11/15. Postanoxic myoclonus. Treatment of a case with 5-hydroxytryptophane and a decarboxylase inhibitor.Postanoxic myoclonus was first accepted as being related to a dysfunction of the ventrolateral thalamic nucleus. Several stereotaxic studies have invalidated this hypothesis. The neurochemical approach, in particular the measure of 5-hydroxyindolacetic acid in the cerebrospinal fluid, has opened new theoretical and therapeutic possibilities involving serotoninergic pathways. A typical case is presented who improved markedly under a combined therapy with 5-hydroxytryptophan and a decarboxylase inhibitor. A review of the pathogenesis and therapeutic approach to postanoxic myoclonus is presented.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
12/15. The pathophysiology of acute high-altitude illness.Complex physiologic responses occur as nonacclimatized lowland dwellers ascend above 10,000 feet, with a resulting partial pressure of arterial oxygen of less than 60 mm Hg. There are marked hemodynamic changes and shifts in body fluids that may result in organ dysfunction. The suspected pathogenesis of these acute hypobaric hypoxic-induced illnesses is discussed. Cerebral dysfunction may present as acute mountain sickness or high-altitude cerebral edema. Usually asymptomatic high-altitude retinal hemorrhage and noncardiogenic high-altitude pulmonary edema also are described. All of these illnesses apparently represent a spectrum of pathologic states initiated by an exaggerated vascular response to hypoxia. With the exception of retinopathy, high-altitude illness can be prevented by slow ascent. Early recognition of cerebral or pulmonary edema and immediate descent will prevent serious consequences of nonacclimatized persons who are acutely exposed to hypobaric environments.- - - - - - - - - - ranking = 2keywords = dysfunction (Clic here for more details about this article) |
13/15. adult respiratory distress syndrome in newborns: 5 cases.Aiming to set out the occurrence of the adult Respiratory Distress syndrome (ARDS) in the neonatal period, and according to recent descriptions in literature, we prospectively analyzed 5 cases. The criterion adopted to characterize ARDS was the expanded definition of the syndrome suggested by Murray & Matthay, (10), conjointly with non-invasive cardiac monitoring, to exclude pulmonary edema resulting from myocardial dysfunction. For each case, evolution was briefly described, as well as the predisposing conditions associated to the clinical score punctuation for diagnosis, stressing the importance of adequate identification and fastest possible management of such source of systemic effects. Upon admission at the intensive care unit (Ped. ICU), the five cases were either related to sepsis or to the syndrome of multiple organ failure, or to both. Both syndromes were essentially triggered by severe anoxia neonatorum, respiratory distress of the newborn and/or previous hospitalization with hypoxemia and use of a higher inspired fraction of oxygen. The primary causes of death were related to uncontrolled infection or shock, and not directly related to pulmonary failure.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
14/15. Specific semantic memory loss after hypoxic-ischemic injury.A patient is reported who suffered hypoxic-ischemic injury causing isolated and eventually partially reversible semantic memory loss. Despite normal MRI findings, single-photon emission CT demonstrated dysfunction in posterior cortical association areas. Semantic memory is the sum of categorical, perceptual, and conceptual knowledge. While not localized in a strict sense like visual fields, semantic memory is thought to be broadly organized in the posterior association cortices, with a particular focus in the inferior temporal regions. Evidence for this has come from patients with herpes simplex encephalitis, temporo-occipital infarctions, and dementias. This case confirms the importance of these cortical regions for semantic memory. The rapid recovery in this case, as opposed to the encephalitis or infarction cases, suggests an important role for preservation of white matter connections in the region for reconstitution of function.- - - - - - - - - - ranking = 1keywords = dysfunction (Clic here for more details about this article) |
15/15. Severe hypoxic biventricular dysfunction in tetralogy of fallot: is Blalock shunt the answer?In a 4-year-old boy with tetralogy of fallot, a right modified Blalock-Taussig anastomosis was created because of severe myocardial dysfunction and repeated hypercyanotic spells. Post-operatively, systemic oxygen saturation improved and also myocardial function. It is postulated that hypoxia was responsible for myocardial dysfunction previously, and its elimination has resulted in markedly improved cardiac performance.- - - - - - - - - - ranking = 231.92745335699keywords = ventricular dysfunction, dysfunction (Clic here for more details about this article) |
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