RESUMO
BACKGROUND: Treatment of herpes zoster (HZ) includes the use of acyclovir with or without steroids. An alternative therapy is the epidural administration of local anesthetics with or without steroids. This trial compared the efficacy of these two treatment regimens in the prevention of post-herpetic neuralgia (PHN). METHODS: Six hundred adults over 55 years of age with a rash of less than 7 days duration, and severe pain due to HZ, were enrolled and randomized to receive either intravenous acyclovir (10 mg/kg three times daily) for 9 days+prednisolone (60 mg per day with progressive reduction) for 21 days, or 6-12 ml bupivacaine (0.25%) every 6-8 or 12 h+methylprednisolone 40 mg every 3-4 days by epidural catheter during a period ranging from 7 to 21 days. Efficacy was evaluated at 1, 3, 6 and 12 months. PHN was assessed as pain and/or allodynia, and "abnormal sensations" (hypoesthesia, burning, itching, etc.). Statistical analysis was performed based on the intent-to-treat population. RESULTS: In the 485 patients who completed the study, the incidence of pain after 1 year was 22.2% (51 patients of 230) after acyclovir+steroids, and 1.6% (4 patients of 255) after epidural analgesia+steroids. The incidence of abnormal sensations was 12.2% (28 patients) after acyclovir+steroids, and 4.3% (11 patients) in group B. CONCLUSIONS: Epidural administration of local anesthetic and methylprednisolone is significantly more effective in preventing PHN at 12 months compared to intravenous acyclovir and prednisolone.
Assuntos
Aciclovir/uso terapêutico , Analgesia Epidural , Anestésicos Locais/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Antivirais/uso terapêutico , Herpes Zoster/complicações , Metilprednisolona/uso terapêutico , Neuralgia/prevenção & controle , Prednisolona/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neuralgia/fisiopatologia , Medição da Dor , Estudos ProspectivosRESUMO
The Authors, in the debate concerning the most appropriate anesthesiologic treatment in thromboendarterectomy surgery, relate their experience using three different types of general anaesthesia under electroencephalographic monitoring. The results are commented correlating data with some physiopathologic considerations. Carotid surgery, in particular the operation of thromboendarterectomy (TEA), during the last few years has assumed features and frequency typical of a routine procedure. Nevertheless, if from a surgical point of view the criteria of choice of the patients and the surgical techniques have been well standardized, in the anesthesiologic field the discussion between the supporters of the locoregional anaesthesia on one side and of the general anaesthesia on the other side is still open. By this report we mean to bring a contribution to the debate correlating our anesthesiologic files with some physiopathologic notations on the theme.
Assuntos
Anestesia Geral , Eletroencefalografia , Endarterectomia das Carótidas , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Estudos RetrospectivosRESUMO
This controlled study considers the effect of ranitidine, both alone and in association with metoclopramide, on the acidity and volume of the gastric content of 75 patients requiring caesarean section. Ranitidine, when used alone (50 mg intravenously 30-60 minutes before the operation) significantly reduced (p less than 0.01) the acidity (pH greater than 2.5) and the volume (less than 25 ml) of the gastric content of the patient thus treated. Ranitidine in association with metoclopramide may also reduce the pH and the volume, but did not show any significant statistical differences when compared with the use of ranitidine alone.
Assuntos
Metoclopramida/uso terapêutico , Pneumonia Aspirativa/prevenção & controle , Ranitidina/uso terapêutico , Adulto , Anestesia Obstétrica/efeitos adversos , Cesárea , Quimioterapia Combinada , Feminino , Determinação da Acidez Gástrica , Humanos , Concentração de Íons de Hidrogênio , Pneumonia Aspirativa/etiologia , Gravidez , SíndromeAssuntos
Artéria Basilar , Ondas de Rádio , Neuralgia do Trigêmeo/cirurgia , Núcleos do Trigêmeo/cirurgia , Dilatação Patológica/complicações , Dilatação Patológica/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Neuralgia do Trigêmeo/etiologia , Doenças Vasculares/complicações , Doenças Vasculares/diagnóstico por imagem , Artéria Vertebral/diagnóstico por imagemRESUMO
A positive direct antiglobulin test (DAT) and hemolytic anemia are uncommon side effect of cisplatin (CDDP) therapy. A 9-year-old girl treated for extraosseus Ewing's sarcoma with a multiagent regimen, including 200 mg/m2 CDDP preceded by vincristine (VCR) and cyclophosphamide (CY), developed a positive DAT, followed by hemolytic anemia. When CDDP therapy was discontinued, the DAT became negative and no signs of anemia were observed during the maintenance treatment, which included VCR and actinomycin D.