By Y. Randall. Texas Chiropractic College.
In full-thickness rupture best 160mg super p-force erectile dysfunction diabetes uk, a complete disruption of Tendons transmit the forces generated in muscles to the tendon causes a retraction of the proximal torn edge bones 160 mg super p-force for sale erectile dysfunction caused by vasectomy. Such echoes are end purchase super p-force 160 mg erectile dysfunction protocol hoax, which can help in choosing the extent of the surgi- not related to the collagen bundles but to the interfaces cal incision. A distinctive type of tendon tear, so called longitudi- Transverse sonograms show tendons as circular ovoid nal fissuration, can be observed in the ankle tendons, par- structures with an internal dotted appearance. Any obliquity of the beam results in arti- ly or completely dividing the tendon into two or more factual tendon hypoechogenicity, which can simulate a bands. An accurate technique of exami- sheath is usually present and facilitates recognition of fis- nation is therefore essential to avoid diagnostic mis- sures . From the anatomic and biomechanical point of view, Inflammatory Conditions tendons can be divided into two main groups. These tendons are surrounded by paratenon, a first group, changes are mainly observed at the level of loose areolar and adipose tissue envelope adherent to the the peritendon (peritendinitis). Tendons of the second group reflect against choic thickening of the peritendon usually associated bones surfaces or retinacula and are surrounded by a with surface irregularities of the outer portion of the ten- synovial sheath, which contains a thin amount of syn- don that appear hypoechoic and do not have a fibrillar ap- ovial fluid that facilitates frictionless movements and pearance. The synovial sheath can be appreciated only when The hallmark of tenosynovitis in tendons of the sec- the examination is performed with high-resolution ond group is the presence of an effusion in the tendon’s equipment and presents as a thin hypoechoic rim sur- sheath. The most common causes of tenosynovitis are rounding the tendons, related to the synovial fluid con- trauma, foreign bodies, infection and arthritis. In tenosyn- shows an enlarged tendon with internal irregularities of ovitis secondary to systemic arthritis, the synovial mem- the normal internal structure, focal hypoechoic areas, brane of the tendon sheath appears hypertrophied and and hyperechoic regions with posterior shadowing . In the most severe cases, the hypoechoic areas correlate with fibromyxoid degenera- synovial pannus can eventually completely fill the syn- tion while hyperechoic images correlate with calcifica- ovial space. Musculoskeletal Sonography 159 Tendon Dislocation mas are mainly observed in nerves entrapments syn- dromes, which typically affect nerves that course in un- Dislocation can occur only in tendons of the second extensible osteofibrous tunnels. The most fre- ing method to confirm clinical suspicion of entrapment quent dislocations affect the long head of the biceps ten- neuropathy and to plan appropriate treatment, since it can don at the shoulder  and the peroneal tendons  at depict nerve changes and the cause of the compression. Transverse images calized flattening at the level of compression and proxi- optimally show the relation of the tendons with the oste- mal bulbous enlargement, hypoechogenicity with loss of ofibrous tunnels that usually house them. Secondary fascicular echo texture, enhanced flow signals on color changes, such as tendon sheath effusion due to inflam- Doppler. In carpal tunnel syndrome, tenosynovitis of the foot may detect intermittent subluxation. Ganglia are peritendi- osteophytes appear as hyperechoic lesion arising from the nous cystic lesions containing mucoid, viscid fluid that joint margins. Rarely, they grow inside the tendon and appear as hy- value in planning operative treatment in patients with poechoic internal masses that follow the tendon during multiple traumas at different levels. Giant-cell tumor of the tendon sheath nerve appears as a local discontinuity in the nerve fasci- presents as a painless, slowly growing mass located in cles. Partial and complete tears can be differentiated in close relationship with a tendon. Schwannomas are encapsulated, well-cir- Ultrasound Anatomy of Nerves cumscribed lesions that can be easily treated surgically, while neurofibromas spread within the fascicles and are Nerves are formed of nervous fibers grouped in fascicles. Longitudinal sonograms show sever- al hypoechoic parallel linear areas (nerve fascicles) sep- arated by hyperechoic bands (connective tissue), forming a fascicular pattern. On transverse scans, the nerve fasci- cles is a hypoechoic rounded structures embedded in a hyperechoic background [12, 13]. In doubtful cases, minor move- ments on dynamic examination performed during muscle activation can help in differentiating them from tendons. Note a solid mass (asterisk) connected Traumatic Lesions with the deep peroneal nerve (arrowheads) corresponding to a schwannoma. Power Doppler can be used for the detection and regularities of the greater tuberosity, and (4) focal carti- follow-up of inflammatory pathology (e. Degenerative changes in tendinosis are, in general, hy- poechoic [17, 19], or hyperechoic . Associated hypoechoic tendon thick- ening and positive Doppler examination reflect inflam- mation. A small effusion, surrounding the biceps tendon may accompany any of the above-mentioned findings. A fracture of the greater tuberosity may lead to a sec- ondary type of impingement. Dynamic examination can also demonstrate anterior and posterior shoulder im- pingement Effusion in the biceps tendon sheath reflects patholo- gy elsewhere in the joint in 90% of cases. In inflamma- tion, the biceps tendon is tender, enlarged, heterogeneous, surrounded by an effusion and may present longitudinal splits. When the bicipital groove is empty, the tendon may be ruptured, with variable retraction, or it may be dislo- Fig. Full-thickness tear of the supraspinatus tendon, transverse cated (almost invariably associated with a tear of the sub- plane A hypoechoic cleft filled with fluid is seen in the supraspina- scapularis tendon). Partial tendon rupture appears as an area of localized swelling and de- creased echogenicity inside the tendon. Microtraumatic tendon diseases, including De Quervain disease  and trigger finger , are due to repetitive movements that induce friction at the level of the osteofibrous tunnel (Fig. Cortical irreg- sheath effusion, and eventually guide a local steroid in- ularity or spur formation can be detected at the epi- jection. Intratendinous neo-angiogenesis or peri- tendinous hyperemia can be demonstrated using power Doppler evaluation. Typical signs of a distal biceps tendon rupture are: a retracted distal biceps tendon causing acoustic shadow- ing, and a triangular-shaped blood-filled cavity at the musculotendinous junction . A thickened heteroge- neous tendon is present in tendinosis; a fluid-filled bicip- ito-radial bursa can also be demonstrated. The ulnar nerve measures 2-3 mm and should be eval- uated comparatively and dynamically during flexing of the elbow . In cubital tunnel syndrome, the ulnar nerve is thickened, hypoechoic and can be subluxed. Sonogram of the dorsal aspect of the wrist wall thickening, hypoechoic fluid and echogenic fibrous shows a hyperechoic foreign body (white arrowhead) surrounded by a hypoechoic inflammatory halo (empty arrowheads). Surgical clots), gout (hyperechoic nodular crystal depositions± exploration revealed a wood splinter acoustic shadowing), or infection (intermediate echogenic fluid, surrounding edema, positive power Doppler, for- eign body). Longitudinal sonogram of tion of a large spectrum of disorders, although several the first extensor compartment of the wrist. At early stages, hand and wrist are ganglia  and giant-cell tumor of when osseous erosions are not detected by standard ra- the tendon sheath. Ganglia are depicted as well-demar- diographs, it demonstrates paraarticular edema as well cated, anechoic masses with regular borders without in- as joint- and tendon-sheath effusions. In older le- the synovial membrane (pannus) producing marginal sions, internal septa and fibrosis explain the hypoechoic erosions can also be detected (Fig.
Arch Phys Med Rehabil 82: 1578 1586 Peck C super p-force 160mg generic erectile dysfunction gel, Coleman G (1991) Implications of placebo theory for clinical research and practice in pain management order generic super p-force on-line effexor xr impotence. Theor Med 12: 247 270 Peuker E (2004) Case report of tension pneumothorax related to acupuncture buy super p-force without prescription erectile dysfunction test yourself. J Spinal Cord Med 26: 21 26 Samuels N (2002) Acupuncture for cancer patients: why not? Altern Ther Health Med 12: 34 41 Soderberg E, Carlsson J, Stener Victorin E (2006) Chronic tension type headache treated with acupuncture, physical training and relaxation training. Cephalalgia 26: 1320 1329 Sprott H (1998) Efficiency of acupuncture in patients with fibromyalgia. Clin Bull Myofascual Therapy 3: 37 43 Streng A, Linde K, Hoppe A, Pfaffenrath V, Hammes M, Wagenpfeil S, Weidenhammer W, Melchart D (2006) Effectiveness and tolerability of acupuncture compared with metoprolol in migraine prophylaxis. Singapore Med J 48: E32 E33 Takeda W, Wessel J (1994) Acupuncture for the treatment of pain of osteoarthritic knees. Acta Anaesthesiol Scand 38: 63 69 Tillu A, Roberts C, Tillu S (2001) Unilateral versus bilateral acupuncture on knee function in advanced osteoarthritis of the knee A prospective randomised trial. Acupunct Med 19: 15 18 Trinh K, Graham N, Gross A, Goldsmith C, Wang E, Cameron I, Kay T (2007) Acupuncture for neck disorders. Pain 126: 245 255 Veith I (2002) The Yellow Emperor’s Classic of internal Medicine. Brain Res 526: 221 227 Wang W, Yin X, He Y, Wei J, Wang J, Di F (1990b) Treatment of periarthritis of the shoulder with acupuncture at the Zhongping (foot) extrapoint in 345 cases. J Tradit Chin Med 10: 209 212 Weidenhammer W, Linde K, Streng A, Hoppe A, Melchart D (2007) Acupuncture for chronic low back pain in routine care: a multicenter observational study. Clin J Pain 23: 128 135 White A (2004) A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 22: 122 133 White P, Lewith G, Hopwood V, Prescott P (2003) The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? Pain 106: 401 409 White P, Lewith G, Prescott P, Conway J (2004) Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial. Arthritis Rheum 54: 3485 3493 Woolhouse M (2005) Migraine and tension headache A complementary and alternative medicine approach. J Tradit Chin Med 7: 116 118 Xing G (1998) Acupuncture treatment of phantom limb pain A report of 9 cases. J Tradit Chin Med 18: 199 201 192 7 Acupuncture Analgesia in Clinical Practice Yamashita H, Tsukayama H, Hori N, Kimura T, Tanno Y (2000) Incidence of adverse reactions associated with acupuncture. J Altern Complement Med 9: 479 490 Yurtkuran M, Alp A, Konur S, Ozcakir S, Bingol U (2007) Laser acupuncture in knee osteoarthritis: a double blind, randomized controlled study. Headache 45: 716 730 193 8 Neurochemical Basis of Electroacupuncture Analgesia on Acute and Chronic Pain Yanqing Wang and Gencheng Wu Department of Integrative Medicine and Neurobiology and State Key Laboratory of Medical Neurobiology Shanghai Medical College of Fudan University, Shanghai 200032, P. Keywords acute pain, chronic pain, endogenous opioid peptides, neurotrans- mitters, inflammatory cytokines 8. Clinical observations and laboratory research have established the overwhelming recognition that acupoint stimulation can produce analgesic effect on various types of acute or chronic pain. A large body of literature has revealed that the essence of acupuncture analgesia is mainly the activation of the endogenous antinociceptive system to modulate pain transmission and pain response, resulting in the diminution of pain perception and aversive reactions. The neural process involves the integration of different neurotransmitter and modulator systems at various levels of the central nervous system. In the early 1970’s, an elegant study from Han’s group found for the first time that when the cerebrospinal fluid of donor rabbits given 8 Neurochemical Basis of Electroacupuncture Analgesia on Acute and Chronic Pain acupuncture was infused into the cerebral ventricles of recipient rabbits, the pain threshold of the recipients was increased, strongly suggesting the involvement of central chemical mediators in acupuncture analgesia (Research Group of Acupuncture Anesthesia, Peking Medical College 1974). Since then, many lines of evidence found in clinical and animal studies has demonstrated that acupuncture analgesia is mediated by various neurotransmitters and modulators. The chronic pain is characterized by hyperalgesia, allodynia and spontaneous pain. The underlying mechanism thought to account for these phenomena include peripheral sensitization (the hyperexcitability in primary nociceptors) and central sensitization (the increase in neuronal activity of spinal dorsal horn neurons). Unlike acute pain, which is a protective response of the body, chronic pain persists and serves no useful purpose, and severely affects the quality of life. Both laboratory research and clinical practice demonstrate that pain is relieved immediately after needling of the acupuncture points in many cases, particularly cases of pain caused by a certain injury. Most importantly, repeated acupuncture has been confirmed to have cumulative (therapeutic) effect in chronic pathological pain. Compared to the large body of previous studies on immediate analgesia effect of acupuncture, it is more clinically significant to assess the cumulative (therapeutic) effect of acupuncture, since clinically acupuncture is chronically applied for chronic pain. Patients with neuropathic pain often suffer from spontaneous pain, allodynia (pain response to normally innocuous stimuli) and hyperalgesia 195 Acupuncture Therapy of Neurological Diseases: A Neurobiological View (aggravated pain evoked by noxious stimuli) (Wang and Wang 2003). Most neuropathic pain models were made to simulate human neuropathic con- ditions by inducing or injuries to the spinal cord or peripheral nerves (Fig. Kim and Chung reported in 1992 another experimental mononeuropathy simulating human causalgia. Allodynia and hyperalgesia develop quickly after ligation and last for at least 4 months. Inflammatory pain arises as a debilitating consequence of injury to the peripheral tissue, which is characterized by combination of spontaneous burning pain, hyperalgesia and allodynia. A sufficient but tolerable intensity of 3 mA was more effective than lower intensities (1 2 mA). They provide important information for designing further clinical acupuncture research on persistent inflammatory pain (Lao et al. Whereas improving diagnosis and treatment methods are increasing the survival rate and life expectancy of cancer patients, cancer pain is increasingly becoming a bigger problem affecting the quality of life. Current treatment is largely based on empirical clinical experience with incomplete success. Cancer-related pain may be caused by tumor infiltration or compression of nerve, plexus, or roots, immunoreactive and pronociceptive substances released from tumors, or by treatment (chemotherapy, radiation, or surgery). The lack of suitable experimental animal models for cancer pain has been the major stumbling block in the 198 8 Neurochemical Basis of Electroacupuncture Analgesia on Acute and Chronic Pain investigation of the mechanisms underlying cancer pain. Bone cancer pain is one of the most common cancer-related pain of which the cancer can be primary or metastatic from breast, prostate, ovary and lung tumors. Deep pain with a burning and stabbing sensation is often described by bone cancer patients. So far a few reports are available for the analgesia effect of acupuncture on cancer pain. The neural process involves the integration of different neuro- transmitter and modulator systems at various levels of the central nervous system. The endomorphin was considered as the pure P opioid receptor endogenous agonist and dynorphin the relatively pure N opioid agonist, the enkephalin and E-endorphin were mixed P and G opioid receptor agonists (Han 2004). Hyperalgesia score was calculated as the difference of the bila teral paw withdrawal latency (ipsilateral contralateral) to radiant heat stimulation (a). The percentage of control latency was calculated as 100% times response latency of experimental mice/response latency of normal mice (b). Opioid receptors are differentially distributed in the neuronal nociceptive system including periaqueductal grey, locus coeruleus, substantia nigra, ventral tegmental area, raphe nuclei, nucleus tractus soli tarii and the spinal cord which are closely involved in the transmission of nociceptive stimuli and the modulation of nociception (Przewlocki and Przewlocki 2001).
Unlike most other foodborne pathogens buy super p-force 160mg lowest price erectile dysfunction exercise, Listeria tends to multiply in refrigerated foods that are contaminated buy 160 mg super p-force with mastercard impotence ruining relationship. Mode of transmission—Outbreaks have been reported in associ- ation with ingestion of raw or contaminated milk order generic super p-force online erectile dysfunction 5k, soft cheeses, vegetables, and ready-to-eat meats, such as paˆte´. Papular lesions on hands and arms may occur from direct contact with infectious material. In neonatal infections, the organism can be transmitted from mother to fetus in utero or during passage through the infected birth canal. There are rare reports of nursery outbreaks attributed to contaminated equipment or materials. Incubation period—Variable; cases have occurred 3–70 days following a single exposure to an implicated product. Period of communicability—Mothers of infected newborn in- fants can shed the infectious agent in vaginal discharges and urine for 7–10 days after delivery, rarely longer. Children and young adults generally are resistant, adults less so after age 40, especially the immunocompromised and the elderly. There is little evidence of acquired immunity, even after prolonged severe infection. Preventive measures: 1) Pregnant women and immunocompromised individuals should avoid ready-to-eat foods, smoked ﬁsh and soft cheeses made with unpasteurized milk. They should also avoid contact with potentially infective materi- als, such as aborted animal fetuses on farms. Irradiate soft cheeses after ripen- ing or monitor nonpasteurized dairy products, such as soft cheeses, by culturing for Listeria. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Obligatory case report required in many countries, Class 2; in others, report of clusters required, Class 4 (see Reporting). For penicillin-allergic patients, tri- methoprim-sulfamethoxazole or erythromycin is preferred. Cephalosporins, including third-generation cephalosporins, are not effective in the treatment of clinical listeriosis. A Gram-stain smear of meconium from clinically suspected newborns should be examined for short Gram-positive rods resem- bling L. Epidemic measures: Investigate outbreaks to identify a com- mon source of infection, and prevent further exposure to that source. Identiﬁcation—A chronic ﬁlarial disease characterized by migra- tion of the adult worm through subcutaneous or deeper tissues of the body, causing transient swellings several centimeters in diameter, located on any part of the body. Migration of the adult worm under the bulbar conjunc- tivae may be accompanied by pain and oedema. Infections with other ﬁlariae, such as Wuchereria bancrofti, Onchocerca volvulus, Mansonella (Dipetalonema) perstans and M. Larvae (microﬁlariae) are present in peripheral blood during the daytime and can be demonstrated in stained thick blood smears, stained sediment of blood where erythrocytes and hemoglobin have been separated (laking) or through membrane ﬁltration. Occurrence—Widely distributed in the African rain forest, espe- cially central Africa. In the Congo River basin, up to 90% of indigenous inhabitants of some villages are infected. Primate Loa loa occur but the two have different transmission complexes and the disease is therefore not a zoonosis. Incubation period—Symptoms usually appear several years after infection but may occur as early as 4 months. Microﬁlariae may appear in the peripheral blood as early as 6 months after infection. Period of communicability—The adult worm may persist in humans, shedding microﬁlariae into the blood for as long as 17 years; in the ﬂy, “communicability” starts from 10–12 days after its infection until all infective larvae have been released, or until the ﬂy dies. Susceptibility—Susceptibility is universal, with repeated infec- tions; immunity, if present, has not been demonstrated. Preventive measures: 1) Measures directed against the ﬂy larvae are effective but have not proven practical because the moist, muddy breeding areas are usually too extensive. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Ofﬁcial report not ordinarily required, Class 5 (see Reporting). During treatment, hypersensitivity reactions (sometimes severe) are common but may be controlled with steroids and/or antihistamines. When microﬁlaraemia is heavy (greater than 2000/mL blood), there is a risk of meningoencephalitis and the advantages of treatment must be weighed against the risk of life-threatening encephalopathy; treatment with either drug must be individualized and undertaken under close medical supervision. Albendazole and mebendazole both cause a slow decrease in microﬁlaraemia with few side-effects and probably kills adult worms. Loa loa enceph- alopathy has been reported following ivermectin treat- ment for onchocerciasis, which is why the drug is not recommended for mass treatment of onchocerciasis in areas where loiasis is endemic. Identiﬁcation—A tick-borne, spirochaetal, zoonotic disease char- acterized by a distinctive skin lesion, systemic symptoms and neurological, rheumatological and cardiac involvement occurring in varying combina- tions over months to years. Recent reports state that the optic nerve may be affected because of inﬂammation or increased intracranial pressure. The illness typically begins in the summer; the ﬁrst manifestation in about 80% of patients is a red macule or papule that expands slowly in an annular manner, often with central clearing. In middle Europe and Scandinavia skin lesions called lymphadenosis benigna cutis and acrodermatitis chronica atrophi- cans are almost exclusively caused by Borrelia afzelii. Weeks to years after onset (mean, 6 months), intermit- tent episodes of swelling and pain in large joints, especially the knees, may develop and recur for several years; chronic arthritis may occasionally result. They are insensitive during the ﬁrst weeks of infection and may remain negative in people treated early with antibiotics. VlsE (Vls locus expression site) or C6 recombinant antigens increase the sensitivity of IgG immunoblot. Diagnosis of nervous system Lyme disease requires demonstration of intrathecal antibody production. The genotype present in North America, Borrelia burgdorferi sensu stricto, grows at 33°C (91. Initial infection occurs primarily during summer, with a peak in June and July, but may occur throughout the year, depending on the seasonal abundance of the tick locally. The distribution of most cases coincides with the distribution of Ixodes scapularis (formerly I. Dogs, cattle and horses develop systemic disease that may include the articular and cardiac manifestations seen in human patients. Larval and nymphal ticks feed on small mammals, and adult ticks primarily on deer. Despite rare case reports of congenital transmission, epidemiological studies have not shown a link between maternal Lyme disease and adverse outcomes of pregnancy. Preventive measures: 1) Educate the public about the mode of tick transmission and the means for personal protection. To minimize expo- sure, wear light-colored clothing that covers legs and arms so that ticks may be more easily seen; tuck trousers into socks and apply tick repellent such as diethyltoluamide to the skin or permethrin (repellent and contact acaricide) to sleeves and trouser legs. Remove ticks by using gentle, steady traction with forceps (tweezers) applied close to the skin, so as to avoid leaving mouth parts in the skin; protect hands with gloves, cloth or tissue when removing ticks. Information regarding vaccine safety and efﬁcacy beyond the transmission season immediately after the third dose is not available.
More studies of antibiotic pharmacokinetics in the multiple-system injured patient are necessary buy 160 mg super p-force free shipping erectile dysfunction protocol by jason. Inadequate antimicrobial prophylaxis during surgery: a study of b-lactam levels during burn debridement effective super p-force 160 mg impotence 20 years old. Gentamicin pharmacokinetics in 1 buy super p-force 160 mg on-line erectile dysfunction doctor los angeles,640 patients: method for control of serum concentrations. Effect of altered volume of distribution on aminoglycoside levels in patients in surgical intensive care. Pharmacokinetic monitoring of nephrotoxic antibiotics in surgical intensive care patients. Variability in aminoglycoside pharmacokinetics in critically ill surgical patients. Aminoglycoside pharmacokinetics: dosage requirements and nephrotoxicity in trauma patients. Pharmacokinetics of vancomycin: observations in 28 patients and dosage recommendations. The pharmacokinetics of once-daily dosing of ceftriaxone in critically ill patients. Intermittent and continuous ceftazidime infusion for critically ill trauma patients. Pharmacokinetic-pharmacodynamic evaluation of ceftazidime continuous infusion vs intermittent bolus injection in septicemic melioidosis. Low plasma cefepime levels in critically ill septic patients: pharmacokinetic modeling indicates improved troughs with revised dosing. Pharmacokinetics of aztreonam and imipenem in critically ill patients with pneumonia. Pharmacokinetics and pharmacodynamics of imipenem during continuous renal replacement therapy in critically ill patients. Pharmacokinetic evaluation of meropenem and imipenem in critically ill patients with sepsis. Ertapenem in critically ill patients with early-onset ventilator-associated pneumonia: pharmacokinetics with special consideration of free-drug concen- tration. Fluid shifts have no influence on ciprofloxacin pharmacokinetics in intensive care patients with intra-abdominal sepsis. Ciprofloxacin pharmacokinetics in critically ill patients: a prospective cohort study. Pharmacokinetics of intravenous and oral levofloxacin in critically ill adults in a medical intensive care unit. Pharmacokinetics and pharmacodynamics of intravenous levofloxacin in patients with early-onset ventilator-associated pneumonia. Pharmacokinetics and pharmacodynamics of levofloxacin in critically ill patients with ventilator-associated pneumonia. Bacteremic pneumonia due to Staphylococcus aureus:a comparison of disease caused by methicillin-resistant and methicillin-susceptible organisms. Staphylococcus aureus bacteremia: recurrence and the impact of antibiotic treatment in a prospective multicenter study. Linezolid vs vancomycin: analysis of two double-blind studies of patients with methicillin-resistant Staphylococcus aureus nosocomial pneumonia. Linezolid versus vancomycin in treatment of complicated skin and soft tissue infections. Antibacterial dosing in intensive care: pharmacokinetics, degree of disease and pharmacodynamics of sepsis. Linezolid pharmacokinetic/pharmacodynamic profile in critically ill septic patients: intermittent versus continuous infusion. A randomized study of carbenicillin plus cefamandole or tobramycin in the treatment of febrile episodes in cancer patients. Pharmacokinetics of ceftazidime in serum and peritoneal exudate during continuous versus intermittent administration to patients with severe intra- abdominal infections. A comparative trial of sisomicin therapy by intermittent versus continuous infusions. Cefepime in critically ill patients: continuous infusion vs an intermittent dosing regimen. Randomized, open-label, comparative study of piperacillin- tazobactam administered by continuous infusion versus intermittent infusion for treatment of hospitalized patients with complicated intra-abdominal infection. Cost-effectiveness of ceftazidime by continuous infusion versus intermittent infusion for nosocomial pneumonia. Is continuous infusion ceftriaxone better than once-a-day dosing in intensive care? Population pharmacokinetics and pharmacodynamics of continuous versus short-term infusion of imipenem-cilastatin in critically ill patients in a randomized, controlled trial. Continuous versus intermittent infusion of vancomycin in severe staphylococcal infections: prospective multicenter randomized study. Better outcomes through continuous infusion of time-dependent antibiotics to critically ill patients? Continuous versus intermittent intravenous administration of antibiotics: a meta-analysis of randomized controlled trials. Piperacillin-tazobactam for Pseudomonas aeruginosa infection: clinical implications of an extended-infusion dosing strategy. Optimal dosing of piperacillin-tazobactam for the treatment of Pseudomonas aeruginosa infections: prolonged or continuous infusion? Antibiotic Therapy in the Penicillin Allergic 30 Patient in Critical Care Burke A. Cunha Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, and State University of New York School of Medicine, Stony Brook, New York, U. Several factors go into antibiotic selection including (i) spectrum of activity against the presumed pathogens, which is related to the source of infection or organ system involved; (ii) pharmacokinetic and pharmacodynamic considerations which affect dosing and concentration in the source organ for the sepsis; and (iii) the resistance potential of the antibiotic needs to be considered. The fourth consideration is the safety profile of the drug, which has to do with adverse side effects and interactions, as well as the patient’s allergic drug history. One of the most common problems encountered in treating critically ill patients is the question of penicillin allergy. Often penicillin allergy is mentioned, but further or detailed question reveals that it is not truly an allergic reaction at all. Patients, if they are able to respond, are either vague or very clear about the nature of their penicillin allergy. In the critical care setting, there is often no way to get a drug allergy history. Relatives are usually uncertain as to the nature of the allergic reaction of the patient. There is poor correlation between the patient reporting penicillin allergy and subsequent penicillin skin testing.