Cir Cir
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Thromboprophylaxis in surgical patients requires specific measures to implement regional anesthesia techniques. In this regard the current clinical practice guidelines of anesthesiology summarizes the recommendations of the review of current evidence. ⋯ the coagulation status should be evaluated and optimized at the time of placement of a needle anesthesia or continue either epidural, spinal or peripheral nerve blockade to continue prophylaxis as a priority without minimizing the risk of serious complications such as spinal bleeding.
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Use of totally implantable central venous access ports in cancer patients is a common practice for chemotherapy not excluding early and late morbidity. ⋯ The combination of a trained surgical team and careful monitoring reduces morbidity and prevents infections. Access through the external jugular is recommended for its accessibility and low morbidity.
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Acute lymphoblastic leukemia initially shows osteoarticular manifestations. However, it is rare that it shows juvenile idiopathic arthritis (JIA) symptoms. ⋯ This case initially showed typical signs of arthritis, and a diagnosis of acute lymphoblastic leukemia was ruled out, since the those clinical features and hematologic alterations characterizing this hematologic neoplasia.
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Clinical Trial
[Ultrasonographic assessment of hemidiaphragm paralysis secondary to interscalene block].
In shoulder surgery, interscalene brachial plexus block has an incidence of 100% hemidiaphragm palsy due to phrenic nerve block. Controling the hemidiaphragm becomes a security ventilation parameter. ⋯ Ultrasound is a reliable tool that allows real time viewing of the respiratory cycle and measurements of the diaphragm dome it serves to identify diaphragmatic hemiparesis.
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Stump appendicitis is a rare disease characterized by inflammation of the appendiceal remnant. Although normally this is an early complication, it can present up to 50 years after surgery. ⋯ The diagnosis is a challenge for the surgeon, because imaging studies have not proved very helpful for diagnosis. Resection of the cecal appendix by laparoscopic techniques is now more common, providing the possibility of leaving a long stump, perhaps due to technical difficulties. A history of appendectomy may delay diagnosis thus increasing the morbidity and mortality. The resolution of appendiceal stump appendicitis by surgery is performed either by laparoscopic or open resection of the appendiceal remnant.