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Query: UMLS:C0011570 (depression)
 172,036 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Endocardial splitting and left atrial rupture were diagnosed in a dog with mitral regurgitation that experienced the sudden onset of collapsing episodes, weakness, depression, labored breathing, and weak pulses. Thoracic radiographs showed a rounded cardiac silhouette with prominent left atrium consistent with hemopericardium due to left atrial rupture. Two-dimensional echocardiography confirmed the presence of severe mitral valve disease, pericardial fluid, and a laminated blood clot caudal to the left ventricle. A sterile emergency thoracotomy was performed, the hemopericardium and blood clot were removed, and the rupture site in the left atrium was repaired with reinforced sutures. The dog recovered from surgery but died the next day, presumably from a ventricular arrhythmia.
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PMID:Echocardiography and surgery in a dog with left atrial rupture and hemopericardium. 240 68

Thoracic epidural fentanyl has been used successfully for postoperative analgesia in patients undergoing thoracic surgery. Prior investigators have suggested that increasing the administered dosage and volume of lumbar epidural fentanyl may increase the spread of analgesia. The feasibility of injecting a high volume (20 mL) of fentanyl into the lumbar epidural space for post-thoracic surgery analgesia was studied in 17 patients undergoing elective thoracotomy or sternotomy. All patients had a lumbar epidural catheter placed before induction of general anesthesia. No narcotic was administered during surgery. Thirty minutes before the conclusion of anesthesia, 200 micrograms of fentanyl in 16 mL of 0.9% saline was administered via the epidural route. In the intensive care unit (ICU), additional fentanyl in the same dosage and volume was injected when the patient complained of pain. Pain was scored on a linear analog scale pre-injection and 30 minutes post-injection. Arterial blood gases were obtained simultaneously. All patients experienced pain relief within 15 minutes of injection. No significant respiratory depression or hypercarbia was noted. Lumbar epidural fentanyl is a safe and practical alternative to thoracic epidural analgesia in the post-thoracic surgical patient.
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PMID:Lumbar epidural fentanyl analgesia after thoracic surgery. 251 38

The authors studied 8 patients (4 males and 4 females) with Cushing's syndrome due to ectopic ACTH secretion. Chronological age ranged from 15 to 45 years and duration of the disease ranged from 3 to 48 months. All patients presented typical signs of Cushing's syndrome, blood hypertension, and four of them had hyperpigmentation of the skin. Five patients had fasting hyperglycemia and all patients but one had serum hypokalemia (serum K = 2.2 to 3.9mEq/l). The circadian rhythm of cortisol was absent in all patients and basal cortisol levels were elevated in all patients but one. Basal ACTH levels evaluated in 7 patients were elevated in 6 (29 to 1050 pg/ml-MRC). One patient presented normal depression of urinary 17-OH after two days of dexamethasone and normal increase of urinary 17-OH and serum 11-dexycortisol after methyrapone. Four patients had carcinoid tumor (3 thymic and 1 bronchial), two had pancreatic islets cell tumors, one had bilateral pheochromocytoma and medular carcinoma of the thyroid, and one had oat cell carcinoma of the lung and medular carcinoma of the thyroid. Thoracic X-rays identified the ectopic ACTH secretion tumor in four cases, all confirmed by CT scan. Abdominal CT showed a difuse enlargement of the adrenals in seven cases and bilateral nodules in one case (pheochromocytomas). Six patients died within 3 years of the diagnosis. The authors concluded that clinical and hormonal findings could mislead the findings of ACTH ectopic secretion and Cushing's disease, and suggest that thoracic X-rays and CT scans of the skull, thorax, and abdome should be done in all cases of Cushing's syndrome.
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PMID:[Cushing syndrome due to ectopic ACTH secretion]. 255 51

The American Thoracic Society respiratory symptom questionnaire (ATS-Q) is widely used and has provided valuable information in epidemiologic studies. To determine the influence of psychological status on respiratory symptoms, we compared subjects' ATS-Q responses to their Ilfeld Psychiatric Symptom Index (PSI) scores. To minimize the potential confounding effect of respiratory disease on the association between respiratory and psychological status, from a population-based survey of 3,628 subjects, we studied only the 600 "healthy" subjects, defined by the following characteristics: between 14 and 55 yr of age; never-smokers; no diagnoses of respiratory, heart, kidney, thyroid disease, or anemia; and normal spirometry (defined as an FEV1 and FVC greater than 80% of predicted). Associations were found between respiratory symptoms (cough, phlegm, wheeze, dyspnea) and PSI subscales (anxiety, anger, depression, and cognitive disturbance). Adjusted odds ratios for respiratory symptoms ranged from 1.13 to 2.15 for every 10% increase in PSI score. Psychological status is an important determinant of respiratory symptoms and therefore must be taken into consideration when interpreting results of epidemiologic studies using questionnaire information.
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PMID:The influence of psychological status on respiratory symptom reporting. 272 53

Autonomic dysfunction was diagnosed in a 2.5-year-old spayed domestic shorthair cat. The cat had an 8-day history of progressive anorexia, signs of depression, constipation, weight loss, and intermittent regurgitation. Physical examination findings were signs of depression, dehydration, cachexia, bradycardia, bilateral nonresponsive mydriasis, prolapse of both nictitating membranes, dry oral and nasal mucous membranes, and urinary bladder atony. Thoracic radiography revealed megaesophagus. The cat lacked esophageal motility and had a decreased gastric emptying rate. Providing adequate fluid intake, electrolyte balance, and nutrition is a major problem in the management of dysautonomic cats. We were able to provide adequate nutritional support for this patient, using total parenteral feeding and, later, enteral nutrition using a nasogastric tube. Results of an ocular pharmacologic study indicated that the mydriasis and prolapse of the nictitating membrane were attributable to complete autonomic denervation of the eye. Using the method described, topical, autonomic-stimulating agents may assist the clinician in diagnosing dysautonomia in the feline. This report describes a syndrome that is well recognized in the United Kingdom and has the potential to develop in the United States.
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PMID:Dysautonomia in a cat. 339 54

The conventional agents (azathioprine and steroids) have been the mainstay or organ allograft immunosuppression for the past 20 years. The main drawback of the immunosuppressive agents at present in use is that they act nonspecifically with sequential general depression of the immune system. The introduction of cyclosporin, an undecapeptide of fungal origin, which selectively inhibits T-cell-dependent immuno-reaction has made a significant impact on organ allograft survival rates. Clinical application has been complicated because of renal or hepatotoxicity. Thoracic duct drainage is of historical interest but the use of antilymphocyte serum, despite its chequered history, has recently been shown to be safe and effective in cadaver kidney transplant recipients. There has also been a resurgence of interest in the use of total lymphoid irradiation as an immunosuppressive agent. The introduction of xenogenic monoclonal antibodies with anti-T-cell specificity opened a new era in clinical immunology and OKT3-PAN has emerged as a powerful major immunosuppressive agent with low toxicity.
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PMID:The application, mechanism of action and side-effects of immunosuppressive agents in clinical transplantation. 353 49

This study was performed on chloralosed rats in order to examine the influence of a minor blood loss on duodenal HCO3- secretion. The HCO3- output was measured by in situ titration in a duodenal segment. Blood loss of 0.3 ml per 100 g body wt (approximately 5% of total blood volume) and 0.6 ml per 100 g body wt (approximately 10% of total body volume) reduced duodenal HCO3- secretion by about 18 and 31%, respectively. Adrenal ligation increased basal output of HCO3- but did not affect the bleeding-induced response. Thoracic epidural anaesthesia or splanchnicotomy did not affect the basal secretion but markedly reduced the depression of duodenal HCO3- secretion due to blood loss. Vagotomy lowered basal duodenal HCO3- secretion and blood loss did not reduce alkaline output in these animals. However, electric stimulation of the cut vagal nerves raised the duodenal HCO3- secretion to a similar level as in rats with intact vagal nerves. In this group blood loss reduced the duodenal HCO3- output as in rats with intact nerves. It is suggested that a small blood loss, via an activation of the sympathetic nervous system, reduces the vagally controlled part of the duodenal HCO3- secretion and that this effect is conveyed in the splanchnic nerves.
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PMID:Bleeding inhibits vagally induced duodenal HCO3- secretion via activation of the splanchnic nerves in anaesthetized rats. 360 15

A 15-year review of children's hospital patients with cystic fibrosis (CF) who underwent surgery yielded 578 cases in 210 patients (mean 2.7 per patient). The median age was 16 years (range newborn to 43 years). Four hundred procedures were done under general anesthesia and 176 under local. There was one anesthetic complication, respiratory depression in a patient whose MediPort (Cormed, Inc, Medina, NY) was inserted using local anesthesia and sedation. The most frequent procedure was nasal polypectomy, with 165 procedures in 50 patients. The second most common procedures were vascular access procedures: 75 central lines and 29 MediPorts were implanted in 57 patients, complicated by two pneumothoraces. Thoracic procedures included 32 bronchoscopies, 8 lobectomies, 2 pneumonectomies, and 30 pleural strippings. There were three reoperations for bleeding in the pulmonary resection patients. Thirteen newborns underwent a total of 26 procedures for meconium ileus and its complications, with two deaths secondary to respiratory failure and sepsis. These, and one death postlobectomy were the only operative deaths in the entire series of 578 cases (0.5% mortality rate). There were four slings for rectal prolapse; two required removal secondary to infection. Eight patients underwent central splenorenal shunts for portal hypertension, 15 underwent cholecystectomy, 5 underwent Nissen fundoplication, 16 underwent inguinal herniorrhaphy, 2 underwent umbilical herniorrhaphy, 3 underwent orchidopexies, and 4 underwent miscellaneous pediatric surgical procedures. Eleven patients underwent appendectomy for appendicitis; four were ruptured at the time of diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgery in patients with cystic fibrosis. 361 55

A 12-year-old Thoroughbred mare, with a history of anorexia, dramatic weight loss, fluctuating pyrexia and intermittent diarrhoea after an episode of colic, was presented for examination with depression, emaciation and ataxia. Thoracic and abdominal paracenteses yielded copious quantities of inflammatory exudate. Palpation per rectum revealed an enlarged spleen. The primary alterations in haematology included a severe leucocytosis with a left shift, and a hyperproteinaemia characterised by hypoalbuminaemia and hypergammaglobulinaemia. Post-mortem examination revealed a low grade pleurisy and peritonitis with fluid accumulation in both cavities. A suppurative gastritis with full thickness perforations of the stomach wall associated with Gasterophilus intestinalis larvae had extended to the juxtaposed organ initiating an extensive suppurative splenitis. Streptococcus zooepidemicus was cultured.
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PMID:Suppurative splenitis and peritonitis in a horse after gastric ulceration caused by larvae of Gasterophilus intestinalis. 363 94

Thoracic gas volume (TGV) cannot be measured in the body plethysmograph by the standard spontaneous breathing technique (SB) when there is a significant respiratory center depression. In this case, either external compression of the chest wall (EC) or phrenic nerve stimulation (PhN) can be used to induce the pressure-volume changes necessary to calculate TGV. In the present study we compared TGV measured in eight pentobarbital-anesthetized dogs by SB, EC, PhN, and the standard He-dilution method. EC and simulated PhN were also used to measure the volume of a lung model, and EC was used to measure the volume of isolated lung lobes. A method for fast and accurate plethysmographic calibration is also described. In the intact dogs, SB, PhN, and He-dilution techniques gave similar results, but EC overestimated TGV. In the isolated lobes and lung model EC accurately measured volume. We speculate that EC induces substantial intersegmental and/or interlobal gas movement in intact lungs and that the pressure drop due to airway resistance causes proximal airway pressure to underestimate alveolar pressure changes, which induces overestimation in calculated TGV. We conclude that PhN is the method of choice to measure plethysmographic TGV when the respiratory center is depressed and that EC overestimates TGV in intact dogs.
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PMID:Comparison of plethysmographic methods for obtaining thoracic gas volume in anesthetized dogs. 403 Jun 19


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