Articles: cations.
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Endovascular treatment of acutely ruptured aneurysms requires the administration of antiplatelet and/or anticoagulant medication to prevent thrombosis. For patients who require an external ventricular drain (EVD) insertion to treat hydrocephalus stemming from aneurysm subarachnoid hemorrhage (aSAH), the administration of the medication may increase risk of hemorrhage in patients. It has become a practice for neurosurgeons to insert EVDs in patients with aSAH before endovascular treatment. However, the benefits and risks of this practice have not been fully assessed. The aim of this study was to compare and quantify the hemorrhagic risks associated with endovascular treatment of patients with sSAH before and after EVD. ⋯ EVD-related hemorrhage risk may increase with administration of antiplatelet and/or anticoagulant medication for endovascular treatment of ruptured aneurysms in aSAH patients.
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Enzyme immunoassays (EIA) have notable limitations for monitoring therapeutic compliance in pain management. Chromatography coupled with mass spectrometry provides definitive results and superior sensitivity and specificity over traditional EIA testing. ⋯ Mass spectrometry is a more robust and reliable method for detection of drugs used in the pain management setting. Due to the extent of undisclosed use and abuse of medications and illicit drugs, LC-MS/MS testing is necessary for adequate and accurate drug detection. In addition, LC-MS/MS methods are superior in terms of sensitivity and number of compounds that can be screened, making this a better method for use in pain management. Key words: Pain management, enzyme immunoassays, mass spectrometry, urine drug testing, prescription status, compliance.
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Randomized Controlled Trial
Dexmedetomidine could enhance surgical satisfaction in trans-sphenoidal resection of pituitary adenoma.
Excessive bleeding is an unwanted complication of trans-sphenoidal resection of pituitary adenoma due to increases in intracranial pressure (ICP) and hemodynamic instability. Dexmedetomidine (Dex) anα2-agonists is the drug of choice in intensive care units (ICU) and cardiac surgeries to control abrupt changes in hemodynamic. Severe cardiovascular responses occur during trans-sphenoidal resection (TSR) of the pituitary adenoma despite adequate depth of anesthesia. The aim of this paper was to determine the effect of Dexmedetomidine on bleeding as primary outcome, and surgeon's satisfaction and hemodynamic stability as secondary outcomes in patients undergoing trans-sphenoidal resection of pituitary adenoma. ⋯ Dexmedetomidine infusion (0.6µg/kg/hour) could reduce bleeding and provide surgeon's satisfaction during trans-sphenoidal resection of pituitary adenoma.
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Osteoporosis is an important problem in those of advanced age. Osteoporosis can induce sacral insufficiency fractures (SIFs). As average life expectancy increases, the number of patients with osteoporotic SIFs also increases. Osteoporotic SIFs cause severe low back pain and immobilization. Treatment of SIFs varies from analgesia to surgery. ⋯ Percutaneous sacroplasty is an effective minimally invasive treatment for osteoporotic SIFs refractory to conservative management. The study patients experienced significant relief of pain and increased mobility.Key words: Sacrum, sacroplasty, insufficiency fractures, osteoporosis, minimally invasive surgery.
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To evaluate the whole experience of liver transplantation (LT) with donors ≥70 years in a single center not applying specific donor/recipient matching criteria. ⋯ Even without specific donor/recipient matching criteria, the outcomes of LT with donors ≥70 and <70 years are comparable with appropriate donor management.