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At least 253 records · Page 14Linked to original sources
PubMed2004

Comparison of regional nerve block to epidural anaesthesia in day care arthroscopic surgery of the knee.

Day care minimally invasive surgery demands minimal complications with anaesthesia. Nerve blocks are increasingly being employed for surgical procedures on the lower limb, and we attempted to evaluate their benefits and drawbacks in a prospective randomised study in patients undergoing knee arthroscopy. We compared the effectiveness, onset time, duration of analgesia, patient acceptance, failure rate and post-operative comfort of epidural anaesthesia (with 20 ml of 2% lidocaine with adrenaline 1 in 200000) and peripheral nerve blocks (combined 3-in-1 and sciatic nerve block, with 50 ml of 1% lignocaine with adrenaline 1 in 200000, using nerve stimulator). Forty nine cases were randomised to receive either single shot epidural anaesthesia (Group-I, n = 23) or combined 3-in-1 and sciatic nerve block (Group-II, n = 26). The anaesthesia procedure and analgesia onset time was longer in Group-II (p < 0.001), with skin incision being significantly delayed as compared to group-I (45.2+/-6.2min vs 30.0+/-5.4 min respectively) (p < 0.001). Haemodynamic changes were comparable in both groups during the study period. All patients had complete analgesia at skin incision in group-I as compared to 89.1% in group-II (p < 0.05). However 52.2% of patients in group-I required rescue analgesia postoperatively, as compared to only 18.7% in group-II (p < 0.05). We concluded that even though combined 3-in-1 and sciatic nerve block technique has longer anaesthesia induction time, the lesser need for postoperative rescue analgesia, and lesser potential complications like inadvertent spinal puncture, retention of urine and late onset of back pain, make this an attractive option for day care arthroscopy. The use of a nerve stimulator ensures accuracy, patient counselling allows good cooperation, and advance planning can include potential skin incision delays.

Adolescent↗
PubMed2005

[Full version of the 2005 Standards, Options and Recommendations for the management of procedure-related pain (lumbar puncture, bone marrow aspiration or biopsy, blood sampling) in adult patients with cancer].

The << Standards, Options and Recommendations >> (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. Objectives : To establish the Standards, Options and Recommendations clinical practice guidelines for the management of procedure related pain (lumbar puncture, bone marrow aspiration or biopsy, blood sampling) in adult oncology patients. To define, on the basis of the critical appraisal of the best available evidence and expert agreement, the clinical situations in which a pain preventive strategy should be implemented. Methods. Medline(R) was searched using specific search strategies from January 1966 to August 2003. Literature monitoring was performed to identify controlled clinical trials published between August 2003 to September 2004. In addition several Internet sites were searched in July 2003. Results. A total of 12 references, corresponding to 10 randomised clinical trials, were identified. Clinical guidelines have been defined for each invasive procedure.

Adult↗
PubMed2006

[Standards, options and recommendations for the management of procedure-related pain (lumbar puncture, bone marrow aspiration or biopsy, blood sampling) in children patients with cancer (summary report)].

CONTEXT: The Standards, Options and Recommendations (SOR) project, started in 1993, is a collaboration between the Federation of French Cancer Centres (FNCLCC), the 20 French cancer centres, and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To establish the Standards, Options and Recommendations clinical practice guidelines for the management of procedure related pain (lumbar puncture, bone marrow aspiration or biopsy, blood sampling) in children oncology patients. To define, on the basis of the critical appraisal of the best available evidence and expert agreement, the clinical situations in which a pain preventive strategy should be implemented. METHODS: MEDLINE was searched using specific search strategies from January 1966 to August 2004. Literature monitoring was performed to identify controlled clinical trials published in 2005. RESULTS: A total of 57 references were identified. Clinical guidelines have been defined for each invasive procedure.

Biopsy↗
PubMedDate not supplied

[Clinical description of three cases of cerebral cryptococcosis in patients with AIDS treated with fluconazole].

The authors have evaluated the efficacy of Fluconazole (400 mg/iv/die for three days and after 200 mg/iv/die for 18 days) in three AIDS and SNC Cryptococcal infection patients. Two patients have shown healing of meningeal syndrome and negative isolation after 21 days of therapy; one patient, however, died because of Cytomegalovirus pneumonia. It is of note that early spinal puncture in AIDS patients with neurological symptoms enables an early diagnosis and immediate therapy. Fluconazole treatment has been well tolerated and immediately effective to resolve two of the cases observed; the oral prophylaxis with 100 mg/die of Fluconazole after 6 months has been effective to prevent the relapses of the disease.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

[Electrocardiographic and arterial pressure changes in the acute phase of subarachnoid hemorrhage].

A prospective study was made of 30 patients, admitted to the neurology ward with subarachnoidal hemorrhage (SAH), at its onset. The diagnosis was established on the basis of anamnesis, clinical examination, spinal puncture, anatomopathological examination. The patients with other cerebrovascular affections or with antecedents of ischaemic cardiac affections were excluded. ECG tracings, serum ionogram, AT and VA at the onset and in evolution, and their modifications were followed and assessed in all the patients. The conclusion is reached that SAH in acute phase is associated with transitory ECG and pressure anomalies which become elements of unfavourable prognosis when persistent and deeply altered. They are valuable, at hand, elements in the differential diagnosis, and in the opportune therapeutical intervention.

Acute Disease↗
PubMed1989

[Present-day course of vitamin B 12 deficiency anemia].

By recent data, B12-deficiency anemia occurs in 14% of overall anemia cases. It arises mostly from gastrointestinal lesions, atrophic gastritis being the main etiological factor. Common clinical signs of the disease (glossitis, nervous disturbances, hemolysis) manifest in only 10-23% of the patients, hematological evidence of pancytopenia is registered in about half of the cases. The early diagnosis may be established with spinal puncture. That of the iliac bone tubera is a method of choice in elderly subjects.

Adult↗
PubMed1989

Topical skin anesthesia for venous, subcutaneous drug reservoir and lumbar punctures in children.

A new topical anesthetic ointment (EMLA, "eutectic mixture of prilocaine and lidocaine was studied in a double-blind, placebo-controlled trial to evaluate its efficiency in alleviating pain associated with venous, subcutaneous drug reservoir and lumbar punctures in children. Pain intensity was scored by the children themselves, using a visual analogue scale in which 0 corresponded to absence of sensation and 10 to the worst imaginable painful sensation. Venipunctures were performed on 18 children (6.1 to 12.2 years of age) equally divided in the study and control groups; EMLA cream was associated with lesser pain scores than those with placebo (means +/- SD: 2.8 +/- 2.4 vs 6.8 +/- 2.1, P less than .01). A crossover trial was used in the studies of subcutaneous drug reservoir and lumbar punctures, eight children (6.1 to 15.1 years of age) were tested for subcutaneous drug reservoir punctures; pain induced by this procedure was rated at 3.9 +/- 2.2 with placebo compared with 1.2 +/- 1.8 with EMLA cream (P less than .04). In lumbar punctures (14 children studied, 5.5 to 15.3 years of age), EMLA cream was again associated with less pain (1.9 +/- 1.9) than was placebo (5.6 +/- 3.0, P less than .01). It was concluded that the use of EMLA cream substantially reduces pain caused by venous, subcutaneous drug reservoir, and lumbar punctures in children and may therefore be offered to young patients, particularly those repeatedly submitted to such procedures.

Adolescent↗
PubMed1989

[Guidelines for the diagnosis and treatment of meningococcal disease at hospitals].

In Norway a hyperendemic situation has persisted since 1974 as regards meningococcal disease, with an adjusted annual incidence of almost 10 per 100,000 inhabitants. 80% of the cases are caused by group B meningococci, and the lethality has been about 10%. This article summarises the new Norwegian guidelines for the diagnosis and management of systemic meningococcal disease. Clinical signs and symptoms are described, together with criteria for the classification of cases into four main categories: I Distinct meningitis; II Severe sepsis; III Simultaneous distinct meningitis and severe sepsis; IV Milder septicaemia and/or meningitis. This type of classification is useful when choosing treatment, and for prediction and evaluation of the outcome. Hospital departments should establish appropriate routines for the management of such life-threatening infections. In cases of suspected meningococcal disease, antibiotic treatment should be started within 15 minutes of admission. Initially, benzylpenicillin and chloramphenicol are recommended, to cover haemophilus infection as well. When the diagnosis has been confirmed chloramphenicol may be discontinued. Laboratory specimens are highly desirable, but sampling procedures should not delay start of treatment. As a main rule patients with meningitis should have a spinal puncture. In severe septicaemia, antibiotic treatment and management of shock are given priority. All patients should be closely monitored. The condition of the patient may deteriorate rapidly. Detailed advice is given on laboratory tests and patient monitoring, and also on the management of septic shock, adult respiratory distress syndrome (ARDS), brain edema, renal failure and coagulation disturbances (DIC).

Hospitalization↗
PubMed1989

[A case of pseudotumor cerebri associated with colon cancer].

A case of pseudotumor cerebri associated with iron deficiency anemia due to colon cancer is reported in a 37-year-old woman. Her initial symptoms were vomiting and severe headache. On physical examination, no lymph nodes and abdominal mass were palpable but marked anemia was noted in her skin and conjunctiva . Neurological examination revealed papilledema in her both eyes and stiff neck. There was no abnormal findings on CT scan on admission. Spinal puncture revealed CSF pressure as high as 620 mmH2O with normal cells, protein, sugar and chloride levels. Hematological examination revealed iron deficiency anemia and thrombocytosis. Angiography at third day revealed no sinus occlusion, but retention of contrast media was seen on the cortical vein of parietal lobe and right transverse sinus. Brain scintigram at sixth day revealed mild accumulation in left parietal lobe, so small venous infarction was suggested. There were two circumscribed stenotic lesions of right ascending colon in the barium enema, and right hemicolectomy was achieved. The pathological diagnosis was adenocarcinoma. The symptoms of pseudotumor cerebri was completely disappeared soon after the surgery together with resolution of anemia. She lives with no deficits now 1 year 3 months after surgery. In conclusion much attention is necessary to a patient of pseudotumor cerebri with iron deficiency anemia for the presence of cancer, because not only this central nervous system lesion is reversible and curable but also the cancer itself may be curable by surgery.

Adenocarcinoma↗
PubMed1988

[Diagnosis and forensic psychiatric expertise in traumatic cerebral arachnoiditis].

Patients (123) with traumatic cerebral arachnoiditis due to closed craniocerebral trauma, were investigated during complications or late sequelae of the trauma. All the patients were subjected to spinal puncture. Asthenic, psychosis-like and hallucinatory-paranoid disorders were detected as well as partial oligophrenia and dullness of consciousness. The degree of mental disorders run parallel with intracranial pressure elevation, suggesting the role of intracranial hypertension in pathogenesis of several psychic disorders.

Adolescent↗
PubMed1987

[A case of superior sagittal thrombosis secondary to hyperlipidemia].

A 42-year-old man was admitted to the Saiseikai Fukuoka General Hospital on March 22, 1985 with complaints of nausea, vomiting and headache which had continued for twelve days. On physical examinations, multiple subcutaneous nodules were noted in the chest, abdomen and extremities with dilated veins in the chest wall. Furthermore, the discoloration of the skin attributable to the venous occlusion was noted in the left foot. Neurological examinations failed to reveal any abnormalities except for moderate choked disc in bilateral ocular fundi. Spinal puncture revealed CSF pressure as high as 350 mmH2O with slight increase in cell numbers. CT demonstrated small intracerebral hematomas bilaterally in occipital lobes with evidence of "empty delta" sign in the superior sagittal sinus. On angiographical findings, the superior sagittal sinus was not demonstrated in venous phase and the blood was drained mainly through the paravertebral plexus and the pterygoid plexus without any abnormalities in arterial and capillary phases. Serological examination revealed a hypercoagulability and hyperlipidemia especially in LDL (Low Density Lipoprotein) and VLDL (Very Low Density Lipoprotein). On etiological considerations, all of these abnormalities seemed to be derived from the hyperlipidemia. Furthermore, multiple symmetrical lipomatosis was defined as a "lipoprotein storage disease" in which laboratory examinations revealed hyperlipidemia especially in LDL and in some subfraction of HDL. Although not a typical case, there must be some possibilities that the lipomatosis of this case is secondary to disorder of lipid metabolisms. In conclusion, all of various pathological conditions observed in this case were considered to be due to the disorder of lipid metabolism.

Adult↗