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Related Concept Videos

Local Anesthetics: Clinical Application as Epidural Anesthesia01:29

Local Anesthetics: Clinical Application as Epidural Anesthesia

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Epidural anesthetics are administered in the fat-filled epidural space, the outermost part of the spinal canal. This technique is commonly employed for pain management and anesthesia during lower abdomen and pelvis surgeries or labor and delivery.
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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
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Acute Pyelonephritis II: Diagnostic Studies and Management01:28

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Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
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Pneumonia is an acute respiratory infection that targets the lungs, specifically the alveoli. These tiny air sacs, essential for oxygen exchange, become engorged with pus and fluid, severely hindering breathing, decreasing oxygen absorption, and causing significant pain and discomfort during respiration.
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Clinical differences between delayed and acute onset postoperative spinal infection.

Sung-Woo Choi1, Jae Chul Lee1, Won Seok Lee1

  • 1Department of Orthopaedic Surgery, Soonchunhyang University College of Medicine, Seoul, Korea.

Medicine
|June 17, 2022
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Summary

Delayed-onset postoperative spinal infection (PSI) requires longer treatment than acute PSI, often involving deep-layer infections and complications like hardware issues. Early detection of surgical site infection is crucial for better patient outcomes.

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Area of Science:

  • Orthopedics
  • Infectious Diseases
  • Surgical Site Infections

Background:

  • Delayed-onset postoperative spinal infection (PSI) is a significant clinical challenge.
  • While acute PSIs are well-studied, delayed PSI cases are less frequently reported.

Purpose of the Study:

  • To compare the clinical features, treatment course, and prognosis of delayed-onset PSI versus acute-onset PSI.

Main Methods:

  • Ninety-six patients with PSI were divided into acute onset (AO, ≤90 days) and delayed onset (DO, >90 days) groups.
  • Baseline data, clinical signs, treatments, and outcomes were compared between the AO (n=73) and DO (n=23) groups.

Main Results:

  • Delayed-onset PSI was associated with diabetes mellitus and metallic instrumentation.
  • Superficial signs were less frequent in DO, which exclusively involved deep-layer infections.
  • DO patients required more revision surgery, longer antibiotic courses, and experienced higher rates of hardware complications (e.g., screw loosening, instability).
  • C-reactive protein levels were lower in the DO group at diagnosis.

Conclusions:

  • Delayed-onset PSI necessitates more intensive and prolonged treatment compared to acute PSI.
  • Early detection of surgical site infections is vital for effective management and improved prognosis.