Mayo Clinic proceedings
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Mayo Clinic proceedings · Sep 2000
ReviewPotential neurotoxicity of spinal anesthesia with lidocaine.
Spinal (intrathecal) anesthesia has evolved into a safe, widely accepted method of anesthesia with many advantages. However, the past decade has seen a large number of case reports and incidence studies that implicate the local anesthetic (LA) lidocaine as being more neurotoxic than other commonly used LAs such as bupivacaine and tetracaine, based on patterns of clinical use current at the time of those reports. Available studies suggest a risk of persistent lumbosacral neuropathy after spinal lidocaine by single injection in about 1 in 1300 procedures and a risk as high as about 1 in 200 after continuous spinal anesthesia with lidocaine. ⋯ Although the pain typically resolves within 1 week without lasting sequelae, it can be severe in up to one third of patients with the syndrome. In addition to clinical studies, both whole animal and in vitro studies have shown that lidocaine can be neurotoxic at clinically available concentrations and that lidocaine is more neurotoxic than equipotent concentrations of other commonly used LAs. The mechanism of this neurotoxicity may involve changes in cytoplasmic calcium homeostasis and mitochondrial membrane potential.
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Mayo Clinic proceedings · Sep 2000
Clinical Trial Controlled Clinical TrialReduction of vancomycin use in orthopedic patients with a history of antibiotic allergy.
To reduce prophylactic vancomycin use in patients with a history of penicillin or cephalosporin allergy undergoing elective orthopedic surgery by using a targeted allergy consultation and penicillin allergy skin testing. ⋯ Prophylactic vancomycin use in patients with a history of penicillin or cephalosporin allergy undergoing elective orthopedic surgery can be reduced by a targeted allergy consultation and penicillin allergy skin testing.
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Mayo Clinic proceedings · Aug 2000
Case ReportsRecalcitrant pyoderma gangrenosum treated with thalidomide.
Pyoderma gangrenosum is a painful, noninfectious, ulcerating skin disorder often associated with systemic disease. Thalidomide has been used to treat many inflammatory dermatologic conditions and has been reintroduced in the United States to treat immune-modulated diseases such as pyoderma gangrenosum. The patient described, a 47-year-old man, had histologically confirmed pyoderma gangrenosum that did not respond to treatment with several courses of methylprednisolone. The ulcer healed with 10 weeks of oral thalidomide administration.
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Mayo Clinic proceedings · Aug 2000
ReviewPrevention and treatment of osteoporosis in women with breast cancer.
Women who have had breast cancer may be at higher risk for osteoporosis than other women. First, they are more likely to undergo early menopause, due to chemotherapy-induced ovarian failure or oopherectomy. In addition, chemotherapy may have a direct adverse effect on bone mineral density (BMD), and osteoclastic activity may increase from the breast cancer itself. ⋯ For osteoporosis, treatment with alendronate should be strongly considered. Raloxifene and calcitonin are alternatives when alendronate is contraindicated. Further studies are needed to evaluate the optimal timing of initial bone mineral analysis in premenopausal women after breast cancer diagnosis and to determine the value of preventive treatment in women scheduled to undergo chemotherapy.