DIGESTIVE ENDOSCOPY, Issue 2 2007
Miyako Niki
Background:, Endoscopic examination influences cardiovascular hemodynamics. Upper gastrointestinal examinations are currently performed with a thin endoscope. In the present study, respiratory and circulatory dynamics and autonomic nervous activity using a thin endoscope (XP260) or a standard endoscope (XQ240) were investigated. Methods:, The subjects were 25 healthy adults aged less than 60 years (middle-aged group) and 15 healthy adults aged 60 years or older (advanced-age group). Percutaneous oxygen saturation, tonometric blood pressure, heart rate, and autonomic nervous activity were evaluated before the examination. After the endoscopic procedure, a questionnaire survey regarding examination-related stress was conducted. Results:, In the questionnaire survey, the proportion of subjects who answered ,very stress free' in the thin endoscope group was significantly higher than that in the standard endoscope group. The low frequency power of blood pressure variability (LFBP), an indicator of sympathetic nervous activity, was significantly lower during the thin endoscopic procedure than during the standard endoscopic procedure. Moreover, the ratio of low frequency power to high frequency power of heart rate variability (LFRR/HFRR), an indicator of sympathetic nervous activity, was significantly lower during thin endoscopic procedure than during the standard endoscopic procedure. The maximum rates of change in the LFBP and HFRR powers in the advanced-age group using thin and standard endoscopic procedures were significantly lower than in the middle-aged group. Conclusions:, The findings, although not in cross-over study, suggest that a thin endoscope has a less marked influence on circulatory kinetics. Gastrointestinal endoscopic examinations using a thin endoscope might reduce complications related to endoscopic screening examinations in advanced-age subjects. [source]

Integrated local correlation: A new measure of local coherence in fMRI data

HUMAN BRAIN MAPPING, Issue 1 2009
Gopikrishna Deshpande
Abstract This article introduces the measure of integrated local correlation (ILC) for assessing local coherence in the brain using functional magnetic resonance imaging (fMRI) data and characterizes the measure in terms of reproducibility, the effect of physiological noise, and the dependence on image resolution. The coupling of local neuronal processes influences coherence in a voxel's neighborhood. ILC is defined, for each voxel, as the integration of its spatial correlation function. This integrated measure does not require the specification of a neighborhood and, as demonstrated by experimental data, is effectively independent of image resolution. Respiratory and cardiac fluctuations do not considerably alter the ILC value except in isolated areas in and surrounding large vessels. With resting-state fMRI data, ILC was demonstrated to be tissue-specific, higher in gray matter than white matter, and reproducible across consecutive runs in healthy individuals. Within the gray matter, ILC was found to be higher in the default mode network, particularly the posterior and anterior cingulate cortices. Comparing ILC maps obtained from resting state and continuous motor task data, we observed reduced local coherence in the default mode network during the task. Finally, we compared ILC and regional homogeneity by examining their ability to discriminate between gray and white matters in resting state data and found ILC to be more sensitive. Hum Brain Mapp 2009. © 2007 Wiley-Liss, Inc. [source]

Ivermectin Toxicity in 17 Collies

JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 1 2002
Kate Hopper
Ivermectin is widely used in veterinary medicine as an anthelminthic and generally has a wide margin of safety, but Collies are prone to ivermectin toxicity. Two groups of Collies were presented to the University of California Veterinary Medical Teaching Hospital (VMTH) with ivermectin toxicity. The medical records of the 2 groups of Collies were reviewed retrospectively. Group I comprised 5 adult Collies that received at least 400 ,g/kg ivermectin PO and were presented to the VMTH 3 hours after intoxication. These Collies showed marked clinical signs on presentation. Three of these dogs required mechanical ventilation and were euthanized for financial reasons; the remaining 2 dogs were comatose but recovered in 5,7 days. Group II was comprised of 12 adult Collies presented to the VMTH 2 days (n = 10) and 5 days (n = 2) after subcutaneous injection of 200,250 ,g/kg ivermectin. These animals showed greater variation in severity of illness among individuals; 5 animals progressed to stupor or coma, whereas 4 animals remained ambulatory. Most of these dogs' clinical signs deteriorated from the day of intoxication until approximately day 6, from which time they showed gradual but steady improvement. All of the Collies in this group survived, but it took 3 weeks for most of them to recover. Collies suffering from ivermectin toxicity can have a severe and prolonged clinical course requiring intensive nursing care. Respiratory, cardiovascular, and nutritional support may all be required. With appropriate care, however, the prognosis for complete recovery is good. [source]

Postoperative continuous intrathecal pain treatment in children after selective dorsal rhizotomy with bupivacaine and two different morphine doses

PEDIATRIC ANESTHESIA, Issue 4 2006
KARIN HESSELGARD RN
Summary Background:, Children undergoing selective dorsal rhizotomy (SDR) experience severe pain postoperatively; a pain related to both the extensive surgical exposure with multilevel laminectomy and nerve root manipulation. We sought to define an optimal dose of continuous intrathecal (IT) morphine and bupivacaine to treat this severe pain. The aim of this study was to compare two different concentrations of morphine in a fixed dose of bupivacaine with regard to the analgesic effect and survey if they differed in side effects. Methods:, Twenty-six children, aged 2.7,7.4 years undergoing SDR were included in this study. Postoperatively 11 children received a continuous infusion of morphine 0.4 ,g.kg,1.h,1 and bupivacaine 40 ,g.kg,1.h,1 (low-dose group) and 15, a continuous infusion of morphine 0.6 ,g.kg,1.h,1 and bupivacaine 40 ,g.kg,1.h,1 (high-dose group). The Behavioral Observational Pain Scale (BOPS) was used to evaluate pain. Results:, Better pain relief was obtained in the high-dose group seen in lower BOPS score compared with the low-dose group [P = 0.03, Fisher's permutation test and P = 0.06 Wilcoxon,Mann,Whitney (WMW) test]. The low-dose group received seven times as much ketobemidone 0.43 ± 0.54 mg.kg,1 48 h,1 compared with 0.06 ± 0.09 mg.kg,1 48 h,1 in the high-dose group (P = 0.0005 Fisher's permutation test, P = 0.0017 WMW test). There was no statistical difference in pruritus and postoperative nausea and vomiting between the groups. Respiratory and hemodynamic depression was not found. Conclusion:, This study shows that, compared with low-dose, the higher dose of continuous IT morphine combined with bupivacaine, significantly reduce pain score and postoperative intravenous analgesic requirements without increasing adverse effects. [source]

Flow Visualization Study of a Novel Respiratory Assist Catheter

ARTIFICIAL ORGANS, Issue 6 2009
Stephanus G. Budilarto
Abstract Respiratory assist using intravenous catheters may be a potential therapy for patients with acute and acute-on-chronic lung failure. An important design constraint is respiratory catheter size, and new strategies are needed that enable size reduction while maintaining adequate gas exchange. Our group is currently developing a percutaneous respiratory assist catheter (PRAC) that uses a rotating bundle of hollow fiber membranes to enhance CO2 removal and O2 supply with increasing bundle rotation rate. In this study, particle image velocimetry (PIV) was used to analyze the fluid flow patterns and velocity fields surrounding the rotating fiber bundle of the PRAC. The goal of the study was to assess the rotational flow patterns within the context of the gas exchange enhancement that occurs with increasing fiber bundle rotation. A PRAC prototype was placed in a 1-in. internal diameter test section of an in vitro flow loop designed specifically for PIV studies. The rotation rate of the PRAC was varied between 500 and 7000 rpm, and PIV was used to determine the velocity fields in the primary (r -,) and secondary (r - z) flow planes. The secondary flow exhibited time-varying and incoherent vortices that were consistent with the classical Taylor vortices expected for Taylor numbers (Ta) corresponding to the rotation speeds studied (2200 < Ta < 31 000). In the primary flow, the tangential velocity exhibited boundary layers of less than ½ mm adjacent to the fiber bundle and vessel wall. The estimated shear stress associated with the Taylor vortices was approximately 11 dyne/cm2 at 7000 rpm and was over 10 times smaller than the shear stress in the primary flow boundary layers. [source]

Combination of Inhaled Nitric Oxide Therapy and Inverse Ratio Ventilation in Patients with Sepsis-Associated Acute Respiratory Distress Syndrome

ARTIFICIAL ORGANS, Issue 11 2000
Kazufumi Okamoto
Abstract: Inverse ratio ventilation (IRV) is a ventilatory technique that uses an inspiratory to expiratory ratio (I:E) greater than 1:1. We studied the effects of mechanical ventilation with an I:E of 1:3, 1:1, and 2:1 on arterial oxygenation in 10 patients with sepsis-associated acute respiratory distress syndrome (ARDS). At each I:E, patients received 0 and 4 ppm of inhaled nitric oxide (INO) in random order for 30 min. Respiratory and cardiovascular parameters were measured. Of the 10 patients studied, 7 responded to IRV and 3 did not. An increase in the I:E and the addition of INO significantly improved arterial oxygenation in the responders (p < 0.0001 and p < 0.006, respectively). The combination of an increase in the I:E and INO had an additive effect on arterial oxygenation. The combined use of IRV and INO is a more effective method of avoiding hypoxemia than either INO or IRV alone. [source]

Assessment of Acute Respiratory and Cardiovascular Toxicity of Casiopeinas in Anaesthetized Dogs

BASIC AND CLINICAL PHARMACOLOGY & TOXICOLOGY, Issue 3 2007
Marco Leal-García
Considering therapeutic dose ranges from 3.6 to 18 mg/m2 for the former and 1.2 to 3 mg/m2 for the latter, true therapeutic margin of safety varies from 4.7 to 23.6 mg/m2 and from 20 to 50 mg/m2, respectively. For both casiopeinas intravenous administration of the corresponding lethal dose in 100 ml of 5% dextrose solution in a time period of 30 min. induced death after an almost uneventful latency time period of 30,50 min. Then, after an apparently sudden onset, changes in blood gases indicated respiratory distress (PO2 from 82.5% to 26.5% for casiopeina III-ia and from 88.6% to 37.5% for casiopeina IIgly; end-tidal CO2 from 38 to 8.1 mmHg for the first and from 35.1 to 11.2 mmHg for the second, this was almost simultaneously confirmed by the onset of tachypnoea (from 16 to almost 60 breaths/min. for both casiopeinas) and by a drop in arterial blood pressure (from 117 to 51 mmHg for casiopeina III-ia and from 108 to 49 mmHg for casiopeina IIgly). Reflex tachycardia occurs at the beginning of intravenous administration followed by bradycardia a few minutes later (from 158 to 63 beats/min. for casiopeina III-ia and from 148 to 56 beats/min. for casiopeina IIgly). Finally, cardiac arrest occurred no later than 25 min. towards the end of these events lung oedema appeared as fluid dripping from the endotracheal tube. Death occurred in a mean of 15 ± 5 min. S.D. from the beginning of the end of the latency period. For both casiopeina's data allow the speculation that lung oedema is caused by a joined toxicity to the lung capillary bed, and particularly to the heart. Carvedilol premedication for 8 days delayed the outcome of lung oedema by approximately 8 hr but could not prevent it. [source]

Nonrenal disease activity following mycophenolate mofetil or intravenous cyclophosphamide as induction treatment for lupus nephritis: Findings in a multicenter, prospective, randomized, open-label, parallel-group clinical trial,

ARTHRITIS & RHEUMATISM, Issue 1 2010
Ellen M. Ginzler
Objective To assess the effect of mycophenolate mofetil compared with intravenous pulses of cyclophosphamide on the nonrenal manifestations of lupus nephritis. Methods Patients with active lupus nephritis (renal biopsy class III, IV, or V) were recruited for the study (n = 370) and treated with mycophenolate mofetil (target dosage 3 gm/day) or intravenous cyclophosphamide (0.5,1.0 gm/m2/month), plus tapered prednisone, for 24 weeks. Nonrenal outcomes were determined using measures of whole body disease activity, including the British Isles Lupus Assessment Group (BILAG) disease activity index, the Safety of Estrogens in Lupus Erythematosus: National Assessment (SELENA) version of the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), and immunologic variables. Results Both treatments were effective on whole body disease activity in the systems examined, as indicated by changes in the classic BILAG index. With either treatment, remission was induced, notably in the mucocutaneous, musculoskeletal, cardiovascular/respiratory, and vasculitis systems, and flares were rare, as measured by the SELENA,SLEDAI. Levels of complement C3, C4, and CH50 and titers of anti,double-stranded DNA antibodies were normalized after treatment with either mycophenolate mofetil or intravenous cyclophosphamide. Conclusion In addition to the efficacy of both treatments on the renal system, this analysis showed that remission could also be induced in other systems. There was no clear difference in efficacy between mycophenolate mofetil and intravenous cyclophosphamide in ameliorating either the renal or nonrenal manifestations. Mycophenolate mofetil is, therefore, a suitable alternative to cyclophosphamide for the treatment of renal and nonrenal disease manifestations in patients with biopsy-proven lupus nephritis. [source]

Recurrent abdominal pain, food allergy and endoscopy

ACTA PAEDIATRICA, Issue 1 2001
Steffen Husby
Gastrointestinal food allergy, a well-recognized clinical entity, has a wide spectrum of clinical features, including cutaneous, respiratory and gastrointestinal symptoms and objective abnormalities. The gastrointestinal alterations in food allergy have been described throughout the gastrointestinal tract. Recurrent abdominal pain (RAP) is a common complaint in school-age children. The findings among children with RAP of an underlying food allergy associated with mucosal pathology of the foregut may support a causal relationship between food allergy and RAP. Further studies are needed to elucidate whether well-documented food allergy (based on double-blind placebo-controlled food challenges) is a major cause of RAP. [source]

Abnormalities in cardiac and respiratory function observed during seizures in childhood

DEVELOPMENTAL MEDICINE & CHILD NEUROLOGY, Issue 1 2005
Mary E O'Regan MRCP MRCPCH
The aim of this study was to observe any changes in cardiac and respiratory function that occur during seizures. Thirty-seven children (20 males, 17 females; median age 7y 6mo, range 1y 6mo to 15y 6mo) were studied. We recorded electroencephalograms, respiratory rate, heart rate, electrocardiograms, blood pressure, oxygen saturation, heart rate variability (time domain analysis), and cardiac vagal tone. A respiratory pause was defined as an interruption in respiration lasting more than 3s but less than 15s. Apnoea was defined as absence of respiration for more than 15s. Tachypnoea was defined as a 10% increase in respiratory rate from the pre-ictal baseline. Bradypnoea was defined as a 10% decrease in respiratory rate from the pre-ictal baseline. Significant hypoxia was defined as a saturation of less than 85%. A significant change in heart rate was taken as a 10% increase or decrease below the baseline rate. Data were obtained from 101 seizures: 40 focal seizures, 21 generalized seizures, and 40 absences. Focal seizures were frequently associated with significant respiratory abnormalities, tachypnoea in 56%, apnoea in 30%, frequent respiratory pauses in 70%, and significant hypoxaemia in 40%. The changes seen in respiratory rate were statistically significant. Changes in cardiac parameters, an increase or decrease in heart rate, were observed in only 26% of focal seizures and 48% of generalized seizures. We conclude that seizure activity can disrupt normal physiological regulation and control of respiratory and cardiac activity. [source]

Respiratory units of motor production and song imitation in the zebra finch

DEVELOPMENTAL NEUROBIOLOGY, Issue 2 2002
Michele Franz
Abstract Juvenile male zebra finches (Taeniopygia guttata) learn a stereotyped song by imitating sounds from adult male tutors. Their song is composed of a series of syllables, which are separated by silent periods. How acoustic units of song are translated into respiratory and syringeal motor gestures during the song learning process is not well understood. To learn about the respiratory contribution to the imitation process, we recorded air sac pressure in 38 male zebra finches and compared the acoustic structures and air sac pressure patterns of similar syllables qualitatively and quantitatively. Acoustic syllables correspond to expiratory pressure pulses and most often (74%) entire syllables are copied using similar air sac pressure patterns. Even notes placed within different syllables are generated with similar air sac pressure patterns when only segments of syllables are copied (9%). A few of the similar syllables (17%) are generated with a modified pressure pattern, typically involving addition or deletion of an inspiration. The high similarity of pressure patterns for like syllables indicates that generation of particular sounds is constrained to a narrow range of air sac pressure conditions. Following presentation of stroboscope flashes, song was typically interrupted at the end of an expiratory pressure pulse, confirming that expirations and, therefore, syllables are the smallest unit of motor production of song. Silent periods, which separate syllables acoustically, are generated by switching from expiration to inspiration. Switching between respiratory phases, therefore, appears to play a dominant role in organizing the stereotyped motor program for song production. © 2002 Wiley Periodicals, Inc. J Neurobiol 51: 129,141, 2002 [source]

PROCEED: Prospective Obesity Cohort of Economic Evaluation and Determinants: baseline health and healthcare utilization of the US sample,

DIABETES OBESITY & METABOLISM, Issue 12 2008
A. M. Wolf
Aim:, To summarize baseline characteristics, health conditions, resource utilization and resource cost for the US population for the 90-day period preceding enrolment, stratified by body mass index (BMI) and the presence of abdominal obesity (AO). Methods:, PROCEED (Prospective Obesity Cohort of Economic Evaluation and Determinants) is a multinational, prospective cohort of control (BMI 20,24.0 kg/m2), overweight (BMI 25,29.9 kg/m2) and obese (BMI , 30 kg/m2) subjects with AO and without AO [non-abdominal obesity (NAO)], defined by waist circumference (WC) >102 and 88 cm for males and females, respectively. Subjects were recruited from an Internet consumer panel. Outcomes were self-reported online. Self-reported anthropometric data were validated. Prevalence of conditions and utilization is presented by BMI class and AO within BMI class. Differences in prevalence and means were evaluated. Results:, A total of 1067 overweight [n = 474 (NAO: n = 254 and AO: n = 220)] and obese [n = 493 (NAO: n = 39 and AO: n = 454)] subjects and 100 controls were recruited. Self-reported weight (r = 0.92) and WC (r = 0.87) were correlated with measured assessments. Prevalence of symptoms was significantly higher in groups with higher BMI, as were hypertension (p < 0.0001), diabetes (p < 0.0001) and sleep apnoea (p < 0.0001). Metabolic risk factors increased with the BMI class. Among the overweight class, subjects with AO had significantly more reported respiratory, heart, nervous, skin and reproductive system symptoms. Overweight subjects with AO reported a significantly higher prevalence of diabetes (13%) compared with overweight subjects with NAO (7%, p = 0.04). Mean healthcare cost was significantly higher in the higher BMI classes [control ($456 ± 937) vs. overweight ($1084 ± 3531) and obese ($1186 ± 2808) (p < 0.0001)]. Conclusion:, An increasing gradient of symptoms, medical conditions, metabolic risk factors and healthcare utilization among those with a greater degree of obesity was observed. The independent effect of AO on health and healthcare utilization deserves further study with a larger sample size. [source]

EXAMINATION OF RESPIRATORY AND CIRCULATORY DYNAMICS DURING EXAMINATION USING A THIN GASTROINTESTINAL ENDOSCOPE IN ADVANCED-AGE SUBJECTS

Gastroesophageal reflux disease and non-small cell lung cancer.

DISEASES OF THE ESOPHAGUS, Issue 5 2008
Results of a pilot study
SUMMARY., The sharp rise in the frequency of adenocarcinoma and relative decrease of squamous cell carcinoma of the respiratory and digestive systems, raises suspicion of a common element in their carcinogenetic cascade, which could result in similar trends in cell,type distribution changes of esophageal and lung cancers. The possible role of chemical irritation caused by gastroesophageal reflux disease (GERD) in non-small cell lung cancer (NSCLC) patients was investigated. There was no significant difference between the adenocarcinoma and the squamous cell carcinoma groups, neither in the composite DeMeester scores nor in any of the separate parameters of the complex score investigated. However, the ratio of detected gastroesophageal reflux cases was considerably higher than in the average population. This factor may be one element of a multifactorial cancer promotion. [source]

Review article: Emergency department implications of the TASER

EMERGENCY MEDICINE AUSTRALASIA, Issue 4 2009
Megan Robb
Abstract The TASER is a conducted electricity device currently being introduced to the Australian and New Zealand police forces as an alternative to firearms in dealing with violent and dangerous individuals. It incapacitates the subject by delivering rapid pulses of electricity causing involuntary muscle contraction and pain. The use of this device might lead to cardiovascular, respiratory, biochemical, obstetric, ocular and traumatic sequelae. This article will summarize the current literature and propose assessment and management recommendations to guide emergency physicians who will be required to review these patients. [source]

Agreement between bicarbonate measured on arterial and venous blood gases

EMERGENCY MEDICINE AUSTRALASIA, Issue 5-6 2004
Anne-Maree Kelly
Abstract Objective:, This study aims to determine the extent of agreement between venous and arterial bicarbonate for a group of emergency department patients with respiratory or metabolic illness requiring blood gas analysis as part of their evaluation. Methods:, This prospective study of patients who were deemed by their treating doctor to require an arterial blood gas analysis to determine their ventilatory or acid-base status, compared bicarbonate on an arterial and a venous sample taken as close to simultaneously as possible. Data were analysed using bias (Bland-Altman) methods. Subgroup analyses were performed for the metabolic, respiratory, chronic obstructive airways disease and acidotic subgroups. Results:, Two hundred and forty-six patients were entered into the study; 195 with acute respiratory disease and 51 with suspected metabolic derangement. The values of bicarbonate on arterial and venous samples showed close agreement with an average difference between the samples of 1.20 mmol/L (95% limits of agreement being ,2.73 to +5.13 mmol/L). Similar agreement was found for all subgroups. Conclusion:, Venous bicarbonate estimation shows a high level of agreement with the arterial value, with acceptably narrow 95% limits of agreement. These results suggest that venous bicarbonate estimation may be an acceptable substitute for arterial measurement. [source]

The meta-analysis of the Italian studies on short-term effects of air pollution (MISA): old and new issues on the interpretation of the statistical evidences

ENVIRONMETRICS, Issue 3 2007
Pierantonio Bellini
Abstract The second meta-analysis of the Italian studies on short-term health effects of air pollution, known as MISA-2, was based on daily time series of indicators of both pollution and of health outcomes. It covered 15 cities during 1996,2002 for a total population of approximately nine millions. Health outcomes included mortality for natural causes, for respiratory diseases and for cardiovascular conditions, as well as hospital admissions for respiratory, cardiac and cerebrovascular diseases. Pollutants considered in univariate analyses were sulphur dioxide (SO2), nitrogen oxide (NO2), carbon monoxide (CO), suspended particulate matter (SPM) measuring less than 10,µm diameter (PM10) and ozone (O3, limited to the summer period). Results, including risk estimates, have been largely confirmatory of findings obtained in previous large meta-analytic studies carried out in North America and in Europe. A full report in Italian is available. The present contribution summarises the results of MISA-2 and addresses three major issues regarding their interpretation: robustness of the causal inferential process, the role of specific air pollutants and the reliability of risk estimates. The former issue is stressed according to Bradford Hill's criteria and the conclusion is reached that at least for the association of air pollution with an increase in mortality the evidence for causality is strong. Assessing the role of each air pollutant is problematic: there is some evidence that the effects of PM10 are partly confounded by other pollutants, but PM10 may not be the best indicator of the role of air SPM (routine measures of PM2.5 have not been introduced in Italy). As for risk estimates, the per cent increase in risk of mortality for unit increase in PM10 concentration, measured in MISA-2, is remarkably similar to estimates in other studies and there is indication for linearity of the dose,response relationship. Copyright © 2007 John Wiley & Sons, Ltd. [source]

Febrile infection,related epilepsy syndrome (FIRES): A nonencephalitic encephalopathy in childhood

EPILEPSIA, Issue 7 2010
Andreas Van Baalen
Summary Encephalitis is generally presumed, even when seizures follow banal febrile infection, and pathogen detection in cerebrospinal fluid fails. This retrospective multicenter case series reports on 22 previously healthy children aged 3,15 years (median 6.5 years) with prolonged or recurrent seizures occurring 2,14 days (median 5 days) after fever onset (19 children with respiratory or nonspecific infections). Cerebrospinal fluid studies revealed 2,42 cells/,l (median 5 cells/,l) and no pathogens. Electroencephalography showed diffuse slowing or multifocal discharges. Neuroimaging demonstrated normal findings in 10 children. Brain biopsies were performed in seven children showing gliosis but no inflammation. Anesthetic barbiturates were used in 14 children with refractory status epilepticus, and immunotherapy in 9. Two children died, eight remained in a state of impaired consciousness, eight developed therapy-refractory epilepsies, two had behavioral disturbances, and two recovered. The lack of evidence for encephalitis suggests another infection-related pathogenesis of this disastrous epileptic encephalopathy. Therefore, we propose the term "febrile infection,related epilepsy syndrome" (FIRES). [source]

Intensive care unit management of patients with status epilepticus

EPILEPSIA, Issue 2007
Thomas P. Bleck
Summary The intensive care unit management of status epilepticus focuses on patients who are refractory to initial treatment, who have an underlying condition that require critical care management, or who experience respiratory or cardiovascular complications of their therapies. The available data suggest that failure of a first-line anticonvulsant agent to terminate status should lead to the use of a definitive therapy in general anesthetic doses. Midazolam, propofol, and phenobarbital have been used most frequently; the place of newer agents (e.g., valproate, levetiracetam, or topiramate) remains to be determined. [source]

Risk Factors in Sudden Death in Epilepsy (SUDEP): The Quest for Mechanisms

EPILEPSIA, Issue 5 2007
Lina Nashef
Summary:, People with epilepsy may die suddenly and unexpectedly without a structural pathological cause. Most SUDEP cases are likely to be related to seizures. SUDEP incidence varies and is <1:1,000 person-years among prevalent cases in the community and ,1:250 person years in specialist centres. Case,control studies identified certain risk factors, some potentially amenable to manipulation, including uncontrolled convulsive seizures and factors relating to treatment and supervision. Both respiratory and cardiac mechanisms are important. The apparent protective effect of lay supervision supports an important role for respiratory factors, in part amenable to intervention by simple measures. Whereas malignant tachyarrhythmias are rare during seizures, sinus bradycardia/arrest, although infrequent, is well documented. Both types of arrhythmias can have a genetic basis. This article reviews SUDEP and explores the potential of coexisting liability to cardiac arrhythmias as a contributory factor, while acknowledging that at present, bridging evidence between cardiac inherited gene determinants and SUDEP is lacking. [source]

M cells and associated lymphoid tissue of the equine nasopharyngeal tonsil

EQUINE VETERINARY JOURNAL, Issue 3 2001
P. KUMAR
Summary The aim of this study was to characterise the morphological and histochemical features of equine nasopharyngeal tonsillar tissue. Nasal and oropharyngeal tonsillar tissue has been described as the gatekeeper to mucosal immunity because of its strategic location at the entrance to the respiratory and alimentary tracts. A combination of light, scanning and transmission electron microscopy has revealed the presence of follicle-associated epithelium (FAE) overlying lymphoid tissue of the equine nasopharyngeal tonsil caudal to the pharyngeal opening of the guttural pouch. Membranous microvillus (M) cells were identified in the FAE on the basis of short microvilli, an intimate association with lymphocytes, cytoplasmic vimentin filaments and epitopes on the apical surface reactive with lectin GS I-B4 specific for ,-linked galactose. CD4-positive lymphocytes were scattered throughout the lamina propria mucosae as well as forming dense aggregates in the subepithelial part. The central follicular area was heavily populated with B lymphocytes and the dome and parafollicular areas contained both CD4- and CD8-positive lymphocytes. CD8-positive lymphocytes were also present in the epithelium and, together with B lymphocytes, in small numbers in the lamina propria mucosae. These observations indicate that the nasopharyngeal tonsil is potentially an important mucosal immune induction site in the horse and an appropriate target forintranasally administered vaccines. [source]

Impaired aortic elastic properties in patients with systemic sarcoidosis

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 2 2008
I. Moyssakis
Abstract Background, Systemic sarcoidosis (Sar) is a granulomatous disorder involving multiple organs. Widespread vascular involvement and microangiopathy are common in patients with Sar. In addition, subclinical cardiac involvement is increasingly recognized in patients with Sar. However, data on the effect of Sar on the elastic properties of the arteries and myocardial performance are limited. In this study we looked for differences in aortic distensibility (AoD) which is an index of aortic elasticity, and myocardial performance of the ventricles, between patients with Sar and healthy subjects. In addition, we examined potential associations between AoD and clinical, respiratory and echocardiographic findings in patients with Sar. Materials and methods, A total of 83 consecutive patients (26 male/57 female, mean age 51·1 ± 13·3 years) with Sar, without cardiac symptoms, were included. All patients underwent echocardiographic and respiratory evaluation including lung function tests. Additionally, 83 age- and sex-matched healthy subjects served as controls. AoD was determined non-invasively by ultrasonography. Results, AoD was lower in the Sar compared to the control group (2·29 ± 0·26 vs. 2·45 ± 0·20 ·10,6 cm2· dyn,1, P < 0·01), while left ventricular mass (LVM) was higher in the Sar group (221·3 ± 50·2 vs. 195·6 ± 31·3 g, P = 0·007). Furthermore, myocardial performance of both ventricles was impaired in the Sar group. Multivariate linear regression analysis in the total sample population demonstrated a significant and independent inverse relationship between AoD and the presence of Sar (P < 0·001). The same analysis in the Sar patients showed that AoD was associated significantly and independently with the stage of Sar, age, systolic blood pressure, LVM and myocardial performance of both ventricles. No significant relationship was found between AoD and disease duration, pulmonary artery pressure or lung function tests. Conclusions, Presence and severity of Sar are associated with reduced aortic distensibility, irrespective of the disease duration, pulmonary artery pressure and lung function. In addition, patients with Sar have increased LVM and impaired myocardial performance. [source]

Gender, age and menopause effects on the prevalence and the characteristics of obstructive sleep apnea in obesity

EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 12 2003
O. Resta
Abstract Background, In the 1970s and 80s it was believed that obstructive sleep apnea (OSA) was primarily a disease of men. The present study was addressed to evaluate the effect of gender and menopause on the prevalence and the characteristics of OSA and on anthropometric, clinical, respiratory and polysomnographic data in a population of obese individuals. Patients and methods, A total of 230 obese subjects (BMI , 30 kg m,2), 148 women and 82 men, aged 16,75 years, were recruited and evaluated for general and anthropometric parameters, respiratory function, sleep-related symptoms and sleep disorders of breathing. Results, Respiratory disturbance index (RDI) and the prevalence of OSA were lower in women than in men (P < 0·001 and P < 0·001, respectively). Among subjects < 55 years, neck circumference, percentage of predicted normal neck circumference (PPNC), waist-to-hip ratio (WHR), PaCO2, RDI and the prevalence of OSA were lower in female subjects (P = 0·05, P < 0·05, P < 0·001, P < 0·01 and P < 0·01, respectively). BMI, neck circumference, PPNC, WHR, RDI and the prevalence of OSA were higher in postmenopausal compared with premenopausal women (P < 0·01, P < 0·01, P < 0·01, P < 0·01 and P < 0·01, respectively). Conclusions, Our study demonstrates that (i) the male dominance regarding the prevalence and the severity of OSA disappears in men older than 55 years, and (ii) menopause seems to play a pivotal role in modulating both the presence and the degree of sleep disorder. [source]

Expression of the Artemia trachealess gene in the salt gland and epipod

EVOLUTION AND DEVELOPMENT, Issue 5 2002
Brian Mitchell
SUMMARY The Drosophila trachealess gene encodes a basic-helix-loop-helix-PAS transcription factor that controls the formation of the trachea and salivary duct. An ortholog of trachealess was identified in the brine shrimp, Artemia franciscana, and was shown to be highly conserved by sequence identity. Expression of Artemia trachealess was observed at two sites during development: the naupliar salt gland and the juvenile thoracic epipod. These two organs function at their respective times of development in osmoregulation, an important aspect of brine shrimp physiology. This extends the range of putative functions of trachealess to include formation of osmoregulatory, respiratory, and ductile organs. [source]

Interaction between genioglossus and diaphragm responses to transcranial magnetic stimulation in awake humans

EXPERIMENTAL PHYSIOLOGY, Issue 4 2007
Wei Wang
The modulation of activity of the upper airway dilator and respiratory muscles plays a key role in the regulation of ventilation, but little is known about the link between their neuromuscular activation processes in vivo. This study investigated genioglossus and diaphragm responses to transcranial magnetic stimulation applied in different facilitatory conditions. The amplitude and latency of motor-evoked potential responses and the stimulation intensity threshold leading to a motor response (motor threshold) were recorded with stimulation applied at the vertex and anterolateral area in 13 awake normal subjects. Stimuli were applied during inspiration with and without resistance, during expiration with and without maximal tongue protrusion and during deep inspiration. In each stimulation location and condition, no diaphragmatic response was obtained without previous genioglossus activity (diaphragmatic and genioglossus responses latencies during expiration: 18.1 ± 2.9 and 6.3 ± 2.6 ms, respectively, mean ±s.d., P < 0.01). Genioglossus motor-evoked potential amplitude, latency and motor threshold were significantly modified with tongue protrusion with a maximal effect observed for stimulation in the anterolateral area. Deep inspiration was associated with a significant facilitatory effect on both genioglossus and diaphragm motor responses. The facilitatory effects of respiratory and non-respiratory manoeuvres were also observed during focal stimulation where isolated genioglossus responses were observed. Genioglossus and diaphragm differed in their motor threshold both at baseline and following facilitatory manoeuvres. Conclusions: (1) transcranial magnetic stimulation-induced genioglossus response systematically precedes that of diaphragm; (2) this sequence of activation is not modified by respiratory and non-respiratory manoeuvres; and (3) the genioglossus and diaphragm are differently influenced by these manoeuvres in terms of latency of the motor response and of motor threshold. [source]

Clenbuterol antagonizes glucocorticoid-induced atrophy and fibre type transformation in mice

EXPERIMENTAL PHYSIOLOGY, Issue 1 2004
Maria Antonietta Pellegrino
Beta-agonists and glucocorticoids are frequently coprescribed for chronic asthma treatment. In this study the effects of 4 week treatment with beta-agonist clenbuterol (CL) and glucocorticoid dexamethasone (DEX) on respiratory (diaphragm and parasternal) and limb (soleus and tibialis) muscles of the mouse were studied. Myosin heavy chain (MHC) distribution, fibres cross sectional area (CSA), glycolytic (phosphofructokinase, PFK; lactate dehydrogenase, LDH) and oxidative enzyme (citrate synthase, CS; cytochrome oxidase, COX) activities were determined. Muscle samples were obtained from four groups of adult C57/B16 mice: (1) Control (2) Mice receiving CL (CL, 1.5 mg kg,1 day,1 in drinking water) (3) Mice receiving DEX (DEX, 5.7 mg kg,1 day,1s.c.) (4) Mice receiving both treatments (DEX + CL). As a general rule, CL and DEX showed opposite effects on CSA, MHC distribution, glycolytic and mitochondrial enzyme activities: CL alone stimulated a slow-to-fast transition of MHCs, an increase of PFK and LDH and an increase of muscle weight and fibre CSA; DEX produced an opposite (fast-to-slow transition) change of MHC distribution, a decrease of muscle weight and fibre CSA and in some case an increase of CS. The response varied from muscle to muscle with mixed muscles, as soleus and diaphragm, being more responsive than fast muscles, as tibialis and parasternal. In combined treatments (DEX + CL), the changes induced by DEX or CL alone were generally minimized: in soleus, however, the effects of CL predominated over those of DEX, whereas in diaphragm DEX prevailed over CL. Taken together the results suggest that CL might counteract the unwanted effects on skeletal muscles of chronic treatment with glucocorticoids. [source]

Growth kinetics of microorganisms isolated from Alaskan soil and permafrost in solid media frozen down to ,35°C

FEMS MICROBIOLOGY ECOLOGY, Issue 2 2007
Nicolai S. Panikov
Abstract We developed a procedure to culture microorganisms below freezing point on solid media (cellulose powder or plastic film) with ethanol as the sole carbon source without using artificial antifreezes. Enrichment from soil and permafrost obtained on such frozen solid media contained mainly fungi, and further purification resulted in isolation of basidiomycetous yeasts of the genera Mrakia and Leucosporidium as well as ascomycetous fungi of the genus Geomyces. Contrary to solid frozen media, the enrichment of liquid nutrient solutions at 0°C or supercooled solutions stabilized by glycerol at ,1 to ,5°C led to the isolation of bacteria representing the genera Polaromonas, Pseudomonas and Arthrobacter. The growth of fungi on ethanol,microcrystalline cellulose media at ,8°C was exponential with generation times of 4.6,34 days, while bacteria displayed a linear or progressively declining curvilinear dynamic. At ,17 to ,0°C the growth of isolates and entire soil community on 14C-ethanol was continuous and characterized by yields of 0.27,0.52 g cell C (g of C-substrate),1, similar to growth above the freezing point. The ,state of maintenance,' implying measurable catabolic activity of non-growing cells, was not confirmed. Below ,18 to ,35°C, the isolated organisms were able to grow only transiently for 3 weeks after cooling with measurable respiratory and biosynthetic (14CO2 uptake) activity. Then metabolic activity declined to zero, and microorganisms entered a state of reversible dormancy. [source]

Timing of spawning and glochidial release in Scottish freshwater pearl mussel (Margaritifera margaritifera) populations

FRESHWATER BIOLOGY, Issue 12 2003
Lee C. Hastie
Summary 1. The timing of reproduction was investigated in six Scottish freshwater pearl mussel populations from 1993 to 2002. Gravid females were examined and the release of mussel larvae (glochidia) was monitored. 2. Annual spawning (oviposition) and spat (glochidial release) events occurred during June to July and June to September, respectively. 3. Between-river differences in timing seem to be related to water temperature. Mussels in the warmest rivers tend to spawn and spat first, and vice-versa. 4. Thermal variations also seem to influence the timing of reproduction within rivers, which can be delayed by several weeks during cold years. At least 3000°-days occur between annual episodes of glochidial release. 5. The timing of spawning is determined gradually, probably by a thermal summation effect. 6. The release stage occurs as a sudden, synchronised event, with most of the glochidia spat over 1,2 days, indicating that it is triggered by an environmental cue. Sudden changes in water temperature and/or river level often result in spats, and the underlying mechanism may be respiratory. [source]

Is Headache Related to Asthma, Hay Fever, and Chronic Bronchitis?

HEADACHE, Issue 2 2007
The Head-HUNT Study
Objectives.,To examine the relationship between migraine and nonmigrainous headache and asthma, hay fever, and chronic bronchitis in a large cross-sectional population-based study. Background.,Associations between prevalence of migraine and asthma or allergy have been demonstrated in clinic-based and epidemiologic studies whereas studies on chronic bronchitis are scarce. Methods.,A total of 51,383 subjects completed a headache questionnaire and constituted the "Head-HUNT" Study. Of these 50,401 (98.1%) answered the questions about asthma and chronic bronchitis, and 47,029 (91.5%) answered the question about hay fever. Associations were assessed in multivariate analyses, estimating prevalence odds ratios (ORs) with 95% confidence intervals (CI). Results.,Both migraine and nonmigrainous headache were approximately 1.5 times more likely among those with current asthma, asthma related symptoms, hay fever, and chronic bronchitis than those without. The association increased with increasing headache frequency. Conclusions.,This large questionnaire-based study confirms that migraine and other headaches are associated with respiratory and allergic disorders. The magnitude of the association between headache and asthma, hay fever, and chronic bronchitis tended to be in the same order. Headache frequency seems to have a greater impact on the association with respiratory or allergic conditions than headache diagnoses. Whether it is a causal relationship is uncertain, but the results underline the importance of considering comorbid disorders among patients with frequent headache. [source]

Indoor residential chemical emissions as risk factors for respiratory and allergic effects in children: a review

INDOOR AIR, Issue 4 2007
M. J. Mendell
First page of article [source]