ABSTRACT
A 45-year-old morbidly obese woman (body mass index 51.9) was scheduled for right knee arthroscopic synovectomy. We selected spinal anesthesia in order to avoid difficult ventilation or intubation during anes- thetic induction of general anesthesia. As she strongly requested unawareness during operation, we decided to sedate her with dexmedetomidine(DEX), a sedative drug which has little possibility to cause upper airway obstruction and respiratory depression. Dose of DEX was determined based on total body weight (TBW) instead of ideal body weight To achieve adequate sedation, DEX was titrated by monitoring Ramsay sedation score (RSS), and was discontinued 10 minutes before the end of operation. She was well sedated dur- ing the operation but developed minimal upper airway obstruction and respiratory depression. She showed a good recovery profile when discharged from the oper- ating room. She was very satisfied with the anesthetic management The similar patient's satisfaction was also obtained at the opposite knee joint operation per- formed using the same anesthetic management Conse- quently, DEX infusion based on TBW appears to be suitable to sedate a morbidly obese patient.
Subject(s)
Obesity, Morbid , Anesthesia, General , Anesthesia, Spinal , Anesthetics , Dexmedetomidine/administration & dosage , Female , Humans , Hypnotics and Sedatives , Middle Aged , Respiratory InsufficiencyABSTRACT
PURPOSE: To investigate the sustainability of effect and the changes in basic and instrumental activities of daily living (ADL and IADL) after long-term prism intervention, we carried out a follow-up assessment on five subjects with hemispatial neglect in the chronic stage. METHOD: At 2-3.5 years after the end of prism intervention, we measured six parameters: 1) eye movement of the neglect side when watching three different video clips, 2) center of gravity as an index of subjective internal midline bias, 3) star and letter cancellation tests, 4) the line bisection test, and ADL scales: 5) Barthel Index and 6) Lawton's IADL scale. In addition, we interviewed and observed the subjects' present ADL performance at home. RESULTS: The eye movement on the neglect side significantly increased compared with that before intervention. The center of gravity was shifted significantly to the left side and forward. The improvement in cancellation and line bisection tests was also observed. All subjects showed improvement in ADL performance. Two of the subjects could return to work after intervention. CONCLUSION: The results suggested that long-term prism intervention might effectively exert long-lasting effects and bring benefits to ADL performance for subjects with hemispatial neglect.
Subject(s)
Activities of Daily Living/psychology , Adaptation, Physiological , Eye Movements , Eyeglasses/statistics & numerical data , Perceptual Disorders/rehabilitation , Stroke Rehabilitation , Aged , Attention , Chronic Disease , Female , Follow-Up Studies , Functional Laterality , Humans , Male , Middle Aged , Perceptual Disorders/etiology , Perceptual Disorders/physiopathology , Perceptual Disorders/psychology , Recovery of Function , Space Perception , Stroke/complications , Stroke/physiopathology , Stroke/psychology , Treatment Outcome , Visual FieldsABSTRACT
Prophylactic oral administration of a novel immunomodulator (immunosuppressant), FTY720 (1 mg/kg, three times a week), completely prevented the development of experimental autoimmune myasthenia gravis (EAMG) in C57BL/6 mice. EAMG has been used as an animal model for human myasthenia gravis, and was established by immunizing the mice with acetylcholine receptor (AChR) from Torpedo californica. FTY720 also suppressed the production of both anti-Torpedo californica AChR antibody and anti-mouse AChR autoantibody by the mice, which were observed in mice in which EAMG had become established. These results strongly suggest that FTY720 is a promising candidate for treatment of human myasthenia gravis.
Subject(s)
Immunosuppressive Agents/pharmacology , Myasthenia Gravis, Autoimmune, Experimental/prevention & control , Propylene Glycols/pharmacology , Animals , Drug Evaluation, Preclinical , Female , Fingolimod Hydrochloride , Mice , Mice, Inbred C57BL , Specific Pathogen-Free Organisms , Sphingosine/analogs & derivatives , Time FactorsABSTRACT
Oral administration of a novel immunomodulator, FTY720 (0.1 mg/kg, once a week), completely prevented the spontaneous development of dermatitis in NC/Nga mice. It also strongly suppressed hyper IgE production in serum, as well as hypertrophy of the epidermis and the degranulation of granulocytes in the skin, all of which were observed in mice in which the dermatitis had become established. These results strongly suggest that FTY720 is a promising candidate for treatment of human atopic dermatitis.
