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Query: UMLS:C0409974 (lupus)
 22,386 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To study the role of free radical formation on the impairment of pulmonary function seen with general anesthesia, we measured the hydrogen peroxide (H2O2) concentration in the exhaled breath condensate of 27 patients. Patients were divided into three study groups: a healthy patient group (group 1, n = 15) consisting of ASA physical status 1 and 2 patients undergoing elective noncardiothoracic surgery; a specific anesthetic event group (group 2, n = 6) composed of patients undergoing cardiopulmonary bypass (CPB); and a positive control group (group 3, n = 6) consisting of patients with the adult respiratory distress syndrome (ARDS). The exhaled breath condensate was collected by diverting exhaled breath through a glass condensation coil submerged in an ice/salt water bath. The exhaled breath condensate samples were then assayed using a spectrophotometric method. In group 1, samples were collected before and after the induction of general anesthesia with intravenous drugs, and before and after the administration of the inhalational anesthetics isoflurane (1.5%) (n = 7) or N2O (70%) (n = 8). In group 2, samples were collected pre- and post-CPB, and in group 3, when specific diagnostic criteria for ARDS were met. There was no significantly detectable H2O2 (not significantly different from zero) in any of the samples from the group 1 patients. Similarly, group 2 patients had exhaled breath H2O2 concentrations near zero except for one patient who was positive for the lupus anticoagulant. Group 3 patients had a mean (+/- SE) exhaled breath H2O2 concentration of 0.55 (+/- 0.08) microM, which was significantly greater than zero (P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:General anesthesia and exhaled breath hydrogen peroxide. 157 37

Treatment of severe hand ischemia a associated to progressive systemic sclerosis and other disorders is controversial. We studied prospectively 45 patients, 41 female and 4 males, over an 11 year period. Age ranged from 16 to 73 years, mean 46. Underlying disease was systemic sclerosis in 30, CREST in 8, overlapping syndrome in 4, systemic lupus in 1 and non rheumatic vasculitis in 2 patients. Treatment consisted of intravenous injection of reserpine, 1 mg, at a superficial arm vein after controlled local circulatory block for 15 min. Regional anesthesia was required in 38 patients. Adequate follow up was obtained in 32 females and 2 males, receiving a mean of 3.1 therapy sessions (range 1 to 13). Morphologic improvement from 3.09 +/- 0.16 to 1.57 +/- 0.13 and functional improvement from 3.6 +/- 0.12 to 1.75 +/- 0.14 (5 grade scoring system), was observed (p < 0.001). These results correlate with adequate rehabilitation confirmed clinically.
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PMID:[Severe ischemia of the hand. Treatment with regional intravenous sympathicolysis with reserpine]. 184 85

The anaesthetic management of pregnant women who suffered from systemic lupus erythematosus (SLE) was reviewed retrospectively. During the ten-year period studied, there were nineteen pregnancies in eighteen women (mean age 27 years) who had either SLE or an isolated lupus type anticoagulant (LAF). Four pregnancies were stopped before the third trimester, two spontaneously, and the other two because of the mother's condition. Of the fifteen remaining pregnancies, eight children were born with a weight less than 2,500 g. One child, birth weight 750 g, died after three days. None of the fourteen living children had neonatal lupus. Six epidural and twelve general anaesthetics were carried out for four abortions, nine Caesarian sections, and five deliveries. Epidural anaesthesia was often contraindicated by neurological and haemostatic complications of the SLE: recent meningitis, thrombocytopaenia, prolonged bleeding, anticoagulant therapy. In fact, management of SLE patients required extensive preanaesthetic clinical and paraclinical assessment, as all the systems may be involved in this condition; moreover, it may worsen during pregnancy (seven times in this series). The most frequent complications were cardiovascular, renal, and haematological. Possible intubation difficulties must also be looked for. A LAF was associated with a great number of venous thromboses. An isolated LAF does not contraindicate epidural anaesthesia, as long as there is no associated haemostatic defect, such as a thrombocytopaenia. Furthermore, the patient should not have had prolonged episodes of unexplained bleeding, or require anticoagulants. In the present series, epidural anaesthesia was contraindicated in three of the four patients with LAF. Finally, prevention of thromboembolism, postoperative infection and adrenal failure (in those patients with long-term steroid therapy) must be carried out.
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PMID:[Obstetrical anesthesia of patients with disseminated lupus erythematosus]. 190 89

Often a "disease" or "state of disease" is defined by a subdomain of a continuous outcome variable. For example, the subdomain of diastolic blood pressure greater than 90 mmHg has been used to define hypertension. The classical method of estimating the risk (or prevalence) of such defined disease states is to dichotomize the outcome variable according to the cutoff value. The standard statistical analysis of such risk of disease then exploits methods developed specifically for binary data, usually based on the binomial distribution. We present a method, based on the assumption of a Gaussian (normal) distribution for the continuous outcome, which does not resort to dichotomization. Specifically, the estimation of risk and its variance is presented for the one- and two-sample situations, with the latter focusing on risk differences and ratios, and odds ratios. The binomial approach applied to the dichotomized data is found to be less efficient than the proposed method by 67% or less. The latter is found to be very accurate, even for small sample sizes, although rather sensitive to substitutions of the underlying distribution by thicker tailed distributions. Canadian total cholesterol data are used to illustrate the problem. For the one-sample case, the approach is illustrated using data from a study of the arterial oxygenation of 20 patients during one-lung anesthesia for thoracic surgery. For the two-sample case, data from a prognostic study of the renal function of 87 lupus nephritic patients are used.
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PMID:Binary methods for continuous outcomes: a parametric alternative. 199 83

Circulating lupus anticoagulant occurs in 5-37% of all patients with systemic lupus erythematosus. Its occurrence is not restricted to collagen vascular disease states. Lupus anticoagulant causes a prolongation of certain laboratory coagulation studies yet it is associated in vivo with a history of systemic intravascular thromboses. Placental vessels are also affected. Less than one in six pregnancies complicated by the presence of this auto-antibody is successful. Treatment of afflicted parturients with anti-platelet therapy has increased perinatal survival rates. Derangements in the coagulation profile and concomitant anti-platelet therapy confound the rational use of regional anaesthesia in the management of labour and delivery in these high-risk pregnancies.
Anaesthesia 1987 Dec
PMID:Lupus anticoagulant. Implications for obstetric anaesthetists. 312 65

Adult wolves (Canis lupus) were immobilized with 6.6 mg/kg ketamine hydrochloride (KET) and 2.2 mg/kg xylazine hydrochloride (XYL) administered intramuscularly. Induction time was 4.6 +/- 0.3 min (mean +/- SE). Immobilization resulted in significant bradycardia and hypertension (P less than 0.05). Twenty min after induction, the wolves were given 0.05-0.60 mg/kg yohimbine hydrochloride (YOH). Yohimbine given intravenously produced dose-related increases in heart rate (HR) with doses greater than 0.15 mg/kg resulting in extreme tachycardia (greater than 300 bpm). All doses of YOH caused a temporary decrease in mean arterial blood pressure (MABP) with some individual animals manifesting profound hypotension (less than 30 torr) at doses greater than 0.15 mg/kg. Increasing the dose of YOH above 0.15 mg/kg did not significantly decrease either arousal or ambulation times. Administering YOH at 40 or 60 min after induction resulted in decreased arousal and ambulation times. Stimulation by weighing and taking repeated blood samples during anesthesia did not shorten arousal times. We recommend that wolves immobilized with XYL-KET be antagonized with doses of YOH less than 0.15 mg/kg.
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PMID:Cardiovascular and behavioral responses of gray wolves to ketamine-xylazine immobilization and antagonism by yohimbine. 362 8

Dapsone is used to treat several systemic inflammatory diseases, many of which have head and neck manifestations, such as leprosy, systemic lupus erythematosus, rhinosporidiosis, relapsing polychondritis, dermatitis herpetiformis, pemphigus vulgaris and bullous pemphigoid. It has also been recently used prophylactically alone or in combination against malaria and in AIDS patients against Pneumocystis carinii infections. This is significant to the otolaryngologist-head and neck surgeon since approximately 40% of AIDS patients will have head and neck manifestations. Thus, the likelihood that otolaryngologists will be treating patients who are taking dapsone regularly is significant. We present a case of a 16-year-old female who presented with a presumptive diagnosis of discoid lupus for biopsy confirmation of her disease. Induction of general anesthesia was complicated by methemoglobinemia, an uncommon side effect of dapsone. We will discuss recognition and prevention of this side effect, its potential anesthetic implications, complications and treatment.
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PMID:Dapsone-induced methemoglobinemia: an anesthetic risk. 755 44

The anesthetic management of a parturient with a circulating lupus anticoagulant and an anticardiolipin antibody presenting to the obstetric suite taking heparin and aspirin is discussed. Issues concerning placement of a regional anesthetic with recent aspirin ingestion and heparin therapy are discussed. Documentation of heparin dissipation via a whole blood heparin concentration assay before induction of regional anesthesia, including several laboratory tests that could be used in monitoring coagulation status in this patient population, is discussed in detail.
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PMID:Anesthesia with antiphospholipid antibodies: anesthetic management of a parturient with lupus anticoagulant and anticardiolipin antibody. 869 80

Antiphospholipid syndrome is a paradoxical disease state with in vitro prolongation of activated partial thromboplastin time and a strong predilection for in vivo thrombosis. The syndrome can be associated with systemic lupus erythematosus or lupus-like diseases or may be primary, presenting with thrombotic phenomena in young patients with no risk factors for thrombosis. We present two cases seen in two different settings in the hospital.
Anaesthesia 1997 Jan
PMID:The anaesthetist and the antiphospholipid syndrome. 920 6

Sexual dimorphism exists in the immune response. Both humoral and cell-mediated immunity are more active in females than in males, and steroid gonadal hormones may play an important role in regulating this response. We have documented gender differences in several aspects of neutrophil and macrophage functions elicited by lipopolysaccharide (LPS) (endotoxin) treatment and/or acute ethanol intoxication. In LPS-treated female rats, circulating neutrophils and alveolar macrophages are resistant to the deleterious effects of surgery and anesthesia on phagocytosis observed in male rats. The generation of cytokine-induced neutrophil chemoattractant (CINC) by hepatocytes and Kupffer cells of LPS-treated rats, as well as TNF-alpha secretion by Kupffer cells and alveolar macrophages of acutely ethanol intoxicated rats are also gender dependent. The effects of alcohol on the immune response are expressed differently in males and females. In LPS plus ethanol-treated rats gender differences were noted in terms of adhesion molecule (CD11b/c) expression on circulating neutrophils, and cytoskeletal reorganization in blood-recruited neutrophils and Kupffer cells. Nitric oxide (NO) plays an important role in inflammatory processes. We found gender differences in NO production by alveolar macrophages of LPS-treated rats; this difference was abrogated by ethanol treatment. LPS tolerance and ethanol treatment modulate hepatic NO production in rats in a cell- and gender-dependent fashion, which may exert a protective influence against oxidative injury in the female liver.
Lupus 1999
PMID:Gender differences in some host defense mechanisms. 1045 17


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