Swiss medical weekly
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Swiss medical weekly · Mar 2001
Patient satisfaction after biofeedback for constipation and pelvic floor dyssynergia.
Patients referred for chronic constipation frequently report symptoms of straining, feeling of incomplete evacuation, or the need to facilitate defecation digitally (dyschezia). When such patients show manometric evidence of inappropriate contraction or failure to relax the pelvic floor muscles during attempts to defecate, they are diagnosed as having pelvic floor dyssynergia (Rome I). ⋯ Satisfaction after biofeedback is high for patients referred for chronic constipation and diagnosed with pelvic floor dyssynergia. Biofeedback improves symptoms related to dyschezia and reduces use of aperients.
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Swiss medical weekly · Feb 2001
Therapeutic efficacy of selective nerve root blocks in the treatment of lumbar radicular leg pain.
The objective of this study was to investigate the clinical effectiveness of nerve root blocks (i.e., periradicular injection of bupivacaine and triamcinolone) for lumbar monoradiculopathy in patients with a mild neurological deficit. We have retrospectively analysed 30 patients (29-82 years) with a minor sensory/motor deficit and an unequivocal MRI finding (20 disc herniations, 10 foraminal stenoses) treated with a selective nerve root block. ⋯ Twenty-six patients (87%) had rapid (1-4 days) and substantial regression of pain, five required a repeat injection. 60% of the patients with disc herniation or foraminal stenosis had permanent resolution of pain, so that an operation was avoided over an average of 16 months (6-23 months) follow-up. Nerve root blocks are very effective in the non-operative treatment of minor monoradiculopathy and should be recommended as the initial treatment of choice for this condition.
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For supportive therapy in sepsis adequate volume loading is probably the first, and possibly the most important step in the treatment of patients with septic shock. An elevated global O2-supply (DO2) may be necessary and beneficial in most of these patients, but the increase in DO2 should be guided by measurement of parameters assessing global and regional oxygenation. Routine strategies for elevating DO2 by the use of very high dosages of catecholamines cannot be recommended. ⋯ Dopexamine has been suggested for improvement of splanchnic perfusion, but since these effects remain somewhat controversial there are no current grounds for a general recommendation in favour of dopexamine in septic patients. These recommendations are currently limited by the lack of sufficient outcome studies and studies evaluating regional perfusion. Until the various catecholamine regimes are more fully examined, recommendations for catecholamine support in sepsis must be considered "conditional".
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Swiss medical weekly · Dec 2000
ReviewNon-conventional vasopressors in septic shock: effects on hepatosplanchnic blood flow.
Vasopressors are necessary to treat the vasodilation characteristic of hypotension in septic shock. In addition to noradrenaline, the reference vasopressor, various drugs, including dopamine, adrenalin, phenylephrine, L-NMMA (a nitric oxide synthase inhibitor), and vasopressin have been used in clinical septic shock. ⋯ All these drugs can modify the perfusion and metabolism of splanchnic organs, changes which cannot be predicted from changes in systemic circulation or metabolism. Due to the complexity of actions and the high potential for severe adverse effects, "compassionate" use of unconventional vasopressors to treat hypotension in septic shock should be abandoned outside the scope of controlled clinical trials.
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Swiss medical weekly · Dec 2000
Review[Role of noninvasiveness ventilation in the weaning phase of mechanical ventilation].
During the last decade, noninvasive ventilation has proved to be a valuable alternative to endotracheal intubation in many patients with acute respiratory failure, allowing a reduction in morbidity, mortality and length of intensive care and hospital stay compared to conventional mechanical ventilation. Recent data from clinical studies suggest that these beneficial effects could also be extended to the weaning phase of mechanical ventilation, by reducing, in some patients at any rate, its duration and complication rate. The present paper focuses on some of these promising new aspects of noninvasive ventilation and attempts to define the possible indications and limits of this technique in the context of weaning.