Articles: patients.
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J Neurosurg Anesthesiol · Dec 1991
A comparison of the cerebral and hemodynamic effects of mannitol and hypertonic saline in a rabbit model of acute cryogenic brain injury.
There has recently been an increased interest in the use of hypertonic saline solutions in the fluid resuscitation of trauma victims and patients with uncontrollable intracranial hypertension. In this study, the cerebral and hemodynamic effects of 3.2% hypertonic saline solution were compared with those of an equiosmolar (20%) mannitol solution or 0.9% saline in a rabbit model of acute cryogenic brain injury. Forty-five minutes following the creation of a left hemispheric cryogenic brain lesion, equal volumes (10 ml/kg) of hypertonic saline, 0.9% saline, or mannitol were infused over a 5-min period. ⋯ However, there appeared to be no significant differences in ICP between animals receiving mannitol or hypertonic saline at any time point following infusion of solutions. We conclude that following acute cryogenic brain injury, infusions of equal volumes of equiosmolar solutions of hypertonic saline or mannitol will transiently reduce ICP as compared to equal volumes of normal saline. However, hypertonic saline is not superior to mannitol in its ability to reduce ICP in this model of intracranial hypertension.
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The chronic headache patients in our neurological outpatient department treated between 1985 and 1987 were retrospectively studied. One-third (n=44) were examined and questioned about the efficacy of treatment. Initial treatment in the outpatient department had been at least 2 years before the study, thus allowing evaluation of the long-term course of the illness. ⋯ Adequate consideration of the non-medical therapeutic elements should be ensured in such structures headache therapy. A uniform classification of headache and records of the course in the form of headache diaries are essential for comparing the results. A sufficiantly long post-therapy observation period should be allowed in order to facilitate evaluation of the therapeutic response.
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A consecutive series of 98 patients presenting at an orthopedic outpatient clinic with chronic low back pain of at least 6 months' duration and with no organic findings (ruled out by clinical and radiological examination) were evaluated by means of a questionnaire which included the constructs "patient history," "pain-related restrictions," and "depression." Pain perception was evaluated with an adjective list revealing four main factors: two affective factors, i.e., "suffering from pain" and "anxiety," and two sensory factors, i.e., "acuteness" and "rhythmics of pain." The two affective factors (as against the sensory factors) subsequently influence the degree of pain intensity (measured with a visual analog scale), the patient's history and the patient's perceived impairment of daily life. Depression (von Zerssen scale) correlated with pain factors only when the whole range of pain factors was considered. The implications for treatment in patients with a high score for affective factors in the adjective list (indicator for a low success rate with traditional therapy) are discussed.
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Dextropropoxyphene is a mild opioid analgesic whose analgesic potency corresponds to that of acetylsalicylic acid and paracetamol. It has a similar analgesic effect to codeine but also a considerably lower addiction and dependence potential. Dextropropoxyphene is a therapeutic alternative to other weak opioids such as codeine or dihydrocodeine. ⋯ Repeated administration of the sustained-release form at the therapeutically recommended intervals does not lead to cumulation, and the risk of accidental overdosage is extremely low. Intoxication can only occur after simultaneous ingestion of alcohol or other centrally depressant substances or in the presence of hepatic and/or renal failure. Sustained-release dextropropoxyphene is a sensible and undeniable alternative for the second stage in the analgesic ladder of chronic pain therapy.
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Medical treatment with effective opioids for patients who suffer chronic pain is greatly lacking in Germany, as is supported by the documentation from Sorge and Zenz. The author comments on this documentation and adds an account of his own experience with the provision of opioid prescriptions over a period of almost 6 years. He asserts that the number of patients who suffer from pain has increased and argues for extending the indications for opioid therapy to include noncancer patients, giving reasons why pure morphine preparations are to be preferred. Finally, the author expresses his belief that only an expanded and appropriate application of today's concepts regarding treatment with analgesics and opioids will be able to clear the way for a liberalization of the laws regulating the prescription of opioids.