Articles: surgery.
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Randomized Controlled Trial Clinical Trial
Immediate reconstruction in breast cancer surgery requires intensive post-operative pain treatment but the effects of axillary dissection may be more predictive of chronic pain.
The aim of this study was to investigate post-operative pain intensity, analgesic consumption and the incidence of chronic pain in women after different types of breast cancer surgery. Patients were randomized to either patient-controlled analgesia or nurse-administered analgesia. Opioid-consumption was registered for 24 h. ⋯ The incidence of remaining pain was 25% after 3-4 years. Immediate breast reconstruction causes severe post-operative pain that can respond poorly to opioids. Chronic pain after breast cancer surgery is common and should be further analysed aiming at better prevention and treatment options.
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'Suspended animation for delayed resuscitation' is a new concept for attempting resuscitation from cardiac arrest of patients who currently (totally or temporarily) cannot be resuscitated, such as traumatic exsanguination cardiac arrest. Suspended animation means preservation of the viability of brain and organism during cardiac arrest, until restoration of stable spontaneous circulation or prolonged artificial circulation is possible. Suspended animation for exsanguination cardiac arrest of trauma victims would have to be induced within the critical first 5 min after the start of cardiac arrest no-flow, to buy time for transport and resuscitative surgery (hemostasis) performed during no-flow. ⋯ In the 1990s, the Pittsburgh group achieved survival without brain damage in dogs after cardiac arrest of up to 90 min no-flow at brain (tympanic) temperature of 10 degrees C, with functionally and histologically normal brains. These studies used emergency cardiopulmonary bypass with heat exchanger or a single hypothermic saline flush into the aorta, which proved superior to pharmacologic strategies. For the large number of normovolemic sudden cardiac death victims, which currently cannot be resuscitated, more research in large animals is needed.
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This paper reports on 80 patients using dual electrode, spinal cord stimulation (SCS) over a four-year period Implant status, stimulation mode, anode-cathode configuration (array), cathode position, paresthesia overlap, explantation rates, complications, Visual Analog Scores (VAS), and overall satisfaction were examined in patients implanted with dual 8 contact, staggered, percutaneous electrodes. All patients had undergone implantation for chronic axial and extremity pain [e.g., Failed Back Surgery Syndrome (FBSS), Complex Regional Pain Syndrome (CRPS)]. Outcomes were evaluated in view of our previous reports in this same group at 24 and 30 months (1,2). ⋯ Thirty-five percent of patients with thoracic implants achieved paresthesia in the low back at 48 months. Explantation rates and overall patient satisfaction were significantly affected by painful radio frequency (RF) antenna coupling. This data supports the efficacy of dual electrodes in optimizing long-term SCS paresthesia overlap and complex pain outcomes.
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Comparative Study
The advantages of frameless stereotactic biopsy over frame-based biopsy.
A comparison study is presented, which examines the outcome, complications and cost of stereotactic brain biopsy performed with a frameless versus a frame-based method. The technique of frameless stereotactic biopsy has been shown previously, in both laboratory and in vivo studies, to achieve a level of accuracy at least equal to frame-based biopsy. The investigators have validated the technique in a large clinical series. ⋯ This resulted in lower ITU bed occupancy (p = 0.02), shorter mean hospital stay (p = 0.0013) and significant cost savings (p = 0.0022) for the frameless stereotactic biopsy group, despite the greater use of more expensive MRI in these cases. This comparison study demonstrates that the superior imaging, target visualization and flexibility of the technique of frameless stereotactic biopsy translates into tangible advantages for safety, time and cost when compared with the current gold-standard of frame-based biopsy. The principles are discussed and the authors propose a definition for the term 'frameless stereotaxy'.
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Comparative Study
[Accuracy of fluoroscopic navigation of pedicle screws. CT-based evaluation of bone screw placement].
While the advantages of C-arm navigation in computer-assisted spine surgery are obvious, the accuracy of pedicle screw placement with virtual fluoroscopy still needs to be verified. The C-arm-based ION system (Medtronic Sofamor Danek) was used to navigate pedicle screw insertion in patients undergoing spinal surgery for various conditions. ⋯ Computed tomography (CT) scans were performed postoperatively by two independent radiologists to control the accuracy of screw placement at the level of the pedicles after reconstruction of axial images according to Laine et al. The comparison of the calculated accuracy rate of pedicle screw placement using virtual fluoroscopy with reported results achieved with CT-based navigation shows similar results for virtual fluoroscopy and a remarkable increase of accuracy in comparison to reports on conventional pedicle screw placement.