Articles: chronic.
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Journal of anesthesia · Jun 2015
Case ReportsDetection and diagnosis of iatrogenic inadvertent diversion of partial inferior vena cava into the left atrium by transesophageal echocardiography during large posteroinferior surgical atrial septal defect closure.
Iatrogenic diversion of the inferior vena cava (IVC) into the left atrium (LA) is usually reported as a rare complication following large posteroinferior atrial septal defect (ASD) surgery. It may cause acute or chronic hypoxemia, and other potentially life-threatening complications such as stroke. We present a case in which the ASD patch straddled the IVC entrance diagnosed immediately by transesophageal echocardiography (TEE) during the period of patient separated from cardiopulmonary bypass, avoiding the related complications. Our report further underlines the important role of TEE to monitor and guide ASD surgical management, especially secundum ASD with inferior extension or inferior sinus venosus defects, for the early diagnosis of iatrogenic surgical errors.
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The increasing prevalence of chronic pain and obesity has significant health and cost implications for economies in the developed and developing world. Evidence suggests that there is a positive correlation between obesity and chronic pain and the link between them is thought to be systemic inflammation. ⋯ Systemic inflammation, mechanical overload and autonomic dysfunction are associated with increased prevalence and severity of chronic pain in individuals with obesity. It has been proposed, therefore, that interventions which target systemic inflammation could help to reduce chronic pain in obese individuals. Reduction in abdominal fat has been shown to alleviate pain and reduce the systemic markers of inflammation that contribute to chronic pain. Interventions which include exercise prescription have been shown to reduce both abdominal fat and systemic inflammation. Furthermore, exercise is also known to reduce pain perception and improve mental health and quality of life which also improves pain outcomes. However, adherence to formal exercise prescription is poor and therefore exercise programmes should be tailored to the interests, needs and abilities of individuals in order to reduce attrition.