Asunto(s)
Infecciones por Acinetobacter/tratamiento farmacológico , Acinetobacter baumannii , Antibacterianos/uso terapéutico , Colistina/uso terapéutico , Meningitis Bacterianas/tratamiento farmacológico , Infecciones por Acinetobacter/líquido cefalorraquídeo , Infecciones por Acinetobacter/microbiología , Antibacterianos/administración & dosificación , Colistina/administración & dosificación , Humanos , Hidrocefalia/líquido cefalorraquídeo , Hidrocefalia/complicaciones , Recién Nacido , Inyecciones Intraventriculares , Imagen por Resonancia Magnética , Masculino , Meningitis Bacterianas/líquido cefalorraquídeo , Meningitis Bacterianas/microbiologíaAsunto(s)
Analgésicos/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Toracotomía , Analgesia Controlada por el Paciente , Analgésicos/administración & dosificación , Analgésicos Opioides/uso terapéutico , Anestesia de Conducción , Niño , Humanos , Morfina/uso terapéutico , Dolor Postoperatorio/fisiopatologíaRESUMEN
BACKGROUND: Essential erythermalgia is a rare acrosyndrome that is difficult to treat. Herein, we report a new case unusual in terms of both the associated partial epileptic seizures and of the favourable outcome achieved through antiepileptic treatment with oxcarbazepine. PATIENTS AND METHODS: A male adolescent born of a non-consanguineous marriage had been followed since the age of 5 years for essential erythermalgia. A number of different treatments had been tried in succession but without success: beta blockers, acetylsalicylic acid, paracetamol and indomethacin. At the age of 15 years, the patient presented serious depression requiring antidepressant therapy with sertraline. Seven days after the start of this medication, the patient presented temporal partial epileptic seizures confirmed by electroencephalogram. The antidepressant was stopped and a new-generation antiepileptic, oxcarbazepine, was instituted. The epileptic seizures subsided and so too did the paroxysmal pain associated with erythermalgia, in addition to which the patient's skin lesions improved. This therapeutic efficacy has persisted for 21 months. DISCUSSION: The novelty of this case report concerns the association of essential erythermalgia and epilepsy and the favourable outcome achieved with antiepileptic therapy. It may well be that the patient's erythermalgia and epilepsy were both responsive to sodium channel therapy, as described with gene SCN9A disorders; however, this point could not be checked in the present case. In practice, we feel there are grounds for use of oxcarbazepine as an alternative treatment in the management of essential erythermalgia.
Asunto(s)
Anticonvulsivantes/uso terapéutico , Carbamazepina/análogos & derivados , Eritromelalgia/tratamiento farmacológico , Adolescente , Antidepresivos/uso terapéutico , Carbamazepina/uso terapéutico , Depresión/tratamiento farmacológico , Depresión/etiología , Eritromelalgia/genética , Eritromelalgia/psicología , Enfermedades del Pie/tratamiento farmacológico , Humanos , Masculino , Canal de Sodio Activado por Voltaje NAV1.7 , Oxcarbazepina , Canales de Sodio/genéticaRESUMEN
The anesthesia for sismotherapy is characterized by its briefness and repetitiveness, resulting in several imperatives: anesthesia of short duration, deep narcosis with muscular relaxation and ambulatory character. Thus anesthesic drugs should have a fast onset of action, in order to obtain a rapid and as alert as possible post anesthesia awakening. The objective of this study is to compare two anesthesic drugs: propofol versus thiopentone. We included in this study patients referred to our unit by the psychiatric service for sismotherapy, which was carried on under general anesthesia in the awakening room of the anesthesia department of Ibn Rochd University hospital. 7 of our patients received sismotherapy for schizophrenia, 2 for acute mania and 1 for suicidal depression. A total of 40 sessions of sismotherapy were analyzed, distributed in two groups: group I (n = 20): benefitted of a general anesthesia by thiopentone, the dose was 2 to 3 mg/kg; group II (n = 20): benefitted of general anesthesia by propofol, the dose was 1 to 1.5 mg/kg. Sismotherapy was carried out only once narcosis was considered as deep. To monitor our patients we used electrocardioscope and pulpe oxymeter. We evaluated the quality and especially the time of onset of anesthesia, its duration, the quality of narcosis, the degree of muscular relaxation, respiratory and cardiovascular parameters as well as side effect linked to anesthesia drugs and sismotherapy. Analysis of the results showed that the quality of anesthesia was excellent for both groups. The necessary dose for narcosis was 202 mg for thiopentone and 167 mg for propofol, time of onset of narcosis was 30 seconds for propofol and 45 seconds for thiopentone, anesthesia and the quality of muscular relaxation were considered deep for the two groups. Many authors showed that propofol is the most efficient agent in anesthesia for sismotherapy due to its brief delay of action and faster reversibility. As for thiopentone despite its convulsive properties and poor hemodynamic tolerance, it still is a good hypnotic in anesthesia for sismotherapy when administered at appropriate dose by slow injection. This is due on the one hand to easy administration, lesser incidence of side effects and on the other hand to brief duration of action and low cost. We conclude that thiopentone can be recommended in anesthesia for sismotherapy owing to good properties: deepness of anesthesia, good awakening, tolerance and lower cost.
Asunto(s)
Anestesia General , Trastorno Bipolar/terapia , Trastorno Depresivo Mayor/terapia , Terapia Electroconvulsiva , Propofol , Esquizofrenia/terapia , Tiopental , Adulto , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Persona de Mediana Edad , MarruecosRESUMEN
The authors report three cases of carotid-cavernous fistula occurring after severe cranio facial trauma. The diagnosis has been suspected on the association of a pulsatil exophtalmia and systolo-diastolic murmur, and confirmed by arteriography. Embolization was successful in two patients, the third one died from neurologic complication before embolization. The carotid cavernous fistula is a rare but severe complication of a craniofacial trauma. The functional (blindness) and vital prognosis (subarachnoid and intracerebral haemorrage). Treatment by interventional neuroadiology has considerably improved the outcome.