect of these mutations raises the question of whether/how the S4-S5 linker alters the binding of a blocker within the ion permeation pathway.

  18. Intracapsular lens extraction for the treatment of pupillary block glaucoma associated with anterior subluxation of the crystalline lens.

    PubMed

    Kim, Yong Joon; Ha, Seung Joo

    2013-01-01

    To report a case of pupillary block glaucoma associated with spontaneous crystalline lens subluxation into the anterior chamber in a 34-year-old man. Dry vitrectomy was performed for securing enough retrolental space, and an intracapsular lens extraction was then performed via a corneolimbal incision. Additional endothelial cell damage was avoided with an injection of viscoelastics and gentle extraction of the crystalline lens. After deepening of the anterior chamber, scleral fixation of the intraocular lens was performed with an ab externo technique. Two months after the operation, a well-fixated intraocular lens was observed and intraocular pressure was stable. The postoperative corneal astigmatism was -3.5 dpt, and the patient had a best-corrected visual acuity of 20/25. Postoperative complications included decreased endothelial cell count and sector iris paralysis near the incision site. An anteriorly subluxated crystalline lens can cause pupillary block glaucoma in healthy young adults. To prevent intraoperative complications, intracapsular lens extraction with dry vitrectomy can be a good surgical option. The endothelial cell density should be closely monitored after surgery.

  19. Which Ultrasound-Guided Sciatic Nerve Block Strategy Works Faster? Prebifurcation or Separate Tibial-Peroneal Nerve Block? A Randomized Clinical Trial.

    PubMed

    Faiz, Seyed Hamid Reza; Imani, Farnad; Rahimzadeh, Poupak; Alebouyeh, Mahmoud Reza; Entezary, Saeed Reza; Shafeinia, Amineh

    2017-08-01

    Peripheral nerve block is an accepted method in lower limb surgeries regarding its convenience and good tolerance by the patients. Quick performance and fast sensory and motor block are highly demanded in this method. The aim of the present study was to compare 2 different methods of sciatic and tibial-peroneal nerve block in lower limb surgeries in terms of block onset. In this clinical trial, 52 candidates for elective lower limb surgery were randomly divided into 2 groups: sciatic nerve block before bifurcation (SG; n = 27) and separate tibial-peroneal nerve block (TPG; n = 25) under ultrasound plus nerve stimulator guidance. The mean duration of block performance, as well as complete sensory and motor block, was recorded and compared between the groups. The mean duration of complete sensory block in the SG and TPG groups was 35.4 ± 4.1 and 24.9 ± 4.2 minutes, respectively, which was significantly lower in the TPG group (P = 0.001). The mean duration of complete motor block in the SG and TPG groups was 63.3 ± 4.4 and 48.4 ± 4.6 minutes, respectively, which was significantly lower in the TPG group (P = 0.001). No nerve injuries, paresthesia, or other possible side effects were reported in patients. According to the present study, it seems that TPG shows a faster sensory and motor block than SG.

  20. Enhancing instruction scheduling with a block-structured ISA

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Melvin, S.; Patt, Y.

    It is now generally recognized that not enough parallelism exists within the small basic blocks of most general purpose programs to satisfy high performance processors. Thus, a wide variety of techniques have been developed to exploit instruction level parallelism across basic block boundaries. In this paper we discuss some previous techniques along with their hardware and software requirements. Then we propose a new paradigm for an instruction set architecture (ISA): block-structuring. This new paradigm is presented, its hardware and software requirements are discussed and the results from a simulation study are presented. We show that a block-structured ISA utilizes bothmore » dynamic and compile-time mechanisms for exploiting instruction level parallelism and has significant performance advantages over a conventional ISA.« less

  1. [A transparent, internal complication management concept: results and consequences].

    PubMed

    Wagner, G; Gritzbach, B; Frank, J; Marzi, I

    2010-09-01

    The acquisition of data and public discussion of complications after therapeutic procedures and surgeries is a sensitive subject, which is mostly avoided even in department meetings. However, it is evident that the broad discussion and the expression of different opinions and aspects provide useful information for continuous improvements. Therefore, we established a system for the transparent acquisition of complications in our department. Since January 2005, we systematically register operative and non-operative complications at our department, evaluate them and therefore gain a great benefit. All the complications are presented, discussed and evaluated within the weekly morbidity and mortality conferences. In 2005 and 2006, among a total number of 2730 and, respectively, 3124 operations, 102 (3.7 %) and 71 (2.3 %) complications have been registered and analysed according to different criteria. We have distinguished between complications which required surgery and complications which only required conservative treatment. There was a higher number of complications which needed surgery. In this group, the most common complications have been found in vertebral spine surgery. The groups of complications with conservative treatment were mostly related to nerve lesions and deep venous thrombosis. With the aid of the internal department evaluation of the registered data, especially the number of complications in vertebral spine surgery could be clearly reduced in 2006. The described method has created a transparency of occurring complications because each colleague is informed as well as involved in the solution process. Furthermore, it is planned to evaluate the impact of risk factors on the various performed surgeries. © Georg Thieme Verlag KG Stuttgart · New York.

  2. Performance enhancement of perovskite solar cells with Mg-doped TiO{sub 2} compact film as the hole-blocking layer

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wang, Jing; Qin, Minchao; Tao, Hong

    2015-03-23

    In this letter, we report perovskite solar cells with thin dense Mg-doped TiO{sub 2} as hole-blocking layers (HBLs), which outperform cells using TiO{sub 2} HBLs in several ways: higher open-circuit voltage (V{sub oc}) (1.08 V), power conversion efficiency (12.28%), short-circuit current, and fill factor. These properties improvements are attributed to the better properties of Mg-modulated TiO{sub 2} as compared to TiO{sub 2} such as better optical transmission properties, upshifted conduction band minimum (CBM) and downshifted valence band maximum (VBM), better hole-blocking effect, and higher electron life time. The higher-lying CBM due to the modulation with wider band gap MgO and themore » formation of magnesium oxide and magnesium hydroxides together resulted in an increment of V{sub oc}. In addition, the Mg-modulated TiO{sub 2} with lower VBM played a better role in the hole-blocking. The HBL with modulated band position provided better electron transport and hole blocking effects within the device.« less

  3. Effect of adding dexamethasone to bupivacaine on transversus abdominis plane block for abdominal hysterectomy: A prospective randomized controlled trial

    PubMed Central

    Ammar, Amany S.; Mahmoud, Khaled M.

    2012-01-01

    Purpose: Different adjuvants have been used to improve the quality and increase the duration of local anesthetics during various nerve block techniques. The current study was aimed to evaluate the effect of adding dexamethasone to bupivacaine on the quality and duration of transversus abdominis plane (TAP) block. Methods: Sixty adult patients undergoing elective open abdominal hysterectomy were randomly allocated to receive TAP block using 20 mL of bupivacaine hydrochloride 0.25% + 2 mL saline 0.9% (control group, n=30) or 20 mL of bupivacaine hydrochloride 0.25% + 2 mL dexamethasone “8 mg” (dexamethasone group, n=30). The primary outcome was postoperative pain, as evaluated by visual analog scale (VAS) for pain scoring at 1, 2, 4, 12, 24 and 48 h postoperatively, whereas the secondary outcomes were time to first analgesia (TFA), morphine consumption and the occurrence of nausea, vomiting or somnolence. Results: The pain VAS score was significantly lower at the postoperative 2 h (4.9 vs. 28.1, P=0.01), 4 h (12.2 vs. 31.1, P=0.01) and 12 h (15.7 vs. 25.4, P=0.02). Furthermore, TFA was significantly longer in the dexamethasone group (459.8 vs. 325.4 min, P=0.002), with lesser morphine requirements in the postoperative 48 h (4.9 vs. 21.2 mg, P=0.003) and lower incidence of nausea and vomiting (6 vs. 14, P=0.03). No complications attributed to the block were recorded. Conclusion: Addition of dexamethasone to bupivacaine in TAP block prolonged the duration of the block and decreased the incidence of nausea and vomiting. PMID:23162395

  4. Program structure-based blocking

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Bertolli, Carlo; Eichenberger, Alexandre E.; O'Brien, John K.

    2017-09-26

    Embodiments relate to program structure-based blocking. An aspect includes receiving source code corresponding to a computer program by a compiler of a computer system. Another aspect includes determining a prefetching section in the source code by a marking module of the compiler. Yet another aspect includes performing, by a blocking module of the compiler, blocking of instructions located in the prefetching section into instruction blocks, such that the instruction blocks of the prefetching section only contain instructions that are located in the prefetching section.

  5. Globe penetration in a cat following maxillary nerve block for dental surgery.

    PubMed

    Perry, Rachel; Moore, Denise; Scurrell, Emma

    2015-01-01

    Dental treatment was carried out in an 8.5-year-old castrated male domestic shorthair cat found to have tooth resorption. Right mandibular, and right and left maxillary nerve blocks were administered using a 1 ml syringe attached to a 25 G x 5/8 inch needle and an intraoral technique. The following day the cat displayed blepharospasm of the right eye. The ocular signs progressed and 5 days later an ophthalmologist confirmed a blind, glaucomatous right eye. It was suspected that the eye had suffered a penetrating injury during dental surgery. Enucleation of the right eye was performed and gross and histopathological examination revealed a penetrating wound consistent with a needle tract injury. Complications arising from veterinary dental regional anaesthesia appear to be rare; however, it may be that they are under-reported. This case report highlights the risks involved and reviews the safest and most efficacious regional anaesthesia technique for the feline maxilla. © ISFM and AAFP 2015.

  6. Quadratus Lumborum Block Versus Transversus Abdominis Plane Block for Postoperative Pain After Cesarean Delivery: A Randomized Controlled Trial.

    PubMed

    Blanco, Rafael; Ansari, Tarek; Riad, Waleed; Shetty, Nanda

    Effective postoperative analgesia after cesarean delivery enhances early recovery, ambulation, and breastfeeding. In a previous study, we established the effectiveness of the quadratus lumborum block in providing pain relief after cesarean delivery compared with patient-controlled analgesia (morphine). In the current study, we hypothesized that this method would be equal to or better than the transversus abdominis plane block with regard to pain relief and its duration of action after cesarean delivery. Between April 2015 and August 2015, we randomized 76 patients scheduled for elective cesarean delivery under spinal anesthesia to receive the quadratus lumborum block or the transversus abdominis plane block for postoperative pain relief. This trial was registered prospectively (NCT 02489851) [corrected]. Patients in the quadratus lumborum block group used significantly less morphine than the transversus abdominis plane block group (P < 0.05) at 12, 24, and 48 hours but not at 4 and 6 hours after cesarean delivery. This group also had significantly fewer morphine demands than the control group (P < 0.05) at 6, 12, 24, and 48 hours after cesarean delivery. No significant differences in visual analog scale results were shown between the 2 groups at rest or with movement. Calculated total pain relief at rest and with movement were similar (P < 0.001) in both groups. The quadratus lumborum block was more effective in reducing morphine consumption and demands than transversus abdominis plane blocks after cesarean section. This effect was observed up to 48 hours postoperatively.

  7. 21 CFR 520.1448a - Monensin blocks.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... DRUGS, FEEDS, AND RELATED PRODUCTS ORAL DOSAGE FORM NEW ANIMAL DRUGS § 520.1448a Monensin blocks. (a)(1) Specifications. Each pound of protein-mineral block contains 400 milligrams of monensin (0.088 percent) as monensin sodium. (2) Sponsor. See 067949 in § 510.600(c) of this chapter. (3) Related tolerances. See § 556...

  8. 21 CFR 520.1448a - Monensin blocks.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... DRUGS, FEEDS, AND RELATED PRODUCTS ORAL DOSAGE FORM NEW ANIMAL DRUGS § 520.1448a Monensin blocks. (a)(1) Specifications. Each pound of protein-mineral block contains 400 milligrams of monensin (0.088 percent) as monensin sodium. (2) Sponsor. See 067949 in § 510.600(c) of this chapter. (3) Related tolerances. See § 556...

  9. Cardiovascular complications associated with chronic active Epstein-Barr virus infection.

    PubMed

    Muneuchi, Jun; Ohga, Shouichi; Ishimura, Masataka; Ikeda, Kazuyuki; Yamaguchi, Kenichiro; Nomura, Akihiko; Takada, Hidetoshi; Abe, Yasunobu; Hara, Toshiro

    2009-04-01

    This study aimed to assess the outcome of cardiovascular diseases for patients with chronic active Epstein-Barr virus infection (CAEBV). The study enrolled 15 patients (7 boys and 8 girls) who fulfilled the diagnostic criteria for CAEBV, including 10 patients with T-cell type and 3 patients with natural killer (NK)-cell type. The median age at the CAEBV onset was 6.3 years (range, 1.2-17.8 years). Regular cardiologic studies were performed during the median follow-up period of 8 years (range, 2-20 years). Nine patients (60%) had cardiac diseases including coronary artery lesion (CAL) (n = 4, 44%), decreased left ventricular ejection fraction and pericardial effusion in (n = 3, 33%), complete atrioventricular block (n = 1), and sudden arrest (n = 1). The frequency of fever (78%, p = 0.04) or cytopenias (100%, p = 0.01), as the major symptom among patients with cardiac complications, was higher than among those without complications. The median time from disease onset to detection of CAL was 3.4 years (range, 1.8-8.6 years). The mean z-score increased to 3.98. Seven patients (78%) with cardiac complications died of disease progression, hematopoietic stem cell transplantation-related events, or both. In two patients, CAL regressed after allogeneic cord blood transplantation. Among CAEBV patients, CAL was the most common cardiac complication and could not be controlled without the eradication of EBV-infected T- and NK-cells.

  10. Surgical Management of Complicated Necrotizing Pneumonia in Children.

    PubMed

    Lai, Jin-Yao; Yang, Wendy; Ming, Yung-Ching

    2017-08-01

    There are no well-established indications for the surgical management of acute necrotizing pneumonitis in children. This study presents our experience regarding this challenging topic. Between 2002 and 2009, 56 necrotizing pneumonitis patients with empyema were treated surgically. The outcomes were analyzed retrospectively. Computed tomography findings of massive lung necrosis or large cavities involving more than 50% of the involved lobe were deemed to be complicated necrotizing pneumonitis. Patients without the above indications were considered uncomplicated. Thirty-one cases were uncomplicated and 25 were complicated. Operative procedures included 38 decortications (31 uncomplicated and seven complicated), 14 wedge resections, and four lobectomies (complicated only). Preoperatively, patients with complicated necrotizing pneumonia had a higher incidence of pneumothorax (32% vs. 14.3%; p = 0.001), endotracheal intubation (44% vs. 9.7%; p = 0.008), and hemolytic uremic syndrome (20% vs. 3.2%; p = 0.01). These patients also had higher incidences of intraoperative transfusion (68% vs. 9.7%; p = 0.03), major postoperative complications (16% vs. 0%; p = 0.02), reoperations (16% vs. 0%; p = 0.02), and longer postoperative stay (19.8 ± 24.2 days vs. 11.2 ± 5.8 days; p = 0.03). Four complicated patients, who initially had decortications and limited resections, underwent reoperations. Compared with uncomplicated patients, those who underwent decortications and wedge resection required longer postoperative stays (23.6 ± 9.9 days, p < 0.01 and 21.1 ± 30.7 days, p = 0.04, respectively), whereas patients who had lobectomy had a similar duration of recovery (9.0 ± 2.1 days, p = 0.23). All patients improved significantly at follow-up. Children with complicated necrotizing pneumonitis have more preoperative morbidities, more major postoperative complications, and require longer postoperative stays. Aggressive surgical treatment results in

  11. Gaussian curvature analysis allows for automatic block placement in multi-block hexahedral meshing.

    PubMed

    Ramme, Austin J; Shivanna, Kiran H; Magnotta, Vincent A; Grosland, Nicole M

    2011-10-01

    Musculoskeletal finite element analysis (FEA) has been essential to research in orthopaedic biomechanics. The generation of a volumetric mesh is often the most challenging step in a FEA. Hexahedral meshing tools that are based on a multi-block approach rely on the manual placement of building blocks for their mesh generation scheme. We hypothesise that Gaussian curvature analysis could be used to automatically develop a building block structure for multi-block hexahedral mesh generation. The Automated Building Block Algorithm incorporates principles from differential geometry, combinatorics, statistical analysis and computer science to automatically generate a building block structure to represent a given surface without prior information. We have applied this algorithm to 29 bones of varying geometries and successfully generated a usable mesh in all cases. This work represents a significant advancement in automating the definition of building blocks.

  12. A discrete element modelling approach for block impacts on trees

    NASA Astrophysics Data System (ADS)

    Toe, David; Bourrier, Franck; Olmedo, Ignatio; Berger, Frederic

    2015-04-01

    These past few year rockfall models explicitly accounting for block shape, especially those using the Discrete Element Method (DEM), have shown a good ability to predict rockfall trajectories. Integrating forest effects into those models still remain challenging. This study aims at using a DEM approach to model impacts of blocks on trees and identify the key parameters controlling the block kinematics after the impact on a tree. A DEM impact model of a block on a tree was developed and validated using laboratory experiments. Then, key parameters were assessed using a global sensitivity analyse. Modelling the impact of a block on a tree using DEM allows taking into account large displacements, material non-linearities and contacts between the block and the tree. Tree stems are represented by flexible cylinders model as plastic beams sustaining normal, shearing, bending, and twisting loading. Root soil interactions are modelled using a rotation stiffness acting on the bending moment at the bottom of the tree and a limit bending moment to account for tree overturning. The crown is taken into account using an additional mass distribute uniformly on the upper part of the tree. The block is represented by a sphere. The contact model between the block and the stem consists of an elastic frictional model. The DEM model was validated using laboratory impact tests carried out on 41 fresh beech (Fagus Sylvatica) stems. Each stem was 1,3 m long with a diameter between 3 to 7 cm. Wood stems were clamped on a rigid structure and impacted by a 149 kg charpy pendulum. Finally an intensive simulation campaign of blocks impacting trees was done to identify the input parameters controlling the block kinematics after the impact on a tree. 20 input parameters were considered in the DEM simulation model : 12 parameters were related to the tree and 8 parameters to the block. The results highlight that the impact velocity, the stem diameter, and the block volume are the three input

  13. An Imide-Based Pentacyclic Building Block for n-Type Organic Semiconductors

    DOE PAGES

    Wu, Fu-Peng; Un, Hio-Ieng; Li, Yongxi; ...

    2017-10-09

    For this study a new electron-deficient unit with fused 5-heterocyclic ring was developed by replacing a cyclopenta-1,3-diene from electron-rich donor indacenodithiophene (IDT) with cyclohepta-4,6-diene-1,3-diimde unit. The imide bridging endows BBI with fixed planar configuration and both low the highest occupied molecular orbital (HOMO) (-6.24 eV) and the lowest unoccupied molecular orbit (LUMO) (-2.57 eV) energy levels. Organic field-effect transistors (OFETs) based on BBI polymers exhibit electron mobility up to 0.34 cm 2 V -1 s -1, which indicates that the BBI is a promising n-type building block for optoelectronics.

  14. An Imide-Based Pentacyclic Building Block for n-Type Organic Semiconductors

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Wu, Fu-Peng; Un, Hio-Ieng; Li, Yongxi

    For this study a new electron-deficient unit with fused 5-heterocyclic ring was developed by replacing a cyclopenta-1,3-diene from electron-rich donor indacenodithiophene (IDT) with cyclohepta-4,6-diene-1,3-diimde unit. The imide bridging endows BBI with fixed planar configuration and both low the highest occupied molecular orbital (HOMO) (-6.24 eV) and the lowest unoccupied molecular orbit (LUMO) (-2.57 eV) energy levels. Organic field-effect transistors (OFETs) based on BBI polymers exhibit electron mobility up to 0.34 cm 2 V -1 s -1, which indicates that the BBI is a promising n-type building block for optoelectronics.

  15. Divergent Gene Expression Responses to Complicated Grief and Non-complicated Grief

    PubMed Central

    Irwin, Michael R.; Arevalo, Jesusa M. G.; Cole, Steven W.

    2014-01-01

    The “widowhood effect” (i.e., morbidity/mortality in recently bereaved spouses) may be related to changes in immune function, but little is known about the impact of bereavement on gene transcription in immune cells. This study examined how Complicated Grief and Non-complicated Grief responses to bereavement differentially affect leukocyte gene expression. Genome-wide transcriptional profiling and bioinformatic analyses were completed on 63 older adults. Thirty-six of them had lost their spouse/partner on average 2 years ago, and 27 were nonbereaved, married controls. Twelve of the bereaved participants met criteria for Complicated Grief. Compared to nonbereaved controls, bereavement (both Complicated Grief and Non-complicated Grief) was associated with upregulated expression of genes involved in general immunologic activation and a selective downregulation of genes involved in B lymphocyte responses. However, Complicated Grief and Non-complicated Grief differed markedly in their expression of Type I interferon-related transcripts, with Non-complicated Grief subjects showing substantial upregulation relative to nonbereaved controls and Complicated Grief subjects showing substantial downregulation. Bereavement significantly modulates immune function gene expression. The magnitude of bereavement-related distress (i.e., Complicated Grief vs. Non-complicated Grief) is linked to differential patterns of transcription factor activation and gene expression involved in innate antiviral responses. These findings provide a molecular framework for understanding the health effects of bereavement, as well as new insights into the particular gene modules that are most sensitive to the individual's psychological response to loss. PMID:24380850

  16. An aberrant carotid artery in the temporal bone with fatal complication.

    PubMed

    Kimura, Yurika; Makino, Nao; Kobayashi, Hitome; Kitamura, Ken

    2016-06-01

    We report the case of an 84-year-old female presenting with an aberrant ICA with cerebral air embolization caused by Eustachian tube air inflation (ETAI). High pressure of air inflation developed because of an aberrant ICA blocking the tympanic orifice of the Eustachian tube, with release of the high-pressure air into the aberrant ICA. It must be kept in mind that complications may occur not only during transtympanic treatment, but also in any treatment, such as ETAI, in aberrant ICA cases. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  17. What is a virtual multidisciplinary team (vMDT)?

    PubMed Central

    Munro, A J; Swartzman, S

    2013-01-01

    Background: Multidisciplinary team meetings (MDTs), also known as tumour boards or multidisciplinary case conferences, are an integral component of contemporary cancer care. There are logistical problems with setting up and maintaining participation in these meetings. An ill-defined concept, the virtual MDT (vMDT), has arisen in response to these difficulties. We have, in order to provide clarity and to generate discussion, attempted to define the concept of the vMDT, outline its advantages and disadvantages, and consider some of the practical aspects involved in setting up a virtual MDT. Methods: This is an unstructured review of published evidence and personal experience relating to virtual teams in general, and to MDTs in particular. Results: We have devised a simple taxonomy for MDTs, discussed some of the practicalities involved in setting up a vMDT, and described some of the potential advantages and disadvantages associated with vMDTs. Conclusion: The vMDT may be useful for discussions concerning rare or unusual tumours, or for helping guide the assessment and management of patients with uncommon complications related to treatment. However, the vMDT is a niche concept and is currently unlikely to replace the more traditional face-to-face MDT in the management of common tumours at specific sites. PMID:23756866

  18. Mosquito larvicidal effectiveness of EcoBio-Block S: a novel integrated water-purifying concrete block formulation containing insect growth regulator pyriproxyfen.

    PubMed

    Kawada, Hitoshi; Saita, Susumu; Shimabukuro, Kozue; Hirano, Masachika; Koga, Masayuki; Iwashita, Toshiaki; Takagi, Masahiro

    2006-09-01

    EcoBio-Block S, a novel controlled release system (CRS) for the insect growth regulator pyriproxyfen, uses a water-purifying concrete block system (EcoBio-Block) composed of a porous volcanic rock and cement, and it incorporates the aerobic bacterial groups of Bacillus subtilis natto. EcoBio-Block S showed high inhibitory activity against mosquito emergence as well as a water-purifying effect. Chemical analysis and bioassay showed that EcoBio-Block S provides a high-performance CRS that controls the release of pyriproxyfen at low levels according to "zero order kinetics".

  19. A short review on a complication of lumbar spine surgery: CSF leak.

    PubMed

    Menon, Sajesh K; Onyia, Chiazor U

    2015-12-01

    Cerebrospinal fluid (CSF) leak is a common complication of surgery involving the lumbar spine. Over the past decades, there has been significant advancement in understanding the basis, management and techniques of treatment for post-operative CSF leak following lumbar spine surgery. In this article, we review previous work in the literature on the various factors and technical errors during or after lumbar spine surgery that may lead to this feared complication, the available options of management with focus on the various techniques employed, the outcomes and also to highlight on the current trends. We also discuss the presentation, factors contributing to its development, basic concepts and practical aspects of the management with emphasis on the different techniques of treatment. Different outcomes following various techniques of managing post-operative CSF leak after lumbar spine surgery have been well described in the literature. However, there is currently no most ideal technique among the available options. The choice of which technique to be applied in each case is dependent on each surgeon's cumulative experience as well as a clear understanding of the contributory underlying factors in each patient, the nature and site of the leak, the available facilities and equipment. Copyright © 2015 Elsevier B.V. All rights reserved.

  20. Concrete Block Pavements

    DTIC Science & Technology

    1983-03-01

    concrete paving block ( Van der Vlist 1980). The concrete paving block was readily accepted as a substitute for the scarce paving brick and today has...seen in Figure 4, its growth.has been steady ( Van der Vlist 1980). 20 15 0< 0. n 10 1𔃺 978 960 1 62 63 64 65 66 67 68 6970 71 72 73 74 7678 7778 79...Figure 4. Concrete paving block production in the Netherlands ( Van der Vlist 1980) 8. The use of concrete paving block in the Netherlands developedI

  1. Pregnancy complications and neuropsychological outcomes: A review.

    PubMed

    Gerner, Gwendolyn; Baron, Ida Sue

    2015-01-01

    Pregnancy complications elevate risk of associated adverse medical, socioenvironmental, and behavioral outcomes in children. These are likely to have a substantial impact on neuropsychological functioning and mental health across the child's lifespan. Thus, an understanding of the complex relationships between pregnancy complications and neuropsychological outcomes is critical for both practitioners and researchers. This review summarizes prevalent pregnancy complications and the associated psychological and neuropsychological findings, highlighting methodological challenges that have restricted investigations of these outcomes and identifying opportune areas for future study.

  2. View southeast of caps for blocks for JFK; blocks are ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    View southeast of caps for blocks for JFK; blocks are used to support ship when it is repositioned to paint inaccessible areas masked by original support blocks. - Naval Base Philadelphia-Philadelphia Naval Shipyard, Carpentry Shop, League Island, Philadelphia, Philadelphia County, PA

  3. A comparison of the fascia iliaca block to the lumbar plexus block in providing analgesia following arthroscopic hip surgery: A randomized controlled clinical trial.

    PubMed

    Badiola, Ignacio; Liu, Jiabin; Huang, Stephanie; Kelly, John D; Elkassabany, Nabil

    2018-05-31

    This randomized controlled single blinded clinical trial compared the fascia iliaca block (FIB) and the lumbar plexus block (LPB) in patients with moderate to severe pain following hip arthroscopic surgery. Single blinded randomized trial. Postoperative recovery area, postoperative days 0 and 1. Fifty patients undergoing hip arthroscopy were approached in the Post Anesthesia Care Unit (PACU) if they had moderate to severe pain (defined as > or equal 4/10 on the numeric rating scale). Twenty-five patients were allocated to the FIB and twenty-five patients to the LPB. Fascia iliaca block or lumbar plexus block. A blinded observer recorded pain scores just prior to the block, 15 min following the block (primary endpoint), and then every 15 min for 2 h (or until the patient was discharged). Total PACU time and opioid use were recorded. Pain scores and analgesic use on postoperative day (POD) 0, and POD 1 were recorded. At 24 h post block the Quality of Recovery 9 questionnaire was administered. The mean pre-block pain scores were comparable between the two groups (P = 0.689). There was no difference in mean post block pain scores between the two groups at 15 min (P = 0.054). In the PACU patients who underwent a LPB consumed less opioids compared to FIB patients (P = 0.02), however no differences were noted between the two groups in PACU length of stay, or POD 0 or 1 opioid use. A fascia iliaca block is not inferior to a lumbar plexus block in reducing PACU pain scores in patients with moderate to severe pain following hip arthroscopic surgery and is a viable option to help manage postoperative pain following hip arthroscopic surgery. Copyright © 2018. Published by Elsevier Inc.

  4. Ice/water slurry blocking phenomenon at a tube orifice.

    PubMed

    Hirochi, Takero; Yamada, Shuichi; Shintate, Tuyoshi; Shirakashi, Masataka

    2002-10-01

    The phenomenon of ice-particle/water mixture blocking flow through a pipeline is a problem that needs to be solved before mixture flow can be applied for practical use in cold energy transportation in a district cooling system. In this work, the blocking mechanism of ice-particle slurry at a tube orifice is investigated and a criterion for blocking is presented. The cohesive nature of ice particles is shown to cause compressed plug type blocking and the compressive yield stress of a particle cluster is presented as a measure for the cohesion strength of ice particles.

  5. 21 CFR 520.1448a - Monensin blocks.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) Limitations. Block to be fed free choice to pasture cattle (slaughter, stocker, feeder, and dairy and beef.... Blocks to be fed free choice to pasture cattle (slaughter, stocker, feeder, and dairy and beef...

  6. Role of crystallins in diabetic complications.

    PubMed

    Reddy, Vadde Sudhakar; Reddy, G Bhanuprakash

    2016-01-01

    Crystallins are the major structural proteins of vertebrate eye lens responsible for maintaining the refractive index of the lens. However, recent studies suggest that they also have a functional significance in non-lenticular tissues. Prolonged uncontrolled diabetes results in the development of macro and microvascular complications that are the leading causes of morbidity and mortality in diabetic patients all over the world. Recent studies have shown that crystallins play an instrumental role in diabetes and its complications. Therefore, this review highlights the current data on the impact of chronic hyperglycemia on expression, distribution, glycation, phosphorylation, chaperone-like function and, anti-apoptotic activity of crystallins. Furthermore, we discussed the insights for developing therapeutic strategies for diabetic complications including natural agents, peptides, and pharmacological chaperones that modulate or mimic chaperone activity of α-crystallins. Upregulation of crystallins appears to be a common feature of chronic diabetes. Further, chronic hyperglycemia induces the glycation and phosphorylation of crystallins, mainly α-crystallins and thereby alters their properties. The disturbed interaction of αB-crystallin with various apoptotic mediators including Bax and caspases is also an important factor for increased cell death in diabetes. Numerous dietary agents, peptides, and chemical chaperones prevent apoptosis and the loss of chaperone activity in diabetes. Understanding the role of crystallins will aid in developing therapeutic strategies for alleviating pathophysiological conditions such as protein aggregation, inflammation, oxidative stress and apoptosis associated with chronic complications of diabetes including cataract, retinopathy, and cardiomyopathy. This article is part of a Special Issue entitled Crystallin Biochemistry in Health and Disease. Copyright © 2015 Elsevier B.V. All rights reserved.

  7. Scalable Nonparametric Low-Rank Kernel Learning Using Block Coordinate Descent.

    PubMed

    Hu, En-Liang; Kwok, James T

    2015-09-01

    Nonparametric kernel learning (NPKL) is a flexible approach to learn the kernel matrix directly without assuming any parametric form. It can be naturally formulated as a semidefinite program (SDP), which, however, is not very scalable. To address this problem, we propose the combined use of low-rank approximation and block coordinate descent (BCD). Low-rank approximation avoids the expensive positive semidefinite constraint in the SDP by replacing the kernel matrix variable with V(T)V, where V is a low-rank matrix. The resultant nonlinear optimization problem is then solved by BCD, which optimizes each column of V sequentially. It can be shown that the proposed algorithm has nice convergence properties and low computational complexities. Experiments on a number of real-world data sets show that the proposed algorithm outperforms state-of-the-art NPKL solvers.

  8. Molecular origin of photovoltaic performance in donor- block-acceptor all-conjugated block copolymers

    DOE PAGES

    Smith, Kendall A.; Lin, Yen -Hao; Mok, Jorge W.; ...

    2015-11-03

    All-conjugated block copolymers may be an effective route to self-assembled photovoltaic devices, but we lack basic information on the relationship between molecular characteristics and photovoltaic performance. Here, we synthesize a library of poly(3-hexylthiophene) (P3HT) block poly((9,9-dialkylfluorene)-2,7-diyl-alt-[4,7-bis(alkylthiophen-5-yl)-2,1,3-benzothiadiazole]-2',2''-diyl) (PFTBT) donor- block-acceptor all-conjugated block copolymers and carry out a comprehensive study of processing conditions, crystallinity, domain sizes, and side-chain structure on photovoltaic device performance. We find that all block copolymers studied exhibit an out-of-plane crystal orientation after deposition, and on thermal annealing at high temperatures the crystal orientation flips to an in-plane orientation. By varying processing conditions on polymer photovoltaic devices, we showmore » that the crystal orientation has only a modest effect (15-20%) on photovoltaic performance. The addition of side-chains to the PFTBT block is found to decrease photovoltaic power conversion efficiencies by at least an order of magnitude. Through grazing-incidence X-ray measurements we find that the addition of side-chains to the PFTBT acceptor block results in weak segregation and small (< 10 nm) block copolymer self-assembled donor and acceptor domains. This work is the most comprehensive to date on all-conjugated block copolymer systems and suggests that photovoltaic performance of block copolymers depends strongly on the miscibility of donor and acceptor blocks, which impacts donor and acceptor domain sizes and purity. Lastly, strategies for improving the device performance of block copolymer photovoltaics should seek to increase segregation between donor and acceptor polymer domains.« less

  9. Molecular origin of photovoltaic performance in donor- block-acceptor all-conjugated block copolymers

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Smith, Kendall A.; Lin, Yen -Hao; Mok, Jorge W.

    All-conjugated block copolymers may be an effective route to self-assembled photovoltaic devices, but we lack basic information on the relationship between molecular characteristics and photovoltaic performance. Here, we synthesize a library of poly(3-hexylthiophene) (P3HT) block poly((9,9-dialkylfluorene)-2,7-diyl-alt-[4,7-bis(alkylthiophen-5-yl)-2,1,3-benzothiadiazole]-2',2''-diyl) (PFTBT) donor- block-acceptor all-conjugated block copolymers and carry out a comprehensive study of processing conditions, crystallinity, domain sizes, and side-chain structure on photovoltaic device performance. We find that all block copolymers studied exhibit an out-of-plane crystal orientation after deposition, and on thermal annealing at high temperatures the crystal orientation flips to an in-plane orientation. By varying processing conditions on polymer photovoltaic devices, we showmore » that the crystal orientation has only a modest effect (15-20%) on photovoltaic performance. The addition of side-chains to the PFTBT block is found to decrease photovoltaic power conversion efficiencies by at least an order of magnitude. Through grazing-incidence X-ray measurements we find that the addition of side-chains to the PFTBT acceptor block results in weak segregation and small (< 10 nm) block copolymer self-assembled donor and acceptor domains. This work is the most comprehensive to date on all-conjugated block copolymer systems and suggests that photovoltaic performance of block copolymers depends strongly on the miscibility of donor and acceptor blocks, which impacts donor and acceptor domain sizes and purity. Lastly, strategies for improving the device performance of block copolymer photovoltaics should seek to increase segregation between donor and acceptor polymer domains.« less

  10. Local infiltration analgesia is comparable to femoral nerve block after anterior cruciate ligament reconstruction with hamstring tendon graft: a randomised controlled trial.

    PubMed

    Kristensen, Pia Kjær; Pfeiffer-Jensen, Mogens; Storm, Jens Ole; Thillemann, Theis Muncholm

    2014-02-01

    Arthroscopic anterior cruciate ligament (ACL) reconstruction is a painful procedure requiring intensive postoperative pain management. Femoral nerve block is widely used in ACL surgery. However, femoral nerve block does not cover the donor site of the hamstring tendons. Local infiltration analgesia is a simple technique that has proven effective in postoperative pain management after total knee arthroplasty. Further, local infiltration analgesia covers the donor site and is associated with few complications. It was hypothesised that local infiltration analgesia at the donor site and wounds would decrease pain and opioid consumption after ACL reconstruction with hamstring tendon graft. Sixty patients undergoing primary ACL surgery with hamstring tendon graft were randomised to receive either local infiltration analgesia or femoral nerve block. Pain was scored on the numeric rating scale, and use of opioid, range of motion and adverse effects were assessed at the postoperative recovery unit (0 h), 3, 24 and 48 h, postoperatively. There were no significant differences between the groups in pain intensity or total opioid consumption at any of the follow-up points. Further, there were no differences between groups concerning side effects and range of motion. Local infiltration analgesia and femoral nerve block are similar in the management of postoperative pain after ACL reconstruction with hamstring tendon graft. Until randomised studies have investigated femoral nerve block combined with infiltration at the donor site, we recommend local infiltration analgesia in ACL reconstruction with hamstring tendon graft.

  11. Second-degree atrioventricular block.

    PubMed

    Zipes, D P

    1979-09-01

    1) While it is possible only one type of second-degree AV block exists electrophysiologically, the available data do not justify such a conclusion and it would seem more appropriate to remain a "splitter," and advocate separation and definition of multiple mechanisms, than to be a "lumper," and embrace a unitary concept. 2) The clinical classification of type I and type II AV block, based on present scalar electrocardiographic criteria, for the most part accurately differentiates clinically important categories of patients. Such a classification is descriptive, but serves a useful function and should be preserved, taking into account the caveats mentioned above. The site of block generally determines the clinical course for the patient. For most examples of AV block, the type I and type II classification in present use is based on the site of block. Because block in the His-Purkinje system is preceded by small or nonmeasurable increments, it is called type II AV block; but the very fact that it is preceded by small increments is because it occurs in the His-Purkinje system. Similar logic can be applied to type I AV block in the AV node. Exceptions do occur. If the site of AV block cannot be distinguished with certainity from the scalar ECG, an electrophysiologic study will generally reveal the answer.

  12. Lumbar Plexus Block for Management of Hip Surgeries

    PubMed Central

    Amiri, Hamid Reza; Zamani, Mohammad Mahdi; Safari, Saeid

    2014-01-01

    Background: Lumbar plexus block (LPB) is one of the anesthetic options in the elderly patients undergoing hip surgeries. LPB could be safe because it targets somatic nerve in psoas region. Effectiveness of LPB is attributed to the sufficient analgesia provided intraoperatively as well as postoperatively. Adequate muscle relaxation and immobility during surgery refers to its acceptability. Objectives: In this study, LPB was used as the anesthetic method to manage the elderly patients subjected to hip surgery. Patients and Methods: A total of 50 patients aged 51 to 100 years were enrolled in this study. LPB was accomplished after a mild sedation and with a modified method using patient's fingertip width (FTW) as the distance unit to determine needle entry point under electrical nerve stimulation assistance. After targeted injection, procedure time, establishment time, block duration, surgery time, hemodynamic variables, and surgeon satisfaction score were documented and analyzed. Propofol in trivial doses was infused intraoperatively to provide clinical sedation. Results: Mean patient's age was 73 ± 12 years with ASA II/III. Procedure time was 5.65 ± 1.24 minutes, establishment time was 130 ± 36 seconds, block duration was 13.1 ± 8 hours, surgery time was 149.7 ± 32.2 minutes, and surgeon satisfaction score was 9.8 ± 0.1. There was no complication and no failure. Hemodynamic stability was pleasantly achieved. Conclusions: By preserving hemodynamic stability, LPB in conjunction with a light sedation could be considered as a reliable prudent satisfying anesthetic option in management of hip fractures in the elderly patients with three beneficial characteristics of safety, effectiveness, and acceptability. PMID:25289374

  13. A Bullet-Block Experiment That Explains the Chain Fountain

    ERIC Educational Resources Information Center

    Pantaleone, J.; Smith, R.

    2018-01-01

    It is common in science for two phenomena to appear to be very different, but in fact follow from the same basic principles. Here we consider such a case, the connection between the chain fountain and a bullet-block collision experiment. When an upward moving bullet strikes a wooden block resting on a horizontal table, the block will rise to a…

  14. On optimizing the blocking step of indirect enzyme-linked immunosorbent assay for Epstein-Barr virus serology.

    PubMed

    Lim, Chun Shen; Krishnan, Gopala; Sam, Choon Kook; Ng, Ching Ching

    2013-01-16

    Because blocking agent occupies most binding surface of a solid phase, its ability to prevent nonspecific binding determines the signal-to-noise ratio (SNR) and reliability of an enzyme-linked immunosorbent assay (ELISA). We demonstrate a stepwise approach to seek a compatible blocking buffer for indirect ELISA, via a case-control study (n=176) of Epstein-Barr virus (EBV)-associated nasopharyngeal carcinoma (NPC). Regardless of case-control status, we found that synthetic polymer blocking agents, mainly Ficoll and poly(vinyl alcohol) (PVA) were able to provide homogeneous backgrounds among samples, as opposed to commonly used blocking agents, notably nonfat dry milk (NFDM). The SNRs for NPC samples that correspond to blocking using PVA were approximately 3-fold, on average, higher than those blocking using NFDM. Both intra- and inter-assay precisions of PVA-based assays were <14%. A blocking agent of choice should have tolerable sample backgrounds from both cases and controls to ensure the reliability of an immunoassay. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. Electrophysiologic and histologic observations of chronic atrioventricular block induced by closed-chest catheter desiccation with radiofrequency energy.

    PubMed

    Huang, S K; Bharati, S; Lev, M; Marcus, F I

    1987-07-01

    Direct-current or laser energy has been used to induce atrioventricular (AV) block, but certain complications associated with this type of energy have been reported. We have previously documented that radiofrequency (RF) energy can effectively and safely induce acute AV block in closed-chest dogs during the 4-7 days of follow-up. This study was undertaken to determine if the ablation was permanent and to define the chronic pathology and site of AV block. Complete AV block was successfully achieved in four dogs immediately after ablation with a bipolar "standard" RF output (750 kHz) delivered between the tip electrode of a standard 7F USCI catheter and an external patch electrode on the left lateral chest wall. During 2 months of follow-up, three dogs had persistent complete AV block with a stable escape rhythm; the other had persistent 2:1 AV block. Repeat His bundle recordings were performed at 2 months prior to sacrifice of the dogs. Supra-His AV block was noted in two dogs; His bundle potential could not be recorded in another two. Histologically, the damaged area was well delineated. In all animals, the AV node and, in some dogs, part of the His bundle were completely replaced by granulation tissue and/or cartilage. There was fatty infiltration and also chronic inflammatory cells around the lesions. Neither perforation, hemorrhage nor vacuolation was seen in the adjacent area. Thrombus was not present. It is concluded that RF energy can effectively achieve chronic AV block and produce well-circumscribed pathological lesions.

  16. Foot Complications in a Representative Australian Inpatient Population

    PubMed Central

    Hurn, Sheree E.; Kamp, Maarten C.; Ng, Vanessa; Thomas, Courtney; Jen, Scott; Wills, Jude; Kinnear, Ewan M.; d'Emden, Michael C.; Reed, Lloyd F.

    2017-01-01

    We investigated the prevalence and factors independently associated with foot complications in a representative inpatient population (adults admitted for any reason with and without diabetes). We analysed data from the Foot disease in inpatients study, a sample of 733 representative inpatients. Previous amputation, previous foot ulceration, peripheral arterial disease (PAD), peripheral neuropathy (PN), and foot deformity were the foot complications assessed. Sociodemographic, medical, and foot treatment history were collected. Overall, 46.0% had a foot complication with 23.9% having multiple; those with diabetes had higher prevalence of foot complications than those without diabetes (p < 0.01). Previous amputation (4.1%) was independently associated with previous foot ulceration, foot deformity, cerebrovascular accident, and past surgeon treatment (p < 0.01). Previous foot ulceration (9.8%) was associated with PN, PAD, past podiatry, and past nurse treatment (p < 0.02). PAD (21.0%) was associated with older age, males, indigenous people, cancer, PN, and past surgeon treatment (p < 0.02). PN (22.0%) was associated with older age, diabetes, mobility impairment, and PAD (p < 0.05). Foot deformity (22.4%) was associated with older age, mobility impairment, past podiatry treatment, and PN (p < 0.01). Nearly half of all inpatients had a foot complication. Those with foot complications were older, male, indigenous, had diabetes, cerebrovascular accident, mobility impairment, and other foot complications or past foot treatment. PMID:29164152

  17. A simple solution for complicated pleural effusions.

    PubMed

    Murthy, Sudish C; Okereke, Ikenna; Mason, David P; Rice, Thomas W

    2006-09-01

    Complicated pleural effusions are difficult to manage with conventional strategies. In this study, we review the safety, efficacy, and durability of PleurX catheters (Denver Biomedical, Golden, CO) for managing complicated pleural effusions and describe a patient population who might benefit. From July 1999 to February 2003, 63 PleurX catheters were placed in 58 symptomatic patients (an additional five had bilateral catheters) to manage complicated pleural effusions. Patients selected for catheter placement tended to have poor performance status (Eastern Cooperative Oncology Group < or =2) or had failed standard therapies. Of the 63 catheters, 52 (83%) were placed because of malignant complicated pleural effusions. A registry of patients was constructed, and data were obtained from review of medical records. Nonparametric estimates of freedom from reintervention and overall survival were obtained by the Kaplan-Meier method. Catheter-related complications were noted in four of 58 patients (7%) and included one each of pneumothorax, seroma, empyema, and pain syndrome. Freedom from reintervention for effusion management was 95%. Of the patients, 86% (50 of 58) experienced dyspnea relief. There were no procedure-related mortalities. Catheters remained functional up to 330 days, and four of 63 (6%) required one-time thrombolysis with tissue plasminogen activator. PleurX catheters are safe, effective, and durable solutions for complicated pleural effusions and seem to provide an attractive alternative for patients who have few other palliative options. We consider the catheters as first-line therapy for these patients.

  18. A Bullet-Block Experiment that Explains the Chain Fountain

    NASA Astrophysics Data System (ADS)

    Pantaleone, J.; Smith, R.

    2018-05-01

    It is common in science for two phenomena to appear to be very different, but in fact follow from the same basic principles. Here we consider such a case, the connection between the chain fountain and a bullet-block collision experiment. When an upward moving bullet strikes a wooden block resting on a horizontal table, the block will rise to a higher height when the bullet strikes near the end of the block. This is because the quickly rotating block experiences an additional upward "reaction" force from its contact with the table. Such a reaction force also explains the chain fountain. When a chain falls from a pile in a container to the floor below, the chain rises up above the container. This rise occurs because the quickly rotating links in the container push off of the surface beneath them. We derive a model that accurately describes our measurements in the bullet-block experiment, and then use this same model to calculate an approximate expression for the distance the chain rises above the container. More extensive discussions of the chain fountain are available elsewhere.

  19. A nonallergenic birch pollen allergy vaccine consisting of hepatitis PreS-fused Bet v 1 peptides focuses blocking IgG toward IgE epitopes and shifts immune responses to a tolerogenic and Th1 phenotype.

    PubMed

    Marth, Katharina; Breyer, Isabella; Focke-Tejkl, Margarete; Blatt, Katharina; Shamji, Mohamed H; Layhadi, Janice; Gieras, Anna; Swoboda, Ines; Zafred, Domen; Keller, Walter; Valent, Peter; Durham, Stephen R; Valenta, Rudolf

    2013-04-01

    Allergen-specific immunotherapy is the only allergen-specific and disease-modifying treatment for allergy. The construction and characterization of a vaccine for birch pollen allergy is reported. Two nonallergenic peptides, PA and PB, derived from the IgE-reactive areas of the major birch pollen allergen Bet v 1 were fused to the hepatitis B surface protein, PreS, in four recombinant fusion proteins containing different numbers and combinations of the peptides. Fusion proteins expressed in Escherichia coli and purified to homogeneity showed a lack of IgE reactivity and allergenic activity when tested with sera and basophils from patients allergic to birch pollen. Compared to Bet v 1 allergen, peptides PA and PB showed reduced T cell activation in PBMCs from allergic patients, whereas PreS fusion proteins induced less IL-5 and more IL-10 and IFN-γ. Immunization of rabbits with the fusion proteins, in particular with a PreS fusion protein 2PAPB-PreS, containing two copies of each peptide, induced high levels of IgG Abs against the major IgE-reactive site on Bet v 1 and related allergens. These IgG Abs inhibited allergic patients' IgE binding to Bet v 1 better than did IgG induced by immunization with complete Bet v 1. Furthermore, 2PAPB-PreS-induced IgG inhibited Bet v 1-induced basophil activation in allergic patients and CD23-facilitated allergen presentation. Our study exemplifies novel beneficial features for a PreS carrier-based peptide vaccine for birch pollen, which, in addition to the established reduction in allergenic activity, include the enhanced focusing of blocking Ab responses toward IgE epitopes, immunomodulatory activity, and reduction of CD23-facilitated allergen presentation.

  20. A Nonallergenic Birch Pollen Allergy Vaccine Consisting of Hepatitis PreS–Fused Bet v 1 Peptides Focuses Blocking IgG toward IgE Epitopes and Shifts Immune Responses to a Tolerogenic and Th1 Phenotype

    PubMed Central

    Marth, Katharina; Breyer, Isabella; Focke-Tejkl, Margarete; Blatt, Katharina; Shamji, Mohamed H.; Layhadi, Janice; Gieras, Anna; Swoboda, Ines; Zafred, Domen; Keller, Walter; Valent, Peter; Durham, Stephen R.; Valenta, Rudolf

    2014-01-01

    Allergen-specific immunotherapy is the only allergen-specific and disease-modifying treatment for allergy. The construction and characterization of a vaccine for birch pollen allergy is reported. Two nonallergenic peptides, PA and PB, derived from the IgE-reactive areas of the major birch pollen allergen Bet v 1 were fused to the hepatitis B surface protein, PreS, in four recombinant fusion proteins containing different numbers and combinations of the peptides. Fusion proteins expressed in Escherichia coli and purified to homogeneity showed a lack of IgE reactivity and allergenic activity when tested with sera and basophils from patients allergic to birch pollen. Compared to Bet v 1 allergen, peptides PA and PB showed reduced T cell activation in PBMCs from allergic patients, whereas PreS fusion proteins induced less IL-5 and more IL-10 and IFN-γ. Immunization of rabbits with the fusion proteins, in particular with a PreS fusion protein 2PAPB-PreS, containing two copies of each peptide, induced high levels of IgG Abs against the major IgE-reactive site on Bet v 1 and related allergens. These IgG Abs inhibited allergic patients’ IgE binding to Bet v 1 better than did IgG induced by immunization with complete Bet v 1. Furthermore, 2PAPB-PreS–induced IgG inhibited Bet v 1–induced basophil activation in allergic patients and CD23-facilitated allergen presentation. Our study exemplifies novel beneficial features for a PreS carrier–based peptide vaccine for birch pollen, which, in addition to the established reduction in allergenic activity, include the enhanced focusing of blocking Ab responses toward IgE epitopes, immunomodulatory activity, and reduction of CD23-facilitated allergen presentation. PMID:23440415

  1. Comparison of the coracoid and retroclavicular approaches for ultrasound-guided infraclavicular brachial plexus block.

    PubMed

    Kavrut Ozturk, Nilgun; Kavakli, Ali Sait

    2017-08-01

    This prospective randomized study compared the coracoid and retroclavicular approaches to ultrasound-guided infraclavicular brachial plexus block (IBPB) in terms of needle tip and shaft visibility and quality of block. We hypothesized that the retroclavicular approach would increase needle tip and shaft visibility and decrease the number of needle passes compared to the coracoid approach. A total of 100 adult patients who received IBPB block for upper limb surgery were randomized into two groups: a coracoid approach group (group C) and a retroclavicular approach group (group R). In group C, the needle was inserted 2 cm medial and 2 cm inferior to the coracoid process and directed from ventral to dorsal. In group R, the needle insertion point was posterior to the clavicle and the needle was advanced from cephalad to caudal. All ultrasound images were digitally stored for analysis. The primary aim of the present study was to compare needle tip and shaft visibility between the coracoid approach and retroclavicular approach in patients undergoing upper limb surgery. The secondary aim was to investigate differences between the two groups in the number of needle passes, sensory and motor block success rates, surgical success rate, block performance time, block performance-related pain, patient satisfaction, use of supplemental local anesthetic and analgesic, and complications. Needle tip visibility and needle shaft visibility were significantly better in group R (p = 0.040, p = 0.032, respectively). Block performance time and anesthesia-related time were significantly shorter in group R (p = 0.022, p = 0.038, respectively). Number of needle passes was significantly lower in group R (p = 0.044). Paresthesia during block performance was significantly higher in group C (p = 0.045). There were no statistically significant differences between the two groups in terms of sensory or motor block success, surgical success, block-related pain, and patient satisfaction

  2. Acute cholecystitis as a postoperative complication.

    PubMed Central

    Ottinger, L W

    1976-01-01

    The clinical course and management of 40 patients who underwent operation for acute cholecystitis developing as a postoperative complication were reviewed. Of note was the mortality of 47%, the high incidence of gangrene, perforation, empyema, and cholangitis, and the atypical clinical presentation of acute cholecystitis under these conditions. Awareness of this possible complication, knowledge of its clinical features, and early surgical intervention are important facets of successful management. PMID:952563

  3. Health-related quality of life and social support among women treated for abortion complications in western Uganda

    PubMed Central

    2013-01-01

    Background While the impact of abortion complications on clinical outcomes and healthcare costs has been reported, we found no reports of their impact on Health-Related Quality of Life (HRQoL), nor the role of social support in moderating such outcomes. In this study, we performed an assessment of the relationship between abortion complications, HRQoL and social support among women in Uganda. Methods We interviewed women who were discharged after treatment for abortion complications and, as a comparison, women visiting a regional referral hospital for routine obstetric care. We administered the EuroQol instrument and the Social Support Questionnaire Short-Form, and collected demographic and socioeconomic data. We performed descriptive analyses using t-tests, Wilcoxon rank-sum tests and chi-square tests, and multivariable linear regressions with interaction effects to examine the associations between abortion complications, EQ-5D utility scores and social support. Results Our study included 139 women (70 with abortion complications, and 69 receiving routine obstetric care). In four out of the 5 dimensions of the EQ-5D, a larger proportion of women with abortion complications reported “some or severe” problems than women receiving routine obstetric care (self-care: 42% v 24%, p=0.033; usual activities: 49% v 16%, p<0.001; pain/discomfort: 68% v 25%, p<0.001; and anxiety/depression: 60% v 22%, p<0.001). After adjusting for age, social support, wealth tertile, employment status, marital status, and HIV status, women with abortion complications had a 0.12 (95% CI: 0.07, 0.18, p < 0.001) lower mean EQ-5D utility score than those receiving routine obstetric care. An analysis of the modifying effect of social support showed that a one-unit higher average number of people providing social support was associated with larger mean difference in EQ-5D utility score when comparing the two groups, while a one unit higher average satisfaction score with social support was

  4. Elastic and Inelastic Collisions of a Ball with a Wood Block

    ERIC Educational Resources Information Center

    Cross, Rod

    2017-01-01

    In a recent article in this journal, Shakur described an interesting problem where a bullet of mass "m" strikes a block of wood of mass "M" and projects the block upward. The same problem was considered earlier by Cowley et al. and others. The main question of interest is whether the block rises to a greater height if it is…

  5. COMPLICATED GRIEF AND RELATED BEREAVEMENT ISSUES FOR DSM-5

    PubMed Central

    Shear, M. Katherine; Simon, Naomi; Wall, Melanie; Zisook, Sidney; Neimeyer, Robert; Duan, Naihua; Reynolds, Charles; Lebowitz, Barry; Sung, Sharon; Ghesquiere, Angela; Gorscak, Bonnie; Clayton, Paula; Ito, Masaya; Nakajima, Satomi; Konishi, Takako; Melhem, Nadine; Meert, Kathleen; Schiff, Miriam; O’Connor, Mary-Frances; First, Michael; Sareen, Jitender; Bolton, James; Skritskaya, Natalia; Mancini, Anthony D.; Keshaviah, Aparna

    2010-01-01

    Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progresses to restoration of a satisfactory, if changed, life. Normally grief does not need clinical intervention. However, sometimes acute grief can gain a foothold and become a chronic debilitating condition called complicated grief. Moreover, the stress caused by bereavement, like other stressors, can increase the likelihood of onset or worsening of other physical or mental disorders. Hence some bereaved people need to be diagnosed and treated. A clinician evaluating a bereaved person is at risk for both over-and under-diagnosis, either pathologizing a normal condition or neglecting to treat an impairing disorder. The authors of DSM IV focused primarily on the problem of over-diagnosis, and omitted complicated grief because of insufficient evidence. We revisit bereavement considerations in light of new research findings. This paper focuses primarily on a discussion of possible inclusion of a new diagnosis and dimensional assessment of complicated grief. We also discuss modifications in the bereavement V code and refinement of bereavement exclusions in major depression and other disorders. PMID:21284063

  6. Influence of the Extent and Dose of Radiation on Complications After Neoadjuvant Chemoradiation and Subsequent Esophagectomy With Gastric Tube Reconstruction With a Cervical Anastomosis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Koëter, M.; Kathiravetpillai, N.; Gooszen, J.A.

    Purpose: To determine, in a large series, the influence of the extent and dose of radiation to the fundus of the stomach and mediastinum on the development and severity of anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by esophagectomy with cervical anastomosis. Methods and Materials: Between 2005 and 2012, 364 consecutive patients with esophageal cancer treated with neoadjuvant chemoradiation (41.4 Gy combined with chemotherapy) followed by esophagectomy were included. The future anastomotic region in the fundus was determined, and the mean dose, V20-V40, and upper planning target volume border in relation to mediastinal length, expressed as themore » mediastinal ratio, were calculated. Results: Anastomotic leakage occurred in 22% and anastomotic stenosis in 41%. Logistic regression analysis revealed no influence of age, comorbidity, mean fundus dose, V20-V40, or the mediastinal ratio on the incidence of anastomotic leakage or anastomotic stenosis. In 28% of the patients severe complications (Clavien-Dindo score of ≥IIIB) occurred. The presence of multiple comorbidities (hazard ratio 2.4 [95% confidence interval 1.3-4.5], P=.006) and a mediastinal ratio of 0.5 to 1.0 (hazard ratio 1.9 [95% confidence interval 1.0-3.5], P=.036) were both independent predictors of severe complications. Conclusion: With a mean radiation dose of 24.2 Gy to the future anastomotic region of the gastric fundus, the radiation dose was not associated with the incidence of anastomotic leakage or anastomotic stenosis. The incidence of severe complications was associated with a high superior mediastinal planning target volume border.« less

  7. Influence of the Extent and Dose of Radiation on Complications After Neoadjuvant Chemoradiation and Subsequent Esophagectomy With Gastric Tube Reconstruction With a Cervical Anastomosis.

    PubMed

    Koëter, M; Kathiravetpillai, N; Gooszen, J A; van Berge Henegouwen, M I; Gisbertz, S S; van der Sangen, M J C; Luyer, M D P; Nieuwenhuijzen, G A P; Hulshof, M C C M

    2017-03-15

    To determine, in a large series, the influence of the extent and dose of radiation to the fundus of the stomach and mediastinum on the development and severity of anastomotic complications in patients with esophageal cancer treated with neoadjuvant chemoradiation followed by esophagectomy with cervical anastomosis. Between 2005 and 2012, 364 consecutive patients with esophageal cancer treated with neoadjuvant chemoradiation (41.4 Gy combined with chemotherapy) followed by esophagectomy were included. The future anastomotic region in the fundus was determined, and the mean dose, V20-V40, and upper planning target volume border in relation to mediastinal length, expressed as the mediastinal ratio, were calculated. Anastomotic leakage occurred in 22% and anastomotic stenosis in 41%. Logistic regression analysis revealed no influence of age, comorbidity, mean fundus dose, V20-V40, or the mediastinal ratio on the incidence of anastomotic leakage or anastomotic stenosis. In 28% of the patients severe complications (Clavien-Dindo score of ≥IIIB) occurred. The presence of multiple comorbidities (hazard ratio 2.4 [95% confidence interval 1.3-4.5], P=.006) and a mediastinal ratio of 0.5 to 1.0 (hazard ratio 1.9 [95% confidence interval 1.0-3.5], P=.036) were both independent predictors of severe complications. With a mean radiation dose of 24.2 Gy to the future anastomotic region of the gastric fundus, the radiation dose was not associated with the incidence of anastomotic leakage or anastomotic stenosis. The incidence of severe complications was associated with a high superior mediastinal planning target volume border. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Long-Term Results of Stent Placement in Patients with Outflow Block After Living-Donor-Liver Transplantation

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Fujimori, Masashi, E-mail: fujimorim@clin.medic.mie-u.ac.jp; Yamakado, Koichiro, E-mail: yamakado47@gmail.com; Takaki, Haruyuki, E-mail: takaki-h@clin.medic.mie-u.ac.jp

    PurposeTo evaluate long-term results of stent placement retrospectively in patients with outflow block after living-donor-liver transplantation (LDLT).Materials and MethodsFor this institutional review board approved retrospective study conducted during 2002–2012, stents were placed in outflow veins in 15 patients (11.3 %, 15/133) (12 men; 3 female) in whom outflow block developed after LDLT. Their mean age was 52.3 years ± 15.3 (SD) (range, 4–69 years). Venous stenosis with a pressure gradient ≥5 mmHg (outflow block) was observed in the inferior vena cava in seven patients, hepatic vein in seven patients, and both in one patient. Technical success, change in a pressure gradient and clinical manifestations, and complicationsmore » were evaluated. Overall survival of 15 patients undergoing outflow block stenting was compared with that of 116 patients without outflow block after LDLT.ResultsStents were placed across the outflow block veins without complications, lowering the pressure gradient ≤ 3 mmHg in all patients (100 %, 15/15). Clinical manifestations improved in 11 patients (73.3 %, 11/15), and all were discharged from the hospital. However, they did not improve in the other 4 patients (26.7 %, 4/15) who died in the hospital 1.0–3.7 months after stenting (mean, 2.0 ± 1.2 months). No significant difference in 5-year survival rates was found between patients with and without outflow block after LDLT (61.1 vs. 72.2 %, p = .405).ConclusionStenting is a feasible, safe, and useful therapeutic option to resolve outflow block following LDLT, providing equal survival to that of patients without outflow block.« less

  9. Characterizing the inverses of block tridiagonal, block Toeplitz matrices

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Boffi, Nicholas M.; Hill, Judith C.; Reuter, Matthew G.

    2014-12-04

    We consider the inversion of block tridiagonal, block Toeplitz matrices and comment on the behaviour of these inverses as one moves away from the diagonal. Using matrix M bius transformations, we first present an O(1) representation (with respect to the number of block rows and block columns) for the inverse matrix and subsequently use this representation to characterize the inverse matrix. There are four symmetry-distinct cases where the blocks of the inverse matrix (i) decay to zero on both sides of the diagonal, (ii) oscillate on both sides, (iii) decay on one side and oscillate on the other and (iv)more » decay on one side and grow on the other. This characterization exposes the necessary conditions for the inverse matrix to be numerically banded and may also aid in the design of preconditioners and fast algorithms. Finally, we present numerical examples of these matrix types.« less

  10. Contact lens complications.

    PubMed

    Suchecki, Jeanine K; Donshik, Peter; Ehlers, William H

    2003-09-01

    Complications associated with contact lenses range from mild to severe and occur with all lens modalities. Contact lens wear can cause a change in corneal physiology, which can lead to epithelial, stromal, and endothelial compromise. Other complications include lens deposition, allergic conjunctivitis, giant papillary conjunctivitis, peripheral infiltrates, microbial keratitis, and neovascularization. Pre-existing conditions can contribute to these complications, or they can occur in association with contact lens wear and care regimens. Patient-related factors, such as alteration of the recommended wearing or replacement schedules and noncompliance with recommended contact lens care regimens for economic reasons, convenience, or in error, contribute to contact lens-related complications and have led to difficulty in accurate determination of complication rates among the various lens wear modalities. Complications may require discontinuation of contact lenses, topical therapy, and changes in contact lens wearing schedules, materials, and care solutions. On initial lens fitting and follow-up evaluations, practitioners should review contact lens replacement and cleaning regimens with patients and discuss complications. To avoid serious complications, patients should be reminded to remove their contact lenses as soon as ocular irritation occurs, and to call their eye care practitioner immediately if symptoms persist.

  11. Combined KHFAC + DC nerve block without onset or reduced nerve conductivity after block

    NASA Astrophysics Data System (ADS)

    Franke, Manfred; Vrabec, Tina; Wainright, Jesse; Bhadra, Niloy; Bhadra, Narendra; Kilgore, Kevin

    2014-10-01

    Objective. Kilohertz frequency alternating current (KHFAC) waveforms have been shown to provide peripheral nerve conductivity block in many acute and chronic animal models. KHFAC nerve block could be used to address multiple disorders caused by neural over-activity, including blocking pain and spasticity. However, one drawback of KHFAC block is a transient activation of nerve fibers during the initiation of the nerve block, called the onset response. The objective of this study is to evaluate the feasibility of using charge balanced direct current (CBDC) waveforms to temporarily block motor nerve conductivity distally to the KHFAC electrodes to mitigate the block onset-response. Approach. A total of eight animals were used in this study. A set of four animals were used to assess feasibility and reproducibility of a combined KHFAC + CBDC block. A following randomized study, conducted on a second set of four animals, compared the onset response resulting from KHFAC alone and combined KHFAC + CBDC waveforms. To quantify the onset, peak forces and the force-time integral were measured during KHFAC block initiation. Nerve conductivity was monitored throughout the study by comparing muscle twitch forces evoked by supra-maximal stimulation proximal and distal to the block electrodes. Each animal of the randomized study received at least 300 s (range: 318-1563 s) of cumulative dc to investigate the impact of combined KHFAC + CBDC on nerve viability. Main results. The peak onset force was reduced significantly from 20.73 N (range: 18.6-26.5 N) with KHFAC alone to 0.45 N (range: 0.2-0.7 N) with the combined CBDC and KHFAC block waveform (p < 0.001). The area under the force curve was reduced from 6.8 Ns (range: 3.5-21.9 Ns) to 0.54 Ns (range: 0.18-0.86 Ns) (p < 0.01). No change in nerve conductivity was observed after application of the combined KHFAC + CBDC block relative to KHFAC waveforms. Significance. The distal application of CBDC can significantly reduce or even

  12. Somatic complications of epilepsy surgery over 25 years at a single center.

    PubMed

    Gooneratne, Inuka K; Mannan, Shahidul; de Tisi, Jane; Gonzalez, Juan C; McEvoy, Andrew W; Miserocchi, Anna; Diehl, Beate; Wehner, Tim; Bell, Gail S; Sander, Josemir W; Duncan, John S

    2017-05-01

    Epilepsy surgery is an effective treatment for refractory focal epilepsy. Risks of surgery need to be considered when advising individuals of treatment options. We describe the frequency and nature of physical adverse events associated with epilepsy surgery in a single center. We reviewed the prospectively maintained records of adults who underwent epilepsy surgery at our center between 1990 and 2014 to identify peri/postsurgical adverse events. These were categorized into neurological deficits and those related to surgery (e.g. wound infections). Neurological deficits were categorized as expected or unexpected and into transient (≤3 months) or persistent (>3 months), RESULTS: There were 911 procedures with no peri-operative deaths. Persistent neurological adverse events were seen following 157 (17.2%) procedures. The most common persistent expected complication was quadrantanopia after temporal lobe resections (72/764, 9.4%). Unexpected persistent neurological complications occurred in 20 procedures (2.2%) and included: quadrantanopia (6, 0.7%); hemianopia (2, 0.2%); hemi/mono-paresis/sensory loss (9, 1%); dysphasia (10, 1%); frontalis muscle weakness (2, 0.2%); and oculomotor weakness (1, 0.1%). 106 surgery related adverse events occurred in 83 procedures, with severe infections requiring bone-flap removal in 24 (2.6%) procedures and intracranial infections in 8 (0.9%). The risk of post-resective severe infection increased by 4 fold (OR 4.32, 95% CI 2.1-8.9, p<0.001) with use of subdural EEG monitoring prior to resection. In consequence, in August 2011 we introduced antibiotic coverage in all individuals undergoing intracranial monitoring. Also, after August 2011 there was greater use of Stereo-EEG (SEEG) than subdural (OR 9.0 CI 0.36-224.2, p=0.18ns). One complicated by severe infection. Other surgical complications included haematoma (0.3%), hydrocephalus (0.3%) and CSF leak (1.2%). None had permanent complications. Adverse event rates are similar to other

  13. Heart block and cardiac embolization of fractured inferior vena cava filter.

    PubMed

    Abudayyeh, Islam; Takruri, Yessar; Weiner, Justin B

    2016-01-01

    A 66-year-old man underwent a placement of an inferior vena cava filter before a gastric surgery 9 years prior, presented to the emergency room with a complete atrioventricular block. Chest x-ray and transthoracic echocardiogram showed struts migrating to right ventricle with tricuspid regurgitation. Cardiothoracic surgery was consulted and declined an open surgical intervention due to the location of the embolized fragments and the patient's overall condition. It was also felt that the fragments had migrated chronically and were adhered to the cardiac structures. The patient underwent a dual-chamber permanent pacemaker implantation. Post-implant fluoroscopy showed no displacement of the inferior vena cava filter struts due to the pacemaker leads indicating that the filter fracture had likely been a chronic process. This case highlights a rare combination of complications related to inferior vena cava filter fractures and the importance of assessing for such fractures in chronic placements. Inferior vena cava filter placement for a duration greater than 1 month can be associated with filter fractures and strut migration which may lead to, although rare, serious or fatal complications such as complete atrioventricular conduction system disruption and valvular damage including significant tricuspid regurgitation. Assessing for inferior vena cava filter fractures in chronic filter placement is important to avoid such complications. When possible, retrieval of the filter should be considered in all patients outside the acute setting in order to avoid filter-related complications. Filter retrieval rates remain low even when a retrievable filter is in place and the patient no longer has a contraindication to anticoagulation.

  14. The Presence of Thyroid-Stimulation Blocking Antibody Prevents High Bone Turnover in Untreated Premenopausal Patients with Graves' Disease.

    PubMed

    Cho, Sun Wook; Bae, Jae Hyun; Noh, Gyeong Woon; Kim, Ye An; Moon, Min Kyong; Park, Kyoung Un; Song, Junghan; Yi, Ka Hee; Park, Do Joon; Chung, June-Key; Cho, Bo Youn; Park, Young Joo

    2015-01-01

    Osteoporosis-related fractures are one of the complications of Graves' disease. This study hypothesized that the different actions of thyroid-stimulating hormone receptor (TSHR) antibodies, both stimulating and blocking activities in Graves' disease patients might oppositely impact bone turnover. Newly diagnosed premenopausal Graves' disease patients were enrolled (n = 93) and divided into two groups: patients with TSHR antibodies with thyroid-stimulating activity (stimulating activity group, n = 83) and patients with TSHR antibodies with thyroid-stimulating activity combined with blocking activity (blocking activity group, n = 10). From the stimulating activity group, patients who had matched values for free T4 and TSH binding inhibitor immunoglobulin (TBII) to the blocking activity group were further classified as stimulating activity-matched control (n = 11). Bone turnover markers BS-ALP, Osteocalcin, and C-telopeptide were significantly lower in the blocking activity group than in the stimulating activity or stimulating activity-matched control groups. The TBII level showed positive correlations with BS-ALP and osteocalcin levels in the stimulating activity group, while it had a negative correlation with the osteocalcin level in the blocking activity group. In conclusion, the activation of TSHR antibody-activated TSH signaling contributes to high bone turnover, independent of the actions of thyroid hormone, and thyroid-stimulation blocking antibody has protective effects against bone metabolism in Graves' disease.

  15. Ionic Blocks

    ERIC Educational Resources Information Center

    Sevcik, Richard S.; Gamble, Rex; Martinez, Elizabet; Schultz, Linda D.; Alexander, Susan V.

    2008-01-01

    "Ionic Blocks" is a teaching tool designed to help middle school students visualize the concepts of ions, ionic compounds, and stoichiometry. It can also assist high school students in reviewing their subject mastery. Three dimensional blocks are used to represent cations and anions, with color indicating charge (positive or negative) and size…

  16. Post-repolarization refractoriness increases vulnerability to block and initiation of reentrant impulses in heterogeneous infarcted myocardium.

    PubMed

    Cabo, Candido

    2015-10-01

    Myocardial infarction causes remodeling of the tissue structure and the density and kinetics of several ion channels in the cell membrane. Heterogeneities in refractory period (ERP) have been shown to occur in the infarct border zone and have been proposed to lead to initiation of arrhythmias. The purpose of this study is to quantify the window of vulnerability (WV) to block and initiation of reentrant impulses in myocardium with ERP heterogeneities using computer simulations. We found that ERP transitions at the border between normal ventricular cells (NZ) with different ERPs are smooth, whereas ERP transitions between NZ and infarct border zone cells (IZ) are abrupt. The profile of the ERP transitions is a combination of electrotonic interaction between NZ and IZ cells and the characteristic post-repolarization refractoriness (PRR) of IZ cells. ERP heterogeneities between NZ and IZ cells are more vulnerable to block and initiation of reentrant impulses than ERP heterogeneities between NZ cells. The relationship between coupling intervals of premature impulses (V1V2) and coupling intervals between premature and first reentrant impulses (V2T1) at NZ/NZ and NZ/IZ borders is inverse (i.e. the longer the coupling intervals of premature impulses the shorter the coupling interval between the premature and first reentrant impulses); this is in contrast with the reported V1V2/V2T1 relationship measured during initiation of reentrant impulses in canine infarcted hearts which is direct. (1) ERP transitions at the NZ-IZ border are abrupt as a consequence of PRR; (2) PRR increases the vulnerability to block and initiation of reentrant impulses in heterogeneous myocardium; (3) V1V2/V2T1 relationships measured at ERP heterogeneities in the computer model and in experimental canine infarcts are not consistent. Therefore, it is likely that other mechanisms like micro and/or macro structural heterogeneities also contribute to initiation of reentrant impulses in infarcted hearts

  17. Ovarian vein thrombosis: A complication of percutaneous nephrolithotomy

    PubMed Central

    Ho, Louisa; Hall, Grayson; Thomas, Richard; Beiko, Darren

    2016-01-01

    The medical and surgical complications of percutaneous nephrolithotomy (PCNL) are well-known, including deep venous thrombosis. Ovarian vein thrombosis (OVT) is a rare, but potentially serious type of venous thrombosis that has not previously been reported as a complication of PCNL or ureteral stent placement. We report a case of OVT associated with ureteral stenting following a tubeless PCNL. This complication was successfully managed conservatively without any short- or long-term sequelae. PMID:27695586

  18. Management of diabetic complications: a chemical constituents based approach.

    PubMed

    Singh, Randhir; Kaur, Navpreet; Kishore, Lalit; Gupta, Girish Kumar

    2013-10-28

    Long term hyperglycemia leads to development of complications associated with diabetes. Diabetic complications are now a global health problem without effective therapeutic approach. Hyperglycemia and oxidative stress are important components for the development of diabetic complications. Over the past few decades, herbal medicines have attracted much attention as potential therapeutic agents in the prevention and treatment of diabetic complications due to their multiple targets and less toxic side effects. This review aims to assess the current available knowledge of medicinal herbs for attenuation and management of diabetic complications and their underlying mechanisms. Bibliographic investigation was carried out by scrutinizing classical text books and peer reviewed papers, consulting worldwide accepted scientific databases (SCOPUS, PUBMED, SCIELO, NISCAIR, Google Scholar) to retrieve available published literature. The inclusion criteria for the selection of plants were based upon all medicinal herbs and their active compounds with attributed potentials in relieving diabetic complications. Moreover, plants which have potential effect in ameliorating oxidative stress in diabetic animals have been included. Overall, 238 articles were reviewed for plant literature and out of the reviewed literature, 127 articles were selected for the study. Various medicinal plants/plant extracts containing flavonoids, alkaloids, phenolic compounds, terpenoids, saponins and phytosterol type chemical constituents were found to be effective in the management of diabetic complications. This effect might be attributed to amelioration of persistent hyperglycemia, oxidative stress and modulation of various metabolic pathways involved in the pathogenesis of diabetic complications. Screening chemical candidate from herbal medicine might be a promising approach for new drug discovery to treat the diabetic complications. There is still a dire need to explore the mechanism of action of

  19. Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications

    PubMed Central

    Rak, Vaclav; Ira, Daniel; Masek, Michal

    2009-01-01

    Background: In a retrospective study we analysed intra-articular calcaneal fracture treatment by comparing results and complications related to fracture stabilization with nonlocking calcaneal plates and locking compression plates. Materials and Methods: We performed 76 osteosynthesis (67 patients) of intra-articular calcaneal fractures using the standard extended lateral approach from February 2004 to October 2007. Forty-two operations using nonlocking calcaneal plates (group A) were performed during the first three years, and 34 calcaneal fractures were stabilized using locking compression plates (group B) in 2007. In the Sanders type IV fractures, reconstruction of the calcaneal shape was attempted. Depending on the type of late complication, we performed subtalar arthroscopy in six cases, arthroscopically assisted subtalar distraction bone block arthrodesis in six cases, and plate removal with lateral-wall decompression in five cases. The patients were evaluated by the AOFAS Ankle-Hindfoot Scale. Results: Wound healing complications were 7/42 (17%) in group A and 1/34 (3%) in group B. No patient had deep osseous infection or foot rebound compartment syndrome. Preoperative size of Böhler's angle correlated with postoperative clinical results in both groups. There were no late complications necessitating corrective procedure or arthroscopy until December 2008 in Group B. All late complications ccurred in Group A. The overall results according to the AOFAS Ankle Hindfoot Scale were good or excellent in 23/42 (55%) in group A and in 30/34 (85%) in group B. Conclusion: Open reduction and internal fixation of intra-articular calcaneal fractures has become a standard surgical method. Fewer complications and better results related to treatment with locking compression plates confirmed in comparison to nonlocking ones were noted for all Sanders types of intra-articular calcaneal fractures. Age and Sanders type IV fractures are not considered to be the contraindications

  20. Analysis of the V2 Vasopressin Receptor (V2R) Mutations Causing Partial Nephrogenic Diabetes Insipidus Highlights a Sustainable Signaling by a Non-peptide V2R Agonist.

    PubMed

    Makita, Noriko; Sato, Tomohiko; Yajima-Shoji, Yuki; Sato, Junichiro; Manaka, Katsunori; Eda-Hashimoto, Makiko; Ootaki, Masanori; Matsumoto, Naoki; Nangaku, Masaomi; Iiri, Taroh

    2016-10-21

    Disease-causing mutations in G protein-coupled receptor (GPCR) genes, including the V2 vasopressin receptor (V2R) gene, often cause misfolded receptors, leading to a defect in plasma membrane trafficking. A novel V2R mutation, T273M, identified in a boy with partial nephrogenic diabetes insipidus (NDI), shows intracellular localization and partial defects similar to the two mutants we described previously (10). Although non-peptide V2R antagonists have been shown to rescue the membrane localization of V2R mutants, their level of functional rescue is weak. Interestingly, it has been reported that a non-peptide agonist, OPC51803, activates misfolded V2R mutants intracellularly without degradation, thus potentially serving as a therapeutic agent against NDI (14). In our current experiments, however, a peptide antagonist blocked arginine vasopressin (AVP)- or OPC51803-stimulated cAMP accumulation both in COS-7 and MDCK cells, suggesting that OPC51803 mainly stimulates cell surface V2R mutants. In addition, our analyses revealed that OPC51803 works not only as a non-peptide agonist that causes activation/β-arrestin-dependent desensitization of V2R mutants expressed at the plasma membrane but also as a pharmacochaperone that promotes the endoplasmic reticulum-retained mutant maturation and trafficking to the plasma membrane. The ratio of the pharmacochaperone effect to the desensitization effect likely correlates negatively with the residual function of the tested mutants, suggesting that OPC5 has a more favorable effect on the V2R mutants with a less residual function. We speculated that the canceling of the desensitization effect of OPC51803 by the pharmacochaperone effect after long-term treatment may produce sustainable signaling, and thus pharmacochaperone agonists such as OPC51803 may serve as promising therapeutics for NDI caused by misfolded V2R mutants. © 2016 by The American Society for Biochemistry and Molecular Biology, Inc.

  1. Complications after surgery for lumbar stenosis in a veteran population.

    PubMed

    Deyo, Richard A; Hickam, David; Duckart, Jonathan P; Piedra, Mark

    2013-09-01

    Secondary analysis of the prospectively collected Veterans Affairs National Surgical Quality Improvement Program database. Determine rates of major medical complications, wound complications, and mortality among patients undergoing surgery for lumbar stenosis and examine risk factors for these complications. Surgery for spinal stenosis is concentrated among older adults, in whom complications are more frequent than among middle-aged patients. Many studies have focused on infections or device complications, but fewer studies have focused on major cardiopulmonary complications, using prospectively collected data. We identified patients who underwent surgery for a primary diagnosis of lumbar stenosis between 1998 and 2009 from the Veterans Affairs National Surgical Quality Improvement Program database. We created a composite of major medical complications, including acute myocardial infarction, stroke, pulmonary embolism, pneumonia, systemic sepsis, coma, and cardiac arrest. Among 12,154 eligible patients, major medical complications occurred in 2.1%, wound complications in 3.2%, and 90-day mortality in 0.6%. Major medical complications, but not wound complications, were strongly associated with age. American Society of Anesthesiologists (ASA) class was a strong predictor of complications. Insulin use, long-term corticosteroid use, and preoperative functional status were also significant predictors. Fusion procedures were associated with higher complication rates than with decompression alone. In logistic regressions, ASA class and age were the strongest predictors of major medical complications (odds ratio for ASA class 4 vs. class 1 or 2: 2.97; 95% confidence interval, 1.68-5.25; P = 0.0002). After adjustment for comorbidity, age, and functional status, fusion procedures remained associated with higher medical complication rates than were decompressions alone (odds ratio = 2.85; 95% confidence interval, 2.14-3.78; P < 0.0001). ASA class, age, type of surgery

  2. Effects of HRV-Guided vs. Predetermined Block Training on Performance, HRV and Serum Hormones.

    PubMed

    Nuuttila, Olli-Pekka; Nikander, Aku; Polomoshnov, Dmitry; Laukkanen, Jari Antero; Häkkinen, Keijo

    2017-11-01

    The aim of this study was to compare heart rate variability -guided (HRVG) and predetermined (PD) block periodization of high intensity aerobic training (HIT). Endurance performance, neuromuscular performance, heart rate variability (HRV) and serum hormone concentrations were measured before, in the middle and after the 8-week training period in 24 endurance trained males. Both groups improved significantly maximal treadmill velocity (V max ) (p<0.001) and 3000 m running performance (HRVG; p<0.001 and PD; p=0.001). The relative changes in V max and countermovement jump were significantly greater in HRVG (p<0.05). Nocturnal heart rate decreased in both groups (p<0.01), but HRV (RMSSD, LF and TP) increased significantly only in HRVG (p<0.05). The significant increase in serum testosterone concentration was observed from mid to post in HRVG (p<0.05). Significant correlations were found between individual V max changes and absolute serum testosterone levels. Individual baseline level of HF correlated significantly with V max changes in PD. Block periodization of HIT seems to be an effective way to improve endurance and running performance in already endurance trained males. Based on training induced increases in endurance and neuromuscular performance combined with significant changes in HRV and serum testosterone levels observed in HRVG, individually HRV -guided block training may be more optimal compared to predetermined training. © Georg Thieme Verlag KG Stuttgart · New York.

  3. Analysis of laparoscopic port site complications: A descriptive study

    PubMed Central

    Karthik, Somu; Augustine, Alfred Joseph; Shibumon, Mundunadackal Madhavan; Pai, Manohar Varadaraya

    2013-01-01

    CONTEXT: The rate of port site complications following conventional laparoscopic surgery is about 21 per 100,000 cases. It has shown a proportional rise with increase in the size of the port site incision and trocar. Although rare, complications that occur at the port site include infection, bleeding, and port site hernia. AIMS: To determine the morbidity associated with ports at the site of their insertion in laparoscopic surgery and to identify risk factors for complications. SETTINGS AND DESIGN: Prospective descriptive study. MATERIALS AND METHODS: In the present descriptive study, a total of 570 patients who underwent laparoscopic surgeries for various ailments between August 2009 and July 2011 at our institute were observed for port site complications prospectively and the complications were reviewed. STATISTICAL ANALYSIS USED: Descriptive statistical analysis was carried out in the present study. The statistical software, namely, SPSS 15.0 was used for the analysis of the data. RESULTS: Of the 570 patients undergoing laparoscopic surgery, 17 (3%) had developed complications specifically related to the port site during a minimum follow-up of three months; port site infection (PSI) was the most frequent (n = 10, 1.8%), followed by port site bleeding (n = 4, 0.7%), omentum-related complications (n = 2; 0.35%), and port site metastasis (n = 1, 0.175%). CONCLUSIONS: Laparoscopic surgeries are associated with minimal port site complications. Complications are related to the increased number of ports. Umbilical port involvement is the commonest. Most complications are manageable with minimal morbidity, and can be further minimized with meticulous surgical technique during entry and exit. PMID:23741110

  4. Should continuous rather than single-injection interscalene block be routinely offered for major shoulder surgery? A meta-analysis of the analgesic and side-effects profiles.

    PubMed

    Vorobeichik, L; Brull, R; Bowry, R; Laffey, J G; Abdallah, F W

    2018-04-01

    Major shoulder surgery is associated with moderate-to-severe pain, but consensus on the optimal analgesic approach is lacking. Continuous catheter-based interscalene block (CISB) prolongs the analgesic benefits of its single-injection counterpart (SISB), but concerns over CISB complications and difficulties in interpreting comparative evidence examining major and minor shoulder procedures simultaneously, despite their differences in postoperative pain, have limited CISB popularity. This meta-analysis evaluates the CISB analgesic role and complications compared with SISB for major shoulder surgery. We retrieved randomised controlled trials (RCTs) comparing the effects of CISB to SISB on analgesic outcomes and side-effects after major shoulder surgery. Postoperative opioid consumption at 24 h was designated as the primary outcome. Secondary outcomes included 24-48 h opioid consumption, postoperative rest and dynamic pain scores up to 72 h, time-to-first analgesic, recovery room and hospital stay durations, patient satisfaction, postoperative nausea and vomiting, respiratory function, and block-related complications. Data from 15 RCTs were pooled using random-effects modelling. Compared with SISB, CISB reduced 24- and 48-h oral morphine consumption by a weighted mean difference [95% confidence interval] of 50.9 mg [-81.6, -20.2], (P=0.001) and 44.7 mg [-80.9, -8.7], (P<0.0001), respectively. Additionally, CISB provided superior rest and dynamic pain control beyond 48 h, prolonged time-to-first analgesic, enhanced satisfaction, and reduced postoperative nausea and vomiting without complications. CISB caused an 11.0-11.7% decrease in respiratory indices. Result heterogeneity was successfully explained. High-level evidence indicates that CISB provides superior analgesia up to 48 h after major shoulder surgery, without increasing side-effects, compared with SISB. The importance of CISB-related changes in respiratory indices is questionable. Copyright © 2017 British

  5. "Transversus Abdominis Plane Blocks in Microsurgical Breast Reconstruction: Analysis of Pain, Narcotic Consumption, Length of Stay and Cost."

    PubMed

    Salibian, Ara A; Frey, Jordan D; Thanik, Vishal D; Karp, Nolan S; Choi, Mihye

    2018-06-02

    Transversus abdominis plane (TAP) blocks are increasingly being utilized in microvascular breast reconstruction. The implications of TAP blocks on specific reconstructive, patient and institutional outcomes remain to be fully elucidated. Patients undergoing abdominally-based microvascular breast reconstruction from 2015-2017 were reviewed. Length of stay, complications, narcotic consumption, donor-site pain and hospital expenses were compared between patients that did and those that did not receive TAP blocks with liposomal bupivacaine. Outcomes were subsequently compared in patients with elevated body mass index (BMI). Fifty patients (43.9%) received TAP blocks (27 [54.0%] under ultrasound guidance) and 64 patients (56.1%) did not. Patients with TAP blocks had significantly decreased oral and total narcotic consumption (p=0.0001 and p<0.0001, respectively) as well as significantly less donor-site pain (3.3 versus 4.3, p<0.0001). There was no significant difference in hospital expenses between the two cohorts ($21,531.53 versus $22,050.15 per patient, p=0.5659). Patients with BMI≥25 who received TAP blocks had a significantly decreased length of stay (3.8 versus 4.4 days, p=0.0345) as well as decreased narcotic consumption and postoperative pain compared to patients without TAP blocks. Patients with BMI<25 did not have a significant difference in postoperative pain, narcotic consumption or length of stay between the TAP versus no TAP block groups. TAP blocks with liposomal bupivacaine significantly reduce oral and total postoperative narcotic consumption as well as donor-site pain in all patients after abdominally-based microvascular breast reconstruction without increasing hospital expenses. TAP blocks additionally significantly decrease length of stay in patients with BMI≥25.

  6. 31 CFR 594.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 594.301 Section 594.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS...

  7. 31 CFR 545.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 545.301 Section 545.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY TALIBAN (AFGHANISTAN) SANCTIONS...

  8. 31 CFR 551.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 551.301 Section 551.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY SOMALIA SANCTIONS REGULATIONS...

  9. Inter-rater agreement among orthodontists in a blocked experiment.

    PubMed

    Korn, E L; Baumrind, S

    1985-01-01

    Five orthodontists were asked to predict for 64 patients a particular dichotomous outcome of treatment based on pre-treatment X-ray films. The orthodontists rated the cases in blocks of size 4-6 with the knowledge of the number of positive outcomes in each block. We discuss the reasons why this blocked design is appropriate whenever clinicians are asked to rate cases which have not been randomly selected from a clinical practice similar to their own. We give a simple description of the inter-rater agreement for this type of blocked experiment as well as a procedure to test that the agreement is no better than that expected by random independent assignment.

  10. Subcostal Transverse Abdominis Plane Block for Acute Pain Management: A Review.

    PubMed

    Soliz, Jose M; Lipski, Ian; Hancher-Hodges, Shannon; Speer, Barbra Bryce; Popat, Keyuri

    2017-10-01

    The subcostal transverse abdominis plane (SCTAP) block is the deposition of local anesthetic in the transverse abdominis plane inferior and parallel to the costal margin. There is a growing consensus that the SCTAP block provides better analgesia for upper abdominal incisions than the traditional transverse abdominis plane block. In addition, when used as part of a four-quadrant transverse abdominis plane block, the SCTAP block may provide adequate analgesia for major abdominal surgery. The purpose of this review is to discuss the SCTAP block, including its indications, technique, local anesthetic solutions, and outcomes.

  11. Beautiful Blocks of Bedrock

    NASA Image and Video Library

    2016-06-01

    This image captured by NASA Mars Reconnaissance Orbiter spacecraft targets a 3-kilometer diameter crater that occurs within the ejecta blanket of the much older Bakhuysen Crater, a 150-kilometer diameter impact crater in Noachis Terra. Impact craters are interesting because they provide a mechanism to uplift and expose underlying bedrock, allowing for the study of the subsurface and the geologic past. An enhanced color image shows the wall of the crater, which exposes layering as well as blocks of rock. There is a distinctive large block in the upper left of the crater wall, generally referred to as a "mega-block." It is an angular, light-toned, highly fragmented block, about 100 meters across. Several smaller light-toned blocks are also in the crater wall, possibly of the same rock type as the "mega-block." Ejecta blocks are thrown outward during the initial excavation of a crater, or are deposited as part of the ground-hugging flows of which the majority of the ejecta blanket is comprised. Through images like these, we are able to study the deeper subsurface of Mars that is not otherwise exposed. http://photojournal.jpl.nasa.gov/catalog/PIA20728

  12. A comparison of the dose of anesthetic agents and the effective interval from the block procedure to skin incision for ultrasound-guided supraclavicular brachial plexus block in upper extremity surgery.

    PubMed

    Nakayama, Masanori; Sakuma, Yu; Imamura, Hitoshi; Yano, Koichiro; Kodama, Takao; Ikari, Katsunori

    2017-12-01

    The aim of this study was to review and evaluate the selection and dose of anesthetic agents and the interval from the block procedure to skin incision for supraclavicular brachial plexus block in upper extremity surgery. We reviewed our cases that underwent upper extremity surgery using only ultrasound-guided supraclavicular brachial plexus block in our hospital between 2011 and 2016. Adverse events during surgery were evaluated. Receiver operating characteristic (ROC) curves were constructed to investigate the relationship between the time from the end of the block procedure to skin incision and the use of local anesthesia on the surgical site. There were 255 patients who were divided into three groups according to the anesthetic agents used: group 1, 1% lidocaine (L) 10 ml + 0.75% ropivacaine (R) 20 ml (n = 62); group 2, L 20 ml + R 10 ml (n = 93); and group 3, L 10 ml + R 15 ml (n = 100). The rate of use of local anesthesia on the surgical site was significantly higher in group 3 than in the other two groups. There were no significant differences in the other evaluated items among the three groups. ROC curve analysis indicated that ≥24 min from the end of the block procedure to skin incision might reduce the use of local anesthesia. The total volume of anesthetic agents had an important influence on the rate of the addition of local anesthesia for surgical pain; however, the combined dose of agents did not influence the evaluation items. For effective analgesia, ≥24 min should elapse from the end of the block procedure to skin incision. Copyright © 2017. Published by Elsevier B.V.

  13. FBCOT: a fast block coding option for JPEG 2000

    NASA Astrophysics Data System (ADS)

    Taubman, David; Naman, Aous; Mathew, Reji

    2017-09-01

    Based on the EBCOT algorithm, JPEG 2000 finds application in many fields, including high performance scientific, geospatial and video coding applications. Beyond digital cinema, JPEG 2000 is also attractive for low-latency video communications. The main obstacle for some of these applications is the relatively high computational complexity of the block coder, especially at high bit-rates. This paper proposes a drop-in replacement for the JPEG 2000 block coding algorithm, achieving much higher encoding and decoding throughputs, with only modest loss in coding efficiency (typically < 0.5dB). The algorithm provides only limited quality/SNR scalability, but offers truly reversible transcoding to/from any standard JPEG 2000 block bit-stream. The proposed FAST block coder can be used with EBCOT's post-compression RD-optimization methodology, allowing a target compressed bit-rate to be achieved even at low latencies, leading to the name FBCOT (Fast Block Coding with Optimized Truncation).

  14. Simulation of car collision with an impact block

    NASA Astrophysics Data System (ADS)

    Kostek, R.; Aleksandrowicz, P.

    2017-10-01

    This article presents the experimental results of crash test of Fiat Cinquecento performed by Allgemeiner Deutscher Automobil-Club (ADAC) and the simulation results obtained with program called V-SIM for default settings. At the next stage a wheel was blocked and the parameters of contact between the vehicle and the barrier were changed for better results matching. The following contact parameters were identified: stiffness at compression phase, stiffness at restitution phase, the coefficients of restitution and friction. The changes lead to various post-impact positions, which shows sensitivity of the results to contact parameters. V-SIM is commonly used by expert witnesses who tend to use default settings, therefore the companies offering simulation programs should identify those parameters with due diligence.

  15. Contact Lens-related Complications: A Review

    PubMed Central

    Alipour, Fateme; Khaheshi, Saeed; Soleimanzadeh, Mahya; Heidarzadeh, Somayeh; Heydarzadeh, Sepideh

    2017-01-01

    Contact lens-related problems are common and can result in severe sight-threatening complications or contact lens drop out if not addressed properly. We systematically reviewed the most important and the most common contact lens-related complications and their diagnosis, epidemiology, and management according to the literature published in the last 20 years. PMID:28540012

  16. Peculiarities of the atmospheric blocking events over the Siberia and Russian Far East region during summertime

    NASA Astrophysics Data System (ADS)

    Antokhina, Olga Yu.; Devjatova, Elena V.; Mordvinov, Vladimir I.

    2017-11-01

    We study the atmospheric blocking event evolution peculiarities over the Siberia and Far Eastern region (Russia) during summertime. Compared are two methods to identify blockings: from the 500 hPa (Z500) isobaric surface height distribution, and from the potential temperature at the dynamic tropopause (PV-θ) for every July 1979 through 2016. We revealed the situations, where blockings are identified only in one of the characteristics. Blocking identification by the PV-θ characteristics is complicated in the cases, when its cyclonic part appears to be filled with air masses of the southern origin, due to which there is no meridional gradient reversal in the PV-θ region. In the Z500 region, the difficulties to identify blocking events may arise in those cases, when the baric field fails to adapt to rapid changes in the temperature field associated with the air mass advection. For example, such events often occur over the ocean surface. We performed a synoptic analysis for several blocking events from the data on the velocity field dynamics at 850 hPa and PV-θ supplemented by the analysis of the observational rainfall data at the stations during those events. Distinguished were several stages of the blocking evolution over the Siberia and Far Eastern region that involved air masses from the East Asian summer monsoon region: 1. The formation of a blocking over Western Siberia; 2. Cold inflow on the blocking eastern periphery, the East Asian summer monsoon front activation, and a cyclone formation (east of Lake Baikal), in whose system the monsoon air was actively involved. Such monsoon cyclones, as a rule, are deep long-living formations, and they bring abnormal precipitations; 3. The formation of a ridge or anticyclone east of the monsoon cyclone, caused by the advection of the same monsoon flow, whose part is involved in a cyclone system. In general, the East Asian summer monsoon influence comes to the effects of regeneration and intensification of the blocking

  17. 31 CFR 594.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 594.301 Section 594.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS REGULATIONS...

  18. 31 CFR 594.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 594.301 Section 594.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS REGULATIONS...

  19. 31 CFR 594.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 594.301 Section 594.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY GLOBAL TERRORISM SANCTIONS REGULATIONS...

  20. 31 CFR 546.302 - Blocked account; blocked property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 546.302 Section 546.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DARFUR SANCTIONS REGULATIONS General...

  1. 31 CFR 593.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 593.301 Section 593.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FORMER LIBERIAN REGIME OF CHARLES...

  2. 31 CFR 510.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 510.301 Section 510.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY NORTH KOREA SANCTIONS REGULATIONS General...

  3. 31 CFR 547.302 - Blocked account; blocked property.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 31 Money and Finance: Treasury 3 2010-07-01 2010-07-01 false Blocked account; blocked property. 547.302 Section 547.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DEMOCRATIC REPUBLIC OF THE CONGO...

  4. Branchial arch anomalies: Recurrence, malignant degeneration and operative complications.

    PubMed

    Al-Mufarrej, Faisal; Stoddard, David; Bite, Uldis

    2017-06-01

    Branchial arch anomalies (BAA) represent one of the commonest pediatric neck masses, but large case series are lacking with none specifically examining risk of recurrence, surgical complications, and malignancy. Retrospective study of patients with BAA at Mayo Clinic from 1/1/1976-7/29/2011. Features studied include age, gender, location, BAA type, symptoms, recurrence, preoperative management, extent of surgery, pathology as well as presence of tracts. Associations with tracts, operative complications, and recurrence were evaluated. 421 subjects underwent BAA excision during the study period at our institution. Subjects with tracts were symptomatic earlier. Four cases (mean age 60.3 years) of malignancy were identified. Among the 358 (non-remenant) BAA patients with no previous excision, 3.6% recurred at a mean of 47.1 months following surgery. Patients who underwent incision and drainage prior to BAA excision were 3.4 times more likely to recur. 2% experienced complications. Age, BAA type, preoperative imaging and extent of surgery did not affect recurrence or complication rates. Patients with history of preoperative incision and drainage should be followed closely for recurrence the first four years. Early BAA excision is not associated with higher complication rate. Extent of resection should be determined by gross margins of BAA. Malignant degeneration was not seen in children. Malignancies have been seen in older patients (over 45 years) diagnosed with BAA, and a thorough work-up is important for correct diagnosis. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Paravertebral Block: An Improved Method of Pain Control in Percutaneous Transhepatic Biliary Drainage

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Culp, William C., E-mail: culpwilliamc@uams.edu; McCowan, Timothy C.; DeValdenebro, Miguel

    Background and Purpose. Percutaneous transhepatic biliary drainage remains a painful procedure in many cases despite the routine use of large amounts of intravenous sedation. We present a feasibility study of thoracic paravertebral blocks in an effort to reduce pain during and following the procedure and reduce requirements for intravenous sedation. Methods. Ten consecutive patients undergoing biliary drainage procedures received fluoroscopically guided paravertebral blocks and then had supplemental intravenous sedation as required to maintain patient comfort. Levels T8-T9 and T9-T10 on the right were targeted with 10-20 ml of 0.5% bupivacaine. Sedation requirements and pain levels were recorded. Results. Ten biliarymore » drainage procedures in 8 patients were performed for malignancy in 8 cases and for stones in 2. The mean midazolam use was 1.13 mg IV, and the mean fentanyl requirement was 60.0 {mu}g IV in the block patients. Two episodes of hypotension, which responded promptly to volume replacement, may have been related to the block. No serious complications were encountered. The mean pain score when traversing the chest wall, liver capsule, and upon entering the bile ducts was 0.1 on a scale of 0 to 10, with 1 patient reporting a pain level of 1 and 9 reporting 0. The mean peak pain score, encountered when manipulating at the common bile duct level or when addressing stones there, was 5.4 and ranged from 0 to 10. Conclusions. Thoracic paravertebral block with intravenous sedation supplementation appears to be a feasible method of pain control during biliary interventions.« less

  6. Parents' experiences managing their child's complicated postoperative recovery.

    PubMed

    Purcell, Mary; Longard, Julie; Chorney, Jill; Hong, Paul

    2018-03-01

    Tonsillectomy is commonly performed as same-day surgery and parents are heavily relied upon for management of children's postoperative recovery. The objective of this study was to provide an in-depth description of the experiences parents face when managing their child's complicated postoperative recoveries at home. An exploratory qualitative study at an academic pediatric hospital in Eastern Canada was performed. Participants included 12 parents of children aged 3-6 years who underwent adeno/tonsillectomy and experienced unexpected outcomes or complications during the postoperative recovery period. Parents participated in semi-structured interviews within 6 months of their child's surgery. Interviews were transcribed verbatim and thematic analysis was used to identify themes in the parents' experiences. Parents described struggling to make the decision to come back to hospital, that adequate information does not prevent emotional difficulties, and feeling somewhat responsible for the unexpected outcome or complicated course of recovery. Communication with healthcare providers was considered very important in helping with the recovery process. This research helps to inform healthcare professionals about how they might better support families during complicated recovery processes. Areas of action may include clear communication, setting expectations, and psychosocial support. Copyright © 2018 Elsevier B.V. All rights reserved.

  7. Main-chain supramolecular block copolymers.

    PubMed

    Yang, Si Kyung; Ambade, Ashootosh V; Weck, Marcus

    2011-01-01

    Block copolymers are key building blocks for a variety of applications ranging from electronic devices to drug delivery. The material properties of block copolymers can be tuned and potentially improved by introducing noncovalent interactions in place of covalent linkages between polymeric blocks resulting in the formation of supramolecular block copolymers. Such materials combine the microphase separation behavior inherent to block copolymers with the responsiveness of supramolecular materials thereby affording dynamic and reversible materials. This tutorial review covers recent advances in main-chain supramolecular block copolymers and describes the design principles, synthetic approaches, advantages, and potential applications.

  8. Organic photosensitive optoelectronic device having a phenanthroline exciton blocking layer

    DOEpatents

    Thompson, Mark E [Anaheim Hills, CA; Li, Jian [Los Angeles, CA; Forrest, Stephen [Princeton, NJ; Rand, Barry [Princeton, NJ

    2011-02-22

    An organic photosensitive optoelectronic device, having an anode, a cathode, and an organic blocking layer between the anode and the cathode is described, wherein the blocking layer comprises a phenanthroline derivative, and at least partially blocks at least one of excitons, electrons, and holes.

  9. Serotonin 5-HT1A agonist improves motor complications in rodent and primate parkinsonian models.

    PubMed

    Bibbiani, F; Oh, J D; Chase, T N

    2001-11-27

    Serotoninergic transmission in the basal ganglia is known to influence dopaminergic mechanisms and motor function. To evaluate the possibility that serotoninergic 5-HT1A autoreceptors (by regulating the release of serotonin as well as dopamine formed from exogenous levodopa) affect the response alterations complicating levodopa treatment of PD. The 5-HT1A receptor agonist sarizotan (EMD128130) was systemically administered alone and together with levodopa to parkinsonian rats and nonhuman primates. In 6-hydroxydopamine-lesioned rats, sarizotan (2.5 mg/kg PO) had no effect on the acute rotational response to levodopa but did attenuate the shortening in motor response duration induced by chronic levodopa treatment. In 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned monkeys, sarizotan (2 mg/kg PO) alone had no effect on parkinsonian severity or on the antiparkinsonian response to levodopa. In contrast, the same dose of sarizotan reduced levodopa-induced choreiform dyskinesias by 91 +/- 5.9%. In both species, the motoric effects of sarizotan were blocked by the selective 5-HT1A antagonist WAY100635 (0.1 mg/kg SC), indicating that the observed sarizotan responses were probably mediated at the 5-HT1A autoreceptor. Pharmaceuticals acting to stimulate 5-HT1A receptors could prove useful in the treatment of the motor response complications in parkinsonian patients.

  10. [Techniques for Preventing Postoperative Complication in Esophageal Salvage Surgery].

    PubMed

    Iwama, Mitsuru; Yasuda, Takushi; Shiraishi, Osamu; Kato, Hiroaki; Hiraki, Yoko; Tanaka, Yumiko; Yasuda, Atsushi; Shinkai, Masayuki; Imano, Motohiro; Kimura, Yutaka; Imamoto, Haruhiko

    2017-07-01

    Patients with esophageal cancer are often treated with definitive chemoradiotherapy (dCRT). Regardless of arrival at dCRT, the risk of local/regional recurrence during follow-up is significant. Many patient are faced with limited options for therapy once dCRT has failed. Salvage surgery is the only way for complete cure of patients with local/regional recurrent esophageal cancer after dCRT. However, salvage surgery has a significant high risk of fatal complications. We examine our preventive measures to reduce the incidence of postoperative complications after salvage surgery for thoracic esophageal cancer. The points of our preventive measures are them; I. the ingenuity of surgery, II. the securement of blood supply for the respiratory tract, III. standard lymphadenectomy, IV. countermeasures of anastomotic failure, V. countermeasures of dead space, VI. countermeasures of respiratory complications, VII. perioperative managements. Salvage surgery is a reasonable option to treat patients with local/regional recurrence after failed dCRT. Our preventive mesures are effective, therefore, we have to make the further technological developments and the safety of salvage surgery.

  11. Combined KHFAC+DC nerve block without onset or reduced nerve conductivity after block

    PubMed Central

    Franke, Manfred; Vrabec, Tina; Wainright, Jesse; Bhadra, Niloy; Bhadra, Narendra; Kilgore, Kevin

    2017-01-01

    Background Kilohertz Frequency Alternating Current waveforms (KHFAC) have been shown to provide peripheral nerve conductivity block in many acute and chronic animal models. KHFAC nerve block could be used to address multiple disorders caused by neural over-activity, including blocking pain and spasticity. However, one drawback of KHFAC block is a transient activation of nerve fibers during the initiation of the nerve block, called the onset response. The objective of this study is to evaluate the feasibility of using charge balanced direct current (CBDC) waveforms to temporarily block motor nerve conductivity distally to the KHFAC electrodes to mitigate the block onset-response. Methods A total of eight animals were used in this study. A set of four animals were used to assess feasibility and reproducibility of a combined KHFAC+CBDC block. A following randomized study, conducted on a second set of four animals, compared the onset response resulting from KHFAC alone and combined KHFAC+CBDC waveforms. To quantify the onset, peak forces and the force-time integral were measured during KHFAC block initiation. Nerve conductivity was monitored throughout the study by comparing muscle twitch forces evoked by supra-maximal stimulation proximal and distal to the block electrodes. Each animal of the randomized study received at least 300 seconds (range: 318 to 1563s) of cumulative DC to investigate the impact of combined KHFAC+CBDC on nerve viability. Results The peak onset force was reduced significantly from 20.73 N (range: 18.6–26.5 N) with KHFAC alone to 0.45 N (range: 0.2–0.7 N) with the combined CBDC and KHFAC block waveform (p<0.001). The area under the force curve was reduced from 6.8 Ns (range: 3.5–21.9 Ns) to 0.54 Ns (range: 0.18–0.86Ns) (p<0.01). No change in nerve conductivity was observed after application of the combined KHFAC+CBDC block relative to KHFAC waveforms. Conclusion The distal application of CBDC can significantly reduce or even completely

  12. Establishing an Appropriate Level of Detail (LoD) for a Building Information Model (BIM) - West Block, Parliament Hill, Ottawa, Canada

    NASA Astrophysics Data System (ADS)

    Fai, S.; Rafeiro, J.

    2014-05-01

    In 2011, Public Works and Government Services Canada (PWGSC) embarked on a comprehensive rehabilitation of the historically significant West Block of Canada's Parliament Hill. With over 17 thousand square meters of floor space, the West Block is one of the largest projects of its kind in the world. As part of the rehabilitation, PWGSC is working with the Carleton Immersive Media Studio (CIMS) to develop a building information model (BIM) that can serve as maintenance and life-cycle management tool once construction is completed. The scale and complexity of the model have presented many challenges. One of these challenges is determining appropriate levels of detail (LoD). While still a matter of debate in the development of international BIM standards, LoD is further complicated in the context of heritage buildings because we must reconcile the LoD of the BIM with that used in the documentation process (terrestrial laser scan and photogrammetric survey data). In this paper, we will discuss our work to date on establishing appropriate LoD within the West Block BIM that will best serve the end use. To facilitate this, we have developed a single parametric model for gothic pointed arches that can be used for over seventy-five unique window types present in the West Block. Using the AEC (CAN) BIM as a reference, we have developed a workflow to test each of these window types at three distinct levels of detail. We have found that the parametric Gothic arch significantly reduces the amount of time necessary to develop scenarios to test appropriate LoD.

  13. International consensus on a complications list after gastrectomy for cancer.

    PubMed

    Baiocchi, Gian Luca; Giacopuzzi, Simone; Marrelli, Daniele; Reim, Daniel; Piessen, Guillaume; Matos da Costa, Paulo; Reynolds, John V; Meyer, Hans-Joachim; Morgagni, Paolo; Gockel, Ines; Lara Santos, Lucio; Jensen, Lone Susanne; Murphy, Thomas; Preston, Shaun R; Ter-Ovanesov, Mikhail; Fumagalli Romario, Uberto; Degiuli, Maurizio; Kielan, Wojciech; Mönig, Stefan; Kołodziejczyk, Piotr; Polkowski, Wojciech; Hardwick, Richard; Pera, Manuel; Johansson, Jan; Schneider, Paul M; de Steur, Wobbe O; Gisbertz, Suzanne S; Hartgrink, Henk; van Sandick, Joanna W; Portolani, Nazario; Hölscher, Arnulf H; Botticini, Maristella; Roviello, Franco; Mariette, Christophe; Allum, William; De Manzoni, Giovanni

    2018-05-30

    Perioperative complications can affect outcomes after gastrectomy for cancer, with high mortality and morbidity rates ranging between 10 and 40%. The absence of a standardized system for recording complications generates wide variation in evaluating their impacts on outcomes and hinders proposals of quality-improvement projects. The aim of this study was to provide a list of defined gastrectomy complications approved through international consensus. The Gastrectomy Complications Consensus Group consists of 34 European gastric cancer experts who are members of the International Gastric Cancer Association. A group meeting established the work plan for study implementation through Delphi surveys. A consensus was reached regarding a set of standardized methods to define gastrectomy complications. A standardized list of 27 defined complications (grouped into 3 intraoperative, 14 postoperative general, and 10 postoperative surgical complications) was created to provide a simple but accurate template for recording individual gastrectomy complications. A consensus was reached for both the list of complications that should be considered major adverse events after gastrectomy for cancer and their specific definitions. The study group also agreed that an assessment of each surgical case should be completed at patient discharge and 90 days postoperatively using a Complication Recording Sheet. The list of defined complications (soon to be validated in an international multicenter study) and the ongoing development of an electronic datasheet app to record them provide the basic infrastructure to reach the ultimate goals of standardized international data collection, establishment of benchmark results, and fostering of quality-improvement projects.

  14. αvβ6 Integrin Regulates Renal Fibrosis and Inflammation in Alport Mouse

    PubMed Central

    Hahm, Kyungmin; Lukashev, Matvey E.; Luo, Yi; Yang, William J.; Dolinski, Brian M.; Weinreb, Paul H.; Simon, Kenneth J.; Chun Wang, Li; Leone, Diane R.; Lobb, Roy R.; McCrann, Donald J.; Allaire, Normand E.; Horan, Gerald S.; Fogo, Agnes; Kalluri, Raghu; Shield, Charles F.; Sheppard, Dean; Gardner, Humphrey A.; Violette, Shelia M.

    2007-01-01

    The transforming growth factor (TGF)-β-inducible integrin αvβ6 is preferentially expressed at sites of epithelial remodeling and has been shown to bind and activate latent precursor TGF-β. Herein, we show that αvβ6 is overexpressed in human kidney epithelium in membranous glomerulonephritis, diabetes mellitus, IgA nephropathy, Goodpasture’s syndrome, and Alport syndrome renal epithelium. To assess the potential regulatory role of αvβ6 in renal disease, we studied the effects of function-blocking αvβ6 monoclonal antibodies (mAbs) and genetic ablation of the β6 subunit on kidney fibrosis in Col4A3−/− mice, a mouse model of Alport syndrome. Expression of αvβ6 in Alport mouse kidneys was observed primarily in cortical tubular epithelial cells and in correlation with the progression of fibrosis. Treatment with αvβ6-blocking mAbs inhibited accumulation of activated fibroblasts and deposition of interstitial collagen matrix. Similar inhibition of renal fibrosis was observed in β6-deficient Alport mice. Transcript profiling of kidney tissues showed that αvβ6-blocking mAbs significantly inhibited disease-associated changes in expression of fibrotic and inflammatory mediators. Similar patterns of transcript modulation were produced with recombinant soluble TGF-β RII treatment, suggesting shared regulatory functions of αvβ6 and TGF-β. These findings demonstrate that αvβ6 can contribute to the regulation of renal fibrosis and suggest this integrin as a potential therapeutic target. PMID:17200187

  15. 31 CFR 593.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 593.301 Section 593.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FORMER LIBERIAN REGIME OF CHARLES TAYLOR...

  16. 31 CFR 593.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 593.301 Section 593.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FORMER LIBERIAN REGIME OF CHARLES TAYLOR...

  17. 31 CFR 593.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 593.301 Section 593.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FORMER LIBERIAN REGIME OF CHARLES TAYLOR...

  18. 31 CFR 593.301 - Blocked account; blocked property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked account; blocked property. 593.301 Section 593.301 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY FORMER LIBERIAN REGIME OF CHARLES TAYLOR...

  19. 31 CFR 547.302 - Blocked account; blocked property.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 31 Money and Finance:Treasury 3 2014-07-01 2014-07-01 false Blocked account; blocked property. 547.302 Section 547.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DEMOCRATIC REPUBLIC OF THE CONGO SANCTIONS...

  20. 31 CFR 547.302 - Blocked account; blocked property.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 31 Money and Finance:Treasury 3 2012-07-01 2012-07-01 false Blocked account; blocked property. 547.302 Section 547.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DEMOCRATIC REPUBLIC OF THE CONGO SANCTIONS...

  1. 31 CFR 547.302 - Blocked account; blocked property.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 31 Money and Finance:Treasury 3 2011-07-01 2011-07-01 false Blocked account; blocked property. 547.302 Section 547.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DEMOCRATIC REPUBLIC OF THE CONGO SANCTIONS...

  2. 31 CFR 547.302 - Blocked account; blocked property.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 31 Money and Finance:Treasury 3 2013-07-01 2013-07-01 false Blocked account; blocked property. 547.302 Section 547.302 Money and Finance: Treasury Regulations Relating to Money and Finance (Continued) OFFICE OF FOREIGN ASSETS CONTROL, DEPARTMENT OF THE TREASURY DEMOCRATIC REPUBLIC OF THE CONGO SANCTIONS...

  3. [Clinical study of modified Gow-Gates technique of inferior alveolar nerve block in impacted mandibular third molar extraction].

    PubMed

    Hu, Yi-ping; Jin, Gui-fang

    2015-06-01

    To introduce a minimally invasive and more effective technique of inferior alveolar nerve block. Two hundred and six patients who needed extraction of the impacted mandibular third molar were divided randomly into 2 groups: the experimental group (105 cases) with modified Gow-Gates technique (modified Gow-Gates group) and the control group (101 cases) with Halstead technique (Halstead group). The anesthetic success rates, effects and complications were recorded and analyzed with SPSS17.0 software package. The anesthetic success rate was 97.15% in modified Gow-Gates group and 89.10% in Halstead group with significant difference between the 2 groups (P=0.038<0.05); In comparing the anesthesia grade, the ration of grade A and B accounted for 90.48% in modified Gow-Gates group and 87.13% in Halstead group (P=0.446>0.05). Modified Gow-Gates group had much fewer of complications than Halstead group (P=0.014<0.05). Modified Gow-Gates technique is a minimally invasive and more effective technique for inferior alveolar nerve block anesthesia. Supported by Science and Technology Planning Project of Yueqing City (2014y027).

  4. Nonalcoholic fatty liver disease is associated with an increased risk of heart block in hospitalized patients with type 2 diabetes mellitus.

    PubMed

    Mantovani, Alessandro; Rigolon, Riccardo; Pichiri, Isabella; Bonapace, Stefano; Morani, Giovanni; Zoppini, Giacomo; Bonora, Enzo; Targher, Giovanni

    2017-01-01

    Recent studies suggested that nonalcoholic fatty liver disease (NAFLD) is associated with an increased risk of cardiac tachyarrhythmias (mainly atrial fibrillation) in patients with and without type 2 diabetes mellitus. The aim of this study was to examine whether an association also exists between NAFLD and heart block. We have retrospectively evaluated a hospital-based cohort of 751 patients with type 2 diabetes discharged from our Division of Diabetes and Endocrinology during years 2007-2014. Standard electrocardiograms were performed on all patients. Diagnosis of NAFLD was based on ultrasonography, whereas the severity of advanced hepatic fibrosis was based on the fibrosis (FIB)-4 score and other non-invasive fibrosis markers. Overall, 524 (69.8%) patients had NAFLD and 202 (26.9%) had heart block (defined as at least one block among first-degree atrio-ventricular block, second-degree block, third-degree block, left bundle branch block, right bundle branch block, left anterior hemi-block or left posterior hemi-block) on electrocardiograms. Patients with NAFLD had a remarkably higher prevalence of any persistent heart block than those without NAFLD (31.3% vs. 16.7%, p<0.001); this prevalence was particularly increased among those with higher FIB-4 score. NAFLD was associated with a threefold increased risk of prevalent heart block (adjusted-odds ratio 3.04, 95% CI 1.81-5.10), independently of age, sex, hypertension, prior ischemic heart disease, hemoglobin A1c, microvascular complication status, use of medications and other potentially confounding factors. In conclusion, this is the largest cross-sectional study to show that NAFLD and its severity are independently associated with an increased risk of prevalent heart block in hospitalized patients with type 2 diabetes.

  5. Ballistic Blocks Surrounding Kilauea's Caldera

    NASA Astrophysics Data System (ADS)

    Swanson, D.; Zolkos, S.; Haravitch, B.

    2010-12-01

    Thousands of lithic blocks dot the surface around Kilauea’s caldera, erupted ballistically at the end of the 1790 eruption or soon thereafter. Most of the blocks occur in the western and southern sectors, probably reflecting the proximity of vents on the caldera floor. We mapped the ejecta field, measuring most of the blocks with nominal diameters ((a+b+c)/3) more than 75 cm and many of the smaller ones, noting distinctive lithologies. The distributions, sizes, and lithologies suggest 7-8 different ballistic bursts from 3-4 generalized vent areas. We measured 15 blocks with nominal diameters (ND) of 150-201 cm, 169 blocks with ND 100-149 cm, 308 blocks with ND 75-99 cm, 684 blocks with ND 50-74 cm, and 545 blocks with ND 25-49 cm. The smaller blocks were measured only in outlying areas, where they were the largest in the neighborhood, but they occur throughout the field. Twelve blocks with ND >150 cm lie within 1.7 km west and south of the center of Halema`uma`u; a vent near this location likely erupted the blocks. Three of the largest blocks, however, are 2.2-2.7 km north of Halema`uma`u and probably came from a more northerly vent. This interpretation is supported by the distributions of all blocks with ND >100 cm, which define at least 4, and possibly 5, different dispersal lobes; three cluster near Halema`uma`u, one is slightly north, and the one with the three large blocks is still farther north. The blocks have typical lithologies for Kilauea’s summit, including coarse basalt or fine gabbro derived from the centers of thick flows, solidified lakes, or small intrusions. Three lithologies are distinctive and help define 3, possibly 4, discrete bursts. Blocks of fine-grained basalt riddled with segregation veins occur only in a lobe 1.3 km wide reaching as far as 1.8 km southwest of Halema`uma`u; this lobe overlaps slightly with one defined by block size but is mostly distinct and probably indicates a separate burst. A cluster of blocks with puffy, somewhat

  6. A population-based analysis of temporal perioperative complication rates after minimally invasive radical prostatectomy.

    PubMed

    Schmitges, Jan; Trinh, Quoc-Dien; Abdollah, Firas; Sun, Maxine; Bianchi, Marco; Budäus, Lars; Zorn, Kevin; Perotte, Paul; Schlomm, Thorsten; Haese, Alexander; Montorsi, Francesco; Menon, Mani; Graefen, Markus; Karakiewicz, Pierre I

    2011-09-01

    Existing population-based reports on complication rates after minimally invasive radical prostatectomy (MIRP) did not address temporal trends. To examine contemporary temporal trends in perioperative MIRP outcomes. Between 2001 and 2007, 4387 patients undergoing MIRP were identified using the Nationwide Inpatient Sample. To examine the rates and trends of intraoperative and postoperative complications, transfusion rates, length of stay in excess of the median, and in-hospital mortality. We tested the effect of the late (2006-2007) versus the early (2001-2005) study period on all outcomes using multivariable logistic regression models controlled for clustering among hospitals. Intraoperative and postoperative complications decreased from 7.0% to 0.8% (p < 0.001) and from 28.5% to 8.7% (p < 0.001), respectively. Transfusion rates decreased from 3.5% to 2.1% (p = 0.3). Hospital length of stay >2 d decreased from 56% to 15% (p < 0.001). In multivariable analyses, intraoperative (odds ratio [OR]: 0.41; p = 0.002) and postoperative (OR: 0.65; p = 0.007) complications were less frequent in the late versus the early study period. Late study period patients were less likely to stay >2 d than early study period patients (OR: 0.34; p > 0.001). Limitations of these findings include the lack of adjustment for several patient variables including disease characteristics, surgeon variables including surgeon caseload, and the restriction to in-hospital events. Our analyses demonstrate that in-hospital complication rates and length of stay after MIRP decreased over time. This implies that temporal differences specific to complication rates after MIRP must be considered when comparisons are made with other radical prostatectomy techniques. Copyright © 2011 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  7. Multi-ligament instability after early dislocation of a primary total knee replacement - case report.

    PubMed

    Sisak, Krisztian; Lloyd, John; Fiddian, Nick

    2011-01-01

    Peripheral nerve blocks have found increased popularity in providing prolonged post-operative analgesia following total knee replacement surgery. They generally provide effective analgesia with fewer complications than epidurals. This report describes an acute low-energy knee dislocation after a well balanced, fixed bearing, cruciate-retaining primary total knee replacement performed under a spinal anaesthetic with combined complimentary femoral and sciatic nerve blocks. The dislocation was not accompanied by neurovascular compromise. Due to the subsequent instability and injury to both collaterals, the posterior cruciate ligament and posterolateral corner structures, the knee was treated with a rotating-hinge revision total knee replacement. The dislocation occurred whilst the peripheral nerve blocks (PNB) were still working. We review our incidence of PNB related complications and conclude that PNB remain a safe and effective analgesia for total knee replacements. However, we advocate that ward staff and patients should be sufficiently educated to ensure that unaided post-operative mobilisation is prevented until such a time that patients have regained complete voluntary muscle control. Copyright © 2009 Elsevier B.V. All rights reserved.

  8. Pre-operative brachial plexus block compared with an identical block performed at the end of surgery: a prospective, double-blind, randomised clinical trial.

    PubMed

    Holmberg, A; Sauter, A R; Klaastad, Ø; Draegni, T; Raeder, J C

    2017-08-01

    We evaluated whether pre-emptive analgesia with a pre-operative ultrasound-guided infraclavicular brachial plexus block resulted in better postoperative analgesia than an identical block performed postoperatively. Fifty-two patients undergoing fixation of a fractured radius were included. All patients received general anaesthesia with remifentanil and propofol. Patients were randomly allocated into two groups: a pre-operative block or a postoperative block with 0.5 ml.kg -1 ropivacaine 0.75%. After surgery, all patients received regular paracetamol plus opioids for breakthrough pain. Mean (SD) time to first rescue analgesic after emergence from general anaesthesia was 544 (217) min in the pre-operative block group compared with 343 (316) min in the postoperative block group (p = 0.015). Postoperative pain scores were higher and more patients required rescue analgesia during the first 4 h after surgery in the postoperative block group. There were no significant differences in plasma stress mediators between the groups. Analgesic consumption was lower at day seven in the pre-operative block group. Pain was described as very strong at block resolution in 27 (63%) patients and 26 (76%) had episodes of mild pain after 6 months. We conclude that a pre-operative ultrasound-guided infraclavicular brachial plexus block provides longer and better analgesia in the acute postoperative period compared with an identical postoperative block in patients undergoing surgery for fractured radius. © 2017 The Association of Anaesthetists of Great Britain and Ireland.

  9. Two-sided block of a dual-topology F- channel.

    PubMed

    Turman, Daniel L; Nathanson, Jacob T; Stockbridge, Randy B; Street, Timothy O; Miller, Christopher

    2015-05-05

    The Fluc family is a set of small membrane proteins forming F(-)-specific electrodiffusive ion channels that rescue microorganisms from F(-) toxicity during exposure to weakly acidic environments. The functional channel is built as a dual-topology homodimer with twofold symmetry parallel to the membrane plane. Fluc channels are blocked by nanomolar-affinity fibronectin-domain monobodies originally selected from phage-display libraries. The unusual symmetrical antiparallel dimeric architecture of Flucs demands that the two chemically equivalent monobody-binding epitopes reside on opposite ends of the channel, a double-sided blocking situation that has never before presented itself in ion channel biophysics. However, it is not known if both sites can be simultaneously occupied, and if so, whether monobodies bind independently or cooperatively to their transmembrane epitopes. Here, we use direct monobody-binding assays and single-channel recordings of a Fluc channel homolog to reveal a novel trimolecular blocking behavior that reveals a doubly occupied blocked state. Kinetic analysis of single-channel recordings made with monobody on both sides of the membrane shows substantial negative cooperativity between the two blocking sites.

  10. Four quadrant transversus abdominis plane block and continuous transversus abdominis plane analgesia: a 3-year prospective audit in 124 patients.

    PubMed

    Niraj, G; Kelkar, Aditi; Hart, Elaine; Kaushik, Vipul; Fleet, Danny; Jameson, John

    2015-11-01

    Transversus abdominis plane (TAP) blocks have been reported to be an effective method of providing analgesia after abdominal surgery. To perform a prospective audit on the effectiveness of a novel technique of providing continuous transversus abdominis plane (TAP) analgesia in patients undergoing emergency and elective abdominal surgery. Prospective single center audit over a 3-year period. University hospital. One hundred twenty-four American Society of Anesthesiologists I to IV adult patients presenting for elective as well as emergency abdominal surgery in whom epidural analgesia was contraindicated or refused. Four quadrant TAP blocks and continuous TAP analgesia. Numerical rating scale pain scores at rest and on coughing, nausea scores, satisfaction scores, complications, frequency of analgesia failure, therapeutic failure with continuous TAP analgesia and opioid consumption. One hundred twenty-four patients who received continuous TAP analgesia were audited. This included 34 patients for elective open surgery, 36 patients for emergency laparotomy, and 54 patients who underwent elective laparoscopic colorectal surgery. Surgical incision was within the dermatomal limit of the block in 70% of the patients (88/124). Therapeutic failure with the technique was 10%. Frequency of analgesic failure over the 48-hour period was none in 39% and below 5 episodes in 57%. Four quadrant transversus abdominis plane blocks and continuous TAP analgesia is an effective technique for providing postoperative analgesia after abdominal surgery. It has the potential to be used as a sole analgesic technique when the surgical incision is within its dermatomal limit. Copyright © 2015 Elsevier Inc. All rights reserved.

  11. Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation

    PubMed Central

    Park, Hee-Sun; Kim, Ha-Jung; Ro, Young-Jin; Yang, Hong-Seuk; Koh, Won-Uk

    2017-01-01

    Abstract Rationale: Recurrent laryngeal nerve block is an uncommon complication that can occur after an interscalene brachial plexus block (ISB), which may lead to vocal cord palsy or paresis. However, if the recurrent laryngeal nerve is blocked in patients with a preexisting contralateral vocal cord palsy following neck surgery, this may lead to devastating acute respiratory failure. Thus, ISB is contraindicated in patients with contralateral vocal cord lesion. To the best of our knowledge, there are no reports of bilateral vocal cord paresis, which occurred after a continuous ISB and endotracheal intubation in a patient with no history of vocal cord injury or surgery of the neck. Patient concerns: A 59 year old woman was planned for open acromioplasty and rotator cuff repair under general anesthesia. General anesthesia was induced following an ISB using 0.2% ropivacaine and catheter insertion for postoperative pain control. Diagnoses: While recovering in the postanesthesia care unit (PACU), however, the patient complained of a sore throat and hoarseness without respiratory insufficiency. On the morning of the first postoperative day, she still complained of mild dyspnea, dysphonia, and slight aspiration. She was subsequently diagnosed with bilateral vocal cord paresis following an endoscopic laryngoscopy examination. Interventions: The continuous ISB catheter was immediately removed and the dyspnea and hoarseness symptoms improved, although mild aspiration during drinking water was still present. Outcomes: On the 4th postoperative day, a laryngoscopy examination revealed that the right vocal cord movement had returned to normal but that the left vocal cord paresis still remained. Lessons: When ISB is planned, a detailed history-taking and examination of the airway are essential for patient safety and we recommend that any local anesthetics be carefully injected under ultrasound guidance. We also recommend the use of low concentration of local anesthetics to avoid

  12. Blocks as a Tool for Learning: Historical and Contemporary Perspectives.

    ERIC Educational Resources Information Center

    Hewitt, Karen

    2001-01-01

    Examines the central historical and contemporary role of blocks and construction toys in early childhood education. Describes how commercially produced blocks were conceptualized as a surface for displaying symbols, as pure form, or as a way to transmit a cultural heritage of architectural styles. Discusses how blocks were used in early…

  13. Island custom blocking technique

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Carabetta, R.J.

    The technique of Island blocking is being used more frequently since the advent of our new head and neck blocking techniques and the implementation of a newly devised lung protocol. The system presented affords the mould room personnel a quick and accurate means of island block fabrication without the constant remeasuring or subtle shifting to approximate correct placement. The cookie cutter is easily implemented into any department's existing block cutting techniques. The device is easily and inexpensively made either in a machine shop or acquired by contacting the author.

  14. Bundle Branch Block

    MedlinePlus

    ... known cause. Causes can include: Left bundle branch block Heart attacks (myocardial infarction) Thickened, stiffened or weakened ... myocarditis) High blood pressure (hypertension) Right bundle branch block A heart abnormality that's present at birth (congenital) — ...

  15. Neurostimulation in ultrasound-guided infraclavicular block: a prospective randomized trial.

    PubMed

    Dingemans, Emmanuel; Williams, Stephan R; Arcand, Geneviève; Chouinard, Philippe; Harris, Patrick; Ruel, Monique; Girard, François

    2007-05-01

    Ultrasound guidance (USG) for infraclavicular blocks provides real time visualization of the advancing needle and local anesthetic distribution. Whether visualization of local anesthetic spread can supplant neurostimulation as the end point for local anesthetic injection during USG block has never been formally evaluated. Therefore, for this prospective randomized study, we recruited 72 patients scheduled for hand or forearm surgery and compared the speed of execution and quality of USG infraclavicular block with either USG alone (Group U) or USG combined with neurostimulation (Group S). In Group U, local anesthetic was deposited in a U-shaped distribution posterior and to each side of the axillary artery using as few injections as possible (1, 2, and 3 injections in 29, 6, and 3 patients, respectively). In Group S, a single injection was made after obtaining a distal motor response with a stimulating current between 0.3 and 0.6 mA. The anesthetic solution consisted of 0.5 mL/kg of lidocaine 1.5%, bupivacaine 0.125%, and epinephrine 1:200 000 (final concentrations). Procedure times were significantly shorter in Group U compared with Group S (3.1 +/- 1.6 min and 5.2 +/- 4.7 min, respectively; P = 0.006). In Group S, anesthetic spread was mainly anterior to the axillary artery in 37% of patients and mainly posterior in 63% of patients. Thirty minutes after the injection, 86% of patients in Group U had complete sensory block in the musculocutaneous, median, radial, and ulnar nerve territories compared with 57% in Group S (P = 0.007). Patients blocked in Group U with a single injection had the same rate of complete block (86%) as those blocked with more than one injection (86%). Block supplementation rates were 8% in Group U versus 26% in Group S (P = 0.049). Block failure occurred in one patient in Group S because of an inability to obtain a distal stimulation after 20 min. We conclude that USG infraclavicular block is more rapidly performed and yields a higher

  16. Diabetic ketoacidosis in acromegaly; a rare complication precipitated by corticosteroid use.

    PubMed

    Weiss, Jeremy; Wood, Anna J; Zajac, Jeffrey D; Grossmann, Mathis; Andrikopoulos, Sofianos; Ekinci, Elif I

    2017-12-01

    Diabetic ketoacidosis has been described in the literature as a rare possible initial presentation of acromegaly before a diagnosis of acromegaly is eventually made. Indeed, diabetic ketoacidosis is a recognised complication of acromegaly. There are a number of factors that can predispose patients with acromegaly to diabetes as well as to diabetic ketoacidosis. These include high levels of growth hormone and insulin-like growth factor 1 in acromegaly and the effect on glycaemia by medications used in the management of acromegaly. Ketoacidosis has been described in patients with acromegaly even without the presence of an underlying autoimmune diabetes. Patients with acromegaly and ketoacidosis often respond to treatment and may not require long-term insulin. Copyright © 2017. Published by Elsevier B.V.

  17. Transversus abdominal plane (TAP) block for postoperative pain management: a review.

    PubMed

    Jakobsson, Jan; Wickerts, Liselott; Forsberg, Sune; Ledin, Gustaf

    2015-01-01

    Transversus abdominal plane (TAP) block has a long history and there is currently extensive clinical experience around TAP blocks. The aim of this review is to provide a summary of the present evidence on the effects of TAP block and to provide suggestions for further studies. There are several approaches to performing abdominal wall blocks, with the rapid implementation of ultrasound-guided technique facilitating a major difference in TAP block performance. During surgery, an abdominal wall block may also be applied by the surgeon from inside the abdominal cavity. Today, there are more than 11 meta-analyses providing a compiled evidence base around the effects of TAP block. These analyses include different procedures, different techniques of TAP block administration and, importantly, they compare the TAP block with a variety of alternative analgesic regimes. The effects of TAP block during laparoscopic cholecystectomy seem to be equivalent to local infiltration analgesia and also seem to be beneficial during laparoscopic colon resection. The effects of TAP are more pronounced when it is provided prior to surgery and these effects are local anaesthesia dose-dependent. TAP block seems an interesting alternative in patients with, for example, severe obesity where epidural or spinal anaesthesia/analgesia is technically difficult and/or poses a risk. There is an obvious need for further high-quality studies comparing TAP block prior to surgery with local infiltration analgesia, single-shot spinal analgesia, and epidural analgesia. These studies should be procedure-specific and the effects should be evaluated, both regarding short-term pain and analgesic requirement and also including the effects on postoperative nausea and vomiting, recovery of bowel function, ambulation, discharge, and protracted recovery outcomes (assessed by e.g., postoperative quality of recovery scale).

  18. Towards A Possible Therapy for Diabetes Complications

    DTIC Science & Technology

    2014-12-01

    Towards A Possible Therapy for Diabetes Complications PRINCIPAL INVESTIGATOR: Massimo Trucco, M.D...September 2014 4. TITLE AND SUBTITLE Towards A Possible Therapy for Diabetes Complications 5a. CONTRACT NUMBER 5b. GRANT NUMBER W81XWH-10-1-1055...of the beta cells. Consistently with this view, the standard of care for diabetic , and especially T1D patients is solely insulin-replacement therapy

  19. [Sacrospinous colpopexy complications].

    PubMed

    Estrade, J-P; Agostini, A; Roger, V; Dallay, D; Blanc, B; Cravello, L

    2004-10-01

    To evaluate complications of sacrospinous ligament fixation. Monocentric retrospective study. Department of Obstetrics & Gynecology, La Conception University Hospital, Marcella. Between January 1991 and September 2002, 277 women (mean age 64.9 years, range 37 to 92 years) underwent a sacrospinous ligament fixation; 91% had a menopausal status, and 15.5% used hormone replacement therapy. 33.2% of the patients had prior hysterectomy, 28.9% had a history of surgery for prolapse, and 18.8% had associated symptoms of stress urinary incontinence. In all cases, sacrospinous ligament fixation was performed under visual control using conventional stitch. Sacrospinous ligament fixation was combined with the following procedures: anterior vaginal repair (N =137), additional incontinence surgery (N =31), vaginal hysterectomy (N =137), levator myorraphy (N =203). Intraoperative complications, postoperative complications, long-term painful symptoms. Intraoperative complications were represented by 1 case of vascular wound and four rectal injuries. Main postoperative complications were vaginal haematomas (N =6) and abscesses (N =2). Long-term symptoms were perineal pain, sciatic neuralgia, and dyspareunia. There was no surgical mortality, and we noted low rates of major complications. Sacrospinous ligament fixation assumes high priority in our therapeutic regimen.

  20. Focal neuronal gigantism: a rare complication of therapeutic radiation.

    PubMed

    Gaughen, J R; Bourne, T D; Aregawi, D; Shah, L M; Schiff, D

    2009-11-01

    Radiation therapy, a mainstay in the treatment of many brain tumors, results in a variety of well-documented acute and chronic complications. Isolated cortical damage following irradiation represents an extremely rare delayed therapeutic complication, described only twice in the medical literature. We report this rare delayed complication in a patient following treatment of a right frontal anaplastic oligodendroglioma.