Sidman, R. D. and Gallagher, E. J. (1995), Exertional Heat-Stroke in a young Woman Gender Differences in Response to Thermal-Stress




НазваниеSidman, R. D. and Gallagher, E. J. (1995), Exertional Heat-Stroke in a young Woman Gender Differences in Response to Thermal-Stress
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References

Sidman, R.D. and Gallagher, E.J. (1995), Exertional Heat-Stroke in A Young Woman - Gender Differences in Response to Thermal-Stress. Academic Emergency Medicine, 2 (4), 315-319.

Abstract: Exertional heat stroke (EHS) is an acute life-threatening emergency that necessitates the immediate institution of cooling measures. Re ported here is a case of EHS in a nonacclimatized young woman who was undergoing strenuous exercise. The patient developed many of the characteristic features of EHS, including central nervous system disturbances, lactic acidosis, rhabdomyolysis, coagulopathy, and abnormal myocardial conduction. While EHS is relatively common in young men, the condition is rare in women. This case presentation addresses gender differences in the response to the thermal stress of intense physical activity

Keywords: activity/acute/central nervous system/EMERGENCY/ENVIRONMENTAL ILLNESS/exercise/GENDER/heat/HEAT ILLNESS/HEAT STROKE/lactic acidosis/MEN/nervous system/response/rhabdomyolysis/stress/stroke/WOMEN

Tannebaum, R.D. and Sloan, E.P. (1995), Nonhemorrhagic Pontine Infarct in A Child Following Mild Head Trauma. Academic Emergency Medicine, 2 (6), 523-526.

Abstract: child who presented with hemiparesis secondary to a delayed nonhemorrhagic pontine infarction following mild head trauma is described. The results of the child's workup, including computed tomography (CT), were negative. The diagnosis of nonhemorrhagic pontine infarct was made by magnetic resonance imaging (MRI). The diagnostic evaluation excluded other possible etiologies of cerebral infarction, including vasculitides, CNS infection, congenital heart disease, hypercoagulable states, and demyelinating diseases. Although trauma cannot be proven as the cause of the infarct, other known causes of infarct were excluded. There are few cases of traumatic nonhemorrhagic cerebral infarction among children in the literature; none describes diagnostic MRI findings. MRI is important in these cases, because it may reveal delayed infarction from small-vessel injury, which is not apparent on CT. This article discusses the etiology of and the diagnostic evaluation of pediatric cerebrovascular accidents and suggests the need for emergency physicians to consider trauma as a potential cause of delayed nonhemorrhagic cerebral infarct in children

Keywords: BASAL GANGLIA/causes/cerebral/cerebral infarction/cerebrovascular/CEREBROVASCULAR ACCIDENT/cerebrovascular accidents/CEREBROVASCULAR-DISEASE/child/children/CNS/computed tomography/CT/diagnosis/disease/diseases/EMERGENCY/etiology/evaluation/HEAD TRAUMA/heart/heart disease/HEMIPARESIS/infarct/INFARCTION/infection/INJURY/ISCHEMIC STROKE/JUN/magnetic resonance/MAGNETIC RESONANCE IMAGING/MRI/MULTIPLE-SCLEROSIS/PEDIATRIC/tomography/trauma/YOUNG

Perdikaris, P.C. and Romeo, A. (1995), Site Effect on Fracture Energy of Concrete and Stability Issues in 3-Point Bending Fracture-Toughness Testing. Aci Materials Journal, 92 (5), 483-496.

Abstract: The effect of the beam size, aggregate size, and compressive strength on the specific fracture energy of plain concrete is studied, based on three-point bending (TPB) static tests on single-edge notched (SEN) beams. Most of the beams with target concrete cylinder compressive strengths of 28 and 55 MPa and two maximum aggregate sizes of 6 and 25 mm were tested under crack mouth opening displacement (CMOD) control. The CMOD, applied load, load-point deflection (LPD), and stroke were recorded. The LPD was measured by two direct current displacement transducers (DCDTs), supported by an aluminum frame attached to both sides of the beam at its mid-height. Three beam sizes (S1, S2, S3), a constant width b = 127 mm, span-to-depth ratio S/d = 4, and notch length-to-depth ratio a(o)/d = 0.3, were considered. Two beams with a shorter notch length of a(o) = 0.1 d were tested to compare their postpeak response. The measured RILEM G(F)(R) values are consistently higher than the calculated G(f)(SEM) values [Bazant's size effect model (SEM)] and the equivalent G(Ic) values based on LEFM and the Jenq and Shah two-parameter model (TPM). A macro- and microscale effect is observed in the fracture energy values. The RILEM C-F(R) values for the smaller d(max) (6 mm) increased by only 35 to 59 percent, which is four times the increase in beam size (S1 to S3), while the larger d(max) (25 mm) only increased by 24 to 36 percent, which is two times the increase in beam size (S2 to S3), The G(F)(R) values are influenced more drastically by d(max). Increasing d(max) from 6 to 25 mm, G(F)(R) increased independently by about 100 percent of the beam size. The G(F)(R) values are influenced rather mildly by the concrete compressive strength. For d(max) = 25 mm and normal concrete compressive strength, rougher crack surfaces are observed and higher G(F)(R) values are obtained, compared to those for d(max) = 6 mm. Symptoms of a possible snap-back instability were detected in the load-LPD diagram of the beams with the shot rer notch a(o) = 0.1 d. Depending on the relative stiffness of the beam and testing frame, snap-back may occur in the load-stroke diagram, Extraneous influence of the load actuator stroke signal on the measured LPD may result in an ''apparent'' instability in the load-LPD diagram that may be inadvertently presumed to be a true snap-back instability

Keywords: AGGREGATES/COMPRESSIVE STRENGTH/CONCRETE/CONCRETES/control/COUNTRIES/CRACKING (FRACTURING)/DRIVE/effect/FAILURE/LOADS (FORCES)/MICROSTRUCTURE/model/RESERVE/response/stroke

Sahlman, L., Waagstein, L., Haljamae, H. and Ricksten, S.E. (1995), Protective Effects of Halothane But Not Isoflurane Against Global Ischemic-Injury in the Isolated Working Rat-Heart. Acta Anaesthesiologica Scandinavica, 39 (3), 312-316.

Abstract: The effects of equi-anaesthetic concentrations of halothane (HAL) and isoflurane (ISO) on myocardial performance, perfusion, oxygenation and lactate release were studied before, during and after a low-flow, global ischaemic insult in isolated, paced rat left heart preparations. An antegrade perfusion technique was used, where left atrial pressure (LAP) and mean aortic pressure (MAP) could be altered independently of each other. Aortic flow, coronary flow (CF) and PO2 in venous coronary effluent were continuously recorded and stroke volume, myocardial oxygen consumption (MVO(2)) and myocardial oxygen extraction as well as lactate release were calculated. The hearts were exposed for at least ten minutes to the perfusate without (control, n=10) or with HAL (n=10) or ISO (n=10) at a MAP of 80 mmHg (10.4 kPa) and a LAP of 7.5 mmHg (1.0 kPa). After baseline measurements, MAP was reduced to 25 mmHg (3,2 kPa) for a total of nine minutes. Thereafter MAP was increased to 80 mmHg (10.4 kPa) for another nine minute period. During the whole experimental procedure, LAP was maintained at 7.5 mmHg (1.0 kPa) and heart rate at 325 beats per minute. In the pre-ischaemic control period, MVO(2) was lower with HAL, compared to ISO (P<0.05) and control (P<0.05). Stroke volume was also lower with HAL compared to control (P<0.05). During hypoperfusion, lactate release was twice as high in the control group (P<0.01) and with ISO (P<0.01) compared to HAL. This was accompanied by a lower oxygen extraction with HAL compared to control (P<0.05) and ISO (P<0.05). Tn the post-ischaemic periods, MVO(2) and stroke volume were lower with HAL compared to ISO and control. There were no significant differences in CF between the groups. We conclude that HAL, but not ISO, exerts a direct protective effect against a glycotic anaerobic metabolism during low-flow global myocardial ischaemia

Keywords: ANESTHESIA/ANESTHETICS/aortic pressure/BLOOD FLOW MYOCARDIAL/CONTRACTILE FUNCTION/control/COPENHAGEN/coronary/CORONARY-ARTERY DISEASE/DENMARK/DOGS/effect/effects/ENFLURANE/experimental/flow/GOTHENBURG/HALOTHANE/HEART/heart rate/hypoperfusion/INTRAOPERATIVE HYPERTENSION/ischaemia/ISCHEMIA/ISOFLURANE/ISOLATED/lactate/MAP/METABOLISM/MVO(2)/MYOCARDIAL BLOOD-FLOW/myocardial oxygen consumption/oxygen/OXYGEN CONSUMPTION/oxygenation/PERFORMANCE/perfusion/PO2/pressure/rat/rate/REPERFUSION/stroke/stroke volume/total/VOLATILE/volume

Sellgren, J., Ejnell, H., Ponten, J. and Sonander, H.G. (1995), Anesthetic Modulation of the Cardiovascular-Response to Microlaryngoscopy - A Comparison of Propofol and Methohexital with Special Reference to Leg Blood-Flow, Catecholamines and Recovery. Acta Anaesthesiologica Scandinavica, 39 (3), 381-389.

Abstract: The modulating effects of propofol versus methohexital on the cardiovascular response to microlaryngoscopy were studied in 35 patients divided into four equal groups (one patient participated twice). Heart rate (HR) mean arterial blood pressure (MAP), cardiac output (CO; impedance cardiography), leg blood flow (LBF; occlusion plethysmography) and concentrations of arterial catecholamines were measured. After administration of atropine and fentanyl (2 mu g . kg(-1)), anesthesia was induced by either an injection of propofol (2.0 mg . kg(-1)) followed by a low (6 mg . kg(-1). h(-1); n=9) or a high (12 mg . kg(-1). h(-1); n=9) dose propofol infusion or an injection of methohexital (1.5 mg . kg(-1)) followed by a low (5 mg . kg(-1). h(-1); n=9) or a high (10 mg . kg(-1). h(-1); n=9) dose methohexital infusion. The low methohexital infusion dose was insufficient to control MAP, which increased 41% during microlaryngoscopy compared to the awake state. The HR increased in all groups but the increase was most prominent in the low dose methohexital group. There were no statistically significant changes in CO in any group, whereas LBF increased consistently in all groups except in patients anesthetized with the low dose of methohexital. The increases of LBF in the propofol groups were intermediate and not dose dependent. The methohexital low dose group showed increases in norepinephrine levels compared to awake values and in epinephrine levels compared to the other groups. Propofol seems to differ from methohexital in modulation of peripheral vascular tone. The insufficient control of the cardiovascular response to microlaryngoscopy by the low methohexital dose in addition to longer recovery after the high methohexital dose favors the use of propofol

Keywords: ANESTHETICS/anesthetized/arterial blood pressure/blood/blood flow/blood pressure/cardiac/CARDIAC OUTPUT/cardiovascular/catecholamines/CATHECHOLAMINES/CO/control/COPENHAGEN/DENMARK/DOPAMINE/effects/EPINEPHRINE/flow/GENERAL-ANESTHESIA/GOTHENBURG/HUMANS/IMPEDANCE CARDIOGRAPHY/INDUCTION/INFUSIONS/INTRAVENOUS/LEG BLOOD FLOW/MAP/mean arterial/METHOHEXITAL/MICROLARYNGOSCOPY/NERVE SYMPATHETIC ACTIVITY/NITROUS-OXIDE ANESTHESIA/NOREPINEPHRINE/occlusion/PERFORMANCE LIQUID-CHROMATOGRAPHY/peripheral/PLETHYSMOGRAPHY/pressure/PROPOFOL/rate/recovery/response/STROKE VOLUME/SURGERY/THIOPENTONE/TOTAL INTRAVENOUS ANESTHESIA/vascular

Hirvonen, E.A., Nuutinen, L.S. and Kauko, M. (1995), Hemodynamic-Changes Due to Trendelenburg Positioning and Pneumoperitoneum During Laparoscopic Hysterectomy. Acta Anaesthesiologica Scandinavica, 39 (7), 949-955.

Abstract: More prolonged gynecological laparoscopic operations are being performed in recent years, and a steeper head-down position is required. The early reports of hemodynamic changes during gynecologic laparoscopy are conflicting, and the effects of anesthesia, head-down tilt and pneumoperitoneum have nor been clearly separated. Invasive hemodynamic monitoring was carried out in 20 female ASA Class I-II patients who underwent laparoscopic hysterectomy. Baseline measurements were made in the supine, supine-lithotomy and Trendelenburg (25-30 degrees) positions in awake patients. Measurements were repeated in the supine-litholomy and Trendelenburg positions after induction of anesthesia, during laparoscopy 5 minutes after the beginning of peritoneal CO2-insufflation (intra-abdominal pressure 13-16 mmHg) and at 15-minute intervals thereafter, after laparoscopy In the Trendelenburg and supine positions, after extubation and in the recovery room at 30-minute intervals. Patients received balanced general anesthesia with isoflurane in 35% O-2 in an oxygen/air mixture. End tidal PCO2 was maintained between 4.5- 4.8 kPa (33-36 mmHg) by changing the minute volume of controlled ventilation. The Trendelenburg position in awake and anesthetized patients increased pulmonary arterial pressures (PAP), central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP). These pressures increased further at the start of CO2-insufflation, decreased towards the end of the laparoscopy and reached pre-insufflation levels after deflation of pneumoperitoneum. The mean arterial pressure (MAP) increased at the beginning of laparoscopy in comparison with the pre- laparoscopic values. Heart rate (HR) was quite stable during laparoscopy. The cardiac index (CI) decreased with anesthesia from 3.8 to 3.21 . min(-1). m(-2) and further during laparoscopy to 2.71 . min(-1). m(-2), returning to pre- insuffiation values soon after deflation. The stroke index (SI) changed in concert with the CI changes. The right Ventricular stroke work index decreased during laparoscopy more than the left ventricular stroke work index. The right atrial pressure (CW) exceeded the PCWP more often during laparoscopy than during any other phase of the procedure. Anesthesia and the Trendelenburg position increased the CVP, PCWP and pulmonary arterial pressures and decreased cardiac output. Pneumoperitoneum increased these pressures further mostly in the beginning of the laparoscopy, and cardiac output decreased towards the end of the laparoscopy. The risk of systemic CO2- embolus was increased during laparoscopy

Keywords: ANESTHESIA/anesthetized/BLOOD-VOLUME DISTRIBUTION/CARBON-DIOXIDE EMBOLISM/cardiac/cardiac index/cardiac output/CARDIAC-OUTPUT/CO2/COPENHAGEN/DENMARK/effects/embolus/hemodynamic/HEMODYNAMICS/HYSTERECTOMY/INTRA- ABDOMINAL PRESSURE/LAPAROSCOPY/left ventricular stroke work/monitoring/PERICARDIAL PRESSURE/PNEUMOPERITONEUM/POSTURE/pressure/pulmonary/rate/recovery/RIGHT ATRIAL PRESSURE/risk/stroke/SURGERY/TRENDELENBURG/ventilation/volume

Frost, L., Jacobsen, C.J., Christiansen, E.H., Molgaard, H., Pilegaard, H., Hjortholm, K. and Thomsen, P.E.B. (1995), Hemodynamic Predictors of Atrial-Fibrillation Or Flutter After Coronary-Artery Bypass-Grafting. Acta Anaesthesiologica Scandinavica, 39 (5), 690-697.

Abstract: The cumulated incidence of atrial fibrillation or flutter after coronary artery bypass grafting is 30%. The causes of these arrhythmias have not yet been sufficiently identified. We therefore undertook the present study to analyze che possible association of hemodynamic function during the various phases of coronary artery bypass grafting and the later development of atrial fibrillation/flutter. Hemodynamic function was measured with a pulmonary artery catheter in 120 consecutive patients undergoing elective coronary artery bypass surgery. Thirty-five (29%) of the patients developed atrial fibrillation/flutter. Logistic regression analysis identified independent predictors of atrial fibrillation/flutter: After induction of general anesthesia, the relative risk (95% confidence interval) of older age was 1.09/year (1.03-1.16), and the reduction in relative risk by an increase in left ventricular stroke work was 0.96/gm (0.93-0.99). After weaning from the extracorporeal circulation the independent significant predictors were age, relative risk 1.07/year (1.01-1.13), and increased central Venous pressure, relative risk 1.12/mm Hg (1.00-1.26). At the time of admission to the intensive care unit, the relative risk of age was 1.10/year (1.03-1.18), and the relative risk of an increased central venous pressure was 1.26/mm Hg (1.06-1.49). However, the best prediction model (prediction after induction of general anesthesia) only provided a median predicted probability of atrial fibrillation/flutter of 0.37 for the patients who had atrial fibrillation/flutter, and a median predicted probability of atrial fibrillation/flutter of 0.20 for the patients without these arrhythmias. We identified possible hemodynamic predictors of atrial fibrillation/flutter after coronary bypass surgery, but the use of a risk stratification for development of atrial fibrillation/flutter based on hemodynamic function cannot be recommended

Keywords: age/analysis/ARRHYTHMIAS/ATRIAL FIBRILLATION/ATRIAL FLUTTER/bypass/bypass grafting/circulation/COPENHAGEN/coronary/coronary artery bypass/coronary artery bypass grafting/CORONARY ARTERY BYPASS SURGERY/DENMARK/development/EPIDEMIOLOGY/fibrillation/function/HEART SURGERY/hemodynamic/HEMODYNAMICS/model/predictors/pressure/pulmonary/PULMONARY ARTERY CATHETER/relative risk/risk/RISK-FACTORS/stroke/SUPRAVENTRICULAR TACHYCARDIA/SURGERY

Raner, C., Biber, B., Henriksson, B.A., Lundberg, J., Martner, J. and Winso, O. (1995), Are the Cardiovascular Actions of Dopamine Altered by Isoflurane. Acta Anaesthesiologica Scandinavica,
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