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At least 1,135 records · Page 63Linked to original sources

PubMed2003

Baroreflex failure as a late sequela of neck irradiation.

Combined chemotherapy and radiotherapy increase long-term survival in patients with head and neck tumors. Late complications of treatment, however, are being recognized increasingly. Surgery or radiotherapy of the carotid sinuses or brain stem can evoke labile hypertension and orthostatic intolerance from acute or subacute baroreflex failure. Here we report cases in which chronic baroreflex failure appeared to develop as a late sequela of neck irradiation. Three patients referred for autonomic nervous system function testing had labile blood pressure and chronic orthostatic intolerance that developed years after neck irradiation for cancer. In each patient, heart rate remained constant during performance of the Valsalva maneuver, suggesting baroreflex-cardiovagal failure. All 3 patients had virtually zero baroreflex-cardiovagal gain, quantified by interbeat interval-systolic blood pressure relationships after intravenous phenylephrine or nitroglycerine. Ambulatory blood pressure monitoring revealed highly variable blood pressure, with sudden pressor and depressor episodes, a characteristic feature of baroreflex failure. Cardiovagal efferent function, assessed by power spectral analysis of heart rate variability during slow, deep respiration, was normal. Sympathetic noradrenergic efferent function, assessed by cold pressor testing and plasma catecholamine levels during supine rest and orthostasis, was also normal or increased. These findings indicated a primarily afferent lesion. Carotid ultrasonography revealed intimal thickening and atheromatous plaques in all 3 patients. We propose that labile hypertension and orthostatic intolerance can develop as a late sequela of neck irradiation, due to chronic carotid baroreflex failure, which in turn is due to radiation-induced accelerated development of carotid arteriosclerosis. Splinting of carotid sinus mechanoreceptors in rigidified arterial walls would impede detection of alterations in blood pressure and thereby disrupt baroreflex regulation of cardiovagal and sympathetic outflows.

Autonomic Nervous System↗

PubMed1989

Cushing's syndrome due to huge nodular adrenocortical hyperplasia with fluctuation of urinary 17-OHCS excretion.

A 51-yr-old male patient with Cushing's syndrome due to huge nodular adrenocortical hyperplasia is described. Urinary 17-OHCS was not suppressed by a high dose of (8 mg) dexamethasone and showed rather a tendency to paradoxical response. There was no response to metyrapone. Plasma cortisol showed a hyperresponse to insulin-induced hypoglycemia and a rapid response to corticotropin releasing hormone-lysine vasopressin (CRH-LVP) administration without an obvious ACTH response. Plasma cortisol responded to synthetic ACTH. Urinary 17-OHCS did not show parallel changes with plasma cortisol. These results and computerized tomography data suggested huge multiple nodular adrenocortical hyperplasia, which was confirmed later by surgery. The left and right adrenal glands weighed 105 and 45 g, respectively. Hyper-reaction of the adrenal gland to a small change in plasma ACTH or "unknown factors" may cause not only the discrepancy between cortisol and ACTH response but also the development of autonomous nodules in the adrenal gland.

17-Hydroxycorticosteroids↗

PubMed1989

[Proposal for anatomo-functional instrumental control of dysfunctional bilio-digestive Roux-en-Y anastomosis].

Various techniques are used for the anatomo-functional study of bilio-digestive anastomoses on jejunal loop autonomized according to Roux. Here a transparietojejunal endoscopic investigation is proposed that permits direct sight of the anastomosis, biliary sampling for cultural examination and dilatative type therapeutic manoeuvres, biopsies or extractions of residual stones from the bile ways that would not otherwise be possible without further surgery. A clinical case is reported.

Adult↗

PubMed1993

[Anesthesia for non-specific surgery in a post-transplantation patient].

The increase of non specific surgeries in transplanted patients may be related to the better survival achieved by the efficacy of immunosuppressive therapy and improved surgical and intensive care conditions. Therefore, the anaesthetist may be mandated to give anaesthesia in such patients, treated in hospitals which are not involved in transplantation procedures. The ignorance of the main physiologic and pharmacological changes in the new grafted organ as well as the knowledge of high risks of rejection or infection contribute to the anxiety often encountered in front of these patients. The denervated heart is unable to respond to stimulations requiring the integrity of autonomic neural mechanisms. Modulation of cardiac output depends on intrinsic activity (Frank-Starling mechanism) and therefore of end diastolic volume (preload). The denervated transplanted lung shows inability to elicit cough reflex; the latter is totally abolished in case of tracheal anastomosis. These physiologic changes have no deleterious effects on early cardiac and pulmonary functions following transplantation. In the same way, renal, liver or pancreatic functions are restored after respective replacement. However chronic rejection occurs frequently in 50% of patients in a mean time of 5 years following surgery except for liver transplanted patients which seem to be better protected. It results in a progressive decrease in organ function tests. The preoperative assessment requires primary contact with the transplant center. This communication should give precious information about the last biological and functional results as well as about the immunosuppressive therapy. Standard preoperative investigations include measurements of haemoglobin, urea, electrolyte and creatinine concentrations, liver tests, ECG, chest X-ray and coagulation pattern. Previsible difficult intubation should be detected in case of previous pancreas transplantation. Immunosuppressive therapy and other treatments should not be disrupted until surgery. Usual premedication may be used. Previsional peroperative transfusion requires specific packed red blood cells, fresh frozen plasma and platelets in order to reduce CMV contamination and GVH reactions. Locoregional or general anaesthesia may be used with respect to usual contraindications. Special attention should be given in cardiac transplanted patients in order to maintain adequate preload. As atropine is ineffective, bradycardia may be treated by isoprenaline. Patients with lung transplants require a reduction of vascular loading and of hydratation and early postoperative pulmonary physiotherapy. Pancreas transplanted patients often suffer from severe cardiac diseases (coronaropathy). The immunosuppressive therapy modifies the pharmacological behavior of many anaesthetic agents. Ciclosporine enhances mainly the effects of muscle relaxants. Peroperative invasive monitoring requires full aseptic techniques. Invasive monitoring should be discussed in terms of benefit-risk ratio.(ABSTRACT TRUNCATED AT 400 WORDS)

Anesthesia↗

PubMed2000

[Computer-assisted oral, maxillary and facial surgery].

BACKGROUND: Methods from the area of virtual reality are used in oral and maxillofacial surgery for the planning and three-dimensional individual simulation of surgeries. SIMULATION: In order to simulate complex surgeries with the aid of a computer, the diagnostic image data and especially various imaging modalities (CT, MRT, US) must be arranged in relation to each other, thus enabling rapid switching between the various modalities as well as the viewing of mixed images. Segmenting techniques for the reconstruction of three-dimensional representations of soft-tissue and osseous areas are required. We must develop ergonomic and intuitively useable interaction methods for the surgeon, thus allowing for precise and fast entry of the planned surgical intervention in the planning and simulation phase. SURGERY: During the surgical phase, instrument navigation tools offer the surgeon interactive support through operation guidance and control of potential dangers. This feature is already available today. Future intraoperative assistance will take the form of such passive tools for the support of intraoperative orientation as well as so-called tracking systems (semi-active systems) which accompany and support the surgeons' work. The final form are robots which execute specific steps completely autonomously. DISCUSSION: The techniques of virtual reality keep gaining in importance for medical applications. Many applications are still being developed or are still in the form of a prototype. However, it is already clear that developments in this area will have a considerable effect on the surgeon's routine work.

Computer Simulation↗

PubMed2003

Hoarseness after laryngeal blunt trauma: a differential diagnosis between an injury to the external branch of the superior laryngeal nerve and an arytenoid subluxation. A case report and literature review.

Arytenoid subluxation is a well-known cause of hoarseness due to incomplete glottic closure with intact inferior laryngeal nerves after severe laryngeal trauma. We report the case of a young man presenting after laryngeal blunt trauma with hoarseness, easy fatigue during phonation, marked difficulty with his high-pitch and singing voice and decreased phonation time, but intact function of both inferior laryngeal nerves, intact endolaryngeal mucosa sensibility and normal CT scans of the larynx and the neck. Due to the asymmetric anteromedial position of the right arytenoid with incomplete glottic closure, the primary diagnosis was arytenoid subluxation, and the patient was referred for instantaneous relocation therapy. The stroboscopic and electromyographic diagnosis of a unilateral paresis of the external branch of the right superior laryngeal nerve caused the therapy to be changed. Without repositioning, the patient had a total recovery of voice quality when the paresis receded 2 months later. In conclusion, the unilateral paresis of the external branch of the superior laryngeal nerve after laryngeal blunt trauma is reported here for the first time. Although the clinical findings are familiar sequelae of thyroid surgery, they may be misdiagnosed as arytenoid subluxation after laryngeal blunt trauma. Stroboscopy and electromyography permitted the correct diagnosis.

Adult↗

PubMed1997

Complex regional pain syndrome of the breast in a patient after breast reduction.

Complex regional pain syndrome (CRPS) is characterized by devastating pain, swelling, and cutaneous discoloration that result from vasomotor dysfunction caused by an abnormally accelerating sympathetic loop reflex after trauma or surgery. Although in the extremities CRPS is well documented as reflex sympathetic dystrophy, it only has been reported anecdotally in the breast after modified radical mastectomy and never reported after breast reduction. We report CRPS in the right breast of a 27-year-old woman after revision breast reduction surgery. The patient had signs of CRPS and symptoms of pain, swelling, epidermal scaling, and cutaneous temperature changes lasting more than 1 year. Liquid crystal thermographic scanning revealed a persistent, clinically significant hypothermic region in the affected breast. Intravenous phentolamine temporarily relieved the symptoms. Subsequent sympathetic blockade of the stellate ganglion alleviated chronic CRPS symptoms. Surgeons should be alert that CRPS may need to be considered in the differential diagnosis of chronic disproportionate pain after breast surgery. Early identification and treatment will help alleviate persistent CRPS symptoms and avoid soft-tissue changes.

Adult↗

PubMed1995

[Carotid endarterectomy using cervical plexus block].

To evaluate the efficacy and level of patient satisfaction, as well as the incidence of neurological manifestations, hemodynamic changes and other perioperative complications of cervical plexus block. This was a prospective study of 52 patients undergoing carotid endarterectomy under superficial and deep cervical plexus block. The anesthetic technique was effective in all cases. Supplementation with local anesthetic was needed for 25% of the patients and none required general anesthesia. The technique was considered good by 92% of the patients, who stated that would accept the same technique in case of having to undergo surgery on the contralateral carotid artery. Hypertension was the hemodynamic change observed most often (in 30%) during surgery. No serious complications related to the anesthetic technique were observed, though transient dysphonia was the most frequently seen effect (in 36.5%). Eight (15.4%) patients showed neurological signs when the carotid was clamped, with symptoms resolving with placement of a shunt. Two deaths due to myocardial infarction occurred after surgery and 1 patient suffered a permanent cerebrovascular accident. Regional anesthesia with deep and superficial cervical plexus block during carotid endarterectomy allows for continuous evaluation of the patient's neurological status and facilitates the selective use of intraluminal shunt for the prevention of stroke accident during surgery. The technique is well-tolerated by patients, does not make surgery more difficult, does not give rise to serious complications and the incidence of local complications is low.

Aged↗

PubMed1988

Potentiation of pentazocine analgesia by low-dose naloxone.

The analgesia produced by combinations of low-dose naloxone with pentazocine or morphine was studied in 105 patients with moderately severe postoperative pain after standardized surgery for removal of impacted third molars. Pain intensity was quantified using a visual-analogue scale. To eliminate the release of endogenous opioids produced by the placebo component of open drug administration, all injections were made by a preprogrammed infusion pump. The analgesia produced by pentazocine, an agonist-antagonist opiate-analgesic acting predominantly at the kappa opiate receptor, was potentiated by low-dose naloxone, whereas the analgesia produced by morphine, a mu-agonist, was attenuated by low-dose naloxone. To evaluate whether similar potentiation would be present in an animal model, and specifically, in the absence of diazepam, which patients receive, we performed an analogous experiment in rats in which nociceptive threshold was determined using the Randall-Selitto paw-withdrawal test. The results were completely analogous to the clinical results: pentazocine analgesia was potentiated by low-dose naloxone, whereas morphine analgesia was attenuated by low-dose naloxone. These data demonstrate a novel interaction between opiates, and suggest a rationale for opiate combinations to produce potent analgesia with fewer autonomic side effects and less abuse potential than presently available analgesics.

Analgesia↗

PubMed1975

General surgery problems in patients with spinal cord injuries.

Twenty-four patients with spinal cord injuries were studied to correlate their responses to intra-abdominal disease with the level and completeness of the cord lesion. Patients with complete cervical lesions and lesions of the upper part of the thoracic region (C-4 to T-6) usually responded by early noniocalized abdominal pain associated with signs of autonomic dysreflexia. As the disease progressed to involve the parietal peritoneum, these patients were more capable of localizing pain to the corresponding dermatome, whereas patients with incomplete lesions were able to localize their pain earlier. Patients with lumbar lesions and lesions of the lower part of the thoracic region (T-7 to L-3) were able to localize their pain earlier than those with lesions located higher in the thoracic region. All patients had delayed diagnoses except those with hemorrhage of the upper part of the gastrointestinal tract. Irrespective of level of cord lesion, increased pulse rate was themost prominent objective acute intra-abdominal pathologic finding. Shoulder pain in the quadriplegic is a most helpful sign.

Adult↗

PubMed2005

Brain metastasis of alveolar echinococcosis in a hyperendemic focus of Echinococcus multilocularis infection.

An unusual female case, with alveolar echinococcosis (AE) disseminated from the primary hepatic lesion to the brain by metastasis formation, was retrospectively identified during a community survey in Ningxia Hui Autonomous Region, northwest China in 2003. Among possible metastases of hepatic AE, locations to the brain are rare and usually fatal; and they have especially been assigned to concomitant immune suppression. An enhancing role of pregnancy, which may be suspected in this case, the favourable outcome after surgery and chemotherapy, and also a mental disability in a child following long-term intrauterine exposure to mebendazole, make the report particularly unique.

Abnormalities, Drug-Induced↗

PubMed2002

Haptic reproduction and interactive visualization of a beating heart for cardiovascular surgery simulation.

This paper aims to achieve haptic reproduction and real-time visualization of a beating heart for cardiac surgery simulation. Unlike most forgoing approaches, the authors focus on time series datasets and propose a new framework for interactive simulation of active tissues. The framework handles both detection and response of collisions between a manipulator and a beating virtual heart. Physics-based force feedback of autonomous cardiac motion is also produced based on a stress-pressure model, which is adapted to elastic objects filled with fluid. Time series datasets of an adult man were applied to an integrated simulation system with a force feedback device. The system displays multi-dimensional representation of a beating heart and provides a basic training environment for surgical palpation. Finally, results of measurement and medical assessment confirm the achieved quality and performance of the presented framework.

Algorithms↗

PubMed1995

Epidemiological trends of tuberculosis in Spain from 1988 to 1992. Collaborative Group for the Study of Tuberculosis in Spain.

SETTING: Spain is one of the few industrialized countries in which reliable official data on the occurrence of tuberculosis are not available. OBJECTIVE: One of the purposes of the Tuberculosis and Respiratory Infection (TRI) working group established by the Spanish Society of Thoracic Surgery (Sociedad Española de Nuemología y Cirugía Torácica [SEPAR]) in 1988, was to determine the true situation of Mycobacterium tuberculosis infection and active tuberculosis disease in our country. DESIGN: A questionnaire requesting epidemiological data on tuberculosis was sent to the Departments of Public Health of all the Autonomous Communities in Spain (n = 17) and 60 members of the TRI working group (pneumologists, epidemiologists or microbiologists most actively working in the field of tuberculosis within their corresponding areas of influence). Results obtained for the period 1988 and 1992 were analyzed. RESULTS: In the 6-year-old group, annual prevalence-of-infection rates were almost 0.95%, with a slight decreasing trend over the study period. In the 14-year-old group, annual figures of around 3% have been registered. The 1992 incidence rates of new cases of tuberculosis and sputum-smear positive tuberculosis were 40 and 21.2 per 100,000, respectively. Frequently distribution by age has shown a similar trend during the study period with a clear predominance in the younger adult age groups. Reliable data in relation to the number of patients with tuberculosis and HIV infection was available in 1992. Of 5290 patients in a population of 16,954,942, there were 792 (15%) with HIV infection. CONCLUSIONS: The current epidemiological situation of tuberculosis in Spain is one of the most unfavourable as compared with epidemiological data from the remaining industrialized countries. Given the lack of a National Programme for Tuberculosis Control, each Autonomous Community should take responsibility for developing and implementing key control activities based on the cure of infectious cases and case-finding.

Adolescent↗

PubMed2005

[The assessment of curative effect after total mesorectal excision with autonomic nerve preservation for rectal cancer].

OBJECTIVE: To evaluate the impact on sexual function, local recurrence and survival after total mesorectal excision (TME) with autonomic nerve preservation (PANP) of rectal cancer. METHODS: One hundred and five patients after TME with PANP were followed by means of questionnaire on postoperative genital function [TME + PANP(+) group], and the results of 110 patients after TME without PANP [TME + PANP(-) group] were compared with, also their local recurrence and 5-year survival were retrospectively analyzed. RESULTS: TME + PANP(+) group was compared to TME + PANP(-) group: the erection dysfunction, 33.3% vs 63.2%; the ejaculation dysfunction, 43.8% vs 70.0% (P < 0.01), there were significant differences between two groups, but no difference in local recurrent rate and 5-year survival rate (7.6% vs 5.5%; 63.4% vs 59.7%, P > 0.05). CONCLUSION: The TME with PANP of rectal surgery ensure the radical cure of rectal cancer, at the same time reasonably save the postoperative sexual function and obtain satisfactory postoperative survival.

Adult↗

PubMedDate not supplied

[Compatibility, indications, and limits of nerve sparing technique in lateral pelvic lymphadenectomy for advanced rectal carcinoma].

The aim of radical surgical treatment of rectal cancer is to control the spread and prevent recurrence of the disease. In an attempt to improve the results of treatment of locally advanced rectal cancer, we advocate an extended surgical approach consisting of total mesorectal excision, lateral pelvic lymphadenectomy and the nerve sparing technique with resection of autonomic nerves whenever these fibers are affected by locally advanced tumor. Nine cases (9.2%) in a personal series of 98 patients with rectal carcinoma, operated on over the period from January 1992 to December 1997, underwent total mesorectal excision, lateral pelvic lymphadenectomy and the nerve sparing technique procedures for locally advanced extraperitoneal disease. In 7 patients with stage II or III disease, the 5-year survival rate was 80% and the 5-year disease-free survival rate 66.7% after a mean follow-up of 55 months. None of them experienced local recurrence, but one patient died of diffuse metastatic disease 50 months after surgery. One patient with stage IV rectal cancer died of disease 13 months postoperatively, while another patient with the same stage of disease is still alive with disease 26 months after surgery. One patient underwent liver resection for a solitary metastasis 25 months after the primary operation. Two patients suffered postoperatively from urinary retention with mild irregular flow at urodynamic testing, but no long-term urinary disturbances persisted. Retrograde ejaculation occurred postoperatively in one of the two patients who experienced urinary disorders, and another patient had erection disturbances. These sexual dysfunctions did not improve during long-term follow-up. Total mesorectal excision, lateral pelvic lymphadenectomy, and the nerve sparing technique, with resection of the autonomic nerves whenever these fibers are involved, allow satisfactory results to be achieved in terms of survival and functional outcome in patients with locally advanced rectal cancer. In western subjects, however, this procedure is safe only after careful patient selection.

Adult↗

PubMedDate not supplied

Atenolol may not modify anesthetic depth indicators in elderly patients--a second look at the data.

PURPOSE: Decreased cardiac chronotropic response in elderly patients along with concomitant ss-blockade may suppress the autonomic responsiveness to surgical stimulation and subsequently obscure episodes of "light anesthesia". METHODS: We analyzed post hoc computerized data from our previous study evaluating the effects of perioperative atenolol administration. Bispectral index (BIS) and the performance of routine anesthetic depth indicators were analyzed in 45 patients undergoing abdominal surgery: Group I (n = 12), isoflurane/fentanyl/nitrous oxide in oxygen anesthesia; Group II (n = 16), isoflurane/fentanyl/nitrous oxide in oxygen with 10 mg atenolol intravenously prior to anesthesia; Group III (n = 17), isoflurane/fentanyl/nitrous oxide in oxygen with a maximum end-tidal isoflurane concentration of 0.4 vol.% and incremental doses of atenolol (5 mg intravenously stepwise). In all groups, blood pressure (BP) was maintained within +/- 20% of preoperatively defined baseline BP and heart rate (HR) between 50-80 beats x min(-1). BP, HR, and end-tidal isoflurane were tested for their potential to predict BIS using a previously described statistical model (P(K)). RESULTS: Although Group III patients received on average 39.5% less isoflurane compared with Group I patients (P = 0.006), and Groups II and III patients received on average 21% less fentanyl compared with Group I patients (P </= 0.002), similar levels of intraoperative average BIS values (53-54) were obtained for all groups. Higher BIS values were reached at emergence in atenolol-treated patients. The performance of hemodynamic variables or end-tidal isoflurane to predict BIS was moderate even at critical intraoperative events, but unaffected by atenolol. CONCLUSION: Atenolol reduces anesthetic requirements but may not modify anesthetic depth indicators in elderly patients.

Abdomen↗

PubMedDate not supplied

Labor analgesia with paravertebral lumbar sympathetic block.

BACKGROUND AND OBJECTIVES: Provision of labor analgesia continues to be a challenge for parturients with spine pathology or history of back surgery. METHODS: We report on the use of paravertebral lumbar sympathetic block for first stage labor analgesia in two parturients with spine pathology.

Adult↗

PubMed1980

Sympathomimetic amines.

The autonomic nervous system may play an important role in tissue autoregulation as the neurohumoral transmission process has been shown to constitute the final common pathway by which the effects of many physiological and pharmacological substances are mediated. The effects of the administration of a sympathomimetic amine cannot be accurately predicted in a subject. Choice of which sympathomimetic amine to use should be determined on the basis of data obtained in relevant clinical circumstances, but the dose should always be titrated against the effect in each individual. It is interesting that adrenaline, "the original autonomic drug" with its "venerable history", is still a first line drug in many of the situations for which it was being prescribed in 1907. It is the drug of first choice in anaphylactic reactions and for severe allergic bronchospasm, and is widely used as a vasoconstrictor in surgery and with local anaesthetic agents. Adrenaline in "physiological" doses is a satisfactory and cheap alternative to other available drugs for use in septic shock and in emergence from cardiopulmonary bypass.

Action Potentials↗