Factors associated with age and gender may contribute to PSPS exacerbations. In particular, females younger than 70 years of age may be more likely to experience these pains.2,4,5 However, according to a large retrospective multicenter survey, older patients are more prone to this syndrome, indicating controversy regarding the effects of age.9 Other contributing factors are reported to include large waist circumference or obesity, smoking history, and preoperative depression or anxiety.5,10
No patient had isolated osseous metastasis at the time of diagnosis, and none developed isolated bone metastasis without other organ involvement during our survey period. It took significantly longer for colorectal cancer patients to develop metastasis to the lungs (23.3 months) or to bone (21.2 months) than to the liver (9.8 months). Conclusion: Metastasis only to bone without other organ involvement in colorectal cancer patients is extremely rare, perhaps more rare than we previously thought. Our findings suggest that resistant metastasis to the lungs predicts potential disease progression to bone in the colorectal cancer population better than liver metastasis does.
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We included all 252 individuals when we determined organ involvement. However, when calculating the time and sequence of metastatic spread, we found that 21 of the 252 patients had presented solely for initial staging and excluded them from that analysis. The 231 individuals had a known date of initial diagnosis and the time of new metastasis noted in the serial imaging reports during the investigation. Of the 102 patients with organ metastasis, 71 patients received further chemotherapy; 12 patients received combined chemotherapy and surgery; 16 patients received combined chemotherapy and radiation therapy; 2 patients received surgery only; and 5 patients received no therapy. The status of treatment for 5 patients after metastasis was uncertain. Nineteen patients developed new organ metastasis only at the end of our survey periods. Time to development of metastatic disease was defined as time from initial diagnosis to the appearance of metastasis in imaging studies.
This study sought to identify whether disease progression to the lungs could predict metastasis to bone. Although lung lesions are of particular interest as a forerunner of future bone metastasis as evidenced by the short time span from lung metastasis to bone involvement, the lesions in bone always appear after metastasis to liver, lung, or (in a large percentage) both. As the average 5-year survival rate of colon cancer patients with metastasis to bone continues to be 8.1% [9], and on average, 67% of those who developed bone involvement during this survey were dead 16 months after detection of bone metastasis, the importance of recognizing disease progression and potential significance of bone metastasis cannot be overemphasized.
Conclusion Vehicle incidents accounted for around one third of trauma team activations and made up a sizeable amount of work in the emergency department including CT scans as part of the primary survey. Fewer patients required urgent surgery and critical care admission than expected and almost 2/5 were discharged on the day of admission. This information is useful in planning services as often members of the trauma team have additional roles in the organisation.
The trauma Tertiary Survey Examination (TSE) is crucial for identification of injuries otherwise missed on primary and secondary surveys and improves outcomes for trauma patients [1]. Advanced Trauma Life Support (ATLS) guidelines recommend TSE within 24-48 hours of hospital admission to include a complete head-to-toe examination with re-evaluation of previous imaging [2]. We conducted an audit of TSE of trauma patients at a Major Trauma Centre to assess whether they meet the ATLS standards and how this changed after implementing a dedicated TSE proforma.
1. Biffl, W. L., Harrington, D. T., & Cioffi, W. G. Implementation of a tertiary trauma survey decreases missed injuries. The Journal of Trauma, Injury, Infection, and Critical Care. 2003; 54(1), 38-44.
36 student responses were analysed; all had completed at-least one year of medical school. 58% of respondents said they had moderate to extensive exposure to acutely unwell patients, with only 31% saying the same for patients with traumatic injuries. Similarly, while 30% respondents were confident or extremely confident in performing ABCDE assessments on medical patients, only 14% felt the same about performing a trauma primary survey.
33 patients had severe TBI, those in cardiac arrest without evidence of return of spontaneous circulation (ROSC) were excluded. 12 (36%) cases of hypotension and/or hypoxia were identified. Of these, 4 (33%) occurred during HEMS primary survey only, the other 8 (64%) occurred subsequent to this whilst under HEMS care. 21/33 (64%) received PHEA. Post PHEA hypotension and hypoxia rates were 15% and 5% respectively. The mean change in sBP following RSI was -15mmHg. sBP reduction post PHEA was most marked in polytrauma patients and the elderly.
We investigated the first 20 cases of prehospital blood product administration by EHAAT using retrospective analysis of the HemsBASE 2.0 database. We conducted a survey of EHAAT clinical staff to review experiences of blood product administration and reviewed the EHAAT standard operating procedure for blood product administration.
British Thoracic Society (BTS) has recommended the triangle of safety as the site for insertion for intercostal drain [8]. This area is bordered by the anterior border of the latissimus dorsi, the lateral border of the pectoralis major muscle, a line superior to the horizontal level of the nipple, and an apex below the axilla (Figure 2). A survey of junior residents on the anatomical landmarks when inserting an intercostal drain revealed that 45% were placed outside the safe area of chest drain insertion with the most common error (20%) being a choice of insertion too low [9].
Areas of concern regarding the use of regional anesthesia in patients with HSV-2 include the risk of introducing the virus into the CNS during administration of neuraxial anesthesia; the possibility that a disseminated infection that develops after a regional anesthetic might be ascribed to the anesthetic itself, despite the lack of a causal relationship; and the safety of neuraxial techniques in primary HSV-2 outbreaks, which may be silent and difficult to distinguish from secondary outbreaks, but more commonly present with viremia, constitutional symptoms, genital lesions, and, in a small percentage of patients, aseptic meningitis. There are no documented cases of septic or neurologic complications following neuraxial procedures in patients with secondary (ie, recurrent) HSV infection; however, the safety of regional anesthesia in patients with primary infection has not been established. Crosby and colleagues conducted a 6-year retrospective analysis of 89 patients with secondary HSV infection who received epidural anesthesia for cesarean delivery and reported that no patients suffered septic or neurologic complications.Similarly, in their retrospective survey of 164 parturients with secondary HSV infection who received spinal, epidural, or GA for cesarean delivery, Bader et al reported no adverse outcomes related to the anesthetic. Based on the findings in these and other reported series, it appears safe to use spinal or epidural anesthesia in patients with secondary HSV infection. Pending more conclusive data, however, it seems prudent to avoid neuraxial block in patients with HSV-2 viremia. Concerns also exist regarding the use of regional anesthesia in adults with either primary or recurrent VZV infections, such as herpes zoster (ie, shingles) and postherpetic neuralgia (PHN). However, neuraxial procedures, including epidural steroid injections, are not uncommonly used to treat acute herpes zoster, prevent PHN, and treat the pain associated with PHN, often in conjunction with antiviral therapy. The presence of active lesions at the site of injection is considered a contraindication to these and other neuraxial techniques. For the small subset of patients who are infected with primary VZV as adults, severe complications such as aseptic meningitis, encephalitis, and varicella pneumonia may result. The performance of regional anesthesia in this setting is more controversial but may be preferable to GA in some cases, primarily due to concerns for pneumonia. Ultimately, a careful risk-benefit analysis, in addition to assessment and documentation of any preexisting neurologic deficits, is recommended prior to initiation of neuraxial block in these patients.Localized skin infection at the site of intended needle puncture is another relative contraindication to neuraxial block, primarily due to concerns that spinal epidural abscess (SEA) or meningitis may result. Hematogenous spread of a localized infection has been implicated in SEA, although a causal relationship is not clearly established in the reported cases. Maintenance of strict sterile precautions and a low index of suspicion in the presence of neurologic signs may minimize the risk. Needle insertion should be attempted after appropriate antibiotic administration, and a site remote from the localized infection is recommended.
Monday afternoon, Monmouth University released a survey showing three different turnout models. Under a standard midterm turnout similar to 2014, Moore would lead, 48%-44%. A higher turnout, more similar to a presidential year, would yield a lead for Jones. And a turnout model based on the midterm election last month in Virginia showed the two candidates tied, with 6% still undecided, they found.
In the past, the available evidence did not suggest that unhealthy weight loss methods and eating disordered behaviors are common in India as proven by stagnant rates of clinically diagnosed eating disorders.[162] However, it appears that rates of eating disorders in urban areas of India are increasing based on surveys from psychiatrists who were asked whether they perceived eating disorders to be a "serious clinical issue" in India.[153] 23.5% of respondents believed that rates of eating disorders were rising in Bangalore, 26.5% claimed that rates were stagnant, and 42%, the largest percentage, expressed uncertainty. It has been suggested that urbanization and socioeconomic status are associated with increased risk for body weight dissatisfaction.[153] However, due to the physical size of and diversity within India, trends may vary throughout the country.[153] 2ff7e9595c
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