1/5. Guillain-Barre's syndrome associated with plasmodium falciparum malaria: role of plasma exchange.Guillain-Barre's syndrome (GBS) associated with malarial infection is a rare condition reported in the literature. We report a case of plasmodium falciparum (PF) malarial infection with Guillain-Barre's syndrome complicated by respiratory failure and review of the literature. Our patient gradually improved after treatment with plasma exchange. review of the literature showed 11 cases of GBS associated with malaria. Four of 8 patients with GBS associated with PF had respiratory failure, whereas, none of the patients with GBS associated with plasmodium vivax (PV) developed respiratory failure. Three of four patients with respiratory failure died and one who survived was treated with intravenous immunoglobulin. Our patient was the second case to survive after treatment with plasma exchange. The role of plasma exchange, the pathogenesis of malaria in GBS and the mechanism that induced more severe GBS in PF than in PV were discussed.- - - - - - - - - - ranking = 1keywords = exchange (Clic here for more details about this article) |
2/5. Diaphragmatic pacing: an alternative to long-term mechanical ventilation.Electrical percutaneous stimulation of the phrenic nerves was first employed in 1948 by Sarnoff to provide temporary artificial ventilation in patients with respiratory failure. However, the technique was limited by development of infection around the electrode. Short-term radiofrequency stimulation of the phrenic nerves was first utilised by Glenn in 1964 and adapted to long-term use in patients with central hypoventilation in 1968 and with traumatic quadriplegia in 1972. The technique employed alternate pacing of each hemidiaphragm with high frequency stimulation (25-30 Hz) with a respiratory rate of 12 to 17 per minute which, in a series of 17 quadriplegic adults, although initially successful, was self-limiting because of eventual damage to the nerves and diaphragms. More recently, continuous bilateral simultaneous low frequency (up to 8 Hz) stimulation with a respiratory rate of 5 to 9 per minute has not induced myopathic changes. This phenomenon has been attributed to: 1. the conversion of the mixture of slow and fast twitch fibres in the diaphragm to a uniform population of fatigue resistant fibres induced by low frequency stimulation, and 2. the reduction in the total current necessary to achieve adequate gas exchange when both diaphragms contract simultaneously with the less frequent stimulation at lower energy. Diaphragmatic pacing has been applied to infants and children with emphasis on the selection of patients and optimum setting of stimulus parameters. This communication presents a case report of diaphragmatic pacing in a child with a review of the principles of application. The advantages and disadvantages compared to mechanical ventilation are also discussed.- - - - - - - - - - ranking = 0.14285714285714keywords = exchange (Clic here for more details about this article) |
3/5. lung function in diaphragm pacing.electric stimulation of the diaphragm via the phrenic nerve to induce ventilation has recently been used for the long-term management of chronic ventilatory insufficiency. Since 1973 three patients with inadequate alveolar ventilation have been treated with diaphragm pacing at the Toronto Western Hospital. Two, who had quadriplegia due to lesions of the spinal cord in the upper cervical region and a severe restrictive ventilatory defect, were treated with continuous diaphragm pacing. The third patient required assisted nocturnal ventilation because of primary alveolar hypoventilation. All three patients tolerated the diaphragm pacing well, and pulmonary function tests showed satisfactory gas exchange with the patients breathing room air. This form of therapy seems to be a practical clinical method of managing chronic ventilatory failure in patients with lesions of the upper cervical cord or primary alveolar hypoventilation.- - - - - - - - - - ranking = 0.14285714285714keywords = exchange (Clic here for more details about this article) |
4/5. Improved arterial oxygenation by diaphragmatic pacing in quadriplegia.Despite increased alveolar ventilation, positive-pressure ventilation (PPV) reproducibly resulted in less efficient arterial oxygenation as compared to diaphragmatic pacing in a quadriplegic patient with respiratory paralysis. Volume loading acutely restored arterial oxygenation during PPV. This report emphasizes the important interaction between the cardiovascular and pulmonary systems in effecting gas exchange, particularly in quadriplegics. In this respect, diaphragmatic pacing seems to perform better than PPV.- - - - - - - - - - ranking = 0.14285714285714keywords = exchange (Clic here for more details about this article) |
5/5. Lupus erythematosus and Miller-Fisher syndrome.OBJECTIVE: To compare the clinical course of an unusual case of Miller-Fisher syndrome in systemic lupus erythematosus with therapeutic interventions, in particular with plasma exchanges. DESIGN: The clinical state and laboratory and electrophysiologic parameters were controlled for over a year and related to therapeutic attempts with immunoglobulins, steroids, and plasma exchanges. SETTING: Medical intensive care unit of a university hospital. PATIENT: A 17-year-old black female student with known systemic lupus erythematosus who developed ataxia, are flexia, and ophthalmoplegia (Miller-Fisher syndrome) and later became tetraplegic and required full mechanical ventilatory support. RESULTS: High-dose immunoglobulin treatment combined with corticosteroid pulse therapy was not beneficial. However, plasma exchange (performed five times over a period of 4 months) was followed by a striking clinical improvement within hours after each plasma exchange. CONCLUSIONS: plasma exchange appears to remove a yet unknown agent producing a distal motor nerve conduction block and is efficacious in severe neuropathy associated with Miller-Fisher syndrome in lupus erythematosus.- - - - - - - - - - ranking = 0.71428571428571keywords = exchange (Clic here for more details about this article) |