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Hiroshi Otake - One of the best experts on this subject based on the ideXlab platform.
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addition of transversus Thoracic Muscle plane block to pectoral nerves block provides more effective perioperative pain relief than pectoral nerves block alone for breast cancer surgery
BJA: British Journal of Anaesthesia, 2017Co-Authors: Hironobu Ueshima, Hiroshi OtakeAbstract:Abstract Background The pectoral nerves (PECS) block cannot block the most internal mammary region, whereas a transversus Thoracic Muscle plane (TTP) block can. The combination of PECS and TTP blocks may be suitable for anterior chest surgery. We studied patients undergoing mastectomy to assess whether the combination of PECS and TTP blocks provides better analgesia than PECS block alone. Methods Seventy adult female patients undergoing unilateral mastectomy under general anaesthesia were randomly allocated to receive either the combination of PECS and TTP blocks (PT group, n=35) or the PECS block only (C group, n=35). The primary outcome measure was visual analog scale pain score. Secondary outcomes were the sensory level loss confirmed by cold tests and additional analgesic drugs within 24 h after the operation. Results The visual analog scale pain scores were lower in the PT group than the C group. The use of postoperative additional analgesic drugs was also lower lower in the PT group than that in the C group. In the majority of patients in the PT group, sensory loss was confirmed in both the anterior and the lateral branches of Thoracic nerves (Th2–6). Conclusion Compared with PECS block, the combination of PECS and TTP blocks provides effective perioperative pain relief for breast cancer surgery. Clinical trial registration University Hospital Medical Information Network (UMIN) ID number 000018299.
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ultrasound guided transversus Thoracic Muscle plane block a cadaveric study of the spread of injectate
Journal of Clinical Anesthesia, 2015Co-Authors: Hironobu Ueshima, Yoshimasa Takeda, Shinichi Ishikawa, Hiroshi OtakeAbstract:[1] Borglum J, Moriggl B, Lonnqvist PA, Christensen AF, Sauter A, Bendtsen AF. Ultrasound-guided transmuscular quadratus lumborum blockade. Br J Anaesth 2013 [http://bja.oxfordjournals.org/forum/topic/ brjana_el%3B9919, Accessed on 24th November, 2014]. [2] Visoiu M, Yakovleva N. Continuous postoperative analgesia via quadratus lumborum block—an alternative to transversus abdominis plane block. Paediatr Anaesth 2013;23:959-61. [3] Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol 2013;29:550-2. [4] Carney J, Finnerty O, Rauf J, Bergin D, Laffey JG, Mc Donnell JG. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia 2011;66:1023-30. [5] Verma A, Bajpai M, Baidya DK. Lumbotomy approach for upper urinary tract surgeries in adolescents: feasibility and challenges. J Pediatr Urol 2014;10:1122-5.
J.w. Knight - One of the best experts on this subject based on the ideXlab platform.
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Ultrastructure of the intracellular melanization of Brugia malayi (Buckley) (Nematoda : Filarioidea) in the Thoracic Muscles of Anopheles quadrimaculatus (Say) (Diptera : Culicidae)
International Journal of Insect Morphology and Embryology, 1995Co-Authors: Marta L. Chikilian, Jai K. Nayar, Timothy J. Bradley, Cora E. Cash-clark, J.w. KnightAbstract:Ultrastructural details of the melanization of the filarial parasite Brugia malayi (Nematoda : Filarioidea) in the Thoracic Muscle cell of selected susceptible and refractory strains of Anopheles quadrimaculatus (Diptera : Culicidae) were examined. In both susceptible and refractory strains, following infection of the Muscle cells, there is a dissolution of the sarcoplasmic cytoskeletal matrix surrounding the myofibrils, causing the myofibrils and mitochondria to drift apart and lose their regular spacing. This is coupled with a reorganization of the cytoplasm near the normally developing intracellular larva. Masses of vesicles and vesiculated cytoplasmic bodies accumulate near the larva. Eventually, these form a dense layer of cytoplasm around the parasite. Fine grains of melanin begin to appear in this dense cytoplasmic layer, increasing gradually until a nearly complete capsule of melanin surrounds the larva. The time course of melanization was found to be quite variable among and even within mosquitoes. Strains of A. quadrimaculatus selected to be refractory or susceptible to B. malayi, were found to vary substantially in the frequency of intracellular melanization, but not in the mechanism.
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Ultrastructural comparison of extracellular and intracellular encapsulation of Brugia malayi in Anopheles quadrimaculatus.
The Journal of parasitology, 1994Co-Authors: Marta L. Chikilian, Jai K. Nayar, Timothy J. Bradley, J.w. KnightAbstract:Ultrastructural aspects of extracellular humoral encapsulation of microfilariae of Brugia malayi in the hemocoel of Anopheles quadrimaculatus were compared with those of intracellular encapsulation of first-stage larvae (L1) of the same parasite species, in the Thoracic Muscle cells of the same species of mosquito. The results showed that extracellular humoral encapsulation of microfilarial sheaths, and sheathed and exsheathed microfilariae, in the hemocoel of mosquitoes occurs around the parasite within the first 6 hr postingestion, apparently without initial participation of hemocytes. Hemocytes and their remnants were observed near the parasite during the first 6 hr postingestion. Within the next 24 hr, hemocytes attach to the initial humoral capsule. By contrast, intracellular encapsulation of L1S is initiated by the accumulation of a dense cytoplasmic layer derived from the infected Thoracic Muscle cell. Melanin deposits accumulate in this layer adjacent to the parasite cuticle, again without visible participation of hemocytes.
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Intracellular development of subperiodic Brugia malayi influenced by mosquito Thoracic Muscle cells
Journal of invertebrate pathology, 1993Co-Authors: Jai K. Nayar, Timothy J. Bradley, L.l. Mikarts, J.w. KnightAbstract:Abstract The in vitro development of 1-day-old intracellularly lodged larvae of Brugia malayi cultured in infected excised thoraces of selected susceptible and refractory strains of Aedes aegypti and Anopheles quadrimaculatus was compared with larvae reared in vivo. In susceptible mosquitoes, both in vitro and in vivo, larvae developed normally and abnormally. In refractory mosquitoes this pattern of both normal and abnormal development was also observed, except that comparatively fewer larvae developed to the infective third-stage larvae (L3) in vitro than in vivo and that more first-stage larvae (L1) were intracellularly melanized in vivo than in vitro. These studies indicate that factors in the Thoracic Muscle cells of the mosquito greatly affect the development of B. malayi microfilariae to L3. Intracellular melanization of L1 in An. quadrimaculatus, previously demonstrated in vivo, rarely occurred in vitro . These studies therefore suggest that refractoriness and melanization of B. malayi larvae in the thoraces of An. quadrimaculatus are controlled by two different and separate mechanisms.
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Characterization of the intracellular melanization response in Anopheles quadrimaculatus against subperiodic Brugia malayi larvae.
The Journal of parasitology, 1992Co-Authors: Jai K. Nayar, L.l. Mikarts, J.w. Knight, Timothy J. BradleyAbstract:Intracellular melanization, a defense or an immune response in the Thoracic Muscle cells, was investigated in a refractory strain of Anopheles quadrimaculatus infected with larvae of Brugia malayi. In mosquitoes fed on B. malayi-infected jirds, intracellular melanization against first-stage larvae (L1) was better expressed when fewer than 40 microfilariae reached the Thoracic Muscle cells than when more than 40 microfilariae reached the Thoracic Muscle cells. This result suggests that when large numbers of microfilariae invade the Thoracic Muscle cells, the immune response of the mosquito may become overloaded. Intracellular melanization response against L1 in the Thoracic Muscle cells also showed a significant decrease in older females (14-16-day-old) as compared to the younger ones (4-9-day-old). A comparison is made between intracellular and extracellular responses of mosquitoes to filarial larvae. It is significant that in both cases high rate of infection can reduce both the number and percentage of larvae melanized.
Hironobu Ueshima - One of the best experts on this subject based on the ideXlab platform.
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addition of transversus Thoracic Muscle plane block to pectoral nerves block provides more effective perioperative pain relief than pectoral nerves block alone for breast cancer surgery
BJA: British Journal of Anaesthesia, 2017Co-Authors: Hironobu Ueshima, Hiroshi OtakeAbstract:Abstract Background The pectoral nerves (PECS) block cannot block the most internal mammary region, whereas a transversus Thoracic Muscle plane (TTP) block can. The combination of PECS and TTP blocks may be suitable for anterior chest surgery. We studied patients undergoing mastectomy to assess whether the combination of PECS and TTP blocks provides better analgesia than PECS block alone. Methods Seventy adult female patients undergoing unilateral mastectomy under general anaesthesia were randomly allocated to receive either the combination of PECS and TTP blocks (PT group, n=35) or the PECS block only (C group, n=35). The primary outcome measure was visual analog scale pain score. Secondary outcomes were the sensory level loss confirmed by cold tests and additional analgesic drugs within 24 h after the operation. Results The visual analog scale pain scores were lower in the PT group than the C group. The use of postoperative additional analgesic drugs was also lower lower in the PT group than that in the C group. In the majority of patients in the PT group, sensory loss was confirmed in both the anterior and the lateral branches of Thoracic nerves (Th2–6). Conclusion Compared with PECS block, the combination of PECS and TTP blocks provides effective perioperative pain relief for breast cancer surgery. Clinical trial registration University Hospital Medical Information Network (UMIN) ID number 000018299.
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ultrasound guided transversus Thoracic Muscle plane block a cadaveric study of the spread of injectate
Journal of Clinical Anesthesia, 2015Co-Authors: Hironobu Ueshima, Yoshimasa Takeda, Shinichi Ishikawa, Hiroshi OtakeAbstract:[1] Borglum J, Moriggl B, Lonnqvist PA, Christensen AF, Sauter A, Bendtsen AF. Ultrasound-guided transmuscular quadratus lumborum blockade. Br J Anaesth 2013 [http://bja.oxfordjournals.org/forum/topic/ brjana_el%3B9919, Accessed on 24th November, 2014]. [2] Visoiu M, Yakovleva N. Continuous postoperative analgesia via quadratus lumborum block—an alternative to transversus abdominis plane block. Paediatr Anaesth 2013;23:959-61. [3] Kadam VR. Ultrasound-guided quadratus lumborum block as a postoperative analgesic technique for laparotomy. J Anaesthesiol Clin Pharmacol 2013;29:550-2. [4] Carney J, Finnerty O, Rauf J, Bergin D, Laffey JG, Mc Donnell JG. Studies on the spread of local anaesthetic solution in transversus abdominis plane blocks. Anaesthesia 2011;66:1023-30. [5] Verma A, Bajpai M, Baidya DK. Lumbotomy approach for upper urinary tract surgeries in adolescents: feasibility and challenges. J Pediatr Urol 2014;10:1122-5.
Dmitry Rozenberg - One of the best experts on this subject based on the ideXlab platform.
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Thoracic Muscle cross sectional area is associated with hospital length of stay post lung transplantation a retrospective cohort study
Transplant International, 2017Co-Authors: Dmitry Rozenberg, Sunita Mathur, Margaret S Herridge, Roger S Goldstein, Heidi Schmidt, N Chowdhury, Polyana Mendes, L G SingerAbstract:Low Muscle mass is common in lung transplant (LTx) candidates; however, the clinical implications have not been well described. The study aims were to compare skeletal Muscle mass in LTx candidates with controls using Thoracic Muscle cross-sectional area (CSA) from computed tomography and assess the association with pre- and post-transplant clinical outcomes. This was a retrospective, single-center cohort study of 527 LTx candidates [median age: 55 IQR (42-62) years; 54% male]. Thoracic Muscle CSA was compared to an age- and sex-matched control group. Associations between Muscle CSA and pre-transplant six-minute walk distance (6MWD), health-related quality of life (HRQL), delisting/mortality, and post-transplant hospital outcomes and one-year mortality were evaluated using multivariable regression analysis. Muscle CSA for LTx candidates was about 10% lower than controls (n = 38). Muscle CSA was associated with pre-transplant 6MWD, but not HRQL, delisting or pre- or post-transplant mortality. Muscle CSA (per 10 cm2 difference) was associated with shorter hospital stay [0.7 median days 95% CI (0.2-1.3)], independent of 6MWD. In conclusion, Thoracic Muscle CSA is a simple, readily available estimate of skeletal Muscle mass predictive of hospital length of stay, but further study is needed to evaluate the relative contribution of Muscle mass versus functional deficits in LTx candidates.
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association of Thoracic Muscle cross sectional area and clinical outcomes in lung transplant candidates
Journal of Heart and Lung Transplantation, 2015Co-Authors: Dmitry Rozenberg, Polyana Mendes, L G Singer, Sunita MathurAbstract:s S15 that the new Lung Transplantation allocation rules implemented in France since 2007 (HELT) allows a rapid organ procurement for patients at imminent risk of death, and is feasible with an acceptable survival (74% at 1 year).
Fengxia Zhang - One of the best experts on this subject based on the ideXlab platform.
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Application of modified Thoracic nerve block combined with general anesthesia in radical mastectomy
International Journal of Anesthesiology and Resuscitation, 2019Co-Authors: Xiaonv Liang, Jianyou Zhang, Jianhong Sun, Fengxia ZhangAbstract:Objective To study the anesthesia and analgesic effect of modified Thoracic nerve block(transversus Thoracic Muscle plane-pectoral nerves block) combined with general anesthesia in radical mastectomy. Methods A total of sixty-six patients who underwent radical mastectomy were randomly divided into three groups (22 cases in each group) by random number table: transversus Thoracic Muscle plane combined with pectoral nerves block group (group PG), Thoracic paravertebral blockade group (group TG) and control group (group G). All patients in three groups were also anesthetized by general anesthesia. The blood pressure, heart rate and the consumption of opioids were recorded in the operation. The Visual Analogue Score (VAS), Ramsay sedation score and the recovery of bowel function were evaluated in the post-operation. Results Intraoperative blood pressure and heart rate of patients in group PG were more stable than these indexes of patients in group G and group TG. Compared with patients in group G, the consumption of sufentanil was low in group PG and group TG (P 0.05), but the VAS score in group PG was lower, especially immediately after operation (P
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Optimized strategy of anesthesia for modified radical mastectomy: transverse Thoracic Muscle plane-Thoracic nerve block combined with general anesthesia
Chinese Journal of Anesthesiology, 2018Co-Authors: Jianyou Zhang, Lin Wang, Maogui Chen, Jianhong Sun, Fengxia ZhangAbstract:Objective To evaluate the efficacy of transverse Thoracic Muscle plane-Thoracic nerve block combined with general anesthesia when used for modified radical mastectomy. Methods Sixty female patients, of American Society of Anesthesiologists physical statusⅠ or Ⅱ, aged 45-63 yr, weighing 48-72 kg, scheduled for elective modified radical mastectomy, were divided into 3 groups (n=20 each) using a random number table method: Thoracic nerve block-general anesthesia group (group P+ G), transverse Thoracic Muscle plane-Thoracic nerve block-general anesthesia group (group T+ P+ G) and general anesthesia group (group G). Anesthesia was induced with midazolam, propofol, fentanyl and cisatracurium and maintained with sevoflurane, fentanyl and cisatracurium.Thoracic nerve block typeⅠ and Ⅱ was performed after implanting laryngeal mask airway in group P+ G.Transverse Thoracic Muscle plane block was performed after performing Thoracic nerve block typeⅠ and Ⅱ in group T+ P+ G.Flurbiprofen 50 mg was intravenously injected after operation as a rescue analgesic to maintain the Visual Analogue Scale score≤3.The consumption of opioids, emergence time and time for removal of the laryngeal mask airway were recorded.Ramsay sedation score was recorded at 10 min after removal of the laryngeal mask airway.The requirement for rescue analgesia, time of passing flatus and development of nausea and vomiting within 24 h after operation were recorded. Results Compared with group G, the emergence time, time for removal of the laryngeal mask airway and time of passing flatus were significantly shortened, and the Ramsay sedation score, consumption of fentanyl and requirement for rescue analgesia were decreased in P+ G and T+ P+ G groups (P 0.05). Conclusion Transverse Thoracic Muscle plane-Thoracic nerve block combined with general anesthesia can provide satisfactory perioperative analgesia and is helpful in improving prognosis for the patients undergoing modified radical mastectomy. Key words: Thoracic nerves; Nerve block; Anesthesia, general; Breast neoplasms; Transversus Thoracic Muscle
