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At least 685 records · Page 38Linked to original sources
PubMed2007

Internal pallidal neuronal activity during mild drug-related dyskinesias in Parkinson's disease: decreased firing rates and altered firing patterns.

The neuronal basis of hyperkinetic movement disorders has long been unclear. We now test the hypothesis that changes in the firing pattern of neurons in the globus pallidus internus (GPi) are related to dyskinesias induced by low doses of apomorphine in patients with advanced Parkinson's disease (PD). During pallidotomy for advanced PD, the activity of single neurons was studied both before and after administration of apomorphine at doses just adequate to induce dyskinesias (21 neurons, 17 patients). After the apomorphine injection, these spike trains demonstrated an initial fall in firing from baseline. In nine neurons, the onset of on was simultaneous with that of dyskinesias. In these spike trains, the initial fall in firing rate preceded and was larger than the fall at the onset of on with dyskinesias. Among the three neurons in which the onset of on occurred before that of dyskinesias, the firing rate did not change at the time of onset of dyskinesias. After injection of apomorphine, dyskinesias during on with dyskinesias often fluctuated between transient periods with dyskinesias and those without. Average firing rates were not different between these two types of transient periods. Transient periods with dyskinesias were characterized by interspike interval (ISI) independence, stationary spike trains, and higher variability of ISIs. A small but significant group of neurons demonstrated recurring ISI patterns during transient periods of on with dyskinesias. These results suggest that mild dyskinesias resulting from low doses of apomorphine are related to both low GPi neuronal firing rates and altered firing patterns.

Aged↗
PubMed1992

[Peroperative endoscopic papillosphincterotomy].

The authors describe their experience with combinations of endoscopic and surgical procedures when dealing with stenoses of the papilla Vateri. They give a detailed account of the endoscopic phase of surgical intervention. In their opinion the most important thing is exclusion of duodenotomy which should reduce the risk of a duodenal fistula. Another important advantage is more rapid convalescence and a shorter hospitalization period as well as a shorter time required for the intervention. Next the authors discuss possible complications described in the literature and their relationship to endoscopic papillotomy. The authors evaluate contemporary possibilities of endoscopic treatment and emphasize the necessity to extend the use of endoscopic methods in everyday surgical practice.

Adult↗
PubMed1989

[Dopplerography and ultrasonic scanning of the internal thoracic artery and of mammary-coronary shunts].

The study was performed in 22 patients with ischemic heart disease who underwent direct myocardial revascularization. The functional and structural state of mammary arteries was estimated by the noninvasive Duplex scanning before surgical operation to evaluate the possibility of using them as mammary-coronary bypasses (MCB). Direct blood velocity measurements in the bypasses during aortocoronary bypass (ACB) surgery and MCB were made by ultrasound pulsed Doppler system with a 10 MHz transducer. A method was developed for noninvasive Duplex scanning and evaluation of coronary bypass flow in the postoperative period by using the ultrasound system with 5 a MHz phased array linear transducer, which enabled one to obtain the bypass image in B-mode and the Doppler velocity spectrum inside the bypass.

Adult↗
PubMed1983

Proximal gastric vagotomy. A prospective study of 829 patients with four-year follow-up.

A prospective controlled trial of proximal gastric vagotomy (PGV) in 829 patients at three surgical services is presented. Peroperative tests of vagotomy completeness were made in two of the three groups of patients. The follow-up period was four to six years. The hospital stay after PGV averaged 9.2 days. The postoperative mortality rate was 0.2%. The reduction of gastric acidity was maintained four years after PGV. Postoperatively no patient had severe diarrhoea. The incidence of dumping after PGV was 1.5% and of gastric stasis 7.3%. Though 7% of the patients reported pyrosis after PGV, only a few required treatment. Transient dysphagia was reported by 2.5% of the patients. In about 4% of the series there were relatively mild ulcer-like symptoms postoperatively, without confirmation of ulcer. Duodenal ulcer recurred in 2% of cases during the observation period and gastric ulcer appeared in 1.5%. According to the Visick classification, 74% of the series showed grade I clinical result, 18% grade II, 4% grade III and 4% grade IV. There were no intergroup differences in Visick grades.

Deglutition Disorders↗
PubMed1996

[Perioperative physiological and cognitive functions following oral premedication with 3.75 mg midazolam in operations with retrobulbar anesthesia].

UNLABELLED: The number of surgical procedures performed as day surgery has significantly increased in recent years. Therefore, a safe and short postoperative recovery period has become increasingly important. The aim of the present study was to investigate perioperative cognitive and physiological function after oral premedication with low-dose midazolam (3.75 mg), especially during the postoperative period. METHODS: Forty-seven men (age > 69 years, weight 50-90 kg) scheduled for elective cataract surgery under retrobulbar anaesthesia (RBA) were included in the study. The patients were randomly assigned to either group 1 (n = 28), receiving 3.75 mg midazolam p.o. (Dormicum), or group 2 (n = 19), receiving a placebo orally 30 min before RBA. We measured the following parameters: sedation (modified Glasgow coma scale); anxiety (visual analogue scale); numerical and verbal memory (digit span and reproduction of previously presented words); concentration (Revisions test of Stender/Marschner). To identify depression of ventilation, pulse oximetry and nasal end-tidal PCO2 were monitored intraoperatively. RESULTS: After premedication with 3.75 mg midazolam, patients were significantly more sedated (P < 0.01) and systolic blood pressures were significantly reduced (P < 0.05); 30 min after midazolam premedication only concentration was significantly (P < 0.05) decreased. The results of the other cognitive functions did not differ. No differences in cognitive and physiological functions between and groups could be found 2 h after the operation (293 +/- min after premedication). Intraoperatively, there were no significant differences in end-tidal PCO2 and oxygenation between the groups. In both groups anxiety and blood pressure were significantly higher pre- than postoperatively. CONCLUSION: Oral administration of low-dose midazolam (0.049 +/- mg/kg) seems to be appropriate for premedication before ambulatory surgical procedures in elderly patients. In the interest of patient safety, standardised oral premedication with 3.75 mg midazolam may not be sufficient for some of the patients.

Aged↗
PubMed1989

[Fibrinolytic activity in patients undergoing hepatic transplantation].

Bleeding complications during liver transplantation have been attributed to accelerated fibrinolysis. In order to determine its cause, 11 adults (mean age: 38.9 +/- 13.2 yr) undergoing liver transplantation were studied. There were three groups of patients: cirrhosis (n = 4), fulminating hepatitis (n = 4) and one group including a primary biliary cirrhosis, a hepatic metastasis and a hepatoma. The following factors were studied in the immediate preoperative period, at different surgical times throughout the procedure and 2-3 h after the end of the abdominal sutures: platelet count, prothrombin concentration, fibrinogen, activated kephalin time, factors II, V, VII + X and VIIIc, antithrombin III, protein C, D-dimers, fibrinogen and fibrin degradation products (PDF), plasma plasminogen, tissue plasminogen activator (tPA) and the fast tPA inhibitor (PAi). Preoperatively, only the two patients with hepatic cancer had a normal haemostatic profile. Throughout the procedure, all patients had only moderate changes in platelets, coagulation factors and their inhibitors, and plasminogen, because platelet concentrates and fresh frozen plasma were transfused. Levels of tPA rose, becoming very high during the anhepatic period and just after graft reperfusion. An abrupt fall occurred at the end of surgery. There were important individual differences in tPA activity. PAi activity was low during the preanhepatic and anhepatic stages, rising rapidly after revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Coagulation Factors↗
PubMed1982

Hemodynamic effects of N2O, O2 barbiturate anesthesia and induced hypotension in early versus late aneurysm clipping.

The cardiovascular effects of large dose thiopental anesthesia and induced hypotension were examined in 22 patients undergoing clipping of ruptured intracranial aneurysms. Eleven patients operated on within 4 days of the initial bleed (early group) were compared with those operated on more than 10 days after the bleed (late group). Systemic and pulmonary arterial pressures, central venous pressure, and cardiac output were measured. The cardiac index and the systemic and pulmonary vascular resistance were calculated. Before the induction of anesthesia, the cardiac index was 4.00 +/- 0.3 litres/minute/m2 in the early group compared with 2.89 +/- 0.23 litres/minute/m2 in the late group (P less than 0.05). Five and 10 minutes after the administration of mannitol (1 g/kg) and at an induced hypotensive level of 60 torr, the cardiac index remained significantly higher in the early group (P less than 0.05). There was no significant difference in the mean arterial blood pressure between the groups. Systemic vascular resistance was significantly higher in the late group during the postinduction and the pre-mannitol infusion periods and at induced hypotensive levels of 50 and 40 torr. Central venous pressure was significantly higher in the early group only at the preanesthesia (control) measurement. There was no significant difference between the groups in the pulmonary artery wedge pressure or the pulmonary vascular resistance.

Adolescent↗
PubMedDate not supplied

Tracing craniosynostosis to its developmental stage through bone center displacement.

In metopic and coronal suture synostosis, the involved bone centers are abnormally situated just next to the affected suture. Bone centers are the starting point of ossification during embryogenesis from which bone growth spreads radially. In this paper, we describe a similar observation for sagittal suture synostosis, with both parietal bone centers located almost completely cranially. The (reduced) distance between the bone centers of a synostotic suture reflects the time during embryogenesis at which fusion took place. We suggest that in craniosynostosis the bone centers arise in their normal position, and initial outgrowth is undisturbed until the bone fronts meet. It is during this developmental stage that fusion occurs instead of suture formation. Due to the fusion, growth can only occur at the free bony rims from then on. The bone centers remain located at a fixed distance from one another in the middle of the fused bones, becoming relatively more displaced with time. This implies that the distance between the involved bone centers directly indicates the developmental period during which sutural growth was arrested. The same phenomenon of bone center displacement is found in types of craniosynostosis with and without fibroblast growth factor receptor (FGFR) or TWIST gene mutations.

Bone Development↗
PubMedDate not supplied

Pancreatic head tumors with portal vein involvement: an alternative surgical approach.

BACKGROUND/AIMS: One of the determining factors for the unresectability of pancreatic head tumors is the involvement of the portal venous system. Recent reports show that the resection of tumors with portal vein involvement has similar results to lesions with same stage without portal vein invasion. The aim of this study is to present a technique that allows the resection of portal vein segments without the use of grafts and with a shorter period of intraoperative venous occlusion. METHODOLOGY: Fifteen patients with pancreatic head tumors and portal vein involvement were submitted to pancreaticoduodenectomy according to this technique. The main feature of the technique is starting the pancreatic dissection at the posterior aspect of the head of the pancreas. The superior mesenteric artery is completely dissected from the pancreatic tissues leaving the section of the pancreas and the resection of the portal vein to the last step. RESULTS: Portal vein flow occlusion did not exceed 10 minutes. There were no major postoperative complications or mortality. CONCLUSIONS: This maneuver allows an easier resection of the mobilized portal vein with a shorter period of venous clamping and reconstruction without the need of venous graft.

Adenocarcinoma↗
PubMed1998

Delayed hearing loss after microvascular decompression of the trigeminal nerve.

OBJECTIVE: The development of sudden postoperative hearing loss as a complication of microvascular decompression (MVD) operations in the cerebellopontine angle has already been reported. A sudden hearing loss of vascular origin may also occur hours or days after such operations, but even in such cases an improvement of hearing over the following weeks is possible. Here we report on a gradual deterioration of hearing over a period of two weeks after MVD which has not been described in the literature up to now. CLINICAL PRESENTATION: A MVD operation was performed twice on a 36 year old patient with trigeminal neuralgia. After the second operation the patient developed a slight hearing impairment 3 days postoperatively which increased over a period of two weeks and ended up with total deafness. The course of intra-operative brainstem auditory evoked potentials and postoperative audiograms is documented. CONCLUSION: Because of gradual development of the delayed hearing loss, we conclude that postoperative tissue scarring may be the underlying pathology.

Adult↗
PubMed1984

Changes of serum pyruvate and lactate in open-heart surgery.

In 20 patients under extracorporeal bypass, a study was undertaken of the changes in plasma of lactate and pyruvate, the lactate/pyruvate ratio and the lactate excess. A decrease has been found in the pyruvate and an increase in the other values lasting for the first days of the post-operative period. The causes may be many, such as changes in the oxidation potential, blood transfusions and liver function, and these may be manifested in an increase in the serum glutamic oxalacetic transaminase, glutamic pyruvic transaminase, lactic dehydrogenase, and gamma-glutamyl transpeptidase.

Adolescent↗
PubMed1998

Production of nitric oxide during surgery involving cardiopulmonary bypass.

OBJECTIVES: Surgery involving cardiopulmonary bypass induces an inflammatory response due to the contact of blood with the extracorporeal circuit. In some patients, this inflammatory response leads to multiple organ failure and death. Inflammatory states may increase the production of nitric oxide, either by increasing the activity of constitutive enzyme systems or by inducing of inflammation-specific systems. We hypothesized that surgery involving cardiopulmonary bypass would increase the production of nitric oxide in association with the inflammatory response. DESIGN: Prospective, single center, observational study. SETTING: University-affiliated, tertiary referral cardiothoracic center. PATIENTS: Eleven adult patients undergoing routine myocardial revascularization. INTERVENTIONS: Surgery for myocardial revascularization. MEASUREMENTS AND MAIN RESULTS: Observations were made after induction of anesthesia, before bypass, after completion of the bypass, and on return to the recovery area. Parameters measured included hemodynamics, exhaled nitric oxide concentrations, plasma nitrate/nitrite concentration, plasma and bronchoalveolar lavage myeloperoxidase concentrations, and protein carbonyl conversion. All patients survived surgery. Oxygenation index fell significantly after bypass. Plasma myeloperoxidase increased significantly during the study period. Plasma carbonyl conversion also increased, although not significantly. Plasma nitrate/nitrite and airway nitric oxide concentrations did not change through the course of the study. CONCLUSION: Surgery involving cardiopulmonary bypass induced a demonstrable inflammatory response, but this response was not associated with increased nitric oxide production.

Aged↗
PubMed1987

Mechanisms of hypoxemia and hypercapnia in the perioperative period.

There are numerous mechanisms of hypoxemia and hypercapnia during the perioperative period. Mechanisms of hypoxemia include oxygen delivery problems, decreased FAC-CC relationship, hypoventilation, decreased cardiac output, increased oxygen consumption, decreased hypoxic pulmonary vasoconstriction, and increased nonalveolar right-to-left shunting. Mechanisms of hypocapnia include increased carbon dioxide production, increased alveolar dead space, and increased external dead spaces. Pulmonary diseases often involve multiple mechanisms to produce hypoxemia and hypercapnia.

Anesthesia↗
PubMedDate not supplied

[Bacteriological study of the wounds during drainage of the abdominal cavity after operations on the liver and pancreas].

Results of bacteriological studies have shown that the secondary infection of wounds and the abdominal cavity in patients comes through the glove-gauze tampon in 76.9% of cases. The pathogenic microflora comes into the wound and the abdominal cavity by the tampon from the skin under the aseptic adhesive. It occurs much more rarely (7.15% of cases--p < 0.001) if tube drains and active aspiration are used for drainage at the postoperative period. This method of drainage of the abdominal cavity is followed by 3 times less amount of complications than when using the glove-gauze tampons. Tampons should be used for drainage of the abdominal cavity but when hemostasis is not thorough for certain and when it is necessary to delimit the pyo-inflammatory process from the free abdominal cavity.

Abdomen↗
PubMed1990

Pre-bypass myocardial ischaemia in patients undergoing coronary artery surgery.

One hundred patients undergoing elective coronary artery surgery were studied to determine the incidence of pre-bypass myocardial ischaemia. Leads II, aVF and V5 of the electrocardiogram (ECG) were recorded at five-minute intervals from arrival in the anaesthetic room until onset of cardiopulmonary bypass. Thirteen patients developed sixteen episodes of significant ST depression on the ECG during the study period. Three patients were diagnosed as having postoperative myocardial infarction by ECG criteria and creatine phosphokinase-MB rise above 80 units. None of these patients had pre-bypass ST depression. Comparisons of these results with similar studies are presented.

Adult↗
PubMed1984

Adjunctive operative coronary artery balloon-catheter dilatation: review of Lenox Hill experience.

Operative transluminal coronary angioplasty (OTCA) has been used as an adjunct to coronary artery bypass surgery in 65 patients over a 56-month period beginning in May 1978. Experience has led us to use OTCA primarily in the left anterior descending coronary artery. The angioplasty catheter has undergone a number of modifications. Late restudy (8 to 56 months; mean, 24.1) data in 17 patients demonstrated that 15 of 19 angioplasty segments (78.9%) were patent.

Angioplasty, Balloon↗
PubMed1993

A comparison of caudal epidural bupivacaine with adrenaline and bupivacaine with adrenaline and pethidine for operative and postoperative analgesia in infants and children.

This study compares the effectiveness of two drug combinations--(a) bupivacaine with adrenaline and (b) bupivacaine with adrenaline and pethidine--on operative and postoperative pain relief when administered by the caudal route in infants and children. A randomised controlled trial was conducted on fifty children below the age of twelve years: 25 children were randomly allocated to each group. Both groups had a significant period of analgesia in the postoperative period. None of the children in either group required parenteral analgesia. Though the group with pethidine had a longer duration of analgesia and sedation, the very high incidence of vomiting and delay in urination observed in this group would preclude the use of pethidine routinely. No respiratory depression was seen in either group.

Analgesia, Epidural↗
PubMedDate not supplied

[Hormonal regulation during cardiac surgery operations on the "dry" heart].

Central and peripheral compartments of hypophyseo-adrenal regulation, the state of renin-angiotensin-aldosterone system (RAAS) and thyroid-stimulating functions of hypophysis have been assessed in 72 patients with heart valve defects operated under profound hypothermal perfusion. It has been established that cardiopulmonary bypass surgery with profound hypothermia is accompanied by moderate and reversible changes in the above parameters. The activity of hypophyseo-adrenal system and RAAS reaches the maximum during a warming-up period and then gradually decreases. TSH content considerably decreases in the early postoperative period. Cardiopulmonary bypass surgery with profound hypothermia causes more pronounced changes in neurohormonal regulation than heart valve correction under hypothermal perfusion, which might be associated with blood flow arrest in major vessels causing changes in peripheral metabolic processes.

Adolescent↗