Articles: patients.
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Journal of anesthesia · Jul 1992
Cardiovascular responses to fiberoptic intubation: a comparison of orotracheal and nasotracheal intubation.
We compared the cardiovascular responses between nasal and oral intubation with a fiberoptic bronchoscope under the combination of neuroleptic analgesia (NLA) and topical anesthesia. The 16 patients studied were divided into 2 groups: the nasal intubation group (N group: 8 patients) and the oral intubation group (O group: 8 patients). There were significant changes in systolic, diastolic and mean arterial pressures in the N group and in the pressure rate quotient in the O group. ⋯ The individual RPP in both groups was relatively stable except for one patient in the N group, who had a marked increase in RPP during the procedure. We conclude that, under the combination of NLA and topical anesthesia, the cardiovascular responses to oral fiberoptic intubation are less severe than those to the nasal approach. The oral approach is recommended, especially in patients with coronary artery disease, taking into consideration of the cardiovascular responses to fiberoptic intubation.
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Treatment of chronic pain disease is a scientific and clinical challenge encountered in all branches of medicine. Essential trigeminal neuralgia and chronic pain situations are noted for their exceptionally marked severity and also for their psychic and social consequences. It is not rare for a primarily somatic pain syndrome to develop into a painful disease in its own right, which is highly refractory to treatment. ⋯ Vincristine iontophoresis was applied in 33 patients hitherto unsuccessfully treated with various other methods. In 78% of the cases, attenuation of the pain was achieved. This noninvasive therapy proved to be free of side effects.
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Epidural steroid injections are frequently used in the conservative treatment of backache, although they are still subject to critical discussion. Relief of pain is attributed to the anti-inflammatory effect of the steroid. During a 3-year period, 53 patients with back pain or differing aetiology were treated with one or more epidural injections of 14 mg betamethasone (2 ml Celestan) in a prospective and retrospective fashion. ⋯ Patients with acute pain (up to 6 months) responded better than patients with chronic symptoms. No significant correlations were detected between response and other characteristics, e.g. age, sex, number of injections, type of pain, intensity of pain, or psychological overlay. For patients with acute pain epidural steroid injections seem to be a safe, appropriate and promising procedure.
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Neuropathic pain is one of the problem areas in the management of cancer pain. In a retrospective study, prevalence and characteristics of neuropathic pain in 1318 cancer patients attending a pain clinic were examined. Of the patients, 135 suffered from neuropathic, 285 from neuropathic and nociceptive, 890 from nociceptive and 8 from unknown pain conditions. ⋯ Of 110 clinically analysed neuropathic pain conditions, 44% were neuralgic, 31% radicular, 13% sympathically maintained, and 10% caused by deafferentiation, while in 3% the nature was unknown. To evaluate the efficacy of cancer pain treatment, nocicepetive pain has to be differentiated from neuropathic pain. In addition to this, neuropathic pain has to be divided into subgroups.
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The efficacy of classic homeopathic therapy is scientifically not well proven. Few of the studies available are acceptable from a scientific point of view. In this paper we will describe a study protocol for a trial of classic homeopathy in chronic headache, which not only is in accordance with currently accepted scientific research standards but also accounts for the special needs of homeopathic therapy. ⋯ The study started in the later part of 1991, and is scheduled to last for 2 1/2 years. We expect a critical discussion of the results from conventional medicine or from homeopathy, depending on the outcome of the study. The study protocol is being published in advance to enable the reviewers of the study to check the original study design and the a priori hypotheses adopted.