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Sample records for parturient paresis

  1. Treatment of cows with parturient paresis using intravenous calcium and oral sodium phosphate.

    Science.gov (United States)

    Braun, U; Grob, D; Hässig, M

    2016-09-01

    The goal of this study was to investigate whether intravenous infusion of 1000 ml 40% calcium borogluconate combined with the oral adminstration of 500 g sodium phosphate leads to a better cure rate and longer-lasting normocalcaemia and normophosphataemia than standard intravenous treatment with 500 ml calcium borogluconate in cows with parturient paresis. Forty recumbent cows with hypocalcaemia and hypophosphataemia were alternately allocated to group A or B. Cows of both groups were treated intravenously with 500 ml 40% calcium borogluconate, and cows of group B additionally received another 500 ml calcium borogluconate via slow intravenous infusion and 500 g sodium phosphate administered via an orogastric tube. Thirty-two cows stood within 8 hours after the start of treatment and 8 did not; of the 32 cows that stood, 18 belonged to group A and 14 to group B (90% of group A vs. 70% of group B; P = 0.23). Seven cows relapsed; of these and the 8 that did not respond to initial treatment, 10 stood after two standard intravenous treatments. Downer cow syndrome occurred in 5 cows, 3 of which recovered after aggressive therapy. The overall cure rate did not differ significantly between groups A and B. Twelve (60%) cows of group A and 14 (70%) cows of group B were cured after a single treatment and of the remaining 14, 11 were cured after two or more treatments. Two downer cows were euthanized and one other died of heart failure during treatment. Serum calcium concentrations during the first eight hours after the start of treatment were significantly higher in group B than in group A, and oral sodium phosphate caused a significant and lasting increase in inorganic phosphate. More cows of group B than group A were cured after a single treatment (P > 0.05). These findings, although not statistically significant, are promising and should be verified using a larger number of cows.

  2. Hot topic: prevention of parturient paresis and subclinical hypocalcemia in dairy cows by zeolite A administration in the dry period

    DEFF Research Database (Denmark)

    Thilsing-Hansen, T; Jørgensen, R J; Thilsing, Trine

    2001-01-01

    To test the effects of a zeolite feed supplement on parturient calcium status and milk fever, two groups of dry cows were treated with either 1 kg of zeolite/d or none for 4 wk prepartum. At calving and d 1 and 2 after calving all cows were given 250 g of calcium carbonate as a drench, and a blood...... sample was taken. Serum calcium analysis revealed a greater calcium concentration in zeolite-treated cows. While three control cows contracted milk fever, necessitating intravenous calcium therapy, and six out of eight control cows experienced serum calcium levels below 2 mmol/L in one or more samples...... taken, none of the zeolite-treated cows contracted milk fever or experienced subclinical hypocalcemia....

  3. Possibilities of pfysiotherapy in facial nerve paresis

    OpenAIRE

    ZIFČÁKOVÁ, Šárka

    2015-01-01

    The bachelor thesis addresses paresis of the facial nerve. The facial nerve paresis is a rather common illness, which cannot be often cured without consequences despite all the modern treatments. The paresis of the facial nerve occurs in two forms, central and peripheral. A central paresis is a result of a lesion located above the motor nucleus of the facial nerve. A peripheral paresis is caused by a lesion located either in the location of the motor nucleus or in the course of the facial ner...

  4. Cardiac surgery in the parturient.

    Science.gov (United States)

    Chandrasekhar, Shobana; Cook, Christopher R; Collard, Charles D

    2009-03-01

    Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L x min(-1) x m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management.

  5. MRI in patients with general paresis

    International Nuclear Information System (INIS)

    Zifko, U.; Wimberger, D.; Lindner, K.; Zier, G.; Grisold, W.; Schindler, E.

    1996-01-01

    Few cases of MRI in neurosyphilis have been reported. We examined the value of MRI in patients with general paresis; MRI was performed on four HIV-negative patients with parenchymatous neurosyphilis. It demonstrated frontal and temporal atrophy, subcortical gliosis and, in one patient, increased ferritin in the basal ganglia. The progression of the lesions on MRI correlated well with the neuropsychiatric disturbances. The MRI findings correlated with the wellknown neuropathological findings. This combination of pathological findings in neurosyphilis has not been described before and we suggest that MRI is of prognostic value in patients with general paresis. (orig.)

  6. Abnormal parietal function in conversion paresis.

    Directory of Open Access Journals (Sweden)

    Marije van Beilen

    Full Text Available The etiology of medically unexplained symptoms such as conversion disorder is poorly understood. This is partly because the interpretation of neuroimaging results in conversion paresis has been complicated by the use of different control groups, tasks and statistical comparisons. The present study includes these different aspects in a single data set. In our study we included both normal controls and feigners to control for conversion paresis. We studied both movement execution and imagery, and we contrasted both within-group and between-group activation. Moreover, to reveal hemisphere-specific effects that have not been reported before, we performed these analyses using both flipped and unflipped data. This approach resulted in the identification of abnormal parietal activation which was specific for conversion paresis patients. Patients also showed reduced activity in the prefrontal cortex, supramarginal gyrus and precuneus, including hemisphere-specific activation that is lateralized in the same hemisphere, regardless of right- or left-sided paresis. We propose that these regions are candidates for an interface between psychological mechanisms and disturbed higher-order motor control. Our study presents an integrative neurophysiological view of the mechanisms that contribute to the etiology of this puzzling psychological disorder, which can be further investigated with other types of conversion symptoms.

  7. Abnormal Parietal Function in Conversion Paresis

    NARCIS (Netherlands)

    van Beilen, Marije; de Jong, Bauke M.; Gieteling, Esther W.; Renken, Remco; Leenders, Klaus L.

    2011-01-01

    The etiology of medically unexplained symptoms such as conversion disorder is poorly understood. This is partly because the interpretation of neuroimaging results in conversion paresis has been complicated by the use of different control groups, tasks and statistical comparisons. The present study

  8. Caring for the Jehovah's Witness Parturient.

    Science.gov (United States)

    Mason, C LaToya; Tran, Connie K

    2015-12-01

    Caring for the Jehovah's Witness parturient is a complex task that presents a number of ethical, medical, and legal concerns because many Jehovah's Witnesses refuse allogeneic blood transfusion. Childbirth and its surrounding events may be associated with significant blood loss. Given their significant role in the intraoperative administration of blood products, anesthesia providers should be familiar with factors that must be considered in the perioperative care of Jehovah's Witness parturients. Several pharmacologic therapies, anesthetic techniques, and operative interventions aimed at blood conservation may be useful in the care of such patients. Aside from their refusal of transfusion, each Witness makes a personal decision on the acceptability of derivatives of plasma or cellular blood components and autologous blood management. Therefore, the patient-physician relationship must ensure that the individual patient's desires are accurately communicated, respected, and documented in the patient's medical record. The Perioperative Surgical Home model is appropriate for use in caring for Jehovah's Witness patients because it allows for the early and continuing coordination of care and communication between the patient and a multidisciplinary team. In this article, we present a focused review of concepts important to the provision of anesthetic care of parturients who are Jehovah's Witnesses and introduce an algorithmic perioperative approach that may be applied to the care of the Jehovah's Witness parturient undergoing an operative procedure.

  9. Vocal fold paresis - a debilitating and underdiagnosed condition.

    Science.gov (United States)

    Harris, G; O'Meara, C; Pemberton, C; Rough, J; Darveniza, P; Tisch, S; Cole, I

    2017-07-01

    To review the clinical signs of vocal fold paresis on laryngeal videostroboscopy, to quantify its impact on patients' quality of life and to confirm the benefit of laryngeal electromyography in its diagnosis. Twenty-nine vocal fold paresis patients were referred for laryngeal electromyography. Voice Handicap Index 10 results were compared to 43 patients diagnosed with vocal fold paralysis. Laryngeal videostroboscopy analysis was conducted to determine side of paresis. Blinded laryngeal electromyography confirmed vocal fold paresis in 92.6 per cent of cases, with vocal fold lag being the most common diagnostic sign. The laryngology team accurately predicted side of paresis in 76 per cent of cases. Total Voice Handicap Index 10 responses were not significantly different between vocal fold paralysis and vocal fold paresis groups (26.08 ± 0.21 and 22.93 ± 0.17, respectively). Vocal fold paresis has a significant impact on quality of life. This study shows that laryngeal electromyography is an important diagnostic tool. Patients with persisting dysphonia and apparently normal vocal fold movement, who fail to respond to appropriate speech therapy, should be investigated for a diagnosis of vocal fold paresis.

  10. Neuromuscular compensation mechanisms in vocal fold paralysis and paresis.

    Science.gov (United States)

    Dewan, Karuna; Vahabzadeh-Hagh, Andrew; Soofer, Donna; Chhetri, Dinesh K

    2017-07-01

    Vocal fold paresis and paralysis are common conditions. Treatment options include augmentation laryngoplasty and voice therapy. The optimal management for this condition is unclear. The objective of this study was to assess possible neuromuscular compensation mechanisms that could potentially be used in the treatment of vocal fold paresis and paralysis. In vivo canine model. In an in vivo canine model, we examined three conditions: 1) unilateral right recurrent laryngeal nerve (RLN) paresis and paralysis, 2) unilateral superior laryngeal nerve (SLN) paralysis, and 3) unilateral vagal nerve paresis and paralysis. Phonatory acoustics and aerodynamics were measured in each of these conditions. Effective compensation was defined as improved acoustic and aerodynamic profile. The most effective compensation for all conditions was increasing RLN activation and decreasing glottal gap. Increasing RLN activation increased the percentage of possible phonatory conditions that achieved phonation onset. SLN activation generally led to decreased number of total phonation onset conditions within each category. Differential effects of SLN (cricothyroid [CT] muscle) activation were seen. Ipsilateral SLN activation could compensate for RLN paralysis; normal CT compensated well in unilateral SLN paralysis; and in vagal paresis/paralysis, contralateral SLN and RLN displayed antagonistic relationships. Methods to improve glottal closure should be the primary treatment for large glottal gaps. Neuromuscular compensation is possible for paresis. This study provides insights into possible compensatory mechanisms in vocal fold paresis and paralysis. NA Laryngoscope, 127:1633-1638, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  11. Delayed-onset bilateral abducens paresis after head trauma

    Directory of Open Access Journals (Sweden)

    Pravin Salunke

    2012-01-01

    Full Text Available Bilateral sixth nerve paresis following closed head injury, though rare, is a known entity. However, delayed-onset post-traumatic bilateral abducens paresis is extremely rare. We present two cases. The first patient had onset of bilateral abducens paresis 2 weeks after closed head injury and the second patient after 3 days. The cause in the former was detected to be chronic subdural hematoma and in the latter is speculated to be edema/ischemia due to injury to soft tissue structures housing these nerves. The delayed onset of bilateral abducens paresis following head injury may vary according to the cause. There may be another mechanism of injury apart from direct trauma. Though rare, it needs to be evaluated and may have a treatable cause like elevated intracranial pressure.

  12. Caesarean section in a parturient with a spinal cord stimulator.

    LENUS (Irish Health Repository)

    Sommerfield, D

    2010-01-01

    A 35-year-old G2P1 parturient at 32 weeks of gestation with an implanted spinal cord stimulator was admitted for urgent caesarean section. Spinal anaesthesia was performed below the spinal cord stimulator leads at the L4-5 level, and a healthy female infant was delivered. A basic description of the technology and resulting implications for the parturient are discussed.

  13. Isolated marginal facial nerve paresis after TMJ discopexy: a case report.

    Science.gov (United States)

    Reychler, H; Mahy, P

    2011-01-01

    Isolated marginal facial nerve paresis after TMJ discopexy: a case report. This is the first report of a transient, isolated marginal facial nerve paresis after temporomandibular joint arthrotomy. The paresis seems to have resulted from a crush lesion by Backhaus forceps, placed transcutaneously during the operation to distract the intra-articular space.

  14. Parturient symphysio-fundal height and abdominal girth ...

    African Journals Online (AJOL)

    Birth weight is known to influence morbidity and mortality. Simple measures to predict birth weight before delivery would therefore be useful in order to plan a delivery. Maternal parturient symphysio-fundal height has been used to detect Low Birth Weight. This study aims at predicting the fetal weight using the maternal ...

  15. Graded epidural anaesthesia for Caesarean section in a parturient ...

    African Journals Online (AJOL)

    Open Access article distributed under the terms of the. Creative Commons License ... CASE REPORT. Graded epidural anaesthesia for Caesarean section in a parturient with Shone's syndrome: a case study. Anjum Naza*, Sugata Dasguptab, Bijoy Kumar Bandyopadhyayb and Hasibul Hasan Shirazeec. aDepartment of ...

  16. Family planning and contraceptive practices among parturients in a ...

    African Journals Online (AJOL)

    Background: Family size predetermination and birthing according to schedule is a strong determinant of family stability as it allows proper resource allocation and management. Aims: To determine the family planning practices among parturients and determine the factors that can influence the uptake of contraceptives in the ...

  17. Knowledge of sickle cell disease among parturiant mothers in Benin ...

    African Journals Online (AJOL)

    Knowledge of sickle cell disease among parturiant mothers in Benin City and their attitude to newborn screening. ... Abstract. BACKGROUND; Sickle cell disease is the commonest genetic disorder of the black race. A high ... They were assessed using a pretested questionnaire a sample of which will be shown in the text.

  18. Anaesthetic management of a parturient with Laron syndrome.

    Science.gov (United States)

    Bhatia, K; Cockerham, R

    2011-10-01

    We report a case of a parturient with Laron syndrome, a rare form of dwarfism which results from an inability to generate insulin-like growth factor 1. In addition to dwarfism these patients may have craniofacial abnormalities, atlantoaxial instability, spinal stenosis and metabolic, musculoskeletal and genitourinary abnormalities. The patient underwent an urgent caesarean section using combined spinal-epidural anaesthesia. Laron syndrome is reviewed and its anaesthetic implications discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

  19. Stretch-sensitive paresis and effort perception in hemiparesis.

    Science.gov (United States)

    Vinti, Maria; Bayle, Nicolas; Hutin, Emilie; Burke, David; Gracies, Jean-Michel

    2015-08-01

    In spastic paresis, stretch applied to the antagonist increases its inappropriate recruitment during agonist command (spastic co-contraction). It is unknown whether antagonist stretch: (1) also affects agonist recruitment; (2) alters effort perception. We quantified voluntary activation of ankle dorsiflexors, effort perception, and plantar flexor co-contraction during graded dorsiflexion efforts at two gastrocnemius lengths. Eighteen healthy (age 41 ± 13) and 18 hemiparetic (age 54 ± 12) subjects performed light, medium and maximal isometric dorsiflexion efforts with the knee flexed or extended. We determined dorsiflexor torque, Root Mean Square EMG and Agonist Recruitment/Co-contraction Indices (ARI/CCI) from the 500 ms peak voluntary agonist recruitment in a 5-s maximal isometric effort in tibialis anterior, soleus and medial gastrocnemius. Subjects retrospectively reported effort perception on a 10-point visual analog scale. During gastrocnemius stretch in hemiparetic subjects, we observed: (1) a 25 ± 7 % reduction of tibialis anterior voluntary activation (maximum reduction 98 %; knee extended vs knee flexed; p = 0.007, ANOVA); (2) an increase in dorsiflexion effort perception (p = 0.03, ANCOVA). Such changes did not occur in healthy subjects. Effort perception depended on tibialis anterior recruitment only (βARI(TA) = 0.61, p hemiparesis, voluntary ability to recruit agonist motoneurones is impaired--sometimes abolished--by antagonist stretch, a phenomenon defined here as stretch-sensitive paresis. In addition, spastic co-contraction increases effort perception, an additional incentive to evaluate and treat this phenomenon.

  20. A Case of 72 Diabetic Woman with Zoster Paresis

    Directory of Open Access Journals (Sweden)

    E. Sajadi

    2009-10-01

    Full Text Available Introduction: VZV is an exclusively human pathogen. The primary infection typically occurs during childhood and causes varicella. As with other members of the herpes viruses’ family, VZV is noninfectious in its latent form but can reactivate at a later time to form intact virions in the involved sensory neurons. These virions then migrate to the skin through axons, spread from cell to cell, and penetrate the epidermis.Case Report: In this case a 72 years old woman with history of diabetes mellitus and hypertension is reported hospitalized because of urinary retention, weakness and parestesia in the right leg, complicated with vesiculoulcerative lesions in sacral area with distribution to the right buttock and vagina. L.P was done to confirm inflammatory radicopathy that showed aseptic meningitis and therapy started with acyclovir and prednisolone. Patient got well and discharged from the hospital.Conclusion: Motor weakness in noncranial nerve is one of the zoster complications known as zoster paresis. Weakness begins suddenly 2-3 weeks after rash and progresses to extremities. In this case 3 weeks after rash, nerve complications were observed. We recommend to do paresthesia examination of skin for eruption in all patients presented with paresis.

  1. Motor mechanisms of vertical fusion in individuals with superior oblique paresis.

    Science.gov (United States)

    Mudgil, Ananth V; Walker, Mark; Steffen, Heimo; Guyton, David L; Zee, David S

    2002-06-01

    We wanted to determine the mechanisms of motor vertical fusion in patients with superior oblique paresis and to correlate these mechanisms with surgical outcomes. Ten patients with superior oblique paresis underwent 3-axis, bilateral, scleral search coil eye movement recordings. Eye movements associated with fusion were analyzed. Six patients had decompensated congenital superior oblique paresis and 4 had acquired superior oblique paresis. All patients with acquired superior oblique paresis relied predominantly on the vertical rectus muscles for motor fusion. Patients with congenital superior oblique paresis were less uniform in their mechanisms for motor fusion: 2 patients used predominantly the oblique muscles, 2 patients used predominantly the vertical recti, and 2 patients used predominantly the superior oblique in the hyperdeviated eye and the superior rectus in the hypodeviated eye. The last 2 patients developed the largest changes in torsional eye alignment relative to changes in vertical eye alignment and were the only patients to develop symptomatic surgical overcorrections. There are 3 different mechanisms for vertical fusion in individuals with superior oblique paresis, with the predominant mechanism being the vertical recti. A subset of patients with superior oblique paresis uses predominantly the superior oblique muscle in the hyperdeviated paretic eye and the superior rectus muscle in the fellow eye for fusion. This results in intorsion of both eyes, causing a large change in torsional alignment. The consequent cyclodisparity, in addition to the existing vertical deviation, may make fusion difficult. The differing patterns of vertical fusional vergence may have implications for surgical treatment.

  2. Anesthetic Management of A Parturient With Diabetic Keto-Acidosis

    OpenAIRE

    Rupasinghe M N; Hemmad A R

    2013-01-01

    Diabetic ketoacidosis (DKA) in pregnancy is a life threatening medical emergency. It can compromise both the fetus and the mother profoundly. The incidence of DKA during pregnancy ranges between 2 to 3%, and carries a 10–20% risk of fetal death.1 DKA is characterized by a biochemical triad of ketonemia, hyperglycemia and acidemia. We present a case of a parturient with mismanaged DKA that was brought to the operating room for a STAT cesarean section (C/S) due to fetal distress and discuss the...

  3. Analysis of laryngoscopic features in patients with unilateral vocal fold paresis.

    Science.gov (United States)

    Woo, Peak; Parasher, Arjun K; Isseroff, Tova; Richards, Amanda; Sivak, Mark

    2016-08-01

    The diagnosis of paresis in patients with vocal fold motion impairment remains a challenge. More than 27 clinical parameters have been cited that may signify paresis. We hypothesize that some features are more significant than others. Prospective case series. Two laryngologists rated laryngoscopy findings in 19 patients suspected of paresis. The diagnosis was confirmed with laryngeal electromyography. A standard set of 27 ratings was used for each examination that included movement, laryngeal configuration, and stroboscopy signs. A Fisher exact test was completed for each measure. A kappa coefficient was calculated for effectiveness in predicting the laterality of paresis. Left-sided vocal fold paresis (n = 13) was significantly associated with ipsilateral axis deviation, thinner vocal fold, bowing, reduced movement, reduced kinesis, and phase lag (P vocal fold paresis (n = 6) was significantly associated with ipsilateral shorter vocal fold, axis deviation, reduced movement, and reduced kinesis (P vocal fold, vocal fold bowing, reduced movement, reduced kinesis, and phase lag were more likely to be associated with vocal fold paresis. 4 Laryngoscope, 126:1831-1836, 2016. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  4. [Fatal amnioinfusion with previous choriocarcinoma in a parturient woman].

    Science.gov (United States)

    Hrgović, Z; Bukovic, D; Mrcela, M; Hrgović, I; Siebzehnrübl, E; Karelovic, D

    2004-04-01

    The case of 36-year-old tercipare is described who developed choriocharcinoma in a previous pregnancy. During the first term labour the patient developed cardiac arrest, so reanimation and sectio cesarea was performed. A male new-born was delivered in good condition, but even after intensive therapy and reanimation occurred death of parturient woman with picture of disseminate intravascular coagulopathia (DIK). On autopsy and on histology there was no sign of malignant disease, so it was not possible to connect previous choricarcinoma with amniotic fluid embolism. Maybe was place of choriocarcinoma "locus minoris resistentiae" which later resulted with failure in placentation what was hard to prove. On autopsy we found embolia of lung with a microthrombosis of terminal circulation with punctiformis bleeding in mucous, what stands for DIK.

  5. Inferior oblique muscle paresis as a sign of myasthenia gravis.

    Science.gov (United States)

    Almog, Yehoshua; Ben-David, Merav; Nemet, Arie Y

    2016-03-01

    Myasthenia gravis may affect any of the six extra-ocular muscles, masquerading as any type of ocular motor pathology. The frequency of involvement of each muscle is not well established in the medical literature. This study was designed to determine whether a specific muscle or combination of muscles tends to be predominantly affected. This retrospective review included 30 patients with a clinical diagnosis of myasthenia gravis who had extra-ocular muscle involvement with diplopia at presentation. The diagnosis was confirmed by at least one of the following tests: Tensilon test, acetylcholine receptor antibodies, thymoma on chest CT scan, or suggestive electromyography. Frequency of involvement of each muscle in this cohort was inferior oblique 19 (63.3%), lateral rectus nine (30%), superior rectus four (13.3%), inferior rectus six (20%), medial rectus four (13.3%), and superior oblique three (10%). The inferior oblique was involved more often than any other muscle (pmyasthenia gravis can be difficult, because the disease may mimic every pupil-sparing pattern of ocular misalignment. In addition diplopia caused by paresis of the inferior oblique muscle is rarely encountered (other than as a part of oculomotor nerve palsy). Hence, when a patient presents with vertical diplopia resulting from an isolated inferior oblique palsy, myasthenic etiology should be highly suspected. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Utricular paresis and semicircular canal hyperactivity: a distinct otolith syndrome.

    Science.gov (United States)

    Angeli, Simon I; Snapp, Hillary; Velandia, Sandra; Morgenstein, Kari

    2015-04-01

    Although combined utricular and canal paresis has been described previously, this is the first report of canal hyperactivity associated with utricular hypofunction. Unsteadiness and swaying were the most common symptoms, and patients with shorter duration of symptoms also had positional vertigo. We propose that this syndrome is a variant of utricular dysfunction and should be considered in the differential diagnosis of peripheral vestibular disorders. To describe a syndrome of instability associated with utricular dysfunction and hyperactive caloric responses. The study comprised 11 consecutive patients exhibiting abnormalities of the eccentric subjective visual vertical test (e-SVV) and high responses during the caloric test of the videonystagmography (VNG). We carried out a review of symptoms, physical examination, and vestibular tests. There was no gender predilection or obvious etiology. The patients' main complaint included instability with linear symptoms (i.e., tilting, rocking, and swaying), with positional vertigo as a secondary symptom. Oculomotor testing, visual fixation index, and brain MRI were normal, excluding a central nervous system disorder. VNG was essentially normal except for hyperactive responses during the caloric testing in all patients. Abnormal e-SVV was found in 10 patients unilaterally and bilaterally in 1 patient. Abnormal oVEMP was found in seven of seven patients, further supporting a utricular site of lesion.

  7. Phenotypical characteristics of group B streptococcus in parturients

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    Jose Antonio Simoes

    Full Text Available Colonization by Group B Streptococcus (GBS is highly prevalent among pregnant women, with prevalence rates ranging between 4% and 30%. The infection may be transmitted vertically and may result in serious neonatal consequences. In the period from November 2003 to May 2004, a cross-sectional study was carried out among 316 parturients at the Jundiaí Teaching Hospital to establish the prevalence of genital GBS colonization, to identify the factors associated with colonization and the characteristic phenotypes of these streptococci. Samples from rectal and vaginal areas were collected for selective culture in Todd-Hewitt broth. Susceptibility to 7 antimicrobial agents was tested using the antibiotic diffusion disk technique, and the isolated strains were classified using specific antisera. The prevalence of GBS colonization was 14.6%. No strain was resistant to penicillin, ampicillin, erythromycin or nitrofurantoin. The majority of strains were sensitive to cephalothin. Greatest resistance was to gentamicin (76.1%, followed by clindamycin (17.4%. The most frequent serotype was Ib (23.9%, followed by serotypes II and Ia (19.6% and 17.4%, respectively. There was no correlation between serotype and greater antimicrobial resistance. In conclusion, the prevalence of GBS in parturients was high and penicillin continues to be the drug of choice for intrapartum prophylaxis. The most frequent serotype (Ib found in this study differs from those found in the majority of studies carried out in other countries, revealing the need to identify prevalent serotypes in each region so that specific vaccines can be designed.

  8. Labor analgesia in parturients of fetal growth restriction having raised umbilical Doppler vascular indices

    Directory of Open Access Journals (Sweden)

    Sukhen Samanta

    2018-01-01

    Conclusions: Continuous epidural ropivacaine causes improved fetoplacental circulation in parturients with growth-restricted fetuses having raised Doppler indices during labor analgesia. We also found better neonatal outcome with continuous infusion of epidural ropivacaine as compared to IM tramadol.

  9. Difficult intubation in a parturient with syringomyelia and Arnold–Chiari malformation: Use of Airtraq™ laryngoscope

    Science.gov (United States)

    Mustapha, Bensghir; Chkoura, K.; Elhassani, M.; Ahtil, R.; Azendour, H.; Kamili, N. Drissi

    2011-01-01

    Anesthetic technique in parturient with syringomyelia and Arnold–Chiari malformation is variable depending on the teams. Difficult intubation is one of the risks when general anesthesia is opted. Different devices have been used to manage the difficult intubation in pregnant women. We report the use of Airtraq™ laryngoscope after failed standard laryngoscopy in a parturient with syringomyelia and Arnold–Chiari type I malformation. PMID:22144932

  10. Difficult intubation in a parturient with syringomyelia and Arnold-Chiari malformation: Use of Airtraq™ laryngoscope

    Directory of Open Access Journals (Sweden)

    Bensghir Mustapha

    2011-01-01

    Full Text Available Anesthetic technique in parturient with syringomyelia and Arnold-Chiari malformation is variable depending on the teams. Difficult intubation is one of the risks when general anesthesia is opted. Different devices have been used to manage the difficult intubation in pregnant women. We report the use of Airtraq™ laryngoscope after failed standard laryngoscopy in a parturient with syringomyelia and Arnold-Chiari type I malformation.

  11. Complications of cesarean delivery in the massively obese parturient.

    Science.gov (United States)

    Alanis, Mark C; Villers, Margaret S; Law, Tameeka L; Steadman, Elizabeth M; Robinson, Christopher J

    2010-09-01

    The objective of the study was to determine predictors of cesarean delivery morbidity associated with massive obesity. This was an institutional review board-approved retrospective study of massively obese women (body mass index, > or = 50 kg/m(2)) undergoing cesarean delivery. Bivariable and multivariable analyses were used to assess the strength of association between wound complication and various predictors. Fifty-eight of 194 patients (30%) had a wound complication. Most (90%) were wound disruptions, and 86% were diagnosed after hospital discharge (median postoperative day, 8.5; interquartile range, 6-12). Subcutaneous drains and smoking, but not labor or ruptured membranes, were independently associated with wound complication after controlling for various confounders. Vertical abdominal incisions were associated with increased operative time, blood loss, and vertical hysterotomy. Women with a body mass index > or = 50 kg/m(2) have a much greater risk for cesarean wound complications than previously reported. Avoidance of subcutaneous drains and increased use of transverse abdominal wall incisions should be considered in massively obese parturients to reduce operative morbidity. Published by Mosby, Inc.

  12. Interrater Reliability in Analysis of Laryngoscopic Features for Unilateral Vocal Fold Paresis.

    Science.gov (United States)

    Isseroff, Tova F; Parasher, Arjun K; Richards, Amanda; Sivak, Mark; Woo, Peak

    2016-11-01

    The diagnosis of paresis in patients with vocal fold motion impairment remains a challenge. In particular, laryngoscopy examination may result in significant disagreement in diagnosis among providers. We hypothesize that systematically evaluating for a standard set of clinical parameters will increase the diagnostic concordance among providers. Prospective case series conducted at a Tertiary referral Laryngology office. Two laryngologists (rater 1) and two trainees (rater 2) rated laryngoscopy findings in 19 patients suspected of paresis. The diagnosis was confirmed with laryngeal electromyogram. A standard set of 27 ratings was used for each examination that included movement, laryngeal configuration, and stroboscopy signs. A kappa coefficient was calculated for agreement in laryngoscopy findings and effectiveness in predicting the laterality of paresis. A substantial agreement (kappa coefficient > 0.61) existed between the raters for vocal fold length, vocal fold thickness, bowing, and reduction in movement. A moderate agreement (kappa coefficient > 0.41) existed between raters for piriform opening and reduced kinesis. The senior author was accurately able to diagnose the side of paresis in 89.5% of cases for a kappa coefficient of 0.78, whereas the trainees correctly predicted the side of paresis in 63.1% for a kappa coefficient of 0.35. The raters agreed on the diagnosis in 73.7% of cases for a kappa coefficient of 0.50. Using a standard set of laryngoscopy findings may improve the provider's ability to identify the laterality of vocal fold paresis and increase interrater reliability compared with other series. Copyright © 2016 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  13. Natural history of idiopathic abducens nerve paresis in a young adult.

    Science.gov (United States)

    Hussaindeen, Jameel Rizwana; Mani, Revathy; Rakshit, Archayeeta; Ramasubramanian, Srikanth; Vittal Praveen, Smitha

    2016-01-01

    The natural history of idiopathic abducens nerve paresis and the role of conservative management such as vision training during the recovery process is not well documented in the literature to the best of our knowledge. This case report presents the natural recovery process of idiopathic abducens nerve paresis in a young adult and the role of vision therapy in the recovery process. Copyright © 2016 Spanish General Council of Optometry. Published by Elsevier España, S.L.U. All rights reserved.

  14. Evaluating Midwives Communication Skills from the Perspective of Parturient Women Attending to Hospitals for Delivery

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    Maryam Sadat Katebi

    2017-04-01

    Full Text Available Background & aim: Communication is a fundamental human need. Medical students and healthcare professionals must be attuned to the needs of patients using effective communication skills. With regards to medical training, currently the focus is on theoretical matters and communication skills are taken for granted. This problem has caused miscommunication with patients referred to teaching hospitals. We conducted this study to assess communication skills of midwives from the perspective of parturient women. Methods: In this descriptive study, we evaluated 50 midwives working in maternity wards of Ghaem, Imam Reza, Omolbanin, and Hasheminejad hospitals in Mashhad, Iran. Three parturient women were selected per one midwife in a maternity ward. The parturient women participating in this study were in labor, delivery, admission or postpartum stages and completed the Interpersonal Communication Skills inventory by interview. To analyze the data, descriptive statistics, t-test, ANOVA, and Pearson product-moment correlation were performed, using SPSS 16. Results: The mean scores of communication behaviors of midwives with parturient in delivery, admission, and postpartum stages were 92.61±10.81, 93.31±10.59, and 94.19±8.26, respectively. Between the previous delivery of parturient, with communication behavior of midwives in the stage of admiss­ion or post-partum (P=0.015 and satisfaction of pregnancy with communication behavior of midwife in labor stage (P

  15. Temporary hindlimb paresis following dystocia due to foetal macrosomia in a Celebes crested macaque (Macaca nigra).

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    Debenham, John James; Bettembourg, Vanessa; Østevik, Liv; Modig, Michaela; Jâderlund, Karin Hultin; Lervik, Andreas

    2017-04-01

    A multiparous Celebes crested macaque presented with dystocia due to foetal macrosomia, causing foetal mortality and hindlimb paresis. After emergency caesarean section, recovery of motor function took 1 month before hindlimbs were weight bearing and 2 months before re-integration with the troop. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  16. An Unusual Case of Neuralgic Amyotrophy Presenting with Bilateral Phrenic Nerve and Vocal Cord Paresis

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    F. Holtbernd

    2011-02-01

    Full Text Available Background: Neuralgic amyotrophy (brachial plexus neuropathy, brachial plexus neuritis, or Parsonage-Turner syndrome is an uncommon inflammatory condition typically characterized by acute and severe shoulder pain followed by paresis with muscle weakness and atrophy of the upper limb or shoulder girdle. We report an unusual clinical manifestation of neuralgic amyotrophy, namely bilateral phrenic nerve palsy with concomitant laryngeal paresis. Case Report: A 55-year-old male presented with orthopnea and aphonia after an episode of bilateral shoulder pain preceded by an upper respiratory tract infection. Spirometry, chest X-ray and videolaryngoscopy revealed bilateral and simultaneous paresis of the diaphragm and the vocal cords. Clinical examination at admission and at the 2-month follow-up did not show upper limb weakness or atrophy, except for a mild atrophy of the right supraspinatus muscle. An electromyography of the upper limb muscles and nerve conduction studies did not reveal signs of denervation. Analysis of the cerebrospinal fluid and an MRI of the neuraxis were unremarkable. After treatment with prednisolone, vocal cord function markedly improved within 8 weeks, whereas paresis of the diaphragm persisted. Conclusion: Shoulder pain followed by diaphragmatic paralysis with dyspnea and hoarseness may be a manifestation of neuralgic amyotrophy even if upper limb or shoulder girdle palsies are absent.

  17. Bell’s Palsy: Symptoms Preceding and Accompanying the Facial Paresis

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    Daniele De Seta

    2014-01-01

    Full Text Available This individual prospective cohort study aims to report and analyze the symptoms preceding and accompanying the facial paresis in Bell’s palsy (BP. Two hundred sixty-nine patients affected by BP with a maximum delay of 48 hours from the onset were enrolled in the study. The evolution of the facial paresis expressed as House-Brackmann grade in the first 10 days and its correlation with symptoms were analyzed. At the onset, 136 patients presented postauricular pain, 114 were affected by dry eye, and 94 reported dysgeusia. Dry mouth was present in 54 patients (19.7%, facial pain, hyperlacrimation, aural fullness, and hyperacusis represented a smaller percentage of the reported symptoms. After 10 days, 39.9% of the group had a severe paresis while 10.2% reached a complete recovery. Dry mouth at the onset was correlated with severe grade of palsy and was prognostic for poor recovery in the early period. These outcomes lead to the deduction that the nervus intermedius plays an important role in the presentation of the BP and it might be responsible for most of the accompanying symptomatology of the paresis. Our findings could be of important interest to early address a BP patient to further examinations and subsequent therapy.

  18. [Left lateral gaze paresis due to subcortical hematoma in the right precentral gyrus].

    Science.gov (United States)

    Sato, K; Takamori, M

    1998-03-01

    We report a case of transient left lateral gaze paresis due to a hemorrhagic lesion restricted in the right precentral gyrus. A 74-year-old female experienced a sudden clumsiness of the left upper extremity. A neurological examination revealed a left central facial paresis, distal dominant muscle weakness in the left upper limb and left lateral gaze paresis. There were no other focal neurological signs. Laboratory data were all normal. Brain CTs and MRIs demonstrated a subcortical hematoma in the right precentral gyrus. The neurological symptoms and signs disappeared over seven days. A recent physiological study suggested that the human frontal eye field (FEF) is located in the posterior part of the middle frontal gyrus (Brodmann's area 8) and the precentral gyrus around the precentral sulcus. More recent studies stressed the role of the precentral sulcus and the precentral gyrus. Our case supports those physiological findings. The hematoma affected both the FEF and its underlying white matter in our case. We assume the lateral gaze paresis is attributable to the disruption of the fibers from the FEF. It is likely that fibers for motor control of the face, upper extremity, and lateral gaze lie adjacently in the subcortical area.

  19. Risks of postoperative paresis in motor eloquently and non-eloquently located brain metastases

    International Nuclear Information System (INIS)

    Obermueller, Thomas; Schaeffner, Michael; Gerhardt, Julia; Meyer, Bernhard; Ringel, Florian; Krieg, Sandro M

    2014-01-01

    When treating cerebral metastases all involved multidisciplinary oncological specialists have to cooperate closely to provide the best care for these patients. For the resection of brain metastasis several studies reported a considerable risk of new postoperative paresis. Pre- and perioperative chemotherapy (Ctx) or radiotherapy (Rtx) alter vasculature and adjacent fiber tracts on the one hand, and many patients already present with paresis prior to surgery on the other hand. As such factors were repeatedly considered risk factors for perioperative complications, we designed this study to also identify risk factors for brain metastases resection. Between 2006 and 2011, we resected 206 brain metastases consecutively, 56 in eloquent motor areas and 150 in non-eloquent ones. We evaluated the influences of preoperative paresis, previous Rtx or Ctx as well as recursive partitioning analysis (RPA) class on postoperative outcome. In general, 8.7% of all patients postoperatively developed a new permanent paresis. In contrast to preoperative Ctx, previous Rtx as a single or combined treatment strategy was a significant risk factor for postoperative motor weakness. This risk was even increased in perirolandic and rolandic lesions. Our data show significantly increased risk of new deficits for patients assigned to RPA class 3. Even in non-eloquently located brain metastases the risk of new postoperative paresis has not to be underestimated. Despite the microsurgical approach, our cohort shows a high rate of unexpected residual tumors in postoperative MRI, which supports recent data on brain metastases’ infiltrative nature but might also be the result of our strict study protocol. Surgical resection is a safe treatment of brain metastases. However, preoperative Rtx and RPA score 3 have to be taken into account when surgical resection is considered

  20. The presentation and pregnancy outcome among teenage parturients in state specialist hospital, Asubiaro, Osogbo, Southwestern, Nigeria

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    Olalekan Olugbenga Awolola

    2018-01-01

    Full Text Available Background: Teenage pregnancies are pregnancies between the age group of 13 and 19 years. Such pregnancies are categorized as high-risk pregnancies worldwide. This makes monitoring during the antenatal, intrapartum, and puerperal periods highly important. Objectives: The aim of this study is to determine the incidence, the mode of presentation, and the materno-fetal outcome in teenage parturients and compare with a control group. Materials and Methods: this prospective case–control study, recruited 63 teenage parturients who presented in labor ward in active phase labour between February 2013 and January 2015. These teenage parturients were matched with a control group in terms of parity and cervical dilatation of not less than or more than 1 cm (+1 cm, but are of age, 22–30 years. Thus, a total number of 126 parturients were studied. The mothers and their babies were followed up until the first 7th day postpartum. Results: In this study, 39 (61.90% and 24 (38.10% were married and unmarried, respectively, among the teenage parturients, whereas 60 (95.24% and 3 (4.7% were married and unmarried among the control group. Majority of the teenage parturients, 57 (90.47% had only primary and secondary education, while 59 (93.47% among the controls had secondary and tertiary levels of education. There were statistically significant differences in the incidences of genital lacerations (9 [14.28%] and 2 [3.18%]: P < 0.05, and the incidences of anemia in pregnancy (9 [14.28%] vs. 2 [3.18%]: P < 0.05 in the teenage and the older parturients. The other outcome measures in the two groups were similar. Conclusion: This study showed that teenage pregnancies with good antenatal, intrapartum, and neonatal care, gives almost the same materno-fetal outcomes as the control group. The determining factors for poor maternal and fetal outcomes are poor socioeconomic status and lack or poor quality of antenatal, intrapartum, and puerperal care.

  1. Partial Recurrent Laryngeal Nerve Paralysis or Paresis? In Search for the Accurate Diagnosis

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    Alexander Delides

    2015-01-01

    Full Text Available “Partial paralysis” of the larynx is a term often used to describe a hypomobile vocal fold as is the term “paresis.” We present a case of a dysphonic patient with a mobility disorder of the vocal fold, for whom idiopathic “partial paralysis” was the diagnosis made after laryngeal electromyography, and discuss a proposition for a different implementation of the term.

  2. Effects of roads on the vertebrates diversity of the Indigenous Territory Paresi and its surrounding.

    Science.gov (United States)

    Brum, T R; Santos-Filho, M; Canale, G R; Ignácio, A R A

    2018-02-01

    Roadkill impact is still underestimated due to the lack of knowledge of its intensity and effect on animal populations. To assess differences between animal roadkills on roads in distinct landscapes, this study recorded meso- and megavertebrate roadkills along 50 km during a year in two highways in the transitional area of Amazonia/Cerrado in Tangará da Serra, Mato Grosso: MT-358 and MT-235, the latter crossing the Paresi Indigenous Land. We assessed roadkill rates and points with higher rates of roadkills, recording the most impacted species, seasonal effects, biomass loss, activity period of species, and traffic volume. We recorded 178 roadkills in 4,950 km travelled, a rate of 0.035 animal/km-travelled. Mammals were the most impacted with 135 roadkills (75.8%), followed by reptiles (6.2%), amphibians (5.6%) and birds (5.1%). Among mammals 51.1% were Carnivora, and the most impacted species was Cerdocyon thous (n = 42). On highway MT-358 (human-modified landscape), we recorded 155 roadkilled mammals, and the most impacted were C. thous (23.9%) and Euphractus sexcinctus (13.5%). Whilst on highway MT-235 (Paresi Indigenous Land), we recorded 23 roadkilled mammals, and the most impacted were Myrmecophaga tridactyla (26.1%) and C. thous (21.7%). The low roadkill rate in the Paresi Indigenous Land might be related to the presence of fauna pathways along the highway and the availability of a forested landscape.

  3. Effects of roads on the vertebrates diversity of the Indigenous Territory Paresi and its surrounding

    Directory of Open Access Journals (Sweden)

    T. R. Brum

    2017-06-01

    Full Text Available Abstract Roadkill impact is still underestimated due to the lack of knowledge of its intensity and effect on animal populations. To assess differences between animal roadkills on roads in distinct landscapes, this study recorded meso- and megavertebrate roadkills along 50 km during a year in two highways in the transitional area of Amazonia/Cerrado in Tangará da Serra, Mato Grosso: MT-358 and MT-235, the latter crossing the Paresi Indigenous Land. We assessed roadkill rates and points with higher rates of roadkills, recording the most impacted species, seasonal effects, biomass loss, activity period of species, and traffic volume. We recorded 178 roadkills in 4,950 km travelled, a rate of 0.035 animal/km-travelled. Mammals were the most impacted with 135 roadkills (75.8%, followed by reptiles (6.2%, amphibians (5.6% and birds (5.1%. Among mammals 51.1% were Carnivora, and the most impacted species was Cerdocyon thous (n = 42. On highway MT-358 (human-modified landscape, we recorded 155 roadkilled mammals, and the most impacted were C. thous (23.9% and Euphractus sexcinctus (13.5%. Whilst on highway MT-235 (Paresi Indigenous Land, we recorded 23 roadkilled mammals, and the most impacted were Myrmecophaga tridactyla (26.1% and C. thous (21.7%. The low roadkill rate in the Paresi Indigenous Land might be related to the presence of fauna pathways along the highway and the availability of a forested landscape.

  4. Awake craniotomy for brain lesions within and near the primary motor area: A retrospective analysis of factors associated with worsened paresis in 102 consecutive patients

    Science.gov (United States)

    Shinoura, Nobusada; Midorikawa, Akira; Yamada, Ryoji; Hana, Taijun; Saito, Akira; Hiromitsu, Kentaro; Itoi, Chisato; Saito, Syoko; Yagi, Kazuo

    2013-01-01

    Background: We analyzed factors associated with worsened paresis in a large series of patients with brain lesions located within or near the primary motor area (M1) to establish protocols for safe, awake craniotomy of eloquent lesions. Methods: We studied patients with brain lesions involving M1, the premotor area (PMA) and the primary sensory area (S1), who underwent awake craniotomy (n = 102). In addition to evaluating paresis before, during, and one month after surgery, the following parameters were analyzed: Intraoperative complications; success or failure of awake surgery; tumor type (A or B), tumor location, tumor histology, tumor size, and completeness of resection. Results: Worsened paresis at one month of follow-up was significantly associated with failure of awake surgery, intraoperative complications and worsened paresis immediately after surgery, which in turn was significantly associated with intraoperative worsening of paresis. Intraoperative worsening of paresis was significantly related to preoperative paresis, type A tumor (motor tract running in close proximity to and compressed by the tumor), tumor location within or including M1 and partial removal (PR) of the tumor. Conclusions: Successful awake surgery and prevention of deterioration of paresis immediately after surgery without intraoperative complications may help prevent worsening of paresis at one month. Factors associated with intraoperative worsening of paresis were preoperative motor deficit, type A and tumor location in M1, possibly leading to PR of the tumor. PMID:24381792

  5. Risk of Epidural Hematoma after Neuraxial Techniques in Thrombocytopenic Parturients : A Report from the Multicenter Perioperative Outcomes Group

    NARCIS (Netherlands)

    Lee, Linden O.; Bateman, Brian T.; Kheterpal, Sachin; Klumpner, Thomas T.; Housey, Michelle; Aziz, Michael F.; Hand, Karen W.; MacEachern, Mark; Goodier, Christopher G.; Bernstein, Jeffrey; Bauer, Melissa E.; Lirk, Philip; Wilczak, Janet; Soto, Roy; Tom, Simon; Cuff, Germaine; Biggs, Daniel A.; Coffman, Traci; Saager, Leif; Levy, Warren J.; Godbold, Michael; Pace, Nathan L.; Wethington, Kevin L.; Paganelli, William C.; Durieux, Marcel E.; Domino, Karen B.; Nair, Bala; Ehrenfeld, Jesse M.; Wanderer, Jonathan P.; Schonberger, Robert B.; Berris, Joshua; Lins, Steven; Coles, Peter; Cummings, Kenneth C.; Maheshwari, Kamal; Berman, Mitchell F.; Wedeven, Christopher; LaGorio, John; Fleishut, Peter M.; Ellis, Terri A.; Molina, Susan; Carl, Curtis; Kadry, Bassam; van Klei, Wilton A A; Pasma, Wietze; Jameson, Leslie C.; Helsten, Daniel L.; Avidan, Michael S.

    BACKGROUND:: Thrombocytopenia has been considered a relative or even absolute contraindication to neuraxial techniques due to the risk of epidural hematoma. There is limited literature to estimate the risk of epidural hematoma in thrombocytopenic parturients. The authors reviewed a large

  6. A dor e o protagonismo da mulher na parturição

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    Raquel da Rocha Pereira

    2011-06-01

    Full Text Available JUSTIFICATIVA E OBJETIVO: Compreender pela teoria das representações sociais, as dimensões socioculturais da dor e seu impacto no protagonismo da mulher na parturição. MÉTODO: Para a investigação, utilizou-se a metodologia qualitativa, com o referencial teórico da fenomenologia e da teoria da representação social. Foram realizadas 45 entrevistas semiestruturadas com gestantes dos serviços público e privado de saúde de Joinville, SC, com no mínimo quatro consultas de pré-natal e que estavam no terceiro trimestre de gestação. RESULTADOS: Da análise de conteúdo das falas, emergiram três categorias empíricas: medos e preocupações, vivências e influência sociocultural, as quais possibilitaram construir três categorias interpretativas: modelo biomédico, desinformação e papel da mulher na decisão pela via de parto. Os achados relatados neste artigo evidenciam a dor como um dos elementos construtores das representações sociais feminina sobre a parturição. Observou-se que a dor influencia o comportamento da gestante a partir do medo e se torna a gênese de outros sentimentos aversivos e preocupações que envolvem o evento da parturição. CONCLUSÃO: Nesse contexto, a dor revela-se como um dos principais construtores das atuais representações sociais femininas sobre a parturição e contribui para a curva ascendente nos índices de cesárea no Brasil.

  7. Anesthetic management for Cesarean delivery in parturients with a diagnosis of dwarfism.

    Science.gov (United States)

    Lange, Elizabeth M S; Toledo, Paloma; Stariha, Jillian; Nixon, Heather C

    2016-08-01

    The literature on the anesthetic management of parturients with dwarfism is sparse and limited to isolated case reports. Pregnancy complications associated with dwarfism include an increased risk of respiratory compromise, an increased risk of Cesarean delivery, and an unpredictable degree of anesthesia with neuraxial techniques. Therefore, we conducted this retrospective review to evaluate the anesthetic management of parturients with a diagnosis of dwarfism. We used a query of billing data to identify short statured women who underwent a Cesarean delivery during May 1, 2008 to May 1, 2013. We then hand searched the electronic medical record for qualifying patients with heights diagnosis of dwarfism. The extracted data included patient demographics and obstetric and anesthetic information. We identified 13 women with dwarfism who had 15 Cesarean deliveries in total. Twelve of the women had disproportionate dwarfism, and ten of the 15 Cesarean deliveries were due to cephalopelvic disproportion. Neuraxial anesthesia was attempted in 93% of deliveries. The dose chosen for initiation of neuraxial anesthesia was lower than the typical doses used in parturients of normal stature. Neuraxial anesthetic complications included difficult neuraxial placement (64%), high spinal (7%), inadequate surgical level (13%), and unrecognized intrathecal catheter (7%). The data collected suggest that females with a diagnosis of dwarfism may have difficult neuraxial placement and potentially require lower dosages of local anesthetic for both spinal and epidural anesthesia to achieve adequate surgical blockade.

  8. Outcome of medial hamstring lengthening in children with spastic paresis: A biomechanical and morphological observational study.

    Science.gov (United States)

    Haberfehlner, Helga; Jaspers, Richard T; Rutz, Erich; Harlaar, Jaap; van der Sluijs, Johannes A; Witbreuk, Melinda M; van Hutten, Kim; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Becher, Jules G; Maas, Huub; Buizer, Annemieke I

    2018-01-01

    To improve gait in children with spastic paresis due to cerebral palsy or hereditary spastic paresis, the semitendinosus muscle is frequently lengthened amongst other medial hamstring muscles by orthopaedic surgery. Side effects on gait due to weakening of the hamstring muscles and overcorrections have been reported. How these side effects relate to semitendinosus morphology is unknown. This study assessed the effects of bilateral medial hamstring lengthening as part of single-event multilevel surgery (SEMLS) on (1) knee joint mechanics (2) semitendinosus muscle morphology and (3) gait kinematics. All variables were assessed for the right side only. Six children with spastic paresis selected for surgery to counteract limited knee range of motion were measured before and about a year after surgery. After surgery, in most subjects popliteal angle decreased and knee moment-angle curves were shifted towards a more extended knee joint, semitendinosus muscle belly length was approximately 30% decreased, while at all assessed knee angles tendon length was increased by about 80%. In the majority of children muscle volume of the semitendinosus muscle decreased substantially suggesting a reduction of physiological cross-sectional area. Gait kinematics showed more knee extension during stance (mean change ± standard deviation: 34±13°), but also increased pelvic anterior tilt (mean change ± standard deviation: 23±5°). In most subjects, surgical lengthening of semitendinosus tendon contributed to more extended knee joint angle during static measurements as well as during gait, whereas extensibility of semitendinosus muscle belly was decreased. Post-surgical treatment to maintain muscle belly length and physiological cross-sectional area may improve treatment outcome of medial hamstring lengthening.

  9. As classes verbais da língua Paresi (Aruák

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    Ana Paula Barros Brandão

    Full Text Available Resumo O objetivo deste artigo é descrever as classes de verbos em Paresi, uma língua Aruák, falada por aproximadamente 3.000 pessoas no estado do Mato Grosso, Brasil. Em Paresi, os verbos são classificados como intransitivos, transitivos e bitransitivos. Em geral, verbos intransitivos em línguas Aruák são subclassificados em intransitivos ativos e intransitivos estativos. A divisão no grupo de intransitivos é morfologicamente marcada, já que sujeitos de intransitivos estativos e objetos de transitivos são marcados da mesma forma, enquanto os sujeitos de transitivos recebem uma forma diferente. A maioria das línguas Aruák exibem alinhamento semântico, isto é, a seleção da marcação de concordância depende do parâmetro de eventividade. Em Paresi, a divisão nos intransitivos é morfologicamente marcada da seguinte forma: a alguns intransitivos recebem a mesma marca de sujeito do que os transitivos (proclíticos do grupo A; b outros intransitivos recebem uma marcação diferente (proclíticos do grupo B. Semanticamente, os verbos são classificados em agentivos e não agentivos. Os traços semânticos de [agentividade] e de [controle] têm um papel fundamental na assignação dos verbos a subclasses. Os dados foram coletados durante pesquisa de campo e a análise tem por base uma abordagem funcionalista-tipológica.

  10. Ipsilateral hemiparesis and contralateral lower limb paresis caused by anterior cerebral artery territory infarct.

    Science.gov (United States)

    Xu, Yongfeng; Liu, Lan

    2016-07-01

    Ipsilateral hemiparesis is rare after a supratentorial stroke, and the role of reorganization in the motor areas of unaffected hemisphere is important for the rehabilitation of the stroke patients. In this study, we present a patient who had a subclinical remote infarct in the right pons developed ipsilateral hemiparesis and contralateral lower limb paresis caused by a new infarct in the left anterior cerebral artery territory. Our case suggests that the motor areas of the unaffected hemisphere might be reorganized after stroke, which is important for the rehabilitation of stroke patients.

  11. General paresis

    Science.gov (United States)

    ... detect syphilis in the body include: CSF-VDRL FTA-ABS Tests of the nervous system may include: ... DO, FACP, Attending Neurologist and Assistant Professor of Clinical Neurology, SUNY Stony Brook, School of Medicine, Stony ...

  12. Perceived vocal fatigue and effort in relation to laryngeal functional measures in paresis patients.

    Science.gov (United States)

    Stager, Sheila V; Bielamowicz, Steven A

    2014-07-01

    To determine if differences in objective measures of laryngeal function can meaningfully explain different levels of self-perceptions of effort or fatigue in patients with vocal fold paresis. A retrospective chart review of 72 patients with vocal fold paresis diagnosed using laryngeal electromyography, who had either been observed (n=21), treated only by injection (n=24), or treated only by surgery (n=27). Before and after treatment/observation, patients' subjective ratings of severity of vocal effort and fatigue were assessed using the Glottal Function Index. Laryngeal function was assessed using maximum phonation time and translaryngeal flow. None of the variables demonstrated a significant linear change across time. Post hoc Tukey analyses following analysis of variance (ANOVA) found significant differences in flow among three groups, those rating symptoms of effort as no problem, moderate problem, or severe problem. Post hoc Tukey analyses following ANOVA found significant differences in the amount that flow changed among three groups, those demonstrating no difference, minor differences, or major differences in ratings of effort before and after treatment. Changes in reported symptom severity of effort were related to changes in translaryngeal midvowel flow that were not explained by passage of time. 4. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  13. [Electromyographic differential diagnosis in cases of abducens nerve paresis with nuclear or distal neurogenic sive myogenic origine (author's transl)].

    Science.gov (United States)

    Heuser, M

    1979-09-01

    Abducens nerve paresis may be of nuclear, of peripheral distal neurogenic origine, or is simulated by a myogenic weakness of abduction. Polygraphic emg analysis of the oculoauricularphenomenon (oap) permits a differentiation. In the emg, the oap proved to be a physiologic and constant automatic and always bilateral interaction between the hemolateral abducens nerve and both Nn. faciales with corresponding and obligatory coinnervation of the Mm. retroauricularis of the external ear. In case of medullary, nuclear or internuclear lesions, the oap is disturbed, instable, diminished or abolished, whereas in distal neurogenic or myogenic paresis, even in complete paralysis the oap is bilaterally well preserved.

  14. [Combined spinal-epidural anesthesia for cesarean section in a parturient with myotonic dystrophy].

    Science.gov (United States)

    Mori, Kosuke; Mizuno, Ju; Nagaoka, Takehiko; Harashima, Toshiya; Morita, Sigeho

    2010-08-01

    Myotonic dystrophy (MD) is a muscle disorder characterized by progressive muscle wasting and weakness, and is the most common form of muscular dystrophy that begins in adulthood, often after pregnancy. MD might be related to occurrence of malignant hyperthermia. Therefore, the cesarean section is often performed for the parturient with MD. We had an experience of combined spinal-epidural anesthesia for cesarean section in a parturient complicated with MD. A 40-year-old woman had rhabdomyolysis caused by ritodrine at 15-week gestation and was diagnosed as MD by electromyography. Her first baby died due to respiratory failure fourth day after birth. She had hatchet face, slight weakness of her lower extremities, and easy fatigability. Her manual muscle test was 5/5 at upper extremities and 4/5 at lower extremities. She underwent emergency cesarean section for premature rupture of the membrane, weak pain during labor, and obstructed labor at 33-week gestation. We placed an epidural catheter from T12/L1 and punctured arachnoid with 25 G spinal needle. We performed spinal anesthesia using 0.5% hyperbaric bupivacaine 1.5 ml and epidural anesthesia using 2% lidocaine 6 ml. Her anesthetic level reached bilaterally to T7 and operation started 18 minutes after combined spinal-epidural anesthesia. Her baby was born 23 minutes after the anesthesia. As her baby was 1/5 at Apgar score, the baby was tracheally intubated and artificially ventilated. The cesarean section was finished in 33 minutes uneventfully. She had no adverse events and was discharged on the 8th postoperative day. Later her baby was diagnosed as congenital MD by gene analysis. Combined spinal-epidural anesthesia with the amide-typed local anesthetic agents could be useful and safe for cesarean section in the parturient with MD.

  15. [Materno-fetal acid-base equilibrium evaluation in parturients submitted to ketamine anesthesia (author's transl)].

    Science.gov (United States)

    Mauad Filho, F; Meirelles, R S

    1975-01-01

    In the present work ketamine was used as anesthetic during the labor in order to evaluate the effect of this anesthetic on the binominal fetus-mother. Two groups of parturients and their fetuses, were studied: 1) The experimental group, with 22 parturients and their fetuses submitted to ketamine anesthesia during the labord, and 2) The control group, with 20 parturients and their fetuses without any analgesic treatment during the labor. In 20 cases of the experimental group the anesthetic was injected during the delivery labor and the other two just before it. It were evaluated in the mother's blood the biochemical parameters of the acid-base balance and others collateral effects of the anesthesia; on the fetus's side the same parameters also and the cardiac frequency. The newborn were evaluated by Apgar Score during the first and fifth minutes of life. The incidence of the spontaneous delivery in the experimental group, was 78%; in 22% of these patients the forceps of relief was used. In 22 cases in which Ketamine was applied it were observed, the following events: elevation of the blood pressure (50%), perineum rigidness (18%), dreams and or hallucinations (18%), increase of the cardiac frequency (9%), apneia (4%) and nausea (4%). It was also observed an increase of uterine tonus an abolishment of abdominal press during the delivery labor, studied through the uterine electromyography register. It was noted after the Ketamine application a fall in the pH of the maternal peripherical venous blood, fetal skull blood and the pH of the blood of the umbilical vein. 22% of the newborns, from the experimental group, presented a depression in the first minute of life (Apgar less than or equals to 6). The pCO2 values in the blood of the umbilical artery were higher in the experimental group than in the control one.

  16. Basal transethmoidal encephalocele and malignant hypertension in a parturient with a seizure disorder. A case report.

    Science.gov (United States)

    Yee, Lynn M; Kacmar, Rachel M; Bolden, Janelle R

    2015-01-01

    Nasal encephaloceles are uncommon in North America and may be diagnosed only as incidental findings. The presence of an encephalocele and malignant hypertension in the parturient requires complex coordination of care. We present a case of severe chronic hypertension in a pregnant patient with a seizure disorder and new finding of a basal transethmoidal encephalocele. She required 5 antihypertensive agents and cesarean delivery at 34 weeks' gestation under general anesthesia. The obstetric and anesthetic management of encephalocele are reviewed. Nasal encephaloceles are rarely reported in pregnancy and present additional peripartum obstetric and anesthetic considerations that require multidisciplinary planning for optimization of maternal and fetal outcomes.

  17. Anesthetic management for cesarean delivery of a parturient with impetigo herpetiformis.

    Science.gov (United States)

    Duffield, Adrienne T; Smith, Kathleen A

    2013-10-01

    Impetigo herpetiformis (IH), or generalized pustular psoriasis of pregnancy, is an exceedingly rare, generalized pustular skin eruption occurring during pregnancy associated with hypovolemia, sepsis, hypocalcemia, and airway edema. Fetal outcomes are generally poor, and parturients with IH may present with emergent indications for cesarean delivery due to placental insufficiency. We present a case of IH in a 19-year-old G1P0 who underwent successful general anesthesia for cesarean delivery. Her case highlights the anesthetic implications for patients afflicted with this rare disease, including perioperative pain management, airway concerns, considerations for neuraxial anesthesia, and monitoring challenges.

  18. Elective cesarean section in a parturient with post burn neck contracture: An anesthetic challenge!

    Directory of Open Access Journals (Sweden)

    Kamlesh Kumari

    2013-01-01

    Full Text Available The incidence of failed intubation in the pregnant population is 1 in 250-300 patients, which is 8 times higher than non-pregnant patients. Regional anesthesia is the technique of choice in a parturient with recognized potentially difficult airway for cesarean section; however, it may be controversial in the presence of anticipated intraoperative hemodynamic instability. We describe anesthetic management of 23-year-old female, gravida 2, para 1 admitted in the labor ward with central placenta previa and severe post burn contracture of neck for elective cesarean delivery.

  19. Emergency mitral valve replacement and cesarean section in parturients: Two case reports

    Directory of Open Access Journals (Sweden)

    P S Nagaraja

    2016-01-01

    Full Text Available Cardiac surgery during pregnancy using cardiopulmonary bypass has a maternal mortality rate (MMR of about 3-15%. Cardiopulmonary bypass, in addition, alters placental perfusion, which can increase infant mortality. Here, we report two cases of parturients with severe mitral stenosis, who developed acute mitral regurgitation (MR after percutaneous transluminal mitral commissurotomy (PTMC due to anterior mitral leaflet tear. They were posted for emergency mitral valve replacement (MVR followed by cesarean section. Altering the routine cardiopulmonary bypass and anesthesia protocol resulted in a favorable maternal and fetal outcome.

  20. Stationary facial nerve paresis after surgery for recurrent parotid pleomorphic adenoma

    DEFF Research Database (Denmark)

    Nøhr, Anders; Andreasen, Simon; Therkildsen, Marianne Hamilton

    2016-01-01

    The purpose was to assess degree of permanent facial nerve dysfunction after surgery for recurrent pleomorphic adenoma (RPA) of the parotid gland, including variables that might influence re-operation outcomes. Nationwide retrospective longitudinal cohort study including a questionnaire survey...... of patients undergoing surgery for RPA. Of 219 living patients, 198 (92 %) responded and 127 (63 %) reported no facial dysfunction. Statistically significant associations were found between number of surgeries and permanent facial nerve dysfunction of all degrees (OR 1.43, 95 % CI 1.16-1.78, p = 0.......001). A not significant tendency for females to be associated with worse outcome was found (p = 0.073). Risks of different degrees of paresis after the second-fourth surgeries were found (OR 1.86-2.19, p RPA of the parotid...

  1. Chorioamnionitis in pregnancy: a comparative study of HIV-positive and HIV-negative parturients.

    Science.gov (United States)

    Ocheke, Amaka N; Agaba, Patricia A; Imade, Godwin E; Silas, Olugbenga A; Ajetunmobi, Olanrewaju I; Echejoh, Godwins; Ekere, Clement; Sendht, Ayuba; Bitrus, James; Agaba, Emmanuel I; Sagay, Atiene S

    2016-03-01

    Chorioamnionitis is an important risk factor for vertical transmission of HIV/AIDS. We compared the prevalence and correlates of histologic chorioamnionitis (HCA) in HIV-positive and HIV-negative pregnant women. HIV-positive and -negative parturients were interviewed, examined and had their placentas examined histologically for chorioamnionitis. Data regarding HIV were also retrieved from their hospital records. A total of 298 parturients (150 HIV positive and 148 HIV negative) were enrolled. The two groups were similar in socio-demographic and obstetric parameters except for age. The prevalence of HCA was 57.1% in HIV-positive women and 61.6% in HIV-negative women (p = 0.43). HCA staging was associated with the number of intrapartum vaginal examinations in HIV-positive subjects and nulliparity in HIV-negative subjects. The number of intrapartum vaginal examinations and coitus in the week prior to delivery significantly affected the grade of HCA in HIV-negative subjects. The prevalence of HCA in both HIV-positive and HIV-negative is high. Most variables did not affect the occurrence of HCA in both groups studied except number of intrapartum examinations, coitus in the preceding one week and nulliparity, which were related to severity of the disease. © The Author(s) 2016.

  2. Ophthalmologic outcome after third cranial nerve palsy or paresis in childhood.

    Science.gov (United States)

    Mudgil, A V; Repka, M X

    1999-02-01

    The purpose of this study was to evaluate the causes and ophthalmologic outcome of oculomotor nerve palsy or paresis in children younger than 8 years of age. Patients evaluated between 1985 and 1997 were retrospectively reviewed. Data analyzed included vision, residual strabismus after surgery, aberrant reinnervation, binocular function, and anisometropia. Long-term outcome was assessed in patients followed-up longer than 6 months. Forty-one patients were identified. The most frequent causes were congenital (39%), traumatic (37%), and neoplastic (17%). Visual acuities were reduced in 71% of patients at the time of the initial visit. Long-term outcome could be assessed in 20 of the 41 patients (49%), with a mean follow-up of 3.6 years (range, 0.5 to 13 years). Visual acuities were reduced because of amblyopia in 35% and nonamblyopic factors in 25% of patients in the long-term outcome group at last follow-up. The best response to amblyopia therapy was in the congenital group, in which all patients improved to normal visual acuity. Strabismus surgery was performed on 8 of 20 children (40%) followed-up, none of whom demonstrated measurable stereopsis after operation despite improved alignment. Aberrant reinnervation was present in 9 of 20 patients (45%). Only 3 patients fully recovered from their oculomotor nerve injuries, and these were the only patients to regain measurable stereopsis. The causes in those 3 patients were congenital, traumatic, and neoplastic. Oculomotor nerve palsy/paresis is associated with poor visual and sensorimotor outcome in children younger than 8 years of age. The best ophthalmologic outcome was in the resolved cases (3 of 20; 15%). Amblyopia therapy was most effective with congenital causes, but treatment results were poor with other causes. Young children with posttraumatic and postneoplastic oculomotor nerve injuries demonstrated the worst ophthalmologic outcomes.

  3. Paresia diafragmática bilateral idiopática Idiopathic bilateral diaphragmatic paresis

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    Mônica Corso Pereira

    2006-10-01

    Full Text Available Relata-se o caso de um paciente com dispnéia intensa ao se deitar, em que foram excluídas doenças pulmonares, neuromusculares ou cardíacas, cuja investigação revelou paresia diafragmática bilateral. Um sinal chave para o diagnóstico foi a evidência de respiração paradoxal com o doente em decúbito supino. Havia piora da oxigenação e da capacidade vital forçada com a mudança da posição ortostática para supina. A fluoroscopia ortostática foi normal. A pressão inspiratória máxima estava muito reduzida. A estimulação elétrica transcutânea do diafragma foi normal, e a eletroestimulação do nervo frênico mostrou ausência de resposta, permitindo o diagnóstico de paresia bilateral do diafragma.We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical respiration in the dorsal decubitus position. When the patient was moved from the orthostatic position to the dorsal decubitus position, oxygenation and forced vital capacity worsened. The orthostatic fluoroscopy was normal. Maximal inspiratory pressure was severely reduced. The responses to transcutaneous electric stimulation of the diaphragm were normal. However, electric stimulation of the phrenic nerve produced no response, leading to the diagnosis of bilateral diaphragmatic paresis.

  4. Early hemi-diaphragmatic plication through a video assisted mini-thoracotomy in postcardiotomy phrenic nerve paresis

    Science.gov (United States)

    Tsakiridis, Kosmas; Visouli, Aikaterini N.; Machairiotis, Nikolaos; Christofis, Christos; Stylianaki, Aikaterini; Katsikogiannis, Nikolaos; Mpakas, Andreas; Courcoutsakis, Nicolaos; Zarogoulidis, Konstantinos

    2012-01-01

    New symptom onset of respiratory distress without other cause, and new hemi-diaphragmatic elevation on chest radiography postcardiotomy, are usually adequate for the diagnosis of phrenic nerve paresis. The symptom severity varies (asymptomatic state to severe respiratory failure) depending on the degree of the lesion (paresis vs. paralysis), the laterality (unilateral or bilateral), the age, and the co-morbidity (respiratory, cardiac disease, morbid obesity, etc). Surgical treatment (hemi-diaphragmatic plication) is indicated only in the presence of symptoms. The established surgical treatment is plication of the affected hemidiaphragm which is generally considered safe and effective. Several techniques and approaches are employed for diaphragmatic plication (thoracotomy, video-assisted thoracoscopic surgery, video-assisted mini-thoracotomy, laparoscopic surgery). The timing of surgery depends on the severity and the progression of symptoms. In infants and young children with postcardiotomy phrenic nerve paresis the clinical status is usually severe (failure to wean from mechanical ventilation), and early plication is indicated. Adults with postcardiotomy phrenic nerve paresis usually suffer from chronic dyspnoea, and, in the absence of respiratory distress, conservative treatment is recommended for 6 months -2 years, since improvement is often observed. Nevertheless, earlier surgical treatment may be indicated in non-resolving respiratory failure. We present early (25th day postcardiotomy) right hemi-diaphragm plication, through a video assisted mini-thoracotomy in a high risk patient with postcardiotomy phrenic nerve paresis and respiratory distress. Early surgery with minimal surgical trauma, short operative time, minimal blood loss and postoperative pain, led to fast rehabilitation and avoidance of prolonged hospitalization complications. The relevant literature is discussed. PMID:23304442

  5. Bacterial infection in deep paraspinal muscles in a parturient following epidural analgesia.

    Science.gov (United States)

    Yang, Ying-Wei; Chen, Wei-Ting; Chen, Jui-Yuan; Lee, She-Chin; Chang, Yi; Wen, Yeong-Ray

    2011-06-01

    We report a case of paraspinal muscle infection shortly after epidural analgesia for labor pain in a nulliparous parturient who was subjected to emergent Cesarean section because of fetal distress. Epidural morphine was administered for 3 days for postoperative pain control. She began to have constant lower back pain on postpartum Day 4. Magnetic resonance image study revealed a broad area of subcutaneous edema with a continuum along the catheter trajectory deep to the paraspinal muscles. An injection-related bacterial infection was suspected; the patient was treated with intravenous antibiotics and was soon cured uncomplicatedly. Epidural analgesia is effective to control labor pain and, in general, it is safe. However, the sequelae of complicated infection may be underestimated. We herein report a case complicated by iatrogenic infection, discuss the causes, and give suggestions for prevention. Copyright © 2011. Published by Elsevier B.V.

  6. Anaesthetic Management of Parturient with Acute Atrial Fibrillation for Emergency Caesarean Section

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    Madhu Gupta

    2013-01-01

    Full Text Available A 31-year-antenatal lady with critical mitral stenosis presented for emergency caesarean section with fetal distress. She had acute onset atrial fibrillation. She was given a combined spinal epidural (CSE anaesthesia and her arrhythmia was successfully managed after delivery of the baby with intravenous calcium channel blocker. Mitral stenosis is the most common valvular heart disease complicating pregnancy in developing countries. The physiological changes during pregnancy may exacerbate their cardiac symptoms. They may present with complications like congestive cardiac failure, atrial fibrillation, or pulmonary thromboembolism during the antenatal, intrapartum, or postpartum period. Here we discuss the management of parturient woman with high maternal and fetal risk presenting for emergency caesarean. The merits of regional anaesthesia and the importance of invasive monitoring are also discussed.

  7. Management of a Parturient with Mast Cell Activation Syndrome: An Anesthesiologist’s Experience

    Directory of Open Access Journals (Sweden)

    Sangeeta Kumaraswami

    2018-01-01

    Full Text Available Mast cell activation syndrome (MCAS is a disorder in which patients experience symptoms and signs attributable to inappropriate mast cell activation and mediator release. Multiorgan involvement in patients can result in significant morbidity and possible mortality. Limited literature exists regarding anesthetic management of patients with MCAS. We report a case of vaginal delivery with neuraxial labor analgesia in a parturient with this condition and highlight the importance of multidisciplinary planning for uneventful outcomes. Stress can trigger life-threatening symptoms, and counseling is important to allay patients’ fears. Optimum medical control, adequate premedication, avoidance of triggers, and preparedness to treat serious mediator effects are key. We review MCAS and discuss anesthetic considerations for patients with this mast cell disorder.

  8. Exploration of sequence alterations of the vitamin D receptor gene in regard to hypocalcemia and periparturient paresis in dairy cows

    OpenAIRE

    Reiche, Maria Agnes

    2012-01-01

    Periparturient hypocalcemia belongs to the most important mineral metabolism dysfunctions in dairy cows. The incidence of subclinical hypocalcemia in the USA is given with 25% in heifers and up to 40 to 50 % in older cows (Reinhardt et al. 2010), the incidence of clinical symptoms (downer cow syndrome) is given with 5-10% (DeGaris und Lean 2008; Goff 2008). Hence manifold prophylaxis and therapy concepts to prevent periparturient paresis are established in current practice in dairy cattle hus...

  9. Central facial paresis and its impact on mimicry, psyche and quality of life in patients after stroke.

    Science.gov (United States)

    Konecny, Petr; Elfmark, Milan; Horak, Stanislav; Pastucha, Dalibor; Krobot, Alois; Urbanek, Karel; Kanovsky, Petr

    2014-01-01

    Using functional scales and face video analysis, changes in central facial paresis are monitored in patients with stroke after orofacial therapy and correlations between changes in mimicry, mental function and overall quality of life of patients after stroke are made. A prospective randomized study of patients after stroke with facial paresis. The functional status of the experimental group of 50 cases with orofacial regulation therapy and 49 control cases without mimicry therapy is observed after four weeks of rehabilitation. Changes in mimicry functions evaluated by the House-Brackmann Grading System (HBGS) clinical range and using 2D video analysis of the distance between the paretic corner of the mouth and earlobe at rest and during smiling were statistically better in the experimental group than in controls. Changes in mental function - depression using Beck Depression Inventory and changes in the quality of life using Bartle index and modified Rankin score (scale) were significantly greater in the experimental group. There was a very close relationship between the changes in mimicry, mental state and overall quality of life according to the Spearman correlative coefficient. Orofacial rehabilitation therapy for patients with paresis after stroke has a significant influence on the adjustment of mimicry, mental functions and overall quality of life after 4 weeks of treatment.

  10. [Autopsy case of Lissauer's general paresis with rapidly progressive left hemiparesis].

    Science.gov (United States)

    Kato, Hiroko; Yoshida, Mari; Ando, Tetsuo; Sugiura, Makoto; Hashizume, Yoshio

    2009-06-01

    A 48-years-old man presented with slowly progressive bradykinesia, personality change and rapidly progressive left hemiparesis. On admission, he presented dementia, poor judgment, left hemiparesis. MRI revealed a widespread high intensity area in right hemisphere and MRA was almost normal. Serological tests of serum and CSF demonstrated high titers of antibodies to Treponema pallidum. He was treated for syphilis with daily penicillin injections without improvement. He died of sepsis eight months after admission. At autopsy, the brain weighed 1,100 g and the right cerebral hemisphere was atrophic, especially in frontal base, temporal, parietal, angular, and posterior regions covered by thickened, fibrotic leptomeninges. Microscopically, chronic meningoencephalitis was observed. Severe neuronal loss with gliosis was seen in the right cerebral cortices. Scattered rod-shaped microglia and inflammatory cell infiltration were visible in the cerebral parenchyma. The dorsal column of the spinal cord was not involved and meningovascular syphilis was unclear. The distribution of the encephalitic lesions was well correlated with the clinical and neuroradiological findings. This was a rare autopsy case presenting Lissauer's general paresis, clinically manifesting as rapidly progressive stroke-like episode.

  11. Ascending paresis as presentation of an unusual association between necrotizing autoimmune myopathy and systemic lupus erythematosus.

    Science.gov (United States)

    García-Reynoso, Marco Julio; Veramendi-Espinoza, Liz Eliana; Ruiz-Garcia, Henry Jeison

    2014-01-01

    A 45 year-old man went to the emergency room due to disease duration of 15 days of insidious onset and progressive course. It began with symmetrical weakness and pain in feet and ankles that extends upward to the knees. Later, this progressed to paraparesis with Creatine phosphokinase levels of 44,270 U/L and respiratory failure that required mechanical ventilation. Electromyography and muscle biopsy of quadriceps were made. The patient responded to corticotherapy in pulses and supporting management. The presentation of ascending paresis suggested the diagnosis of Guillain-Barré syndrome. However, the degree of muscle involvement with rhabdomyolysis explains the neurological damage by itself. The biopsy revealed pathological criteria for necrotizing autoimmune myopathy (NAM), as well as other clinical and laboratory evidence. Patient disease continued and reached criteria for systemic lupus erythematosus (SLE). To our best knowledge, this is the first report of the NAM and SLE association. Copyright © 2012 Elsevier España, S.L. All rights reserved.

  12. Comparison of Spinal Block Levels between Laboring and Nonlaboring Parturients Using Combined Spinal Epidural Technique with Intrathecal Plain Bupivacaine

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    Yu-Ying Tang

    2012-01-01

    Full Text Available Background. It was suggested that labor may influence the spread of intrathecal bupivacaine using combined spinal epidural (CSE technique. However, no previous studies investigated this proposition. We designed this study to investigate the spinal block characteristics of plain bupivacaine between nonlaboring and laboring parturients using CSE technique. Methods. Twenty-five nonlaboring (Group NL and twenty-five laboring parturients (Group L undergoing cesarean delivery were enrolled. Following identification of the epidural space at the L3-4 interspace, plain bupivacaine 10 mg was administered intrathecally using CSE technique. The level of sensory block, degree of motor block, and hemodynamic changes were assessed. Results. The baseline systolic blood pressure (SBP and the maximal decrease of SBP in Group L were significantly higher than those in Group NL (=0.002 and =0.03, resp.. The median sensory level tested by cold stimulation was T6 for Group NL and T5 for Group L (=0.46. The median sensory level tested by pinprick was T7 for both groups (=0.35. The degree of motor block was comparable between the two groups (=0.85. Conclusion. We did not detect significant differences in the sensory block levels between laboring and nonlaboring parturients using CSE technique with intrathecal plain bupivacaine.

  13. Efficacy and safety of combined spinal: Epidural versus epidural technique for labor analgesia in parturients with rheumatic valvular heart disease

    Directory of Open Access Journals (Sweden)

    Babita Ghai

    2013-01-01

    Full Text Available Background: Hemodynamic changes induced by labor pain and apprehension in addition to physiological changes may pose risk to parturients with rheumatic heart disease (RHD. Therefore, it is important to provide adequate pain relief during labor in these patients. We planned this study to compare the efficacy and safety of epidural (E versus combined spinal - epidural (CSE for labor analgesia in parturients with rheumatic valvular heart disease. Methods: Twenty-five parturients with RHD included in this study were randomized to one of the two groups - E group (n = 12, received 6 mL of 0.0625% bupivacaine with 25 μg fentanyl or CSE group (n = 13, received 25 μg of fentanyl with 1.25 mg bupivacaine diluted to 1 mL in subarachnoid space. Afterward, a continuous infusion of 0.1% bupivacaine with 2 μg/mL fentanyl was started at 6-8 mL/h. Primary outcome, analgesic efficacy, was assessed by visual analog scale (VAS for pain. VAS ≤ 3 was considered as effective analgesia. Rescue analgesia in the form of epidural bolus was given if VAS > 3. Results: Demographic characteristics of the patients were comparable. Mitral stenosis was the predominant valvular lesion. The VAS at which the parturients received analgesia was comparable. The mean time to achieve effective analgesia was significantly faster in CSE group (4.46 ± 0.87 min compared with group E (15.09 ± 5.7 min (P < 0.001. Significantly lower median pain scores were recorded until the initial 15 min in CSE group. Afterward, median VAS for pain was comparable between the groups. VAS for pain was significantly low at all time intervals than baseline in both the groups. Maternal satisfaction and incidence of cesarean rate and complication were comparable between the groups. Conclusion: Both epidural and CSE are equally effective and safe for labor analgesia in parturients with rheumatic valvular heart disease. However, CSE technique provides a faster onset of analgesia.

  14. A Randomized Controlled Trial of Music Use During Epidural Catheter Placement on Laboring Parturient Anxiety, Pain, and Satisfaction.

    Science.gov (United States)

    Drzymalski, Dan M; Tsen, Lawrence C; Palanisamy, Arvind; Zhou, Jie; Huang, Chuan-Chin; Kodali, Bhavani S

    2017-02-01

    Although music is frequently used to promote a relaxing environment during labor and delivery, the effect of its use during the placement of neuraxial techniques is unknown. Our study sought to determine the effects of music use on laboring parturients during epidural catheter placement, with the hypothesis that music use would result in lower anxiety, lower pain, and greater patient satisfaction. We conducted a prospective, randomized, controlled trial of laboring parturients undergoing epidural catheter placement with or without music. The music group listened to the patient's preferred music on a Pandora® station broadcast through an external amplified speaker; the control group listened to no music. All women received a standardized epidural technique and local anesthetic dose. The primary outcomes were 3 measures of anxiety. Secondary outcomes included pain, patient satisfaction, hemodynamic parameters, obstetric parameters, neonatal outcomes, and anesthesia provider anxiety. Intention-to-treat analysis with Bonferroni correction was used for the primary outcomes. For secondary outcomes, a P value of music group, the duration of music use was 31.1 ± 7.7 minutes (mean ± SD). The music group experienced higher anxiety as measured by Numeric Rating Scale scores immediately after epidural catheter placement (2.9 ± 3.3 vs 1.4 ± 1.7, mean difference 1.5 [95% confidence interval {CI} 0.2-2.7], P = .02), and as measured by fewer parturients being "very much relaxed" 1 hour after epidural catheter placement (51% vs 78%, odds ratio {OR} 0.3 [95% CI 0.1-0.9], P = .02). No differences in mean pain scores immediately after placement or patient satisfaction with the overall epidural placement experience were observed; however, the desire for music use with future epidural catheter placements was higher in the music group (84% vs 45%, OR 6.4 [95% CI 2.5-16.5], P Music use during epidural catheter placement in laboring parturients is associated with higher postprocedure

  15. A study to determine minimum effective dose of oxytocin infusion during caesarean delivery in parturients at high risk of uterine atony

    Directory of Open Access Journals (Sweden)

    Shashikiran

    2017-01-01

    Full Text Available Background: Oxytocin, a commonly used drug to prevent uterine atony after caesarean section, should be administered as dilute rapid infusion rather than as a bolus. This study was conducted to calculate ED90 of oxytocin infusion during caesarean delivery in parturients at high risk of postpartum haemorrhage (PPH. Materials and Methods: One hundred and twenty parturients having one or more risk factors for PPH received a blinded infusion of oxytocin following emergency caesarean delivery. The initial dose of oxytocin infusion was started as 0.4 IU min−1. The dose of oxytocin infusion for the next parturient was based on the response of preceding patient in increments or decrements of 0.1 IU min−1 as per a biased-coin design up-down sequential method (UDM. Measurements of non-invasive blood pressure and heart rate were taken at 2 min intervals from the time of oxytocin infusion. Intraoperative blood loss was noted. Side effects such as tachycardia, hypotension, nausea, vomiting, chest pain, headache and flushing were also recorded. Results: The ED90 of oxytocin infusion was found to be 0.405 IU min−1 (95% confidence interval 0.3864–0.4125 as calculated by Firth's penalised likelihood estimation using a biased-coin design UDM. Hypotension was observed for brief period of time in 25.6% of parturients and brief period of tachycardia was observed in 9.4% of parturients. No headache, flushing, chest pain and vomiting were observed in any parturients in our study. The estimated blood loss was within the normal limits. Conclusion: Our study showed that ED90 of oxytocin infusion required to achieve adequate uterine tone (UT after an emergency caesarean delivery in parturients at high risk of uterine atony was 0.405 IU min−1. The higher doses of oxytocin did not result in further improvement of UT. Therefore, early use of alternative uterotonic therapy is preferable to achieve adequate UT.

  16. The management of peripheral facial nerve palsy: "paresis" versus "paralysis" and sources of ambiguity in study designs.

    Science.gov (United States)

    Linder, Thomas E; Abdelkafy, Wael; Cavero-Vanek, Sandra

    2010-02-01

    Conservative management of idiopathic or herpetic acute peripheral facial palsy (herpes zoster oticus, HZO) often leads to a favorable outcome. However, recent multicenter studies have challenged the necessity of antivirals. Whereas large numbers of patients are required to reveal statistical differences in a disease with an overall positive outcome, surprisingly few studies differentiate between patients with paresis and paralysis. Analyzing our own prospective cohort of patients and reviewing the current literature on conservative treatment of Bell's palsy and HZO, we reveal the importance of initial baseline assessment of the disease course to predict the outcome and to validate the impact of medical treatment options. STUDY DESIGN AND DATA SOURCE: Prospective analysis of consecutive patients referred to 2 tertiary referral centers and research on the Cochrane Library for current updates of their previous reviews and search of MEDLINE (1976-2009) for randomized trials on conservative treatment of acute facial palsy were conducted. One hundred ninety-six patients with Bell's palsy or HZO were followed up prospectively until complete recovery or at least for 12 months. The numeric Fisch score (FS) was used to classify facial function, and patients were separated between incomplete palsy (=paresis) and complete paralysis. Electroneuronography (ENoG) was used to further subdivide patients with paralysis. The treatment protocol was independent of the ongoing investigation including prednisone and valacyclovir in most patients. A total of 250 previous studies on facial palsy outcome were evaluated regarding their distinction between different severity scores at baseline and its impact on treatment outcome. Trials not making the distinction between paresis and paralysis at baseline and with an insufficient follow-up of less than 12 months were excluded. In the Bell's and HZO paresis group, all except 1 patient recovered completely, most of them within 3 months

  17. Maternal and fetal outcome in pregnant and parturient women with cardiac disease

    International Nuclear Information System (INIS)

    Arif, S.; Baqar, S.; Arif, A.

    2013-01-01

    Objective: To study the maternal and fetal outcome in pregnant and parturient women with cardiac disease admitted in Armed Forces Institute of Cardiology Rawalpindi. Type of Study: Cross sectional descriptive study. Place and Duration: Armed Forces Institute of Cardiology Rawalpindi Jan 2008 to June 2008. Patients and Methods: All pregnant patients beyond 28 weeks gestation with cardiac disease diagnosed before pregnancy or during the index pregnancy admitted for delivery or with cardiac complications were included in the study. All neonates less than 2.5 kg were taken as low birth weight and deliveries between 28 and 37 weeks were considered preterm. Cardiac patients with pregnancy less than 28 weeks were excluded from the study. Results: Maternal mortality was 5% with 31% mortality in NYHA Class III and IV. Perinatal mortality was 9% and low birth weight babies were 17%.Perinatal mortality was 0% in NYHA Class I and II and 60% in NYHA class III and IV. There was no maternal mortality in booked patients. All patients who expired were unbooked. Conclusion: Functional cardiac status is the most important factor affecting maternal and perinatal outcome. Antenatal booking status of the patient is the next important factor. (author)

  18. Minidose Bupivacaine – Fentanyl Spinal Anesthesia for Cesarean Section In Preeclamptic Parturients

    Directory of Open Access Journals (Sweden)

    N. Fatholahzadeh

    2006-07-01

    Full Text Available Background:Spinal anesthesia for cesarean section is associated with a high incidence of hypotension. The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic. Methods: Forty-four preeclamptic parturients undergoing cesarean section were randomized in two groups of 22 patients. Group A received a spinal anesthetic of bupivacaine 6 mg plus fentanyl 20 µg , and group B received 12 mg bupivacaine. Hypotension was defined as a 30% decrease in systolic and diastolic pressure from baseline. Hypotension was treated with intravenous ephedrine boluses 2.5-5 mg up to maximum 50 mg. Results: All patients had satisfactory anesthesia. Five of 22 patients in group A required ephedrine, a single dose of 5 mg. Seventeen of 22 patients in group B required vasopressor support of blood pressure.The lowest recorded systolic,diastolic and mean blood pressures as fractions of the baseline pressures were 71.2%, 64.5% and 70.3% versus 59.9%, 53.5% and 60.2% respectively for group A versus group B. Conclusion: A “minidose” of 6 mg bupivacaine in combination with 20 µg fentanyl may provide satisfactory spinal anesthesia for cesarean section in the preeclamptic patient. The minidose combination caused dramatically less hypotension than 12 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure. 

  19. Safety and community: the maternity care needs of rural parturient women.

    Science.gov (United States)

    Kornelsen, Jude; Grzybowski, Stefan

    2005-06-01

    To investigate rural parturient women's experiences of obstetric care in the context of the social and economic realities of life in rural, remote, and small urban communities. Data collection for this exploratory qualitative study was carried out in 7 rural communities chosen to represent diversity of size, distance to hospital with Caesarean section capability and distance to secondary hospital, usual conditions for transport and access, and cultural and ethnic subpopulations. We interviewed 44 women who had given birth up to 24 months before the study began. When asked about their experiences of giving birth in rural communities, many participants spoke of unmet needs and their associated anxieties. Self-identified needs were largely congruent with the deficit categories of Maslow's hierarchy of needs, which recognizes the contingency and interdependence of physiological needs, the need for safety and security, the need for community and belonging, self-esteem needs, and the need for self-actualization. For many women, community was critical to meeting psychosocial needs, and women from communities that currently have (or have recently had) access to local maternity care said that being able to give birth in their own community or in a nearby community was necessary if their obstetric needs were to be met. Removing maternity care from a community creates significant psychosocial consequences that are imperfectly understood but that probably have physiological implications for women, babies, and families. Further research into rural women's maternity care that considers the loss of local maternity care from multiple perspectives is needed.

  20. Elective cesarean delivery in a parturient with Klippel-Feil syndrome.

    Science.gov (United States)

    Kavanagh, T; Jee, R; Kilpatrick, N; Douglas, J

    2013-11-01

    Klippel-Feil syndrome is defined by congenital fusion of two or more cervical vertebrae and can be associated with abnormalities in multiple systems. Management poses challenges to the anesthesiologist, particularly in pregnancy. Cervical spine immobility and instability can make the management of the airway fraught with danger and vertebral column distortion may make neuraxial anesthesia unreliable. We present the management of a nulliparous patient with features consistent with Type I Klippel-Feil syndrome undergoing elective cesarean delivery. The patient had a potentially difficult airway and features consistent with an unstable cervical spine and severe thoracic and lumbar scoliosis. A combined spinal-epidural technique was used which initially provided satisfactory anesthesia, but ultimately proved inadequate despite use of the epidural component. Satisfactory anesthesia for surgery was eventually achieved with the addition of an intravenous remifentanil infusion. We review previous case reports discussing anesthetic management of parturients with Klippel-Feil syndrome, and describe the challenges encountered and lessons learned from management of this case. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Vivenciando a experiência da parturição em um modelo assistencial humanizado

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    Larissa Mandarano da Silva

    Full Text Available Tratou-se de um estudo qualitativo baseado na abordagem fenomenológica com o objetivo de compreender as experiências de puérperas que vivenciaram o trabalho de parto e o parto em um modelo assistencial humanizado. Os dados foram coletados em um hospital localizado na cidade de São Paulo, onde foram entrevistadas oito puérperas. Da análise dos dados surgiram os temas: Suportando o trabalho de parto e Tendo a oportunidade de resgatar a autonomia, e o fenômeno desvelado foi "Vivendo a ambiguidade da parturição em um modelo assistencial humanizado". Os relatos evidenciaram sentimentos como dor, medo e ansiedade, porém, possibilitou a participação e resgate da autonomia. Embora o estudo tenha sido realizado em um modelo assistencial considerado humanizado, as experiências das puérperas revelam que ainda se distanciam de uma efetiva humanização, conforme seus princípios. Este estudo pode ser utilizado para nortear ações educativas voltadas à humanização e gerar mudanças assistenciais

  2. Prevalence, pattern, and determinants of placental malaria in a population of southeastern Nigerian parturients.

    Science.gov (United States)

    Ezebialu, Ifeanyichukwu U; Eke, Ahizechukwu C; Ezeagwuna, Dorothy A; Nwachukwu, Chukwuemeka E; Ifediata, Francis; Ezebialu, Chinenye U

    2012-12-01

    Placental malaria is a complication of malaria in pregnancy and is associated with adverse outcomes. Its burden is highest in Sub-Saharan Africa, but despite this, data based on histological analysis are scarce from this region. Questionnaires administered by the researchers were used to obtain information from parturients at a university teaching hospital in southeastern Nigeria between April and November 2010. Maternal blood and placental blood were collected for analysis. Placental blocks were taken for histological analysis. Statistical analyses were done using SPSS v. 17. Three hundred and sixty-five placentas were analyzed, out of which 254 showed histological evidence of malaria parasitization, giving a prevalence of 69.6%. Of the 254 placentas, 23 (9.0%) showed active infection and 196 (77.2%) showed active-on-past infection, while 35 (13.8%) showed past infection. Rural residence, hemoglobin genotype AA, not receiving intermittent preventive treatment in pregnancy (IPTp), and not sleeping under insecticide-treated bed nets (ITN) were significantly associated with placental malaria. Placental parasite density was inversely related to parity. This study showed that the prevalence of placental malaria in southeastern Nigeria is high, and demonstrated that the mean parasite density was inversely related to parity. Significant factors associated with placental malaria were also identified. Appreciation of these significant factors will assist program managers in implementing the strategies for the prevention of malaria in pregnancy. Copyright © 2012 International Society for Infectious Diseases. All rights reserved.

  3. Can repetitive transcranial magnetic stimulation increase muscle strength in functional neurological paresis? A proof-of-principle study.

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    Broersma, M; Koops, E A; Vroomen, P C; Van der Hoeven, J H; Aleman, A; Leenders, K L; Maurits, N M; van Beilen, M

    2015-05-01

    Therapeutic options are limited in functional neurological paresis disorder. Earlier intervention studies did not control for a placebo effect, hampering assessment of effectivity. A proof-of-principle investigation was conducted into the therapeutic potential of repetitive transcranial magnetic stimulation (rTMS), using a single-blind two-period placebo-controlled cross-over design. Eleven patients received active 15 Hz rTMS over the contralateral motor cortex (hand area), in two periods of 5 days, for 30 min once a day at 80% of resting motor threshold, with a train length of 2 s and an intertrain interval of 4 s. Eight of these eleven patients were also included in the placebo treatment condition. Primary outcome measure was change in muscle strength as measured by dynamometry after treatment. Secondary outcome measure was the subjective change in muscle strength after treatment. In patients who received both treatments, active rTMS induced a significantly larger median increase in objectively measured muscle strength (24%) compared to placebo rTMS (6%; P difference due to treatment, i.e. patients did not perceive these objectively measured motor improvements (P = 0.40). Our findings suggest that rTMS by itself can potentially improve muscle weakness in functional neurological paresis disorder. Whereas patients' muscle strength increased as measured with dynamometry, patients did not report increased functioning of the affected hand, subjectively. The results may indicate that decreased muscle strength is not the core symptom and that rTMS should be added to behavioral approaches in functional neurological paresis. © 2015 EAN.

  4. Facial paresis in patients with mesial temporal sclerosis: clinical and quantitative MRI-based evidence of widespread disease.

    Science.gov (United States)

    Lin, Katia; Carrete, Henrique; Lin, Jaime; de Oliveira, Pedro Alessandro Leite; Caboclo, Luis Otávio Sales Ferreira; Sakamoto, Américo Ceiki; Yacubian, Elza Márcia Targas

    2007-08-01

    To assess the frequency and significance of facial paresis (FP) in a well-defined cohort of mesial temporal lobe epilepsy (MTLE) patients. One hundred consecutive patients with MRI findings consistent with mesial temporal sclerosis (MTS) and concordant electroclinical data underwent facial motor examination at rest, with voluntary expression, and with spontaneous smiling. Hippocampal, amygdaloid, and temporopolar (TP) volumetric measures were acquired. Thirty healthy subjects, matched according to age and sex, were taken as controls. Central-type FP was found in 46 patients. In 41 (89%) of 46, it was visualized at rest, with voluntary and emotional expression characterizing true facial motor paresis. In 33 (72%) of 46 patients, FP was contralateral to the side of MTS. By using a 2-SD cutoff from the mean of normal controls, we found reduction in TP volume ipsilateral to MTS in 61% of patients with FP and in 33% of those without (p = 0.01). Febrile seizures as initial precipitating injury (IPI) were observed in 34% of the patients and were classified as complex in 12 (26%) of 46 of those with FP and in five (9%) of 54 of those without (p = 0.02). The presence of FP was significantly associated with a shorter latent period and younger age at onset of habitual seizures, in particular, with secondarily generalized tonic-clonic seizures. Facial paresis is a reliable lateralizing sign in MTLE and was associated with history of complex febrile seizures as IPI, younger age at onset of disease, and atrophy of temporal pole ipsilateral to MTS, indicating more widespread disease.

  5. A hybrid BMI-based exoskeleton for paresis: EMG control for assisting arm movements.

    Science.gov (United States)

    Kawase, Toshihiro; Sakurada, Takeshi; Koike, Yasuharu; Kansaku, Kenji

    2017-02-01

    Brain-machine interface (BMI) technologies have succeeded in controlling robotic exoskeletons, enabling some paralyzed people to control their own arms and hands. We have developed an exoskeleton asynchronously controlled by EEG signals. In this study, to enable real-time control of the exoskeleton for paresis, we developed a hybrid system with EEG and EMG signals, and the EMG signals were used to estimate its joint angles. Eleven able-bodied subjects and two patients with upper cervical spinal cord injuries (SCIs) performed hand and arm movements, and the angles of the metacarpophalangeal (MP) joint of the index finger, wrist, and elbow were estimated from EMG signals using a formula that we derived to calculate joint angles from EMG signals, based on a musculoskeletal model. The formula was exploited to control the elbow of the exoskeleton after automatic adjustments. Four able-bodied subjects and a patient with upper cervical SCI wore an exoskeleton controlled using EMG signals and were required to perform hand and arm movements to carry and release a ball. Estimated angles of the MP joints of index fingers, wrists, and elbows were correlated well with the measured angles in 11 able-bodied subjects (correlation coefficients were 0.81  ±  0.09, 0.85  ±  0.09, and 0.76  ±  0.13, respectively) and the patients (e.g. 0.91  ±  0.01 in the elbow of a patient). Four able-bodied subjects successfully positioned their arms to adequate angles by extending their elbows and a joint of the exoskeleton, with root-mean-square errors  exoskeleton, successfully carried a ball to a goal in all 10 trials. A BMI-based exoskeleton for paralyzed arms and hands using real-time control was realized by designing a new method to estimate joint angles based on EMG signals, and these may be useful for practical rehabilitation and the support of daily actions.

  6. A hybrid BMI-based exoskeleton for paresis: EMG control for assisting arm movements

    Science.gov (United States)

    Kawase, Toshihiro; Sakurada, Takeshi; Koike, Yasuharu; Kansaku, Kenji

    2017-02-01

    Objective. Brain-machine interface (BMI) technologies have succeeded in controlling robotic exoskeletons, enabling some paralyzed people to control their own arms and hands. We have developed an exoskeleton asynchronously controlled by EEG signals. In this study, to enable real-time control of the exoskeleton for paresis, we developed a hybrid system with EEG and EMG signals, and the EMG signals were used to estimate its joint angles. Approach. Eleven able-bodied subjects and two patients with upper cervical spinal cord injuries (SCIs) performed hand and arm movements, and the angles of the metacarpophalangeal (MP) joint of the index finger, wrist, and elbow were estimated from EMG signals using a formula that we derived to calculate joint angles from EMG signals, based on a musculoskeletal model. The formula was exploited to control the elbow of the exoskeleton after automatic adjustments. Four able-bodied subjects and a patient with upper cervical SCI wore an exoskeleton controlled using EMG signals and were required to perform hand and arm movements to carry and release a ball. Main results. Estimated angles of the MP joints of index fingers, wrists, and elbows were correlated well with the measured angles in 11 able-bodied subjects (correlation coefficients were 0.81  ±  0.09, 0.85  ±  0.09, and 0.76  ±  0.13, respectively) and the patients (e.g. 0.91  ±  0.01 in the elbow of a patient). Four able-bodied subjects successfully positioned their arms to adequate angles by extending their elbows and a joint of the exoskeleton, with root-mean-square errors  exoskeleton, successfully carried a ball to a goal in all 10 trials. Significance. A BMI-based exoskeleton for paralyzed arms and hands using real-time control was realized by designing a new method to estimate joint angles based on EMG signals, and these may be useful for practical rehabilitation and the support of daily actions.

  7. Study of knowledge rate of parturient mothers about breast feeding adventages

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    mahnaz mardani

    2008-02-01

    Full Text Available Mardani M1, Mohsen-zadeh A2, Yari-pour M3 1. Assistant professor, Department of Nutritional, Faculty of medicine, Lorestan University of medical sciences 2. Assistant professor, Department of Pediatrics, Faculty of medicine, Lorestan University of medical sciences 3. PhD Student, Faculty of medicine, Lorestan University of medical sciences Abstract Background: Mothers milk is the only nourishing source in the first six months of life. If it is suitable and enough, all nutrients and reguired energe will be provided for a breast–fed to grow. Insufficient knowledge and information, wrong beliefs and traditional information about a breast – fed, working out side the home and the desire of working mothers to feed their children with powdered milk and to start the implementary feeding very early. The increasing of mothers willing to abdominal delivery and being away from the child in the first golden hours and misleading advertisements about powdered milk are all some reasons of decreasing the desire to mothers milk and increasing desire to powdered milk. Therefor, the aim of this study is to consider mothers knowledge about the importance of breast – feeding. Materials and methods: In this study, we completed questionnaires with seventeen questions to parturient mothers who came to Asali hospital in 2006 which included some variables such as benefits of breast feeding, the mother’s milk composition. The information was extracted and analyzed by SPSS software. Results: From 550 parturient mothers who came to Asali hospital in 2006, 33 mothers (6 percent had low knowledge, 216 of them (39 percent had medium knowledge and 301 of them (55 percent had high knowledge. This study indicates that regardless to consider some variables, mothers knowledge has been very high and also there is a significantl relationship between mothers age and their knowledge. The average age of low – knowledge mothers was 26, the medium knowledge was 28 and the high

  8. Hemato-biochemical and clinico-epidemiological aspects of parturient hemoglobinuria in Nili-Ravi buffaloes

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    A. Khan

    2010-02-01

    Full Text Available For this study, 60 buffaloes suffering from parturient hemoglobinuria (PHU were randomly selected from field cases occurring in three districts of Punjab, Pakistan and simultaneously, 60 clinically healthy buffaloes of similar description from the same localities were included for case control study. Clinico-epidemiological data were collected. Blood/serum samples from all buffaloes were collected and analyzed. The most prominent clinical sign was passing of red to coffee colored urine. Milk production was reduced and respiration and pulse rates were significantly accelerated. Ruminal motility was significantly weak and reduced along with characteristic straining while defecating. The case fatality was 15%. A significantly high occurrence of PHU was observed in the winter season (41.8%. Maximum number of affected buffaloes (25.0% was in 4th lactation. Twenty-seven (45.0% buffaloes developed hemoglobinuria in the post calving period and majority (59.3% of these were within 1-23 days of calving. Of the 33 (55.0% PHU affected pregnant buffaloes, 18 (54.6% were in their third trimester. The highest cases of PHU were observed in buffaloes producing 10 or more liters of milk/day (42.5%. Recurrence of PHU was observed in 18.3% buffaloes. Mean values of total erythrocyte counts, hemoglobin concentration and packed cell volume were lower (P<0.001, while erythrocyte sediment rate was higher (P<0.001 in PHU affected buffaloes as compared to the values in healthy buffaloes. Neutrophils were significantly higher, while lymphocytes and erythrocytic glucose-6-phosphate dehydrogenase (G6PD were lower, in PHU affected buffaloes than in healthy buffaloes. Serum phosphorus, copper and selenium were significantly (P<0.001 lower, whereas potassium, iron and molybdenum (P<0.001 were higher in buffaloes suffering from PHU than healthy buffaloes.

  9. EFEK AROMA EKSTRAK MELATI TERHADAP PENGURANGAN NYERI PERSALINAN KALA I FASE AKTIF PADA PARTURIENT

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    Nike Sari Oktavia

    2017-12-01

    Full Text Available Labor pain arising from physical and psychological reflex response of from the pain that experienced by the patient. Jasmine essential oil is proven to nervous exhoustion, reduce pain, emotional distress, reduce anxiety, energy, and euphoria that everything that is needed by a mother while facing the birth process. Purpose of this study was to determine whether the jasmine essnstial oil can be used to reduce the pain of the active phase on first stage of parturient. This study used a quasi-experimental method, the sampel was 48 people inpartu who are in the active phase of the first stage of labor. Study subjects were devided into 2 groups; jasmine essential oil (n = 24 and control (n = 24. Pain assessed twice in each group with a numerical rating scale (NRS, that when the woman is in the active phase before inhalation the smell of jasmine essential oil and at the end of the first stage after inhalation the smell. Test statistical analysis using Wilcoxon Signed Ranks test and Mann Whitney test.  The result is; in jasmine essential oil group the median 6 with a range  4-9 decreased to 4 (3-9, while controls had increased pain intensity with a median value of 4.5 (2-10 to 9 (4 -10. There are difference between pain assesment I and II in both groups p = 0.000 (p <0,05. Comparison between jasmine essential oil  group and control group p = 0.000 (p <0,05.      Keyword: Jasmine essential oil, labor pain

  10. Prevalence and descriptive analysis of congenital heart disease in parturients: obstetric, neonatal, and anesthetic outcomes.

    Science.gov (United States)

    Warrick, Christine M; Hart, Jan E; Lynch, Anne M; Hawkins, Joy A; Bucklin, Brenda A

    2015-09-01

    The study objectives are to (1) assess prevalence of congenital heart disease (CHD), (2) describe outcomes of pregnancies in women with CHD, (3) compare outcomes in women with and without CHD, and (4) characterize neonatal outcomes in pregnancies complicated by CHD. This was a retrospective cohort study of women who delivered at the University of Colorado Hospital. Diagnosis of CHD was identified based on history of cardiac disease, pulmonary disease, or subacute bacterial endocarditis prophylaxis during labor and confirmed with echocardiogram when available. Comprehensive retrospective review of anesthetic, obstetric, and neonatal outcomes was performed. University of Colorado Hospital. 18,226 women. Medical record review. Valvular abnormalities, New York Heart Failure Association classification scores, types of CHD, maternal age, race, gravidity, parity, maternal prepregnancy body mass index, cigarette use, type of delivery, type of analgesia used, early initiation of neuraxial analgesia, arrhythmias, need for peripartum diuretics, prolonged maternal hospital stay, preterm birth, small for gestational age, neonatal CHD, neonatal or maternal intensive care unit (ICU) admissions, and maternal or neonatal death. We identified 117 pregnancies in 110 women with CHD. Parturients with CHD were more likely to have operative vaginal delivery (P neonatal ICU admissions (P = .003), and had prolonged hospital stays. Occurrence of CHD in neonates was 6%. Moderate-to-severe valvular disease was associated with increased rates of operative vaginal delivery, early initiation of neuraxial labor analgesia, cardiac complications (including arrhythmia and use of diuretics), prolonged hospital stay, and maternal ICU admission. However, most deliveries and births were uncomplicated; and there were one case each of maternal mortality and fetal death after birth. Operative abdominal deliveries and neonatal ICU admissions are more common in women with CHD, but these pregnancies are

  11. Anesthetic Implications of Emergent Cesarean Section in a Parturient with Marfan Syndrome Complicated by Ascending Aortic Aneurysm and Heart Failure

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    Young Sung Kim

    2014-07-01

    Full Text Available Cardiovascular comorbidities to the Marfan syndrome may induce hemodynamic instability especially in the parturients during labor or delivery. For anesthesiologists, it is challenging to maintain hemodynamic stability during Cesarean section in those patients with Marfan syndrome. Remifentanil is an ultra-short-acting opioid with rapid onset and offset of action which provides cardiovascular stability during surgery. Together with remifentanil, the use of a laryngeal mask airway can reduce the risk of hypertensive response followed by tracheal intubation. We describe the successful administration of remifentanil and application of laryngeal mask airway for emergent Cesarean section performed under general anesthesia in a patient with Marfan syndrome complicated by ascending aortic aneurysm and heart failure. The use of remifentanil (loading dose of 1 μg/kg for 1 min, 2 min before induction; thereafter continuous infusion dose of 0.1 μg/kg/min was useful to maintain hemodynamic stability of the parturient throughout the surgery without neonatal respiratory depression. Keywords: Ascending Aortic Aneurysm; Cesarean section; Laryngeal mask airway; Marfan syndrome; Remifentanil

  12. EFFICACY OF TRANEXAMIC ACID IN DECREASING BLOOD LOSS DURING AND AFTER CAESAREAN SECTION IN MULTIGRAVIDA PARTURIENTS: A CASE CONTROLLED PROSPECTIVE STUDY

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    Gunavathi Kandappan

    2016-06-01

    Full Text Available OBJECTIVES To study the efficacy of Tranexamic acid in reducing blood loss during and after the lower segment caesarean section in Multigravida parturients. METHODOLOGY A case controlled prospective study was conducted in 50 multigravida parturient women undergoing elective lower segment caesarean section in our hospital after getting Institutional Ethical Committee approval, over a period of two months. 25 of them were given Tranexamic acid 15 mg/kg immediately before caesarean section. Blood loss was collected and measured during two periods. The first period was from placental delivery to end of LSCS and the second from the end LSCS to 2 hours postpartum. RESULTS Tranexamic acid significantly reduces the quantity of blood loss from the end of LSCS to 2 hours post-partum in multigravida parturients. No complications or side effects are noted in both the groups. CONCLUSION Tranexamic acid significantly reduces the amount of blood loss during and after the lower segment caesarean section in multigravida parturients and its use was not associated with any side effects or complications.

  13. Genetic parameters for ewe reproductive performance and peri-parturient fecal egg counts and their genetic relationships with lamb body weights and fecal egg counts in Katahdin sheep

    Science.gov (United States)

    Genetic parameters for ewe reproductive traits [number of lambs born (NLB) and number of lambs weaned (NLW)] and ewe peri-parturient rise (PPR) fecal egg counts (FEC) at lambing (PPR0) and at 30-d post lambing (PPR30), and their genetic relationships with lamb BW and FEC in Katahdin sheep were estim...

  14. Genetic parameters for ewe reproductive performance and peri-parturient fecal egg counts and their genetic relationships with lamb body weights and fecal egg counts in Katahdin sheep

    Science.gov (United States)

    This study estimated genetic parameters for ewe reproductive traits [number of lambs born (NLB) and weaned (NLW) per ewe lambing] and peri-parturient (PPR) fecal egg counts (FEC) at lambing (PPR0) and 30 d postpartum (PPR30), and their genetic relationships with lamb BW and FEC in Katahdin sheep. Th...

  15. Efficacy of magnesium sulphate and/or fentanyl as adjuvants to intrathecal low-dose bupivacaine in parturients undergoing elective caesarean section

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    Shelly Rana

    2017-01-01

    Full Text Available Background and Aim: Recent developments in the field of intrathecal adjuvants have led to accelerated functional recovery with adequate postoperative analgesia following caesarean section. Encouraging results have been obtained with the use of intrathecal magnesium with or without fentanyl in parturients. This study was conceived to evaluate the effects of adding magnesium sulphate and/or fentanyl to low-dose intrathecal bupivacaine in parturients undergoing caesarean section under subarachnoid block (SAB. Materials and Methods: Ninety, American Society of Anesthesiologists I or II, parturients for the elective caesarean section were enrolled in this prospective randomized, double-blind study. The parturients were randomly assigned to three groups. In Group M, parturients received 8.5 mg (1.7 mL hyperbaric bupivacaine 0.5% with 50 mg (0.1 mL magnesium sulphate and 0.4 mL normal saline. Group F received 8.5 mg hyperbaric bupivacaine 0.5% with 20 μg (0.4 mL fentanyl and 0.1 mL of normal saline and Group MF parturients received 8.5 mg hyperbaric bupivacaine 0.5% with 20 μg fentanyl added to 50 mg magnesium sulphate. Results: Parturients in the group MF were pain free for longest period (273.70 ± 49.30 min as compared to group M (252.67 ± 40.76 min and group F (239.80 ± 38.45 mins [gp MF vs F and, gp M vs F (P = 0.00]. The total doses of rescue analgesics were least in group MF (2.43 ± 0.56 and maximum in group F (3.30 ± 0.63, with comparable neonatal outcomes in three groups. Conclusion: Our data supports synergistic action of intrathecal magnesium sulphate to fentanyl, and it is concluded that on addition of intrathecal magnesium sulphate and fentanyl to low-dose bupivacaine as adjuvant in subarachnoid block, results in prolonged duration of postoperative analgesia with lesser pain scores and lesser dose of rescue analgesia with better haemodynamic stability.

  16. Relationship between severe obesity and depth to the cricothyroid membrane in third-trimester non-labouring parturients: a prospective observational study.

    Science.gov (United States)

    Gadd, K; Wills, K; Harle, R; Terblanche, N

    2018-05-01

    Severely obese parturients have increased 'cannot intubate, cannot oxygenate' risk during Caesarean section under general anaesthesia. Front-of-neck access (FONA) at the cricothyroid membrane (CTM) is definitive management; however, attempted FONA can fail. Point-of-care ultrasonography may provide useful information about CTM depth to aid FONA in obesity. This study determined the difference in CTM depth between severely obese and non-obese parturients, utilising ultrasonography. In this prospective observational study, two anaesthetists performed airway ultrasonography on 15 severely obese (BMI >45 kg m -2 ) and 15 normal-weight (BMI ≤25 kg m -2 ) parturients in the third trimester, using the transverse and longitudinal planes, sniffing and extended head positions, and nil and firm transducer pressures. The primary outcome was CTM depth (millimetres) measured in the transverse plane with the head extended and nil transducer pressure. Secondary outcomes included CTM depth measurements using other factor configurations. Intra-class correlation coefficients assessed the inter-observer reliability. CTM depth measured in the transverse plane with head extended and nil transducer pressure was significantly greater in severely obese parturients, mean 18.0 mm (95% confidence interval 16.3-19.8), vs 10.6 mm (8.81-12.4) in non-obese (P<0.001); mean difference 7.4 mm (4.9-9.9; P<0.001). CTM depths were increased in the severely obese group regardless of scanning plane, head and neck position, or transducer pressure (all P<0.001). There was excellent inter-observer reliability. Cricothyroid membrane depth is significantly increased in severely obese vs normal-weight parturients independently of scanning plane, head and neck position, or transducer pressure. Copyright © 2018 British Journal of Anaesthesia. All rights reserved.

  17. Femoral nerve compression syndrome with paresis of the quadriceps muscle caused by radiotherapy of malignant tumours. A report of four cases

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    Laurent, L E [Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland

    1975-01-01

    Four patients showed signs of femoral nerve compression with subsequent paresis of the quadriceps muscle, after radiation therapy of malignant tumours. The compression was caused by scar tissue due to radiation treatment of the inguinal region. The first symptom was radiating pain in the front of the thigh and lower leg which appeared 12-16 months after X-ray treatment. A decrease in the strength of quadriceps muscle occurred some months later. In one case the femoral nerve was decompressed, another patient was treated by an intradural phenolglycerin injection and one patient was treated with cortisone and oxiphenbutanzone. In these cases the pain decreased considerably, but in one case only the paresis of the quadriceps muscle improved after treatment.

  18. Effects of Voice Therapy on Laryngeal Motor Units During Phonation in Chronic Superior Laryngeal Nerve Paresis Dysphonia.

    Science.gov (United States)

    Kaneko, Mami; Hitomi, Takefumi; Takekawa, Takashi; Tsuji, Takuya; Kishimoto, Yo; Hirano, Shigeru

    2017-09-26

    Injury to the superior laryngeal nerve can result in dysphonia, and in particular, loss of vocal range. It can be an especially difficult problem to address with either voice therapy or surgical intervention. Some clinicians and scientists suggest that combining vocal exercises with adjunctive neuromuscular electrical stimulation may enhance the positive effects of voice therapy for superior laryngeal nerve paresis (SLNP). However, the effects of voice therapy without neuromuscular electrical stimulation are unknown. The purpose of this retrospective study was to demonstrate the clinical effectiveness of voice therapy for rehabilitating chronic SLNP dysphonia in two subjects, using interspike interval (ISI) variability of laryngeal motor units by laryngeal electromyography (LEMG). Both patients underwent LEMG and were diagnosed with having 70% recruitment of the cricothyroid muscle, and 70% recruitment of the cricothyroid and thyroarytenoid muscles, respectively. Both patients received voice therapy for 3 months. Grade, roughness, breathiness, asthenia, and strain (GRBAS) scale, stroboscopic examination, aerodynamic assessment, acoustic analysis, and Voice Handicap Index-10 were performed before and after voice therapy. Mean ISI variability during steady phonation was also assessed. After voice therapy, both patients showed improvement in vocal assessments by acoustic, aerodynamic, GRBAS, and Voice Handicap Index-10 analysis. LEMG indicated shortened ISIs in both cases. This study suggests that voice therapy for chronic SLNP dysphonia can be useful for improving SLNP and voice quality. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  19. Laryngeal neuropathy of Charcot-Marie-Tooth disease: further observations and novel mutations associated with vocal fold paresis.

    Science.gov (United States)

    Benson, Brian; Sulica, Lucian; Guss, Joel; Blitzer, Andrew

    2010-02-01

    To describe and define laryngeal neuropathy in Charcot-Marie-Tooth (CMT) disease. Retrospective record review from a university laryngology practice. Four adult CMT patients presented with laryngeal symptoms. Three patients exhibited bilateral vocal fold palsy, in each case with more severe hypomobility on the left. One case exhibited an isolated left vocal fold palsy. All patients complained of hoarseness and stridor, three had dyspnea, two patients had dysphagia, and one had obstructive sleep apnea (OSA). One patient has required airway surgery to date. Genetic testing revealed known sequence alterations in one case and sequence alterations previously not associated with laryngeal dysfunction in two cases. One case was familial and two were sporadic; information is not available in a fourth. The clinical course of the cases suggests slowly progressive neuropathy that appears to be nerve length dependent. The lack of severe respiratory distress despite dense bilateral paresis is consistent with existing reports and with the reported low rate of tracheostomy in adults with laryngeal manifestations of CMT. Genetic testing does not currently inform expectations or management of laryngeal disease. Dyspnea, dysphagia, and OSA symptoms in patients with CMT require careful laryngologic evaluation.

  20. Combined Spinal-Epidural Analgesia for Laboring Parturient with Arnold-Chiari Type I Malformation: A Case Report and a Review of the Literature

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    Clark K. Choi

    2013-01-01

    Full Text Available Anesthetic management of laboring parturients with Arnold-Chiari type I malformation poses a difficult challenge for the anesthesiologist. The increase in intracranial pressure during uterine contractions, coughing, valsalva maneuvers, and expulsion of the fetus can be detrimental to the mother during the process of labor and delivery. No concrete evidence has implicated high cerebral spinal fluid pressure on maternal and fetal complications. The literature on the use of neuraxial techniques for managing parturients with Arnold-Chiari is extremely scarce. While most anesthesiologists advocate epidural analgesia for management of labor pain and spinal anesthesia for cesarean section, we are the first to report the use of combined spinal-epidural analgesia for managing labor pain in a pregnant woman with Arnold-Chiari type I malformation. Also, we have reviewed the literature and presented information from case reports and case series to support the safe usage of neuraxial techniques in these patients.

  1. Experiências das puérperas adolescentes no processo de parturição Experiences in the process of teenage pregnancy parturition

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    Ana Paula de Lima Escobal

    2016-07-01

    Full Text Available Objetivo: Conhecer as experiências das puérperas adolescentes no processo de parturição. Método: De abordagem qualitativa e caráter descritivo, trata-se de um recorte dos dados da pesquisa multicêntrica Atenção Humanizada ao Parto de Adolescentes. Fizeram parte do estudo dez adolescentes que tiveram seus partos no hospital participante da pesquisa no período que compreendeu entre novembro de 2008 a novembro de 2009. As participantes foram selecionadas no banco de dados da pesquisa multicêntrica.  Para análise, os dados foram agrupados em consonância com Minayo (2010. Resultados: Obtendo-se como resultado dois temas: percepções das puérperas sobre o cuidado recebido no centro obstétrico e os profissionais de saúde no processo de parturição. Conclusão: Constatou-se que as puérperas adolescentes que perceberem o comprometimento da equipe e julgarem que aquele cuidado fora o ideal, experimentaram o processo de parturição de mais forma prazerosa.

  2. Reported Pain During Labour - A Qualitative Study of Influencing Factors among Parturient During Confinement in Private or Government Hospital.

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    Parthasarathy, S; Ravishankar, M; Hemanthkumar, V R

    2016-03-01

    Labour pain is distressing and it produces undue side effects both to the mother and the baby. The incidence is high in developing countries like India where the awareness about labour analgesia is still lacking. It is to find out the incidence of labour pain and the influence of various described factors on pain with a comparison between patients admitted in a government set up with a private set up in a south Indian semi-urban area. Two hundred continuous uneventful normal deliveries each in a Government (group G) and a private hospital (group P) were enrolled for the study. The reported pain during labour was noted 6-7 hours after delivery by interacting with the patient. The factors like age of the mother, sex and weight of the baby, literacy, socioeconomic status, the use of oxytocics and analgesia were evaluated. The incidence of severe pain was more in group G (43.5%) than group P (12%). There was no analgesic intervention in 68.5% in group G while it was 13.5% (27/200) in group P. Even among these 27 patients who did not receive analgesics, only three parturients reported severe pain. Even administration of analgesics in a Government set up did not decrease pain to a significant extent. There were richer and more literate patients in group P. Booked cases were less in group G. Logistic regression analyses to find out factors which influenced pain in either group was used. Gravida, analgesic intervention and admission in a Govt. hospital influenced the pain experience of the parturient. There was minimal antenatal preparation in both the groups. There were no post partum complications. Mothers suffered from labour pain to a significant extent and there is an urgent need for awareness about labour analgesia. Primigravida, admission in a Govt. set up and analgesic interventions were the factors which influenced pain than others. Patients admitted in Govt. hospitals suffered more pain with less analgesic intervention possibly due to illiteracy. The increased

  3. Knee Moment-Angle Characteristics and Semitendinosus Muscle Morphology in Children with Spastic Paresis Selected for Medial Hamstring Lengthening.

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    Haberfehlner, Helga; Jaspers, Richard T; Rutz, Erich; Becher, Jules G; Harlaar, Jaap; van der Sluijs, Johannes A; Witbreuk, Melinda M; Romkes, Jacqueline; Freslier, Marie; Brunner, Reinald; Maas, Huub; Buizer, Annemieke I

    2016-01-01

    To increase knee range of motion and improve gait in children with spastic paresis (SP), the semitendinosus muscle (ST) amongst other hamstring muscles is frequently lengthened by surgery, but with variable success. Little is known about how the pre-surgical mechanical and morphological characteristics of ST muscle differ between children with SP and typically developing children (TD). The aims of this study were to assess (1) how knee moment-angle characteristics and ST morphology in children with SP selected for medial hamstring lengthening differ from TD children, as well as (2) how knee moment-angle characteristics and ST morphology are related. In nine SP and nine TD children, passive knee moment-angle characteristics and morphology of ST (i.e. fascicle length, muscle belly length, tendon length, physiological cross-sectional area, and volume) were assessed by hand-held dynamometry and freehand 3D ultrasound, respectively. At net knee flexion moments above 0.5 Nm, more flexed knee angles were found for SP compared to TD children. The measured knee angle range between 0 and 4 Nm was 30% smaller in children with SP. Muscle volume, physiological cross-sectional area, and fascicle length normalized to femur length were smaller in SP compared to TD children (62%, 48%, and 18%, respectively). Sixty percent of the variation in knee angles at 4 Nm net knee moment was explained by ST fascicle length. Altered knee moment-angle characteristics indicate an increased ST stiffness in SP children. Morphological observations indicate that in SP children planned for medial hamstring lengthening, the longitudinal and cross-sectional growth of ST muscle fibers is reduced. The reduced fascicle length can partly explain the increased ST stiffness and, hence, a more flexed knee joint in these SP children.

  4. Parturient hypocalcemia in jersey cows fed alfalfa haylage-based diets with different cation to anion ratios.

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    Gaynor, P J; Mueller, F J; Miller, J K; Ramsey, N; Goff, J P; Horst, R L

    1989-10-01

    Jersey cows were fed three alfalfa haylage-based diets with different cation-anion balances beginning 6 wk preceding third or later calving and ending 24 to 36 h postpartum. Sodium and Cl as percentages of dietary DM were .08 and 1.66 in diet 1 (anionic, 5 cows), .44 and .91 in diet 2 (intermediate, 6 cows), and 1.60 and .34 in diet 3 (cationic, 6 cows). Cation-anion balances were 22, 60, and 126 meq/100 g DM; Ca:P ratios averaged 4:1. Cows fed diet 1 in comparison with cows fed diets 2 or 3 over 6 wk had similar concentrations of Ca, P, and Na but higher concentrations of Mg and K in plasma and higher urinary excretions of Ca and Mg. Concentrations of 1,25-dihydroxyvitamin D 3 d before parturition were higher in cows fed diet 1 than in cows fed diets 2 or 3. Within 36 h after calving, mean concentrations of Ca in plasma (mg/dl, range) of cows fed diets 1 to 3, respectively, were 7 (8.7 to 6.2), 6.5 (7.8 to 3.9), and 6.3 (7.8 to 3.8). Number of cases of clinical milk fever by diet were 0 of 5, 2 of 6, and 1 of 6 cows. Alteration of dietary cation-anion balance by addition of Cl may effectively reduce incidence and severity of parturient hypocalcemia.

  5. The effects of labor on differential gene expression in parturient women, placentas, and fetuses at term pregnancy

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    Hsiu-Huei Peng

    2011-11-01

    Full Text Available Labor and its associated pain are thought to have unique impacts on parturient women. The goal of this study was to investigate the effects of labor and associated pain on differential gene expression profiles in the maternal, fetal, and placental compartments. We used microarrays to analyze maternal blood (MB, fetal cord blood (CB, and placental tissue samples in pregnant women after term vaginal deliveries (laboring group and in term pregnant women after scheduled Ceasarean sections (nonlaboring group. The upregulated genes in the MB of the laboring group are involved in cytokine and nuclear factor-kappa B signaling pathways, regulation of the networks of toll-like receptor 4, and suppressor of cytokine signaling 3. Upregulated genes in the CB of the laboring group are involved in responding to stress and stimuli by regulating the network genes of the T-cell receptor beta locus and the FK506 binding protein 8. Differentially expressed genes in the placenta of the laboring group are involved in nitric oxide transport, gas transport, response to hydrostatic pressure, oxygen transport, acute phase responses, and the tumor necrosis factor-mediated signaling pathway, which are important during the transient hypoxemia and hypoperfusion that occur in the placenta during uterine contractions. Interestingly, few of the genes exhibited simultaneous changes in all three compartments, indicating that different pathways and complex interactions may be involved in human labor. In conclusion, human labor and its associated pain elicit unique gene regulatory changes in MB, placenta, and CB.

  6. Post-traumatic stress disorder in parturients delivering by caesarean section and the implication of anaesthesia: a prospective cohort study.

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    Lopez, U; Meyer, M; Loures, V; Iselin-Chaves, I; Epiney, M; Kern, C; Haller, G

    2017-06-02

    Post-traumatic stress disorder (PTSD) occurs in 1-7% of women following childbirth. While having a caesarean section (C-section) is known to be a significant risk factor for postpartum PTSD, it is currently unknown whether coexisting anaesthesia-related factors are also associated to the disorder. The aim of this study was to assess anaesthesia-linked factors in the development of acute postpartum PTSD. We performed a prospective cohort study on women having a C-section in a tertiary hospital in Switzerland. Patients were followed up six weeks postpartum. Patient and procedure characteristics, past morbidity or traumatic events, psychosocial status and stressful perinatal events were measured. Outcome was divided into two categories: full PTSD disease and PTSD profile. This was based on the number of DSM-IV criteria of the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV) present. The PTSD Checklist Scale and the Clinician Administered PTSD Scale were used for measurement. Of the 280 patients included, 217 (77.5%) answered the questionnaires and 175 (62.5%) answered to an additional phone interview. Twenty (9.2%) had a PTSD profile and six (2.7%) a PTSD. When a full predictive model of risk factors for PTSD profile was built using logistic regression, maternal prepartum and intrapartum complications, anaesthetic complications and dissociative experiences during C-section were found to be the significant predictors for PTSD profile. This is the first study to show in parturients having a C-section that an anaesthesia complication is an independent risk factor for postpartum PTSD and PTSD profile development, in addition to known perinatal and maternal risk factors.

  7. Efeitos tempo, parturição e quantum no Brasil: indicadores de período e evidências empíricas

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    Adriana de Miranda-Ribeiro

    2013-06-01

    Full Text Available O presente artigo tem como objetivo estimar e comparar diferentes indicadores de fecundidade de período, com enfoque naqueles que corrigem distorções causadas na taxa de fecundidade total (TFT observada em determinado período, a fim de criar e avaliar novas possibilidades de análise da fecundidade no Brasil. São apresentadas séries de TFT, TFT PPR, PATFR, PATFRajustada (K-O, PDTFR e PADTFR, bem como as séries históricas dos efeitos tempo e parturição e da idade média da fecundidade. Foram utilizados os bancos de dados sobre histórias de nascimentos, obtidos a partir das edições de 1980, 1991 e 2000 do Censo Demográfico brasileiro. Os resultados mostram que, no Brasil, a transição da fecundidade foi acompanhada, durante praticamente todo o período de análise, por um efeito tempo negativo e um efeito parturição positivo, que atuaram no sentido de inflar a fecundidade observada. No futuro próximo, a fecundidade observada no Brasil deverá ser diminuída, principalmente pela ação do efeito tempo positivo.

  8. Diabetic parturient - Anaesthetic implications

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    Nibedita Pani

    2010-01-01

    Full Text Available Pregnancy induces progressive changes in maternal carbohydrate metabolism. As pregnancy advances insulin resistance and diabetogenic stress due to placental hormones necessitate compensatory increase in insulin secretion. When this compensation is inadequate gestational diabetes develops. ′Gestational diabetes mellitus′ (GDM is defined as carbohydrate intolerance with onset or recognition during pregnancy. Women diagnosed to have GDM are at increased risk of future diabetes predominantly type 2 DM as are their children. Thus GDM offers an important opportunity for the development, testing and implementation of clinical strategies for diabetes prevention. Timely action taken now in screening all pregnant women for glucose intolerance, achieving euglycaemia in them and ensuring adequate nutrition may prevent in all probability, the vicious cycle of transmitting glucose intolerance from one generation to another. Given that diabetic mothers have proportionately larger babies it is likely that vaginal delivery will be more difficult than in the normal population, with a higher rate of instrumentally assisted delivery, episiotomy and conversion to urgent caesarean section. So an indwelling epidural catheter is a better choice for labour analgesia as well to use, should a caesarean delivery become necessary. Diabetes in pregnancy has potential serious adverse effects for both the mother and the neonate. Standardized multidisciplinary care including anaesthetists should be carried out obsessively throughout pregnancy. Diabetes is the most common endocrine disorder of pregnancy. In pregnancy, it has considerable cost and care demands and is associated with increased risks to the health of the mother and the outcome of the pregnancy. However, with careful and appropriate screening, multidisciplinary management and a motivated patient these risks can be minimized.

  9. Prevalence of Hospitalized Live Births Affected by Alcohol and Drugs and Parturient Women Diagnosed with Substance Abuse at Liveborn Delivery: United States, 1999–2008

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    Pan, I-Jen; Yi, Hsiao-ye

    2015-01-01

    Objective To describe prevalence trends in hospitalized live births affected by placental transmission of alcohol and drugs, as well as prevalence trends among parturient women hospitalized for liveborn delivery and diagnosed with substance abuse problems in the United States from 1999 to 2008. Comparison of the two sets of trends helps determine whether the observed changes in neonatal problems over time were caused by shifts in maternal substance abuse problems. Methods This study independently identified hospitalized live births and maternal live born deliveries from discharge records in the Nationwide Inpatient Sample, one of the largest hospital administrative databases. Substance-related diagnosis codes on the records were used to identify live births affected by alcohol and drugs and parturient women with substance abuse problems. The analysis calculated prevalence differences and percentage changes over the 10 years, with Loess curves fitted to 10-year prevalence estimates to depict trend patterns. Linear and quadratic trends in prevalence were simultaneously tested using logistic regression analyses. The study also examined data on costs, primary expected payer, and length of hospital stays. Results From 1999 to 2008, prevalence increased for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid. Conclusions The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women to reduce the number of substance-affected live births. PMID:22688539

  10. Prevalence of hospitalized live births affected by alcohol and drugs and parturient women diagnosed with substance abuse at liveborn delivery: United States, 1999-2008.

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    Pan, I-Jen; Yi, Hsiao-ye

    2013-05-01

    To describe prevalence trends in hospitalized live births affected by placental transmission of alcohol and drugs, as well as prevalence trends among parturient women hospitalized for liveborn delivery and diagnosed with substance abuse problems in the United States from 1999 to 2008. Comparison of the two sets of trends helps determine whether the observed changes in neonatal problems over time were caused by shifts in maternal substance abuse problems. This study independently identified hospitalized live births and maternal live born deliveries from discharge records in the Nationwide Inpatient Sample, one of the largest hospital administrative databases. Substance-related diagnosis codes on the records were used to identify live births affected by alcohol and drugs and parturient women with substance abuse problems. The analysis calculated prevalence differences and percentage changes over the 10 years, with Loess curves fitted to 10-year prevalence estimates to depict trend patterns. Linear and quadratic trends in prevalence were simultaneously tested using logistic regression analyses. The study also examined data on costs, primary expected payer, and length of hospital stays. From 1999 to 2008, prevalence increased for narcotic- and hallucinogen-affected live births and neonatal drug withdrawal syndrome but decreased for alcohol- and cocaine-affected live births. Maternal substance abuse at delivery showed similar trends, but prevalence of alcohol abuse remained relatively stable. Substance-affected live births required longer hospital stays and higher medical expenses, mostly billable to Medicaid. The findings highlight the urgent need for behavioral intervention and early treatment for substance-abusing pregnant women to reduce the number of substance-affected live births.

  11. The impact of body mass index on the risk of high spinal block in parturients undergoing cesarean delivery: a retrospective cohort study.

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    Lamon, Agnes M; Einhorn, Lisa M; Cooter, Mary; Habib, Ashraf S

    2017-08-01

    To investigate the hypothesis that the risk of high spinal block is not increased in obese parturients undergoing cesarean delivery compared to non-obese parturients. This is a retrospective study at an academic center. We searched the perioperative database for women who underwent cesarean delivery under spinal or combined spinal epidural anesthesia with hyperbaric bupivacaine ≥10.5 mg. A body mass index (BMI) ≥30 kg/m 2 was defined as obese. We categorized obesity into: obesity class I (BMI = 30-34.9 kg/m 2 ), obesity class II (BMI = 35-39.9 kg/m 2 ), obesity class III (BMI = 40-49.9 kg/m 2 ), and super obese (BMI ≥50 kg/m 2 ). The primary outcome was high spinal block defined as need to convert to general anesthesia within 20 min of spinal placement as a result of altered mental status, weakness, or respiratory distress resulting from the high block, or a recorded block height ≥T1. The analysis included 5015 women. High spinal blocks occurred in 29 patients (0.6%). The risk of high spinal was significantly different according to BMI (p = 0.025). In a multivariate model, BMI (p = 0.008) and cesarean delivery priority (p = 0.009) were associated with high blocks. BMI ≥50 kg/m 2 was associated with greater odds of high block compared to BMI block compared with unscheduled delivery. At standard spinal doses of hyperbaric bupivacaine used in our practice (≥10.5 mg), there were greater odds of high block in those with BMI ≥50 kg/m 2 .

  12. Sífilis em parturientes: aspectos relacionados ao parceiro sexual Syphilis in parturients: aspects related to the sex partner

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    Ana Luiza de Araújo Campos

    2012-09-01

    behavioral profile of sex partners, the proportion of those inadequately treated as well as to verify how many of them were inadequately treated and why some were not treated. METHODS: Quantitative study with data collected from May to October, 2008 at five public maternities in Fortaleza, Ceará. A survey was carried out with parturients who were hospitalized with syphilis and had a stable sex partner. We analyzed sociodemographic variables and those related to communication, diagnosis and treatment of sex partners. The data were entered into the Statistical Package for the Social Sciences and were analyzed using frequency distributions, measures of central tendency and dispersion. RESULTS: The study included 56 pregnant women. Most sexual partners were young adults aged on average 29 years, 50% of them had studied for less than seven years, 82.1 worked and 46.4% had a family income of less than a minimum wage. Of all the partners, 92.9% were the child's father and 69.6% lived with the women. Fifty percent and 12% were alcohol and drug users, respectively. Most partners (75.0% were told about the diagnosis by the women, and in 78.6% of cases they were aware of the VDRL result before or during the prenatal period. However, 25.0% of the women did not communicate the result to their partners for the following reasons: not knowing the importance of the partner's treatment (50.0%, not being together after the diagnosis (42.9% and having a quarrel (7.1%. Of the partners who were informed about the result before or during the prenatal period, 56.0% were treated and six (42.8% were considered to have been properly treated. Among the ones who did not receive treatment, 63.6% refused it because they did not feel sick, because they did not believe in the treatment and because they were afraid of injections. CONCLUSIONS: Partners are told about the syphilis diagnosis of the pregnant women; however, only a few are properly treated.

  13. Impairment-oriented training or Bobath therapy for severe arm paresis after stroke: a single-blind, multicentre randomized controlled trial.

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    Platz, T; Eickhof, C; van Kaick, S; Engel, U; Pinkowski, C; Kalok, S; Pause, M

    2005-10-01

    To study the effects of augmented exercise therapy time for arm rehabilitation as either Bobath therapy or the impairment-oriented training (Arm BASIS training) in stroke patients with arm severe paresis. Single blind, multicentre randomized control trial. Three inpatient neurorehabilitation centres. Sixty-two anterior circulation ischaemic stroke patients. Random assignment to three group: (A) no augmented exercise therapy time, (B) augmented exercise therapy time as Bobath therapy and (C) augmented exercise therapy time as Arm BASIS training. Fugl-Meyer arm motor score. Secondary measure: Action Research Arm Test (ARA). Ancillary measures: Fugl-Meyer arm sensation and joint motion/pain scores and the Ashworth Scale (elbow flexors). An overall effect of augmented exercise therapy time on Fugl-Meyer scores after four weeks was not corroborated (mean and 95% confidence interval (CI) of change scores: no augmented exercise therapy time (n=20) 8.8, 5.2-12.3; augmented exercise therapy time (n=40) 9.9, 6.8-13.9; p = 0.2657). The group who received the augmented exercise therapy time as Arm BASIS training (n=20) had, however, higher gains than the group receiving the augmented exercise therapy time as Bobath therapy (n=20) (mean and 95% CI of change scores: Bobath 7.2, 2.6-11.8; BASIS 12.6, 8.4-16.8; p = 0.0432). Passive joint motion/pain deteriorated less in the group who received BASIS training (mean and 95% CI of change scores: Bobath -3.2, -5.2 to -1.1; BASIS 0.1, -1.8-2.0; p = 0.0090). ARA, Fugl-Meyer arm sensation, and Ashworth Scale scores were not differentially affected. The augmented exercise therapy time as Arm BASIS training enhanced selective motor control. Type of training was more relevant for recovery of motor control than therapeutic time spent.

  14. Sympatho-vagal balance, as quantified by ANSindex, predicts post spinal hypotension and vasopressor requirement in parturients undergoing lower segmental cesarean section: a single blinded prospective observational study.

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    Prashanth, Anitha; Chakravarthy, Murali; George, Antony; Mayur, Rohini; Hosur, Rajathadri; Pargaonkar, Sumant

    2017-08-01

    Hypotension subsequent to spinal anesthesia occurs in a significant number of parturients undergoing lower segment caesarian section. Currently available methods to predict the incidence of hypotension, its severity and the outcome are sub-optimal. Many workers have used basal heart rate as one of the predictors. But using this method it is not possible to objectively analyze and predict the extent and severity of hypotension. We used an equipment measuring the level of sympatho-vagal balance, ANSiscope™, which derives these values from computed value of RR interval variability. We made a single measure of the value which was blinded to the patient and the anesthesiologist. We studied one hundred eight patients who underwent lower segment caesarian section under spinal anesthesia and found the variability of preoperative ANSindex (% activity displayed by the equipment) from 9 to 65 %. Higher ANSindex value was significantly associated with post spinal hypotension (p 0.017). A value of 24 % indicated the critical level above which hypotension appeared commonly. The ANSindex value might help anesthesiologist to anticipate and prepare for hypotension that is likely to ensue.

  15. Ultrasound-guided epidural anesthesia for a parturient with severe malformations of the skeletal system undergoing cesarean delivery: a case report

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    Luo LL

    2015-05-01

    Full Text Available LinLi Luo,* Juan Ni,* Lan Wu, Dong Luo Department of Anesthesiology, West China Second Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China  *These authors contributed equally to this work and should be considered co-first authors Abstract: Anesthetic management of patients with preexisting diseases is challenging and individualized approaches need to be determined based on patients' complications. We report here a case of ultrasound-guided epidural anesthesia in combination with low-dose ketamine during cesarean delivery on a parturient with severe malformations of the skeletal system and airway problems. The ultrasound-guided epidural anesthesia was performed in the L1–L2 space, followed by an intravenous administration of ketamine (0.5 mg/kg for sedation and analgesia. Satisfactory anesthesia was provided to the patient and spontaneous ventilation was maintained during the surgery. The mother and the baby were discharged 5 days after surgery, no complications were reported for either of them. Our work demonstrated that an ultrasound-guided epidural anesthesia combined with low-dose ketamine can be used to successfully maintain spontaneous ventilation and provide effective analgesia during surgery and reduce the risk of postoperative anesthesia-related pulmonary infection. Keywords: anesthesia, regional, cesarean delivery, ketamine, ultrasound-guided

  16. Adherence to intermittent preventive treatment for malaria with sulphadoxine-pyrimethamine and outcome of pregnancy among parturients in South East Nigeria

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    Onyebuchi AK

    2014-04-01

    Full Text Available Azubike Kanario Onyebuchi,1 Lucky Osaheni Lawani,2 Chukwuemeka Anthony Iyoke,3 Chukwudi Robinson Onoh,1 Nwabunike Ekene Okeke4 1Department of Obstetrics and Gynecology, Federal Teaching Hospital, Abakaliki, Nigeria; 2School of Postgraduate Studies, Department of Community Medicine, University of Nigeria; 3Department of Obstetrics and Gynecology, University of Nigeria Teaching Hospital, Enugu, Nigeria; 4Department of Obstetrics and Gynecology, Mile Four Catholic Hospital, Abakaliki, Nigeria Background: Intermittent preventive treatment of malaria for pregnant women (IPTp is a very important strategy for the control of malaria in pregnancy in malaria-endemic tropical countries, where mosquito bites easily occur during evening outdoor activities. Issues related to provision, cost, and acceptability may affect the use of IPTp in some developing countries. The aim of the study was to assess the uptake and adherence to sulphadoxine-pyrimethamine-based intermittent preventive treatment of malaria during pregnancy and the relationship of IPTp use to pregnancy outcomes in two major obstetric centers in South East Nigeria. Methods: This was a prospective descriptive study involving women who received antenatal and delivery services. All recruited women were followed-up from booking until delivery, and statistical analysis was done with Epi Info version 7. Results: A total of 516 parturients were studied. The mean gestational age at booking was 21.8±6.9 weeks while the mean number of antenatal visits throughout the pregnancy was 5.5±3.1. The rate of uptake of at least one dose of prescribed IPTp was 72.1% (367/516. Of the 367 who took prescribed IPTp, adherence to second doses of IPTp was 59.7% (219/367, and only 4.9% (18/367 took a third dose. Clinical malaria occurred in 85% (127/149 of women who did not receive IPTp at all compared to 20.5% of those who received at least one dose of IPTp. All those who had clinical malaria despite IPTp had only one

  17. EFFICACY OF COMPLEX NEUROREHABILITATION OF PATIENTS WITH A POST-STROKE ARM PARESIS WITH THE USE OF A BRAIN-COMPUTER INTERFACE+EXOSKELETON SYSTEM

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    A. A. Frolov

    2016-01-01

    1.05 points in the comparison group, p<0.001. Conclusion: Rehabilitation of patients with post-stroke paresis with the use of BCI+exoskeleton led not also to a decrease in neurological deficit and an improvement of the paretic arm motor function, but also improved parameters of daily activities. Further studies of the effects of BCI+exoskeleton rehabilitation procedures on the course of motor function restoration are planned.

  18. Wallerian degeneration of the corticodescending tract in the cerebral peduncle following a supratentorial cerebrovascular lesion detected by MRI; The relationship between Wallerian degeneration at the center of the cerebral peduncle and functional recovery of paresis

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    Waragai, Masaaki; Iwabuchi, Sadamu (Nanasawa Rehabilitation Hospital, Kanagawa (Japan))

    1993-11-01

    We studied Wallerian degeneration of the corticodescending tract in the cerebral peduncle following a supratentorial cerebrovascular lesion by MRI. A total of 57 patients with palsy following a supratenotorial cerebrovascular lesion were prospectively studied. Wallerian degeneration was detected as a high signal intensity (HSI) in 37 patients between 70 days and 100 days after the onset, but not detected in the remaining 27 patients. Patient with as HSI in all areas of the cerebral peduncle had a large lesion involving the hemisphere. Patient with an HSI at the center of the cerebral peduncle had a lesion confined to the paracentral gyrus, precentral gyrus, corona radiata or posterior limb of the internal capsule. Patient with an HSI at the lateral side of the cerebral peduncle had a lesion of parietal lobe or temporal lobe which spares the corticospinal tract originating from the paracentral gyrus, precentral gyrus, corona radiata or posterior limb of the internal capsule. These findings suggest that as HSI at the center of the cerebral peduncle may reveal Wallerian degeneration of the corticospinal tract, and an HSI at the lateral side of the cerebral peduncle may show Wallerian degeneration of the corticopontine tract. The functional recovery of paresis was poor in all patients with an HSI at the center of the cerebral peduncle, while it was good in all patients without an HSI in that region. Our data suggested that somatotopical localization of the corticodescending tract in the cerebral peduncle may be identified by detecting Wallerian degeneration following a supratentorial lesion, and the functional recovery of patients with paresis could be predicted according to presence or absence of Wallerian degeneration at the center of the cerebral peduncle. (author).

  19. Dexmedetomidine for an awake fiber-optic intubation of a parturient with Klippel-Feil syndrome, Type I Arnold Chiari malformation and status post released tethered spinal cord presenting for repeat cesarean section

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    Tanmay H. Shah

    2011-08-01

    Full Text Available Patients with Klippel-Feil Syndrome (KFS have congenital fusion of their cervical vertebrae due to a failure in the normal segmentation of the cervical vertebrae during the early weeks of gestation and also have myriad of other associated anomalies. Because of limited neck mobility, airway management in these patients can be a challenge for the anesthesiologist. We describe a unique case in which a dexmedetomidine infusion was used as sedation for an awake fiber-optic intubation in a parturient with Klippel-Feil Syndrome, who presented for elective cesarean delivery. A 36-yearold female, G2P1A0 with KFS (fusion of cervical vertebrae who had prior cesarean section for breech presentation with difficult airway management was scheduled for repeat cesarean delivery. After obtaining an informed consent, patient was taken in the operating room and non-invasive monitors were applied. Dexmedetomidine infusion was started and after adequate sedation, an awake fiberoptic intubation was performed. General anesthetic was administered after intubation and dexmedetomidine infusion was continued on maintenance dose until extubation. Klippel-Feil Syndrome (KFS is a rare congenital disorder for which the true incidence is unknown, which makes it even rare to see a parturient with this disease. Patients with KFS usually have other congenital abnormalities as well, sometimes including the whole thoraco-lumbar spine (Type III precluding the use of neuraxial anesthesia for these patients. Obstetric patients with KFS can present unique challenges in administering anesthesia and analgesia, primarily as it relates to the airway and dexmedetomidine infusion has shown promising result to manage the airway through awake fiberoptic intubation without any adverse effects on mother and fetus.

  20. An evaluation of the effect of age and the peri-parturient period on bone metabolism in dairy cows as measured by serum bone-specific alkaline phosphatase activity and urinary deoxypyridinoline concentration.

    Science.gov (United States)

    Sato, Reiichiro; Onda, Ken; Kato, Hajime; Ochiai, Hideharu; Kawai, Kazuhiro; Iriki, Tsunenori; Kaneko, Kazuyuki; Yamazaki, Yukio; Wada, Yasunori

    2013-08-01

    Various biochemical markers help to evaluate the state of bone turnover in humans and could be used during the peri-parturient period in dairy cows when calcium (Ca) metabolism changes dramatically. To investigate this, the peri-partum characteristics of serum bone-specific alkaline phosphatase (BAP) and urinary deoxypyridinoline (DPD) were investigated. Both serum BAP activity and urinary DPD concentrations were increased and demonstrated wide variability in younger animals, and these findings were consistent with other bone turnover markers. Around the time of parturition, serum Ca concentration and serum BAP activity in multiparous cows were significantly lower than in primiparous cows, but urinary DPD concentration was unchanged. The use of BAP as a bone formation marker appears to be valuable for evaluating bone remodelling status in cows, but the specificity of the test needs to be confirmed. The DPD/BAP ratio around parturition demonstrated a clear difference in bone turnover status between the two parity groups with multiparous cows demonstrating increased signs of bone resorption compared with primiparous cows, corresponding to the Ca requirement for milk production. In future studies, the applicability of the ratio of bone resorption marker to bone formation marker should be evaluated for bone turnover assessment. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Representações sociais e decisões das gestantes sobre a parturição: protagonismo das mulheres Pregnant women's social representations and decisions about delivery: women's protagonism

    Directory of Open Access Journals (Sweden)

    Raquel da Rocha Pereira

    2011-09-01

    Full Text Available O objetivo central deste estudo foi compreender, a partir das representações sociais femininas, o protagonismo da mulher na decisão sobre a parturição. Por meio de pesquisa qualitativa com abordagem fenomenológica, foram entrevistadas 45 gestantes, no último trimestre da gravidez, que realizavam pré-natal nos sistemas público e privado de saúde de Joinville, Santa Catarina. A análise de conteúdo dos relatos possibilitou emergirem três categorias empíricas: medos e preocupações; vivências e influência sociocultural. Com esse substrato teórico-metodológico, analisou-se a representação social da mulher no processo da parturição, que é simbolizado por conflitos de sentimentos, dúvidas e apreensões originadas principalmente pelo medo do sofrimento imposto pela dor. Tal concepção é apoiada pelo modelo biomédico e pela mídia. A parturição no Brasil, como que "terceirizada", é culturalmente entendida como uma etapa complexa que requer conhecimentos especializados, que legitima o saber técnico-científico em detrimento do fisiológico, reforçando assim a assimetria do poder de decisão entre médico e gestante. Além disso, o desconhecimento das mulheres grávidas sobre o significado, o impacto e os benefícios da etapa da parturição para o recém-nascido deixa-as inseguras e sem o devido senso crítico sobre o conteúdo de outras fontes de informações, como telenovelas, histórias de outras mulheres construídas pelo meio social e a própria experiência em partos anteriores. Isso gera um comportamento de dúvidas e apreensões. Fragilizada, submete-se a uma cesárea programada para evitar a dor física e emocional provocada pelos medos. A reversão desse quadro perpassa por uma revisão na formação do médico e pelas ações de empoderamento da mulher.The main objective of this study was to understand, based on female social representations, women's protagonism concerning the decision about child delivery

  2. Diagnosis of functional (psychogenic paresis and weakness

    Directory of Open Access Journals (Sweden)

    Savkov V.S.

    2018-03-01

    Full Text Available Functional (conversion neurological symptoms represent one of the most common situations faced by neurologists in their everyday practice. Among them, acute or subacute functional weakness may mimic very prevalent conditions such as stroke or traumatic injury. In the diagnosis of functional weakness, although elements of the history are helpful, physical signs are often of crucial importance in the diagnosis and positive signs are as important as absence of signs of disease. Hence, accurate and reliable positive signs of functional weakness are valuable for obtaining timely diagnosis and treatment, making it possible to avoid unnecessary or invasive tests and procedures up to thrombolysis. Functional weakness commonly presents as weakness of an entire limb, paraparesis, or hemiparesis, with observable or demonstrable inconsistencies and non-anatomic accompaniments. Documentation of limb movements during sleep, the arm drop test, the Babinski’s trunk-thigh test, Hoover tests, the Sonoo abductor test, and various dynamometer tests can provide useful bedside diagnostic information on functional weakness. We therefore present here a brief overview of the positive neurological signs of functional weakness available, both in the lower and in the upper limbs; but none should be used in isolation and must be interpreted in the overall context of the presentation. It should be borne in mind that a patient may have both a functional and an organic disorder.

  3. From Paresis to PANDAS and PANS

    Science.gov (United States)

    ... 8 items) Schizophrenia (21 items) Populations Children and Adolescents (12 items) Diversity and Ethnic Groups (5 items) Women’s Mental Health (1 item) Military Service Members (4 items) Global Mental Health (2 items) Prevention Prevention (7 items) Suicide Prevention (16 items) Research ...

  4. Assistência à parturiente por enfermeiras obstétricas no Projeto Midwifery: um relato de experiência Atención a la parturienta por parte de enfermeras obstetricas en el Proyecto Midwifery: uno relato de experiencia The care to the parturient provided by obstetric nurses in the Midifery Project: an experience report

    Directory of Open Access Journals (Sweden)

    Rejane Marie Barbosa Davim

    2002-10-01

    Full Text Available Este estudo destaca os modelos assistenciais de enfermagem que valorizam a mulher no processo do trabalho de parto, parto e nascimento. Descreve a assistência humanizada prestada à parturiente por enfermeiras obstétricas no Projeto Midwifery de uma maternidade escola. Ressalta que a prática desses modelos possibilita a participação ativa do enfermeiro no processo de trabalho de parto, parto e nascimento, proporcionando, fundamentalmente, satisfação à parturiente e ao profissional.Este estudio destaca los modelos asistenciales de enfermería que valoran la mujer en el proceso de trabajo de parto, parto y nacimiento. Describe la atención humanizada prestada a la parturienta por enfermeras obstétricas en el Proyecto Midwifery de una maternidad escuela. Resalta que la práctica de estos modelos facilita la participación activa de lo enfermero en el proceso de trabajo de parto, parto y nacimiento, ofreciendo, fundamentalmente, satisfacción a la parturienta y al profesional.This study focuses on the nursing care models that value the woman in childbirth process. Authors described the humanized care provided to the parturient by obstetric nurses in the "Midwifery Project" developed at a University Maternity Hospital. They emphasized that the practice of these models enable the nurse's active participation in the childbirth process, resulting in the satisfaction of the parturient and of the professional.

  5. Oral Supplementation of Parturient Mothers with Vitamin D and Its Effect on 25OHD Status of Exclusively Breastfed Infants at 6 Months of Age: A Double-Blind Randomized Placebo Controlled Trial.

    Science.gov (United States)

    Naik, Prasanna; Faridi, M M A; Batra, Prerna; Madhu, S V

    2017-12-01

    Exclusively breastfed infants are at increased risk of vitamin D deficiency and many lactating mothers have been found deficient in 25OHD stores. To compare serum vitamin D levels in exclusively breastfed infants at 6 months of age with or without oral supplementation of 600,000 IU of vitamin D3 to mothers in early postpartum period. Exclusively breastfeeding term parturient mothers were randomized 24-48 hours following delivery to receive either 600,000 IU of vitamin D3 (Cholecalciferol) over 10 days in a dose of 60,000 IU/day or placebo. 25OHD levels were measured by Radio Immuno Assay method at recruitment and after 6 months in all mothers and their infants. Urinary calcium and creatinine ratio was measured to monitor adverse effects of vitamin D3 in both mothers and infants at 14 weeks and 6 months of age. X-ray of both wrists in anteroposterior view and serum alkaline phosphatase of infants were done in both groups at 6 months of age to look for evidence of rickets. Maternal profile was similar in intervention (A) and control (B) groups. Mothers' serum 25OHD levels at recruitment were also similar being 16.2 ± 9.3 ng/mL in group A and 14.1 ± 7.1 ng/mL in group B. After 6 months, 25OHD levels were 40.3 ± 21.6 and 22.9 ± 20.1 ng/mL in group A and group B mothers (p ≤ 0.00), respectively. The serum 25OHD levels in cord blood were 9.9 ± 5.7 and 8.9 ± 5.1 ng/mL, respectively, in infants born to mothers in intervention and control groups (p = 0.433). At 6 months of age, the serum 25OHD levels significantly (p vitamin D3. Serum 25OHD levels of exclusively breastfed infants significantly rise at 6 months of age when their mothers are orally supplemented with 60,000 IU of vitamin D3 daily for 10 days in the early postpartum period in comparison to infants of vitamin D3 unsupplemented mothers.

  6. Anesthesia for parturient with renal transplantation

    Directory of Open Access Journals (Sweden)

    Beena K Parikh

    2012-01-01

    Full Text Available Management of successful pregnancy after renal transplantation is a unique challenge to nephrologist, obstetrician, and anesthesiologist, as these patients have altered physiology and are immune-compromised. We present the anesthetic management of three postrenal transplant patients scheduled for cesarean section. While conducting such cases, cardiovascular status, hematological status, and function of transplanted kidney should be assessed thoroughly. Side effects of immunosuppressant drugs and their interaction with anesthetic agents should be taken into consideration. Main goal of anesthetic management is to maintain optimum perfusion pressure of renal allograft to preserve its function.

  7. Anesthesia for the parturient with cardiovascular disease

    African Journals Online (AJOL)

    QuickSilver

    closed mitral commissurotomies for severe congestive heart failure due to mitral .... chycardia, as the time required for left ventricular diastolic filling is prolonged. ..... Patent ductus arteriosus (PDA) accounts for 15% of all cases of congenital ...

  8. Mammary gland pathologies in the parturient buffalo

    Directory of Open Access Journals (Sweden)

    G N Purohit

    2014-12-01

    Full Text Available Parturition related mammary gland pathologies in the buffalo appear to be low on accord of anatomic (longer teat length, thicker streak canal and physiologic (lower cisternal storage of secreted milk, lower milk production differences with cattle. Hemolactia, udder edema and hypogalactia usually occur in the buffalo due to physiologic changes around parturition however mastitis involves pathologic changes in the udder and teats; the incidence of mastitis is however lower compared to cattle. The incidence and therapy of hemolactia, udder edema and hypogalactia are mentioned and the risk factors, incidence, diagnosis, therapy and prevention for mastitis in buffalo are also described.

  9. Vivenciando a experiência da parturição em um modelo assistencial humanizado Viviendo la experiencia de la parturición en un modelo asistencial humanizado Living the birth process in a humanized assistance model

    Directory of Open Access Journals (Sweden)

    Larissa Mandarano da Silva

    2011-02-01

    Full Text Available Tratou-se de um estudo qualitativo baseado na abordagem fenomenológica com o objetivo de compreender as experiências de puérperas que vivenciaram o trabalho de parto e o parto em um modelo assistencial humanizado. Os dados foram coletados em um hospital localizado na cidade de São Paulo, onde foram entrevistadas oito puérperas. Da análise dos dados surgiram os temas: Suportando o trabalho de parto e Tendo a oportunidade de resgatar a autonomia, e o fenômeno desvelado foi "Vivendo a ambiguidade da parturição em um modelo assistencial humanizado". Os relatos evidenciaram sentimentos como dor, medo e ansiedade, porém, possibilitou a participação e resgate da autonomia. Embora o estudo tenha sido realizado em um modelo assistencial considerado humanizado, as experiências das puérperas revelam que ainda se distanciam de uma efetiva humanização, conforme seus princípios. Este estudo pode ser utilizado para nortear ações educativas voltadas à humanização e gerar mudanças assistenciaisEste es un estudio cualitativo con abordaje fenomenológica con la finalidad de comprender las experiencias de puerperas que vivieron el trabajo de parto y el parto en la asistencia humanizada. La colecta de los dados ocurrio en un hospital en la ciudad de São Paulo, donde fuera entrevistadas ocho mujeres en el periodo post-partum. De la analisis de los dados surgieron los temas: Soportando el trabajo de parto y Tiendo la oportunidad de rescatar la autonomía, siendo desvelado lo fenómeno "Viviendo la ambigüedad de la parturición en un modelo asistencial humanizado". Los relatos evidenciaron sentimientos relacionados a dolor, miedo y ansiedad, pero, posibilitou la participación y rescate de la autonomía. Aunque el estudio tener sido realizad en la asistencia humanizada, las experiencias de las puérperas fueram distantes de los principios de la asistencia humanizada. El actual estudio puede nortear aciones educativas al parto direccionadas para

  10. O processo de parir assistido pela enfermeira obstétrica no contexto hospitalar: significados para as parturientes El proceso de parto asistido por la enfermera obstétrica en el contexto hospitalario: significados para las parturientes The process of giving birth assisted by obstetrician nurse in a hospital context: mean for the parturients

    Directory of Open Access Journals (Sweden)

    Eliz Cristine Maurer Caus

    2012-03-01

    expresión, aprendizaje, presencia que da seguridad y ánimo en las horas más temibles. El dolor es muy mencionado, seguida de la satisfacción por el nacimiento saludable. Se concluye que la parturienta asistida por la enfermera obstétrica percibe una vía de comunicación intersubjetiva abierta para el encuentro, proporcionándole mecanismos de llamadas-respuestas indispensables al cuidado de sí y del recién nacido.Convergent-Services Program researches, that aimed to understand the meaning of what the parturient attributes to the process of giving birth assisted by a nurse, to the light of the Humanistic Theory and identify the contributions of this process to promote humanistic care. Data were collected in a public maternity hospital in Santa Catarina, with nine pregnant women, being obtained through dialogue lived during the implementation process of the Phenomenological Nursing. The analysis followed steps of apprehension, synthesis, theory and transfer, from which emerged the central category: the being-parturient recognizes in the obstetric nurse a differentiated caretaker, evidencing that its performance means respect to the femininity, gentleness, freedom of speech, learning, reassuring presence and courage in the most feared time. The pain is strongly referred, followed by the satisfaction for the healthy birth. It is concluded that the parturient attended by the obstetric nurse notices an intersubjective channel opened for the encounter, providing its mechanisms of indispensable call-answers under the care of yourself and of the newborn.

  11. Vestibular system paresis due to emergency endovascular catheterization

    Directory of Open Access Journals (Sweden)

    Simoceli, Lucinda

    2012-01-01

    Full Text Available Objective: The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case: Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing loss to the right and crippling vertigo, without focal neurological signals. To the otorhinolaryngological clinical examination it presented: Test of Weber lateralized for the left, spontaneous nystagmus for the left, marches rocking, has taken normal disbasia and ataxia, index-nose and diadochokinesia, Test of Romberg with oscillation without fall and Fukuda with lateral shunting line for the right. The audiometric examination evidenced deafness to the right and sensorineural loss to the left in sharps, areflexia initial to the right in caloric test e, the computerized tomography of the secular bones and brainstem, presence of metallic connecting rod crossing the right secular bone, from the vein internal jugular vein and bulb jugular vein, crossing the posterior, superior and vestibule semicircular canals, projecting itself in temporal lobe. The radiological diagnoses was traumatic injury for guide to endovascular metallic during catheterization of urgency and the behavior, considering that the patient had not compensated the balance, it was vestibular rehabilitation. Conclusion: Complaints of giddiness in the aged patient must be closely evaluated of its pathological clinical description because the antecedents of illnesses and previous treatments, in general, direct the diagnostic hypotheses however they can bring unexpected alterations.

  12. Vestibular system paresis due to emergency endovascular catheterization.

    Science.gov (United States)

    Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

    2012-04-01

     The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case: Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing loss to the right and crippling vertigo, without focal neurological signals. To the otorhinolaryngological clinical examination it presented: Test of Weber lateralized for the left, spontaneous nystagmus for the left, marches rocking, has taken normal disbasia and ataxia, index-nose and diadochokinesia, Test of Romberg with oscillation without fall and Fukuda with lateral shunting line for the right. The audiometric examination evidenced deafness to the right and sensorineural loss to the left in sharps, areflexia initial to the right in caloric test e, the computerized tomography of the secular bones and brainstem, presence of metallic connecting rod crossing the right secular bone, from the vein internal jugular vein and bulb jugular vein, crossing the posterior, superior and vestibule semicircular canals, projecting itself in temporal lobe. The radiological diagnoses was traumatic injury for guide to endovascular metallic during catheterization of urgency and the behavior, considering that the patient had not compensated the balance, it was vestibular rehabilitation.  Complaints of giddiness in the aged patient must be closely evaluated of its pathological clinical description because the antecedents of illnesses and previous treatments, in general, direct the diagnostic hypotheses however they can bring unexpected alterations.

  13. Vestibular system paresis due to emergency endovascular catheterization

    OpenAIRE

    Simoceli, Lucinda; Sguillar, Danilo Anunciatto; Santos, Henrique Mendes Paiva; Caputti, Camilla

    2012-01-01

    Summary Objective:?The objective of this story of case is to describe an uncommon cause of associated peripheral Vestibulopathy to the unilateral auditory loss in aged patient after catheterization of urgency. Story of case:?Patient of the masculine sort, 82 years, submitted to the correction of abdominal ragged aneurism of aorta, in the intra-operative suffered heart attack acute from the myocardium needing primary angioplasty. High after hospital it relates to complaint of accented hearing ...

  14. Estudo das variações dos níveis de retinol no colostro humano de parturientes a termo e pré-termo Study of retinol level variations of human colostrum among parturient women with term and pre-term newborns

    Directory of Open Access Journals (Sweden)

    Illana Louise Pereira de Melo

    2004-09-01

    Full Text Available OBJETIVOS: analisar as variações dos níveis de retinol no colostro de parturientes a termo e pré-termo. MÉTODOS: foram analisadas amostras de leite de 78 lactantes, sendo metade delas mães de recém-nascidos prematuros. As amostras de colostro foram obtidas por expressão manual de uma mama, até 72 horas após o parto, no turno vespertino e no início da mamada, até atingir um volume de 2,0 ml. A determinação do retinol foi realizada por cromatografia líquida de alta eficiência e os resultados foram submetidos à análise estatística através do teste t de Student. RESULTADOS: o valor médio do retinol no colostro de mães a termo (n = 39 e pré-termo (n = 39 foram, respectivamente, 89,4 ± 46,1 mig/dL e 55,6 ± 27,7 mig/dL. A diferença entre as médias foi estatisticamente significante (p OBJECTIVES: to analyze retinol levels variations in the colostrum of term and pre-term parturient women. METHODS: colostrum samples of 78 lactating women, half of which were mothers of premature newborns, were analyzed. The samples were manually extracted from one breast until 2.0 ml were obtained. They were collected up to 72 hours after birth, during the morning hours and right before nursing. Retinol levels were determined by high-performance liquid chromatography and analyzed by the T-test for means comparison. RESULTS: the mean retinol values in the colostrums of women with term (n = 39 and pre-term newborns (n = 39 were 89,4 ± 46,1 mug/dL and 55,6 ± 27,7 mug/dL, respectively. The difference of means was considered statistically significant at (p < 0,001. Human milk meets the need for Vitamin A in the term newborn. However, for the premature newborn, it only supplied 66% of the needs. CONCLUSIONS: results suggest that exclusive use of human milk does not meet the needs of pre-term newborn completely and that a Vitamin A supplement for the mother is necessary in order to reduce Vitamin A risk deficiency.

  15. 麻痹性痴呆患者认知功能障碍与精神行为症状的随访研究%Cognitive impairment and psychotic symptoms in patients with general paresis of insane: a follow-up study

    Institute of Scientific and Technical Information of China (English)

    陈贲; 彭琪; 李丽娟; 宁玉萍; 施海姗; 钟笑梅; 侯乐; 王华丽; 王艳华; 陈辛茹; 罗新妮; 吴章英

    2017-01-01

    Objective To investigate the characteristics of cognitive impairment and psychotic symptoms in general paresis of insane (GPI) before and after penicillin therapy, and explore factors that may predict the clinical outcomes. Methods Thirty patients with GPI were recruited. All GPI patients underwent a comprehensive neuropsychological assessment before receiving penicillin therapy, and returned for follow-up visits after 7 months. The severity of dementia was determined by Clinical Dementia Rating Scale (CDR), cognitive functions were assessed by Mini Mental State Examination (MMSE) and Alzheimer 's Disease Assessment Scale-cognitive subscale (ADAS-Cog), ability of daily living was assessed by Instrumental Activities of Daily Living Scale (IALD) and Physical Self maintenance Scale(PSMS), behavioral and psychological symptoms were assessed by Neuropsychiatric Inventory (NPI). Aqueous crystalline penicillin G 24 million units per day was administered as continuous infusion for 14 days, followed by benzathine penicillin 2.4 million units IM once per week for 3 weeks. Patients returned for follow-up visits after 7 months. Clinical outcomes were determined by the improvement of neuropsychological test scores at the end of the treatment. Grouped by CDR scores, changes in neuropsychological tests scores among different GPI groups were used to explore the correlation between severity of dementia and clinical outcomes. Univariate analysis and multivariate linear regression analysis were used to identify factors that may predict the clinical outcomes. Results (1)After penicillin therapy, GPI patients' MMSE scores(14.4± 6.9 vs.17.1 ± 9.1)and IADL scores(4.0(2.0, 5.0)vs.6.0(2.0, 7.3))both improved significantly(t=5.820, Z=3.710, P1,significant change was found only in total scores of NPI (t=-3.772,P1.0分)患者治疗前后各量表评分的变化;采用相关分析、多元线性逐步回归分析GPI患者预后相关的因素.结果 (1)GPI患者MMSE总分[(14.4±6.9)

  16. Perfil das parturientes e seus recém-nascidos atendidos em um hospital-escola do Noroeste do Estado do Paraná Perfil de las parturientas y sus recién nacidos atendidos en un hospital escuela del noroeste del Estado de Paraná Profile of parturients and their newborn babies receiving care in a university hospital in northwestern Paraná

    Directory of Open Access Journals (Sweden)

    Gisele Ferreira da Silva

    2009-03-01

    demostrar la posibilidad de utilizar el SINASC como uno de los instrumentos de evaluación de la salud en una unidad terciaria y proponer intervenciones capaces de prevenir la morbimortalidad materno-infantil.The study had the purpose to outline the profile of parturients and their newborn babies receiving care in a school hospital, based on the Live Birth Information System - Sistema de Informações sobre Nascidos Vivos - SINASC. For so, a descriptive, exploratory study was elaborated, identifying the characteristics of all the parturients and their newborns receiving care at Hospital Universitário de Maringá - HUM in 2006. It was observed that 27.1% of the parturients were adolescents, 68.4% had no partner, 59.3% lived outside Maringá, and 63.6% had seven or more pre-natal appointments. The ratio of cesarian sections was 50.4%. The newborns, mostly, had good vitality at birth, although 25.5% were preterms and 23.6% had low weight at birth. With the results, it was possible to outline the profile of the parturients and their newborns receiving care at the HUM, show the possibility of using the SINASC as an instrument of health evaluation in tertiary units and propose interventions capable of preventing maternal-child morbimortality.

  17. The febrile parturient: choice of anesthesia | Kuczkowski | Southern ...

    African Journals Online (AJOL)

    Southern African Journal of Anaesthesia and Analgesia. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 8, No 5 (2002) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF ...

  18. The pattern of obstructed labour among parturients in a tertiary ...

    African Journals Online (AJOL)

    ... seen in the developed world but remains very prevalent in the developing world. ... Methods: This retrospective study was based on analysis of medical records of ... Obstetrics Unit of the University of Port Harcourt Teaching Hospital, Nigeria, ...

  19. Anaesthetic Challenges in a High Risk Parturient with Myasthenia ...

    African Journals Online (AJOL)

    The prevalence of myasthenia gravis is low. The management implications of this disease in pregnant women are very challenging for anaesthetists. The objective is to highlight some of the challenges, the management and the lessons learnt during the management of this patient. This is a case report of a 31-year old ...

  20. The febrile parturient: choice of anesthesia | Kuczkowski | Southern ...

    African Journals Online (AJOL)

    Abstract. No Abstratct. Key words: Pregnancy, Fever, Infection, Herpes simplex virus, Hepatitis, Human immunodeficiency virus, Urinary tract infections, Chorioamnionitis, Pneumonia, Septic shock, Anesthesia; regional, general, Epidural analgesia and maternal fever ...

  1. Postpartum Practices of Parturient Women in Enugu, South East ...

    African Journals Online (AJOL)

    Annals of Medical and Health Sciences Research | Jan-Mar 2013 | Vol 3 | Issue 1 |. 47. Address for ... and finally, a period of depression and altered self image.[4]. In Nigeria and .... cause for great concern in our poor resource setting with a.

  2. Incidence and Determinants of Stillbirth amongst Parturients in Two ...

    African Journals Online (AJOL)

    Journal of Basic and Clinical Reproductive Sciences · January - June 2014 · Vol 3 · Issue 1. 15 ... Conclusion: The fetal mortality (stillbirth) rate was low and the determinants were identified. Public ... conception, irrespective of the duration of pregnancy and .... tract infection (UTI), anemia, diabetes mellitus, antepartum.

  3. Anaesthesia for parturients with severe cystic fibrosis: a case series.

    LENUS (Irish Health Repository)

    Deighan, M

    2014-02-01

    Cystic fibrosis affects 1 in 1600-2500 live births and is inherited in an autosomal recessive manner. It primarily involves the respiratory, gastrointestinal and reproductive tracts, with impaired clearance of, and obstruction by, increasingly viscous secretions. Severe respiratory disease, diabetes and gastro-oesophageal reflux may result. Improvements in medical management and survival of cystic fibrosis patients means more are committing to pregnancies. Although guidance for anaesthesia in this patient group is available, management and outcome data associated with more severe cases are sparse. Patients with severe cystic fibrosis require multidisciplinary input and should be managed in a tertiary referral centre. Close monitoring of respiratory function and preoperative optimisation during pregnancy are mandatory. The risk of preterm labour and delivery is increased. Pregnancy and delivery can be managed successfully, even in patients with FEV1 <40% predicted. Neuraxial anaesthesia and analgesia should be the technique of choice for delivery. Postoperative care should be carried out in a critical care setting with the provision of postoperative ventilation if necessary.

  4. Post -Episiotomy Morbidity amongst Parturients at the University of ...

    African Journals Online (AJOL)

    Alasia Datonye

    because of the deviation of attention after a successful delivery .... (figure 2). 30% of respondents had the episiotomy affecting their sexual life with dyspareunia .... This alone provides a good ground for ... Routine versus Selective Episiotomy.

  5. Postpartum Practices of Parturient Women in Enugu, South East ...

    African Journals Online (AJOL)

    Twenty five percent [25.2% (106/420)] of the women drank various forms of alcoholic beverages to induce lactation while 80.2% (337/420) of the women applied hot compresses on the lower abdomen to aid lochia drainage and involution of the uterus, 75% (315/420) of the women sat in hot water salt (Nacl) solution (sitz ...

  6. anaesthetic challenges in a high risk parturient with myasthenia

    African Journals Online (AJOL)

    2013-10-10

    Oct 10, 2013 ... Intraoperative myasthenia crisis was managed with neostigmine infusion. She was managed in ... but world-wide, it is twice as common in women as in men and frequently .... could be a challenge when they present for surgery. The ideal anaesthetic ... intravenous opioids, neuromuscular blocking drugs,.

  7. Anaesthetic Challenges In An Untreated Grave's Disease Parturient ...

    African Journals Online (AJOL)

    Alasia Datonye

    of heat and sweated excessively. There were associated ... diarrhoea and polyphagia with progressive weight loss. She did ... She had a spontaneous vaginal delivery of a male baby at home 3 years .... The conduction of tracheal anaesthesia ...

  8. Prevalence of Hepatitis B virus infection amongst parturients in the ...

    African Journals Online (AJOL)

    Background: Hepatitis B virus (HBV) infection is endemic in Nigeria and indeed the whole of Sub-Saharan Africa. The Society of Gastroenterology and Hepatology in Nigeria (SOGHIN) recommends HBV screening for all Nigerians to pave way for early detection and treatment of the infection in those who are infected and ...

  9. Parturients' need of continuous labor support in labor wards

    African Journals Online (AJOL)

    Administrator

    Continuous labor support is practiced in different parts of the world. In Ethiopia ... Objective: The purpose of the study was to assess the attitude of women in response to labor support based at institutional ... The reasons given for wanting companion were emotional ..... mothers play vital role in labor and delivery while men.

  10. Parturients' Awareness and Perception of Benefits of Breast Feeding ...

    African Journals Online (AJOL)

    associated with similar dental erosion to that of formula and more than that of plain cow milk.19 In addition, this is also sequel to the issue of rampant caries associated with night breastfeeding whereby mothers leave the breast nipple in the mouth of the infants to comfort them while they sleep, and this feeding method or ...

  11. Conduta anestésica em cesariana em gestante com aneurisma intracraniano não roto Conducta anestésica en cesárea en embarazada con aneurisma cerebral íntegro Anesthetic conduct in cesarean section in a parturient with unruptured intracranial aneurysm

    Directory of Open Access Journals (Sweden)

    Luciana de Souza Cota Carvalho

    2009-12-01

    refuten la anestesia general o regional en ese contexto. Por lo tanto, la decisión de cuál técnica utilizar, debe ser usada con bases individuales, mensurado los riesgos y los beneficios de cada procedimiento y la experiencia del profesional que la llevará a cabo.BACKGROUND AND OBJECTIVES: The anesthetic management of a parturient with unruptured intracranial aneurysm scheduled to undergo cesarean section is interesting, since it has several particularities associated with pregnancy-related physiologic changes that are associated with the risk of aneurismal rupture during the anesthetic procedure. Studies on this subject are rare in the literature and, therefore, the dissemination of those cases is important. CASE REPORT: This is a 31-year old female at term with unruptured intracranial aneurysm scheduled for cesarean section under epidural block. The procedure evolved without maternal or fetal intercurrences. CONCLUSIONS: Evidence-based recommendations for obstetric anesthesia in patients with unruptured intracranial aneurysm are lacking. Experimental or clinical data confirming or refuting general anesthesia or regional blocks in this context do not exist. Thus, the decision of which technique should be used is individual, considering the risks and benefits of each procedure and the experience of the anesthesiologist.

  12. Care cost for pregnant and parturient women with diabetes and mild hyperglycemia Costo de la asistencia de gestantes y parturientas diabéticas y con hiperglicemia leve Custo da assistência de gestantes e parturientes diabéticas e com hiperglicemia leve

    Directory of Open Access Journals (Sweden)

    Ana Claudia Molina Cavassini

    2012-04-01

    Full Text Available OBJECTIVE: To compare inpatient and outpatient care costs for pregnant/parturient women with diabetes and mild hyperglycemia. METHODS: A prospective observational quantitative study was conducted in the Perinatal Diabetes Center in the city of Botucatu, Southeastern Brazil, between 2007 and 2008. Direct and indirect costs and disease-specific costs (medications and tests were estimated. Thirty diet-treated pregnant women with diabetes were followed up on an outpatient basis, and 20 who required insulin therapy were hospitalized. RESULTS: The cost of diabetes disease (prenatal and delivery care was US$ 3,311.84 for inpatients and US$ 1,366.04 for outpatients. CONCLUSIONS: Direct and indirect costs as well as total prenatal care cost were higher for diabetic inpatients while delivery care costs and delivery-postpartum hospitalization were similar. Prenatal and delivery-postpartum care costs were higher for these patients compared to those paid by Brazilian National Health System.OBJETIVO: Comparar costos de hospitalización y de atención por ambulatorio en gestantes/parturientas diabéticas y con hiperglicemia leve. MÉTODOS: Estudio observacional, prospectivo, cuantitativo descriptivo realizado en centro de diabetes perinatal en Botucatu, Sureste de Brasil, entre 2007 y 2008. Se estimaron los costos por absorción directos e indirectos disponibles en la institución y los costos específicos para la enfermedad (medicamentos y exámenes. Las 30 gestantes diabéticas tratadas con dieta fueron acompañadas en ambulatorio y 20 tratadas con dieta más insulina fueron hospitalizadas. RESULTADOS: El costo de la enfermedad diabetes (para asistencia prenatal y parto fue de US$ 3,311.84 para las gestantes hospitalizadas y de US$ 1,366.04 para las acompañadas en ambulatorio. CONCLUSIONES: Los costos directos e indirectos y el costo total de la asistencia prenatal fueron más elevados en las gestantes diabéticas hospitalizadas mientras que los costos de

  13. Measuring the energy spent by parturient women in fasting and in ingesting caloric replacement (HONEY Mensuración de la energia despendida en el ayuno y en el aporte calórico (MIEL en parturientas Mensuração da energia despendida no jejum e no aporte calórico (MEL em parturientes

    Directory of Open Access Journals (Sweden)

    Célia Regina Maganha e Melo

    2007-08-01

    Full Text Available This research aims to measure the energy spending in parturient women of low gestation risk. Participants were selected randomly and submitted to fasting (n=15; Group I or honey ingestion (n=15; Group II. Data were collected by means of capillary blood values and heart frequency monitoring. The paired t-test with a 5% significance level and Tukey's method were used in statistical analysis. The results showed that honey ingestion did not promote an overload in the mother's glucose; the lactate response demonstrated that the substrate offered was well used; the cardiorespiratory rate demonstrated good performance for both groups; the total energy spent during labor demonstrated that carbohydrate ingestion exerts significant influence, improving maternal anaerobic performance; the group which remained in fasting presented, immediately after labor, higher levels of lactate, showing the organism's efforts to compensate for the energy spent.Este estudio tiene como objetivo mensurar el gasto energético de parturientas de bajo riesgo de gestación. Las participantes han sido seleccionadas en dos grupos de manera aleatoria y sometidas a ayuno (n=15; Grupo I e ingestión de miel (n=15; Grupo II. Los datos han sido colectados a partir de los valores de la sangre capilar y monitor de frecuencia cardíaca. Para el análisis estadística han sido empleados el test t pareado, y el método de Tukey. Los resultados han mostrado que la ingestión de miel no provocó sobrecarga en la glicemia materna; la respuesta del lactato demostró que el substrato ofrecido fue bien utilizado; los índices de capacidad cardiorrespiratoria han demostrado buen desempeño para los dos grupos; el gasto energético total durante el trabajo de parto demuestra que la ingestión de carbohidrato tiene influencia significativa, mejorando el desempeño anaeróbico materno; el grupo que ha permanecido en ayuno presentó, inmediatamente después del parto, niveles de lactato más altos

  14. Utilização de técnicas de respiração e relaxamento para alívio de dor e ansiedade no processo de parturição Utilización de técnicas de respiración y relajación para el alivio del dolor y de la ansiedad en el proceso de parto The use of respiration and ralaxation techniques for pain and anxiety relief in the parturition process

    Directory of Open Access Journals (Sweden)

    Nilza Alves Marques Almeida

    2005-02-01

    Full Text Available Objetivou-se avaliar o efeito de técnicas de respiração e de relaxamento sobre a dor e a ansiedade, na parturição. Dezessete primigestas (grupo controle - GC receberam assistência de rotina e dezenove (grupo experimental - GE foram orientadas e estimuladas a realizar técnicas de respiração e relaxamento. Avaliou-se a dor, através da escala analógica visual, e a ansiedade, através dos inventários de ansiedade-traço e estado. A intensidade de dor aumentou com a evolução do trabalho de parto para ambos os grupos. O nível de ansiedade na fase latente foi baixo para ambos os grupos; na fase ativa foi médio para o GC e baixo para o GE; na fase de transição foi médio e, no pós-parto, imediato, foi baixo, para ambos os grupos. Concluiu-se que as técnicas utilizadas não reduziram a intensidade de dor, mas promoveram ao GE a manutenção de nível baixo de ansiedade por maior tempo da parturição.La finalidad de este estudio fue evaluar el efecto de técnicas de respiración y relajación sobre el dolor y la ansiedad durante el parto. Diecisiete primerizas (grupo control-GC recibieron asistencia de rutina y diecinueve (grupo de experimento-GE fueron orientadas y estimuladas a realizar técnicas de respiración y relajación. Se evaluó el dolor a través de la escala analógica visual y la ansiedad a través de los inventarios de ansiedad-apariencia y estado. La intensidad del dolor aumentó con la evolución del trabajo de parto para ambos grupos. El nivel de la ansiedad, en la fase latente, fue bajo para ambos grupos; en la fase activa fue medio para el GC y bajo para el GE; en la fase de transición fue medio y, en el post parto inmediato, bajo para ambos grupos. Se llegó a la conclusión de que las técnicas utilizadas no redujeron la intensidad del dolor, pero sí promovieron al GE el mantenerse en un nivel bajo de ansiedad por mayor tiempo en el parto.This study aimed to evaluate the effect of respiration and relaxation

  15. Concentração plasmática do hormônio adrenocorticotrófico de parturientes submetidas a método não farmacológico de alívio da ansiedade e dor do parto Concentración de la hormona adrenocorticotrófica en parturientas sometidas a un método no farmacológico de alivio de ansiedad y el dolor durante el parto Corticotrophin hormone serum levels of parturients submitted to nonpharmacologic anxiety and pain relief method during labor

    Directory of Open Access Journals (Sweden)

    Nilza Alves Marques Almeida

    2005-04-01

    Full Text Available Objetivo: analisar os níveis séricos do hormônio adrenocorticotrófico (ACTH e a correlação entre esses níveis, a ansiedade e a dor na parturição. Dezessete parturientes (grupo controle - GC receberam assistência de enfermagem de rotina, e dezenove (grupo experimental - GE foram estimuladas e orientadas a realizar técnicas de respiração e relaxamento. Os níveis plasmáticos do ACTH, o traço e estado de ansiedade e a intensidade de dor foram avaliados. Os níveis de ACTH foram baixos no início do trabalho de parto, com pico no final e regressão no pós-parto imediato, sem diferença estatisticamente significativa entre os grupos. A redução do ACTH com alívio parcial do estresse do GE, sugere a interferência das técnicas de respiração e relaxamento. Os níveis do ACTH, não se correlacionaram à ansiedade e à dor, em ambos os grupos.La finalidad de este estudio fue analizar los niveles séricos de la hormona adrenocorticotrófica (ACTH, la correlación entre esos niveles, la ansiedad y el dolor en el parto. Diecisiete parturientas (grupo control - GC recibieron atención de enfermería de rutina y diecinueve (grupo experimento - GE fueron preparadas y orientadas a realizar técnicas de respiración y relajación. Los niveles de la ACTH, el trazo y estado de ansiedad y la intensidad del dolor fueron evaluados. Los niveles de la ACTH fueron bajos en el inicio del trabajo de parto, con elevación en el final y regresión en el postparto inmediato, sin diferencia estadísticamente significativa entre los grupos. La reducción de la ACTH con alivio parcial del stress del GE, sugiere la interferencia de las técnicas de respiración y relajación. Los niveles de la ACTH no se correlacionaron ni con la ansiedad ni con el dolor, en ambos grupos.This study aimed to analyze the plasma ACTH levels and the correlation between the ACTH levels and pain and anxiety during the parturition. Seventeen parturients received routine nursing

  16. Low cortisol levels in blood from dairy cows with ketosis: a field study.

    Science.gov (United States)

    Forslund, Kristina B; Ljungvall, Orjan A; Jones, Bernt V

    2010-05-20

    An elevated plasma glucose concentration has been considered to be a potential risk factor in the pathogenesis of left-displaced abomasums (DA). Therefore the present study was performed to investigate if spontaneous disease (parturient paresis, metritis, ketosis etc) in dairy cows results in elevated concentrations of glucose and cortisol in blood as cortisol is the major regulator of glucose in ruminants. Cortisol, insulin, beta-hydroxybutyric acid (BHBA), non esterified fatty acids (NEFA), and serum calcium were analyzed in blood serum and glucose, in whole blood, from 57 spontaneously diseased cows collected at different farms. The cows were grouped according to the disease; parturient paresis, recumbent for other reasons, mastitis, metritis, ketosis, inappetance and others. No elevated concentrations of cortisol or glucose were found in cows with metritis and mastitis but both cortisol and glucose were elevated in cows stressed by recumbency. Cows with ketonemia (BHBA > 1.5 mmol/l) did not have low concentration of glucose in blood but significantly low levels of cortisol. Some of these cows even had cortisol concentrations below the detection limit of the analysing method (ketosis, recommending glucocorticoids, insulin etc. However further studies of this problem are needed to understand why cows with ketosis have low levels of cortisol and normal levels of glucose. To what extent elevated cortisol and glucose levels in hypocalcemic and recumbent cows are involved in the ethiology and /or the pathogenesis of DA also will need further research.

  17. Local cortical hypoperfusion imaged with CT perfusion during postictal Todd's paresis

    Energy Technology Data Exchange (ETDEWEB)

    Mathews, Marlon S.; Binder, Devin K. [University of California, Department of Neurological Surgery, Irvine, CA (United States); Smith, Wade S. [University of California, Department of Neurology, San Francisco, CA (United States); Wintermark, Max; Dillon, William P. [University of California, Department of Radiology, San Francisco, CA (United States)

    2008-05-15

    Postictal ('Todd's') paralysis, or 'epileptic hemiplegia,' is a well-known complication of focal or generalized epileptic seizures. However, it is unclear whether the pathophysiology of Todd's paralysis is related to alterations in cerebral perfusion. We report CT perfusion findings in a patient presenting with postictal aphasia and right hemiparesis. A 62-year-old woman with a history of alcohol abuse, closed head injury and posttraumatic epilepsy, presented with acute onset aphasia and right hemiparesis. A non-contrast head CT scan demonstrated no acute hemorrhage. Left hemispheric ischemia was suspected, and the patient was considered for acute thrombolytic therapy. MRI revealed a subtle increase in signal intensity involving the left medial temporal, hippocampal and parahippocampal regions on both T2-weighted FLAIR and diffusion-weighted sequences. CT angiography and CT perfusion study were performed. The CT perfusion study and CT angiography demonstrated a dramatic reduction in cerebral blood flow and blood volume involving the entire left hemisphere, but with relative symmetry of mean transit time, ruling out a large vessel occlusion. Clinical resolution of the aphasia and hemiparesis occurred within a few hours, and correlated with normalization of perfusion to the left hemisphere (detected by MR perfusion). This unique case is the first in which clinical evidence of Todd's paralysis has been correlated with reversible postictal hemispheric changes on CT and MR perfusion studies. This is important because CT perfusion study is being used more and more in the diagnosis of acute stroke, and one needs to be careful to not misinterpret the data. (orig.)

  18. Local cortical hypoperfusion imaged with CT perfusion during postictal Todd's paresis

    International Nuclear Information System (INIS)

    Mathews, Marlon S.; Binder, Devin K.; Smith, Wade S.; Wintermark, Max; Dillon, William P.

    2008-01-01

    Postictal (''Todd's'') paralysis, or ''epileptic hemiplegia,'' is a well-known complication of focal or generalized epileptic seizures. However, it is unclear whether the pathophysiology of Todd's paralysis is related to alterations in cerebral perfusion. We report CT perfusion findings in a patient presenting with postictal aphasia and right hemiparesis. A 62-year-old woman with a history of alcohol abuse, closed head injury and posttraumatic epilepsy, presented with acute onset aphasia and right hemiparesis. A non-contrast head CT scan demonstrated no acute hemorrhage. Left hemispheric ischemia was suspected, and the patient was considered for acute thrombolytic therapy. MRI revealed a subtle increase in signal intensity involving the left medial temporal, hippocampal and parahippocampal regions on both T2-weighted FLAIR and diffusion-weighted sequences. CT angiography and CT perfusion study were performed. The CT perfusion study and CT angiography demonstrated a dramatic reduction in cerebral blood flow and blood volume involving the entire left hemisphere, but with relative symmetry of mean transit time, ruling out a large vessel occlusion. Clinical resolution of the aphasia and hemiparesis occurred within a few hours, and correlated with normalization of perfusion to the left hemisphere (detected by MR perfusion). This unique case is the first in which clinical evidence of Todd's paralysis has been correlated with reversible postictal hemispheric changes on CT and MR perfusion studies. This is important because CT perfusion study is being used more and more in the diagnosis of acute stroke, and one needs to be careful to not misinterpret the data. (orig.)

  19. Dry Needle Acupuncture In Locomotory Paresis Post Column Trauma In Dog – Case Study

    Directory of Open Access Journals (Sweden)

    Calin Hulea

    2013-05-01

    Full Text Available In this case study a dog from Timisoara, Romania, 4 years old, female, victim of an accident was taken in therapy. The dog was examined clinically and radiographically. Major clinical sign was that dog unable to lift the hindquarters and in terms of radiographic fracture was identified in the lumbar spine at L1 vertebra, which led to the displacement of spinal canal and compression of the spinal cord. Treatment was established through the dry needle acupuncture technique perpendicular insertion into (Bladder channel, BL acupoints, in our case BL: -18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30; 40; 47, 48, 49, 50, 51, 52, 53, 54 and respectively 60, for 30 minutes a session / day, consecutively, for 60 days treatment period. Treatment outcomes showed a clear increase in skin and neural sensitivity of the area, finally animal being recovered.

  20. Efficacy of brain-computer interface-driven neuromuscular electrical stimulation for chronic paresis after stroke.

    Science.gov (United States)

    Mukaino, Masahiko; Ono, Takashi; Shindo, Keiichiro; Fujiwara, Toshiyuki; Ota, Tetsuo; Kimura, Akio; Liu, Meigen; Ushiba, Junichi

    2014-04-01

    Brain computer interface technology is of great interest to researchers as a potential therapeutic measure for people with severe neurological disorders. The aim of this study was to examine the efficacy of brain computer interface, by comparing conventional neuromuscular electrical stimulation and brain computer interface-driven neuromuscular electrical stimulation, using an A-B-A-B withdrawal single-subject design. A 38-year-old male with severe hemiplegia due to a putaminal haemorrhage participated in this study. The design involved 2 epochs. In epoch A, the patient attempted to open his fingers during the application of neuromuscular electrical stimulation, irrespective of his actual brain activity. In epoch B, neuromuscular electrical stimulation was applied only when a significant motor-related cortical potential was observed in the electroencephalogram. The subject initially showed diffuse functional magnetic resonance imaging activation and small electro-encephalogram responses while attempting finger movement. Epoch A was associated with few neurological or clinical signs of improvement. Epoch B, with a brain computer interface, was associated with marked lateralization of electroencephalogram (EEG) and blood oxygenation level dependent responses. Voluntary electromyogram (EMG) activity, with significant EEG-EMG coherence, was also prompted. Clinical improvement in upper-extremity function and muscle tone was observed. These results indicate that self-directed training with a brain computer interface may induce activity- dependent cortical plasticity and promote functional recovery. This preliminary clinical investigation encourages further research using a controlled design.

  1. Acoustic neuroma: predominance of Antoni type B cells in tumors of patients with vestibular paresis.

    NARCIS (Netherlands)

    Stipkovits, E.M.; Graamans, K.; Jansen, G.H.; Velthof, M.A.

    2001-01-01

    OBJECTIVE: This study aimed to investigate whether in patients with acoustic neuroma (AN), the presence or absence of vestibular symptoms is related to the histologic characteristics of the tumor. STUDY DESIGN: The study design was a retrospective clinical study. SETTING: The study was conducted at

  2. Ipsilateral Brachial Plexus Block and Hemidiaphragmatic Paresis as Adverse Effect of a High Thoracic Paravertebral Block

    NARCIS (Netherlands)

    Renes, Steven H.; van Geffen, Geert J.; Snoeren, Miranda M.; Gielen, Matthieu J.; Groen, Gerbrand J.

    Background: Thoracic paravertebral block is regularly used for unilateral chest and abdominal surgery and is associated with a low complication rate. Case Reports: We describe 2 patients with an ipsilateral brachial plexus block with Horner syndrome after a high continuous thoracic paravertebral

  3. Factors affecting fecal egg counts in peri-parturient Katahdin ewes and their lambs

    Science.gov (United States)

    Selection for low fecal egg counts (FEC) can be used to genetically enhance resistance to gastrointestinal nematode parasites in growing lambs, thereby reducing the frequency of use of anthelmintics, facilitating marketing of organic lamb, and reducing the risk of development of anthelmintic resista...

  4. Anesthetic management of a parturient with Guillain-Barre syndrome posted for emergency caesarian section

    Directory of Open Access Journals (Sweden)

    Abhijit Paul

    2012-01-01

    Full Text Available We report the anesthetic management of a case of Guillain-Barre syndrome in the 34 th week of gestation coming for an emergency Cesarean section. The perioperative anesthetic challenges have been discussed with emphasis on the medical and anesthetic management which includes the use of plasma-pheresis, intravenous gamma-globulin, and the safety of preservative free 0.75% isobaric ropivacaine, which was administered intrathecally in this difficult medical condition with excellent hemodynamic, maternal, and fetal outcome. The sensory and motor blocks achieved were well suited to the clinical risks and conditions.

  5. Headache in the parturient: Pathophysiology and management of post-dural puncture headache

    Directory of Open Access Journals (Sweden)

    Gita Nath

    2011-01-01

    Full Text Available Headache in the postpartum period is common and multifactorial in origin. Apart from primary causes such as tension headaches and migraine, secondary headaches such as post-dural puncture headache (PDPH are increasingly common because of increasing use of regional anaesthesia and analgesia during childbirth. Preventive measures for PDPH include the use of smaller gauge pencil-point needles for spinal blocks; epidural needles of 18 G or less; using saline rather than air for epidural space identification and the use of ultrasound guidance, especially for difficult cases such as morbid obesity and spinal deformities. In case of accidental dural puncture (ADP, the choice is between inserting the catheter in an adjacent space or intrathecal catheterization. Current evidence seems to be in favour of inserting the epidural catheter into the subarachnoid space and using the intrathecal catheter for analgesia/anaesthesia after prominently labelling it as intrathecal, to prevent misuse. It should be removed after at least 24 hours and a 10 ml bolus of saline injected before removal of catheter may be helpful. Either way, having written protocols for the management of accidental dural puncture helps to reduce the incidence of PDPH. PDPH can be disabling in severity and can mar the whole experience of childbirth. In addition, severe untreated PDPH can cause complications such as nerve palsies, subdural hematoma and cerebral venous thrombosis. Conservative methods of treatment should be tried first such as adequate hydration, paracetamol, caffeine, sumatriptan or ACTH/hydrocortisone. Epidural blood patching is the most effective treatment for PDPH. It is more effective if done 24-48 hours after dural puncture. It is an invasive procedure with its own complications as well as a failure rate of up to 30%, so that a second or even third patch may be necessary. Both these facts should be intimated to the patient beforehand. Meticulous follow-up and evaluation of these patients is an important responsibility of the obstetric and anaesthetic team. Persistent headache, loss of the postural nature of the headache, altered sensorium, onset of focal neurological deficits and seizures are all features necessitating further investigation including neuroradiological imaging.

  6. Gene expression of estrogen and oxytocin receptors in the uterus of pregnant and parturient bitches

    Energy Technology Data Exchange (ETDEWEB)

    Veiga, G.A.L. [Departamento de Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP (Brazil); Milazzotto, M.P. [Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Santo André, SP (Brazil); Nichi, M.; Lúcio, C.F.; Silva, L.C.G.; Angrimani, D.S.R.; Vannucchi, C.I. [Departamento de Reprodução Animal, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP (Brazil)

    2015-02-13

    In the canine species, the precise mechanisms of pregnancy maintenance and the initiation of parturition are not completely understood. The expression of genes encoding the receptors for estrogen (ERα mRNA) and oxytocin (OTR mRNA) was studied in the endometrium and myometrium during pregnancy and parturition in dogs. Real-time PCR was performed to quantify the levels of ERα mRNA and OTR mRNA in the uterus of bitches during early (up to 20 days of gestation), mid (20 to 40 days) and late pregnancy (41 to 60 days), and parturition (first stage of labor). All tissues expressed ERα and OTR mRNA, and are thus possibly able to respond to eventual estrogen and oxytocin hormonal stimuli. No statistically significant differences in the expression of ERα mRNA were verified in the endometrium and myometrium throughout pregnancy and parturition, but expression of OTR mRNA increased at both parturition and late pregnancy. We concluded that the increase of endometrial and myometrial OTR mRNA expression in dogs is not an event dependent on estrogenic stimulation. Moreover, the contractility response of the canine uterus to oxytocin begins during pregnancy and maintains myometrial activity. The expression of OTR mRNA in canine uterine tissues varied over time, which supports an interpretation that the sensitivity and response to hormone therapy varies during the course of pregnancy and labor. Further studies are needed to elucidate the factors underlying the synthesis of uterine oxytocin receptors and the possible role of ERβ rather than ERα in the uterine tissues during pregnancy and parturition in dogs.

  7. Coxiella burnetii associated placental lesions and infection level in parturient cows

    DEFF Research Database (Denmark)

    Hansen, Mette Sif; Rodolakis, Annie; Cochonneau, Denis

    2011-01-01

    Cotyledons (n=170) from dairy cattle were analysed for Coxiella burnetii by real-time (rt) PCR targeting the IS1111a and icd genes. Positive cases (n=90) and a random selection of negative cases (n=20) were examined by histology, immunohistochemistry and, if infection level was high, by fluoresce......Cotyledons (n=170) from dairy cattle were analysed for Coxiella burnetii by real-time (rt) PCR targeting the IS1111a and icd genes. Positive cases (n=90) and a random selection of negative cases (n=20) were examined by histology, immunohistochemistry and, if infection level was high...

  8. Gene expression of estrogen and oxytocin receptors in the uterus of pregnant and parturient bitches

    International Nuclear Information System (INIS)

    Veiga, G.A.L.; Milazzotto, M.P.; Nichi, M.; Lúcio, C.F.; Silva, L.C.G.; Angrimani, D.S.R.; Vannucchi, C.I.

    2015-01-01

    In the canine species, the precise mechanisms of pregnancy maintenance and the initiation of parturition are not completely understood. The expression of genes encoding the receptors for estrogen (ERα mRNA) and oxytocin (OTR mRNA) was studied in the endometrium and myometrium during pregnancy and parturition in dogs. Real-time PCR was performed to quantify the levels of ERα mRNA and OTR mRNA in the uterus of bitches during early (up to 20 days of gestation), mid (20 to 40 days) and late pregnancy (41 to 60 days), and parturition (first stage of labor). All tissues expressed ERα and OTR mRNA, and are thus possibly able to respond to eventual estrogen and oxytocin hormonal stimuli. No statistically significant differences in the expression of ERα mRNA were verified in the endometrium and myometrium throughout pregnancy and parturition, but expression of OTR mRNA increased at both parturition and late pregnancy. We concluded that the increase of endometrial and myometrial OTR mRNA expression in dogs is not an event dependent on estrogenic stimulation. Moreover, the contractility response of the canine uterus to oxytocin begins during pregnancy and maintains myometrial activity. The expression of OTR mRNA in canine uterine tissues varied over time, which supports an interpretation that the sensitivity and response to hormone therapy varies during the course of pregnancy and labor. Further studies are needed to elucidate the factors underlying the synthesis of uterine oxytocin receptors and the possible role of ERβ rather than ERα in the uterine tissues during pregnancy and parturition in dogs

  9. Anesthetic implications of emergent Cesarean section in a parturient with Noonan syndrome and bacterial endocarditis.

    Science.gov (United States)

    Chase, Charles J; Holak, Elena J; Pagel, Paul S

    2013-08-01

    Noonan syndrome is a relatively common genetically transmitted disorder characterized by facial, cardiac, and musculoskeletal abnormalities. The management of a 27 year old woman with Noonan syndrome at 23 weeks' gestation, presenting with premature labor, who required an emergent Cesarean section for placental abruption, is discussed. In addition to Noonan syndrome, this patient had bacterial endocarditis involving the mitral and aortic valves. The anesthetic implications of Noonan syndrome and endocarditis during pregnancy are presented. © 2013 Elsevier Inc. All rights reserved.

  10. Evaluating Midwives Communication Skills from the Perspective of Parturient Women Attending to Hospitals for Delivery

    OpenAIRE

    Maryam Sadat Katebi; Talat Khadivzadeh; Zohre Sepehri Shamloo; Habibolah Esmaily

    2017-01-01

    Background & aim: Communication is a fundamental human need. Medical students and healthcare professionals must be attuned to the needs of patients using effective communication skills. With regards to medical training, currently the focus is on theoretical matters and communication skills are taken for granted. This problem has caused miscommunication with patients referred to teaching hospitals. We conducted this study to assess communication skills of midwives from the perspective of partu...

  11. Postoperative pain control in the parturient: new challenges in the new millennium.

    Science.gov (United States)

    Kuczkowski, Krzysztof M

    2011-02-01

    In the new millennium, the horizons of modern anesthesia practice continue to expand beyond the provision of surgical anesthesia to encompass areas outside of the operating room, including preoperative evaluation, labor analgesia, postanesthesia care, critical care and acute and chronic pain management. Adequate postoperative analgesia following caesarean delivery hastens ambulation, decreases maternal morbidity, improves patient outcome, and facilitates care of the newborn. There is currently no "gold standard" for post-cesarean pain management. The number of options is large and the choice of the method of pain control is determined by drug availability, institutional protocols, individual preferences, available resources, and financial considerations. This article provides an overview of the currently available methods of post-cesarean analgesia.

  12. [Anaesthesic management of vaginal delivery in a parturient with C1 esterase deficiency].

    Science.gov (United States)

    Libert, N; Schérier, S; Dubost, C; Franck, L; Rouquette, I; Tortosa, J-C; Rousseau, J-M

    2009-04-01

    Hereditary and acquired angioedema (HAE/AAE) are the clinical translation of a qualitative or a quantitative deficit of C1 esterase inhibitor (C1 INH). The frequency and severity of clinical manifestations vary greatly, ranging from a moderate swelling of the extremities to obstruction of upper airway. Anaesthesiologists and intensivists must be prepared to manage acute manifestations of this disease in case of life-threatening laryngeal edema. Surgery, physical trauma and labour are classical triggers of the disease. The anaesthesiologists should be aware of the drugs used as prophylaxis and treatment of acute attacks when considering labour and caesarean section. Androgens are contraindicated during pregnancy. If prophylaxis is required, tranexamic acid may be used with caution. The safest obstetric approach appears to be to administer a predelivery infusion of C1 INH concentrate. It is important to avoid manipulation of the airway as much as possible by relying on regional techniques. We report the case of a patient suffering from an HAE discovered during pregnancy. The management included administration of C1 INH during labor and early epidural analgesia for pain relief. A short review of the pathophysiology and therapeutic options follows.

  13. Anaesthetic consideration for caesarean delivery of a parturient without ′The Master Gland′

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    Tuhin Mistry

    2015-01-01

    Full Text Available We are presenting the management of a patient posted for elective caesarean delivery who conceived after ovulation induction and in vitro fertilisation, 20 years after postsurgical hypopituitarism. She had uneventful pregnancy and delivered a healthy baby by caesarean section under general anaesthesia.

  14. Gene expression of estrogen and oxytocin receptors in the uterus of pregnant and parturient bitches.

    Science.gov (United States)

    Veiga, G A L; Milazzotto, M P; Nichi, M; Lúcio, C F; Silva, L C G; Angrimani, D S R; Vannucchi, C I

    2015-04-01

    In the canine species, the precise mechanisms of pregnancy maintenance and the initiation of parturition are not completely understood. The expression of genes encoding the receptors for estrogen (ERα mRNA) and oxytocin (OTR mRNA) was studied in the endometrium and myometrium during pregnancy and parturition in dogs. Real-time PCR was performed to quantify the levels of ERα mRNA and OTR mRNA in the uterus of bitches during early (up to 20 days of gestation), mid (20 to 40 days) and late pregnancy (41 to 60 days), and parturition (first stage of labor). All tissues expressed ERα and OTR mRNA, and are thus possibly able to respond to eventual estrogen and oxytocin hormonal stimuli. No statistically significant differences in the expression of ERα mRNA were verified in the endometrium and myometrium throughout pregnancy and parturition, but expression of OTR mRNA increased at both parturition and late pregnancy. We concluded that the increase of endometrial and myometrial OTR mRNA expression in dogs is not an event dependent on estrogenic stimulation. Moreover, the contractility response of the canine uterus to oxytocin begins during pregnancy and maintains myometrial activity. The expression of OTR mRNA in canine uterine tissues varied over time, which supports an interpretation that the sensitivity and response to hormone therapy varies during the course of pregnancy and labor. Further studies are needed to elucidate the factors underlying the synthesis of uterine oxytocin receptors and the possible role of ERβ rather than ERα in the uterine tissues during pregnancy and parturition in dogs.

  15. Low cortisol levels in blood from dairy cows with ketosis: a field study

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    Jones Bernt V

    2010-05-01

    Full Text Available Abstract Background An elevated plasma glucose concentration has been considered to be a potential risk factor in the pathogenesis of left-displaced abomasums (DA. Therefore the present study was performed to investigate if spontaneous disease (parturient paresis, metritis, ketosis etc in dairy cows results in elevated concentrations of glucose and cortisol in blood as cortisol is the major regulator of glucose in ruminants. Methods Cortisol, insulin, β-hydroxybutyric acid (BHBA, non esterified fatty acids (NEFA, and serum calcium were analyzed in blood serum and glucose, in whole blood, from 57 spontaneously diseased cows collected at different farms. The cows were grouped according to the disease; parturient paresis, recumbent for other reasons, mastitis, metritis, ketosis, inappetance and others. Results No elevated concentrations of cortisol or glucose were found in cows with metritis and mastitis but both cortisol and glucose were elevated in cows stressed by recumbency. Cows with ketonemia (BHBA > 1.5 mmol/l did not have low concentration of glucose in blood but significantly low levels of cortisol. Some of these cows even had cortisol concentrations below the detection limit of the analysing method ( Conclusions The study gives patho-physiological support to the treatment strategies of ketosis, recommending glucocorticoids, insulin etc. However further studies of this problem are needed to understand why cows with ketosis have low levels of cortisol and normal levels of glucose. To what extent elevated cortisol and glucose levels in hypocalcemic and recumbent cows are involved in the ethiology and /or the pathogenesis of DA also will need further research.

  16. A thalamic-fronto-parietal structural covariance network emerging in the course of recovery from hand paresis after ischemic stroke

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    Eugenio eAbela

    2015-10-01

    Full Text Available Aim: To describe structural covariance networks of grey matter volume (GMV change in 28 patients with first-ever stroke to the primary sensorimotor cortices, and to investigate their relationship to hand function recovery and local GMV change.Methods: Tensor based morphometry maps derived from high resolution structural images were subject to principal component analyses to identify the networks. We calculated correlations between network expression and local GMV change, sensorimotor hand function and lesion volume. To verify which of the structural covariance networks of GMV change have a significant relationship to hand function we performed an additional multivariate regression approach.Results: Expression of the second network, explaining 9.1% of variance, correlated with GMV increase in the medio-dorsal (md thalamus and hand motor skill. Patients with positive expression coefficients were distinguished by significantly higher GMV-increase of this structure during stroke recovery. Significant nodes of this network were located in md thalamus, dorsolateral prefrontal cortex and higher order sensorimotor cortices. Parameter of hand function had a unique relationship to the network and depended on an interaction between network expression and lesion volume. Inversely network expression is limited in patients with large lesion volumes.Conclusions: Chronic phase of sensorimotor cortical stroke has been characterized by a large scale covarying structural network in the ipsilesional hemisphere associated specifically with sensorimotor hand skill. Its expression is related to GMV-increase of md thalamus, one constituent of the network, and correlated with the cortico-striato-thalamic loop involved in control of motor execution and higher order sensorimotor cortices. A close relation between expression of this network with degree of recovery might indicate reduced compensatory resources in the impaired subgroup.

  17. [Depressor anguli oris sign (DAO) in facial paresis. How to search it and release the smile (technical note)].

    Science.gov (United States)

    Labbé, D; Bénichou, L; Iodice, A; Giot, J-P

    2012-06-01

    After facial paralysis recovery, it is common to note a co-contraction between depressor anguli oris (DAO) muscle and zygomatic muscles. This DAO co-contraction will "obstruct" the patient's smile. The purpose of this technical note is to show how to find the DAO sign and how to free up the smile. TECHNICAL: This co-contraction between the zygomatic muscles and DAO research is placing a finger on marionette line, asking the patient to smile: we perceive a rope under the skin corresponding to the abnormal contraction and powerful DAO. A diagnostic test with lidocaine injection into the DAO can be performed to confirm the diagnosis. The treatment of pathological DAO's contraction can be by injection of botulinum toxin in the DAO, or by surgical myectomy. In all cases, a speech therapy complete the treatment. The DAO sign is a semiological entity easy to find. His treatment releases smile without negative effect on the facial expression as the DAO is especially useful in the expression of disgust. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  18. Pulmonary effects of bupivacaine, ropivacaine, and levobupivacaine in parturients undergoing spinal anaesthesia for elective caesarean delivery: a randomised controlled study

    NARCIS (Netherlands)

    Lirk, P.; Kleber, N.; Mitterschiffthaler, G.; Keller, C.; Benzer, A.; Putz, G.

    2010-01-01

    BACKGROUND: Spinal anaesthesia is the method of choice for elective caesarean delivery, but has been reported to worsen dynamic pulmonary function when using bupivacaine. Similar investigations are lacking for ropivacaine and levobupivacaine. We have therefore compared the pulmonary effects of

  19. Low-dose spinal-epidural anesthesia for Cesarean section in a parturient with uncontrolled hyperthyroidism and thyrotoxic heart disease.

    Science.gov (United States)

    Liao, Zhimin; Xiong, Yaqin; Luo, Linli

    2016-08-01

    A 29-year-old woman at 34 weeks' gestation with uncontrolled hyperthyroidism and thyrotoxic heart disease was admitted to urgency Cesarean section. After preoperative sedation and good communication, low-dose spinal anesthesia (7.5 mg 0.5 % bupivacaine) combined with epidural anesthesia (6 ml 2 % lidocaine) was performed through L3-4 inter-vertebral. Opioids were given intravenously to the mother for sedation after delivery of the baby. Satisfactory anesthesia and sedation was provided during surgery. The mother and the neonate were safe and no special complication was found after surgery. Our case demonstrated that low-dose spinal anesthesia combined with epidural anesthesia with intravenous opioids can provide satisfactory anesthesia and sedation, and reduce the risk of heart failure and thyroid storm.

  20. Amino acid composition of parturient plasma, the intervillous space of the placenta and the umbilical vein of term newborn infants

    Directory of Open Access Journals (Sweden)

    J.S. Camelo Jr.

    2004-05-01

    Full Text Available The objective of the present study was to determine the levels of amino acids in maternal plasma, placental intervillous space and fetal umbilical vein in order to identify the similarities and differences in amino acid levels in these compartments of 15 term newborns from normal pregnancies and deliveries. All amino acids, except tryptophan, were present in at least 186% higher concentrations in the intervillous space than in maternal venous blood, with the difference being statistically significant. This result contradicted the initial hypothesis of the study that the plasma amino acid levels in the placental intervillous space should be similar to those of maternal plasma. When the maternal venous compartment was compared with the umbilical vein, we observed values 103% higher on the fetal side which is compatible with currently accepted mechanisms of active amino acid transport. Amino acid levels of the placental intervillous space were similar to the values of the umbilical vein except for proline, glycine and aspartic acid, whose levels were significantly higher than fetal umbilical vein levels (average 107% higher. The elevated levels of the intervillous space are compatible with syncytiotrophoblast activity, which maintain high concentrations of free amino acids inside syncytiotrophoblast cells, permitting asymmetric efflux or active transport from the trophoblast cells to the blood in the intervillous space. The plasma amino acid levels in the umbilical vein of term newborns probably may be used as a standard of local normality for clinical studies of amino acid profiles.

  1. Initial non-opioid based anesthesia in a parturient having severe aortic stenosis undergoing cesarean section with aortic valve replacement

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    Subrata Podder

    2015-01-01

    Full Text Available Pregnancy in presence of severe aortic stenosis (AS causes worsening of symptoms needing further intervention. In the advanced stages of pregnancy, some patients may even require aortic valve replacement (AVR and cesarean delivery in the same sitting. Opioid based general anesthesia for combined lower segment cesarean section (LSCS with AVR has been described. However, the use of opioid may lead to fetal morbidity and need of respiratory support for the baby. We describe successful anesthetic management for LSCS with AVR in a >33 week gravida with severe AS and congestive heart failure. We avoided opioids till delivery of the baby AVR; the delivered neonate showed a normal APGAR score.

  2. Challenges that Hinder Parturients to Deliver in Health Facilities: A Qualitative Analysis in Two Districts of Indonesia

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    Sudirman Nasir

    2016-12-01

    Full Text Available Background: There are many challenges women face to be able to give birth in health facilities in many parts of Indonesia. This study explores the roles and observations of close-to-community maternal health providers and other community members on potential barriers faced by women to deliver in health facilities in two districts within The Archipelago. Methods: Employing an explorative qualitative approach, 110 semi-structured interviews and 7 focus group discussions were conducted in 8 villages in Southwest Sumba, in the East Nusa Tenggara province, and in 8 villages in Cianjur, in the West Java province. The participants included village midwives, Posyandu kader (village health volunteers, traditional birth attendants (TBAs, mothers, men, village heads and district health officials. Results: The main findings were mostly similar in the two study areas. However, there were some key differences. Preference for TBA care, traditional beliefs, a lack of responsiveness of health providers to local traditions, distance, cost of travel and indirect costs of accompanying family members were all barriers to patients attending health facilities for the birth of their child. TBAs were the preferred health providers in most cases due to their close proximity at the time of childbirth and their adherence to traditional practices during pregnancy and delivery. Conclusions: Improving collaborations between midwives and TBAs, and responsiveness to traditional practices within health facilities and effective health promotion campaigns about the benefits of giving birth in health facilities may increase the use of health facilities in both study areas.

  3. Randomized controlled trial of tranexamic acid among parturients at increased risk for postpartum hemorrhage undergoing cesarean delivery.

    Science.gov (United States)

    Sujata, Nambiath; Tobin, Raj; Kaur, Ranjeet; Aneja, Anjila; Khanna, Mona; Hanjoora, Vijay M

    2016-06-01

    To assess the effects of tranexamic acid among patients undergoing cesarean delivery who were at high risk of postpartum hemorrhage. Between August 1, 2012, and April 30, 2013, a randomized controlled trial was performed at a tertiary care center in India. Women undergoing an elective or emergency cesarean delivery who were at high risk for postpartum hemorrhage were enrolled. They were randomly assigned using sealed, opaque envelopes to receive 10mg/kg tranexamic acid or normal saline 10min before skin incision. Anesthesiologists were not masked to group assignment, but patients and obstetricians were. The primary outcome was need for additional uterotonic drugs within 24h after delivery. Analyses were by intention to treat. Thirty patients were assigned to each group. Additional uterotonic drugs were required in 7 (23%) patients assigned to tranexamic acid and 25 (83%) patients in the control group (Ptranexamic acid, administered before skin incision, significantly reduced the requirement for additional uterotonics among women at increased risk for postpartum hemorrhage. Clinical Trials Registry India: CTRI/2015/05/005752. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  4. [Regional anaesthesia for labor adn delivery in a parturient with neuropathy with liability to pressure palsy (tomaculous neuropathy)].

    Science.gov (United States)

    Berdai, S; Benhamou, D

    2004-10-01

    Tomaculous neuropathy (or hereditary neuropathy with liability to pressure palsy [HNLPP]) is a rare and hereditary disease which incidence has probably been underestimated. It is characterised by demyelination resulting in numbness and weakness after nerve pressure, injury or stretch. Despite a well-documented genetic pathophysiologic mechanism, implications for anaesthesia in patients with HNLPP are only speculative and the use of regional anaesthesia is debatable. We report here the case of a patient with HNLPP who was followed during two consecutive pregnancies in the same hospital and for whom an expert of the SOS-RA hotline service was consulted before each delivery. For the first delivery, epidural analgesia was performed for labour pain control but a caesarean section was necessary because of failure to progress (0.0625% bupivacaine with 0.2 microg/ml sufentanil for labour then 2% lidocaine with adrenaline for surgery). Two years later, the patient was again seen for a preanaesthetic visit because elective Caesarean section was planned. Spinal anaesthesia using hyperbaric bupivacaine and sufentanil was used. Both deliveries were uneventful and there were no neurologic complaints in the postpartum periods.

  5. História da parturição no Brasil, século XIX

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    Anayansi Correa Brenes

    1991-06-01

    Full Text Available A presente pesquisa objetivou resgatar as particularidades da constituição da Arte Obstétrica no Brasil do século XIX, quando, por edital de Dom João VI, é incluída nas disciplinas que inauguram as escolas de medicina e cirurgia, na Bahia e Rio de Janeiro, em 1808. Para realizar a pesquisa foram revistas 83 teses médicas obstétricas - produzidas tanto na Bahia quanto no Rio de Janeiro - no século XIX. Verificou-se que, tradicionalmente, esta Arte era realizada por mulheres denominadas "aparadeiras" ou "comadres", que assistiam as mulheres, seja no trabalho de parto e nos cuidados pré e pós-parto, quanto em outras circunstâncias, tais como doenças venéreas e abortos. A entrada dos médicos-parteiros nesta prática inaugurou, não só o esquadrinhamento do corpo feminino, como a produção de um saber anatômico e fisiológico da mulher, a partir do olhar masculino.This research aimed at recovering the peculiarities of the development of Obstetrical Art in Brazil during XIX century, starting in 1808, when a legal act signed by D. João VI included this discipline in the initial curriculum of the schools of medicine and surgery founded in Bahia and Rio de Janeiro. Research was undertaken through the review of 83 medical theses in the field of Obstetrics, produced in Bahia and Rio de Janeiro in XIX century. The data showed that Obstetrical Art was traditionally performed by women called "aparadeiras" (catchers or "comadres", who cared for women before, during and after delivery, and provided assistance in other situations, like venereal diseases and abortion. The inclusion of physicians-obstetricians in this practice led not only to a scrutinizing of the female body, but also to the production of an anatomical and physiological knowledge of the female organism from a male standpoint.

  6. Effects of thermal environment on HPA-axis hormones, oxytocin and behavioral activity in peri-parturient sows

    DEFF Research Database (Denmark)

    Malmkvist, Jens; Damgaard, Birthe Marie; Pedersen, Lene Juul

    2009-01-01

    Provision of additional floor heating (33 to 34C) at birth and during the early postnatal hours is favorable for newborn piglets of domestic sows (Sus scrofa). We investigated whether this relatively high temperature influenced sow behavior and physiology around farrowing. Half of 28 second......-parity pregnant sows were randomly chosen to be exposed to floor heating 12 h after onset of nest building and until 48 h after birth of the first piglet (treatment = HEAT), whereas the rest of the sows entered the control group (treatment = CONT) with no floor heating. Hourly blood sampling from 8 h before...... and until 24 h after the birth of the first piglet was used for investigation of temporal changes in plasma concentrations of oxytocin, cortisol, and ACTH. In addition, occurrence and duration of sow postures were recorded -8 h to +48 h relative to the birth of first piglet. There was a clear temporal...

  7. Diagnostic comparison of malaria infection in peripheral blood, placental blood and placental biopsies in Cameroonian parturient women

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    Anchang-Kimbi Judith K

    2009-06-01

    Full Text Available Abstract Background In sub-Saharan Africa, Plasmodium falciparum malaria in pregnancy presents an enormous diagnostic challenge. The epidemiological and clinical relevance of the different types of malaria diagnosis as well as risk factors associated with malaria infection at delivery were investigated. Method In a cross-sectional survey, 306 women reporting for delivery in the Mutenegene maternity clinic, Fako division, South West province, Cameroon were screened for P. falciparum in peripheral blood, placental blood and placental tissue sections by microscopy. Information relating to the use of intermittent preventive treatment in pregnancy with sulphadoxine/pyrimethamine, history of fever attack, infant birth weights and maternal anaemia were recorded. Results Among these women, P. falciparum infection was detected in 5.6%, 25.5% and 60.5% of the cases in peripheral blood, placental blood and placental histological sections respectively. Placental histology was more sensitive (97.4% than placental blood film (41.5% and peripheral blood (8.0% microscopy. In multivariate analysis, age (≤ 20 years old (OR = 4.61, 95% CI = 1.47 – 14.70, history of fever attack (OR = 2.98, 95% CI = 1.58 – 5.73 were significant risk factors associated with microscopically detected parasitaemia. The use of ≥ 2 SP doses (OR = 0.18, 95% CI = 0.06 – 0.52 was associated with a significant reduction in the prevalence of microscopic parasitaemia at delivery. Age (>20 years (OR = 0.34, 95% CI = 0.15 – 0.75 was the only significant risk factor associated with parasitaemia diagnosed by histology only in univariate analysis. Microscopic parasitaemia (OR = 2.74, 95% CI = 1.33–5.62 was a significant risk factor for maternal anaemia at delivery, but neither infection detected by histology only, nor past infection were associated with increased risk of anaemia. Conclusion Placenta histological examination was the most sensitive indicator of malaria infection at delivery. Microscopically detected parasitaemia was associated with increased risk of maternal anaemia at delivery, but not low-grade parasitaemia detected by placental histology only.

  8. Mapping the neural substrates involved in maternal responsiveness and lamb olfactory memory in parturient ewes using Fos imaging.

    Science.gov (United States)

    Keller, Matthieu; Meurisse, Maryse; Lévy, Frédéric

    2004-12-01

    In sheep, recognition of the familiar lamb by the mother depends on the learning of its olfactory signature after parturition. The authors quantified Fos changes in order to identify brain regions activated during lamb odor memory formation. Brain activation was compared with those measured in anosmic ewes displaying maternal behavior but not individual lamb recognition. In intact ewes, parturition induced significant increase in Fos expression in olfactory cortical regions and in cortical amygdala, whereas in anosmic mothers, Fos expression was very low. In contrast, no difference was observed between intact and anosmic ewes in hypothalamic areas and medial amygdala, suggesting a differentiation between the neural network controlling maternal responsiveness and that involved in olfactory lamb memory.

  9. The effect of addition of dexamethasone to levobupivacaine in parturients receiving combined spinal-epidural for analgesia for vaginal delivery

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    Amr Samir Wahdan

    2017-01-01

    Full Text Available Background and Aims: Regional analgesia is commonly used for the relief of labour pain, Prolongation of analgesia can be achieved by adjuvant medications. The aim of this randomised controlled trial was to evaluate the efficacy of intrathecal levobupivacaine with dexamethasone for labour analgesia. Methods: A total of 80 females were included in this study, all were primigravidas undergoing vaginal delivery with cervical dilatation ≥4 cm and 50% or more effacement. Forty females were included randomly in either Group L (received intrathecal levobupivacaine 0.25% in 2 mL or Group LD (received intrathecal levobupivacaine 0.25% combined with dexamethasone 4 mg in 2 mL. The primary outcome was the duration of spinal analgesia. Secondary outcomes included the total dose of epidural local anaesthetic given, time to delivery, neonatal outcome and adverse effects. Results: The duration of spinal analgesia was significantly longer in the LD group compared with L group (80.5 ± 12.4 min vs. 57.1 ± 11.5 min, respectively; P< 0.001. In Group LD compared with Group L, time from spinal analgesia to delivery was significantly lower (317.4 ± 98.9 min vs. 372.4 ± 118.8 min, respectively; P = 0.027, and total epidural levobupivacaine consumption was significantly lower (102.4 ± 34.8 mg vs. 120.1 ± 41.9 mg, respectively; P = 0.027. The two groups were comparable with respect to characteristics of sensory and motor block, haemodynamic parameters, pain scores, neonatal outcome and frequency of adverse effects. Conclusion: Intrathecal dexamethasone plus levobupivacaine prolongs the duration of spinal analgesia during combined spinal-epidural CSE for labour analgesia.

  10. Use of Medicines with Unknown Fetal Risk among Parturient Women from the 2004 Pelotas Birth Cohort (Brazil

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    Andréa Dâmaso Bertoldi

    2012-01-01

    Full Text Available Background. To estimate the exposure to medicines with unknown fetal risk during pregnancy and to analyze the maternal characteristics associated with it. Methods. A questionnaire was administered to 4,189 mothers of children belonging to the 2004 Pelotas (Brazil birth cohort study about use of any medicine during gestation. We evaluated the associations between use of medicines with unknown fetal risk and the independent variables through logistic regression models. Unknown fetal risk was defined as medicines in which studies in animals have revealed adverse effects on the fetus, and no controlled studies in women, or studies in women and animals, are available. Results. Out of the 4,189 women, 52.5% used at least one medicine from unknown fetal risk. Use of these medicines was associated with white skin color, high schooling, high income, six or more antenatal care consultations, hospital admission during pregnancy, and morbidity during gestation. Conclusion. The use of unknown fetal risk medicines is high, suggesting that their use must be addressed with caution with the aim of restricting their use to cases in which the benefits are greater than the potential risks.

  11. Clinical, serological and virological characteristics of an outbreak of paresis and neonatal foal disease due to equine herpesvirus-1 on a stud farm.

    Science.gov (United States)

    McCartan, C G; Russell, M M; Wood, J L; Mumford, J A

    1995-01-07

    An outbreak of equine herpesvirus-1 (EHV-1) occurred on a large stud farm with 133 mares, 54 foals and four stallions, and at least 85 mares, 22 foals and three stallions were infected. Clinical disease was observed in 16 mares, two stallions and 13 foals and the predominant clinical signs were scrotal oedema, ataxia and loss of libido in the stallions, ataxia and recumbency in the mares and uveitis and nasal discharge in the foals, although pneumonia and colic with intussusception were also recorded at autopsy. Neurological disease was more common in the mares nursing foals (12 of 38 infected) than in barren mares (one of 46 infected). Three mares died during the outbreak and no mares that had been recumbent bred again. Control procedures were based on virological and serological testing and stringent management practices to limit the spread of infection between groups of mares and foals and away from the stud farm. There were marked antibody responses in the adult horses, but they were generally poor in the foals; three of the nine viraemic foals did not develop significant increases in the levels of circulating antibody. Recommendations are made for the management of future outbreaks.

  12. On the influence of orciprenaline on uterine motility and on plasma levels of estradiol-17β in pregnant and parturient sheep

    NARCIS (Netherlands)

    Bontekoe, E.H.M.; Blacquiére, J.F.; Naaktgeboren, C.; Dieleman, S.J.

    Orciprenaline infusions in laboring ewes suppressed uterine activity. A complete inhibition of uterine activity could only be obtained in the empty uterine horn of laboring ewes. During late pregnancy a complete inhibition of the pregnant horn could be established with orciprenaline doses much lower

  13. Atuação da enfermeira na assistência à mulher no processo de parturição

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    Lena Maria Barros

    2004-01-01

    Full Text Available Nuestro objetivo en el presente trabajo fue conocer la acción de la enfermera del centro obstétrico en el momento del parto en lo que se refiere a la ayuda y amparo a la mujer que da a luz. Es un estudio de campo del tipo descriptivo, llevado a cabo en cuatro maternidades públicas de São Luís – Maranhão, de abril a julio de 2002, con el debido consentimiento de los inmiscuidos, respetando los aspectos éticos. Participaron del estudio, 21 enfermeras del Centro Obstétrico. La coletanea de testimonios realizado por la técnica de Análisis de Contenido, posibilitó la organización de la categoria “acción de la enfermera en la ayuda y amparo a la mujer durante el proceso de dar a luz”, con las categorias derivadas de “amparo temporal en la trayectória del nacimiento y modo de cuidar en la trayectória natural del nacimiento”. Al finalizar el estudio, evidenciamos que la enfermera del centro obstétrico actúa lado a lado con la mujer con acciones directas y pasivas (observando, protegiendo; indirectas (administrando y con la participación más efectiva, tomando decisiones e influyendo en la acción y el comportamiento de la misma (ofreciendo cuidados solidarios y obstétricos.

  14. Changes in milk proteome and metabolome associated with dry period length, energy balance and lactation stage in post parturient dairy cows

    NARCIS (Netherlands)

    Lu, J.; Antunes Fernandes, E.C.; Páez Cano, A.E.; Vinitwatanakhun, J.; Boeren, S.; Hooijdonk, van A.C.M.; Knegsel, van A.T.M.; Vervoort, J.; Hettinga, K.A.

    2013-01-01

    The early lactation period of dairy cows, which produce high quantities of milk, is normally characterized by an insufficient energy intake to cover milk production and maintenance requirements. Mobilization of body reserves occurs to compensate this negative energy balance (NEB), and probably as a

  15. Calcium, phosphorus and magnesium metabolism, with particular reference to milk fever (parturient hypocalcaemia) and grass tetany (hypomagnesaemic tetany) in ruminant animals

    International Nuclear Information System (INIS)

    Todd, J.R.

    1976-01-01

    Calcium and phosphorus are taken together and their metabolism and interrelationship with vitamin D reviewed, together with the clinical effects of deficiencies of one or more of these nutrients. An account is given of milk fever, a disease affecting high-producing dairy cows at calving. Studies of the effects of calcium and phosphorus intakes on parathyroid function would tend to indicate that high calcium levels in the diet of dairy cows prepartum is a predisposing cause of milk fever, and recent studies would indicate that prevention of milk fever may be possible by limiting calcium intakes in the weeks before calving and increasing immediately after calving. This procedure has the effect of stimulating parathyroid function and enables the cow to withstand the sudden drain of calcium and phosphorus into colostrum at the initiation of lactation. Magnesium metabolism is considered separately and particular reference is given to ruminant animals since they are the species mainly affected by hypomagnesaemic tetany. The incidence and aetiology of hypomagnesaemic tetany are outlined and methods of control reviewed. In general, control methods depend upon increasing the intake of magnesium by susceptible animals during the danger periods. Supplementary magnesium can be supplied directly to animals in the concentrate ration or as magnesium compounds incorporated in molasses licks or in blocks for free-access feeding. Alternatively the pasture content of magnesium may be increased by 'dusting' magnesium oxide on to the pasture before grazing, or by soil applications of magnesium compounds to raise the magnesium content of the resulting pasture above 0.20% in the dry matter. (author)

  16. THE PREDICTIVE VALUE OF SERUM URIC ACID FOR THE OCCURRENCE, SEVERITY AND OUTCOMES OF PRE-ECLAMPSIA AMONG PARTURIENTS AT NNEWI, NIGERIA.

    Science.gov (United States)

    Osakwe, Chukwudi Richmond; Ikpeze, Okechukwu C; Ezebialu, Ifeanyi Uzoma; Osakwe, Joy Oluchi; Mbadugha, Norah Nwadiogo

    2015-01-01

    To determine the predictive value of serum uric acid for preeclampsia, its severity and pregnancy outcome. This is a cohort study that was performed on normal pregnant women attending antenatal clinic at Nnamdi Azikiwe University Teaching Hospital Nnewi Nigeria. Serum uric acid was determined in 200 women attending antenatal clinic between the gestational ages of 14 and 26 weeks. The women were followed up at 2 weekly intervals until 36 weeks and weekly thereafter until delivery. Women who developed pre-eclampsia or eclampsia were identified. Pregnancy outcomes were determined as well as fetal and placental weights. The data was analised with SPSS version 16.0. The chi square was used for test of significance. The positive and negative predictive values were determined. A total of 200 normal pregnant women were recruited for the study. Nine of them were lost to follow up. Subsequently, 10.5% of the women developed preeclampsia. The positive and negative predictive values of serum uric acid for preeclampsia were 78.9% and 97.1%, respectively. Serum uric acid was found to be a useful predictor of the occurrence of preeclampsia and its severity.

  17. Postpartum intrauterine contraceptive device: Knowledge and factors affecting acceptance among pregnant/parturient women attending a large tertiary health center in Puducherry, India

    Directory of Open Access Journals (Sweden)

    Abinaya Valliappan

    2017-01-01

    Full Text Available Context: Intrauterine contraceptive device (IUCD has been recommended for insertion within 10 min of placental delivery or within 48 h of delivery (postpartum IUCD [PPIUCD] by the WHO. However, the acceptance across our country has been low. Aims: To determine the level of knowledge and the factors affecting it and the likely adoption of PPIUCD. Settings and Design: This cross-sectional study was carried out in the antenatal clinic and postnatal ward of a large tertiary care center in South India. Subjects and Methods: A total of 339 women were studied with the help of a validated structured pro forma. Proportions were expressed in percentage. Chi-square test was applied to compare proportions and univariate analysis for the factors affecting knowledge and likely acceptance. Results: Among the 339 women, 152 (44.8% were aware of the method. Of the 152 women, 56 had a negative attitude about the method. Multiparity of the women was a significant factor affecting knowledge (χ2 = 8.068, P = 0.045. Women who were not exposed to formal health counseling were significantly associated with a lack of knowledge (χ2 = 23.332, P = 0.0001. Primiparity (χ2 = 14.683, P = 0.0001, husbands with skilled jobs (χ2 = 8.272, P = 0.0407, having shared information with their husband regarding the method (χ2 = 38.1, P < 0.001, and family support (χ2 = 58.25, P < 0.001 were the major factors associated with willingness to adopt the method. Conclusion: The level of knowledge about PPIUCD of our study population is 44.8%. Exposure to formal health counseling classes and prior discussion with husbands and family members could improve the knowledge and likelihood of acceptance of PPIUCD.

  18. Plasma Vitamin E and Blood Selenium Concentrations in Norwegian Dairy Cows: Regional Differences and Relations to Feeding and Health

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    Østerås O

    2005-12-01

    Full Text Available Plasma α-tocopherol (vit E and blood selenium (Se concentrations in February were determined in samples from 314 dairy cows in Norway, selected to provide a representative subset of the Norwegian dairy cow population. Each sample was followed by a questionnaire with information about feeding of the cow at the time of sampling. The results were correlated to herd data and to calving and health data for each cow from the Norwegian Dairy Herd Recording System and the Norwegian Cattle Health Recording System. The mean concentrations were 6.9 μg vit E per ml plasma and 0.16 μg Se per g blood. Both levels were highest in mid lactation. Plasma vit E varied with the amount of silage fed to the cow, while blood Se varied with the amount of concentrates and mineral supplements, and with geographical region. No differences in vit E or Se levels were found between cows with recorded treatments for mastitis, parturient paresis or reproductive disorders in the lactation during or immediately prior to sampling, and those without such treatments. For ketosis, a small difference in blood Se was found between the groups with or without recorded treatments. It is concluded that winter-fed lactating cows in Norway had an adequate plasma level of vit E and a marginal-to-adequate level of Se.

  19. Plasma Vitamin E and Blood Selenium Concentrations in Norwegian Dairy Cows: Regional Differences and Relations to Feeding and Health

    Directory of Open Access Journals (Sweden)

    Sivertsen T

    2006-12-01

    Full Text Available Plasma α-tocopherol (vit E and blood selenium (Se concentrations in February were determined in samples from 314 dairy cows in Norway, selected to provide a representative subset of the Norwegian dairy cow population. Each sample was followed by a questionnaire with information about feeding of the cow at the time of sampling. The results were correlated to herd data and to calving and health data for each cow from the Norwegian Dairy Herd Recording System and the Norwegian Cattle Health Recording System. The mean concentrations were 6.9 μg vit E per ml plasma and 0.16 μg Se per g blood. Both levels were highest in mid lactation. Plasma vit E varied with the amount of silage fed to the cow, while blood Se varied with the amount of concentrates and mineral supplements, and with geographical region. No differences in vit E or Se levels were found between cows with recorded treatments for mastitis, parturient paresis or reproductive disorders in the lactation during or immediately prior to sampling, and those without such treatments. For ketosis, a small difference in blood Se was found between the groups with or without recorded treatments. It is concluded that winter-fed lactating cows in Norway had an adequate plasma level of vit E and a marginal-to-adequate level of Se.

  20. [Impact of a simultaneous application of anionic salts and rumen buffer on acid-base-balance and mineral metabolism in dairy cows].

    Science.gov (United States)

    Gelfert, Carl-Christian; Hauser, Simone; Löptien, Antje; Montag, Nicole; Passmann, Mareike; Baumgartner, Walter; Staufenbiel, Rudolf

    2006-01-01

    In this study, the influence of simultaneous application of anionic salts (AS) and rumen buffer (RB) on the metabolism of dairy cows was examined. Eleven rumen fistulated, non-pregnant and non-lactating dairy cows received equal amounts of one AS (CaCl2 or CaSO4) and one RB (NaHCO3 or KHCO3) via rumen cannula during feeding time over a period of eight days. Before the first application of AS and RB and on day eight of the treatment period, blood, urine and rumen fluid samples were taken. The following parameters were measured: whole blood: pH, base excess, bicarbonate; serum: sodium, potassium, chloride, calcium; urine: pH, net acid base excretion, sodium, potassium, chloride, calcium; rumen fluid: pH. The changes of each parameter were compared via ANOVA. The changes in acid-base balance on day eight were very small, although significant. But p-values showed that the statistical evidence was low. The most changes occurred when NaHCO3 was fed in combination with one of the AS used. In this case a small acidogenic load was seen in blood (p buffer must not be fed, if anionic salts are given for prevention of parturient paresis.

  1. Effect of Anionic Salt and Highly Fermentable Carbohydrate Supplementations on Urine pH and on Experimentally Induced Hypocalcaemia in Cows

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    Enemark JMD

    2004-09-01

    Full Text Available The objective of this experiment was to determine the effect of dietary grain on calcium homeostasis. Six rumen-fistulated dairy cows with 3 or more previous lactations and no history of parturient paresis were randomly assigned to a sequence of diets in a crossover study with 4 periods of 10 days each. Dietary treatments were: A control ration consisting of wrap grass silage alone (1, the control ration supplemented with ammonium chloride and ammonium sulphate salt solution (2, control ration following a period with supplementation (3 and control ration supplemented with increasing amounts of barley from 4 to 10 kg/cow per day, expected to produce subclinical rumen acidosis (4. Daily intake of the diets was adjusted to 14 kg DM/cow per day. On day 11, the calcium-regulating mechanisms in cows were challenged until recumbency by a standardized intravenous EDTA infusion and cows were left to recover spontaneously. Anion supplementation and the feeding of highly fermentable carbohydrate lowered urine pH below 7.0 due to subclinical acidosis. During spontaneous recovery from EDTA induced hypocalcaemia, the cows more quickly regained a whole blood free calcium concentration of 1.00 mmol/L if they had most recently been supplemented with either anionic salts or with increasing amounts of barley, as compared to the basic ration. It is concluded that so-called slug-feeding or 'steaming up' with highly fermentable carbohydrates before parturition in milk fever susceptible cows enhanced calcium homeostasis similar to the effect seen in cows on anionic diets.

  2. The Efficacy of Intraoperative Neurophysiological Monitoring Using Transcranial Electrically Stimulated Muscle-evoked Potentials (TcE-MsEPs) for Predicting Postoperative Segmental Upper Extremity Motor Paresis After Cervical Laminoplasty.

    Science.gov (United States)

    Fujiwara, Yasushi; Manabe, Hideki; Izumi, Bunichiro; Tanaka, Hiroyuki; Kawai, Kazumi; Tanaka, Nobuhiro

    2016-05-01

    Prospective study. To investigate the efficacy of transcranial electrically stimulated muscle-evoked potentials (TcE-MsEPs) for predicting postoperative segmental upper extremity palsy following cervical laminoplasty. Postoperative segmental upper extremity palsy, especially in the deltoid and biceps (so-called C5 palsy), is the most common complication following cervical laminoplasty. Some papers have reported that postoperative C5 palsy cannot be predicted by TcE-MsEPs, although others have reported that it can be predicted. This study included 160 consecutive cases that underwent open-door laminoplasty, and TcE-MsEP monitoring was performed in the biceps brachii, triceps brachii, abductor digiti minimi, tibialis anterior, and abductor hallucis. A >50% decrease in the wave amplitude was defined as an alarm point. According to the monitoring alarm, interventions were performed, which include steroid administration, foraminotomies, etc. Postoperative deltoid and biceps palsy occurred in 5 cases. Among the 155 cases without segmental upper extremity palsy, there were no monitoring alarms. Among the 5 deltoid and biceps palsy cases, 3 had significant wave amplitude decreases in the biceps during surgery, and palsy occurred when the patients awoke from anesthesia (acute type). In the other 2 cases in which the palsy occurred 2 days after the operation (delayed type), there were no significant wave decreases. In all of the cases, the palsy was completely resolved within 6 months. The majority of C5 palsies have been reported to occur several days after surgery, but some of them have been reported to occur immediately after surgery. Our results demonstrated that TcE-MsEPs can predict the acute type, whereas the delayed type cannot be predicted. A >50% wave amplitude decrease in the biceps is useful to predict acute-type segmental upper extremity palsy. Further examination about the interventions for monitoring alarm will be essential for preventing palsy.

  3. Prevalence and correlates of preterm labor among young parturient women attending public hospitals in Brazil Prevalencia y factores correlativos del parto prematuro en las jóvenes parturientas que acuden a los hospitales públicos del Brasil

    Directory of Open Access Journals (Sweden)

    Angélica E. Miranda

    2012-11-01

    Full Text Available OBJECTIVE: To determine the prevalence of and risk factors for preterm labor (OBJETIVO: Determinar la prevalencia y los factores de riesgo de parto prematuro (menos de 37 semanas de gestación en las jóvenes embarazadas del Brasil. MÉTODOS: Se llevó a cabo un estudio transversal a escala nacional en jóvenes parturientas de 15 a 24 años de edad que acudieron a las maternidades públicas brasileñas en el 2009. Los entrevistadores administraron cuestionarios al ingresar la parturienta en la maternidad (o poco después de parto, si las mujeres participantes tenían demasiado dolor como para responder durante el trabajo del parto. Las participantes respondieron a un cuestionario que recopilaba datos demográficos, conductuales y clínicos. RESULTADOS: Se incluyeron en el estudio un total de 2 071 (86,3% parturientas de las 2 400 invitadas a participar. La media de edad fue de 20,2 años (desviación estándar [SD]: 2,7 y el promedio de años de enseñanza escolar fue de 8 (SD: 2,4. Se produjo un parto prematuro en 450 mujeres (21,7%. La proporción más alta de parto prematuro (36,1% se observó en la región del Norte y la proporción más baja (6,9% en la región del Sur. En el modelo final de regresión logística con variables múltiples, el vivir en la región del Norte (razón de posibilidades [OR]: 1,43; intervalo de confianza [IC] de 95%: 1,28-1,59; el tener ingresos mensuales inferiores a dos veces el salario mínimo brasileño (OR: 1,27, IC de 95%: 1,01-1,60; el haber sido víctima de violencia doméstica (OR: 2,27, IC de 95%: 1,23-4,18; y el haber recibido una atención prenatal inadecuada (OR: 3,17, IC de 95%: 2,54-3,97 seguían siendo factores correlativos significativos de parto prematuro en esta población. CONCLUSIONES: Los resultados muestran una alta prevalencia del parto prematuro en las mujeres jóvenes del Brasil. El parto prematuro presenta una etiología multifactorial. Se deben destinar más recursos de salud pública para acelerar el conocimiento de este complejo proceso.

  4. Correlation of serum IgG concentration in foals and refractometry index of the dam's pre- and post-parturient colostrums: an assessment for failure of passive transfer in foals.

    Science.gov (United States)

    Korosue, Kenji; Murase, Harutaka; Sato, Fumio; Ishimaru, Mutsuki; Kotoyori, Yasumitsu; Nambo, Yasuo

    2012-11-01

    The object of this study was to evaluate the usefulness of measuring the differences in the values of the serum total protein (DVSTP) concentration of foals and the refractometry index (DVRI) of the milk of dams before and after nursing of the colostrum for assessing failure of passive transfer (FPT) in foals. Serum samples from 31 foals were collected before the first nursing and other 1 to 6 times between 4 and 24 hr after birth. Paired colostrum and milk samples were collected from 14 of their dams at the same time. Serum samples were analyzed for IgG concentration using a single radial immunodiffusion (SRID) test (98 samples) and total protein concentration using a temperature-compensating refractometer (98 samples). Colostrum and milk samples were analyzed for refractometry index (RI) using a Brix refractometer (71 samples). DVSTP concentration and DVRI were significantly correlated with serum IgG concentration. The negative predictive values (NPVs) of DVSTP concentration for detecting serum IgG concentrations<400 mg/dl and<800 mg/dl were 98.2% and 91.3% when the cutoff value is set to 0.4 mg/dl and 0.8 mg/dl, respectively. Furthermore, the NPVs of DVRI for detecting serum IgG concentrations<400 mg/dl and<800 mg/dl were 97.3% and 96.3% when the cutoff value is set to 6% and 10%, respectively. The results suggest that measurement of DVRI is useful in assessing FPT as an initial "stall-side" screening test, because it is easy, inexpensive to perform and allows for rapid interpretation.

  5. Obstetric and newborn outcomes and risk factors for low birth weight ...

    African Journals Online (AJOL)

    There remains uncertainty about the impact of HIV on pregnancy outcomes and effects of highly active antiretroviral therapy on fetal development. This study describes obstetric outcomes among HIV positive parturients at the University College Hospital, Ibadan. HIV positive parturients were identified in the birth register.

  6. Author Details

    African Journals Online (AJOL)

    Abstract PDF · Vol 8, No 5 (2002) - Articles The febrile parturient: choice of anesthesia. Abstract PDF · Vol 9, No 2 (2003) - Articles Anesthesia for the parturient with cardiovascular disease. Abstract PDF · Vol 9, No 4 (2003) - Articles Marijuana use in Pregnancy: Anaesthetic Implications Abstract PDF. ISSN: 2220-1173.

  7. TropJrnal Vol 32 No 1

    African Journals Online (AJOL)

    Mr Olusoji

    ABSTRACT. There remains uncertainty about the impact of HIV on pregnancy outcomes and effects of highly active antiretroviral therapy on fetal development. This study describes obstetric outcomes among HIV positive parturients at the University College Hospital, Ibadan. HIV positive parturients were identified in the birth.

  8. The effect of zeolite A supplementation in the dry period on periparturient calcium, phosphorus, and magnesium homeostasis

    DEFF Research Database (Denmark)

    Thilsing-Hansen, T; Jørgensen, R J; Enemark, J M D

    2002-01-01

    One potential way of preventing parturient hypocalcemia in the dairy cow is to feed dry cow rations very low in calcium (......One potential way of preventing parturient hypocalcemia in the dairy cow is to feed dry cow rations very low in calcium (...

  9. Laryngeal Electromyographic findings in patients with vocal fold motion asymmetry.

    Science.gov (United States)

    Woo, Peak; Isseroff, Tova F; Parasher, Arjun; Richards, Amanda; Sivak, Mark

    2016-08-01

    Vocal fold motion asymmetry (VFMA) is often attributed to vocal fold paresis or an anatomical variant. Although laryngeal electromyography (LEMG) may be used to evaluate patients with vocal fold paresis, electrodiagnostic findings in VFMA have not been well defined. Review of a case series Twenty-five symptomatic patients with VFMA were examined by LEMG, and the findings were analyzed. Although all were thought to have unilateral recurrent laryngeal nerve paresis, LEMG showed only nine to have unilateral recurrent nerve paresis. There were nine with both ipsilateral recurrent laryngeal nerve and superior laryngeal nerve paresis, four with bilateral paresis, and three were normal. Reduced total number of units, reduced recruitment, motor units firing fast, and polyphasic units were more common, whereas fibrillation potentials, fasciculation, positive sharp waves, and complex repetitive discharges were uncommon. The LEMG findings are most consistent with old, healed neuropathy. McNemar's test for the acute versus chronic denervation potentials showed significant differences. VFMA has a high incidence of vocal fold paresis that can be better defined by LEMG. The site and side of paresis is often wrong based on laryngoscopy findings alone. The LEMG findings of VFMA appear to be consistent with old, healed neuropathy 4 Laryngoscope, 126:E273-E277, 2016. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  10. Parâmetros sangüíneos e urinários, no pré e pós parto, de búfalas criadas em sistema exclusivo de pastejo The blood and urinary values in the pre and pos-parturient period of buffaloes, kept on exclusive pasture feeding

    Directory of Open Access Journals (Sweden)

    Carlos Magno Chaves de Oliveira

    2003-06-01

    Full Text Available Foi avaliada a ocorrência de alterações nas concentrações de glicose sanguínea, proteína plasmática total, hematócrito e presença de corpos cetônicos na urina de oito búfalas leiteiras da raça Murrah, com idade variando entre 5 e 10 anos, com no mínimo duas lactações, clinicamente sadias, desde 60 dias antes até 60 dias pós-parto. As concentrações médias de glicose sangüínea e o valor médio do hematócrito diminuíram significativamente no pós-parto (pEight lactating buffaloes of the Murrah breed were used from 60 days before up to 60 days after calving, in order to evaluate alterations in the concentration of blood glucose, total plasmatic protein, haematocrit and the presence of ketonic bodies in the urine. The 5 to 10- year old buffaloes were clinically healthy and had had at least two lactations. During the experimental period the animals were maintained on Brachiaria brizantha pasture and supplemented with a mineral mixture and water.The media concentrations of blood glucose and the media values of the haematocrit diminished significantly after calving (p<0,05. The concentrations of total plasmatic protein did not show significant variation during the pre and post-calving period. The ketonic bodies in the pre-calving period were only detected in the urine of one buffaloe, but after the 32nd day of lactation ketonic bodies were detected in all animals. There was a direct relationship between the color of the urine positive by the Rothera test and blood glucose concentrations. It can be concluded that at the beginning of lactation the buffaloes had an energetic deficit, characterized by a decline of blood glucose concentrations and the presence of ketonic bodies in the urine, and that lactation caused a progressive decline of the hematocrit, but that the concentration of total plasmatic protein did not vary during the pre and post-calving period.

  11. Analgesia de parto em paciente com tetralogia de Fallot não corrigida: relato de caso Analgesia de parto en paciente con tetralogía de Fallot no corregida: relato de caso Labour analgesia in parturient with uncorrected tetralogy of Fallot: case report

    Directory of Open Access Journals (Sweden)

    Florentino Fernandes Mendes

    2005-02-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: Embora a tetralogia de Fallot seja a mais comum das cardiopatias congênitas cianóticas, as publicações nacionais, relacionando essa doença com a prática anestésica são escassas. O objetivo deste relato é apresentar um caso de analgesia de parto em paciente portadora de tetralogia de Fallot não corrigida e diagnosticada durante a gestação. RELATO DO CASO: Paciente com 26 anos, 56 kg, 1,56 m, idade gestacional 32 semanas e 5 dias, com diagnóstico de tetralogia de Fallot realizado durante a gestação. Internou em trabalho de parto. A conduta obstétrica foi a de parto via baixa, sendo realizada analgesia através de bloqueio peridural com bupivacaína a 0,125% e fentanil (100 µg e colocação de cateter peridural. Após 1h30 minutos do início da analgesia, ocorreu o nascimento. O peso do recém-nascido foi 1485 g e o índice de Apgar 6 e 8 no primeiro e no quinto minutos, respectivamente. A paciente permaneceu estável e sem alterações hemodinâmicas e/ou eletrocardiográficas. CONCLUSÕES: A escolha da técnica anestésica é de fundamental importância no manuseio das pacientes com tetralogia de Fallot não corrigidas. Condições favoráveis do colo e boa dinâmica uterina, particularmente naquelas pacientes sem história de síncope, tornam-se imprescindíveis para uma boa indicação da analgesia de parto.JUSTIFICATIVA Y OBJETIVOS: Aunque la tetralogía de Fallot sea la más común de las cardiopatías congénitas cianóticas, las publicaciones nacionales, relacionando esa enfermedad con la práctica anestésica son escasas. El objetivo de este relato es presentar un caso de analgesia de parto en paciente portadora de tetralogía de Fallot no corregida y diagnosticada durante la gestación. RELATO DEL CASO: Paciente con 26 años, 56 kg, 1,56 m, edad gestacional 32 semanas y 5 días, con diagnóstico de tetralogía de Fallot realizado durante la gestación. Internó en trabajo de parto. La conducta obstétrica fue la de parto vía baja, siendo realizada analgesia de parto a través de bloqueo peridural con bupivacaína a 0,125% y fentanil (100 µg y colocación de catéter peridural. Después de 1h30 minutos del inicio de la analgesia, ocurrió el nacimiento. El peso del recién nacido fue 1485 g y el índice de Apgar 6 y 8 en el primero y en el quinto minutos, respectivamente. La paciente permaneció estable y sin alteraciones hemodinámicas y/o electrocardiográficas. CONCLUSIONES: La elección de la técnica anestésica es de fundamental importancia en el manoseo de las pacientes con tetralogía de Fallot no corregidas. Condiciones favorables del cuello y buena dinámica uterina, particularmente en aquellas pacientes sin historia de síncope, se vuelven imprescindibles para una buena indicación de la analgesia de parto.BACKGROUND AND OBJECTIVES: Although tetralogy of Fallot is the most common cyanotic congenital heart disease, national publications correlating this condition with anesthetic practice are scarce. This report aimed at presenting a case of labor epidural analgesia in a patient with uncorrected tetralogy of Fallot diagnosed during gestation. CASE REPORT: Patient 26 years old, 1.54 m, 56 kg, 32 weeks and 5 days of gestational age, who had been diagnosed with tetralogy of Fallot during gestation. Patient was admitted in labour. After obstetric evaluation and decision for natural birth, epidural analgesia was performed with 0.125% bupivacaine associated to 100µg fentanyl through a catheter. Patient gave birth 1 hour and 30 minutes after the procedure. The newborn weighed 1485 grams and had an Apgar score of 6 and 8 at one and five minutes, respectively. Patient remained stable, with no hemodynamic or ECG changes. CONCLUSIONS: Selecting the appropriate anesthetic technique is extremely important when managing patients with uncorrected tetralogy of Fallot. Favorable uterine dynamics and cervical conditions, particularly in patients with no history of syncope, are critical findings for adequate labour analgesia indication.

  12. Spinal Anaesthesia for Cesarean Section in a Patient with Vascular Type Ehlers-Danlos Syndrome

    Directory of Open Access Journals (Sweden)

    Jeffrey M. Carness

    2018-01-01

    Full Text Available We report the administration of spinal anaesthesia for cesarean delivery in a parturient with vascular Ehlers-Danlos syndrome. Parturients who genetically inherit this disorder are at risk for significant morbidity and mortality. Risks during pregnancy include premature labor, uterine prolapse, and uterine rupture. Additionally, such laboring parturients are at increased risk of hemodynamic volatility, vascular stress, and severe postpartum hemorrhage. Instrumented delivery and cesarean delivery bring additional risks. Nonpregnancy-related complications include excessive bleeding, intestinal rupture, cardiac valvular dysfunction, and arterial dissection. Despite the complexity of this condition, literature focusing on specific intraoperative anaesthetic management is sparse.

  13. Dengue as a cause of fever during pregnancy: a report of two cases

    Directory of Open Access Journals (Sweden)

    Ariani Impieri Souza

    2016-06-01

    Full Text Available Abstract: Dengue infection has not been routinely investigated among pregnant women and parturients with acute febrile syndrome in endemic settings. Here, we report two cases of dengue fever detected at the time of delivery in parturients enrolled in a cohort prospective study conducted in a hospital in Recife, Brazil. The parturients reported fever onset within seven days prior to delivery, and dengue infection was confirmed upon detection of viral ribonucleic acid (RNA by using the reverse transcriptase-polymerase chain reaction. Dengue infection should be considered as a diagnostic possibility in cases of fever during pregnancy and labor, especially in endemic areas.

  14. A short introduction to the new principle of binding ration calcium with sodium zeolite

    DEFF Research Database (Denmark)

    Jørgensen, R J; Bjerrum, M J; Classen, H

    2003-01-01

    This paper summarise the development of the new principle of preventing parturient hypocalcaemia by reducing the bioavailability of ration calcium with calcium binders, based on the idea that a negative calcium balance would stimulate natural defence mechanisms against threatening hypocalcaemia...

  15. Addition of low-dose ketamine to midazolam and low-dose bupivacaine improves hemodynamics and postoperative analgesia during spinal anesthesia for cesarean section

    Directory of Open Access Journals (Sweden)

    Ahmed Sobhy Basuni

    2016-01-01

    Conclusion: Intrathecal low-dose ketamine combined with midazolam and low-dose bupivacaine stabilizes hemodynamics and prolongs postoperative analgesia without significant side-effects in parturients undergoing CS.

  16. Download this PDF file

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    Anaesthetic and Obstetric challenges of morbid obesity in caesarean .... the hazards of both surgery and anaesthesia are increased. ... this study delivered under spinal anaesthesia using ... obese parturients may relate to the large abdominal.

  17. Plasma Triglyceride and Cholesterol Levels in Normotensive and ...

    African Journals Online (AJOL)

    Plasma Triglyceride and Cholesterol Levels in Normotensive and Hypertensive Pregnant and Parturient Nigerian Women. Kashope D. Thomas, Oyebola G. Adeosun, Norah O. Akinola, Uche Onwudiegwu, Alexander T. Owolabi ...

  18. Preoperative measurement of maternal abdominal circumference relates the initial sensory block level of spinal anesthesia for cesarean section: An observational study

    Directory of Open Access Journals (Sweden)

    Chi-Hang Kuok

    2016-12-01

    Conclusion: Parturients with greater abdominal circumference value have a higher level of sensory blockade at 5 minutes after spinal anesthesia. Abdominal circumference cannot predict the maximum sensory blockade level and the incidence of hypotension.

  19. Anaesthetic and Obstetric challenges of morbid obesity in ...

    African Journals Online (AJOL)

    Anaesthetic and Obstetric challenges of morbid obesity in caesarean ... in morbidly obese parturient that had caesarean delivery in a Nigerian tertiary care centre. ... This mirrors a World Health Organisation report published in the World Health ...

  20. Prevalence and Parasite Density of Asymptomatic Malaria ...

    African Journals Online (AJOL)

    Results: A total of 250 unbooked parturients participated in the study. The mean age of the ... and pains, malaise, generalized body weakness, etc., It is termed asymptomatic when ... underwent microscopic examination under oil immersion.

  1. A comparative observational study on the reproductive performance ...

    African Journals Online (AJOL)

    The reproductive performance of cows with post parturient metritis treated systemically with long-acting oxytetra- ..... of voluntary waiting period before breeding, heat detec- ... then these results stress the variability of the response among.

  2. Browse Title Index

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    Items 51 - 100 of 553 ... Vol 9, No 4 (2003), Anaesthesia and Freeman Sheldon Syndrome, Abstract PDF ... type B in Marfan syndrome complicating end-stage pregnancy ... of a parturient with antiphospholipid antibody syndrome, Abstract PDF.

  3. Feto-Maternal Outcome in Supervised Pregnancies of the ...

    African Journals Online (AJOL)

    obese parturients Materials and Methods 106 obese, pregnant women and an equal number of non–obese matched controls who booked and delivered in LASUTH were studied. Biosocial data as well as feto-maternal parameters were recorded ...

  4. Combined spinal and epidural anaesthesia for an elective ...

    African Journals Online (AJOL)

    2012-02-02

    Feb 2, 2012 ... This was followed by the injection of. 2 ml normal saline into the ... expressed feeling minimal discomfort during the application of fundal pressure to .... CSE anaesthesia as a safe technique in a parturient with achondroplasia ...

  5. Combined Use of Hyperbaric and Hypobaric Ropivacaine Significantly Improves Hemodynamic Characteristics in Spinal Anesthesia for Caesarean Section: A Prospective, Double-Blind, Randomized, Controlled Study

    OpenAIRE

    Quan, ZheFeng; Tian, Ming; Chi, Ping; Li, Xin; He, HaiLi; Luo, Chao

    2015-01-01

    Purpose To observe the hemodynamic changes of parturients in the combined use of hyperbaric (4 mg) and hypobaric (6 mg) ropivacaine during spinal anesthesia for caesarean section in this randomized double-blind study. Methods Parturients (n = 136) undergoing elective cesarean delivery were randomly and equally allocated to receive either combined hyperbaric and hypobaric ropivacaine (Group A) or hyperbaric ropivacaine (Group B). Outcome measures were: hemodynamic characteristics, maximum heig...

  6. Left is right and right is wrong: fluorodeoxyglucose uptake in left hemi-diaphragm due to right phrenic nerve palsy

    International Nuclear Information System (INIS)

    Joshi, Prathamesh; Lele, Vikram

    2013-01-01

    A 36-year-old Indian man, a recently diagnosed case of the right lung carcinoma underwent fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) for staging of the malignancy. PET/CT showed increased FDG uptake in the right lung mass, consistent with the known primary tumor. Right hemidiaphragm was found to be elevated on CT, suggesting right diaphragmatic paresis. The PET scan demonstrated asymmetric, intense FDG uptake in the left hemidiaphragm and accessory muscles of respiration, which was possibly due to compensatory increased workload related to contralateral right diaphragmatic paresis. The right diaphragmatic paresis was hypothesized to be caused by phrenic nerve palsy by right lung neoplasm. (author)

  7. Left is right and right is wrong: Fluorodeoxyglucose uptake in left hemi-diaphragm due to right phrenic nerve palsy.

    Science.gov (United States)

    Joshi, Prathamesh; Lele, Vikram

    2013-01-01

    A 36-year-old Indian man, a recently diagnosed case of the right lung carcinoma underwent fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) for staging of the malignancy. PET/CT showed increased FDG uptake in the right lung mass, consistent with the known primary tumor. Right hemidiaphragm was found to be elevated on CT, suggesting right diaphragmatic paresis. The PET scan demonstrated asymmetric, intense FDG uptake in the left hemidiaphragm and accessory muscles of respiration, which was possibly due to compensatory increased workload related to contralateral right diaphragmatic paresis. The right diaphragmatic paresis was hypothesized to be caused by phrenic nerve palsy by right lung neoplasm.

  8. aa alysis of the retinal, cardiovascular and neurological disorders in ...

    African Journals Online (AJOL)

    DISORDERS IN DIABETICS ATTENDING AN OUT-PATIENT CLINIC. P. MARKMAN ..... of individual abnormalities within this group was as follows: I. Paresis of the ..... found gross involvement of vibration sense to be less common than loss of ...

  9. Gait training assisted by multi-channel functional electrical stimulation early after stroke: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Bloemendaal, M. van; Bus, S.A.; Boer, C.E. de; Nollet, F.; Geurts, A.C.H.; Beelen, A.

    2016-01-01

    BACKGROUND: Many stroke survivors suffer from paresis of lower limb muscles, resulting in compensatory gait patterns characterised by asymmetries in spatial and temporal parameters and reduced walking capacity. Functional electrical stimulation has been used to improve walking capacity, but evidence

  10. MOG-IgG in NMO and related disorders: A multicenter study of 50 patients. Part 3

    DEFF Research Database (Denmark)

    Jarius, Sven; Kleiter, Ingo; Ruprecht, Klemens

    2016-01-01

    identified. All were negative for AQP4-IgG. Symptoms included respiratory insufficiency, intractable nausea and vomiting (INV), dysarthria, dysphagia, impaired cough reflex, oculomotor nerve palsy and diplopia, nystagmus, internuclear ophthalmoplegia (INO), facial nerve paresis, trigeminal hypesthesia...

  11. Documentation of diaphragmal paralysis with digital subtraction techniques

    International Nuclear Information System (INIS)

    Waggershauser, T.; Muenchen Univ.; Buente, E.; Muenchen Univ.; Kohz, P.; Muenchen Univ.; Fink, U.; Muenchen Univ.

    1992-01-01

    The causative factors for a paresis of the diaphragm are primarily subsequent to operations on lesions of the phrenic nerve or on such mediastinal tumors as lyphomas which result in compression or infiltration of the nerves. (orig.) [de

  12. Documentation of diaphragmal paralysis with digital subtraction techniques. Dokumentation von Zwerchfellparesen mit digitaler Subtraktionstechnik

    Energy Technology Data Exchange (ETDEWEB)

    Waggershauser, T. (Muenchen Univ. (Germany). Radiologische Klinik und Poliklinik Muenchen Univ. (Germany). Klinik und Poliklinik fuer Hals-, Nasen- und Ohrenkranke); Buente, E. (Muenchen Univ. (Germany). Radiologische Klinik und Poliklinik Muenchen Univ. (Germany). Klinik und Poliklinik fuer Hals-, Nasen- und Ohrenkranke); Kohz, P. (Muenchen Univ. (Germany). Radiologische Klinik und Poliklinik Muenchen Univ. (Germany). Klinik und Poliklinik fuer Hals-, Nasen- und Ohrenkranke); Fink, U. (Muenchen Univ. (Germany). Radiologische Klinik und Poliklinik Muenchen Univ. (Germany). Klinik und Poliklinik fuer Hals-, Nasen- und Ohrenkranke)

    1992-01-01

    The causative factors for a paresis of the diaphragm are primarily subsequent to operations on lesions of the phrenic nerve or on such mediastinal tumors as lyphomas which result in compression or infiltration of the nerves. (orig.)

  13. COMPLICATIONS DURING A SUPRACLAVICULAR ANESTHESIA OF THE BRACHIAL PLEXUS WITH INTERSCALENE APPROACH

    OpenAIRE

    Minko Minkov; Maria Vankova; Radoslav Minkov; Stefaniya Terzieva; Toni Dimitrov; Iskren Velikov

    2012-01-01

    A hemidiaphragmatic paresis is one of the most frequently observed complications following the supraclavicular anesthesia of the brachial plexus with interscalene approach. In patients, crucially dependant on adequate diaphragmatic function, hemidiaphragmatic paresis may provoke acute respiratory disturbances. The aim of this study was to analyze the anatomical features the brachial plexus with regard of the anesthesia of specific areas of the shoulder and the upper limb.A dissection of the c...

  14. Pupilparalyse. En sjaelden komplikation ved øjeninfektion med Varicella zoster-virus

    DEFF Research Database (Denmark)

    Hallas, P

    2001-01-01

    Pupillary paralysis and paresis of the peripheral facial nerve on the left side was found in a 68-year-old man with concussion and herpes zoster ophthalmicus on the left eye. Post mortem examination showed no sign of intracranial hemorrhage. The cause of death was pulmonary oedema and aspiration....... The neurological signs were probably caused by herpes zoster affection of the oculomotor and optic nerves in association with the facial nerve paresis induced by zoster....

  15. Posterior fossa gangliocytoma with facial nerve invasion: case report

    Directory of Open Access Journals (Sweden)

    Koerbel Andrei

    2003-01-01

    Full Text Available A 5 year-old boy with a cerebellar gangliocytoma with a peripheral right facial paresis and ataxia is presented. His MRI showed a heterogenous, diffuse lesion, isointense on T1 and hyperintense on T2-weigthed sequences, involving the right cerebellar hemisphere with direct extension into the right facial nerve. The present case is the first description of a gangliocytoma with direct facial nerve invasion, as demonstrated for the facial nerve paresis and supported by MRI and surgical inspection.

  16. Managing anesthesia  for cesarean section in obese patients: current perspectives

    Directory of Open Access Journals (Sweden)

    Lamon AM

    2016-08-01

    Full Text Available Agnes M Lamon, Ashraf S Habib Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA Abstract: Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging. An existing labor epidural catheter can be topped up for cesarean delivery. In patients who do not have a well-functioning labor epidural, a combined spinal epidural technique might be preferred over a single-shot spinal technique since it is technically easier in obese parturients and allows for extending the duration of the block as required. A continuous spinal technique can also be considered. Studies suggest that there is no need to reduce the dose of spinal bupivacaine in the obese parturient, but there is little data about spinal dosing in super obese parturients. Intraoperatively, patients should be placed in a ramped position, with close monitoring of ventilation and hemodynamic status. Adequate postoperative analgesia is crucial to allow for early mobilization. This can be achieved using a multimodal regimen incorporating neuraxial morphine (with appropriate observations with scheduled nonsteroidal anti-inflammatory drugs and acetaminophen. Thromboprophylaxis is also important in this patient population due to the increased risk of thromboembolic complications. These patients should be monitored carefully in the postoperative period, since there

  17. Epidural analgesia during labor vs no analgesia: A comparative study

    Directory of Open Access Journals (Sweden)

    Wesam Farid Mousa

    2012-01-01

    Full Text Available Background: Epidural analgesia is claimed to result in prolonged labor. Previous studies have assessed epidural analgesia vs systemic opioids rather than to parturients receiving no analgesia. This study aimed to evaluate the effect of epidural analgesia on labor duration compared with parturients devoid of analgesia. Methods: One hundred sixty nulliparous women in spontaneous labor at full term with a singleton vertex presentation were assigned to the study. Parturients who request epidural analgesia were allocated in the epidural group, whereas those not enthusiastic to labor analgesia were allocated in the control group. Epidural analgesia was provided with 20 mL bolus 0.5% epidural lidocaine plus fentanyl and maintained at 10 mL for 1 h. Duration of the first and second stages of labor, number of parturients receiving oxytocin, maximal oxytocin dose required for each parturient, numbers of instrumental vaginal, vacuum-assisted, and cesarean deliveries and neonatal Apgar score were recorded. Results: There was no statistical difference in the duration of the active-first and the second stages of labor, instrumental delivery, vacuum-assisted or cesarean delivery rates, the number of newborns with 1-min and 5-min Apgar scores less than 7 between both groups and number of parturients receiving oxytocin, however, the maximal oxytocin dose was significantly higher in the epidural group. Conclusion: Epidural analgesia by lidocaine (0.5% and fentanyl does not prolong labor compared with parturients without analgesia; however, significant oxytocin augmentation is required during the epidural analgesia to keep up the aforementioned average labor duration.

  18. Abdominal girth and vertebral column length aid in predicting intrathecal hyperbaric bupivacaine dose for elective cesarean section.

    Science.gov (United States)

    Wei, Chang-Na; Zhou, Qing-He; Wang, Li-Zhong

    2017-08-01

    Currently, there is no consensus on how to determine the optimal dose of intrathecal bupivacaine for an individual undergoing an elective cesarean section. In this study, we developed a regression equation between intrathecal 0.5% hyperbaric bupivacaine volume and abdominal girth and vertebral column length, to determine a suitable block level (T5) for elective cesarean section patients.In phase I, we analyzed 374 parturients undergoing an elective cesarean section that received a suitable dose of intrathecal 0.5% hyperbaric bupivacaine after a combined spinal-epidural (CSE) was performed at the L3/4 interspace. Parturients with T5 blockade to pinprick were selected for establishing the regression equation between 0.5% hyperbaric bupivacaine volume and vertebral column length and abdominal girth. Six parturient and neonatal variables, intrathecal 0.5% hyperbaric bupivacaine volume, and spinal anesthesia spread were recorded. Bivariate line correlation analyses, multiple line regression analyses, and 2-tailed t tests or chi-square test were performed, as appropriate. In phase II, another 200 parturients with CSE for elective cesarean section were enrolled to verify the accuracy of the regression equation.In phase I, a total of 143 parturients were selected to establish the following regression equation: YT5 = 0.074X1 - 0.022X2 - 0.017 (YT5 = 0.5% hyperbaric bupivacaine volume for T5 block level; X1 = vertebral column length; and X2 = abdominal girth). In phase II, a total of 189 participants were enrolled in the study to verify the accuracy of the regression equation, and 155 parturients with T5 blockade were deemed eligible, which accounted for 82.01% of all participants.This study evaluated parturients with T5 blockade to pinprick after a CSE for elective cesarean section to establish a regression equation between parturient vertebral column length and abdominal girth and 0.5% hyperbaric intrathecal bupivacaine volume. This equation can accurately

  19. Concurrent intraoperative uterine rupture and placenta accreta. Do preoperative chronic hypertension, preterm premature rupture of membranes, chorioamnionitis, and placental abruption provide warning to this rare occurrence?

    Science.gov (United States)

    Cometa, M Anthony; Wasilko, Scott M; Wendling, Adam L

    2018-04-01

    Uterine and placental pathology can be a major cause of morbidity and mortality in the parturient and infant. When presenting alone, placental abruption, uterine rupture, or placenta accreta can result in significant peripartum hemorrhage, requiring aggressive surgical and anesthetic management; however, the presence of multiple concurrent uterine and placental pathologies can result in significant morbidity and mortality. We present the anesthetic management of a parturient who underwent an urgent cesarean delivery for non-reassuring fetal tracing in the setting of chronic hypertension, preterm premature rupture of membranes, and chorioamnionitis who was subsequently found to have placental abruption, uterine rupture, and placenta accreta.

  20. Anesthetic management of an obstetric patient with MELAS syndrome: case report and literature review.

    Science.gov (United States)

    Maurtua, M; Torres, A; Ibarra, V; DeBoer, G; Dolak, J

    2008-10-01

    Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS syndrome) is a mitochondrial disorder associated with neurologic, cardiac, neuromuscular, hepatic, metabolic and gastrointestinal dysfunction and potential anesthetic and obstetric complications. The case of a parturient with MELAS syndrome requiring labor analgesia is presented. A Medline literature search limited to the English language was undertaken to review cases of MELAS syndrome. Based on our experience and literature review, parturients with MELAS syndrome appear to benefit from neuraxial analgesia and anesthesia, which blunt excessive oxygen consumption and acidosis.

  1. Predictors of vertigo in patients with untreated vestibular schwannoma.

    Science.gov (United States)

    Andersen, Jan Fredrik; Nilsen, Kathrin Skorpa; Vassbotn, Flemming Slinning; Møller, Per; Myrseth, Erling; Lund-Johansen, Morten; Goplen, Frederik Kragerud

    2015-04-01

    Previous studies have shown that vertigo is the most powerful negative predictor of quality of life in patients with vestibular schwannomas, but the variability in vertigo symptom severity is still poorly understood. We wanted to find out whether vertigo could be related to objective parameters such as tumor size, location, vestibular nerve function, hearing, and postural stability in patients with untreated vestibular schwannomas. Baseline data from prospective cohort study. Tertiary referral center. Four hundred thirty-four consecutive patients with unilateral VS diagnosed on MRI. Mean age 56 years (range 16-84 yr). Fifty-three percent women. Diagnostic, with a medical history, otolaryngological examination, pure-tone and speech audiometry, MRI, posturography, and videonystagmography with bithermal caloric tests. Dizziness measured on a 100-mm visual analog scale (VAS). Secondary outcome measures were canal paresis and postural imbalance (static and dynamic posturography). Three hundred three patients (70%) completed the VAS. Severe dizziness, defined as VAS 75 or greater, was reported by 9% of the patients. Larger tumors were associated with higher risk of postural instability and canal paresis. Moderate to severe dizziness was associated with postural imbalance and canal paresis, and possibly with small to medium-sized tumors. Postural instability was related to tumor size and canal paresis when measured by dynamic, but not with static, posturography. A minority of VS patients experience severe vestibular symptoms related to canal paresis and postural instability. A curvilinear relationship is hypothesized between tumor size and dizziness.

  2. IMPAIRED MOBILITY OF VOCAL FOLDS - etiology and symptoms

    Directory of Open Access Journals (Sweden)

    Karlo Pintarić

    2015-06-01

    Full Text Available Paresis or paralysis of one or both vocal cords affects some significant aspects of a human life: breathing, swallowing and speech. The major causes for reduced mobility or even immobility are innervation damage, less often fixation of vocal cord or impaired mobility of crycoarytenoid joint. An injury of the superior or/and inferior laryngeal nerve can be a consequence of different medical procedures, tumor growth, trauma, infection, neurological disorders, radiation exposure, toxic damage, impaired circulation of the area or it is idiopathic. The symptoms are different in the case of unilateral and bilateral paresis of the vocal folds. They also depend on the cause for the impaired mobility. In the patients with unilateral vocal fold paresis, hoarseness and aspiration during swallowing are the leading symptoms. In the bilateral vocal fold paralysis, dyspnea prevails. 

  3. COMPLICATIONS DURING A SUPRACLAVICULAR ANESTHESIA OF THE BRACHIAL PLEXUS WITH INTERSCALENE APPROACH

    Directory of Open Access Journals (Sweden)

    Minko Minkov

    2012-11-01

    Full Text Available A hemidiaphragmatic paresis is one of the most frequently observed complications following the supraclavicular anesthesia of the brachial plexus with interscalene approach. In patients, crucially dependant on adequate diaphragmatic function, hemidiaphragmatic paresis may provoke acute respiratory disturbances. The aim of this study was to analyze the anatomical features the brachial plexus with regard of the anesthesia of specific areas of the shoulder and the upper limb.A dissection of the cervical and the brachial plexuses was done in human cadavers. We established that in some cases the phrenic nerve and the accessory phrenic nerve arise from the superior trunk of the brachial plexus. This type of anatomical arrangement significantly increases the risk of hemidiaphragmatic paresis during supraclavicular anesthesia with interscalene approach because the anesthetic tends to invade the supraclavicular space.

  4. Temporary ectropion therapy by adhesive taping: a case study

    Directory of Open Access Journals (Sweden)

    Habermann Anke

    2008-07-01

    Full Text Available Abstract Introduction Various surgical procedures are available to correct paralytic ectropion, which are applied in irreversible facial paresis. Problems occur when facial paresis has an unclear prognosis, since surgery of the lower eyelid is usually irreversible. We propose a simple method to correct temporary ectropion in facial palsy by applying an adhesive strip. Patients and methods Ten patients with peripheral facial paresis and paralytic ectropion were treated with an adhesive strip to correct paralytic ectropion. We used "Steri-Strips" (45 × 6.0 mm, which were taped on the carefully cleaned skin of the lower eyelid and of the adjacent zygomatic region until the prognosis of the paresis was clarified. In addition to the examiner's evaluation of the lower lacrimal point in the lacrimal lake, subjective improvement of the symptoms was assessed using a visual analogue scale (VAS, 1–10. Results 9 patients reported a clear improvement of the symptoms after adhesive taping. There was a clear regression of tearing (VAS (median = 8; 1 = no improvement, 10 = very good improvement, the cosmetic impairment of the adhesive tape was low (VAS (median = 2.5; 1 = no impairment, 10 = severe impairment and most of the patients found the use of the adhesive strip helpful. There was slight reddening of the skin in one case and well tolerated by the facial skin in the other cases. Conclusion The cause and location of facial nerve damage are decisive for the type of surgical therapy. In potentially reversible facial paresis, procedures should be used that are easily performed and above all reversible without complications. Until a reliable prognosis of the paresis can be made, adhesive taping is suited for the temporary treatment of paralytic ectropion. Adhesive taping is simple and can be performed by the patient.

  5. [Hemiparesis and facial palsy caused by methotrexate].

    Science.gov (United States)

    Rueda Arenas, E; García Corzo, J; Franco Ospina, L

    2013-12-01

    Methotrexate used in the treatment of acute lymphocytic leukemia, can cause neurotoxicity, including a rare presentation with hemiparesis. We describe two teenagers, who during the implementation of the M phase of the protocol, suffered hemiparesis, facial paresis and dysarthria which quickly reversed. Leukemia involvement of the central nervous system and stroke, were ruled out. We briefly review the pathophysiology of methotrexate neurotoxicity, the characteristics of the focal paresis presentation and magnetic resonance image findings. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  6. TropJrnal Vol 32 No 1

    African Journals Online (AJOL)

    Mr Olusoji

    Results: The parturients were predominantly within the age group 26 – 35 years and their mean gestational age at ... group C. Foetal outcome was comparable in all the three groups. ... for a single medication that is safe for use in labour,.

  7. Nigerian Journal of Gastroenterology and Hepatology - Vol 7, No 1 ...

    African Journals Online (AJOL)

    Prevalence of Hepatitis B virus infection amongst parturients in the University of Ilorin Teaching Hospital · EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. OA Ogunlaja, MO Bojuwoye, AA Fawole, AK Adesina, HO Olawumi, IP Ogunlaja, 7-12 ...

  8. Knowledge and attitudes of pregnant women towards anaesthetic ...

    African Journals Online (AJOL)

    As caesarean deliveries increase globally, more women will be exposed to anaesthesia as part of the surgical procedures. Evaluation of the knowledge and attitudes of parturient will guide patient education and counselling and may improve overall satisfaction with caesarean delivery. This was a cross sectional study ...

  9. Prof Anyanwu 2009 dec edition...

    African Journals Online (AJOL)

    User

    Sometimes presents with symptoms similar to those of postdural puncture headache, and can therefore be easily misdiagnosed, especially in a parturient that has undergone spinal anaesthesia. This is particularly significant because of the difference in the management between both conditions. Whereas the former might.

  10. Knowledge and willingness of prenatal women in Enugu ...

    African Journals Online (AJOL)

    Background: Nigerian parturients desire, but experience unsatisfactory pain relief as labour analgesia is underutilised and unpopular among skilled-birth attendants. Objectives: To assess pregnant women's knowledge and willingness to use non-pharmacological labour pain reliefs. Methods: Using a descriptive ...

  11. [PERIOPERATIVE ANALGESIA INFLUENCE ON MOTHER REHABILITATION PERIOD AFTER CESAREAN SECTION].

    Science.gov (United States)

    Sedykh, S V

    2015-01-01

    Early breast-feeding is a standard of perinatal care currently. After cesarean section it can be possible in case of early mother activation (verticalization). Assessment of perioperative analgesia influence on activation timing was the aim of our research. We included 120 parturient women. It was proved, that local analgesia using in postoperative period promotes early mother verticaliration, and optimal breast-feeding starting.

  12. Author Details

    African Journals Online (AJOL)

    Alagbe-Briggs, OT. Vol 90, No 10 (2013) - Articles Anaesthetic Challenges in a High Risk Parturient with Myasthenia Gravis Undergoing Caesarean Section Under Spinal Anaesthesia Abstract PDF. ISSN: 0012-835X. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's ...

  13. Author Details

    African Journals Online (AJOL)

    Fyneface-Ogan, S. Vol 86, No 12 (2009) - Articles Comparison of maternal satisfaction following epidulral and general anaesthesia for repeat caesarean section. Abstract PDF · Vol 90, No 10 (2013) - Articles Anaesthetic Challenges in a High Risk Parturient with Myasthenia Gravis Undergoing Caesarean Section Under ...

  14. Social-demographic and reproductive characteristics of mothers ...

    African Journals Online (AJOL)

    Conclusion: Analysis of the historical factors of parturients surveyed at the KBTH showed a high risk load related mainly to lack of education. Formal education of the female child and family health education of our women are recommended to reduce the high past abortion rate and risk load. Additionally, postpartum tubal ...

  15. Correlation between spinal column length and the spread of ...

    African Journals Online (AJOL)

    Correlation between spinal column length and the spread of subarachnoid hyperbaric bupivacaine in the term parturient. W.M Wan Rahiza, A.R Raha, A Muhd, M.N Nadia, M Muhammad, Z Azmil, I Azarinah, M.Z Jaafar ...

  16. Tropical Journal

    African Journals Online (AJOL)

    Results: There were 298 patients with primary PPH, a frequency of 6.6%. Atonic uterus 84 (33.8%), ... Active management of the third stage of labour should be promoted and ... operative vaginal deliveries and when parturients push. 7 before the cervix is fully dilated . ... Nigeria. It is the usual practice in the hospital for the.

  17. Evaluation of 25-gauge Quincke and 24 — gauge Gertie Marx ...

    African Journals Online (AJOL)

    Objective: To compare the insertion characteristics and rate of complications between 25-gauge Quincke and 24-gauge Gertie Marx needles. Design: Prospective, randomized. Setting: University of Benin Teaching Hospital; a university-affiliated tertiary centre. Subjects: Parturients (ASA 1 and 2) scheduled for elective ...

  18. JUNE 2010.for Ogidi (final).cdr

    African Journals Online (AJOL)

    User

    clinical audit, intra-partum care, birth attendants, health facilities, quality ... of the baby at birth. Names were excluded from extracted information in order to ensure confidentiality of individual parturients and health care providers, which a study of this nature required. ... records reviewed was 23.4 ± 3.3 years (Confidence.

  19. Browse Title Index

    African Journals Online (AJOL)

    Items 451 - 500 of 641 ... Vol 3, No 1 (2013), Postpartum Practices of Parturient Women in Enugu, ... Vol 1, No 2 (2011), Prevalence of Dental Caries in a Nigerian Rural ... and Consequences of Intimate Partner Violence During Pregnancy at ...

  20. Comparative effectiveness of malaria preventive measures on ...

    African Journals Online (AJOL)

    The burden of malaria and its associated problems in pregnancy can be reduced by the use of different malaria preventive measures. This study was conducted to determine the comparative effectiveness of three different malaria preventive measures on populations of parturient in Abeokuta, Ogun State, Nigeria.

  1. Author Details

    African Journals Online (AJOL)

    Ezebialu, Ifeanyichukwu U. Vol 30, No 1-2 (2018) - Articles Perception of labour pain and desire for pain relief in labour among parturients in a tertiary health facility in south-eastern Nigeria Abstract · Vol 30, No 1-2 (2018) - Articles Prevalence and correlates of postpartum depression among women visiting postnatal clinic in ...

  2. The effect of second-stage pushing and body mass index on postdural puncture headache.

    Science.gov (United States)

    Franz, Amber M; Jia, Shawn Y; Bahnson, Henry T; Goel, Akash; Habib, Ashraf S

    2017-02-01

    To explore how pushing during labor and body mass index affect the development of postdural puncture headache in parturients who experienced dural puncture with Tuohy needles. Retrospective cohort. Obstetric ward and operating rooms at a university-affiliated hospital. One hundred ninety parturients who had witnessed dural puncture with 17 or 18 gauge Tuohy needles from 1999-2014. Patients were categorized by pushing status and body mass index (kg/m 2 ): nonobese push, women who pushed during labor had increased risk of postdural puncture headache (odds ratio [OR], 2.1 [1.1-4.0]; P=.02), more days of headache (P=.02), and increased epidural blood patch placement (P=.02). Super obese patients were less likely to develop headache compared with nonobese (OR, 0.33 [0.13-0.85]; P=.02), obese (OR, 0.37 [0.14-0.98]; P=.045], and morbidly obese patients (OR, 0.20 [0.05-0.68]; Ppushing (OR, 0.57 [0.29-1.10]; P=.096) and super obesity (OR, 0.41 [0.16-1.02]; P=.056] were no longer significantly associated with reduced risk of postdural puncture headache. Parturients who did not push before delivery and parturients with body mass index ≥50kg/m 2 were less likely to develop postdural puncture headache in a univariate analysis. Similar trends were demonstrated in a multivariate model, but were no longer statistically significant. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Author Details

    African Journals Online (AJOL)

    Ogunlaja, IP. Vol 7, No 1 (2015) - Articles Prevalence of Hepatitis B virus infection amongst parturients in the University of Ilorin Teaching Hospital Abstract. ISSN: 2251-0079. AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about AJOL · AJOL's Partners · Terms ...

  4. Differences in maternal temperature during labour with remifentanil patient-controlled analgesia or epidural analgesia: a randomised controlled trial

    NARCIS (Netherlands)

    Douma, M.R.; Stienstra, R.; Middeldorp, J.M.; Arbous, M.S.; Dahan, A

    2015-01-01

    BACKGROUND: Epidural analgesia and remifentanil patient-controlled analgesia are two popular techniques for the treatment of labour pain, each with its own efficacy and toxicity. METHODS: Parturients requesting analgesia were randomly assigned to either patient-controlled intravenous remifentanil or

  5. Causes and Consequences of Late Arrival in Labour | Aziken ...

    African Journals Online (AJOL)

    Background: The outcome of labour depends to a large extent on the quality of intrapartum care given. Prompt arrival in hospital is essential for optimal care of parturient women. The causes and consequences of late arrival in labour have not been analysed in our setting. Objective: To determine the causes and ...

  6. Cost Implication of Abdominal wound Dehiscence in Obstetric ...

    African Journals Online (AJOL)

    Conclusion: Prolonged hospitalisation, high cost of treatment, and prolonged job loss, which might lead to aversion to obstetric operations and hospital delivery, were evident. The consequence is a self- perpetuating cycle of high costs and increased morbidity. It is expected that with the mass mobilization of our parturients ...

  7. EPIDURAL LABOUR ANALGESIA IN IZOLA GENERAL HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sabina Verem

    2018-02-01

    Full Text Available Background. The study presents the experience with epidural analgesia (EPA for pain relief in Izola General Hospital from 2003 to 2006, the differences of labour between epidural analgesia and without it and the parturients’ satisfaction. Methods. A retrospective observational study was performed. Data were compared between 214 parturients with EPA matched by 214 parturients without. The control parturient was the equiipara with a term birth and the cephalic presentation of fetus that delivered just before the parturient of the EPA group. Maternal age, labor length, rate of oxitocin use, instrumental deliveries and cesarean sections, Apgar scores and birthweights were compared. The questionnaire was used to estimate the pain in 62 parturients. Results. In GH Izola in 214 parturients (10 % EPA was applied for labour pain relief in the period from July 2003 till December 2006. In the EPA group there was a statistically significance compared with the control group: higher parturients’ mean age (30.5 vs 28.7 y.o.; p < 0.0005, longer labour length (278 vs 222 min; p < 0.0005, higher oxitocin use rate (93.4 % vs 72.9 %; p < 0.0001 and higher instrumental delivery rate (vacuum extraction 14 % vs 1.9 %; p < 0.0001. The cesarean section rates were equal in both groups. Despite the higher instrumental delivery rate and the longer labour length in the EPA group there were no worse perinatal outcomes, neither was statisticaly significant difference in Apgar scores compared with the control group. The mean intensity of pain was highest before the EPA application (VAS 7, lowest during the transition stage (VAS 1.5 and some higher during the second phase (VAS 2.7. Most of parturients in the EPA group were satisfied; 92 % of them evaluated the EPA as good or very good. Conclusions. EPA is a very effective method for pain control during labor. The parturients’ satisfaction with this pain control method is appropriate. Despite the higher instrumental

  8. Magnesium Therapy in Pre-eclampsia Prolongs Analgesia Following Spinal Anaesthesia with Fentanyl and Bupivacaine: An Observational Study

    Directory of Open Access Journals (Sweden)

    Tülay Özkan Seyhan

    2014-06-01

    Full Text Available Background: Magnesium has anti-nociceptive effects and potentiates opioid analgesia following its systemic and neuraxial administration. However, there is no study evaluating the effects of intravenous (IV magnesium sulphate (MgSO4 therapy on spinal anaesthesia characteristics in severely pre-eclamptic patients. Aims: The aim of this study was to compare spinal anaesthesia characteristics in severely pre-eclamptic parturients treated with MgSO4 and healthy preterm parturients undergoing caesarean section. Thus, our primary outcome was regarded as the time to first analgesic request following spinal anaesthesia. Study Design: Case-control Study. Methods: Following approval of Institutional Clinical Research Ethics Committee and informed consent of the patients, 44 parturients undergoing caesarean section with spinal anaesthesia were enrolled in the study in two groups: Healthy preterm parturients (Group C and severely pre-eclamptic parturients with IV MgSO4 therapy (Group Mg. Following blood and cerebrospinal fluid (CSF sampling, spinal anaesthesia was induced with 9 mg hyperbaric bupivacaine and 20 µg fentanyl. Serum and CSF magnesium levels, onset of sensory block at T4 level, highest sensory block level, motor block characteristics, time to first analgesic request, maternal haemodynamics as well as side effects were evaluated. Results: Blood and CSF magnesium levels were higher in Group Mg. Sensory block onset at T4 were 257.1±77.5 and 194.5±80.1 sec in Group C and Mg respectively (p=0.015. Time to first postoperative analgesic request was significantly prolonged in Group Mg than in Group C (246.1±52.8 and 137.4±30.5 min, respectively, p<0.001; with a mean difference of 108.6 min and 95% CI between 81.6 and 135.7. Side effects were similar in both groups. Group C required significantly more fluids. Conclusion: Treatment with IV MgSO4 in severe pre-eclamptic parturients significantly prolonged the time to first analgesic request compared

  9. Perioperative Management of Pregnant Women With Idiopathic Pulmonary Arterial Hypertension: An Observational Case Series Study From China.

    Science.gov (United States)

    Zhang, Jinglan; Lu, Jiakai; Zhou, Xiaorui; Xu, Xuefeng; Ye, Qing; Ou, Qitan; Li, Yanna; Huang, Jiapeng

    2018-03-07

    The mortality of pregnant women with idiopathic pulmonary arterial hypertension (PAH) is very high. There are limited data on the management of idiopathic PAH during pregnancy. The authors aimed to examine systematically the characteristics of parturient women with idiopathic PAH, to explore the adverse effects of idiopathic PAH on pregnancy outcomes, and to report the multidisciplinary perioperative management strategy from the largest comprehensive cardiac hospital in China. Observational case series study. Tertiary referral acute care hospital in Beijing, China. The cases of 17 consecutive pregnant idiopathic PAH patients undergoing abortion or parturition at Anzhen Hospital were reviewed retrospectively. Preoperative characteristics, anesthesia method, intensive care management, PAH-specific therapy, and maternal and neonatal outcomes were analyzed in this case series study. Maternal and neonatal outcomes were the main measures. The mean ages of the 17 parturient women with idiopathic PAH were 28.3 ± 5.4 years, and the mean systolic pulmonary arterial pressure was 97.9 ± 18.6 mmHg. Fifteen patients (88.2%) received PAH-specific therapy before delivery, including sildenafil, iloprost, and treprostinil. All except 1 parturient received epidural anesthesia for surgery due to an emergency Caesarean section. Three patients experienced pulmonary hypertension crisis that necessitated conversion to general anesthesia. Ten parturients underwent Caesarean delivery at a median gestational age of 31 weeks. Three patients developed acute pulmonary hypertensive crisis intraoperatively. Two patients underwent cardiopulmonary resuscitation and extracorporeal membrane oxygenation support. The maternal mortality was 17.6% (3/17). Of the 10 delivered neonates, 9 (90.0%) survived. The maternal mortality of the idiopathic PAH parturient was high in this case series from China. The authors applied epidural anesthesia, early management with multidisciplinary approaches, PAH

  10. An Evaluation of the Outcomes of Mutual Health Organizations in Benin

    Science.gov (United States)

    Haddad, Slim; Ridde, Valery; Yacoubou, Ismaelou; Mák, Geneviève; Gbetié, Michel

    2012-01-01

    Background Mutual health organizations (MHO) have been seen as a promising alternative to the fee-based funding model but scientific foundations to support their generalization are still limited. Very little is known about the extent of the impact of MHOs on health-seeking behaviours, quality and costs. Methodology/Principal Findings We present the results of an evaluation of the effects attributable to membership in an MHO in a rural region of Benin. Two prospective studies of users (parturients and hospitalized patients) were conducted on the territory of an inter-mutual consisting of 10 MHOs and as many healthcare centres (one, Ouessé, serving as a referral hospital) and one hospital (Papané). Members and non-members were matched (142 pairs of parturients and 109 triads of hospitalized patients) and multilevel multiple regression was used. Results show that member parturients went to healthcare centres sooner (p = 0.049) and were discharged more quickly after delivery (p = 0.001) than non-members. Length of stay in some cases was longer for hospitalized member parturients (+41%). Being a member did not shorten hospital stay, total length of episode of care, or time between appearance of symptoms and recourse to care. Regarding expenses, member parturients paid one-third less than non-members for a delivery. For hospitalized patients, the average savings for members was around $35 US. Total expenses incurred by patients hospitalized at Papané Hospital were higher than at Ouessé but the two hospitals’ relative advantages were comparable at −36% and −39%, respectively. Conclusion/Significance These results confirm mutual health organizations’ capacity to protect households financially, even if benefits for the poor have not been clearly determined. The search for scientific evidence should continue, to understand their impacts with regard to services obtained by their members. PMID:23077556

  11. An evaluation of the outcomes of mutual health organizations in Benin.

    Directory of Open Access Journals (Sweden)

    Slim Haddad

    Full Text Available BACKGROUND: Mutual health organizations (MHO have been seen as a promising alternative to the fee-based funding model but scientific foundations to support their generalization are still limited. Very little is known about the extent of the impact of MHOs on health-seeking behaviours, quality and costs. METHODOLOGY/PRINCIPAL FINDINGS: We present the results of an evaluation of the effects attributable to membership in an MHO in a rural region of Benin. Two prospective studies of users (parturients and hospitalized patients were conducted on the territory of an inter-mutual consisting of 10 MHOs and as many healthcare centres (one, Ouessé, serving as a referral hospital and one hospital (Papané. Members and non-members were matched (142 pairs of parturients and 109 triads of hospitalized patients and multilevel multiple regression was used. Results show that member parturients went to healthcare centres sooner (p = 0.049 and were discharged more quickly after delivery (p = 0.001 than non-members. Length of stay in some cases was longer for hospitalized member parturients (+41%. Being a member did not shorten hospital stay, total length of episode of care, or time between appearance of symptoms and recourse to care. Regarding expenses, member parturients paid one-third less than non-members for a delivery. For hospitalized patients, the average savings for members was around $35 US. Total expenses incurred by patients hospitalized at Papané Hospital were higher than at Ouessé but the two hospitals' relative advantages were comparable at -36% and -39%, respectively. CONCLUSION/SIGNIFICANCE: These results confirm mutual health organizations' capacity to protect households financially, even if benefits for the poor have not been clearly determined. The search for scientific evidence should continue, to understand their impacts with regard to services obtained by their members.

  12. Impact of Analgesia on the Course of Spontaneous Labor in Women with Diabetes Mellitus

    Directory of Open Access Journals (Sweden)

    M. I. Neimark

    2013-01-01

    Full Text Available Objective: to improve the results of spontaneous labor in female patients with diabetes mellitus (DM. Subjects and methods. The results of physiological labor analgesia were analyzed in 140 patients. The parturients were divided into 3 groups: 1 40 parturients in whom analgesia was performed by the intravenous administration of promedol; 2 40 parturients in whom analgesia was done by the fractional administration of 0.2% ropivacaine hydrochloride into the epidural space; 3 40 parturients in whom analgesia was carried out with intravenous paracetamol 2000—3000 mg. In all the patients, the investigators estimated central hemodynamic parameters by echocardiography, the efficiency of labor analgesia according to the scale described by N. N. Rasstrigina and B. V. Shnaider, as well as blood glucose levels, fetal status by a cardiotocographic technique, and neonatal status by Apgar scores at 1 and 5 minutes of life. Results. Analgesia quality assessment established that the best analgesic effect was achieved in the patients in Group 2 where 75.0% of the parturients had 8—10 scores. A comparative analysis of carbohydrate metabolic parameters also ascertained that the most steady-state and physiological glycemic level was recorded in Group 2 patients throughout the study. In addition, epidural analgesia versus other analgesic techniques provides the most steady-state hemodynamic parameters during labor, which promotes improved labor and has a beneficial effect on fetal and neonatal states. Conclusion. Glycemic levels during labor and delivery can be optimized in patients with DM only if adequate analgesia is achieved. By ensuring adequate labor analgesia, epidural analgesia normalizes glycemic and central hemodynamic parameters, favors elimination of delivery abnormalities, and has a beneficial effect on fetal and neonatal states. Key words: epidural analgesia, diabetes mellitus, spontaneous labor.

  13. Intoxication following minor stabs from the spines of a porcupine fish.

    NARCIS (Netherlands)

    Gorcum, Teetske F van; Janse, Max; Leenders, Marianne E C; Vries, Irma de; Meulenbelt, Jan

    2006-01-01

    We report an unusual intoxication by tetrodotoxin (TTX). A curator of an aquarium sustained minor punctures in his finger from the spines of a porcupine fish during an autopsy of a dead porcupine fish. He developed paresthesias, numbness, paresis, dizziness and headache. The death of the fish might

  14. Case report: Calcified chronic subdural haematoma in an elderly ...

    African Journals Online (AJOL)

    Calcified chronic subdural haematoma [CCSDH] is a rare complication of the relatively more common condition of Chronic Subdural Haematoma (CSDH). We present the case of a 68yr old man referred with a 2 week history of sudden onset Right hemi paresis generalized tonic clonic seizures and aphasia. There was a ...

  15. An automatic hinge system for leg orthoses

    NARCIS (Netherlands)

    Rietman, J. S.; Goudsmit, J.; Meulemans, D.; Halbertsma, J. P. K.; Geertzen, J. H. B.

    2004-01-01

    This paper describes a new automatic hinge system for leg orthoses, which provides knee stability in stance, and allows knee-flexion during swing. Indications for the hinge system are a paresis or paralysis of the quadriceps muscles. Instrumented gait analysis was performed in three patients, fitted

  16. An automatic hinge system for leg orthoses

    NARCIS (Netherlands)

    Rietman, J.S.; Goudsmit, J.; Meulemans, D.; Halbertsma, J.P.K.; Geertzen, J.H.B.

    This paper describes a new, automatic hinge system for leg orthoses, which provides knee stability in stance, and allows knee-flexion during swing. Indications for the hinge system are a paresis or paralysis of the quadriceps muscles. Instrumented gait analysis was performed in three patients,

  17. Characterizing the protocol for early modified constraint-induced movement therapy in the EXPLICIT-stroke trial

    NARCIS (Netherlands)

    Nijland, R van; Wegen, E. van; Krogt, H. van der; Bakker, C.D.; Buma, F.; Klomp, A.; Kordelaar, J. van; Kwakkel, G.; Geurts, A.C.; Kuijk, A.A. van; Lindeman, E.; Visser-Meily, J.M.A.; Arendzen, H.J.; Meskers, C.G.; Helm, F.C.T. van der; Vlugt, E. de

    2013-01-01

    Constraint-induced movement therapy (CIMT) is a commonly used rehabilitation intervention to improve upper limb function after stroke. CIMT was originally developed for patients with a chronic upper limb paresis. Although there are indications that exercise interventions should start as early as

  18. Australian bat lyssavirus infection in a captive juvenile black flying fox.

    OpenAIRE

    Field, H.; McCall, B.; Barrett, J.

    1999-01-01

    The newly emerging Australian bat lyssavirus causes rabieslike disease in bats and humans. A captive juvenile black flying fox exhibited progressive neurologic signs, including sudden aggression, vocalization, dysphagia, and paresis over 9 days and then died. At necropsy, lyssavirus infection was diagnosed by fluorescent antibody test, immunoperoxidase staining, polymerase chain reaction, and virus isolation. Eight human contacts received postexposure vaccination.

  19. Differentiation between non-neural and neural contributors to ankle joint stiffness in cerebral palsy

    NARCIS (Netherlands)

    De Gooijer-van de Groep, K.L.; De Vlugt, E.; De Groot, J.H.; Van der Heijden-Maessen, H.C.M.; Wielheesen, D.H.M.; Van Wijlen-Hempel, R.M.S.; Arendzen, J.H.; Meskers, C.G.M.

    2013-01-01

    Background Spastic paresis in cerebral palsy (CP) is characterized by increased joint stiffness that may be of neural origin, i.e. improper muscle activation caused by e.g. hyperreflexia or non-neural origin, i.e. altered tissue viscoelastic properties (clinically: “spasticity” vs. “contracture”).

  20. Trunk sway analysis to quantify the warm-up phenomenon in myotonia congenita patients.

    NARCIS (Netherlands)

    Horlings, G.C.; Drost, G.; Bloem, B.R.; Trip, J.; Pieterse, A.J.; Engelen, B.G.M. van; Allum, J.H.J.

    2009-01-01

    OBJECTIVE: Patients with autosomal recessive myotonia congenita display myotonia and transient paresis that diminish with repetitive muscle contractions (warm-up phenomenon). A new approach is presented to quantify this warm-up phenomenon under clinically relevant gait and balance tasks. METHODS:

  1. Intoxication of sheep exposed to ozark milkweed (Asclepias viridis Walter).

    Science.gov (United States)

    Smith, R A; Scharko, P; Bolin, D; Hong, C B

    2000-12-01

    Some 20 sheep died 1 at a time on a farm in Fleming County, KY, in late July of 1999 after consumption of Asclepias viridis Walter. Major histological lesions were mild multifocal nonsuppurative myocarditis. Gross pathology revealed wet and heavy lungs. Many affected animals had a hunched appearance, and marked posterior paresis was also observed.

  2. Neuroimaging in patients with conversion disorder

    NARCIS (Netherlands)

    Noort, P.D.

    2013-01-01

    Background: Medically unexplained symptoms are not uncommon in the clinical setting. Conversion disorder is a psychological disorder in which there is no neurological explanation for patients’ physical symptoms. These physical symptoms can be both positive or negative, e.g. tremor or paresis. This

  3. INTRACRANIAL PATHOLOGY AND DIPLOPIA

    African Journals Online (AJOL)

    1971-04-10

    Apr 10, 1971 ... bance. Muscle paretic diplopia is the clinical entity com- ... occurring with chiasmal involvement by pituitary tumours. In these cases a new central functioning area or pseudo- fovea may ... may be a cerebral dissociation allowing the independent ... Long-standing convergence paresis in ep~demic encepha-.

  4. Celebral computerized tomography

    International Nuclear Information System (INIS)

    Lofteroed, B.; Sortland, O.

    1985-01-01

    Indications for cerebral computerized tomography (CT) and the diagnostic results from this examination are evaluated in 127 children. Pathological changes were found in 31 children, mostly based on such indications as increasing head size, suspicion of brain tumor, cerebral paresis, delayed psychomotor development and epileptic seizures. A list of indications for CT in children is given

  5. Laryngeal dysfunction after thyroid surgery: diagnostic and treatments

    OpenAIRE

    FINCK, Camille

    2006-01-01

    Vocal fold hypomobility after thyroidectomy is a frequent complication of thyroidectomy. Laryngeal nerve paresis or paralysis may present with various symptoms like dysphagia, aspiration, voice alteration or dyspnea. Are described: the normal anatomophysiology of the larynx, the symptoms of nerve trauma following thyroidectomy, techniques of thoroughfull laryngeal and voice examination, some clinical entities( unilateral recurrent nerve paralysis, bilateral recurrent nerve paralysis, superior...

  6. Ophthalmoplegia, Dysphonia and Tetraparesis Due to Guillain ...

    African Journals Online (AJOL)

    Guillain-Barre's syndrome (GBS) or inflammatory/post-infectious acute polyradiculoneuropathy is due to demyelination of nerves, causing a progressive paresis or paralysis. It usually begins in the legs and sometimes goes up to the respiratory muscles and cranial nerves. The exact mechanism of GBS occurrance is still ...

  7. Paraneoplastic ophthalmoplegia and subacute motor axonal neuropathy associated with anti-GQ1b antibodies in a patient with malignant melanoma

    NARCIS (Netherlands)

    L. Kloos; C.W. Ang (Wim); W.H.J. Kruit (Wim); G. Stoter (Gerrit); P.A.E. Sillevis Smitt (Peter)

    2003-01-01

    textabstractA 68 year old woman developed oculomotor paresis shortly after metastatic progression of her melanoma was discovered. She was then immunised with the tumour antigen MAGE-3 in combination with an immunological adjuvant. During immunisation her symptoms worsened and she

  8. CEREBROVASCULAR ACCIDENTS IN NIGERIANS: A STUDY OF ...

    African Journals Online (AJOL)

    Table III shows the sex and age distribution in patients with NEICVD. .... children under 5 years old, haemoglobin sickle cell crisis was associated with .... +ve. Right hemiparesis. Left hemiparesis. Quadri-paresis. 128. 90. 12. 42. 37. 6. 54. 40. 4.

  9. Efficacy of a combined physical and occupational therapy intervention in patients with subacute neuralgic amyotrophy: A pilot study

    NARCIS (Netherlands)

    Ijspeert, J.; Janssen, R.M.J.; Murgia, A.; Pisters, M.F.; Cup, E.H.C.; Groothuis, J.T.; Alfen, N. van

    2013-01-01

    BACKGROUND: Neuralgic Amyotrophy (NA) is characterized by neuropathic pain, subsequent patchy paresis and possible sensory loss in the upper extremity. Many patients experience difficulties in performing activities of daily life and are unable to resume work. We developed a combined physical- and

  10. Submandibular gland excision

    DEFF Research Database (Denmark)

    Springborg, Line Kanstrup; Møller, Martin Nue

    2013-01-01

    long-term clinical follow-up of 113 of these patients after a median of 81 months. In all patients, the operation was effective. We found a 4.3 % risk of reoperation for wound infection or postoperative hematomas and an 18.7 % risk of early paresis of the marginal branch of the facial nerve, which...

  11. Pituitary apoplexy masquerading as meningitis | Merwitz | Journal of ...

    African Journals Online (AJOL)

    Pituitary apoplexy is an uncommon condition and medical emergency that classically presents with abrupt onset of severe headache, nausea, fever, impaired level of consciousness, visual disturbances and a variable degree of ocular paresis. The constellation of signs, symptoms and cerebrospinal fluid findings in keeping ...

  12. Motor and cognitive impairment after stroke : A common bond or a simultaneous deficit?

    NARCIS (Netherlands)

    Verstraeten, S.M.M.; Mark, R.E.; Sitskoorn, M.M.

    2016-01-01

    Background: The prevalence of both motor deficit and cognitive impairment after stroke is high and persistent. Motor impairment, especially paresis, is often ore obvious to both patients and their carers while cognitive problems can also have devastating effects on quality of life. The current

  13. Sound-induced facial synkinesis following facial nerve paralysis

    NARCIS (Netherlands)

    Ma, Ming-San; van der Hoeven, Johannes H.; Nicolai, Jean-Philippe A.; Meek, Marcel F.

    Facial synkinesis (or synkinesia) (FS) occurs frequently after paresis or paralysis of the facial nerve and is in most cases due to aberrant regeneration of (branches of) the facial nerve. Patients suffer from inappropriate and involuntary synchronous facial muscle contractions. Here we describe two

  14. Disease: H01837 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available lbar paresis (Worster- Drought syndrome) is a permanent movement disorder of the bulbar muscles causing persistent...ndrome: poorly recognized despite severe and persistent difficulties with feeding and speech. ... JOURNAL ... Dev Med Child Neurol 52:27-32 (2010) DOI:10.1111/j.1469-8749.2009.03475.x ...

  15. Linear Identification of Nonlinear Wrist Neuromechanics in Stroke

    NARCIS (Netherlands)

    Klomp, A.

    2015-01-01

    In many stroke patients, a motor cortex lesion alters motor control. Initially, paresis is most prominent, but then over time, joint stiffening and hyperreflexia may occur. How these different disorders develop over time is still unknown due to high system complexity. Secondary changes in the

  16. Pupilparalyse. En sjaelden komplikation ved øjeninfektion med Varicella zoster-virus

    DEFF Research Database (Denmark)

    Hallas, P

    2001-01-01

    Pupillary paralysis and paresis of the peripheral facial nerve on the left side was found in a 68-year-old man with concussion and herpes zoster ophthalmicus on the left eye. Post mortem examination showed no sign of intracranial hemorrhage. The cause of death was pulmonary oedema and aspiration...

  17. Gait training assisted by multi-channel functional electrical stimulation early after stroke: study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    van Bloemendaal, Maijke; Bus, Sicco A.; de Boer, Charlotte E.; Nollet, Frans; Geurts, Alexander C. H.; Beelen, Anita

    2016-01-01

    Many stroke survivors suffer from paresis of lower limb muscles, resulting in compensatory gait patterns characterised by asymmetries in spatial and temporal parameters and reduced walking capacity. Functional electrical stimulation has been used to improve walking capacity, but evidence is mostly

  18. Opaque iris claw lens in a phakic eye to correct acquired diplopia

    NARCIS (Netherlands)

    Landesz, M; Worst, JGF; Rij, GV; Houtman, WA

    1997-01-01

    A 25-year-old man had diplopia caused by abducens nerve paresis on both sides after cranial injury. Because of the patient's reports of persistent diplopia after surgical correction, a specially manufactured, tinted iris claw lens was implanted in the left eye, with the crystalline lens in situ.

  19. [An unusual cause of acute dyspnoea: neuralgic amyotrophy

    NARCIS (Netherlands)

    Ven, A.C. van de; Alfen, N. van; Heijdra, Y.F.

    2009-01-01

    A 40-year-old man presented at the neurology outpatient clinic with sudden severe pain in both shoulders, followed by paresis of the muscles in this region. These complaints, in combination with acute dyspnoea when lying flat, and paradoxal movements of the abdomen during respiration, led to the

  20. Efficacy of a combined physical and occupational therapy intervention in patients with subacute neuralgic amyotrophy : A pilot study

    NARCIS (Netherlands)

    IJspeert, Jos; Janssen, Renske M. J.; Murgia, Alessio; Pisters, Martijn F.; Cup, Edith H. C.; Groothuis, Jan T.; van Alfen, Nens

    2013-01-01

    BACKGROUND: Neuralgic Amyotrophy (NA) is characterized by neuropathic pain, subsequent patchy paresis and possible sensory loss in the upper extremity. Many patients experience difficulties in performing activities of daily life and are unable to resume work. We developed a combined physical- and

  1. Comparing unilateral and bilateral upper limb training: the ULTRA-stroke program design

    NARCIS (Netherlands)

    van Delden, A.E.Q.; Peper, C.E.; Harlaar, J.; Daffertshofer, A.; Zijp, N.I.; Nienhuys, K.; Koppe, P.; Kwakkel, G.; Beek, P.J.

    2009-01-01

    Background: About 80% of all stroke survivors have an upper limb paresis immediately after stroke, only about a third of whom (30 to 40%) regain some dexterity within six months following conventional treatment programs. Of late, however, two recently developed interventions - constraint-induced

  2. Effects of ankle foot orthoses on body functions and activities in people with floppy paretic ankle muscles : a systematic review

    NARCIS (Netherlands)

    Wilk, van der Dymphy; Dijkstra, Pieter Ubele; Postema, Klaas; Verkerke, Gijsbertus Jacob; Hijmans, Juha Markus

    2015-01-01

    Background: People with floppy ankle muscles paresis use ankle foot orthoses to improve their walking ability. Ankle foot orthoses also limit ankle range of motion thereby introducing additional problems. Insight in effects of ankle foot orthoses on body functions and activities in people with

  3. Functional neuroimaging of recovery from motor conversion disorder: A case report.

    Science.gov (United States)

    Dogonowski, Anne-Marie; Andersen, Kasper W; Sellebjerg, Finn; Schreiber, Karen; Madsen, Kristoffer H; Siebner, Hartwig R

    2018-03-27

    A patient with motor conversion disorder presented with a functional paresis of the left hand. After exclusion of structural brain damage, she was repeatedly examined with whole-brain functional magnetic resonance imaging, while she performed visually paced finger-tapping tasks. The dorsal premotor cortex showed a bilateral deactivation in the acute-subacute phase. Recovery from unilateral hand paresis was associated with a gradual increase in task-based activation of the dorsal premotor cortex bilaterally. The right medial prefrontal cortex displayed the opposite pattern, showing initial task-based activation that gradually diminished with recovery. The inverse dynamics of premotor and medial prefrontal activity over time were found during unimanual finger-tapping with the affected and non-affected hand as well as during bimanual finger-tapping. These observations suggest that reduced premotor and increased medial prefrontal activity reflect an effector-independent cortical dysfunction in conversion paresis which gradually disappears in parallel with clinical remission of paresis. The results link the medial prefrontal and dorsal premotor areas to the generation of intentional actions. We hypothesise that an excessive 'veto' signal generated in medial prefrontal cortex along with decreased premotor activity might constitute the functional substrate of conversion disorder. This notion warrants further examination in a larger group of affected patients. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  4. Development of a hybrid strength training technique for paretic lower-limb muscles

    NARCIS (Netherlands)

    Bennett, T. L.; Glaser, R. M.; Janssen, T. W J; Couch, W. P.; Herr, C. J.; Almeyda, J. W.; Petrofsky, S. H.; Akuthota, P.

    1996-01-01

    A hybrid resistance exercise technique for strength training of patients with lower-limb paresis was developed. It consists of electrical stimulation-induced contractions (ESIC) superimposed on voluntary contractions to increase recruitment of motor units and the functional load capability of

  5. Gadolinium-DTPA enhanced MRI in neonatal osteomyelitis of the cervical-spine

    NARCIS (Netherlands)

    Martijn, A; van der Vliet, AM; van Waarde, WM; van Aalderen, WMC

    Although the radiographic features of neonatal osteomyelitis are well described, spinal localizations are very rare and occur in about 2–4%. Clinical presentation with paresis and paralysis occurs in less than 1% (Resnick & Niwayama, 1988). In the neonate negative bone scintigraphy in the presence

  6. A Case of Classic Raymond Syndrome

    Directory of Open Access Journals (Sweden)

    Nicholas George Zaorsky

    2012-01-01

    Full Text Available Classic Raymond syndrome consists of ipsilateral abducens impairment, contralateral central facial paresis, and contralateral hemiparesis. However, subsequent clinical observations argued on the presentation of facial involvement. To validate this entity, we present a case of classic Raymond syndrome with contralateral facial paresis. A 50 year-old man experienced acute onset of horizontal diplopia, left mouth drooling and left-sided weakness. Neurological examination showed he had right abducens nerve palsy, left-sided paresis of the lower part of the face and limbs, and left hyperreflexia. A brain MRI showed a subacute infarct in the right mid-pons. The findings were consistent with those of classic Raymond syndrome. To date, only a few cases of Raymond syndrome, commonly without facial involvement, have been reported. Our case is a validation of classic Raymond syndrome with contralateral facial paresis. We propose the concept of two types of Raymond syndrome: (1 the classic type, which may be produced by a lesion in the mid-pons involving the ipsilateral abducens fascicle and undecussated corticofacial and corticospinal fibers; and (2 the common type, which may be produced by a lesion involving the ipsilateral abducens fascicle and undecussated corticospinal fibers but sparing the corticofacial fibers.

  7. Dysphonia and dysphagia after anterior cervical decompression.

    Science.gov (United States)

    Tervonen, Hanna; Niemelä, Mika; Lauri, Eija-Riitta; Back, Leif; Juvas, Anja; Räsänen, Pirjo; Roine, Risto P; Sintonen, Harri; Salmi, Tapani; Vilkman, S Erkki; Aaltonen, Leena-Maija

    2007-08-01

    In this paper, the authors investigate the effects of anterior cervical decompression (ACD) on swallowing and vocal function. The study comprised 114 patients who underwent ACD. The early group (50 patients) was examined immediately pre- and postoperatively, and the late group (64 patients) was examined at only 3 to 9 months postoperatively. Fifty age- and sex-matched patients from the Department of Otorhinolaryngology-Head and Neck Surgery who had not been intubated in the previous 5 years were used as a control group. All patients in the early and control groups were examined by a laryngologist; patients in the late group were examined by a laryngologist and a neurosurgeon. Videolaryngostroboscopy was performed in all members of the patient and control groups, and the function of the ninth through 12th cranial nerves were clinically evaluated. Data were collected concerning swallowing, voice quality, surgery results, and health-related quality of life. Patients with persistent dysphonia were referred for phoniatric evaluation and laryngeal electromyography (EMG). Those with persistent dysphagia underwent transoral endoscopic evaluation of swallowing function and videofluorography. Sixty percent of patients in the early group reported dysphonia and 69% reported dysphagia at the immediate postoperative visit. Unilateral vocal fold paresis occurred in 12%. The prevalence of both dysphonia and dysphagia decreased in both groups 3 to 9 months postoperatively. All six patients with vocal fold paresis in the early group recovered, and in the late group there were two cases of vocal fold paresis. The results of laryngeal EMG were abnormal in 14 of 16 patients with persistent dysphonia. Neither intraoperative factors nor age or sex had any effect on the occurrence of dysphonia, dysphagia, or vocal fold paresis. Most patients were satisfied with the surgical outcome. Dysphonia, dysphagia, and vocal fold paresis are common but usually transient complications of ACD

  8. Diaphragmatic thickness ratio (inspiratory/expiratory) as a diagnostic method of diaphragmatic palsy associated with interescalene block.

    Science.gov (United States)

    López Escárraga, V M; Dubos España, K; Castillo Bustos, R H; Peidró, L; Sastre, S; Sala-Blanch, X

    2018-02-01

    Diaphragmatic paralysis is a side-effect associated with interscalene block. Thickness index of the diaphragm muscle (inspiratory thickness/expiratory thickness) obtained by ultrasound has recently been introduced in clinical practice for diagnosis of diaphragm muscle atrophy. Our objective was to evaluate this index for the diagnosis of acute phrenic paresis associated with interscalene block. We designed an observational study in 22 patients scheduled for shoulder arthroscopy. Spirometry was performed (criteria of phrenic paresis was a decrease in FVC and FEV1 ≥20%). Ultrasound apposition zone was assessed in anterior axillary line and diaphragmatic displacement was evaluated on inspiration and expiration (number of intercostal spaces; phrenic paresis considered a reduction ≥25%) and thickness of the diaphragm muscle (a phrenic paresis was considered an index block at C5-C6 with 20ml of 0.5% ropivacaine. Twenty-one patients (95%) presented phrenic nerve block according to one or more of the methods used. One patient did not show any symptoms or signs suggestive of phrenic paralysis and was excluded. All the patients presented phrenic paresis based on the diaphragmatic thickness index, with the pre-block index being 1.8±0.5 and post-block of 1.05±0.06 (Pblock (from 1.9±0.5 intercostal spaces to 0.5±0.3; Pblock. This index does not require a baseline pre-assessment. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  9. High rate of unplanned pregnancy in the context of integrated family planning and HIV care services in South Africa.

    Science.gov (United States)

    Adeniyi, Oladele Vincent; Ajayi, Anthony Idowu; Moyaki, Mayowa Gabriel; Goon, Daniel Ter; Avramovic, Gordana; Lambert, John

    2018-02-27

    Integration of family planning services into HIV care was implemented in South Africa as a core strategy aimed at reducing unintended pregnancies among childbearing women living with HIV. However, it is unclear whether this strategy has made any significant impact at the population level. This paper describes the prevalence and correlates of self-reported unplanned pregnancy among HIV-infected parturient women attending three large maternity centres in the Eastern Cape, South Africa. We also compare unplanned pregnancy rates between HIV-infected parturient women already in care (who have benefitted from services' integration) and newly diagnosed parturient women (who have not benefitted from services' integration). Drawing from the baseline data of the East London Prospective Cohort Study (ELPCS), data of 594 parturient women living with HIV in the Eastern Cape were included. Chi-square statistics and binary logistics regression were employed to determine the correlates of unplanned pregnancy among the cohort. The prevalence of unplanned pregnancy was 71% (n = 422) with a higher rate among parturient women newly diagnosed during the index pregnancy (87%). Unplanned pregnancy was significantly associated with younger age, single status, HIV diagnosis at booking, high parity and previous abortion. Women who reported unplanned pregnancy were more likely to book late and have lower CD4 counts. After adjusting for confounding variables, having one child and five to seven children (AOR = 2.2; CI = 1.3-3.1), age less than 21 years (AOR = 3.3; CI = 1.1-9.8), late booking after 27 weeks (AOR = 2.7; CI = 1.5-5.0), not married (AOR = 4.3; CI = 2.7-6.8) and HIV diagnosis at booking (AOR = 3.0; CI = 1.6-5.8) were the significant correlates of unplanned pregnancy in the cohort. Unplanned pregnancy remains high overall among parturient women living with HIV in the region, however, with significant reduction among those who were

  10. The effect of dietary calcium and phosphorus supplementation in zeolite A treated dry cows on periparturient calcium and phosphorus homeostasis

    DEFF Research Database (Denmark)

    Thilsing, Trine; Larsen, T.; Jørgensen, Rolf Jess

    2007-01-01

    Previous studies have proved the possibility of preventing parturient hypocalcaemia by zeolite A supplementation during the dry period, and a recent in vitro study has indicated a marked calcium (Ca) as well as phosphorus (P) binding effect of zeolite A in rumen fluid solutions. Because...... of the connection between the Ca and P homeostatic systems, the preventive effect against parturient hypocalcaemia may arise from zeolite induced decreased availability of dietary Ca as well as P. In the present study, the expected Ca and P binding capacity was challenged by feeding high and low levels of dietary...... Ca and/or P to zeolite A treated dry cows. Twenty-one pregnant dry cows were assigned to four experimental groups receiving a dry cow ration unsupplemented or supplemented with extra Ca and/or P. During the last 2 weeks of the dry period all cows additionally received 600 g of zeolite A per day...

  11. [Excrement of the meconium and the intra-partum cardiotocogram].

    Science.gov (United States)

    Santeler, P; Hochuli, E

    1976-01-01

    Of 2233 parturients, 170 cases with evidence of meconium during delivery were examined. We tried to establish the correlation between the appearance of meconium and the occurance of contraction induced FHR-decelerations in continuous intra partum monitoring. In addition we purposed to determine, whether the appearing of meconium during labor can be used as a clinical prognosite sign for fetal outcome. Our data support the assumption that the passage of meconium during any stage of labor only represents a sign of potential fetal distress showing the intra partum records pathology FHF-patterns. The appearance of meconium alone -- diagnosed at the time of the entrance of parturients or in an advanced stage of labor -- demands supplemented diagnostic methods for a better interpreting of an actual or compensated fetal distress.

  12. [Correlation between the inspired fraction of oxygen, maternal partial oxygen pressure, and fetal partial oxygen pressure during cesarean section of normal pregnancies].

    Science.gov (United States)

    Castro, Carlos Henrique Viana de; Cruvinel, Marcos Guilherme Cunha; Carneiro, Fabiano Soares; Silva, Yerkes Pereira; Cabral, Antônio Carlos Vieira; Bessa, Roberto Cardoso

    2009-01-01

    Despite changes in pulmonary function, maternal oxygenation is maintained during obstetric regional blocks. But in those situations, the administration of supplementary oxygen to parturients is a common practice. Good fetal oxygenation is the main justification; however, this has not been proven. The objective of this randomized, prospective study was to test the hypothesis of whether maternal hyperoxia is correlated with an increase in fetal gasometric parameters in elective cesarean sections. Arterial blood gases of 20 parturients undergoing spinal block with different inspired fractions of oxygen were evaluated and correlated with fetal arterial blood gases. An increase in maternal inspired fraction of oxygen did not show any correlation with an increase of fetal partial oxygen pressure. Induction of maternal hyperoxia by the administration of supplementary oxygen did not increase fetal partial oxygen pressure. Fetal gasometric parameters did not change even when maternal parameters changed, induced by hyperoxia, during cesarean section under spinal block.

  13. The role of fibrinogen and haemostatic assessment in postpartum haemorrhage

    DEFF Research Database (Denmark)

    Wikkelsø, Anne Juul

    2015-01-01

    Pregnancy is a state of hypercoagulobility that might be an evolutionary way of protecting parturients from exsanguination following child birth. Observational studies suggest an association between a low level of fibrinogen (coagulation factor I) at the start of postpartum haemorrhage (PPH....... Paper III was based on two national Danish registries evaluating the predictability of postpartum blood transfusion. Prediction was found difficult. However, retained placental parts seemed to be the strongest predictor. Since this diagnosis is made very late and often in association with the onset...... describes the protocol for a RCT of early fibrinogen supplementation in women with severe postpartum haemorrhage. Several practical, ethical and trial management challenges need to be addressed when conducting independent clinical research involving parturients with severe bleeding, placebo...

  14. Leukocyte counts and lymphocyte subsets in relation to pregnancy and HIV infection in Malawian women.

    Science.gov (United States)

    Mandala, Wilson L; Gondwe, Esther N; Molyneux, Malcolm E; MacLennan, Jenny M; MacLennan, Calman A

    2017-09-01

    We investigated leukocyte and lymphocyte subsets in HIV-infected or HIV-uninfected, pregnant or non-pregnant Malawian women to explore whether HIV infection and pregnancy may act synergistically to impair cellular immunity. We recruited 54 pregnant and 48 non-pregnant HIV-uninfected women and 24 pregnant and 20 non-pregnant HIV-infected Malawian women. We compared peripheral blood leukocyte and lymphocyte subsets between women in the four groups. Parturient HIV-infected and HIV-uninfected women had more neutrophils (each PHIV-uninfected parturient women had fewer CD4 + and γδ T cells, B and NK cells (each Ppregnancy. Malawian women at parturition have an increased total white cell count due to neutrophilia and an HIV-unrelated pan-lymphopenia. © 2017 The Author. American Journal of Reproductive Immunology Published by John Wiley & Sons Ltd.

  15. Epidural Analgesia and Fever at Labor

    Directory of Open Access Journals (Sweden)

    Ye. M. Shifman

    2008-01-01

    Full Text Available Objective: to study the incidence of labor fever under epidural analgesia (EA and to evaluate its impact on the courses of puerperium and early neonatality. Subjects and methods. The paper presents the data of a prospective study of the course of labor, puerperium, and early neonatality in 397 women in whom labors occurred at the Republican Peritoneal Center in 2006. A study group included 324 parturients in whom labor pain was relieved by EA. A comparison group comprised 55 parturients in whom no analgesics were used at labor. Results. There were no significant statistical differences between the groups in the incidence of labor fever and complicated puerperium and in that of neonatal pyoseptic diseases. Key words: labor hyperthermia, epidural analgesia, labor pain relief.

  16. Protecting Against Child-Killing Demons: Uterus Amulets in the Late Antique and Byzantine Magical World

    OpenAIRE

    Björklund, Heta

    2017-01-01

    This doctoral dissertation examines medicinal-magical amulets pertaining to the uterus and the protection of women and children, the accompanying tradition of magical texts, and the mythology and folktales of demons believed to kill children and parturient women. The amulets and the folktales of the demons they were believed to protect against are intertwined. The amulets cannot be studied merely as archaeological or art historical objects, but must be taken together with folktales and narrat...

  17. [Relationship between factors of labour pain and delivery outcomes].

    Science.gov (United States)

    Ye, Hui-jun; Jiang, Yan-jiao; Ruan, Zhi-fang

    2011-10-01

    To evaluate factors associated with labor pain and delivery outcomes. From Jul. to Dec. 2009, 111 normal singleton cephalic presentation pregnancies (including 5 elderly parturient) who delivered at the Department of Obstetrics and Gynecology, Second Affiliated Hospital, Zhejiang Chinese Medical University were enrolled in this study to evaluate the relationship between factors of labor pain and delivery outcomes. The labor pain of latent phase and active phase were scored by the visual analogue scale (VAS). Factors associated with pain included the age of parturient, the number of gravidity and parity, occupation, education profile, dwell location, etc. The questionnaire was designed by ourselves. Childbirth awareness, psychological preparation of delivery, emotional controllability, couple relationship, the relationship of parturient and mother-in-law, the relationship of parturient and parents, family economic status, use of sedative during the labor process and delivery outcomes were collected and analyzed. (1) Factors associated with pain: in the latent phase, the rate of moderate labour pain of 1/5 in women with more than 35 years old was statistically lower than 76.4% (81/106) in suitable age group (P emotion control expressed significantly severe labour pain (59.0%, 36/61) than 35.6% (16/45) in well-prepared group. The rate of severe labour pain in good control of emotion group of 44.8% (43/96) was a statistically lower than 9/10 in poor control group. There was a statistically lower severe labour pain in women given by sedatives (29.2%, 7/24) than 54.9% (45/82) in women without sedatives treatment (P emotion control, young age and uniparous have severe labour pain. Sedative use could alleviate pain in active phase. Women with mild labour pain have good delivery outcomes.

  18. Non-invasive mechanical ventilation with spinal anesthesia for cesarean delivery.

    Science.gov (United States)

    Erdogan, G; Okyay, D Z; Yurtlu, S; Hanci, V; Ayoglu, H; Koksal, B; Turan, I O

    2010-10-01

    We present the successful use of perioperative non-invasive mechanical ventilation in a morbidly obese pregnant woman with bronchial asthma, severe preeclampsia and pulmonary edema undergoing an emergency cesarean delivery with spinal anesthesia. The combination of non-invasive mechanical ventilation with neuraxial anesthesia may be of value in selected parturients with acute or chronic respiratory insufficiency requiring surgery. Copyright © 2010 Elsevier Ltd. All rights reserved.

  19. Effect of QTc interval on prediction of hypotension following subarachnoid block in patients undergoing cesarean section: A comparative study

    Directory of Open Access Journals (Sweden)

    Sampa Dutta Gupta

    2012-01-01

    Full Text Available Background: Previous studies have revealed that QTc interval is prolonged in pre-eclamptic parturients. Another study reflected the relationship between the sympathetic block and QTc interval. Subarachnoid block was safely administered in patients with severe pre-eclampsia. It has also been noticed that hypotension in response to spinal anesthesia is relatively less in pre-eclamptic patients than normal parturients. Aim: To compare the QTc values in normal and pre-eclamptic term parturients and to establish whether any correlation exists between the QTc interval and the systemic hypotension following subarachnoid block. Materials and Methods: Twenty-five pre-eclamptic patients (Group A and 25 normotensive patients (Group B were included in this study. QTc interval was recorded for each patient before subarachnoid block for cesarean section. Changes in arterial blood pressure and heart rate were measured in both the groups and compared. Results: Baseline QTc was significantly higher in the pre-eclamptic group (Group A: 0.47 ± 0.11 with that of control (Group B: 0.36. ± 0.02. Significant fall in blood pressure was seen only in one group with QTc between 0.38 and 0.39 in Group A. Hypotension was significantly more in normotensive mothers (Group B. However, no statistical correlation could be drawn from this study between QTc interval and hypotension, although a trend toward increasing hypotension with decreasing QTc was present. Discussion : The prolonged QTc intervals seen in pre-eclamptic patients may be due to the contributory effects of sympathetic hyperactivity, hypertension, and hypocalcemia secondary to underlying vasoconstriction. Decreased vagal control of heart in pre-eclampsia may have produced the difference in change in hemodynamic status between pre-eclamptic and normotensive parturient. Conclusion: Any consistent correlation between QTc and hypotension following subarachnoid block could not be derived from this study. To achieve a

  20. Nitrofurantoin-induced acute respiratory distress syndrome during pregnancy: A case report

    Directory of Open Access Journals (Sweden)

    Sherif S. Wahba

    2014-01-01

    Full Text Available Acute respiratory distress syndrome (ARDS is a rarely seen complication with nitrfurantoin. We report improvement of a parturient who was admitted to our hospital’s obstetrical unit with life threatening nitrofurantoin-induced acute respiratory failure. She had been taking nitrofurantoin for one week for urinary tract infection (UTI. Her chest radiography showed bilateral parenchymal infiltrates of the lung. The patient responded well to nitrofurantoin discontinuation and methylprednisolone infusion 1 mg/kg/day.

  1. A Comparison of Intrathecal and Epidural Analgesia and Its Effect on Length of Labor

    Science.gov (United States)

    1997-09-10

    differences were found between agents, lidocaine with epinephrine or bupivacaine with epinephrine, in depression of uterine activity (Willdeck-Lund et al...effects. Also, all parturients except for three reported pain relief lasting throughout labor. Local infiltration of lidocaine was performed for...are not reached. In response to the relative ineffectiveness of epidural morphine and the high incidence of side effects with morphine injected

  2. Pre-term Spontaneous Unscarred Uterine Rupture; A Case Report and Review

    OpenAIRE

    Shima Sheybani; Nahid Zirak; Razieh Poorandi; Elnaz Hosseini

    2014-01-01

    Introduction: Spontaneous uterine rupture, a life-threatening condition for both parturient and their fetus, often tends to occur during labour, particularly in those with a scarred uterus (rare in unscarred ones). The diagnosis must be born in mind in case of a pregnant woman presenting with shock, abdominal pain and diminished fetal heart rate. Any additional preoperative evaluation seems redundant as it only wastes golden surgical time. Case:The case we intend to present is a multigravi...

  3. Comparison of Intravenous Ranitidine with Pantoprazole in Decreasing Gastric Fluid Acidity in Emergency Cesarean Section

    OpenAIRE

    Alipour M; Soltani Gh; Zirak N; ParaviTorghabeh N; Peivandi Yazdi A

    2013-01-01

    Objectives: Peri-operative aspiration of gastric contents is a problem that causes certain respiratory problems including ARDS. Prophylaxis against aspiration of gastric contents is performed routinely in elective surgeries, but there is rare evidence on the efficacy of this method in emergency cesarean section. Materials and Methods: This is a randomized, controlled, double-blinded clinical trial. 60 parturients undergoing emergency cesarean section were randomly assigned into three groups o...

  4. Congenital and perinatal complications of chikungunya fever: a Latin American experience

    Directory of Open Access Journals (Sweden)

    Jaime R. Torres

    2016-10-01

    Conclusions: This study presents the largest number of symptomatic neonates with CHIKF analyzed so far in any region and is the first involving infection with the Asian genotype of CHIKV. Although the clinical manifestations found were similar to those reported previously, the percentage of neurological complications was lower. The CFR was comparatively high. Chikungunya represented a substantial risk for neonates born to symptomatic parturients during the chikungunya outbreak in the Americas Region, with important clinical and public health implications.

  5. Bækkenbundstræning til gravide og barslende kvinder--en gennemgang af et Cochrane-review

    DEFF Research Database (Denmark)

    Brostrøm, Søren; Due, Ulla; Lose, Gunnar

    2010-01-01

    Urinary and anal incontinence are prevalent in pregnant and parturient women. Pelvic floor muscle training is frequently employed for prevention and treatment. A recent Cochrane review is discussed. Fifteen studies with a total of 6,181 women were included. Pregnant women without urinary...... incontinence experienced a reduction of the risk of developing urinary incontinence in later pregnancy or post partum. Peripartum patients with urinary and anal incontinence experienced a reduction of their symptoms following training....

  6. Bækkenbundstræning til gravide og barslende kvinder--en gennemgang af et Cochrane-review

    DEFF Research Database (Denmark)

    Brostrøm, Søren; Due, Ulla; Lose, G.

    2010-01-01

    Urinary and anal incontinence are prevalent in pregnant and parturient women. Pelvic floor muscle training is frequently employed for prevention and treatment. A recent Cochrane review is discussed. Fifteen studies with a total of 6,181 women were included. Pregnant women without urinary...... incontinence experienced a reduction of the risk of developing urinary incontinence in later pregnancy or post partum. Peripartum patients with urinary and anal incontinence experienced a reduction of their symptoms following training...

  7. Baekkenbundstraening til gravide og barslende kvinder--en gennemgang af et Cochrane-review

    DEFF Research Database (Denmark)

    Brostrøm, Søren; Due, Ulla; Lose, Gunnar

    2010-01-01

    Urinary and anal incontinence are prevalent in pregnant and parturient women. Pelvic floor muscle training is frequently employed for prevention and treatment. A recent Cochrane review is discussed. Fifteen studies with a total of 6,181 women were included. Pregnant women without urinary...... incontinence experienced a reduction of the risk of developing urinary incontinence in later pregnancy or post partum. Peripartum patients with urinary and anal incontinence experienced a reduction of their symptoms following training....

  8. Patient Involvement in Safe Delivery: A Qualitative Study

    OpenAIRE

    Olfati, Forozun; Asefzadeh, Saeid; Changizi, Nasrin; Keramat, Afsaneh; Yunesian, Masud

    2015-01-01

    Introduction: Patient involvement in safe delivery planning is considered important yet not widely practiced. The present study aimed at identifythe factors that affect patient involvementin safe delivery, as recommended by parturient women. Methods: This study was part of a qualitative research conducted by content analysis method and purposive sampling in 2013. The data were collected through 63 semi-structured interviews in4 hospitalsand analyzed using thematic content analysis. The partic...

  9. Anaesthesia Management of Caesarean Section in Two Patients with Eisenmenger's Syndrome

    Directory of Open Access Journals (Sweden)

    G. Fang

    2011-01-01

    Full Text Available Recently two parturients with Eisenmenger's syndrome underwent caesarean section at our hospital. They were managed by a multidisciplinary team during their perioperative period. The caesarean sections were uneventfully performed, one under general anaesthesia and one with epidural anaesthesia, with delivery of two newborns with satisfactory Apgar scores. One patient died in the post-partum period, and the other did well. We discuss the anaesthetic considerations in managing these high-risk patients.

  10. Risk factors for placenta praevia presenting with severe vaginal ...

    African Journals Online (AJOL)

    Results: Significant predictors for severe bleeding in parturients with placenta praevia were: previous history of evacuation of the uterus or dilation and curettage (O.R. 3.6, CI: 1.1-12.5), delivery by caesarean section in previous pregnancy (O.R. 19.9, CI: 6.4-61.7), residing more than ten kilometres from Mulago hospital (O.R. ...

  11. Draft genome sequence of Coxiella burnetii Dog Utad, a strain isolated from a dog-related outbreak of Q fever

    Directory of Open Access Journals (Sweden)

    F. D’amato

    2014-07-01

    Full Text Available Coxiella burnetii Dog Utad, with a 2 008 938 bp genome is a strain isolated from a parturient dog responsible for a human familial outbreak of acute Q fever in Nova Scotia, Canada. Its genotype, determined by multispacer typing, is 21; the only one found in Canada that includes Q212, which causes endocarditis. Only 107 single nucleotide polymorphisms and 16 INDELs differed from Q212, suggesting a recent clonal radiation.

  12. Comparison of induced labour pattern in women with premature rupture of membranes at term and those with intact membranes

    Directory of Open Access Journals (Sweden)

    J A Osaikhuwuomwan

    2011-01-01

    Conclusion: The finding of a significant shorter latent period, requirement for less oxytocin dose and overall shorter duration of stimulated labour cases with PROM compared to induction of labour for those with intact membranes suggest that PROM may be a means of labour initiation by some parturients and thus implies that these two groups of paturients are different obstetric entities and should therefore be treated as such in their labour management and research consideration.

  13. Comparison of ropivacaine (0.2%) with or without clonidine 1 μg/kg for epidural labor analgesia: A randomized controlled study

    OpenAIRE

    Indira Kumari; Kapil Sharma; Vikram Bedi; Madhan Mohan; Hemraj Tungaria; Manish Kumar Modi

    2018-01-01

    Background and Aims: The aim is to determine the effect of addition of clonidine to ropivacaine for epidural labor analgesia with regard to onset of analgesia, duration of analgesia, neonatal outcome, and quality of analgesia. Material and Methods: A total of 60 term parturients of the American Society of Anesthesiologists Grade I and II with uncomplicated pregnancy, vertex presentation, posted for on-demand epidural labor analgesia after informed consent were divided in two groups. Group ...

  14. LABOUR ANALGESIA: EPIDURAL DEXMEDITOMIDINE WITH EITHER BUPIVACAINE OR ROPIVACAINE

    OpenAIRE

    Varaprasad

    2015-01-01

    BACKGROUND: Pain relief in labour is associated with myths and controversies. Providing effective and safe analgesia has remained a challenge. AIM: The purpose of the study was to compare the effect of analgesia with epidural bupivacain or ropivacain along with dexme ditomidine. METHODS AND MATERIAL: Sixty parturients of ASA grade I and II were randomly selected for the study. Each group consisted of thirty patients. The analgesia, motor loss and level of seda...

  15. A prospective observational study of skin to subarachnoid space depth in the Indian population

    Directory of Open Access Journals (Sweden)

    Smita Prakash

    2014-01-01

    Full Text Available Background and Aims: A pre-puncture estimate of skin to subarachnoid space depth (SSD may guide spinal needle placement and reduce complications associated with lumbar puncture. Our aim was to determine (1 The SSD in Indian males, females, parturients and the overall population; (2 To derive formulae for predicting SSD and (3 To determine which previously suggested formula best suited our population. Methods: In this prospective, observational study, 800 adult Indian patients undergoing surgery under spinal anaesthesia were divided into three groups: Males (Group M, females (Group F and parturients (Group PF. SSD was measured after lumbar puncture. The relationship between SSD and patient characteristics was studied and statistical models were used to derive formula for predicting SSD. Statistical analysis included One-way ANOVA with post hoc analysis, forward stepwise multivariate regression analysis and paired t-tests. Results: Mean SSD was 4.71 ± 0.70 cm in the overall population. SSD in adult males (4.81 ± 0.68 cm was significantly longer than that observed in females (4.55 ± 0.66 cm but was comparable with SSD in parturients (4.73 ± 0.73 cm. Formula for predicting SSD in the overall population was 2.71 + 0.09 × Body Mass Index (BMI. Stocker′s formula when applied correlated best with the observed SSD. Formulae were derived for the three groups. Conclusions: We found gender-based differences in SSD, with SSD in males being significantly greater than that observed in the female population. SSD correlated with BMI in the parturient and the overall population. Amongst the previously proposed formulae, Stocker′s formula was most accurate in predicting SSD in our population.

  16. Anesthetic management of cesarean section in cases of placenta accreta, with versus without abdominal aortic balloon occlusion: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Chu, Qinjun; Shen, Dan; He, Long; Wang, Hongwei; Zhao, Xianlan; Chen, Zhimin; Wang, Yanli; Zhang, Wei

    2017-05-26

    Placenta accreta (PA), a severe complication during delivery, is closely linked with massive hemorrhage which could endanger the lives of both mother and baby. Moreover, the incidence of PA has increased dramatically with the increasing rate of cesarean deliveries in the past few decades. Therefore, studies evaluating the effects of different perioperative managements based on different modalities in the treatment of PA are necessary. Among the numerous treatment measures, prophylactic abdominal aortic balloon occlusion (AABO) in combination with cesarean section for PA seems to be more advantageous than others. However, up to now, all studies on AABO were almost retrospective. Current evidence is insufficient to recommend for or against routinely using the AABO technology for control intraoperative hemorrhage in patients with PA. Thus, we hope to carry out a prospective, randomized controlled trial (RCT) study to confirm the effectiveness of the AABO technology in patients with PA. This trial is an investigator-initiated, prospective RCT that will test the superiority of AABO in combination with cesarean section compared to the traditional hysterectomy following cesarean section for parturients with PA. A total of 170 parturients with PA undergoing cesarean section will be randomized to receive either AABO in combination with cesarean section or the traditional hysterectomy following cesarean section. The primary outcome is estimated blood loss. The most important secondary outcome is the occurrence of cesarean hysterectomy during delivery; others include blood transfusion volume, operating time, neonate's Apgar scores (collected at 1, 5 and 10 min), length of stay in intensive care unit, total hospital stay, and balloon occlusion-relative data. This prospective trial will test the superiority of AABO in combination with cesarean section compared to the traditional hysterectomy following cesarean section for parturients with PA. It may provide strong evidence

  17. [Crisis management during obstetric surgery].

    Science.gov (United States)

    Okutomi, Toshiyuki

    2009-05-01

    Obstetric crisis includes hemorrhagic shock, embolisms and difficult airway. Life will be rapidly threatened with disseminated intravascular coagulation, multiple organ failure or systemic inflammatory response syndrome in these crises. In the face of the crisis, repeated evaluation of parturients and differential diagnosis are necessary along with fetal heart monitoring. For evaluation of bleeding, one should notice that the visual estimation of vaginal bleeding does not reflect the extent of intravascular volume deficit. Treatments for hemorrhagic shock include fluid replacement, blood transfusion as well as fresh frozen plasma, platelet, anticoagulants, anti-thrombin III, and protease inhibitors. When bleeding is still uncontrollable, arterial embolization or hysterectomy will be considered. Embolic disorders are another cause of maternal mortality. The signs and symptoms are all similar (dyspnea, cyanosis and sudden cardiovascular collapse). Strategies against the embolism will be basically symptomatic therapy. The physiological change with pregnancy results in the need of careful pre-anesthetic airway evaluation for parturients. A difficult or failed intubation drill is also extremely important. Recently, laryngeal mask airway has been successfully used in these parturients. During resuscitation of a pregnant woman, left uterine displacement is essential. For a patient who has not responded after 4 to 5 minutes of ACLS, immediate cesarean delivery should be considered.

  18. Intrathecal hypobaric versus hyperbaric bupivacaine with morphine for cesarean section.

    Science.gov (United States)

    Richardson, M G; Collins, H V; Wissler, R N

    1998-08-01

    Both hyper- and hypobaric solutions of bupivacaine are often combined with morphine to provide subarachnoid anesthesia for cesarean section. Differences in the baricity of subarachnoid solutions influence the intrathecal distribution of anesthetic drugs and would be expected to influence measurable clinical variables. We compared the effects of hyper- and hypobaric subarachnoid bupivacaine with morphine to determine whether one has significant advantages with regard to intraoperative anesthesia and postoperative analgesia in term parturients undergoing elective cesarean section. Thirty parturients were randomized to receive either hyper- or hypobaric bupivacaine (15 mg) with morphine sulfate (0.2 mg). Intraoperative outcomes compared included extent of sensory block, quality of anesthesia, and side effects. Postoperative outcomes, including pain visual analog scale scores, systemic analgesic requirements, and side effects, were monitored for 48 h. Sedation effects were quantified and compared using Trieger and digit-symbol substitution tests. We detected no differences in sensory or motor block, quality of anesthesia, quality of postoperative analgesia, incidence of side effects, or psychometric scores. Both preparations provide highly satisfactory anesthesia for cesarean section and effective postoperative analgesia. Dextrose alters the density of intrathecal bupivacaine solutions and is thought to influence subarachnoid distribution of the drug. We randomized parturients undergoing cesarean section to one of two often used spinal bupivacaine preparations, hypobaric and hyperbaric. We detected no differences in clinical outcomes between groups.

  19. Combined spinal-epidural analgesia in labour: its effects on delivery outcome

    Directory of Open Access Journals (Sweden)

    Suneet Kaur Sra Charanjit Singh

    2016-06-01

    Full Text Available ABSTRACT BACKGROUND AND OBJECTIVES: Combined spinal-epidural (CSE has become an increasingly popular alternative to traditional labour epidural due to its rapid onset and reliable analgesia provided. This was a prospective, convenient sampling study to determine the effects of CSE analgesia on labour outcome. METHODS: One hundred and ten healthy primigravida parturients with a singleton pregnancy of ≥37 weeks gestation and in the active phase of labour were studied. They were enrolled to the CSE (n = 55 or Non-CSE (n = 55 group based on whether they consented to CSE analgesia. Non-CSE parturients were offered other methods of labour analgesia. The duration of the first and second stage of labour, rate of instrumental vaginal delivery and emergency cesarean section, and Apgar scores were compared. RESULTS: The mean duration of the first and second stage of labour was not significantly different between both groups. Instrumental delivery rates between the groups were not significantly different (CSE group, 11% versus Non-CSE group, 16%. The slightly higher incidence of cesarean section in the CSE group (16% versus 15% in the Non-CSE group was not statistically significant. Neonatal outcome in terms of Apgar score of less than 7 at 1 and 5 min was similar in both groups. CONCLUSION: There were no significant differences in the duration of labour, rate of instrumental vaginal delivery and emergency cesarean section, and neonatal outcome in parturients who received compared to those who did not receive CSE for labour analgesia.

  20. Seasonal variation in hormonal responses of timber rattlesnakes (Crotalus horridus) to reproductive and environmental stressors.

    Science.gov (United States)

    Lutterschmidt, William I; Lutterschmidt, Deborah I; Mason, Robert T; Reinert, Howard K

    2009-08-01

    Data addressing adrenocortical modulation across taxonomic groups are limited, especially with regard to how female reproductive condition influences the sensitivity of the hypothalamus-pituitary-adrenal axis. We investigated seasonal and reproductive variation in basal and stress-induced hormone profiles in a population of free-ranging timber rattlesnakes (Crotalus horridus) in north-central Pennsylvania during spring (i.e., May), summer (i.e., July), and early fall (i.e., September). Baseline corticosterone concentrations varied seasonally and were significantly lower during the summer sampling period in July. We observed a significant negative relationship between baseline corticosterone and testosterone in male snakes, while baseline corticosterone and estradiol tended to be positively correlated in females. Treatment of snakes with 1 h of capture stress significantly increased corticosterone across all seasons. However, there was a significant interaction between corticosterone responses to capture stress and season, suggesting that adrenocortical function is modulated seasonally. Because elevated corticosterone may be associated with reproduction, we asked whether hormonal stress responses vary with female reproductive condition. Although sample sizes are low, reproductive snakes had significantly higher baseline and stress-induced corticosterone concentrations than non-reproductive or post-parturient females. Further, despite similar baseline corticosterone concentrations between non-reproductive and post-parturient rattlesnakes, post-parturient females responded to capture stress with a significantly higher increase in corticosterone. Collectively, these data suggest that the sensitivity of the hypothalamus-pituitary-adrenal axis varies both seasonally and with changing reproductive states.

  1. Cultures of risk and their influence on birth in rural British Columbia

    Directory of Open Access Journals (Sweden)

    Kornelsen Jude

    2012-11-01

    Full Text Available Abstract Background A significant number of Canadian rural communities offer local maternity services in the absence of caesarean section back-up to parturient residents. These communities are witnessing a high outflow of women leaving to give birth in larger centres to ensure immediate access to the procedure. A minority of women choose to stay in their home communities to give birth in the absence of such access. In this instance, decision-making criteria and conceptions of risk between physicians and parturient women may not align due to the privileging of different risk factors. Methods In-depth qualitative interviews and focus groups with 27 care providers and 43 women from 3 rural communities in B.C. Results When birth was planned locally, physicians expressed an awareness and acceptance of the clinical risk incurred. Likewise, when birth was planned outside the local community, most parturient women expressed an awareness and acceptance of the social risk incurred due to leaving the community. Conclusions The tensions created by these contrasting approaches relate to underlying values and beliefs. As such, an awareness can address the impasse and work to provide a resolution to the competing prioritizations of risk.

  2. Intermittent preventive treatment with sulphadoxine-pyrimethamine is effective in preventing maternal and placental malaria in Ibadan, south-western Nigeria

    Directory of Open Access Journals (Sweden)

    Mokuolu Olugbenga A

    2007-07-01

    Full Text Available Abstract Background Intermittent preventive treatment with sulphadoxine-pyrimethamine (IPT-SP is currently the recommended regimen for prevention of malaria in pregnancy in endemic areas. This study sets out to evaluate the effectiveness of IPT-SP in the prevention of maternal and placental malaria in parturient mothers in Ibadan, Nigeria, where the risk of malaria is present all year round. Method During a larger study evaluating the epidemiology of congenital malaria, the effect of malaria prophylaxis was examined in 983 parturient mothers. Five hundred and ninety eight mothers (60.8% received IPT-SP, 214 (21.8% received pyrimethamine (PYR and 171 (17.4% did not take any chemoprophylactic agent (NC. Results The prevalence of maternal parasitaemia in the IPT-SP, PYR and NC groups was 10.4%, 15.9% and 17% respectively (p = 0.021. The prevalence of placental parasitaemia was 10.5% in the IPT-SP, 16.8% PYR and 17% NC groups, respectively (p = 0.015. The prevalence of maternal anaemia (haematocrit Conclusion IPT-SP is effective in preventing maternal and placental malaria as well as improving pregnancy outcomes among parturient women in Ibadan, Nigeria. The implementation of the recently adopted IPT-SP strategy should be pursued with vigour as it holds great promise for reducing the burden of malaria in pregnancy in Nigeria.

  3. IL-17-Expressing CD4+ and CD8+ T Lymphocytes in Human Toxoplasmosis

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    Jéssica Líver Alves Silva

    2014-01-01

    Full Text Available This study aimed to measure the synthesis of Th1 and Th2 cytokines by mononuclear cells after culture with live T. gondii and identified Th17 (CD4+ and Tc17 (CD8+ cells in toxoplasma-seronegative and toxoplasma-seropositive parturient and nonpregnant women. Cytometric bead arrays were used to measure cytokine levels (IL-2, TNF-α, IFN-γ, IL-4, IL-5, and IL-10; immunophenotyping was used to characterize Th17 and Tc17 cells, and the cells were stained with antibodies against CD4+ and CD8+ T cells expressing IL-17. The addition of tachyzoites to cell cultures induced the synthesis of IL-5, IL-10, and TNF-α by cells from seronegative parturient women and of IL-5 and IL-10 by cells from seropositive, nonpregnant women. We observed a lower level of IL-17-expressing CD4+ and CD8+ T lymphocytes in cultures of cells from seronegative and seropositive parturient and nonpregnant women that were stimulated with tachyzoites, whereas analysis of the CD4+ and CD8+ T cell populations showed a higher level of CD4+ T cells compared with CD8+ T cells. These results suggest that the cytokine pattern and IL-17-expressing CD4+ and CD8+ T lymphocytes may have important roles in the inflammatory response to T. gondii, thus contributing to the maintenance of pregnancy and control of parasite invasion and replication.

  4. Effect of Single Shot Intrathecal Sufentanil on Delivery Time and Analgesia in Nuliparae

    Directory of Open Access Journals (Sweden)

    E. Khoshraftar

    2008-04-01

    Full Text Available Introduction & Objective : The objective of this study was to determine the evaluation of intrathecal sufentanil for labor analgesia with respect to duration of labor stages and relief of pain during labor.Materials & Methods : In a clinical trial 60 subjects with ASA class I were selected and randomly divided in two equal groups. 30 subjects had received sufentanil 10 gr in 1 ml of saline during active phase of first stage of labor. The other group as controls, did not receive anything for analgesia. Parturient visual analog scale (VAS , HR, RR, BP, sensory and motor block, FHR and complications such as nausea, vomiting, pruritus and duration of stage I been monitored recorded and compared among those two groups.Results : Comparison of results in two groups have showed that sufentanil does not prolong the duration of labor in stage 1 and 2. We observed lack of hypotension and respiratory depression in sufentanil group FHR changes that had been associated with adverse neonatal out come had not occurred. The apgar scores in two groups were identical. There was itching in majority of parturient who had received sufentanil (83.3%. The pruritus were defined as mild and moderate. Conclusion : Intrathecal sufentanil provide a good analgesia in stage I labor and does not prolong the duration of labor with minimum adverse effects on parturient and fetus.

  5. COMPARISON BETWEEN FENTANYL 2 μG/mL VERSUS DEXMEDETOMIDINE 1.5 μG/mL AS ADJUVANTS WITH ISOBARIC BUPIVACAINE 0.0625% IN EPIDURAL LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Karuna Harsoor

    2016-11-01

    Full Text Available BACKGROUND Low-dose bupivacaine with opioids like fentanyl have been used traditionally as an adjunct for epidural labour analgesia, but has side effects like pruritus, urinary retention, nausea, vomiting, etc. Dexmedetomidine, an α-2 adrenergic agonist with a high placental retention, decreased sympathetic outflow and norepinephrine release thereby causing sedation, anxiolysis, analgesia, sympatholysis and maternal haemodynamic stability. Hence, this study was carried out to compare dexmedetomidine and fentanyl as adjuvants in epidural labour analgesia. MATERIALS AND METHODS A prospective randomised, double-blind study was conducted in 60 term parturients in active labour of ASA I and II physical status. They were randomised into 2 groups with 30 parturients in each and received 15 mL of 0.0625% Inj. Bupivacaine plus either 1.5 μg/mL Inj. Dexmedetomidine (BD group or 2 μg/mL Inj. Fentanyl (BF group. VAS, sedation scores, modified four grade Bromage scale, haemodynamics, peripheral oxygen saturation were recorded at baseline and regular intervals. When VAS was ≥4, subsequent doses of 5 mL of the respective group drug was administered. Parturients were ambulated when Bromage scale was 0 with no postural hypotension. Duration of analgesia, labour outcome, neonatal Apgar scores and side effects were noted. RESULTS Demography and haemodynamic stability were similar and comparable. Duration of analgesia was significantly longer in BD group (131.83±45.760 than BF group (85.33±22.512 (p<0.0001. More no. of top-ups was needed in BF group (1.80±1.518 than BD group (0.17±0.461 (p<0.0001. Significantly reduced VAS scores was observed in BD group than BF group. Mean sedation scores (p<0.05 and maximum Bromage scores (p=0.004 were significantly higher in BD group than BF group. Ambulation was less in BD group (3 parturients than BF group (26 parturients. Side effects were significantly more in BF group than BD group (p=0.007. The labour outcomes

  6. A pilot study of robotic-assisted exercise for hand weakness after stroke.

    Science.gov (United States)

    Stein, Joel; Bishop, Joel; Gillen, Glen; Helbok, Raimund

    2011-01-01

    Upper limb paresis is a major source of disability in stroke survivors, and robotic aided exercise therapy is a promising approach to enhance motor abilities. Few devices have been available to provide robotic therapy to the fingers and hand. We report an open-label pilot study of 12 individuals with chronic moderate hemiparesis after stroke who underwent a six-week training program using a hand robotic device. Participants received a total of 18 hours of robotic therapy. Improvements were found in multiple measures of motor performance, including the Upper Extremity Fugl-Meyer, the Motor Activity Log, the Manual Ability Measure-36, and the Jebsen Hand Function Test. All subjects tolerated the treatment well and no complications were observed. We conclude that robotic therapy for hand paresis after stroke is safe and feasible, and that further studies of efficacy are justified by these preliminary results. © 2011 IEEE

  7. Functional neuroimaging of recovery from motor conversion disorder: A case report

    DEFF Research Database (Denmark)

    Dogonowski, A M; Andersen, Kasper W.; Sellebjerg, F

    2018-01-01

    A patient with motor conversion disorder presented with a functional paresis of the left hand. After exclusion of structural brain damage, she was repeatedly examined with whole-brain functional magnetic resonance imaging, while she performed visually paced finger-tapping tasks. The dorsal premotor...... cortex showed a bilateral deactivation in the acute-subacute phase. Recovery from unilateral hand paresis was associated with a gradual increase in task-based activation of the dorsal premotor cortex bilaterally. The right medial prefrontal cortex displayed the opposite pattern, showing initial task...... that an excessive 'veto' signal generated in medial prefrontal cortex along with decreased premotor activity might constitute the functional substrate of conversion disorder. This notion warrants further examination in a larger group of affected patients....

  8. Is upper limb virtual reality training more intensive than conventional training for patients in the subacute phase after stroke?

    DEFF Research Database (Denmark)

    Brunner, Iris; Skouen, Jan Sture; Hofstad, Håkon

    2016-01-01

    Background: Virtual reality (VR) training is thought to improve upper limb (UL) motor function after stroke when utilizing intensive training with many repetitions. The purpose of this study was to compare intensity and content of a VR training intervention to a conventional task......-oriented intervention (CT). Methods: A random sample of 50 video recordings was analyzed of patients with a broad range of UL motor impairments (mean age 61y, 22 women). Patients took part in the VIRTUES trial and were randomized to either VR or CT and stratified according to severity of paresis. A standardized scoring...... and graphical methods were used. Results: Patients in the VR group spent significantly more time actively practicing with an activity rate of 77.6 (8.9) % than patients in the CT 67.3 (13.9) %, (p = .003). This difference was attributed to the subgroup of patients with initially severe paresis (n = 22). While...

  9. Surgical correction of strabismus in Lambert-Eaton myasthenic syndrome: case reports Correção cirúrgica do estrabismo na síndrome de Lambert-Eaton: relato de dois casos

    Directory of Open Access Journals (Sweden)

    Fernanda Teixeira Krieger

    2009-02-01

    Full Text Available Lambert-Eaton myasthenic syndrome is a rare and acquired autoimmune disorder. We describe two female patients with medial rectus paresis as the only ocular manifestation. After a unilateral medial rectus recession and lateral rectus resection procedure, both patients recovered normal adduction. To our knowledge, this is the first report of surgery for extraocular muscle paresis in Lambert-Eaton myasthenic syndrome.A síndrome de Lambert-Eaton é um distúrbio autoimune raro e adquirido. Apresentamos duas pacientes com paresia do reto medial como única manifestação ocular. Após retrocesso do reto lateral e ressecção do reto medial, unilateral, ambas as pacientes apresentaram normalização da adução. Até onde sabemos, este é o primeiro relato de cirurgia para paresia do reto medial na síndrome de Lambert-Eaton.

  10. Jugular foramen meningiomas. Review of the major surgical series

    International Nuclear Information System (INIS)

    Bakar, B.

    2010-01-01

    Primary jugular foramen meningiomas are uncommon, with 96 previous cases published between 1992 and 2007. Exact location and extent of tumor were determined on the basis of radiologic and operative findings and used to develop a staging system. The mean age of patients was 39.4 years. The lesion was located on the right in 14 patients and on the left in 11 patients. The series identified 23 males and 58 females. The most common presenting clinical symptoms were hearing loss and tinnitus. Most clinical findings were middle ear mass and neck mass. Most meningiomas were World Health Organization grade I. The most common postoperative complications were lower cranial nerve paresis and facial nerve paresis. Surgical planning should consider that meningiomas usually invade the dura mater, cranial nerves, and surrounding bone. The surgeon should carefully collect detailed data about the tumor, and consult an otolaryngologist preoperatively for lower cranial nerve functions and hearing levels.(author)

  11. Jugular foramen meningiomas. Review of the major surgical series

    Energy Technology Data Exchange (ETDEWEB)

    Bakar, B [Faculty of Medicine, Kirikkale Univ., Kirikkale (Turkey)

    2010-02-15

    Primary jugular foramen meningiomas are uncommon, with 96 previous cases published between 1992 and 2007. Exact location and extent of tumor were determined on the basis of radiologic and operative findings and used to develop a staging system. The mean age of patients was 39.4 years. The lesion was located on the right in 14 patients and on the left in 11 patients. The series identified 23 males and 58 females. The most common presenting clinical symptoms were hearing loss and tinnitus. Most clinical findings were middle ear mass and neck mass. Most meningiomas were World Health Organization grade I. The most common postoperative complications were lower cranial nerve paresis and facial nerve paresis. Surgical planning should consider that meningiomas usually invade the dura mater, cranial nerves, and surrounding bone. The surgeon should carefully collect detailed data about the tumor, and consult an otolaryngologist preoperatively for lower cranial nerve functions and hearing levels.(author)

  12. Jellyfish Envenomation Resulting In Vascular Insufficiency And Neurogenic Injury of Upper Limb

    Directory of Open Access Journals (Sweden)

    Choong CYL

    2015-11-01

    Full Text Available Following a week after a jellyfish sting, a young man presented with regional cyanosis and threat of distal gangrene secondary to vascular spasm in the forearm. The patient also suffered from transient paresis and numbness of the affected upper limb. Contrasted imaging revealed unopacified vessels in the distal forearm and worsening swelling warranted emergency surgical fasciotomy for impending compartment syndrome. This case highlights the occurrence of jellyfish envenomation and the need for early treatment.

  13. Effect of Auditory Constraints on Motor Learning Depends on Stage of Recovery Post Stroke

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    Viswanath eAluru

    2014-06-01

    Full Text Available In order to develop evidence-based rehabilitation protocols post stroke, one must first reconcile the vast heterogeneity in the post-stroke population and develop protocols to facilitate motor learning in the various subgroups. The main purpose of this study is to show that auditory constraints interact with the stage of recovery post stroke to influence motor learning. We characterized the stages of upper limb recovery using task-based kinematic measures in twenty subjects with chronic hemiparesis, and used a bimanual wrist extension task using a custom-made wrist trainer to facilitate learning of wrist extension in the paretic hand under four auditory conditions: 1 without auditory cueing; 2 to non-musical happy sounds; 3 to self-selected music; and 4 to a metronome beat set at a comfortable tempo. Two bimanual trials (15 s each were followed by one unimanual trial with the paretic hand over six cycles under each condition. Clinical metrics, wrist and arm kinematics and electromyographic activity were recorded. Hierarchical cluster analysis with the Mahalanobis metric based on baseline speed and extent of wrist movement stratified subjects into three distinct groups which reflected their stage of recovery: spastic paresis, spastic co-contraction, and minimal paresis. In spastic paresis, the metronome beat increased wrist extension, but also increased muscle co-activation across the wrist. In contrast, in spastic co-contraction, no auditory stimulation increased wrist extension and reduced co-activation. In minimal paresis, wrist extension did not improve under any condition. The results suggest that auditory task constraints interact with stage of recovery during motor learning after stroke, perhaps due to recruitment of distinct neural substrates over the course of recovery. The findings advance our understanding of the mechanisms of progression of motor recovery and lay the foundation for personalized treatment algorithms post stroke.

  14. Effects of Stroke on Ipsilesional End-Effector Kinematics in a Multi-Step Activity of Daily Living

    OpenAIRE

    Gulde, Philipp; Hughes, Charmayne Mary Lee; Hermsdörfer, Joachim

    2017-01-01

    Background: Stroke frequently impairs activities of daily living (ADL) and deteriorates the function of the contra- as well as the ipsilesional limbs. In order to analyze alterations of higher motor control unaffected by paresis or sensory loss, the kinematics of ipsilesional upper limb movements in patients with stroke has previously been analyzed during prehensile movements and simple tool use actions. By contrast, motion recording of multi-step ADL is rare and patient-control comparisons f...

  15. Imaging of Horner's syndrome

    Energy Technology Data Exchange (ETDEWEB)

    George, A.; Haydar, A.A. [Derriford Hospital Plymouth, Derriford, Plymouth (United Kingdom); Adams, W.M. [Derriford Hospital Plymouth, Derriford, Plymouth (United Kingdom)], E-mail: william.adams@phnt.swest.nhs.uk

    2008-05-15

    Horner's syndrome, or oculosympathetic paresis, results from interruption of the sympathetic trunk innervation to the eye and presents typically with meiosis, ptosis and facial anhydrosis on the affected side.{sup 1} The pathological process ranges from benign, such as cluster headache, or life threatening, such as lung malignancy. Appropriate imaging requires an anatomical appreciation of the complex and circuitous route the neuronal pathway takes as it passes from the central nervous system to the eye.

  16. Imaging of Horner's syndrome

    International Nuclear Information System (INIS)

    George, A.; Haydar, A.A.; Adams, W.M.

    2008-01-01

    Horner's syndrome, or oculosympathetic paresis, results from interruption of the sympathetic trunk innervation to the eye and presents typically with meiosis, ptosis and facial anhydrosis on the affected side. 1 The pathological process ranges from benign, such as cluster headache, or life threatening, such as lung malignancy. Appropriate imaging requires an anatomical appreciation of the complex and circuitous route the neuronal pathway takes as it passes from the central nervous system to the eye

  17. Effects of mirror therapy through functional activites and motor standards in motor function of the upper limb after stroke

    OpenAIRE

    Medeiros, Candice Simões Pimenta de; Fernandes, Sabrina Gabrielle Gomes; Lopes, Johnnatas Mikael; Cacho, Enio Walker Azevedo; Cacho, Roberta de Oliveira

    2014-01-01

    The study aimed to evaluate the effects of mirror therapy through functional activities and motor standards in upper limb function of chronic stroke subjects. Six patients with paresis of the arm within at least six months after stroke were randomly to a group of functional activities (GAF - n=3) and group of motor standards (GPM - n=3). Both groups performed 15 sessions of mirror therapy for 30 minutes, but the first one (GAF) were instructed to do the bilateral and symmetrical movements bas...

  18. BRAIN-COMPUTER-INTERFACE – SUPPORTED MOTOR IMAGERY TRAININTG FOR PATIENTS WITH HEMIPARESIS

    Directory of Open Access Journals (Sweden)

    O. A. Mokienko

    2013-01-01

    Full Text Available The aim of study was to assess the feasibility of motor imagery supported brain-computer interface in patients with hemiparesis. 13 patients with central paresis of the hand and 15 healthy volunteers were learning to control EEG-based interface with feedback. No differences on interface control quality were found between patients and healthy subjects. The trainings were accompanied by the desynchronization of sensorimotor rhythm. In patients with cortical damage the source of EEG-activity was dislocated.

  19. CLINICAL AND HAEMATO-BIOCHEMICAL ALTERATIONS FOLLOWING TREATMENT WITH INTERFERENTIAL THERAPY IN THE BACK PAIN IN DOGS

    Directory of Open Access Journals (Sweden)

    A.K. Sharma

    2017-06-01

    Full Text Available A total of sixteen clinical cases, comprising of 8 animals each in Group I (animals with hindquarter weakness, which could stand, and had staggering gait and intact pain sensation and Group II (animals with hind quarter paresis, which were unable to stand and dragged hind legs while walking with intact pain sensation were treated with Computerized interferential unit and conventional therapy. Different clinical and haematobiochemical study revealed that the post treatment changes were transient and remains within normal physiological limits.

  20. The Body Mass Index and Waist Circumference as Predictors of Body Composition in Post CSCI Wheelchair Rugby Players (Preliminary Investigations

    Directory of Open Access Journals (Sweden)

    Zwierzchowska Anna

    2014-12-01

    Full Text Available The enforced sedentary lifestyle and muscle paresis below the level of injury are associated with adipose tissue accumulation in the trunk. The value of anthropometric indicators of obesity in patients with spinal cord injuries has also been called into question. We hypothesized that the Body Mass Index recommended by the WHO to diagnose obesity in general population has too low sensitivity in case of wheelchair rugby players.

  1. [Atypical Guillain-Barre syndrome clustering: is it necessary to reconsider the diagnostic criteria and microbiological protocol?

    Science.gov (United States)

    Dominguez-Mayoral, A; Gutierrez, C; Lopez-Dominguez, J M; Eichau, S; Abril, J; Navarro-Mascarell, G; Quesada-Garcia, M A; Ramos, M; Alvarez-Lopez, M; Menendez-De Leon, C; Izquierdo, G

    2017-05-01

    Guillain-Barre syndrome is classically defined as a symmetrical ascending acute polyradiculoneuropathy, although there are atypical variants that make diagnosis difficult. The medical data of six patients in our hospital area are collected during the first quarter of 2013. Lumbar punctures, imaging, neurophysiological studies, ganglioside antibodies and serologies have been proposed in all cases. We focus on the atypical features as late hyporeflexia, increased frequency of asymmetry and distal paresis and initial fever. From a neurophysiological point of view, all patients presented sensorimotor axonal forms. The most consistent datas in early studies is the F wave's alteration. A Miller Fisher variant associated with faciocervicobraquial paresis and cerebral reversible vasoconstriction syndrome has been detected. A bilateral brachial paresis and lumbar polyradiculopathy in the context of influenza A infection is other interesting case. The saltatory variant with cranial nerve involvement and lower limbs paresis has been demonstrated in one patient. Bands in cerebrospinal fluid are positive in three cases and anti-ganglioside antibodies in one patient. The syndrome of inappropriate secretion of antidiuretic hormone may explain some of the hyponatremias registered. The first line of treatment are inmunoglobulins in all patients. Plasmapheresis exchanges has been used as an additional therapy in four cases. These clusters of six axonal cases with atypical clinical features justifies the need for knowledge of these variants in order to achieve an early treatment. Late hyporeflexia and brachialfaciocervico, saltatory and lumbar forms should be considered in the spectrum of Guillain-Barre syndrome. The etiological study should rule out a lots of pathogens as influenza A.

  2. Using Biophysical Models to Understand the Effect of tDCS on Neurorehabilitation: Searching for Optimal Covariates to Enhance Poststroke Recovery

    OpenAIRE

    Malerba, Paola; Straudi, Sofia; Fregni, Felipe; Bazhenov, Maxim; Basaglia, Nino

    2017-01-01

    Stroke is a leading cause of worldwide disability, and up to 75% of survivors suffer from some degree of arm paresis. Recently, rehabilitation of stroke patients has focused on recovering motor skills by taking advantage of use-dependent neuroplasticity, where high-repetition of goal-oriented movement is at times combined with non-invasive brain stimulation, such as transcranial direct current stimulation (tDCS). Merging the two approaches is thought to provide outlasting clinical gains, by e...

  3. Vocal Fold Injection: Review of Indications, Techniques, and Materials for Augmentation

    OpenAIRE

    Mallur, Pavan S.; Rosen, Clark A.

    2010-01-01

    Vocal fold injection is a procedure that has over a 100 year history but was rarely done as short as 20 years ago. A renaissance has occurred with respect to vocal fold injection due to new technologies (visualization and materials) and new injection approaches. Awake, un-sedated vocal fold injection offers many distinct advantages for the treatment of glottal insufficiency (vocal fold paralysis, vocal fold paresis, vocal fold atrophy and vocal fold scar). A review of materials available and ...

  4. Diagnostic and therapeutic pitfalls in benign vocal fold diseases

    Science.gov (United States)

    Bohlender, Jörg

    2013-01-01

    More than half of patients presenting with hoarseness show benign vocal fold changes. The clinician should be familiar with the anatomy, physiology and functional aspects of voice disorders and also the modern diagnostic and therapeutic possibilities in order to ensure an optimal and patient specific management. This review article focuses on the diagnostic and therapeutic limitations and difficulties of treatment of benign vocal fold tumors, the management and prevention of scarred vocal folds and the issue of unilateral vocal fold paresis. PMID:24403969

  5. Occlusion of the artery of Percheron: an unusual cause of bilateral stroke

    OpenAIRE

    Anderson, Clare; O'Brien, Richard

    2012-01-01

    The artery of Percheron is a rare anatomical variant whereby a single vessel arising from the proximal segment of one posterior cerebral artery supplies both medial thalami. This is a rare example of a single arterial supply to brain structures on both sides of the midline. Occlusion of the artery of Percheron results in bilateral medial thalamic infarction, which is manifest clinically as gaze paresis, cognitive disturbance and altered consciousness. The presentation can mimic subarachnoid h...

  6. Genetic Studies of Strabismus, Congenital Cranial Dysinnervation Disorders (CCDDs), and Their Associated Anomalies

    Science.gov (United States)

    2018-03-21

    Congenital Fibrosis of Extraocular Muscles; Duane Retraction Syndrome; Duane Radial Ray Syndrome; Mobius Syndrome; Brown Syndrome; Marcus Gunn Syndrome; Strabismus Congenital; Horizontal Gaze Palsy; Horizontal Gaze Palsy With Progressive Scoliosis; Facial Palsy; Facial Paresis, Hereditary, Congenital; Third Nerve Palsy; Fourth Nerve Palsy; Sixth Nerve Palsy; Synkinesis; Ocular Motility Disorders; Levator-Medial Rectus Synkinesis; Athabaskan Brainstem Dysgenesis; Tongue Paralysis; Ninth Nerve Disorder; Fifth Nerve Palsy; Seventh Nerve Palsy; Eleventh Nerve Disorder; Twelfth Nerve Disorder; Vagus Nerve Paralysis; Moebius Sequence

  7. Pontine infarction caused by medial branch injury of the basilar artery as a rare complication of cisternal drain placement

    OpenAIRE

    Horiuchi, Tetsuyoshi; Yamamoto, Yasunaga; Kuroiwa, Masafumi; Rahmah, Nunung Nur; Hongo, Kazuhiro

    2012-01-01

    We present a rare complication of cisternal drain placement during aneurysm surgery. A ruptured anterior communicating artery aneurysm was clipped through a right pterional approach. A cisternal drain was inserted from the retro-carotid to the prepontine cistern. Postoperatively, a left-sided paresis of the upper extremity had developed. A CT brain scan revealed that the drain was located between the pons and the basilar artery, resulting in a pontine infarction. Vascular neurosurgeons should...

  8. Lakridsinduceret hypertension og hypokaliæmi

    DEFF Research Database (Denmark)

    Nielsen, Mette Lundgren; Pareek, Manan; Andersen, Inger

    2012-01-01

    Consumption of large amounts of liquorice can cause hypertension and hypokalaemia. Liquorice contains glycyrrhetinic acid, which inhibits the enzyme 11 beta-hydroxysteroid dehydrogenase type 2, and ultimately leads to an apparent mineralocorticoid excess syndrome. This case report describes a 50...... year-old woman presenting with hypertension and hypokalaemia-induced limb paresis due to chronic liquorice ingestion. The patient was treated with potassium supplementation and spironolactone. Her blood pressure and electrolyte status normalised within a month after cessation of liquorice intake....

  9. Incidence and diagnosis of anosognosia for hemiparesis revisited

    Science.gov (United States)

    Baier, B; Karnath, H

    2005-01-01

    Background: In previous studies, the incidence of anosognosia for hemiparesis has varied between 17% and 58% in samples of brain damaged patients with hemiparesis. Objective: To determine whether this wide variation might be explained by the different criteria used for diagnosing anosognosia. Methods: 128 acute stroke patients with hemiparesis or hemiplegia were tested for anosognosia for hemiparesis using the anosognosia scale of Bisiach et al. Results: 94% of the patients who were rated as having "mild anosognosia"—that is, they did not acknowledge their hemiparesis spontaneously following a general question about their complaints—suffered from, and mentioned, other neurological deficits such as dysarthria, ptosis, or headache. However, they immediately acknowledged their paresis when they were asked about the strength of their limbs. Their other deficits clearly had a greater impact. These patients had significantly milder paresis than those who denied their disorder even when asked directly about their limbs. Conclusions: Patients who do not mention their paresis spontaneously but do so when questioned about it directly should not be diagnosed having "anosognosia." If this more conservative cut off criterion is applied to the data of the present as well as previous studies, a frequency of between 10% and 18% for anosognosia for hemiparesis is obtained in unselected samples of acute hemiparetic stroke patients. The incidence thus seems smaller than previously assumed. PMID:15716526

  10. Effect of platelet-activating factor receptor antagonist, etizolam, on resolution of chronic subdural hematoma. A prospective study to investigate use as conservative therapy

    International Nuclear Information System (INIS)

    Hirashima, Yutaka; Kurimoto, Masanori; Nagai, Shoichi; Hori, Emiko; Origasa, Hideki; Endo, Shunro

    2005-01-01

    Inflammatory reaction is very important for formation of the neomembrane of chronic subdural hematoma (CSDH). The present study evaluated medical treatment with the platelet-activating factor receptor antagonist, etizolam, for the resolution of CSDH, and the factors indicating surgery or conservative therapy. Alternate patients were assigned to the etizolam group or control group without medical treatment. Patients in the etizolam group received 3.0 mg etizolam per day for 14 days. A total of 53 patients were followed up for at least 6 months. Univariate analysis of differences in demographic characteristics, clinical findings, and initial computed tomography (CT) findings, and multiple logistic regression analysis of the relationship between etizolam treatment and requirement for surgery using age, sex, low density of hematoma on CT, and paresis as confounders were performed. Etizolam treatment (adjusted odds ratio [OR] 0.156, 95% confidence interval [CI] 0.024-0.999, p=0.049) was negatively correlated with requirement for surgery. Low density of hematoma (adjusted OR 0.125, 95% CI 0.019-0.846, p=0.033) was found to be an independent negative predictor, and paresis as an initial symptom (adjusted OR 6.35, 95% CI 1.04-38.7, p=0.045) was an independent positive predictor of requirement for surgery. Etizolam administration can promote the resolution of CSDH, especially at the stage of hygroma appearing as low density on CT. Surgery is recommended if the patient presents with paresis. (author)

  11. Medialization thyroplasty in glottis insufficiency due to unilateral vocal fold paralysis and after laser cordectomies - preliminary report.

    Science.gov (United States)

    Rzepakowska, Anna; Osuch-Wójcikiewicz, Ewa; Sielska-Badurek, Ewelina; Niemczyk, Kazimierz

    2017-02-28

    Medialization thyroplasty (type I) is surgical procedure performed on the thyroid cartilage. The major indication for this surgery is significant glottis insufficiency due to unilateral vocal fold paresis. However the proce¬dure is also performed after vocal fold resections during cordectomy. The evaluation of voice results in patients after medialisation throplasty. In Otolaryngology Department of Medical University of Warsaw there were performed so far 8 thyroplasty procedures under local anaesthesia with implantation of medical silicon protesis. 6 patients had unilat¬eral vocal fold paresis and the rest two underwent in the past laser cordectomy due to T1a vocal carcinoma. There were no complications during and post the surgery. The follow up examination in 1st , 3rd, 6th i 12th months postoperatively revealed for all patients significant improvement of glottal closure in laryngeal videostrobos¬copy. The voice quality improved both in perceptual evaluation (GRBAS scale) and acoustic analysis (F0, jitter, shim¬mer, NHR) in both patients groups. However the rate of improvement was much more significant in group with uni¬lateral vocal fold paresis. In all patients the maximum phonation time (MPT) increased. The self-evaluation of voice quality with Voice Handicap Index questionnaire confirmed also individual improvement. The speech rehabilitations is not successful in each patient with glottis insufficiency. The medialisation thyroplasty remains the standard procedure for permanent improvement of voice quality in those cases.

  12. Injection laryngoplasty as miniinvasive office-based surgery in patients with unilateral vocal fold paralysis - voice quality outcomes.

    Science.gov (United States)

    Sielska-Badurek, Ewelina M; Sobol, Maria; Jędra, Katarzyna; Rzepakowska, Anna; Osuch-Wójcikiewicz, Ewa; Niemczyk, Kazimierz

    2017-09-01

    Injection laryngoplasty (glottis augmentation) is the preferred method in surgical management of unilateral vocal fold paralysis (UVFP). Traditionally, these procedures are performed in the operating room. Nowadays, however, these procedures have moved into the office. To evaluate the voice quality after transoral injection laryngoplasty under local anaesthesia in patients with unilateral vocal fold paralysis. Fourteen subjects (5 women and 9 men) with unilateral vocal fold paresis (9 with right vocal fold paresis and 5 with left vocal fold paresis) were included in the study. The mean age of the group was 57.8 ±19.0 years (32-83 years). All of the injection laryngoplasties were performed transorally, under local anaesthesia. The injection material was calcium hydroxylapatite. Before and 1, 3 and 6 months after the procedure the following variables were evaluated: voice perception, videostroboscopy, acoustic analysis, aerodynamic evaluation, and the subjective rating of the voice quality by the patient. After injection laryngoplasty, complete glottal closure was achieved or there was a significant improvement in the glottal closure of each subject. We noted great improvement in the post-injection objective and subjective voice outcomes and patients reported improvement in the voice-related quality of life. The transoral approach for injection laryngoplasty under local anaesthesia is an effective and safe way to treat incomplete glottal closure in patients with UVFP. The transoral approach is an efficient alternative to other surgical techniques used for vocal fold injection.

  13. A randomised controlled trial of the effect of a head-elevation pillow on intrathecal local anaesthetic spread in caesarean section.

    Science.gov (United States)

    Elfil, H; Crowley, L; Segurado, R; Spring, A

    2015-11-01

    A head-elevation pillow places a patient in a ramped posture, which maximises the view of the larynx during laryngoscopy, particularly in obese parturients. In our institution an elevation pillow is used pre-emptively for neuraxial anaesthesia. We hypothesised that head-elevation may impair cephalad spread of local anaesthetic before caesarean section resulting in a lower block or longer time to achieve a T6 level. We aimed to investigate the effect of head-elevation on spread of intrathecal local anaesthetics during anaesthesia for caesarean section. One-hundred parturients presenting for caesarean section under combined spinal-epidural anaesthesia were randomised to either the standard supine position with lateral displacement or in the supine position with lateral displacement on an head-elevation pillow. Each patient received intrathecal hyperbaric bupivacaine 11 mg, morphine 100 μg and fentanyl 15 μg. Patients were assessed for adequacy of sensory block (T6 or higher) at 10 min. Sensory block to T6 was achieved within 10 min in 65.9% of parturients in the Elevation Pillow Group compared to 95.7% in the Control Group (P<0.05). Compared to the Control Group, patients in the Elevation Pillow Group had greater requirements for epidural supplementation (43.5% vs 2.1%, P<0.001) or conversion to general anaesthesia (9.3% vs 0%, P<0.04). Use of a ramped position with an head-elevation pillow following injection of the intrathecal component of a combined spinal-epidural anaesthetic for scheduled caesarean section was associated with a significantly lower block height at 10min. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Determination of a cutoff value for pelvic floor distensibility using the Epi-no balloon to predict perineal integrity in vaginal delivery: ROC curve analysis. Prospective observational single cohort study

    Directory of Open Access Journals (Sweden)

    Miriam Raquel Diniz Zanetti

    Full Text Available CONTEXT AND OBJECTIVE: Several risk factors are involved in perineal lacerations during vaginal delivery. However, little is known about the influence of perineal distensibility as a protective factor. The aim here was to determine a cutoff value for pelvic floor distensibility measured using the Epi-no balloon, which could be used as a predictive factor for perineal integrity in vaginal delivery. DESIGN AND SETTING: Prospective observational single cohort study conducted in a maternity hospital. METHODS: A convenience sample of 227 consecutive at-term parturients was used. All women had a single fetus in the vertex presentation, with up to 9.0 cm of dilation. The maximum dilation of the Epi-no balloon was measured using a tape measure after it had been inflated inside the vagina up to the parturients' maximum tolerance. The receiver operating characteristic (ROC curve was used to obtain the Epi-no circumference measurement with best sensitivity and specificity. RESULTS: Among the 161 patients who were included in the study, 50.9% underwent episiotomy, 21.8% presented lacerations and 27.3% retained an intact perineum. Age > 25.9 years; number of pregnancies > 3.4; number of deliveries > 2.2 and circumference measured by Epi-no > 21.4 cm were all directly correlated with an intact perineum. Circumference measurements using the Epi-no balloon that were greater than 20.8 cm showed sensitivity and specificity of 70.5% and 66.7% (area under curve = 0.713, respectively, as a predictive factor for an intact perineum in vaginal delivery. CONCLUSION: Circumferences greater than 20.8 cm achieved using the Epi-no balloon are a predictive factor for perineal integrity in parturients.

  15. Factors affecting adherence to antiretroviral therapy among pregnant women in the Eastern Cape, South Africa.

    Science.gov (United States)

    Adeniyi, Oladele Vincent; Ajayi, Anthony Idowu; Ter Goon, Daniel; Owolabi, Eyitayo Omolara; Eboh, Alfred; Lambert, John

    2018-04-13

    Context-specific factors influence adherence to antiretroviral therapy (ART) among pregnant women living with HIV. Gaps exist in the understanding of the reasons for the variable outcomes of the prevention of mother-to-child transmission (PMTCT) programme at the health facility level in South Africa. This study examined adherence levels and reasons for non-adherence during pregnancy in a cohort of parturient women enrolled in the PMTCT programme in the Eastern Cape, South Africa. This was a mixed-methods study involving 1709 parturient women in the Eastern Cape, South Africa. We conducted a multi-centre retrospective analysis of the mother-infant pair in the PMTCT electronic database in 2016. Semi-structured interviews of purposively selected parturient women with self-reported poor adherence (n = 177) were conducted to gain understanding of the main barriers to adherence. Binary logistic regression was used to determine the independent predictors of ART non-adherence. A high proportion (69.0%) of women reported perfect adherence. In the logistic regression analysis, after adjusting for confounding factors, marital status, cigarette smoking, alcohol use and non-disclosure to a family member were the independent predictors of non-adherence. Analysis of the qualitative data revealed that drug-related side-effects, being away from home, forgetfulness, non-disclosure, stigma and work-related demand were among the main reasons for non-adherence to ART. Non-adherence to the antiretroviral therapy among pregnant women in this setting is associated with lifestyle behaviours, HIV-related stigma and ART side-effects. In order to eliminate mother-to-child transmission of HIV, clinicians need to screen for these factors at every antenatal clinic visit.

  16. Association between Intrapartum Magnesium Administration and the Incidence of Maternal Fever: A Retrospective Cross-sectional Study.

    Science.gov (United States)

    Lange, Elizabeth M S; Segal, Scott; Pancaro, Carlo; Wong, Cynthia A; Grobman, William A; Russell, Gregory B; Toledo, Paloma

    2017-12-01

    Intrapartum maternal fever is associated with several adverse neonatal outcomes. Intrapartum fever can be infectious or inflammatory in etiology. Increases in interleukin 6 and other inflammatory markers are associated with maternal fever. Magnesium has been shown to attenuate interleukin 6-mediated fever in animal models. We hypothesized that parturients exposed to intrapartum magnesium would have a lower incidence of fever than nonexposed parturients. In this study, electronic medical record data from all deliveries at Northwestern Memorial Hospital (Chicago, Illinois) between 2007 and 2014 were evaluated. The primary outcome was intrapartum fever (temperature at or higher than 38.0°C). Factors associated with the development of maternal fever were evaluated using a multivariable logistic regression model. Propensity score matching was used to reduce potential bias from nonrandom selection of magnesium administration. Of the 58,541 women who met inclusion criteria, 5,924 (10.1%) developed intrapartum fever. Febrile parturients were more likely to be nulliparous, have used neuraxial analgesia, and have been delivered via cesarean section. The incidence of fever was lower in women exposed to magnesium (6.0%) than those who were not (10.2%). In multivariable logistic regression, women exposed to magnesium were less likely to develop a fever (adjusted odds ratio = 0.42 [95% CI, 0.31 to 0.58]). After propensity matching (N = 959 per group), the odds ratio of developing fever was lower in women who received magnesium therapy (odds ratio = 0.68 [95% CI, 0.48 to 0.98]). Magnesium may play a protective role against the development of intrapartum fever. Future work should further explore the association between magnesium dosing and the incidence of maternal fever.

  17. Outcomes of labor epidural analgesia among women aged over 40: A single-institution retrospective study.

    Science.gov (United States)

    Okazaki, Atsuko; Fukushima, Risa; Nagashima, Sayuri; Mazda, Yusuke; Tamura, Kazumi; Terui, Katsuo; Tanaka, Motoshi

    2016-12-01

    The purpose of this study was to investigate the effects of labor epidural analgesia (LEA) on maternal and neonatal outcomes among parturients aged 40 years or older. We retrospectively reviewed medical records of all laboring, singleton and cephalic deliveries at ≥36 weeks' gestation at the Saitama Medical Center from April 2003 to September 2012. Women aged ≥40 years who received LEA (≥40 with LEA group) were compared with women aged ≥40 years who delivered without LEA (≥40 without LEA group) and women <40 years who received LEA (<40 with LEA group). Extracted outcomes included mode of delivery, oxytocin augmentation, duration of labor, amount of estimated blood loss, umbilical artery pH, Apgar scores, and neonatal intensive care unit admission. This study included 4441 women. There were 74 women in the ≥40 with LEA group, 369 in the ≥40 without LEA group, and 601 in the <40 with LEA group. The maternal outcomes of emergency cesarean delivery rate (9.5%, 12.5%, 9.0%), instrumental delivery rate (33.8%, 10.3%, 28.3%), duration of labor (521 min, 321 min, 565 min), and estimated blood loss (524 g, 351 g, 412 g) were reported for the ≥40 with LEA, ≥40 without LEA, and <40 with LEA groups, respectively. Neonatal outcomes were not different between these groups. LEA use was not associated with emergency cesarean delivery in the multivariable analysis. Our study showed that parturients aged ≥40 with LEA can expect similar LEA-associated labor outcomes to younger parturients with LEA. © 2016 Japan Society of Obstetrics and Gynecology.

  18. Spatial processes decouple management from objectives in a heterogeneous landscape: predator control as a case study.

    Science.gov (United States)

    Mahoney, Peter J; Young, Julie K; Hersey, Kent R; Larsen, Randy T; McMillan, Brock R; Stoner, David C

    2018-04-01

    Predator control is often implemented with the intent of disrupting top-down regulation in sensitive prey populations. However, ambiguity surrounding the efficacy of predator management, as well as the strength of top-down effects of predators in general, is often exacerbated by the spatially implicit analytical approaches used in assessing data with explicit spatial structure. Here, we highlight the importance of considering spatial context in the case of a predator control study in south-central Utah. We assessed the spatial match between aerial removal risk in coyotes (Canis latrans) and mule deer (Odocoileus hemionus) resource selection during parturition using a spatially explicit, multi-level Bayesian model. With our model, we were able to evaluate spatial congruence between management action (i.e., coyote removal) and objective (i.e., parturient deer site selection) at two distinct scales: the level of the management unit and the individual coyote removal. In the case of the former, our results indicated substantial spatial heterogeneity in expected congruence between removal risk and parturient deer site selection across large areas, and is a reflection of logistical constraints acting on the management strategy and differences in space use between the two species. At the level of the individual removal, we demonstrated that the potential management benefits of a removed coyote were highly variable across all individuals removed and in many cases, spatially distinct from parturient deer resource selection. Our methods and results provide a means of evaluating where we might anticipate an impact of predator control, while emphasizing the need to weight individual removals based on spatial proximity to management objectives in any assessment of large-scale predator control. Although we highlight the importance of spatial context in assessments of predator control strategy, we believe our methods are readily generalizable in any management or large

  19. Study of patient satisfaction and self-expressed problems after emergency caesarean delivery under subarachnoid block

    Directory of Open Access Journals (Sweden)

    V R Hemanth Kumar

    2014-01-01

    Full Text Available Background and Aims: Subarachnoid block is one of the common modes of anaesthesia opted for emergency caesarean section, if the maternal and foetal conditions are favourable. Various factors influence the quality of care administered during the procedure. This questionnaire based study was undertaken to look for self-expressed problems in peri-operative period in patients undergoing emergency caesarean surgery under subarachnoid block. Methods: All the parturients who underwent emergency caesarean section under subarachnoid block during 6 months period were distributed a questionnaire in post-operative period. They were encouraged to fill and return the form within 15 days. Patient satisfaction and the self-expressed problems were analysed at the end of 6 months. Results: One hundred and seventy five out of 220 parturients responded. 58.3% of them said that they were explained about the anaesthesia prior to surgery and 85.3% overall remained anxious. With people around them, 93.1% of them felt comfortable and 91.4% expressed that they were made comfortable inside the theatre. The self-expressed problems were shivering (43.4%, breathlessness (21.7%, pain (20%, post-operative headache (15.4% and backache (19.4%. Parturients who heard their babies cry was 85.1%. After their babies were shown after delivery, 77.1% mothers slept well; 86.9% fed their babies within 4 h of delivery. Conclusion: Pre-operative communication in emergency caesarean section by health personnel did not reduce the anxiety level, which shows that communication was ineffective. Intra-operative psychological support like making the patient comfortable, showing baby to mother and early breast feeding improve bonding between child and mother and essentially contribute to patient satisfaction.

  20. Comparison of remifentanil: Entonox with Entonox alone in labor analgesia

    Directory of Open Access Journals (Sweden)

    Mojtaba Rahimi Varposhti

    2013-01-01

    Full Text Available Background: We designed a study to evaluate the effectiveness of continuous low dose infusion of remifentanil adding to self-administration of entonox administered for pain relief during the active phase of first stage of labor. Materials and Methods: Thirty healthy term pregnant women recruited in our randomized double-blind, cross over study. They received the study medicines during two 30-min periods with a 15-min wash-out sequence after each period. Fifteen parturient used remifentanil as a single bolus dose followed by constant low dose infusion and self-administration of entonox (group R during the first period and entonox and saline (group P during the second period, while the remainder of the parturient used the drugs in a reverse order. Pain and Ramsay score, maternal and fetal hemodynamic, and ventilation were assessed during each intervention. Results: In this study, mean pain severity scores were 8 ± 0.9 before and 5.4 ± 1.7 after intervention in group P, and 7.8 ± 0.1, 3.5 ± 1.3 in group R, respectively. Mean pain severity difference was 2.6 ± 1.5 in group P, while 4.3 ± 1.5 in group R; so, use of entonox and remifentanil can decrease labor pain two times more in comparison with entonox/placebo (normal saline. However, hemodynamic and ventilation parameter in remifentanil/entonox period were same as in entonox/placebo period. No statistical differences were seen in mean Ramsay score between group R and P. There was no episode of maternal bradycardia, hypotension, or hypoxemia. Conclusion: Not only adding low dose infusion of remifentanil to self-administration of entonox was notable in labor pain reduction, it did n′t make more parturient and neonatal side-effects.

  1. Choline concentrations are lower in postnatal plasma of preterm infants than in cord plasma.

    Science.gov (United States)

    Bernhard, Wolfgang; Raith, Marco; Kunze, Rebecca; Koch, Vera; Heni, Martin; Maas, Christoph; Abele, Harald; Poets, Christian F; Franz, Axel R

    2015-08-01

    Choline is essential to human development, particularly of the brain in the form of phosphatidylcholine, sphingomyelin and acetylcholine, for bile and lipoprotein formation, and as a methyl group donator. Choline is actively transported into the fetus, and maternal supply correlates with cognitive outcome. Interruption of placental supply may therefore impair choline homeostasis in preterm infants. Determination of postnatal plasma concentrations of choline and its derivatives betaine and dimethylglycine (DMG) in preterm infants compared to cord and maternal blood matched for postmenstrual age (PMA). We collected plasma of very low-birth-weight infants undergoing neonatal intensive care (n = 162), cord plasma of term and preterm infants (n = 176, 24-42-week PMA), serum of parturients (n = 36), and plasma of healthy premenopausal women (n = 40). Target metabolites were analyzed with tandem mass spectrometry and reported as median (25th/75th percentiles). Cord plasma choline concentration was 41.4 (31.8-51.2) µmol/L and inversely correlated with PMA. In term but not in preterm infants, cord plasma choline was lower in girls than in boys. Prenatal glucocorticoid treatment did not affect choline levels in cord plasma, whereas betaine was decreased and DMG increased. In parturients and non-pregnant women, choline concentrations were 14.1 (10.3-16.9) and 8.8 (5.7-11.2) µmol/L, respectively, whereas betaine was lowest in parturients. After delivery, preterm infant plasma choline decreased to 20.8 (16.0-27.6) µmol/L within 48 h. Betaine and DMG correlated with plasma choline in all groups. In preterm infants, plasma choline decreases to 50 % of cord plasma concentrations, reflecting choline undernourishment and postnatal metabolic adaptation, and potentially contributing to impaired outcome.

  2. Efficacy and side effects of intravenous remifentanil patient-controlled analgesia used in a stepwise approach for labour: an observational study.

    Science.gov (United States)

    Tveit, T O; Halvorsen, A; Seiler, S; Rosland, J H

    2013-01-01

    Remifentanil has a suitable pharmacological profile for labour analgesia. In this prospective, observational study, intravenous patient-controlled analgesia with remifentanil, using stepwise bolus doses without background infusion, was examined during the first and second stages of labour. Outcomes were pain reduction, maternal satisfaction, maternal and neonatal side effects and remifentanil metabolism in the neonate. Parturients with normal term singleton pregnancies were recruited. The initial remifentanil bolus dose was 0.15 μg/kg, increasing in steps of 0.15 μg/kg, with a 2-min lock-out. Pain scores using a 100 mm visual analogue scale, systolic and diastolic blood pressures, respiratory rate and maternal sedation were recorded every 15 min. Maternal oxygen saturation and heart rate were monitored continuously. Neonatal data included Apgar scores, clinical examination, naloxone use, resuscitation, umbilical cord blood gases and remifentanil concentrations. Forty-one parturients were enrolled. Pain scores were significantly reduced in the first 3 h of patient-controlled analgesia use compared to baseline, and at the end of the first and second stages of labour (Panalgesia. The mean highest dose of remifentanil was 0.7 μg/kg [range 0.3-1.05]. Ninety-three percent of patients were satisfied with their analgesia. The lowest oxygen saturation was 91% and the lowest respiratory rate was 9 breaths/min. Eleven parturients (27%) received supplemental oxygen due to oxygen saturations neonatal data reassuring. Remifentanil intravenous patient-controlled analgesia provides adequate pain relief and high maternal satisfaction during the first and second stages of labour. Maternal sedation and respiratory depression may occur, but no serious neonatal side effects were recorded. Careful monitoring is mandatory. Copyright © 2012 Elsevier Ltd. All rights reserved.

  3. Effects of intrathecal dexmedetomidine on shivering after spinal anesthesia for cesarean section: a double-blind randomized clinical trial

    Directory of Open Access Journals (Sweden)

    Nasseri K

    2017-04-01

    Full Text Available Karim Nasseri,1,2 Negin Ghadami,1 Bijan Nouri2 1Department of Anesthesiology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran; 2Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran Background: Shivering is among the common troublesome complications of spinal anesthesia (SA, and causes discomfort and discontentment in parturients undergoing cesarean sections (CSs. The aim of this study was to investigate the effects of intrathecal dexmedetomidine in the prevention of shivering in those who underwent CS under SA.Subjects and methods: Fifty parturients planned for elective CSs under SA were enrolled in this prospective, double-blinded, controlled study and randomly divided into two equal groups. Spinal block was achieved with 12.5 mg 0.5% heavy bupivacaine plus 5 µg dexmedetomidine (BD group or 0.5 mL 0.9% normal saline (BN group. The incidence and intensity of shivering, peripheral and core body temperature, hemodynamic parameters, and adverse events was recorded.Results: The incidence of shivering was significantly higher in the BN group (52% than the BD group (24% (P=0.04. Likewise, the intensity of shivering was significantly higher in the BN group than the BD group (P=0.04. The incidence of adverse events, such as hypotension, nausea/vomiting, and bradycardia, was not significantly different between the two groups, although the grade of sedation was higher in the BD group than the BN group (P=0.004.Conclusion: We conclude that intrathecal dexmedetomidine is effective in lowering the incidence and intensity of shivering in parturients undergoing CSs under SA without major adverse effects. Keywords: dexmedetomidine, shivering, spinal anesthesia, cesarean sections, bupivacaine

  4. OUR EXPERIENCE WITH EPIDURAL LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Uršula Reš Muravec

    2003-12-01

    Full Text Available Background. To evaluate the effects of regional labour analgesia used at the Hospital for Gynecology and Obstetrics in Postojna, Slovenia, in the year 2002.Patients and methods. In this retrospective study we enrolled 294 parturients who delivered in the year 2002 in the Postojna Maternity Hospital: in group 1 there were 147 parturients in whom three different regional analgesic techniques (study group were used at labour; in group 2 there were 147 parturients in whom regional analgesia was not used (control group. In the first step the two groups were compared in terms of maternal demographic data, duration and outcome of labour and 1' and 5' Apgar scores. In the second step the three regional analgesic groups were compared in terms of the course and outcome of labour, fetal condition, side and adverse effects of regional analgesic techniques, and patient satisfaction with a particular analgesic technique.Results. Regional labour analgesia was used in 147 (14% of the 1048 women who delivered in 2002: epidural analgesia (EPI was performed in 51.0%, combined spinal-epidural (CSE in 42.2% and spinal analgesia (SA in 6.8% of cases. The women in the regional analgesia group were significantly older, more educated, more often nulliparous and accompanied by their partner at labour than the women in the control group. Further, the duration of labour was significantly longer, oxytocin more frequently administered than in the control group. In terms of labour outcome there were no differences in the Cesarean section rates and 1- and 5-min Apgar scores minutes, but and the vacuum extraction rate was significantly higher in the regional analgesia group. Among the three regional analgesia techniques used, there were no statistically significant differences observed in terms of labour duration and outcome, and Apgar scores. The patient satisfaction was greatest with CSE. Adverse side effects such as weak muscles, reduced motion abilities, itching, nausea

  5. Pregnancy with aortic dissection in Ehler-Danlos syndrome. Staged replacement of the total aorta (10-year follow-up).

    Science.gov (United States)

    Babatasi, G; Massetti, M; Bhoyroo, S; Khayat, A

    1997-10-01

    Pregnancy complicated by aortic dissection in patients with hereditary disorder of connective tissue presents interesting considerations including management of caesarean section with the unexpected need for cardiac surgery in emergency. Generalizations can be made on management principles with long-term follow-up requiring an aggressive individualized approach by a multidisciplinary team. A 33-year-old parturient presenting an aortic dissection at 37 weeks gestation required prompt diagnosis of Ehlers-Danlos syndrome in combination with correct surgical therapy resulted in the survival of both the mother and infant. During the 10-year follow-up, multiple complex dissection required transverse aortic arch and thoracoabdominal aortic replacement.

  6. Maternofetal outcome of asymptomatic bacteriuria among pregnant women in a Nigerian Teaching Hospital.

    Science.gov (United States)

    Izuchukwu, Kenneth Ebele; Oranu, Emmanuel Okwudili; Bassey, Goddy; Orazulike, Ngozi Clare

    2017-01-01

    Asymptomatic bacteriuria has been reported to be associated with adverse pregnancy outcome. This study sought to determine the prevalence and complications of asymptomatic bacteriuria amongst parturient in the University of Port Harcourt Teaching Hospital (UPTH). The study was a prospective cohort study involving 220 eligible antenatal attendees. Urine culture and sensitivity was conducted for each participant and the fetomaternal outcome between affected and unaffected women were compared and p value women. Contrary to widely held view, there was no significant increase in adverse pregnancy outcome amongst affected women.

  7. Intubation af førstegangsfødende med Klippel-Feils syndrom

    DEFF Research Database (Denmark)

    Münter, Kristine; Johansen, Jakob; Atke, Anders

    2014-01-01

    We describe a case of a first time parturient with Klippel-Feil syndrome (KFS). KFS is defined by fusion of cervical vertebrae and the clinical triad of low posterior hairline, short wide neck and limited neck movement. KFS represents a complex challenging anaesthesiologic condition due to limite...... spine disorder that might need airway management....... movement of the neck and the risk of irreversible neurologic sequelae if manipulated, as well as unpredictable effect of neuroaxial anaesthesia. We recommend awake fiberoptic intubation for airway management in this rare disorder and stress the necessity of early anaesthesiologic assessment in any cervical...

  8. Sonographic Examination of The Fetus Vis-à-Vis Shoulder Dystocia: A Vexing Promise.

    Science.gov (United States)

    Doty, Morgen S; Al-Hafez, Leen; Chauhan, Suneet P

    2016-12-01

    Since antepartum and intrapartum risk factors are poor at identifying women whose labor is complicated by shoulder dystocia, sonographic examination of the fetus holds promise. Though there are several measurements of biometric parameters to identify the parturient who will have shoulder dystocia, none are currently clinically useful. Three national guidelines confirm that sonographic measurements do not serve as appropriate diagnostic tests to identify women who will have shoulder dystocia with or without concurrent injury. In summary, biometric measurements of the fetus should not be used to alter clinical management with the aim of averting shoulder dystocia.

  9. Acute severe asthma presenting in late pregnancy.

    Science.gov (United States)

    Holland, S M; Thomson, K D

    2006-01-01

    Asthma is the commonest pre-existing medical condition to complicate pregnancy. Acute severe asthma in pregnancy is rare, but poses difficult problems. In particular, the decision about when and where to deliver the fetus is complex, since maternal response to asthma treatment is unpredictable. We report the successful management of a parturient presenting with acute severe asthma at 37 weeks' gestation. The controversies involved and the importance of adopting a multi-disciplinary team approach to optimise maternal and neonatal outcomes are discussed.

  10. Ketosis in buffalo (Bubalus bubalis): clinical findings and the associated oxidative stress level.

    Science.gov (United States)

    Youssef, Mohamed A; El-Khodery, Sabry Ahmed; El-deeb, Wael M; Abou El-Amaiem, Waleed E E

    2010-12-01

    As little is known about the oxidant/antioxidant status in buffalo with ketosis, the present study was delineated to assess the oxidative stress level associated with clinical ketosis in water buffalo. A total of 91 parturient buffalo at smallholder farms were studied (61 suspected to be ketotic and 30 healthy). Clinical and biochemical investigations were carried out for each buffalo. Based on clinical findings and the level of beta-hydroxybutyrate (BHB), buffalo were allocated into ketotic (42), subclinical cases (19). Clinically, there was an association between clinical ketosis and anorexia (pketosis compared with subclinical and control cases, there was a significant increase (pketosis.

  11. Bronchoscopic resection of a tracheobronchial leiomyoma in a pregnant patient.

    Science.gov (United States)

    Falce, K; Guy, E; Hyman, D; Hotze, T; Lazarus, D; Bandi, V; Parchem, J; Davidson, C; Munnur, U

    2018-04-10

    Flexible bronchoscopy, therapeutic bronchoscopy and other procedures requiring anesthesia are generally avoided in pregnancy and postponed until after delivery if possible. We report a case of a parturient with an abnormal chest radiograph and mild obstructive symptoms of unknown etiology. At bronchoscopy, a tumor associated with post-obstructive suppuration was found and excised using electrocautery snare and cryotherapy, for restoration of airway patency. Coordination between pulmonary, obstetric, anesthesia, neonatology and thoracic surgery services was essential in ensuring success and the safety of the mother and fetus. Copyright © 2018 Elsevier Ltd. All rights reserved.

  12. 16-årig kvinde med multiorgandysfunktion efter HELLP

    DEFF Research Database (Denmark)

    Wulff Hauritz, Rasmus; Køhler, Flemming; Jørgensen, Jan Stener

    2010-01-01

    of hypovolaemic shock. Blood sample values were critical and the patient was diagnosed with HELLP with DIC. She developed liver shock with encephalopathy and acute renal failure. Her condition stabilized on the 8th day of admission and the woman was extubated on the 16th day. She was discharged without......HELLP is a syndrome with haemolysis, elevated liver enzymes and thrombocytopenia. It occurs in 1 to 6 per 1,000 parturient. Approximately 10% of the cases occur post partum. A 16-year-old woman delivered twins in the 34th gestational week. During the following hours, she developed symptoms...

  13. Inadvertent intrathecal injection of labetalol in a patient undergoing post-partum tubal ligation.

    Science.gov (United States)

    Balestrieri, P J; Hamza, M S; Ting, P H; Blank, R S; Grubb, C T

    2005-10-01

    After receiving a continuous spinal anesthetic for labor following an inadvertent dural puncture with a 17-gauge epidural needle, a morbidly obese parturient underwent post-partum tubal ligation 12 h after vaginal delivery. The patient received a total of 2 mL of 0.75% hyperbaric bupivacaine for the surgery. In response to moderate hypertension the patient received intravenous labetalol hydrochloride 20 mg. She subsequently was inadvertently administered approximately 15 mg of labetalol through the spinal catheter. The spinal catheter was removed immediately after the procedure. She suffered no apparent adverse neurologic effects.

  14. Anaesthesia for caesarean section in a patient with acute generalised pustular psoriasis.

    Science.gov (United States)

    Samieh-Tucker, A; Rupasinghe, M

    2007-10-01

    We describe a 30-year-old parturient with acute generalised pustular psoriasis who presented for urgent caesarean section. A multidisciplinary team was involved and general anaesthesia was used successfully. Management of this condition is discussed and the literature reviewed. While generalised pustular psoriasis or impetigo herpetiformis is well recognised in pregnancy, it has not hitherto been reported in obstetric anaesthesia literature. The purpose of this article is to delineate the clinical picture of this disease, its treatment, and the effect on the mother and the fetus.

  15. Anaesthetic management for emergency caesarean section in a patient with an untreated recently diagnosed phaeochromocytoma

    Directory of Open Access Journals (Sweden)

    Anil Agarwal

    2011-01-01

    Full Text Available Phaeochromocytoma is a rare cause of hypertension during pregnancy with potentially fatal consequences. If not detected and treated early in pregnancy, it is catastrophic for both the mother and the baby. Management requires close co-ordination between the obstetrician, anaesthesiologist, paediatrician and the endocrinologist. Perioperative management for an emergency caesarean section in a parturient with untreated phaeochromocytoma is an anaesthetic challenge and no standard recommendations have been reported till date. In this case report, we present anaesthetic management in such a case with successful maternal and foetal outcome.

  16. Lokale retningslinier for forløsning ved underkropspraesentation til termin. En landsaekkende spørgeskemaundersøgelse

    DEFF Research Database (Denmark)

    Krebs, L; Langhoff-Roos, J; Weber, T

    1996-01-01

    All 30 Danish obstetric departments have answered a questionnaire focusing on local guidelines for delivery of singleton foetuses in breech presentation at term. Two departments recommended caesarean section to all parturients and ten departments to all primiparae. The criteria for recommendation...... of vaginal delivery varied, one department used pelvimetry, one did not attempt external version, ten did not permit induction of labour. All departments except two always had a specialist in obstetrics present at the delivery, 24 (of 28 departments) an anaesthetist and 20 a paediatrician. The complexity...

  17. Remifentanil kan i særlige tilfælde anvendes som alternativ til epiduralanalgesi til fødende

    DEFF Research Database (Denmark)

    Ravn, Toke; Afshari, Arash

    2011-01-01

    Epidural analgesia remains the gold standard during labour, but is contraindicated in several clinical settings due to increased risk of serious complications. There are few effective alternatives to epidural analgesia. However, there is an increasing interest for the use of remifentanil...... as a labour analgesic. In this focused review, we describe the effect, dose and safety of remifentanil for the mother and fetus/neonate. Remifentanil appears to have a potential as labour analgesic. Careful monitoring of the parturient and the newborn is advised....

  18. Successful Resuscitation Following Massive Obstetric Hemorrhage in a Patient of the Jehovah's Witness Faith: A Case Report.

    Science.gov (United States)

    Hubbard, Richard M; Waters, Jonathan H; Yazer, Mark H

    2017-06-15

    Hemorrhage is a leading cause of maternal morbidity and mortality worldwide. It is especially difficult to treat in patients of the Jehovah's Witness faith because they refuse certain blood products. This case report describes the resuscitation of a parturient Jehovah's Witness whose postcesarean delivery course was complicated by massive hemorrhage from unrecognized arterial bleeding in the intensive care unit with significant hemodynamic instability that necessitated an emergency bedside laparotomy. Her hemoglobin nadir was 1.5 mg/dL. The case demonstrates the key place of preprocedure planning, blood conservation, and coagulation factor management in this specific patient population.

  19. Distinct modulation of event-related potentials during motor preparation in patients with motor conversion disorder.

    Directory of Open Access Journals (Sweden)

    Rebekah L Blakemore

    Full Text Available OBJECTIVE: Conversion paresis patients and healthy people feigning weakness both exhibit weak voluntary movement without detectable neuropathology. Uniquely, conversion patients lack a sense of conscious awareness of the origin of their impairment. We investigated whether conversion paresis patients show distinct electroencephalographic (EEG markers associated with their unconscious movement deficits. METHODS: Six unilateral upper limb conversion paresis patients, 12 feigning participants asked to mimic weakness and 12 control participants performed a precued reaction time task, requiring movements of either hand, depending on precue information. Performance measures (force, reaction and movement time, and event-related EEG potentials (ERP were compared, between groups and across hands or hemisphere, using linear mixed models. RESULTS: Feigners generated the same inter-hand difference in reaction and movement time as expressed by patients, even though no specific targets were set nor feedback given on these measures. We found novel ERP signatures specific to patients. When the symptomatic hand was precued, the P3 ERP component accompanying the precue was dramatically larger in patients than in feigning participants. Additionally, in patients the earlier N1 ERP component was diminished when the precue signalled either the symptomatic or asymptomatic hand. CONCLUSIONS: These results are consistent with previous suggestions that lack of awareness of the origin of their symptoms in conversion disorder patients may result from suppression of brain activity normally related to self-agency. In patients the diminished N1 to all precues is consistent with a generalised reduction in cognitive processing of movement-related precues. The P3 enhancement in patients is unlikely to simply reflect changes required for generation of impaired movements, because it was not seen in feigners showing the same behavioural deficits. Rather, this P3 enhancement in

  20. Radiation response of the rat cervical spinal cord after irradiation at different ages: Tolerance, latency and pathology

    International Nuclear Information System (INIS)

    Ruifrok, A.C.C.; Van Der Kogel, A.J.; Stephens, L.C.

    1994-01-01

    Investigation of the age dependent single-dose radiation tolerance, latency to radiation myelopathy, and the histopathological changes after irradiation of the rat cervical spinal cord is presented. Rats were irradiated with graded single doses of 4 MV photons to the cervical spinal cord. When the rats showed definite signs of paresis of the forelegs, they were killed and processed for histological examination. The radiation dose resulting in paresis due to white matter damage in 50% of the animals (ED 50 ) after single dose irradiation was about 21.5 Gy at all ages ≥ 2 weeks. Only the Ed 50 at 1 week was significantly lower. The latency to the development of paresis clearly changed with the age at irradiation, from about 2 weeks after irradiation at 1 week to 6-8 months after irradiation at age ≥ 8 weeks. The white matter damage was similar in all symptomatic animals studied. The most prominent were areas with diffuse demyelination and swollen axons, often with focal necrosis, accompanied by glial reaction. This was observed in all symptomatic animals, irrespective of the age at irradiation. Expression of vascular damage appeared to depend on the age at irradiation. Although the latency to myelopathy is clearly age dependent, single dose tolerance is not age dependent at age ≥ 2 weeks in the rat cervical spinal cord. The white matter damage is similar in all symptomatic animals studied, but the vasculopathies appear to be influenced by the age at irradiation. It is concluded that white matter damage and vascular damage are separate phenomena contributing to the development of radiation myelopathy, expression of which may depend on the radiation dose applied and the age at irradiation. 28 refs., 5 figs., 3 tabs

  1. [Facial nerve neurinomas].

    Science.gov (United States)

    Sokołowski, Jacek; Bartoszewicz, Robert; Morawski, Krzysztof; Jamróz, Barbara; Niemczyk, Kazimierz

    2013-01-01

    Evaluation of diagnostic, surgical technique, treatment results facial nerve neurinomas and its comparison with literature was the main purpose of this study. Seven cases of patients (2005-2011) with facial nerve schwannomas were included to retrospective analysis in the Department of Otolaryngology, Medical University of Warsaw. All patients were assessed with history of the disease, physical examination, hearing tests, computed tomography and/or magnetic resonance imaging, electronystagmography. Cases were observed in the direction of potential complications and recurrences. Neurinoma of the facial nerve occurred in the vertical segment (n=2), facial nerve geniculum (n=1) and the internal auditory canal (n=4). The symptoms observed in patients were analyzed: facial nerve paresis (n=3), hearing loss (n=2), dizziness (n=1). Magnetic resonance imaging and computed tomography allowed to confirm the presence of the tumor and to assess its staging. Schwannoma of the facial nerve has been surgically removed using the middle fossa approach (n=5) and by antromastoidectomy (n=2). Anatomical continuity of the facial nerve was achieved in 3 cases. In the twelve months after surgery, facial nerve paresis was rated at level II-III° HB. There was no recurrence of the tumor in radiological observation. Facial nerve neurinoma is a rare tumor. Currently surgical techniques allow in most cases, the radical removing of the lesion and reconstruction of the VII nerve function. The rate of recurrence is low. A tumor of the facial nerve should be considered in the differential diagnosis of nerve VII paresis. Copyright © 2013 Polish Otorhinolaryngology - Head and Neck Surgery Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

  2. A case of hemorrhagic pineal cyst: MR/CT correlation

    International Nuclear Information System (INIS)

    Osborn, R.E.

    1989-01-01

    A 30-year-old male had headache pain for one month and was evaluated with both computed tomography (CT) and magnetic resonance (MR). These scans demonstrated an obstructing pineal cyst containing layered acute and subacute blood products by MR criteria. The concurrent scans allowed correlation between CT and MR findings in this rare complication of an unusual entity, explained his headache (and the development of later upward gaze paresis), provided a precise surgical/anatomic approach, and gave a good final clinical result. The report illustrates appropriate CT and MR images and pathological specimen. (orig.)

  3. Anesthesia for hemicolectomy in a known porphyric with cecal malignancy

    Directory of Open Access Journals (Sweden)

    B K Naithani

    2015-01-01

    Full Text Available Intraoperative management of a known acute intermittent porphyria patient is a challenge requiring awareness of factors, which trigger an acute crisis, clinical features of a porphyric attack, knowledge of safe pharmacologic intervention, and preparedness for reintubation and ventilatory support. The classical signs of a porphyric crisis such as pain abdomen, vomiting and neuropsychiatric symptoms are masked under general anesthesia and can be confused with postoperative pain and vomiting and postoperative cognitive dysfunction, especially for intra-abdominal surgeries. Eternal vigilance for onset of an acute crisis is imperative. After a crisis of acute intermittent porphyria, residual paresis may persist for years in the absence of further attacks.

  4. Radiation-induced cerebrovascular disease in children

    International Nuclear Information System (INIS)

    Wright, T.L.; Bresnan, M.J.

    1976-01-01

    Radiation-induced internal carotid artery occlusion has not been well recognized previously as a cause of childhood cerebrovascular disease. A child who had received radiation as a neonate for a hemangioma involving the left orbit at the age of 6 years experienced a recurrent right-sided paresis, vascular headaches, and speech difficulties. Angiography showed a hypoplastic left carotid artery with occlusion of both the anterior and middle cerebral arteries. Collateral vessels bypassed the occluded-stenotic segments. Review of the literature showed two additional cases of large vessel occlusion in childhood associated with anastomatic telangiectatic vessel development following early radiation therapy of facial hemangioma

  5. Chondrosarcoma of T2 Vertebrae Treated by Combined Anterior and Posterior Approach: A Case Report

    Directory of Open Access Journals (Sweden)

    K Norazian

    2010-11-01

    Full Text Available Chondrosarcoma of the spine is rare; it presents predominantly in very young males and presentation with neurological deficit is uncommon. Treatment of this type of tumour is mainly through surgery as adjuvant therapy is ineffective. En bloc resection of tumours in the spine are difficult although it remains the recommended treatment for chondrosarcoma. We report here presentation of a female with paresis (Frankel C whom was diagnosed with a large chondrosarcoma of the T2 vertebra extending to the right upper thoracic cavity. The patient underwent radical excision through an anterior and posterior approach to the spine.

  6. Severe ischemic colitis following olanzapine use: a Case Report

    Directory of Open Access Journals (Sweden)

    Samuel Raimundo Fernandes

    Full Text Available Ischemic colitis is the most common subtype of intestinal ischemia usually resulting from vasospasm, vessel occlusion or mesenteric hypoperfusion. Neuroleptics have seldom been linked to ischemic colitis by blocking peripheral anticholinergic and antiserotonergic receptors inducing severe gastrointestinal paresis. We report a young patient with severe ischemic colitis requiring surgery due to necrosis of the bowel. After exclusion of other potential causes, olanzapine was admitted as the cause of ischemia. Clinicians should be aware of how to recognize and treat the potentially life-threatening effects of neuroleptics.

  7. Effects of the pyrethroid insecticide Cypermethrin on the locomotor activity of the wolf spider Pardosa amentata: quantitative analysis employing computer-automated video tracking

    DEFF Research Database (Denmark)

    Baatrup, E; Bayley, M

    1993-01-01

    Pardosa amentata was quantified in an open field setup, using computer-automated video tracking. Each spider was recorded for 24 hr prior to pesticide exposure. After topical application of 4.6 ng of Cypermethrin, the animal was recorded for a further 48 hr. Finally, after 9 days of recovery, the spider...... paresis, the effects of Cypermethrin were evident in reduced path length, average velocity, and maximum velocity and an increase in the time spent in quiescence. Also, the pyrethroid disrupted the consistent distributions of walking velocity and periods of quiescence seen prior to pesticide application...

  8. Stenosis of the thoracolumbar vertebral canal in a Basset Hound

    International Nuclear Information System (INIS)

    Stigen, Ø.; Hagen, G.; Kolbjørnsen, Ø.

    1990-01-01

    A three-month-old female basset hound was referred to the Norwegian College of Veterinary Medicine with a history of progressive paresis of the pelvic limbs. Following neurological examination and the study of myelograms, extradural masses causing spinal cord compressions at the T 12.13 and T 13 -L 1 junctions were diagnosed. At necropsy bone-tissue of the vertebral laminae was found to have formed stenoses of the vertebral canal producing compressions of the spinal cord. Irreversible tissue-damage was observed in histological sections prepared from the compressed areas of the spinal cord

  9. Dysphagia caused by a lateral medullary infarction syndrome (Wallenberg's syndrome)

    Science.gov (United States)

    El Mekkaoui, Amine; Irhoudane, Hanane; Ibrahimi, Adil; El Yousfi, Mounia

    2012-01-01

    A 68-year-old man was referred to our hospital for a dysphagia evolving for 10 days. Clinical examination had found neurological signs as contralateral Horner's syndrome, ipsilateral palatal paresis, gait ataxia and hoarseness. Video-fluoroscopy showed a lack of passage of contrast medium to the distal esophagus. Esogastroduodenoscopy was normal. The cranial MRI had shown an acute ischemic stroke in the left lateral medullar region and the diagnosis of Wallenberg syndrome (WS) was established. WS remains an unknown cause of dysphagia in the clinical practice of the gastroenterologist. PMID:23077713

  10. Can bilateral bronchospasm be a sign of unilateral phrenic nerve palsy after supraclavicular brachial plexus block?

    Directory of Open Access Journals (Sweden)

    Souvik Chaudhuri

    2012-01-01

    Full Text Available Ultrasound-guided peripheral nerve blocks facilitate ambulatory anesthesia for upper limb surgeries. Unilateral phrenic nerve blockade is a common complication after interscalene brachial plexus block, rather than the supraclavicular block. We report a case of severe respiratory distress and bilateral bronchospasm following ultrasound-guided supraclavicular brachial plexus block. Patient did not have clinical features of pneumothorax or drug allergy and was managed with oxygen therapy and salbutamol nebulization. Chest X-ray revealed elevated right hemidiaphragm confirming unilateral phrenic nerve paresis.

  11. [Incidence and follow-up characteristics of neurologically relevant psychogenic symptoms].

    Science.gov (United States)

    Franz, M; Schellberg, D; Reister, G; Schepank, H

    1993-06-01

    The author reports on the prevalence and stability of the course of neurologically relevant psychogenic symptoms as well as their dependence on age and sex. Altogether 240 probands from the Mannheim Cohort Study on the epidemiology of psychogenic disorders were examined for psychogenic impairment over a 10-year period during three investigation periods. On the whole, seven neurologically relevant groups of symptoms (headache, lumbar and cervical vertebral complaints, non-systematic vertigo, functional hyperkinesia, functional paresis, sleep disturbances, concentration disturbances) differ clearly in frequency, characteristics of the course and clinical relevance.

  12. Verletzung der A. subscapularis durch Reposition einer vorderen Schulterluxation

    DEFF Research Database (Denmark)

    Schmal, H; Strohm, P C; Rosahl, S K

    2006-01-01

    report a case with rupture of the arteria subscapularis following reduction of an anterior shoulder dislocation with formation of an axillary hematoma and consecutive paresis of the plexus brachialis. Interdisciplinary operative revision was necessary to remove the hematoma, stop the hemorrhage...... and for neurolysis of the plexus brachialis. Treatment resulted in a speedy recovery of the patient. Gentle reduction of a dislocated shoulder is a prerequisite for a low complication rate. Contrast-enhanced computed tomography facilitated diagnosis of the hematoma and identification of the bleeding vessel....

  13. Laparoscopic feeding jejunostomy: also a simple technique.

    Science.gov (United States)

    Albrink, M H; Foster, J; Rosemurgy, A S; Carey, L C

    1992-01-01

    Placement of feeding tubes is a common procedure for general surgeons. While the advent of percutaneous endoscopic gastrostomy has changed and improved surgical practice, this technique is contraindicated in many circumstances. In some patients placement of feeding tubes in the stomach may be contraindicated due to the risks of aspiration, gastric paresis, or gastric dysmotility. We describe a technique of laparoscopic jejunostomy tube placement which is easy and effective. It is noteworthy that this method may be used in patients who have had previous abdominal operations, and it has the added advantage of a direct peritoneal view of the viscera. We suggest that qualified laparoscopic surgeons learn the technique of laparoscopic jejunostomy.

  14. Spastic paretic hemifacial contracture as a presenting feature of multiple sclerosis.

    Science.gov (United States)

    Koutsis, Georgios; Breza, Marianthi; Evangelopoulos, Maria-Eleftheria; Anagnostouli, Maria; Andreadou, Elisavet; Karagiorgis, Georgios; Kokotis, Panagiotis; Kilidireas, Costas; Karandreas, Nikolaos

    2017-04-01

    Spastic paretic hemifacial contracture (SPHC) is characterized by sustained unilateral contraction of the facial muscles associated with mild ipsilateral facial paresis. Rarely described in the context of multiple sclerosis (MS), it has never been reported as presenting symptom of MS. Two patients developed SPHC within the context of a clinically isolated syndrome suggestive of MS. EMG revealed continuous resting activity of irregularly firing motor unit potentials, associated with impaired recruitment upon voluntary contraction. SPHC remitted fully in both patients. SPHC, a rare but distinct clinical and EMG entity, can occasionally be the presenting feature of MS. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Central nervous system dysfunction associated with Rocky Mountain spotted fever infection in five dogs.

    Science.gov (United States)

    Mikszewski, Jessica S; Vite, Charles H

    2005-01-01

    Five dogs from the northeastern United States were presented with clinical signs of neurological disease associated with Rocky Mountain spotted fever (RMSF) infection. Four of the five dogs had vestibular system dysfunction. Other neurological signs included paresis, tremors, and changes in mentation. All of the dogs had an elevated indirect fluorescent antibody titer or a positive semiquantitative enzyme screening immunoassay titer for Rickettsia rickettsii at the time of presentation. Although a higher mortality rate has been reported for dogs with neurological symptoms and RMSF infection, all of the dogs in this study improved with appropriate medical therapy and supportive care.

  16. Hypersomnia as presenting symptom of anti-Ma2-associated encephalitis: case study.

    Science.gov (United States)

    Rojas-Marcos, Iñigo; Graus, Francesc; Sanz, Gema; Robledo, Arturo; Diaz-Espejo, Carlos

    2007-01-01

    We describe a patient who presented with excessive daytime sleepiness (EDS) and was eventually diagnosed with anti-Ma2 encephalitis. Neurological examination disclosed somnolence, left palpebral ptosis, and vertical gaze paresis. A brain MRI showed high signal intensity in the hypothalamus and each hippocampus. Ma2 antibodies were found in the patient's serum, and fiberbronchoscopy disclosed a lung carcinoma. After three months of steroid treatment, the results of the patient's neurological exam became normal. We conclude that anti-Ma2 encephalitis may present with mostly isolated EDS and that it may respond to steroids despite old age and the presence of an untreated lung cancer.

  17. Quadriplegia due to celiac crisis with hypokalemia as initial presentation of celiac disease: a case report.

    Science.gov (United States)

    Bhattacharya, Malobika; Kapoor, Seema

    2012-02-01

    Celiac crisis is a rare, life-threatening complication of celiac disease characterized by worsening of clinical symptoms, multiple metabolic derangements and shock. We report an 8-year-old girl with previously undiagnosed celiac disease who presented with flaccid quadriparesis secondary to severe hypokalemia associated with celiac crisis. Diagnosis was expedited by an elevated anti-tissue transglutaminase antibody titer. The patient improved with correction of hypokalemia, corticosteroids and gluten-free diet. In tropical countries such as India, where both acute flaccid paresis and diarrhea are usually of infective etiologies, this rare clinical condition should also be considered in the differential diagnosis of both.

  18. Moya - Moya syndrome: Diagnose by means of magnetic resonance

    International Nuclear Information System (INIS)

    Borrero Borrero, Leonidas; Henao Gomez, Liliana; Hernandez Castro, John Jairo

    1997-01-01

    We present a case of moya-moya syndrome diagnosed by means of study of magnetic resonance angiography (MRA) in an eight-year old patient with Seckel syndrome and progressive neurological deficit of several years, characterized by left hemi paresis and gait limitation as well as microcephalus. Previous imaging studies included cerebral CT (CCT) that showed several infarctions, without affecting a particular vascular territory. The MRA study was carried out in a 1.5 t system. Besides confirming the CCT findings, it demonstrated characteristic images of the moya - moya syndrome. This is the first case published in Colombia

  19. The outcome after head injury in patients with radiologically demonstrated brain contusion

    International Nuclear Information System (INIS)

    Eide, P.K.; Tysnes, O.B.

    1993-01-01

    The early and late outcome was evaluated in head injury patients who presented brain contusion(s) on the cranial CT scan and in patients hospitalized for concussion. There was a high degree of concurrence between mortality and CT findings. Late complaints were common among cases of concussion of the brain. However, the frequency of impaired memory and concentration, speech problems, paresis and epileptic seizures was increased in cases where the CT scan showed brain contusion. Adaptive and social functioning was most impaired in cases with multifocal contusions in both hemispheres. 16 refs., 5 tabs

  20. Sporadic Endolymphatic Sac Tumor-A Very Rare Cause of Hearing Loss, Tinnitus, and Dizziness

    DEFF Research Database (Denmark)

    Schnack, Didde Trærup; Kiss, Katalin; Hansen, Søren

    2017-01-01

    Sporadic endolymphatic sac tumor is a very rare neoplasm. It is low malignant, locally destructive and expansive, but non-metastasizing. The tumor is very rare in the sporadic form, but more often associated with Von Hippel-Lindau disease. A 65-year old man with left sided tinnitus and hearing loss......-operative freeze-microscopy showed inflammation tissue, whereas subsequent microscopy showed papillary-cystic endolymphatic sac tumor. Endolymphatic sac tumor is a rare neoplasm. The tumor may present with asymmetrically sensory neural hearing loss with or without tinnitus, dizziness and facial nerve paresis...

  1. Experimental arsanilic acid poisoning in pigs

    Energy Technology Data Exchange (ETDEWEB)

    Harding, J D.J.; Lewis, G; Done, J T

    1968-11-30

    Twenty-one pigs were poisoned with rations containing 611, 1000 or 2000 g. arsanilic acid per ton. The chief symptoms were tremor of the head and incoordination followed by progressive blindness, ataxia and paresis. The only post-mortem abnormality was distension of the urinary bladder. The principal histological lesions were degeneration of the optic nerves, optic tracts and peripheral nerves, but such lesions could not be detected until about four, 10 and 14 days respectively after the onset of symptoms. The arsenic levels in various tissues were estimated. Concentrations in liver and kidney cortex were highest in the early stages of illness, two to 14 days after the onset of symptoms.

  2. Botulinum toxin in myotonia congenita: it does not help against rigidity and pain.

    Science.gov (United States)

    Dressler, Dirk; Adib Saberi, Fereshte

    2014-05-01

    Botulinum toxin (BT) is a potent local muscle relaxant with analgetic properties. Myotonia congenita (MC) is a genetic disorder producing muscle rigidity and pain. BT injected into the trapezius produced mild paresis, but no effect on rigidity and pain. There were no signs of systemic effects. Lack of BT efficacy on MC rigidity confirms its origin from muscle membrane dysfunction rather than from inappropriate neuromuscular activation. Lack of BT efficacy on pain could be caused by lack of anti-rigidity effect. It could also be due to separate non-muscular pain mechanisms unresponsive to BT.

  3. Brainstem Tuberculoma in Pregnancy

    Directory of Open Access Journals (Sweden)

    Dana A. Muin

    2015-01-01

    Full Text Available We report a case of a Somali refugee who presented in the second trimester of her first pregnancy with a four-week history of gradual right-sided sensomotoric hemisyndrome including facial palsy and left-sided paresis of the oculomotorius nerve causing drooping of the left eyelid and double vision. Cranial magnetic resonance imaging revealed a solitary brainstem lesion. Upon detection of hilar lymphadenopathy on chest X-ray (CXR, the diagnosis of disseminated tuberculosis with involvement of the central nervous system was confirmed by PCR and treatment induced with rifampicin, isoniazid, pyrazinamide, and ethambutol. The patient had a steady neurological improvement and a favorable pregnancy outcome.

  4. Neurothekeoma of petrous apex: A rare entity

    Directory of Open Access Journals (Sweden)

    Zarina Abdul Assis

    2013-01-01

    Full Text Available Intraosseous nerve sheath tumors are very rare tumors accounting for lesser than 0.2% of primary bone tumors. We present an 18-year-old female who presented with left facial paresis for the last 1 year. Magnetic resonance imaging (MRI demonstrated expansile, multiseptated, enhancing bony lesion in the left petrous apex. There was also abnormal enhancement of the 7-8 th nerve complex within the internal auditory canal. Tumor was excised by subtemporal extradural approach. The lesion was diagnosed as intraosseous neurothekeoma on histopathology. This is an extremely rare tumor and its MRI appearance in this location is being described for the first time in literature.

  5. Red herring: Acute back pain after combined spinal epidural for labor analgesia

    Directory of Open Access Journals (Sweden)

    Yoong Chuan Tay

    2018-04-01

    Full Text Available Symphysis pubis diastases complicate 1:300 to 1:30,000 pregnancies. Peripartum pain in chronological sequence with labor epidural analgesia often attracts instinctive causation and distress. Predisposing risk factors include macrosomia, short second stage of labor, forceps use, multiparity, small pelvis, intense uterine contractions, previous pelvic ring pathology and trauma. A gestational diabetic primigravid parturient presents with acute post-partum back pain after an uneventful analgesic labor epidural. Her pain distributed over the right paravertebral L5-S1 region without radiculopathy, worsened with positional change and accompanied by urinary incontinence, precluding child care. Spine imaging incidentally revealed a 38 mm symphysis pubis diastasis. A pelvic binder by orthopaedics aided physiotherapy and ambulation. Pubic diastases are usually conservatively managed, unless separation exceeds 5 cm when early surgery may improve functional outcomes. Although symptoms may recur in subsequent pregnancies, it does not preclude vaginal delivery. Early recognition and prompt management aim to reduce parturient morbidity and promote resumption of activity. Keywords: Symphysis pubis diasthesis, Pubic symphysis diasthesis, Post-epidural pain, Labor epidural pain, Post-partum pain

  6. Embryonic duplications in sheep.

    Science.gov (United States)

    Dennis, S M

    1975-02-01

    Twenty-seven embryonic duplications were examined during a 3-year investigation into the causes of perinatal lamb mortality. Twenty of the 27 were anomalous twins with 19 being conjoined (diplopagus 9 and heteropagus 10). The various duplications were: haloacardius acephalus 1, diprosopus 2, dicephalus 2, dipypus 3, diprosopus dipygus 1, syncephalus dipygus 1, pygopagus parasiticus 1, heteropagus dipygus 3, melodidymus 6, polyury 4, penile duplication 2, and bilateral otognathia 1. Four lambs were living and the time of death of the others was: parturient 8, and post-parturient 15. Average dry weight of the lambs was 3.35 kg (range 1.59 to 5.45 kg). Breed distribution was: Merino 77.8%, Crossbred 14.8%, Dorset Horn 3.7%, and Corriedale 3.7%. The caudal region was involved in 10 of the conjoined twins (52.6%), anterior region in 7 (36.9%), and both anterior and caudal regions in 2 (10.5%). Associated defects were present in 70.4% of the 27 lambs, the most common being atresia ani.

  7. Ropivacaine 7.5 mg/mL for Caesarean Section

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    N. K. Nguyen

    2010-01-01

    Full Text Available Background. Pain after Caesarean delivery is partly related to Pfannenstiel incision, which can be infiltrated with local anaesthetic solutions. Methods. A double- blind randomized control trial was designed to assess the analgesic efficacy of 7.5 mg/mL ropivacaine solution compared to control group, in two groups of one hundred and forty four parturients for each group, who underwent Caesarean section under spinal anaesthesia: group R (ropivacaine group and group C (control group. All parturients also received spinal sufentanil (2.5 g. Results. Ropivacaine infiltration in the Pfannenstiel incision for Caesarean delivery before wound closure leads to a reduction of 30% in the overall consumption of analgesics (348 550 mg for group R versus 504 426 mg for group C with <.05, especially opioids in the first 24 hours, but also significantly increases the time interval until the first request for an analgesic (4 h 20 min ± 2 h 26 for group R versus 2 h 42 ± 1 h 30 for group C. The P values for the two groups were: <.0001 for paracetamol, <.0001 for ketoprofen and P for nalbuphine which was the most significant. There is no significant difference in the threshold of VAS in the two series. Conclusion. This technique can contribute towards a programme of early rehabilitation in sectioned mothers, with earlier discharge from the post-labour suite.

  8. ROPIVACAINE VERSUS LIDOCAINE FOR EPISIOTOMY-A RANDOMISED DOUBLE BLIND STUDY

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    Pushpalatha Nagaraj

    2017-04-01

    Full Text Available BACKGROUND Episiotomy is a most common surgical procedure for parturients during vaginal delivery. The problem encountered with episiotomy is pain, which is maximum during first 24 hours and may be severe enough to disturb the puerperium. This study aims to compare analgesic efficacy of analgesics, ropivacaine and lidocaine for perineal infiltration during episiotomy. MATERIALS AND METHODS We conducted a randomised double blind study for a period one year from August 2013 in a tertiary hospital. 100 parturients were included. RESULTS Ropivacaine 0.75% compared to lidocaine 2% did not show any statistical significant changes at suturing and after 4 hours; however, there were great statistically significant changes in VAS scores after 8 hours, 12 hours, 24 hours of episiotomy suturing. Ropivacaine group did not require systemic analgesics for 24 hours, but lidocaine group required systemic analgesics after 4 hours of suturing. Both groups (Ropivacaine and Lidocaine did not have any adverse effects. CONCLUSION Ropivacaine can be used safely for episiotomy wound infiltration thereby reducing the need for systemic analgesia.

  9. Two syringe spinal anesthesia technique for cesarean section: A controlled randomized study of a simple way to achieve more satisfactory block and less hypotension.

    Science.gov (United States)

    Keera, Amr Aly Ismail; Elnabtity, Ali Mohamed Ali

    2016-01-01

    Multiple trials have been tried to prevent hypotension during spinal anesthesia. However, the drug choice and mode of administration is still a matter of debate. To compare the outcome of spinal injection of hyperbaric bupivacaine and fentanyl separately to standard injection of mixed fentanyl with hyperbaric bupivacaine. A randomized, controlled clinical trial. One hundred twenty-four parturient scheduled for elective cesarean section were randomly allocated into two groups, each 62 parturient: Group M received spinal anesthesia using 10 mg bupivacaine 0.5% premixed with 25 μg fentanyl in the same syringe and Group S received 25 μg fentanyl in one syringe and 10 mg bupivacaine 0.5% without barbotage in a second syringe. Patients with intraoperative pain that was controllable without the need for a shift to general anesthesia was significantly lower in Group S (3.2%) than in Group M (16.1%). The frequency of hypotension was significantly lower in Group S compared to Group M (P 0.05). There was no significant difference in the time till occurrence of hypotension, duration of hypotension, mean dose of ephedrine used for the treatment of hypotension and frequency of patients developed itching between the groups (P > 0.05). Separate intrathecal injection of fentanyl and hyperbaric bupivacaine provided a significant improvement in the quality of sensory block and significant reduction of the frequency of hypotension compared to injection of mixed medications.

  10. Combined use of hyperbaric and hypobaric ropivacaine significantly improves hemodynamic characteristics in spinal anesthesia for caesarean section: a prospective, double-blind, randomized, controlled study.

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    ZheFeng Quan

    Full Text Available To observe the hemodynamic changes of parturients in the combined use of hyperbaric (4 mg and hypobaric (6 mg ropivacaine during spinal anesthesia for caesarean section in this randomized double-blind study.Parturients (n = 136 undergoing elective cesarean delivery were randomly and equally allocated to receive either combined hyperbaric and hypobaric ropivacaine (Group A or hyperbaric ropivacaine (Group B. Outcome measures were: hemodynamic characteristics, maximum height of sensory block, time to achieve T8 sensory blockade level, incidence of complications, Apgar scores at 1 and 5 min, and neonatal blood gas analysis.Group A had a lower level of sensory blockade (T6 [T6-T7] and longer time to achieve T8 sensory blockade level (8 ± 1.3 min than did patients in Group B (T3 [T2-T4] and 5 ± 1.0 min, respectively; P < 0.001, both. The incidence rates for hypotension, nausea, and vomiting were significantly lower in Group A (13%, 10%, and 3%, respectively than Group B (66%, 31%, and 13%; P < 0.001, P = 0.003, P = 0.028.Combined use of hyperbaric (4 mg and hypobaric (6 mg ropivacaine significantly decreased the incidences of hypotension and complications in spinal anesthesia for caesarean section by extending induction time and decreasing the level of sensory blockade.Chinese Clinical Trial Register ChiCTR-TRC-13004622.

  11. Combined use of hyperbaric and hypobaric ropivacaine significantly improves hemodynamic characteristics in spinal anesthesia for caesarean section: a prospective, double-blind, randomized, controlled study.

    Science.gov (United States)

    Quan, ZheFeng; Tian, Ming; Chi, Ping; Li, Xin; He, HaiLi; Luo, Chao

    2015-01-01

    To observe the hemodynamic changes of parturients in the combined use of hyperbaric (4 mg) and hypobaric (6 mg) ropivacaine during spinal anesthesia for caesarean section in this randomized double-blind study. Parturients (n = 136) undergoing elective cesarean delivery were randomly and equally allocated to receive either combined hyperbaric and hypobaric ropivacaine (Group A) or hyperbaric ropivacaine (Group B). Outcome measures were: hemodynamic characteristics, maximum height of sensory block, time to achieve T8 sensory blockade level, incidence of complications, Apgar scores at 1 and 5 min, and neonatal blood gas analysis. Group A had a lower level of sensory blockade (T6 [T6-T7]) and longer time to achieve T8 sensory blockade level (8 ± 1.3 min) than did patients in Group B (T3 [T2-T4] and 5 ± 1.0 min, respectively; P hyperbaric (4 mg) and hypobaric (6 mg) ropivacaine significantly decreased the incidences of hypotension and complications in spinal anesthesia for caesarean section by extending induction time and decreasing the level of sensory blockade. Chinese Clinical Trial Register ChiCTR-TRC-13004622.

  12. Applying Lean Six Sigma methodology to reduce cesarean section rate.

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    Chai, Ze-Ying; Hu, Hua-Min; Ren, Xiu-Ling; Zeng, Bao-Jin; Zheng, Ling-Zhi; Qi, Feng

    2017-06-01

    This study aims to reduce cesarean section rate and increase rate of vaginal delivery. By using Lean Six Sigma (LSS) methodology, the cesarean section rate was investigated and analyzed through a 5-phase roadmap consisting of Define, Measure, Analyze, Improve, and Control. The principal causes of cesarean section were identified, improvement measures were implemented, and the rate of cesarean section before and after intervention was compared. After patients with a valid medical reason for cesarean were excluded, the main causes of cesarean section were maternal request, labor pain, parturient women assessment, and labor observation. A series of measures was implemented, including an improved parturient women assessment system, strengthened pregnancy nutrition guidance, implementation of painless labor techniques, enhanced midwifery team building, and promotion of childbirth-assist skills. Ten months after introduction of the improvement measures, the cesarean section rate decreased from 41.83% to 32.00%, and the Six Sigma score (ie, Z value) increased from 1.706 to 1.967 (P < .001). LSS is an effective way to reduce the rate of cesarean section. © 2016 John Wiley & Sons, Ltd.

  13. Nosocomial infection in a Nigerian rural maternity centre: a series of nine cases.

    Science.gov (United States)

    Okezie, O A; Onyemelukwe, N F

    2007-02-01

    An outbreak of urinary tract infection in a rural maternity hospital near Enugu, Nigeria led to bacteriological assessment which identified Serratia marcescens as the causative organism. An epidemiological investigation was done to trace the source of this organism. To investigate an outbreak of urinary tract infection in a rural maternity centre. A descriptive study. Maternity centre in a rural community near Enugu run by local midwives assisted by auxiliary nurses trained by the midwives. Nine patients at term with symptoms of urinary tract infection. In all nine cases, the pigmented form of Serratia marcescens was found to be the cause of the urinary tract infection and the source of this organism was traced to the auxillary nurse who shaved the patients and the instrument she used. Since the causative organism of the outbreak of urinary infection in these women was traced to the shaving instruments used and the fingers of the auxillary nurse who shaved them, there is the need for better hygiene practices in the health centre and the use of properly trained staff to attend to pregnant and parturient women. It is recommended that the practice of shaving parturient women should be discarded.

  14. Comparison of analgesic efficacy of paracetamol and tramadol for pain relief in active labor.

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    Kaur Makkar, Jeetinder; Jain, Kajal; Bhatia, Nidhi; Jain, Vanita; Mal Mithrawal, Sanwar

    2015-03-01

    To evaluate the efficacy and safety profile of paracetamol in comparison with tramadol for pain relief during active labor. Prospective, randomized, double-blind study. Maternity Wing of the Postgraduate Institute of Medical Education and Research, Chandigarh. Sixty laboring, primiparous, full-term parturients with uncomplicated, singleton pregnancy in spontaneous labor and cervical dilatation of 3-5 cm. Parturients were randomized into 2 groups to receive either 1 mg/kg of tramadol intramuscularly (group T; n = 29) or 1 g of paracetamol intravenously (group P; n = 30). Same doses of the drugs were repeated after 4 hours of initial dose. Primary outcome of the study was to assess the analgesic efficacy of the 2 drugs as measured by visual analog scale (VAS) score. Secondary outcome recorded was duration of labor, presence of any maternal, or fetal adverse events during the study. Both the groups showed comparable VAS scores at all times of observation. Lower mean VAS scores were reported in both the groups till 120 minutes only. The duration of first stage of labor was shorter in group P (248.00 ± 98.171 vs 340.63 ± 111.592 minutes; P = .003). The duration of second stage of labor was comparable between the 2 groups. Higher incidence of maternal side effects such as nausea/vomiting and sedation was associated with the use of tramadol. Neonatal outcome was comparable. Intravenous paracetamol provides comparable analgesia as intramuscular tramadol during active labor. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. Observational study comparing non-invasive blood pressure measurement at the arm and ankle during caesarean section.

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    Drake, M J P; Hill, J S

    2013-05-01

    Upper-arm non-invasive blood pressure measurement during caesarean section can be uncomfortable and unreliable because of movement artefact in the conscious parturient. We aimed to determine whether ankle blood pressure measurement could be used instead in this patient group by comparing concurrent arm and ankle blood pressure measured throughout elective caesarean section under regional anaesthesia in 64 term parturients. Bland-Altman analysis of mean difference (95% limits of agreement [range]) between the ankle and arm was 11.2 (-20.3 to +42.7 [-67 to +102]) mmHg for systolic arterial pressure, -0.5 (-21.0 to +19.9 [-44 to +91]) mmHg for mean arterial pressure and -3.8 (-25.3 to +17.8 [-41 to +94]) mmHg for diastolic arterial pressure. Although ankle blood pressure measurement is well tolerated and allows greater mobility of the arms than measurement from the arm, the degree of discrepancy between the two sites is unacceptable to allow routine use of ankle blood pressure measurement, especially for systolic arterial pressure. However, ankle blood pressure measurement may be a useful alternative in situations where arm blood pressure measurement is difficult or impossible. Anaesthesia © 2013 The Association of Anaesthetists of Great Britain and Ireland.

  16. Efficacy of an educational manual for childbirth companions: pilot study of a randomized clinical trial

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    Liana Mara Rocha Teles

    2018-05-01

    Full Text Available ABSTRACT Objective: to evaluate the effectiveness of an educational manual in the instrumentalization of companions to provide support to the parturients and check its influence on the satisfaction of companions and women during vaginal delivery. Method: pilot study of a randomized controlled clinical trial with 65 companions and puerperal women (intervention = 21 and control = 44. The previous knowledge of the companions was evaluated at baseline. The Evaluation Form for Companions in the Delivery Room was used to measure the actions provided and the satisfaction with the experience, and the Questionnaire for Evaluation of the Experience and Satisfaction of Puerperal Women with Labor and Delivery was used to evaluate the satisfaction of women with childbirth. The Student’s t-test or Wilcoxon, chi-square or Fisher’s exact test, risk ratios and 95% confidence intervals were used. Results: the companions in the intervention group performed a greater number of support actions (7.2 vs 4.6, p: 0.001 and had higher satisfaction scores (72.4 vs 64.2; p = 0.00. Puerperal women in the intervention group had higher satisfaction with childbirth (119.6 vs 107.9; p: 0.000. Conclusion: the manual was effective for the instrumentalization of companions, contributed to support actions to the parturients and had repercussions on the satisfaction of companions and women with the birthing process. RBR-776d9s

  17. Comparison of dural puncture epidural technique versus conventional epidural technique for labor analgesia in primigravida

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    Pritam Yadav

    2018-01-01

    Full Text Available >Background: Dural puncture epidural (DPE is a method in which a dural hole is created prior to epidural injection. This study was planned to evaluate whether dural puncture improves onset and duration of labor analgesia when compared to conventional epidural technique.Methods and Materials: Sixty term primigravida parturients of ASA grade I and II were randomly assigned to two groups of 30 each (Group E for conventional epidural and Group DE for dural puncture epidural. In group E, epidural space was identified and 18-gauge multi-orifice catheter was threaded 5 cm into the epidural space. In group DE, dura was punctured using the combines spinal epidural (CSE spinal needle and epidural catheter threaded as in group E followed by 10 ml of injection of Ropivacaine (0.2% with 20 mcg of Fentanyl (2 mcg/ml in fractions of 2.5 ml. Later, Ropivacaine 10 ml was given as a top-up on patient request. Onset, visual analouge scale (VAS, sensory and motor block, haemodynamic variables, duration of analgesia of initial dose were noted along with mode of delivery and the neonatal outcome.Results: Six parturients in group DE achieved adequate analgesia in 5 minutes while none of those in group E (P 0.05.Conclusions: Both techniques of labor analgesia are efficacious; dural puncture epidural has the potential to fasten onset and improve quality of labor analgesia when compared with conventional epidural technique.

  18. Sobre as dores e temores do parto: dimensões de uma escuta On pains and fear in childbirth: dimensions of listening

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    Ana Verônica Rodrigues

    2008-03-01

    Full Text Available OBJETIVOS: desenvolver algumas reflexões sobre os possíveis efeitos benéficos de uma escuta responsiva à verbalização da presença de dor, medos e seus correlatos na cena do parto tomando como base dados empíricos de pesquisa realizada em maternidade situada na cidade de São Paulo, Brasil. MÉTODOS: estudo descritivo, de metodologia qualitativa, referenciado no quadro teórico da Psicologia Social, Psicanálise e Lingüística, utilizando entrevistas semi-estruturadas com 20 parturientes e sete doulas e observação de rotinas da maternidade. RESULTADOS: a análise, apoiada em categorias estabelecidas (subjetividade auto-referida, intersubjetividade, acolhimento, apropriação da experiência mostrou, entre outros pontos, a importância e a valorização da interlocução qualificada no processo da parturição. Processo esse referido pelas parturientes como experiência de elevado grau de estresse, com vivências de dor, medos e ansiedades, porém mitigados pelo apoio recebido. CONCLUSÕES: a análise permitiu compreender as relações interpessoais como campo de interlocução e acolhimento percebidos pelas mulheres do estudo capazes de produzir efeitos favoráveis sobre as vivências do estresse materno, configurando-se como recurso técnico, qualificado e valioso, oferecido à parturiente.OBJECTIVES: to reflect on the possibilities raised by listening to the life-experiences related by parturient women concerning pain on delivery, using empirical data from research carried out in a Maternity ward in the city of São Paulo, Brazil. METHODS: a descriptive study, with a qualitative methodology, based on the theoretical framework of Social Psychology, Psychoanalysis and Linguistics was carried out, by means of semi-structured interviews with parturient women and midwives, in addition to observation of maternity routines. RESULTS: one of the findings of the analysis, based on established categories (self-referred subjectivity

  19. Via de parto em gestações sucessivas em adolescentes: estudo de 714 casos Route of delivery in successive gestations in adolescents: study of 714 cases

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    Vamberto Oliveira de Azevedo Maia

    2004-10-01

    Full Text Available OBJETIVO: analisar a associação da via de partos consecutivos de 714 gestantes adolescentes, que pariram na Maternidade do Hospital das Clínicas da Universidade Federal de Pernambuco, no período de janeiro a dezembro de 2001. PACIENTES E MÉTODOS: em estudo prospectivo, analítico, transversal, tipo incidência, foi analisada a sucessão das vias de parto da primeira até a quarta gestação de 714 parturientes adolescentes, com idade variando entre 13 e 19 anos (média 17,2±1,5 anos. Identificando-se, no livro da sala de parto, a cada dia, as adolescentes que pariram, após ter obtido o consentimento livre e esclarecido, cada uma respondeu a um questionário estruturado, com 65 perguntas diretas e respostas fechadas, pré-codificadas, entre as quais estavam vias de parto e o número de gestações. RESULTADOS: observou-se que 527 (73,8% adolescentes tiveram uma única parturição, 149 (20,9% duas parturições, 35 (4,9% três partos e 3 (0,4% quatro partos. Dentre os 273 partos cesáreos, 207 (75,8% ocorreram em primíparas, 65 (23,8% em paucíparas e 1 (0,4% em multípara. Houve associação estatisticamente significante entre via de parto da primeira e da segunda parturições; em 83 (55,7% gestantes adolescentes quanto à via transvaginal e em 41 (27,5%, para a via cesárea. Coincidiram também as vias de parto de segunda e terceira parturições, em 23 (65,7% gestantes adolescentes no parto transvaginal e em outras 10 (28,6% na cesárea. CONCLUSÃO: identificou-se tendência da coincidência das vias de parto em gestações sucessivas em parturientes adolescentes, até a terceira parturiçãoPURPOSE: to analyze the association between modes of consecutive deliveries of 714 adolescents attended at the Maternity sector of the Hospital das Clínicas da Universidade Federal de Pernambuco (Federal University of Pernambuco, from January to December 2001. PATIENTS AND METHODS: according to a prospective, analytic, transversal, and incidence

  20. The influence of body position on Bielschowsky's test

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    Carlos R. Souza-Dias

    2014-04-01

    Full Text Available Purpose: To investigate the veracity of Jampolsky's statement that Bielschowsky's head tilt test is inverted if performed with the patient in the upside-down position and to interpret its neuromuscular mechanism. Methods: We present a series of 10 patients selected from a referred sample who were diagnosed with superior oblique paresis. Hypertropia was measured in the primary position, with the head erect and tilted toward both shoulders with the patient in the erect, supine, and upside-down positions. The last position was achieved by hanging the patient upside-down. Results: As expected, our results showed the veracity of Jampolsky's statement. The forced head tilt difference was inverted or significantly decreased when the test was performed in the upside-down position. Moreover, in all patients, Bielschowsky's phenomenon was neutralized in the supine body position, in which hypertropia with the head erect tended to vanish. In 3 patients, it disappeared completely. Conclusions: This study showed that, in patients with superior oblique paresis, differences in the extent of hypertropia in Bielschowsky's test tended to vanish when the test was performed with the patient in the supine position and invert when it was performed with the patient in the upside-down position.

  1. Historic evidence to support a causal relationship between spirochetal infections and Alzheimer’s disease

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    Judith eMiklossy

    2015-04-01

    Full Text Available Following previous observations a statistically significant association between various types of spirochetes and Alzheimer’s disease (AD fulfilled Hill’s criteria in favor of a causal relationship. If spirochetal infections can indeed cause AD, the pathological and biological hallmarks of AD should also occur in syphilitic dementia. To answer this question, observations and illustrations on the detection of spirochetes in the atrophic form of general paresis, which is known to be associated with slowly progressive dementia, were reviewed and compared with the characteristic pathology of AD. Historic observations and illustrations published in the first half of the 20th Century indeed confirm that the pathological hallmarks, which define AD, are also present in syphilitic dementia. Cortical spirochetal colonies are made up by innumerable tightly spiraled Treponema pallidum spirochetes, which are morphologically indistinguishable from senile plaques, using conventional light microscopy. Local brain amyloidosis also occurs in general paresis and, as in AD, corresponds to amyloid beta. These historic observations enable us to conclude that chronic spirochetal infections can cause dementia and reproduce the defining hallmarks of AD. They represent further evidence in support a causal relationship between various spirochetal infections and AD. They also indicate that local invasion of the brain by these helically shaped bacteria reproduce the filamentous pathology characteristic of AD. Chronic infection by spirochetes, and co-infection with other bacteria and viruses should be included in our current view on the etiology of AD. Prompt action is needed as AD might be prevented.

  2. Clinical practice guideline: Bell's Palsy executive summary.

    Science.gov (United States)

    Baugh, Reginald F; Basura, Gregory J; Ishii, Lisa E; Schwartz, Seth R; Drumheller, Caitlin Murray; Burkholder, Rebecca; Deckard, Nathan A; Dawson, Cindy; Driscoll, Colin; Gillespie, M Boyd; Gurgel, Richard K; Halperin, John; Khalid, Ayesha N; Kumar, Kaparaboyna Ashok; Micco, Alan; Munsell, Debra; Rosenbaum, Steven; Vaughan, William

    2013-11-01

    The American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF) has published a supplement to this issue featuring the new Clinical Practice Guideline: Bell's Palsy. To assist in implementing the guideline recommendations, this article summarizes the rationale, purpose, and key action statements. The 11 recommendations developed encourage accurate and efficient diagnosis and treatment and, when applicable, facilitate patient follow-up to address the management of long-term sequelae or evaluation of new or worsening symptoms not indicative of Bell's palsy. There are myriad treatment options for Bell's palsy; some controversy exists regarding the effectiveness of several of these options, and there are consequent variations in care. In addition, there are numerous diagnostic tests available that are used in the evaluation of patients with Bell's palsy. Many of these tests are of questionable benefit in Bell's palsy. Furthermore, while patients with Bell's palsy enter the health care system with facial paresis/paralysis as a primary complaint, not all patients with facial paresis/paralysis have Bell's palsy. It is a concern that patients with alternative underlying etiologies may be misdiagnosed or have an unnecessary delay in diagnosis. All of these quality concerns provide an important opportunity for improvement in the diagnosis and management of patients with Bell's palsy.

  3. Metastatic tumours to hypophysis: a report of three cases and review of literature

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    Tomaž Šmigoc

    2016-10-01

    Full Text Available Background. Metastatic tumours to pituitary are rare. The most frequent are metastases from breast and lung.Methods. In this paper, three cases of metastatic tumours to the pituitary are presented with panhypopituitarism as a common symptom: I a 60-year-old gentleman with metastasis of diffuse large B cell lymphoma, who presented with diabetes insipidus, II a 54-year-old lady with metastatic renal clear cell carcinoma and consequent disturbances in visual acuity, brain nerve paresis and III a 57-year-old lady with breast cancer metastasis, visual impairment and brain nerve paresis.Results. A transnasal endoscopic resection of the tumours was performed in all cases, followed by oncological treatment. All patients improved after the treatment.Conclusions. Despite the rarity of the disease, a metastatic tumour to the pituitary gland must be included in the differential diagnosis when symptoms such as diabetes insipidus, ophthalmoplegy due to brain nerve palsies, rapid course of the disease and headache are observed. In 20% to 30%, pituitary metastases are the first manifestation of a tumour of unknown origin. Surgical and adjuvant therapy may improve the quality of life. The survival and prognosis are generally poor.

  4. Motor cortex stimulation therapy for post-stroke weakness

    International Nuclear Information System (INIS)

    Ogura, Koichiro; Aoshima, Chihiro; Yamanouchi, Takashi; Tachibana, Eiji

    2009-01-01

    Motor cortex stimulation (MCS) delivered concurrently with rehabilitation therapy may enhance motor recovery following stroke. We investigated the effects of MCS on the recovery from upper extremity paresis in patients with chronic stroke. In 12 patients who had moderate arm and finger paresis at more than 4 months after stroke, an electrode was placed through a small craniotomy on the epidural space of the motor cortex that was identified using functional MRI. MCS during occupational therapy for one hour was performed 3 times a day for at least 4 weeks. The mean scores for Fugl-Meyer assessments of the arm improved, from 37 preoperatively to 46 postoperatively. The mean grip strength improved from 3.25 to 9.0 kg. All patients appeared satisfactory in their results because they recognized an improvement of arm function. Although the mechanism of the beneficial effects of MCS on recovery after stroke has not been well known, the neuroplasticity might play a important role. In a few cases of the present series, it was observed that the hand motor cortex area detected on functional MRI had been enlarged after MCS therapy. MCS could become a novel neurosurgical treatment modality for the chronic post-stroke weakness. (author)

  5. The impact of cognitive impairment on upper body dressing difficulties after stroke: a video analysis of patterns of recovery.

    Science.gov (United States)

    Walker, C M; Sunderland, A; Sharma, J; Walker, M F

    2004-01-01

    to study the underlying cognitive deficits influencing a stroke patient's ability to relearn to dress. The aim was to investigate how recovery had occurred and whether the nature of cognitive impairment was the reason for persistent dressing problems. the dressing performance of 30 stroke patients was compared at the sub-acute stage and three months later. Standardised cognitive and physical tests were carried out, together with a video analysis of patients putting on a polo shirt. thirteen patients with preserved power in the upper limb used both arms to put on the shirt. Despite visuospatial impairment or apraxia in some cases, all were successful given sufficient time. Out of 17 patients with arm paresis, 12 were dependent putting on the shirt. Amongst the five who were independent, significantly fewer cases of cognitive impairment were seen on tests for apraxia (papraxia. Three patients who failed shirt dressing showed neglect or apraxia at follow up and had persistent arm paresis. Test failures also occurred amongst those who were independent. cognitive impairment affected patients attempting to relearn to dress with one hand, but did not affect patients who used both hands. The three patients who remained impaired on cognitive tests at follow up were unable to adapt or learn any compensatory strategies. The influence of cognition on a person's ability to learn compensatory strategies has implications for the design of rehabilitation therapies.

  6. Ultrasonography of the larynx for diagnosis of the vocal folds mobility impairment

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    Petr S. Vetshev

    2017-03-01

    Full Text Available Purpose. To study a possibility of performance and diagnostic accuracy of ultrasonography (US of a larynx in identification of motility disorders of VF (vocal folds in comparison with the laryngoscope which is traditionally applied for this purpose. Materials and methods. According to the objectives of the study, two patient groups were formed. In first group of patients (n = 466 we studied acceptability of ultrasonografy to discriminate various laryngeal structures. In second group of patient (n = 432 we evaluated the diagnostic accuracy of ultrasonography in point of detection of vocal muscles paresis. Results. Laryngeal structures were available to examination by ultrasound (without taking in account age and sex in 92.7% of patients. Two patterns have been identified in the course of this part of the study: deterioration of visibility of the vocal folds with increasing patient age and better visibility of the vocal folds in women than in men. According to the comparative analysis, ultrasonography accuracy rate (in those patients who had had clearly visible vocal folds during ultrasonography did not differ from that during videolaryngoscopy. Conclusion. During the conducted research it was found that the US of the larynx is an effective and perspective method for detection of a paresis of VF with sensitivity and specificity 93,55% and 100% respectively. Among those patients who' VF are available to ultrasound evaluation the accuracy of method is comparable with a videolaryngoscopy and can be used with success in daily work of units of endocrine surgery.

  7. Motor Imagery Impairment in Postacute Stroke Patients

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    Niclas Braun

    2017-01-01

    Full Text Available Not much is known about how well stroke patients are able to perform motor imagery (MI and which MI abilities are preserved after stroke. We therefore applied three different MI tasks (one mental chronometry task, one mental rotation task, and one EEG-based neurofeedback task to a sample of postacute stroke patients (n=20 and age-matched healthy controls (n=20 for addressing the following questions: First, which of the MI tasks indicate impairment in stroke patients and are impairments restricted to the paretic side? Second, is there a relationship between MI impairment and sensory loss or paresis severity? And third, do the results of the different MI tasks converge? Significant differences between the stroke and control groups were found in all three MI tasks. However, only the mental chronometry task and EEG analysis revealed paresis side-specific effects. Moreover, sensitivity loss contributed to a performance drop in the mental rotation task. The findings indicate that although MI abilities may be impaired after stroke, most patients retain their ability for MI EEG-based neurofeedback. Interestingly, performance in the different MI measures did not strongly correlate, neither in stroke patients nor in healthy controls. We conclude that one MI measure is not sufficient to fully assess an individual’s MI abilities.

  8. Recurrent Laryngeal Edema Imitating Angioedema Caused by Dislocated Screw after Anterior Spine Surgery

    Directory of Open Access Journals (Sweden)

    Piotr Wójtowicz

    2015-01-01

    Full Text Available The anterior cervical spine surgery is a common procedure to stabilize vertebrae damaged by various diseases. The plates and screws are usually used in the spine fixation. This kind of instrumentation may detach from the bones which is a rare but well-known complication. A 77-year-old male presented to the otorhinolaryngology department with throat pain, choking, and dysphagia. At first the angioedema was diagnosed and he was treated conservatively. The endoscopy revealed laryngeal edema, being more defined on the right side with right vocal fold paresis. CT scans showed the stabilizing plate with two screws attached tightly and the back-out of the third screw toward soft tissue of the neck. In the meantime, his condition deteriorated and he needed tracheotomy. In few days the surgical removal of the dislocated screw was performed successfully. Although two-month follow-up reported no obstruction of the larynx, the vocal folds paresis with gradual functional improvement was observed. Long-term complication of anterior spine surgery sometimes may suggest laryngeal angioedema at first. If the conservative treatment is ineffective and there is a history of anterior spine surgery, the clinicians should consider the displacement of the plate or screws in differential diagnosis.

  9. Neurovascular complications due to the Hippocrates method for reducing anterior shoulder dislocations.

    Science.gov (United States)

    Regauer, Markus; Polzer, Hans; Mutschler, Wolf

    2014-01-18

    In spite of the fact that the Hippocrates method hardly has been evaluated in a scientific manner and numerous associated iatrogenic complications have been reported, this method remains to be one of the most common techniques for reducing anterior shoulder dislocations. We report the case of a 69-year-old farmer under coumarin anticoagulant therapy who sustained acute first time anterior dislocation of his dominant right shoulder. By using the Hippocrates method with the patient under general anaesthesia, the brachial vein was injured and an increasing hematoma subsequently caused brachial plexus paresis by pressure. After surgery for decompression and vascular suturing, symptoms declined rapidly, but brachial plexus paresis still was not fully reversible after 3 mo of follow-up. The hazardousness of using the Hippocrates method can be explained by traction on the outstretched arm with force of the operator's body weight, direct trauma to the axillary region by the physician's heel, and the topographic relations of neurovascular structures and the dislocated humeral head. As there is a variety of alternative reduction techniques which have been evaluated scientifically and proofed to be safe, we strongly caution against the use of the Hippocrates method as a first line technique for reducing anterior shoulder dislocations, especially in elder patients with fragile vessels or under anticoagulant therapy, and recommend the scapular manipulation technique or the Milch technique, for example, as a first choice.

  10. Comparison of Self-Report Versus Sensor-Based Methods for Measuring the Amount of Upper Limb Activity Outside the Clinic.

    Science.gov (United States)

    Waddell, Kimberly J; Lang, Catherine E

    2018-03-10

    To compare self-reported with sensor-measured upper limb (UL) performance in daily life for individuals with chronic (≥6mo) UL paresis poststroke. Secondary analysis of participants enrolled in a phase II randomized, parallel, dose-response UL movement trial. This analysis compared the accuracy and consistency between self-reported UL performance and sensor-measured UL performance at baseline and immediately post an 8-week intensive UL task-specific intervention. Outpatient rehabilitation. Community-dwelling individuals with chronic (≥6mo) UL paresis poststroke (N=64). Not applicable. Motor Activity Log amount of use scale and the sensor-derived use ratio from wrist-worn accelerometers. There was a high degree of variability between self-reported UL performance and the sensor-derived use ratio. Using sensor-based values as a reference, 3 distinct categories were identified: accurate reporters (reporting difference ±0.1), overreporters (difference >0.1), and underreporters (difference sensor-based assessment. Participants did not consistently or accurately self-report UL performance when compared with the sensor-derived use ratio. Although self-report and sensor-based assessments are moderately associated and appear similar conceptually, these results suggest self-reported UL performance is often not consistent with sensor-measured performance and the measures cannot be used interchangeably. Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  11. A Neuromotor Device for Reducing Phantom Limb Pain in Individuals with Spinal Cord Injury

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    Cui Lei

    2016-01-01

    Full Text Available Phantom Limb Pain is a disorder that can be experienced by individuals after amputation or spinal cord injury. In spinal cord injury the paralysis or paresis is often bilateral, thus limiting the application of apparent movement as a therapeutic model for phantom limb pain. This project aimed to develop a robotic rehabilitation device that replicated apparent movement to apply the same therapeutic principles with individuals with lower limb phantom pain that have bilateral paralysis of paresis. The proposed device achieved lower limb planar motion of the knee by a six-bar linkage of a single degree of freedom (DOF. It is driven by a linear actuator while the ankle motion is achieved by a gear motor, reaching an effective 70° range of motion for both joints. The system features closed loop control using feedback from surface electromyography sensors, limit switches and position sensors with an Arduino microcontroller as the control unit. This device will be used to further our understanding of the disorder and create opportunities for robot aided treatment for individuals with phantom limb pain as a result of spinal cord injury.

  12. Acute paretic syndrome in juvenile White Leghorn chickens resembles late stages of acute inflammatory demyelinating polyneuropathies in humans

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    Preisinger Rudolf

    2010-01-01

    Full Text Available Abstract Background Sudden limb paresis is a common problem in White Leghorn flocks, affecting about 1% of the chicken population before achievement of sexual maturity. Previously, a similar clinical syndrome has been reported as being caused by inflammatory demyelination of peripheral nerve fibres. Here, we investigated in detail the immunopathology of this paretic syndrome and its possible resemblance to human neuropathies. Methods Neurologically affected chickens and control animals from one single flock underwent clinical and neuropathological examination. Peripheral nervous system (PNS alterations were characterised using standard morphological techniques, including nerve fibre teasing and transmission electron microscopy. Infiltrating cells were phenotyped immunohistologically and quantified by flow cytometry. The cytokine expression pattern was assessed by quantitative real-time PCR (qRT-PCR. These investigations were accomplished by MHC genotyping and a PCR screen for Marek's disease virus (MDV. Results Spontaneous paresis of White Leghorns is caused by cell-mediated, inflammatory demyelination affecting multiple cranial and spinal nerves and nerve roots with a proximodistal tapering. Clinical manifestation coincides with the employment of humoral immune mechanisms, enrolling plasma cell recruitment, deposition of myelin-bound IgG and antibody-dependent macrophageal myelin-stripping. Disease development was significantly linked to a 539 bp microsatellite in MHC locus LEI0258. An aetiological role for MDV was excluded. Conclusions The paretic phase of avian inflammatory demyelinating polyradiculoneuritis immunobiologically resembles the late-acute disease stages of human acute inflammatory demyelinating polyneuropathy, and is characterised by a Th1-to-Th2 shift.

  13. Conservative management of neuromuscular scoliosis: personal experience and review of literature.

    Science.gov (United States)

    Kotwicki, Tomasz; Jozwiak, Marek

    2008-01-01

    The principles of conservative management of neuromuscular scoliosis in childhood and adolescence are presented. Analysis of personal experience and literature review. The topic is discussed separately for patients with flaccid or spastic paresis. These demonstrate that conservative management might be proposed for patients with neuromuscular scoliosis in many clinical situations. In spastic disorders, it maintains the symmetry around the hip joints. Bracing is technically difficult and often is not tolerated well by cerebral palsy children. In patients with flaccid paresis, the fitting and the use of brace is easier than in spastic patients. The flexibility of the spinal curvature is more important. Functional benefits of conservative management of neuromuscular scoliosis comprise stable sitting, easier use of upper limbs, discharge of the abdomen from the collapsing trunk, increased diaphragm excursion, and, not always, prevention of curve progression. Specific natural history and multiple medical problems associated with the disease make the treatment of children with neuromuscular scoliosis an extremely complex issue, best addressed when a team approach is applied. Continuously improving techniques of conservative management, comprising bracing and physiotherapy, together with correctly timed surgery incorporated in the process of rehabilitation, provide the optimal care for patients.

  14. [Impairment and disability in patients with a severe ischemic cerebral infarction at admission to the rehabilitation center and six months after stroke].

    Science.gov (United States)

    Prevo, A J; Dijkman, M M; Le Fèvre, F A

    1998-03-21

    Evaluation of impairment and disability in stroke patients with a severe cortical infarction at admission as well as six months after the stroke. Prospective and descriptive study. Rehabilitation Centre Heliomare, Wijk aan Zee, the Netherlands. Between 1 January 1987 en 31 May 1992 stroke patients were admitted to the rehabilitation centre with a severe, first ever, cortical infarction without any comorbidity. The patients were dependent in activities of daily living and wheel-chair-bound. Motor and neuropsychological impairment and disability were evaluated at admission to the rehabilitation centre as well as six months after the stroke. Return to home and length of stay were evaluated. 43 patients were included. Recovery of arm and hand function was very poor (there was complete paresis at admission in 33 patients (77%) and six months after the CVA in 25 patients (58%)); recovery of the affected leg was reasonable (complete paresis in 10 (23%) and 0 patients, respectively). Cognitive deficits diminished in severity, but remained noticeable in three-quarters of the patients. Independent walking was achieved by 30 patients (70%), independence in personal activities of daily living by 32 patients (74%) and returning home by 36 patients (84%). The mean hospital stay was 26 weeks (SD: 9.26; range: 11-30). Prognosis of personal independence and returning home after a severe cortical infarction was rather good despite poor recovery of motor and cognitive impairment.

  15. CT and MR findings in HIV-negative neurosyphilis

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    Peng Fuhua [Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630 Guangdong Province (China)], E-mail: pfh93@21cn.com; Hu Xueqiang [Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630 Guangdong Province (China)], E-mail: huxueqiangqm@yahoo.com.cn; Zhong Xiufeng [State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center of Sun Yat-Sen University, 54 Xianlie Road, Guangzhou, 510060 Guangdong Province (China)], E-mail: xiufengzhong@yahoo.com.cn; Wei Qiu [Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630 Guangdong Province (China)], E-mail: qw9406@tom.com; Jiang Ying [Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630 Guangdong Province (China)], E-mail: jiangying722@163.com; Bao Jian [Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630 Guangdong Province (China)], E-mail: baoj92@tom.com; Wu Aimin [Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630 Guangdong Province (China)], E-mail: wuaim@126.com; Pei Zhong [Department of Neurology, First Affiliated Hospital of Sun Yat-Sen University, 89 Zhongshaner Road, Guangzhou, 510080 Guangdong Province (China)], E-mail: peizhong@yahoo.com

    2008-04-15

    Background and purpose: The purpose of this study was to describe and evaluate neuroimaging findings of patients with neurosyphilis. Methods: The neuroimaging studies of 14 patients with documented neurosyphilis were reviewed. Diagnosis was established in 14 patients with cerebrospinal fluid for a Treponema Pallidum Particle Agglutination (TPPA) test. All patients had reactive TPPA and Unheated Serum Regain test (USR) in their sera. Imaging studies included plain, contrast-enhanced CT of the brain, plain and gadolinium-enhanced MR, and MR angiography. Results: In the 14 HIV-negative patients with neurosyphilis, CT and MR showed the presence of cerebral infarction in six cases, arteritis in four cases, nonspecific white matter lesion in three cases, acute syphilitic meningitis in one case and normal neuroimaging finding in one case. In addition, 4 in 14 patients had general paresis, and MRI showed high signal intensity on T2 -weighted images involving frontotemporal lobes, hippocampus and periventricular area. Treatment with penicillin significantly diminished the size of these high signal intensity on T2-weighted images with general paresis. Conclusion: These results suggest that MR and CT images have some characteristic manifestations in patients of neurosyphilis. Because early diagnosis and treatment of neurosyphilis are crucial to avoid persistent brain damage, the neuroimaging findings are valuable adjunct to clinical diagnosis and to provide useful information to follow-up after therapy.

  16. The importance of neurophysiological-Bobath method in multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Adrian Miler

    2018-02-01

    Full Text Available Rehabilitation treatment in multiple sclerosis should be carried out continuously, can take place in the hospital, ambulatory as well as environmental conditions. In the traditional approach, it focuses on reducing the symptoms of the disease, such as paresis, spasticity, ataxia, pain, sensory disturbances, speech disorders, blurred vision, fatigue, neurogenic bladder dysfunction, and cognitive impairment. In kinesiotherapy in people with paresis, the most common methods are the (Bobathian method.Improvement can be achieved by developing the ability to maintain a correct posture in various positions (so-called postural alignment, patterns based on corrective and equivalent responses. During the therapy, various techniques are used to inhibit pathological motor patterns and stimulate the reaction. The creators of the method believe that each movement pattern has its own postural system, from which it can be initiated, carried out and effectively controlled. Correct movement can not take place in the wrong position of the body. The physiotherapist discusses with the patient how to perform individual movement patterns, which protects him against spontaneous pathological compensation.The aim of the work is to determine the meaning and application of the  Bobath method in the therapy of people with MS

  17. Could visual neglect induce amblyopia?

    Science.gov (United States)

    Bier, J C; Vokaer, M; Fery, P; Garbusinski, J; Van Campenhoudt, G; Blecic, S A; Bartholomé, E J

    2004-12-01

    Oculomotor nerve disease is a common cause of diplopia. When strabismus is present, absence of diplopia has to induce the research of either uncovering of visual fields or monocular suppression, amblyopia or blindness. We describe the case of a 41-year-old woman presenting with right oculomotor paresis and left object-centred visual neglect due to a right fronto-parietal haemorrhage expanding to the right peri-mesencephalic cisterna caused by the rupture of a right middle cerebral artery aneurysm. She never complained of diplopia despite binocular vision and progressive recovery of strabismus, excluding uncovering of visual fields. Since all other causes were excluded in this case, we hypothesise that the absence of diplopia was due to the object-centred visual neglect. Partial internal right oculomotor paresis causes an ocular deviation in abduction; the image being perceived deviated contralaterally to the left. Thus, in our case, the neglect of the left image is equivalent to a right monocular functional blindness. However, bell cancellation test clearly worsened when assessed in left monocular vision confirming that eye patching can worsen attentional visual neglect. In conclusion, our case argues for the possibility of a functional monocular blindness induced by visual neglect. We think that in presence of strabismus, absence of diplopia should induce the search for hemispatial visual neglect when supratentorial lesions are suspected.

  18. [Successive subcortical hemorrhages in the superior parietal lobule and postcentral gyrus in a 23-year-old female].

    Science.gov (United States)

    Sato, K; Yoshikawa, H; Komai, K; Takamori, M

    1998-04-01

    We report a non-hypertensive 23-year-old female with successive hemorrhages in parietal subcortical regions. She had first experienced a transient pain in the left upper extremity one month before admission. She noticed dysesthesia in the same limb and weakness on her left hand, and, five days after, visited our hospital because of suddenly developed convulsion in the limb and loss of consciousness for a few minutes. Neurological examination revealed distal dominant flaccid paresis, positive pathological reflex and touch and position sense disturbances in the affected limb. Brain CT detected two high-density areas in the parietal lobe. Brain MRI demonstrated an acute phase subcortical hematoma in the left postcentral gyrus and a subacute phase one in the left superior parietal lobule. SPECT indicated hypoperfusion in the left frontal and parietal cortex. Cerebral angiography showed no abnormal findings. Her symptoms gradually improved, but left ulnar-type pseudoradicular sensory impairment remained on discharge. We considered the hemorrhage in this patient have arisen from rupture of cavernous hemangioma, because she was relatively young, the hematomas were oval in shape and successively developed in the left parietal lobe. Our patient suggests that a subcortical hemorrhage in the post-central gyrus causes flaccid paresis and pyramidal tract involvement.

  19. Specific features of vocal fold paralysis in functional computed tomography

    International Nuclear Information System (INIS)

    Laskowska, K.; Mackiewicz-Nartowicz, H.; Serafin, Z.; Nawrocka, E.

    2008-01-01

    Vocal fold paralysis is usually recognized in laryngological examination, and detailed vocal fold function may be established based on laryngovideostroboscopy. Additional imaging should exclude any morphological causes of the paresis, which should be treated pharmacologically or surgically. The aim of this paper was to analyze the computed tomography (CT) images of the larynx in patients with unilateral vocal fold paralysis. CT examinations of the larynx were performed in 10 patients with clinically defined unilateral vocal fold paralysis. The examinations consisted of unenhanced acquisition and enhanced 3-phased acquisition: during free breathing, Valsalva maneuver, and phonation. The analysis included the following morphologic features of the paresis.the deepened epiglottic vallecula, the deepened piriform recess, the thickened and medially positioned aryepiglottic fold, the widened laryngeal pouch, the anteriorly positioned arytenoid cartilage, the thickened vocal fold, and the filled infraglottic space in frontal CT reconstruction. CT images were compared to laryngovideostroboscopy. The most common symptoms of vocal cord paralysis in CT were the deepened epiglottic vallecula and piriform recess, the widened laryngeal pouch with the filled infraglottic space, and the thickened aryepiglottic fold. Regarding the efficiency of the paralysis determination, the three functional techniques of CT larynx imaging used did not differ significantly, and laryngovideostroboscopy demonstrated its advantage over CT. CT of the larynx is a supplementary examination in the diagnosis of vocal fold paralysis, which may enable topographic analysis of the fold dysfunction. The knowledge of morphological CT features of the paralysis may help to prevent false-positive diagnosis of laryngeal cancer. (author)

  20. Ramsay Hunt syndrome in a child – case report

    Directory of Open Access Journals (Sweden)

    Joanna Grabowska

    2016-12-01

    Full Text Available Introduction. Ramsay Hunt syndrome is a rare disease characterized by complications of herpes zoster oticus. This syndrome is defined by characteristic skin lesions with paresis of the facial and/or vestibulocochlear nerve. Objective. To present a case of a 14-year-old child with Ramsay Hunt syndrome. Case report . A 14-year-old patient was admitted to the Department of Dermatology due to vesicular lesions in the left auricular region. On medical examination, insufficiency of the left eyelid, asymmetry of the facial lines, drooping of the left corner of the mouth, and smoothing of the forehead were observed. According to the House-Brackmann scale, the patient had paresis (grade IV of the facial nerve. The patient was treated with intravenous acyclovir, antibiotics and anti-inflammatory drugs. Supplementation with vitamin B and rehabilitation procedures were also introduced. Conclusions . Ramsay Hunt syndrome is very rare in the pediatric population. It requires interdisciplinary cooperation between doctors. The presented case confirms the validity of therapy with acyclovir and prednisone and rehabilitation.

  1. Bald Eagle nestling mortality associated with Argas radiatus and Argas ricei tick infestation and successful management with nest removal in Arizona, USA

    Science.gov (United States)

    Justice-Allen, Anne; Orr, Kathy; Schuler, Krysten L.; McCarty, Kyle; Jacobson, Kenneth; Meteyer, Carol U.

    2016-01-01

    Eight Bald Eagle (Haliaeetus leucocephalus) nestlings heavily infested with larval ticks were found in or under a nest near the confluence of the Verde and Salt rivers in Arizona in 2009-11. The 8-12-wk-old nestlings were slow to respond to stimuli and exhibited generalized muscle weakness or paresis of the pelvic limbs. Numerous cutaneous and subcutaneous hemorrhages were associated with sites of tick attachment. Ticks were identified as Argas radiatus and Argas ricei. Treatment with acaricides and infection with West Nile virus (WNV) may have confounded the clinical presentation in 2009 and 2010. However, WNV-negative birds exhibited similar signs in 2011. One nestling recovered from paresis within 36 h after the removal of all adult and larval ticks (>350) and was released within 3 wk. The signs present in the heavily infested Bald Eagle nestlings resembled signs associated with tick paralysis, a neurotoxin-mediated paralytic syndrome described in mammals, reptiles, and wild birds (though not eagles). Removal of the infested nest and construction of a nest platform in a different tree was necessary to break the cycle of infection. The original nesting pair constructed a new nest on the man-made platform and successfully fledged two Bald Eagles in 2012.

  2. [Neurology of hysteria (conversion disorder)].

    Science.gov (United States)

    Sonoo, Masahiro

    2014-07-01

    Hysteria has served as an important driving force in the development of both neurology and psychiatry. Jean Martin Charcot's devotion to mesmerism for treating hysterical patients evoked the invention of psychoanalysis by Sigmund Freud. Meanwhile, Joseph Babinski took over the challenge to discriminate between organic and hysterical patients from Charcot and found Babinski's sign, the greatest milestone in modern neurological symptomatology. Nowadays, the usage of the term hysteria is avoided. However, new terms and new classifications are complicated and inconsistent between the two representative taxonomies, the DSM-IV and ICD-10. In the ICD-10, even the alternative term conversion disorder, which was becoming familiar to neurologists, has also disappeared as a group name. The diagnosis of hysteria remains important in clinical neurology. Extensive exclusive diagnoses and over investigation, including various imaging studies, should be avoided because they may prolong the disease course and fix their symptoms. Psychological reasons that seem to explain the conversion are not considered reliable. Positive neurological signs suggesting nonorganic etiologies are the most reliable measures for diagnosing hysteria, as Babinski first argued. Hysterical paresis has several characteristics, such as giving-way weakness or peculiar distributions of weakness. Signs to uncover nonorganic paresis utilizing synergy include Hoover's test and the Sonoo abductor test.

  3. Anatomical study of the facial nerve canal in comparison to the site of the lesion in Bell's palsy.

    Science.gov (United States)

    Dawidowsky, Krsto; Branica, Srećko; Batelja, Lovorka; Dawidowsky, Barbara; Kovać-Bilić, Lana; Simunić-Veselić, Anamarija

    2011-03-01

    The term Bell's palsy is used for the peripheral paresis of the facial nerve and is of unknown origin. Many studies have been performed to find the cause of the disease, but none has given certain evidence of the etiology. However, the majority of investigators agree that the pathophysiology of the palsy starts with the edema of the facial nerve and consequent entrapment of the nerve in the narrow facial canal in the temporal bone. In this study the authors wanted to find why the majority of the paresis are suprastapedial, i.e. why the entrapment of the nerve mainly occurs in the proximal part of the canal. For this reason they carried out anatomical measurements of the facial canal diameter in 12 temporal bones. By use of a computer program which measures the cross-sectional area from the diameter, they proved that the width of the canal is smaller at its proximal part. Since the nerve is thicker at that point because it contains more nerve fibers, the authors conclude that the discrepancy between the nerve diameter and the surrounding bony walls in the suprastapedial part of the of the canal would, in cases of a swollen nerve after inflammation, cause the facial palsy.

  4. Risk of marginal mandibular nerve injury in neck dissection

    DEFF Research Database (Denmark)

    Møller, Martin Nue; Sørensen, Christian Hjort

    2012-01-01

    The immediate and permanent frequency of injury to the marginal mandibular branch of the facial nerve (MMN) after neck dissection has only scarcely been addressed in the medical literature. We investigated the risk of injury in 159 consecutive patients after neck dissection for various reasons...... in level I B and level II A, respectively. In 95 patients with oral cancer 13 (14%) of the cases had malfunction of the lower lip domain 2 weeks after neck dissection in level I B indicating paresis to the MMN. Follow-up analyses 1-2 years after the operation showed permanent paralysis in 4 to 7......% of the cases in whom two of them had the nerve sacrificed for oncologic reasons during the operation. In 18 patients with parotic cancer the corresponding permanent frequency of MMN paralysis was 11.1%. In 46 patients with neck dissection in level II A but not in level I B, no paresis of the MMN was registered...

  5. Outcomes of surgical treatment of thyroid disease in children

    Directory of Open Access Journals (Sweden)

    Olga S. Rogova

    2017-01-01

    Full Text Available Background. In recent years there has been a tendency of increase in the proportion of nodular goiter and Graves’ disease in thyroid pathology in children, which necessitates a choice of rational tactics for treatment of these diseases. At present there is no optimal method of treatment for thyroid gland pathology, but one of the methods is surgery. Thyroid surgery due to the determination of the indications and choice of the optimal volume of the surgical intervention continues to be under debate as postoperative complications of surgical treatment of thyroid diseases in children are possible.Aim: to study the outcomes of surgical treatment for thyroid pathology in children, depending on the volume of operation.Materials and methods. This article presents the results of a survey of 77 children operated on in the period of 2002–2016 for Graves’ disease, single-node goiter, and multinodular goiter. The examination included the determination of the levels of ionized calcium and TSH, FT4, FT3 in the blood serum, the evaluation of the functional state of the pituitary-thyroid system, thyroid ultrasound examination, and examination by an otolaryngologist.Results. The incidence of adverse outcomes of surgical treatment in children with nodular goiter was 27%. Adverse outcomes were observed equally often after organ-preserving operations and after thyroidectomy, but they were of different structure. The frequency of postoperative complications after thyroidectomy performed on the nodular goiter was 27%. Complications presented as postsurgical hypoparathyroidism and vocal cord paresis. In children with nodular goiter, after thyroidectomy hypoparathyroidism occurred more frequently than paresis of the vocal folds. Symptomatic hypocalcemia was observed more frequently than the asymptomatic variant, and in most cases hypoparathyrodism was transient. Among children with a single-node goiter who underwent organ-preserving surgery on the thyroid gland

  6. Obstetric outcome in pregnant women subjected to domestic violence.

    Science.gov (United States)

    Ameh, N; Shittu, S O; Abdul, M A

    2009-06-01

    To determine the prevalence of domestic violence and its relationship to adverse obstetric outcomes amongst pregnant women who deliver at a tertiary level hospital in Zaria, Nigeria. A cross-sectional study involving 310 women who delivered at the labour ward. Questionnaires were administered to parturient women. Details of their socio-demographic characteristics and obstetric outcome were compiled and the relationship to experiences of domestic violence studied. The prevalence of domestic violence was 28.4%. There was positive relationship between domestic violence during pregnancy, non-supervision of pregnancy and poor attendances to antenatal clinic (pviolence, and complications of labour and neonatal outcome (p>0.05). The prevalence of domestic violence in pregnancy is high in this environment. Poor attendances to the antenatal clinic is a significant association.

  7. [New Insights into Maternal Cardiopulmonary Resuscitation--Significance of Simulation Research and Training].

    Science.gov (United States)

    Komasawa, Nobuyasu; Fujiwara, Shunsuke; Majima, Nozomi; Minami, Toshiaki

    2015-08-01

    Pregnancy-related mortality, estimated to occur in approximately 1: 50,000 deliveries, is rare in developed countries. The 2010 American Heart Association (AHA) Guidelines for Resuscitation emphasize the importance of high-quality chest compression as a key determinant of successful cardiopulmonary resuscitation. During pregnancy, the uterus can compress the inferior vena cava, impeding venous return and thereby reducing stroke volume and cardiac output. To maximize the effectiveness of chest compressions in pregnancy, the AHA guidelines recommend the 27-30 degrees left-lateral tilt (LLT) position. When CPR is performed on parturients in the LLT position, chest compressions will probably be more effective if performed with the operator standing on the left side of the patient. The videolaryngoscope Pentax-AWS Airwayscope (AWS) was found to be an effective tool for airway management during chest compressions in 27 LLT simulations, suggesting that the AWS may be a useful device for airway management during maternal resuscitation.

  8. Anaesthetic Management of Caesarean Section in an Achondroplastic Dwarf

    Directory of Open Access Journals (Sweden)

    Kirti N Saxena

    2008-01-01

    A twenty year old parturient with short stature presented to the hospital in early labour. An elective lower segment caesarean section(LSCS was planned in view of cephalopelvic disproportion. She had papers which suggested that she had been diagnosed as a case of achondroplasia though details were not available. Combined spinal epidural(CSE anaesthesia was planned in the patient in view of the death of her first baby following caesarean section under general anaesthesia. Repeatedly dry taps were achieved on attempting dural puncture. Dural puncture was abandoned and an 18 G epidural catheter was threaded via the Tuohy needle. Sensory block till T 6 was achieved with 6ml of local anaesthetic solution. The patient was stable during the intraoperative and postoperative period.

  9. Early kit mortality and growth in farmed mink are affected by litter size rather than nest climate

    DEFF Research Database (Denmark)

    Schou, Toke Munk; Malmkvist, Jens

    2017-01-01

    increased growth (P=0.026). Nest box temperature had little effect on early kit survival and growth, which could be due to dams’ additional maternal behaviour. Therefore, we cannot confirm that temperature is the primary reason for kit mortality, under the conditions of plenty straw access for maternal nest......We investigated the effects of nest box climate on early mink kit mortality and growth. We hypothesised that litters in warm nest boxes experience less hypothermia-induced mortality and higher growth rates during the 1st week of life. This study included data from 749, 1-year-old breeding dams...... building. Instead, prenatal and/or parturient litter size is the primary factor influencing early kit vitality. The results indicate that the focus should be on litter size and dam welfare around the times of gestation and birth to increase early kit survival in farmed mink....

  10. Expectant fathers' experience during labor with or without epidural analgesia.

    Science.gov (United States)

    Capogna, G; Camorcia, M; Stirparo, S

    2007-04-01

    For men the worst aspect of childbirth is witnessing their partner in pain. The aim of this study was to investigate fathers' attitudes towards labor and delivery with and without epidural analgesia. The study was performed using a questionnaire that included yes/no, multiple choice or 6-point ordinal scale answers. Expectant fathers whose partners were nullipara between 36 and 38 weeks of gestation were recruited and the questionnaires were administered on the day after the birth. To investigate paternal anxiety during labor, the State part of the State-Trait Anxiety Inventory was used. The questionnaire was completed by 243 fathers. Sixty percent (145) of the parturients received epidural analgesia and 40% (98) did not. Paternal characteristics were comparable. Fathers whose partners did not receive epidural analgesia felt their presence as troublesome and unnecessary (Pinvolvement (Pfathers whose partners did not or did receive epidural analgesia (Pinvolvement, participation and satisfaction with the experience of childbirth.

  11. Experimentando cuidados en el contexto de una casa de partos: visión de las pacientes

    OpenAIRE

    GONÇALVES, Roselane; AGUIAR, Cláudia de Azevedo; MERIGHI, Miriam Aparecida Barbosa; JESUS, Maria Cristina Pinto de

    2011-01-01

    O modelo de assistência ao parto e nascimento no Brasil tem sido tema de muitas discussões e estudos sobre a incorporação de práticas obstétricas que considerem a autonomia da mulher no processo de parturição. O modelo proposto pelas Casas de Parto configura-se como um cenário para esses cuidados. Este estudo voltou-se para a compreensão da vivência da mulher parturiente no contexto de uma Casa de Parto situada em São Paulo. Os dados foram coletados no período de março a outubro de 2007 e ana...

  12. The Nordic Obstetric Surveillance Study

    DEFF Research Database (Denmark)

    Colmorn, Lotte B.; Petersen, Kathrine B; Jakobsson, Maija

    2015-01-01

    by using International Classification of Diseases, 10th revision codes on diagnoses and the Nordic Medico-Statistical Committee Classification of Surgical Procedure codes. MAIN OUTCOME MEASURES: Rates of the studied complications and possible risk factors among parturients in the Nordic countries. RESULTS......OBJECTIVE: To assess the rates and characteristics of women with complete uterine rupture, abnormally invasive placenta, peripartum hysterectomy, and severe blood loss at delivery in the Nordic countries. DESIGN: Prospective, Nordic collaboration. SETTING: The Nordic Obstetric Surveillance Study...... (NOSS) collected cases of severe obstetric complications in the Nordic countries from April 2009 to August 2012. SAMPLE AND METHODS: Cases were reported by clinicians at the Nordic maternity units and retrieved from medical birth registers, hospital discharge registers, and transfusion databases...

  13. The effect of small dose bupivacaine-fentanyl in spinal anesthesia on hemodynamic nausea and vomiting in cesarean section

    International Nuclear Information System (INIS)

    Seyedhejazi, M.; Madarek, E.

    2007-01-01

    To compare the hemodynamic, nausea and vomiting with small dose bupivacaine-fentanyl spinal anesthetic versus a conventional dose of spinal bupivacaine in parturients undergoing cesarean section. Forty patients aged 17-35 years old which underwent cesarean section were randomized into two groups. Group-A received spinal anesthesia with 8 mg of bupivacaine and 10 microg fentanyl, group B received 12 mg bupivacaine. The mean dose of ephedrine needed was 4mg in group A and 11.75 mg in group B (P=0.006). The mean ratio of lowest systolic pressure to baseline systolic pressure was 0.75 for group A and 0.65 for group B (P=0.04). Nausea and vomiting was observed in 10% of group A versus 20% in group B. Small dose of bupivacaine and fentanyl provides good spinal anesthesia for cesarean section with less hypotension, nausea and vomiting. (author)

  14. The motivation-based calving facility: Social and cognitive factors influence isolation seeking behaviour of Holstein dairy cows at calving

    DEFF Research Database (Denmark)

    Rørvang, Maria Vilain; Herskin, Mette S.; Jensen, Margit Bak

    2018-01-01

    solution may be to allow the cow to seek isolation prior to calving. This study examined whether pre-parturient dairy cows will isolate in an individual calving pen placed in a group calving setting and whether a closing gate in this individual calving pen will cause more cows to isolate prior to calving....... Danish Holstein cows (n = 66) were housed in groups of six in a group pen with access to six individual calving pens connected to the group area. Cows were trained to use one of two isolation opportunities i.e. individual calving pens with functional closing gates (n = 35) allowing only one cow access...... at a time, or individual calving pens with permanently open gates allowing free cow traffic between group area and individual pen (n = 31). The response variables were calving site, calving behaviour and social behaviour. Unexpectedly, a functional gate did not facilitate isolation seeking, perhaps because...

  15. Comparison of Bolus Phenylephrine, Ephedrine and Mephentermine for Maintenance of Arterial Pressure during Spinal Anesth

    Directory of Open Access Journals (Sweden)

    B Bhattarai

    2010-03-01

    Full Text Available INTRODUCTION: Hypotension is common following spinal anesthesia. Various vasopressors have been indicated to prevent it. The study compares three such agents namely phenylephrine, ephedrine and mephentermine. METHODS: The study included 90 patients undergoing elective and emergency cesarean section who developed hypotension following subarachnoid blockade. Parturient were randomly divided into three groups each group had 30 patients. Group P received bolus of Phenylephrine 25 microgram, where as group E received Ephedrine 5mg and Group M received Mephentermine 6mg. RESULTS: It was found that rise of blood pressure was significantly higher in case of phenylephrine group in first six minutes, after the bolus, there was significant reduction in the heart rate in phenylephrine group, but there was tachycardia following administration of bolus ephedrine and mephenteramine. Neonatal APGAR score were similar in all three groups. CONCLUSIONS: All three drugs maintained hemodynamics within 20 percent of the baseline values on intravenous administration. Keywords: APGAR, ephedrine, hypotension, mephentermine, phenylephrine, spinal anesthesia.

  16. Digitaalisen markkinoinnin ja sosiaalisen median hyödyntäminen kampaamoalalla : Pienyritykset

    OpenAIRE

    Myllymäki, Hanna

    2016-01-01

    Tämän opinnäytetyön aiheena oli digitaalisen markkinoinnin ja sosiaalisen median hyödyntäminen kampaamoalalla, erityisesti pienissä yrityksissä. Tavoitteena oli opastaa lukijaa ymmärtämään digitaalisen markkinoinnin ja sosiaalisen median keskeisimmät perusteet ja antaa neuvoja parturi-kampaamoalan yrittäjälle, joka ei ole vielä huomioinut tai osannut hyödyntää niiden työkaluja. Työn teoriaosuudessa käsiteltiin mitä markkinointiviestintä on ja mitä sosiaalisen media on. Tämän lisäksi käsit...

  17. Case Report: Postpartum hemorrhage associated with Dengue with warning signs in a term pregnancy and delivery [version 1; referees: 2 approved, 1 not approved

    Directory of Open Access Journals (Sweden)

    Le Phi Hung

    2015-12-01

    Full Text Available Background: Dengue infection during peripartum period, although rare in endemic regions, has challenged clinicians regarding its management, especially if a parturient woman experiences postpartum hemorrhage due to a classical risk factor of maternal bleeding. Case: A full-term pregnant Vietnamese woman was diagnosed with polyhydramnios and Dengue with warning signs (DWS. She was administered platelet transfusion prior to delivery and then gave birth to a healthy newborn. After active management of the third stage of labor, the patient suffered a postpartum hemorrhage which was caused by uterine atony and accompanied with thrombocytopenia. Therefore, we decided to administer uterotonic drugs and additionally transfuse platelets. Conclusion: We describe a case of postpartum hemorrhage caused by uterine atony and coinciding with Dengue infection during delivery period, which is a rare clinical entity. With timely detection and management, the patient was finally discharged without complications.

  18. Trichomonas vaginalis infection among young pregnant women in Brazil.

    Science.gov (United States)

    Miranda, Angelica E; Pinto, Valdir M; Gaydos, Charlotte A

    2014-01-01

    Our goal was to determine the prevalence of Trichomonas vaginalis and its associated risk factors in parturient women aged 15-24 years attending Brazilian public maternity units. Participants answered a demographic, behavioral, and clinical data questionnaire. A sample of urine was screened for T. vaginalis. A total 299 women participated in this study. The prevalence rate of T. vaginalis was 7.7% (95% CI: 4.7-10.7%). The factors associated with T. vaginalis were use of illicit drugs [OR=4.70 (95% CI: 1.63-13.56, p=0.004)] and not attending antenatal care [OR=5.15 (95% CI: 1.15-23.25, p=0.032)]. These data demonstrate that it is important to discuss how to include routine screening for T. vaginalis during antenatal care in Brazil. Copyright © 2014 Elsevier Editora Ltda. All rights reserved.

  19. Effects of bovine necrotic vulvovaginitis on productivity in a dairy herd in Israel.

    Science.gov (United States)

    Blum, S; Mazuz, M; Brenner, J; Friedgut, O; Koren, O; Goshen, T; Elad, D

    2008-05-01

    Bovine necrotic vulvovaginitis (BNVV) is characterized by the development of a necrotic vulvovaginal lesion, almost exclusively in post-parturient first-lactation cows, associated with Porphyromonas levii. The scope of this survey was to evaluate the impact of BNVV on herd productivity as a means to rationally evaluate the resources that should be allocated in dealing with the syndrome. During an outbreak of BNVV in a dairy herd, following the introduction of a large number of cows from another farm, the impact of the animals' origin (local or transferred) and BNVV (positive or negative) upon involuntary culling rate, milk yield and days between pregnancies were assessed. The results indicated that the number of days between pregnancies was significantly higher in first-lactation cows with BNVV but was not influenced by the other independent variables. None of the other variables included in this survey had any effect on the involuntary culling rate and milk yield.

  20. Efetividade de estratégias não farmacológicas no alívio da dor de parturientes no trabalho de parto La efectividad de estratégias no farmacológicas en el alivio del dolor de parturientas en el trabajo de parto Effectiveness of non-pharmacological strategies in relieving labor pain

    Directory of Open Access Journals (Sweden)

    Rejane Marie Barbosa Davim

    2009-06-01

    aumentaba la dilatación del cuello del útero. Se concluye que las estrategias fueron efectivas para aliviar la intensidad del dolor de las parturientas de este estudio durante el trabajo de parto.The study objective was to evaluate the effectiveness of non-pharmacological strategies to relieve pain in parturients in labor. This is a before and after therapeutic intervention clinical trial, performed at a public maternity in the city of Natal, in the state of Rio Grande do Norte, Brazil, with 100 parturients applying breathing exercises, muscle relaxation, lumbosacral massage, and showers. A visual analogue scale was used for data collection. Most parturients were between 20 and 30 years old (60%, had incomplete primary-level education (85%, family income of up to 2 minimum salaries (74%, and 78% had a companion with them at the hospital. Oxytocine was administered in 81% of cases, but 15% did not receive any medication. A significant difference was observed in pain relief after using non-pharmacological strategies, showing reduced pain as cervix dilation increased. It was concluded that the strategies were effective in reducing the intensity of pain in the studied parturients in labor.

  1. Reversible posterior leucoencephalopathy syndrome in a peripartum patient.

    Science.gov (United States)

    Prout, R E; Tuckey, J P; Giffen, N J

    2007-01-01

    We present the case of a multiparous parturient who developed hypertension associated with a severe headache in the immediate post-partum period. She subsequently suffered a generalised tonic clonic seizure on the fifth post-partum day. Following recovery of consciousness, she developed a left homonymous hemianopia. Apart from hypertension, headache and convulsion, she had no symptoms and no proteinuria or other biochemical or haematological changes associated with eclampsia. The magnetic resonance imaging findings were consistent with vasogenic oedema in the right posterior parieto-occipital white matter and these in turn are consistent with reversible posterior leucoencephalopathy syndrome. The differential diagnosis of convulsions in the post-partum period is discussed and the clinical and radiological features of reversible posterior leucoencephalopathy syndrome are described.

  2. Alterations in physiology and anatomy during pregnancy.

    Science.gov (United States)

    Tan, Eng Kien; Tan, Eng Loy

    2013-12-01

    Pregnant women undergo profound anatomical and physiological changes so that they can cope with the increased physical and metabolic demands of their pregnancies. The cardiovascular, respiratory, haematological, renal, gastrointestinal and endocrine systems all undergo important physiological alterations and adaptations needed to allow development of the fetus and to allow the mother and fetus to survive the demands of childbirth. Such alterations in anatomy and physiology may cause difficulties in interpreting signs, symptoms, and biochemical investigations, making the clinical assessment of a pregnant woman inevitably confusing but challenging. Understanding these changes is important for every practicing obstetrician, as the pathological deviations from the normal physiological alterations may not be clear-cut until an adverse outcome has resulted. Only with a sound knowledge of the physiology and anatomy changes can the care of an obstetric parturient be safely optimized for a better maternal and fetal outcome. Copyright © 2013 Elsevier Ltd. All rights reserved.

  3. [Emergency cesarean in a patient with Coffin-Siris syndrome].

    Science.gov (United States)

    Fornet, I; Morillas, P; López, M A; Palacio, F J; Aguilar, J M; Mesa, J L

    2007-11-01

    Coffin-Siris syndrome is a rare genetic disease characterized by coarse facial features, sparse scalp hair, hirsutism, hypoplasia of the distal phalanges, hypoplastic nail in the fifth digit, and mental retardation and delayed growth evident in both weight and height. Most cases are sporadic, but the possibility of recessive or dominant autosomal inheritance has been suggested. Facial abnormalities that make intubation difficult and mental retardation that interferes with cooperation are aspects of this disease that can affect the choice of type of anesthesia. We report the case of a parturient with Coffin-Siris syndrome who refused epidural analgesia for labor pain and for whom the obstetrician later decided that an emergency cesarean was necessary due to fetal distress.

  4. Cerebrospinal fluid cutaneous fistula following obstetric epidural analgaesia. Case report.

    Science.gov (United States)

    Fedriani de Matos, J J; Quintero Salvago, A V; Gómez Cortés, M D

    2017-10-01

    Cutaneous fistula of cerebrospinal fluid is a rare complication of neuroaxial blockade. We report the case of a parturient in whom an epidural catheter was placed for labour analgesia and 12h after the catheter was removed, presented an abundant asymptomatic fluid leak from the puncture site, compatible in the cyto-chemical analysis with cerebrospinal fluid. She was treated with acetazolamide, compression of skin orifice of the fluid leakage, antibiotic prophylaxis, hydration and rest, and progressed satisfactorily without requiring blood patch. Copyright © 2017 Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. [Morphological features of the myometrium in connective tissue dysplasia in women with uterine inertia].

    Science.gov (United States)

    Konovalov, P V; Mitrofanova, L B; Gorshkov, A N; Ovsyannikov, F A

    2015-01-01

    to reveal the morphological features of the lower uterine segment myometrium in connective tissue dysplasia (CTD) in women with uterine inertia. Histological, immunohistochemical (with antibodies against collagen types I and III, matrix metalloproteinases 1 and 9 (MMR-1, MMP-9), tissue inhibitor of metalloproteinase 1 (TIMP-1), fibronectin; fibulin-5, connexin-43), electron microscopic, and electron immunocytochemical studies with morphometry of myometrial fragments from 15 parturient women with CTD and uterine inertia (a study group) and those from 10 women without CTD (a control group). The myometrium in CTD exhibited the decreased expression of connextin-43, fibulin-5, TIMP-1, collagens types I and III with collagen type III predominance and the unchanged levels of fibronectin and MMP-1 and MMP-9. Electron microscopy and immunocytochemistry showed fewer intercellular contacts and the dramatically lower expression of connexin-43 than in the control. A set of found myometrial changes in women with uterine inertia is a manifestation of CTD.

  6. The need to include obstetric nurses in prenatal care visits in the public health system

    Directory of Open Access Journals (Sweden)

    Selma Aparecida Lagrosa Garcia

    2010-06-01

    Full Text Available Objective: To investigate, with a qualitative approach, the role of Obstetric Nurses at the primary level of care given to women’s health as a vital component of the multidisciplinary team, which today is fundamental for providing care, prevention as well as health education and promotion, especially in programs whose activities are geared towards primary care of pregnant, parturient, and puerpera women. Methods: Brazilian laws and the determinations of Nursing Councils in reference to the activities of the obstetric nurse were researched, including the nurse’s responsibilities and limits. The bibliographic search was conducted in health-related journals, lay publications, and the Internet. Results: The conflicts between professional physicians and nurses were discussed. Conclusions: It was concluded that the activities of the nurse, conducting low-risk prenatal clinical visits in the basic healthcare network, has legal and ethical support and provides true benefit to the clients.

  7. PGE1 nebulisation during caesarean section for Eisenmenger's syndrome: a case report

    Directory of Open Access Journals (Sweden)

    Siddiqui Shahla

    2008-05-01

    Full Text Available Abstract Introduction Eisenmenger's syndrome in pregnancy can lead to death in 50% to 65% of parturients. Expensive invasive monitoring and medication have improved management and outcomes. Cheaper alternatives for the management of high-risk patients who present with no prenatal care are still not available. Case presentation We describe the obstetric anaesthesia management of a 34-year-old, 34-weeks pregnant woman who presented with a recent diagnosis of severe Eisenmenger's syndrome. A combined spinal epidural anaesthesia was used together with invasive cardiac monitoring as well as PGE1 nebulisation after delivery of the baby. This helped achieve a reduction of shunt, improvement of hypoxia and reduction of pulmonary pressures. Conclusion We found this to be a cheaper and safe alternative in the management of such patients who present with no adequate prior management.

  8. The impact of controlled nutrition during the dry period on dairy cow health, fertility and performance.

    Science.gov (United States)

    Beever, David E

    2006-12-01

    Average dairy herd fertility is declining, with more serves per successful conception, extended calving intervals and increased culling due to failure to rebreed, all adding significant costs to milk production. Genetics, management and nutrition have all contributed to this decline in fertility; the paper focuses primarily on nutritional issues. The extent of body condition loss after calving and its possible impact on fertility is considered, with evidence that this phenomenon is common in many herds irrespective of average milk yields. Body tissue mobilisation after calving increases the flux of non-esterified fatty acids to the liver and pathways of fatty acid metabolism are considered. Particular attention is given to the effects of high plasma non-esterified fatty acid levels on fat accumulation in liver cells and possible impacts on nitrogen and glucose metabolism. Current nutritional practices with early lactation cows which aim to stimulate milk yield and peak milk production but have been shown to exacerbate body condition loss, are reviewed. The paper also considers cow health issues during the peri-parturient period and how these may affect milk yield and fertility. It is concluded that current feeding practices for dry cows, with the provision of increasing amounts of the lactation ration during the Close-up period to accustom the rumen microbes and offset the expected reduction in feed intake as pregnancy reaches term, have largely failed to overcome peri-parturient health problems, excessive body condition loss after calving or declining fertility. From an examination of the energy and protein requirements of dry cows, it is suggested that current Close-up feeding practices can lead to luxury intakes of nutrients that can increase fat deposition in the viscera and the liver. Under such conditions, metabolism of nutrients by the cow may be compromised. In contrast, limited feeding throughout the whole dry period has been shown to prevent many of the

  9. RANDOMISED CONTROLLED STUDY COMPARING A 0.75% ROPIVACAINE TO A CONVENTIONAL DOSE OF HYPERBARIC BUPIVACAINE FOR CESARIAN SECTION BY EPIDURAL ANALGESIA

    Directory of Open Access Journals (Sweden)

    Porika

    2015-09-01

    Full Text Available Central neuraxial blocked is one of the safest and efficacious methods of anaesthesia and analgesia. It has the added advantage of prolonged pain relief into the postoperative period. Epidural analgesia has increased steadily in popularity when compared to spinal anaesthes ia due to its neurological consequences and improved post - operative analgesia with epidural Opioids and as a consequence decreased side effects and prolonged the duration of analgesia. Present study is undertaken to compare hemodynamic and analgesic charac teristics using a 0.75% ropivacaine to a conventional dose of 0.5% bupivacaine for cesarean section under epidural anaesthesia. This study was conducted in ASA Grade I 50 singleton parturient to compare hemodynamics, APGAR scores and analgesic characterist ics of ropivacaine and bupivacaine. We have observed that the onset of sensory blockade was slower with ropivacaine and the duration of sensory blockade was also less. Whereas there was no significant change in haemodynamics and APGAR scores with both the drugs.

  10. [Trends in the prevalence of malaria and anemia at delivery in Libreville from 1995 to 2011].

    Science.gov (United States)

    Bouyou-Akotet, Marielle Karine; Nzenze-Afène, Solange; Mawili-Mboumba, Denise Patricia; Owono-Medang, Mathieu; Guiyedi, Vincent; Kombila, Maryvonne

    2011-01-01

    In 1995, 2005 and 2011, cross-sectional studies of 611 parturients at the Centre Hospitalier de Libreville in Gabon assessed the prevalence of maternal malaria and anaemia; two indicators of poor pregnancy outcomes. The prevalence of Plasmodium falciparum infection in maternal peripheral blood decreased from 25% in 2005 to 6% in 2011. Parasite density was significantly lower in 2005 (31 p/μL) than in 1995 (1,240 p/μL) or 2011 (35,055 p/μL). Anaemia prevalence was high (>50%) in 1995 and in 2005, but fell by more than 50% (24%) in 2011. After implementation of new malaria prevention strategies during pregnancy, the prevalence of both maternal peripheral P. falciparum infection and anaemia fell. Studies are necessary to assess the efficacy of these strategies and to seek other causes of anaemia.

  11. [Women's complaint leadership in the Causa Kleinwächter. A contribution to patient history of the Innsbruck maternity hospital].

    Science.gov (United States)

    Hilber, Marina

    On the basis of the Innsbruck Maternity Clinic this paper deals with the individual and collective worlds of experience of obstetric patients. However, not only the patient's view on the proceedings in this specific medical space is being reconstructed, also the prevailing conventions surrounding the treatment of pregnant, parturient and puerperal patients serving as clinical material in obstetric research and education are critically scrutinised. At the centre of this paper stands Dr. Ludwig Kleinwächter's period of duty, who acted as professor for obstetrics and gynaecology in Innsbruck between 1877 and 1881. During this period numerous conflicts regarding the treatment of patients are documented. Concerned about the good reputation of the Maternity Clinic, the Tyrolean State Committee, as the Clinic's provider, tried to solve the crisis. The existing letters of complaint and protocols do not only give a voice to the women concerned, but also to the medical professions as well as the local political representatives involved.

  12. Non-pharmacological strategies on pain relief during labor: pre-testing of an instrument Estrategias no farmacológicas en el alivio del dolor durante el trabajo de parto: pre-test de un instrumento Estratégias não farmacológicas no alívio da dor durante o trabalho de parto: pré-teste de um instrumento

    Directory of Open Access Journals (Sweden)

    Rejane Marie Barbosa Davim

    2007-12-01

    Full Text Available This descriptive study aimed to evaluate the effectiveness of Non-Pharmacological Strategies (NFS on pain relief of parturients as part of a research instrument to be utilized in a Doctoral Dissertation. In order to evaluate the NFS, the Analogous Visual Scale (AVS was used on 30 parturients attended at the Humanized Labor Unit of a school-maternity hospital in Natal, RN, Brazil. Of the six NFS (respiratory exercises, muscular relaxation, lumbossacral massage, shower washing, deambulation and pelvic swing, two were excluded post-test (deambulation and pelvic swing for not being accepted by the parturients. The remaining NFS (respiratory exercises, muscular relaxation, lumbossacral massage, and shower washing which reached satisfactory acceptation and applicability rates, were found to be effective in relieving pain of these parturients, and thus deemed adequate for use in the Doctoral Dissertation data collection process.Estudio descriptivo, objetivizando evaluar la efectividad de Estratégias No Farmacológicas (ENF en el alivio del dolor de parturientas para hacer parte de un instrumento de investigación a ser utilizado en la preparación de Tesis de Doctorado. Para evaluar las ENF, utilizamos la Escala Analógica Visual (EAV, con 30 parturientas, teniendo como local de la investigación la Unidad de Parto Humanizado de una Maternidad Escuela en Natal/RN. Verificamos que, de las seis ENF (ejercicios respiratorios, relajamiento muscular, masaje lombo-sacra, baño de lluvia, deambulación y balance pélvico, dos fueron excluidas después del Pre-Test (deambulación y balance pélvico, por presentar dificultades en su aplicación. Los demás (ejercicios respiratorios, relajamiento muscular, masaje lombo-sacra y baño de lluvia tuvieron índices satisfactorios de aceptación y aplicación, demostrando ser efectivas en el alivio del dolor de esas parturientas, siendo por lo tanto adecuadas su utilización como instrumento de recolecta de datos en

  13. Effect of pre-calving zeolite, magnesium and phosphorus supplemention on periparturient serum mineral concentrations

    DEFF Research Database (Denmark)

    Pallesen, Anders; Pallesen, Flemming; Jørgensen, Rolf Jess

    2008-01-01

    The objective of this study was to test whether supplementing dry cow rations with phosphorus (P) and magnesium (Mg) would interfere with the beneficial effect of zeolite supplementation on the periparturient blood calcium (Ca) concentration in dairy cattle. Three groups (A-C) of 10 Danish Jersey...... cows were each given the following daily supplements from 2 weeks before the expected date of calving until actual calving: group A: zeolite, monoammonium phosphate, standard dry cow mineral and vitamin mix, containing 61g magnesium phosphate; group B: zeolite, standard mineral and vitamin mix without...... the magnesium phosphate and group C: standard mineral and vitamin mix, monoammonium phosphate. All cows in group B had an apparently less variable serum calcium concentration around calving with no cases of milk fever and no subclinical hypocalcaemia or hypomagnesaemia recorded. In contrast, a parturient drop...

  14. A STUDY COMPARING DIFFERENT CONCENTRATIONS OF ROPIVACAINE 0.125% VS. 0.2%, WHEN GIVEN WITH FENTANYL 2 MCG/ML FOR EPIDURAL LABOUR ANALGESIA

    Directory of Open Access Journals (Sweden)

    Vindhya K

    2017-07-01

    Full Text Available BACKGROUND Epidural administration of local anaesthetics, with or without opioids, is commonly used for the relief of pain in labor. Lower concentration of local anesthetics is used for providing labor epidural analgesia. MATERIALS AND METHODS After approval of the Institutional Ethical Committee, this study was conducted at a teaching hospital in GGH, Kakinada on 50 term parturients. 50 parturients of ASA I & II, primi or multi gravida with singleton pregnancy having vertex presentation were taken up for the study. They were randomly divided into 2 groups–Group R1 and Group R2 each comprising of 25 parturients. Study patients (n=50 were randomly assigned to one of two groups of 25 each. They received aliquots of epidural injection using either, 10 ml of ropivacaine 0.125 % with 2 μg/ml fentanyl (group R1 or 10 ml of ropivacaine 0.2% with 2 μg/ml fentanyl (group R2. RESULTS Demographic data, obstetric data, and injection delivery interval were comparable in both groups. Effective labor analgesia with no motor blockade was observed in both groups. Duration of analgesia after initial bolus dose was also significantly longer in group R2 (126.45 ± 12.34 min than in group R1 (73.05±27.4min. Ropivacaine at both concentrations (0.2% vs. 0.125% along with fentanyl 2μg / ml decreased visual analog scale (VAS scores to <3 in all parturients uniformly. Mean VAS scores were significantly less in group R2 than in group R1 at 5,60, and 90 min. Requirement of top-up doses was significantly less in group R2 as compared to group R1. Consumption of ropivacaine was comparable in both the groups (58.23 ± 5.48 mg in group R1 and 65.88 ± 6.29 mg in group R2, but consumption of fentanyl was significantly more in group R1 (94.31 ± 4.93 mg as compared to group R2 (31.58 ± 2.38 mg. There were no significant changes in haemodynamics, nor adverse effects related to neonatal or maternal outcomes in both groups. CONCLUSION We conclude that both the concentrations

  15. Analgesia obstétrica farmacológica: um estudo sobre os desfechos obstétricos e neonatais

    Directory of Open Access Journals (Sweden)

    Ruanna Lorna Vieira Fernandes

    2017-01-01

    Full Text Available Objective: to investigate the association between pharmacological obstetric analgesia and obstetric and neonatal outcomes. Methods: it was a retrospective case-control study conducted with 393 pregnant women comprising 131 cases of pharmacological obstetric analgesia and 262 controls that did not perform this procedure. The sociodemographic and obstetric profile, the circumstances of parturient admission, obstetrical decisions, and obstetric and neonatal outcomes were investigated. Results: pregnant women submitted to pharmacological analgesia during labor presented an increased risk for the use of exogenous oxytocin (p<0.001, episiotomy (p=0.001, Kristeller maneuver (p=0.036, and forceps (p=0.004. Conclusion: pharmacological analgesia does not increase the risk of spontaneous perineal tear, abdominal delivery, and hospitalization in neonatal unit. Nevertheless, it influences the increased risk of synthetic oxytocin use, Kristeller maneuver, episiotomy, forceps, and the occurrence of lower first-minute Apgar scores.

  16. The effects of epidural/spinal opioids in labour analgesia on neonatal outcomes: a meta-analysis of randomized controlled trials.

    Science.gov (United States)

    Wang, Kai; Cao, Liang; Deng, Qian; Sun, Li-Qiang; Gu, Tian-Yu; Song, Jie; Qi, Dun-Yi

    2014-08-01

    Epidural/spinal opioids are increasingly used to relieve parturients' pain in labour. Some studies indicate that opioids can induce side effects in neonates, such as respiratory depression and neurobehavioural changes. This meta-analysis aimed to clarify the effects of opioids in labour analgesia on neonates. PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE™ were searched for relevant randomized controlled trials (RCTs). The neonatal data of Apgar scores, Neurological and Adaptive Capacity Scores (NACS), and umbilical cord pH values were extracted. Statistical analyses were carried out using Review Manager 5.2 and Stata(®) 10. Twenty-one trials with 2,859 participants were included in our meta-analysis. No difference in the incidence of Apgar scores analgesia are safe for neonates up to 24 hr after delivery. In future studies, more attention should be paid to the long-term side effects in neonates.

  17. Epidural analgesia for labour: maternal knowledge, preferences and informed consent.

    LENUS (Irish Health Repository)

    2012-02-29

    Epidural analgesia has become increasingly popular as a form of labour analgesia in Ireland. However obtaining true inform consent has always been difficult. Our study recruited 100 parturients who had undergone epidural analgesia for labour, aimed to determine the information they received prior to regional analgesia, and to ascertain their preferences regarding informed consent. Only 65 (65%) of patients planned to have an epidural. Knowledge of potential complications was variable and inaccurate, with less than 30 (30%) of women aware of the most common complications. Most women 79 (79%) believed that discomfort during labour affected their ability to provide informed consent, and believe consent should be taken prior to onset of labour (96, 96%). The results of this study helps define the standards of consent Irish patients expect for epidural analgesia during labour.

  18. Administration of copper oxide wire particles in a capsule or feed for gastrointestinal nematode control in goats.

    Science.gov (United States)

    Burke, J M; Soli, F; Miller, J E; Terrill, T H; Wildeus, S; Shaik, S A; Getz, W R; Vanguru, M

    2010-03-25

    Widespread anthelmintic resistance in small ruminants has necessitated alternative means of gastrointestinal nematode (GIN) control. The objective was to determine the effectiveness of copper oxide wire particles (COWP) administered as a gelatin capsule or in a feed supplement to control GIN in goats. In four separate experiments, peri-parturient does (n=36), yearling does (n=25), weaned kids (n=72), and yearling bucks (n=16) were randomly assigned to remain untreated or administered 2g COWP in a capsule (in Experiments 1, 2, and 3) or feed supplement (all experiments). Feces and blood were collected every 7 days between Days 0 and 21 (older goats) or Day 42 (kids) for fecal egg counts (FEC) and blood packed cell volume (PCV) analyses. A peri-parturient rise in FEC was evident in the untreated does, but not the COWP-treated does (COWP x date, P<0.02). In yearling does, FEC of the COWP-treated does tended to be lower than the untreated (COWP, P<0.02). FEC of COWP-treated kids were reduced compared with untreated kids (COWP x date, P<0.001). FEC of treated and untreated bucks were similar, but Haemonchus contortus was not the predominant nematode in these goats. However, total worms were reduced in COWP-fed bucks (P<0.03). In summary, it appeared that COWP in the feed was as effective as COWP in a gelatin capsule to reduce FEC in goats. COWP administration may have a limited effect where H. contortus is not the predominant nematode.

  19. Maternal and anaesthesia-related risk factors and incidence of spinal anaesthesia-induced hypotension in elective caesarean section: A multinomial logistic regression.

    Science.gov (United States)

    Fakherpour, Atousa; Ghaem, Haleh; Fattahi, Zeinabsadat; Zaree, Samaneh

    2018-01-01

    Although spinal anaesthesia (SA) is nowadays the preferred anaesthesia technique for caesarean section (CS), it is associated with considerable haemodynamic effects, such as maternal hypotension. This study aimed to evaluate a wide range of variables (related to parturient and anaesthesia techniques) associated with the incidence of different degrees of SA-induced hypotension during elective CS. This prospective study was conducted on 511 mother-infant pairs, in which the mother underwent elective CS under SA. The data were collected through preset proforma containing three parts related to the parturient, anaesthetic techniques and a table for recording maternal blood pressure. It was hypothesized that some maternal (such as age) and anaesthesia-related risk factors (such as block height) were associated with occurance of SA-induced hypotension during elective CS. The incidence of mild, moderate and severe hypotension was 20%, 35% and 40%, respectively. Eventually, ten risk factors were found to be associated with hypotension, including age >35 years, body mass index ≥25 kg/m 2 , 11-20 kg weight gain, gravidity ≥4, history of hypotension, baseline systolic blood pressure (SBP) 100 beats/min in maternal modelling, fluid preloading ≥1000 ml, adding sufentanil to bupivacaine and sensory block height >T 4 in anaesthesia-related modelling ( P < 0.05). Age, body mass index, weight gain, gravidity, history of hypotension, baseline SBP and heart rate, fluid preloading, adding sufentanil to bupivacaine and sensory block hieght were the main risk factors identified in the study for SA-induced hypotension during CS.

  20. Labour analgesia: Recent advances

    Science.gov (United States)

    Pandya, Sunil T

    2010-01-01

    Advances in the field of labour analgesia have tread a long journey from the days of ether and chloroform in 1847 to the present day practice of comprehensive programme of labour pain management using evidence-based medicine. Newer advances include introduction of newer techniques like combined spinal epidurals, low-dose epidurals facilitating ambulation, pharmacological advances like introduction of remifentanil for patient-controlled intravenous analgesia, introduction of newer local anaesthetics and adjuvants like ropivacaine, levobupivacaine, sufentanil, clonidine and neostigmine, use of inhalational agents like sevoflourane for patient-controlled inhalational analgesia using special vaporizers, all have revolutionized the practice of pain management in labouring parturients. Technological advances like use of ultrasound to localize epidural space in difficult cases minimizes failed epidurals and introduction of novel drug delivery modalities like patient-controlled epidural analgesia (PCEA) pumps and computer-integrated drug delivery pumps have improved the overall maternal satisfaction rate and have enabled us to customize a suitable analgesic regimen for each parturient. Recent randomized controlled trials and Cochrane studies have concluded that the association of epidurals with increased caesarean section and long-term backache remains only a myth. Studies have also shown that the newer, low-dose regimes do not have a statistically significant impact on the duration of labour and breast feeding and also that these reduce the instrumental delivery rates thus improving maternal and foetal safety. Advances in medical technology like use of ultrasound for localizing epidural space have helped the clinicians to minimize the failure rates, and many novel drug delivery modalities like PCEA and computer-integrated PCEA have contributed to the overall maternal satisfaction and safety. PMID:21189877