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Biomedical subjects

E Gaertner

Publications and source records attributed to E Gaertner.

At least 19 recordsLinked to original sources
PubMed2006

[Assessment of patient satisfaction after regional anaesthesia in two institutions].

OBJECTIVES: This study was designed to assess patient satisfaction after regional anaesthesia for limb surgery. METHODS: An anaesthesia satisfaction questionnaire was developed, validated (Kappa coefficient) and submitted to 314 patients operated in two institutions (one university hospital with anaesthesiology residents and one specialised in orthopaedics with experienced anaesthesiologists). Items explored were information modalities, pain and anxiety during procedure and global satisfaction rated with four levels (very satisfied [VS], satisfied [S], partially satisfied [PS], non-satisfied [NS]). Patients were interviewed by telephone at postoperative D1 and D8 by a pharmacist student not involved in the patient's care. RESULTS: Inspite of a high level of patient satisfaction at D8 (VS: 50%, S: 44%), some interesting aspects should be emphasised: a) sedation given before nerve block was not efficient to reduce anxiety and pain during procedure; b) VS levels decreased from D1 (56%) to D8 (50%) mainly because of late postoperative pain (after discharge) and discomforts; c) willingness to undergo the same nerve block again (294/314) was not correlated with patient's satisfaction since among PS and NS patients, a majority (9/15) wished for a block in case of renewed limb surgery; d) multivariate analysis showed that VS level was highly correlated with the quality of communication by the anaesthesiologist mainly for informations about pre and postoperative periods. No correlation was found with pain level during procedure; e) satisfaction levels were not different in the two institutions. CONCLUSION: This study has emphasised some important factors of patient satisfaction which were not sufficiently taken into account in our daily practice.

Adolescent↗
PubMed2003

[Continuous lumbar plexus block sets in France. Our experience].

The undeniable postoperative analgesia brought by the lumbar plexus block among patients scheduled for major surgery of the hip or knee justifies, the setting of a catheter to allow a continues analgesia more durable. Having drawn aside the difficulties of the daily practice (in allusion to the number of blocks carried out per day) and anatomical variations, the failure of the perineural catheter setting is in direct relationship with the material used by the anaesthesiologists for neurostimulation. The presentation of a case report describes a failure of catheter introduction due to the canula in deep continuous blocks, and the advantages and disadvantages of the various sets of neurostimulation. The authors conclude that the sets with the "catheter through the needle" are to be recommended, particularly the stimulating Tuohy needle.

Aged↗
PubMed2001

Continuous post-operative regional analgesia at home.

OBJECTIVE: Describe early discharge of patients treated with continuous perineural analgesia after orthopaedic surgery. METHODS: A prospective and descriptive study including 56 patients undergoing multiple orthopaedic procedures, who had received oral and written information and given informed consent. Literature on the topic was reviewed, a preliminary study performanced and home nurses were trained. The following blocks were performed: interscalene block (ISKT), infraclavicular block (ICKT), posterior popliteal sciatic block (PPKT) or tibial block at the ankle (TKT). The analgesic catheter (KT) was inserted pre-operatively with nerve stimulation technique. Blockade was induced with mepivacaine and surgery performed under regional anaesthesia. Postoperatively, an elastomeric pump delivering 0.2% ropivacaine(R) at 5 ml/h (tibial blocks) and 7 ml/h (other blocks) was implemented. Analgesic efficacy and side-effects were monitored for 24 hours (patient discharge on Day+1). Pain was evaluated using visual analogical scores (VAS) (0-100) every 12 hours; rescue analgesics were prescribed (propacetamol IV). Nurses ensured patient monitoring at home. Finally, each patient was asked a satisfaction score (0-100). RESULTS: Two patients were excluded. Twenty-one tibial blocks, 24 posterior popliteal sciatic blocks, 6 infraclavicular blocks and 3 interscalene blocks were performed. No major incidents were reported. VAS showed satisfactory post-operative analgesia. Median values (max-min) were measured every morning and evening on Day+1 and Day+2. Patient satisfaction was high: 89 (70-100). Hospitalisation costs analysis showed a 46 to 27% decrease in surgery-depending costs. CONCLUSIONS: Continuous, post-operative, perineural analgesia at home is safe and effective, less expensive with high patient satisfaction.

Adolescent↗
PubMed1999

Block of the brachial plexus branches by the humeral route. A prospective study in 503 ambulatory patients. Proposal of a nerve-blocking sequence.

BACKGROUND: Brachial plexus is usually approached by the supraclavicular or axillary route. A technique for selective blockade of the branches of the plexus at the humeral canal using electrolocation has recently been proposed. The aim of the present study was to assess the feasibility of this technique in the ambulatory patient and to determine the optimal sequence of nerve-blocking. METHODS: The nerves originating from the brachial plexus were located in the humeral canal, at the junction of the proximal and the middle third of the arm, with a stimulator and blocked using either lidocaine or a mixture of lidocaine and bupivacaine, depending on the anticipated duration of surgery. The minimal stimulating intensity eliciting an adequate response, type of local anaesthetic and injected volume, and time of onset of surgical anaesthesia were collected. RESULTS: The study included 503 consecutive ambulatory patients due to undergo surgery of the elbow, wrist or hand in one year. Suitable anaesthesia was obtained with the humeral blockade in 82.1% of cases. In the remaining 17.9%, an additional block at the elbow was required, mainly for ulnar and median nerves. The onset times of sensory blocks were the longest for the median nerve, similar for the radial and ulnar nerves, shorter for the musculocutaneous nerve and the shortest for the medial brachial and antebrachial cutaneous nerves. The difference was more significant with the lidocaine-bupivacaine mixture, than with lidocaine alone (P<0.001 vs P<0.05, respectively). The onset times of motor blocks were the longest for the median nerve (P<0.05) and the shortest for the musculocutaneous nerve (P<0.001). Neither nervous nor vascular complications occurred. CONCLUSION: This study shows that the nerve block at the humeral canal is an efficient and safe technique. Considering the onset times of nerve blocks, the following sequence for blockade can be recommended: median, ulnar, radial, musculocutaneous, medial (brachial and antebrachial) cutaneous nerves. The selective blockade of the main nerves of the upper limb at the humeral canal can be recommended for surgery of the forearm and the hand in the ambulatory patient.

Adolescent↗
PubMed1998

Comparison of the footpump suction evacuator with the manual vacuum aspirator for uterine evacuation.

OBJECTIVE: To compare the efficacy of a novel footpump suction evacuator with the manual vacuum aspirator in the management of women with incomplete abortions requiring uterine evacuation. DESIGN: A prospective comparative analysis of women allocated to either manual vacuum aspiration of the uterus or footpump suction evacuation, following first- or second-trimester incomplete abortion. SETTING: The gynaecology casualty theatre, Groote Schuur Hospital, Cape Town. PATIENTS: 121 women with first- or second-trimester abortions. Patients with signs of septic abortion were excluded from the study. INTERVENTIONS: Uterine evacuation under general anaesthesia by means of a manual vacuum aspirator or a novel footpump suction evacuator. OUTCOME MEASURES: Endpoints assessed included duration of the procedures, ease of evacuation, estimated blood loss, volume of products of conception obtained, postoperative complications of the procedures and amount of analgesia required postoperatively. RESULTS: The manual vacuum aspirator and footpump suction evacuator appeared equally effective for uterine evacuation. There were no significant differences in the endpoints assessed. CONCLUSIONS: Both methods appear equally effective for uterine evacuation.

Abortion, Incomplete↗
PubMed1997

Leukemic thyroiditis as the initial relapsing sign in a patient with acute lymphocytic leukemia and blast expression of the neural cell adhesion molecule.

We report a patient with a history of T-cell ALL in remission who presented with symptoms and laboratory values consistent with subacute thyroiditis but was found to have leukemic thyroiditis as the first clinical manifestation of leukemic relapse. Bone marrow examination at this time demonstrated recurrent ALL. After successful re-induction with chemotherapy and an allogeneic bone marrow transplant this patient developed an isolated recurrence of her ALL manifested by symptomatic thyromegaly and a new mediastinal mass that was treated with irradiation. Despite no medullary recurrence of ALL, the patient developed pleuritic chest pain and shortness of breath and succumbed to pericardial extramedullary leukemia 9 months later. This to our knowledge is the third reported case of symptomatic ALL involvement of the thyroid gland and the first to be confirmed histologically. Furthermore, this patient had blast expression of the neural cell adhesion molecule (CD56), a cell surface marker that has not been studied in ALL but has previously been identified as a risk factor for extramedullary leukemia (EML) in acute non-lymphocytic leukemia. The authors hypothesize that CD56 expression in this patient might have contributed to her predisposition to EML.

Adult↗
PubMed1996

Biphasic synovial sarcomas arising in the pleural cavity. A clinicopathologic study of five cases.

Five cases of primary synovial sarcoma of the pleura are presented with a discussion of differentiation from other biphasic malignant neoplasms, most notably malignant mesothelioma. The cases have clinical, histologic, and immunohistochemical features consistent with synovial sarcoma of soft tissue. The average age at initial presentation of the reported patients was 25 years with an approximate range of 9 to 50 years. A large pleural-based intrathoracic mass was identified in each case. Histologic analysis showed a biphasic (mixed) pattern composed of epithelial and spindle cells. The epithelial cells showed cleft-like to tubulopapillary growth with focal intraluminal periodic acid Schiff's (PAS)-positive, diastase-resistant secretions identified in four of the five cases. The spindle cell component was composed predominantly of densely packed, elongated, fusiform cells. Immunohistochemical staining showed positivity with antibodies against cytokeratin, BER.EP4, epithelial membrane antigen, and vimentin in all cases. The patients seem to have an aggressive course, with four deaths reported within 3 years from initial surgery. These cases represent the first reported cases of primary synovial sarcoma of the pleura and lend further credence to the theory that synovial sarcomas are derived from immature mesenchymal elements, not from synovium.

Adolescent↗
PubMed1995

[Interscalenic block: accidental catheterization of the epidural space].

A case is reported of inadvertent insertion of a brachial plexus catheter into the cervical epidural space, at the sitting of an interscalene block for postoperative analgesia, during the recovery from general anaesthesia after surgical repair of a rupture of the rotator cuff of the shoulder. No features of cervical epidural anaesthesia were seen after the first injection of local anaesthetic, as it was made through the catheter insertion cannula. Once inserted, the catheter position was checked prior to the second injection of local anaesthetic. The X-ray obtained after catheter opacification showed the penetration of contrast medium into the epidural space. In our case, two out of the three means of prevention of this complication were not possible: a) sitting of the interscalene block before induction of anaesthesia, as the insertion conditions of the catheter are better in a conscious, sitting patient; b) adequate cannula orientation (namely medial, dorsal and slightly caudal); c) routine X-ray control of the catheter position before the first injection, associated with careful clinical monitoring for 30 min after each local anaesthetic injection.

Brachial Plexus↗
PubMed1995

[Fat embolism still exists. A retrospective study of 17 cases in a surgical intensive care unit].

Fat embolism is a severe complication in patients with femoral fractures. This retrospective study records 17 cases of post traumatic fat embolism diagnosed between 1979 and 1993 among 430 patients admitted for femoral fractures (incidence: 2.7%). These cases underline the high frequency of early hypovolaemia (10/17), of respiratory and cerebral disorders (15/17), all occurring during the first post trauma week. Three cases were observed in the postoperative period. Severity of fat embolism is proved by three deaths and a mean mechanical ventilation period of 13 days. With early osteosynthesis, incidence of fat embolism could be lowered to 0.2%. Prevention is based on osteosynthesis, avoidance of hypovolemia and of hypoalbuminemia.

Critical Care↗
PubMed1994

[Multiple trauma in the elderly].

Morbidity and mortality following multiple trauma are high in elderly patients. Head trauma has a particularly poor prognosis. However intensive care may improve the survival rate and the quality of life in survivors, allowing those to return home.

Age Factors↗
PubMed1986

[Expiratory blockage of a Monnal S respirator caused by rupture of the capsule of a pneumatic Bennett valve].

In the recovery room, a ventilated patient suddenly developed bradycardia and severe cardiovascular collapse due to increased airway pressure. The cause of this life-threatening complication was continuous occlusion of the expiratory valve by a ruptured diaphragm in a Bennett's valve. When the rupture is located within the circular contact area with the expiratory port, the valve occludes normally during insufflation. On expiration, the expiratory gas under pressure penetrates the ruptured capsule, maintaining the valve occluded. A small part of the expired gas escapes through the small-bore connecting tube of the diaphragm.

Equipment Failure↗
PubMed1975

Phenylalanyl-tRNA synthetase from baker's yeast: role of 3'-terminal adenosine of tRNA-Phe in enzyme-substrate interaction studied with 3'-modified tRNA-Phe species.

TRNA-Phe species from baker's yeast modified at the 3'-terminus in many cases are phenylalanylatable substrates. Out of several tRNA-Phe species possessing a modified 3'-end that cannot be phenylalanylated, only two, tRNA-Phe-C-C-2'dA and the tRNA-Phe-C-C-formycin-oxi-red, are strong competitive inhibitors for tRNA-Phe-C-C-A during phenylalanylation. In the ATP/PPi exchange, both these inhibitors reduce Vmax to about 25%; but whereas tRNA-Phe-C-C-2dA has no influence on KmATP and Km Phe during ATP/PPi exchange, tRNA-Phe-C-C-formycin-oxi-red reduces KmATP from 1430 muM, found in the absence of tRNA-Phe, to 230 muM, and Km-Phe, from 38 to 14 muM. The values found in the presence of tRNA-Phe-C-C-formycin-oxi-red during ATP/PPi exchange are identical with those determined in the phenylalanylation of tRNA-Phe-C-C-A. All other tRNA-Phe species carrying a modified 3'end that cannot be phenylalanylated exhibit a mixed competitive-noncompetitive inhibition in the phenylalanylation reaction. In the ATP/PPi exchange, they do not influence KmATP and KmPHE and only weakly, if at all, Vmax. The results show that the 3'adenosine of tRNA-Phe cannot solely be a passive acceptor for phenylalanine, but must in addition play an active role during enzyme-substrate interaction. The data can be consistently explained by the hypothesis that the 3'-adenosine of tRNA-Phe triggers a conformational change of the enzyme.

Adenosine↗