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Biomedical subjects

H H Ali

Publications and source records attributed to H H Ali.

70 records · Page 4Linked to original sources
PubMed1975

The effect of tubocurarine on indirectly elicited train-of-four muscle response and respiratory measurements in humans.

The effect of tubocurarine on the respiratory function of conscious, non-medicated volunteers was correlated with the degree of neuromuscular blockade measured with the train-of-four technique (the evoked response of the adductor pollicis brevis muscle to trains of four supramaximal ulnar nerve stimuli at 2 Hz, repeated once every 10 sec). Respiratory frequency, tidal volume, vital capacity, inspiratory force and peak expiratory flow rate were measured, (a) before administration of tubocurarine, (b) when the ratio of the amplitude of the fourth response to the amplitude of the first response of the train-of-four reached 60%, and (c) during recovery of the ratio until the control (100%) value was reached. Respiratory frequency, tidal volume and peak expiratory flow rate were not altered. Vital capacity and inspiratory force were both reduced significantly at the 60% level and the former also at the 70% level when compared with the control. The magnitude of change in all variables is of minor clinical importance, however, since the lowest measured values are well above acceptable minimum limits required for adequate respiratory function.

Dose-Response Relationship, Drug↗
PubMed1975

Train-of-four nerve stimulation in the management of prolonged neuromuscular blockade following succinylcholine.

Four patients, all possessing an atypical form of plasma cholinesterase, developed prolonged paralysis following succinylcholine administration. The clinical management of all four cases was facilitated by monitoring the train-of-four stimulus. All patients showed marked "fade" of the train-of-four ratio, the initial ratios of the fourth to the first twitches being 50 per cent or less, indicating variable degrees of nondepolarizing neuromuscular blockade. Reversal of paralysis with anticholinesterase agents was completely successful in three cases, but only partially effective in the fourth because of the probable presence of a mixture of both depolarizing block and nondepolarizing block. In such a situation, caution in the interpretation of the train-of-four ratio is necessary, since this test measures only the nondepolarizing component of the block. Whether or not reversal with anticholinesterase drugs is attempted, clinical estimates of neuromuscular function, such as head lift, vital capacity, and inspiratory force, must be carefully correlated with train-of-four values. If reversal is attempted, the brief action of edrophonium provides a useful clinical trial.

Adolescent↗
PubMedDate not supplied

Using the laryngeal indices caliper to predict difficulty of laryngoscopy with a Macintosh #3 laryngoscope.

STUDY OBJECTIVE: (1) To evaluate a device of the authors' design, the laryngeal indices caliper, which quantitates the position of the anterior edges of the larynx relative to the upper teeth and the external auditory canals; (2) to determine how relative laryngeal position affects ease of direct laryngoscopy with a Macintosh #3 laryngoscope. DESIGN: Randomized, double-blind study. SETTING: Inpatient surgery center at a university medical center. PATIENTS: 101 renal lithotripter patients. INTERVENTIONS: Patients were measured with the laryngeal indices caliper prior to induction of general endotracheal anesthesia. They were then given a sleep dose of thiopental sodium (4 mg/kg) and paralyzed with a bolus dose of succinylcholine (1 mg/kg). MEASUREMENTS AND MAIN RESULTS: Of the measurements taken or calculated, only laryngeal tilt (LT) showed a significant correlation with grade of difficulty of laryngoscopy. When the anterior surface of the thyroid cartilage was tilted more than 20 degrees anteriorly to a line perpendicular to the laryngeal indices line, the vocal cords could not be seen in 83% of the patients. CONCLUSIONS: (1) Laryngeal tilt is a good predictor of difficulty of laryngoscopy with a Macintosh #3 laryngoscope; (2) the laryngeal indices caliper is a simple pocket device to measure LT indirectly.

Double-Blind Method↗
PubMedDate not supplied

Using the bubble inclinometer to measure laryngeal tilt and predict difficulty of laryngoscopy.

STUDY OBJECTIVE: To evaluate a simple device, the bubble inclinometer, to measure degrees of laryngeal tilt (LT) for predicting difficulty of direct laryngoscopy using a Macintosh #3 laryngoscope. DESIGN: Randomized, double-blind study. SETTING: Inpatient surgery center at a university medical center. PATIENTS: 50 renal lithotripter patients. INTERVENTIONS: Patients were measured with the bubble inclinometer and the laryngeal indices caliper. A sleep dose of thiopental sodium (4 mg/kg) and a muscle-relaxing dose of succinylcholine (1 mg/kg) were then given to each patient. MEASUREMENTS AND MAIN RESULTS: LT was measured by both methods (directly and indirectly). Difficulty of laryngoscopy was graded as follows: Grade 1 = all of vocal cords seen; Grade 2 = part of vocal cords seen; Grade 3 = no part of vocal cords seen. CONCLUSIONS: The bubble inclinometer accurately and reproducibly measures relative LT, and the anterior tilt of the larynx directly correlates with the ability to see the laryngeal opening during direct laryngoscopy with a Macintosh #3 laryngoscope.

Adult↗
PubMedDate not supplied

Myofibroblastoma of breast: evidence favoring smooth-muscle rather than myofibroblastic differentiation.

A histopathological study of two cases of the tumor known in the literature as myofibroblastoma of the breast is presented. The tumors occurred in Caucasian males aged 57 and 62 years. Histologically, these were moderately cellular, lobulated spindle-cell lesions, each with a reasonably well-delineated edge with surrounding fatty connective tissue. No breast ducts or lobules were present. Tumor cell nuclei were bland, with small nucleoli and some nuclear grooving. Nuclear atypia and mitoses were absent. Immunostaining revealed positivity for a-smooth-muscle actin, desmin, and CD34. Tumor cells contained rough endoplasmic reticulum, bundles of myofilaments with focal densities, intermediate filaments, attachment plaques alternating with plasmalemmal caveolae, and focal lamina. Ultrastructural findings pointed to true smooth-muscle differentiation, and the cell-surface in particular lacked surface features of myofibroblasts (fibronectin fibrils [microtendons] and fibronexus junctions). These and published data suggest that at least some of the lesions referred to in the literature as myofibroblastoma may not be myofibroblastic and may be better designated as myogenic stromal tumors or as variants of leiomyoma.

Actin Cytoskeleton↗
PubMedDate not supplied

Spontaneous recovery from nondepolarizing neuromuscular blockade: correlation between clinical and evoked responses.

The effects of nondepolarizing muscle relaxants were allowed to wear off spontaneously in 10 ASA class III and IV patients following major surgery. Neuromuscular and respiratory function were followed by clinical testing and by evoked muscle responses using a train of 4 (TOF) supramaximal stimuli. At a TOF of 70 percent (range 62 to 78%), all patients sustained eye-opening, hand-grasp, and tongue-protrusion, while 9/10 sustained head-lift. Vital capacity (VC) averaged 17 ml/kg when the TOF reached 70 percent. The increase in VC correlated with the increase in TOF (r = 0.88). There was no correlation between inspiratory force (IF) and TOF, but all patients achieved an IF equal to or greater than -22 cm H2O at 70 percent. Thus, TOF correlates well with clinical signs of neuromuscular and respiratory recovery in this group of patients and complements earlier studies in healthy anesthetized patients and nonmedicated volunteers.

Electric Stimulation↗
PubMedDate not supplied

Cumulative dose-response curves for gallamine: effect of altered resting thumb tension and mode of stimulation.

Neuromuscular blockade studies often use the thumb adductor twitch response to ulna nerve stimulation. Two factors that may influence the results are the resting muscle tension (initial fiber length) and the pattern of the stimulus wave form. This study was undertaken to improve understanding of the effect of these factors and lead to better controlled study conditions and more consistent data. During nitrous oxide-barbiturate-narcotic anesthesia in 10 normal adult patients, as the resting thumb tension was increased from 50 to 200 g, the evoked thumb adductor twitch response (Grass stimulator, 0.25 Hz) was augmented by 28%. There was only a 2.5% increase in the evoked (developed) tension when the resting tension was further increased from 200 to 300 g. Developed tension at 50 g was significantly (p less than 0.001) less than at the other resting tensions. The developed tension at 100 g was also significantly (p less than 0.05) less than at resting tensions of 200 or 300 g. Cumulative dose-response curves for gallamine in nine patients were not significantly altered by increasing resting tension from 50 to 200 g. Biphasic (Block-Aide monitor) or single square wave (Grass stimulator) stimuli wave forms in nine normal adult patients yielded gallamine dose-response curves that were not statistically different. The muscle response to biphasic stimulation during a non-depolarizing blockade was not affected by the average muscle refractory period. Because of the significantly lower developed tension at resting tension settings of 50 to 100 g, a practical consideration during neuromuscular function studies would be to have the resting thumb tension adjusted and rechecked for each patient and kept within the 200-300-g range to ensure maximum uniform developed tension. The type of stimulus wave form selected will not affect results as long as it is used consistently throughout the study.

Adjuvants, Anesthesia↗