Articles: treatment.
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J Neurosurg Anesthesiol · Dec 1990
In vitro demonstration of the antidotal efficacy of hydroxocobalamin in cyanide poisoning.
The effects of sodium cyanide (1 mM) and the antidotal action of hydroxocobalamin (1 mM) were studied on rat cardiac papillary muscle. A 10-min period of exposure to cyanide induced a marked decrease in inotropy as shown by a decrease in the maximum unloaded shortening velocity (Vmax: 64 +/- 11% of precyanide values, p <0.01) and active isometric force (AF/s: 35 +/- 13%, p <0.01). The impairment of contraction-relaxation coupling under low load and the nearly complete disappearance of the load sensitivity of relaxation suggested a decrease in sarcoplasmic reticulum function. ⋯ The effects of hydroxocobalamin developed very quickly, beat to beat. The main toxic target of cyanide is brain and heart cytochrome oxidase, and brain damage appears only a few minutes after the onset of anoxia. Because hydroxocobalamin is a rapid and powerful antidote, it may be useful in the treatment of acute cyanide poisoning.
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Despite all of the progress that has been made in diagnostic procedures and the increasing number of treatment facilities available the number of people suffering from chronic pain conditions seems to be growing constantly in all industrialized countries, a fact which is demonstrated impressively by the epidemiology of low back pain. "Chronic" means "life-determining"-chronic pain, as all chronic illnesses represent a turning point in the life situation of the people concerned. They not only affect the patients, but also the members of their immediate social environment. Chronic pain becomes a destructive stigma when society reduces the afflicted persons to the status of the chronically ill. ⋯ The introduction of the concept of the "healthy pain patient" has the goal of raising the competence of the individual and his/her social environment to improve the quality of life in spite of chronic pain. The educational aim is to enable patients with pain to be autonomous and to maximize their potential health. The therapeutic approach is demonstrated by individual case histories.
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Many studies have demonstrated that cancer pain can be relieved in most cases by suitable analgesic medication. Patients with a diagnosis of "intractable cancer pain", however, are referred to our pain clinic nearly every day. A retrospective study of 1140 patients was therefore performed to evaluate the pain mechanisms and whether analgesic pretreatment had been adequate. ⋯ The principal causes for the inadequacy of the analgesic pretreatment were: failure to prescribe analgesics (10% of the patients), irregular intake schedule or prolonged intervals between applications (66%), underdosage of nonopioid analgesics (27%) or opioids (42%), and withholding of nonopioid analgesics (30%), strong opioids (14%), or co-analgesic drugs (17%), although their prescription was indicated. The severe pain was thus caused in many patients by simple mistakes in the prescription of analgesics. Terms like "intractable" should be used with caution when referring to cancer pain because they are often unreflected and can make patients and physicians feel helpless or insecure.
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Mol. Cell. Neurosci. · Dec 1990
Sex steroids and fos expression in the CNS of prepubertal and newborn rats.
Fos-like immunoreactivity (IR) within estrogen-concentrating regions of the hypothalamus and within sexually dimorphic regions of the hypothalamus and spinal cord was studied both as a function of estrogen treatment and during specific stages of postnatal development. Two sets of experiments were performed. First, Fos expression in the arcuate (Arc) and ventromedial (VMN) nuclei of the hypothalamus of 25-day-old female rats was examined 1, 3, and 6 h after estrogen treatment. ⋯ Specific patterns of staining were observed, some of which were different by 10 days after birth. Most striking was the striatum in which Fos-like IR cells were distributed in patches and along the border adjacent to the corpus callosum on Postnatal Day 0, but were no longer observed 10 days after birth. These data were confirmed by in situ hybridization studies in which the expression and distribution of c-fos mRNA in many of these areas were consistent with the distribution of Fos-like IR cells.