TheScientificWorldJournal
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Effective brachial plexus blockade requires a thorough understanding of the anatomy of the plexus, as well as an appreciation of anatomic variations that may occur. This review summarizes relevant anatomy of the plexus, along with variations and anomalies that may affect nerve blocks conducted at these levels. The Medline, Cochrane Library, and PubMed electronic databases were searched in order to compile reports related to the anatomy of the brachial plexus using the following free terms: "brachial plexus", "median nerve", "ulnar nerve", "radial nerve", "axillary nerve", and "musculocutanous nerve". ⋯ Brachial plexus blockade has been effectively utilized as a component of anesthesia for upper extremity surgery for a century. Over that period, our understanding of anatomy and its variations has improved significantly. The ability to explore anatomy at the bedside, with real-time ultrasonography, has improved our appreciation of brachial plexus anatomy as well.
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TheScientificWorldJournal · Jan 2009
Case ReportsPhlegmasia cerulea dolens--a rare, life-threatening condition.
Phlegmasia cerulea dolens is a rare form of massive proximal venous thrombosis of the lower extremities associated with a high degree of morbidity, presenting with sudden severe lower extremity pain with edema and cyanosis. Venous gangrene, venous congestion with massive fluid sequestration leading to circulatory collapse, and shock causing death can ensue if not promptly diagnosed and treated. We present a clinical image of a 55-year-old man with newly diagnosed cholangiocarcinoma who presented with worsening left lower extremity pain. ⋯ Anticoagulation with heparin was initiated. The patient underwent an emergency left iliac thrombectomy for salvage of the limb and placement of a prophylactic inferior vena cava filter. The patient's symptoms resolved.
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A 38-year-old man presented to the accident and emergency department complaining of severe neck pain. This had started immediately after swinging his Wii game console control during a rather vigorous game. ⋯ This had radiological features to suggest an acute injury. This is the first report of a clay-shoveler's fracture strongly suggestive of being related to the use of a Wii console.
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TheScientificWorldJournal · Jan 2009
Aprepitant in a multimodal approach for prevention of postoperative nausea and vomiting in high-risk patients: is there such a thing as "too many modalities"?
Postoperative and postdischarge nausea and vomiting (PONV and PDNV, respectively) add morbidity to perioperative outcomes. Combining some antiemetic agents of different mechanisms is more effective than using single agents, although this concept has not yet been tested extensively with aprepitant. Consecutive high-risk patients for PONV (n = 100) were given preoperative aprepitant 40 mg before surgery and were followed perioperatively. ⋯ There were no other predictors of PONV/PDNV (transabdominal surgery, four vs. three Apfel risk factors) in these patients. The low incidence of vomiting (2-5%) suggests the potential importance of aprepitant in a multimodal antiemetic regimen. However, there may be the potential that too many unique antiemetic mechanisms combined with preoperative aprepitant may actually increase the incidence of perioperative nausea.
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TheScientificWorldJournal · Jan 2009
Beliefs about volunteerism, volunteering intention, volunteering behavior, and purpose in life among Chinese adolescents in Hong Kong.
The relationships among beliefs about volunteerism, volunteering intention, volunteering behavior, and purpose in life were examined in this study. A total of 5,946 participants completed a series of scales, including the Revised Personal Functions of Volunteerism Scale, Volunteering Intention Scale, and Purpose in Life Scale. The results showed that participants whose purpose in life had different levels also had varied prosocial beliefs about volunteerism, volunteering intention, and volunteering behavior. ⋯ Purpose in life was also associated with volunteering intention and behavior. Path analyses showed that purpose in life predicted volunteering behavior via beliefs and intention. While other-serving beliefs predicted volunteering behavior directly, self-serving beliefs did not have such direct effect.