Recent advances on CT scan imaging followed by further investigation techniques (if applicable) such as endobronchial ultrasound (EBUS), fiberoptic bronchoscopy (FOB), video assisted thoracoscopy (VATS), surgery and pathological diagnosis have played a key role in the early and accurate diagnosis Abstract OBJECTIVE: To determine whether the American College of Chest Physicians' lung nodule screening recommendation is an effective tool in diagnosing Asian patients with pulmonary nodules. MATERIALS AND METHODS: This is a retrospective study of 36 patients from 2012-2014 that were identified to have had pulmonary nodules through chest CT scan results. The data collected from patients were evaluated then illustrated to find out the nature of lung nodules among Asian population. The pulmonary nodule is based on size alone regardless of other morphology for instance border, calcification etc. RESULTS: Out of 36 patients, 23 were diagnosed with tuberculosis (TB), 19 tested positive for lung malignancy, 5 cases of TB co existing with cancer and 6 cases of non-tuberculous mycobacterium (NTM) infection. The types of lung cancer found were 7% small cell lung cancer, 7% squamous cell lung cancer and 86% adenocarcinoma. Nodule sizes were classified into 3 groups according to measurement. 4.5-11 mm (100% TB and 0% cancer), 12-20 mm (60% TB and 40% cancer) and 21-88 mm (52% TB and 48% cancer). CONCLUSION: Lung nodule evaluation among Asian patients requires specific guidelines that consider the high prevalence of tuberculosis and other infections. The statistical results from our study proves that the American College of Chest Physicians' lung nodule screening recommendation, if practiced by Asian physicians, should be revised according to the current health status and presence of other diseases of the Asian population.
Background
The combination of the adductor canal block (ACB) and the infiltration of anesthetic solution into the interspace between the popliteal artery and capsule of the knee (iPACK) has become increasingly used to augment rapid recovery protocols in total knee arthroplasty (TKA). However, its efficacy in comparison with periarticular anesthetic injection (PAI) alone has yet to be evaluated. Hence, we conducted a retrospective study to compare PAI and ACB + iPACK for controlling pain after TKA.
Methods
Propensity scores, incorporating American Society of Anesthesiologists scores, body mass index, age, and sex, were used to match the ACB + iPACK group with the PAI group. All patients received the identical surgical technique and postoperative care. Outcome measures were visual analog scale (VAS) for pain, morphine consumption, knee flexion angle, straight leg raising (SLR), postoperative nausea vomiting (PONV), and length of stay (LOS) after the surgery.
Results
After matching by propensity score, there were 49 patients with comparable demographic data in each group. The VAS and morphine requirements of the PAI and ACB + iPACK groups were not different during the first 48 hours after TKA. At 72 hours postoperatively, the VAS of the ACB + iPACK was 0.97 higher than that of the PAI group (
p
= 0.020). Knee flexion angle, SLR, PONV, and LOS were not significantly different between groups. No procedure-related complications were identified in either group.
Conclusions
The anesthesiologist-administered ACB + iPACK was as effective as surgeon-administered PAI in controlling pain in the first 48 hours after TKA. However, the ACB + iPACK group had higher intensity of pain than did the PAI group at 72 hours after TKA.
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