Articles: patients.
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Published studies of intradiscal thermal annuloplasty (IDTA) have shown at most 50% pain relief as an improved outcome with little focus on functional improvement in the treatment of discogenic pain. Previous studies have used a number of criteria for patient selection including low back pain unresponsive to conservative care, no compressive radiculopathy, positive provocative discography and absence of previous surgery at the same symptomatic level. The purpose of present study is to examine the hypothesis that additional inclusion criteria for patient selection such as disc height, absence of degenerative disc disease (DDD) in untreated discs, absence of herniated nucleus pulposus or lumbar canal stenosis may improve the outcome of treatment. ⋯ We found dramatic improvement of pain scores and ADLs following IDTA when strict patient selection was applied. We believe that IDTA is an effective, minimally invasive treatment for discogenic pain in properly selected patients.
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To review current concepts in the diagnosis of adrenocortical disease in the critically ill patient. ⋯ We suggest that the following caveats be borne in mind when diagnosing adrenal insufficiency in the critically ill patient. Firstly, the gold standard for the diagnosis has not been established. Secondly, caution must be exercised when interpreting a single plasma cortisol value. In the event of a single result indicating adrenal hypofunction, we suggest repeating the measurements after a 6 to 12 hour interval. The clinician must also be aware of variations in cortisol concentrations induced by the assay. Thirdly, the clinician must be aware of the potential limitations of the conventional high dose corticotrophin test. We also suggest that plasma free cortisol is more relevant than total plasma cortisol in the assessment of adrenal function in critical illness and that the low dose corticotrophin test is more sensitive than the conventional high dose test. These areas should be the subject of further investigations.
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Eur. J. Intern. Med. · Jun 2004
The predictive value of white blood cell count on the success of primary percutaneous intervention of the left anterior descending artery in patients admitted with acute anterior wall myocardial infarction.
Background: Epidemiological studies have shown correlations between the white blood cell (WBC) count and the risk of acute myocardial infarction (AMI) and stroke. The risk of AMI is four times as great in patients with WBC counts in the high-normal range (>9000/microl) as it is in those in the low-normal range (<6000/microl). A high WBC count also predicts a greater risk of re-infarction and in-hospital death. ⋯ Multiple logistic dregression analysis demonstrated that low ejection fraction (p=0.01) and high WBC counts (p=0.04) were correlated with failure of angioplasty and referral for an emergency CABG. WBC counts were positively correlated with heart rate (p=0.005), platelet count (p=0.0006), and Hg level (p=0.001). Conclusions: These data suggest that measuring WBC count on admission to the catheterization laboratory for primary angioplasty provides clinically important prognostic information.
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Continuous cardiac output measurement using pulse contour analysis is a technique gaining widespread acceptance in intensive care units. We report a case where a pulse contour analysis computer (PiCCO, Pulsion Medical Systems, Munich, Germany) failed to calibrate in a patient who was undergoing induced hypothermia for anoxic brain injury. ⋯ Subsequent rewarming of the patient allowed calibration of the arterial waveform and continuous cardiac output measurement. We were unable to find any previous reports of this problem using a PiCCO device, although similar problems with thermodilution cardiac output estimation using the pulmonary artery catheter during hypothermic cardiopulmonary bypass have been documented.
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Comparative Study
Diagnostic CT scans: assessment of patient, physician, and radiologist awareness of radiation dose and possible risks.
To determine the awareness level concerning radiation dose and possible risks associated with computed tomographic (CT) scans among patients, emergency department (ED) physicians, and radiologists. ⋯ Patients are not given information about the risks, benefits, and radiation dose for a CT scan. Patients, ED physicians, and radiologists alike are unable to provide accurate estimates of CT doses regardless of their experience level.