Articles: patients.
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The role of zygapophysial (facet) joints in chronic thoracic pain has received very little attention with only a few publications discussing these joints as sources of pain. In contrast, facet joints have been implicated as responsible for chronic pain in a significant proportion of patients with chronic neck and low back pain. However, thoracic spinal pain, though less common, has been reported to be as disabling as neck and low back pain. ⋯ Results showed that 46 patients underwent single blocks with lidocaine and 36 of these patients, or 78%, were positive for facet joint pain, reporting a definite response. Confirmatory blocks with bupivacaine were performed in all patients who were lidocaine-positive, with 61%, or 48% of the total sample of the lidocaine-positive group, reporting a definite response with improvement in their pain. Thus, comparative local anesthetic blocks showed the prevalence of facet joint pain to be 48%, with single blocks carrying a false-positive rate of 58%.
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To describe the red blood cell transfusion practices of pediatric intensivists. ⋯ This survey documented a significant variation in transfusion practice patterns among pediatric critical care practitioners with respect to the threshold hemoglobin concentration for red blood cell transfusion. The volume of packed red blood cells given was not adjusted to the hemoglobin concentration.
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Pediatr Crit Care Me · Oct 2002
Alternative arterial catheterization site using the ulnar artery in critically ill pediatric patients.
To examine the patterns of usage and associated complications among radial, femoral, and ulnar artery catheters in the pediatric intensive care unit to ascertain the utility of the ulnar artery as an alternative vessel of peripheral cannulation. ⋯ Based on the ischemic and infectious complication rates, the ulnar artery should be considered as a viable site for peripheral vessel cannulation in cases in which arterial catheterization is necessary and attempts at more common sites of catheterization are unsuccessful.
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Burn pain is often under treated. Burn patients suffer from daily background pain as well as procedural pain. Direct mechanical and chemical stimulation to peripheral nociceptors, peripheral- and central sensitization contribute to the pathophysiology of pain. The purpose of this review is to discuss the current management of burn pain and also to stimulate future studies. ⋯ There is no clear evidence to show that the use of opioids in acute pain may increase the likelihood of developing opioid dependency. Thus, pain after burn injury should be aggressively treated using pharmacologic and non-pharmacologic approaches. Further controlled studies are yet to be conducted to define appropriate treatments for different burn patients and to establish standard treatment protocols for burn pain.
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Guillain-Barré syndrome is characterized by acute paralysis and ascending neuropathy due to an inflammatory attack on the myelin of peripheral nerves. About 2/3 of patients with Guillain-Barré syndrome have an infection 1-3 weeks before the onset of the symptoms. Guillain-Barré syndrome has rarely been reported after solid organ transplantation (18 cases with three cases after liver transplantation), and these cases are mostly related to a CMV infection. ⋯ Although the patient received tacrolimus as immunosuppressant agent and is hepatitis C positive, we can conclude that the Campylobacter infection was probably the primary trigger for the development of Guillain-Barré syndrome. As T-cell response is depressed in our patient and cross-reactive antibodies (anti-ganglioside GM-1) exists after Campylobacter infection, we suppose that a humorally mediated attack is responsible for Guillain-Barré syndrome after solid organ transplantation. A review of the literature is performed.