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1.
This research study was undertaken to examine the relationship between pulmonary artery blood temperature (regarded as the 'gold standard' measurement for core body temperature), axilla temperature using the Tempa.DOT Ax chemical thermometer and tympanic membrane temperature using the Diatek 9000 InstaTemp thermometer. Sixty adult intensive care patients had their temperatures monitored. A single set of five simultaneous temperatures, i.e. left and right axilla, left and right tympanic membrane (TM), and pulmonary artery (PA) blood were recorded. The mean difference between left and right TM temperatures was 0.58 degree C, and although both were moderately well correlated with PA temperature (r = 0.63 and 0.78, respectively) the mean differences between the two sites were clinically significant (0.85 degree C and 0.94 degree C, respectively). The range of differences between the sites was significant. Plotting limits of agreement showed that both left and right TM temperatures may be up to 1.2 degrees C above or 1.3 degrees C below PA blood temperature: a clinically unacceptable range. In particular, large temperature differences were recorded when patients were lying with one side of their head to a pillow. Fan therapy directed to the head was not found to affect these differences significantly. The mean difference between left and right axilla temperatures was 0.36 degree C, and although both were modestly correlated with PA temperature (r = 0.48 and 0.53, respectively) the mean differences between the two sites were clinically significant (0.47 degree C and 0.50 degree C, respectively). The range of differences between the sites was particularly significant. Plotting limits of agreement showed that both left and right axilla temperatures may be up to 1.2 degrees C above or 1.6 degrees C below PA blood temperature: a clinically unacceptable range. Because the range of temperature differences found between PA blood and the other sites was so great, it is concluded that neither the chemical axilla thermometer nor the tympanic membrane thermometer used in this study are clinically reliable tools for adult intensive care patients.  相似文献   

2.
BACKGROUND: Different regions within the left ventricle are preferentially supplied by the left or right sympathetic system. In order to characterize different influences of left vs right sympathetic lateralization on LV function, haemodynamic effects of right and left stellate ganglion stimulations (RSGS and LSGS) as well as a right sympathetic block (RSB) were compared. METHODS: Seven alpha-chloralose anaesthetized open chest dogs were instrumented for measurement of LV pressure (tip manometers) and regional LV wall thickness (WT, sonomicrometry) in the antero-apical wall (AW, innervated by right stellate ganglion) and postero-basal wall (PW, left stellate ganglion). Timing of regional myocadial wall motion was evaluated by the phase of the first Fourier transform of the WT signals, LV asynchrony by the phase difference (phi) between both regions, and LV diastolic function by the time constant of isovolumic relaxation (tau). Measurements were performed before and after RSB (5 ml of lidocaine 1%); in 6 dogs of this group, RSGS and LSGS (4 V, 0.2 ms, 20 Hz) were performed before RSB. In order to investigate a regional inotropic stimulation without systemic effect, 6 additional dogs received intracoronary noradrenaline injections (NIC, 0.25 microgram) into the left circumflex artery perfused myocardium. RESULTS: LSGS and NIC led to an earlier PW-motion within the cardiac cycle (phase reduction by 40.0 +/- 15.0 degree (SEM) and 55.5 +/- 11.2 degrees) and RSGS induced an earlier AW-motion (by 33.7 +/- 15.2 degrees). After RSB, AW-motion was delayed (38.1 +/- 9.2 degrees). The consequence was an asynchronous wall motion pattern after all interventions (change in phi: LSGS-64.7 +/- 18.7 degrees, RSGS 41.1 +/- 15.7 degrees, NIC -74.5 +/- 17.4 degrees, RSB -52.6 +/- 14.6 degrees), and a prolonged relaxation (tau increase: RSGS 9.4 +/- 1.9, NIC 8.3 +/- 1.5, RSB 3.7 +/- 0.8 ms). CONCLUSION: Unilateral increases as well as decreases of sympathetic tone to the heart result in an asynchronous wall motion pattern and an impaired LV relaxation.  相似文献   

3.
BACKGROUND AND OBJECTIVES: A 9-year-old boy with a history of poorly controlled insulin-dependent diabetes mellitus was found at home unresponsive. QT prolongation was diagnosed on inspection of Holter monitoring performed immediately before episodes of ventricular fibrillation. METHODS: In spite of medical management with propranolol, esmolol, phenytoin, and diazepam, the patient continued to have episodes of QT prolongation followed by ventricular dysrhythmias that reverted to sinus rhythm only after cardiopulmonary resuscitation and cardioversion. RESULTS: A series of left stellate ganglion blocks with bupivacaine eradicated the dysrhythmias. The child was then referred to another institution for insertion of an automatic internal cardioverter defibrillator. CONCLUSIONS: This case report emphasizes the effectiveness of left stellate ganglion block with bupivacaine in a child with a variant of long QT syndrome.  相似文献   

4.
In anesthetized dogs the circumflex and/or the anterior descending coronary artery were briefly occluded (10 to 90 seconds) and ectopic beats occurring during the occlusion or for 60 seconds following release were counted. Control occlusions were alternated with occlusions performed during complete, reversible, unilateral blockade of either the right or the left stellate ganglion. This was achieved with thermodes through which coolant was circulated. In this way the shortcomings associated with stellectomy, which is irreversible, are avoided. Blockade of the right stellate ganglion increased the number of ectopic beats associated with coronary occlusion. The occurrence of episodes of ventricular tachycardia and fibrillation was also greater. By contrast, blockade of the left stellate ganglion reduced or abolished occlusion-induced arrhythmias. These effects are independent of changes in heart rate or vegal activity; they depend solely upon unilateral alteration in sympathetic tone, and are not demonstrable when such tone is low. We suggest that the right and left cardiac sympathetic nerves have a different influence upon cardiac excitability.  相似文献   

5.
The purpose of this study was to determine whether infrared tympanic membrane thermometry can replace mercury-in-glass temperatures as an assessment tool for detecting fevers earlier and more reliably in a pediatric oncology outpatient setting. A total of 313 patient visits had infrared tympanic temperatures (obtained by using the LighTouch LTX Pedi-Q thermometer (Exergen; Watertown, MA) and axillary temperatures taken simultaneously (obtained by using mercury-in-glass thermometers). Those patients with a normal axillary temperature and an elevated tympanic measurement of 38 degrees C or higher had a follow-up axillary temperature conducted that evening to determine whether an elevated tympanic temperature predicted on coming fever or infection. The mean tympanic temperature was 37.5 degrees C and the mean axillary temperature was 36.8 degrees C, a difference of 0.7 degree C (P = .0001). Sixty-two (20%) patients had discrepant temperatures with a febrile tympanic and normal axillary measurement. Three (5%) of these patients were febrile at their follow-up axillary reading. Tympanic thermometry resulted in a significantly higher temperature reading than the axillary method. Elevated tympanic temperatures were not predictive of oncoming fever or infection. Fevers were not missed when using the tympanic method. To prevent unnecessary medical intervention, it is recommended that mercury-in-glass thermometers verify elevated tympanic temperatures.  相似文献   

6.
The alteration of extracranial blood flow in conjunction with clinical signs of autonomic nervous system dysfunction have led to various explanations concerning the pathophysiology of migraine headache. Reflex sympathetic dystrophy, a painful disorder of the sympathetic nervous system, can be treated by blocking the sympathetic nerves located in the stellate ganglion, resulting in vasodilation, ptosis, miosis, and anhydrosis. In theory, these changes could trigger a migraine headache attack secondary to autonomic dysfunction reflecting an imbalance between sympathetic and parasympathetic nervous systems. This may be especially true in a patient with a previous history of meningitis that may have resulted in a disorder of cerebrovascular regulation. We report a 56-year-old man with no previous history of migraine who developed migraine with aura after a stellate ganglion block. These episodic headaches occurred with decreasing frequency and severity for over 6 months, with eventual complete resolution. This interesting phenomenon has not been reported in the English literature and may help to better understand the pathophysiology of migraine.  相似文献   

7.
BACKGROUND: This study was designed to determine the magnitude and frequency of measurement errors with infrared tympanic thermometers in the clinical setting. METHODS: In a convenience sample of 137 adult inpatients, we compared body temperatures measured by a Diatek 9000 Infrared Aural Thermometer and an IVAC 2090 CoreCheck Tympanic Thermometer between themselves, in right versus left ears, and against concurrently measured oral temperatures using both an electronic thermoprobe and conventional glass mercury thermometer. RESULTS: There was a significant between-brand difference of 0.6 degrees C (IVAC 相似文献   

8.
Temperature of the tympanic membrane is recommended as a "gold standard" of core-temperature recording. However, use of temperature probes in the auditory canal may lead to damage of tympanic membrane. Temperature measurement in the auditory canal with infrared thermometry does not pose this risk. Furthermore it is easy to perform and not very time-consuming. For this reason infrared thermometry of the auditory canal is becoming increasingly popular in clinical practice. We evaluated two infrared thermometers-the Diatek 9000 Thermoguide and the Diatek 9000 Instatemp-regarding factors influencing agreement with conventional tympanic temperature measurement and other core-temperature recording sites. In addition, we systematically evaluated user dependent factors that influence the agreement with the tympanic temperature. MATERIALS AND METHODS: In 20 volunteers we evaluated the influence of three factors: duration of the devices in the auditory canal before taking temperature (0 or 5 s), interval between two following recordings (30, 60, 90, 120, 180 s) and positioning of the grip relative to the auditory-canal axis (0, 60, 180 and 270 degrees). Agreement with tympanic contact probes (Mon-a-therm tympanic) in the contralateral ear was investigated in 100 postoperative patients. Comparative readings with rectal (YSI series 400) and esophageal (Mon-a-therm esophageal stethoscope with temperature sensor) probes were done in 100 patients in the ICU. The method of Bland and Altman was taken for comparison. RESULTS: Shortening of the interval between two consecutive readings led to increasing differences between the two measurements with the second reading decreasing. A similar effect was seen when positioning the infrared thermometers in the auditory canal before taking temperatures: after 5 s the recorded temperatures were significantly lower than temperature recordings taken immediately. Rotation of the devices out of the telephone handle position led to increasing lack of agreement between infrared thermometry and contact probes. Mean differences between infrared thermometry (Instatemp and Thermoguide, CAL-Mode) and tympanic probes were -0.41 +/- 0.67 degree C (2 SD) and -0.43 +/- 0.70 degree C, respectively. Mean differences between the Thermoquide (Rectal-Mode) and rectal probe were -0.19 +/- 0.72 degree C, and between the Thermoguide (Core Mode) and esophageal probe -0.13 +/- 0.74 degree C. DISCUSSION: Although easy to use, infrared thermometry requires careful handling. To obtain optimal recordings, the time between two consecutive readings should not be less than two min. Recordings should be taken immediately after positioning the devices in the auditory canal. Best results are obtained in the 60 degrees position with the grip of the devices following the ramus mandibulae (telephone handle position). The lower readings of infrared thermometry compared with tympanic contact probes indicate that the readings obtained represent the temperature of the auditory canal rather than of the tympanic membrane itself. To compensate for underestimation of core temperature by infrared thermometry, the results obtained are corrected and transferred into core-equivalent temperatures. This data correction reduces mean differences between infrared recordings and traditional core-temperature monitoring, but leaves limits of agreement between the two methods uninfluenced.  相似文献   

9.
Paired tympanic membrane and rectal temperatures were compared for 103 female fallow deer (Dama dama) after short-term anesthesia to determine if tympanic temperature was a reliable indicator of hyperthermia associated with handling stress. Each deer was restrained in a drop-floor chute, anesthetized by i.v. injection of xylazine hydrochloride and ketamine hydrochloride, and removed from the chute. After a short procedure was completed, i.m. antibiotics and i.v. yohimbine hydrochloride were given to each deer. Temperature measurements were obtained during recovery from anesthesia, approximately 10 min after initial restraint. Mean tympanic temperature (38.6 degrees C +/- 0.7 degrees C; range 37.4-40.8 degrees C) was significantly lower than mean rectal temperature (40.1 degrees C +/- 0.8 degrees C; range 37.5-42.0 degrees C) [corrected]. One animal had rectal and tympanic temperatures of 42.0 degrees C and 40.8 degrees C, respectively, but regained normal body temperature after cooling measures were applied. Tympanic membrane temperature measurement may provide a method for evaluation of body temperature by separating retained body heat caused by exertion from critical elevations in core body temperature associated with clinical disease or capture stress.  相似文献   

10.
Monitoring and maintaining body temperature during the perioperative period has a significant impact on the risk of myocardial ischemia, cardiac morbidity, wound infection, surgical bleeding, and patient discomfort. To test the hypothesis that body temperature is inadequately monitored during regional anesthesia (RA), we randomly surveyed 60 practicing anesthesiologists to determine practice patterns for temperature monitoring. Only 33% of the clinicians surveyed routinely monitor body temperature during RA. Although skin temperature monitoring has limitations, it was the most commonly used method among the survey respondents. When temperature is monitored during RA, most clinicians use either liquid crystal skin-surface monitoring or axillary temperature probes. Of those surveyed, < 15% use acceptable core temperature monitoring techniques (urinary bladder or tympanic membrane). In conclusion, it seems that body temperature is often not monitored in patients receiving RA. Implications: The results of this survey of practicing anesthesiologists indicate that body temperature is often not monitored in patients receiving regional anesthesia. It is therefore likely that significant hypothermia goes undetected and untreated in these patients.  相似文献   

11.
STUDY OBJECTIVE: To determine the agreement between rectal temperature and infrared tympanic membrane temperatures in marathon runners presenting to a field hospital at the finish line. METHODS: The subjects of this prospective, blinded, controlled study were runners 18 years or older who were triaged to the acute care medical area at the finish line for suspected hypothermia, hyperthermia, dehydration, or altered mental status. Rectal and tympanic temperatures were measured simultaneously in all subjects for whom rectal temperature measurement had been deemed necessary and recorded on separate data cards. RESULTS: Of the 239 runners treated in the acute care medical area, 37 required rectal temperature measurement and were enrolled in the study. The mean rectal temperature was 38.45 degrees +/- 1.20 degrees C (range, 35.9 degrees to 41.5 degrees C). The mean tympanic membrane temperature was 37.81 degrees +/- 95 degrees C (range, 36.3 degrees to 40.4 degrees C). Pearson's correlation coefficient revealed a moderate correlation (r = .6902, P = .00023). The mean temperature difference between the two thermometers, mean rectal minus mean tympanic membrane, was .64 degrees C (95% confidence interval, .35 degrees to .93 degrees C). Sixty-Two percent of the tympanic membrane readings were within 1 degree C of their rectal counterparts. Agreement ranged from 1.16 degrees (+2 SD) to -2.95 degrees (-2 SD). The 95% confidence interval was 1.67 degrees to -2.95 degrees C. CONCLUSION: We were able to demonstrate only a moderate correlation between the two thermometer readings, with a wide spread between the limits of agreement. This spread could be clinically significant and therefore limits the usefulness of tympanic temperature in the marathon race setting. Because of the potentially large and clinically significant differences in rectal and tympanic temperatures and the limitations inherent in our study, we cannot endorse the use of tympanic temperature in the setting of a marathon event.  相似文献   

12.
We examined three patients with irritable bowel syndrome (IBS) who did not respond to drug therapy and who were treated by stellate ganglion block (SGB) alone. The clinical symptoms improved by the SGB in all these three patients. There was no recurrence. The pathophysiological mechanism of this disease and the therapeutic efficacy of SGB should be elucidated with respect to the autonomic nervous, endocrine and immune systems. These results suggest that SGB therapy is effective for IBS, a typical psychosomatic disease.  相似文献   

13.
A patient with Wolff-Parkinson-White syndrome type B developed 2:1 atrioventricular block resulting from the association of persistent right bundle-branch block with tachycardia-dependent (phase 3) left bundle-branch block. Electrophysiological studies disclosed the coexistence of a tachycardia-dependent (phase 3) block in the accessory pathway. This conduction disturbance was exposed, not by carotid sinus massage as in previous studies, but by pacing-induced prolongation of the interval between two consecutively conducted atrial impulses. Furthermore, the surface electrocardiogram showed, at different times, ventricular complexes resulting from: (1) exclusive atrioventricular conduction through the normal pathway without bundle-branch block; (2) predominant, or exclusive, atrioventricular conduction through a right-sided accessory pathway; (3) exclusive atrioventricular conduction through the normal pathway with right bundle-branch block; (4) exclusive conduction through the normal pathway, with left bundle-branch block; (5) fusion between (1) and (2); and finally, (6) fusion between (2) and (3) However, QRS complexes resulting from simultaneously occurring Wolff-Parkinson-White syndrome type B and left bundle-branch block could not be identified. Future electrophysiological investigations should re-evaluate the criteria used to diffrentiate between true and false patterns of Wolff-Parkinson-White syndrome type B coexisting with left bundle-branch block.  相似文献   

14.
We assessed the onset of sensory and motor blockade as well as the distribution of sensory blockade after axillary brachial plexus block with 1.5% lidocaine hydrochloride 1:200,000 epinephrine with and without sodium bicarbonate in 38 patients. The onset of analgesia and anesthesia was recorded over the distributions of the median, ulnar, radial, and medial cutaneous nerves of the forearm, medial cutaneous and lateral cutaneous nerves of the arm, and musculocutaneous nerve. The onset of motor blockade of elbow and wrist movements was also recorded. Data were analyzed by using survival techniques and compared by using log rank tests. Only the onset of analgesia in the medial cutaneous nerves of the arm and forearm, and the onset of anesthesia in the medial cutaneous nerve of the arm were significantly faster (P < 0.05) with alkalinization of lidocaine. Our study showed that alkalinization of lidocaine does not significantly hasten block onset in most terminal nerve distributions. IMPLICATIONS: We examined whether alkalinizing a local anesthetic would quicken the onset of a regional upper limb nerve blockade. We found that alkalinization of lidocaine did not offer a significant clinical advantage in axillary brachial plexus blockade.  相似文献   

15.
Ground reaction force (GRF) patterns from 20 clinically sound Dutch Warmbloods were recorded at the right fore-leading canter, and a standard horse was composed. These GRF data for the standard can be used for evaluation of jumping horses. The GRF patterns were asymmetric for all 4 limbs. The leading right forelimb decelerated the body. The trailing left forelimb propelled the body and decelerated it slightly. The trailing left hind limb propelled, and the leading right hind limb contributed to deceleration and propulsion. Referred to the maximal vertical load of the leading right forelimb, the load of the trailing left forelimb was 25% more; the load of the right hind limb was slightly less, whereas the load of the left hind limb was about 80% of that value.  相似文献   

16.
The changes of monophasic action potential durations due to stellate stimulation for the period of 3 sec were studied in dogs with suction electrodes from the anterior surface of the right ventricle and the posterior surface of the left ventricle. Prolongation of monophasic action potential duration was observed from the period of 2 to 3 sec during stimulation to that of 10 to 20 sec after the termination of stimulation. Prolongation of monophasic action potential duration due to right stellate stimulation was predominant in the right ventricle and that due to left stellate stimulation was predominant in the left ventricle. The transient T wave change in the surface electrocardiogram occurring immediately after the beginning of stellate stimulation could be explained by this local difference in prolongation of ventricle repolarization. Since the onset of prolongation of monophasic action potential duration preceded increase in blood pressure following stellate stimulation, this prolongation of monophasic action potential duration did not result from the hemodynamic changes and could be a primary effect of the sympathetic nerve stimulation.  相似文献   

17.
The efficacy and safety of ear drops containing phenazone and lidocaine hydrochloride (Otipax) for the treatment of congestive myringitis were evaluated in 18 infants and children aged 1 to 10 years. Relief of pain was evident 5 minutes after instillation and significant after 15 to 30 minutes. Serial photographs of the tympanic membrane demonstrated prompt improvement of inflammation. Congestion was significantly reduced after five minutes and overall ear drum color was significantly improved after 15 to 30 minutes. No adverse effects were recorded. These data suggest that Otipax is effective and safe for the treatment of painful congestive myringitis in infants and children.  相似文献   

18.
In intraventricular conducting defects distal the bundle of His we see different forms, i.e. left anterior and left posterior hemiblock, left bundle branch block and right bundle branch block. The left anterior hemiblock is electrocardiographically responsible for a left axis deviation, the left posteriof hemiblock for a vertical axis or right axis deviation. If there is in addition to a hemiblock a right bundle branch block, it is called a bifascicular block. Are at the same time all three fascicles concerned, there will be a trifascicular block, i.e. a complete atrioventricular block, the so-called peripheral form. The common cause of fascicular blocks is coronary heart disease. Because of the possible progressing of the disease patients need further surveillance and eventually therapy.  相似文献   

19.
We investigated the effects of i.v. prostaglandin E1 (PGE1) on intraoperative changes of core temperature and the incidence of postoperative shivering in neurosurgical patients undergoing deliberate mild hypothermia. Eighty-three patients were randomly assigned to one of three groups: patients in the control group did not receive PGE1, whereas patients in the PG20 group and PG50 group received PGE1 at a dose of 0.02 and 0.05 microg x kg(-1) x min(-1), respectively. The administration of PGE1 was started just after the induction of anesthesia and continued until the end of anesthesia. Anesthesia was maintained with nitrous oxide in oxygen, sevoflurane, and fentanyl. After the induction of anesthesia, patients were cooled using a water blanket and a convective device blanket. Tympanic membrane temperature was maintained at 34.5 degrees C. During surgical wound closure, patients were rewarmed. Intraoperative changes in tympanic membrane and skin temperatures and the incidence of postoperative shivering were compared among groups. Demographic and intraoperative variables were similar among groups. There were no significant differences in tympanic temperatures among groups at each point during the operation. Skin temperature 30 min after rewarming and just after tracheal extubation was significantly lower in the PG20 group than in the PG50 group. Postoperative shivering was more frequent in the PG20 group (43%) than in the control (13%) and PG50 (17%) groups. These results suggest that the intraoperative administration of PGE1 does not affect changes in core temperature during deliberate mild hypothermia and that PGE1 at a dose of 0.02 microg x kg(-1) x min(-1) may increase the occurrence of postoperative shivering. Implications: Deliberate mild hypothermia has been proposed as a means of providing cerebral protection during neurosurgical procedures. Vasodilating drugs may be used during deliberate mild hypothermia to maintain peripheral circulation and to enhance the cooling and rewarming rate. In the present study, however, we found no benefit from i.v. prostaglandin E1 administration during deliberate mild hypothermia in neurosurgical patients.  相似文献   

20.
The tympanic membrane is a biomembrane made of thin vibrant material. The tension and strength of the tympanic membrane rely mainly on the radial fibers in the lamina propria. Experimental myringotomy by linear incisions were made at right angles to the radial fiber bundles in the tympanic membrane of 54 guinea pigs. The healing process was observed chronologically by light, polarized light and electron microscopy for two years. The mechanical strength of recovery of the tympanic membranes were then studied using a microtension tester developed by our laboratory. The tensile direction was parallel to the radial fiber bundles of the tympanic membrane, and the tensile rate was 1 x 10(-3) m/sec. 1. Light microscopic observation showed that the radial fiber bundles did not reconstruct continuously even after two years. Polarized light microscopic observation showed that parts of the linear incision of the tympanic membrane contained polarized fibers in place of the normal radial fibers. Transmission electron microscopic observation of the tympanic membranes after four months showed that the radial fibers were cut off sharply, but that the lamina propria had regenerated with different fibers. Several fibroblasts were also observed. Scanning electron microscopic observation through the auditory canal after two years showed that thick masses of scar adhered to the site of the experimental incision of the tympanic membrane. This scar was composed of several layers of collagen fibers. The area of scar adhesion was also observed on the membrane facing the tympanic cavity, but it was thinner than the scars on the meatal side.(ABSTRACT TRUNCATED AT 250 WORDS)  相似文献   

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