Medicine
-
Case Reports
Application of an OFA strategy to ERAS in a 102-year-old patient undergoing colon cancer surgery: A case report.
Colorectal cancer is the third most common cancer and the second leading cause of cancer-related deaths worldwide. Opioid-free anesthesia (OFA) is an opioid-sparing technique that focuses on multimodal or balanced analgesia, relying on non-opioid adjuncts and regional anesthesia. Enhanced recovery after surgery (ERAS) protocols, often under the auspices of a perioperative pain service, can help guide and promote opioid reduced and OFA, without negatively impacting perioperative pain management or recovery. Ultrasound-guided regional nerve block is currently a good option for OFA due to anesthesiologists' mastery of ultrasound techniques. The safety of the OFA strategy for quadratus lumborum block (QLB) + transversus abdominis plane block (TAP) in the super-elderly patients has not been reported and remains unclear. We report a case of OFA anesthesia in a super-elderly patient with colon cancer. ⋯ The OFA strategies of ultrasound guidance quadratus lumborum block (Ul-QLB) and ultrasound guidance transversus abdominis plane block (Ul-TAP) may be safe and effective for ERAS in super-elderly patients with colorectal cancer surgery.
-
Obesity is an important risk factor linked to the incidence of both neck pain (NP) and intervertebral disc degeneration (IVDD). Subcutaneous fat tissue thickness (SFTT) has been proposed as a more effective biomarker than body mass index (BMI) when gauging body fat levels. This study was thus designed to explore the optimal SFTT cutoff value for differentiating between NP patients and asymptomatic individuals by using the subcutaneous fat index (SFI). ⋯ Females in this study cohort more frequently exhibited spine deterioration with an SFI > 9.64 mm as compared to males with an SFI > 8.21 mm. Cervical SFTT is strongly correlated with the degree of disc degeneration. IVDD, Modic changes, and fatty infiltration in the paravertebral muscles were all more prevalent among both males and females exhibiting SFTT at the C3 level that was above the defined cutoff value.
-
To evaluate the accuracy of contrast-enhanced ultrasound (CEUS) for assessing vascular injury from blunt abdominal trauma in solid organs using angiography as the reference standard and to compare it with contrast-enhanced multidetector computed tomography (MDCT). Forty-nine patients with 52 blunt abdominal trauma lesions who underwent CEUS, MDCT, and angiography were enrolled in this retrospective study. Injuries included the liver (n = 23), kidney (n = 10), and spleen (n = 19). ⋯ CEUS and MDCT exhibited comparable consistency with angiography for detecting and classifying vascular injury from blunt abdominal trauma in solid organs. Therefore, CEUS may be an accurate and rapid imaging tool to detect bleeding and determine the need for transcatheter arterial embolization. We suggest that CEUS could be considered a first-line approach during the preparation time before MDCT to determine the appropriate management for blunt abdominal trauma.
-
We report the case of a patient who initially presented with peripheral neuropathy and myositis without typical organ involvement, such as the kidneys, skin, or gastrointestinal system, but was ultimately diagnosed with polyarteritis nodosa (PAN). ⋯ In patients presenting with radicular and focal muscle pain, it is crucial to consider the potential for PAN, as observed in this case report.
-
N-terminal pro-brain natriuretic peptide (NT-proBNP) has been studied as a diagnostic screening tool for Kawasaki disease (KD). However, brain natriuretic peptide (BNP) has been less studied while has less variability among age groups. We aimed to find out if BNP can be used as a diagnostic screening tool for KD in Korea. ⋯ The AUC of KD and CAA were 0.884 and 0.726, respectively, which was the highest AUCs among all variables. Additionally, we proposed a scoring system for KD and CAA. It is important to clinically suspect KD and CAA in children with high BNP levels.