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1.
Am J Emerg Med ; 38(2): 165-172, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-30770244

RESUMO

STUDY OBJECTIVE: To compare analgesic efficacy and safety of intravenous lidocaine and ketorolac combination to each analgesic alone for ED patients with suspected renal colic. METHODS: We conducted a randomized, double-blind trial comparing analgesic efficacy of a combination of intravenous lidocaine (1.5 mg/kg) and ketorolac (30 mg), to ketorolac (30 mg), and to lidocaine (1.5 mg/kg) in patients aged 18-64 presenting to the ED with suspected renal colic. Primary outcome included difference in pain scores between the groups at 30 min. Secondary outcomes included a comparative reduction in pain scores in each group from baseline to 30 and 60 min as well as rates of adverse events and need for rescue analgesia at 30 and 60 min. RESULTS: We enrolled 150 subjects (50 per group). The difference in mean pain scores at 30 min between Lidocaine and Lidocaine/Ketorolac groups was -2.89 (95% CI: -4.39 to -1.39); between Ketorolac and Lidocaine/Ketorolac group was -0.92 (95% CI: -2.44 to 0.61); and between Ketorolac and Lidocaine was -1.98 (95% CI: -3.69 to -0.27). A comparative percentage of subjects in each group required rescue analgesia at 30 and 60 min. No clinically concerning changes in vital signs were observed. No serious adverse events occurred in either group. Commonly reported adverse effects were dizziness, nausea, and headache. CONCLUSION: The administration of intravenous lidocaine/ketorolac combination to ED patients with suspected renal colic results in better analgesia in comparison to lidocaine alone but provides no analgesic advantages over ketorolac alone. Clinicaltrials.gov Registration: NCT02902770.


Assuntos
Combinação de Medicamentos , Cetorolaco/normas , Lidocaína/normas , Cólica Renal/tratamento farmacológico , Administração Intravenosa , Adulto , Analgésicos/normas , Analgésicos/uso terapêutico , Método Duplo-Cego , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Cetorolaco/uso terapêutico , Lidocaína/uso terapêutico , Masculino , Pessoa de Meia-Idade , Manejo da Dor/métodos , Manejo da Dor/normas , Cólica Renal/fisiopatologia
2.
Clin Pract Cases Emerg Med ; 2(1): 67-70, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29849281

RESUMO

We present the case of an 88-year-old female who presented to the emergency department (ED) with suspected massive pulmonary embolism (PE) causing respiratory failure, right heart strain, and shock, who despite early and aggressive resuscitation with vasopressors and continuous peripheral infusion of tissue plasminogen activator (tPA), suffered a cardiac arrest in the ED. We describe the approach of a tPA bolus directed through a central venous catheter, resulting in return of spontaneous circulation and immediate improvement in physiologic parameters prior to confirmation of PE with computed tomography angiogram. We further hypothesize that in patients deemed too unstable to be transferred for embolectomy or catheter-directed thrombolysis, central venous catheter-directed bolus tPA may be more effective than peripheral infusion alone.

5.
Radiology ; 277(2): 607-11, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26492026

RESUMO

A 71-year-old man with a history of atrial fibrillation refractory to medical therapy and lung cancer status after left upper lobectomy presented to our hospital for elective cardioversion and rate control with tikosyn. Overnight, the patient became unresponsive and was found to be in a state of cardiogenic shock. A code was called, and he was stabilized after cardioversion and bedside intubation. His stay in the intensive care unit was complicated by ventilator-associated pneumonia. The patient subsequently underwent multiple failed extubation attempts, requiring two additional reintubations. He was finally extubated 18 days after his initial admission to the intensive care unit. After he was discharged, he reported a hoarse voice and was only able to whisper. His voice varied in timbre and volume, and it became hoarser with use. Otolaryngology evaluation, including laryngoscopy and video stroboscopy, showed immobility of the right vocal cord. He was referred for speech therapy, and a computed tomographic (CT) examination of the neck was ordered.


Assuntos
Cartilagem Aritenoide/diagnóstico por imagem , Cartilagem Aritenoide/lesões , Intubação Intratraqueal/efeitos adversos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/etiologia , Tomografia Computadorizada por Raios X , Paralisia das Pregas Vocais/diagnóstico por imagem , Paralisia das Pregas Vocais/etiologia , Idoso , Diagnóstico Diferencial , Humanos , Laringoscopia , Masculino
6.
Catheter Cardiovasc Interv ; 85(2): 292-6, 2015 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-24905444

RESUMO

Pulmonary vein stenosis (PVS) is a late and rare complication of pulmonary vein isolation for the treatment of atrial fibrillation. The ideal approach to the management of PVS has not yet been established, however, corrective procedures may include both surgical and percutaneous techniques. We describe the case of a complex bifurcation lesion involving the left superior pulmonary vein. The condition required percutaneous intervention using a modified kissing stent technique with bare metal stents that resulted in an excellent post-operative course, sustained symptomatic relief, and uncomplicated 1-year follow-up. © 2014 Wiley Periodicals, Inc.


Assuntos
Angioplastia com Balão/instrumentação , Fibrilação Atrial/cirurgia , Ablação por Cateter/efeitos adversos , Doença Iatrogênica , Veias Pulmonares/cirurgia , Pneumopatia Veno-Oclusiva/terapia , Stents , Fibrilação Atrial/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Veias Pulmonares/diagnóstico por imagem , Veias Pulmonares/fisiopatologia , Pneumopatia Veno-Oclusiva/diagnóstico , Pneumopatia Veno-Oclusiva/etiologia , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
7.
J Proteomics ; 110: 195-7, 2014 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-25150946

RESUMO

Treatment decisions for refractory diseases are frequently challenging because the benefits of disease-free survival and relief of symptoms must be balanced against the severity and frequency of side effects. A precise measure of disease resistance would therefore be valuable when assessing possible treatment strategies. In recent years there has been much interest in the modeling of proteomes and genomes as a means of identifying major pathways of disease causation. We suggest that these analyses may offer the additional benefit of quantifying refractory.


Assuntos
Doença Crônica , Genoma/genética , Modelos Genéticos , Proteoma/genética , Transdução de Sinais/genética , Humanos
8.
Nanomaterials (Basel) ; 2(3): 217-250, 2012 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-28348305

RESUMO

This review examines the role of membrane rafts in neural disease as a rationale for drug targeting utilizing lipid-based nanoparticles. The article begins with an overview of methodological issues involving the existence, sizes, and lifetimes of rafts, and then examines raft function in the etiologies of three major neural diseases-epilepsy, Parkinson's disease, and Alzheimer's disease-selected as promising candidates for raft-based therapeutics. Raft-targeting drug delivery systems involving liposomes and solid lipid nanoparticles are then examined in detail.

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