Articles: outcome.
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Analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (LP) is fundamental to the management of inflammatory disease of the central nervous system (CNS), particularly that due to infection. This review summarises the role of lumbar puncture, anatomy and pathophysiology of CSF, techniques of obtaining CSF, indications, contraindications and complications of LP, methods of analysis and some of the implications of specific changes in CSF. The CNS is protected by unique immunological barriers, and has some unique responses to processes that breach these barriers. ⋯ Some CSF testing is sensitive, specific and timely, but other CNS disease processes will generate obscure and ambiguous results, and interpretation may benefit from liaison with experienced specialists in several fields. Polymerase chain reaction (PCR) testing has changed the practice of LP and is likely to generate further evolution. Some findings on CSF analysis may have implications beyond the individual patient - the consequences of the diagnosis of meningococcal meningitis, emerging pathogens such as West Nile virus or Nipah virus, and the identification of anthrax meningitis in the USA may be quite profound on both a local and global scale.
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Curr Opin Anaesthesiol · Aug 2005
Arginine vasopressin as a rescue vasopressor agent in the operating room.
This review gives an overview of the current knowledge and research on the use of arginine vasopressin in cardiac arrest and severe shock states. ⋯ Whereas arginine vasopressin in combination with epinephrine can significantly increase hospital discharge in cardiac arrest, arginine vasopressin combined with catecholamines improved haemodynamics in vasodilatory and haemorrhagic shock, but effects on outcome remain unknown. Nonetheless, in the perioperative setting, arginine vasopressin may already be considered as a potent adjunct vasopressor agent in advanced shock states unresponsive to conventional therapy.
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Low doses of ketamine or isomers are promising possibilities for anesthesia and postoperative analgesia. This study aimed at reviewing major properties of low ketamine doses, which may justify their use in anesthesia and postoperative analgesia. ⋯ Most studies with low S(+) ketamine doses have shown preventive effects, decreasing central nervous system sensitization, opioid-induced tolerance and hyperalgesia, anesthetic and analgesic consumption, and the incidence of postoperative adverse effects.
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Postoperative epidural fibrosis may contribute to between 5% to 60% of the poor surgical outcomes following decompressive surgery. Correlations have been reported between epidural scarring and radicular pain, poor surgical outcomes, and a lack of any form of surgical treatment. The use of spinal endoscopic adhesiolysis in recent years in the management of chronic refractory low back and lower extremity pain has been described. ⋯ Spinal endoscopic adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of patients with chronic low back and lower extremity pain without major adverse effects.
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Objective. The purpose of this study was to investigate the utility of a 7-day percutaneous spinal cord stimulator trial using a 7-day diary to measure outcomes during the trial and at long-term follow-up. Materials and Method. Diaries completed prior to and during the trial were analyzed, as was a follow-up questionnaire. Trial and follow-up data were compared using nonparametric statistics and descriptive analyses. ⋯ Conclusion. Patients who underwent a 7-day percutaneous trial, had a positive trial and received permanent implantation fared well long-term. The 7-day diary did not result in a superior method of determining responders vs. nonresponders at long-term follow-up. More research is needed to determine whether different quantitative measures would predict long-term outcome.