Acta bio-medica : Atenei Parmensis
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Randomized Controlled Trial Multicenter Study
72-hour epidural infusion of 0.125% levobupivacaine following total knee replacement: a prospective, randomized, controlled, multicenter evaluation.
To evaluate the efficacy in terms of pain relief and degree of motor impairment of a continuous epidural infusion of 0.125% levobupivacaine in patients undergoing total knee replacement surgery. ⋯ Continuing the epidural infusion of a concentration of levobupivacaine as low as 0.125% improves pain relief with a 50% reduction of hourly morphine consumption after total knee replacement even during the second and third postoperative days, and does not result in a gross impairment of motor function.
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Spinal anesthesia is a simple technique that provides a deep and fast surgical block through the injection of small doses of local anesthetic solution into the subarachnoid space. The purpose of this review is to provide an overview on recent developments on local anesthetic drugs, side effects, and special techniques of intrathecal anesthesia. Spinal anesthesia can be considered adequately safe, and severe complications are reasonably rare. ⋯ In the last years we have assisted important changes in the health care organization, with most of the surgical procedures performed on outpatients or on elderly patients with concomitant diseases. This forced us to change the indications and clinical use of intrathecal anesthesia techniques, which have been modified according to the changing needs of surgery. The development of new drugs and special techniques for spinal anesthesia will further improve the clinical use of this old but evergreen technique.
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Neurocysticercosis is the most common parasitic infestation of the CNS. Most authors have reported the incidence of spinal neurocysticercosis as only 1.5-3% of all cases, even in endemic areas. ⋯ The authors present a case of focal intramedullary spinal cysticercosis. The authors highlight the strategy for successful treatment of focal lesions in the intramedullary location.
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Lung cancer is the leading cause of cancer death world-wide. Among the possible causes, occupational risk factors play a major role and are potentially preventable. We reviewed the scientific evidence about lung cancer burden due to occupation. ⋯ A significant proportion of lung cancers is attributable to occupational carcinogens. The estimates are extremely variable in time and place and mainly depend on the industrial setting of the area under study; caution is therefore required in generalizing these results to the whole country. Alternative approaches to evaluate occupational lung cancer burden among women are necessary.
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Review Comparative Study
Inhalatory therapy training: a priority challenge for the physician.
Patients with asthma and COPD commonly use inhaled drugs. The 3 types of currently available devices for inhaled therapy (Metered-dose inhaler, dry powder inhaler, and nebulizer) are clinically equivalent. However, since many different inhalers are available for inhaled therapy, the choice of the delivery device is important for optimizing the results of aerosol therapy. ⋯ The choice of the device has to be tailored according to the patient's needs, situation, and preference. Whatever the chosen inhaler, education from health caregivers has a key-role for improving inhaler technique and compliance. Differences among delivery devices represent another challenge to patient use and caregiver instruction.