ABSTRACT
A 60-year-old patient was under follow-up for pulmonary hypertension consistent with pulmonary veno-occlusive disease. During his follow-up, a parenchymal opacity was discovered. We describe the management of the suspicion of lung cancer, highlighting the modification of the conventional diagnostic and therapeutic strategy on account of the pulmonary hypertension. Chest physicians should be able to adapt their diagnostic and therapeutic management in the case of neoplasia in patients with severe pulmonary hypertension.
Subject(s)
Hypertension, Pulmonary/complications , Lung Neoplasms/complications , Lung Neoplasms/diagnosis , Pulmonary Veno-Occlusive Disease/complications , Diagnosis, Differential , Humans , Hypertension, Pulmonary/diagnosis , Incidental Findings , Lung Neoplasms/pathology , Lymphatic Metastasis , Male , Mediastinal Neoplasms/diagnosis , Mediastinal Neoplasms/secondary , Middle Aged , Pulmonary Veno-Occlusive Disease/diagnosis , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Intravenous patient-controlled analgesia (IV PCA) with tramadol is an accepted method to deliver postoperative analgesia outside North America; however, the analgesic efficacy of this analgesic agent when compared with IVPCA with opioids is uncertain. As such, the authors undertook a systematic review to compare the analgesic efficacy of IVPCA tramadol with that of IVPCA with opioids. METHODS: The authors used the National Library of Medicine's Medline database to search for terms related to tramadol and patient-controlled analgesia. Inclusion criteria were randomized controlled trials (RCTs) comparing IVPCA tramadol with IVPCA opioid and RCTs published in the English language. Relevant data were abstracted from accepted studies. Meta-analysis was performed using RevMan 4.2.10 (The Cochrane Collaboration, 2004). A random effects model was used. RESULTS: A total of 190 abstracts were obtained from the above search, and a total of 12 RCTs met the above inclusion criteria. There was no difference in weighted visual analog scale pain scores between IVPCA tramadol versus IVPCA opioid at 48 hours postoperatively or risk of sedation or fatigue. IVPCA tramadol was associated with a higher odds of postoperative nausea and vomiting [odds ratio (OR) = 1.52, 95% confidence interval (CI) = 1.07-2.14) but a lower odds of pruritus (OR = 0.43, 95% CI = 0.19-0.98). DISCUSSION: IVPCA tramadol appears to produce similar pain scores when compared with that from IVPCA opioids; however, the side effect profile is different between the two groups. Because of the relatively small sample size, no determination of the relative "safety" (eg, respiratory depression) of one regimen over the other can be made, and larger RCTs would be needed for such a determination.
Subject(s)
Abdominal Pain/drug therapy , Analgesia, Patient-Controlled , Analgesics, Opioid/therapeutic use , Selective Serotonin Reuptake Inhibitors/therapeutic use , Tramadol/therapeutic use , Adult , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/adverse effects , Fentanyl/administration & dosage , Fentanyl/adverse effects , Fentanyl/therapeutic use , Humans , Infusion Pumps , Morphine/administration & dosage , Morphine/adverse effects , Morphine/therapeutic use , Opioid-Related Disorders/prevention & control , Oxycodone/administration & dosage , Oxycodone/adverse effects , Oxycodone/therapeutic use , Pain Measurement , Postoperative Nausea and Vomiting , Pruritus/chemically induced , Randomized Controlled Trials as Topic , Selective Serotonin Reuptake Inhibitors/administration & dosage , Selective Serotonin Reuptake Inhibitors/adverse effects , Tramadol/administration & dosage , Tramadol/adverse effectsABSTRACT
The application of polymerase chain reaction (PCR) with respect to Helicobacter pylori is useful for molecular epidemiologic aspects and detection purposes. The authors address the current detection methods by PCR aimed at detecting H. pylori in clinical samples collected by less invasive methods, such as gastric juice, saliva, dental plaque, and feces. Enzyme immunoassay also is discussed.
