Hypotension on continuous ambulatory peritoneal dialysis.

Hypotension in patients on CAPD is almost an unexplored area in the literature. This retrospective analysis of 525 patients treated at the Toronto Hospital. Toronto over the last five years, of whom 65 were hypotensive, describes the possible causes of hypotension, the response to treatment, morbidity and mortality rates.

The role of ERCP in laparoscopic cholecystectomy-related cystic duct stump leaks.

Background: Laparoscopic cholecystectomy has resulted in an increase in the incidence of cystic duct stump leaks. To assess the role of endoscopic retrograde cholangiopancreatography (ERCP) a review of 14 cystic duct stump leaks following laparoscopic cholecystectomy was carried out.

Methods: A retrospective chart review of fourteen patients was carried out.

Periodic K-alpha sleep EEG activity and periodic limb movements during sleep: comparisons of clinical features and sleep parameters.

The K-alpha sleep electroencephalographic (EEG) phenomenon is characterized by periodic (approximately 20-40 seconds) K-complexes, immediately followed by alpha-EEG activity (7.5-11 Hz) of 0.5- to 5.

Associated postural adjustments are impaired by a lesion of the cortex.

A ballistic movement of one arm may be accompanied by contractions of contralateral postural muscles known as "associated postural adjustments." Ballistic movements are considered to involve the motor cortex, but it is not known where associated postural adjustments are generated. We recorded the EMG activity in the deltoid and latissimus dorsi muscles during ballistic abduction of the arm in 10 normal subjects and five subjects with lesions of the motor cortex.

Methods for microelectrode-guided posteroventral pallidotomy.

Methods for localizing the posteroventral globus pallidus intermus are described. The authors' techniques include the use of microelectrodes to record single-unit activity and to microstimulate in human pallidum and its surrounding structures. This technique allows a precise determination of the locations of characteristic cell types in sequential trajectories through the external and internal segments of the pallidum.

Acute effect of L-arginine on hemodynamics and vascular capacitance in the canine pacing model of heart failure.

The effect of L-arginine, 250 mg/kg over 10 min, on hemodynamics and venous function was studied in nine splenectomized dogs under light pentobarbital anesthesia before and after 17 +/- 1 days of rapid right ventricular pacing (RRVP) at 250 beats/min. Chronic RRVP induced mild congestive heart failure with increased mean circulatory filling (Pmcf), right atrial (Pra) and pulmonary capillary wedge pressures (Ppcw), and reduced cardiac output (CO). During the development of heart failure, total vascular compliance assessed from Pmcf-blood volume relationships during circulatory arrest was unchanged, but total vascular capacitance was markedly reduced, with an increase in stressed and reduction in unstressed blood volumes.

The reliability of visual scoring of alpha EEG activity during sleep.

The reliability of visual scoring of alpha electroencephalogram activity in nonrapid eye movement sleep was evaluated. Three trained scorers independently, on two occasions, assessed one record from each of 10 patients. In addition to standard sleep staging of the records, alpha activity was scored using three methods: a) while the record was being scored, an assessment of alpha activity during the preceding stage was made at each stage change; b) after the record was scored a single global rating of alpha was made; and c) each 20-second epoch of the record was rated on the amount of alpha present.

Alexithymia, depression, and treatment outcome in bulimia nervosa.

Disturbances in emotional awareness, sometimes referred to as alexithymia, have been hypothesized to contribute to the development of binge/purge symptoms among women with bulimia nervosa (BN) and/or are considered secondary to the state of depression and/or disordered eating. The present study was designed to assess alexithymia among women with BN, to evaluate the interrelationship between alexithymia, depression, and somatic symptoms, and to determine whether an intensive group psychotherapy program contributes to a reduction in the degree of alexithymia. Thirty-one of 50 BN women (62%) who completed The Toronto Hospital Day Hospital Program for Eating Disorders (DHP) were administered pretreatment and posttreatment questionnaires.

Altered pain and temperature perception following cingulotomy and capsulotomy in a patient with schizoaffective disorder.

Recent studies have renewed interest in the role of limbic structures, such as the cingulate cortex, in nociception. To investigate the involvement of the limbic system in pain and temperature perception further, we have quantified ratings of innocuous and noxious thermal stimuli in a patient with schizoaffective disorder before and after 2 surgical procedures. Psychophysical tests were conducted at a control session prior to surgery.

Rotational angiography assessment of cerebral aneurysms.

Purpose: To compare rotational angiography with conventional digital subtraction angiography in the assessment of cerebral aneurysms.

Methods: Conventional digital subtraction angiography and rotational angiography were compared in 57 patients investigated for the preoperative diagnosis of subarachnoid hemorrhage and in 13 patients after surgery. Images were compared for location, visibility of the aneurysmal neck, vascular branch anatomy, projection, size, presence of spasm, and shape of the aneurysm.

Oscillatory motion of the normal cervical spinal cord.

Purpose: To determine the normal pattern of cervical spinal cord motion with measurement of cervical spinal cord velocity by means of phase-contrast magnetic resonance (MR) imaging.

Materials And Methods: Spinal cord velocity was measured in 11 healthy subjects with a modified gradient-echo pulse sequence on a conventional 1.5-T MR imaging system that generated phase images sensitive to slow motion.

Effect of surgical sympathectomy on arterial blood flow in reflex sympathetic dystrophy: Doppler US assessment.

Purpose: To assess duplex Doppler ultrasound (US) in providing objective, reproducible measurements of blood flow in patients with reflex sympathetic dystrophy (RSD) who underwent surgical sympathectomy.

Materials And Methods: Findings in eight adult patients with RSD who were evaluated with arterial duplex Doppler US after surgical sympathetectomy were retrospectively reviewed. Pulsatility index (PI) and waveform characteristics were compared to clinical findings (temperature and sudomotor state) in sympathectomized limbs.

Alterations of the three-phase bone scan after sympathectomy.

Objective: To evaluate alterations of the three-phase bone scan (TPBS) in patients with the clinical diagnosis of reflex sympathetic dystrophy (RSD) before and after surgical or chemical sympathectomy.

Design: The TPBS was done after i.v.

Releasable "U" suture for trabeculectomy surgery.

Overfiltration after glaucoma surgery can lead to significant complications. Tight suturing of the trabeculectomy flap reduces this problem but can lead to higher pressure and poor drainage of aqueous. Releasable sutures often leave irritating exposed suture ends.

Anabolic steroids in the treatment of malnourished CAPD patients: a retrospective study.

Objective: To assess the effect of anabolic steroids on malnutrition of continuous ambulatory peritoneal dialysis (CAPD) patients.

Design: Retrospective analysis of medical records, charts, and computer-generated laboratory and medication data.

Setting: Peritoneal Dialysis Unit of The Toronto Hospital.

Patient restraint: a new philosophy.

In 1992, The Toronto Hospital (Western Division) established a safety task force to examine the ethics of restraining patients. The task force developed tools to assess the need for restraint in consultation with other disciplines, the patient, and family. A six-week pilot study evaluated restraint devices and tested assessment methods for patients whose behaviour puts them or others at risk of injury.

Effect of asymmetry on calculations of convergence in prism diopters.

Calculations of convergence in units of prism diopters are based on an assumption that convergence is symmetrical, that is, the visual axes intersect on the median plane. The effect of departure from symmetrical convergence is shown to produce systematic errors in calculations of convergence distance, if the convergence angle is constrained to be constant. On the other hand, if the convergence distance is constrained to be constant, departure from symmetry results in a systematic reduction in the convergence angle.