Articles: patients.
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In recent years there has been a renewed interest in regional anesthesia, particularly peripheral nerve blockade, in order not only to improve the patient's well being, but also to meet the requirements of modern orthopedic surgery. These requirements include appropriate conditions to perform early and efficient rehabilitation. ⋯ Early rehabilitation is currently a key point for the success of orthopedic surgery. The rapid development of peripheral nerve blockade gives the anesthesiologist the means to face this new challenge.
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There have been reported cases of children with histories of pauciarticular juvenile chronic arthritis (JCA) later developing myasthenia gravis (MG) as young adults. This is intriguing because it had been considered rare to diagnose a second autoimmune disease in a patient with pauciarticular JCA, unlike in those with adult-onset rheumatoid arthritis. We report a case of MG in a 20-year-old woman with a history of pauciarticular JCA. ⋯ The patient underwent a surgical thymectomy and was treated with pyridostigmine, intravenous immunoglobulin, and corticosteroids with a fluctuating clinical course. Previous cases have been reported of MG associated with this subtype of JCA, suggesting a connection in autoimmune pathology. The earlier recognition and management of MG in a patient with pauciarticular JCA presenting with weakness may improve the prognosis of this disease.
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Epilepsy & behavior : E&B · Oct 2002
Effect of Wada methodology in predicting lateralized memory impairment in pediatric epilepsy surgery candidates.
Because Wada evaluations are not standardized, it is impossible to know to what degree method variance accounts for reported differences in results. To examine this problem, three comprehensive epilepsy surgery centers compared the efficacy of two Wada memory methods to predict seizure onset laterality in 152 children being considered for epilepsy surgery. Wada memory asymmetries were evaluated using either real objects with no verbal response required or more mixed stimuli requiring a verbal response. ⋯ In contrast, Wada memory performance using mixed stimuli was worse on the side of seizure onset only among patients with seizures originating in the left-hemisphere. The superiority of real objects was most apparent in younger children with left side seizure onset. Results suggest the use of mixed stimuli is less sensitive to the effects of unilateral seizure onset, and thus, diminishes the capacity of the Wada test to predict lateralized seizure onset in children.
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Zygapophysial or facet joints have been implicated as cause of low back, mid back, upper back and neck pain with referred pain. Cervical, thoracic and lumbar facet joints are innervated by the medial branches of the dorsal rami. Zygapophysial (facet) joints have been implicated as the source of chronic pain in 15% to 45% of the patients with chronic low back pain, 54% to 60% of the patients with chronic neck pain and 48% of the patients with thoracic pain. ⋯ Both studies showed positive results. Similar to randomized trials, prospective, as well as retrospective evaluations showed positive evidence, both in short-term and long-term. The results of this systematic review of 2 well-designed randomized trials, 4 prospective well-designed trials without randomization and 3 retrospective evaluations provided strong evidence that radiofrequency denervation offers short-term relief and moderate evidence of long-term pain relief of facet joint origin.
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There has recently been a growing interest in developing and modulating the techniques of neuraxial analgesia to meet the changing individual needs of parturients for pain relief during the course of labour and delivery. ⋯ Labour epidural analgesia still remains the 'gold standard' of obstetric pain management, although spinal analgesia with the single-injection technique is an attractive option due to its simplicity, reliability and efficacy. Up till now, there has been no single new drug to overcome the superiority of neuraxial analgesia in obstetrics.