Exploring the impact of pain management programme attendance on complex regional pain syndrome (CRPS) patients’ decision making regarding immunosuppressant treatment to manage their chronic pain condition

2020 ◽  
Vol 20 (4) ◽  
pp. 707-716
Author(s):  
Calum Murray ◽  
Samantha Harrison ◽  
Andreas Goebel ◽  
Hannah Twiddy
Keyword(s):  
Decision Making ◽  
Chronic Pain ◽  
Pain Management ◽  
Treatment Options ◽  
Pain Syndrome ◽  
Management Programme ◽  
Chronic Pain Condition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

AbstractObjectivesComplex regional pain syndrome (CRPS) is a rare chronic pain condition for which no curative treatment exists. Patients in tertiary centres are often required to make decisions about treatment options. This study was conducted to explore how prior attendance of a pain management program might alter patients’ decision making processes.MethodsThis qualitative study uses focus groups to gather patient views on an immunosuppressant drug treatment (mycophenolate) for the management of CRPS. Participants were allocated to one of three focus groups based on their treatment journey; Group 1 (n=3) were involved in a recent mycophenolate drug trial; Group 2 (n=5) were neither involved in the trial nor attended a Pain Management Programme (PMP); Group 3 (n=6) were not involved in the trial but had attended a PMP. Outcomes were considered within the framework of Leventhal’s Common Sense Model (CSM) in relation to the decision making process.ResultsThematic analysis identified differing themes for each group. Group 1: (1) Medication as a positive form of treatment, (2) The trial/drug and (3) Pacing. Group 2: (1) Medication as form of treatment, (2) Other forms of support/treatment and (3) Side effects of mycophenolate. Group 3: (1) Varied view of medication, (2) Consideration of other forms of support and (3) Side effects.ConclusionsAttendance on a PMP might provide patients with skills to better manage uncertainty when faced with various treatment options. Leventhal’s model goes some way to explaining this. The specific importance of, and benefit from understanding pacing when commencing an effective drug treatment for chronic pain became apparent.

scholarly journals NEUROTRANSMITTER IMBALANCES AND PSYCHOLOGICAL DYSFUNCTIONS AS PREDICATIVE FACTORS OF POSTOPERATIVE CHRONIC PAIN SYNDROME IN OPERATIVE GYNECOLOGY CENTER

2020 ◽  
pp. 48-56
Author(s):  
L.N. Gumenyuk ◽  
L.I. Seytumerova ◽  
A.A. Serafimova ◽  
A.V. Yatsiv
Keyword(s):  
Chronic Pain ◽  
Postoperative Pain ◽  
Visual Analogue Scale ◽  
Analogue Scale ◽  
Depressive Disorders ◽  
Pain Syndrome ◽  
Chronic Pain Syndrome ◽  
Chronic Postoperative Pain ◽  
Group 2 ◽  
Group 1

Chronic postoperative pain is one of the urgent medical and social problems of operative gynecology. The problem is preconditioned by a high prevalence rate, a significant impact on the outcomes of operative therapy and, as a consequence, patients’ quality of life. The goal of the paper is to study the role of preoperative neurotransmitter and psychoemotional dysfunctions in the development of postoperative chronic pain syndrome in an operative gynecology center. Materials and Methods. The study enrolled 156 patients aged 18–45 years who underwent planned surgical treatment for gynecological pathology. Patients were subsequently divided into 2 groups: Group 1 – women with postoperative chronic pain syndrome; Group 2 – women without chronic postoperative pain syndrome. The authors conducted general clinical examination, and also determined the levels of g-aminobutyric acid and β-endorphin in serum of patients using enzyme-linked immunosorbent assay. A visual analogue scale was used to assess quantitative characteristics of pain syndrome. Qualitative characteristics of pain syndrome were assessed according to the McGill Pain Questionnaire. HAM-A and HDRS were used to assess psychoemotional state. Results. Postoperative chronic pain was observed in 39.7 % of patients 12 months after surgery. In the preoperative period, a pain syndrome was registered in all patients. However, there were no significant intergroup differences in its severity. Statistically significant predominance of the affective scale indicators was revealed in the pain syndrome structure in Group 1, while Group 2 demonstrated predominance of the sensory scale indicators (p=0.003). Group 1 demonstrated more pronounced changes in GABA and β-endorphin levels. An inverse correlation was found between the level of β-endorphin and the affective and evaluative McGill questionnaire scales. Various affective pathologies were verified in Group 1. However, depressive disorders dominated. Group 2 demonstrated only subdepression and individual clinically unformed anxiety symptoms. The authors found out depressive disorder correlation with the severity of preoperative pain syndrome according to visual-analogue scale, McGill questionnaire affective scale, and β-endorphin concentration. Conclusion. Neurotransmitter disorders and psychological dysfunctions affect the formation of postoperative chronic pain syndrome. There is a correlation between chronic postoperative pain syndrome, preoperative β-endorphin concentration (r=-0.70; p=0.028), and the severity of depressive disorders (r=0.65; p=0.012), which confirms their role as non-specific prognostic markers while monitoring the postoperative chronic pain syndrome. Keywords: gynecological pathology, postoperative chronic pain syndrome, neurotransmitters, affective disorders. Хроническая послеоперационная боль – одна из актуальных медико-социальных проблем оперативной гинекологии, что обусловлено высоким уровнем распространенности, значительным влиянием на исходы хирургического лечения и, как следствие, качество жизни пациентов. Цель – изучение роли предоперационных нейромедиаторных и психоэмоциональных дисфункций в формировании хронического послеоперационного болевого синдрома в клинике оперативной гинекологии. Материалы и методы. В исследовании приняли участие 156 больных в возрасте от 18 до 45 лет, которым выполнено плановое хирургическое лечение по поводу гинекологической патологии. Пациенты в последующем были разделены на 2 группы: 1-я – женщины с хроническим послеоперационным болевым синдромом; 2-я – пациентки без хронического послеоперационного болевого синдрома. Наряду с общеклиническим обследованием c помощью иммуноферментного анализа определяли уровень кислоты и β-эндорфина в сыворотке крови. С целью оценки количественной характеристики боли применяли визуальную аналоговую шкалу, качественной – болевой опросник McGill, для оценки психоэмоционального статуса – клиническую шкалу HAM-A и HDRS. Результаты. Спустя 12 мес. после оперативного вмешательства хронический послеоперационный болевой синдром наблюдался у 39,7 % обследованных. В предоперационном периоде у всех обследованных отмечался болевой синдром, при этом достоверных межгрупповых различий его интенсивности не выявлено. В структуре болевого синдрома у пациенток 1-й группы выявлено статистически значимое преобладание показателей аффективной шкалы, у женщин 2-й группы – сенсорной (p=0,003). У пациенток 1-й группы изменения уровней ГАМК и β-эндорфина носили более выраженный характер. Установлена обратная корреляционная связь уровня β-эндорфина с показателями аффективной и эвалюативной шкал опросника McGill. Аффективная патология различной степени выраженности верифицирована у всех больных 1-й группы. В структуре преобладали депрессивные нарушения. У пациенток 2-й группы наблюдались лишь субдепрессивные состояния и отдельные, клинически не оформленные симптомы тревоги. Установлены корреляции депрессивных расстройств c выраженностью предоперационного болевого синдрома по визуально-аналоговой шкале, аффективной шкалой опросника McGill, концентрацией β-эндорфина. Выводы. Нейромедиаторные и психологические дисфункции влияют на формирование послеоперационного хронического болевого синдрома. Установлена связь между хроническим послеоперационным болевым синдромом и предоперационными значениями концентрации β-эндорфина (r=-0,70; p=0,028), выраженностью депрессивных расстройств (r=0,65; p=0,012), что подтверждает их роль как неспецифических прогностических маркеров при мониторинге формирования послеоперационного хронического болевого синдрома. Ключевые слова: гинекологическая патология, хронический послеоперационный болевой синдром, нейромедиаторы, аффективные расстройства.

scholarly journals Neuropeptide system parameters in acute herpes zoster

2020 ◽  
Vol 10 (2) ◽  
pp. 329-337
Author(s):  
S. V. Knysh ◽  
E. V. Markelova ◽  
A. I. Simakova ◽  
A. V. Karaulov
Keyword(s):  
Herpes Zoster ◽  
Basic Protein ◽  
Neuron Specific Enolase ◽  
Pain Syndrome ◽  
Study Groups ◽  
Control Group ◽  
Group 3 ◽  
Group 2 ◽  
Protein S100b ◽  
Group 1

The neuropeptides comprise an important part in the nervous system interacting with endocrine and immune systems. Peptide regulators are responsible for the continuity of communicating elements, which support homeostasis, however, despite abundant research examining neuropeptides, not all specific mechanisms and features of interacting proteins with cells and immune components have been uncovered. Objective: to perform a comprehensive assessment of neuropeptide system in patients with herpes zoster. Materials and methods: 106 in-hospital patients were examined diagnosed with herpes zoster within 2016–2019 period. Control group consisted of 30 healthy age- and sex-matched volunteers. Blood serum was collected after verifying diagnosis on day 1. After discharge, patients were monitored for signs of pain syndrome and overall state within 3 months. It allowed to divide patients into 3 groups retrospectively. Group 1 — patients with herpes zoster, accompanied by mild or moderate pain syndrome; group 2 — patients with herpes zoster, accompanied by severe pain; group 3 — patients with herpes zoster, complicated by postherpetic neuralgia. Level of serum protein s100B, myelin basic protein, nerve growth factor, brain-derived neurotrophic factor, neuron specific enolase was measured by using specific reagents purchased from “R&D Diagnostics Inc.” (США). Results. it was found that level of serum protein S100B in all groups was significantly increased compared to control group, showing no inter-group differences. Amount of myelin basic protein in all study groups vs. control was significantly higher. Moreover, level of these parameters in group 2 vs. group 1 and 3 was significantly elevated. In addition, level of nerve growth factor was significantly increased in group 1 vs. groups 2 and 3, whereas in group 3 it was significantly lower than in control and group 2. Brain-derived neurotrophic factor was significantly decreased in all the study groups compared to control, showing no significant intergroup differences. Level of neuron-specific enolase was significantly increased in group 3 vs. control as well as group 1 and 2. The data obtained allowed to identify two parameters for assessing a risk of postherpetic neuralgia in acute herpes zoster, as well as provided deeper insights into the pathogenesis of neuroimmune disorders accompanying herpes zoster.

scholarly journals Compensated hypothyroidism and statin administration: symptoms of muscle damage and muscle metabolism disorders.

2020 ◽  
Author(s):  
Liya Lugovaya ◽  
Tatyana Necrasova ◽  
Leonid Strongin ◽  
Natalya Belyaeva
Keyword(s):  
Muscle Damage ◽  
Muscle Pain ◽  
Muscle Metabolism ◽  
Pain Syndrome ◽  
Control Groups ◽  
Group 3 ◽  
Group 2 ◽  
Tsh Levels ◽  
Additional Monitoring ◽  
Group 1

Abstract There is no unequivocal opinion regarding the safety of statin in patients with hypothyroidism. However, based on some new data, it can be assumed that hypothyroidism, even in a stage of compensation, may cause muscle damage in patients receiving statins. As part of this study, this hypothesis was tested, and was confirmed. Aim To study the possibility of muscle damage and the nature of muscle metabolism in patients with compensated hypothyroidism who takes statin. Materials and methods The study is transverse and observational with the inclusion of 120 women, subdivided on three groups (n=40). The main group of patients with hypothyroidism who took statins (group 1) was compared with two control groups, including those who took statins without hypothyroidism (group 2), and who did not take statins with hypothyroidism (group 3). Results Patients taking statins and have compensated hypothyroidism are more likely to develop complaints of muscle pain, which are often associated with the elevation of muscle lesion markers, as well as the presence of the C allele in the SLCO1B1 * 5 gene (c.521T C). In patients with compensated hypothyroidism, relative frequency of occurrence of muscle pain syndrome associated with CPK elevation increases with TSH levels above 2.86 mU / L. Compensated hypothyroidism increases the possibility of development of SPM-ATP by 2.7 times. Conclusions Compensated hypothyroidism is not a contraindication for statin therapy. However, the presence of even compensated hypothyroidism in patients taking statins increases the possibility of the development of muscle symptoms associated with taking statins, and requires additional monitoring of the clinical and biochemical parameters of muscle metabolism (especially the level of CPK).

scholarly journals Systematic Review of the Effect of Taping Techniques on Patellofemoral Pain Syndrome

2017 ◽  
Vol 9 (5) ◽  
pp. 456-461 ◽  
Author(s):  
Catherine A. Logan ◽  
Abhiram R. Bhashyam ◽  
Ashley J. Tisosky ◽  
Daniel B. Haber ◽  
Anna Jorgensen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Syndrome ◽  
Patellofemoral Pain Syndrome ◽  
Patellofemoral Pain ◽  
Exercise Group ◽  
Level Of Evidence ◽  
Comparison Groups ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Context: Taping is commonly used in the management of several musculoskeletal conditions, including patellofemoral pain syndrome (PFPS). Specific guidelines for taping are unknown. Objective: To investigate the efficacy of knee taping in the management of PFPS. Our hypothesis was that tension taping and exercise would be superior to placebo taping and exercise as well as to exercise or taping alone. Data Sources: The PubMed/MEDLINE, Cochrane, Rehabilitation and Sports Medicine Source, and CINAHL databases were reviewed for English-language randomized controlled trials (RCTs) evaluating the efficacy of various taping techniques that were published between 1995 and April 2015. Keywords utilized included taping, McConnell, kinesio-taping, kinesiotaping, patellofemoral pain, and knee. Study Selection: Studies included consisted of RCTs (level 1 or 2) with participants of all ages who had anterior knee or patellofemoral pain symptoms and had received nonsurgical management using any taping technique. Study Design: Systematic review. Level of Evidence: Level 2. Data Extraction: A checklist method was used to determine selection, performance, detection, and attrition bias for each article. A quality of evidence grading was then referenced using the validated PEDro database for RCTs. Three difference comparison groups were compared: tension taping and exercise versus placebo taping and exercise (group 1), placebo taping and exercise versus exercise alone (group 2), and tension taping and exercise versus taping alone (group 3). Results: Five RCTs with 235 total patients with multiple intervention arms were included. Taping strategies included McConnell and Kinesiotaping. Visual analog scale (VAS) scores indicated improvement in all 3 comparison groups (group 1: 91 patients, 39% of total, mean VAS improvement 44.9 [tension taping + exercise] vs 66 [placebo taping + exercise]; group 2: 56 patients, 24% of total, mean VAS improvement 66 [placebo taping + exercise] vs 47.6 [exercise alone]; and group 3: 112 patients, 48% of total, mean VAS improvement 44.9 [tension taping + exercise] vs 14.1 [taping alone]). Conclusion: This systematic review supports knee taping only as an adjunct to traditional exercise therapy for PFPS; however, it does not support taping in isolation.

scholarly journals Extended Salvage Pelvic Lymph Node Dissection in Patients with Recurrent Prostate Cancer

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Daniar K. Osmonov ◽  
Alexey V. Aksenov ◽  
Annkathrin Boller ◽  
Almut Kalz ◽  
Diana Heimann ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radical Prostatectomy ◽  
Initial Treatment ◽  
Treatment Options ◽  
Adjuvant Radiation ◽  
Multicenter Studies ◽  
Group 3 ◽  
Group 2 ◽  
Lymph Nodes Dissection ◽  
Group 1

Background. Treatment of patients with a biochemical recurrence (BCR) of prostate cancer (PCa) is generally difficult and without valid treatment options. Since 2004 we have been developing therapeutic possibilities for these patients.Methods. We retrospectively analyzed a cohort of 41 patients with a BCR of PCa and a mean followup of40.3±20.8months. Group 1 (n=10): salvage radical prostatectomy (sRP) with SePLND (salvage extended pelvic lymph nodes dissection) (initial treatment: combined brachytherapy). Group 2 (n=22): SePLND (initial treatment: radical prostatectomy (RP)). Group 3 (n=9): SePLND (initial treatment: RP and adjuvant radiation therapy (RT)). We observed PSA, PSA-velocity, localization of LNs and LNs+, BCR-free period, and BR (biochemical response).Results. Group 1: 60% with BCR-freedom (mean 27.2 months). Group 2: 63.6% with BCR-freedom (mean 17.5 months). Group 3: 33.3% with BCR-freedom (mean 17.6 months). In total, BCR-freedom was observed in 23 of 41 patients (56.1%) after salvage surgery. 75.6% of all patients showed a BR. 765 LNs were removed and 14.8% of these were LN+.Conclusions. The BCR-free period and BR are comparable in all three groups. Sensibility to ADT can be reestablished and prolonged as a result of SePLND. Multicenter studies are needed for a reliable output.

Liposomal Bupivacaine Utilization in Total Knee Replacement Does Not Decrease Length of Hospital Stay

2018 ◽  
Vol 32 (09) ◽  
pp. 934-939 ◽  
Author(s):  
Grace Schumer ◽  
John W. Mann ◽  
Matthew David Stover ◽  
John F. Sloboda ◽  
Carol Sue Cdebaca ◽  
...  
Keyword(s):  
Pain Management ◽  
Total Knee Replacement ◽  
Wound Infiltration ◽  
Liposomal Bupivacaine ◽  
Pain Scores ◽  
Perioperative Pain Management ◽  
Total Knee ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

AbstractLiposomal bupivacaine has reportedly been used as an adjunct for perioperative pain management in total knee replacement (TKR). The purpose of our single-blind, prospective study is to show that wound infiltration with long-acting liposomal bupivacaine during TKR will shorten length of stay (LOS) as compared with standard bupivacaine injection and spinal anesthetic with or without spinal narcotic. A total of 195 patients were randomized into three groups: wound infiltration with bupivacaine and a spinal with narcotic (Group 1, N = 65), wound infiltration with liposomal bupivacaine and a spinal without narcotic (Group 2, N = 67), and bupivacaine wound infiltration with a spinal without narcotic (Group 3, N = 64). The groups were then compared with look for any benefit in using the liposomal bupivacaine with regard to LOS, pain control, function, and complications. There was a trend toward a decreased LOS (days) in the liposomal bupivacaine (Group 2) with a mean LOS of 1.83 as compared with wound infiltration with bupivacaine with spinal narcotic LOS of 2.04 (Group 1) and without spinal narcotic LOS of 1.94 (Group 3). These results were not statistically significant (p = 0.37). Patient-reported pain scores were no different between the three groups. The daily narcotic usage (morphine equivalents) during the hospitalization was statistically highest in the liposomal bupivacaine group at 77.2 versus 55.0 in Group 1 and 68.1 in Group 3 (p = 0.025). Nausea or vomiting was most common in Group 1 at 42%, followed by 28% in Group 2 and 22% in Group 3. Pruritus was most common in the spinal narcotic group at 38% versus Group 2 at 14% and Group 3 at 11%.Liposomal bupivacaine showed a trend toward a decreased LOS, but this was not statistically significant. There was no difference in pain scores reported by these patients. In conclusion, we cannot justify the extra cost of liposomal bupivacaine as compared with plain bupivacaine as an adjunct for perioperative pain management in TKR patients.

Efficacy of enterosorption in comprehensive treatment for lambliasis in children

2020 ◽  
Vol 15 (5) ◽  
pp. 93-101
Author(s):  
V.P. Novikova ◽  
◽  
A.P. Listopadova ◽  
A.E. Blinov ◽  
◽  
...  
Keyword(s):  
Key Words ◽  
Treatment Regimen ◽  
Therapy Group ◽  
Pain Syndrome ◽  
Key Words Children ◽  
Control Group ◽  
Comprehensive Treatment ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective. To evaluate the efficacy of Zosterin-Ultra enterosorbent in comprehensive treatment of children with lambliasis. Patients and methods. This study included 60 children with lambliasis aged between 3 and 17 years. Patients were divided into 3 groups depending on their therapy. Group 1 included 20 children who received Zosterin-Ultra-30% plus albendazole; Group 2 was composed of 20 children who received Zosterin-Ultra-60% plus albendazole; and Group 3 (control group) comprised 20 children who received albendazole alone. Results. All children who received Zosterin-Ultra had their pain syndrome completely eliminated and asthenic complaints subsided. The inclusion of enterosorbents into the treatment regimen also eliminated flatulence and normalized appetite. Conclusion. Our findings allow us to recommend Zosterin-Ultra as a part of comprehensive treatment for lambliasis in children. Key words: children, Zosterin-Ultra, lambliasis, fecal ELISA for lamblia, enterosorption

In-vivo evaluation of the effect of cyanoacrylate on prosthetic vascular graft infection – does cyanoacrylate increase the severity of infection?

VASA ◽  
2020 ◽  
Vol 49 (4) ◽  
pp. 281-284
Author(s):  
Atıf Yolgosteren ◽  
Gencehan Kumtepe ◽  
Melda Payaslioglu ◽  
Cuneyt Ozakin
Keyword(s):  
Vascular Graft ◽  
Graft Infection ◽  
Vascular Graft Infection ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Prosthetic Vascular Graft Infection ◽  
Group 1

Summary. Background: Prosthetic vascular graft infection (PVGI) is a complication with high mortality. Cyanoacrylate (CA) is an adhesive which has been used in a number of surgical procedures. In this in-vivo study, we aimed to evaluate the relationship between PVGI and CA. Materials and methods: Thirty-two rats were equally divided into four groups. Pouch was formed on back of rats until deep fascia. In group 1, vascular graft with polyethyleneterephthalate (PET) was placed into pouch. In group 2, MRSA strain with a density of 1 ml 0.5 MacFarland was injected into pouch. In group 3, 1 cm 2 vascular graft with PET piece was placed into pouch and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. In group 4, 1 cm 2 vascular graft with PET piece impregnated with N-butyl cyanoacrylate-based adhesive was placed and MRSA strain with a density of 1 ml 0.5 MacFarland was injected. All rats were scarified in 96th hour, culture samples were taken where intervention was performed and were evaluated microbiologically. Bacteria reproducing in each group were numerically evaluated based on colony-forming unit (CFU/ml) and compared by taking their average. Results: MRSA reproduction of 0 CFU/ml in group 1, of 1410 CFU/ml in group 2, of 180 200 CFU/ml in group 3 and of 625 300 CFU/ml in group 4 was present. A statistically significant difference was present between group 1 and group 4 (p < 0.01), between group 2 and group 4 (p < 0.01), between group 3 and group 4 (p < 0.05). In terms of reproduction, no statistically significant difference was found in group 1, group 2, group 3 in themselves. Conclusions: We observed that the rate of infection increased in the cyanoacyrylate group where cyanoacrylate was used. We think that surgeon should be more careful in using CA in vascular surgery.

The influence of continuous local wound infusion on postoperative pain in patients undergoing transfemoral amputation

VASA ◽  
2015 ◽  
Vol 44 (5) ◽  
pp. 381-386 ◽  
Author(s):  
Christian Uhl ◽  
Thomas Betz ◽  
Andrea Rupp ◽  
Markus Steinbauer ◽  
Ingolf Töpel
Keyword(s):  
Pain Management ◽  
Pilot Study ◽  
Local Anaesthetic ◽  
Phantom Pain ◽  
Transfemoral Amputation ◽  
Postoperative Wound ◽  
Stump Pain ◽  
Management Protocol ◽  
Group 2 ◽  
Group 1

Abstract. Summary: Background: This pilot study was set up to examine the effects of a continuous postoperative wound infusion system with a local anaesthetic on perioperative pain and the consumption of analgesics. Patients and methods: We included 42 patients in this prospective observational pilot study. Patients were divided into two groups. One group was treated in accordance with the WHO standard pain management protocol and in addition to that received a continuous local wound infusion treatment (Group 1). Group 2 was treated with analgesics in accordance with the WHO standard pain management protocol, exclusively. Results: The study demonstrated a significantly reduced postoperative VAS score for stump pain in Group 1 for the first 5 days. Furthermore, the intake of opiates was significantly reduced in Group 1 (day 1, Group 1: 42.1 vs. Group 2: 73.5, p = 0.010; day 2, Group 1: 27.7 vs. Group 2: 52.5, p = 0.012; day 3, Group 1: 23.9 vs. Group 2: 53.5, p = 0.002; day 4, Group 1: 15.7 vs. Group 2: 48.3, p = 0.003; day 5, Group 1 13.3 vs. Group 2: 49.9, p = 0.001). There were no significant differences between the two groups, neither in phantom pain intensity at discharge nor postoperative complications and death. Conclusions: Continuous postoperative wound infusion with a local anaesthetic in combination with a standard pain management protocol can reduce both stump pain and opiate intake in patients who have undergone transfemoral amputation. Phantom pain was not significantly affected.

Abnormal Haemostasis and Blood Viscosity in Malignant Hypertension

1984 ◽  
Vol 52 (03) ◽  
pp. 253-255 ◽  
Author(s):  
C Isles ◽  
G D O Lowe ◽  
B M Rankin ◽  
C D Forbes ◽  
N Lucie ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Viscosity ◽  
Renal Damage ◽  
Antithrombin Iii ◽  
Plasma Viscosity ◽  
Malignant Hypertension ◽  
Fibrin Deposition ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

SummaryWe have previously shown abnormalities of haemostasis suggestive of intravascular coagulation in patients with malignant hypertension, a condition associated with retinopathy and renal fibrin deposition. To determine whether such abnormalities are specific to malignant hypertension, we have measured several haemostatic and haemorheological variables in 18 patients with malignant hypertension (Group 1), 18 matched healthy controls (Group 2), and 18 patients with non-malignant hypertension (Group 3) matched for renal pathology, blood pressure and serum creatinine with Group 1. Both Groups 1 and 3 had increased mean levels of fibrinogen, factor VIIIc, beta-thrombo- globulin, plasma viscosity and blood viscosity (corrected for haematocrit); and decreased mean levels of haematocrit, antithrombin III and platelet count. Mean levels of fast antiplasmin and alpha2-macroglobulin were elevated in Group 1 but not in Group 3. We conclude that most blood abnormalities are not specific to malignant hypertension; are also present in patients with non-malignant hypertension who have similar levels of blood pressure and renal damage; and might result from renal damage as well as promoting further renal damage by enhancing fibrin deposition. However increased levels of fibrinolytic inhibitors in malignant hypertension merit further investigation in relation to removal of renal fibrin.

Sign in / Sign up

Export Citation Format

Share Document