ABSTRACT
A simple ergometer is described that allows highly reproducible plethysmographic measurements of blood flow to be made within 10 seconds of ceasing rhythmic quantitated exercise of the calf muscle. A power output of some 25 Watts is developed with a mechanical efficiency of some 20%. The device seems applicable to a variety of clinical assessments.
Subject(s)
Ergometry/instrumentation , Exercise/physiology , Muscles/blood supply , Plethysmography/instrumentation , Humans , Leg , Regional Blood FlowABSTRACT
The procedures involved in cerebral and medullary embolization produce special problems for the anesthesiologist. Some imperatives must be followed in order to minimize the high neuroradiological risks associated with these long and repetitive procedures. The first of these imperatives is sedation, which throughout the procedure should be sufficient, although not narcotic enough to prevent neurological evaluations. The use of a benzodiazepine (Midazolam) in conjunction with an analgesic (Alfentanil) that is rapidly eliminated answers this need. The prescription of vasodilatator agents depends on the location of the embolization. Calcium channel blockers should be used following embolism of the internal carotid while nitrate derivatives are recommended after embolism of the external carotid. Reduction of the risk of thrombosis is accomplished by perfusion with anti-sludge or, with exception to therapeutic procedures involving hemostasis, by perfusion with acetylsalicylic acid. Following evaluation of 105 procedures in 75 patients it is concluded that this sedation produces reliable results and allows the procedure to be performed with maximal security.
Subject(s)
Conscious Sedation/methods , Embolization, Therapeutic , Radiology, Interventional , Adolescent , Adult , Aged , Alfentanil , Cerebral Angiography , Child , Child, Preschool , Clinical Protocols , Female , Humans , Infant , Isosorbide Dinitrate/therapeutic use , Male , Midazolam , Middle Aged , Monitoring, Intraoperative , Myelography , Nicardipine/therapeutic use , Platelet Aggregation Inhibitors/therapeutic useABSTRACT
The potential neurotoxicity of iohexol and iopamidol in lumbar myelography was investigated in 20 patients using three criteria: clinical symptoms, EEG recordings with spectral analysis and CT scans of the brain. There was no significant difference in clinical side-effects between the two groups (Iopaminol, Iohexol). In 10 patients (iopaminol 4, iohexol 6) CT scans revealed an important penetration of the contrast media into the subarachnoid spaces at 3 hours and into the cerebral cortex at 24 hours. This cerebral contamination was unrelated to the headaches experienced by the patients or to the electrophysiological disturbances observed. Spectral analysis in brain-contaminated subjects showed a reduction of delta, beta 1 and beta 2 bands with iohexol. This reduction suggests that EEG activation is less pronounced with this agent than with iopaminol.
Subject(s)
Brain/drug effects , Iohexol/adverse effects , Iopamidol/adverse effects , Myelography , Brain/diagnostic imaging , Electroencephalography , Female , Headache/chemically induced , Humans , Lumbosacral Region , Male , Middle Aged , Myelography/adverse effects , Sciatica/chemically induced , Tomography, X-Ray ComputedSubject(s)
Anesthesia, Intravenous , Cerebrovascular Disorders/diagnostic imaging , Etomidate , Adjuvants, Anesthesia , Adult , Alfentanil , Blood Pressure/drug effects , Cerebral Angiography , Drug Administration Schedule , Etomidate/administration & dosage , Etomidate/adverse effects , Fentanyl/analogs & derivatives , Humans , Middle Aged , Postoperative PeriodSubject(s)
Anesthesia, Intravenous/methods , Etomidate , Neuroradiography , Adult , Etomidate/pharmacology , Hemodynamics/drug effects , Humans , Middle AgedABSTRACT
Radio-immunoassayable methionine-enkephalin (ME) and radioreceptor-active opiate peptide levels (OP) were determined in CSF from patients, both with and without chronic pain, under investigation for vertebral disk disease. This study showed: that there was no direct correlation between ME and OP levels in CSF; OP levels were negatively correlated with the ME/OP ratio; migraine patients had higher levels of ME; ME concentrations were reduced in patients receiving anti-inflammatory drugs (nonsteroidal): patients with chronic pain (non migraine, no anti-inflammatory drug therapy) had lower ME levels than patients without pain. The data are discussed in relation to animal models of chronic pain.
Subject(s)
Enkephalin, Methionine/cerebrospinal fluid , Enkephalins/cerebrospinal fluid , Pain, Intractable/cerebrospinal fluid , Adolescent , Adult , Aged , Animals , Chronic Disease , Female , Humans , Intervertebral Disc Displacement/physiopathology , Kinetics , Male , Middle Aged , Radioimmunoassay/methods , Rats , Receptors, Opioid/metabolismSubject(s)
Brain/diagnostic imaging , Hypnotics and Sedatives/administration & dosage , Tomography, X-Ray Computed , Child, Preschool , Contrast Media , Diazepam/administration & dosage , Drug Therapy, Combination , Humans , Infant , Injections, Intravenous , Pentobarbital/administration & dosage , Suppositories , Trimeprazine/administration & dosageABSTRACT
The side effects in myelography are well known and frequently observed. The most common are headache, nausea, and vomiting. In this study, a rather new compound, Thiorphan, was examined, which displays an antinociceptive activity by inhibiting enkephalinase activity. Forty-two patients received intravenous infusions of Thiorphan before myelography. Another 42 patients were in a control group, and Thiorphan was not administered. In the treated group, postmyelographic headache was found in 24% (versus 52% in the control group). Nausea and vomiting were never seen. Low back pain or sciatica was diminished in 33% of cases. Enkephalin levels in cerebrospinal fluid were measured by a radioreceptor-assay method in both groups without any correlation.
