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[en] Objectives: To compare effectiveness of low-dose bupivacaine-fentanyl versus conventional dose of bupivacaine in parturients undergoing cesarean section and the frequency of hypotension in two regimens. Study design: Randomized clinical study Place and duration of study: Anesthesiology Department and Surgical Intensive Care Unit and Pain Management, Civil Hospital, Dow University of Health Sciences, from July to December 2019. Material and methods: 52-women undergoing cesarean section were randomly allocated into two groups; 26-patients in group-A were given 10 mg bupivacaine, and 26 in group-B, 5 mg bupivacaine-25μg fentanyl. Blood pressure (BP) and heart rate were recorded. Intra-operative pain assessment was done using visual analog scale (VAS). Duration of effective analgesia was taken from the time of intra-thecal injection to a VAS score ≥4. Systolic BP (SBP)<20% of preoperative value was labelled as hypotension. Data was analyzed with SPSS 19. Results: Mean age was 26.19±4.31 years. There was no significant difference among age, weight, height and ASA of patients in two groups (p=0.65, 0.052, 0.19, and 0.39, respectively). Mean baseline SBP, diastolic blood pressure (DBP), and heart rate were not significantly different. Men final SBP was significantly different (p = 0.006), while no significant difference was seen in DBP and heart rate and duration of surgery (p=0.23, 0.42, 0.23, respectively). The duration of analgesia was more prolonged in group-B (p<0.001), and hypotension was significantly higher in group-A (p=0.005). Conclusion: Low-dose intra-thecal bupivacaine and fentanyl provides more effective spinal anesthesia for cesarean section with less hypotensive episodes. (author)
[en] Aim: To compare the effectiveness of hyperbaric bupivacaine with isobariclevobupivacaine for cesarean section. Study design: Randomized control trial Place and duration of study: Department of Anaesthesia, Doctors Trust Teaching Hospital, Sargodha from 1st July 2019 to 31st March 2020. Methodology: Sixty patients have been included in this study for lower segment cesarean section. The age of the patient was between 20 to 40 years. They were divided in to two groups; Group I contained 30 patients received 2 ml isobaric levobupivacaine 5mg/ml (10mg) with fentanyl 15μg, Group II, with 30 patients received hyperbaric bupivacaine 10 mg with a fentanyl 15μg. Time to block T10 was analyzed and contrasts between the two groups. Time to first rescue analgesia was recorded. Results: The mean age was 27.84+-6.33 years for Group I patients, and the mean age was 27.33±4.84 years for Group II patients. In the time of T10 sensory blockade, we found the findings were close. But we saw an important difference in time after skin closure to the first rescue analgesia. It was 273.40 minutes in Group I and 183.52 minutes for Group II. Conclusion: Levobupivacaine and fentanyl combination give shorter block time for motors, more time to rescue analgesia as compared to hyperbaric bupivacaine in the spinal anaesthesia for cesarean section. (author)
[en] The aim of the present study was to correlate prognostic factors with spinal cord myelitis and test the role of ERD for probability of myelitis for lesser than conventional, conventional and higher than conventional dose per fraction
[en] Objective: To assess the effect of intrathecal tramadol added to bupivacaine to prolong the duration of analgesia in subarachnoid block for lower limb orthopedic surgeries. Study Design: Randomized controlled trial. Place and Duration of Study: Anesthesia department of Combined Military Hospital Sialkot, from Nov 2015 to Apr 2016. Material and Methods: Patients were selected by non-probability consecutive sampling. One hundred and fifty patients from American Society of Anesthesiologists (ASA) I, II and III category fulfilling inclusion criteria undergoing various lower limb orthopedic surgeries were divided into two groups by lottery system. Group tramadol bupivacaine (TB) received 25mg (1 ml) of tramadol plus 2ml (10mg) of 0.5 percent bupivacaine while group bupivacaine alone (SB) received 1 ml normal saline plus 2ml (10mg) of 0.5 percent bupivacaine. Time to first analgesia request was noted as a measure of duration of analgesia. Time of onset of sensory block level and peak sensory block level and time to reach the peak sensory block level were also noted. Quality of anesthesia was compared among two groups. Data were analyzed by using SPSS version 22. Results: Four patients were excluded from the study. The duration of anesthesia was effectively prolonged in group TB 181.56 ± 12.42 mins as compared to group SB 120.93 ± 15.54 mins. VAS score was significantly lower in group TB. Higher peak sensory block levels (T6) were achieved in group TB as compared to group SB. However time to reach the peak sensory block levels were significantly longer in group TB. (4.5 ± 0.47mins vs 3.09 ± 0.54 mins). Conclusion: This study showed that intrathecal tramadol (25mg) can safely be used along with bupivacaine in subarachnoid blockade to prolong the duration of analgesia and improve the quality of anesthesia as well. (author)
[en] Epilepsy is a typical neural disease in nervous system, and the control of seizures is very important for treating the epilepsy. It is well known that the drug treatment is the main strategy for controlling the epilepsy. However, there are about 10–15 percent of patients, whose seizures cannot be effectively controlled by means of the drug. Alternatively, the deep brain stimulus (DBS) technology is a feasible method to control the serious seizures. However, theoretical explorations of DBS are still absent, and need to be further made. Presently, we will explore to control the absence seizures by introducing the DBS to a basal ganglia thalamocortical network model. In particular, we apply DBS onto substantia nigra pars reticulata (SNr) and the cortex to explore its effects on controlling absence seizures, respectively. We can find that the absence seizure can be well controlled within suitable parameter ranges by tuning the period and duration of current stimulation as DBS is implemented in the SNr. And also, as the DBS is applied onto the cortex, it is shown that for the ranges of present parameters, only adjusting the duration of current stimulation is an effective control method for the absence seizures. The obtained results can have better understanding for the mechanism of DBS in the medical treatment.
[en] Purpose: To propose a simple and effective cost value function to search optimal planning phase (gating window) and demonstrated its feasibility for respiratory correlated radiation therapy. Methods: We acquired 4DCT of 10 phases for 10 lung patients who have tumor located near OARs such as esophagus, heart, and spinal cord (i.e., central lung cancer patients). A simplified mathematical optimization function was established by using overlap volume histogram (OVH) between the target and organ at risk (OAR) at each phase and the tolerance dose of selected OARs to achieve surrounding OARs dose-sparing. For all patients and all phases, delineation of the target volume and selected OARs (esophagus, heart, and spinal cord) was performed (by one observer to avoid inter-observer variation), then cost values were calculated for all phases. After the breathing phases were ranked according to cost value function, the relationship between score and dose distribution at highest and lowest cost value phases were evaluated by comparing the mean/max dose. Results: A simplified mathematical cost value function showed noticeable difference from phase to phase, implying it is possible to find optimal phases for gating window. The lowest cost value which may result in lower mean/max dose to OARs was distributed at various phases for all patients. The mean doses of the OARs significantly decreased about 10% with statistical significance for all 3 OARs at the phase with the lowest cost value. Also, the max doses of the OARs were decreased about 2∼5% at the phase with the lowest cost value compared to the phase with the highest cost value. Conclusion: It is demonstrated that optimal phases (in dose distribution perspective) for gating window could exist differently through each patient and the proposed cost value function can be a useful tool for determining such phases without performing dose optimization calculations. This research was supported by the Mid-career Researcher Program through NRF funded by the Ministry of Science, ICT & Future Planning of Korea (NRF-2014R1A2A1A10050270) and by the Radiation Technology R&D program through the National Research Foundation of Korea funded by the Ministry of Science, ICT & Future Planning (No. 2013M2A2A7038291)
[en] The purpose of this study is to correlate the MR findings with clinical stage and clinical outcome, and to describe the evolutional changes of abnormal MR findings of transverse myelitis. Medical records and spinal MR images of 23 patients with both clinical and radiological diagnosis of transverse myelitis were retrospectively reviewed. MR findings were correlated with clinical stages including interval between MR imaging and full development of clinical symptoms, and compared with the clinical outcome. Diffuse high signal intensity of the spinal cord on T2-weighted image with mild cord bulging (67%) and focal contrast enhancement of the cord (75%) were observed within the first four weeks after full development of clinical symptoms. The findings decreased in extent or vanished later than four weeks on either initial or follow-up MR images. Most patients with either cord atrophy or focal hemorrhage within the cord lesion had poor clinical outcome. The MR findings of transverse myelitis are nonspecific, which may be seen in a variety of diseases. Serial MRIs, especially follow-up examination over at least one month after full development of clinical symptoms are useful in the diagnosis of transverse myelitis and predicting its prognosis
[en] In the author's opinion computed tomography should be applied as an instrument of basic research also in psychiatry. The problem of standardisation is, for the time being, not yet sufficiently solved. Wrong judgements on the cerebral cortex resulting from wrongly positive findings occur frequently. For re-handling the topic 'brain atrophy and psychosyndrome', which is important for clinical psychiatry, the CT-results should be compared with the findings obtained in the preceding systematical pneumoencephalographical-clinical correlation examinations. The excellent possibilities provided by the new method for practical diagnostics and research must be utilized with critical appreciation of the experience gained until now. If groups of examining of capacities closely co-operate over a long-term period, there may be some chances to bring some questions still open and unresolved closer to their solution and, maybe, even to finish the scientific handling of the complex of questions on 'brain atrophic and psychopathological finding' with radiological-morphological methods. (orig./MG)
[de]Die Computertomographie sollte nach Ansicht des Autors auch in der Psychiatrie als Instrument der Grundlagenforschung verwendet werden. Das Problem der Normbildung ist zur Zeit u.E. noch nicht zufriedenstellend geloest. Fehlbeurteilungen an der Hirnrinde i.S. falsch-positiver Befunde sind besonders haeufig. Fuer die Neubearbeitung des fuer die klinische Psychiatrie wichtigen Themas 'Hirnatrophie und Psychosyndrom' sollten die computertomographischen Ergebnisse mit den Befunden verglichen werden, die in den frueheren systematischen pneumencephalographisch-klinischen Korrelationsuntersuchungen ermittelt wurden. Die ausgezeichneten Moeglichkeiten, die das neue Verfahren fuer die diagnostische Praxis und die Forschung eroeffnet, muessen unter kritischer Wuerdigung der bisher vorhandenen Erfahrungen genutzt werden. Wenn Gruppen von Untersuchern mit entsprechender Sachkompetenz langfristig eng zusammenarbeiten, sind u.E. die Aussichten gut, auf diesem Weg einige bisher offene oder umstrittene Fragen meines Fachgebietes einer Loesung naeher und vielleicht sogar die wissenschaftliche Bearbeitung des Fragenkomplexes 'hirnatrophischer und psychopathologischer Befund' mit roentgenologisch-morphologischen Methoden zum Abschluss zu bringen. (orig./MG)
[en] Background: There is extreme shortage of data regarding effects and safety profile of use of intrathecal dexmedetomidine as an adjunctive agents in Pakistani adult women undergoing caesarian section. Aims: To observe the outcome of dexmedetomidine utilization in spinal anesthesia as an adjunctive agent, its side effect depiction, and to find the most efficacious and safe dose of intrathecal dexmedetomidine. Methodology: A total of 135 patients were included in this randomized, prospective study by isolating 45 patients in each of three groups. Each of two study groups were given intrathecal dexmedetomidine 10µg in group D-10 and 15µg in D-15 along 12mg of hyperbaric bupivacaine and bupivacaine only in control group. We recorded onset and regression of sensory and motor blockade, any untoward effect and hemodynamic variability mean arterial BP Results: Both the study groups [D-10 and D-15] revealed significant results(p<0.05) in onset and regression of sensory and motor blockade as compared to control group[bupivacaine only]. By addition of adjuncts [dexmedetomidine] in spinal anesthesia, resulted in delayed administration and lower dose of postoperative analgesia and less intraoperative hemodynamic instability and postoperative side effects. Conclusion: Dexmedetomidine as an adjunctive agent in intrathecal route is a safer and efficacious agent without producing significant side effects. 10 microgram dexmedetomidine is a more appropriate dose than 15 microgram showing comparable efficiency and low untoward effects. (author)
[en] Numerical modelling of magnetic stimulation in the spine is a scarce subject in the literature, although it has been gaining clinical acceptance. In the present work we present the results from a simplified computational model of the spine. The results indicate that it is necessary to use a numerical technique for solving the problem, which takes into account tissue dispersion and both dielectric properties (conductivity and permittivity), since a difference of 14% in the induced electric fields was found when displacement currents were included. With respect to the role of tissues in stimulation efficiency, it was confirmed that water-rich tissues lead to a shielding effect of the spinal cord. However, this effect becomes smaller at the height of the intervertebral discs, resulting in an increase of the field inside the spine.