Peripheral nerve blocks for outpatient surgery: evidence-based indications.

Purpose Of Review: There has been an increasing use of peripheral nerve blocks (PNBs) in ambulatory surgery. Several recent reports have contributed to our understanding of the optimal PNB technique for specific surgical procedures in this setting. In this review, we have summarized the available literature on indications of PNBs for outpatient surgery of the upper extremity.

The interaction of exercise ability and body mass index upon long-term outcomes among patients undergoing stress-rest perfusion single-photon emission computed tomography imaging.

Background: The obesity paradox has been reported in several populations of patients with cardiovascular disease. Recent data have shown that physical fitness may attenuate the obesity paradox. Patients who undergo pharmacologic stress testing are known to have a higher risk of mortality than those who can exercise.

Hoarseness evaluation: a transatlantic survey of laryngeal experts.

Objectives/hypothesis: Hoarseness is a symptom of laryngeal dysfunction, without an existing consensus regarding its appropriate evaluation. A survey of laryngeal specialists is proposed to establish expert opinion on the methodology for evaluation of hoarseness, and to identify divergence of opinion regarding appropriate management.

Study Design: Cross-sectional survey.

The effects of ultrasound-guided adductor canal block versus femoral nerve block on quadriceps strength and fall risk: a blinded, randomized trial of volunteers.

Background And Objectives: Adductor canal block (ACB) has been suggested as an analgesic alternative to femoral nerve block (FNB) for procedures on the knee, but its effect on quadriceps motor function is unclear. We performed a randomized, blinded study to compare quadriceps strength following adductor canal versus FNB in volunteers. Our hypothesis was that quadriceps strength would be preserved following ACB, but not FNB.

Electroretinographic detection of human brain dopamine response to oral food stimulation.

Objective: The activity of dopamine-dependent retinal signaling can be assessed using electroretinography. Response of this system to oral food stimulation might provide accessible insight into the brain dopamine response to oral stimuli as retinal dopamine concentration is dependent upon mid brain dopamine concentration was postulated.

Design And Methods: Nine individuals had cone ERG (b wave) response to oral food stimulation and oral methylphenidate (MPH) administration measured on separate days, and completed self reported eating behavior questionnaires.

Point-of-care ultrasound in a resource-limited setting: diagnosing intussusception.

Background: Department of Radiology performed ultrasound for patients suspected of having intussusception in resource-limited settings might be either unavailable or significantly time delayed.

Objective: Our objective was to present a case of intussusception successfully diagnosed by point-of-care ultrasound and to review the sonographic appearance and diagnostic criteria for intussusception.

Case Report: An emergency physician utilized point-of-care ultrasound to diagnose intussusception in a young patient in Haiti.

Noninvasive mapping of ventricular activation in patients with transplanted hearts.

This is the first reported study of ventricular activation patterns after cardiac transplantation, using electrocardiographic imaging (ECGI), a noninvasive method for electrophysiologic mapping. This study of ten patients reveals that transplanted hearts have unique ventricular activation patterns in sinus rhythm, activating early in the epicardial aspect of the anterior or inferior septum, with intact right and left bundle branch conduction. They have late activation with slowing of conduction near the right ventricular (RV) basal free wall, causing a mild QRS prolongation and an rSr' pattern in lead V1 of the ECG.

Association between severe eczema in children and multiple comorbid conditions and increased healthcare utilization.

Background: Atopic dermatitis (AD) is associated with multiple comorbid conditions, such as asthma and food allergy. We sought to determine the impact of eczema severity on the development of these disorders and other non-atopic comorbidities in AD.

Methods: We used the 2007 National Survey of Children's Health, a prospective questionnaire-based study of a nationally representative sample of 91,642 children aged 0-17 yr.

Vitiligo patients seeking depigmentation therapy: a case report and guidelines for psychological screening.

Vitiligo is characterized by a loss of cutaneous and mucosal pigmentation and often is associated with psychological distress. Depigmentation therapy can be used to eliminate residual pigment, thereby creating an evenly depigmented skin tone. Patients often seek depigmentation therapy to even their skin tone when a large body surface area is affected by vitiligo or when exposed areas (eg, face, hands) are affected and do not respond to repigmentation therapy.

Fatal pulmonary embolism complicating a postoperative chylothorax despite adequate thromboprophylaxis.

Chylothorax is a recognized complication of intrathoracic surgery, but its occurrence after coronary artery bypass grafting (CABG) is very rare. We report a case of a fatal pulmonary embolism as a complication of chylothorax following CABG. The patient was an 82-year-old woman who presented with increasing chest pain 2 weeks after discharge after an uncomplicated CABG.

Effect of allopurinol on blood pressure: a systematic review and meta-analysis.

Allopurinol is a potent xanthine oxidase inhibitor that is used in hyperuricemic patients to prevent gout. It has also been shown to decrease cardiovascular complications in a myriad of cardiovascular conditions. However, studies have reported conflicting evidence on its effects on blood pressure (BP).

Why triptan treatment can fail: focus on gastrointestinal manifestations of migraine.

Background: Results of randomized, double-blind, controlled studies establish the efficacy of triptans in the acute treatment of migraine, but triptan benefits demonstrated in clinical trials have not consistently been realized in clinical practice. This paper explores the contribution of gastrointestinal manifestations of migraine--namely nausea (with or without vomiting) and gastroparesis--to triptan treatment failure.

Synthesis: Migraine-related nausea and vomiting and migraine-associated gastroparesis appear to be prevalent and highly impactful and have been characterized as being among the greatest challenges affecting migraine care today.

Sublingual buprenorphine for chronic pain: a survey of clinician prescribing practices.

Objectives: Sublingual buprenorphine, with and without naloxone, is indicated for the treatment of opioid use disorders. Although not approved for pain, some evidence suggests it may be a safe and effective alternative to conventional opioid analgesics, particularly for those with addiction problems. This study surveyed pain specialists to examine the extent to which sublingual buprenorphine was prescribed for chronic pain and explore associated clinician attitudes and characteristics.

Stable deuterium internal standard for the isotope-dilution LC-MS/MS analysis of elastin degradation.

Chemical synthesis of the deuterium isotope desmosine-d4 has been achieved. This isotopic compound possesses all four deuterium atoms at the alkanyl carbons of the alkyl amino acid substitution in the desmosine molecule and is stable toward acid hydrolysis; this is required in the measurement of two crosslinking molecules, desmosine and isodesmosine, as biomarkers of elastic tissue degradation. The degradation of elastin occurs in several widely prevalent diseases.

Internal mammary silicone lymphadenopathy diagnosed by robotic thoracoscopic lymphadenectomy.

Internal mammary lymphadenopathy can be caused by a variety of disease processes and is a difficult diagnostic dilemma. We report a case of internal mammary lymphadenopathy, in a patient with a significant history of malignancy, requiring a tissue diagnosis. Robotic thoracoscopic lymphadenectomy was used to facilitate excisional biopsy.

Treatment of obstructive hypertrophic cardiomyopathy symptoms and gradient resistant to first-line therapy with β-blockade or verapamil.

Background: There is controversy about preferred methods to relieve obstruction in hypertrophic cardiomyopathy patients still symptomatic after β-blockade or verapamil.

Methods And Results: Of 737 patients prospectively registered at our institution, 299 (41%) required further therapy for obstruction for limiting symptoms, rest gradient 61 ± 45, provoked gradient 115 ± 49 mm Hg, and followed up for 4.8 years.

Regional anesthesia for trauma outside the operating theatre.

Purpose Of Review: Pain management in the trauma patient can be challenging, especially outside the operating room setting. Traditional analgesics such as opioids and NSAIDs are also problematic in trauma care. In this review, the use of regional anesthetic techniques outside the operating theatre is discussed.

Survey of New York City resident physicians on cause-of-death reporting, 2010.

Introduction: Death certificates contain critical information for epidemiology, public health research, disease surveillance, and community health programs. In most teaching hospitals, resident physicians complete death certificates. The objective of this study was to examine the experiences and opinions of physician residents in New York City on the accuracy of the cause-of-death reporting system.

Postoperative pain and recovery after conventional laparoscopy compared with robotically assisted laparoscopy.

Objective: To compare postoperative pain after conventional laparoscopic and robotically assisted laparoscopic surgery in gynecology.

Methods: This is a prospective nonrandomized analysis of patients undergoing conventional laparoscopy or robotically assisted laparoscopy in a university-affiliated hospital between March 2011 and March 2012. Postoperative pain was measured using the Numeric Rating Scale and the narcotic use converted to morphine sulfate equivalents.

Targeted therapies and the treatment of non-clear cell renal cell carcinoma.

Background: Targeted therapies have shown profound effects on the outcome of patients with advanced renal cell carcinoma (RCC). However, the optimal treatment for RCC of non-clear cell histology (nccRCC)-typically excluded from trials of targeted agents-remains uncertain.

Materials And Methods: By carrying out extensive searches of PubMed and ASCO databases, we identified and summarised research into the biological characteristics, clinical behaviour and treatment of different histological subtypes of nccRCC, focusing on targeted therapy.

Vitiliginous lesions induced by amyl nitrite exposure.

Chemical (or contact) leukoderma is a condition induced by local cutaneous exposure to chemicals or medicaments that are toxic to melanocytes and/or koebnerize preexisting vitiligo vulgaris. Chemicals known to induce leukoderma include phenol/catechol derivatives (eg, hydroquinone), sulfhydryls, contact sensitizing agents (eg, squaric acid dibutylester), and more recently imiquimod, among others. We report the case of a 37-year-old black man with human immunodeficiency virus who developed chemical leukoderma in the nasal and perioral areas within 4 weeks of spilling liquid amyl nitrite, which he had been inhaling as a recreational drug, on his lower face.