Southern medical journal
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Southern medical journal · Dec 1996
Randomized Controlled Trial Clinical TrialEMLA cream as a topical anesthetic before office phlebotomy in children.
We studied the effectiveness of EMLA cream (2.5% lidocaine, 2.5% prilocaine) in reducing distress, anxiety, and pain associated with phlebotomy in pediatric outpatients. This was a randomized, double-blind, placebo-controlled study using EMLA cream or placebo 1 hour before phlebotomy. Distress, anticipatory anxiety, pain, and adverse reactions were measured. ⋯ Pain was decreased with use of EMLA cream. Anticipatory anxiety levels were equal within both groups. Ratings of cream efficacy by parent/observer scales were in favor of EMLA cream.
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Southern medical journal · Nov 1996
Case ReportsRegression of ST segment elevation after thrombolysis in acute aortic dissection.
A 55-year-old man was admitted to the hospital with chest pain and electrocardiogram consistent with the diagnosis of evolving myocardial infarction. Treatment with streptokinase was administered, resulting in clinical and electrocardiographic signs of reperfusion. ⋯ At catheterization the diagnosis of aortic dissection was made, but the patient died before surgery. Thus, clinical and electrocardiographic signs of reperfusion after streptokinase may occur in patients with aortic dissection and myocardial infarction.
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Southern medical journal · Nov 1996
Review Case ReportsMuscle rigidity due to fentanyl infusion in the pediatric patient.
Two cases of fentanyl-induced muscle rigidity are presented. Significant features of these cases include the unusual pattern of rigidity and the use of fentanyl doses lower than those usually associated with muscle rigidity.
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Southern medical journal · Nov 1996
Review Case ReportsLong-term subcutaneous infusion of midazolam for refractory delirium in terminal breast cancer.
We describe the case of a 56-year-old woman with terminal metastatic breast cancer who had delirium in the form of frightening hallucinations, paranoid delusions, and nightmares resulting in violent agitation. During this period, her bone pains from metastases were well controlled with narcotic analgesics, but her delirium proved refractory to standard doses of drugs such as lorazepam, diazepam, and haloperidol. We report the use of a subcutaneous infusion of midazolam at home and its effectiveness in control of her delirium after other drugs had failed.
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Age is often a marker for comorbid illnesses that may complicate attempts at surgical intervention. Careful selection is important in deciding to recommend surgery for geriatric patients, but selected elderly patients may even benefit from major surgery. ⋯ Case series have shown the ability of geriatric patients to recover from major surgical procedures, including cardiac surgery, neurosurgery, and oncologic surgery. In general, advanced age is not a contraindication to surgery but it reinforces the need for careful preoperative evaluation and vigorous postoperative support of the patient.