Glossopharyngeal neuralgia; a cause of cardiac arrest

Glossopharyngeal tic douloureux or neuralgia is a comparatively rare but well-recognized syndrome. In respect to the stabbing paroxysmal nature of the pain and its relation to specific trigger zones, it is exactly comparable to the commoner trigeminal tic douloureux. In neurosurgical clinics the two types of neuralgia occur in a ratio of about one to forty.The significance of cardiac arrest and syncope associated with glossopharyngeal neuralgia was first emphasized by Riley and associates,¹ in a brief report of two cases in 1942. This report called attention to the afferent pathway of the carotid sinus reflex through the glossopharyngeal nerve and suggested the correlation of the simultaneous neuralgia and excessive stimuli to the sinus reflex. Neither of the two cases was reported to have been subjected to operation. Since then, no other reports of similar cases have come to light in medical literature. However, one of us (Ray) had the opportunity of examining such a case with Dr. Jefferson Browder in 1943 and this patient was relieved of all symptoms by intracranial section of the glossopharyngeal nerve.Because of the importance of further establishing the authenticity of the syndrome and calling wider attention to the importance of its recognition, there is justification for reporting another comparable case.     

The high prevalence of colorectal neoplasms in preoperative patients with abdominal aortic aneurysm or peripheral artery disease.

OBJECTIVE: In Japan, the incidence of both colorectal carcinoma and vascular disease is increasing. We screened preoperative patients with abdominal aortic aneurysm (AAA) or peripheral artery disease (PAD) for colorectal cancer. DESIGN OF STUDY: This study was retrospective and cross-sectional. MATERIALS: The subjects were 492 patients admitted for elective surgery of AAA or PAD. METHODS: The patients underwent immunochemical faecal occult blood tests (FOBT) before operation, and those with positive results underwent investigations for colorectal neoplasm. We compared the results with that of screening programmes performed on the general population. RESULTS: Of the 408 patients that underwent FOBT, 104 (25.5%) were positive. After colonoscopy, six (1.5%) had colorectal carcinoma and 16 (3.9%) had advanced adenoma. These values were several folds higher than that for the general population in Japan. CONCLUSIONS: Patients with AAA or PAD carry a high risk for colorectal neoplasm.     

Carotid sinus nerve blockade to reduce blood pressure instability following carotid endarterectomy: a systematic review and meta-analysis.

OBJECTIVES: Local anaesthetic infiltration into the carotid sinus during carotid endarterectomy (CEA) has been recommended to minimise blood pressure fluctuations but its use remains controversial. The aim of this meta-analysis was to determine whether intra-operative administration of local anaesthetic reduces the incidence of haemodynamic instability following CEA. MATERIALS AND METHODS: A search of the Medline, Pubmed and Embase databases and the Current Controlled Trials register identified four trials, which met the pre-defined inclusion criteria for data extraction. Pooled odds ratios with 95 per cent confidence intervals (c.i.) for the development of post-operative hypotension and hypertension were calculated using a random-effects model. RESULTS: Outcomes of 432 patients were studied. Local anaesthetic blockade of the carotid sinus was associated with a pooled odds ratio of 1.25 (95 per cent c.i. 0.496 to 3.15); p=0.216) and 1.28 (95 per cent c.i. 0.699 to 2.33; p=0.428) for the development of post-operative hypotension and hypertension respectively. Although none reach significance there was a trend towards increased risk of developing a complication in those patients who received local anaesthetic. CONCLUSIONS: There are insufficient data to determine the role of intra-operative local anaesthetic administration in reducing post-operative blood pressure lability following CEA. Conversely, the possibility of harm cannot be excluded on the basis of the currently available data.