Biomedical subjects
Publications and source records attributed to M Schürch.
Neuroleptic malignant syndrome is a rare complication when using neuroleptic drugs. We report the case of a patient with severe Parkinson's disease who developed neuroleptic malignant syndrome after withdrawal of his antiParkinsonian medication for elective coronary artery bypass grafting. Sodium dantrolene may be a therapeutic option in severe cases.
A 55-year-old man presented for coronary artery bypass graft (CABG) surgery. Malignant hyperthermia (MH) was suspected in his family. This case report describes a diagnostic approach to obtain a definite MH diagnosis by performing an in vitro contracture test at the time of CABG surgery in combination with molecular genetic investigations.
UNLABELLED: In patients with difficult airways, the standard of care involves fiberoptic intubation under spontaneous ventilation. However, the safety and feasibility of a fiberoptic intubation teaching program has only been documented in paralyzed and apneic patients, whereas data obtained in patients under spontaneous respiration are limited and conflicting. We evaluated 100 anesthetized patients undergoing orotracheal fiberoptic intubation. Five anesthesia residents with no prior experience in fiberoptic laryngoscopy participated in the study. In a randomized fashion, each participant tracheally intubated 10 spontaneously breathing patients (Group A: sevoflurane anesthesia via an airway endoscopy mask) and 10 paralyzed patients (Group B: total IV anesthesia with propofol, fentanyl, atracurium). Overall rate of success (96%), defined as successful intubation of the trachea within two attempts, was not different between groups. During fiberoptic intubation, Spo2 values remained >95% in Group A, whereas Spo2 decreased to <95% in two patients in Group B. Failure to pass the tube into the trachea over the bronchoscope was encountered in four patients in Group A and in no patient in Group B. Our data suggest that it is safe to teach the use of fiberoptic intubation in anesthetized, spontaneously breathing patients with normal airway anatomy. IMPLICATIONS: Fiberoptic intubation under spontaneous respiration is a well established technique for management of difficult airways. Our study demonstrates the feasibility and safety of a novice training program for fiberoptic intubation under general anesthesia, not only in paralyzed patients but also in those breathing spontaneously.
To investigate whether the common cold follicles in human multinodular goiters are the consequence of a functional defect of the apical membrane peroxidase, a failure of the iodide transport system, or both deficiencies, we studied iodide accumulation and iodine organification in 30 fragments of a large multinodular goiter transplanted to nude mice and labeled with 125I. Transplants were frozen to -80 C immediately after removal to avoid diffusion of inorganic iodide. Autoradiographic assessment of over 1000 cryosections (exposed either at -20 C or after thawing and washing out unbound iodide) showed two types of cold follicles, namely those that failed to accumulate iodide and, therefore, did not organify iodine, and those that readily accumulated iodide but failed to bind it, suggesting a failure of apical membrane peroxidase. The two types of pathogenetically different cold follicles coexisted in an apparently randomly intermingled fashion throughout the whole goiter.
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