The first long-term follow-up after aortic root replacement with the Shelhigh® BioConduit revealed a relatively high rate of death and very high rate of reoperations due to endocarditis, aorto-ventricular disconnection and structural valve failure. This may be potentially connected to the nature of the implanted valved conduit.
Background: Clavicle fractures occur in 35% of shoulder girdle fractures. Surgical fixation is preferred, especially in young patients for optimal functional outcomes, while nondisplaced fractures are usually treated conservatively. Case: A 38-year-old male patient was admitted to the emergency services with a fracture of the left clavicle following a fall. During the preoperative evaluation, the patient requested to be awake during the surgery. Combined supraclavicular and superficial cervical plexus block was performed under ultrasound guidance without complications and the patient experienced no pain. Conclusions: This technique may avoid possible complications related to interscalene brachial plexus block. Future studies are required to confirm the safety and efficacy of this approach.
Background and objectives Hypertension is one of the most important risk factors for cardiovascular and cerebrovascular events. Inflammatory processes occupy an important place in the pathogenesis of hypertension. Many studies have studied inflammatory markers responsible for the onset of hypertension and organ damage. In this study, we investigated whether the systemic immune-inflammation index (SII) (platelet × neutrophil/lymphocyte), -one of the new inflammatory markers -can be used to predict cerebrovascular events in hypertensive patients.Methods Ambulatory blood pressure monitoring results between January 2019 and June 2020 of approximately 379 patients followed up with hypertension were retrospectively analyzed. These patients were divided into two groups as with or without a previous cerebrovascular event in the analyzed database. In all patients, complete blood count and biochemistry test results just before the cerebrovascular event were found from the database. SII, atherogenic index, neutrophil-lymphocyte ratio were calculated from the complete blood count. Fortynine patients with stroke (group 1: 12.9%; mean age: 64.3 ± 14.6) and 330 patients without stroke (group 2: 87.1%; mean age: 50.8 ± 14.4).Results Ambulatory blood pressure measurements were lower in group 1. Lipid parameters were also lower in this group. Receiver operating characteristic curve analysis showed that SII had a sensitivity of 85.7% and specificity of 84.8 % for stroke in individuals who participated in the study when the cutoff value of SII was 633.26 × 10 3 (P = 0.0001) area under curve (95%); 0.898 (0.856-0.941). In multivariate logistic regression analysis, age and SII were significantly associated with a higher risk of stroke. Age, (hazard ratio:1.067; 95% CI, 1.021-1.115), SII (hazard ratio:1.009; 95% CI, 1.000-1.009), respectively.
ConclusionsIn conclusion, SII is a simple, useful new inflammatory parameter for predicting stroke from hypertension. We found that the high SII levels increase the risk of stroke in hypertensive patients.
Reports on pacemaker placement/relocation surgery under pectoralis nerve block are limited. We herein report a case involving a 74-year-old woman with an infected cardiac pacemaker generator who underwent pacemaker relocation surgery under an ultrasound-guided pectoralis nerve block. On preoperative evaluation, she had congestive heart failure, type 2 diabetes mellitus, and a pacer-dependent heart rhythm. She was considered to be at high risk for general anesthesia. Thus, an ultrasound-guided pectoralis nerve block was planned. The surgery was completed successfully, without notable complications. Our findings might help in the management of patients who require pacemaker implantation/relocation.
Objective Erector spinae plane (ESP) block is an alternative to neuraxial block for post-surgical pain in nephrectomy patients. However, no clinical trial has directly compared ESP block with a control group. Methods In a single-center, double-blind randomized comparative trial, patients undergoing nephrectomy with a subcostal flank incision under general anesthesia were divided into the following two groups: ESP block group (ESP block before anesthesia) and non-ESP (control) group (no intervention). The primary outcome measure was pain score (Numeric Rating Scale [NRS] 0 to 10). Secondary outcomes were postoperative opiate use, anesthetic and surgical complications, length of hospital stay, and patient-reported outcomes. Results Postoperatively (0 to 24 hours), the ESP block group experienced less pain and had lower NRS pain scores 0 to 24 hours postoperatively than the non-ESP group. Opioid consumption and the number of rescue analgesic doses decreased significantly in the ESP group compared with the non-ESP group. Patient-Reported Outcomes Information System (Quality of Recovery-15) scores significantly improved in the ESP group compared with the non-ESP block group. Conclusions Patients receiving an ESP block for intraoperative and postoperative analgesia during radical nephrectomies experienced less postoperative pain 0 to 24 hours compared with the non-ESP group.
Background
Ultrasound-guided erector spinae plane block has been reported to reduce postoperative pain following a laparoscopic surgery, which is one of the most common abdominal surgeries. The case reports and randomized controlled trials published previously mostly used bilateral erector spinae plane block; however, we report a case in which a unilateral erector spinae plane block was performed.
Case presentation
A 34-year-old male patient who underwent laparoscopic cholecystectomy was scheduled for a unilateral erector spinae plane block. The block was performed preoperatively, followed by the induction of general anesthesia.
Conclusions
The patient was comfortable and had a visual analog scale score of 2 for 12 h. Thus, we report successful pain management with the unilateral erector spinae plane block; however, more studies are needed for conclusive information.
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