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Query: UMLS:C0036572 (seizures)
 80,221 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Preliminary reports have suggested that chronic, intermittent stimulation of the vagus nerve (VNS) is an alternative treatment for patients with medically refractory seizures. We performed a multicenter, randomized, controlled trial to evaluate the efficacy and safety of adjunctive VNS in patients with poorly controlled partial seizures. An implanted, programmable pacemaker-like device was connected to two stimulating electrodes wrapped around the left vagus nerve. One hundred fourteen patients were randomized to receive 14 weeks of high-level stimulation (presumed therapeutic dose) or low-level stimulation (presumed subtherapeutic dose) using a blinded, parallel study design. Seizure frequency was compared with a 12-week baseline. Mean reduction in seizure frequency was 24.5% for the "high" stimulation group versus 6.1% for the "low" stimulation group (p = 0.01). Thirty-one percent of patients receiving high stimulation had a seizure frequency reduction of > or = 50%, versus 13% of patients in the low group (p = 0.02). Treatment emergent side effects were largely limited to a transient hoarseness occurring during the stimulation train. One patient with no previous history of cardiac disease experienced a myocardial infarction during the third month of vagal stimulation. VNS may be an effective alternative treatment for patients who have failed antiepileptic drug therapy and are not optimal candidates for epilepsy surgery.
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PMID:A randomized controlled trial of chronic vagus nerve stimulation for treatment of medically intractable seizures. The Vagus Nerve Stimulation Study Group. 785 16

Patients requiring creation of an arteriovenous (AV) fistula for long-term dialysis access have a high incidence of cardiovascular risk factors, as well as immunosuppression, neuropathy, and platelet dysfunction related to renal failure. However, the morbidity and mortality of AV fistula creation, and the effect of anesthetic technique on outcome, have not been reported. We therefore retrospectively studied all patients (n = 469) having an AV fistula placed at the Mayo Clinic between 1986 and 1991. Preoperative variables studied were age (mean 63 +/- 14 yr), sex (60% male), diabetes mellitus (26% incidence), hypertension (92%), the presence of a previous AV fistula (31%), coronary artery disease (86%), and previous myocardial infarction (MI) (42%). Outcome variables studied were fistula failure prior to first attempted dialysis (8.7% incidence), infection (3.4%), neuropathy (1.9%), seizure (0.2%), nonfatal cardiac event (MI or arrest) (1.5%), and fatal cardiac event (2.1%). Associations of preoperative factors, outcomes, and anesthetic technique were analyzed by analysis of variance and Wilcoxon rank sum analysis for age, and by exact conditional frequency table analysis for all other factors. A previous AV fistula was associated with infection (P < 0.002) and nonfatal cardiac events (P < 0.003). Increased age (P < 0.025) and previous MI (P < 0.01) were associated with adverse cardiac outcomes. Neither local anesthesia, brachial plexus block, nor general anesthesia were significantly associated with an increased frequency of any adverse outcome. The comparison of general with local and brachial plexus anesthetics was limited by low statistical power.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Risk factors in patients having surgery to create an arteriovenous fistula. 794 77

A retrospective investigation was performed to determine whether patients undergoing transurethral surgery soon after cardiac surgery experienced increased morbidity or mortality rates. From 1986 to 1990, 24 patients first underwent open heart surgery and then either transurethral prostatectomy, bladder tumor resection or bladder cup biopsy during the same hospital stay. Postoperative complications included significant hematuria in 2 patients (8%), mild stress incontinence in 1 (4%) and bladder perforation in 1. One patient died of a spontaneous pneumothorax 17 days after the urological operation. None of these patients had had a previous myocardial infarction. The outcome of these patients was compared to that of 115 men who underwent transurethral prostatectomy for presumed benign disease during 1990. Complications of transurethral prostatectomy in this group included significant gross hematuria in 5 men, while 6 experienced urinary retention (1), atrial fibrillation (1), delirium (1), myocardial infarction (1), seizure (1) and intraoperative urethral injury (1). There was 1 death from multiple postoperative complications. Morbidity and mortality rates did not differ significantly between the 2 groups. Transurethral surgery performed after cardiac surgery during the same hospital stay appears to be safe, provided the patient is stable.
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PMID:Safety of transurethral surgery in the early postoperative period following an open cardiac procedure. 812 22

To examine the effects of recombinant human erythropoietin (rHuEPO) on hospital utilization, hospital costs, and Medicare reimbursements for hospital care, a longitudinal, matched cohort study was conducted using Medicare claims data of 23,806 Medicare-eligible, dialysis patients who received rHuEPO, did not have a transplant, and were alive for 18 mo or longer and 22,720 controls matched on age, sex, race, cause of ESRD, and dialysis modality. The relative odds (rHuEPO versus control) of admission for all causes and for specific causes over 9 mo, adjusted for admission in the prior 9 mo and the per patient change in total admissions, inpatient days, hospital costs, and Medicare hospital payments between the prior 9-mo period and the subsequent 9-mo period was examined. The adjusted relative odds (95% confidence interval) of admission (rHuEPO versus control) was: higher and statistically significant for all causes, 1.08 (1.03 to 1.14); seizure, 1.52 (1.28 to 1.75); vascular access revision, 1.11 (1.06 to 1.17), and heart failure, 1.17 (1.09 to 1.26); higher but not statistically significant for angina, 1.09 (0.99 to 1.20) and stroke, 1.08 (0.86 to 1.31); and lower but not statistically significant for myocardial infarction, 0.91 (0.72 to 1.10); peripheral vascular disease, 0.81 (0.60 to 1.02); anemia, 0.86 (0.56 to 1.17); and depression, 0.89 (0.37 to 1.40). The mean change per 1,000 patients in admissions was less by 38 (P = 0.03) because of fewer readmissions, and in days was 1,309 less (P < 0.001), for patients treated with rHuEPO versus controls. The mean change per patient in hospital costs was $371 less and was statistically significant (P = 0.03) and in Medicare hospital payments was $132 less but was not statistically significant (P = 0.43) for patients treated with rHuEPO versus controls. rHuEPO was associated with an increase in the probability of hospital admission (particularly admissions potentially related to adverse effects) but a decrease in readmissions, overall admissions, hospital days, and cost to hospitals in this cohort of patients surviving for 18 mo. Although not realized short term, Medicare savings from potential rHuEPO-related reductions in hospital care may be long term through future adjustments in diagnosis-related group-based hospital payment.
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PMID:Effect of recombinant erythropoietin on hospital admissions, readmissions, length of stay, and costs of dialysis patients. 816 27

The purpose of this study was to estimate the net cost effect to Medicare of the increasing use of recombinant human erythropoietin (EPO) instead of red blood cell transfusions or androgens in the management of anemia for the approximately 100,000 hemodialysis patients in the U.S. End-Stage Renal Disease (ESRD) program. A computerized decision model that takes into account the effectiveness and possible side effects of transfusions, androgens, and EPO and predicts 1- and 5-yr direct medical costs to Medicare associated with each therapy was constructed. Probability estimates for clinical events were derived from the literature. Costs were assigned by use of the amounts Medicare pays providers of ESRD care for: (1) use of EPO, transfusions, and androgens; and (2) health care services related to the treatment of anemia (including complications of treatment and possible reductions in morbidity). For every 10,000 hemodialysis patients treated with EPO, net Medicare expenditures will be much greater than if only transfusions are used by $42,530,000 at 1 yr (6% of ESRD program costs) and by $118,050,000 at 5 yr and also much greater than if androgens are used (by $42,700,000 at 1 yr and $118,370,000 at 5 yr). The increase in cost was highly sensitive to the dose of EPO; moderately sensitive to changes in estimated anemia response rates for EPO, frequency of EPO-induced vascular access clotting, and reduction in cardiovascular or overall morbidity; and slightly sensitive to transfusion rates, estimated anemia response rates for androgens, frequency of EPO-induced seizure or hypertensive complications (stroke, myocardial infarction), frequency of transfusion-related viral infection, and frequency of androgen-induced virilization. Considering both effectiveness and side effects of alternative treatments for the anemia of ESRD, it was projected that the increasing use of EPO will markedly increase the cost to Medicare of ESRD medical care.
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PMID:Cost implications to Medicare of recombinant erythropoietin therapy for the anemia of end-stage renal disease. 831 82

During December 1993-September 1995, the Bureau of Food and Drug Safety, Texas Department of Health (TDH), received approximately 500 reports of adverse events in persons who consumed dietary supplement products containing ephedrine and associated alkaloids (pseudoephedrine, norephedrine, and N-methyl ephedrine). This total included reports by individuals and reports identified by the Bureau of Epidemiology, TDH, in a review of records from the six centers of the Texas Poison Center Network. Reported adverse events ranged in severity from tremor and headache to death in eight ephedrine users and included reports of stroke, myocardial infarction, chest pain, seizures, insomnia, nausea and vomiting, fatigue, and dizziness. Seven of the eight reported fatalities were attributed to myocardial infarction or cerebrovascular accident. This report describes three patients in which the recommended dosage for the dietary supplements reportedly was not exceeded, summarizes results from ongoing investigations, and underscores the potential health risks associated with the use of products containing ephedrine.
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PMID:Adverse events associated with ephedrine-containing products--Texas, December 1993-September 1995. 877 3

Most physiologic reflex mechanisms subserve obvious and logical purposes. For example, the arterial baroreflex responds to hypotension by eliciting tachycardia and vasoconstriction, thus increasing cardiac output and raising blood pressure. The raison d'etre for a reflex such as the Bezold-Jarisch is not immediately apparent. Consider, however, the predominant stimulus for the Bezold-Jarisch reflex in the clinical context, namely, rapid forceful ventricular contraction around a relatively empty chamber. Allowing such a situation to continue would be counterproductive. Decreased diastolic filling time, regardless of ventricular contractility, would not permit any improvement in forward cardiac output and hence lead to even further hypotension and thus increasing tachycardia and adrenergic drive to the heart. The cardiac inhibitory reflex acts as a "safety valve," so to speak, slowing the heart rate, increasing diastolic filling, and decreasing afterload. This would be beneficial in myocardial infarction and aortic stenosis. In some persons, however, the reflex may be potentiated, thus predisposing to neurally mediated syncope with relatively minor provocation. We have attempted to explore the role of the cardiac inhibitory reflex in syncope associated with several clinical situations. The advent of direct measurements of sympathetic activity by microneurography, together with the availability of provocative testing such as upright tilt and programmed electrical cardiac stimulation, has provided much new insight but has also given rise to a host of additional questions. Mechanisms other than the Bezold-Jarisch reflex may be implicated. Induction of vasodepressor syncope in heart transplant recipients, as well as the association of bradycardia and syncope with partial seizures, provides some evidence that left ventricular mechanoreceptors may not be the exclusive afferent trigger for syncope and that central mechanisms may be implicated. The study of biochemical mediators such as nitric oxide and serotonin, acting perhaps at a central level, holds promise for an increased understanding of basic cardiovascular physiology, as well as for effective therapy for neurally mediated syncope. These biochemical mediators may in and of themselves give rise to neurogenic syncope or may act to increase the gain of the cardiac inhibitory reflex at a central level.
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PMID:Neurocardiogenic syncope. 890 95

We report a 45-year-old man with monocytosis and right hemiparesis. The patient suffered from an acute myocardial infarction from which he recovered completely when he was 42 years old. One year prior to his death, he was found to have increase in monocyte count (35.5% of leukocytes) in peripheral blood and splenomegaly; he was admitted to the hematology service of our hospital. He was diagnosed as having chronic myelomonocytic leukemia after bone marrow examination. He was treated with radiation therapy with improvement in splenomegaly. In May of 1995, he had fever, anemia, and thrombocytopenia for which he needed daily blood transfusion. In November of 1995, he had an onset of weakness in his right hand, and neurologic consultation was asked for in November 27, 1995. Neurologic examination revealed a chronically ill japanese man in no acute distress. He was alert and not demented. Higher cerebral functions were intact. Cranial nerve examination revealed right facial paresis of the central type. Motor-wise, he was right hemiparetic. Generalized muscle wasting was noted apparently due to the chronic debilitating disease. Deep tendon reflexes were within normal range in the right upper extremity, but were diminished in other areas. Sensation was intact, and no meningeal signs were noted. Pertinent laboratory findings were as follows: Hb 8 g/dl, RBC 238 x 10(4)/microliter, WBC 2,900/microliter (band 1.0%, seg 18.5%, lym 28.0%, mono 44.0%, Baso 2.5%), Plt 13 x 10(4)/microliter, PT 16.6"/10.9", APTT 44.7"/35.0". CSF contained 87 mg/dl of protein, 155 mg/dl of glucose and 2 mononuclear cells/microliter. Bone marrow was slightly hypercellular with mild increase in blast forms. No chromosome abnormality was found. CT and MRI revealed a large mass in the left fronto-parietal region and the meninges showed marked thickening with enhancement after gadolinium-DTPA in MRI. The patient was treated with glycerol and steroid, but the subsequent course was complicated by a seizure, agitation, and pneumonia. He died from respiratory failure on January 13, 1996. The patient was discussed in a neurologic CPC and the chief discussant arrived at the conclusion that the patient had chronic myelomonocytic leukemia with infiltration of leukemic cells into meninges and the parenchyme of the cerebrum. Thickening of the dura was thought to be in part a reaction to the subdural hematoma as well as to leukemic cells along the meninges. Postmortem examination revealed hypercellular bone marrow with increase in monocytic cells (more than 20%). The lungs showed pneumonia with scattered old tuberculous lesions. The heart showed an old myocardial infarction in the posterior wall of the left ventricle. The brain showed an old chronic subdural hematoma in the left fronto-temporal region and a cystic mass lesion in the left frontoparietal region. The mass was hypercellular and most of them were monocytes. The dura mater showed reactive thickening without leukemic cell infiltration. It was concluded that this patient had chronic myelomonocytic leukemia with a formation of leukemic mass in the brain. Pathologists thought that the mass was a hematogenous spread. It is rare for chronic myelomonocytic leukemia to form a mass lesion in the brain.
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PMID:[A 45-year-old man with peripheral monocytosis and right hemiparesis]. 962 75

The apparent diffusion coefficient (ADC) of extravascular tissue water in rat brains was measured in response to step-wise injections of the superparamagnetic intravascular contrast agent AMI-227. These data were normalized and compared with measured changes in R2* and blood magnetic susceptibility. Linear regression showed that ADC changes 33%/ppm shift of intravascular susceptibility and 0.43% s(-1) change in R2*. These changes correspond to a predicted ADC change of approximately 6% for a change between fully oxygenated and fully deoxygenated blood. The source of these ADC changes was confirmed to be background gradients within the sample by the use of diffusion weighting with bipolar gradients of odd symmetry designed to cancel such background gradient effects on ADC. The results suggest that diffusion-weighted imaging is sensitive to blood-oxygenation and may provide a means of measuring changes in blood oxygen. They also provide estimates of the potential contribution of susceptibility changes to changes in ADC that occur, for example, in stroke and seizure.
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PMID:In vivo measurement of ADC change due to intravascular susceptibility variation. 1008 Feb 68

The purpose of this study was to determine the appropriateness of air medical scene response for illness. The study consisted of a retrospective chart review of a two-helicopter urban air medical transport program with a transport volume of 1,700 flights annually. During the study period, January 1988 through March 1990, 68 patients were transported by helicopter from scene of illness to a tertiary care facility. In cases in which patients could be managed appropriately locally, air transport was deemed unnecessary. Of the 68 patients with illness, 40 were males and 28 were females; the average age was 39.2 years (from a range of 0 to 93). The average transport time was 46.3 minutes. Dispatch diagnoses were cardiac arrest (20), seizure (14), myocardial infarction (8), overdose (6), stroke (5), labor (4), respiratory distress (3) and miscellaneous (8). The discharge (final) diagnosis was different from dispatch diagnoses in 10 patients (14.7%). Fifty-four patients (79.4%) required no tertiary care, and 30 of them were discharged from the emergency department or were pronounced dead there or at the scene. The results of the study indicate air medical response to scene of illness did not appear justified in this study. Transport should be local, by ground, with subsequent tertiary care being arranged as needed. Further prospective study is warranted.
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PMID:Is air medical scene response for illness appropriate? 1012 89


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