Magnesium and Esophageal Pain After Peroral Endoscopic Myotomy of the Esophagus: A Randomized, Double-Blind, Placebo-Controlled Trial.

Background: Postoperative esophageal pain occurs in 67% of patients after peroral endoscopic esophageal myotomy (POEM). Magnesium can act as a smooth muscle relaxant. This study investigated whether intraoperative magnesium can reduce postoperative esophageal pain in patients undergoing POEM.

Stellate ganglion block catheter for paroxysmal sympathetic hyperactivity: calming the 'neuro-storm'.

Background: Paroxysmal sympathetic hyperactivity (PSH) is an autonomic disorder affecting patients with severe acquired brain injury characterized by intermittent sympathetic discharges with limited therapeutic options. We hypothesized that the PSH pathophysiology could be interrupted via stellate ganglion blockade (SGB).

Case Presentation: A patient with PSH after midbrain hemorrhage followed by hydrocephalus obtained near-complete resolution of sympathetic events for 140 days after SGB.

Characterization of Epidural Analgesia Interruption and Associated Outcomes After Esophagectomy.

Introduction: Interruption of thoracic epidural analgesia may impact the postoperative course following esophagectomy. This study investigates the incidence and causes of epidural interruption in esophagectomy patients along with associated postoperative outcomes.

Methods: This single-institution retrospective analysis examined patients undergoing esophagectomy who received a thoracic epidural catheter from 2016 to 2020.

Utility of Electrical Stimulation for Correct Placement and Neuromodulation of the Erector Spinae Plane Block for Total Shoulder Arthroplasty: A Case Report.

The role of neuromodulation in fascial plane blocks is unknown. This case report presents a complex patient who underwent shoulder arthroplasty with a high thoracic-erector spinae plane (HT-ESP) catheter that provided electrical and chemical neuromodulation, highlighting the potential of electrical stimulation in the identification of and therapy at the fascial plane level.

Utilization of Magnesium in Opioid-Free Anesthesia for Peroral Endoscopic Myotomy: A Case Report.

Optimal anesthetic management has not been studied for peroral endoscopic myotomy (POEM). This case report documents 2 patients with esophageal motility disorders who underwent POEM with opioid-free, magnesium-based anesthesia. Both patients had no postoperative esophageal complications nor need for opioid therapy.

Risk of Acute Ischemic Stroke in Patients With Monocular Vision Loss of Vascular Etiology.

Background: To evaluate the risk of concurrent acute ischemic stroke and monocular vision loss (MVL) of vascular etiology.

Design: Retrospective, cross-sectional study.

Subjects: Patients aged 18 or older diagnosed with MVL of suspected or confirmed vascular etiology who had no other neurologic deficits and who received brain MRI within 7 days of onset of visual symptoms were included.

Glucagon-induced hypertensive emergency: a case report.

Glucagon is well acknowledged as a sphincter of Oddi relaxant for both diagnostic and therapeutic uses in choledocholithiasis, and an empiric treatment for β-blocker overdose. Although it has been implicated in inducing cardiovascular crises in patients with asymptomatic pheochromocytoma, adverse effects in other patient populations have not been characterized. This case report describes a patient with hypertension controlled on β blockers who, after glucagon administration during an intraoperative cholangiography, experienced hypertensive emergency despite adequate pain control.

Efficacy and Safety of Nonopioid Analgesics in Perioperative Pain Control.

Opioids have been the mainstay for management of acute postoperative pain for several decades. Extensive use, however, has been associated with multiple side effects. Multimodal approaches that incorporate nonopioid medications and techniques have been observed to achieve optimum pain control whilst decreasing side effects.

Tumor necrosis factor disrupts claudin-5 endothelial tight junction barriers in two distinct NF-κB-dependent phases.

Capillary leak in severe sepsis involves disruption of endothelial cell tight junctions. We modeled this process by TNF treatment of cultured human dermal microvascular endothelial cell (HDMEC) monolayers, which unlike human umbilical vein endothelial cells form claudin-5-dependent tight junctions and a high-resistance permeability barrier. Continuous monitoring with electrical cell-substrate impedance sensing revealed that TNF disrupts tight junction-dependent HDMEC barriers in discrete steps: an ~5% increase in transendothelial electrical resistance over 40 minutes; a decrease to ~10% below basal levels over 2 hours (phase 1 leak); an interphase plateau of 1 hour; and a major fall in transendothelial electrical resistance to < 70% of basal levels by 8-10 hours (phase 2 leak), with EC50 values of TNF for phase 1 and 2 leak of ~30 and ~150 pg/ml, respectively.

Reduction of intestinal neoplasia with adenomatous polyposis coli gene replacement and COX-2 inhibition is additive.

Mutations of the adenomatous polyposis coli (APC) gene are implicated early in colorectal tumorigenesis. Restoration of normal APC expression through gene therapy may prevent or reduce intestinal neoplasia. Furthermore, the relationship between colorectal tumors and increased cyclooxygenase-2 (COX-2) activity provides a rationale for the use of selective COX-2 inhibitors such as rofecoxib (Vioxx) to prevent the formation of polyps.

Hepatocyte nuclear factor-1 alpha, GATA-4, and caudal related homeodomain protein Cdx2 interact functionally to modulate intestinal gene transcription. Implication for the developmental regulation of the sucrase-isomaltase gene.

Sucrase-isomaltase (SI), an intestine-specific gene, is induced in the differentiated small intestinal villous epithelium during the suckling-weaning transition in mice. We have previously identified cis-acting elements within a short evolutionarily conserved SI promoter. However, the nature and profile of expression of the interacting proteins have not been fully characterized during this developmental transition.