RESUMEN
BACKGROUND: One of the most prevalent illnesses of the shoulder is rotator cuff tendinosis, which is also a major contributor to shoulder discomfort and shoulder joint dysfunction. According to statistics, rotator cuff tendinosis occurs in 0.3-5.5% of cases and affects 0.5-7.4% of people annually. It will be necessary to conduct a meta-analysis to evaluate the efficacy of hypertonic glucose proliferation therapy in the treatment of rotator cuff problems. METHODS: The databases Cochrane PubMed, Library, Web of Science and EMbase, are retrieved by the computer. Individuals with rotator cuff lesions in the intervention group were treated with hypertonic dextrose proliferation therapy, whereas individuals in the control condition were treated with a placebo. Outcome markers for rotator cuff lesions patients; Pursuant to studies, the visual analogue scale (VAS) score, the shoulder pain & disability index (SPADI), & other metrics are used to evaluate the effects of hypertonic dextrose proliferation treatment on individuals with rotator cuff diseases. After carefully evaluating the calibre of the literature, data analysis was performed utilising the RevMan 5.3 programme. RESULTS: Meta-analysis finally contained 6 papers. In six investigations, the test & control group's VAS scores improved, with the test team's score considerably outperforming the control team [standardized mean difference (SMD): 1.10; 95% Cl: 0.37,1.83; P < 0.01], shoulder pain and disability index (SPADI) score (SMD:8.13; 95% Cl: 5.34,10.91; P < 0.01), Flexion (SMD:5.73; 95% Cl: 0.99,10.47; P < 0.05), Abduction (SMD:6.49; 95% Cl: 0.66,12.31; P < 0.05), Internal rotation (SMD:-1.74; 95% Cl: -4.25,0.78; P = 0.176) and External rotation (SMD:2.78; 95% Cl: -0.13,5.69; P = 0.062). CONCLUSION: The findings of this study suggest that individuals with rotator cuff injuries may benefit from hypertonic dextrose proliferation treatment based on the visual analogue scale (VAS) score, the Shoulder Pain and Disability Index (SPADI) score, Flexion, & Abduction. These results must, nevertheless, be supported by high-caliber follow-up research.
Asunto(s)
Lesiones del Manguito de los Rotadores , Humanos , Lesiones del Manguito de los Rotadores/tratamiento farmacológico , Lesiones del Manguito de los Rotadores/terapia , Resultado del Tratamiento , Solución Hipertónica de Glucosa/uso terapéutico , Solución Hipertónica de Glucosa/administración & dosificación , Tendinopatía/tratamiento farmacológico , Dolor de Hombro/tratamiento farmacológico , Dolor de Hombro/etiología , Manguito de los RotadoresRESUMEN
Deterioration of drugs due to light exposure is one of the major concerns, especially regarding protection of high-calorie infusion solutions, lightproof covers are used in hospitals. In the absence of any set standards regarding their usage, they are often reused. This study aimed to investigate bacterial contamination of lightproof covers used in hospital wards. For this, lightproof covers which had been used or stored in wards were collected and bacterial cultures were carried out from them. Examination of the cultures revealed that bacteria were present in the used lightproof covers. The bacterial species detected in the used lightproof covers were Bacillus species Coagulase-negative Staphylococci (CNS) and Methicillin-resistant Staphylococcus aureus (MRSA). Bacillus species and CNS were also detected in lightproof covers stored in wards, whereas MRSA was not detected. Intestinal bacteria were detected in only one lightproof cover. However, no bacteria were detected from either inside or outside of the unused lightproof covers that were stored in the drugs department. After allowing the unused lightproof covers stored in the drugs department to stand for 24 h, Bacillus species and CNS were detected in only one of the covers, whereas no bacteria was detected in other covers. These results indicate that there is a risk of bacterial contamination in the reuse of lightproof covers and that they should either be disposed off properly after usage or hand, finger disinfectants should be used while handling them to prevent any possible contamination.
Asunto(s)
Embalaje de Medicamentos/instrumentación , Contaminación de Equipos , Equipos y Suministros de Hospitales/microbiología , Solución Hipertónica de Glucosa , Bacillus/aislamiento & purificación , Infección Hospitalaria/prevención & control , Almacenaje de Medicamentos , Solución Hipertónica de Glucosa/efectos de la radiación , Solución Hipertónica de Glucosa/uso terapéutico , Hospitales , Humanos , Japón , Luz/efectos adversos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Soluciones para Nutrición Parenteral/efectos de la radiación , Soluciones para Nutrición Parenteral/uso terapéutico , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
Povidone-iodine is known for successfully treating surgical wounds; the combination between povidone-iodine and sugar, also called Knutson's formula, has been proposed to improve wound healing. Currently, no studies have investigated the effects of Knutson's formula to treat defects in wound closure following radio-chemotherapy in the head and neck region. The aim of this study is to evaluate the efficacy of Knutson's formula in improving the wound-healing process in patients who underwent radio-chemotherapy after surgery for head and neck cancer. The study, conducted from August 2013 to January 2017, included a sample of 34 patients (25 males and 9 females; age range: 60-75 years) treated with radio-chemotherapy after head and neck cancer surgery. All patients suffered from defect of wound regeneration. Patients were randomly divided into two groups: patients in the study group (n = 18) were treated with Knutson's formula; patients in the control group (n = 16) were treated with traditional topical drugs. In the study group, 16 of 18 (88.9%) patients reached complete wound closure 1 month after treatment, with no wound infections. In the control group, only three patients (18.7%) showed complete wound closure within a month; in addition, one patient required systemic antibiotic treatment because of supra-bacterial infection of the wound. In our sample, the combination of povidone-iodine and sugar had a higher success rate compared with traditional topical treatment in the treatment of wound defect closure in oncological patients who underwent radio-chemotherapy.
Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Antineoplásicos/efectos adversos , Solución Hipertónica de Glucosa/uso terapéutico , Neoplasias de Cabeza y Cuello/cirugía , Povidona Yodada/uso terapéutico , Radioterapia/efectos adversos , Dehiscencia de la Herida Operatoria/etiología , Infección de la Herida Quirúrgica/tratamiento farmacológico , Administración Tópica , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dehiscencia de la Herida Operatoria/fisiopatología , Cicatrización de Heridas/efectos de los fármacosRESUMEN
Abstract Background: To evaluate the efficacy and safety of prolotherapy with hypertonic dextrose in patients with knee osteoarthritis. A systematic search was performed in electronic databases including PUBMED, SCIELO, DIALNET and Google Scholar. Main body: We searched for randomized clinical trials that evaluated therapeutic interventions in patients with knee osteoarthritis. These trials compared the effect of intra-articular and / or extra-articular infiltrations of hypertonic dextrose vs the effect of intra-articular and / or extra-articular infiltrations of other substances or some interventional procedure application, via assessing pain, physical function and secondary effects and / or adverse reactions. Ten randomized clinical trials were included in this systematic review, the total sample size comprised 328 patients treated with hypertonic dextrose (prolotherapy) vs 348 controls treated with other infiltrations such as local anesthetics, hyaluronic acid, ozone, platelet-rich plasma or interventional procedures like radiofrequency. Conclusions: In terms of pain reduction and function improvement, prolotherapy with hypertonic dextrose was more effective than infiltrations with local anesthetics, as effective as infiltrations with hyaluronic acid, ozone or radiofrequency and less effective than PRP and erythropoietin, with beneficial effect in the short, medium and long term. In addition, no side effects or serious adverse reactions were reported in patients treated with hypertonic dextrose. Although HDP seems to be a promising interventional treatment for knee OA, more studies with better methodological quality and low risk of bias are needed to confirm the efficacy and safety of this intervention.
Asunto(s)
Humanos , Osteoartritis de la Rodilla/tratamiento farmacológico , Proloterapia/instrumentación , Solución Hipertónica de Glucosa/uso terapéutico , Evaluación en Salud , Resultado del TratamientoRESUMEN
OBJECTIVES: The main purpose of this study was to quantify the risk of mortality linked to various regimens of hypertonic peritoneal dialysis (PD) solution. METHODS: A retrospective cohort study of patients using home-based PD was carried out. The prescribed regimen of glucose-based PD solution for all patients, determined on the basis of their individual conditions, was extracted from their medical chart records. The primary outcome was death. The treatment regimens were categorized into 3 groups according to the type of PD solution used: original PD (1.5% glucose), shuffle PD (1.5 and 2.5% glucose), and serialized PD (2.5 and 4.5% glucose). Multivariate analysis (using the Weibull model) was applied to comprehensively examine survival probabilities related to the explanatory variable, while adjusting for other potential confounders. RESULTS: Of 300 consecutive patients, 38% died over a median follow-up time of 30 months (interquartile range: 15-46 months). Multivariate analysis showed that a treatment regimen with continued higher-strength PD solution (serialized PD) resulted in a lower survival rate than when the conventional strength solution was used (adjusted hazard ratio, 2.6; 95% confidence interval, 1.6 to 4.6, p<0.01). Five interrelated risk factors (age, length of time on PD, hemoglobin levels, albumin levels, and oliguria) were significant predictors contributing to the outcome. CONCLUSIONS: Frequent exposure to high levels of glucose PD solution significantly contributed to a 2-fold higher rate of death, especially when hypertonic glucose was prescribed continuously.
Asunto(s)
Solución Hipertónica de Glucosa/uso terapéutico , Enfermedades Renales/mortalidad , Diálisis Peritoneal , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Complicaciones de la Diabetes/patología , Femenino , Hemoglobinas/análisis , Humanos , Enfermedades Renales/terapia , Masculino , Persona de Mediana Edad , Análisis Multivariante , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Factores de Riesgo , Factores Sexuales , Tasa de Supervivencia , Adulto JovenRESUMEN
BACKGROUND: Needleless transcutaneous pneumatic injections (TPIs) are a minimally invasive way to deliver the solution into the skin for therapeutic purposes. The suggested action mechanisms of TPI therapy include mechanical stimulation, immediate tissue shrinkage and late wound healing. METHODS: Thirteen Korean patients were treated with TPI for atrophic skin disorders, including acne scars, striae albae, post-furuncle, or carbuncle scars, and horizontal wrinkles with lipoatrophy. At each TPI treatment session, a single pass was made along with the atrophic skin lesions without overlapping. Thereafter, two dermatologists objectively evaluated the clinical improvement in the lesions in the photographs via the global aesthetic improvement scale (GAIS). RESULTS: One month after the final treatment, the overall mean GAIS score was 2.3 ± 0.8. Six of the 13 (46.2%) patients exhibited clinical improvement of grade 3, five (38.5%) patients grade 2 and two (15.4%) patients grade 1. The overall mean subjective satisfaction score with the TPI treatment was 2.3 ± 0.9. Six of the 13 (46.2%) patients achieved subjective satisfaction of grade 3, six (46.2%) patients grade 2 and one (7.7%) patient grade 0. CONCLUSIONS: The present study demonstrated that the TPI treatment is effective and safe for treating atrophic skin disorders of varying causes in Korean patients.
Asunto(s)
Solución Hipertónica de Glucosa/uso terapéutico , Enfermedades de la Piel/terapia , Adulto , Ántrax/terapia , Cicatriz/terapia , Femenino , Forunculosis/terapia , Solución Hipertónica de Glucosa/administración & dosificación , Humanos , Inyecciones a Chorro , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , República de CoreaRESUMEN
BACKGROUND AND AIMS: EMR is being increasingly practiced for the removal of large colorectal polyps. A variety of solutions such as normal saline solution (NS) and other viscous and hypertonic solutions (VS) have been used as submucosal injections for EMR. A systematic review and meta-analysis is presented comparing the efficacy and adverse events of EMR performed using NS versus VS. METHODS: Two independent reviewers conducted a search of all databases for human, randomized controlled trials that compared NS with VS for EMR of colorectal polyps. Data on complete en bloc resection, presence of residual lesions, and adverse events were extracted using a standardized protocol. Pooled odds ratio (OR) estimates along with 95% confidence intervals (CI) were calculated using fixed effect or random effects models. RESULTS: Five prospective, randomized controlled trials (504 patients) met the inclusion criteria. The mean polyp sizes were 20.84 mm with NS and 21.44 mm with VS. On pooled analysis, a significant increase in en bloc resection (OR, 1.91; 95% CI, 1.11-3.29; P = .02; I2 = 0%) and decrease in residual lesions (OR, 0.54; 95% CI, 0.32-0.91; P = .02; I2 = 0%) were noted in VS compared with NS. There was no significant difference in the rate of overall adverse events between the 2 groups. CONCLUSIONS: Use of VS during EMR leads to higher rates of en bloc resection and lower rates of residual lesions compared with NS, without any significant difference in adverse events. Endoscopists could consider using VS for EMR of large colorectal polyps and NS for smaller polyps because there is no significant difference in the outcomes with lesions <2 cm.
Asunto(s)
Pólipos del Colon/cirugía , Resección Endoscópica de la Mucosa/métodos , Gelatina/uso terapéutico , Solución Hipertónica de Glucosa/uso terapéutico , Ácido Hialurónico/uso terapéutico , Derivados de Hidroxietil Almidón/uso terapéutico , Cloruro de Sodio/uso terapéutico , Succinatos/uso terapéutico , Viscosuplementos/uso terapéutico , Humanos , Soluciones Hipertónicas/uso terapéutico , Inyecciones , Pólipos Intestinales/cirugía , Oportunidad RelativaRESUMEN
OBJECTIVE: A fatal cardiac complication can occasionally present in malnourished patients during refeeding; this is known as refeeding syndrome. However, to our knowledge, hyperglycemia preceding torsades de pointes with QT prolongation during refeeding has not been reported. In the present study, we present a case in which hyperglycemia preceded torsades de pointes with QT prolongation during refeeding. The aim of this study was to determine the possible mechanism underlying QT prolongation during refeeding and indicate how to prevent it. METHODS: A 32-y-old severely malnourished woman (body mass index 14.57 kg/m2) was admitted to the intensive care unit of our institution after resuscitation from cardiopulmonary arrest due to ventricular fibrillation. She was diagnosed with anorexia nervosa. Although no obvious electrolyte abnormalities were observed, her blood glucose level was 11 mg/dL. A 12-lead electrocardiogram at admission showed sinus rhythm with normal QT interval (QTc 0.448). RESULTS: Forty mL of 50% glucose (containing 20 g of glucose) was intravenously injected, followed by a drip infusion of glucose to maintain blood glucose level within normal range. After 9 h, the patient's blood glucose level increased to 569 mg/dL. However, after 38 h, an episode of marked QT prolongation (QTc 0.931) followed by torsades de pointes developed. CONCLUSIONS: Hyperglycemia during refeeding can present with QT prolongation; consequently, monitoring blood glucose levels may be useful in avoiding hyperglycemia, which can result in QT prolongation. Furthermore, additional monitoring of QT intervals using a 12-lead electrocardiogram should allow the early detection of QT prolongation when glucose solution is administered to a malnourished patient with (severe) hypoglycemia.
Asunto(s)
Arritmias Cardíacas/etiología , Solución Hipertónica de Glucosa/efectos adversos , Hiperglucemia/etiología , Hipoglucemia/terapia , Desnutrición/terapia , Síndrome de Realimentación/fisiopatología , Torsades de Pointes/etiología , Adulto , Anorexia Nerviosa/fisiopatología , Anorexia Nerviosa/psicología , Arritmias Cardíacas/prevención & control , Índice de Masa Corporal , Terapia Combinada/efectos adversos , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Suplementos Dietéticos , Nutrición Enteral , Femenino , Solución Hipertónica de Glucosa/administración & dosificación , Solución Hipertónica de Glucosa/uso terapéutico , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/sangre , Hipoglucemia/etiología , Hipoglucemia/fisiopatología , Infusiones Intravenosas , Japón , Desnutrición/etiología , Desnutrición/fisiopatología , Desnutrición/psicología , Síndrome de Realimentación/prevención & control , Índice de Severidad de la Enfermedad , Torsades de Pointes/prevención & control , Resultado del TratamientoRESUMEN
We herein describe a case of tension hydrothorax that occurred on continuous ambulatory peritoneal dialysis (CAPD), highlighting the problems of diagnosis and a novel management. A 38-year-old male with end-stage renal disease (ESRD) due to diabetes mellitus developed dyspnea and poor drainage after 13 months of CAPD. Chest X-ray revealed massive right-sided hydrothorax and mediastinal shift. He underwent emergency thoracentesis and pleural fluid showed a high level of glucose. Pleuroperitoneal communication was strongly suspected, although the methylene blue test was negative. We temporarily performed hemodialysis. Two weeks later, PD was resumed but failed with recurrent right-side hydrothorax in 4 months. The pleuroperitoneal leakage was definitively confirmed by video-assisted thoracoscopic surgery (VATS). Diaphragmatic repair and pleurodesis with hypertonic glucose were performed. There was no recurrence of hydrothorax after treatment.
Asunto(s)
Hidrotórax/diagnóstico , Hidrotórax/terapia , Adulto , Diafragma/cirugía , Solución Hipertónica de Glucosa/uso terapéutico , Humanos , Hidrotórax/etiología , Fallo Renal Crónico/terapia , Masculino , Diálisis Peritoneal Ambulatoria Continua/efectos adversos , Pleurodesia , Cirugía Torácica Asistida por VideoRESUMEN
Soft tissue losses from acute or chronic trauma are a challenge for surgeons. To explore a method to expedite granulation tissue formation in preparation for a split-thickness skin graft (STSG), the medical records of 3 patients - 2 adult men with wounds related to trauma injury and 1 infant with necrotizing fasciitis, all infected with Pseudomonas aeruginosa - were reviewed. All wounds were surgically debrided and managed by applying gauze soaked in 50% glucose followed by continuous negative pressure wound therapy (NPWT) before definitive skin grafting. NPWT pressure was applied at -80 mm Hg for the 2 adult males (ages 39 and 25 years) and -50 mm Hg for the 7-month-old male infant. The dressings were changed every 2 to 3 days. No adverse events occurred, and wounds were successfully closed with a STSG after an average of 7 days. In 1 case, NPWT was able to help affix dressings in a difficult-to-dress area (genital region). The combination of hypertonic glucose and hand-made, gauze-based NPWT was found to be safe, well-tolerated, and effective in preparing the wound bed for grafting. Prospective, randomized, controlled clinical studies are needed to compare the safety, effectiveness, and efficacy of this method to other treatment approaches for P. aeruginosa-infected wounds.
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Vendajes/normas , Solución Hipertónica de Glucosa/uso terapéutico , Terapia de Presión Negativa para Heridas/métodos , Trasplante de Piel/métodos , Adulto , Desbridamiento/métodos , Humanos , Lactante , Masculino , Terapia de Presión Negativa para Heridas/normas , Estudios Prospectivos , Pseudomonas aeruginosa/patogenicidad , Cicatrización de Heridas/fisiología , Heridas y Lesiones/terapiaRESUMEN
PURPOSE: To compare the advantages of prolotherapy in the treatment of first carpometacarpal osteoarthritis (OA) with those of corticosteroid local injection in the short and long term. METHODS: We performed a randomized controlled trial from March 2010 to March 2011 in an outpatient clinic at a university hospital. Sixty participants (60 hands) with OA of the first carpometacarpal joint were assigned equally to two groups. For the corticosteroid group, after 2 monthly saline placebo injections, a single dose of 40 mg methylprednisolone acetate (0.5 ml) mixed with 0.5 ml of 2% lidocaine was injected. For the dextrose (DX) group, 0.5 ml of 20% DX was mixed with 0.5 ml of 2% lidocaine and the injection was repeated monthly for 3 months. Pain intensity, hand function and the strength of lateral pinch grip were measured at the baseline and at 1, 2, and 6 months after the treatment. RESULTS: Mean age (STD) was 63.6 (9.7) years, and mean (STD) visual analog scale (VAS) was 6 (2). The two groups were comparable at 2 months, but significantly different at 1 month, with better results for corticosteroid, and at 6 months with apparently more favorable outcome for DX [mean difference (95% CI) in VAS = 1.1 (0.2, 2.0), p = 0.02]. After 6 months of treatment, both DX and corticosteroid injection increased functional level, but DX seemed to be more effective [mean difference (95% CI) in total function score = 1.0 (0.2, 1.8), p = 0.01]. DISCUSSION: For the long term, DX seems to be more advantageous, while the two treatments were comparable in the short term. Because of the satisfactory pain relief and restoring of function, we would prefer DX prolotherapy for the treatment of patients with OA. LEVEL OF EVIDENCE: Therapeutic studies--investigating the results of treatment; level I.
Asunto(s)
Antiinflamatorios/uso terapéutico , Articulaciones Carpometacarpianas , Solución Hipertónica de Glucosa/uso terapéutico , Metilprednisolona/análogos & derivados , Osteoartritis/tratamiento farmacológico , Adulto , Anciano , Anciano de 80 o más Años , Anestésicos Locales/uso terapéutico , Estudios de Cohortes , Método Doble Ciego , Femenino , Fuerza de la Mano , Humanos , Inyecciones Intraarticulares , Lidocaína/uso terapéutico , Masculino , Metilprednisolona/uso terapéutico , Acetato de Metilprednisolona , Persona de Mediana Edad , Osteoartritis/complicaciones , Osteoartritis/fisiopatología , Recuperación de la Función , Resultado del TratamientoAsunto(s)
Sangre , Tubos Torácicos/efectos adversos , Fibrina , Pleurodesia/efectos adversos , Neumotórax/terapia , Solución Hipertónica de Glucosa/uso terapéutico , Humanos , Enfermedades Pulmonares Intersticiales/complicaciones , Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Pleurodesia/métodos , Neumotórax/diagnóstico por imagen , Neumotórax/etiología , RadiografíaRESUMEN
Conservative interventions with simple procedures and predictable benefits are expected by patients with recurrent dislocation of the temporomandibular joint (TMJ). We have introduced a modified technique of prolotherapy that comprises injection of lignocaine and 50% dextrose at a single site in the posterior periarticular tissues. We studied the effects in 45 younger patients (age range 17-59 years) with non-neurogenic recurrent dislocation of the TMJ, and confirmed the therapeutic effect after more than a year's follow-up. There were appreciable improvements in the number of episodes of dislocation and clicking after the injection. The overall success rate, defined as the absence of any further dislocation or subluxation for more than 6 months, was 41/45 (91%). Of the 41 rehabilitated patients, 26 (63%) required a single injection, 11 (27%) had 2 treatments, and 4 (10%) needed a third injection. All patients tolerated the injections well. The modified dextrose prolotherapy is simple, safe, and cost-effective for the treatment of recurrent dislocation of the TMJ.
Asunto(s)
Anestésicos Locales/administración & dosificación , Solución Hipertónica de Glucosa/uso terapéutico , Luxaciones Articulares/tratamiento farmacológico , Lidocaína/administración & dosificación , Trastornos de la Articulación Temporomandibular/tratamiento farmacológico , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Solución Hipertónica de Glucosa/administración & dosificación , Humanos , Inyecciones Intraarticulares , Irritantes/administración & dosificación , Irritantes/uso terapéutico , Inestabilidad de la Articulación/tratamiento farmacológico , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular/fisiología , Recurrencia , Medicina Regenerativa , Seguridad , Resultado del Tratamiento , Adulto JovenRESUMEN
A 68-year-old man with cholangiocarcinoma underwent percutaneous transhepatic portal embolization to expand the indication for hepatic resection. Selective right posterior portography revealed an intrahepatic portosystemic venous shunt (IPSVS) connecting the segment VII branch to the right hepatic venous branch. An infusion of 50 % glucose solution was given to occlude the shunt. This is novel management for IPSVSs when they are numerous, small, or torturous, and makes the subsequent procedures simpler, shorter, and less expensive.
Asunto(s)
Neoplasias de los Conductos Biliares/terapia , Conductos Biliares Intrahepáticos , Colangiocarcinoma/terapia , Embolización Terapéutica/métodos , Solución Hipertónica de Glucosa/uso terapéutico , Vena Porta/anomalías , Malformaciones Vasculares/terapia , Anciano , Neoplasias de los Conductos Biliares/complicaciones , Colangiocarcinoma/complicaciones , Hepatectomía , Humanos , Masculino , Resultado del Tratamiento , Malformaciones Vasculares/complicacionesRESUMEN
Treatment for significant hypoglycemia includes administration of dextrose containing agents, including 50% dextrose (D50%W) intravenously. Significant extravasation of D50%W can lead to complications, including skin and soft tissue injury, loss of limb, or death. The aim of this case report, using an interdisciplinary team approach, explores extravasation protocols as well as literature review, is to provide information about the proper use of hyaluronidase in patients with D50%W extravasations. A 46-year-old African American man presented to the emergency department (ED) after blood glucose level was initially 13 mg/dL. Emergency medical service established a large bore intravenous (IV) line in the right antecubital vein and administered a total of 50 g of D50%W. Upon arrival to the ED, the patient's level of consciousness had significantly improved. After arrival to the ED, the patient started complaining of pain in his right arm, near the site of the IV line insertion. On inspection, the IV site was grossly infiltrated. Hospital protocols for hyperosmolar infiltration were used. Extravasation is a common medical complication of infused medications and needs to be properly identified and treated. The multitude of skills from nursing, medicine, and pharmacy ensures that extravasation is managed appropriately and effectively to ensure safety to patients. Recognition, communication, and awareness of the institutional guidelines on how to treat infiltration and extravasation should be encouraged in all ED and intensive care unit medical personnel who deal with a variety of infusions and IV medications that have serious implications if not treated correctly.
Asunto(s)
Antídotos/uso terapéutico , Extravasación de Materiales Terapéuticos y Diagnósticos , Solución Hipertónica de Glucosa/efectos adversos , Glucosa/efectos adversos , Hialuronoglucosaminidasa/uso terapéutico , Hipoglucemia/tratamiento farmacológico , Extravasación de Materiales Terapéuticos y Diagnósticos/diagnóstico , Extravasación de Materiales Terapéuticos y Diagnósticos/tratamiento farmacológico , Extravasación de Materiales Terapéuticos y Diagnósticos/etiología , Glucosa/uso terapéutico , Solución Hipertónica de Glucosa/uso terapéutico , Humanos , Infusiones Intravenosas , Masculino , Persona de Mediana EdadRESUMEN
OBJECTIVE: Chronic lateral epicondylosis is common, debilitating, and often refractory. Prolotherapy (PrT) is an injection therapy for tendinopathy. The efficacy of two PrT solutions for chronic lateral epicondylosis was evaluated. DESIGN: This study is a three-arm randomized controlled trial. Twenty-six adults (32 elbows) with chronic lateral epicondylosis for 3 mos or longer were randomized to ultrasound-guided PrT with dextrose solution, ultrasound-guided PrT with dextrose-morrhuate sodium solution, or watchful waiting ("wait and see"). The primary outcome was the Patient-Rated Tennis Elbow Evaluation (100 points) at 4, 8, and 16 wks (all groups) and at 32 wks (PrT groups). The secondary outcomes included pain-free grip strength and magnetic resonance imaging severity score. RESULTS: The participants receiving PrT with dextrose and PrT with dextrose-morrhuate reported improved Patient-Rated Tennis Elbow Evaluation composite and subscale scores at 4, 8, and/or 16 wks compared with those in the wait-and-see group (P < 0.05). At 16 wks, compared with baseline, the PrT with dextrose and PrT with dextrose-morrhuate groups reported improved composite Patient-Rated Tennis Elbow Evaluation scores by a mean (SE) of 18.7 (9.6; 41.1%) and 17.5 (11.6; 53.5%) points, respectively. The grip strength of the participants receiving PrT with dextrose exceeded that of the PrT with dextrose-morrhuate and the wait and see at 8 and 16 wks (P < 0.05). There were no differences in magnetic resonance imaging scores. Satisfaction was high; there were no adverse events. CONCLUSIONS: PrT resulted in safe, significant improvement of elbow pain and function compared with baseline status and follow-up data and the wait-and-see control group. This pilot study suggests the need for a definitive trial.
Asunto(s)
Solución Hipertónica de Glucosa/uso terapéutico , Calidad de Vida , Rango del Movimiento Articular/efectos de los fármacos , Morruato de Sodio/uso terapéutico , Codo de Tenista/tratamiento farmacológico , Adulto , Enfermedad Crónica , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Proyectos Piloto , Rango del Movimiento Articular/fisiología , Valores de Referencia , Medición de Riesgo , Índice de Severidad de la Enfermedad , Método Simple Ciego , Codo de Tenista/diagnóstico por imagen , Resultado del Tratamiento , Ultrasonografía DopplerAsunto(s)
Epistaxis/terapia , Solución Hipertónica de Glucosa/administración & dosificación , Adolescente , Adulto , Anciano , Endoscopía , Femenino , Solución Hipertónica de Glucosa/uso terapéutico , Técnicas Hemostáticas , Humanos , Masculino , Persona de Mediana Edad , Mucosa Nasal , Adulto JovenRESUMEN
BACKGROUND: treatment of severe preeclampsia (SP) includes administration of crystalloid solutions to expand plasma circulating volume. Our objective was to compare the effects of two schemes of crystalloid solutions on glycemia in patients with SP. METHODS: cross-sectional study with two groups of patients: group A (123 patients) received a 10 % glucose solution and group B (146 patients) received Ringer lactate solution. We compared glycemia, endogenous creatinine clearance (ECrCl), frequency of urinary tract infection (UTI) and length of hospital stay. Student t-test and Pearson correlation coefficient were used. RESULTS: final glycemia of group A was higher than group B (168.27 ± 70.85 adversus 94.20 ± 26.63, p = 0.009). No differences were shown in ECrCl (group A 99.26 ± 30.67 adversus group B, p = 0.14) or in UTI [group A 21.95 % (27 cases) adversus group B 18.48 % (27 cases) (p = 0.43)]. Length of hospital stay was different (group A 2.2 ± 1.79 adversus group B 2.67 ± 1.78 days, p = 0.03). CONCLUSIONS: patients receiving a 10 % glucose solution presented significant hyperglycemia but not in the group receiving Ringer lactate solution.
Asunto(s)
Glucemia/análisis , Solución Hipertónica de Glucosa/uso terapéutico , Soluciones Isotónicas/uso terapéutico , Preeclampsia/sangre , Preeclampsia/tratamiento farmacológico , Adulto , Estudios Transversales , Soluciones Cristaloides , Femenino , Humanos , Embarazo , Lactato de Ringer , Índice de Severidad de la EnfermedadAsunto(s)
Fluidoterapia/métodos , Soluciones Hipotónicas/uso terapéutico , Soluciones Isotónicas/uso terapéutico , Anestesia , Niño , Preescolar , Coloides/administración & dosificación , Coloides/uso terapéutico , Solución Hipertónica de Glucosa/administración & dosificación , Solución Hipertónica de Glucosa/uso terapéutico , Humanos , Soluciones Hipotónicas/administración & dosificación , Soluciones Hipotónicas/química , Lactante , Recién Nacido , Infusiones Intravenosas , Soluciones Isotónicas/administración & dosificación , Soluciones Isotónicas/química , Pediatría , Atención PerioperativaRESUMEN
OBJECTIVE: To study the change in intestinal barrier and organ functions of burned dog after enteral administration of hypertonic electrolyte glucose solution (HEGS) in shock stage. METHODS: Twenty-four Beagle dogs inflicted with 35% TBSA full-thickness burn were divided into no-fluid group (NF), intravenous infusion with isotonic electrolyte glucose solution (IEGS) group (II group), enteral infusion with IEGS group (EI), and enteral infusion with HEGS group (EH) according to the random number table, with 6 dogs in each group. Saline, containing 50 g/L glucose, was intravenously or enterally infused into dogs in II group and EI group respectively 0.5 hour post injury (PIH) for resuscitation. Total infusion volume within PIH 24 was 4 mL x kg(-1) x %TBSA(-1) (half of the total volume was infused in the first 8 hours in a constant speed, the other half volume was infused in the rest 16 hours in a constant speed). HEGS, containing 18 g/L NaCl and 50 g/L glucose, was enterally infused into dogs in EH group. Total infusion volume within PIH 24 was 2 mL x kg(-1) x %TBSA(-1), with the same infusion speed as that in II and EI groups. Liver and kidney function indexes [activity of ALT and CK-MB, expression levels of creatinine and blood urea nitrogen (BUN) in serum], activity of diamine oxidase (DAO), and activity of Na(+)-K(+)-ATPase in intestinal mucosa at PIH 24 were determined. RESULTS: ALT activity in each group was close to one another. Serum levels of creatinine and BUN in II, EI, and EH groups were significantly lower than those in NF group. CK-MB activity obviously increased at PIH 2 in every group. CK-MB activity in EH group at PIH 2 to 8 was respectively lower than that in NF and II groups. DAO activity in serum in II, EI, and EH groups decreased since PIH 4 or PIH 6, respectively from (3.9 + or - 0.6) U/L to (3.6 + or - 0.5) U/L, (4.8 + or - 0.4) U/L to (2.8 + or - 0.8) U/L, (6.4 + or - 1.8) U/L to (3.5 + or - 0.8) U/L, all were significantly lower than those in NF group [from (12.5 + or - 0.4) U/L to (9.7 + or - 1.1) U/L, comparison between EH group and NF group, t value at PIH 4, 6, 8, 24 was respectively 10.25, 12.44, 17.99, 16.21, P values all below 0.05]. The order of Na(+)-k(+)-ATPase activity in intestinal mucosa at PIH 24 in each group from high to low was II group, EH group, EI group, and NF group (comparison between former 3 groups and NF group, t value was respectively 10.09, 4.96, 8.32, F value was 26.79, P values all below 0.05). CONCLUSIONS: HEGS does not cause significant harm to the barrier function of intestinal mucosa of shock dog after burn. Compared with NF, HEGS can significantly improve functions of heart, liver, and kidney, and it can achieve the same resuscitation effect as enteral or intravenous infusion of IEGS with only half of the solution volume.