Southern medical journal
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Southern medical journal · Nov 1993
Compensation status as a predictor of outcome in nonsurgically treated low back injury.
Whether the compensation status of patients injured in occupational accidents influences treatment outcome remains a controversial issue. This article describes the treatment outcome status of compensated versus noncompensated patients who received comprehensive functional restoration treatment of low back pain in a hospital-based, interdisciplinary, occupational rehabilitation and pain management program. Results of this investigation revealed treatment outcome differences between the two groups in two of three measures at discharge (subjective pain intensity and return-to-work), and outcome differences in one of five measures at 6-month follow-up (subjective pain intensity). Interestingly, significant group differences in return-to-work rates noted at the time of treatment discharge were not found during the follow-up period, with no group outcome difference in return-to-work rates noted at 6-month follow-up.
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Southern medical journal · Nov 1993
Randomized Controlled Trial Clinical TrialEvaluation of flumazenil for reversing the effects of midazolam-induced conscious sedation or general anesthesia.
To evaluate the effectiveness of flumazenil in reversing midazolam-induced conscious sedation and general anesthesia, we gave either flumazenil or placebo to 55 patients in a double-blind manner after surgery. Whether surgery was done under conscious sedation (CS group) or general anesthesia (GA group) depended on the procedure. Recovery was assessed by an Observer Assessment of Alertness and Sedation (OAAS) Scale, Finger-Nose (F-N) test, and picture recall and recognition. ⋯ In both groups, picture recall and recognition improved significantly immediately after flumazenil administration, but this improvement was generally not sustained for pictures shown at later times. These results imply that flumazenil is beneficial for reversing amnesia briefly after midazolam-induced sedation. However, flumazenil hastens recovery only when larger doses of midazolam are used for general anesthesia.
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Drug dispensing error should be considered as a cause of hypoglycemia when the usual initial workup is unrevealing, as in the case described.
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Phenazopyridine has been associated with methemoglobinemia in patients who have received an overdose, have decreased renal function, or are discovered to be unusually susceptible to the drug (ie, they may have an undetected NADH methemoglobin reductase deficiency). The case we have presented is unusual in that normal doses of phenazopyridine were given, no renal dysfunction was evident, and our patient had previously been given this drug without complication. ⋯ We saw no evidence to indicate that bupivacaine contributed to its development. Enzyme pathway changes induced by chemotherapy should be considered, though few studies have linked alterations of enzyme levels and pathways with chemotherapy and malignancy.
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Southern medical journal · Oct 1993
Case Reports Clinical TrialSystemic lidocaine therapy for poststroke pain.
Poststroke pain syndrome is commonly regarded as an intractable disease. We describe four patients who responded to an intravenous lidocaine infusion for relief of central pain after a stroke. The infusion was administered over a 48-hour period after an initial bolus of 50 to 100 mg intravenously over 40 to 120 seconds. ⋯ All patients were subsequently given a trial of mexiletine, an oral congener of lidocaine. Two have continued taking the drug and report excellent relief at 12 months' follow-up; the other two had side effects that precluded further use of the drug. We conclude that lidocaine can reduce poststroke pain, and we propose a treatment algorithm based on our experience with 40 additional patients treated for other neuropathic pain states.