1/23. The prevention of irreversible lung changes following reversible phrenic nerve paralysis.phrenic nerve paralysis frequently follows operations on the neck such as resection of a cervical or first rib. It all too often passes unrecognised or is incorrectly treated, leading to permanent lung damage which may be severe enough as to result in a functional pneumonectomy. This is particularly unfortunate since the phrenic nerve paralysis is usually temporary. Three case histories are described of reversible paralysis of the phrenic nerve in which, due to prompt diagnosis, the ensuing lung changes were either prevented or immediatley treated. Intermittent assisted respiration with a Monaghan respirator was used to provide nebulised inhalations of mesna several times a day. The method is applicable via a tracheostomy, an endotracheal tube or a simple mouthpiece. The latter is illustrated. The therapy is not hindered by immobilisation of the head and neck and the level of consciousness of the patients is of no importance. Many chest x-rays demonstrate the rapid clearing of the lungs achieved. All three patients were discharged with perfectly normal lungs.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
2/23. Reduced expression of neuropeptides can be related to respiratory disturbances in rett syndrome.We immunohistochemically examined neurotransmitter systems, which function in the brainstem and are involved in neuronal organization of respiration, in an autopsy brain from a patient with rett syndrome (RS). Immunoreactivity (IR) for tyrosine hydroxylase, a functional marker for catecholaminergic neurons, was severely reduced in the locus ceruleus, while that for tryptophan hydroxylase involved in serotonin synthesis was spared in the raphe nuclei. In the brainstem, IR for substance p (SP) was reduced in the parabrachial complex and that for methionine-enkephalin (met-enk) was affected in the parabrachial, hypoglossal, dorsal vagal and solitary nuclei. In addition, expressions of these neuropeptides were also disturbed in the basal ganglia. A widespread altered expression of antagonistic neuropeptides, SP and met-enk, may be involved in the pathogenesis of RS, especially in its respiratory manifestation.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
3/23. A case of effective gastrostomy for severe abdominal distention due to breathing dysfunction of Rett's syndrome: a treatment of autonomic disorder.We report a case of 13-year-old-girl with Rett's syndrome and effectiveness of gastrostomy for severe paradoxical respiration, seizures and abdominal distention. Since the age of 3, she was observed to have typical hand-washing movement and autistic behavior. At the age of 8, she began to have hyperventilation and seizures in awake stage. Her symptoms were worse from year to year. At the age of 13, gastrostomy was done to treat severe abdominal distention. Her symptoms were improve dramatically by the gastric air removal through gastrobutton.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
4/23. Disordered respiration as a levodopa-induced dyskinesia in Parkinson's disease.Symptomatic respiratory disturbance as a consequence of levodopa (L-dopa) therapy for Parkinson's disease (PD) has been described only rarely and may be underrecognized in clinical practice. We report on two patients with PD in whom the introduction or augmentation of L-dopa therapy was associated with the development of irregular and rapid breathing. Analysis of breathing patterns before and after L-dopa demonstrated a striking change in respiratory rate after administration of L-dopa, with the emergence of irregular tachypnea alternating with brief periods of apnea, in a pattern consistent with a central origin. In both cases, the temporal relationship of the respiratory disturbance to the administration of L-dopa suggested a peak-dose drug effect. Previous reports of L-dopa-induced respiratory dyskinesia are reviewed, and the potential mechanisms whereby L-dopa might influence the central control of respiration to produce irregular breathing patterns are discussed.- - - - - - - - - - ranking = 5keywords = respiration (Clic here for more details about this article) |
5/23. Effects of left amygdala lesions on respiration, skin conductance, heart rate, anxiety, and activity of the right amygdala during anticipation of negative stimulus.The present study reports the effects of lesions in the left amygdala on anxiety, respiration, skin conductance, heart rate, and electrical potentials in the right amygdala in two patients. Trait and anticipatory-state anxiety were measured before and after left amygdala resection to control medically intractable epilepsy in the patients. Lesions in the left amygdala resulted in decreases of trait and state anxiety, respiratory rate, and activity in the right amygdala in both patients; one patient also showed notable decreases in skin conductance and heart rate. The study also reports that activities in the right amygdala before the lesion were not observed after the lesion. We suggest that the activity of the right amygdala is dominantly activated in anxiety and anxiety-related physiological responses but needs excitatory inputs from the left amygdala.- - - - - - - - - - ranking = 5keywords = respiration (Clic here for more details about this article) |
6/23. risperidone withdrawal-related respiratory dyskinesia: a case diagnosed by spirography and fibroscopy.risperidone is a frequently used member of a new class of atypical antipsychotics-the serotonin-dopamine antagonists (SDAs)-due to its comparatively high efficacy and low D2/5HT2 binding ratio, which results in a low incidence of extrapyramidal side effects including tardive dyskinesia (TD). The authors present an elderly patient with mixed dementia who developed TD at multiple sites, (including respiratory dyskinesia [RD], limb dyskinesia, and orofacial dyskinesia) following abrupt withdrawal of risperidone therapy. RD is not a rare condition, but is often misdiagnosed and is potentially lethal. Therefore, clinicians should pay close attention to possible onset of RD in patients with multiple risk factors for TD, even when SDA therapy is used. If RD is suspected, assessment should include spirography combined with fibroscopy for examination of irregularities in the rate, rhythm, and depth of respiration.- - - - - - - - - - ranking = 1keywords = respiration (Clic here for more details about this article) |
7/23. lipoblastoma of the neck: a rare cause of respiratory problems in children.Lipoblastomatous tumours are rare, and they occur primarily in children younger than 3 years of age. They are benign and may be divided in lipoblastomas and lipoblastomatosis. A case with cervical lipoblastoma causing respiratory difficulty is reported, and a clinical characterisation of patients with lipoblastomatous tumours in the neck is presented. A 6-year-old boy with complains of stridorous respiration and significant reduction in physical capacity was referred to the ENT Department, Odense University Hospital, denmark. He was treated with total surgical resection of a soft and slowly growing tumour in the left side of the neck, extending from the base of the skull to the upper part of the mediastinum. The histological examination showed a lipoblastoma. After surgery all symptoms disappeared, and the patient was without any operative sequelae. Including the actual case, a review of English literature resulted in the identification of 37 patients with cervical lipoblastoma or lipoblastomatosis. However, in most cases the information was sparse, and only 13 patients were eligible for an analysis of basic clinical and demographic data. The median age was 25 months (range: 7-75 months), and the median tumour size 9 cm (range: 3-18 cm). No difference in sex distribution was found. Lipoblastomas (85%) seemed more frequent than lipoblastomatosis (15%). Stridorous respiration was present in 31%. It is concluded that a considerable part of lipoblastomatous tumours in the neck are combined with respiratory difficulties (31%), and that complete but gentle surgical treatment in most cases will restore normal physiological conditions.- - - - - - - - - - ranking = 2keywords = respiration (Clic here for more details about this article) |
8/23. Diaphragmatic relaxation: pathophysiological alterations and current possibilities of surgical repair.Diaphragmatic relaxation is a pathology not frequently observed because it is generally oligosymptomatic. The development of modern technology has induced an important contribution to the diagnosis and treatment of the disease which can find a possibility of restoration in surgery. A 63-year-old patient with a light syndrome of respiration deficiency and an altered relaxed profile of the right cupola was subjected to surgical treatment with the technique of diaphragmatic plicature without any adverse implication during and after the operation. After a brief recovery, the patient was discharged and after 9 years he affirmed still absence of dyspnoea from limited labor and absence of respiration problems. The selected surgical technique for the restoration of the altered muscle is the diaphragmatic plicature without incision or excision of the altered part of the muscle. The preferable access way today is that of laparotomy which is devoid of problems of thoracotomy and generally it permits quite easily the restoration of all diaphragmatic defects. Diaphragmatic plicature is a simple, effective and long-lasting intervention but we cannot determine the complete recovery of the normal contractile function of the muscle. There is no morbidity and mortality directly related to this technique, the latter incidentally associated with complications of general anesthesia.- - - - - - - - - - ranking = 2keywords = respiration (Clic here for more details about this article) |
9/23. The abnormal pupil in cheyne-stokes respiration. Case report.cheyne-stokes respiration commonly induces a rhythmic pupillary dilatation during hyperpnea and constriction during apnea. Failure of a pupil to dilate during hyperventilation indicates underlying sympathetic nerve paralysis. This report deals with an instance in which one pupil failed to constrict during apnea due to oculomotor nerve compression. The periodic respirations and anisocoria disappeared following surgical evacuation of a large ipsilateral subdural hematoma.- - - - - - - - - - ranking = 6keywords = respiration (Clic here for more details about this article) |
10/23. End-expiratory pressure best approximates intrinsic lower esophageal sphincter pressure. Report of a patient with cheyne-stokes respiration.Recent studies have shown that the respiratory oscillation inherent in the station pull-through technique of measuring lower esophageal sphincter (LES) pressure is the result of active diaphragmatic contraction. A recent study in cats suggested that intrinsic LES tone is best reflected by end-expiratory pressure during spontaneous respiration. This finding is confirmed in a patient we report with achalasia and Waldenstrom's macroglobulinemia who had Cheyne-Stokes breathing. LES pressure during periods of central apnea approximated end-expiratory pressure during periods of hyperpnea.- - - - - - - - - - ranking = 5keywords = respiration (Clic here for more details about this article) |
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