Electronic Notes in Theoretical Computer Science, 2001
... Integrating Model Information in UML Sequence Diagrams Aliki Tsiolakis1 Department of Mathema... more ... Integrating Model Information in UML Sequence Diagrams Aliki Tsiolakis1 Department of Mathematics and Computer Science Universität Bremen, Germany Abstract ... April 2001. Available at http://www.cs.tu-berlin.de/~ aliki/. [4] Object Management Group. ...
Discharging patients with a long-acting peripheral nerve block remains controversial. Concerns ab... more Discharging patients with a long-acting peripheral nerve block remains controversial. Concerns about accidental injury of the limb or surgical site because of an insensate extremity are common despite a lack of data on the subject. We report a study examining the efficacy and complications of discharge after long-acting block. This prospective study included 1791 patients receiving an upper or lower extremity nerve block with 0.5% ropivacaine and discharged the day of surgery. Efficacy (conversion to general anesthesia and opioid use), persistent motor or sensory weakness, complications, satisfaction, and unscheduled health care visits were assessed in the postanesthesia care unit (PACU) and at 24 h and 7 days postoperatively using a detailed questionnaire. There were 2382 blocks placed: 1119 upper extremity blocks and 1263 lower extremity blocks. Efficacy was demonstrated by a small conversion to general anesthesia (1%-6%) and a lack of patients requiring opioids in the PACU (89%-92%). A large percentage of patients continued to use opioids at 7 days (17%-22%). Despite the requirement for opioids, satisfaction with the anesthesia experience was high at 24 h and 7 days (Liekert scale [1-5] mean at 24 h, 4.88 +/- 0.44; mean at 7 days, 4.77 +/- 0.69) and most (98%) would choose the same anesthetic again. Thirty-seven patients (1.6%) were identified with symptoms or complaints at 7 days. After review, 6 of them (0.25%) had a persistent paresthesia that may have been related to the block or discharge. We conclude that long-acting peripheral nerve blockade may be safely used in the ambulatory setting with a high degree of efficacy, safety, and satisfaction. This technique is associated with an infrequent incidence of neurologic complications and injuries. Given the frequent incidence of persistent pain at 7 days, prolongation of the analgesia would be beneficial. This study demonstrates that long-acting peripheral nerve blockade may be safely used in the ambulatory setting with a high degree of efficacy and satisfaction. This technique is associated with an infrequent incidence of neurologic complications and injuries despite discharge with an insensate extremity. The frequent incidence of pain at 7 days suggests that longer-acting local anesthetics are still needed.
Objective. In view of the critical importance of the CD28–CD80 (B7/BB1) costimulatory pathway in ... more Objective. In view of the critical importance of the CD28–CD80 (B7/BB1) costimulatory pathway in antigen-specific T cell activation and clonal expansion, we examined CD28 surface molecule expression in vivo, and T cell receptor/CD3-mediated and B7/BB1-costimulated T cell proliferation in vitro, in rheumatoid arthritis (RA).Methods. Two-color immunofluorescence analyses of peripheral blood and synovial fluid–derived T cells, as well as 3H-thymidine incorporation assays, were performed.Results. In the peripheral blood of 31 patients with active, untreated RA, a mean of 91% (range 48–100%) of CD4+ and 46% (range 13–82%) of CD8+ T cell subsets were CD28+, which was not significantly lower than normal. Although an overall decrease in the number of T cells was not observed, the numbers of CD28+CD8+ T cells were significantly lower in RA patients (mean 233/μl, versus 292/μl in controls), and this decrease was more pronounced in patients with severe disease (mean 172/μl). CD28 expression on peripheral CD8+ T cells in RA patients, but not in healthy individuals, correlated inversely with T cell activation as assessed by HLA–DR antigen expression. In contrast to the peripheral blood, RA synovial fluid T cells were almost exclusively CD28+, suggesting that migration of CD28+CD8+ T cells to active sites of inflammation may occur. In vitro proliferative responses of peripheral blood T cells to B7/BB1 costimulation in the presence of mitogenic doses of anti-CD3 monoclonal antibody were identical in patients with RA and healthy individuals.Conclusion. Functionally intact CD28+ T cells may contribute to the abnormal immunoregulation and joint inflammation in RA.
Background: Obese patients undergoing bariatric surgery are at a high risk of developing fatal pu... more Background: Obese patients undergoing bariatric surgery are at a high risk of developing fatal pulmonary embolism or post-thrombotic syndrome.The prophylactic use of low molecular weight heparins (LMWHs) is correlated with a significant reduction in post-operative venous thrombosis in patients undergoing orthopedic or general surgery. In morbidity obese patients, the limited number of comparative trials are too sparse to allow a consensus on the effective dose and dosing schedule. Methods: In a prospective study to evaluate the effect of two doses of nadroparin as prophylaxis for venous thromboembolism following bariatric surgery, 60 consecutive patients undergoing Rouxen-Y gastric bypass were randomized to receive either 0.6 ml (5700 IU) or 1.0 ml (9500 IU) of nadroparin started pre-operatively and then given once daily post-operatively until discharge. Results: No statistically significant differences between the two groups were detected in any of the measured coagulation parameters either preoperatively or at days 1, 3 and 5 postoperatively.No thrombotic events were observed pre- or post- operatively, and no patient developed meta-thrombotic syndrome at the 3 and 6 months follow-up. No bleeding events occurred in the patients given the lower dose compared with two major hemorrhages in those given the higher dose. Conclusion: Our results indicate that 0.6 ml (5700 IU) of nadroparin once daily is safe and well-tolerated, and it is as effective in prophylaxis of venous thromboembolism as the higher dose of 1 ml (9500 IU), in such high risk patients.
Electronic Notes in Theoretical Computer Science, 2001
... Integrating Model Information in UML Sequence Diagrams Aliki Tsiolakis1 Department of Mathema... more ... Integrating Model Information in UML Sequence Diagrams Aliki Tsiolakis1 Department of Mathematics and Computer Science Universität Bremen, Germany Abstract ... April 2001. Available at http://www.cs.tu-berlin.de/~ aliki/. [4] Object Management Group. ...
Discharging patients with a long-acting peripheral nerve block remains controversial. Concerns ab... more Discharging patients with a long-acting peripheral nerve block remains controversial. Concerns about accidental injury of the limb or surgical site because of an insensate extremity are common despite a lack of data on the subject. We report a study examining the efficacy and complications of discharge after long-acting block. This prospective study included 1791 patients receiving an upper or lower extremity nerve block with 0.5% ropivacaine and discharged the day of surgery. Efficacy (conversion to general anesthesia and opioid use), persistent motor or sensory weakness, complications, satisfaction, and unscheduled health care visits were assessed in the postanesthesia care unit (PACU) and at 24 h and 7 days postoperatively using a detailed questionnaire. There were 2382 blocks placed: 1119 upper extremity blocks and 1263 lower extremity blocks. Efficacy was demonstrated by a small conversion to general anesthesia (1%-6%) and a lack of patients requiring opioids in the PACU (89%-92%). A large percentage of patients continued to use opioids at 7 days (17%-22%). Despite the requirement for opioids, satisfaction with the anesthesia experience was high at 24 h and 7 days (Liekert scale [1-5] mean at 24 h, 4.88 +/- 0.44; mean at 7 days, 4.77 +/- 0.69) and most (98%) would choose the same anesthetic again. Thirty-seven patients (1.6%) were identified with symptoms or complaints at 7 days. After review, 6 of them (0.25%) had a persistent paresthesia that may have been related to the block or discharge. We conclude that long-acting peripheral nerve blockade may be safely used in the ambulatory setting with a high degree of efficacy, safety, and satisfaction. This technique is associated with an infrequent incidence of neurologic complications and injuries. Given the frequent incidence of persistent pain at 7 days, prolongation of the analgesia would be beneficial. This study demonstrates that long-acting peripheral nerve blockade may be safely used in the ambulatory setting with a high degree of efficacy and satisfaction. This technique is associated with an infrequent incidence of neurologic complications and injuries despite discharge with an insensate extremity. The frequent incidence of pain at 7 days suggests that longer-acting local anesthetics are still needed.
Objective. In view of the critical importance of the CD28–CD80 (B7/BB1) costimulatory pathway in ... more Objective. In view of the critical importance of the CD28–CD80 (B7/BB1) costimulatory pathway in antigen-specific T cell activation and clonal expansion, we examined CD28 surface molecule expression in vivo, and T cell receptor/CD3-mediated and B7/BB1-costimulated T cell proliferation in vitro, in rheumatoid arthritis (RA).Methods. Two-color immunofluorescence analyses of peripheral blood and synovial fluid–derived T cells, as well as 3H-thymidine incorporation assays, were performed.Results. In the peripheral blood of 31 patients with active, untreated RA, a mean of 91% (range 48–100%) of CD4+ and 46% (range 13–82%) of CD8+ T cell subsets were CD28+, which was not significantly lower than normal. Although an overall decrease in the number of T cells was not observed, the numbers of CD28+CD8+ T cells were significantly lower in RA patients (mean 233/μl, versus 292/μl in controls), and this decrease was more pronounced in patients with severe disease (mean 172/μl). CD28 expression on peripheral CD8+ T cells in RA patients, but not in healthy individuals, correlated inversely with T cell activation as assessed by HLA–DR antigen expression. In contrast to the peripheral blood, RA synovial fluid T cells were almost exclusively CD28+, suggesting that migration of CD28+CD8+ T cells to active sites of inflammation may occur. In vitro proliferative responses of peripheral blood T cells to B7/BB1 costimulation in the presence of mitogenic doses of anti-CD3 monoclonal antibody were identical in patients with RA and healthy individuals.Conclusion. Functionally intact CD28+ T cells may contribute to the abnormal immunoregulation and joint inflammation in RA.
Background: Obese patients undergoing bariatric surgery are at a high risk of developing fatal pu... more Background: Obese patients undergoing bariatric surgery are at a high risk of developing fatal pulmonary embolism or post-thrombotic syndrome.The prophylactic use of low molecular weight heparins (LMWHs) is correlated with a significant reduction in post-operative venous thrombosis in patients undergoing orthopedic or general surgery. In morbidity obese patients, the limited number of comparative trials are too sparse to allow a consensus on the effective dose and dosing schedule. Methods: In a prospective study to evaluate the effect of two doses of nadroparin as prophylaxis for venous thromboembolism following bariatric surgery, 60 consecutive patients undergoing Rouxen-Y gastric bypass were randomized to receive either 0.6 ml (5700 IU) or 1.0 ml (9500 IU) of nadroparin started pre-operatively and then given once daily post-operatively until discharge. Results: No statistically significant differences between the two groups were detected in any of the measured coagulation parameters either preoperatively or at days 1, 3 and 5 postoperatively.No thrombotic events were observed pre- or post- operatively, and no patient developed meta-thrombotic syndrome at the 3 and 6 months follow-up. No bleeding events occurred in the patients given the lower dose compared with two major hemorrhages in those given the higher dose. Conclusion: Our results indicate that 0.6 ml (5700 IU) of nadroparin once daily is safe and well-tolerated, and it is as effective in prophylaxis of venous thromboembolism as the higher dose of 1 ml (9500 IU), in such high risk patients.
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