British medical bulletin
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Transmission of pain signals evoked by tissue damage leads to sensitization of the peripheral and central pain pathways. Pre-emptive analgesia is a treatment that is initiated before the surgical procedure in order to reduce this sensitization. Owing to this 'protective' effect on the nociceptive system, pre-emptive analgesia has the potential to be more effective than a similar analgesic treatment initiated after surgery. ⋯ The only way to prevent sensitization of the nociceptive system might be to block completely any pain signal originating from the surgical wound from the time of incision until final wound healing. Other pharmacological interventions, including 'antihyperalgesic' drugs such as NMDA-receptor antagonists and gabapentin, may interfere with the induction and maintenance of sensitization. Future studies will investigate the analgesic effect of prolonged multimodal combinations of different classes of 'traditional' analgesics and 'antihyperalgesics' on postoperative pain.
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Non-invasive ventilation (NIV) has been shown to be effective in acute respiratory failure of various aetiologies in different health care systems and ward settings. It should be seen as complementary to invasive ventilation and primarily a means of preventing some patients from deteriorating to the point at which intubation is needed. ⋯ Important benefits include the avoidance of endotracheal-tube-associated infections, which carry an important morbidity and mortality, and a reduction in health care costs. The most important ingredient for an acute NIV service is a well-trained enthusiastic ward team.
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British medical bulletin · Jan 2003
ReviewMolecular and clinical classification of human prion disease.
While rare in humans, the prion diseases have become an area of intense clinical and scientific interest. The recognition that variant Creutzfeldt-Jakob disease is caused by the same prion strain as bovine spongiform encephalopathy in cattle has dramatically highlighted the need for a precise understanding of the molecular biology of human prion diseases. Detailed clinical, pathological and molecular data from a large number of human prion disease cases have shown that distinct abnormal isoforms of prion protein are associated with prion protein gene polymorphism and neuropathological phenotypes. A molecular classification of human prion diseases seems achievable through characterisation of structural differences of the infectious agent itself.