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Biomedical subjects

A Kadari

Publications and source records attributed to A Kadari.

15 recordsLinked to original sources
PubMed1997

Cell death of adult pyramidal CA1 neurons after intraventricular injection of a novel peptide derived from trkA.

Members of the nerve growth factor (NGF) family of neurotrophins bind to the second leucine-rich motif (LRM2) within the extracellular domains of their respective receptors (trkA, trkB, trkC). Small LRM2 peptides have been recently demonstrated to selectively bind the neurotrophins revealing similar complex binding characteristics as full-length receptors. We extend our recent findings, showing that the peptides (A and C) do not block nerve fiber outgrowth through high affinity trk receptors in a ganglia bioassay. Since the highest concentration of neurotrophins [NGF, brain-derived neurotrophic factor (BDNF), neurotrophin-3 (NT-3)] is found in the hippocampus, the peptides were injected into the 3rd ventricle of anesthetized adult rats. The (NGF binding) LRM2-A peptide, but not the (BDNF binding) LRM2-B or the (NT-3 binding) LRM2-C peptides, caused severe apoptotic neurodegeneration of hippocampal pyramidal CA1 neurons as revealed by cresyl violet staining and the TUNEL reaction. The degeneration was protected by intrahippocampal injection of NGF-beta and by the non-N-methyl-D-aspartate (NMDA) antagonist CNQX (6-cyano-7-nitroquinoxaline-2,3-dione), indicating a glutamatergic mechanism. In situ hybridization revealed that pyramidal CA1 neurons did not express trkA and p75 receptor mRNA in sham and LRM2-A-lesioned animals. It is concluded that the LRM2-A peptide represents a novel peptide with properties to induce apoptotic cell death of pyramidal CA1 neurons and may be useful as an experimental agent.

2-Amino-5-phosphonovalerate↗
PubMed1997

Aspects of spinal deformity in familial dysautonomia (Riley-Day syndrome).

Familial dysautonomia (FD) is a rare autosomal recessive disease occurring in Jews of Ashkenazi descent, with only some 500 recognized cases. The causative gene was identified on chromosome 9. FD is of considerable orthopedic interest, because of the prevalence of skeletal deformity. About 90% of surviving dysautonomic children will develop a spinal curvature, commonly a scoliosis. The scoliotic curve is usually kyphotic rather than lordotic, and appears during the first decade of life. Fifty-one of the 90 reported cases of familial dysautonomia in Israel involved patients who were seen at the scoliosis clinic for assessment and treatment of their spinal deformities. Most of the patients presented with a scoliotic deformity associated in 37 cases with an increased thoracic kyphosis. In our series orthotic treatment and physiotherapy were found to be minimally successful at best. Surgical treatment of the spine was performed in 13 of 51 patients in this series. A retrospective review of these patients' charts and radiographs was carried out. Six years of follow-up are reported. The primary indication for surgery was progression of the spinal curve. Only posterior spinal fusions were performed. Anterior transthoracic procedures were avoided in spite of the significance of the kyphotic deformity, because of the frequency of pulmonary complications. Harrington distraction and compression instrumentation was used. Three-millimeter compression rods were used in a distraction mode in thin, young children. "Harri-Luque" segmental sublaminar wiring technique and Wisconsin spinous process segmental wiring was used in some. In all cases, the spine fusion was supplemented by bank bone only, to avoid the additional trauma of graft removal. We believe that surgical intervention is advantageous, if done early in the evolution of spinal deformity. Greater technical difficulties and a higher complication rate were encountered in this series relative to the problems usually seen after spinal deformity surgery in children; this is all the more important in a disease in which general anesthesia is an additional major complicating factor. It is hoped that the improved physical condition now seen after early gastrostomy and fundoplication will aid in reducing this high complication rate. Only a small degree (about 25%) of correction was achieved in the majority of patients. Some of this apparent rigidity derived from the inability to apply sufficient instrumental corrective force because of the friable osteoporotic bone. After surgery, there was a marked decrease in the frequency of pneumonia and an improvement in the degree of ataxia, for reasons not understood, which led to an obvious improvement in the quality of life.

Adolescent↗
PubMed1997

Anaesthetic management of a patient with Leigh's syndrome.

PURPOSE: Leigh's syndrome, a progressive neurodegenerative disorder of infancy and childhood, is clinically characterized mainly by developmental delay, nervous system dysfunction and respiratory abnormalities such as aspiration, wheezing, breathing difficulties, gasping, hypoventilation and apnoea. Acute exacerbation and respiratory failure may follow surgery, general anaesthesia or intercurrent illnesses. Hyperlecithinemia is variably present. Histopathological findings include necrosis, vascular proliferation, astrocytosis and demyelination of several brain areas. We present a 30-month-old patient with Leigh's syndrome anaesthetized for extracorporeal shockwave lithotripsy, and describe the anaesthetic considerations. CLINICAL FEATURES: Leigh's syndrome was diagnosed at five months of age based on failure to thrive, lethargy, hypotonicity, choreo-athetosis and lactic acidaemia, with basal ganglia hypodense areas demonstrated by brain computerized tomographic scan. Muscle pyruvate dehydrogenase complex and NADH coenzyme Q oxidoreductase activity were 25% and 13% of control. No preoperative respiratory symptoms or signs were present. Preoperative fasting lasted two hours and gastric aspiration was negative. Anaesthesia was induced with ketamine and midazolam im, and N2O in oxygen, and maintained with propotol and N2O. No volatile anaesthetics were used. Intravenous fluids given were 1/2 normal saline and glucose 5% administered. Besides laryngospasm during anaesthetic induction, relieved by sublingual succinylcholine injection, the perianaesthetic course was uneventful. The lungs were mechanically ventilated and lithotripsy was performed. No adverse sequelae have occurred, and the patient was discharged one day later. CONCLUSION: Perioperative management of patients with Leigh's syndrome requires cautious attention to the metabolic, neurological and respiratory aspects of the disease, and appropriate selection of anaesthetic drugs.

Anesthesia, General↗
PubMed1994

The laryngeal mask airway in pediatric anesthesia: experience with 120 patients undergoing elective groin surgery.

The laryngeal mask airway (LMA) was recently introduced in pediatric anesthesia as an alternative to the face mask or tracheal intubation for airway maintenance. The authors report their experience with LMA on 120 consecutively treated children who underwent elective inguinal herniorrhaphy or orchidopexy. The patients were monitored with electrocardiograms, noninvasive blood pressure determinations, pulse oxymetry, and capnometry. Anesthesia was induced and maintained with halothane, nitrous oxide, and oxygen. There were 96 males and 24 females; the age range was 1 month to 14 years (average, 3.2 years). They weighed between 2.5 and 46 kg (mean, 14 kg). Patients were allowed to breath spontaneously until anesthesia was deep enough (average, 6.3 minutes; range, 2 to 15 minutes). The appropriate-size LMA was inserted and inflated, and patients were divided into three groups. Group I patients (n = 24) weighed 2.6 to 6 kg and received LMA size no. 1. Group II (n = 84) weighed 6 to 30 kg and received LMA size no. 2. Group III (n = 12) weighed more than 30 kg and received LMA size no. 3. Patients in groups II and III breathed spontaneously; those in group I were on volume-controlled ventilation. The LMA was easily inserted in 115 patients (95.8%)--on the first attempt in 100, and on the second attempt in 15. In five patients, LMA was successfully inserted on the third attempt. The ease of insertion was not significantly different between the groups. Anesthesia was maintained by halothane (mean, 1.34%; range, 0.8% to 2.54%) for an average of time of 39.2 minutes (range, 15 to 90 minutes).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1994

Complication of jet ventilation during microlaryngeal surgery.

Complications during jet ventilation for microlaryngoscopy, which is usually a relatively safe procedure, are rare. Those described have included hypoventilation, pneumothorax, pneumomediastinum, subcutaneous emphysema, pneumoperitoneum, and gastric distention. We describe herein a case of a life-threatening complication during jet ventilation with a Carden's tube that ended in laparotomy.

Esophagogastric Junction↗
PubMed1988

Anaesthetic considerations in facial reconstruction for Down's syndrome.

Sixty-three patients with Down's syndrome underwent facial reconstructive surgery under general anaesthesia in order to improve their acceptability and potential for functioning effectively in society. Preoperatively, one-third of the patients had respiratory illnesses, 11 (17.5%) had cardiac anomalies, and 5 (7.9%) had endocrinological abnormalities. Anaesthesia was based on spontaneous ventilation of halothane and N2O in oxygen via an endotracheal tube with appropriate monitoring. Only one patient had an intraoperative complication, an episode of ventricular dysrhythmia, but postoperatively 9 patients required nasopharyngeal airways or endotracheal intubation in order to maintain a patent upper airway. The anaesthetic considerations for facial reconstructive surgery in Down's syndrome are discussed.

Adolescent↗
PubMedDate not supplied

Regional versus general anesthesia for bone marrow harvesting.

STUDY OBJECTIVE: To compare regional versus general anesthesia for bone marrow harvesting. DESIGN: Retrospective study. SETTING: Inpatients at a bone marrow transplantation unit of a university medical center. PATIENTS: One hundred sixty-two donors: 63 healthy patients donating heterologous marrow, 99 patients donating autologous marrow. INTERVENTIONS: Anesthesia and patient charts from 1986 to 1990 were reviewed. MEASUREMENTS AND MAIN RESULTS: Regionally anesthesized patients required less transfused blood in the perioperative period, even though more bone marrow was aspirated. This group also required less postoperative analgesia. We found no difference between the groups with regard to length of hospitalization or amount of colloid required in the perioperative period. CONCLUSIONS: Our data suggest that both modes of anesthesia can be safely administered. Further investigations should be carried out to determine whether the two types of anesthesia, regional and general, are equivalent.

Adolescent↗
PubMedDate not supplied

Nitrous oxide analgesia in selected dental patients.

Nitrous oxide analgesia is presented as the analgesic method of choice in medically compromised patients. The resemblance between the action of nitrous oxide and that of morphine is emphasized. The combination of the opiate-like action of nitrous oxide with the advantages of an inhalation technique makes it preferable and superior to parenteral opiate administration. It may thus be termed as an inhalation "opiate".Since its introduction into clinical use by Wells in 1844 (1), nitrous oxide (N(2)0) has been applied as an anesthetic and analgesic agent in various medical situations, including dentistry (2). The development of equipment affording safe administration of accurate concentrations of either pre-mixed or adjustable N(2)0 and oxygen enabled the application of "relative analgesia" as an important technique in the relief of pain. The pharmacological action and analgesic properties of N(2)0 received renewed interest after Berkowitz et al (3) showed the resemblance between its mode of action and that of opiates. Recent human and animal studies indicated that N(2)0 activates the endogenous opiate system(s) in a manner similar to that of morphine (4). The availability of an analgesic gas which, on the one hand, mimics opiate action whilst on the other hand its administration is continuously adjustable, as opposed to other modes of sedation, makes it into an ideal adjunct in dental procedures. Owing to its minimal side effects, the use of N(2)0 is especially recommended in the management of anxious children and medically compromised patients.This report presents three illustrative patients in whom nitrous oxide proved to be the drug of choice during dental procedures.

Anesthesia, Dental↗
PubMedDate not supplied

Temperature elevation in children following dental treatment under general anesthesia with or without prophylactic antibiotics.

Bacteremia, tissue damage, and dehydration are mentioned frequently as factors that might be responsible for postoperative temperature elevation (PTE). In a prospective, randomized, double-blind, placebo-controlled study, the influence of a single dose of oral amoxicillin administered 1 hr prior to the procedure on PTE was examined. Twenty-six healthy children (21 boys and 5 girls) 2 to 5 years old, who received dental treatment under general anesthesia (GA) were evaluated. Anesthesia was maintained with nitrous oxide and Fluothane and the patients were well-hydrated intravenously during the procedure. Half of the children received prophylactic antibiotic 1 hr prior to the procedure. The other half received a flavored syrup as placebo. Thirteen patients (50%) presented PTE (rectal temperature > or = 37.9 degrees C) 2-5 hr after extubation. The results were statistically analyzed using ANOVA. However, no association was found between PTE and antibiotic administration or any of the parameters investigated such as, number of dental procedures, type of treatment performed, patient's weight, or change in temperature during dental treatment. (Pediatr Dent 15:99-103, 1993).

Amoxicillin↗