1/6. Postoperative confusion preceded by decreased frontal lobe haemoglobin oxygen saturation.We describe a 58-year-old male patient with confusion and prolonged recovery after liver transplantation. A cause was not apparent for the confusion, but during surgery, monitoring of the frontal lobe cerebral haemoglobin oxygen saturation by near-infrared spectrophotometry showed cerebral hypo-oxygenation despite optimization of conventional cardiovascular parameters. It is possible that intraoperative cerebral ischaemia is the cause of postsurgical confusion and with near-infrared spectrophotometry this hypothesis may be tested clinically.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
2/6. Possible mechanisms in infants for selective basal ganglia damage from asphyxia, kernicterus, or mitochondrial encephalopathies.magnetic resonance imaging and neuropathologic studies have demonstrated remarkably selective patterns of injury to subregions of the basal ganglia in children. Examples are kernicterus and certain mitochondrial encephalopathies, which cause selective injury to the globus pallidus, and near-total perinatal asphyxia, which causes lesions in the putamen and thalamus. To explain the differential vulnerability of nuclei within millimeters of each other, we hypothesize that their locations within the neurotransmitter-specific circuitry of the basal ganglia motor loop are important. In severe hypoxic-ischemic encephalopathy, excitatory glutamatergic pathways into the putamen and thalamus are overactive, but the globus pallidus might be protected because its activity is silenced by inhibitory neuronal activity. In contrast, the relatively high resting neuronal activity in the globus pallidus might make it more vulnerable to less intense, subacute oxidative stresses from mitochondrial toxins such as bilirubin or from genetic mitochondrial disorders. This hypothesis has implications for designing neuroprotective therapies and for treating associated chronic movement disorders.- - - - - - - - - - ranking = 0.5keywords = near (Clic here for more details about this article) |
3/6. mandibular nerve block treatment for trismus associated with hypoxic-ischemic encephalopathy.BACKGROUND AND OBJECTIVES: We describe the use of mandibular nerve block for the management of bilateral trismus associated with hypoxic-ischemic encephalopathy. CASE REPORT: The patient was a 65-year-old man with bilateral trismus due to hypoxic-ischemic encephalopathy. Despite his impaired consciousness, we performed fluoroscopically guided bilateral mandibular nerve block. The bilateral symptoms were sufficiently improved, without obvious side effects, by injecting a local anesthetic near the right mandibular nerve and a neurolytic near the left mandibular nerve. CONCLUSIONS: mandibular nerve block may be an effective treatment for patients with bilateral trismus due to ischemic-encephalopathy, even when consciousness is impaired.- - - - - - - - - - ranking = 1keywords = near (Clic here for more details about this article) |
4/6. Checkmark fetal heart rate pattern associated with severe fetal hypoxia. A case report.A 31-year-old nulliparous woman developed vaginal bleeding after spontaneous rupture of the membranes at 40 weeks of gestation. fetal heart rate monitoring showed checkmark and sinusoidal patterns. A 3,281 g male neonate was delivered by emergency cesarean section, with Apgar scores of 1 and 3 at 1 and 5 min, respectively. The neonate exhibited severe acidosis with arterial blood gas pH of 6.96, and was diagnosed to have severe hypoxic-ischemic encephalopathy. An umbilical artery branch was noted in the membrane near the cervical os and found to be torn, representing hemorrhagic vasa previa. Severe fetal hypoxia resulting from hemorrhagic vasa previa might be associated with checkmark fetal heart rate pattern.- - - - - - - - - - ranking = 0.5keywords = near (Clic here for more details about this article) |
5/6. Complete neurological recovery following delayed initiation of hypothermia in a victim of warm water near-drowning.Induced hypothermia has been demonstrated to improve outcome following cardiac arrest and is now widely endorsed. However, the optimal method of cooling and the identification of patients most likely to benefit from this therapy remains to be determined. We report a patient in whom there was a long delay in return of spontaneous circulation (at least 45 min) and the initiation of induced hypothermia (12 h) who made an almost complete neurological recovery following cardiac arrest from warm-water near-drowning.- - - - - - - - - - ranking = 2.5keywords = near (Clic here for more details about this article) |
6/6. Rapid diagnosis of cannula migration by cerebral oximetry in neonatal arch repair.Although it has gained much interest in other surgical specialties, the application of near-infrared spectroscopy to assess cerebral perfusion during cardiac surgery is relatively new. Regional cerebral oxygen saturation (rSO2) is a function of cerebral oxygen supply and demand. Continuous monitoring of the rSO2 permits early detection of cerebral ischemia allowing for prompt intervention. The following is a description of a repair of truncus arteriosus with type A interrupted aortic arch during which continuous cerebral oximetry assisted with the positioning of the arterial cannula avoiding a prolonged episode of cerebral ischemia.- - - - - - - - - - ranking = 0.5keywords = near (Clic here for more details about this article) |