ABSTRACT
Dental anesthesia is one of the most frequently performed medical procedures. Although the frequency of ocular complications is extremely low, these reactions can be highly alarming and may bring up medicolegal issues when they do occur. Dentists and oral surgeons should be well-informed of these adverse reactions and should be aware that both ophthalmologists and emergency physicians might be required to care for these patients.
Subject(s)
Anesthesia, Dental/adverse effects , Anesthesia, Local/adverse effects , Anesthetics, Local/adverse effects , Carticaine/adverse effects , Diplopia/etiology , Epinephrine/adverse effects , Ophthalmoplegia/etiology , Tooth Extraction , Adult , Anesthesia, Dental/methods , Anesthesia, Local/methods , Anesthetics, Local/administration & dosage , Carticaine/administration & dosage , Epinephrine/administration & dosage , HumansABSTRACT
BACKGROUND: Massive antibiotic use in intensive care units (ICU) is associated with increased microbial resistance. Therefore avoiding unneccesary antibiotic usage is essential. To achieve a more considered antibiotic prescribing practice, a new antibiotic policy was implemented at our ICU. In this paper, we evaluated the impact of this intervention, and described the aetiology and incidence of blood stream infections and selected antibiotic-resistant pathogens. MATERIALS AND METHODS: In November 2002, a local antibiotic management program (LAMP) was implemented. This included a new infectious diseases specialist consultation service and restricted authorisation to prescribe antibiotics. The effect on ward-level antibiotic use was examined by segmented regression analysis. Patient, ICU and microbiology data were also recorded and compared before and after policy implementation. RESULTS: The patient populations and the subsequent mortality rate were comparable before and after the implementation of the policy. Total antibiotic consumption was markedly reduced from 162.9 to 101.3 defined daily dose (DDD) per 100 patients, and per day (DDD per 100 patient-days). This was mainly accounted for a reduction in the use of quinolones, aminoglycosides, glycopeptides, metronidazol, carbepenems and third generation cephalosporins. CONCLUSION: This study has confirmed that establishing a targeted LAMP, based on close co-operation between intensive care physicians and infectious disease specialists together with a restricted prescribing authority, can reduce the use of antibiotics.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Drug Utilization , Intensive Care Units , Practice Patterns, Physicians' , Program Evaluation , Surgery Department, Hospital , Bacteremia/drug therapy , Bacteremia/epidemiology , Bacteremia/microbiology , Bacteremia/mortality , Drug Resistance, Microbial , Drug Utilization/standards , Drug Utilization/statistics & numerical data , Fungemia/drug therapy , Fungemia/epidemiology , Fungemia/microbiology , Fungemia/mortality , Humans , Hungary/epidemiology , Incidence , Intensive Care Units/standards , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians'/statistics & numerical data , Regression Analysis , Surgery Department, Hospital/standardsABSTRACT
BACKGROUND: The combination of laser Doppler flowmetry and non-invasive blood pressure monitoring allows the continuous observation of cutaneous vascular resistance (CVR). Continuous recording of unmodulated skin blood flow (SBF) is very sensitive to artefacts, rendering the method unreliable. In contrast, intermittent short lasting challenges of the CVR by cardiovascular autonomic reflexes may provide information about the responsiveness of the sympathetic nervous system in the skin. METHODS: Eleven patients with below-wrist hand surgery (six males and five females; aged 35.2+/-7.1 years) performed Valsalva maneuver following axillary blockade. Skin blood flow was continuously monitored on the forearm of the side axillary blockade, as well as on the contra-lateral forearm, which was used as the control. The responses were expressed as changes compared with the baseline level derived from a resting period of 30 s. The maximal change in CVR was determined during the late strain phase of the Valsalva maneuver on both sides. For numerical comparison the change in CVR on the axillary blockade and control sides were simultaneously calculated. RESULTS: During the Valsalva maneuver a significant increase in CVR was observed on the control side with a maximum value during the late strain phase (baseline 0.18+/-0.1 and late strain phase 0.42+/-0.2 relative units; P<0.01). In contrast, only minimal changes were detected on the side of axillary blockade in CVR (baseline 0.17+/-0.8 and late strain 0.16+/-0.2 relative units; P=NS). CONCLUSIONS: Our findings support the disputed hypothesis that the human skin microvasculature is involved in baroreflex regulation under thermoneutral conditions. The determination of baroreflex stimulus-induced microvascular responses may serve as a feasible method for monitoring the effectiveness of sympathetic blockade.
Subject(s)
Autonomic Nerve Block , Baroreflex/physiology , Brachial Plexus , Skin/blood supply , Vascular Resistance , Adult , Blood Flow Velocity , Blood Pressure , Electrocardiography , Female , Forearm , Hand/surgery , Heart Rate , Humans , Laser-Doppler Flowmetry , Male , Microcirculation/physiology , Middle Aged , Monitoring, Intraoperative , Skin/innervation , Valsalva ManeuverABSTRACT
Menopause and related symptoms are direct consequences of insufficient ovarian oestrogen production. During the last two centuries women life expectancy increased from 48 to 79 in developed countries resulting a 20 years periods without proper hormone support. Extraovarian steroid production and its effects are presented. The role of hormone replacement therapy (HRT) and locally aviable products discussed.
