Management of pain in intensive care settings.

An organized treatment plan for providing analgesia in ICU settings can make a significant difference in patient comfort and outcome. Advanced analgesic techniques are available for use at each level of the "pain pathway." These include agents and methods that act at the periphery, at the spinal cord level, and through a systemic approach. Consultation with specialists in pain management can help achieve optimum therapy for patients in the ICU setting.

Management of pain in mechanically ventilated patients.

Acute pain management in critically ill ICU patients is an area that needs increased attention. Modern techniques exist that can help speed recovery and reduce duration of ICU and, potentially, hospital stay. Application of contemporary knowledge in this area benefits both clinician and patient.

Coaxial imaging technique for superior hypogastric plexus block.

BACKGROUND AND OBJECTIVES: Previously described techniques for superior hypogastric plexus (SHP) block are technically difficult. A simple coaxial imaging technique for SHP block is described. METHODS AND RESULTS: Fluoroscopic guidance for coaxial approach to SHP block is described. A successful block is easily achieved. CONCLUSIONS: A new approach to SHP block is described, which is technically effective. Other approaches involve more difficult needle angulations or use of computed tomography guidance. The coaxial technique avoids these issues and is easy to perform.

A highly sensitive rapid diagnostic test for Chagas disease that utilizes a recombinant Trypanosoma cruzi antigen.

Improved diagnostic tests for Chagas disease are urgently needed. A new lateral flow rapid test for Chagas disease is under development at PATH, in collaboration with Laboratorio Lemos of Argentina, which utilizes a recombinant antigen for detection of antibodies to Trypanosoma cruzi. To evaluate the performance of this test, 375 earlier characterized serum specimens from a region where Chagas is endemic were tested using a reference test (the Ortho T. cruzi ELISA, Johnson & Johnson), a commercially available rapid test (Chagas STAT-PAK, Chembio), and the PATH-Lemos rapid test. Compared to the composite reference tests, the PATH-Lemos rapid test demonstrated an optimal sensitivity of 99.5% and specificity of 96.8%, while the Chagas STAT-PAK demonstrated a sensitivity of 95.3% and specificity of 99.5%. These results indicate that the PATH-Lemos rapid test shows promise as an improved and reliable tool for screening and diagnosis of Chagas disease.

Treatment of sympathetically maintained pain with terazosin.

BACKGROUND AND OBJECTIVES: alpha-adrenergic antagonists can be effective in the treatment of sympathetically maintained pain. METHODS: Oral terazosin was prescribed to treat sympathetically maintained pain refractory to other therapies. RESULTS: The authors describe a patient whose symptoms could not be controlled with commonly prescribed therapies, who obtained total relief of sympathetically maintained pain and vasospasm with terazosin, a new alpha 1 antagonist. CONCLUSIONS: Terazosin is effective in the treatment of sympathetically maintained pain when given once daily because of a long elimination half-time and a long duration of action. This may encourage better patient compliance than do other alpha antagonists of shorter effective duration.

Abrogation of the hematological and biological activities of the interleukin-3/granulocyte-macrophage colony-stimulating factor fusion protein PIXY321 by neutralizing anti-PIXY321 antibodies in cancer patients receiving high-dose carboplatin.

This dose-escalation study was performed to evaluate the hematologic activity, biological effects, immunogenicity, and toxicity of PIXY321 (an interleukin-3/granulocyte-macrophage colony-stimulating factor fusion protein) administered after high-dose carboplatin (CBDCA) treatment. Patients with advanced cancers received CBDCA at 800 mg/m2 intravenously on day 0 of repeated 28-day cycles. In part A of the study, patients were treated with CBDCA alone during cycle 1 and then received PIXY321 on days 1 through 18 of cycle 2 and later cycles. In part B, patients received 18 days of PIXY321 beginning on day 1 of all CBDCA cycles, including cycle 1. PIXY321 was administered subcutaneously in 2 divided doses. Total doses of 135, 250, 500, 750, and 1,000 micrograms/m2/d were administered to successive cohorts of 3 to 6 patients in part A. In part B, patient groups received PIXY321 doses of 750, 1,000, and 1,250 micrograms/m2/d. The hematologic effects of PIXY321 were assessed in the first 2 cycles of therapy. Anti-PIXY321 antibody formation was assessed by enzyme-linked immunosorbent assay (ELISA) and neutralization assay. Of the 49 patients enrolled, 31 were fully evaluable for hematologic efficacy. When comparing the first B cycle (cycle B-1; with PIXY321) with the first A cycle (cycle A-1; without PIXY321), the fusion protein had no significant effect on platelet nadirs or duration of platelets less than 20,000/microL but was able to speed the time of recovery of platelet counts to 100,000/microL (15 v 20 days; P =.01). Significant improvements in neutrophil nadir and duration of ANC less than 500 were observed in cycles A-2 and B-1 (with PIXY321) as compared with cycle A-1 (without PIXY321). Initial PIXY321 prophylaxis (cycle A-2 and cycle B-1), enhanced the recovery of ANC to greater than 1,500/microL by an average of at least 8 days as compared with cycle A-1 (without PIXY321; P