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361.
The International Association for the Study of Pain, has defined pain as “an unpleasant sensory and emotional experience connected with actual or potential tissue damage or described in terms of such damage”. It was thought that the newborn baby does not experience pain because of incompletely developed nervous system. However, it has been shown that neurological system known to be associated with pain transmission and modulation, is intact and functional. A study was conducted in our center to study the analgesic effect of administration of oral glucose in various concentrations, in neonates undergoing heel punctures, for collection of blood for investigations. This was compared with the analgesic effects of breast milk (which contains lactose). 125 full term normal neonates with no history of birth asphyxia or underlying neurological abnormality, requiring heel punctures for collection of blood for various investigations were selected for the study. They were matched for gestational age, birth weight and sex distribution and divided into 5 groups of 25 each. One group comprised control subjects and was administered sterile water. 3 groups were administered 1 ml of varying strengths of glucose solutions i.e. 10%, 25% and 50% respectively. The last group was given 1 ml of expressed breast milk (EBM). Prior to heel pricks, state of arousal, baseline heart rate (HR) and transcutaneous oxygen saturation (SpO2) were recorded by pulse oximeter in each neonate. Autolet, a mechanical device for capillary sampling, was used for heel pricks to give equal strength of painful stimulus in each procedure. Audio tape recorder was used to record the cry. The oral solution was administered slowly over 30 seconds by means of a syringe placed in the mouth. Heel puncture was done after 2 minutes, taking all aseptic precautions. HR and SpO2 were monitored using pulse oximeter. Pain response was assessed, by recording duration of crying, change in HR, change in SpO2 and facial action score after the procedure. Mean duration of cry and total cry over 5 minutes was significantly less in groups given 25% and 50% glucose solutions as compared to the control group and babies given EBM. Difference in mean increase in HR, fall in SpO2 were statistically significant between control group, EBM group and neonates given 25% and 50% glucose solutions respectively. Compared to control group, all other administered solutions (10%, 25%, 50% glucose and EBM) were found to reduce physiological and behavioral responses in neonates undergoing heel punctures. 25% and 50% glucose solutions were found to have maximal analgesic effect and both were found to be equally effective. EBM and 10% glucose solution have an equal analgesic effect but less than 25% or 50% glucose. This simple, cheap and safe method of oral analgesia can be easily used in neonates undergoing heel prick procedures during routine neonatal care.Key Words: Analgesic effect, Breast milk, Glucose, Neonates 相似文献
362.
Penetrating eye injuries in rural New South Wales 总被引:1,自引:0,他引:1
CG Thompson MB BS DipObs RKS Griffits FRACO W Nardi FRACO MP Tester FRACO MJ Noble FRCOphth L Cottee FRACO P Weir FRACO 《Clinical & experimental ophthalmology》1997,25(1):37-41
Purpose: To determine the epidemiology and outcomes of penetrating eye injuries in a rural Australian setting. Methods: A retrospective study of an 11 year period to identify 77 cases of penetrating eye injury in Lismore, New South Wales. Results: The commonest cause of penetrating eye injury was fencing wire followed by hammering metal. The average age was 32.6 years, and males were involved in 88% of cases. A final visual acuity of 6/12 or better was achieved in 61% of cases. Enucleation was performed in 14%. Visual outcome was best for wounds involving the cornea only. Conclusions: Penetrating eye injuries are potentially devastating to vision, but with modern surgical techniques patients are likely to achieve reasonable vision. Prevention requires education to ensure adequate protective measures are taken in potentially hazardous settings. 相似文献
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Jones CH; Newstead CG; Wills EJ; Davison AM 《Nephrology, dialysis, transplantation》1997,12(3):554-558
HYPOTHESIS: Trends in serum albumin concentration over time provide a
better prediction of clinical outcome in CAPD patients than a single mean
value. METHODS: This was a retrospective review of outcome at 36 months in
225 adult CAPD patients. Mean serum albumin was determined for the first
(SA1) and second (SA2) 6 months of treatment and patients grouped according
to SA1 (group I, > 37; group II, 34-37; group III, < 34 g/l) and
according to the change in serum albumin (delta SA) between the first and
second 6 months (increased/static or decreased). Patient (PS) and technique
(TS) survival were determined by Kaplan-Meier survival analysis. The effect
of SA1 and delta SA on survival were determined in a multivariate Cox
regression analysis model that included age and presence or absence of a
systemic disease. RESULTS: By SA1 group, PS and TS survival at 36 months
were 94 and 76% (group I), 64 and 53% (group II) and 70 and 52% (group
III). If delta SA increased/remained static, then SA1 did not predict PS
(group I, 100%; group II, 96%; group III, 74%; P = n.s.) or TS (group I,
72%; group II, 63%; group III, 65%; P = n.s.). If delta SA decreased, PS
was worse in groups II and III, both as compared to group I (PS group I,
88%; group II, 52%; group III, 34%; P = 0.02) and as compared to the groups
II and III when delta SA increased (PS group II, 74 vs 52%, P = 0.05; group
III, 82 vs 34%, P = 0.005) The same trend was seen for TS. In the
multivariate Cox regression model, age, direction of change in serum
albumin, and presence of a multisystem disease were significant predictors
of survival, whereas SA1 was not. CONCLUSION: Early hypoalbuminaemia in
CAPD only predicts a worse patient and technique survival if mean serum
albumin decreases further from the first to second 6 months of dialysis
therapy. Change in serum albumin between the first and second 6 months of
CAPD and the mean serum albumin over the first 6 months together offer
better discrimination of outcome than either alone.
相似文献
365.
Kushner DC; Cleveland RH; Herman TE; McLoud TC; Waltman AC; Shepard JA; Dedrick CG; Kopans DB; Greene RE 《Radiology》1987,163(3):685-688
Standard film examinations of the chest were compared with low-dose flying spot digital radiographic examinations obtained with a prototype unit in 174 patients. Analysis of pooled data from a double-blind study of 120 patients showed that film was more sensitive than digital images in the detection of pulmonary parenchymal abnormalities, that is, abnormal opacities, atelectasis, scar, and interstitial lung disease (P less than .05). Analysis of pooled data from a side-by-side study of 54 patients showed that the digital images were more sensitive than film in the detection of normal mediastinal and pleural soft-tissue contours, including the azygoesophageal recess, paraspinal line, and vertebral disk spaces (P less than .05). However, film was more sensitive than digital images in the detection of abnormalities of the lung, including scar, interstitial lung disease, septal lines, and the presence of vascular catheters (P less than .05). These findings suggest that low-dose flying spot digital radiography of the chest, as performed with this specific prototype unit, is not adequate to replace film in the detection of abnormalities of the lung parenchyma. 相似文献
366.
Protein C is a vitamin K-dependent zymogen of the serine protease, activated protein C (APC), an important regulatory enzyme in hemostasis. In view of the potential of human APC as an anticoagulant and profibrinolytic agent, the pharmacokinetics and tissue distribution of APC were studied in guinea pigs. The plasma elimination of a trace dose of 125I-APC was biphasic following an initial rapid elimination of approximately 15% of the injected dose within 1 to 2 minutes. This rapid removal of 125I-APC from the circulation was found to be a result of an association with the liver regardless of the route of injection. Essentially identical results were obtained with active site-blocked forms of APC generated with either diisopropylfluorophosphate or D- phenylalanyl-L-prolyl-L-arginine chloromethyl ketone, which indicates that the active site was not essential for the liver association. Accumulation of all three forms of APC in the liver peaked at 30 minutes and then declined as increasing amounts of degraded radiolabeled material appeared in the gastrointestinal tract and urine. Removal of the gamma-carboxyglutamic acid (gla) domain of diisopropylphosphoryl-APC resulted in a 50% reduction in the association with liver and an accumulation in the kidneys. Protein C and protein S were cleared from the circulation at rates approximately one-half and one-fourth, respectively, that of APC. Both in vitro and in vivo, APC was found to form complexes with protease inhibitors present in guinea pig plasma. Complex formation resulted in a more rapid disappearance of the enzymatic activity of APC than elimination of the protein moiety. These findings indicate two distinct mechanisms for the elimination of APC. One mechanism involves reaction with plasma protease inhibitors and subsequent elimination by specific hepatic receptors. The other mechanism involves the direct catabolism of APC by the liver via a pathway that is nonsaturable over a substantial dose range and independent of the active site. This pattern of elimination is distinctly different from that observed with the homologous coagulation enzymes thrombin, factor IXa, and factor Xa. 相似文献
367.
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369.
Assessment of nutritional status in CAPD patients: serum albumin is not a useful measure 总被引:4,自引:2,他引:2
Jones CH; Newstead CG; Will EJ; Smye SW; Davison AM 《Nephrology, dialysis, transplantation》1997,12(7):1406-1413
INTRODUCTION: In CAPD patients serum albumin is frequently used as an index
of nutritional status, although it is recognized that hypoalbuminaemia may
be caused by many factors. We have further examined the relationship
between serum albumin and nutrition. METHODS: Nutritional status was
assessed by biochemistry, anthropometry, mid-arm muscle circumference,
muscle strength (hand grip and back), and lean body mass (from
anthropometry, creatinine kinetics and bioimpedance) in a group of 76
stable CAPD patients. Correlations between biochemical and nutritional
parameters were sought and data were compared between patient groups
defined by serum albumin (> or = 37 vs < 37 g/l on two occasions 2
months apart) and separately according to subjective global assessment
score (normal nutrition, A vs mild to moderate, B, and severe, C,
malnutrition). RESULTS: In patients with a low SGA score, actual body
weight, body mass index, mid-arm muscle circumference, lean body mass,
subscapular skinfold thickness, hand grip strength (males and females) and
iliac and triceps skinfold thicknesses and back strength (females only)
were all significantly less than in patients with a normal SGA score. In
contrast, none of these variables differed in either gender when patients
were compared according to serum albumin. Serum albumin was correlated with
serum creatinine (r = 0.45, P = 0.01), daily urine protein excretion (r =
-0.42, P = 0.02) and uncorrected weekly creatinine clearance (r = -0.39) in
females, but not with any index of body composition in either gender.
CONCLUSION: Whilst SGA identified a patient group with significantly
abnormal body mass, muscle mass and muscle strength, serum albumin did not.
Serum albumin is not a useful marker of malnutrition in stable patients on
CAPD.
相似文献
370.