Control del dolor postoperatorio con clorhidrato de tramadol sublingual / Management of postoperative pain with sublin gual tramadol hydrochloride

Antecedentes: Buscando nuevas alternativas terapéuticas para el control del dolor postoperatorio, se probó un fármaco con mecanismo de acción mixto: clorhidrato de tramadol, aplicado por una vía no convencional, la sublingual (s.l.).Objetivos: 1. Probar la eficacia analgésica del clorhidrato de tramadol por vía s.l. 2. Determinar, de las tres dosis propuestas, cuál es la más adecuada para el alivio del dolor postoperatorio en cirugía abdominal.Material y métodos: Estudio ciego, randomizado, prospectivo y longitudinal. Noventa pacientes ASA I-II, entre 15 y 65 años, operados de cirugía abdominal, con anestesia general balanceada, se dividieron al azar en 3 grupos y se aplicó el tramadol por vía s.l. (gotas, media hora antes de concluir la cirugía, a 3 dosis distintas 100 mg (grupo A), 125 mg (grupo B) y 150 mg (grupo C). En el postoperatorio se evaluaron: test de Aldrete, estabilidad hemodinámica, escala visual analógica (E VA), y número de pacientes por grupo, que ameritaron rescates (con tramadol i.v.). Resultados: La distribución poblacional (por razones estrictamente debidas al azar) no fue homogénea. En el grupo C se incluyeron un mayor número de pacientes intervenidos de abdomen superior, sujetos con mayor peso promedio y tiempos anestésico-quirúrgicos más prolongados; todos ellos, factores que influyen negativamente en el control del dolor postoperatorio. Aun así, se encontraron a favor del grupo C diferencias estadísticamente significativas (p < 0,05), con respecto al A y al B, en la EVA, con menores mediciones de dolor, asimismo, menos pacientes del grupo C utilizaron rescates durante las primeras 3 horas postoperatorias .Conclusiones: 1. El clorhidrato de tramadol por vía s.l. es útil para el control del dolor postoperatorio. 2. La dosis que resultó más efectiva fue la de 150 mg (grupo C) (AU)

Factors affecting student program and career selection.

This study uses a national sample of freshman radiography students to examine demographic data and factors that affected career and program choice. The data are discussed in terms of implications for marketing and recruitment strategies.

Cadaver imaging proves valuable learning method.

In evaluating the project as a whole, students expressed feeling greater worthwhileness through participation in a special project. They enjoyed working as a team with faculty in an imaging environment and reported having fun and learning simultaneously. Also, students felt a sense of accomplishment in contributing to medical students' learning by participating in this service experience. This helped reinforce their role in health care and the need for cooperative relationships in medical education and practice. Based on student and faculty perceptions, this learning method is considered a valuable alternative to traditional means of performance practice and clinical education. The project's success is the result of: Its organization to meet the needs of both the service commitment and a learning environment. The motivational nature of a special voluntary experience alternative. The highly interactive and dynamic nature of the imaging sessions. The realistic feedback for performance with opportunity for analysis and improvement. While it is evident that a cadaver resource must exist to make such a project a viable option for radiography programs, those with such a resource should consider integrating it with the more traditional learning methods. Many program sponsors may have similar resources available in their environments for projects that provide imaging services as well as unique learning laboratories for radiography students. Close interaction with health educators and researchers along with creative investigation may reveal opportunities for special projects.

Radiographic measurements of intervertebral foramina of cervical vertebra in forward and normal head posture.

Forward head posture has long since been associated with a number of clinical problems treated by the fields of physical therapy and dentistry. The consistent and longstanding difficulty in the diagnosis and treatment of these conditions has been a lack of a clear understanding of the anatomical and biomechanical conditions that underly forward head posture. It has been reported that there is a narrowing of the cervical interspaces in forward head posture with the greatest change being between C4-5 and C5-6. These observations were made by viewing lateral radiographic films, yet the size of the foramina can only be viewed using oblique views. This study used oblique radiographic views of the intervertebral foramina to determine if there is a difference in the size of the intervertebral foramina in the forward head posture versus the normal head posture. The intervertebral foramina of the cervical vertebra were found to be larger in the forward head posture from levels C3 to T1. These results conflict with previous observations, suggesting that additional research is needed to assist in determining the underlying mechanisms responsible for the pain associated with forward head posture.

Urinary and serum steroid concentrations in the management of congenital adrenal hyperplasia. Lack of physiologic correlations.

Serum concentrations of 17-hydroxyprogesterone, dehydroepiandrosterone, dehydroepiandrosterone sulfate, progesterone, testosterone, and androstenedione and 24-hour excretion of 17-ketosteroids and pregnanetriol were measured serially in 18 children with congenital adrenal hyperplasia (21-hydroxylase deficiency) during a two-year period. Correlations were sought between results of measurements of these steroids and clinical progress assessed by physical examination and skeletal maturity to determine if measurement of concentration of these substances at a single point in time could be used to gauge the dose of corticosteroids for optimum treatment. We found that these measurements of steroids were generally not useful indicators of optimum control of the disease. Repeated careful clinical examination and assessment of changes in growth velocity and skeletal maturation seem to be the best criteria on which to base dosage of corticosteroids used for therapy.

Management of congenital adrenal hyperplasia using serum dehydroepiandrosterone sulfate and 17-hydroxyprogesterone concentrations.

Simultaneous serum concentrations of dehydroepiandrosterone sulfate (DHEA-S) and 17-hydroxyprogesterone (17-OHP) were compared with urinary 17-ketosteroid (17-KS) and pregnanetriol (PT) excretion during therapy in 18 prepubertal patients with the 21-hydroxylase deficiency form of congenital adrenal hyperplasia (CAH). Patients were classified into those in good, poor, or questionable control on the basis of clinical examination, skeletal age, and 17-KS and PT excretion. During therapy, use of serum steroid concentrations was found to be nearly as accurate in judging adequacy of control as use of urine steroid concentrations. Of 34 evaluations, a definite assessment of adequacy of control could be arrived at 25 times using urinary values and 22 times using both serum DHEA-S and 17-OHP concentrations. DHEA-S concentration responded sluggishly when treatment was not adequate, being greater than 100 microgram/dl only in patients significantly undertreated. It was never elevated in well-controlled patients. Mid-afternoon 17-OHP concentrations were less than 200 ng/dl in well-controlled patients but readily escaped suppression and could not be used to differentiate poor from borderline control or from temporary noncompliance. Therefore, an increases DHEA-S concentration indicated poor control and a suppressed 17-OHP concentration indicated good control. The combination of normal DHEA-S level with elevated 17-OHP level, however, did not permit exact evaluation of the degree of control. Of significance is that not all patients with CAH present with an elevated DHEA-S concentration, and only in those in whom an elevated level has been documented can DHEA-S level be used as an index of control during therapy.

Role of adenosine 3', 5'-monophosphate in maturation of fetal lungs.

Fetal lung cyclic AMP phosphodiesterase, cyclic AMP, phosphatidyl choline, and incorporation of precursors into phosphatidyl choline were measured in rabbits after maternal administration of hydrocortisone phosphate and aminophylline. Both agents inhibited lung phosphodiesterase activity and augmented cyclic AMP concentrations (Table 1). Aminophylline administration was associated with a significant increase in lung saturated phosphatidyl choline (Table 2). Incorporation of [14C] choline and [3H] methionine was increased by both aminophylline and hydrocortisone (Table 3).

An action of disodium cromoglycate: inhibition of cyclic 3',5'-AMP phosphodiesterase.

Disodium cromoglycate (DSCG) prevents allergic asthma by inhibiting the release of chemical mediators of immediate-type allergic reactions. The mechanism of this action is unclear and prompted us to examine the effect of DSCG on cyclic adenosine 3',5'-monophosphate (cAMP), the implicated regulator of IgE-mediated reactions. We used the peripheral blood lymphocyte as a model to mirror the biochemical events occurring in the allergic shock organs. Isolated peripheral blood lymphocytes from perennial allergic asthmatic children receiving only DSCG had significantly (p less than 0.005) lower phosphodiesterase (PDE) activity (mean 1.05 +/- 0.17 SE per 10(6) cells) than normal individuals (2.93 +/- 0.14) and allergic children receiving methylxanthines (4.08 +/- 0.28) or no medications (3.58 +/- 0.2). DSCG (10 mug/ml) significantly lowered PDE activity in normal lymphocytes (p less than 0.005) in a beef heart extract (p less than 0.001), and 100 mug/ml lowered PDE activity in fetal rabbit lung homogenates (p less than 0.001). DSCG (10 mug/ml) significantly elevated (p less than 0.01) cAMP concentration in normal human lymphocytes (118 +/- 38 vs 30 +/- 10 picomoles cAMP/10(6) lymphocytes). Thus, DSCG appears to inhibit chemical mediator release by increasing intracellular cAMP through the inhibition of cAMP PDE.

Reversible hypothyroidism in growth hormone-deficient children treated with human growth hormone.

Six children with human growth hormone (hGH) deficiency became hypothyroid during the course of their therapy with hGH. This was accompanied by a decreasing growth rate, clinical symptoms of hypothyroidism and decreased serum T4 concentrations. Three of the 6 patients returned to the euthyroid state, both clinically and biochemically, with cessation of hGH therapy, and reinstitution of hGH precipitated hypothyroidism again in 2 of the three. The patients who remained hypothyroid have evidence of multiple pituitary trophic hormone deficiencies while those who reverted to euthyroidism appear to have isolated hGH deficiency. Evaluation of thyroid function while on hGH showed low T4, free T4 and T3 concentrations. The serum thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH) was absent or markedly blunted in 4 of 6 patients while receiving long-term hGH therapy but was normal or exaggerated in all patients when tested before or after only 5 days of hGH therapy. These data indicate that exogenous hGH results in an inhibition of the TSH response to TRH. The mechanism of this inhibition is unclear, but we postulate that it may be mediated by somatostatin secretion in response to pulse doses of hGH.