International journal of clinical practice
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The study was designed to investigate the effects of simultaneously combined spinal-epidural anaesthesia in elderly patients and to evaluate the problems encountered during and after performing spinal block following epidural blockade. Nineteen ASA grade III elderly patients (mean age 75.8 years) were included in the study. The first 10 patients (group 1) were given 0.5% hyperbaric bupivacaine 2 ml (10 mg) and fentanyl 0.25 ml (12.5 microg) intrathecally. ⋯ The highest sensory block was achieved at T6 and T9 in groups 1 and 2, respectively. None of the patients experienced respiratory depression, sedation, vomiting, shivering or headache. In conclusion, simultaneous combination of subarachnoid and epidural blockade may provide sufficient anaesthesia with fewer complications.
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Intermittent claudication, the most common symptomatology of peripheral arterial disease, is characterised by lower-extremity discomfort induced by exercise and relieved by rest. The most serious potential outcome of the condition is increased morbidity and mortality from cardiovascular disease, with which it is often associated, thus prompt diagnosis and management are crucial. Therapy consists of structured exercise and reduction of cardiovascular risk factors, followed by or together with pharmacological interventions with anticlaudicants (cilostazol or pentoxifylline) and specific antiplatelet agents (aspirin, clopidogrel). Revascularisation procedures are indicated in those with limb-threatening or lifestyle disabling disease.
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A case of a child with acute cerebellar ataxia associated with chickenpox virus infection is described. Acute cerebellar ataxia associated with chickenpox is a well-recognised complication and the pertinent features of this condition are discussed.
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An impaired function of the protein C pathway plays a central role in the pathogenesis of sepsis. Administration of human recombinant activated protein C (Xigris) may restore the dysfunctional anticoagulant mechanism and prevent amplification and propagation of thrombin generation and formation of microvascular thrombosis but may simultaneously modulate the systemic pro-inflammatory response. Experimental studies indicated that the administration of activated protein C could block the derangement of coagulation, inhibit inflammatory effects and preserve organ function. Randomised controlled clinical studies in patients with severe sepsis confirmed these beneficial effects and demonstrated that administration of recombinant human activated protein C resulted in a reduction of mortality in patients with severe sepsis.
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Int. J. Clin. Pract. · Jul 2002
Comparative StudyEffects of somatostatin, octreotide and pitressin plus nitroglycerine on systemic and portal haemodynamics in the control of acute variceal bleeding.
To examine the haemodynamic effects of somatostatin (SS) and octreotide (OC) versus pitressin plus nitroglycerine (PN) in the control of variceal bleeding, 224 patients with acute oesophageal and gastric variceal haemorrhage were randomly divided into three groups and treated with SS, OC and PN; they also had their Doppler ultrasound parameters measured before, during and after treatment. The success rates of bleeding control in the SS (80.9%, 86.8% and 89.7%, p<0.001) and OC (75.3%, 80.8% and 84.9%, p<0.01) groups were significantly higher than in the PN group (51.8%, 59.0% and 65.1%) at 24, 48 and 72 hours respectively, and the average duration of SS (12.7 + 6.8 h) and OC (13.8 + 8.0 h) was significantly lower than that of PN (24.6 + 15.4 h, p<0.001). Side-effects of SS (7.4%) and OC (8.2%) were less than those of PN (41.0%, p<0.001 and p<0.01). ⋯ Heart rate and cardiac output decreased significantly in patients treated with SS and OC; mean arterial pressure was unchanged. However, heart rate and mean arterial pressure increased, and cardiac output decreased, with PN. Somatostatin and octreotide were more effective than pitressin plus nitroglycerine in patients with acute variceal haemorrhage, with fewer side-effects, and may decrease PVF and portal vein pressure through reduction of cardiac output and dilatation of the visceral blood vessels.