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Rehabilitation after Trauma
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
Muscle contractures can be prevented with a combination of regular stretching programmes, splinting and intramuscular botulinum toxin injections. These measures reduce the requirements for tendon-lengthening surgery and will continue for many years. Further denervation with phenol injections is rarely used as the effect is irreversible.
Chronic Pancreatitis: Small Duct Disease with Uncontrolled Pain
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Michael F. Nentwich, Jakob R. Izbicki
Surgical procedures can be divided in both drainage or resection procedures, combination procedures, and denervation procedures. Thereby, the aim of surgery is to achieve a good drainage of the ductal system including the side ducts, to remove an inflammatory (or potentially malignant mass) and to preserve a maximum of pancreatic functionality. A larger number of procedures for drainage, resection, drainage, and resection, as well as for denervation exist (Table 38.1) and are beyond the scope of this chapter to be described in detail. Reference [2] gives a good figured overview on these techniques.
Free Transplantation of Striated Muscle
Published in Han C. Kuijpers, Colorectal Physiology: Fecal Incontinence, 2019
Two to 3 weeks after denervation, transplantation is made. Two days prior to surgery, the patient is put on a low-bulk diet. The colon is emptied with three water enemas during these 2 d. No antibiotics are used.
Anatomic surface landmarks to guide injection for posterior interosseous nerve block
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Swapnil D. Kachare, Bradley J. Vivace, Luke T. Meredith, Milind D. Kachare, Christina N. Kapsalis, Michael Ablavsky, Rachel H. Safeek, Claude Muresan, Joshua H. Choo, Morton L. Kasdan, Bradon J. Wilhelmi
Vital to establishing the potential usefulness of denervation is a diagnostic injection of local anesthetic. It is paramount the injection be accurate to provide adequate blockade of the PIN, or a false negative result may preclude patients from a beneficial procedure, as Wilhelm originally listed non-remediation of pain with injection as a contraindication to denervation [3]. Grutter et al. described a technique delivering a large amount of methylene blue to the PIN with 100% accuracy with injecting 1 cm ulnar to the proximal aspect of Lister’s tubercle [6]. Given patients come in varying shapes and sizes, the goal of this study is to standardize the use of Lister’s tubercle to locate the PIN based on individual anthropometry to ensure accuracy and safety with injecting local anesthetic.
Cardiac arrhythmias in pregnant women: need for mother and offspring protection
Published in Current Medical Research and Opinion, 2020
Theodora A. Manolis, Antonis A. Manolis, Evdoxia J. Apostolopoulos, Despoina Papatheou, Helen Melita, Antonis S. Manolis
CPVT is a rare inherited cardiac arrhythmia caused by an imbalance in the homeostasis of intracellular calcium, and characterized by catecholamine-sensitive polymorphic VT, which can present with palpitations and/or syncope and can lead to SCD83. Patients with CPVT typically have a normal resting ECG and a structurally normal heart. Polymorphic VT is triggered by exertion or emotional stress. CPVT is caused by mutations in the cardiac ryanodine receptor (RyR2) gene, responsible for the autosomal dominant form, or in the sarcoplasmic reticulum protein calsequestrin 2 gene (CASQ2), responsible for the recessive form. Beta blockers remain the cornerstone of therapy in these patients, aided by flecainide, which has an adjunctive role in those not responding to beta blocker84. Implantation of a defibrillator and/or cardiac sympathetic denervation might also be alternative therapeutic options in certain cases.
Unaltered neurocardiovascular reactions to mental stress after renal sympathetic denervation
Published in Clinical and Experimental Hypertension, 2020
Sebastian Völz, Linda C. Lundblad, Bert Andersson, Jonas Multing, Bengt Rundqvist, Mikael Elam
Limitations: 1) The study´s sample size is small and includes a few patients with co-morbidities that could affect primarily resting levels of MSNA. However, we did not note any numerical trends regarding MS-induced changes in MSNA, BP or HR in the group, nor between RDN-BP-responders vs non-responders. 2) Our mixed gender sample could be considered a confounder. MSNA changes during mental stress are similar in young men vs women, whereas BP increases more in men (40). However, the relationship between MSNA and blood pressure changes in older women, leaving little remaining gender difference (41). All the women in our study group were postmenopausal. 3) We used four different types of denervation devices with potentially different impact on renal nerve fibers. However, available study results suggest similar BP results with all applied denervation systems (42). 4) We did consider adding a cold pressor test, a stress procedure which in our experience generates a more consistent MSNA response (augmentation). However, this was deemed to strenuous for our participating patients who had already been subject to numerous procedures during the course of the study. 5) Concomitant medication is potentially a confounding factor in the assessment of MSNA, BP, and HR. We noted merely minor medication changes at follow-up and an impact on the study results was deemed unlikely.