Minerva medica
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Essential tremor (ET) is one of the most common neurological disorders among adults, and is the most common tremor disorder. ET has classically been viewed as a benign monosymptomatic condition. Yet over the past 10 years, a growing body of evidence indicates that this is a progressive condition that is clinically heterogeneous, and may be associated with a variety of different features such as gait abnormalities, parkinsonism, cognitive impairment, dementia, personality disturbances, depressive symptoms, and sensory abnormalities (e.g., mild olfactory dysfunction and hearing impairment). ⋯ Effective pharmacological treatments for the disorder currently remain limited. Drugs are generally initiated when the tremor begins to interfere with the patient's ability to perform daily activities or when the tremor becomes embarrassing. For severe, medically refractory ET, thalamic ventralis intermedius nucleus deep brain stimulation may lessen tremor and improve function.
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Case Reports
Cardiorespiratory effects of change in posture after spinal anesthesia with hyperbaric bupivacaine.
Spinal anesthesia is a special regional anesthetic technique that is applied in lower limb orthopedic and other surgical procedures made below the transverse umbilical line, which is able to produce a neuraxial central block. The patient's position, together with the baricity of the drug solution injected, is a variable that can affect the success of anaesthesia. ⋯ We describe a case of cardiovascular and respiratory effects occurred approximately 65 min after spinal anesthesia with 7 mg of 1% hyperbaric bupivacaine in a patient during change in posture from mild anti-Trendelemburg to supine decubitus. These findings show that a change in posture after spinal anaesthesia with hyperbaric bupivacaine can affect the safety of this anesthesia technique, also after a longer period of time than is usually recommended to avoid the spread of anaesthetic drug.
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Parkinson's disease (PD) traditionally has been defined by its characteristic motor hallmarks, but non-motor features such as cognitive impairment and dementia are increasingly recognized as part of PD. Mild cognitive impairment (MCI) is common in non-demented PD patients, occurring in about 20-50%. Frequency estimates and clinical features of mild cognitive impairment in PD (PD-MCI), however, vary across studies due to methodological differences and lack of uniform diagnostic criteria for PD-MCI. ⋯ PD-MCI patients, particularly those with posterior cortical profiles, may be at high risk for developing dementia. Various biomarkers studied in PD-MCI including cerebrospinal fluid, genetic analyses, and neuroimaging suggest that there may be distinct PD-MCI profiles. Future studies using uniform PD-MCI diagnostic criteria and incorporating biomarkers and longitudinal follow-up of PD-MCI cohorts are needed to understand PD-MCI as a transitional state between normal cognition and dementia.
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Randomized Controlled Trial Comparative Study
Regional versus IV analgesics in labor.
The aim of this study was to compare combined spinal epidural (CSE), epidural (E) and IV pethidine analgesia and their effects on the mother, fetus, newborn and the labor course. ⋯ Regional analgesia especially CSE using bupivacaine or lidocaine is a safe effective method for analgesia in labor with relative better efficacy of bupivacaine.
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Left main coronary artery disease, present in 5-9% of patients with angina pectoris, is associated with high mortality risk when treated medically. For several decades coronary artery bypass grafting (CABG) has been regarded as the treatment choice for unprotected left main coronary artery (ULMCA) disease patients. ⋯ A number of registry reports, as well as a substudy from a large, randomized trial, have indicated that PCI may be an acceptable alternative to CABG in some patients with ULMCA stenosis. PCI already offers tangible short-term advantages over CABG as it is less invasive, reduces hospitalization duration, avoids the disability of surgical recovery, and allows patients to subsequently have CABG if necessary.