Wound analgesia in a patient with hemophilia in a highly traumatic operation

Given a number of limitations on the use of perioperative analgesia in patients with hemophilia, wound analgesia may be one of the components of multimodal analgesia in this category of patients. The aim of the study was to describe the use of the wound analgesia method in a patient with hemophilia in the case of a clinical case. Materials and methods. A patient with severe hemophilia A underwent postoperative analgesia after total knee replacement (within the first 48 hours) with an extended infusion of local anesthetic (ropivacaine) into the wound. Results. During the first 8 hours, the patient received 20 mg of morphine (with the aid of a device for patient-controlled analgesia), the pain level ranged from 7 to 4 points. Further, there was a sufficient effect (NRS - 2 points), from anesthesia only with ropivacaine, using a system for anesthetizing surgical wounds. Complications and side effects were not noted. Conclusion. The clinical case demonstrates an effective and safe method of prolonged analgesia in patients with hemophilia. Considering encouraging data, further study of wound analgesia in this category of patients is necessary

Expert Statements on the Standard of Care in Critically Ill Adult Patients With Atypical Hemolytic Uremic Syndrome.

A typical hemolytic uremic syndrome (aHUS) presents similarly to thrombotic thrombocytopenic purpura (TTP) and other causes or conditions with thrombotic microangiopathy (TMA), such as disseminated intravascular coagulation or sepsis. Similarity in clinical presentation may hinder diagnosis and optimal treatment selection in the urgent setting in the ICU. However, there is currently no consensus on the diagnosis or treatment of aHUS for ICU specialists. This review aims to summarize available data on the diagnosis and treatment strategies of aHUS in the ICU to enhance the understanding of aHUS diagnosis and outcomes in patients managed in the ICU. To this end, a review of the recent literature (January 2009-March 2016) was performed to select the most relevant articles for ICU physicians. Based on the paucity of adult aHUS cases overall and within the ICU, no specific recommendations could be formally graded for the critical care setting. However, we recognize a core set of skills required by intensivists for diagnosing and managing patients with aHUS: recognizing thrombotic microangiopathies, differentiating aHUS from related conditions, recognizing involvement of other organ systems, understanding the pathophysiology of aHUS, knowing the diagnostic workup and relevant outcomes in critically ill patients with aHUS, and knowing the standard of care for patients with aHUS based on available data and guidelines. In conclusion, managing critically ill patients with aHUS requires basic skills that, in the absence of sufficient data from patients treated within the ICU, can be gleaned from an increasingly relevant literature outside the ICU. More data on critically ill patients with aHUS are needed to validate these conclusions within the ICU setting

A cytogenetic follow-up of some highly irradiated victims of the Chernobyl accident

Altres ajuts: The authors wish to thank INTAS (research grant no. 97-1152) for financial support for this workA follo w-up of 10 highly irradiated men, mostly reactor crew, from the Chernobyl accident is described. Their pre-accident medical conditions and relevant medical status approximately 10-13 y later are listed. A comparison is made between estimates of their average whole-body penetrating radiation doses derived from several biological parameters. First estimates were based on their presenting severity of prodromal sickness, early changes in blood cell counts and dicentric chromosome aberrations in lymphocytes. In three cases ESR measurements on tooth enamel were also made. Retrospective dosimetry using FISH translocations was attempted 10-13 y later. This showed good agreement for those patients with the lower earlier dose estimates, up to about 3 Gy. For the others, extending up to about 12 Gy, the translocations indicated lower values, suggesting that in these cases translocations had somewhat declined. Repeated chromosomal examinations during the follow-up period showed an expected decline in dicentric frequencies. The pattern of decline was bi-phasic with a more rapid first phase, with a half-life of ∼4 months followed by a slower decline with half-lives around 2-4 y. The rapid phase persisted for a longer time in those patients who had received the highest doses. 10-13 y later dicentric levels were still above normal background, but well below the translocation frequencies

On deconvolution methods

Several methods for solving efficiently the one-dimensional deconvolution problem are proposed. The problem is to solve the Volterra equation ku:=R t 0 k(t \Gamma s)u(s)ds = g(t); 0 ^ t ^ T. The data, g(t), are noisy. Of special practical interest is the case when the data are noisy and known at a discrete set of times. A general approach to the deconvolution problem is proposed: represent k = A(I + S), where a method for a stable inversion of A is known, S is a compact operator, and I + S is injective. This method is illustrated by examples: smooth kernels k(t), and weakly singular kernels, corresponding to Abel-type of integral equations, are considered. A recursive estimation scheme for solving deconvolution problem with noisy discrete data is justified mathematically, its convergence is proved, and error estimates are obtained for the proposed deconvolution method

Polarization-Dependent Photoinduced Surface Microgratings In Amorphous Chalcogenide Glasses

Recently, the chalcogenide glasses (ChG) have attracted much attention in the field of optical communication and integrated optics. High transparency in the infrared spectral region, low phonon energy, high nonlinear properties, and high photosensitivity at near band-gap (Eg 2.35 eV, a 1-2 x iO cm1 at 5 14 nm) are important characteristics of these glasses. In particular, the photosensitive effects, among them photodarkening and giant photoexpansion (2-5%) [1], have been extensively studied and several holographic elements, such as microlenses, diffraction and Bragg gratings, and channel waveguides have been realized in fiber, bulk, and thin film forms of these materials [2-4]. In this work, we report for the first time to our knowledge, the observation and study of the strong polarization dependent photoinduced surface relief gratings in As2S3 thin films. A model to describe the observed phenomena is also presented. © 2000 SPIE