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1.
Kaniecki RG 《Current pain and headache reports》2001,5(2):183-188
Headache poses diagnostic challenges to the clinician for many reasons. It is an extremely common complaint, and may be associated
with acute illness or serious pathology such as brain tumor or cerebral aneurysm. However, the majority of patients experiencing
recurrent headache in the population suffer either from a variant of tension-type headache or migraine. Because migraine is
more likely to be disabling, it becomes the most likely diagnosis for any patient presenting with recurrent headache interfering
with function. Although the diagnostic criteria developed by the International Headache Society in 1998 are useful as a guide,
migraine may be more readily recognized in a clinical setting by its consideration at the top of the differential for patients
presenting with recurrent headache.
This article reviews the standard diagnostic criteria for migraine, while also addressing the primary and secondary headache
syndromes that may be considered in a differential diagnosis. The indications and roles for specific investigative procedures
such as neuroimaging are reviewed. Specific emphasis is placed on the clinical recognition of migraine in the context of an
assortment of headache conditions. 相似文献
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Imazio M 《Expert review of cardiovascular therapy》2011,9(9):1221-1233
Pericarditis may be caused by infectious or noninfectious noxa. Most cases are labeled as 'idiopathic' because the traditional diagnostic approach often fails to identify the etiology. Most important causes are presumed to be viruses in countries with a low prevalence of tuberculosis and tuberculosis in developing countries. Noninfectious pericarditis mainly includes autoimmune systemic diseases, post-pericardiotomy syndromes and neoplastic pericardial disease. Treatment should be targeted to the cause, but remains empirical with NSAIDs and the possible adjunct of colchicine in idiopathic cases. Corticosteroids use should be limited to patients with NSAID contraindications/intolerance or failure, and rarely for specific conditions (i.e., pregnancy and systemic autoimmune diseases). Recurrences are the most common complication, but the overall prognosis is related to the etiology, usually benign in idiopathic pericarditis. 相似文献
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《Expert review of cardiovascular therapy》2013,11(9):1221-1233
Pericarditis may be caused by infectious or noninfectious noxa. Most cases are labeled as ‘idiopathic’ because the traditional diagnostic approach often fails to identify the etiology. Most important causes are presumed to be viruses in countries with a low prevalence of tuberculosis and tuberculosis in developing countries. Noninfectious pericarditis mainly includes autoimmune systemic diseases, post-pericardiotomy syndromes and neoplastic pericardial disease. Treatment should be targeted to the cause, but remains empirical with NSAIDs and the possible adjunct of colchicine in idiopathic cases. Corticosteroids use should be limited to patients with NSAID contraindications/intolerance or failure, and rarely for specific conditions (i.e., pregnancy and systemic autoimmune diseases). Recurrences are the most common complication, but the overall prognosis is related to the etiology, usually benign in idiopathic pericarditis. 相似文献
5.
Sacco S 《Current pain and headache reports》2008,12(6):437-441
The diagnosis of tension-type headache (TTH) is divided into two categories: episodic TTH and chronic TTH. It is important
to differentiate TTH from other headaches, including primary and secondary headaches. Significant overlap in the diagnostic
criteria makes it difficult to differentiate TTH from other headache disorders and, in particular, migraine. A controversy
exists about whether TTH and migraine represent a continuum of the same pathophysiological process. 相似文献
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Giorgio Sandrini MD Alberto Proietti Cecchini MD Cristina Tassorelli MD PhD Giuseppe Nappi MD 《Current pain and headache reports》2001,5(6):551-556
A number of patients attending specialty headache centers complain of very frequent, almost continuous headaches, which are usually grouped together under the term chronic daily headache (CDH), a category which does not appear in the International Headache Society (IHS) classification published in 1988. More than 10 years later, this issue is still debated, also in light of the foreseen revised classification. Several terms have been used to define the clinical picture of CDH, and different criteria have been proposed for the diagnosis of these forms. In most cases, CDH appears to evolve from an episodic migraine, but the temporal limits between an episodic and a no-longer episodic form of migraine are questionable. Although some theoretic problems remain unresolved, it seems that the next revision of the IHS classification can no longer ignore the existence of CDH. 相似文献
8.
Update of the clinical issues regarding methadone (Dolophine) therapy in pain management 总被引:1,自引:0,他引:1
Linda R Linderbeck 《AACN advanced critical care》2008,19(3):253-257
9.
Liaschenko J 《Home Care Provider》1999,4(3):98-99
Home care takes place in a complex landscape in which multiple interests and responsibilities intersect in many ways and at many levels. These responsibilities include the agency to the public, management to care providers and vice versa, workers to each other, patients to workers, and workers to caregivers, to name but a few relationships. In such complicated situations, not surprisingly, some of these interests and responsibilities are at odds. 相似文献
10.
Intrapericardial fibrinolysis: a useful treatment in the management of purulent pericarditis 总被引:3,自引:0,他引:3
C. Defouilloy G. Meyer M. Slama C. Galy P. Verhaeghe G. Touati M. Ossart 《Intensive care medicine》1997,23(1):117-118
Since the introduction of antibiotics into clinical practice, purulent pericarditis has become a rare disease. The major
complication of the standard management for this condition is constrictive pericarditis. We report two cases of purulent pericarditis
in which intrapericardial fibrinolysis was performed in order to minimize this complication. The first case was a 38-year-old
man admitted to our intensive care unit (ICU) for management of constrictive pericarditis complicating purulent pericarditis
diagnosed 17 days previously. The patient was treated with four intrapericardial injections of streptokinase (250000 IU each).
Fluid drainage and cardiac output were improved. No change in clotting parameters was noted. Pericardiectomy and esophagectomy
were then performed for a diagnosis of esophageal neoplasm. The postoperative course was uneventful. The second case was a
16-year-old boy admitted with loss of consciousness due to cardiac tamponade. Percutaneous pericardiocentesis drained 900 ml
of cloudy fluid. Two intrapericardial injections were performed (day 1 and day 5) without any complication. Pericardial drainage
was withdrawn on day 13 and the patient was discharged from ICU on the same day. Six months later, there was no evidence of
constrictive pericarditis. Intrapericardial fibrinolysis appears to be safe and effective when prescribed rapidly in the course
of purulent pericarditis.
Received: 19 June 1996 Accepted: 15 September 1996 相似文献
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Augustin P Desmard M Mordant P Lasocki S Maury JM Heming N Montravers P 《Critical care (London, England)》2011,15(2):220-8
Purulent pericarditis (PP) is a potentially life-threatening disease. Reported mortality rates are between 20 and 30%. Constrictive
pericarditis occurs over the course of PP in at least 3.5% of cases. The frequency of persistent PP (chronic or recurrent
purulent pericardial effusion occurring despite drainage and adequate antibiotherapy) is unknown because this entity was not
previously classified as a complication of PP. No consensus exists on the optimal management of PP. Nevertheless, the cornerstone
of PP management is complete eradication of the focus of infection. In retrospective studies, compared to simple drainage,
systematic pericardiectomy provided a prevention of constrictive pericarditis with better clinical outcome. Because of potential
morbidity associated with pericardiectomy, intrapericardial fibrinolysis has been proposed as a less invasive method for prevention
of persistent PP and constrictive pericarditis. Experimental data demonstrate that fibrin formation, which occurs during the
first week of the disease, is an essential step in the evolution to constrictive pericarditis and persistent PP. We reviewed
the literature using the MEDLINE database. We evaluated the clinical efficacy, outcome, and complications of pericardial fibrinolysis.
Seventy-four cases of fibrinolysis in PP were analysed. Pericarditis of tuberculous origin were excluded. Among the 40 included
cases, only two treated by late fibrinolysis encountered failure requiring pericardiectomy. No patient encountered clinical
or echocardiographic features of constriction during follow-up. Only one serious complication was described. Despite the lack
of definitive evidence, potential benefits of fibrinolysis as a less invasive alternative to surgery in the management of
PP seem promising. Early consideration should be given to fibrinolysis in order to prevent both constrictive and persistent
PP. Nevertheless, in case of failure of fibrinolysis, pericardiectomy remains the primary option for complete eradication
of infection. 相似文献
13.
Current issues in the management of endometrial cancer 总被引:1,自引:0,他引:1
Bakkum-Gamez JN Gonzalez-Bosquet J Laack NN Mariani A Dowdy SC 《Mayo Clinic proceedings. Mayo Clinic》2008,83(1):97-112
Endometrial cancer (EC) remains the most common gynecologic malignancy in the United States. It is expected to become more common as the prevalence of obesity, one of the most common risk factors for EC, increases worldwide. The 2 main histologic subcategories of EC, endometrioid and nonendometrioid EC, show unique molecular aberrations and are responsible for markedly disparate clinical behaviors. The primary treatment of EC is surgery, ie, hysterectomy, removal of the adnexa, and pelvic and para-aortic lymphadenectomy, either via laparotomy or endoscopic techniques. Adjuvant therapy is necessary for patients at high risk of recurrence and consists of vaginal brachytherapy, teletherapy, systemic chemotherapy, or some combination thereof. Multi-institutional trials are in progress in this country and in Europe to better define optimal adjuvant treatment for subsets of patients, as well as the role of surgical staging in reducing both overuse and underuse of radiation therapy. Hormonal therapy is an option for some young women with EC who wish to preserve fertility. This review summarizes the diagnosis and management of EC and discusses current controversies and upcoming investigations pertaining to EC staging and adjuvant treatment. 相似文献
14.
Pharmacologic issues in the management of septic shock 总被引:1,自引:0,他引:1
Despite our increased understanding of the biochemistry and physiology of sepsis, the treatment of septic shock remains a challenge. Initial management of septic shock entails urgent and emergent stabilization of the patient followed by broad-spectrum, empiric antibiotic therapy. After volume resuscitation, vasopressors or inotropic therapy or both may be necessary to restore perfusion. Adjunctive therapies and monitoring strategies may be helpful in preventing complications in the intensive care setting. Additional research and clinical trials are needed to identify supportive interventions that may affect the outcome of the septic patient. 相似文献
15.
Dr Albert Schweitzer is reported to have stated, "We must all die. But that I can save ... [someone] from days of torture, that is what I feel is my great and ever new privilege". If, in spite of their anecdotal texture, the reflections in this article challenge my clinical colleagues to further hard reflection, comparison, or contrast with their own professional experience, they will have been worthwhile. If our collective experiences view pain management as a clinical-ethical issue, then no patient should ever have to bear pain due to the ignorance or apathy of well-intentioned but misinformed caregivers. I conclude with the words of Judith Spross, an oncology nurse: Pain is an emergency for the person who experiences it regardless of the urgency of the underlying pathology. I believe we must apply the science and art of pain relief as though life depended upon it. Certainly the quality of life does. 相似文献
16.
Current management issues in angina 总被引:2,自引:0,他引:2
17.
Swenson CJ 《Seminars in Oncology Nursing》2002,18(2):135-142
OBJECTIVE: To review the ethical principles of autonomy, nonmaleficence, beneficence, and justice to assist in understanding nursing's ethical obligation to patients and families in the practice of pain management. DATA SOURCES: Position papers, government guidelines, and nursing and legal literature. CONCLUSION: Cancer pain management has been an issue in nursing and medical practice for more than a quarter of a century. Today we have numerous organisations that focus exclusively on the issue of pain and yet the oncology patient continues to have inadequate pain control. IMPLICATIONS FOR NURSING PRACTICE: With the acknowledgement that we have the technical skills and the physiological knowledge to reduce pain, yet it is not being done, health care professionals have begun to explore the ethics behind pain. 相似文献
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Christine Grady 《Seminars in Oncology Nursing》1991,7(4):288-296
The oncology nurse may assume many different roles in clinical trials, including direct care provider, educator, advocate, data collector, primary investigator, and member of the IRB. Regardless of the role, the nurse is in a key position to promote the interests of the individual subject as well as helping to assure that the clinical trial is conducted with scientific and ethical integrity. The nurse can help to assure that the subject is adequately informed and facilitate rational decision making. The nurse can also assure that the requirements of the protocol are consistently attended to and that subjects are well monitored and data precisely collected.
“In oncology, perhaps more than in any other medical specialty, there is a blurring of the distinction between research, therapeutic innovation, and medical practice.”23 The frontiers of knowledge in cancer are continuously advancing. The final step in the process of procuring usable knowledge is the clinical trial, a meeting place of the practice of medicine and clinical research., 4 Because of this there are many ethical considerations which must be attended to in the justification of and conduct of a clinical trial. 相似文献