Articles: treatment.
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The treatment of childhood headaches requires a thorough investigation of the underlying etiology, including the use of standardized diagnostic criteria, and neurologic and comprehensive examinations. If secondary headaches are identified, the headaches should resolve with treatment of the underlying cause. ⋯ This includes acute therapy, preventative therapy, and biobehavioral therapy. All of these components need to be addressed in the treatment of childhood headaches, and clear goals of treatment must be discussed with the patient and parents.
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We report an acute thrombosis of an abdominal aortic aneurysm presenting with paralysis of a lower extremity. The usual presentation of such thrombosis is vascular compromise of the lower extremities. When the thrombus obstructs the artery of Adamkiewicz, the main blood supply to the lower spinal cord, spinal ischemia and paralysis can occur. Mechanisms of aortic occlusion and treatment of aortic thrombosis are briefly outlined.
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Over 500,000 percutaneous disc decompression procedures have been performed in the past 20 years. Various percutaneous techniques include chemonucleolysis, percutaneous lumbar discectomy, and laser discectomy which have reported success rates in the 70% to 75% range. This retrospective evaluation of 49 patients who underwent nucleoplasty procedures for treatment of herniated discs, evaluates the effectiveness of nucleoplasty in the reduction of pain, improvement of functional activity, and reduction of pain medication. ⋯ Nucleoplasty should be used in those patients who fail conservative medical management including medication, physical therapy, behavioral management, psychotherapy, and who are unwilling to undergo a more invasive technique such as spinal surgery.
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Curr Opin Anaesthesiol · Oct 2005
Postoperative pain, nausea and vomiting in neurosurgical patients.
Postoperative pain and postoperative nausea and vomiting are significant problems for neurosurgical patients and their carers. The treatment of these problems is widely perceived to be inadequate, however, especially in patients undergoing craniotomy, and there are few large, randomized controlled trials. The main issue has been fear of side effects, especially those masking neurological signs. A review of the recent literature therefore is justified. ⋯ There is still a lot of scope to research and refine pain and postoperative nausea and vomiting management in cranial and spinal neurosurgical patients. Large-scale studies are required to define the current state of practice, determine effective treatments and define the incidence of side-effects.
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In the United States, physicians are faced with two opposing dilemmas in the treatment of pain - the potential for drug abuse and diversion, and the possible undertreatment of pain. While controlled prescription drugs such as narcotic analgesics, anxiolytics, antidepressants, stimulants, and sedative-hypnotics, play a legitimate role in managing chronic pain and other conditions, the illicit use of prescribed medicines is increasing at epidemic proportions. Diversion and abuse of prescription drugs is costly in terms of addiction, overdose, death, and related criminal activities, but chronic pain carries significant economic, social, and health impact as well. ⋯ President George W. Bush signed NASPER on August 11, 2005, and it became Public Law 109-60. Implementation of NASPER will improve patient care and reduce abuse and diversion of prescription controlled substances.