Agressologie: revue internationale de physio-biologie et de pharmacologie appliquées aux effets de l'agression
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The effect of pentobarbital was evaluated in 12 comatose brain injured patients (Glasgow coma scale < 7 at admission). Mean hemispheric cerebral blood flow (CBF) was studied following intravenous administration of 133Xenon. ⋯ The increase in cerebral perfusion pressure (PP) was found only in patients with diffuse brain injury. The results supports the hypothesis that barbiturate therapy is more effective at reducing ICP while preserving CPP when the cause is a diffuse lesion.
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Severe head injury (Glasgow Coma Score less than or equal to 7) is associated with high mortality and morbidity which can be improved by early energetic therapy. Such patients must be picked up by prehospital/EMS service with three aims: controlling ventilation, controlling haemodynamics, avoiding any increased intracranial pressure. ⋯ At admission to emergency unit, intensive care must be continued while X-rays and CT-scan are achieved. Imperative indications of transport to neuro-intensive care unit are discussed for hospitals without a neuro-surgeon.
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Each class (mu, delta kappa and epsilon) of opioid receptors has a characteristic pattern of distribution in the nervous system, which may, however, exhibit species differences. The effects of opioid receptor stimulation depend on the class of receptor involved, the localization of these specific receptors and the animal species under investigation. Endogenous ligands of opioid receptors, which include more than twenty peptides, derive from three precursors:proopiomelanocortin (beta-endorphin), proenkephalin A (enkephalins) and prodynorphin (dynorphins, neo-endorphins). ⋯ At this level, opioids reduce the activity of spinal neurones that convey the nociceptive messages. The classes of opioid receptors (certainly mu [mu 2?] and a, perhaps kappa) involved in this effect, and their pre- or postsynaptic location are not firmly established to date. Further developments on these points can be expected from the use of new ligands which are highly selective of the various classes of opioid receptors.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nitrous oxide (N2O) is far from inert in terms of its cerebral effects. It can increase the cerebral blood flow (CBF) and the cerebral metabolic rate for oxygen in animals and in man. ⋯ Because of its greater solubility than Nitrogen it can increase ICP, in case of pneumoencephalus and the size and consequences of gazous embolism. In neurosurgical patients, nitrous oxide should be used cautiously in regards of its neurological effects.
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A number of chronic pain syndromes in the perineal area can be related to pudental nerves suffering. The constancy of symptoms among various patients, and in duration for a particular one, alterations revealed by electrophysiologic studies, pain relief by diagnostic blocks, data from anatomic studies, preliminary results of medical and surgical applied therapies, give consistent arguments for possible organic lesions of pudental nerves.