Advances in therapy
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Advances in therapy · Mar 2007
Morbidity and mortality among elderly Americans with different stroke subtypes.
The long-term outcomes of hemorrhagic stroke (HS), which includes subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), are not well understood relative to ischemic stroke (IS). This analysis was undertaken to assess short and long-term survival and morbidity of patients with hemorrhagic stroke, as well as risk factors associated with these outcomes. American Medicare beneficiaries >65 y of age in whom SAH, ICH, or IS was diagnosed were identified and followed over 4 y through the use of longitudinal claims data. ⋯ The recurrence rate was highest among patients with SAH. Those with HS tended to be younger than those with IS and had a greater number of comorbidities at the time of stroke. Among the elderly, patients with HS have a substantially worse prognosis than do those with IS, which highlights the need for more effective treatment of patients with HS.
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Advances in therapy · Mar 2007
Randomized Controlled TrialEffects of ropivacaine on pain after laparoscopic cholecystectomy: a prospective, randomized study.
Postoperative pain after laparoscopic cholecystectomy is an ongoing problem. To relieve this pain, practitioners have used many anesthetic and analgesic drugs. This study was undertaken to assess the effects of incisional and intraperitoneal administration of ropivacaine on postoperative pain and stress response in patients undergoing laparoscopic cholecystectomy. ⋯ The earliest analgesic requirements were seen in group 2 (P<.005), and less shoulder pain was noted in group 3 (P<.005). Norepinephrine and epinephrine levels showed no statistically significant differences between the 3 groups. Administration of ropivacaine preoperatively and postoperatively for laparoscopic cholecystectomy has similar effects on postoperative pain and the stress response of patients.
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Advances in therapy · Mar 2007
Comparative Study Clinical TrialCeliac plexus block with the long stylet needle technique.
Neurolytic celiac plexus block has been used successfully in the treatment of patients with intractable intra-abdominal pain due to malignancy or to benign pain syndromes. A new technique is described here for blocking the celiac plexus through the retrocrural approach with a special long stylet needle inserted under fluoroscopic guidance. Celiac blocks were performed in 2 groups of patients. ⋯ In the classic technique group, fluoroscopy injection time was 13+/-3 min and the number of attempts was 5.3+/-3; values in the long guided needle group were 8.9+/-3 min and 4.9+/-2, respectively. The difference in fluoroscopy injection times was significant (P<.05). The long guided needle technique for celiac plexus block may be an effective and appropriate method for beginners or for practitioners who are not knowledgeable about imaging techniques used in various medical specialties.