Comparison of measures of physiologic stress during treadmill exercise in a patient with 20% lower extremity burn injuries and healthy matched and nonmatched individuals.

Patients with burn injuries are referred for rehabilitation within days after the injuries to encourage early ambulation and functional training. Many of these patients are hypermetabolic at rest. Metabolic demands of activity are added to the already hypermetabolic state and elevate total energy requirements and some physiologic measures. Reports on the physiologic stress imposed by therapeutic activities for patients with burn injuries are limited to low levels of metabolic demand (< or =2 metabolic equivalents [METS]). The degree of stress imposed by functional activities such as ambulation (3 METS) and stair climbing (5 METS) is not known for adults with burn injuries. The purpose of this study was to report the clinical measures of myocardial and physiologic stress in a patient with 20% lower extremity total body surface area burns during an exercise challenge equivalent to stair climbing. Physiologic measures were assessed before and during a treadmill activity (5 METS) for a 40-year-old obese man 3 weeks after he had lower extremity burn injuries. These measures were compared with mean values for 62 healthy counterparts and 6 healthy subjects matched for age, gender, and fitness level. Heart rate, systolic blood pressure, rate pressure product, and the rating of perceived exertion for the patient with burn injuries were higher at baseline and during exercise than the mean values for the 62 healthy individuals and the 6 matched subjects. The steady state exercise values for heart rate, systolic blood pressure, rate pressure product, and rating of perceived exertion at 6 minutes were 189 beats per minute, 190 mm Hg, 3591, and 17, respectively, for the patient with burn injuries and were 111.3 beats per minute, 149 mm Hg, 1680, and 11.7, respectively, for the 6 matched subjects. Ventilation during exercise also increased for the patient with burn injuries more than for the matched subjects (3/4 vs 1/4). Pain experienced by the patient with burn injuries decreased with activity (9.8 vs 7.3 on a 15-cm scale). Treadmill walking produced near maximal responses for most physiologic measures for this patient who was hypermetabolic at rest. We provided normative data to assist therapists who work with patients with similar burn injuries.

[Pharmacotherapy of trigeminal neuralgia]. / Farmacoterapia de la neuralgia del trigemino.

The efficacy of drug treatment on 119 patients with trigeminal neuralgia is reported in the present paper. Among them, 112 were idiopathic trigeminal neuralgias while only 7 cases were secondary trigeminal neuralgias. All patients were treated with drugs at different stages of the evolution of the neuralgia. Carbamazepine was used on all patients. 12.6% was treated with imipramine (tricyclic antidepressive drug), 4 patients received amphetamines due to psychiatric emergencies, 4 patients were treated with phenytoin before this study and three patients received baclofen during short periods of follow-up. Drug therapy was the only treatment method in 51 patients. In 43 patients it was combined with peripheral surgical treatments including injections of alcohol and neurectomies. 16.8% of the patients were treated with drugs and acupuncture; the results of this experience will be reported in a future paper. Only 4.2% (5 patients) underwent neurosurgical treatment: one ponto cerebellar angle tumour, one electrocoagulation of the gasserian ganglion through the stereotaxic method and three cases of microvascular decompression of the trigeminal root. Clinical, pharmacological and neurophysiological aspects of trigeminal neuralgia pharmacotherapy are discussed.

[Kawasaki's disease]. / Enfermedad de Kawasaki.

We described a case of Kawasaki's disease in a chilean girl, one year and 5 months old of age, who presented the oral characteristics, cutaneous and systemic manifestation of the condition, that is not very common for the dentist but that it is necessary to know due to the heart complications and the mortality associated with the disease, and it is necessary that the dentist recognize early this condition.

[Diagnosis of facial pain: a clinical experience]. / Diagnostico de algias faciales: una experiencia clinica.

A sample of 228 patients with facial pain is reported in the present paper. Among them, 112 cases are typical idiopathic trigeminal neuralgias, 111 are cases of secondary facial pain (including 7 cases symptomatic trigeminal neuralgias) and 5 patients were classified as vascular facial pain. Among the 119 cases of clinically diagnosed trigeminal neuralgias there were 112 (94, 11%) with no evidence of organic cause. Only 7 cases (5.89%) were identified as organic, including 3 cases of bulbar and pontic vascular lesions, 2 cases of iatrogenic injuries following neurosurgery, 1 case of meningioma of the ponto-cerebellar angle and 1 case of neurosyphillis. The most frequent conditions that produce secondary facial pain were: miofacial pain syndrome, sinusitis, cervical vertebral lesions, post herpetic neuralgias, malignant head and neck tumours and encephalic vascular lesions of the pain pathway.

Clinical pharmacology of netilmicin in preterm and term newborn infants.

Sixty-four neonates, with gestational age ranging from 27 1/2 to 40 weeks, postnatal age from 1 to 15 days, and birth weight from 800 to 3400 gm, were given netilmicin 2.5 mg/kg intramuscularly two or three times per day according to postnatal age, for 5 to 14 days. Serum concentrations were measured before and 1 hour after a dose at least twice during treatment. The serum washout profile of the drug was observed in 22 neonates after discontinuation of therapy. Renal function was studied in 37 infants by measuring serum creatinine concentrations and in 27 by urinary excretion of N-acetyl-glucosaminidase during and up to 15 days after therapy. Behavioral and impedance audiometry, and in infants failing those, auditory brainstem evoked response tests, were performed between 6 and 12 months of age. In 23.5% of the neonates, trough serum levels were greater than 3 micrograms/ml. The serum washout followed a multiexponential decay, accounting for distributional, rapid (initial), and slow (tissue) elimination phases. Linear regression analysis performed between each kinetic parameter and gestational age or birth weight showed that initial elimination half-life, steady-state volume of distribution, and total body clearance were significantly correlated with both variables. Netilmicin did not cause detectable renal or auditory damage.