Ultrasound-guided suprascapular nerve block, description of a novel supraclavicular approach.

BACKGROUND AND OBJECTIVES: The suprascapular nerve (SSN) block is frequently performed for different shoulder pain conditions and for perioperative and postoperative pain control after shoulder surgery. Blind and image-guided techniques have been described, all of which target the nerve within the supraspinous fossa or at the suprascapular notch. This classic target point is not always ideal when ultrasound (US) is used because it is located deep under the muscles, and hence the nerve is not always visible. Blocking the nerve in the supraclavicular region, where it passes underneath the omohyoid muscle, could be an attractive alternative. METHODS: In the first step, 60 volunteers were scanned with US, both in the supraclavicular and the classic target area. The visibility of the SSN in both regions was compared. In the second step, 20 needles were placed into or immediately next to the SSN in the supraclavicular region of 10 cadavers. The accuracy of needle placement was determined by injection of dye and following dissection. RESULTS: In the supraclavicular region of volunteers, the nerve was identified in 81% of examinations (95% confidence interval [CI], 74%-88%) and located at a median depth of 8 mm (interquartile range, 6-9 mm). Near the suprascapular notch (supraspinous fossa), the nerve was unambiguously identified in 36% of examinations (95% CI, 28%-44%) (P < 0.001) and located at a median depth of 35 mm (interquartile range, 31-38 mm; P < 0.001). In the cadaver investigation, the rate of correct needle placement of the supraclavicular approach was 95% (95% CI, 86%-100%). CONCLUSIONS: Visualization of the SSN with US is better in the supraclavicular region as compared with the supraspinous fossa. The anatomic dissections confirmed that our novel supraclavicular SSN block technique is accurate.

Notes on human cases of cystic echinococcosis in Peru

Cystic echinococcosis (CE) is a high prevalent zoonosis in the central and southern Peruvian Andes. Serum samples (n50)frompatients presenting presumptive clinical and radiological diagnosis of CE (group 1), were tested for antibodies against Echinococcus granulosus metacestode using Arc-5 double diffusion assay (DD5), immunoelectrophoresis (IEF), and immunoelectrotransfer blot (EITB) techniques. Serum samples (n18) from patients presenting other parasite infections (paragonomiasis, cysticercosis, and fascioliasis) or healthy blood donors (n15), were designated as control groups. The overall sensitivity of the tests was of 94% (DD5 and IEF tests) or 96% (EITB test). Only patients from group 1 were seropositive for CE. Polypeptides of 21, 31, and 48 kDa were considered positive for CE. Based on these results, this study demonstrates that CE also occurs in other coastal departments (Piura, Ancash, Ica, Arequipa, and Tacna) besides Lima.

Cochrane Training, Short Courses Guidance Notes 2011

Guidance Notes for Training Courses on Conducting Systematic Reviews, 2011.

Childhood immunisation: Guidance notes for professionals

This booklet summarises the childhood immunisation programme and provides guidance for professionals adminstering vaccines.

Arbre de Notes.Net

Els objectius del projecte és que l¿estudiant utilitzi moltes de les tecnologies possibles recollidesdintre d¿aquesta nova plataforma de desenvolupament, entre altres existeixen: ASP.NET, ADO.NET, Serveix Web, ...

Immunisation guidance notes for professionals (2015 edition)

Informed consent – which can be either written or oral (depending on local Trust policy) – must be obtained and recorded in the notes at the time of each immunisation, after the child’s fitness and suitability have been established. It is important that the person giving consent is fully informed about the vaccine at the time they give consent. Written material is available to assist in this, but is not a substitute for an opportunity to discuss the issues with a health professional. Consent is given by the person with parental responsibility; however, this person does not necessarily need to be present at the time the immunisation is given. Although the decision to immunise must be taken by the person with parental responsibility, they can arrange for someone else (eg grandparent or childminder) to bring the child to be immunised. You do not need consent in writing – if they have received all the relevant information and arranged for another person to bring the child, the circumstances indicate they have consented. A child under 16 years may give consent provided he or she understands fully the benefits and risks involved. If a competent child consents to treatment, a parent cannot override that consent. Obviously they should be encouraged to involve the person with parental responsibility in the decision. Legally, a parent can consent if a competent child refuses �

Systematic notes on Anopheles Meigen (Diptera: Culicidae) species in the state of Amapá, Brazil

Identification of Anopheles nuneztovari Gabaldón and An. goeldii Rozeboom and Gabaldón based on the male genitalia traits is discussed. An. goeldii is in the synonymy of An. nuneztovari, however, characters of the aedeagus of male genitalia distinguish both species. We hypothesize that An. goeldii may be a valid species, however, further studies using molecular characters, especially ITS2 rDNA sequences will be necessary to elucidate the taxonomic status of the species. An. konderi Galvão and Damasceno and An. forattinii Wilkerson and Sallum are registered for the first time in the state of Amapá.

NOTES et trocart unique: révolution chirurgicale ou marketing [NOTES and single port access: surgical or marketing revolution?].

Promising new technologies are emerging in digestive surgery: Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Single Port Access Surgery. They both aim to limit the surgical morbidity by decreasing the number of parietal accesses. The feasibility in human is obviously demonstrated, but numerous issues remain concerning the safety of these techniques. Furthermore, the expected advantages are not clearly demonstrated until now in the literature. In the future, it will be advisable to standardize techniques, in order to allow large clinical studies and to limit the potential complications of these approaches.

La Llengua de l'heroi: notes sobre la llengua del segle XX a partir de les traduccions catalanes de David Copperfield de Charles Dickens

Estudi comparatiu de les dues traduccions catalanes publicades de David Copperfield de Charles Dickens. La primera de Josep Carner feta l’any 1930 però publicada el 1964 i la segona obra deJoan Sellent del 2003. L’anàlisi mostra que ambdues traduccions, excel·lents, reflecteixen una evolució singular i força accelerada del model de llengua que els traductors fan arribar al seu públic, que és reflex de la complexa història de la llengua catalana del segle xx, que encara s’had’escriure.