Medical science monitor : international medical journal of experimental and clinical research
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Ultrasound measurement of the optic nerve sheath diameter (ONSD) has been shown to correlate with intracranial pressure (ICP). This study looked at intra-observer and inter-observer reliability among three emergency physicians (EPs) using three different imaging protocols. ⋯ These data suggest comparable precision and inter-observer reliability can be achieved. However, larger values when using the 10-5 MHz probe suggest different cut-off thresholds for normal upper limits. The coronal imaging technique demonstrated less inter-rater variance and may be a better technique when such small measurement differences are important.
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Electroconvulsive therapy (ECT) is reported to be effective for intractable chronic pain with depression. However, not much has been done to clarify the ECT target in patients, whether the pain or the depression. We report a case of intractable chronic regional pain syndrome (CRPS) with secondary depression in which the depression was treated successfully with an initial acute ECT course, and the pain finally improved with two additional ECT courses. ⋯ Our experience in thin case suggests that the therapeutic target in patients with chronic organic pain and secondary depression should be the pain; repeated ECT courses are likely to be effective for the pain, although the depression may resolve first.
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This is a review of current knowledge on cardiogenic shock (CS), with particular attention to recommended management. The bibliography for the study was compiled through a search of different databases between 1966-2008. The references cited in the selected articles were also reviewed. ⋯ Although patients with cardiogenic shock often present a left ventricular ejection fraction of around 30%, survivors often have a good functional classification one year after the event. Neurohormonal and inflammatory mechanisms play a fundamental role in the pathophysiology of CS. These mechanisms are currently the target of studies looking into developing new therapeutic strategies.
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Survivors of severe traumatic brain injury (TBI) may show transient or persistent extrapyramidal symptoms such as rigidity, akinesia and parkinsonian posture, associated with hypomimia, not estinguishable glabellar tap reflex, seborrhea and hypersalivation. The Blink Reflex (BR), an electrically-induced reflex, is abnormal in Parkinson's disease (PD) and in some parkinsonisms. The aim of the study was to investigate BR habituation and its recovery cycle in survivors of severe TBI suffering from parkinsonian syndrome and the possible correlation with neuroimaging findings. ⋯ BR changes correlate with parkinsonian signs and neuroimaging findings. BR may have a role as a diagnostic tool in post-traumatic parkinsonism and as a prognostic tool to evaluate the effect of therapeutic options.
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Randomized Controlled Trial
Magnesium sulfate reduces postoperative morphine requirement after remifentanil-based anesthesia.
The aim was to investigate the effect of magnesium sulfate on postoperative pain and analgesic consumption after remifentanil-based anesthesia. ⋯ It was concluded that magnesium sulfate decreased the postoperative morphine requirement when remifentanil was used for intraoperative analgesia.