RESUMO
INTRODUCTION: We aimed to determine the prevalence and duration of prodromal periods in patients with celiac disease and inflammatory bowel disease (Crohn's disease and ulcerative colitis). Furthermore, we explored to what extent vague abdominal symptoms consistent with both disorders were attributed to irritable bowel syndrome (IBS) and if the presence of prodromal IBS (P-IBS) had an impact on prodrome duration. METHODS: In the study, 683 biopsy-proven patients (celiac n = 225, ulcerative colitis n = 228, Crohn's disease n = 230) completed a postal survey including an assessment of prodromal periods and IBS symptoms during both the prodrome and at present (achieved by completion of the ROME II criteria). Results were compared to age/sex-matched controls (n = 348). RESULTS: Crohn's disease patients had the highest prevalence of prodromes (94%) in comparison to ulcerative colitis (48%) and celiac disease (44%). However, Crohn's disease patients have the lowest prevalence of P-IBS (29%) in comparison to ulcerative colitis (38%) and celiac disease (67%). Prodrome duration in patients with P-IBS Crohn's disease was 4 years in comparison to 2 years without (p = 0.018). Prodrome duration in P-IBS celiac disease was 10 years in comparison to 7 years without (p = 0.046). Prodrome duration in patients with ulcerative colitis was not affected by P-IBS (p ≥ 0.05). Age and sex were not confounding factors. CONCLUSIONS: This is the first study to make direct comparisons of prodrome periods between celiac disease and IBD. Prodrome duration in celiac disease is significantly longer and more often characterized by P-IBS than IBD. In celiac disease and CD, P-IBS increases prodrome duration. This may represent a failure to understand the overlap between IBS and celiac disease/IBD.
Assuntos
Doença Celíaca/diagnóstico , Diagnóstico Tardio/estatística & dados numéricos , Doenças Inflamatórias Intestinais/diagnóstico , Síndrome do Intestino Irritável/complicações , Adulto , Idoso , Estudos de Casos e Controles , Doença Celíaca/complicações , Doença Celíaca/epidemiologia , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Doenças Inflamatórias Intestinais/epidemiologia , Síndrome do Intestino Irritável/epidemiologia , Masculino , Pessoa de Meia-Idade , Reino Unido/epidemiologia , Adulto JovemAssuntos
Anticoagulantes/efeitos adversos , Enoxaparina/efeitos adversos , Trombocitopenia/induzido quimicamente , Anticoagulantes/uso terapêutico , Sulfatos de Condroitina/uso terapêutico , Dermatan Sulfato/uso terapêutico , Combinação de Medicamentos , Feminino , Heparitina Sulfato/uso terapêutico , Humanos , Pessoa de Meia-Idade , Contagem de Plaquetas , Cintilografia , Trombocitopenia/diagnóstico por imagem , Varfarina/uso terapêuticoRESUMO
BACKGROUND AND OBJECTIVES: We aimed to determine the following in an experimental acute pain model in sheep: (1) whether multimodal analgesia with intravenous fentanyl and ketorolac was more effective than fentanyl alone; (2) whether secondary hyperalgesia (central sensitization) occurred in adjacent (foreleg) dermatomes after thoracic surgery; (3) whether ketorolac used preemptively influenced the development of secondary hyperalgesia after surgery. METHODS: Changes in primary nociception were measured by increases to tolerated pressure, applied to the foreleg by a blunt pin, before foreleg withdrawal occurred. Changes to breath-to-breath interval and estimated end-tidal CO2 were used as indices of respiratory effects. Study 1 (n = 6) compared the paired responses to acute nociception after ketorolac (90 mg) or saline (control) pretreatment, followed by fentanyl (graded, 0 mg to 1.5 mg). Study 2 (n = 6) used a cross-over of ketorolac (90 mg) or saline (control) 24 hours and 1 hour, respectively, before a standardized thoracotomy incision, followed by antinociceptive testing with ketorolac (90 mg) and fentanyl (0.6 mg) daily over 4 days. RESULTS: In study 1, fentanyl produced naloxone-antagonizable antinociception and respiratory depression. Ketorolac did not affect fentanyl antinociception, except for prolonging antinociception at the highest dose; it did not affect the respiratory effects. In study 2, preemptive ketorolac had no effect on the postoperative antinociceptive or respiratory effects of fentanyl. The pharmacokinetics of fentanyl were unaltered by ketorolac. CONCLUSIONS: The results obtained in this acute pain model found no significant evidence of a fentanyl-ketorolac interaction, of central sensitization as shown by secondary hyperalgesia, or of a preemptive analgesic effect.
Assuntos
Hiperalgesia/prevenção & controle , Dor Pós-Operatória/prevenção & controle , Doença Aguda , Analgesia/métodos , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/farmacocinética , Analgésicos Opioides/uso terapêutico , Análise de Variância , Animais , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Área Sob a Curva , Dióxido de Carbono/análise , Modelos Animais de Doenças , Combinação de Medicamentos , Fentanila/administração & dosagem , Fentanila/farmacocinética , Fentanila/uso terapêutico , Hiperalgesia/etiologia , Hiperalgesia/fisiopatologia , Injeções Intravenosas , Cetorolaco/administração & dosagem , Cetorolaco/uso terapêutico , Naloxona/uso terapêutico , Antagonistas de Entorpecentes/uso terapêutico , Dor Pós-Operatória/fisiopatologia , Pré-Medicação , Pressão , Respiração/efeitos dos fármacos , Ovinos , Estatísticas não Paramétricas , Toracotomia , Volume de Ventilação PulmonarRESUMO
A patient developed an epidural haematoma 6 days after removal of an epidural catheter resulting in paraplegia and death. Insertion and removal of the epidural catheter during anticoagulation with prophylactic unfractionated heparin and subsequent administration of high-dose enoxaparin (Clexane), which commenced 3 days after catheter removal, were implicated.
Assuntos
Analgesia Epidural/efeitos adversos , Anticoagulantes/efeitos adversos , Enoxaparina/efeitos adversos , Hematoma Epidural Craniano/etiologia , Idoso , Idoso de 80 Anos ou mais , Anticoagulantes/administração & dosagem , Enoxaparina/administração & dosagem , Evolução Fatal , Hematoma Epidural Craniano/induzido quimicamente , Humanos , MasculinoRESUMO
The purpose of this prospective cohort study was to compare metabolic effects of epidural or patient controlled analgesia (PCA) in patients undergoing major upper abdominal surgery. Seventeen patients undergoing major upper abdominal surgery were included: 10 received perioperative epidural analgesia (Group I) and the remainder received morphine via a PCA device for postoperative analgesia (Group II). A number of measures compared between one day preoperatively (day 1) and day 2 postoperatively included femoral arterial and venous blood concentrations of glucose, lactate, pyruvate and amino acids. In addition, the relevant flux values were measured from the products of the respective arteriovenous substrate concentration differences and calf blood flow. The efflux of lactate from peripheral tissues was greater in Group II than in Group I (P < 0.01): glucose and pyruvate efflux did not differ between groups. There was no difference between groups in mean individual and total flux of amino acids on day-1. However increased efflux between day-1 and day 2 was found for alanine, valine, isoleucine, leucine, phenylalanine, lysine, arginine in both groups, and for serine, glycine, tyrosine and histidine in Group II (P < 0.05). The efflux of glycine, methionine, amino benzoic acid, alanine, and lysine was less in Group I than Group II on day 2 (P < 0.05). There was a significant difference in the total amino acid flux on day 2 (Group I = -1.2 mumol. (100 ml tissue)-1.min-1 cf Group II = -2.5 mumol. (100 ml tissue)-1.min-1; P = 0.04). In conclusion, perioperative epidural analgesia was associated with a reduced postoperative amino acid efflux two days following major upper abdominal surgery.
Assuntos
Aminoácidos/metabolismo , Analgesia Epidural , Procedimentos Cirúrgicos do Sistema Digestório , Estresse Fisiológico/metabolismo , Analgesia Controlada pelo Paciente , Analgésicos Opioides/administração & dosagem , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morfina/administração & dosagem , Período Pós-Operatório , Estudos ProspectivosAssuntos
Anafilaxia/etiologia , Anafilaxia/prevenção & controle , Antivenenos/efeitos adversos , Epinefrina/uso terapêutico , Gelatina/uso terapêutico , Substitutos do Plasma/uso terapêutico , Polímeros/uso terapêutico , Ressuscitação/métodos , Venenos de Serpentes , Vasoconstritores/uso terapêutico , HumanosAssuntos
Dor Pós-Operatória/tratamento farmacológico , Doença Aguda , Analgesia/efeitos adversos , Analgesia/métodos , Analgésicos/uso terapêutico , Humanos , Dor Pós-Operatória/fisiopatologia , Dor Pós-Operatória/prevenção & controle , Estresse Fisiológico/fisiopatologia , Procedimentos Cirúrgicos Operatórios/efeitos adversosRESUMO
Transoesophageal Doppler cardiac output measurement was evaluated against the thermodilution method in eleven patients undergoing elective cardiac surgery. A total of 106 pairs of Doppler and thermodilution values were obtained. Cardiac output was measured over a range of 2.3 l.min-1. to 11.51 l.min-1. The mean difference between the Doppler and thermodilution measures was -1.0 l.min-1 (thermodilution minus Doppler). Standard deviction was 1.8 l.min-1. This is a significant difference. It is concluded that these techniques do not agree when measuring cardiac outputs.