The Journal of international medical research
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Randomized Controlled Trial Comparative Study
The effects of colloid pre-loading on thromboelastography prior to caesarean delivery: hydroxyethyl starch 130/0.4 versus succinylated gelatine.
This prospective, randomized, double-blind study compared the effects on thromboelastography (TEG) of pre-loading with two different colloid fluids prior to spinal anaesthesia for caesarean section. Healthy full-term parturients received either 500 ml 6% hydroxyethyl starch 130/0.4 (HES, n = 25) or 500 ml 4% succinylated gelatine (GEL, n = 25) prior to spinal anaesthesia. TEG parameters including reaction time (r-time), clot formation time (k-time), clot formation rate (α-angle) and maximum amplitude (MA) were measured immediately before and after pre-loading. ⋯ The α-angle was significantly decreased after pre-loading with HES but not with GEL. No significant differences in k-time were induced pre-loading. In conclusion, pre-loading with HES or GEL was associated with a mild hypocoagulable effect in healthy parturients presenting for elective caesarean section; however, all TEG parameters in both groups remained within or very close to the normal range after pre-loading.
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Randomized Controlled Trial Clinical Trial
Effect of single-injection versus continuous local infiltration analgesia after total knee arthroplasty: a randomized, double-blind, placebo-controlled study.
In this randomized, double-blind, placebo-controlled, single-centre study, 80 patients (American Society of Anesthesiologists physical status I-III) received postoperative single-injection local infiltration analgesia (SLIA), continuous local infiltration analgesia (CLIA) or placebo (control group). Intravenous patient-controlled morphine was used as rescue analgesia. ⋯ Patient satisfaction was higher, and maximum flexion of the knee on postoperative days 7 and 90 was greater, in the CLIA group compared with the SLIA group. CLIA provided prolonged superior analgesia and was associated with more favourable functional recovery and patient satisfaction compared with SLIA.
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Randomized Controlled Trial
The effect of ketamine with remifentanil for improving the quality of anaesthesia and recovery in paediatric patients undergoing middle-ear ventilation tube insertion.
This prospective randomized study evaluated the effects of ketamine with remifentanil to improve the quality of anaesthesia and postoperative recovery, following brief procedures, in 60 paediatric patients undergoing middle-ear ventilation tube insertion (MEVTI). Patients were randomly assigned to either ketamine 2 mg/kg intravenous [i.v.] bolus plus normal saline by i.v. infusion (K group, n = 30) or ketamine 2 mg/kg i.v. bolus, plus remifentanil 0.15 μg/kg per min i.v. infusion (KR group, n = 30). ⋯ Time to recovery was significantly shorter in the KR group than in the K group. In conclusion, remifentanil was a good adjuvant to ketamine, improving the quality of anaesthesia and postoperative recovery in children undergoing MEVTI.
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Case Reports
Dural metastasis of atypical extraventricular neurocytoma with the codeletion of chromosomes 1p/19q.
Extraventricular neurocytoma (EVN) is a rare neoplasm described in the 2007 World Health Organization classification of tumours of the nervous system. Due to the rarity of the tumour, there is limited literature available. The clinical characteristics, pathological features, biological behaviour and outcome of EVN remain unclear, and there are challenges regarding its diagnosis and management. ⋯ Atypical pathological features included vascular proliferation, the presence of mitosis and a high MIB-1 (an antibody against Ki-67) labelling index. The disease recurred 7 months after the initial complete resection and radiation treatment, presenting with dural metastasis and codeletion of chromosomes 1p/19q. The present case history and treatment course are discussed with respect to the literature.
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This retrospective study investigated preoperative markers of appendix perforation in 351 acute appendicitis cases: group 1, appendicitis not histologically confirmed; group 2, appendicitis without perforation or gangrenous changes; and group 3, histologically confirmed perforated appendicitis with gangrenous changes. In group 3, symptom duration was significantly longer, and white blood cell (WBC) and bilirubin values significantly higher, than for the other groups. Symptom duration, gender, bilirubin and elevated WBC were significantly associated with early diagnosis of acute appendicitis in univariate analysis. ⋯ Receiver operating characteristic curve analysis showed good discrimination of bilirubin and moderate discrimination of WBC as markers of appendix perforation. It is concluded that assessment of preoperative total bilirubin is useful for the differential diagnosis of perforated versus acute suppurative appendicitis, whereas WBC assessment is effective for diagnosing the presence versus absence of appendicitis. Symptom duration, WBC and total bilirubin should be used as independent parameters in the early diagnosis of appendix perforation.