The Journal of international medical research
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Comparative Study Clinical Trial Controlled Clinical Trial
The effect of nimodipine monotherapy and combined treatment with ketamine and lignocaine in aneurysmal subarachnoid haemorrhage.
The clinical effects of nimodipine monotherapy were compared with the effects of nimodipine combined with ketamine and lignocaine (combination therapy) in a single-centre, one investigator, open study in patients with proven aneurysmal subarachnoid haemorrhage (aSAH). After clipping of the aneurysm, nimodipine was administered intravenously until day 5-7 after clipping. Thereafter the intravenous nimodipine was substituted by oral doses of nimodipine. ⋯ Our data indicate that combined treatment with ketamine and lignocaine is not more effective than nimodipine monotherapy in patients with mild aSAH, but this does not rule out an effect in severe cases. There was no indication of a pharmacodynamic interaction between nimodipine and co-medication. No serious or clinically relevant adverse reactions were noted during the study.
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Randomized Controlled Trial Comparative Study Clinical Trial
Anti-emetic efficacy of tropisetron and metoclopramide.
Post-operative vomiting, especially in ambulatory surgical patients, remains a troublesome problem. This placebo-controlled, randomized, prospective double-blind trial was designed to evaluate the efficacy of two prophylactic anti-emetic regimens on post-operative vomiting in 1-day thyroid surgery. Altogether 60 elective surgical patients were followed for 4 h post-operatively. ⋯ In group 2, three patients required rescue medication during the first 2 h post-operation, but no significant difference was observed between groups 2 and 3 (P > 0.05). None of the cases in any of the groups needed any rescue medication during post-operative 2-4 h. It is concluded that tropisetron is a highly effective anti-emetic drug in the prophylaxis of post-operative vomiting.
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The aim of this study was to assess the efficacy of epidural morphine plus bupivacaine for post-operative pain control following Harrington rod insertion. In 22 scoliotic patients, studied prospectively, the epidural catheter was positioned under direct vision, intra-operatively before wound closure. Post-operatively, the patients received 2 mg morphine in 4 ml of 0.25% bupivacaine through the epidural catheter whenever they complained of pain. ⋯ The mean (+/- SD) pre-injection pain score decreased from 2.5 +/- 0.15 on the first post-operative day to 0.7 +/- 0.2 by the fourth day. The side-effects, including nausea, vomiting and pruritus, were minimal. It is concluded that morphine, in 0.25% bupivacaine administered through an intra-operatively placed epidural catheter, provides a safe and effective post-operative analgesia in patients undergoing Harrington rod insertion for idiopathic scoliosis.
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The "nutcracker" phenomenon results from compression of the left renal vein between the superior mesenteric artery and the aorta. The main features of this phenomenon are non-glomerular haematuria on urinalysis and stenosis of the left renal vein with dilatation of the vein distal to the stenosis. ⋯ The coexistence of immunoglobulin A nephropathy was suspected when these characteristics were observed in patients with the "nutcracker" phenomenon. In such cases, a renal biopsy is needed for a final diagnosis.
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Twenty-eight patients, aged 58 years or more and with clinical and radiological evidence of degenerative osteoarthritis of the knee joint, were entered into an open 6-month pilot study. Patients received a single intra-articular injection of tenoxicam (20 mg) into the affected knee with rigid adherence to aseptic technique. Efficacy was assessed in 25 evaluable patients according to three parameters: pain, hydrarthrosis and range of joint movement. ⋯ Range of movement of the affected joint 1 month after injection was increased in 60% (15/25) of patients, decreased in 16% (4/25), and unchanged in 24% (6/25). Two patients reported a slight allergic reaction to the injection; no other side-effects were detected. The results of this pilot study justify investigating the efficacy of intra-articular tenoxicam in controlled double-blind studies.