Effect of acute intermittent hypoxia treatment on ventilatory load compensation and magnitude estimation of inspiratory resistive loads in an individual with chronic incomplete cervical spinal cord injury

Context

Spinal cord injury (SCI) causes disruption of the efferent input to and afferent input from respiratory muscles, which impairs respiratory motor and sensory functions, respectively. This disturbs the injured individual''s ability to respond to ventilatory loads and may alter the respiratory perceptual sensitivity of applied loads. Acute intermittent hypoxia with elevated CO₂ (AIH treatment) has been shown to induce ventilatory long-term facilitation in individuals with chronic SCI. This study evaluated the effect of ten days of AIH treatment on ventilatory load compensation and respiratory perceptual sensitivity to inspiratory resistive loads (IRL), in an individual with chronic, incomplete cervical SCI.

Methods

Case report and literature review.

Findings

We report a case of a 55-year-old female with a C4 chronic, incomplete SCI (American Spinal Injury Association Impairment Scale D). The subject underwent evaluation at four time-points: Baseline, Post Sham, AIH Day 1 and AIH Day 10. Significant improvements in airflow generated in response to applied IRL were found after AIH treatment compared to Baseline. There were no significant changes in the respiratory perceptual sensitivity to applied IRL after AIH treatment.

Clinical relevance

Rehabilitative interventions after SCI demand restoration of the respiratory motor function. However, they must also ensure that the respiratory perceptual sensitivity of the injured individual does not hinder their capability to compensate to ventilatory challenges.     

Postoperative management using intensive patient-controlled epidural analgesia and early rehabilitation after an esophagectomy

Purpose  Patient-controlled epidural analgesia (PCEA) was developed for use after surgery for thoracic esophageal cancer to relieve wound pain, introduce early rehabilitation, and provide an uneventful postoperative recovery. Methods  This retrospective study investigated 22 patients who underwent esophageal surgery to determine the efficacy of postoperative management with PCEA. In the PCEA group (n = 12), patients had two epidural catheters inserted to cover both the thoracic and abdominal incision with a patient-controlled bolus capability. Results  Postoperative mechanical ventilation was administered in all cases in the control group (n = 10). On the other hand, this was only necessary in two patients in the PCEA group. The amount of time the patients stayed in the intensive care unit and the hospital was significantly shorter in the PCEA group than in the control group (P < 0.001 and P < 0.01, respectively). Respiratory complications occurred in four patients in the control group, and none in the PCEA group. The mean number of supplemental analgesics administered for breakthrough pain until the 7th postoperative day was 5.5 in the control group, and 1.3 in the PCEA group (P < 0.001). Conclusions  Early rehabilitation is facilitated with intensive PCEA, while it also improves postoperative management and reduces hospitalization after esophageal surgery.     

硬膜外不同浓度辣椒辣素对大鼠痛阈及脊神经根组织结构的影响

目的观察硬膜外不同浓度辣椒辣素(CAP)对大鼠痛阈及脊神经根组织结构的影响。方法选择成年雄性Wistar大鼠24只,体重250 g-300 g,随机分成4组:对照组、A、B、C组,每组6 只。用动尾试验测痛阈后,腹腔注射1%戊巴比妥钠40mg/kg麻醉,于L5,6间隙硬膜外穿刺置管。置管后A、B、C组分别注入0.1%、0.25%、0.5?P 0.4 ml,对照组注入10%Tween 80溶液(CAP赋形剂)0.4 ml。注药后3、7、14 d测痛阈,随后将L4-6背根神经取出。每组取5只在光镜下观察形态学变化,余1只在电镜下观察其超微结构变化。结果与对照组相比,注药后A、B、C组痛阈明显升高(P <0.05),B、C组引起神经组织水肿和各细胞器的损害较A组明显。结论硬膜外腔注入0.1%、0.25%、0.5?P可明显提高大鼠痛阈,但0.25%、0.5?P对脊神经根损害明显。     

Bilateral gluteal compartment syndrome after total hip arthroplasty under epidural anesthesia

The gluteal compartment syndrome is uncommon and is discussed in only a few published case reports. The simultaneous bilateral gluteal compartment syndrome is exceptionally rare and is tackled in only 4 case reports to date. We report a case of bilateral gluteal compartment syndrome after total hip arthroplasty under epidural anesthesia and discuss its management.     

Spinal epidural metastasis from pineal germinoma

A 16-year-old boy first presented with a pineal tumour identified by neuroimaging but without positive serum or cerebrospinal fluid markers. The tumour disappeared after 50 Gy cranial irradiation. One year later he returned with spinal epidural metastasis from the pineal germinoma and required emergency surgery. Intraoperative findings showed that the spinal tumour had originated from cerebrospinal fluid dissemination and had passed through the spinal nerve sleeve. The pathologic diagnosis of the tumour was of a pure germinoma metastasis. An epidural tumour frequently requires emergency diagnosis and treatment. Attention should be paid to the possibility of this rare but serious clinical situation caused by a metastasis from a pineal germinoma.     

Pelvi-ureteric junction obstruction by crossing renal vessels: clinical and imaging features

OBJECTIVE: To present the characteristic clinical and imaging findings of pelvi-ureteric junction (PUJ) obstruction caused by crossing renal vessels (CRV), as it presents particular features within the spectrum of congenital hydronephrosis. PATIENTS AND METHODS: Between April 1982 and December 2000, 384 children underwent surgery for PUJ obstruction. In 71 (18.5%; mean age 8.5 years, range 2 months to 14 years; 49 aged> 5 years), the obstruction was caused by CRV. The data collected from the medical records of these patients were analysed for their clinical presentation and imaging findings, i.e. ultrasonography (US), intravenous urography (IVU) and diuretic renography. RESULTS: The main presenting symptom was recurrent renal colic (pain, nausea, vomiting) in 59%, followed by urinary infection (UTI) in 20%, gross haematuria in 11% and an incidental diagnosis in 10%. By contrast, in the 313 children with intrinsic PUJ obstruction, renal colic was present in only 10.5%. Moreover, from 1991 to 2000, when the use of prenatal US became widespread, hydronephrosis was detected prenatally in 42 of 212 children (20%) with intrinsic PUJ obstruction, but in only two of 31 (6%) with obstruction by CRV. However, in 10 children with CRV operated on during this period, prenatal US had shown mild hydronephrosis (< 15 mm), which during the follow-up decreased until the children became symptomatic after 5-9 years (eight renal colic, two UTI). US during acute symptoms showed significant hydronephrosis (> 25 mm), and colour Doppler US of two patients directly showed the CRV. In all 71 children with CRV obstruction diuretic IVU and renography during the acute symptoms had an obstructive pattern, and in 24 renal colic was reproduced during the examination. The differential kidney function was < 40% in 11 children who presented with UTI; two required nephrectomy and in the remaining 69 an Anderson-Hynes pyeloplasty, after which none had an episode of renal colic or UTI during a mean (range) follow-up of 10.2 (2-20) years. CONCLUSIONS: PUJ obstruction by CRV should be suspected in older children presenting with recurrent renal colic and hydronephrosis. Good kidney function is expected in most of these children, despite their age, because the vascular obstruction is intermittent. Mild prenatal hydronephrosis that could decrease postnatally does not exclude the possibility of vascular obstruction, which may later become symptomatic. Imaging (US, diuretic IVU and renography) during an episode of pain is essential and colour Doppler US could help to establish the diagnosis in these cases. Knowing that a child has a CRV is important for choosing an open surgical approach rather than endoscopic pyelotomy, to avoid potential complications     

跨窦骨瓣开颅术治疗骑跨静脉窦硬膜外血肿

目的 探讨骑跨静脉窦硬膜外血肿的手术治疗策略及疗效.方法 对43例骑跨静脉窦硬膜外血肿病例的临床资料、手术方式和预后进行回顾性分析.43例患者均采用跨窦骨瓣开颅,骨瓣复位,窦旁(周)硬脑膜悬吊于骨瓣相应位置的骨孔上.结果 43例术后第3、6天头部CT扫描显示血肿无复发、无残留,骨瓣无移位.出院时GOS预后评分:术后死亡1例,重度残疾1例,中度残疾2例,恢复良好39例.结论 跨窦骨瓣开颅术是治疗骑跨静脉窦硬膜外血肿的一种安全而且有效的方法.     

Anaesthetic management of a parturient with pulmonary stenosis and aortic incompetence for Caesarean section

Anaesthetic management of Caesarean section in a parturientwith severe pulmonary stenosis and aortic regurgitation is described.The valvular sequelae resulted from previous unsuccessful surgicalcorrection (Ross procedure) of congenital aortic stenosis. Thiscase demonstrates the importance of multi-disciplinary assessmentand careful anaesthetic planning, to avoid deterioration inperioperative cardiac performance in parturients with complexvalvular disease. Br J Anaesth 2003; 90: 241–3     

静注加肌注曲马多防治硬膜外麻醉期间寒战反应的研究

目的　观察曲马多防治硬膜外麻醉期间寒战反应时两种用药方法的临床效果。　方法硬膜外麻醉手术期间发生寒战的 6 0例成年患者 ,当出现寒战分级达 2～ 3级时 ,用室温下盐酸曲马多 1mg kg加氟哌啶 2 .5mg缓慢静脉推注 ,随机分成二组 :研究组 (R组 )与对照组 (C组 ) ,每组各 30例 ;R组在 5min内用上述同样药物和剂量予以肌内注射 ,C组以生理盐水 2ml肌内注射。观察寒战的治疗效果及 6h内寒战复发率。　结果　两组均于静注曲马多后 3min内起效 ,所有病人寒战反应均得到缓解 ,6h内R组均无寒战反应复发 ,C组有 5例再次出现寒战达 2级以上 ,给予追加首次量的 1 2后缓解 ,两组间差异有显著性 (P <0 .0 5 )。　结论　静注加肌注曲马多和氟哌啶可更有效地防治硬膜外麻醉期间的寒战反应。     

不同穿刺点硬膜外镇痛分娩效果比较

目的探讨不同穿刺点硬膜外镇痛分娩的效果。方法将 12 0例单胎足月初产妇随机分为两组各 6 0例。观察组以L1～L2 为穿刺间隙 ,对照组为L3 ～L4。两组镇痛方法、所用药物及浓度相同。观察两组镇痛药首剂量、起效时间 ,PCA次数 ,VAS评分 ,运动神经阻滞评分 ,第一、二产程时间 ,分娩方式 ,新生儿Apgar评分 ,产后 2h出血量等指标。结果VAS评分、运动神经阻滞程度、新生儿Apgar评分、产后 2h出血量两组比较 ,差异无显著性意义(均P >0 .0 5 ) ;其余项观察组均优于对照组 (均P <0 .0 5 )。结论L1～L2 间隙穿刺硬膜外镇痛分娩 ,有良好的镇痛效果 ,可缩短产程 ,提高自然分娩率。