Decompressive Craniectomy for Traumatic Brain Injury: Postoperative TCD Cerebral Hemodynamic Evaluation
Conclusion: There is a wide heterogeneity of postoperative cerebral hemodynamic findings among TBI patients who underwent DC, including hemodynamic heterogeneity between their cerebral hemispheres. DC was proved to be effective for the treatment of cerebral oligoemia. Our data support the concept of heterogeneous nature of the pathophysiology of the TBI and suggest that DC as the sole treatment modality is insufficient. Introduction Decompressive craniectomy (DC) may effectively decrease intracranial pressure (ICP) and increase cerebral perfusion pressure (CPP) in traumatic brain injury (TBI) patients with refractory elevated ICP (1, 2). However, randomized controlled trials failed to disclose the efficacy of this procedure for improving these patients' neurological outcome (3, 4). This means that ICP control to ensure CPP, as the sole treatment strategy, is not sufficient to achieve satisfactory therapeutic results in most cases. New research should focus on different pathophysiological mechanisms of posttraumatic brain swelling. Transcranial Doppler (TCD) ultrasonography is a non-invasive and bedside method for real-time assessment of cerebral blood circulation. This technique is routinely used in clinical and scientific scenario (5–8). To date, few studies have addressed the cerebral hemodynamic and metabolic effects of DC for uncontrolled elevation of ICP (2, 9–15). To our knowledge, there are no studies describing the different cerebral hemo...
Have the risks of intraoperative hypothermia been overestimated? This meta-analysis examined the evidence as to whether intraoperative hypothermia is associated with higher risks of adverse events.BMC Anesthesiology
From both a public health and an economic perspective, Britain performed poorly during the Covid-19 crisis in comparison with similar countries. When put to the test, many of Britain's core systems were revealed to be incapable of withstanding extra stress and demand. Written in partnership with Local Trust, this paper intends to start a conversation about how the country can move towards resilience for a more prepared and better future. It identifies five pillars that need to form the centrepiece of any approach: economic resilience; public sector resilience; community resilience; environmental resilience; and workforce resilience.
Ontario doctors warn of an "imminent crisis in influenza vaccination" at a time when it's more important that ever that children be immunized.
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CONCLUSIONS: Small bowel obstruction resulting from LAGB tubing is an uncommon complication which was reported in few cases. Although bariatric surgery currently represents the best treatment option for morbid obesity and its related- diseases, peri- and post-operative complications have always to be taken into account. KEY WORDS: Adjustable gastric band complications, Bariatric surgery, Bowel obstruction, CT scan, LAGB tube. PMID: 32945272 [PubMed - in process]
Authors: Polistina GE, Simioli F, Imitazione P, Lanza M, Annunziata A, Fiorentino G Abstract The coronavirus disease 2019 (COVID-19) is a recent pandemic that affected more than 5 million people worldwide. Chest high resolution computed tomography (HRCT) is an essential tool in diagnosis and management of the disease. Pulmonary parenchymal opacity is a typical sign of the disease, but not the only one. Pneumothorax, pneumomediastinum, bronchiectasis and cysts are probably underrated complications of COVID-19 that can worsen prognosis, in terms of prolonged hospitalization and need of oxygen therapy. In our single c...
Conclusion: Moderate quality evidence suggests that OMTh is effective for CNCP patients. There was a significant association between visceral OMTh and reduced pain severity and disability. More robust, high-quality randomized controlled trials with larger sample sizes are required to further explore the effectiveness of the OMTh in the management of CNCP. PMID: 32946545 [PubMed - as supplied by publisher]
We report a patient with glucagonoma differentiation into a malignant form after 13 years. A 63-year-old asymptomatic man was evaluated for an enhancing lesion at the distal pancreas. Physical examination was normal. Laboratory values were normal except for an elevated serum glucagon level (206 pg/mL, Ref. 50 –150). Somatostatin and other tumor markers were normal. A PET scan confirmed abnormal uptake at the distal pancreas, correlating with a CT scan. The patient underwent laparoscopic distal pancreatectomy with resection of a 2.6-cm mass which predominantly expressed glucagon. Serum glucagon levels n ormalized imme...
Conclusion: The axonal degeneration rate is faster in RRMS patients in the first years of the disease than in later years. In addition, axonal degeneration occurs independently of inflammatory activity. Axonal degeneration is correlated with disability progression, but not with inflammatory findings, such as clinical episodes and MRI activity.Eur Neurol
Conclusion: The spatial QRS-T angle and Twvm are emerging VCG indices which are independently associated with mortality in patients with reduced left ventricular ejection fraction due to ICMP or NICMP. Using a composite score of all 3 vector indices, a maximum score was associated with poor long-term survival.Cardiology
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