Revista médica de Chile
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Revista médica de Chile · Apr 1995
Review[Refractory epilepsy in adults and the new antiepileptic drugs: the role of gabapentin].
The features of refractory epilepsies and the role of functional surgery and new antiepileptic drugs is reviewed. Among the latter, gabapentin, a drug with peculiar pharmacokinetic properties, is highlighted as a therapeutic alternative in refractory epilepsies and eventually for epileptic patients without previous treatment. A new type of relationship between the pharmaceutical industry and physicians, that privileges clinical research, is discussed.
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Revista médica de Chile · Sep 1994
Review Case Reports[Dissection of vertebral artery: report of a case and review of the literature].
Vertebral artery dissection seems to be a frequent cause of stroke in young adults. We report a 34 years old female that suffered a cardiac arrest while practicing aerobics, with complete recovery and four months later developed an acute Wallenberg's syndrome. Magnetic resonance imaging showed an infarction in the right posterolateral medulla oblongata and in the right cerebellar hemisphere. ⋯ A follow up angiography, performed six months later, showed an incomplete recanalization of the vessel. Vertebral artery dissection should be suspected in every patient with ischemic symptoms or signs related to the vertebrobasilar territory, specially in young or middle aged patients with a history of trauma. Magnetic resonance imaging and ultrasound-doppler examinations are the diagnostic test of choice.
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When immediate defibrillation fails, successful cardiac resuscitation is contingent on prompt reestablishment of myocardial blood flow. Conventional methods of closed-chest resuscitation generates only critical levels of myocardial blood flow and therefore are of limited value for successful resuscitation. Methods that optimize the site, depth, rate and duration of precordial compression may increase myocardial blood flow, however, the lack of objective measurements of their hemodynamic effects limits the optimal performance of this resuscitation method. ⋯ With measurement of the end-expired PCO2, operator fatigue may be recognized, the technique of precordial compression may be optimized, and the likelihood of restoring spontaneous circulation may be estimated. When conventional cardiac resuscitation fails or is predicted to fail by measurements of end-tidal PCO2, more effective interventions such as open-chest direct cardiac massage may be instituted. Regarding the vast resuscitation polypharmacy, only agents that act by selectively augmenting coronary perfusion pressure and myocardial blood flow are of proven benefit for successful resuscitation.
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We report 6 patients with Munchausen syndrome, a fictitious disorder with physical symptoms. There were 4 females and 2 males, the age ranged from 21 to 29 years. ⋯ Two patients were ill enough to be at risk of death. An early diagnosis may help prevent unnecessary or risky procedures in these patients.
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Revista médica de Chile · Oct 1990
Review[The admission and discharge criteria of a unit for critical patients].
Admission and discharge criteria for patients in an intensive care unit are controversial, especially in view of the fact that some patients derive no benefit from intensive care therapy while depriving others from a potential benefit. The general characteristics of patients in need of intensive care are discussed. Irreversibility of the underlying condition, the quality of "terminal patient" and other factors that may contraindicate admission to an intensive care unit are analyzed. Discharge criteria for patients not expected to derive further benefit from a prolonged stay in the unit are outlined.