Articles: function.
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Critical care medicine · Mar 2015
The Epidemiology of Vasospasm in Children With Moderate-to-Severe Traumatic Brain Injury.
To gain a description of the prevalence and time course of vasospasm in children suffering moderate-to-severe traumatic brain injury. ⋯ Vasospasm occurs in a sizeable number of children with moderate and severe traumatic brain injury. Children in whom vasospasm developed were more likely to have been involved in a motor vehicle accident, had higher Injury Severity Scores, had fever at admission, and had lower Glasgow Coma scores than in those whom vasospasm did not develop. Based on these findings, we recommend aggressive screening for posttraumatic vasospasm in these patients. Future studies should establish the relationship between vasospasm and long-term functional outcomes and should also evaluate potential preventative or therapeutic options for vasospasm in these children.
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The underlying mechanisms of adaptations to pain are unclear. In order to explore whether central or peripheral mechanisms predominate, the effects of two centrally mediated phenomena - spatial summation of pain (SSP) and transcutaneous electrical nerve stimulation (TENS) - were examined. The effect of the degree of painfulness, rather than absolute stimulation intensity, was also examined. ⋯ The mathematical models and the lack of effect of SSP on adaptation suggest that its dominant component is peripheral. Whereas relative painfulness determines whether pain adaptation or intensification occurs (probably a defence mechanism), absolute stimulation intensities influence the magnitude of the effect. Pain intensification is differentially affected by probe size, depending upon the occurrence of initial adaptation.
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Osteoarthr. Cartil. · Mar 2015
Multicenter Study Comparative StudyKnee osteoarthritis radiographic progression and associations with pain and function prior to knee arthroplasty: a multicenter comparative cohort study.
We determined the radiographic osteoarthritic worsening rate prior to knee arthroplasty (TKA) and whether this worsening was associated with worsening pain and function as compared to a non-surgical matched sample. ⋯ Persons undergoing TKA 2 years later had substantial worsening pain and function over the 2-year pre-operative period as compared to a non-surgical sample matched based on KL grades. Almost 30% of persons who elect to undergo TKA undergo rapid disease progression and symptom worsening during the 2 years prior to TKA.
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Minerva anestesiologica · Mar 2015
ReviewManagement of pediatric delirium in critical illness: a practical update.
Pediatric delirium (PD) is an acute state of brain dysfunction and is often seen in the pediatric intensive care unit (PICU). There is a growing awareness of its clinical interdisciplinary importance. The aim of this article was to describe the three clinical presentations, to evaluate the differential diagnosis and to give a concise and practical update for the pharmacological and non-pharmacological treatment of PD at the PICU, based on recent literature and expert opinions. We discuss an interdisciplinary flow chart which helps the reader dealing with the diagnosis and management of any acute emotional and or behavioral disturbance, of which PD is a special case.
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Comparative Study
Poor symptom control is associated with reduced CT segmental airway lumen area in asthmatic smokers.
Cigarette smoking is associated with worse symptoms in asthma and abnormal segmental airways in healthy subjects. We tested the hypothesis that current symptom control in smokers with asthma is associated with altered segmental airway dimensions measured by CT scan. ⋯ The CT scan segmental airway lumen area is reduced in smokers with asthma compared with never smokers with asthma, particularly in severe disease, and is associated with worse current symptom control and small airway dysfunction.