Articles: patients.
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J Stroke Cerebrovasc Dis · Jan 1993
Diagonal earlobe creases and ischemic stroke: Preliminary report.
Diagonal earlobe creases are associated with coronary arterial disease, cardiac morbidity and mortality, and all-cause mortality. We studied the influence of earlobe creases on the incidence of ischemic stroke as well as the relationship between earlobe creases and gender, coronary arterial disease, hypertension, diabetes mellirus, and hypercholesterolemia. Data were obtained prospectively from the medical records of 116 patients with ischemic stroke and 232 age- and gender-matched patients without ischemic stroke. ⋯ In those with ischemic stroke, earlobe creases were significantly related to coronary arterial disease, diabetes mellitus, and nonlacunar ischemic stroke. The cumulative incidences of coronary arterial disease, hypertension, diabetes mellitus, and hypercholesterolemia were also significantly higher in those patients with earlobe creases who also had ischemic stroke. When controlled for coronary arterial disease, earlobe creases, in those with ischemic stroke, continued to be significantly related to nonlacunar ischemic stroke.
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Journal of anesthesia · Jan 1993
Sustained effects of plasma norepinephrine levels on femoral-radial pressure gradient after cardiopulmonary bypass.
In order to determine the influence of the sympathetic nervous system upon the femoral-radial artery pressure gradient after cardiopulmonary bypass (CPB), we examined plasma norepinephrine levels in 34 adult male patients undergoing coronary artery bypass grafting. Cardiovascular parameters, including systolic arterial pressure, mean arterial pressure, cardiac index (CI), systemic vascular resistance index (SVRI), pulmonary artery pressure (PAP), hemoglobin (Hb) and peak dP/dt of radial and femoral artery pressures were measured after sternotomy, and immediately after the discontinuation of CPB and 90 min after CPB. Plasma norepinephrine levels were measured after sternotomy, after aortic declamping and 90 min after CPB. ⋯ Although there was no significant difference in Hb or PAP of 90 min after CPB in Groups A and B, the following values, listed in the order of A to B, were obtained; CI, 2.79 +/- 0.10 versus 3.46 +/- 0.16 l.min(-1).m(-2) (P < 0.01); mean radial artery pressure (MRP), 58.7 +/- 2.4 versus 65.1 +/- 1.8 mmHg (P < 0.05); peak dP/dt of radial artery pressure, 568 +/- 64 versus 1026 +/- 61 mmHg.sec(-1) (P < 0.001); and plasma norepinephrine concentration, 1.81 +/- 0.25 versus 0.98 +/- 0.10 ng.ml(-1) (P < 0.01), which were statistically significant. The higher femoral-radial artery pressure gradient after CPB was observed in patients with both a longer CPB time and a higher plasma norepinephrine concentration. These results suggest that a marked constriction of peripheral arteries might have produced a damped transmission of the pressure pulse to the radial artery.
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Opioids have been used for analgesia in nearly all civilizations. In paediatrics their use has become widely accepted for combating severe pain, especially postoperative pain and tumour pain. Receptors in the central nervous system are the best known sites of action of opioids, but the existence of peripheral receptors is also probable. ⋯ Tramadol is widely used for emergencies, as it has the least sedative action; but it has disadvantages in causing nausea and vomiting. Codeine is widely used for its antitussive action. While the necessity of good analgesia for even the smallest infant cannot be overstated, the opioid used must be carefully selected with reference to the age of the child and the pain to be controlled.