Objective
The primary goal of this study was to determine the prevalence of peripheral spondyloarthritis (pSpA) in patients with ultrasonography (USG)‐confirmed enthesitis. The secondary aim of the ...study was to reveal the demographic, clinical, and ultrasonographic differences of patients diagnosed with pSpA.
Methods
Fifty‐nine patients with USG‐confirmed enthesitis were evaluated by a rheumatologist to evaluate if they met the Assessment of SpondyloArthritis International Society (ASAS) criteria for pSpA. Elementary lesions assessed by USG were based on the definition of the Outcome Measures in Rheumatology in Clinical Trials group which included hypoechogenicity, thickening, Doppler signal within 2 mm of bone, enthesophytes, bone erosions, and calcifications. For all patients, clinical and demographic data included: age, gender, smoking habits, body mass index, comorbid diseases, symptom duration, enthesitis region, the presence of bilateral enthesitis, entheseal pain visual analog scale (0‐10), standardized enthesitis count following Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) and SPondyloArthritis Research Consortium Canada (SPARCC) enthesitis index.
Results
Eight (13.6%, 95% CI 6.0% to 25.0%) of 59 patients were diagnosed with pSpA according to the ASAS classification criteria. Participants diagnosed with pSpA had a longer duration of symptoms (54 vs 12 months), were more likely to present bilateral enthesitis (87.5% vs 49%) with higher SPARCC (11 vs 3) and MASES (6.5 vs 2) scores and higher C‐reactive protein (7 vs 3.2 mg/L) concentrations. Entheseal Doppler signal and hypoechogenicity were also more frequently observed (50% vs 0% and 100% vs 49% respectively).
Conclusion
Peripheral SpA is not uncommon among patients presenting with enthesitis and more likely in cases with prolonged, extensive, and bilateral enthesitis with entheseal hypoechogenicity and Doppler signal. Musculoskeletal ultrasonography can facilitate the diagnosis of pSpA in patients presenting with enthesitis.
In this paper we give two characterizations of the Poletsky–Stessin–Hardy spaces in the complex plane: First we completely describe functions in these spaces by having a harmonic majorant with a ...certain growth condition and we prove some basic results about these spaces. Second we describe these functions in terms of their boundary values as a weighted subclass of the usual
L
p
class with respect to the arclength measure on the boundary, when the boundary is
C
2
. In particular, we extend the classical result of Beurling which describes the invariant subspaces of the shift operator. Additionally we provide non-trivial examples.
Background and objective: This prospective, randomized trial was designed to test the hypothesis that continuous infusion of low‐dose remifentanil can provide effective analgesia, sedation, amnesia, ...patient comfort and stable recovery profile without respiratory depression when compared with propofol infusion during colonoscopy.
Methods: One hundred patients were randomly assigned to receive either remifentanil (group R, 0.5 μg/kg followed by 0.05 μg/kg/min, n= 50) or propofol (group P, 0.5 mg/kg followed by 50 μg/kg/min, n= 50). Supplemental doses of remifentanil 12.5 μg in group R and propofol 10 mg in group P were given to treat complaints of moderate to severe pain and discomfort. Hemodynamic and respiratory data, pain, discomfort and sedation scores, patient and gastroenterologist satisfaction and recovery profiles were recorded.
Results: The duration of colonoscopy was longer in group P. The mean arterial pressure, heart rate and end‐tidal CO2 remained stable during the procedure and were comparable between the groups. After bolus injection of the study drugs, the respiratory rate and oxygen saturation values were lower in group R than in group P. Only one patient in group R required airway support. Pain and discomfort scores were better in group R than in group P. Sedation levels were higher in group P than in group R. Group P needed more supplemental doses than group R. The time to reach an Aldrete score of nine or more was shorter in group R, but discharge times were similar in the two groups. Amnesia was better in group P. Nausea and vomiting were more frequent in group R during the recovery phase.
Conclusion: Low‐dose remifentanil infusion with intermittent bolus injections can provide adequate sedation, amnesia and better analgesia than propofol infusion during colonoscopy. However, remifentanil‐induced nausea and vomiting may be a problem during the recovery phase.
Inguinal herniorrhaphy (IH) is a common surgical procedure that can be successfully performed by using general, regional or local anesthesia and is usually performed in an outpatient setting. In this ...study, recovery profile, incidence of adverse effects, postoperative pain scores and patient satisfaction between paravertebral block (PVB) and spinal anesthesia (SA) for fast track ambulatory IH were compared.
Sixty patients were randomly assigned to receive either PVB or unilateral SA under standardized protocols (PVB at T9-L1 levels with 5 mL of 0.5 % levobupivacaine for each, unilateral SA at L2-L3 level with 8 mg 0.5% hyperbaric levobupivacaine). All patients were sedated with propofol, 10-70 mg.kg.min. Data on anesthesia, surgery and PACU times, hemodynamic changes, home readiness, pain, and incidence of adverse effects were recorded.
One block failed in the PVB group. Anesthesia-related time and onset time were longer in the PVB group, but phase 1 PACU time, time to home-readiness with and without voiding and actual discharge time were significantly shorter in the PVB group. Although the fast-tracking rate was higher in the PVB group, this difference was not significant. The mean propofol dose was higher in the PVB group (52.03+/-19.32 35-73 mg x kg x min-1) than in the SA group (44.0+/-18.8 33-70 mg x kg x min-1) (P=0.002). VAS scores at 4, 6 and 12 hours were significantly lower in the PVB group, both at rest and during movement. VAS scores at 30, 60, 120, 180 min and at 18, 24 and 48 hours were comparable in the two groups. Duration of sensory block, onset time of discomfort, time to first analgesic, and time to first rescue analgesic were longer in the PVB group.
In ambulatory IH, PVB provided shorter home readiness time, long lasting postoperative analgesia and improved quality of recovery, and could be a good alternative to SA.
Background and objective: Propofol may decrease seizure duration in electroconvulsive therapy. Although not proven, prolonged seizures may be more efficacious. The goal of this study was to evaluate ...and compare effects of alfentanil and remifentanil on seizure duration, recovery parameters and degree of stimulus amplitude in patients undergoing electroconvulsive therapy.
Methods: Twenty‐four ASA I–II patients enrolled in this prospective, randomized trial, each receiving a total of seven electroconvulsive therapies. Patients were randomized to receive only Propofol, group P (0.75 mg kg−1, n = 8), Propofol with alfentanil, group A (10 µg kg−1 alfentanil + 0.5 mg kg−1 Propofol, n = 8) and Propofol with remifentanil, group R (1 µg kg−1 remifentanil +0.5 mg kg−1 propofol, n = 8) via an iv route. Supplemental doses of propofol were given as required to achieve loss of consciousness. Succinylcholine 0.5 mg kg−1 iv was given to all groups for muscular paralysis. We recorded hemodynamic parameters, cortical and motor seizure durations, and recovery parameters.
Results: Mean motor seizure duration was found to be significantly longer in patients receiving propofol‐remifentanil anesthesia (53.3 ± 13.6 s) and propofol‐alfentanil anesthesia (52.2 ± 0.4 s) compared with propofol anesthesia (37.6 ± 9.2 s) (P = 0.001). Recovery parameters and stimulus amplitudes were similar in groups A and R; significantly different from group P (P = 0.001).
Conclusions: Adding 10 µg kg−1 alfentanil or 1 µg kg−1 remifentanil to reduced doses of propofol provided unconsciousness and increased seizure durations. For patients who need higher stimulus amplitudes for longer seizure durations, combining low‐dose propofol with alfentanil or remifentanil may be good alternative regimens for ECT.
In this study, we determined the effects of transcranial electrical stimulation (TCES) on the anaesthetic requirements of thiopental and the analgesic requirements of remifentanil, in rats. The ...experiments were performed on 120 albino male Wistar rats, which were randomly allocated to four groups (n=30). (Thiopental, Thiopental+TCES, Thiopental+Remifentanil, and Thiopental+Remifenta-nil+TCES). Animals were anaesthetized with thiopental, and 15 min later, remifentanil was injected to rats in the Remifentanil groups. TCES was started in the stimulated groups 20 min after thiopental administration. Rats were stimulated 5 times for this experiment. The times for recovery, herein called Cognition Recovery Time and Motion Recovery Time were measured. Cognition Recovery and Motion Recovery Times were not affected by the stimulation. Analgesia was assessed using the wet tail-flick latency (TFL). In the Thiopental group, the analgesia level returned to control values on the 35th min. In the Thiopental+Remifentanil group, me analgesia level returned to control values on me 50th min. In the Thiopental+ TCES group, the analgesia level reached the peak value on the 65th min. In the Thiopental+Remifentanil+TCES group, the analgesia level reached the peak value on the 35th min and analgesia remained high during me 90 min after cessation of the stimulation. The analgesic potency for the Thiopental+Remifentanil+TCES group was increased by 30-40% when compared with the prior TFL values, 160% when compared with the control group, and 50-75% when compared with Thiopental+ TCES group on me 35th min (P<0.001). In conclusion, TCES markedly decreases the anaesthetic and analgesic requirements for thiopental and remifentanil in rats. key words: remifentanil, thiopental, transcranial electrical stimulation.
Purpose
Outpatient inguinal herniorrhaphy (IH) can be successfully performed under general, regional, or local anesthesia. In this study recovery profile, postoperative pain scores, incidence of ...adverse effects, and patient and surgeon satisfaction were compared between paravertebral block (PVB) and fast-track general anesthesia (GA) via laryngeal mask airway (LMA) for outpatient IH.
Methods
Sixty patients were randomly assigned to receive either PVB or GA under standardized protocols (group PVB: at T
9
–L
1
levels, 5 mL of 0.5% levobupivacaine for both procedures, and continuous propofol sedation; group GA: GA with 2 mg kg
−1
propofol induction and 2–4% desflurane maintenance via LMA, and routine antiemetic prophylaxis and multimodal analgesic treatment). Anesthesia-related, onset, recovery, and home discharge times, hemodynamic changes, pain, and incidence of adverse effects were compared.
Results
Anesthesia-related time and onset time were longer, but recovery and home discharge times were shorter in group PVB. Verbal rating scores (VRS) at 30, 60, 120, and 180 min and 6, and 12 h post-surgery were significantly lower in group PVB patients. VRS at 18, 24, and 48 h were comparable in both groups. No patient in group PVB and eight patients in group GA needed meperidine in the post-anesthesia care unit, and time to first analgesic and first rescue analgesic requirements were significantly longer in group PVB.
Conclusion
In outpatient IH, PVB with 0.5% levobupivacaine provided improved recovery, long-lasting analgesia, shorter recovery room stays, and earlier home readiness time than fast-track GA via LMA.
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