Articles: treatment.
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Increasing experimental evidence is indicating that volatile anesthetic agents may exert direct cardioprotective effects. They have been shown to directly precondition or indirectly enhance ischemic preconditioning. This results in protection against reversible and irreversible ischemic myocardial damage. In addition, volatile anesthetics also decrease the extent of the reperfusion injury when administered only during the reperfusion period. The implementation of these properties during clinical anesthesia might provide an additional tool in the treatment and prevention of ischemic cardiac dysfunction in the perioperative period. ⋯ This review will summarize the current knowledge in this field and also discuss the potential mechanisms involved in cardioprotection by anesthetic agents.
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Eur. J. Intern. Med. · Feb 2004
Acute pancreatitis complicating intrabiliary rupture of liver hydatid cyst.
Acute pancreatitis is a rare complication of hydatidosis, and the successful use of endoscopic sphincterotomy in the treatment of pancreatitis complicating ruptured hydatid cyst has been very rarely reported. We report here a case of a 50-year-old man, known to have hydatid cyst of the liver, who presented with upper abdominal pain. ⋯ At endoscopic retrograde cholangiopancreatography (ERCP) the common bile duct was dilated. A sphincterotomy was performed and a mucoid structure was extracted, after which the patient made an uneventful recovery.
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Postherpetic neuralgia (PHN) is by far the most common complication of herpes zoster (HZ) and one of the most intractable pain disorders. Since PHN is seen most often in the elderly, the number of patients with this disorder is expected to increase in our ageing society. PHN may last for months to years and has a high impact on the quality of life. The results of PHN treatment are rather disappointing. Epidural injection of local anaesthetics and steroids in the acute phase of HZ is a promising therapy for the prevention of PHN. Since randomised trials on the effectiveness of this intervention are lacking, the PINE (Prevention by epidural Injection of postherpetic Neuralgia in the Elderly) study was set up. The PINE study compares the effectiveness and cost-effectiveness of a single epidural injection of local anaesthetics and steroids during the acute phase of HZ with that of care-as-usual (i.e. antivirals and analgesics) in preventing PHN in elderly patients. METHODS / DESIGN: The PINE study is an open, multicenter clinical trial in which 550 elderly (age >/= 50 yr.) patients who consult their general practitioner in the acute phase of HZ (rash < 7 days) are randomised to one of the treatment groups. The primary clinical endpoint is the presence of HZ-related pain one month after the onset of the rash. Secondary endpoints include duration and severity of pain, re-interventions aiming to treat the existing pain, side effects, quality of life, and cost-effectiveness. ⋯ The PINE study is aimed to quantify the (cost-) effectiveness of a single epidural injection during the acute phase of HZ on the prevention of PHN.
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This was a pilot study to test the potential effectiveness of intradiscal restorative injection therapy and compare with intradiscal electrothermal therapy (IDET). Thirty-five patients for intradiscal injection and seventy-four for IDET took part in the study. All patients had intractable chronic discogenic low back pain, confirmed by discogram study. ⋯ However, the duration of pain flare-up was notably shorter for restorative injections (8.6 days) than for IDET (33.1 days). Biochemical intradiscal restorative injections may be useful to reduce pain and disability in patients with chronic discogenic low back pain, and have clinically similar efficacy to IDET, but with improved cost-benefit ratio. The results of this study indicate that controlled random prospective comparative studies need to be performed to establish the efficacy of this treatment.
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To demonstrate the effectiveness of Sarapin in prolonging the action of neural blockade with improved pain relief. ⋯ This prospective, double-blind trial of 500 patients undergoing 828 treatments, one time with Sarapin and a subsequent time without, with each patient acting as their own control, showed no significant differences in the pain relief or duration of significant relief with the addition of Sarapin.