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TEE should be considered the first-line imaging modality for the evaluation of trauma patients with suspected injuries of the thoracic aorta because of its portability, safety, diagnostic accuracy, and potential impact on patient management.

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Persistent neuropathic pain after inguinal herniorrhaphy depending on the procedure (open mesh v. laparoscopy): a propensity-matched analysisBackground: A greater incidence of persistent pain after inguinal herniorrhaphy is suspected with the open mesh procedure than with laparoscopy (transabdominal preperitoneal), but the involvement of neuropathy needs to be clarified. Methods:We examined the cumulative incidence of neuropathic persistent pain, defined as self-report of pain at the surgical site with neuropathic aspects, within 6 months after surgery in 2 prospective subcohorts of a multicentre study. We compared open mesh with laparoscopy using different analysis, including a propensitymatched analysis with the propensity score built from a multivariable analysis using a generalized linear model. Results:Considering the full patient sample (242 open mesh v. 126 laparoscopy), the raw odds ratio for neuropathic persistent pain after inguinal herniorrhaphy was 4.3. It reached 6.8 with the propensity-matched analysis conducted on pooled subgroups of 194 patients undergoing open mesh and 125 undergoing laparoscopy (95% confidence interval 1.5-30.4, p = 0.012). A risk factor analysis of these pooled subgroups revealed that history of peripheral neuropathy was an independent risk factor for persistent neuropathic pain, while older age was protective. Conclusion:We found a greater risk of persistent pain with open mesh than with laparoscopy that may be explained by direct or indirect lesion of nerve terminations. Strategies to identify and preserve nerve terminations with the open mesh procedure are needed.Contexte : On soupçonne que l'incidence de la douleur persistante à la suite d'une hernioplastie inguinale est plus élevée avec la mise en place d'un filet par voie ouverte qu'avec la laparoscopie (transabdominale prépéritonéale), mais encore faut-il clarifier le rôle de la neuropathie.Méthodes : Nous avons mesuré l'incidence cumulative de la douleur neuropathique persistante, décrite comme une douleur au site opératoire accompagnée d'éléments neuropathiques déclarés par le patient dans les 6 mois suivant la chirurgie, auprès de 2 sous-cohortes prospectives d'une étude multicentrique. Nous avons comparé la mise en place d'un filet par voie ouverte et la laparoscopie à l'aide de différentes analyses, dont une analyse avec appariement des scores de propension, les scores de propension découlant d'une analyse multivariée générée à partir d'un modèle linéaire généralisé.

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We conducted a randomized, double-blind, placebo-controlled study to assess the cardioprotective effects of trimetazidine (TMZ), an antiischemic drug, on left ventricular function using transesophageal echocardiography (TEE) after coronary artery bypass grafting (CABG). Forty patients undergoing elective CABG received either TMZ or a placebo (PCB). The primary measures of efficacy were serial measurements of fractional area change (FAC), percent of systolic wall thickening (SWT), and malonedialdehyde (MDA) production. The two groups were similar for the following variables: number of vessels revascularized (2.5 +/- 0.2 in the TMZ group and 2.8 +/- 0.1 in the PCB group), duration of aortic clamping (46 +/- 4 min in the TMZ group and 48 +/- 3 min in the PCB group), and bypass time (63 +/- 4 min in the TMZ group and 70 +/- 4 min in the PCB group). FAC increased by 12% in both groups 20 min after aortic unclamping (P < 0.05) and remained above the initial value at the sixth postoperative hour. SWT was 23.8% +/- 1.6%, 25.4% +/- 1.9%, then 21.6% +/- 1.5% in the TMZ group and 22.8% +/- 1.6%, 23.8% +/- 1.4%, then 22.3% +/- 1.6 % in the PCB group, after induction of anesthesia and 1 and 6 h after aortic unclamping (not significant). MDA increased by 24% in the PCB group and 25% in the TMZ group 20 min after aortic unclamping (P < 0.01). Lactate levels were lower in the TMZ group (P < 0.05) and patients from the TMZ group received less intravenous calcium before aortic clamping (P < 0.02) and less calcium channel entry blocking drugs in the early phase after aortic unclamping (P < 0.01) compared to the PCB group. We conclude that in patients with good preoperative ejection fraction undergoing CABG, TMZ as administered did not demonstrate clinically significant cardioprotective effects on left ventricular performance and lipid peroxidation compared to PCB.