RESUMO
Various opioid compounds were examined before and after administration of a 40µg (i.c.v.) dose of norbinaltorphimine (nor-BNI) in rats responding under a fixed ratio 20 schedule of food presentation. At time points ranging from 1 to 133 days after administration of nor-BNI, the dose-effect curve for the kappa opioid bremazocine was shifted to the right of that obtained prior to the administration of nor-BNI. The magnitude of these rightward shifts were somewhat larger at day 14 than day 1, remained unchanged between days 14 and 49, and then declined between days 70 and 133. Nor-BNI also produced large rightward shifts in the dose-effect curves for the kappa opioids U50,488, spiradoline and U69,593, and a small rightward shift in the curve for ethylketocyclazocine. In contrast, nor-BNI did not alter the dose-effect curves for (-)-n-allylnormetazocine, (-)-cyclazocine, nalorphine and the mu opioid morphine. The present findings indicate that the rate-decreasing effects of bremazocine, U50,488, U69,593, spiradoline and ethylketocyclazocine are mediated by agonist activity at the kappa opioid receptor(s). These findings also indicate that nor-BNI is a long-lasting and kappa opioid-selective antagonist that offers a number of advantages over naloxone and naltrexone as a pharmacological tool for examining the kappa opioid-mediated activity of opioid compounds.
RESUMO
Anterior gastropexy in properly selected patients is a simple, safe, and effective procedure for the surgical correction of symptomatic esophageal reflux in the presence of a sliding type of hiatal hernia not accompanied by fibrosis and secondary shortening of the esophagus. This technic is particularly useful in poor risk, elderly, and excessively obese patients and as an adjunct to other intraabdominal procedures.
Assuntos
Hérnia Diafragmática/cirurgia , Hérnia Hiatal/cirurgia , Estômago/cirurgia , Adulto , Esofagite/complicações , Esôfago/cirurgia , Feminino , Seguimentos , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/cirurgia , Hérnia Hiatal/complicações , Humanos , Lactente , Masculino , Complicações Pós-Operatórias , Técnicas de SuturaRESUMO
Six cases representing selected complications of pancreatic pseudocyst are reported and their surgical management is discussed. Patients with mediastinal extension of a pseudocyst frequently present with symptoms in the chest rather than in the abdomen. Chronic recurrent pleural effusion, rich in protein and amylase, often accompanies mediastinal extension of a pancreatic pseudocyst. It is important to recognize that such an effusion almost certainly represents disruption of the pancreatic duct with formation of a pancreatic pseudocyst or a pancreaticopleural fistula. Internal drainage from below the diaphragm is the treatment of choice for pancreatic pseudocysts extending into the mediastinum. To be certain that obstructive jaundice is due to a pancreatic pseudocyst, there must be operative demonstration of compression of the common bile duct by the pseudocyst, relief of the obstruction by surgical drainage of the cyst, and subsequent disappearance of jaundice. Cysts that cause jaundice are located in the head of the pancreas, and cystoduodenostomy is the treatment of choice. Intraperitoneal rupture has been associated with a high mortality, but with adequate fluid replacement, prompt evacuation of the cyst contents from the peritoneal cavity, and adequate drainage, mortality can be lowered. Pancreatic ascites is much more common than is generally supposed and may result from a leaking pancreatic pseudocyst. In contrast to cirrhotic ascites, pancreatic ascites produces elevation of both the serum amylase level and protein concentration. Massive hemorrhage from pancreatic pseudocysts is usually due to the development of a false aneurysm in a branch of the celiac axis in the wall of the pseudocyst, with subsequent rupture of the aneurysm into the gut or peritoneal cavity. Any patient with a pancreatic pseudocyst who shows signs of bleeding should have prompt arteriography for determination of the bleeding site and appropriate surgical control. Pancreaticobronchial fistula is a rare complication. Treatment should be directed toward adequate drainage of the pseudocyst in the abdomen.
Assuntos
Icterícia/etiologia , Doenças do Mediastino/etiologia , Cisto Pancreático/complicações , Adulto , Aneurisma/etiologia , Aneurisma/cirurgia , Ascite/complicações , Fístula Brônquica/etiologia , Fístula Brônquica/cirurgia , Diafragma/lesões , Drenagem , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Humanos , Icterícia/cirurgia , Masculino , Doenças do Mediastino/diagnóstico , Doenças do Mediastino/cirurgia , Pessoa de Meia-Idade , Ruptura Espontânea/etiologia , Ruptura Espontânea/cirurgia , Artéria Esplênica/cirurgia , Fístula da Bexiga Urinária/etiologia , Fístula da Bexiga Urinária/cirurgiaRESUMO
Although there is a widely held argument that pressure ulcers are preventable, they continue to cause major healthcare and financial problems. The blame for pressure ulcers has typically focused on the patient's self-neglect or self-destructiveness. However, more recently, there has been a call for a paradigm shift from the current "paternalistic" medical model to one that includes the patient as a participant in his or her own care. Contingency management, a procedure well known in behaviorism, is presented as one such possibility. Controversy about the use of monetary reward, as well as discussion of initial efficacy in a current study, are discussed.
Assuntos
Ética Médica , Motivação , Participação do Paciente , Úlcera por Pressão/prevenção & controle , Úlcera por Pressão/psicologia , Autocuidado , Adulto , Redução de Custos , Feminino , Humanos , Controle Interno-Externo , Masculino , Obesidade/complicações , Projetos Piloto , Úlcera por Pressão/economia , Úlcera por Pressão/etiologia , Traumatismos da Medula Espinal/complicaçõesRESUMO
Pressure ulcers are dynamic and therefore require frequent assessment and immediate treatment. For many patients who live long distances from rehabilitation hospitals, frequent assessment and immediate treatment are often unavailable. Recent advances during the last two decades have resulted in the development of telemedicine--long-distance delivery of medical education and services to patients. This pilot study reports on a patient enrolled in a telemedicine program during his fifth hospitalization for pressure ulcers in 16 months. Although this is only a single case study, the results suggest the potential efficacy of this new intervention.
Assuntos
Úlcera por Pressão/enfermagem , Telemedicina , Adulto , Enfermagem em Saúde Comunitária/métodos , Serviços de Assistência Domiciliar , Humanos , Masculino , Enfermeiros Clínicos , Avaliação em Enfermagem/métodos , Projetos Piloto , Úlcera por Pressão/etiologia , Enfermagem em Reabilitação/métodos , Traumatismos da Medula Espinal/complicaçõesAssuntos
Colangiografia , Icterícia/diagnóstico , Idoso , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Colecistite/cirurgia , Doença Aguda , Adulto , Fatores Etários , Idoso , Colangiografia , Colecistite/diagnóstico , Colecistite/mortalidade , Infecção Hospitalar , Infecções por Escherichia coli/epidemiologia , Feminino , Vesícula Biliar/cirurgia , Hospitais Gerais , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Estatística como Assunto , Fatores de TempoAssuntos
Traumatismos Abdominais/cirurgia , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/fisiopatologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Seguimentos , Humanos , Pessoa de Meia-Idade , Ferimentos por Arma de Fogo/cirurgiaAssuntos
Artérias Carótidas/cirurgia , Lesões das Artérias Carótidas , Adulto , Transtornos Cerebrovasculares/complicações , Feminino , Seguimentos , Hemorragia/complicações , Humanos , Masculino , Medicina Militar , Doenças do Sistema Nervoso/complicações , Ferimentos e Lesões/cirurgia , Ferimentos por Arma de Fogo/cirurgiaAssuntos
Colelitíase/terapia , Complicações Pós-Operatórias/terapia , Ductos Biliares Intra-Hepáticos , Colangiografia , Colelitíase/diagnóstico por imagem , Colelitíase/cirurgia , Ducto Colédoco/cirurgia , Ducto Cístico , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/cirurgia , Cálculos Biliares/terapia , Humanos , Métodos , Cuidados Pós-OperatóriosAssuntos
Ferimentos e Lesões/terapia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/terapia , Obstrução das Vias Respiratórias/terapia , Asfixia/etiologia , Tamponamento Cardíaco/terapia , Emergências/terapia , Serviço Hospitalar de Emergência , Hemorragia/etiologia , Hemotórax/terapia , Humanos , Pneumotórax/terapia , Radiografia , Costelas/lesões , Choque/etiologia , Traumatismos Torácicos/diagnóstico por imagem , Traumatismos Torácicos/terapia , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/prevenção & controleAssuntos
Obtenção de Fundos , Educação de Pacientes como Assunto/métodos , Úlcera por Pressão/enfermagem , Úlcera por Pressão/prevenção & controle , Enfermagem em Reabilitação/métodos , Traumatismos da Medula Espinal/complicações , Recusa do Paciente ao Tratamento/psicologia , Adulto , Humanos , Masculino , Úlcera por Pressão/etiologia , Úlcera por Pressão/psicologia , Recidiva , RecompensaRESUMO
BACKGROUND AND OBJECTIVES: The initial response of trigeminal neuralgia to medication is about 69%. However drug therapy is ineffective in 25% of patients and about 8% become drug-intolerant. These patients proceed to surgical interventions, which require constant appraisal to determine their efficacy and acceptability. The purpose of this study was to evaluate the long-term outcome of surgical interventions for trigeminal neuralgia to offer a guide to patients and surgeons when choosing the right procedure for the appropriate patient and to investigate the effects of patients' and surgeons' preferences on the outcome. PATIENTS AND METHODS: The study design was consecutive case review. Participants were 256 consecutive patients with refractory trigeminal neuralgia, who underwent 405 surgical procedures to control trigeminal neuralgia. The main outcome measures were: the response rate, time to pain recurrence and surgical complications. 172 were fit for microvascular decompression (MVD), glycerol injection (GI) or radiofrequency thermocoagulation (RF) and were offered the choice between the three procedures; 95 went for MVD and 77 underwent either GI or RF. The choice between GI and RF was a surgical decision. RESULTS: The 3-year success rate was 54.8% in patients who underwent GI and 70.7% in patients who underwent percutaneous RF. In contrast 85.6% of patients who underwent MVD remained pain-free at 3 years. The complication rate following these surgical interventions was relatively low with no deaths. CONCLUSIONS: Surgical intervention for the treatment of refractory trigeminal neuralgia is effective and safe and should be considered in patients after failed medical therapy. Whilst MVD offered the best long-term outcome in this series, percutaneous GI or RF offered a safe and reliable alternative for those who chose to undergo these procedures.
Assuntos
Procedimentos Neurocirúrgicos , Neuralgia do Trigêmeo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anestesia Geral , Ablação por Cateter/efeitos adversos , Crioprotetores/administração & dosagem , Crioprotetores/uso terapêutico , Descompressão Cirúrgica/efeitos adversos , Resistência a Medicamentos , Feminino , Seguimentos , Glicerol/administração & dosagem , Glicerol/efeitos adversos , Glicerol/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Recidiva , Análise de Sobrevida , Falha de Tratamento , Resultado do TratamentoRESUMO
Two alternative treatment methods for preventive interventions for pressure ulcers, tele-rehabilitation and contingency management, are discussed. Telerehabilitation uses a videophone that transmits both audio and still images over a telephone line. Using this technology, the WOC nurse can interview a patient who cannot be present at a clinic because of physical condition or distance. Telerehabilitation allows the nurse to assess a patient's pressure ulcer, consult with appropriate caregivers, and make recommendations for treatment. Contingency management procedures are designed for patients with high rates of noncompliance in skin care. The patients are seen as outpatients and are compensated systematically for appropriate skin care (ie, the lack of pressure ulcers). Examples of each of these patient interventions is described, discussed, and contrasted.