C. Akascha. Alfred University.

Materials from Acute Hospitalization and Method: The records of 283 consecutive stroke patients ad- 1 1 2 mitted to a 200 bed rehabilitation center between April 2014 and *N purchase duloxetine 60 mg with visa anxiety before period. Out of the total 181 patients with a frst incidence of stroke 83 had right sided stroke lesion Introduction/Background: The term “transition of care” refers to a and 98 had left sided stroke lesion buy duloxetine 20mg online anxiety 30000. Univariate and multivariate patient moving to another setting of care as his/her condition or re- logistic regression statistical analyses were used to determine the quirements of health care change (1). Hospital discharge is a major factors associated with any statistically signifcant difference on point of transition. Conclusion: We found no evidence of any association search study in Traumatic Brain Injury) multicenter study Work between side of stroke lesion and rehabilitation outcome and be- Package 14 “Transition of care and post-acute care”. Studies including more variables measured at the and format of communications between referring and receiving time of admission to a rehabilitation centers should be examined. The data will be derived from the pa- tient’s medical records and summarized with descriptive statistics. Beuret Blanquart3, quality of transitional care for persons with complex care needs. Bavikatte2 to identify and characterized swallowing disorders in severe trau- 1University of Liverpool, Manchester, 2Aintree University Hospi- matic brain injury. The possibility of an oral feed- been reported to affect up to 80% of the patient population. Results: 11 patients were included dur- consequences of sleep disturbance can be severe, with even rela- ing the period. All the tively short periods of disturbance potentially resulting in major patients presented swallowing disorders, with clinically alteration impairment of cognitive function. The nasoendoscopy showed that there was an alteration of part be due to neurological factors and confounding psychologi- swallowing coordination in these patients which could explained cal and non-neurological factors such as pain, depression, anxi- the aspirations. Factors Associated with Depression after a Traffc Acci- Data was gathered through review of the patients’ medical records dent in a Cohort of Patients with Traumatic Brain Injury and questionnaires with objective scales used to analyse the pres- ence of sleep disturbance, depression, anxiety, pain and seizure and without It activity. Patients with of life lost; and will be the third leading cause of disability after post-traumatic epilepsy reported an average sleep disturbance ischemic heart disease and depression. They were as- of external factors on sleep disturbance such as excessive noise sessed at baseline, 3 and 12 months. Women and age increase the likelihood of depres- functional outcome after the rehabilitation program. Several pharmacological classes were pre- 1University of Deusto, Bilbao, 2University of Almeria, Almería, scribed and polymedication was frequent. All 58 individuals completed erogeneity, may contribute for the lack of statistical difference. Progesterone is a neurosteroid that is involved involved in spinal circuits has shown promising results in improving arm and neuroprotection and repair after brain injury. However, reduced neuronal loss, enhanced remyelination, improved func- future clinical trials with larger sample size are warranted to fur- tional recovery, and overall decrease in cerebral edema. Together with progesterone, estrogen can in 8 Cases of Spinal Cord Injury and 3 Cases of My- regulate multiple non-reproductive brain functions, such as cogni- elomeningocele tion and neuroprotection. Discussion/Conclusion: Neuroprotective roles of pro- giogenesis and neurogenesis and promotes the endothelial nitric gesterone and allopregnanolone may involve signaling through a oxide production. Elucidating these mechanisms of action is of utmost impor- motor activity and the sensibility. Medications known to affect sexual function as described region of the spinal cord lesion. Results: We included 211 pa- tients (n = 543) after excluding neurologically intact; those attend- ing for other than follow-up; 15% (n = 32) were females. Sexuality in Korean Men with Motor Complete Spinal Only 63% (n = 133) had dysfunction documented; 40% (n = 84) Cord Injury with erectile and ejaculatory dysfunction; 23% (n = 49) with only ejaculatory dysfunction. More than 50% (n = 116) were 1Seoul National University College of Medicine, 2Seoul National on medications with adverse effect on sexual function.

There was also a statistically significant difference in the one-year post transplantation Cr level cheap duloxetine 30 mg visa anxiety symptoms body, which was higher in group B at 2 duloxetine 30mg visa anxiety 30 minute therapy. This raises the question of whether these patients should hemodialysis, and survival were compared in both groups. Daniel Eyraud1,3, Jean Christophe Vaillant1, Pascal Lebray2, Pierre Coriat3, Alain Pavie4, Abstract# P-121 Laurent Hannoun1. Surgery, Federal University procedure, with only 47 procedures reported in the United States. Poor of Ceara, Fortaleza, Ceara, Brazil exact description of the intra and postoperative procedure and outcomes Liver transplantation is a lifesaving procedure for patients who have chronic was reported. All patients had proved cirrhosis with evidence of portal hypertension, operated by a Liver Transplantation Group of the University Hospital of one with renal insufficiency, another with pulmonary hypertension, and Ceara, Brazil. From May 2002 to August 2008, 300 liver transplantations clinical signs of cardiomyopathy with reduced ejection fraction. The performed and liver transplantation was performed with total liver exclusion main indication of transplant was post-hepatitis C cirrhosis (25%), followed and venovenous bypass. Thirty nine patients were Child A (13%), 153 were Child B (51%) liver was 2H46 min and 12H47 min respectively. Biliary complications occurred in 54 patients in all three patients revealed no evidence of rejection. Mean hospital length (18%) and vascular complications were found in 32 patients (10. Each DeVera, Eisaburo Sasatomi, Roberto Lopez, Paulo Fontes, Wallis surgical team proceeds exactly as he used to. Indications for surgical intervention were: perforation (4 cases), at Hospital Santa Isabel, Blumenau, Brazil. Gian Luigi Adani, Dario Lorenzin, Claudio Avellini, Miriam Isola, Anna Rossetto, Pierluigi Toniutto, Vittorio Bresadola, Andrea Risaliti, Umberto Baccarani. Transplantation, University, Udine, Italy Despite recent advances in organ preservation, immunosuppression, and surgical techniques the biliary tree is still considered the Achilles’ heel of liver transplantation. The aim of this study is to identify risk factors that might predispose to the development of biliary problems. Methods: from 2004 to 2007, 117 deceased liver transplantations were retrospectively analyzed for biliary complications. Median follow-up was 23 often, life-threatening complications (such as hemorrhage, hemodynamic months (range 1-49 months). Results: overall biliary complication rate was derangement, poor graft function, sepsis) in the latter. Univariate analysis indicated as significant predictors of biliary complications the time between portal and arterial reperfusion (p=0. Maria-Curie significant there was a trend toward an higher incidence of sepsis as a cause Hospital, Szczecin, Poland of death in the patients with biliary complications (75% vs 37%, p=0. Cirrhosis was confirmed with survival were noted between the two group; for patient’s survival 1 and 3 biopsy with unequivocal biochemistry exponents of active liver cirrhosis. No haemorrhage or clotting episode multivariate Cox models identified risk factors for 1-yr mortality. Thanks to the liver transplantation this patient was cured from haemophilia type A. By multivariate analysis, presence of antiretroviral therapy at the time of the first referral (p=0. As results we obtained a 75% of answering with focusing of risk on tranplantation, using extended liver donor criteria has extended the pool of communication, errors perception and their managements and competence. In these cases, the accepting transplant center can freely choose a patient from its waiting list and is not bound to regular recipient allocation criteria. There is only limited data available on the outcome of transplantations with those organs, especially when compared to regularily allocated livers.

Patients with 217 indicating the likely need for a procedure more invasive mesothelioma present with chest pain and shortness of than a thoracentesis (in increasing order of importance) breath cheap duloxetine 40 mg with visa anxiety symptoms chills. The chest radiograph reveals a pleural effusion 30 mg duloxetine amex anxiety network, include: generalized pleural thickening, and a shrunken hemitho- rax. The presence of gross pus in the pleural space Effusion Secondary to Pulmonary If the fluid recurs after the initial therapeutic thoracentesis Embolization and if any of the above characteristics are present, a repeat The diagnosis most commonly overlooked in the differ- thoracentesis should be performed. If the pleural effusion increases in size after anticoagulation, the patient proba- Effusion Secondary to Malignancy bly has recurrent emboli or another complication such as a hemothorax or a pleural infection. Malignant pleural effusions secondary to metastatic disease are the second most common type of exudative pleural effusion. The three tumors that cause ∼75% of all malig- Tuberculous Pleuritis nant pleural effusions are lung carcinoma, breast carci- (See also Chap. If the initial cytologic examination is with tuberculous pleuritis present with combinations of negative, then thoracoscopy is the best next procedure fever, weight loss, dyspnea, or pleuritic chest pain. At the time of tho- pleural fluid is an exudate with predominantly small lym- racoscopy, a procedure such as pleural abrasion should phocytes. The diagnosis is established by demonstrating be performed to effect a pleurodesis. Patients with a malignant pleural effusion are treated Alternatively, the diagnosis can be established by culture symptomatically for the most part because the presence of the pleural fluid, needle biopsy of the pleura, or thora- of the effusion indicates disseminated disease and most coscopy. In with the instillation of a sclerosing agent such as 500 mg many series, no diagnosis is established for ∼20% of exuda- of doxycycline. The importance of these Mesothelioma effusions is that one should not be too aggressive in try- Malignant mesotheliomas are primary tumors that arise ing to establish a diagnosis for the undiagnosed effusion, from the mesothelial cells that line the pleural cavities; particularly if the patient is improving clinically. The most common cause is Kaposi’s sarcoma followed Transudative Pleural Effusions by parapneumonic effusion. Peritoneal dialysis Chylothorax Exudative Pleural Effusions A chylothorax occurs when the thoracic duct is dis- 1. Metastatic disease bypass surgery rupted and chyle accumulates in the pleural space. Post–cardiac injury sclerotherapy syndrome chest tube drainage because this will lead to malnutrition g. Pericardial disease When a diagnostic thoracentesis reveals bloody pleural erythematosus 20. If the hematocrit is more than half of that in the lymphadenopathy peripheral blood, the patient is considered to have a e. Churg-Strauss syndrome tube thoracostomy, which allows continuous quantifica- tion of bleeding. If the bleeding emanates from a lacera- tion of the pleura, apposition of the two pleural surfaces is likely to stop the bleeding. If the pleural hemorrhage The diagnosis of an asbestos pleural effusion is one of exceeds 200 mL/h, consideration should be given to tho- exclusion. Several drugs can cause pleural effusion; the associated fluid is usually eosinophilic. Pleural Miscellaneous Causes of Pleural Effusion effusions commonly occur after coronary artery bypass There are many other causes of pleural effusion surgery. Key features of some of these conditions typically left sided and bloody with large numbers of are as follows: If the pleural fluid amylase level is ele- eosinophils and respond to one or two therapeutic tho- vated, the diagnosis of esophageal rupture or pancreatic racenteses. If the patient is febrile, has predominantly are typically left sided and clear yellow with predomi- polymorphonuclear cells in the pleural fluid, and has no nantly small lymphocytes and tend to recur. Other pulmonary parenchymal abnormalities, an intraabdomi- medical manipulations that induce pleural effusions nal abscess should be considered. Most can be managed with supplemental oxy- Pneumothorax is the presence of gas in the pleural space. Whereas a primary sponta- neous pneumothorax occurs in the absence of underlying Tension Pneumothorax lung disease, a secondary pneumothorax occurs in its presence. A traumatic pneumothorax results from penetrating or non- This condition usually occurs during mechanical ventila- penetrating chest injuries. The positive pleural pressure is pneumothorax in which the pressure in the pleural space life threatening both because ventilation is severely com- is positive throughout the respiratory cycle.

Mode of Administration: Potentilla is available in commer- cial forms for oral intake generic 30 mg duloxetine anxiety symptoms all the time. It is also available in crude and Leaves safe 60 mg duloxetine anxiety dreams, Stem and Root: The plant is a two-axis herbacious powder forms. The stems are 80 cm long, creeping, rooting Preparation: To prepare a tea, pour boiling water over 2 gm at the nodes, softly pubescent eventually becoming glabrous. Daily Dosage: 4 to 6 gm of drug; Tea: 1 cup freshly Characteristics: The plant has an almond-like fragrance and prepared several times a day between meals. Habitat: The plant is found in temperate and colder regions of the entire Northern Hemisphere. Production: Potentilla herb consists of the fresh or dried leaf and flowers of Potentilla anserina harvested shortly before or Kombal R, Glasl H, Flavan-3-ols and flavonoids from Potentilla during flowering, as well as its preparations. Hydroxycoumarins: umbelliferone, scopoletin Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, Nachdruck, Georg Olms Verlag Hildesheim 1979. On isolated rat uterus a paralyzing effect was proven which Steinegger E, Hansel R, Pharmakognosie, 5. Potentilla erecta Unproven Uses: In folk medicine, Potentilla is used external- ly as a wash for poorly healing wounds. There have been complaints of stomach irritation Potentilla reptans associated with Potentilla. Flower and Fruit: The flowers are purple-blue, globular and Madaus G, Lehrbuch der Biologischen Arzneimittel, Bde 1-3, long pedicled composite blooms, with a 2 to 3 rowed Nachdruck, Georg Olms Verlag Hildesheim 1979. Primula veris Leaves, Stem and Root: The plant grows from 15 to 80 cm See Cowslip high. Later it becomes woody and dies off except for the upper part, which accounts for its appearance. The stem is erect, sparsely Prunella vulgaris branched, pubescent and has few leaves. The cholesterol with the herb have been seen in many studies bracts are about 3 mm, suborbicular to ovate and sometimes (Davidson, 1998; MacMahon, 1998; Rodriguez-Moran, shortly pubescent. Glucose Control: Postprandial glucose and fasting plasma Leaves, Stem and Root: The plant is an annual almost glucose significantly improved in type 2 diabetic patients stemless, softly pubescent plant. The plant may have one or taking psyllium (Anderson, 1999; Rodriguez-Moran, 1998). The leaves are entire-mar- Inhibition of Gallstones: Psyllium hydrocolloid exerts bile gined or slightly denticulate and sparsely to densely villous- acid sequestrant properties determined by a rise in the cholic/ lanate. Psyllium Habitat: The plant grows in India, Afghanistan, Iran, Israel, also protects against cholesterol - gallstone formation by northern Africa, Spain and the Canary Islands. The protective cultivated in India and neighboring countries, Arizona and effect is associated with a selective decrease in biliary southern Brazil. Production: Psyllium consists of the ripe seeds or epidermis Irritable Bowel Syndrome/Ulcerative Colitis: Stool frequen- of Plantago ovata (synonym: Plantago isphagula). Mucilages (20-30%): chiefly arabinoxylans and Laxative Effects: Psyllium decreases the passage time of the glacturonosidorhamnoses bowel content by increasing the volume of the stool, thus Fatty oil exerting a laxative effect. Psyllium was superior to Iridoids: aucubin docusate sodium in subjects with chronic idiopathic consti- Proteic Substances pation (McRorie, 1998). Hypercholesterolemia/Hyperglycemia Antidiarrheal: When used for diarrhea, psyllium absorbs A randomized, double-blind, placebo-controlled study was water to increase the bowel content viscosity and delay conducted to determine the lipid and glucose lowering gastric emptying (Washington, 1998). Prior to the treatment period, all patients fissures and hemorrhoids; following anal/rectal surgery; and participated in a 6-week period of diet counseling. Externally, increased in the Psyllium treatment group compared to the Psyllium is used for gout, rheumatism, furuncles and as an placebo group, suggesting Psyllium as a useful adjunct to analgesic. Indian Medicine: Psyllium is used for gastritis, chronic Hypercholesterolemia/Hyperglycemia diarrhea, constipation, dysentery, dry cough, gout, gonor- rhea, nephropathy, dysuria, duodenal ulcers and The safety and effectiveness of Psyllium husk fiber as an hemorrhoids. The Psyllium group had significant threatening obstruction of the bowel (ileus), or difficulties in improvements in glucose and lipid values compared with the regulating diabetes mellitus. All day and postprandial glucose concen- of the esophagus or of the intestine,, particularly with older trations were 11. Patients with exocrine pancreatic insufficiency the Psyllium treatment group than in the placebo group should avoid use of Psyllium due to inhibitory actions on (Anderson, 1999). Ulcerative Colitis Allergic Reactions/Anaphylaxis: Allergic reactions ranging from sneezing to chest congestion and wheezing were The objective of an open label, parallel-group, randomized reported in three nurses after Psyllium use (Ford, 1992).