Lethal complication after abdominal wall reduction

Obesity is a growing medical problem in Europe and the USA. Plastic surgery is increasing in popularity as a treatment option for correcting skin surplus after dieting. This is often done in private clinics, and is not without risk. In this case, the early symptoms of disproportionate pain and swelling were not followed by immediate inspection in a hospital. The patient died within 48 hours due to clostridium infection. We advocate a 24/7 postoperative care facility, and recommend a sequence of diagnostic and therapeutic measure

Negative Myoclonus Induced by Ciprofloxacin

Background:&nbsp;Negative myoclonus is characterized by a brief sudden loss of muscle activity, and can be caused by a variety of acquired factors and epilepsy syndromes.Phenomenology Shown:&nbsp;We show a clear video example of a patient with an extensive negative myoclonus that was induced by ciprofloxacin.Educational Value:&nbsp;Several neurotoxic effects have been associated with the use of ciprofloxacin, but negative myoclonus has not been reported previously.&nbsp;</p

Serum levels of bupivacaine after pre-peritoneal bolus vs. epidural bolus injection for analgesia in abdominal surgery: A safety study within a randomized controlled trial

Continuous wound infiltration (CWI) has become increasingly popular in recent years as an alternative to epidural analgesia. As catheters are not placed until the end of surgery, more intraoperative opioid analgesics might be needed. We, therefore, added a single pre-peritoneal bolus of bupivacaine at the start of laparotomy, similar to the bolus given with epidural analgesia. This was a comparative study within a randomized controlled trial (NTR4948). Patients undergoing hepato-pancreato-biliary surgery received either a pre-peritoneal bolus of 30ml bupivacaine 0.25%, or an epidural bolus of 10ml bupivacaine 0.25% at the start of laparotomy. In a subgroup of patients, we sampled blood and determined bupivacaine serum levels 20, 40, 60 and 80 minutes after bolus injection. We assumed toxicity of bupivacaine to be >1000 ng/ml. A total of 20 patients participated in this sub-study. All plasma levels measured as well as the upper limit of the predicted 99% confidence intervals per time point were well below the toxicity limit. In a mixed linear-effect model both groups did not differ statistically significant (p = 0.131). The intra-operative use of opioids was higher with CWI as compared to epidural (86 (SD 73) μg sufentanil vs. 50 (SD 32). In this exploratory study, the pre-peritoneal bolus using bupivacaine resulted in serum bupivacaine concentrations well below the commonly accepted toxic threshold. With CWI more additional analgesics are needed intraoperatively as compared to epidural analgesia, although this is compensated by a reduction in use of vasopressors with CWI. Netherlands Trial Register NTR494

Baseline characteristics of the 20 participants.

<p>Baseline characteristics of the 20 participants.</p

Mean plasma levels of bupivacaine per time point in ng/ml.

<p>Time point 1-2-3-4 are 20, 40, 60 and 80 minutes after bolus injection. The green bar is the mean, the error line the upper limit of the 99% confidence interval. Since toxicity symptoms can occur from 1000ng/ml we chose that as the upper limit of the Y-axis.[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0178917#pone.0178917.ref017" target="_blank">17</a>, <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0178917#pone.0178917.ref018" target="_blank">18</a>]</p

Value of scintigraphy for assessing delayed gastric emptying after pancreatic surgery

Delayed gastric emptying (DGE) occurs frequently after pancreatic surgery. Recently a consensus definition of DGE was introduced, and this grading system is currently widely used. The aim of this study was to compare results of gastric emptying scintigraphy with the grade of DGE after pancreatic surgery. In 44 patients undergoing exploration for a pancreatic head or periampullary tumor, 28 pancreatoduodenectomies (PDs) and 16 double-bypass procedures were performed. All patients underwent preoperative and postoperative gastric emptying scintigraphy. We investigated whether the incidence of DGE was correlated with the results of gastric emptying scintigraphy. DGE occurred in 19 (43 %) patients. Clinically relevant DGE (grades B and C) prevailed in the PD group. Median postoperative residual activity at t = 2 h (%RA120) in these groups was 36 % (no DGE), 75 % (grade A), 93 % (grade B), and 95 % (grade C). DGE grade B or C was found in 7 of 10 patients with %RA120 of ≥94 % on postoperative day (POD) 7. Postoperative %RA120 on scintigraphy is positively associated with severity of DGE. Gastric emptying scintigraphy on POD 7 can predict the severity of DGE. When postoperative gastric emptying scintigraphy shows high residual radioactivity, the likelihood of further progression to grade B or C DGE is high and warrants investigation for underlying cause