To evaluate the efficacy of aminophylline infusion as a painkiller compared with placebo in patients with acute renal colic.
From March to August 2005, 141 patients with clinical renal colic, who ...were under 60 years of age, had no history of heart or hepatic failure, asthma, theophylline or beta blocker use, reaction to methylxantines, pregnancy or breast feeding, and were not prescribed spasmolytic or analgesics, entered our study. They were randomly assigned to receive either 375 mg of aminophylline or placebo infusion under double blind conditions. Pain intensity was recorded using a visual analog scale (VAS), before drug administration and 30 and 60 minutes afterwards. The drug effectiveness was defined as > or =40% decrease in pain intensity 60 minutes after the onset of infusion, without exacerbation during the following 4 hours.
Seventy patients received aminophylline; it was effective in 45 (64%; 95% confidence interval 52-75%). Alternatively, placebo was effective in 12 of 71 control patients (17%; 95% confidence interval 9-28%); (P < 0.001). Thirty and 60 minutes after administration, aminophylline reduced pain by 24% and 39% respectively, as compared with 6% and 8% pain reduction in the placebo group.
This prospective study provides remarkable information about the efficacy of aminophylline on pain relief and decreasing narcotic usage in symptomatic urinary calculi. It is safe, inexpensive, with minute side effects and can be considered a good alternative or additive to narcotic analgesics in the management of renal colic.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Many individuals who are candidates for thoracic endovascular aortic repair (TEVAR) are found to have iliac artery anatomy and/or disease that preclude transfemoral endovascular access and require ...retroperitoneal surgical approach through more proximal arteries. This relatively more invasive technique could potentially affect the procedural outcomes. This study compares the retroperitoneal with transfemoral access used for TEVAR in a single center.
In this study, 133 consecutive patients (96 men; mean age ± SD: 69.5 ± 14.7 years) who underwent TEVAR between 1994 and 2009 in a single center were retrospectively evaluated. The type of endovascular access was identified in all the patients. The basic demographics, access method, endograft type, 30-day morbidity and mortality rates, as well as procedure recordings including fluoroscopic and procedure duration, estimated blood loss, and duration of hospitalization were compared between the TEVAR procedures performed using a surgical retroperitoneal approach and those using the standard femoral access.
Retroperitoneal access was used in 19 (14.3%; 13 women; mean age ± SD: 71 ± 12.2 years) and direct femoral access in 114 (85.7%; 24 women; mean age ± SD: 69 ± 15.4 years) patients. Two of the retroperitoneal accesses were obtained after failure of femoral approach. Techniques that were used included iliac artery conduit (seven patients), aortic artery conduit (eight patients), aortobifemoral artery graft conduit (one patient), and direct sheath introduction through the distal aorta (two patients) or common iliac artery (one patient). Retroperitoneal approach was used more frequently in women (35%) as compared with men (6%) (p = 0.0001). In all, 79% of the retroperitoneal approaches were associated with use of delivery sheath sizes larger than 24F (p = 0.049). TEVAR technical success was 100% with retroperitoneal and 97.3% with femoral access (p > 0.05). Thirty-day mortality rates were 0% and 8.8% and the rates of access artery injury were 5.3% and 4.4% in retroperitoneal and femoral access groups, respectively (p > 0.05). The incidence of retroperitoneal hematoma was significantly higher with retroperitoneal access (21% vs. 2.6%, p = 0.008). Additionally, retroperitoneal access was associated with significant increase in estimated blood loss and duration of hospitalization (p < 0.05).
Type of access does not affect TEVAR success and the early mortality rate. Retroperitoneal approach is a valuable alternative technique in cases involving failed or impossible femoral access. However, this approach is associated with higher chances of retroperitoneal bleeding and longer procedural time and duration of hospitalization. Thoracic endografts with smaller delivery systems could minimize the need for this approach in the future.
PDF