Medical science monitor : international medical journal of experimental and clinical research
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With the popular use of the laryngeal mask airway (LMA), recurrent laryngeal nerve injury associated with the LMA, which might cause serious complications, has recently been reported. The true mechanism, however, remains unclear, which makes effective prevention and treatment of this disorder difficult. On the basis of the anatomical relationship of the laryngopharynx and the laryngeal mask and the progressive recovery in most reported cases, we hypothesize that demyelinating neuropraxia resulting from direct mechanical compression contributes to the recurrent nerve injury associated with the LMA. ⋯ Several animal studies also reveal that high laryngeal mask airway intra-cuff pressure might cause laryngopharyngeal mucosa damage, but there is no experimental research about LMA-related recurrent nerve injury. Therefore, further investigation by establishing an animal model might disclose the definite mechanism of the injury and evaluate the process of nerve recovery. The potential implications arising from this testable hypothesis might be helpful in developing clinical therapeutic approaches for this complication.
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Case Reports
Intravenous administration of vitamin C in the treatment of herpetic neuralgia: two case reports.
Acute herpetic neuralgia (AHN) due to a reactivated varicella zoster virus infection is a common problem. Furthermore, about 18% of all patients with confirmed herpes zoster (HZ) develop postherpetic neuralgia (PHN). The leading factors of the prognosis and persistence of symptoms are patient age and the size of the lesions. Animal studies came to a similar conclusions that in both AHN and PHN, inflammatory cytokines such as IL-6 and IL-8 could serve as predictive markers and that a positive influence of vitamin C administration, by modifying cytokine metabolism, could be demonstrated. ⋯ The use of the vitamin C appears to be an interesting component of alternative therapeutic strategies in the treatment of HZ. Especially for therapy-resistant cases of PHN, vitamin C administration should be examined as an additional option. To test and confirm the clinical findings, randomized clinical studies concerning the use of vitamin C in the concomitant treatment of zoster-associated neuralgia should be performed.
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Comparative Study Clinical Trial
Comparison of arterial pressure cardiac output monitoring with transpulmonary thermodilution in septic patients.
The measurement of cardiac output in critically ill patients is complicated by rapid pathophysiological changes. The aim of this study was to compare the recently developed Arterial Pressure Cardiac Output algorithm (APCO) with transpulmonary thermodilution (TDCO). Clinical and hemodynamic parameters were tested for their impact on the measurements. ⋯ The APCO algorithm provides a broad range of hemodynamic measurements with a minimally invasive approach and simple access to the patient's hemodynamic state. However, an underestimation at high cardiac output and an overestimation at low cardiac output relative to transpulmonary thermodilution were observed in septic patients. Therefore, the APCO algorithm in its current state cannot be substituted for transpulmonary thermodilution.
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Antiplatelet agents play an essential role in the treatment of acute coronary syndrome (ACS). Thienopyridines are a class of drugs that function via inhibition of the adenosine diphosphate (ADP) P2Y12 platelet receptors. Currently, clopidogrel, a second generation thienopyridine, is the main drug of choice and the combination of aspirin and clopidogrel is administered orally for the treatment of ACS. ⋯ Ticagrelor compared with clopidogrel had a significantly greater reduction in the death rate from vascular causes, myocardial infarction, or stroke without major bleeding. There was however, an increase in non-procedure related bleeding, dyspnoea and ventricular pauses in the first week of treatment. Further studies on new antiplatelet agents are needed to establish a new "gold standard" antiplatelet therapy.
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Although the flow velocities of portal veins (PV) and flow patterns of hepatic veins (HV) during pregnancy were evaluated in the literature, changes in PV flow pattern during pregnancy have not been assessed. The aim of this study was to detect changes in HV and PV flow velocities and patterns during pregnancy. ⋯ When evaluating physiological changes in pregnancy, flow pattern changes of the HV and flow velocity changes of the PV may be accepted as sensitive parameters and may be indicators of physiological alterations related to pregnancy.