Science.gov

Sample records for parturient paresis

  1. Effect of intravenous calcium borogluconate and sodium phosphate in cows with parturient paresis.

    PubMed

    Braun, U; Zulliger, P; Liesegang, A; Bleul, U; Hässig, M

    2009-03-07

    Thirty cows with parturient paresis were divided into three groups of 10. All the cows were given 500 ml of a 40 per cent calcium borogluconate solution intravenously over a period of 10 minutes, and 20 were also given 500 ml of a 10 per cent solution of sodium phosphate intravenously; in 10 of the cows this solution was administered over a period of 10 minutes immediately after the calcium borogluconate solution, and in the other 10 cows 200 ml of the solution was administered rapidly and the remaining 300 ml was added to 10 litres of sodium chloride and glucose solution and infused slowly over six hours. There were no significant differences between the groups with respect to the outcome of the treatments; six or seven of the cows in each group stood within eight hours of the treatment. There were no significant differences between the changes in serum calcium concentrations among the groups. The mean concentrations of inorganic phosphorus in the groups given sodium phosphate were increased above the normal range initially, but after eight hours there were no significant differences between the groups in terms of the numbers of cows that were hypophosphataemic. There were no significant differences between the three groups with respect to changes after treatment in the serum concentrations of magnesium or parathyroid hormone.

  2. Hot topic: prevention of parturient paresis and subclinical hypocalcemia in dairy cows by zeolite A administration in the dry period.

    PubMed

    Thilsing-Hansen, T; Jørgensen, R J

    2001-03-01

    To test the effects of a zeolite feed supplement on parturient calcium status and milk fever, two groups of dry cows were treated with either 1 kg of zeolite/d or none for 4 wk prepartum. At calving and d 1 and 2 after calving all cows were given 250 g of calcium carbonate as a drench, and a blood sample was taken. Serum calcium analysis revealed a greater calcium concentration in zeolite-treated cows. While three control cows contracted milk fever, necessitating intravenous calcium therapy, and six out of eight control cows experienced serum calcium levels below 2 mmol/L in one or more samples taken, none of the zeolite-treated cows contracted milk fever or experienced subclinical hypocalcemia.

  3. General paresis

    MedlinePlus

    ... due to damage to the brain from untreated syphilis. Causes General paresis is one form of neurosyphilis . ... usually occurs in people who have had untreated syphilis for many years. Syphilis is bacterial infection that ...

  4. Diagnosing limb paresis and paralysis in sheep

    PubMed Central

    Crilly, James Patrick; Rzechorzek, Nina; Scott, Philip

    2015-01-01

    Paresis and paralysis are uncommon problems in sheep but are likely to prompt farmers to seek veterinary advice. A thorough and logical approach can aid in determining the cause of the problem and highlighting the benefit of veterinary involvement. While this may not necessarily alter the prognosis for an individual animal, it can help in formulating preventive measures and avoid the costs – both in economic and in welfare terms – of misdirected treatment. Distinguishing between central and peripheral lesions is most important, as the relative prognoses are markedly different, and this can often be achieved with minimal equipment. This article describes an approach to performing a neurological examination of the ovine trunk and limbs, the ancillary tests available and the common and important causes of paresis and paralysis in sheep. PMID:26752801

  5. [Antioxidant therapy in combined treatment of postoperative intestinal paresis].

    PubMed

    Magomedov, M A

    2004-01-01

    Method of treatment of postoperative intestinal paresis with antioxidant emoxipin in experiment demonstrated that stabilization of redox processes and antioxidant systems in intestinal tissues leads to compensation of energy deficiency and recovery of intestinal peristalsis. Clinical use of this method in combined treatment of patients with postoperative intestinal paresis in acute generalized peritonitis reduces time of postoperative intestinal paresis and intoxication, lethality reduced 1,7-fold.

  6. Voice range in superior laryngeal nerve paresis and paralysis.

    PubMed

    Eckley, C A; Sataloff, R T; Hawkshaw, M; Spiegel, J R; Mandel, S

    1998-09-01

    Evaluation of Physiologic Frequency Range (PFR) and Musical Frequency Range (MRP) of Phonation was performed on 56 adults (singers and nonsingers) presenting with superior laryngeal nerve (SLN) paresis or paralysis confirmed by laryngeal electromyography. The most common etiology was neuritis (69.7%), followed by iatrogenic and unknown causes,each accounting for 10.2% of cases, and finally trauma (8.9%). Both female and male singers with SLN paresis or paralysis had significantly higher PFR and MPR than nonsingers. Female classical singers presented PFR and MPR of up to 10 semitones (ST) higher than nonclassical singers and nonsingers. The lowest PFR and musical ranges were found in patients with SLN paresis associated with recurrent laryngeal nerve paresis or paralysis. The authors suggest that voice range measurement is a useful parameter for analyzing the effects of SLN paresis or paralysis on voice and that it may also assist in measuring outcome following voice therapy.

  7. Role of vitamin D in calcium homeostasis and its use in prevention of bovine periparturient paresis.

    PubMed

    Horst, R L; Goff, J P; Reinhardt, T A

    2003-01-01

    Calcium (Ca) is essential for life in higher animals. It is involved in the normal functioning of a wide variety of tissues and physiologic processes which include bone formation, muscle contraction, nerve transmission, blood clotting and as a second messenger regulating the actions of many hormones. In order for these functions to be carried out properly, blood Ca concentrations must be monitored and regulated within strict limitations. The discovery of the vitamin D endocrine system has resulted in the realization that Ca regulation in mammals and birds involves a coordinated effort between the hormones parathyroid hormone (PTH), calcitonin and the hormonally-active form of vitamin D3, 1,25-dihydroxyvitamin D3 [1,25(OH)2D3]. Failure of this system to maintain normal blood Ca concentrations at parturition is a common occurrence in ruminants leading to clinical (periparturient paresis, milk fever) and subclinical hypocalcemia. Vitamin D sterols have played a significant role in efforts to avoid parturient hypocalcemia and this report will summarize advantages and disadvantages associated with their use.

  8. Bell's palsy: symptoms preceding and accompanying the facial paresis.

    PubMed

    De Seta, Daniele; Mancini, Patrizia; Minni, Antonio; Prosperini, Luca; De Seta, Elio; Attanasio, Giuseppe; Covelli, Edoardo; De Carlo, Andrea; Filipo, Roberto

    2014-01-01

    This individual prospective cohort study aims to report and analyze the symptoms preceding and accompanying the facial paresis in Bell's palsy (BP). Two hundred sixty-nine patients affected by BP with a maximum delay of 48 hours from the onset were enrolled in the study. The evolution of the facial paresis expressed as House-Brackmann grade in the first 10 days and its correlation with symptoms were analyzed. At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. After 10 days, 39.9% of the group had a severe paresis while 10.2% reached a complete recovery. Dry mouth at the onset was correlated with severe grade of palsy and was prognostic for poor recovery in the early period. These outcomes lead to the deduction that the nervus intermedius plays an important role in the presentation of the BP and it might be responsible for most of the accompanying symptomatology of the paresis. Our findings could be of important interest to early address a BP patient to further examinations and subsequent therapy.

  9. Bell's Palsy: Symptoms Preceding and Accompanying the Facial Paresis

    PubMed Central

    Mancini, Patrizia; Minni, Antonio; Prosperini, Luca; De Seta, Elio; Attanasio, Giuseppe; Covelli, Edoardo; De Carlo, Andrea; Filipo, Roberto

    2014-01-01

    This individual prospective cohort study aims to report and analyze the symptoms preceding and accompanying the facial paresis in Bell's palsy (BP). Two hundred sixty-nine patients affected by BP with a maximum delay of 48 hours from the onset were enrolled in the study. The evolution of the facial paresis expressed as House-Brackmann grade in the first 10 days and its correlation with symptoms were analyzed. At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. Dry mouth was present in 54 patients (19.7%), facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. After 10 days, 39.9% of the group had a severe paresis while 10.2% reached a complete recovery. Dry mouth at the onset was correlated with severe grade of palsy and was prognostic for poor recovery in the early period. These outcomes lead to the deduction that the nervus intermedius plays an important role in the presentation of the BP and it might be responsible for most of the accompanying symptomatology of the paresis. Our findings could be of important interest to early address a BP patient to further examinations and subsequent therapy. PMID:25544960

  10. Isolated marginal facial nerve paresis after TMJ discopexy: a case report.

    PubMed

    Reychler, H; Mahy, P

    2011-01-01

    Isolated marginal facial nerve paresis after TMJ discopexy: a case report. This is the first report of a transient, isolated marginal facial nerve paresis after temporomandibular joint arthrotomy. The paresis seems to have resulted from a crush lesion by Backhaus forceps, placed transcutaneously during the operation to distract the intra-articular space.

  11. A parturient with severe bullous emphysema from intravenous drug abuse.

    PubMed

    Siddiqui, S; Afrangui, B M; Malinow, A M

    2002-04-01

    A parturient with severe talcosis-induced, bullous emphysema presented for urgent cesarean delivery. Respiratory effects of anesthesia, positioning for delivery and residual effects of postoperative analgesics all potentially affect the choice of anesthetic technique and drugs used in a patient with severe emphysema. This parturient was given epidural anesthesia for delivery and postoperative analgesia maintained with epidural infusion of bupivacaine and clonidine.

  12. Effects of Hypergravity Exposure on Prolactin Levels in Pre-parturient , Parturient and Lactating Rat Dams

    NASA Technical Reports Server (NTRS)

    Baer. Lisa A.; Wade, Charles E.; Ronca, April E.; Sun, Sid (Technical Monitor)

    2001-01-01

    We analyzed the effects of 2.0-g, 1.75-g and 1.5-g hypergravity exposure on plasma concentrations of the lactotrophic hormone, prolactin (PRL), in female rats on pre-parturient (Gestation Day 20), parturient (Post-natal day 0) and lactating (P10) days. PRL levels have been found to be reduced in rat dams around the time of birth following exposure to gravitational loads varying from 2.16 to 3.14-g (Megory et. al., Aviation, Space and Environs 1129-1135, 1984). It has also been reported that at these high gravitational loads, neonatal mortality has been extremely high, suggesting a possible interaction between dam PRL concentration and neonatal outcome. We have previously reported no significant differences in PRL levels of parturient (PO) and lactating (P6 & P 15) dams when exposed to 1.5-g hypergravity, but did observe a slight elevation of PRL on PO and P 15, with a decrease on P6. In the present study, time-bred pregnant dams were exposed to either continuous 2.0-g, 1.75-g or 1.5-g centrifugation, beginning on Gestational day (G) 11 of the rats' 22-day pregnancy. We observed no significant differences in PRL concentrations between SC and any of the HG conditions. On G20 and PO, PRL concentrations of the 2.0-g and 1.5-g groups were slightly elevated as compared to SC. Similar to what we previously reported. PRL secretion was elevated in both HG and SC conditions on the day of birth relative to later during lactation, but on P10 it appeared to be reduced in HG relative to SC dams. These findings suggests that hypergravity slightly elevates plasma concentration of PRL in pre-parturient and lactating rat dams, with effects most pronounced during the periparturitional period and in a direction opposite to that observed following microgravity exposure.

  13. A Rare Complication of Herpes Zoster: Segmental Zoster Paresis

    PubMed Central

    Teo, Hooi Khee; Chawla, Mayank; Kaushik, Manish

    2016-01-01

    Herpes zoster is a common presentation in both the community and emergency department; however segmental zoster paresis is a rare complication that can lead to misdiagnosis. We present a case of a 74-year-old Indian gentleman with a background of well controlled diabetes mellitus, hypertension, and ischaemic heart disease who presented with sudden right lower limb weakness. This was preceded by a 5-day history of paraesthesia starting in the right foot and ascending up the right lower limb. On examination, there was a characteristic vesicular rash in the L2/3 region with MRC grading 3/5 in the right hip flexors. The rest of the neurological examination was unremarkable. MRI of the spine did not show any evidence of spinal disease. The patient was initiated on IV acyclovir with improvement of the lower limb weakness to MRC grading 5/5 as the vesicles improved. This is an interesting case as it highlights a rare presentation of zoster: segmental motor paresis that recovered fully with resolution of the rash. It shows the importance of recognizing motor neuropathy as a complication of shingles as it has a very good prognosis with most patients regaining full motor function of the affected limb with treatment. PMID:27313622

  14. Natural history of idiopathic abducens nerve paresis in a young adult.

    PubMed

    Hussaindeen, Jameel Rizwana; Mani, Revathy; Rakshit, Archayeeta; Ramasubramanian, Srikanth; Vittal Praveen, Smitha

    2016-01-01

    The natural history of idiopathic abducens nerve paresis and the role of conservative management such as vision training during the recovery process is not well documented in the literature to the best of our knowledge. This case report presents the natural recovery process of idiopathic abducens nerve paresis in a young adult and the role of vision therapy in the recovery process.

  15. Inferior oblique muscle paresis as a sign of myasthenia gravis.

    PubMed

    Almog, Yehoshua; Ben-David, Merav; Nemet, Arie Y

    2016-03-01

    Myasthenia gravis may affect any of the six extra-ocular muscles, masquerading as any type of ocular motor pathology. The frequency of involvement of each muscle is not well established in the medical literature. This study was designed to determine whether a specific muscle or combination of muscles tends to be predominantly affected. This retrospective review included 30 patients with a clinical diagnosis of myasthenia gravis who had extra-ocular muscle involvement with diplopia at presentation. The diagnosis was confirmed by at least one of the following tests: Tensilon test, acetylcholine receptor antibodies, thymoma on chest CT scan, or suggestive electromyography. Frequency of involvement of each muscle in this cohort was inferior oblique 19 (63.3%), lateral rectus nine (30%), superior rectus four (13.3%), inferior rectus six (20%), medial rectus four (13.3%), and superior oblique three (10%). The inferior oblique was involved more often than any other muscle (p<0.01). Eighteen (60%) patients had ptosis, six (20%) of whom had bilateral ptosis. Diagnosing myasthenia gravis can be difficult, because the disease may mimic every pupil-sparing pattern of ocular misalignment. In addition diplopia caused by paresis of the inferior oblique muscle is rarely encountered (other than as a part of oculomotor nerve palsy). Hence, when a patient presents with vertical diplopia resulting from an isolated inferior oblique palsy, myasthenic etiology should be highly suspected.

  16. [Anesthetic management for caesarean delivery in a parturient with achondroplasia].

    PubMed

    Ando, Akira; Hishinuma, Norimasa; Shirotori, Toru; Sasao, Junichi; Tanaka, Satoshi; Kawamata, Mikito

    2014-06-01

    A 27-year-old parturient (height, 130 cm; weight, 43 kg) with achondroplasia, which is characterized by rhizomeric short stature, large head and frontal bossing, was scheduled for elective caesarean section (C/S) because of her contracted pelvis. Her first delivery had been performed by C/S under general anesthesia at a regional hospital 6 years before. Preoperative airway assessment showed normal mouth opening and mobile cervical spine. Since she had anxiety about needle puncture and refused neuraxial blockade and since we considered the trachea could be intubated, we decided to perform C/S under general anesthesia at 37 weeks of gestation. The patient and baby had an uneventful perioperative course. Underdevelopment of bone formation results in characteristic craniofacial and vertebral abnormalities in patients with achondroplasia. Anesthetic management of achondroplastic parturients should be specified to individual basis based on careful preoperative assessment of craniofacial and vertebral deformities.

  17. Anaesthetic management of a parturient with Laron syndrome.

    PubMed

    Bhatia, K; Cockerham, R

    2011-10-01

    We report a case of a parturient with Laron syndrome, a rare form of dwarfism which results from an inability to generate insulin-like growth factor 1. In addition to dwarfism these patients may have craniofacial abnormalities, atlantoaxial instability, spinal stenosis and metabolic, musculoskeletal and genitourinary abnormalities. The patient underwent an urgent caesarean section using combined spinal-epidural anaesthesia. Laron syndrome is reviewed and its anaesthetic implications discussed.

  18. Literature review of evidence based physiotherapy in patients with facial nerve paresis.

    PubMed

    Hg Beurskens, Carien; Al Burgers-Bots, Ingrid; W Kroon, Dineke; Ab Oostendorp, Rob

    2004-01-01

    A variety of physiotherapeutic approaches have been tried out during the past 25 years to alleviate the plight of patients with peripheral facial nerve paresis. The objective of this review was to assess the effectiveness of physiotherapy in patients with facial nerve paresis. Trials were identified by computerised searches of biomedical databases, reference lists, and by contacting investigators. Selection criteria were randomised controlled trials of physiotherapy for the improvement of sequelae of facial nerve paresis, comparing the treatment with either another intervention or no intervention. Two reviewers independently assessed the trials using the PEDro scale. Two physiotherapy randomised controlled studies were identified. Interventions used for treatment of patients with facial nerve paresis in the included studies were relaxation, biofeedback and exercise therapy. Neither of the two randomised controlled studies showed scientific evidence of a physiotherapeutic approach in comparison with a control group. Both studies described benefits of the interventions. Further randomised controlled studies are required to determine the effectiveness of physiotherapy in patients with facial nerve paresis.

  19. Peripartum management of two parturients with ornithine transcarbamylase deficiency.

    PubMed

    Ituk, U; Constantinescu, O C; Allen, T K; Small, M J; Habib, A S

    2012-01-01

    Ornithine transcarbamylase deficiency is a rare X-linked disorder in which female carriers are usually heterozygous for the ornithine transcarbamylase deficiency gene. In pregnancy it has been associated with altered mental status, seizures, coma and death, especially in the postpartum period. We report the management of labor and delivery in two parturients with known ornithine transcarbamylase deficiency. Both patients were maintained on arginine, citrulline and sodium phenylacetate therapy with restricted protein intake during pregnancy. Neuraxial techniques were used for pain relief in labor and anesthesia for operative delivery. A dextrose infusion provided caloric intake during labor and perioperatively.

  20. Combined Spinal Epidural Anaesthesia for Caesarean Section and Hysterectomy in a Parturient with Placenta Accreta

    PubMed Central

    Seyhan, Tülay Özkan; Sungur, Mukadder Orhan; Edipoğlu, İpek; Baştu, Ercan

    2014-01-01

    Placenta accreta complicates the anaesthetic and surgical approach in caesarean section. In this report, a parturient with placenta accreta and multiple drug allergies who was managed using combined spinal epidural anaesthesia for caesarean hysterectomy is discussed. PMID:27366410

  1. Transesophageal echocardiography monitoring in the delivery of a preeclamptic parturient with severe left ventricular noncompaction.

    PubMed

    Ashford, Eric J; Klimkina, Oksana; Hassan, Zaki-Udin; Colclough, George; Fragneto, Regina

    2014-09-01

    A multidisciplinary approach to the preterm delivery of a preeclamptic parturient with severe left ventricular (LV) noncompaction and pulmonary hypertension using transesophageal echocardiography (TEE) as a monitor of hemodynamic status in lieu of a pulmonary artery catheter during general anesthesia for Cesarean section is presented. This case adds to the available literature on LV noncompaction with pulmonary hypertension in preeclamptic parturients, and addresses the anesthetic concerns and approaches to management using echocardiography in these highly complex patients.

  2. Transient unilateral combined paresis of the hypoglossal nerve and lingual nerve following intubation anesthesia.

    PubMed

    Ulusoy, Hulya; Besir, Ahmet; Cekic, Bahanur; Kosucu, Muge; Geze, Sukran

    2014-01-01

    Nerve damage may occur in the pharyngolaryngeal region during general anesthesia. The most frequently injured nerves are the hypoglossal, lingual and recurrent laryngeal. These injuries may arise in association with several factors, such as laryngoscopy, endotracheal intubation and tube insertion, cuff pressure, mask ventilation, the triple airway maneuver, the oropharyngeal airway, manner of intubation tube insertion, head and neck position and aspiration. Nerve injuries in this region may take the form of an isolated single nerve or of paresis of two nerves together in the form of hypoglossal and recurrent laryngeal nerve palsy (Tapia's syndrome). However, combined injury of the lingual and hypoglossal nerves following intubation anesthesia is a much rarer condition. The risk of this damage can be reduced with precautionary measures. We describe a case of combined unilateral nervus hypoglossus and nervus lingualis paresis developing after intubation anesthesia.

  3. The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section

    PubMed Central

    Eiamcharoenwit, Jatuporn; Itthisompaiboon, Napon

    2017-01-01

    Background. There have not yet been any studies to validate the intubation difficulty scale (IDS) in obese parturients. Objectives of this study were to determine the performance of the IDS in defining difficult intubation (DI) and to identify the optimal cutoff points of the IDS among obese parturients. Methods. This was a prospective observational study. Parturients with a body mass index ≥ 30 kg/m2 who underwent cesarean section utilizing endotracheal intubation were enrolled. The intubating performers were asked to assess the difficulty of endotracheal intubation and categorize it as easy, somewhat DI, and DI. Main Results. A total of 517 parturients were recruited with a mean BMI of 33.9 kg/m2. The incidence of some degree of DI was 14.5%. The area under the receiver operating characteristic curves of the IDS for detecting somewhat DI and DI was 1.0. The optimal cutoff point to define somewhat DI was ≥3 and DI was ≥5, which both had sensitivity and specificity of 100%. Conclusions. The IDS scoring is a good tool for defining DI among obese parturients. The IDS scores of ≥3 and ≥5 are the optimal cutoff points to define somewhat DI and DI, respectively. PMID:28246593

  4. Anaesthetists' experiences with the early labour epidural recommendation for obese parturients: a qualitative study.

    PubMed

    Eley, V A; Callaway, L K; van Zundert, A A J; Lipman, J; Gallois, C

    2016-09-01

    Caring for obese pregnant women presents challenges for all medical professionals. Despite a lack of supporting evidence, expert opinion and international guidelines suggest early labour epidural insertion for obese women. Anecdotally this is not supported by all anaesthetists. This qualitative study explored the experiences of anaesthetists regarding early epidural analgesia in obese parturients, to answer the research question: Are anaesthetists consistent in how they apply early epidural analgesia in obese parturients? Personal in-depth interviews with 42 specialist anaesthetists working in south-east Queensland, Australia, were completed between February and April, 2015. Leximancer™ text analysis software applied a validated algorithm to the data to identify themes and concepts. The major themes were explored by the first author to answer the research question. Three major themes were identified: the demands associated with caring for obese women; concern regarding the anaesthetic technique used in obese women; and the importance of communication with obstetric staff. Disagreement regarding interpretation and application of early epidural analgesia was identified within this group of anaesthetists. These anaesthetists were inconsistent in how they interpreted and applied early epidural analgesia for obese parturients, with some questioning the validity of the practice. The combination of uncertainty, urgency and technical difficulty presented by obese parturients provoked anxiety in these clinicians, particularly the anticipation of unplanned general anaesthesia. Consistent anaesthetic practice could improve the implementation of early epidural analgesia in obese parturients.

  5. The Performance of the Intubation Difficulty Scale among Obese Parturients Undergoing Cesarean Section.

    PubMed

    Eiamcharoenwit, Jatuporn; Itthisompaiboon, Napon; Limpawattana, Panita; Siriussawakul, Arunotai

    2017-01-01

    Background. There have not yet been any studies to validate the intubation difficulty scale (IDS) in obese parturients. Objectives of this study were to determine the performance of the IDS in defining difficult intubation (DI) and to identify the optimal cutoff points of the IDS among obese parturients. Methods. This was a prospective observational study. Parturients with a body mass index ≥ 30 kg/m(2) who underwent cesarean section utilizing endotracheal intubation were enrolled. The intubating performers were asked to assess the difficulty of endotracheal intubation and categorize it as easy, somewhat DI, and DI. Main Results. A total of 517 parturients were recruited with a mean BMI of 33.9 kg/m(2). The incidence of some degree of DI was 14.5%. The area under the receiver operating characteristic curves of the IDS for detecting somewhat DI and DI was 1.0. The optimal cutoff point to define somewhat DI was ≥3 and DI was ≥5, which both had sensitivity and specificity of 100%. Conclusions. The IDS scoring is a good tool for defining DI among obese parturients. The IDS scores of ≥3 and ≥5 are the optimal cutoff points to define somewhat DI and DI, respectively.

  6. Efficacy of the methoxyflurane as bridging analgesia during epidural placement in laboring parturient

    PubMed Central

    Anwari, Jamil S.; Khalil, Laith; Terkawi, Abdullah S.

    2015-01-01

    Background: Establishing an epidural in an agitated laboring woman can be challenging. The ideal pain control technique in such a situation should be effective, fast acting, and short lived. We assessed the efficacy of inhalational methoxyflurane (Penthrox™) analgesia as bridging analgesia for epidural placement. Materials and Methods: Sixty-four laboring women who requested epidural analgesia with pain score of ≥7 enrolled in an observational study, 56 of which completed the study. The parturients were instructed to use the device prior to the onset of uterine contraction pain and to stop at the peak of uterine contraction, repeatedly until epidural has been successfully placed. After each (methoxyflurane inhalation-uterine contraction) cycle, pain, Richmond Agitation Sedation Scale (RASS), nausea and vomiting were evaluated. Maternal and fetal hemodynamics and parturient satisfaction were recorded. Results: The mean baseline pain score was 8.2 ± 1.5 which was reduced to 6.2 ± 2.0 after the first inhalation with a mean difference of 2.0 ± 1.1 (95% confidence interval 1.7-2.3, P < 0.0001), and continued to decrease significantly over the study period (P < 0.0001). The RASS scores continuously improved after each cycle (P < 0.0001). Only 1 parturient from the cohort became lightly sedated (RASS = −1). Two parturients vomited, and no significant changes in maternal hemodynamics or fetal heart rate changes were identified during treatment. 67% of the parturients reported very good or excellent satisfaction with treatment. Conclusion: Penthrox™ provides rapid, robust, and satisfactory therapy to control pain and restlessness during epidural placement in laboring parturient. PMID:26543451

  7. Anesthetic management of a parturient with Stiff person syndrome for urgent cesarean delivery.

    PubMed

    Boettcher, B T; Muravyea, M; Kuo, C; Drexler, C; Pagel, P S

    2016-08-01

    Stiff person syndrome is a rare neurologic disorder with an estimated incidence of 1:1000000. The underlying pathophysiology is truncal and proximal limb muscle stiffness resulting from continuous co-contracture of agonist and antagonist muscle groups concomitant with superimposed episodic muscle spasms. Loss of gamma-aminobutyric acid-mediated inhibition creates chronic excitation manifested by tonic agonist-antagonist muscle contraction. To date, only three case reports referred indirectly to the anesthetic management of parturients with Stiff person syndrome. The authors describe their management of a parturient with Stiff person syndrome who underwent urgent cesarean delivery under epidural anesthesia.

  8. Post-traumatic Vertical Gaze Paresis in Nine Patients: Special Vulnerability of the Artery of Percheron in Trauma?

    PubMed Central

    Galvez-Ruiz, Alberto

    2015-01-01

    Purpose: The purpose was to present a case series of vertical gaze paresis in patients with a history of cranioencephalic trauma (CET). Methods: The clinical characteristics and management are presented of nine patients with a history of CET secondary to motor vehicle accidents with associated vertical gaze paresis. Results: Neuroimaging studies indicated posttraumatic contusion of the thalamic-mesencephalic region in all nine patients who corresponded to the artery of Percheron region; four patients had signs of hemorrhagic transformation. Vertical gaze paresis was present in all patients, ranging from complete paralysis of the upward and downward gaze to a slight limitation of upward gaze. Discussion: Posttraumatic vertical gaze paresis is a rare phenomenon that can occur in isolation or in association with other neurological deficits and can cause a significant limitation in the quality-of-life. Studies in the literature have postulated that the unique anatomy of the angle of penetration of the thalamoperforating and lenticulostriate arteries makes these vessels more vulnerable to isolated selective damage in certain individuals and can cause-specific patterns of CET. PMID:26180479

  9. Ascending paresis as presentation of an unusual association between necrotizing autoimmune myopathy and systemic lupus erythematosus.

    PubMed

    García-Reynoso, Marco Julio; Veramendi-Espinoza, Liz Eliana; Ruiz-Garcia, Henry Jeison

    2014-01-01

    A 45 year-old man went to the emergency room due to disease duration of 15 days of insidious onset and progressive course. It began with symmetrical weakness and pain in feet and ankles that extends upward to the knees. Later, this progressed to paraparesis with Creatine phosphokinase levels of 44,270 U/L and respiratory failure that required mechanical ventilation. Electromyography and muscle biopsy of quadriceps were made. The patient responded to corticotherapy in pulses and supporting management. The presentation of ascending paresis suggested the diagnosis of Guillain-Barré syndrome. However, the degree of muscle involvement with rhabdomyolysis explains the neurological damage by itself. The biopsy revealed pathological criteria for necrotizing autoimmune myopathy (NAM), as well as other clinical and laboratory evidence. Patient disease continued and reached criteria for systemic lupus erythematosus (SLE). To our best knowledge, this is the first report of the NAM and SLE association.

  10. A novel homozygous HOXB1 mutation in a Turkish family with hereditary congenital facial paresis.

    PubMed

    Sahin, Yavuz; Güngör, Olcay; Ayaz, Akif; Güngör, Gülay; Sahin, Bedia; Yaykasli, Kursad; Ceylaner, Serdar

    2017-02-01

    Hereditary congenital facial paresis (HCFP) is characterized by isolated dysfunction of the facial nerve (CN VII) due to congenital cranial dysinnervation disorders. HCFP has genetic heterogeneity and HOXB1 is the first identified gene. We report the clinical, radiologic and molecular investigations of three patients admitted for HCFP in a large consanguineous Turkish family. High-throughput sequencing and Sanger sequencing of all patients revealed a novel homozygous mutation p.Arg230Trp (c.688C>T) within the HOXB1 gene. The report of the mutation brings the total number of HOXB1 mutations identified in HCFP to four. The results of this study emphasize that in individuals with congenital facial palsy accompanied by hearing loss and dysmorphic facial features, HOXB1 mutation causing HCFP should be kept in mind.

  11. [Clinical course and serial brain MRI findings in a patient with Lissauer form of general paresis].

    PubMed

    Ishihara, Tomohiko; Ishihara, Ayako; Ozawa, Tetutaro; Sanpei, Kazuhiro; Shimohata, Takayoshi; Nishizawa, Masatoyo

    2015-01-01

    A 60-year-old man presented with progressive dementia and generalized convulsions. An initial MRI revealed a widespread high-intensity area with a mass effect in the right frontal and temporal lobes on T2-weighted images. Findings on digital subtraction angiography were normal. Serum and CSF tests showed high titers of antibodies to Treponema pallidum, which helped to distinguish neurosyphilis from glioma. He was initially treated with penicillin injection; however, it caused liver dysfunction and penicillin was switched to erythromycin. Even after antibiotic therapy for 2 months, his dementia did not improve. He underwent brain MRI four times during the treatment course, and they showed steady progression of brain atrophy in the right hemisphere. Taking these findings together, we diagnosed Lissauer form of general paresis. To the best of our knowledge, this is the first case of Lissauer form of paretic neurosyphilis, in which the progression of brain atrophy was clearly demonstrated on MRI.

  12. Regional cerebral oxygen saturation guided cerebral protection in a parturient with Takayasu's arteritis undergoing cesarean section: a case report.

    PubMed

    Xiao, Wei; Wang, Tianlong; Fu, Wenya; Wang, Fengying; Zhao, Lei

    2016-09-01

    The objective of this case report is to present the successful use of regional cerebral oxygen saturation (rScO2) monitoring guided cerebral protection for cesarean delivery in a parturient with Takayasu's arteritis at 38weeks' gestation. The parturient presented with impaired cerebral and renal perfusion. Titrated epidural anesthesia was performed. During the procedure, we used rScO2 guided cerebral protection strategies, which helped to optimize cerebral oxygen delivery and prevent cerebral complications.

  13. Bridle transfer for paresis of the anterior and lateral compartment musculature.

    PubMed

    Prahinski, J R; McHale, K A; Temple, H T; Jackson, J P

    1996-10-01

    In the Riordan (bridle) transfer, the posterior tibialis muscle as motor is routed through the interosseous membrane and anastomosed into a "bridle" formed by the distal tibialis anterior and peroneus longus muscles. In theory, the bridle provides inversion/eversion balance even if the transfer effects only tenodesis. However, the procedure has been criticized because its insertion is not into bone. This review analyzes the use of bridle transfer in flaccid paresis involving musculature innervated by the peroneal nerve. Surgery was performed 1 to 3 years after injury for patients with traumatic etiology. Ten patients are reviewed at 61 months' mean follow-up. Eight patients had traumatic peroneal nerve loss. Two had neuromuscular etiology. Evaluation included review of records, telephone interviews, and physical examinations. Data on functional status included walking barefoot running, need for bracing, return to duty, and patient satisfaction. Physical examination recorded ankle position and motions, gait findings, and results of static electromyograms. All patients were able to walk barefoot, but 6 of 10 had a mild to moderate limp. Five patients returned to running initially; only two were able to keep running. Nine patients were brace-free initially (polio sequela required bracing initially), and four others returned to bracing. Of these, two experienced an acute "tearing" and dorsiflexion loss, one sustained a prolonged gradual loss of dorsiflexion, and one sustained a contralateral cerebrovascular accident. Only three of seven patients returned to active duty, and one is on jump status. All patients were satisfied with their initial result. Only two patients had no detectable swing phase problems (both returned to active duty). Five patients had peroneal nerve exploration with repair or neurolysis; two of them sustained complete transections. Postoperative electromyograms showed insignificant, if any, nerve return. The Riordan transfer works well for

  14. Stance control is not affected by paresis and reflex hyperexcitability: the case of spastic patients

    PubMed Central

    Nardone, A; Galante, M; Lucas, B; Schieppati, M

    2001-01-01

    OBJECTIVES—Spastic patients were studied to understand whether stance unsteadiness is associated with changes in the control of voluntary force, muscle tone, or reflex excitability, rather than to abnormal posture connected to the motor deficit itself.
METHODS—Twenty four normal subjects, 12 patients affected by amyotrophic lateral sclerosis (ALS), seven by spastic paraparesis, and 14 by hemiparesis were studied. All patients featured various degrees of spasticity and paresis but were free from clinically evident sensory deficits. Body sway during quiet upright stance was assessed through a stabilometric platform under both eyes open (EO) and eyes closed (EC) conditions. The sudden rotation of a supporting platform, in a toe up and toe down direction respectively, evoked short (SLR) and medium latency (MLR) reflex responses to stretch of the soleus or the tibialis anterior (TA) muscle.
RESULTS—No relation was found between clinical findings (tone, muscle strength, tendon reflexes, plantar response, and duration of disease) and body sway. On average, all patient groups exhibited a forward shift of the centre of foot pressure (CFP) with respect to normal subjects; in addition, paraparetic and to a much larger extent hemiparetic patients showed a lateral shift of CFP. Body sway area was significantly increased only in the hemiparetic patients. No relation was found between position of the CFP and sway within any patient group. Soleus SLR was increased in all patients with respect to normal subjects. TA SLR was often seen in both patients with ALS and paraparetic patients, but only rarely in normal subjects and hemiparetic patients. However, no relation was found between amplitude of soleus or TA SLRs and stabilometric variables. The frequency and size of soleus MLR and TA MLR were decreased in all patients. These responses were decreased in size and not modulated by background EMG in the affected leg of hemiparetic patients, suggesting a disturbed control of

  15. Management of parturients in active labor with Arnold Chiari malformation, tonsillar herniation, and syringomyelia

    PubMed Central

    Ghaly, Ramsis F.; Tverdohleb, Tatiana; Candido, Kenneth D.; Knezevic, Nebojsa Nick

    2017-01-01

    Background: Arnold-Chiari malformation Type 1 (ACM-1) in parturients is a topic of ongoing discussion between obstetricians and anesthesiologists. The primary unanswered question remains; How should the anesthesia provider proceed with labor analgesia and anesthesia for cesarean section when confronted with an advanced, asymptomatic, or minimally symptomatic case of ACM-1 during labor? Case Description: A 24-year-old, ASA II, G1P0 full-term parturient presented to Labor and Delivery for vaginal delivery. A diagnosis of ACM-1 was made 12 years ago when a brain magnetic resonance imaging (MRI) was performed for right-sided numbness following a rear-end motor vehicle collision. The patient had been asymptomatic since then and had been seen by an outside neurologist frequently for the past 10 years. During the anesthesia evaluation, it was noted that she had an exaggerated patellar reflex, and a questionable left-sided Babinski; subsequently, an MRI study was requested. Review of a brain MRI demonstrated an advanced form of ACM with a 1.7 cm transtonsillar herniation and a large syrinx extending from C1 down to C5. Following a discussion with the patient, family, and primary OB team, a plan for elective cesarean section was made per neurosurgical recommendations. This was conducted uneventfully under general anesthesia. The patient had no complaints in the post-anesthesia care unit. Conclusion: Unfamiliarity of health care providers with regards to ACM-1 parturients can be countered by increasing awareness of this condition throughout medical specialties involved in their care. The Ghaly Obstetric Guide to Arnold-Chiari malformation Type 1, along with proper training of anesthesia care providers regarding the specificities of ACM-1 parturients aids in better management and understanding of this complex condition. PMID:28217389

  16. Anesthetic considerations in a parturient with congenital insensitivity to pain with anhidrosis.

    PubMed

    Pirani, Z; Qasem, F; Katsiris, S

    2017-02-01

    Congenital insensitivity to pain is a rare autosomal recessive disease characterized by varying degrees of autonomic dysfunction and sensory loss, including nociceptive hyposensitivity. It is this autonomic dysfunction that makes both general and neuraxial anesthesia challenging. Testing the block during neuraxial anesthesia may be difficult and the patient may be prone to hypotension and bradycardia. This case report describes the anesthetic management of a parturient with congenital insensitivity to pain presenting for cesarean delivery.

  17. Anesthetic Management of the Parturient for Lumbar Disc Surgery in the Prone Position

    PubMed Central

    Martel, Colleen G.; Volpi-Abadie, Jacqueline; Ural, Kelly

    2015-01-01

    Background While back pain is common in pregnancy, urgent surgical intervention is rarely required. Case Report A parturient in the third trimester presented with foot drop and sensory deficits. Surgical intervention was deemed necessary and was performed in the prone position to facilitate exposure. A multidisciplinary approach was vital to the management plan. Conclusion For any pregnant patient undergoing nonobstetric surgery, the care provided should be individualized and thoughtful, keeping in mind both the mother and fetus. PMID:26412999

  18. Pain perception among parturients at a University Teaching Hospital, South-Western Nigeria

    PubMed Central

    Aduloju, Olusola Peter

    2013-01-01

    Introduction: Labour pain is a universal experience. Relief of labour pains and companionship in labour are important aspects of quality of care in labour. Objectives: To evaluate perception of labour pains among parturients, their knowledge and awareness of pain relief during labour, the types of obstetric analgesia available and the outcome of their labour at the Ekiti State University Teaching Hospital, Ado-Ekiti. Materials and Methods: A cross-sectional study using questionnaire administered to pregnant women between 37 and 42 weeks gestational age in labour ward of the hospital. Results: The study revealed that 75.2% of the parturients experienced severe labour pains and 35.3% of them received analgesia in labour with Pentazocine injection being the only analgesic used. Only 18.3% had maximum relief of their pains. Parturients with increasing parity, higher social class and educational attainment and who had antenatal education on labour pains were associated with severe perception of labour pains with P values of 0.03, 0.03, 0.02 and 0.01, respectively. Parturients who were given Pentazocine injection for pains and had relief in labour had more spontaneous vaginal deliveries, P = 0.030 and better outcome for their babies, P = 0.028. Majority of the women reported that the practice of companionship and back rubbing in labour helped them to cope better with the labour process. Conclusion: Most women desire relief of pains of labour but the practice is still suboptimal in this centre. Efforts should be made towards developing the practice of obstetric analgesia and companionship in labour in this environment. PMID:24249944

  19. Premedication with midazolam prior to cesarean delivery in preeclamptic parturients: A randomized controlled trial

    PubMed Central

    Mokhtar, Ali M.; Elsakka, Ahmed I.; Ali, Hassan M.

    2016-01-01

    Background: Anxiety is a concern in obstetrics, especially in preeclamptic mothers. Sedation is not commonly used in parturients for fear of adverse neonatal effect. We investigated maternal and neonatal outcome of midazolam as an adjuvant to spinal anesthesia for elective cesarean delivery. Methods: A prospective randomized controlled trial, in which eighty preeclamptic parturients received either an intravenous dose of 0.035 mg/kg of midazolam or an equal volume of normal saline, 30 min before spinal anesthesia. Maternal anxiety was assessed using Amsterdam Preoperative Anxiety and Information Scale (APAIS); postoperative maternal satisfaction was assessed using Maternal Satisfaction Scale for Cesarean Section (MSSCS). Newborns were assessed using Apgar score, Neonatal Neurologic and Adaptive Capacity Score (NACS), and umbilical artery blood gases. Results: Mothers premedicated with midazolam showed a lower level of preoperative anxiety and a higher degree of postoperative satisfaction than the control group. There were no between-group differences regarding the neonatal outcome. Conclusion: Preeclamptic parturients premedicated with midazolam (0.035 mg/kg) before spinal anesthesia have lower anxiety and higher postoperative satisfaction levels, with no adverse effects on the newborns. PMID:27746564

  20. Interlimb coordination of posture in patients with spastic paresis. Impaired function of spinal reflexes.

    PubMed

    Dietz, V; Berger, W

    1984-09-01

    Activation of leg musculature on both sides following a unilateral displacement was studied during stance on separate see-saws, or on stable force-measuring platforms, in patients with spastic hemiparesis and paraparesis. During balancing the movements on the spastic side were damped and the degree of muscle activation reduced. Whereas in healthy subjects the tibialis anterior muscles of both sides were activated, following a unilateral displacement, with the same strength and latency (see-saws 55 ms, platforms 85 ms), in hemispastic patients the EMG responses were delayed (by about 20 to 30 ms) and of reduced strength on the spastic leg, irrespective of whether the unaffected or the spastic side was displaced. In addition, the compensatory movements on the spastic side were damped in both conditions, although the amplitude of displacement was the same bilaterally. Although there was no correlation between the delay and the reduction in EMG response, the latter was correlated with the severity of paresis. In patients with spastic paraparesis quite similar results were obtained with delayed and reduced EMG responses on both sides. It is concluded that in spasticity the impaired regulation of quick compensatory movements is due to a dysfunction of a spinal interneuronal system by which the early EMG responses are mediated. This could be explained by loss of supraspinal control. In addition to the impaired neural activation of leg muscles, changes in the mechanical properties of muscle can be assumed to contribute to the damped movements on the spastic side.

  1. Dynamics of prolactin, gonadotropin, and of sex steroids in the blood serum of parturients during laser therapy

    NASA Astrophysics Data System (ADS)

    Kovalyov, M. I.

    2001-04-01

    An investigation was made of the effect (lambda) equals 0.63 micrometers diode laser radiation with the energy density of 0.6 to 0.8 J cm-2 on parturients affected by nipples' rhagades. In our experiments, we determined the content of prolactin (PRL), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), and of progesterone (P) in the parturients' blood serum. It was found that laser radiation produced an insignificant effect on the prolactic (PRL) content in parturients with the normal lactation level. On the contrary, it produced a stimulating effect on the PRL level in parturients with hypogalactia. Possibly, laser radiation promoted the decrease in the FSH level in the parturients' blood serum. It was also found that this laser radiation produced an insignificant effect on the levels of LH, estradiol (E2), and of progesterone. Women subsequently affected by mastitis exhibited a significantly higher PRL level in their blood serum, as compared with women of the control group.

  2. Prevalence and factors associated with syphilis in parturient women in Northeast, Brazil

    PubMed Central

    2013-01-01

    Background Congenital syphilis is a major public health concern, even after the implementation of intervention protocols in several countries. This study aimed to analyze the prevalence and socio-demographic, behavioral and institutional factors associated with syphilis in parturient women attending public maternity hospitals in Northeast, Brazil. Methods A cross-sectional study was conducted from June to September 2010 with a proportionate stratified sampling of 222 parturient women using a structured questionnaire. The study analyzed socio-demographic, behavioral and institutional variables. The structured questionnaire was conducted with parturient women and complementary information was obtained through hospitals records, admission forms and prenatal cards. Data were stored using the Statistical Package SPSS version 18. A descriptive statistical analysis was performed using frequency distribution, central tendency and measures of spread for the variables. A bivariate analysis was done using chi square test and Fisher’s exact test, with a significance level of 5% and a 95% confidence interval, in order to analyze the relation between the variables and risk factors for syphilis. The multivariate logistic regression analysis was done in the statistical package STATA, version 11.0. Results The prevalence of syphilis in parturient women was 7.7%. The bivariate analyses showed that the rate was higher among women who: were from Fortaleza (p = 0.019), studied for less than nine years (p = 0.044), had more than one sexual partner in life (p = 0.021), did not live with partner (p = 0.022), used illegal drugs (p < 0.0001), whose partner used illegal drugs and had diagnosis of syphilis (p = 0.001 and p < 0.0001 respectively). The non-adjusted analysis found significant positive association between syphilis and the following variable: being from Fortaleza (OR = 7.26; CI 95% = 1.49-100.20), having studied for less than nine years (OR

  3. Role of contralesional hemisphere in paretic arm reaching in patients with severe arm paresis due to stroke: A preliminary report.

    PubMed

    Mohapatra, Sambit; Harrington, Rachael; Chan, Evan; Dromerick, Alexander W; Breceda, Erika Y; Harris-Love, Michelle

    2016-03-23

    Stroke is highly prevalent and a leading cause of serious, long-term disability among American adults. Impaired movement (i.e. paresis) of the stroke-affected arm is a major contributor to post-stroke disability, yet the mechanisms of upper extremity motor recovery are poorly understood, particularly in severely impaired patients who lack hand function. To address this problem, we examined the functional relevance of the contralesional hemisphere in paretic arm motor performance in individuals with severe arm paresis. Twelve individuals with severe stroke-induced arm paresis (Upper Extremity Fugl-Meyer Assessment=17.1 ± 8.5; maximum score=66) participated in the study. Participants performed a reaching response time task with their paretic arm. At varying time intervals following a 'Go' cue, a pair of transcranial magnetic stimulation (TMS) pulses were delivered to contralesional hemisphere primary motor (M1) or dorsal pre-motor cortex (PMd) to momentarily disrupt the pattern of neural firing. Response time components and hand-path characteristics were compared across the 2 sites for trials with and without TMS disruption. There was no significant effect of TMS disruption on overall Response time or Reaction time, but Movement time was significantly longer (i.e. slower) with disruption of the contralesional hemisphere (p=0.015), regardless of which area was stimulated. Peak hand-path velocity and hand-path smoothness were also significantly lower (p=0.005 and p<0.0001, respectively) with TMS disruption of the contralesional hemisphere. The data from this study provide evidence supporting a functionally relevant role of contralesional hemisphere motor areas in paretic arm reaching movements in individuals with severe post-stroke arm impairment.

  4. A hybrid BMI-based exoskeleton for paresis: EMG control for assisting arm movements

    NASA Astrophysics Data System (ADS)

    Kawase, Toshihiro; Sakurada, Takeshi; Koike, Yasuharu; Kansaku, Kenji

    2017-02-01

    Objective. Brain-machine interface (BMI) technologies have succeeded in controlling robotic exoskeletons, enabling some paralyzed people to control their own arms and hands. We have developed an exoskeleton asynchronously controlled by EEG signals. In this study, to enable real-time control of the exoskeleton for paresis, we developed a hybrid system with EEG and EMG signals, and the EMG signals were used to estimate its joint angles. Approach. Eleven able-bodied subjects and two patients with upper cervical spinal cord injuries (SCIs) performed hand and arm movements, and the angles of the metacarpophalangeal (MP) joint of the index finger, wrist, and elbow were estimated from EMG signals using a formula that we derived to calculate joint angles from EMG signals, based on a musculoskeletal model. The formula was exploited to control the elbow of the exoskeleton after automatic adjustments. Four able-bodied subjects and a patient with upper cervical SCI wore an exoskeleton controlled using EMG signals and were required to perform hand and arm movements to carry and release a ball. Main results. Estimated angles of the MP joints of index fingers, wrists, and elbows were correlated well with the measured angles in 11 able-bodied subjects (correlation coefficients were 0.81  ±  0.09, 0.85  ±  0.09, and 0.76  ±  0.13, respectively) and the patients (e.g. 0.91  ±  0.01 in the elbow of a patient). Four able-bodied subjects successfully positioned their arms to adequate angles by extending their elbows and a joint of the exoskeleton, with root-mean-square errors  <6°. An upper cervical SCI patient, empowered by the exoskeleton, successfully carried a ball to a goal in all 10 trials. Significance. A BMI-based exoskeleton for paralyzed arms and hands using real-time control was realized by designing a new method to estimate joint angles based on EMG signals, and these may be useful for practical rehabilitation and the support of

  5. Bacterial Infection in Deep Paraspinal Muscles in a Parturient Following Epidural Analgesia

    PubMed Central

    Xue, Xuhong; Song, Jiefu; Liang, Qingyuan; Qin, Jibin

    2015-01-01

    Abstract Bacterial infection related to epidural catheterizations could occur. In general, the incidence of postoperative infection at the insertion site is very low. Paucity literatures are reported for paraspinal muscle infection after epidural analgesia in parturient. We report a case of paraspinal muscle infection shortly after epidural analgesia in a parturient, who was subjected to because of threatened preterm labor. Epidural morphine was administered for 2 days for childbirth pain control. She began to have constant low-back pain and fever on postpartum Day 2. Magnetic resonance image revealed a broad area of subcutaneous edema with a continuum along the catheter trajectory deep to the paraspinal muscles. A catheter-related bacterial infection was suspected. The surgical debridement and drainage was required combined with intravenous antibiotics on postpartum Day 3. She was soon cured uncomplicatedly. Epidural analgesia is effective to control labor pain and, in general, it is safe. However, the sequelae of complicated infection may be underestimated. A literature search yielded 7 other cases of catheter-related epidural abscess or soft tissue infection. Vigilance for these infections, especially in postpartum patients with backache, is needed. Moreover, early detection and proper treatment of infectious signs at postanesthetic visit are very important. PMID:26683923

  6. Chorioamnionitis in pregnancy: a comparative study of HIV-positive and HIV-negative parturients

    PubMed Central

    Ocheke, Amaka N; Agaba, Patricia A; Imade, Godwin E; Silas, Olugbenga A; Ajetunmobi, Olanrewaju I; Echejoh, Godwins; Ekere, Clement; Sendht, Ayuba; Bitrus, James; Agaba, Emmanuel I; Sagay, Atiene S

    2016-01-01

    Background Chorioamnionitis is an important risk factor for vertical transmission of HIV/AIDS. We compared the prevalence and correlates of chorioamnionitis in HIV-positive and HIV-negative pregnant women. Methods HIV-positive and -negative parturients were interviewed, examined and had their placenta examined histologically for chorioamnionitis. Data regarding HIV were also retrieved from their hospital records. Results A total of 298 parturients (150 HIV positive and 148 HIV negative) were enrolled. The two groups were similar in socio-demographic and obstetric parameters except for age. The prevalence of HCA was 57.1% in HIV-positive women and 61.6% in HIV-negative women (p = 0.43). HCA staging was associated with the number of intrapartum vaginal examinations in HIV-positive subjects and nulliparity in HIV-negative subjects. The number of intrapartum vaginal examinations and coitus in the week prior to delivery significantly affected the grade of HCA in HIV-negative subjects. Conclusion The prevalence of HCA in both HIV-positive and HIV-negative is high. Most variables did not affect the occurrence of histologic chorioamnionitis in both groups studied except number of intrapartum examinations, coitus in the preceding one week and nulliparity which were related to severity of the disease. PMID:25887063

  7. A survey of Papua New Guinean parturients at the Port Moresby General Hospital: sociodemographic and reproductive characteristics.

    PubMed

    Klufio, C A; Amoa, A B; Kariwiga, G

    1994-04-01

    A survey of 673 consecutive Papua New Guinea parturients carried out at the Port Moresby General Hospital between May and June 1990 showed that socioeconomic and educational factors played a part in predicting perinatal death. Mothers who have previously experienced a perinatal death are more likely to experience a second one.

  8. The Hsp72 response in peri-parturient dairy cows: relationships with metabolic and immunological parameters.

    PubMed

    Catalani, Elisabetta; Amadori, Massimo; Vitali, Andrea; Bernabucci, Umberto; Nardone, Alessandro; Lacetera, Nicola

    2010-11-01

    The study was aimed at assessing whether the peri-parturient period is associated with changes of intracellular and plasma inducible heat shock proteins (Hsp) 72 kDa molecular weight in dairy cows, and to establish possible relationships between Hsp72, metabolic, and immunological parameters subjected to changes around calving. The study was carried out on 35 healthy peri-parturient Holstein cows. Three, two, and one week before the expected calving, and 1, 2, 3, 4, and 5 weeks after calving, body conditions score (BCS) was measured and blood samples were collected to separate plasma and peripheral blood mononuclear cells (PBMC). Concentrations of Hsp72 in PBMC and plasma increased sharply after calving. In the post-calving period, BCS and plasma glucose declined, whereas plasma nonesterified fatty acids (NEFA) and tumor necrosis factor-alpha increased. The proliferative responses of PBMC to lipopolysaccharide (LPS) declined progressively after calving. The percentage of PBMC expressing CD14 receptors and Toll-like receptors (TLR)-4 increased and decreased in the early postpartum period, respectively. Correlation analysis revealed significant positive relationships between Hsp72 and NEFA, and between PBMC proliferation in response to LPS and the percentage of PBMC expressing TLR-4. Conversely, significant negative relationships were found between LPS-triggered proliferation of PBMC and both intracellular and plasma Hsp72. Literature data and changes of metabolic and immunological parameters reported herein authorize a few interpretative hypotheses and encourage further studies aimed at assessing possible cause and effect relationships between changes of PBMC and circulating Hsp72, metabolic, and immune parameters in dairy cows.

  9. Gene expression in pre-term, pre-labour and parturient canine placenta.

    PubMed

    Fellows, E J; Hazzard, T M; Kutzler, M A

    2012-12-01

    Matrix metalloproteinases (MMPs), tissue inhibitors of metalloproteinases (TIMPs), vascular endothelial growth factor (VEGF)-A, VEGF-A receptor (Flt-1) and KiSS-1 receptor (KiSS-1R) all play a role in trophoblast invasion in a number of mammalian species. However, mRNA expression of factors regulating trophoblast invasion has not been studied in dogs. Abnormal expression of these factors at the end of canine gestation may contribute to placental retention and/or subinvolution of placental sites. Therefore, we sought to determine the relative mRNA expression of these factors in canine chorioallantois tissue at 61 ± 1 day past the LH surge (pre-term; n = 4), following elective c-section at 64 ± 1 day past the LH surge prior to first-stage labour (pre-labour; n = 4) and following natural delivery (parturient; n = 3). Total RNA was isolated, real-time RT-PCR was performed, and relative expression was calculated using the relative quantitation (2-ΔΔCT) method. MMP-9 mRNA expression was significantly higher in pre-term samples compared to pre-labour and parturient samples. The results showed no significant difference between MMP-2, TIMP-2, VEGF-A and Flt-1 mRNA expression among the three groups. KiSS-1R mRNA was not expressed in any tissues studied. Gene expression of MMP-9 may be related to the onset of labour, whereas MMP-2, VEGF-A, Flt-1, TIMP-2 and KiSS-1R mRNA do not appear to play a role at the end of gestation in the dog.

  10. Julius Wagner-Jauregg and the Legacy of Malarial Therapy for the Treatment of General Paresis of the Insane

    PubMed Central

    Tsay, Cynthia J.

    2013-01-01

    Julius Wagner-Jauregg, a preeminent Austrian psychiatrist was awarded the Nobel Prize in Medicine in 1927 for the development of malaria therapy for the treatment of neurosyphilis, or general paresis of the insane. Despite being only one of three psychiatrists to win a Nobel Prize, he has faded from public consciousness and his name recognition pales in comparison to his contemporary and fellow Austrian, Sigmund Freud. This paper explores his contributions to the field of biological psychiatry and also touches upon reasons, such as the growing bioethics movement, his controversial affiliation with the Nazi Party, and the evolution of neurosyphilis, that explain why Wagner-Jauregg is not more widely celebrated for his contributions to the field of psychiatry, even though his malarial treatment could be considered the earliest triumph of biological psychiatry over psychoanalysis. PMID:23766744

  11. Neck abscess and vocal cord paresis: delayed complications of a self-extruded long fishbone stuck in throat.

    PubMed

    Vallamkondu, V; Carlile, S; Shakeel, M; Ah-See, K W

    2013-11-18

    A 57-year-old Caucasian man, otherwise fit and well, presented with a 2-week history of dysphagia, odynophagia. Two weeks prior to the presentation, he had felt a fishbone stuck in his throat which was self-extruded after 3 days. Subsequently he developed a right anterior neck swelling and hoarseness. Transnasal endoscopic examination of larynx revealed an injected and oedematous right hemilarynx with right vocal cord paresis. An ultrasound examination of the neck confirmed a collection in the neck on the right side, and frank pus was aspirated from the neck abscess and he responded well to conservative management. Subsequent examination in follow-up had shown complete recovery of vocal cord movement. The patient did not seek medical attention immediately after getting a 5 cm fishbone extruded from the throat which resulted in significant morbidity. All patients should be alerted to the possibility of delayed complications and they should be encouraged to seek urgent medical attention.

  12. The parturient with implanted spinal cord stimulator: management and review of the literature.

    PubMed

    Young, Adam C; Lubenow, Timothy R; Buvanendran, Asokumar

    2015-01-01

    Spinal cord stimulation (SCS) is an approved treatment for complex regional pain syndrome and other chronic pain conditions. These devices enable women with chronic pain to maintain relatively normal lives, with some encountering pregnancy. Use of previously implanted SCS systems in pregnant women is considered controversial due to lack of long-term prospective studies evaluating both maternal and fetal safety. Seven patients at a university pain clinic were identified as having SCS implanted before becoming pregnant. Data on these patients before, during, and after labor were collected through chart review and patient interview. Onset of labor varied among the 7 patients (2 preterm and 5 term). Mode of anesthesia for delivery included 4 neuraxial anesthetics, with 3 successfully obtaining an adequate level of anesthesia for delivery. Four general anesthetics were administered for cesarean delivery, one of which included a failed attempt at neuraxial anesthesia. All infants were born healthy. Management approaches and outcomes in our patients, as well as those previously reported are discussed within this article. Definitive conclusions cannot be drawn from this small cohort. We believe that management of a parturient with an implanted SCS requires careful planning between all peripartum physicians.

  13. Elective cesarean delivery in a parturient with Klippel-Feil syndrome.

    PubMed

    Kavanagh, T; Jee, R; Kilpatrick, N; Douglas, J

    2013-11-01

    Klippel-Feil syndrome is defined by congenital fusion of two or more cervical vertebrae and can be associated with abnormalities in multiple systems. Management poses challenges to the anesthesiologist, particularly in pregnancy. Cervical spine immobility and instability can make the management of the airway fraught with danger and vertebral column distortion may make neuraxial anesthesia unreliable. We present the management of a nulliparous patient with features consistent with Type I Klippel-Feil syndrome undergoing elective cesarean delivery. The patient had a potentially difficult airway and features consistent with an unstable cervical spine and severe thoracic and lumbar scoliosis. A combined spinal-epidural technique was used which initially provided satisfactory anesthesia, but ultimately proved inadequate despite use of the epidural component. Satisfactory anesthesia for surgery was eventually achieved with the addition of an intravenous remifentanil infusion. We review previous case reports discussing anesthetic management of parturients with Klippel-Feil syndrome, and describe the challenges encountered and lessons learned from management of this case.

  14. Pulmonary effects of bupivacaine and ropivacaine in parturients undergoing spinal anesthesia for elective cesarean delivery

    PubMed Central

    Geng, Guiqi; Li, Wenhui; Huang, Shaoqiang

    2014-01-01

    To study the change of maternal pulmonary function when ropivacaine and bupivacaine were used in spinal anesthesia for cesarean section, 40 ASA physical status I and II parturient scheduled to undergo cesarean section were randomly divided into bupivacaine and ropivacaine groups. Bupivacaine 9 mg and ropivacaine 14 mg were intrathecal injected respectively. FVC, FEV1 and PEFR were measured with spirometry before anesthesia and 2 h after intrathecal injection. Anesthesia level, the degree of motor block and VAS were also recorded. Results: The final level of sensory blockade was not different between groups. Forced vital capacity was significantly decreased with bupivacaine (3.0 ± 0.4 L to 2.7 ± 0.3 L, P < 0.05) and ropivacaine (2.9 ± 0.4 L to 2.5 ± 0.4 L, P < 0.05) while there were no difference between two groups. Forced expiratory volume during the first second and Peak expiratory flow rate were not decreased in each group. The degree of motor block in group R was less than group B at 2 h after intrathecal injection. Conclusions: Decreases in maternal pulmonary function tests were similar following spinal anaesthesia with bupivacaine or ropivacaine for cesarean section. The clinical maternal effects of these alterations appeared negligible. PMID:24995105

  15. The energy cost of level walking before and after hydro-kinesi therapy in patients with spastic paresis.

    PubMed

    Zamparo, P; Pagliaro, P

    1998-08-01

    In this study the energy cost of level walking was measured in 23 patients with stationary spastic paresis before and after a two-week treatment (45 min daily) of hydro-kinesi therapy, the latter consisting of passive and active movements in warm (32 degrees C) sea water, free swimming and water immersion walking. Among the subjects (80.2 +/- 13.2 kg body mass; 56.0 +/- 14.6 years of age; 10.7 +/- 6.6 years of duration of spasticity), 12 were affected by hemiparesis, 4 by multiple sclerosis and 7 by spinal cord injury. The energy cost of level walking (Cw) was measured before and after therapy from the ratio of the overall steady-state oxygen consumption to the effective speed of progression. The differences in Cw due to the treatment, at matched speeds, were found to be negligible at speeds higher than 0.75 m.s-1 (less than 5%) but to increase, with decreasing speed, up to about 17% at 0.1 m.s-1. The treatment was therefore effective in improving the gait characteristics of the subjects, through a decrease of their Cw, mainly at low speeds of progression.

  16. [Delayed paresis of the femoral nerve after total hip arthroplasty associated with hereditary neuropathy with liability to pressure palsies (HNPP)].

    PubMed

    Schuh, A; Dürr, V; Weier, H; Zeiler, G; Winterholler, M

    2004-07-01

    Delayed lesions of the femoral or sciatic nerve are a rare complication after total hip arthroplasty. Several cases in association with cement edges, scar tissue, broken cerclages, deep hematoma, or reinforcement rings have been published. We report about a 62-year-old female who developed a pure motor paresis of the quadriceps muscle 2 weeks after total hip arthroplasty. After electrophysiological evaluation had revealed an isolated femoral nerve lesion, revision of the femoral nerve was performed. During operative revision no pathologic findings could be seen. One week later the patient developed paralysis of the left wrist and finger extensors after using crutches. Electrophysiological evaluation revealed several nerve conduction blocks in physiological entrapments and the diagnosis of hereditary neuropathy with liability to pressure palsies (HNPP) was established. Hereditary neuropathy with liability to pressure palsies (HNPP) is a rare disease with increased vulnerability of the peripheral nerve system with mostly reversible sensorimotor deficits. It should be taken into consideration in cases of atypical findings of compression syndromes of peripheral nerves or delayed neuropathy, e. g., after total hip arthroplasty.

  17. Intrauterine Pressure (IUP) Telemetry in Pregnant and Parturient Rats: Potential Applications for Spacecraft and Centrifugation Studies

    NASA Technical Reports Server (NTRS)

    Ronca, A. E.; Baer, L. A.; Wade, C. E.

    2003-01-01

    Rats exposed to spaceflight or centrifugation from mid-to late pregnancy undergo either more or fewer labor contractions at birth, respectively, as compared to those in normal Earth gravity (1-g). In this paper, we report the development and validation of a new telemetric method for quantifying intrauterine pressure (IUP) in freely-moving, late pregnant and parturient rats. We plan to utilize this technique for studies of labor in altered gravity, specifically, to ascertain forces of uterine during birth, which we believe may be changed in micro- and hypergravity. The technique we describe yields precise, reliable measures of the forces experienced by rat fetuses during parturition. A small, surgically-implantable telemetric pressure sensor was fitted within a fluid-filled balloon. The total volume of the sensor-balloon assembly matched that of a full term rat fetus. Real-time videorecordings of sensor-implanted rat dams and non- implanted control dams enabled us to characterize effects of the intrauterine implant on behavioral aspects of parturition. Contraction frequency, duration, pup-to-pup birth intervals and pup-oriented activities of the dams measured during the peri-birth period were unaffected by the sensor implant. These findings establish intrauterine telemetry as a reliable, non-invasive technique for quantifying intrauterine pressures associated with parturition on Earth and in altered gravity environments. This new technology, readily amenable to spaceflight and centrifugation platforms, will enable us to answer key questions regarding the role of altered labor frequency labor in the adaptation of newborn mammals to hypo- and hypergravity.

  18. Prevalence of constipation and its influence on post-parturient disorders in tropical sows.

    PubMed

    Pearodwong, Pachara; Muns, Ramon; Tummaruk, Padet

    2016-03-01

    The present study aimed to investigate the prevalence of constipation and its influence on farrowing duration and the evidence of post-parturient disorders in tropical sows and to evaluate the efficacy of a laxative supplementation during gestation and around farrowing on the incidence of constipation. Two experiments were performed in a commercial swine herd in Thailand. In experiment 1, the prevalence of constipation was determined in 96 gestating sows. Subsequently, 62 of them (64.6 %), with a severe to moderate degree of constipation, received 20 ml of a laxative for 3 days during gestation. In experiment 2, constipation score was determined in sows before, during, and after farrowing. A total of 98 sows were randomly allocated to one of two groups: the treatment group (n = 48) received 20 ml of a laxative for 3 days before farrowing, and the control group (n = 50) did not receive any laxative. Rectal temperature, appetite score, incidence of postpartum dysgalactia syndrome (PDS), and vaginal discharge score was determined for 4 days. In experiment 1, supplementation of laxative reduced the proportion of sows with moderate to severe constipation (P < 0.05). In experiment 2, sows with moderate to very severe constipation had a 28-min longer duration of farrowing than sows with normal faeces. Constipation in sows on the day of farrowing resulted in reduced appetite on day 1 postpartum (P = 0.008). The incidence of sows with fever on day 1 postpartum was two times higher in sows with constipation than in sows with normal faeces (36.2 and 16.7 %, respectively; P = 0.041).

  19. Offspring-exposure reduces depressive-like behaviour in the parturient female rat.

    PubMed

    Pawluski, Jodi L; Lieblich, Stephanie E; Galea, Liisa A M

    2009-01-30

    In women, breastfeeding generally results in reductions in anxiety and increased positive mood. However, approximately 10-15% of women experience depressed mood and increased anxiety during the first year postpartum. Recent research has demonstrated that offspring-exposure is important for the reduction in behaviours related to depression and anxiety in the mother. It remains to be determined whether these effects are due to factors related to pregnancy and/or pup-exposure, are associated with the degree of maternal behaviour by the mother towards offspring, or persist after weaning. To address these questions the present study used four groups of female rats; primiparous, nulliparous, primip-no-pups (primiparous females with pups permanently removed), and sensitized females. Depressive- and anxiety-like behaviours were assessed 1 week after weaning/pup-exposure (4 weeks after birth for primip-no-pups animals) using the forced swim test for measures of depressive-like behaviour, and the open field test and elevated plus maze for measure of anxiety-like behaviour. Results demonstrate that primiparous females without pup-exposure have increased depressive-like, but not anxiety-like, behaviour compared to primiparous and sensitized females. In addition, kyphotic nursing by primiparous mothers was negatively related to behavioural measures of depression and anxiety. From this work it is clear that pup-exposure is important for reductions in depressive-like behaviour in parturient females. Further research is needed to determine the extent of these changes and the neural and hormonal correlates of these events.

  20. Risk of Chronic Low Back Pain Among Parturients Who Undergo Cesarean Delivery With Neuraxial Anesthesia

    PubMed Central

    Chia, Yuan-Yi; Lo, Yuan; Chen, Yan-Bo; Liu, Chun-Peng; Huang, Wei-Chun; Wen, Chun-Hsien

    2016-01-01

    Abstract To investigate the risk of chronic low back pain (LBP) in parturients undergoing cesarean delivery (CD) with neuraxial anesthesia (NA). LBP is common during pregnancy and also after delivery, but its etiology is poorly understood. Previous studies that investigated the correlation between epidural labor analgesia and chronic low back pain were inconclusive. These studies lacked objective diagnostic criteria for LBP and did not exclude possible confounders. We performed this nationwide population-based retrospective cohort study to explore the relationship between CD with NA and subsequent LBP. From the Taiwan National Health Insurance Research Database (NHIRD), we identified all primiparas who had given birth between January 1, 2000 and December 31, 2013. Using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes, we identified the women who had vaginal delivery (VD) and those who had CD. The mode of anesthesia was ascertained by the NHI codes. Multivariable logistic regression was used to estimate the odds of postpartum LBP in women undergoing CD with NA compared with those having VD. The outcome was a diagnosis of LBP according to the first ICD-9-CM diagnosis code. The patients were observed for 3 years after delivery or until diagnosis of postpartum LBP, withdrawal from the NHI system, death, or December 31, 2013. Of the 61,027 primiparas who underwent delivery during the observation period, 40,057 were eligible for inclusion in the study. Of these women, 27,097 (67.6%) received VD, 8662 (21.6%) received CD with spinal anesthesia, and 4298 (10.7%) received CD with epidural anesthesia (EA). Women who received CD with EA were found to have higher risk of LBP than did women who received VD, with the adjusted OR being 1.26 (95% CI: 1.17–1.34). CD with EA might increase the risk of subsequent chronic LBP. PMID:27100449

  1. Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening

    PubMed Central

    Haberfehlner, Helga; Jaspers, Richard T.; Rutz, Erich; Becher, Jules G.; Harlaar, Jaap; van der Sluijs, Johannes A.; Witbreuk, Melinda M.; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald

    2016-01-01

    To increase knee range of motion and improve gait in children with spastic paresis (SP), the semitendinosus muscle (ST) amongst other hamstring muscles is frequently lengthened by surgery, but with variable success. Little is known about how the pre-surgical mechanical and morphological characteristics of ST muscle differ between children with SP and typically developing children (TD). The aims of this study were to assess (1) how knee moment-angle characteristics and ST morphology in children with SP selected for medial hamstring lengthening differ from TD children, as well as (2) how knee moment-angle characteristics and ST morphology are related. In nine SP and nine TD children, passive knee moment-angle characteristics and morphology of ST (i.e. fascicle length, muscle belly length, tendon length, physiological cross-sectional area, and volume) were assessed by hand-held dynamometry and freehand 3D ultrasound, respectively. At net knee flexion moments above 0.5 Nm, more flexed knee angles were found for SP compared to TD children. The measured knee angle range between 0 and 4 Nm was 30% smaller in children with SP. Muscle volume, physiological cross-sectional area, and fascicle length normalized to femur length were smaller in SP compared to TD children (62%, 48%, and 18%, respectively). Sixty percent of the variation in knee angles at 4 Nm net knee moment was explained by ST fascicle length. Altered knee moment-angle characteristics indicate an increased ST stiffness in SP children. Morphological observations indicate that in SP children planned for medial hamstring lengthening, the longitudinal and cross-sectional growth of ST muscle fibers is reduced. The reduced fascicle length can partly explain the increased ST stiffness and, hence, a more flexed knee joint in these SP children. PMID:27861523

  2. How muscles recover from paresis and atrophy after intramuscular injection of botulinum toxin A: Study in juvenile rats.

    PubMed

    Shen, Jian; Ma, Jianjun; Lee, Cassandra; Smith, Beth P; Smith, Thomas L; Tan, Kim H; Koman, L Andrew

    2006-05-01

    Botulinum toxin A (BoNT-A) is a potent biological toxin widely used for the management of skeletal muscle spasticity or dynamic joint contracture. Intramuscular injection of BoNT-A causes muscle denervation, paresis, and atrophy. This clinical effect of botulinum toxin A lasts 3 to 6 months, and injected muscle eventually regains muscle mass and recovers muscle function. The goal of the present study was to characterize the molecular and cellular mechanisms leading to neuromuscular junction (NMJ) regeneration and skeletal muscle functional recovery after BoNT-A injection. Fifty-six 1-month-old Sprague-Dawley rats were used. Botulinum toxin A was injected into the left gastrocnemius muscle at a dosage of 6 units/kg body weight. An equivalent volume of saline was injected into the right gastrocnemius muscle to serve as control. The gastrocnemius muscle samples were harvested from both hind limbs at 3 days, 7 days, 15 days, 30 days, 60 days, 90 days, 180 days, and 360 days after administration of toxin. In addition, the gastrocnemius muscles from 1-month-old rats with no injections were harvested to serve as uninjected control group. Muscle samples were processed and mRNA was extracted. Real-time polymerase chain reaction (PCR) and gene microarray technology were used to identify key molecules involved in NMJ stabilization and muscle functional recovery. More than 28,000 rat genes were analyzed and approximately 9000 genes are expressed in the rat gastrocnemius muscle. Seven days following BoNT-A injection, 105 genes were upregulated and 59 genes were downregulated. Key molecules involved in neuromuscular junction (NMJ) stabilization and muscle functional recovery were identified and their time course of gene expression following BoNT-A injection were characterized. This animal study demonstrates that following intramuscular injection of BoNT-A, there is a sequence of cellular events that eventually leads to NMJ stabilization, remodeling, and myogenesis and muscle

  3. [The Mysterious Paresis].

    PubMed

    Biskup, Ewelina; Necek, Magdalena; Changjin, Qu; Xue, Guanhua

    2016-04-27

    Internal jugular central venous line placement is a standardized and common clinical procedure. However, even the most skillful physician may face complications. Careful patient evaluation and detailed vascular anatomical knowledge can minimize the risk of iatrogenic injuries. Following a strict protocol in case of unsuccessful attempts of venous puncture helps to improve patient outcome. In this case report, we present a patient who suffered an unusual injury. Further, we discuss current treatment options for pseudoaneurysms.

  4. Influence of gestational diabetes on the stereoselective pharmacokinetics and placental distribution of metoprolol and its metabolites in parturients

    PubMed Central

    Antunes, Natalícia de Jesus; Cavalli, Ricardo Carvalho; Marques, Maria Paula; Moisés, Elaine Christine Dantas; Lanchote, Vera Lucia

    2015-01-01

    AIM To investigate the influence of gestational diabetes mellitus (GDM) on the kinetic disposition and transplacental and amniotic fluid distribution of metoprolol and its metabolites O-desmethylmetoproloic acid and α-hydroxymetoprolol stereoisomers in hypertensive parturients receiving a single dose of the racemic drug. METHODS The study was conducted on hypertensive parturients with well-controlled GDM (n = 11) and non-diabetic hypertensive parturients (n = 24), all receiving a single 100 mg oral dose of racemic metoprolol tartrate before delivery. Serial maternal blood samples (0–24 h) and umbilical blood and amniotic fluid samples were collected for the quantitation of metoprolol and its metabolite stereoisomers using LC-MS/MS or fluorescence detection. RESULTS The kinetic disposition of metoprolol and its metabolites was stereoselective in the diabetic and control groups. Well-controlled GDM prolonged tmax for both enantiomers of metoprolol (1.5 vs. 2.5 h R-(+)-MET; 1.5 vs. 2.75 h S-(−)-MET) and O-desmethylmetoproloic acid (2.0 vs. 3.5 h R-(+)-AOMD; 2.0 vs. 3.0 h S-(−)-OAMD), and for the four stereoisomers of α-hydroxymetoprolol (2.0 vs. 3.0 h for 1′S,2R-, 1′R,2R- and 1′R,2S-OHM; 2.0 vs. 3.5 h for 1′S,2S-OHM) and reduced the transplacental distribution of 1′S,2S-, 1′R,2R-, and 1′R,2S-OHM by approximately 20%. CONCLUSIONS The kinetic disposition of metoprolol was enantioselective, with plasma accumulation of the S-(−)-MET eutomer. Well-controlled GDM prolonged the tmax of metoprolol and O-desmethylmetoproloic acid enantiomers and the α-hydroxymetoprolol stereoisomers and reduced by about 20% the transplacental distribution of 1′S,2S-, 1′R,2R-, and 1′R,2S-OHM. Thus, well-controlled GDM did not change the activity of CYP2D6 and CYP3A involved in metoprolol metabolism. PMID:25291152

  5. Partially irreversible paresis of the deep peroneal nerve caused by osteocartilaginous exostosis of the fibula without affecting the tibialis anterior muscle.

    PubMed

    Paprottka, Felix Julian; Machens, Hans-Günther; Lohmeyer, Jörn Andreas

    2012-08-01

    Dysfunction of the lower limb's muscles can cause severe impairment and immobilisation of the patient. As one of the leg's major motor and sensory nerves, the deep peroneal nerve (synonym: deep fibular nerve) plays a very important role in muscle innervation in the lower extremities. We report the case of a 19-year-old female patient, who suffered from a brace-like exostosis 6-cm underneath her left fibular head causing a partially irreversible paresis of her deep peroneal nerve. This nerve damage resulted in complete atrophy of her extensor digitorum longus and extensor hallucis longus muscle, and in painful sensory disturbance at her left shin and first web space. The tibialis anterior muscle stayed intact because its motor branch left the deep peroneal nerve proximal to the nerve lesion. Diagnosis was first verified 6 years after the onset of symptoms by a magnetic resonance imaging (MRI) scan of her complete left lower leg. Subsequently, the patient was operated on in our clinic, where a neurolysis was performed and the 4-cm-long osteocartilaginous exostosis was removed. Paralysis was already irreversible but sensibility returned completely after neurolysis. The presented case shows that an osteocartilaginous exostosis can be the cause for partial deep peroneal nerve paresis. If this disorder is diagnosed at an early stage, nerve damage is reversible. Typical for an exostosis is its first appearance during the juvenile growth phase.

  6. Stationary facial nerve paresis after surgery for recurrent parotid pleomorphic adenoma: a follow-up study of 219 cases in Denmark in the period 1985-2012.

    PubMed

    Nøhr, Anders; Andreasen, Simon; Therkildsen, Marianne Hamilton; Homøe, Preben

    2016-10-01

    The purpose was to assess degree of permanent facial nerve dysfunction after surgery for recurrent pleomorphic adenoma (RPA) of the parotid gland, including variables that might influence re-operation outcomes. Nationwide retrospective longitudinal cohort study including a questionnaire survey of patients undergoing surgery for RPA. Of 219 living patients, 198 (92 %) responded and 127 (63 %) reported no facial dysfunction. Statistically significant associations were found between number of surgeries and permanent facial nerve dysfunction of all degrees (OR 1.43, 95 % CI 1.16-1.78, p = 0.001). A not significant tendency for females to be associated with worse outcome was found (p = 0.073). Risks of different degrees of paresis after the second-fourth surgeries were found (OR 1.86-2.19, p < 0.05). Our study demonstrates a significant correlation between number of surgeries for RPA of the parotid and severity of facial nerve paresis. This is important when informing and planning treatment of these patients.

  7. Therapeutic synergism in the treatment of post-stroke arm paresis utilizing botulinum toxin, robotic therapy, and constraint-induced movement therapy.

    PubMed

    Takebayashi, Takashi; Amano, Satoru; Hanada, Keisuke; Umeji, Atsushi; Takahashi, Kayoko; Koyama, Tetsuo; Domen, Kazuhisa

    2014-11-01

    Botulinum toxin type A (BtxA) injection, constraint-induced movement therapy (CIMT), and robotic therapy (RT) each represent promising approaches to enhance arm motor recovery after stroke. To provide more effective treatment for a 50-year-old man with severe left spastic hemiparesis, we attempted to facilitate CIMT with adaptive approaches to extend the wrist and fingers using RT for 10 consecutive weeks after BtxA injection. This combined treatment resulted in substantial improvements in arm function and the amount of arm use in activities of daily living, and may be effective for stroke patients with severe arm paresis. However, we were unable to sufficiently prove the efficacy of combined treatment based only on a single case. To fully elucidate the efficacy of the combined approach for patients with severe hemiparesis after stroke, future studies of a larger number of patients are needed.

  8. A petrogenetic study of anorogenic felsic magmatism in the Cretaceous Paresis ring complex, Namibia: evidence for mixing of crust and mantle-derived components

    NASA Astrophysics Data System (ADS)

    Mingram, B.; Trumbull, R. B.; Littman, S.; Gerstenberger, H.

    2000-10-01

    Paresis is one of a group of Cretaceous ring complexes extending from the coast some 350 km NE across the Damara Belt. It consists of over 90% rhyolites and comendites, with subordinate intrusions of quartz syenite and alkali-feldspar syenite. These felsic units are accompanied by very minor amounts of silica-undersaturated basalt, phonolite and lamprophyre. Located near the edge of the Congo Craton, Paresis is the farthest inland of any felsic complex in the Cretaceous ring complex group. The other ring complexes in the vicinity consist of carbonatites and undersaturated alkaline rocks (e.g., Okorusu, Kalkfeld, Etaneno, Ondurakorume). Geochemical and isotopic data provide evidence for both mantle and crustal components in the sources of the Paresis magmas. The alkaline basalts, phonolite and lamprophyre have overlapping Sr and Nd isotopic initial ratios which plot within the mantle array close to bulk-earth values ( ɛNd=-0.9 to -2.8 and 87Sr/ 86Sr(i)=0.7042-0.7054) and may indicate a mantle plume component. The rhyolite units comprise metaluminous feldspar rhyolites and peraluminous, more differentiated quartz-feldspar rhyolites. Both units show prominent negative Nb and Ta anomalies on mantle-normalized multielement diagrams and have extremely nonradiogenic Nd ratios ( ɛNd=-21) and Sr initial ratios of 0.7117-0.7138. These isotopic values suggest a crustal origin from pre-Damara (Early Precambrian) gneisses and granitoids, which are exposed in the Congo craton and related inliers in northern Namibia. The comendites are peralkaline, highly differentiated rocks. In contrast to the rhyolites, comendites lack mantle-normalized Nb and Ta anomalies, have higher HFSE and LREE contents, extreme negative Eu anomalies and ɛNd values of -11. Like the comendites, alkali-feldspar syenites are peralkaline, lack Nb and Ta anomalies, have negative Eu anomalies and high HFSE concentrations. Their ɛNd values are -6.5 to -8. The quartz syenites overlap with the peralkaline

  9. Electrical stimulation-supported voice exercises are superior to voice exercise therapy alone in patients with unilateral recurrent laryngeal nerve paresis: results from a prospective, randomized clinical trial.

    PubMed

    Ptok, Martin; Strack, Daniela

    2008-08-01

    For more than 40 years, electrical stimulation procedures for unilateral recurrent laryngeal nerve paresis (URLNP) therapy have been proposed. However, it is unclear whether electrical stimulation therapy is effective for URLNP patients. In this study we compare the outcome of traditional voice exercise treatment (VE) with electrical stimulation-supported voice exercise (ES). A total of 90 URLNP patients were recruited to participate in a prospective, randomized trial. The decrease in vocal fold irregularity (CFx) and increase in maximum phonation time (MPT) after a 3-month therapy period were the dependent variables. In the ES group, CFx improved to a significantly greater extent than in the VE group. MPT increased similarly in both groups. Our data indicate that ES is superior to VE for patients with URLNP. Because no further data exist, it can be assumed that improvement following VE only reflects spontaneous recovery. However ES appears to be an effective non-surgical therapeutic procedure.

  10. Utilization of "Stand-By" Extracorporeal Membrane Oxygenation in a High-Risk Parturient With Methamphetamine-Associated Cardiomyopathy Undergoing Dilation and Evacuation: A Case Report.

    PubMed

    Padilla, Cesar; Hernandez Conte, Antonio; Ramzy, Danny; Lubin, Lorraine; LaBounty, Troy; Chung, Judith H; Zeng, Ying

    2017-03-01

    Parturients may present with evidence of acute heart failure or respiratory distress during the peripartum period. This case report documents utilization of "stand-by" extracorporeal membrane oxygenation (ECMO) for a 40-year-old woman with a history of severe left ventricular dysfunction who presented for elective dilation and evacuation of triplets at 20 weeks' gestation. The patient's medical history was significant for hypertension, diabetes mellitus, methamphetamine use (acute/chronic), and cardiac-respiratory arrest before her previous emergent cesarean delivery. The patient underwent general anesthesia with the placement of peripheral venous and arterial cannulas for "stand-by" ECMO. The patient remained stable throughout the procedure, and "stand-by" ECMO was not initiated; the patient was discharged 5 days' postprocedure. The use of "stand-by" ECMO in the parturient with severe cardiopulmonary dysfunction is still in its infancy. Centers managing populations of both high-risk parturients and nonparturients may consider development of algorithms for implementation and utilization of ECMO.

  11. Reported Pain During Labour – A Qualitative Study of Influencing Factors among Parturient During Confinement in Private or Government Hospital

    PubMed Central

    Ravishankar, M.; Hemanthkumar, V.R.

    2016-01-01

    Introduction Labour pain is distressing and it produces undue side effects both to the mother and the baby. The incidence is high in developing countries like India where the awareness about labour analgesia is still lacking. Aim It is to find out the incidence of labour pain and the influence of various described factors on pain with a comparison between patients admitted in a government set up with a private set up in a south Indian semi-urban area. Materials and Methods Two hundred continuous uneventful normal deliveries each in a Government (group G) and a private hospital (group P) were enrolled for the study. The reported pain during labour was noted 6-7 hours after delivery by interacting with the patient. The factors like age of the mother, sex and weight of the baby, literacy, socioeconomic status, the use of oxytocics and analgesia were evaluated. Results The incidence of severe pain was more in group G (43.5%) than group P (12%). There was no analgesic intervention in 68.5% in group G while it was 13.5% (27/200) in group P. Even among these 27 patients who did not receive analgesics, only three parturients reported severe pain. Even administration of analgesics in a Government set up did not decrease pain to a significant extent. There were richer and more literate patients in group P. Booked cases were less in group G. Logistic regression analyses to find out factors which influenced pain in either group was used. Gravida, analgesic intervention and admission in a Govt. hospital influenced the pain experience of the parturient. There was minimal antenatal preparation in both the groups. There were no post partum complications. Conclusion Mothers suffered from labour pain to a significant extent and there is an urgent need for awareness about labour analgesia. Primigravida, admission in a Govt. set up and analgesic interventions were the factors which influenced pain than others. Patients admitted in Govt. hospitals suffered more pain with less analgesic

  12. Parturient hypocalcemia in jersey cows fed alfalfa haylage-based diets with different cation to anion ratios.

    PubMed

    Gaynor, P J; Mueller, F J; Miller, J K; Ramsey, N; Goff, J P; Horst, R L

    1989-10-01

    Jersey cows were fed three alfalfa haylage-based diets with different cation-anion balances beginning 6 wk preceding third or later calving and ending 24 to 36 h postpartum. Sodium and Cl as percentages of dietary DM were .08 and 1.66 in diet 1 (anionic, 5 cows), .44 and .91 in diet 2 (intermediate, 6 cows), and 1.60 and .34 in diet 3 (cationic, 6 cows). Cation-anion balances were 22, 60, and 126 meq/100 g DM; Ca:P ratios averaged 4:1. Cows fed diet 1 in comparison with cows fed diets 2 or 3 over 6 wk had similar concentrations of Ca, P, and Na but higher concentrations of Mg and K in plasma and higher urinary excretions of Ca and Mg. Concentrations of 1,25-dihydroxyvitamin D 3 d before parturition were higher in cows fed diet 1 than in cows fed diets 2 or 3. Within 36 h after calving, mean concentrations of Ca in plasma (mg/dl, range) of cows fed diets 1 to 3, respectively, were 7 (8.7 to 6.2), 6.5 (7.8 to 3.9), and 6.3 (7.8 to 3.8). Number of cases of clinical milk fever by diet were 0 of 5, 2 of 6, and 1 of 6 cows. Alteration of dietary cation-anion balance by addition of Cl may effectively reduce incidence and severity of parturient hypocalcemia.

  13. Depiction of facial nerve paresis in the gallery of portraits carved in stone by George Matthew the Dalmatian on the Sibenik Cathedral dating from the 15th century.

    PubMed

    Skrobonja, Ante; Culina, Tatjana

    2011-06-01

    The introductory segment of this paper briefly describes George Matthew the Dalmatian, the architect who, between 1441 and 1473, oversaw the construction of the Cathedral of St. James in Sibenik, a city on the Croatian side of the Adriatic coast. Of the most impressive details included in this monumental construction and sculptural flamboyant gothic production infused with distinctive Dalmatian spirit is a frieze of 71 stone and three lion portraits encircling the outer apse wall. From the intriguing amalgamation of portraits of anonymous people this master came across in his surrounding, the fiftieth head in the row has been selected for this occasion. On the face of a younger man the authors have recognized and described pathognomonic right-sided facial nerve paresis. The question posed here is whether this is coincidental or it represents the master's courage, given that instead of famous people in the cathedral he situated not only ordinary people but also those "labelled" and traditionally marginalized, thus, in the most beautiful manner, foreshadowing the forthcoming spirit of Humanism and Renaissance in Croatian and European art.

  14. Use of a robotic device for the rehabilitation of severe upper limb paresis in subacute stroke: exploration of patient/robot interactions and the motor recovery process.

    PubMed

    Duret, Christophe; Courtial, Ophélie; Grosmaire, Anne-Gaëlle; Hutin, Emilie

    2015-01-01

    This pioneering observational study explored the interaction between subacute stroke inpatients and a rehabilitation robot during upper limb training. 25 stroke survivors (age 55 ± 17 years; time since stroke, 52 ± 21 days) with severe upper limb paresis carried out 16 sessions of robot-assisted shoulder/elbow training (InMotion 2.0, IMT, Inc., MA, USA) combined with standard therapy. The values of 3 patient/robot interaction parameters (a guidance parameter: Stiffness, a velocity-related parameter: Slottime, and Robotic Power) were compared between sessions 1 (S1), 4 (S4), 8 (S8), 12 (S12), and 16 (S16). Pre/post Fugl-Meyer Assessment (FMA) scores were compared in 18 patients. Correlations between interaction parameters and clinical and kinematic outcome measures were evaluated. Slottime decreased at S8 (P = 0.003), while Guidance decreased at S12 (P = 0.008). Robotic Power tended to decrease until S16. FMA scores improved from S1 to S16 (+49%, P = 0.002). Changes in FMA score were correlated with the Stiffness parameter (R = 0.4, P = 0.003). Slottime was correlated with movement velocity. This novel approach demonstrated that a robotic device is a useful and reliable tool for the quantification of interaction parameters. Moreover, changes in these parameters were correlated with clinical and kinematic changes. These results suggested that robot-based recordings can provide new insights into the motor recovery process.

  15. Use of a Robotic Device for the Rehabilitation of Severe Upper Limb Paresis in Subacute Stroke: Exploration of Patient/Robot Interactions and the Motor Recovery Process

    PubMed Central

    Courtial, Ophélie; Grosmaire, Anne-Gaëlle; Hutin, Emilie

    2015-01-01

    This pioneering observational study explored the interaction between subacute stroke inpatients and a rehabilitation robot during upper limb training. 25 stroke survivors (age 55 ± 17 years; time since stroke, 52 ± 21 days) with severe upper limb paresis carried out 16 sessions of robot-assisted shoulder/elbow training (InMotion 2.0, IMT, Inc., MA, USA) combined with standard therapy. The values of 3 patient/robot interaction parameters (a guidance parameter: Stiffness, a velocity-related parameter: Slottime, and Robotic Power) were compared between sessions 1 (S1), 4 (S4), 8 (S8), 12 (S12), and 16 (S16). Pre/post Fugl-Meyer Assessment (FMA) scores were compared in 18 patients. Correlations between interaction parameters and clinical and kinematic outcome measures were evaluated. Slottime decreased at S8 (P = 0.003), while Guidance decreased at S12 (P = 0.008). Robotic Power tended to decrease until S16. FMA scores improved from S1 to S16 (+49%, P = 0.002). Changes in FMA score were correlated with the Stiffness parameter (R = 0.4, P = 0.003). Slottime was correlated with movement velocity. This novel approach demonstrated that a robotic device is a useful and reliable tool for the quantification of interaction parameters. Moreover, changes in these parameters were correlated with clinical and kinematic changes. These results suggested that robot-based recordings can provide new insights into the motor recovery process. PMID:25821804

  16. Influence of macro and micro minerals in the peri-parturient period on fertility in dairy cattle.

    PubMed

    Wilde, D

    2006-12-01

    Infertility in dairy cattle is a complex, multi-factorial problem that cannot be evaluated in isolation of other diseases and disorders. Clearly there is a role for the prevention of problems in the peri-parturient period, in particular hypocalcaemia, mastitis, lameness and retained placenta (RP), that all have a negative impact on the subsequent fertility of the cow. Minerals, trace elements and vitamins play a vital role in the prevention of these disorders at this time. Macro minerals are involved in the acid base status of the dairy cow and influence calcium metabolism. The use of anionic salts in combination with adequate calcium and magnesium supplementation may help to improve dry matter intakes and reduce negative energy balance in the post-calving period as well as prevent hypocalcaemia. Vitamin E and zinc are effective in prevention of mastitis that occurs predominantly in the first weeks of lactation, through enhanced antioxidant function and keratinisation of the teat canal. Lameness in dairy cattle also occurs mainly in lactation though most of the original insults to the hoof can occur prior to calving. Zinc and biotin are implicated in improving keratinisation of the hoof and prevention of this disease. Organic forms of zinc are retained better than inorganic sources and may provide greater benefit in disease prevention. Retained placenta can be reduced by prevention of hypocalcaemia and also adequate selenium status of the dairy cow. Selenium yeast is known to have higher retention in tissues and may play an important role in ensuring sufficient selenium is available to the cow for reduction of disease.

  17. Charcot–Marie–Tooth disease type 1A duplication with severe paresis of the proximal lower limb muscles: a long‐term follow‐up study

    PubMed Central

    Berciano, J; Gallardo, E; García, A; Infante, J; Mateo, I; Combarros, O

    2006-01-01

    Objective To describe a large pedigree with Charcot–Marie–Tooth disease type 1A (CMT1A) duplication in which severe pelvic and thigh musculature weakness occurred in two patients, detected by analysing the leg muscle atrophy pattern on magnetic resonance imaging (MRI). Methods The pedigree comprised 18 patients, aged between 15 and 85 (median 46) years, who were serially evaluated for up to three decades. All 18 patients and 13 non‐affected at‐risk people underwent electrophysiological examination. An MRI study of lower limb musculature was carried out in four patients. Three patients underwent sural‐nerve biopsy. Genetic testing was carried out in 17 patients and in all 13 at‐risk normal people. Results Fourteen patients were asymptomatic or slightly disabled. The two oldest patients, aged 84 and 80, showed a moderate phenotype. Two other patients, aged 70 and 53, showed late‐onset and gradually progressive peroneal paresis extending up to the thigh and pelvic musculature, resulting in waddling gait. MRI scans of all three patients with a mild phenotype showed subtle and subclinical fatty infiltration of calf anterolateral muscle compartments, with thigh muscle involvement in one patient, and extensive atrophy of intrinsic foot muscles. In the youngest patient with proximal leg weakness, the MRI scan showed massive fatty atrophy of all the calf muscles, posteromedial thigh muscle compartments, and internal and external hip rotator muscles. Sural‐nerve biopsy specimens showed hypertrophic neuropathy with no superimposed inflammation. Good correlation was seen between electrophysiological and genetic testing. Conclusions Late in the clinical course, a small proportion of patients with CMT1A develop severe proximal leg weakness, and long‐term follow‐up is essential for its detection. MRI scans may show subclinical involvement of the thigh musculature. PMID:16788010

  18. Prevalence of hospitalized live births affected by alcohol and drugs and parturient women diagnosed with substance abuse at liveborn delivery: United States, 1999-2008.

    PubMed

    Pan, I-Jen; Yi, Hsiao-ye

    2013-05-01

    To describe prevalence trends in hospitalized live births affected by placental transmission of alcohol and drugs, as well as prevalence trends among parturient women hospitalized for liveborn delivery and diagnosed with substance abuse problems in the United States from 1999 to 2008. Comparison of the two sets of trends helps determine whether the observed changes in neonatal problems over time were caused by shifts in maternal substance abuse problems. This study independently identified hospitalized live births and maternal live born deliveries from discharge records in the Nationwide Inpatient Sample, one of the largest hospital administrative databases. Substance-related diagnosis codes on the records were used to identify live births affected by alcohol and drugs and parturient women with substance abuse problems. The analysis calculated prevalence differences and percentage changes over the 10 years, with Loess curves fitted to 10-year prevalence estimates to depict trend patterns. Linear and quadratic trends in prevalence were simultaneously tested using logistic regression analyses. The study also examined data on costs, primary expected payer, and length of hospital stays. From 1999 to 2008, prevalence increased for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid. The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women to reduce the number of substance-affected live births.

  19. Ultrasound-guided epidural anesthesia for a parturient with severe malformations of the skeletal system undergoing cesarean delivery: a case report

    PubMed Central

    Luo, LinLi; Ni, Juan; Wu, Lan; Luo, Dong

    2015-01-01

    Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients’ complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided epidural anesthesia was performed in the L1–L2 space, followed by an intravenous administration of ketamine (0.5 mg/kg) for sedation and analgesia. Satisfactory anesthesia was provided to the patient and spontaneous ventilation was maintained during the surgery. The mother and the baby were discharged 5 days after surgery, no complications were reported for either of them. Our work demonstrated that an ultrasound-guided epidural anesthesia combined with low-dose ketamine can be used to successfully maintain spontaneous ventilation and provide effective analgesia during surgery and reduce the risk of postoperative anesthesia-related pulmonary infection. PMID:25999759

  20. [The relationship between the peri-parturient period and output of nematodes eggs in naturally infected Anglo Nubiana goats in a semi-extensive system of production].

    PubMed

    Pinto, Jaqueline Maria Da S; De Oliveira, Marcos Antônio L; Alvares, Caio Tácito; Costa-Dias, Roberta; Dos Santos, Maico Henrique

    2008-09-01

    The purpose of this study was to identify the relationship between the excretion of nematodes eggs in naturally infected Anglo-Nubians breed goats under conditions of semi-extensive production system and the peri-parturient period. Were used 63 goats, with weight average 35, 05 +/- 6, 54 kg and reproductive cycle from goats. Animals were separated and two groups homogeneous as to the age and nutritional status and two groups (pregnants and nonpregnants). Faecal samples were collected weekly during the periparturient period (ended four weeks of pregnancy and the four first weeks of post-parturition) and equal dates in non-pregnants group. The group of pregnant animals showed increasing EPG (eggs per gram of faeces) in the 5th and 8th week of collection and animals not pregnant and in the 5th and 6th week. The highest counts of EPG were coincident with the highest concentration of births; there is a direct relationship between to release eggs from gastrointestinal nematodes in the female goats, near to birth.

  1. Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report.

    PubMed

    Lee, Jae Woo; Song, In Ae; Ryu, Junghee; Park, Hee-Pyoung; Jeon, Young-Tae; Hwang, Jung-Won

    2014-10-01

    Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach.

  2. Anesthetic management of a parturient with placenta previa totalis undergoing preventive uterine artery embolization before placental expulsion during cesarean delivery: a case report

    PubMed Central

    Lee, Jae Woo; Song, In Ae; Ryu, Junghee; Jeon, Young-Tae; Hwang, Jung-won

    2014-01-01

    Placenta previa totalis can cause life-threatening massive postpartum hemorrhage, and careful anesthetic management is essential. Preventive uterine artery embolization (UAE) before placental expulsion was introduced to reduce postpartum bleeding in cases of placenta previa totalis. We describe the case of a 40-year-old woman (gravida 0, para 0) with placenta previa totalis and uterine myomas who underwent intraoperative UAE, which was preoperatively planned at the strong recommendation of the anesthesiologist, immediately after delivery of a fetus and before removal of the placenta during cesarean delivery under spinal-epidural anesthesia. After confirming embolization of both uterine arteries, removal of the placenta resulted in moderate bleeding. The estimated blood loss was 2.5 L, and 5 units of red blood cells were transfused. The parturient was discharged uneventfully on postoperative day 4. This case shows that the bleeding risk is reduced by intraoperative UAE in a patient with placenta previa totalis, and anesthesiologists have an important role in a multidisciplinary team approach. PMID:25368788

  3. Could local dynamic stability serve as an early predictor of falls in patients with moderate neurological gait disorders? A reliability and comparison study in healthy individuals and in patients with paresis of the lower extremities.

    PubMed

    Reynard, Fabienne; Vuadens, Philippe; Deriaz, Olivier; Terrier, Philippe

    2014-01-01

    Falls while walking are frequent in patients with muscular dysfunction resulting from neurological disorders. Falls induce injuries that may lead to deconditioning and disabilities, which further increase the risk of falling. Therefore, an early gait stability index would be useful to evaluate patients in order to prevent the occurrence of future falls. Derived from chaos theory, local dynamic stability (LDS), defined by the maximal Lyapunov exponent, assesses the sensitivity of a dynamic system to small perturbations. LDS has already been used for fall risk prediction in elderly people. The aim of the present study was to provide information to facilitate future researches regarding gait stability in patients with neurological gait disorders. The main objectives were 1) to evaluate the intra-session repeatability of LDS in patients and 2) to assess the discriminative power of LDS to differentiate between healthy individuals and neurological patients. Eighty-three patients with mild to moderate neurological disorders associated with paresis of the lower extremities and 40 healthy controls participated in the study. The participants performed 2×30 s walking wearing a 3D accelerometer attached to the lower back, from which 2×35 steps were extracted. LDS was defined as the average exponential rate of divergence among trajectories in a reconstructed state-space that reflected the gait dynamics. LDS assessed along the medio-lateral axis offered the highest repeatability and discriminative power. Intra-session repeatability (intraclass correlation coefficient between the two repetitions) in the patients was 0.89 and the smallest detectable difference was 16%. LDS was substantially lower in the patients than in the controls (33% relative difference, standardized effect size 2.3). LDS measured in short over-ground walking tests seems sufficiently reliable. LDS exhibits good discriminative power to differentiate fall-prone individuals and opens up the possibility of

  4. Dexmedetomidine for an awake fiber-optic intubation of a parturient with Klippel-Feil syndrome, Type I Arnold Chiari malformation and status post released tethered spinal cord presenting for repeat cesarean section.

    PubMed

    Shah, Tanmay H; Badve, Manasi S; Olajide, Kowe O; Skorupan, Havyn M; Waters, Jonathan H; Vallejo, Manuel C

    2011-07-01

    Patients with Klippel-Feil Syndrome (KFS) have congenital fusion of their cervical vertebrae due to a failure in the normal segmentation of the cervical vertebrae during the early weeks of gestation and also have myriad of other associated anomalies. Because of limited neck mobility, airway management in these patients can be a challenge for the anesthesiologist. We describe a unique case in which a dexmedetomidine infusion was used as sedation for an awake fiber-optic intubation in a parturient with Klippel-Feil Syndrome, who presented for elective cesarean delivery. A 36-year-old female, G2P1A0 with KFS (fusion of cervical vertebrae) who had prior cesarean section for breech presentation with difficult airway management was scheduled for repeat cesarean delivery. After obtaining an informed consent, patient was taken in the operating room and non-invasive monitors were applied. Dexmedetomidine infusion was started and after adequate sedation, an awake fiber-optic intubation was performed. General anesthetic was administered after intubation and dexmedetomidine infusion was continued on maintenance dose until extubation. Klippel-Feil Syndrome (KFS) is a rare congenital disorder for which the true incidence is unknown, which makes it even rare to see a parturient with this disease. Patients with KFS usually have other congenital abnormalities as well, sometimes including the whole thoraco-lumbar spine (Type III) precluding the use of neuraxial anesthesia for these patients. Obstetric patients with KFS can present unique challenges in administering anesthesia and analgesia, primarily as it relates to the airway and dexmedetomidine infusion has shown promising result to manage the airway through awake fiberoptic intubation without any adverse effects on mother and fetus.

  5. From Paresis to PANDAS and PANS

    MedlinePlus

    ... 4 items) Genetics (18 items) Brain Anatomy and Physiology (7 items) RDoC (6 items) Research Funding (36 ... 4 items) Genetics (18 items) Brain Anatomy and Physiology (7 items) RDoC (6 items) Research Funding (36 ...

  6. An evaluation of the effect of age and the peri-parturient period on bone metabolism in dairy cows as measured by serum bone-specific alkaline phosphatase activity and urinary deoxypyridinoline concentration.

    PubMed

    Sato, Reiichiro; Onda, Ken; Kato, Hajime; Ochiai, Hideharu; Kawai, Kazuhiro; Iriki, Tsunenori; Kaneko, Kazuyuki; Yamazaki, Yukio; Wada, Yasunori

    2013-08-01

    Various biochemical markers help to evaluate the state of bone turnover in humans and could be used during the peri-parturient period in dairy cows when calcium (Ca) metabolism changes dramatically. To investigate this, the peri-partum characteristics of serum bone-specific alkaline phosphatase (BAP) and urinary deoxypyridinoline (DPD) were investigated. Both serum BAP activity and urinary DPD concentrations were increased and demonstrated wide variability in younger animals, and these findings were consistent with other bone turnover markers. Around the time of parturition, serum Ca concentration and serum BAP activity in multiparous cows were significantly lower than in primiparous cows, but urinary DPD concentration was unchanged. The use of BAP as a bone formation marker appears to be valuable for evaluating bone remodelling status in cows, but the specificity of the test needs to be confirmed. The DPD/BAP ratio around parturition demonstrated a clear difference in bone turnover status between the two parity groups with multiparous cows demonstrating increased signs of bone resorption compared with primiparous cows, corresponding to the Ca requirement for milk production. In future studies, the applicability of the ratio of bone resorption marker to bone formation marker should be evaluated for bone turnover assessment.

  7. Using Laryngeal Electromyography to Differentiate Presbylarynges from Paresis

    ERIC Educational Resources Information Center

    Stager, Sheila V.; Bielamowicz, Steven A.

    2010-01-01

    Purpose: Differential diagnosis of patients over 64 years of age reporting hoarseness is challenging. Laryngeal electromyography (LEMG) was used to determine the status of the recurrent and superior laryngeal nerves. The authors hypothesized that individuals with hoarseness but normal LEMG would have measures similar to those of patients from…

  8. Vestibular system paresis due to emergency endovascular catheterization.

    PubMed

    Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

    2012-04-01

    Objetivo: O objetivo deste relato de caso é descrever uma causa incomum de vestibulopatia periférica associada à perda auditiva unilateral em paciente idoso pós- cateterismo de urgência.Relato de caso: Paciente do gênero masculino, 82 anos, submetido à correção de aneurisma roto de aorta abdominal, no intra-operatório sofreu infarto agudo do miocárdio necessitando de angioplastia primária. Após alta hospitalar refere queixa de hipoacusia acentuada à direita e vertigem incapacitante, sem sinais neurológicos focais. Ao exame clínico otorrinolaringológico apresentava: Teste de Weber lateralizado para a esquerda, nistagmo espontâneo para a esquerda , marcha oscilante, leve disbasia e ataxia, índex-nariz e diadococinesia normais, Teste de Romberg com oscilação sem queda e Fukuda com desvio lateral para a direita. O exame audiométrico evidenciava anacusia à direita e perda neurossensorial à esquerda em agudos, arreflexia vestibular à direita na prova calórica e, na tomografia computadorizada dos ossos temporais e tronco-encefálico, presença de haste metálica atravessando o osso temporal direito, a partir da veia jugular interna e bulbo jugular, atravessando os canais semicirculares posterior, superior e vestíbulo, projetando-se em lobo temporal. O diagnóstico radiológico foi lesão traumática por guia endovascular metálico durante cateterismo de urgência e a conduta, considerando que o paciente não havia compensado o equilíbrio, foi reabilitação vestibular.Conclusão: Queixas de tontura no paciente idoso devem ser criteriosamente avaliadas diante do seu histórico clínico patológico pois os antecedentes de doenças e tratamentos prévios, em geral, direcionam as hipóteses diagnósticas porém podem trazer alterações inesperadas.

  9. Vestibular system paresis due to emergency endovascular catheterization

    PubMed Central

    Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

    2012-01-01

    Summary Objective: The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case: Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing loss to the right and crippling vertigo, without focal neurological signals. To the otorhinolaryngological clinical examination it presented: Test of Weber lateralized for the left, spontaneous nystagmus for the left, marches rocking, has taken normal disbasia and ataxia, index-nose and diadochokinesia, Test of Romberg with oscillation without fall and Fukuda with lateral shunting line for the right. The audiometric examination evidenced deafness to the right and sensorineural loss to the left in sharps, areflexia initial to the right in caloric test e, the computerized tomography of the secular bones and brainstem, presence of metallic connecting rod crossing the right secular bone, from the vein internal jugular vein and bulb jugular vein, crossing the posterior, superior and vestibule semicircular canals, projecting itself in temporal lobe. The radiological diagnoses was traumatic injury for guide to endovascular metallic during catheterization of urgency and the behavior, considering that the patient had not compensated the balance, it was vestibular rehabilitation. Conclusion: Complaints of giddiness in the aged patient must be closely evaluated of its pathological clinical description because the antecedents of illnesses and previous treatments, in general, direct the diagnostic hypotheses however they can bring unexpected alterations. PMID:25991947

  10. [What does conservative therapy of "idiopathic" facial paresis accomplish?].

    PubMed

    Oeken, F W; Görisch, I; Weilepp, M

    1978-09-01

    The results of conservative therapy in 160 patients with so-called idiopathic facial paralysis are reported. In 94.2% of the patients a complete or far extending normalisation took place. In incomplete paralysis the number of patients restored to health was about 96.1%, and 93.3% incomplete paralysis. We treated with salicyl-pyrazon-dervatives or combined with corticosteroids and with antibiotics resp. sulfonamids combined with corticosteroids. Physical therapy was applicated additionally in every case. Recovery did not depend from the sort of medicaments which were chosen.

  11. Challenges in the Caesarean Section of a Severely Kyphotic Parturient

    PubMed Central

    Chhetry, Manisha; Banerjee, Basudeb; Subedi, Shanti; Gharti Chhetri, Narayan Bahadur; Gupta, Yogendra

    2016-01-01

    Caesarean section in a severely kyphotic patient presents with unique challenges. We report a case of obstructed labor in case of a pregnant lady with severe kyphosis of spine that was managed by caesarean section. Lateral recumbent position with adequate assistance and paramedian or vertical skin incision was used and found to provide good exposure. Baby was delivered by lower segment uterine incision by reverse breech extraction. Postpartum hemorrhage was managed with uterotonics and bilateral uterine artery ligation. Tubal ligation though advised was refused by the patient. Prolonged catheterization was done in view of obstructed labor. Postoperative period was uneventful. PMID:27066281

  12. Anesthetic Considerations for the Parturient After Solid Organ Transplantation.

    PubMed

    Moaveni, Daria M; Cohn, Jennifer H; Hoctor, Katherine G; Longman, Ryan E; Ranasinghe, J Sudharma

    2016-08-01

    Over the past 40 years, the success of organ transplantation has increased such that female solid organ transplant recipients are able to conceive and carry pregnancies successfully to term. Anesthesiologists are faced with the challenge of providing anesthesia care to these high-risk obstetric patients in the peripartum period. Anesthetic considerations include the effects of the physiologic changes of pregnancy on the transplanted organ, graft function in the peripartum period, and the maternal side effects and drug interactions of immunosuppressive agents. These women are at an increased risk of comorbidities and obstetric complications. Anesthetic management should consider the important task of protecting graft function. Optimal care of a woman with a transplanted solid organ involves management by a multidisciplinary team. In this focused review article, we review the anesthetic management of pregnant patients with solid organ transplants of the kidney, liver, heart, or lung.

  13. Pneumorrhachis Resulting in Transient Paresis after PICC Line Insertion into the Ascending Lumbar Vein

    PubMed Central

    Sieg, Emily P; Choudhary, Arabinda; Iantosca, Mark

    2016-01-01

    Obtaining intravascular access in the neonatal intensive care unit (NICU) is not only critical but also technically challenging. Malposition of the catheter tip is a known and well-documented complication. Specifically, peripherally inserted central venous catheter (PICC) line insertion into the ascending lumbar vein can lead to neurological dysfunction and, in some cases, even death. We present the first reported case of pneumorrhachis (PR) following PICC line insertion into the ascending lumbar vein. Our patient presented with lower extremity weakness and imaging confirmed the presence of air within the spinal canal. After conservative treatment, the strength deficit resolved and subsequent imaging revealed resolution of the air within the spinal canal. Insertion of central venous catheters into the ascending lumbar vein is a well-documented complication that can lead to neurologic injury and even death. This should be considered in the evaluation of any neonate presenting with an abnormal neurological examination or unexplained change in exam after line insertion. PMID:27904815

  14. Pneumorrhachis Resulting in Transient Paresis after PICC Line Insertion into the Ascending Lumbar Vein.

    PubMed

    Payne, Russell; Sieg, Emily P; Choudhary, Arabinda; Iantosca, Mark

    2016-10-17

    Obtaining intravascular access in the neonatal intensive care unit (NICU) is not only critical but also technically challenging. Malposition of the catheter tip is a known and well-documented complication. Specifically, peripherally inserted central venous catheter (PICC) line insertion into the ascending lumbar vein can lead to neurological dysfunction and, in some cases, even death. We present the first reported case of pneumorrhachis (PR) following PICC line insertion into the ascending lumbar vein. Our patient presented with lower extremity weakness and imaging confirmed the presence of air within the spinal canal. After conservative treatment, the strength deficit resolved and subsequent imaging revealed resolution of the air within the spinal canal. Insertion of central venous catheters into the ascending lumbar vein is a well-documented complication that can lead to neurologic injury and even death. This should be considered in the evaluation of any neonate presenting with an abnormal neurological examination or unexplained change in exam after line insertion.

  15. [On the problem of voice rehabilitation in the case of unilateral vocal fold paresis].

    PubMed

    Shilenkova, V V

    Односторонний парез голосовых складок (ОПГС) значительно снижает качество жизни пациента. Ведущая роль в реабилитации пациентов с ОПГС принадлежит стимулирующей терапии, которая заключается в активации реиннервации мышц гортани и компенсаторных механизмов, позволяющих достичь наиболее полного смыкания голосовых складок при фонации. Цель исследования — оптимизация консервативного лечения больных с ОПГС. 50 пациентам с ОПГС в возрасте 18—70 лет и давностью заболевания не более 6 мес было проведено комплексное лечение, включающее электростимуляцию гортани, витаминотерапию, фонопедию. Пациенты были объединены в две группы — А и Б по 25 человек. В группе А в комплекс лечения был добавлен нейромидин курсом 1,5 мес. Результаты оценивались с использованием ларингостробоскопии, флоуметрии, шкалы GRBAS, акустического анализа голоса (lingWaves), опросника VHI. В группе А восстановление подвижности голосовой складки наступило в 20% случаев, в группе Б — в 8%. Отсутствие эффекта имело место в 12% случаев в группе А и в 28% в группе Б. Различия между группами статистически достоверны, р<0,05. В остальных случаях отмечалась положительная динамика флоуметрии, GRBAS, VHI, времени максимальной фонации, Jitter, DSI, частотного и динамического диапазонов, интенсивности голоса (68% пациентов группы А и 64% больных группы Б). Полученные данные подтверждают целесообразность проведения при ОПГС комплексной терапии, представляющей сочетание электростимуляции гортани, фонопедии и применения холинергических препаратов. Добавление нейромидина в общепринятую схему консервативного лечения позволяет повысить его результативность с 72 до 88%.

  16. Hind-limb paresis in a dog with paralumbar solitary T-cell lymphoma.

    PubMed

    Ortega, Maria; Castillo-Alcala, Fernanda

    2010-05-01

    A 2-year-old, neutered, male golden retriever was referred to the Ontario Veterinary College, with a 6-week history of hind limb weakness and back pain. Magnetic resonance imaging of the lumbar vertebral column, and histopathology and immunohistochemistry following euthanasia identified an uncommon solitary T-cell lymphoma in the paralumbar area.

  17. A Symptomatic Case of Thoracic Vertebral Hemangioma Causing Lower Limb Spastic Paresis.

    PubMed

    Alfawareh, Mohammad; Alotaibi, Tariq; Labeeb, Abdallah; Audat, Ziad

    2016-10-31

    BACKGROUND Despite being the most common tumor of the spine, vertebral hemangioma is rarely symptomatic in adults. In fact, only 0.9-1.2% of all vertebral hemangiomas may be symptomatic. When hemangiomas occur in the thoracic vertebrae, they are more likely to be symptomatic due to the narrow vertebral canal dimensions that mandate more aggressive management prior to the onset of severe neurological sequelae. CASE REPORT An 18-year-old male presented to the emergency room with a one-month history of mild to moderate mid-thoracic back pain, radiating to both lower limbs. It was associated with both lower limb weakness and decreased sensation. There was no history of bowel or bladder incontinence. Neurological examination revealed lower limb weakness with power 3/5, exaggerated deep tendon reflexes, bilateral sustained clonus, impaired sensation below the umbilicus, spasticity, and a positive Babinski sign. A CT scan showed a diffuse body lesion at the 8th thoracic vertebra with coarse trabeculations, corduroy appearance, or jail-bar sign. The patient underwent decompression and fixation. Biopsy of permanent samples showed proliferation of blood vessels with dilated spaces and no malignant cells, consistent with hemangioma. Postoperatively, spasticity improved, and the patient regained normal power. CONCLUSIONS Symptomatic vertebral hemangiomas are rare but should be considered as a differential diagnosis. They can present with severe neurological symptoms. When managed appropriately, patients regain full motor and sensory function. Decompression resulted in quick relief of symptoms, which was followed by an extensive rehabilitation program.

  18. Superficial peroneal nerve paresis in a dancer caused by a midfoot ganglion: case report.

    PubMed

    Martin, Darrell; Dowling, Jamie; Rowan, Fiachra; Casey, Mary; O'Grady, Paul

    2015-06-01

    Ganglion cysts are common benign masses, usually occurring in the hands and feet. This report describes the case of a young female Irish dancer who presented with paresthesia of her foot due to a ganglion in near proximity to the superficial peroneal nerve. Midfoot ganglia in young girls engaged in Irish dance can limit their ability to participate. This pathology requires further epidemiological studies to investigate its prevalence. In the event of failed conservative management, surgical intervention to excise the cyst and decompress the nerve is an effective treatment to facilitate return to dancing.

  19. A Symptomatic Case of Thoracic Vertebral Hemangioma Causing Lower Limb Spastic Paresis

    PubMed Central

    Alfawareh, Mohammad; Alotaibi, Tariq; Labeeb, Abdallah; Audat, Ziad

    2016-01-01

    Patient: Male, 18 Final Diagnosis: Hemangioma Symptoms: Pain • weaknes of lower limbs Medication: — Clinical Procedure: Decompression and fixation Specialty: Neurosurgery Objective: Unusual clinical course Background: Despite being the most common tumor of the spine, vertebral hemangioma is rarely symptomatic in adults. In fact, only 0.9–1.2% of all vertebral hemangiomas may be symptomatic. When hemangiomas occur in the thoracic vertebrae, they are more likely to be symptomatic due to the narrow vertebral canal dimensions that mandate more aggressive management prior to the onset of severe neurological sequelae. Case Report: An 18-year-old male presented to the emergency room with a one-month history of mild to moderate midthoracic back pain, radiating to both lower limbs. It was associated with both lower limb weakness and decreased sensation. There was no history of bowel or bladder incontinence. Neurological examination revealed lower limb weakness with power 3/5, exaggerated deep tendon reflexes, bilateral sustained clonus, impaired sensation below the umbilicus, spasticity, and a positive Babinski sign. A CT scan showed a diffuse body lesion at the 8th thoracic vertebra with coarse trabeculations, corduroy appearance, or jail-bar sign. The patient underwent decompression and fixation. Biopsy of permanent samples showed proliferation of blood vessels with dilated spaces and no malignant cells, consistent with hemangioma. Postoperatively, spasticity improved, and the patient regained normal power. Conclusions: Symptomatic vertebral hemangiomas are rare but should be considered as a differential diagnosis. They can present with severe neurological symptoms. When managed appropriately, patients regain full motor and sensory function. Decompression resulted in quick relief of symptoms, which was followed by an extensive rehabilitation program. PMID:27795545

  20. Metabolic disorders of cattle.

    PubMed

    Reid, G

    1993-05-01

    Goldberger discovered human pellagra was a non-infectious disease, affecting mostly the small and the timid in overcrowded institutions. Symptoms were diarrhoea, dermatitis and dementia. The staff and older children escaped the disease. They ate the meat and left the small and timid with the gravy. The 'Goldberger syndrome' is observed during competitive feeding of livestock, in ketotic animals and in the zinc depleted which are lethargic and pick all day at their feed. The pellagra preventative factor was later found to be nicotinic acid, derived from the amino acid tryptophan. Deficiencies of copper, magnesium, vitamin B6 (activated by a zinc kinase) inhibit the conversion of tryptophan to nicotinic acid. Stresses, including liver diseases, malabsorption, iron overload, porphyria, marasmus, cold stress, pregnancy, lactation, antibiotics and sulfa drugs, all increase dietary needs of nicotinic acid. Elevated free fatty acids and ketone bodies in the blood are associated with ketosis, zinc depletion and the pre-diabetic state. There is a diminished uptake of glucose by the tissues, a condition also found in parturient paresis of dairy cows when elevated hydrocortisone promotes insulin resistance and hyperglycaemia. This defect in insulin response leads to a diabetic-like state. The major predisposing factor in parturient paresis of dairy cows is hypocalcaemia. Gut absorption of dietary calcium may not meet the primary demands of lactation initiation until bone calcium mobilisation is established.

  1. Combined Spinal-Epidural for Vaginal Delivery in a Parturient With Takayasu’s Arteritis

    PubMed Central

    Clifford, Sean Patrick; Mick, Paul Brian; Derhake, Brian Matthew

    2016-01-01

    Takayasu’s arteritis is a rare, progressive panendarteritis involving all layers of the arterial wall. This disease includes variable involvement of the aorta and its major branches. The most common complication with this condition is severe, uncontrolled hypertension, often leading to end organ dysfunction. We describe the management of a 27-year-old woman diagnosed with Takayasu’s arteritis that presented in labor with intense pain and underwent a combined spinal-epidural for anesthetic management. Per literature review, a combined spinal-epidural technique for planned vaginal delivery has not been described for a laboring Takayasu patient. Our technique, utilizing intrathecal opioids and a low-dose local anesthetic-opioid epidural infusion, provided adequate analgesia while maintaining hemodynamic stability throughout labor augmentation and successful vaginal delivery. PMID:28210635

  2. Meralgia paresthetica affecting parturient women who underwent cesarean section -A case report-

    PubMed Central

    Chung, Kum Hee; Ko, Tong Kyun; Park, Chung Hyun; Chun, Duk Hee; Yang, Hyeon Jeong; Gill, Hyun Jue; Kim, Min Ku

    2010-01-01

    Meralgia paresthetica is commonly caused by a focal entrapment of lateral femoral cuteneous nerve while it passes the inguinal ligament. Common symptoms are paresthesias and numbness of the upper lateral thigh area. Pregnancy, tight cloths, obesity, position of surgery and the tumor in the retroperitoneal space could be causes of meralgia paresthetica. A 29-year-old female patient underwent an emergency cesarean section under spinal anesthesia without any problems. But two days after surgery, the patient complained numbness and paresthesia in anterolateral thigh area. Various neurological examinations and L-spine MRI images were all normal, but the symptoms persisted for a few days. Then, electromyogram and nerve conduction velocity test of the trunk and both legs were performed. Test results showed left lateral cutaneous nerve injury and meralgia paresthetica was diagnosed. Conservative treatment was implemented and the patient was free of symptoms after 1 month follow-up. PMID:21286469

  3. Gene expression of estrogen and oxytocin receptors in the uterus of pregnant and parturient bitches.

    PubMed

    Veiga, G A L; Milazzotto, M P; Nichi, M; Lúcio, C F; Silva, L C G; Angrimani, D S R; Vannucchi, C I

    2015-04-01

    In the canine species, the precise mechanisms of pregnancy maintenance and the initiation of parturition are not completely understood. The expression of genes encoding the receptors for estrogen (ERα mRNA) and oxytocin (OTR mRNA) was studied in the endometrium and myometrium during pregnancy and parturition in dogs. Real-time PCR was performed to quantify the levels of ERα mRNA and OTR mRNA in the uterus of bitches during early (up to 20 days of gestation), mid (20 to 40 days) and late pregnancy (41 to 60 days), and parturition (first stage of labor). All tissues expressed ERα and OTR mRNA, and are thus possibly able to respond to eventual estrogen and oxytocin hormonal stimuli. No statistically significant differences in the expression of ERα mRNA were verified in the endometrium and myometrium throughout pregnancy and parturition, but expression of OTR mRNA increased at both parturition and late pregnancy. We concluded that the increase of endometrial and myometrial OTR mRNA expression in dogs is not an event dependent on estrogenic stimulation. Moreover, the contractility response of the canine uterus to oxytocin begins during pregnancy and maintains myometrial activity. The expression of OTR mRNA in canine uterine tissues varied over time, which supports an interpretation that the sensitivity and response to hormone therapy varies during the course of pregnancy and labor. Further studies are needed to elucidate the factors underlying the synthesis of uterine oxytocin receptors and the possible role of ERβ rather than ERα in the uterine tissues during pregnancy and parturition in dogs.

  4. Observations on the alkaline phosphatase isoenzyme distribution in maternal and amniotic fluid compartments in Nigerian parturients.

    PubMed

    Okpere, E; Okorodudu, A; Gbinigie, O

    1988-01-01

    Estimation of the alkaline phosphates isoenzymes in paired maternal serum and amniotic fluids in term uncomplicated pregnancies and in patients with pre-eclampsia, showed poor correlation coefficients between the levels of both heat stable and heat labile isoenzymes. There was a statistically significant fall in AF (P less than .05) HSAP in pre-eclampsia and a highly significant rise of HLAP in meconial liquor. It is concluded that the poor correlation between the levels of HSAP in maternal serum and amniotic fluid (despite their common source of origin), the normal levels of HLAP in maternal serum in the presence of significantly high levels of HSAP in maternal serum in the presence of significantly diminished levels in amniotic fluid point to a state of relatively diminished permeability of the chorioamniotic membranes to the alkaline phosphatase isoenzymes in Nigerians.

  5. Complete Heart Block in Pregnancy: A Report of Emergency Caesarean Section in a Parturient without Pacemaker.

    PubMed

    Mohapatra, Vandana; Panda, Aparajita; Behera, Satyanarayan; Behera, Jagadish Chandra

    2016-10-01

    Management of women with Complete Heart Block (CHB) presenting without pacing, during pregnancy and labour is debatable. Temporary pacemakers have been routinely inserted for labour and birth probably to withstand any haemodynamic variations. However, due to lack of large scale prospective studies, the necessity of this procedure has not been objectively assessed. Also, the most appropriate anaesthetic technique for caesarean section in women with CHB is yet to be clarified. We report herein the case of a pregnant woman with CHB who had uneventful emergency caesarean delivery under spinal anaesthesia without temporary pacing. She was an unbooked case detected with congenital CHB first time during active labour; echocardiography showed no structural cardiac disease and her heart rate increased with atropine. We suggest further research so that guidelines could be established to prevent unnecessary morbidity and expense of temporary pacemaker insertion. Newly diagnosed cases of asymptomatic CHB in late pregnancy should be worked up for chronotropic responsiveness using atropine and responsive cases may be managed without pacemaker.

  6. Anesthetic management of urgent cesarean delivery in a parturient with acute malaria infection: a case report

    PubMed Central

    Dell'Anna, Antonio Maria; Catarci, Stefano; Frassanito, Luciano; Vagnoni, Salvatore; Draisci, Gaetano

    2016-01-01

    Malaria is associated with high rates of morbidity and mortality worldwide, particularly in Africa, Southeast Asia and South America. Nonetheless, several cases of malaria have been reported in Western countries involving travelers from endemic areas, though very few involve pregnant women. In this article, we report a case of a young woman born in Sierra Leone who had been living in Italy for two years. She was admitted to our hospital with malaise; worsening of her condition led to Plasmodium falciparum infection diagnosis early during her hospital stay, as well as an urgent cesarean delivery. We briefly discuss the features of malaria in pregnancy, the difficulties associated with early diagnosis, and the possible fetal and maternal implications, and also consider how the disease may affect anesthetic management. PMID:27066212

  7. Anesthetic management of a parturient with type III Klippel-Feil syndrome.

    PubMed

    Hsu, G; Manabat, E; Huffnagle, S; Huffnagle, H J

    2011-01-01

    Klippel-Feil syndrome is believed to occur from failure of normal segmentation of cervical somites during gestation. We present the case of a 38-year-old primiparous woman with type III Klippel-Feil syndrome for elective cesarean delivery. Our patient had a short webbed neck, short stature, limited neck flexion and extension, and thoraco-lumbar abnormalities. A multidisciplinary approach, involving obstetrics, medical subspecialties, anesthesiology, otolaryngology, and radiology, were utilized to evaluate and manage this patient. Pulmonary function testing revealed a restrictive defect, but transthoracic echocardiography was normal without pulmonary hypertension. We planned a combined spinal-epidural technique; however, only the epidural technique was obtained. Cesarean delivery was commenced with favorable maternal and fetal outcomes. Post-operative pain management was provided with intravenous morphine patient-controlled analgesia.

  8. Epidural anesthesia for repeat cesarean delivery in a parturient with Klippel-Feil syndrome.

    PubMed

    Smith, Kathleen A; Ray, Adrienne P

    2011-07-01

    A patient with Klippel-Feil syndrome, morbid obesity, and scoliosis required cesarean delivery. Her previous cesarean deliveries were performed under general anesthesia. She desired a regional technique. Following aspiration prophylaxis and placement of standard monitors, ultrasound was used to identify midline and L(2-3) interspace. Unintentional dural puncture occurred at 10 cm, with an inability to advance the catheter. On second attempt, an epidural catheter was placed easily. After negative test dose, 18 ml of 2% lidocaine with epinephrine was administered to the patient. A T4 level was achieved. The patient tolerated surgery well. Complete block resolution occurred at 4 hours with no neurologic sequelae.

  9. [Cesarean section on a full-term parturient with convulsive crises].

    PubMed

    Errando, C L; Tatay, J; Revert, A; Peiró, C; Lloréns, J

    2003-01-01

    A 34-years-old woman in her 35th week of pregnancy experienced epileptic seizures and underwent emergency cesarean delivery of a healthy boy under general anesthesia. The patient had no history of epilepsy and the seizures were later attributed to an intracerebral cavernous angioma. She received treatment with phenytoin and was asymptomatic 3 months later. Although seizures unrelated to preeclampsia or eclampsia in pregnancy are rare, differential diagnosis must determine the etiology of the crisis.

  10. Iatrogenic water intoxication in healthy parturient causing convulsions and fractured mandible.

    PubMed

    Abu Halaweh, Sami A; Aloweidi, Abdelkareem S; Qudaisat, Ibraheem Y; Al-Kazaleh, Fawaz A

    2014-02-01

    We report a case of a mandibular dentoalveolar fracture caused by severe iatrogenic hyponatremia-induced grand mal seizure in a 31-year-old pregnant lady who underwent normal vaginal delivery. She had oxytocin augmentation of her labor, and the seizure happened in the immediate postpartum period. The seizure was thought to be because of severe hyponatremia and prompt management controlled the metabolic disorder. The fracture was reduced and fixed successfully, and she was discharged after 48 hours, healing was uneventful.

  11. Complete Heart Block in Pregnancy: A Report of Emergency Caesarean Section in a Parturient without Pacemaker

    PubMed Central

    Panda, Aparajita; Behera, Satyanarayan; Behera, Jagadish Chandra

    2016-01-01

    Management of women with Complete Heart Block (CHB) presenting without pacing, during pregnancy and labour is debatable. Temporary pacemakers have been routinely inserted for labour and birth probably to withstand any haemodynamic variations. However, due to lack of large scale prospective studies, the necessity of this procedure has not been objectively assessed. Also, the most appropriate anaesthetic technique for caesarean section in women with CHB is yet to be clarified. We report herein the case of a pregnant woman with CHB who had uneventful emergency caesarean delivery under spinal anaesthesia without temporary pacing. She was an unbooked case detected with congenital CHB first time during active labour; echocardiography showed no structural cardiac disease and her heart rate increased with atropine. We suggest further research so that guidelines could be established to prevent unnecessary morbidity and expense of temporary pacemaker insertion. Newly diagnosed cases of asymptomatic CHB in late pregnancy should be worked up for chronotropic responsiveness using atropine and responsive cases may be managed without pacemaker. PMID:27891405

  12. Distal hereditary motor neuropathy with vocal cord paresis: from difficulty in choral singing to a molecular genetic diagnosis.

    PubMed

    Ingram, Gillian; Barwick, Katy E S; Hartley, Louise; McEntagart, Meriel; Crosby, Andrew H; Llewelyn, Gareth; Morris, Huw R

    2016-06-01

    Patients presenting with distal weakness can be a diagnostic challenge; the eventual diagnosis often depends upon accurate clinical phenotyping. We present a mother and daughter with a rare form of distal hereditary motor neuropathy type 7 in whom the diagnosis became apparent by initial difficulty in singing, from early vocal cord dysfunction. This rare neuropathy has now been identified in two apparently unrelated families in Wales. This family's clinical presentation is typical of distal hereditary motor neuropathy type 7, and they have the common truncating mutation in the SLC5A7 gene. Advances in genetic analysis of these rare conditions broaden our understanding of their potential molecular mechanisms and may allow more directed therapy.

  13. Identification of a novel mutation in the spastin gene (SPG4) in an Italian family with hereditary spastic paresis.

    PubMed

    Bertelli, M; Cecchin, S; Lorusso, L; Sidoti, V; Fabbri, A; Lapucci, C; Buda, A; Pandolfo, M

    2006-09-01

    Hereditary spastic paraparesis (HSP) includes a heterogeneous group of neurodegenerative diseases characterised by progressive spasticity and hyper-reflexia of the lower limbs. Autosomal dominant HSP type 4 is the most common clinical form, accounting for about 40-50% of autosomal dominant HSP families. This form is due to mutation of the gene encoding spastin (SPG4), an ATP-ase associated with a variety of cellular function (AAA). Here we describe a novel missense mutation (1297T>C; 391L>P) in exon 8 of SPG4 gene, identified in 2 members (mother and son) of an Italian family with autosomal dominant HSP, clinically pure in the mother and complicated in the son. The mutation lies in a highly conserved AAA box domain between amino acids 342 and 599 in spastin sequence. In both patients, this novel mutation was associated with the absence of relatively common clinical characteristics, such as vibratory sensory deficit and loss of sphincter control, and partial temporal epilepsy, particularly in the son, with infantile onset, secondarily generalised and moderately severe neuropsychiatric symptoms.

  14. Facilitating robot-assisted training in MS patients with arm paresis: a procedure to individually determine gravity compensation.

    PubMed

    Bastiaens, H; Alders, G; Feys, P; Notelaers, S; Coninx, K; Kerkhofs, L; Truyens, V; Geers, R; Goedhart, A

    2011-01-01

    Gravity compensation (GC) of the arm is used to facilitate arm movements in conventional therapy as well as in robot-assisted rehabilitation of neurologically impaired persons. Positive effects of GC on Range of Motion (ROM) have been demonstrated in stroke. In Multiple Sclerosis (MS), research regarding this topic is lacking. Since an active participation of the patient is required for effective training, full support of the arm might not be advisable. The present study reports on the development of a procedure to measure actively the individual need for GC and to estimate the influence of GC on ROM during reaching, lifting and transporting in severely affected Persons with MS (PwMS). Ten PwMS were tested with the procedure for determination of GC. Maximal reaching movements were performed in a 3D space in three conditions: No support (NS), with GC by the HapticMaster (GC-HM) and with GC by the HapticMaster combined with a sling suspension system (GC-HMS). For the total sample, significant correlations were found between the amount of GC and clinical tests for upper limb function. In four subjects with severe arm dysfunction it was found that mean ROM is larger in the GC-HMS condition compared to the GC-HM condition, and in the GC-HM condition compared to the NS condition, suggesting positive effects of GC on active ROM in PwMS. Therefore, GC could have a positive effect on arm rehabilitation by enabling the PwMS to actively reach a larger ROM during training.

  15. Thrombocytopenia in pregnancy: do the time of diagnosis and delivery route affect pregnancy outcome in parturients with idiopathic thrombocytopenic purpura?

    PubMed

    Yuce, T; Acar, D; Kalafat, E; Alkilic, A; Cetindag, E; Soylemez, F

    2014-12-01

    The objective of this study was to investigate the determining effects of diagnosis time on pregnancy outcomes in a population of pregnant women with idiopathic thrombocytopenic purpura (ITP). Records of all the pregnant women with thrombocytopenia were evaluated. Those with a confirmed diagnosis of ITP were included in the study. Main outcome measures were antenatal thrombocyte count, postpartum haemorrhage rate, and route of delivery. Foetal outcomes such as foetal thrombocyte count, haemorrhage, and birth weight were also reported as secondary outcome measures. Time of diagnosis either antenatal or preconception did not significantly alter the investigated parameters. Delivery route had no impact on complication rates. Time of diagnosis also did not affect treatment modality. ITP is rare disorder accounting for less than 5 % of all pregnant thrombocytopenias. Time of diagnosis does not affect maternal-foetal outcomes or treatment modality unless diagnosis is made during labour. Compared to gestational thrombocytopenia, treatment rates may differ but treatment modalities remain the same and the effort put into making the differential should be weighed against maternal stress factors for lengthy laboratory evaluation as long as the thrombocytopenia is of pure nature without any systemic involvement.

  16. [Regional anaesthesia for labor adn delivery in a parturient with neuropathy with liability to pressure palsy (tomaculous neuropathy)].

    PubMed

    Berdai, S; Benhamou, D

    2004-10-01

    Tomaculous neuropathy (or hereditary neuropathy with liability to pressure palsy [HNLPP]) is a rare and hereditary disease which incidence has probably been underestimated. It is characterised by demyelination resulting in numbness and weakness after nerve pressure, injury or stretch. Despite a well-documented genetic pathophysiologic mechanism, implications for anaesthesia in patients with HNLPP are only speculative and the use of regional anaesthesia is debatable. We report here the case of a patient with HNLPP who was followed during two consecutive pregnancies in the same hospital and for whom an expert of the SOS-RA hotline service was consulted before each delivery. For the first delivery, epidural analgesia was performed for labour pain control but a caesarean section was necessary because of failure to progress (0.0625% bupivacaine with 0.2 microg/ml sufentanil for labour then 2% lidocaine with adrenaline for surgery). Two years later, the patient was again seen for a preanaesthetic visit because elective Caesarean section was planned. Spinal anaesthesia using hyperbaric bupivacaine and sufentanil was used. Both deliveries were uneventful and there were no neurologic complaints in the postpartum periods.

  17. Combined spinal-epidural anesthesia for urgent cesarean section in a parturient with a single ventricle: a case report

    PubMed Central

    Sbaraglia, Fabio; Zanfini, Bruno Antonio; Vagnoni, Salvatore; Frassanito, Luciano; Draisci, Gaetano

    2016-01-01

    The number of women with major congenital heart defects reaching reproductive age is likely increasing. We herein describe the anesthetic management of a 33-year-old woman at 37 gestational weeks with a history of Glenn surgery who was undergoing an urgent cesarean section due to pathological cardiotocography. Combined spinal-epidural anesthesia was the most suitable technique for urgent cesarean section in our patient with a single ventricle and phasic flow in the pulmonary artery because it provided rapid-onset anesthesia with negligible hemodynamic effects. PMID:27924207

  18. Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new?

    PubMed

    Rao, Durga Prasada; Rao, Venkateswara A

    2010-11-01

    The purpose of this article is to review the fundamental aspects of obesity, pregnancy and a combination of both. The scientific aim is to understand the physiological changes, pathological clinical presentations and application of technical skills and pharmacological knowledge on this unique clinical condition. The goal of this presentation is to define the difficult airway, highlight the main reasons for difficult or failed intubation and propose a practical approach to management Throughout the review, an important component is the necessity for team work between the anaesthesiologist and the obstetrician. Certain protocols are recommended to meet the anaesthetic challenges and finally concluding with "what is new?" in obstetric anaesthesia.

  19. Uterine blood flow in sheep and goats during the peri-parturient period assessed by transrectal Doppler sonography.

    PubMed

    Elmetwally, Mohammed; Bollwein, Heinrich

    2017-01-01

    The aim of the present study was to evaluate uterine blood flow (UBF) during the postpartum period in small ruminants. The study involved measures of UBF in 5 ewes and 5 goats during the first 4 weeks after parturition. Transrectal quantification of UBF was assessed by determining the diameter (DM), time averaged mean velocity (TAMEAN), blood flow volume (BFV), blood flow acceleration (ACCE) and pulsatility index (PI) in the uterine arteries ipsilateral to the previously gravid uterine horn(s) at Wk 20 of gestation and every 3days from the day of parturition (D 0) until Day 27 postpartum (D 27). The diameters of the uterine arteries decreased (P<0.01) in both species during the postpartum period. The results revealed decreases (P<0.0001) in BFV, ACCE and TAMEAN, while PI increased during the postpartum period in both sheep and goats. Furthermore, there were positive correlations (P<0.05) between blood flow parameters in sheep and goats, respectively (BFV and DM, r=0.62 and 0.58; BFV and ACCE, r=0.32 and 0.26; BFV and TAMEAN, r=0.51 and 0.37). There were negative correlations (P<0.05) between PI and other parameters (PI and BFV, r=-0.39 and -0.36; PI and DM, r=-0.54 and -0.24; PI and ACCE, r=-0.58 and -0.48; and PI and TAMEAN, r=-0.80 and -0.79) in sheep and goats, respectively. Altogether, these results indicate that non-invasive Doppler ultrasound parameters provide important information toward understanding changes in the vasculature and its perfusion of the uterus during the postpartum period in sheep and goats.

  20. Comparison of Remifentanil and Fentanyl Regarding Hemodynamic Changes Due to Endotracheal Intubation in Preeclamptic Parturient Candidate for Cesarean Delivery

    PubMed Central

    Pournajafian, Alireza; Rokhtabnak, Faranak; Kholdbarin, Alireza; Ghodrati, Mohammadreza; Ghavam, Siamak

    2012-01-01

    Background Intravenous opioids are administered to prevent and control hemodynamic changes due to endotracheal intubation. Except for special cases such as preeclampsia, these drugs are not recommended for parturants candidate for cesarean section because of the respiratory depression caused in the newborn. Objectives According to rapid metabolism of remifentanil, the current study aimed to compare hemodynamic changes in preeclamptic parturants who received remifentanil and fentanyl for cesarean section under general anesthesia. Patients and Methods This single blind randomized clinical trial was performed on preeclamptic pregnant women candidate for cesarean section under general anesthesia. They were divided into two groups. In the first group 0.05 μg/kg/min remifentanil was infused for 3 minutes before induction of anesthesia and in the second group 1ml (50 μg) fentanyl was injected before induction. Heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) before and after intubation and also Apgar index were measured and compared between the two groups. Results All hemodynamic variables increased after intubation in the fentanyl group (pSBP = 0.146, pDBP = 0.019, pHR < 0.001). Additionally, decrease in SBP (P = 0.018) and DBP (P = 0.955) and mild increase in HR (P = 0.069) after intubation in the remifentanil group was observed. No significant difference was found between Apgar indexes of the two groups (P = 0.771). Conclusions It can be postulated that remifentanil can be used in partituents candidate for cesarean delivery under general anesthesia to prevent severe increase in blood pressure and heart rate during tracheal intubation without adverse effects on newborn. PMID:24223345

  1. A Novel Telometric Metric for In-Situ Measurement of Intrauterine Pressure (IUP) in Pregnant and Parturient Rats

    NASA Technical Reports Server (NTRS)

    Baer, Lisa A.; LaFramboise, M. N.; Hills, E. M.; Daly, M. E.; Mills, N. A.; Wade, C. E.; Ronca, A. E.; Dalton, Bonnie (Technical Monitor)

    2001-01-01

    During labor and birth, considerable forces exerted on fetuses help instigate certain adaptive postpartum responses (viz., breathing and suckling). To make precise, reliable measures of the forces experienced by rat fetuses during parturition, we developed a novel method for measuring intrauterine pressure (IUP) in late pregnant rats. A small (1.25 x 4cm) telemetric blood pressure sensor is fitted within a fluid-filled balloon, similar in size to a full term rat fetus. The balloon is surgically implanted in the uterus on Gestational Day 19 of the rats' 22-day pregnancy. During birth, dams are able to deliver their pups and the balloon. IUP arsenals are recorded during labor (G22 or 23) and birth. Data derived from a group of implanted rats indicated that pressures on the balloon increased across the period of birth, reaching 18 mmHg during labor, 25 mmHg during pup births and 39 mmHg just prior to delivery of the balloon. These data are within the range reported for conventional IUP measurement techniques. Dams are simultaneously videotaped, enabling us to analyze behavioral expressions of labor contractions and to integrate in-situ and behavioral findings.

  2. [Anesthetic Management of a Parturient with Eclampsia, Posterior Reversible Encephalopathy Syndrome and Pulmonary Edema due to Pregnancy-induced Hypertension].

    PubMed

    Aida, Junko; Okutani, Hiroai; Oda, Yutaka; Okutani, Ryu

    2015-08-01

    A 27-year-old woman with mental retardation was admitted to a nearby hospital for an abrupt onset of seizure. Physical examination revealed remarkable hypertension and pregnancy with estimated gestational age of 28th week. Severe pulmonary edema and hypoxia led to a diagnosis of pregnancy-induced hypertension (PIH) accompanied by eclampsia. She was orotracheally intubated because of refractory seizure and hypoxemia, and transferred to our hospital for further treatment. Besides severe hypoxia and hypercapnea, an enhanced lesion was detected in the left posterior cerebrum by brain MRI. No abnormal findings were detected in the fetus, with heart rate of 150 beats x min. She was diagnosed with posterior reversible encephalopathy syndrome (PRES) caused by PIH and emergency cesarean section under general anesthesia was scheduled. A male newborn was delivered with Apgar score of 1/4 (1/5 min), followed by starting continuous infusion of nicardipine for controlling hypertension. Chest X-P on completion of surgery revealed remarkably alleviated pulmonary edema. She received intensive treatment and continued positive pressure ventilation for four days after delivery. She recovered with no neurological deficits and her child was well without any complications.

  3. Culling of dairy cows. Part I. Effects of diseases on culling in Finnish Ayrshire cows.

    PubMed

    Rajala-Schultz, P J; Gröhn, Y T

    1999-07-20

    The effects of 15 diseases on time until culling were studied in 39,727 Finnish Ayrshire cows that calved during 1993 and were followed until the next calving or culling. The diseases studied were: dystocia, milk fever, retained placenta, displacement of the abomasum, metritis, non-parturient paresis, ketosis, rumen disorders, acute mastitis, hypomagnesemia, lameness, traumatic reticuloperitonitis, anestrus, ovarian cysts, and teat injuries. Survival analysis, using the Cox proportional hazards model, was performed and diseases were modeled as time-dependent covariates. Different stages of lactation when culling can occur were also considered. Parity, calving season and herd were included as covariates in every model. Parity had a significant effect on culling, the risk of culling being four times higher for a cow in her sixth or higher parity than for a first parity cow. The effects of diseases varied according to when the diseases occurred and when culling occurred. Mastitis, teat injuries and lameness had a significant effect on culling throughout the whole lactation. Anestrus and ovarian cysts had a protective effect against culling at the time when they were diagnosed. In general, diseases affected culling decisions mostly at the time of their occurrence. The effect seemed to decrease with time from the diagnosis of the disease. However, milk fever, dystocia and metritis also had a significant effect on culling at the end of the lactation.

  4. Successful Delivery by a Cesarean Section in a Parturient with Severe Dilated Cardiomyopathy, an Implantable Cardioverter Defibrillator, and a Repaired Tetralogy of Fallot

    PubMed Central

    Al-Aqeedi, Rafid Fayadh; Alnabti, Abdulrahman; Al-Ani, Fuad; Dabdoob, Wafer; Abdullatef, Waleed Khalid

    2011-01-01

    Repaired congenital heart disease has become more prevalent in women of childbearing age. We report an unusual case of a 24-year-old multigravida with a repaired tetralogy of Fallot, severe dilated cardiomyopathy, and implantable cardioverter defibrillator placement who was managed successfully by a cesarean section three times. This case underscores the impact of such events on maternal and fetal safety and the importance of a multidisciplinary approach in the management of pregnant patients with complex congenital and medical problems. PMID:21731806

  5. Role of acid-base physiology on the pathogenesis of parturient hypocalcaemia (milk fever)--the DCAD theory in principal and practice.

    PubMed

    Goff, J P; Horst, R L

    2003-01-01

    The hypocalcemia associated with the clinical disease known as milk fever is due to a failure of the calcium homeostatic mechanisms in the cow to restore normal blood calcium concentration in a timely manner at the onset of lactation. The defect in calcium homeostasis appears to reside in the sensitivity of bone and kidney tissues to parathyroid hormone (PTH) stimulation. Evidence suggests the acid-base status of the cow dictates the sensitivity of the tissues to PTH stimulation, and that metabolic alkalosis is responsible for blunting tissue PTH responsiveness. Hypomagnesemia can also reduce tissue PTH responsiveness but hypomagnesemia can be corrected in most rations. Excessive dietary potassium is very common and is the most important factor causing metabolic alkalosis in dairy cows. Formulation of rations to reduce metabolic alkalosis and/or induce a compensated metabolic acidosis in the pre-partal cow has proved a useful strategy for prevention of milk fever. The concept of dietary cation-anion difference manipulation and the physiologic effects this can have in the cow are presented, with special emphasis on the Strong Ion Difference theory of acid-base physiology.

  6. Using copper oxide wire particles or sericea lespedeza to prevent a peri-parturient rise of gastrointestinal nematodes in sheep and goats

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Gastrointestinal nematodes (GIN) continue to plague the small ruminant industry, especially parts of the world with warm, humid climates. Alternatives to chemicals are needed for GIN control because of anthelmintic resistance of GIN and a desire to reduce chemical residues in meat products. A stud...

  7. The Use of Intermittent Auscultation in Parturients of Varying BMI Categories: Experience From a Mid-Sized Tertiary Care Obstetrical Unit.

    PubMed

    Sheth Thakkar, Sheila; Lammers, Stephanie; Hahn, Philip M; Waddington, Ashley

    2015-04-01

    Objectifs : Ce projet d’assurance de la qualité avait pour but de déterminer le nombre des patientes répondant aux critères nécessaires à la mise en œuvre d’une auscultation intermittente (AI) pendant le travail qui ont bel et bien fait l’objet d’un tel monitorage. Son objectif secondaire était de déterminer si le taux d’utilisation de l’AI dépend de l’IMC maternel. Méthodes : Nous avons mené une analyse de dossiers rétrospective auprès d’un échantillon de femmes ayant reçu des soins obstétricaux au Kingston General Hospital sur une période d’un an à partir du 31 juillet 2012. L’admissibilité a été déterminée au moyen des critères d’inclusion et d’exclusion décrits par les lignes directrices de l’hôpital sur l’auscultation intermittente. Résultats : Deux cent sept des 244 dossiers analysés dans le cadre de cette analyse ont répondu aux critères nécessaires à la mise en œuvre d’une AI. L’âge moyen des femmes étudiées était de 29,3 ans (plage : de 17 à 41 ans). Leur âge gestationnel moyen était de 39,6 semaines (plage : de 37 à 42 semaines). Cinquante-six pour cent (116/207) des femmes admissibles ont bel et bien fait l’objet d’une AI. Quarante-sept pour cent des femmes obèses admissibles (47/100) ont fait l’objet d’une AI, par comparaison avec 64,4 % des femmes présentant une surcharge pondérale (58/90). Cette différence (17,4 %) était significative sur le plan statistique (P = 0,019, test exact de Fisher). Conclusion : Cinquante-six pour cent (116/207) des femmes qui connaissaient une grossesse exposée à de faibles risques et que l’on estimait être admissibles à la mise en œuvre d’une AI plutôt qu’à celle d’un monitorage fœtal électronique ont bel et bien fait l’objet d’une AI. Les femmes obèses étaient moins susceptibles de faire l’objet d’une AI que les femmes présentant une surcharge pondérale. La tenue d’un plus grand nombre de recherches s’avère requise au sujet des obstacles à l’utilisation de l’AI chez les femmes admissibles, tant au sein de notre établissement qu’ailleurs.

  8. The Efficacy of Intraoperative Neurophysiological Monitoring Using Transcranial Electrically Stimulated Muscle-evoked Potentials (TcE-MsEPs) for Predicting Postoperative Segmental Upper Extremity Motor Paresis After Cervical Laminoplasty

    PubMed Central

    Manabe, Hideki; Izumi, Bunichiro; Tanaka, Hiroyuki; Kawai, Kazumi; Tanaka, Nobuhiro

    2016-01-01

    Study Design: Prospective study. Objective: To investigate the efficacy of transcranial electrically stimulated muscle-evoked potentials (TcE-MsEPs) for predicting postoperative segmental upper extremity palsy following cervical laminoplasty. Summary of Background Data: Postoperative segmental upper extremity palsy, especially in the deltoid and biceps (so-called C5 palsy), is the most common complication following cervical laminoplasty. Some papers have reported that postoperative C5 palsy cannot be predicted by TcE-MsEPs, although others have reported that it can be predicted. Methods: This study included 160 consecutive cases that underwent open-door laminoplasty, and TcE-MsEP monitoring was performed in the biceps brachii, triceps brachii, abductor digiti minimi, tibialis anterior, and abductor hallucis. A >50% decrease in the wave amplitude was defined as an alarm point. According to the monitoring alarm, interventions were performed, which include steroid administration, foraminotomies, etc. Results: Postoperative deltoid and biceps palsy occurred in 5 cases. Among the 155 cases without segmental upper extremity palsy, there were no monitoring alarms. Among the 5 deltoid and biceps palsy cases, 3 had significant wave amplitude decreases in the biceps during surgery, and palsy occurred when the patients awoke from anesthesia (acute type). In the other 2 cases in which the palsy occurred 2 days after the operation (delayed type), there were no significant wave decreases. In all of the cases, the palsy was completely resolved within 6 months. Discussion: The majority of C5 palsies have been reported to occur several days after surgery, but some of them have been reported to occur immediately after surgery. Our results demonstrated that TcE-MsEPs can predict the acute type, whereas the delayed type cannot be predicted. Conclusions: A >50% wave amplitude decrease in the biceps is useful to predict acute-type segmental upper extremity palsy. Further examination about the interventions for monitoring alarm will be essential for preventing palsy. PMID:26147699

  9. Effect of a metabolically created systemic acidosis on calcium homeostasis and the diurnal variation in urine pH in the non-lactating pregnant dairy cow.

    PubMed

    Roche, John R; Dalley, Dawn E; O'Mara, Frank P

    2007-02-01

    Reducing the dietary cation-anion difference (DCAD) has been shown to be an effective means of preventing parturient paresis in confinement systems where cows are offered a total mixed ration containing DCAD-reducing mineral compounds (anionic salts). Such a supplementation strategy is not possible in cows being group fed forages precalving, and little is known about the effect of supplementing these cows with large amounts of anionic salts twice daily. Eight non-lactating, pregnant Holstein-Friesian cows were allocated to two levels of DCAD (-20 and +18 meq/100 g DM) for 24 d, with an intensive Ca balance undertaken in metabolism stalls following a 2-week acclimatization to diet. The basal diet was 3 kg DM of crushed barley and 7 kg DM of pasture-hay. Urine and faeces were collected separately, weighed daily for 5 d and analysed for Ca content. Urinary Ca, creatinine and hydroxyproline concentration and plasma Ca concentration were determined during the period of the balance study. The diurnal pattern in urine and rumen pH was determined over 2 d. Decreasing DCAD reduced (P<0.001) the pH of urine, and increased (P<0.05) Ca absorption. Plasma Ca concentration was not affected by DCAD, and DCAD did not affect the output of urinary hydroxyproline, a marker of bone resorption. Twice-daily supplementation of anionic salts was sufficient to reduce the pH of blood and increase gastrointestinal Ca absorption. There was no diurnal variation in the pH of urine, suggesting that time of sampling to determine efficacy of DCAD in reducing systemic pH was not important.

  10. Effect of Anionic Salt and Highly Fermentable Carbohydrate Supplementations on Urine pH and on Experimentally Induced Hypocalcaemia in Cows

    PubMed Central

    Mellau, LSB; Jørgensen, RJ; Bartlett, PC; Enemark, JMD; Hansen, AK

    2004-01-01

    The objective of this experiment was to determine the effect of dietary grain on calcium homeostasis. Six rumen-fistulated dairy cows with 3 or more previous lactations and no history of parturient paresis were randomly assigned to a sequence of diets in a crossover study with 4 periods of 10 days each. Dietary treatments were: A control ration consisting of wrap grass silage alone (1), the control ration supplemented with ammonium chloride and ammonium sulphate salt solution (2), control ration following a period with supplementation (3) and control ration supplemented with increasing amounts of barley from 4 to 10 kg/cow per day, expected to produce subclinical rumen acidosis (4). Daily intake of the diets was adjusted to 14 kg DM/cow per day. On day 11, the calcium-regulating mechanisms in cows were challenged until recumbency by a standardized intravenous EDTA infusion and cows were left to recover spontaneously. Anion supplementation and the feeding of highly fermentable carbohydrate lowered urine pH below 7.0 due to subclinical acidosis. During spontaneous recovery from EDTA induced hypocalcaemia, the cows more quickly regained a whole blood free calcium concentration of 1.00 mmol/L if they had most recently been supplemented with either anionic salts or with increasing amounts of barley, as compared to the basic ration. It is concluded that so-called slug-feeding or 'steaming up' with highly fermentable carbohydrates before parturition in milk fever susceptible cows enhanced calcium homeostasis similar to the effect seen in cows on anionic diets. PMID:15663074

  11. Correlation of serum IgG concentration in foals and refractometry index of the dam's pre- and post-parturient colostrums: an assessment for failure of passive transfer in foals.

    PubMed

    Korosue, Kenji; Murase, Harutaka; Sato, Fumio; Ishimaru, Mutsuki; Kotoyori, Yasumitsu; Nambo, Yasuo

    2012-11-01

    The object of this study was to evaluate the usefulness of measuring the differences in the values of the serum total protein (DVSTP) concentration of foals and the refractometry index (DVRI) of the milk of dams before and after nursing of the colostrum for assessing failure of passive transfer (FPT) in foals. Serum samples from 31 foals were collected before the first nursing and other 1 to 6 times between 4 and 24 hr after birth. Paired colostrum and milk samples were collected from 14 of their dams at the same time. Serum samples were analyzed for IgG concentration using a single radial immunodiffusion (SRID) test (98 samples) and total protein concentration using a temperature-compensating refractometer (98 samples). Colostrum and milk samples were analyzed for refractometry index (RI) using a Brix refractometer (71 samples). DVSTP concentration and DVRI were significantly correlated with serum IgG concentration. The negative predictive values (NPVs) of DVSTP concentration for detecting serum IgG concentrations<400 mg/dl and<800 mg/dl were 98.2% and 91.3% when the cutoff value is set to 0.4 mg/dl and 0.8 mg/dl, respectively. Furthermore, the NPVs of DVRI for detecting serum IgG concentrations<400 mg/dl and<800 mg/dl were 97.3% and 96.3% when the cutoff value is set to 6% and 10%, respectively. The results suggest that measurement of DVRI is useful in assessing FPT as an initial "stall-side" screening test, because it is easy, inexpensive to perform and allows for rapid interpretation.

  12. Obstetric Analgesia

    PubMed Central

    Thistlewood, John M.

    1988-01-01

    This article deals with current knowledge about labour pain; the effects of labour pain on the parturient, the fetus, and uterine activity; the benefits and risks of the various labour-pain options; and the parturient's right to exercise informed choice of analgesia options. PMID:21253234

  13. [Vocal cord paralysis--analysis of a cohort of 400 patients].

    PubMed

    Reiter, R; Pickhard, A; Smith, E; Hansch, K; Weber, T; Hoffmann, T K; Brosch, S

    2015-02-01

    Vocal cord paralysis has diverse etiologies. In the present study, vocal chord paralysis caused by surgery/trauma was present in more than two thirds of the cases, followed by primary malignancy-associated paralysis. Thyroidectomy was the most common cause in bilateral paresis, especially if performed in recurrent or malignant disease. Voice therapy was promising in pa-tients with unilateral paresis and hoarseness as main symptom. Persistent dysphonia due to insufficiency of the glottic closure led to an operative glottis restricting procedure in only 6% of cases. In almost half the patients with dyspnea as the main symp-tom of bilateral vocal cord paresis, temporary tracheotomy or surgical glottis widening procedures had to be performed. The group of idiopathic and traumatic paresis patients showed the best spontaneous recovery within the first 12 months in comparison to primary malignancy-associated paralysis, which showed no recovery of the recurrens nerve.

  14. Management of paretic vertical deviations.

    PubMed

    Archer, Steven M

    2011-01-01

    Paretic vertical deviations are characterized by complex patterns of incomitance that make them some of the most challenging strabismus problems to treat. Optimum results are obtained by performing surgery on those muscles, selected from among the eight cyclovertical muscles in the two eyes, that minimize the incomitance. In superior oblique paresis the additional factors of torticollis and torsion need to be addressed and aberrant regeneration can alter the surgical plan in third nerve paresis.

  15. Relation between symptoms and pathophysiology in inflammatory neuropathies: Controversies and hypotheses.

    PubMed

    Franssen, Hessel

    2015-06-02

    This review attempts to explain the symptoms experienced by patients with inflammatory neuropathies by pathophysiological events. The emphasis is not on the primary events that may cause a particular illness but on downstream events taking place in peripheral nerves or muscles. Symptoms that will be discussed include sensory predominance, motor predominance, activity-induced weakness, heat paresis, and cold paresis. Each symptom is associated with, but not limited to, particular neuropathies.

  16. Isolated pyocele of anterior clinoid process presenting as a cavernous sinus syndrome.

    PubMed

    O'Donnell, Thomas J; Michael, L Madison; Laster, Robert; Fleming, James C

    2013-05-01

    A 37-year-old man presented with fever, decreased vision in the left eye, a partial left cranial nerve III paresis, and a left cranial nerve VI paresis. Neuro-imaging showed an opacification of a left pneumatised anterior clinoid process. After failing a course of intravenous antibiotics, a craniotomy was performed with exenteration of the cavity and resolution of symptoms. Although rare, a pyocele of a pneumatised anterior clinoid process may cause ocular morbidity and require surgical intervention.

  17. [Hemiparesis and facial palsy caused by methotrexate].

    PubMed

    Rueda Arenas, E; García Corzo, J; Franco Ospina, L

    2013-12-01

    Methotrexate used in the treatment of acute lymphocytic leukemia, can cause neurotoxicity, including a rare presentation with hemiparesis. We describe two teenagers, who during the implementation of the M phase of the protocol, suffered hemiparesis, facial paresis and dysarthria which quickly reversed. Leukemia involvement of the central nervous system and stroke, were ruled out. We briefly review the pathophysiology of methotrexate neurotoxicity, the characteristics of the focal paresis presentation and magnetic resonance image findings.

  18. Managing anesthesia for cesarean section in obese patients: current perspectives

    PubMed Central

    Lamon, Agnes M; Habib, Ashraf S

    2016-01-01

    Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations) with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there is increased risk of postoperative complications in the morbidly obese parturients. PMID:27574464

  19. Rising fecal glucocorticoid concentrations track reproductive activity in the female giant panda (Ailuropoda melanoleuca).

    PubMed

    Kersey, David C; Wildt, David E; Brown, Janine L; Snyder, Rebecca J; Huang, Yan; Monfort, Steven L

    2011-09-01

    To better understand the adaptive significance of adrenal glucocorticoid (GC) variation in the giant panda, we assessed patterns of fecal GC excretion over time as well as during estrus, parturient and non-parturient luteal phases, lactation and acyclicity in 17 adult females. Fecal estrogen and GC patterns were positively correlated (P<0.05) in four of five periestrual females (r = 0.57-0.92). Among all reproductive states, fecal GC was highest (P<0.05) during periestrus (non-parturient, 495.9 ± 100.7 ng/g [mean ± SE]; parturient, 654.1 ± 10 6.5 ng/g; P>0.05). Concentrations of GC metabolites were lower (P<0.05) during the later stage of the luteal phase in non-parturient (334.8 ± 24.8 ng/g) compared to parturient (470.4 ± 54.0 ng/g) females. Although fecal GC concentrations in cyclic, non-parturient females did not differ (P>0.05) across all seasons, there were seasonal variations (P<0.05) in females that were acyclic and non-lactational. However, the overall lack of difference (P>0.05) in GC values between reproductively cyclic and acyclic females did not support the hypothesis that ovarian acyclicity is due to increased adrenal activity (related or unrelated to physiological stress). Furthermore, GCs may play an important role in the normal endocrine milieu associated with sexual receptivity and late pregnancy. These data demonstrate that both reproductive status and seasonal factors are important modulators of adrenal function in this endangered species.

  20. Epidural analgesia during labor vs no analgesia: A comparative study

    PubMed Central

    Mousa, Wesam Farid; Al-Metwalli, Roshdi; Mostafa, Manal

    2012-01-01

    Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5%) and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration. PMID:22412775

  1. Disorders of coagulation in pregnancy.

    PubMed

    Katz, D; Beilin, Y

    2015-12-01

    The process of haemostasis is complex and is further complicated in the parturient because of the physiological changes of pregnancy. Understanding these changes and the impact that they have on the safety profile of the anaesthetic options for labour and delivery is crucial to any anaesthetist caring for the parturient. This article analyses current theories on coagulation and reviews the physiological changes to coagulation that occur during pregnancy and the best methods with which to evaluate coagulation. Finally, we examine some of the more common disorders of coagulation that occur during pregnancy, including von Willebrand disease, common factor deficiencies, platelet disorders, the parturient on anticoagulants, and the more rare acute fatty liver of pregnancy, with a focus on their implications for neuraxial anaesthesia.

  2. Complete heart block in pregnancy: case report, analysis, and review of anesthetic management.

    PubMed

    Sundararaman, Lalitha; Hochman Cohn, Jennifer; Ranasinghe, J Sudharma

    2016-09-01

    Maternal complete heart block can pose significant challenges for the anesthesiologist in the antepartum, peripartum, and postpartum periods. Some patients may present for the first time in the puerperium with dizziness, weakness, syncope, or congestive heart failure as a result of the additional hemodynamic burden that accompanies pregnancy. Although there is an increase in permanent pacemaker placement in young symptomatic patients before pregnancy, prophylactic placement of pacemakers in asymptomatic parturients is not always indicated. The need for temporary or permanent pacemakers in asymptomatic women should be assessed on a case-by-case basis; many of these patients may be safely managed during labor and delivery without pacing. The parturient with complete heart block must be followed vigilantly during pregnancy and post delivery, as the need for pacemaker insertion can also arise in the postpartum period. We present a case of third-degree heart block in a 26-year-old parturient.

  3. Intrathecal injection of morphine for obstetric analgesia.

    PubMed

    Baraka, A; Noueihid, R; Hajj, S

    1981-02-01

    Intrathecal injection of morphine was used to provide obstetric analgesia in 20 primiparous women in labor. When the cervix was at least 3 cm dilated, morphine, 1 or 2 mg, was injected intrathecally. In all parturients, labor pains were completely relieved after 15-60 min and analgesia lasted as long as eight to 11 hours. The analgesia was not associated with any alteration of pin-prick sensation or motor power, and there was no change in the arterial blood pressure or heart rate. All infants were delivered vaginally by use of episiotomy annd a low forceps, except two infants of mothers in the 2 mg of morphine group who needed cesarean section. During the second stage of labor, analgesia was supplemented by lidocaine, 2 per cent, using local perineal infiltration in 14 parturients and pudendal block in two parturients, and by epidural block in four parturients. Nineteen of the 20 newborns cried immediately at birth, and had Apgar scores o 7-9 at 1 min and 8-10 at 5 min. During the first 24 hours of life, the neurobehavioral responses of all newborns were scored as normal. Systemic maternal side effects such as somnolence, nausea, vomiting, and itching occurred in a high proportion of the parturients. However, in the majority of cases, these side effects were mild. Only two parturients of the 2 mg morphine group complained of marked somnolence, itching, and vomiting, which persisted post partum; these were effectively reversed by the specific antagonist naloxone. The analgesic effect of intrathecal morphine can be attributed to its action on the opiate receptors in the substantia gelatinosa of the dorsal horn of the spinal cord. However, supraspinal effects of morphine cannot be excluded. The low lipid solubility of morphine can explain its slow onset and prolonged duration of action. Also, this will result in minimal systemic absorption of morphine, which protects the fetus and results in selective maternal analgesia.

  4. The use of narcotics and street drugs during pregnancy.

    PubMed

    Lindsay, Michael K; Burnett, Erin

    2013-03-01

    All prenatal care providers should offer routine voluntary substance use screening to all patients. Parturients who screen positive for illicit substances require a multidisciplinary team approach to drug rehabilitation and prenatal care. This review will examine the pharmacological properties and the neonatal consequences of the use of opioids and amphetamines. Substance-abusing parturients typically abuse multiple substances simultaneously and have other comorbidities including psychosocial instability and mental illness. These comorbidities must be effectively addressed to achieve optimal health outcomes for both mother and infant.

  5. Chest ultrasonography in emergency Cesarean delivery in multi-valvular heart disease with pulmonary edema during spinal anesthesia.

    PubMed

    Samanta, Sukhen; Samanta, Sujay; Ghatak, Tanmoy; Grover, V K

    2014-05-01

    Valvular heart disease in a parturient presenting for Cesarean section is challenging. A 25 year old primigravida parturient with severe mitral stenosis, mild mitral regurgitation, mild aortic regurgitation, and mild pulmonary arterial hypertension required Cesarean delivery after developing pulmonary edema. Low-dose spinal with hyperbaric bupivacine 0.5% 1.8 mL plus 25 μg of fentanyl was used for anesthesia. Chest ultrasonography (US) and transthoracic echocardiography (TTE) were used for monitoring purposes. Spinal-induced preload reduction improved the pulmonary edema, as evidenced by chest US. Chest US and TTE helped in fluid management.

  6. Normoglycemic Diabetic Ketoacidosis in a Pregnant Patient with Type II Diabetes Mellitus Presenting for Emergent Cesarean Delivery.

    PubMed

    Cardonell, Bradford L; Marks, Barry A; Entrup, Michael H

    2016-04-15

    The development of acute abdominal pain in a laboring parturient after a previous cesarean delivery is of concern and may be the result of a potentially life-threatening condition such as uterine rupture. We present a case of a parturient with type II diabetes mellitus, who had undergone 2 previous cesarean deliveries and now presented in labor with increasing abdominal pain. An emergency cesarean delivery was performed for probable uterine rupture. Intraoperatively, the patient was noted to be severely hypocarbic with significant metabolic acidosis, and the diagnosis of diabetic ketoacidosis was established.

  7. [The head-up-orthosis - a good solution for ambulant patients with Dropped-head-syndrome].

    PubMed

    Czell, D; Weber, M

    2012-11-14

    Severe paresis of the neck muscles, dystonia or an increased activation of the head flexor can lead to dropped-head syndrome. It can be based on various neurological diseases. We present a patient with amyotrophic lateral sclerosis with severe paresis of the head extensor muscles, which led to a dropped-head syndrome. Usual advices did not permit an adequate swallowing and breathing. The new developed device (head-up) can be adjusted on the individual needs which lead to a marked improvement in quality of life of the patient. Especially for ambulatory patients with Dropped-head syndrome is the «head-up» a very good solution.

  8. Changes in rumen bacterial communities and rumen chemistry in primiparous Holstein cows during the periparturient period

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The objectives of this study were to study the changes in: 1) rumen bacterial community composition (BCC) and fermentation as influenced by feeding regimen and period; and 2) pH and VFA profiles among selected cows with minimum (stable) and maximum variation (unstable) between pre- and post-parturie...

  9. [PERIOPERATIVE ANALGESIA INFLUENCE ON MOTHER REHABILITATION PERIOD AFTER CESAREAN SECTION].

    PubMed

    Sedykh, S V

    2015-01-01

    Early breast-feeding is a standard of perinatal care currently. After cesarean section it can be possible in case of early mother activation (verticalization). Assessment of perioperative analgesia influence on activation timing was the aim of our research. We included 120 parturient women. It was proved, that local analgesia using in postoperative period promotes early mother verticaliration, and optimal breast-feeding starting.

  10. Piriformis pyomyositis, an unusual presentation of leg pain post partum--case report and review of literature.

    PubMed

    Wong, L F A; Mullers, S; McGuinness, E; Meaney, J; O'Connell, M P; Fitzpatrick, C

    2012-08-01

    Piriformis pyomyositis is defined as a subacute infection of skeletal muscles associated with systemic infectious symptoms. In the literature it rarely occurs postpartum. We report a case of piriformis pyomyositis involving a parturient and review the published cases available in the literature.

  11. 21 CFR 520.1010 - Furosemide.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    .... For treatment of physiological parturient edema of the mammary gland and associated structures. (iii...) Indications for use—(A) For treatment of edema (pulmonary congestion, ascites) associated with cardiac insufficiency and acute noninflammatory tissue edema. (B) For treatment of edema (pulmonary congestion,...

  12. 21 CFR 520.1010 - Furosemide.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    .... For treatment of physiological parturient edema of the mammary gland and associated structures. (iii...) Indications for use—(A) For treatment of edema (pulmonary congestion, ascites) associated with cardiac insufficiency and acute noninflammatory tissue edema. (B) For treatment of edema (pulmonary congestion,...

  13. 21 CFR 520.1010 - Furosemide.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    .... For treatment of physiological parturient edema of the mammary gland and associated structures. (iii...) Indications for use—(A) For treatment of edema (pulmonary congestion, ascites) associated with cardiac insufficiency and acute noninflammatory tissue edema. (B) For treatment of edema (pulmonary congestion,...

  14. 21 CFR 520.1010 - Furosemide.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    .... For treatment of physiological parturient edema of the mammary gland and associated structures. (iii...) Indications for use—(A) For treatment of edema (pulmonary congestion, ascites) associated with cardiac insufficiency and acute noninflammatory tissue edema. (B) For treatment of edema (pulmonary congestion,...

  15. 21 CFR 520.1010 - Furosemide.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    .... For treatment of physiological parturient edema of the mammary gland and associated structures. (iii...) Indications for use—(A) For treatment of edema (pulmonary congestion, ascites) associated with cardiac insufficiency and acute noninflammatory tissue edema. (B) For treatment of edema (pulmonary congestion,...

  16. Effect of rubber flooring on cow locomotion and gene expression

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The aim of this study was to evaluate the effect of 2 dairy cow housing systems on cow locomotion and expression of genes associated with lameness, during the dry and peri-parturient period. Cows were assigned to free-stall housing with either rubber (RUB; n=13) or concrete (CON; n=14) at the feed-f...

  17. The effect of floor surface on dairy cow immune function and locomotion score

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The study evaluated the effect of 2 dairy cow housing systems on cow locomotion, leukocyte activity and expression of genes associated with lameness, during the dry and peri-parturient period. Cows were assigned to free-stall housing with either rubber (RUB; n=13) or concrete (CON; n=14) at the feed...

  18. Side effects of spiramycin masquerading as local anesthetic toxicity during labor epidural analgesia.

    PubMed

    Julliac, B; Théophile, H; Begorre, M; Richez, B; Haramburu, F

    2010-07-01

    Significant fetal bradycardia occurred when a parturient receiving labor epidural analgesia experienced generalized numbness and tingling, a metallic taste and hot flushes. An emergent cesarean delivery under general anesthesia was performed with favorable outcomes for the mother and baby. The most likely source of the maternal symptoms was spiramycin, which was being administered for treatment of toxoplasmosis.

  19. [Obstetric analgesia using nitralgin inhalation and lumbal peridural anesthesia (a model for obstetric analgesia)].

    PubMed

    Hardonyi, A; Sándor, C; Barkai, L; Koltai, M

    1990-06-10

    Authors report the systems of anesthesia used at their ward for delivery in the last eight years. Nitralgin inhalation is used since 1981, lumbar peridural anesthesia is used since 1983. Of 13,458 deliveries in case of 3893 parturiants Nitralgin analgesia was used, while LEDA was used for 2300 parturients. By means of Nitralgin inhalation system it could be assured in the delivery room to apply the pain relief gas mixture (Nitralgin) simultaneously for several parturients. With direction of anesthesiologists employed for the ward the LEDA was attained by gynecologists knowing the use and application of general anesthesia. Thus the continuous application of both procedures can be ensured in 24 hours a day. In our study the frequency of vacuum extraction (0.26 p. c.) and that of Cesarean section (12.81 p. c.) did not increase. With application of these methods it could be achieved that 60 p. c. of vaginal deliveries are performed with anesthesia. Authors propose their system for wider application since in the same ward more and more parturients can be applied anesthesia for pain relief at vaginal delivery.

  20. PubMed Central

    Cécyre, A.; Baril, J.; Morin, M.

    1979-01-01

    Postparturient hemoglobinuria in a Quebec dairy herd A case of post parturient hemoglobinuria which occurred in a Quebec dairy herd is reported. Anemia and hypophosphoremia were present in many animals without any clinical signs, while others were showing severe signs of hemoglobinuria. History, diagnostic techniques and treatment are discussed. PMID:509383

  1. Hormonal control of birth behavior in the Tasmanian devil Sarcophilus harrisii.

    PubMed

    Rose, R W; Bell, L; Shaw, G

    2006-09-01

    In a number of marsupial species, females exhibit characteristic, stereotyped parturient behavior that facilitates the passage of the neonates to the pouch. In macropodids, this parturient behavior can be induced in non-pregnant females and males by treatment with either prostaglandin F2alpha (PGF2alpha) or oxytocin (OT). This study investigated the effects of PGF2alpha and OT on behavior of Tasmanian devils. Animals tended to sit or lie down quickly, with little vocalization, after treatment with PGF2alpha or OT, while after saline, the animals remained alert, seldom sat, and frequently vocalized. Hormone treatment caused increased respiration. Urogenital and pouch grooming, a characteristic element of parturient behavior in macropodids, was seen in only one devil after hormone treatment. However, no pouch or urogenital grooming was seen in videotape of a devil giving birth, so this may not be a feature of parturient behavior in this species. Overall behavior of males and females was very similar suggesting that the behavioral effects observed may be due to direct neural action of PGF2alpha or OT, rather than an indirect response to uterine or vaginal contractions caused by the hormones. This study is the first to demonstrate that OT results in PGF2alpha secretion as PGFM levels rose after OT injection.

  2. Mutism following left hemisphere infarction.

    PubMed Central

    David, A S; Bone, I

    1984-01-01

    A case of mutism due to left hemisphere infarction is described. Recovery revealed mild motor dysphasia. Review of the literature showed that the case resembles aphemia but is unique by virtue of its duration, and the absence of associated apraxia and paresis. Images PMID:6210346

  3. Bacterial diskospondylitis in juvenile mink from 2 Ontario mink farms.

    PubMed

    Martínez, Jorge; Vidaña, Beatriz; Cruz-Arambulo, Robert; Slavic, Durda; Tapscott, Brian; Brash, Marina L

    2013-09-01

    Nine juvenile mink with hind-limb paresis/paralysis from 2 Ontario farms were submitted for necropsy. Diagnostic tests revealed spinal compression and severe thoracic diskospondylitis with intralesional Gram-positive coccoid bacterial colonies. Streptococcus canis, Streptococcus dysgalactiae subsp. equisimilis, and hemolytic Staphylococcus spp. were isolated from vertebral lesions.

  4. Intoxication of sheep exposed to ozark milkweed (Asclepias viridis Walter).

    PubMed

    Smith, R A; Scharko, P; Bolin, D; Hong, C B

    2000-12-01

    Some 20 sheep died 1 at a time on a farm in Fleming County, KY, in late July of 1999 after consumption of Asclepias viridis Walter. Major histological lesions were mild multifocal nonsuppurative myocarditis. Gross pathology revealed wet and heavy lungs. Many affected animals had a hunched appearance, and marked posterior paresis was also observed.

  5. Retroperitoneal abscesses in two western lowland gorillas (Gorilla gorilla gorilla).

    PubMed

    Hahn, Alicia; D'Agostino, Jennifer; Cole, Gretchen A; Raines, Jan

    2014-03-01

    This report describes two cases of retroperitoneal abscesses in female western lowland gorillas (Gorilla gorilla gorilla). Clinical symptoms included perivulvar discharge, lameness, hindlimb paresis, and general malaise. Retroperitoneal abscesses should be considered as part of a complete differential list in female gorillas with similar clinical signs.

  6. Bacterial diskospondylitis in juvenile mink from 2 Ontario mink farms

    PubMed Central

    Martínez, Jorge; Vidaña, Beatriz; Cruz-Arambulo, Robert; Slavic, Durda; Tapscott, Brian; Brash, Marina L.

    2013-01-01

    Nine juvenile mink with hind-limb paresis/paralysis from 2 Ontario farms were submitted for necropsy. Diagnostic tests revealed spinal compression and severe thoracic diskospondylitis with intralesional Gram-positive coccoid bacterial colonies. Streptococcus canis, Streptococcus dysgalactiae subsp. equisimilis, and hemolytic Staphylococcus spp. were isolated from vertebral lesions. PMID:24155490

  7. Periorbital scleroderma associated with heterochromia iridis.

    PubMed

    Stone, R A; Scheie, H G

    1980-12-01

    Two patients had biopsy-proven linear scleroderma, associated with a pigmentary abnormality of the anterior segment of the eye. One patient had heterochromia iridis, atrophy of the upper eyelid, a typical coup de sabre lesion, and a markedly asymmetric pigmentary glaucoma. The second patient had bilateral scalp involvement, paresis of the extraocular muscles, blepharoptosis, and heterochromia iridis.

  8. Cerebral Salt-Wasting Associated with the Guillain-Barre Syndrome

    DTIC Science & Technology

    1965-07-01

    Research Unit No. 2 (NAMRU-2). onset of symptoms revealed bilateral facial paresis, SClinical investigator (Dr. Cooper) and virologist (Drs. complete...two weeks before the appearance of his paraly - virus was cultured from his throat at the onset sis.10 Viral complement-fixation tests suggested of the

  9. Impairment-oriented training (IOT)--scientific concept and evidence-based treatment strategies.

    PubMed

    Platz, T

    2004-01-01

    Everyday activities can be affected by many different body dysfunctions (impairments). A multi-modal analysis of electric brain activity revealed that movement-related brain activity is differentially altered in patients with different impairments, i.e. paresis, somatosensory deficits, and apraxia. Each body dysfunction has its own characteristics in terms of the resulting sensorimotor control deficits. The Impairment-oriented Training concept intends to characterise the resulting sensorimotor control deficits for each impairment. Based on such analyses two specific training techniques have been developed for stroke patients with mild and severe arm paresis: (1.) The Arm Ability training for mild arm paresis trains different sensorimotor abilities such as dexterity, speed of isolated hand and finger movements, steadiness, aiming, or tracking under visual guidance. Improvement of these motor abilities leads to improved motor performance in every day life circumstances. (2.) The Arm BASI S training for severe arm paresis intends to restore more basic motor control, i.e. the full range of active non-segmented motion of all limb segments, both postural activities and dynamic motion control, interjoint-coordination, and adequate motor control when external forces are applied. Clinical trials with representative study populations supported both techniques' clinical efficacy.

  10. Comparative imaging of spinal extradural lymphoma in a Bordeaux dog.

    PubMed

    Veraa, Stefanie; Dijkman, Reinie; Meij, Björn P; Voorhout, George

    2010-05-01

    A lumbar extradural lymphoma compressing the spinal cord was identified on contrast enhanced computed tomography (CT) and magnetic resonance imaging (MRI) images in a 4-year-old Bordeaux dog presented with posterior paresis. A significant paravertebral extension was only clearly defined on contrast MRI images; therefore, MRI was more useful than CT in imaging of spinal extradural lymphoma in this dog.

  11. Worster-Drought Syndrome: Poorly Recognized despite Severe and Persistent Difficulties with Feeding and Speech

    ERIC Educational Resources Information Center

    Clark, Maria; Harris, Rebecca; Jolleff, Nicola; Price, Katie; Neville, Brian G. R.

    2010-01-01

    Aim: Worster-Drought syndrome (WDS), or congenital suprabulbar paresis, is a permanent movement disorder of the bulbar muscles causing persistent difficulties with swallowing, feeding, speech, and saliva control owing to a non-progressive disturbance in early brain development. As such, it falls within the cerebral palsies. The aim of this study…

  12. A thymic carcinoid in a Bengal tiger (Panthera tigris).

    PubMed

    Powe, Joshua; Castleman, William; Fiorello, Christine

    2005-09-01

    An 18-yr-old Bengal tiger (Panthera tigris) presented with acute onset hind limb paresis. Radiographic and ultrasonographic imaging revealed a caudal abdominal aortic thrombus and a cranial mediastinal mass. Necropsy confirmed aortic thrombosis. Necrotizing enteritis and multifocal renal thrombosis were also noted. The cranial mediastinum contained a bilobed mass that histologically and ultrastructurally was consistent with a carcinoid.

  13. Perceived health in a population based sample of victims of the 1956 polio epidemic in the Netherlands

    PubMed Central

    Nollet, F; Ivanyi, B; Beelen, A; de Haan, R J; Lankhorst, G; de Visser, M

    2002-01-01

    Objective: To investigate perceived health and its relation to residual paresis from polio, late onset neuromuscular symptoms following poliomyelitis (LSP), and sex, in a population based sample of polio survivors. Methods: 350 subjects traced from the notification records of the Dutch 1956 polio epidemic received a mailed questionnaire on residual polio paresis and new neuromuscular symptoms. Perceived health was measured using the Nottingham health profile. Respondents with new muscle weakness and new neuromuscular symptoms were considered as cases with LSP. Results: Health problems were perceived by 151 of the 260 respondents. Respondents with residual paresis had significantly more health problems than clinically recovered respondents for the Nottingham health profile category of physical mobility. The perceived health of respondents with LSP (45.5%) was significantly worse than that of respondents without LSP for all the health profile categories. Among the respondents with LSP, health status did not differ between those with residual paresis and those who had recovered, except for physical mobility. Female respondents with LSP reported worse health status than male respondents with regard to physical mobility and social isolation. Conclusions: In this population based sample, health problems were frequently reported. They were mainly related to late onset neuromuscular symptoms following poliomyelitis, which were perceived by a substantial proportion of all polio survivors—not only subjects with polio residuals but also individuals who (subjectively) had recovered from polio. PMID:12438472

  14. Analgesic efficacy using loss of resistance to air vs. saline in combined spinal epidural technique for labour analgesia.

    PubMed

    Leo, S; Lim, Y; Sia, A T H

    2008-09-01

    Identification of the epidural space is often performed using the loss of resistance technique to either air or saline. We sought to investigate if the medium used affected the quality of analgesia obtained by parturients who received labour epidurals. We conducted a retrospective audit of labour epidurals performed on nulliparous parturients in our institution from May 2003 to March 2005. All epidural catheters were inserted by senior obstetric anaesthetists using a combined spinal epidural technique. The following information was recorded: parturients' demographic data, loss of resistance technique used, type and amount of local anaesthetic solution administered, complications encountered during procedure, pre-block and post-block pain scores, incidence of breakthrough pain requiring supplemental medication and post-block side-effects. Data from 2848 patients were collected and analysed; 56% of patients made up the saline group and 44% the air group. Patients in both groups had similar demographic profiles and similar incidences of complications and post-block side-effects. However patients in the air group had a higher incidence of recurrent breakthrough pain P = 0.023). We also identified three other factors that were associated with an increased incidence of recurrent breakthrough pain; administration of pre-block oxytocin, sitting position of the parturient during the procedure and the use of intrathecal bupivacaine for induction of analgesia. Our findings suggest that a loss of resistance to air is associated with a higher incidence of recurrent breakthrough pain among parturients who received combined spinal epidural analgesia for labour than a loss of resistance to saline.

  15. [Investigating into whether systematic fetal weight estimation by ultrasound in the delivery room increases the risk of cesarean delivery].

    PubMed

    Dimassi, Kaouther; Ajroudi, Meryam; Saidi, Olfa; Salem, Safa; Robbana, Monia; Triki, Amel; Gara, Mohammed Faouzi

    2016-01-01

    Ultrasound is a valuable tool commonly used in the delivery room. It has multiple applications. The objective of this study was to investigate whether systematic fetal weight estimation by ultrasound in the delivery room increases the risk of cesarean delivery. Monocentric cohort study. All parturients with singleton pregnancies who gave birth full-term at = 39 weeks were enrolled in the study. We excluded all patients with a contraindication to vaginal birth as well as those in whom fetal weight estimation (FWE) by ultrasound on day of delivery was deemed necessary in making obstetric decision. Parturients enrolled in the study were divided into two groups: - G1: parturients who systematically underwent FWE - G2: parturients who never underwent FWE. We compared cesarean delivery rate with adjustment for potentially confounding factors according to logistic regression. 838 parturients were enrolled in the study. Prematurity, FWE and weight at birth were risk factors for cesarean delivery. After adjustment for confounding factors, FWE by ultrasound systematically performed in G1 proved to be an independent risk factor for cesarean delivery with OR = 3.8 (CI 95% = [2.67 to 5.48]). This risk increased significantly with estimated fetal weight (EFW): OR=2,27(CI 95;1,15-4,47; p=0.018) for 3500 < EFW < 4000g and OR = 10.64 (CI 95; 4.28 to 26.41; p < 0.001 ) for EFW > 4000 g. FWE by ultrasound systematically performed in the delivery room represents an independent and potentially modifiable risk factor for cesarean delivery.

  16. A comparison of the analgesic effects of methoxyflurane-nitrous oxide and nitrous oxide alone during labour related to the Eysenck personality inventory test.

    PubMed

    Arozenius, S; Dahlgren, B E; Lindwall, L; Akerlind, I

    1980-01-01

    One hundred and thirty-three paturients who had received either methoxyflurane-nitrous oxide or nitrous oxide analgesia with or without pudendal block, underwent the Eysenck Personality Inventory Test on the second postpartum day and evaluated their memory of the pain (Subjectively Evaluated Pain Suffering Scores) during labor. Parturients who had received methoxyflurance-nitrous oxide analgesia reported significantly lower pain suffering than parturients who had had nitrous oxide analgesia. Subdivision according to Personality Inventory factors showed that at the introvert end of the Extroversion-Introversion scale, methoxyflurance-nitrous oxide analgesia with or without additional pudendal block resulted in significantly lower pain suffering than did not nitrous oxide analgesia. On the other hand, nitrous oxide analgesia without additional pudendal block gave significantly lower pain suffering at the extrovert end of the scale. Among the extroverts there was a tendency, though not statistically significant, towards non-approval of the pudendal block.

  17. Relationship between blood calcium level and ST peak interval of electrocardiographic variables in peripartum Holstein cows

    PubMed Central

    ITOH, Megumi; SAKURAI, Yoshie; NAKAJIMA, Yasuhiro; KAWAMOTO, Satoshi

    2015-01-01

    The association between blood calcium levels and electrocardiographic variables was compared in 137 normal parturient and 36 peripartum recumbent Holstein cows to determine whether hypocalcemia in peripartum dairy cows can be rapidly diagnosed using electrocardiograph. Inverse of STc (ST peak interval/SS interval0.5) and blood ionized calcium or serum calcium concentrations were strongly correlated, and both correlation coefficients were 0.81 (P<0.001). The 95% prediction interval indicated that cows with STc >0.385 ± 0.001 sec are very likely to be hypocalcemic (blood ionized or serum calcium concentrations of <0.9 mmol/l or <7.5 mg/dl, respectively). These findings indicate that hypocalcemia in parturient cows can be non-invasively estimated using the STc. PMID:26118411

  18. Placentophagia in Weanling Female Laboratory Rats

    PubMed Central

    Harding, Kaitlyn M.; Lonstein, Joseph S.

    2014-01-01

    Placentophagia is common in parturient mammals and offers physiological and behavioral advantages for mothers. In natural environments, weanlings are often present during the birth of younger siblings, but it is unknown if weanling rats are placentophagic or prefer placenta over other substances. To examine this, primiparous rats were remated during the postpartum estrus and weanling females remained in the nest during their mother’s next parturition. Continuous observation revealed that 58% of weanlings were placentophagic. To determine if this placentophagia occurs away from parturient mothers, weanling females still living in their natal nest were offered placenta, liver, or cake frosting in a novel chamber. They ingested more placenta and liver than frosting. Thus, many weanling female laboratory rats are placentophagic during birth of younger siblings but do not selectively prefer placenta when tested outside their natal nest. Consequences of placentophagia by weanlings are unknown, but it may promote their alloparenting or postpartum mothering. PMID:24604548

  19. Chronic adhesive arachnoiditis after repeat epidural blood patch.

    PubMed

    Carlswärd, C; Darvish, B; Tunelli, J; Irestedt, L

    2015-08-01

    Epidural blood patching is an effective treatment for postdural puncture headache but has potential risks. Arachnoiditis is a very rare disabling condition and few cases have been described following an epidural blood patch. We present a case of chronic adhesive arachnoiditis in a parturient treated with a repeat epidural blood patch. A healthy 29-year-old woman had an accidental dural puncture following epidural insertion during labour. Initial treatment of postdural puncture headache with an epidural blood patch was ineffective and was therefore repeated. She gradually developed severe neurological symptoms consistent with arachnoiditis confirmed with magnetic resonance imaging. Despite intensive multimodal treatment with analgesics and physiotherapy, her neurological condition remains unresolved two years later. This serious but rare complication should encourage caution when treating parturients with postdural puncture headache with a repeat epidural blood patch.

  20. Sequential drug verification errors resulting in wrong drug administration during caesarean section.

    PubMed

    Calderbank, S; Uncles, D R; Burns, N; Kariyawasam, H K C D; Allan, G D L

    2011-01-01

    An intravenous bolus of phentolamine was inadvertently given to a parturient during an emergency caesarean section following delivery of her infant when the intention had been to give an intravenous bolus of 5 IU Syntocinon. Root cause analysis identified a series of errors originating in the hospital pharmacy when one drug package was mistakenly issued in place of another. Subsequent checks failed to detect the original mistake. The final and most important check immediately before intravenous administration was also at fault. This case highlights a systems failure that permitted issue, transportation and administration of the wrong drug to a parturient. Robust measures to ensure avoidance of drug administration errors should be evaluated and introduced where possible.

  1. Intact Survival After Obstetric Hemorrhage and 55 Minutes of Cardiopulmonary Resuscitation.

    PubMed

    Anast, Nicholas; Kwok, Joseph; Carvalho, Brendan; Lipman, Steven; Flood, Pamela

    2015-07-01

    Cardiac arrest occurs in approximately 1:12,000 parturients. Among nonpregnant patients who have in-hospital cardiac arrest, those whose spontaneous circulation does not return within 15 to 20 minutes have a high risk of death and disability, so life support efforts are generally stopped after this period. However, among parturients, witnessed in-hospital arrest is often reversible and has a better prognosis. We describe a successful clinical outcome after maternal cardiac arrest and 55 minutes of advanced cardiac life support. This case underscores the importance of high-quality cardiopulmonary resuscitation and raises questions about the appropriate duration of resuscitation efforts in otherwise healthy young mothers with a potentially reversible cause of arrest.

  2. Subarachnoid block for caesarean section in severe preeclampsia.

    PubMed

    Chaudhary, Sujata; Salhotra, Rashmi

    2011-04-01

    Pregnancy-induced hypertension constitutes a major cause of morbidity and mortality in developing nations and it complicates about 6-8% of pregnancies. Severe preeclampsia poses a dilemma for the anesthesiologist especially in emergency situations where caesarean deliveries are planned for uninvestigated or partially investigated parturients. This article is aimed to review the literature with regards to the type of anesthesia for such situations. A thorough search of literature was conducted on PubMed, EMBASE, and Google to retrieve the articles. Studies on parturients with severe preeclampsia, undergoing caesarean section, were included in this article. There is growing evidence to support the use of subarachnoid block in such situations when the platelet counts are >80,000 mm(-3). Better hemodynamic stability with the use of low-dose local anesthetic along with additives and better neonatal outcomes has been found with the use of subarachnoid block when compared to general anesthesia.

  3. [Health education: repercussions in the neuropsychomotor growth and development of the newborn].

    PubMed

    Marcacine, Karla Oliveira; Orati, Priscila Lopes; Abrão, Ana Cristina Freitas de Vilhena

    2012-01-01

    The postpartum period is characterized by great physical and emotional changes, when parturients and families experience ambivalent and conflicting feelings and emotions, especially with the arrival of the baby, requiring the need of professional orientation and support. Having it in mind, it was searched the available literature evidence about health education, coming from a nursing team and directed to parturients and families, dealing with the newly born care and regarding its appropriate neuropsychomotor growth and development. It is clear the need of motivating the mother and the family to participate in the development of child care, increasing the success of health action results, once it provides autonomy and trust to this nucleus towards its acts, especially to the maternal role.

  4. Cutaneous and neurologic disease associated with HTLV-I infection.

    PubMed

    Sharata, H H; Colvin, J H; Fujiwara, K; Goldman, B; Hashimoto, K

    1997-05-01

    Human T-lymphotropic virus type I (HTLV-I) is the etiologic agent of HTLV-I associated myelopathy (HAM)/tropical spastic paresis (TSP), and adult T-cell leukemia/lymphoma (ATLL). ATLL has been associated with HTLV-I in the southeastern United States. However, to our knowledge, no case reports of HAM/TSP in association with ATLL occurring in the United States have been described. We describe a 40-year-old black woman with a 10-year history of recalcitrant psoriasiform eruption and erythrodermic flares. Medical history is additionally significant for a 2-year history of HTLV-I-associated myelopathy and lower extremity spastic paresis. Polymerase chain reaction with Southern blot analysis was used to detect HTLV-I proviral genome from frozen skin biopsy specimens and peripheral blood mononuclear cells.

  5. Pituitary adenoma apoplexy with initial presentation mimicking bacterial meningoencephalitis: a case report.

    PubMed

    Huang, Wen-Yi; Chien, Yu-Yi; Wu, Chia-Lun; Weng, Wei-Chieh; Peng, Tsung-I; Chen, Hsien-Chih

    2009-05-01

    Pituitary apoplexy is a rare but life-threatening disorder. Clinical presentation of this condition includes severe headache, impaired consciousness, fever, visual disturbance, and variable ocular paresis. Signs of meningeal irritation are very rare. However, if present and associated with headache, fever, and pleocytosis, meningeal irritation may lead to misinterpretation as infectious meningoencephalitis. To the best of our knowledge, pituitary apoplexy with an initial presentation mimicking infectious meningoencephalitis had rarely been reported in the literature. Here, we report a 57-year-old man who had acute severe headache, high fever, neck stiffness, disturbance in consciousness, and left ocular paresis. Laboratory data showed leukocytosis, an elevated C-reactive protein level, and neutrophilic pleocytosis in the cerebrospinal fluid. Because bacterial meningoencephalitis was suspected, empiric antibiotic therapy was administered but in vain. Further examinations indicated a diagnosis of pituitary adenoma with apoplexy. After the immediate administration of intravenous corticosteroid supplement and surgical decompression, the patient recovered.

  6. Nomenclature proposal to describe vocal fold motion impairment.

    PubMed

    Rosen, Clark A; Mau, Ted; Remacle, Marc; Hess, Markus; Eckel, Hans E; Young, VyVy N; Hantzakos, Anastasios; Yung, Katherine C; Dikkers, Frederik G

    2016-08-01

    The terms used to describe vocal fold motion impairment are confusing and not standardized. This results in a failure to communicate accurately and to major limitations of interpreting research studies involving vocal fold impairment. We propose standard nomenclature for reporting vocal fold impairment. Overarching terms of vocal fold immobility and hypomobility are rigorously defined. This includes assessment techniques and inclusion and exclusion criteria for determining vocal fold immobility and hypomobility. In addition, criteria for use of the following terms have been outlined in detail: vocal fold paralysis, vocal fold paresis, vocal fold immobility/hypomobility associated with mechanical impairment of the crico-arytenoid joint and vocal fold immobility/hypomobility related to laryngeal malignant disease. This represents the first rigorously defined vocal fold motion impairment nomenclature system. This provides detailed definitions to the terms vocal fold paralysis and vocal fold paresis.

  7. Unruptured internal carotid-posterior communicating artery aneurysm splitting the oculomotor nerve: a case report and literature review.

    PubMed

    Toyota, Shingo; Taki, Takuyu; Wakayama, Akatsuki; Yoshimine, Toshiki

    2014-08-01

    Objective To report a rare case of unruptured internal carotid-posterior communicating artery (IC-PC) aneurysm splitting the oculomotor nerve treated by clipping and to review the previously published cases. Case Presentation A 42-year-old man suddenly presented with left oculomotor paresis. Three-dimensional digital subtraction angiography (3D DSA) demonstrated a left IC-PC aneurysm with a bulging part. During surgery, it was confirmed that the bulging part split the oculomotor nerve. After the fenestrated oculomotor nerve was dissected from the bulging part with a careful microsurgical technique, neck clipping was performed. After the operation, the symptoms of oculomotor nerve paresis disappeared within 2 weeks. Conclusions We must keep in mind the possibility of an anomaly of the oculomotor nerve, including fenestration, and careful observation and manipulation should be performed to preserve the nerve function during surgery, even though it is very rare.

  8. Paroxysmal hemipareses in childhood.

    PubMed

    Dittrich, J; Havlová, M; Nevsímalová, S

    1979-12-01

    The authors report three patients suffering since infancy from transient attacks of paresis. The flaccid pareses most frequently affect the extremities in a hemiplegic fashion, but occasionally there is monoparesis or quadriparesis. The laterality and degree of the paresis are variable. Conciousness is always preserved, and in two cases attacks were preceded by ocular motor disturbances (skew deviation, nystagmoid jerks and conjugate deviations). Exceptionally, the transient hemiparesis may be preceded by a grand mal epileptic fit, though they are more likely to appear sporadically and independently of the paretic changes. In the interparoxysmal periods the children showed pronounced hypotonia, hyperkinetic extrapyramidal features and oligophrenia. Neuroradiological procedures have excluded brain anomalies of vascular or other aetiology and simple biochemical analyses were negative. EMG during paretic periods have revealed central motor neuron lesions, while EEG demonstrated non-specific paroxysmal features. A brain-stem dysfunction in the aetiology is postulated.

  9. [Post-polio syndrome - a case report].

    PubMed

    Pastuszak, Żanna; Tomczykiewicz, Kazimierz; Stępień, Adam

    2015-07-01

    Post-polio syndrome occurs 30-40 years after polio virus infection. The main symptoms of PPS are slowly progressive muscle limbs paresis with muscle atrophy, joints pain, paresthesia. In 90% of patients the main symptom is fatigue that leads to physical and mental activity deterioration. The cause of disease remains unknown. Probably it is an effect of motoneurons damage during acute virus polio infection, their overloading and degeneration of remaining ones. In this study we described a case of man who developed PPS 36 years after Heine-Medin disease. The main symptom was intensification of right limb paresis and muscle atrophy. In electromyography there were damage features of muscle clinically affected and unaffected. Changes in lifestyle made possible to continue occupational activity.

  10. Surgery for a giant arteriovenous malformation without motor deterioration: preoperative transcranial magnetic stimulation in a non-cooperative patient.

    PubMed

    Kronenburg, Annick; van Doormaal, Tristan; van Eijsden, Pieter; van der Zwan, Albert; Leijten, Frans; Han, Kuo Sen

    2014-07-01

    Transcranial magnetic stimulation (TMS) is a noninvasive activation method that is increasingly used for motor mapping. Preoperative functional mapping in vascular surgery is not routinely performed; however, in cases of high-grade arteriovenous malformations (AVMs), it could play a role in preoperative decision making. A 16-year-old male was suffering from a giant, right-sided insular, Spetzler-Martin Grade V AVM. This patient's history included 3 hemorrhagic strokes in the past 3 years, resulting in Medical Research Council Grade 2-3 (proximal) and 2-4 (distal) paresis of the left side of the body and hydrocephalus requiring a ventriculoperitoneal shunt. Preoperative TMS showed absent contralateral innervation of the remaining left-sided motor functions. Subsequently, the AVM was completely resected without any postoperative increase of the left-sided paresis. This case shows that TMS can support decision making in AVM treatment by mapping motor functions.

  11. [Anesthesia for cesarean section].

    PubMed

    Eldor, J; Guedj, P; Lavie, A

    1992-11-15

    Of 684 parturients who underwent cesarean section between July 1985-August 1990, 371 (54.2%) were given epidural anesthesia; 50 (7.3%) required general anesthesia after a failed attempt at epidural anesthesia; and 5 (0.7%) underwent inadvertent spinal anesthesia because of dural penetration by the epidural needle. In 258 (37.7%) general anesthesia was decided on before operation. The intentional avoidance of spinal anesthesia for cesarean section in this university hospital is criticized.

  12. Cervical balloon for dysfunctional labor following amniotomy.

    PubMed

    Lurie, S; Rabinerson, D; Feinstein, M; Mamet, Y

    1998-01-01

    The conventional treatment for arrest of protracted active phase dilatation is amniotomy and oxitocin. This kind of labor dystocia is associated with an increased incidence in Cesarean delivery. We describe the use of cervical balloon after amniotomy for protracted active phase dilatation. We have used this approach in five parturients. All five patients had a spontaneous vaginal delivery. Intrapartum cervical balloon in patients with dysfunctional labor may reduce the need for Cesarean delivery.

  13. Altered gravity effects on mothers and offspring: the importance of maternal behavior

    NASA Technical Reports Server (NTRS)

    Ronca, A. E.

    2001-01-01

    In this paper, I review and discuss recent studies of pregnant, parturient and lactating rat mothers and neonates exposed to hypo- and hypergravity. These studies are revealing new insights into how deviations form Earth-normal gravity may affect fundamental reproductive and ontogenetic processes in mammals. By way of background, I will first briefly summarize the spaceflights that have carried mammalian mothers and their offspring into space.

  14. Altered gravity effects on mothers and offspring: the importance of maternal behavior.

    PubMed

    Ronca, A E

    2001-07-01

    In this paper, I review and discuss recent studies of pregnant, parturient and lactating rat mothers and neonates exposed to hypo- and hypergravity. These studies are revealing new insights into how deviations form Earth-normal gravity may affect fundamental reproductive and ontogenetic processes in mammals. By way of background, I will first briefly summarize the spaceflights that have carried mammalian mothers and their offspring into space.

  15. Anesthetic management in a case of antiphospholipid antibody syndrome.

    PubMed

    Mikkiliineni, Venkata Rama Rao; Panidapu, Nagarjuna; Parasa, Mrunalini; Shaik, Mastan Saheb

    2015-01-01

    Antiphospholipid antibody (APLA) syndrome is one of the most common thrombocytophilias but, unfortunately, goes unrecognized most often. It is an auto-immune disorder in which thrombotic events and a recurrent fetal loss occur in the presence of antibodies to phospholipids. It is the most common acquired hyper-coagulable state. There is a limited literature on peroperative management of patients with this syndrome. We report a case of APLA syndrome in a parturient due to its rarity and complexity.

  16. Possible Neonatal Herpes Simplex Virus (HSV) Acquired Postpartum from Maternal Oral HSV Reactivation after Neuraxial Morphine.

    PubMed

    De Guzman, M Cecilia; Chawla, Rupesh; Duttchen, Kaylene

    2014-05-01

    In this report, we describe a case of a neonatal oral herpes simplex virus (HSV) infection possibly acquired from a mother who had oral HSV reactivation in association with neuraxial morphine. Neuraxial morphine is commonly administered for postpartum analgesia after cesarean delivery. While there is evidence that neuraxial morphine increases the risks of oral HSV reactivation in parturients, there has been no report of neonatal HSV infection directly acquired from a mother who had HSV recurrence from neuraxial morphine.

  17. Cerebrospinal fluid cutaneous fistula following obstetric epidural analgaesia. Case report.

    PubMed

    Fedriani de Matos, J J; Quintero Salvago, A V; Gómez Cortés, M D

    2017-03-28

    Cutaneous fistula of cerebrospinal fluid is a rare complication of neuroaxial blockade. We report the case of a parturient in whom an epidural catheter was placed for labour analgesia and 12h after the catheter was removed, presented an abundant asymptomatic fluid leak from the puncture site, compatible in the cyto-chemical analysis with cerebrospinal fluid. She was treated with acetazolamide, compression of skin orifice of the fluid leakage, antibiotic prophylaxis, hydration and rest, and progressed satisfactorily without requiring blood patch.

  18. Symmetrical peripheral gangrene associated with peripartum cardiomyopathy

    PubMed Central

    Jaryal, Ajay; Raina, Sujeet; Thakur, Surender; Sontakke, Tushar

    2013-01-01

    Symmetrical peripheral gangrene (SPG) is a rare clinical entity. It was first described in late 19th century and since then has been reported with array of medical conditions mainly those complicated with shock, sepsis, and disseminated intravascular coagulation (DIC). Here in, we describe a parturient with peripartum cardiomyopathy (PPCM) and SPG. Clinicians should be aware of this entity as early recognition can help in reducing morbidity and mortality. PMID:23984243

  19. Familial long thoracic nerve palsy: a manifestation of brachial plexus neuropathy.

    PubMed

    Phillips, L H

    1986-09-01

    Long thoracic nerve palsy causes weakness of the serratus anterior muscle and winging of the scapula. It is usually traumatic in origin. Isolated long thoracic nerve palsy has not been recognized as the major manifestation of familial brachial plexus neuropathy, but I have studied the syndrome in four members of three generations of one family. One individual suffered an episode of facial paresis. The inheritance pattern was autosomal dominant.

  20. Control of robot assistant for rehabilitation of upper extremities.

    PubMed

    Kostić, Miloš D; Popović, Mirjana B; Popović, Dejan B

    2012-01-01

    The assisted movement in humans with paresis of upper extremities is becoming popular for neurorehabilitation. We propose a novel method for trajectory selection and assistance control. This paper presents simulation of a planar two degrees of freedom robot that assists horizontal movement of the hand. The control assumes that during the exercise the hand needs to follow healthy alike trajectories. The robot is assumed to provide minimal assistance and operate as a teacher of the movement.

  1. The Toxicology, Environmental Fate, and Human Risk of Herbicide Orange and Its Associated Dioxin

    DTIC Science & Technology

    1978-10-01

    peripheral neuropathy occurred. 4. Exposure to 2,4-D in Spray Operatic.; A fourth group of exposed individuals is those who were involved in spraying...first reported on three patients who developed peripheral neuropathies manifested by pain, paresthesias and paresis. There had been previous skin...recovery was complete except for hyporeflexia of the lower limbs. Berkley and Magee (11) described the development of peripheral neuropathy in a 39-year

  2. [Idiopathic facial paralysis].

    PubMed

    Wolf, S R

    1998-09-01

    Although acute idiopathic facial paresis is often labelled "Bell's palsy", historical studies show that Nicolaus Anton Friedreich (1761-1836) from Würzburg was the first physician to describe the typical symptoms of the disorder in 1797, approximately 24 years prior to the paper published by Sir Charles Bell. Diagnostics has now improved to the extent that acute idiopathic facial palsy can more frequently be assigned to etiologies caused by inflammatory disorders. Herpes simplex virus type I and Borrelia burgdorferi are particularly relevant. Underestimation of the degree of paresis is, particularly in children, a drawback of the clinical examination. "Incomplete eyelid closure" is not a reliable indicator of remaining nerve function. For this reason complete electromyography (EMG) is recommended in all cases of severe facial paresis. Since electroneurography does not reliably reflect the degree of denervation present, needle EMG is preferred. The therapy of the facial palsy of unclear etiology is still not well defined. Nevertheless, we recommend that a combined treatment should be used early, at least in patients with disfiguring pareses. Combinations may consist of cortisone, virostatic agents and hemorrheologic substances and possibly antibiotics. Surgical decompression of the facial nerve remains controversial, since positive surgical results lack statistical support. Individual instructions for facial exercises, massage and muscle relaxation can support rehabilitation and possibly reduce the production of pathological synkinesia. Electrical stimulation should not be used. There are a number of possibilities available to reduce the effects of misdirected reinnervation, especially the use of botulinum-A-toxin. However, intensive diagnosis and therapy in the early phase of paresis are decisive in obtaining a favorable outcome. Further refinements in rehabilitation and comparative multicenter controlled studies are still required for future improvements in

  3. Diagnostic and therapeutic pitfalls in benign vocal fold diseases

    PubMed Central

    Bohlender, Jörg

    2013-01-01

    More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis. PMID:24403969

  4. Long-Term outcome of neonatal Citrobacter koseri (diversus) meningitis treated with imipenem/meropenem and surgical drainage.

    PubMed

    Straussberg, R; Harel, L; Amir, J

    2001-10-01

    Neonatal Citrobacter koseri (diversus) meningitis is often complicated by the formation of brain abscesses and has a poor neurological outcome with seizures, mental retardation and paresis as sequelae in 50% of the cases. As there is emerging resistance to ampicillin, gentamicin and third-generation cephalosporins, we attempted to treat this infection with carbapenems. Carbapenems in combination with cefotaxime and surgical drainage may play an important role in treating C. koseri meningitis.

  5. Genetic Studies of Strabismus, Congenital Cranial Dysinnervation Disorders (CCDDs), and Their Associated Anomalies

    ClinicalTrials.gov

    2017-02-16

    Congenital Fibrosis of Extraocular Muscles; Duane Retraction Syndrome; Duane Radial Ray Syndrome; Mobius Syndrome; Brown Syndrome; Marcus Gunn Syndrome; Strabismus Congenital; Horizontal Gaze Palsy; Horizontal Gaze Palsy With Progressive Scoliosis; Facial Palsy; Facial Paresis, Hereditary, Congenital; Third Nerve Palsy; Fourth Nerve Palsy; Sixth Nerve Palsy; Synkinesis; Ocular Motility Disorders; Levator-Medial Rectus Synkinesis; Athabaskan Brainstem Dysgenesis; Tongue Paralysis; Ninth Nerve Disorder; Fifth Nerve Palsy; Seventh Nerve Palsy; Eleventh Nerve Disorder; Twelfth Nerve Disorder; Vagus Nerve Paralysis; Moebius Sequence

  6. Verminous myelitis in a pit bull puppy.

    PubMed

    Snook, Eric R; Baker, David G; Bauer, Rudy W

    2009-05-01

    A 10-week-old, male pit bull dog presented to the referring veterinarian with hind limb paresis and epaxial muscle atrophy. No spinal lesions were identified at gross necropsy; however, histologically there was marked granulomatous myelitis in the spinal cord between T13 and L2 with occasional, intralesional nematode larvae. Based on morphologic characteristics, the nematode larvae were identified as Strongyloides spp., possibly Strongyloides stercoralis.

  7. Spinal Dural Arteriovenous Fistula and Cecal Arteriovenous Malformation in a Boy

    PubMed Central

    Soni, Vimlesh; Vaidya, Pankaj C; Sahu, Jitendra Kumar; Yadav, Mukesh

    2017-01-01

    Concurrent spinal dural arteriovenous fistula (AVF) and cecal arteriovenous malformation (AVM) are very rare. A 6-year old boy presented with lower limb paresis after trauma. On imaging work-up spinal dural AVF was found. It was managed with endovascular glue embolization. After two years, the boy presented with severe anemia and occult gastrointestinal tract (GIT) bleed. Cecal AVM was diagnosed and managed with embolization. PMID:28164000

  8. Design and development of a hand robotic rehabilitation device for post stroke patients.

    PubMed

    Rashedi, E; Mirbagheri, A; Taheri, B; Farahmand, F; Vossoughi, G R; Parnianpour, M

    2009-01-01

    Robot-mediated rehabilitation is a rapidly advancing discipline that seeks to develop improved treatment procedures using new technologies, e.g., robotics, coupled with modern theories in neuroscience and rehabilitation. A robotic device was designed and developed for rehabilitation of upper limbs of post stroke patients. A novel force feedback bimanual working mode provided real-time dynamic sensation of the paretic hand. Results of the preliminary clinical tests revealed a quantitative evaluation of the patient's level of paresis and disability.

  9. Monoparesis in association with feline pulmonary carcinoma: A literature review with 3 new cases

    PubMed Central

    van Stee, Lucinda; Boston, Sarah; Singh, Ameet; Park, Fiona; Richardson, Danielle; Abrams-Ogg, Anthony; Vince, Andrew

    2014-01-01

    We describe 3 cases of cats that were presented with a sudden onset of monoparesis as a result of arterial thromboembolism without evidence of cardiovascular disease that were subsequently diagnosed with a primary pulmonary carcinoma. Arterial tumor thromboemboli due to pulmonary carcinoma should be considered as a differential diagnosis in cases of lameness or paresis in older cats. We theorize that large tumor emboli may obstruct peripheral arteries leading to acute monoparesis. PMID:25183892

  10. Burn Resuscitation

    DTIC Science & Technology

    2009-01-01

    areas involving large areas of skin the patient is exposed to death first from shock . . .’’ [10]. In describing the pathophysiology leading to the shock...state seen in burns he postulated that various irritants , mental and physical, caused vasomotor paresis leading to accumulation of blood in the...resuscitation volumes. Subsequent studies suggested a decrease in abdominal compartment syndrome (ACS). Oda et al., in 2006, published their experience

  11. Focal thoracolumbar spinal cord lymphosarcoma in a ferret (Mustela putorius furo)

    PubMed Central

    Ingrao, Joelle C.; Eshar, David; Vince, Andrew; Lee-Chow, Bridget; Nykamp, Stephanie; DeLay, Josepha; Smith, Dale

    2014-01-01

    A 6-year-old, castrated male domestic ferret (Mustela putorius furo) was euthanized following progressive hind limb paresis and atonia of the bladder of 1-year duration. Neurological evaluation localized the lesion to the thoracolumbar spinal region, and magnetic resonance imaging showed a focal intramedullary spinal cord lesion. Histopathology revealed an extensive, unencapsulated, poorly demarcated mass within the thoracolumbar spinal cord, diagnosed as lymphosarcoma. PMID:24982519

  12. Effect of Auditory Constraints on Motor Performance Depends on Stage of Recovery Post-Stroke

    PubMed Central

    Aluru, Viswanath; Lu, Ying; Leung, Alan; Verghese, Joe; Raghavan, Preeti

    2014-01-01

    In order to develop evidence-based rehabilitation protocols post-stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post-stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in 20 subjects with chronic hemiparesis. We used a bimanual wrist extension task, performed with a custom-made wrist trainer, to facilitate learning of wrist extension in the paretic hand under four auditory conditions: (1) without auditory cueing; (2) to non-musical happy sounds; (3) to self-selected music; and (4) to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each) were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics, and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups, which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post-stroke. PMID

  13. Iatrogenic salt poisoning in captive sandhill cranes

    USGS Publications Warehouse

    Franson, J.C.; Sileo, L.; Fleming, W.J.

    1981-01-01

    Salt poisoning developed in captive sandhill cranes (Grus canadensis) when sea salt was added to normal drinking water to produce a sodium chloride concentration of 1%. Two of 18 cranes died and 2 were euthanatized when moribund. Muscle weakness, paresis, dyspnea, and depression were observed. Brain and serum sodium, serum uric acid,:and plasma osmolality values were abnormally high. Lesions were those of visceral gout, renal tubular necrosis, nephrosis, and skeletal muscle.necrosis.

  14. Design and performance characterization of a hand orthosis prototype to aid activities of daily living in a post-stroke population.

    PubMed

    Gasser, Benjamin W; Goldfarb, Michael

    2015-01-01

    This paper presents the design of a hand orthosis prototype intended to assist persons with hand paresis, as a result of stroke, perform activities of daily living. Among its attributes, the orthosis is characterized by a low mass and small profile, while still offering the power assistance of a robotic exoskeleton. Experimental characterization of the orthosis is presented, including its mass, envelope dimensions, motion bandwidth, and joint torque characteristics.

  15. Focal thoracolumbar spinal cord lymphosarcoma in a ferret (Mustela putorius furo).

    PubMed

    Ingrao, Joelle C; Eshar, David; Vince, Andrew; Lee-Chow, Bridget; Nykamp, Stephanie; DeLay, Josepha; Smith, Dale

    2014-07-01

    A 6-year-old, castrated male domestic ferret (Mustela putorius furo) was euthanized following progressive hind limb paresis and atonia of the bladder of 1-year duration. Neurological evaluation localized the lesion to the thoracolumbar spinal region, and magnetic resonance imaging showed a focal intramedullary spinal cord lesion. Histopathology revealed an extensive, unencapsulated, poorly demarcated mass within the thoracolumbar spinal cord, diagnosed as lymphosarcoma.

  16. [Liquorice-induced hypertension and hypokalaemia].

    PubMed

    Nielsen, Mette Lundgren; Pareek, Manan; Andersen, Inger

    2012-04-09

    Consumption of large amounts of liquorice can cause hypertension and hypokalaemia. Liquorice contains glycyrrhetinic acid, which inhibits the enzyme 11 beta-hydroxysteroid dehydrogenase type 2, and ultimately leads to an apparent mineralocorticoid excess syndrome. This case report describes a 50 year-old woman presenting with hypertension and hypokalaemia-induced limb paresis due to chronic liquorice ingestion. The patient was treated with potassium supplementation and spironolactone. Her blood pressure and electrolyte status normalised within a month after cessation of liquorice intake.

  17. Oxytocin discontinuation after the active phase of labor is established.

    PubMed

    Vlachos, Dimitrios-Efthymios G; Pergialiotis, Vasilios; Papantoniou, Nikolaos; Trompoukis, Stamoulis; Vlachos, Georgios D

    2015-08-01

    Despite the widespread usage of oxytocin, there is still no consensus on its mode of administration. The scope of the present meta-analysis was to assess the effect of oxytocin discontinuation after the active phase of labor is established on maternal fetal and neonatal outcomes. We searched Medline, Scopus, Popline, ClinicalTrials.gov and Google Scholar databases. Eight studies were finally retrieved, which involved 1232 parturient. We observed significantly decreased rates of cesarean sections among parturient that discontinued oxytocin (OR 0.51, 95% CI 0.35, 0.74) as well as decreased rates of uterine hyperstimulation (OR 0.33, 95% CI 0.19, 0.58). Similarly, cases of non-reassuring fetal heart rates were fewer among women that did not receive oxytocin after the establishment of the active phase of labor (OR 0.63, 95% CI 0.41, 0.97). Keeping in mind the aforementioned maternal and neonatal adverse effects that seem to result from infusion of oxytocin until delivery, future practice should aim towards its discontinuation after the establishment of the active phase of labor, as it does not seem to influence the total duration of labor. Future studies should aim towards specific populations of parturient in order to clarify whether different approaches are needed.

  18. Women's needs and expectations during normal labor and delivery

    PubMed Central

    Iravani, Mina; Zarean, Elahe; Janghorbani, Mohsen; Bahrami, Masod

    2015-01-01

    Background: Pregnancy and birth are unique processes for women. Women and families hold different expectation during childbearing based on their knowledge, experiences, belief systems, culture, and social and family backgrounds. These differences should be understood and respected, and care is adapted and organized to meet the individualized needs of women and families. The purpose of this study was to explore Iranian parturient needs, values and preferences during normal labor and delivery. Materials and Methods: An exploratory qualitative study was used. Twenty-four parturient women from three governmental medical training centers in Isfahan, Iran were recruited using purposive sampling. Participants were recruited to low-risk women after they had given birth, but before they were discharged from hospital. Data were collected through semi-structured in-depth interviews, informal observations and field notes. Interviews were transcribed verbatim and analyzed by the conventional content analysis according to Graneheim and Lundman approach. Results: Women's needs and expectations fell into seven main categories: Physiological, psychological, informational, social and relational, esteem, security and medical needs. All of the key needs in these data relates to a fundamental need, named “sense of control and empowerment in childbirth.” Conclusion: Knowing a woman's needs, values, preferences and expectations during normal labor and delivery assists healthcare professionals especially midwives in providing high-quality care to parturient women. PMID:25767817

  19. Individual variation in the seasonal reproduction of the terrestrial isopod Armadillidium vulgare Latr. (Crustacea, Oniscidea)

    NASA Astrophysics Data System (ADS)

    Souty-Grosset, Catherine; Nasri, Karima; Mocquard, Jean-Pierre; Juchault, Pierre

    1998-08-01

    Under particular conditions of photoperiod and temperature, Armadillidium vulgare females, originating from a single population, might exhibit individual differences in the onset of reproduction and duration of the breeding period. In a population issued from a strain from middle latitudes, some females underwent only one parturial moult (northern tendency) and others three parturial moults (southern tendency). Females with an atypical northern phenology are the most numerous and tend to be found near the Danish population. In the latter, there is an asymmetrical response to laboratory selection (favourable to females with a longer breeding period). The asymmetrical variation in atypical individuals acts as a safety device against the unpredictability of the environment. The adaptation of this species, originally from the Mediterranean periphery, to a northern environment has led to a reduction in its capacity to breed over long periods of time. Populations from middle latitudes can undergo one or several parturial moults which enables the species to successfully colonize even far-away countries. These intrapopulation differences have an essential role and explain why Armadillidium vulgare is one of the most widely distributed species among Oniscidea.

  20. Habitat use by female caribou: Tradeoffs associated with parturition

    USGS Publications Warehouse

    Barten, Neil L.; Bowyer, R.T.; Jenkins, Kurt J.

    2001-01-01

    We compared habitat use, forage characteristics, and group size among preparturient, parturient, and nonparturient female caribou (Rangifer tarandus) during and after the birthing season to test hypotheses involving acquisition of forage and risk of predation. We monitored 39 radiocollared females from the Mentasta caribou herd, Alaska, in 1994 and 40 animals in 1995. Group size of females giving birth at higher elevations was smaller (P 0.5). During peak parturition, females with young used sites with fewer predators (P < 0.05), a lower abundance of forage (P < 0.05), but with variable forage quality compared with those sites used by females without young. We hypothesized that parturient females used birth sites that lowered risk of predation, and traded-off forage abundance for increased safety. Nonetheless, few differences existed between parturient and nonparturient females in composition of diet or in indices of diet quality; we could not demonstrate a nutritional cost to maternal females from our analyses. We suggest that increasing population density might intensify intraspecific competition among females for birth sites, and thereby increase nutritional costs of using high-elevation areas with less forage but fewer predators.

  1. A prospective review of the labor analgesia programme in a teaching hospital

    PubMed Central

    Sikdar, Indranil; Singh, Shivinder; Setlur, Rangraj; Mohan, C.V.R.; Datta, Rashmi; Patrikar, S.R.

    2013-01-01

    Background The structured labor analgesia programme in our tertiary care hospital has been in place for the past few years. We undertook this study to analyze the programme and to draw conclusions to further improve the outcomes. Methods A prospective analysis of the data pertaining to 200 patients participating in an ongoing labor analgesia programme in a tertiary care hospital from Nov 2008 to Aug 2009 was performed. Results Mean visual analog score (VAS) before epidural block was 8.34 ± 0.79. Post procedure the average VAS score was 2.20 ± 0.79. One hundred and fifty six (78%) parturients delivered vaginally, 18 (9%) required instrumentation with vacuum including 1 forceps delivery in a multiparous parturient. In 17parturients (8.7%) fetal distress led to a decision to perform LSCS for delivery. Multiparous patients were significantly more satisfied as compared to nulliparous patients (p = 0.010). Conclusion The study demonstrated excellent pain relief and patient satisfaction with minimal complications. The safety and efficacy of epidural bupivacaine in concentrations less than 0.625% combined with 25 mcg of fentanyl demonstrated in our study should be considered are commendation for the widespread adoption of the procedure in tertiary care hospitals. PMID:24600144

  2. Effect of Anaesthesia Method on Preoperative Anxiety Level in Elective Caesarean Section Surgeries

    PubMed Central

    Akildiz, Mahmut; Aksoy, Yakup; Kaydu, Ayhan; Kaçar, Cem Kıvılcım; Şahin, Ömer Fatih; Yıldırım, Zeynep Baysal

    2017-01-01

    Objective In this study, the effect of the anaesthesia method on preoperative anxiety in parturients scheduled to undergo elective caesarean surgery was investigated. Methods After Dicle University Ethics Committee approval, 100 American Society of Anesthesiologists (ASA) II parturients, aged between 18 and 45 years, were included in this study from 2011 to 2012 at the Dicle University Faculty of Medicine, Department of Anaesthesiology. The parturients were divided into two groups, with 50 patients in each group: general anaesthesia (GA) and spinal anaesthesia (SA). Patients were evaluated during the preoperative visit. Demographic data and STAI TX-1 form to measure preoperative anxiety were recorded. Results There were no significant differences between the two groups in maternal age, gestational age, level of education and number of children (p>0.05). The average anxiety score was significantly higher in the SA group than in the GA group (p<0.05). Conclusion In conclusion, spinal anaesthesia is associated with a higher preoperative anxiety level than general anaesthesia in obstetric patients. Therefore, it is necessary to take prevention against preoperative anxiety for the patients undergoing caesarean section surgeries under spinal anaesthesia. PMID:28377838

  3. Increase of immunity to rubella and interruption of rubella transmission in Gipuzkoa (Basque Country, Spain) after an enhanced vaccination programme.

    PubMed Central

    Cilla, G.; Dorronsoro, M.; Sáenz-Domínguez, J. R.; Serrano, E.; Pérez-Trallero, E.

    2004-01-01

    In Spain, vaccination against rubella was initiated in schoolgirls in the mid-1970s. In Gipuzkoa, subsequent extensions to the vaccination schedule culminated in 1992 with the introduction of the two-dose measles, mumps and rubella vaccine in children and adolescents of both sexes. Moreover, in 1985 a programme for the identification and vaccination of non-immune parturient women was implemented in the region's main hospital. The prevalence of rubella-susceptible parturient women decreased from 3.7 % at the beginning of the study to < 1.5 % by 1992. Despite this overall decrease, 4.8 % of adolescent parturients were susceptible to rubella during 2001--2002. From 1984, the number of reported cases of rubella (children and adults) progressively decreased until 1997, after which there have been no cases of indigenous rubella. There have been no cases of reported congenital rubella since 1984. These results indicate that the vaccine policy carried out in this geographical area has been effective in achieving considerable progress towards rubella elimination. PMID:15310170

  4. Increase of immunity to rubella and interruption of rubella transmission in Gipuzkoa (Basque Country, Spain) after an enhanced vaccination programme.

    PubMed

    Cilla, G; Dorronsoro, M; Sáenz-Domínguez, J R; Serrano, E; Pérez-Trallero, E

    2004-08-01

    In Spain, vaccination against rubella was initiated in schoolgirls in the mid-1970s. In Gipuzkoa, subsequent extensions to the vaccination schedule culminated in 1992 with the introduction of the two-dose measles, mumps and rubella vaccine in children and adolescents of both sexes. Moreover, in 1985 a programme for the identification and vaccination of non-immune parturient women was implemented in the region's main hospital. The prevalence of rubella-susceptible parturient women decreased from 3.7 % at the beginning of the study to < 1.5 % by 1992. Despite this overall decrease, 4.8 % of adolescent parturients were susceptible to rubella during 2001--2002. From 1984, the number of reported cases of rubella (children and adults) progressively decreased until 1997, after which there have been no cases of indigenous rubella. There have been no cases of reported congenital rubella since 1984. These results indicate that the vaccine policy carried out in this geographical area has been effective in achieving considerable progress towards rubella elimination.

  5. Normal Caloric Responses during Acute Phase of Vestibular Neuritis

    PubMed Central

    Lee, Sun-Uk; Park, Seong-Ho; Kim, Hyo-Jung; Koo, Ja-Won

    2016-01-01

    Background and Purpose We report a novel finding of caloric conversion from normal responses into unilateral paresis during the acute phase of vestibular neuritis (VN). Methods We recruited 893 patients with a diagnosis of VN at Dizziness Clinic of Seoul National University Bundang Hospital from 2003 to 2014 after excluding 28 patients with isolated inferior divisional VN (n=14) and those without follow-up tests despite normal caloric responses initially (n=14). We retrospectively analyzed the neurotological findings in four (0.5%) of the patients who showed a conversion from initially normal caloric responses into unilateral paresis during the acute phase. Results In those four patients, the initial caloric tests were performed within 2 days of symptom onset, and conversion into unilateral caloric paresis was documented 1–4 days later. The clinical and laboratory findings during the initial evaluation were consistent with VN in all four patients except for normal findings in bedside head impulse tests in one of them. Conclusions Normal findings in caloric tests should be interpreted with caution during the acute phase of suspected VN. Follow-up evaluation should be considered when the findings of the initial caloric test are normal, but VN remains the most plausible diagnosis. PMID:26932259

  6. [A case of brachial plexus neuropathy who presented with acute paralysis of the hand after sleep].

    PubMed

    Iijima, Makiko; Okuma, Yasuyuki; Ohizumi, Hideki; Fujishima, Kenji; Goto, Keigo; Mizuno, Yoshikuni

    2002-09-01

    We report a 46-year-old woman who presented with acute paresis of the right hand and arm. She was well until when she noted a paresis and dysesthesia in her right hand in the morning. Neurological examination revealed weakness in the muscles which were supplied by lower cervical segments, with increased deep tendon reflexes in the right arm. Allen's test and Wright's test were positive. The nerve conduction studies disclosed a reduced CMAPs more severely by right median than ulnar nerve stimulation. The frequency and amplitude of the F waves was also reduced. Needle electromyogram showed a mild neurogenic pattern in the right hand muscles. Digital subtraction angiography revealed a tapering of the subclavian artery when the right arm was abducted. She underwent decompression surgery. A remarkable improvement of the symptoms was observed after surgery. Our patient suggests that brachial plexus neuropathy should be considered in the acute paresis of the hand after sleep, and that surgical procedure would lead to a successful outcome.

  7. [A winged scapula].

    PubMed

    Faber, C G; Klaver, M M; Wokke, J H J

    2002-09-14

    Three patients, one woman aged 22 and two men aged 54 and 28, presented with scapular winging. In the first patient amyotrophic plexus neuralgia was diagnosed. The second patient most probably suffered from a stretch injury of the long thoracic nerve. The third patient had scapular winging due to an isolated paresis of the trapezius muscle, which was caused by an idiopathic lesion of the accessory nerve. In the first and second patient an improvement was noticeable after 9 months and 1.5 years respectively. There was no improvement in the third patient after 11 years. Paresis of the M. serratus anterior occurs due to paralysis of the N. thoracicus longus, as a result of direct compression, stump trauma, interventions such as thoracic operations, (repeated) stretch injuries or neuralgic brachial plexus amyotrophy; in these cases the scapular winging increases as the arm is lifted forwards. Paresis of the M. trapezius occurs due to the paralysis of the N. accessorius, due to trauma, interventions such as in the neck area, a space-occupying abnormality or an idiopathic abnormality; in these cases the scapular winging increases upon the arm being lifted sideways. Another possible cause of scapular winging is muscular dystrophy, especially fascioscapulohumeral muscular dystrophy (FSHD). Usually the prognosis for recovery from a neuropraxia and an idiopathic lesion of the N. thoracicus longus within a two-year period is good. The prognosis for an isolated lesion of the N. accessorius is much less favourable. An EMG is essential for establishing a diagnosis.

  8. Testing a Protocol for a Randomized Controlled Trial of Therapeutic versus Placebo Shoulder Strapping as an Adjuvant Intervention Early after Stroke.

    PubMed

    Appel, Caroline; Perry, Lin; Jones, Fiona

    2015-06-01

    This study tested a protocol for a randomized controlled trial of therapeutic versus placebo shoulder strapping as an adjuvant intervention early after stroke. Despite widespread use, there is little evidence of the efficacy or acceptability of shoulder strapping to improve arm function in patients with shoulder paresis following stroke. This study tested a protocol designed to trial shoulder strapping as an adjuvant therapy in patients with shoulder paresis after stroke and tested its acceptability for patients and clinical staff. A multiple-method design comprised one quantitative randomized, double-blind, placebo-controlled study and two qualitative exploratory investigations entailing patient interviews and staff surveys. Seventeen sub-acute stroke patients with shoulder paresis were recruited in London stroke service settings between November 2007 and December 2009. Outcomes from a 4-week therapeutic strapping protocol were compared with those of placebo strapping as an adjunct to conventional rehabilitation. Minimal adverse events and greater improvement in arm function (Action Research Arm Test) were seen with therapeutic compared with placebo strapping (effect size 0.34). Patients and staff found the strapping acceptable with minimal adverse effects. This study provided data for sample size calculation and demonstrated a workable research protocol to investigate the efficacy of shoulder strapping as an adjuvant intervention to routine rehabilitation for stroke patients. Small-scale findings continue to flag the importance of investigating this topic. The protocol is recommended for a definitive trial of shoulder strapping as an adjuvant intervention.

  9. [Rehabilitation of post stroke patients using a bioengineering system "brain-computer interface + exoskeleton"].

    PubMed

    Kotov, S V; Turbina, L G; Bobrov, P D; Frolov, A A; Pavlova, O G; Kurganskaia, M E; Biriukova, E V

    2014-01-01

    Objective. To investigate the possibility of using a bioengineering system, which includes an electroencephalograph and a personal computer with a software for synchronous data transmission, recognition and classification of EEG signals, development of directions for intended actions in real time in the combination with the hand exoskeleton (the bioengineering system "brain-computer interface + exoskeleton"), in motor rehabilitation of post stroke patients with paresis of the upper extremity. Material and methods. Brain-computer interface is a promising field of neurorehabilitation. Rehabilitation treatment, including 8-10 sessions, was conducted in 5 patients with paresis of the upper extremity. All patients had large MRI lesions in cortical/subcortical areas. Results. Positive changes in neurological status measured with the NIHSS, a significant increase in the volume and power of movements in the paretic hand, improvement of coordination and slight decrease in the level of spasticity were found after the treatment. There was an increase in daily activities measured with the Barthel index, mostly due to the improvement of fine motor skills. The level of disability assessed by the modified Rankin scale was changed significantly. Conclusion. The use of "brain-computer interface + exoskeleton" in the rehabilitation of post stroke patients with hand paresis provided positive results that would need to be verified in further studies.

  10. The Effect of Epidural Analgesia on Labour, Mode of Delivery and Neonatal Outcome in Nullipara of India, 2011-2014

    PubMed Central

    Makhija, Bela; Arora, Manjeet; Haritwal, Arpana; Gurha, Pavan

    2014-01-01

    Aims: This study aimed to evaluate the effect of ropivacaine epidural analgesia on duration and outcome of labour in nulliparous parturients of India with parturient not receiving any analgesia. Settings and Design: One hundred and twenty nulliparous parturient in established labour at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group (n=60), whereas those not enthusiastic to labour analgesia were allocated in the control group (n=60). Materials and Methods: Epidural analgesia was provided by a bolus injection of 10 ml of ropivacaine 0.2% and 50μg fentanyl and maintained by using a continuous infusion of ropivacaine 0.1% with fentanyl 2μl/ml at a 10ml/hour rate. The outcomes were duration of labour, incidence of cesarean sections and instrumental vaginal delivery and neonatal outcome. Statistical Analysis used: Statistical analysis was conducted using unpaired student t-test and chi-square test as required. All tests of significance were performed using two-tailed probability tests. Differences were considered significant when p-value was <0.05. Results: The two groups were comparable in terms of socio-demographic data. The mean duration of first stage of labour was shorter in epidural group (4.83 ± 1.59 h) compared with control group (5.48 ± 1.56 h) while the duration of second stage of labour was prolong in epidural group (33.13 ± 12.78 min) as compared to control (27.53 ± 11.73 min). Instrumental vaginal or caesarean delivery rate did not increase in the epidural group. The APGAR scores at 5 min were statistically similar in both groups. Conclusion: Epidural analgesia by ropivacaine in Indian nulliparous resulted in shorter duration of first stage and prolongs duration of second stage of labour compared with parturients without analgesia; however, instrumental vaginal or caesarean delivery rate does not increase in the epidural group. PMID:25478409

  11. Detection of Cytomegalovirus (CMV) Infection in Wheezing Infants by Urine DNA and Serum IgG Testing

    PubMed Central

    Zeng, Zhao-cheng; Chang, Qing; Sun, Zhi-wei; Song, Ming-mei; Jin, Xin-ling; Jiang, Shu-ya; Yang, Xia

    2017-01-01

    Background The aim of this study was to investigate the involvement of CMV infection in wheezing infants and the association between CMV-DNA and immunoglobulins (Igs). Material/Methods A total of 243 wheezing infants and 3,000 parturients were enrolled in this study. The infants were randomly grouped to receive blood HCMV-DNA tests (n=46) or urine HCMV-DNA tests (n=197). Furthermore, all participants had serum CMV-specific IgM and IgG testing. Afterwards, 10 HCMV-IgG positive infants were randomly selected for simultaneous blood and urine HCMV-DNA tests, and 25 HCMV-IgG positive puerperants were randomly selected for urine HCMV-DNA tests. Results The detection rate of urine HCMV-DNA was significantly higher than that of blood HCMV-DNA (67.5% vs. 13.0%, p<0.001). Fifteen (6.2%) and 190 (80.0%) infants showed positive CMV-specific IgM and IgG results (p<0.001), respectively. Among the 10 HCMV-IgG positive infants tested further, only two infants had positive HCMV-DNA blood tests, while all of the 10 infants had positive HCMV-DNA urine tests. However, HCMV-DNA was not detected in the urine of the 25 randomly selected parturients positive for HCMV-IgG. Conclusions CMV infection may be one of the causes of wheezing in infants; CMV infection can be detected by urine-HCMV-DNA and serum HCMV-IgG testing. Infants were more susceptible to CMV infection than parturients. PMID:28283676

  12. Epidemiology of congenital abnormalities in West Africa: Results of a descriptive study in teaching hospitals in Abidjan: Cote d’Ivoire

    PubMed Central

    Kouame, Bertin Dibi; N’guetta-Brou, Isabelle Ama; Kouame, Guy Serge Yapo; Sounkere, Moufidath; Koffi, Maxime; Yaokreh, Jean Baptiste; Odehouri-Koudou, Thierry; Tembely, Samba; Dieth, Gaudens Atafi; Ouattara, Ossenou; Dick, Ruffin

    2015-01-01

    Background: Congenital abnormalities constitute one of the major causes of infant mortality, particularly in developing countries. The aim of this study was to describe the epidemiology of congenital anomalies in Cote d’Ivoire. Materials and Methods: It was a multicentric study of three academic hospitals and the Heart Institute of Abidjan over 10 years. The epidemiologic Data concerned the Parturients, the annual frequency of congenital abnormalities. Distribution of the congenital abnormalities according to the organs, overall mortality and lethality of congenital abnormalities were evaluated. Results: Over 10 years, 1.632 newborns with 1.725 congenital anomalies were recorded. Frequency was 172.5 congenital anomalies per annum. Parturients were less than 35 years in 33% of cases, multigravida in 20%, multiparous in 18% and had a low socio economic status in 96% of cases. Prenatal diagnosis of congenital anomalies was performed in 1.5%. Congenital anomalies were orthopedic in 34%, neurological in 17%, gastrointestinal in 15%, facial in 11.5%, parietal in 13%, urogenital in 9% and cardiac in 0.5% of cases. The overall mortality rate of congenital anomalies was 52% and gastroschisis was the most lethal disease with 100% mortality. Conclusion: This descriptive study reveals the low socio economic status of Parturients with congenital anomalies and their poor prenatal diagnosis. These factors explain the very high mortality of congenital anomalies due to a delay management in our country in which medical expenses were borne by parents and where technical platforms remain obsoletes for good resuscitation and neonatal surgery. PMID:25659551

  13. Effect of Position During Spinal Anesthesia on Postdural Puncture Headache After Cesarean Section: A Prospective, Single-Blind Randomized Clinical Trial

    PubMed Central

    Davoudi, Maryam; Tarbiat, Masoud; Ebadian, Mohammad Reza; Hajian, Puran

    2016-01-01

    Background The most common method of anesthesia for cesarean section is spinal anesthesia, and postdural puncture headache (PDPH) remains a major complication of this procedure. Nowadays, PDPH is a major cause of morbidity in parturients after spinal anesthesia. This headache is the third most popular reason for claims against anesthesiologists in obstetrics. The position after spinal anesthesia has been evaluated as a contributory factor in the occurrence of PDPH, but the position before spinal anesthesia has not yet been evaluated. Objectives This study was designed to compare the incidence of PDPH following spinal anesthesia in the sitting position and in the left lateral decubitus position in parturients who underwent elective caesarian section. Patients and Methods After institutional approval, 100 parturients who had been scheduled for elective caesarian section with spinal anesthesia were enrolled in the study. Following patient preparation for the neuraxial blockade, spinal anesthesia was randomly performed in the sitting or in the left lateral decubitus position. Patients were interviewed for PDPH on either postoperative day one, two, or three. The incidence and intensity of PDPH were evaluated and compared using a numeric rating scale (NRS-11). Results A total of 94 patients were included in the data analysis. The overall incidence of PDPH was 12.7%. In the sitting group, ten patients (20.8%) had PDPH, compared with two patients (4.3%) in the lateral group (P = 0.017). Conclusions Spinal anesthesia in the sitting position is more associated with significant PHDH than that in the left lateral decubitus position for patients undergoing elective caesarian section. PMID:27843773

  14. Epidural analgesia complicated by dural ectasia in the Marfan syndrome

    PubMed Central

    Gray, Chelsea; Hofkamp, Michael P.; Noonan, Patrick T.; McAllister, Russell K.; Pilkinton, Kimberly A.; Diao, Zhiying

    2016-01-01

    Patients with the Marfan syndrome are considered to be high risk during pregnancy and warrant a complete multidisciplinary evaluation. One goal is to minimize hemodynamic fluctuations during labor since hypertensive episodes may result in aortic dissection or rupture. Although they may prevent these complications, neuraxial techniques may be complicated by dural ectasia. The case of a parturient with the Marfan syndrome and mild dural ectasia is presented. During attempted labor epidural placement, unintentional dural puncture occurred. A spinal catheter was used for adequate labor analgesia, and a resultant postdural puncture headache was alleviated by an epidural blood patch under fluoroscopic guidance. PMID:27695168

  15. Primary nonmedically indicated cesarean section ("section on request"): evidence based or modern vogue?

    PubMed

    Grisaru, Sorina; Samueloff, Arnon

    2004-09-01

    Cesarean section, initially described as an emergency operative procedure for delivering moribund parturients, is now advocated by many as a routine technique with major advantages over vagi-nal delivery. In fact, it has been suggested that labor and vaginal delivery are no longer the desired consequence of pregnancy, a conclusion that reflects perceived medical advantages and patient and physician convenience. This article systematically reviews the various medical implications to the mother and infant of this procedure in the hope of facilitating a more rational approach to this spreading and controversial phenomenon.

  16. Should Nitrous Oxide Be Used for Laboring Patients?

    PubMed

    Richardson, Michael G; Lopez, Brandon M; Baysinger, Curtis L

    2017-03-01

    Nitrous oxide, long used during labor in Europe, is gaining popularity in the United States. It offers many beneficial attributes, with few drawbacks. Cost, safety, and side effect profiles are favorable. Analgesic effectiveness is highly variable, yet maternal satisfaction is often high among the women who choose to use it. Despite being less effective in treating labor pain than neuraxial analgesic modalities, nitrous oxide serves the needs and preferences of a subset of laboring parturients. Nitrous oxide should, therefore, be considered for inclusion in the repertoire of modalities used to alleviate pain and facilitate effective coping during labor.

  17. Chronic kidney disease in pregnancy.

    PubMed

    Chinnappa, V; Ankichetty, S; Angle, P; Halpern, S H

    2013-07-01

    Parturients with renal insufficiency or failure present a significant challenge for the anesthesiologist. Impaired renal function compromises fertility and increases both maternal and fetal morbidity and mortality. Close communication amongst medical specialists, including nephrologists, obstetricians, neonatologists and anesthesiologists is required to ensure the safety of mother and child. Pre-existing diseases should be optimized and close surveillance of maternal and fetal condition is required. Kidney function may deteriorate during pregnancy, necessitating early intervention. The goal is to maintain hemodynamic and physiologic stability while the demands of the pregnancy change. Drugs that may adversely affect the fetus, are nephrotoxic or are dependent on renal elimination should be avoided.

  18. Remifentanil-nitroglycerin combination as an anesthetic support for ex utero intrapartum treatment (EXIT) procedure.

    PubMed

    Ioscovich, Alexander; Shen, Ori; Sichel, Jean-Yves; Lajos, Yishay; Orkin, Dina; Bromiker, Reuven; Briskin, Alexander

    2011-03-01

    A 21 year old healthy parturient was diagnosed as having a fetus with micrognathia. She was scheduled for an ex-utero intrapartum treatment (EXIT) procedure. General anesthesia consisted of remifentanil, nitrous oxide, and midazolam. Intravenous nitroglycerin was used for uterine relaxation. This technique offered hemodynamic stability and provided uterine relaxation that may be rapidly terminated. For the fetus, it provided excellent transplacental anesthesia. Supplemental direct fetal anesthesia is recommended to prevent the rapid decline of analgesia/anesthesia that occurs after placental separation.

  19. Use of laserotherapy in multimodality treatment and prevention of obstetric pathology

    NASA Astrophysics Data System (ADS)

    Dudchenko, Antonyna A.; Yuzko, Olexander M.; Marynchyna, Iryna M.; Rotar, Oksana M.

    2002-02-01

    The purpose of our research was an analysis of the influence of laserotherapy in the process of treating late gestoses in gravidas, as well as preventing complications following cesarean section. An improvement of the state of the gravida and fetus was detected according to the findings of the disease pattern, coagulogram and cardiotachography. We want to demonstrate the positive effect of laserotherapy which was carried out with the purpose of prophylaxis on the course of the postoperative period in parturients. The results of observations is the following: pyo-septic complications reduced by 14.3%.

  20. Pregnancy with aortic dissection in Ehler-Danlos syndrome. Staged replacement of the total aorta (10-year follow-up).

    PubMed

    Babatasi, G; Massetti, M; Bhoyroo, S; Khayat, A

    1997-10-01

    Pregnancy complicated by aortic dissection in patients with hereditary disorder of connective tissue presents interesting considerations including management of caesarean section with the unexpected need for cardiac surgery in emergency. Generalizations can be made on management principles with long-term follow-up requiring an aggressive individualized approach by a multidisciplinary team. A 33-year-old parturient presenting an aortic dissection at 37 weeks gestation required prompt diagnosis of Ehlers-Danlos syndrome in combination with correct surgical therapy resulted in the survival of both the mother and infant. During the 10-year follow-up, multiple complex dissection required transverse aortic arch and thoracoabdominal aortic replacement.

  1. [Obstetric analgesia in patients with Klippel-Trenaunay syndrome].

    PubMed

    Felten, M L; Mercier, F J; Bonnet, V; Benhamou, D

    2001-11-01

    We report three cases of delivery in two parturients with a Klippel-Trenaunay syndrome. These patients have a rare hereditary disorder that results in three main features: haemangiomas, varicose veins, bone and soft tissue hypertrophy. In the absence of angiographic magnetic resonance imaging of the spinal cord and of perispinal tissues, arteriovenous malformations of the central nervous system could not been ruled out. Intravenous sufentanil and pudendal block were used for labour analgesia and vaginal delivery respectively; general anaesthesia was used for uterine revision and for caesarean section.

  2. [100 years ago: Oskar Kreis, a pioneer in spinal obstetric analgesia at the University Women's Clinic of Basel].

    PubMed

    Schneider, M C; Holzgreve, W

    2001-07-01

    In 1900, Oskar Kreis (1872-1958), a gynecologist and obstetrician who received his training at the Basle University Women's Hospital, pioneered the use of spinal anaesthesia in six parturients for labour pain relief. Cocaine was used as a local anaesthetic, which had previously been shown to be effective for spinal anaesthesia by August Bier in 1898. This important advance in anaesthetic care was not widely acknowledged for a long period of time and it has only been during the past few decades that spinal anaesthesia was rediscovered as an important technique available for obstetric anaesthesia.

  3. Obstetric analgesia and immunoreactive endorphin peptides in maternal plasma during labor.

    PubMed

    Riss, P A; Bieglmayer, C

    1984-01-01

    We studied the effect of obstetric analgesia on maternal plasma levels of immunoreactive endorphin peptides (ir-EP) during labor and the postpartum period in three groups of parturients: group I (n = 22) had no analgesia, group II (n = 20) received pethidine intramuscularly, and group III (n = 10) had continuous epidural analgesia. Initial levels of ir-EP were similar in all three groups. Patients without any medication and patients on pethidine showed a significant rise in ir-EP in late labor and at delivery. Epidural analgesia was characterized by constant levels of ir-EP during labor and an insignificant rise at delivery.

  4. [Anesthesia for cesarean section in a patient with recessive dystrophic epidermolysis bullosa].

    PubMed

    García, I; Manrique, S; Muñoz, C; López-Gil, M V; Munar, F; Montferrer, N

    2009-11-01

    Recessive dystrophic epidermolysis bullosa is inherited as a rare autosomal disorder which causes blisters to form in the skin. We describe the treatment of a 39-year-old parturient with this condition. She was scheduled for elective cesarean section at 37 weeks' gestation. The patient had widespread skin lesions, had lost fingers, and had esophageal stenosis. The cesarean was performed under spinal anesthesia without complications. Recessive dystrophic epidermolysis bullosa requires adaptation of anesthetic technique that includes control over posture and careful handling of the skin. Material for attaching monitoring devices and inserting venous lines must be adapted to the particular deformities and skin lesions present.

  5. Astrocytoma in an African hedgehog (Atelerix albiventris) suspected wobbly hedgehog syndrome.

    PubMed

    Nakata, Makoto; Miwa, Yasutsugu; Itou, Takuya; Uchida, Kazuyuki; Nakayama, Hiroyuki; Sakai, Takeo

    2011-10-01

    A 28-month-old African hedgehog was referred to our hospital with progressive tetraparesis. On the first presentation, the hedgehog was suspected as having wobbly hedgehog syndrome (WHS) and the animal was treated with medication and rehabilitation. The animal died 22 days after onset. Pathological examination revealed that the animal was involved in astrocytoma between the medulla oblongata and the spinal cord (C1). This report indicates that a primary central nervous system tumor should be considered as one of the differential diagnoses for hedgehogs presenting with progressive paresis, together with WHS.

  6. Neuralgic Amyotrophy Manifesting as Mimicking Posterior Interosseous Nerve Palsy

    PubMed Central

    Yang, Jin Seo; Kang, Suk Hyung; Choi, Eun Hi

    2015-01-01

    The upper trunk of the brachial plexus is the most common area affected by neuralgic amyotrophy (NA), and paresis of the shoulder girdle muscle is the most prevalent manifestation. Posterior interosseous nerve palsy is a rare presentation in patients with NA. It results in dropped finger on the affected side and may be misdiagnosed as entrapment syndrome or compressive neuropathy. We report an unusual case of NA manifested as PIN palsy and suggest that knowledge of clinical NA phenotypes is crucial for early diagnosis of peripheral nerve palsies. PMID:26713154

  7. A Rare Case of Ocular Myositis

    PubMed Central

    ALBU, CARMEN VALERIA; CĂTĂLIN, B.; ZAHARIA, CORNELIA

    2014-01-01

    We report the case of a 43 year old man who presented recurrent left abducens palsy. His medical history included arterial hypertension, ischemic cardiomiopathy, dyslipidemia, rhinitis, maxillary sinusitis. Physical examination revealed a overweight patient, horizontal gaze diplopia, left nerve VI paresis, mild left retro-orbital pain. The orbital MRI also didn’t offer new information: mild external edema on the left eye, with normal tendon aspect, no thickening or enhancement of the muscle belly and also normal aspect of the bony orbit. Recurrent palsy of EOMs can be caused in rare cases by ocular myositis. PMID:24791211

  8. A report of paracentric inversion of chromosome 8 in Moebius syndrome.

    PubMed

    Kersey, James P; Vivian, Anthony J; Reid, Evan

    2006-03-01

    An eight-year-old girl with bilateral facial paresis and restricted eye movements was diagnosed with Moebius syndrome. A chromosomal analysis showed a paracentric inversion on the long arm of chromosome 8 (46, XX, inv(8) (q21.3q24.13)). Candidate genes have been found on chromosomes 3q21, 10q21, and 13q12. We discuss the genes which are known to have associated ocular movement dysfunction in the 8q21-24 region. We hope this case will add to the current body of knowledge regarding Moebius syndrome and its genetics.

  9. Prolonged ictal monoparesis with parietal Periodic Lateralised Epileptiform Discharges (PLEDs).

    PubMed

    Murahara, Takashi; Kinoshita, Masako; Usami, Kiyohide; Matsui, Masashi; Yamashita, Kouhei; Takahashi, Ryosuke; Ikeda, Akio

    2013-06-01

    We report a patient with prolonged monoparesis and parietal periodic lateralised epileptiform discharges (PLEDs). The patient was a 73-year-old man with chronic myelomonocytic leukaemia who developed persisting monoparesis of the right arm, sensory aphasia, and finger agnosia, initially associated with focal clonic seizures. These neurological deficits remained for seven days without subsequent focal clonic seizures. The EEG showed left-sided PLEDs, maximal in the left occipito-parietal area. Ten days later, following phenytoin treatment, these symptoms suddenly improved and parietal PLEDs disappeared. Sustained PLEDs in the left parietal region may have been causally associated with ictal paresis in this patient.

  10. Diplopia as the primary presentation of foodborne botulism

    PubMed Central

    Khakshoor, Hamid; Moghaddam, Ali Akbar Saber; Vejdani, Amir Hossein; Armstrong, Blair K.; Moshirfar, Majid

    2012-01-01

    Foodborne botulism is a serious condition caused by Clostridium botulinum neurotoxin. Clinically, botulism presents as bilateral cranial nerve neuropathy and descending paralysis. We report a unique presentation of botulism to remind clinicians of this potentially fatal condition. In this observational case report initial evaluation showed only esodeviation. This progressed to unilateral cranial nerve six (CN VI) paresis along with systemic signs. Clinical diagnosis was made based on in-depth history and concurrent symptoms in three other patients. Foodborne botulism presenting as diplopia and unilateral motility deficits is rare and can represent a diagnostic and therapeutic challenge to the ophthalmologist. PMID:22993467

  11. Spasticity Management After Stroke.

    PubMed

    Bethoux, Francois

    2015-11-01

    Many poststroke survivors develop spasticity. Spasticity is usually associated with other neurologic impairments, in particular paresis, which complicate the evaluation of its consequences and of treatment outcomes. The diagnosis and the assessment of spasticity are based on clinical examination, in particular resistance to passive movement and abnormal involuntary muscle contraction. Nonpharmacologic and pharmacologic treatments are commonly combined to manage spasticity, based on prespecified goals. There is evidence supporting the effectiveness and safety of most medications commonly used to treat spasticity; however, more evidence is needed regarding functional outcomes and the impact of combining treatment modalities.

  12. [Personage-Turner syndrome--case report].

    PubMed

    Tomczykiewicz, Kazimierz; Stepień, Adam; Staszewski, Jacek

    2011-08-01

    Personage-Turner syndrome or acute brachial radiculitis is rare syndrome. In typical cases it was manifested by strong pain of shoulder region and the weakness of muscles which are supplies by individual nerves or part of brachial plexus and in longer time with atrophy. Aetiology of this disease is unknown, probably on the autoimmuno-inflammatory background. Diagnosis is made on the typical clinical picture and in exclusion many illness with impairment brachial plexus. In presented case the course of disease as well as executed investigations suggested that discopathy could be the reason of paresis, however renewed estimation caused the change of the diagnosis.

  13. An unusual presentation of spinal dural arteriovenous fistula: A case report

    PubMed Central

    Saadat, Payam; Adabi, Marzie

    2016-01-01

    Background: Spinal dural AVF is the most common type of spinal vascular malformation. However, presenting symptoms differ according to site of spinal involvement. This study described a case of arteriovenous malformation with paraparesis and incontinence. Case Presentation: Diagnosis of patient was confirmed by clinical and imaging examination using magnetic resonance image and ruling out other possibilities Result: A definitive diagnosis of arterio venous fistula was confirmed by clinical and MRI examination and demonstrated abnormalities compatible with dural arteriovenous fistula. Conclusion: Dural arteriovenous fistula should be considered in patients with paresis in both lower extremities. PMID:27757211

  14. Unilateral facial paralysis after treatment of secondary syphilis.

    PubMed

    Berger, Emily M; Galadari, Hassan I; Gottlieb, Alice B

    2008-06-01

    Bell's palsy is an acute facial paralysis of unknown etiology. Infections including syphilis have been implicated as causes for peripheral facial paresis. The Jarisch-Herxheimer reaction is an acute worsening of skin manifestations and systemic symptoms occurring after administration of antimicrobial therapy for spirochetal infections. Although rare, neurological signs can present as part of the Jarisch-Herxheimer reaction. The authors report a case of Bell's palsy experienced by a patient shortly after treatment with penicillin for secondary syphilis and propose that this acute unilateral peripheral facial paralysis was a Jarisch-Herxheimer reaction in response to therapy.

  15. Muscle Paralysis in Herpes Zoster

    PubMed Central

    Rubin, David; Fusfeld, Robert D.

    1965-01-01

    Herpes zoster may, in some instances, cause motor paralysis as well as the usual sensory and cutaneous manifestations. It is suggested that the presence of electromyographic denervation potentials be used as the criterion of muscle paresis in order to avoid mistaking atrophy of disuse for true lower motor neuron disease. Use of the proper physical therapy procedures hastens the recovery of function and may serve to retard denervation atrophy and fibrosis in patients with muscle paralysis. ImagesFigure 1 (Case 1).Figure 1 (Case 1). PMID:5828175

  16. [Multifocal polyneuropathy with persistent conduction blockage. A new subset of chronic inflammatory polyneuropathies].

    PubMed

    Alvarez Vadillo, E; Ferrer Gila, M T; Amer Ferrer, G; Anciones Rodríguez, B; Pérez Conde, M C; Gutiérrez Molina, M; Cruz Martínez, A

    1989-09-09

    Recently a subset of chronic demyelinating inflammatory polyneuropathies with asymmetrical involvement limited to upper limbs, at least at the onset, resembling a multifocal mononeuropathy has been described. Electrodiagnostic testing disclosed multifocal CB outside the common entrapment sites has been described. We report a 55 years old man with a 4 years history of paresis, numbness, fasciculations, myokymia, cramps and mild amyotrophy. Electrophysiological evaluation showed proximal multifocal conduction block and abundant spontaneous activity as fasciculations, myokymia and scarce denervation activity. The importance of taking into account this entity in the differential diagnosis of patients with suspected mononeuritis multiplex or motoneuron disease is emphasized. The nosologic place of this entity is also discussed.

  17. [Foix-Chavany-Marie syndrome: anarthria and severe dyphagia after sequential bilateral infarction of the middle cerebral artery].

    PubMed

    Guhra, M; Poppenborg, M; Hagemeister, C

    2008-02-01

    Bilateral lesions of the opercula frontoparietalia are uncommon and cause a symptom cluster including anarthria, severe dysphagia, inability to chew and sometimes facial paresis. At the same time there is an automatic-voluntary dissociation, meaning that the affected muscles are functional within the scope of involuntary movements. This syndrome is known as Foix-Chavany-Marie syndrome (FCMS), (bilateral) anterior operculum syndrome or facio-pharyngo-glosso-masticatory diplegia. We report the case of a patient who suffered from FCMS after having infarctions in the territory of the middle cerebral artery on each side 4 years apart.

  18. Study of Preoperative Predictive Signs in Management of Facial Nerve in Parotid Tumors

    PubMed Central

    CHIRILA, Magdalena; MURESAN, Mihaela; BOLBOACA, Sorana D.

    2014-01-01

    Objectives: To find preoperative predictive signs for better surgical planning of the facial nerve in parotid tumors. Methods: Prospective study in patients with primary parotid malignancies. Patients with primary parotid malignant tumor were investigated for preoperative clinical signs in correlation with histological findings and surgical management of the facial nerve. Outcomes: The study included 47 patients. Several clinical findings as facial pain, paresthesia, and rapid growth of tumor might suggest the risk of malignancy. Paresis/palsy of the facial nerve was correlates with direct neural involvement. Conclusion: There are several predictive clinical signs that might suggest malignancy of a parotid tumor. PMID:25553124

  19. Pineal cyst apoplexy: report of an unusual case managed conservatively.

    PubMed

    Ayhan, Selim; Bal, Ercan; Palaoglu, Selcuk; Cila, Aysenur

    2011-01-01

    Pineal cyst apoplexy is a very rare entity with previously reported symptoms of severe frontal or occipital headache, gaze paresis and visual field defects, nausea or vomiting, syncope, ataxia, hearing loss and sudden death. The treatment options for symptomatic pineal cysts are observation, shunting, aspiration via stereotactic guidance or endoscopy, third ventriculostomy, ventriculocysternostomy, and/or surgical resection by craniotomy and microsurgery. Here, the authors report an unusual case of a 28-year-old male patient with pineal cyst apoplexy, presenting with headache, insomnia, and sexual dysfunction symptoms who is being managed conservatively and observed for two years by an academic tertiary care unit.

  20. Lumbo-sacral radiculopathy referral decision-making and primary care management. A case report.

    PubMed

    Haswell, Kate; Gilmour, John Martin; Moore, Barbara Joyce

    2015-04-01

    Low back pain guideline recommendations can inform a decision in primary care to refer for surgical assessment. The purpose of this report is to present a patient with clinical signs and symptoms of lumbo-sacral radiculopathy who experienced pain of high intensity, severe paresis and depression. The guideline informed decision-making process resulted in a decision not to refer. This case report aims to increase awareness of referral guidelines and to demonstrate radicular pain and weakness, disability and depression outcomes subsequent to primary care management.

  1. [Social medicine assessment after surgical and targeted treatment of renal cell cancer].

    PubMed

    Vahlensieck, W; Hoffmann, W; Zermann, D-H

    2016-12-01

    In Germany, renal cell cancer counts for 2.5 % of all carcinomas in women and 3.5 % in men. Curative therapy ensures good chances of recovery. But there might be permanent complications like renal insufficiency, pain, incisional hernia, flank muscle relaxation, and paresis. In addition, targeted therapy is associated with several potential side effects. In both therapy groups, severe psychological problems may occur. Still employed patients with these problems must be examined by an expert to estimate the possibilities of returning to working (positive scope of work) and occupations which can not be performed anymore (negative scope of work).

  2. Diseases of the tendons and tendon sheaths.

    PubMed

    Steiner, Adrian; Anderson, David E; Desrochers, André

    2014-03-01

    Contracted flexor tendon leading to flexural deformity is a common congenital defect in cattle. Arthrogryposis is a congenital syndrome of persistent joint contracture that occurs frequently in Europe as a consequence of Schmallenberg virus infection of the dam. Spastic paresis has a hereditary component, and affected cattle should not be used for breeding purposes. The most common tendon avulsion involves the deep digital flexor tendon. Tendon disruptions may be successfully managed by tenorrhaphy and external coaptation or by external coaptation alone. Medical management alone is unlikely to be effective for purulent tenosynovitis.

  3. Central nervous system dysfunction associated with Rocky Mountain spotted fever infection in five dogs.

    PubMed

    Mikszewski, Jessica S; Vite, Charles H

    2005-01-01

    Five dogs from the northeastern United States were presented with clinical signs of neurological disease associated with Rocky Mountain spotted fever (RMSF) infection. Four of the five dogs had vestibular system dysfunction. Other neurological signs included paresis, tremors, and changes in mentation. All of the dogs had an elevated indirect fluorescent antibody titer or a positive semiquantitative enzyme screening immunoassay titer for Rickettsia rickettsii at the time of presentation. Although a higher mortality rate has been reported for dogs with neurological symptoms and RMSF infection, all of the dogs in this study improved with appropriate medical therapy and supportive care.

  4. Benign monomelic amyotrophy with proximal upper limb involvement: case report.

    PubMed

    Neves, Marco Antonio Orsini; Freitas, Marcos R G de; Mello, Mariana Pimentel de; Dumard, Carlos Henrique; Freitas, Gabriel R de; Nascimento, Osvaldo J M

    2007-06-01

    Monomelic amyotrophy (MA) is a rare condition in which neurogenic amyotrophy is restricted to an upper or lower limb. Usually sporadic, it usually has an insidious onset with a mean evolution of 2 to 4 years following first clinical manifestations, which is, in turned, followed by stabilization. We report a case of 20-years-old man who presented slowly progressive amyotrophy associated with proximal paresis of the right upper limb, which was followed by clinical stabilization 4 years later. Eletroneuromyography revealed denervation along with myofasciculations in various muscle groups of the right upper limb. We call attention to this rare location of MA, as well as describe some theories concerning its pathophysiology .

  5. Strabismus complications from local anesthetics.

    PubMed

    Guyton, David L

    2008-01-01

    Strabismus developing after retrobulbar or peribulbar anesthesia for both anterior and posterior segment eye surgery may be due to myotoxicity to an extraocular muscle from the local anesthetic agent. Initial paresis often causes diplopia immediately after surgery, but later progressive segmental fibrosis occurs, and/or hypertrophy of the muscle, producing diplopia in the opposite direction from the direction of the initial diplopia. The inferior rectus muscle is most commonly affected. Usually a large recession on an adjustable suture of the involved muscle(s) yields good alignment. Using topical anesthesia or sub-Tenon's anesthesia can avoid this complication.

  6. Neural Reanimation Advances and New Technologies.

    PubMed

    Kim, Jennifer

    2016-02-01

    Facial paralysis can have a profound effect on the patient from both an aesthetic and functional point of view. Just as there are numerous etiologies of facial paresis, there are as many therapeutic options and variations of these options. The purpose of this article was to review the most current surgical options for neural reanimation of a damaged facial nerve, including recent advances in nerve repair, conduit technology, and nerve transfers, as well as emerging technology in translational research with biomedical engineering and tissue engineering.

  7. Unusual skeletal deformities in calves in a Saskatchewan beef herd.

    PubMed

    Orr, J P; McKenzie, G C

    1981-05-01

    A very high incidence of posterior paresis in growing calves was casued by abnormal development of the vertebral column. The pathological changes were focal premature synostoses of vertebral growth plates with resulting reduction in size of the vertebral canal. Malacic changes were seen in sections from all areas of the spinal cord. Abnormalities in growth of the cranium and appendicular skeleton were also present. The growth plates in the cranial base were prematurely closed and the cranial cavity was shortened. Long bones were shortened and distorted. Possible causes include teratogenic plants or chemicals, mineral deficiencies, and hypervitaminosis A.

  8. [Venomous and poisonous animals. III. Elapidae snake envenomation].

    PubMed

    Chippaux, J P

    2007-02-01

    Envenomation by Elapidae snakes is less frequent than by Viperidae snakes but represents a true medical emergency due to rapid progression of cobra syndrome. Elapidae venom contains neurotoxins that paralyze striated muscles especially in the thoracic cavity. Respiratory paralysis can occur within a few hours and is preceded by neurological symptoms (local paresthesia and paresis progressing to the cranial nerves). When cobra envenomation is suspected, antivenom administration by the direct venous route must be undertaken as quickly as possible to stop the envenomation process. Artificial ventilation is necessary in case of dyspnea.

  9. Severe ischemic colitis following olanzapine use - A case report.

    PubMed

    Fernandes, Samuel R; Alves, Rosa; Araújo Correia, Luís; Rita Gonçalves, Ana; Malaquias, João; Oliveira, Emilia; Velosa, José

    2016-09-01

    Ischemic colitis is the most common subtype of intestinal ischemia usually resulting from vasospasm, vessel occlusion or mesenteric hypoperfusion. Neuroleptics have seldom been linked to ischemic colitis by blocking peripheral anticholinergic and antiserotonergic receptors inducing severe gastrointestinal paresis. We report a young patient with severe ischemic colitis requiring surgery due to necrosis of the bowel. After exclusion of other potential causes, olanzapine was admitted as the cause of ischemia. Clinicians should be aware of how to recognize and treat the potentially life-threatening effects of neuroleptics.

  10. Unusual Skeletal Deformities in Calves in a Saskatchewan Beef Herd

    PubMed Central

    Orr, J. P.; McKenzie, G. C.

    1981-01-01

    A very high incidence of posterior paresis in growing calves was casued by abnormal development of the vertebral column. The pathological changes were focal premature synostoses of vertebral growth plates with resulting reduction in size of the vertebral canal. Malacic changes were seen in sections from all areas of the spinal cord. Abnormalities in growth of the cranium and appendicular skeleton were also present. The growth plates in the cranial base were prematurely closed and the cranial cavity was shortened. Long bones were shortened and distorted. Possible causes include teratogenic plants or chemicals, mineral deficiencies, and hypervitaminosis A. ImagesFigure 1.Figure 2.Figure 3.Figure 4. PMID:7248886

  11. Facial nerve rerouting in skull base surgery.

    PubMed

    Parhizkar, Nooshin; Hiltzik, David H; Selesnick, Samuel H

    2005-08-01

    Facial nerve rerouting techniques were developed to facilitate re-section of extensive tumors occupying the skull base. Facial nerve rerouting has its own limitations and risks, requiring microsurgical expertise, additional surgical time, and often some degree of facial nerve paresis. This article presents different degrees of anterior and posterior facial nerve rerouting, techniques of facial nerve rerouting, and a comprehensive review of outcomes. It then reviews anatomic and functional preservation of the facial nerve in acoustic neuroma resection, technical aspects of facial nerve dissection, intracranial facial nerve repair options, and outcomes for successful acoustic neuroma surgery.

  12. Losing Your Voice: Etiologies and Imaging Features of Vocal Fold Paralysis

    PubMed Central

    Vachha, Behroze; Cunnane, Mary Beth; Mallur, Pavan; Moonis, Gul

    2013-01-01

    Neurogenic compromise of vocal fold function exists along a continuum encompassing vocal cord hypomobility (paresis) to vocal fold immobility (paralysis) with varying degrees and patterns of reinnervation. Vocal fold paralysis (VFP) may result from injury to the vagus or the recurrent laryngeal nerves anywhere along their course from the brainstem to the larynx. In this article, we review the anatomy of the vagus and recurrent laryngeal nerves and examine the various etiologies of VFP. Selected cases are presented with discussion of key imaging features of VFP including radiologic findings specific to central vagal neuropathy and peripheral recurrent nerve paralysis. PMID:23814687

  13. Aldosterone and cortisol co-secreting bifunctional adrenal cortical carcinoma: A rare event.

    PubMed

    Chowdhury, Puskar Shyam; Nayak, Prasant; Gurumurthy, Srinivasan; David, Deepak

    2014-07-01

    Adrenocortical carcinoma (ACC) co-secreting aldosterone and cortisol is extremely rare. We report the case of a 37-yearold female who presented with paresis and facial puffiness. Evaluation revealed hypertension, hyperglycemia, severe hypokalemia and hyperaldosteronemia with elevated plasma aldosterone to renin ratio (ARR). Urinary free cortisol estimation showed elevated levels. Computed tomography scan revealed a right adrenal mass. Radical adrenalectomy specimen revealed ACC (T3N1). Post-operatively, the patient became normotensive and euglycemic with normalization of urinary cortisol and ARR. This case highlights the need for a complete evaluation in patients of hyperaldosteronism if overlapping symptoms of hypercortisolism are encountered, to avoid post-operative adrenal crisis.

  14. Female sociality during the daytime birth of a wild bonobo at Luikotale, Democratic Republic of the Congo.

    PubMed

    Douglas, Pamela Heidi

    2014-10-01

    Parturition is one of the most important yet least observed events in studies of primate life history and reproduction. Here, I report the first documented observation of a bonobo (Pan paniscus) birth event in the wild, at the Luikotale Bonobo Project field site, Democratic Republic of the Congo. The nulliparous mother's behaviour before, during and after parturition is described, along with reactions of other community members to the birth and the neonate. Data were collected through focal-animal observations, and the events postpartum were photo-documented. The behaviour and spatial distribution of party members were recorded using scan samples. Parturition occurred during the late morning in a social context, with parous females in close proximity to the parturient mother. Placentophagia occurred immediately after delivery, and the parturient shared the placenta with two of the attending females. I compare this observation with reports of parturition in captive bonobos, and highlight the observed female sociality and social support during the birth event. Plausible adaptive advantages of parturition occurring in a social context are discussed, and accrued observations of birth events in wild and free-ranging primates suggest that females may give birth within proximity of others more frequently than previously thought. This account contributes rare empirical data for examining the interface between female sociality and parturition, and the evolution of parturitional behaviours in primates.

  15. Epidural analgesia using loss of resistance with air versus saline: does it make a difference? Should we reevaluate our practice?

    PubMed

    Norman, David

    2003-12-01

    The choice of using air or saline in epidural syringes during the loss-of-resistance technique, for identifying the epidural space, has been based largely on personal preference of the anesthesia provider. A survey of practice in the United Kingdom, thought to be similar to practice in the United States, revealed that the majority of anesthesia providers use air. Case reports have appeared in the literature suggesting that air may be harmful to patients or, at the very least, impede the onset and quality of epidural analgesia. Two studies have evaluated air vs saline to determine whether one may lead to more rapid or better quality epidural analgesia in laboring parturients. Results are mixed. However, they seem to indicate that the use of saline for the loss-of-resistance may result in more rapid and satisfactory quality of pain relief in laboring parturients. Current anesthesia literature suggests using saline with an air bubble in the loss-of-resistance syringe. Many anesthesia training programs continue to teach the use of air, saline, and saline with an air bubble. Further studies may help to determine whether there is a scientific or safety basis for using air vs saline.

  16. Longitudinal fecal hormone analysis for monitoring reproductive activity in the female polar bear (Ursus maritimus).

    PubMed

    Stoops, M A; MacKinnon, K M; Roth, T L

    2012-12-01

    The objective was to identify suitable enzyme immunoassays to monitor gonadal and placental function in the female polar bear. Immunoreactive progesterone, progesterone metabolite (PdG), estrogen, and androgen metabolite (T) concentrations were measured in fecal samples collected over 24 mo from captive female bears (N = 20). Whereas fecal extracts produced displacement curves parallel to the standard curve for each respective steroid, T and PdG more accurately reflected reproductive events. Concentrations of fecal T increased (P < 0.05) during the breeding season, and brief spikes were associated with estrus and mating. A postovulatory increase in PdG was not always detected, but sustained baseline T after mating appeared consistent with ovulation. Parturient bears excreted higher PdG concentrations (P < 0.05) during expected time of embryo implantation in Fall, and a late gestational rise in fecal T occurred 30 days prepartum. Many nonparturient bears also had a PdG rise in the Fall, suggesting they experienced either pregnancy loss or a pseudopregnancy. Differentiating pregnant and pseudopregnant states was not achieved using fecal PdG alone, but when combined with fecal T, comprehensive diagnoses could be made. Nonparturient bears demonstrated elevated (P < 0.05) fecal T during summer months, whereas parturient bears did not. In summary, noninvasive hormone monitoring techniques were established for the female polar bear. Although this study was directed at facilitating management and breeding efforts of captive polar bears, the methods could be applied to studies of reproductive function in wild populations.

  17. The Prevalence of Human Immunodeficiency Virus Infection among Pregnant Women in Labour with Unknown Status and those with Negative Status Early in the Index Pregnancy in a Tertiary Hospital in Nigeria.

    PubMed

    Ukaire, Binyerem C; Agboghoroma, Chris O; Durojaiye, Korede W

    2015-09-01

    Rapid HIV test in labour provide an opportunity for the identification of HIV positive pregnant women who should benefit from interventions to reduce the risk of mother-to-child transmission (MTCT) of HIV. Between November 2013 and June 2014 we conducted rapid HIV testing of pregnant women in labour at the National Hospital Abuja to determine the HIV seroconversion rate in pregnancy and the prevalence of HIV in pregnant women in labour with previously unknown status. HIV testing and counseling (HTC) was acceptable to 224 (99.6%) of the pregnant women who met the study criteria. The mean 'turnaround' time for test result was 288 minutes and 16.2 minutes for tests performed in the hospital laboratory and those performed at the point-of-care (labour ward) respectively. HIV seroconversion was detected in 2(1.2%) of the 165 parturients with initial HIV negative result early in the index pregnancy. HIV infection was detected in four (2.7%) of the 59 parturients with unknown HIV status. Secondary school level education was significantly associated with HIV seroconversion in pregnancy P < 0.001. HTC in labour using rapid testing strategy is feasible and acceptable in our setting. The introduction of HCT will lead to the diagnosis of HIV positive women in labour, appropriate interventions and prevention of MTCT of HIV.

  18. Analgesic Efficacy of Pfannenstiel Incision Infiltration with Ropivacaine 7.5 mg/mL for Caesarean Section.

    PubMed

    Nguyen, N K; Landais, A; Barbaryan, A; M'barek, M A; Benbaghdad, Y; McGee, K; Lanba, P

    2010-01-01

    Background. Pain after Caesarean delivery is partly related to Pfannenstiel incision, which can be infiltrated with local anaesthetic solutions. Methods. A double- blind randomized control trial was designed to assess the analgesic efficacy of 7.5 mg/mL ropivacaine solution compared to control group, in two groups of one hundred and forty four parturients for each group, who underwent Caesarean section under spinal anaesthesia: group R (ropivacaine group) and group C (control group). All parturients also received spinal sufentanil (2.5 mug). Results. Ropivacaine infiltration in the Pfannenstiel incision for Caesarean delivery before wound closure leads to a reduction of 30% in the overall consumption of analgesics (348 550 mg for group R versus 504 426 mg for group C with P < .05), especially opioids in the first 24 hours, but also significantly increases the time interval until the first request for an analgesic (4 h 20 min +/- 2 h 26 for group R versus 2 h 42 +/- 1 h 30 for group C). The P values for the two groups were: P < .0001 for paracetamol, P < .0001 for ketoprofen and P for nalbuphine which was the most significant. There is no significant difference in the threshold of VAS in the two series. Conclusion. This technique can contribute towards a programme of early rehabilitation in sectioned mothers, with earlier discharge from the post-labour suite.

  19. Systematic review of accuracy of prenatal diagnosis for abnormal chromosome diseases by microarray technology.

    PubMed

    Xu, H B; Yang, H; Liu, G; Chen, H

    2014-10-31

    The accuracy of prenatal diagnosis for abnormal chromosome diseases by chromosome microarray technology and karyotyping were compared. A literature search was carried out in the MEDLINE database with the keywords "chromosome" and "karyotype" and "genetic testing" and "prenatal diagnosis" and "oligonucleotide array sequence". The studies obtained were filtered by using the QUADAS tool, and studies conforming to the quality standard were fully analyzed. There was one paper conforming to the QUADAS standards including 4406 gravidas with adaptability syndromes of prenatal diagnosis including elderly parturient women, abnormal structure by type-B ultrasound, and other abnormalities. Microarray technology yielded successful diagnoses in 4340 cases (98.8%), and there was no need for tissue culture in 87.9% of the samples. All aneuploids and non-parallel translocations in 4282 cases of non-chimera identified by karyotyping could be detected using microarray analysis technology, whereas parallel translocations and fetal triploids could not be detected by microarray analysis technology. In the samples with normal karyotyping results, type-B ultrasound showed that 6% of chromosomal deficiencies or chromosome duplications could be detected by microarray technology, and the same abnormal chromosomes were detected in 1.7% of elderly parturient women and samples with positive serology screening results. In the prenatal diagnosis test, compared with karyotyping, microarray technology could identify the extra cell genetic information with clinical significance, aneuploids, and non-parallel translocations; however, its disadvantage is that it could not identify parallel translocations and triploids.

  20. Does Nursery-Based Intensified Anticipatory Guidance Reduce Emergency Department Use for Nonurgent Conditions in the First Month of Life? A Randomized Controlled Trial

    PubMed Central

    Kamimura-Nishimura, Kelly; Chaudhary, Vikram; Olaosebikan, Folake; Azizi, Maryam; Galiveeti, Sneha; Adeniyi, Ayoade; Neugebauer, Richard; Hagmann, Stefan H. F.

    2016-01-01

    Objective. We aimed to evaluate the impact of an intensified anticipatory guidance program in the nursery on Emergency Department (ED) use for nonurgent conditions (NUCs) in the neonatal period. Methods. Parturient mothers of healthy newborns were randomized to an intervention group or control group. Baseline and 1-month follow-up knowledge surveys regarding newborn care were conducted. The primary outcome was the proportion of neonates who used the ED for a NUC. Secondary outcome was change in caregivers' knowledge on NUC. Results. Of a total of 594 mothers, 323 (54%) agreed to participate and were randomized to intervention (n = 170) or control (n = 153) group. Most were Hispanic (68%), single (61%), primiparous (39%), and without high school diploma (44%). 35 (21%) neonates in the intervention group and 41 (27%) in the control group were brought at least once for a NUC to the ED (p = 0.12). There was no statistically significant difference in within subject change on knowledge scores between the two study arms. Conclusions. Neonatal ED visits for NUCs occur frequently. This nursery-based intensified anticipatory guidance program had no statistically significant impact on neonatal ED use for NUC, nor on neonatal care-relevant knowledge among parturient mothers. Alternative modalities and timing of parental educational intervention may need to be considered. This trial is registered with Clinical Trials Number NCT01859065 (Clinicaltrials.gov). PMID:27212955

  1. Effects of oral administration of caffeine on some physiological parameters and maternal behaviour of sows at farrowing.

    PubMed

    Superchi, Paola; Saleri, Roberta; Farina, Elena; Cavalli, Valeria; Riccardi, Enzo; Sabbioni, Alberto

    2016-04-01

    Caffeine has been demonstrated to have a protective effect on neonatal viability of piglets. In order to assess whether caffeine, administered to parturient sows, also affects maternal behaviour, respiratory rate, and dopamine, nitric oxide and serotonin plasma levels, 20 sows, with induced parturition, received orally 27 mg/kg of body weight of caffeine (T group; n=10) or not (NT group; n=10), on day 113 of gestation. Treatment did not affect the farrowing length. There were less stillborn piglets in T group than NT group (0.67 vs 2.44; P<0.05), whereas no differences in dead piglets at 24h from birth was observed. Caffeine did not affect physiological parameters of sows, as the behaviour score of sows laying on belly was reduced (P<0.05). In conclusion, although the present study was carried out with a limited number of sows, administration of caffeine to parturient sows has the potential for reducing the number of stillborn.

  2. Vasotocin receptor blockade disrupts maternal care of offspring in a viviparous snake, Sistrurus miliarius.

    PubMed

    Lind, Craig M; Birky, Nikolette K; Porth, Anita M; Farrell, Terence M

    2017-02-15

    Parental care is a complex social behavior that is widespread among vertebrates. The neuroendocrine regulation of parent-offspring social behavior has been well-described in mammals, and to a lesser extent, in birds and fish. However, little is known regarding the underlying mechanisms that mediate the expression of care behaviors in squamate reptiles. In mammalian model species and humans, posterior pituitary hormones of the oxytocin and vasopressin families mediate parental care behaviors. To test the hypothesis that the regulatory role of posterior pituitary neuropeptides is conserved in a viviparous squamate reptile, we pharmacologically blocked the vasotocin receptor in post-parturient pigmy rattlesnakes, Sistrurus miliarius, and monitored the spatial relationship between mothers and offspring relative to controls. Mothers in the control group demonstrated spatial aggregation with offspring, with mothers having greater post-parturient energy stores aggregating more closely with their offspring. Blockade of vasotocin receptors eliminated evidence of spatial aggregation between mothers and offspring and eliminated the relationship between maternal energetic status and spatial aggregation. Our results are the first to implicate posterior pituitary neuropeptides in the regulation of maternal behavior in a squamate reptile and are consistent with the hypothesis that the neuroendocrine mechanisms underlying social behaviors are broadly conserved among vertebrates.

  3. Double blind comparison of combination of 0.1% ropivacaine and fentanyl to combination of 0.1% bupivacaine and fentanyl for extradural analgesia in labour

    PubMed Central

    Bawdane, Kishori Dhaku; Magar, Jyoti S; Tendolkar, Bharati A

    2016-01-01

    Background and Aims: Ropivacaine is considered as a safe alternative to bupivacaine for labor analgesia. The aim was to compare epidural ropivacaine and bupivacaine in intermittent doses for obstetric analgesia. Material and Methods: In this prospective, randomized, double-blind study, 60 women in labor were randomly allocated to receive either bupivacaine 0.1% with fentanyl 2 μg/mL (BF), or ropivacaine 0.1% with fentanyl 2 μg/mL (RF). Bromage scale, loss of cold sensation to ether swab in midclavicular line, visual analog scale were used to test for motor block, sensory block and pain, respectively. Hemodynamic parameters, onset of analgesia, dose requirement of drug to produce analgesia, duration of labor, and incidence of side effects were also recorded. Data were expressed as mean ± standard deviation and analyzed using students unpaired t-test, Chi-square and Mann-Whitney U-tests at P < 0.05. Results: Both drugs were similar with respect to hemodynamic stability, onset of analgesia, quality of analgesia, sensory blockade, neonatal outcome, requirement of drugs, duration of labor, and incidence of side effects. Three parturient in bupivacaine (B-F) group had a motor block of Bromage 1 and were delivered using forceps. None of the parturient in ropivacaine (R-F) group had any motor block, and all had spontaneous vaginal delivery, but this difference was not statistically significant (P = 0.081). Conclusions: Bupivacaine and ropivacaine provide equivalent analgesia in low (0.1%) concentration. PMID:27006539

  4. Vasotocin receptor blockade disrupts maternal care of offspring in a viviparous snake, Sistrurus miliarius

    PubMed Central

    Birky, Nikolette K.; Porth, Anita M.; Farrell, Terence M.

    2017-01-01

    ABSTRACT Parental care is a complex social behavior that is widespread among vertebrates. The neuroendocrine regulation of parent-offspring social behavior has been well-described in mammals, and to a lesser extent, in birds and fish. However, little is known regarding the underlying mechanisms that mediate the expression of care behaviors in squamate reptiles. In mammalian model species and humans, posterior pituitary hormones of the oxytocin and vasopressin families mediate parental care behaviors. To test the hypothesis that the regulatory role of posterior pituitary neuropeptides is conserved in a viviparous squamate reptile, we pharmacologically blocked the vasotocin receptor in post-parturient pigmy rattlesnakes, Sistrurus miliarius, and monitored the spatial relationship between mothers and offspring relative to controls. Mothers in the control group demonstrated spatial aggregation with offspring, with mothers having greater post-parturient energy stores aggregating more closely with their offspring. Blockade of vasotocin receptors eliminated evidence of spatial aggregation between mothers and offspring and eliminated the relationship between maternal energetic status and spatial aggregation. Our results are the first to implicate posterior pituitary neuropeptides in the regulation of maternal behavior in a squamate reptile and are consistent with the hypothesis that the neuroendocrine mechanisms underlying social behaviors are broadly conserved among vertebrates. PMID:28069591

  5. Spinal cord injuries in ice hockey in Finland and Sweden from 1980 to 1996.

    PubMed

    Mölsä, J J; Tegner, Y; Alaranta, H; Myllynen, P; Kujala, U M

    1999-01-01

    Traumatic spinal cord injury (SCI) in the cervical or thoracic region is one of the most catastrophic types of sport injuries. This study was designed to determine incidence and mechanisms of major SCI in ice hockey in Finland and Sweden from 1980 to 1996 in order to find possibilities for prevention. Retrospective analysis of injury occurrence were carried out. Medical case records were reviewed and injured players were interviewed to complete the data. From 1980 to 1996, there were 16 accidents involving spinal cord injury with permanent disability. All players were male. The mean age was 21.1 years (range = 14 to 33 yr). In 50% of the cases the mechanism was body checking from behind and a blow to the head from the boards. In 69% of the cases the vertebral injury was fracture or/and luxation between C5 and C7. The neurological endstate was tetraplegia/paresis in 10 cases and paraplegia/paresis of the lower extremities in 6 cases. Ice hockey is one of the most popular sports in Europe, and the number of participants is still increasing. The typical mechanism in SCI is body checking from behind, falling down and a head-first blow from the boards. These serious injuries may be prevented by changing the rules (banning body checking near the boards) with strict refereeing and education of trainers and players.

  6. Sudden falls as a persistent complication of selective dorsal rhizotomy surgery in children with bilateral spasticity: report of 3 cases.

    PubMed

    Grootveld, Laura R; van Schie, Petra E M; Buizer, Annemieke I; Jeroen Vermeulen, R; van Ouwerkerk, Willem J R; Strijers, Rob L M; Becher, Jules J G

    2016-08-01

    Selective dorsal rhizotomy (SDR) surgery is a well-established treatment for ambulatory children with bilateral spastic paresis and is performed to eliminate spasticity and improve walking. The objective of this case report is to describe sudden falls as a persistent complication of SDR. The authors report on 3 patients with bilateral spastic paresis, aged 12, 6, and 7 years at the time of surgery. The percentage of transected dorsal rootlets was around 40% at the L2-S1 levels. Sudden falls were reported with a frequency of several a day, continuing for years after SDR. The falls were often triggered by performing dual tasks as well as occurring in the transition from sitting to standing, during running, after strenuous exercise, or following a fright. Patients also had residual hyperesthesia and dysesthesia of the foot sole. The authors hypothesize that the sudden falls are caused by a muscle inhibition reflex of the muscles in the legs, as an abnormal reaction to a sensory stimulus that is perceived with increased intensity by a patient with hyperesthesia. A favorable effect of gabapentin medication supports this hypothesis.

  7. [A case of multiple myeloma (biclonal type) associated with an intracranial mass invading the skull base and oculomotor palsy].

    PubMed

    Takano, K; Ohgami, S; Yonemasu, Y; Fukuda, H; Nakai, H; Tomabechi, M; Kawata, M; Takemori, N

    1991-12-01

    A case of multiple myeloma forming an intracranial mass which invaded the skull base was reported. A 72-year-old woman was admitted to the hospital because of left oculomotor paresis. Plain craniograms showed multiple punched out lesions. A CT scan demonstrated a mass lesion, which was homogeneously slightly enhanced with contrast medium, in the middle cranial fossa. MRI, both T1 and T2 weighted images, showed an isodensity mass. In the carotid angiograms the tumor was fed by the right branches of the cavernous portion of the internal carotid artery and the maxillary artery. Laboratory data were as follows: ESR: 132mm/30min, serum TP: 9.0g/dl, IgG: 4670mg/dl, IgA: 430mg/dl, and urinary Bence-Jones protein was detected. Bone marrow biopsy of the illiac bone demonstrated myeloma cells. During hospitalization oculomotor paresis disappeared, and the patient was treated with intramuscular interferon-alpha. Multiple myeloma which invades the skull base is rare, and only 10 cases have been reported since 1977. Moreover, the biclonal type is only 0.5% of all multiple myelomas.

  8. Laryngeal structure and function in dogs with cough.

    PubMed

    Johnson, Lynelle R

    2016-07-15

    OBJECTIVE To investigate the prevalence and type of laryngeal abnormalities in dogs examined because of cough that did not have signs of upper airway disease and to compare the prevalence of those abnormalities among dogs with various respiratory tract diseases. DESIGN Prospective study. ANIMALS 138 dogs with cough that did not have signs of upper airway disease. PROCEDURES The study was conducted between July 2001 and October 2014 and included dogs examined for cough that had laryngoscopic and bronchoscopic examinations performed by 1 examiner. Laryngeal hyperemia and swelling were recorded, and laryngeal function was assessed before and after doxapram stimulation when indicated. Results were compared among dogs on the basis of cough duration (acute [< 2 weeks], subacute [2 weeks to 2 months], and chronic [> 2 months]) and disease diagnosed (inflammatory airway disease, airway collapse, lower respiratory tract infection, and eosinophilic bronchopneumopathy). RESULTS Laryngeal hyperemia was detected in 73 of 134 (54%) dogs with cough of subacute or chronic duration, and its prevalence did not vary significantly among dogs with various diseases. Thirteen dogs had laryngeal paresis, and 13 dogs had laryngeal paralysis; dysphonia (n = 2) and stridor (1) were uncommon findings in those dogs. The prevalence of laryngeal dysfunction (paresis or paralysis) did not differ significantly among diseases. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that 26 of 138 (19%) dogs examined because of cough alone had laryngeal dysfunction, which suggested that a complete laryngoscopic examination should be included in the diagnostic evaluation of dogs with cough.

  9. Ipsilesional trajectory control is related to contralesional arm paralysis after left hemisphere damage.

    PubMed

    Haaland, Kathleen Y; Schaefer, Sydney Y; Knight, Robert T; Adair, John; Magalhaes, Alvaro; Sadek, Joseph; Sainburg, Robert L

    2009-06-01

    We have recently shown ipsilateral dynamic deficits in trajectory control are present in left hemisphere damaged (LHD) patients with paresis, as evidenced by impaired modulation of torque amplitude as response amplitude increases. The purpose of the current study is to determine if these ipsilateral deficits are more common with contralateral hemiparesis and greater damage to the motor system, as evidenced by structural imaging. Three groups of right-handed subjects (healthy controls, LHD stroke patients with and without upper extremity paresis) performed single-joint elbow movements of varying amplitudes with their left arm in the left hemispace. Only the paretic group demonstrated dynamic deficits characterized by decreased modulation of peak torque (reflected by peak acceleration changes) as response amplitude increased. These results could not be attributed to lesion volume or peak velocity as neither variable differed across the groups. However, the paretic group had damage to a larger number of areas within the motor system than the non-paretic group suggesting that such damage increases the probability of ipsilesional deficits in dynamic control for modulating torque amplitude after left hemisphere damage.

  10. High risk of cerebrospinal fluid leakage in surgery of a rare primary intraosseous cavernous hemangioma of the clivus showing meningeal infiltration: A case report and review of the literature

    PubMed Central

    Serrano, Lucas; Archavlis, Eleftherios; Januschek, Elke; Ulrich, Peter T.

    2015-01-01

    Background: Primary intraosseous cavernous hemangiomas (PICH) of the skull represent an infrequent bone tumor. Although some rare cases of PICHs located in the skull base have been published, to our concern only three cases have been reported in the English literature of PICHs arising within the clivus. Case Description: We present the case of a patient presenting an isolated abducens paresis due to a rare PICH of the clivus showing also an unusual destruction of the inner table as well as infiltration of the dura mater. Due to this uncommon infiltrative pattern of an otherwise expected intraosseous tumor, a cerebrospinal fluid (CSF)-fistula occurred while performing a transnasal biopsy. The patient recovered successfully without need of lumbar drainage or re-surgery. Additionally, intratumoral decompression was sufficient to relief the abducens paresis. Conclusions: Our case provides new and meaningful information about clinical features as well as growth pattern of these rare clival tumors. We also discuss the importance of knowing these peculiarities before surgery in order to plan the optimal operative management as well as to avoid complications while approaching PICHs localized in such a delicate cranial region. PMID:25949853

  11. Implementation, testing and pilot clinical evaluation of superelastic splints that decrease joint stiffness.

    PubMed

    Pittaccio, Simone; Garavaglia, L; Viscuso, S; Beretta, E; Strazzer, S

    2013-09-01

    The present work aims at demonstrating that a customised choice of shape memory alloy (SMA) composition, thermo-mechanical treatment and shaping can lead to effective rehabilitation devices applicable to sub-acute and chronic spastic paresis in paediatric patients. SMA pseudoelasticity is regarded as a means to implement a corrective action on posture without hindering residual voluntary or reflex mobility of the affected limb. Specific hinges containing NiTi or NiTiNb elements were designed and constructed to transfer pseudoelastic recovery force to fitted splints for the elbow or the ankle joint. The devices were mechanically tested and showed complete stability after 20-100 cycles, and unchanged characteristics after 1000 full-range deflections. Repositioning splints equipped with patient-specific pseudoelastic hinges were prescribed to 25 individuals (aged 7.75 ± 5.40 years) with mild to severe spastic tetraparesis. Clinical and instrumental evaluations were carried out during crossover trials with traditional and pseudoelastic splints. The sequence of treatment steps was randomized for each subject. The results show that, compared to fixed-angle braces, pseudoelastic devices decrease passive joint stiffness while providing the same control on limb posture. Dynamic pseudoelastic braces are therefore an innovative treatment for spastic paresis, which may reduce joint stiffness.

  12. Potential determinants of efficacy of mirror therapy in stroke patients – A pilot study

    PubMed Central

    Brunetti, Maddalena; Morkisch, Nadine; Fritzsch, Claire; Mehnert, Jan; Steinbrink, Jens; Niedeggen, Michael; Dohle, Christian

    2015-01-01

    Abstract Background: Mirror therapy (MT) was found to improve motor function after stroke. However, there is high variability between patients regarding motor recovery. Objectives: The following pilot study was designed to identify potential factors determining this variability between patients with severe upper limb paresis, receiving MT. Methods: Eleven sub-acute stroke patients with severe upper limb paresis participated, receiving in-patient rehabilitation. After a set of pre-assessments (including measurement of brain activity at the primary motor cortex and precuneus during the mirror illusion, using near-infrared spectroscopy as described previously), four weeks of MT were applied, followed by a set of post-assessments. Discriminant group analysis for MT responders and non-responders was performed. Results: Six out of eleven patients were defined as responders and five as non-responders on the basis of their functional motor improvement. The initial motor function and the activity shift in both precunei (mirror index) were found to discriminate significantly between responders and non-responders. Conclusions: In line with earlier results, initial motor function was confirmed as crucial determinant of motor recovery. Additionally, activity response to the mirror illusion in both precunei was found to be a candidate for determination of the efficacy of MT. PMID:26409402

  13. Bald Eagle Nestling Mortality Associated with Argas radiatus and Argas ricei Tick Infestation and Successful Management with Nest Removal in Arizona, USA.

    PubMed

    Justice-Allen, Anne; Orr, Kathy; Schuler, Krysten; McCarty, Kyle; Jacobson, Kenneth; Meteyer, Carol

    2016-10-01

    Eight Bald Eagle ( Haliaeetus leucocephalus ) nestlings heavily infested with larval ticks were found in or under a nest near the confluence of the Verde and Salt rivers in Arizona in 2009-11. The 8-12-wk-old nestlings were slow to respond to stimuli and exhibited generalized muscle weakness or paresis of the pelvic limbs. Numerous cutaneous and subcutaneous hemorrhages were associated with sites of tick attachment. Ticks were identified as Argas radiatus and Argas ricei. Treatment with acaricides and infection with West Nile virus (WNV) may have confounded the clinical presentation in 2009 and 2010. However, WNV-negative birds exhibited similar signs in 2011. One nestling recovered from paresis within 36 h after the removal of all adult and larval ticks (>350) and was released within 3 wk. The signs present in the heavily infested Bald Eagle nestlings resembled signs associated with tick paralysis, a neurotoxin-mediated paralytic syndrome described in mammals, reptiles, and wild birds (though not eagles). Removal of the infested nest and construction of a nest platform in a different tree was necessary to break the cycle of infection. The original nesting pair constructed a new nest on the man-made platform and successfully fledged two Bald Eagles in 2012.

  14. [A case of Cogan's syndrome associated with multiple cranial neuropathy].

    PubMed

    Yamamoto, K; Takase, Y; Nogaki, H; Fukusako, T; Morimatus, M

    1990-06-01

    A 52-year-old woman was admitted to our hospital because of disturbance of right visual acuity and double vision. At 38-year-old she became deaf bilaterally and experienced many vertigo attacks. She was diagnosed as Ménière disease. At 45-year-old vertigo attacks disappeared. At 47-year-old right peripheral facial nerve palsy developed transiently with interstitial keratitis and episcleritis of the both eyes. Oral adrenocorticosteroid therapy produced an improvement of interstitial keratitis and episcleritis. On admission, ophthalmological examination revealed bilateral interstitial keratitis and episcleritis, right retrobulbar optic neuritis and she was proven to have bilateral sensorineural deafness by otologist. Neurological examination revealed right abducens nerve paresis. Laboratory examinations revealed slightly increased erythrocyte sedimentation rate. CRP was positive. Serological tests for syphilis were negative. CSF showed mildly elevated protein level. Orbital CT scans revealed the swelling of right optic nerve. Cerebral MRI showed multiple high spotty areas in left thalamus, bilateral basal ganglia and deep white matter in T2 weighted images. After treatment with adrenocorticosteroid, right optic neuritis and abducens nerve paresis improved together with bilateral interstitial keratitis and episcleritis. Multiple cranial neuropathy may develop with Cogan's syndrome.

  15. Clinical practice guideline: Bell's Palsy executive summary.

    PubMed

    Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

    2013-11-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy.

  16. [A case of Lissauer form of paretic neurosyphilis with drop attacks and dementia].

    PubMed

    Syouzaki, Taisaku; Arahata, Sou; Araki, Eiichi; Furuya, Hirokazu; Fujii, Naoki

    2010-07-01

    A 52-year-old man was admitted to our hospital due to drop attack accompanied with progressive right hand's clumsiness and recent memory impairment. Neurological examination revealed postural involuntary movement of the right hand, and impaired finger fine movements. He showed mild mental deterioration with lower MMSE score. Toreponema Pallidum Latex immuno Assay (TPLA) titers in serum and cerebrospinal fluid (CSF) were remarkably elevated. MRI revealed cerebral atrophy in the left hemisphere. The 99mTc-ECD SPECT analysis showed reduced cerebral blood flow in the left hemisphere. EEG showed slow background activity in the left hemisphere. Drop attacks and involuntary movement were diminished by the administration of the valproate. We diagnosed this case as Lissauer's general paresis and treated with intravenous benzylpenicillin potassium 24 million units per day for 2 weeks. After this treatment, the titer of TPLA in the serum and CSF decreased. The clinical symptoms and signs, the score of MMSE, findings of SPECT and EEG also improved. Although Lissauer's general paresis is a rare form of neurosyphilis, it is important to distinguish this disease in case of progressive dementia and focal neurological signs. Early diagnosis and treatment are the only way to prevent irreversible neurological damage in this disease.

  17. Neurovascular complications due to the Hippocrates method for reducing anterior shoulder dislocations.

    PubMed

    Regauer, Markus; Polzer, Hans; Mutschler, Wolf

    2014-01-18

    In spite of the fact that the Hippocrates method hardly has been evaluated in a scientific manner and numerous associated iatrogenic complications have been reported, this method remains to be one of the most common techniques for reducing anterior shoulder dislocations. We report the case of a 69-year-old farmer under coumarin anticoagulant therapy who sustained acute first time anterior dislocation of his dominant right shoulder. By using the Hippocrates method with the patient under general anaesthesia, the brachial vein was injured and an increasing hematoma subsequently caused brachial plexus paresis by pressure. After surgery for decompression and vascular suturing, symptoms declined rapidly, but brachial plexus paresis still was not fully reversible after 3 mo of follow-up. The hazardousness of using the Hippocrates method can be explained by traction on the outstretched arm with force of the operator's body weight, direct trauma to the axillary region by the physician's heel, and the topographic relations of neurovascular structures and the dislocated humeral head. As there is a variety of alternative reduction techniques which have been evaluated scientifically and proofed to be safe, we strongly caution against the use of the Hippocrates method as a first line technique for reducing anterior shoulder dislocations, especially in elder patients with fragile vessels or under anticoagulant therapy, and recommend the scapular manipulation technique or the Milch technique, for example, as a first choice.

  18. Recurrent Laryngeal Edema Imitating Angioedema Caused by Dislocated Screw after Anterior Spine Surgery

    PubMed Central

    Wójtowicz, Piotr; Szafarowski, Tomasz; Migacz, Ewa; Krzeski, Antoni

    2015-01-01

    The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis. PMID:25755901

  19. Assessment of 3-nitropropionic acid-evoked peripheral neuropathy in rats: neuroprotective effects of acetyl-l-carnitine and resveratrol.

    PubMed

    Binienda, Zbigniew K; Beaudoin, Micheal A; Gough, Bobby; Ali, Syed F; Virmani, Ashraf

    2010-08-16

    Oxidative stress and secondary excitotoxicity, due to cellular energy deficit, are major factors playing roles in 3-nitropropionic acid (3-NPA) induced mitochondrial dysfunction. Acute or chronic exposure to 3-NPA also leads to neuronal degeneration in different brain regions. The present study quantitatively assessed peripheral neuropathy induced by chronic exposure to 3-NPA in rats. The neuroprotective abilities of two antioxidants, acetyl-l-carnitine and resveratrol, were investigated as well. Rats were exposed for up to four weeks to 3-NPA alone or 3-NPA combined with acetyl-l-carnitine or resveratrol, administered peripherally. The experimental outcome was evaluated by neurophysiological, histological, and morphometric analyses. Rats exposed to 3-NPA developed hind limb paresis. Furthermore, a significant decrease in motor nerve conduction velocity (MCV) was detected in tail nerves and axonal degeneration in sciatic nerves (p<0.05). Treatment with resveratrol prevented the functional effects of 3-NPA exposure, whereas treatment with acetyl-l-carnitine, preventing paresis, was not effective to MCV and morphological changes. These data suggest that resveratrol is a good candidate for treatment of metabolic neuropathy. The experimental outcome of this study shows that chronic treatment with 3-NPA in rats is relevant in development of an experimental model of toxic neuropathy.

  20. Somatotopic organization of the corticospinal tract in the human brainstem: a MRI-based mapping analysis.

    PubMed

    Marx, Juergen J; Iannetti, Gian D; Thömke, Frank; Fitzek, Sabine; Urban, Peter P; Stoeter, Peter; Cruccu, Giorgio; Dieterich, Marianne; Hopf, Hanns C

    2005-06-01

    To investigate the incompletely understood somatotopical organization of the corticospinal tract in the human brainstem, we performed a voxel-based statistical analysis of standardized magnetic resonance scans of 41 prospectively recruited patients with pyramidal tract dysfunction caused by acute brainstem infarction. Motor hemiparesis was rated clinically and by the investigation of motor evoked potentials to arms and legs. Infarction affected the pons in 85% of cases. We found the greatest level of significance of affected brainstem areas between the pontomesencephalic junction and the mid pons. Lesion location was significantly more dorsal in patients with hemiparesis affecting more proximal muscles and was significantly more ventral in patients with predominantly distal limb paresis. Comparison of magnetic resonance lesion from patients with paresis predominantly affecting arm or leg did not show significant topographical differences. We conclude that a topographical arm/leg distribution of corticospinal fibers is abruptly broken down as the descending corticospinal tract traverses the pons. Corticospinal fibers, however, follow a somatotopical order in the pons with fibers controlling proximal muscles being located close to the reticular formation in the dorsal pontine base, and thus more dorsal than the fibers controlling further distal muscle groups.

  1. Bald Eagle nestling mortality associated with Argas radiatus and Argas ricei tick infestation and successful management with nest removal in Arizona, USA

    USGS Publications Warehouse

    Justice-Allen, Anne; Orr, Kathy; Schuler, Krysten L.; McCarty, Kyle; Jacobson, Kenneth; Meteyer, Carol

    2016-01-01

    Eight Bald Eagle (Haliaeetus leucocephalus) nestlings heavily infested with larval ticks were found in or under a nest near the confluence of the Verde and Salt rivers in Arizona in 2009-11. The 8-12-wk-old nestlings were slow to respond to stimuli and exhibited generalized muscle weakness or paresis of the pelvic limbs. Numerous cutaneous and subcutaneous hemorrhages were associated with sites of tick attachment. Ticks were identified as Argas radiatus and Argas ricei. Treatment with acaricides and infection with West Nile virus (WNV) may have confounded the clinical presentation in 2009 and 2010. However, WNV-negative birds exhibited similar signs in 2011. One nestling recovered from paresis within 36 h after the removal of all adult and larval ticks (>350) and was released within 3 wk. The signs present in the heavily infested Bald Eagle nestlings resembled signs associated with tick paralysis, a neurotoxin-mediated paralytic syndrome described in mammals, reptiles, and wild birds (though not eagles). Removal of the infested nest and construction of a nest platform in a different tree was necessary to break the cycle of infection. The original nesting pair constructed a new nest on the man-made platform and successfully fledged two Bald Eagles in 2012.

  2. Localized diseases of the bovine brain and spinal cord.

    PubMed

    Sherman, D M

    1987-03-01

    Localized lesions of the central nervous system do occur in cattle. Those affecting the cranial nerves and focal lesions of the spinal cord are most easily recognized by careful neurologic examination. Once the lesion has been anatomically localized, likely etiologic causes can be pursued. Probably the most common cause of cranial nerve deficits in cattle is listeriosis. Important differential diagnoses include brain and pituitary abscesses and extensions of ear infections. Other possible causes include PEM, TEME, hypovitaminosis A, and several rare, sporadic causes. In young cattle, spinal trauma and vertebral body abscesses are the most common causes of progressive paresis resulting from spinal cord lesions. Congenital abnormalities must be considered in the differential diagnoses for very young calves. Non-neurologic conditions, including fractures of the limbs and especially nutritional muscular dystrophy, must be ruled out. In older cattle, compressive neoplasms, most notably lymphosarcoma, are primarily responsible for progressive paresis. Differential diagnosis should include other neurologic conditions such as delayed organophosphate neurotoxicity; early progressive diffuse neurologic diseases such as rabies, pseudorabies, and botulism; plant toxicities; and non-neurologic conditions resulting in recumbency, such as hypocalcemia and musculoskeletal trauma.

  3. The influence of functional electrical stimulation on hand motor recovery in stroke patients: a review.

    PubMed

    Quandt, Fanny; Hummel, Friedhelm C

    2014-01-01

    Neuromuscular stimulation has been used as one potential rehabilitative treatment option to restore motor function and improve recovery in patients with paresis. Especially stroke patients who often regain only limited hand function would greatly benefit from a therapy that enhances recovery and restores movement. Multiple studies investigated the effect of functional electrical stimulation on hand paresis, the results however are inconsistent. Here we review the current literature on functional electrical stimulation on hand motor recovery in stroke patients. We discuss the impact of different parameters such as stage after stoke, degree of impairment, spasticity and treatment protocols on the functional outcome. Importantly, we outline the results from recent studies investigating the cortical effects elicited by functional electrical stimulation giving insights into the underlying mechanisms responsible for long-term treatment effects. Bringing together the findings from present research it becomes clear that both, treatment outcomes as well as the neurophysiologic mechanisms causing functional recovery, vary depending on patient characteristics. In order to develop unified treatment guidelines it is essential to conduct homogenous studies assessing the impact of different parameters on rehabilitative success.

  4. Occam's razor in the management of ventriculoperitoneal shunt dysfunction: Diagnosis and management of an unusual pediatric case.

    PubMed

    Dadlani, Ravi; Dadlani, Reena; Ghosal, Nandita; Hegde, Alangar

    2015-01-01

    Ventriculoperitoneal (VP) shunt surgery is probably the commonest surgical procedure in neurosurgery. Belying its technical simplicity is the myriad complications associated with it. Shunt malfunction is a common complication associated with this surgery, second only to shunt related infections, which may be associated with it. Sterile cerebrospinal fluid (CSF) eosinophilia (CE) has been reported with VP shunts, which may or may not be related to the dysfunction. Eosinophilia in the CSF has also been associated with a number of other conditions including parasitic infestations in the brain. This may be unrelated to the shunt surgery. We present a case of a child, operated earlier for hydrocephalus, who presented with sub-acute loss of vision and bilateral oculomotor paresis. CSF from a chamber tap revealed eosinophilia. The commonest presenting symptom of shunt malfunction is raised intracranial pressure. There are no reports in the literature of VP shunt malfunction presenting with bilateral oculomotor paresis and decreased visual acuity. The associated CE complicated the clinical picture, especially since the initial brain radiology was normal. We discuss the clinical differential diagnosis of this very interesting presentation, management dilemmas and outcome in this child. This rare clinical presentation was found to be the result of a shunt malfunction and not due to any rare parasitic infestation of the brain. Occam's razor dictates that the simplest explanation in a given situation is usually the most accurate, as is seen in this case.

  5. Mirror therapy activates outside of cerebellum and ipsilateral M1.

    PubMed

    Shinoura, Nobusada; Suzuki, Yuichi; Watanabe, Yasuko; Yamada, Ryozi; Tabei, Yusuke; Saito, Kuniaki; Yagi, Kazuo

    2008-01-01

    Mirror therapy is effective in the rehabilitation of patients with hemiparesis, but its mechanism is not clear. In this study, a patient with brain tumor (patient 1) who underwent mirror therapy after surgery and showed drastic recovery of hand paresis, a patient with visual memory disturbance (patient 2), and five normal volunteers performed tasks related to mirror therapy in fMRI study. In patient 1 and all normal volunteers, right and left hand clenching with looking at a mirror (eye open) activated outside of cerebellum, while right and left hands clenching with eye closed activated inside of cerebellum. In patient 2, mirror therapy did not activate outside of cerebellum. In patient 1, and 3 out of 5 normal volunteers, the area of right (affected) M1 activated by right and left hands clenching with eye open was more than that by right and left hands clenching with eye closed, and that right M1 was activated by right hand clenching with eye open. In conclusion, mirror therapy facilitate the paresis of patients by activating ipsilateral M1 and outside of cerebellum, which is possibly related to visual memory function.

  6. Historic evidence to support a causal relationship between spirochetal infections and Alzheimer’s disease

    PubMed Central

    Miklossy, Judith

    2015-01-01

    Following previous observations a statistically significant association between various types of spirochetes and Alzheimer’s disease (AD) fulfilled Hill’s criteria in favor of a causal relationship. If spirochetal infections can indeed cause AD, the pathological and biological hallmarks of AD should also occur in syphilitic dementia. To answer this question, observations and illustrations on the detection of spirochetes in the atrophic form of general paresis, which is known to be associated with slowly progressive dementia, were reviewed and compared with the characteristic pathology of AD. Historic observations and illustrations published in the first half of the 20th Century indeed confirm that the pathological hallmarks, which define AD, are also present in syphilitic dementia. Cortical spirochetal colonies are made up by innumerable tightly spiraled Treponema pallidum spirochetes, which are morphologically indistinguishable from senile plaques, using conventional light microscopy. Local brain amyloidosis also occurs in general paresis and, as in AD, corresponds to amyloid beta. These historic observations enable us to conclude that chronic spirochetal infections can cause dementia and reproduce the defining hallmarks of AD. They represent further evidence in support a causal relationship between various spirochetal infections and AD. They also indicate that local invasion of the brain by these helically shaped bacteria reproduce the filamentous pathology characteristic of AD. Chronic infection by spirochetes, and co-infection with other bacteria and viruses should be included in our current view on the etiology of AD. Prompt action is needed as AD might be prevented. PMID:25932012

  7. Aneurysmal Bone Cyst of the Temporal Bone Presenting with Headache and Partial Facial Palsy

    PubMed Central

    Kletke, Stephanie N.; Popovic, Snezana; Algird, Almunder; Alobaid, Abdullah; Reddy, Kesava K. V.

    2015-01-01

    Background Aneurysmal bone cysts (ABCs) are benign bony lesions that rarely affect the skull base. Very few cases of temporal bone ABCs have been reported. We describe the first case of a temporal bone ABC that was thought to be consistent with a meningioma based on preoperative magnetic resonance imaging (MRI) findings. Clinical Presentation An otherwise healthy 23-year-old woman presented with a pulsatile noise in her left ear and a 4-week history of throbbing headache with nausea. There was no associated emesis, visual or auditory changes, or other neurologic features. Neurologic examination revealed a left lower motor neuron facial paresis. Computed tomography and MRI studies demonstrated a large lesion in the left middle cranial fossa skull base with erosion of the petrous temporal bone. Based on the presence of a “dural tail” on preoperative contrast-enhanced T1-weighted imaging, the lesion was interpreted to likely be consistent with a meningioma. An orbitozygomatic approach was utilized for surgical excision. Histopathologic evaluation was consistent with an ABC. Conclusion Postoperatively the patient had improvement in the lower motor neuron facial paresis. It is important to consider ABC in the differential diagnosis of intracranial lesions accompanied by the dural tail sign on MRI. PMID:26251800

  8. Acute paretic syndrome in juvenile White Leghorn chickens resembles late stages of acute inflammatory demyelinating polyneuropathies in humans

    PubMed Central

    2010-01-01

    Background Sudden limb paresis is a common problem in White Leghorn flocks, affecting about 1% of the chicken population before achievement of sexual maturity. Previously, a similar clinical syndrome has been reported as being caused by inflammatory demyelination of peripheral nerve fibres. Here, we investigated in detail the immunopathology of this paretic syndrome and its possible resemblance to human neuropathies. Methods Neurologically affected chickens and control animals from one single flock underwent clinical and neuropathological examination. Peripheral nervous system (PNS) alterations were characterised using standard morphological techniques, including nerve fibre teasing and transmission electron microscopy. Infiltrating cells were phenotyped immunohistologically and quantified by flow cytometry. The cytokine expression pattern was assessed by quantitative real-time PCR (qRT-PCR). These investigations were accomplished by MHC genotyping and a PCR screen for Marek's disease virus (MDV). Results Spontaneous paresis of White Leghorns is caused by cell-mediated, inflammatory demyelination affecting multiple cranial and spinal nerves and nerve roots with a proximodistal tapering. Clinical manifestation coincides with the employment of humoral immune mechanisms, enrolling plasma cell recruitment, deposition of myelin-bound IgG and antibody-dependent macrophageal myelin-stripping. Disease development was significantly linked to a 539 bp microsatellite in MHC locus LEI0258. An aetiological role for MDV was excluded. Conclusions The paretic phase of avian inflammatory demyelinating polyradiculoneuritis immunobiologically resembles the late-acute disease stages of human acute inflammatory demyelinating polyneuropathy, and is characterised by a Th1-to-Th2 shift. PMID:20109187

  9. [Neurology of hysteria (conversion disorder)].

    PubMed

    Sonoo, Masahiro

    2014-07-01

    Hysteria has served as an important driving force in the development of both neurology and psychiatry. Jean Martin Charcot's devotion to mesmerism for treating hysterical patients evoked the invention of psychoanalysis by Sigmund Freud. Meanwhile, Joseph Babinski took over the challenge to discriminate between organic and hysterical patients from Charcot and found Babinski's sign, the greatest milestone in modern neurological symptomatology. Nowadays, the usage of the term hysteria is avoided. However, new terms and new classifications are complicated and inconsistent between the two representative taxonomies, the DSM-IV and ICD-10. In the ICD-10, even the alternative term conversion disorder, which was becoming familiar to neurologists, has also disappeared as a group name. The diagnosis of hysteria remains important in clinical neurology. Extensive exclusive diagnoses and over investigation, including various imaging studies, should be avoided because they may prolong the disease course and fix their symptoms. Psychological reasons that seem to explain the conversion are not considered reliable. Positive neurological signs suggesting nonorganic etiologies are the most reliable measures for diagnosing hysteria, as Babinski first argued. Hysterical paresis has several characteristics, such as giving-way weakness or peculiar distributions of weakness. Signs to uncover nonorganic paresis utilizing synergy include Hoover's test and the Sonoo abductor test.

  10. The influence of NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke.

    PubMed

    Krukowska, Jolanta; Bugajski, Marcin; Sienkiewicz, Monika; Czernicki, Jan

    In stroke patients, the NDT - (Bobath - Neurodevelopmental Treatment) and PNF (Proprioceptive Neuromuscular Facilitation) methods are used to achieve the main objective of rehabilitation, which aims at the restoration of maximum patient independence in the shortest possible period of time (especially the balance of the body). The aim of the study is to evaluate the effect of the NDT-Bobath and PNF methods on the field support and total path length measure foot pressure (COP) in patients after stroke. The study included 72 patients aged from 20 to 69 years after ischemic stroke with Hemiparesis. The patients were divided into 4 groups by a simple randomization. The criteria for this division were: the body side (right or left) affected by paresis and the applied rehabilitation methods. All the patients were applied the recommended kinesitherapeutic method (randomized), 35 therapy sessions, every day for a period of six weeks. Before initiation of therapy and after 6 weeks was measured the total area of the support and path length (COP (Center Of Pressure) measure foot pressure) using stabilometer platform - alpha. The results were statistically analyzed. After treatment studied traits decreased in all groups. The greatest improvement was obtained in groups with NDT-Bobath therapy. NDT-Bobath method for improving the balance of the body is a more effective method of treatment in comparison with of the PNF method. In stroke patients, the effectiveness of NDT-Bobath method does not depend on hand paresis.

  11. Multifocal motor neuropathy: update on clinical characteristics, pathophysiological concepts and therapeutic options.

    PubMed

    Meuth, Sven G; Kleinschnitz, Christoph

    2010-01-01

    Multifocal motor neuropathy (MMN) is an acquired immune-mediated neuropathy characterized by chronic or stepwise progressive asymmetrical limb weakness without sensory deficits. The upper extremities are more often affected than the lower extremities with distal paresis dominating over proximal paresis. Important diagnostic features are persistent multifocal partial conduction blocks (CBs) and the presence of high-titer anti-GM1 serum antibodies. Motor neuron disease, other chronic dysimmune neuropathies, such as chronic inflammatory demyelinating polyneuropathy and the Lewis-Sumner syndrome (MADSAM neuropathy), are important differential diagnoses. While corticosteroids and plasma exchange are largely ineffective, high-dose intravenous immunoglobulins are regarded as first-line treatment. In spite of significant success in elucidating the underlying disease mechanisms in MMN during the past few years, important pathophysiological issues and the optimum long-term therapy remain to be clarified. The present review summarizes the clinical picture and current pathophysiological concepts of MMN with a special focus on the molecular and electrophysiological basis of CBs and highlights established therapies as well as possible novel treatment options.

  12. Associations between clinical outcome and navigated transcranial magnetic stimulation characteristics in patients with motor-eloquent brain lesions: a combined navigated transcranial magnetic stimulation-diffusion tensor imaging fiber tracking approach.

    PubMed

    Sollmann, Nico; Wildschuetz, Noémie; Kelm, Anna; Conway, Neal; Moser, Tobias; Bulubas, Lucia; Kirschke, Jan S; Meyer, Bernhard; Krieg, Sandro M

    2017-03-31

    OBJECTIVE Navigated transcranial magnetic stimulation (nTMS) and diffusion tensor imaging fiber tracking (DTI FT) based on nTMS data are increasingly used for preoperative planning and resection guidance in patients suffering from motor-eloquent brain tumors. The present study explores whether nTMS-based DTI FT can also be used for individual preoperative risk assessment regarding surgery-related motor impairment. METHODS Data derived from preoperative nTMS motor mapping and subsequent nTMS-based tractography in 86 patients were analyzed. All patients suffered from high-grade glioma (HGG), low-grade glioma (LGG), or intracranial metastasis (MET). In this context, nTMS-based DTI FT of the corticospinal tract (CST) was performed at a range of fractional anisotropy (FA) levels based on an individualized FA threshold ([FAT]; tracking with 50%, 75%, and 100% FAT), which was defined as the highest FA value allowing for visualization of fibers (100% FAT). Minimum lesion-to-CST distances were measured, and fiber numbers of the reconstructed CST were assessed. These data were then correlated with the preoperative, postoperative, and follow-up status of motor function and the resting motor threshold (rMT). RESULTS At certain FA levels, a statistically significant difference in lesion-to-CST distances was observed between patients with HGG who had no impairment and those who developed surgery-related transient or permanent motor deficits (75% FAT: p = 0.0149; 100% FAT: p = 0.0233). In this context, no patient with a lesion-to-CST distance ≥ 12 mm suffered from any new surgery-related permanent paresis (50% FAT and 75% FAT). Furthermore, comparatively strong negative correlations were observed between the rMT and lesion-to-CST distances of patients with surgery-related transient paresis (Spearman correlation coefficient [rs]; 50% FAT: rs = -0.8660; 75% FAT: rs = -0.8660) or surgery-related permanent paresis (50% FAT: rs = -0.7656; 75% FAT: rs = -0.6763). CONCLUSIONS This is

  13. Incidence estimate and guideline-oriented treatment for post-stroke spasticity: an analysis based on German statutory health insurance data

    PubMed Central

    Egen-Lappe, Veronika; Köster, Ingrid; Schubert, Ingrid

    2013-01-01

    Background Spasticity after stroke has been internationally recognized as an important health problem causing impairment of mobility, deformity, and pain. The aim of this study was to assess the frequency of first-ever and recurrent stroke and of subsequent spastic and flaccid paresis. Factors influencing the development of spasticity were analyzed. A further major aim was to provide a “real-life” assessment of the treatment of spasticity in Germany and to discuss this in view of the treatment recommended by German and international clinical guidelines. Methods The database used in this study comprised a cohort of 242,090 insurants from a large statutory health insurance fund in the federal state of Hesse, Germany. A first hospital discharge diagnosis in 2009 with any of the International Classification of Diseases, Tenth Revision (ICD-10) codes I60–I64 was used to identify patients with acute stroke (hemorrhage and ischemic). These patients were followed up six months after stroke to monitor whether they developed spastic or flaccid paresis (hospital or ambulatory care diagnoses ICD-10 code G81–G83 [excluding G82.6/G83.4/G83.8]). For patients with spastic paresis after stroke the spasticity treatment was analyzed for a six-month period (physiotherapy, oral muscle relaxants, intrathecal baclofen, and botulinum toxin). Results Standardized to the population of Germany, 3.7 per 1000 persons suffered a stroke in 2009 (raw 5.2/1000). Of all surviving patients, 10.2% developed spasticity within 6 months. Cox regression revealed no significant influence of patient age, gender, morbidity (diabetes, hypertensive diseases, ischemic heart diseases) or type of stroke on development of spasticity. 97% of surviving patients with spasticity received physiotherapy (inpatient care 89%, ambulatory care 48%). Oral muscle relaxants were prescribed to 13% of the patients. No patient received intrathecal baclofen or botulinum toxin. Conclusion Claims data enabled analysis of

  14. Randomised, controlled trial of squatting in the second stage of labour.

    PubMed

    Gardosi, J; Hutson, N; B-Lynch, C

    1989-07-08

    A new obstetric aid, the 'Birth Cushion' allows the parturient to sink into a supported squatting posture for the second stage of labour and delivery; it fits onto conventional delivery beds. A prospective, controlled trial of 427 primiparae compared the outcome of labour in women randomly allocated to squatting (218) or conventional semirecumbent (209) management. The squatting group had significantly fewer forceps deliveries (9% vs 16%) and significantly shorter second stages (median length of pushing 31 vs 45 min) than the semirecumbent group. There were fewer perineal tears, but more labial tears, in the squatting group. Apgar scores, blood loss, and post-partum vulvar oedema were similar in both groups. 82% of the women in the squatting group maintained upright positions for most of the second stage, and reported great satisfaction with the supported squatting position. The traditional birth posture of squatting can be easily adapted for modern labour management and has advantages for women in their first labour.

  15. Current Concepts of Immunology and Diagnosis in Amniotic Fluid Embolism

    PubMed Central

    Benson, Michael D.

    2012-01-01

    Amniotic fluid embolism (AFE) is one of the leading causes of maternal mortality and morbidity in developed countries. Current thinking about pathophysiology has shifted away from embolism toward a maternal immune response to the fetus. Two immunologic mechanisms have been studied to date. Anaphylaxis appears to be doubtful while the available evidence supports a role for complement activation. With the mechanism remaining to be elucidated, AFE remains a clinical diagnosis. It is diagnosed based on one or more of four key signs/symptoms: cardiovascular collapse, respiratory distress, coagulopathy, and/or coma/seizures. The only laboratory test that reliably supports the diagnosis is the finding of fetal material in the maternal pulmonary circulation at autopsy. Perhaps the most compelling mystery surrounding AFE is not why one in 20,000 parturients are afflicted, but rather how the vast majority of women can tolerate the foreign antigenic presence of their fetus both within their uterus and circulation? PMID:21969840

  16. Effects of bovine necrotic vulvovaginitis on productivity in a dairy herd in Israel.

    PubMed

    Blum, S; Mazuz, M; Brenner, J; Friedgut, O; Koren, O; Goshen, T; Elad, D

    2008-05-01

    Bovine necrotic vulvovaginitis (BNVV) is characterized by the development of a necrotic vulvovaginal lesion, almost exclusively in post-parturient first-lactation cows, associated with Porphyromonas levii. The scope of this survey was to evaluate the impact of BNVV on herd productivity as a means to rationally evaluate the resources that should be allocated in dealing with the syndrome. During an outbreak of BNVV in a dairy herd, following the introduction of a large number of cows from another farm, the impact of the animals' origin (local or transferred) and BNVV (positive or negative) upon involuntary culling rate, milk yield and days between pregnancies were assessed. The results indicated that the number of days between pregnancies was significantly higher in first-lactation cows with BNVV but was not influenced by the other independent variables. None of the other variables included in this survey had any effect on the involuntary culling rate and milk yield.

  17. Antibiotic Therapy for Chorioamnionitis to Reduce the Global Burden of Associated Disease

    PubMed Central

    Johnson, Clark T.; Adami, Rebecca R.; Farzin, Azadeh

    2017-01-01

    Chorioamnionitis is associated with significant maternal and neonatal morbidity and mortality throughout the world. In developed countries, great progress has been made to minimize the impact of chorioamnionitis, through timely diagnosis and appropriate treatment. In the global setting, where many women deliver outside the healthcare facilities, this diagnosis is frequently overlooked and not properly treated. In addition to its impact on maternal health, a significant proportion of neonatal morbidity and mortality can be prevented by both recognition and access to readily available treatment. With the increasing focus on saving the most vulnerable members of society, we echo the need for providing parturient women with suspected chorioamnionitis universal access to appropriate therapy. We describe known effective antibiotic therapies for chorioamnionitis and provide an overview of additional potential antimicrobial treatments that might be effectively implemented in areas with limited access to care. PMID:28352229

  18. Anaesthetic challenges and management during pregnancy: Strategies revisited

    PubMed Central

    Bajwa, Sukhminder Jit Singh; Bajwa, Sukhwinder Kaur

    2013-01-01

    During pregnancy, an obstetrician can encounter various complications and sometimes require surgery or operative intervention for delivery. However, the role of anaesthesiologists during such clinical scenario is grossly under-estimated. Without any close coordination and team work among obstetricians, neonatologists and an anaesthesiologist, morbidity and mortality can increase during these surgical interventions. The clinical scenario can become more challenging if the parturient suffers from any comorbid diseases. The present article reviews some of the common challenging scenarios during pregnancy that an anaesthesiologist frequently encounters during routine practice. Anaesthetic management has been discussed briefly and separately for each trimester and post-partum period. The article also aims at gaining in-depth knowledge of these obstetrical and surgical emergencies so as to ensure close-knit team work among obstetricians, anaesthesiologists, intensivists and a neonatologist. PMID:25885826

  19. [Maternal mortality and referral maternities in Morocco: how to (re)motivate professionals?].

    PubMed

    Péchevis, M; Fernandez, H; Cook, J; Bensalah, A; Aouraghe, M; Benbaha, A

    1999-06-01

    The very high rates of maternal mortality and perinatal mortality, as well as the deficiencies and dysfunctions observed in maternity hospitals, which play the role of referential maternity wards, led the Moroccan Minister of Public Health to implement a project in order to improve the quality of care of parturient women and new-borns. This project included 8 provinces in the country. The strategy chosen was "the team approach to resolving health problems", which is a learning process which leads local teams to implement and evaluate projects they have developed themselves. This pedagogical approach, which is carried out over a period of more than a year, proved itself to be very motivating and mobilising for the professionals included, despite the obstacles that were encountered. It also contributed to creating a true team spirit. Most activities planned within these projects were carried out and many indicators improved.

  20. Teaching neuraxial anesthesia techniques for obstetric care in a Ghanaian referral hospital: achievements and obstacles.

    PubMed

    Olufolabi, Adeyemi J; Atito-Narh, Evans; Eshun, Millicent; Ross, Vernon H; Muir, Holly A; Owen, Medge D

    2015-06-01

    Anesthesia providers in low-income countries may infrequently provide regional anesthesia techniques for obstetrics due to insufficient training and supplies, limited manpower, and a lack of perceived need. In 2007, Kybele, Inc. began a 5-year collaboration in Ghana to improve obstetric anesthesia services. A program was designed to teach spinal anesthesia for cesarean delivery and spinal labor analgesia at Ridge Regional Hospital, Accra, the second largest obstetric unit in Ghana. The use of spinal anesthesia for cesarean delivery increased significantly from 6% in 2006 to 89% in 2009. By 2012, >90% of cesarean deliveries were conducted with spinal anesthesia, despite a doubling of the number performed. A trial of spinal labor analgesia was assessed in a small cohort of parturients with minimal complications; however, protocol deviations were observed. Although subsequent efforts to provide spinal analgesia in the labor ward were hampered by anesthesia provider shortages, spinal anesthesia for cesarean delivery proved to be practical and sustainable.

  1. Intrathecal Opioid-Induced Hypothermia Following Subarachnoid Block With Morphine Injection for Elective Cesarean Delivery: A Case Report.

    PubMed

    Mach, John; Van Havel, Teresa; Gadwood, John; Biegner, M Andrew

    2016-02-01

    Opioids have been administered intrathecally with subarachnoid block for postoperative pain relief in parturients undergoing elective cesarean deliveries. This case report presents the uncommon occurrence of intrathecal opioid-induced hypothermia in the latent phase of recovery following elective cesarean delivery. There are few case reports on the occurrence of latent-phase postanesthesia care hypothermia in patients receiving subarachnoid block with morphine sulfate injection (Duramorph). Hypothermia can occur postoperatively for many reasons and can be life-threatening. In this case, hypothermia developed and progressed throughout the postoperative period. The causes of hypothermia were evaluated and treated without success initially. Thyroid dysfunction and alternative differential diagnoses were ruled out. Further assessment determined that the morphine injection might have been a contributing factor. Naloxone at 40-μg increments was administered intravenously and corrected the hypothermia. Awareness of hypothermia postoperatively with associated morphine administration through subarachnoid block must be ruled out in cases of progressing hypothermia.

  2. [In search of puerperal madness in Argentina].

    PubMed

    Vaschetto, Emilio

    2008-01-01

    The aim of this paper is to identify cases and scientific works about "puerperal madness" between 1850 and 1940 in Buenos Aires. The gradual installation of the device of maternities in the Argentina, and especially in the city of Buenos Aires, was not exempt from difficulties, in the medical boarding of the pregnant woman and parturient as well as in the cultural conception of the mothers. This fact presupposes an increase of the phenomenon called "puerperal madness" in the moment where the displacement of the act of giving birth in the house to the hospital takes place. Certainly, the clinical fact of the "puerperal madness" exceeds to the historical social context, and in this way appear all the psychopathologies related to the pregnancy, childbirth and the puerperal fevers. We also must take in account the influence of the medical speech about the feminine body and his translation to a scientific and institutional speech never before experienced in Argentina.

  3. [Women's complaint leadership in the Causa Kleinwächter. A contribution to patient history of the Innsbruck maternity hospital].

    PubMed

    Hilber, Marina

    On the basis of the Innsbruck Maternity Clinic this paper deals with the individual and collective worlds of experience of obstetric patients. However, not only the patient's view on the proceedings in this specific medical space is being reconstructed, also the prevailing conventions surrounding the treatment of pregnant, parturient and puerperal patients serving as clinical material in obstetric research and education are critically scrutinised. At the centre of this paper stands Dr. Ludwig Kleinwächter's period of duty, who acted as professor for obstetrics and gynaecology in Innsbruck between 1877 and 1881. During this period numerous conflicts regarding the treatment of patients are documented. Concerned about the good reputation of the Maternity Clinic, the Tyrolean State Committee, as the Clinic's provider, tried to solve the crisis. The existing letters of complaint and protocols do not only give a voice to the women concerned, but also to the medical professions as well as the local political representatives involved.

  4. The concentration of alpha-1-antichymotrypsin in blood serum of women in labour.

    PubMed

    Wasiluk, A; Dabrowska, M; Jaworski, S; Prokopowicz, J

    1999-01-01

    Concentration of alpha-1-antichymotrypsin (A-1-ACT) in blood serum of parturient women was determined. The investigation was conducted in 33 women bearing eutrophic newborns and 36 women bearing hypotrophic newborns. The control group consisted of 30 healthy non-pregnant women in reproductive age. Concentrations of A-1-ACT were determined using the radial immunodiffusion method according to Mancini et al. Maximal concentration of A-1-ACT determined in group I was three times higher than minimal concentration. Maximal concentration of A-1-ACT determined in group II was two times higher than minimal concentration. In the control group, the difference between minimal and maximal concentrations of A-1-ACT was inconsiderable. The lack of statistically significant differences between these three groups suggests that labour stress does not influence serum concentrations of this inhibitor. The importance of A-1-ACT in the placental tissue may be connected with immunological mechanisms that assure development and maintenance of pregnancy.

  5. New diagnosis myasthenia gravis and preeclampsia in late pregnancy.

    PubMed

    Ozcan, John; Balson, Ian Frank; Dennis, Alicia T

    2015-02-26

    Myasthenia gravis is a chronic autoimmune disease of neuromuscular transmission resulting in fatigable skeletal muscle weakness. Preeclampsia is a multisystem disease of pregnancy which is characterised by hypertension and involvement of one or more organ systems. Both diseases are responsible for considerable morbidity and mortality for mother and fetus. The occurrence of both preeclampsia and myasthenia gravis in pregnancy is very rare, and conflicts arise when considering the optimal management of each disease.We present a case of a parturient who was newly diagnosed with both myasthenia gravis and preeclampsia in late pregnancy. Myasthenia treatment was started with prednisolone and pyridostigmine, and delivery was by caesarean section at 37 weeks gestation under spinal anaesthesia. Postnatally, the patient developed worsening of myasthenia and preeclampsia symptoms. We consider the anaesthetic implications for both diseases and describe our approach for the management of this case.

  6. Alterations in physiology and anatomy during pregnancy.

    PubMed

    Tan, Eng Kien; Tan, Eng Loy

    2013-12-01

    Pregnant women undergo profound anatomical and physiological changes so that they can cope with the increased physical and metabolic demands of their pregnancies. The cardiovascular, respiratory, haematological, renal, gastrointestinal and endocrine systems all undergo important physiological alterations and adaptations needed to allow development of the fetus and to allow the mother and fetus to survive the demands of childbirth. Such alterations in anatomy and physiology may cause difficulties in interpreting signs, symptoms, and biochemical investigations, making the clinical assessment of a pregnant woman inevitably confusing but challenging. Understanding these changes is important for every practicing obstetrician, as the pathological deviations from the normal physiological alterations may not be clear-cut until an adverse outcome has resulted. Only with a sound knowledge of the physiology and anatomy changes can the care of an obstetric parturient be safely optimized for a better maternal and fetal outcome.

  7. CHALLENGES OF OBSTETRIC ANESTHESIA: DIFFICULT LARYNGEAL VISUALIZATION.

    PubMed

    Alanoğlu, Zekeriyya; Erkoç, Süheyla Karadağ; Güçlü, Çiğdem Yildirim; Meço, Başak Ceyda Orbey; Baytaş, Volkan; Can, Özlem Selvi; Alkiş, Neslihan

    2016-03-01

    Obstetric anesthesia is one of the high risk subspecialties of anesthesia practice. Anesthesia related complications are the sixth leading cause of maternal mortality. Difficult or failed intubation following induction of general anesthesia for CS remains the major contributory factor to anesthesia-related maternal complications. The airway management of obstetric patients is a challenging issue for several reasons. Anatomic and physiologic changes related to pregnancy may increase the difficult and failed intubation rates compared to the general surgical population. Proper evaluation of the airway anatomy and airway structures is vital to prevent airway management related catastrophes. In addition to basic airway and intubation equipment, each anesthesia department must have difficult intubation equipment cart including fiber optic laryngoscope, video laryngoscopes, and different types of laryngeal masks. It is essential that all anesthesiologists have a preconceived and well thought-out algorithm and emergency airway equipment to deal with airway emergencies during difficult or failed intubation of a parturient.

  8. Trichomonas vaginalis infection among young pregnant women in Brazil.

    PubMed

    Miranda, Angelica E; Pinto, Valdir M; Gaydos, Charlotte A

    2014-01-01

    Our goal was to determine the prevalence of Trichomonas vaginalis and its associated risk factors in parturient women aged 15-24 years attending Brazilian public maternity units. Participants answered a demographic, behavioral, and clinical data questionnaire. A sample of urine was screened for T. vaginalis. A total 299 women participated in this study. The prevalence rate of T. vaginalis was 7.7% (95% CI: 4.7-10.7%). The factors associated with T. vaginalis were use of illicit drugs [OR=4.70 (95% CI: 1.63-13.56, p=0.004)] and not attending antenatal care [OR=5.15 (95% CI: 1.15-23.25, p=0.032)]. These data demonstrate that it is important to discuss how to include routine screening for T. vaginalis during antenatal care in Brazil.

  9. [Jacuzzi-immersion for obstetric analgesia].

    PubMed

    Eldor, J; Burstein, M; Dudakova, I; Stark, M

    1992-12-15

    The effect of immersion in a jacuzzi in relieving labor pains, and on cervical dilatation was examined in 40 parturients. They were immersed in the jacuzzi during labor for an average of 25.5 minutes. Labor pains decreased during immersion by 2.59 degrees (scale of 0-10) compared with an average increase in labor pains of 0.25 degrees in 40 control women who were not immersed (p < 0.01). The cervical opening increased during immersion by an average of 1.5 cm in the test group, compared with 0.3 cm in the controls (p < 0.01). Immersion in a jacuzzi during labor is apparently associated with analgesia and accelerated cervical dilatation.

  10. [Effectiveness and tolerance of tramadol with or without an antiemetic and pethidine in obstetric analgesia].

    PubMed

    Kainz, C; Joura, E; Obwegeser, R; Plöckinger, B; Gruber, W

    1992-01-01

    The aim of this prospective, randomised, blind study was to investigate the analgesic potency and tolerance of intramuscular Tramadol compared to a standard obstetric analgesia with Pethidine. Triflupromazine was administrated in combination with the two tested analgesics in order to study its efficacy in alleviating the emetic side effects of the tested analgesics. 66 parturients were randomly assigned to three groups: group A: 100 mg Tramadol (Tramal), group B: 100 mg Tramadol (Tramal) and 10 mg Triflupromazine (Psyquil), group C: 50 mg Pethidine (Alodan) and 10 mg Triflupromazine (Psyquil). No significant differences concerning duration of labour, FHR-alterations, umbilical cord blood gases, respiration pattern and Apgar Scores of the neonate occurred. In all three groups the analgesic effect was equally good. Combination of the analgesic with the antiemetic showed no reduction of the incidence and severity of side effects.

  11. Treatment of Postpartum Hemorrhage With Blood Products in a Tertiary Hospital

    PubMed Central

    Gilsanz, Fernando

    2015-01-01

    Postpartum hemorrhage (PPH) remains a leading cause of maternal mortality and morbidity worldwide. This retrospective observational study describes patient characteristics and hemostatic therapies administered to 352 parturients experiencing PPH and analyzes risk factors for developing severe PPH. During the study period, bleeding was controlled in all cases and 99.4% survived. The majority (98%) of patients received packed red blood cells. The most frequent hemostatic therapies administered were fibrinogen concentrate (56%), fresh frozen plasma (49%), and platelets (30%). A total of 124 (35%) women experienced severe PPH. Significant independent predictors for evolution to severe PPH were age, obstetric comorbidity, and plasma fibrinogen concentration. The latter was based on records from 267 (76%) patients. Plasma fibrinogen concentration before labor was the only modifiable prepartum risk factor independently associated with severe PPH, indicating that fibrinogen monitoring is warranted in these patients. PMID:25712981

  12. Obstetric anaesthesia in low-resource settings.

    PubMed

    Dyer, Robert A; Reed, Anthony R; James, Michael F

    2010-06-01

    Close co-operation between obstetricians and obstetric anaesthesia providers is crucial for the safety and comfort of parturients, particularly in low-resource environments. Maternal and foetal mortality is unacceptably high, and the practice of obstetric anaesthesia has an important influence on outcome. Well-conducted national audits have identified the contributing factors to anaesthesia-related deaths. Spinal anaesthesia for caesarean section is the method of choice in the absence of contraindications, but is associated with significant morbidity and mortality. Minimum requirements for safe practice are adequate skills, anaesthesia monitors, disposables and drugs and relevant management protocols for each level of care. The importance of current outreach initiatives is emphasised, and educational resources and the available financial sources discussed. The difficulties of efficient procurement of equipment and drugs are outlined. Guiding principles for the practice of analgesia for labour, anaesthesia for caesarean section and the management of obstetric emergencies, where the anaesthetist also has a central role, are suggested.

  13. A short introduction to the new principle of binding ration calcium with sodium zeolite.

    PubMed

    Jørgensen, R J; Bjerrum, M J; Classen, H; Thilsing-Hansen, T

    2003-01-01

    This paper summarise the development of the new principle of preventing parturient hypocalcaemia by reducing the bioavailability of ration calcium with calcium binders, based on the idea that a negative calcium balance would stimulate natural defence mechanisms against threatening hypocalcaemia. Synthetic sodium zeolite was selected as a first choice among the many calcium binders available commercially, such as polyphosphates, citrate, EDTA and it derivatives. Testing was done on non-pregnant rumen fistulated cows in the first place, followed by cows in late lactation. Encouraged by the tendencies seen in these animals, the final proof of concept was done on pregnant dry cows fed a supplement of synthetic sodium zeolite A from 4 weeks before expected calving until calving. By analysis of blood calcium levels, this supplementation was shown to have a stabilizing effect during the critical period shortly after calving.

  14. [Humanized attention to parturition of adolescents: analysis of practices developed in an obstetric center].

    PubMed

    Busanello, Josefine; Kerber, Nalú Pereira da Costa; Mendoza-Sassi, Raúl Andrés; Mano, Patrícia de Souza; Susin, Lulie Rosane Odeh; Gonçalves, Bruna Goulart

    2011-01-01

    Quantitative study that aimed to analyze the practices developed in assisting the adolescent, from the account of health workers, in an Obstetric Center in a teaching hospital, based on the proposal of humanization of parturition of the Health Ministry. According to the workers, useful practices in assisting parturition, among them, orientations about relaxation techniques at parturition, improving the attachment between mother and child, are being carried out. However, the right to a companion has not been taken into account. The lithotomy position and standardization of trichotomy, episiotomy e amniotomy were registered. Medical records, among them partogram, anamnesis and physical and obstetric exam of the parturient, proved to the unsatisfactory. We conclude that, in the scenario investigated, are developed practices considered appropriate and inappropriate, showing the need to further encourage the use of procedures grounded in scientific evidence and inserted into the proposal to the humanization of birth.

  15. Epidural anesthesia for cesarean delivery facilitated by minimally invasive hemodynamic monitoring in a patient with Fontan repair: a case report.

    PubMed

    Wilhelm, Tyler

    2013-08-01

    With the advancement of medicine, surgery, and technology, along with the decline in mortality, anesthesia providers encounter patients with complex and rare conditions. One such example is the single ventricle congenital cardiac defect, which is corrected with Fontan reconstructive surgery. To care for patients who have undergone the Fontan procedure, the anesthesia provider needs an in-depth knowledge of the anatomy and physiology behind Fontan circulation. This article presents a brief overview of the anatomy and physiology of Fontan circulation. The case report describes a parturient who, approximately 2 decades earlier, had undergone a Fontan operation at the age of 4 years and recovered uneventfully. This article discusses the anesthetic management for the patient during cesarean delivery using epidural anesthesia, and the minimally invasive monitoring technology (Vigileo monitor, Edwards Lifesciences) to assist in monitoring the patient intraoperatively.

  16. [Emergency cesarean in a patient with Coffin-Siris syndrome].

    PubMed

    Fornet, I; Morillas, P; López, M A; Palacio, F J; Aguilar, J M; Mesa, J L

    2007-11-01

    Coffin-Siris syndrome is a rare genetic disease characterized by coarse facial features, sparse scalp hair, hirsutism, hypoplasia of the distal phalanges, hypoplastic nail in the fifth digit, and mental retardation and delayed growth evident in both weight and height. Most cases are sporadic, but the possibility of recessive or dominant autosomal inheritance has been suggested. Facial abnormalities that make intubation difficult and mental retardation that interferes with cooperation are aspects of this disease that can affect the choice of type of anesthesia. We report the case of a parturient with Coffin-Siris syndrome who refused epidural analgesia for labor pain and for whom the obstetrician later decided that an emergency cesarean was necessary due to fetal distress.

  17. [Two cases of congenital airway obstruction managed with ex utero intrapartum treatment procedures: anesthetic implications].

    PubMed

    Manrique, S; Blasco, J; Munar, F; Andreu, E; Mateo, M D; Suescun, M C; López Gil, M V

    2007-01-01

    An ex utero intrapartum treatment (EXIT) procedure provides sufficient time to gain control of the potentially obstructed fetal upper airway while uterine placental circulation is maintained during cesarean section. We report 2 cases in which fetal congenital upper airway obstruction was managed without complications during EXIT procedures. We also discuss general considerations concerning the obstetric patient and the performance of intramuscular fetal anesthesia. Before the hysterotomy, sevoflurane at 1.5 minimum alveolar concentration was administered to assure sufficient uterine relaxation during EXIT. The 2 parturients remained hemodynamically stable during the procedure and uterine and placental perfusion was adequate. Nasotracheal intubation was possible in 1 fetus after a cervical mass was dissected. In the other, a tracheostomy was created. After the umbilical cord was clamped, the concentration of sevoflurane anesthetic gas was reduced and oxytocin and methylergometrine were administered to induce adequate uterine contractions within a few minutes. Both neonates survived the EXIT procedure with no complications.

  18. Care of the migrant obstetric population.

    PubMed

    Hayes, I; Enohumah, K; McCaul, C

    2011-10-01

    Care of pregnant migrants is a considerable challenge for all health care workers and health systems. Maternal mortality and serious morbidity are both greatly increased among migrants in western countries, particularly in Africans and asylum seekers. While in many instances, migrants are healthier than native populations and have better perinatal outcomes, this is inconsistent and poorer outcomes are described in many groups. The causes of suboptimal outcomes are numerous and are strongly influenced by the health-seeking behaviour of the parturients. Accordingly, improvement in outcome requires a multifaceted approach with a focus on early access to antenatal services and enhanced medical screening and surveillance for detection and optimisation of comorbid conditions. Provision and/or acceptance of analgesia in labour have not been well researched but existing data are sufficient to suggest that some migrant groups do not receive equivalent pain relief during labour. Provision of information and translation services are important components in improvement of standards of care.

  19. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

    PubMed

    Fröhlich, S; Tan, T; Walsh, A; Carey, M

    2011-01-01

    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  20. Obstetric emergencies.

    PubMed

    Crochetière, Chantal

    2003-03-01

    Obstetric hemorrhage is still a significant cause of maternal morbidity and mortality. Prevention, early recognition, and prompt intervention are the keys to minimizing complications. Resuscitation can be inadequate because of under-estimation of blood loss and misleading maternal response. A young woman may maintain a normal blood pressure until sudden and catastrophic decompensation occurs. All members of the obstetric team should know how to manage hemorrhage because timing is of the essence. Good communication with the blood bank ensures timely release of appropriate blood products. A well-coordinated team is one of the most important elements in the care of a compromised fetus. If fetal anoxia is presumed, there is less than 10 minutes to permanent fetal brain damage. Antepartum anesthesia consultation should be encouraged in parturients with medical problems.

  1. Spontaneous Pneumomediastinum in Labor

    PubMed Central

    Benlamkadem, Said; Labib, Smael; Harandou, Mustapha

    2017-01-01

    Spontaneous pneumomediastinum and subcutaneous emphysema also known as Hamman's syndrome is a very rare complication of labor that is often related to the valsalva maneuver during the labor. In most case, Hamman's syndrome is a self-limiting condition, rarely complicated unless there are underlying respiratory diseases. Chest X-ray can be a useful early diagnostic technique in severe clinical presentation. We report an uneventful pregnancy in a primigravid parturient, which was complicated in the late second stage of labor by the development of subcutaneous emphysema, pneumomediastinum, and mild pneumothorax. Spontaneous recovery occurred after four days of conservative management. This condition shows the major interest of labor analgesia especially locoregional techniques. PMID:28316849

  2. Malariotherapy--insanity at the service of malariology.

    PubMed

    Snounou, Georges; Pérignon, Jean-Louis

    2013-01-01

    From the early 1920s until the advent of penicillin in the mid 1940s, a clinical course of malaria was the only effective treatment of general paresis, a common manifestation of tertiary syphilis that was nearly always fatal. For a number of reasons, Plasmodium vivax became the parasite species most often employed for what became known as malariotherapy. This provided an opportunity, probably unique in the annals of medicine, to observe and investigate the biology, immunology and clinical evolution of a dangerous human pathogen in its natural host. There is little doubt that the lessons learned from these studies influenced the malaria research and control agendas. It is equally true that over the last 40 years, the insights afforded by malariotherapy have remained largely undisturbed on the dusty shelves of institutional libraries. In this chapter, we broadly review the published data derived from malariotherapy, and discuss its relevance to current challenges of P. vivax epidemiology, immunology and pathology.

  3. Direct approach to the ventrolateral medulla for cavernous malformation--case report.

    PubMed

    Oshiro, Shinya; Yamamoto, Masaaki; Fukushima, Takeo

    2002-10-01

    A 49-year-old man presented with symptomatic cavernous malformation in the ventrolateral portion of the medulla oblongata manifesting as left-sided numbness and gait disturbance. Neurological examination disclosed sensory disturbance on the left, cerebellar ataxia, nystagmus, dysphagia, and right hypoglossal nerve paresis. Magnetic resonance imaging revealed a cavernous malformation with hemorrhage occupying the right paramedian field of the medulla oblongata. The patient underwent complete removal of the lesion through vertical incision of the bulging surface of the ventrolateral medulla, anatomically coinciding with the inferior olive. The neurological deficits improved without additional postoperative deficits. This unusual microsurgical approach through a ventrolateral medullary incision permits direct resection of a subpial intrinsic lesion, even on the ventral medulla.

  4. Sarcopenia or muscle modifications in neurologic diseases: a lexical or patophysiological difference?

    PubMed

    Carda, S; Cisari, C; Invernizzi, M

    2013-02-01

    Sarcopenia is a condition characterized by a decrease in muscle mass and function (strength and mobility) that is frequently observed in the elderly. In people with paresis and altered mobility due to central nervous system (CNS) diseases, this definition then may not be applicable. In CNS diseases, mainly stroke and spinal cord injury, different and specific patterns of muscle loss and muscle changes have been described, due to denervation, disuse atrophy, spasticity and myosteatosis. The main observations available about these phenomena in CNS diseases are reviewed, and a broad view on the specific physiopathological mechanisms is also described. Moreover, a description of the potential pharmacological targets and treatment strategies (physical and nutritional) is provided. Since sarcopenia of the elderly and muscle modifications and muscle atrophy in CNS diseases have different mechanisms, it is probable that they do not respond equally to the same treatments.

  5. Diplopia as an initial manifestation of disseminated non-hodgkin's lymphoma.

    PubMed

    Claeys, A; Trullemans, F; Maes, J; Hennekes, R; Salu, P

    2002-01-01

    A 37-year-old male presented a sudden diplopia. Ocular examination showed a partial paresis of the left eye (LE) on the left gaze, progressing in a few days towards a total ophthalmoplegia. Further investigation revealed an intra-orbital mass, immunohistologically diagnosed as a Diffuse Large B-cell Lymphoma (DLBCL), according to the WHO classification. Since the patient was in an advanced, disseminated stage of the disease (IVA-E), treatment was based on systemic and intrathecal chemotherapy with a pancranial radiotherapy. The clinical course was poor with only a 10-month survival. We wish to stress that the possibility of orbital malignancy in young adults with acute onset of ophthalmoplegia should be included in the differential diagnosis.

  6. Changes in Upper-Extremity Functional Capacity and Daily Performance During Outpatient Occupational Therapy for People With Stroke

    PubMed Central

    Doman, Caitlin A.; Waddell, Kimberly J.; Bailey, Ryan R.; Moore, Jennifer L.

    2016-01-01

    OBJECTIVE. This study explored how upper-extremity (UE) functional capacity and daily performance change during the course of outpatient rehabilitation in people with stroke. METHOD. Fifteen participants receiving outpatient occupational therapy services for UE paresis poststroke were enrolled. UE motor capacity was measured with the Action Research Arm Test (ARAT), and UE performance was measured using bilateral, wrist-worn accelerometers. Measurements were taken at or near the start of therapy, at every 10th visit or every 30 days throughout the duration of services, and at discharge. RESULTS. Three patterns were observed: (1) increase in ARAT scores and more normalized accelerometry profiles, (2) increase in ARAT scores but no change in accelerometry profiles, and (3) no change in ARAT scores or in accelerometry profiles. CONCLUSION. UE performance in daily life was highly variable, with inconsistencies between change in UE capacity and change in UE performance. UE capacity and performance are important constructs to assess separately during rehabilitation. PMID:27089298

  7. Spondylitis in broiler breeder farms in West-Azerbaijan province, Iran: Clinical Report.

    PubMed

    Talebi, Alireza; Taifebagherlu, Jafar; Sharifi, Arian; Delkhosh-Kasmaie, Fatemeh

    2016-01-01

    Spondylitis is a reemerging epidemic spinal infection in male broiler chickens (5 to 7 weeks of age) as well as broiler breeder roosters (15 to 18 weeks of age). Among various causative agents, Enterococcus species and in particular E. cecorum, a gram-positive bacterium as a gastrointestinal flora of birds, have mostly been isolated. On late September 2015, a number of 10 weeks old roosters with characteristic clinical signs of lameness and hock-sitting posture were autopsied. During thorough general routine post-mortem examinations, abnormalities like nodular masses correlated well with the hock-sitting posture and posterior paresis/paralysis were observed in joint spaces on the caudal thoracic vertebral column (T6-T7) immediately anterior to the kidneys in all affected birds. At histopathological examinations, osteomyelitis with limited pathological lesions including mononuclear inflammatory cells infiltration and edema in spinal cord were seen and the infection was diagnosed as an acute spondylosis.

  8. Disappearance of spasticity after selective dorsal rhizotomy does not prevent muscle shortening in children with cerebral palsy: a case report.

    PubMed

    Spijker, Margje; Strijers, Rob L M; van Ouwerkerk, Willem J R; Becher, Jules G

    2009-05-01

    Selective dorsal rhizotomy is an effective treatment for spasticity in children with cerebral palsy who have a spastic motor disorder. It is hypothesized that muscle shortening is related to spasticity; the lack of stretch of a muscle is thought to be the cause of muscle shortening. If this is true, the treatment for spasticity should prevent the occurrence of muscle shortening during growth. We present the case of 1 child with cerebral palsy and spastic diplegia, for whom the treatment with selective dorsal rhizotomy was successful in improving the walking abilities. She did, however, develop muscle shortening during growth. In conclusion, the development of muscle shortening during growth in children with cerebral palsy and spastic paresis cannot be prevented by treatment for the spasticity alone.

  9. Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)?

    PubMed Central

    Fernandes, Carina; Pereira, Pedro; Rodrigues, Miguel

    2015-01-01

    Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome. PMID:25750219

  10. [Clinical problems in medical mycology: Problem number 47].

    PubMed

    Corti, Marcelo; Muzzio, Estela; Villafañe, María Florencia; Priarone, María Marta; Messina, Fernando; Arechavala, Alicia; Maiolo, Elena; Negroni, Ricardo; Franze, Oscar

    2013-01-01

    A 66 year-old man, who had lived in Paraguay and was a rural worker, was admitted to Infectious Diseases Hospital F. J. Muñiz in Buenos Aires. He presented fever, loss of body weight, cough, mucopurulent expectoration, wide perianal ulceration, paresthesia and paresis of both legs as well as vesical and anal sphincter dysfunction. He was a heavy smoker and drinker. Thorax X-ray examination showed bilateral micronodular interstitial lesions. With a NMR of the dorsolumbar spine region a nodular lesion outside the spinal cord (which produced compression of this organ) was shown. The diagnosis of disseminated paracoccidiodomycosis was based on the finding of Paracoccidioides brasiliensis in the skin ulcer in histopathology and mycology studies, and on the positive results of serologic tests with paracoccidioidin antigen. The patient was treated with trimethoprim-sulfamethoxazole with good clinical outcome.

  11. Debilitating clinical disease in a wild-born captive western lowland gorilla (Gorilla gorilla gorilla) co-infected with varicella zoster virus (VZV) and simian T-lymphotropic virus (STLV).

    PubMed

    Masters, Nicholas; Niphuis, Henk; Verschoor, Ernst; Breuer, Judith; Quinlivan, Mark; Wawrzynczyk, Teresa; Stidworthy, Mark

    2010-12-01

    A wild-born, 34-yr-old female western lowland gorilla (Gorilla gorilla gorilla) was transferred between zoologic collections in the United Kingdom. Adjustment to its new environment was difficult and a series of health problems ensued. Progressive severe illness of multiple etiologies, and a failure to respond to multiple therapies, led to its euthanasia 5 mo later. Disease processes included severe thoracic and axillary cutaneous ulceration of T2-3 dermatome distribution, gastroenteritis, ulcerative stomatitis, emaciation, hind limb weakness or paresis, and decubitus ulcers of the ankles and elbows. Ante- and postmortem infectious disease screening revealed that this animal was not infected with Mycobacterium tuberculosis, simian varicella virus (SVV), simian immunodeficiency virus (SIV), or hepatitis B virus; but was infected with varicella-zoster virus (VZV) and simian T-lymphotropic virus (STLV). It is hypothesized that recrudescence of VZV and other disease processes described were associated with chronic STLV infection and the end of a characteristically long incubation period.

  12. Not all cases of nyctalopia are benign: Unusual and serendipitous presentation of Arnold–Chiari Type 1 malformation at a Pediatric Tertiary Care Center

    PubMed Central

    Patra, Kailash Chandra; Kirtane, Abhijeet Prakash

    2016-01-01

    The Arnold–Chiari Type 1 malformation (CM1) is a rare congenital abnormality characterized by ectopia or caudal herniation of the cerebellar tonsils through the foramen magnum into the cervical spine, resulting in crowding at the craniocervical junction. It seldom presents in childhood with symptoms and a normal neurological examination. More typically, CM1 presents in young adult women with neurological symptoms including a headache, cervical pain, cranial nerve palsies, neurosensory deficit, and ataxia. Ocular manifestations associated with Chiari I include third and sixth cranial nerve paresis and convergence/divergence abnormalities. Papilledema is a rare manifestation of Chiari I with a clinical presentation often similar to that of idiopathic intracranial hypertension. To underscore this noteworthy complication, the authors report a case of an 8-year-old boy who presented with nyctalopia and suboccipital headaches, but was diagnosed serendipitously as a case of papilledema due to Chiari I malformation. PMID:27857798

  13. Not all cases of nyctalopia are benign: Unusual and serendipitous presentation of Arnold-Chiari Type 1 malformation at a Pediatric Tertiary Care Center.

    PubMed

    Patra, Kailash Chandra; Kirtane, Abhijeet Prakash

    2016-01-01

    The Arnold-Chiari Type 1 malformation (CM1) is a rare congenital abnormality characterized by ectopia or caudal herniation of the cerebellar tonsils through the foramen magnum into the cervical spine, resulting in crowding at the craniocervical junction. It seldom presents in childhood with symptoms and a normal neurological examination. More typically, CM1 presents in young adult women with neurological symptoms including a headache, cervical pain, cranial nerve palsies, neurosensory deficit, and ataxia. Ocular manifestations associated with Chiari I include third and sixth cranial nerve paresis and convergence/divergence abnormalities. Papilledema is a rare manifestation of Chiari I with a clinical presentation often similar to that of idiopathic intracranial hypertension. To underscore this noteworthy complication, the authors report a case of an 8-year-old boy who presented with nyctalopia and suboccipital headaches, but was diagnosed serendipitously as a case of papilledema due to Chiari I malformation.

  14. Neurogenic cough.

    PubMed

    Altman, Kenneth W; Noordzij, J Pieter; Rosen, Clark A; Cohen, Seth; Sulica, Lucian

    2015-07-01

    We review contemporary concepts of the pathophysiology of neurogenic cough, and its evaluation and treatment based on scientific publications addressing neurogenic cough. Neurogenic cough is thought to be the result of sensory neuropathy, most commonly idiopathic. Because it is principally a sensory phenomenon, clinical evaluation is challenging, the diagnosis most often being made by exclusion. Identification of motor paresis, either by laryngoscopy or laryngeal electromyography, may suggest the presence of sensory neuropathy. The utility of amitriptyline and gabapentin has been demonstrated in randomized clinical trials, and retrospective series and case reports have suggested efficacy of pregabalin, baclofen, and botulinum toxin. Sensory neuropathy appears to be an important cause of chronic refractory cough, and appears amenable to treatment with a variety of pharmacologic agents.

  15. [Effects of steroid therapy on long-term canal prognosis and activity in the daily life of vestibular neuronitis patients].

    PubMed

    Kitahara, T; Okumura, S; Takeda, N; Nishiike, S; Uno, A; Fukushima, M; Kubo, T

    2001-11-01

    We studied 28 patients with vestibular neuronitis treated at our hospital between 1997 and 1999. To determine the effects of steroid therapy on long-term canal prognosis and daily activity, we examined caloric tests and gave questionnaires to 12 steroid-treated and 16 nonsteroid-treated patients 2 years after onset. We found that canal improvement was 50% in the nonsteroid-treated group and 75% in the steroid-treated one. In cases with severe canal paresis (CP > or = 60%), canal improvement was 33% in the nonsteroid-treated group and 67% in the steroid-treated one. Steroid therapy at the acute stage of this disease significantly reduced the duration of spontaneous nystagmus and handicap in daily life due to dizziness induced by head and body movement, decreasing mood disturbance.

  16. Genetic connections between neurological disorders and cholesterol metabolism

    PubMed Central

    Björkhem, Ingemar; Leoni, Valerio; Meaney, Steve

    2010-01-01

    Cholesterol is an essential component of both the peripheral and central nervous systems of mammals. Over the last decade, evidence has accumulated that disturbances in cholesterol metabolism are associated with the development of various neurological conditions. In addition to genetically defined defects in cholesterol synthesis, which will be covered in another review in this Thematic Series, defects in cholesterol metabolism (cerebrotendinous xanthomatosis) and intracellular transport (Niemann Pick Syndrome) lead to neurological disease. A subform of hereditary spastic paresis (type SPG5) and Huntington's disease are neurological diseases with mutations in genes that are of importance for cholesterol metabolism. Neurodegeneration is generally associated with disturbances in cholesterol metabolism, and presence of the E4 isoform of the cholesterol transporter apolipoprotein E as well as hypercholesterolemia are important risk factors for development of Alzheimer's disease. In the present review, we discuss the links between genetic disturbances in cholesterol metabolism and the above neurological disorders. PMID:20466796

  17. Transient paralysis of the bladder due to wound botulism.

    PubMed

    Sautter, T; Herzog, A; Hauri, D; Schurch, B

    2001-05-01

    In the last 10 years, wound botulism has increasingly been reported and nearly all of these new cases have occurred in injecting-drug abusers. After absorption into the bloodstream, botulinum toxin binds irreversibly to the presynaptic nerve endings, where it inhibits the release of acetylcholine. Diplopia, blurred vision, dysarthria, dysphagia, respiratory failure and paresis of the limbs are common symptoms of this intoxication. Surprisingly and despite the well-known blocking action of the botulinum toxin on the autonomic nerve system, little attention has been paid to changes in the lower urinary tract following acute botulinum toxin poisoning. Here we report a case of bladder paralysis following wound botulism. Early diagnosis and adequate management of bladder paralysis following botulism is mandatory to avoid urologic complications. Accordingly, the prognosis is usually favorable and the bladder recovery complete.

  18. Computed tomography-guided bone biopsies for evaluation of proliferative vertebral lesions in two boa constrictors (Boa constrictor imperator).

    PubMed

    Di Girolamo, Nicola; Selleri, Paolo; Nardini, Giordano; Corlazzoli, Daniele; Fonti, Paolo; Rossier, Christophe; Della Salda, Leonardo; Schilliger, Lionel; Vignoli, Massimo; Bongiovanni, Laura

    2014-12-01

    Two boa constrictors (Boa constrictor imperator) presented with paresis of the trunk originating cranial to the cloaca. Radiographs were consistent with proliferative bone lesions involving several vertebrae. Computed tomography (CT) demonstrated the presence of lytic/expansile lesions. Computed tomography-guided biopsies of the lesions were performed without complications. Histology was consistent with bacterial osteomyelitis and osteoarthritis. Gram-negative bacteria (Salmonella sp. and Pseudomonas sp.) were isolated from cultures of the biopsies. Medical treatment with specific antibiotics was attempted for several weeks in both cases without clinical or radiographic improvements. The animals were euthanized, and necropsy confirmed the findings observed upon CT. To the authors' knowledge, this is the first report of the use of CT-guided biopsies to evaluate proliferative vertebral lesions in snakes. In the present report, CT-guided biopsies were easily performed, and both histologic and microbiologic results were consistent with the final diagnosis.

  19. An autopsy case of sudden unexpected death due to a glial cyst of the pineal gland.

    PubMed

    Na, Joo-Young; Lee, Kyung-Hwa; Kim, Hyung-Seok; Park, Jong-Tae

    2014-09-01

    Pineal cysts are usually asymptomatic; however, they may rarely cause symptoms such as chronic headache, paroxysmal headache with gaze paresis, postural syncope, loss of consciousness, and sudden death. A 30-year-old woman with no specific medical history except chronic headache was found collapsed in a public toilet per se. Postmortem examination revealed no external injuries or internal diseases except a cystic lesion of the pineal gland. Histologic examination showed an internal cyst surrounded by glial tissues and pineal parenchyma that was diagnosed as a glial cyst of the pineal gland. Although the pineal cyst cannot be confirmed as the cause of death, it was considered, as no other cause was evident. Herein, we report a pineal cyst considered as an assumed cause of death.

  20. [Calcification of the cervical ligamentum flavum. Case report and review of the literature].

    PubMed

    Guesmi, H; Lamouchi, T; Mlaiki, A; Ksira, I; Tlili, K; Krifa, H

    2005-12-01

    Calcification of the cervical ligamentum flavum is a rare entity observed exclusively in Japanese people. We report a new case in a 65-year-old man from Tunisia who presented with symptoms of cervical myelopathy with mild tetra paresis, sensory abnormalities and dysuria. Magnetic resonance imaging (MRI) showed a posterior compression of the spinal cord at C3-C4. CT-scan showed a calcification of the ligamentum flavum at level C3-C4, compressing the left postero-lateral aspect of the spinal cord. C3-C4 laminectomy was performed with removal of abnormal ligamentum flavum tissue. The postoperative course was uneventful and all symptoms resolved. Calcification of the cervical ligamentum flavum is a rare entity; the diagnosis is easy but the pathogenesis remains unclear. Literature regarding this pathology is reviewed.

  1. Nonlinear dynamic mechanism of vocal tremor from voice analysis and model simulations

    PubMed Central

    Zhang, Yu; Jiang, Jack J.

    2009-01-01

    Nonlinear dynamic analysis and model simulations are used to study the nonlinear dynamic characteristics of vocal folds with vocal tremor, which can typically be characterized by low frequency modulation and aperiodicity. Tremor voices from patients with disorders such as paresis, Parkinson's disease, hyperfunction, and adductor spasmodic dysphonia show low-dimensional characteristics, differing from random noise. Correlation dimension analysis statistically distinguishes tremor voices from normal voices. Furthermore, a nonlinear tremor model is proposed to study the vibrations of the vocal folds with vocal tremor. Fractal dimensions and positive Lyapunov exponents demonstrate the evidence of chaos in the tremor model, where amplitude and frequency play important roles in governing vocal fold dynamics. Nonlinear dynamic voice analysis and vocal fold modeling may provide a useful set of tools for understanding the dynamic mechanism of vocal tremor in patients with laryngeal diseases. PMID:22505778

  2. Electrophysiologic nerve stimulation for identifying the recurrent laryngeal nerve in thyroid surgery: review of 70 consecutive thyroid surgeries.

    PubMed

    Echeverri, A; Flexon, P B

    1998-04-01

    To describe a simple technique for identifying the recurrent laryngeal nerve (RLN) with a nerve stimulator to prevent damage to the nerve during thyroid surgery. A retrospective review of 70 thyroidectomies performed from October 1989 to January 1995 by one surgeon using electrophysiologic nerve stimulation to identify the RLN was conducted. The technique is described. Outpatient flexible fiberoptic laryngoscopy was performed preoperatively and postoperatively in all patients. From 70 thyroidectomies, 80 RLNs were identified to be at risk for injury. Five patients had transient unilateral vocal cord paresis postoperatively. No RLN transection or permanent vocal cord paralysis occurred. This is the first large series of patients undergoing the use of electrophysiologic nerve stimulation for identifying the RLN during thyroid surgery. We found the technique to be useful and safe for identifying the RLN. We present this technique as a less costly and time-consuming alternative to intraoperative RLN monitoring.

  3. Gait apraxia after bilateral supplementary motor area lesion

    PubMed Central

    Della, S; Francescani, A; Spinnler, H

    2002-01-01

    Objectives: The study aimed at addressing the issue of the precise nature of gait apraxia and the cerebral dysfunction responsible for it. Methods: The case of a patient, affected by a bilateral infarction limited to a portion of the anterior cerebral artery territory is reported. The patient's ability to walk was formally assessed by means of a new standardised test. Results: Due to an anomaly within the anterior cerebral artery system, the patient's lesion was centred on the supplementary motor regions of both hemispheres. He presented with clear signs of gait apraxia that could not be accounted for by paresis or other neurological deficits. No signs of any other form of apraxia were detected. Conclusions: The clinical profile of the patient and the analysis of 49 cases from previous literature suggest that gait apraxia should be considered a clinical entity in its own right and lesions to the supplementary motor areas are responsible for it. PMID:11784830

  4. [Brachial plexus compression from supraclavicular encapsulated fat necrosis. A case report].

    PubMed

    Domínguez-Páez, Miguel; de Miguel-Pueyo, Luis; Marín-Salido, Esteban José; Carrasco-Brenes, Antonio; Martín-Gallego, Alvaro; Arráez-Sánchez, Miguel Ángel

    2014-01-01

    We report the case of a 44-year-old male, lacking clinical history of previous illness, who had surgery at our hospital to treat a mass in the supraclavicular space. The patient presented with a 1-month progressive distal paresis of the left arm. The histo-pathological examination of the mass revealed an encapsulated fat necrosis. Fat necrosis is characterised by cystic architecture, encapsulation with fat necrosis within, and inflammatory infiltration of its walls. Neural structure compression secondary to this tumour mass is very rare. Fat necrosis is more frequent in the lower limbs, in areas exposed to trauma. This article is the first report of brachial plexus compression due to supraclavicular fat necrosis.

  5. Evaluation of a physiotherapeutic treatment intervention in "Bell's" facial palsy.

    PubMed

    Cederwall, Elisabet; Olsén, Monika Fagevik; Hanner, Per; Fogdestam, Ingemar

    2006-01-01

    The aim of this study was to evaluate a physiotherapeutic treatment intervention in Bell's palsy. A consecutive series of nine patients with Bell's palsy participated in the study. The subjects were enrolled 4-21 weeks after the onset of facial paralysis. The study had a single subject experimental design with a baseline period of 2-6 weeks and a treatment period of 26-42 weeks. The patients were evaluated using a facial grading score, a paresis index and a written questionnaire created for this study. Every patient was taught to perform an exercise program twice daily, including movements of the muscles surrounding the mouth, nose, eyes and forehead. All the patients improved in terms of symmetry at rest, movement and function. In conclusion, patients with remaining symptoms of Bell's palsy appear to experience positive effects from a specific training program. A larger study, however, is needed to fully evaluate the treatment.

  6. Spondylitis in broiler breeder farms in West-Azerbaijan province, Iran: Clinical Report

    PubMed Central

    Talebi, Alireza; Taifebagherlu, Jafar; Sharifi, Arian; Delkhosh-Kasmaie, Fatemeh

    2016-01-01

    Spondylitis is a reemerging epidemic spinal infection in male broiler chickens (5 to 7 weeks of age) as well as broiler breeder roosters (15 to 18 weeks of age). Among various causative agents, Enterococcus species and in particular E. cecorum, a gram-positive bacterium as a gastrointestinal flora of birds, have mostly been isolated. On late September 2015, a number of 10 weeks old roosters with characteristic clinical signs of lameness and hock-sitting posture were autopsied. During thorough general routine post-mortem examinations, abnormalities like nodular masses correlated well with the hock-sitting posture and posterior paresis/paralysis were observed in joint spaces on the caudal thoracic vertebral column (T6-T7) immediately anterior to the kidneys in all affected birds. At histopathological examinations, osteomyelitis with limited pathological lesions including mononuclear inflammatory cells infiltration and edema in spinal cord were seen and the infection was diagnosed as an acute spondylosis. PMID:28144429

  7. A disease resembling inclusion body disease of boid snakes in captive palm vipers (Bothriechis marchi).

    PubMed

    Raymond, J T; Garner, M M; Nordhausen, R W; Jacobson, E R

    2001-01-01

    Between April 1998 and June 1999, 8 palm vipers (Bothriechis marchi) were diagnosed with a disease similar to inclusion body disease (IBD) of boids. Six palm vipers were captive bred, and 2 were wild caught. All of the vipers were adults at the time of death. Three palm vipers were found dead with no premonitory clinical signs, and 5 had anorexia plus possibly 1 of the following clinical signs: regurgitation, paresis, and dehydration. Histologically, all snakes had intracytoplasmic, round to oval, single to multiple eosinophilic inclusion bodies in hepatocytes and renal tubular epithelial cells. Inclusion bodies were distributed among other organs with varying frequency. Common concurrent histologic lesions were urate nephrosis, septic thrombi, and hepatocellular degeneration. Ultrastructurally, inclusions had features similar to inclusions in boid snakes with IBD.

  8. Robotic arm skate for stroke rehabilitation.

    PubMed

    Wong, Chee Kit; Jordan, Kimberlee; King, Marcus

    2011-01-01

    Upper limb paresis after stroke greatly affects the performance of Activities of Daily Living (ADL). Unfortunately, rehabilitation for upper limb impairment can have poor results. The current robot-assisted devices are expensive and not readily accessible for homecare. This paper presents the development of a low-cost tabletop robotic device for upper limb rehabilitation. Conceptually, patients perform computer-based goal-directed tasks using the robotic platform. Their progress is monitored and intervention, in the form of assistance or resistance, is introduced accordingly. A prototype platform is described. Experiments demonstrate the ability of the device to provide the necessary forces during movement exercises, in relation to task completion progress, device and target location. Appropriate exercises need to be developed before clinical trials can proceed.

  9. Epidemiology of venous thromboembolism

    PubMed Central

    Heit, John A.

    2015-01-01

    Thrombosis can affect any venous circulation. Venous thromboembolism (VTE) includes deep-vein thrombosis of the leg or pelvis, and its complication, pulmonary embolism. VTE is a fairly common disease, particularly in older age, and is associated with reduced survival, substantial health-care costs, and a high rate of recurrence. VTE is a complex (multifactorial) disease, involving interactions between acquired or inherited predispositions to thrombosis and various risk factors. Major risk factors for incident VTE include hospitalization for surgery or acute illness, active cancer, neurological disease with leg paresis, nursing-home confinement, trauma or fracture, superficial vein thrombosis, and—in women—pregnancy and puerperium, oral contraception, and hormone therapy. Although independent risk factors for incident VTE and predictors of VTE recurrence have been identified, and effective primary and secondary prophylaxis is available, the occurrence of VTE seems to be fairly constant, or even increasing. PMID:26076949

  10. Naturally occurring Parelaphostrongylus tenuis-associated choriomeningitis in a guinea pig with neurologic signs.

    PubMed

    Southard, T; Bender, H; Wade, S E; Grunenwald, C; Gerhold, R W

    2013-05-01

    An adult male guinea pig (Cavia porcellus) with a 1-month history of hind limb paresis, torticollis, and seizures was euthanized and submitted for necropsy. Gross examination was unremarkable, but histologic examination revealed multifocal eosinophilic and lymphoplasmacytic choriomeningitis and cross sections of nematode parasites within the leptomeninges of the midbrain and diencephalon. Morphologic features of the nematode were consistent with a metastrongyle, and the parasite was identified as Parelaphostrongylus tenuis by polymerase chain reaction testing and nucleotide sequencing. Further questioning of the owner revealed that the guinea pig was fed grass from a yard often grazed by white-tailed deer (Odocoileus virginianus). To the authors' knowledge, this is the first report of a naturally occurring P. tenuis infection in a guinea pig.

  11. The Variegate Neurological Manifestations of Varicella Zoster Virus Infection

    PubMed Central

    Nagel, Maria A.; Cohrs, Randall J.; Mahalingam, Ravi

    2014-01-01

    Varicella zoster virus (VZV) is an exclusively human neurotropic alphaherpesvirus. Primary infection causes varicella (chickenpox), after which the virus becomes latent in ganglionic neurons along the entire neuraxis. With advancing age or immunosuppression, cell-mediated immunity to VZV declines, and the virus reactivates to cause zoster (shingles), dermatomal distribution, pain, and rash. Zoster is often followed by chronic pain (postherpetic neuralgia), cranial nerve palsies, zoster paresis, vasculopathy, meningoencephalitis, and multiple ocular disorders. This review covers clinical, laboratory, and pathological features of neurological complications of VZV reactivation, including diagnostic testing to verify active VZV infection in the nervous system. Additional perspectives are provided by discussions of VZV latency, animal models to study varicella pathogenesis and immunity, and of the value of vaccination of elderly individuals to boost cell-mediated immunity to VZV and prevent VZV reactivation. PMID:23884722

  12. Painful Spastic Hip Dislocation: Proximal Femoral Resection

    PubMed Central

    Albiñana, Javier; Gonzalez-Moran, Gaspar

    2002-01-01

    The dislocated hip in a non-ambulatory child with spastic paresis tends to be a painful interference to sleep, sitting upright, and perineal care. Proximal femoral resection-interposition arthroplasty is one method of treatment for this condition. We reviewed eight hips, two bilateral cases, with a mean follow-up of 30 months. Clinical improvement was observed in all except one case, with respect to pain relief and sitting tolerance. Some proximal migration was observed in three cases, despite routine post-operative skeletal traction in all cases and careful soft tissue interposition. One case showed significant heterotopic ossification which restricted prolonged sitting. This patient needed some occasional medication for pain. PMID:12180614

  13. Administration of recombinant human granulocyte colony-stimulating factor (rhG-CSF) for the intracranial hemorrhage in two dogs: a case report

    PubMed Central

    Kang, M. H.; Park, H. M.

    2016-01-01

    Two dogs with generalized seizures were evaluated. The dogs were diagnosed with traumatic intracranial hemorrhages based on the history, neurological examinations, and magnetic resonance imaging (MRI) of the brain. Treatment was started with oxygen, prednisolone and anticonvulsant agents. No further seizure activity was observed after treatment in both dogs, however cushing reflex was detected in case 1 and a left-sided hemi-paresis was detected in case 2. Further supportive treatment with recombinant human granulocyte colony-stimulating factor (rhG-CSF) was attempted. No abnormal signs were noted in either of the dogs and no recurrence was noted 16 and 14 months later, in case 1 and 2, respectively. These cases indicate that a combination of rhG-CSF treatment with previous therapy could be used in dogs with traumatic brain injury. PMID:27656233

  14. Lumbosacral intervertebral disk disease in six cats.

    PubMed

    Harris, Jennipher E; Dhupa, Sarit

    2008-01-01

    Medical records of six cats diagnosed with lumbosacral intervertebral disk disease were reviewed. Clinical signs included reluctance to jump, low tail carriage, elimination outside the litter box, reluctance to ambulate, pelvic-limb paresis, urinary incontinence, and constipation. All cats had lumbosacral hyperpathia on palpation. Computed tomography in four cats revealed evidence of extradural spinal cord compression at the seventh lumbar (L(7)) to first sacral (S(1)) vertebral interspace. Compression was confirmed via myelography in three of these four cats, with confirmation in the fourth cat at the time of decompressive laminectomy. Each of the six cats underwent dorsal decompressive laminectomy at the L(7) to S(1) interspace. Postoperative clinical follow-up lasted 3 to 35 months, with most cats having excellent outcomes.

  15. [Differential diagnostics of diseases of the brachial plexus].

    PubMed

    Ritter, C; Wunderlich, G; Macht, S; Schroeter, M; Fink, G R; Lehmann, H C

    2014-02-01

    Progressive, atrophic, asymmetrically distributed flaccid paresis of arm and hand muscles represents a frequent symptom of neuromuscular diseases that can be attributed to injury of the arm nerves, the plexus or the cervical roots. A timely and exact diagnosis is mandatory; however, the broad spectrum of differential diagnoses often represents a diagnostic challenge. A large variety of neuromuscular disorders need to be considered, encompassing autoimmune mediated inflammatory neuropathic conditions, such as multifocal motor neuropathy, as well as chronic degenerative and nerve compression disorders. This review provides an overview of the most frequent disorders of the upper plexus and cervical roots and summarizes the characteristic clinical features as well as electrodiagnostic and laboratory test results. In addition the diagnostic value of magnetic resonance imaging and sonography is discussed.

  16. Sarcocystis neurona encephalitis in a dog.

    PubMed

    Cooley, A J; Barr, B; Rejmanek, D

    2007-11-01

    A 1.5-year-old male Feist dog was presented to a veterinarian for reluctance to stand on the hind legs. Treatment included dexamethasone and resulted in a favorable initial response, but posterior paresis returned and progressed to recumbency, hyperesthesia, and attempts to bite the owner. The dog was euthanized. The brain was negative for rabies by fluorescent antibody analysis. Multiple foci of encephalitis were found in the cerebrum and particularly in the cerebellum. Protozoa morphologically consistent with Sarcocystis sp. were identified at sites of intense inflammation and malacia. Additionally, multiple schizonts were identified in areas without inflammation. Immunohistochemistry using both polyclonal and monoclonal antibodies specific for Sarcocystis neurona was strongly positive. No reaction to polyclonal antisera for Toxoplasma gondii or Neospora caninum was found. Polymerase chain reaction confirmed that the protozoa were S. neurona. Additional aberrant hosts for S. neurona other than horses have been identified, but S. neurona encephalitis has not been documented previously in the dog.

  17. Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome.

    PubMed

    Carvalho, Sandrina; Sanches, Madalena; Alves, Rosário; Selores, Manuela

    2015-01-01

    Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-year old woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900 mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries.

  18. Brachioradial pruritus in a patient with cervical disc herniation and Parsonage-Turner syndrome*

    PubMed Central

    Carvalho, Sandrina; Sanches, Madalena; Alves, Rosário; Selores, Manuela

    2015-01-01

    Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-yearold woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries. PMID:26131874

  19. Nonlinear dynamic mechanism of vocal tremor from voice analysis and model simulations

    NASA Astrophysics Data System (ADS)

    Zhang, Yu; Jiang, Jack J.

    2008-09-01

    Nonlinear dynamic analysis and model simulations are used to study the nonlinear dynamic characteristics of vocal folds with vocal tremor, which can typically be characterized by low-frequency modulation and aperiodicity. Tremor voices from patients with disorders such as paresis, Parkinson's disease, hyperfunction, and adductor spasmodic dysphonia show low-dimensional characteristics, differing from random noise. Correlation dimension analysis statistically distinguishes tremor voices from normal voices. Furthermore, a nonlinear tremor model is proposed to study the vibrations of the vocal folds with vocal tremor. Fractal dimensions and positive Lyapunov exponents demonstrate the evidence of chaos in the tremor model, where amplitude and frequency play important roles in governing vocal fold dynamics. Nonlinear dynamic voice analysis and vocal fold modeling may provide a useful set of tools for understanding the dynamic mechanism of vocal tremor in patients with laryngeal diseases.

  20. Respiratory Management in the Patient with Spinal Cord Injury

    PubMed Central

    Galeiras Vázquez, Rita; Rascado Sedes, Pedro; Montoto Marqués, Antonio; Ferreiro Velasco, M. Elena

    2013-01-01

    Spinal cord injuries (SCIs) often lead to impairment of the respiratory system and, consequently, restrictive respiratory changes. Paresis or paralysis of the respiratory muscles can lead to respiratory insufficiency, which is dependent on the level and completeness of the injury. Respiratory complications include hypoventilation, a reduction in surfactant production, mucus plugging, atelectasis, and pneumonia. Vital capacity (VC) is an indicator of overall pulmonary function; patients with severely impaired VC may require assisted ventilation. It is best to proceed with intubation under controlled circumstances rather than waiting until the condition becomes an emergency. Mechanical ventilation can adversely affect the structure and function of the diaphragm. Early tracheostomy following short orotracheal intubation is probably beneficial in selected patients. Weaning should start as soon as possible, and the best modality is progressive ventilator-free breathing (PVFB). Appropriate candidates can sometimes be freed from mechanical ventilation by electrical stimulation. Respiratory muscle training regimens may improve patients' inspiratory function following a SCI. PMID:24089664

  1. [Herpes zoster and postherpetic neuralgia].

    PubMed

    Wollina, U; Machetanz, J

    2016-08-01

    Herpes zoster develops by endogenous reactivation of varizella zoster virus (VZV). Incidence increases with age. Females are more frequently affected than males. The reactivation rate in seropositive individuals is about 20 %. After a short prodromal stage, herpetiform-grouped vesicles appear in segmental arrangement. Pain and paresthesia are typical zoster symptoms. Complications like bacterial superinfections, vasculopathy, paresis, and oculopathy may occur. During pregnancy herpes zoster is a threat for mother and child. Among elderly patients, cardiovascular risk is increased during the first week of herpes zoster infection. Postherpetic neuropathy is feared. Diagnosis can be made clinically and by the use of polymerase chain reaction. First-line treatment is systemic antiviral drug therapy with either acyclovir or brivudine. Adjuvant therapies consist of pain management and topical treatment.

  2. Idiopathic acute onset myelopathy in cheetah (Acinonyx jubatus) cubs.

    PubMed

    Walzer, Christian; Url, Angelika; Robert, Nadia; Kübber-Heiss, Anna; Nowotny, Norbert; Schmidt, Peter

    2003-03-01

    Numerous cases of ataxia, hind limb paresis, and paralysis have occurred in cheetah (Acinonyx jubatus) cubs over the past 10 yr within the European Endangered Species Program population, including 12 in mainland Europe, two in the British Isles, one in Namibia, and one in Dubai. The condition is the most important medical factor limiting European cheetah population growth. Eight cubs at the Salzburg Zoo, Austria, were affected. They demonstrated upper motor neuron lesions when alive and bilateral, symmetrical myelin degeneration of the spinal cord on necropsy. Ballooning of myelin sheaths surrounded mostly preserved axons, and no spheroids, characteristic of acute axonal degeneration, were found. Myelin loss markedly exceeded axonal degeneration. The syndrome's etiology is unclear, although viral, bacterial, parasitic, genetic, nutritional-metabolic, toxic, and physical causes have been considered.

  3. Immunohistochemical screening for viral agents in cheetahs (Acinonyx jubatus) with myelopathy.

    PubMed

    Shibly, S; Schmidt, P; Robert, N; Walzer, C; Url, A

    2006-10-21

    Numerous cases of acute-onset progressive ataxia, hindlimb paresis and paralysis of unknown aetiology occurred during 1993 to 2003 in cheetahs (Acinonyx jubatus) within the European Endangered Species Programme (eep). This study describes the immunohistochemical investigation of a possible viral aetiology of the "cheetah myelopathy". Antibodies to feline herpesvirus type 1, canine distemper virus, canine parvovirus and Borna disease virus were applied to formalin-fixed and paraffin-embedded brain and spinal cord sections from 25 affected cheetahs aged between three-and-a-half months and 13 years. Using the avidin-biotin complex technique, none of the antibodies gave positive immunosignals in either the brain or the spinal cord tissue.

  4. A woman with forearm amyotrophy

    PubMed Central

    Sagui, Emmanuel; Correa, Éléonore; Ricobono, Diane; Bregigeon, Michel; Brosset, Christian

    2009-01-01

    We present the case of a 33-year-old woman with benign sporadic monomelic amyotrophy of the distal part of the arm, called Hirayama disease. Clinical features included forearm amyotrophy sparing the brachioradialis muscle, cold paresis and causalgia. Neck magnetic resonance imaging was normal in neutral and flexion position. Electromyography showed denervated patterns in the extensor digitorum communis, and conduction studies ruled out multifocal motor neuropathy. Motor evoked potentials were normal. Serum IgG anti-GM1 antibodies were moderately raised but were negative 8 months later. Outcome was favourable within 15 months, with partial motor recovery. Pathogenesis remains controversial: neck flexion induced myelopathy via chronic anterior horn ischaemia due to forward displacement of the posterior wall of the dura mater, or benign variant of lower motor neuron disease? Whatever the pathomechanism is, the clinical features and outcome are the same. PMID:22171230

  5. A woman with forearm amyotrophy.

    PubMed

    Sagui, Emmanuel; Correa, Eléonore; Ricobono, Diane; Bregigeon, Michel; Brosset, Christian

    2009-01-01

    We present the case of a 33-year-old woman with benign sporadic monomelic amyotrophy of the distal part of the arm, called Hirayama disease. Clinical features included forearm amyotrophy sparing the brachioradialis muscle, cold paresis and causalgia. Neck magnetic resonance imaging was normal in neutral and flexion position. Electromyography showed denervated patterns in the extensor digitorum communis, and conduction studies ruled out multifocal motor neuropathy. Motor evoked potentials were normal. Serum IgG anti-GM1 antibodies were moderately raised but were negative 8 months later. Outcome was favourable within 15 months, with partial motor recovery. Pathogenesis remains controversial: neck flexion induced myelopathy via chronic anterior horn ischaemia due to forward displacement of the posterior wall of the dura mater, or benign variant of lower motor neuron disease? Whatever the pathomechanism is, the clinical features and outcome are the same.

  6. Does C5 or C6 Radiculopathy Affect the Signal Intensity of the Brachial Plexus on Magnetic Resonance Neurography?

    PubMed Central

    Seo, Tae Gyu; Kim, In-Soo; Son, Eun Seok

    2016-01-01

    Patients with C5 or C6 radiculopathy complain of shoulder area pain or shoulder girdle weakness. Typical idiopathic neuralgic amyotrophy (INA) is also characterized by severe shoulder pain, followed by paresis of shoulder girdle muscles. Recent studies have demonstrated that magnetic resonance neurography (MRN) of the brachial plexus and magnetic resonance imaging (MRI) of the shoulder in patients with INA show high signal intensity (HSI) or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle. We evaluated the value of brachial plexus MRN and shoulder MRI in four patients with typical C5 or C6 radiculopathy. HSI of the brachial plexus was noted in all patients and intramuscular changes were observed in two patients who had symptoms over 4 weeks. Our results suggest that HSI or thickening of the brachial plexus and changes in intramuscular denervation of the shoulder girdle on MRN and MRI may not be specific for INA. PMID:27152289

  7. The 10th Bielschowsky Lecture. Changes in strabismus over time: the roles of vergence tonus and muscle length adaptation.

    PubMed

    Guyton, David L

    2006-01-01

    Patients with long-standing unilateral strabismus, such as "sensory" exotropia in the absence of fusion, or esotropia with unilateral amblyopia, typically show bilateral deviations under anesthesia, often symmetric. Forced ductions usually show symmetric muscle tightness. Changes in extraocular muscle lengths thus appear to occur primarily bilaterally, whether fusion is present or not. With skeletal muscles responding to changes in stimulation by the gain or loss of sarcomeres, it is likely that abnormal or unguided vergence tonus, which changes the lengths of the extraocular muscles bilaterally, is largely responsible for changes in the angle of strabismus over time. This mechanism helps explain the development of [1] increasing "basic" deviations in accommodative esotropia; [2] torsional deviations with apparent oblique muscle "overaction/underaction" and A and V patterns; [3] recurrent esotropia with early presbyopia; [4] occasional divergence insufficiency in presbyopes; and [5] basic cyclovertical deviations that mimic superior oblique muscle paresis.

  8. [A case of medial medullary infarction with persistent primitive hypoglossal artery].

    PubMed

    Jin, Kazutaka; Aihara, Naoto; Tsukamoto, Tetsuro

    2002-04-01

    A 66-year-old woman was admitted to our hospital because of vomiting, dizziness and vertigo. Neurological examination on admission revealed only upbeat nystagmus without cranial nerve symptoms, paresis, cerebellar signs or sensory disturbances. Magnetic resonance(MR) images demonstrated a new T 2 high intensity and T 1 iso-intensity signal lesion in the right upper medial medulla. This medial medullary infarction caused central vestibular dysfunction. MR angiography and digital subtraction angiography demonstrated a persistent primitive hypoglossal artery (PPHA) originating from the right internal carotid artery to the vertebrobasilar artery associated with the stenosis of the right internal carotid artery at the level of the cervical bifurcation. This is the first report of medullary infarction with persistent carotid-basilar anastomosis. We suspected this medullary infarction was caused by artery to artery embolism in the branch of the right vertebral artery through the PPHA distal originated from the stenosis of the right internal carotid artery.

  9. Myobiofeedback in motor reeducation of wrist and fingers after hemispherial stroke.

    PubMed

    Rathkolb, O; Baykoushev, S; Baykousheva, V

    1990-01-01

    32 patients with different grade of hemiparesis, were in the first weeks after a cerebral vascular accident treated by means of EMG-feedback in respect to volar and dorsal flexion of the wrist, flexion and extension of the fingers, and opposition of thumb to the second ev. other fingers. EMG was registered from suitable muscles of the paretic limb. The attempt of volitional movement at the paretic side was conditioned with a reinforced mirror synergia of the same type from the healthy to the damaged side. The patient observed the effect on the EMG screen. After 3-6 conditionings the patient performed the volitional movement alone. In 25 of patients (e.g. 78.1%) improvement was obtained, at least in EMG. A good correlation was found between effect of the procedures and severity of paresis (p less than 0.05; chi 2 = 7.35).

  10. Spontaneous iliopsoas muscle haematoma as a complication of anticoagulation in acute cerebral venous thrombosis: to stop or not to stop (the anticoagulation)?

    PubMed

    Fernandes, Carina; Pereira, Pedro; Rodrigues, Miguel

    2015-03-06

    Spontaneous iliopsoas muscle haematoma is an infrequent complication of anticoagulation, potentially causing neurological dysfunction through compression of the femoral nerve or lumbar plexus. The authors report the case of a puerperal woman admitted for an extensive cerebral venous thrombosis. Anticoagulation was started, with clinical improvement. The patient later reported low back pain irradiating to the right thigh and developed neurological impairment consistent with lumbar plexus dysfunction. A pelvic CT scan revealed a right iliopsoas muscle haematoma. Considering the risk of anticoagulation suspension, a conservative approach was chosen, with maintenance of anticoagulation. Clinical and functional improvement occurred, with mild right hip and knee flexion paresis as sequelae. Anticoagulation complications are challenging, especially when interruption of anticoagulation may threaten vital and functional outcomes. Therefore, a careful evaluation is essential, since no clinical guidelines are available. In this case, continuing anticoagulation provided a good functional outcome.

  11. Friedrich Nietzsche: the wandering and learned neuropath under Dionisius.

    PubMed

    Gomes, Marleide da Mota

    2015-11-01

    Friedrich Nietzsche (1844-1900) was a remarkable philologist-philosopher while remaining in a condition of ill-health. Issues about his wandering/disruptive behavior that might be a consequence and/or protection against his cognitive decline and multifaceted disease are presented. The life complex that raises speculations about its etiology is constituted by: insight, creativity and wandering behavior besides several symptoms and signs of disease(s), mainly neurological one. The most important issue to be considered at the moment is not the disease diagnosis (Lissauer's general paresis or CADASIL, e.g.), but the probable Nietzsche's great cognitive reserve linked to the multifactorial etiology (genetic and environmental), and shared characteristics both to creativity and psychopathology. This makes any disease seems especial regarding Nietzsche, and whichever the diagnostic hypothesis has to consider the Nietzsche's unique background to express any disease(s).

  12. [Philosophy, psychiatry and psychoanalysis: the case of Nietzsche].

    PubMed

    Wolf, M A

    1995-05-01

    In this work dedicated to Frederic Nietzsche, we were first interested by the philosopher's personal psychopathology. Biographic and personality factors, the physical and moral pain, the mood variations, hypersensitivity, solitude and finally megalomanic traits have probably contributed to the development of his thought. Nietzsche gave personal interpretations of his own suffering. Freud himself recognized the organic component of the philosopher's illness. We reviewed the different symptoms in favor of a progressive general paresis. Philologist and moralist, Nietzsche was also a "psychologist". His intuitions in this area often preceded and prepared those of Freud. The relationship is surprising on certain points such as love and sexuality, the unconscious, the interpretation of dreams. We wish to remind readers that a prepsychoanalytic stream of thought, at the end of the 19th century, preceded the teaching now ascribed to Freud and his followers.

  13. Friedrich Nietzsche: the wandering and learned neuropath under Dionisius.

    PubMed

    Gomes, Marleide da Mota

    2015-08-18

    Friedrich Nietzsche (1844-1900) was a remarkable philologist-philosopher while remaining in a condition of ill-health. Issues about his wandering/disruptive behavior that might be a consequence and/or protection against his cognitive decline and multifaceted disease are presented. The life complex that raises speculations about its etiology is constituted by: insight, creativity and wandering behavior besides several symptoms and signs of disease(s), mainly neurological one. The most important issue to be considered at the moment is not the disease diagnosis (Lissauer's general paresis or CADASIL, e.g.), but the probable Nietzsche's great cognitive reserve linked to the multifactorial etiology (genetic and environmental), and shared characteristics both to creativity and psychopathology. This makes any disease seems especial regarding Nietzsche, and whichever the diagnostic hypothesis has to consider the Nietzsche's unique background to express any disease(s).

  14. Ductus arteriosus aneurysm with community-acquired methicillin-resistant Staphylococcus aureus infection and spontaneous rupture: a potentially fatal quandary.

    PubMed

    Stewart, Audra; Dyamenahalli, Umesh; Greenberg, S Bruce; Drummond-Webb, Jonathan

    2006-06-01

    We present the case of a 6-month-old previously healthy girl who presented with high fever, labored breathing, and an enlarged cardiac silhouette on her chest radiograph. Comprehensive evaluation discovered a ductus arteriosus aneurysm and pericardial effusion with methicillin-resistant Staphylococcus aureus bacteremia. Despite pericardiocentesis and appropriate intravenous antibiotics, there was rapid enlargement of the aneurysm and accumulation of echogenic material within the ductus arteriosus aneurysm. Infected aneurysm rupture was identified during emergency surgery. This infant also had vocal cord paresis, a likely complication of the surgery. The clinical course, diagnosis, and treatment of this patient are discussed. Infection of a ductus arteriosus or an infected ductal arteriosus aneurysm is a rare and potentially fatal clinical entity. In the era of increasing community-acquired methicillin-resistant S aureus infections, this is a diagnosis that requires a high index of suspicion.

  15. Bilateral paramedian thalamic artery infarcts: report of eight cases.

    PubMed Central

    Gentilini, M; De Renzi, E; Crisi, G

    1987-01-01

    Eight consecutive patients with CT scan evidence of a bilateral infarct in the territory of the paramedian thalamic artery are reported. In seven cases the infarct also extended to the territory of the polar artery. The main symptoms were: disorder of vigilance which cleared in a few days, and hypersomnolence which lasted longer and in two patients was still present a year later; amnesia, detectable clinically in four patients and only with tests in two patients, which persisted in one patient for three years; changes of mood and bulimia present in five and four patients respectively; and vertical gaze paresis in five patients. Only one patient died, and in the remainder the symptoms tended to subside, but none of the patients who could be followed-up for a year returned to normal behaviour. Clinical and CT scan correlations pointed to the mammillo-thalamic tract as the structure whose damage was responsible for the memory disorders. Images PMID:3625213

  16. Drop attacks in elderly patients secondary to otologic causes with Meniere's syndrome or non-Meniere peripheral vestibulopathy.

    PubMed

    Lee, Hyung; Yi, Hyon-Ah; Lee, Seong-Ryong; Ahn, Byung-Hoon; Park, Byung-Rim

    2005-05-15

    Many neurologists are unaware of the drop attack that may occur from an inner ear dysfunction especially in elderly. We studied the clinical features and results of quantitative audiovestibular tests in six elderly patients (> or =65 years of age) who presented with drop attacks attributable to an inner ear pathology. Group was divided into Meniere's syndrome (4) or non-Meniere peripheral vestibulopathy (2). Standard dizziness questionnaire and quantitative audiovestibular function testing were performed. Episodes were described as a sudden push to the ground in four or a violent illusionary movement of environment leading to a fall in two. All cases gave a history of prior vertiginous episodes and vestibular testing revealed unilateral caloric paresis. Ipsilateral hearing loss was documented in four cases. Our results suggest that otologic causes should be considered in the differential diagnosis of the drop attack in elderly, even if the symptoms and signs were not consistent with Meniere's syndrome.

  17. Effectiveness of Botulinum Toxin Administered to Abolish Acquired Nystagmus

    NASA Technical Reports Server (NTRS)

    Leigh, R. John; Tomsak, Robert L.; Grant, Michael P.; Remler, Bernd F.; Yaniglos, Stacy S.; Lystad, Lisa; Dell'Osso, Louis F.

    1992-01-01

    We injected botulinum toxin into the horizontal rectus muscles of the right eyes of two patients who had acquired pendular nystagmus with horizontal, vertical, and torsional components. This treatment successfully abolished the horizontal component of the nystagmus in the injected eye in both patients for approximately 2 months. Both patients showed a small but measurable improvement of vision in the injected eye that may have been limited by coexistent disease of the visual pathways. The vertical and torsional components of the nystagmus persisted in both patients. In one patient, the horizontal component of nystagmus in the noninjected eye increased; we ascribe this finding to plastic-adaptive changes in response to paresis caused by the botulinum toxin. Such plastic-adaptive changes and direct side effects of the injections - such as diplopia and ptosis - may limit the effectiveness of botulinum toxin in the treatment of acquired nystagmus. Neither patient elected to repeat the botulinum treatment.

  18. Suspected natural lysosomal storage disease from ingestion of pink morning glory (Ipomoea carnea) in goats in northern Argentina

    PubMed Central

    RÍOS, Elvio E.; CHOLICH, Luciana A.; CHILESKI, Gabriela; GARCÍA, Enrique N.; LÉRTORA, Javier; GIMENO, Eduardo J.; GUIDI, María G.; MUSSART, Norma; TEIBLER, Gladys P.

    2015-01-01

    This study describes an occurrence of pink morning glory (Ipomoea carnea) intoxication in goats in northern Argentina. The clinical signs displayed by the affected animals were ataxia, lethargy, emaciation, hypertonia of the neck muscles, spastic paresis in the hind legs, abnormal postural reactions and death. The clinico-pathologic examination revealed that the affected animals were anemic and their serum level of aspartate aminotransferase was significantly increased. Cytoplasmic vacuolation in the Purkinje cells and pancreatic acinar cells was observed by histological examination. The neuronal lectin binding pattern showed a strong positive reaction to WGA (Triticum vulgaris), sWGA (succinylated T. vulgaris) and LCA (Lens culinaris). Although I. carnea is common in tropical regions, this is the first report of spontaneous poisoning in goats in Argentina. PMID:25728544

  19. Electromyographic (EMG) neuromonitoring in otolaryngology-head and neck surgery.

    PubMed

    Dillon, Francis X

    2010-09-01

    Intraoperative neuromonitoring (IONM) is a relatively recent advance in electromyography (EMG) applied to otolaryngology-head and neck surgery. Its purpose is to allow real-time identification and functional assessment of vulnerable nerves during surgery. The nerves most often monitored in head and neck surgery are the motor branch of the facial nerve (VII), the recurrent or inferior laryngeal nerves (X), the vagus nerve (X), and the spinal accessory nerve (XI), with other cranial lower nerves monitored less frequently. Morbidity from trauma to these nerves is significant and obvious, such as unilateral facial paresis. Although functional restorative surgery is usually considered to repair the effects of such an insult, the importance of preventing nerve injury in head and neck surgery is obvious. This article focuses on the anesthetic considerations pertinent to IONM of peripheral cranial nerves during otolaryngologic-head and neck surgery. The specific modality of IONM is EMG, both spontaneous and evoked.

  20. Fibular nerve palsy after hip replacement: Not only surgeon responsibility. Hereditary neuropathy with liability to pressure palsies (HNPP) a rare cause of nerve liability.

    PubMed

    Logroscino, G; Del Tedesco, F; Cambise, C; Coraci, D; Donati, F; Santilli, V; Padua, L

    2016-06-01

    Mononeuropathy after surgery may occur and hereditary neuropathy with liability to pressure palsies is a possible pathological condition related to paresis after hip surgery. We present a case of 66-year-old man presenting severe weakness at inferior limb muscles after hip prosthesis revision. Clinic and electrophysiology showed severe right fibular nerve damage and ultrasound found a marked enlargement of the same nerve, associated with focal enlargements in other nerves. A diagnosis of hereditary neuropathy with liability to pressure palsies was suspected and confirmed by genetic test. The patient gradually recovered returning to a normal daily active life. Ultrasound was crucial for diagnosis. The suspicion and diagnosis of latent neuropathy, which can occur after surgical intervention, may lead to a better understand of the risks of the surgery, specific for the patient, and avoid the wrong attribution to surgical malpractice.

  1. Transtympanic Facial Nerve Paralysis: A Review of the Literature

    PubMed Central

    Schaefer, Nathan; O’Donohue, Peter; French, Heath; Griffin, Aaron; Gochee, Peter

    2015-01-01

    Summary: Facial nerve paralysis because of penetrating trauma through the external auditory canal is extremely rare, with a paucity of published literature. The objective of this study is to review the literature on transtympanic facial nerve paralysis and increase physician awareness of this uncommon injury through discussion of its clinical presentation, management and prognosis. We also aim to improve patient outcomes in those that have sustained this type of injury by suggesting an optimal management plan. In this case report, we present the case of a 46-year-old white woman who sustained a unilateral facial nerve paresis because of a garfish penetrating her tympanic membrane and causing direct damage to the tympanic portion of her facial nerve. On follow-up after 12 months, her facial nerve function has largely returned to normal. Transtympanic facial nerve paralysis is a rare injury but can have a favorable prognosis if managed effectively. PMID:26090278

  2. Giant Dural Supratentorial Chondroma Generating the Question of How Large Can a Tumor Become Without Revealing Itself.

    PubMed

    Doukas, Alexandros; Tallo, Annamarie; Parvin, Richard; Hans, Volkmar; Daemi, Pooya; Cheko, Azad; Scholz, Martin; Petridis, Athanasios K

    2015-11-05

    Chondromas usually affect the small bones of hand and feet and account for only 0.5% of all intracranial tumors. We present a case of a giant, supratentorial meningeal chondroma in a 19-year old male patient and discuss the preoperative diagnostic findings as well as the appropriate treatment options. A 19-old male presented with headache, new onset of focal seizures and paresis of left upper extremity. Magnetic resonance imaging revealed a large right parietal tumor in the precentral region with local mass effect. The patient underwent right parietal craniotomy and gross total resection of the tumor. The histopathological report revealed a chondroma. Intradural supratentorial chondromas are extremely rare. As with other slow growing intracranial masses, they often reach a relatively large size before generating symptoms. Maximal surgical resection is the treatment of choice and if this is achieved no adjuvant therapy is necessary.

  3. Giant Dural Supratentorial Chondroma Generating the Question of How Large Can a Tumor Become Without Revealing Itself

    PubMed Central

    Doukas, Alexandros; Tallo, Annamarie; Parvin, Richard; Hans, Volkmar; Daemi, Pooya; Cheko, Azad; Scholz, Martin

    2015-01-01

    Chondromas usually affect the small bones of hand and feet and account for only 0.5% of all intracranial tumors. We present a case of a giant, supratentorial meningeal chondroma in a 19-year old male patient and discuss the preoperative diagnostic findings as well as the appropriate treatment options. A 19-old male presented with headache, new onset of focal seizures and paresis of left upper extremity. Magnetic resonance imaging revealed a large right parietal tumor in the precentral region with local mass effect. The patient underwent right parietal craniotomy and gross total resection of the tumor. The histopathological report revealed a chondroma. Intradural supratentorial chondromas are extremely rare. As with other slow growing intracranial masses, they often reach a relatively large size before generating symptoms. Maximal surgical resection is the treatment of choice and if this is achieved no adjuvant therapy is necessary. PMID:26918096

  4. An unusual case of orbito-frontal rod fence stab injury with a good outcome

    PubMed Central

    2013-01-01

    Background High-energy non-missile penetrating injuries (stab injuries) account for a small percentage of penetrating head injuries and they present a series of special features. Case presentation A 35-year-old man suffered orbito-frontal? and trans-cranial injuries after falling five meters from a terrace onto a rod iron fence. The removal of the metal rod was performed outside the operating room. The orbital roof was exposed and repaired through a bifrontal craniotomy and the frontal sinuses were cranialised. The orbital floor and zygoma were plated with micro-screws. Conclusion The patient recovered without significant complications, apart from a slight paresis of the right superior rectus; the ocular globe remained intact. The positive outcome obtained in this very challenging case is attributable to the competency of the Neurotrauma Unit and to the use of a synergistic approach which involved the contribution of neurosurgeons, maxillo-facial surgeons, radiologists and anaesthesiologists. PMID:23941677

  5. Force regulation is deficient in patients with parietal lesions: a system-analytic approach.

    PubMed

    Scholle, H C; Bradl, U; Hefter, H; Dohle, C; Freund, H J

    1998-06-01

    By means of a quantitative system-analytic investigation strategy, the postural motor control of the fingers was evaluated, to characterise the possible deficit of force regulation in patients with parietal lesions. In spite of a normal response to short torque pulses, the parietal-lesion patients had difficulties in returning to the preload level after the application of an additional step torque load to fingers II-IV of their left or right hands. The control offset (measured 500 ms after step torque application) was significantly larger in the patient group. This deficit in the investigated patients with parietal lesions to compensate for step torque loads was not due to a paresis, but rather resulted from a disturbance in the generation of a sufficient counterforce against the applied step torque within an adequate time window and motor pattern. This distinct force-regulation deficit was found in patients with left- and right-sided parietal lesions.

  6. Burkitt Lymphoma with Initial Clinical Presentation due to Infiltration of the Central Nervous System and Eye Orbits

    PubMed Central

    Camilo, Gustavo Bittencourt; Machado, Dequitier Carvalho; de Oliveira, Celso Estevão; Lacerda, Letícia da Silva; de Oliveira, Romulo Varella; de França Silva, Monique; Lopes, Agnaldo José

    2014-01-01

    Patient: Male, 17 Final Diagnosis: Burkitt lymphoma Symptoms: Anisocoria, ipsilateral ptosis, opthalmoparesis, paresis Medication: — Clinical Procedure: — Specialty: Oncology Objective: Unusual clinical course Background: Burkitt lymphoma rarely affects the central nervous system and ocular region. Under these conditions, computed tomography and (particularly) magnetic resonance imaging of the skull increase the diagnostic accuracy, as they objectively show the topography of lesions and the effect of neoplasia on structures. Case Report: We report here the case of a 17-year-old male whose initial clinical manifestations were related to neurological impairment and to the ocular musculature and ocular innervation. The diagnosis of Burkitt lymphoma with leukemization and infiltration of the central nervous system was confirmed. Conclusions: In this case, it is important to recognize that the neuroimaging findings were fundamentally important in indicating the initial form of the disease and in directing the appropriate clinical management. PMID:25243420

  7. Quality of Labor Epidural Analgesia and Maternal Outcome With Levobupivacaine and Ropivacaine: A Double-Blinded Randomized Trial

    PubMed Central

    Kumar, T. Senthil; Rani, P.; Hemanth Kumar, V. R.; Samal, Sunita; Parthasarathy, S.; Ravishankar, M.

    2017-01-01

    Background: Quality of labor analgesia plays a vital role in the maternal outcome. Very few literature are available analyzing the quality of epidural labor analgesia. Aim: The aim of this study was to compare the effectiveness of 0.1% levobupivacaine and 0.1% ropivacaine with fentanyl as an adjuvant for epidural labor analgesia in terms of onset, duration, quality of analgesia, and degree of motor blockade. Methodology: Sixty nulliparous parturients, with singleton uncomplicated pregnancy, were recruited by continuous sampling. Parturients were randomized to receive either levobupivacaine 0.1% or ropivacaine 0.1% with 2 μg/ml fentanyl as an intermittent epidural bolus. The epidural analgesia was initiated with 12 ml of study drug solution in the active stage of labor (cervix 3 cm dilated). Demand bolus was given whenever the visual analog scale (VAS) score >3. Onset, duration, and quality of analgesia and degree of motor blockade were analyzed. Maternal outcome was evaluated in terms of mode of delivery, duration of labor, and assisted vaginal delivery. Statistical Analysis: All the data were recorded in Microsoft Office Excel. Statistical analysis was carried out using SPSS version 19.0 (IBM SPSS, USA) software with Regression Modules installed. Descriptive analyses were reported as mean and standard deviation of continuous variables. Results: The mean onset of analgesia was shorter in ropivacaine (21.43 ± 2 min) than in levobupivacaine group (23.57 ± 1.71 min) (P = 0.000). Duration of analgesia was shorter in ropivacaine (60 ± 14 min) than levobupivacaine (68 ± 11 min) (P = 0.027). Levobupivacaine produced a better quality of analgesia in terms of not perceiving pain and uterine contraction during labor analgesia but was associated with 37% incidence of instrumental delivery. Duration of labor and rate of cesarean section were comparable between the groups. Conclusion: Quality of analgesia in labor epidural was superior to levobupivacaine but was associated

  8. Psychological Factors in Experience of Pain During Childbirth.

    PubMed

    Mestrović, Ana Havelka; Bilić, Morana; Loncar, Larisa Buhin; Micković, Vlatko; Loncar, Zoran

    2015-09-01

    Pain during delivery is unique because it is accompanied by powerful emotions. Emotions that occur in women during labor and delivery are closely tied to upbringing and culture in which they were raised and consequently with the sensation of experienced pain. According to the Melzack-Wall Theory of Pain, general mood is directly related to the intensity and quality of pain and it is therefore justifiable to presuppose that certain psychosocial factors will be linked with the intensity and quality of pain experienced during childbirth. (Melzack et al., 1981). We endeavored to show the effect of psychosocial factors that influence the intensity and quality of labor pain. Data was collected in a sample of 176 parturient women who delivered without Cesarean sections or epidural anesthesia. The intensity and quality of pain were obtained through the administration of the McGill Pain Questionnaire-Short Form. Psychosocial factors included: number of births, presence of partner, self-evaluation of knowledge of physio-anatomical aspects of birth and the completion of a pregnancy course. Labor and delivery pain is of high intensity anl the quality of pain is most frequently characterized as smarting, cramping, exhausting, and sharp. The presence of a partner and the completion of a pregnancy course is exercised by a small number of parturients. Self-evaluation of preexisting knowledge of physio-anatomical aspects of delivery is predictive of the affective component of intensity of childbirth pain. Psychosocial factors have been shown as significant for the intensity and quality of experienced childbirth pain.

  9. Cross-sectional study on the obstetric performance of primigravidae in a teaching hospital in Lagos, Nigeria

    PubMed Central

    Okunade, Kehinde Sharafadeen; Okunola, Halimat; Oyeneyin, Lawal; Habeeb-Adeyemi, Fatimah N.

    2016-01-01

    Background: A woman carrying her first pregnancy is starting a new life, and this is a crucial time in her obstetric career. This study was aimed to compare the obstetric performance of primigravidae to that of the multigravidae with a view to suggesting ways of preventing the associated complications. Patients and Methods: The study was a cross-sectional case-control study carried out among women who delivered in the study center over a year period. Relevant data of primigravid parturients who delivered in the hospital were retrieved from the labor ward register, and an equal number of multigravidae who delivered during the same study were selected by simple random sampling as the control group. Results: Primigravidae constituted 15.3% of the total number of parturients seen during the study period. The age range of the primigravidae was 20–48 years and with a mean age of 28.24 ± 4.28 years. The obstetric complications seen in statistically significant proportion among the primigravidae case group include hypertensive disorder (P = 0.048), prolonged pregnancy (P = 0.039), prolonged labor (P = 0.006), oxytocin augmentation (P = 0.022), cephalopelvic disproportion (P = 0.001), obstructed labor (P = 0.008), instrumental delivery (P = 0.035), cesarean delivery rates (P = 0.011), and increased neonatal unit admission rate (P = 0.002). Conclusion: Primigravidity is a high-risk pregnancy with several associated obstetric complications. Primigravidae should, therefore, be managed by specialists in well-equipped hospitals that will provide comprehensive antenatal and intrapartum care which will eventually result in a satisfactory obstetric outcome. PMID:27833251

  10. A comparison of continuous infusion and intermittent bolus administration of 0.1% ropivacaine with 0.0002% fentanyl for epidural labor analgesia

    PubMed Central

    Patkar, Chinmayi Surendra; Vora, Kalpana; Patel, Harshal; Shah, Veena; Modi, Manisha Pranjal; Parikh, Geeta

    2015-01-01

    Background and Aims: Minimal consumption of local anesthetic and opioid for epidural labor analgesia has been advocated for safe obstetric outcome and superior maternal satisfaction. The primary objective of this study was to evaluate and compare the analgesic efficacy of mode of administration of epidural 0.1% ropivacaine with 0.0002% fentanyl via continuous infusion or intermittent boluses during labor. Material and Methods: Sixty term primi or second gravida healthy parturients in labor requesting epidural analgesia were recruited in this study. Lumbar epidural catheter was inserted, and analgesia initiated with 0.2% ropivacaine. Patients were randomized to receive ropivacaine 0.1% with fentanyl 0.0002% via either continuous infusion (Group A) or intermittent boluses (Group B) on an hourly basis. If the parturient complained of pain and visual analog scale (VAS) score was >3, an additional bolus of the study drug was given. VAS score, motor blockade, maternal hemodynamics and fetal heart sounds were frequently monitored. Side effects, mode of delivery and neonatal outcome were noted. Results: To achieve similar VAS, the mean total dose of ropivacaine was 18.78 ± 3.88 mg in Group A and 16.86 ± 4.3 mg in Group B, the difference being statistically significant (P = 0.04). Seventeen out of 30 patients in Group A that is, 56.6% and nine patients in Group B that is, 30% required additional top-ups, and this was significantly higher (P = 0.037). Side effects, mode of delivery and neonatal outcome were comparable in both groups. Conclusion: Intermittent bolus administration provides a more efficacious route of drug delivery when compared to continuous infusion by significantly decreasing the total amount of local anesthetic plus opioid without adversely affecting patient safety or maternal satisfaction. PMID:25948908

  11. Alcohol Consumption during Pregnancy: Analysis of Two Direct Metabolites of Ethanol in Meconium

    PubMed Central

    Sanvisens, Arantza; Robert, Neus; Hernández, José María; Zuluaga, Paola; Farré, Magí; Coroleu, Wifredo; Serra, Montserrat; Tor, Jordi; Muga, Robert

    2016-01-01

    Alcohol consumption in young women is a widespread habit that may continue during pregnancy and induce alterations in the fetus. We aimed to characterize prevalence of alcohol consumption in parturient women and to assess fetal ethanol exposure in their newborns by analyzing two direct metabolites of ethanol in meconium. This is a cross-sectional study performed in September 2011 and March 2012 in a series of women admitted to an obstetric unit following childbirth. During admission, socio-demographic and substance use (alcohol, tobacco, cannabis, cocaine, and opiates) during pregnancy were assessed using a structured questionnaire and clinical charts. We also recorded the characteristics of pregnancy, childbirth, and neonates. The meconium analysis was performed by liquid chromatography—tandem mass spectrometry (LC-MS/MS) to detect the presence of ethyl glucuronide (EtG) and ethyl sulfate (EtS). Fifty-one parturient and 52 neonates were included and 48 meconium samples were suitable for EtG and EtS detection. The median age of women was 30 years (interquartile range (IQR): 26–34 years); EtG was present in all meconium samples and median concentration of EtG was 67.9 ng/g (IQR: 36.0–110.6 ng/g). With respect to EtS, it was undetectable (<0.01 ng/g) in the majority of samples (79.1%). Only three (6%) women reported alcohol consumption during pregnancy in face-to-face interviews. However, prevalence of fetal exposure to alcohol through the detection of EtG and EtS was 4.2% and 16.7%, respectively. Prevention of alcohol consumption during pregnancy and the detection of substance use with markers of fetal exposure are essential components of maternal and child health. PMID:27011168

  12. Labour analgesia: Recent advances.

    PubMed

    Pandya, Sunil T

    2010-09-01

    Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients. Technological advances like use of ultrasound to localize epidural space in difficult cases minimizes failed epidurals and introduction of novel drug delivery modalities like patient-controlled epidural analgesia (PCEA) pumps and computer-integrated drug delivery pumps have improved the overall maternal satisfaction rate and have enabled us to customize a suitable analgesic regimen for each parturient. Recent randomized controlled trials and Cochrane studies have concluded that the association of epidurals with increased caesarean section and long-term backache remains only a myth. Studies have also shown that the newer, low-dose regimes do not have a statistically significant impact on the duration of labour and breast feeding and also that these reduce the instrumental delivery rates thus improving maternal and foetal safety. Advances in medical technology like use of ultrasound for localizing epidural space have helped the clinicians to minimize the failure rates, and many novel drug delivery modalities like PCEA and computer-integrated PCEA have contributed to the overall maternal satisfaction and safety.

  13. Two syringe spinal anesthesia technique for cesarean section: A controlled randomized study of a simple way to achieve more satisfactory block and less hypotension

    PubMed Central

    Keera, Amr Aly Ismail; Elnabtity, Ali Mohamed Ali

    2016-01-01

    Background: Multiple trials have been tried to prevent hypotension during spinal anesthesia. However, the drug choice and mode of administration is still a matter of debate. Objectives: To compare the outcome of spinal injection of hyperbaric bupivacaine and fentanyl separately to standard injection of mixed fentanyl with hyperbaric bupivacaine. Settings and Design: A randomized, controlled clinical trial. Patients and Methods: One hundred twenty-four parturient scheduled for elective cesarean section were randomly allocated into two groups, each 62 parturient: Group M received spinal anesthesia using 10 mg bupivacaine 0.5% premixed with 25 μg fentanyl in the same syringe and Group S received 25 μg fentanyl in one syringe and 10 mg bupivacaine 0.5% without barbotage in a second syringe. Results: Patients with intraoperative pain that was controllable without the need for a shift to general anesthesia was significantly lower in Group S (3.2%) than in Group M (16.1%). The frequency of hypotension was significantly lower in Group S compared to Group M (P < 0.05). Time till the onset of sensory block was nonsignificantly shorter with nonsignificantly higher mean level of maximal sensory block in Group S compared to Group M (P > 0.05). There was no significant difference in the time till occurrence of hypotension, duration of hypotension, mean dose of ephedrine used for the treatment of hypotension and frequency of patients developed itching between the groups (P > 0.05). Conclusion: Separate intrathecal injection of fentanyl and hyperbaric bupivacaine provided a significant improvement in the quality of sensory block and significant reduction of the frequency of hypotension compared to injection of mixed medications. PMID:27212767

  14. [Toxoplasmosis mother-to-child screening: study of cases followed in the Pasteur Institute of Tunis (2007-2010)].

    PubMed

    Ben Abdallah, R; Siala, E; Bouafsoun, A; Maatoug, R; Souissi, O; Aoun, K; Bouratbine, A

    2013-05-01

    Toxoplasmosis when occurring during pregnancy can be transmitted to the fetus and lead to congenital toxoplasmosis (CT). Therefore, pregnant women are a risk group, for which it is necessary to determine the serologic profile. The objective of this study is to determine the serologic profile of toxoplasmosis in pregnant women followed at the Parasitology Laboratory of the Pasteur Institute in Tunis, to establish the prevalence of toxoplasmic infections during pregnancy and the incidence of the CT, noting the difficulties faced in the interpretation of serological results. This is a retrospective study concerning 2833 toxoplasmic serologies practiced on 2070 pregnant women, followed at the Parasitology-Mycology Laboratory of the Pasteur Institute of Tunis, between 2007 and 2010. Serological diagnosis of toxoplasmosis was done by ELISA (Enzyme Linked Immunosorbent Assay) for the detection of Immunoglobulin (Ig) G and M and the study of toxoplasmosis IgG avidity. Prenatal diagnosis was performed for 58 women by amniotic fluid sampling. Toxoplasma gondii was detected by Polymerase Chain Reaction (PCR). At birth, the diagnosis of congenital toxoplasmosis was established based on serology. The toxoplasmic serologies carried out have shown that 45.6% of the pregnant women were formerly immunized while 49.6% had a negative serology. A toxoplasmosis primary infection acquired during pregnancy was detected in 79 cases (3.8%). Among them, 33% had a true seroconversion while 67% had a recent toxoplasmosis infection in view of the positivity of IgG and IgM on the first sample with a low index of avidity (IA). For 21 parturients whose serology showed the presence of IgG, IgM and an intermediate or high IA. Among the 58 parturients in whom prenatal diagnosis was performed, PCR was positive in four cases. After birth, six cases of congenital toxoplasmosis were detected by serology.

  15. Maternal and foetal outcome after epidural labour analgesia in high-risk pregnancies

    PubMed Central

    Samanta, Sukhen; Jain, Kajal; Bhardwaj, Neerja; Jain, Vanita; Samanta, Sujay; Saha, Rini

    2016-01-01

    Background and Aims: Low concentration local anaesthetic improves uteroplacental blood flow in antenatal period and during labour in preeclampsia. We compared neonatal outcome after epidural ropivacaine plus fentanyl with intramuscular tramadol analgesia during labour in high-risk parturients with intrauterine growth restriction of mixed aetiology. Methods: Forty-eight parturients with sonographic evidence of foetal weight <1.5 kg were enrolled in this non-randomized, double-blinded prospective study. The epidural (E) group received 0.15% ropivacaine 10 ml with 30 μg fentanyl incremental bolus followed by 7–15 ml 0.1% ropivacaine with 2 μg/ml fentanyl in continuous infusion titrated until visual analogue scale was three. Tramadol (T) group received intramuscular tramadol 1 mg/kg as bolus as well as maintenance 4–6 hourly. Neonatal outcomes were measured with cord blood base deficit, pH, ionised calcium, sugar and Apgar score after delivery. Maternal satisfaction was also assessed by four point subjective score. Results: Baseline maternal demographics and neonatal birth weight were comparable. Neonatal cord blood pH, base deficit, sugar, and ionised calcium levels were significantly improved in the epidural group in comparison to the tramadol group. Maternal satisfaction (P = 0.0001) regarding labour analgesia in epidural group was expressed as excellent by 48%, good by 52% whereas it was fair in 75% and poor in 25% in the tramadol group. Better haemodynamic and pain scores were reported in the epidural group. Conclusion: Epidural labour analgesia with low concentration local anaesthetic is associated with less neonatal cord blood acidaemia, better sugar and ionised calcium levels. The analgesic efficacy and maternal satisfaction are also better with epidural labour analgesia. PMID:27013750

  16. Continuous assessment of labour pain using handgrip force

    PubMed Central

    Wickboldt, Nadine; Savoldelli, Georges; Rehberg-Klug, Benno

    2015-01-01

    BACKGROUND: Assessment of dynamic changes in painful experiences, such as labour, using conventional rating scales (eg, numerical rating scale [NRS]) has limitations. An alternative for continuous pain evaluation could be a signal generated by voluntary action of the parturient. Remifentanil administration for obstetric analgesia could be improved by these dynamic measures of labour pain. In the present study, handgrip force was measured by a dynamometer to signal labour pain. OBJECTIVES: To evaluate: whether continuous monitoring of labour pain using handgrip force allows for determination of pain measurement during contractions; and the correlation between handgrip force and pain intensity on NRS. METHODS: The present observational, single-centre study included 43 parturients. After calibration of the dynamometer for individual hand muscle strength, pain was recorded during early and late labour using a dynamometer and an NRS. The primary end point was the correlation coefficient between NRS ratings and peak intensity recorded by the dynamometer. RESULTS: All dynamometer-registered readings were also registered by the external tocogram. All contractions recorded by external tocogram were also registered by the dynamometer. Handgrip force was moderately correlated with pain scores on the NRS. Mean handgrip force during contractions had the highest correlation coefficient (Pearson’s r=0.67) compared with peak handgrip force (r=0.56) and area under the curve of handgrip force (r=0.55). CONCLUSIONS: Pain intensity and duration can be assessed continuously using handgrip force measured via a dynamometer. The feedback of intensity and duration of pain could optimize patient-controlled remifentantil application for obstetric analgesia and other situations of highly variable pain intensity. PMID:25996768

  17. Obstetric analgesia for vaginal birth in contemporary obstetrics: a survey of the practice of obstetricians in Nigeria

    PubMed Central

    2014-01-01

    Background Contemporary obstetrics in sub-Saharan Africa is yet to meet the analgesic needs of most women during child birth for a satisfactory birth experience and expectedly, obstetricians have a major role to play in achieving this. Methods This was a questionnaire-based, cross-sectional study of 151 obstetricians and gynecologists that attended the 46th Annual General Meeting and Scientific Conference of the Society of Gynaecology and Obstetrics of Nigeria (SOGON) held in Abakaliki, southeast Nigeria in November, 2012. SOGON is the umbrella body that oversees the obstetric and gynecological practice in Nigeria. Data was collated and analyzed with Epi-info statistical software, and conclusions were drawn by means of simple percentages and inferential statistics using Odds Ratio, with P-value < 0.05 at 95% Confidence Interval (CI) taken to be statistically significant. Results Of the 151 participants, males predominated; 110 (72.9%) practiced in government-owned tertiary hospitals in urban locations. Only 74 (49%) offered obstetric analgesia. Among users, only 20 (13.3%) offered obstetric analgesia routinely to parturients, 44 (29.1%) sometimes and 10 (6.6%) on patients’ requests. The commonest analgesia was opioids (41.1%). Among non-users, the commonest reasons adduced were fear of respiratory distress (31.1%), cost (24.7%) and late presentation in labour (15.6%). Conclusion The routine prescription and utilization of obstetric analgesia by obstetricians in Nigeria is still low. Obstetricians are encouraged to step up its use to make childbirth a more fulfilling experience for parturients. PMID:24725280

  18. Alcohol Consumption during Pregnancy: Analysis of Two Direct Metabolites of Ethanol in Meconium.

    PubMed

    Sanvisens, Arantza; Robert, Neus; Hernández, José María; Zuluaga, Paola; Farré, Magí; Coroleu, Wifredo; Serra, Montserrat; Tor, Jordi; Muga, Robert

    2016-03-22

    Alcohol consumption in young women is a widespread habit that may continue during pregnancy and induce alterations in the fetus. We aimed to characterize prevalence of alcohol consumption in parturient women and to assess fetal ethanol exposure in their newborns by analyzing two direct metabolites of ethanol in meconium. This is a cross-sectional study performed in September 2011 and March 2012 in a series of women admitted to an obstetric unit following childbirth. During admission, socio-demographic and substance use (alcohol, tobacco, cannabis, cocaine, and opiates) during pregnancy were assessed using a structured questionnaire and clinical charts. We also recorded the characteristics of pregnancy, childbirth, and neonates. The meconium analysis was performed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) to detect the presence of ethyl glucuronide (EtG) and ethyl sulfate (EtS). Fifty-one parturient and 52 neonates were included and 48 meconium samples were suitable for EtG and EtS detection. The median age of women was 30 years (interquartile range (IQR): 26-34 years); EtG was present in all meconium samples and median concentration of EtG was 67.9 ng/g (IQR: 36.0-110.6 ng/g). With respect to EtS, it was undetectable (<0.01 ng/g) in the majority of samples (79.1%). Only three (6%) women reported alcohol consumption during pregnancy in face-to-face interviews. However, prevalence of fetal exposure to alcohol through the detection of EtG and EtS was 4.2% and 16.7%, respectively. Prevention of alcohol consumption during pregnancy and the detection of substance use with markers of fetal exposure are essential components of maternal and child health.

  19. The effect of dietary calcium and phosphorus supplementation in zeolite a treated dry cows on periparturient calcium and phosphorus homeostasis.

    PubMed

    Thilsing, T; Larsen, T; Jørgensen, R J; Houe, H

    2007-03-01

    Previous studies have proved the possibility of preventing parturient hypocalcaemia by zeolite A supplementation during the dry period, and a recent in vitro study has indicated a marked calcium (Ca) as well as phosphorus (P) binding effect of zeolite A in rumen fluid solutions. Because of the connection between the Ca and P homeostatic systems, the preventive effect against parturient hypocalcaemia may arise from zeolite induced decreased availability of dietary Ca as well as P. In the present study, the expected Ca and P binding capacity was challenged by feeding high and low levels of dietary Ca and/or P to zeolite A treated dry cows. Twenty-one pregnant dry cows were assigned to four experimental groups receiving a dry cow ration unsupplemented or supplemented with extra Ca and/or P. During the last 2 weeks of the dry period all cows additionally received 600 g of zeolite A per day. A high level of dietary P prepartum significantly decreased the plasma Ca concentration before as well as immediately after calving (day 0-3). Conversely, the plasma inorganic phosphate concentration was higher among these cows than among cows receiving no supplemental P. The prepartum dietary Ca level significantly affected the serum 1,25-dihydroxyvitamin D concentration during zeolite supplementation, whereas the periparturient plasma Ca concentration was apparently not affected by the dietary Ca level. During zeolite A supplementation plasma parathyroid hormone was significantly higher among cows receiving additional P. The urinary deoxypyridinoline/creatinine ratio was not affected by the prepartal dietary Ca or P level. Serum aluminium (Al) was significantly higher during zeolite A supplementation than during the preceding period, indicating partial destruction of the zeolite in the intestinal tract with subsequent release and absorption of Al. It is suggested that the effect of prepartum zeolite supplementation on the periparturient Ca homeostasis depends on the level of Ca as

  20. Effect of pre-calving zeolite, magnesium and phosphorus supplementation on periparturient serum mineral concentrations.

    PubMed

    Pallesen, Anders; Pallesen, Flemming; Jørgensen, Rolf J; Thilsing, Trine

    2008-02-01

    The objective of this study was to test whether supplementing dry cow rations with phosphorus (P) and magnesium (Mg) would interfere with the beneficial effect of zeolite supplementation on the periparturient blood calcium (Ca) concentration in dairy cattle. Three groups (A-C) of 10 Danish Jersey cows were each given the following daily supplements from 2 weeks before the expected date of calving until actual calving: group A: zeolite, monoammonium phosphate, standard dry cow mineral and vitamin mix, containing 61g magnesium phosphate; group B: zeolite, standard mineral and vitamin mix without the magnesium phosphate and group C: standard mineral and vitamin mix, monoammonium phosphate. All cows in group B had an apparently less variable serum calcium concentration around calving with no cases of milk fever and no subclinical hypocalcaemia or hypomagnesaemia recorded. In contrast, a parturient drop in blood Ca was seen in group A as well as group C. In group A, one cow was hypocalcaemic at calving, and developed milk fever. In group C, 12 blood samples, representing six cows, were hypocalcaemic, and three of these cows were treated for milk fever. All groups remained normomagnesaemic and there were no significant differences in blood Mg across groups. In conclusion, the combined P and Mg supplementation in addition to zeolite supplementation did not increase the serum Mg level (forage Mg 16.9g/day; 0.21% of DM). Combined P and Mg supplementation reduced the zeolite-induced hypophosphataemia but also reduced the stabilising effect of zeolite on parturient serum Ca.

  1. Different Levels of CEA, CA153 and CA125 in Milk and Benign and Malignant Nipple Discharge

    PubMed Central

    Zhao, Song; Mei, Yu; Wang, Jianli; Zhang, Kai; Ma, Rong

    2016-01-01

    Background The aim of this study was to assess the diagnostic values of three breast tumor markers (i.e., CEA, CA153 and CA125) in milk and nipple discharge in the prediction of different breast diseases diagnoses. Methods Three hundred thirty-six patients (96 breast cancer and 240 benign disease patients) with nipple discharge and a control group of 56 healthy parturient participants were enrolled in the present study. Nipple discharge samples were preoperatively collected from the patients, and milk was collected from the colostrum of the parturient participants. The samples were assayed for the CEA, CA153 and CA125 levels. Cutoff values were determined for the detection of breast diseases using ROC curves. Results The levels of CEA, CA153 and CA125 were significantly different between the nipple discharge and the milk (all ps < 0.001). In the nipple discharge, the CEA and CA153 levels in the breast cancer group were significantly greater than those in the benign group (all ps < 0.001), and cutoff values of 263.3 ng/mL and 1235.3 U/mL, respectively, were established. However, the expression of CA125 did not differ significantly between the breast cancer and benign groups. Conclusion Differences in the apparent expression levels of CEA, CA153 and CA125 in patients with nipple discharge and healthy persons were validated. The present data suggest that CEA and CA153 might potentially be useful in the differential diagnoses of benign tumors and breast cancer. CA125 did not seem to be useful for breast cancer detection. PMID:27327081

  2. Reproductive experience alters corticosterone and CBG levels in the rat dam.

    PubMed

    Pawluski, Jodi L; Charlier, Thierry D; Lieblich, Stephanie E; Hammond, Geoffrey L; Galea, Liisa A M

    2009-01-08

    Reproductive experience has significant effects on the brain, behavior and hormone profiles of the mother. Recent work has demonstrated that primiparous rats exhibit decreased dendritic arborizations in the hippocampus, and enhanced hippocampus-dependent spatial memory performance at the time of weaning compared to nulliparous and, to a lesser degree, multiparous rats. Interestingly, enhanced spatial learning and reduced dendritic arbors are seen in nulliparous female rats exposed to chronic stress or repeated corticosterone administration. Based on these observations, we hypothesized that corticosterone may be altered in primiparous rats compared to multiparous and nulliparous rats. The present study investigated whether the levels of circulating corticosterone and its binding protein, corticosteroid binding globulin (CBG), are altered with reproductive experience and pup-exposure during late pregnancy and the postpartum. Total serum corticosterone and CBG were assayed from five groups; multiparous, primiparous, nulliparous, primip-no-pups, and sensitized rats during gestation (days 14 and 19) and the postpartum period (days 1, 5, 14, 21, and 35). Results show that primiparous rats had significantly elevated total corticosterone on postpartum day 1. In addition, primiparous and multiparous rats had significantly lower CBG throughout the postpartum period than all other groups, with primiparous rats exhibiting lower levels than multiparous rats during mid-lactation. These data suggest that free corticosterone is elevated in both primiparous and multiparous dams and is elevated to a greater degree in primiparous compared to multiparous dams during lactation. Corticosterone and CBG levels were positively correlated with specific maternal behaviors during the first week postpartum in parturient rats, but not in sensitized rats, suggesting a role for corticosterone in the modulation of maternal behavior in parturient rats alone.

  3. Corpectomy of three cervical vertebral bodies for malignant tumours--a study of two cases.

    PubMed

    Guzik, Grzegorz

    2013-01-01

    The increased detection rate of spinal tumours is due to more precise methods used for imaging the spinal column and better survival of cancer patients. It is therefore associated with greater incidence of metastatic complications. Primary tumours of the spine, both malignant and benign, are very rare. Histopathological confirmation is a prerequisite of correct treatment. Two patients with pain in the neck area, progressive paresis, breathing disorders and dysphagia were admitted to our hospital. In the first patient, a 78-year-old woman, imaging examinations revealed a large exophytic tumour originating from C5-C7 vertebrae and compressing other neck structures. In view of the progressive paresis and dyspnoea, we decided to perform surgical resection of the tumour without a prior biopsy. We used the Southwick and Robinson approach on the right side and the tumour was removed together with damaged vertebral bodies, which were replaced by an implant. The next stage of the treatment involved stabilisation of the spine from C3 to Th2. Histopathological evaluation confirmed a diagnosis of chordoma. The second patient was a 73-year-old man. Imaging examinations revealed destruction of the C6 to Th1 vertebral bodies by a tumour with pathological fractures and compression of the spinal canal. The tumour was approached from the left side and removed according to the method presented by Southwick and Robinson. The removed vertebral bodies were replaced with implants. The spine was stabilised in the second stage of treatment. A diagnosis of metastatic adenocarcinoma was confirmed by a histopathological examination. Tumours located in the cervical spine, especially at the C7-Th1 level, cause considerable diagnostic and therapeutic problems. Southwick and Robinson's anterior approach allows for good exposure of vertebral bodies down to the Th2 level.

  4. Toxicological studies of shale oils, some of their components, and commercial products.

    PubMed Central

    Veldre, I A; Jänes, H J

    1979-01-01

    Estonian shale oil contains about 25--30% phenols, and their action determines the toxicity of shale oils. The clinical symptoms of intoxication are rather similar, regardless of route of administration. Due to neurotropic action, the coordination of movements is impaired, and clonic and tetanic convulsions, paresis and paralysis of extremities, and narcosis are observed. In subacute and chronic toxicity tests, dysfunction of the central nervous system was found. In long-term (4--6 month) experiments, changes in liver and kidney function were found. Shale oil has gonadotropic activity and causes changes in the sexual cycle as well as diminution of the number of primordial folicles in the ovaries or a decrease in the quantity of normal spermatogonia in testicular germinal epithelium. Shale oils produce local irritation of skin and mucous membranes. Shale oil can induce sensitization of the organism after repeated administration. The results of acute intoxication tests have proved that volatile and nonvolatile phenol fractions, isomeric dimethylphenols, and 5-methylresorcinol, must be characterized as moderately toxic substances; the LD50 ranges from 501 to 1500 mg/kg. The clinical symptoms of acute toxication are similar for all studied phenols (restlessness, unsteadiness, clonic tremor, paresis and paralysis of extremities, and death). In spite of the moderate toxicity of phenols in acute experiments, repeated administration of small doses can cause different changes in the nervous system and internal organs of experimental animals. For all the phenols studied, the maximum allowable concentration in water was limited by their effect on the organoleptic properties of water. The nonactive dose for warm-blooded animals is from 100 to 3000 times the threshold limit value of phenols on the basis of their organoleptic properties. The effect of commercial products of oil shale industry is generally determined by the toxicity of the main components: water-soluble oil shale

  5. Survey of young patients with polio and a foreign background at a Swedish post-polio outpatient clinic.

    PubMed

    Werhagen, Lars; Borg, Kristian

    2016-10-01

    Nowadays, polio survivors aged under 60 years are non-native Swedes which pose new aspects and challenges to a post-polio outpatient clinic. To analyze the medical data, walking aids, occupational, and family situation in non-native polio survivors aged less than 60 years at a Swedish post-polio outpatient clinic. Retrospective data analysis. Data were retrieved from medical records at the post-polio outpatient clinic. Actual age, age at acute polio infection, walking capacity, pain, concomitant diseases, working and family situation, and ethnical origin were analyzed. Data are presented in numbers and percentage. 153 patients were included. Mean age was 45 (17-60) years, and mean age at acute polio infection was 2 (0-12) years. Paresis of the lower extremities was the most common disability. 10 % were wheelchair dependent. Pain occurred in 70 % with a mean intensity of 55 measured with the visual analog scale. Hypertension was the most common concomitant disease. Half of the polio survivors were working at least part time, and roughly half were singles. Data were comparable with data earlier published in Swedish native polio survivors. Non-native polio survivors aged under 60 years showed similarities in age at acute polio infection, paresis, prevalence, and intensity of pain when compared with native Swedish polio survivors. They were, however, younger, and were less often working and married/cohabitants than native Swedish polio survivors. The results of this study underline the importance of social and vocational rehabilitation tailoring rehabilitation suitable for polio survivors with a foreign background.

  6. Experimental lead toxicosis in ponies: comparison of the effects of smelter effluent-contaminated hay and lead acetate

    SciTech Connect

    Burrows, G.E.; Borchard, R.E.

    1982-12-01

    Grass hay produced in the Coeur d'Alene River Basin of northern Idaho was fed to a group of 4 ponies. The hay contained Pb in concentration of 423 +/- 82 mg/kg and Cd in concentration of 10.8 +/- 1.4 mg/kg, resulting in daily exposures of the ponies to approximately 7.4 mg of Pb/kg and 0.19 mg of Cd/kg/day. The results in this group of ponies were compared with those from a group fed noncontaminated grass hay and given a daily dose of 10 mg of Pb/kg of body weight, in the form of lead acetate. Clinical toxicologic signs, hematologic changes, and blood and tissue Pb concentrations were similar in the 2 groups. However, the severity of the disease process appeared to be greater in the ponies fed the Pb- and Cd-contaminated hay. This was shown clearly by the shorter interval between onset of clinical changes and death in the ponies fed contaminated hay. The possibility of multiple heavy metal effects is discussed. Clinical toxicologic signs observed include incoordination, labial paresis, pharyngeal paresis, CNS depression, anorexia, and body weight loss. Anemia or marginal anemia was common and was often accompanied by the appearance of nucleated RBC and Howell-Jolly bodies in peripheral blood. Neither the hematologic response nor the blood Pb concentrations were reflective of the severity of poisoning, although blood Pb concentrations were greater than 0.35 micrograms/ml once clinical signs of toxicity were observed. Liver, kidney, spleen, brain, and bone Pb concentrations and liver, kidney, and brain Cd concentrations were increased in both the ponies fed contaminated hay and the ponies given lead acetate.

  7. Threshold dose for peripheral neuropathy following intraoperative radiotherapy (IORT) in a large animal model

    SciTech Connect

    Kinsella, T.J.; DeLuca, A.M.; Barnes, M.; Anderson, W.; Terrill, R.; Sindelar, W.F. )

    1991-04-01

    Radiation injury to peripheral nerve is a dose-limiting toxicity in the clinical application of intraoperative radiotherapy, particularly for pelvic and retroperitoneal tumors. Intraoperative radiotherapy-related peripheral neuropathy in humans receiving doses of 20-25 Gy is manifested as a mixed motor-sensory deficit beginning 6-9 months following treatment. In a previous experimental study of intraoperative radiotherapy-related neuropathy of the lumbro-sacral plexus, an approximate inverse linear relationship was reported between the intraoperative dose (20-75 Gy range) and the time to onset of hind limb paresis (1-12 mos following intraoperative radiotherapy). The principal histological lesion in irradiated nerve was loss of large nerve fibers and perineural fibrosis without significant vascular injury. Similar histological changes in irradiated nerves were found in humans. To assess peripheral nerve injury to lower doses of intraoperative radiotherapy in this same large animal model, groups of four adult American Foxhounds received doses of 10, 15, or 20 Gy to the right lumbro-sacral plexus and sciatic nerve using 9 MeV electrons. The left lumbro-sacral plexus and sciatic nerve were excluded from the intraoperative field to allow each animal to serve as its own control. Following treatment, a complete neurological exam, electromyogram, and nerve conduction studies were performed monthly for 1 year. Monthly neurological exams were performed in years 2 and 3 whereas electromyogram and nerve conduction studies were performed every 3 months during this follow-up period. With follow-up of greater than or equal to 42 months, no dog receiving 10 or 15 Gy IORT shows any clinical or laboratory evidence of peripheral nerve injury. However, all four dogs receiving 20 Gy developed right hind limb paresis at 8, 9, 9, and 12 mos following intraoperative radiotherapy.

  8. Early Controversies Over Athetosis: II. Treatment

    PubMed Central

    Lanska, Douglas J.

    2013-01-01

    Background Athetosis has been controversial since it was first described by William Hammond in 1871; many aspects of Hammond’s career were equally controversial. Methods Primary sources have been used to review treatment controversies in the 50-year period following the initial description of athetosis. Results The treatments used most commonly employed available pharmaceutical agents and modalities (e.g., galvanism). Initial anecdotal reports of success were seldom confirmed with subsequent experience. Several novel invasive therapies were also developed and promoted, all of which damaged or destroyed either upper or lower motor neuron pathways, and were also often associated with high mortality rates. In general, these therapies substituted paresis for abnormal spontaneous movements. These included peripheral nerve stretching, excision of a portion of the precentral gyrus, rhizotomy, nerve “transplantation” (i.e., neurotomy and nerve-to-nerve anastomoses), and “muscle group isolation” (i.e., alcohol neurolysis). There was no agreement on the appropriateness of such high-risk procedures, particularly given the intentional generation of further neurological morbidity. Discussion Pharmaceutical agents and modalities initially employed for athetosis had little a priori evidence-based justification and no biologically plausible theoretical framework to guide empiric treatment selection. Subsequently, all the invasive procedures employed were directed at lessening or removing the manifestations, rather than the underlying cause, of the abnormal central nervous system “irritation,” usually by imposing paresis or paralysis. Factors contributing to the disparity in outcomes between favorable initial reports and the often-disappointing results of later studies included reliance on anecdotal reports or small uncontrolled case series, placebo effects, biased observation, misdiagnosis, and biased reporting. PMID:23450199

  9. Preoperative navigated transcranial magnetic stimulation in patients with motor eloquent lesions with emphasis on metastasis.

    PubMed

    Hendrix, Philipp; Senger, Sebastian; Griessenauer, Christoph J; Simgen, Andreas; Schwerdtfeger, Karsten; Oertel, Joachim

    2016-10-01

    Navigated transcranial magnetic stimulation (nTMS) is a frequently used, non-invasive method to map the motor cortex. It is of great value in the preoperative workup of patients that suffer from motor eloquent brain lesions. Here, we present a single-center experience using preoperative nTMS in cortical motor eloquent lesions with emphasis on metastasis. All patients that underwent preoperative nTMS between June 2013 and January 2016 were evaluated. A total of 61 patients underwent nTMS before undergoing surgery for a motor eloquent brain lesion. Patients suffered from cerebral metastasis (23), glioblastoma (16), high grade glioma WHO III (4), low grade glioma WHO II (4), lymphoma (2), meningioma (8), cavernous hemangioma (3), or arteriovenous malformation (1). Thirty patients (49.2%) presented with a preoperative motor deficit. One week after surgery, paresis had resolved or improved in 56.7% of the patients. Out of the patients with postoperative paresis, 89.5% experienced an improvement of motor status at follow-up. All metastatic lesions were completely resected compared to 78.9% of non-metastatic lesions (P = 0.02). Only 4.3% of patients with a metastatic lesion, but 26.3% of patients with a non-metastatic lesion experienced deterioration of motor function after surgery (P = 0.04). Preoperative nTMS is suitable for mapping of a variety of motor eloquent brain lesions resulting in favorable neurological outcome. Particularly in metastatic motor eloquent lesion, motor function appears to be preserved after surgery. Clin. Anat. 29:925-931, 2016. © 2016 Wiley Periodicals, Inc.

  10. VORICONAZOLE TOXICITY IN MULTIPLE PENGUIN SPECIES.

    PubMed

    Hyatt, Michael W; Georoff, Timothy A; Nollens, Hendrik H; Wells, Rebecca L; Clauss, Tonya M; Ialeggio, Donna M; Harms, Craig A; Wack, Allison N

    2015-12-01

    Aspergillosis is a common respiratory fungal disease in penguins managed under human care. Triazole antifungal drugs, including itraconazole, are most commonly used for treatment; however, itraconazole treatment failures from drug resistance are becoming more common, requiring newer treatment options. Voriconazole, a newer triazole, is being used more often. Until recently, no voriconazole pharmacokinetic studies had been performed in penguins, leading to empiric dosing based on other avian studies. This has led to increased anecdotal reporting of apparent voriconazole toxicity in penguins. This report describes 18 probable and 6 suspected cases of voriconazole toxicity in six penguin species from nine institutions: 12 African penguins (Spheniscus demersus), 5 Humboldt penguins (Spheniscus humboldti), 3 Magellanic penguins (Spheniscus magellanicus), 2 gentoo penguins (Pygoscelis papua papua), 1 macaroni penguin (Eudyptes chrysolophus), and 1 emperor penguin (Aptenodytes forsteri). Observed clinical signs of toxicity included anorexia, lethargy, weakness, ataxia, paresis, apparent vision changes, seizure-like activity, and generalized seizures. Similar signs of toxicity have also been reported in humans, in whom voriconazole therapeutic plasma concentration for Aspergillus spp. infections is 2-6 μg/ml. Plasma voriconazole concentrations were measured in 18 samples from penguins showing clinical signs suggestive of voriconazole toxicity. The concentrations ranged from 8.12 to 64.17 μg/ml, with penguins having plasma concentrations above 30 μg/ml exhibiting moderate to severe neurologic signs, including ataxia, paresis, and seizures. These concentrations were well above those known to result in central nervous system toxicity, including encephalopathy, in humans. This case series highlights the importance of species-specific dosing of voriconazole in penguins and plasma therapeutic drug monitoring. Further investigation, including pharmacokinetic studies, is

  11. Calculated globulin (CG) as a screening test for antibody deficiency.

    PubMed

    Jolles, S; Borrell, R; Zouwail, S; Heaps, A; Sharp, H; Moody, M; Selwood, C; Williams, P; Phillips, C; Hood, K; Holding, S; El Shanawany, T

    2014-09-01

    Calculated globulin (total protein - albumin) is usually tested as part of a liver function test profile in both primary and secondary care and determines the serum globulin concentration, of which immunoglobulins are a major component. The main use hitherto of calculated globulin is to detect paraproteins when the level is high. This study investigated the potential to use low levels of calculated globulin to detect antibody deficiency. Serum samples with calculated globulin cut-off < 18 g/l based on results of a pilot study were collected from nine hospitals in Wales over a 12-month period. Anonymized request information was obtained and the samples tested for immunoglobulin levels, serum electrophoresis and, if appropriate, immunofixation. A method comparison for albumin measurement using bromocresol green and bromocresol purple was undertaken. Eighty-nine per cent (737 of 826) samples had an immunoglobulin (Ig)G level of < 6 g/l using the bromocresol green methodology with a cut-off of < 18 g/l, and 56% (459) had an IgG of < 4 g/l. Patients with both secondary and primary antibody deficiency were discovered and serum electrophoresis and immunofixation showed that 1·2% (10) had previously undetected small paraproteins associated with immune-paresis. Using bromocresol purple, 74% of samples had an IgG of < 6 g/l using a cut-off of < 23 g/l. Screening using calculated globulin with defined cut-off values detects both primary and secondary antibody deficiency and new paraproteins associated with immune-paresis. It is cheap, widely available and under-utilized. Antibody-deficient patients have been discovered using information from calculated globulin values, shortening diagnostic delay and time to treatment with immunoglobulin replacement therapy.

  12. Treatment of cows with milk fever using intravenous and oral calcium and phosphorus.

    PubMed

    Braun, U; Blatter, M; Büchi, R; Hässig, M

    2012-09-01

    Fifteen cows with milk fever were treated with 500ml of 40 % calcium borogluconate (group A) administered intravenously. Fifteen other cows with milk fever received the same treatment, supplemented with 500ml of 10 % sodium phosphate administered intravenously, and 80g calcium as calcium lactate and 70g inorganic phosphorus as sodium phosphate administered orally in drinking water. The cows were monitored and blood samples collected for 3 days to measure the concentrations of total and ionized calcium, inorganic phosphorus and magnesium and the activity of creatine kinase. The two groups did not differ significantly with respect to the course of the disease. In each group 14 cows were cured. A rapid and significant increase in serum calcium concentration from the hypo- to the hypercalcaemic range occurred in both groups within 10min of the start of treatment, followed by a slow and steady decrease to the hypocalcaemic range. Calcium lactate did not prevent the calcium concentration from returning to the hypocalcaemic range, and the calcium profiles of the two groups did not differ significantly. As expected, treatment had little effect on the concentration of inorganic phosphorus in group A. In group B, treatment caused a rapid increase in the concentration of inorganic phosphorus to a maximum 20min after the start of treatment. This was followed by a slow decrease in the phosphorus concentration to the normophosphataemic range. Our findings confirmed that combined intravenous and oral administration of sodium phosphate in cows with periparturient paresis attributable to hypocalcaemia and hypophosphataemia results in a rapid and sustained increase in serum phosphorus, but not in serum calcium concentration. This modified therapy did not improve the success rate of milk fever treatment and further studies are needed to improve treatment of periparturient paresis.

  13. Cholestenoic acids regulate motor neuron survival via liver X receptors

    PubMed Central

    Theofilopoulos, Spyridon; Griffiths, William J.; Crick, Peter J.; Yang, Shanzheng; Meljon, Anna; Ogundare, Michael; Kitambi, Satish Srinivas; Lockhart, Andrew; Tuschl, Karin; Clayton, Peter T.; Morris, Andrew A.; Martinez, Adelaida; Reddy, M. Ashwin; Martinuzzi, Andrea; Bassi, Maria T.; Honda, Akira; Mizuochi, Tatsuki; Kimura, Akihiko; Nittono, Hiroshi; De Michele, Giuseppe; Carbone, Rosa; Criscuolo, Chiara; Yau, Joyce L.; Seckl, Jonathan R.; Schüle, Rebecca; Schöls, Ludger; Sailer, Andreas W.; Kuhle, Jens; Fraidakis, Matthew J.; Gustafsson, Jan-Åke; Steffensen, Knut R.; Björkhem, Ingemar; Ernfors, Patrik; Sjövall, Jan; Arenas, Ernest; Wang, Yuqin

    2014-01-01

    Cholestenoic acids are formed as intermediates in metabolism of cholesterol to bile acids, and the biosynthetic enzymes that generate cholestenoic acids are expressed in the mammalian CNS. Here, we evaluated the cholestenoic acid profile of mammalian cerebrospinal fluid (CSF) and determined that specific cholestenoic acids activate the liver X receptors (LXRs), enhance islet-1 expression in zebrafish, and increase the number of oculomotor neurons in the developing mouse in vitro and in vivo. While 3β,7α-dihydroxycholest-5-en-26-oic acid (3β,7α-diHCA) promoted motor neuron survival in an LXR-dependent manner, 3β-hydroxy-7-oxocholest-5-en-26-oic acid (3βH,7O-CA) promoted maturation of precursors into islet-1+ cells. Unlike 3β,7α-diHCA and 3βH,7O-CA, 3β-hydroxycholest-5-en-26-oic acid (3β-HCA) caused motor neuron cell loss in mice. Mutations in CYP7B1 or CYP27A1, which encode enzymes involved in cholestenoic acid metabolism, result in different neurological diseases, hereditary spastic paresis type 5 (SPG5) and cerebrotendinous xanthomatosis (CTX), respectively. SPG5 is characterized by spastic paresis, and similar symptoms may occur in CTX. Analysis of CSF and plasma from patients with SPG5 revealed an excess of the toxic LXR ligand, 3β-HCA, while patients with CTX and SPG5 exhibited low levels of the survival-promoting LXR ligand 3β,7α-diHCA. Moreover, 3β,7α-diHCA prevented the loss of motor neurons induced by 3β-HCA in the developing mouse midbrain in vivo.Our results indicate that specific cholestenoic acids selectively work on motor neurons, via LXR, to regulate the balance between survival and death. PMID:25271621

  14. A case of possible paraneoplastic neurological syndrome presenting as multiple cranial nerve palsies associated with gallbladder cancer.

    PubMed

    Kaido, Misako; Yuasa, Yoshihito; Yamamoto, Tameyoshi; Munakata, Satoru; Tagawa, Naohiro; Tanaka, Keiko

    2016-09-29

    We report the case of a patient who had developed multiple cranial nerve palsies in the course of possible paraneoplastic neurological syndrome (PNS) associated with gallbladder cancer. Twelve days prior to visiting our hospital, a 69-year-old man began experiencing neurological symptoms, beginning with diplopia and progressing to ptosis of the left palpebra and subsequent complete closure of the eye within 8 days. Results of the initial medical examination indicated paresis of left oculomotor (III) and abducens (VI) nerves. MRI of the brain revealed no focal lesion that could have resulted in compression of the affected nerves, while further examination ruled out diabetes mellitus, infection, vasculitis, and other systemic autoimmune diseases as potential causes. Gadolinium-enhanced MRI revealed high intensity located in the oculomotor nerves, and steroid pulse therapy was performed based on the assumption of inflammatory diseases. Although slight improvement was observed with respect to the left extraocular paresis, subsequent emergence of bilateral facial nerve (VII) palsy, right abducens nerve palsy, and right oculomotor nerve palsy occurred in succession. PET/CT performed under suspicion of PNS, confirmed the presence of gallbladder cancer. Surgical extirpation of the cancer occurred 3 months following the appearance of left oculomotor paralysis, after which the patient underwent postoperative chemotherapy. All cranial nerve palsies resolved within 2 months after the operation, and both cancer and PNS have shown no recurrence for over 5 years. Pathological examination of the resected tumor revealed well-differentiated tubular adenocarcinoma showing some signs of epithelial-mesenchymal transition, typically an indicator of a poor prognosis. Nevertheless, lymph node metastasis did not progress beyond N2, and the cancer was completely removed by lymph node dissection. Therefore, the presence of multiple cranial palsies in this patient led to early detection of

  15. Reduction in memory in passive avoidance learning, exploratory behaviour and synaptic plasticity in mice with a spontaneous deletion in the ubiquitin C-terminal hydrolase L1 gene.

    PubMed

    Sakurai, Mikako; Sekiguchi, Masayuki; Zushida, Ko; Yamada, Kazuyuki; Nagamine, Satoshi; Kabuta, Tomohiro; Wada, Keiji

    2008-02-01

    Overexpression of ubiquitin C-terminal hydrolase L1 (UCH-L1) in mice rescues amyloid beta-protein-induced decreases in synaptic plasticity and memory. However, the physiological role of UCH-L1 in the brain is not fully understood. In the present study, we investigated the role of UCH-L1 in the brain by utilizing gracile axonal dystrophy (gad) mice with a spontaneous deletion in the gene Uch-l1 as a loss-of-function model. Although gad mice exhibit motor paresis beginning at approximately 12 weeks of age, it is possible to analyse their brain phenotypes at a younger age when no motor paresis is evident. Maintenance of memory in a passive avoidance test and exploratory behaviour in an open field test were reduced in 6-week-old gad mice. The maintenance of theta-burst stimulation-induced long-term potentiation (LTP) of field synaptic responses from Schaffer collaterals to CA1 pyramidal cells in hippocampal slices was also impaired in gad mice. The LTP in gad mice was insensitive to actinomycin D, suggesting that a transcription-dependent component of the LTP is impaired. Phosphorylation of cyclic AMP response element binding protein (CREB) in the CA1 region of hippocampal slices from gad mice occurred earlier than in the slices from wild-type mice and was transient, suggesting that CREB phosphorylation is altered in gad mice. These results suggest that memory in passive avoidance learning, exploratory behaviour and hippocampal CA1 LTP are reduced in gad mice. We propose that UCH-L1-mediated maintenance of the temporal integrity and persistence of CREB phosphorylation underlies these impairments.

  16. Spinal cord compression in two related Ursus arctos horribilis.

    PubMed

    Thomovsky, Stephanie A; Chen, Annie V; Roberts, Greg R; Schmidt, Carrie E; Layton, Arthur W

    2012-09-01

    Two 15-yr-old grizzly bear littermates were evaluated within 9 mo of each other with the symptom of acute onset of progressive paraparesis and proprioceptive ataxia. The most significant clinical examination finding was pelvic limb paresis in both bears. Magnetic resonance examinations of both bears showed cranial thoracic spinal cord compression. The first bear had left-sided extradural, dorsolateral spinal cord compression at T3-T4. Vertebral canal stenosis was also observed at T2-T3. Images of the second bear showed lateral spinal cord compression from T2-T3 to T4-T5. Intervertebral disk disease and associated spinal cord compression was also observed at T2-T3 and T3-T4. One grizzly bear continued to deteriorate despite reduced exercise, steroid, and antibiotic therapy. The bear was euthanized, and a necropsy was performed. The postmortem showed a spinal ganglion cyst that caused spinal cord compression at the level of T3-T4. Wallerian-like degeneration was observed from C3-T6. The second bear was prescribed treatment that consisted of a combination of reduced exercise and steroid therapy. He continued to deteriorate with these medical therapies and was euthanized 4 mo after diagnosis. A necropsy showed hypertrophy and protrusion of the dorsal longitudinal ligament at T2-T3 and T3-T4, with resulting spinal cord compression in this region. Wallerian-like degeneration was observed from C2-L1. This is one of few case reports that describes paresis in bears. It is the only case report, to the authors' knowledge, that describes spinal magnetic resonance imaging findings in a grizzly bear and also the only report that describes a cranial thoracic myelopathy in two related grizzly bears with neurologic signs.

  17. Facial disability index (FDI): Adaptation to Spanish, reliability and validity

    PubMed Central

    Gonzalez-Cardero, Eduardo; Cayuela, Aurelio; Acosta-Feria, Manuel; Gutierrez-Perez, Jose-Luis

    2012-01-01

    Objectives: To adapt to Spanish the facial disability index (FDI) described by VanSwearingen and Brach in 1995 and to assess its reliability and validity in patients with facial nerve paresis after parotidectomy. Study Design: The present study was conducted in two different stages: a) cross-cultural adaptation of the questionnaire and b) cross-sectional study of a control group of 79 Spanish-speaking patients who suffered facial paresis after superficial parotidectomy with facial nerve preservation. The cross-cultural adaptation process comprised the following stages: (I) initial translation, (II) synthesis of the translated document, (III) retro-translation, (IV) review by a board of experts, (V) pilot study of the pre-final draft and (VI) analysis of the pilot study and final draft. Results: The reliability and internal consistency of every one of the rating scales included in the FDI (Cronbach’s alpha coefficient) was 0.83 for the complete scale and 0.77 and 0.82 for the physical and the social well-being subscales. The analysis of the factorial validity of the main components of the adapted FDI yielded similar results to the original questionnaire. Bivariate correlations between FDI and House-Brackmann scale were positive. The variance percentage was calculated for all FDI components. Conclusions: The FDI questionnaire is a specific instrument for assessing facial neuromuscular dysfunction which becomes a useful tool in order to determine quality of life in patients with facial nerve paralysis. Spanish adapted FDI is equivalent to the original questionnaire and shows similar reliability and validity. The proven reproducibi-lity, reliability and validity of this questionnaire make it a useful additional tool for evaluating the impact of facial nerve paralysis in Spanish-speaking patients. Key words:Parotidectomy, facial nerve paralysis, facial disability. PMID:22926474

  18. Parsonage-Turner syndrome following post-exposure prophylaxis

    PubMed Central

    2014-01-01

    Background The ‘Parsonage-Turner syndrome’ (PTS) is a rare but distinct disorder with an abrupt onset of shoulder pain, followed by weakness and atrophy of the upper extremity musculature, and a slow recovery requiring months to years. To our best knowledge, this is the first case describing symptoms and signs of PTS following the administration of a post-exposure prophylaxis (PEP) regimen against possible human immunodeficiency virus (HIV) and hepatitis B virus (HBV) infection. Case presentation A 25-year-old Caucasian man presented with pain and unilateral scapular winging following PEP against possible HIV and HBV infection. Although atrophy and weakness were observed for the right supraspinatus muscle, a full range of motion was achievable. Neurological examination, plain radiography of the right shoulder and electromyography showed no additional abnormalities. The patient was diagnosed with post-vaccination PTS and treated non-operatively. During the following 15 months the scapular winging receded and full muscle strength was regained. Conclusion Parsonage-Turner syndrome is a rare clinical diagnosis. The precise pathophysiological mechanism of PTS remains unclear, but it seems to involve an interaction between genetic predisposition, mechanical vulnerability and an autoimmune trigger. An immunological event, such as – in this case – a vaccination as part of PEP treatment, can trigger the onset of PTS. The clinical presentation is distinctive with acute severe pain followed by patchy paresis, atrophy and sensory symptoms that persist for months to years. No currently available tests can provide a definite confirmation or exclusion of PTS. Routine blood examination, electromyography (EMG), and computed tomography (CT) or magnetic resonance imaging (MRI) serve mainly to exclude other disorders. The recovery can be quite lengthy, non-operative treatment is the accepted practice. Supplementary administration of oral prednisolone could shorten the

  19. An imaging informatics-based ePR (electronic patient record) system for providing decision support in evaluating dose optimization in stroke rehabilitation

    NASA Astrophysics Data System (ADS)

    Liu, Brent J.; Winstein, Carolee; Wang, Ximing; Konersman, Matt; Martinez, Clarisa; Schweighofer, Nicolas

    2012-02-01

    Stroke is one of the major causes of death and disability in America. After stroke, about 65% of survivors still suffer from severe paresis, while rehabilitation treatment strategy after stroke plays an essential role in recovery. Currently, there is a clinical trial (NIH award #HD065438) to determine the optimal dose of rehabilitation for persistent recovery of arm and hand paresis. For DOSE (Dose Optimization Stroke Evaluation), laboratory-based measurements, such as the Wolf Motor Function test, behavioral questionnaires (e.g. Motor Activity Log-MAL), and MR, DTI, and Transcranial Magnetic Stimulation (TMS) imaging studies are planned. Current data collection processes are tedious and reside in various standalone systems including hardcopy forms. In order to improve the efficiency of this clinical trial and facilitate decision support, a web-based imaging informatics system has been implemented together with utilizing mobile devices (eg, iPAD, tablet PC's, laptops) for collecting input data and integrating all multi-media data into a single system. The system aims to provide clinical imaging informatics management and a platform to develop tools to predict the treatment effect based on the imaging studies and the treatment dosage with mathematical models. Since there is a large amount of information to be recorded within the DOSE project, the system provides clinical data entry through mobile device applications thus allowing users to collect data at the point of patient interaction without typing into a desktop computer, which is inconvenient. Imaging analysis tools will also be developed for structural MRI, DTI, and TMS imaging studies that will be integrated within the system and correlated with the clinical and behavioral data. This system provides a research platform for future development of mathematical models to evaluate the differences between prediction and reality and thus improve and refine the models rapidly and efficiently.

  20. Evolution of Neurological Impairment in Pediatric Infratentorial Ependymoma Patients

    PubMed Central

    Morris, E. Brannon; Li, Chenghong; Khan, Raja B.; Sanford, Robert A; Boop, Frederick; Pinlac, Renee; Xiong, Xiaoping; Merchant, Thomas E.

    2009-01-01

    Background Infratentorial ependymoma is a common central nervous system tumor of childhood and in patients > 1 year of age is treated with maximally feasible surgical resection and radiotherapy. Because of this tumor typically arises within the 4th ventricle and can invade the brainstem, patients are at risk for significant neurological impairment. Purpose To characterize the incidence, evolution, and persistence of neurologic impairment in children with infratentorial ependymoma following maximal safe surgery and conformal or intensity-modulated radiation therapy (CRT/IMRT). Patients and Methods After surgical resection, 96 children with non-metastatic infratentorial ependymoma were enrolled on a phase II study of image-guided radiation therapy and were prospectively followed with interval comprehensive neurological examinations. Late adverse neurological severity was graded according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE), version 3.0. Results The most common deficits detected at baseline examination were limb dysmetria, cranial nerve VI/VII palsy, limb paresis, dysphagia, and truncal ataxia/hypotonia. When present, gait dysfunction and dysphagia were often severe. Oculomotor dysfunction, facial paresis, dysphagia, and gait impairment improved over time. With the exception of hearing loss, in the survivor cohort, very few severe late effects (CTCAE Grade 3/4/5) were present at 60 month survival. Conclusion In general, neurological deficits were maximal in the post-operative period and either remained stable or improved during radiation and the post-treatment evaluation period. With the exception of hearing, the majority of chronic residual neurological deficits in this at-risk population are mild and only minimally intrude upon daily life. PMID:19330288

  1. The transfer of maternal IgE and other immunoglobulins specific for Trichostrongylus colubriformis larval excretory/secretory product to the neonatal lamb.

    PubMed

    Pfeffer, A; Shaw, R J; Green, R S; Phegan, M D

    2005-12-15

    The transference of immunoglobulins from six New Zealand Romney ewes to their lambs was examined. Immunoglobulin levels were determined in ewe plasma, colostrum and lamb plasma shortly after birth and before the lambs fed, in lamb plasma 2 days after birth, and lamb plasma, ewe plasma and milk 30 days after parturition. Levels of total IgE, and IgE, IgG1, IgG2, IgM, and IgA with specificity for Trichostronglus colubriformis third stage larval secretory/excretory products (TcL3E/S) were determined. Mean levels of total IgE were three times higher in colostrum than in parturient ewe plasma while only trace amounts were detected in milk at 30 days after birth (107.7, 34.3, and 0.2U ml(-1), respectively, differences between means P< or =0.01). Mean total IgE in lamb plasma rose from being undetectable before suckling to levels comparable to those of the ewes by 2 days after birth (21.7U ml(-1)) and then declined to low levels by 30 days (0.4U ml(-1)). Total IgE levels in lamb plasma were significantly correlated with levels in ewe plasma and colostrum (r=0.91, P< or =0.01; r=0.96, P< or =0.003, respectively). The transference of TcL3E/S-specific IgE, IgG1 and IgA was substantial with mean levels of these antibodies in lamb plasma at 2 days comparable to that in parturient ewe plasma (absorbance levels in lamb plasma of 0.283, 0.537, and 0.334, respectively). Proportionally less maternal IgM and IgG2 appeared to be transferred to the lambs (absorbance of 0.112 and 0.081, respectively). Levels of TcL3E/S-specific IgE and IgG1 in lamb plasma at 2 days were significantly correlated with levels in parturient ewe plasma and colostrum (r=0.89 and 0.82, 0.85 and 0.96; all P< or =0.05, respectively). These results indicate that IgE is concentrated in ewe colostrum and that substantial amounts of maternal IgE are transferred to lambs via colostrum. Further, the results suggest that humoral immunity against gastro-intestinal nematode parasites and potentially other parasites in

  2. A spatial analysis to study access to emergency obstetric transport services under the public private “Janani Express Yojana” program in two districts of Madhya Pradesh, India

    PubMed Central

    2014-01-01

    Background The government in Madhya Pradesh (MP), India in 2006, launched “Janani Express Yojana” (JE), a decentralized, 24X7, free emergency transport service for all pregnant women under a public-private partnership. JE supports India’s large conditional cash transfer program, the “Janani Suraksha Yojana” (JSY) in the province and transports on average 60,000 parturients to hospital every month. The model is a relatively low cost one that potentially could be adopted in other parts of India and South Asia. This paper describes the uptake, time taken and geographic equity in access to the service to transport women to a facility in two districts of MP. Methods This was a facility based cross sectional study. We interviewed parturients (n = 468) who delivered during a five day study period at facilities with >10 deliveries/month (n = 61) in two study districts. The women were asked details of transportation used to arrive at the facility, time taken and their residential addresses. These details were plotted onto a Geographic Information System (GIS) to estimate travelled distances and identify statistically significant clusters of mothers (hot spots) reporting delays >2 hours. Results JE vehicles were well dispersed across the districts and used by 236 (50.03%) mothers of which 111(47.03%) took >2 hours to reach a facility. Inability of JE vehicle to reach a mother in time was the main reason for delays. There was no correlation between the duration of delay and distance travelled. Maps of the travel paths and travel duration of the women are presented. The study identified hot spots of mothers with delays >2 hours and explored the possible reasons for longer delays. Conclusions The JE service was accessible in all parts of the districts. Relatively high utilization rates of JE indicate that it ably supported JSY program to draw more women for institutional deliveries. However, half of the JE users experienced long (>2 hour) delays. The delayed mothers

  3. Efficacy of lipophilic vs lipophobic opioids in addition to hyperbaric bupivacaine for patients undergoing lower segment caeserean section

    PubMed Central

    Agrawal, Amit; Asthana, Veena; Sharma, J. P.; Gupta, Vineeta

    2016-01-01

    Background: Subarachnoid block is the preferred technique for providing anesthesia for patients undergoing cesarean section. Various pharmacological agents in added to local anesthetics (LA) modify their original effects in terms of block characteristics and quality of analgesia. However, there is ongoing debate about this practice of using adjuncts with LA. We tested whether addition of lipophilic versus lipophobic opioids to LA gives any clinical benefits to maternal and fetal outcome when used in these patients requiring spinal anesthesia. Subjects and Methods: Sixty American Society of Anesthesiologists I and II parturients, undergoing elective cesarean section requiring subarachnoid block, were included in our study. The parturients were allocated randomly to three groups of 20 each to receive bupivacaine 12.5 mg (Group I), bupivacaine 12.5 mg + morphine 0.2 mg (Group II), bupivacaine 12.5 mg + fentanyl 25 μg (Group III), preservative free physiological saline 0.9% was added to all the solutions to achieve a total volume of 4 ml. The parameters studied were the time of onset, sensory level of the block achieved, total duration of analgesia, any need of rescue analgesics, maternal side effects, and fetal outcome. Results: Onset of block was early 4.30 ± 0.12 min in Group III as compared to Group I 4.64 ± 0.28 min and Group II 4.505 ± 0.22 min. Mean duration of analgesia (hours) was higher in Group II 15.91 ± 0.96 h as compared to Group I 1.95 ± 0.55 h and Group III 4.39 ± 0.2 h. Incidence of nausea, vomiting, and shivering was more in the control group as compared to study groups, whereas sedation and pruritus were seen more in the study groups. No adverse effects on fetus were seen with use of opioids and comparable Apgar scores were noted. Conclusion: Addition of intrthecal fentanyl causes rapid onset of block whereas intrathecal morphine provides prolonged analgesia with comparable neonatal wellbeing. PMID:27746526

  4. Patient-controlled intravenous analgesia as an alternative to epidural analgesia during labor: questioning the use of the short-acting opioid remifentanil. Survey in the French part of Belgium (Wallonia and Brussels).

    PubMed

    Lavand'homme, P; Roelants, F

    2009-01-01

    Childbirth ranks among the most intense experiences of acute pain. Neuraxial analgesia (i.e. epidural or combined spinal-epidural technique) is the most effective way to relieve that pain but it is contraindicated or impossible to perform for some parturients. We designed a survey of the current use of analgesic alternatives to epidural analgesia (EA) for labor pain, specifically the use of opioid patient-controlled intravenous analgesia (PCIA), in the French part of Belgium (Wallonia and Brussels). A questionnaire was mailed to the departmental chair of the hospitals with an obstetric unit, both in university and non-university centers (total of 53 centers). The questionnaire evaluated the availability of EA, the alternatives used when EA was contraindicated, the use of opioid-based PCIA for labor analgesia as well as opioid preference and doses, and finally the reasons for not using opioid PCIA. The response rate was 67.5% (36 centers). Among the responding hospitals, EA was available for 68% (range 25-85%) of labors and deliveries. When EA was not available or contraindicated, a parenteral opioid (piritramide, tramadol or pethidine) was proposed in 19% (7/36) of the centers, Entonox in 11% (4/36), a pudendal block by obstetricians in 28% (10/36) and non-pharmacologic alternatives (i.e. hypnosis, sophrology, baths and massages) in 19% (7/36). In 28% (10/36) of the centers however, no analgesic alternative was proposed. Opioid PCIA was employed in 36% (13/36) of the centers and for an additional 11% (4/36) only in case of intrauterine death. Remifentanil was the first choice (76.5% of the PCIA), followed by sufentanil (23.5%). Other opioids (piritramide, morphine, fentanyl) and ketamine were also administered by PCIA. Forty-five percents of the centers reported never using opioid PCIA by either lack of knowledge (7%), fear of maternal or fetal side effects (48%) and unability to provide a correct supervision of the parturient during PCIA use (48%), opposition from

  5. The role of fibrinogen and haemostatic assessment in postpartum haemorrhage: preparations for a randomised controlled trial.

    PubMed

    Wikkelsø, Anne Juul

    2015-04-01

    Pregnancy is a state of hypercoagulobility that might be an evolutionary way of protecting parturients from exsanguination following child birth. Observational studies suggest an association between a low level of fibrinogen (coagulation factor I) at the start of postpartum haemorrhage (PPH) and subsequent severity of bleeding. Fibrinogen concentrate may be prescribed to correct acquired hypofibrinogenaemia, but evidence is lacking regarding the treatment efficacy. This thesis assesses the current evidence for the use of fibrinogen concentrate and haemostatic assessment in bleeding patients with special attention to the obstetrical population. It includes five papers: In Paper I the benefits or harms of fibrinogen concentrate in bleeding patients in general was evaluated using a systematic Cochrane review methodology with metaanalysis of all published randomized controlled trials (RCTs). Six trials with high risk of bias were included (248 patients). Fibrinogen appeared to reduce the need of allogenic transfusions by 53%. However, the included trials were conducted only in an elective surgical setting with a population of mainly cardiac surgical patients. Paper II was also a systematic review based on Cochrane methodology evaluating the use of viscoelastic haemostatic assays to guide haemostatic transfusion in bleeding patients. Nine RCTs (776 patients) with high risk of bias were included primarily in elective cardiac surgical patients and none were specific for the obstetric subpopulation. Viscoelastic haemostatic assay guided transfusion algorithm reduced blood loss and the proportion of patients exposed to fresh frozen plasma (FFP) or platelets. In both studies, we were unable to make firm conclusion on our primary outcome, "all cause mortality" due to lack of adequate data. Paper III was based on two national Danish registries evaluating the predictability of postpartum blood transfusion. Prediction was found difficult. However, retained placental parts seemed

  6. Maternal Chlamydia trachomatis Infections and Preterm Births in a University Hospital in Vitoria, Brazil

    PubMed Central

    Schmidt, Renylena; Muniz, Renan Rosetti; Cola, Elizandra; Stauffert, Dulce; Silveira, Mariangela Freitas; Miranda, Angelica E.

    2015-01-01

    Background Preterm birth (PTB) is a major determinant of neonatal morbimortality with adverse consequences for health. The causes are multifactorial, with intrauterine infection probably explaining most of these outcomes. It is believed that infection with Chlamydia trachomatis (CT) is also involved in PTB and premature rupture of membranes. Objetives To evaluate the prevalence of and associated factors for CT among cases of PTB attended at a University Hospital in Vitoria, Brazil. Methods A cross-sectional study performed among parturient who had preterm birth from June 2012 to August 2013 in Vitoria, Brazil. Participants answered a questionnaire including demographic, behavioral, and clinical data. A sample of urine was collected and screened for CT using polymerase chain reaction. Chi-square tests were used for proportion differences and Student’s-t tests and variance analysis were used for testing differences between mean values. Odds ratio was used as a measure of association with a 95% confidence interval. Results The prevalence of PTB during the period of the study was 26% and the prevalence of CT among them was 13.9%. A total of 31.6% pregnant women were younger than 25 years old and women infected by CT were even younger than women not infected by CT (p = 0.022). Most of them (76.2%) were married or had a living partner, and CT infection was more frequent among the single ones (p = 0.018); 16.7% of women reported their first sexual intercourse under 14 years old. The causes of prematurity were maternal-fetal in 40.9%; rupture of the membranes in 29.7% and premature labor in 29.4%. In multivariate analysis, being married was a protective factor for infection [OR = 0.48 (95%CI:0.24–0.97)]. None of the other characteristics were associated with CT infection. Conclusions This study shows a high prevalence of CT infection among parturient who have preterm birth. This high prevalence highlight the need for defining screening strategies focused on young

  7. The effect of zeolite A supplementation in the dry period on periparturient calcium, phosphorus, and magnesium homeostasis.

    PubMed

    Thilsing-Hansen, T; Jørgensen, R J; Enemark, J M D; Larsen, T

    2002-07-01

    One potential way of preventing parturient hypocalcemia in the dairy cow is to feed dry cow rations very low in calcium (<20 g/d); but, because it is difficult to formulate rations sufficiently low in calcium, this principle has been almost abandoned. Recent studies have shown, however, that it is possible to prevent milk fever, as well as subclinical hypocalcemia, by supplementing the dry cow ration with sodium aluminium silicate (zeolite A), which has the capacity to bind calcium. The aim of this study was to further evaluate the effect, if any, of such supplementation on other blood constituents, feed intake, and milk production in the subsequent lactation. A total of 31 pregnant dry cows about to enter their third or later lactation were assigned as experimental or control cows according to parity and expected date of calving. The experimental cows received 1.4 kg of zeolite pellets per d (0.7 kg of pure zeolite A) for the last 2 wk of pregnancy. Blood samples were drawn from all cows 1 wk before the expected date of calving, at calving, at d 1 and 2 after calving, and 1 wk after calving. Additionally, a urine sample was drawn 1 wk before the expected date of calving. Zeolite supplementation significantly increased the plasma calcium level on the day of calving, whereas plasma magnesium as well as inorganic phosphate was suppressed. Serum 1,25(OH)2D was significantly increased 1 wk before the expected date of calving among the experimental cows, whereas there was no difference in the urinary excretion of the bone metabolite deoxypyridinoline between the two groups. Feed intake was decreased among the zeolite-treated cows during the last 2 wk of pregnancy. No effect was observed on milk yield, milk fat, and milk protein in the subsequent lactation. The mechanisms and interactions involved in zeolite supplementation are discussed in relation to the observed improvement in parturient calcium homeostasis and to the observed depression in blood magnesium and

  8. Dietary selenium and nutritional plane alter specific aspects of maternal endocrine status during pregnancy and lactation.

    PubMed

    Lemley, C O; Meyer, A M; Neville, T L; Hallford, D M; Camacho, L E; Maddock-Carlin, K R; Wilmoth, T A; Wilson, M E; Perry, G A; Redmer, D A; Reynolds, L P; Caton, J S; Vonnahme, K A

    2014-01-01

    Objectives were to examine effects of selenium (Se) supply and maternal nutritional plane during gestation on placental size at term and maternal endocrine profiles throughout gestation and early lactation. Ewe lambs (n = 84) were allocated to treatments that included Se supply of adequate Se (ASe; 11.5 μg/kg BW) or high Se (HSe; 77 μg/kg BW) initiated at breeding and nutritional plane of 60% (RES), 100% (CON), or 140% (EXC) of requirements beginning on day 40 of gestation. At parturition, lambs were removed from their dams, and ewes were transitioned to a common diet that met requirements of lactation. Blood samples were taken from a subset of ewes (n = 42) throughout gestation, during parturition, and throughout lactation to determine hormone concentrations. Cotyledon number was reduced (P = 0.03) in RES and EXC ewes compared with CON ewes. Placental delivery time tended (P = 0.08) to be shorter in HSe ewes than in ASe ewes, whereas placental delivery time was longer (P = 0.02) in RES ewes than in CON and EXC ewes. During gestation, maternal progesterone, estradiol-17β, and GH were increased (P < 0.05) in RES ewes and decreased (P < 0.05) in EXC ewes compared with CON ewes. In contrast, maternal cortisol, IGF-I, prolactin, triiodothyronine, and thyroxine were decreased in RES ewes and increased in EXC ewes compared with CON ewes during gestation. Selenium supply did not alter maternal hormone profiles during gestation. During parturition and lactation, maternal hormone concentrations were influenced by both Se and maternal nutritional plane. During the parturient process, HSe ewes tended to have greater (P = 0.06) concentrations of estradiol-17β than ASe ewes. Three hours after parturition a surge of GH was observed in ASe-RES ewes that was muted in HSe-RES ewes and not apparent in other ewes. Growth hormone area under the curve during the parturient process was increased (P < 0.05) in ASe-RES vs HSe-RES ewes. Ewes that were overfed during gestation had

  9. Social psychological predictors of satisfaction with intrapartum and postpartum care – what matters to women in Czech maternity hospitals?

    PubMed Central

    Seidlerová, Jitka Mlíková; Šulová, Lenka; Hoskovcová, Simona Horáková

    2015-01-01

    Objective To identify the social psychological factors affecting women’s evaluation of care provided in Czech maternity hospitals using following criteria: satisfaction with intrapartum and postpartum care, willingness to return to a given hospital and to recommend the hospital to others. Methods 762 women completed a 71-item original Czech questionnaire KLI-P designed to measure the psychosocial climate in both delivery and after-birth unit on six scales. The sample was representative of the Czech parturients population. Multivariate logistic regression was used to investigate the predictive value of the questionnaire scales for maternal satisfaction, willingness to return to and to recommend a given hospital. Results For delivery unit, the satisfaction predictors were: helpfulness and empathy of midwives (Χ2=48.9), communication of information and availability of caregivers (Χ2=16.6), helpfulness and empathy of physicians (Χ2=10.9), symmetrical and respectful attitude of staff members (Χ2=9.7) and physical comfort and services (Χ2=7.6). The predictors of satisfaction with after-birth unit included helpfulness and empathy of the staff (Χ2≥42.1), communication of information and availability of caregivers (Χ2=52.5), physical comfort and services (Χ2=30.6), control and involvement in decision-making (Χ2=6.6) and parity (Χ2=8.6). The factors influencing women’s willingness to return to and to recommend a hospital differed from the predictors of general satisfaction. Conclusions The satisfaction factors revealed in this research correspond predominantly to the results of studies conducted in other countries (warm, non-formal and supportive approach, sufficient and well-timed provision of information and explanation, availability of caregivers, physical environment). However, participation in decision making, which has been repeatedly shown to be among the strongest predictors of childbirth satisfaction, was not important for the Czech parturients

  10. Recovery of motor disability and spasticity in post-stroke after repetitive transcranial magnetic stimulation (rTMS).

    PubMed

    Málly, J; Dinya, E

    2008-07-01

    Lately it has been indicated that the stimulation of both sides of the motor cortices with different frequencies of rTMS can improve the behaviour of a paretic arm. We studied the effect of rTMS in severe cases of post-stroke after nearly 10 years. They had wide hemispheric lesion and their paresis had not changed for more than 5 years. The majority of patients could not move their fingers on the affected side. In our study we examined whether the active movement could be induced by rTMS even several years after stroke and which hemisphere (affected or unaffected) stimulated by rTMS would be the best location for attenuating the spasticity and for developing movement in the paretic arm. Sixty-four patients (more than 5 years after stroke in a stable state) were followed for 3 months. They were treated with rTMS with 1 Hz at 30% of 2.3T 100 stimuli per session twice a day for a week. The area to be stimulated was chosen according to the evoked movement by TMS in the paretic arm. That way, four groups were created and compared. In group A, where both hemispheres were stimulated (because of the single stimulation of TMS could induce movement from both sides of hemispheres) the spasticity decreased but the movement could not be influenced. A highly significant improvement in spasticity, in movement induction and in the behaviour of paresis was observed in group B, where before treatment, there was no evoked movement in the paretic arm from stimulating either hemispheres of the brain. For treatment we stimulated the unaffected hemisphere from where the intact arm is moved (ipsilateral to the paretic side). In both groups C (contralateral hemisphere to the paretic arm) and D (ipsilaterally evoked movement in the paretic arm), the spasticity decreased during the first week, but the movement of the paretic arm improved only in group C. It seems that spasticity can be modified by the stimulation either the affected or the unaffected hemisphere, but the induction of movement

  11. Carbon Ion Irradiation of the Rat Spinal Cord: Dependence of the Relative Biological Effectiveness on Linear Energy Transfer

    SciTech Connect

    Saager, Maria; Glowa, Christin; Peschke, Peter; Brons, Stephan; Scholz, Michael; Huber, Peter E.; Debus, Jürgen; Karger, Christian P.

    2014-09-01

    Purpose: To measure the relative biological effectiveness (RBE) of carbon ions in the rat spinal cord as a function of linear energy transfer (LET). Methods and Materials: As an extension of a previous study, the cervical spinal cord of rats was irradiated with single doses of carbon ions at 6 positions of a 6-cm spread-out Bragg peak (16-99 keV/μm). The TD{sub 50} values (dose at 50% complication probability) were determined according to dose-response curves for the development of paresis grade 2 within an observation time of 300 days. The RBEs were calculated using TD{sub 50} for photons of our previous study. Results: Minimum latency time was found to be dose-dependent, but not significantly LET-dependent. The TD{sub 50} values for the onset of paresis grade 2 within 300 days were 19.5 ± 0.4 Gy (16 keV/μm), 18.4 ± 0.4 Gy (21 keV/μm), 17.7 ± 0.3 Gy (36 keV/μm), 16.1 ± 1.2 Gy (45 keV/μm), 14.6 ± 0.5 Gy (66 keV/μm), and 14.8 ± 0.5 Gy (99 keV/μm). The corresponding RBEs increased from 1.26 ± 0.05 (16 keV/μm) up to 1.68 ± 0.08 at 66 keV/μm. Unexpectedly, the RBE at 99 keV/μm was comparable to that at 66 keV/μm. Conclusions: The data suggest a linear relation between RBE and LET at high doses for late effects in the spinal cord. Together with additional data from ongoing fractionated irradiation experiments, these data will provide an extended database to systematically benchmark RBE models for further improvements of carbon ion treatment planning.

  12. Pharmacological treatment of vertigo.

    PubMed

    Hain, Timothy C; Uddin, Mohammed

    2003-01-01

    This review discusses the physiology and pharmacological treatment of vertigo and related disorders. Classes of medications useful in the treatment of vertigo include anticholinergics, antihistamines, benzodiazepines, calcium channel antagonists and dopamine receptor antagonists. These medications often have multiple actions. They may modify the intensity of symptoms (e.g. vestibular suppressants) or they may affect the underlying disease process (e.g. calcium channel antagonists in the case of vestibular migraine). Most of these agents, particularly those that are sedating, also have a potential to modulate the rate of compensation for vestibular damage. This consideration has become more relevant in recent years, as vestibular rehabilitation physical therapy is now often recommended in an attempt to promote compensation. Accordingly, therapy of vertigo is optimised when the prescriber has detailed knowledge of the pharmacology of medications being administered as well as the precise actions being sought. There are four broad causes of vertigo, for which specific regimens of drug therapy can be tailored. Otological vertigo includes disorders of the inner ear such as Ménière's disease, vestibular neuritis, benign paroxysmal positional vertigo (BPPV) and bilateral vestibular paresis. In both Ménière's disease and vestibular neuritis, vestibular suppressants such as anticholinergics and benzodiazepines are used. In Ménière's disease, salt restriction and diuretics are used in an attempt to prevent flare-ups. In vestibular neuritis, only brief use of vestibular suppressants is now recommended. Drug treatments are not presently recommended for BPPV and bilateral vestibular paresis, but physical therapy treatment can be very useful in both. Central vertigo includes entities such as vertigo associated with migraine and certain strokes. Prophylactic agents (L-channel calcium channel antagonists, tricyclic antidepressants, beta-blockers) are the mainstay of treatment

  13. Effects of Stroke on Ipsilesional End-Effector Kinematics in a Multi-Step Activity of Daily Living

    PubMed Central

    Gulde, Philipp; Hughes, Charmayne Mary Lee; Hermsdörfer, Joachim

    2017-01-01

    Background: Stroke frequently impairs activities of daily living (ADL) and deteriorates the function of the contra- as well as the ipsilesional limbs. In order to analyze alterations of higher motor control unaffected by paresis or sensory loss, the kinematics of ipsilesional upper limb movements in patients with stroke has previously been analyzed during prehensile movements and simple tool use actions. By contrast, motion recording of multi-step ADL is rare and patient-control comparisons for movement kinematics are largely lacking. Especially in clinical research, objective quantification of complex externally valid tasks can improve the assessment of neurological impairments. Methods: In this preliminary study we employed three-dimensional motion recording and applied kinematic analysis in a multi-step ADL (tea-making). The trials were examined with respect to errors and sub-action structure, durations, path lengths (PLs), peak velocities, relative activity (RA) and smoothness. In order to check for specific burdens the sub-actions of the task were extracted and compared. To examine the feasibility of the approach, we determined the behavioral and kinematic metrics of the (ipsilesional) unimanual performance of seven chronic stroke patients (64a ± 11a, 3 with right/4 with left brain damage (LBD), 2 with signs of apraxia, variable severity of paresis) and compared the results with data of 14 neurologically healthy age-matched control participants (70a ± 7a). Results: T-tests revealed that while the quantity and structure of sub-actions of the task were similar. The analysis of end-effector kinematics was able to detect clear group differences in the associated parameters. Specifically, trial duration (TD) was increased (Cohen’s d = 1.77); the RA (Cohen’s d = 1.72) and the parameters of peak velocities (Cohen’s d = 1.49/1.97) were decreased in the patient group. Analysis of the task’s sub-actions repeated measures analysis of variance (rmANOVA) revealed

  14. The Effect of Virtual Reality on Pain in Primiparity Women during Episiotomy Repair: A Randomize Clinical Trial

    PubMed Central

    JahaniShoorab, Nahid; Ebrahimzadeh Zagami, Samira; Nahvi, Ali; Mazluom, Seyed Reza; Golmakani, Nahid; Talebi, Mahdi; Pabarja, Ferial

    2015-01-01

    Background Pain is one of the side effects of episiotomy. The virtual reality (VR) is a non-pharmacological method for pain relief. The purpose of this study was to determine the effect of using video glasses on pain reduction in primiparity women during episiotomy repair. Methods This clinical trial was conducted on 30 primiparous parturient women having labor at Omolbanin Hospital (Mashhad, Iran) during May-July 2012. Samples during episiotomy repair were randomly divided into two equal groups. The intervention group received the usual treatment with VR (video glasses and local infiltration 5 ml solution of lidocaine 2%) and the control group only received local infiltration (5 ml solution of lidocaine 2%). Pain was measured using the Numeric Pain Rating Scale (0-100 scale) before, during and after the episiotomy repair. Data were analyzed using Fisher’s exact test, Chi-square, Mann-Whitney and repeated measures ANOVA tests by SPSS 11.5 software. Results There were statistically significant differences between the pain score during episiotomy repair in both groups (P=0.038). Conclusion Virtual reality is an effective complementary non-pharmacological method to reduce pain during episiotomy repair. Trial Registration Number: IRCT138811063185N1. PMID:25999621

  15. Analgesia in Obstetrics

    PubMed Central

    Heesen, M.; Veeser, M.

    2012-01-01

    Background: An effective relief of labour pain has become an important part of obstetric medicine. Therefore regional nerve blocks, systemic analgesic and non-pharmacologic techniques are commonly used. This review article gives a summary of pathophysiology and anatomy of labour pain as well as advantages, disadvantages, risks and adverse reactions of analgesic techniques in newborns and parturients. Methods: We performed a selective literature search in Medline via PubMed using the search-terms “Analgesia” and “Obstetrics”. We also included the current guidelines of the German Society for Anesthesiology and Intensive Care Medicine. Results: PDA and CSE are safe techniques for the relief of labour pain if contraindications are excluded. The risk for instrumental delivery but not for caesarean section is increased under neuraxial analgesia. PDA and CSE should be performed in an early stage of labour using low doses of local anaesthetics if possible. It is not necessary to wait for a defined cervical dilatation before starting neuraxial analgesia. Anesthesiologists and obstetricians should inform patients as soon as possible before the situation of stress during labour. Systemic opioid analgesia is a possible alternative for neuraxial techniques. Because of possible side effects systemic remifentanil analgesia should only be performed under continuous monitoring. Several nonpharmacologic methods can also relieve labour pain, but results of studies about their effectiveness are inconsistent. PMID:25264376

  16. Labor epidural anesthetics comparing loss of resistance with air versus saline: does the choice matter?

    PubMed

    Norman, David; Winkelman, Chris; Hanrahan, Edward; Hood, Ray; Nance, Ben

    2006-08-01

    This study examined whether air or saline, used for the loss-of-resistance (LOR) technique, resulted in a difference in pain relief or adverse events for laboring parturients. Previous studies had mixed findings regarding the onset of analgesia and subsequent pain relief. Research questions were as follows: Is there difference in analgesic onset for patients receiving air vs saline during the LOR technique? Do women receiving the air method for LOR experience any difference in the quality of pain relief from that of women receiving saline? Is there any difference in the incidence of analgesic distribution or segmental pain relief in women receiving the air vs the saline method? Is there any difference in the incidence of adverse effects in women receiving air vs saline during the LOR technique? This was an experimental, prospective study with 50 women. Subjects were randomized to receive air or saline. The visual analogue scale was used to measure pain. A dermatome level recorded the spread of analgesia. No significant differences were found between groups for onset or quality of analgesia. There was a significant increase in the number of subjects who experienced segmental blocks after receiving air during the LOR technique.

  17. Testing alternative hypotheses for variation in amphipod behaviour and life history in relation to parasitism.

    PubMed

    McCurdy, D G; Forbes, M R; Boates, J S

    1999-07-01

    We tested two hypotheses concerning changes in investment in current reproduction for parasitised hosts, using amphipods (Corophium volutator) which act as second intermediate hosts for trematodes (Gynaecoyla aduncta). One hypothesis requires that parasites exert control over their hosts (parasite manipulation), whereas the other predicts that hosts control decisions over investment (adaptive host response). Although these hypotheses are viewed as mutually exclusive, our various results support both hypotheses. For example, female amphipods infected by late-stage larvae were often found crawling at times when predation by sandpipers (Calidris pusilla), which are the final hosts for trematodes, was likely, while uninfected females typically remained in their burrows. Furthermore, old females that were newly-infected by trematodes often aborted and ate their young. Both of these responses seem inconsistent with female investment in current reproduction, but can be interpreted as adaptive parasite manipulation. In contrast, young non-ovigerous females that were newly-infected hastened the onset of their parturial moult and thus, time to becoming receptive. This response can be explained as a host adaptation to minimise the cost of parasites. We contend that differences between parasitised and unparasitised hosts in behaviour or investment can be explained as both parasite and host adaptations, expressed at different times in the host's life history. Such compromise will help explain the persistence of parasite-host associations in nature.

  18. The intrauterine treatment of the retained foetal membrane in dairy goats by ozone: novel alternative to antibiotic therapy.

    PubMed

    Djuricic, D; Valpotic, H; Samardzija, M

    2015-04-01

    One of the major post-parturient complications in dairy goats is the retention of foetal membrane (RFM), which negatively influences their health, reproductive efficacy and welfare. The aim of this study was to compare the efficiency of intrauterine either ozone (OZ) or antibiotic (AB) treatments to establish the use of OZ as a novel and potential alternative to AB therapy in does with the RFM. The study was performed on 7 herds of dairy goats (n = 563) kept in the farms in Croatia. The conception rate was 563 of 641 total matings or 87.83%. The does from selected farms were observed during early puerperium and were divided into animals without the RFM (n = 522) and with the RFM (n = 41), treated either with foam spray OZ (n = 21) or with foaming AB oxytetracycline tablets (n = 20). The does with the RFM were mated successfully and became pregnant next kidding season, regardless of the treatment applied. Treatment with OZ attained similar results to the standard AB therapy, indicating that it could be novel potential alternative therapy of the RFM in dairy goats.

  19. Women's Choice of Positions during Labour: Return to the Past or a Modern Way to Give Birth? A Cohort Study in Italy

    PubMed Central

    Gizzo, Salvatore; Di Gangi, Stefania; Noventa, Marco; Bacile, Veronica; Zambon, Alessandra; Nardelli, Giovanni Battista

    2014-01-01

    Background. Childbirth medicalization has reduced the parturient's opportunity to labour and deliver in a spontaneous position, constricting her to assume the recumbent one. The aim of the study was to compare recumbent and alternative positions in terms of labour process, type of delivery, neonatal wellbeing, and intrapartum fetal head rotation. Methods. We conducted an observational cohort study on women at pregnancy term. Primiparous women with physiological pregnancies and single cephalic fetuses were eligible for the study. We considered data about maternal-general characteristics, labour process, type of delivery, and neonatal wellbeing at birth. Patients were divided into two groups: Group-A if they spent more than 50% of labour in a recumbent position and Group-B when in alternative ones. Results. 225 women were recruited (69 in Group-A and 156 in Group-B). We found significant differences between the groups in terms of labour length, Numeric Rating Scale score and analgesia request rate, type of delivery, need of episiotomy, and fetal occiput rotation. No differences were found in terms of neonatal outcomes. Conclusion. Alternative maternal positioning may positively influence labour process reducing maternal pain, operative vaginal delivery, caesarean section, and episiotomy rate. Women should be encouraged to move and deliver in the most comfortable position. PMID:24955365

  20. The experience of labor, maternal perception of the infant, and the mother's postpartum mood in a low-risk community cohort.

    PubMed

    Weisman, Omri; Granat, Adi; Gilboa-Schechtman, Eva; Singer, Magi; Gordon, Ilanit; Azulay, Hila; Kuint, Jacob; Feldman, Ruth

    2010-12-01

    Postpartum negative mood interferes with maternal-infant bonding and carries long-term negative consequences for infant growth. We examined the effects of birth-related risks on mother's postpartum anxiety and depression. A community cohort of 1,844 low-risk women who delivered a singleton term baby completed measures assessing delivery, emotions during labor, attitudes toward pregnancy and infant, mood regulation, and postpartum anxiety and depression. Under conditions of low risk, 20.5% of parturient women reported high levels of depressive symptoms. Following Cesarean Section Delivery (CSD), 23% reported high depressive symptoms, compared to 19% following Vaginal Delivery (VGD), and 21% after Assisted Vaginal Delivery (AVGD). State anxiety was highest in CSD and lowest in VGD. Mothers undergoing CSD experienced labor as most negative, reported highest somatic symptoms during the last trimester, and were least efficient in regulating negative mood. Postpartum depression was independently associated with higher maternal age, CSD, labor pain, lower negative and higher positive emotions during labor, inefficient mood regulation, somatic symptoms, and more negative and less positive perception of fetus during last trimester. Results demonstrate that elevated depressive symptoms are prevalent in the postpartum even under optimal socioeconomic and health conditions and increase following CSD. Interventions to increase positive infant-related perceptions and emotions may be especially important for promoting bond formation following CSD.

  1. Testing for HIV in the antenatal clinic: the views of midwives.

    PubMed

    Meadows, J; Catalan, J; Sherr, L; Stone, Y; Gazzard, B

    1992-01-01

    Self administered questionnaires were given to 34 midwives, who regularly counsel parturient women about the HIV antibody test, to investigate their attitudes to the test being offered in the antenatal clinic. Most of the midwives felt that testing should not be compulsory and that the test should be offered to all pregnant women who ask for it, not only those in recognized risk groups. Most also felt that women should be told the results of the test and that it should not be the midwives aim to increase the number of women having the test. Most felt that all midwives should counsel about the test but would like health advisers, GPs and obstetricians to be involved also. They also felt that they did not have sufficient knowledge in some areas to counsel particularly with regard to the practical and psychological implications of being HIV positive. This has implications in terms of the provision of adequate pre-test counselling for all pregnant women as an improvement in counselling services requires an allocation of finances, e.g. for training of midwives, which may be seen as unnecessary in areas of low seroprevalence. Further discussion and debate of these issues is required.

  2. Prenatal centrifugation: A model for fetal programming of adult weight?

    NASA Astrophysics Data System (ADS)

    Baer, Lisa A.; Rushing, Linda; Wade, Charles E.; Ronca, April E.

    2005-08-01

    'Fetal programming' is a newly emerging field that is revealing astounding insights into the prenatal origins of adult disease, including metabolic, endocrine, and cardiovascular pathophysiology. In the present study, we tested the hypothesis that rat pups conceived, gestated and born at 2-g have significantly reduced birth weights and increased adult body weights as compared to 1-g controls. Offspring were produced by mating young adult male and female rats that were adapted to 2-g centrifugation. Female rats underwent conception, pregnancy and birth at 2-g. Newborn pups in the 2-g condition were removed from the centrifuge and fostered to non-manipulated, newly parturient dams maintained at 1-g. Comparisons were made with 1-g stationary controls, also cross- fostered at birth. As compared to 1-g controls, birth weights of pups gestated and born at 2-g were significantly reduced. Pup body weights were significantly reduced until Postnatal day (P)12. Beginning on P63, body weights of 2-g-gestated offspring exceeded those of 1-g controls by 7-10%. Thus, prenatal rearing at 2-g restricts neonatal growth and increases adult body weight. Collectively, these data support the hypothesis that 2-g centrifugation alters the intrauterine milieu, thereby inducing persistent changes in adult phenotype.

  3. Combining intrathecal bupivacaine and meperidine during caesarean section to prevent spinal anaesthesia-induced hypotension and other side-effects.

    PubMed

    Atalay, C; Aksoy, M; Aksoy, A N; Dogan, N; Kürsad, H

    2010-01-01

    This study compared intrathecal hyperbaric bupivacaine with low-dose intrathecal plain bupivacaine plus different doses of meperidine (pethidine), administered sequentially, with regard to blood pressure stability, post-operative analgesia and incidence of side-effects in 80 parturients undergoing caesarean section. Patients were randomly assigned to one of four groups (n=20 each group): the HB group received 10 mg hyperbaric bupivacaine intrathecally; the BM35, BM30 and BM25 groups received 5 mg plain bupivacaine plus 35, 30 or 25 mg of meperidine intrathecally, respectively. The incidence of hypotension in the BM25 group was significantly lower than in the HB group. Nausea and vomiting were less prevalent in the BM25 group than in the HB and BM35 groups. In conclusion, sequential administration of 5 mg plain bupivacaine and 25 mg meperidine intrathecally provided better blood pressure stability and a lower incidence of side-effects than bupivacaine alone, without affecting quality of anaesthesia or surgical and patient satisfaction.

  4. Phenylephrine infusion for spinal-induced hypotension in elective cesarean delivery: Does preload make a difference?

    PubMed Central

    Bottiger, Brandi A; Bezinover, Dmitri S; Mets, Berend; Dalal, Priti G; Prozesky, Jansie; Ural, Serdar; Vaida, Sonia

    2016-01-01

    Background and Aims: Patients undergoing elective cesarean delivery (CD) have a high-risk of spinal-induced hypotension (SIH). We hypothesized that a colloid preload would further reduce SIH when compared with a crystalloid preload. Material and Methods: Eighty-two healthy parturients undergoing elective CD were included in the study. Patients were randomly assigned to two groups (41 patients in each group) to receive either Lactated Ringer's solution (1500 ml) or hydroxyethyl starch (6% in normal saline, 500 ml) 30 min prior to placement of spinal anesthesia. All patients were treated with a phenylephrine infusion (100 mcg/min), titrated during the study. Results: There was no statistical difference between groups with regards to the incidence of hypotension (10.8% in the colloid group vs. 27.0% in the crystalloid group, P = 0.12). There was also no difference between groups with respect to bradycardia, APGAR scores, and nausea and vomiting. Significantly less phenylephrine (1077.5 ± 514 mcg) was used in the colloid group than the crystalloid group (1477 ± 591 mcg, P = 0.003). Conclusion: The preload with 6% of hydroxyethyl starch before CD might be beneficial for the prevention of SIH. PMID:27625478

  5. Anesthetic management of a patient undergoing an ex utero intrapartum treatment (EXIT) procedure: a case report.

    PubMed

    Choleva, Abbie J

    2011-12-01

    The ex utero intrapartum treatment (EXIT) procedure involves partial delivery of the fetus with the fetal-placental circulation maintained. This allows for management of the obstructed fetal airway via direct laryngoscopy, bronchoscopy, tracheostomy, or surgical intervention. These complex and often challenging procedures have been performed about 100 times in the United States to date. Recent advances in prenatal diagnosis of fetal congenital malformations, in particular, abnormalities involving the fetal airway, have allowed for the development of the EXIT strategy to convert potentially catastrophic situations during fetal delivery to a controlled environment. Indications for the EXIT procedure have expanded to a variety of congenital abnormalities, including fetal neck masses, lung or mediastinal tumors, congenital high airway obstruction syndrome, conjoined twin separation, and acute respiratory distress syndrome requiring transitioning from EXIT to extracorporeal membrane oxygen transitioning. Various considerations must be managed by the anesthesia provider during the EXIT procedure to ensure positive maternal and fetal outcomes. Careful attention to achieving adequate uterine relaxation, maintaining maternal blood pressure, avoiding placental abruption, prioritizing fetal airway establishment, and providing return of uterine tone when indicated are examples of these considerations. In this case report, a parturient presented for an EXIT procedure secondary to fetal cystic hygroma.

  6. Amniotic Band Syndrome, Perinatal Hospice, and Palliative Care versus Active Management

    PubMed Central

    Faye, Justin; Chadee, Annika; Gottimukkala, Sri; Upadhyay, Ruchi; Lara, Carla; Rajegowda, Benamanahalli H.; Corwin, Andrew D.; Lala, Rasila V.; Vernon, Jessica; Nuritdinova, Dilfuza; Chasen, Stephen

    2016-01-01

    Introduction. Amniotic band syndrome and sequence are a relatively rare condition in which congenital anomalies occur as a result of the adherence and entrapment of fetal parts with coarse fibrous bands of the amniotic membrane. A large percentage of reported cases have an atypical gestational history. The frequency of this obstetric complication is not affected by fetal gender, genetic abnormality, or prenatal infection. Case. A 21-year-old, G1P0 female parturient at 18 weeks and 5 days with a single intrauterine gestation during a routine ultrasound evaluation was noted to have amniotic band sequence. The pregnancy was subsequently complicated by preterm premature rupture of membranes with oligohydramnios, resulting in a surviving neonate scheduled for rehabilitative treatment. Conclusion. Amniotic band syndrome is an uncommon congenital anomaly resulting in multiple disfiguring and disabling manifestations. Several theories are proposed with most involving early rupture of the amnion and entanglement of fetal parts by amniotic bands. This syndrome can be manifested by development of multiple malformations, with the majority of the defects being limb abnormalities of a disorganized nature, as in the case we present. In the absence of a clear etiology of consequential congenital abnormalities, obstetric management guidelines should use shared decision models to focus on the quality of life for the offspring. PMID:28025631

  7. Labor and delivery in a patient with hemophilia B.

    PubMed

    Przkora, R; Euliano, T Y; Roussos-Ross, K; Zumberg, M; Robicsek, S A

    2011-07-01

    Hemophilia B is a rare X-linked disorder that may cause dramatic bleeding. Women account for only 3.2% of those clinically affected. The X-linked inheritance frequently delays the diagnosis in women and may expose the patient to an increased risk of adverse events. There is limited experience with these patients during labor and delivery. A 28-year-old primiparous woman with hemophilia B (bleeding phenotype) delivered a male infant by an unplanned cesarean delivery under general anesthesia following treatment with factor IX and normalization of her coagulation parameters, guided by thromboelastography. Postpartum vaginal bleeding required transfusion of two units of packed red blood cells. Factor IX supplementation continued for one week. Once diagnosed with hemophilia B, a multidisciplinary approach and advanced antenatal planning can increase the likelihood of a safe delivery. Neuraxial approaches and cesarean delivery are recommended only after normalization of the coagulation profile. The male fetus of a hemophilia A or B patient requires special attention. Operative vaginal delivery and invasive fetal monitoring should be avoided. Thromboelastography is an excellent technique to assess parturients with bleeding disorders or peripartum hemorrhage and may be underused.

  8. Comparison of 2% lignocaine with adrenaline and fentanyl, 0.75% ropivacaine and 0.5% levobupivacaine for extension of epidural analgesia for urgent caesarean section after low dose epidural infusion during labour.

    PubMed

    Sng, B L; Pay, L L; Sia, A T H

    2008-09-01

    Low dose local anaesthetic and fentanyl epidural solutions are commonly 'topped-up' for urgent caesarean section. However, the block characteristics associated with newer local anaesthetics such as ropivacaine 0.75% and levobupivacaine 0.5% have not been fully determined. In a randomised double-blinded controlled clinical trial, we compared 2% lignocaine with adrenaline and fentanyl (LAF), 0.75% ropivacaine and 0.5% levobupivacaine for extension of low dose epidural analgesia for urgent caesarean section in 90 Asian parturients. There was no significant difference in the median, interquartile range, time to T4 loss of sensation to cold between LAF (9.5, 7.0 to 13.3 minutes), 0.75% ropivacaine (10.0, 7.0 to 15.0 minutes) and 0.5% levobupivacaine (10.0, 7.0 to 15.0 minutes). No woman required conversion to general anaesthesia. The supplementation rate did not differ between groups. Levobupivacaine provided a longer duration of sensory block compared to LAF but a similar duration to 0.75% ropivacaine. Under the conditions of this study there was no significant difference in time to surgical readiness (defined as loss of sensation to cold to T4) between LAF, 0.75% ropivacaine and 0.5% levobupivacaine groups. Ropivacaine and levobupivacaine are suitable alternatives for extending epidural analgesia for urgent caesarean section.

  9. Immunoglobulin G and M composition of naturally occurring antibody to type III group B streptococci.

    PubMed Central

    Anthony, B F; Concepcion, N F; Wass, C A; Heiner, D C

    1984-01-01

    Human sera were examined by an enzyme-linked immunosorbent assay for immunoglobulin G (IgG) and IgM antibodies to purified type III polysaccharide of group B streptococci. The antigen-binding capacity of a reference human serum was determined by a radioimmunoassay, and the total antibody content was determined by quantitative precipitation. The serum was then depleted of IgM and IgA to determine the effect on the antigen-binding capacity. Duplicate samples of 81 sera were tested by the enzyme-linked assay in comparison with reference standard serum. Although levels of IgG antibody were greater in subjects who had carried type III streptococci during pregnancy, concentrations of this antibody were generally low. Only 2 of 28 sera (7%) from parturient subjects and 7 of 25 sera (28%) from adult volunteers contained greater than or equal to 1 microgram of IgG antibody per ml; the mean levels were 0.13 and 0.53 micrograms/ml, respectively. In contrast, 19 of 28 maternal sera (68%) and 22 of 25 (88%) volunteer adult sera contained greater than or equal to 1 microgram/ml of IgM antibody; mean levels were 1.33 and 1.54 micrograms/ml, respectively. The cord serum levels of IgG antibody were almost identical to maternal serum concentrations, whereas IgM antibody was essentially undetected. Images PMID:6384050

  10. Successful Pregnancy in a Patient with Combined Deficiency of Factor V and Factor VIII.

    PubMed

    El Adib, Ahmed Ghassan; Majdi, Farah; Dilai, Mohamed Othmane; Asmouki, Hamid; Bassir, Ahlam; Harou, Karam; Soumani, Abderraouf; Younous, Said; Mahmal, Lahoucine

    2014-01-01

    Inherited combined factor V and factor VIII deficiency (F5F8D) is autosomal recessive transmission disorder. Epistaxis, postsurgical bleeding, and menorrhagia are the most common symptoms. The risk of miscarriage and placental abruption is consequent. We report a case of successful pregnancy in a patient with F5F8D. 20-year-old woman, born of consanguineous parents, third gestate, first parity, two miscarriages, admitted for child birth of a spontaneous pregnancy estimated at 38 weeks and was diagnosed with F5F8D. At admission, patient was hemodynamically stable, with good obstetric conditions. The biologic results showed low levels of PT (52%), factor V (7%), and factor VIII (5%), and the activated partial thromboplastin time was prolonged (68,6%). Parturient was admitted in intensive care unit, maternal and fetal monitoring was performed. Fresh frozen plasma (FFP) and factor VIII concentrates were perfused at the induction of labor. Analgesia used fentanyl titration. The delivery gave birth to a newborn male, with Apgar 10/10 and 3000 g. The puerperium was simple without any important bleeding. Laboratory tests for the newborn were acceptable. Little literature is available on this subject and there are no guidelines available concerning pregnancy; we chose to prescribe a combination of factor VIII concentrate and FFP in pre-, per- and postpartum. The same protocol was successfully used in a patient before dental extraction and prostatectomy. Vaginal delivery is possible, as our case. Management by multidisciplinary team is recommended.

  11. Report on Maternal Anxiety 16 Months After the Great East Japan Earthquake Disaster: Anxiety Over Radioactivity

    PubMed Central

    Yoshii, Hatsumi; Saito, Hidemitsu; Kikuchi, Saya; Ueno, Takashi; Sato, Kineko

    2014-01-01

    The Great East Japan Earthquake occurred on March 11, 2011. The tsunami caused extensive damage to the Fukushima Daiichi Nuclear Power Plant, resulting in a level 7 nuclear accident. Among those affected by this combined disaster were many pregnant and parturient women. Sixteen months after the earthquake, we conducted a questionnaire survey on anxiety among 259 women who gave birth around the time of the earthquake in Miyagi Prefecture, one of the affected areas. Participants reported 12 categories of anxiety, including anxiety over radioactivity. This study aimed to determine anxiety over radioactivity among this specific population and to record measures for future study. Anxiety over radiation was classified into seven subcategories: food safety, outdoor safety, effects on the fetuses of pregnant women, effects on children, radiation exposure, economic problems, and distrust of information disclosed. This study confirmed that concrete types of anxiety over radiation were keenly felt by mothers who had experienced the disaster who were currently raising children. The findings suggest the need to provide accurate information to these mothers, who are otherwise inundated with miscellaneous confusing information. PMID:25363115

  12. [Studies of the attitude of a group of puerperas of the Brianza region toward contraception and the services offered for such purposes by the public health organizations].

    PubMed

    Remotti, G; Mambretti, C; Brambilla, G

    1982-01-01

    The authors have studied fertility control and the role of the public health structure among a group of 1000 parturients. Contraceptive methods, the social and cultural levels of the women, and the analysis of their responses have been described. The more significant answers were correlated with the social and economic levels of the women. An awareness of sexual problems was poor, particularly among younger women, immigrants, and women of a low socioeconomic level; therefore, fertility control was not as diffuse as previously suspected. The best known contraceptive methods were coitus interruptus (67.9%), oral contraceptives (OCs) (72.7%), and the IUD (66.5%). The methods used most often were OCs (9.9%) and the condom (2.4%). The consultorio was well known (70%) but the activities were not. Those that were well known were the sanitarie, including the management of pregnancy (56.5%) contraception (38.8%), and pediatric assistance. The lesser known activities were those of a social interest such as social assistance (22.3%), those in connection with family problems (22.8%), and psychological problems (16.5%). (author's)

  13. Serological survey of leptospirosis in sows with premature birth and stillbirth in Chiba and Gunma prefectures of Japan.

    PubMed

    Kazami, Ayako; Watanabe, Hideki; Hayashi, Tetsu; Kobayashi, Kazuhiko; Ogawa, Yasuki; Yamamoto, Koshi; Adachi, Yoshikazu

    2002-08-01

    In 1996 and 1997, the seroprevalence against Leptospira in parturient sows with premature birth or stillbirth from two herds was investigated. In three out of four sow serum samples obtained in Gunma Prefecture, the antibody titers to Leptospira interrogans serovar copenhageni (M20) were higher than 10,000 (the reciprocal of the serum dilution). Furthermore, the antibody titers to L. interrogans serovar canicola (Hond Utrecht IV) were significantly high in the three sows and the titers ranged from 1,000 to 3,000. In sows obtained in Chiba Prefecture, significantly high antibody titers to serovar copenhageni (M20) were confirmed in eight out of 40 sows, and antibody titers greater than 10,000 in six of them. Significantly high antibody titers to L. interrogans serovar icterohaemorrhagiae (RGA) and L. canicola (Hond Utrecht IV) were confirmed in four and 18 out of the 40 sows, respectively, compared with the titers to the other serovars. These findings may indicate the prevalence of leptospirosis in pig herds in both Gunma and Chiba Prefectures.

  14. Effects of acupressure on progress of labor and cesarean section rate: randomized clinical trial.

    PubMed

    Mafetoni, Reginaldo Roque; Shimo, Antonieta Keiko Kakuda

    2015-01-01

    OBJECTIVE To analyze the effects of acupressure at the SP6 point on labor duration and cesarean section rates in parturients served in a public maternity hospital. METHODS This controlled, randomized, double-blind, pragmatic clinical trial involved 156 participants with gestational age ≥ 37 weeks, cervical dilation ≥ 4 cm, and ≥ 2 contractions in 10 min. The women were randomly divided into an acupressure, placebo, or control group at a university hospital in an inland city in the state of Sao Paulo, Brazil, in 2013. Acupressure was applied to the SP6 point during contractions for 20 min. RESULTS The average labor duration was significantly different between the SP6 acupressure group [221.5 min (SD = 162.4)] versus placebo [397.9 min (SD = 265.6)] and versus control [381.9 min (SD = 358.3)] (p = 0.0047); however, the groups were similar regarding the cesarean section rates (p = 0.2526) and Apgar scores in the first minute (p = 0.9542) and the fifth minute (p = 0.7218) of life of the neonate. CONCLUSIONS The SP6 acupressure point proved to be a complementary measure to induce labor and may shorten the labor duration without causing adverse effects to the mother or the newborn. However, it did not affect the cesarean section rate.

  15. Fundamental restoration of the Civic Hospital in Split (1866-1872).

    PubMed

    Brisky, Livia

    2007-09-01

    The aim of this study was to investigate the progress of the fundamental restoration and enlargement of the Civic Hospital in Split between 1866 and 1872 on the basis of the previously unexplored materials, such as Shorthand reports of the Dalmatian Parliament in Zadar kept in the Split University Library, and the archival documents about the completion of this renewal preserved in the State Archives in Zadar. The right author of the restoration project and the name of the building manager were found. The data of the renewal beginning were corrected. The findings showed that the renewal of the Civic Hospital in Split started after the decision of the Dalmatian Parliament about its enlargement and restoration on February 9, 1866, according to the project drafted by the Provincial director of the public buildings doctor Ivan Lucchini. On October 7, 1871, the Dalmatian Parliament determined about the way for the continuation of these works. The complete restoration of the Civic Hospital in Split finished in 1872. The study revealed the realization of longtime efforts for the enlargement of hospital capacity in Split. With this restoration and appropriate organizational structure, the Civic Hospital in Split could offer better treatment to the patients, parturient women and foundlings.

  16. Q fever through consumption of unpasteurised milk and milk products - a risk profile and exposure assessment.

    PubMed

    Gale, P; Kelly, L; Mearns, R; Duggan, J; Snary, E L

    2015-05-01

    Q fever is a zoonotic disease caused by the bacterium Coxiella burnetii which is endemic in cattle, sheep and goats in much of the world, including the United Kingdom (UK). There is some epidemiological evidence that a small proportion of cases in the developed world may arise from consumption of unpasteurised milk with less evidence for milk products such as cheese. Long maturation at low pH may give some inactivation in hard cheese, and viable C. burnetii are rarely detected in unpasteurised cheese compared to unpasteurised milk. Simulations presented here predict that the probability of exposure per person to one or more C. burnetii through the daily cumulative consumption of raw milk in the UK is 0·4203. For those positive exposures, the average level of exposure predicted is high at 1266 guinea pig intraperitoneal infectious dose 50% units (GP_IP_ID50 ) per person per day. However, in the absence of human dose-response data, the case is made that the GP_IP_ID50 unit represents a very low risk through the oral route. The available evidence suggests that the risks from C. burnetii through consumption of unpasteurised milk and milk products (including cheese) are not negligible but they are lower in comparison to transmission via inhalation of aerosols from parturient products and livestock contact.

  17. Analgesic Effects of Preincision Ketamine on Postspinal Caesarean Delivery in Uganda's Tertiary Hospital: A Randomized Clinical Trial

    PubMed Central

    Mwase, Richard; Kasumba, John Mark; Wanzira, Humphrey; Kintu, Andrew; Tindimwebwa, Joesph V. B.; Obua, Daniel

    2017-01-01

    Background. Good postoperative analgesic management improves maternal satisfaction and care of the neonate. Postoperative pain management is a challenge in Mulago Hospital, yet ketamine is accessible and has proven benefit. We determined ketamine's postoperative analgesic effects. Materials and Methods. We did an RCT among consenting parturients that were randomized to receive either intravenous ketamine (0.25 mg/kg) or placebo after spinal anesthetic. Pain was assessed every 30 mins up to 24 hours postoperatively using the numerical rating scale. The first complaint of pain requiring treatment was noted as “time to first breakthrough pain.” Results. We screened 100 patients and recruited 88 that were randomized into two arms of 44 patients that received either ketamine or placebo. Ketamine group had 30-minute longer time to first breakthrough pain and lower 24-hour pain scores. Postoperative diclofenac consumption was lesser in the ketamine group compared to placebo and Kaplan-Meier graphs showed a higher probability of experiencing breakthrough pain earlier in the placebo group. Conclusion. Preincision intravenous ketamine (0.25 mg/kg) offered 30-minute prolongation to postoperative analgesia requirement with reduced 24-hour pain scores. We recommend larger studies to explore this benefit. This trial is registered with Pan African Clinical Trial Registry number PACTR201404000807178. PMID:28321251

  18. Report on maternal anxiety 16 months after the great East Japan earthquake disaster: anxiety over radioactivity.

    PubMed

    Yoshii, Hatsumi; Saito, Hidemitsu; Kikuchi, Saya; Ueno, Takashi; Sato, Kineko

    2014-06-25

    The Great East Japan Earthquake occurred on March 11, 2011. The tsunami caused extensive damage to the Fukushima Daiichi Nuclear Power Plant, resulting in a level 7 nuclear accident. Among those affected by this combined disaster were many pregnant and parturient women. Sixteen months after the earthquake, we conducted a questionnaire survey on anxiety among 259 women who gave birth around the time of the earthquake in Miyagi Prefecture, one of the affected areas. Participants reported 12 categories of anxiety, including anxiety over radioactivity. This study aimed to determine anxiety over radioactivity among this specific population and to record measures for future study. Anxiety over radiation was classified into seven subcategories: food safety, outdoor safety, effects on the fetuses of pregnant women, effects on children, radiation exposure, economic problems, and distrust of information disclosed. This study confirmed that concrete types of anxiety over radiation were keenly felt by mothers who had experienced the disaster who were currently raising children. The findings suggest the need to provide accurate information to these mothers, who are otherwise inundated with miscellaneous confusing information.

  19. Loss of prostaglandin F2alpha, but not thromboxane, responsiveness in pregnant human myometrium during labour.

    PubMed

    Fischer, Deborah P; Hutchinson, Jonathon A; Farrar, Diane; O'Donovan, Peter J; Woodward, David F; Marshall, Kay M

    2008-04-01

    Prostaglandins (PG) E2, PGF2alpha and thromboxane (TX) mediate uterine contractility by targeting prostonoid EP, FP and TP receptors respectively. The aim of this study was to elucidate the function of these receptors in isolated human myometrium taken at term gestation prior to and following labour onset. Lower segment myometrial strips were immersed in organ baths in oxygenated Krebs' solution at 37 degrees C and connected to isometric force transducers. After equilibration, spontaneous activity and concentration responses to PGE2, PGF2alpha and U46619 (a stable TX mimetic) were measured as area under the curve and expressed as a percentage of the final contraction induced by hypotonic shock. Results were expressed as arithmetic means+/-s.e.m. and analysed using two-way ANOVA with Bonferroni's post hoc test. Myometrium excised at late gestation displayed the greatest spontaneous activity compared with the tissues taken during labour (P<0.001). Excitation evoked by PGF2alpha (P<0.01) and PGE2 at 10(-5) mol/l were attenuated after labour onset. U46619 consistently stimulated concentration-dependent contractions (P<0.001) and selective antagonists confirmed TP-mediated effects. The maintained responses to TX indicate crucial roles for TP receptors in the muscular tonus of the parturient uterus. This receptor and its secondary messenger system represent effective myometrial targets for tocolytic agents in both pregnancy and labour-associated disorders.

  20. Effects of acupressure on progress of labor and cesarean section rate: randomized clinical trial

    PubMed Central

    Mafetoni, Reginaldo Roque; Shimo, Antonieta Keiko Kakuda

    2015-01-01

    OBJECTIVE To analyze the effects of acupressure at the SP6 point on labor duration and cesarean section rates in parturients served in a public maternity hospital. METHODS This controlled, randomized, double-blind, pragmatic clinical trial involved 156 participants with gestational age ≥ 37 weeks, cervical dilation ≥ 4 cm, and ≥ 2 contractions in 10 min. The women were randomly divided into an acupressure, placebo, or control group at a university hospital in an inland city in the state of Sao Paulo, Brazil, in 2013. Acupressure was applied to the SP6 point during contractions for 20 min. RESULTS The average labor duration was significantly different between the SP6 acupressure group [221.5 min (SD = 162.4)] versus placebo [397.9 min (SD = 265.6)] and versus control [381.9 min (SD = 358.3)] (p = 0.0047); however, the groups were similar regarding the cesarean section rates (p = 0.2526) and Apgar scores in the first minute (p = 0.9542) and the fifth minute (p = 0.7218) of life of the neonate. CONCLUSIONS The SP6 acupressure point proved to be a complementary measure to induce labor and may shorten the labor duration without causing adverse effects to the mother or the newborn. However, it did not affect the cesarean section rate. PMID:25741644

  1. [Human immunodeficiency virus (HIV) infection in mothers and infants in French Guyana. Epidemiologic study apropos of 44 women having conceived 55 children].

    PubMed

    Pradinaud, R; Sainte-Marie, D; Plat, J M; Cassiede, P; Vienne, P; Vigneron-Meleder, H; Wojcick, L; Wojcick, J M; Sankale-Suzanon, J; Patient, G

    1989-01-01

    The French Guyana is an Overseas French Department in South America, with 100,000 inhabitants among them are 20% of Haitian immigrants. At 31 December 1987, 103 AIDS cases have been recorded, 86% by heterosexual transmission. The first case dated May 1979 was retroactively diagnosed in an Haitian parturient, thank to her serum kept in the Pasteur institute of Cayenne. 44 women got their pregnancy during their HIV infection: 5 with clinical and biological evidence of AIDS, 7 developed AIDS after getting pregnant, and 10 out of these 12 women died. All of them were from a rather low social group and, generally, were not married. 43 are black (40 Haitians and 3 Guyanese Creoles), one is Indian and presented some psychic disorders. The mean age was 32 1/2 (from 15 to 51 years old). 55 babies were born: 12 developed AIDS (6 died during the first 15 months of their life); 14 are HIV +, 3 stillborns, 4 never tested and 22 developed negative reaction (with ELISA and Western-Blot) between 7.5 and 10 months of their life. Two Hutchinson's triads were observed. Prurigo is the most commonly skin manifestation observed.

  2. Simultaneous appearance of cerebral venous thrombosis and subdural hematomas as rare cause of headache in puerperium following epidural analgesia: a case report

    PubMed Central

    Župan, Željko; Sotošek Tokmadžić, Vlatka; Matanić-Manestar, Marinka; Šustić, Alan; Antončić, Igor; Dunatov, Siniša; Pavlović, Ivan; Antulov, Ronald

    2012-01-01

    The aim of this study is to report the first case of simultaneous appearance of cerebral venous thrombosis (CVT) and bilateral subdural hematomas (SDHs) following epidural analgesia for labor and delivery and to point out the difficulty of establishing such a diagnosis in the presence of postpartum headache. A 26-year old primigravida with a history of epilepsy received epidural analgesia for delivery. Three days after the uneventful spontaneous vaginal delivery she complained about the headache. Patient responded very well to the pain medication and oral hydration, and the headache was relieved. Ten days after the delivery, the headache reoccurred, and an epidural blood patch was performed that successfully relieved her symptom. Stronger progressive headache with nausea reappeared two days later and the parturient was readmitted to hospital. Urgent neuroimaging examinations detected CVT of right the transverse sinus, ipsilateral cortical veins, and partially occluded superior sagittal sinus, as well as bilateral subacute/chronic SDHs. The treatment of the patient with low molecular weight heparin and antiaggregation therapy was effective. In this case, the diagnosis was delayed because of atypical clinical presentation and potentially confounding events (epidural analgesia and assumption that it was a case of PDPH). It is important to carefully observe patients in such conditions and promptly conduct suitable diagnostic tests. Otherwise, unrecognized intracranial complications and delay of appropriate therapy could be life-threatening. PMID:22911532

  3. Predator evasion by white-tailed deer fawns

    USGS Publications Warehouse

    Grovenburg, Troy W.; Monteith, Kevin L.; Klaver, Robert W.; Jenks, Jonathan A.

    2012-01-01

    Despite their importance for understanding predator–prey interactions, factors that affect predator evasion behaviours of offspring of large ungulates are poorly understood. Our objective was to characterize the influence of selection and availability of escape cover and maternal presence on predator evasion by white-tailed deer, Odocoileus virginianus, fawns in the northern Great Plains, U.S.A. We observed 45 coyote, Canis latrans, chases of fawns, and we participated in 83 human chases of fawns during 2007–2009, of which, 19 and 42 chases, respectively, ended with capture of the fawn. Evasive techniques used by fawns were similar for human and coyote chases. Likelihood of a white-tailed deer fawn escaping capture, however, was influenced by deer group size and a number of antipredator behaviours, including aggressive defence by females, initial habitat and selection of escape cover, all of which were modified by the presence of parturient females. At the initiation of a chase, fawns in grasslands were more likely to escape, whereas fawns in forested cover, cultivated land or wheat were more likely to be captured by a coyote or human. Fawns fleeing to wetlands and grasslands also were less likely to be captured compared with those choosing forested cover, wheat and cultivated land. Increased probability of capture was associated with greater distance to wetland and grassland habitats and decreased distance to wheat. Use of wetland habitat as a successful antipredator strategy highlights the need for a greater understanding of the importance of habitat complexity in predator avoidance.

  4. The use of clenbuterol in large animal obstetrics: manual correction of bovine dystocias.

    PubMed Central

    Ménard, L

    1994-01-01

    This study was undertaken to test the effect of clenbuterol, a smooth muscle relaxant, as an aid for the manual correction of bovine dystocias in a rural Quebec practice. The drug was given initially by intravenous coccygeal or jugular injection at a dose of 0.6 micrograms-0.8 micrograms/kg of body weight to parturient cows affected with fetal malpresentations (n = 37), malpostures (n = 112), or uterine torsions (n = 70). These cases comprised 32% (219/688) of the manually corrected dystocias encountered in cattle during the trial. Ease provided for obstetrical maneuvers of different types of dystocias was the evaluation criteria used in this report. The drug's myometrial relaxant effect made corrections easier for the veterinarian, and shorter and less traumatic for the dam. The success rates achieved for vaginal corrections and delivery of uterine torsions were 84% (76/91) and 77% (70/91), respectively. Other recorded benefits included the need for less frequent use of epidural anesthesia and a significantly lower incidence of retained fetal membranes (chi 2 = 11.18, p < 0.001). No adverse reactions were observed at any time. Clenbuterol proved to be a useful drug for manual correction of dystocias in cattle. Images Figure 1. PMID:7848411

  5. Reduced likelihood of bovine coronavirus and bovine respiratory syncytial virus infection on organic compared to conventional dairy farms.

    PubMed

    Bidokhti, Mehdi R M; Tråvén, Madeleine; Fall, Nils; Emanuelson, Ulf; Alenius, Stefan

    2009-12-01

    The prevalence of antibodies to bovine coronavirus (BCV) and bovine respiratory syncytial virus (BRSV) infections was studied in 20 conventional and 20 organic dairy herds. The organic farms had produced 'certified' milk for at least 2 years. On two occasions, with a 1-year interval, 699 serum samples from 624 peri-parturient cows were tested by ELISA for antibodies to BCV and BRSV. Accompanying data relating to the sampled animals were collected in order to identify potential factors associated with increased antibody prevalence. The antibody prevalence was high at both sampling times with approximately 85% and 80% of animals positive for antibodies to BCV and to BRSV, respectively. Conventional herds had a significantly higher mean antibody prevalence to BCV and BRSV than the organically managed herds (P<0.01). Animal age was significantly associated with increased antibody prevalence (P<0.001). The findings of this study suggest that organic farm management may be effective in reducing the seroprevalence of these viruses relative to conventional farming methods.

  6. Patient Involvement in Safe Delivery: A Qualitative Study

    PubMed Central

    Olfati, Forozun; Asefzadeh, Saeid; Changizi, Nasrin; Keramat, Afsaneh; Yunesian, Masud

    2016-01-01

    Introduction: Patient involvement in safe delivery planning is considered important yet not widely practiced. The present study aimed at identifythe factors that affect patient involvementin safe delivery, as recommended by parturient women. Methods: This study was part of a qualitative research conducted by content analysis method and purposive sampling in 2013. The data were collected through 63 semi-structured interviews in4 hospitalsand analyzed using thematic content analysis. The participants in this research were women before discharge and after delivery. Findings were analyzed using Colaizzi’s method. Results: Four categories of factors that could affect patient involvement in safe delivery emerged from our analysis: patient-related (true and false beliefs, literacy, privacy, respect for patient), illness-related (pain, type of delivery, patient safety incidents), health care professional-relatedand task-related factors (behavior, monitoring &training), health care setting-related (financial aspects, facilities). Conclusion More research is needed to explore the factors affecting the participation of mothers. It is therefore, recommended to: 1) take notice of mother education, their husbands, midwives and specialists; 2) provide pregnant women with insurance coverage from the outset of pregnancy, especially during prenatal period; 3) form a labor pain committee consisting of midwives, obstetricians, and anesthesiologists in order to identify the preferred painless labor methods based on the existing facilities and conditions, 4) carry out research on observing patients’ privacy and dignity; 5) pay more attention on the factors affecting cesarean. PMID:26755469

  7. Placental malaria, anaemia and low birthweight in Yemen.

    PubMed

    Albiti, Anisa H; Adam, Ishag; Ghouth, Abdulla S

    2010-03-01

    A cross-sectional study was conducted during the period of August 2007-April 2008 at Al-Wahda Teaching Hospital in Yemen to investigate prevalence and risk factors for placental malaria and anaemia and their effects on birthweight. Sociodemographic characteristics were gathered, maternal haemoglobin was measured and blood films were examined for malaria. Newborn birthweight was recorded. Out of 900 parturient women, malaria blood films were positive in 32 (3.6%) cases: in six sets of peripheral, placental and cord samples; in 15 placental and cord samples; and in 11 placental samples only. Malaria was not associated with age and parity, but it was significantly associated with history of fever [odds ratio (OR) 8.5, 95% CI 3.7-19, P<0.001], rural residence (OR 2.5, 95% CI 1.1-5.3, P=0.01) and rainy season (OR 5.1, 95% CI 1.7-15.2, P=0.003). Overall, 694 (77.1%) out of these 900 women had anaemia (Hb<11g/dl) and 16 (1.8%) patients had severe anaemia (Hb<7g/dl). Anaemia was not associated with age, parity and malaria. Low birthweight was significantly associated with malaria (OR 5.7, 95% CI 1.7-18.5; P=0.004). Thus, preventive measures (bednets and intermittent preventive treatment) should be employed for pregnant women regardless of their age or parity.

  8. [Accidental out-of-hospital deliveries].

    PubMed

    Bouet, P-E; Chabernaud, J-L; Duc, F; Khouri, T; Leboucher, B; Riethmuller, D; Descamps, P; Sentilhes, L

    2014-03-01

    Unexpected out-of-hospital delivery accounts for 0.5% of the total number of delivery in France. The parturient is placed under constant multiparametric monitoring. Fetus heart rate is monitored thanks to fetal doppler. A high concentration mask containing a 50-to-50 percent mix of O(2) and NO performs analgesia. Assistance of mobile pediatric service can be required under certain circumstances such as premature birth, gemellary pregnancy, maternal illness or fetal heart rate impairment. Maternal efforts should start only when head reaches the pelvic floor, only if the rupture of the membranes is done and the dilation is completed. The expulsion should not exceed 30 min. Episiotomy should not be systematically performed. A systematic active management of third stage of labour is recommended. Routine care such as warming and soft drying can be performed when the following conditions are fulfilled: clear amniotic liquid, normal breathing, crying and a good tonus. Every 30 seconds assessment of heart rate, breathing quality and muscular tonus then guide the care. The redaction of birth certificate is a legal obligation and rests with the attending doctor.

  9. Breastfeeding, amenorrhea and contraceptive practice among postpartum women in Zibo, China.

    PubMed

    Zhang, L Y; Liu, Y R; Shah, I H; Tian, K W; Zhang, L H

    2002-09-01

    This paper reports a hospital-based longitudinal study that was conducted in Zibo, China, in June 1996. The objective was to investigate the existing patterns of breastfeeding, amenorrhea and contraceptive use among postpartum women in urban areas of China. Information was obtained from 492 newly parturient women. Follow-up interviews were done at 42 days. 4 months and 1 year after delivery. The results showed that the full breastfeeding rate (including exclusive and almost exclusive breastfeeding) was 78% and 43% at 42 days and 4 months after delivery, respectively. The mean reported length of abstinence from sexual intercourse after delivery was 71 days. The mean reported time to menses resumption was 184 days. Ninety-three per cent of women had resumed sexual intercourse at 4 months after delivery. Seventy-three per cent of women were using contraceptive methods when they resumed sexual activity after delivery. After childbirth, the majority ofthe women interviewed used condoms within 3 months. Thereafter, most of them switched to intrauterine device (IUD)). Life table analysis shows that the continuation rates of full breastfeeding and amenorrhea at 4 months after delivery were 35% and 68%, respectively. This implies that if the full breastfeeding rate can be prolonged, it is feasible to use the lactational amenorrhea method (LAM) among Chinese postpartum women. The policy implications of this study are that quality care on contraceptive services and information for postpartum women in urban areas need to be improved further.

  10. [Eduard C. H. von Siebold: "The use of sulfur ether vapor in obstetrics" (1847). A contribution to the beginning of modern obstetric analgesia and anesthesia in Germany].

    PubMed

    Wulf, H

    1998-06-01

    In 1847 J.Y. Simpson in Scotland was the first to describe the administration of ether for analgesia in painful deliveries. Only a few days later E.C.J. von Siebold (1801 in Würzburg-1861 in Göttingen) performed the first systematic study on ether in obstetrics. Following a preceding evaluation of the action of ether on non-pregnant woman and on pregnant women not in active labour, he administered ether for analgesia during the second stage of labour in eight parturients. The first administration was on February 25th 1847. While he was satisfied with the good analgesia without sequelae of the new-born, he was discouraged by the termination of uterine contractions observed in all his patients. He concluded that ether was not a useful substance for analgesia during vaginal delivery, since it disturbed the natural course of labour. On the other hand, von Siebold was very pleased with the administration of ether for operative obstetric procedures such as forceps deliveries or placental retention.

  11. Epidural labour analgesia using Bupivacaine and Clonidine

    PubMed Central

    Syal, K; Dogra, RK; Ohri, A; Chauhan, G; Goel, A

    2011-01-01

    Background: To compare the effects of addition of Clonidine (60 μg) to Epidural Bupivacaine (0.125%) for labour analgesia, with regard to duration of analgesia, duration of labour, ambulation, incidence of instrumentation and caesarean section, foetal outcome, patient satisfaction and side effects. Patients & Methods: On demand, epidural labour analgesia was given to 50 nulliparous healthy term parturients (cephalic presentation), divided in two groups randomly. Group I received bupivacaine (0.125%) alone, whereas Group II received bupivacaine (0.125%) along with Clonidine (60 μg). 10 ml of 0.125% bupivacaine was injected as first dose and further doses titrated with patient relief (Numerical Rating Scale <3). Top ups were given whenever Numerical Rating Scale went above 5. Results: There was statistically significant prolongation of duration of analgesia in Group II, with no difference in duration of labour, ambulation, incidence of instrumentation and caesarean section or foetal outcome. Also clonidine gave dose sparing effect to bupivacaine and there was better patient satisfaction without any significant side effects in Group II. Conclusion: Clonidine is a useful adjunct to bupivacaine for epidural labour analgesia and can be considered as alternative to opioids. PMID:21804714

  12. Prevalence of gestational, placental and congenital malaria in north-west Colombia

    PubMed Central

    2013-01-01

    Background The frequency of pregnancy-associated malaria is increasingly being documented in American countries. In Colombia, with higher frequency of Plasmodium vivax over Plasmodium falciparum infection, recent reports confirmed gestational malaria as a serious public health problem. Thick smear examination is the gold standard to diagnose malaria in endemic settings, but in recent years, molecular diagnostic methods have contributed to elucidate the dimension of the problem of gestational malaria. The study was aimed at exploring the prevalence of gestational, placental and congenital malaria in women who delivered at the local hospitals of north-west Colombia, between June 2008 and April 2011. Methods A group of 129 parturient women was selected to explore the prevalence of gestational, placental and congenital malaria in a descriptive, prospective and transversal (prevalence) design. Diagnosis was based on the simultaneous application of two independent diagnostic tests: microscopy of thick blood smears and a polymerase chain reaction assay (PCR). Results The prevalence of gestational malaria (thick smear /PCR) was 9.1%/14.0%; placental malaria was 3.3%/16.5% and congenital malaria was absent. A history of gestational malaria during the current pregnancy was significantly associated with gestational malaria at delivery. Plasmodium vivax caused 65% of cases of gestational malaria, whereas P. falciparum caused most cases of placental malaria. Conclusions Gestational and placental malaria are a serious problem in the region, but the risk of congenital malaria is low. A history of malaria during pregnancy may be a practical indicator of infection at delivery. PMID:24053184

  13. Recurrence of Preterm Delivery in Women with a Family History of Preterm Delivery.

    PubMed

    Sherf, Yehonatan; Sheiner, Eyal; Vardi, Ilana Shoham; Sergienko, Ruslan; Klein, Jamie; Bilenko, Natalya

    2017-03-01

    Objective This study aims to evaluate the role of a family history of preterm delivery on the risk of preterm delivery in the next generation. Study Design A retrospective population-based study was conducted. Perinatal information was gathered from 2,303 familial triads, composed of mothers (F1), daughters (F2), and children (F3). All births occurred in the same regional medical center between the years 1991 and 2013. Statistical analysis using logistic regression was performed to define the risk of F2 delivering a preterm baby (F3) if she was born preterm herself, and then to define the risk of F2 delivering preterm if her mother (F1) gave birth preterm during any of her birthing events. Results The risk for preterm delivery of the F2 parturient was 34% greater if their mother (F1) at any of her births had delivered preterm, controlling for parity, maternal age at delivery, and preeclampsia (adjusted odds ratio: 1.34, 95% confidence interval: -1.01 to 1.77; p = 0.042). Conclusion The family history of preterm delivery is an independent risk factor for preterm delivery. The family history includes the mother as well as one of the mother's sisters (F2 generation) being born preterm.

  14. [Epidemiological and chronological profile of the low birth weight in the region of Monastir (Tunisia) between 1994 and 2007].

    PubMed

    El Mhamdi, S; Lifi, B; Bouanène, I; Hadded, A; Sriha, A; Letaief, M; Ben Salem, K; Soltani, M S

    2011-01-01

    In Tunisia, despite the activities of national programs of maternal and child health, low birth weight (LBW) remains common. The aim of this study is to draw up the epidemiological profile of the LBW in the region of Monastir and to study the chronological trends of the associated factors during a period of 14 years (1994-2007). We conducted a population study which interest 97.630 live births (from 26 to 43 weeks) in the public maternities of the region of Monastir. The mean's age of pregnant women was 28.7 +/- 5.5 years. Among them 14.2% were aged 35 and older and 40% were primipara. Newborns were in term in 94.7% of cases. Maternal age, prenatal care, twin pregnancies and fetal complications were the factors independently associated with the occurrence of LBW in term newborns. However, only prenatal care and twin pregnancies were independently associated to LBW in preterm newborns. During the fourteenth years of the study the parturient mean age and the frequency of preterm birth increased significantly (P < 0.001) while the frequency of multiparty decreased significantly (P < 0.001). We found that the risk factors of LBW (advanced age, multiparty, etc.) are still common in our country and require targeted interventions.

  15. Estimating risk factors and causes for postpartum febrile morbidity in teenage mothers.

    PubMed

    Haeri, S; Baker, A M

    2013-02-01

    In this cohort study, our objective was to identify potentially modifiable risk factors and causes for febrile morbidity in teenage mothers. We identified all cases of febrile morbidity using the United States Joint Commission on Maternal Welfare definition in a cohort of teenage deliveries over a 4-year period at one institution. Of the 730 included teenage deliveries, 49 (7%) women suffered postpartum febrile morbidity. Higher maternal pre-pregnancy body mass index (BMI: 34.0 ± 8.6 vs 30.3 ± 6.0 kg/m(2), p = 0.0001), caesarean delivery (RR 21.3, 95% CU 8.9-54.9) and postpartum haemorrhage (RR 3.0, 95% CI 1.1-6.7) were associated with postpartum febrile morbidity. Risk factors for febrile morbidity in the teenage parturient include obesity, caesarean delivery and postpartum haemorrhage. Considering the increasing rates of teenage obesity and overall caesarean delivery rates, attention must be focused on these modifiable risk factors to avoid this complication during a tenuous time for the teenage parent.

  16. Acute respiratory failure in a 35-year-old woman following preterm vaginal delivery.

    PubMed

    Bhandari, H M; Gorecha, M; Woodman, J

    2014-03-19

    A 35-year-old woman, a non-smoker with a normal body mass index, 'felt wheezy' and developed profound hypoxia 30 min after preterm vaginal delivery at 24+ weeks of gestation. She denied other symptoms, had no fever but was tachycardic and tachypnoeic with normal blood pressure. Pulmonary embolism, amniotic fluid embolism, cardiomyopathy, arrhythmias, sepsis and non-cardiogenic pulmonary oedema were considered as differential diagnoses. Chest X-ray showed an increased pulmonary vasculature, but the blood tests, ECG, echocardiogram and CT pulmonary angiogram were essentially normal. She was managed on a high dependency area with high-flow oxygen and intravenous antibiotics. She improved dramatically and the oxygen requirements dropped to 2 L over the next 4 h. It is plausible that this woman had acute non-cardiogenic pulmonary oedema secondary to a combination of risk factors. This case highlights the importance of a methodical and multidisciplinary approach for a prompt diagnosis and successful treatment of an acutely ill parturient.

  17. The physical activity of parturition in ancient Egypt: textual and epigraphical sources.

    PubMed

    Töpfer, Susanne

    2014-01-01

    Many medical and magical texts concerning childbirth and delivery are known from ancient Egypt. Most of them are spells, incantations, remedies and prescriptions for the woman in labour in order to accelerate the delivery or protect the unborn child and parturient. The medical and magical texts do not contain any descriptions of parturition itself, but there are some literary, astronomical and mythological texts, as well as a few incantations, which describe the biological act of childbirth and also miscarriage in more detail. Besides the textual sources, the decoration of temple walls and mammisis (birth houses), as well as illustrations on a birth brick provide an insight into the moment of delivery. In this paper, I focus on the "scientific"depiction of the biological act of childbirth, on how it is described in non-medical sources. Although the main sources are mythological-theological texts with numerous analogies, it is remarkable how many details they provide. They contain descriptions that would be expected in the context of medical sources.

  18. Recent observations of intraspecific predation and cannibalism among polar bears in the southern Beaufort Sea

    USGS Publications Warehouse

    Amstrup, Steven C.; Stirling, I.; Smith, T.S.; Perham, C.; Thiemann, G.W.

    2006-01-01

    Intraspecific killing has been reported among polar bears (Ursus maritimus), brown bears (U. arctos), and black bears (U. americanus). Although cannibalism is one motivation for such killings, the ecological factors mediating such events are poorly understood. Between 24 January and 10 April 2004, we confirmed three instances of intraspecific predation and cannibalism in the Beaufort Sea. One of these, the first of this type ever reported for polar bears, was a parturient female killed at her maternal den. The predating bear was hunting in a known maternal denning area and apparently discovered the den by scent. A second predation event involved an adult female and cub recently emerged from their den, and the third involved a yearling male. During 24 years of research on polar bears in the southern Beaufort Sea region of northern Alaska and 34 years in northwestern Canada, we have not seen other incidents of polar bears stalking, killing, and eating other polar bears. We hypothesize that nutritional stresses related to the longer ice-free seasons that have occurred in the Beaufort Sea in recent years may have led to the cannibalism incidents we observed in 2004. ?? Springer-Verlag 2006.

  19. [Application of a standardized-human biomonitoring methodology to assess prenatal exposure to mercury].

    PubMed

    Egorov, A I; Ilchenko, I N; Lyapunov, S M; Marochkina, E V; Okina, O I; Ermolaev, B V; Karamysheva, T V

    2014-01-01

    World Health Organization (WHO), in cooperation with the Consortium to Perform Human Biomonitoring on a European Scale (COPHES), has developed a standardized methodology for human biomonitoring (HBM) surveys in maternities in order to assess prenatal exposure to mercury. To test this standard methodology and adapt it to Russian settings, a cross-sectional HBM survey involving 120 parturient women was conducted in six maternities of the Moscow Region. Levels of total mercury in maternal hair (geometric mean: 0.21 μg/g, 95th percentile: 0.54 μg/g), cord blood (0.89 μg/L and 2.38 μg/L, respectively) and maternal urine (0.27 μg/L and 0.94 μg/L) in this population were similar to those in other European countries with relatively low fish consumption. Consumption of all types of fish at least once per week during the third trimester of pregnancy compared to fish consumption less than once per month was associated with the increase of geometric mean level of total mercury: in hair by 31% (95% confidence interval: 4%, 66%) higher, in cord blood--by 38% (9%, 74%) and in maternal urine--by 36% (2%, 81%). No biomarker values exceeded levels recommended by WHO or national agencies in the USA and Germany. However; at the population level, adverse effects of prenatal exposures to mercury can still be substantial.

  20. Does the conceptus of the viviparous lizard Barisia imbricata imbricata participates in the regulation of progesterone production and the control of luteolysis?

    PubMed

    Martínez-Torres, Martín; Salcedo-Álvarez, Martha; Alvarez-Rodríguez, Carmen; Cárdenas-León, Mario; Luis, Juana; Moreno-Fierros, Leticia

    2014-08-01

    It is generally accepted that progesterone is necessary to maintain gestation; however, the mechanisms that control the production of this steroid remain unknown. The corpus luteum has been assigned a central role in the maintenance of gestation based on its capacity to produce progesterone. A pseudopregnancy model was performed in a viviparous lizard, Barisia imbricata imbricata, to determine whether the absence of embryos would affect the pattern of progesterone production or the corpus luteum histology. Blood samples were obtained prior to ovulation and at 8, 16, and 24 weeks after ovulation (pseudopregnant and pregnant lizards), as well as one day after parturition (pregnant lizards) or 32 weeks after ovulation (pseudopregnant lizards). The corpus luteum was surgically removed one day after blood samples were obtained. Blood aliquots from nongravid females were obtained at similar timepoints. We found a significant reduction in plasma progesterone concentrations at 24 and 32 weeks post-ovulation in pseudopregnant lizards compared with those observed at similar times in intact pregnant lizards, whereas the progesterone levels in non-gestant lizards remained significantly lower than in either pseudopregnant or pregnant lizards. Moreover, we observed that the histological appearance of the corpus luteum from pseudogestational females (obtained 24 and 32 weeks post-ovulation) differed from the corpora lutea from lizards in late gestation and intact parturient lizards. These observations suggest that the conceptus participates in the regulation of progesterone production in late gestation and also in luteolysis control.