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181.
Michael F. Maguire Janet A. Latter Ravi Mahajan F. David Beggs John P. Duffy 《European journal of cardio-thoracic surgery》2006,29(6):873-879
Objective: Our aim was to investigate the prevalence of intra-operative nerve damage and its association with chronic pain. Methods: Our prospective study of 33 patients used nerve conduction studies to assess intercostal nerve function during elective thoracic surgical procedures. We used two methods to study nerve conduction: pre-operative magnetic stimulation (in 10 patients) and intra-operative nerve conduction studies (in all patients) We correlated these findings with specific intra-operative parameters, pain and psychological questionnaires pre-op and 3 month post-op and altered cutaneous sensation. Results: Magstim (magnetic stimulation) assessments were not reliable and were therefore abandoned. Intraoperative intercostal nerve studies revealed two distinct patterns of nerve injury and also that nerve injury was less in those cases where a rib was not resected. However, intercostal nerve damage detected at the time of operation is not associated with chronic pain or altered cutaneous sensation at 3 months post-op. Conclusions: The study findings suggest that either the amount of intra-operative intercostal nerve damage is not indicative of long-term nerve damage or that there is a more significant cause for chronic pain other than intercostal nerve injury. 相似文献
182.
We present a case of a female patient suffering from type I complex regional pain syndrome (CRPS) who developed “mirror imaging” of her CRPS and was successfully treated with dual spinal cord stimulation (SCS) in the paraforaminal epidural space. This patient initially had unilateral pain that was unsuccessfully treated with midline SCS and single‐lead lateral epidural lead placement “paraforaminally.” One year later, because we believed that paraforaminal stimulation would preferentially stimulate primary sensitized afferents innervating the painful area, we reperformed SCS with two leads positioned laterally and paraforaminally close to the roots within the epidural space. After repositioning and after 1 year of paraforaminal stimulation, there was significant improvement in the patient's symptoms, resolving all unilateral and “mirrored” symptoms. We conclude that paraforaminal stimulation may be a valid therapeutic option for the treatment of CRPS. 相似文献
183.
脊髓损伤后中枢性疼痛的实验模型和机制研究进展 总被引:1,自引:0,他引:1
中枢性疼痛(central pain,CP)是脊髓损伤(spi-nal cord injury,SCI)的顽固性合并症,为患者主观上感到损伤平面以下皮肤痛觉消失区一种以自发痛为主的疼痛,发生率为11%~94%,严重者为5%~30%。近年来其发生率逐年增高,使很多患者陷于抑郁、药物成瘾、甚至自杀的悲惨境地。许多疼痛 相似文献
184.
Postoperative analgesia: pain by choice? The influence of patient attitudes and patient education 总被引:3,自引:0,他引:3
Postoperative pain control can be unsatisfactory for a variety of reasons, including patients' attitudes towards pain treatment itself. To assess patients' expectations and their influence on postoperative analgesia, as well as the prevalence of pain following common gynaecological surgery, a prospective study was performed in 166 patients with either adbominal hysterectomy, mastectomy, laparoscopy or uterine curettage. After a first postoperative period with routine on-demand analgesia, a nurse specialised in pain treatment discussed the purposes and risks of pain treatment with the patients and cared for these patients in the second, subsequent study period. Following this discussion, 30 of 40 patients refusing analgesics in the first study period agreed to be given pain medication. In the groups with hysterectomy or mastectomy, pain control improved in the second postoperative period, even though the doses of analgesics administered were generally lower. Education of patients regarding the aims and risks of pain therapy is an essential part of pain control and can lead to an improvement of postoperative analgesia. 相似文献
185.
186.
Michael C. Kontos Kristin L. Schmidt Michael McCue Louis F. Rossiter Michael Jurgensen Christopher S. Nicholson Robert L. Jesse Joseph P. Ornato James L. Tatum 《Journal of nuclear cardiology》2003,10(3):284-290
BACKGROUND: Our objective was to determine the cost-effectiveness of a comprehensive, risk-based triage system, composed of multiple critical pathways, with the use of early myocardial perfusion imaging (MPI) in low-risk patients. We found previously that a chest pain evaluation system that uses MPI in low-risk patients was safe and effective, but the cost-effectiveness of this approach was not studied. METHODS AND RESULTS: We compared two groups. The Acute Cardiac Team (ACT) group (n = 874) was assigned prospectively to 1 of 4 risk levels by emergency department (ED) physicians. Level 1, 2, and 3 patients were admitted; level 4 patients were evaluated in the ED. Level 3 and 4 patients underwent ED MPI. The control group (n = 713) represented consecutive patients evaluated in the prior year according to standard care and assigned retrospectively to an ACT level based on the presenting electrocardiographic and clinical data. Record and hospital administrative data were assessed for clinical variables, outcomes, lengths of stay, and all expenses incurred within 30 days of the index visit. The baseline characteristics of the two groups were similar, including age, sex, myocardial infarction prevalence, and 30-day revascularization rates within each level or between the two groups. Mean costs per encounter were reduced for the ACT patients for each level, which was significant when all patients were compared ($5,030 +/- $7,081 vs $6,044 +/- $10,432, P =.02). Use of MPI in the low-risk patients was associated with reduced costs (level 3, $4,958 +/- $4,948 vs $5,051 +/- $7,036; level 4, $1,529 +/- $2,664 vs $1,794 +/- $6,854) and was associated with a significantly lower angiography rate and shorter length of stay. CONCLUSIONS: Implementation of a comprehensive strategy for chest pain evaluation and triage reduced overall costs for patients with chest pain on presentation. Acute MPI in the ED setting did not increase net cost. 相似文献
187.
S.L. CHARLES NGU PETER DUVAL CATHRYN COLLINS 《Journal of Medical Imaging and Radiation Oncology》1992,36(4):321-322
Management of breast cancer during pregnancy is complicated by the high risks of abortion and foetal malformation from the use of radio therapy and chemotherapy. A case of breast cancer during pregnancy, treated with radiotherapy, and the estimated foetal dose is reported. 相似文献
188.
周季英 《现代临床医学生物工程学杂志》1996,2(4):292-294
13例有心绞痛样胸痛的住院病人入院均诊有冠心病心绞痛,后均经ECG、8例心脏“B”超、核素心肌灌注及24小时动态ECG各2例,确诊冠心病5例,不支持冠心病8例;后均行GI,并同时行胃镜、食管24小时pH测定及压力测定各2例,确诊有胃食管反流疾病(GERD),本组自胸痛症状出现至GERD确诊病程平均29.5个月(0.5~120个月),报告2例典型病例,讨论了误漏诊原因,探讨了老年人食管性胸痛的诊疗程序。 相似文献
189.
刺激视上核对大鼠痛阈及电针镇痛的影响 总被引:2,自引:1,他引:1
以钾离子透引起的大鼠甩尾反应为痛指标,观察了电和化学刺激视上核(SON)对大鼠痛阈(PT)和电针(EA)镇痛的影响。电刺激SON后,PT明显高于假刺激组(P<0.05~0.001),电刺激SON后电针足三里,镇痛效应明显提高,并有明显的量效关系。电刺激SON的近旁部位(0.5—1mm)对PT及电针镇痛无明显影响。SON内注射L-谷氨酸(L-Glu)后痛阈和电针镇痛效应都明显对照组,也有明显的量效关 相似文献
190.
本文报告260例恶性肿瘤患者血清维生素A、E、C水平的测定结果。发现除慢性白血病外,蓁7种恶性肿瘤患者血清维生素A水平平均显著低于健康人(P<0.01);急性白血,肝癌、食管癌患者血清维生素E水平显著低于健康人(P<0.05);急性粒细胞白血病、急性单核细胞白血病、肝癌患者血维生素C水平显著低于健康人(P<0.01)。本研究工作为维生素A、E、C药物在肿瘤临床上的应用提供了参考。 相似文献