Articles: treatment.
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Although temporal lobectomy is an effective alternative treatment for many patients with medication-resistant epilepsy, the risk of cognitive morbidity is not inconsequential. The ability to predict cognitive outcome is increasingly dependent on convergent information from multiple sources, including direct (e.g., Wada test) and indirect (e.g., psychometric testing) functional assessments along with magnetic resonance imaging studies that detect structural abnormalities. This brief review summarizes the relationship between imaging and function at baseline and predicting cognitive outcome following temporal lobectomy.
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Measuring outcome in pediatric intensive care is necessary to equate the high cost of treatment with benefits to the patient. Although mortality rates and morbidity are relatively insensitive measures of the benefits of treatment, quality of life measurement gives insight into the long-term outcomes. The aim of this study was to investigate the long-term quality of life outcome of children admitted to a pediatric intensive care unit. ⋯ Our results indicate that the long-term outcome in terms of quality of life after admission to a pediatric intensive care unit is good or normal for the majority of surviving children. Those children with a poor outcome are likely to have significant comorbidities or a diagnosis of malignancy.
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The effects of deep brain stimulation (DBS) of the subthalamic nucleus (STN) or the internal pallidum (GPi) on the parkinsonian triad and on levodopa-induced dyskinesias are very similar. The antiakinetic effect of STN DBS seems to be slightly better. On the contrary to pallidal DBS, stimulation of the STN allows to reduce dopaminergic treatment by more than 50p.100 on average. ⋯ It is the responsibility of the operating centre to determine the levodopa response, to confirm the diagnosis, to rule out contraindications and to make sure that the medical treatment cannot be further optimised. Severe surgical complications with permanent sequels are relatively rare, about 1p.100 per implanted side. The patient selection, the precision of the surgery and the quality of the postoperative follow-up are the three main determinants of success.
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Journal of anesthesia · Jan 2002
Effects of fentanyl on cardiovascular and plasma catecholamine responses in surgical patients.
Whether opioids administered before skin incision, under inhalational anesthesia, improve cardiovascular and plasma catecholamine responses to surgical stimulation compared with those administered after skin incision remains unclear. We compared the effects of fentanyl injected before and after skin incision on these responses. ⋯ Our results indicated that fentanyl depressed cardiovascular and plasma catecholamine responses irrespective of the time of administration, and that the higher dose of fentanyl produced a greater suppression of MAP and HR responses. In addition, the depressant effects on MAP of high-dose fentanyl administered 5 min before skin incision lasted longer than when injected 5 min after incision. At both doses, the opioid attenuated the rise in plasma Epi, but not Nor.
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Ethical issues can be more difficult to address in the emergency department than in other settings. We present two cases, with the goal of stimulating moral reflection and encouraging emergency physicians to gain a better understanding of two important ethical issues: advance directives and resource allocation decisions. ⋯ Although patients or substitute decision-makers define the value of a treatment goal, emergency physicians must ensure that this goal does indeed represent the patient's wishes, that it is achievable, and that competing claims for the same resource are considered. Learning from others' experiences and preparing for ethical problems in advance will help physicians feel more comfortable in dealing with ethical issues.