Curēus
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Interscalene brachial plexus block (ISBPB) is the gold standard method in shoulder surgery. Serratus plane block (SPB) provides anesthesia in hemithorax, axillary region, and posterior of the shoulder. This randomized controlled study evaluated the effect of SPB added to ISBPB on surgical anesthesia quality in arthroscopic shoulder surgery. ⋯ SPB added to the ISBPB increases the quality of surgical anesthesia and reduces the need for intraoperative sedoanalgesia for arthroscopic shoulder surgery.
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Background Nonunions of tibial shaft fractures have devastating physical and psychological consequences for patients. It remains unknown if early functional status can identify patients at risk for nonunion. Questions/Purposes To determine if functional status at three months after surgery, as measured by either the short form 36 (SF-36) or the short form 12 (SF-12) health survey physical component summary (SF-12 PCS) score, can serve as a prognostic indicator for nonunion at one year in patients with fractures of the tibial shaft. ⋯ Open fractures also conferred a 2.8-fold increase in odds of nonunion as compared to closed injuries (OR 2.77, 95%CI: 1.58-4.83), as did complex fractures when compared to simple fractures (OR 2.57, 95%CI: 1.64-4.02). Conclusion A considerable portion of patients with fractures of the tibial shaft treated with intramedullary nailing will experience nonunion at one-year postoperatively. Nonunion can be accurately predicted by patient functional recovery at three months as measured by the PCS of the SF-36 and SF-12 instruments.
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Silicone gel implants are widely used for cosmetic and reconstructive breast surgery. There has been a paradigm shift with increased utilization of implant-based breast reconstruction compared to autologous reconstruction in the United States over the past couple of decades. Implant rupture is a known complication of silicone gel implants with variable incidence and increased propensity with the age of the implant. Usually, the clinical findings suggestive of implant rupture are not obvious to the patient and surgeon. Intracapsular implant rupture, when the shell of the implant ruptures but the fibrous capsule formed by the breast remains intact, occurs in the majority of cases. While extracapsular rupture, which denotes silicone leakage extending beyond the capsule, is less common. ⋯ Following mastectomy with lymph node dissection, the disruption of normal breast lymphatic drainage may result in aberrant drainage to internal mammary nodes and contralateral axillary lymph nodes. We present a unique case of axillary silicone lymphadenopathy due to contralateral breast intracapsular implant rupture in a patient with no previous ipsilateral breast surgery. The condition was found during a routine breast cancer screening. We also engage in a review of the relevant literature.
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The coronavirus (COVID-19), discovered in 2019, has been creating havoc since it first emerged in China and is now spreading worldwide. Its presentation is somewhat similar to influenza. We hereby discuss the salient features of the coronavirus and present the case of a 33-year-old male who was tested positive for COVID-19.
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Coronavirus disease 2019 (COVID-19) is a declared global pandemic. There are multiple parameters of the clinical course and management of the COVID-19 that need optimization. A hindrance to this development is the vast amount of misinformation present due to scarcely sourced manuscript preprints and social media. ⋯ Furthermore, the biochemistry of the major candidates for novel therapies is briefly reviewed and a summary of their current status in the clinical trials is presented. Lastly, the current scientific data and status of governing bodies such as the Center of Disease Control (CDC) and the WHO on the usage of controversial therapies such as angiotensin-converting enzyme (ACE) inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs) (Ibuprofen), and corticosteroids usage in COVID-19 are discussed. The composite collection of accredited studies on each of these subtopics of COVID-19 within this review will enable clarification and focus on the current status and direction in the planning of the management of this global pandemic.