RESUMO
Background: Cerebral vasospasm after subarachnoid hemorrhage remains a major source of morbidity and mortality. Various agents have come into vogue to deal with this complication but none has shown any absolute results. We conducted this study to asses the effectiveness of intracisternal lavage of papavarine both prophylactically and therapeutically in a simple cost effective way. Methods: This is a retrospective analysis of patients who were admitted at our institution between January 2002 and July 2003. Eighty five patients with anterior circulation aneurysmal bleed who underwent microsurgical clipping were divided into two groups. Group A: patients who received papavarine through a reservoir and Group B patients who did not receive papavarine. The location of aneurysm, timing of surgery , incidence and outcome of vasospasm were assessed in the patients in two comparable groups. Results: 13 por ciento of patients in Group A developed vasospasm whereas 38 por ciento of patients in Group B developed vasospasm. Symptoms of vasospasm reversed in all patients in Group A. There were 3 deaths in Group A but none where attributed to vasospasm. Four of seven deaths in Group B were attributed to consequence of vasospasm. Eleven patients who survived in Group B in spite of vasospasm had significant morbidity at the time of discharge. Conclusion: Intracisternal lavage with papavarine both prophylactically and theraputically can prevent and reverse vasospasm and this can be achieved by installing a simple reservoir. It is a cost effective and rapid bedside procedure for dealing with vasospasm (AU)
Assuntos
Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/terapia , Vasoespasmo Intracraniano , Papaverina/administração & dosagemRESUMO
Background: Cerebral vasospasm after subarachnoid hemorrhage remains a major source of morbidity and mortality. Various agents have come into vogue to deal with this complication but none has shown any absolute results. We conducted this study to asses the effectiveness of intracisternal lavage of papavarine both prophylactically and therapeutically in a simple cost effective way. Methods: This is a retrospective analysis of patients who were admitted at our institution between January 2002 and July 2003. Eighty five patients with anterior circulation aneurysmal bleed who underwent microsurgical clipping were divided into two groups. Group A: patients who received papavarine through a reservoir and Group B patients who did not receive papavarine. The location of aneurysm, timing of surgery , incidence and outcome of vasospasm were assessed in the patients in two comparable groups. Results: 13 por ciento of patients in Group A developed vasospasm whereas 38 por ciento of patients in Group B developed vasospasm. Symptoms of vasospasm reversed in all patients in Group A. There were 3 deaths in Group A but none where attributed to vasospasm. Four of seven deaths in Group B were attributed to consequence of vasospasm. Eleven patients who survived in Group B in spite of vasospasm had significant morbidity at the time of discharge. Conclusion: Intracisternal lavage with papavarine both prophylactically and theraputically can prevent and reverse vasospasm and this can be achieved by installing a simple reservoir. It is a cost effective and rapid bedside procedure for dealing with vasospasm
Assuntos
Papaverina , Hemorragia Subaracnóidea , Vasoespasmo IntracranianoRESUMO
The evolution of thinking about energy is discussed. When the authors began collaborating 20 years ago, energy was typically considered from a growth-oriented, supply-side perspective, with a focus on consumption trends and how to expand supplies to meet rising demand. They were deeply troubled by the environmental, security and equity implications of that approach. For instance, about two billion people lack access to affordable modern energy, seriously limiting their opportunities for a better life. And energy is a significant contributor to environmental problems, including indoor air pollution, urban air pollution, acidification, and global warming. The authors saw the need to evolve a different perspective in which energy is provided in ways that help solve such serious problems. They argued that energy must become an instrument for advancing sustainable development--economically viable, need-oriented, self-reliant and environmentally sound development--and that the focus should be on the end uses of energy and the services that energy provides. Energy technological options that can help meet sustainable development goals are discussed. The necessity of developing and employing innovative technological solutions is stressed. The possibilities of technological leap-frogging that could enable developing countries to avoid repeating the mistakes of the industrialized countries is illustrated with a discussion of ethanol in Brazil. The role foreign direct investment might play in bringing advanced technologies to developing countries is highlighted. Near- and long-term strategies for rural energy are discussed. Finally, policy issues are considered for evolving the energy system so that it will be consistent with and supportive of sustainable development.
Assuntos
Conservação dos Recursos Naturais , Países em Desenvolvimento , Fontes Geradoras de Energia , Transferência de Tecnologia , Brasil , Conservação dos Recursos Naturais/economia , Fontes Geradoras de Energia/economia , Etanol , Previsões , Humanos , Indústrias , Condições Sociais , SolventesRESUMO
Bilateral fenestration of the labial gingival tissue of the permanent mandibular central incisors is described. The situation was followed over a 2-year period with no treatment other than prophylaxis and oral hygiene instruction. The final outcome was an apical positioning of the gingival margin, which was lower than that of the adjacent uninvolved teeth.