Report of two cases
01 Nov 1995-Acta Anaesthesiologica Scandinavica (Blackwell Publishing Ltd)-Vol. 39, Iss: 8, pp 1134-1137
TL;DR: Two patients underwent thoracotomy for resection of pulmonary or esophageal carcinoma and regained motor and sensory functions 14 and 18 hours later, respectively, without sequelae.
Abstract: Two patients underwent thoracotomy for resection of pulmonary or esophageal carcinoma. Postoperatively, epidural catheters were inserted for pain management. Complaints of severe injection pain over the abdomen or lower extremities were made during one administration of pain medication. Progressive weakness and numbness developed over the lower trunk and lower extremities, with subsequent respiratory difficulties. Potassium chloride (KCl) was suspected to have been mistaken for normal saline as the diluent for morphine. In addition to endotracheal intubation and ventilatory support, steroids were administered both intravenously and epidurally to suppress spinal cord irritation. The two patients regained motor and sensory functions 14 and 18 hours later, respectively, without sequelae.
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TL;DR: Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy; however, infection due to Cunninghamella species and dissemination were independently associated with increased rates of death.
Abstract: Background Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease. Methods We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described. Results The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively). Conclusions Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.
2,351 citations
TL;DR: The present guidelines include recent information and recommendations based on the current understanding, and highlight issues that remain controversial and areas where further research is required.
2,053 citations
TL;DR: Once ischaemia has occurred, treatment regimens such as a combination of induced hypertension and hypervolaemia, or transluminal angioplasty, are plausible, but of unproven benefit.
Abstract: The incidence of subarachnoid haemorrhage (SAH) is stable, at around six cases per 100 000 patient years. Any apparent decrease is attributable to a higher rate of CT scanning, by which other haemorrhagic conditions are excluded. Most patients are <60 years of age. Risk factors are the same as for stroke in general; genetic factors operate in only a minority. Case fatality is approximately 50% overall (including pre-hospital deaths) and one-third of survivors remain dependent. Sudden, explosive headache is a cardinal but non-specific feature in the diagnosis of SAH: in general practice, the cause is innocuous in nine out of 10 patients in whom this is the only symptom. CT scanning is mandatory in all, to be followed by (delayed) lumbar puncture if CT is negative. The cause of SAH is a ruptured aneurysm in 85% of cases, non-aneurysmal perimesencephalic haemorrhage (with excellent prognosis) in 10%, and a variety of rare conditions in 5%. Catheter angiography for detecting aneurysms is gradually being replaced by CT angiography. A poor clinical condition on admission may be caused by a remediable complication of the initial bleed or a recurrent haemorrhage in the form of intracranial haematoma, acute hydrocephalus or global brain ischaemia. Occlusion of the aneurysm effectively prevents rebleeding, but there is a dearth of controlled trials assessing the relative benefits of early operation (within 3 days) versus late operation (day 10-12), or that of endovascular treatment versus any operation. Antifibrinolytic drugs reduce the risk of rebleeding, but do not improve overall outcome. Measures of proven value in decreasing the risk of delayed cerebral ischaemia are a liberal supply of fluids, avoidance of antihypertensive drugs and administration of nimodipine. Once ischaemia has occurred, treatment regimens such as a combination of induced hypertension and hypervolaemia, or transluminal angioplasty, are plausible, but of unproven benefit.
1,208 citations
TL;DR: It is suggested that PDCs and PDC-derived IFN-α represent potential early targets for the treatment of psoriasis and a novel innate immune pathway for triggering a common human autoimmune disease is uncovered.
Abstract: Psoriasis is one of the most common T cell-mediated autoimmune diseases in humans. Although a role for the innate immune system in driving the autoimmune T cell cascade has been proposed, its nature remains elusive. We show that plasmacytoid predendritic cells (PDCs), the natural interferon (IFN)-alpha-producing cells, infiltrate the skin of psoriatic patients and become activated to produce IFN-alpha early during disease formation. In a xenograft model of human psoriasis, we demonstrate that blocking IFN-alpha signaling or inhibiting the ability of PDCs to produce IFN-alpha prevented the T cell-dependent development of psoriasis. Furthermore, IFN-alpha reconstitution experiments demonstrated that PDC-derived IFN-alpha is essential to drive the development of psoriasis in vivo. These findings uncover a novel innate immune pathway for triggering a common human autoimmune disease and suggest that PDCs and PDC-derived IFN-alpha represent potential early targets for the treatment of psoriasis.
1,042 citations
TL;DR: It is suggested that the anterior insula is concerned with the integration of all the concordant multimodal sensory signals associated with voluntary movements, and the inferior parietal cortex represents movements in an allocentric coding system that can be applied to the actions of others as well as the self.
871 citations
References
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Journal Article•
TL;DR: The epithelioid hemangioendothelioma (EHE) as discussed by the authors is a type of cancer characterized by a histiocytoid endothelial cell, which grows in small nests or cords and only focally line well-formed vascular channels.
1,079 citations
Journal Article•
TL;DR: The capacity of single embryonal carcinoma cells to differentiate into benign tissues supports neither the dogma of the irreversibility of the malignant transformation nor the somatic cell mutation theory of cancer.
Abstract: Summary In order to test the hypothesis that embryonal carcinoma cells are multipotential stem cells of a teratocarcinoma, an in vivo cloning technic was designed. Small embryoid bodies containing mostly embryonal carcinoma were obtained from ascitic conversion of a murine teratocarcinoma and were dissociated with trypsin to form a suspension of single cells; the single cells were picked up in small capillary tubes and transplanted directly into mice. From over 1700 single cell grafts, 44 clonal lines were obtained; 43 of these lines were teratocarcinomas composed of as many as fourteen well differentiated somatic tissues in addition to embryonal carcinoma. These 43 lines varied in their degree of differentiation, capacity to produce embryoid bodies, and in growth rate. The remaining clonal line showed limited potential for differentiation, producing only yolk sac, trophoblast, and embryonal carcinoma. The results demonstrated the multipotentiality of single embryonal carcinoma cells, as well as the heterogeneity of the embryonal carcinoma of a teratocarcinoma. The capacity of single embryonal carcinoma cells to differentiate into benign tissues supports neither the dogma of the irreversibility of the malignant transformation nor the somatic cell mutation theory of cancer. These findings were interpreted as giving strong support to the stem cell theory of cancer.
808 citations
Book•
22 May 1986
TL;DR: The author's classification of the neuroepithelial tumors follows closely the histogenetic one of Bailey and Cushing, and insists rightly upon the importance of avoiding too great a dependence upon the cell type alone for morphological diagnosis.
Abstract: an internationally recognized authority, the reviewer can only repeat his comments upon the earlier edition, for the main body of the work remains unchanged. In a comparatively short compass the author has managed to achieve a well balanced and discriminating systematic condensation of a huge literature and of his own wide experience in the pathology of brain tumors. The book is addressed to the needs and interests of clinicians. The first half of the work is devoted to the general characteristics of brain tumors : their classification, structure, age and sex incidence, preferential localization, and displacements of intracranial structures. These topics are discussed always with their diagnostic and prognostic significance in mind. Although the author's classification of the neuroepithelial tumors follows closely the histogenetic one of Bailey and Cushing, he insists rightly upon the importance of avoiding too great a dependence upon the cell type alone for morphological diagnosis, and emphasizes the neces¬ sity of giving full consideration to the total archi¬ tecture of the tumor and its manner of growth. The remainder of the book is concerned with the gross and microscopic anatomy of the indi¬ vidual tumor types, illustrated by well chosen photographs of excellent technical quality. The new edition has been revised by the addition to the appropriate chapters of a brief resume of the re¬
493 citations
TL;DR: The state of knowledge concerning the neuroprotective pharmacology of methylprednisolone, including mechanism(s) of action, dosing requirements, and time-action considerations is reviewed, as are the results of studies with high doses in experimental and clinical head injury, subarachnoid hemorrhage, and cerebral ischemia.
Abstract: A 24-hour intensive intravenous dosing regimen with the glucocorticoid steroid methylprednisolone has recently been shown to be effective in enhancing neurological recovery in spinal cord-injured patients when initiated within 8 hours after injury. The state of knowledge concerning the neuroprotective pharmacology of methylprednisolone, including mechanism(s) of action, dosing requirements, and time-action considerations is reviewed, as are the results of studies with high doses in experimental and clinical head injury, subarachnoid hemorrhage, and cerebral ischemia. A primary neuroprotective mechanism of action in each of these cases is hypothesized to involve the ability of high doses of methylprednisolone to inhibit oxygen free radical-induced lipid peroxidation, although additional mechanisms may contribute. Unresolved issues are also addressed, including the therapeutic window, optimum duration of treatment, and rational combination with other neuroprotective agents. A newer methylprednisolone pro-drug with improved solution stability is discussed, together with a brief consideration of novel nonglucocorticoid steroids that surpass methylprednisolone's lipid antioxidant effects without unwanted glucocorticoid properties.
443 citations
TL;DR: Results suggest that epidural morphine travels cephalad in the cerebrospinal fluid to reach the brain stem and fourth ventricle by the sixth hour, and Hypalgesia and side effects were not related to serum concentrations of morphine.
Abstract: Ten healthy males between 18 and 33 years received 10 mg morphine sulfate intravenously, or by lumbar epidural injection at two sessions 2-4 weeks apart, in random sequence. The following observations were made at intervals for 22 h. (1) Segmental hypalgesia to ice and pin scratch. (2) Cold pressor response test in hand and foot as an index of analgesia. (3) Time of onset and duration of side effects. (4) Serum concentrations of morphine. Few non-respiratory changes were seen after intravenous morphine. Cold pressor response was unchanged in hand and foot, no segmental hypalgesia or itching occurred, and only one subject complained of nausea. Marked changes occurred after epidural morphine. Cutaneous hypalgesia to ice and pin scratch appeared in the thoracolumbar region all subjects. In six subjects hypalgesia rose to the midthoracic region during the second or third hour and to the trigeminal distribution between the sixth and ninth hour in five subjects. Cold pressor response fell rapidly in the foot during the first 1.5 h after epidural morphine, and a little later cold pressor response also fell in the hand in all subjects, and remained depressed for the duration of the experimental period. Pruritus occurred at three hours in nine of the 10 subjects, nausea at about four hours in six of the subjects, and vomiting at about six hours in five of the subjects. Hypalgesia and side effects were not related to serum concentrations of morphine. These results suggest that lumbar epidural morphine travels cephalad in the cerebrospinal fluid to reach the brain stem and fourth ventricle by the sixth hour.
325 citations