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PubMed1979

Predictability of the response to the ergonovine test. Value in the diagnosis of coronary spasm.

Thirty-five patients with atypical chest pain were given ergonovine maleate as a provocative test for coronary spasm. None of the patients had significant coronary atherosclerosis. The patients were divided into two groups based on clinical information available before ergonovine testing. Group 1 patients (n=13) had objective evidence of cardiac disease manifested by episodes of syncope, ventricular tachyarrhythmias, myocardial infarction, or transient ST segment shifts with chest pain. Group 2 patients had chest pain but no objective evidence of cardiac disease. The ergonovine test was positive in 11 of 13 patients in group 1. None of the 22 group 2 patients had a positive response to ergonovine. These data suggest that ergonovine testing does not allow for any more precise recognition of patients with atypical chest pain who have coronary artery spasm than do clinical data alone.

Adult↗
PubMed1984

[Arterial spasm caused by administration of DHE-heparin in a tibial fracture].

A 38 years old white woman suffered a tibial fracture which was primarily managed by traction therapy. 3 X 5000 IU Heparin DHE was given as prophylaxis against thromboembolism. 6 days after administration of the drug a severe arterial spasm (documented by arteriography) with high-grade ischaemia of the left leg occurred. Successful arterial dilatation with a Fogarty catheter within the entire infragenual region down to the foot arteries was performed and consecutively during the same anaesthesia the intramedullary stabilisation using an interlocking nail was also performed. 8 months later the patient was free from symptoms, the fracture had healed, and the function was unrestricted. All pulses were palpable and the ultrasound Doppler index was greater than 1. In conclusion, we recommend in arterial spasm during heparin DHE therapy, immediate operative exposure of the vessel--if possible under local anaesthesia--and adequate vascular surgery as balloon catheter dilatation.

Adult↗
PubMed1983

Convergence spasm--treatment by amytal interview. A case report.

Convergence spasm is manifest by intermittent occurrence of ocular convergence, accommodative spasm, and miosis. It is usually due to hysteria but can have an organic basis. Treatment has included various ophthalmologic interventions. An amytal interview was used successfully to establish a nonorganic basis for the gaze palsy and, more importantly, concomitant narcosuggestion proved to be effective treatment.

Accommodation, Ocular↗
PubMed1983

Hemimasticatory and hemifacial spasm: a common pathophysiology?

The case is described of a 60-year-old woman with a 4-year history of left hemimasticatory spasm. Detailed electrophysiological studies are compared with those from 6 patients with typical idiopathic hemifacial spasm. On the basis of comparable patterns of EMG activity in the 2 conditions, it is concluded that they may have both a common pathophysiology and a peripheral site of involvement.

Aged↗
PubMed1984

Esophageal spasm associated with apnea and bradycardia in an infant.

A newborn infant was found to have diffuse esophageal spasm in association with apnea and bradycardia. This association has not been physiologically documented before. The infant's condition improved after the administration of glycopyrrolate, an anticholinergic agent. It is speculated that the association of esophageal spasm and bradycardia may be mediated by the vagus.

Apnea↗
PubMed1984

Ergonovine-provoked esophageal spasm during coronary angiography.

In many patients with chest pain of esophageal origin, findings are normal on routine esophageal manometry and dysmotility develops only upon provocation with ergonovine maleate. Unfortunately, ergonovine may induce myocardial ischemia in patients in whom coronary artery spasm did not occur during previous provocative testing in a cardiac laboratory-limiting its clinical usefulness. We have recorded esophageal pressure simultaneously with ergonovine infusion during angiography in ten patients without significant arterial stenoses. In two patients their usual chest pain developed associated with esophageal spasm and without changes in coronary vessels. Simultaneous performance of angiography and manometry enhanced the diagnostic yield of provocative testing by showing esophageal motility changes. This method may detect significant changes in the esophageal motility, is easy to carry out and does not interfere with angiography. It maximizes the information gained from a single provocative test and avoids the risk of ergonovine infusion outside of a cardiac laboratory.

Adult↗
PubMed1984

[A case of paroxysmal tinnitus and nystagmus accompanied by facial spasm].

Trigeminal neuralgia and facial spasm are usually caused by cross vascular compression of the trigeminal root entry zone and facial nerve exit zone. A similar mechanism is believed to affect the acoustic nerve as well, giving rise to tinnitus and nystagmus. We present one case of paroxysmal tinnitus and nystagmus, accompanied by facial spasm, and discuss the mechanism and the significance of the neurotological examination.

Arteries↗
PubMed1980

Studies with isolated human coronary arteries. Some general observations, potential mediators of spasm, role of calcium antagonists.

We studied the basic mechanisms involved in human coronary artery smooth-muscle contraction in an attempt to gain insight into the pathophysiology and pathopharmacology of coronary spasm. coronary arteries were obtained from recipient hearts of patients receiving cardiac transplantation at Stanford University. Coronary ring segments were studied in an organ bath using standard Tyrode's solution. Observation included characterizations of spontaneous contractile activity, factors affecting basal tone, type of agonist-induced contractile respnse, receptor distribution, activity of cardioactive drugs, and species differences. Agents mediating contraction included histamine, acetylcholine, norepinephrine, potassium, and prostaglandins. Because of recent clinical interest in calcium antagonists, diltiazem was studied extensively. Diltiazem demonstrated noncompetitive antagonism to the effects of several agonists and competitive antagonism to calcium. The exact cause and mechanism of coronary spasm is still unknown, but we have identified new areas for future investigation.

Acetylcholine↗
PubMed1983

Reversal of fentanyl induced spasm of the sphincter of Oddi.

We believe it is advisable to avoid narcotics, if possible, in patients with known or suspected gallbladder disease. Occasionally, however, this will not be possible, and narcotic induced spasm of the sphincter of Oddi may require treatment. Except for the stated contraindications of glucagon administration, it seems to be based upon this study and other available data that glucagon is just as effective as naloxone in reversing spasm of the sphincter of Oddi and may be associated with fewer undesirable effects, such as reversal of analgesia and adverse hemodynamic changes. Anticholingergic drugs in man have proved to be of minimal or no benefit in this regard.

Ampulla of Vater↗
PubMed1983

Manometric findings during spontaneous chest pain in patients with presumed esophageal "spasms".

Nine patients with intermittent chest pain thought clinically to be secondary to esophageal "spasms" developed typical pain while being studied with an intraluminal transducer probe placed in the distal esophagus. Manometric changes from control periods were examined preceding and during pain episodes. No significant difference in distal esophageal wave duration or amplitude or in frequency of abnormal peristalsis was observed preceding or during pain episodes when compared with nonpain periods over a mean monitoring time of 227 min. No change from the nonpain periods in esophageal baseline pressure occurred during pain episodes, nor was there any other obvious manometric change by gross inspection of the tracings. We conclude that patients clinically suspected of having esophageal "spasms" as the source of chest pain frequently do not, regardless of the presence or absence of motility abnormalities on conventional esophageal manometric studies.

Adult↗
PubMedDate not supplied

Hemifacial spasm: report of nine cases treated by posterior fossa microsurgical decompression.

Nine cases of hemifacial spasm have been treated, in our department until 1979, by posterior fossa microsurgical decompression, as described by Jannetta, without mortality or significant postoperative complications. A blood vessel was found crossing or looping the facial nerve in 8 cases. The relief of hemifacial spasm was immediate and complete in 7 cases, and partial in 1 case. This technique seems to be an effective and safe treatment, in this particular disease.

Adult↗
PubMed1982

Hemifacial spasm: location of the lesion by electrophysiological means.

In hemifacial spasm a late abnormal motor response was elicited by the antidromic volley after stimulating a peripheral branch of the facial nerve. The site of the lesion was calculated from the latency of that motor response and the conduction velocity. In 5 patients the distance was long, and corresponded with a tumor or a vascular anomaly at the cerebellopontine region in 3 of them. An artery sling entering the internal acoustic meatus was found in 2 out of 3 patients with short distances. It is concluded that hemifacial spasm results from a nerve lesion that may be located as far peripherally as the internal acoustic meatus. The theory of facial nuclear irritation is incompatible with such a peripheral lesion.

Cerebellopontine Angle↗
PubMed1982

[Arterial spasm of the lower limbs caused by pheochromocytoma].

The authors report the case of a 66-year-old man hospitalised with a clinical picture of stage III arterial disease of the lower limbs. Aortography revealed complete spasm of both popliteal arteries and a right adrenal tumour. Excision of the phaeochromocytoma led to the disappearance of symptoms of obliterative arterial disease and normalisation of Doppler results. The role of catecholamines in spasm is discussed.

Adrenal Gland Neoplasms↗
PubMed1980

Idiopathic hemifacial spasm treated with alcohol injection: a case report.

A case of idiopathic hemifacial spasm is presented. Review of the literature shows that systemic medical treatment has been of little value in relieving this condition. Many neurosurgical techniques are now available but there is a significant incidence of recurrence. Also, not all patients desire such surgery nor may they be good surgical candidates. There is the inherent tendency for postoperative morbidity and surgical complications. After proper neurological and otological examination, alcohol injection is a safe and simple office procedure that can be used effectively in the relief of hemifacial spasm.

Adult↗
PubMed1980

Acromio-clavicular separation masked by muscle spasm.

Weight-bearing views in suspected acromio-clavicular separation may be misleading if there is extensive spasm of the deltoid and trapezius muscles. The effect of this spasm may be lessened by strapping the weights to the wrist rather than having them hand-held. However, if there is strong clinical suspicion of an acromio-clavicular separation and the stress films, however taken, fail to reveal an upward displacement of the clavicle or widening of the joint space, the study should be repeated after infiltration of the acromio-clavicular joint with local anesthetic.

Acromioclavicular Joint↗
PubMed1978

Oddi's sphincter spasm in hypocalcaemia of dogs.

1. Decreases of serum calcium concentration in dogs lead to increased basal tone of Oddi's sphincter in the employed experimental model. 2. This effect is independent of the agent used for decreasing the serum calcium level. 3. Spasmolysis was observed immediately after the injection of CaCl2. CaCl2 alone, however, had no effect in "normocalcaemic" animals. 4. Local decrease of calcium level plays no significant role in the sphincter spasm. It is suggested that the spasm is elicited by increased smooth muscle excitability as a consequence of the hypocalcaemic state prevailing in the body.

Ampulla of Vater↗
PubMedDate not supplied

[The dopplerographic diagnosis of arterial spasm in patients with subarachnoid hemorrhages].

The paper deals with the specific features of using Doppler transcranial sonography in patients with subarachnoid hemorrhage. It describes the advantages and disadvantages of the method for the diagnosis of arterial spasm of various intracranial arteries. A comparison of angiographic and Doppler sonographic findings revealed that the values of the peak systolic velocity of blood flow (r = -0.875, p < 0.0001) are the most informative for the diagnosis of the extent of intracranial arterial lumenal narrowing. Patients with aneurysm ruptures in the internal carotid and middle cerebral arteries were found to have a pronounced increase in the blood flow velocity at the site of aneurysm. The intracranial arterial blood flow parameters critical for the development of brain ischemia during cerebral arterial spasm after subarachnoid hemorrhage are specified in the paper.

Aneurysm, Ruptured↗