Articles: patients.
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To determine whether there is any systemic relationship between the distance from the skin to the epidural space and physical constitution, the distance from the skin to the epidural space was measured in 1007 epidural punctures. The distance from the skin to the epidural space in male was greater than that in female ( P < 0.001). However, the analysis of the distance from the skin to the epidural space of the selected patients who had both a weight of 50-60 kg and a height of 1.5-1.7 m indicated no statistical difference between male and female. ⋯ The correlation between the distance from the skin to the epidural space and height was less striking. Ninety-five percent of the patients who received epidural puncture at the thoraco-cervical area (C7-T2) had a distance to the epidural space of 4.0-6.9 cm; 87% at the lower-thoracic area (T8-T10), 4.0-6.9 cm; 93% at the thoraco-lumbar area (T12-L2), 3.0-4.9 cm; 85% at the mid-lumbar area (L2-L4), 3.0-4.9 cm. These results may be useful for young anesthesiologists to master epidural block safely and efficiently.
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The aim of this study was to evaluate a new modified visual analog scale, called the dolorimeter, together with a verbal rating scale (VRS) and a linear visual scale (VAS), in the measurement of acute postoperative pain. The scales were evaluated with reference to their sensitivity, reliability and validity, and correlation. During the study 200 patients 11-70 years of age (125 men, 75 women) were interviewed after orthopedic surgery to ascertain the intensity of the pain. ⋯ On the other hand, the high sensitivity of the two analog scales which patients can use to determine their individual pain intensity proved to be much more sensitive. All three methods correlated statistically; the highest correlation coefficients were found between the analog scales VAS and the dolorimeter. Because the dolorimeter is clearly preferred to the other methods, especially by elderly patients, we came to the conclusion that the dolorimeter is less abstract than the VAS and more practical to handle.
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Comparative Study
A comparison of two patient classification systems for an MICU.
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When treating a cancer patient with severe pain it is not sufficient to treat the cancer and the pain. Effective therapy must adhere to the principles of psychosomatic medicine, i.e., the disease, cancer, isnot treated, but instead a human being who is suffering from this disease, has severe, ongoing pain as a result, and is going to die. Irrespective of the question of whether the patient has been told his diagnosis or not, he will be in an extreme situation psychologically, as he instinctively suspects what is wrong with him. ⋯ If, however, they receive the proper guidance, they will live more consciously and more intensively. In the awareness of imminent death they can experience every day of their life as a gift. Care of terminally ill cancer patients with severe pain thus also must include a guided approach to death.
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Reflex sympathetic dystrophy (RSD) is a disease of the extremities that can be elicited by different factors, occurring at different sites (e.g., trauma, herpes zoster, myocardial infarction). Independently of its etiology, however, the clinical symptoms of RSD are found most often in distal parts of the extremities affected (hand or foot). In a generalized distribution pattern, the following signs, representing a triad of autonomic, motoric and sensory disturbances, are commonly observed in these regions: 1. dysregulation of blood flow to the skin and of sweating, together with diffuse swelling, 2. impairment of movement and muscular strength; 3. diffuse sensory skin disturbances and spontaneous pain of ariable character (e.g., burning, throbbing, aching, shooting). ⋯ This excitation, in turn, maintains the abnormal vasoconstrictor outflow via reflex mechanisms, thus initiating a vicious circle. Sympatholytic therapy can interrupt the abnormal vasoconstrictor outflow, leading to increased venous return and reducing interstitial pressure and nociceptor activation (interruption of the vicious circle). If sympatholytic therapy is applied early, full recovery may occur.