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

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 rumination syndrome is defined as a process in which a person chews regurgitated gastric contents and then either partially ejects or swallows them. We report 12 cases of rumination in which the clinical diagnosis was supported by esophageal and gastrointestinal motility studies. These patients showed a characteristic pressure spike-wave pattern that was associated with regurgitation and was recorded simultaneously at all manometric sites. These spike waves increased significantly in frequency (p less than 0.001) and amplitude (p less than 0.04) during the postprandial period. The underlying gastrointestinal motility was normal except for a small decrease in postprandial antral motility index, with mean (+/- SE) values of 13.2 +/- 0.3 for patients compared with 14.2 +/- 0.3 for eight healthy adult controls (p less than 0.03). Nine patients had significant personality disturbances, including six whose scores on the Minnesota Multiphasic Personality Inventory for hypochondriasis and depression were significantly above the reference population (p less than 0.02). The rumination syndrome should be considered in adult patients with long-standing postprandial vomiting. The manometric pattern is characteristic.
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PMID:The rumination syndrome in adults. A characteristic manometric pattern. 375 57

Protecting the patient's airway is of paramount importance in the induction of general anesthesia. For the patient at risk of regurgitation of stomach contents, the rapid-sequence (crash) induction provides protection, but at the expense of increased stress response to laryngoscopy and intubation. This stress response is especially dangerous for the patient at risk for myocardial ischemia. The purpose of this study was to examine the efficacy of using low-dose fentanyl (5 micrograms/kg) to reduce cardiovascular and neuroendocrine stress responses to rapid-sequence induction. Thirty patients were randomly assigned to a rapid-sequence induction protocol either with or without fentanyl preloading. Fentanyl-preloaded patients (fentanyl group) received 2 mg/kg of thiopental whereas patients who were not preloaded with fentanyl (control group) received 4 mg/kg of thiopental. Data collected as indices of the stress response included heart rate, systolic, diastolic, and mean blood pressures, and plasma concentrations of catecholamines (epinephrine, norepinephrine, dopamine) and beta-endorphin. Electrocardiograms (modified V5 lead) were monitored for dysrhythmias and ST segment depression. Control patients had higher systolic, diastolic, and mean blood pressures after intubation than did patients given fentanyl (P less than 0.05). Although the incidence of dysrhythmias was decreased by fentanyl (20% vs 42%), this difference was not statistically significant. Plasma concentrations of beta-endorphin and norepinephrine increased significantly in control patients but not in patients given fentanyl (P less than 0.05). Low-dose fentanyl (5 micrograms/kg) reduces some aspects of the stress response to rapid-sequence induction of anesthesia.
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PMID:Fentanyl preloading for rapid-sequence induction of anesthesia. 631 5

It is not known if the favorable changes in preload and afterload that augment ejection performance in acute experimental aortic and mitral regurgitation are also present in patients with chronic regurgitation. Additionally, observations that patients with mitral versus aortic regurgitation respond differently to valve replacement suggest that differences exist preoperatively between these two types of volume overload. Therefore, ventricular mechanics were compared in nine patients with severe aortic regurgitation, eight patients with severe mitral regurgitation and seven normal subjects. The amount of volume overload was similar in both groups with regurgitation. In both aortic and mitral regurgitation, ejection performance was reduced compared with findings in normal subjects. Preload estimated as enddiastolic stress was comparably elevated above normal in both groups with regurgitation: 69 +/- 24 dynes X 10(3)/cm2 in mitral regurgitation compared with 81 +/- 34 dynes X 10(3)/cm2 in aortic regurgitation and 36 +/- 11 dynes X 10(3)/cm2 in normal subjects. However, afterload estimated as mean systolic stress was normal in mitral regurgitation (186 +/- 34 dynes X 10(3)/cm2) but markedly elevated in aortic regurgitation (260 +/- 41 dynes X 10(3)/cm2) (p less than 0.01). Contractile depression tended to be more severe in mitral regurgitation despite similar ejection performance in mitral and aortic regurgitation. Thus, in mitral regurgitation favorable loading conditions may mask contractile dysfunction, and in aortic regurgitation excessive afterload contributes to poor pump performance, possibly accounting for previously observed differences in the response to valve replacement.
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PMID:Differences in myocardial performance and load between patients with similar amounts of chronic aortic versus chronic mitral regurgitation. 670 57

The technical problems and morbi-mortality related with operations in two stages repair of tetralogy of Fallot (T.F) had lead several groups to correct it in early stages. We present 19 infants with T.F operated between July of 1988 and August 1992, 11 males and 8 females whose ages ranged from eleven months to eleven years. Without previous surgery, the preoperative catheterization show 71.4 mm Hg of trans-infundibular gradient. The obstruction was relieved through right atriotomy in combination with one pulmonary arteriotomy from above. The ventricular septal defect was closed. One patient with severe pulmonary hypertension died. The rest show gradient less than 21 mm Hg, and NYHA I-II without medicine (23.1 months of follow up). The echocardiography shows that pulmonary regurgitation was present in 54.9% but only 3 cases was it graded as moderated and none was it severe. Transatrial transpulmonary repairs avoids the depression of ventricular performance caused by transannular corrections with ventriculotomy. Preserves muscular contractions and thus reduces the propensity to right ventricular failure. It can be performed to many patients included anomalous origin of the left anterior descending coronary artery.
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PMID:[The transatrial-transpulmonary correction of tetralogy of Fallot]. 821 3

This retrospective study analyzed the cases of difficult intubations carried out with a fiberoptic bronchoscope between March 1984 and May 1989. During this period, 222 such procedures were attempted in 131 male and 68 female patients. All cases were diagnosed at the preoperative visit. A fiberoptic bronchoscope was used as a guide under topical nasal and laryngeal anaesthesia, together with appropriate benzodiazanalgesia, in order to maintain spontaneous breathing. The nasotracheal route was used in 218 cases. Successful intubation was achieved in 219 cases (98.6%), 209 of them (95.4%) within fifteen minutes. Of the three failures, only one was unpredictable (inability to withdraw the fiberoptic bronchoscope from the endotracheal tube). In the two others, the technique was subsequently found to have been wrongly indicated: major nasopharyngeal secretions occluded the fiberoptic device in the first one, and an anatomically compromised airway led to apnoea under sedation in the other. A narrow nasotracheal passage, spreading oedema, bloody secretions or coughing gave rise to technical difficulties in 39 cases (17.5%). There was one case of regurgitation without any drawback. Benzodiazanalgesia was responsible for two cases of respiratory depression. This technique was otherwise very satisfactory, patients being cooperative and frequently having amnesia of intubation. The indications for the use of a fiberoptic bronchoscope were: insufficient oral opening, orofacial obstacles to laryngoscopy, and cases where laryngoscopy had to be avoided. The main drawbacks of this technique were the cost and fragility of fiberoptic device as well as operator efficiency. The anaesthesiologists involved in the present series performed ten easy intubations each with the fiberoptic bronchoscope, and routinely used the teaching eye-piece.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Use of fiberoptic bronchoscope for difficult intubation in maxillofacial surgery]. 825 Mar 66

Congestive heart failure is a widely prevalent sequel to myocardial infarction and other chronic conditions (including ischaemia without infarction, hypertension, various infections, toxic metabolic and endocrine disorders). Exercise tolerance is severely limited; the cardiac ejection fraction is often less than 20% and the peak oxygen intake may be less than 10 ml/kg x min, with a resulting deterioration in the quality of life. Possible factors contributing to the poor tolerance of exercise include: (i) disturbances of myocardial function (damage to the ventricular wall; decreased inotropic response, mitral valve regurgitation and increased diastolic pressures); (ii) peripheral vascular factors (decreased metaboreceptor discharge, reduced vasodilator response, increased activity of sympathetic afferents and less efficient distribution of cardiac output); (iii) hormonal disturbances (increases of catecholamines, renin/angiotensin/aldosterone, antidiuretic and natriuretic factors, endothelin and decreased endothelium-relaxing factor); (iv) impaired muscle function (loss of lean tissue, increase of type II fibres, increased impedance to perfusion, enzyme changes); (v) ventilatory disturbances (increased oxygen cost of activity, pulmonary congestion, increased ventilatory drive, mismatching of ventilation and perfusion, increased anaerobic effort); and (vi) psychological factors (anxiety, depression and iatrogenic limitation of effort). The prognosis with conventional treatment is poor, but patients with stable congestive heart failure respond favourably to a progressive exercise programme. Reported gains depend on the cause of congestive failure, initial status, study duration and compliance, and the type of training programme. Most studies to date have been short term (4 to 16 weeks), and relatively few have adopted a randomised controlled design. Suggested bases for the enhancement of aerobic performance of up to 20% include an increased intensity of peak effort, an enhanced matching of ventilation to perfusion, improved cardiac function, a strengthening of skeletal muscle and an increase of aerobic enzyme activity in the muscles. A few studies have continued for a year or longer and it appears that the gains realised over the first 16 weeks of training can be sustained for this period; the quality of life is enhanced, but data are as yet insufficient to judge effects upon mortality rates. Useful clinical information can be obtained from a 6-minute walk, but the choice for more precise evaluation lies between a measurement of ventilatory threshold or peak oxygen intake. Given initial muscle wasting, prescribed exercise should include both aerobic activity and resisted muscle exercises.
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PMID:Exercise for patients with congestive heart failure. 906 93

We investigated the hemodynamic effect of regurgitation (or back-flow) due to sudden failure of a rotary blood pump (diagonal pump). Seven healthy sheep (Group C) and 7 with chronic heart failure (Group F) were studied. Chronic heart failure was obtained by intracoronary injection of microspheres several weeks earlier. Left ventricular function and ventricular efficacy were assessed by the pressure-volume relationship. The back-flow through the stopped pump was significantly lower in Group F (2.3 +/- 0.34 L/min) than in Group C (2.8 +/- 0.33 L/min). Mean aortic blood pressure dropped significantly from 68.3 +/- 9.65 to 61.9 +/- 9.75 mm Hg in Group C and from 62.5 +/- 9.12 to 51.5 +/- 9.08 in Group F but remained stable during the 15 min period of pump stop. Parameters of left ventricular contractility (preload recruitable stroke work) dropped significantly in both groups, remained stable during the pump stop, and returned to baseline values 30 min after the end of back-flow. The ventricular efficacy (in terms of energy transfer) was tolerant against this acute volume overload even in the failing hearts. Sudden pump failure of a rotary blood pump leads to an acute depression of the hemodynamic state and myocardial contractility. However, this depression remained stable over 15 min, did not lead to further deterioration of the animals, and was completely reversible.
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PMID:The effect of sudden failure of a rotary blood pump on left ventricular performance in normal and failing hearts. 1111 78

Gastroesophageal reflux disease (GERD) is defined as symptoms or tissue damage that results from the abnormal reflux of gastric contents into the esophagus. A systematic review of population-based studies estimates that heartburn or regurgitation symptoms occur in 21% to 59% of the population during a given year. The frequency of GERD in specific populations is provided in Table 1. Although only 1 in 5 patients with upper intestinal symptoms that occur at least weekly seeks medical attention, nearly 1% of all visits to a family physician's office are for GERD or related conditions. GERD significantly affects the quality of patients' lives. In a survey of patients presenting for upper endoscopy with symptoms of at least 3 months' duration, those with a diagnosis of GERD reported low scores at baseline for general well-being. Fortunately, follow-up data reported 4 weeks after treatment note improvement in gastrointestinal symptoms, general well-being, general health, vitality, and depression.
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PMID:The evaluation and treatment of adults with gastroesophageal reflux disease. 1119 82

Although aspiration is a relatively rare event during anaesthesia, it represent an important cause of anaesthesia related mortality and also of ventilator associated pneumonia in intensive care unit. The incidence of aspiration is markedly increased after trauma owing to the risk of recent ingestion of food, depression of consciousness and airways reflexes, and gastric stasis induced by raised sympathoadrenal tone. The factors which contribute to the likelihood of aspiration include the urgency of surgery, airways problems, inadequate depth of anaesthetic, use of the lithotomy position, gastrointestinal problems, depressed consciousness, increased severity of illness and obesity. Factors that predispose to aspiration pneumonia are: a gastric content with a pH less than 2.5 and a gastric volume of 0.4 ml kg-1; a reduction in lower oesophageal sphincter tone; a reduction of upper oesophageal sphincter tone and a not coordination between the pharyngeal muscle and the upper oesophageal sphincter tone during swallowing; and a depression of protective airway reflexes. Methods to minimize regurgitation and aspiration involve control of gastric contents (preoperative starvation is the method universal accepted), application of cricoid pressure and control of the airways.
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PMID:Gastric reflux and pulmonary aspiration in anaesthesia. 1276 74


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