Annales chirurgiae et gynaecologiae
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Comparative Study
The predictive value of three diagnostic procedures in the evaluation of palpable breast tumours.
In a prospective study of 200 palpable breast tumours of 200 women, the diagnostic specificity and sensitivity of clinical examination, mammography, and fine needle aspiration were compared, alone and in combinations. All tumours were excised and examined histologically, and 38 were malignant. The diagnostic sensitivity of clinical examination was high, 98% (91-99), whereas the specificity was rather low, 48% (36-60). ⋯ It is concluded that the possibility of distinguishing between malignant and benign palpable breast tumours is not increased by adding mammography and/or fine needle aspiration, but the discovery of two non-palpable malignant tumours by mammography underscores the importance of this method in disclosing subclinical malignant lesions. The study disclosed a statistical possibility of overlooking a few malignant tumours when using these three procedures. Therefore, we advise that all palpable breast tumours should be excised.
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Narcotics have been shown to act selectively upon nociceptive synaptic junctions in laminae 1 and 2 of the dorsal horn of the spinal cord. Subarachnoid or epidural injection of narcotics can produce selective segmental analgesia of great intensity and prolonged duration that is free of motor or sympathetic blockade. However, poorly lipid-soluble drugs, such as morphine, that tend to linger in the water phase of the CSF may spread rostrally to involve opiate receptors in brain stem nuclei. ⋯ Obstetrical pain is less amenable to this approach. Effective and safe management of acute pain requires that the patients be under adequate surveillance to avoid the danger of insidious respiratory depression. Chronic malignant pain is well controlled by relatively small doses of narcotic, and these patients can be managed at home on a long-term basis.
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The clinically useful local anesthetic agents can be divided chemically into the amino-esters, e.g., procaine, chloroprocaine and tetracaine, and the amino-amides, e.g., lidocaine, mepivacaine, prilocaine, bupivacaine and etidocaine. Pharmacologically, these agents can be categorized as agents of low potency and short duration of action, e.g., procaine and chloroprocaine; agents of intermediate potency and duration of action, e.g., lidocaine, mepivacaine and prilocaine; and agents of high potency and long duration, e.g., tetracaine, bupivacaine and etidocaine. The blood level of local anesthetics is determined by the rate of uptake, tissue redistribution, metabolism and excretion. ⋯ Among the ester agents chloroprocaine is cleared most rapidly due to its fast rate of hydrolysis. Within the amide series, prilocaine is cleared most rapidly due to its fast rate of tissue redistribution and its rapid hepatic metabolism. Bupivacaine is cleared most slowly due primarily to its decreased rate of hepatic degradation.
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The clinical course and outcome of 49 consecutive near-drowned patients is presented. All the immersions occurred in fresh water. 37 patients (76%) survived. All 28 patients who were conscious upon admission to hospital recovered fully. ⋯ Among unconscious patients, the non-survivors had on arrival an average lower rectal temperature than the survivors. The following factors during intensive care correlated with bad prognosis: low PaO2/FiO2, low serum protein concentration and disturbances in renal function. Furthermore, the findings of this study suggest that although a specific near-drowned patient has on admission most abnormal laboratory values, these do not predict his fate, but effective treatment has to be given.
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Historical Article
History, current status and future of regional anesthesia.