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1.
Dig Dis Sci ; 64(12): 3502-3517, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31187328

RESUMO

BACKGROUND: Gastrointestinal (GI) motility dysfunction is the most common non-motor symptom of Parkinson's disease (PD). Studies have indicated that GI motility functions are impaired before the onset of PD. AIMS: To investigate the underlying mechanism of PD-induced GI dysmotility in MPTP (1-methyl 4-phenyl 1,2,3,6-tetrahydropyridine)-induced animal model. METHODS: C57BL/6 mice were administered with or without a selective dopamine neurotoxin, MPTP, to induce parkinsonian symptoms. In addition to in vivo studies, in vitro experiments were also conducted in colon specimens using l-methyl-4-phenylpyridinium (MPP+), a metabolic product of MPTP. Gastric emptying, colon motility, nitrergic relaxation, and western blot experiments were performed as reported. RESULTS: MPTP-induced PD mice showed decreased expression of nuclear factor erythroid 2-related factor (Nrf2) and its target phase II genes in gastric and colon neuromuscular tissues. Decreased levels of tetrahydrobiopterin (BH4, a critical cofactor for nNOS dimerization) associated with uncoupling of nNOS in gastric and colon tissues exposed to MPTP. Impaired enteric nitrergic system led to delayed gastric emptying and slower colonic motility compared to the control mice. In vitro results in colon specimens confirm that activation of Nrf2 restored MPP+-induced suppression of alpha-synuclein, tyrosine hydroxylase (TH), Nrf2, and heme oxygenase-1. In vitro exposure to L-NAME [N(w)-nitro-L-arginine methyl ester], a NOS synthase inhibitor, reduced protein expression of TH in colon tissue homogenates. CONCLUSIONS: Loss of Nrf2/BH4/nNOS expression in PD impairs antioxidant gene expression, which deregulates NO synthesis, thereby contributing to the development of GI dysmotility and constipation. Nitric oxide appears to be important to maintain dopamine synthesis in the colon.

2.
Dentomaxillofac Radiol ; : 20180027, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-30028185

RESUMO

OBJECTIVES: To examine the outcomes of e-learning or blended learning interventions in undergraduate dental radiology curricula and analyze the nature of the knowledge levels addressed in learning interventions. METHODS: A systematic literature review was performed using a search strategy based on MeSH key words specific to the focus question and indexed in the MEDLINE database. The search again was supplemented by hand-searching of selected journals. Data were extracted relating to outcomes of knowledge and student perceptions. Analysis of the e-learning intervention was performed using a new framework to examine the level of knowledge undertaken: (1) remember/understand (2) analysis or evaluation or diagnosis and (3) performance ("knows how" or "shows how"). RESULTS: From the selected 17 papers, 11 were positive about student reported outcomes of the interventions, and 8 reported evidence that e-learning interventions enhanced learning. Out of the included studies, 8 used e-learning at the level of remember/understand, 4 at the level of analysis/evaluate/diagnosis, and 5 at the level of performance ("knows how," "shows how"). CONCLUSIONS: The learning objectives, e-learning intervention, outcome measures and reporting methods were diverse and not well reported. This makes comparison between studies and an understanding of how interventions contributed to learning impractical. Future studies need to define "knowledge" levels and performance tasks undertaken in the planning and execution of e-learning interventions and their assessment methods. Such a framework and approach will focus our understanding in what ways e-learning is effective and how it contributes to better evidence-based e-learning experiences.

3.
J Cytol ; 33(2): 98-100, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27279686

RESUMO

We report a case of microinvasive carcinoma of the breast cytologically diagnosed as ductal carcinoma - in situ in an 80-year-old lady with a breast lump. Extensive sampling of mastectomy specimen showed ductal carcinoma in situ (DCIS). Many ducts showed stromal reaction - periductal sclerosis and lymphocytic infiltration-features suggestive of microinvasion. However, no definite invasion was noted histologically. Immunohistochemical study highlighted the microinvasive foci.

4.
Int J Health Sci (Qassim) ; 9(4): 478-81, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26715928

RESUMO

Schwannomatosis is a term used to describe patients with multiple nonvestibular schwannomas with no other stigmata of neurofibromatosis type-2 (NF2). Neuroblastoma-like schwannoma is a rare subtype of schwannoma, with histological features resembling a neuroblastoma. This case is probabaly the second case of very uncommon neuroblastoma-like schwannoma, in a patient of schwannomatosis.

5.
Malays J Pathol ; 37(3): 293-9, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-26712678

RESUMO

Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm arising from lymph nodes as well as extranodal sites. Despite the characteristic histopathological features and distinctive immunophenotype, extranodal FDCS are often misdiagnosed initially as undifferentiated carcinoma, inflammatory pseudotumour, meningioma, metastatic malignant melanoma, ectopic thymoma, etc., because of its rarity and lack of awareness. Correct diagnosis of this tumour is imperative given its potential for recurrence and metastasis. We report a case of tonsillar FDCS in a 30-year-old lady who presented with slowly progressing throat pain and dysphagia for a duration of one year. Local examination showed an enlarged left tonsil with an ulceroproliferative growth. The right tonsil was normal. There was no regional lymphadenopathy. Histopathological examination of the tonsillectomy specimen showed a 2.2x1.5 cm infiltrative tumour composed of ovoid to spindle cells arranged in characteristic storiform, interlacing fascicular and diffuse patterns. The tumour cells were immunopositive for CD21, CD23, CD35, and S-100 protein and negative for cytokeratin. The Ki-67 antigen-labelling index (Ki-67 LI) was 6%. The EBV status was negative. It was classified as a low risk FDCS. The patient was lost to follow-up after 6 months.


Assuntos
Sarcoma de Células Dendríticas Foliculares/patologia , Neoplasias Tonsilares/patologia , Adulto , Biomarcadores Tumorais/análise , Feminino , Humanos , Imuno-Histoquímica
6.
J Clin Diagn Res ; 9(1): TC01-7, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25738053

RESUMO

OBJECTIVE: Though both clinical evaluation and MRI are complimentary in detection and precise localization of the level of lesion in patients with cervical myelopathy, there is paucity of data comparing segment specific clinical features with the MRI abnormalities in cervical myelopathy. MATERIALS AND METHODS: Thirty one patients with cervical myelopathy and abnormal MRI of the cervical spine (signal changes in the cord) admitted to the neurology and neurosurgery wards during the study period were included in the study. The patients were prospectively evaluated by a detailed neurological examination. Clinically, the site of lesion was determined by highest of the pyramidal, sensory or segmental features of involvement. The MRI lesions were categorized based on the vertebral level at which the abnormalities were seen. The patients were divided into three groups according to the site of lesion on MRI: (1) cervico-medullary (foramen magnum to C1) lesions (2) upper cervical (C2-C4) lesions and (3) lower cervical (C5-T1) lesions. Comparisons of clinical symptoms, signs and level of lesion with MRI abnormalities were done and the level of significance was set at p < 0.05. RESULTS: Clinical evaluation showed limb weakness in all, sensory loss in 90%, sphincter disturbances in 67.7%, scissoring gait in 32.2%, diaphragmatic weakness in 12.9% of patients. Based on clinical examination the site of lesion was cervico-medullary in 9, upper cervical region in 4 and lower cervical region of involvement in five patients. The maximal antero-posterior extent of the lesion and neurological deficits were concordant (p-0.05). As compared to pyramidal signs or sensory abnormalities, segmental features - segmental sensory loss, weakness, wasting or 'reflex' loss - were most concordant with the MRI level of lesion (p - 0.03). Among 'motor', 'sensory' and 'reflex' levels, the 'reflex (DTR)' levels were most concordant with the MRI level of lesion (p - 0.04). CONCLUSION: Segmental features form the foundation for clinical localization of the level of lesion. Though the clinical level of lesion and MRI level of lesion were discordant in 14 patients, clinical evaluation may still provide useful information.

7.
J Cancer Res Ther ; 10(3): 767-9, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25313781

RESUMO

Proliferating trichilemmal tumor (PTT) is an uncommon appendageal skin tumor that affects mainly elderly women. It arises from the external root sheath of the hair follicle and is most commonly observed on the scalp. Although most cases pursue a favorable clinical course and surgical excision is curative, malignant transformation has rarely been reported in these lesions. Because of limited number of cases reported in the literature, management of malignant PTT is controversial and mainly entails wide local excision. Many other adjuvant modalities have been tried. In this report, we present a case of malignant PTT in a 65-year-old male patient who presented with ulceroproliferative growth over occipital region since 4 months.


Assuntos
Carcinoma de Apêndice Cutâneo/diagnóstico , Neoplasias Cutâneas/diagnóstico , Idoso , Biópsia , Humanos , Masculino
8.
J Anaesthesiol Clin Pharmacol ; 30(2): 238-42, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24803765

RESUMO

BACKGROUND: Recently introduced ropivacaine is 40% less potent than bupivacaine. Ropivacaine made hyperbaric by the addition of dextrose is known to provide reliable spinal anesthesia (SA). This study was designed to compare the clinical efficacy of equal doses of hyperbaric 0.5% ropivacaine with 0.5% bupivacaine for SA. MATERIALS AND METHODS: Eighty American Society of Anesthesiologists grade I-II patients undergoing elective infraumbilical surgeries under SA were recruited and randomized to receive 3ml of hyperbaric ropivacaine 5mg/ml containing dextrose 83 mg/ml (by the addition of desired dose of 25% dextrose) in Group R or 3ml of hyperbaric bupivacaine 5mg/ml containing dextrose 80 mg/ml in Group B. Monitoring of vitals and observation for the block parameters were carried out. The data were presented as mean with a standard deviation and frequency with percentage. Statistical analysis was performed using InStat computer software with appropriate tests and P < 0.05 was considered to be significant. RESULTS: Ropivacaine produced a slower onset of sensory block (ropivacaine 4.5 min; bupivacaine 3.2 min; P < 0.05) and the mean total duration of sensory block was significantly lesser (ropivacaine155 min; bupivacaine 190.5 min; P < 0.05). Patients in the ropivacaine Group R had significantly more rapid recovery from the motor blockade (ropivacaine120 min; bupivacaine 190 min; P < 0.05) and passed urine sooner than the patients in bupivacaine Group B (ropivacaine 257 min; bupivacaine 358 min; P < 0.05). CONCLUSION: Ropivacaine 15 mg in dextrose 8.3% provides reliable SA of shorter duration than bupivacaine 15 mg in 8% dextrose.

9.
J Oral Maxillofac Pathol ; 18(3): 361-4, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25948989

RESUMO

OBJECTIVE: The present study was undertaken to estimate and compare salivary interleukin-2 (IL-2) levels in patients with recurrent aphthous stomatitis, among healthy controls and their variation with age and sex. STUDY DESIGN: Saliva was collected from 60 patients within the age range of 16-60 years which included 30 patients (17 Females and 13 Males) with recurrent aphthous stomatitis and healthy control group consisted of 30 participants (18 Females and 12 Males). IL-2 estimation was done in both the groups using enzyme linked immunosorbent assay (ELISA). Statistical analysis of the data was done using Independent 't' test. RESULTS: The results showed increased salivary IL-2 levels in patients with recurrent aphthous stomatitis compared to the healthy controls. The IL-2 levels were also increased in patients with the age group of 16-30 years compared to other age groups. Similar increase of IL-2 was also seen in female patients. CONCLUSION: Age related and sex related alterations of IL-2 in recurrent aphthous stomatitis patients were observed.

10.
JAMA Surg ; 148(7): 675-86, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23754086

RESUMO

We sought to assess the comparative effectiveness and safety of pharmacologic and mechanical strategies to prevent venous thromboembolism (VTE) in patients undergoing bariatric surgery. We searched (through August 2012) for primary studies that had at least 2 different interventions. Of 30,902 citations, we identified 8 studies of pharmacologic strategies and 5 studies of filter placement. No studies randomized patients to receive different interventions. One study suggested that low-molecular-weight heparin is more efficacious than unfractionated heparin in preventing VTE (0.25% vs 0.68%, P < .001), with no significant difference in bleeding. One study suggested that prolonged therapy (after discharge) with enoxaparin sodium may prevent VTE better than inpatient treatment only. There was insufficient evidence supporting the hypothesis that filters reduce the risk of pulmonary embolism, with a point estimate suggesting increased rates with filters (pooled relative risk [RR], 1.21 95% CI, 0.57-2.56). There was low-grade evidence that filters are associated with higher mortality (pooled RR, 4.30 95% CI, 1.60-11.54) and higher deep vein thrombosis rates (2.94 1.35-6.38). There was insufficient evidence to support that augmented subcutaneous enoxaparin doses (>40 mg daily or 30 mg twice daily) are more efficacious than standard dosing, with a trend toward increased bleeding. Of note, for both filters and augmented pharmacologic dosing strategies, patients at highest risk for VTE were more likely to receive more intensive interventions, limiting our ability to attribute outcomes to prophylactic strategies used.


Assuntos
Cirurgia Bariátrica , Complicações Pós-Operatórias/prevenção & controle , Tromboembolia Venosa/prevenção & controle , Anticoagulantes/uso terapêutico , Pesquisa Comparativa da Efetividade , Enoxaparina/uso terapêutico , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava
11.
Int J Appl Basic Med Res ; 3(1): 69-71, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23776844

RESUMO

Malignant tumors rarely metastasize to the oral cavity and account for about 1% of all oral tumors. Metastasis to soft-tissue of the oral cavity is much rarer than jaw bones. Because of the rarity, metastatic tumors in the oral region are challenging for diagnosis. Primary tumors which metastasize to mouth are the most commonly lung, breast, and kidney. Oral cavity metastases represent distant spread and are associated with poor prognosis with short survival. We present a case of the gastroesophageal junction adenocarcinoma with metastasis to the oral soft-tissue.

12.
J Hosp Med ; 8(7): 394-401, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23761111

RESUMO

BACKGROUND: There is uncertainty about optimal strategies for venous thromboembolism (VTE) prophylaxis among select populations such as patients with renal insufficiency, obesity, or patients taking antiplatelet drugs including aspirin. Their physiologies make prophylaxis particularly challenging. PURPOSE: We performed a comparative effectiveness review of the literature on efficacy and safety of VTE prophylaxis in these populations. DATA SOURCES: We searched MEDLINE, EMBASE, SCOPUS, CINAHL, International Pharmaceutical Abstracts, clinicaltrial.gov, and the Cochrane Library through August 2012. Eligible studies included controlled trials and observational studies. DATA EXTRACTION: Two reviewers evaluated studies for eligibility, serially abstracted data, and independently evaluated the risk of bias and strength of evidence supporting interventions to prevent VTE in these populations. RESULTS: After a review of 30,902 citations, we identified 9 controlled studies, 5 of which were trials, and the other 4 were observational studies. Five articles addressed prophylaxis of patients with renal insufficiency, 2 addressed obese patients, and 2 addressed patients on antiplatelet agents. No study tested prophylaxis in underweight patients or those with liver disease. The majority of observational studies had a high risk of bias. The strength of evidence ranged from low to insufficient regarding the comparative effectiveness and safety of VTE prophylaxis among these patients. CONCLUSION: The current evidence is insufficient regarding optimal VTE prophylaxis for patients with renal insufficiency, obesity, or those who are on antiplatelet drugs including aspirin. High-quality studies are needed to inform clinicians about the best VTE prophylaxis for these patients.


Assuntos
Anticoagulantes/administração & dosagem , Obesidade/tratamento farmacológico , Inibidores da Agregação de Plaquetas/administração & dosagem , Insuficiência Renal/tratamento farmacológico , Tromboembolia Venosa/prevenção & controle , Humanos , Obesidade/epidemiologia , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Insuficiência Renal/epidemiologia , Resultado do Tratamento , Tromboembolia Venosa/epidemiologia
13.
Indian J Anaesth ; 57(6): 562-8, 2013 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24403615

RESUMO

BACKGROUND AND AIM: Anaesthesia for cleft surgery in children is associated with a variety of airway related problems. This study aims to review the frequency of associated anomalies and other conditions as well as perioperative respiratory complications during the cleft lip/palate repair surgeries. METHODS: An audit of 1000 cleft surgeries in children enrolled under "Smile Train" is presented. Following informed consent, general anaesthesia was induced with endotracheal (ET) intubation using halothane in O2 and/or intravenous thiopentone 5 mg/kg or propofol 1.5 mg/kg, suxamethonium 1.5 mg/kg or rocuronium 0.8 mg/kg and maintained with halothane/isoflurane 0.4-1% in 50% N2O in O2 with rocuronium. The observational data regarding the occurrence of perioperative complications in 1000 cleft surgeries are mentioned as mean (standard deviation), number and percentage as appropriate. 'Two sample t-test between percentage' is applied for significance. RESULTS: The frequency of isolated cleft lip was 263 (36.4%), cleft palate 183 (25.3%) and combined defect 277 (38.3%) of the operated cases. Other congenital anomalies were present in 21 (2.8%) of the children. The intraoperative airway complications occurred in 13 (2.4%) of cleft lip and 40 (8.7%) of cleft palate repairs (P < 0.05). Post-operative respiratory complications were observed in 9 (1.7%) and 34 (7.4%) patients of cleft lip and palate repairs respectively (P < 0.05). Mortality occurred post-operatively in 2 (0.2%) of cleft repairs (n = 1000). CONCLUSION: Cleft deformities in children when associated with other congenital anomalies or respiratory problems pre-dispose them to difficult airway and pulmonary complications. Frequency of perioperative respiratory complications were significantly higher with cleft palate repair than with cleft lip repair. Anaesthetic expertise, optimum monitoring facility and specialised post-operative care is necessary to decrease the morbidity.

14.
Int J Bioinform Res Appl ; 7(3): 273-86, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-21816715

RESUMO

Brain White Matter (BWM) is formed on nerve fibres (due to myelin coating) and it undergoes continuous changes with aging throughout the life of humans. This age-related morphology, however, also gets further modified when a subject is infected by a viral disease such as HIV. In the present study, textural variations in BWM specific to a set of control images vs. images of a HIV + subject are assayed via an algorithm based on the Grey Level Co-occurrence Matrix (GLCM); and the associated Haralick features that are extracted from the GLCM. The clinical images of the brain used in the study are gathered from the noninvasive technique of Diffusion Tensor Magnetic Resonance Imaging (DT MRI). Results observed in the images of normal (nonpathogenic) subjects show progressive changes in the image parameters with aging; whereas, a wider variation is observed in the relevant parameters of the images pertinent to pathogenic subjects who exhibit cognitive (or motor impairments) due to HIV infection. The findings of the proposed method are reasonably correlated with clinical diagnosis in two HIV+ cases.


Assuntos
Infecções por HIV , Substância Branca , Encéfalo , Imagem de Tensor de Difusão , Humanos , Processamento de Imagem Assistida por Computador
15.
Breast Dis ; 33(3): 121-4, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22460186

RESUMO

Intracystic papillary carcinoma (IPC) of the breast has traditionally been considered to be a variant of ductal carcinoma in-situ (DCIS). It is an uncommon tumor accounting for less than 3% of all breast cancers and predominantly affects elderly women. IPC is extremely rare in men and only few cases have been reported in the literature. The tumor has excellent prognosis regardless of whether it is in-situ or invasive. Hence an accurate diagnosis plays a crucial role in the management of patients with IPC. We report two cases of IPC, one in a 68-year-old woman and the other one in a 70-year-old man. The diagnosis was suspected on fine needle aspiration cytology (FNAC) and was confirmed by histopathology.


Assuntos
Adenocarcinoma Papilar/patologia , Neoplasias da Mama Masculina/patologia , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/patologia , Adenocarcinoma Papilar/diagnóstico , Idoso , Biópsia por Agulha Fina , Neoplasias da Mama/diagnóstico , Neoplasias da Mama Masculina/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico , Feminino , Humanos , Masculino
16.
Indian J Pathol Microbiol ; 53(2): 322-4, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20551545

RESUMO

Embryonal (undifferentiated) sarcomas arising in mesenchymal hamartoma are on record but cases of hepatic angiosarcoma (AS) arising in mesenchymal hamartoma (MH) of the liver are extremely rare. We report one such case in a 20-year-old male patient. He presented with a lump in the right hypochondriac region and pain of two years duration with rapid increase in size since two months. Ultrasonography (USG) revealed a well circumscribed mass on the undersurface of the right lobe of liver suggestive of hemangioma. The patient underwent resection of the mass. Histopathology revealed AS with areas of MH.


Assuntos
Hamartoma/complicações , Hamartoma/diagnóstico , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/patologia , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/patologia , Abdome/diagnóstico por imagem , Abdome/patologia , Hamartoma/patologia , Hamartoma/cirurgia , Hemangiossarcoma/cirurgia , Histocitoquímica , Humanos , Neoplasias Hepáticas/cirurgia , Masculino , Microscopia , Ultrassonografia , Adulto Jovem
17.
Cryst Growth Des ; 10(4): 1478-1781, 2010 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-20495667

RESUMO

A chloride complex of a hexaprotonated azamacrocycle has been isolated, and its structure has been determined by X-ray crystallography showing two encapsulated chloride anions in the cavity. The two internal guests are coordinated at two binding sites on the opposite side of the macrocycle through trigonal recognition by hydrogen-bonding interactions. The other four chlorides are located outside the cavity, each with a single hydrogen bond from secondary amines. Ab initio calculations based on density functional theory (DFT) suggest that the encapsulation of two chlorides inside the cavity leads to a significant charge transfer from the anions to the protonated amines.

18.
Tetrahedron Lett ; 51(9): 1329-1332, 2010 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-20401319

RESUMO

A macrocyclic-based fluorescence chemosensor has been designed and synthesized from the reaction of dansyl chloride and a hexaaminomacrocycle containing four secondary and two tertiary amines. The new chemosensor has been examined for its binding ability toward phosphate, sulfate, nitrate, iodide, bromide, chloride, and fluoride by fluorescence spectroscopy in DMSO. The results indicate that the compound binds each of the anions with a 1:1 stoichiometry, showing high affinity for the oxoanions, chloride and iodide with the binding constants up to four orders of magnitude. Ab initio calculations based on density functional theory (DFT) suggest that the ligand is deformed in order to encapsulate an anion, and each anion, except fluoride, is bonded to the macrocycle through two NH…X(-) and four CH…X(-) interactions.

19.
Inorg Chem Commun ; 13(12): 1515-1518, 2010 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-21218161

RESUMO

An expanded azamacrocycle L, containing four secondary and two tertiary amines was synthesized, and its binding ability towards chloride, bromide, iodide, sulfate, nitrate and perchlorate were determined by (1)H NMR titrations in D(2)O at pH 1.7. The results suggest that the ligand is capable of forming a complex with each of the anions examined, showing the selectivity for sulfate in water. X-ray diffraction analysis of the perchlorate complex of L suggests that the ligand is tetraprotonated and is involved in interacting anions from both sides forming a ditopic complex with strong NH···O bonds. In the packing diagram, the macrocycles and external perchlorates are alternatively linked though hydrogen bonding to form a 1D chain.

20.
Indian J Anaesth ; 54(6): 546-51, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21224973

RESUMO

Stellate ganglion block (STGB) is commonly indicated in painful conditions like reflex sympathetic dystrophy, malignancies of head and neck, Reynaud's disease and vascular insufficiency of the upper limbs. The sympathetic blockade helps to relieve pain and ischaemia. Diagnostic STGB is usually performed with local anaesthetics followed by therapeutic blockade with steroids, neurolytic agents or radiofrequency ablation of ganglion. There is increasing popularity and evidence for the use of adjuvants like opioid, clonidine and N Methyl d Aspartate (NMDA) receptor antagonist - ketamine - for the regional and neuroaxial blocks. The action of ketamine with sympatholytic block is through blockade of peripherally located NMDA receptors that are the target in the management of neuropathic pain, with the added benefit of counteracting the "wind-up" phenomena of chronic pain. We studied ketamine as an adjuvant to the local anaesthetic for STGB in 20 cases of peripheral vascular disease of upper limbs during the last 5 years at our institution. STGB was given for 2 days with 2 ml of 2% lignocaine + 8 ml of 0.25% bupivacaine, followed by block with the addition of 0.5 mg/kg of ketamine for three consecutive days. There was significant pain relief of longer duration with significant rise in hand temperature. We also observed complete healing of the gangrenous fingers in 17/19 patients.

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