We report here a very rare case of de novo inversion-duplication chromosomal abnormality with a pure 3qter duplication syndrome. Interestingly, the 3q duplication includes an overlap of the syndromes critical region. Although there have only been 9 cases of this syndrome reported in the past, our patient had more severe neurological abnormalities than anticipated. In this regard, we have gathered the 3q chromosomal duplication abnormalities known to cause pure 3q duplication syndrome to date as a reference for comparisons and we discuss the particulars of our case.
Background Recently, the number of orthopedic patients receiving epidural anesthesia (EA) has declined because of the increasing use of anticoagulant therapy, such as fondaparinux [1] and edoxaban [2], as prophylaxis against perioperative deep vein thrombosis. Alternative regional anesthetic techniques also have limitations: lumbar plexus block is associated with the risk of hematoma [3-5]. Recently, ultrasound-guided Femoral Nerve Block (FNB) has been adopted as a safe, reliable analgesic technique for Total Knee Arthroplasty (TKA). The additional precision in location of the nerve sheath afforded by ultrasound has been shown to reduce the volume of local anesthetic needed by 42% compared with FNB guided by nerve stimulation [6]. Although two previous studies have compared the postoperative effects of EA and FNB after TKA, the drug combinations and infusion rates in those studies differed from those used in our institution [7, 8]. The efficacy of opioids combined with local anesthetics for peripheral nerve block remains controversial. However, some studies have reported that the addition of fentanyl to 1.5% lidocaine [9] and 0.25% bupivacaine [10] can prolong analgesia in axillary brachial plexus block. There are also a few perioperative studies that have compared total opioid dose and postoperative analgesia in patients undergoing TKA. This prospective, randomized, controlled and blinded study examined the role of EA or ultrasound-guided continuous FNB in patients undergoing unilateral TKA under general anesthesia. We compared the total fentanyl and propofol dose requirements in order to evaluate the intraoperative analgesic efficacy and side effects of each. We also compared-in a blinded evaluation-postoperative analgesic efficacy, frequency of analgesia, postoperative nausea and vomiting (PONV), Bromage scale, continuous passive motion (CPM), and satisfaction score on postoperative days (PODs) 0-3, using the same regimen for continuous EA and FNB. Methods After obtaining institutional ethics committee approval (Saitama Social Insurance Hospital, #112, 12 October 2007) and registration of the trial on a publicly accessible database https://upload.umin. ac.jp/cgi-open-bin/ctr/ctr.cgi?function=brows&action=brows&type= summary&recptno=R000013078&language=E; ID-UMIN000011166 R000013078, patients scheduled to undergo primary TKA were invited to participate in the study. Written informed consent was obtained from all subjects. Exclusion criteria included: inability to give informed consent for language or cognitive reasons; contraindications for neuraxial blockade, including patient refusal and platelet count of <100,000 cells/μl; contraindications for epidural block, such as current therapy with anticoagulant drugs or infection overlying the proposed injection site; and contraindications to any of the study drugs.
Lipid emulsion treatment did not increase inflammatory cytokine levels or aggravate respiratory disorders. Lipid emulsions, if proven safe, could be used to treat VLBW infants soon after birth, which may prevent extrauterine growth restriction and improve intellectual development prognosis.
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