Resuscitation with lipid, epinephrine, or both in levobupivacaine-induced cardiac toxicity in newborn piglets.

Background: The optimal dosing regimens of lipid emulsion, epinephrine, or both are not yet determined in neonates in cases of local anaesthetic systemic toxicity (LAST).

Methods: Newborn piglets received levobupivacaine until cardiovascular collapse occurred. Standard cardiopulmonary resuscitation was started and electrocardiogram (ECG) was monitored for ventricular tachycardia, fibrillation, or QRS prolongation.

Violence to and maltreatment of people with disabilities: a short review.

Objective: Violence to disabled persons constitutes a major ethical problem. The European Academy of Rehabilitation Medicine has debated the matter; it presents this short report to alert a wider audience to the problem, with the aim of provoking debate and facilitating prevention.

Design: The Academy has produced a full report on the literature.

Patient-controlled regional analgesia is effective in children: a preliminary report.

Purpose: To report a preliminary analysis of prospectively recorded data in 27 children in whom patient-controlled regional analgesia (PCRA) was used for postoperative pain control following lower limb surgery.

Methods: Under general anesthesia, perineural catheters (popliteal and fascia iliaca compartment block) were inserted and infused with ropivacaine 0.2% (0.

Evaluation of the use of Urocath-Gel catheters for intermittent self-catheterization by male patients using conventional catheters for a long time.

Study Design: Prospective study of intermittent self-catheterization (CIC) with change from conventional catheter to low-friction Urocath-Gel catheter.

Objectives: To evaluate if such catheters are well accepted and to evaluate their practical use.

Methods: Thirty-nine male patients, between 19 and 74 years old, performing clean intermittent self-catheterization with conventional catheters for a neuropathic bladder for many years were included in this study after written informed consent.

Effects of abdominal strapping on forced expiration in tetraplegic patients.

Patients with traumatic transection of the lower segments of the cervical cord contract the clavicular portion of the pectoralis major during forced expiration and cough, and the rise in intrathoracic pressure resulting from this contraction produces dynamic airway compression in many patients. Because the abdominal muscles are paralyzed, however, there is paradoxical expansion of the abdomen, which may reduce the rise in intrathoracic pressure and the degree of airway collapse. To evaluate the magnitude of this effect, we measured expiratory flow rate (Vexp) and esophageal pressure (Pes) during a series of forced expiratory vital capacity maneuvers and constructed isovolume-pressure flow (IVPF) curves before and after abdominal strapping in eight C5-8 tetraplegic subjects.

Chronic intrathecal baclofen in severely disabling spasticity: selection, clinical assessment and long-term benefit.

Flexor and extensor spasms associated with severe spasticity frequently cause pain and suffering in neurologically impaired patients, and greatly interfere with comfort and activities. When high doses of oral medications are necessary to keep the symptoms under control and are poorly tolerated, the long-term spinal-selective intrathecal infusion of baclofen by means of implanted drug pump and catheter is a safe, efficient and reversible alternative to destructive surgical procedures. Between September 1991 and March 1995, intrathecal baclofen was infused in 18 selected patients out of a series of 42 severely disabled spastic cases.

Longitudinal study of the bone mineral content and of soft tissue composition after spinal cord section.

We present the results of a 1 year longitudinal study of bone mineral measurements and soft tissue composition in supra- and infra-lesional areas of 31 patients with a spinal cord injury (level D2-L3). Like others, we observed a rapid decrease of BMC in the paralysed areas, of approximately 4%/month during the first year in areas rich in trabecular bone and of approximately 2%/month in areas containing mainly compact bone. Lean soft tissue mass (muscle mass) decreases dramatically during the first months post injury in the legs, while fat content tends to increase.

Evidence of dynamic airway compression during cough in tetraplegic patients.

Although all the well-recognized muscles of expiration are paralyzed after traumatic transection of the lower cervical cord, tetraplegic subjects can still empty their lungs actively by contracting the clavicular portion of the pectoralis major. It is not known, however, whether contraction of this muscle bundle may raise pleural pressure enough to cause dynamic compression of the intrathoracic airways, which is critical for the production of an effective cough. To investigate this question, we measured expiratory flow rate and esophageal pressure during a series of forced expiratory vital capacity (VC) maneuvers in twelve subjects with C5-8 traumatic tetraplegia and constructed isovolume-pressure flow (IVPF) curves.

Lung volume restriction in patients with chronic respiratory muscle weakness: the role of microatelectasis.

Background: It is well established that patients with longstanding weakness of the respiratory muscles have a reduction in lung distensibility. Although this occurs in most patients without any radiographic changes suggesting parenchymal lung disease, it has been attributed to the development of microatelectasis.

Methods: A high resolution computed tomographic (CT) scanner was used in eight patients with traumatic tetraplegia and six patients with generalised neuromuscular disorders to look for areas of atelectasis.

Psychological factors in the causation of pressure sores: case reports.

A high incidence of re-admissions to a spinal injuries unit by a small number of patients suffering from multiple pressure sores is described. The study shows an increased association of skin fragility and poor healing with an altered psychological behaviour. This combination of vulnerability to recurrent pressure sores in association with the pathological intellectual debility is described as 'ectodermic syndrome'.

Anaemia and marrow blood flow in the rat.

An increase in bone marrow blood flow has been previously described in anaemic rabbits and dogs. We examined the effect of haemorrhage and haemolysis in female Sprague-Dawley rats, with the hypothesis that high blood flow was related to hyperplasia of bone marrow tissue and that the increase would affect bone as well. Blood flow was measured in tibia and femur by the microspheres trapping method.

The effect of pectoralis muscle training in tetraplegic subjects.

We have previously shown that subjects with traumatic tetraplegia use the clavicular portion of the pectoralis major to expire actively. To determine if we could improve the expiratory function of these subjects, we studied six patients in whom the pectoralis major was trained by repetitive, strenuous, isometric contractions for 6 wk. Six patients receiving conventional respiratory rehabilitation served as control subjects.

Evolution of post-traumatic cervical syringomyelia: case report.

A patient with complete post-traumatic paraplegia below T6 developed urinary problems and late secondary syringolmyelia. The concordance between the appearance of micturition difficulties and the first sensory symptoms leads us to discuss the rôle of important and repeated efforts to obtain reflex micturition, during the development of post-traumatic syringomyelia.

Bone loss and bone blood flow in paraplegic rats treated with calcitonin, diphosphonate, and indomethacin.

Sham-operated (SO) and paraplegic rats were treated from the day of operation during a period of 4 or 6 weeks with salmon calcitonin 4 IU/kg/day or a diphosphonate (APD) 1mM/kg/day or indomethacin 2.5 mg/kg/day. The consequence of spinal cord section on the femur and tibia is a loss of mineral which affects predominantly trabecular bone (-24 and -13% in calcium content for the tibial metaphysis and the whole bone, respectively, when compared with the SO controls), a twofold increase in bone blood flow as measured by the technique of the microspheres trapping, a moderate decrease of the 72 hour 45Ca accretion rate in the bone shaft, and an increase in the number of metaphyseal osteoclasts in the tibia.

The effect of orchidectomy on bone metabolism in aging rats.

We have shown that orchidectomy in postpubertal 55-day-old rats led beyond 2 months to a decrease in bone growth and loss of weight. At 1 month postorchidectomy, we observed a three-fold increase in bone blood flow, an increase in calcium accretion rate, and an increase in the number of osteoclasts in the metaphysis. In the present experimental study, orchidectomy was performed in 1-year-old rats when bone growth in length was no longer measurable.

Mechanism of active expiration in tetraplegic subjects.

Traumatic tetraplegia produces paralysis of all the well-recognized muscles of expiration. Yet, tetraplegic subjects usually have a small expiratory reserve volume on spirographic examination. To understand the mechanism that enables these patients to empty their lungs actively, we studied the pattern of chest-wall motion during voluntary expiration.

Growth and bone haemodynamic responses to castration in male rats. Reversibility by testosterone.

Orchidectomy in postpubertal 55 day old rats, compared to sham-operated controls, led beyond 2 months to a decrease in body weight (87% of controls by 120 d), tibial length (97% of controls) and in tibial calcium content (85% of controls). Bone plasma flow increased three times to reach a peak at 31 days; it was decreased but no significantly at 86 and 120 days. The number of osteoclasts was maximal at 51 days (X 2.

Chest wall stiffness in patients with chronic respiratory muscle weakness.

Using the weighted spirometer technique we studied chest wall compliance (Cw) in 16 nonobese patients with chronic weakness of the respiratory muscles and 20 healthy control subjects. In order to evaluate the validity of the technique, while Cw was being measured, we monitored thoracoabdominal configuration with 2 pairs of linearized magnetometers and electrical activity of the external oblique with a concentric needle electrode in 3 healthy subjects and 4 patients; in addition, we recorded in 3 subjects the electrical activity from the intercostal muscles and diaphragm throughout the procedure. The method was reproducible within 5.

Respiratory mechanics in quadriplegia. The respiratory function of the intercostal muscles.

Pulmonary mechanics and inspiratory muscle pressures were studied in relation to electromyograms (EMG) of the respiratory muscles in 10 chronic quadriplegic patients . Transdiaphragmatic pressures at maximal inflation were normal, but minimal pleural pressures at functional residual capacity (FRC) were reduced to about one half the normal values. On the basis of the parasternal intercostal EMG results, 2 groups were defined.