Oxcarbazepine monotherapy in postherpetic neuralgia unresponsive to carbamazepine and gabapentin.

OBJECTIVES: We present the results of a preliminary, open-label trial to evaluate the efficacy and tolerability of oxcarbazepine in postherpetic neuralgia (PHN) unresponsive to treatment with antiepileptic drugs (carbamazepine and gabapentin) and local anesthetic blocks. MATERIALS AND METHODS: Twenty-four patients were treated with oxcarbazepine monotherapy for 8 weeks. Starting dose was 150 mg/day, subsequently increased by 150 mg/day every 2 days until a maintenance dose of 900 mg/day. Pain was assessed using a visual analog scale (VAS). RESULTS: There was a significant decrease in the mean VAS score following 8 weeks of treatment (Delta=5.33; paired t-test: P <0.0001) compared with baseline. Oxcarbazepine was effective from the first week of treatment. There was a significant reduction in allodynia, leading to improvements in patients' functioning and quality of life. Oxcarbazepine was generally well tolerated. CONCLUSION: Oxcarbazepine appears to be a promising alternative monotherapeutic approach for patients affected by PHN.

[Locoregional anesthesia in inguinal hernia surgery]. / L'anestesia locoregionale nella chirurgia dell'ernia inguinale.

BACKGROUND: It is a current opinion that local anesthesia (LA) is the primary choice in surgical treatment of the inguinal region, particularly herniorrhaphy. The LA technique personally used for herniorrhaphy is described: it consists of iliohypogastric, ilioinguinal and genito-femoral nerve blocks, and incision line anesthetic infiltration. METHODS: From January 1998 to April 1999, 95 patients underwent inguinal herniorrhaphy employing LA: 77 (81%) in elective surgery, 18 (19%) in emergency; 2 cases with bilateral hernia (97 total LA procedures). RESULTS: Partial success was obtained in only 8 cases (8.4%), which required an association with a hypnotic drug ("blended anesthesia": propofol or midazolam): there were no cases of conversion to general anesthesia. Specific complications of local anesthetic drugs infiltration developed in 8 cases on 97 LA procedures (8.2%), but none required reoperation: 6 inguinal hematomas, 1 female external genitalia hematoma, 1 hematocele. CONCLUSIONS: In conclusion, it is stressed that LA is the technique of choice in herniorrhaphy and surgery of other inguinal pathologies, associating high success rates, rare complications and rapid dismissal: this allows for easy management of the patients and a very important reduction of sanitary costs. The association of LA-hypnotic drugs (blended anesthesia) represents another important resource, since it avoids general anesthesia in many cases and allows a rapid psychophysical recovery.

Systemic lithium reabsorption from lithium-chloride-coated heat and moisture exchangers.

OBJECTIVE: To evaluate possible reabsorption and systemic effects of lithium released by lithium-chloride-coated heat and moisture exchangers (HMEs) during prolonged mechanical ventilation. DESIGN: Prospective study, including all patients mechanically ventilated for 5-30 days. SETTING: A 7 bed general-traumatological ICU in a University Hospital. PATIENTS: 27 consecutive ICU patients, admitted following trauma, neurosurgery and respiratory insufficiency, mechanically ventilated for at least 5 days, with a lithium coated hygroscopic HME in the circuit. MEASUREMENTS AND RESULTS: Serum lithium levels were measured daily, with a standard laboratory spectrophotometric method, from admission to discharge from the ICU, and showed a reabsorption of lithium in all the patients; in the adults, levels were 5 to 15 times lower than therapeutic range, while in a child therapeutic and even toxic levels were reached. CONCLUSIONS: LiCl coat enhances HMEs' performance greatly, but reabsorption and systemic action must be considered. In adults, serum lithium levels were lower than the therapeutic range, but lithium is effective at low concentrations and it has a narrow therapeutic range; moreover, toxicity can be observed within this range too. In children, the risk of toxicity is much greater. When lithium coated HMEs are used, the risk/benefit ratio between good performance and systemic reabsorption must be evaluated carefully.

[Regional changes in endothelin levels in venous and arterial blood in a limb subjected to postural variations]. / Modificazioni distrettuali dell'endotelina a livello del sangue venoso e arterioso in un arto sottoposto a variazioni posturali.

The aim of this study was to evaluate the behaviour of plasma endothelin in humans both in venous and arterial blood at the level of a limb subjected to postural changes. An experimental model was designed for this purpose in which tissue hypoperfusion conditions were created in a subject lying on his back by maintaining an upper limb in a vertical position for approximately one hour. The limb was then lowered and remained horizontal for another hour. The study was performed in 5 healthy subjects aged between 59 and 75 years old. Both venous and arterial blood samples were collected, virtually contemporaneously, at times 0.60 and 120 minutes, namely before and after raising the limb and after the limb had been lowered for one hour. Mean endothelin levels +/- SD in arterial blood were respectively 3.36 +/- 1.29 pg/ml, 4.13 +/- 1.16 pg/ml and 3.82 +/- 1.11 pg/ml at times 0.60 and 120 min. Mean endothelin levels SD in venous blood at the same times were respectively 3.84 +/- 1.41 pg/ml, 5.62 +/- 2.26 pg/ml and 4.95 +/- 1.39 pg/ml. In both arterial and venous blood, the difference between the first two values was statistically significant (p < 0.05). Endothelin therefore appears to be affected by changes in district hemodynamics.