Brainstem anaesthesia after peribulbar anaesthesia

Purpose  To present a case of brainstem anaesthesia as a complication of peribulbar anaesthesia. Clinical features  A 75-yr-old woman received peribulbar anaesthesia for cataract surgery. A few seconds after the block was performed, she had a respiratory arrest, became unconscious, and developed hypertension and tachycardia followed by hypotension and bradycardia. Ventilatory and haemodynamic support were performed before the patient regained adequate spontaneous breathing and normal heart rate and blood pressure. Conclusion  Peribulbar anaesthesia generally cames a low risk of serious complications. However, respiratory arrest and brainstem anaesthesia may occur as complications of peribulbar blocks.

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Résumé Objectif  Présenter un cas d’anesthésie du tronc cérébral compliquant une anesthésie péribulbaire. éléments cliniques  Un bloc péribulbaire était réalisé chez une femine de 75 ans pour l’extraction d’une cataracte. Quelques secondes après l’injection, la patiente cessait de respirer et perdait conscience. Elle devenait hypertendue et tachycarde puts hypotendue et bradycarde. La ventilation et la circulation devaient être supportées jusqu’au retour spontané à la normale. Conclusion  En général, l’anesthésie péribulbare comporte un faible risque de complications sérieuses. Un arrêt respiratoire par anesthésie du tronc cérébral est toujours possible.

     

Do weekly and fast-rotating shiftwork schedules differentially affect duration and quality of sleep?

 Characteristics of shiftwork schedules can have distinct impacts on workers’ sleep. This report presents comparisons of the effects of two different shiftwork schedules on duration and quality of the main sleep episodes in comparable worker populations at two different petrochemical plants. No significant differences were found for sleep duration in comparing the two plants. However, within each plant’s shift cycles, morning and night shifts showed shorter sleep durations than all other workdays and days off. Quality of sleep was perceived as lowest for night shifts of both plant schedules, and of lesser quality for weekly than for fast-rotating shifts. These results support recommendations for reducing the number of consecutive nights of shiftwork. However, before recommending any optimal shift schedule, interactions of sleep duration and quality with shift schedules need much further evaluation. Received: 18 December 1995/Accepted: 18 July 1996     

Percutaneous selective thermorhizotomy in the treatment of "essential" trigeminal neuralgia. The importance of lesion selectivity

Results following percutaneous thermorhizotomy for trigeminal neuralgia are described in 111 patients. Recurrences and side effects are more frequent whenever selectivity of the surgical lesion has been imperfect (exceeding the original pain area and causing marked hypoesthesia), and less frequent in the cases with strictly selective lesion.     

L-Dopa-responsive Parkinson's syndrome in association with phenylketonuria: In vivo dopamine transporter and D2 receptor findings.

Reports of parkinsonism in phenylketonuria are exceedingly rare. We report on a patient who had received a delayed diagnosis of phenylketonuria as an infant and subsequently developed levodopa-responsive parkinsonism at the age of 33. Single-photon emission computed tomography (SPECT) using (123)I-FP-CIT ([(123))I]-2 beta-carbomethoxy-3beta-(-4-iodophenyl)-N-(3-fluoropropyl)-nortropane) used to measure dopamine transporter levels on two occasions, 7 and 9 years after the onset of neurological symptoms, were normal. Iodine-123-iodo-lisuride SPECT (IBZM) imaging, however, showed reduced caudate over putamen binding. This combination of imaging findings indicates a possible upregulation of postsynaptic D2 receptors in the context of intact presynaptic dopamine nerve terminal density.     

Fetal magnetic resonance imaging in the prenatal diagnosis of cerebellar hemorrhage.

We report the case of a fetus with a sonographic mid-gestation diagnosis of hyperechogenic cerebellum suspected to be of hemorrhagic origin on fetal brain magnetic resonance imaging (MRI). No etiological factors for fetal hemorrhage were found other than a maternal heterozygocity for factor V Leiden. Following termination of the pregnancy, autopsy confirmed the prenatal diagnosis of massive cerebellar hemorrhage without underlying vascular anomaly. As an additional tool to ultrasonography, fetal brain MRI can affirm the hemorrhagic origin of hyperechogenic cerebellar lesions, especially by showing a high signal on T1-weighted images.