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Gastric Perforation in a 28-Month-Old Child: Complicated by Peritonitis Admitted to the Surgical Emergency Room after a Case

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Open Journal of Emergency Medicine 2020年第4期8卷 118-124页

作者： Abdoulaye Touré Fofana Naby Amadou Yalla Camara Joseph Donamou Boubacar Atigou Dramé Oularé Ibrahima Camara M’mah Lamine Bangoura Almamy Camara Mariama Mohamed Emile Camara Godwe Justin Naibe anesthesia-intensive Care Unit at the National Ignace Deen Hospital Conakry Guinea General Surgery department of the National Ignace Deen Hospital Conakry Guinea anesthesia-intensive Care Unit at the Donka National Hospital Conakry Guinea

We report the case of a 28-month-old male child with no particular history who was admitted to the emergency room for severe abdominal pain associated with vomiting, asthenia and fever at 39.1˚C that had progressed for 4 days. He was conscious, polypneic at 32 cycles/min on admission. On palpation the abdomen was distended, painful as a whole, more pronounced in the epigastrium. There was abdominal contracture, generalized defense, a cry with sudden decompression of the umbilicus. On abdominal auscultation, there was a disappearance of prehepatic dullness, a decrease in the dullness of the flanks and absence of hydro-aeric noises. On the digital rectal examination, Douglas’s cul de sac was bulging and sensitive. An unprepared X-ray of the abdomen revealed diffuse grayness, lateral gas crescent pneumoperitoneum under diaphragm. The preoperative resuscitation consisted of the placement of a nasogastric tube, a urinary catheter, a peripheral venous route and the fluid electrolyte rebalancing adapted according to the blood ionogram, early antibiotic therapy with broad aero and anaerobic spectrum. Surgical management under general anesthesia found at laparotomy a perforation of the anterior surface of the duodenal bulb which we estimate to be 1 cm in diameter with fibrin deposits. The gesture was the toilet of the peritoneal cavity;suture of the bank and the operative consequences were simple.

关键词： Resuscitation Gastric Perforation Child Peritonitis Ignace Deen

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Comparison of emergency surgical cricothyroidotomy and percutaneous cricothyroidotomy by experienced airway providers in an obese,in vivo porcine hemorrhage airway model

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Military Medical Research 2023年第4期10卷 421-430页

作者： Tomas Karlsson Andreas Brännström Mikael Gellerfors Jenny Gustavsson Mattias Günther department of Clinical Science and Education Section of Anesthesiology and Intensive CareKarolinska Institutet11883 StockholmSweden department of Neuroscience Karolinska Institutet17177 StockholmSweden department of Physiology and Pharmacology Section of Anesthesiology and Intensive CareKarolinska Institutet11883 StockholmSweden department of Perioperative Medicine and intensive Care Karolinska University Hospital17177 StockholmSweden Swedish Air Ambulance(SLA) 79291 MoraSweden Rapid Response Cars 18233 StockholmSweden.

Background: Emergency front-of-neck airway(eFONA) is a life-saving procedure in “cannot intubate, cannot oxygenate”(CICO). The fastest and most reliable method of eFONA has not been determined. We compared two of the most advocated approaches: surgical cricothyroidotomy and percutaneous cricothyroidotomy, in an obese, in vivo porcine hemorrhage model, designed to introduce real-time physiological feedback, relevant and high provider stress. The primary aim was to determine the fastest method to secure airway. Secondary aims were arterial saturation and partial pressure of oxygen, proxy survival and influence of ***: Twelve pigs [(60.3±4.1) kg] were anesthetized and exposed to 25%–35% total blood volume hemorrhage before extubation and randomization to Seldinger technique “percutaneous cricothyroidotomy”(n=6) or scalpelbougie-tube technique “surgical cricothyroidotomy”(n=6). Specialists in anesthesia and intensive care in a tertiary referral hospital performed the eFONA, simulating an actual ***: In surgical cricothyroidotomy vs. percutaneous cricothyroidotomy, the median(interquartile range, IQR) times to secure airway were 109(IQR 71–130) s and 298(IQR 128–360) s(P=0.0152), arterial blood saturation(SaO2) were 74.7(IQR 46.6–84.2)% and 7.9(IQR 4.1–15.6)%(P=0.0167), PaO_(2) were 7.0(IQR 4.7–7.7) kPa and 2.0(IQR 1.1–2.9) kPa(P=0.0667), and times of cardiac arrest(proxy survival) were 137–233 s, 190(IQR 143–229) s, from CICO. All six animals survived surgical cricothyroidotomy, and two of six(33%) animals survived percutaneous cricothyroidotomy. Years in anesthesia, 13.5(IQR 7.5–21.3), did not influence time to secure ***: eFONA by surgical cricothyroidotomy was faster and had increased oxygenation and survival, when performed under stress by board certified anesthesiologists, and may be an indication of preferred method in situations with hemorrhage and CICO, in obese patients.

关键词： Emergency front-of-neck airway “Cannot intubate cannot oxygenate”(CICO) Surgical cricothyroidotomy,Percutaneous cricothyroidotomy Porcine model

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Pain management in acute musculoskeletal injury: Effect of opioid vs nonopioid medications

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World Journal of Orthopedics 2024年第9期15卷 882-890页

作者： Marco Fiore Luigi Aurelio Nasto Eleni McCaffery Fannia Barletta Angela Visconti Francesca Gargano Enrico Pola Maria Caterina Pace department of Women Child and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy department of Orthopaedics University of Campania“Luigi Vanvitelli”Naples 80138Italy department of Emergency Medicine New York Presbyterian-Brooklyn Methodist HospitalNew YorkNY 11215United States department of anesthesia and intensive Care “San Carlo”HospitalPotenza 85100Italy department of Anaesthesia “San Giuliano”HospitalGiugliano 80014Italy Unit of anesthesia and intensive Care The Fondazione Policlinico Universitario Campus Bio-MedicoRome 00128Italy

BACKGROUND The use of opioids for pain is linked to an increased risk of developing opioid use disorder,and has resulted in the emergence of the opioid crisis over the last few *** The systematic review question is“How does the use of opioid medications in pain management,compared with non-opioid medications,affect pain intensity over the short,intermediate,and long-term in adults with acute traumatic pain?”.METHODS The protocol was prospectively registered on the International Prospective Re-gister of Systematic Reviews:*** and Google Scholar were electronically searched for controlled peer-reviewed studies published in full,with the PICO framework:P:Adult patients with traumatic injuries,I:Opioid medications,C:Non-opioid medi-cations,O:A minimum clinically important difference(MCID)in *** After full-text screening,we included 14 studies in the qualitative *** these 14 studies,12 were rando-mized clinical trials(RCTs)and 2 were pseudo-RCTs with a total of 2347 patients *** was heteroge-neity in both medication utilized and outcome in these studies;only two studies were homogeneous regarding the type of study conducted,the opioid used,its comparator,and the outcome *** MCID was evaluated in 8 studies,while in 6 studies,any measured pain reduction was considered as an *** 11 cases,the setting of care was the Emergency department;in 2 cases,care occurred out-of-hospital;and in one case,the setting was not *** included studies were found to have a low-moderate risk of *** Non-opioids can be considered an alternative to opioids for short-term pain management of acute musculoskeletal *** ketamine may cause more adverse events than other routes of administration.

关键词： Acute musculoskeletal injury Acute traumatic pain Non-opioid analgesia Non-opioid pain control Opioid-sparing analgesia Opioid crisis Opioid disorder Systematic review

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Significance of Fractional Exhaled Nitric Oxide Combined with Serum Procalcitonin and C-Reactive Protein in Evaluation of Elderly Asthma

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Journal of Huazhong University of Science and Technology(Medical Sciences) 2013年第2期33卷 185-188页

作者：吴纪珍马利军赵丽敏张晓宇陈献亮况红艳 department of Respiratory Medicine and intensive Care Union the People's Hospital of Henan Province

Bronchial asthma is a common chronic airway inflammatory disease. Asthma is associated with high mortality, especially in the elderly patients. Repeated exacerbations cause disease progression. Therefore, identifying the onset of acute elderly asthma as soon as possible and giving the effective treatment is crucial to improve the prognosis. This study was to investigate the significance of fractional exhaled nitric oxide （FeNO） combined with serum procalcitonin （PCT） and C-reactive protein （CRP） in the evaluation of elderly asthma. A total of 120 elderly patients with an acute attack of asthma from July, 2010 to May, 2012 were studied. On presentation, FeNO, serum PCT and CRP concentrations were measured and sputum culture was also performed. The elderly patients were re-evaluated when they had returned to their stable clinical state. The elderly patients were classified into two groups： positive bac- terial culture group （A） and negative bacterial culture group （B）. The results showed that：（1） In patients with an acute exacerbation of asthma, 48 （40%） patients had positive sputum bacterial culture and 72 （60%） had negative sputum bacterial culture. （2） The levels of FeNO in patients with acute exacerbation of asthma were significantly higher than in those with no acute exacerbation state （63.8±24.6 vs. 19±6.5 ppb, P〈0.05）. There was no significant difference in FeNO between group A and group B （P〉0.05）. （3） The levels of PCT and CRP in group A patients with an acute exacerbation of asthma were significantly higher （P〈0.05） than in group B （for PCT： 27.46±9.32 vs. 7.85±3.52 ng/mL; for CRP： 51.25±11.46 vs. 17.11±5.87 mg/L, respectively）. When they had returned to stable clinical state, the levels of PCT and CRP in group A were decreased significantly （P〈0.05）, and those in group B had no significant change （P〉0.05） when compared with the exacerbation group. There were no significant differences in the levels of PCT and CRP between the two groups in non-acute exacerb

关键词： elderly asthma fractional exhaled nitric oxide procalcitonin C-reactive protein bacterial infection

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Correlation between circulating endothelial cell level and acute respiratory distress syndrome in postoperative patients

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World Journal of Clinical Cases 2021年第32期9卷 9731-9740页

作者： Min Peng Qing-He Yan Ying Gao Zhen Zhang Ying Zhang Yi-Feng Wang He-Ning Wu department of intensive Care Unit Tianjin Medical University General HospitalTianjin 300070China

BACKGROUND Acute respiratory distress syndrome(ARDS)is injury of alveolar epithelial cells and capillary endothelial cells caused by various factors,including endogenous and exogenous lung factors,leading to diffuse pulmonary interstitial and alveolar edema,and acute respiratory *** involves alveolar epithelial cells and pulmonary interstitial capillary endothelial *** endothelial cells(CECs)are the only marker that directly reflects vascular endothelial injury in *** have been few studies on the correlation between peripheral blood CECs and ARDS at home and *** lungs are the organs with the highest capillary density and the most endothelial cells,thus,it is speculated that when ARDS occurs,CECs are stimulated and damaged,and released into the circulatory *** To explore the correlation between CEC level and severity of ARDS in patients *** Blood samples were collected from all patients on day 2(d2)and day 5(d5)after *** control group comprised 32 healthy *** of CECs was measured by flow cytometry,and operation time was *** in various indexes of patients were monitored,and diagnosis of ARDS was determined based on ARDS Berlin *** comprised d2 CECs in different groups,correlation between operation time and d2 CECs,ARDS of different severity by d2 CECs,and predictive value of d2 CECs for ARDS in postoperative *** The number of d2 CECs in the ARDS group was significantly higher than that in the healthy control group(P<0.001).The number of d2 CECs in the ARDS group was significantly higher than that in the non-ARDS group(P<0.001).The number of d2 CECs in the non-ARDS group was significantly higher than that in the healthy control group(P<0.001).Operation time was positively correlated with number of CECs on d2(rs=0.302,P=0.001).The number of d2 CECs in the deceased group was significantly higher than that in the improved group(P<0.001).There was no si

关键词： Circulating endothelial cells Acute respiratory distress syndrome intensive care unit Postoperative period Outcome Flow cytometry

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Rapid identification of spinal ventral and dorsal roots using a quartz crystal microbalance

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Neural Regeneration Research 2013年第8期8卷 686-692页

作者： Tao Sui Jun Que Dechao Kong Hao Xie Daode Wang Kun Shi Xiaojian Cao Xiang Li department of Orthopedics the First Affiliated Hospital of Nanjing Medical University department of intensive Care Unit the First Affiliated Hospital of Nanjing Medical University

The fast and accurate identification of nerve tracts is critical for successful nerve anastomosis. Taking advantage of differences in acetylcholinesterase content between the spinal ventral and dorsal roots, we developed a novel quartz crystal microbalance method to distinguish between these nerves based on acetylcholinesterase antibody reactivity. The acetylcholinesterase antibody was immobilized on the electrode surface of a quartz crystal microbalance and reacted with the acetylcholinesterase in sample solution. The formed antigen and antibody complexes added to the mass of the electrode inducing a change in frequency of the electrode. The spinal ventral and dorsal roots were distinguished by the change in frequency. The ventral and dorsal roots were cut into 1 to 2-mm long segments and then soaked in 250 pL PBS. Acetylcholinesterase antibody was immobilized on the quartz crystal microbalance gold electrode surface. The results revealed that in 10 minutes, both spinal ventral and dorsal roots induced a frequency change; however, the frequency change induced by the ventral roots was notably higher than that induced by the dorsal roots. No change was induced by bovine serum albumin or PBS. These results clearly demonstrate that a quartz crystal microbalance sensor can be used as a rapid, highly sensitive and accurate detection tool for the quick identification of spinal nerve roots intraoperatively.

关键词： neural regeneration peripheral nerve injury basic research quartz crystal microbalance biosensor spinal nerve nerve tract acetylcholinesterase antigen-antibody reaction identification anastomosis nerve repair grants-supported paper neuroregeneration

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Hypoxia in the pulmonary vein increases pulmonary vascular resistance independently of oxygen in the pulmonary artery

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Animal Models and Experimental Medicine 2024年第2期7卷 156-165页

作者： Sigridur Olga Magnusdottir Carsten Simonsen Dan Stieper Karbing Bodil Steen Rasmussen Benedict Kjaergaard Biomedical Research Laboratory Aalborg University HospitalAalborgDenmark department of Clinical Medicine Aalborg UniversityAalborgDenmark department of Cardiothoracic Surgery Aalborg University HospitalAalborgDenmark department of Health Science and Technology Aalborg UniversityAalborgDenmark department of anesthesia and intensive Care Aalborg University HospitalAalborgDenmark

Introduction:Hypoxic pulmonary vasoconstriction(HPV)can be a challenging clinical *** is not fully elucidated where in the circulation the regulation of resistance takes *** is often referred to as if it is in the arteries,but we hypothesized that it is in the venous side of the pulmonary ***:In an open thorax model,pigs were treated with a veno-venous extra corporeal membrane oxygenator to either oxygenate or deoxygenate blood passing through the pulmonary *** the same time the lungs were ventilated with extreme variations of inspired air from 5%to 100%oxygen,making it possible to make combinations of high and low oxygen content through the pulmonary circulation.A flow probe was inserted around the main pulmonary artery and catheters in the pulmonary artery and in the left atrium were used for pressure monitoring and blood *** different combinations of oxygenation,pulmonary vascular resistance(PVR)was ***:With unchanged level of oxygen in the pulmonary artery and reduced inspired oxygen fraction lowering oxygen tension from 29 to 6.7 kPa in the pulmonary vein,PVR was *** more extreme hypoxia PVR suddenly *** with low oxygenation in the pulmonary artery did not systematic influence PVR if there was enough oxygen in the inspired air and in the pulmonary ***:The impact of hypoxia occurs from the alveolar level and forward with the blood *** experiments indicated that the regulation of PVR is mediated from the venous side.

关键词： animal models cardiopulmonary support Hypoxic pulmonary vasoconstriction pulmonary circulation

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The Impact of Total Intravenous Propofol Anaesthesia versus Sevoflurane Anaesthesia on Perioperative Pain in Patients Undergoing Colonic Cancer Surgery

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Open Journal of Anesthesiology 2021年第1期11卷 1-11页

作者： Bahaa Gamal Saad Samy Abdelrahman Amr Ashraf Amin Mohammed Montaser Abdelfattah Mohammed department of anesthesia Intensive Care and Pain Management South Egypt Cancer Institute Assuit University Assuit Egypt

Background: Cancer colon is one of the most common malignancies. After colon cancer surgery patients may experience severe pain. Several studies have reported that a significant decrease in postoperative pain with propofol while other studies have showed this effect was not significant. Aim: Our goal was to assess the effect of combined epidural anaesthesia either with propofol or sevoflurane on intraoperative fentanyl consumption and postoperative pain in patients undergoing open surgical resection of colon cancer. Patients and Methods: 48 adult patients suffering from cancer colon scheduled for open surgical resection randomly allocated either to receive epidural-propofol by total intra venous anaesthesia (TIVA) (n = 24) or epidural-sevoflurane

关键词： Cancer Colon Epidural anesthesia Propofol Sevoflurane Postoperative Pain

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Three-Stage Transfer Learning with AlexNet50 for MRI Image Multi-Class Classification with Optimal Learning Rate

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Computer Modeling in Engineering & Sciences 2025年第1期142卷 155-183页

作者： Suganya Athisayamani A.Robert Singh Gyanendra Prasad Joshi Woong Cho School of Computing Sastra Deemed to be UniversityThanjavur613401India department of Computational Intelligence SRM Institute of Science and TechnologyKattankulathur603203India department of AI and Software Engineering Kangwon National UniversitySamcheok25913Republic of Korea department of Electronics Information and Communication EngineeringKangwon National UniversitySamcheok25913Republic of Korea

In radiology,magnetic resonance imaging(MRI)is an essential diagnostic tool that provides detailed images of a patient’s anatomical and physiological *** is particularly effective for detecting soft tissue ***,radiologists manually interpret these images,which can be labor-intensive and time-consuming due to the vast amount of *** address this challenge,machine learning,and deep learning approaches can be utilized to improve the accuracy and efficiency of anomaly detection in MRI *** manuscript presents the use of the Deep AlexNet50 model for MRI classification with discriminative learning *** are three stages for learning;in the first stage,the whole dataset is used to learn the *** the second stage,some layers of AlexNet50 are frozen with an augmented dataset,and in the third stage,AlexNet50 with an augmented dataset with the augmented *** method used three publicly available MRI classification datasets:Harvard whole brain atlas(HWBA-dataset),the School of Biomedical Engineering of Southern Medical University(SMU-dataset),and The National Institute of Neuroscience and Hospitals brain MRI dataset(NINS-dataset)for *** hyperparameter optimizers like Adam,stochastic gradient descent(SGD),Root mean square propagation(RMS prop),Adamax,and AdamW have been used to compare the performance of the learning ***-dataset registers maximum classification *** evaluated the performance of the proposed classification model using several quantitative metrics,achieving an average accuracy of 98%.

关键词： MRI tumors classification AlexNet50 transfer learning hyperparameter tuning optimizer

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Effectiveness of the Suprainguinal Ultrasound-Guided Block for the Management of Postoperative Pain after Application of a Total Hip Prosthesis

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Open Journal of Anesthesiology 2021年第10期11卷 306-315页

作者： Joseph Donamou Abdoulaye Touré Amadou Yalla Camara Bangoura Almamy Camara M’Mah Lamine Camara Mariama Mohamed Diallo Thierno Sadou Drame Boubacar Atigou Touré Aboubacar anesthesia-intensive Care Unit Donka National Hospital Conakry Guinea anesthesia-intensive Care Unit National Ignace Deen Hospital Conakry Guinea General and Visceral Surgery department Ignace Deen National Hospital Conakry Guinea

Objective: To assess the effectiveness of ultrasound-guided supraginguinal block (SIB) in the management of pain after total hip replacement. Material and Methods: This was a prospective, randomized, single-blind controlled study carried out in the anesthesia-intensive care unit of the Donka National Hospital in Conakry, over a period of 06 months (01/01/2020 to 30/06/2020). It concerned 32 patients: 16 patients in the “ultrasound-guided SIB” group and 16 patients in the “standard analgesia” group. Results: The pain scores assessed by the simple verbal scale and collected at the different time intervals (6H, 12H, 24H, 36H, 48H) showed mean scores 3 in the standard analgesia group (P Conclusion: Our study demonstrated that echo-guided SIB provided better analgesia compared to standard analgesia for the management of postoperative pain after total hip replacement.

关键词： Ultrasound-Guided Suprainguinal Block Total Hip Replacement Postoperative Pain Conakry

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