Articles: treatment.
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Constriction of the sciatic nerve by loose ligation produces an inflammatory neuropathic injury. This represents an animal model for peripheral mononeuropathy. Oxygen-derived free radicals are suspected to play an important role in the pathogenesis of ischemia/reperfusion injury, leading to neurogenic inflammation. Hyperbaric oxygen (HBO) has been used anecdotally to treat clinically similar conditions in humans, but specific effects on the animal model have not been well studied. ⋯ This study evaluated tissue changes after nerve injury caused by loose ligation of the sciatic nerve in rats. Hyperbaric oxygen treatment following sciatic nerve injury reduced tissue edema, improved skin blood flow, and preserved muscle and neuronal ultrastructural integrity.
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Traumatic brain and spinal cord injuries continue to be a public health problem. These types of injuries often occur in early adulthood and have a major impact for society. This review discusses strategies and therapeutic agents for perioperative neuroprotection in the management of brain and spinal cord trauma. ⋯ The main priority in the initial treatment of brain and spinal cord trauma is to maintain oxygenation and perfusion in order to avoid aggravating secondary injury. Future progress will depend on the translation of neuroprotective strategies into well designed clinical trials with promising outcomes.
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Complex regional pain syndrome (CRPS) is characterized by pain that is out of proportion to the injury and is regional in distribution. A large body of literature supports a dynamic change in the physiology and structure of central pain projecting neurons mediated through the N-methyl-D-aspartate (NMDA) receptor. A critical factor in central sensitization seems to be the release of the magnesium block on the NMDA receptor with influx of calcium and initiation of intracellular cascades. Current literature supports the effectiveness of ketamine in blocking central sensitization through its effects on the NMDA receptor. Recent treatment with anesthetic doses of ketamine in severely ill patients with generalized CRPS prompted our interest in a lower dose therapy. ⋯ A four-hour ketamine infusion escalated from 40-80 mg over a 10-day period can result in a significant reduction of pain with increased mobility and a tendency to decreased autonomic dysregulation.
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Discography has been widely used in the lumbar and cervical spine as a diagnostic tool to identify sources of discogenic pain that may be amenable to surgical treatment. Discography in the cervical spine is currently performed without the benefit of pressure monitoring, and corresponding pressure parameters have not been determined. ⋯ In the cervical spine, iatrogenic disc injury may be caused at significantly lower pressures and volumes infused than in the lumbar spine. There was no measurable pressure change in any of the adjacent disc levels evaluated at maximum intradiscal pressurization. Further cadaveric testing will be necessary to develop parameters for intradiscal pressure monitoring in the cervical spine.
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Patients with critical illness, particularly those who depend on intensive care for a prolonged period of time, have a high morbidity and mortality. The acute and chronic phases of critical illness are associated with distinct endocrine alterations. Acute endocrine adaptations to the severe stress of critical illness, comprising an activated anterior pituitary function, have been selected by nature and can, as such, be considered as beneficial for surviving. ⋯ Insulin infusion titrated to maintain normoglycemia may be a notable exception, as this intervention has been proven to increase survival and reduce morbidity of surgical intensive care patients. Treatment of "relative adrenal failure" with hydrocortisone also appears to improve the outcome of patients with septic shock, but diagnostic and dosing issues still remain unresolved. Although extensive research has shown that infusion of hypothalamic-releasing peptides is able to restore physiological hormonal patterns within the somatotropic, thyrotropic, and gonadal axes and, thereby, to generate a controlled anabolic response, further research is needed to investigate whether such interventions actually improve the outcome of critical illness.