Neurological research
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The outcomes of devastating neurological emergencies such as stroke and subarachnoid hemorrhage may be measurably improved by timely treatment in a neurointensive care unit (NICU). Optimal care requires a multidisciplinary approach, with attention to a wide range of treatment issues. This review examines the key therapeutic concerns in the NICU management of acute ischemic and hemorrhagic stroke and subarachnoid hemorrhage, including mechanical ventilation, blood pressure management, cardiac monitoring, intracranial pressure assessment, vasospasm, seizures, sedation, fluids, electrolytes, and nutrition. ⋯ The discussion of vasospasm includes evaluation, prophylaxis, and treatment with medications, hypervolemic hemodilution, and angioplasty. Management of seizure and status epilepticus in stroke and subarachnoid hemorrhage are reviewed and current algorithms are presented. The management of fluids, electrolytes and enteral nutrition are also reviewed.
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Neurological research · Jan 2002
Astrocytes mediate cerebral cortical neuronal axon and dendrite growth, in part, by release of fibroblast growth factor.
Astrocytes occupy a central role in central nervous system (CNS) function. In particular astyrocytes can support neurite growth, in part, by release of diffusable factors. We therefore performed biochemical analysis of astrocyte conditioned medium to examine possible mechanisms of astrocyte mediated axon and dendrite growth in the mammalian CNS. ⋯ We then examined axon and dendrite growth from cortical neurons after the addition of various growth factors to chemically defined medium. Axon and dendrite growth, similar to that found in astrocyte CM was observed after the addition of bFGF or aFGF. Astrocyte support of cerebral cortical neuron axon and dendrite growth in vitro may be explained, in part, by FGF release.
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Gabapentin is an anti-epileptic drug (AED) that was approved in 1993 for the adjunct treatment of complex partial seizures (CPS) with and without generalization. Although the mechanism of action of gabapentin has not been fully elucidated, it has been shown to be effective not only as an adjunct AED in patients with CPS, but also in children with epilepsy, many pain syndromes (most notably neuropathic pain), and several other neurological diseases. The efficacy of the drug as an AED In both adults and children has been mostly seen when used as an adjunct with other AEDs. ⋯ Also, the dosing of the drug in children has been complicated by negative behavioral adverse effects. Overall, gabapentin has a low incidence of adverse effects, a pharmacokinetic profile that limits its drug interactions, and limited effects on cognition when compared to traditional AEDs. The dosing of the drug is dependent on the disease state targeted, the number of specific therapeutic drugs used, and the renal function of the patient.
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Neurological research · Dec 2001
Clinical TrialClinical cerebral microdialysis: brain metabolism and brain tissue oxygenation after acute brain injury.
While continuous monitoring of brain tissue oxygenation (P(ti)O2) is known as a practicable, safe and reliable monitoring technology supplementing traditional ICP-CPP-monitoring, the impact of cerebral microdialysis, now available bedside, is not proven extensively. Therefore our studies focused on the practicability, complications and clinical impact of microdialysis during long term monitoring after acute brain injury, especially the analysis of the correlation between changes of local brain oxygenation and metabolism. Advanced neuromonitoring including ICP-CPP-p(ti)O2 was performed in 20 patients suffering from acute brain injury. ⋯ Our data strongly suggest partly evidence of correlation between hypoxic oxygenation and metabolic disturbances after brain injury. On the other hand brain metabolism is altered without changes of cerebral oxygenation. Further studies are indicated to improve our pathophysiological knowledge before microdialysis is routinely useful in neurointensive care.
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Neurological research · Oct 2001
Randomized Controlled Trial Comparative Study Clinical TrialA prospective randomized controlled study of VAX-D and TENS for the treatment of chronic low back pain.
Low back pain is one of the most significant medical and socioeconomic problems in modern society. International guidelines call for evidence-based management for the pain and disability associated with musculoskeletal disorders. The purpose of this randomized controlled trial is to address the question of efficacy and appropriateness of vertebral axial decompression (VAX-D) therapy, a new technology that has been shown in clinical research to create negative intradiscal pressures, and has been shown to be effective in treating patients presenting with chronic low back pain (> 3 months duration) with associated leg pain. ⋯ Patients were randomly assigned to VAX-D or to TENS which was used as a control treatment or placebo. The TENS treatment demonstrated a success rate of 0%, while VAX-D demonstrated a success rate of 68.4% (p < 0.001). A statistically significant reduction in pain and improvement in functional outcome was obtained in patients with chronic low back pain treated with VAX-D.