Articles: function.
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To review current concepts in the diagnosis of adrenocortical disease in the critically ill patient. ⋯ We suggest that the following caveats be borne in mind when diagnosing adrenal insufficiency in the critically ill patient. Firstly, the gold standard for the diagnosis has not been established. Secondly, caution must be exercised when interpreting a single plasma cortisol value. In the event of a single result indicating adrenal hypofunction, we suggest repeating the measurements after a 6 to 12 hour interval. The clinician must also be aware of variations in cortisol concentrations induced by the assay. Thirdly, the clinician must be aware of the potential limitations of the conventional high dose corticotrophin test. We also suggest that plasma free cortisol is more relevant than total plasma cortisol in the assessment of adrenal function in critical illness and that the low dose corticotrophin test is more sensitive than the conventional high dose test. These areas should be the subject of further investigations.
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Published studies of intradiscal thermal annuloplasty (IDTA) have shown at most 50% pain relief as an improved outcome with little focus on functional improvement in the treatment of discogenic pain. Previous studies have used a number of criteria for patient selection including low back pain unresponsive to conservative care, no compressive radiculopathy, positive provocative discography and absence of previous surgery at the same symptomatic level. The purpose of present study is to examine the hypothesis that additional inclusion criteria for patient selection such as disc height, absence of degenerative disc disease (DDD) in untreated discs, absence of herniated nucleus pulposus or lumbar canal stenosis may improve the outcome of treatment. ⋯ We found dramatic improvement of pain scores and ADLs following IDTA when strict patient selection was applied. We believe that IDTA is an effective, minimally invasive treatment for discogenic pain in properly selected patients.
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Partial seizures of extratemporal origin may present unique challenges in the patient with medically refractory seizures. The efficacy of an extratemporal focal cortical resection may be less effective than an anterior temporal lobectomy for intractable epilepsy. The potential operative complications may be increased in individuals with extratemporal epilepsy because of functional cerebral cortex involvement and the need for a large cortical resection to significantly reduce seizure tendency. ⋯ Chronic intracranial EEG monitoring may be necessary to confirm the localization of the ictal onset zone before epilepsy surgery. Patients with normal neuroimaging studies and extratemporal epilepsy are unlikely to be rendered seizure-free with focal cortical resection and should be considered candidates for other alternative forms of treatment for intractable partial epilepsy. Patients with non-substrate-directed extratemporal epilepsy should undergo a preoperative evaluation and surgical treatment at a comprehensive epilepsy center with extensive experience in chronic intracranial EEG monitoring and contemporary neuroimaging procedures because of the inherently high acuity associated with the operative management clinical disorder.
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The effect of non-steroidal anti-inflammatory drugs (NSAIDs) for reduced platelet aggregation and thromboxane A2 synthesis has been well documented. However, the influence on platelet function is not fully explained. Aim of this study was to examine the influence of the COX-1 inhibiting NSAIDs, diclofenac and metamizol on platelet activation and leukocyte-platelet complexes, in vitro. Surface expression of GPIIb/IIIa and P-selectin on platelets, and the percentage of platelet-leukocyte complexes were investigated. ⋯ Accordingly, the inhibitory effect of diclofenac and metamizol on platelet aggregation is not related to a reduced surface expression of P-selectin and GPIIb/IIIa on platelets.