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Biomedical subjects

O May

Publications and source records attributed to O May.

At least 37 records · Page 2Linked to original sources
PubMed1992

Double burst stimulation for monitoring profound neuromuscular blockade: a comparison with posttetanic count and train of four.

Double burst stimulation (DBS) is a new nerve stimulation pattern introduced to facilitate tactile evaluation of recovery from neuromuscular blockade. DBS consists of two bursts of high frequency stimulations separated by a short time interval. The relationships between DBS, post-tetanic count (PTC) and train-of-four (TOF) on the evoked twitch response was investigated in 16 surgical patients and 7 intensive care patients given atracurium for muscle relaxation. A significant correlation between the twitch height of the first response to DBS and the number of post-tetanic responses was demonstrated when PTC was more than five (r = 0.47, p < 0.0003). When the first twitch of TOF was still not measurable, the first twitch of DBS ranged from 0 to 20% of the TOF-control twitch height. Furthermore the DBS ratio was significantly correlated to the TOF ratio (r = 0.92-0.96, p < 0.0002). It is concluded that DBS not only can be used for monitoring of recovery from neuromuscular blockade, but also for monitoring of intense degrees of neuromuscular blockade.

Electric Stimulation↗
PubMed1991

[Felty's syndrome].

Felty's syndrome (FS) consists of the triad: rheumatoid arthritis (RA), leukopenia and splenomegaly. FS occurs in approximately 1% of patients with RA. In this syndrome, the risk of infection is increased and anaemia, thrombocytopenia and cutaneous ulcers are more frequently observed. The literature is reviewed on the basis of a case history. The pathogenesis is unknown but is probably multifactorial. Cell antibodies, increased occurrence of immune complexes, inhibited neutrophil production, altered neutrophil distribution and reduced neutrophil function have been observed. The main indication for treatment is present if the patient has severe neutropenia (less than 0.1 x 10(9)/l) and repeated infections. Various methods of treatment are available. The most important are: gold, low-dose methotrexate, lithium, methylprednisolone pulse therapy, penicillamine and splenectomy. According to the literature, conventional steroid treatment cannot be recommended.

Aged↗
PubMed1990

[Complications of long-term treatment with vitamin K antagonists].

Long-term treatment with vitamin K antagonists (vKA) frequently involves complications. The commonest complication is haemorrhage and cases of serious haemorrhage are stated in the literature to occur with a frequency per 1,000 treatment years of 12-108, of which 2-17 are fatal. The majority of deaths associated with haemorrhage are due to intracranial haemorrhage. Notifications of complications of vKA treatment in Denmark are considerably fewer than might be anticipated from the literature. The stability of anticoagulation treatment decreases with the number of drugs administered simultaneously and numerous drugs and other factors interact with the effect of vKA. A series of examples are reviewed and some known drugs which do not interact are mentioned. Non-haemorrhagic side effects of coumarin derivatives are rare. Anticoagulation treatment during pregnancy is associated with very special problems and must be regarded as a specialist task.

Anticoagulants↗
PubMed1990

Incidence and prediction of postdural puncture headache. A prospective study of 1021 spinal anesthesias.

The incidence of postdural puncture headache (PDPH) was investigated prospectively in 873 consecutive patients undergoing a total of 1021 spinal anesthesias, and its association to age, sex, needle size, number of attempted dural punctures, needle bevel direction, duration of postoperative recumbency, and previous PDPH was analyzed. Multivariate analysis showed that age (P less than 0.0001), direction of the bevel of the needle when puncturing the dura mater (P = 0.022), and a history of previous PDPH (P = 0.018) were significant predictors of PDPH. The estimated relation between PDPH, on the one hand, and age and orientation of the bevel, on the other, enables the anesthetist to predict the risk of PDPH and thereby to choose an acceptable age limit for spinal anesthesia.

Adolescent↗
PubMed1990

Effect of prophylactic sucralfate suspension on stomatitis induced by cancer chemotherapy. A randomized, double-blind cross-over study.

We have studied whether mouth-swishing with sucralfate, a well-known gastric mucosal protective agent, may be used as prophylaxis against chemotherapy-induced stomatitis. Using radioactively labelled sucralfate we found that 20-30% was still bound to the oral mucosal lining 2 1/2 h after mouth-swishing. Forty patients receiving cisplatin and continuous infusion with 5-fluorouracil (5-FU) for 5 days entered a double-blind placebo-controlled cross-over study. Among 23 evaluable patients a significant reduction (p = 0.04) in an objective score of edema, erythema, erosion and ulcerations was seen during treatment with sucralfate. Patient preference favored sucralfate, but this preference failed to reach statistical significance (p = 0.06). Seven patients were inevaluable for reasons not associated with the study treatment. However, ten patients did not complete the study since the swishing procedure aggravated chemotherapy-induced nausea. An equal rate of non-compliance was seen with sucralfate and placebo. To overcome this problem, the oral medication should have a neutral taste, the solution should not be swallowed after the swishing, which should not be started until the nausea had ceased.

Adult↗
PubMed1990

Priming principle with atracurium.

In order to substantiate the "priming principle" discussion, 44 patients admitted for elective gynecological surgery under modified neurolept anesthesia were randomized into two groups. In group I, atracurium was administered by a priming technique in which 0.1 mg/kg was given i.v. and, after 6 min, 0.5 mg/kg. In group II was given an atracurium bolus injection of 0.6 mg/kg. In group I onset time (median 61 sec, range 44-160 sec) was significantly more rapid than in group II (median 83 sec, range 60-128 sec). The median train-of-four ratio in group I was 0.80 (range 0.43-1.00, n = 23), 6 min after the priming dose, in 30% of these patients the TOF ratio was above 0.90 and in 22% below 0.70. It is impossible to determine a fixed pretreatment dose per kg body weight owing to the large individual variation in neuromuscular depression. Modification of the priming principle using incremental small doses of non-depolarizing neuromuscular blocking agents, with anesthetic induction, when the train-of-four ratio is between 0.90 and 0.70 or when there is clinical signs of neuromuscular block, might be an alternative in situations where rapid induction is required and where the use of suxamethonium is contraindicated.

Adult↗
PubMed1990

Domiciliary nebulized terbutaline in severe chronic airways obstruction.

Forty-eight patients with severe chronic airways obstruction were given 5 mg terbutaline or placebo from a nebulizer twice daily for 2 + 2 weeks. Twenty three patients preferred terbutaline, 9 placebo and 16 had no preference. The baseline lung function and the 6 minute walking distance were not increased after the terbutaline period. The patients who preferred terbutaline indicated less dyspnoea after the terbutaline period as compared to the placebo period, but did not differ with regard to lung function or walking distance after the terbutaline treatment. The physiology behind the subjective relief from the terbutaline inhalations remains unexplained.

Administration, Inhalation↗
PubMed1989

[Exercise-induced ST segment depression following acute myocardial infarction. Occurrence and prognostic significance].

On the basis of a review of 20 investigations (3,587 patients), the prevalence of significant ST-segment-depression (ST-depr) in patients performing an exercise test 9-30 days after acute myocardial infarction (AMI) was found to be 33% (3-70%). The reason for the considerable variation is due to a combination of several factors: 1) different and frequently incomplete definition of significant ST-depr; 2) heterogenically composed patient groups (first vs subsequent AMI, different prevalence of infarct types and localization, consecutive vs selected patients, +/- cardioactive drugs during the exercise test); 3) different procedures for the exercise tests (submaximal vs maximal; few vs several ECG leads). The great variation in the prevalence of ST-depr, is also reflected in the prognostic significance. In about half of the investigations ST-depr has been prognostic for future death and/or cardiac events while ECG changes as an isolated variable did not prove to be of prognostic significance in the remainder. In general, it may be stated that a maximal exercise test with several ECG leads is more sensitive while ST-depr at a submaximal work capacity appears to be more specific for subsequent cardiac events.

Aged↗
PubMed1989

[Familial isolated thrombocytopenia. A family with autosomal dominant heredity].

Thrombocytopenia as a hereditary isolated phenomenon is recognized in an X-linked recessive form and also an autosomally dominant form. Investigation of a family with the autosomally dominant form is presented. This condition is important in the differential diagnosis in cases of suspected immune thrombocytopenia as the autosomally dominant form does not respond to splenectomy.

Adult↗
PubMed1988

The acceleration transducer--an assessment of its precision in comparison with a force displacement transducer.

A new and simple acceleration transducer (ACT)-based system of neuromuscular monitoring has recently been introduced. The precision of this transducer has been evaluated as compared to a conventional force displacement transducer (FDT) in the present study. Ten progressions of spontaneous recovery from atracurium-induced block with simultaneous measurements using the ACT on one hand and the FDT on the other were studied. Five individuals undergoing elective surgery in modified neurolept anaesthesia and one ICU-patient requiring prolonged neuromuscular blockade, sedated with pentobarbital, were included. Measurements were carried out on the latter patient on 5 consecutive days. Train-of-four (TOF) stimulation was used, readings were given in twitch heights (TH) (T1/control value), and when four responses were obtained in TOF-ratios (T4/T1). Linearity was achieved after logit-transformation and the values regressed on time for each progression of recovery. Analysis of variance was applied to the regressions for the TH and TOF-ratio readings of each transducer. No significant differences were found, either between variation due to differences between slopes or variation due to technical error between the two transducers. The study indicates that the ACT is equal to the FDT with regard to precision in clinical recordings on atracurium-relaxed individuals.

Aged↗
PubMed1988

Assessment of neuromuscular transmission by the evoked acceleration response. An evaluation of the accuracy of the acceleration transducer in comparison with a force displacement transducer.

This paper presents preliminary observations on an acceleration-responsive transducer designed to monitor neuromuscular transmission. Simultaneously evoked acceleration and tension responses of the adductor pollicis muscles were studied. Registrations were obtained during recovery from atracurium-induced block in 29 individuals in neurolept II anaesthesia (Group I) and in 4 ICU patients (Group II) sedated with pentobarbital or midazolam. Regression analysis of 1567 train-of-four (TOF) registrations, in regard to TOF-ratio (T4/T1) and first twitch ratio (T1/T0), demonstrated regression coefficients (b) and correlation coefficients (r) in the range 0.91-1.06 and 0.89-0.98, respectively. During 1 Hz single twitch stimulation and post-tetanic count stimulation, b and r were in the range 0.85-1.03 and 0.77-0.90, respectively. Following administration of edrophonium (n = 6, Group I) a deviation of T1/T0 regression values was observed in four individuals, i.e. 0.48 (b) and 0.56 (r). This investigation proved a good level of accuracy of the acceleration transducer compared to the force displacement transducer during spontaneous and neostigmine-induced recovery from atracurium block. The acceleration transducer-based system does not require a rigid suspension and seems to have a good monitoring potential in clinical assessment of neuromuscular transmission.

Adult↗
PubMed1988

Comparison of terbutaline, isotonic saline, ambient air and non-treatment in patients with reversible chronic airway obstruction.

The increase in forced expiratory volume in one second (FEV1) seen in asthmatics after inhalation of isotonic saline was studied in a blind, cross-over investigation of 24 consecutive out-patients presenting with reversible chronic airway obstruction. Forced expiratory manoeuvres allowing the measurement of FEV1 and forced vital capacity (FVC) were performed at six time intervals during a period of one hour according to the following regimes: inhalation of terbutaline by means of a Pari-inhalier Boy for 10 min; inhalation of isotonic saline under the same conditions; inhalation of ambient air under the same conditions (placebo with noisy nebulizer); inhalation of air without the nebulizer (non-treatment) in order to determine whether the impact of treatment by a nebulizer influences the measured lung function. A statistically significant increase in FEV1 was observed after each of the four regimes. The increase was large following terbutaline inhalation. After the other three regimes, it was significantly smaller and of about the same magnitude in each case. The increase in FEV1 after the non-treatment regime was unexpected and could possibly be due to the repeated dynamic spirometry. The increase in FEV1 after isotonic saline and ambient air (noisy nebulizer) did not differ from the increase after the non-treatment regime. We conclude that neither isotonic saline nor the impact of treatment with a noisy nebulizer have a measurable effect on lung function.

Administration, Inhalation↗