Clinical calcium
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Procalcitonin, a propeptide of calcitonin, is normally produced in the C-cells of the thyroid gland, but it's plasma level markedly increases, mostly due to extra-thyroidal production in cases of severe infections (bacterial, parasitic and fungal) with systemic manifestations, especially in the presence of septic shock. Since noninfectious inflammatory reaction, viral infection and localized bacterial infections manifest only small to modest increases of procalcitonin in plasma, procalcitonin levels may be useful in differentiating between these diseases and sepsis. In addition, it has been suggested that procalcitonin is an early and good marker of elevated cytokines in patients with sepsis, and that it's plasma level is correlated with Sepsis-related Organ Failure Assessment (SOFA) score. Since plasma procalcitonin is measured easily, quickly and accurately by immunoluminometric assay, it is useful for early diagnosis of sepsis in patients with severe systemic inflammatory response syndrome and as an indicator of severity of sepsis in such patients.
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Various spinal diseases that cause low back pain have two distinct pathologies, including mechanical disruption of the spinal column and compression of the cauda equina and the nerve roots. Although, the advancement in surgical techniques has brought satisfactory neural recovery, resolution of low back pain still remains unpredictable. The development of low back pain is affected by psychosocial factors besides pathological lesions in the lumbar spine leading to functional impairment. Surgical indication for low back should be carefully decided considering such nonorganic aspects of low back pain.
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Neural blocks are commonly used for patients with acute or chronic low back pain. It is important to do correctly technical procedure of neural blocks and more important to be well aware of the indication and clinical value of neural blocks. Neural blocks have two aspects of diagnostic and therapeutic value. In this article, the indication and clinical value of neural blocks were reviewed in trigger point blocks, epidural blocks, selective nerve root blocks, facet blocks and lumbar posterior medial branch blocks.
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Neurophysiologic function and ischemia causes neurogenic symptoms in lumbar spinal stenosis. Neurophysiologic function and potential therapeutic agents were investigated using a chronic cauda equina compression model that was developed according to a clinical pathogenesis. In the chronic cauda equina compression model, nerve conduction velocity and blood flow in spinal nerves decreased but mechanical allodynia was not induced. Prostaglandins and 5-HT receptor antagonist effected to improve blood flow in nerve roots after cauda equina compression;therefore, they might be potential agents for lumbar spinal stenosis.
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As the understanding for the mechanism of absorption and metabolism has not been clarified adequately, a lot of works about these issues are still carrying on. Changes in maternal blood and intracellular magnesium concentration during the early stage of pregnancy suggest magnesium may play important roles around the period of implantation. Alternation in absorption of the mineral from colon, in levels of maternal blood and those of intracellular magnesium, or in urinary excretion of magnesium during pregnancy suggest that contents of magnesium in the whole maternal body tend to be decreased with the course of pregnancy. ⋯ The magnesium deficiency is speculated to have a relation with vascular hypertonus or eclamptic seizures. Magnesium sulfate is frequently used for first choice drug, as it is effective to improve the hypertension of preeclampsia, to prevent or to cure the seizures of eclampsia. The administration of magnesium sulfate to preeclamtic women is reasonable to improve magnesium deficiency, which may be one of pathophysiological aspects of preeclampsia.