Proceedings (Baylor University. Medical Center)
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Proc (Bayl Univ Med Cent) · Jul 2020
ReviewHidradenitis suppurativa for the nondermatology clinician.
Hidradenitis suppurativa (HS) is a chronic, recurrent inflammatory skin condition resulting in the formation of nodules, sinus tracts, and abscesses typically in intertriginous regions. HS management is often difficult and involves a multimodal approach, evaluating the benefit of both medical and surgical treatment options, along with treating associated pain and medical comorbidities that present concomitantly with the disease. In this article, we synthesize for the nondermatology clinician the evidence for various HS treatments, along with the diagnostic and therapeutic guidelines for HS published by the British Association of Dermatologists, US and Canadian HS Foundations, HS ALLIANCE, Canadian Dermatology Association, and Brazilian Society of Dermatology. Management of HS requires an individualized, patient-centered approach due to the lack of rigorous evidence for many interventions.
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Proc (Bayl Univ Med Cent) · Jul 2020
The use of adjunct anesthetic medication with regional anesthesia and rates of general anesthesia for 1867 cesarean deliveries from 2014 to 2018 in a community hospital.
The number of cesarean deliveries performed with a general anesthetic decreased when regional anesthesia for cesarean delivery was reported to be associated with lower maternal mortality. Anesthetic adjunct administration for cesarean deliveries performed with regional anesthesia is typically not reported alongside general anesthesia rates for cesarean delivery. This retrospective study analyzed rates of general anesthesia and systemic anesthetic adjunct administration for cesarean deliveries performed under regional anesthesia at a community hospital from 2014 to 2018. ⋯ Of the subjects, 104 (5.6%) received general anesthesia and 333 (17.8%) received regional anesthesia with at least one systemic anesthetic adjunct. These adjuncts included a variety of intravenous agents-midazolam (1.7%), fentanyl (5.2%), morphine (6.6%), propofol (7.9%), and ketamine (1.7%)-as well as inhaled nitrous oxide (1.4%) and sevoflurane (0.1%). These data on anesthetic adjunct administration with regional anesthesia provide clinical context for the rates of general anesthesia reported for cesarean delivery.
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Proc (Bayl Univ Med Cent) · Jul 2020
Case ReportsSubsternal goiter excision in a Jehovah's Witness.
Jehovah's Witnesses present a unique challenge in oral and head and neck surgery. We report a case of a substernal goiter excised on a Jehovah's Witness without the use of blood transfusion, in accordance with the patient's beliefs. Additionally, we review the literature on the care of this patient population, focusing on preoperative optimization, perioperative management, and postoperative care.
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Proc (Bayl Univ Med Cent) · Jul 2020
Case ReportsHydrodissection as a therapeutic and diagnostic modality in treating peroneal nerve compression.
A 51-year-old man presented with pain in the region of his left patellar tendon and fibular head. He had previously undergone three L5 epidural steroid injections and physical therapy without relief. Prior magnetic resonance imaging was significant only for fat pad impingement, and electromyography and nerve conduction studies were negative. ⋯ Three ultrasound-guided hydrodissection procedures offered symptomatic improvement and identified an area posterior to the fibular head that was unable to be hydrodissected, indicating scar tissue causing peroneal nerve compression. The patient was referred for peroneal nerve decompression at the area of entrapment with complete symptom relief. This case is unique in describing the ability of hydrodissection to identify nerve compression not visualized with other diagnostic tests.