Revista medico-chirurgicală̆ a Societă̆ţ̜ii de Medici ş̧i Naturaliş̧ti din Iaş̧i
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Pain is a common occurrence for the hospitalized elderly, and may often be under recognized and inadequately managed. Insufficient pain management can lead to the sequelae of emotional distress and depression, delirium, anxiety, sleep disturbances, and physical disabilities, as well as increased health care costs. Effective pain management of the older adult begins with pain assessment using the proper tools. ⋯ Paracetamol is commonly prescribed and may be the drug of choice for mild to moderate postoperative pain. Older adults may enjoy the benefits of Patient-Controlled Analgesia and Patient Controlled Epidural Analgesia in the postoperative period; however, thorough and ongoing teaching must occur to ensure understanding and compliance with the therapy. Treating post-procedure pain in the elderly patient requires an understanding of the normal changes associated with aging and the impact on medications, and multimodal analgesia can be the best approach.
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Mechanical ventilation, a life saving procedure in ARDS aims to optimally ventilate the patient and to avoid at the same time the ventilator induced lung injury (VILI). In ARDS the lung contains a variable portion of collapsed alveoli witch impair the normal oxygenation. ⋯ Multiple recruiting maneuvers are reported in the literature but there is no consensus regarding the optimal one(s), as each maneuver is only partially efficient and has several down falls. While in animal studies theses maneuvers have proved their efficiency and safety, there are not enough humans studies to guide the decision on how, when and which technique should be used.
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Cerebral-vascular events represent a major cause of mortality worldwide. Resulting respiratory complications are common and possibly composing a marker of severe neurological disorder. Cheyne-Stokes respiration is a disorder characterised by recurrent central apnoeas during sleep, alternating with a crescendo-decrescendo pattern of tidal volume, thus constituting an additional burden to the patient. In this paper the authors review the physio-pathological background, clinical presence and latest therapy-related data on Cheyne Stokes respiration in stroke patients.
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Rev Med Chir Soc Med Nat Iasi · Oct 2005
Review[Differentiated thyroid cancer--peculiar morphological and clinical forms].
The most common clinical presentation of differentiated thyroid cancer (DTC), consisting of papillary and follicular adenocarcinoma (with their histological variants), is the solitary thyroid nodule. A review of the literature is performed in order to describe particular forms of DTC, in terms of incidence, diagnosis and treatment: occult carcinoma, carcinoma on aberrant thyroid tissue, "functional" thyroid carcinoma and familial non-medullary carcinoma. A particular interest is shown to the coexistence of malignancy with benign thyroid diseases, such as goiter, hyperthyroidism and Hashimoto's thyroiditis, as well as parathyroid adenoma. In conclusion, the authors emphasize that the association of carcinoma with benign thyroid conditions is not rare and it substantiate an aggressive approach in regard to diagnosis and treatment, increasing the indication for surgery and, moreover, for total thyroidectomy.
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Rev Med Chir Soc Med Nat Iasi · Apr 2004
Review[Dewar-Barrington technique original adaptation used in the treatment of acromioclavicular dislocations].
The authors are presenting a method of treatment of acromioclavicular dislocations using the Dewar-Barrington technique modified in an original manner. The originality of the technique consists in the supplementary fixation of the tip of the coracoid process using a "figure-of-eight" loop of wire, placed around the head and the prominent tip of the screw. The advantages due to this modification of the technique are: avoiding of technical difficulties, the absence of complications which could appear after the original Dewar-Barrington procedure, the shorter immobilization period and the earlier beginning of full range of motion of the shoulder.