1/15. hypoventilation after high unilateral cervical chordotomy in a patient with preexisting injury of the phrenic nerve.Unilateral cervical chordotomy for the relief of intractable pain is a well accepted procedure but is not without hazard. Postoperative respiratory failure is not an uncommon occurrence, but the likelihood increases with a number of factors, particularly preexisting pulmonary abnormalities or previous contralateral cervical chordotomy. Preoperative assessment of the pulmonary function of patients who are about to have cervical chordotomy is emphasized to predict and anticipate potential postoperative respiratory failure.- - - - - - - - - - ranking = 1keywords = nerve (Clic here for more details about this article) |
2/15. Noninvasive ventilatory strategies in the management of a newborn infant and three children with congenital central hypoventilation syndrome.Four children with congenital central hypoventilation syndrome (CCHS) treated with noninvasive techniques of ventilation are presented. Two infants (one in the newborn period) were treated with nasal mask bilevel positive airway pressure (BiPAP), and then both were transitioned to negative pressure chamber ventilation at several years of age because of possible midface hypoplasia. Tracheostomies were not performed. Two older children were transitioned from mechanical ventilation via tracheostomy to nasal mask BiPAP, and then in one case to negative pressure chamber ventilation, and in the other to phrenic nerve pacing. Their tracheostomies were removed.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
3/15. Moebius syndrome with central hypoventilation and brainstem calcification: a case report.Moebius syndrome (MS) is described in an infant with central hypoventilation and brainstem calcification. The patient had limb defects and bilateral paralysis of the 6th, 7th, 9th, 10th, and 12th cranial nerves. Mechanical ventilation was continued from birth because of shallow spontaneous respiration. Computed tomography revealed brainstem atrophy and four small calcifications restricted to the dorsal portion of the pons and medulla. Prenatal brainstem injury such as ischaemia may have caused MS and central hypoventilation.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
4/15. Primary alveolar hypoventilation treated with nocturnal electrophrenic respiration.A case of primary alveolar hypoventilation is described. Despite characteristic clinical findings, the diagnosis was delayed for 4 years. Alleviation of nocturnal hypoxemia and hypercapnia initially by a rocking bed and subsequently by phrenic nerve stimulation was accompanied by reversal of cor pulmonale and polycythemia. Electrophrenic respiration is an effective form of long-term management in primary alveolar hypoventilation.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
5/15. lung function in diaphragm pacing.electric stimulation of the diaphragm via the phrenic nerve to induce ventilation has recently been used for the long-term management of chronic ventilatory insufficiency. Since 1973 three patients with inadequate alveolar ventilation have been treated with diaphragm pacing at the Toronto Western Hospital. Two, who had quadriplegia due to lesions of the spinal cord in the upper cervical region and a severe restrictive ventilatory defect, were treated with continuous diaphragm pacing. The third patient required assisted nocturnal ventilation because of primary alveolar hypoventilation. All three patients tolerated the diaphragm pacing well, and pulmonary function tests showed satisfactory gas exchange with the patients breathing room air. This form of therapy seems to be a practical clinical method of managing chronic ventilatory failure in patients with lesions of the upper cervical cord or primary alveolar hypoventilation.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
6/15. Electrophrenic respiration: report of six cases.The development of electrophrenic respiration has permitted freedom from mechanical ventilation for patients who have irreversible respiratory failure in association with high-cervical spinal cord or brainstem lesions. There are three basic criteria for successful diaphragm pacing: (1) the need for long-term mechanical ventilatory assistance, (2) a functionally intact phrenic nerve-diaphragm axis, and (3) chest wall stability. Inability to achieve satisfactory pacing can be due to malfunction of equipment, instability of the chest wall, or inadequate neuromuscular responsiveness. These features of diaphragm pacing are exemplified in a series of six patients. Three achieved independence from mechanical ventilatory assistance with full-time phrenic pacing. In one patient, only limited electrophrenic respiration was achieved, and in another the method was entirely unsuccessful. Although functioning well, pacing systems were removed from the sixth patient because of infection. diaphragm pacing can be a valuable form of respiratory support for carefully selected patients.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
7/15. Conditioning of the diaphragm by phrenic nerve pacing in primary alveolar hypoventilation.A patient with respiratory muscle weakness due to alveolar hypoventilation was treated with nocturnal bilateral phrenic nerve pacing for one year. Treatment was associated with a progressive increase in diaphragmatic strength and endurance.- - - - - - - - - - ranking = 1.25keywords = nerve (Clic here for more details about this article) |
8/15. Central hypoventilation syndrome: experience with bilateral phrenic nerve pacing in 3 neonates.Successful long-term phrenic nerve pacing has been reported in adults with acquired central hypoventilation syndrome. This report summarizes our experience with phrenic nerve pacing in 3 infants with congenital central hypoventilation syndrome. The electrodes were implanted in the lower thoracic portion of each phrenic nerve. In all patients. bilateral simultaneous pacing was required to maintain an adequate arterial PO2, tidal volume, and minute ventilation during quiet sleep. Case 1 died of problems primarily related to the severe cor pulmonale that had been present before pacemaker insertion; at autopsy, the pacemaker system was intact and there were no significant phrenic nerve abnormalities. Case 2 later developed failure of awake ventilatory control and died because of extensive phrenic nerve damage incurred by 19 days of continuous pacing. Case 3 has received quiet sleep pacemaker support since September 1977 and has been able to maintain normal quiet sleep ventilation in this manner. phrenic nerve pacing can be successful in infants as long as continuous pacing is not required. Bilateral simultaneous pacing appears to be an appropriate alternative to home-based intermittent positive-pressure breathing for long-term management of children with central hypoventilation syndrome.- - - - - - - - - - ranking = 2.5keywords = nerve (Clic here for more details about this article) |
9/15. Congenital central hypoventilation syndrome: a pathologic study of the neuromuscular system.An infant with congenital central hypoventilation was managed by bilateral phrenic nerve pacing for 3 months. He died at 8 months of age, following 19 days of continuous bilateral pacing necessitated by the eventual loss of voluntary as well as autonomic ventilatory control. The phrenic nerves showed axonal dystrophy at the site of electrode implantation and more severe distal degeneration. Focal neurogenic atrophy was seen in the diaphragmatic muscle. These changes were attributed to electrical injury resulting from the period of continuous pacing. The most significant neuropathologic finding was a mild generalized decrease in the density of neurons and myelinated nerve fibers in the respiratory centers of the medulla. These morphologic abnormalities were attributed to a sublethal intrauterine lesion that would be the first example of a morphologic correlation with the functional abnormality in congenital central hypoventilation.- - - - - - - - - - ranking = 0.75keywords = nerve (Clic here for more details about this article) |
10/15. Ventilatory dysfunction resulting from bilateral anterolateral high cervical cordotomy. Dual beneficial effect of aminophylline.Because of metastatic pain resistant to medical treatment after left pneumonectomy for squamous cell carcinoma, a 46-year-old patient underwent a bilateral cervical cordotomy at the C1-C2 anterolateral level, in two phases. The second intervention was followed by severe ventilatory problems requiring mechanical ventilation, and at a later stage, the implantation of a phrenic pacemaker on the right side. Analysis of the ventilatory pattern during spontaneous breathing and during phrenic pacing and measurement of the transdiaphragmatic pressure during phrenic nerve stimulation revealed the existence of a beneficial effect of aminophylline on both the regulation of ventilation and diaphragmatic contractility.- - - - - - - - - - ranking = 0.25keywords = nerve (Clic here for more details about this article) |
| | Next -> |