- Good birth narratives: Diverse South African women's perspectives. [Journal Article]
- MMidwifery 2019 Jun 16; 77:1-8
- CONCLUSIONS: The bodily and corporeal aspects of the birth experience were found to be central to women's 'good birth' narratives. A key conclusion is that maternal healthcare provision needs to be reimagined in ways which acknowledge, centre and respect the unique and vulnerable corporeality of birthing women, regardless of type of birth.
- Trauma Bay Disposition of Infants and Young Children With Mild Traumatic Brain Injury and Positive Head Imaging. [Journal Article]
- PCPediatr Crit Care Med 2019 Jun 18
- CONCLUSIONS: Nearly half of our cohort was briefly monitored in the ICU (with disposition mostly explained by trauma bay imaging, rather than clinical findings); however, less than 10% required ICU-specific interventions. Although ICU could be used for close neuromonitoring to prevent further neurologic injury, additional research should explore if less conservative approaches may preserve patient safety while optimizing healthcare resource utilization.
- A multicentre, prospective, observational cohort study of variation in practice in perioperative analgesia strategies in elective laparoscopic colorectal surgery (the LapCoGesic study). [Journal Article]
- ARAnn R Coll Surg Engl 2019 Jun 24; :1-8
- CONCLUSIONS: Postoperative pain is managed in a variable manner in patients undergoing elective colorectal surgery, which has an impact on patient reported outcomes of pain scores and pain severity.
- Percutaneous Endoscopic Contralateral Lumbar Foraminal Decompression via an Interlaminar Approach: 2-Dimensional Operative Video. [Journal Article]
- ONOper Neurosurg (Hagerstown) 2019 Jun 24
- Nerve root compression by foraminal pathology is challenging for a surgeon to decompress without violating the facet joint, which may necessitate a fusion procedure. One nonfusion approach to foramin…
Nerve root compression by foraminal pathology is challenging for a surgeon to decompress without violating the facet joint, which may necessitate a fusion procedure. One nonfusion approach to foraminal pathology is a combination intracanal approach for a laminotomy/foraminotomy followed by a paraspinal Wiltse approach for far lateral decompression. Unfortunately, even with the combination approach, it continues to be difficult to achieve adequate decompression without violating much of the facet joint overlying the nerve root. Spine endoscopy offers the ability to decompress the foraminal portion of the nerve without significant violation of the facet joint. We present a surgical video describing the technique for performing a percutaneous endoscopic contralateral L5-S1 foraminal decompression via an interlaminar approach, for a patient presenting with a left L5 radiculopathy due to L5-S1 foraminal stenosis. We explain the differences in the endoscopic channel docking point between ipsilateral and contralateral interlaminar approaches. The steps of an endoscopic foraminotomy are then described: dissect soft tissue and ligamentum flavum off the medial left S1 lamina and superior articulating process (SAP), undercut the superior articulating process of S1 and the inferior articulating process (IAP) of L5 with a drill, resect lateral ligamentum flavum off SAP and IAP exposing epidural fat, and finally dissect the left L5 nerve root and remove compressive lesions throughout its course in the lateral recess, foramen, and laterally. The presentation ends with an intraoperative photograph showing a decompressed L5 nerve root and postoperative imaging confirming this decompression. Appropriate patient consent was obtained.
- Benign paroxysmal positional vertigo presenting as persistent vomiting in a parturient using epidural analgesia. [Letter]
- IJInt J Obstet Anesth 2019 Jun 07
- Remifentanil patient-controlled intravenous analgesia during labour: a retrospective observational study of 10 years' experience. [Journal Article]
- IJInt J Obstet Anesth 2019 Jun 05
- CONCLUSIONS: We found remifentanil PCA to be neither less safe nor associated with poorer outcomes than other analgesic options offered in our unit, when used within our guidelines for more than a 10-year period.
- Labor epidural analgesia onset time and subsequent analgesic requirements: a prospective observational single-center cohort study. [Journal Article]
- IJInt J Obstet Anesth 2019 May 17
- CONCLUSIONS: There was a correlation between the onset time of lumbar epidural analgesia during labor and the pain score 60 min later but this had disappeared by 120 min.
- Assessment of blood-brain barrier integrity and neuroinflammation in preeclampsia. [Journal Article]
- AJAm J Obstet Gynecol 2019 Jun 20
- CONCLUSIONS: Through measurements of albumin, complement proteins, and cytokines in paired samples of blood and cerebrospinal fluid at the time of delivery, we found no evidence of blood-brain barrier impairment or neuroinflammation in preeclampsia. Larger studies investigating a wider range of proteins are suggested to validate our findings.
- Epidural lipomatosis and syringomyelia in the adulthood: Case and literature review. [Journal Article]
- WNWorld Neurosurg 2019 Jun 19
- We review the two previously published cases of epidural lipomatosis associated with syringomyelia and present the case of a 42-year-old woman with a medullary syrinx from C1 to T3 initially only wit…
We review the two previously published cases of epidural lipomatosis associated with syringomyelia and present the case of a 42-year-old woman with a medullary syrinx from C1 to T3 initially only with upper limbs paraesthesias that presented after 10 years of follow up left hemiparesis and paraesteshias in the tongue. Chiari malformation, cerebral or spinal space occupant lesions were ruled out so as other causes of syrinx except the presence of epidural lipomatosis extending from T1 to T12. Right laminotomies where performed from T1 to T12 removing the excess of epidural fat tissue. After the surgery the symptoms remained stable, at discharge the patient progressively recovered from the hemiparesis and in a follow up magnetic resonance (MRI) it was confirmed the resolution of the syrinx. This is the third case of a patient with a spinal syrinx and no other related causes except from spinal lipomatosis, although with only three cases it is not possible to completely state that lipomatosis caused the syrinx. Our case supports the trend stablished by the two previous cases. For the treatment, initially patients should be managed conservatively trying to correct the underlying etiologies of spinal lipomatosis and in cause of failure surgical treatment, consisting on the removal of adipose epidural excess in the most appropriate way, should be preferred.
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- Dilution and microfiltration of particulate corticosteroids for spinal epidural injections: impact on drug concentration and agglomerate formation. [Journal Article]
- AAnaesthesia 2019 Jun 22
- Particulate corticosteroids have been described to lead to greater pain improvement compared with their non-particulate counterparts when used in epidural injections. It is hypothesised that filterin…
Particulate corticosteroids have been described to lead to greater pain improvement compared with their non-particulate counterparts when used in epidural injections. It is hypothesised that filtering may significantly impact their concentration and long-term efficacy. We investigated if passing particulate suspensions through different commonly-used filters affects drug dosage. Two particulate corticosteroid formulations, triamcinolone acetonide and methylprednisolone acetate, were mixed at different concentrations with either bupivacaine hydrochloride or 0.9% sodium chloride. Solutions were passed through a 5-μm and a 0.2-μm filter. Mass spectroscopy results indicated a complete loss of corticosteroid from the solutions using both filters, and light microscopy imaging demonstrated agglomerate formation, suggesting that filtering interferes with drug dosage. The choice of diluents must also be considered to reduce large agglomerate formation. Clinicians should be aware of the consequences of filtering particulate suspensions and carefully consider the selection of diluent when considering treatment plans.