1/9. Preservation of the brainstem auditory evoked potential in non-convulsive status epilepticus.Brainstem auditory evoked potentials (BAEPs) were recorded from a patient simultaneously experiencing non-convulsive generalized status epilepticus (NGSE). Waves I, III and V were normal but all subsequent waves were absent. This finding indicates that structures within the brainstem adjacent to the generators for the BAEP are likely not affected by NGSE and also illustrates the resilient nature of the BAEP. This is the first report of the recording of an evoked potential during a naturally occurring generalized seizure.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/9. Sequential change of heterogeneous cerebral blood blow patterns after diffuse brain ischemia.In order to provide an insight into the basic nature of ischemic brain injury, we sequentially studied cerebral blood flow with [99mTc]hexamethylpropyleneamine oxime single photon emission computed tomography (CBF imaging) in a patient with diffuse brain ischemia due to prolonged cardiac arrest. On the 10th postarrest day, concentrated blood flow over superior-medial portion of the occipital lobe was demonstrated. On the 18th postarrest day, the same region became high density on a CT scan, while the concentrated flow on the CBF imaging had diminished. Thus, an abnormal cerebral blood flow (CBF) pattern preceded the density change on CT scan. On the 23rd postarrest day, remarkably concentrated flow over the brainstem was demonstrated. This might have illustrated the reduced metabolic demand of the damaged tissue over the cerebral and cerebellar hemispheres with relative preservation of brainstem perfusion. In patients with diffuse brain ischemia, a CBF imaging may be a useful tool for clarifying pathological process and prognosis.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/9. Function of ventricular pacemakers during resuscitation.The reciprocal effects of resuscitation and permanent, ventricular-inhibited pacemakers were examined in four, well-documented cases of witnessed out-of-hospital arrest. The resulting observations provide useful insight in the treatment of cardiac arrest in the large number of patients with permanent pacemakers. Transient sensing malfunctions occurred in the two patients in whom direct current countershocks were not required and were probably related to the severely deranged state of the myocardium. In spite of periods of asynchronous pacing in this critically unstable setting, no arrhythmias were precipitated. In the two patients who required defibrillation, transient malfunctions of pacing, capture and sensing occurred in spite of protective electronics in the pacing system, the left-sided location of the generator and, in one patient, the bipolar configuration. The pacemaker appeared to intermittently sense coarse ventricular fibrillatory waves. The malfunctions in the two latter cases were probably the result of the combined effects of the countershock and the abnormal state of the myocardium. All four patients succumbed, three in the emergency room and one on the eighth hospital day. Outcome was predominantly determined by the patient's response to therapeutic interventions. The observed pacemaker malfunctions, although potentially life-threatening, had no obvious, adverse effect on outcome in these four cases, mainly because of the transient nature of the abnormalities. Indeed, in one case, the presence of pacemaker activity was pivotal in identifying the native rhythm, illustrating the diagnostic potential of this analytical approach.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/9. Near-death experiences in a pediatric population. A preliminary report.Numerous accounts of a unique psychological state associated with near-fatal events have been described in adults; however, we know of no studies in the medical literature of the nature or incidence of such experiences in children. Four of seven children who survived cardiopulmonary arrests or coma associated with trauma, drownings, or hyperosmolar states reported near-death experiences. Their subjective accounts of their experiences included a sense of being out of the body, traveling in a tunnel or staircase, seeing beings dressed in white, and a decisional return to the body. Six patients hospitalized in the intensive care unit for epiglottitis, heart surgery, or guillain-barre syndrome, all of whom had mechanical ventilatory support and were treated with anesthetic agents and narcotics, had no memories of the time they were unconscious. Clearly, children report near-death experiences similar to ones previously described in adults. Further systematic study of this phenomenon is indicated.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/9. Total atrioventricular block with syncopes complicating carbamazepine therapy.At case of carbamazepine-induced intermittent total atrioventricular block with asystole and Stokes-Adams attacks is reported. The diagnosis was proved by repeated administration of carbamazepine after insertion of a demand pacemaker. If syncopes occur or change nature in a patient treated with carbamazepine, evaluation of cardiac conduction is recommended.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/9. Utility of magnetic resonance imaging in a patient with anomalous origin of the right coronary artery, acute myocardial infarction, and near-sudden cardiac death.A 46-year-old female presented with an acute myocardial infarction and cardiac arrest. coronary angiography revealed an anomalous origin of the right coronary artery coursing between the aorta and pulmonary artery. magnetic resonance imaging confirmed the life-threatening nature of this anomaly and led to referral for surgical revascularization.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/9. Vasovagal syncope: asystole provoked by head-up tilt testing under sertraline therapy.syncope is defined as a sudden transient loss of consciousness. Vasovagally mediated hypotension and bradycardia are believed common, yet difficult to diagnose, causes of syncope in healthy children and adolescents. These episodes are often both sudden and sporadic in nature and, if recurrent and severe (malignant vasovagal syncope), can be a source of morbidity and possibly mortality. head-up tilt testing has emerged as a useful investigation in patients who are thought to have recurrent vasovagal syncope with systemic hypotension, bradycardia, or both, and it has been suggested as a potential method to test for vasovagal episodes. sertraline hydrochloride, a serotonin reuptake inhibitor, has been reported to be effective in preventing the vasovagal syncopal episodes in children and adults. Here, two cases of recurrent, unexplained syncope are presented. Both were under sertraline therapy and underwent provocative head-up tilt testing that resulted in asystole.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/9. survival following cardiac tamponade and arrest in a paediatric patient with penetrating trauma to pulmonary artery.A seven-year-old child with an airgun pellet injury to the upper part of the anterior chest wall was transported in a state of shock from a nearby hospital to this trauma centre. The nature and site of injury associated with engorged neck veins, hypotension, pulsus paradoxus and an enlarged liver suggested the possibility of acute pericardial tamponade. On arrival in the emergency room the child had a brief period of cardiac arrest revived by basic resuscitation procedures. pericardiocentesis was negative in the emergency room. Emergency median sternotomy with pericardiotomy was done to relieve the tamponade which was peroperatively diagnosed to be due to a tear in the pulmonary artery close to its origin. Early clinical diagnosis, rapid surgical intervention in the operating room and efficient anaesthetic management within the 'Golden Hour' saved life. It is believed that this is the first report of survival of a paediatric patient with a gunshot penetrating trauma to the pulmonary artery leading to cardiac tamponade and a brief period of cardiac arrest.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/9. Hazards in the management of large intra-abdominal tumours.Whatever their nature, large intra-abdominal tumours interfere with respiratory and circulatory function by producing elevation and splinting of the diaphragm and partial occlusion of the inferior vena cava. The main hazards involved in removing such tumours are consequences of abdominal decompression, which may produce a labile cardiovascular state, respiratory difficulties, and rapid intestinal distension. A knowledge of the deranged physiology and its management may avert these complications. Careful preparation, modification of anaesthetic technique, postoperative ventilation, and external abdominal compression are important. To illustrate the discussion two cases of large ovarian cysts are described.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |