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At least 469 records · Page 26Linked to original sources
PubMed2003

Expiratory-synchronized sleep in a quadriplegic patient using inspiratory neck muscles to breathe.

In a patient with C3 quadriplegia causing complete diaphragm paralysis who developed inspiratory neck muscles (INM) hypertrophy to sustain ventilation, spontaneous breathing deeply altered sleep architecture, relegating sleep to the expiratory phase of the ventilatory cycle. A polysomnographic recording performed during mechanical ventilation (without INM activity), showed that sleep was abnormal but unaffected by the respiratory cycle. During spontaneous breathing, the polygraphic recordings showed expiratory microsleep episodes, with inspiratory arousals synchronous to bursts of INM activity. This case report illustrates the powerful adaptability of the respiratory and sleep control systems to maintain each vital function.

Adult↗
PubMed1999

Airway abnormalities in patients with Arnold-Chiari malformation.

OBJECTIVES: The goal was to determine the incidence and types of airway abnormalities in patients with Arnold-Chiari malformation (ACM). METHODS: The study was a retrospective chart review of 24 patients with ACM who were evaluated and treated between November 1991 and August 1997. RESULTS: Eighteen (75%) and 6 (25%) of the 24 patients had types I and II ACM, respectively. Three (12.5% of 24 patients) of the type II ACM patients had vocal cord impairment: 1 bilateral paralysis, 1 bilateral paresis, and 1 unilateral paralysis. None of the type I ACM patients had vocal cord impairment. Tracheotomy was necessary in 3 of the 24 patients and all in patients with type II ACM. Central sleep apnea was found in 5 of 6 type II ACM patients, but not in any of the type I ACM patients. CONCLUSIONS: Vocal cord impairment and sleep apnea were found in 12. 5% and 21%, respectively, of this ACM population. When type II ACM patients were considered separately, the incidences of vocal cord impairment and sleep apnea were 50% and 83%, respectively. Type II ACM patients tend to have a higher incidence of airway abnormalities and other neurologic dysfunctions. Flexible fiberoptic laryngoscopy is recommended in the airway evaluation of ACM patients. Early recognition, diagnosis, and management of these abnormalities may be lifesaving.

Adolescent↗
PubMed2001

[Respiratory disorders during sleep in amyotrophic lateral sclerosis].

Amyotropic lateral sclerosis is a severe degenerative disease of the nervous system. Progressive death of central and peripheral motor neurons leads to rapidly extensive paralysis of the four limbs, the bulbar region and the respiratory system. Sleep respiratory disorders is a useful sign to follow in these patients. Apnea is generally central rather than obstructive. Hypoventilation, particularly during REM sleep has been reported and causes nocturnal desaturation. These patients also appear to have a disrupted sleep pattern with a longer phase I and a shorter total duration of sleep. These nocturnal respiratory disorders observed in amyotropic lateral sclerosis are similar to those observed in muscle diseases. Management must however be undertaken very early in these patients because outcome can be rapidly fatal after the development of significant desaturation. Nasal ventilation can improve not only quality of life but also life expectancy for these patients.

Humans↗
PubMed1978

The B-vitamin group and the activity of hepatic microsomal mixed-function oxidases of the growing Wistar rat.

1. Male Wistar rats were given isoenergetic, semi-synthetic diets deficient in thiamin, riboflavin, pyridoxine or all the B-vitamins. 2. In rats given these deficient diets the 'sleeping time' induced with pentobarbital (PB) and the 'paralysis time' with zoxazolamine (Zz) were prolonged. 3. The tolerance effect against both drugs was nearly independent of the levels of B-vitamins in the diets. 4. In preparations from vitamin-B deficient animals the activities of the following hepatic microsomal enzymes were reduced: the aliphatic hydroxylase of PB, the aromatic hydroxylases of aniline (EC 1.14.14.1) and of Zz, the N-demethylase of aminopyrine, the UDP glucuronyltransferase (EC 2.4.1.17) of p-nitrophenol. The reactions most influenced were those of 'type-1' substrates, particularly those involving the hydroxylases. 5. The effects observed were caused mainly by deficiency of riboflavin and to a lesser extent of thiamin or pyridoxine.

Animals↗
PubMed1983

Effect of enzymatic induction and inhibition on cyclophosphamide-induced sister chromatid exchange in vivo.

The influence of the enzymatic inducer beta-naphthoflavone (BNF) and of the inhibitors alpha-naphthoflavone (ANF) and 2-diethylaminoethyl-2,2-diphenylvalerate HCl (SKF 525-A) on the frequency of sister chromatid exchanges (SCE) induced by cyclophosphamide (CPA) was studied in vivo in C57BL/6J male mice. Neither inducer nor inhibitors substantially modified the SCE level induced by 5 or 10 mg/kg CPA. The enzymatic induction by BNF was effective as treated animals showed a reduced paralysis time by zoxazolamine whereas ANF appeared to be ineffective. The enzymatic inhibition by SKF 525-A was confirmed by a longer sleeping time in pentobarbital-treated mice and also by a longer paralysis in zoxazolamine-treated mice. The lower susceptibility to CPA-induced SCEs of C57BL/6J mice relative to DBA/2 strain observed in a previous work seems not to be simply related to Ah locus mediated metabolism.

Animals↗
PubMed1988

Effect of tetrachlorophthalic anhydride on hepatic microsomal metabolism in rats and mice.

The capacity for induction of microsomal metabolic enzymes by tetrachlorophthalic anhydride (TCPA) was evaluated in male Sprague-Dawley rats and male CD-1 mice. The rats were orally dosed for 7 d with TCPA suspended in corn oil at 25, 100, 250, or 500 mg/kg. Following this treatment a dose-dependent reduction in the zoxazolamine paralysis time occurred over the dose range 100-500 mg/kg in the rat. No effect on the hexobarbital sleep time was observed at any test level. TCPA was found to produce statistically significant increases in hepatic aminopyrine N-demethylase, aniline hydroxylase, and cytochrome P-450 in the rat at 500 mg per kg. In addition statistically significant increases were seen in aniline hydroxylase and cytochrome P-450 at 25 mg/kg. Mice were orally dosed with TCPA for 7 d at 250, 500, or 1000 mg/kg. There was no effect in the zoxazolamine paralysis time or the hexobarbital sleep time in this species. Hepatic microsomal enzyme levels were not measured in the mouse. These results suggest that following oral dosage TCPA is a weak inducer of microsomal enzymes in the rat. A similar effect was not observed in the mouse for the parameters tested.

Aminopyrine N-Demethylase↗
PubMed1977

Facial palsy: unusual etiology.

This is a report of three patients who presented at the Mayo Clinic over a two-year period. All were initially diagnosed as having Bell's palsy but were later found to have a malignant neoplasm causing the paralysis. Two of the patients had breast carcinoma metastases involving the mastoid portion of the facial nerve. The third patient had an adenocarcinoma of the deep lobe of the parotid that involved the facial nerve distal to the stylomastoid foramen. The course of the facial paralysis in the two patients with the metastitic breast disease was almost identical. It consisted of episodes of pain in the mastoid area. generally in the late evening or during the night, often awakening the patient from sleep. This was then followed by peripheral facial-nerve paralysis, sometimes partial and at other times complete. These episodes lasted from 10 minutes to several hours and then resolved completely. They recurred over several months. The patients were completely asymptomatic and normal on examination in the intervals between episodes of paralysis until it became permanent. Metastatic lesions causing facial paralysis are extremely rare in the literature. In those cases that have been reported, the paralysis was progressive from the start and in the vast majority of cases was either painless or associated with other aural symptoms such as otorrhea, hearing loss, and periauricular swelling. There are two unusual features of these two cases: 1. the initial presentation of a breast metastasis as a facial paralysis; in the first case there were no other metastatic lesions present at diagnosis, whereas the second patient had other, asymptomatic, metastatic nodules; and 2. the multiple, brief, recurring episodes of facial paralysis, which have not previously been reported as a mode of presentation of metastitic disease. The third patient was diagnosed as having Bell's palsy. A facial nerve decompression was performed, and the nerve apparently looked normal. The paralysis failed to resolve. He was later found to have adenocarcinoma of the deep lobe of the parotid that involved the facial nerve distal to the stylomastoid foramen. A report of only one similar case could be found in the literature. The sequence of events in these three cases emphasizes the importance of submitting a patient suspected of having Bell's palsy to a thorough otoneurologic examination.

Adenocarcinoma↗
PubMed1985

[Malignant external otitis caused by Pseudomonas aeruginosa. Report of 3 cases].

The cases of three patients aged over sixty, diabetic for a long time and having clinical, otological, neurological and microbiological findings of malignant external otitis by Pseudomonas aeruginosa are registered. The first patient, a 62 years old woman, had important neurological alterations, such as proven P. aeruginosa meningitis and involvement of the 6th, 7th, 8th, 9th and 10th left cranial nerves. Although mortality and morbidity rates of cases with these characteristics are reported to be high, this patient survived. The second was a 64 years old male with the classical complaints of this condition consisting of persistent and intensive ear pain, serous purulent discharge and an emerging tumourous lesion in the left external ear canal. Good results were obtained with the surgical treatment administered along with an antimicrobial plan which remained incomplete because the patient has requested his discharge from the hospital. In less than one month, he was again hospitalized already presenting neurological manifestations (paralysis of the 6th cranial nerve) following a fatal course in a few days. The third was also a male patient, 70 years old, whose initial complaints occurred after a month a butterfly penetrated his right ear during his sleep. In spite of the presence of neurological troubles (facial paralysis and stupor) he survived with a prolonged antibiotic therapy. After a literature revision on this pathology, considerations are made concerning its pathogeny, clinical findings, diagnosis, therapy and prognosis.

Aged↗
PubMed1995

Spinal phobia: survey results of patient attitudes and preferences regarding anesthesia.

STUDY OBJECTIVE: To determine unbiased patient preferences for either spinal or general anesthesia for upcoming surgeries. DESIGN: Prior to contact with anesthesia personnel, a simple questionnaire was completed by surgical patients to determine their demographic characteristics and previous anesthetic experiences. Their concerns regarding a list of complications of general and spinal anesthesia and their preferences for general or spinal anesthesia if either method could be used were also determined. SETTING: University-affiliated suburban community hospital. MEASUREMENTS AND MAIN RESULTS: The survey was completed by 254 patients. A preference for general over spinal anesthesia was expressed by 80.2% of the patients responding. They expressed significantly more concerns regarding nausea/vomiting, sore throat, feeling sleepy, and death with general anesthesia than with spinal anesthesia. Concerns of back pain, nerve damage and paralysis were statistically related to spinal anesthesia. CONCLUSIONS: This survey shows a strong patient preference for general anesthesia and a phobia for spinal anesthesia.

Anesthesia, General↗
PubMed2004

Use of Sniff nasal-inspiratory force to predict survival in amyotrophic lateral sclerosis.

Respiratory muscle weakness is the usual cause of death in amyotrophic lateral sclerosis. The prognostic value of the forced vital capacity (FVC), mouth-inspiratory force, and sniff nasal-inspiratory force were established in a group of 98 patients with amyotrophic lateral sclerosis who were followed trimonthly for 3 years. Sniff nasal-inspiratory force correlated with the transdiaphragmatic pressure (r = 0.9, p < 0.01). Sniff nasal-inspiratory force was most likely to be recorded at the last visit (96% of cases), compared with either the FVC or mouth-inspiratory force (86% and 81%, respectively, p < 0.01). A sniff nasal-inspiratory force less than 40 cm H(2)O was significantly related with nocturnal hypoxemia. When sniff nasal-inspiratory force was less than 40 cm H(2)O, the hazard ratio for death was 9.1 (p = 0.001), and the median survival was 6 +/- 0.3 months. The sensitivity of FVC < 50% for predicting 6-month mortality was 58% with a specificity of 96%, whereas sniff nasal-inspiratory force less than 40 H(2)O had a sensitivity of 97% and a specificity of 79% for death within 6 months. Thus the sniff nasal-inspiratory force test is a good measure of respiratory muscle strength in amyotrophic lateral sclerosis, it can be performed by patients with advanced disease, and it gives prognostic information.

Adult↗
PubMedDate not supplied

Intermittent positive airway pressure by nasal mask as a treatment for respiratory insufficiency in a patient with Charcot-Marie-Tooth disease.

Charcot-Marie-Tooth disease (CMT) is a slowly progressive hereditary neuropathy characterised by degeneration of motor and sensory peripheral nerves resulting in distal muscle weakness with atrophy and sensory impairment. We report a 35-year-old woman with CMT presenting with respiratory failure due to a pneumonia, sputum impaction and insufficient cough reflex. After recovery, we diagnosed a very severe restrictive lung function disturbance caused by muscle weakness and a possible coexistent unilateral diaphragm paralysis. A very severe REM (Rapid Eye Movement Sleep) related sleep hypopnea syndrome was successfully treated with Nasal Intermittent Positive Pressure Ventilation (NIPPV).

Adult↗
PubMed2002

Unusual neurotoxic envenomations by Vipera aspis aspis snakes in France.

Vipera aspis aspis (V.a.a.) is the most dangerous poisonous snake in South-Eastern France. The clinical symptoms observed after V.a.a. envenomations involve mostly local signs (pain, edema) associated in the more severe cases with systemic symptoms (gastro-intestinal and cardiovascular manifestations). Since 1992, several unusual cases of moderate and severe 'neurotoxic' envenomations by V.a.a. snakes have been reported in a very localized area in South-Eastern France. Most of the human patients mainly suffered neurological signs owing to cephalic muscle paralysis. Drowsiness and dyspnea were observed for the most severe cases. Envenomed animals suffered respiratory distress and paralysis. The local signs were never as severe as observed after envenomations by vipers in other French regions. Human patients with moderate or severe clinical features received two intravenous injections of Viperfav antivenom, the first dose inducing the decrease of the neurological signs and the second reducing significantly the edema. Neurotoxic components immunologically cross-reacting with toxins from V. ammodytes ammodytes venom from Eastern Europe were detected in the blood of all patients suffering neurological symptoms after a V.a.a. bite. The protective efficacy of various antivenoms was evaluated in mice. The existence of geographical variations in the composition of V.a.a. venom emphasizes on the use of polyvalent antivenom in the treatment of viper envenomations in France.

Adult↗