Datasets:

MiliLab
/

AnesCorpus

text stringlengths 195 665k
Original Research ARTICLE\nElamipretide (SS-31) Ameliorates Isoflurane-Induced Long-Term Impairments of Mitochondrial Morphogenesis and Cognition in Developing Rats\n- 1Jiangsu Key Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing, China\n- 2Medical School of Henan Polytechnic University, Jiaozuo, China\n- 3Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China\nMitochondria are supposed to be involved in the early pathogenesis of general anesthesia (GA)-induced neurotoxicity and long-term cognitive deficits in developing brains. However, effective pharmacologic agents targeted on mitochondria during GA exposure are lacking. This study explores the protective effects of mitochondrion-targeted antioxidant elamipretide (SS-31) on mitochondrial morphogenesis and cognition in developing rats exposed to isoflurane. Rat pups at postnatal day (PND) 7 were exposed to 1.5% isoflurane for 6 h following intraperitoneal administration of elamipretide or vehicle with 30 min interval. The hippocampus was immediately removed for biochemical assays. Histopathological studies were conducted at PND 21, and behavioral tests were performed at PND 40 or 60. We found that early exposure to isoflurane caused remarkable reactive oxygen species (ROS) accumulation, mitochondrial deformation and neuronal apoptosis in hippocampus. The injury occurrence ultimately gave rise to long-term cognitive deficits in developing rats. Interestingly, pretreatment with elamipretide not only provided protective effect against oxidative stress and mitochondrial damages, but also attenuated isoflurane-induced cognitive deficits. Our data support the notion that mitochondrial damage is an early and long lasting event of GA-induced injury and suggest that elamipretide might have clinically therapeutic benefits for pediatric patients undertaking GA.\nThousands of infants and children require prolonged periods of anesthesia when complicated surgery is needed each year. A large number of preclinical studies have raised concern about the potential of neurotoxicity and long-term cognitive impairments caused by general anesthetics in developing brains (Ing et al., 2014a; Lin et al., 2014; Rappaport et al., 2015; Walters and Paule, 2017). Due to the increasing demand for pediatric patients to have anesthesia during surgery, recent research efforts are focusing on deciphering the earliest cellular targets and mechanistic pathways of general anesthesia (GA)-induced developmental neurotoxicity so that strategies for effective ameliorating or preventing the adverse effects can be devised (Boscolo et al., 2012, 2013a; Jevtovic-Todorovic et al., 2012; Noguchi et al., 2016).\nImpaired mitochondrial function and morphology are centrally involved in the neurotoxicity and play key pathogenic roles in GA-induced cognitive deficits (Sanchez et al., 2011; Boscolo et al., 2012, 2013a,b). The mitochondrial abnormalities exist in vulnerable brain regions evidenced by increased reactive oxygen species (ROS) generation and lipid peroxidation, mitochondrial enlargement, and impaired structural integrity (Sanchez et al., 2011; Boscolo et al., 2012, 2013a,b). However, efforts to directly target mitochondria to limit ROS and oxidative stress and modify mitochondrial function during GA exposure are still in progress because of the absence of effective pharmacological agents. Elamipretide (SS-31, D-Arg-dimethylTyr-Lys-Phe-NH2) is a novel mitochondrion-targeted antioxidant. It has an alternating aromatic-cationic structure that allows it to freely cross the blood-brain barrier and cell membrane, then concentrate >1000 fold in the mitochondrial inner membrane independently of mitochondrial membrane potential. It has been demonstrated that elamipretide inhibits ROS generation and lipid peroxidation in many processes both in vitro and in vivo (Zhao et al., 2005; Szeto, 2008; Min et al., 2011; Hao et al., 2015; Yin et al., 2016). Our previous studies provided evidences that elamipretide protected mitochondrial function by reducing ROS generation, maintaining adenosine triphosphate (ATP) production and mitochondrial membrane potential, and inhibiting opening of mitochondrial permeability transition pore in aged mice receiving isoflurane anesthesia (Wu et al., 2015a, 2016). However, the efficacy of elamipretide has yet to be studied in the developing rats.\nIn the present study, we sought to examine the antioxidative and mitochondrial protective effects of elamipretide in rats during the critical stage of brain development. We administered elamipretide and isoflurane anesthesia to rat pups at postnatal day (PND) 7 and discovered that elamipretide treatment ameliorated isoflurane-induced oxidative stress and long-term impairments of mitochondrial morphogenesis and cognition in developing rats.\nMaterials and Methods\nSprague-Dawley rat pups at PND 7 were used in the present study. All experimental procedures and protocols were reviewed and approved by the Animal Investigation Ethics Committee of Nanjing University and were performed in accordance with the Guidelines for the Care and Use of Laboratory Animals from the National Institutes of Health, USA. The pups were housed in a room maintained under standard environmental condition (temperature 22–24°C, a 12 h light/dark cycle, and 50 ± 10% humidity) with their mothers till PND 20. At PND 21, the pups were weaned and housed 4–5 per cage in standard condition.\nNinety-six rat pups at PND 7 of both sexes were randomly assigned to one of the following four treatment protocols (n = 24/group): control, control + elamipretide, isoflurane and isoflurane + elamipretide. Elamipretide (5 mg/kg, synthesized in China Peptides Co., Ltd., Shanghai, China) or phosphate-buffered saline (PBS) was intraperitoneally administered to the pups with a volume of 0.4 ml/kg 30 min before gas inhalation. The dose of elamipretide was chosen according to our previous studies (Wu et al., 2015a,b, 2016). Anesthesia was performed based on previous optimization, in which 6 h isoflurane anesthesia can induce developmental neurotoxicity (Boscolo et al., 2012, 2013a; Wang et al., 2014; Xu et al., 2015). Anesthesia was induced by placing the pups in an anesthetizing chamber prefilled with 1.8% isoflurane plus 30% oxygen (O2) for 10 min and then changed to 1.5% isoflurane plus 30% O2 for 350 min. For control experiments, 30% O2 was delivered for 6 h at the same flow rate. The composition of the chamber gas was continuously monitored using a DatexTM infrared analyzer (Capnomac, Helsinki, Finland). Rats were kept normothermic throughout the experiment.\nAfter the administration of anesthesia, rats were randomly divided into three subgroups. Six rats in subgroup 1 were sacrificed immediately postanesthesia (at PND 7), and the hippocampi were rapidly removed for biochemical studies. Six rats in subgroup 2 were sacrificed at PND 21 and the brain of each rat was cut into two halves for histopathological studies, and 12 rats in subgroup 3 were used for behavioral studies at PND 40 or 60. Efforts were made to minimize the number of animals used in this study.\nROS Level, Superoxide Dismutase (SOD) Activity and Malondialdehyde (MDA) Content Assays\nRats (n = 6 for each group) were sacrificed immediately postanesthesia (at PND 7), and the hippocampi were removed quickly. Intracellular ROS were detected using a ROS assay kit (Genmed Scientifics Inc., Shanghai, China) containing an oxidation-sensitive fluorescent probe (DCFH-DA) with a spectrofluorometer (excitation 490 nm, emission 520 nm). Malondialdehyde (MDA) is an end-product of ROS-induced peroxidation. Superoxide Dismutase (SOD) is an important enzyme that participates in the removal of ROS from the cellular environment. The extent of lipid peroxidation was estimated by MDA levels, which were measured by using the spectrophotometric diagnostic kits (Jiancheng Biological Technology Co., Ltd., Nanjing, China) according to the manufacturer’s instructions. The SOD activity was determined using a SOD assay kit (Jiangsu KeyGEN BioTECH Co., Ltd., Nanjing, China) according to manufacturer’s instructions. Enzyme activity was converted to units per milligram of protein. One unit of SOD activity was defined as the amount that reduced the absorbance at 550 nm by 50%.\nWestern Blotting Analysis\nHippocampal homogenate was prepared for the determination of SOD2 expression by standard western blotting. Total protein (35 μg/lane) was electrophoretically separated and blotted onto nitrocellulose membrane. Protein levels were determined via incubation with antibodies against SOD2 (1:1000; Abcam, Cambridge, MA, USA) and tubulin (1:1000; Sigma, St. Louis, MO, USA). Bands were visualized by enhanced chemiluminescence and quantified with the Image Quant Software (Syngene).\nDetermination of Mitochondrial Swelling\nHippocampal tissue was removed immediately post-anesthesia and cut into small pieces for mitochondria isolation. The tissue was homogenized in 1.5 ml lysis buffer supplemented with protease inhibitor solution (QIAGEN China Co., Ltd., Shanghai, China) and centrifuged at 1000 g for 10 min at 4°C. The cell pellet was resuspended and homogenized in 1.5 ml ice-cold disruption buffer and centrifuged at 1000 g for 10 min. The supernatant was carefully transferred to a clean 1.5 ml tube and centrifuged at 6000 g for 10 min. The mitochondrion-enriched pellet was resuspended in 1 ml mitochondrial storage buffer and centrifuged at 6000 g for 20 min at 4°C.\nThe hippocampal mitochondrial swelling assay was performed by measuring the changes of the absorbance following addition of the mitochondrial suspension at 540 nm for 10 min using a colorimetric assay kit (Genmed Scientifics Inc., Wilmington, DE, USA). A decrease in absorbance represents the degree of mitochondrial swelling.\nAt PND 21, rats (n = 6 for each group) were perfused with normal saline, followed by 4% paraformaldehyde. Brains were then immersed in 4% paraformaldehyde for later embedding. Ultrastructural changes in hippocampal mitochondria were assessed by transmission electron microscopy. Briefly, the brain was fixed with 4% buffered glutaraldehyde and postfixed with 1% osmium tetroxide. The preparation was dehydrated through an ethanol gradient, processed for Epon 812 embedding, and sectioned at a thickness of 80 nm on a rotary microtome. The ultrathin sections were stained with 4% uranyl acetate-lead citrate and examined with a Tecnai G2 Transmission Electron Microscopy (FEI Company, Hillsboro, OR, USA). Electron microscope photographs were analyzed using Image-Pro Plus 6.1 software (Media Cybernetics, Silver Spring, MD, USA). We analyzed four neurons from each rat (n = 6 rats/group) for a total of 24 neurons in each group. Morphometric analyses were conducted as previously described by an investigator blinded to the experimental conditions (Sanchez et al., 2011; Boscolo et al., 2012, 2013a).\nParaffin sections were deparaffinized and hydrated using the following incubation steps: 10 min in xylene twice; 5 min in 100%, 10 min in 95%, 10 min in 85%, and 10 min in 70% ethanol; and 5 min three times in PBS at room temperature. Antigen retrieval was achieved by boiling the sections in 10 mM sodium citrate for 10 min in a microwave oven. The sections were washed with PBS three times, and treated with 3% H2O2-methanol for 15 min. Immunostaining was performed by incubation with antibody against cleaved caspase 3 (1:200; Cell Signaling Technology, Beverly, MA, USA) for 2 h. Sections were then washed three times and incubated with secondary antibodies labeled with horseradish peroxidase for 30 min at room temperature. Immunohistochemical (IHC) imaging was performed using ZEISS HB050 (Zeiss, Jena, Germany) inverted microscope system and handled by Image-Pro Plus 6.1 software (Media Cybernetics, Rockville, MD, USA). Cells with brownish-yellow cytoplasm were counted as positive cells. The numbers of caspase 3 immunoreactive cells in the hippocampal CA1 and dentate gyrus (DG) regions were counted and analyzed in four microscopic fields (at ×200 magnification) by an investigator blinded to the treatment conditions.\nTUNEL Fluorescent Assays\nThe TUNEL assay was carried out with the in situ Cell Death Detection Kit (Roche Inc., Indianapolis, IN, USA) following the protocols as previously described (Wu et al., 2015a). Sections were counterstained by 4′,6-diamidino-2-phenylindole (DAPI, Beyotime Institute of Biotechnology, Shanghai, China) for 3 min, washed with PBS three times, and covered by microscopic glass with antifade mounting medium (Beyotime) for further analyses. Fluorescence microscopy imaging was performed using ZEISS HB050 (Zeiss, Jena, Germany) inverted microscope system and handled by Image-Pro Plus 6.1 software (Media Cybernetics, Rockville, MD, USA). The positive cells were identified, counted and analyzed by an investigator blinded to the grouping. The apoptotic index was defined as the average percentage of TUNEL-positive cells in each section counted in four hippocampal CA1 microscopic fields (at ×400 magnification).\nOpen Field Tests\nTo evaluate the anxiety behavior and general locomotor activity, we subjected rats (n = 12 for each group) to the open field test at PND 40. Each rat was gently placed in the center of a black plastic chamber (100 cm × 100 cm × 40 cm) for 10 min, while exploratory behavior was automatically recorded by a video tracking system (XR-XZ301, Shanghai Soft Maze Information Technology Co., Ltd., Shanghai, China). The total distance and the amount of time traveled in the center area (50 cm × 50 cm) of the maze were measured. After each test, the arena was cleaned with 75% alcohol to avoid the presence of olfactory cues.\nMorris Water Maze (MWM) Tests\nTo investigate spatial learning and memory function, we subjected rats (n = 12 for each group) to the Morris water maze (MWM) test (XR-XM101; Shanghai Xinruan Information Technology Co., Ltd., Shanghai, China) at PND 60. The MWM was a black metal tank (120 cm in diameter, 60 cm in depth) equipped with a platform (10 cm in diameter) 1–2 cm below the surface of the water. The MWM task was performed according to our previous study (Zhang et al., 2016). Briefly, it consisted of two phases, training phase for five consecutive days and probe trial phase on day 6. In the training phase, the rat was allowed to face to the pool wall in four random places (N, S, E, W) in the pool to find the fixed platform. Release positions were randomly predetermined. The trial was terminated once the rat reached the platform. If the rat failed to reach the platform within 60 s, it would be guided to the platform and allowed to stay for 15 s, then the latency was recorded for 60 s. In the probe test, single-probe trial was conducted with the original platform removed 24 h after the last training session. The rat was released at a random start position and allowed to swim for 60 s in the pool.\nData are presented as the mean ± SEM and analyzed by the Statistical Product for Social Sciences (SPSS; version 17.0, Chicago, IL, USA). The difference between the groups was determined by one-way analysis of variance followed by the Tukey’s tests. Comparisons for the spatial training sessions of MWM and mitochondrial size classification were performed by repeated two-way analysis of variance (ANOVA) followed by LSD test. A p value < 0.05 was regarded as statistical significance.\nElamipretide Inhibits ROS Accumulation and Oxidative Stress in the Hippocampus of Developing Rats Exposed to Isoflurane\nSince early exposure to isoflurane would induce excessive ROS accumulation inside the mitochondria, leading to the subsequent oxidative stress (Zhang et al., 2010; Boscolo et al., 2012, 2013a; Sun et al., 2014), we initially examined whether mitochondrion-targeted antioxidant elamipretide could timely inhibit hippocampal ROS accumulation and oxidative stress induced by isoflurane exposure. Our results showed that the levels of ROS (Figure 1A) and MDA (Figure 1B) were increased, while the expression and activity of SOD were reduced (Figures 1C,D) in the isoflurane group. However, the consequence was curtailed by elamipretide pretreatment (Figure 1), indicating that elamipretide provided rapidly antioxidative effects by inhibiting ROS accumulation and oxidative stress in the hippocampus of developing rat brain exposed to isoflurane.\nFigure 1. Effects of elamipretide pretreatment on isoflurane-induced oxidative stress in the hippocampus of developing rats. Elamipretide (5 mg/kg) or phosphate-buffered saline (PBS) was intraperitoneally administered to the pups with a volume of 0.4 ml/kg 30 min before gas inhalation. Anesthesia was induced by placing the pups in an anesthetizing chamber prefilled with 1.8% isoflurane plus 30% oxygen (O2) for 10 min and then changed to 1.5% isoflurane plus 30% O2 for 350 min. For control experiments, 30% O2 was delivered for 6 h at the same flow rate. Con: rats treated with PBS and 30% O2; Con + Ela: rats treated with elamipretide and 30% O2; Iso: rats treated with PBS and isoflurane; Iso + Ela: rats treated with elamipretide and isoflurane. The definition of Con/Con + Ela/Iso/Iso + Ela is the same as in the following figures. Reactive oxygen species (ROS) levels (A), Malondialdehyde (MDA) levels (B), Superoxide Dismutase (SOD) protein levels (C) and SOD activities (D) were determined with the fresh homogenates of hippocampal tissues obtained from postnatal day (PND) 7 rats (See “Materials and Methods” Section) immediately after 6 h of gas inhalation. Values are presented as mean ± SEM (n = 6 rats/group). p < 0.05 vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance.\nElamipretide Reverses Mitochondrial Ultrastructural Damages in the Hippocampus of Developing Rats Exposed to Isoflurane\nEarly exposure to GA may cause oxidative damages and long-term disturbances of mitochondrial morphology in developing rat brain (Sanchez et al., 2011; Boscolo et al., 2012). Here, we assessed whether timely diminishing substantial ROS and attenuating oxidative stress would ameliorate the damages of mitochondrial ultrastructure in developing rats exposed to isoflurane. We noted that isoflurane exposure caused early mitochondrial swelling (Figure 2A) at PND 7, and subsequently ultrastructural abnormalities (Figures 2B,C) at PND 21. In the isoflurane group, many mitochondria presented disorganized and vacuolated cristae (white arrows, Figures 2B, 3A) which made the mitochondria appear over-swelling and larger than normal ones. Other mitochondria were dark and condensed, indicating severe degenerative changes (black arrows, Figures 2B, 3A). In contrast, mitochondrial ultrastructure in the elamipretide-treated isoflurane group appeared similar to the control group with normal morphology of mitochondria without swelling or injury (Figures 2B,C). These results demonstrated that treatment with elamipretide before isoflurane exposure offered complete and lasting protection against isoflurane-induced ultrastructural damages of mitochondria in the hippocampus of developing rats.\nFigure 2. Ultrastructural changes in mitochondria of the hippocampal neurons after elamipretide pretreatment and isoflurane anesthesia. (A) Mitochondrial swelling was measured from fresh homogenates of the hippocampal tissues obtained from PND 7 rats. (B) Representative images of mitochondrial ultrastructure in hippocampal neuron of the developing rats at PND 21. White arrows: swollen mitochondria with disintegrated and disorganized mitochondrial inner membrane. Black arrows: degenerative mitochondria with dark and condensed presence. Scale bar = 0.5 μm for all the photographs. (C) Quantification analysis of abnormal-looking mitochondria in hippocampus of each group. Values are presented as mean ± SEM (n = 6 rats/group, four neurons from each rat). p < 0.05, vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance.\nFigure 3. Mitochondrial density and size classification in the hippocampal neurons after elamipretide pretreatment and isoflurane anesthesia. (A) Mitochondrial overview in hippocampal neuron of the developing rats at PND 21. Scale bar = 1 μm for all the photographs except for the last one (scale bar = 0.5 μm). (B) Mitochondrial density was assessed by counting the number of mitochondria per unit area (μm2) of cytoplasmic area in each neuron. (C) Mitochondrial area was presented as a percentage of the cytoplasmic area of hippocampal neuron. (D) Size classification was assessed by mitochondrial size and counting the number of mitochondria in each group. Values are presented as mean ± SEM (n = 6 rats/group, four neurons from each rat). p < 0.05, vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance.\nElamipretide Rescues Changes of Mitochondrial Density and Size in the Hippocampus of Developing Rats Exposed to Isoflurane\nSince GA appears to cause mitochondrial enlargement and disturb the regional distribution of developing neuronal mitochondria (Sanchez et al., 2011; Boscolo et al., 2012, 2013a), we performed detailed morphometric analysis of each mitochondrion and determined mitochondrial density in the soma of hippocampal neurons. We calculated mitochondrial density by counting the number of mitochondria per unit area (μm2) of cytoplasmic soma and measured mitochondrial areas as a percentage of the cytoplasmic area in each neuron (Figures 3A–C). The results showed that mitochondrial density in isoflurane group is less than that in control group (Figures 3A,B), but the mitochondria occupied more area of the cytoplasmic soma area in the isoflurane group than in the control group (Figures 3A,C). When classing mitochondria by their sizes and counting the number of mitochondria in each cell, we found more mitochondria larger than 0.5 μm in the isoflurane group than in the control group (Figure 3D). Interestingly, all the changes were completely reversed by elamipretide pretreatment (Figure 3). These results suggest that elamipretide offers mitochondrial protective effects associated with maintenance of mitochondrial density and size in spite of isoflurane exposure.\nElamipretide Suppresses Neuroapoptosis in the Hippocampus of Developing Rats Exposed to Isoflurane\nBecause isoflurane not only caused severe ROS generation and oxidative stress, but also disturbed mitochondrial morphogenesis, we examined whether these effects had long-lasting consequence with regard to developmental neuroapoptosis and whether elamipretide pretreatment would attenuate this neurotoxicity. Our results showed that prolonged (6 h) isoflurane exposure induced significant increase of caspase 3 (Figure 4) and the number of TUNEL-positive cells (Figure 5) in hippocampus, which was attenuated by elamipretide pretreatment, supporting that mitochondrion-targeted peptide elamipretide presented a long-lasting protection of hippocampal neurons from apoptosis.\nFigure 4. Isoflurane-induced activation of caspase 3 was attenuated by elamipretide pretreatment in the hippocampal CA1 and dentate gyrus (DG) regions. Representative images of cleaved caspase 3 in the hippocampal CA1 and DG regions are shown, revealed by immunohistochemical (IHC) staining at PND 21. Cells with brownish-yellow cytoplasm are positive for cleaved caspase 3. Scale bar = 100 μm for all the photographs except for the last two (scale bar = 50 μm). Lower panel presents statistical data from the four experimental groups. Values are presented as mean ± SEM (n = 6 rats/group). p < 0.05, vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance.\nFigure 5. The number of TUNEL-positive cells was diminished by elamipretide pretreatment in the hippocampal CA1. Representative images of TUNEL in the hippocampal CA1 region at PND 21 are shown. Green color indicates TUNEL-positive cells; blue, 4′,6-diamidino-2-phenylindole (DAPI) stained nucleus. Scale bar = 25 μm. The lower panel shows statistical numbers of TUNEL-positive cells. Values are presented as mean ± SEM (n = 6 rats/group). p < 0.05, vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance.\nElamipretide Ameliorates Isoflurane-induced Long-term Cognitive Deficits in Adolescent Rats\nTo further verify the beneficial effects of elamipretide on cognitive development, open field and MWM tests were performed at PND 40 or 60, respectively. Open field test showed no difference among the four groups in the spontaneous locomotor activity as reflected by the total distance (Figure 6A) and the time spent in the center (Figure 6B), excluding the possibility that locomotor activity per se affected the results in MWM tests. Elamipretide pretreatment successfully shortened the escape latency in training test (Figure 6C) and increased the crossing-platform times (Figures 6D,E) and target quadrant time (Figures 6D,F) in probe trial in the developing rats exposed to isoflurane. These results suggest that elamipretide has a potential therapeutic effect on long-term cognitive deficits in adolescent rats after early exposure to isoflurane.\nFigure 6. Elamipretide pretreatment prevented isoflurane-induced cognitive deficits in adolescent rats, tested at PND 40 or 60. (A) Total distance traveled and (B) time spent in the center in open field test. (C) Escape latency in every day during the spatial training of MWM. (D) Representative swimming trajectory of the rats, (E) crossing-platform times and (F) time spent in the target quadrant in the probe trial of MWM. Values are presented as mean ± SEM (n = 12 rats/group). p < 0.05 vs. the control group; #p < 0.05 vs. the isoflurane group; ns, no significance. The procedures of the water maze test are in “Materials and Methods” Section. MWM, Morris water maze.\nIn the present study, we showed that early exposure to isoflurane for the developing rats caused increased oxidative stress, mitochondrial deformation and neuronal apoptotic toxicity in the hippocampus. Pretreatment with mitochondrion-targeted antioxidant elamipretide resulted in significant improvement of mitochondrial integrity in the early and later period and, most importantly, prevented the young rats from development of anesthesia-induced cognitive deficits.\nA growing body of preclinical as well as some retrospective clinical evidences suggests that exposure to GA during the critical periods of development has been associated with neurotoxicity and long-term behavioral impairments (Flick et al., 2011; Ing et al., 2014b; Lin et al., 2014; Rappaport et al., 2015; Pinyavat et al., 2016; Walters and Paule, 2017). Consistently, we found that isoflurane administration induced long lasting neuronal apoptosis and cognitive deficits in developing rats. Mitochondria are supposed to be the most vulnerable initial target of these disorders (Sanchez et al., 2011; Boscolo et al., 2012, 2013a,b). Available evidences accompanying with our results suggest that rats exposed to isoflurane at PND 7 present substantial alterations in mitochondrial morphogenesis and regional distribution, manifested as a decrease of mitochondrial size as acute effects (at PND 8; Boscolo et al., 2013a) and an enlargement of mitochondria as long-term effects (at PND 21; Sanchez et al., 2011; Boscolo et al., 2012). Our findings are in agreement with previous studies (Sanchez et al., 2011; Boscolo et al., 2012) demonstrating that prolonged (6 h) isoflurane exposure causes swollen mitochondria with lower density and more cytoplasmic area occupation in the soma of hippocampal neurons at PND 21, suggesting long-term ultrastructural damages of mitochondria. It is likely that the swelling enlargement leads to “leakage” and results in neurotoxicity via activating the intrinsic mitochondria-dependent apoptotic pathway (Zhang et al., 2010; Wu et al., 2015a).\nAgents and strategies have been proposed to be potential to ameliorate the mitochondrial morphologic abnormality induced by neonatal GA (Boscolo et al., 2012, 2013a; Xu et al., 2016). These findings suggest that mitochondrial ROS as well as lipid peroxidation are important in the development and progression of impaired mitochondrial morphogenesis. In agreement with these, molecules that are capable of targeting and treating the dysfunctional mitochondria to suppress oxidative stress are needed. Elamipretide is a novel mitochondrion-targeted peptide to meet the need (Zhao et al., 2005; Szeto, 2008; Min et al., 2011; Hao et al., 2015; Yin et al., 2016). Previously, we found that elamipretide prevented isoflurane-induced mitochondrial ROS generation to improve mitochondrial function in aged mice (Wu et al., 2015a, 2016). Here, we show that elamipretide attenuates acute ROS accumulation induced by isoflurane exposure and, more importantly, protects mitochondrial morphology from enlargement in neonatal rats lasting to early adulthood. As a result, elamipretide ameliorated isoflurane-induced long-term cognitive deficits. Thus, we provide the evidences that elamipretide not only improves biochemical and pathological processes, but also the preclinical symptoms. Consistence with that, elamipretide was reported to reduce impaired mitochondrial dynamics and enhance mitochondrial biogenesis in Huntington’s disease neurons (Yin et al., 2016). Due to the superpower properties of elamipretide, more than 20 clinical trials (registered as elamipretide or Bendavia) have been being conducted as phase 1 or 2 drug1 covering a number of mitochondrial disorders. So far the safety and tolerability were well confirmed (Gibson et al., 2016), which might potentially raise a new therapeutic strategy for elamipretide as a drug to protect pediatric patients undertaking GA.\nIn conclusion, this is the first study to our knowledge that directly targeting mitochondrial ROS ameliorated isoflurane-induced long-term impairments of mitochondrial morphogenesis and cognition in developing rats. This work suggests a new strategy to reverse developing- and/or mitochondrion-related impairments in GA-induced neurotoxicity and cognitive deficits.\nJW, KL and J-JY conceived and designed experiments. JW and SH performed experiments and data acquisition. JW, SH, KL and J-JY analyzed and interpreted data. JW and KL wrote the manuscript. X-RS, HZ, HL, HtZ and M-HJ contributed to acquiring and analyzing data. All authors read and approved the final manuscript.\nConflict of Interest Statement\nThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.\nThis work was supported by the National Basic Research Program of China (Grant No. 2015CB856300), the National Nature Science Foundation of China (Grant Nos. 31371060, 81271216, 81471105) and the Program B for Outstanding PhD Candidate of Nanjing University (Grant No. 201602B070).\nBoscolo, A., Milanovic, D., Starr, J. A., Sanchez, V., Oklopcic, A., Moy, L., et al. (2013a). Early exposure to general anesthesia disturbs mitochondrial fission and fusion in the developing rat brain. Anesthesiology 118, 1086–1097. doi: 10.1097/ALN.0b013e318289bc9b\nBoscolo, A., Ori, C., Bennett, J., Wiltgen, B., and Jevtovic-Todorovic, V. (2013b). Mitochondrial protectant pramipexole prevents sex-specific long-term cognitive impairment from early anaesthesia exposure in rats. Br. J. Anaesth. 110, i47–i52. doi: 10.1093/bja/aet073\nBoscolo, A., Starr, J., Sanchez, V., Lunardi, N., DiGruccio, M., Ori, C., et al. (2012). The abolishment of anesthesia-induced cognitive impairment by timely protection of mitochondria in the developing rat brain: the importance of free oxygen radicals and mitochondrial integrity. Neurobiol. Dis. 45, 1031–1041. doi: 10.1016/j.nbd.2011.12.022\nFlick, R. P., Katusic, S. K., Colligan, R. C., Wilder, R. T., Voigt, R. G., Olson, M. D., et al. (2011). Cognitive and behavioral outcomes after early exposure to anesthesia and surgery. Pediatrics 128, e1053–e1061. doi: 10.1542/peds.2011-0351\nGibson, C. M., Giugliano, R. P., Kloner, R. A., Bode, C., Tendera, M., Janosi, A., et al. (2016). EMBRACE STEMI study: a Phase 2a trial to evaluate the safety, tolerability, and efficacy of intravenous MTP-131 on reperfusion injury in patients undergoing primary percutaneous coronary intervention. Eur. Heart J. 37, 1296–1303. doi: 10.1093/eurheartj/ehv597\nHao, S., Ji, J., Zhao, H., Shang, L., Wu, J., Li, H., et al. (2015). Mitochondrion-targeted peptide SS-31 inhibited oxidized low-density lipoproteins-induced foam cell formation through both ROS scavenging and inhibition of cholesterol influx in RAW264.7 cells. Molecules 20, 21287–21297. doi: 10.3390/molecules201219764\nIng, C. H., DiMaggio, C. J., Malacova, E., Whitehouse, A. J., Hegarty, M. K., Feng, T., et al. (2014a). Comparative analysis of outcome measures used in examining neurodevelopmental effects of early childhood anesthesia exposure. Anesthesiology 120, 1319–1332. doi: 10.1097/ALN.0000000000000248\nIng, C. H., DiMaggio, C. J., Whitehouse, A. J., Hegarty, M. K., Sun, M., von Ungern-Sternberg, B. S., et al. (2014b). Neurodevelopmental outcomes after initial childhood anesthetic exposure between ages 3 and 10 years. J. Neurosurg. Anesthesiol. 26, 377–386. doi: 10.1097/ANA.0000000000000121\nJevtovic-Todorovic, V., Boscolo, A., Sanchez, V., and Lunardi, N. (2012). Anesthesia-induced developmental neurodegeneration: the role of neuronal organelles. Front. Neurol. 3:141. doi: 10.3389/fneur.2012.00141\nMin, K., Smuder, A. J., Kwon, O. S., Kavazis, A. N., Szeto, H. H., and Powers, S. K. (2011). Mitochondrial-targeted antioxidants protect skeletal muscle against immobilization-induced muscle atrophy. J. Appl. Physiol. 111, 1459–1466. doi: 10.1152/japplphysiol.00591.2011\nNoguchi, K. K., Johnson, S. A., Kristich, L. E., Martin, L. D., Dissen, G. A., Olsen, E. A., et al. (2016). Lithium protects against anaesthesia neurotoxicity in the infant primate brain. Sci. Rep. 6:22427. doi: 10.1038/srep22427\nPinyavat, T., Warner, D. O., Flick, R. P., McCann, M. E., Andropoulos, D. B., Hu, D., et al. (2016). Summary of the update session on clinical neurotoxicity studies. J. Neurosurg. Anesthesiol. 28, 356–360. doi: 10.1097/ANA.0000000000000347\nRappaport, B. A., Suresh, S., Hertz, S., Evers, A. S., and Orser, B. A. (2015). Anesthetic neurotoxicity—clinical implications of animal models. N. Engl. J. Med. 372, 796–797. doi: 10.1056/NEJMp1414786\nSanchez, V., Feinstein, S. D., Lunardi, N., Joksovic, P. M., Boscolo, A., Todorovic, S. M., et al. (2011). General anesthesia causes long-term impairment of mitochondrial morphogenesis and synaptic transmission in developing rat brain. Anesthesiology 115, 992–1002. doi: 10.1097/ALN.0b013e3182303a63\nSun, Y., Cheng, B., Dong, Y., Li, T., Xie, Z., and Zhang, Y. (2014). Time-dependent effects of anesthetic isoflurane on reactive oxygen species levels in HEK-293 cells. Brain Sci. 4, 311–320. doi: 10.3390/brainsci4020311\nWalters, J. L., and Paule, M. G. (2017). Review of preclinical studies on pediatric general anesthesia-induced developmental neurotoxicity. Neurotoxicol. Teratol. 60, 2–23. doi: 10.1016/j.ntt.2016.11.005\nWang, W. Y., Luo, Y., Jia, L. J., Hu, S. F., Lou, X. K., Shen, S. L., et al. (2014). Inhibition of aberrant cyclin-dependent kinase 5 activity attenuates isoflurane neurotoxicity in the developing brain. Neuropharmacology 77, 90–99. doi: 10.1016/j.neuropharm.2013.09.006\nWu, J., Li, H., Sun, X., Zhang, H., Hao, S., Ji, M., et al. (2015a). A mitochondrion-targeted antioxidant ameliorates isoflurane-induced cognitive deficits in aging mice. PLoS One 10:e0138256. doi: 10.1371/journal.pone.0138256\nWu, J., Zhang, M., Hao, S., Jia, M., Ji, M., Qiu, L., et al. (2015b). Mitochondria-targeted peptide reverses mitochondrial dysfunction and cognitive deficits in sepsis-associated encephalopathy. Mol. Neurobiol. 52, 783–791. doi: 10.1007/s12035-014-8918-z\nWu, J., Zhang, M., Li, H., Sun, X., Hao, S., Ji, M., et al. (2016). BDNF pathway is involved in the protective effects of SS-31 on isoflurane-induced cognitive deficits in aging mice. Behav. Brain Res. 305, 115–121. doi: 10.1016/j.bbr.2016.02.036\nXu, F., Armstrong, R., Urrego, D., Qazzaz, M., Pehar, M., Armstrong, J. N., et al. (2016). The mitochondrial division inhibitor Mdivi-1 rescues mammalian neurons from anesthetic-induced cytotoxicity. Mol. Brain 9:35. doi: 10.1186/s13041-016-0210-x\nXu, K. X., Tao, J., Zhang, N., and Wang, J. Z. (2015). Neuroprotective properties of vitamin C on equipotent anesthetic concentrations of desflurane, isoflurane, or sevoflurane in high fat diet fed neonatal mice. Int. J. Clin. Exp. Med. 8, 10444–10458.\nYin, X., Manczak, M., and Reddy, P. H. (2016). Mitochondria-targeted molecules MitoQ and SS31 reduce mutant huntingtin-induced mitochondrial toxicity and synaptic damage in Huntington’s disease. Hum. Mol. Genet. 25, 1739–1753. doi: 10.1093/hmg/ddw045\nZhang, H., Sun, X. R., Wang, J., Zhang, Z. Z., Zhao, H. T., Li, H. H., et al. (2016). Reactive oxygen species-mediated loss of phenotype of parvalbumin interneurons contributes to long-term cognitive impairments after repeated neonatal ketamine exposures. Neurotox. Res. 30, 593–605. doi: 10.1007/s12640-016-9653-1\nZhang, Y., Dong, Y., Wu, X., Lu, Y., Xu, Z., Knapp, A., et al. (2010). The mitochondrial pathway of anesthetic isoflurane-induced apoptosis. J. Biol. Chem. 285, 4025–4037. doi: 10.1074/jbc.M109.065664\nZhao, K., Luo, G., Giannelli, S., and Szeto, H. H. (2005). Mitochondria-targeted peptide prevents mitochondrial depolarization and apoptosis induced by tert-butyl hydroperoxide in neuronal cell lines. Biochem. Pharmacol. 70, 1796–1806. doi: 10.1016/j.bcp.2005.08.022\nKeywords: elamipretide, general anesthesia, antioxidant, mitochondrial morphology, cognition\nCitation: Wu J, Hao S, Sun X-R, Zhang H, Li H, Zhao H, Ji M-H, Yang J-J and Li K (2017) Elamipretide (SS-31) Ameliorates Isoflurane-Induced Long-Term Impairments of Mitochondrial Morphogenesis and Cognition in Developing Rats. Front. Cell. Neurosci. 11:119. doi: 10.3389/fncel.2017.00119\nReceived: 16 February 2017; Accepted: 10 April 2017;\nPublished: 25 April 2017.\nEdited by:Chao Deng, University of Wollongong, Australia\nReviewed by:Cláudia Fragão Pereira, University of Coimbra, Portugal\nHari Prasad Osuru, University of Colorado Hospital, USA\nCopyright © 2017 Wu, Hao, Sun, Zhang, Li, Zhao, Ji, Yang and Li. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.\n† These authors have contributed equally to this work.
Septoplasty is a surgery to straighten a\n. The septum is the wall dividing the left and right nasal cavities. It is made of cartilage and bone and is lined with a thin mucus membrane.\nA normal septum is straight and in the center of the nose. A deviated septum is bent or off-center. Septal deviation may occur during development in the womb, during birth, as your nose grows, or after a traumatic injury. Septoplasty may be done at the same time as other nasal surgery, like\nSeptoplasty is considered if a deviated septum obstructs your nasal passages. The obstruction can cause impaired nasal breathing,\nobstructive sleep apnea\n, or a runny nose. A deviated septum may also need to be corrected with septoplasty if it causes chronic headaches.\nDeviated Nasal Septum\nCopyright © Nucleus Medical Media, Inc.\nProblems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like: Numbness in the tip of the nose or upper front teethBleedingInfectionSeptal perforation—a hole in the septumNo improvement in symptomsPoor cosmetic outcome\nBefore your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as: SmokingDrinkingChronic diseases, such as diabetes or obesity\nTo prepare for surgery, follow any instructions provided by your doctor.\nTalk to your doctor about your medications, including vitamins, herbs, or dietary supplements. You may be asked to stop taking some medications up to one week before the procedure, like:\nBlood thinnersAntiplateletsIf you are having local anesthesia for the procedure, it is likely that no other special preparation is needed. If you will be having general anesthesia, your doctor will give you additional instructions.\nSeptoplasty can be done using local or\nanesthesia. Local anesthesia will numb the area. General anesthesia will put you to sleep.\nAn incision will be made inside the nose. The lining of the septum will be lifted up and out of the way.\nThe bent bone or cartilage will be straightened by moving it or cutting off the bent piece. After the repair is done, the lining will be replaced over the top of the septum. Gauze may be placed in the nose to soak up any blood. A plastic splint may also be inserted to keep the septum in place while it heals.\nAnesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.\nMost people leave the care center after 3-4 hours.\nDuring your stay, the care center staff will take steps to reduce your chance of infection, such as: Washing their handsWearing gloves or masksKeeping your incisions covered\nThere are also steps you can take to reduce your chance of infection, such as: Washing your hands often and reminding your healthcare providers to do the sameReminding your healthcare providers to wear gloves or masksNot allowing others to touch your incision\nIf nasal packing is used, it is removed 1-2 days after the surgery. The splint remains in the nose for up to a week. After the surgery, do the following to ensure a smooth recovery: Try to breathe through your mouth for the first few days.Do not blow your nose.Keep your head elevated when lying down for the first 1-2 days.Apply ice packs to your nose to reduce pain and swelling.Do not take aspirin products for pain.Your doctor may want to see you for a follow-up visit to monitor healing or to remove the gauze packing or splint.\nCall your doctor if any of the these occur: Signs of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteHeavy bleedingPacking from your nose falls into the back of your throat, causing discomfortPersistent nausea and/or vomitingVomit that is bloody or the color of coffee groundsPain that you cannot control with the medications you have been givenCough, shortness of breath, or chest pain\nIf you think you have an emergency, call for medical help right away.\nDeviated septum. Cedars-Sinai website. Available at:\nhttp://www.cedars-sinai.edu/Patients/Health-Conditions/Deviated-Septum.aspx. Accessed July 23, 2013.\nDeviated septum. Children's Hospital of Pittsburgh website. Available at:\nhttp://www.chp.edu/CHP/P02062. Accessed July 23, 2013.\nFact sheet: deviated septum. American Academy of Otolaryngology website. Available at\nhttp://www.entnet.org/HealthInformation/deviatedSeptum.cfm. Accessed July 23, 2013.\n6/3/2011 DynaMed's Systematic Literature Surveillance\nhttp://www.ebscohost.com/dynamed: Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis.\nAm J Med.\nLast reviewed July 2013 by Marcin Chwistek, MD; Michael Woods, MD\nPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.\nCopyright © EBSCO Publishing. All rights reserved.
Bone augmentation in upper jaw â€“ in other words: Sinus lift.\nThe “sinus floor augmentation”, aka “sinus lift” is a procedure to level out the too little bone substance in the upper jaw. The problem ofÂ limited bone supply may occur because the maxillary sinuses get larger and continuously extend in the upper jaw bone as we get older.\nDentists also use this solution when the jaw ridge is too narrow.\nIn this article you will get answers to the following:\n- When is a sinus lift necessary?\n- Materials for bone augmentation – What options are available?\n- What is the procedure of a sinus lift operation?\n- Is there any pain?\n- Where can the jawbone augmentation be carried out?\nWhen is a sinus lift necessary?\nIn a successful implantation, the quality of the bone plays the most important role. The bone must have a very good substance, as the artificial tooth root is embedded in the bone. The implant has to join with the surrounding bone. Therefore it is important that the jaw ridge has enough substance, so that the implant can grow together with the bone.\nMaterials for bone augmentation – What options are available?\nAutologous bone can be recovered sufficiently from different parts of the body. There is no risk of infection for the patient and therefore the body’s own bone is superior to all other materials.\nNatural bone substitute materials are obtained from animals (bone and connective tissues). Natural bone replacement materials are suitable for the filling of smaller jaw defects, or as addition to the patient’s own bone.\nSynthetic bone substitute materials consist of ceramics based on calcium. They are producedÂ as granules. Due to their moderate stability, dentists only use them to correct smaller jaw defects.\nYour dentist will determine the rightÂ material for your case in base of the results of the necessary clinical and radiological examinations.\nWhat is the procedure of a sinus lift operation?\nIn most cases, the dentist performs the sinus lift surgery under local anesthesia. The dentist lifts the sinus floor, carefully detaches the mucous membrane and pushes it upwards. This results in a deepening between the mucous membrane and alveolar ridge. The dentist fills this void with bone graft material or with the patient’s own bone.\nIn some cases the dentist can carry out the sinus lift and the placement of implants in the same session, but oftentimes there is a healing period of 3 to 6 months between the two procedures.\nIs there any pain?\nYou may experience some pain after the effect of theÂ anesthesia wears off. Your dentist will recommend you suitable painkillers (mostly: Ibuprofen 400) for any eventualÂ discomfort and pain. YouÂ must avoid medications containing ASA (acetylsalicylic acid), as aspirin, as they cause or enhance bleeding. If your doctor has prescribed you antibiotics, take the medication as prescribed, even if you have no complaints whatsoever.\nWhere can the jawbone augmentation be carried out?\nIn principle, there are only a few places in Europe where dental surgeons perform the surgery for the jaw bone grafting. Hungary is one of the most famous places of internationally renowned dental treatments. A dental treatment in Hungary is exceptionally reliable because of our excellent and well-trained doctors. Furthermore, it is important to know that the dental tourism in Hungary is well developed and organised, so that patients can travel back home with the greatest satisfaction about their teeth.\nThe cost of a sinus lift in Hungary is around 510 usd.
Your pet is an important part of your family, and when he or she is ill, you want the best medical care available.\nSpay & Neuter\nSurgery includes routine as well as unexpected procedures. Spaying and Neutering your pet can prevent unwanted litters and avoid multiple illnesses related to reproductive systems such as pyometra (infection of the uterus), mammary cancer, dystocia, perineal hernia, urethral prolapse, testicular cancer – all of which can be deadly.\nOur experienced team of doctors and staff make it their number one priority to focus on pain management, patient safety, and we use the most current surgical practices to ensure your pet receives the best veterinary care. Our team will be working with you before, during, and after surgery to address any questions or concerns you may have about the surgical procedure, anesthesia, or postoperative care.\nIt is recommended to examine your pet’s feces annually to ensure no new parasitic infections have been acquired.\nEven if dewormer was administered a fecal examination is recommended to ensure the appropriate medication was used, there are numerous infectious organisms that can be identified in the feces that require different medications to be cleared. Not all parasites are visible by eye and not all parasitic infestations necessarily cause diarrhea.\nWest Russell Animal Hospital requires a negative fecal examination within the past year to permit boarding.\nFlea and tick prevention\n\|Weight (lbs)\|\|Cat Neuter\|\|Cat Spay\|\n\|Dog Neuter\|\|Cat Spay\|\nPricing includes Pre-anesthetic exam, IV cath, anesthesia monitoring, pre and post-operative pain meds, e-collar and nail trim. Not valid with any other specials or coupons.\nPlease note there are various options when spaying or neutering your pet. Call to speak to a member of our veterinary team to discuss your pet’s individualized needs. Additional costs may apply to pets in heat, pregnant, or with other health concerns
Analgesia for day-case shoulder surgery\nSingle-shot nerve blocks provide excellent postoperative analgesia for a limited period and are increasingly used in day-case units. They allow early patient discharge following painful operative procedures that would otherwise require overnight hospitalization. We investigated the adequacy of analgesia at home after the block had worn off.Methods\nA prospective audit by telephone 1 week after surgery of 50 consecutive patients who had had a single-shot interscalene block for day-case shoulder arthroscopic surgery.Results\nThe mean length of adequate sensory block was 22.5 h (9–48 h) after which 20% of patients had a maximum visual analogue scale (VAS) score of 5/5. Most patients did not take analgesics as prescribed and two patients (5.4%) required additional analgesia from their family doctor or accident and emergency department.Conclusions\nWe conclude that analgesia at home is often inadequate after painful day-case surgical procedures if single-shot local anaesthetic blockade is used.
Learn About Your Surgery Experience\nBefore your procedure we work with you to gather paper work, review financial information, and ensure you’re completely prepared and comfortable.\nAfter getting checked in, you’ll be assisted by one of our friendly nurses to review your health history and get you all prepped. Then your physician and anesthesiologist will discuss the entire procedure with you, making everyone is on the same page. When everything is set, you will be taken back for your procedure.
Case Reports in Anesthesiology\nVolume 2012 (2012), Article ID 592198, 3 pages\nImpossible Airway Requiring Venovenous Bypass for Tracheostomy\nDepartment of Anesthesiology, Montefiore Medical Center, Bronx, New York City, NY 10467, USA\nReceived 26 June 2012; Accepted 29 July 2012\nAcademic Editors: J. J. Derose, M. Kodaka, and M. Marandola\nCopyright © 2012 Johnathan Gardes and Tracey Straker. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.\nThe elective surgical airway is the definitive management for a tracheal stenotic lesion that is not a candidate for tracheal resection, or who has failed multiple-tracheal dilations. This case report details the management of a patient who has failed an elective awake tracheostomy secondary to the inability to be intubated as well as severe scar tissue at the surgical site. A combination of regional anesthesia and venovenous bypass is used to facilitate the surgical airway management of this patient. Cerebral oximetry and a multidisciplinary team approach aid in early detection of an oxygenation issue, as well as the emergent intervention that preserved this patient’s life.\nProper management of the difficult airway presents one of the most important skill sets for the anesthesiologist to master. However, certain situations necessitate one look beyond traditional algorithms. In this case, a multidisciplinary team of otorhinolaryngologists, cardiac surgeons, perfusionists, and anesthesiologists decided to use venovenous bypass as a means to oxygenate a patient whose airway could not be secured because of severe tracheal stenosis.\n2. Case Report\nA 45-year-old woman with a long history of tracheal stenosis and upper airway obstruction presented for elective tracheostomy placement in the setting of supra- and infraglottic stenosis after failed awake tracheostomy by an otorhinolaryngologist (ORL) (Figures 1 and 2). It was felt by the attending ORL surgeon that the airway could not be secured from above after serial diagnostic scopes. Due to the failed awake tracheostomy, it was felt that surgical airway under bypass was the only option.\nEight years previously, the patient presented for an elective bilateral tubal ligation. At the time, she was otherwise healthy. The intraoperative course was unremarkable and the patient’s trachea was extubated on the operating table. However, after moving to the stretcher for transport, she developed acute respiratory distress. She was quickly returned to the operating room (OR) table and her trachea reintubated after several attempts at direct laryngoscopy. At the time, her airway was noted to be acutely swollen and edematous. She remained intubated in the intensive care unit for two weeks during which time several attempts at extubation failed. Finally, she was weaned off support and discharged home. The presumptive diagnosis was an acute allergic reaction to the antibiotic cephazolamine, which she had received intraoperatively.\nTwo days after discharge the patient returned to the emergency room in acute respiratory distress and could not be intubated. An emergency tracheostomy was performed to secure her airway. The patient remained with the tracheostomy for the next 7 months before she was successfully decannulated. Since that time, the patient has returned to the operating room several times with tracheal stenosis requiring dilation. Her past medical history was also significant for hypothyroidism, morbid obesity, obstructive sleep apnea requiring continuous positive airway pressure (CPAP), and hypertension. Medications included levothyroxine sodium, furoate monohydrate by nasal inhalation and esomeprazole. Allergies to latex and cephalosporins were reported. Review of symptoms was significant for chronic shortness of breath and three pillow orthopnea. The patient had fasted for more than 8 hours. On physical examination, the patient was mildly hypertensive, with a class III airway, mild stridor, and oozing from the site of the prior tracheostomy. All laboratory values and the cardiogram were within normal limits.\nBecause of the inability to secure the airway, even by tracheostomy, and repeated incidents of desaturation during prior attempts, the team felt that adequate oxygenation could best be managed by venovenous bypass. Venovenous bypass was suggested after consultation with the cardiac anesthesiology team because oxygenation would be maintained and the cardiac function of the patient was normal. The ORL surgeon requested that we do not cannulate any structures in the neck as they would be working in that area. With this request from the ORL service and the fact that arterial venous bypass provides greater control over hemodynamics, femoral bypass was the chosen area for cannulation.\nThe anesthetic plan for spinal without sedation was discussed with the patient. The patient was brought into the OR where standard ASA monitors were placed including arterial cannulation and cerebral oximetry. Spinal anesthesia was placed at L4-5 using 24G Gertie Marx spinal needle and 1.2 mL of hyperbaric 7.5% bupivacaine. The patient had a T10 level at 5 minutes with vital signs stable throughout. Of note, the patient started to receive an infusion of vancomycin prior to incision and immediately experienced pruritus and scratchy throat. The antibiotic infusion was promptly discontinued and the patient was given steroids and subcutaneous epinephrine. The symptoms resolved and surgery continued. The patient was heparinized. Just prior to going on femoral venovenous bypass, general anesthesia was induced using midazolam, fentanyl, and etomidate. Once on bypass, vecuronium was given. As the patient was to have a tracheostomy on bypass, general anesthesia was instituted to assure no issues of recall.\nShortly bypass was initiated, cerebral oximetry and pulse oximetry values as well as blood pressure all dropped rapidly, likely from poor brain and upper extremity perfusion caused by the bypass. During cutdown on the patient’s vasculature, it was discovered that he had severe tortuosity of the vessels. The cut-down time was extensive and the spinal anesthetic began to wear off. It was thought that one of the differentials for failure of bypass was the creation of a false lumen from the cannulation.\nAt this point, the otorhinolaryngologist rapidly secured the airway using rigid laryngoscopy and placed an oral endotracheal tube. With proper ventilation, the vital signs all returned to normal and she was taken off bypass and the heparin was reversed. The tracheostomy was then performed by the surgeon under general anesthesia. The remainder of the intraoperative course was unremarkable and the patient was extubated at the end of the case. The patient did well postoperatively and was discharged home.\nThe difficult airway algorithm from the American Society of Anesthesiologists details a complex decision tree of basic and advanced airway management choices in both the awake and anesthetized patient who has suspected or known difficult ventilation and/or intubation . The final steps in this algorithm end with invasive or surgical airway access. In this case, the patient had already failed awake surgical airway and was believed to have additional upper airway obstruction and anatomy that would prevent safe intubation either awake or asleep. With the failure of what is usually the final step in the algorithm, the anesthesia team in consultation with other surgical specialists opted for venovenous bypass as a means to oxygenate and anesthetize a patient whose airway could not be secured. While extracorporeal membrane oxygenation (ECMO) has been utilized and reported in the pediatric population fairly extensively, venovenous bypass has only rarely been reported in the literature as a means of oxygenation in the setting of the impossible airway in an adult, often in the setting of a large thyroid or mediastinal tumor or severe tracheal trauma [2, 3]. Rosa and colleagues and Jeon and colleagues both presented cases of cardiopulmonary bypass being safely utilized in this manner for cases of a cervical and thyroid tumor, respectively [4, 5]. Shiraishi and colleagues presented a series of 18 cases of tracheal resection and reconstruction, one of which required percutaneous cardiopulmonary support under minimal sedation . Cardiopulmonary bypass is not without risk and complications as demonstrated by the fall in cerebral oximetry and pulse oximetry in our patient. .\nThe ORL surgeon admitted that this case was transferred to him from a colleague, and he had actually never instrumented the patient’s airway in the operating room for a direct laryngoscopy. Perhaps had the otorhinolaryngologist actually instrumented the airway previously, better objective data would have been available to avoid the case outcome.\nThe otorhinolaryngologist was present throughout the procedure and was able to provide a rapid and safe emergency airway intervention that allowed the patient to be adequately oxygenated. While our patient had an uncomplicated postoperative course, the risk of hemorrhage in this population is significant.\nEven though the patient was unable to tolerate bypass for the length of the tracheostomy procedure and required alternative means of securing the airway, the presence of the multidisciplinary team provided safe and effective backup. We believe that rare and complex airway situations such as this case should always be approached with a multidisciplinary team of surgeons and anesthesiologists as the alternatives to traditional airway management such as venovenous bypass can be extremely challenging and unpredictable.\n- American Society of Anesthesiologists Task Force on Management of the Difficult Airway, “Practice guidelines for management of the difficult airway: an updated report by the American Society of Anesthesiologists task force on management of the difficult airway,” Anesthesiology, vol. 98, no. 5, pp. 1269–1277, 2003.\n- J. Raake, B. Johnson, B. Seger, et al., “Extracorporeal membrane oxygenation, extubation, and lung-recruitment maneuvers as rescue therapy in a patient with tracheal dehiscence following slide tracheoplasty,” Respiratory care, vol. 56, no. 8, pp. 1198–1202, 2011.\n- C. SenDasgupta, G. Sengupta, K. Ghosh, A. Munshi, and A. Goswami, “Femoro-femoral cardiopulmonary bypass for the resection of an anterior mediastinal mass,” Indian Journal of Anaesthesia, vol. 54, no. 6, pp. 565–568, 2010.\n- P. Rosa, E. A. Johnson, and P. J. Barcia, “The impossible airway: a plan,” Chest, vol. 109, no. 6, pp. 1649–1650, 1996.\n- H.-K. Jeon, Y. K. So, J. H. Yang, and H. S. Jeong, “Extracorporeal oxygenation support for curative surgery in a patient with papillary thyroid carcinoma invading the trachea,” Journal of Laryngology and Otology, vol. 123, no. 7, pp. 807–810, 2009.\n- T. Shiraishi, J. Yanagisawa, T. Higuchi et al., “Tracheal resection for malignant and benign diseases: surgical results and perioperative considerations,” Surgery Today, vol. 41, no. 4, pp. 490–495, 2011.\n- M. J. Belmont, M. K. Wax, and F. N. DeSouza, “The difficult airway: cardiopulmonary bypass—the ultimate solution,” Head and Neck, vol. 20, pp. 266–269, 1998.
The Gräfenberg spot, more commonly known as the G-spot, is an internal erogenous zone located on the front vaginal wall. There is some controversy about its existence. When stimulated, the G-spot can lead to more intense sexual arousal and stronger orgasms, yet can be difficult for women and their partners to locate and stimulate properly. The G-spot augmentation procedure is a simple injection that enlarges the G-spot for improved sensation without surgery.\nBoard certified plastic surgeon Dr. Otto Placik is a leading provider of G-spot enhancement for women in the Chicago area. A genital rejuvenation specialist, Dr. Placik has helped thousands of women to feel positive about their bodies and enjoy a more vibrant sex life.\nAbout G-Spot Enhancement\nThe G-spot is located beneath the surface of the anterior vaginal wall, typically about halfway between the cervix and the pubic bone. Because of its location, this erogenous zone can only be stimulated indirectly through the vaginal wall. This normally occurs during intercourse to some extent, but G-spot augmentation can help those women who desire more sensation, or who want to experience more intense vaginal orgasms.\nG-spot augmentation delivers a shot of filler directly to the G-spot, enlarging the erogenous area to about the size of a quarter in diameter and augmenting the thickness as well. In a pilot study, 87 percent of women reported enhanced sexual arousal and gratification following the injection.\nDuring your appointment, Dr. Placik will position you in stirrups, similar to getting a Pap smear. Next, he’ll measure exactly where you currently feel the most sensation in your vaginal wall, so he can more precisely target the treatment to your unique anatomy. Finally, the area is numbed with a local anesthetic and Dr. Placik administers the injection. After the treatment, Dr. Placik will ask you to wear a tampon for 4 hours.\nThe entire appointment generally takes less time than your lunch break, and you can resume sexual activity as soon as the tampon is removed, about 4 hours following your procedure. Results should be immediately noticeable, and can last for several months or more.\nG-Spot Enhancement FAQ\nThe best results from G-spot augmentation are seen in sexually active women who are familiar with their own anatomy and who enjoy G-spot stimulation. Any woman who is interested in more a accessible G-spot or who wants to experience more intense vaginal orgasms may be a good candidate.\nMaking G-spot stimulation easier by amplifying the G-spot itself can lead to faster arousal and stronger vaginal orgasms. The majority of women who undergo the G-spot augmentation report a more intense sex life after the procedure. If clitoral stimulation is a concern for you as well, Dr. Placik may also recommend clitoral hood reduction to allow easier access to the clitoris during intercourse.\nThe cost of G-spot enhancement can vary depending whether the procedure is administered on its own or in combination with additional vaginal rejuvenation. G-spot augmentation may also be included as part of a mommy makeover, in which case the total surgical costs would also include the anesthesiologist’s fee and charge for the surgical facility. However, it is often best to defer the injection when sexual activity is permissible and resumed following the more extensive procedures. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nSince you can resume sexual activity just a few hours after your appointment, most women notice results almost immediately. You and your partner should be able to locate your G-spot in a non-aroused state more easily, and notice heightened G-spot stimulation during intercourse along with deeper vaginal orgasms. Although the body naturally absorbs the injected collagen over time, the effects typically last between 3-6 months, with an average of 4 months for most women.\nDr. Placik uses a local anesthetic prior to performing the treatment, so the procedure should be completely painless with a comfort level that’s similar to an annual gynecological exam. There may be slight spotting after your appointment, but this is not normally accompanied by pain or cramping. More time during your appointment will be spent on determining the correct measurements than delivering the injection itself, which only takes a few seconds.\nBecause a G-spot injection is nonsurgical, the risks are very minimal, and include concerns like itching, irritation or bleeding at the injection site. More serious complications, like urinary tract infections, scarring or lumpiness, are possible but rare.\nDr. Placik is a board certified plastic surgeon in Chicago and an active member of The American Society of Plastic Surgeons. He received his medical degree from Northwestern University where he also completed residencies in general and plastic and reconstructive surgery.\nClitoral Hood Reduction\nThe clitoris is the most sensitive area of a woman’s body, with over 8000 nerve endings. The visible tip of the clitoris (clitoral glans) is partially covered by the clitoral hood. Although the clitoral hood provides protection, excess hood tissue can interfere with stimulation and make achieving orgasm more difficult.\nClitoral hood reduction permanently removes excess or redundant tissue so the clitoris can be more easily stimulated or accessed during sex. This can help women become aroused and achieve orgasm more quickly. The clitoral hood can also be reduced for aesthetic reasons, often as part of a labiaplasty. It is quite different from a hoodectomy, where all the hood tissue is removed with constant exposure of the clitoris. Clitoral hood reduction has many other names such as a hoodoplasty, hoodotomy, and may be referred to as a clitoroplasty, although this should be distinguished from a clitoropexy or clitoral reduction, which are performed for an excessively large or protruding clitoris.\nGenital rejuvenation specialist Dr. Otto Placik is a board-certified plastic surgeon serving Chicago and its suburbs. Dr. Placik is a skilled surgeon who has helped hundreds of women achieve improved sexual confidence through clitoral hood reduction.\nAbout Clitoral Hood Reduction\nThe sole purpose of the clitoris (sometimes colloquially referred to as the “clit”) is to provide sexual pleasure, and the majority of women cannot climax without clitoral stimulation. However, if the clitoral hood provides too much protective coverage or the excess tissue is so bulky that direct stimulation of the clitoris cannot occur, the feelings of arousal can be greatly diminished. An overly large clitoral hood can also make reaching orgasm more difficult.\nDuring clitoral hood reduction, Dr. Placik uses a meticulous and cautious surgical technique to avoid removing too much tissue that could leave the clitoris overly exposed, a sensation that patients may find too intense. The clitoris itself and surrounding nerves are not touched during the procedure, ensuring that you retain full sensation after surgery.\nIn most cases, clitoral hood reduction is performed as an outpatient procedure and doesn’t require general anesthesia or a hospital stay. Instead, Dr. Placik prefers using a local anesthetic, sometimes combined with oral sedation. Dr. Placik adopts a delicate approach toward clitoral hood reduction in order to prevent scarring and ensure optimum results.\nPatients typically return home the same day as their surgery, although recovery time will vary depending on if other procedures were performed at the same time. It’s common to perform a clitoral hood reduction in combination with other female genital rejuvenation procedures such as labiaplasty or vaginal rejuvenation. Incorporating G-spot enhancement at the same time can help increase internal sexual sensation in addition to the enhanced clitoral stimulation women often experience after clitoral hood reduction.\nClitoral Hood Reduction\nClitoral Hood Reduction FAQ\nWomen who find that achieving clitoral stimulation is difficult or diminished or who are unhappy with the physical appearance of excess tissue covering their clitoris are usually good candidates for a clitoral hood reduction. It’s also important to have realistic expectations about the procedure, and to be in good general physical and mental health overall.\nDuring your first meeting with Dr. Placik at our office in Chicago or Arlington Heights, you’ll discuss your hopes fur surgery in detail. Dr. Placik will also ask you several questions in order to gain a better understanding of your goals. It’s not uncommon for Dr. Placik to recommend additional procedures that can complement the effects of your clitoral hood reduction either in terms of aesthetics or function.\nCosts for clitoral hood reduction will vary depending on the complexity of surgery and whether other procedures are being performed at the same time. The fees include payment to Dr. Placik himself as well as the fee for the surgical facility. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nA clitoral hood reduction can typically be performed in a fairly quick amount of time under a local anesthetic, even when combined with other genital rejuvenation procedures. Because the surgery is relatively simple and the vaginal area has such a robust blood supply, recovery is also reasonably fast for most women. Over-the-counter pain medication can help ease discomfort, especially in combination with ice packs. You can expect some swelling initially, but this should dissipate rapidly. Dr. Placik will give you detailed information about the surgery itself as well as instructions he’ll ask you to follow during your recovery.\nThe purpose of clitoral hood reduction is to enhance clitoral stimulation during sex by facilitating access. In women for whom aesthetics were a concern prior to surgery, the renewed self-confidence that often arises as a result of clitoral hood reduction can contribute to a more positive sexual relationship as well.\nBecause clitoral hood reduction is not a complex surgery in the technical sense, the risks of serious side effects during or after the procedure are minimal. Potential risks include those that exist during any surgery such as bleeding or infection. The risks for more serious complications, like numbness or scarring, are possible but rare.\nThe hymen is a thin membrane that partially covers the vaginal opening. In the past, the integrity of a woman’s hymen was used as evidence of her virginity, since the hymen would normally only be broken during her first sexual encounter. However, in this modern age of vigorous exercise and tampons, the hymen may be broken for a number of non-sexual reasons.\nHymen repair, reconstruction or restoration, also known as hymenoplasty or hymenorrhaphy, can restore the hymen to an unbroken state. This procedure can be performed out of respect for religious or cultural influences, or for personal reasons. It’s not uncommon to incorporate hymen repair along with other vaginal rejuvenationprocedures.\nDr. Otto Placik is a female genital rejuvenationspecialist serving Chicago and its suburbs. A board-certified plastic surgeon, Dr. Placik understands the significance that hymen repair and reconstruction can represent, and has helped women feel whole and confident again.\nAbout Hymen Repair and Reconstruction\nVirginity used to be the greatest determining factor of a woman’s worth as a new bride. If her sexual history was suspect, the family of the bride could present the sheets from the wedding night to prove their daughter’s innocence, as breaking the hymen typically causes bleeding after intercourse. While today’s women may espouse and assimilate with contemporaneous ideals of female independence and strength, many still value their cultural traditions; there are still many reasons why a woman may prefer an intact hymen for her wedding night, or to restore her hymen for personal reasons.\nIn the course of the consultation, Dr. Placik discusses the unique considerations of the individual with attention to their specific personal and, perhaps, cultural expectations. Different techniques may be applied depending on the desired outcome and timing. During a standard procedure, Dr. Placik first treats the fragments of the hymen to remove the top layer of tissue through a process called denuding, which allows the membrane edges to heal together after surgery. Next, Dr. Placik gathers together the remnants of the hymen and reattaches them using dissolvable stitches. However, there are a variety of alternative surgical approaches.\nDr. Placik most often performs hymenoplasty as an outpatient procedure, so neither general anesthesia nor a hospital stay is required. Instead, Dr. Placik uses a local anesthetic to ensure that you’re comfortable throughout the surgery, or can offer oral sedation if you prefer. The entire surgery takes just an hour or two.\nThe actual restoration of the hymen takes place during your recovery, as the body’s natural healing process heals and regrows the reconstructed membrane when a standard procedure is performed. Most patients can resume normal daily activities almost immediately. More vigorous exercise, tampon use and sexual activity should all be abstained during the recommended period. Women can expect sexual intercourse after hymenoplasty to rupture their repaired hymen, often accompanied by some discomfort and spotting or bleeding.\nHymen Repair & Reconstruction\nHymen Repair & Reconstruction FAQ\nWomen who are concerned about the integrity of their hymen may be good candidates for hymenoplasty. Hymen reconstruction may be performed for societal reasons, as part of the healing process following sexual abuse, to correct an injury to the hymen or as part of “revirginization,” the process of reclaiming a virginal status for yourself or as a symbolic gift for your partner.\nDr. Placik will meet with you at our office in Chicago or Arlington Heights, where you’ll talk about your personal hopes for hymen repair and reconstruction. Dr. Placik will conduct a pelvic exam to determine the best approach to take and discuss your options with you, as well as gain a better understanding of your goals for surgery. Dr. Placik may recommend additional genital rejuvenation procedures if he feels they may better help you meet those goals.\nThe length of time since your hymen was torn has no bearing on the outcome of your hymenoplasty. Whether your hymen was broken in childhood due to a love for gymnastics or during a sexual encounter as a young adult, Dr. Placik can help recreate a complete hymen again.\nCosts for repair or reconstruction of your hymen depend on a number of different factors, including the complexity of the procedure and whether additional surgeries will be performed as well. The total cost will include Dr. Placik’s fee, as well as any payments for the surgical facility or anesthesiologist, if necessary. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nDuring your hymenoplasty, Dr. Placik will administer a local anesthetic to ensure that you feel comfortable throughout your procedure. The surgery itself is relatively quick, and you can normally return home to begin your recovery as soon as later the same day. You may notice a feeling of tightness or soreness for the first few days, although this is mild for most women. You should refrain from sexual intercourse and tampon use for the recommended period.\nThe risks associated with hymen repair are considered very minimal, and include discomfort, bleeding or hymen discoloration, premature hymen breakdown or, conversely, a repair that may require surgical release or intervention. The risks for more serious complications, such as hematoma or numbness, are rare but still possible.\nThe labia are the most visible portion of a woman’s sexual anatomy, so it’s only natural to feel sensitive about their appearance. Labiaplasty is the enhancement or reduction of the inner and/or outer labia (vaginal lips) to create more aesthetic contours that can help you feel more confident in your intimate relationships.\nWhile cosmetic appearance is one of the primary reasons why women seek this procedure (some women may refer to the “camel toe” appearance), other concerns such as visibility or irritation from clothing, interference with sexual intercourse, discomfort with sexual activity, repeated infections, redundant tissues and hygiene issues, and/or diversion of the urinary stream are a few of the other complaints women report.\nDr. Otto Placik is a Chicago labiaplasty specialist and board-certified plastic surgeon serving Chicago and its suburbs who has helped thousands of women like you to feel better about the appearance of their labia. He has likely the greatest experience in the Midwest and has participated in and conducted numerous research studies, performed presentations, written book chapters and attended conferences on this subject. In addition to labiaplasty, Dr. Placik offers a number of other vaginal rejuvenation proceduresthat can help improve the appearance of your vaginal area as well enhance sexual sensation.\nMore than just cosmetic concern, labia that are asymmetrical or too large can cause discomfort during daily activities like exercising or sexual intercourse. Emotionally, worries over looking “normal” can undermine your self-confidence, especially with regards to sexual relationships. Dr. Placik performs one of the best surgical labiaplasty Chicago has to offer and can improve symmetry and create more discreet contours that are more in line with your cosmetic goals.\nDr. Placik considers the size and shape of the inner and outer labia in relation to each other and the surrounding area to determine the best surgical approach. For example, the outer labia (labia majora) may benefit from fat transfer to add fullness, creating a more proportionate look relative to the inner labia (labia minora). Alternatively, large or redundant labia majora which occur frequently in combination with a prominent mons pubis may create an undesirable fullness or visibility in clothing and may be treated with reduction and/or liposuction. Most commonly, the inner labia are reduced to improve any existing discomfort, or to remove the darkened edges that can become more prominent after pregnancy or with age. It’s very common to include additional genital rejuvenation procedures with a labiaplasty, such as vaginoplasty, clitoral hood reduction and G-spot enhancement.\nLabiaplasty is generally performed as an outpatient procedure under local anesthesia or local anesthesia with oral sedation. In some cases, usually if labiaplasty is performed as part of a more extensive procedure such as a mommy makeover, Dr. Placik may recommend general anesthesia. Most women who undergo a labiaplasty alone or in combination with other genital rejuvenation procedures can return home the same day.\nReasons to get Labiaplasty\nThe reasons to get a labiaplasty usually stem from cosmetic, hygienic, and comfort issues that women experience either due to the aging process, genetics, or other factors. Some of the reasons women choose to undergo a labiaplasty include:\nWith larger labia there is the potential for chronic discomfort during certain activities such as strenuous exercise, sexual intercourse, or even while walking. Pinching and chafing of the labia during these activities can lead women to seek to have their labia reduced to enhance daily comfort.\nExcess labia skin\nAn excess of labia skin can add discomfort during exercise but can also interfere with intercourse or be a source of embarrassment for some women. Excess labia skin can hang low enough beyond the vulva that they interfere with simple activities such as walking and can prevent women from feeling comfortable while wearing tight-fighting clothes or swimsuits. Having the skin of the labia reduced allows for greater comfort during activities and boosts self-confidence.\nThere are also situations where women have undergone a labiaplasty and now require a correction due to unsatisfactory results. Due to Dr. Placik’s vast experience performing labiaplasty procedures he is often sought out to correct surgeries that have been performed by other surgeons. Reasons for a labiplasty revision could be that the results from the initial surgery were uneven or that the patient is unhappy with the results.\nA labiaplasty does not only have to involve surgery performed solely on the labia but can include other aspects of the vulva. Such procedures that could be performed during a labiaplasty would be a clitoral hood reduction or liposuction of excess fat on the mons pubis.\nResolving the issues “downstairs” can increase vaginal hygiene and comfort, and it can also help you feel more confident about the appearance of the area, along with all of its intricate and delicate parts.\nRecovery from Labiaplasty\nImmediately after surgery, you can expect to see some bruising and swelling, both of which should dissipate over the next few weeks. You should be able to resume your normal routine within a few days, and active exercise at 3 weeks, although Dr. Placik recommends waiting at least 6 weeks before engaging in sexual activity.\nLabiaplasty is a cosmetic gynecology procedure that can improve the appearance of the inner labia (labia minora, or inner vaginal lips) and/or outer labia (labia majora, or outer vaginal lips) by creating a more proportionate look. While labiaplasty is often used to describe the reduction of elongated inner labia, the procedure can also include enlarging or reducing the outer labia, although this is less common. This is often confused with vaginal rejuvenation which refers to tightening of the vaginal canal.\nIf you feel self-conscious about the size, shape or appearance of your labia, or notice discomfort during sexual activity or while wearing slim-fitting clothing, you may be a good candidate for labiaplasty. Cosmetic vaginal surgery can help you feel more confident about your appearance by reshaping the contours of your labia for greater comfort and symmetry. The best candidates for labiaplasty are old enough to have fully mature labia, and should be in good mental and physical health overall. Similar to breast reduction surgery, labia reduction may be considered at any time if causing significant discomfort or interference with daily activities.\nThe best candidates for labiaplasty want to change the size, shape or contours of their external vaginal area. This is often due to physical reasons, like feeling that labia get in the way during normal daily activities like exercise or sexual intercourse. Labiaplasty can also be performed for emotional reasons, such as feeling that the inner labia look overly prominent or the outer labia appear deflated. Concern over a visible “camel toe” is another reason women may consider labiaplasty. Since the labia often change in appearance following pregnancy and childbirth, many women include labiaplasty as part of a mommy makeover.\nMost women can return home the same day as their surgery, after which they can expect to rest for the first few days. When privacy is a concern, procedures can be performed under straight local and patients may then drive themselves to and from surgery. However, most women prefer some oral sedation, in which case a driver is required to safely transport patients home. Swelling is normal the first few days, sometimes accompanied by bruising and bleeding. Ice packs and over-the-counter pain medications can help you feel more comfortable. After the first week, you can return to work and regular daily routine, although exercise and sexual intercourse should wait at least 6 weeks.\nAfter surgery, you can expect your genital region to look swollen and feel sore for the first few days. Discomfort can often be alleviated using ice packs and over-the-counter pain medications, although Dr. Placik may prescribe a pain reliever as well. Although you should refrain from vigorous exercise or sexual activity for the first 6 weeks after surgery, you should be able to return to work and your normal routine in about a week.\nThe costs of your labiaplasty will vary depending on the approach Dr. Placik needs to take during surgery, whether there will be other procedures performed at the same time and a number of other factors. In some cases, insurance may cover all or a portion of the surgery. The total fees include not just Dr. Placik’s surgical fees, but also the cost for the surgical facility and anesthesiologist. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nThere are two approaches that can be taken during labiaplasty: the “trim” method or the “wedge” method. Dr. Placik is experienced in both techniques. The trim method is fairly straightforward, and involves a simple trimming away of excess tissue to shorten the labia minora. The wedge method removes a triangular segment of tissue from the middle third of the inner labia instead. There are pros and cons to each technique, so Dr. Placik will go into more detail on your options during your consultation to help you decide which is best for you.\nThe subject of trim vs. wedge labiaplasty is hotly debated among cosmetic gynecological surgeons.\n- Trim labiaplasty is a relatively simple procedure that removes the outer edge of the labia by trimming the excess away.\n- During the more complex wedge labiaplasty, a V-shaped section of tissue is removed from the middle third of the labia, and then the edges are sutured together.\nAlthough many surgeons currently advocate for wedge labiaplasty, this approach does not address one of the most common cosmetic concerns for many women: the darker labial edge. By fully removing this portion of the labia, trim labiaplasty creates a more uniformly pink edge for a discreet final result.\nBoth approaches allow for safe, effective reduction of the inner labia in a way that should still preserve sensation. The decision of which surgical technique is best for you often comes down to your anatomy, your personal goals and the recommendation of your surgeon.\nAlthough it’s impossible to perform any surgery without incisions, labiaplasty scars are typically minimal. The initial incisions should heal completely by about the two-week mark, although the scars may appear red or pink for several months. The trim method of labia reduction will leave longer scars than the wedge method but can remove more of the darkened edge. In either case, scars from either surgical approach should fade to nearly invisible with time. To see real patient results look at our Labiaplasty before and after gallery\nDr. Placik performs labiaplasty revisions for “botched” labiaplasty procedures or situations where patients are not happy with the results they have achieved from other surgeons. These procedures are highly customized to the unique situation of the patient, and Dr. Placik will work closely with you so that you can feel confident about your result. Watch our video on labiaplasty revision for more information about arguably the best labiaplasty in the US.\nDr. Placik will cover the possible labiaplasty risks, side effects and potential complications during your initial consultation at our office in Chicago or Arlington Heights to ensure that you completely understand the procedure. Although serious side effects are rare, they are possible, and include concerns such as scarring, infection, changes in sensation and asymmetry.\nBecause female sexual satisfaction is a complex issue that includes many different factors, labiaplasty can play an important role in improving your sex life, especially when performed with additional genital rejuvenation procedures.\nFor women who feel frustrated about their labia size detracting from their sexual experience, labiaplasty can correct physical issues to help make intercourse more physically comfortable. Additionally, women who may have previously felt inhibited during sex due to the cosmetic appearance of their labia can find that sex becomes more emotionally enjoyable after surgery.\nFrequently, larger inner labia can also mean excess clitoral hood tissue, which can interfere with clitoral stimulation during intercourse. Dr. Placik can combine clitoral hood reduction with labiaplasty to improve sexual sensation.\nTypically, insurance companies view labiaplasty as cosmetic and therefore elective, a category that is not covered under most insurance plans. Exceptions may be made in some cases, such as if the surgery is being performed to repair a torn labia or other form of injury or trauma, although this is not common. However, since labiaplasty is usually performed under local anesthesia, the total costs can be kept low. You can also look into cosmetic surgery financing to help make your labiaplasty even more affordable.\nLabiaplasty is normally performed as an outpatient procedure using local anesthesia to help you stay comfortable during surgery, which can last an hour or two. The surgery most often includes reducing the size of the inner labia using either the wedge or trim technique. Labiaplasty can also enhance the size of the outer labia using fat transfer (following the same principles as those used in fat transfer breast augmentation). The goal is to improve symmetry and balance for a flattering final result.\nTime takes a toll on our bodies, including on the genitals. Some women take the step of having a labiaplasty to correct these issues. Sadly, many women are left with a bad outcome, with too much or too little tissue removed, uneven lips, or a vaginal area that appears deformed. These botched surgeries can be surgically corrected, but only a highly-skilled surgeon should perform the corrective surgery.\nRESTORATION AFTER BOTCHED LABIA SURGERY\nThe labia are the most prominent and visible portion of a woman’s genitals, having the area appear pleasing and “normal” (although every woman is different) is important. Women go to surgeons to correct a range of aesthetic or medical problems, including the following:\n- Reduce the size of the inner labia\n- Reduce the size of the outer labia\n- Reduce both areas\n- To resolve uneven, overlarge labia\n- Create a more youthful appearance to the labia\n- Reduce visibility\n- Address irritation and multiple infections\n- Hygienic concerns\n- Resolve urine stream diversion issues\nAfter surgery is performed, the patient could be shocked – or even horrified – to see the results of the surgery. In these cases, Dr. Placik is known for being particularly skilled in correcting labiaplasty surgeries that have gone terribly wrong.\nDR. PLACIK: QUALIFICATIONS AND CREDENTIALS IN GENITAL SURGERY\nIf you had labiaplasty that was botched, and left you with a look that is distressing, it is important that the surgeon who fixes the problem is highly-skilled and respected as a leader in this type of surgery. Dr. Placik is a highly-trained, Board Certified plastic surgeon, and a speaker and author on the subject of female genital plastic surgery. Much of his practice is devoted to these surgeries, and he is renowned leader in the field. If your labiaplasty surgery left you with a result that was uneven, appears deformed, or other problem, you want a surgeon with this level of skill and knowledge to help.\nBOTCHED LABIAPLASTY: THE SOLUTION IS LABIAPLASTY REVISION SURGERY\nUnfortunately, certain surgeons may be less than familiar with performing a labiaplasty, and failed to create a natural, pleasing result — or worse. In these cases, the surgical errors can be corrected. The first step is a consultation to determine what needs to be done to bring the genital area back to a natural, pleasing appearance, both balanced, even, and normal.\nRESEARCHER. AUTHOR. SPEAKER.\nDr. Placik has skills and knowledge far above and beyond the ordinary in female genital surgery, as well the processes that are effective in correcting botched genital surgeries. As a researcher, author and speaker on female genital surgery, he is a leader in the field and known throughout the country. He understands that these are very personal issues, and you can be confident that you will be treated with the utmost sensitivity, kindness, compassion, and discretion. The first step is to speak with us to find out more about what can be done to get this very important personal physical issue resolved, and the result you were seeking when you underwent surgery the first time.\nLabiaplasty & Mommy Makeover\nPregnancy can affect the body in a number of different ways, both during your pregnancy and following the birth of your child. A mommy makeover is a combination of procedures that work together to address the major appearance concerns most women have after pregnancy, like separated abdominal muscles or loss of breast volume that also may be accompanied by sagging (ptosis). Labiaplasty can be incorporated as part of a mommy makeover as well.\nDr. Otto Placik is a labiaplasty specialist and board-certified plastic surgeon serving Chicago and the surrounding suburbs. His expertise is acknowledged by numerous other professionals via instructional courses, meeting presentations, book chapters, scientific articles, research studies and Assistant Clinical Professor status. By offering a wide range of body contouring and genital rejuvenation procedures, Dr. Placik can work closely with you to develop a mommy makeover plan that helps you meet your cosmetic goals.\nAbout Including Labiaplasty with Mommy Makeovers\nWhile pregnancy itself may only be temporary, some of the physical changes you notice in your body following your pregnancy and after giving birth can be long-term. Although external differences like a gain or loss in breast size, breast sagging or stretched-out skin over the tummy are often the most immediately noticeable, there are more intimate changes that can occur as well, such as those in the vaginal area.\nLabioplasty reduces the size of internal labia that have grown longer as a result of pregnancy and childbirth, and can remove the darker edges that may become more prominent after giving birth as well. The outer labia (majora) may lose volume and appear shrunken. This can be treated with volume restoration with fillers or fat injection, or with skin removal for a more taut appearance. Internal changes in vaginal muscle tone can also be corrected as part of a mommy makeover by including vaginoplasty to tighten the vaginal walls and improve sexual sensation for both partners.\nDr. Placik works closely with each patient to discuss your goals and hopes for a mommy makeover so he can be sure that your specific concerns are addressed. Since a mommy makeover isn’t a single procedure but instead includes a combination of surgical and nonsurgical treatments, your mommy makeover is infinitely customizable, and can easily incorporate labiaplasty at the same time.\nThe specific approach Dr. Placik takes during your mommy makeover depends on which procedures you have scheduled, and recovery time will vary from patient to patient as well. Generally speaking, you should be back to work and your normal daily routine about two weeks after a mommy makeover, with or without including labiaplasty. Sexual activity should wait until Dr. Placik gives the all clear, typically about six months after surgery.\nActual Patient NOT A MODEL\nLabiaplasty & Mommy Makeover FAQ\nThe best candidates for combined mommy makeover plus labiaplasty are interested in regaining their pre-pregnancy figure again. Mommy makeovers primarily include body contouring procedures such as breast implants, breast fat transfer, breast lift, a tummy tuck and liposuction. They also can incorporate vaginal rejuvenation procedures like labiaplasty, vaginoplasty and perineoplasty. If pregnancy and childbirth have affected your sexual response as well, you may also want to also ask Dr. Placik if you could benefit from clitoral hood reduction or G-spot enhancement. If a C-section or episiotomy incision have left you with unacceptable scars, a revision may help improve the appearance.\nNeither a mommy makeover nor a labiaplasty will physically affect your ability to carry future healthy pregnancies to term. However, pregnancy can create enough physical changes in your body to potentially compromise the results of your mommy makeover. Normally, Dr. Placik recommends waiting until you’ve completed your family before considering tummy tuck procedures.\nSurgical rates vary significantly for mommy makeovers because no two women have exactly the same combination of procedures. The total surgical fees will include payment to the anesthesiologist as well as the surgical center fee, plus Dr. Placik’s surgical fee. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nThis answer is different for every woman, and depends on your specific appearance concerns following pregnancy. Labiaplasty itself is often performed in combination with other genital rejuvenation procedures like vaginoplasty and clitoral hood reduction and perineoplasty. As for the mommy makeover, the most commonly included procedures are breast augmentation (with or without a breast lift), a tummy tuck and liposuction. Some women may also include med spa treatments such as BOTOX® Cosmetic or Xeomin® or Dysport® with or without fillers such as Restylane® or JUVÉDERM® to look younger and more refreshed.\nMost women are back to work in about 2 to 3 weeks following a mommy makeover, whether or not labiaplasty is included. Adding labiaplasty should not significantly extend your recovery period, although you may notice some localized swelling and soreness in your vaginal area following surgery. Labiaplasty incisions are quite small and are difficult for the untrained eye to see after healing.\nLabiaplasty does not significantly increase the risks associated with a mommy makeover. The same side effects are possible after labiaplasty as for any other surgery, such as scarring, bleeding or infection. More serious concerns, like permanent changes in sensation or reactions to anesthesia, are possible side effects but rare.\nLabiaplasty & Pregnancy\nThe body goes through a number of changes during pregnancy and childbirth, including changes to the inner and outer labia. The labia may become larger or develop darker edges, or may stretch or tear during childbirth. In other instances, a surgical incision may be performed (episiotomy) to help control stretching and dilation of the vaginal canal during delivery. Because of these concerns, many women choose to wait until after they’ve completed their family before pursuing labiaplasty or vaginoplasty. However, labiaplasty before pregnancy can help alleviate physical discomfort due to the size or shape of your labia even if you have plans to become pregnant in the future.\nBoard-certified plastic surgeon Dr. Otto Placik serves Chicago and its suburbs, specializing in labiaplasty and other female genital rejuvenation procedures. Dr. Placik is highly experienced in labial contouring and repair for results that help you feel confident about your vaginal appearance. He has been interviewed, taught other medical professionals, attended numerous conferences, performed multiple presentations, written book chapters and online articles as well as conducted and participated in research studies on this subject.\nAbout Labiaplasty and Pregnancy\nPregnancy can take a heavy physical toll on a woman’s body. While many of the changes associated with having a baby are temporary, others may be permanent. The labia enlarge in response to pregnancy-related hormones, and may also darken, stretch or tear during childbirth. Because of this, labiaplasty is often performed on women who have already given birth, either for cosmetic reasons or to repair damaged tissue.\nAfter pregnancy, other appearance concerns and physical changes can also be addressed through cosmetic gynecology, including vaginal rejuvenation to correct lax musculature in the vaginal wall. It’s common to combine labiaplasty with vaginal rejuvenation either as a separate procedure or as part of a mommy makeover.\nDr. Placik performs labiaplasty to create a more proportionate look, which can be accomplished by reducing the size of the labia minora (inner labia) or reducing/augmenting the size of the labia majora (outer labia). Sometimes a combination of both approaches, with or without a clitoral hood reduction, will deliver the best results. In other instances, a C-section scar (Pfannenstiel incision) may contribute to or cause an undesirable fullness of the mons pubis, which can be treated with scar revision and/or liposuction. Poorly healed episiotomy scars may cause discomfort or an unacceptable appearance, which can be addressed with a perineoplasty in combination with the above procedures.\nLabiaplasty is usually performed under local anesthetic, so you can return home the same day of your surgery. Dr. Placik and his staff will give you detailed instructions to follow during your recovery, and you should be back to work within about a week after your procedure.\nLabiaplasty and Pregnancy FAQ\nThe best candidates for labiaplasty notice significant changes in the size, shape or color of their labia following pregnancy or childbirth. Other women may be genetically disposed toward larger labia even before pregnancy. Candidates should be in good general health overall and have realistic expectations about their results, and should not be pregnant at the time of surgery.\nSince labiaplasty is primarily a cosmetic procedure, there’s no medical reason you can’t continue having children after an earlier labiaplasty that corrected pregnancy-related changes in your labia. However, you should be aware that future pregnancies could impact the results of your initial surgery.\nThe cost for labiaplasty will depend on many factors, including whether additional procedures will be performed at the same time. Your total fees will cover the cost of the surgical facility and anesthesiologist as well as Dr. Placik’s fee. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financingto make your procedure even more affordable.\nIt’s very common to include labiaplasty with additional genital rejuvenation procedures. For example, Dr. Placik may recommend a clitoral hood reduction in combination with an inner labia reduction for a more aesthetic final result. Women who choose labiaplasty to help decrease discomfort during intercourse may also want to heighten sexual sensations with G-spot amplification. Every woman is different, and Dr. Placik will work with you to determine the combination of procedures that will work best to meet your needs.\nIn general, the labia heal very rapidly and scars should be minimal. You may notice a pinkish or reddish tone to the scars at first, but this should fade over the first several months after surgery to become nearly invisible. Most women feel that the small scars that remain visible after labiaplasty are worth the trade-off for the improvement in physical comfort and self-confidence.\nLabiaplasty is not a complex surgery, but there are still risks such as bleeding, infection or scarring to consider. In rare cases, more serious complications like hypersensitivity or loss of sensation at the incision site can occur. Dr. Placik will discuss all of these issues in more detail at your consultation.\nLabiaplasty vs. Vaginoplasty\nThe term “vaginal rejuvenation” is often incorrectly used to refer to a number of different procedures, including both labiaplasty and vaginoplasty. Although these and other genital rejuvenation treatments are complementary and may frequently be performed together, they’re not the same thing.\nDr. Otto Placik is a board-certified plastic surgeon serving Chicago and its suburbs who specializes in external and internal genital rejuvenation, including both labiaplasty and vaginoplasty. By working closely with you from consultation through recovery, Dr. Placik can help you understand which treatments will best help you meet your cosmetic and personal goals.\nLabiaplasty is performed to address concerns over the aesthetic appearance of the inner or outer labia, or vaginal lips. Labia that feel or look too large (colloquially known as a “camel toe”) or too small, that interfere with normal sexual intercourse or that become chafed or irritated during daily activities can lead to self-consciousness and physical discomfort.\nDuring labiaplasty, Dr. Placik can reduce the labia minora (inner lips) or reduce/augment the labia majora (outer lips) for a more proportionate look. Women state that Labia reduction can also make sex more pleasurable and help them feel less uncomfortable in slim-fitting clothing like swimsuits. It’s common to include clitoral hood reduction (also referred to as clitoroplasty or hoodotomy or hoodoplasty) with labiaplasty to create a more aesthetic appearance overall.\nVaginoplasty is primarily used to reduce the size of the vaginal canal. Traditionally, it is not used to treat the external appearance but may reduce the visibility of protruding tissue or a wide opening. It is usually combined with a perineoplasty, which treats the area between the vaginal opening and the anus where scars or widening may result following an episiotomy or tears during delivery. Childbirth and age can both contribute to the vaginal muscles losing strength and tightness, which can diminish sensation and intimate sexual contact or desirable friction during intercourse for both partners. Internal vaginal changes after pregnancy can also lead to embarrassing problems like stress incontinence.\nDr. Placik performs vaginal rejuvenation to repair and tighten the inner vaginal walls to restore normal function. As a result, women can feel more sensation and a greater sense of emotional satisfaction during sex. Including G-spot enhancement can help take these results to the next level.\nLabiaplasty vs. Vaginoplasty FAQ\nFor the most part, women who feel unhappy with the look of their vaginal area are better candidates for labiaplasty, while vaginoplasty is best for those who are more concerned with sexual sensation and improved function. However, labiaplasty vs. vaginoplasty is not an either-or proposition. Both surgeries are extremely complementary and can be performed together for cosmetic improvement as well internal rejuvenation.\nAt your first meeting, Dr. Placik will ask you about your goals for surgery in order to determine whether a vaginoplasty or labiaplasty (or a combination of both) will better meet your needs. He may also suggest additional procedures if he feels they may further benefit you. During the examination, the different goals which can be achieved with either procedure will be reviewed and demonstrated.\nBecause genital rejuvenation is so highly customized, the prices vary widely depending on many different considerations. In addition to Dr. Placik’s surgical fee, there’s also the cost of the surgical facility and anesthesiologist’s fee to keep in mind. Costs will also differ for one procedure compared to combined procedures performed at the same time. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nLike other aspects of your surgery, the specific procedural steps Dr. Placik takes will depend on the procedure itself. Most of the time, patients undergoing a labiaplasty are treated with local anesthetic (with or without oral sedation) and don’t require a hospital stay. If a vaginoplasty is planned, this may best be performed under a general anesthetic for overall comfort and to allow a more thorough repair. This procedure also does not typically require a hospital stay. Dr. Placik will explain the entire process before surgery, including very detailed instructions for you to follow during your recovery.\nVaginoplasty is specifically intended to help you feel stronger sensation during intercourse. And, although labiaplasty is primarily cosmetic in nature, many women feel more confident sexually once they’re less self-conscious about the appearance of their vaginal area. Labial reduction can help reduce physical discomfort that can occur during sex as well.\nDuring your consultation at our Chicago or Arlington Heights office, Dr. Placik will go over the potential side effects and risks associated with labiaplasty and/or vaginoplasty. These include the same risks that are associated with any surgery, like bleeding or infection. There is also the possibility for more serious risks such as permanent changes in physical sensation, nerve damage or scarring, although these complications are rare.\nThe area between the vaginal opening (introitus) and the anus, known as the perineum or by the slang term “taint,” can tear during childbirth or become scarred from a surgical episiotomy or become stretched out as a result of obesity. This can cause lax muscles, a feeling of the introitus being too loose or open, diminished sexual sensation and problems with incontinence or other urogenital concerns. Women commonly report dissatisfaction with the associated protrusion of visible tissue from the vaginal cavity.\nPerineoplasty can help resolve aesthetics or functionality relative to the perineum. Although in some ways similar to vaginal rejuvenation, perineoplasty only addresses the skin and muscles that immediately surround the introitus rather than the muscles inside the vaginal canal.\nBoard certified plastic surgeon Dr. Otto Placik has helped women from Chicago and the surrounding suburbs to feel more confident about the appearance of their vaginal area and improve sexual confidence and sensation. A female genital rejuvenation specialist, Dr. Placik has the right combination of surgical skill and professional discretion to ensure that you feel comfortable from consultation through recovery.\nDuring childbirth, it’s not uncommon for physicians to perform an episiotomy, an incision made through the perineum that temporarily widens the introitus to allow an easier birthing process and preemptively prevent the possibility of a spontaneous tear. Either an episiotomy or a natural tear runs the risk of not healing optimally. Even without tearing, the introitus may be permanently stretched out in the birthing process. Obesity can also weaken, stress or separate the perineal structures. Perineoplasty can help improve the physical appearance of the perineal area as well as tighten the introitus.\nWhen performing perineoplasty, Dr. Placik repairs damage to the perineum, addressing both the upper layers of skin and the lower muscle layers that are most commonly damaged during an episiotomy. Dr. Placik also restores the introitus to its pre-pregnancy state to improve sexual sensation and excise the visible protruding vaginal tissue (hymenal fragments). Perineoplasty may be performed as an isolated procedure or as part of vaginal rejuvenation, in combination with labia reduction or both.\nActual Patient NOT A MODEL\nThe perineum presents a unique concern for many women, as there may be problems if the introitus is either too loose or too tight; perineoplasty can help with either. A too-tight introitus can lead to dyspareunia (painful sexual intercourse), and can also be a contributing factor to vaginismus, the involuntary contraction of vaginal muscles that prevents penetration. While perineoplasty is most commonly associated with correcting excessive looseness of the introitus, in these cases Dr. Placik may use the procedure to relieve the opposite concern and promote easier, more comfortable intercourse.\nPerineoplasty can be performed under local or general anesthesia, depending on Dr. Placik’s recommendation and whether other procedures will be performed at the same time. Most patients are able to return to work and other day-to-day activities after a few days, although you should avoid more strenuous exercise, sexual intercourse and tampon use for about 6 weeks.\nIf your doctor performed an episiotomy during childbirth, you experienced tearing during delivery or notice significant looseness around your vaginal opening, you may be a candidate for perineoplasty. Many women report dissatisfaction with the appearance of protruding tissue from the introitus. Problems with decreased sexual sensation can also be improved with perineoplasty. Alternatively, perineoplasty may help alleviate the discomfort associated with dyspareunia or vaginismus. However, this is usually performed in combination with botulinum toxin (BOTOX®) injections to diminish the intensity of the accompanying painful muscle spasms.\nExcessive laxity or tightness of the introitus can significantly impair your sexual satisfaction, and a perineoplasty is intended to resolve these concerns. Additional procedures, such as G-spot amplification or clitoral hood reduction can also be beneficial for enhancing sexual stimulation and satisfaction.\nAt our office in Chicago or Arlington Heights, Dr. Placik will discuss your concerns and give you a general physical exam as well as a pelvic exam. From there, you’ll work together to decide the best surgical approach to help you meet your goals. Dr. Placik may also suggest different or further treatments if he feels they may be beneficial.\nThe total costs for perineoplasty vary widely, depending on many varying factors. In some cases, your health insurance provider may pay for all or a portion of your procedure if your primary doctor determines that a perineoplasty is medically necessary. Surgical fees include Dr. Placik’s fees, the cost of the surgical center and the anesthesiologist fee, if needed. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nA perineoplasty typically takes about an hour, depending on whether other procedures are performed at the same time and which type of anesthesia (local or general) is used. After your procedure, you can expect to feel swollen and sore for the first few days, but most patients are able to return to work in less than a week. Dr. Placik will give you detailed instruction to follow during your recovery to help you feel comfortable. You should be able to return to your normal exercise routine after about 2 weeks, and resume sexual activity 4 weeks later.\nThere are only negligible risks associated with perineoplasty, including itching, bleeding (which may be exacerbated by walking) vaginal discharge and pain. Other possible risks may occur although this is rare. In the majority of cases, the potential benefits of perineoplasty far outweigh the minimal risks.\nA feeling of looseness or decreased sexual pleasure can be a common frustration for women following childbirth, as pregnancy and the birthing process can permanently stretch out the muscles of the vaginal canal. On occasion, this may occur in women without a prior history of childbirth and may be related to chronic pelvic strain associated with constipation or bearing down.\nVaginoplasty, often called vaginaplasty, vaginal rejuvenation or vaginal tightening, is a procedure that repairs lax internal muscles, and may increase sexual pleasure to help you feel like yourself again after pregnancy. For others, the increase in sexual friction achieved through more direct contact of the genitalia during intercourse can enhance one’s feelings of sexual intimacy.\nA board-certified plastic surgeon serving Chicago and its suburbs, Dr. Otto Placik is a vaginal rejuvenation specialist whose discreet, professional approach ensures that you feel comfortable from consultation through recovery. Dr. Placik has helped many women feel revitalized through vaginaplasty, and offers a full spectrum of female genital rejuvenation procedures to address any concerns over external aesthetics as well.\nChoosing Vaginoplasty from Our Chicago Area Practice\nNo matter how much joy being a mom can bring to your life, there are a number of physical changes associated with pregnancy and childbirth that may not be quite as welcome as a new baby. Internal changes in sensation or function are among the most upsetting for many women.\nVaginal rejuvenation is a procedure designed to correct the internal differences many women notice following childbirth, like reduced sensation during intercourse. In some instances, combined procedures with other elective procedures such as the mommy makeover may be performed. If improved sexual response is of particular concern, Dr. Placik may also recommend G-spot enhancement for more comprehensive results. Vaginal rejuvenation can also include labiaplastyand perineoplasty to improve the external appearance of your vaginal area as well. This latter procedure can correct the “open” appearance of the vagina that may lead to protrusion of tissue which many women find undesirable. Patients have also desired revision of unacceptable episiotomy scars or tears sustained at the time of delivery.\nVaginaplasty is typically performed as an outpatient procedure using a local anesthetic in combination with oral sedation or a general anesthetic for more extensive repairs, so you can recover at home after surgery. If vaginoplasty is performed with additional procedures, as in the case of a mommy makeover, Dr. Placik may recommend general anesthesia instead.\nDuring vaginal rejuvenation, Dr. Placik uses precise techniques to accomplish the procedure and minimize discomfort. He removes excess tissue and closes the incisions using internal absorbable sutures without mesh. After surgery, you should feel a youthful tightness again along with improved sensation during intercourse for both partners.\nVaginal Rejuvenation FAQ\nIf you’ve noticed diminished sensation during sex, or have a persistent feeling of internal looseness, you may be a candidate for vaginoplasty. Vaginoplasty can tighten the internal muscles of the vagina or the vaginal opening itself to decrease the visibility of protruding tissue or an “open” appearance. Women with alteration in their bowel or bladder habits (fecal retention or stress urinary incontinence or leaking) should discuss this with their urogynecologist first as this may require reconstructive procedures.\nThe price of vaginal rejuvenation varies depending on a number of different factors, such as whether additional genital rejuvenation procedures will be included. Surgical fees include the cost of the operating facility and anesthesiologist fees as well as Dr. Placik’s surgical fee. Dr. Placik and his staff strive to provide excellent value and can help you with cosmetic surgery financing to make your procedure even more affordable.\nDuring your consultation, Dr. Placik will review your relevant past medical history and will talk to you about your hopes for surgery, as well as take time to make sure you understand the benefits and limitations of vaginal rejuvenation. For example, he can explain the difference between a perineoplasty and vaginoplasty using an anterior or posterior repair as well as limitations in altering the external appearance of the vaginal area unless a labiaplasty is included at the same time. During the physical exam, the size and extent of vaginal laxity will be assessed and discussed.\nPlan to rest for the first few days after surgery. Stool softeners are highly recommended. You may notice some bruising and swelling, both of which can be alleviated with the use of ice packs or oral medication. Most women return to work and their daily routine after 2 or 3 days, although sexual activity and tampon use should not resume for at least 6 weeks. Specific exercises such as vaginal dilation and scar massage may be instituted during this period. You should also avoid baths, swimming and hot tubs during your recovery period.\nWhile improving your sexual function is a primary goal of vaginal rejuvenation, it’s impossible to predict how different women will respond sexually after surgery. Typically, women report stronger, tighter muscle tone and increased sensation for both them and their partner. The effects of renewed self-confidence after surgery can also be a contributor to an improved sex life after surgery.\nDr. Placik will discuss all potential risks, complications or side effects with you at your initial consultation at our office in Chicago or Arlington Heights. Like any surgery, vaginoplasty carries a low chance of general risks such as bleeding, infection or a reaction to anesthesia. More serious complications are rare but still possible, and include concerns such as permanent changes in sensation.\nSubmit your review
Intraocular lens (IOL) is a lens implanted in the eye used to treat cataracts or myopia. Insertion of an intraocular lens for the treatment of cataracts is the most common performed eye surgical procedure. This procedure can be done under local anesthesia with the patient awake.\nLaser vision correction, is a type of refractive surgery for the correction of myopia, astigmatism and hypermetropia. Lasik is performed by an ophthalmologist who uses a laser or microkeratome to reshape the eye's cornea in order to improve visual acuity. To most of the patients, LASIK provides a permanent alternative to eyeglasses or contact lenses.\nCataract surgery is the removal of the natural lens of the eye that has developed an opacification, known as cataract. Cataract surgery is generally performed by an ophthalmologist (eye surgeon) in an ambulatory, in a surgical center or hospital, using local anesthesia, causing little or no discomfort to the patient.\nLachrymal surgery is a sub-specialty of ophthalmology which focuses on disorders of the eyelids and tear-drainage system. The surgical repertoire of the oculoplastic and lachrymal surgeon includes correction of eyelid malposition’s, treatment of in growing eyelashes, tumors’ of the lids removal and surrounding tissues and reconstruction of these tissues following tumor excision or trauma.\nEye treatment is one of the most popular procedures for international medical tourism. Patients from Albania and abroad are being treated by top eye specialists in the country.\nHigh quality eye care and sophisticated equipment provided by the most reputable brands are attracting more and more international patients every year.\nOur specialists are achieving excellent results in laser eye surgery, cataract surgery, cataract treatment, glaucoma treatment, ocular oncology, vitro-retinal surgery, etc.\nThere are many glaucoma surgery variations and combinations, that facilitate the escape of excess aqueous humor from the eye to lower intra-ocular pressure, and a few that lower the IOP by decreasing the production of aqueous.\nAll rights reserved.\nNo part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher. For permission requests, write to the website administrator at :\nAddress : Rr. "Qemal Stafa",\nTirana - Albania\nTel : + 355 69 95 75 551\nCopyright © 2014 by Albanian Medical Tourism Agency.
Join now to get access to this content and more.\nBecome a SOAP member and have access to our benefits.\n- For Review: SOAP Consensus Statement on Neuraxial Procedures in Thrombocytopenic Parturients\n- Sample Centers of Excellence Applications\n- ASA Corner\n- SOAP Policy and Procedure Manual (P&P Manual)\n- SOAP Expert Opinions\n- SOAP's Learning Modules\n- 2019 Annual Meeting Lecture Videos\n- December 2018 - SOAP Unofficial Guide to ASA Committees Webinar\n- Submit a Position\n- View Job Postings\n- Previous Meeting Archives\n- Previous Meeting Abstract Search\n- CMS Guidelines\n- Member Benefits\n- Newsletter Clinical Articles\n- ACOG Documents\n- Search our Patient Safety Archive\n- Ask SOAP a Question\n- Global Health Opportunities\n- And more…\nAnesthetic Management of Labor in a Patient with Traumatic T3 Paraplegia\nAbstract Number: T 50\nAbstract Type: Case Report/Case Series\nSpinal cord injury in pregnancy can present significant anesthetic challenges. We present a case of a 23-year-old female, with new-onset T3 paraplegia sustained during her pregnancy, who presented in active labor.\nA 23 y/o G2P0 female was admitted at 15 weeks gestation after a gunshot wound with the bullet lodged in the T3 vertebra. Her immediate injuries included a left hemothorax, left pulmonary contusion, and complete paraplegia of the lower extremities. Neurosurgery treated her unstable spine injury conservatively with bracing. Anesthesia consult at 23 weeks recommended, after neurosurgical clearance, early neuraxial analgesia to prevent possible autonomic dysreflexia. The patient was then discharged to a rehab facility. After multidisciplinary planning meetings, she was readmitted to our obstetric service at 28 weeks for obstetric care, and began having irregular contractions presenting as back pain and premature rupture of membranes at 33 weeks.\nA combined spinal-epidural catheter (CSE) was placed uneventfully, with 2 mg of midazolam for anxiolysis. An epidural solution of 0.125% bupivacaine with 3.33 mcg/mL of fentanyl was run for the next 12 hours without significant hemodynamic instability. Breakthrough back pain was treated with 5-8cc of 0.25% bupivacaine. She had an uncomplicated forceps-assisted vaginal delivery. Patient recovered well and was discharged to a rehab facility for further treatment.\nAutonomic hyperreflexia (AH) is caused by loss of hypothalamic control of sympathetic reflexes. AH is common with spinal cord injury above T6, and manifests as hypertension, bradycardia, tachycardia, cardiac arrhythmias, or respiratory distress. Visceral or cutaneous stimulation below the level of the spinal cord lesion are common precipitants (1). During labor, untreated AH may lead to fetal distress, maternal intracranial hemorrhage, hypertensive encephalopathy and death. (2) Both undiagnosed labor with precipitous delivery and preterm labor are common. Labor is often diagnosed because of unexplained AH.\nWe placed a combined spinal epidural (CSE) for labor analgesia because this technique would provide both rapid analgesia and verification that the epidural was in the correct space (3). Assessing sensory level of neuraxial anesthesia can be impossible. Our patient had chronic back pain that allowed her to report contractions. We also used a high concentration of epidural medications to provide a dense block to prevent AH. In the event that the patient did develop symptoms of AH, we had planned to place an arterial line and treat with hydralazine and nitroprusside. In conclusion, this patient had a safe outcome following labor as a result of careful planning with a multidisciplinary team and early initiation of labor analgesia.\n1. Kuczkowski, et al. Arch Gynecol Obstet 2006;274:108-12.\n2. Strowonski, et al. Austral New Zeal J Obstet Gynaecol 2008;48:485-91.\n3. Norris. IJOA. 2000;9:3-6.
A set of actions is the official or accepted way of doing something\nHarmonic Scalped and its advantages, experienced doctors and team, success rate of last 20 years.\nAll cores were done under regional anesthesia; either spinal or epidural.\nTransurethral resection of the Postate is a urological operation.\nRemoving a calculus from upper ureter using laparoscopy.\nThe lens inside your eye that has become cloudy is removed and replaced with an artificial or man made lens.\nA pace maker typically is implamted in the upper chest.\nBabies can enter this world in one of two ways.
Halifax Health is committed to providing meaningful information and assistance to our patients related to the financial obligations for healthcare services. Our representatives are available to provide information on our charges and your individual cost based on your personal healthcare coverage and service needs.\nYour final bill from Halifax Health will vary depending on the actual services provided, existing health conditions that may impact the procedure and your insurance coverage if you are insured. Also, our charges do not include physician fees such as the anesthesiologist, radiologist or surgeon. Physicians will bill you separately for their services.\nPersonalized Price Estimates\nWe can also assist you in understanding your cost based on your specific service and insurance. If you would like a personalized estimate for a particular service, please have the following information available, so that we can provide you with the most accurate estimate possible:\nDescription and procedure codes of services needed - we will need to know as much information as possible about the specific services as described by your physician.\nType of Services needed - we need to know if you will be admitted to the hospital as an inpatient overnight, or if you are expected to be treated on an outpatient basis.\nPhysician/Specialist Name - example, if you are having surgery, we will want to know the surgeon's name. In order to give a more accurate estimate, we may call your physician to confirm your procedure.\nYour Insurance Card\nFinancial Counseling Contact Information\nFor financial counseling, please call 386.425.4107 Monday - Friday 9:00 am - 4:00 pm or email: [email protected]\nPlease contact your practitioner (physician, anesthesiologist, radiologist, surgeon or other specialist) directly for individual pricing estimates, billing practices, and insurance participation.\nA list of standard hospital charges for common inpatient, outpatient and diagnostic procedures can be found in the links below.\nDiagnosis-Related Group (DRG) Standard Charges\nThere are also resources to assist you as a healthcare consumer.\n- The Florida Health Finder Website is a resource provided by the Agency for Health Care Administration (AHCA) for health care consumers to compare quality indicators and charges for Florida Hospitals.\n- Florida Hospital Association also provides the Mission To Care Website, which provides Floridians with healthcare information and the ability to compare hospital prices and quality ratings.\n- Consumer Guide for Understanding Healthcare Prices\n- Consumer Guide for Understanding Healthcare Prices (Spanish Version)
Rotator Cuff Surgery\nRotator Cuff Surgery\nThe rotator cuff surgery you have been scheduled for is to correct the problems that you have been having in your shoulder. Your doctor has discussed with you the possible surgeries that may assist in helping correct your problems. Your surgeon has elected to perform the following surgery for you:\nRotator Cuff Repair\nA rotator cuff repair involves reattaching the end of the torn tendon to the bone. This can, in the majority of cases, be performed as an arthroscopic outpatient procedure. An arthroscopic rotator cuff repair requires a few small (1 cm or less) incisions. We make a small incision in the back of the shoulder and a camera is placed inside the shoulder joint. We make a small incision in the front of the shoulder and working instruments are placed through this incision. We examine all the structures in the shoulder at the time of surgery and address any problems that we may see. The camera is then repositioned above the rotator cuff and another incision is made on the side of the shoulder. Instruments are used to remove the inflamed bursa. The rotator cuff tear is then repaired: One or two small incisions are made on the top of the shoulder in order to place anchors. Anchors look like very small screws that have an eyelet through which a couple of sutures are passed. The anchors are placed into the bone where we wish to reattach the tendon. Instruments are used to pass the sutures through the tendon and knots are tied restoring an anatomic tendon insertion to the bone. The number of anchors required depends on the size of the tear. In some cases of larger cuff tears or tears in front of the rotator cuff tendon, an open (larger incision) may need to be performed. This decision is made at the time of surgery.\nAbove: Rotator Cuff Tear\nAbove: Surgically Repaired Rotator Cuff\nA subacromial decompression involves removal of inflamed tissue within the space above the shoulder joint between the rotator cuff and the acromion which is part of the shoulder blade on the top of the shoulder. If there are any bone spurs present, we smooth them with a small burr. This is a standard part of rotator cuff surgery.\nBiceps Tenotomy or Tenodesis\nSurgery for a torn biceps tendon involves removing it from inside the joint and reattaching it where it exits the joint. In some cases, we simply cut the tendon and allow it to retract from the joint. The negative consequences of this procedure are possible asymmetry of the biceps muscles (that it will look different from side to side) and possibly some spasm in the muscle belly which routinely resolves. This rarely causes a problem, and removing the long head of the biceps tendon from the shoulder does not affect shoulder function. The biceps muscle continues to work at the elbow and moving or releasing this tendon does not affect motion or strength of the shoulder.\nSometimes a biceps tenodesis can be performed arthroscopically. However, in younger or more active patients, an open biceps tenodesis surgery may be recommended. Your surgeon will discuss this with you prior to surgery. A biceps tendon procedure is only performed if there is a problem with the biceps tendon which is felt to be significant enough to remain a source of shoulder pain after rotator cuff surgery.\nDistal Clavicle Resection\nA distal clavicle resection is performed if there is pain at the acromioclavicular joint. The decision to perform a distal clavicle resection is based on symptoms. Many patients have changes of this joint on radiographic studies (x-rays or MRI). If the joint is not painful, there is no reason to perform surgery on it, regardless of x-ray/MRI reports. If the joint is painful, surgery is performed to debride the joint and remove about 5-7 mm of the bone. The ligaments are left attached to preserve stability. Performing a distal clavicle resection will not lengthen your recovery period.\nDepending on the location of your surgery it may be required to have preoperative testing. In some cases blood work, EKG (heart tracing), or a chest X-ray may be needed. If any of these tests are needed they will be scheduled for you and will be done during pre-testing when you meet with the anesthesia staff. If it has been some time since you have seen your primary care physician and you have several medical problems, it would be best that you see your medical doctor before your pre-test date.\nYou will arrive at the hospital approximately two hours before your scheduled surgery time. Procedures are performed on a “to follow” basis. Occasionally, a procedure scheduled ahead of yours may take longer than expected, so there may be some delay before your surgery. Regardless, it is important that you arrive on time.\nYou should not have anything to eat or drink after midnight the night before surgery. You may be advised to take some of your medications with a sip of water only. The anesthesia staff will discuss this with you at the time of your pre-testing. Upon arrival to the hospital you will go through a check-in process. A nurse will see you, review your records, and an IV will be started. A member of the anesthesia team will meet with you to discuss any anesthesia concerns and anesthetic options. Your surgery will be performed under general anesthesia (you will go to sleep.) In addition, the anesthesiologist may recommend a regional block if they think that you are a good candidate. This involves an injection of local anesthetic (numbing medicine) or placement of a catheter near the nerves at the base of the neck. These blocks are generally recommended to help control your pain following surgery. The anesthesiologist will discuss the risks of the block and the decision to perform this is a mutual decision between the patient and the anesthesiologist.\nYou can anticipate that your surgery will last approximately 1 ½ to 2 ½ hours, although this varies from case to case. If you have family members with you they will wait for you in the waiting room. Your doctor will speak with them immediately after your surgical procedure to let them know that you are finished. During your surgery, family members should plan on remaining in or near the waiting area in order to be accessible at the completion of the procedure. Belongings will be stored in a locker in the pre-operative area.\nWhen you wake from surgery you will be located in the post-operative recovery room. Once you have been stabilized and are comfortable family members will be invited to sit with you while you continue recovering from surgery. Criteria for discharge include that your pain is under control and that you are eating, drinking, and able to walk to the bathroom with minimal assistance. You will have a dressing on your shoulder and your arm will be immobilized in a sling.\n>>Next topic: Postoperative Care
TORONTO, April 11 (UPI) -- A Canadian anesthesiologist on trial for allegedly sexually assaulting patients sometimes caressed the faces of unconscious women, a nurse testified.\nLaura Cameron testified Wednesday against George Doodnaught, the Toronto Star reported. She said she once observed him fiddling with his pants.\nCameron was formerly a surgical nurse at North York General Hospital in Toronto.\n"When I first started working at North York General he appeared to be a very, very compassionate individual," Cameron said. "As time went on it became more than just caring and compassionate, from what I observed."\nCameron did not describe actual sexual acts but said she saw a lot of inappropriate behavior. Under cross-examination, Doodnaught's lawyer suggested he had a certain style of interacting with patients of both sexes, but Cameron said he got physically closer to women.\nDoodnaught, 64, is charged with assaulting 21 women ranging in age from 25 to 75. All but one were surgical patients at North York from 2006 to 2010.\nCameron said his dealings with patients could be disturbing: "Many times he would be sitting very close and actually touching the woman's face and caressing the woman's face, speaking softly."
A lip lift is designed for patients that have a greater distance between the base of their nose and their upper lip, either due to genetics or the effects of aging. A noticeable sign is a lessening of “dental show” where the upper lip is so low that it conceals the teeth to some extent when the patient smiles.\nThe lip lift procedure usually takes about 1 hour and is done on an outpatient basis under general anesthesia. Superficial skin between the bottom of the nostrils and a point above the upper lip (each patient will vary) is surgically removed. Once the flap of skin has been removed, the bottom portion of the open area, located just above the lip, will be sutured together with the upper portion of the open area, located just inside of the nostrils, thus “lifting” the upper lip. Stitches are removed after the lip lift procedure in about one week by the lip augmentation specialist and you can return to work in 7-10 days with make-up to help camouflage any residual bruising that may persist.
I'll write down a bit of what I remember from today, since I hear I have one or two readers new to IVF.\nI got to CCRM at 8 a.m. and a very nice nurse named Jennifer set me up in a room to change into a gown and start an IV. I have had some bad experiences with IVs, so I was nervous, but she used all the tricks I have heard of, including wrapping my arm in a warm moist towel and injecting lidocaine under the skin of the back of my hand before putting in the actual IV. Close to painless.\nJennifer let my husband into the room, and soon after, the anesthesiologist came to talk with my and have me sign the consent for general anesthesia. (Note that I had been fasting since midnight.) For this procedure, I was not intubated, but they put in a device to keep my airway open. My only moment of nervousness was when the doctor told me that since they were running short of Versed, they were trying to conserve it, so I might remember being scrubbed in preparation for the procedure.\nA few minutes later, Dr. Minjarez came in. My main doctor at CCRM is Dr. Surrey, but I have only met him once, during my day-of-tests. Various nurses convey all of his instructions. I technically have one main nurse at CCRM, but I have only seen her once since I arrived in Colorado. All of which is to say that I did not have a real relationship with any other medical professional, and thus was not disappointed to see a new doctor. I liked Dr. Minjarez immediately, especially when she said, "I go by Deb."\nDr. M instructed me to come back for an ultrasound tomorrow, and then to drink lots of water and eats lots of salty foods for the time being. She also said that I should avoid exercise for at least the next week, and that my hyperstimulation symtoms should go away completely with my next menstrual cycle.\nAfter Dr. Minjarez left, the anesthesiologist came back in and turned something on in the IV, and that's the last thing I remember. I guess she found some Versed.\nWhile I was in the retrieval, DH went off to do his thing.\nI awoke to the sound of beeping. I looked up and saw that my heart rate was 46. I wanted to go back to sleep, but the beeping continued, so I could not. Jennifer brought DH to the recovery room.\n32 eggs retrieved. Jennifer was impressed. It was nice to feel like I was good at something related to fertility. DH has been referring to me as the ovipositor, which, thanks to Google, I learned is both an organ used by some insects for laying eggs and also an ongoing experiment in groove versus dissonance. So the lab will work with these 32 eggs, and they will also defrost the 5 embryos I had shipped here. Before anyone gets too excited, the number of embryos that fertilize AND make it to blast AND test normal will be a good deal smaller, like one fifth of that at the most.\nBut back to retrieval day itself.\nBefore I left the surgery center, I had 2 extra strength tylenol and one can of ginger ale.\nI slept for most of the rest of the day, and I am ready for more sleep now.\nCetrotide by injection\nSurprising no one\n1 year ago
This is the story of my son Jake and his battle with Fibromuscular Dysplasia.\nI have a beautiful son named Jake. He is my “MIRACLE” child. I held him in my arms for the first time, and instantly felt overwhelming love. A love that only a mother feels when her child is born. I made a promise to always love, care, and protect him to the best of my ability. My vision of protecting him was kissing his scrapped knees, or hugging him when he fell and to comfort him when he had a bad dream. I was worried about his first cold, earache, runny nose, and fever. I was a new mother and I wanted to be prepared. I knew that these were some of the small challenges I would face with being a mom. I was so excited for the major milestones a child goes through, such as rolling over, walking, talking, and riding a bike. Teaching him about his ABC;s and 1-2-3’s. My life was perfect with my little guy. I couldn’t imagine my life without him. He was growing, walking, talking, and most importantly HEALTHY! I was fortunate that I had two years of this “normal” life with Jake.\nAll this seems to have stopped at 2 1/2 years of age. My otherwise happy, healthy boy would cry because he had a headache. While the mutters of other children were outside playing, Jake was on the couch with a cold washcloth on his forehead. Tylenol, Motrin, baths, or even the washcloth did not seem to help him. We went to the pediatricians and they gave us antibiotics and then more antibiotic’s. I think they felt that I was so nagging that they wanted me to be quiet and quit calling the office. Fast-forward a few months and Jake still has his headaches. Noticeably when he would exert himself. At his three year checkup with the pediatrician on September 11th, the nurse was checking his blood pressure. She said under her breath that’s not right.\nThen took of the blood pressure cuff and placed in on the other arm. That’s when she informed me that he had high blood pressure — 146/92. She told me that she felt he was hyper and worked up with the doctors visit and would recheck it prior to us leaving. Needless to say I was worried. Jake may have been hyper, after all it was his birthday, but worried- NO! The pediatrician then informed me that we should see a Nephrologist and for me to check his blood pressure daily. She also felt a CT would be helpful, but thought it would not show any reason as to why Jake was so hypertensive. Then I received a phone call that changed my and Jakes life. I never envisioned what we were about to face.\nHe had an enlarged Basilar artery. They needed to get more imaging which resulted in an MRI. Jake needed to be sedated for the MRI seeing that he was only 3 years old. The nurses and the MRI tech let me sit in the MRI room with Jake. As I was nervously remembering the traumatic IV start I heard the nurse call a Code 333. Knowing what this meant I looked at Jake and he was not breathing. He was BLUE!!!! I was so scared I jumped up and started to shake his feet and yell his name. That’s when the room filled with doctors and I was escorted out of the MRI room.\nIn the hallway I was sobbing, worried my son was gone. I prayed and prayed for God to see him through this. And that’s just what he did. Come to find out the nurse had administered to much Nembutal which caused Jake to have a very low heart rate, and stop breathing. Because of the complications the MRI was not completed. This prompted Jake to have general anesthesia. The MRI was completed under general anesthesia successfully. He was discharged from the hospital and he was doing well. The doctor had told me that he would be unsteady for up to 12 hours and sleepy.\nI was constantly checking on Jake to make sure he was doing well at home. I had him on the couch, and when he wanted to eat I put him in a highchair. That’s when I noticed that his upper body was leaning to the right. I would sit him straight up in the chair and he would lean to the right. That’s when I felt something was not right. I stood him up and he fell over. He could not walk. His whole right side was not working. I brought him to the hospital and they blew me off stating it was the anesthesia. It had been over 12 hours since he had the anesthesia. Jake recovered and was able to walk without falling over and leaning to the right.\nDuring the next couple of weeks I changed pediatricians (because I felt she was not helping us) and saw the Nephrologist. Jake had renal ultrasounds and that would show that he had hydronephrosis in his right kidney. The flow was normal. This however did not explain the HTN. We saw a neurosurgeon and he went over the MRI images with us. He stated that he was uncertain what Jake has but is very complicated and he would refer us to Cincinnati Children’s Hospital. We drove the six hours down and saw a neuro-radiologist. He performed and angiogram. Jake had underwent a previous Angiogram in Grand Rapids and the radiologist stated that the carotids had too much artifact. After the six hour Angiogram was done the Doctor came out and informed us that Jake had Fibromuscular Dysplasia. He told us that there was nothing they could do for him. I asked about his prognosis and he told me that he “did not know, but to take him home and treat him as a normal kid.” We left Cincinnati hopeless and discouraged.\nBeing a nurse I felt that I was not going to just wait to see what happened. If I did wait then my son could/would die. My impression was he would. I looked to the internet for information and educated myself about FMD and looked to any doctors that would look at Jakes radiology films. I sent them to Australia, Tennessee, and Boston. I spoke with many Doctors and all ended up with I’m sorry there is nothing I am able to do. BUT I WOULD NOT GIVE UP!!!!\nI found this doctor in Boston that helps children with Moya-Moya. He looked at Jakes films and told us that we needed to come out to see him as soon as possible. A week later we were in his office discussing Jakes findings. He recommended that we repeat all tests including, MRI, CT, Renal Ultrasounds, Carotid Doppler, PET scan and Angiogram. After a grueling week in Boston the tests were completed. The Doctor confirmed the diagnosis of FMD. That’s when she told us that she could perform surgery on Jake but with fatal risks. If she were to perform and angioplasty of his right carotid and it dissected then there would not be a large enough stent to fit his carotid. This would prove fatal, being his left carotid was already dissected. She told us that there would be a 50/50 chance of death or success. She gave us the option of going home to think about it. We prayed on it and felt the best option was to go with the surgery. If we were to bring him home he would surely die. Surgery is was.\nThis would prove to be the longest 6 hours I have ever been through. After the six hours the doctor had come out to speak with us. The angioplasty was a success!! But Jake was not in the clear yet. The next 24 hours would prove that the procedure did not cause any permanent damage. Sitting in a chair next to Jakes bed in Boston’s ICU for three days was a relief but scary at the same time. I was praying that we saw the last of this HATEFUL disease FMD.\nFor the most we have seen the worst of this disease. Jake still has TIA’s, learning problems, and PTSD. He has been through a total of 22 procedures all except 2 being under general anesthesia. He has seen more doctors than I can even count, and had so many painful experiences. He is a pro at Angiograms. MRI’s, CT’s, lab draws, and Carotid Doppler’s.\nAt his young age of 17 he has endured what I could never have. He has given me the strength when I was at my weakest.\nHe has allowed me to cry, and hold him. I am so blessed that the doctors in Boston took a chance on Jake. If they hadn’t I am certain he would not be with me today. Even though there is so much more to Jakes story this is just a glimpse of his life. I thank all of you that take your time to research, learn, raise awareness about FMD. Jake is just one story of many but to me he is my story.
Secondary epidermoid cyst of the penis is a very rare epidermoid cyst that occurs in the penis. The purpose of this study was to investigate the relationship between the occurrence of secondary epidermoid cyst of penis and circumcision-related factors, and to provide possible reasonable and effective suggestions for circumcision. The data of all patients who visited the clinic for epidermoid cysts of the penis from September 2000 to September 2021 in Xiangya Hospital were collected. A retrospective study was carried out on whether the patients had been circumcised and the surgical method, anesthesia method, cyst location, surgical age, postoperative wound infection, whether they were phimosis patients, and the level of the surgeon. Among the 24 patients followed up, 95.8% had a history of circumcision, and only 4.2% had no history of circumcision, and the more traumatic surgical methods developed secondary epidermoid cyst of the penis after surgery the higher the probability. Injecting anesthesia at the base of the penis increases the chances of developing a secondary epidermoid cyst of the penis. Postoperative secondary epidermoid cyst of the penis were mainly located in the anterior segment and posterior segment, and the anterior segment had a higher proportion, followed by the posterior segment. Secondary epidermoid cyst of the penis occur mainly in adults. Postoperative wound infection accelerates the appearance of secondary epidermoid cyst of the penis. Patients with phimosis have an increased probability of developing secondary epidermoid cysts of the penis after surgery. The incidence of secondary epidermoid cysts and postoperative infection after manual circumcision by the attending physician was higher than that of the chief physician. Circumcision, injection of anesthesia at the base of the penis, ligation of the penis, and postoperative wound infection may be the etiologies and triggers of secondary epidermoid cysts of the penis. Adults and phimosis patients may be high-risk groups. Lower-level surgeons may increase the odds of postoperative secondary epidermoid cysts of the penis, and it is recommended that surgery be performed by a clinically-experienced, higher-level surgeon. The indications for circumcision should be strictly evaluated and the operation should be performed as soon as possible, and the less invasive surgical method and anesthesia method should be selected. Reduce irrelevant operations during surgery and avoid wound infection after surgery.\nEpidermoid cysts are one of the common benign lesions in dermatology, accounting for about 90% of resectable cysts1,2. The affected population is mainly adults3,4, and it can occur in any part, mainly in the head, neck and trunk5,6. Epidermoid cysts rarely worsen7,8,9, but rare malignancies may develop over time3,10. Epidermoid cysts of the penis are one of the types of epidermoid cysts, but they are very rare and usually painless11. The clinical manifestations are mainly the progressive enlargement of the cyst, and inflammatory pain may be manifested after infection or rupture of the cyst wall4. Treatment is based on complete surgical excision. At present, the etiology of penile epidermoid cysts is still controversial12, and there are reports in the literature that it may be caused by residual congenital material, or damage to the hair follicle structure due to trauma, infection, and other reasons13,14,15. The occurrence of secondary epidermoid cysts of the penis after circumcision has been noted, and so far there has never been any literature on the specific relationship between the occurrence of secondary epidermoid cysts of the penis and circumcision. The purpose of this study was to specifically analyze the relationship between secondary epidermoid cysts of the penis and circumcision-related factors, and to provide possible reasonable and effective suggestions for circumcision.\nThe data of all patients with epidermoid cysts of the penis from September 2000 to September 2021 in Xiangya Hospital were collected. Whether the patient has been circumcised and the surgical method, anesthesia method, cyst location, surgical age, postoperative wound infection, whether it is a phimosis patient, and the level of the surgeon were investigated. In this study, a total of 27 patients with penile epidermoid cysts were identified. Among them, 2 patients could not be contacted due to wrong phone numbers, and 1 patient refused to communicate and did not complete the follow-up, so only 24 patients were finally investigated. Among them, 23 patients had a history of circumcision, and 1 patient had no history of circumcision.\nThis study has been reviewed by the Ethics Committee of Xiangya Hospital of Central South University, and the ethics number is: 202,111,212. Due to the spread of COVID-19 during the follow-up period, no written informed consent was signed, but the patient was informed in detail by telephone and verbal consent was obtained from the patient himself or his legal guardian. As the follow-up took place during a special period of covid-19 transmission, verbal consent was also approved by the Ethics Committee of Xiangya Hospital of Central South University. All data in this study were obtained from patient dictation. This study was conducted in strict accordance with the Declaration of Helsinki.\nThis study uses coding to hide all identifiable information of patients, and will follow the principles of scientific research risk control, privacy protection, and special protection. This research promises to comply with the requirements of scientific research management standards, and the research content will not cause harm and risk to the research subjects. The research subjects will be based on the principle of voluntariness, the right to know is guaranteed, and the rights and privacy of the research subjects will be protected to the greatest extent possible.\nResults and discussion\nThe etiology of penile epidermoid cyst has not been fully clarified. It has been reported in the literature that after neonatal circumcision, secondary epidermoid cysts of the penis may occur as a complication16, and the specific mechanism has not been studied.According to the etiology, epidermoid cysts of the penis are roughly divided into congenital and secondary epidermoid cysts of the penis17. Congenital epidermoid cysts of the penis may result from abnormal closure of the embryonic median raphe18,19. According to relevant literature reports, the occurrence of secondary epidermoid cysts of the penis may be due to trauma, surgery, and inflammation20,21,22, but no further research and analysis were conducted, which is also the significance of this study (Table 1). In this study, we found that regardless of circumcision or injection of anesthesia at the root of the penis, the incidence of postoperative secondary epidermoid cysts of the penis will increase, and the more traumatic surgical methods, the incidence of secondary epidermoid cysts of the penis (Tables 2 and 3). This may be related to the implantation of epidermal tissue into the dermis, occlusion of hair follicles, and obstruction of exocrine ducts after surgery and invasive procedures with injection of anesthesia at the base of the penis23. Patients undergoing three different surgical procedures were observed and found to have the highest incidence of secondary epidermoid cysts after manual circumcision (Table 3). The main reason may be that manual circumcision involves more operative steps than ligation and stapler circumcision. The ligation circumcision and stapler circumcision can be sutured at the same time as the overly long foreskin is removed. The time is short, the speed is fast, the effect is ideal, and there is no need for repeated operations. Manual circumcision requires a rubber band to ligate the base of the penis before the operation to reduce bleeding during the operation. After that, the overly long foreskin needs to be completely excised, and then the wound is sutured intermittently. In this process, the skin of the penis needs to be pulled and fixed with toothed forceps repeatedly. The presence of these invasive procedures described above greatly increases the risk of epidermal tissue implantation into the dermis, postoperative hair follicle occlusion, exocrine duct occlusion, and postoperative infection. This may be the main reason for the higher incidence of secondary epidermoid cysts after manual circumcision. In this study, all patients undergoing manual circumcision had the base of the penis bandaged with a rubber band before surgery to reduce bleeding, a procedure that may result in damage to the skin of the penis, which may promote secondary. The occurrence of penile epidermoid cysts, but the specific pathogenesis needs further study. From the location of the secondary epidermoid cysts of the penis, we found that when the secondary epidermoid cysts of the penis occurred in the posterior segment, the anesthesia was injected into the root of the penis, which may be related to the epidermal injection debris during the injection of anesthesia at the root of the penis24 (Table 4). Therefore, whether we can consider using other anesthesia methods to replace penile root injection anesthesia, which not only relieves the pain of anesthesia, but also reduces the occurrence of secondary epidermoid cysts of the penis after surgery.Relevant literature reports that the incidence of secondary epidermoid cysts of the penis is mainly adults3,4. Among the 23 patients with a history of circumcision in our study, 19 were adults and only 4 were minors (Tables 1 and 5). Is there a higher risk of secondary epidermoid cysts of the penis after adult circumcision?To avoid postoperative secondary epidermoid cysts of the penis, should surgery be recommended for male patients with indications for circumcision in adolescence? Of course, this requires more data to illustrate. Post-operative wound infection is a common complication after circumcision25, and post-circumcision wound infection may lead to occlusion of hair follicles or obstruction of exocrine ducts22, thereby increasing the occurrence of secondary epidermoid cysts of the penis. In this study, we did find that in patients with postoperative infection, the appearance of secondary epidermoid cysts of the penis was earlier (Tables 6 and 7), so the prevention of infection after circumcision is very important.Phimosis is one of the indications for circumcision, and it has been reported that secondary epidermoid cysts of the penis occurred in patients after phimosis23. In this study, we found that patients with phimosis had a higher rate of secondary epidermoid cysts of the penis (Table 8), probably due to the need for more invasive procedures during surgery in patients with phimosis. Therefore, it is necessary to explain the postoperative complications to the phimosis patients in detail before the operation, and avoid irrelevant invasive operations as much as possible during the operation, so as to avoid the probability of postoperative secondary epidermoid cysts of the penis.We found a higher incidence of secondary epidermoid cysts and postoperative infections after manual circumcision in the attending physician than in the chief physician (Table 9). This may be related to the lack of clinical experience of the attending physician, and there are many steps in manual circumcision. Low-level surgeons added ineffective manipulations in the process, further damaging the skin of the penis. It is also possible that with the increase of operation steps and the increase of operation time, the probability of infection is increased, and postoperative infection is more likely to occur, thereby inducing secondary epidermoid cysts of the penis. The diagnosis of secondary epidermoid cyst of the penis is easily confused with lipomas, fatty cysts, dermoid cysts, boils, and carbuncles26. A diagnosis must be made before treatment in order to decide on a treatment plan. Diagnosis mainly depends on the following points: (1) Medical history: whether there is a history of trauma and inflammation, especially whether there is a history of circumcision (2) Physical examination: a skin mass with a clear boundary can be seen on inspection, and a painless palpable mass can be palpated by palpation. Non-volatile compressible substances (3) Auxiliary examination: round or oval hypoechoic mass under color Doppler ultrasound (4) Pathological examination: keratin filling, fibrous tissue coverage27, secretory cell formation under immunohistochemistry Factors 1 and 1028, the most important of which is to carry out pathological examination. The main treatment is surgery, especially after it is known that it may turn into a malignant direction, such as squamous cell carcinoma and basal cell carcinoma29,30,31. Most of the local anesthesia surgery can be successfully resected, a small part requires general anesthesia, in order to avoid recurrence, the cyst wall must be completely removed. All surgically removed secondary epidermoid cysts of the penis should be confirmed histopathologically 32. Since secondary epidermoid cysts are very rare, this study was limited by the limited number of cases collected. However, we found some association and regularity between secondary epidermoid cysts and circumcision-related factors in a limited number of cases, which is a very meaningful study for surgeons. This will help surgeons to make more reasonable choices in circumcision operation methods, anesthesia methods, operation age, and selection of surgeons, and make clearer recommendations on the prevention of postoperative infection.\nCircumcision, injection of anesthesia at the base of the penis, ligation of the penis, and postoperative wound infection may be the etiologies and triggers of secondary epidermoid cysts of the penis. Adults and phimosis patients may be high-risk groups. Lower-level surgeons may increase the odds of postoperative secondary epidermoid cysts of the penis, and it is recommended that surgery be performed by a clinically-experienced, higher-level surgeon. The indications for circumcision should be strictly evaluated and the operation should be performed as soon as possible, and the less invasive surgical method and anesthesia method should be selected. Reduce irrelevant operations during surgery and avoid wound infection after surgery.\nAlmost all the data of this study has been included in the manuscript. Since the patients did not agree to disclose personal privacy information, this study cannot provide relevant personal privacy information including the patient's name, telephone number, home address, etc.\nFaltaous, A. A. et al. A rare transformation of epidermoid cyst into squamous cell carcinoma: a case report with literature review. Am. J. Case Rep. 20, 1141–1143 (2019).\nSorenson, E. P. et al. Scalp dermoids: A review of their anatomy, diagnosis, and treatment. Childs Nerv. Syst. 29(3), 375–380 (2012).\nVan Hoang, T. et al. Overview of epidermoid cyst. Eur. J. Radiol. Open 6, 291–301 (2019).\nde Mendonça, J. C. G. et al. Epidermoid cyst: Clinical and surgical case report. Ann. Maxillofac. Surg. 7, 151–154 (2017).\nSabhlok, S., Kalele, K., Phirange, A. & Kheur, S. Congenital giant keratinous cyst mimicking lipoma: Case report and review. Indian J. Dermatol. 60(6), 637 (2015).\nBlanco, G. et al. Orbital intradiploic giant epidermoid cyst. Arch. Ophthalmol. 119, 771–773 (2001).\nLopez-Rios, F., Rodriguez-Peralto, J. L., Castano, E. & Benito, A. Squamous cell car- cinoma arising in a cutaneous epidermal cyst. Am. J. Dermatopathol. 21(2), 174–177 (1999).\nBauer, B. S. & Lewis, V. L. Carcinoma arising in sebaceous and epidermoid cysts. Ann. Plast. Surg. 5(3), 222–224 (1980).\nYaffe, H. S. Squamous cell carcinoma arising in an epidermal cyst. Arch. Dermatol. 118(12), 961 (1982).\nDutta, M. et al. Epidermoid cysts in head and neck: our experiences, with review of literature. Indian J. Otolaryngol. Head Neck Surg. 65, 14–21 (2013).\nSuwa, M. et al. Epidermoid cyst of the penis: a case report and review of the literature. Int. J. Urol. 7, 431–433 (2000).\nKinebuchi, Y. et al. Epidermoid cyst of the penis: a case report. Nihon Hinyokika Gakkai Zasshi 94, 452–455 (2003).\nAsarch, R. G. et al. Median raphe cysts of the penis. Arch. Dermatol. 115, 1084–1086 (1979).\nShah, S. S. et al. Giant epidermoid cyst of penis. Urology 14, 389–391 (1979).\nAlvarez Múgica Miguel,Jalón Monzón Antonio,González Alvarez Roberto C et al.[Giant intertesticular epidermoid cyst].[J].Arch Esp Urol,2006,59:297–9.\nNobeyama, Y. & Nakagawa, H. Case of epidermal cyst on the glans penis. J Dermatol. 40(7), 575–577. https://doi.org/10.1111/1346-8138.12176.Epub (2013).\nPark, H. J. et al. Penile epidermal inclusion cyst: A late complication of penile girth enhancement surgery. J. Sex Med. 5, 2238–2240 (2008).\nOtsuka, T., Ueda, Y., Terauchi, M. & Kinoshita, Y. Median raphe (parameatal) cysts of the penis. J. Urol. 159, 1918–1920 (1998).\nGoyal, N. K., Trivedi, S., Dwivedi, U. S. & Singh, P. B. Congenital mucus retention cyst of penis presenting as skin papilloma. Urology 69, 381 (2007).\nCraigen, M. A. & Anderson, E. G. Traumatic epidermal inclusion cysts due to shoe impingement: A report of two cases. Foot Ankle 11, 239–241 (1991).\nShah, S. S. et al. Giant epidermoid cyst of penis. Urology 14, 389–91 (1979).\nOnuigbo, W. I. Vulval epidermoid cysts in the Igbos of Nigeria. Arch. Dermatol. 112, 1405–1406 (1976).\nKhanna, S. Epidermoid cyst of the glans penis. Eur. Urol. 19, 176–177 (1991).\nRattan, J., Rattan, S. & Gupta, D. K. Epidermoid cyst of the penis with extension into the pelvis. J. Urol. 158, 593–594 (1997).\nEttanji, A. et al. Foreskin necrosis - complication following self-circumcision. Urol. Case Rep. 38, 101671 (2021).\nWollina, U. et al. Epidermoid cysts - a wide spectrum of clinical presentation and successful treatment by surgery: A retrospective 10-year analysis and literature review. Open Access Maced. J. Med. Sci. 6, 28–30 (2018).\nHazra, S. P. et al. Epidermoid cyst of the glans penis. Indian J. Dermatol. Venereol. Leprol. 80, 279 (2014).\nBroekaert, D. et al. An investigation of cytokeratin expression in skin epithelial cysts and some uncommon types of cystic tumours using chain-specific antibodies. Arch. Dermatol. Res. 282, 383–91 (1990).\nLiau, J. L. et al. Basal cell carcinoma arising from an epidermal cyst: When a cyst is not a cyst. Case Rep. Dermatol. 7, 75–78 (2015).\nSze, S. et al. Squamous cell carcinoma arising from a vulval epidermal cyst. J. Obstet. Gynaecol. Res. 42, 1623–1626 (2016).\nAljufairi, E. & Alhilli, F. Merkel cell carcinoma arising in an epidermal cyst. Am. J. Dermatopathol. 39, 842–844 (2017).\nMorritt, A. N., Tiffin, N. & Brotherston, T. M. Squamous cell carcinoma arising in epidermoid cysts: report of four cases and review of the literature. J. Plast. Reconstr. Aesthet. Surg. 65, 1267–1269 (2012).\nThis research was funded by the Hunan Provincial Natural Science Foundation of China (2021JJ40868) and the National Natural Science Foundation of China (No. 82001738).\nI confirm that this manuscript has not been submitted for publication elsewhere. All authors have significantly contributed to the manuscript and all agree with its contents. None of the authors has any potential financial conflict of interest related to this manuscript.\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nAbout this article\nCite this article\nYu, J., Tang, R. & Ding, K. Analysis of related factors between the occurrence of secondary epidermoid cyst of penis and circumcision. Sci Rep 12, 13563 (2022). https://doi.org/10.1038/s41598-022-16876-y
Susan C. Harvey, MD et al. (1) from the Medical University of South Carolina, Charleston, South Carolina, reported recently a case of spinal epidural hematoma detected by lumbar epidural puncture. A 75 year old patient underwent femoral-distal bypass to the posterior tibial artery under epidural anesthesia. On the 10th postoperative day, he again complained of left foot pain. Repeat arteriography revealed flow-limiting stenosis above the distal anastomosis. An epidural anesthetic was once again planned. Coagulation variables were within normal limits. When an 18-gauge Tuohy needle was inserted at the L3-4 level, black, tarry, liquefied blood returned under pressure from the epidural space.After removal of approximately 10 ml of old blood, no additional blood returned passively or with gentle aspiration. The needle was withdrawn, and the anesthetic technique was converted to a spinal anesthetic at the L2-3 interspace. The surgery proceeded uneventfully.Computerized tomography (CT) without contrast was performed postoperatively. The CT scan was equivocal for the presence of epidural hematoma. Subsequent magnetic resonance imaging (MRI) revealed epidural hematoma at interspace L2-4. The patient remained neurologically intact and was discharged on the sixth postoperative day.\n1. Harvey SC, Roland PJ, Cure JK, Cuddy BG, O`Neil MG. Spinal epidural hematoma detected by lumbar epidural puncture.Anesth Analg 1997;84:1136-9\nAlmost a year and a half ago I have suggested in the Gasnet Discussion Group that evacuation of epidural hematoma by an epidural needle and/or catheter is a clinical option before any operation.\nThe case report by Harvey et al. shows that it is not only possible but it should be the first immediate treatment in every case suspected of developing an epidural hematoma.\nAs always, Mark Twain is correct: "Name the greatest of all the inventors. Accident"...\nFrom [email protected] Tue Jan 23 06:57:48 1996\nReceived: from mail.netvision.net.il by moe.med.yale.edu (4.1/1.30)\nid AA18092; Tue, 23 Jan 96 06:57:48 EST\nReceived: from mypc.netvision.net.il (ts2cp1.NetVision.net.il [184.108.40.206]) by mail.netvision.net.il (8.7.3/8.7.3) with SMTP id NAA06763; Tue, 23 Jan 1996 13:58:19 +0200 (IST)\nDate: Tue, 23 Jan 96 12:40:30 PST\nSubject: csea focus group #11\nX-Mailer: Chameleon - TCP/IP for Windows by NetManage, Inc.\nContent-Type: TEXT/PLAIN; charset=US-ASCII\nJoseph Eldor, MD\nCSEA FOCUS GROUP #11:\nA NEW TREATMENT FOR EPIDURAL HEMATOMA?\nA 24 year old parturient requested an epidural analgesia for labor. The\nanesthesiologist advised her a "walking" epidural using the combined\nspinal-epidural technique. Blood pressure was 110/80 mmHg and pulse - 100\nbeats/min. The patient received 1,000 ml Lactated Ringer`s solution before\nstarting the procedure. Lying on her right side at the "epidural position"\nan 18G Eldor needle (Alexander Medical Inc.,Coral Springs, FL) was inserted\nat the L2-3 interspace. After identification of the epidural space an\nepidural catheter 20G was inserted and tested by 3 ml lidocaine 2%. Two\nminutes later a 26G Double-hole pencil point spinal needle (DHPP), which is\nan integral part of the Eldor needle minipack, was inserted through the\nspinal conduit of the Eldor needle into the subarachnoid space. After the\nappearance of CSF at the hub of the spinal needle fentanyl 15 microgram were\ninjected through the spinal needle. Then the spinal needle was withdrawn and\nafterwards the Eldor needle leaving the epidural catheter in the epidural\nspace. The patient had a good analgesia during contractions and could move\nher legs as before. One hour and a half later the patient had an almost pain\nfree vaginal delivery. Half an hour later the patient complained of\ninability to move both legs. An epidural hematoma was suspected and the\npatient was taken immediately to the CT scan where the diagnosis was proved.\nAt the CT scan the patient was lain on her right side at the epidural\nposition and an 18G epidural needle was inserted into the subarachnoid space\nat the L1-2 interspace. An epidural catheter was inserted through it\nevacuating a bloody CSF.Another 18G epidural needle was inserted into the\nepidural space at the L3-4 interspace evacuating also blood at the range of\n20-30 ml. Another epidural catheter was left also in the epidural space.\nFive minutes later the patient could move both her legs. She was supervised\nat the intensive care unit for two days with no return of the paralysis. The\ncatheters were withdrawn at the second day post delivery. The patient was\ndischarged from the hospital two days later.\nThis case report didn`t happen. It serves for the description of a potential\ntreatment for epidural hematoma - evacuation of blood by an epidural needle\nand catheter in the epidural and subarachnoid spaces.\nComments are invited.
Influence of CPB Temperature on CABG Morbidity\nTo compare three accepted modes of myocardial preservation, warm, tepid, and cold blood cardioplegia, coinciding with normothermic (37 degrees centigrade), tepid (32 degrees centigrade) and hypothermic (8 to 10 degrees centigrade) cardiopulmonary bypass (CPB) to define differences in neurologic function in coronary artery bypass graft (CABG) patients.\nProcedure: cardiopulmonary bypass\nProcedure: heart arrest, induced\n\|Study Design:\|\|Allocation: Randomized\nPrimary Purpose: Treatment\n\|Study Start Date:\|\|January 1994\|\n\|Estimated Study Completion Date:\|\|December 1996\|\nA pilot study of warm versus cold perfusion and preservation was completed in 32 patients prior to the ongoing study. The findings of the pilot study showed 53 percent of patients had evidence of new neurologic disturbance at postoperative day four. Only the neurologic dysfunction could be correlated with warm versus cold perfusion (37.5 percent warm versus 75 percent cold, P less than 0.05). The changes in neurologic function had abated or clearly improved by one month of follow-up, and the distinction in neurologic dysfunction grading was no longer apparent between the two groups.\nPatients were randomly assigned to cold, tepid, or warm blood cardioplegia, coinciding with normothermic, tepid, and hypothermic cardiopulmonary bypass. All patients received a standard anesthetic protocol combining narcotic and inhalational anesthesia. Each patient entering the study had extensive clinical data collected prospectively incorporating most aspects of measurable determinants related to myocardial preservation. Additionally, neurologic tests were performed by a blinded neurologist and rated by an objective scoring system, the Mathew scale. The studies were performed preoperatively, on the third or fourth postoperative day, and at one month following surgery. Hematologic data were measured for fibrinolytic potential.\nNo Contacts or Locations Provided
300 Pasteur Dr, Stanford, 94305, USA\nStanford Hospital & Clinics operates as a hospital that provides patient care services in the United States.\nThe hospital offers clinical services in the areas of cardiac care, cancer treatment, neurology, neurosurgery, orthopedics, and surgery and organ transplants. It also offers medical services including aging adult, anesthesia, blood center, clinical nutrition, diabetes education, emergency medicine, imaging, infection control, interventional neuroradiology and radiology, laboratory, life flight, neurodiagnostics laboratory, PET/CT, in-patient, radiology, rehabilitation, trauma, and vascular laboratory services.\nStanford Hospital & Clinics provides guest services including patient representation, interpreter, spiritual care, massage therapy, arts program, cancer supportive care program, health library, music program, and pet-assisted wellness services.\nFounded in 1959, Stanford Hospital & Clinics is based in Palo Alto, California.\nThere is much more to this profile.\nLog in or sign up for free to see the whole thing.\nGet free access to these powerful tools:\n- Advanced search filters\n- Full startup and investor profiles\n- Follow startups and investors\n- Custom follow-lists\n- Startup benchmarking\n- Network maps\n- Market stats
Job Description & Requirements\nAcademic Anesthesiology Physician in Minnesota\nA growing department at a reputable academic medical center is seeking qualified candidates with training and/or experience in solid organ transplant, non-cardiac vascular, or thoracic anesthesia. This role will include a mix of general anesthesia, excluding cardiac, pain, and pediatrics.\nThe ideal candidate will have a strong desire to teach medical students and trainees and will be able to work comfortably in a tertiary academic medical center with complex cases. Applicants must be ABA board-certified or board-eligible in anesthesiology.Job Specifics:\n- The department sees approximately 80+ liver transplants per year, including an increasing number of living donor cases\n- The department is initiating a blood clotting study, creating plenty of opportunity for publications, if desired\n- Opportunity to work in a tertiary care referral center with state-of-the-art facilities and an excellent teaching environment\n- Experience a collaborative team-based approach with weekly grand rounds—culture of sharing best practices to strive for continual improvement as a group\n- Enjoy a healthy work-life balance with a 1:10 call schedule and ample trainee support\n- Academic medical center located within a Big Ten land-grant university, allowing for a variety of collaboration opportunities\n- H-1B candidates are encouraged to apply\nPart of the 14th largest metropolitan area in the United States, our city offers an exceptional quality of life to all of its residents. This beautiful Upper Midwest region is an outdoor enthusiast’s dream, featuring a riverfront skyline, breathtaking waterfalls, an array of lakes, and more hiking and biking trails than you could imagine.As part of our community, you’ll enjoy the following:\nRanked #1 in Best Places to Practice by Medscape and in the Top 3 in Best States Overall by U.S. News\n- Our town boasts exceptional public and private schools, including one of the top 20 elementary schools and two of the top 20 private schools in the state (according to Niche)\n- With a local university and NFL, NBA, NHL, and MLB teams, enjoy collegiate and professional sporting events throughout the year\n- You will have convenient access to a major international airport, ranked in the Top 10 Domestic Airports by Travel + Leisure magazine\n- Experience a variety of engaging events year-round, including one of the largest state fairs in the nation, as well as an abundance of top-notch entertainment and unique shopping and dining options\nBE or BC in General AnesthesiologyAbout the Company\nMerritt Hawkins, an AMN Healthcare company, is a permanent physician placement service that fills more physician jobs than any other firm. In addition to being the nation’s leader in physician employment search and consulting services, Merritt Hawkins also recruits and places select allied health professionals. AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer. We encourage minority and female applicants to apply.\nAnesthesiologist, Anesthesiology, Anesthesia, Physician, Healthcare, Patient Care, Hospital, Medical, Doctor, Perioperative Medicine, Perioperative, Md, ANES\nPlease Click Apply!
Are you Dr. Anderson Greenhaw?\nAnderson F Greenhaw M.D.\nDr. Anderson Greenhaw is an anesthesiologist practicing in Norman, OK. Dr. Greenhaw ensures the safety of patients who are about to undergo surgery. Anestesiologists specialize in general anesthesia, which will (put the patient to sleep), sedation, which will calm the patient or make him or her unaware of the situation, and regional anesthesia, which just numbs a specific part of the body. As an anesthesiologist, Dr. Greenhaw also might help manage pain after an operation.\n\|\|American Board of Anesthesiology (ABA)
Athletic Sculpt Services\nFDA approved technique using low-level sound wave and Radio Frequency rupture the dermis layer of fat in designated areas of the body. Liquified fat is the eliminated through the Lymphatic system; the bodies natural detox and transport system to eliminate toxins through urine, stool and sweat.) Straightforward procedures listed below that do not require invasive skin puncture, incisions or the dangers of local anesthesia\nProcedures and post health & fitness services are provided at a commercial fitness, health and wellness facility located in Lanham Maryland. Services are offered to both women and men (no persons under 18 years of age) for non-invasive body sculpting, contour and fat loss services.\nImmediate Fat Dissolve & Athletic Body Shaping (Trimmed Waistline, Visibly Slimmer Stomach, Ab Structure, Leaner Legs & Back)\nNon- Surgical Procedures or Surgical Costs\nImmediate Improvement To Skin Appearance\nDetox, Skin Tightening, Competition Prep\nPost Op Plan For Ongoing Physical, Health & Wellness Success
Pet anesthesia risks are quite low, but most pet owners still worry. Modern medication protocols and inhaled gas anesthetics provide smooth inductions, allow precise adjustments during surgery, and fast recoveries. The Palm Valley Veterinary Center team follows the highest anesthesia standards, and takes every necessary precaution to ensure a safe anesthesia for your pet. To allay your fears, we share the anesthetic protocols that help us maintain the highest care standards.\nWhat is pet anesthesia?\nBy definition, anesthesia is the absence of feeling—meaning your pet cannot feel any pain. We achieve this by putting your pet in a controlled unconscious state that we maintain using precise amounts of inhaled gasses. Anesthesia is required to perform complete dentistry and surgical procedures, while lesser sedation may be sufficient for minor procedures, such as wound repair or imaging. Pet anesthesia is extremely safe because of modern anesthetic protocols—in one study, average mortality rates ranged from 0.05% to 0.1% in healthy pets, and up to only 1.3% for sick pets.\nYour pet’s pre-anesthetic evaluation\nYour veterinarian will perform a complete physical examination and full blood panel prior to anesthesia, to help them understand your pet’s kidney and liver function, which affects drug and gas anesthetic metabolism. If your pet is older or has a heart murmur, additional tests can help provide a more complete picture of organ function and overall health. These tests include:\n- Echocardiogram (i.e., heart ultrasound)\n- Chest X-rays\n- Blood pressure evaluation\nYour veterinarian will recommend treating underlying health problems prior to anesthesia to minimize your pet’s risks. If their underlying disease is mild, elective anesthesia can typically still be safely performed with a few drug protocol modifications, but for pets who have serious health problems, such as heart failure, lung disease, or uncontrolled diabetes, their risks versus benefits need careful consideration. Emergency surgeries do not allow time for these pre-evaluations, but the life-saving surgery benefits are considered to outweigh the anesthesia risks for these pets, regardless of overall health status.\nBefore your pet’s anesthesia\nAfter you drop off your pet, we house them in a cozy cage or run until their surgery. We first administer a pre-anesthetic drug cocktail that provides relaxation and minor sedation to facilitate placing an intravenous (IV) catheter. If we expect that your pet’s procedure will be painful, we also give preoperative analgesics. Using multiple drugs can minimize doses and subsequent side effects.\nAfter IV catheter placement, we administer a drug to induce unconsciousness and place a breathing tube in your pet’s trachea for the administration of oxygen and the anesthetic gas that maintains their anesthesia. Next, we attach sophisticated monitoring equipment, run IV fluids, and prepare your pet’s surgical site, if needed. Only qualified, credentialed veterinary technicians perform and monitor anesthesia under the attending veterinarian’s supervision.\nDuring your pet’s anesthesia\nWe closely monitor your pet’s vital signs throughout their procedure, so we can intervene as needed. IV fluids help to maintain your pet’s blood pressure and circulation, and external warming devices prevent hypothermia. Your pet’s technician constantly monitors heart rhythm and rate, so we can treat and reverse minor arrhythmias, which are common under anesthesia. The gas vaporizer allows precise, quick adjustments to anesthetic depth, so your pet’s depth does not become too light or too deep. Pets under anesthesia lack muscle tone, so we handle them carefully to prevent nerve or joint injuries.\nAfter your pet’s anesthesia\nWhen your pet’s procedure is complete, we turn off the gas vaporizer and administer pure oxygen for five to 10 minutes to flush the anesthetic from their lungs. Most pets wake up shortly after, and we continue to monitor vitals closely, carefully removing the breathing tube only when your pet can swallow on their own, which indicates they can protect their own airway.\nWe return your pet to their cage or run, where we wrap them in warm blankets, monitor vital signs, and provide additional pain medications, if needed, as they recover. A few pets will react to the anesthetic drugs and wake up vocalizing or confused, but we can provide them with a low-dose sedative to ensure their smooth recovery. We keep your pet in the hospital for several hours until their vitals are normal, and send you home with detailed postoperative instructions and medications.\nBecause of our strict screening and preparation protocols, you do not need to worry about your pet undergoing anesthesia. If you’ve been delaying an elective surgery or dentistry procedure, you can now go ahead, knowing that anesthesia is low risk. Contact our experienced and knowledgeable Palm Valley Veterinary Center team to schedule your pre-anesthetic evaluation and provide your pet with our high-level care.\nLeave A Comment
“Our goal is to bring New York City-level care and the full range of subspecialty orthopedic care that we offer at Columbia up to Westchester,” said Jeffrey A. Geller, MD, Chief of Orthopedic Surgery at NewYork-Presbyterian Lawrence Hospital and the Chief and Director of Research, Division of Hip and Knee Reconstruction at CUMC’s Department of Orthopedic Surgery. Dr. Geller is also the Nas S. Eftekhar Professor of Orthopedic Surgery at CUMC. “Columbia stands at the very forefront of research, education and collaboration in orthopedics. We are the only academic orthopedic department in New York City that has the capacity to provide comprehensive orthopedic surgical services to patients living in Westchester.”\nAs a result of the collaboration with Columbia, NewYork-Presbyterian Lawrence can now offer a wider range of advanced surgical and non-operative orthopedic services. Dr. Geller, a nationally recognized expert in the non-operative and operative treatment of arthritic disorders of the hip and knee, leads a team of fellowship trained experts in the specialties of hip and knee reconstruction, pediatric and adult sports medicine, foot and ankle, hand, elbow, shoulder, spine and trauma.\nDr. Geller has extensive experience in the latest and most advanced minimally invasive techniques for procedures including partial knee replacements, anterior hip replacements, hip resurfacing, as well as minimally invasive hip and knee replacements. He performs primary joint replacement surgery and revisions of failed or painful joint replacements only after he considers all non-operative treatment options.\n“We are very conservative in our care and choose non-operative approaches first and foremost,” said Dr. Geller. “However, if surgery is necessary, it is nice to know that you can have the surgery right here at NYP Lawrence, which means you do not have to travel to New York City for your care.”\nAs a specialist in trauma of the lower extremities including hip fractures, fractures around joint replacements and fractures related to osteoporosis, one of Dr. Geller’s primary goals as the Director of Orthopedic Surgery is to establish a large orthopedic trauma service in the Westchester region that can quickly and expediently treat patients who present with a broad variety of orthopedic trauma, from every-day injuries to highly complex fractures requiring surgical intervention.\n“Hip fractures are on the rise, particularly among the elderly,” said Dr. Geller. “Our goal is to standardize care for trauma patients, which involves getting them to surgery faster, and get them up and moving as soon as possible after surgery. This standard of care has been proven to improve the outcomes and quality of life for hip fracture patients.”\nDr. Geller’s other initiative at the Hospital is pre-emptive pain control, the prevention of surgical pain before it begins after surgery, in order to help orthopedic surgery patients experience a faster, more comfortable healing process. “We can now prevent pain before it begins by taking a multimodal approach to pain control,” he said. “Our team of orthopedic surgeons is prescribing smaller doses of medication that target specific pain centers, and we are working with anesthesiologists who can provide nerve blocks and local anesthetics to prevent the onset of pain.”\nFor Dr. Geller, teamwork is the cornerstone of orthopedic care that is now available at NYP Lawrence. “We collaborate closely with anesthesiologists, pain management specialists, physical therapists and nutritionists to create a plan of care that addresses each patient’s unique needs before, during and after surgery,” he said. “The new generation of medicine is all about collaboration. We are proud to work with the specialists at NYP Lawrence to bring true multidisciplinary orthopedic care to patients living in Westchester.”\nDr. Geller sees patients in Bronxville and Tarrytown, with surgical procedures performed at NewYork-Presbyterian Lawrence Hospital. To make an appointment with Dr. Geller, call 914-750-4650.\nGet comfortable with the technology you’ll be using, and have relevant medical devices and logs at hand April 9, 2020;... MORE >

End of preview. Expand in Data Studio

The AnesBench Datasets Collection comprises three distinct datasets: AnesBench, an anesthesiology reasoning benchmark; AnesQA, an SFT dataset; and AnesCorpus, a continual pre-training dataset. This repository pertains to AnesCorpus. For AnesBench and AnesQA, please refer to their respective links: https://huggingface.co/datasets/MiliLab/AnesBench and https://huggingface.co/datasets/MiliLab/AnesQA.

AnesCorpus

AnesCorpus is a large-scale, domain-specific corpus constructed for Continuous Pre-training (CPT) in the field of anesthesiology. It is built from two primary sources:

Domain-specific filtering from large-scale corpora such as FineWeb, using keyword-based heuristics.
PubMed research articles related to anesthesiology, processed through rigorous cleaning and formatting to ensure high relevance and quality.

Language	Rows	Tokens
English	~1.59M	~3B
Chinese	~593K	~0.2B

This curated dataset provides a rich foundation for pretraining language models to understand anesthesiology-related concepts, terminology, and clinical context.

Recommended Usage

This dataset and AnesQA are compatible with a wide range of instruction-tuned language models and popular training frameworks.

Downloads last month: 47

Size of the auto-converted Parquet files (First 5GB per split):

5.34 GB

Number of rows (First 5GB per split):

1,705,215

Estimated number of rows:

2,182,437

Collection including MiliLab/AnesCorpus

AnesBench Datasets Collection

Collection

Collection for AnesBench: Multi-Dimensional Evaluation of LLM Reasoning in Anesthesiology, featuring AnesBench, AnesCorpus, and AnesQA. • 3 items • Updated 2 days ago