The Journal of international medical research
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Comparative Study
The role of serum D-dimer level in the diagnosis of patients admitted to the emergency department complaining of chest pain.
This study investigated D-dimer levels in 241 patients admitted to the emergency department with sudden-onset chest pain. The patient group included those diagnosed with acute coronary syndrome (ACS; i.e., unstable angina pectoris [USAP], non-ST elevated myocardial infarction [NSTEMI], ST-elevated myocardial infarction [STEMI]); the control group included those diagnosed with non-cardiac chest pain. Mean serum levels of D-dimer, creatine kinase-MB (CK-MB) and troponin I (TPI) were compared between the groups. ⋯ There were also significantly higher D-dimer, CK-MB and TPI levels in the STEMI and NSTEMI patient subgroups compared with the control group. Only the D-dimer level was significantly higher in the USAP subgroup versus the control group. The sensitivity and specificity of D-dimer for ACS were 83.7% and 95.4%, respectively, suggesting that evaluating D-dimer levels might be useful in the emergency room for diagnosing ACS and predicting mortality in patients presenting with acute chest pain.
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Randomized Controlled Trial
The analgesic effect of remifentanil on prevention of withdrawal response associated with the injection of rocuronium in children: no evidence for a peripheral action.
Remifentanil pre-treatment has been reported to decrease the incidence of rocuronium injection-associated withdrawal movement. This study was designed to explore the site of action of remifentanil for reducing withdrawal response during rocuronium injection in children. Ninety-six paediatric patients were randomly assigned to three groups. ⋯ Withdrawal response was graded using a four-point scale. The incidence of withdrawal movement after rocuronium administration was 94%, 22% and 81% in the placebo, R, and R' groups, respectively. This study demonstrated that the pre-treatment effect of remifentanil for reducing rocuronium-associated withdrawal response occurs mainly through a central action.
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Comparative Study
Delayed treatment of delirium increases mortality rate in intensive care unit patients.
Delirium in the intensive care unit (ICU) is a serious complication associated with a poor outcome in critically ill patients. In this prospective observational study of the effect of a delay in delirium therapy on mortality rate, 418 ICU patients were regularly assessed using the Delirium Detection Score (DDS). The departmental standard required that if delirium was diagnosed (DDS >7), therapy should be started within 24 h. ⋯ In 184 of the delirious patients (90.2%), therapy was started within 24 h; in 20 patients (9.8%), therapy was delayed. During their ICU stay, patients whose delirium treatment was delayed were more frequently mechanically ventilated, had more nosocomial infections (including pneumonia) and had a higher mortality rate than patients whose treatment was not delayed. Thus, it would appear that a delay in initiating delirium therapy in ICU patients was associated with increased mortality.
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Using monofactorial and multivariate logistic regression analyses, the correlation of perioperative risk factors with postoperative pulmonary complications (PPCs) within 1 month after orthotopic liver transplantation (OLT) was investigated. Data on 107 patients (median age 46.8 years, 72% male) with end-stage liver disease who received OLT were retrospectively analysed. The incidence of PPCs was 60.7%. ⋯ A fluid balance of < or = -300 ml for > or =2 days of the first 3 days after surgery was protective. Other variables studied did not predict PPCs. It was concluded that improving the patient's preoperative medical condition, restricting intraoperative transfusion volumes and maintaining a negative fluid balance in the first 3 days after operation may decrease PPCs.
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Randomized Controlled Trial
Combining intrathecal bupivacaine and meperidine during caesarean section to prevent spinal anaesthesia-induced hypotension and other side-effects.
This study compared intrathecal hyperbaric bupivacaine with low-dose intrathecal plain bupivacaine plus different doses of meperidine (pethidine), administered sequentially, with regard to blood pressure stability, post-operative analgesia and incidence of side-effects in 80 parturients undergoing caesarean section. Patients were randomly assigned to one of four groups (n=20 each group): the HB group received 10 mg hyperbaric bupivacaine intrathecally; the BM35, BM30 and BM25 groups received 5 mg plain bupivacaine plus 35, 30 or 25 mg of meperidine intrathecally, respectively. ⋯ Nausea and vomiting were less prevalent in the BM25 group than in the HB and BM35 groups. In conclusion, sequential administration of 5 mg plain bupivacaine and 25 mg meperidine intrathecally provided better blood pressure stability and a lower incidence of side-effects than bupivacaine alone, without affecting quality of anaesthesia or surgical and patient satisfaction.