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 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Depo-Provera injections appear to be a safe and effective alternative for women who cannot tolerate the estrogenic side effects associated with oral contraceptives or the pain and bleeding associated with IUDs. However, women considering the method should be fully aware of the possible risks: (a) inability to withdraw the drug promptly in the event of a serious reaction, (b) disruption of menstrual patterns, and (c) delayed return of fertility after discontinuing therapy. Some women may consider the required trip to the doctor every 3 months an additional disadvantage. For women in developing countries where anemia and nutritional problems are prevalent, Depo-Provera has additional advantages in relation to IUDs and OCs: it causes less bleeding than IUDs or OCs and, unlike oral contraceptives, it does not suppress vitamin levels (4-8). Since it requires a trip to the doctor every 3 months, it also provides a better opportunity for medical supervision and care. For postpartum women who which to breastfeed their babies, Depo-Provera has the additional advantage of causing no adverse effect on lactation (1, 2, 13, 14, 16, 18, 19, 25, 32, 36).
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PMID:Experience with medroxyprogesterone acetate (Depo-Provera) as an injectable contraceptive. 60 84

Our experience has shown ketamine to be a safe and effective method of providing pain relief during specific procedures in burned children. It renders high doses of narcotics unnecessary and offers children the benefit of general anesthesia without the requirement of endotracheal intubation and a trip to the operating room. The response of parents and staff to the use of ketamine has been positive. Parents often experience feelings of guilt following injury to a child and are eager to employ methods that reduce their child's pain. So far, no parent has refused the administration of ketamine; some have even asked that it be used during subsequent procedures on their child. With adequate pre-procedure teaching, parents are prepared for the possible occurrence of emergent reactions and can assist in reorienting the child during recovery. Staff have found that the stress of doing painful procedures on children is reduced when ketamine is used. The procedures tend to be quicker and the predicament of working on a screaming, agitated child is eliminated. At the same time, nursing staff have had to get used to the nystagmic gaze of the children and accept that these patients are truly anesthetized even though they might move and talk. Despite the success we and others have had with ketamine, several questions about its use in burn patients remain unanswered. The literature does not answer such questions as: Which nursing measures reduce the incidence of emergent reactions? How many ketamine anesthetics can safely be administered to one individual? How does the frequency of administration relate to tolerance in a burn patient? Are there detrimental effects of frequent or long-term use? Clearly, an understanding of these questions is necessary to determine the safe boundaries of ketamine use in burn patients. Ketamine is not a panacea for the problem of pain in burned children. But it is one means of managing procedural pain, which is, after all, a significant clinical factor in treatment and recovery.
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PMID:Ketamine. A solution to procedural pain in burned children. 145 Oct 87

A 63-year-old man who grows orchids as a hobby, fell ill with weakness and pain in his hips and legs 2 months after his latest trip to South America (Ecuador). The WBC count was 9900/microliters with unremarkable differential count while blood sedimentation rate was raised to 60/100 mm. The chest X-ray demonstrated in the right upper lobe a well-circumscribed coin lesion (3 cm diameter) of soft-tissue density, uncalcified and without cavitation. Computed tomography in addition revealed an enlarged lymph-node at the lower hilar pole, but no mediastinal lymphoma. Bronchoscopy demonstrated narrowing of a subsegmental ostium of the 6th segment on the right. An attempt at transbronchial biopsy failed. As a peripheral bronchial carcinoma was suspected, a posterolateral thoracotomy was performed (4 months after the trip to Ecuador). Rapid histological examination was negative for tumour and the lesion was therefore enucleated. Histologically (Grocott silver staining) a histoplasmoma was diagnosed. Several serum samples were positive for precipitating (M-band) and complement-binding antibodies (titre 12 days preoperatively was 1:16). The postoperative course was without complication. No anti-histoplasma antibodies were demonstrable 1 year postoperatively.
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PMID:[The solitary pulmonary histoplasmoma]. 149 21

A nurse followed 50 patients at the outpatient unit of Ipswich Hospital in Ipswich, England for 3 weeks. They underwent either laparoscopy, laparoscopy/hydrotubation, or laparoscopic sterilizations. She wanted to determine whether the women felt a need to take analgesics for pain and discomfort after discharge. Only 37 women completed the questionnaire. Anesthetists found 82% of the women exhibited some degree of anxiety. Further women who had a sterilization were less anxious than the other 2 groups. No significant association existed between preoperative anxiety and postoperative headache or nausea, however. 19 women experienced nausea upon the return home or at bedtime. The man distance between the hospital and home was 10.3 miles. 7 women still felt nauseous 3 days after leaving the hospital. Further 2 patients had nausea for 2 weeks. 1 woman stayed in the hospital overnight since she was nauseous and dizzy. 3 women had headaches right after laparoscopy. The next day, 11 patients had headaches. 5 women wanted to spend 1 night in the hospital. 24 (65%) women needed analgesics for up to 3 days after laparoscopy, 20 of whom had pain in 1 location (head, back, shoulders, and abdomen). The analgesics included omnopon, fentanyl, cocodaprin, and alfentanil. 13 women who experienced pain, but did not use any analgesics. The study did not consider several factors, e.g., whether the women had a headache before laparoscopy. Neither did it take into account the home environment or the number of children to tend to when they returned home. Further the study did not look at patient mobility and activity at home, reasons for talking the analgesics (specific pain or generalized discomfort), or use of nitrous oxide which has an emetic effect. The researcher ended with recommendations such as further research on the effects of the trip home on pain, nausea, or headaches.
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PMID:Are analgesics necessary for women at home following laparoscopic gynaecological day surgery? 183 69

Aerotitis, an acute inflammation of the middle ear caused by the difference in air pressure between the airplane cabin and the middle-ear space, is becoming more common in the United States as our society becomes increasingly mobile. We describe a case in which a 33-year-old woman with a resolving upper respiratory tract infection and mildly blocked eustachian tubes flew on a business trip. During ascent, her ears became blocked. This blockage was partially alleviated by a Valsalva's maneuver. On descent, however, her ears became severely blocked, she experienced intense pain, and her tympanic membranes ruptured. She became nauseated and vomited. Her hearing became significantly diminished and she experienced vertigo. On landing, she was taken to a local emergency room and treated with penicillin and antivertiginous medication. Subsequent otologic evaluation revealed severe permanent sensorineural hearing loss. The vestibular symptoms lasted several months. She now requires hearing aids on a permanent basis. Suggestions are presented for prevention and treatment of aerotitis.
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PMID:Aerotitis: cause, prevention, and treatment. 227 66

The breasts are one of the symbols of femininity. Even if it is for the treatment of cancer, the loss or deformity of the breast brings a considerable psychological burden in addition to the physical pain. Authors have performed breast reconstruction on 150 cases during the past fifteen years and have obtained largely favorable results, which were already reported in several papers. Authors administered questionnaires to these patients in order to ascertain their candid opinions which are often not expressed in a hospital. The results of the survey are presented in this report. The survey was conducted anonymously and the questions were all multiple-choices. Approximately 82% of the patient responded. About the pain, inconvenience and motives for undergoing reconstruction, there was a wide variety of answers and many of those surprised authors. For instance; hesitant to go to a hot spring, or on a trip with friends (76%), hesitant to go to a clinic or a hospital for physical check-ups and common illness (74%), troublesome to wear special underwear (69%), inconvenient because ordinary clothes cannot be worn (56%), distressed when viewing own body (52%), unable to dress in thin clothes in hot summer season (50%), imbalance of the breasts (49%), inconvenient to participate in sports (47%). The most patients experienced inconveniences in daily life and had mental and emotional problems. Overall, an impression of the results of breast reconstruction was 83% satisfactory or near satisfaction. About the condition after reconstruction: Patients also expressed a wide variety of opinions about the improvements. For instance, they are relieved from the troubles of wearing special clothing and enjoy selecting and shopping for clothes. They are able to walk on the street with dignity. They enjoy hot spring baths, sports, and leisure activities. They can go for physical check-ups without hesitation. They have a sense of liberation, and become free from constant anxiety. They developed again a forward-looking and positive attitude. Some patients say that they forgot that they had breast reconstruction and that they had breast cancer. As for marriage after reconstruction, which seems to be author's ultimate goal, 12 of the 52 single women have married, and another 22 are currently planning to marry. To the question, "If you are consulted by someone who is in a similar situation". 99% said they would recommend the reconstruction.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Experiences of breast reconstruction following mastectomy in cases of cancer and evaluation of psychological aspects of the patients]. 234 93

We have been performing endoscopic carpaltunnel release using the two-portal technique since November 1992. Altogether, 139 hands were operated on until November 1993, among them 35 endoscopically. All patients were examined pre- and postoperatively. Beyond the known advantages (less postoperative pain, earlier return to work and less loss of grip strength), the complications (one case of hematoma and three cases of hypaesthesia in the trip of the middle finger) and one reoperation (incomplete release) were analyzed. Interestingly, two of the five patients who were operated on both hands (endoscopic and open method) preferred the open method. These patients complained of persistent morning stiffness after endoscopic release. After modification of the method (i.e. mobilization of the soft tissue from the retinaculum in the distal incision before insertion of the slotted cannula), we resumed our trials which lasted until the end of 1994. The patients were selected preoperatively. In our opinion, the endoscopic method should not be performed on patients with hypertrophic synovium, metabolic or rheumatic diseases, extreme posttraumatic or arthritic deformities, thenar atrophy, scars, as well as patients with distal ulnar nerve compression. During the second trial, 41 hands of 126 were endoscopically operated. In this follow-up group, the results were better than in the first group due to careful selection of patients (no complications and no reoperations).
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PMID:[2 1/2 years experience with endoscopic carpal tunnel release]. 876 44

During an 8-day visit to Jalapa, Nicaragua, in 1996, a Short-Term Volunteers in Mission team from Minnesota, US, performed 107 outpatient laparoscopic sterilizations and 14 vasectomies in this remote town near the Honduran border. Standard medical procedures were modified to adapt to the inadequate medical facilities and large patient load. The mean age of female sterilization acceptors was 28.92 years; they had an average of 4.4 living children. 75% lived in or near the town and walked a total of 1 hour or less to and from the hospital; another 20% walked an average of 4 hours round trip. Because of the women's need to walk home after the procedure, local anesthesia (1% lidocaine) was administered in conjunction with oral ibuprofen. More than 75% of acceptors experienced mild or no intraoperative pain and were sent home right after the procedure; 20% reported moderate pain and 3% severe pain, but in all cases the pain dissipated within 10-45 minutes. The length of time from admission to discharge averaged 45 minutes (range, 25-75 minutes). Civil war, overpopulation, and severe poverty limit the ability of government-sponsored programs to deliver family planning services consistently. Thus, sterilization is an ideal method of fertility control for appropriate candidates.
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PMID:Sterilization for family planning in a Third World country. 924 25

Travel and tourism are associated with an increased risk of sexually transmitted infections (STIs) and unwanted pregnancy. This article offers guidelines for health professionals on pre-travel counseling and outlines steps in the clinical management of returning travelers who have been exposed to STIs or pregnancy. The imperative for controlling STIs is particularly urgent now that an epidemiologic link between STIs and vulnerability to HIV infection has been established. Much can be done before a trip abroad in terms of prevention, including the provision of condoms and leaflets explaining the risks of unprotected sex while on holiday or a business trip. Patients should be questioned about their sexual behaviors before, during, and after travel and those who have taken sexual risks while traveling should be offered screening for STIs. The STI-related conditions addressed in this article include vaginal discharge, lower abdominal pain, urethral discharge, scrotal pain, genital ulcer disease, inguinal bubo, and genital warts. Recommended treatment regimens for the most prevalent reproductive tract infections are outlined.
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PMID:The sexual health of travelers. 965 51

"I fear a trip to the dentist more than I fear death" is the response one person gave in a national survey recently cited in USA Today. While clearly representing an extreme, the results of many surveys suggest that fear of dentistry is still prevalent and is a measure of the failure of current therapeutic approaches to reduce pain and anxiety sufficiently to enable people, especially those with special needs, to visit the dentist. Patients who are fearful would likely seek oral health care more regularly if anesthesia and sedation were more readily available. Taking into consideration that the safety of anxiolytic drugs is highly dependent on the drug, dose, and route of administration used, oral premedication should be the sedative technique used by most dentists because it is efficacious, requires little monitoring when appropriate doses are used, and is unlikely to result in serious morbidity.
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PMID:Oral sedation. 985


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