Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

One hundred patients on methadone maintenance admitted to our surgical service were analyzed. The average duration of prior narcotics abuse was ten years and was followed by an average of 2.2 years of methadone maintenance treatment. Sixty-three patients were admitted on an emergency basis, half of these for trauma. Sixty-two patients underwent operative procedures. There were four deaths, none directly related to methadone use. Five patients were admitted for intestinal obstruction secondary to methadone ingestion. This disease entity results from fecal impaction which is induced by methadone's spastic effect on the gastrointestinal tract. Evidence of chronic liver disease was present in half the patients. The associated medical illnesses presented no problems with anesthesia. WHILE METHADONE MAINTENANCE WAS CONTINUED IN THE ACCUSTOMED DOSAGE, POSTOPERATIVE ANALGESIA WAS ACCOMPLISHED SATISFACTORILY WITH 5O TO 100 MG DOSES OF MEPERIDINE AT 3 HOUR INTERVALS, AS REQUIRED.
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PMID:Management of surgical problems in patients on methadone maintenance. 5 61

In protriptyline (25 mg/kg) pretreated rats stereotactic 5,7-dihydroxytryptamine (5,7-DHT) lesions of the medial plus laternal 5-hydroxytryptamine (5-HE) bundles in the mesencephalon increased the 5-HT fluorescence in these bundles, and reduced the in vitro uptake of [3H] 5-HT in the hypothalamus to 16% of control values after 2 mug 5,7-DHT/4mul and 12% after 4 mug 5,7-DHT/4mul, and in the cortex cerebri to 35 and 34% of control values, respectively. Selective lesion of the medial 5-HT bundle reduced [3H] 5-HT uptake both in hypothalamus and in cortex cerebri to 45-48% of control values, while selective lesion of the lateral 5-HT bundles significantly reduced [3H] 5-HT uptake only in cortex (to 73-75%). No significant change was observed in [3H] noradreanaline uptake after any injection, or in [3H] 5-HT uptake after vehicle injections. Locomotor activity in an open field 3-10 days postoperatively was significantly reduced by lesions of the medial plus lateral 5-HT bundles. 5-Hdroxytryptophan (50 mg/kg) and a peripheral decarboxylase inhibitor (MK 486, 75 mg/kg) 17 days postoperatively induced a pronounced behavioral "5-HT syndrome" in these rats with medial plus lateral lesions but not in controls. Pain sensitivity, as measured by the hot plate test, was not changed by any lesion, even when tryptophan hydroxylase was partly inhibited with alpha-propyldopacetamide (100 mg/kg). Morphine analgesia and acquisition of a one-way avoidance response also were unchanged. Apomorphine (2 mg/kg)-induced locomotor activity and stereotyped behavior, as measured in an Animex activity meter, were not significantly different from control values in the 5,7-DHT groups. It was concluded that the medial 5-JT BUNDLE INNERVATES BOTH THE HYPOTHALAMUS AND THE CORTEX CEREBRI AND THE LATERAL 5-HT bundle mainly the cortex. These ascending 5-HT neurons are involved in maintaining open field ambulation. No wupport was obtained for the view that they are involved in pain mechanisms, in morphine-induced analgesia, in apomorphine-induced motor behavior, or in one-way avoidance learning.
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PMID:Behavioral effects of 5, 7-dihydroxytryptamine lesions of ascending 5-hydroxytryptamine pathways. 94 13

THE PREGNANT PATIENT: Age; maternal disease; prophylactic antibiotics; gastroesophageal reflux; obesity; starvation; genotyping; coagulopathy; infection; substance abuse; altered drug responses in pregnancy; physiological changes of pregnancy. THE FETUS: Fetal monitoring; intrauterine surgery. THE NEWBORN: Breastfeeding; maternal infection, fever, and neonatal sepsis evaluation. OBSTETRIC COMPLICATIONS: Embolic phenomena; hemorrhage; preeclampsia; preterm delivery. OBSTETRIC MANAGEMENT: External cephalic version and cervical cerclage; elective cesarean delivery; fetal malpresentation; vaginal birth after cesarean delivery; termination of pregnancy. OBSTETRIC ANESTHESIA: Analgesia for labor and delivery; anesthesia for cesarean delivery; anesthesia for short obstetric operations; complications of anesthesia. MISCELLANEOUS: Consent; ethics; history; labor support; websites/books/leaflets/journal announcements.
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PMID:What's new and novel in obstetric anesthesia? Contributions from the 2003 scientific literature. 1579 48

PURPOSE OF THE STUDY Our study compared early outcomes of total knee arthroplasty performed in conventional and enhanced perioperative care regimes, i.e. without the use of Redon drain, with intensified perioperative analgesia and more frequent and intensive rehabilitation regime in the latter. MATERIAL AND METHODS The prospective study included 194 patients (76 men and 118 women) implanted with primary knee endoprosthesis. The mean age was 68.8 (44.7 - 88.0 years). The patients were divided into two groups - the "enhanced" and "conventional" procedures. In the first group, Redon suction drain was not inserted at the end of the surgery, and the patients commenced passive knee mobility exercise of the operated knee immediately after being brought back from the operating theatre. The general anaesthesia was supplemented by a combined femoral nerve block and wound infiltration with local anaesthetics. The second group comprised the patients who underwent conventional surgery, i.e. with the use of drain, without femoral nerve block, with no wound infiltration with local anaesthetics, and without immediate post-operative mobilization of the joint. The evaluation was carried out using regular clinical tools (subjective evaluation, objective examination, questionnaire and Knee Society Score (KSS)). Standard statistical methods were applied to data processing. RESULTS The patients under the "conventional regime" showed a significantly sharper drop in haemoglobin and haematocrit levels, higher consumption of blood transfusion and analgesics during the first three days after the surgery. The patients under the "enhanced regime" showed a better range of joint motion at hospital discharge, flexion in particular (p = 0.001). During the hospital stay no frequent swelling, secretion or wound reddening was reported in any of the monitored groups. In the "conventional" group, however, haematomas were more frequently present. The postoperative checks did not reveal any differences in satisfaction of the patients with the surgery. At the first follow-up examination at the outpatient department the "conventional" group patients more often reported knee pain and a feeling of a swollen knee. Nonetheless, their statements did not correspond with the VAS score. In the period between the 6th and 12th months following the surgery, the differences in the range of motion disappeared. The KSS showed a noticeable improvement in both the groups as against the preoperative values. In the "enhanced" group patients, the score increased dramatically at the beginning, whereas in the "conventional" group, the score was growing slowly and gradually until the last follow-up check after the surgery. The "conventional" group patients more frequently reported infectious complications (surface and deep wound infections: 4 vs. 2 patients) requiring a revision surgery (p = 0.024). DISCUSSION Recently, attention has been drawn to the rapid recovery approach, which eliminated postoperative immobilization and enabled the patient to start exercising already on the day of the surgery, with some patients even walking independently. The individual enhanced recovery regimes differ in details but mostly result in achieving the aim much sooner when compared to the conventional approaches. The patients under the enhanced recovery regimes can accomplish better functional outcomes in the first few months after the surgery than the patients undergoing the surgery under the conventional regime. The routine use of Redon drains in TKA is obviously unnecessary; it tends to be associated with a higher blood loss and a higher risk of prosthetic joint infection. CONCLUSIONS The TKA implant without suction drains combined with intensified perioperative analgesia and intensive postoperative rehabilitation is a safe way to earlier recovery of the function of the operated knee, or, by extension, the lower limb. The described approach is not associated with a higher risk of perioperative complications (bleeding, healing disorders or early infections). Patients also benefit from lower blood losses. Based on the results of our study, we recommend performing the TKA surgeries routinely without drains, with perioperative analgesia and immediate postoperative joint mobilization. Key words: total knee arthroplasty; perioperative care; rapid recovery; drainage; active movement; postoperative outcomes; pain; infection.
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PMID:[Influence of Enhanced Recovery Regime on Early Outcomes of Total Knee Arthroplasty]. 2935 37

PURPOSE OF THE STUDY The postoperative delirium is a frequent, oftentimes underestimated complication of total hip arthroplasty. Its occurrence is reported to be between 10% and 50%. The postoperative delirium increases mortality, the length of hospital stay and leads to worse functional results. Even though there is evidence of efficiency of preventive measures and effectiveness of treatment interventions, inadequate attention has been paid so far to this serious complication related to inpatient hospital care. This paper aimed to determine the incidence of cognitive function impairment in relation to the total hip replacement, to determine the influence of the defined parameters on changes in cognitive functions and to draft practice guidelines for the care of patients after a total hip replacement in the framework of prevention and early detection of changes in cognition of patients after total hip replacement. MATERIAL AND METHODS Prospective observational descriptive study, the evaluated parameters included: type of anaesthesia, duration of surgical procedure (operation), type of analgesia, O2 saturation, haemoglobin levels, changes in the ionogram, body temperature, presence of concomitant diseases, polypragmasia, abuse, level of self-sufficiency of patients evaluated by ADL. In order to obtain the data, the Mini Mental State Examination (MMSE), the Abbreviated Mental Test Score (AMTS), Recall and naming test, and the Activities of Daily Living Test (ADL) were used. The monitored group of patients included a total of 116 persons, of whom 68 men and 48 women. The mean age was 71.16 years; the range from 65 to 86 years; median - 72.36 years. RESULTS A statistically significant dependence was revealed between the change in cognitive functions and all the monitored parameters, except for the haemoglobin levels after 120 hours postoperatively, ion levels after 120 hours and sex by the 10-point Mini Mental Test score. A statistically significant dependence was revealed between the change in cognitive functions and 02 saturation, ion levels, elevated body temperature after 120 hours postoperatively, age, diabetes, polypragmasia and in correlation with the ADL 120 hours postoperatively by the MMSE test. A statistically significant dependence was revealed between the change in cognitive functions and all the monitored parameters, except for anaesthesia and analgesia, haemoglobin levels after 24 and 120 hours, ion levels after 120 hours, renal insufficiency and in correlation with the ADL after 24 hours by the "Recall and naming" test. DISCUSSION The correlation between delirium and long-term cognition impairment was described by several studies. Both the recent literature and our study clearly indicate a correlation between the postoperative cognitive impairment on the one hand and polypragmasia, age, presence of concomitant diseases on the other hand. In some parameters such as the sex of the patient its influence was not clearly established by the relevant literature or our study. The perioperative factors influencing the onset of delirium referred to in literature are anaesthesia and its duration. Our study reveals the correlation between the anaesthesia and the onset of cognitive impairment when evaluated by the Abbreviated Mental Test Score. As regards the monitored postoperative parameters, the influence of postoperative hyposaturation, decreased haemoglobin level, changes in ionogram, elevated body temperature, lower self-sufficiency of the patient was established. Also our study shows the correlation between the change in the aforementioned parameters and the cognitive impairment, even though not quite clearly in all the parameters. The most sensitive evaluation tool turned out to be the Abbreviated Mental Test Score. CONCLUSIONS Our study clearly showed that a highly sensitive test to detect the current changes in cognition in a short-term horizon is the Abbreviated Mental Test Score. Based on the statistically significant factors determining the onset of the change in cognition that we had revealed, we elaborated a clearly arranged scheme of identified risk factors and interventions for the prevention and early identification of the onset of changes in cognitive functions and potential delirium. Key words:total hip arthroplasty, cognitive impairment, delirium.
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PMID:[Changes in Cognitive Functions after Total Hip Arthroplasty]. 3029 1

PURPOSE OF THE STUDY Septic arthritis is an infection of joints caused by a pathogenic microorganism. Septic arthritis has a mortality rate of 11-40% when it's not treated properly. The mortality rate with methicillin-sensitive Staphylococcus aureus (MSSA)is 5-7%, while the rate with methicillin-resistant Staphylococcus aureus (MRSA)is 13-20%. The aim of this study is to evaluate the effects of intraarticular vancomycin and teicoplanin on joint cartilage in in vivo settings and its utility in routine MRSA treatment. MATERIALS AND METHODS In our study, 35 male Sprague-Dawley rats aged 28 days were used. Rats were obtained from the Regenerative and Restorative Medicine Research Center (REMER) of Istanbul Medipol University. Rats were randomly divided into 5 groups each containing 7 rats. Joint injections were administered with isoflurane analgesia every day at 6 am. Three rats (15 rats) from each group were sacrified in seventh day and evaluated immunohistologically to evaluate acute healing in articular cartilage. All remaining rats were sacrificed on day 28 and their knees were evaluated by immunohistochemical examination. RESULTS In our study, there were no complications in any rat during injection and the study period. Hematoxylin eosin (H & E) histological staining for evaluating cartilage healing and healing levels did not show statistically significant differences between the groups at first week (p > 0.05). Matrix metalloproteinase-13 (MMP-13) staining did not show any statistically significant difference between the groups. (p > 0.05). DISCUSSION MRSAseptic arthritis, diagnosed for the first time in 1960, has recently been responsible for 6-22% of all septic arthritis and is increasing day by day. The use of systemic vancomycin or teicoplanin is the first-line treatment method in MRSA septic arthritis. Serum levels reach the desired level, especially with intravenous infusion dose. On the other hand, it has been shown that intraarticular concentration does not reach a sufficient level in studies conducted. The use of intraarticular antibiotics during treatment can lead to more effective and early disease control by turning this negative situation into favor of the patient. As a result, intraarticular vancomycin and teicoplanin maximale tolerable and maintenance doses can be safely used beside surgery and intravenous antibiotics to increase efficacy of treatment, reduction of recurrence rates and reduction of mortality in MRSAseptic arthritis. CONCLUSIONS Intraarticular vancomycin and teicoplanin maximale tolerable and maintenance doses can be safely used beside surgery and intravenous antibiotics to increase efficacy of treatment, reduction of recurrence rates and reduction of mortality in MRSA septic arthritis. Key words:arthritis, infectious; methicillin-resistant Staphylococcus aureus; mortality.
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PMID:Is Intraarticular Antibiotic Administration Effective in the Treatment of Methicillin-Resistant Staphylococcus aureus? 3152 89

PURPOSE OF THE STUDY Rib fractures represent one of the most common fractures sustained by 10-40% of all patients with blunt chest trauma, their incidence increases with age. In the current literature, however, new indication criteria continue to emerge. The purpose of this study is to assess the indication criteria, the timing of surgery and the use of individual plates in dependence on fracture location in our patients after the chest wall stabilisation in a retrospective analysis. MATERIAL AND METHODS Our group of patients (n = 349) included the patients who were hospitalised in the Trauma Centre of the University Hospital Olomouc from 1 January 2015 to 31 January 2019, of whom 16 patients were indicated for a surgery. In case of polytrauma, spiral CT was performed, while all patients with a more serious wall chest trauma underwent 3D CT chest wall reconstruction. The surgical approach was chosen based on the fracture location, most frequently posterolateral thoracotomy was opted for. The type of plates was chosen based on the location and type of the fracture. The most common was the lateral type of fracture. RESULTS The most common indication for surgery was multiple rib fractures with major chest wall disfiguration with the risk of injury to intrathoracic organs, present hemothorax or pneumothorax. The age of patients ranged from 44 to 92 years. 8 patients sustained a thoracic monotrauma, the remaining patients suffered multiple injuries, mostly craniocerebral trauma, pelvic or long bone fractures or parenchymal organ injury. The patients were indicated for surgery between 1 hour and 7 days after the hospital admission, on average 3 plates per patient were used and the most commonly used type of plate was the newly modified Judet plate made by Medin. All the patients underwent a surgical revision of pleural cavity, in 3 patients diaphragmatic rupture was found despite a negative preoperative CT scan. The duration of mechanical ventilation in polytrauma patients was 16 days, in thoracic monotrauma patients it was 2 days. CONCLUSIONS Prevailing majority of patients with a blunt chest trauma with rib fractures is still treated non-operatively, which is confirmed also by our group of patients. Nonetheless, correctly and early indicated stabilisation of the chest wall based on accurate indication criteria is of a great benefit to the patients. The aim of each and every trauma centre should be to develop a standardised protocol for the management of blunt chest trauma (the so-called "rib fracture protocol"), which comprises precisely defined criteria for patient admission, multimodal analgesia, indications for surgery, comprehensive perioperative and postoperative care and a subsequent rehabilitation of patients. Key words: rib fracture protocol, chest wall stabilisation, flail chest.
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PMID:[Evolution of Opinions on Chest Wall Stabilisation and Our Experience]. 3277 15

THE ARRIVE (Animals in Research: Reporting In Vivo Experiments) guidelines were endorsed by the Shock Society in 2012, but to date there has been no systematic evaluation of research reporting quality for Shock. We systematically assessed 100 randomly selected animal-based research articles published between 2014 and 2018 for reporting quality and statistical practice, compared to 40 pre-ARRIVE studies. More than half of surveyed papers omitted verifiable ethical oversight information and basic animal descriptive information. Few papers reported best-practice methods, such as sample size justification (10%), randomization (43%), randomization method (7%), blinding (23%). Only one paper reported effect sizes to interpret study results. Most troubling was inadequate reporting of welfare-related information (anesthesia, analgesia, humane endpoints, euthanasia). Almost a decade after ARRIVE endorsement, our findings show that reporting deficiencies have persisted with little sign of correction. There is a clear need for investigators to increase transparency of research methods reporting, and drastically improve skills in experimental design. Improvement in standards and greater attention paid to reporting will lead to improvement in reproducibility, replicability, and research quality. It is incumbent upon the research community to improve reporting practices; accurate and transparent reporting is integral to producing rigorous and ethical science.
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PMID:Preclinical Research Reporting in Shock: Room for Improvement. 3294 86