Biomedical subjects
Publications and source records attributed to P Hans.
The present report describes a young child who developed generalized epileptic seizures in the course of severe head injury. The start of epileptic seizures was associated with the occurrence of acute hyponatremia and hypoosmolality due to excessive Desmopressine administration. The seizures resistant to conventional therapy resolved completely with intravenous nimodipine infusion.
Spontaneous spinal extradural hematomas are rare entities, especially during pregnancy. The authors report a case of a 26 years old women who developed as Brown-Sequard syndrome during pregnancy. The patient underwent first a caesarean and thereafter a prompt spinal surgical decompression. Complete sensory-motor recovery occurred after 48 hours. Differential diagnosis of cord compression, etiology of bleeding, conditions of recovery after surgery are discussed.
The safety and efficacy of alprazolam and hydroxyzine administered orally as surgical premedicants were compared in a double-blind controlled study. Sixty-five patients were given either alprazolam 1 mg or hydroxyzine 75 mg, one to two hours before surgery. Anxiety was assessed by both the patient and the anaesthetist, the patient using a visual analogue scale, the anaesthetist employing both analogue and ordinal ratings. Sedation was assessed by the anaesthetist only, using the same two methods. Amnesia was appraised with a simple memory test. Safety was assessed by recording adverse effects and measuring haemodynamic variables. Premedication with alprazolam produced a modest reduction in anxiety (28%) (P < 0.01) while hydroxyzine had no detectable effect. The comparison of the sedation level and of the memory test revealed no difference between the two premedicants. Minor side effects were only observed in the hydroxyzine group. Changes in blood pressure were more pronounced in the hydroxyzine group. This study shows that alprazolam and hydroxyzine are safe and efficient oral premedicants. However, alprazolam is preferable to hydroxyzine in terms of anxiolytic and adverse effects.
Enolase in cerebrospinal fluid is a sensitive marker for many types of neurological injuries including head injury and ischemia. We assessed neuron-specific enolase (NSE) as a quantitative and specific biochemical marker of neuronal damage in an experimental model of kainate neurotoxicity. Rat hippocampal cultures were treated with various concentrations of kainate. NSE release into the culture medium was compared with neuronal death estimated either by direct cell counting or by lactate dehydrogenase (LDH) release, largely used to quantify neuronal injury. A dose-response relationship was observed between kainate concentration and the amount of NSE released (r = -0.69; p < 0.05) as well as a significant correlation between NSE release and neuronal death (r = 0.64; p < 0.05). Likewise, a significant correlation was found between LDH and NSE release (r = 0.85; p < 0.05). The specificity of NSE as an indicator of neuronal death was demonstrated using immunocyto-chemistry labeling and measurement of NSE release by pure astrocyte cultures. We concluded that NSE is a reliable, quantitative, and specific marker of neuronal injury.
The protective effect of astrocytes on hippocampal neurons against kainate-induced toxicity was investigated using neuron-specific enolase as an indicator of neuronal death. Astrocyte-rich and astrocyte-poor mixed rat hippocampal cultures were submitted to various concentrations of kainate. At each kainate concentration, the amount of NSE released by neurons was significantly greater in astrocyte-poor than in astrocyte-rich cultures (p < 0.05). This protective effect was not observed when neuronal survival was tested on astrocyte-poor cultures in astrocyte-conditioned culture medium with or without 10(-4) M kainate. In conclusion, astrocytes significantly attenuate kainate toxicity on hippocampal neurons, and this effect is not mediated by a diffusible factor.
This study was undertaken to determine whether alfentanil (A) or sufentanil (S) associated with propofol (P) or etomidate (E) can abolish or attenuate the hemodynamic response to laryngoscopy and orotracheal intubation in ASA I or II patients, during induction of anesthesia for lumbar spinal surgery. Eighty patients were randomly divided into four groups. Group I (AE) received alfentanil 30 micrograms/kg and etomidate 0.3 mg/kg; group II (AP) received alfentanil 30 micrograms/kg and propofol 1.5 mg/kg; group III (SE) received sufentanil 0.3 microgram/kg and etomidate 0.3 mg/kg; group IV (SP) received sufentanil 0.3 microgram/kg and propofol 1.5 mg/kg. In each group, narcotic and hypnotic were given respectively five minutes and three minutes before laryngoscopy. The intubation was facilitated by vecuronium 0.1 mg/kg. The sequence of laryngoscopy and orotracheal intubation was always performed in less than 20 seconds. The anesthesia was maintained by O2/N2O in IPPV (TV = 10 ml/kg; respiratory rate 12). Heart rate, systolic, diastolic and mean blood pressure were recorded at the following times: on arrival in the operating room (T-5), 3 minutes before laryngoscopy (T-3), just at laryngoscopy (T0) and 1 (T1), 3 (T3), 54 (T5) minutes after intubation. The comparison of baseline values (T-5) with T1 values showed that the heart rate did not change significantly in any group. Systolic blood pressure increased (p < 0.05) in SE group, decreased (p < 0.05) in AE and SE groups and did not change in AP and SP groups. Mean blood pressure increased in AE and SE groups, decreased in AP group but did not change significantly in SP group.(ABSTRACT TRUNCATED AT 250 WORDS)
The influence of intravenous propacetamol hydrochlorid administration on postoperative analgesia and intramuscular opioid consumption was assessed in a randomized placebo-controlled study. Fourty patients scheduled for lumbar disc surgery were randomly allocated to two groups. They were given either propacetamol 2 g or saline every 6 hours, starting at the end of procedure for a 24 hours period. The pain intensity (VAS) was not significantly different between the two groups except 3 and 4 hours after surgery, where it was higher in the paracetamol group. The cumulative narcotic consumption (piritramide on request) was higher in the placebo group from 6 hours till 9 hours after surgery but not significantly different after 24 hours. Piritramide administration decreased VAS score significantly in both groups while propacetamol reduced it in a significant way only when given from 12 hours after surgery.
Explore the source record for details and available documents.
BACKGROUND: It is unknown whether patients want primary care physicians to inquire about physical abuse (PA) or sexual abuse (SA) or how frequently physicians make such inquiries. METHODS: To determine patient preferences and physician practices, we surveyed 164 patients and 27 physicians at private and public primary care sites. Data were collected using confidential, anonymous, written, multiple-choice questionnaires and were evaluated using univariate analysis. RESULTS: Among patients, routine PA inquiry was favored by 78% and routine SA inquiry was favored by 68%. Only 7% were ever asked about PA and 6% about SA. A history of PA was reported by 16% and a history of SA by 17%. Ninety percent believed physicians could help with problems from PA and 89% felt physicians could help with problems from SA. Among physicians, one third believed that PA and SA questions should be asked routinely. However, SA inquiries were never made by 89% at initial visits or by 85% at annual visits. Physical abuse inquiries were never made by 67% at initial visits, or by 60% at annual visits. Eighty-one percent believed they could help with problems associated with PA and 74% with SA. CONCLUSIONS: Most patients favor inquiries about physical and sexual abuse and believe physicians can help with these problems. Physicians believe they can help with these problems though they frequently do not inquire.
We report the repeated improvement in neurological function following naloxone administration in a patient who developed acute hemiplegia after an intracranial neurological procedure. The mechanisms responsible for the neurological deficit and for its reversal by naloxone are discussed. A review of the literature suggests that the beneficial effect of naloxone can result from an improvement in haemodynamic status or from metabolic effects that could be favorable during cerebral ischaemia.
This preliminary study was designed to assess a possible role of neutrophil activation and to determine the prognostic value of plasma myeloperoxidase (MPO) and vitamin E (Vit. E) levels in severe head injury. Plasma MPO and Vit. E levels were measured in nine severely head-injured patients (Glasgow Coma Score </=8) (ages 12-80 years) 6, 12. 18, 24, and 30 h after trauma. Patients were classified into two groups according to outcome after discharge from the ICU: group D (death; n = 5) and group S (survival; n = 4). Plasma MPO levels were increased immediately after trauma and then decreased. The MPO peak observed after 6 h was significantly higher (p < 0.05) in group D (mean +/- SEM: 1,237 +/- 122 ng/ml) than in group S (mean +/- SEM: 543 +/- 148 ng/ml). Plasma Vit. E levels were lower than normal values and decreased over time. They were always significantly lower (p < 0.05) in group D than in group S, except for the first sample. These differences cannot be explained entirely by total plasma lipid (TL) values since no statistical difference in TL concentrations was found between the two groups during the course of study. The ratio of Vit. E to TL. considered as the best index of Vit. E status, was lower in group D than in group S. and the difference reached statistical significance (p < 0.05) 12 h after trauma. In conclusion, in spite of the limited number of patients included in this study, it appears that severe head injury is associated with an increase in MPO and a decrease in Vit. E levels. These biochemical changes are of greater magnitude in group D than in group S; they suggest neutrophil activation and lipoperoxidation processes. Finally, plasma MPO and Vit. E seem to be new discriminant factors of outcome in head-injured patients.
Correlation between increased cranial and peripheral norepinephrines and increased cranial to systemic renin ratio has been observed in a small number of patients with postcarotid endarterectomy hypertension. In an effort to confirm these findings, we studied cranial and peripheral levels of catecholamines and peripheral renin activity in 120 consecutive carotid endarterectomies. Samples were taken before carotid clamping (Sample I) and just after clamp release (Sample II). Norepinephrine, epinephrine and dopamine values did not correlate with postcarotid endarterectomy hypertension. There was no association between peripheral renin values and postcarotid endarterectomy hypertension.
Plasma levels of vitamin E (Vit. E), total lipids (TL), Vit. E to TL ratio and myeloperoxidase (MPO) were studied in 20 patients undergoing lumbar spinal surgery and randomly allocated to two anesthetic groups: propofol (bolus dose + continuous infusion and thiopental/isoflurane. Peripheral blood samples were withdrawn prior to induction, each hour during anesthesia and 1 h after the end of surgery. Mean Vit. E and TL levels as well as mean Vit. E to TL ratios remained in the normal range over the entire period of study whatever the anesthetic regimen. MPO levels rose significantly in the post-operative period only, but without statistical difference between the two groups. Therefore, anesthesia with propofol or thiopental/isoflurane modifies neither total lipid concentrations nor plasma Vit. E, which is a potent endogenous inhibitor of lipid peroxidation bound to lipoproteins. The rise of plasma MPO suggests a moderate post-operative neutrophil activation which is not influenced by anesthetic techniques.
Monitoring cerebral oxygen availability and utilization is of the utmost importance for patients with brain insults or potentially at risk of brain oxygen deprivation. The availability of the continuous measurement of oxygen saturation in the jugular bulb questions the value of this parameter as an indicator of brain oxygenation. This article reviews the theoretical background and the practical aspects of this monitoring. It describes its possible applications to neurosurgical patients in the operating theater as well as in the intensive therapy unit. Finally, it comments on its main limitations which could impede an extensive utilization in clinical practice.
Elevated intracranial pressure (ICP) is undoubtedly a determinant factor of outcome in severe head injured patient. Until now, medical treatment of elevated ICP in diffuse brain lesions consisted of hyperventilation, CSF drainage, mannitol and barbiturates without accurate selection criteria. In fact, in comatose patients, the cerebral blood flow (CBF) can vary independently of the cerebral metabolic rate of oxygen (CMRO2) which is typically reduced. The venous oxygen saturation (SjO2) measured in the jugular bulb and the arterial-jugular oxygen difference (ajDO2) can be used for more appropriately selecting therapeutic measures. According to the following equation: CMRO2 = CBF x ajDO2, the measurement of the changes in ajDO2 might serve as an indicator of CBF adequacy, out of the presence of cerebral ischemia. A decreased ajDO2 suggests that CBF is excessive for cerebral metabolic requirements and an elevated ajDO2 indicates a decreased CBF. Consequently, treatment of elevated ICP in the presence of a low ajDO2 should be more oriented towards moderate hyperventilation and administration of metabolic depressive agents with maintenance of normal arterial blood pressure. Conversely, in case of high ajDO2, ICP control should aim to increase CBF by maintaining normocapnia, improving hemodynamic status or reducing extravascular volume accordingly.
Explore the source record for details and available documents.
A multicentric crossover randomized trial of 100 mg of thalidomide vs placebo each for 2 months was conducted in patients with severe aphthous stomatitis of more than 6 months' duration. Seventy-three patients were included. Complete remission was obtained in 32 patients who received thalidomide and in 6 patients who received placebo. The confidence interval of the difference between the two treatments ranged from 25% to 53%. Most of the patients who did not achieve a complete remission had a dramatic improvement with regard to the number of aphthae when they were receiving thalidomide. Thirteen of 17 patients who had a complete remission while they were receiving thalidomide had a recurrence with placebo, 19 +/- 9 (mean +/- SD) days after stopping this drug. Side effects were significantly more frequent with thalidomide, especially drowsiness and constipation. We concluded that thalidomide in a dosage of 100 mg/d is an effective treatment of severe aphthous stomatitis but is not without some risk.
Ginkgo biloba extract is known to be efficient in diseases associated with free radical generation. The purpose of this work was to study, under in vitro conditions, the action of Ginkgo biloba extract (Gbe) against superoxide anion (O2-.), which is directly or indirectly implicated in cell damage. Gbe appears to have both an O2-. scavenging effect and also a superoxide dismutase activity. Its antiradical effect was demonstrated by low temperature electron spin resonance and in a non-enzymatic system (phenazine methosulfate-NADH), and its enzymatic activity was shown by polarographic determination.