RESUMO
Although compressed gas (CO2) blowers have been used safely to aid accurate grafting during off-pump coronary bypass surgery, hemodynamic collapse due to gas embolism into the right coronary artery may occur. Supportive measures to facilitate gas clearance by increasing the coronary perfusion pressure have been reported to be successful in restoring hemodynamic stability. However, right ventricular dysfunction and atrioventricular nodal ischemia may hinder effective systemic delivery of the vasoactive medications, even when performing resuscitative measures such as direct cardiac massage. We herein report a case of cardiac arrest that was caused by a right coronary gas embolism and that could not be restored by cardiac resuscitation. When supportive measures fail, direct aortic injection of epinephrine to increase the coronary perfusion pressure can be attempted before initiating cardiopulmonary bypass, and this approach may be life-saving in situations that limit systemic drug delivery from the venous side despite the performance of direct cardiac massage.
Assuntos
Aorta , Ponte Cardiopulmonar , Ponte de Artéria Coronária sem Circulação Extracorpórea , Vasos Coronários , Embolia , Embolia Aérea , Epinefrina , Parada Cardíaca , Massagem Cardíaca , Hemodinâmica , Isquemia , Perfusão , Ressuscitação , Transplantes , Disfunção Ventricular DireitaRESUMO
OBJECTIVE: To observe the change of sympathetic skin response (SSR) before and after sympathectomy in patients with idiopathic palmar hyperhidrosis and to find the usefulness of SSR for assessment of the effects of sympathectomy. METHOD: The SSR was measured in 20 patients with palmar hyperhidrosis and 20 normal control group. Ten days after thoracoscopic sympathectomy, SSR was also measured. A 50~150 V stimulus was applied over the median nerve and SSR was recorded on bilateral palms and soles with Viking IV (Nicolet Biomedical Ins., U.S.A.). Patient's satisfaction with operation was assessed by questionnaire. RESULTS: Absent or unstable SSR recordings rate was increased and amplitudes of SSR were significantly decreased in patients with palmar hyperhidrosis compared with control group. After sympathectomy, SSR was absent in all cases on bilateral palms and these results were correlated with clinical improvment. All patients who had undergone surgery showed significant clinical improvement for palmar hyperhidrosis and about 75% of the cases were found to have compensatory sweating from other site of the body. CONCLUSION: Abnormal sympathetic nerve system responses were observed in patients with palmar hyperhidrosis. SSR recordings and clinical manifestations were influenced by sysmpathectomy.
Assuntos
Humanos , Hiperidrose , Nervo Mediano , Inquéritos e Questionários , Pele , Suor , Sudorese , SimpatectomiaRESUMO
Surface electromyogram in the lumbar paraspinal muscles was studied to evaluate back muscle impairment in twenty chronic low back pain patients and twenty control subjects. Turns-amplitude and power spectrum analysis of electromyographic signals were performed at different force levels during fatigue from sustained isometric contraction and recovery from fatigue in trunk extensor muscles. Results indicated that with increasing force level mean amplitude and Root Mean Square (RMS) values were increased, but mean and median frequencies increased initially until 20% Maximal Voluntary Contraction (MVC) and decreased tendency after then. Turns, mean amplitude, RMS, mean and median frequencies were all higher in control subject than those of low back pain patients. During sustained isometric contraction at 70% MVC, mean and median frequencies were linearly decreased, and the slopes were steeper in the patients group. Mean amplitude and RMS value showed decreased tendency during fatigue. During recovery from fatigue turns, mean and median frequencies increased especially in the first 3 minutes and nearly completely recovered in the 7~8 minutes in both patients and control groups. Therefore the mean amplitude and RMS value could be used as indicators of the level of muscle contraction and the mean and median frequencies reflect well the muscle fatigue in paralumbar muscle. These results validate the use of surface EMG spectral parameters as an objective measure of back muscle impairment in chronic low back pain patients.
Assuntos
Humanos , Músculos do Dorso , Dor nas Costas , Fadiga , Contração Isométrica , Dor Lombar , Contração Muscular , Fadiga Muscular , Músculos , Músculos Paraespinais , Análise EspectralRESUMO
Quantitative analysis of abnormal spontaneous activities, motor unit action potentials and interference patterns were recorded in 55 subjects with traumatic peripheral nerve injury to understand the changes of electromyographic signals. We analyzed amplitudes of fibrillation potentials and positive sharp waves at rest, amplitude, duration, spike duration and polyphasicity of motor unit action potentials at minimal contraction, and the root mean square(RMS), and mean rectified voltage (MRV) at maximal contraction. The amplitudes of fibrillation potentials and positive sharp waves had negative correlations with the duration of peripheral nerve injury but the amplitudes of motor unit action potentials, RMS, and MRV had positive correlations. Therefore electromyographic evaluation could be used for the estimation of the duration of peripheral nerve injury.