Medicine
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Case Reports
Recovery of an injured cingulum via an aberrant neural tract in a patient with traumatic brain injury: A case report.
We report on a patient who appeared to show recovery of an injured anterior cingulum via an aberrant neural tract between an injured cingulum and the basalis nucleus of Meynert following traumatic brain injury (TBI), which was demonstrated on diffusion tensor tractography (DTT). ⋯ Recovery of an injured anterior cingulum via an aberrant neural tract between an injured cingulum and Ch 4 was demonstrated in a patient with TBI. Our result appears to suggest a mechanism for recovery of an injured cingulum following brain injury.
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The differences in the incidence and severity of emergence agitation (EA) and emergence times between desflurane and sevoflurane anesthesia have not been as clearly elucidated in children as in adults. ⋯ The incidence and severity of EA were comparable between desflurane and sevoflurane anesthesia in children; however, emergence times, including extubation and awakening times, were shorter in desflurane anesthesia.
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Observational Study
Association of obstructive sleep apnea plus hypertension and prevalent cardiovascular diseases: A cross-sectional study.
Current study sought to evaluate the associations of obstructive sleep apnea (OSA) plus hypertension (HTN) and prevalent cardiovascular diseases (CVD). This was a cross-sectional study and a total of 1889 subjects were enrolled. The apnea-hypopnea index (AHI) was measured by polysomnography and OSA degree was classified as mild (AHI 5-14.9) and moderate-severe (AHI ≥ 15), and AHI < 5 was considered no-OSA. ⋯ In hypertensive subjects, however, the associations remained significant but were reduced. Further adjusted for mean and lowest SaO2, the associations remained significant in HTN plus no-OSA (OR: 1.808, 95% CI: 1.207-2.707), HTN plus mild-OSA (OR: 2.003, 95% CI: 1.346-2.980), and HTN plus moderate-severe OSA (OR: 1.834, 95% CI: 1.214-2.770) groups. OSA plus HTN is associated with prevalent CVD, and OSA may potentiate the adverse cardiovascular effects on hypertensives patients but not normotensives.
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Coccygodynia is a pain in the region of the coccyx that radiates to the sacral, perineal area. The cause of the pain is often unknown. Coccygodynia is diagnosed through the patient's past history, a physical examination, and dynamic radiographic study, but the injection of local anesthetics or a diagnostic nerve blockade are needed to distinguish between somatic, neuropathic, and combined pain. Ganglion impar is a single retroperitoneal structure made of both paravertebral sympathetic ganglions. Although there are no standard guidelines for the treatment of coccygodynia, ganglion impar blockade is one of the effective options for treatment. ⋯ Our case report offers the ganglion impar blockade using the transsacrococcygeal approach with absolute alcohol can improve intractable coccydynia.
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Comparative Study
Risk-adjusted outcomes in Medicare inpatient nephrectomy patients.
Without risk-adjusted outcomes of surgical care across both the inpatient and postacute period of time, hospitals and surgeons cannot evaluate the effectiveness of current performance in nephrectomy and other operations, and will not have objective metrics to gauge improvements from care redesign efforts. We compared risk-adjusted hospital outcomes following elective total and partial nephrectomy to demonstrate differences that can be used to improve care. We used the Medicare Limited Dataset for 2010 to 2012 for total and partial nephrectomy for benign and malignant neoplasms to create prediction models for the adverse outcomes (AOs) of inpatient deaths, prolonged length-of-stay outliers, 90-day postdischarge deaths without readmission, and 90-day relevant readmissions. ⋯ With a minimum of 25 cases for each study hospital, no statistically valid improvement in outcomes was seen with increased case volume. Inpatient and 90-day postdischarge risk-adjusted adverse outcomes demonstrated marked variability among study hospitals and illustrate the opportunities for care improvement. This analytic design is applicable for comparing provider performance across a wide array of different inpatient episodes.