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At least 595 records · Page 33Linked to original sources
PubMed2004

Anesthesia for removal of inhaled foreign bodies in children.

BACKGROUND: Foreign body aspiration may be a life-threatening emergency in children requiring immediate bronchoscopy under general anesthesia. Both controlled and spontaneous ventilation techniques have been used during anesthesia for bronchoscopic foreign body removal. There is no prospective study in the literature comparing these two techniques. This prospective randomized clinical trial was undertaken to compare spontaneous and controlled ventilation during anesthesia for removal of inhaled foreign bodies in children. METHODS: Thirty-six children posted for rigid bronchoscopy for removal of airway foreign bodies over a period of 2 years and 2 months in our institution were studied. After induction with sleep dose of thiopentone or halothane, they were randomly allocated to one of the two groups. In group I, 17 children were ventilated after obtaining paralysis with suxamethonium. In group II, 19 children were breathing halothane spontaneously in 100% oxygen. RESULTS: All the patients in the spontaneous ventilation group had to be converted to assisted ventilation because of either desaturation or inadequate depth of anesthesia. There was a significantly higher incidence of coughing and bucking in the spontaneous ventilation group compared with the controlled ventilation group (P = 0.0012). CONCLUSION: Use of controlled ventilation with muscle relaxants and inhalation anesthesia provides an even and adequate depth of anesthesia for rigid bronchoscopy.

Anesthesia, General↗
PubMed1992

[Positive anti-Borrelia antibodies in patients with clinical manifestations compatible with neuroborreliosis].

The clinical features of 19 patients with neurological manifestations unexplained by another disease and positive serology for Borrelia burgdorferi were studied. ECM was present in only 11% of the cases and 32% referred tick bite. The characteristic features for suspicion of NB according to our series was the presence of polyneuritis in 84% of the cases specially in the form of multiple mononeuritis and involvement of the facial nerve (79%) leading to even greater suspicion with the association of V pair involvement. Seizures, sleep disorders, and higher mental dysfunction may be found in association with other more characteristic neurological features. The typical triad of NB (aseptic meningitis, facial paralysis and polyradiculoneuritis) was found in 21% of the patients and in the absence of another disease to justify the same neuroborreliosis (NB) seemed evident. In all the cases components of this triad were found. Headache, arthralgia, fever and, less frequently, arthritis are other symptoms often past with the presence of anti-BB antibodies. Patients with the shortest evolution most frequently presented antecedents of facial paralysis, sensory alterations and Romberg's sign than patients of longer evolution. CSF demonstrated the presence of pleocytosis in 24% of the cases and in only one patient a slight increase in the intrathecal activity of IgG was observed which may be of use in differential diagnosis with MS. MR showed alterations in 61% of the patients and, while not specific, the lesions present subcortical predominance.

Adult↗
PubMedDate not supplied

[Respiratory form of onset of motor neuron disease].

OBJECTIVE: To present a case of respiratory failure as the form of onset of amyotrophic lateral sclerosis, to review the main clinical findings, data of the investigations done which suggest the presence of this disorder and describe its therapeutic management. CLINICAL CASE: A 68 year old man presented with a subacute illness characterized by a sleep disorder with sleep fragmentation, snoring of increasing intensity, without clear pauses of apnea, progressive diurnal hypersomnia accompanied by progressive dyspnea followed by respiratory failure with respiratory acidosis and difficulty in manipulating things with his hands. Diagnostic investigations showed a restrictive pattern without pulmonary fibrosis, due to paralysis of the diaphragm, and the presence of electromyographic signs compatible with motorneuron disease. The patient was treated with riluzole 100 mg/day and non-invasive mechanical ventilation and maintained an acceptable quality of life. CONCLUSIONS: Motorneuron disease may start with acute or progressive respiratory failure without a clear etiological cause and may appear to be similar to obstructive sleep apnea syndrome. The treatment of choice for this respiratory problem is non-invasive mechanical ventilation. Absence of symptoms of bulbar involvement is essential for a favourable prognosis.

Acute Disease↗
PubMed2004

Recurrence after a first unprovoked cryptogenic/idiopathic seizure in children: a prospective study from São Paulo, Brazil.

PURPOSE: To evaluate the recurrence risk after a first unprovoked seizure in a large population of children and adolescents of a developing country. METHODS: This prospective study was conducted at two tertiary hospitals, between September 1989 and August 1998. Children were enrolled if they had a first unprovoked cryptogenic/idiopathic seizure and maximal interval to the enrollment < or =90 days. EEG and computed tomography (CT) were performed in most patients. Potential predictors of recurrence were compared by using the Cox proportional hazards model in univariate and multivariate analyses. Survival analysis was performed by using the Kaplan-Meier curves. RESULTS: Two hundred thirteen children were included. Recurrence occurred in 34% of the patients, and mean time for recurrence was 12 months. Statistical analysis showed significance for seizure recurrence only for patients with abnormal EEGs. CT was performed in 182 patients, and abnormalities were found in 9.5%. Small calcifications were the most frequent finding, and this was not a predictor for recurrence. CONCLUSIONS: The risk of recurrence after a first unprovoked seizure in children from a developing country is similar to that found in developed countries. An abnormal EEG is a risk factor for seizure recurrence in children with a cryptogenic/idiopathic seizure. Calcifications on CT do not increase the risk of recurrence.

Adolescent↗
PubMedDate not supplied

[Respiratory failure in disseminated sclerosis].

The development and patterns of respiratory failure (RF) are analyzed in 9 patients with disseminated sclerosis (DS). Forced ventilation of the lungs was carried out with consideration for main location of the process. Relationship between patterns of respiratory disorders and neuroanatomy of respiratory regulation is discussed. Involvement of the corticospinal routes is paralleled by dissociation during functional pulmonary tests: spontaneous volumes are less than controlled inspirations. The most severe symptom complexes were observed in RF of predominantly bulbar localization: respiratory anarchy, blocking of airways caused by impaired swallowing, impaired mechanism of coughing reflex, loss of spontaneous respiration, sometimes apnea during sleeping. Involvement of the respiratory nuclei of medullary respiratory center and airways and of the corticonuclear routes of caudal cranial nerves causes the development of a triad of symptoms: glossopharyngolaryngeal paralysis, dysfunction of respiratory nuclei of medulla oblongata, and decreased sensitivity of respiratory center to CO2. Aspiration complications caused by dysphagia are characteristic of bulbar DS. Respiratory function in 5 patients without clinical picture of RF are specially discussed. The authors emphasize unfavorable prognostic significance of signs of extracorporeal obstruction indicating the probability of RF long before its manifestation. Special attention is paid to early diagnosis of symptoms of coming RF when evaluating the status of patients with DS during treatment. Timely use of respiratory resuscitation methods reduces the mortality and ensures a good chance for remissions with recovery of respiratory function, which are characteristic of RF.

Adolescent↗
PubMed1994

Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and Gerhardt syndrome associated with Shy-Drager syndrome.

This is the first report on a case of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with Gerhardt syndrome (paralysis of bilateral vocal cords). A 67-year-old Japanese man suffering from progressive autonomic failure was diagnosed as having Shy-Drager syndrome (SDS) with hyponatremia due to SIADH and severe sleep apnea caused by a bilateral recurrent nerve palsy. Water load test showed alteration in diuresis which was corrected by phenytoin. Arginine vasopressin secretion was not suppressed by plasma osmolality below 280 mOsm/kgH2O. Impairment of the afferent pathways of baroreceptors, or impairment of the osmoreceptors could be speculated as the etiological factor of the SIADH observed in this case.

Aged↗
PubMed2004

[Usefulness of ND:YAG laser in head and neck surgery].

Nd:YAG laser is widely used in surgery as well as in otolaryngology and head and neck surgery for 25 years. This type of laser is characterized by low absorption in water and haemoglobin, deep penetration to the tissue and high ability for vessels coagulation. The laser light can be guided with glassfiber and can be focussed with handpices and micromanipulators. These characteristics make Nd:YAG laser very useful surgical instrument, especially in ORL and head and neck surgery. One institution's experiences, based on 300 operations with Nd:YAG laser are presented and discussed. Main indications to Nd:YAG laser operations in our material were: malignant neoplasms of oral cavity, pharynx and larynx, papillomas and haemangiomas of mucosa of upper respiratory tract, tracheal stenoses, scars of the larynx after partial laryngectomies and snoring and sleep apnoea syndrome. In our opinion, Nd:YAG laser has high usefulness in treatment of malignant and benign head and neck neoplasms, as well as in laryngeal scars and treatment of snoring. In cases of post intubation tracheal stenoses and in cases of post strumectomy bilateral paralysis of larynx the treatment results were not satisfactory. High usefulness of Nd:YAG laser results from very good coagulation ability and wide possibility of transmission of laser light with glassfiber.

Head and Neck Neoplasms↗
PubMed1988

Clinical significance of severe isolated diaphragm weakness.

We studied six patients with isolated bilateral paralysis or severe weakness of the diaphragm, present for 2 to 60 months (mean = 25), to document the clinical and respiratory sequelae of the condition. Severe diaphragm dysfunction was confirmed by the demonstration of the very low maximal transdiaphragmatic pressure (Pdi) generated by either a sniff (13 +/- 6 cm H2O, normal 148 +/- 24) or a static inspiration (11 +/- 8, normal 108 +/- 30) and during bilateral phrenic nerve stimulation (0.8 +/- 2.0, normal 22 +/- 4). Resting arterial blood gases were normal (SaO2 = 95 to 97%) and no oxygen desaturation occurred during maximal exercise on a treadmill. Maximum voluntary ventilation was low and related to PImax (r = 0.89). Overnight sleep monitoring showed that time spent in rapid eye movement sleep was normal (mean 55 +/- 36 min, range 26 to 117 min). Mean maximum increment in transcutaneous CO2 was within normal limits (6 +/- 2 mm Hg, range 3 to 9 mm Hg). Three patients had occasional brief episodes of oxygen desaturation (mean maximal decrease 13 +/- 10%, range 2 to 27%); however, only two of these spent a measurable proportion of total sleep time (TST) with an SaO2 of less than 80% (1% and 3% TST, respectively). No patient has developed any symptoms of nocturnal hypoventilation or chronic respiratory failure during periods of observation of up to five yr. We conclude that bilateral paralysis or very severe weakness of the diaphragm does not of itself lead to respiratory failure unless weakness of other respiratory muscles is present.

Blood Gas Analysis↗
PubMed1998

Efficacy of early plasmapheresis in Bickerstaff's encephalitis.

Double filtration plasmapheresis (DFPP) was performed in a patient with Bickerstaff's brainstem encephalitis (BBE) in its early phase. He was a 27-year-old male patient suffering from diplopia, facial palsy and drowsiness following upper respiratory tract infection, and had high titers of immunoglobulin G (IgG) antibodies against ganglioside NeuAc(alpha)2-8NeuAc(alpha)2-3Gal(beta)1-3GalNAc(beta)1-4(NeuAc(al pha)2-8NeuAc(alpha)2-3)Gal(beta)1-4Glc(beta)1-1'Cer (GQ1b) in the serum. DFPP effected immediate improvement of his drowsiness, supporting the diagnosis of BBE. Our observations suggest that DFPP during the early phase of BBE efficiently prevents the progression of consciousness disturbances.

Adult↗
PubMed1993

Awareness and recall during general anesthesia. Facts and feelings.

BACKGROUND: Experiences of awareness and recall during general anesthesia can be most distressing for patients. To obtain relevant information, the authors systematically interviewed patients in whom awareness during surgery had occurred, and questioned them about their experiences. METHODS: Twenty-six patients, referred by colleagues, described the facts and feelings they had experienced during the period of awareness, and whether these had had any consequences. Available anesthetic records were independently judged by three experienced anesthesiologists for relevant parameters. RESULTS: Auditory perception and the sensation of paralysis were most frequently mentioned, followed by the sensation of pain. Patients' feelings were mostly related to anxiety, panic, powerlessness, and helplessness. Eighteen patients (70%) experienced unpleasant aftereffects, including sleep disturbances, dreams and nightmares, and flashbacks and anxiety during the day. Only nine patients (35%) had informed their anesthesiologists about what had taken place. Twelve anesthetic records were assessed. In three, the occurrence of awareness had been indicated, while, in a fourth, it was noted that an amnesic drug had been given at a moment of increased blood pressure. Experienced anesthesiologists were unable to reliably distinguish awareness cases from matched controls when judging the records. CONCLUSIONS: Details recalled from the period of awareness correspond with data from the literature. The anesthesiologist's role in discussing, and dealing with, traumatic experiences related to anesthesia may be of great importance. The hand-written anesthetic record is of limited value in retrospectively explaining why awareness and recall have occurred.

Adult↗
PubMed1985

[A sudden-death in a case of Arnold-Chiari malformation (type I) with sleep apnea].

UNLABELLED: We presented a sudden-death case of Arnold-Chiari malformation (type 1) accompanied with spina bifida and closed meningomyelocele. Polysomnography revealed the increase of both central and mixed type apneas to compare with the findings of typical Pickwikian syndrome. THE CASE: 30-year-old female without obese or obstruction of upper air way. Spina bifida and closed meningomyelocele at sacral portion were found at her birth. She had no treatment and had not been able to walk because of paralysis at low extremities. Since she was 25-year-old, she had had insomnia which accompanied by choked feelings, palpitations, clumsiness of hands and anxiety. Snoring was light, and she had neither respiratory disturbances nor hypersomnia during awake. She was admitted to our hospital for treatment of decubitus. 2nd June, 1977, she was found acrocyanosis during sleep and immediately she was resurrected. Physical examinations revealed there was no accounting for sudden respiratory arrest: the cardio-pulmonary system was normal during awake and laboratory findings also failed to disclose the episode. But she had slight dysfunctions of lower cranial nerves: fine nystagmus according to the head-position, decreased gag reflex, and paresis in the recurrence nerve of N.XII and etc. Angiography showed communicating hydrocephalus. Though ventriculoperitoneal shunt operation was performed at 8th June, sleep apnea could not be improved. Therefore we examined in order to clarify her sleep apnea. She was not obese, we could not find any obstructions of upper air way. Nocturnal polygraphy was performed at 8th July. The results were summarized as follows: (1) Total sleep time was 293 minutes and numbers of sleep apnea were 134 times.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1996

[A case of X-linked bulbospinal muscular atrophy with bilateral abductor vocal cord paralysis].

We report a 54-year-old man with X-linked bulbospinal muscular atrophy (BSMA) with bilateral abductor vocal cord paralysis. He noticed distal weakness in the lower limbs at age 20. In the following 18 years the weakness and atrophy of his leg muscles increased gradually. He has complained of stridors during respiratory tract infection and snored heavily during sleep since his age of 50. He was admitted to our hospital for the progressive stridors during meals. His two brothers were said to have similar complaints. Physical examination showed gynecomastia, hypertension and inspiratory stridor. Neurologic examination revealed distal muscular atrophy in his four extremities, especially more severe in bilateral lower limbs. Deep tendon reflexes were absent in all extremities. His tongue was slightly atrophic with fasciculation. Neurological diagnosis was made by family history, neurological findings, electromyography and a CAG repeat expansion in the androgen receptor gene. Lungs and diaphragm were normal on the chest radiograph. Cranial MRI including brain stem was also normal. Direct laryngoscopy showed a complete paralysis of both vocal cords in paramedian position. Tracheostomy was done right away; his respiratory distress showed prompt improvement after the tracheostomy. No previous report of bilateral vocal cord paralysis in BSMA has been found. Life expectancy in BSMA patients with vocal cord paralysis may be shortened because of respiratory distress or asphyxia. Of clinical importance is a careful assessment of vocal cord function in BSMA patients.

Endoscopy↗
PubMed1993

[A dementia occurred during therapy for multi-drug resistant pulmonary tuberculosis].

A 47-year-old woman was thirdly admitted to our hospital for therapy to multi-drug resistant tuberculosis of the lung in June 88. Although she was treated with TH, PAS and EVM, M. tuberculosis were positive constantly in her sputum. She complained of sleep disturbance, irritability, headache on September 89, she was diagnosed reactive depression. But her symptoms were progressive, low level of intelligence test in November, apatic in December and became spastic paralysis and vegetable state at next year. She was died of pneumonia in November 90. Her autopsy findings showed no brain atrophy nor meningitis. Microscopically, central chromatolysis were showed in Betz cells and anterior horn cells, these findings sometimes suspected for Peragulla, but we could not obtained definite pathological diagnosis, because we could not have been obtained findings indicating for Peragulla. Finally, we reported the clinical course and autopsy findings of dementia occurred during therapy for multi-drug resistant pulmonary tuberculosis.

Dementia↗
PubMed1990

[Bilateral radial nerve paralysis. Diagnostic and differential diagnostic aspects].

Bilateral radial nerve palsies are rare, and hence in this situation an underlying generalized peripheral neuropathy must always be considered. Among 103 patients with radial nerve palsies seen at our department during the last five years, there were three cases presenting with bilateral non-traumatic radial nerve palsies. These patients are presented in detail. One had a bilateral nerve entrapment in the supinator channel associated with a neuropathy of unclear origin, the second had bilateral sleep palsy, and the third had mononeuropathy multiplex associated with HIV infection. Following a summary of the cases reported in the literature, diagnostic considerations and additional investigations are discussed.

Adult↗
PubMed1983

Bilateral diaphragmatic paralysis.

Ventilatory failure developed insidiously in a patient due to bilateral diaphragmatic paralysis from bilateral phrenic neuropathy. The ventilatory failure progressed to respiratory arrest. We assessed the patient's diaphragmatic function by fluoroscopy, transdiaphragmatic pressure measurements during maximal inspiration, measurement of abdominal paradoxic motion, and electrical conduction measurements of the phrenic nerves. He improved and was discharged. A rocking bed was recommended for sleep after appropriate measurements of various respiratory support apparatuses. A history of supine breathlessness and a clinical observation of paradoxic abdominal wall motion during breathing in the supine position should suggest this possible cause.

Aged↗