Awake C1-2 laminectomy, instrumentation, and fusion: case report.

Awake C1-2 laminectomy, instrumentation, and fusion: case report. J Neurosurg Spine. 2019 Dec 06;:1-5 Authors: Barrenechea IJ, Márquez L, Rojas HP, Nicola M, Dumont C Abstract Surgery of the cervical spine under conscious sedation has been rarely reported in the literature. The main indications are the lack of neurophysiological monitoring and surgery in patients with high cardiovascular risk. To date, no reports of awake C1-2 instrumentation have been published in the English-language literature. The authors present the case of a 76-year-old patient with multiple myeloma and severe cardiomyopathy associated with primary amyloidosis who experienced severe myelopathy from a C2 pseudotumor associated with an odontoid fracture. Due to his high cardiovascular risk, the patient underwent C1 decompression and C1-2 instrumentation and fusion via an awake technique. To accomplish this task, the authors performed multilayered muscular infiltration of local anesthetics and avoided manipulating the C2 root by anchoring C1 with a rod-claw system. The procedure did not last longer than that of general anesthetic approaches, and no complaints were reported by the patient during surgery, which he described as an overall "good experience." The patient was discharged on the 7th postoperative day and resumed his previous work 3 months later. Performing surgery under local anesthesia and conscious sedation reduces the risk of perioperative cardiovascular a...
Source: Journal of Neurosurgery.Spine - Category: Neurosurgery Authors: Tags: J Neurosurg Spine Source Type: research

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ConclusionsCMR is a key tool for diagnosing LDAC. Characteristic findings are subepicardial fatty infiltration and midwall-subepicardial late gadolinium enhancement. The prognosis of this population is poor with a high incidence of sudden cardiac death and ventricular arrhythmias.ResumenIntroducción y objetivosRecientemente, la miocardiopatía arritmogénica del ventrículo izquierdo (MCAVI) ha sido reconocida como parte del espectro de la miocardiopatía arritmogénica. Se caracteriza por el reemplazo fibroadiposo de la pared de dicho ventrículo. Se describen las formas de prese...
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research
Publication date: Available online 25 January 2020Source: Anaesthesia &Intensive Care MedicineAuthor(s): Sarah L. Perrin, Christopher Bull, Sheila BlackAbstractLocal anaesthetics (LA) are weak bases consisting of a lipophilic aromatic ring linked to a hydrophilic tertiary amine by either an ester or amide bond. It is this chemical link that enables classification of the LA. They exist in solution as an equilibrium of ionized and unionized forms. The unionized form is free to diffuse across the axonal membrane, but it is the ionized form which then binds and blocks the intracellular portion of the voltage gated sodium c...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Publication date: Available online 25 January 2020Source: Anaesthesia &Intensive Care MedicineAuthor(s): Peter Carachi, Glyn WilliamsAbstractAcute pain management in the neonatal period remains a challenge for the clinician. Responses to pain and analgesic intervention are developmentally influenced and cannot be directly extrapolated from the older child. Successful and safe intervention will minimize acute physiological and behavioural distress, reduce pain scores and potentially improve short- and long-term outcomes. This requires an understanding of the physiology and pharmacology in this age group alongside a mult...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
Cardiac involvement is associated with poor prognosis in immunoglobulin light-chain amyloidosis (AL amyloidosis), with a median survival of 6 months without heart transplantation (HT) from the onset of symptomatic heart failure. Although HT is a promising treatment option for patients with amyloid cardiomyopathy (ACM), consensus on its indication is not fully established because of limited experience. Method: We reviewed our prospective AL amyloidosis database to identify all patients who received HT for their ACM.
Source: Clinical Lymphoma, Myeloma and Leukemia - Category: Hematology Authors: Source Type: research
​BY ANDRZEJ KIELTYKA, PA; PARDEEP THANDI, MD; &ANUMEHA SINGH, MDA 56-year-old man presented to the emergency department with shortness of breath for one month and pleural effusions on an outpatient chest x-ray. He had been taking adalimumab, methotrexate, and steroids for arthritis and Sjogren's syndrome.A right pleural effusion in a patient with nephrotic syndrome.His monoclonal gammopathy of undetermined significance (MGUS) was monitored annually, but no medical intervention beyond surveillance was required. He had excessive thirst but normal urine output. He noted face and hand swelling in the morning that gave wa...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Disease OverviewImmunoglobulin light chain amyloidosis is a clonal, nonproliferative plasma cell disorder in which fragments of immunoglobulin light chain are deposited in tissues. Clinical features depend on organs involved but can include restrictive cardiomyopathy, nephrotic syndrome, hepatic failure, peripheral/autonomic neuropathy, and atypical multiple myeloma. DiagnosisTissue biopsy stained with Congo red demonstrating amyloid deposits with applegreen birefringence is required for diagnosis. Invasive organ biopsy is not required because amyloid deposits can be found in bone marrow biopsy or subcutaneous fat aspirate...
Source: American Journal of Hematology - Category: Hematology Authors: Tags: CME Information: Immunoglobulin Light Chain Amyloidosis: 2016 Update on Diagnosis, Prognosis, and Treatment Source Type: research
We present a case of cardiac amyloidosis accompanying undiagnosed multiple myeloma to illustrate the rapid progression of the disease and the complexities of diagnosing and treating this disorder.
Source: American Journal of Therapeutics - Category: Drugs & Pharmacology Tags: Case Reports Source Type: research
Patients undergoing high-dose melphalan followed by autologous stem cell transplant (Mel + ASCT) for multiple myeloma (MM) are subject to significant risk including fluid and electrolyte shifts and organ toxicity, particularly when there is pre-existing cardiovascular disease. Moreover, patients with MM have a 12-15% risk of developing clinical cardiac amyloidosis (CAL). It is not known whether subclinical CAL will affect outcomes in these patients. Echocardiography is the gold standard for the diagnosis of CAL with global longitudinal strain (GLS) and segmental longitudinal strain (SLS) as biomarkers for infiltrative cardiomyopathy.
Source: Biology of Blood and Marrow Transplantation - Category: Hematology Authors: Tags: Session C: Autologous Transplants, Lymphoma and Myeloma Source Type: research
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 6. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs
We describe a rare case of cardiac amyloidosis that initially presented with severe tricuspid regurgitation in a 42-year-old woman who was successfully treated with tricuspid valve replacement. Unusual surgical findings prompted additional evaluation that established a diagnosis of plasma cell myeloma. PMID: 26665112 [PubMed]
Source: Korean Journal of Thoracic and Cardiovascular Surgery - Category: Cardiovascular & Thoracic Surgery Tags: Korean J Thorac Cardiovasc Surg Source Type: research
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