Advances in therapy
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Advances in therapy · Mar 2007
Comparative Study Clinical TrialCeliac plexus block with the long stylet needle technique.
Neurolytic celiac plexus block has been used successfully in the treatment of patients with intractable intra-abdominal pain due to malignancy or to benign pain syndromes. A new technique is described here for blocking the celiac plexus through the retrocrural approach with a special long stylet needle inserted under fluoroscopic guidance. Celiac blocks were performed in 2 groups of patients. ⋯ In the classic technique group, fluoroscopy injection time was 13+/-3 min and the number of attempts was 5.3+/-3; values in the long guided needle group were 8.9+/-3 min and 4.9+/-2, respectively. The difference in fluoroscopy injection times was significant (P<.05). The long guided needle technique for celiac plexus block may be an effective and appropriate method for beginners or for practitioners who are not knowledgeable about imaging techniques used in various medical specialties.
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Advances in therapy · Mar 2007
Morbidity and mortality among elderly Americans with different stroke subtypes.
The long-term outcomes of hemorrhagic stroke (HS), which includes subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), are not well understood relative to ischemic stroke (IS). This analysis was undertaken to assess short and long-term survival and morbidity of patients with hemorrhagic stroke, as well as risk factors associated with these outcomes. American Medicare beneficiaries >65 y of age in whom SAH, ICH, or IS was diagnosed were identified and followed over 4 y through the use of longitudinal claims data. ⋯ The recurrence rate was highest among patients with SAH. Those with HS tended to be younger than those with IS and had a greater number of comorbidities at the time of stroke. Among the elderly, patients with HS have a substantially worse prognosis than do those with IS, which highlights the need for more effective treatment of patients with HS.
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A median and ulnar nerve block was administered for endoscopic carpal tunnel release. Three (14.2%) of 21 patients required further anesthesia with local anesthetic agents and sedation. No solution ran back to the surgical site. This technique is rapid and reliable, and it seems to be suitable for outpatient surgery.
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Advances in therapy · Jul 2006
Totally implantable venous access devices via subclavian vein: a retrospective study of 368 oncology patients.
Totally implantable catheters and totally implantable venous access devices (TIVADs) represent a valid method of administering long-term chemotherapy. TIVADs have several advantages over other methods of venous access: they are easy to implant under local anesthesia, they cause less discomfort for patients, and they can be implanted and managed on an outpatient basis. A total of 368 oncology patients were scheduled for percutaneous venous access devices. ⋯ Late complications included 3 cases (0.8%) of venous thrombosis, 2 cases (0.5%) of pocket infection, and 1 case (0.3%) of port-related bacteremia. This study describes a series of patients with subcutaneous infusion ports connected to various catheters. This device is a good option for long-term access to the subclavian vein; major complications related to implantation are rare, and ongoing management of these devices supports their increased use in oncology patients.
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This 2-year prospective study was conducted to identify those at risk for ophthalmologic emergencies, to define the risk factors and reasons for eye injuries, to analyze treatment options, and to compare findings with those of previous studies. A total of 203 patients (74% male, mean age 27.3+/-13.9 y, 51% right eye injuries, 44% left eye injuries, 5% bilateral injuries) with injury to 208 eyes who presented to the emergency department for treatment were included in this study. All patients were evaluated by an ophthalmologist, who completed a formal questionnaire. ⋯ In this study, the leading cause of eye injury was workplace accidents, probably attributable to growing industrialization in the region. Ocular trauma continues to be an important health problem in Turkey. Investigators believe that with education about and use of proper eye protection, 90% of eye injuries could be prevented.