Articles: treatment.
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Spontaneous intracranial hypotension (SIH) is a postural headache syndrome unrelated to dural puncture. Because of the increasing failure of epidural blood patch (EBP) to relieve headache in SIH, we retrospectively investigated the epidemiological features and treatment outcomes in 55 cases of SIH. The study population was stratified by age and sex; continuous variables were compared for differences by t-tests; categorical variables were compared by Chi-squared analysis or Fisher exact tests. ⋯ EBP failures were more common in patients aged 40 and younger than in older patients (P = 0.003). Postural headache from SIH was not uniformly responsive to EBP, and had significant comorbidities, especially in men. The management of postural headache in SIH by other techniques to restore brain position and cerebrospinal fluid dynamics should be investigated.
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Intradiscal electrothermal annuloplasty (IDET) is an effective treatment for chronic discogenic low back pain (LBP). However, efficacy of IDET for the treatment of referred leg pain has not been examined. This study was performed to assess the long-term efficacy of IDET for the treatment of referred leg pain in chronic discogenic LBP patients. ⋯ A relatively large number of LBP patients who underwent IDET (84%) presented with referred leg pain without sciatica. The IDET procedure afforded improvements in leg pain that correlated well with improvements in back pain (0.75/4 and 0.88/4, respectively). These data suggest that IDET may relieve associated limb pain in chronic discogenic LBP patients.
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Survival from acute coronary syndromes and major trauma has been shown to depend on timely access to definitive treatment. We sought to identify the significance of intensive care unit (ICU) admission delay (lead-time) on the outcome of critically-ill medical patients with other diagnoses. ⋯ ICU admission delay (lead-time) is associated with a greater mortality-risk in critically ill medical patients requiring MV and/or RRT.
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Rev Bras Anestesiol · Dec 2004
[Pharmacological treatment of trigeminal neuralgia: systematic review and metanalysis.].
Trigeminal neuralgia is a syndrome of chronic pain, characterized by paroxysms of excruciating pain which dramatically affect patients' quality of life. Systemic drug therapy is the first line treatment for this disease. This study aimed at evaluating efficacy, safety and tolerability of several pharmacologic treatments offered to trigeminal neuralgia patients, trying to supply evidences for clinical practice recommendations and to identify the needs for further research. ⋯ Carbamazepine is still the drug of choice for treating trigeminal neuralgia, being lamotrigine and pimozide indicated for cases refractory to conventional therapy. In addition, further studies are needed to determine future therapeutic options.
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The objective of this study was to evaluate the utility of circumferential casting in the emergency department (ED), orthopedic follow-up visits, and radiographic follow-up in the management of children with wrist buckle fractures. ⋯ Orthopedic follow-up visits and radiographic follow-up may have minimal utility in the treatment of pediatric wrist buckle fractures. ED casting may pose more risk than benefit for these children. Splinting in the ED with primary care follow-up appears to be a reasonable management strategy for these fractures. A prospective study comparing ED splinting and casting for pediatric wrist buckle fractures is needed.