Posthyperventilation isocapnic hyperpnea

From the results of this study, it appears that whole blood alone or red blood cells reconstituted with saline solution do not adequately replace the loss of albumin and concomitant decrease in colloid oncotic pressure that occur during extensive intraabdominal and intrathoracic operations. Since colloid oncotic pressure is a major factor in the restitution of intravascular volume from stores of interstitial fluid and since it may also play a role in the development of postoperative pulmonary problems, it is important to maintain a relatively normal colloid oncotic pressure during the operation and in the immediate postoperative period. Although dextran can be used for this purpose, its short half-life of four to six hours and associated coagulation problems militate against its use in large quantities. This leaves purified protein fraction or salt-poor albumin as the main sources of protein for the maintenance of colloid oncotic pressure. Both of these products are expensive and short in supply. The oncometer in present use is a clinically feasible and rapid, one to three minutes, means of determining the colloid oncotic pressure. It permits a rational approach to the use of albumin products, avoiding the pitfalls of under or excess administration in the operative and postoperative periods.     

Primary biliary cirrhosis complicated by severe hypoxemia

The case reported here is of a 61-year-old woman diagnosed with hepatopulmonary syndrome. She had had severe hypoxemia for 5 years. In room air, her arterial oxygen tension was low, and although we anticipated that treatment with oxygen would increase it, the treatment failed to do so. Pulmonary perfusion imaging with Tc-99m-labelled macroaggregated albumin showed an arterio-venous shunt in the lungs. Blood tests and liver scanning with Tc-99m-labelled galactosyl human serum albumin showed abnormalities of liver function, and per-rectal portal scintigraphy with Tc-99m pertechnetate showed severe portal hypertension. Inspection of a biopsy specimen taken under ultrasonographic guidance showed primary biliary cirrhosis of Scheuer stage I. The causes of hepatopulmonary syndrome are unknown, but seem to include a decrease in hepatic functional reserve, portal hypertension, or other factors. The development of hepatopulmonary syndrome due to portal hypertension in this patient is of interest.     

Liver transplantation for severe hypoxemia caused by patent ductus venosus

The authors describe the case of a 9-year-old girl who underwent liver transplantation because she suffered from severe hypoxemia caused by patent ductus venosus (PDV). Generally, severe hypoxemia (PaO2 < 50 mm Hg in room air or < 300 mm Hg in pure oxygen) is not an indication for liver transplantation because the hypoxemia may not be improved, and may lead to a fatal outcome. PDV, which is associated with mild liver dysfunction, is not an indication for liver transplantation by itself. But in our patient, most of the mesenteric venous flow directly entered the systemic circulation through the PDV just like the portosystemic shunt, and this caused the pulmonary arteriovenous shunt and hypoxemia. Thus, the authors operated on the patient in an attempt to restore her pulmonary function. Nitric oxide (10 to 20 ppm) was added to the inhaled gas to dilate the functional pulmonary capillaries and to deliver sufficient oxygen after the transplantation. Although the patient suffered various complications after the operation, the final results were excellent.     

Bilateral lateral geniculitis associated with severe diarrhea

PURPOSE: We examined a 28-year-old woman who developed incongruous binasal and bitemporal visual field defects one week after having a febrile gastroenteritis characterized by severe diarrhea while traveling in Mexico. METHODS: The patient was treated with intravenous methylprednisolone sodium succinate, 1 g daily for three days, followed by an eight-week course of oral prednisone. RESULTS: Neuroradiologic examination demonstrated bilaterally increased signal intensity within the lateral geniculate bodies. Cerebrospinal fluid analysis disclosed isolated protein increase. CONCLUSION: Severe diarrhea may be associated with an aseptic bilateral lateral geniculitis resulting in hourglass-shaped visual fields. Corticosteroid therapy may provide mild improvement.     

Personality factors associated with severe traumatic disability.

Investigated whether persons with traumatic injuries are more extraverted than nontraumatically disabled persons. 111 rehabilitation patients with either traumatic or nontraumatic disabilities associated with either chronic pain or motor loss completed the Eysenck Personality Inventory and the SCL-90. Results show that the traumatically disabled Ss with motor loss (paraplegia or quadriplegia) were more extraverted and less distressed than Ss with nontraumatic disabilities or with traumatically induced pain. It is contended that the external orientation characteristic of extraversion and the style of learning through actively and repeatedly challenging the environment may account for the prominence of extraversion within the traumatically disabled group with motor loss and for the relative absence of distress for this group in the highly structured medical/rehabilitation environment. It is suggested that the psychological adjustment of more extraverted personalities to disability involving motor loss may be better facilitated by interventions that encourage experiential learning and challenging environmental limits than by introspective psychotherapy or counseling. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A case report of obstructive sleep apnea syndrome associated with primary aldosteronism

A 60-year-old obese woman was admitted for evaluation of excessive daytime sleepiness, loud snoring, cyanosis, systemic edema, hypertension and diabetes mellitus. Laboratory examination showed severe hypoxemia, hypercapnea, metabolic alkalosis, hypokalemia and hyperaldosteronism. CT scan showed a left adrenal tumor. A diagnosis of obstructive sleep apnea syndrome associated with primary aldosteronism was established. Metabolic alkalosis, hypokalemia and sodium retention due to hyperaldosteronism were thought to be factors exacerbating her sleep apnea.     

Tongue base reduction with hyoid-epiglottoplasty. A surgical alternative in severe sleep apnea syndromes

We present preliminary results and indications of tongue base reduction with hyo-epiglottoplasty for the treatment of severe obstructive sleep apnea syndrome (OSAS) due to isolated hyolingual abnormalities. The procedure consists in a subtotal resection of the tongue base after identification and derouting of the lingual neurovascular bundle. Hypopharyngeal enlargement, epiglottis verticalization, floor of the mouth tension and hyoid bone repositioning are also performed during the procedure. 14 severe OSAS male patients (mean apnea-hypopnea index of 71) were treated in our institution from November 1992 to February 1996. Indications were determined after a cephalometric analysis and a magnetic resonance imaging evaluation. Results were evaluated on clinical and polysomnographic criteria. No neurovascular complications occurred. Clinical results were excellent but success rate based on polysomnography was 50%. These preliminary results led us to change some of the steps in the technique. We also identified a predictive factor of success on the cephalometrics: an oropharyngeal area greater than 25 cm2.     

Cutaneous necrosis associated with acquired severe protein S deficiency

The incidence of benign lymphoepithelial lesions of the parotid gland in patients afflicted with HIV has increased. Enucleation is a safe and effective procedure that provides the patient with complete removal of the cyst and a low recurrence rate. Enucleation of these parotid cysts should be considered in treating these patients.     

Giant T wave inversion associated with severe aortic regurgitation

In 1978, the Food and Drug Administration (FDA), developed a generic anesthesia equipment preuse checklist. The checklist was first released by the FDA in August 1986 and endorsed by the American Association of Nurse Anesthetists on October 18, 1986. The FDA checklist was revised in 1992 to improve the abilities of anesthesia providers to detect machine faults. In the present study, the investigators attempted to determine the effectiveness of the revised FDA checklist in detection of anesthesia machine faults as compared to providers' usual methods. Whereas no published study of preanesthesia safety inspection had been performed since the revision of the FDA checklist, the authors compared the detection abilities of anesthesia providers before and after inclusion of the revised FDA checklist. Twenty-two anesthesia providers were tested to compare the number of prearranged anesthesia machine faults that could be detected with (1) their usual checkout methods, and (2) with the revised FDA checklist. Data describing the subjects' fault detection abilities were analyzed using the t test for paired observation (P value < 0.05 considered significant). Statistical analysis revealed no significant difference (P = 0.479) when subjects used the FDA checklist and when they used their usual method. Use of the FDA machine checklist was no more effective than the provider's usual method in discovering machine faults. When using their normal method, 54.5% of providers did not discover more than 50% of programmed faults. Approximately 40.9% of providers who used the revised FDA checklist did not discover over 50% of programmed faults.     

Deficiency of adenosine deaminase not associated with severe combined immunodeficiency

The 12-year-old Kung ("Bushman') boy from South West Africa who has marked deficiency of red cell adenosine deaminase has been found to have 2 to 3% of enzyme activity in red blood cells, 10 to 12% in leukocytes, and 10 to 30% in cultured fibroblasts. The enzyme has ADA 1 electrophoretic mobility: SV40 transformation of cultured fibroblasts caused a decrease of "tissue ADA' and an increase in "red cell ADA' isozymes. A battery of investigations revealed that the child has normal humoral and cellular immunity. A family study showed that a sibling had the same level of red cell ADA and the parents had intermediate levels. Studies of the Kung population from which the child comes have shown that the allele responsible for the condition, and which we designate ADA8, is polymorphic.     

Variables associated with employment following severe traumatic brain injury.

Results of a survey of employment outcome and their relationship to psychometric indices indicated that competitive employment following severe traumatic brain injury is an ambitious endeavor. While 98% of the 94 Ss sampled were either employed or in school premorbidly, 43% of them were unemployed postinjury. Psychometric variables were most highly related to employment outcome which suggested a useful role of neuropsychological testing in assisting in vocational rehabilitation planning. Furthermore, the psychometric test results indicated that many Ss who were unemployed may be capable of parttime employment. Future studies are needed to further examine those neuropsychological abilities which subsequently affect employability following severe traumatic brain injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Surgical removal of right atrial myxoma with severe hypoxemia caused by right to left shunt through persistent foramen ovale]

A 41-year-old woman was referred to our hospital due to dyspnea and cyanosis. Echocardiography revealed a right atrial tumor with right to left shunt through PFO. There was no evidence of pulmonary embolism from the tumor. The tumor was removed under cardiopulmonary bypass and PFO was closed. The patient is doing well now.     

Serum immunoglobulins in children with asthma associated with severe respiratory tract infections

High school males (N = 109) and junior high school males (N = 112) administered the Physical Estimation and Attraction Scales (PEAS), the Tennessee Self-Concept Scale (TSCS), and a physical fitness battery. Previous research results were replicated in the h.s. group in that fitness and self-esteem were not significantly related but Estimation (of physical ability) correlated significantly with both fitness and self-esteem (p less than .01). Similar results were obtained in the jr. h.s. sample. Additionally, the validity of the Estimation (EST) scale was extended to include significant relationships with indices of emotional adjustment other than self-esteem. EST scores were shown to be influenced to significant but not inordinate degree by certain response bias tendencies. Negatively phrased EST items were denied significantly more often than positive EST items were affirmed and were more highly related to both response bias and emotional adjustment scores. Controlling for response bias influence by partial correlation failed to extinguish the significance of EST validating relationships. It was concluded that these relationships exist independently of response style or response set.