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1.
Clin Neurol Neurosurg ; 140: 43-6, 2016 Jan.
Article in English | MEDLINE | ID: mdl-26624920

ABSTRACT

OBJECTIVE: (1) To determine the frequency of subarachnoid blood spread following epidural blood patch (EBP) in a cohort of subjects with spontaneous intracranial hypotension (SIH). (2) To describe the outcome of these patients. PATIENTS AND METHODS: In a cohort of 106 patients exhibiting SIH, spiral spinal CT scans were obtained post-lumbar EBP and neuroradiological data was reviewed for evidence of subarachnoideal bleeding. RESULTS: Subarachnoideal blood spread was detected on spinal CT scans following EBP in 9 of 106 patients with SIH. All patients exhibited a complete recovery and no neurological complications were observed. CONCLUSIONS: A low incidence of subarachnoideal blood spread was observed following EBP given to treat SIH. Instances of subarachnoideal blood spread were not associated with neurological complications or altered efficacy of the EBP procedure.


Subject(s)
Blood Patch, Epidural , Brain/surgery , Headache/surgery , Intracranial Hypotension/surgery , Postoperative Complications/etiology , Spinal Cord/surgery , Adult , Blood Patch, Epidural/methods , Brain/blood supply , Female , Headache/etiology , Humans , Intracranial Hypotension/complications , Male , Middle Aged , Spinal Cord/pathology , Treatment Outcome
2.
Eur J Neurol ; 17(5): 715-9, 2010 May.
Article in English | MEDLINE | ID: mdl-20050898

ABSTRACT

BACKGROUND: Spontaneous intracranial hypotension (SIH) is characterized by orthostatic headache, diffuse pachymeningeal enhancement on brain magnetic resonance imaging (MRI) and low cerebrospinal fluid (CSF) pressure. Treatment ranges from conservative management, such as bed rest, overhydration and caffeine, to invasive procedures, such as the autologous epidural blood patch (EBP), computed tomography (CT)-guided fibrin glue injection at the site of the leak and open surgical intervention. EBP has emerged as the treatment of choice for SIH when initial conservative measures fail to bring relief. METHODS: Forty-two patients with SIH were treated with lumbar autologous EBP in Trendelenburg position preceded by pre-medication with acetazolamide. RESULTS: A complete recovery was obtained in all patients after one (90%), two (5%) or three (5%) EBPs. After EBP, two patients (5%) also performed evacuation of bilateral chronic subdural hematoma with mass effect. CONCLUSIONS: Spontaneous intracranial hypotension can be effectively cured by lumbar autologous EBP in Trendelenburg position pre-medicated with acetazolamide.


Subject(s)
Acetazolamide/administration & dosage , Blood Patch, Epidural/methods , Head-Down Tilt/physiology , Intracranial Hypotension/drug therapy , Patient Positioning/methods , Premedication/methods , Subdural Effusion/drug therapy , Adult , Aged , Carbonic Anhydrase Inhibitors/administration & dosage , Female , Humans , Male , Middle Aged , Patient Positioning/standards , Recovery of Function/physiology , Subdural Effusion/complications , Treatment Outcome
4.
Riv Eur Sci Med Farmacol ; 13(5-6): 265-7, 1991.
Article in English | MEDLINE | ID: mdl-1819856

ABSTRACT

The authors describe problems about anaesthesia management in peri- and post-operative periods in seven patients undergoing total pancreatectomy. They underline that metabolic alterations in these cases show, until now, some unsolved problems. Sometimes artificial pancreas is very useful in post-operative management of these patients.


Subject(s)
Pancreatectomy/adverse effects , Postoperative Complications/metabolism , Adult , Aged , Anesthesia , Humans , Male , Middle Aged , Postoperative Complications/therapy
8.
Riv Eur Sci Med Farmacol ; 13(5-6): 199-204, 1991.
Article in English | MEDLINE | ID: mdl-1687899

ABSTRACT

In the present study a comparison has been made between intubating condition obtainable after anesthesia induction with Thiopental or Propofol, using Vecuronium Bromide to achieve muscle relaxation. Data were collected about hemodynamic parameters, vocal cords position, coughing or bucking, and involuntary movements. Three-hundred patients, males and females, ASA classes I and II, not premedicated, were included in the study; they all had to undergo surgery requiring tracheal intubation. The patients were divided in six different groups, and in each of them intubation was performed at different times from injection of inducing agents (2-2, 30-3-4-5-6 minutes). Overall results show a lack of satisfying intubating conditions on the extreme of selected times (2 and 5-6 minutes), with no significant difference between Thiopental and Propofol, except for a minimal unlike behaviour in hemodynamics. Therefore, on the basis of our data, as far as intubating conditions are considered, we can conclude that there is no reason to prefer one of the two inducing agents.


Subject(s)
Anesthesia , Propofol , Thiopental , Vecuronium Bromide , Adolescent , Adult , Female , Humans , Intubation, Intratracheal , Male , Preanesthetic Medication , Propofol/administration & dosage
13.
Resuscitation ; 12(1): 1-7, 1984 May.
Article in English | MEDLINE | ID: mdl-6330821

ABSTRACT

Lidocaine and Mexiletine are two anti-arrhythmic drugs which when administered in toxic doses cause alterations in the central nervous system (convulsions, tremors, coma). An experimental study was carried out to clarify some neurological side-effects caused by these two drugs, by studying the variations of the brain amino acid pool. With Lidocaine one can observe an increase of phenyl-alanine and tyrosine, a decrease of glycine, GABA, alanine, aspartate and glutamate, while taurine and ammonia showed no significant changes. After Mexiletine one can observe an increase of ammonia, a decrease of GABA, glutamine, glycine and alanine, while glutamate, taurine, phenyl-alanine and tyrosine remain within normal values. In conclusion, on the basis of the data obtained by comparing the two drugs, one could say that Lidocaine has a greater interference on the catecholaminic precursors which are little influenced by Mexiletine. For the rest, the data obtained are practically super- imposable .


Subject(s)
Amino Acids/metabolism , Brain Chemistry/drug effects , Lidocaine/toxicity , Mexiletine/toxicity , Propylamines/toxicity , Ammonia/metabolism , Animals , Guinea Pigs , Lidocaine/pharmacology , Mexiletine/pharmacology
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