Articles: outcome.
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Background. Spinal cord stimulation (SCS) is being used with increasing frequency in the treatment of various chronic pain conditions. There is a paucity of reliable outcome data regarding changes in pain tolerance and peripheral sensory nerve function. ⋯ The results of this study appear to substantiate the postulates that both segmental and suprasegmental effects are involved in SCS-mediated analgesia. SCS modulates segmental large afferent fiber input as reflected by a statistically significant increase in large fiber CPTs (2000 Hz) at the symptomatic site post-SCS. A statistically significant increase in small fiber (5 Hz) CPTs at the control site suggests a central sensory (suprasegmental) modulating effect on nociceptive fiber activity. sNCT testing provided reliable outcome data for evaluating response to SCS.
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Objective. Post-herniorrhaphy pain syndrome can be difficult to treat. The exact mechanism of pain is not always apparent. ⋯ Conclusion. Post-herniorrhaphy pain can have the same features of both nociceptive and neuropathic pain syndromes. In cases which have failed conservative therapy we believe that a trial of spinal cord stimulation is warranted as in other cases of neuropathic pain syndromes.
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Pediatr Crit Care Me · Jul 2000
Biochemical, cellular, and molecular mechanisms in the evolution of secondary damage after severe traumatic brain injury in infants and children: Lessons learned from the bedside.
To present a state-of-the-art review of mechanisms of secondary injury in the evolution of damage after severe traumatic brain injury in infants and children. DATA SOURCES: We reviewed 152 peer-reviewed publications, 15 abstracts and proceedings, and other material relevant to the study of biochemical, cellular, and molecular mechanisms of damage in traumatic brain injury. Clinical studies of severe traumatic brain injury in infants and children were the focus, but reports in experimental models in immature animals were also considered. Results from both clinical studies in adults and models of traumatic brain injury in adult animals were presented for comparison. DATA SYNTHESIS: Categories of mechanisms defined were those associated with ischemia, excitotoxicity, energy failure, and resultant cell death cascades; secondary cerebral swelling; axonal injury; and inflammation and regeneration. ⋯ A constellation of mediators of secondary damage, endogenous neuroprotection, repair, and regeneration are set into motion in the brain after severe traumatic injury. The quantitative contribution of each mediator to outcome, the interplay between these mediators, and the integration of these mechanistic findings with novel imaging methods, bedside physiology, outcome assessment, and therapeutic intervention remain an important target for future research.
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Patients with suspected opioid overdose frequently require naloxone treatment. Despite recommendations to observe such patients for 4 to 24 hours after naloxone, earlier discharge is becoming more common. This prospective, observational study of patients with presumed opioid overdose examines the safety of early disposition decisions and the accuracy of outcome prediction by physicians 1 hour after the administration of naloxone. ⋯ Emergency physicians can clinically identify patients at risk of deterioration after naloxone reversal of suspected opioid overdose. Prolonged observation or hospital admission is not usually required. Selective early discharge of patients with presumed opioid overdose is feasible and appears safe. A clinical prediction rule may be useful in identifying patients eligible for early discharge.
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Curr Opin Anaesthesiol · Jun 2000
Perioperative considerations in the management of the patient taking herbal medicines.
The use of herbal products has recently increased dramatically in the United States. Patients are flocking to use these and many other complementary or alternative therapies. ⋯ The following review will discuss the limitations of Food and Drug Administration protection, and will review as well as provide an outline of the potential adverse reactions and side-effects that might affect anesthesia administration. To date, no double-blind, placebo-controlled studies have been carried out that specifically address herbal-anesthetic interactions or outcomes.