surgical manipulations
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2022 ◽  
Vol 3 ◽  
pp. 01-07
Author(s):  
Gian Maria Pacifici

The main clinical use of the neuromuscular blocking agents is an adjuvant in surgical anaesthesia to obtain relaxation of skeletal muscle, particularly of the abdominal wall, to facilitate surgical manipulations. Rocuronium can be used instead of suxamethonium to provide rapid muscle paralysis during tracheal intubation but the recovery is much slower. Rocuronium is administered intravenously to infants and children. In infants, rocuronium is administered at a dose of 450 µg/kg for providing muscle relaxation for laryngeal intubation. To provide sustained paralysis, rocuronium is given at a dose of 600 µg/kg. In children, the neuromuscular blockade is obtained with 600 µg/kg followed by an intravenous infusion of 150 µg/kg per hour. For assisted ventilation in intensive care, rocuronium is administered at a dose of 600 µg/kg followed by an intravenous infusion of 300 to 600 µg/kg per hour. The effects of rocuronium have been extensively studied in infants and children. Rocuronium is converted into 17-desacetyl rocuronium. The pharmacokinetics of rocuronium have been studied in infants and children and the mean residence time is 55.6 and 25.6 min (P-value < 0.01) in infant and children, respectively. Rocuronium interacts with drugs, the treatment of infants and children with rocuronium has been studied, and rocuronium poorly crosses the human placenta. The aim of this study is to review the published data on rocuronium dosing, pharmacokinetics, and treatment in infants and children, and rocuronium metabolism and transfer across the human placenta.


2021 ◽  
Author(s):  
Boris Cepunov ◽  
Konstanciya Gozhenko ◽  
Evgeniy Zhilyaev

The tutorial consists of two sections. The section "General surgery" covers the issues of prevention of surgical infection, issues of anesthesia, organization of preoperative and postoperative periods and other issues of general surgery (blood transfusion, transfusion, open and closed injuries, types of operative and non-operative surgical techniques, surgical infection, tumors). Attention is paid to general disorders of the vital activity of the body, as well as resuscitation, emergency care in case of accidents. The section "Specific types of surgical pathology" describes injuries and diseases of the head and neck, chest, abdominal cavity, spine and pelvis, limbs, peripheral vessels and nerves. Much attention is paid to the care of surgical patients at all stages of treatment. The principles and methods of providing first medical and pre-medical care in critical conditions of the patient are described in detail. The final chapter is devoted to the technique of surgical manipulations. Meets the requirements of the federal state educational standards of secondary vocational education of the latest generation. It is intended for students of paramedic, obstetric and nursing departments of medical colleges and colleges.


Author(s):  
Volodymyr I. Smolanka ◽  
Andrey V. Smolanka ◽  
Oleksandr S. Sechko ◽  
Olga S. Herasymenko

Surgery of intrinsic brainstem lesions is extremely dangerous, consequently the knowledge of anatomy and safe entry zones is extremely important. The technological progress was achieved with the widespread clinical use of intraoperative neurophysiological monitoring (IONM) which has proven to further improve the safety of operating on intrinsic brainstem lesions. The relevance of the study is conditioned by the fact that the tumor alters the normal anatomy and distorts the location of well-known landmarks and structures. In this regard, this paper is directed at identification of the placement of conductive pathways in the thickness of the brain stem and directly in the depth of the lesion (in the tumor or cavern), respectively to the surgical manipulations aimed at injury prevention. The results were achieved by a retrospective review of medical reports. The paper represents the results of surgical treatment of 42 patients with brainstem lesions, reviews the localization of the lesion and neurological status of patients, describes available methods of intraoperative monitoring (IOM) and on-line techniques for the brainstem surgery. The materials of the paper are of practical significance for the development of brainstem surgery with IONM modifications for wider and more comfortable use by neurosurgeons.


2021 ◽  
Vol 11 (2) ◽  
pp. 184-187
Author(s):  
Bogdan Shumilovich ◽  
Anna Podoprigora ◽  
Andrey Sushchenko ◽  
Vladimir Rostovtsev ◽  
Irina Bishtova ◽  
...  

This article presents clinical cases of successful endodontic treatment of the main types of combined apical and marginal pathology. Based on the results obtained, the optimal method that ensures a successful treatment result for this pathology in one visit, often without subsequent surgical manipulations, is an adequate endodontic mechanical intervention with subsequent obturation of the root canals with a bioceramic sealer, which is confirmed by the literature data.


2021 ◽  
Vol 22 (10) ◽  
pp. 5332
Author(s):  
Raquel G. Bardallo ◽  
Rui Teixeira da Silva ◽  
Teresa Carbonell ◽  
Emma Folch-Puy ◽  
Carlos Palmeira ◽  
...  

The total damage inflicted on the liver before transplantation is associated with several surgical manipulations, such as organ recovery, washout of the graft, cold conservation in organ preservation solutions (UW, Celsior, HTK, IGL-1), and rinsing of the organ before implantation. Polyethylene glycol 35 (PEG35) is the oncotic agent present in the IGL-1 solution, which is an alternative to UW and Celsior solutions in liver clinical transplantation. In a model of cold preservation in rats (4 °C; 24 h), we evaluated the effects induced by PEG35 on detoxifying enzymes and nitric oxide, comparing IGL-1 to IGL-0 (which is the same as IGL-1 without PEG). The benefits were also assessed in a new IGL-2 solution characterized by increased concentrations of PEG35 (from 1 g/L to 5 g/L) and glutathione (from 3 mmol/L to 9 mmol/L) compared to IGL-1. We demonstrated that PEG35 promoted the mitochondrial enzyme ALDH2, and in combination with glutathione, prevented the formation of toxic aldehyde adducts (measured as 4-hydroxynonenal) and oxidized proteins (AOPP). In addition, PEG35 promoted the vasodilator factor nitric oxide, which may improve the microcirculatory disturbances in steatotic grafts during preservation and revascularization. All of these results lead to a reduction in damage inflicted on the fatty liver graft during the cold storage preservation. In this communication, we report on the benefits of IGL-2 in hypothermic static preservation, which has already been proved to confer benefits in hypothermic oxygenated dynamic preservation. Hence, the data reported here reinforce the fact that IGL-2 is a suitable alternative to be used as a unique solution/perfusate when hypothermic static and preservation strategies are used, either separately or combined, easing the logistics and avoiding the mixture of different solutions/perfusates, especially when fatty liver grafts are used. Further research regarding new therapeutic and pharmacological insights is needed to explore the underlying mitochondrial mechanisms exerted by PEG35 in static and dynamic graft preservation strategies for clinical liver transplantation purposes.


2021 ◽  
pp. 112067212110177
Author(s):  
Ayse Gul Kocak Altintas ◽  
Cagri Ilhan

Purpose: To compare the phaco time parameters including ultrasound time (UST), effective phaco time (EPT), and average phaco power (APP) in eyes with pseudoexfoliation glaucoma (PEG) and had or had not glaucoma filtration surgery. Methods: In this retrospective comparative study, Group 1 was constructed with 84 PEG patients who had not operated previously, and Group 2 was constructed with 49 PEG patients who had glaucoma filtration surgery. The mean values of UST, EPT, and APP were compared. The preoperative clinical characteristics and surgical manipulations were also compared. Results: The mean ages and male-to-female ratios of the groups were similar ( p > 0.05, for both). There was no difference in the preoperative clinical characteristics, including biometric values between the groups ( p > 0.05, for all). Some surgical manipulations, including pupillary stretching ( p = 0.004), pupillary membrane peeling ( p = 0.021), iris hook using ( p = 0.041), and capsular tension ring implantation ( p = 0.041), were significantly performed more commonly in Group 2. Although the mean UST and EPT values were similar ( p > 0.05, for both), the mean APP value was significantly lower in Group 2 ( p = 0.011). Conclusion: The lower APP parameter was observed in PEG patients having had glaucoma filtration surgery. Needing more surgical manipulation to overcome poor pupillary dilation and weak zonular instability can be a reason for this result.


2021 ◽  
Vol 19 (1) ◽  
pp. 61-70
Author(s):  
B. R. Shumilovich ◽  
V. V. Rostovtsev ◽  
I. S. Bishtova ◽  
D. E. Khrenov ◽  
R. V. Selin

A number of researchers note the fact that today, in more than 5.7% of the teeth in patients over 40-45 years old with apical periodontal lesions, during a comprehensive examination, lesions of the marginal periodontium are also diagnosed.Materials and methods. The success of endodontic treatment of such teeth with the use of traditionally used polymer sealers is extremely low. Pathology develops due to a mixed apical-periodontal microflora. The use of bioceramic sealers has been reported to significantly improve the prognosis for endodontic intervention. Bioceramics inherently is the most biocompatible material and consists of aluminum oxide, zirconium dioxide, bioactive glass, glass ceramics, composite components and coatings, hydroxyapatite and resorbable calcium phosphates.Results. This article presents clinical cases of successful endodontic treatment of the main types of combined apical and marginal pathology. 9-11 months after treatment, the diagnosed signs of perio-dontal and periapical pathology are not determined.Conclusions. Based on the results obtained, the optimal method that ensures a successful treat-ment result for this pathology in one visit, often without subsequent surgical manipulations, is an ade-quate endodontic mechanical intervention with subsequent obturation of the root canals with a bioc-eramic sealer, which is confirmed by the literature data.


2021 ◽  
pp. 263-268
Author(s):  
Lada S. Starostina

The problem of anesthesia includes mainly the treatment of pre-existing pain or surgical manipulations with the use of anesthesia. However, the problems of pain prevention during traumatic (invasive) procedures are also actively solved, methods of prevention are improved and expanded, taking into account the impact of pain on the quality of life. Pain is not a simple physiological process of conducting stimulation from the receptor apparatus to the CNS structures, but a complex phenomenon that includes biological, emotional, psychological and social components. Pain is one of the earliest formed psychophysical functions; by the 30 th week of fetal development all pathways of pain conduction and perception are already formed, so both fetus and child are already capable of perceiving pain, and the intensity is often even higher than in adults. Many believe that: young children do not feel pain because their central nervous system is immature; children remember themselves from the age of 4–5 years, so they do not remember the pain they suffered, so all surgical problems that cause pain should be addressed as early as possible; if the child is sleeping or playing, he or she has no pain, etc. Current research has demonstrated significant short-term adverse reactions and long-term negative effects in children in response to pain-related manipulations. Anesthesia of intact skin was previously impossible without prior painful anesthetic injection. Today, other ways of administering anesthetics are used as alternatives: oral, in enemas or suppositories, locally as sprays, ointments, or by application. To address the pain associated with invasive procedures, the effectiveness of a 5% local anesthetic cream based on a water-oil emulsion of lidocaine and prilocaine (1:1), which has good absorption properties, has been studied. Using local anesthesia can prevent and/or reduce the risk of pain-induced stress. Considering the results of these studies, the use of a local combined anesthetic containing 2.5% lidocaine and 2.5% prilocaine may be suggested.


2021 ◽  
pp. jeb.237529
Author(s):  
Itamar Katz ◽  
Tal Shomrat ◽  
Nir Nesher

Controlling the octopus's flexible hyper-redundant body is a challenging task. It is assumed that the octopus has poor proprioception which has driven the development of unique mechanisms for efficient body control. Here we report on such a mechanism, a phototactic response of extraocular photoreception. Extraocular photoreception has been observed in many and diverse species. Previous research on cephalopods revealed that increased illumination on their skin evokes chromatophore expansion. Recently, the mechanism was investigated and has been termed 'light-activated chromatophore expansion' (LACE). In this work we show that in response to illumination, the arm tip reacts in a reflex-like manner, folding in and moving away from the light beam. We applied a set of behavioral experiments and surgical manipulations to elucidate and characterize this phototactic response. We found that in contrast to the local activation and control of LACE, the phototactic response is mediated by the brain, although it is expressed in a reflex-like pattern. Our research results and observations led us to propose that the phototaxis is a means for protecting the arms in an instinctive manner from potential daytime predators such as fish and crabs, that could identify the worm-like tips as food. Indeed, observation of behaving octopuses revealed that the arm tips are folded-in during the daytime, while at night they are extended. Thus, the phototactic response might compensate for the octopus's poor proprioception by keeping the arms folded in illuminated areas, without the need to be aware of their state.


2021 ◽  
Vol 19 (3) ◽  
pp. 81-86
Author(s):  
A. M. SHCHIKOTA ◽  
◽  
I. V. POGONCHENKOVA ◽  
S. A. GUMENYUK ◽  
◽  
...  

The article presents a review of literature on the value of ultrasonography in acute musculoskeletal injury diagnostics. The main objectives of emergency ultrasonography are outlined: detection of fractures, large hematomas, injuries of tendons, muscles and nerves, detection of foreign bodies of soft tissues, ultrasonic navigation of surgical manipulations and reposition of fractures. The ultrasound method is highly sensitive цand specific in the detection of long-bone fractures, muscles and tendons rupture, which can make an impact on therapeutic tactic and patient’s routing. Ultrasound diagnostics has become useful for pediatric patients due to its ease of use, mobility and non-ionizing qualities. Ultrasonography of acute musculoskeletal injury will probably be increasingly important for orthopedic surgeons and emergency physicians.


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