Postgraduate medical journal
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Pain about the bridge of the nose is often a diagnostic dilemma. There is an important recognizable subgroup who may, as a consequence of involvement of the external nasal nerve in nasal injury, exhibit neuralgic pain after a latent interval. Temporary relief by anaesthesia can be achieved and cure is possible by division of the anterior ethmoidal nerve. This rare cause of facial pain is presented using two illustrative cases.
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Metabolic acidosis and hyperlactataemia are important, independent findings in acute illness, and the combination of these abnormalities carries a grave prognosis. Despite this there is still controversy about the most appropriate therapy of lactic acidosis, and the relationship of commonly used acid base measurements to blood lactate levels. This paper details studies in shock and multiple organ failure examining these issues. ⋯ Serious acid base derangements were not seen. Significant hyperlactataemia was present throughout haemofiltration as a result of the infusion of replacement fluid containing 45 mmol/l lactate. The only alterations in acid base status were transient falls in arterial bicarbonate and base excess at one hour.
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The purpose of this study was to describe family factors which influence cancer pain. Previous research has focused on the patients' and professional caregivers' perspective of pain. ⋯ Findings of the study demonstrate family perceptions of pain, caregiver burden associated with pain, caregiver moods and differences in caregiver experiences of pain between three sites of care including a hospice, a community hospital and a cancer centre. Understanding the perspective of the family caregivers and their role in pain management can assist health care providers in management of the patient's pain.
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Morphine consumption for medical purposes in Japan showed a 17-fold increase between 1979 and 1989, due to increased use in cancer pain management. This increase is a reflection of the improving attitude of the health care professionals and health policy makers towards narcotics use. The WHO Cancer Pain Relief Programme has ultimately become the basis for a national cancer pain relief programme. The Ministry of Health and Welfare amended the Narcotics and Psychotropics Control Law in 1990, to improve accessibility of morphine preparations to cancer patients with pain, and edited four manuals for palliative care, that include guidelines on cancer pain relief, and legislative management of narcotics use in hospital, clinic and pharmacy.
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Systemic and renal haemodynamic and functional indices were measured in 15 anaesthetised pigs during systemic sepsis induced by faecal peritonitis. Five animals were assigned to maintenance of cardiac output (CO) at baseline, pre-infection values throughout the study (controls n = 5). In the remaining 10 animals, CO was increased by 25% prior to induction of sepsis and maintained at this level for the duration of the study using volume expansion with intravenous colloid and an infusion of either 20 micrograms/kg/min dobutamine (n = 5) or placebo (n = 5). ⋯ In the dobutamine group systemic oxygen uptake (VO2) increased from 173 +/- 30 to 277 +/- 73 ml/min (P less than 0.05), however this resulted in a decrease in renal DO2 (20 +/- 9 to 10 +/- 2 ml/min P less than 0.05) and there was no equivalent rise in renal VO2 (3.3 +/- 1.6 to 3.2 +/- 1.5 ml/min). There was however no significant difference in the effect on renal function of the three management protocols. Agents used to increase cardiac output during systemic sepsis may result in significantly different effects on the renal vascular bed which are not revealed by the measurement of systemic indices alone.