Articles: treatment.
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This prospective, non-randomized clinical trial was designed to determine the clinical outcome of patients who underwent Intradiscal Electrotherapy (IDET) for the treatment of chronic discogenic low back pain. Twenty-seven consecutive patients undergoing IDET were prospectively evaluated. All patients, as determined by provocative discography and/or MRI, had discogenic disease with chronic low back pain and were non-responsive to conservative treatment for at least 6 months. ⋯ This did not translate into a significant improvement in the SF-36 survey scores. The risks are negligible, and recovery time is minimal. The procedure may be useful in selected patients who would otherwise undergo an interbody fusion procedure.
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This review describes recent advances in multimodal neuromonitoring of patients following severe head injury during the period from 2001 to 2002. ⋯ Technology is rapidly changing the nature of neuromonitoring. New devices are becoming available which make the monitoring truly multimodal. Studies are needed to determine how to best incorporate these new parameters into effective management protocols.
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Semin Respir Crit Care Med · Oct 2002
Pneumonia complicating the acute respiratory distress syndrome.
Ventilator-associated pneumonia (VAP) complicating the course of acute respiratory distress syndrome (ARDS) is one of the most challenging diagnostic and treatment dilemmas in critical care medicine. The VAP incidence rate ranges from 37 to 60% in ARDS patients, significantly greater than for other causes of respiratory failure. Although the normal risk factors for VAP are the same in ARDS patients, multiple aspects of the underlying disease and its management increase the risk compared with non-ARDS patients. ⋯ The multilobar but predominantly lower lobe pattern of pneumonia in ARDS makes use of quantitative cultures of lower respiratory secretions (sampled by various techniques) very accurate to confirm the presence of pneumonia. VAP in ARDS patients is usually late-onset and therefore caused by highly antibiotic-resistant microorganisms. Somewhat surprisingly, the mortality of ARDS patients with VAP is not significantly greater than that of ARDS patients without VAP, although subsequent duration of mechanical ventilation is consistently prolonged in patients with VAP.
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The use of percutaneous radiofrequency (RF) lesion adjacent to the dorsal root ganglion (RF-DRG) in the treatment of pain has been established for years. A relatively novel indication for RF-DRG treatment is spasticity in children with cerebral palsy. In this article the pathophysiology and management of spasticity is discussed with an emphasis on the role of RF-DRG. In the management of spasticity, RF-DRG could prove to be a little invasive treatment option with little adverse effects.
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The International Headache Society applies the term exertional headache to head pain precipitated by exertion. The Society recognizes cough headache and sexual headache as distinct diagnoses. All three types of headache share characteristics and mechanisms, and together may be considered as headache provoked by exertional factors ( Table 1). ⋯ The consensus to date is that secondary HAPEF resolves if the underlying illness can be treated; primary HAPEF responds well to prophylactic treatment. Treatment strategy varies little among headaches precipitated by cough, sex, or other forms of exertion. Avoidance strategies, sometimes combined with medication (particularly indomethacin), can effectively treat headaches produced by exertional factors in most cases.