Acta clinica Croatica
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Acta clinica Croatica · Jun 2014
Randomized Controlled TrialThe influence of postoperative epidural analgesia on postoperative pain and stress response after major spine surgery--a randomized controlled double blind study.
Major spinal surgery is associated with severe postoperative pain and stress response, bowel dysfunction, and a potential for chronic pain development. Epidural analgesia has been shown to be advantageous compared to intravenous analgesia alone. The aim of the study was to investigate whether postoperative addition of epidural levobupivacaine to intravenous opioid analgesia offers advantage over intravenous opioid analgesia alone. ⋯ Bowel recovery and first postoperative defecation also occurred earlier in group A (6% vs. 45%, p < 0.01). Blood cortisol, glucose and cholesterol levels and the incidence of paresthesia did not differ between the groups. In conclusion, after spinal fusion, postoperative epidural administration of levobupivacaine provides better analgesia and fewer side effects with no impact on stress response.
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Acta clinica Croatica · Jun 2014
Case ReportsAn unusual manifestation of osteoarticular tuberculosis: case report.
Although osteoarticular tuberculosis is usually presented as monoarthritis of the large, weight-bearing joints (predominantly hip, knee or ankle joint), or in the form of spinal disease, it is rarely seen as oligoarthritis. In this article, we present case history of a female patient with tuberculous oligoarthritis of the right talocruraljoint and left talocalcaneal joint. A 77-year-old female patient was admitted to our department due to the symptoms of painful and swollen right talocrural joint and left talocalcaneal joint accompanied with fever, general weakness and night sweating. ⋯ Plain x-rays and magnetic resonance imaging of the affected joints showed demineralization, significant narrowing of joint space, erosions of articular surfaces, numerous calcifications, and ankylosis of both right talocrural and left talocalcaneal joint. Synovial biopsy confirmed the diagnosis of tuberculous arthritis. Our patient underwent triple tuberculostatic therapy with rifampicin, isoniazid and pyrazinamide, which resulted in the resolution of arthritis.