Intrathecal pumps for pain therapy. Lennart Stieglitz
|
|
|
- Avice Hill
- 5 years ago
- Views:
Transcription
1 Itrathecal pumps for pai therapy Leart Stieglitz
2 Itrathecal pumps itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
3 Itrathekale Schmerztherapie Pai is perfect miserie, the worst of evils, ad, excessive, overturs all patiece. Joh Miller, Paradise Lost
4 itrathecal? The sesatio of pai has ist origis i the CNS ad is also processed there Aalgetics have to provide: Good resorptio, low systemic side-effects, good peetratio ito the CNS Aalgetics have to reach the CNS i cocetratios as high as possible to allow optimal effects. itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
5 itrathecal? Systemic (p.o. or pareteral) Itrathecal High dose required Dose lower towards p.o. by factor 300 Paret. By factor 100 Blood-brai-barrier Highest availability i the CNS Systemic ADR Mior systemic ADR itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
6 History 1898 August Bier: Versuche über die Cocaiisierug des Rückemarks 1976 Yaksh ud Rudy: Successful experimets with itrathecal morphi-admiistratio i aimals 1982 Itroductio of the first implatable pump Shirley Ifusaid Pump (Northwood) 1991 First programmable pump SychroMed (Medtroic) itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
7 History Idicatios: 1) Tumor related pai 1) Severe spasticity 2) Failed back surgery sydrome (FBSS) 3) Complex regioal pai sydrom (CRPS) 4) Postperpetic euralgia 5) Paiful periphere europathy itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
8 Morphi Aus: Nieuwehuys: Das Zetralervesystem des Mesche, 1988 itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
9 Morphi N-type- Calciumcaal Ca 2+ Noziceptive eurotrasmitter Mo μ Opioid rezeptor itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
10 Morphi - ADR -Lethargy/ Sedatio (10-14%) -Nausea / Vomitig (ca. 30%) -Obstipatio (ca. 30%) -Urie retetio(42-80%) -Pruritus (ca. 14%) (Severe i 1% of the pat.) -Myoclous (late, after moths) -Suppressio of sexual hormos (frequet) -Periphere edema, mior respose to diuretics (6-21%) -Respiratory depressio Dose maagemet Atiemetics (ad combiatios) Dose maagemet Dose maagemet Wears off after h, Atihistamis Dose maagemet / Chage to Hydromorphoe Substitutio Salt/Water-Restrictio, Stockigs Atagoizatio (Naloxo) Quelle: Rua, Pai Physicia 2007;10 itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
11 Baclofe itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
12 Baclofe Baclofe Ca 2+ N-Type- Ca 2+ - caal K + -Caal GABA B - Receptor GABA B - Receptor Noziceptive eurotrasmitter - präsyaptic: Ca 2+ -Iflow reduced (Reduced liberatio of NT ito syaptic cleft) - postsyaptic: K + -Iflow slightly raised (Hyperpolarisatio Reductio of the excitability) - Reduced liberatio of substace P i oziceptive afferet fibers(reduced mediatio of paiful muscle spasms) itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
13 Baclofe History: 1920 Developmet as atiepileptic drug 1970 Use as oral spasmolytic drug Kietics: - High resorptio from GI-tract - Hydrophil, therefore bad CNS peetratio ADR: Sedatio, cofusio, stragury, sleepiess Lethargy, bradykardia, respiratory depressio Dose maagemet (titratio) itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
14 Patiet selectio Step 1: Step 2: Step 3: Oral treatmet. Up to 90% of the patiets ca be treated sufficietly this way. Idicatio for itrathecal applicatio i case of: - failure of the systemic therapy - o-acceptable ADR Evaluatio of cost-effectiveess... itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
15 Treatmet costs Costs for implatatio of a pump: Material: ca CHF plus OP Mea umber of refills per year: 2-4 Costs per refill: ca. 300 CHF I case of tumor related pai: Cose-effective after 22 Mo No-maligat pai sydroms: Cost-effective after 3-6 Mo Hassebusch et al. J Pai Symptom Maage 1997;14 itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
16 Evaluatio Morphi 1. Step: Is there a profit from IT admiistratio? LP ad bolus admiistratio exteral pump p.o.-medicatio has to be cotiued to prevet withdrawal 2. Step: Neurological moitorig for 24h with Pulse-oxymetry Respiratory depressio Keep Naloxo at had. Start of therapeutic effect: mi after admiistratio. Duratio: 18-24h. 3. Step: Dose-calculatio. Reduktio i.c.o. former p.o.-admi. by 300x i.c.o. former pareteral admi. by 100x itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
17 Evaluatio Baclofe After test-admiistratio: Maximal effect at the lower extremities after 60 mi Start of effect at the upper extremities after 2 h, max. effect after 4 h. Cease of effect after 8-10h Judgemet of Effectiveess Accordig to the Ashworth-scale: Ashworth scale 1 Normal muscle tous 2 Slightly icreased muscle tous, catch -peomeo 3 Icreased muscle tous, good flexio 4 Severely icreased muscle tous, impaired passive movemet 5 Extremity is fixed i flexio or extesio itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
18 Implatatio itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
19 Complicatios Complicatio % of patiets Prevetio / Treatmet Superficial hematoma? Self-limited Epidural bleedig durig catheter isertio New eurologic deficit / pai? - Catheter implatatio uder fluoroscopic cotrol - MRT/CT? Preop. CT / MRT for exclusio of steosis etc. CSF leak Ca. 20% Self limited Rest, drikig Blood patch Quelle: Medtroic itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
20 Complicatios Catheter-related complicatios Catheter dislocatio / migratio % of patiets 6.1% Fracture / break 5.1% Kikig / occlusio 4.0% Cut / pucture 3.0% Discoectio from pump 0.7% Leak 0.4% Discoect 0.3% Misplacemet 0.3% Ukow 0.1% Tip fibrosis 0.1% Quelle: Medtroic itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
21 Evaluatioo of the overall ad eurological status of the patiet ad reactio to the therapy. Preparatio of the material Pump read-out Preparatio of drugs ad ski for pucture Emptyig of the pump Compariso of volumes Pump update Verificatio of the ext refill-appoitmet Documetatio itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
22 Peristaltic uit Catheter access poit (CAP) Coector for catheter Motor -port Electroics Fixatio loop Battery itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
23 The reservoir of the SychroMed II-pump has to be refilled regularly. The iterval depeds o: Drug cocetratio Drug storage life Reservoir volume Daily dosage / flexible dosage Aims of each refill appoitmet: Assessmet of eurological status ad therapeutic effect Assessmet of ecissity of dose titratio System check of the pump Moitorig of the disease Fixatio of the ext appoitmet documetatio itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
24 Use oly o-puchig Huber-eedles to prevet damagig of the device resultig i eed of explatatio. itrathecal? History Morphi Baclofe Evaluatio Implatatio Complicatios
25 Thak you for your attetio.
Injectable Gel with 0.3% Lidocaine
Patiet Brochure Table of Cotets Frequetly Asked Questios 4 Safety 6 Troubleshootig 11 Admiistratio 12 Ijectable Gel with.3% Lidocaie Post Marketig Surveillace 13 Post-treatmet Checklist 14 User Assistace
Primary: To assess the change on the subject s quality of life between diagnosis and the first 3 months of treatment.
Study No.: AVO112760 Title: A Observatioal Study To Assess The Burde Of Illess I Prostate Cacer Patiets With Low To Moderate Risk Of Progressio Ratioale: Little data are available o the burde of illess
OPIOID OVERDOSE RELATED EMERGENCY DEPARTMENT VISITS AT PROVIDENCE EVERETT
OPIOID OVERDOSE RELATED EMERGENCY DEPARTMENT VISITS AT PROVIDENCE EVERETT Quarterly Report Jue August 2017 Xiyao degrauw Sohomish Health District 3020 Rucker Ave., Everett, WA 98201 Opioid Overdose Related
RADIESSE Dermal Filler for the Correction of Moderate to Severe Facial Wrinkles and Folds, Such As Nasolabial Folds
A PATIENT S GUIDE RADIESSE Dermal Filler for the Correctio of Moderate to Severe Facial Wrikles ad Folds, Such As Nasolabial Folds Read all the iformatio before you are treated with Radiesse dermal filler.
Modified Early Warning Score Effect in the ICU Patient Population
Lehigh Valley Health Network LVHN Scholarly Works Patiet Care Services / Nursig Modified Early Warig Score Effect i the ICU Patiet Populatio Ae Rabert RN, DHA, CCRN, NE-BC Lehigh Valley Health Network,
DEMAND RESULTS. TRUST ENDURANT.
DEMAND RESULTS. TRUST ENDURANT. Edurat ll AAA Stet System Edurat IIs AAA Stet System THE ENDURANT II SYSTEM FAMILY OF PRODUCTS Icludes Edurat II, Edurat II AUI ad Edurat IIs stets. Desiged to meet a wide
YOUR BEST DAYS START WITH BETTER PROTECTION FROM LOWS. *,1,2
YOUR BEST DAYS START WITH BETTER PROTECTION FROM LOWS. *,1,2 Oly SmartGuard TM from MiiMed takes actio for you whe you eed it most. MiiMed 530G system HIT THE ROAD. WORRY LESS ABOUT GOING LOW. *,1,3 37.5%
INFORMATION FOR YOU AND YOUR FAMILY. Melody Transcatheter Pulmonary Valve Therapy
INFORMATION FOR YOU AND YOUR FAMILY Melody Trascatheter Pulmoary Valve Therapy This booklet is provided to help you ad your loved oes lear more about Melody Trascatheter Pulmoary Valve (TPV) Therapy. Please
PATIENT INFORMATION BOOKLET. Endovascular Stent Grafts: A Treatment for Abdominal Aortic Aneurysms
PATIENT INFORMATION BOOKLET Edovascular Stet Grafts: A Treatmet for Abdomial Aortic Aeurysms TABLE OF CONTENTS Itroductio 1 Glossary 2 Abdomial Aorta 4 Abdomial Aortic Aeurysm 5 Causes 6 Symptoms 6 Treatmet
SCULPTRA Aesthetic (First Treatment Session: N = 116) Cosmoplast (First Treatment Session: N = 117) Severity of Adverse Event a Moderate n.
SCULPTRA AESTHETIC Rx Oly (ijectable poly-l-lactic acid) The Sculptra implat package (i.e., lyophilized vials ad syrige) are provided sterile. Cautio: Federal (USA) law restricts this device to sale by
Caution: Federal Law restricts this device to sale by or on the order of a physician or licensed practitioner.
Restylae Lyft with Lidocaie Ijectable Gel with.% Lidocaie Cautio: Federal Law restricts this device to sale by or o the order of a physicia or licesed practitioer. Descriptio Restylae Lyft with Lidocaie
Early Ambulation Reduces the Risk of Venous Thromboembolism After Total Knee Replacement. Introduction/Background. Research Team.
Research Team Early Ambulatio Reduces the Risk of Veous Thromboembolism After Total Kee Replacemet Marily Szekedi, PhD, RN Baafsheh Sadeghi, MD, PhD, School of Medicie, Uiversity of Califoria Davis Patrick
Whether you have a bacterial infection or a viral infection, there are things you can do to help yourself feel better:
HEALTHPLUS, AN AMERIGROUP COMPANY MakeHealth Happe Vol. 2, 2013 Do I Need Atibiotics? Atibiotics are medicies used to treat bacterial ifectios ad keep them from spreadig. But if a virus makes you sick,
Hypertension in patients with diabetes is a well recognized
Cotrol of Hypertesio amog Type II Diabetics Kawther El-Shafie, Sayed Rizvi Abstract Objectives: Numerous studies have cofirmed the high prevalece of hypertesio amog type 2 diabetics, ad that itesive hypertesive
Valve Aortic Accessories Trifecta Valve Sizer Set Handles Global Headquarters Cardiovascular Division St. Jude Medical Coordination Center BVBA
Trifecta Valve Whe the Goal Is Superior Hemodyamics 1 The Valve Is Trifecta. Itroducig the ext-geeratio pericardial tissue heart valve ad perfect complemet to the lie of tissue valves from St. Jude Medical
ACE-27 with Dr. Piccirillo from Washington University St. Louis. August 18, 2009
ACE-27 with Dr. Piccirillo from Washigto Uiversity St. Louis August 18, 2009 Itroductio Patiets with cacer ofte have other diseases, illesses, or coditios i additio to their idex cacer These other coditios
Epilepsy and Family Dynamics
Epilepsy ad Family Dyamics BC Epilepsy Society November 15, 2010 Guests: Susa Murphy, Registered Nurse, Paret Rita Marchildo, Child Life Specialist, Paret Speakers: Audrey Ho PhD., R.Psych Josef Zaide
Single and multidose pharmacokinetic study of a vaginal micronized progesterone insert (Endometrin)
Sigle ad multidose pharmacokietic study of a vagial microized progesteroe isert (Edometri) 按一下以編輯母片副標題樣式 compared with vagial gel i healthy reproductive-aged E m ily J. B la ke, M.D., Fertility a d S terility
Chapter 25 Fluid, electrolyte, and acid-base homeostasis
Chapter 25 Fluid, electrolyte, ad acid-base homeostasis Body Fluid Compartmets I lea adults, body fluids costitute 55% of female ad 60% of male total body mass Itracellular fluid (ICF) iside cells About
IMAGING THE BIOLOGICAL EFFECT OF DOSE IN THE LIVER NORMAL TISSUE
8/5/2 IMAGING THE BIOLOGICAL EFFECT OF DOSE IN THE LIVER NORMAL TISSUE Yue Cao, Ph.D. Departmets of Radiatio Ocology ad Radiology Uiversity of Michiga Ackowledgemets James Balter, Ph.D. Edgar Be-Josef,
Evidence Based Evaluation and Treatment of Psychiatric Patient in the Emergency Setting
Evidece Based Evaluatio ad Treatmet of Psychiatric Patiet i the Emergecy Settig Leslie S Zu, MD, MBA, FAAEM Presidet, America Associatio for Emergecy Psychiatry Chairma ad Professor Departmet of Emergecy
Lecture 9. Dr. Sameh Sarray Hlaoui
Lecture 9 Dr. Sameh Sarray Hlaoui Steroid Hormoes aall steroid hormoes are derived from cholesterol but their structure differ from the cholesterol (rig structure ad side chais) anomeclature: Steroids
Experimental Study on Sustained-release 5-Fluorouracil Implantation in Canine Peritoneum and Para-aortic Abdominalis
RESEARCH ARTICLE Experimetal Study o Sustaied-release -Fluorouracil Implatatio i Caie Peritoeum ad Para-aortic Abdomialis Guo Wei 1&, Mig-Mig Nie 1&, Xiao-Ju She 1, Xu-Chao Xue 1, Li-Ye Ma 1, Cheg- Hui
Caution: Federal Law restricts this device to sale by or on the order of a physician or licensed practitioner.
Restylae Lyft with Lidocaie Ijectable Gel with.3% Lidocaie Cautio: Federal Law restricts this device to sale by or o the order of a physicia or licesed practitioer. Descriptio Restylae Lyft with Lidocaie
Information Following Treatment for Patients with Early Breast Cancer. Bradford Teaching Hospitals. NHS Foundation Trust
Iformatio Followig Treatmet for Patiets with Early Breast Cacer Bradford Teachig Hospitals NHS Foudatio Trust What happes ext? You have ow completed your iitial treatmet to remove your breast cacer. There
Study No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
UM27/189/ The study listed may iclude approved ad o-approved uses, formulatios or treatmet regimes. The results reported i ay sigle study may ot reflect the overall results obtaied o studies of a product.
The Opioid Epidemic. Dr. John McAuliffe Medical Director, Sauk Prairie Memorial Hospital
The Opioid Epidemic Dr. Joh McAuliffe Medical Director, Sauk Prairie Memorial Hospital Sharo Boesl, Ph.D., LMFT Metal Health ad Recovery Services Sauk Couty Departmet of Huma Services Slides are courtesy
CHAPTER NINE: MITOSIS NOTES PT. 3
CHAPTER NINE: MITOSIS NOTES PT. 3 The Cellular Basis of Iheritace What Happes Whe Mitosis Goes Wrog?? Cacer Caused by ucotrolled cell reproductio (mitosis) ad severe disruptio of the mechaisms that cotrol
After 3 months. bin. Time(PT), Internatio. Internation Endarterectomy; al Catheter directed thrombolysis. nal. (INR) Normalize d Ration (INR)
Cardiology & CT & CVS Follow-ups No Procedures Code First Follow-up Secod Follow-up Third Follow-up Fourth Fifth Duratio Ivestigatios Amout Duratio Ivestigati o Amout Duratio Ivestigati o Amout Duratio
Product datasheet. Combi 400V. Characteristics. Technical specifications
Product datasheet Combi 400V The Combi 400V, for electrotherapy, ultrasoud therapy, combiatio therapy ad laser therapy. Icludes a vacuum uit with 2 idepedet chaels. The Combi 400V, helps achievig your
Pharmacotherapy in patients with painful diabetic neuropathy: what do recent guidelines tell us?
Guidelies Perspective Pharmacotherapy i patiets with paiful diabetic europathy: what do recet guidelies tell us? Kathri Doppler & Claudia Sommer* Practice Poits Aticovulsats (e.g., pregabali ad gabapeti)
Role of Intrathecal Baclofen. Mr. Chirag Patel Consultant Paediatric Neurosurgeon Children s Hospital for Wales, Cardiff.
Role of Intrathecal Baclofen Mr. Chirag Patel Consultant Paediatric Neurosurgeon Children s Hospital for Wales, Cardiff. History of Intrathecal Baclofen therapy 1978: First used in guinea pigs by Wilson.
A novel approach for diabetes: recent evidence on endoluminal liners
A ovel approach for diabetes: recet evidece o edolumial liers Héctor Romero-Talamás 1 & Stacy A Brethauer* 1 Practice Poits Two moder pademics, obesity ad diabetes, are cosidered the most sigificat causes
STATISTICAL ANALYSIS & ASTHMATIC PATIENTS IN SULAIMANIYAH GOVERNORATE IN THE TUBER-CLOSES CENTER
March 3. Vol., No. ISSN 37-3 IJRSS & K.A.J. All rights reserved STATISTICAL ANALYSIS & ASTHMATIC PATIENTS IN SULAIMANIYAH GOVERNORATE IN THE TUBER-CLOSES CENTER Dr. Mohammad M. Faqe Hussai (), Asst. Lecturer
Certify your stroke care program. Tell your community you re ready when needed.
Certify your stroke care program. Tell your commuity you re ready whe eeded. Stroke Certificatio Optios STROKE READY PRIMARY STROKE Stroke Ready Certificatio Demostrates to commuity emergecy services ad
Revision of Carpal Tunnel Release for Persistent or Recurrent Carpal Tunnel Syndrome
2014 ASPS Revisio of Carpal Tuel Release for Persistet or Recurret Carpal Tuel Sydrome Chao-Mig Wu, Yu-Te Li, Bo-Yu Chou, Chih-Hao Che, Ha-Tsug Liao, Cheg-Hug Li, Chug-Che Hsu, JiuTig Yeh Divisio of Trauma
MICHELANGELO: OASIS 5 Women s Substudy
MICHELANGELO: OASIS 5 Wome s Substudy Dr. Eva Swah Departmet of Cardiology, Heart Cetre, Uiversity Hospital, Liköpig Swede Disclosure Fuded by Saofi-Sythelabo, Orgao NV ad GSK Dr. Swah has o coflicts of
Clinical Research The details of the studies undertaken year wise along with the outcomes is given below: SNo Name of Project
No. studies take Cliical Research 2012-13 No. publi 9 4 The details the studies take year wise alog with the outcomes is give below: 1. Homoeopathic therapy for lower uriary tract symptoms i me with Beig
Pain Management in Hospital Medicine. Disclosures
Pai Maagemet i Hospital Medicie Daiel Burkhardt M.D. Associate Professor Departmet of Aesthesia ad Perioperative Care Uiversity of Califoria Sa Fracisco daiel.burkhardt@ucsf.edu burkhardt.us/2015-10-15.pdf
Disclosures. Pain Management in the Optometric Practice. Optometric indications. Optometric indications. Before treatment 4/18/16
4/18/16 Disclosures Pai Maagemet i the Optometric Practice Speakers bureau/advisory board: Marc R Bloomestei, OD, FAAO Schwartz Laser Eye Ceter Scottsdale, Arizoa Alco Allerga Akor B&L OCuSOFT Bruder TearLab
Biomedical Research 2018; 29 (5):
Biomedical Research 2018; 29 (5): 933-937 ISSN 0970-938X www.biomedres.ifo Effects of recipe o serum pai substaces 5-HT, Β-EP, histamie ad bradykii i rats with paiful diabetic peripheral europathy of streptozotoci
WHAT YOU SHOULD KNOW ABOUT RoACTEMRA
RoACTEMRA for Giat Cell Arteritis WHAT YOU SHOULD KNOW ABOUT RoACTEMRA This brochure provides key iformatio to assist i the patiet s uderstadig of the beefits ad risks associated with RoACTEMRA therapy
Autism Awareness Education. April 2018
Autism Awareess Educatio April 2018 What is Autism Autism is a wide-spectrum metal disorder that is talked about every day i health circles, but few really kow all the facts about it. Research cotiues
APPROVAL REQUIRED. By approving this proof you are confirming that the contact information is correct.
APPROVAL REQUIRED Attached is a proof for your review. Please pay particular attetio to cotact iformatio such as phoe umbers, email addresses, web addresses ad mailig address. By approvig this proof you
Mechanism of Action: The Importance of Liver THR-β in NASH
MGL-3196, a selective thyroid hormoe receptor-beta agoist, sigificatly decreases hepatic fat i NASH patiets at 12 weeks, the primary edpoit i a 36 week serial liver biopsy study Stephe Harriso 1, Sam Moussa
Stacy Norman, D.D.S. William A. Stellenwerf, M.S., D.D.S., P.C Timber Shadows Dr., Bldg. A Kingwood, Texas (281)
Stac Norma, D.D.S. William A. Stellewerf, M.S., D.D.S., P.C. 2325 Timber Shadows Dr., Bldg. A Kigwood, Texas 77339 (281) 359-9100 PERSONAL HISTORY: Date: Name: Birth Date: Sex: Marital Status: Address:
A PATIENT S GUIDE TO PLASMA EXCHANGE
Some drugs may be affected by plasma exchage; ask your doctor about ay impact to drugs you are takig. It is importat to drik water ad cosume foods high i calcium, such as cheese or milk. This ca help your
The relationship between hypercholesterolemia as a risk factor for stroke and blood viscosity measured using Digital Microcapillary
Joural of Physics: Coferece Series PAPER OPEN ACCESS The relatioship betwee hypercholesterolemia as a risk factor for stroke ad blood viscosity measured usig Digital Microcapillary To cite this article:
WALLENPAUPACK. Lake Wallenpaupack Operations during the April 2005 Flood
LAKE WALLENPAUPACK Lake Wallepaupack Operatios durig the April 2005 Flood Lake Performace Summary March-April Storm Evet LAKE WALLENPAUPACK Over 14 BG of water stored betwee March 28 ad April 3 icludig
INTRATHECAL THERAPY TREATMENT OF PAIN AND SPASTICITY. Christopher S. Rumana, M.D. Tallahassee Neurological Clinic Department of Neurosurgery
INTRATHECAL THERAPY TREATMENT OF PAIN AND SPASTICITY Christopher S. Rumana, M.D. Tallahassee Neurological Clinic Department of Neurosurgery Intrathecal Therapy Insertion of a drug into CSF space, commonly
Safety concerns regarding inhaled adrenergic. Long-acting b-agonists: a review of formoterol safety data from asthma clinical trials
Eur Respir J 2009; 33: 21 32 DOI: 10.1183/09031936.00145006 CopyrightßERS Jourals Ltd 2009 Log-actig b-agoists: a review of formoterol safety data from asthma cliical trials M.R. Sears*,#, A. Ottosso ",
Anesthesia and the Sick Heart. Billy Corbett MD FAAP Capitol Anesthesiology Association Dell Children s Medical Center
Aesthesia ad the Sick Heart Billy Corbett MD FAAP Capitol Aesthesiology Associatio Dell Childre s Medical Ceter Talk Overview The safety of aesthesia Preoperative evaluatio ad risk stratificatio Iductio
Use of Serum FSH to Identify Perimenopausal Women with Pituitary hcg
Cliical Chemistry 54:4 652 656 (2008) Edocriology ad Metabolism Use of Serum FSH to Idetify Perimeopausal Wome with Pituitary hcg A M. Groowski, 1* Corie R. Fatz, 2 Curtis A. Parvi, 1 Lori J. Sokoll, 3
CANALOPLASTY. RESTORATIVE GLAUCOMA SURGERY. Minimally Invasive & Maximally Effective. NEW! INTRODUCING A COMPREHENSIVE APPROACH TO MIGS
CANALOPLASTY MICROCATHETER Desiged specifically for 60 viscodilatio of Schlemm s caal i ope-agle glaucoma patiets, the itrack system eables surgeos to: 1. Ope a collapsed Schlemm s caal; 2. Stretch the
Health Concerns Overview
F L A M E R E T A R D A N T S V. Health Cocers Overview Edocrie-disruptig chemicals ca mimic estroges (female sex hormoes), adroges (male sex hormoes), ad thyroid hormoes, which ca cotribute to hormoally
HCPCS Level II Expert. Updateable
HP Level II Expert Updateable 2015 Itroductio ORGIZTIO OF HP The OptumIsight 2011 HP Level II book cotais madated chages ad ew codes for use as of Jauary 1, 2011. Deleted codes have also bee idicated ad
Sexuality and chronic kidney disease
Sexuality ad chroic kidey disease T H E K I D N E Y F O U N D A T I O N O F C A N A D A 1 Sexuality ad chroic kidey disease Let s talk about it Sexuality is a vital part of us all. It icludes may aspects
Disclosure. Fertility after Childhood Cancer. Female Oncofertility. Learning Objectives
Fertility after Childhood Cacer Possibilities for Improvig Success Sheila Pritchard BC Childre s Hospital Disclosure I have o coflict of iterest No commercial iterests Nothig to disclose Cofessio. I am
Intrathecal Infusion Therapy for Chronic Pain: Challenges, Lessons and Opportunities
June 14-15, 2016 Mult imodal Therapies for Brain Disorders: A Workshop Hosted by: Forum on Neuroscience and Nervous System Disorders Intrathecal Infusion Therapy for Chronic Pain: Challenges, Lessons and
Plantar Pressure Difference: Decision Criteria of Motor Relearning Feedback Insole for Hemiplegic Patients
22 4th Iteratioal Coferece o Bioiformatics ad Biomedical Techology IPCBEE vol.29 (22) (22) IACSIT Press, Sigapore Platar Pressure Differece: Decisio Criteria of Motor Relearig Feedback Isole for Hemiplegic
Depression among Patients Attending Physiotherapy Clinics in Erbil City
amog Patiets Attedig.. Zaco J. Med. Sci., Vol. 13, No. (2), 2009 amog Patiets Attedig Physiotherapy Cliics i Erbil City Dr. Sirwa K. Ali * Dr. Jwa M. Zagaa ** Dr. Diyar H. Tahir *** ABSTRACT Backgroud
Pregnant and Postpartum Women and Their Infants
Treatmet for Pregat ad Paretig Wome with Opioid Use Disorder: Cosideratios for Mother ad Child Karol Kaltebach, PhD Emeritus Professor of Pediatrics Sidey Kimmel Medical College at Thomas Jefferso Uiversity
Screening for microalbuminuria in patients with type 2 diabetes is incomplete in general practice
Da Med J / September DANISH MEDICAL JOURNAL Screeig for microalbumiuria i patiets with type 2 diabetes is icomplete i geeral practice Søre Tag Kudse 1, Thomas Hammershaimb Mosbech 2, Birtha Hase 1, Else
The effect of three different denture adhesives on the retention of mandibular complete denture (Comparative study)
The effect of three differet deture adhesives o the retetio of madibular complete deture (Comparative study Ilham H. Al-Abdulla B.D.S, M.Sc (1 Amer M. Khamas B.D.S, M.S.D (2 ABSTRACT Backgroud: Retetio
SYNTAX score. Number & location of lesions. Dominance. Left Main. Calcification. 3 Vessel. Thrombus. Total Occlusion. Bifurcation.
PCI vs CABG for Multivessel Disease: Calculatio of Risk ad Log Term Outcome Pawel Buszma, MD, PhD, FESC, FACC Professor of Medicie, Medical Uiversity of Silesia, Katowice, Polad TCT AP 2010 Strategy qlocal
Product datasheet. Combi 400. Characteristics. Technical specifications
Product datasheet Combi 400 The Combi 400, for electrotherapy, ultrasoud therapy, combiatio therapy ad laser therapy. The Combi 400, helps achievig your 3 therapeutical goals of pai relief, tissue repair
INHIBITORS IN MILK: PROBLEMS and METHODS OF DETERMINATION. Joana Šalomskienė KTU Food Institute, Kaunas, Lithuania
INHIBITORS IN MILK: PROBLEMS ad METHODS OF DETERMINATION Joaa Šalomskieė KTU Food Istitute, Kauas, Lithuaia mikrobjs@lmai.lt, 837312380 Ihibitors (atimicrobials, atibacterial substaces) i dairy idustry:
Clinical research on using acupuncture to treat female adult abdominal
Olie Submissios: http://www.jouraltcm.com J Tradit Chi Med 2014 Jue 15; 34(3): 274-278 ifo@jouraltcm.com ISSN 0255-2922 2014 JTCM. All rights reserved. CLINICAL STUDY TOPIC Cliical research o usig acupucture
COMPARISON OF A NEW MICROCRYSTALLINE
Br. J. cli. Pharmac. (1979), 8, 59-64 COMPARISON OF A NEW MICROCRYSTALLINE DICOUMAROL PREPARATION WITH WARFARIN UNDER ROUTINETREATMENTCONDITIO D. LOCKNER & C. PAUL Departmet of Medicie, Thrombosis Uit,
Limits of Hip Arthroscopy -
Limits of Hip Arthroscopy - Arthroscopic vs. Ope Michael Diest Problems/Aatomy Costraied Ball-Socket Socket-Joit Limited distractio Strog capsule Thick soft tissue matle Orthopaedic Surgery Uiv. Hospital
Technical Assistance Document Algebra I Standard of Learning A.9
Techical Assistace Documet 2009 Algebra I Stadard of Learig A.9 Ackowledgemets The Virgiia Departmet of Educatio wishes to express sicere thaks to J. Patrick Liter, Doa Meeks, Dr. Marcia Perry, Amy Siepka,
Development of dependence following treatment with opioid analgesics for pain relief: a systematic review
bs_bs_baer REVIEW doi:10.1111/j.1360-0443.2012.04005.x Developmet of depedece followig treatmet with opioid aalgesics for pai relief: a systematic review Silvia Miozzi, Laura Amato & Maria Davoli Departmet
Management of Preschool Recurrent Wheezing and Asthma: A Phenotype-Based Approach
Maagemet of Preschool Recurret Wheezig ad Asthma: A Pheotype-Based Approach Leoard B. Bacharier, MD Robert C. Struk Edowed Chair for Lug ad Respiratory Research Professor of Pediatrics & Medicie Cliical
Preparing for Colon or Rectal Surgery
Preparig for Colo or Rectal Surgery A successful surgery starts with plaig OUR MISSION As people of Providece, we reveal God s love for all, especially the poor ad vulerable, through our compassioate service.
Dr P.W.Buczkowski. Consultant in Anaesthesia & Pain Medicine. Royal Derby Hospital
Dr P.W.Buczkowski Consultant in Anaesthesia & Pain Medicine Royal Derby Hospital INTERVENTIONAL PAIN MANAGEMENT III Neuroaxial Drug Delivery KYIV May 2010 Dr J Azzopardi MD FRCA FFPMANZCA FFPMRCA Consultant
Introducing You (And Your Novice/Older Clients) to the TRX
Itroducig You (Ad Your Novice/Older Cliets) to the TRX ACSM Health & Fitess Summit 2012 Christia Thompso, Ph.D. Uiversity of Sa Fracisco Thompso Fitess Solutios, LLC Leigh Crews Seior Master Traier TRX
CEREC Omnicam: scanning simplicity.
C A D / C A M S Y S T EM S I N S T RU M EN T S H YG I EN E S Y S T EM S T R E AT M EN T CEN T ER S I M AG I N G S Y S T EM S C A D / C A M came r as. M ade t o i s p i r e cerec Omicam ad cerec Bluecam.
Raising Healthy Kids: Colostrum Management and Prevention of Failure of Passive Transfer
11/11/14! Raisig Healthy Kids: Colostrum Maagemet ad Prevetio of Failure of Passive Trasfer Cassi Plummer, DVM Iowa State Uiversity College of Veteriary Medicie Itroductio Colostrum Maagemet Failure of
Adverse Events From Cough and Cold Medications After a Market Withdrawal of Products Labeled for Infants
Adverse Evets From Cough ad Cold Medicatios After a Market Withdrawal of Products Labeled for Ifats WHAT S KNOWN ON THIS SUBJECT: A volutary market withdrawal of orally admiistered, over-the-couter cough
GSK Medicine Study Number: Title: Rationale: Study Period: Objectives: Primary Secondary Indication: Study Investigators/Centers: Research Methods
The study listed may iclude approved ad o-approved uses, formulatios or treatmet regimes. The results reported i ay sigle study may ot reflect the overall results obtaied o studies of a product. Before
Hospital Measures. Region 1
Regio 1 Hospital Measures Northwest ad West Cetral: Becker, Beltrami, Clay, Clearwater, Douglas, Grat, Hubbard, Kittso, Lake of the Woods, Mahome, Marshall, Norma, Otter Tail, Peigto, Polk, Pope, Red Lake,
IMPAIRED THEOPHYLLINE CLEARANCE IN PATIENTS WITH COR PULMONALE
Br. J. cli. Pharmac. (1979), 7, 33--37 IMPAIRED THEOPHYLLINE CLEARANCE IN PATIENTS WITH COR PULMONALE N. VICUNA,1 J.L. McNAY,l T.M. LUDDEN2 & H. SCHWERTNER3 'Divisio of Cliical Pharmacology, Departmets
Delirium is a pathophysiological condition characterized. Delirium Resolution in Hospitalized Older Patients With Cancer
Copyright B 2008 Wolters Kluwer Health Lippicott Williams & Wilkis Stewart M. Bod, PhD, RN, AOCN Virgiia J. Neelo, PhD, RN Delirium Resolutio i Hospitalized Older Patiets With Cacer K E Y W O R D S Agig
prescription drug Approval No. solution Attached dissolving (Content per kit) Flomoxef sodium 1 g (potency) Sodium chloride 50 mg
Shioogi & Co., Ltd. Revised: Jue 9 (9th versio) Stadard Commodity Classificatio o. of Japa 87 - Oxacephem atibiotic aget - FLUMARI for Itraveous Ijectio. g FLUMARI for Itraveous Ijectio g FLUMARI Kit for
WRAP'S YOUTH GUIDE. The Washington Regional Alcohol Program s (WRAP) 2017 School Resource Guide to Preventing Underage Drinking
WRAP'S 7 YOUTH GUIDE The Washigto Regioal Alcohol Program s (WRAP) 7 School Resource Guide to Prevetig Uderage Drikig Washigto Regioal Alcohol Program Sposored by Table of Cotets I 5,,886 5--year-old drivers
Surgery for Congenital Heart Disease. A novel adhesion barrier facilitates reoperations in complex congenital cardiac surgery
Surgery for Cogeital Heart Disease A ovel adhesio barrier facilitates reoperatios i complex cogeital cardiac surgery Thomas Walther, MD, PhD Ardawa Rasta, MD Igo Dähert, MD Volkmar Falk, MD, PhD Stefa
Retention in HIV care among a commercially insured population,
Retetio i HIV care amog a commercially isured populatio, 2006-2012 Kathy Byrd, MD, MPH 10th Iteratioal Coferece o HIV Treatmet ad Prevetio Adherece Jue 28 30, 2015 Natioal Ceter for HIV/AIDS, Viral Hepatitis,
A STUDY OF PETHIDINE KINETICS AND ANALGESIA IN WOMEN IN LABOUR FOLLOWING INTRAVENOUS, INTRAMUSCULAR AND EPIDURAL ADMINISTRATION
Br. J. cli. Pharmac. (12), 13, 171-176 A STUDY OF PETHIDINE KINETIS AND ANALGESIA IN WOMEN IN LABOUR FOLLOWING INTRAVENOUS, INTRAMUSULAR AND EPIDURAL ADMINISTRATION R.P. HUSEMEYER '*, A.J. UMMINGS ', J.R.
Treatment of Acute Cerebral Hemorrhage With Intravenous Glycerol
9 Treatmet of Acute Cerebral Hemorrhage With Itraveous A Double-Blid, -Cotrolled, Radomized Trial Y.L. Yu, FRCPE; C.R. Kumaa, FRCP; I.J. Lauder, PhD; Y.K. Cheug, FRCR; F.L. Cha, FRCR; M. Kou, HV; CM. Chag,
Blood pressure responsiveness to obstructive events during sleep after chronic CPAP
Eur Respir J 23; 21: 59 514 DOI: 1.1183/931936.3.3983a Prited i UK all rights reserved Copyright #ERS Jourals Ltd 23 Europea Respiratory Joural ISSN 93-1936 Blood pressure resposiveess to obstructive evets
The Human Body. Introduction. Human body. Nervous system Musculoskeletal system. Cardiovascular system. Produces movements.
Itroductio Huma body Nervous system Musculoskeletal system Muscular forces Muscle extesio ad cotractio Complex system of muscles ad boes Produces movemets Cardiovascular system Heart Blood vessels Respiratory
ORIGINAL ARTICLE. Xiao Jie Wang 1 *, Kun Miao 1 *, Yan Luo 2, Rui Li 1, Tao Shou 1, Ping Wang 3, Xin Li 2. Summary. Introduction
JBUON 2018; 23(1): 92-97 ISSN: 1107-0625, olie ISSN: 2241-6293 www.jbuo.com E-mail: editorial_office@jbuo.com ORIGINAL ARTICLE Radomized cotrolled trial of edostar combied with cisplati/pemetrexed chemotherapy
PDSS: The decision support system of diabetic patient for Public Health
Proceedigs of the 3rd Iteratioal Coferece o Idustrial Applicatio Egieerig 5 PDSS: The decisio support system of diabetic patiet for Public Health Bejapuk Jogmuewai, Kailas Bumrugchat, Papo kaewhi Iformatics
Hospital Measures. Region 3. Twin Cities Metro: Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, Washington
Regio 3 Hospital Measures Twi Cities Metro: Aoka, Carver, Dakota, Heepi, Ramsey, Scott, Washigto 48 Hospital Measures November 2010 2010 Health Care Quality Report Hospital Measures Quality of Care for
You Take My Breath Away: Management of Asthma in Children. David Seal, Pharm.D., BCACP, MS March 10, 2019
You Take My Breath Away: Maagemet of Asthma i Childre David Seal, Pharm.D., BCACP, MS March 10, 2019 Disclosures I have othig to disclose. Use of the GINA slide set has bee authorized. Pediatric Asthma
Practical guide to basic Skin Grafting in practice
SKIN GRAFTING I Maual Practical guide to basic Ski Graftig i practice Professor Derek C Kottebelt OBE, BVM&S, DVM&S, DipECEIM, MRCVS Cosultat i Equie Iteral Medicie RCVS ad Europea Recogised Specialist
A French survey of 3,225 patients treated with CPAP for obstructive sleep apnoea: benefits, tolerance, compliance and quality of life
Eur Respir J 1998; 12: 185 192 DOI:.1183/931936.98.1185 Prited i UK - all rights reserved Copyright ERS Jourals Ltd 1998 Europea Respiratory Joural ISSN 93-1936 A Frech survey of 3,225 patiets treated
Outline. Neutron Interactions and Dosimetry. Introduction. Tissue composition. Neutron kinetic energy. Neutron kinetic energy.
Outlie Neutro Iteractios ad Dosimetry Chapter 16 F.A. Attix, Itroductio to Radiological Physics ad Radiatio Dosimetry Neutro dosimetry Thermal eutros Itermediate-eergy eutros Fast eutros Sources of eutros
Journal of Hainan Medical University. Jiao-Na Wei 1, Rui-Hai Yang 2, Yong-Jin Wang 1, Hong-Yan Du Introduction
46 Joural of Haia Medical Uiversity 2017; 23(10): 46-50 Joural of Haia Medical Uiversity http://www.hykdxxb.com Correlatio of serum glutamyl trasferase (GGT) ad C-reactive protei (CRP) with agiogeesis
DESCRIPTION 1. Composition
Shioogi & Co., Ltd. 1 Revised: Jue 2009 (8th versio) Stadard Commodity Classificatio No. of Japa 876133 - Oxacephem atibiotic aget - SHIOMARIN for Itraveous Ijectio 1 g < Latamoxef sodium for ijectio >